Multiple Indicator Cluster Survey (MICS) 2011-2012, Bosnia and Herzegovina, Roma Survey, Final report

Publication date: 2013

Bosnia and Herzegovina: Roma Survey Multiple Indicator Cluster Survey 2011–2012 Bosnia and Herzegovina: Roma Survey Monitoring the situation of children and women Bosnia and H erzegovina: Rom a Survey 2011–2012 M ultiple Indicator Cluster Survey Bosnia and Herzegovina Ministry for Human Rights and Refugees United Nations Children’s Fund Agency for Statistics of Bosnia and Herezegovina Multiple Indicator Cluster Survey 2011–2012 BOSNIA AND HERZEGOVINA: ROMA SURVEY MULTIPLE INDICATOR CLUSTER SURVEY 2011–2012 Final Report February, 2013 BOSNIA AND HERZEGOVINA: ROMA SURVEY MULTIPLE INDICATOR CLUSTER SURVEY 2011–2012 Publisher UNICEF Office for Bosnia and Herzegovina Authors Dajana Mitrovic Enida Imamovic Mirza Puzic Translation Almir Comor Proofreading Chris Hughes Design Sandra Ozimica Cover photo Dzenan Krijestorac Printed by Amos graf Print run 300 Published in February, 2013 The Multiple Indicator Cluster Survey (MICS) is an international household survey programme developed by the United Nations Children’s Fund (UNICEF). MICS provides up-to-date information on the situation of children and women and measures key indicators that allow countries to monitor progress towards the Millennium Development Goals (MDGs) and other internationally agreed upon commitments. The MICS focusing on Roma in Bosnia and Herzegovina (BiH) was conducted in 2011–2012 by the Ministry for Human Rights and Refugees of Bosnia and Herzegovina (MHRR BiH) in collaboration with the Agency for Statistics of Bosnia and Herzegovina (BHAS). Financial and technical support was provided by UNICEF. Additional financial support was provided by the United Nations Population Fund (UNFPA) and the United Nations High Commissioner for Refugees (UNHCR). MICS was conducted as part of the fourth global round of the MICS programme (MICS4). Additional information on the global MICS programme can be obtained from www.childinfo.org. Suggested citation The Ministry for Human Rights and Refugees of Bosnia and Herzegovina and the Agency for Statistics of Bosnia and Herzegovina. (2013). Multiple Indicator Cluster Survey (MICS) 2011–2012, Bosnia and Herzegovina: Roma Survey, Final Report. Sarajevo: UNICEF. MONITORING THE SITUATION OF CHIlDREN AND wOMEN iii Summary Table of Findings1 Multiple Indicator Cluster Survey (MICS) and Millennium Development Goals (MDG) Indicators for Bosnia and Herzegovina: Roma Survey 2011–2012 Topic MICS4 Indicator Number MDG Indicator Number Indicator Value CHILD MORTALITY Child mortality 1.1 4.1 Under-five mortality rate2 27 per 1,000 1.2 4.2 Infant mortality rate3 24 per 1,000 NUTRITION Nutritional status Underweight prevalence 2.1a 1.8 Moderate and Severe (- 2 SD) 8.8 per cent 2.1b 1.8 Severe (- 3 SD) 2.4 per cent Stunting prevalence 2.2a Moderate and Severe (- 2 SD) 21.1 per cent 2.2b Severe (- 3 SD) 8.0 per cent wasting prevalence 2.3a Moderate and Severe (- 2 SD) 8.3 per cent 2.3b Severe (- 3 SD) 3.5 per cent Breastfeeding and infant feeding 2.4 Children ever breastfed 95.0 per cent 2.5 Early initiation of breastfeeding 50.3 per cent 2.6 Exclusive breastfeeding under 6 months 22.3 per cent 2.7 Continued breastfeeding at 1 year 50.1 per cent 2.8 Continued breastfeeding at 2 years 68.8 per cent 2.9 Predominant breastfeeding under 6 months 64.0 per cent 2.10 Duration of breastfeeding 20.9 months 2.11 Bottle feeding 56.3 per cent 2.12 Introduction of solid, semi-solid or soft foods (67.2) per cent 2.13 Minimum meal frequency 60.1 per cent 2.14 Age-appropriate breastfeeding 39.8 per cent 2.15 Milk feeding frequency for non-breastfed children 78.4 per cent low birth weight 2.18 low birth weight infants 13.7 per cent 2.19 Infants weighed at birth 96.2 per cent CHILD HEALTH Vaccinations 3.1 Tuberculosis immunisation coverage 85.6 per cent 3.2 Polio immunisation coverage 14.2 per cent 3.3 Immunisation coverage for diphtheria, pertussis and tetanus (DPT) 12.5 per cent 3.4 4.3 Measles, mumps and rubella immunisation coverage 21.8 per cent 3.5 Hepatitis B immunisation coverage 14.5 per cent Care of illness 3.8 Oral rehydration therapy with continued feeding 52.1 per cent 3.9 Care-seeking for suspected pneumonia 79.8 per cent 3.10 Antibiotic treatment of suspected pneumonia 74.9 per cent Solid fuel use 3.11 Solid fuels (used as the primary source of energy for cooking) 92.2 per cent WATER AND SANITATION water and sanitation 4.1 7.8 Use of improved drinking water sources 97.4 per cent 4.2 water treatment 2.7 per cent 4.3 7.9 Use of improved sanitation 73.1 per cent 4.4 Safe disposal of child’s faeces 12.3 per cent 4.5 Place for hand washing 91.6 per cent 4.6 Availability of soap 96.5 per cent 1 See Appendix E for details on indicator definitions. 2 Rate refers to 2005. 3 Rate refers to 2005. iv MUlTIPlE INDICATOR ClUSTER SURVEy 2011–2012 MONITORING THE SITUATION OF CHIlDREN AND wOMEN v Topic MICS4 Indicator Number MDG Indicator Number Indicator Value HIV/AIDS, SEXUAL BEHAVIOUR AND ORPHANED AND VULNERABLE CHILDREN HIV/AIDS knowledge and attitudes 9.1 Comprehensive knowledge about HIV prevention women aged 15-49 years 8.6 per cent men aged 15-49 years 17.8 per cent 9.2 6.3 Comprehensive knowledge about HIV prevention amongst women and men aged 15-24 women aged 15-24 years 8.9 per cent men aged 15-24 years 20.9 per cent 9.3 Knowledge of mother-to-child transmission of HIV women aged 15-49 years 41.5 per cent men aged 15-49 years 40.8 per cent 9.4 Accepting attitudes towards people living with HIV women aged 15-49 years 6.5 per cent men aged 15-49 years 13.8 per cent 9.5 women who know where to be tested for HIV 22.6 per cent Men who know where to be tested for HIV 48.6 per cent 9.6 women who have been tested for HIV and know the results 1.7 per cent Men who have been tested for HIV and know the results 1.4 per cent 9.7 Sexually active women aged 15-24 who have been tested for HIV and know the results 1.6 per cent Sexually active men aged 15-24 who have been tested for HIV and know the results 2.3 per cent 9.8 HIV counselling during antenatal care 2.7 per cent 9.9 HIV testing during antenatal care 0.4 per cent Sexual behaviour 9.10 women aged 15-24 who have never had sex 87.4 per cent Men aged 15-24 who have never had sex 45.8 per cent 9.11 Sex before age 15 amongst women and men age 15-24 women aged 15-24 years 12.0 per cent men aged 15-24 years 14.2 per cent 9.12 Age mixing amongst sexual partners women aged 15-24 years 4.3 per cent men aged 15-24 years 0.8 per cent 9.13 Sex with multiple partners women aged 15-49 years 1.2 per cent men aged 15-49 years 5.4 per cent 9.14 Condom use during sex with multiple partners women aged 15-49 years (*) per cent men aged 15-49 years 27.7 per cent 9.15 Sex with non-regular partners women aged 15-24 years 12.9 per cent men aged 15-24 years 55.6 per cent 9.16 6.2 Condom use with non-regular partners women aged 15-24 years (32.4) per cent men aged 15-24 years 49.0 per cent Orphaned children 9.17 Children’s living arrangements 3.5 per cent 9.18 Prevalence of children with one or both parents dead 4.3 per cent Topic MICS4 Indicator Number MDG Indicator Number Indicator Value REPRODUCTIVE HEALTH Contraception and unmet need 5.1 5.4 Adolescent birth rate 145 per 1,000 5.2 Early childbearing 31.0 per cent 5.3 5.3 Contraceptive prevalence rate 24.8 per cent 5.4 5.6 Unmet need 28.4 per cent Maternal and newborn health Antenatal care coverage 5.5a 5.5 At least once by skilled personnel 79.1 per cent 5.5b 5.5 At least four times by any provider 62.0 per cent 5.6 Content of antenatal care 70.2 per cent 5.7 5.2 Skilled attendant at delivery 98.7 per cent 5.8 Institutional deliveries 99.0 per cent 5.9 Caesarean section 13.2 per cent CHILD DEVELOPMENT Child development 6.1 Support for learning 66.1 per cent 6.2 Father’s support for learning 59.8 per cent 6.3 learning materials: children’s books 10.8 per cent 6.4 learning materials: playthings 47.7 per cent 6.5 Inadequate care 6.6 per cent 6.6 Early Childhood Development Index 84.9 per cent 6.7 Attendance at early childhood education 1.5 per cent EDUCATION literacy and education 7.1 2.3 literacy rate amongst women and men aged 15-24 women aged 15-24 years 68.9 per cent men aged 15-24 years 90.4 per cent 7.2 School readiness 4.1 per cent 7.3 Net intake rate for primary education 46.9 per cent 7.4 2.1 Primary school net attendance ratio (adjusted) 69.3 per cent 7.5 Secondary school net attendance ratio (adjusted) 22.6 per cent 7.6 2.2 Children reaching last grade of primary school 74.8 per cent 7.7 Primary completion rate 73.3 per cent Net primary completion rate 40.1 per cent 7.8 Transition rate to secondary school 71.1 per cent 7.9 Gender Parity Index (primary school) 0.96 ratio 7.10 Gender Parity Index (secondary school) 0.67 ratio CHILD PROTECTION Birth registration 8.1 Birth registration 95.8 per cent Child discipline 8.5 Violent discipline 57.6 per cent Early marriage and polygyny 8.6 Marriage before age 15 women aged 15-49 years 14.6 per cent men aged 15-49 years 3.9 per cent 8.7 Marriage before age 18 women aged 20-49 years 48.3 per cent men aged 20-49 years 20.5 per cent 8.8 women aged 15-19 years currently married or in union 38.3 per cent Men aged 15-19 years currently married or in union 13.4 per cent 8.9 Polygyny women aged 15-49 years 1.0 per cent men aged 15-49 years 0.4 per cent Spousal age difference 8.10a women aged 15-19 years 2.5 per cent 8.10b women aged 20-24 years 4.8 per cent Domestic violence 8.14 Attitudes towards domestic violence women aged 15-49 years 43.5 per cent men aged 15-49 years 21.1 per cent vi Multiple indicator cluster survey 2011–2012 Monitoring the situation of children and woMen vii Topic MICS4 Indicator Number MDG Indicator Number Indicator Value ACCESS TO MASS MEDIA AND USE OF INFORMATION/COMMUNICATION TECHNOLOGY access to mass media Mt.1 exposure to mass media women aged 15-49 years 15.5 per cent men aged 15-49 years 38.6 per cent use of information/ communication technology Mt.2 use of computers women aged 15-24 years 36.1 per cent men aged 15-24 years 59.7 per cent Mt.3 use of the internet women aged 15-24 years 33.1 per cent men aged 15-24 years 60.6 per cent SUBJECTIVE WELL-BEING subjective well-being sw.1 life satisfaction women age d15-24 years 38.6 per cent men aged 15-24 years 47.6 per cent sw.2 happiness women aged 15-24 years 70.8 per cent men aged 15-24 years 77.3 per cent sw.3 perception of a better life women aged 15-24 years 25.3 per cent men aged 15-24 years 19.4 per cent TOBACCO AND ALCOHOL USE tobacco use ta.1 tobacco use women aged 15-49 years 54.7 per cent men aged 15-49 years 56.2 per cent ta.2 smoking before age 15 women aged 15-49 years 21.8 per cent men aged 15-49 years 19.3 per cent alcohol use ta.3 alcohol use women aged 15-49 years 14.3 per cent men aged 15-49 years 48.1 per cent ta.4 use of alcohol before age 15 women aged 15-49 years 5.3 per cent men aged 15-49 years 18.9 per cent ( ) figures that are based on 25–49 unweighted cases (*) figures that are based on less than 25 unweighted cases SuMMary Table of fINDINGS . . . . . . . . . . . . . . . . . . . iii Table of CoNTeNTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii lIST of TableS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .viii lIST of fIGureS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi lIST of abbreVIaTIoNS . . . . . . . . . . . . . . . . . . . . . . . . . xii aCkNowleDGMeNTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii exeCuTIVe SuMMary . . . . . . . . . . . . . . . . . . . . . . . . . . . xiv I INTroDuCTIoN . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 survey objectives . . . . . . . . . . . . . . . . . . . . . . . . . . 2 II SaMple aND SurVey MeThoDoloGy . . 3 sample design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Questionnaires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 training and fieldwork . . . . . . . . . . . . . . . . . . . . . 6 data processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 report structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 how to read the tables . . . . . . . . . . . . . . . . . . . . . 6 III SaMple CoVeraGe aND The CharaCTerISTICS of houSeholDS aND reSpoNDeNTS . . . . . . . . . . . . . . . . . . . . . . 7 sample coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 characteristics of households . . . . . . . . . . . . . . . 8 characteristics of female and Male respondents 15-49 years of age and children under-5 . . . . . . . . . . . . . . . . . . . . . . 11 children’s living arrangements . . . . . . . . . . . . 14 IV ChIlD MorTalITy . . . . . . . . . . . . . . . . . . . . . . . 16 V NuTrITIoN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 nutritional status . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Breastfeeding and infant and young child feeding . . . . . . . . . . . . . . . . . . 20 low Birth weight . . . . . . . . . . . . . . . . . . . . . . . . . . 27 VI ChIlD healTh . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 immunisation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 oral rehydration treatment . . . . . . . . . . . . . . . . 32 care-seeking and antibiotic treatment of pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 solid fuel use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 VII waTer aND SaNITaTIoN . . . . . . . . . . . . . . . . 41 use of improved drinking water sources . . . 41 use of improved sanitation facilities . . . . . . . 48 hand washing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 VIII reproDuCTIVe healTh . . . . . . . . . . . . . . . . . 57 fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Knowledge of contraceptive Methods . . . . . 58 use of contraceptives. . . . . . . . . . . . . . . . . . . . . . 60 unmet need . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 antenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 assistance at delivery . . . . . . . . . . . . . . . . . . . . . . 66 place of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Ix ChIlD DeVelopMeNT . . . . . . . . . . . . . . . . . . . 69 early childhood education and learning . . . 69 early childhood development . . . . . . . . . . . . . 73 x lITeraCy aND eDuCaTIoN . . . . . . . . . . . . . 76 literacy amongst women and Men aged 15-24 . . . . . . . . . . . . . . . . . . . . . . . 76 school readiness . . . . . . . . . . . . . . . . . . . . . . . . . . 77 primary and secondary school participation . . . . . . . . . . . . . . . . . . . . . . . 78 xI ChIlD proTeCTIoN . . . . . . . . . . . . . . . . . . . . . 86 Birth registration . . . . . . . . . . . . . . . . . . . . . . . . . . 86 child discipline . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 early Marriage and polygyny . . . . . . . . . . . . . . . 88 attitudes towards domestic violence . . . . . . . 94 xII hIV/aIDS aND Sexual behaVIour ThaT INCreaSeS The rISk of hIV TraNSMISSIoN . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Knowledge about hiv transmission and Misconceptions about hiv/aids . . . . . . . 97 accepting attitudes towards people living with hiv/aids . . . . . . . . . . . . . . . . . . . . . . 106 Knowledge of a place for hiv testing, counselling and testing during antenatal care . . . . . . . . . . . . . . . . . . . . 108 sexual Behaviour related to hiv transmission . . . . . . . . . . . . . . . . . . . . . . . 115 xIII aCCeSS To MaSS MeDIa aND uSe of INforMaTIoN/CoMMuNICaTIoN TeChNoloGy . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 access to Mass Media . . . . . . . . . . . . . . . . . . . . . 123 use of information/communication technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 xIV TobaCCo aND alCohol uSe . . . . . . . . . . 128 tobacco use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 alcohol use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 xV SubjeCTIVe well-beING . . . . . . . . . . . . . . . 136 appeNDIx a: Sample Design . . . . . . . . . . . . . . . . . . . . 144 appeNDIx b: list of personnel Involved in the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 appeNDIx C: estimates of Sampling errors . . . . . . 153 appeNDIx D: Data Quality Tables . . . . . . . . . . . . . . . 164 appeNDIx e: MICS4 bih roma Survey Indicators – Numerators and Denominators . . . . . . . . . 175 appeNDIx f: MICS4 bih roma Survey Questionnaires . . . . . . . . . . . 183 appeNDIx G: education Tables by ISCeD . . . . . . . . 240 Table of Contents viii MUlTIPlE INDICATOR ClUSTER SURVEy 2011–2012 MONITORING THE SITUATION OF CHIlDREN AND wOMEN ix List of Tables Table HH.1: Results of household, women’s, men’s and under-5 interviews . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Table HH.2: Household age distribution by sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Table HH.3: Household composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Table HH.4: women’s background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Table HH.4M: Men’s background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Table HH.5: Under-5’s background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Table HH.6: Children’s living arrangements and orphanhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Table CM.1: Children ever born, children surviving and proportion dead . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Table CM.2: Child mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Table NU.1: Nutritional status of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Table NU.2: Initial breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Table NU.3: Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Table NU.4: Duration of breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Table NU.5: Age-appropriate breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Table NU.6: Minimum meal frequency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Table NU.7: Bottle feeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Table NU.8: low birth weight infants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Table CH.1: Vaccinations in first year of life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Table CH.2: Vaccinations by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Table CH.3: Oral rehydration solutions and recommended homemade fluids . . . . . . . . . . . . . . . . . . . . . . 33 Table CH.4: Feeding practices during diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Table CH.5: Oral rehydration therapy with continued feeding and other treatments . . . . . . . . . . . . . . . . 36 Table CH.6: Prevalence of suspected pneumonia by background characteristics . . . . . . . . . . . . . . . . . . . 37 Table CH.7: Knowledge of the two danger signs of pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Table CH.8: Solid fuel use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Table CH.9: Solid fuel use by place of cooking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Table wS.1: Use of improved water sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Table wS.2: Household water treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Table wS.3: Time to source of drinking water . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Table wS.4: Person collecting water . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Table wS.5: Types of sanitation facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Table wS.6: Use and sharing of sanitation facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Table wS.7: Disposal of child’s faeces . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Table wS.8: Drinking water and sanitation ladders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Table wS.9: water and soap at place for hand washing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Table wS.10: Availability of soap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Table RH.1: Early childbearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Table RH.2: Trends in early childbearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Table RH.3: Knowledge of specific contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Table RH.4: Knowledge of contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Table RH.5: Use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Table RH.6: Unmet need for contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Table RH.7: Antenatal care coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Table RH.8: Number of antenatal care visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Table RH.9: Content of antenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Table RH.10: Assistance during delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Table RH.11: Place of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Table CD.1: Early childhood education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Table CD.2: Support for learning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Table CD.3: learning materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Table CD.4: Inadequate care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Table CD.5: Early Childhood Development Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Table ED.1: literacy amongst women aged 15-24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Table ED.1M: literacy amongst men aged 15-24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Table ED.2: School readiness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Table ED.3: Primary school entry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Table ED.4: Primary school attendance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Table ED.5: Secondary school attendance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Table ED.6: Children reaching last grade of primary school . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Table ED.7: Primary school completion and transition to secondary school . . . . . . . . . . . . . . . . . . . . . . . . 84 Table ED.8: Education gender parity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Table CP.1: Birth registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Table CP.2: Child discipline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Table CP.3: Early marriage and polygyny: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Table CP.3M: Early marriage and polygyny: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Table CP.4: Trends in early marriage: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Table CP.4M: Trends in early marriage: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Table CP.5: Spousal age difference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Table CP.6: Attitudes towards domestic violence: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Table CP.6M: Attitudes towards domestic violence: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 Table HA.1: Knowledge about HIV transmission, misconceptions about HIV/AIDS, and comprehensive knowledge about HIV transmission: women aged 15-49 . . . . . . . . . . . 99 Table HA.1M: Knowledge about HIV transmission, misconceptions about HIV/AIDS and comprehensive knowledge about HIV transmission: men aged 15-49 . . . . . . . . . . . . . . . . .100 Table HA.2: Knowledge about HIV transmission, misconceptions about HIV/AIDS and comprehensive knowledge about HIV transmission: women aged 15-24 . . . . . . . . . .102 Table HA.2M: Knowledge about HIV transmission, misconceptions about HIV/AIDS and comprehensive knowledge about HIV transmission: men aged 15-24 . . . . . . . . . . . . . . . . .103 Table HA.3: Knowledge of mother-to-child HIV transmission: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . .104 Table HA.3M: Knowledge of mother-to-child HIV transmission: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .105 Table HA.4: Accepting attitudes towards people living with HIV/AIDS: women . . . . . . . . . . . . . . . . . . . .107 Table HA.4M: Accepting attitudes towards people living with HIV/AIDS: men . . . . . . . . . . . . . . . . . . . . . . .108 Table HA.5: Knowledge of a place for HIV testing: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .110 Table HA.5M: Knowledge of a place for HIV testing: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .111 Table HA.6: Knowledge of a place for HIV testing amongst sexually active women aged 15-24 . . . . . . .112 Table HA.6M: Knowledge of a place for HIV testing amongst sexually active men aged 15-24 . . . . . . . .113 Table HA.7: HIV counselling and testing during antenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .114 Table HA.8: Sexual behaviour that increases the risk of HIV infection: women . . . . . . . . . . . . . . . . . . . . .115 Table HA.8M: Sexual behaviour that increases the risk of HIV infection: men . . . . . . . . . . . . . . . . . . . . . . . .116 Table HA.9: Sex with multiple partners: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .117 Table HA.9M: Sex with multiple partners: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .118 Table HA.10: Sex with multiple partners: women aged 15-24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .119 Table HA.10M: Sex with multiple partners: men aged 15-24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .120 Table HA.11: Sex with non-regular partners: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .121 Table HA.11M: Sex with non-regular partners: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .122 x MUlTIPlE INDICATOR ClUSTER SURVEy 2011–2012 MONITORING THE SITUATION OF CHIlDREN AND wOMEN xi List of Figures Table MT.1: Exposure to mass media: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .124 Table MT.1M: Exposure to mass media: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .125 Table MT.2: Use of computers and the Internet: women aged 15-24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .126 Table MT.2M: Use of computers and the Internet: men aged 15-24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .127 Table TA.1: Current and ever use of tobacco: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .129 Table TA.1M: Current and ever use of tobacco: men. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .130 Table TA.2: Age at first use of cigarettes and frequency of use: women . . . . . . . . . . . . . . . . . . . . . . . . . . .131 Table TA.2M: Age at first use of cigarettes and frequency of use: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .132 Table TA.3: Use of alcohol: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .134 Table TA.3M: Use of alcohol: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .135 Table Sw.1: Domains of life satisfaction: women aged 15-24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .137 Table Sw.1M: Domains of life satisfaction: men aged 15-24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .138 Table Sw.2: life satisfaction and happiness: women aged 15-24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .140 Table Sw.2M: life satisfaction and happiness: men aged 15-24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .141 Table Sw.3: Perception of a better life: women aged 15-24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .142 Table Sw.3M: Perception of a better life: men aged 15-24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .143 Table SD.1: Allocation of sample households (primary sampling units) by municipality (stratum) . . . . . .145 Table SD.2: Adjusted (normalised) weights by sample strata . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .148 Table SE.1: Indicators selected for sampling error calculations, BiH Roma Survey . . . . . . . . . . . . . . . . .154 Table SE.2: Sampling errors: Total sample, Roma Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .156 Table SE.3: Sampling errors: FBiH, Roma Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .158 Table SE.4: Sampling errors: RS, Roma Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .160 Table SE.5: Sampling errors: BD, Roma Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .162 Table DQ.1: Age distribution of household population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .164 Table DQ.2: Age distribution of eligible and interviewed women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .165 Table DQ.2M: Age distribution of eligible and interviewed men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .165 Table DQ.3: Age distribution of under-5’s in household and under-5 questionnaires . . . . . . . . . . . . . . .165 Table DQ.4: women’s completion rates by socio-economic characteristics of households . . . . . . . . . .166 Table DQ.4M: Men’s completion rates by socio-economic characteristics of households . . . . . . . . . . . . .166 Table DQ.5: Completion rates for under-5 questionnaires by socio-economic characteristics of households . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .167 Table DQ.6: Completeness of reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .168 Table DQ.7: Completeness of information for anthropometric indicators . . . . . . . . . . . . . . . . . . . . . . . . . .169 Table DQ.8: Heaping in anthropometric measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .170 Table DQ.9: Observation of places for hand washing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .170 Table DQ.10: Observation of under-5’s birth certificates. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .170 Table DQ.11: Observation of vaccination cards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .171 Table DQ.12: Presence of mother in the household and the person interviewed for the under-5 questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .171 Table DQ.13: Selection of children aged 2-14 years for the child discipline module . . . . . . . . . . . . . . . . .172 Table DQ.14: School attendance by single age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .172 Table DQ.15: Sex ratio at birth amongst children ever born and living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .173 Table ED.1 ISCED: Primary school attendance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .241 Table ED.2 (a) ISCED: lower secondary school attendance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .242 Table ED.2 (b) ISCED: Upper secondary school attendance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .243 Table ED.3 ISCED: Education gender parity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .244 Figure HH.1 Distribution of municipalities by administrative unit and distribution of sampled households by fieldwork teams, BiH Roma Survey 2011-2012 . . . . . . . . . . . . . . . 8 Figure HH.2: Age and sex distribution of household population, BiH Roma Survey 2011–2012 . . . . . . . . 9 Figure NU.1: Percentage of children under age 5 who are underweight, stunted, wasted or overwight, BiH Roma Survey 2011–2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 Figure NU.2: Percentage of mothers who started breastfeeding within one hour and within one day of birth, BiH Roma Survey 2011–2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22 Figure NU.3: Percentage of infants weighing less than 2,500 grams at birth, BiH Roma Survey 2011–2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28 Figure CH.1: Percentage of children aged 18-29 months who received the recommended vaccinations by 12 months (18 months for MMR), BiH Roma Survey 2011–2012 . . . . . . . .30 Figure CH.2: Percentage of children under age 5 with diarrhoea in the two weeks preceding the survey by age group, BiH Roma Survey 2011–2012 . . . . . . . . . . . . . . . . . . . . . .32 Figure wS.1: Per cent distribution of household members by source of drinking water, BiH Roma Survey 2011–2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42 Figure HA.1: Percentage of women who have comprehensive knowledge of HIV/AIDS transmission, BiH Roma Survey 2011–2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .98 Figure HA.1M: Percentage of men who have comprehensive knowledge of HIV/AIDS transmission, BiH Roma Survey 2011–2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .98 Figure DQ.1: Number of household population by single age, BiH Roma Survey 2011–2012 . . . . . . . 174 xii MUlTIPlE INDICATOR ClUSTER SURVEy 2011–2012 MONITORING THE SITUATION OF CHIlDREN AND wOMEN xiii Acknowledgments The report before you is the result of a joint effort by a number of individuals, institutions and organisations that have contributed, through their enthusiasm and commitment, to the successful implementation of the first MICS survey on Roma in Bosnia and Herzegovina (BiH). The application of a unified MICS methodology enabled the production of a significant number of MICS and Millennium Development Goals (MDG) indicators, which represent a valuable foundation for evidence-based policy making. We therefore primarily wish to thank the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA) and the United Nations High Commissioner for Refugees (UNHCR), whose financial support for the implementation of the survey made it possible. As in previous MICS rounds, the survey concept, including improvements and innovations, was created and led by the UNICEF global MICS team. With this in mind, we would especially like to thank Siraj Mahmudlu, the MICS coordinator for the CEE/CIS region, whose professional contribution and patience was of vital importance for all phases of the survey; the regional MICS consultants, Aleksandar Zoric, Emma Holmberg, Pierre Martel and Sinan Turkyilmaz and global MICS consultants, Bo Pedersen, David Megill and Shane M. Khan who provided unselfish support in the fields of methodology, sampling, data processing and analysis and we also owe our gratitude to the representatives of the global MICS team of Ivana Bjelic, Turgay Unalan and Yadigar Coşkun and led by Attila Hancioglu, who were willing at all times to share their vast experience and knowledge. Survey implementation was supported by the relevant ministries as well as institutions and organisations whose representatives were members of the project’s Steering Board. Implementation would not have been possible without the support of representatives of the Roma non-governmental sector and regional coordinators for Roma issues whose assistance was of critical importance during many phases of the survey, in particular during implementation of the fieldwork. The training of fieldwork personnel in conducting anthropometric measurements was conducted with the participation of staff and beneficiaries of the Drop-in Centre for Children Involved in Street Work of the Sarajevo Canton, to whom we owe special thanks. Of crucial importance for survey implementation were the supervisors, editors and interviewers as well as those people who worked on data entry. Through their enthusiasm and commitment they enabled the production of valuable indicators on Roma in BiH. The knowledge and experience gained will be of great value for future similar actions in the country. Finally, our deepest gratitude goes to all of the households and individuals for their patience and the time they set aside as well as the hospitality with which they welcomed us into their homes. Without them the implementation of this survey would not have been possible. Their willingness to participate reflects their need to present a true and comprehensive picture of the conditions in which Roma families live as well as their hope that they will thus contribute to the improvement of the living conditions of Roma children and women in BiH. List of Abbreviations AIDS Acquired Immune Deficiency Syndrome BCG Bacillis-Cereus-Geuerin (Tuberculosis) BD Brcko District of Bosnia and Herzegovina BHAS Agency for Statistics of Bosnia and Herzegovina BiH Bosnia and Herzegovina CDC Centres for Disease Control and Prevention CEDAw Convention on the Elimination of All Forms of Discrimination against women CEE Central and Eastern Europe CIS Commonwealth of Independent States CRC Convention on the Rights of the Child CSPro Census and Survey Processing System DPT Diphtheria Pertussis Tetanus ECDI Early Childhood Development Index EPI Expanded Programme on Immunisation FBiH Federation of Bosnia and Herzegovina FMH Federal Ministry of Health FOS Federal Office of Statistics GAP Gender Action Plan of Bosnia and Herzegovina GPI Gender Parity Index Hep B Hepatitis B Hib Haemophilus influenzae type B HIV Human Immunodeficiency Virus IUD Intrauterine Device IPH FBiH Institute for Public Health of the Federation of Bosnia and Herzegovina IPV Inactive polio vaccine JMP Joint Monitoring Programme lAM lactational Amenorrhea Method MDG Millennium Development Goals MHSw RS Ministry of Health and Social welfare of the Republic of Srpska MICS Multiple Indicator Cluster Survey MICS4 Fourth global round of Multiple Indicator Clusters Surveys programme MMR Measles Mumps Rubella NAR Net Attendance Ratio OPV Oral polio vaccine ORS Oral rehydration solution ORT Oral rehydration treatment ppm Parts per million pps Probability proportional to size PSU Primary Sampling Unit RS Republic of Srpska RSIS Republic of Srpska Institute of Statistics SPSS Statistical Package for Social Sciences STI Sexually transmitted infection TFR Total Fertility Rate UNAIDS United Nations Programme on HIV/AIDS UNDP United Nations Development Programme UNFPA United Nations Population Fund UNGASS United Nations General Assembly Special Session on HIV/AIDS UNHCR United Nations High Commissioner for Refugees UNICEF United Nations Children’s Fund U5MR Under-five mortality rate wFFC A world Fit For Children wHO world Health Organization xiv MUlTIPlE INDICATOR ClUSTER SURVEy 2011–2012 MONITORING THE SITUATION OF CHIlDREN AND wOMEN xv Child Health Immunisation According to UNICEF and WHO guidelines children should receive the BCG vaccination, to protect against tuberculosis, three doses of DPT, to protect against diphtheria, pertussis, and tetanus, and three doses of the polio vaccine, and the measles vaccination by 12 months of age. A World Fit for Children goal is to ensure full immunisation coverage for children under one year of age at 90 per cent nationally, with at least 80 per cent coverage in every administrative unit. z The immunisation coverage of Roma children aged 18-29 months was low at only 4 per cent (this percentage includes children of this age that had received a BCG vaccine, three doses of the DPT vaccination and three doses of the polio vaccination by the age of 12 months as well as an MMR vaccine by the age of 18 months). z By the age of 12 months, 86 per cent of children had received a BCG vaccination. z For all vaccines the coverage was highest for the first dose and declined for the second and third doses. The first dose of DPT vaccine had been given to 30 per cent of Roma children, the second dose to 21 per cent and the third dose to 13 per cent of children. Thirty-two per cent of children had received the first dose of the polio vaccine by the age of 12 months, 24 per cent of children had received the second dose yet only 14 per cent of children had received the third dose of the polio vaccine. z Thirteen per cent of Roma children had not received any of the listed vaccinations (this percentage includes children that had not received a BCG vaccine, three doses of the DPT vaccination and three doses of the polio vaccination during infancy as well as an MMR vaccine by 18 months). z Immunisation coverage against MMR by the age of 18 months was 22 per cent. Oral Rehydration Treatment In the treatment of diarrhoea of particular importance are increased fluid intake, continued feeding of the child and use of oral rehydration salts (ORS). z In the two weeks preceding the survey as many as 15 per cent of Roma children under 5 years of age had diarrhoea. More than one half of these children received ORS (58 per cent), while 16 per cent drank more than usual, 73 per cent drank the same or somewhat less and 11 per cent drank much less than usual. More than four-fifths of children ate the same, somewhat less or more than usual (85 per cent), while 15 per cent of children ate much less than usual or stopped food altogether. z Nineteen per cent of children received antimotility medication, 7 per cent received an antibiotic in the form of tablets or syrup, 4 per cent of children received an injectable antibiotic and 1 per cent of children received an intravenous infusion for the treatment of diarrhoea. No diarrhoea treatment or medication was received by 25 per cent of children. Care-Seeking and Antibiotic Treatment of Pneumonia A World Fit for Children goal is to reduce by one-third deaths due to acute respiratory infection. z One in ten children aged 0-59 months had symptoms of suspected pneumonia in the two weeks preceding the survey and 80 per cent of which were taken to an appropriate service provider, most often to a government health centre (68 per cent) or government hospital (12 per cent). Three quarters of children under five with suspected pneumonia in the two weeks prior to the survey were treated with antibiotics (75 per cent). z A low percentage of mothers (6 per cent) knew of the two danger signs of pneumonia: fast and difficult breathing. Most mothers identified fever as a symptom for immediately taking a child to a health facility (81 per cent), while a lower proportion of mothers would take their child to see a doctor if experiencing difficulty breathing (28 per cent) or fast breathing (13 per cent). Executive Summary The 2011–2012 Multiple Indicator Cluster Survey (MICS) on Roma in BiH was conducted by the Ministry for Human Rights and Refugees of BiH (MHRR BiH) in cooperation with the Agency for Statistics of BiH (BHAS). Financial and technical support was provided by UNICEF, with additional financial support being provided by UNFPA and the UNHCR. The survey was undertaken as part of the fourth global round of MICS (MICS4). The survey is based on a representative sample of 1,791 households, with a response rate of 86 per cent. In these households, 1,380 women and 1,456 men aged 15-49 were interviewed and questionnaires completed for 748 children under age five. Child Mortality The infant mortality rate is the probability of dying before the first birthday; the under-five mortality rate is the probability of dying before the fifth birthday. z The infant mortality rate for Roma children was estimated at 24 per one thousand live births, while the under-five mortality rate was 27 per one thousand live births. The estimates refer to 2005. Nutrition Nutritional Status When children have access to an adequate food supply, are not exposed to repeated illness and are well cared for they can reach their growth potential and are considered as well nourished. z Survey findings show that 9 per cent of Roma children under age five were underweight and 2 per cent of children were severely underweight. Twenty-one per cent of children were stunted (too short for their age), while 8 per cent were severely stunted. In addition, 8 per cent of children were wasted, of which, half were severely wasted; 8 per cent of Roma children were overweight. Breastfeeding and Child Feeding Exclusive breastfeeding is considered appropriate feeding for infants aged 0-5 months, while infants aged 6-23 months are considered to be appropriately fed if they are receiving breast milk and solid, semi-solid or soft food. z One half of babies born in the 2 years preceding the survey were breastfed for the first time within one hour of birth. z Twenty-two per cent of children aged less than six months were exclusively breastfed, indicating a low rate of exclusive breastfeeding. The median duration of exclusive breastfeeding amongst these children was 1.8 months. One half of children aged 12–15 months are still being breastfed, with a mean duration of predominant breastfeeding of 8.3 months. Amongst children in households where the mother tongue of the household head was Romani the median duration of any breastfeeding (27.5 months) and predominant breastfeeding (6.4 months) was longer compared to children in households where the mother tongue of the household head was other (17.2 months for any breastfeeding and 1.9 months for predominant breastfeeding). z Less than one half of children aged 6-23 months were breastfed and receiving solid, semi-solid and soft foods (46 per cent), while two-fifths of children aged 0-23 months were breastfed appropriately according to their age. Low Birth weight Low birth weight (less than 2,500 grams) carries a range of serious health risks for children, while undernourishment in the womb leads to increased risk of disease and infant death. z Almost all Roma children born in the two years preceding the survey were weighed at birth (96 per cent), with 14 per cent of them weighing below 2,500 grams. xvi MUlTIPlE INDICATOR ClUSTER SURVEy 2011–2012 MONITORING THE SITUATION OF CHIlDREN AND wOMEN xvii z The most widely known modern method was the male condom (88 per cent), followed by the IUD (82 per cent) and the pill (76 per cent). Of the traditional methods, the most widely known method was withdrawal (64 per cent) as well as periodic abstinence/the rhythm method (43 per cent). z One quarter of Roma women aged 15-49 who were married or in union were using some form of contraception during the survey period. The most popular contraceptive methods were withdrawal (16 per cent) and the male condom (4 per cent). Amongst other methods of contraception, women used the pill (2 per cent), IUD (1 per cent) and female sterilisation (1 per cent). The higher a women’s level of education the higher the prevalence of the use of modern contraceptive methods as opposed to traditional methods. Modern methods were used by only 5 per cent of women with no formal education and 18 per cent of women with secondary or higher education. Unmet Need for Contraception Unmet need for contraception refers to fecund women who are not using any method of contraception but who wish to postpone their next birth or who wish to stop childbearing altogether. z Unmet need for contraception was present amongst three in ten Roma women aged 15-49 who were currently married or in union. This need was highest amongst women aged 25-34 (38 per cent). z Nineteen per cent of women had an unmet need for stopping childbearing altogether, while 9 per cent of women had an unmet need for postponing their next birth. Antenatal Care UNICEF and the World Health Organization (WHO) recommend a minimum of four antenatal care visits during pregnancy. z About two-thirds of Roma women had received antenatal care four or more times (62 per cent), while a lower proportion of mothers had received one (5 per cent), two (7 per cent) or three (5 per cent) antenatal care visits. Antenatal care was largely provided by medical doctors (76 per cent) and nurses/midwives (3 per cent). z About one-fifth of Roma women (21 per cent) did not receive antenatal care. Assistance at Delivery and Place of Delivery A World Fit for Children goal is to ensure that women have readily available and affordable access to skilled attendance at delivery. z Almost all births by Roma women that occurred in the two years preceding the survey were delivered by skilled personnel in public sector health facilities (99 per cent). Doctors assisted with the delivery of 79 per cent of births and nurses assisted with 20 per cent of births. Child Development Early Childhood Education and Learning Activities that support early childhood learning include the involvement of adult household members in reading books or looking at picture books, telling stories, singing songs, counting or drawing, taking children outside the home, compound or yard and playing or spending time with children. z An adult had engaged in four or more activities that promote learning and school readiness during the three days that preceded the survey with two-thirds of children under-five. The average number of activities was 4. Father’s involvement in one or more activity with children was reported in 60 per cent of cases, more frequently with male (66 per cent) than with female children (53 per cent). z Nearly one half of children had 2 or more types of playthings at home (48 per cent) and 11 per cent of Roma children aged 0-59 months live in households where 3 or more children’s books are present. z During the week prior to the interview 7 per cent of children aged 0-59 months were left with inadequate care. Five per cent of children where left alone at home, while 4 per cent were left in the care of other children under 10 years of age. Inadequate care was more prevalent amongst children whose mothers had no formal education (7 per cent), while children whose mothers had secondary or higher education had not been left with inadequate care at all. Children in the poorest 60 per cent of the population (9 per cent) were more often left with inadequate care than children in the richest 40 per cent of the population (2 per cent). Solid Fuel Use Cooking and heating with solid fuel leads to high levels of health damaging indoor smoke. z Almost all Roma households used soil fuel for cooking (92 per cent). The use of solid fuel was most common amongst households where the household head had no formal education (96 per cent) and least common amongst those with secondary or higher education (88 per cent). z A special room designated for cooking was used by only two-fifths of Roma households that use solid fuel for cooking (41 per cent), the lowest percentage being amongst the poorest households (22 per cent). water and Sanitation Use of Improved Drinking water Sources and Improved Sanitation An important A World Fit for Children goal is to reduce the proportion of households without access to hygienic sanitation facilities and affordable and safe drinking water by at least one-third. z Almost all Roma household members used improved sources of drinking water (97 per cent), the most common being piped water (91 per cent) and the second most important being protected springs (5 per cent). z In a substantial majority of households that needed to collect water, the water was collected by adult men (61 per cent) or adult women (25 per cent). Water was less frequently collected by female or male children under age 15 (4 per cent in both cases). z Four-fifths of the Roma population used improved sanitation for excreta disposal, the most commonly used facilities being flush toilets with connection to a sewerage system (61 per cent) or septic tanks (15 per cent). z Improved sources of drinking water and improved sanitation were least commonly used by household members when the household head had no formal education (59 per cent) and those in the poorest wealth quintile (32 per cent). Hand washing Hand washing with water and soap is the most cost-effective health intervention to reduce incidence of both diarrhoea and pneumonia in children under five. z Almost all Roma households had soap somewhere in the dwelling (97 per cent). There was no soap available (anywhere) in 14 per cent of households in the poorest wealth quintile and in 7 per cent of households where the household head had no formal education. Reproductive Health Fertility and Early Childbearing The total fertility rate (TFR) denotes the average number of children to whom a woman will have given birth by the end of her reproductive years if current fertility rates prevail. z The adolescent birth rate was 145 births per 1,000 women aged 15-19 for the one year period preceding the survey. z More than one quarter of women aged 15-19 had had a live birth (27 per cent), while 3 per cent of women in this age group had a live birth before age 15. z Nearly one-third of women aged 20-24 (31 per cent) had a live birth before age 18. knowledge and Use of Contraceptives Appropriate family planning is important for the health of women and children and it is therefore critical to ensure access for all couples to information and services to prevent pregnancies that are too early, too closely spaced, too late or too many. z Almost all women aged 15-49 knew at least one contraceptive method (95 per cent). Modern methods were more widely known than traditional methods; 95 per cent of all women had heard of at least one modern method while 68 per cent of women knew at least one traditional method. xviii MUlTIPlE INDICATOR ClUSTER SURVEy 2011–2012 MONITORING THE SITUATION OF CHIlDREN AND wOMEN xix Child Protection Birth Registration An important goal of the International Convention on the Rights of the Child and A World Fit for Children is to ensure the registration of each child at or shortly after birth. z Birth registration was assessed by examining the birth certificate or based on the mother/caretaker’s report on birth registration. Almost all Roma children under five, according to the mother/caretaker’s declaration, had been registered at birth (96 per cent); however, interviewers were not shown a birth certificate in 20 per cent of cases. The lowest percentage of registered children (91 per cent) was found amongst those of the earliest age, 0-11 months, which indicates that a notable proportion of parents continue to not register their children at or shortly after birth. Child Discipline A World Fit for Children states that children must be protected against any acts of violence. The Millennium Declaration also calls for the protection of children against abuse exploitation and violence. z More than one half of Roma children aged 2-14 years had been subjected to psychological aggression as punishment or physical punishment by their parents or other adult household members during the past month (58 per cent). Forty-nine per cent of children had been subjected to psychological aggression, 45 per cent of children had been physically punished, while 7 per cent suffered severe physical punishment. z A lower percentage of adult household members stated that they believed in the need for the physical punishment of children (8 per cent) compared to the actual percentage of children who had been subjected to such punishment (45 per cent). Early Marriage and Polygyny Child marriage is a violation of human rights and compromises the development of girls and often results in early pregnancy and social isolation. z More Roma women than men aged 15-19 were currently married or in union (38 per cent of women and 13 per cent of men). The percentage of these women and men who were married was higher amongst those with no formal education (53 per cent for women and 20 per cent for men) compared to those with secondary or higher education. z Fifteen per cent of women aged 15-49 were married before age 15 and the highest percentage of these women who married while being underage had no formal education and belonged to the poorest wealth quintile. Three per cent of Roma women aged 15-19 as well as 5 per cent of women aged 20-24 were currently married to a man who was older by ten years or more. A very small percentage of Roma women and men aged 15-49 lived in a union in which the husband had more than one wife/partner. Attitudes towards Domestic Violence It is believed that those women who feel that a man has the right to hit or beat his wife are frequently abused by their husbands/partners and that those men who hold the same opinion frequently abuse their wives or partners. z A higher percentage of women than men felt that a husband/partner has the right to hit or beat his wife/partner. Women most often justified a husband’s violence through instances where the woman neglected the children (32 per cent) or went out without telling her husband (27 per cent) or if she argued with him (22 per cent) or refused to have sex with him (20 per cent). The highest proportion of men believed that a man has the right to hit or beat his wife/partner if she neglects the children (14 per cent), went out without telling her husband or refused to have sex with him (10 per cent in both cases). z Men and women who lived in families in the poorest wealth quintile more often supported at least one of the reasons for justifying violence against women (25 per cent of men and 48 per cent of women), compared to men and women who were in the richest wealth quintile (15 per cent of men and 38 per cent women). z Only 2 per cent of Roma children aged 36-59 months were attending an organised early childhood programme, with a similar percentage amongst boys and girls. Early Childhood Development Index The Early Childhood Development Index (ECDI) is calculated as the percentage of children who are developmentally on track in at least three of four domains: literacy and numeracy skills, physical growth, socio-emotional development and learning. z Eighty-five per cent of Roma children aged 36-59 months were developmentally on track, with no large variations by sex. While it is usual that children develop more skills with increasing age, the data indicates that the ECDI of Roma children aged 48-59 months (85 per cent) was the same as that of children age 36-47 months (85 per cent). z Nearly all children aged 36-59 months were on track in the learning domain (99 per cent) and were also on track in the physical domain (98 per cent), but less children were on track in the socio-emotional domain (86 per cent) and the lowest percentage were on track in the literacy-numeracy domain (8 per cent). Children in households where the mother tongue of the household head was Romani were less likely to be on track in the literacy-numeracy domain (5 per cent) as opposed to those in households where the household head spoke another mother tongue (13 per cent). Education School Readiness Readiness of children for primary school can be improved through attendance at early childhood education programmes or through preschool attendance. z Four per cent of Roma children who were currently attending the first grade of primary school had attended preschool during the previous year. Primary and Secondary School Participation Education is an essential prerequisite for combating poverty, promoting human rights and democracy and empowering women and children. z One half of Roma children who were of primary school entry age were attending the first grade (47 per cent). Children of primary school entry age in households where the mother tongue of the household head was Romani were less likely to be attending the first grade of primary school (39 per cent) compared to children in households where the household head spoke another mother tongue (59 per cent). z More than two-thirds of Roma children of primary school age were attending school (69 per cent). This percentage rose with the mother’s level of education and was higher amongst the richer families. The net primary school completion rate was 40 per cent. z The Gender Parity Index (GPI) for primary school was 0.96, indicating that girls were slightly less likely to attend primary school than boys; however, girls were much more disadvantaged compared to boys at the secondary school level (GPI: 0.67). Literacy amongst women and Men aged 15-24 Youth literacy is an important MDG indicator. z There were more literate men (90 per cent) than women (69 per cent) in the 15-24 age group. Literacy was lower amongst women in households where the mother tongue of the household head was Romani compared to those where the household head spoke another mother tongue (59 per cent versus 83 per cent). Amongst men there were no large differentials in terms of literacy in relation to their mother tongue. In addition, amongst respondents aged 15-24 who had no formal education a much higher percentage of men were able to successfully read the statement shown to them (64 per cent) compared to women (16 per cent). xx MUlTIPlE INDICATOR ClUSTER SURVEy 2011–2012 MONITORING THE SITUATION OF CHIlDREN AND wOMEN xxi Access to Mass Media MICS4 collected information on exposure of women and men aged 15-49 to newspapers/magazines, radio and television, as well as the use of computers and the Internet amongst persons aged 15-24. z Thirty-nine per cent of Roma men and 16 per cent of Roma women had been exposed to all of the three types of media at least once a week, more of them coming from amongst those with secondary or higher education and those from the richest wealth quintile. Men (34 per cent) and women (8 per cent) in households where the mother tongue of the household head was Romani were less exposed to the three media types compared to men (45 per cent) and women (25 per cent) in households where the household head spoke another mother tongue. z Forty-three per cent of women and 69 per cent of men aged 15-24 had ever used a computer, while a lower proportion of both men and women had used a computer at least once a week during the last one month (29 per cent of women and 57 per cent of men). z Internet use over the last 12 months was higher amongst men (88 per cent) and women (75 per cent) aged 15-24 with secondary or higher education, compared to those with no formal education (26 per cent of men and 8 per cent of women), as well as amongst men (86 per cent) and women (61 per cent) in the richest wealth quintile compared to those in the poorest wealth quintile (30 per cent of men and 9 per cent of women). Tobacco and Alcohol Use Tobacco Use Numerous studies have shown that smoking is a risk factor for many diseases and that it can lead to serious diseases in non-smokers, especially children. z About two-thirds of men and women aged 15-49 reported having ever used a tobacco product. About one-fifth of women (22 per cent) and men (19 per cent) had smoked a cigarette for the first time before age 15; the percentage was highest, for both sexes, amongst those with no formal education (25 per cent each) and those from the poorest households (29 per cent each). z More than one half of men (56 per cent) and women (55 per cent) had used a tobacco product on one or more days during the last one month, with no difference between men and women in the use of tobacco products by type or combination of the product used. z Most of the men and women that currently smoked cigarettes had smoked more than 20 cigarettes in the last 24 hours, men (87 per cent) more than women (63 per cent). Alcohol Use Excessive alcohol use increases the risk of many harmful health conditions and can also lead to social problems. Alcohol abuse is also associated with injuries and violence, including domestic violence. z Forty-five per cent of Roma women and 69 per cent of Roma men aged 15-49 had consumed alcohol in their lifetime. A higher percentage of men aged 15-49 (19 per cent) had had at least one drink of alcohol before age 15, compared to women (5 per cent). z At least one drink of alcohol had been consumed on one or more days during the last one month by a higher proportion of men aged 15-49 (48 per cent) than women (14 per cent). Subjective well-Being Understanding young women and young men’s satisfaction in different areas of their lives can help to gain a comprehensive picture of young people’s life situations. z A higher percentage of men (48 per cent) than women (39 per cent) age 15-24 are satisfied with their life. For both sexes, people in the 15-19 age group as well as men and women aged 15-24 with secondary or higher education and those from the richest households were most satisfied with their life compared to the other respondents. z For both sexes, the happiest were men and women in the 15-19 age group and those aged 15-24 who had secondary or higher education and those in the richest wealth quintile. z The survey findings show that a higher percentage of Roma women aged 15-24 thought that their lives had improved over the last year (29 per cent compared to men 21 per cent) and that a higher percentage of women (77 per cent compared to men 61 per cent) expected their lives to improve in one year. HIV/AIDS and Sexual Behaviour that Increases the Risk of HIV Transmission knowledge about HIV Transmission and Misconceptions about HIV/AIDS and Attitudes towards People Living with HIV/AIDS An essential prerequisite to protect oneself against HIV infection is accurate knowledge of how the virus is transmitted. z Seventy-three per cent of Roma men and 67 per cent of Roma women aged 15-49 have heard of HIV/AIDS. However, a lower percentage of men (58 per cent) and women (42 per cent) knew of the two main ways of preventing HIV transmission (having only one faithful uninfected partner and using a condom every time). z Two-thirds of Roma men (67 per cent) and one half of Roma women aged 15-49 knew that having only one faithful uninfected partner can reduce the risk of transmission of HIV. z About one-third of men (35 per cent) and women (30 per cent) knew that HIV cannot be transmitted by mosquito bites, while more than a quarter of women (27 per cent) and more than one-third of men (37 per cent) knew that HIV cannot be transmitted by sharing food with an infected person. z Eleven per cent of women and 20 per cent of men aged 15-49 rejected the two most common misconceptions concerning HIV (that HIV can be transmitted by mosquito bites and by sharing food with an infected person) and at the same time knew that a healthy looking person can be infected). z Comprehensive knowledge of HIV prevention was found amongst one-fifth of men aged 15-24 and 15-49 (21 and 18 per cent respectively) and a lower percentage of women in both age groups (9 per cent in both cases). z Accepting attitudes towards persons living with HIV for all four indicators were found amongst 14 per cent of men and 7 per cent of women. More educated women and men and those from the richest households expressed a higher level of accepting attitudes towards people living with HIV/AIDS than those with lower education and from the poorest households. HIV Testing In order to protect themselves and to prevent infecting others it is important for individuals to know their HIV status. Knowledge of where to be tested for HIV and use of such services is a critical factor in the decision to seek treatment. z More Roma men aged 15-49 (49 per cent) than women (23 per cent) knew of a facility where they could be tested for HIV. Nonetheless, few of them had ever tested for HIV (about 5 per cent): more women and men with secondary or higher education, compared to those with no formal education, and those from the richest wealth quintile had been tested for HIV. Amongst persons aged 15-24 one half of men (52 per cent) and one-fifth of women (19 per cent) knew where to be tested for HIV, with 5 per cent of men and 3 per cent of women having been tested for HIV. z HIV counselling during antenatal care had been received by only 3 per cent of women who had given birth in the two years prior to the survey. During the antenatal period, a small percentage of women were offered an HIV test, were tested and were told the result (less than 1 per cent). Sexual Behaviour Related to HIV Transmission Promoting safer sexual behaviour is critical for reducing HIV prevalence. The use of condoms during sex, especially with non-regular partners, is especially important for reducing the spread of HIV. z Amongst people aged 15-24 years 70 per cent of men and 65 per cent of women had had sex, with 14 per cent of men and 12 per cent of women having had sex before 15 years of age. In the last 12 months 8 per cent of men and 2 per cent of women aged 15-24 had sex with more than one partner. z Fifty-six per cent of men and 13 per cent of women aged 15-24 had sex with a non-marital/non-cohabiting partner in the last 12 months and male respondents had used a condom the last time they had sex with these partners in 49 per cent of cases. z Within the last 12 months 4 per cent of women aged 15-24 had had sex with a man who was older by ten years or more. MONITORING THE SITUATION OF CHIlDREN AND wOMEN 1 I Introduction Background This report provides valuable and comprehensive information on the situation of Roma children, women and men in BiH, obtained for the first time through a MICS survey on Roma in BiH. The survey was conducted in 2011 and 2012 by MHRR BiH in cooperation with BHAS; technical and financial support was provided by UNICEF with additional financial support from UNFPA and UNHCR. The survey is based, in large part, on the need to monitor progress towards the goals and targets emanating from recent international agreements: the Millennium Declaration, adopted by all 191 United Nations Member States in September 2000, and the Plan of Action of A World Fit For Children, adopted by 189 Member States at the United Nations Special Session on Children in May 2002. 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 improve the conditions for their children and to monitor progress towards that end. UNICEF was assigned a supporting role in this task. A Commitment to Action: National and International Reporting Responsibilities The governments that signed the Millennium Declaration and the A World Fit for Children Declaration and Plan of Action also committed themselves to monitor 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 subnational 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 specialised agencies of the United Nations system, and all other relevant actors, as appropriate, information on the progress made in the implementation of the Declaration and the Plan of Action.” Similarly, the Millennium Declaration (paragraph 31) calls for periodic reporting on progress: “… We request the General Assembly to review on a regular basis the progress made in implementing the provisions of this Declaration and ask the Secretary-General to issue periodic reports for consideration by the General Assembly and as a basis for further action.” One of the main challenges in monitoring and reporting on the progress made towards the goals and targets of the Millennium Declaration and the Plan of Action of A World Fit for Children in BiH is the scarcity of relevant statistical data and administrative resources, which makes the results of the MICS survey on Roma particularly important for assessing the situation and level of progress towards the 2015 goals and targets. The MICS survey on Roma in BiH is also important as a source of information for monitoring the implementation of the Convention on the Rights of the Child and the Convention on the Elimination of All Forms of Discrimination 2 MUlTIPlE INDICATOR ClUSTER SURVEy 2011–2012 MONITORING THE SITUATION OF CHIlDREN AND wOMEN 3 II Sample and Survey Methodology Sample Design The sample for the MICS survey on Roma in BiH was designed to provide estimates for a large number of indicators on the situation of Roma children, women and men at the level of BiH as well as the FBiH and RS. Sampling frames for the Roma population were non-existent up until 20094 when MHRR BiH implemented the project entitled ‘Registration of the Roma Population and Roma Households’. Within this project MHRR BiH conducted an enumeration of Roma in BiH as part of activities contained in the Decade of Roma Inclusion 2005-2015. During the enumeration process data was collected on 4,307 Roma households living in 67 municipalities, out of a total of 142 municipalities in BiH. No data was collected for the remaining 75 municipalities due to lack of information on the presence of Roma in these municipalities. A stratified one-stage sample design was applied. In each of the three administrative units of BiH, namely the FBiH, RS and Brcko District of BiH (BD), municipalities were identified as the main sampling strata, the primary sampling unit being the household. Five municipalities were excluded from the sample since only one Roma household was present. Results presented in the report are representative of the 62 remaining municipalities (with more than one Roma household), for which there was a sampling frame. All households where the head of household declared himself or herself to be of Roma ethnicity were considered as Roma households. A specific number of households was allocated to each stratum (municipality) proportional to the size of the stratum identified during the enumeration carried out by MHRR BiH in 2009. Within each stratum the designated number of sample Roma households was selected randomly with equal probability.5 During the MICS fieldwork Roma households within each sampled municipality were enumerated and this updated information about the size of each stratum was reflected in the weights. Overall, fewer households were listed during MICS fieldwork (3,784), compared to the number of households from the 2009 enumeration (4,302). The fieldwork teams were informed that many households had left BiH during the period between the 2009 enumeration and MICS fieldwork. As a component of the enumeration activities conducted within MICS4, households within each stratum were selected for an interview based on the date of birth of the household head. In order to ensure a random selection of households a ‘starting point’ was randomly selected and an ‘end point’ calculated based on the sample size, using available information from the sampling frame. Only those households in which the date of birth of the household head fell between the starting point and end point were interviewed. This resulted in the selection of a total of 1,791 Roma households: 542 households with children under five and 1,249 households without children under five. In order to have a random sample design – for each stratum (municipality) a list of Roma settlements was produced then this list was ordered randomly (using a random number generator). Interviewers were instructed to interview settlements in a predefined (random) order. In this way each household had the same probability of selection within each stratum. The sample was not self-weighting; the sample weights were used for reporting the results. A more detailed description of the sample design can be found in Appendix A. 4 The last census in BiH was conducted in 1991. 5 There was large variability in the number of households per stratum (ranging from 1 to 132 households). against Women as well as the Gender Action Plan of BiH. It will aid reporting under the Guidelines for Identifying Socially Excluded Groups of Children in BiH and other commitments arising from the European integration processes and human rights principles contained in the Constitution of BiH, the Constitution of the Federation of Bosnia and Herzegovina (FBiH) and the Constitution of the Republic of Srpska (RS). Policy documents and strategic plans concerning children in BiH stress the provision of equal access to services for all children through multi-sector action. MICS indicators will provide an insight into the level of progress made. These indicators are presented according to the topics covered by the survey. Towards the end of 2011 and the beginning of 2012 the Federal Ministry of Health, Ministry of Health and Social Welfare of the RS, the Institute of Public Health of the FBiH, in cooperation with the Agency for Statistics of BiH, conducted a MICS4 survey on a sample of the total population in BiH using the same methodology and similar survey tools. The results of the MICS4 for BiH will be available in a separate survey report. Survey Objectives The 2011–2012 Multiple Indicator Cluster Survey on Roma in BiH has as its primary objectives: z provide essential information for assessing the situation of Roma children, women and men in BiH; z furnish data needed for monitoring progress towards the goals established through the Millennium Declaration and other internationally agreed upon goals as a basis for future action; z contribute to the improvement of data and monitoring systems in BiH and strengthen technical expertise in the design, implementation and analysis of such systems; z generate data on the situation of Roma children, women and men, including the identification of vulnerable groups and disparities, to provide information for policies and interventions within health and social care services and the reduction of poverty. 4 MUlTIPlE INDICATOR ClUSTER SURVEy 2011–2012 MONITORING THE SITUATION OF CHIlDREN AND wOMEN 5 The Questionnaire for Individual Men was administered for all men aged 15-49 years living in the households and included the below modules. z Men’s Background z Access to Mass Media and Use of Information/Communication Technology z Child Mortality z Attitudes towards Domestic Violence z Marriage/Union z Sexual Behaviour z HIV/AIDS z Tobacco and Alcohol Use z Life Satisfaction z Health Care10 The Questionnaire for Children Under Five was administered for mothers or caretakers of children under five years of age11 living in the households. Normally, the questionnaire was administered for mothers of children under-5; however, in cases where the mother was not listed on the household roster, a primary caretaker for the child was identified and interviewed. The questionnaire included the below modules. z Age z Birth Registration z Early Childhood Development z Breastfeeding z Care of Illness z Immunisation z Anthropometry The questionnaires were based on the MICS4 model questionnaire.12 From the MICS4 model English version the questionnaires were translated into the local languages used in BiH. The questionnaires were pre-tested in the FBiH in three municipalities in Sarajevo Canton (Centar, Ilijas and Novo Sarajevo) during September 2011. The plan provided for 18 households to be interviewed (9 each in urban and rural areas). These households were selected using a random selection method based on the date of birth of the household head. On the basis of the pre-test results, modifications were then made to the wording and translation of the questionnaires for the survey. A copy of the questionnaires used in the MICS survey on Roma in BiH is provided in Appendix F to this report. A separate MICS4 survey for a sample the total population in BiH was conducted by the Federal Ministry of Health, Ministry of Health and Social Welfare of the Republic of Srpska, the Institute of Public Health of the FBiH, in cooperation with the Agency for Statistics of BiH, in parallel to MICS4 for a sample of the Roma population. Both surveys used the same methodology and similar survey tools. The questionnaires provided in Appendix F of this report reflect the survey tools of both surveys (apart from the Questionnaire for Defining Residency Status, which was an additional, country specific form used only within the survey of the sample of the total population). The results of the MICS4 for BiH will be available in a separate survey report 10 Country specific module that was only used within the MICS4 Roma Survey. The findings for these questionnaires are not presented in this report and will be analysed separately. 11 The terms ‘children under 5’, ‘children aged 0-4 years’ and ‘children aged 0-59 months’ are used interchangeably throughout this report. 12 The model MICS4 questionnaires can be found at <www.childininfo.org/mics4_questionnaire.html> Questionnaires Four sets of MICS4 questionnaires were used in the survey: 1) a household questionnaire that was used to collect information on all de jure household members,6 the household and the dwelling; 2) a women’s questionnaire administered in each household for all women aged 15-49 years, 3) a men’s questionnaire administered in each household for all men aged 15-49 years and 4) an under-5’s questionnaire administered for mothers or caretakers of all children under five living in the household. The survey also included two country specific questionnaires that are not part of the standard MICS survey instruments: 1) Questionnaire Form for Drug Use Assessment (self-administered questionnaire for women and men age 15-49) and 2) Questionnaire Form about the Possession of Documents (asked to household questionnaire respondent or another knowledgeable adult). The findings for these questionnaires are not presented in this report and will be analysed separately. The Household Questionnaire included the below modules. z Household Listing Form z Education z Water and Sanitation z Household Characteristics z Child Discipline z Hand washing The Questionnaire for Individual Women was administered for all women aged 15-49 years living in the households and included the below modules. z Women’s Background z Access to Mass Media and Use of Information/Communication Technology z Child Mortality7 z Desire for Last Birth z Maternal and Newborn Health z Illness Symptoms z Contraception8 z Unmet Need z Attitudes towards Domestic Violence z Marriage/Union z Sexual Behaviour z HIV/AIDS z Tobacco and Alcohol Use z Life Satisfaction z Health Care9 6 This applies to only those persons who were usual residents in the household. 7 Country specific questions on wasted pregnancies were added to this module. 8 A country specific question on knowledge of contraceptives methods was added to this module. 9 Country specific module that was only used within the MICS4 Roma Survey. The findings for these questionnaires are not presented in this report and will be analysed separately. 6 MUlTIPlE INDICATOR ClUSTER SURVEy 2011–2012 MONITORING THE SITUATION OF CHIlDREN AND wOMEN 7 III Sample Coverage and the Characteristics of Households and Respondents Sample Coverage Of the 1,791 households selected for the sample 1,788 were found to be occupied. Of these, 1,544 households were successfully interviewed for a household response rate of 86 per cent. In the interviewed households 1,457 women aged 15-49 were identified of which 1,380 were successfully interviewed, yielding a response rate of 95 per cent. In addition, 1,559 men aged 15-49 were listed in the household questionnaire. Questionnaires were completed for 1,456 eligible men, which corresponds to a response rate of 93 per cent. There were 760 children under age five listed in the household questionnaire and questionnaires were completed for 748 children, which corresponds to a response rate of 98 per cent. The overall response rates for the women’s, men’s and children’s questionnaires were 82 per cent, 81 per cent and 85 per cent respectively (see Table HH.1). Table HH.1: Results of household, women’s, men’s and under-5 interviews Number of households, women, men, and children under 5 by results of the household; women’s, men’s and under-5’s interviews and household, women’s, men’s and under-5’s response rates, BiH Roma Survey 2011–2012     Administrative unit Total FBiH RS BD Households   Sampled 1,365 354 72 1,791 Occupied 1,362 354 72 1,788 Interviewed 1,147 327 70 1,544 Household response rate 84.2 92.4 97.2 86.4 women   Eligible 1,091 294 72 1,457 Interviewed 1,041 268 71 1,380 women’s response rate 95.4 91.2 98.6 94.7 women’s overall response rate 80.4 84.2 95.9 81.8 Men   Eligible 1181 312 66 1559 Interviewed 1126 266 64 1456 Men’s response rate 95.3 85.3 97.0 93.4 Men’s overall response rate 80.3 78.8 94.3 80.6 Children under 5   Eligible 547 159 54 760 Mothers/caretakers interviewed 540 154 54 748 Under-5’s response rate 98.7 96.9 100.0 98.4 Under-5’s overall response rate 83.1 89.5 97.2 85.0 The response rates for men were lower than the response rates for women and children in RS, whereas the response rates for men in the FBiH and BD were similar to women’s and children’s response rates. Figure HH.2 shows the distribution of 62 municipalities in which the survey was conducted by administrative unit, as well as the sample distribution by fieldwork teams.14 14 The sample frame comprised of 67 municipalities, out of the 142 municipalities in BiH. The remaining 75 municipalities were excluded from the sample due to lack of information on the presence of Roma in these municipalities. Five municipalities were excluded from the sample since only one Roma household was present. Training and Fieldwork Training for the fieldwork was conducted over 12 days13 during October 2011. Training included lectures on interviewing techniques and the content of the questionnaires as well as practical work that offered practice in asking the questions. Towards the end of the training period the trainees spent two days conducting practice interviews in urban and rural areas in the municipalities of Novi Grad (Sarajevo) and Visoko. Fieldwork was conducted by three teams. Each team was comprised of 4 interviewers (2 female and 2 male interviewers), one editor, one measurer and a supervisor. Fieldwork began on 9 November 2011 and was concluded on 30 March 2012. Data Processing The data was entered and processed by the MHRR BiH. The data was entered using CSPro software into four microcomputers by 4 trained data entry operators; the process was supervised by data entry supervisors and a data entry coordinator. Data entry began ten days after the start of data collection (20 November 2011) and was completed on 26 April 2012. The SPSS (Statistical Package for Social Sciences) software programme (Version 18) was used to analyse the data and model syntax and tabulation plans developed by UNICEF were also used for this purpose. In order to ensure quality control all questionnaires were double entered and internal consistency checks were performed. Procedures and standard programmes developed under the global MICS4 programme and adapted to the questionnaires for the survey on Roma in BiH were used throughout. Report Structure The Constitution of BiH, which is an integral part of the Dayton Peace Agreement (Annex 4), defines the administrative structure of BiH as a state comprised of two entities, the FBiH and RS, as well as a third administrative unit BD. The FBiH, RS and BD have their own governments and all jurisdictions and responsibilities that are not otherwise assigned through the Constitution of BiH to state institutions. This includes legislative and executive jurisdiction over healthcare and social protection, which in the FBiH are also delegated to the 10 federal units (Cantons). Due to the administrative structure and respective responsibilities of the BiH, FBiH and the RS for strategies that address child well-being and development, the data and analyses contained in this report are presented in such a way that they reflect data at the BiH, FBiH and RS level. The relatively small sample size in BD provides too few cases to produce statistically sound estimates for all indicators for the report. The data for BD is shown in the tables contained in this report wherever possible. How to Read the Tables The following data collected within this survey is not presented in tables in this report: z ‘Missing/Don’t know’ cases for the background characteristic ‘Language of household head’ (except in Tables HH.3–HH.5 and DQ.4–DQ.5); z data disaggregated by area type, since urban/rural categorisations could not be applied at the municipal level; z data that is not part of the global MICS report template, except data on knowledge of contraceptive methods, (data not presented in the report, coming from country specific survey instruments, includes data on: drug use, possession of documents, wasted pregnancies and health care). Please note: z (M) — the letter ‘M’ after a table/figure code indicates that it refers to the male population; z (*) — an asterisk in tables indicates that a percentage or proportion has been suppressed because it was based on fewer than 25 unweighted cases; z (number) — values in parenthesis indicate that the percentage or proportion is based on only 25 to 49 unweighted cases and should be treated with caution; z age groups presented in this report include those persons that had reached the full age indicated by the upper limit for the group; for instance, respondents aged 15-49 included persons who had turned 49, while the age group of children aged 20-23 months includes those who had reached a full 23 months. 13 The 12 day training included a 2 day practice pilot study. 8 MUlTIPlE INDICATOR ClUSTER SURVEy 2011–2012 MONITORING THE SITUATION OF CHIlDREN AND wOMEN 9 Table HH.2: Household age distribution by sex Per cent and frequency distribution of the household population by five-year age groups, dependency age groups and by child (aged 0-17 years) and adult populations (age 18 or above) by sex, BiH Roma Survey 2011–2012   Males Females Total Number Per cent Number Per cent Number Per cent Age (years)   0-4 398 13.3 356 12.5 754 12.9 5-9 348 11.6 332 11.6 680 11.6 10-14 353 11.8 351 12.3 704 12.0 15-19 323 10.8 282 9.9 606 10.3 20-24 313 10.5 270 9.4 583 10.0 25-29 238 8.0 218 7.6 456 7.8 30-34 187 6.2 188 6.6 375 6.4 35-39 171 5.7 188 6.6 359 6.1 40-44 177 5.9 157 5.5 334 5.7 45-49 153 5.1 154 5.4 307 5.2 50-54 134 4.5 140 4.9 274 4.7 55-59 80 2.7 95 3.3 175 3.0 60-64 56 1.9 54 1.9 110 1.9 65-69 24 0.8 34 1.2 58 1.0 70-74 18 0.6 19 0.7 37 0.6 75-79 15 0.5 14 0.5 30 0.5 80-84 3 0.1 8 0.3 11 0.2 85+ 0 0.0 1 0.0 1 0.0 Missing/DK 1 0.0 0 0.0 1 0.0 Dependency age groups   0-14 1,099 36.7 1,039 36.3 2,137 36.5 15-64 1,832 61.2 1,745 61.0 3,577 61.1 65+ 60 2.0 76 2.7 136 2.3 Missing/DK 1 0.0 0 0.0 1 0.0 Child and adult populations   Children aged 0-17 years 1,301 43.5 1,220 42.7 2,521 43.1 Adults aged 18+ years 1,690 56.5 1,640 57.3 3,329 56.9 Missing/DK 1 0.0 0 0.0 1 0.0 Total 2,992 100.0 2,860 100.0 5,852 100.0 8 6 4 2 0 2 4 6 8 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Per cent Females Males Figure HH.2: Age and sex distribution of household population, BiH Roma Survey 2011–2012 Figure HH.1 Distribution of municipalities by administrative unit and distribution of sampled households by fieldwork teams, BiH Roma Survey 2011-2012 Characteristics of Households The weighted age and sex distribution of the survey population is provided in Table HH.2. The distribution was also used to produce the population pyramid in Figure HH.1. In the 1,544 households successfully interviewed during the survey 5,852 household members were listed. Of these, there were an approximately equal number of males (2,992) and females (2,860). The age and sex distribution of the Roma population through MICS4 differs from this distribution in the overall population obtained through other household surveys15 and the MICS3 survey for the overall population in BiH, with a higher proportion of children under 15 and the population aged 15-64, and a lower proportion of the population aged 65 and above. The proportion of children aged 0-14 within the Roma population was higher (37 per cent) than the proportion of persons age 65 and above in the population (2 per cent). The sex distribution shows some differences: in the population aged 0-29 there was a slightly higher proportion of males than females (especially in the age groups 0-4 and 15-24), yet this proportion was reversed in favour of females in the older age groups. Figure HH.2 shows a population pyramid with a wide base, which indicates a higher proportion of the population aged 0-4. 15 2007 BiH Household Budget Survey: Final Results, BHAS, FOS and RSIS, Banja luka/Sarajevo, 2008. 10 MUlTIPlE INDICATOR ClUSTER SURVEy 2011–2012 MONITORING THE SITUATION OF CHIlDREN AND wOMEN 11 Data on the sex of the household heads differs somewhat from the findings of surveys on the overall population conducted as part of the activities of the statistical system in BiH.16 In 33 per cent of cases in this survey the household heads were women. Households with 4 members are the most frequent (21 per cent), which does not differ from the overall population, while the proportion of households with 2 to 3 members was around 18 per cent (the estimated average household size was 3.8 members). The majority of households had at least one female and one male aged 15-49 (about 75 per cent), around two quarters had a child aged 0-17, while a lower proportion of households had a child aged 0-4 (35 per cent). Characteristics of Female and Male Respondents 15-49 Years of Age and Children Under-5 Tables HH.4, HH.4M and HH.5 provide information on the background characteristics of female and male respondents 15-49 years of age and of children under age 5. In all three tables the numbers of weighted and unweighted observations are presented. In addition, these tables also show the number of observations for each background category. These categories were used in the subsequent tabulations of this report. Table HH.4: women’s background characteristics Per cent and frequency distribution of women aged 15-49 years by selected background characteristics, BiH Roma Survey 2011–2012     weighted per cent Number of women weighted Unweighted Administrative unit   FBiH 78.6 1,085 1,041 RS 16.2 224 268 BD 5.2 71 71 Age (years)   15-19 18.3 253 258 20-24 18.7 258 256 25-29 15.0 207 205 30-34 13.3 183 185 35-39 13.3 184 181 40-44 10.7 147 148 45-49 10.7 148 147 Marital/Union status   Currently married/in union 71.1 981 982 widowed 2.7 38 37 Divorced 1.7 24 24 Separated 5.6 78 78 Never married/in union 18.8 259 259 Motherhood status   Ever gave birth 72.7 1,003 1,000 Never gave birth 27.3 377 380 Births in last two years   Had a birth in last two years 19.0 263 267 Had no birth in last two years 81.0 1,117 1,113 Education   No formal education 27.8 383 394 Primary 57.6 796 791 Secondary 13.9 191 186 Higher 0.7 10 9 wealth index quintile   Poorest 17.4 240 246 Second 18.4 254 263 Middle 20.5 283 275 Fourth 19.8 273 264 Richest 23.9 329 332 wealth index   Poorest 60 per cent 56.3 777 784 Richest 40 per cent 43.7 603 596 Language of household head   Romani 56.3 777 810 Other 43.5 601 567 Missing/DK 0.2 3 3 Total 100.0 1,380 1,380 16 Nearly 80 per cent of household heads in the overall population of BiH were men. The 2007 BiH Household Budget Survey: Final Results, BHAS, FOS and RSISS, Banja luka/Sarajevo, 2008, indicates that 80 per cent of household heads in BiH were men (page 21). The overall dependency rate, namely the ratio of the inactive population (aged 0-14 and 65+) to the active population (aged 15-64), expressed as a percentage was 52 per cent, meaning that there were 52 inactive persons for each 100 active ones. Tables HH.3 to HH.5 provide basic information on the households, the female and male respondents aged 15-49 and children under-5, by presenting both the unweighted and weighted figures. Information on the basic characteristics of the households, women, men and children under-5 interviewed during the survey is essential for an interpretation of the findings presented later in the report. This information can also provide an indication of the representativeness of the survey. The remaining tables in this report are presented with only weighted numbers (see Appendix A for more details about the weighting). Table HH.3 provides basic background information on the households. The sex of the household head, administrative unit, number of household members and the education and mother tongue of the household head are shown in the table. These background characteristics are used in subsequent tables in this report; the figures in the table are also intended to show the number of observations by major categories of analysis contained in the report. Table HH.3: Household composition Per cent and frequency distribution of households by selected characteristics, BiH Roma Survey 2011–2012     weighted per cent Number of households weighted Unweighted Sex of household head   Male 66.9 1,032 1,029 Female 33.1 512 515 Administrative unit   FBiH 77.7 1,200 1,147 RS 17.6 271 327 BD 4.7 73 70 Number of household members   1 11.4 175 177 2 18.3 282 281 3 18.5 286 289 4 20.2 312 301 5 13.9 214 216 6 8.4 130 132 7 4.7 73 75 8 2.1 33 34 9 1.2 19 20 10+ 1.2 19 19 Education of household head   No formal education 26.5 409 420 Primary 59.4 917 906 Secondary 13.8 213 213 Higher 0.3 5 5 Language of household head   Romani 57.7 891 917 Other 42.2 652 626 Missing/DK 0.1 1 1 Total 100.0 1,544 1,544     Households with at least   One child aged 0-4 years 35.0 1,544 1,544 One child aged 0-17 years 68.2 1,544 1,544 One woman aged 15-49 years 74.9 1,544 1,544 One man aged 15-49 years 75.8 1,544 1,544     Mean household size 3.8 1,544 1,544 The weighted and unweighted numbers of households were equal, since the sample weights were normalised (see Appendix A). The table also shows the proportions of households with at least one child under 18, at least one child under 5, at least one woman aged 15-49 and at least one man aged 15-49. The table also shows the weighted average household size as estimated by the survey. 12 MUlTIPlE INDICATOR ClUSTER SURVEy 2011–2012 MONITORING THE SITUATION OF CHIlDREN AND wOMEN 13 Table HH.4M: Men’s background characteristics Per cent and frequency distribution of men aged 15-49 years by selected background characteristics, BiH Roma Survey 2011–2012     weighted per cent Number of men weighted Unweighted Administrative unit       FBiH 79.0 1,151 1,126 RS 16.5 241 266 BD 4.4 64 64 Age (years)   15-19 20.5 299 301 20-24 19.7 286 283 25-29 15.1 220 222 30-34 11.7 170 171 35-39 11.3 164 168 40-44 11.8 172 171 45-49 9.9 145 140 Marital/Union status   Currently married/in union 61.9 901 906 widowed 0.4 5 6 Divorced 1.5 21 21 Separated 3.9 57 58 Never married/in union 32.3 471 464 Missing 0.1 1 1 Education   No formal education 15.4 225 236 Primary 62.6 911 914 Secondary 21.9 318 304 Higher 0.1 2 2 wealth index quintile   Poorest 17.0 248 254 Second 18.1 264 266 Middle 21.9 319 316 Fourth 21.6 314 307 Richest 21.4 312 313 wealth index   Poorest 60 per cent 57.0 830 836 Richest 40 per cent 43.0 626 620 Language of household head   Romani 57.4 836 866 Other 42.4 618 588 Missing/DK 0.1 2 2 Total 100.0 1,456 1,456 Some background characteristics of children under 5 are presented in Table HH.5. These include the distribution of children by several background characteristics: administrative unit, sex, age, mother’s or caretaker’s education, wealth (wealth index quintiles), wealth by the poorest 60 per cent and richest 40 per cent of the population and the mother tongue of the household head. Most mothers of children under-5 had primary education (57 per cent), 10 per cent of mothers had secondary or higher education, while 33 per cent of mothers had no formal education. Slightly more than two-thirds of children (69 per cent) were in the three poorest quintiles of the population. Table HH.4 provides the background characteristics for female respondents aged 15-49 years. The table includes information on the distribution of women according to administrative unit, age, marital status, motherhood status, births in last two years, education,17 wealth (wealth index quintiles),18 wealth index (by the poorest 60 per cent and richest 40 per cent of the household population) and the mother tongue of the household head. The age distribution of female respondents shows general trend of decline with age; with percentages declining from 18 per cent for women aged 15-19 to 11 per cent for women aged 45-49. The highest proportion of women had primary education (58 per cent), while 28 per cent had no formal education. Nearly 81 per cent of women were currently married or living in union or had been married or lived in union. Similarly, Table HH.4M provides background characteristics for male respondents aged 15-49 years. The table provides information on the distribution of men according to administrative unit, age, marital status, education, wealth (wealth index quintiles), wealth by the poorest 60 per cent and richest 40 per cent of the population, and the mother tongue of the household head. As with women, the age distribution of male respondents also shows a general trend of decline with age; with a relatively even distribution amongst men aged 30-44 . A higher proportion of men compared to women had primary education (63 per cent men and 58 per cent women) and secondary or higher education (22 per cent men and 15 per cent women), while a lower proportion of men (15 per cent) compared to women (28 per cent) had no formal education. Around two-thirds of male respondents were married or lived in union or had been married or lived in union (68 per cent). 17 Unless otherwise stated, throughout this report ‘education’ refers to the education level attended by the respondent when it is used as a background variable. 18 Principal components analysis was performed using information on the ownership of consumer goods (assets), dwelling characteristics, water and sanitation, and other characteristics related to the household’s wealth in order 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 were living in and was finally divided into 5 equal parts (quintiles) from lowest (poorest) to highest (richest). The assets used in these calculations are listed below. · Source of drinking water · Type of sanitation facility · Number of rooms used for sleeping · Materials of the dwelling floor, roof and exterior walls · Type of fuel used for cooking · Presence in the household of electricity, radio, television, mobile and or non-mobile phone, refrigerator, bed, stove, personal computer/ laptop, Internet connection, air-conditioner, digital camera, washing machine, tumble dryer, dishwasher, vacuum cleaner, DVD player, Jacuzzi and video surveillance system · Presence in the household of a watch, bicycle, motorcycle/scooter, animal-drawn cart, car/truck, tractor · Possession of a bank account The wealth index is assumed to capture the underlying long-term wealth through information on household assets and is intended to produce a ranking of households by wealth from the poorest to the richest. The wealth index does not provide information on absolute poverty, current income or expenditure levels. The wealth scores calculated are applicable only to the particular data set on which they are based. Further information on the construction of the wealth index can be found in Filmer, D. and Pritchett, L., 2001. ‘Estimating wealth effects without expenditure data – or tears: An application to educational enrolments in states of India’. Demography 38(1): 115-132. Gwatkin, D.R., Rutstein, S., Johnson, K., Pande, R. and Wagstaff. A., 2000. Socio-Economic Differences in Health, Nutrition and Population. HNP/Poverty Thematic Group, Washington, DC: World Bank. Rutstein, S.O. and Johnson, K., 2004. The DHS Wealth Index. DHS Comparative Reports No. 6. Calverton, Maryland: ORC Macro. 14 MUlTIPlE INDICATOR ClUSTER SURVEy 2011–2012 MONITORING THE SITUATION OF CHIlDREN AND wOMEN 15 Table HH.5: Under-5’s background characteristics Per cent and frequency distribution of children under five years of age by selected characteristics, BiH Roma Survey 2011–2012     weighted per cent Number of under-5 children weighted Unweighted Sex       Male 52.4 392 396 Female 47.6 356 352 Administrative unit   FBiH 76.1 570 540 RS 16.4 123 154 BD 7.5 56 54 Age (months)   0-5 9.9 74 74 6-11 9.4 70 71 11-23 19.7 147 148 24-35 20.2 151 150 36-47 22.7 170 172 48-59 18.2 136 133 Mother’s education*   No formal education 33.0 247 257 Primary 57.1 427 421 Secondary 9.9 74 70 wealth index quintile   Poorest 28.9 216 222 Second 24.2 181 185 Middle 16.3 122 117 Fourth 17.0 127 122 Richest 13.6 102 102 wealth index   Poorest 60 per cent 69.4 519 524 Richest 40 per cent 30.6 229 224 Language of household head   Romani 60.6 454 469 Other 39.2 293 278 Missing/DK 0.1 1 1 Total 100.0 748 748 * Mother’s education refers to the educational attainment of mothers and caretakers of children under 5. Children’s Living Arrangements Children without parental care are a vulnerable group and monitoring their living conditions enables a community to better address their needs. Table HH.6 presents information on the living arrangements of children under age 18. According to the data, over three quarters of Roma children aged 0-17 lived with both parents (78 per cent). There were 13 per cent of children living with only one parent, while 4 per cent of Roma children lived with neither of their parents. The percentage of children living with neither parent was higher in the 15-17 age group (14 per cent) compared to the 0-4 age group (1 per cent). In addition, a slightly higher percentage of children who had lost one or both parents was found amongst older children than amongst younger (8 per cent of older and 2 per cent of younger children). Table HH.6 also shows that the percentage of children living with both parents was highest in the richest wealth quintile (86 per cent). Eight per cent of children in the poorest households compared to 3 per cent in the richest wealth quintile lived with only their mother while their father was alive. Ta bl e H H .6 : C hi ld re n’ s liv in g ar ra ng em en ts a nd o rp ha nh oo d Pe r c en t d is tr ib ut io n of c hi ld re n ag ed 0 -1 7 ye ar s a cc or di ng to li vi ng a rr an ge m en ts , p er ce nt ag e of c hi ld re n ag ed 0 -1 7 ye ar s i n ho us eh ol ds n ot li vi ng w ith a b io lo gi ca l p ar en t a nd p er ce nt ag e of c hi ld re n w ho h av e on e or b ot h pa re nt s de ad , B iH R om a Su rv ey 2 01 1– 20 12 li vi ng w ith b ot h pa re nt s Li vi ng w it h ne it he r p ar en t Li vi ng w it h m ot he r o nl y Li vi ng w it h fa th er o nl y Im po ss ib le to de te rm in e To ta l N ot li vi ng w ith a bi ol og ic al pa re nt 1 O ne or b ot h pa re nt s de ad 2 N um be r of c hi ld re n ag ed 0- 17 y ea rs O nl y fa th er al iv e O nl y m ot he r al iv e Bo th al iv e Bo th de ad Fa th er al iv e Fa th er de ad M ot he r al iv e M ot he r de ad Se x   M al e 79 .7 0. 2 0. 6 1. 9 0. 1 5. 8 3. 0 2. 9 0. 7 5. 2 10 0. 0 2. 8 4. 6 1, 30 1 Fe m al e 75 .6 0. 0 0. 4 3. 9 0. 0 7. 4 3. 2 2. 8 0. 4 6. 4 10 0. 0 4. 3 3. 9 1, 22 0 A dm in is tr at iv e un it   FB iH 77 .4 0. 1 0. 5 3. 1 0. 1 7. 0 2. 5 2. 9 0. 3 6. 1 10 0. 0 3. 8 3. 5 1, 93 7 RS 77 .8 0. 0 0. 7 2. 0 0. 0 4. 7 5. 0 3. 5 1. 6 4. 8 10 0. 0 2. 7 7. 3 44 7 BD 81 .7 0. 0 0. 0 3. 1 0. 0 5. 3 5. 3 0. 8 0. 0 3. 8 10 0. 0 3. 1 5. 3 13 7 A ge (y ea rs )   0- 4 84 .9 0. 0 0. 0 0. 7 0. 0 8. 9 1. 3 1. 5 0. 1 2. 5 10 0. 0 0. 7 1. 5 75 4 5- 9 80 .5 0. 0 0. 0 1. 4 0. 0 6. 8 3. 2 4. 2 0. 4 3. 4 10 0. 0 1. 4 3. 7 68 0 10 -1 4 79 .3 0. 2 0. 7 1. 8 0. 1 5. 3 3. 9 3. 9 0. 9 3. 8 10 0. 0 2. 9 5. 9 70 4 15 -1 7 55 .8 0. 3 1. 9 11 .7 0. 2 3. 8 4. 7 1. 0 0. 8 19 .8 10 0. 0 14 .1 7. 9 38 4 w ea lt h in de x qu in ti le   Po or es t 73 .0 0. 0 0. 7 2. 9 0. 2 7. 8 4. 6 4. 2 0. 7 6. 1 10 0. 0 3. 7 6. 1 61 3 Se co nd 79 .2 0. 4 0. 0 2. 7 0. 0 9. 8 1. 3 1. 1 0. 3 5. 1 10 0. 0 3. 2 2. 0 53 0 M id dl e 79 .1 0. 0 0. 8 3. 5 0. 0 4. 9 4. 9 2. 1 0. 0 4. 8 10 0. 0 4. 2 5. 6 49 5 Fo ur th 73 .3 0. 0 0. 6 2. 0 0. 2 6. 1 2. 2 4. 6 1. 0 10 .0 10 0. 0 2. 8 4. 0 47 5 Ri ch es t 86 .4 0. 0 0. 4 3. 4 0. 0 2. 8 2. 1 1. 9 0. 6 2. 3 10 0. 0 3. 9 3. 2 40 9 w ea lt h in de x   Po or es t 6 0 pe r c en t 76 .8 0. 1 0. 5 3. 0 0. 1 7. 6 3. 6 2. 6 0. 4 5. 4 10 0. 0 3. 7 4. 6 1, 63 8 Ri ch es t 4 0 pe r c en t 79 .3 0. 0 0. 5 2. 7 0. 1 4. 6 2. 2 3. 4 0. 8 6. 4 10 0. 0 3. 3 3. 6 88 3 La ng ua ge o f h ou se ho ld h ea d*   Ro m an i 78 .6 0. 0 0. 4 3. 4 0. 1 4. 8 3. 1 2. 9 0. 5 6. 2 10 0. 0 3. 8 4. 1 1, 48 2 O th er 76 .4 0. 2 0. 7 2. 2 0. 1 9. 0 3. 1 2. 8 0. 5 5. 1 10 0. 0 3. 1 4. 6 1, 03 3 To ta l 77 .7 0. 1 0. 5 2. 9 0. 1 6. 5 3. 1 2. 9 0. 5 5. 8 10 0. 0 3. 5 4. 3 2, 52 1 1 M IC S in di ca to r 9 .1 7 2 M IC S in di ca to r 9 .1 8 * M is si ng c as es fo r t he b ac kg ro un d ch ar ac te ris tic “l an gu ag e of h ou se ho ld h ea d” a re n ot s ho w n in th e ta bl e. 16 MUlTIPlE INDICATOR ClUSTER SURVEy 2011–2012 MONITORING THE SITUATION OF CHIlDREN AND wOMEN 17 V Nutrition Nutritional Status Children’s nutritional status is a reflection of their overall health. When children have access to an adequate food supply, are not exposed to repeated illness and are well cared for they can reach their growth potential and are considered well nourished. A Millennium Development Goals target is to reduce by half between 1990 and 2015 the proportion of people who suffer from hunger; this will also assist in the goal to reduce child mortality. Malnutrition is associated with more than half of all child deaths worldwide. Three-quarters of children who die from causes related to malnutrition are only mildly or moderately malnourished and show no outward signs of their vulnerability. In addition, undernourished children are more likely to die from common childhood ailments and more frequently have faltering growth. In a well-nourished population there is a reference distribution of height and weight for children under age five. The reference population used in the 2011–2012 MICS survey on Roma in BiH is based on the WHO growth standards.21 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 of linear growth. Children whose height-for-age is more than two standard deviations below the median of the reference population are considered moderately or severely stunted. Children whose height- for-age is more than three standard deviations below the median are classified as severely stunted. Stunting is a reflection of chronic malnutrition as a result of failure to receive adequate nutrition over a long period and recurrent or chronic illness. 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 i.e., they are falling behind in developing their body weight relative to their height. Children whose weight-for-height is more than three standard deviations below the median are classified as severely wasted i.e., they are severely falling behind in developing their body weight relative to their height. Wasting is usually the result of a recent nutritional deficiency. The indicator may exhibit significant seasonal shifts associated with changes in the availability of food or disease prevalence. In this survey weights and heights 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. It is a known fact that a large amount of missing data may result in biased findings. The extent of anthropometric data and data on a child’s age is of particular importance for the quality of survey. Thus, children whose measures are outside a plausible range and children whose full birth date (month and year) were not obtained have been excluded from Table NU.1. Children were excluded from one or more of the anthropometric indicators if their weight and height had not been measured, whichever was applicable. For example, if a child had been weighed but his or her height had not been measured then the child was included in underweight calculations but not in the calculations for stunting and wasting. Percentages of children by age and reasons for exclusion are shown in the data quality tables DQ.6 and DQ.7. For example, amongst children under five 3 per cent had not had their weight as well as weight and height measured while 6 per cent of children had not had their height measured. Due to incomplete dates of birth, implausible measurements and missing weight and or height 4 per cent of children were excluded from calculations for the weight-for-age indicator; the figures were 8 per cent for both the height-for-age indicator and weight-for-height indicator. 21 http://www.who.int/childgrowth/standards/second_set/technical_report_2.pdf IV Child Mortality One of the overarching goals of the Millennium Development Goals (MDGs) is the reduction in under-five mortality by two-thirds between 1990 and 2015; monitoring progress towards this goal is an important but difficult objective. Measuring childhood mortality is extremely important for achieving this goal but is a difficult task. Using specific measures, such as asking direct questions about deaths in the last year, to measure child mortality from birth histories gives inaccurate results. Alternatively, indirect methods developed to measure child mortality produce robust estimates that are comparable with those obtained from other sources. Indirect methods minimise the pitfalls of memory lapses, inexact or misinterpreted definitions and poor interviewing techniques. The infant mortality rate is the probability of dying before the first birthday, while the under-five mortality rate is the probability of dying before the fifth birthday. In the MICS survey infant and under-five mortality rates were calculated based on an indirect estimation technique known as the Brass Method.19 The data used in the estimation is the mean number of children ever born for the five year age groups of women, from age 15 to 49, and the proportion of these children who are dead (see Table CM.1). The technique converts the proportion of dead children for the 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 and assuming a particular model age pattern for mortality. Due to a lack of mortality data on Roma children in BiH the East model life table was selected as being most appropriate, based on previous information on the mortality of Roma in neighbouring countries.20 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, BiH Roma Survey 2011-2012     Children ever born Children surviving Proportion dead Number of womenMean Total Mean Total Age   15-19 0.350 88 0.345 87 0.014 253 20-24 1.283 331 1.262 325 0.016 258 25-29 2.137 443 2.076 431 0.029 207 30-34 3.104 568 3.026 554 0.025 183 35-39 3.538 650 3.416 628 0.034 184 40-44 3.211 473 3.082 454 0.040 147 45-49 3.609 535 3.486 517 0.034 148 Total 2.238 3,088 2.171 2,995 0.030 1,380 Table CM.2 provides estimates of child mortality. These estimates have been calculated by averaging mortality estimates obtained from women age 25-29 and 30-34 years, and refer to the year 2005. The infant mortality rate is estimated at 24 per thousand live births, while the probability of dying under age 5 (U5MR) is around 27 per thousand live births. Table CM.2: Child mortality Infant and under-five mortality rates, East Model, BiH Roma Survey 2011-2012   Infant mortality rate1 Under-five mortality rate2 Sex   Male (29) (33) Female (18) (20) Total 24 27 1 MICS indicator 1.2; MDG indicator 4.2 2 MICS indicator 1.1; MDG indicator 4.1 * Rates refer to 2005, the East Model was assumed to approximate the age pattern of mortality in BiH. ( ) Figures that are based on 250-499 unweighted exposed children 19 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. 20 Based on MICS data for Serbia and the Former yugoslav Republic of Macedonia. 18 MUlTIPlE INDICATOR ClUSTER SURVEy 2011–2012 MONITORING THE SITUATION OF CHIlDREN AND wOMEN 19 Table NU.1 shows the percentages for children under age 5 in relation to the three anthropometric indicators – weight- for-age, height-for-age and weight-for-height – based on anthropometric measurements taken during the fieldwork. The results show that 9 per cent of children under age five were underweight, while 2 per cent were classified as severely underweight. Around one-fifth of the children of that age (21 per cent) were too short for their age (stunted), of which 8 per cent were severely stunted. The highest percentage of stunted children (27 per cent) was found in households in the poorest wealth quintile. The survey also found that 8 per cent of children were wasted, including 4 per cent severely wasted (8 per cent of children in the FBiH and 6 per cent in RS are wasted). Furthermore, the survey data indicates that 8 per cent of children were overweight. The highest percentage of underweight (21 per cent) and wasted children (22 per cent) was found amongst children aged 6-11 months, while the highest percentage of stunted children (26 per cent) was amongst children aged 36-47 months (see Figure NU.1). Children aged 48-59 months included the highest percentage of overweight children. Table NU.1 shows that the highest percentage of stunted children (27 per cent) was found in households in the poorest wealth quintile. Figure NU.1: Percentage of children under age 5 who are underweight, stunted, wasted or overwight, BiH Roma Survey 2011–2012 Ta bl e N U .1 : N ut ri ti on al s ta tu s of c hi ld re n Pe rc en ta ge o f c hi ld re n un de r a ge 5 b y nu tr iti on al s ta tu s ac co rd in g to th re e an th ro po m et ric in di ce s: w ei gh t- fo r- ag e, h ei gh t- fo r- ag e a nd w ei gh t- fo r- he ig ht , B iH R om a Su rv ey 2 01 1– 20 12   w ei gh t f or a ge N um be r of c hi ld re n un de r a ge 5 H ei gh t f or a ge N um be r of c hi ld re n un de r ag e 5 w ei gh t f or h ei gh t N um be r of c hi ld re n un de r a ge 5 U nd er w ei gh t M ea n Z- Sc or e (S D ) St un te d M ea n Z- Sc or e (S D ) w as te d O ve rw ei gh t M ea n Z- Sc or e (S D ) pe r c en t b el ow pe r c en t b el ow pe r c en t b el ow pe r c en t ab ov e - 2 S D 1 - 3 S D 2 - 2 S D 3 - 3 S D 4 - 2 S D 5 - 3 S D 6 + 2 SD Se x   M al e 8. 8 2. 0 -0 .3 37 8 21 .8 8. 6 -0 .7 36 4 8. 4 4. 1 8. 8 0. 1 35 6 Fe m al e 8. 8 2. 8 -0 .4 34 1 20 .2 7. 3 -0 .6 32 5 8. 3 2. 8 6. 8 0. 0 32 6 A dm in is tr at iv e un it   FB iH 8. 8 2. 6 -0 .4 54 7 22 .9 9. 6 -0 .8 52 1 8. 1 3. 1 7. 0 0. 0 51 5 RS 6. 8 2. 6 0. 1 11 7 14 .3 2. 7 -0 .2 11 5 6. 0 3. 0 10 .6 0. 2 11 6 BD 13 .5 0. 0 -0 .2 54 17 .6 3. 9 0. 1 53 (1 6. 3) (8 .2 ) (1 0. 2) (-0 .2 ) 51 A ge (m on th s)   0- 5 7. 6 4. 3 0. 0 73 9. 0 2. 6 0. 4 69 13 .9 9. 5 8. 4 -0 .5 68 6- 11 21 .4 8. 7 -0 .7 66 18 .8 15 .1 -0 .3 59 22 .0 15 .4 7. 4 -0 .6 59 12 -2 3 12 .4 3. 4 -0 .4 13 9 24 .6 11 .2 -0 .7 13 0 12 .1 2. 1 6. 2 0. 0 13 0 24 -3 5 6. 0 1. 4 -0 .3 15 1 22 .6 9. 8 -0 .8 14 7 7. 8 3. 7 5. 5 0. 2 14 6 36 -4 7 4. 3 0. 9 -0 .3 16 2 25 .9 8. 6 -0 .9 15 6 2. 7 0. 0 8. 9 0. 4 15 7 48 -5 9 8. 0 0. 0 -0 .3 12 7 17 .3 1. 5 -0 .7 12 8 2. 4 0. 0 11 .1 0. 3 12 2 M ot he r’s e du ca ti on   N o fo rm al e du ca tio n 9. 7 3. 1 -0 .3 23 3 18 .0 7. 5 -0 .6 22 9 8. 1 2. 9 7. 4 0. 0 22 2 Pr im ar y 9. 1 2. 2 -0 .4 41 7 23 .3 9. 2 -0 .7 39 5 9. 1 3. 9 7. 8 0. 1 39 5 Se co nd ar y+ 4. 0 1. 3 0. 0 68 18 .2 2. 2 -0 .4 65 4. 6 2. 7 10 .1 0. 2 65 w ea lt h in de x qu in ti le   Po or es t 10 .6 2. 7 -0 .5 20 5 26 .9 11 .8 -1 .0 19 6 9. 1 3. 0 6. 9 0. 1 19 8 Se co nd 11 .9 4. 7 -0 .6 17 7 24 .2 6. 0 -0 .8 17 1 11 .9 4. 5 4. 6 -0 .2 17 0 M id dl e 5. 9 0. 8 -0 .2 11 8 19 .9 8. 6 -0 .6 11 3 4. 3 0. 9 12 .3 0. 3 11 0 Fo ur th 5. 2 0. 8 -0 .1 12 4 10 .7 3. 9 -0 .2 11 9 5. 7 3. 3 5. 6 0. 2 11 6 Ri ch es t 7. 5 1. 3 0. 1 94 17 .4 8. 1 0. 0 90 8. 4 6. 1 13 .6 0. 1 88 w ea lt h in de x   Po or es t 6 0 pe r c en t 9. 9 3. 0 -0 .5 50 0 24 .3 9. 0 -0 .8 48 0 9. 0 3. 0 7. 4 0. 0 47 8 Ri ch es t 4 0 pe r c en t 6. 2 1. 0 0. 0 21 8 13 .6 5. 7 -0 .1 20 9 6. 8 4. 5 9. 1 0. 2 20 4 La ng ua ge o f h ou se ho ld h ea d *  Ro m an i 10 .6 3. 7 -0 .3 43 5 20 .1 8. 2 -0 .4 41 8 12 .3 5. 0 8. 6 -0 .1 40 6 O th er 6. 1 0. 4 -0 .3 28 3 22 .3 7. 6 -0 .9 27 0 2. 5 1. 3 6. 8 0. 3 27 4 To ta l 8. 8 2. 4 -0 .3 71 8 21 .1 8. 0 -0 .6 68 9 8. 3 3. 5  7 .9 0. 1 68 2 1 M IC S in di ca to r 2 .1 a an d M D G in di ca to r 1 .8 2 M IC S in di ca to r 2 .1 b 3 M IC S in di ca to r 2 .2 a 4 M IC S in di ca to r 2 .2 b 5 M IC S in di ca to r 2 .3 a 6 M IC S in di ca to r 2 .3 b ( ) F ig ur es th at a re b as ed o n 25 –4 9 un w ei gh te d ca se s * M is si ng c as es fo r t he b ac kg ro un d ch ar ac te ris tic “l an gu ag e of h ou se ho ld h ea d” a re n ot s ho w n in th e ta bl e. 0 5 10 15 20 25 30 0 6 12 18 24 30 36 42 48 54 60 Per cent Age (months) Underweight Stunted wasted Overweight 20 MUlTIPlE INDICATOR ClUSTER SURVEy 2011–2012 MONITORING THE SITUATION OF CHIlDREN AND wOMEN 21 Table NU.2: Initial breastfeeding Percentage of last-born children in the 2 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, BiH Roma Survey 2011–2012     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 Administrative unit   FBiH 94.7 51.1 83.2 16.1 207 RS 94.6 47.3 85.3 9.3 41 BD (*) (*) (*) (*) 15 Months since last birth   0-11 months 95.8 49.6 85.8 14.3 134 12-23 months 93.9 51.1 83.4 15.1 125 Assistance at delivery   Skilled attendant 95.9 50.9 85.3 14.7 259 Missing/DK (*) (*) (*) (*) 3 Place of delivery Public sector health facility 95.9 50.8 85.3 14.6 260 Missing/DK (*) (*) (*) (*) 3 Mother’s education   No formal education 94.4 50.8 90.5 6.6 89 Primary 95.1 49.0 81.2 20.5 148 Secondary+ (96.4) (55.5) (82.0) (7.5) 26 wealth index quintile   Poorest 94.0 49.1 85.2 9.4 74 Second 95.9 52.7 87.0 18.4 69 Middle (97.6) (42.1) (86.6) (16.2) 38 Fourth (92.4) (54.6) (85.1) (17.5) 43 Richest (95.4) (51.4) (75.9) (12.3) 39 wealth index   Poorest 60 per cent 95.5 49.0 86.2 14.2 181 Richest 40 per cent 93.8 53.1 80.7 15.0 82 Language of household head   Romani 94.9 47.5 87.7 9.5 159 Other 95.0 54.5 79.5 22.1 104 Total 95.0 50.3 84.5 14.5 263 1 MICS indicator 2.4 2 MICS indicator 2.5 ( ) Figures that are based on 25–49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Breastfeeding and Infant and Young Child Feeding Breastfeeding in the first few years of life protects children from infection, provides an ideal source of nutrients and is economical and safe. However, many mothers stop breastfeeding too soon and there are often pressures to switch to artificial feeding (infant formula). This can contribute to growth faltering and micronutrient malnutrition and is unsafe if clean water is not readily available. WHO/UNICEF have the feeding recommendations below. z Exclusive breastfeeding for the first six months. z Continued breastfeeding for two years or more. z Safe and age-appropriate complementary foods beginning at 6 months. z Frequency of complementary feeding: 2 times per day for infants aged 6-8 months and 3 times per day for those aged 9-11 months. z It is also recommended that breastfeeding be initiated within one hour of birth. The indicators related to recommended child feeding practices are shown below. z Early initiation of breastfeeding (within one hour of birth) z Exclusive breastfeeding rate (< 6 months) z Predominant breastfeeding (< 6 months) z Continued breastfeeding rate (at 1 year and at 2 years) z Duration of breastfeeding (exclusive, predominant and any breastfeeding) z Age-appropriate breastfeeding (0-23 months) z Introduction of solid, semi-solid and soft foods (6-8 months) z Minimum meal frequency (6-23 months) z Milk feeding frequency for non-breastfeeding children (6-23 months) z Bottle feeding (0-23 months) Table NU.2 shows the proportion of children born in the two years prior to the survey who were ever breastfed, those who were first breastfed within one hour and one day of birth and those who received a prelacteal feed. The survey findings show that 95 per cent of Roma children were ever breastfed. Although a very important step in the management of lactation and the establishment of a physical and emotional relationship between the baby and the mother, only one half of babies (50 per cent) were breastfed for the first time within one hour of birth, while 85 per cent of newborns started breastfeeding within one day of birth (see Figure NU.2). The percentage of children who received a prelacteal feed was 15 per cent. A prelacteal feed was received by 7 per cent of children whose mother has no formal education and by 21 per cent of children whose mother has primary education. 22 MUlTIPlE INDICATOR ClUSTER SURVEy 2011–2012 MONITORING THE SITUATION OF CHIlDREN AND wOMEN 23 Figure NU.2: Percentage of mothers who started breastfeeding within one hour and within one day of birth, BiH Roma Survey 2011–2012 * Figures for the education category ‘Secondary+’ are based on 25-49 unweighted cases and should be treated with caution. ‘Exclusively breastfed’ refers to infants who received only breast milk (and vitamins, mineral supplements or medicine as needed). ‘Predominantly breastfed’ refers to infants who received breast milk and certain other liquids (water, water-based drinks, fruit juice, oral rehydration solutions, drops, vitamins, minerals and medications) but who did not receive anything else, in particular any other milk, food-based liquids or semi-solid and solid foods. Table NU.3 shows the exclusive breastfeeding of infants during the first six months of life and the complementary feeding of children aged 6-9 months as well as continued breastfeeding of children at 12-15 and 20-23 months. The data is based on the reports of mothers/caretakers on their children’s consumption of foods and fluids during the previous day or night prior to the interview. Slightly more than one-fifth of Roma children (22 per cent) aged less than six months were exclusively breastfed, which is a low level of exclusive breastfeeding compared to the WHO/UNICEF recommended level. By age 12-15 months one half of children were still being breastfeed (50 per cent) and by age 20-23 months a little more than two-thirds of children (69 per cent) were still being breastfed. Table NU.3: Breastfeeding Percentage of living children according to breastfeeding status in selected age groups, BiH Roma Survey 2011–2012     Children aged 0-5 months Children aged 12-15 months Children aged 20-23 months Per cent exclusively breastfed1 Per cent predominantly breastfed2 Number of children Per cent breastfed (Continued breastfeeding at 1 year)3 Number of children Per cent breastfed (Continued breastfeeding at 2 years)4 Number of children Sex   Male (20.2) (63.2) 35 (41.5) 27 (68.1) 32 Female (24.3) (64.8) 38 (*) 21 (*) 20 Administrative unit   FBiH 21.3 57.1 55 (42.3) 35 (63.9) 40 RS (*) (*) 12 (*) 11 (*) 9 BD (*) (*) 6 (*) 2 (*) 3 Mother’s education   No formal education (20.6) (73.0) 27 (*) 13 (*) 20 Primary (21.6) (66.0) 36 (50.5) 29 (63.9) 26 Secondary+ (*) (*) 11 (*) 6 (*) 5 wealth index   Poorest 60 per cent 21.9 59.8 51 (49.6) 32 (74.5) 33 Richest 40 per cent (*) (*) 22 (*) 17 (*) 18 Language of household head   Romani (25.2) (79.7) 44 (63.2) 28 (74.7) 36 Other (18.2) (41.3) 30 (*) 20 (*) 16 Total 22.3 64.0 74 50.1 48 68.8 52 1 MICS indicator 2.6 2 MICS indicator 2.9 3 MICS indicator 2.7 4 MICS indicator 2.8 ( ) Figures that are based on 25–49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Table NU.4 shows the median duration of breastfeeding amongst children at 0-35 months. Amongst children of this age the mean duration of any breastfeeding was 20.9 months (the median duration was 20.0 months for boys and 23.7 months for girls). The mean duration of exclusive breastfeeding was 1.8 months, while the mean duration of predominant breastfeeding was 8.3 months. The median duration of any breastfeeding expressed in months was longer in RS (25.6) than in the FBiH (18.3). Amongst children in households where the mother tongue of the household head was Romani the median duration of any breastfeeding (27.5) and predominant breastfeeding (6.4) in months was longer compared to children in households where the household head spoke another mother tongue (17.2 months for any breastfeeding and 1.9 months for predominant breastfeeding). 83 85 91 81 82 51 47 51 49 56 50 0 10 20 30 40 50 60 70 80 90 100 FBiH RS Primary Secondary+ BiH Per cent within one day within one hour 85 No formal education 24 MUlTIPlE INDICATOR ClUSTER SURVEy 2011–2012 MONITORING THE SITUATION OF CHIlDREN AND wOMEN 25 Table NU.5: Age-appropriate breastfeeding Percentage of children aged 0-23 months who were appropriately breastfed during the previous day, BiH Roma Survey 2011–2012   Children aged 0-5 months Children aged 6-23 months Children aged 0-23 months Per cent exclusively breastfed1 Number of children Per cent currently breastfeeding and receiving solid, semi- solid or soft foods Number of children Per cent appropriately breastfed2 Number of children Sex   Male (20.2) 35 47.2 125 41.2 160 Female (24.3) 38 43.9 93 38.2 131 Administrative unit   FBiH 21.3 55 47.8 172 41.4 227 RS (*) 12 (36.7) 37 35.0 49 BD (*) 6 (*) 9 (*) 16 Mother’s education   No formal education (20.6) 27 50.1 69 41.8 95 Primary (21.6) 36 45.5 128 40.3 164 Secondary+ (*) 11 (*) 21 (31.8) 32 wealth index quintile   Poorest (*) 18 45.6 66 42.2 84 Second (*) 16 49.4 57 42.2 73 Middle (*) 17 (38.4) 27 (30.9) 45 Fourth (*) 11 (41.8) 39 (37.2) 50 Richest (*) 12 (51.3) 29 (44.0) 40 wealth index   Poorest 60 per cent 21.9 51 45.7 151 39.7 202 Richest 40 per cent (*) 22 45.8 67 40.2 90 Language of household head   Romani (25.2) 44 44.3 136 39.7 180 Other (18.2) 30 48.1 82 40.1 112 Total 22.3 74 45.8 218 39.8 292 1 MICS indicator 2.6 2 MICS indicator 2.14 ( ) Figures that are based on 25–49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Appropriate complementary feeding of children from 6 months to two years of age is particularly important for growth and development and the prevention of undernutrition. Continued breastfeeding beyond six months should be accompanied by consumption of nutritionally adequate, safe and appropriate complementary foods that help meet nutritional requirements when breastmilk is no longer sufficient. This requires that for breastfed children, two or more meals of solid, semi-solid or soft foods are needed if they are six to eight months old, and three or more meals if they are 9-23 months of age. For children 6-23 months and older who are not breastfed, four or more meals of solid, semi-solid or soft foods or milk feeds are needed. Overall, 67 per cent of infants aged 6-8 received solid, semi-solid, or soft foods (MICS indicator 2.12; the figure is based on 25-49 unweighted cases and should be treated with caution).22 Table NU.6 presents the proportion of children aged 6-23 months who received solid, semi-solid or soft foods the minimum recommended number of times or more during the day or night preceding the interview. The survey findings show that under two-thirds of children aged 6-23 months (60 per cent) were receiving complementary foods the minimum recommended number of times. Amongst those children of this age currently breastfeeding less than one half of them were receiving complementary foods the minimum recommended number of times (46 per cent). 22 The table on introduction of solid, semi-solid or soft foods is not presented in the report since percentages for appropriate complementary feeding disaggregated by sex and area were based on fewer than 25 unweighted cases. Table NU.4: Duration of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding and predominant breastfeeding amongst children aged 0-35 months, BiH Roma Survey 2011–2012   Median duration (in months) of: Number of children aged 0-35 monthsAny breastfeeding1 Exclusive breastfeeding Predominant breastfeeding Sex   Male 20.0 0.6 3.6 229 Female 23.7 1.7 4.8 213 Administrative unit   FBiH 18.3 0.7 3.3 340 RS 25.6 1.3 7.9 73 BD (24.5) (1.8) (16.5) 29 Mother’s education   No formal education 25.7 0.6 6.3 145 Primary 24.3 0.7 3.8 254 Secondary+ (14.9) (1.8) (5.6) 43 wealth index quintile   Poorest 19.0 1.4 6.5 126 Second 13.8 0.7 0.7 113 Middle 17.8 0.4 3.3 67 Fourth 21.4 1.9 3.2 73 Richest 23.5 1.4 5.8 64 wealth index   Poorest 60 per cent 16.9 0.8 3.5 102 Richest 40 per cent 22.4 1.6 4.5 68 Language of household head   Romani 27.5 0.9 6.4 267 Other 17.2 1.0 1.9 176     Median 24.5 0.9 4.0 442     Mean for all children (0-35 months) 20.9 1.8 8.3 442 1 MICS indicator 2.10 ( ) Figures that are based on 25–49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Age-appropriate infant feeding for children under 24 months is shown in Table NU.5. Different criteria of feeding have been used, dependent on the age of the child. Exclusive breastfeeding for infants aged 0-5 months is considered as age- appropriate feeding, while infants aged 6-23 months are considered to be appropriately fed if they are receiving breast milk and solid, semi-solid or soft foods. In accordance with these feeding patterns slightly more than one-fifth of children aged 0-5 months who were exclusively breastfed (22 per cent) and less than one half of children aged 6-23 months (46 per cent) who were being breastfed and receiving solid, semi-solid and soft foods were considered as being appropriately fed. The overall percentage of Roma children aged 0-23 months who were appropriately fed for their age was 40, being somewhat higher in the FBiH (41 per cent) than in RS (35 per cent). Amongst the currently breastfeeding children aged 6-8 months the minimum meal frequency meant receiving solid, semi-solid or soft foods 2 or more times. Amongst the currently breastfeeding children aged 9-23 months receiving solid, semi-solid or soft foods at least 3 times was the minimum meal frequency. For children aged 6-23 months who were currently not breastfeeding the minimum meal frequency was defined as receiving solid, semi-solid or soft foods and milk at least 4 times. 26 Multiple indicator cluster survey 2011–2012 Monitoring the situation of children and woMen 27 Table NU.7: Bottle feeding percentage of children aged 0-23 months who were fed with a bottle with a nipple during the previous day, Bih roma survey 2011–2012   percentage of children aged 0-23 months fed with a bottle with a nipple1 number of children aged 0-23 months Sex   Male 54.4 160 female 58.7 131 Age (months)   0-5 46.8 74 6-11 61.9 70 12-23 58.4 147 Administrative unit   fBih 64.9 227 rs 34.3 49 Bd (*) 16 Mother’s education   no formal education 43.6 95 primary 60.2 164 secondary+ (74.1) 32 Wealth index quintile   poorest 58.4 84 second 53.0 73 Middle (59.9) 45 fourth (61.4) 50 richest (47.7) 40 Wealth index   poorest 60 per cent 56.8 202 richest 40 per cent 55.3 90 Language of household head   romani 49.4 180 other 67.4 112 Total 56.3 292 1 Mics indicator 2.11 ( ) figures that are based on 25–49 unweighted cases Low Birth Weight Low birth weight (less than 2,500 grams) carries a range of grave health risks for children. Babies who are undernourished in the womb face a greatly increased risk of disease and dying during their early months and years. Low birth weight is most commonly associated with the mother’s poor health and inadequate feeding as well as cigarette smoking, especially during pregnancy. Teenagers who give birth while their own bodies have yet to finish growing run the risk of bearing underweight babies. Because many infants in the developing world are not weighed at birth and those that are weighed may constitute a biased sample of all births the reported birth weights usually cannot be used to estimate the prevalence of low birth weight amongst all children. Therefore, in MICS the percentage of births weighing below 2,500 grams was estimated from two items in the questionnaire: the mother’s assessment of her child’s size at birth (i.e., very small, smaller than average, average, larger than average or very large) and the mother’s recollection of the child’s weight or if the child was weighed at birth the weight as recorded on a health card.23 The findings in this survey, presented in Table NU.8, show that a total of 96 per cent of newborns were weighted at birth, of which 14 per cent weighed less than 2,500 grams (see Figure NU.3). 23 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. Table NU.6: Minimum meal frequency percentage of children aged 6-23 months who received solid, semi-solid or soft foods (and milk feeds for non-breastfeeding children) the minimum number of times or more during the previous day, according to breastfeeding status, Bih roma survey 2011–2012     Currently breastfeeding Currently not breastfeeding All per cent receiving solid, semi- solid and soft foods the minimum number of times number of children aged 6-23 months per cent receiving at least 2 milk feeds1 per cent receiving solid, semi- solid and soft foods or milk feeds 4 times or more number of children aged 6-23 months per cent with minimum meal frequency2 number of children aged 6-23 months Sex   Male 48.4 84 (83.2) (90.2) 41 62.0 125 female 43.3 58 (72.8) (81.1) 35 57.6 93 Age (months)   6-8 (*) 22 (*) (*) 12 (71.6) 34 9-11 (42.9) 28 (*) (*) 9 (56.4) 37 12-17 (45.9) 38 (80.9) (93.2) 34 68.3 73 18-23 43.0 54 (*) (*) 21 48.9 75 Administrative unit   fBih 55.3 105 82.4 87.8 66 67.8 172 rs (27.6) 27 (*) (*) 10 (39.6) 37 Bd (*) 9 – – – (*) 9 Mother’s education   no formal education 44.5 53 (*) (*) 15 54.1 69 primary 46.2 79 (77.5) (84.4) 50 61.0 128 secondary+ (*) 10 (*) (*) 11 (*) 21 Wealth index quintile   poorest (52.0) 42 (*) (*) 24 66.3 66 second (38.5) 43 (*) (*) 14 50.3 57 Middle (*) 17 (*) (*) 10 (57.8) 27 fourth (*) 23 (*) (*) 16 (62.0) 39 richest (*) 17 (*) (*) 11 (65.2) 29 Wealth index   poorest 60 per cent 45.8 102 (79.3) (85.7) 48 58.7 151 richest 40 per cent (47.7) 40 (76.7) (86.3) 27 63.4 67 Language of household head   romani 37.2 99 (77.2) (83.8) 37 49.9 136 other (67.4) 43 (79.5) (88.0) 39 77.1 82 Total 46.4 142 78.4 85.9 76 60.1 218 1 Mics indicator 2.15 2 Mics indicator 2.13 ( ) figures that are based on 25–49 unweighted cases (*) figures that are based on fewer than 25 unweighted cases amongst those currently breastfeeding children aged 6-8 months the minimum meal frequency was defined as children who also received solid, semi- solid or soft foods 2 times or more. amongst those currently breastfeeding children aged 9-23 months receipt of solid, semi-solid or soft foods at least 3 times constituted the minimum meal frequency. for non-breastfeeding children aged 6-23 months the minimum meal frequency was defined as children receiving solid, semi-solid or soft foods and milk feeds at least 4 times during the previous day. The continued practice of bottle-feeding was a concern due to a number of factors, including possible contamination due to unsafe water and lack of hygiene during preparation. Table NU.7 shows that more than one half of Roma children aged 0-23 months were fed using a bottle with a nipple (56 per cent). It was also a matter of concern that this feeding practice was used for nearly half of children aged 0-5 months (47 per cent) who should be exclusively breastfeeding at this time. The findings show that children whose mother had no formal education were less likely to be fed using a bottle with a nipple (44 per cent) than children whose mother had primary education (60 per cent). 28 MUlTIPlE INDICATOR ClUSTER SURVEy 2011–2012 MONITORING THE SITUATION OF CHIlDREN AND wOMEN 29 VI Child Health Immunisation Millennium Development Goal (MDG) 4 is to reduce child mortality by two-thirds between 1990 and 2015. Immunisation plays a key part in this goal. Immunisation has saved the lives of millions of children in the three decades since the launch of the Expanded Programme on Immunisation (EPI) in 1974. According to UNICEF data, worldwide there are still 27 million children overlooked by routine immunisation and as a result vaccine preventable diseases cause more than 2 million deaths each year. A World Fit for Children goal is to ensure full immunisation of children under one year of age at 90 per cent nationally with at least 80 per cent coverage in every administrative unit. According to UNICEF and WHO guidelines a child should receive a BCG vaccination to protect against tuberculosis, three doses of DPT to protect against diphtheria, pertussis, and tetanus; three doses of the polio vaccine; three doses of the Hepatitis B (HepB) vaccine and a measles vaccination by the age of 12 months. In accordance with the UNICEF and WHO guidelines and the recommendations for immunisation against measles rubella and mumps (MMR) outlined in the regulations on immunisations and prophylactics in the FBiH and RS, as well as for purposes of international comparison, estimates on full immunisation based on this survey refer to children aged 18-29 months that have received a BCG vaccine, three doses of DPT and the polio vaccine by 12 months and the MMR vaccine by 18 months. Data on immunisation against HepB is not included in the calculation of the percentage of children aged 18-29 who have received all vaccinations.24 Information on vaccination coverage was collected for all children under five years of age. Mothers or caretakers were asked to provide vaccination cards or health booklets for all of these children. If the vaccination card for a child was available the interviewers copied the vaccination information from the card onto the questionnaire. If no vaccination card was available then the interviewer proceeded to ask the mother to recall whether or not the child had received each of the vaccinations and for polio and DPT and how many doses the child had received. The final vaccination coverage estimates were based on both the information obtained from the vaccination card and the mother’s reports on the vaccinations received by the child. The percentage of children aged 18-29 months who had received each of the specific vaccinations recommended by UNICEF and WHO is shown in Table CH.1. The denominator comprises of children aged 18-29 months so that only children who were old enough to be fully vaccinated with these vaccines were taken into consideration. In the first three columns of the table the numerator includes all children who were vaccinated at any time before the survey; in the last column only those children who were vaccinated by age 12 months, as recommended, were included (by 18 months of age for MMR). For children without vaccination cards the proportion of vaccinations given by 12 months was assumed to be the same as for children with vaccination cards. Overall, 41 per cent of Roma children had vaccination cards available at the time of the survey (see Table CH.2). According to the data shown in Table CH.1, 86 per cent of children aged 18-29 months had received a BCG vaccination by the age of 12 months. Thirty-two per cent of children had received the first dose of the polio vaccine; however, the percentage decreased with subsequent doses of this vaccine to 24 per cent for the second dose and only 14 per cent for the third. The first dose of the DPT vaccine was given to 30 per cent of Roma children. The percentage declined for subsequent doses of this vaccine to 21 per cent for the second dose and 13 per cent for the third (see Figure CH.1). The first dose of the HepB vaccine was received by 65 per cent of children, the second dose by 35 per cent and the third dose by 15 per cent of children. Immunisation coverage against measles rubella and mumps (MMR) by the age of 18 months was 22 per cent. The percentage of Roma children who received all of the UNICEF and WHO recommended vaccinations during infancy was low at only 4 per cent. This indicator includes the percentage of children who received a BCG vaccine and three doses of DPT, and three doses of the polio vaccine by age 12 months and an MMR vaccine by age 18 months (see Figure CH.1). Data on immunisation to protect against HepB and Hib, both of which are part of the immunisation calendars in FBiH and RS, is not included in the calculation of the percentage of children with all immunisations. Thirteen per cent of Roma children did not receive any of the vaccines mentioned by age 12 months. 24 For the purposes of comparing the percentage of children who had received the UNICEF and wHO recommended vaccines during infancy with data from the BiH MICS3 (2005-2006) data on the Hepatitis B vaccines is not included in the calculation of full immunisation. Data on immunisation against illnesses caused by Haemophilus influenzae type B (Hib), which is a part of the immunisation calendars in the FBiH and RS, are not presented in this report. Table NU.8: Low birth weight infants Percentage of last born children in the 2 years preceding the survey that are estimated to have weighed below 2,500 grams at birth and percentage of live births weighed at birth, BiH Roma Survey 2011–2012   Per cent of live births Number of last born children in the two years preceding the surveyBelow 2,500 grams 1 weighed at birth2 Administrative unit   FBiH 13.0 96.7 207 RS 17.4 95.0 41 BD (*) (*) 15 Mother’s education   No formal education 14.0 91.5 89 Primary 14.4 98.4 148 Secondary+ (8.5) (100.0) 26 wealth index quintile   Poorest 19.4 95.5 74 Second 17.8 97.9 69 Middle (4.5) (92.5) 38 Fourth (8.1) (97.1) 43 Richest (10.6) (97.4) 39 wealth index   Poorest 60 per cent 15.6 95.8 181 Richest 40 per cent 9.3 97.3 82 Language of household head   Romani 13.6 96.8 159 Other 13.7 95.3 104 Total 13.7 96.2 263 1 MICS indicator 2.18 2 MICS indicator 2.19 ( ) Figures that are based on 25–49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Figure NU.3: Percentage of infants weighing less than 2,500 grams at birth, BiH Roma Survey 2011–2012 13 17 16 9 14 0 2 4 6 8 10 12 14 16 18 20 FBiH RS Poorest 60 per cent Richest 40 per cent BiH Per cent 30 MUlTIPlE INDICATOR ClUSTER SURVEy 2011–2012 MONITORING THE SITUATION OF CHIlDREN AND wOMEN 31 Figure CH.1: Percentage of children aged 18-29 months who received the recommended vaccinations by 12 months (18 months for MMR), BiH Roma Survey 2011–2012 * The percentage for all vaccines excludes vaccines to prevent Hepatitis B. Table CH.1: Vaccinations in first year of life Percentage of children aged 18-29 months immunised against childhood diseases at any time before the survey and by age 12 months (by 18 months for MMR), BiH Roma Survey 2011–2012   Vaccinated at any time before the survey according to: Vaccinated by 12 months of age (by 18 months for MMR)Vaccination card Mother’s report Either BCG1 37.6 48.1 85.6 85.6 Polio   1 21.7 14.0 35.7 32.4 2 17.4 9.0 26.4 24.2 32 12.9 2.3 15.2 14.2 DPT   1 22.1 11.2 33.3 29.9 2 15.4 7.6 23.0 20.9 33 9.7 4.0 13.7 12.5 MMR4 15.7 9.2 24.9 21.8     All vaccinations (BCG, Polio, DPT and MMR) 6.3 1.6 7.9 4.3 No vaccinations (BCG, Polio, DPT and MMR) 1.0 12.3 13.3 13.3 HepB 1 (at birth) 35.6 29.3 64.8 64.8 2 25.8 9.5 35.3 35.3 35 13.7 2.4 16.1 14.5 Number of children aged 18-29 months 146 146 146 146 1 MICS indicator 3.1 2 MICS indicator 3.2 3 MICS indicator 3.3 4 MICS indicator 3.4; MDG indicator 4.3 5 MICS indicator 3.5 Table CH.2 presents immunisation coverage amongst children aged 18-29 months by background characteristics. The figures indicate children receiving the vaccinations at any time up to the date of the survey and are based on information from both the vaccination cards and mothers’/caretakers’ reports. The overall percentage of children who had received all of the recommended vaccinations, apart from the HepB vaccine, at any time before the survey was 8 per cent. Eighty-six per cent of children had received a BCG vaccine at any time before the survey. The third dose of the polio vaccine was received by 15 per cent of children, the third dose of DPT was received by 14 per cent of children, while the third dose of the HepB vaccine was received by 16 per cent of children. The MMR vaccine had been received by 25 per cent of children at any time before the survey. Ta bl e CH .2 : V ac ci na ti on s by b ac kg ro un d ch ar ac te ri st ic s Pe rc en ta ge o f c hi ld re n ag ed 1 8- 29 m on th s cu rr en tly v ac ci na te d ag ai ns t c hi ld ho od d is ea se s, Bi H R om a Su rv ey 2 01 1– 20 12     Pe rc en ta ge o f c hi ld re n w ho 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 ed 1 8- 29 m on th s BC G Po lio D PT M M R N o va cc in at io ns (B CG , P ol io , D PT a nd M M R) A ll va cc in at io ns (B CG , P ol io , D PT a nd M M R) H ep B 1 2 3 1 2 3 1 2 3 Se x   M al e 87 .9 33 .3 26 .1 13 .6 29 .7 20 .2 10 .9 23 .9 12 .1 6. 8 64 .0 36 .6 14 .5 38 .0 80 Fe m al e 83 .0 38 .6 26 .6 17 .1 37 .4 26 .3 16 .9 26 .0 14 .7 9. 1 65 .8 33 .7 18 .1 44 .7 66 A dm in is tr at iv e un it   FB iH 90 .0 33 .8 25 .6 12 .8 28 .6 20 .3 11 .5 25 .7 10 .0 7. 0 63 .2 34 .1 13 .8 37 .4 10 5 RS (8 0. 0) (4 7. 7) (3 2. 3) (2 5. 7) (5 7. 1) (4 0. 8) (2 7. 6) (3 1. 5) (1 4. 2) (1 6. 2) (7 5. 4) (4 3. 3) (3 0. 0) (5 0. 2) 27 BD (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 15 M ot he r’s e du ca ti on   N o fo rm al e du ca tio n 74 .7 26 .2 19 .6 10 .1 21 .0 16 .1 9. 7 14 .3 22 .2 0. 0 56 .6 24 .5 11 .5 30 .9 50 Pr im ar y 89 .9 36 .6 24 .2 12 .1 32 .9 20 .4 9. 6 22 .9 10 .1 6. 9 65 .4 36 .2 13 .3 42 .0 83 Se co nd ar y+ (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 13 w ea lt h in de x qu in ti le   Po or es t (8 8. 1) (3 0. 2) (2 3. 0) (1 1. 2) (2 0. 0) (1 7. 1) (5 .8 ) (1 3. 9) (1 1. 9) (5 .3 ) (6 3. 3) (3 0. 5) (1 4. 0) (2 9. 1) 34 Se co nd (8 4. 3) (3 0. 2) (2 1. 4) (1 5. 6) (3 5. 9) (2 4. 6) (1 4. 0) (2 3. 7) (1 5. 7) (6 .5 ) (5 8. 6) (3 0. 4) (1 3. 5) (4 6. 1) 41 M id dl e (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 23 Fo ur th (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 23 Ri ch es t (9 3. 2) (3 4. 5) (2 9. 9) (2 6. 4) (4 2. 1) (2 5. 7) (2 2. 3) (2 8. 1) (6 .8 ) (1 8. 1) (8 9. 2) (5 6. 3) (3 3. 8) (5 9. 6) 25 w ea lt h in de x   Po or es t 6 0 pe r c en t 83 .6 32 .7 21 .8 13 .3 27 .5 17 .7 9. 5 20 .7 14 .8 4. 5 58 .5 30 .0 12 .0 37 .4 98 Ri ch es t 4 0 pe r c en t (8 9. 8) (4 1. 7) (3 5. 4) (1 9. 0) (4 4. 2) (3 3. 2) (2 1. 7) (3 3. 6) (1 0. 2) (1 4. 6) (7 7. 8) (4 6. 1) (2 4. 6) (4 8. 5) 48 La ng ua ge o f h ou se ho ld h ea d   Ro m an i 80 .4 27 .8 18 .5 10 .4 29 .1 17 .2 9. 3 17 .3 17 .8 2. 8 60 .7 27 .0 11 .3 37 .2 90 O th er 93 .9 48 .4 39 .0 22 .9 40 .3 32 .6 20 .8 35 .9 6. 1 15 .8 71 .2 48 .1 23 .7 47 .1 57 To ta l 85 .6 35 .7 26 .4 15 .2 33 .3 23 .0 13 .7 24 .9 13 .3 7. 9 64 .8 35 .3 16 .1 41 .0 14 6 ( ) F ig ur es th at a re b as ed o n 25 –4 9 un w ei gh te d ca se s (* ) F ig ur es th at a re b as ed o n fe w er th an 2 5 un w ei gh te d ca se s 32 24 14 30 21 13 22 4 35 15 0 10 20 30 40 50 60 70 80 90 100 86 65 (BCG , Poli o, DT P and MM R) HepB 3 HepB 2 HepB 1 (BCG , poli o, P i M RP) DTP3 DTP2 DTP1 Polio 3 Polio 2 Polio 1 BCG All va ccina tions Per cent MMR 32 MUlTIPlE INDICATOR ClUSTER SURVEy 2011–2012 MONITORING THE SITUATION OF CHIlDREN AND wOMEN 33 Oral Rehydration Treatment Diarrhoea is the second leading cause of death amongst children under five worldwide. In the treatment of diarrhoea of particular importance are increased fluid intake, continued adequate feeding of the child and use of oral rehydration salts (ORS). The goal is to reduce by two-thirds the mortality rate amongst children under five by 2015.25 In addition, A World Fit for Children calls for a reduction in the incidence of diarrhoea by 25 per cent. In MICS the prevalence of diarrhoea was estimated by asking mothers or caretakers whether their child had had an episode of diarrhoea in the two weeks prior to the survey (see Table CH.4). In those cases where mothers reported that a child had had diarrhoea a series of questions were asked about the treatment of the illness, including what the child had to drink and eat during the episode and whether this was more or less than the child usually drank or ate. Table CH.3 also shows the percentage of Roma children who had diarrhoea in the two weeks preceding the survey as well as the percentage of children who received various types of recommended liquids during the episode of diarrhoea. The data shows that in BiH 15 per cent of Roma children under 5 years of age had suffered diarrhoea in the two weeks prior to the survey. Diarrhoea prevalence amongst these children was highest in the FBiH (18 per cent) and lower in RS and BD (7 per cent and 4 per cent respectively). According to age, the peak diarrhoea prevalence was amongst children aged 12-23 months (23 per cent), while the lowest prevalence was amongst children aged 4-5 (7 per cent). Diarrhoea prevalence was similar amongst girls (16 per cent) and boys (14 per cent). Figure CH.2 shows the percentage of children who had diarrhoea in the two weeks preceding the survey by age groups.Fifty-eight per cent of children with diarrhoea received ORS (fluid from ORS packet or pre-packaged ORS fluid). Figure CH.2: Percentage of children under age 5 with diarrhoea in the two weeks preceding the survey by age group, BiH Roma Survey 2011–2012 25 Compared to 1990 (Millennium Development Goals) Table CH.3: Oral rehydration solutions and recommended homemade fluids Percentage of children aged 0-59 months with diarrhoea in the last two weeks, and treatment with oral rehydration solutions and recommended homemade fluids, BiH Roma Survey 2011–2012 Had diarrhoea in last two weeks Number of children aged 0-59 months Children with diarrhoea who received ORS (Fluid from ORS packet or pre-packaged ORS fluid) Number of children aged 0-59 months with diarrhoea in last two weeks Sex   Male 14.2 392 62.5 56 Female 15.9 356 53.3 57 Administrative unit   FBiH 17.8 570 59.4 101 RS 7.3 123 (*) 9 BD 3.7 56 (*) 2 Age (months)   0-11 18.8 144 (45.6) 27 12-23 22.5 147 (74.7) 33 24-35 12.0 151 (*) 18 36-47 14.3 170 (*) 24 48-59 7.1 136 (*) 10 Mother’s education   No formal education 13.6 247 (57.4) 34 Primary 16.3 427 55.4 69 Secondary+ 12.6 74 (*) 9 wealth index quintile   Poorest 17.6 216 (60.7) 38 Second 16.6 181 (52.4) 30 Middle 18.0 122 (*) 22 Fourth 11.3 127 (*) 14 Richest 7.9 102 (*) 8 wealth index   Poorest 60 per cent 17.3 519 56.9 90 Richest 40 per cent 9.8 229 (*) 22 Language of household head*   Romani 13.8 454 55.9 63 Other 17.0 293 (60.5) 50 Total 15.0 748 57.9 112 ( ) Figures that are based on 25–49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases * Missing cases for the background characteristic “language of household head” are not shown in the table. Table CH.4 shows feeding practices for children during the episode of diarrhoea. The data shows that during the episode of diarrhoea only 16 per cent of Roma children under 5 years of were given more than usual to drink and that 84 per cent were given the same or less to drink. With respect to food intake, 11 per cent of children were given much less to eat than usual and 58 per cent were given somewhat less to eat. Five per cent of children stopped feeding, while 6 per cent were given more than usual to eat (continued feeding). 19 23 12 14 7 15 0 5 10 15 20 25 0-11 24-35 36-47 48-59 BiH Per cent Age (months) 12-23 34 MUlTIPlE INDICATOR ClUSTER SURVEy 2011–2012 MONITORING THE SITUATION OF CHIlDREN AND wOMEN 35 Table CH .4: Feeding practices during diarrhoea Per cent distribution of children aged 0-59 m onths w ith diarrhoea in the last tw o w eeks by am ount of liquids and food given during episode of diarrhoea, BiH Rom a Survey 2011–2012 H ad diarrhoea in last tw o w eeks N um ber of children aged 0-59 m onths D rinking practices during diarrhoea Total Eating practices during diarrhoea Total N um ber of children aged 0-59 m onths w ith diarrhoea in last tw o w eeks G iven m uch less to drink G iven som ew hat less to drink G iven about the sam e to drink G iven m ore to drink G iven m uch less to eat G iven som ew hat less to eat G iven about the sam e to eat G iven m ore to eat Stopped f ood Sex   M ale 14.2 392 9.0 51.8 23.8 15.5 100.0 13.1 49.2 23.7 5.9 8.1 100.0 56 Fem ale 15.9 356 13.7 53.2 17.2 16.0 100.0 7.9 66.8 18.3 5.4 1.5 100.0 57 A dm inistrative unit FBiH 17.8 570 11.1 52.9 20.6 15.4 100.0 10.8 57.9 19.8 6.3 5.3 100.0 101 RS 7.3 123 (*) (*) (*) (*) 100.0 (*) (*) (*) (*) (*) 100.0 9 BD 3.7 56 (*) (*) (*) (*) 100.0 (*) (*) (*) (*) (*) 100.0 2 A ge (m onths) 0-11 18.8 144 (5.2) (39.5) (33.1) (22.1) 100.0 (12.2) (33.0) (33.9) (12.4) (8.5) 100.0 27 12-23 22.5 147 (20.2) (42.6) (18.8) (18.3) 100.0 (7.2) (75.8) (11.8) (2.6) (2.6) 100.0 33 24-35 12.0 151 (*) (*) (*) (*) 100.0 (*) (*) (*) (*) (*) 100.0 18 36-47 14.3 170 (*) (*) (*) (*) 100.0 (*) (*) (*) (*) (*) 100.0 24 48-59 7.1 136 (*) (*) (*) (*) 100.0 (*) (*) (*) (*) (*) 100.0 10 M other’s education N o form al education 13.6 247 (9.8) (67.4) (16.1) (6.7) 100.0 (11.5) (52.9) (23.3) (9.8) (2.5) 100.0 34 Prim ary 16.3 427 10.8 48.6 22.0 18.6 100.0 6.2 60.1 22.7 4.4 6.5 100.0 69 Secondary+ 12.6 74 (*) (*) (*) (*) 100.0 (*) (*) (*) (*) (*) 100.0 9 w ealth index quintile Poorest 17.6 216 (3.7) (61.0) (18.4) (16.8) 100.0 (5.3) (57.9) (25.6) (6.0) (5.1) 100.0 38 Second 16.6 181 (16.8) (42.7) (14.1) (26.5) 100.0 (8.0) (60.2) (22.5) (6.5) (2.8) 100.0 30 M iddle 18.0 122 (*) (*) (*) (*) 100.0 (*) (*) (*) (*) (*) 100.0 22 Fourth 11.3 127 (*) (*) (*) (*) 100.0 (*) (*) (*) (*) (*) 100.0 14 Richest 7.9 102 (*) (*) (*) (*) 100.0 (*) (*) (*) (*) (*) 100.0 8 w ealth index Poorest 60 per cent 17.3 519 9.7 54.0 20.3 16.0 100.0 7.2 56.1 24.7 6.1 6.0 100.0 90 Richest 40 per cent 9.8 229 (*) (*) (*) (*) 100.0 (*) (*) (*) (*) (*) 100.0 22 Language of household head* Rom ani 13.8 454 10.4 55.8 22.2 11.5 100.0 6.7 66.2 20.5 3.3 3.4 100.0 63 O ther 17.0 293 (12.5) (48.3) (18.3) (20.9) 100.0 (15.2) (47.9) (21.7) (8.7) (6.5) 100.0 50 Total 15.0 748 11.3 52.5 20.5 15.7 100.0 10.5 58.1 21.0 5.7 4.8 100.0 112 ( ) Figures that are based on 25–49 unw eighted cases (*) Figures that are based on few er than 25 unw eighted cases * M issing cases for the background characteristic “language of household head” are not show n in the table. Table CH.5 provides the proportion of children aged 0-59 months with diarrhoea in the last two weeks who received oral rehydration therapy with continued feeding and the percentage of children with diarrhoea who received other treatments. Overall 64 per cent of children with diarrhoea received oral rehydration salts or increased fluids. It was observed that 52 per cent of children received oral rehydration therapy (ORT) and, at the same time, feeding was continued, as is the recommendation. Nineteen per cent of children received antimotility medication in the form of tablets or syrup, 7 per cent of children received an antibiotic in the form of tablets or syrup, 4 per cent of children received an injectable antibiotic and 1 per cent of children received an intravenous infusion. Diarrhoea was treated by home remedies/herbal medicine in 5 per cent of children, while 19 per cent of children were treated in some other way. No diarrhoea treatment or medication was received by 25 per cent of children. 36 MUlTIPlE INDICATOR ClUSTER SURVEy 2011–2012 MONITORING THE SITUATION OF CHIlDREN AND wOMEN 37 Care-Seeking and Antibiotic Treatment of Pneumonia Pneumonia is the leading cause of death in children and the use of antibiotics in under-5’s 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 infection. In the MICS survey on Roma in BiH the prevalence of suspected pneumonia was estimated by asking mothers or caretakers whether children under age five had experienced an illness with a cough accompanied by rapid or difficult breathing whose symptoms were due to a problem with the chest or both a problem with the chest and a blocked nose. Table CH.6 present the percentage of children with suspected pneumonia. During the two weeks that preceded the survey 10 per cent of children aged 0-59 months were reported to have had symptoms of suspected pneumonia. Of these children 80 per cent were taken to an appropriate service provider (MICS indicator 3.9 which is not shown in Table CH.6).26 The largest proportion of children were taken to a government health centre (68 per cent) or government hospital (12 per cent), while a small proportion of children were taken to a private medical practice (1 per cent) and or a private pharmacy (2 per cent). The highest percentage of children with suspected pneumonia was found in the FBiH (11 per cent), followed by RS (6 per cent) and BD (2 per cent). Three quarters of children under-5 with suspected pneumonia in the two weeks prior to the survey (75 per cent) were treated with antibiotics (MICS indicator 3.10 which is not shown in Table CH.6).27 Table CH.6: Prevalence of suspected pneumonia by background characteristics Percentage of children aged 0-59 months with suspected pneumonia in the last two weeks, BiH Roma Survey 2011–2012   Had suspected pneumonia in the last two weeks Number of children aged 0-59 months Sex   Male 9.1 392 Female 10.2 356 Administrative unit FBiH 11.1 570 RS 6.3 123 BD 1.9 56 Age (months) 0-11 9.4 144 12-23 11.7 147 24-35 8.4 151 36-47 9.5 170 48-59 8.9 136 Mother’s education No formal education 7.7 247 Primary 9.9 427 Secondary+ 14.2 74 wealth index quintile Poorest 10.9 216 Second 12.3 181 Middle 8.6 122 Fourth 9.3 127 Richest 3.4 102 wealth index Poorest 60 per cent 10.9 519 Richest 40 per cent 6.7 229 Language of household head* Romani 6.6 454 Other 14.2 293 Total 9.6 748 MICS indicator 3.9: Percentage of children aged 0-59 months with suspected pneumonia in the last two weeks who were taken to a health provider; the indicator is not shown in Table CH.6 because of the low number of unweighted cases for the background characteristics (less than 25 unweighted cases). MICS indicator 3.10: Percentage of children aged 0-59 with suspected pneumonia who received antibiotics in the last two weeks; the indicator is not shown in Table CH.6 because of the low number of unweighted cases for the background characteristics (less than 25 unweighted cases). * Missing cases for the background characteristic “language of household head” are not shown in the table. 26 MICS indicator 3.9: percentages by basic characteristics are based on fewer than 25 unweighted cases, and are not shown in Table CH.6. 27 MICS indicator 3.10: percentages by basic characteristics are based on fewer than 25 unweighted cases, and are not shown in Table CH.6. Table CH .5: O ral rehydration therapy w ith continued feeding and other treatm ents Percentage of children aged 0-59 m onths w ith diarrhoea in the last tw o w eeks w ho received oral rehydration therapy w ith continued feeding and percentage of children w ith diarrhoea w ho received other treatm ents, BiH Rom a Survey 2011–2012   Children w ith diarrhoea w ho received: O ther treatm ents N ot given any treatm ent or drug N um ber of children aged 0-59 m onths w ith diarrhoea in last tw o w eeks O RS or increased fluids O RT w ith continued feeding 1 Pill or syrup Injection Intra- venous H om e rem edy, herbal m edicine O ther A nti-biotic A nti- m otility Zinc O ther U nknow n A nti- biotic N on- antibiotic U nknow n Sex   M ale 70.3 54.0 9.5 13.8 0.0 0.0 1.8 6.0 0.0 2.5 1.2 6.9 15.9 24.6 56 Fem ale 58.1 50.1 5.4 23.9 0.0 1.6 0.0 2.2 0.0 0.0 1.2 3.6 21.9 25.1 57 A dm inistrative unit   FBiH 65.4 52.9 7.4 15.9 0.0 0.9 1.0 4.5 0.0 1.4 1.3 5.8 20.1 23.2 101 RS (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 9 BD (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 2 A ge   0-11 m onths (56.6) (35.8) (14.4) (13.6) (0.0) (3.3) (3.8) (8.5) (0.0) (0.0) (2.5) (4.7) (11.9) (25.5) 27 12-23 m onths (77.8) (73.5) (6.4) (27.4) (0.0) (0.0) (0.0) (3.8) (0.0) (4.3) (2.0) (0.0) (14.3) (16.3) 33 24-35 m onths (*) 56.5 (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 18 36-47 m onths (*) 31.5 (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 24 48-59 m onths (*) 67.3 (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 10 M other’s education   N o form al education (59.9) (51.4) (18.5) (10.0) (0.0) (0.0) (0.0) (10.6) (0.0) (0.0) (2.0) (3.8) (10.9) (34.8) 34 Prim ary 64.3 52.8 3.1 25.7 0.0 1.3 1.5 1.5 0.0 0.0 1.0 6.6 22.0 20.5 69 Secondary+ (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 9 w ealth index quintile   Poorest (68.0) (57.6) (6.0) (23.8) (0.0) (2.4) (0.0) (6.0) (0.0) (0.0) (3.6) (8.7) (19.6) (18.2) 38 Second (66.5) (61.8) (10.0) (17.0) (0.0) (0.0) (3.4) (7.6) (0.0) (0.0) (0.0) (.0) (20.7) (27.2) 30 M iddle (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 22 Fourth (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 14 Richest (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 8 w ealth index   Poorest 60 per cent 64.7 53.6 7.3 20.2 0.0 1.0 1.1 5.1 0.0 0.0 1.5 6.5 18.7 23.5 90 Richest 40 per cent (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 22 Language of household head * Rom ani 57.5 50.3 9.3 21.2 0.0 0.0 0.0 3.3 0.0 0.0 2.2 2.0 10.2 31.0 63 O ther (72.5) (54.3) (5.1) (16.0) (0.0) (1.8) (2.1) (5.1) (0.0) (2.9) (0.0) (9.2) (29.8) (17.2) 50 Total 64.1 52.1 7.4 18.9 0.0 0.8 0.9 4.1 0.0 1.3 1.2 5.2 18.9 24.9 112 1 M ICS indicator 3.8 ( ) Figures that are based on 25–49 unw eighted cases (*) Figures that are based on few er than 25 unw eighted cases * M issing cases for the background characteristic “language of household head” are not show n in the table. 38 MUlTIPlE INDICATOR ClUSTER SURVEy 2011–2012 MONITORING THE SITUATION OF CHIlDREN AND wOMEN 39 It is obvious that a mothers’ knowledge of the danger signs is an important determinant of care-seeking behaviour; issues related to knowledge of the danger signs of pneumonia are presented in Table CH.7. Overall 6 per cent of mothers were aware of the two danger signs of pneumonia: fast and difficult breathing. Twenty-eight per cent of mothers identified difficult breathing and 13 per cent of mothers identified fast breathing as symptoms for immediately taking a child to a health facility. A higher percentage of mothers in RS (40 per cent) believed that a child should be taken immediately to a health facility if the child experienced difficulty breathing than in the FBiH (27 per cent). The highest percentage of mothers believed that a child should immediately be taken to a health facility in the case of fever (81 per cent). Table CH .7: know ledge of the tw o danger signs of pneum onia Percentage of m others and caretakers of children aged 0-59 m onths by sym ptom s that w ould cause them to take the child im m ediately to a health facility and percentage of m others w ho recognised fast and or diffi cult breathing as signs to seek im m ediate care, BiH Rom a Survey 2011–2012     Percentage of m others/caretakers of children aged 0-59 m onths w ho think that a child should be taken im m ediately to a health facility if the child: M others/ caretakers w ho recognise the tw o danger signs of pneum onia N um ber of m others/ caretakers of children aged 0-59 m onths Is not able to drink or breastfeed Becom es w orse D evelops a fever H as fast breathing H as diffi culty breathing H as blood in stool Is drinking poorly H as other sym ptom s A dm inistrative unit   FBiH 5.1 7.1 80.0 14.2 27.2 3.3 4.3 55.2 5.6 404 RS 11.6 4.8 87.4 13.3 39.8 8.1 5.9 74.5 10.1 78 BD (5.9) (0.0) (82.4) (2.9) (5.9) (0.0) (5.9) (70.6) (0.0) 34 M other’s education   N o form al education 8.9 5.5 81.9 11.9 28.9 4.3 5.7 59.3 5.1 163 Prim ary 4.7 6.6 79.5 14.0 27.3 3.1 4.0 60.4 6.7 299 Secondary+ 5.5 7.4 88.7 14.5 26.2 6.5 5.3 51.3 4.1 55 w ealth index quintile   Poorest 2.4 6.3 78.5 7.3 25.9 3.1 3.2 67.8 4.8 135 Second 6.3 6.2 82.9 17.5 25.8 7.5 5.1 55.9 6.3 124 M iddle 9.7 10.0 75.4 13.9 33.5 1.4 4.2 58.2 6.4 86 Fourth 5.6 3.7 83.2 19.2 26.5 2.5 2.9 58.9 6.2 95 Richest 9.1 5.6 87.5 9.4 28.9 3.6 9.3 50.4 6.4 76 w ealth index   Poorest 60 per cent 5.6 7.2 79.3 12.6 27.8 4.3 4.1 61.1 5.8 345 Richest 40 per cent 7.2 4.6 85.1 14.8 27.6 3.0 5.8 55.1 6.3 171 Language of household head*   Rom ani 7.0 6.7 78.5 10.0 25.2 3.2 6.8 60.8 4.7 296 O ther 4.9 5.9 85.3 18.0 31.2 4.7 1.8 56.6 7.7 219 Total 6.1 6.3 81.2 13.4 27.7 3.8 4.7 59.1 5.9 517 ( ) Figures that are based on 25–49 unw eighted cases * M issing cases for the background characteristic “language of household head” are not show n in the table. Solid Fuel Use More than 3 billion people around the world rely on solid fuel for their basic energy needs, including cooking and heating. Solid fuels include biomass such as wood, charcoal, crop or other agricultural residues, dung, shrubs and straw, and coal. Cooking and heating with solid fuel leads to high levels of indoor smoke, a complex mix of health damaging pollutants. The main problem with the use of solid fuel is incomplete combustion, which produces toxic elements such as, amongst others, carbon monoxide and sulphur oxide (SO2). Use of solid fuel increases the risks of acute respiratory illness, pneumonia, chronic obstructive lung disease and cancer. The primary indicator of solid fuel use is the proportion of the population using solid fuel as their primary source of domestic energy for cooking. Table CH.8 shows that, overall, 92 per cent of Roma households used solid fuel for cooking; solid fuel use was somewhat higher in RS (97 per cent) and BD (95 per cent) than in the FBiH (91 per cent). The highest percentage of households used wood for cooking (84 per cent). Charcoal was used for cooking by 7 per cent of households and coal/lignite by 1 per cent of households. The findings show that the use of solid fuel for cooking was most common amongst households where household heads had no formal education (96 per cent) and least common amongst those with secondary or higher education (88 per cent). A higher percentage of households in the poorest 60 per cent of the population use solid fuels for cooking (84 per cent), compared to those in the richest 40 per cent of the population (98 per cent). Households in the poorest 60 per cent of the population are more likely to use wood for cooking (92 per cent) than households in the richest 40 per cent of the population (73 per cent), whereas the richest households use electricity for cooking more frequently (16 per cent) than poorest households (2 per cent). Table CH.8: Solid fuel use Per cent distribution of household members according to type of cooking fuel used by the household and percentage of household members living in households using solid fuel for cooking, BiH Roma Survey 2011–2012       Percentage of household members in households using: Number of household membersElectricity liquefied petroleum gas (lPG) Solid fuel No food cooked in the household Missing Total Solid fuel for cooking1 Coal, lignite Char- coal wood Straw, shrubs, grass Administrative unit FBiH 8.7 0.0 0.6 6.2 84.1 0.1 0.0 0.3 100.0 90.9 4,543 RS 1.8 1.0 1.4 7.2 88.1 0.4 0.1 0.0 100.0 97.1 1,027 BD 2.2 0.0 0.0 20.0 74.8 0.0 0.0 3.0 100.0 94.8 282 Education of household head No formal education 3.2 0.2 1.1 7.7 86.9 0.0 0.0 0.9 100.0 95.8 1,478 Primary 7.7 0.2 0.5 6.7 84.4 0.0 0.1 0.3 100.0 91.6 3,560 Secondary+ 11.7 0.0 0.8 7.4 79.2 0.8 0.0 0.0 100.0 88.3 814 wealth index quintile Poorest 0.4 0.0 0.6 3.4 94.9 0.0 0.2 0.4 100.0 98.9 1,171 Second 1.2 0.0 0.9 4.8 91.8 0.0 0.0 1.3 100.0 97.5 1,168 Middle 2.8 0.0 0.6 5.7 90.0 0.6 0.0 0.3 100.0 96.8 1,173 Fourth 9.8 0.0 0.5 6.1 83.7 0.0 0.0 0.0 100.0 90.2 1,173 Richest 21.6 0.9 0.9 15.3 61.3 0.0 0.0 0.0 100.0 77.5 1,167 wealth index Poorest 60 per cent 1.5 0.0 0.7 4.6 92.2 0.2 0.1 0.7 100.0 97.7 3,512 Richest 40 per cent 15.7 0.5 0.7 10.7 72.5 0.0 0.0 0.0 100.0 83.9 2,340 Language of household head* Romani 4.3 0.1 0.6 9.7 84.8 0.0 0.0 0.5 100.0 95.2 3,373 Other 11.1 0.3 0.8 3.5 83.6 0.3 0.1 0.3 100.0 88.1 2,469 Total 7.2 0.2 0.7 7.0 84.3 0.1 0.0 0.4 100.0 92.2 5,852 1 MICS indicator 3.11 * Missing cases for the background characteristic “language of household head” are not shown in the table. The use of solid fuel is in itself a weak indicator of indoor air pollution, since the concentration of pollutants varies when the same type of fuel is burned in different types of stoves or fireplaces. The use of sealed stoves with chimney flukes minimises indoor air pollution, whereas the use of open stoves or fireplaces without a chimney or smoke extractor provides no protection against the harmful effects of solid fuel combustion. 40 MUlTIPlE INDICATOR ClUSTER SURVEy 2011–2012 MONITORING THE SITUATION OF CHIlDREN AND wOMEN 41 Solid fuel use by place of cooking is depicted in Table CH.9. Indoor air pollution depends on cooking practices, the place of cooking and the type of fuel used. The findings of this survey show that, overall, the place of cooking in 41 per cent of Roma households was a room designated to serve solely as a kitchen, while 52 per cent of households cooked somewhere else in the house (no designated room). Two-thirds of households in RS (67 per cent) had a designated room for cooking compared to more than one half in BD (54 per cent) and only one-third of households in the FBiH (34 per cent). The data shows that the percentage of households with a room designated solely for cooking increased with the education level of the household head and household wealth: the highest percentage was amongst those with secondary or higher education (51 per cent) and amongst households in the richest 40 per cent of the population (56 per cent). Table CH.9: Solid fuel use by place of cooking Per cent distribution of household members in households using solid fuel by place of cooking, BiH Roma Survey 2011–2012   Place of cooking Number of household members in households using solid fuel for cooking In a separate room used as kitchen Elsewhere in the house In a separate building Outdoors At another place Missing Total Administrative unit   FBiH 34.0 57.9 1.0 1.6 4.8 0.7 100.0 4,131 RS 67.2 29.8 1.4 0.7 0.0 0.9 100.0 997 BD 53.9 46.1 0.0 0.0 0.0 0.0 100.0 267 Education of household head   No formal education 33.7 56.0 2.1 2.8 4.8 0.6 100.0 1,416 Primary 42.1 52.4 0.7 1.1 3.1 0.6 100.0 3,262 Secondary+ 51.1 43.1 0.5 0.0 3.9 1.4 100.0 718 wealth index quintile   Poorest 22.3 57.8 2.0 6.4 10.4 1.1 100.0 1,159 Second 36.4 59.6 1.6 0.0 2.2 0.3 100.0 1,138 Middle 38.6 57.0 1.2 0.0 2.9 0.3 100.0 1,136 Fourth 50.3 47.4 0.0 0.0 1.8 0.5 100.0 1,059 Richest 63.4 35.0 0.0 0.0 0.0 1.6 100.0 905 wealth index   Poorest 60 per cent 32.4 58.1 1.6 2.2 5.2 0.6 100.0 3,433 Richest 40 per cent 56.4 41.7 0.0 0.0 1.0 1.0 100.0 1,963 Language of household head*  Romani 38.5 54.6 1.5 2.1 2.4 1.0 100.0 3,210 Other 45.1 48.3 0.4 0.3 5.6 0.3 100.0 2,176 Total 41.1 52.1 1.0 1.4 3.7 0.7 100.0 5,396 * Missing cases for the background characteristic “language of household head” are not shown in the table. VII water and Sanitation Safe drinking water is a basic necessity for good health; unsafe drinking water can be a significant carrier of numerous diseases.28 Drinking water can also be tainted with chemical, physical and radiological contaminants with harmful effects on human health. In addition to its association with disease access to drinking water may be particularly important for women and children, especially in rural areas where they bear the primary responsibility for carrying water, often over long distances. One of the Millennium Development Goals (7, C) is to reduce by half, between 1990 and 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation. A 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.29 The list of indicators used in MICS is shown below. water z Use of improved drinking water sources z Use of an adequate water treatment method z Time to source of drinking water z Person collecting drinking water Sanitation z Use of improved sanitation z Sanitary disposal of child’s faeces MICS also collects additional information on the availability of facilities and conditions for hand washing. The indicators below were collected. z Place for hand washing observed z Availability of soap Use of Improved Drinking water Sources Improved sources of drinking water include piped water (into dwelling, compound, yard or plot or to a neighbour or public tap/standpipe), tube wells/boreholes, protected wells, protected springs and rainwater collection. Bottled water is considered as an improved water source only if the household is also using an improved water source for hand washing and cooking. The distribution of the population by main source of drinking water is shown in Table WS.1 and Figure WS.1. Overall 97 per cent of Roma households were using an improved source of drinking water: all households in BD, 99 per cent of households in RS and 97 per cent in the FBiH. The highest percentage of Roma household members used drinking water that was piped into their dwelling or into their yard or plot (91 per cent). Piped water was used by the highest percentage of household members in BD (98 per cent) and RS (96 per cent), with the lowest percentage of household members in the FBiH (90 per cent). The second most important source of drinking water amongst the Roma population were protected springs (5 per cent), while only a very low percentage of households used protected wells or tube wells. Unimproved water sources used by the Roma population were unprotected springs (2 per cent) and a negligible percentage of unprotected wells. While only 24 per cent of household members in the poorest wealth quintile had water in the dwelling, a high percentage of these household members used improved sources of drinking water (93 per cent). 28 Such as dysentery, cholera and hepatitis A 29 For more details on water and sanitation and to access reference documents please visit the UNICEF ‘childinfo’ website <http://www.childinfo. org/wes.html> 42 MUlTIPlE INDICATOR ClUSTER SURVEy 2011–2012 MONITORING THE SITUATION OF CHIlDREN AND wOMEN 43 Figure wS.1: Per cent distribution of household members by source of drinking water, BiH Roma Survey 2011–2012 Table wS.1: Use of improved water sources Per cent distribution of household population according to main source of drinking water and percentage of household population using improved drinking water sources, BiH Roma Survey 2011–2012 Main source of drinking water Total Percentage using improved sources of drinking water1 Number of household members Improved sources Unimproved sources Piped water Tube-well/ borehole Pro-tected well Pro-tected spring Bottled water** Unpro- tected well Unpro- tected spring Surface water Bottled water** OtherInto dwelling Into yard/plot To neighbour Public tap/ standpipe Administrative unit   FBiH 73.0 8.0 6.3 2.7 0.0 0.7 5.4 0.6 0.4 2.7 0.0 0.0 0.1 100.0 96.8 4,543 RS 75.0 7.8 11.9 1.1 0.8 0.3 2.0 0.6 0.0 0.0 0.3 0.3 0.0 100.0 99.4 1,027 BD 90.7 4.1 0.0 3.0 0.0 0.0 2.2 0.0 0.0 0.0 0.0 0.0 0.0 100.0 100.0 282 Education of household head   No formal education 62.3 10.0 12.5 5.7 0.3 0.5 3.8 0.6 0.7 3.1 0.2 0.1 0.0 100.0 95.9 1,478 Primary 76.4 8.0 5.2 1.4 0.1 0.7 5.2 0.6 0.2 2.0 0.0 0.1 0.2 100.0 97.6 3,560 Secondary+ 86.3 2.7 4.5 0.9 0.0 0.4 4.1 0.6 0.0 0.5 0.0 0.0 0.0 100.0 99.5 814 wealth index quintile   Poorest 24.1 23.9 25.6 10.0 0.0 1.2 7.6 0.4 0.9 5.6 0.0 0.3 0.5 100.0 92.7 1,171 Second 67.9 11.8 7.3 1.9 0.2 0.5 7.7 0.0 0.0 2.6 0.2 0.0 0.0 100.0 97.2 1,168 Middle 87.1 3.0 1.9 0.3 0.5 0.3 4.4 0.3 0.7 1.4 0.0 0.1 0.0 100.0 97.8 1,173 Fourth 94.6 0.2 0.0 0.0 0.0 1.1 2.1 1.3 0.0 0.7 0.0 0.0 0.0 100.0 99.3 1,173 Richest 97.4 0.0 0.0 0.0 0.0 0.0 1.7 0.9 0.0 0.0 0.0 0.0 0.0 100.0 100.0 1,167 wealth index   Poorest 60 per cent 59.7 12.9 11.6 4.0 0.2 0.7 6.5 0.2 0.5 3.2 0.1 0.1 0.2 100.0 95.9 3,512 Richest 40 per cent 96.0 0.1 0.0 0.0 0.0 0.6 1.9 1.1 0.0 0.3 0.0 0.0 0.0 100.0 99.7 2,340 Language of household head*   Romani 70.4 9.8 9.3 3.3 0.1 0.5 3.1 0.7 0.5 2.3 0.0 0.1 0.0 100.0 97.0 3,373 Other 79.8 5.1 3.4 1.2 0.3 0.9 6.8 0.4 0.0 1.8 0.1 0.0 0.3 100.0 97.9 2,469 Total 74.2 7.8 7.0 2.4 0.1 0.6 4.7 0.6 0.3 2.1 0.0 0.1 0.1 100.0 97.4 5,852 1 MICS indicator 4.1; MDG indicator 7.8 * Missing cases for the background characteristic “language of household head” are not shown in the table. ** Households using bottled water as the main source of drinking water were classifi ed into improved or unimproved drinking water users according to the water source used for other purposes such as cooking and hand washing. Tubewell/borehole 0% Public tap/standpipe 3% Other unimproved source 0% Unprotected well or spring 2% Bottled water 1% Piped into dwelling (yard or plot or to neighbour) 89% Protected well or spring 5% 44 MUlTIPlE INDICATOR ClUSTER SURVEy 2011–2012 MONITORING THE SITUATION OF CHIlDREN AND wOMEN 45 The use of household water treatment is presented in Table WS.2. Households were asked about ways they may be treating water at home to make it safer to drink. Boiling water, adding bleach or chlorine, using a water filter or using solar disinfection were considered as proper treatments for 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. Most household members used no water treatment method in the household (96 per cent). Other household members used boiling water (4 per cent) and, to a negligible extent, adding chlorine, as water treatment methods. The percentage of household members living in households that used unimproved water sources but did use an appropriate water treatment method was 3 per cent. Table wS.2: Household water treatment Percentage of household population by drinking water treatment method used in the household, and for household members living in households where an unimproved drinking water source is used, the percentage who are using an appropriate treatment method, BiH Roma Survey 2011–2012 water treatment method used in the household Number of household members Percentage of household members in households using unimproved drinking water sources and using an appropriate water treatment method1 Number of household members in households using unimproved drinking water sources None Boil Add bleach/ chlorine Strain through a cloth Use water filter Solar dis- infection let it stand and settle Other Missing/DK Administrative unit                       FBiH 95.4 4.2 0.4 0.0 0.0 0.0 0.0 0.1 0.0 4,543 2.8 146 RS 95.6 4.4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1,027 (*) 6 BD 100.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 282 – 0 Main source of drinking water   Improved 95.6 4.0 0.3 0.0 0.0 0.0 0.0 0.1 0.0 5,700 N/A N/A Unimproved 97.3 2.7 0.0 0.0 0.0 0.0 0.0 0.0 0.0 152 2.7 152 Education of household head   No formal education 98.3 1.7 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1,478 0.0 61 Primary 95.3 4.3 0.3 0.0 0.0 0.0 0.0 0.0 0.1 3,560 0.0 87 Secondary+ 92.2 7.0 0.8 0.0 0.0 0.0 0.0 0.3 0.0 814 (*) 4 wealth index quintile   Poorest 97.5 2.4 0.0 0.0 0.0 0.0 0.0 0.1 0.0 1,171 4.8 86 Second 94.3 5.4 0.3 0.0 0.0 0.0 0.0 0.0 0.0 1,168 (0.0) 33 Middle 96.4 3.4 0.0 0.0 0.0 0.0 0.0 0.0 0.2 1,173 (0.0) 25 Fourth 92.1 6.9 1.0 0.0 0.0 0.0 0.0 0.2 0.0 1,173 (*) 8 Richest 98.0 2.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1,167 – 0 wealth index   Poorest 60 per cent 96.1 3.7 0.1 0.0 0.0 0.0 0.0 0.0 0.1 3,512 2.8 144 Richest 40 per cent 95.1 4.4 0.5 0.0 0.0 0.0 0.0 0.1 0.0 2,340 (*) 8 Language of household head*   Romani 97.3 2.7 0.1 0.0 0.0 0.0 0.0 0.1 0.0 3,373 4.1 100 Other 93.5 5.8 0.5 0.0 0.0 0.0 0.0 0.1 0.1 2,469 0.0 52 Total 95.7 4.0 0.3 0.0 0.0 0.0 0.0 0.1 0.0 5,852 2.7 152 1 MICS indicator 4.2 ( ) Figures that are based on 25–49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases * Missing cases for the background characteristic “language of household head” are not shown in the table. N/A: “Not applicable” 46 MUlTIPlE INDICATOR ClUSTER SURVEy 2011–2012 MONITORING THE SITUATION OF CHIlDREN AND wOMEN 47 Ta bl e w S. 4: P er so n co lle ct in g w at er Pe rc en ta ge o f h ou se ho ld s w ith ou t d rin ki ng w at er o n pr em is es a nd p er c en t d is tr ib ut io n of h ou se ho ld s w ith ou t d rin ki ng w at er o n pr em is es a cc or di ng to th e pe rs on w ho u su al ly c ol le ct s th e dr in ki ng w at er u se d in th e ho us eh ol d, B iH R om a Su rv ey 2 01 1– 20 12 Pe rc en ta ge o f h ou se ho ld s w ith ou t d rin ki ng w at er on p re m is es N um be r of h ou se ho ld s Pe rs on u su al ly c ol le ct in g dr in ki ng w at er N um be r o f h ou se ho ld s w ith ou t d rin ki ng w at er on p re m is es Ad ul t w om an Ad ul t m an Fe m al e ch ild un de r a ge 1 5 M al e ch ild un de r a ge 1 5 M is si ng /D K To ta l A dm in is tr at iv e un it   FB iH 10 .5 1, 20 0 23 .5 60 .6 4. 6 4. 0 7. 4 10 0. 0 12 6 RS 4. 2 27 1 (* ) (* ) (* ) (* ) (* ) 10 0. 0 11 BD 2. 9 73 (* ) (* ) (* ) (* ) (* ) 10 0. 0 2 Ed uc at io n of h ou se ho ld h ea d   N o fo rm al e du ca tio n 13 .0 40 9 21 .2 59 .5 4. 6 6. 4 8. 3 10 0. 0 53 Pr im ar y 8. 2 91 7 28 .8 60 .2 4. 4 0. 0 6. 5 10 0. 0 75 Se co nd ar y+ 5. 5 21 8 (* ) (* ) (* ) (* ) (* ) 10 0. 0 12 w ea lt h in de x qu in ti le   Po or es t 20 .4 29 3 25 .5 53 .1 9. 6 4. 1 7. 6 10 0. 0 60 Se co nd 13 .5 31 1 (2 8. 6) (6 2. 5) (0 .0 ) (2 .2 ) (6 .7 ) 10 0. 0 42 M id dl e 7. 3 32 0 (* ) (* ) (* ) (* ) (* ) 10 0. 0 23 Fo ur th 3. 2 31 0 (* ) (* ) (* ) (* ) (* ) 10 0. 0 10 Ri ch es t 1. 6 31 0 (* ) (* ) (* ) (* ) (* ) 10 0. 0 5 w ea lt h in de x   Po or es t 6 0 pe r c en t 13 .5 92 4 26 .4 58 .2 4. 6 3. 4 7. 4 10 0. 0 12 5 Ri ch es t 4 0 pe r c en t 2. 4 62 0 (* ) (* ) (* ) (* ) (* ) 10 0. 0 15 La ng ua ge o f h ou se ho ld h ea d*   Ro m an i 8. 7 89 1 22 .6 63 .2 3. 1 5. 3 5. 8 10 0. 0 78 O th er 9. 5 65 2 28 .0 57 .4 5. 3 1. 5 7. 8 10 0. 0 62 To ta l 9. 1 1, 54 4 25 .0 60 .6 4. 1 3. 6 6. 7 10 0. 0 14 0 ( ) F ig ur es th at a re b as ed o n 25 –4 9 un w ei gh te d ca se s (* ) F ig ur es th at a re b as ed o n fe w er th an 2 5 un w ei gh te d ca se s * M is si ng c as es fo r t he b ac kg ro un d ch ar ac te ris tic “l an gu ag e of h ou se ho ld h ea d” a re n ot s ho w n in th e ta bl e. The amount of time it takes to obtain water is presented in Table WS.3 and the person who usually collects the water in Table WS.4. Note that these results refer to one roundtrip from home to the source of drinking water. Information on the number of trips made in one day was not collected. The findings in this survey show that most of the Roma household population had a drinking water source on the premises (91 per cent). For 4 per cent of the household population using improved sources of drinking water it took 30 minutes or more to get to the water source and bring the water, while 3 per cent of the household population spent less than 30 minutes for this purpose. Household members using improved water sources in the FBiH spent more time collecting drinking water compared to those in RS and BD. A negligible percentage of the household population that used unimproved sources of drinking water had water on the premises. Table wS.3: Time to source of drinking water Per cent distribution of household population according to time to go to source of drinking water and get water and return, for users of improved and unimproved drinking water sources, BiH Roma Survey 2011–2012     Time to source of drinking water Total Number of household members Users of improved drinking water sources Users of unimproved drinking water sources water on premises less than 30 minutes 30 minutes or more Missing/ DK water on premises less than 30 minutes 30 minutes or more Administrative unit FBiH 88.7 3.1 5.0 0.0 0.2 0.7 2.3 100.0 4,543 RS 96.4 1.2 1.8 0.0 0.0 0.3 0.3 100.0 1,027 BD 97.8 2.2 0.0 0.0 0.0 0.0 0.0 100.0 282 Education of household head No formal education 86.3 5.1 4.5 0.0 0.4 0.5 3.2 100.0 1,478 Primary 91.3 2.0 4.3 0.0 0.1 0.7 1.6 100.0 3,560 Secondary+ 94.5 1.8 3.2 0.0 0.0 0.0 0.5 100.0 814 wealth index quintile Poorest 77.3 7.1 8.2 0.0 0.8 2.3 4.2 100.0 1,171 Second 87.9 2.0 7.2 0.1 0.0 0.5 2.3 100.0 1,168 Middle 92.7 3.1 2.1 0.0 0.0 0.1 2.0 100.0 1,173 Fourth 96.1 0.6 2.6 0.0 0.0 0.0 0.7 100.0 1,173 Richest 98.3 0.9 0.8 0.0 0.0 0.0 0.0 100.0 1,167 wealth index Poorest 60 per cent 86.0 4.1 5.8 0.0 0.3 1.0 2.8 100.0 3,512 Richest 40 per cent 97.2 0.7 1.7 0.0 0.0 0.0 0.3 100.0 2,340 Language of household head* Romani 91.1 3.0 2.9 0.0 0.2 0.4 2.3 100.0 3,373 Other 89.5 2.4 5.9 0.0 0.2 0.8 1.2 100.0 2,469 Total 90.5 2.7 4.2 0.0 0.2 0.6 1.8 100.0 5,852 * Missing cases for the background characteristic “language of household head” are not shown in the table. Table WS.4 shows that 9 per cent of Roma households had no water sources on the premises; the highest percentage of them were in the FBiH (11 per cent) with the lowest percentages being in RS (4 per cent) and BD (3 per cent). The percentage of households with no sources of drinking water on the premises was higher amongst those households where the household head had no formal education (13 per cent), compared to those with primary education (8 per cent) and secondary or higher education (6 per cent). The percentage of households with no sources of drinking water on the premises declined with improved household wealth. When the source of drinking water was not on the premises an adult male collected the water in a substantial majority of households (61 per cent). Adult females collected water in one quarter of cases (25 per cent), while water was less frequently collected by female or male children under age 15 (4 per cent in both cases). 48 MUlTIPlE INDICATOR ClUSTER SURVEy 2011–2012 MONITORING THE SITUATION OF CHIlDREN AND wOMEN 49 Use of Improved Sanitation Facilities 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 a third and can significantly lessen the adverse health impact of other disorders. An improved sanitation facility is defined as one that hygienically separates human excreta from human contact. Improved sanitation facilities for excreta disposal include flush

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