Multiple Indicator Cluster Survey (MICS) in the Republic of Kazakhstan, 2010-2011. Final Report.

Publication date: 2012

Multiple Indicator Cluster Survey in the Republic of Kazakhstan 2010-2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Astana, 2012 2 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Multiple Indicator Cluster Survey (MICS) in the Republic of Kazakhstan 2010-2011 Monitoring the situation of children and women. Directed by Smailov A.A., Astana 2012, 378 p. Contributors to the report: Amirkhanova M. M. Tanibergenov S. T. Editorial Board: Ashuyev A. Z. Kukanova G. Z. Sissemaliyev R. A. Alkuatova N. Y. This Kazakhstan Multiple Indicator Cluster Survey (MICS) was carried out in 2010-2011 by the Agency of Statistics, RK in collaboration with the Republican State Enterprise Information Computing Centre. Financial and technical support was provided mainly by the United Nations Children’s Fund (UNICEF) and co-financed by the United Nations Population Fund (UNFPA). MICS is an international programme on household surveys developed by UNICEF. In Kazakhstan, MICS was conducted within the framework of the fourth global round of MICS surveys (MICS4). The MICS provides up-to-date information on the situation of children, women and men and measures key indicators that allow countries to monitor progress towards the Millennium Development Goals (MDGs) and other internationally agreed upon commitments. Additional information on the global MICS project may be obtained from www.childinfo.org. Suggested citation: The Agency of Statistics, RK, United Nations Children’s Fund (UNICEF), 2012 Multiple Indicator Cluster Survey (MICS) in the Republic of Kazakhstan, 2010-2011. Final Report. Astana, Kazakhstan: the Agency of Statistics, RK and the Republican State Enterprise Information Computing Center. Any information from this publication may be reproduced but proper acknowledgement of the source must be provided. This publication is not for sale. The Agency of Statistics, RK Entrance 4, House of Ministries Left Bank of Ishim River, 010000, Astana Tel: +7 (7172) 749016, Fax: +7 (7172) 749494, Website: www.stat.kz., www.stat.gov.kz The United Nations Children’s Fund (UNICEF) in the Republic of Kazakhstan Block 1, 10A, Beibitshilik str., 010000, Astana, Tel: +7 (7172) 321797, 322969, Fax: +7 (7172) 321803 Website: www.unicef.kz., www.unicef.org 3MONITORING THE SITUATION OF CHILDREN AND WOMEN Multiple Indicator Cluster Survey (MICS) In the Republic of Kazakhstan 2010-2011 The Agency of Statistics, RK Entrance 4, House of Ministries Left Bank of Ishim River, 010000, Astana Tel: +7(7172) 749016, Fax: +7(7172) 749494, Website: www.stat.kz., www.stat.gov.kz United Nations Children’s Fund (UNICEF) in the Republic of Kazakhstan Block 1, 10A, Beibitshilik str., 010000, Astana, Tel: +7 (7172) 321797, 322969, Fax: +7 (7172) 321803 Website: www.unicef.kz., www.unicef.org 4 Summary Table of Findings Multiple Indicator Cluster Survey (MICS) and Millennium Development Goals (MDG) Indicators in Kazakhstan, 2010-2011 Topic M IC S4 In di ca to r N um be r M D G In di ca to r N um be r Indicator Value CHILD MORTALITY Child Mortality 1.1 4.1 Under-5 mortality rate 31 per thousand 1.2 4.2 Infant mortality rate 28 per thousand NUTRITION Nutritional Status 2.1a 2.1b 1.8 Underweight prevalence Moderate and Severe (- 2 SD) Severe (- 3 SD) 3,7 1,2 percent percent 2.2a 2.2b Stunting prevalence Moderate and Severe (- 2 SD) Severe (- 3 SD) 13,1 5,4 percent percent 2.3a 2.3b Wasting prevalence Moderate and Severe (- 2 SD) Severe (- 3 SD) 4,1 1,7 percent percent Breastfeeding and Infant Feeding 2.4 Children ever breastfed 96,4 percent 2.5 Early initiation of breastfeeding 67,8 percent 2.6 Exclusive breastfeeding under 6 months 31,8 percent 2.7 Continued breastfeeding at 1 year 50,8 percent 2.8 Continued breastfeeding at 2 years 26,1 percent 2.9 Predominant breastfeeding under 6 months 60,6 percent 2.10 Duration of breastfeeding 14,8 percent 2.11 Bottle feeding 46,7 percent 2.12 Introduction of solid, semi-solid or soft foods 49,4 percent 2.13 Minimum meal frequency 55,3 percent 2.14 Age-appropriate breastfeeding 31,0 percent 2.15 Milk feeding frequency for non-breastfed children 89,4 percent Salt Iodization 2.16 Iodized salt consumption 85,4 percent Low Birth Weight 2.18 Low-birthweight infants 4,5 percent 2.19 Infants weighed at birth 97,6 percent 5 Topic M IC S4 In di ca to r N um be r M D G In di ca to r N um be r Indicator Value CHILD HEALTH Vaccinations 3.1 Tuberculosis immunization coverage (BCG) 99,2 percent 3.2 Polio immunization coverage (PIC) 81,3 percent 3.3 Immunization coverage for diphtheria, pertussis and tetanus (DPT) 93,0 percent 3.4 4.3 Measles immunization coverage 84,2 percent 3.5 Hepatitis B immunization coverage (Hep B) 67,0 percent Care of Illness 3.8 Oral rehydration therapy with continued feeding 54,0 percent 3.9 Care seeking for suspected pneumonia 81,2 percent 3.10 Antibiotic treatment of suspected pneumonia 86,6 percent Solid Fuel Use 3.11 Solid fuels 10,8 percent WATER AND SANITATION Water and Sanitation 4.1 7.8 Use of improved drinking water sources 93,9 percent 4.2 Water treatment 70,7 percent 4.3 7.9 Use of improved sanitation 97,3 percent 4.4 Safe disposal of child’s faeces 66,7 percent REPRODUCTIVE HEALTH Contraception and Unmet Need 5.1 5.4 Adolescent birth rate 23,4 per thousand 5.2 Early childbearing 2,3 percent 5.3 5.3 Contraceptive prevalence rate among Women age 15-49 Men age 15-49 51,0 48,0 percent percent 5.4 5.6 Unmet need 11,6 percent Maternal and Newborn Health 5.5a 5.5b 5.5 Antenatal care coverage At least once by skilled personnel At least four times by any provider 99,2 87,0 percent percent 5.6 Content of antenatal care 98,9 percent 5.7 5.2 Skilled attendant at delivery 99,9 percent 5.8 Institutional deliveries 99,6 percent 5.9 Caesarean section 15,9 percent CHILD DEVELOPMENT Child Development 6.1 Support for learning 91,5 percent 6 Topic M IC S4 In di ca to r N um be r M D G In di ca to r N um be r Indicator Value Child Development 6.2 Father’s support for learning 49,1 percent 6.3 Learning materials: children’s books 47,8 percent 6.4 Learning materials: playthings 44,8 percent 6.5 Inadequate care 4,4 percent 6.6 Early child development index 86,1 percent 6.7 Attendance in early childhood education 37,0 percent EDUCATION Literacy and Education 7.1 2.3 Literacy rate among young Women age 15-24 Men age 15-24 99,9 99,9 percent percent 7.2 School readiness 81,6 percent Literacy and Education 7.3 Net intake rate in primary education 93,8 percent 7.4 2.1 Primary school net attendance ratio (adjusted) 99,3 percent 7.5 Secondary school net attendance ratio (adjusted) 96,1 percent 7.6 2.2 Children reaching last grade of primary 100,0 percent 7.7 Primary completion rate 107,4 percent 7.8 Transition rate to secondary school 100,0 percent 7.9 Gender parity index (primary school) 1,00 ratio 7.10 Gender parity index (secondary school) 1,00 ratio CHILD PROTECTION Birth Registration 8.1 Birth registration 99,7 percent Child Discipline 8.5 Violent discipline 49,4 percent Early Marriage 8.6 Marriage before age 15 among Women age 15-49 Men age 15-49 0,2 0,3 percent percent 8.7 Marriage before age 18 among Women age 20-49 Men age 20-49 8,6 1,0 percent percent 8.8 Currently married or in union Women age 15-19 Men age 15-19 4,5 0.9 percent percent 8.10a 8.10b Spousal age difference Women age 15-19 Women age 20-24 8,4 7.2 percent percent 7 Topic M IC S4 In di ca to r N um be r M D G In di ca to r N um be r Indicator Value Domestic Violence 8.14 Attitudes towards domestic violence: Women age 15-49 Men age 15-49 12,2 16,7 percent percent HIV/AIDS and SEXUAL BEHAVIOUR HIV/AIDS Knowledge and Attitudes 9.1 Comprehensive knowledge about HIV prevention Women age 15-49 Men age 15-49 38,0 37,9 percent percent 9.2 6.3 Comprehensive knowledge about HIV prevention among young people Women age 15-24 Men age 15-24 36,2 34,1 percent percent 9.3 Knowledge of mother-to-child transmission of HIV Women age 15-49 Men age 15-49 52,5 38,4 percent percent HIV/AIDS Knowledge and Attitudes 9.4 Accepting attitude towards people living with HIV Women age 15-49 Men age 15-49 2,5 2,7 percent percent 9.5 Respondents who know where to be tested for HIV Women age 15-49 Men age 15-49 81,1 76,4 percent percent 9.6 Respondents who have been tested for HIV and know the results Women age 15-49 Men age 15-49 22,5 15,4 percent percent 9.7 Sexually active young people who have been tested for HIV and know the results Women age 15-24 Men age 15-24 34,3 16,2 percent percent 9.8 HIV counselling during antenatal care 58,1 percent 9.9 HIV testing during antenatal care 71,5 percent Sexual Behaviour 9.10 Young respondents who have never had sex Women age 15-24 Men age 15-24 90,4 55,4 percent percent 9.11 Sex before age 15 Among young women age 15-24 Among young men age 15-24 0,4 1,4 percent percent 8 Topic M IC S4 In di ca to r N um be r M D G In di ca to r N um be r Indicator Value Sexual Behaviour 9.12 Age-mixing among sexual partners Women age 15-24 Men age 15-24 7,9 2,5 percent percent 9.13 Sex with multiple partners Women age 15-24 Men age 15-24 1,2 16,6 percent percent 9.14 Condom use during sex with multiple partners Women age 15-24 Men age 15-24 73,5 76,2 percent percent 9.15 Sex with non-regular partners Women age 15-24 Men age 15-24 7,4 38,6 percent percent 9.16 6.2 Condom use with non-regular partners Women age 15-24 Men age 15-24 69,9 78,3 percent percent TOBACCO AND ALCOHOL USE Tobacco Use ТА.1 Tobacco use Women age 15-49 Men age 15-49 7,5 53,9 percent percent ТА.2 Smoking until age 15 Women age 15-49 Men age 15-49 1,3 8,7 percent percent Alcohol Use ТА.3 Alcohol use Women age 15-49 Men age 15-49 26,6 46,4 percent percent ТА.4 Alcohol use until age 15 Women age 15-49 Men age 15-49 0,9 3,5 percent percent MASS MEDIA AND ICI Access to mass media and use of information/ communication technologies МТ.1 Access to mass media Women age 15-49 Men age 15-49 22,9 30,3 percent percent МТ.2 Use of computers Women age 15-24 Men age 15-24 83,6 82,4 percent percent МТ.2 Use of the Internet Women age 15-24 Men age 15-24 67,5 69,7 percent percent 9 Table of Contents Summary Table of Findings.4 Table of Contents.9 List of Tables .11 List of Figures .16 List of Abbreviations .17 Acknowledgements .18 Executive Summary.22 I. Introduction .29 Background .30 Survey Objectives .31 II. Sample and Survey Methodology .32 Sample Design .33 Questionnaires .33 Training and Fieldwork .35 Data Processing .35 III. Sample Coverage and the Characteristics of Households and Respondents .36 Sample Coverage .37 Characteristics of Households .39 Characteristics of Female Respondents 15-49, Male Respondents 15-59 Years of Age and Children Under 5 .43 Children’s Living Arrangements and Orphanhood .49 IV. Child Mortality .52 V. Nutrition .56 Nutritional Status .57 Breastfeeding, Infant and Young Child Feeding .60 Salt Iodization .71 Low Birth Weight .73 VI. Child Health .76 Vaccinations .77 Oral Rehydration Treatment .82 Care Seeking and Antibiotic Treatment of Pneumonia .84 Solid Fuel Use .87 VII. Water and Sanitation .91 Use of Improved Water Sources.92 Use of Improved Sanitation Facilities .99 VIII. Reproductive Health .107 Fertility .108 Contraception .111 Unmet Need .115 Antenatal Care .118 Assistance at Delivery .122 Place of Delivery .124 Abortions .126 10 IX. Child Development .131 Early Childhood Education and Learning .132 Early Childhood Development .139 X. Literacy and Education.142 Literacy among Young Women and Men .143 School Readiness .143 Primary and Secondary School Participation .145 XI. Child Protection .153 Birth Registration .154 Child Discipline .155 Early Marriage .158 Attitude toward Domestic Violence .165 XII. HIV/AIDS and Sexual Behaviour .169 Knowledge about HIV Transmission and Misconceptions about HIV/AIDS .170 Accepting Attitudes toward People Living with HIV/AIDS……………. .183 Knowledge of a Place for HIV Testing, Counselling and Testing during Antenatal Care .187 Sexual Behaviour Related to HIV Transmission .196 Circumcision .206 XIII. Tobacco and Alcohol Use .208 Tobacco Use .209 Alcohol Use .215 XIV. Access to Mass Media and Use of Information/Communication Technologies .219 Access to Mass Media .220 Use of Information/Communication Technologies .223 XV. Domestic Violence .227 Appendix A. Sample Design .243 Appendix B. List of Personnel Involved in the Survey .251 Appendix C. Estimates of Sampling Errors .254 Appendix D. Data Quality Tables .295 Appendix E. MICS4 Indicators: Numerators and Denominators .307 Appendix F. Questionnaires.316 Appendix G. Table NU.1A : Assessment of nutritional status of children based on the international standards for population set by the National Centre for Health Statistics, USA (NCHS)/Center for Disease Control and Prevention, USA (CDC)/WHO .377 11 List of Tables Table HH.1: Results of household, women’s, men’s and under-5 interviews Table HH.2: Household age distribution by sex Table HH.3: Household composition Table HH.4: Women’s background characteristics Table HH.4M: Men’s background characteristics Table HH.5: Children’s background characteristics Table НH.6: Children’s living arrangements and orphanhood Table CM.1: Children ever born, children surviving and proportion dead Table CM.2: Child Mortality Table NU.1: Nutritional status of children Table NU.2: Initial breastfeeding Table NU.3: Breastfeeding Table NU.4: Duration of breastfeeding Table NU.5: Age-appropriate breastfeeding Table NU.6: Introduction of solid, semi-solid or soft food Table NU.7: Minimum meal frequency Table NU.8: Bottle feeding Table NU.9: Iodized salt consumption Table NU.11: Low birth weight infants Table CH.1: Vaccinations in first year of life Table CH.2: Vaccinations by background characteristics Table CH.4: Oral rehydration solutions and recommended homemade fluids Table CH.5: Feeding practices during diarrhoea Table CH.6: Oral rehydration therapy with continued feeding and other treatments Table CH.7: Care seeking for suspected pneumonia and antibiotic use during suspected pneumonia Table CH.8: Knowledge of the two danger signs of pneumonia Table CH.9: Solid fuel use Table CH.10: Solid fuel use by place of cooking Table WS.1: Use of improved water sources Table WS.2: Household water treatment Table WS.3: Time to the source of drinking water Table WS.4: Person collecting water Table WS.5: Types of sanitation facilities Table WS.6: Use and sharing of sanitation facilities Table WS.7: Disposal of a child’s faeces Table WS.8: Drinking water and sanitation ladders 12 Table RH.1: Adolescent birth rate and total fertility rate Table RH.2: Early childbearing Table RH.3: Trends in early childbearing Table RH.4: Use of contraception among women Table RH.4M: Use of contraception among men Table RH.5: Unmet need for contraception Table RH.6: Antenatal care provider Table RH.7: Number of antenatal care visits Table RH.8: Content of antenatal care Table RH.9: Assistance during delivery Table RH.10: Place of delivery Table RH.10A: Lifetime experience with wasted pregnancies Table RH.10B: Induced abortion rates by residence Table RH.10C: Induced abortion rates by background characteristics Table RH.10D: Place of abortion Table RH.10E: Person that had the final say on taking the abortion decision Table RH.10F: Person assisting abortion Table CD.1: Early childhood education Table CD.2: Support for learning Table CD.3: Learning materials Table CD.4: Inadequate care Table CD.5: Early Child Development Index Table ED.1: Literacy among young people Table ED.2: School readiness Table ED.3: Primary school entry Table ED.4: Primary school Attendance Table ED.5: Secondary school Attendance Table ED.6: Children reaching last grade of primary school Table ED.7: Primary school completion and transition to secondary school Table ED.8: Education gender parity Table CP.1: Birth registration Table CP.4: Child discipline Table CP.5: Early marriage among women Table CP.5М: Early marriage among men Table CP.6: Trends in early marriage among women Table CP.6М: Trends in early marriage among men Table CP.7: Spousal age difference Table CP.11: Attitude towards domestic violence among women Table CP.11М: Attitude towards domestic violence among men 13 Table HA.1: Knowledge about HIV transmission, misconceptions about HIV/AIDS and comprehensive knowledge about HIV transmission Table HA.2: Knowledge about HIV transmission, misconceptions about HIV/AIDS and comprehensive knowledge about transmission among young women Table HA.1M: Knowledge about HIV transmission, misconceptions about HIV/AIDS and comprehensive knowledge about HIV transmission Table HA.2M: Knowledge about HIV transmission, misconceptions about HIV/AIDS and comprehensive knowledge about transmission among young men Table НА.3: Knowledge of mother-to-child HIV transmission among women Table НА.3М: Knowledge of mother-to-child HIV transmission among men Table НА.4: Accepting attitudes toward people living with HIV/AIDS among women Table НА.4М: Accepting attitudes toward people living with HIV/AIDS among men Table НА.5: Knowledge of a place for HIV testing among women Table НА.5М: Knowledge of a place for HIV testing among men Table HA.6: Knowledge of a place for HIV testing among sexually active young women Table HA.6M: Knowledge of a place for HIV testing among sexually active young men Table НА.7: HIV counseling and testing during antenatal care Table НА.8: Sexual behaviour that increases the risk of HIV infection among women Table НА.8М: Sexual behaviour that increases the risk of HIV infection among men Table НА.9: Sex with multiple partners among women Table НА.9М Sex with multiple partners among men Table НА.10: Sex with non-regular partners (young women) Table НА.10M: Sex with non-regular partners (young men) Table HA.14: Male circumcision Table TA.1: Current and ever use of tobacco among women Table TA.1M: Current and ever use of tobacco among men Table TA.2: Age at first use of cigarettes and frequency of use among women Table TA.2M: Age at first use of cigarettes and frequency of use among men Table TA.3: Use of alcohol among women Table TA.3M: Use of alcohol among men Table MT.1: Exposure to mass media among women Table MT.1M. Exposure to mass media among men Table MT.2: Use of computers and internet among women Table MT.2M: Use of computers and internet among men Table DV.1: Experience of physical violence Table DV.2: Persons committing physical violence Table DV.3: Force at sexual initiation Table DV.4: Experience of sexual violence Table DV.5: Experience of different forms of violence Table DV.6: Violence during pregnancy Table DV.7: Degree of marital control experienced by husbands Table DV.8: Forms of spousal violence 14 Table DV.9: Spousal violence by background characteristics Table DV.10: Spousal violence by husband’s characteristics and empowerment indicators Table DV.11: Injuries to women caused by spousal violence Table DV.12: Help seeking to stop violence Table SD.1: Expected ratios of completed interviews of Women and Children under 5 in selected households by Urban/Rural areas Table SD.2: Expected number of selected households to reach the target of completed interviews by administrative regions Table SD.3: Proportional and disproportional (Sqrt) sample allocation Table SD.4: Values, standard errors (SE), design effects (deff) for selected indicators, Kazakhstan, MICS3 (2006) Table SD.5: Final recommended sample size Table SE.1: Indicators selected for sampling error calculations Table SE.2: Sampling errors: Total sample Table SE.3: Sampling errors: Urban areas Table SE.4: Sampling errors: Rural areas Table SE.5: Sampling errors: Akmola Table SE.6: Sampling errors: Aktobe Table SE.7: Sampling errors: Almaty Table SE.8: Sampling errors: Almaty city Table SE.9: Sampling errors: Astana city Table SE.10: Sampling errors: Atyrau Table SE.11: Sampling errors: East Kazakhstan Table SE.12: Sampling errors: Zhambyl Table SE.13: Sampling errors: West Kazakhstan Table SE.14: Sampling errors: Karaganda Table SE.15: Sampling errors: Kostanai Table SE.16: Sampling errors: Kyzylorda Table SE.17: Sampling errors: Mangistau Table SE.18: Sampling errors: Pavlodar Table SE.19: Sampling errors: North Kazakhstan Table SE.20: Sampling errors: South Kazakhstan Table DQ.1: Age distribution of household population Table DQ.2: Age distribution of eligible and interviewed women Table DQ.2M: Age distribution of eligible and interviewed men Table DQ.2M-A: Percentage of selected households for interviews of men and percentage of interviewed men by area and region Table DQ.3: Age distribution of under-5 household population and under-5 questionnaires Table DQ.4: Women’s completion rates by socio-economic characteristics of households Table DQ.4M: Men’s completion rates by socio-economic characteristics of households Table DQ.5: Completion rates for under-5 questionnaires by socio-economic characteristics of households 15 Table DQ.6: Completeness of reporting Table DQ.7: Completeness of information for anthropometric indicators Table DQ.8: Accumulation in the results of anthropometric measurements Table DQ.11: Observation of under-5 birth certificates Table DQ.12: Observation of vaccination cards Table DQ.13: Presence of mother in the household and the person interviewed for the under-5 questionnaire Table DQ.14: Selection of children age 2-14 years for the child discipline module Table DQ.15: School attendance by one-year age group Table DQ.16: Sex ratio at birth among children ever born and living 16 List of Figures Figure HH.1: Age-sex distribution of household population in percent Figure CM.1: Under 5 years old children mortality rate by background characteristics Figure CM.2: Under 5 mortality trends Figure NU.1: Percentage of children under-5 who are underweight, stunted and wasted Figure NU.2: Initial Breastfeeding (within one hour and one day of birth) Figure NU.3: Infant feeding patterns by age Figure NU.4: Percentage of households consuming adequately iodized salt Figure NU.5: Percentage of infants weighing less than 2,500 grams at birth Figure CH.1: Percentage of children aged 15-26 months who received recommended vaccination by 12 months Figure WS.1: Percent distribution of households by sources of drinking water Figure WS.2: Use of improved sanitation facilities Figure CD.1: Percentage of children aged 36-59 months developmentally on track in the indicated domains Figure ED.1: Primary and secondary school net attendance ratio (NAR) (adjusted) Figure ED.2: Percentage of household members aged 5-24, attending school, by sex Figure CP.1: Percentage of children aged 2-14 ever disciplined by means of physical punishment, by sex Figure CP.2: Percentage of women aged 20-49 married before 18, by wealth index quintiles Figure HA.1: Percentage of women aged 15-49 who have comprehensive knowledge about HIV/AIDS transmission Figure HA.2: Sexual behaviour that increases the risk of HIV infection Figure TA.1: Alcohol consumption in one or more days within the last month by area of residence Figure MT.1: Use of computers and the Internet by women aged 15-24 Figure MT.1M: Use of computers and the Internet by men aged 15-24 Figure DQ.1: Number of household population by single ages 17 List of Abbreviations AIDS Acquired Immunodeficiency Syndrome BCG Bacillis-Cereus-Geuerin (Tuberculosis) CEE/CIS Central and Eastern Europe/Commonwealth of Independent States CIS Commonwealth of Independent States CDC Center for Disease Control and Prevention CSPro Census and Survey Processing System DHS Demographic Health Survey DPT Diphtheria Pertussis Tetanus EB Exclusive Breastfeeding ECD Early Child Development EPI Expanded Programme on Immunization FAP Feldsher Ambulatory Point GAR General Abortion Rate GPI Gender Parity Index Hep B Hepatitis B vaccine Hib Haemophilus influenza type B HIV Human Immunodeficiency Virus IDD Iodine Deficiency Disorder IQ Intelligence Quotient IUD Intrauterine Device LAM Lactational Amenorrhea Method Media Mass Media MDG Millennium Development Goals MICS Multiple Indicator Cluster Survey MoH Ministry of Health MMR Measles, Mumps, Rubella NAR Net Attendance Rate NCHS National Center for Health Statistics OPV Poliomyelitis Vaccination ORT Oral Rehydration Treatment ppm Parts Per Million PSU Primary Sampling Unit RACS Registration of Acts of Civil Status RSE Republican State Enterprise SD Standard Deviation SPSS Statistical Package for Social Sciences STD Sexually Transmitted Diseases TAR Total Abortion Rate 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 UNICEF United Nations Children’s Fund WFFC World Fit for Children WHO World Health Organization 18 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Acknowledgements Foreword and acknowledgements by Mr. Alikhan Smailov, Chairman of the Agency of Statistics, RK It has been 20 years since the day Kazakhstan gained its independence and embarked on the path of reform, building an open democratic society with a market and socially oriented economy. Over these years, there have been significant changes in all areas of the society. The entire society needs to have information on the status of children, women and men in the country. In this context, the outcomes of the fourth round of Multiple Indicator Cluster Survey conducted in Kazakhstan in 2010/11 (MICS4) performed to obtain information for assessing the status of children, women and men in Kazakhstan and monitoring progress towards the Millennium Development Goals and targets of the ‘World Fit for Children’ (WFFC) document and other internationally agreed instruments, are of great interest. Due to significant discrepancies in social and economic development of the regions of the country, the Kazakhstan survey was conducted at the subnational level as well, which makes it unique. I hope that the survey findings will be useful for the Government and civil society institutions in planning and developing social programmes that meet the requirements of the current situation and needs of women and children both at the national level and at the level of each region. Many experts at different levels have contributed to the successful completion of MICS4 and publication of this Final Report. We should mention a noble and rewarding role played by the UN and its organizations in our country. In particular, I would like to thank and mention international organizations operating in Kazakhstan such as the UN Children’s Fund (UNICEF) and the UN Population Fund (UNFPA) for their technical and financial support in preparation and implementation of MICS4 in Kazakhstan. I would like to thank the staff of the UNICEF Office in Kazakhstan in the person of Mr. Jun Kukita, UNICEF Representative in Kazakhstan, Ms. Hanaa Singer, former UNICEF Representative in Kazakhstan, Mr. Radoslav Rzehak, Deputy Representative of UNICEF in Kazakhstan, Mr. Raimbek Sissemaliyev, UNICEF Programme Monitoring and Evaluation Officer, for their significant technical, methodological and financial support in training and preparing the staff of the Agency of Statistics, RK and ongoing support in preparation and conduct of this survey. I would like to thank Global MICS Coordinator Mr. Attila Hancioglu (USA, New York) and, in his person, dozens of UNICEF staff around the world who conducted a series of training workshops, developed questionnaires and data input and indicator computation programmes, provided overall management as well as advice at all stages of preparation, conduct and processing of the results of this global survey, and in particular, MICS Project Coordinator from UNICEF Regional Office Mr. Siraj Mahmudlu (Switzerland, Geneva), who provided the best possible assistance to the Agency’s staff in preparing and conducting the survey in Kazakhstan. We would like to express our particular appreciation to Mr. Oleg Benes, international sampling consultant, for his expert assistance in the Kazakhstan MICS sampling. I would like to thank UNFPA Kazakhstan in the person of Mr. Nikolai Botev, Director of Subregional Office of the UN Population Fund, Mr. Alexander Kosukhin, UNFPA Programme Coordinator in Kazakhstan, Ms. Gaziza Moldakulova, UNFPA 19MONITORING THE SITUATION OF CHILDREN AND WOMEN Programme Coordinator in Kazakhstan, for co- financing provided to train and prepare the Agency of Statistics, RK staff and MICS fieldwork. I would like to thank all senior officials from oblast/city statistics departments, supervisors, editors and interviewers as well as management of RSE Information and Computer Centre of the Agency of Statistics for their significant contribution to successful completion of this Project. On this occasion, I would like to express my appreciation to representatives of national ministries and agencies, non-governmental sector and international institutions, which expressed their interest in MICS4 survey findings and provided their feedback on this Final Report. Alikhan Smailov Chairman Agency of Statistics, RK 20 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Foreword and acknowledgments by Mr. Jun Kukita, Representative of the UN Children’s Fund (UNICEF) in Kazakhstan It is with great pleasure that I present the Final Report on findings of the 2010-2011 Kazakhstan Mul- tiple Indicator Cluster Survey (MICS). To assist the Government of Kazakhstan in achieving the global goals and national priorities, the UN System coordinates and integrates the efforts of individual UN Agencies at the country level using stra- tegic tools, such as the 2010- 2015 United Nations Development Assistance Framework Programme (UN- DAF). It should also be noted that Kazakhstan, via the Agency of Statistics, has implemented this Multiple Indicator Cluster Survey for the second time and has provided co-financing for a part of activities such as training, data entry and processing. Many experts from the Agency of Statistics and its territorial divisions as well as its structural subdivi- sion RSE ‘Information and Computer Centre’ have con- tributed to successful completion of the MICS. In this context, I would like to express my sincere appreciation for the assistance of Mr. Alikhan Smailov, Chairman of the Agency of Statistics, RK who set the stage for its successful completion and provided his ongoing sup- port to the MICS project1; Mr. Nurbolat Aidapkelov, Executive Secretary of the Agency of Statistics, RK- Project Director, for arrangement of the survey at the preparatory and data collection stages and Mr. Aidyn Ashuyev, Deputy Chairman of the Agency of Statis- tics, RK (since August 2011), for arrangement of the preparation of the Final Report and, in his capacity as Head of RSE ‘Information and Computer Centre’ (until July 2011) for timely data collection and processing. I would like to thank staff of the Agency of Sta- tistics, RK and Information and Computer Centre in- volved in the Project: Ms. Gyulnara Kukanova, Direc- tor of Social and Demographic Statistics Department of the Agency of Statistics, RK (‘SDSD’), for overall coordination of efforts of all entities involved in the Project and planning of organization efforts to prepare and implement MICS4 and training of field teams dur- ing regional training workshops; Mr. Yerbolat Mussa- bek, Deputy Director of SDSD, for forming field teams for data collection purposes; Ms. Maira Amirkhano- va, Head of the Social Statistics Division of the SDSD (until March 2011), for training field teams and assisting in development and adaptation of MICS4 tools, field- work monitoring and preparation of this Report (August- December 2011); Ms. Nurzhamal Alkuatova, Head of the Social Statistics Division of the SDSD (since March 2011) for her assistance in development of data entry and processing monitoring and adaptation of MICS4 tools for Kazakhstan; Mr. Eldar Kazganbayev, Director of RSE ‘ICC’; Ms. Zinagul Dzhumanbayeva, Deputy Director of RSE ‘Information and Computing Centre’ for arranging the collection and processing of MICS data and handling financial reports of the executive partner of the Project; staff of RSE ‘ICC’: Ms. Gulzhan Kopeyeva, Deputy Head of the Department of Statistics Informa- tion Management and Information Systems Operation, for high-quality entry of MICS primary data, Ms. Aigul Kapisheva, Deputy Head of the Information Manage- ment Unit, for adaptation of MICS software and output generation; Ms. Saule Dauylbayeva, Deputy Head of the Information Management Unit, for survey sam- 1 Mentioned job titles of all Project participants are those held at the time of preparation and implementation of the MICS (2010-2011). 21MONITORING THE SITUATION OF CHILDREN AND WOMEN pling and editing of MICS primary data input; as well as all other staff involved in data processing. I highly appreciate the assistance of all directors of territorial statistics departments in Kazakhstan for al- locating skilled and responsible human resources (civil servants) for fieldwork, thus greatly contributing to the implementation of the survey, as well as staff of terri- torial statistics departments involved in data collection fieldwork. I would like to express my particular apprecia- tion to field team supervisors for high level of fieldwork arrangement, implementation and development of optimal routes for teams; interviewers for high-quality and timely data collection in the field in compliance with MICS requirements; editors for quality question- naire editing, fieldwork monitoring and timely delivery of questionnaires to the central office; and drivers for delivering teams to population centres on schedule. Unlike the 2006 Final Report, this final report in- cludes several new chapters featuring topical issues and a lot of interesting information on the status of chil- dren, women and men in Kazakhstan, and I believe it will be very useful to government agencies, non- governmental organizations, international institutions, faculties, students and the general public exploring the aforementioned problems. Jun Kukita Representative UNICEF in Kazakhstan Executive Summary 23MONITORING THE SITUATION OF CHILDREN AND WOMEN 2 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. The Multiple Indicator Cluster Survey in Kazakhstan is a nationally representative household sample. The sample size was 16,380 households. The sample is not self-weighting. For reporting national level results, sample weights are used. A more detailed description of the sample design can be found in Appendix A. Sample Coverage Of the 16,380 households selected for the sample, 16,018 were found to be occupied. Of these, 15,800 were successfully interviewed for a household response rate of 98.6 percent. In the interviewed households 14,228 women (age 15-49) were identified. Of these, 14,014 women were successfully interviewed, yielding a response rate of 98.5 percent. For men (age 15-59), these indicators were 4,043 – listed, 3,846 – successfully interviewed that gives response rate at 95.1 percent. In addition, 5,227 children under-5 were listed in the household questionnaire. Questionnaires were completed for 5,181 of these children, which corresponds to a response rate of 99.1 percent. Overall response rates of 97.2 percent and 97.8 percent are calculated for 15-49-year-old women’s and under-5’s interviews respectively. This response rate calculated for men aged 15-59 was 93.8 percent. Infant and Child Mortality In MICS surveys, infant and under-5 mortality rates are calculated based on an indirect estimation technique known as the Brass method2. The infant mortality rate is estimated at 28 per 1,000 live births, while the probability of dying under-5 is around 31 per 1,000 live births (these estimates refer to 2006). Nutritional Status of under-5 children In Kazakhstan 3.7 percent of children under 5 are moderately underweight (weight for age) and 1.2 percent are classified as severely underweight. At the same time, 13.1 percent of children are moderately stunted and 5.4 percent are too short. About 4.1 percent of children are wasted (weight for height) and 1.7 percent are severely wasted. Breastfeeding and Infant and Young Child Feeding Mothers of children born within the 2 years preceding the survey were interviewed during the survey. Despite the importance of early start of lactation and establishment of a physical and emotional relationship between a baby and a mother, only 67.8 percent of babies are breastfed for the first time within one hour of birth, and 87.9 percent of mothers started breastfeeding not later than within one day of giving birth. Only 31.8 percent of children aged less than six months are exclusively breastfed (a level considerably lower than recommended). By age 12-15 months, 50.8 percent of children are breastfed and by age 20-23 months, 26.1 percent are still breastfed. Overall, 49.4 percent of infants aged 6-8 months received solid, semi-solid, or soft foods. 24 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Salt Iodization In almost all households (98.7 percent), salt used for cooking was tested for iodine content by using salt test kits and testing for the presence of potassium iodate. In an extremely small proportion of households (0.8 percent), there was no salt available. In an overwhelming majority of households (85.4 percent), salt was found to contain 15 parts per million (ppm) or more of iodine. Low Birth Weight In Kazakhstan, almost all children (97.6 percent) were weighed at birth and approximately 4.5 percent of infants are estimated to weigh less than 2,500 grams at birth. Vaccinations According to all sources of information (respondents’ reports/vaccination cards) approximately all children (99.2 percent) aged 15-26 months received a BCG vaccination by the age of 12 months and the first dose of DPT was given to 98.4 percent. According to the same information sources, the percentage declines for subsequent doses of DPT to 96.8 percent for the second dose, and 93 percent for the third dose. Similarly, 98.1 percent of children received the polio vaccine by age 12 months and this declines to 81.3 percent by the third dose. The coverage for measles vaccine by 12 months is lower than for the other vaccines at 89 percent. At the same time, the percentage of children who had all the recommended vaccinations by their first birthday is 70.6 percent. Solid Fuel Use Overall, 10.8 percent of all households in Kazakhstan are using solid fuels for cooking. Use of solid fuels is very low in urban areas (3.1 percent), but high in rural areas, where 19.8 percent of the households are using solid fuels. About 87.8 percent of households use a separate room such as a kitchen for cooking; the percentage of such households is 94.5 percent in urban areas and 86.6 percent in rural areas. Use of Improved Water Sources In Kazakhstan, 93.9 percent of population use improved sources of drinking water. For 88.4 percent of households, the improved drinking water source is on the premises. For 3.9 percent of all households, it takes less than 30 minutes to get to the water source and bring water, while members of 1.6 percent of households spend 30 minutes or more for this purpose. A total of 70.7 percent of the population uses one or another way to treat drinking water obtained from all sources, both improved and unimproved sources. Over 55 percent of population boils water as the main method of water treatment, 11.4 percent of population let the water stay and settle, 12.4 percent uses filters and about one percent of population said that they strain water through a cloth. Other methods of water treatment are not very popular. Use of Improved Sanitation Close to 99.4 percent of the population in Kazakhstan are living in households using improved sanitation facilities. Almost 100 percent of population uses improved sanitation facilities almost in all regions (except for Mangistau Oblast – 88 percent). In Kazakhstan, 66.7 percent of children faeces were disposed safely. This figure was about the same in urban and rural areas. 25MONITORING THE SITUATION OF CHILDREN AND WOMEN Contraception Current use of contraception was reported by 51 percent of women currently married or in union. The most popular method is the intrauterine device (IUD) which is used by one in three (33.5 percent) women in Kazakhstan. The next most popular method is male condom (7.2. percent), while oral contraceptives are used by 7.1 percent of women. Only 40.6 percent of male respondents answered affirmatively to the question about their own or their partner’s use of any method of contraception. Unmet Need The survey shows that 11.6 percent of surveyed women have an unmet need for contraception. Unmet need for spacing and limiting are 6.9 and 4.7 percent respectively. Antenatal Care Coverage of antenatal care is very high in Kazakhstan with almost all women (99.2 percent) receiving skilled antenatal care (by a doctor, nurse, midwife or feldsher) at least once during the pregnancy. About 87 percent of women had more than four antenatal care visits during pregnancy. Assistance at Delivery In Kazakhstan all births (100 percent) occurring in the two years preceding the MICS survey were delivered by skilled personnel. Doctors assisted with the delivery of 81.7 percent of births, midwives and nurses assisted with 17.8 percent of births and feldshers and auxiliary midwives assisted with 0.4 percent. Abortions The average number of incomplete pregnancies per woman is 0.4. There are no major differences in abortion practice depending on the area, wealth quintile or the level of woman’s education. Age-related abortion rates increase after the age of 19 and stay at approximately the same level in the age groups 20-24, 25-29 and 30- 34 years old. An insignificantly larger number of induced abortions per 1,000 women may be observed in rural areas. Total abortion rate is 0.26 per woman. General abortion rate is 6.9 per 1,000 women. In 36.7 percent of the cases the woman makes an independent decision to have an abortion, at the same time every third woman (31.2 percent) is influenced by the doctor (medical worker), while every fourth respondent (26.3 percent) makes this decision together with her husband or partner. Literacy among Young Women and Men Literacy level among all women and men aged 15-24 is 99.9 percent. School Readiness Overall, 81.6 percent of children who are currently attending the first grade of primary school were attending pre- school the previous year in Kazakhstan. There are no significant differences across this indicator among boys and girls; however, there are differences across regions and socio-economic status of the households. It is important to note that compared to 2006 (MICS, Kazakhstan 2006)3, child pre-school attendance rate has increased by 5 times. 3 Multiple Indicator Cluster Survey 2006, Kazakhstan. Final Report. 26 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Primary and Secondary School Entry and Attendance Of all children of school entry age (7 years old) 93.8 percent entered the first grade. A total of 99.3 percent of children aged 7-10 are attending primary school4. Only 0.7 percent of children are out of school when they are expected to be participating in school. The proportion of children aged 11-17 attending secondary school is 96.1 percent. The ratio of girls to boys attending primary and secondary education is better known as the Gender Parity Index (GPI). The gender parity index for primary and secondary education in Kazakhstan is 1.00. Birth Registration The births of 99.7 percent of children aged under 5 in Kazakhstan were registered. Child Discipline In Kazakhstan, 49.4 percent of children aged 2-14 were subjected to at least one form of psychological or physical punishment by their mothers/caretakers or other household members in the month preceding the survey. As a whole, 2.1 percent of children were subjected to severe physical punishment in the country. It should also be noted that only a small part of respondents to household questionnaire (6.5 percent) believe that children should be physically punished to be raised properly; although in reality more than 29 percent of children aged 2-14 years were subjected to any form of physical punishment. Early Marriage In Kazakhstan, 4.5 percent of women aged 15-19 were married or in union. The proportion of women at the age of 15-49 who got married or lived in union with men before they turned 15 was 0.2 percent. This indicator for men in the age group 15-59 is 0.3 percent. The proportion of people at the age of 20-49 who married before they turned 18 was 8.6 percent among women and 1.1 percent among men. Slightly more than 7 percent of women aged 20- 24 and 8 percent of women aged 15-19 were married to a man ten or more years older at the time of the survey. The percentage of women reported that their husbands were younger is 9.8 percent. Attitude towards Domestic Violence Overall, 12.2 percent of women in Kazakhstan feel that a husband/partner has a right to hit or beat them for at least one of a variety of reasons. Women who approve their partner’s violence in most cases agree and justify violence in instances when they neglect the children (9.7 percent), or if they demonstrate their autonomy, e.g. go out without telling their husbands (3.1 percent) or argue with them (3.7 percent). Only 1.2 percent of women believe that a partner has a right to hit or beat them if they refuse to have sex with their partners or if they burn the food (0.8 percent). The percentage of men (16.7 percent) who agree to beat his wife refer at least one of the variety of reasons is higher than women (12.2 percent). 4 Ratios presented in this table are “adjusted” since they include not only primary school attendance, but also secondary school attendance in the numerator. 27MONITORING THE SITUATION OF CHILDREN AND WOMEN Knowledge about HIV Transmission and Misconceptions about HIV/AIDS In Kazakhstan, almost all interviewed women (95.9 percent) have heard of HIV/AIDS. However, the percentage of women who know of two main ways of preventing HIV transmission (having only one faithful uninfected partner and using a condom every time while having sex) is only 70.5 percent. About 79 percent of interviewed women know of having one faithful uninfected sex partner and about the same percentage (78.9 percent) know of using a condom every time while having sex as main ways of preventing HIV transmission. Almost 95.6 percent of women in the 15-24 age group have heard about HIV, but only 67.2 percent of the respondents indicated that they were aware of at least two ways to prevent HIV transmission. Women aged 15-19 are less aware about ways to prevent HIV (61.5 percent) than those respondents (72.5 percent) who are older. The results of a similar survey among men showed that almost all interviewed men aged 15-59 years (94.6 percent) had ever heard of HIV, with the proportion of men knowing the two main ways of HIV prevention being 73.6 percent. The survey showed that men are better aware of HIV prevention methods than women. In terms of knowledge of where to get HIV tested, 81.1 percent of women and 75.5 percent of men knew where to be tested. Accepting Attitudes toward People Living with HIV/AIDS In Kazakhstan 90.7 percent of interviewed women who have heard of HIV/AIDS agree with at least one of the accepting attitudes. Men are less loyal to people with HIV/AIDS than women. The most popular loyal attitude is the readiness to take care of the family member with AIDS at home – 86.4 percent of interviewed women and 83.5 percent of interviewed men agreed to do it. Only 33.8 percent of women and 28.5 percent of men believe that a female teacher with HIV/AIDS should be allowed to continue teaching at school and only 18 percent of women and men are ready to buy fresh vegetables from an HIV/AIDS infected seller, while 15.3 percent of women and 14.5 percent of men would not keep secret that their family member is infected with the HIV virus. In Kazakhstan only a little over 2.5 percent of women and men agree with all loyal attitudes towards people living with HIV/AIDS. Use of Tobacco In Kazakhstan, tobacco use is more prevalent among men than among women. About 74.3 percent of men and 20.8 percent of women reported ever using a tobacco product. Major differences are found when 7.5 percent of women and 54.9 percent of men smoked cigarettes or used smokeless or smoking tobacco products on one or more days in the past month. Cigarettes are now the most popular tobacco product among men and women using tobacco (6.5 percent of women and 50.7 percent of men smoked only cigarettes in the past month). Those currently smoking cigarettes whith more than 20 cigarettes in the past 24 hours are vastly greater among men with 36.2 percent as compared to women with 9.7 percent. The survey showed that 1.3 percent of women aged 15-49 and 8.7 percent of men aged 15-49 smoked their first cigarette before the age of 15. Use of Alcohol In Kazakhstan, 26.6 percent of women aged 15-49 had at least one serving of alcohol on one or more days in the past month while among men, 45.6 percent aged 15-59 had at least one serving of alcohol on one or more days in the past month, which is higher than the same indicator among women (aged 15-49). The proportion of men who first had alcohol before the age of 15, is also higher than that of women (3.4 percent of men in the age group 15-49 compared to 0.9 percent of women in the age group 15 -49). 28 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Access to Mass Media A little over 60 percent of women and men read a newspaper, 29.1 percent of women and 40 percent of men listen to the radio and practically all interviewed women and men (98 percent each) watch television at least once a week. A small percentage of 0.8 of women are not exposed to some of the three mass media on a regular basis, whereas 22.9 percent are exposed to all three types of mass media at least once a week. Among men, the percentage of those exposed to all three types of mass media at least once a week is somewhat larger at 30.3 percent. Age groups 35-39 and 45-49 (67 percent in both groups) have a higher percentage of newspaper readers, whereas younger groups 15-19 and 20-24 have a higher percentage of radio listeners. Among men the highest percent of those reading newspapers is in the age group 45-49 (73.7 percent), men aged 20-24 and 25- 29 are most active radio listeners. Use of Information / Communication Technology According to the survey 95.1 percent of women aged 15-24 have ever used a computer, 83.6 percent used a computer within the past year, and 71 percent used it at least once a week during the past month. Overall, 76.6 percent of women aged 15-24 have ever used the Internet, while 67.5 percent used the Internet within the past year. The proportion of young women using the Internet more frequently, i.e., at least once a week during the past month, was smaller, 54 percent. The proportion of young men and women who used a computer and the Internet in the past year is almost the same. In the past year, 82.4 percent of men aged 15-24 years used computers and 55.7 percent used the Internet at least once. Domestic Violence In Kazakhstan 12.8 percent of ever-married women aged 15-49 experienced physical violence and 3.2 percent experienced sexual violence after the age 15. Of the women aged 15-49 who reported having been physically abused, 60.2 percent reported being abused by their husbands/partners and 39.6 percent by their ex-husbands/ partners. Of the currently married women who reported having been physically abused, 100 percent reported being abused by their husband/partner and 9.3 percent by their ex-husbands/ex-partners. Of the never married women who reported having been physically abused, 30.1 percent reported being abused by their mothers/ stepmothers, 18.4 percent by their sisters/brothers, 13.1 percent by their fathers/stepfathers and 18.8 percent by their ex-boyfriends. Husbands/partners demonstrated the following specific types of behaviour: jealousy (42.6 percent), constant control (44.3 percent), and accusing wife of unfaithfulness (10.9 percent). Limitations of contacts with the wife’s family and girlfriends could also be observed (4.1 percent and 9.0 percent respectively). Besides moral and psychological forms of abuse, there were also economic abuse of women demonstrated in not trusting wives with the money (7.0 percent). Of those who have ever sought help the largest proportion of women sought help from their families and their husbands’ families (33.7 and 14.3 percent respectively); only 8.8 percent of women sought help from policemen and 8.8 percent sought help from relatives. There were very few cases of women seeking help from advocates/lawyers and organizations providing social assistance (0.2 -0.4 percent respectively). 29MONITORING THE SITUATION OF CHILDREN AND WOMEN I. Introduction 30 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Background Declaration by the President of the Republic of Kazakhstan, the Government of the Republic of Kazakhstan committed itself to monitoring progress towards the Millennium Development Goals (MDGs) by 2015. Assessment of progress indicators is crucial both as input for further action and for assessment of changes. Long-term strategic development of This report is based on the Kazakhstan Multiple Indicator Cluster Survey (MICS), conducted in 2010- 2011 by the Agency of Statistics, RK primarily with technical and financial support of the United Nations Children’s Fund (UNICEF) and co-financing of the United Nations Population Fund (UNFPA). The survey provides valuable information on the situation of children, women and men in Kazakhstan, and was based, in large part, on the needs to monitor progress towards goals and targets emanating from recent international agreements: the Millennium Declaration, adopted by all 191 United Nations Member States in September 2000, and the Plan of Action of a World Fit For Children, adopted by 189 Member States at the United Nations Special Session on Children in May 2002. Both of these commitments build upon promises made by the international community at the 1990 World Summit for Children. In signing these international agreements, governments committed themselves to improving conditions for their children and to monitoring progress towards that end. UNICEF was assigned a supporting role in this task (see table below). Following the signing of the Millennium A Commitment to Action: National and International Reporting Responsibilities The governments that signed the Millennium Declaration and the World Fit for Children Declaration and Plan of Action also committed themselves to monitoring progress towards the goals and objectives they contained: “We will monitor regularly at the national level and, where appropriate, at the regional level and assess progress towards the goals and targets of the present Plan of Action at the national, regional and global levels. Accordingly, we will strengthen our national statistical capacity to collect, analyse and disaggregate data, including by sex, age and other relevant factors that may lead to disparities, and support a wide range of child- focused research. We will enhance international cooperation to support statistical capacity-building efforts and build community capacity for monitoring, assessment and planning.” (A World Fit for Children, paragraph 60) The Plan of Action (paragraph 61) also calls for the specific involvement of UNICEF in the preparation of periodic progress reports: “… As the world’s lead agency for children, the United Nations Children’s Fund is requested to continue to prepare and disseminate, in close collaboration with Governments, relevant funds, programmes and the specialized agencies of the United Nations system, and all other relevant actors, as appropriate, information on the progress made in the implementation of the Declaration and the Plan of Action.” Similarly, the Millennium Declaration (paragraph 31) calls for periodic reporting on progress: “…We request the General Assembly to review on a regular basis the progress made in implementing the provisions of this Declaration, and ask the Secretary-General to issue periodic reports for consideration by the General Assembly and as a basis for further action.” 31MONITORING THE SITUATION OF CHILDREN AND WOMEN Kazakhstan is closely linked to the MDGs. State and sectoral programmes as well as national development strategies incorporate all MDGs and targets of the international conmitment. Strategic development priorities of Kazakhstan are also enshrined in the long- term National Strategy ‘Kazakhstan-2030’ and the Mid-Term Development Plan ‘Kazakhstan-2015’ and are focused on bridging gaps between the rich and the poor, strengthening human security through lower social vulnerability, better quality of social services, environment enhancement, civil society involvement in development and strengthening the institutional capacity of government authorities. Over the past 20 years Kazakhstan has made significant progress towards the MDGs. The Republic has developed a number of strategies and state programmes to achieve national goals and priorities such as: • 2000-2002 Programme to Combat Poverty and Unemployment in the Republic of Kazakhstan; • 2003-2005 State Poverty Reduction Programme; • 2005-2010 State Programme to Reform and Develop Public Healthcare; • 2005-2010/11 State Education Programme in Kazakhstan; • 2011-2020 State Education Development Programme of the Republic of Kazakhstan; • 2006-2016 Gender Equality Strategy of the Republic of Kazakhstan; • 2004-2010 Rural Development Programme; • 2002-2010 Sectoral Programme ‘Drinking Water’; • 2001-2005 Programme to Counteract AIDS Epidemics in the Republic of Kazakhstan; • 2006-2011 ‘Children of Kazakhstan’ Programme; • 2010-2014 Pre-Schooling Coverage Programme ‘Balapan’; • 2011-2015 State Healthcare Development Programme ‘Salamatty Kazakhstan’; • 2011-2020 Water Supply Programme ‘Ak Bulak’; • Programme to Upgrade the Housing and Public Utility Sector until 2020; • 2007-2009 Programme to Bridge Informational Divide in the Republic of Kazakhstan; • The Convention on the Rights of the Child; • The Convention on the Elimination of All Forms of Discrimination against Women; • UN Framework Development Assistance Programme This Final Report presents the results of the indicators and topics covered in the survey. Survey Objectives The primary objectives of the Kazakhstan MICS 2010-2011 are: • To provide up-to-date information for assessing the situation of children, women and men in Kazakhstan; • To furnish data needed for monitoring progress toward goals established in the Millennium Declaration and other internationally agreed upon goals, as a basis for future action; • To contribute to the improvement of data and monitoring systems in Kazakhstan and to strengthen technical expertise in the design, implementation, and analysis of such systems; • To generate data on the situation of children and women, including the identification of vulnerable groups and disparities, to inform policies and interventions and develop state programmes on the improvement of all spheres of life. II. Sample and Survey Methodology 33MONITORING THE SITUATION OF CHILDREN AND WOMEN Sample Design The sample for MICS4 2010-2011 was de- signed to provide estimates for a large number of indicators on the situation of children and women at the national level, for urban and rural areas, and for 16 regions: Akmola, Aktobe, Almaty, Atyrau, East Ka- zakhstan, Zhambyl, West Kazakhstan, Karaganda, Kostanai, Kyzylorda, Mangistau, Pavlodar, North Ka- zakhstan and South Kazakhstan Oblasts and Astana and Almaty cities. The sample was selected in three stages. The sample was stratified down to urban and rural ar- eas as follows: each of 14 oblasts was divided into 2 groups: urban and rural, forming 28 strata, plus two urban strata, Astana and Almaty cities, thus result- ing in 30 strata (16 urban and 14 rural ones). Primary sampling units (PSUs) or clusters were determined based on the 2009 Population Census enumeration areas as one (or more) enumeration area per PSU. At the first stage, 780 PSUs throughout the country were selected with probability proportional to size within each stratum, where the measure of size of each PSU was based on the estimated number of segments. Some of the PSUs were so large that it was not economically possible to compile a new list of households, in such cases the use of smaller seg- ments as clusters was more effective. In Kazakhstan MICS for 2010-2011, the size of PSUs was measured by the number of standard segments determined by dividing the number of PSU households by 100 and rounding it up to the nearest whole number. At the second stage, each selected PSU was divided into segments with 100 households each, us- ing available maps or new sketch maps drawn up by enumerators in the field. Segmentation was only done for PSUs with a size corresponding to 2 or more seg- ments. In this case, the PSU was divided into parts equal to the number of segments and each segment had approximately the same number of households. Following that, one segment was selected with equal probability. A list of households was made for each of the selected segments and used afterwards during the third sampling stage. During the third stage, 21 households were selected systematically with equal probability in each selected PSU or segment. Thus, the total sample size was 16,380 households. The sample is not self-weighting. For report- ing national level results, sample weights are used. A more detailed description of the sample design can be found in Appendix A. Questionnaires o Child Discipline o Salt Iodization The Questionnaire for Individual Women was ad- ministered to all women aged 15-49 years living in the households, and included the following modules: o Women’s Background o Access to Mass Media and Use of Information/ Communication Technology o Child Mortality o Desire for Last Birth o Maternal and Newborn Health o Illness Symptoms o Contraception o Unmet Need o Attitudes Towards Domestic Violence o Marriage/Union o Sexual Behaviour o HIV/AIDS o Tobacco and Alcohol Use o Domestic Violence Four sets of questionnaires were used in the survey: 1) Household questionnaire which was used to collect information on all de jure household members (usual residents), the household, and the dwelling; 2) Women’s questionnaire administered in each house- hold to all women aged 15-49 years; 3) Under-5 questionnaire, administered to mothers or caretakers for all children under 5 living in the house- hold; 4) Men’s questionnaire was introduced in Kazakhstan MICS4 for the first time and was administered to se- lected men aged 15-59 living in every third household in the cluster. Each questionnaires included its own modules: The Household Questionnaire included the following modules: o Household Listing Form o Education o Water and Sanitation o Household Characteristics 34 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN 5 The terms “children under 5”, “children aged 0-4 years”, and “children aged 0-59 months” are used interchangeably in this report. 6 The model MICS4 questionnaires can be found at www.childinfo.org The Questionnaire for Individual Men was adminis- tered to each third man among all men aged 15-59 living in the households, and included the following modules: o Men’s Background o Access to Mass Media and Use of Information/ Communication Technology o Contraception o Attitudes Towards Domestic Violence o Marriage/Union o Sexual Behaviour o HIV/AIDS o Circumcision o Tobacco and Alcohol Use The Questionnaire for Children Under 5 was admin- istered to mothers or caretakers of children under 5 5 living in the households. Normally, the questionnaire was administered to mothers of under-5 children; in cases when the mother was not listed in the household roster, a primary caretaker for the child was identified and interviewed. The questionnaire included the fol- lowing modules: o Age o Birth Registration o Early Childhood Development o Breastfeeding o Care of Illness o Immunization o Anthropometry The questionnaires are based on the MICS 2006 model questionnaire6. From the MICS 2006 model Eng- lish version, the questionnaires were translated into Rus- sian and Kazakh. The MICS 2010-2011 questionnaires include new modules on Access to Mass Media and Use of Information and Communication Technology, Sexual Behaviour, Tobacco and Alcohol Use. As recommend- ed by UNFPA a module on Abortions was added and due to the adoption of the Law of the Republic of Ka- zakhstan on the Prevention of Domestic Violence. The Agency of Statistics suggested including a module on Domestic Violence. The questionnaires were pre-test- ed in Astana during July-August 2010. Based on the results of the pre-test, modifications were made to the wording and translation of the questionnaires into Ka- zakh. A copy of the Kazakhstan MICS questionnaires is provided in Appendix F. In addition to conducting interviews, the teams working in the fields tested salt used for cooking in the households for iodine content and measured the weights and heights of children under 5. Details and findings of these measurements are provided in the respective sections of the report. 35MONITORING THE SITUATION OF CHILDREN AND WOMEN Training and Fieldwork tures on interviewing techniques and the contents of the questionnaires, and mock interviews between trainees to gain practice in asking questions. To- wards the end of the training period, trainees spent 2 days in practice interviewing in Schuchye in Ak- mola Oblast. The data were collected by 16 teams; each was comprised of 6 interviewers (of them 5 wom- en and 1 man who was simultaneously measur- ing children’s weight and height), one driver, one editor, one measurer and a supervisor. Fieldwork began in November 2010 and concluded in Janu- ary 2011. The data were entered on 18 computers and carried out by 14 data entry operators and 4 data en- try supervisors (including 2 editors) using the CSPro software. In order to ensure quality control, all ques- tionnaires were double entered and internal consis- tency checks were performed. Procedures and stan- dard programmes developed under the global MICS4 programme and adapted to the Kazakhstan question- naire were used throughout. Data processing began simultaneously with data collection in November 2010. Data entry was completed in the end of January 2011; processing and editing of the primary database was completed in July – August 2011. In August 2011 the results of preliminary MICS4 analysis were presented to concerned authorities (representatives of various ministries and agencies) as well as international orga- nizations. The tables in certain new modules (for in- stance on Domestic Violence and Abortions) and the Questionnaire for Individual Men were discussed and corrected with the help of UNICEF international consul- tants up until the end of 2011. Data were analysed using the Statistical Pack- age for Social Sciences (SPSS) software programme, Version 18, and the model syntax and tabulation plans developed by UNICEF and adapted to the Ka- zakhstan questionnaires by a software expert from the Information and Computer Centre of the Agency of Statistics, RK. Data Processing The preparation of the Agency of Statistics, RK staff involved in Kazakhstan MICS4 was carried out by UNICEF headquarters in New York and UNICEF Regional Office for CEE/CIS countries who organized their participation in regional training seminars in 2009- 2011 (2009 – Amman (Jordan); 2010, 2011 – Istanbul (Turkey); 2010 – Belgrade (Serbia). Training seminar programmes focused on sampling design, survey lo- gistics and budget planning; themes for certain MICS4 questionaire modules, MICS indicators, data and tabu- lation processing as well as MICS results dissemina- tion. Training for the fieldwork was conducted for 12 days in September 2010. Training included lec- III. Sample Coverage and the Characteristics of Households and Respondents 37MONITORING THE SITUATION OF CHILDREN AND WOMEN Sample Coverage Of the 16,380 households selected for the sample, 16,018 were found to be occupied. Of these, 15,800 were successfully interviewed for a house- hold response rate of 98.6 percent. In the interviewed households, 14,228 women (age 15-49 years) were identified. Of these, 14,014 women were success- fully interviewed, yielding a response rate of 98.5 percent. For men (age 15-59 years), these indicators were 4,043 – listed, 3,846 – successfully interviewed giving response rate 95.1 percent. In addition, 5,227 children under 5 were listed in the household ques- tionnaire. Questionnaires were completed for 5,181 of these children, which corresponds to a response rate of 99.1 percent. Overall response rates of 97.2 and 97.8 percent are calculated for 15-49 year-old women’s and under-5’s interviews respectively. The response rate for men (aged 15-59 years) was 93,8 percent. Table HH.1: Results of household, women, men and under-5 interviews Numbers of households, and response rates of women, men and children under 5, Kazakhstan, 2010/11 Residence Total Urban Rural Households Households sampled 10038 6342 16380 Households occupied 9822 6196 16018 Households interviewed 9629 6171 15800 Overall response rate 98,0 99,6 98,6 Women Women eligible 8341 5887 14228 Women interviewed 8234 5780 14014 Women response rate 98,7 98,2 98,5 Women’s overall response rate 96,8 97,8 97,2 Men Men eligible 2332 1711 4043 Men interviewed 2207 1639 3846 Men response rate 94,6 95,8 95,1 Men’s overall response rate 92,8 95,4 93,8 Children under 5 Children under 5 eligible 2678 2549 5227 Interviewed children under 5 2653 2528 5181 Child response rate 99,1 99,2 99,1 Children’s overall response rate 97,1 98,8 97,8 38 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Continued REGIONS Akmola Oblast Aktobe Oblast Almaty Oblast Almaty city Astana Atyrau Oblast East Kazakhstan Oblast Zhambyl Oblast Households Households sampled 1176 882 1008 1008 924 798 1218 882 Households occupied 1134 849 975 1000 923 785 1177 866 Households interviewed 1118 813 956 990 920 774 1142 857 Household response rate 98,6 95,8 98,1 99,0 99,7 98,6 97,0 99,0 Women Eligible women 771 794 996 801 937 887 836 815 Interviewed women 744 788 985 800 931 859 819 804 Women response rate 96,5 99,2 98,9 99,9 99,4 96,8 98,0 98,7 Women’s overall response 95,1 95,0 97,0 98,9 99,0 95,5 95,1 97,6 Men Eligible men 267 226 268 217 233 225 276 229 Interviewed men 250 210 254 211 231 198 258 223 Men response rate 93,6 92,9 94,8 97,2 99,1 88,0 93,5 97,4 Men’s overall response rate 92,3 89,0 92,9 96,3 98,8 86,8 90,7 96,4 Children under 5 Eligible children under 5 239 297 357 138 294 383 258 387 Interviewed children under 5 229 295 356 137 294 382 255 386 Child response rate 95,8 99,3 99,7 99,3 100,0 99,7 98,8 99,7 Children’s overall response rate 94,5 95,1 97,8 98,3 99,7 98,3 95,9 98,7 Continued REGIONS West Kazakhstan Oblast Karaganda Oblast Kostanai Oblast Kyzylorda Oblast Mangistau Oblast Pavlodar Oblast North Kazakhstan Oblast South Kazakhstan Oblast Households Households sampled 966 1218 1260 798 798 1176 1260 1008 Households occupied 953 1210 1249 777 743 1144 1242 991 Households interviewed 949 1207 1237 776 714 1129 1240 978 Household response rate 99,6 99,8 99,0 99,9 96,1 98,7 99,8 98,7 Women Eligible women 843 955 879 874 887 917 906 1130 Interviewed women 840 944 871 869 863 881 893 1123 Women response rate 99,6 98,8 99,1 99,4 97,3 96,1 98,6 99,4 Women’s overall response 99,2 98,6 98,1 99,3 93,5 94,8 98,4 98,1 Men Eligible men 245 260 270 235 217 287 296 292 39MONITORING THE SITUATION OF CHILDREN AND WOMEN REGIONS West Kazakhstan Oblast Karaganda Oblast Kostanai Oblast Kyzylorda Oblast Mangistau Oblast Pavlodar Oblast North Kazakhstan Oblast South Kazakhstan Oblast Interviewed men 238 246 261 231 197 275 283 280 Men response rate 97,1 94,6 96,7 98,3 90,8 95,8 95,6 95,9 Men’s overall response rate 96,7 94,4 95,7 98,2 87,2 94,6 95,5 94,6 Children under 5 Eligible children under 5 291 314 250 455 468 268 218 610 Interviewed children under 5 291 312 249 453 457 259 218 608 Child response rate 100,0 99,4 99,6 99,6 97,6 96,6 100,0 99,7 Children’s overall response rate 99,6 99,1 98,6 99,4 93,8 95,4 99,8 98,4 It should be noted that household response rate is 99.6 percent in rural areas, which is slightly higher than in urban areas at 98 percent. The overall household response rate through- out the country was high and varied from 95.8 to 96.1 percent in Aktobe and Mangistau Oblasts, to 97 per- cent in East Kazakhstan Oblast, from 98.1 to 98.7 percent in Almaty, Akmola, Atyrau, South-Kazakhstan and Pavlodar Oblasts, from 99 to 99.9 percent in Kostanai, Zhambyl, West Kazakhstan, Karaganda, North-Kazakhstan and Kyzylorda Oblasts and Astana and Almaty cities. According to table HH.1, the response rate among men (95.1 percent) is slightly lower than the response rate among women (98.5 percent) and moth- ers/caretakers (99.1 percent). The age and sex distribution of survey popu- lation is provided in Table HH.2. The distribution is also used to produce the population pyramid in Fig- ure HH.1. A total of 54,549 household members were listed, from the 15,800 households successfully inter- viewed. These data also demonstrate that according to the assessment made during the 2009 Census, the size of an average household is 3.5 people. Table HH.2: Household age distribution by sex Percent and frequency distribution of the household population by five-year age groups, dependency age groups, and by child (age 0-17 years) and adult populations, by sex, Kazakhstan, 2010/11 MALES FEMALES TOTAL Number Percent Number Percent Number Percent Age 0–4 2654 10,2 2544 8,9 5198 9,5 5–9 2117 8,1 2217 7,8 4334 7,9 10–14 2056 7,9 2065 7,2 4120 7,6 15–19 2249 8,6 2039 7,2 4289 7,9 20–24 2361 9,1 2206 7,7 4567 8,4 25–29 2085 8,0 2036 7,1 4122 7,6 30–34 1960 7,5 2030 7,1 3990 7,3 35–39 1829 7,0 1916 6,7 3745 6,9 40–44 1788 6,9 1936 6,8 3724 6,8 45–49 1863 7,2 1993 7,0 3856 7,1 50–54 1599 6,1 2040 7,2 3639 6,7 Characteristics of Households 40 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN MALES FEMALES TOTAL Number Percent Number Percent Number Percent 55–59 1120 4,3 1520 5,3 2640 4,8 60–64 919 3,5 1204 4,2 2123 3,9 65–69 445 1,7 679 2,4 1125 2,1 70-74 600 2,3 1020 3,6 1620 3,0 75-79 214 0,8 502 1,8 716 1,3 80-84 139 0,5 381 1,3 519 1,0 85+ 50 0,2 167 0,6 217 0,4 Missing/DK 0 0,0 3 0,0 3 0,0 Dependency age groups Below 15 6827 26,2 6825 23,9 13653 25,0 15–64 17774 68,2 18921 66,4 36695 67,3 65 and older 1449 5,6 2749 9,6 4198 7,7 Missing/DK 0 0,0 3 0,0 3 0,0 Children and adult populations Children age 0–17 8243 31,6 8080 28,4 16323 29,9 Adults 18+ 17807 68,4 20416 71,6 38223 70,1 Missing/DK 0 0,0 3 0,0 3 0,0 Total 26050 100,0 28499 100,0 54549 100,0 The population aged 0-14 make up 25 percent of the surveyed population, including 6,827 boys (26.2 percent of all men) and 6,825 girls (23.9 percent of all women). The population aged 15-64 make up 67.3 per- cent, where 68.2 percent or 17,744 are men and 66.4 percent or 18,925 are women. For the population aged above 65 were surveyed a total of 4,198 people or 7.7 percent including 1,449 men (5.6 percent) and 2,749 women (9.6 percent). There are 16,323 children aged 0-17, account- ing for 29.9 percent of all surveyed household mem- bers, 31.6 percent are males and 28.4 percent are females. Compared to the 2009 Census data, the MICS shows a 3, 0.3 and 0.7 percent larger popula- tion in the 0-14, 0-17 and 65+ age groups respec- tively, and a 2 percent smaller population in the age group 15-64. 41MONITORING THE SITUATION OF CHILDREN AND WOMEN From Figure HH.1, a total of 54,549 people aged 0 to 85 years and older were surveyed in these house- holds, of these 47.8 percent are men and 52.2 percent are women. As currently reported by the Agency of Sta- tistics, RK as of January 1, 2011, the proportion of men and women was 48.2 percent and 51.8 percent respec- tively, and the sample did not show large deviations. In the age-sex pyramid, age groups are broken down into five-year groups: 0-4 years, 5-9 years, and so forth to 85 years and above. The proportion of men and women in these age groups was grouped: based on 0-4 years with 4.8 percent male and 4.7 percent female; 5-9 years with 3.9 percent male and 4.1 percent female; 10-14 years with 3.8 percent male and 3.8 percent female; 15-19 years with 4.1 percent male and 3.7 percent female; 20-24 years with 4.3 percent male and 4.0 percent female; 25-29 years with 3.8 percent male and 3.7 percent female; 30-34 years with 3.6 percent male and 3.7 percent female; 35-39 years with 3.4 percent male and 3.5 percent female; 40-44 years with 3.3 percent male and 3.6 percent female. In the age group 85 years and above the make up of men is 0.1 percent and women is 0.3 percent. It should be noted that starting from the age group 55-59, the gap between the proportions of men and women widens, reaching 1.9 percent in the age group 70 and above. These data show the same trend in the age-sex population pyramid in current statistics as of Janu- ary 1, 2011. Distribution of male and female shares by these age groups in the sample is similar to the current statistics. Tables HH.3 to HH.5 provide basic information on the households, female respondents aged 15-49, male respondents aged 15-59 and children under-5 by presenting the unweighted, as well as the weighted numbers. Information on the basic characteristics of households, women, men and children under-5 inter- viewed in the survey is essential for the interpretation of findings presented later in the report and also can provide an indication of the representativeness of the survey. The remaining tables in this report are present- ed only with weighted numbers. See Appendix A for more details about the weighting. Table HH.3 provides basic background informa- tion on the households. Within households, the sex of the household head, region, residence, number of household members, education of household head and language/ethnicity7 of the household head are shown in the table. These background characteristics are used in subsequent tables in this report. The fig- ures in the table are also intended to show the numbers of observations by major categories of analysis in the report. Table HH.3: Household composition Percentage distribution of households by selected characteristics, Kazakhstan, 2010/11 Weighted percent Number of Households weighted unweighted Sex of household head Male 63,9 10090 10136 Female 36,1 5710 5664 Region Akmola Oblast 5,6 884 1118 Aktobe Oblast 4,5 713 813 Almaty Oblast 9,3 1470 956 Almaty city 9,3 1473 990 Astana city 3,4 544 920 Atyrau Oblast 2,3 359 774 East Kazakhstan Oblast 10,6 1673 1142 Zhambyl Oblast 5,6 890 857 West Kazakhstan Oblast 4,1 647 949 Karaganda Oblast 10,3 1629 1207 Kostanai Oblast 7,1 1129 1237 7 Determined by asking the question regarding the mother tongue of the household head. The question was asked in the following way: HC1b. What is the mother tongue of the household head? 42 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Weighted percent Number of Households weighted unweighted Kyzylorda Oblast 3,2 498 776 Mangistau Oblast 2,4 372 714 Pavlodar Oblast 5,9 931 1129 North Kazakhstan Oblast 5,0 795 1240 South Kazakhstan Oblast 11,4 1794 978 Residence Urban 60,7 9598 9629 Rural 39,3 6202 6171 Number of Household Members 1 15,7 2488 2462 2 20,8 3284 3292 3 19,7 3113 3147 4 17,9 2831 2910 5 11,9 1875 1859 6 6,9 1084 1070 7 3,8 597 558 8 1,6 256 243 9 0,9 147 133 10+ 0,8 125 126 Education of Household Head No 0,5 74 60 Incomplete secondary 12,0 1904 1896 Secondary 30,3 4793 4720 Specialized secondary 32,4 5120 5242 Higher 24,7 3910 3882 Ethnicity/language of Household Head Kazakh 53,8 8501 8740 Russian 32,6 5158 5051 Other ethnic groups 13,5 2141 2009 Total 100 15800 15800 Households with At least one child age 0-4 years 24,9 15800 15800 At least one child age 0-17 years 52,9 15800 15800 One woman age 15-49 67,6 15800 15800 One man age 15-59 73,9 15800 15800 Mean Household Size 3,5 15800 15800 43MONITORING THE SITUATION OF CHILDREN AND WOMEN The weighted and unweighted numbers of households are equal, since sample weights were normalized (See Appendix A). The table also shows the proportions of households with at least one child under 18, at least one child under 5, and at least one eligible woman aged 15-49 and one eligible man aged 15-59. The percentage of households with at least one child under 18 was 52.9 percent, 24.9 percent of households had children under 5, and the pro- portion of households with at least one woman (age 15-49) and one man (age 15-59) was 67.6 and 73.9 percent respectively. About 15.7 percent of households had one member (14.6 percent accord- ing to the 2009 census), 20.8 percent had 2-3 mem- bers (38.3 percent), 19.7 percent had 4-5 members (31 percent), 17.9 percent had 6-7 members (11.6 percent), 11.9 percent had 8-9 members (3 percent) and 6.9 percent had 10 or more members (1.5 percent). Characteristics of Female Respondents 15-49 / Male Respondents 15-59 Years of Age and Children Under 5 Tables HH.4, HH.4M and HH.5 provide infor- mation on the background characteristics of female respondents 15-49 years of age, male respondents 15-59 years of age and of children under 5. In all tables, the total numbers of weighted and unweighted obser- vations are equal, since sample weights have been normalized (standardized). In addition to providing useful information on the background characteristics of women and children, the tables are also intended to show the numbers of observations in each background category. These categories are used in the subsequent tabulations of this report. Table HH.4: Women’s background characteristics Percentage distribution of women age 15-49 years by background characteristics, Kazakhstan, 2010/11 Weighted percent Number of Women Weighted Unweighted Region Akmola 4,3 603 744 Aktobe 4,9 694 788 Almaty 10,8 1518 985 Almaty city 8,5 1190 800 Astana city 3,8 539 931 Atyrau 2,9 409 859 East Kazakhstan 8,6 1210 819 Zhambul 6,0 836 804 West Kazakhstan 4,0 566 840 Karaganda 9,1 1274 944 Kostanai 5,6 791 871 Kyzylorda 3,9 553 869 Mangistau 3,3 461 863 Pavlodar 5,3 746 881 North Kazakhstan 4,1 577 893 South Kazakhstan 14,6 2048 1123 Residence Urban 57,5 8055 8234 Rural 42,5 5959 5780 44 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Weighted percent Number of Women Weighted Unweighted Age 15-19 14,4 2022 2012 20-24 15,5 2178 2170 25-29 14,4 2016 2024 30-34 14,3 2005 1996 35-39 13,6 1901 1892 40-44 13,7 1919 1941 45-49 14,1 1972 1979 Marital/Union status Currently married/in union 60,2 8434 8426 Widowed 3,0 418 421 Divorced 6,3 888 885 Separated 2,2 311 318 Never married/in union 28,3 3963 3964 Motherhood Status Ever gave birth 67,6 9469 9490 Never gave birth 32,4 4545 4524 Births in Last Two Years Had a birth in last two years 14,2 1993 2027 Had no birth in last two years 85,8 12021 11987 Education None 0,2 25 26 Secondary incomplete 3,9 553 534 Secondary 31,5 4407 4227 Secondary specialised 32,4 4539 4705 High 32,0 4489 4522 Wealth Index Quintile Poorest 18,0 2528 2243 Second 18,5 2599 2527 Middle 19,6 2743 2812 Fourth 20,3 2839 2946 Richest 23,6 3305 3486 Religion/Language/Ethnicity of Household Head Kazakh 64,2 9003 9275 Russian 22,6 3168 3126 Other ethnic group 13,2 1843 1613 Total 100,0 14014 14014 45MONITORING THE SITUATION OF CHILDREN AND WOMEN 8 Unless otherwise stated, “education” refers to educational level attended by the respondent throughout this report when it is used as a background variable. 9 Principal components analysis was performed by using information on the ownership of consumer goods, dwelling characteristics, water and sanitation, and other characteristics that are related to the household’s wealth to assign weights (factor scores) to each of the household assets. Each household was then assigned a wealth score based on these weights and the assets owned by that household. The survey household population was then ranked according to the wealth score of the household they are living in, and was finally divided into 5 equal parts (quintiles) from lowest (poorest) to highest (richest). The assets used in these calculations were as follows: electricity, radio, colour TV set, mobile phone, stationary (non-mobile) telephone, refrigerator, PC/laptop, DVD player, dish washer, microwave oven, washing machine, vacuum cleaner as well as the following items belonging to household members such as bicycle, motorbike/, horse cart, vehicle, motor boat). The wealth index is assumed to capture the underlying long-term wealth through information on the household assets, and is intended to produce a ranking of households by wealth, from poorest to richest. The wealth index does not provide information on absolute poverty, current income or expenditure levels. The wealth scores calculated are applicable for only the particular data set they are based on. Further information on the construction of the wealth index can be found in 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. Table HH.4 provides background characteristics of female respondents 15-49 years of age. The table includes information on the distribution of women ac- cording to region, residence, age, marital status, moth- erhood status, education8, wealth index quintiles9, and ethnicity/language. Key findings from Table HH.4 are as follows. In the weighted sample, 57.5 percent of women aged 15- 49 lived in an urban and 42.5 percent lived in a rural area. At the time 60.2 percent of women were married or in union, 11.5 percent were divorced/separated or widowed, and 28.3 percent were never married. In terms of the motherhood status, 67.6 percent of women had given birth at least once. By educational attainment, the distribution is as follows: 3.9 percent have incomplete secondary education, 31.5 percent have completed secondary education, 32.4 percent have completed specialized secondary education and 32 percent completed higher education. In terms of wealth, the share of second and poorest quintiles were about the same, 18.0 and 18.5 percent respectively. The middle quintile was 19.6 per- cent; while the fourth and richest quintiles were 20.3 percent and 23.6 percent respectively. In terms of eth- nicity 64.2 percent were headed by Kazakhs, 22.6 per- cent – by Russians, and 13.2 percent were headed by other ethnic groups. 46 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Table HH.4М: Men’s background characteristics Percentage distribution of men age 15-59 years by background characteristics, Kazakhstan, 2010/11 Weighted percent Number of Men weighted weighted Region Akmola Oblast 4,6 178 250 Aktobe Oblast 4,7 182 210 Almaty Oblast 11,0 423 254 Almaty city 7,8 302 211 Astana city 3,2 125 231 Atyrau Oblast 2,9 112 198 East Kazakhstan Oblast 8,8 340 258 Zhambyl Oblast 6,2 240 223 West Kazakhstan Oblast 4,1 158 238 Karaganda Oblast 8,7 333 246 Kostanai Oblast 5,7 219 261 Kyzylorda Oblast 4,1 157 231 Mangistau Oblast 3,1 121 197 Pavlodar Oblast 5,3 206 275 North Kazakhstan Oblast 4,3 164 283 South Kazakhstan Oblast 15,3 587 280 Residence Urban 53,6 2061 2207 Rural 46,4 1785 1639 Age 15-19 10,2 394 398 20-24 11,3 433 425 25-29 11,3 434 439 30-34 14,3 548 557 35-39 14,0 539 519 40-44 11,8 453 444 45-49 11,2 432 431 50-54 9,4 361 363 55-59 6,5 251 270 Marital Status Currently married/in union 67,5 2595 2616 Widowed 0,7 26 24 Divorced 3,7 141 134 Separated 1,2 46 47 Never married/in union 27,0 1039 1025 Education of Household Head No 0,1 3 4 Incomplete secondary 4,8 184 194 Secondary 37,6 1444 1362 Specialized secondary 32,8 1261 1316 Higher 24,8 953 970 47MONITORING THE SITUATION OF CHILDREN AND WOMEN Weighted percent Number of Men weighted weighted Wealth Index Quintile Poorest 19,2 737 631 Second 19,4 748 702 Middle 20,1 773 785 Fourth 20,5 789 837 Richest 20,8 799 891 Ethnicity of Household Head Kazakh 61,7 2374 2386 Russian 24,8 952 1007 Other ethnic groups 13,5 520 453 Total 100,0 3846 3846 poorest quintiles was about the same, 19.2 and 19.4 percent respectively; the middle quintile was 20.1 percent; and the fourth and richest quintiles was 20.5 and 20.8 percent respectively. In terms of ethnicity, 61.7 percent of men were 20.5 and 20.8 percent lived in households headed by Kazakhs, 24.8 per- cent by Russians, and 13.5 percent lived in house- holds headed by other ethnic groups. Table HH.5 provides background characteristics of children under 5 including information on the distri- bution of children according to such attributes as sex, region, residence, age, mother’s/caretaker’s educa- tion, wealth index quintile and ethnicity. Table HH.4M provides background characteris- tics of male respondents. In the weighted sample, 53.6 percent of men aged 15-59 lived in an urban and 46.4 percent lived in a rural area. At the time of the survey 67.5 percent of men were married or in union, 5.6 per- cent were divorced/separated or widowed, and 27.0 percent were never married. By educational attainment, 4.8 percent of men have incomplete secondary education, 37.6. percent have completed secondary education, 32.8 percent have completed specialized secondary education and 24.8 percent completed higher education. In terms of wealth, the share of second and Table HH.5: Children’s background characteristics Percentage distribution of children under 5 by background characteristics, Kazakhstan, 2010/11 Weighted percent Number of Children Under 5 weighted weighted Sex of Household Head Male 51,0 2644 2615 Female 49,0 2537 2566 Region Akmola Oblast 3,7 189 229 Aktobe Oblast 5,0 260 295 Almaty Oblast 10,6 551 356 Almaty city 3,9 202 137 Astana city 3,2 166 294 Atyrau Oblast 3,5 182 382 East Kazakhstan Oblast 7,2 372 255 Zhambyl Oblast 7,7 400 386 West Kazakhstan Oblast 3,8 195 291 Karaganda Oblast 8,1 420 312 Kostanai Oblast 4,3 222 249 Kyzylorda Oblast 5,6 292 453 48 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Weighted percent Number of Children Under 5 weighted weighted Mangistau Oblast 4,7 244 457 Pavlodar Oblast 4,2 217 259 North Kazakhstan Oblast 2,7 139 218 South Kazakhstan Oblast 21,8 1129 608 Residence Urban 48,4 2508 2653 Rural 51,6 2673 2528 Age 0-5 months 10,3 532 543 6-11 months 10,3 532 538 12-23 months 20,0 1037 1044 24-35 months 21,2 1097 1095 36-47 months 19,4 1005 998 48-59 months 18,9 978 963 Mother’s Education* No 0,2 9 8 Incomplete secondary 1,9 96 83 Secondary 37,0 1916 1803 Specialized secondary 27,6 1432 1502 Higher 33,4 1729 1785 Wealth Index Quintile Poorest 24,1 1249 1053 Second 21,9 1134 1082 Middle 19,6 1015 1072 Fourth 16,7 865 934 Richest 17,7 919 1040 Ethnicity of Household Head Kazakh 71,9 3724 3862 Russian 15,2 785 778 Other ethnic groups 13,0 672 541 Total 100,0 5181 5181 * Mother’s education refers to educational attainment of mothers and caretakers of children under 5 ing levels of education. About 1.9 percent of mothers had incomplete secondary education, 37 percent of mothers had completed secondary education, 27.6 percent of mothers had secondary specialized educa- tion and 33.4 percent of mothers had completed high- er education. In terms of household’s wealth, children were distributed as follows: poorest – 24.1 percent, second – 21.9 percent, middle – 19.6 percent, fourth – 16.7 percent and richest – 17.7 percent. By ethnicity, 71.9 percent of children lived in households headed by Ka- zakhs, 15.2 percent by Russians and 13 percent lived in households headed by other ethnic groups. Key conclusions from Table HH.5 are as follows. The weighted and unweighted numbers of households are equal, since sample weights were normalized (see Appendix A). The weighted sample shows the following background characteristics of children under 5. A total of 5,181 children under 5 were surveyed including 51 percent of boys, and 49 percent of girls. 48.4 percent of children lived in urban and 51.6 percent lived in rural area. The distribution of the number of chil- dren in this age group are: under 6 months – 10.3 per- cent, 6-11 months – 10.3 percent, 12-23 months – 20 percent, 24-35 months – 21.2 percent, 36-47 months – 19.4 percent and 48-59 months – 18.9 percent. Mothers with children under 5 possessed vary- 49MONITORING THE SITUATION OF CHILDREN AND WOMEN Children’s living arrangements and orphanhood Table HH.6 provides information on living ar- rangements and prevalence of orphanhood among children under 18. Out of 16,323 children aged 0-17 covered by MICS, 81.9 percent live with both parents, 13.3 per- cent live with their mother only and 1 percent live only with their father. 3.3 percent of children live with neither of their biological parents. Only 2.7 percent of children live with neither of their living biological parents. A total of 9.4 percent of children live with their mother sepa- rately from their (biological) father. There are very few children who lost one or both parents. Close to 4.1 percent of children have only their father deceased, and they live with their mother, while 0.5 percent have only their mother deceased. Table HH.6 also shows that the percentage of children living with both parents is the highest in the poorest households (84.8 percent) and the lowest in the richest households (78 percent). There is only marginal difference between rural and urban popu- lation and between regions in prevalence of orphan- hood. 50 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Ta bl e Н 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 P er ce nt d is tri bu tio n of c hi ld re n ag e 0- 17 a cc or di ng t o liv in g ar ra ng em en ts , pe rc en ta ge o f ch ild re n ag e 0- 17 n ot l iv in g w ith b io lo gi ca l pa re nt s an d pe rc en ta ge o f c hi ld re n w ho h av e bo th p ar en ts d ea d, K az ak hs ta n, 2 01 0/ 11 Li vi ng w ith bo th pa re nt s Li vi ng w ith N ei th er P ar en t Li vi ng w ith M ot he r O nl y Li vi ng w ith Fa th er O nl y Im po s- si bl e to de te r- m in e To ta l N ot li vi ng w ith a b io - lo gi ca l p ar - en t1 O ne o r bo th pa re nt s de ad 2 N um be r o f ch ild re n ag e 0- 17 y ea rs O nl y fa th er al iv e O nl y m ot he r al iv e B ot h ar e al iv e B ot h ar e de ad Fa - th er al iv e Fa th er de ad M o- th er al iv e M ot he r de ad Se x M al e 81 ,1 0, 1 0, 2 2, 8 0, 4 9, 6 4, 1 0, 7 0, 5 0, 6 10 0, 0 3, 5 5, 3 82 43 Fe m al e 82 ,7 0, 2 0, 1 2, 5 0, 4 9, 2 3, 7 0, 4 0, 4 0, 3 10 0, 0 3, 2 4, 7 80 80 R eg io n A km ol a O bl as t 73 ,4 0, 9 0, 8 4, 2 0, 9 11 ,8 5, 6 1, 0 0, 4 1, 0 10 0, 0 6, 8 8, 6 63 1 A kt ob e O bl as t 82 ,6 0, 1 0, 0 2, 1 0, 6 8, 0 5, 9 0, 2 0, 3 0, 2 10 0, 0 2, 9 6, 9 77 3 A lm at y O bl as t 85 ,7 0, 1 0, 2 3, 2 0, 2 7, 6 2, 1 0, 2 0, 7 0, 2 10 0, 0 3, 6 3, 2 18 04 A lm at y ci ty 78 ,3 0, 0 0, 0 1, 7 0, 5 13 ,1 3, 4 1, 2 0, 4 1, 2 10 0, 0 2, 3 4, 4 80 6 A st an a ci ty 82 ,8 0, 0 0, 0 2, 3 0, 0 12 ,2 1, 9 0, 3 0, 2 0, 3 10 0, 0 2, 3 2, 2 46 4 A ty ra u O bl as t 84 ,9 0, 0 0, 4 1, 3 0, 4 5, 4 4, 9 0, 9 0, 1 1, 9 10 0, 0 2, 0 5, 7 51 1 E as t K az ak hs ta n O bl as t 76 ,7 0, 0 0, 2 3, 9 0, 2 15 ,2 3, 2 0, 5 0, 0 0, 1 10 0, 0 4, 4 3, 6 11 99 Zh am by l O bl as t 80 ,6 0, 1 0, 5 5, 5 0, 6 7, 8 3, 3 0, 5 0, 3 0, 7 10 0, 0 6, 7 5, 0 12 16 W es t K az ak hs ta n O bl as t 79 ,0 0, 0 0, 3 3, 9 0, 2 10 ,1 5, 3 0, 4 0, 1 0, 6 10 0, 0 4, 4 5, 9 60 4 K ar ag an da O bl as t 72 ,0 0, 3 0, 1 3, 9 0, 0 16 ,7 4, 8 1, 2 0, 8 0, 2 10 0, 0 4, 3 6, 0 13 62 K os ta na i O bl as t 76 ,0 0, 6 0, 2 1, 7 0, 1 15 ,9 3, 1 0, 5 0, 8 0, 9 10 0, 0 2, 7 5, 0 74 0 K yz yl or da O bl as t 87 ,0 0, 0 0, 0 2, 3 0, 7 5, 5 3, 2 0, 3 0, 8 0, 3 10 0, 0 3, 0 4, 6 86 9 M an gi st au O bl as t 89 ,4 0, 0 0, 0 0, 6 1, 0 1, 9 6, 3 0, 1 0, 2 0, 6 10 0, 0 1, 5 7, 5 65 5 P av lo da r O bl as t 73 ,7 0, 2 0, 1 2, 2 0, 4 16 ,7 3, 3 0, 8 1, 0 1, 6 10 0, 0 3, 0 5, 0 64 9 N or th K az ak hs ta n O bl as t 78 ,6 0, 1 0, 2 2, 1 0, 5 11 ,3 4, 5 1, 5 0, 6 0, 6 10 0, 0 2, 9 5, 9 54 4 51MONITORING THE SITUATION OF CHILDREN AND WOMEN S ou th K az ak hs ta n O bl as t 88 ,9 0, 0 0, 2 1, 4 0, 3 4, 4 4, 0 0, 4 0, 3 0, 0 10 0, 0 1, 9 4, 8 34 97 R es id en ce U rb an 78 ,8 0, 1 0, 2 2, 1 0, 4 12 ,5 4, 3 0, 7 0, 3 0, 6 10 0, 0 2, 8 5, 3 77 50 R ur al 84 ,7 0, 1 0, 2 3, 1 0, 4 6, 6 3, 5 0, 4 0, 6 0, 4 10 0, 0 3, 8 4, 8 85 73 A ge 0- 4 88 ,1 0, 1 0, 0 1, 7 0, 0 8, 0 1, 5 0, 2 0, 1 0, 3 10 0, 0 1, 9 1, 7 51 98 5- 9 82 ,7 0, 2 0, 1 2, 5 0, 2 9, 9 3, 1 0, 7 0, 2 0, 4 10 0, 0 3, 0 3, 8 43 34 10 -1 4 78 ,6 0, 2 0, 4 2, 6 0, 4 10 ,2 5, 6 0, 7 0, 8 0, 4 10 0, 0 3, 5 7, 4 41 20 15 -1 7 73 ,7 0, 1 0, 3 4, 7 1, 3 9, 9 7, 2 0, 8 1, 0 0, 9 10 0, 0 6, 5 10 ,1 26 70 W ea lth In de x Q ui nt ile P oo re st 84 ,8 0, 1 0, 1 3, 0 0, 2 6, 2 4, 7 0, 2 0, 5 0, 2 10 0, 0 3, 4 5, 6 40 49 S ec on d 82 ,9 0, 2 0, 2 3, 2 0, 5 7, 5 3, 7 0, 6 0, 8 0, 5 10 0, 0 4, 1 5, 4 35 68 M id dl e 83 ,0 0, 1 0, 2 2, 7 0, 6 8, 9 3, 1 0, 7 0, 2 0, 4 10 0, 0 3, 7 4, 2 31 42 Fo ur th 79 ,2 0, 1 0, 3 2, 4 0, 2 12 ,3 3, 9 0, 6 0, 4 0, 5 10 0, 0 3, 1 4, 9 27 42 R ic he st 78 ,0 0, 2 0, 1 1, 6 0, 4 14 ,1 3, 8 0, 7 0, 3 0, 8 10 0, 0 2, 2 4, 8 28 22 Et hn ic ity o f H ou se ho ld H ea d K az ak h 85 ,1 0, 1 0, 2 2, 8 0, 4 6, 3 3, 9 0, 4 0, 5 0, 4 10 0, 0 3, 4 5, 1 11 65 8 R us si an 68 ,8 0, 3 0, 2 2, 8 0, 4 21 ,1 4, 0 1, 2 0, 2 1, 1 10 0, 0 3, 6 5, 1 25 72 O th er e th ni c gr ou ps 80 ,2 0, 2 0, 2 1, 9 0, 3 12 ,4 3, 5 0, 7 0, 3 0, 3 10 0, 0 2, 6 4, 5 20 93 To ta l 81 ,9 0, 1 0, 2 2, 7 0, 4 9, 4 3, 9 0, 6 0, 4 0, 5 10 0, 0 3, 3 5, 0 16 32 3 1 M IC S In di ca to r 9 .1 7 2 M IC S In di ca to r 9 .1 8 IV. Child Mortality 53MONITORING THE SITUATION OF CHILDREN AND WOMEN 10 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. 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, Kazakhstan, 2010/11 Children ever born Children Surviving Proportion dead Number of women Mean number of children ever born Mean number children surviving Mean number children surviving Total number of children surviving Age 15-19 0,028 57 0,027 55 0,037 2022 20-24 0,518 1128 0,509 1109 0,017 2178 25-29 1,327 2674 1,299 2619 0,021 2016 30-34 2,038 4087 1,956 3922 0,040 2005 35-39 2,352 4472 2,248 4274 0,044 1901 40-44 2,543 4880 2,408 4622 0,053 1919 45-49 2,601 5129 2,452 4835 0,057 1972 Total 1,600 22427 1,530 21436 0,044 14014 One of the overarching goals of the Millennium Development Goals (MDGs) is the reduction of infant and under-5 mortality. Specifically, the MDGs call for the reduction in under-5 mortality by two-thirds between 1990 and 2015. Monitoring progress towards this goal is an important but difficult objective. Measuring child- hood mortality may seem easy, but attempts using di- rect questions, such as “Has anyone in this household died in the last year?” give inaccurate results. Using direct measures of child mortality from birth histories is time consuming, more expensive, and requires greater attention to training and supervision. Alternatively, in- direct methods developed to measure child mortality produce robust estimates that are comparable with the ones obtained from other sources. Indirect meth- ods minimize the pitfalls of memory lapses, inexact or misinterpreted definitions, and poor interviewing tech- nique. The infant mortality rate is the probability of dy- ing before the first birthday. The under-5 mortality rate is the probability of dying before the fifth birthday. In MICS surveys, infant and under-5 mortality rates are calculated based on an indirect estimation technique known as the Brass method10. The data used in the estimation are: the mean number of children ever born for five year age groups of women from age 15 to 49, and the proportion of these children who are dead, also for five-year age groups of women (Table CM.1). The technique converts the proportions of dead among children of women in each age group into probabilities of dying by taking into account the approximate length of exposure of children to the risk of dying, assum- ing a particular model age pattern of mortality. Based on previous information on mortality in Kazakh- stan, the East model life table was selected as most appropriate. Table CM.2 provides estimates of child mortality. The infant mortality rate is estimated at 28 per 1,000 live births, while the probability of dying under age 5 (U5MR) is around 31 per 1,000 live births. These es- timates have been calculated by averaging mortality estimates obtained from women age 25-29 and 30-34, and refer to 2006. There is some difference between the probabili- ties of dying among males and females. Mortality in boys is appreciably higher than in girls standing at 34 and 22 per thousand live births, and 38 and 25 for children under 5. Moreover, mortality rates differed signifi- cantly depending on the level of mother’s educa- 54 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN tion, the level of household wealth and ethnicity. In terms of residence there were some differen- ces in mortality rates: in rural area infant mortal- ity rate and under-5 child mortality rate was by 3 and 4 pro mille higher respectively compared to urban area. While in urban area child mortality rate was 26 per 1,000 live births, in rural area it was 29 per 1,000 births; similarly for under- 5child mortality rate – 29 as opposed to 33 per 1,000 live births. In terms of wealth, infant mortality was high in the second and poorest quintiles, 27 and 34 per 1,000 live births respectively, similarly for child mor- tality rate – 31 and 40 per 1,000 live births compared to 18 and 24 per 1,000 births and 20 and 27 per 1,000 live births in the fourth and richest quintiles. Table CM.2: Child Mortality Infant and under-5 mortality rates, East Model, Kazakhstan, 2010/11 Infant Mortality Rate1 Under-5 Mortality Rate2 Sex Male 34 38 Female 22 25 Residence Urban 26 29 Rural 29 33 Mother’s education Incomplete secondary 92 (*) Secondary 30 34 Specialized secondary 30 34 Higher 16 17 Wealth index quintile Poorest 34 40 Second 27 31 Middle 29 33 Fourth 18 20 Richest 24 27 Ethnicity of household head Kazakh 26 29 Russian 25 28 Other ethnic groups 40 46 Total 28 31 Rates for women with incomplete education not shown due to small number of cases 1 MICS Indicator 1.2; MDG Indicator 4.2 2 MICS Indicator 1.1; MDG Indicator 4.1 (*) the rates for the mothers with incomplete secondary education are not indicated due to limited number of cases * refers to 2006, East Model, in accordance with age staffs of mortality Differences in under-5 mortality rates by selected background characteristics are shown in Figure CM.1. 55MONITORING THE SITUATION OF CHILDREN AND WOMEN Figure CM.2 shows the series of under-5 mortality rate estimates of the survey, based on re- sponses of women in different age groups, and re- ferring to various points in time, thus showing the estimated trend in U5MR based on three surveys, DHS-1995, MICS-2006 and MICS-2010/11 as well as the country’s official statistics. The MICS surveys indicate that mortality has been declining for the past 15 years. Discrepancies between data until mid-2008 from different sources сan be explained in part by dif- ferent approaches to live birth definitions and child mortality estimation techniques beginning from 2008 when Kazakhstan started using new criteria on live and still births recommended by WHO. Further quali- fication of these apparent declines and differences as well as its determinants should be taken up in a more detailed and separate analysis. *Refers to 2006, East Model chosen in accordance with the age mortality structure r V. Nutrition 57MONITORING THE SITUATION OF CHILDREN AND WOMEN 11 http://www.who.int/childgrowth/standards/second_set/technical_report_2.pdf Children’s nutritional status is a reflection of their overall health. When children have access to an ad- equate food supply they are not exposed to repeated illness and well cared for, reach their growth potential and are considered well nourished. Malnutrition is associated with more than half of all child deaths worldwide. Undernourished children are more likely to die from common childhood ailments. For those children undernourished who survive will ex- perience recurring sicknesses and faltering growth. Three-quarters of the children who die from causes related to malnutrition were only mildly or moderately malnourished. The MDG target is to reduce by half the proportion of people who suffer from hunger between 1990 and 2015. A reduction in the prevalence of mal- nutrition will also assist in the goal to reduce child mor- tality. In a well-nourished population height and weight for children under 5 are used as a reference. Under- nourishment in a population can be gauged by compar- ing children to a reference population. The reference population used in this report is based on new WHO growth standards11. 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 two standard deviations below the median of the refer- ence population are considered moderately or severe- ly 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. Nutritional Status Children whose height-for-age is more than two stan- dard deviations below the median of the reference pop- ulation are considered short for their age and are clas- sified as moderately or severely stunted. Those whose height-for-age is more than three standard deviations below the median are classified as severely stunted. Stunting is a reflection of chronic malnutrition as a re- sult of failure to receive adequate nutrition over a long period and recurrent or chronic illness. Finally, children whose weight-for-height is more than two standard deviations below the median of the reference population are classified as moderately or severely wasted, while those who fall more than three standard deviations below the median are classified as severely wasted. Wasting is usually the result of a recent nutritional deficiency. The indicator may exhibit significant seasonal shifts associated with changes in the availability of food or disease prevalence. In MICS, weights and heights of all children un- der 5 were measured using anthropometric equipment recommended by UNICEF (www.childinfo.org). Find- ings in this section are based on the results of these measurements. Table NU.1 shows percentages of children clas- sified into each of these categories, based on the anthropometric measurements that were taken dur- ing fieldwork. Additionally, the table includes the per- centage of children who are overweight, which takes into account those children whose weight for height is above 2 standard deviations from the median of the reference population, and mean z-scores for all three anthropometric indicators. Table NU.1: Nutritional status of children Percentage of children under 5 by nutritional status according to three anthropometric indices: weight for age, height for age, and weight for height, Kazakhstan, 2010/11 Weight for age: N um be r o f c hi ld re n Height for age: N um be r o f c hi ld re n Weight for height: N um be r o f c hi ld re n Under- weight M ea n Z- S co re (S D ) Stunted M ea n Z- S co re (S D ) Wasted Wasted O ve rw ei gh t % a bo ve % below % below % below % below - 2 S D 1 - 3 S D 2 - 2 S D 3 - 3 S D 4 - 2 S D 5 - 3 S D 6 - 2 S D Sex Male 3,7 1,1 0,2 2555 13,2 5,5 -0,4 2541 4,4 1,9 14,8 0,6 2518 Female 3,6 1,3 0,2 2460 13,0 5,3 -0,4 2446 3,7 1,4 11,8 0,5 2436 58 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Weight for age: N um be r o f c hi ld re n Height for age: N um be r o f c hi ld re n Weight for height: N um be r o f c hi ld re n Under- weight M ea n Z- S co re (S D ) Stunted M ea n Z- S co re (S D ) Wasted Wasted O ve rw ei gh t % a bo ve % below % below % below % below - 2 S D 1 - 3 S D 2 - 2 S D 3 - 3 S D 4 - 2 S D 5 - 3 S D 6 - 2 S D Region Akmola Oblast 1,8 0,9 0,4 183 8,1 2,8 -0,2 182 2,6 0,9 13,6 0,7 181 Aktobe Oblast 11,9 6,0 -0,1 248 36,2 19,7 -1,2 246 8,6 3,9 33,5 0,9 245 Almaty Oblast 4,8 0,9 0,1 529 10,8 4,2 -0,3 525 3,7 2,0 7,6 0,3 529 Almaty city 7,1 3,5 0,7 178 17,1 7,1 0,7 173 7,8 3,0 15,6 0,5 165 Astana city 2,5 1,0 0,6 165 19,7 10,1 -0,2 163 4,5 2,8 22,1 0,8 159 Atyrau Oblast 3,5 0,5 0,1 159 18,4 11,1 -0,8 159 3,2 1,9 16,2 0,7 158 East Kazakhstan Oblast 6,5 2,3 0,0 350 16,6 7,2 -0,6 350 8,1 2,7 20,2 0,6 340 Zhambyl Oblast 3,5 0,3 0,4 398 16,2 3,7 -0,6 394 2,8 1,4 21,3 1,0 394 West Kazakhstan Oblast 2,3 0,4 0,2 193 9,8 1,1 -0,3 190 1,8 1,1 6,6 0,5 191 Karaganda Oblast 2,3 1,1 0,2 397 4,8 1,5 -0,1 396 0,4 0,4 6,1 0,4 394 Kostanai Oblast 1,5 0,7 0,2 221 12,7 5,0 -0,4 220 0,4 0,0 6,6 0,6 221 Kyzylorda Oblast 2,1 0,2 0,2 291 7,1 1,8 -0,4 290 1,3 0,2 6,8 0,6 290 Mangistau Oblast 3,6 1,2 0,3 229 10,2 4,2 -0,3 228 4,5 1,7 15,7 0,7 226 Pavlodar Oblast 1,8 0,4 0,4 208 8,9 2,5 -0,1 204 2,7 1,5 13,6 0,6 202 North Kazakhstan Oblast 2,7 0,0 0,1 136 10,6 2,3 -0,6 136 1,7 0,4 11,6 0,6 136 South Kazakhstan Oblast 2,5 0,8 0,1 1129 12,1 5,8 -0,4 1127 5,8 2,0 11,1 0,4 1122 Residence Urban 4,0 1,5 0,2 2407 12,8 5,7 -0,2 2388 4,9 2,1 13,7 0,5 2363 Rural 3,3 0,9 0,1 2608 13,4 5,1 -0,5 2598 3,3 1,3 13,0 0,6 2591 Age 0-5 months 10,0 4,0 0,0 498 10,7 3,7 0,2 496 13,4 7,4 9,8 -0,1 485 6-11 months 3,0 1,0 0,5 525 13,8 6,6 0,1 519 4,4 1,0 19,0 0,7 521 12-23 months 3,2 1,2 0,4 1014 18,6 8,1 -0,5 1006 2,1 0,6 17,4 0,8 1009 24-35 months 3,5 1,4 0,2 1063 14,4 6,5 -0,6 1057 2,5 1,2 12,9 0,6 1050 36-47 months 2,3 0,4 0,1 968 11,6 5,3 -0,5 963 2,4 0,7 11,6 0,7 956 48-59 months 2,6 0,4 0,0 947 8,1 1,7 -0,4 945 4,5 1,8 9,7 0,4 935 Mother’s Education Incomplete secondary 2,7 1,0 0,1 96 12,9 3,9 -0,4 93 7,2 4,7 6,3 0,3 94 Secondary 4,6 1,3 0,1 1879 15,5 5,5 -0,6 1869 4,1 1,5 12,3 0,6 1869 Specialized secondary 2,7 1,1 0,3 1380 11,7 5,8 -0,3 1374 3,9 1,8 14,6 0,6 1355 Higher 3,4 1,2 0,3 1652 11,5 5,0 -0,2 1642 4,0 1,6 13,8 0,5 1628 Wealth Index Quintile Poorest 4,1 1,2 0,1 1239 14,4 5,1 -0,6 1235 4,9 2,3 12,8 0,6 1235 Second 3,9 0,8 0,1 1113 14,5 6,2 -0,6 1110 2,8 0,7 12,6 0,6 1105 Middle 2,8 1,1 0,2 982 9,9 3,9 -0,2 975 3,9 1,7 11,0 0,5 965 Fourth 4,0 1,6 0,2 817 13,9 5,8 -0,3 809 4,5 1,6 14,7 0,6 797 Richest 3,5 1,4 0,4 866 12,1 6,1 -0,1 857 4,3 2,0 16,3 0,6 852 59MONITORING THE SITUATION OF CHILDREN AND WOMEN Weight for age: N um be r o f c hi ld re n Height for age: N um be r o f c hi ld re n Weight for height: N um be r o f c hi ld re n Under- weight M ea n Z- S co re (S D ) Stunted M ea n Z- S co re (S D ) Wasted Wasted O ve rw ei gh t % a bo ve % below % below % below % below - 2 S D 1 - 3 S D 2 - 2 S D 3 - 3 S D 4 - 2 S D 5 - 3 S D 6 - 2 S D Ethnicity of Household Head Kazakh 3,9 1,3 0,2 3605 13,6 5,7 -0,4 3583 4,2 1,8 13,9 0,6 3557 Russian 2,9 0,6 0,2 746 11,9 5,4 -0,2 743 3,1 0,7 12,9 0,5 737 Other ethnic groups 3,2 1,2 0,1 664 11,5 3,9 -0,3 661 4,6 2,1 10,6 0,4 661 Total 3,7 1,2 0,2 5015 13,1 5,4 -0,4 4987 4,1 1,7 13,3 0,6 4955 ‘No education’ category has been excluded due to insignificant number of responses; 1 MICS Indicator 2.1a ; MDG Indicator 1.8 2 MICS Indicator 2.1b 3 MICS Indicator 2.2a; 4 MICS Indicator 2.2b 5 MICS Indicator 2.3a, 6 MICS Indicator 2.3b For children with no complete data regarding their birthdate (month and year) and measurement re- sults out of the acceptable range have been excluded from Table NU.1. Children are excluded from one or several anthropometric indices are excluded in case their weight or height were not measured. For instance, if the child was weighted but his/her height was not measured, this child is included into the underweight indice but is excluded from the stunted or wasted in- dice. Percentage of children by age and reasons for exclusion are shown in data quality verification tables DQ.6 and DQ.7. Overall, 96.8 percent of children had their weight and height measured (Table DQ.6). While 3.2 percent of children did not have their weight measured, 3.3 percent of children did not have their height measured. Table DQ.7 shows that due to unacceptable result measure- ments and missing data on weight and/or height, 3.6 percent of children were excluded from the calculation of the indice of weight for age. The proportion of children excluded from the indices on height for age and weight for height is 4.1 percent and 4.7 percent respectively. Most often the results of infants until the age of 6 months anthropometric measurement were excluded: 6.4 per- cent – weight to age and 7.2 percent – height for age and 9.2 percent – weight for height. In Kazakhstan 3.7 percent of children under 5 are underweight, including 1.2 percent severely un- derweight (table NU.1). at the same time 13.1 percent are stunted, including 5.4 percent severely stunted. 4.1 percent of children are wasted (weight for height) and 1.7 percent of children are severely wasted. Table NU.1 was compiled according to new height standards established by WHO. In order to compare nutrition status with MICS3 results we have made calculations using old standards from the Na- tional Center for Health Statistics (USA), Center for Disease Control and Prevention (USA) and the World Health Organization. The table calculated according to old standards is shown in Table NU1.A in Appendix G. 60 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Four percent of moderately underweight and 1.5 percent of severely underweight children were reported in MICS4. Children in Aktobe Oblast are more likely to be underweight for their age (11.9 percent) and stunted (36.2 percent). In this oblast, children are more exposed to the risk of being underweight or stunted than children in other regions. The highest proportion of moderately underweight children for their height (wasting) was found in Aktobe (8.6 percent) and East Kazakhstan Oblasts (8.1 percent). The highest proportion of moderately un- derweight and wasted children is found in urban areas, whereas that of stunted children is found in rural areas. Those children whose mothers have higher education are less likely to be underweight (3.4 percent), stunted (11.5 percent) and wasted (4 percent) compared to children of mothers with incomplete secondary or specialized secondary education combined. Age distribution shows that children in the age group 0-5 months are more likely to be underweight for age and height, with this group having the highest percentage. At the same time, the highest percentage (18.6 percent) of stunted children is found in the age group 12-23 months. About 13.3 percent of children are overweight, with the percentage of boys (14.8 percent) being higher than girls (11.8 percent). Percentage of urban children (13.7 percent) is slightly higher than that of children living in the rural area (13 percent). A higher percentage of overweight children is found in Aktobe Oblast (33.5 percent), Astana (22.1 percent) and in Zhambyl Oblast (21.3 percent). Such children are most likely to be found in the age group 6-11 months (19 percent). Breastfeeding and Infant and Young Child Feeding Feeding recommendations based on WHO and UNICEF are: • Exclusive breastfeeding for first six months • Continued breastfeeding for two years or more • Safe, appropriate and adequate complementary foods beginning at 6 months • Frequency of complementary feeding: 2 times per Breastfeeding for the first few years of life pro- tects children from infection, provides an ideal source of nutrients, and is economical and safe. However, many mothers stop breastfeeding too soon and there are often pressures to switch to infant formula, which can contrib- ute to growth faltering and micronutrient malnutrition as when as unsafe if clean water is not readily available. 61MONITORING THE SITUATION OF CHILDREN AND WOMEN day for 6-8 month old; 3 times per day for 9-11 month old It is also recommended that breastfeeding be initiated within one hour of birth. The indicators related to recommended child feeding practices are as follows: • Early initiation of breastfeeding (within one hour of birth) • Exclusive breastfeeding rate (< 6 months) • Predominant breastfeeding (< 6 months) • Continued breastfeeding rate (at 1 year and at 2 years) • Duration of breastfeeding • Age-appropriate breastfeeding (0-23 months) • Introduction of solid, semi-solid and soft foods (6-8 months) • Minimum meal frequency (6-23 months) • Milk feeding frequency for non-breastfeeding chil- dren (6-23 months) • Bottle feeding (0-23 months) 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, Kazakhstan, 2010/11 Percentage 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 birth Within one hour of birth2 Within one day of birth Region Akmola Oblast 96,3 44,6 82,0 13,3 68 Aktobe Oblast 91,1 59,5 83,0 18,5 115 Almaty Oblast 92,0 69,0 85,3 2,3 194 Almaty city (100,0) (46,5) (97,7) (4,7) 68 Astana city 97,8 47,9 96,8 1,3 72 Atyrau Oblast 98,1 63,7 87,0 21,2 77 East Kazakhstan Oblast 93,7 71,9 87,1 9,0 143 Zhambyl Oblast 97,8 83,4 94,4 8,8 166 West Kazakhstan Oblast 96,9 72,1 90,8 16,2 75 Karaganda Oblast 97,3 74,2 88,1 23,0 148 Kostanai Oblast 97,1 61,7 83,6 20,0 86 Kyzylorda Oblast 95,5 82,7 88,7 4,8 119 Mangistau Oblast 98,7 54,7 80,6 27,1 99 Pavlodar Oblast 96,8 54,2 87,3 15,3 82 North Kazakhstan Oblast 96,1 67,3 86,4 25,2 46 South Kazakhstan Oblast 98,0 73,1 88,3 5,1 436 Residence Urban 96,4 66,2 88,6 11,7 983 Rural 96,3 69,4 87,3 10,9 1011 Months Since Last Birth 0-11 months 95,9 66,7 86,4 12,6 1023 12-23 months 96,9 69,0 89,5 9,9 970 Assistance at Delivery Skilled attendant 96,4 67,8 87,9 11,3 1990 62 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Percentage 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 birth Within one hour of birth2 Within one day of birth Traditional birth attendant (*) (*) (*) (*) 3 Place of Delivery Public sector health facility 96,3 67,8 87,8 11,1 1978 Private sector health facility (*) (*) (*) (*) 7 Home (*) (*) (*) (*) 8 Education Incomplete secondary (88,0) (61,3) (74,7) (12,5) 32 Secondary 95,7 68,8 87,5 10,1 698 Specialized secondary 97,5 64,2 87,6 11,2 565 Higher 96,5 69,9 89,2 12,6 695 Wealth Index Quintile Poorest 97,5 73,0 87,6 8,5 463 Second 95,7 69,3 87,8 11,0 443 Middle 95,5 68,7 88,7 9,2 406 Fourth 95,3 67,1 87,9 13,3 330 Richest 97,9 58,8 87,7 15,8 352 Ethnicity of Household Head Kazakh 97,6 70,0 89,4 11,8 1413 Russian 94,4 59,9 83,0 14,6 322 Other ethnic groups 92,0 65,9 86,1 4,4 259 Total 96,4 67,8 87,9 11,3 1993 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 2.4 2 MICS Indicator 2.5 () Indicators are based on 25-49 cases of unweighted observations (*) Indicators are based on less than 25 cases of unweighted observations respectively). The highest proportion of women who started breastfeeding within one hour of birth was in Zhambyl (83.4 percent) and Kyzylorda (82.7 percent) Oblasts, the lowest proportion was found in Akmola Oblast (44.6 percent) and in Almaty (46.5 percent). The percentage of mothers who started breast- feeding within one day of birth were 87.9. The differ- ence between such women in urban and rural areas is marginal, 1.4 percent in favour of urban women (88.6 and 87.3 percent respectively). Only in two regions, Al- maty and Astana, over 95 percent of women started breastfeeding within one day of birth (97.7 and 96.8 percent respectively). The lowest percentage is found in Mangistau (80.6 percent) and Akmola (82 percent) Oblasts. Table NU.2 provides the proportion of children born in the last two years who were ever breastfed, those who were first breastfed within one hour of birth, and those who received a prelacteal feed. About 1,993 mothers of children born within the 2 years preceding the survey were interviewed during the survey. Although first breastfeeding is a very important step in manage- ment of lactation and establishment of a physical and emotional relationship between the baby and the moth- er, only 67.8 percent of babies are breastfed for the first time within one hour of birth. The difference between urban and rural women was 3.2 percent (66.2 and 69.4 percent respectively). Mothers from the richest households are less likely to start timely breastfeeding than those from the poorer households (58.8 percent and 73.0 percent 63MONITORING THE SITUATION OF CHILDREN AND WOMEN Breastfeeding status in Table NU.3 is based on the responses given by mothers/caretakers regarding food and liquids taken by children within the past 24 hours be- fore the survey. Exclusive breastfeeding relates to the in- fants who were receiving only breast milk (also vitamins, minerals and medication). This table shows the proportion of infants who were breastfed during the first 6 months of life and also the proportion of children who were still being breastfed at ages 12-15 and 20-23 months. Only 31.8 percent of children aged less than six months are exclusively breastfed (a level considerably lower than recommended), since 60.6 percent of children are predominantly breastfed. By age 12-15 months, 50.8 percent of children are still being breastfed and by age 20-23 months, 26.1 percent are still breastfed (Figure NU.3). Exclusive breastfeeding is found in urban areas more often than in rural areas (34.4 and 29.2 percent re- spectively). In older age groups, urban children continue receiving breast milk more often than rural children. The level of mothers’ education has a certain impact on the incidence of breastfeeding, with children of mothers with higher education more likely to be exclusively breastfed than children of women with lower education levels (34.8 percent compared to 30.1 percent). Table NU.3: Breastfeeding Percentage of living children according to breastfeeding status at selected age groups, Kazakhstan, 2010/11 Children 0-5 months N um be r o f c hi ld re n Children 12-15 months N um be r o f c hi ld re n Children 20-23 months N um be r o f c hi ld re n Percent exclusively breastfed1 Percent exclusively breastfed2 Percent breastfed (Continued breastfeeding at 1 year) 3 Percent breastfed (Continued breastfeeding at 2 years) 4 Sex Male 32,4 61,1 264 55,1 158 24,4 169 Female 31,2 60,1 268 46,9 174 27,8 177 Residence Urban 34,4 62,2 268 51,1 160 17,9 178 Rural 29,2 59,0 265 50,5 171 34,9 168 Mother’s Education Incomplete Secondary (*) (*) 11 (*) 3 (*) 6 Secondary 31,0 56,9 179 49,3 115 32,3 123 64 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Children 0-5 months N um be r o f c hi ld re n Children 12-15 months N um be r o f c hi ld re n Children 20-23 months N um be r o f c hi ld re n Percent exclusively breastfed1 Percent exclusively breastfed2 Percent breastfed (Continued breastfeeding at 1 year) 3 Percent breastfed (Continued breastfeeding at 2 years) 4 Specialized Secondary 30,1 62,0 160 54,9 88 26,4 99 Higher 34,8 63,4 183 49,8 123 21,0 117 Wealth Index Quintile Poorest 33,8 60,5 120 51,7 80 33,1 63 Second 32,0 61,7 121 50,1 86 28,3 96 Middle 30,4 53,3 108 58,2 67 23,1 68 Fourth 30,2 64,7 104 52,2 55 17,4 45 Richest 32,7 63,6 81 37,5 44 25,5 74 Ethnicity of Household Head Kazakh 31,2 61,9 381 54,7 245 30,8 247 Russian 29,0 49,4 74 40,1 53 12,4 50 Other ethnic groups 37,4 64,9 77 (39,4) 33 (16,9) 49 Total 31,8 60,6 532 50,8 331 26,1 346 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 2.6 2 MICS Indicator 2.9 3 MICS Indicator 2.7 4 MICS Indicator 2.8 ( ) indicators are based on 25-49 cases of unweighted observations (*) indicators are based on less than 25 cases of unweighted observations 65MONITORING THE SITUATION OF CHILDREN AND WOMEN Table NU.4 shows the median duration of breast- feeding by selected background characteristics. Among children under 3, the median duration is 14.8 months for any breastfeeding, 2.1 months for exclusive breastfeeding, and 4.2 months for predominant breastfeeding. Boys receive any kind of breastfeeding longer than girls. In rural areas, infants receive exclusive or any other type of breastfeeding a bit longer than in urban areas (1.1 vs. 0.9 months and 13.8 vs. 13.2 months respectively). Children are exclusively breastfed for the longest time (3 months) in Almaty city and shortest (0.5-0.6 months) in Almaty, West Kazakhstan, Kostanai, Karaganda and Mangistau Oblasts. At the same time, infants in South Kazakhstan, Aktobe, Atyrau and West Kazakhstan Oblasts (15.0-17.0 percent) receive any kind of breastfeeding and infants in East Kazakhstan, North Kazakhstan Oblasts and Almaty city receive mixed breastfeeding (4.1-5.4 months) longer than children in other regions. By level of household income, children from the poorest households are exclusively breastfed and children from the fourth and richest households receive mixed breastfeeding longer than others households. Table NU.4: Duration of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children age 0-35 months, Kazakhstan, 2010/11 Median duration (in months) Number of children age 0-35 months Any Breastfeeding1 Exclusive Breastfeeding Predominant Breastfeeding Sex Male 13,9 1,2 3,6 1598 Female 13,0 0,7 3,4 1600 Region Akmola Oblast 13,9 1,0 2,3 117 Aktobe Oblast 15,2 0,7 2,5 166 Almaty Oblast 12,1 0,6 4,1 321 Almaty city 11,5 3,0 5,1 124 Astana city 13,7 1,3 3,3 101 Atyrau Oblast 16,6 0,7 2,5 120 East Kazakhstan Oblast 9,6 0,6 5,4 224 Zhambyl Oblast 13,0 1,6 3,8 250 West Kazakhstan Oblast 17,1 0,6 3,2 129 Karaganda Oblast 11,8 0,5 3,7 245 Kostanai Oblast 12,9 0,6 3,4 140 Kyzylorda Oblast 14,0 1,5 2,7 178 Mangistau Oblast 14,3 0,5 2,7 157 Pavlodar Oblast 13,8 1,7 3,2 135 North Kazakhstan Oblast 9,3 2,5 4,5 78 South Kazakhstan Oblast 14,9 2,0 3,6 712 Residence Urban 13,2 0,9 3,6 1562 Rural 13,8 1,1 3,4 1635 Education Incomplete secondary 7,5 0,6 2,7 61 Secondary 13,3 1,2 3,2 1129 Specialized secondary 14,7 0,7 3,5 900 Higher 13,4 1,2 3,8 1101 Wealth Index Quintile Poorest 14,8 1,7 3,5 762 Second 13,1 1,1 3,8 716 Middle 13,8 0,6 2,9 614 66 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Median duration (in months) Number of children age 0-35 months Any Breastfeeding1 Exclusive Breastfeeding Predominant Breastfeeding Fourth 13,6 0,9 3,8 535 Richest 12,5 0,7 3,4 571 Ethnicity of Household Head Kazakh 14,1 0,9 3,5 2311 Russian 11,0 0,8 2,5 489 Other ethnic groups 11,5 1,6 4,6 398 Mean for all children (0-35 months) 14,8 2,1 4,2 3198 1 MICS Indicator 2.10 children. There are 29.4 percent of boys and 32.2 per- cent of girls respectively who are adequately fed for chil- dren age 6-23 months. The share of children aged 6-23 months receiving complementary foods living in rich and poor households is almost the same at about 30- 32 percent. In the poorest quintile household this indica- tor is somewhat lower at 28.7 percent. There is certain variation depending on the level of mothers’ education, where children of mothers with specialized secondary education (32.7 percent), being more likely to be ade- quately fed. The largest proportion of children receiving complementary foods live in Akmola, Almaty, Kostanai, Pavlodar Oblasts and Astana (40.0- 46.2 percent) while the least number of children receiving complementary foods live in Atyrau and South Kazakhstan Oblasts (21.9 percent each). In addition, 31.0 percent of children at the age 0-23 months are being adequately breastfed. There are no significant deviations in terms of gender, residence, level of education and income as well as eth- nicity. The adequacy of infant feeding in children un- der 24 months is provided in Table NU.5. Different criteria of adequate feeding are used depending on the age of the child. For infants aged 0-5 months, ex- clusive breastfeeding is considered as adequate feed- ing, while infants aged 6-23 months are considered to be adequately fed if they are receiving breastmilk and solid, semi-solid or soft food. As a result of these feeding patterns, only 31.8 percent of children aged 0-5 months are being ade- quately fed. Among them, there are more boys (32.4 percent) than girls (31.2 percent); urban infants (34.4 percent) are more likely to be adequately fed than their rural peers (29.2 percent). The survey found that ade- quate feeding practically does not depend either on the level of household wealth or on the level of mother’s education. A slightly lower percentage of infants aged 6-23 months, 30.8 percent is adequately fed, of which 29.9 percent are urban children and 31.7 percent are rural Table NU.5: Age-appropriate breastfeeding Percentage of children age 0-23 months who were appropriately breastfed during the previous day, Kazakhstan, 2010/11 Children age 0-5 months Children age 6-23 months Children age 0-23 months Percent exclusively breastfed1 N um be r o f ch ild re n Percent currently breastfeeding and receiving solid, semi-solid or soft foods N um be r o f ch ild re n Percent appropriately breastfed2 N um be r o f ch ild re n Sex Male 32,4 264 29,4 782 30,1 1047 Female 31,2 268 32,2 786 32,0 1055 Region Akmola Oblast (23,4) 21 41,2 52 36,1 73 Aktobe Oblast (14,1) 23 36,8 95 32,3 118 Almaty Oblast (39,4) 61 40,2 143 40,0 204 Almaty city (*) 13 (10,4) 58 (19,0) 71 Astana city (25,2) 20 45,3 55 39,9 75 Atyrau Oblast (23,7) 21 21,9 55 22,4 76 67MONITORING THE SITUATION OF CHILDREN AND WOMEN Children age 0-5 months Children age 6-23 months Children age 0-23 months Percent exclusively breastfed1 N um be r o f ch ild re n Percent currently breastfeeding and receiving solid, semi-solid or soft foods N um be r o f ch ild re n Percent appropriately breastfed2 N um be r o f ch ild re n East Kazakhstan Oblast (32,7) 45 30,5 103 31,2 147 Zhambyl Oblast (34,7) 46 30,4 130 31,5 175 West Kazakhstan Oblast (22,8) 23 37,1 56 33,0 79 Karaganda Oblast (20,2) 33 28,0 128 26,4 162 Kostanai Oblast (30,8) 24 44,9 64 41,1 88 Kyzylorda Oblast (23,9) 25 27,4 101 26,7 126 Mangistau Oblast 13,9 31 31,3 76 26,3 107 Pavlodar Oblast (*) 19 46,2 62 42,5 81 North Kazakhstan Oblast (*) 12 33,1 37 37,7 49 South Kazakhstan Oblast 41,0 116 21,9 354 26,6 470 Residence Urban 34,4 268 29,9 754 31,1 1022 Rural 29,2 265 31,7 815 31,0 1079 Education Incomplete Secondary (*) 11 (*) 25 (10,3) 36 Secondary 31,0 179 30,4 566 30,5 745 Specialized Secondary 30,1 160 32,7 430 32,0 590 Higher 34,8 183 30,9 543 31,9 726 Wealth Index Quintile Poorest 33,8 120 28,7 370 29,9 490 Second 32,0 121 32,0 373 32,0 494 Middle 30,4 108 30,3 316 30,3 424 Fourth 30,2 104 32,1 231 31,5 335 Richest 32,7 81 31,5 278 31,7 359 Ethnicity of Household Head Kazakh 31,2 381 32,3 1131 32,0 1512 Russian 29,0 74 29,3 248 29,3 322 Other ethnic groups 37,4 77 23,7 190 27,7 267 Total 31,8 532 30,8 1569 31,0 2101 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 2.6 2 MICS Indicator 2.14 ( ) indicators are based on 25-49 cases of unweighted observations (*) indicators are based on less than 25 cases of unweighted observations 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, 49.4 percent of infants age 6-8 received solid, semi-solid, or soft foods (Table NU.6). Among currently breastfeeding infants this percentage is 48 percent, while 57.5 percent among infants are currently not breastfeeding. The proportion of girls receiving sol- id, semi-solid or soft foods is higher than that of boys in both groups. The percentage of children receiving solid, semi-solid or soft foods in urban areas is also higher than in rural areas. Adequate complementary feeding of children from 6 months to two years of age is particularly important for growth and development and the pre- vention of undernutrition. Continued breastfeeding beyond six months should be accompanied by con- sumption of nutritionally adequate, safe and appropri- ate 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 68 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Table NU.6: Introduction of solid, semi-solid or soft food Percentage of infants age 6-8 months who received solid, semi-solid or soft foods during the previous day, Ka- zakhstan, 2010/11 Currently breastfeeding Currently not breastfeeding All Percent receiving solid, semi-solid or soft foods Number of children aged 6-8 months Percent receiving solid, semi-solid or soft foods Number of children aged 6-8 months Percent receiving solid, semi-solid or soft foods1 Number of children aged 6-8 months Gender Male 41,5 125 (*) 17 41,3 142 Female 54,8 119 (*) 24 57,4 143 Residence Urban 53,1 112 (*) 20 53,7 131 Rural 43,7 133 (*) 22 45,7 155 Total 48,0 244 (57,5) 42 49,4 286 1 MICS Indicator 2.12 (*) indicators are based on less than 25 cases of unweighted observations Overall, more than half of children age 6-23 months (55.3 percent) were receiving solid, semi-solid and soft foods the minimum number of times. A slightly higher proportion of females (57.5 percent) were enjoying the minimum meal frequency compared to males (53.1 percent). Table NU.7 presents the proportion of chil- dren age 6-23 months who received semi-solid or soft foods the minimum number of times or more during the previous day according to breastfeeding status (see the note in Table NU.7 for a definition of minimum number of times for different age groups). Table NU.7: Minimum meal frequency Percentage of children age 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 breastfeed- ing status, Kazakhstan, 2010/11 Currently breastfeeding Currently not breastfeeding All Percent receiving solid, semi- solid and soft foods the minimum number of times Number of children aged 6-23 months Percent receiving at least 2 milk feeds1 Percent receiving solid, semi-solid and soft foods or milk feeds 4 times or more Number of children aged 6-23 months Percent with minimum meal frequency 2 Number of children aged 6-23 months Sex Male 22,7 391 90,8 83,4 392 53,1 782 Female 26,4 390 88,0 88,0 397 57,5 786 Age 6-8 months 29,3 244 (97,3) (89,3) 42 38,0 286 9-11 months 11,5 167 91,5 92,2 79 37,5 246 12-17 months 24,8 235 89,0 85,7 289 58,4 523 18-23 months 31,6 135 88,4 84,0 379 70,2 514 Region Akmola Oblast (34,9) 26 (77,2) (80,6) 26 57,5 52 Aktobe Oblast 26,6 50 93,8 86,1 44 54,5 95 69MONITORING THE SITUATION OF CHILDREN AND WOMEN Currently breastfeeding Currently not breastfeeding All Percent receiving solid, semi- solid and soft foods the minimum number of times Number of children aged 6-23 months Percent receiving at least 2 milk feeds1 Percent receiving solid, semi-solid and soft foods or milk feeds 4 times or more Number of children aged 6-23 months Percent with minimum meal frequency 2 Number of children aged 6-23 months Almaty Oblast (40,8) 70 (81,1) (90,9) 72 66,2 143 Almaty city (*) 20 (*) (*) 38 (62,6) 58 Astana city 69,0 30 (96,6) (94,0) 25 80,5 55 Atyrau Oblast 13,1 29 89,2 71,9 26 41,2 55 East Kazakhstan Oblast (32,0) 45 (87,9) (95,1) 58 67,7 103 Zhambyl Oblast 17,0 65 91,0 90,3 65 53,6 130 West Kazakhstan Oblast (32,3) 27 (93,8) (88,4) 29 61,0 56 Karaganda Oblast (28,9) 49 89,2 94,4 79 69,3 128 Kostanai Oblast (46,1) 33 (66,7) (88,7) 31 66,6 64 Kyzylorda Oblast 13,5 53 94,8 89,4 48 49,3 101 Mangistau Oblast 15,4 45 98,2 88,1 31 45,3 76 Pavlodar Oblast (53,0) 32 (91,5) (86,8) 30 69,3 62 North Kazakhstan Oblast (*) 13 (86,9) (92,2) 24 85,2 37 South Kazakhstan Oblast 5,4 192 91,4 70,4 162 35,1 354 Residence Urban 29,6 348 92,4 90,5 406 62,4 754 Rural 20,5 432 86,1 80,6 382 48,7 815 Mother’s Education Incomplete Secondary (*) 6 (*) (*) 19 (*) 25 Secondary 24,5 280 87,4 81,8 286 53,4 566 Specialized Secondary 25,0 227 86,8 84,8 203 53,2 430 Higher 24,9 266 93,1 90,6 277 58,4 543 Wealth Index Quintile Poorest 17,5 204 86,6 78,2 166 44,8 370 Second 20,0 176 88,0 83,3 197 53,4 373 Middle 24,2 154 88,0 83,4 163 54,6 316 Fourth 31,5 112 90,2 92,9 119 63,1 231 Richest 35,6 135 95,4 94,4 144 66,0 278 Ethnicity of Household Head Kazakh 22,7 610 90,8 84,6 521 51,2 1131 Russian 38,2 95 88,7 93,4 153 72,2 248 Other ethnic groups 22,1 75 83,6 80,8 115 57,5 190 Total 24,5 780 89,4 85,7 788 55,3 1569 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 2.15 2 MICS Indicator 2.13 ( ) indicators are based on 25-49 cases of unweighted observations (*) indicators are based on less than 25 cases of unweighted observations 70 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Among currently breastfeeding children aged 6-8 months, minimum meal frequency is defined as children who also received solid, semi-solid or soft foods 2 times or more. Among currently breastfeed- ing children aged 9-23 months, receipt of solid, semi- solid or soft foods at least 3 times constitutes mini- mum meal frequency. For non-breastfeeding chil- dren aged 6-23 months, minimum meal frequency is defined as children receiving solid, semi-solid or soft foods, and milk feeds, at least 4 times during the previous day. Among currently breastfeeding children aged 6-23 months, nearly one-fourth of them (24.5 percent) were receiving solid, semi-solid and soft foods the minimum number of times and this proportion was higher among fe- males (26.4 percent) compared to males (22.7 percent). Children were most likely to receive solid, semi- solid and soft foods the minimum number of times a day in Astana (69 percent), and least likely in South- Kazakhstan Oblast (5.4 percent). The proportion of urban children receiving adequate complementary foods is 9.1 percent higher than that of rural infants. The survey found a clear variation by the welfare of households, with the proportion of breastfed children and children receiving solid, semi-solid and soft foods increasing with the household’s income. Among non-breastfeeding children, a majority (85.7 percent) of children were receiving solid, semi- solid and soft foods or milk feeds 4 times or more. Among them, the proportion of females was 88 per- cent, 4.6 percent higher than that of males. The share of infants living in urban areas is 9.9 percent higher than in rural areas. There is a clear variation by the level of mothers’ education and households’ welfare. Women with a higher level of education and those from the richest households are more likely to have children receiving solid, semi-solid, soft foods or milk feeds 4 and more times a day. The continued practice of bottle-feeding is a concern because of the possible contamination due to unsafe water and lack of hygiene in preparation. Table NU.8 shows that bottle-feeding is quite prevalent in Ka- zakhstan. About 46.7 percent of children under 6 months are fed using a bottle with a nipple. Children in Kostanai (57.4 percent) and South Kazakhstan (57.2 percent) Oblasts are more likely to be fed using a bottle with a nipple, while children from Zhambyl Oblast (29 percent) are least likely to be fed using a bottle with a nipple. Table NU.8: Bottle feeding Percentage of children age 0-23 months who were fed with a bottle with a nipple during the previous day, Kazakhstan, 2010/11 Percentage of children aged 0-23 months fed with a bottle with a nipple1 Number of children aged 0-23 months: Sex Male 47,7 1047 Female 45,8 1055 Age 0-5 months 40,7 532 6-11 months 53,6 532 12-23 months 46,4 1037 Region Akmola Oblast 48,9 73 Aktobe Oblast 41,7 118 Almaty Oblast 33,2 204 Almaty city (40,4) 71 Astana city 43,4 75 Atyrau Oblast 57,7 76 East Kazakhstan Oblast 40,4 147 Zhambyl Oblast 29,0 175 West Kazakhstan Oblast 46,5 79 Karaganda Oblast 41,8 162 Kostanai Oblast 57,4 88 Kyzylorda Oblast 44,9 126 Mangistau Oblast 70,0 107 Pavlodar Oblast 42,5 81 North Kazakhstan Oblast 50,3 49 71MONITORING THE SITUATION OF CHILDREN AND WOMEN Percentage of children aged 0-23 months fed with a bottle with a nipple1 Number of children aged 0-23 months: South Kazakhstan Oblast 57,2 470 Residence Urban 48,4 1022 Rural 45,2 1079 Mother’s Education Incomplete secondary (65,3) 36 Secondary 44,0 745 Specialized secondary 49,8 590 Higher 46,5 726 Wealth Index Quintile Poorest 44,2 490 Second 47,9 494 Middle 45,9 424 Fourth 46,2 335 Richest 50,2 359 Ethnicity of Household Head Kazakh 45,8 1512 Russian 51,5 322 Other ethnic groups 46,6 267 Total 46,7 2101 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 2.11 ( ) indicators are based on 25-49 cases of unweighted observations Salt Iodization mance. The indicator is the percentage of households consuming adequately iodized salt (>15 parts per million). Following global political recommendations, the Government of Kazakhstan committed itself to elimi- nate iodine deficiency in the country through universal salt iodization with potassium iodate during salt pro- duction at 40±15 РРМ both for home consumption, for the food industry and for animals. These commit- ments were documented in the legislation. Iodine Deficiency Disorders (IDD) is the world’s leading cause of preventable mental retardation and impaired psychomotor development in young children. In its most extreme form, iodine deficiency causes cre- tinism. It also increases the risks of stillbirth and mis- carriage in pregnant women. Iodine deficiency is most commonly and visibly associated with goitre. IDD takes its greatest toll in impaired mental growth and develop- ment, contributing in turn to poor school performance, reduced intellectual ability, and impaired work perfor- Table NU.9: Iodized salt consumption Percentage of households consuming adequately iodized salt, Kazakhstan, 2010/11 Percent of households in which salt was tested Num- ber of house- holds Percentage of households with the salt test results Total Number of households in which salt was tested or with no salt Percent- age of house- holds not consum- ing salt Salt test results Non-io- dized salt 0 mg/kg >0 and <15 PPM 15+ PPM1 Region Akmola Oblast 97,6 884 2,4 0,8 1,6 95,2 100 884 72 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Percent of households in which salt was tested Num- ber of house- holds Percentage of households with the salt test results Total Number of households in which salt was tested or with no salt Percent- age of house- holds not consum- ing salt Salt test results Non-io- dized salt 0 mg/kg >0 and <15 PPM 15+ PPM1 Aktobe Oblast 99,4 713 0,4 0,6 20,4 78,6 100 712 Almaty Oblast 99,8 1470 0,1 2,7 6,8 90,4 100 1469 Almaty city 94,6 1473 3,1 0,0 32,0 64,9 100 1437 Astana city 99,6 544 0,3 0,2 1,5 98,0 100 544 Atyrau Oblast 99,8 359 0,0 6,7 14,2 79,1 100 359 East Kazakhstan Oblast 99,6 1673 0,3 0,7 2,2 96,7 100 1671 Zhambyl Oblast 95,9 890 3,6 9,2 9,6 77,7 100 886 West Kazakhstan Oblast 99,6 647 0,3 1,7 1,8 96,1 100 646 Karaganda Oblast 99,7 1629 0,2 1,3 1,6 96,8 100 1627 Kostanai Oblast 99,8 1129 0,1 0,2 5,8 94,0 100 1128 Kyzylorda Oblast 99,7 498 0,3 6,6 8,3 84,9 100 498 Mangistau Oblast 99,0 372 0,4 2,7 19,7 77,1 100 370 Pavlodar Oblast 96,1 931 1,1 7,3 7,8 83,9 100 904 North Kazakhstan Oblast 99,6 795 0,3 1,4 0,9 97,4 100 794 South Kazakhstan Oblast 100,0 1794 0,0 20,3 15,6 64,0 100 1794 Residence Urban 98,1 9598 1,2 2,4 10,1 86,4 100 9530 Rural 99,5 6202 0,3 7,5 8,3 83,9 100 6192 Wealth Index Quintile Poorest 99,5 2624 0,5 10,3 11,2 78,0 100,0 2623 Second 99,5 2628 0,3 7,1 7,8 84,8 100,0 2623 Middle 98,5 3036 1,2 3,5 7,7 87,6 100,0 3026 Fourth 98,1 3845 1,1 2,0 8,8 88,1 100,0 3814 Richest 98,3 3667 0,9 1,3 11,3 86,5 100,0 3635 Total 98,7 15800 0,8 4,4 9,4 85,4 100 15722 1 MICS Indicator 2.16 South Kazakhstan Oblast (64 percent) and in Almaty City (64.9 percent) and highest in Astana City (98 per- cent) and North Kazakhstan Oblast (97.4 percent). 86.4 percent of urban households were found to be using adequately iodized salt as compared to 83.9 percent in rural areas (Figure NU.4). The difference between the richest and poorest households in terms of iodized salt consumption is 8.5 percent (86.5 and 78.0 percent respectively). In almost all households (98.7 percent), salt used for cooking was tested for iodine content by using salt test kits and testing for the presence of potassium iodate (Table NU.9). Table NU.9 shows that in an extremely small proportion of households (0.8 percent), there was no salt available. In an overwhelming majority of house- holds (85.4 percent), salt was found to contain 15 PPM or more of iodine. Use of iodized salt was lowest in 73MONITORING THE SITUATION OF CHILDREN AND WOMEN Low Birth Weight Weight at birth is a good indicator not only of a mother’s health and nutritional status but also the new- born’s chances for survival, growth, long-term health and psychosocial development. Low birth weight (less than 2,500 grams) carries a range of grave health risks for children. Babies who were undernourished in the womb face a greatly increased risk of dying during their early months and years. Those who survive have impaired immune function and increased risk of dis- ease; they are likely to remain undernourished, with reduced muscle strength, throughout their lives, and suffer a higher incidence of diabetes and heart dis- ease in later life. Children born underweight also tend to have a lower IQ and cognitive disabilities, affecting their performance in school and their job opportunities as adults. In the developing world, low birth weight stems primarily from the mother’s poor health and nutrition. Three factors have most impact: the mother’s poor nutritional status before conception, short stature (due mostly to under nutrition and infections during her childhood), and poor nutrition during the pregnancy. Inadequate weight gain during pregnancy is particu- larly important since it accounts for a large proportion of foetal growth retardation. Moreover, diseases such as diarrhoea and malaria, which are common in many developing countries, can significantly impair foetal 74 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN 12 For a detailed description of the methodology, see Boerma, Weinstein, Rutstein and Sommerfelt, 1996. growth if the mother becomes infected while preg- nant. In the industrialized world, cigarette smoking during pregnancy is the leading cause of low birth weight. In developed and developing countries alike, teenagers who give birth when their own bodies have yet to finish growing run the risk of bearing underweight babies. One of the major challenges in measuring the incidence of low birth weight is the fact that more than half of infants in the developing world are not weighed. In the past, most estimates of low birth weight for developing countries were based on data compiled from health facilities. However, these es- timates are biased for most developing countries because the majority of newborns are not deliv- ered in facilities, and those who are represent only a selected sample of all births. Because many infants are not weighed at birth and those who are weighed may be a biased sample of all births, the reported birth weights usually cannot be used to estimate the prevalence of low birth weight among all children. Therefore, the percentage of births weighing below 2500 grams is estimated from two items in the questionnaire: the mother’s assessment of the child’s size at birth (i.e., very small, smaller than average, average, larger than average, very large) and the mother’s recall of the child’s weight or the weight as recorded on a health card if the child was weighed at birth12. Table NU.11: 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, Kazakhstan, 2010/11 Percent of live births: Number of live births in the last 2 yearsBelow 2,500 grams 1 Weighed at birth 2 Region Akmola Oblast 5,9 97,6 84 Aktobe Oblast 3,7 96,9 130 Almaty Oblast 3,0 97,6 125 Almaty city (3,2) (87,0) 46 Astana city 3,0 100,0 125 Atyrau Oblast 4,5 97,5 162 East Kazakhstan Oblast 2,4 98,0 99 Zhambyl Oblast 7,6 97,5 158 West Kazakhstan Oblast 4,9 98,2 112 Karaganda Oblast 6,6 95,5 112 Kostanai Oblast 5,5 100,0 95 Kyzylorda Oblast 3,4 98,4 187 Mangistau Oblast 3,6 96,8 186 Pavlodar Oblast 3,4 97,9 97 North Kazakhstan Oblast 9,3 100,0 73 South Kazakhstan Oblast 4,4 97,9 236 Residence Urban 4,1 97,8 1069 Rural 5,1 97,5 958 Education Incomplete Secondary (10,4) (85,7) 28 Secondary 4,9 97,5 650 Specialized Secondary 4,4 98,3 606 Higher 4,1 97,8 740 75MONITORING THE SITUATION OF CHILDREN AND WOMEN Percent of live births: Number of live births in the last 2 yearsBelow 2,500 grams 1 Weighed at birth 2 Wealth Index Quintile Poorest 4,9 96,6 385 Second 5,3 98,6 424 Middle 4,3 97,9 430 Fourth 4,6 98,1 374 Richest 3,5 96,9 414 Ethnicity of Household Head Kazakh 4,3 97,9 1494 Russian 5,0 97,8 323 Other ethnic groups 5,8 95,7 210 Total 4,5 97,6 2027 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 2.18 2 MICS Indicator 2.19 ( ) indicators are based on 25-49 cases of unweighted observations In Kazakhstan, almost all children (97.6 per- cent) were weighed at birth and approximately 4.5 percent of infants are estimated to weigh less than 2,500 grams at birth (Table NU.11). The survey found certain variation by region; the highest percentage of low birth weight children was found in North Ka- zakhstan Oblast (9.3 percent), while the lowest was found in East Kazakhstan Oblast (2.4 percent) (Fig- ure NU.5). In seven regions, the share of low weight children was 3-3.7 percent. The share of low birth weight infants is 1 percent higher in rural (5.1 per- cent) than in urban areas. 76 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN VI. Child Health 77MONITORING THE SITUATION OF CHILDREN AND WOMEN The Millennium Development Goal (MDG) 4 is to reduce child mortality by two thirds between 1990 and 2015. Immunization plays a key part in this goal. Immunizations have saved the lives of millions of children in the three decades since the launch of the Expanded Programme on Immunization (EPI) in 1974. Worldwide there are still 27 million children overlooked by routine immunization and as a result, vaccine-preventable diseases cause more than 2 mil- lion deaths every year. A World Fit for Children goal is to ensure full immunization of children under one at 90 percent nationally, with at least 80 percent coverage in ev- ery district or equivalent administrative unit. Vaccinations National Vaccination Calendar, Kazakhstan, 2010 Age Tubercu- losis (BCG) Hepatitis В Polio- myelitis (OPV/IPV) Pertussis, Diphtheria, Tetanus (DPT) Haemophilus influenza (HIB) Diphtheria, Tetanus (DT) Diphtheria (DT with lower dose of anti- gens) Diphtheria, Tetanus (DPT with lower dose of antigens) MMR: Measles, mumps, rubella) 1-4 days х х 2 months х х х х 3 months х х х 4 months х х х х 12-15 months. х х 18 months х х 6 years (1st grade.) х Х х 12 years х 15 years 16 years х Every 10 years х Interviewers copied vaccination information from the cards onto the MICS questionnaire. If no cards were available, information was filled in based on mothers’ reports. To confirm mother’s reports and in cases when vaccination cards were stored in healthcare centres, the team editor visited them to complete a separate immunization module for each child under 5 years of age. Data were entered from the separate immuniza- tion module or based on mothers’ reports. According to UNICEF and WHO guidelines as well as Kazakhstani Vaccination Calendar, every child should receive a BCG vaccination to protect against tu- berculosis, three doses of DPT to protect against diph- theria, pertussis, and tetanus, three doses of hepatitis B vaccine, three doses of polio vaccine, the fourth po- lio vaccine and a measles, mumps and rubella vacci- nation at the age of 12-15 months. Mothers were asked to provide vaccination cards for children under 5. 78 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Table CH.1: Vaccinations in first year of life Percentage of children aged 15-26 months immunized against childhood diseases at any time before the survey and before the first birthday, Kazakhstan, 2010/2011 Percentage vaccinated at any time before the survey according to the vaccination card Vaccinated by 12 months of age Vaccination card Vaccinated at any time before the survey according to: mother’s report Vaccinated at any time before the survey according to: any source BCG1 96,0 3,4 99,5 99,2 Polio 1 95,5 3,6 99,1 98,9 2 94,5 3,1 97,6 96,1 32 86,3 2,1 88,4 81,3 DPT 1 95,3 3,5 98,8 98,4 2 95,1 3,3 98,5 96,8 33 94,2 2,6 96,8 93,0 Measles (MMR)4 90,5 3,4 93,9 89,0 Hepatitis B 1 76,1 20,4 96,6 95,9 2 75,0 18,5 93,5 91,9 35 63,1 7,1 70,2 67,0 All vaccinations 36,3 25,3 61,6 46,7 No vaccination 0,0 0,2 0,2 0,2 All, excluding hepatitis 54,7 28,9 83,6 70,6 None, excluding hepatitis 0,0 0,2 0,2 0,2 Number of children aged 15-26 months 1076 1076 1076 1076 For Measles or MRR vaccination is calculated until 15 months 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; percent by the third dose. Vaccination of children at the age from 2 to 4 is carried out via an injection of a vaccine, which consists of DPT vaccine, hepatitis B vaccine HepB, type B haemophilic infection vac- cine, with the simultaneous oral polio vaccine injection Hib (OPV). Kazakhstan positions itself as a polio free country, and the low coverage of polio vaccines in the second and third doses can be explained by the con- scious refusal of mothers to vaccinate as well as the absence of records on vaccines. In Kazakhstan, Hepatitis B vaccination is also recommended as part of the immunization schedule. The first HepB vaccine is introduced at age of 1-4 days of birth, the second one at age of 2 months and the third one at age of 4 months. By the age of 12 months 95.9 percent of children in survey received first dose of HepB vaccine. Percentage of coverage with the sec- ond dose was 91.9 percent and 67 percent with the third one (Tables CH.1). The denominator for the table is comprised of children age 15-26 months so that only children who are old enough to be fully vaccinated are counted. In the top panel, the numerator includes all children who were vaccinated at any time before the survey accord- ing to the vaccination card or the mother’s report. In the bottom panel, only those who were vaccinated before their first birthday, as recommended, are included. For children without vaccination cards, the proportion of vaccinations given before the first birthday is assumed to be the same as for children with vaccination cards. Approximately all children (99.2 percent) age 15-26 months received a BCG vaccination by the age of 12 months and the first dose of DPT was given to 98.4 percent of children. The percentage declines for subsequent doses of DPT to 96.8 percent for the sec- ond dose, and 93 percent for the third dose (Figure CH.1). Similarly, 98.9 percent of children received Polio 1 by age 12 months and this declines to 81.3 79MONITORING THE SITUATION OF CHILDREN AND WOMEN In 2008 in order to introduce safe injection prac- tices, the Ministry of Healthcare of the Republic of Kazakhstan introduced the use of combined vaccina- tion for children. Vaccination of children aged 2 and 4 months is carried out by administering a single injec- tion consisting of DPT, Hepatitis B and Haemophilus in- fluenza type B with simultaneous administration of oral polio vaccine. Percentage of immunization coverage of children against DPT 3 is significantly higher (93.0 percent) than against Hepatitis B3 (67.0 percent), al- though according to the abovementioned, percentage of coverage by third dose vaccinations against Hep- atitis B and DPT should be approximately the same. The difference in findings on the level of coverage with DPT 3 and Hepatitis B vaccinations may be possible related to the fact that Vaccination cards most often re- flect DPT immunization and more rarely immunization against Hepatitis B. In this regard, according to survey findings the percentage of children who received full recommend- ed course of vaccination before their first birthday (12 months) was 70.6 percent, excluding vaccination against Hepatitis B and only 46.7 percent counting Hepatitis B vaccination. Table CH.2 shows the level of vaccination cover- age of children aged 15-26 months by main charac- teristics. The numbers include the number of children who had been vaccinated at some time prior to the sur- vey and are based both on the data from Vaccinations Cards and responses of mothers and caretakers. In Kazakhstan, at the time of the survey 61.6 per- cent of children aged 15-26 months (based on immuni- zation cards) had all necessary vaccinations. The rural immunization level is slightly higher (65.9 percent) than urban (56.8 percent). The highest immunization cover- age was reported in Karaganda (92.9 percent), Kosta- nai (90.1 percent), Zhambyl (88.5 percent), Pavlodar Oblasts (80.2 percent), whereas the lowest coverage rate was reported in Astana city (21.6 percent) and West Kazakhstan Oblast (26.9 percent). The interviewers saw vaccination cards of 65.9 percent of children and copies all types of vaccination received into a separate Mod- ule on Immunization during the visits of households or medical institutions. There was no difference in cover- age with BCG vaccination by sex, place of residence, mother’s education and household wealth. By the age of 26 months, 98.8 percent of chil- dren received first dose of DPT. The percentage de- clines to 98.5 percent for the second dose, and 96.8 percent for the third dose; the coverage of boys and girls and those living in urban and rural areas is almost the same. During the survey no major disparities were observed in terms of the region, mother’s education or wealth quintile. A somewhat different situation ex- ists with polio vaccination. A total 99.1 percent of chil- dren received OPV 1 and this declines to 88.4 percent by the third dose oral polio vaccine. OPV coverage of boys and girls was almost the same. Both in urban and rural areas by the third dose of OPV the proportion of children vaccinated against polio significantly decreas- es and is at 87.1 percent and 89.6 percent respectively compared to 99.0 percent and 99.2 percent for the first dose. About 93.9 percent of children age 15-26 months were covered with mumps, measles and rubella vaccine. One hundred percent measles vaccination coverage was only reported in Kostanai Oblast, while in other regions it is also high and exceeds 90 percent. A total of 70.2 per- cent of children received three doses of HepB vaccine by the age of 26 months; the share of rural children was 5.4 80 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN pe rc en t h ig he r t ha n ur ba n ch ild re n (7 2. 8 an d 67 .4 p er ce nt re sp ec tiv el y) . Ta bl e C H .2 : V ac ci na tio ns b y ba ck gr ou nd c ha ra ct er is tic s P er ce nt ag e of c hi ld re n ag ed 1 5- 26 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, K az ak hs ta n, 2 01 0/ 20 11 Pe rc en ta ge o f c hi ld re n w ho re ce iv ed : Percentage with vac- cination card seen Number of children age 15-26 months B C G Po lio D PT Measles+parotitis, rubella H ep B N on e A ll 1 2 3 1 2 3 1 2 3 Se x M al e 99 ,4 99 ,5 97 ,7 88 ,8 98 ,7 97 ,8 96 ,9 94 ,8 96 ,0 93 ,1 69 ,3 0, 1 62 ,2 64 ,0 55 7 Fe m al e 99 ,6 98 ,6 97 ,5 88 ,0 98 ,9 99 ,2 96 ,6 92 ,9 97 ,2 93 ,9 71 ,2 0, 3 60 ,9 68 ,0 51 9 R eg io n A km ol a (1 00 ,0 ) (9 6, 0) (9 1, 9) (7 2, 0) (9 8, 0) (9 5, 9) (9 6, 1) (9 7, 9) (9 4, 2) (8 4, 4) (5 0, 1) (0 ,0 ) (3 8, 1) (9 7, 4) 40 A kt ob e 10 0, 0 97 ,4 97 ,4 73 ,7 10 0, 0 10 0, 0 10 0, 0 91 ,5 98 ,3 91 ,5 68 ,1 0, 0 42 ,5 51 ,4 56 A lm at y 10 0, 0 10 0, 0 98 ,4 82 ,2 10 0, 0 98 ,4 95 ,3 94 ,8 98 ,4 90 ,9 82 ,3 0, 0 76 ,2 80 ,9 10 0 A lm at y ci ty (1 00 ,0 ) (1 00 ,0 ) (8 9, 6) (6 9, 8) (1 00 ,0 ) (9 6, 7) (7 3, 3) (9 0, 4) (9 2, 5) (7 5, 0) (1 6, 9) (0 ,0 ) (1 3, 2) (6 8, 9) 46 A st an a ci ty 10 0, 0 10 0, 0 97 ,3 79 ,8 98 ,6 10 0, 0 97 ,9 97 ,9 10 0, 0 84 ,2 30 ,3 0, 0 21 ,6 85 ,1 37 A ty ra u 10 0, 0 10 0, 0 10 0, 0 81 ,6 10 0, 0 10 0, 0 96 ,7 93 ,0 92 ,6 97 ,9 57 ,0 0, 0 40 ,5 24 ,6 38 E as t K az ak hs ta n 10 0, 0 98 ,1 98 ,1 96 ,3 98 ,1 98 ,1 98 ,1 90 ,7 98 ,1 98 ,1 77 ,6 0, 0 71 ,4 69 ,9 75 Zh am by l 10 0, 0 10 0, 0 10 0, 0 97 ,6 10 0, 0 10 0, 0 10 0, 0 93 ,2 10 0, 0 10 0, 0 96 ,6 0, 0 88 ,5 34 ,2 76 W es t K az ak hs ta n 10 0, 0 10 0, 0 98 ,3 95 ,4 10 0, 0 98 ,3 96 ,6 94 ,8 85 ,6 96 ,4 43 ,1 0, 0 26 ,9 96 ,3 40 K ar ag an da 97 ,0 97 ,3 97 ,0 94 ,3 95 ,7 97 ,0 97 ,0 97 ,0 97 ,0 97 ,0 97 ,0 1, 4 92 ,9 31 ,9 10 1 K os ta na i 10 0, 0 10 0, 0 10 0, 0 97 ,5 10 0, 0 10 0, 0 10 0, 0 10 0, 0 10 0, 0 10 0, 0 90 ,1 0, 0 90 ,1 28 ,0 45 K yz yl or da 99 ,2 99 ,2 99 ,2 97 ,4 99 ,2 99 ,2 98 ,1 97 ,3 90 ,8 99 ,2 79 ,4 0, 8 68 ,0 99 ,2 62 M an gi st au 96 ,4 98 ,8 97 ,1 87 ,6 98 ,8 98 ,8 98 ,8 97 ,9 10 0, 0 98 ,8 82 ,7 0, 0 75 ,9 56 ,4 58 P av lo da r 10 0, 0 97 ,2 93 ,7 84 ,9 95 ,2 95 ,2 93 ,4 93 ,3 94 ,8 93 ,4 83 ,8 0, 0 80 ,2 96 ,5 48 N or th K az ak hs ta n (1 00 ,0 ) (1 00 ,0 ) (9 5, 4) (8 8, 0) (1 00 ,0 ) (9 7, 6) (9 5, 3) (9 2, 9) (9 5, 1) (9 5, 1) (7 2, 6) (0 ,0 ) (6 6, 2) (4 2, 8) 25 S ou th K az ak hs ta n 10 0, 0 10 0, 0 99 ,0 91 ,4 99 ,0 99 ,0 99 ,0 90 ,4 97 ,3 91 ,2 57 ,3 0, 0 48 ,7 76 ,5 22 7 A re a U rb an 99 ,6 99 ,0 96 ,9 87 ,1 98 ,7 98 ,6 95 ,0 93 ,6 96 ,9 94 ,3 67 ,4 0, 4 56 ,8 64 ,0 51 2 R ur al 99 ,3 99 ,2 98 ,2 89 ,6 98 ,9 98 ,4 98 ,4 94 ,2 96 ,3 92 ,8 72 ,8 0, 0 65 ,9 67 ,7 56 4 M ot he r’s E du ca tio n S ec on da ry in co m pl et e (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 17 S ec on da ry 99 ,1 98 ,9 96 ,7 88 ,3 98 ,3 97 ,8 96 ,6 94 ,3 96 ,9 95 ,3 74 ,0 0, 0 66 ,4 68 ,7 39 8 81MONITORING THE SITUATION OF CHILDREN AND WOMEN Pe rc en ta ge o f c hi ld re n w ho re ce iv ed : Percentage with vac- cination card seen Number of children age 15-26 months B C G Po lio D PT Measles+parotitis, rubella H ep B N on e A ll 1 2 3 1 2 3 1 2 3 S ec on da ry s pe ci al is ed 10 0, 0 98 ,8 98 ,6 88 ,3 98 ,8 98 ,4 96 ,3 93 ,8 97 ,2 92 ,8 71 ,1 0, 0 62 ,0 67 ,0 29 7 H ig h 99 ,5 99 ,5 97 ,7 88 ,6 99 ,2 99 ,2 97 ,2 93 ,8 95 ,7 91 ,8 64 ,4 0, 5 55 ,9 62 ,3 36 1 W ea lth In de x Q ui nt ile P oo re st 99 ,4 99 ,2 97 ,6 88 ,6 98 ,5 97 ,9 97 ,1 93 ,3 96 ,8 94 ,6 71 ,8 0, 0 62 ,6 74 ,3 24 9 S ec on d 10 0, 0 99 ,4 98 ,9 90 ,4 10 0, 0 98 ,9 98 ,9 93 ,7 98 ,7 97 ,4 71 ,7 0, 0 63 ,8 62 ,5 27 2 M id dl e 98 ,8 99 ,3 97 ,4 90 ,4 98 ,8 98 ,8 97 ,0 90 ,2 95 ,4 90 ,5 75 ,8 0, 0 64 ,8 68 ,9 19 8 Fo ur th 10 0, 0 98 ,4 96 ,3 83 ,6 97 ,0 97 ,7 94 ,4 95 ,9 96 ,9 90 ,4 66 ,5 0, 0 59 ,2 61 ,4 16 8 R ic he st 99 ,0 99 ,0 97 ,0 87 ,5 99 ,0 99 ,0 95 ,2 97 ,1 94 ,2 92 ,4 63 ,6 1, 0 55 ,5 60 ,8 18 9 R el ig io n/ La ng ua ge /E th ni ci ty o f H ou se ho ld H ea d K az ak h 99 ,7 99 ,3 98 ,8 90 ,5 99 ,3 98 ,9 97 ,9 94 ,7 97 ,0 94 ,6 71 ,3 0, 0 62 ,3 67 ,2 75 9 R us si an 99 ,2 97 ,8 93 ,8 81 ,3 98 ,2 97 ,8 93 ,4 93 ,5 95 ,8 89 ,6 66 ,5 0, 8 57 ,9 61 ,0 17 1 O th er e th ni c gr ou p 98 ,6 99 ,7 95 ,8 86 ,0 96 ,9 96 ,9 94 ,8 90 ,0 95 ,1 92 ,5 69 ,2 0, 3 62 ,0 64 ,9 14 6 To ta l 99 ,5 99 ,1 97 ,6 88 ,4 98 ,8 98 ,5 96 ,8 93 ,9 96 ,6 93 ,5 70 ,2 0, 2 61 ,6 65 ,9 10 76 ‘N o ed uc at io n’ c at eg or y ha s be en e xc lu de d du e to in si gn ifi ca nt n um be r o f r es po ns es ( ) i nd ic at or s ar e ba se d on 2 5- 49 c as es o f u nw ei gh te d ob se rv at io ns (* ) in di ca to rs a re b as ed o n le ss th an 2 5 ca se s of u nw ei gh te d ob se rv at io ns 82 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Diarrhoea is the second leading cause of death among children under 5 worldwide. Most diarrhoea- related deaths in children are due to dehydration from loss of large quantities of water and electrolytes from the body in liquid stools. Management of diar- rhoea – either through oral rehydration salts (ORS) or a recommended home fluid (RHF) - can prevent many of these deaths. Preventing dehydration and malnutrition by increasing fluid intake and continu- ing to feed the child are also important strategies for managing diarrhoea. The goals are to: 1) reduce by one half death due to diarrhoea among children under by 2010 com- pared to 2000 (A World Fit for Children); and 2) reduce by two thirds the mortality rate among children under 5 by 2015 compared to 1990 (Millennium Develop- ment Goals). In addition, the World Fit for Children calls for a reduction in the incidence of diarrhoea by 25 percent. Oral Rehydration Treatment Table CH.4: Oral rehydration solutions and recommended homemade fluids Percentage of children age 0-59 months with diarrhoea in the last two weeks, and treatment with oral rehydration solutions and recommended homemade fluids, Kazakhstan, 2010/11 Had diar- rhoea in last two weeks Num- ber of children aged 0-59 months Children with diarrhoea who received: Number of children aged 0–59 months with diarrhoea Oral rehydration solu- tions (Fluid from ORS packet or pre-pack- aged ORS fluid) Any recommended homemade fluids ORS or any recommended homemade fluid Sex Male 2,0 2644 (67,9) (20,9) (69,7) 53 Female 1,5 2537 (53,1) (23,7) (57,5) 37 Residence Urban 1,8 2508 (70,3) (25,8) (73,9) 46 Rural 1,6 2673 (53,0) (18,2) (55,1) 44 Education Incomplete secondary 1,6 96 (*) (*) (*) 1 Secondary 1,4 1916 (56,8) (32,0) (63,6) 28 Specialized secondary 1,7 1432 (61,2) (14,7) (61,2) 25 Higher 2,1 1729 (67,1) (18,9) (69,1) 36 Ethnicity of Household Head Kazakh 1,5 3724 71,8 24,2 71,8 54 Russian 2,7 785 (*) (*) (*) 21 Other 2,0 672 (*) (*) (*) 14 Total 1,7 5181 61,8 22,1 64,7 90 ‘No education’ category has been excluded due to insignificant number of responses ( ) – indicators are based on 25-49 cases of unweighted observations (*) – indicators are based on less than 25 cases of unweighted observations The indicators are: • Prevalence of diarrhoea • Oral rehydration therapy (ORT) • Home management of diarrhoea • ORT with continued feeding In the MICS questionnaire, mothers (or caretak- ers) were asked to report whether their child had had di- arrhoea in the two weeks prior to the survey. If so, the mother was asked a series of questions about what the child had to drink and eat during the episode and whether this was more or less than the child usually ate and drank. Since the survey was conducted in winter period for which the incidence of diarrhoea is uncharacteristic, only 1.7 percent or 90 under-5 children had diarrhoea in the two weeks preceding the survey (Table CH.4). Due to the small number of cases, data is distributed by residence and sex of children. Diarrhoea prevalence was slightly higher among boys; no difference between rural and urban areas was found. 83MONITORING THE SITUATION OF CHILDREN AND WOMEN Table CH.4 also shows the percentage of children receiving various types of recommended liquids during the episode of diarrhoea. Since mothers were able to name more than one type of liquid, the percentages do not necessarily add to 100. About 61.8 percent received fluids from ORS packets or pre-packaged ORS fluids and 22.1 percent received recommended homemade fluids. Less than one third (29.9 percent) of under-5 children with diarrhoea drank more than usual while 30.2 percent drank the same (Table CH.5). Table CH.5: Feeding practices during diarrhoea Percent distribution of children age 0-59 months with diarrhoea in the last two weeks by amount of liquids and food given during episode of diarrhoea, Kazakhstan, 2010/11 H ad d ia rr he a in la st tw o w ee ks N um be r o f c hi ld re n ag e 0- 59 m on th s Drinking practices during diarrhoea: To ta l Eating practices during diarrhoea: To ta l N um be r o f c hi ld re n ag ed 0 -5 9 m on th s w ith di ar rh oe a G iv en m uc h le ss to dr in k G iv en s om ew ha t le ss to d rin k G iv en a bo ut th e sa m e to d rin k G iv en m or e to d rin k G iv en n ot hi ng to dr in k G iv en m uc h le ss to e at G iv en s om ew ha t le ss to e at G iv en a bo ut th e sa m e to e at G iv en m or e to e at S to pp ed fo od H ad n ev er b ee n gi ve n fo od M is si ng /D K Sex Male 2,0 2644 (5,5) (34,3) (28,7) (27,5) (3,9) 100 (7,7) (38,0) (43,3) (3,6) (0,0) (6,2) (1,3) 100 53 Female 1,5 2537 (10,1) (22,1) (32,2) (33,3) (2,3) 100 (24,7) (29,7) (37,3) (4,0) (2,2) (2,2) (0,0) 100 37 Residence Urban 1,8 2508 (1,0) (23,0) (32,9) (40,4) (2,7) 100 (11,2) (27,3) (49,4 (7,3) (0,0) (3,2) (1,5) 100 46 Rural 1,6 2673 (14,1) (35,8) (27,4) (18,9) (3,8) 100 (18,4) (42,0) (31,9) (0,0) (1,8) (5,9) (0,0) 100 44 Ethnicity of Household Head Kazakh 1,5 3724 12,2 26,7 26,2 30,2 4,7 100 18,7 31,9 35,4 6,1 1,5 5,2 1,2 100 54 Russian 2,7 785 (*) (*) (*) (*) (*) 100 (*) (*) (*) (*) (*) (*) (*) 100 21 Other 2,0 672 (*) (*) (*) (*) (*) 100 (*) (*) (*) (*) (*) (*) (*) 100 14 Total 1,7 5181 7,4 29,3 30,2 29,9 3,3 100 14,7 34,5 40,8 3,7 0,9 4,5 0,8 100 90 ( ) – indicators are based on 25-49 cases of unweighted observations (*) – indicators are based on less than 25 cases of unweighted observations Table CH.6 provides the proportion of children age 0-59 months with diarrhoea in the last two weeks who received oral rehydration therapy with continued feeding, and percentage of children with diarrhoea who received other treatments. Overall, 70 percent of children with diarrhoea received ORS or increased flu- ids, 71.1 percent received ORT (ORS or recommend- ed homemade fluids or increased fluids). Combining the information in Table CH.5 with those in Table CH.6 on oral rehydration therapy, it is observed that 54 per- cent of children either received ORT and, at the same time feeding was continued, which is based on what is recommended. In a number of cases children with diarrhoea received other medicine in addition to ORT. Whereby 17.2 percent of children received antibiot- ics through injections, 5.2 percent of children received antispasmodics in pills or syrup. 84 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Table CH.6: Oral rehydration therapy with continued feeding and other treatments Percentage of children age 0-59 months with diarrhoea in the last two weeks who received other treatments, Kazakhstan, 2010/2011 Children with diarrhoea who received: Other treatment: N ot g iv en a ny tr ea tm en t or d ru g N um be r o f c hi ld re n ag ed 0 -5 9 m on th s w ith di ar rh oe a O R S o r i nc re as ed flu id s O R T (O R S o r r ec - om m en de d ho m e- m ad e flu id s or in cr ea se d flu id s) O R T w ith c on tin - ue d fe ed in g1 Pill or syrup Injections In tra ve no us H om e re m ed y/ H er ba l m ed ic in e O th er A nt ib io tic A nt im ot ili ty Zi nc O th er U nk no w n: A nt ib io tic In je ct io n N on an tib io tic In je ct io n U nk no w n Sex Male (71,5) (71,5) (59,7) (20,9) (5,7) (0,0) (3,2) (10,8) (0,0) (0,0) (0,0) (0,0) (8,8) (25,0) (8,9) 53 Female (68,0) (70,5) (45,8) (12,1) (4,5) (0,0) (4,5) (6,5) (4,1) (0,0) (0,0) (0,0) (2,1) (13,9) (20,3) 37 Residence Urban (85,3) (85,3) (69,4) (17,1) (10,2) (0,0) (7,4) (4,5) (2,1) (0,0) (0,0) (0,0) (3,5) (13,2) (8,5) 46 Rural (54,2) (56,3) (37,9) (17,4) (0,0) (0,0) (0,0) (13,8) (1,2) (0,0) (0,0) (0,0) (8,6) (27,9) (18,8) 44 Mother’s Education Incomplete Secondary (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 1 Secondary (60,2) (63,6) (51,3) (12,5) (0,0) (0,0) (0,0) (10,3) (0,0) (0,0) (0,0) (0,0) (2,9) (20,9) (16,2) 28 Specialized Secondary (73,9) (73,9) (59,8) (21,7) (6,9) (0,0) (6,9) (2,4) (2,2) (0,0) (0,0) (0,0) (9,4) (19,0) (7,3) 25 Higher (73,8) (73,8) (51,7) (18,5) (8,3) (0,0) (4,7) (13,0) (2,7) (0,0) (0,0) (0,0) (6,3) (19,2) (16,5) 36 Total 70,0 71,1 54,0 17,2 5,2 0,0 3,8 9,0 1,7 0,0 0,0 0,0 6,0 20,4 13,6 90 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 3.8 ( ) – indicators are based on 25-49 cases of unweighted observations (*) – indicators are based on less than 25 cases of unweighted observations Care Seeking and Antibiotic Treatment of Pneumonia A total of 2.8 percent or 145 children age 0-59 months were reported to have had symptoms of pneu- monia during the two weeks preceding the survey. Of these children, 81.2 percent sought care and advice in various healthcare facilities including 80.2 percent in public healthcare facilities, 10.1 percent in private fa- cilities and 3.7 percent in other sources of care. Among public healthcare hospitals, people were more likely to seek care in public hospitals and health centres (36.5 and 33.8 percent respectively), whereas among private institutions, most popular were private hospitals/clinics and private pharmacies (2.7 and 5.3 percent of total number of institutions, respectively). In urban areas, people were more likely to seek care for suspected pneumonia in public hospitals (49.5 percent), whereas in rural areas people were more likely to seek care in public healthcare centres (37.7 percent). Table CH.7 also presents the use of antibiotics for the treatment of suspected pneumonia in under-5s. In Kazakhstan, 86.6 percent of under-5 children with suspected pneumonia had received an antibiotic dur- ing the two weeks prior to the survey. Pneumonia is the leading cause of death in chil- dren and the use of antibiotics in under-5s with sus- pected pneumonia is a key intervention. A World Fit for Children goal is to reduce by one-third the deaths due to acute respiratory infections. The prevalence of suspected pneumonia was estimated by asking mothers or caretakers whether their child under 5 had an illness with a cough ac- companied by rapid or difficult breathing, and whose symptoms were due to a problem in the chest or both a problem in the chest and a blocked nose. • Prevalence of suspected pneumonia • Care seeking for suspected pneumonia • Antibiotic treatment for suspected pneumonia • Knowledge of the danger signs of pneumonia Table CH.7 presents the prevalence of sus- pected pneumonia and, if care was sought outside the home, the site of care. THE INDICATORS ARE: 85MONITORING THE SITUATION OF CHILDREN AND WOMEN Ta bl e C H .7 : C ar e se ek in g fo r s us pe ct ed p ne um on ia a nd a nt ib io tic u se d ur in g su sp ec te d pn eu m on ia P er ce nt ag e of c hi ld re n ag e 0- 59 m on th s w ith s us pe ct ed p ne um on ia in th e la st tw o w ee ks w ho w er e ta ke n to a h ea lth p ro vi de r a nd p er ce nt ag e of ch ild re n w ho w er e gi ve n an tib io tic s, K az ak hs ta n, 2 01 0/ 20 11 Had suspected pneumonia in the last two weeks Number of children age 0-59 months C hi ld re n w ith s us pe ct ed p ne um on ia w ho w er e ta ke n to : Any appropriate provider 1 Percentage of children with sus- pected pneumonia who received antibiotics in the last two weeks 2 Number of children age 0-59 months with suspected pneumo- nia in the last two weeks Pu bl ic s ec to r Pr iv at e se ct or O th er s ou rc es Public sector: Hospital Public sector: Basic health unit Public sector: Satellite clinic Village health worker Outreach clinic Other public sector health facilities Private hospital/clinic Private physician Private pharmacy Mobile clinic Other private health pro- vider Relative / Friend Shop Traditional practitioner Other Se x M al e 2,9 26 44 32 ,0 2,3 35 ,4 8,9 0,0 0,0 4,3 1,7 7,3 0,0 1,9 1,4 0,0 0,8 1,9 82 ,5 83 ,3 78 Fe m al e 2,6 25 37 41 ,8 0,9 32 ,0 5,9 0,0 1,5 0,9 0,5 3,0 0,0 0,0 3,0 0,0 0,0 0,0 79 ,6 90 ,4 67 R es id en ce U rb an 2,7 25 08 49 ,5 2,7 29 ,3 0,0 0,0 1,5 1,6 2,4 5,2 0,0 2,2 0,0 0,0 0,0 2,2 86 ,8 82 ,5 67 R ur al 2,9 26 73 25 ,3 0,8 37 ,7 14 ,0 0,0 0,0 3,7 0,0 5,4 0,0 0,0 4,0 0,0 0,8 0,0 76 ,2 90 ,2 77 A ge 0- 11 m on th s (3, 2) (10 64 ) (34 ,0) (4, 7) (31 ,0) (15 ,2) (0, 0) (0, 0) (8, 4) (0, 0) (10 ,3) (0, 0) (4, 3) (9, 2) (0, 0) (1, 9) (0, 0) (91 ,8) (93 ,3) 34 12 -2 3 m on th s (2, 9) (10 37 ) (42 ,6) (0, 0) (39 ,2) (5, 6) (0, 0) (0, 0) (0, 0) (1, 9) (0, 0) (0, 0) (0, 0) (0, 0) (0, 0) (0, 0) (0, 0) (87 ,2) (93 ,7) 30 24 -3 5 m on th s (2, 6) (10 97 ) (33 ,3) (0, 0) (39 ,2) (9, 5) (0, 0) (0, 0) (0, 0) (2, 5) (0, 0) (0, 0) (0, 0) (0, 0) (0, 0) (0, 0) (0, 0) (82 ,2) (69 ,9) 29 36 -4 7 m on th s (3, 1) (10 05 ) (31 ,7) (2, 6) (26 ,0) (0, 0) (0, 0) (0, 0) (1, 9) (1, 1) (10 ,1) (0, 0) (0, 0) (0, 0) (0, 0) (0, 0) (4, 8) (58 ,1) (91 ,6) 31 48 -5 9 m on th s (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 21 Ed uc at io n In co m pl et e S ec on da ry (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 1 S ec on da ry (2, 6) (19 16 ) (27 ,1) (4, 8) (45 ,9) (6, 7) (0, 0) (0, 0) (0, 6) (1, 4) (10 ,9) (0, 0) (2, 9) (4, 0) (0, 0) (1, 3) (0, 0) (82 ,3) (80 ,5) 51 S pe ci al iz ed S ec on da ry (2, 8) (14 32 ) (37 ,8) (0, 0) (33 ,7) (4, 1) (0, 0) (2, 5) (0, 5) (1, 7) (5, 2) (0, 0) (0, 0) (0, 0) (0, 0) (0, 0) (0, 0) (78 ,4) (88 ,3) 41 H ig he r 3,0 17 29 45 ,7 0,0 23 ,0 11 ,0 0,0 0,0 6,6 0,4 0,0 0,0 0,0 2,1 0,0 0,0 2,9 84 ,3 91 ,0 52 To tal 2,8 51 81 36 ,5 1,7 33 ,8 7,5 0,0 0,7 2,7 1,1 5,3 0,0 1,0 2,2 0,0 0,5 1,0 81 ,2 86 ,6 14 5 ‘N o ed uc at io n’ c at eg or y ha s be en e xc lu de d du e to in si gn ifi ca nt n um be r o f r es po ns es 1 M IC S In di ca to r 3 .9 2 M IC S In di ca to r 3 .1 0 ( ) – in di ca to rs a re b as ed o n 25 -4 9 ca se s of u nw ei gh te d ob se rv at io ns (* ) – in di ca to rs a re b as ed o n le ss th an 2 5 ca se s of u nw ei gh te d ob se rv at io ns 86 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Issues related to knowledge of danger signs of pneumonia are presented in Table CH.8. Obviously, mothers’ knowledge of the danger signs is an important determinant of care-seeking behaviour. Overall, 22.2 percent of women know of the two danger signs of pneumonia – fast and difficult breath- ing. The most commonly identified symptom for taking a child to a health facility is high fever (89.3 percent). 42.9 percent of mothers identified difficult breathing and 32.7 percent of mothers identified fast breath- ing as symptoms for taking children immediately to a health care provider. For over 45 percent of mothers one of the danger signs for seeking care is if the child becomes weaker, for 26.7 percent of mothers one of the danger signs is blood in stool, for 21.6 percent of mothers – if a child is not able to drink or breastfeed. Only 13.6 percent of mothers will seek care if a child drinks poorly. The highest percentage of mothers aware of two danger signs of pneumonia was found in Almaty (73.3 percent) and in Mangistau (48.4 percent) and East Kazakhstan (43.9 percent) Oblasts, the low- est was in Almaty (7.3 percent), South Kazakhstan (8.7 percent) and West Kazakhstan (9.6 percent) Oblasts. 27 percent of mothers in urban and 17.2 percent in rural area are aware of main pneumonia symptoms. Knowledge of two symptoms of pneumonia in- creases with women’s education (from 18.1 to 26 per- cent) and household wealth (from 15.8 in the poorest to 32.3 percent in the richest families). Table CH.8: Knowledge of the two danger signs of pneumonia Percentage of mothers/caretakers of children aged 0-59 months by knowledge of types of symptoms for taking a child immediately to a health facility, and percentage of mothers/caretakers who recognize fast and difficult breathing as signs for seeking care immediately Percentage of mothers/caretakers of children aged 0-59 months who think that a child should be taken immediately to a health facility if the child M ot he rs /c ar et ak er s w ho re c- og ni ze th e tw o da ng er s ig ns o f pn eu m on ia N um be r o f m ot he rs /c ar et ak er s of ch ild re n ag ed 0 -5 9 m on th s Is n ot a bl e to d rin k or br ea st fe ed B ec om es s ic ke r D ev el op s a fe ve r H as fa st b re at hi ng H as d iffi cu lt br ea th in g H as b lo od in s to ol Is d rin ki ng p oo rly H as o th er s ym pt om s Region Akmola Oblast 8,5 37,9 87,1 41,7 55,4 45,3 10,5 14,4 32,7 159 Aktobe Oblast 32,3 42,9 86,7 32,2 32,1 16,4 12,6 8,9 14,9 206 Almaty Oblast 26,4 28,6 95,4 10,8 38,0 18,6 6,7 12,5 7,3 439 Almaty city 56,2 80,3 95,7 78,1 84,6 81,5 52,6 6,9 73,3 181 Astana city 21,9 49,7 89,9 30,2 35,3 29,3 24,6 7,0 20,1 136 Atyrau Oblast 28,2 46,9 97,0 49,6 43,9 13,3 20,4 1,1 32,8 131 East Kazakhstan Oblast 40,9 52,8 81,0 50,5 59,1 52,1 16,6 18,8 43,9 312 Zhambyl Oblast 13,4 28,6 92,5 33,7 29,8 16,0 12,7 26,7 15,3 282 West Kazakhstan Oblast 16,4 55,7 92,4 31,3 42,1 17,2 6,8 7,5 9,6 153 Karaganda Oblast 12,9 36,9 92,4 28,2 56,6 22,0 8,1 32,0 15,5 342 Kostanai Oblast 21,2 46,7 97,6 40,0 57,0 30,1 19,9 28,2 35,2 185 Kyzylorda Oblast 25,5 31,6 89,4 26,3 37,8 20,2 9,7 0,6 15,1 206 Mangistau Oblast 46,9 65,3 83,9 64,8 63,7 39,8 32,0 1,2 48,4 169 Pavlodar Oblast 11,1 45,9 78,5 25,3 51,1 31,9 15,4 58,1 23,1 190 87MONITORING THE SITUATION OF CHILDREN AND WOMEN Percentage of mothers/caretakers of children aged 0-59 months who think that a child should be taken immediately to a health facility if the child M ot he rs /c ar et ak er s w ho re c- og ni ze th e tw o da ng er s ig ns o f pn eu m on ia N um be r o f m ot he rs /c ar et ak er s of ch ild re n ag ed 0 -5 9 m on th s Is n ot a bl e to d rin k or br ea st fe ed B ec om es s ic ke r D ev el op s a fe ve r H as fa st b re at hi ng H as d iffi cu lt br ea th in g H as b lo od in s to ol Is d rin ki ng p oo rly H as o th er s ym pt om s North Kazakhstan Oblast 10,6 23,7 94,9 25,9 38,6 24,6 7,4 57,5 20,0 122 South Kazakhstan Oblast 7,1 54,7 85,2 20,7 21,2 13,7 4,7 7,9 8,7 750 Residence Urban 24,8 49,1 89,2 37,6 50,6 34,2 16,9 18,5 27,0 2020 Rural 18,4 41,3 89,4 27,7 35,0 18,9 10,1 15,2 17,2 1944 Mother’s Education Incomplete secondary 21,6 40,3 90,0 25,0 34,7 22,8 14,8 13,6 18,1 65 Secondary 19,9 43,9 89,1 30,5 40,1 23,4 12,4 15,5 19,3 1380 Specialized secondary 21,8 45,5 89,5 31,6 43,0 27,8 13,9 17,9 21,3 1134 Higher 23,3 46,8 89,5 36,3 46,1 29,4 14,4 17,5 26,0 1381 Wealth Index Quintile Poorest 15,6 42,8 87,4 28,1 32,1 19,0 8,8 14,5 15,8 880 Second 19,6 38,3 90,6 24,9 33,4 18,2 9,3 14,8 15,7 816 Middle 23,1 46,1 89,0 33,0 41,4 26,2 13,8 16,9 20,4 782 Fourth 27,9 48,3 91,2 37,3 53,5 34,2 17,9 16,8 28,1 693 Richest 23,5 51,6 88,8 41,7 57,0 38,2 19,3 21,7 32,3 793 Ethnicity of Household Head Kazakh 22,5 45,0 89,2 33,1 41,4 25,2 14,4 13,9 21,5 2764 Russian 22,0 48,5 89,9 37,4 54,5 38,1 14,6 24,6 29,5 693 Other 16,3 42,2 89,2 24,3 35,4 19,5 7,8 22,7 15,8 507 Total 21,6 45,3 89,3 32,7 42,9 26,7 13,6 16,9 22,2 3964 ‘No education’ category has been excluded due to insignificant number of responses Solid Fuel Use More than 3 billion people around the world rely on solid fuels (biomass and coal) for their basic energy needs, including cooking and heating. Cook- ing and heating with solid fuels leads to high levels of indoor smoke, a complex mix of health-damaging pollutants. The main problem with the use of solid fuels is products of incomplete combustion, including CO, polyaromatic hydrocarbons, SO2, and other toxic elements. Use of solid fuels increases the risks of acute respiratory illness, pneumonia, chronic obstruc- tive lung disease, cancer, and possibly tuberculosis, low birth weight, cataracts, and asthma. The primary indicator is the proportion of the population using sol- id fuels as the primary source of domestic energy for cooking. 88 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Table CH.9: Solid fuel use Percentage distribution of household members according to type of cooking fuel used by the household, and percentage of household members living in households using solid fuels for cooking, Kazakhstan, 2010/2011 Percentage of households using N um be r o f ho us eh ol d m em be rs E le ct ric ity Li qu efi ed pe tro le um g as / pr op an e N at ur al g as K er os en e Solid fuels O th er N o fo od c oo ke d in h ou se ho ld To ta l U se o f s ol id fu el fo r c oo ki n1 g C oa l/ br ow n co al C ha rc oa l W oo d A ni m al d un g Region Akmola Oblast 2,7 92,9 0,2 0,0 2,5 0,2 0,9 0,0 0,0 0,7 100,0 3,5 2470 Aktobe Oblast 0,6 13,2 73,4 0,0 5,5 3,0 0,6 3,7 0,0 0,0 100,0 12,8 2595 Almaty Oblast 1,0 89,2 9,4 0,0 0,0 0,0 0,0 0,2 0,2 0,0 100,0 0,3 5879 Almaty city 1,6 23,5 71,2 0,0 3,7 0,0 0,0 0,0 0,0 0,0 100,0 3,7 4129 Astana city 30,1 69,1 0,6 0,0 0,1 0,1 0,0 0,0 0,0 0,0 100,0 0,2 1710 Atyrau Oblast 3,0 4,5 84,6 0,0 3,2 0,1 0,3 4,2 0,0 0,0 100,0 7,9 1542 East Kazakhstan Oblast 43,4 38,5 0,6 0,0 9,7 0,3 3,5 4,0 0,0 0,0 100,0 17,5 4782 Zhambyl Oblast 0,3 29,2 46,0 0,0 18,5 2,1 3,3 0,4 0,0 0,0 100,0 24,5 3521 West Kazakhstan Oblast 0,2 11,0 63,9 0,0 0,2 0,6 8,6 15,6 0,0 0,0 100,0 25,0 2208 Karaganda Oblast 36,6 40,5 0,0 0,0 20,9 0,3 1,1 0,7 0,0 0,0 100,0 23,0 4838 Kostanai Oblast 7,2 33,1 53,8 0,0 4,6 0,0 1,2 0,1 0,0 0,0 100,0 5,9 3058 Kyzylorda Oblast 0,1 59,7 16,7 0,0 0,7 13,5 9,2 0,0 0,0 0,0 100,0 23,5 2292 Mangistau Oblast 0,6 8,5 90,9 0,0 0,0 0,0 0,0 0,0 0,0 0,0 100,0 0,0 1722 Pavlodar Oblast 67,5 30,2 0,0 0,0 2,2 0,0 0,0 0,0 0,0 0,0 100,0 2,2 2770 North Kazakhstan Oblast 9,4 87,1 0,5 0,1 1,0 0,0 1,9 0,0 0,0 0,0 100,0 2,9 2304 South Kazakhstan Oblast 2,1 37,2 49,4 0,0 0,4 2,7 4,9 3,3 0,0 0,0 100,0 11,3 8729 Residence Urban 19,8 35,2 41,8 0,0 2,8 0,3 0,1 0,0 0,0 0,0 100,0 3,1 29257 Rural 5,3 53,3 21,6 0,0 7,9 2,7 5,0 4,2 0,0 0,0 100,0 19,8 25292 Education of Household Head Incomplete Secondary 9,4 47,6 24,5 0,0 7,1 1,7 5,1 4,6 0,0 0,0 100,0 18,5 6151 Secondary 10,5 46,5 27,3 0,0 7,2 2,1 3,5 2,8 0,0 0,0 100,0 15,6 18496 Specialized Secondary 15,1 43,3 34,4 0,0 3,8 1,0 1,3 0,9 0,0 0,1 100,0 7,0 17226 Higher 16,2 37,6 41,4 0,0 2,7 0,5 0,9 0,6 0,0 0,0 100,0 4,8 12355 Wealth Index Quintile Poorest 1,7 51,1 13,2 0,0 11,5 4,7 9,1 8,6 0,0 0,0 100,0 34,0 10909 Second 4,1 56,5 26,1 0,0 8,0 1,8 2,3 1,0 0,0 0,0 100,0 13,2 10911 Middle 8,5 50,5 34,7 0,0 5,4 0,3 0,4 0,0 0,1 0,1 100,0 6,1 10909 Fourth 16,8 41,3 41,1 0,0 0,9 0,0 0,0 0,0 0,0 0,0 100,0 0,9 10905 Richest 34,2 18,6 47,1 0,0 0,0 0,0 0,0 0,0 0,0 0,0 100,0 0,0 10916 Ethnicity of Household Head Kazakh 9,5 42,5 32,9 0,0 6,8 2,0 3,4 2,8 0,0 0,0 100,0 15,1 34089 Russian 24,3 42,8 30,0 0,0 2,2 0,1 0,5 0,0 0,0 0,1 100,0 2,9 13089 Other 9,7 50,2 34,7 0,0 2,8 0,6 0,9 1,1 0,0 0,0 100,0 5,4 7371 Total 13,1 43,6 32,4 0,0 5,2 1,4 2,4 1,9 0,0 0,0 100,0 10,8 54549 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 3.11 89MONITORING THE SITUATION OF CHILDREN AND WOMEN Overall, 10.8 percent of all households in Ka- zakhstan are using solid fuels for cooking. Use of sol- id fuels is very low in urban areas (3.1 percent), but high in rural areas, where 19.8 percent of the house- holds are using solid fuels. Differences with respect to household wealth and the educational level of the household head are also significant. A total of 34.0 per- cent of poorest households and 0.9 percent of fourth quintile households use solid fuel for cooking. The sur- vey results show that solid fuels are virtually not used in Astana and in Almaty Oblast (0.2 and 0.3 percent, respectively) and not used in Mangistau Oblast at all. The highest percentage of use of solid fuels for cooking was reported in West Kazakhstan (25 percent), Zham- byl (24.5 percent), Kyzylorda (23.5 percent) and Kara- ganda (23 percent) Oblasts. The table also clearly shows that the overall per- centage of households using solid fuels is due to pre- dominant use of coal and wood for cooking purposes. Solid fuel use alone is a poor proxy for indoor air pol- lution, since the concentration of the pollutants is dif- ferent when the same fuel is burnt in different stoves or fires. Use of closed stoves with chimneys minimizes indoor pollution, while open stove or fire with no chim- ney or hood means that there is no protection from the harmful effects of solid fuels. Solid fuel use by place of cooking is depicted in Table CH.10. About 87.8 percent of households use a sepa- rate room such as a kitchen for cooking; the percent- age of such households is 94.5 percent in urban ar- eas and 86.6 percent in rural areas. 9.1 percent of households cook elsewhere in the house; percentage of furnaces used for cooking is lower in urban (4.6 per- cent) than in rural areas (10 percent). Other premises in the house (other than kitchen) are most common in the poorest (11.2 percent) households and are used only by 1.7 percent of richest households. There is no significant differential by education of household head. Other premises (other than kitchen) are primarily com- mon in Aktobe and Atyrau Oblasts (32.4 percent each). Separate buildings used for cooking are primarily com- mon in South Kazakhstan Oblast. Table CH.10: Solid fuel use by place of cooking Percentage distribution of household members in households using solid fuels by place of cooking, Kazakhstan, 2010/2011 Place of cooking Number of household members in households using solid fuels for cooking In a separate room used as kitchen Elsewhere in the house In a separate building Total Region Akmola Oblast 87,1 12,9 0,0 100,0 87 Aktobe Oblast 67,6 32,4 0,0 100,0 333 Almaty Oblast (*) (*) (*) 100,0 16 Almaty city 91,7 8,3 0,0 100,0 152 Astana city (*) (*) (*) 100,0 3 Atyrau Oblast 67,6 32,4 0,0 100,0 122 East Kazakhstan Oblast 77,1 22,0 1,0 100,0 838 Zhambyl Oblast 95,2 3,1 1,8 100,0 862 West Kazakhstan Oblast 100,0 0,0 0,0 100,0 552 Karaganda Oblast 98,1 1,2 0,7 100,0 1111 Kostanai Oblast 87,7 10,4 1,9 100,0 179 Kyzylorda Oblast 91,6 6,8 1,7 100,0 538 Pavlodar Oblast 100,0 0,0 0,0 100,0 61 North Kazakhstan Oblast 92,3 7,7 0,0 100,0 67 South Kazakhstan Oblast 77,6 8,6 13,8 100,0 985 Residence Urban 94,5 4,6 0,9 100,0 909 Rural 86,6 10,0 3,4 100,0 4998 Education of Household Head Incomplete secondary 86,8 6,4 6,8 100,0 1135 Secondary 87,4 10,4 2,2 100,0 2889 90 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Place of cooking Number of household members in households using solid fuels for cooking In a separate room used as kitchen Elsewhere in the house In a separate building Total Specialized secondary 89,3 8,7 2,0 100,0 1214 Higher 89,5 8,0 2,4 100,0 594 Wealth Index Quintile Poorest 85,1 11,2 3,7 100,0 3705 Second 91,0 6,5 2,5 100,0 1438 Middle 94,2 4,6 1,2 100,0 667 Fourth 98,3 1,7 0,0 100,0 97 Richest Ethnicity of Household Head Kazakh 87,3 9,6 3,1 100,0 5133 Russian 93,7 6,3 0,0 100,0 373 Other 89,3 5,6 5,1 100,0 400 Total 87,8 9,1 3,1 100,0 5906 ‘No education’ category has been excluded due to insignificant number of responses (*) – indicators are based on less than 25 cases of unweighted observations 91MONITORING THE SITUATION OF CHILDREN AND WOMEN VII. Water and Sanitation 92 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Safe drinking water is a basic necessity for good health. Unsafe drinking water can be a significant carri- er of diseases such as trachoma, cholera, typhoid, and schistosomiasis. Drinking water can also be tainted with chemical, physical and radiological contaminants with harmful effects on human health. In addition to its association with disease, access to drinking water may be particularly important for women and children, espe- cially in rural areas, who bear the primary responsibility for carrying water, often for long distances. The MDG goal is to reduce by half, between 1990 and 2015, the proportion of people without sus- tainable access to safe drinking water and basic sani- tation. A World Fit for Children goal calls for a reduc- tion in the proportion of households without access to hygienic sanitation facilities and affordable and safe drinking water by at least one-third. The list of indicators used in MICS is as follows: Water • Use of improved drinking water sources • Use of adequate water treatment method • Time to source of drinking water • Person collecting drinking water Sanitation • Use of improved sanitation • Sanitary disposal of child’s faeces For more details on water and sanitation and to access some reference documents, please visit the UNICEF childinfo website http://www.childinfo.org/wes.html. Use of Improved Water Sources The distribution of the population by source of drinking water is shown in Table WS.1 and Fig- ure WS.1. The population using improved sources of drinking water are those using any of the fol- lowing types of supply: piped water (into dwell- ing, compound, yard or plot, public tap/standpipe), tube well/borehole, protected well, protected spring, and rainwater collection. Bottled water is considered as an improved water source only if the household is using an improved water source for other purposes, such as handwashing and cook- ing. Table WS.1: Use of improved water sources Percent distribution of household population (members) by main sources of drinking water and percentage of household members using improved sources of drinking water, Kazakhstan 2010/11 Main source of drinking water To ta l P er ce nt ag e u si ng im pr ov ed s ou rc - u si ng im pr ov ed s ou rc - us in g im pr ov ed s ou rc - im pr ov ed s ou rc - im pr ov ed s ou rc - s ou rc - so ur c- es o f d rin ki ng w at er 1 N um be r o f h ou se ho ld m em be rsImproved sources of drinking water1 Unimproved sources of drinking water Piped water Tu be -w el l/b or e- ho le P ro te ct ed w el l P ro te ct ed s pr in g R ai nw at er c ol le ct io n B ot tle d w at er U np ro te ct ed w el l U np ro te ct ed s pr in g Ta nk er tr uc k C ar t w ith ta nk / d ru m s S ur fa ce w at er (r iv er , s pr in g, da m , l ak e, p oo l) B ot tle d w at er * O th er P ip ed in to dw el lin g P ip ed in to ya rd / p lo t P ip ed to n ei gh bo ur P ub lic ta p/ st an d- pi pe Region Akmola Oblast 45,6 0,2 0,1 35,3 11,2 1,8 1,2 0,0 1,7 0,8 0,3 1,5 0,0 0,3 0,0 0,1 100,0 96,9 2470 Aktobe Oblast 55,5 7,7 1,8 17,7 0,5 13,9 0,7 0,0 1,8 0,0 0,0 0,0 0,0 0,0 0,4 0,0 100,0 99,6 2595 93MONITORING THE SITUATION OF CHILDREN AND WOMEN Main source of drinking water To ta l P er ce nt ag e u si ng im pr ov ed s ou rc - u si ng im pr ov ed s ou rc - us in g im pr ov ed s ou rc - im pr ov ed s ou rc - im pr ov ed s ou rc - s ou rc - so ur c- es o f d rin ki ng w at er 1 N um be r o f h ou se ho ld m em be rsImproved sources of drinking water1 Unimproved sources of drinking water Piped water Tu be -w el l/b or e- ho le P ro te ct ed w el l P ro te ct ed s pr in g R ai nw at er c ol le ct io n B ot tle d w at er U np ro te ct ed w el l U np ro te ct ed s pr in g Ta nk er tr uc k C ar t w ith ta nk / d ru m s S ur fa ce w at er (r iv er , s pr in g, da m , l ak e, p oo l) B ot tle d w at er * O th er P ip ed in to dw el lin g P ip ed in to ya rd / p lo t P ip ed to n ei gh bo ur P ub lic ta p/ st an d- pi pe Almaty Oblast 42,8 6,1 1,5 14,9 29,2 1,2 0,8 0,0 0,0 1,1 0,5 0,4 0,1 0,2 0,0 1,1 100,0 96,6 5879 Almaty city 94,7 4,5 0,0 0,0 0,0 0,0 0,0 0,0 0,7 0,0 0,0 0,0 0,0 0,0 0,1 0,0 100,0 99,9 4129 Astana city 83,8 1,3 2,7 10,1 0,2 0,1 0,0 0,0 1,8 0,1 0,0 0,0 0,0 0,0 0,0 0,0 100,0 99,9 1710 Atyrau Oblast 57,4 5,9 2,7 6,5 0,0 23,9 0,0 0,0 1,0 1,0 0,0 0,0 0,0 1,5 0,0 0,0 100,0 97,4 1542 East Kazakhstan Oblast 58,4 3,3 0,3 14,0 13,2 2,2 0,1 0,0 0,2 0,4 0,7 0,0 0,0 7,3 0,0 0,0 100,0 91,6 4782 Zhambyl Oblast 37,4 10,2 1,9 7,1 34,0 4,9 0,3 0,0 0,1 0,4 0,4 3,3 0,0 0,0 0,0 0,0 100,0 95,9 3521 West Kazakhstan Oblast 43,0 0,7 0,1 14,4 3,6 26,4 0,1 0,0 0,8 4,1 0,1 6,1 0,1 0,4 0,0 0,0 100,0 89,1 2208 Karaganda Oblast 70,3 0,9 0,2 11,3 4,5 2,6 2,0 0,0 5,4 0,0 2,1 0,2 0,3 0,0 0,1 0,0 100,0 97,3 4838 Kostanai Oblast 49,6 0,1 0,2 12,7 11,0 13,7 0,6 0,0 3,8 0,1 1,0 3,3 0,3 2,3 0,2 1,1 100,0 91,6 3058 Kyzylorda Oblast 46,3 11,7 3,8 18,7 0,2 9,6 0,2 0,0 0,5 0,2 0,0 8,3 0,0 0,5 0,0 0,0 100,0 91,0 2292 Mangistau Oblast 49,3 0,5 0,0 0,0 0,0 44,2 0,7 0,0 0,0 0,6 0,0 4,7 0,0 0,0 0,0 0,0 100,0 94,7 1722 Pavlodar Oblast 72,1 3,1 0,4 10,7 4,2 5,0 0,0 0,0 0,2 0,4 0,3 3,2 0,0 0,4 0,0 0,0 100,0 95,6 2770 North Kazakhstan Oblast 31,5 0,4 0,1 31,9 4,6 14,8 0,4 0,1 3,8 1,3 0,1 3,0 0,2 1,3 0,2 6,3 100,0 87,6 2304 South Kazakhstan Oblast 30,1 34,0 1,6 1,2 6,4 11,9 2,0 0,0 0,1 0,4 1,1 10,8 0,0 0,2 0,1 0,0 100,0 87,4 8729 Residence Urban 79,2 5,7 0,5 6,6 2,2 2,5 0,4 0,0 2,0 0,1 0,3 0,2 0,0 0,0 0,1 0,2 100,0 99,1 29257 Rural 21,2 12,4 1,6 17,0 18,2 15,9 1,2 0,0 0,3 1,2 0,9 6,9 0,1 2,1 0,0 0,8 100,0 87,9 25292 Education of Household Head Incomplete Secondary 35,7 10,8 0,5 16,7 13,0 13,3 1,4 0,0 0,3 1,5 1,2 3,6 0,1 1,1 0,0 0,9 100,0 91,7 6151 Secondary 38,7 10,3 1,7 15,1 12,8 11,8 1,0 0,0 0,5 0,8 0,4 4,5 0,1 1,7 0,0 0,5 100,0 92,0 18496 Specialized Secondary 58,3 7,9 0,9 10,2 8,7 6,9 0,6 0,0 1,4 0,3 0,8 2,7 0,0 0,7 0,0 0,5 100,0 95,0 17226 Higher 73,1 6,5 0,5 5,1 4,2 4,4 0,3 0,0 2,7 0,2 0,4 2,1 0,0 0,2 0,2 0,2 100,0 96,7 12355 Wealth Index Quintile Poore

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