Nepal Multiple Indicator Cluster Survey 2014

Publication date: 2015

Monitoring the situation of children and women Nepal Multiple Indicator Cluster Survey Final Report 2014 United Nations Children’s Fund Government of Nepal National Planning Commission Secretariat Central Bureau of Statistics Monitoring the situation of children and women Nepal Multiple Indicator Cluster Survey Final Report 2014 United Nations Children’s Fund Government of Nepal National Planning Commission Secretariat Central Bureau of Statistics © Central Bureau of Statistics and UNICEF Nepal December 2015 All UNICEF materials are protected by copyright, including text, photographs, images and videotapes. Permission is required to reproduce any part of this publication. Permission will be freely granted to educational or non-profit organizations. Please contact: Government of Nepal Central Bureau of Statistics Thapathali Kathmandu, Nepal Tel: 977 1 4245947, 4229406 Website: www.cbs.gov.np United Nations Children’s Fund (UNICEF) United Nations House Pulchowk, Lalitpur Tel: 977 1 5523200 PO Box 1187 Kathmandu, Nepal Website: http://www. unicef.org/nepal The Nepal Multiple Indicator Cluster Survey (MICS) was carried out in 2014 by the Central Bureau of Statistics (CBS) as part of the global MICS programme. Technical and financial support was provided by the United Nations Children’s Fund (UNICEF). The global MICS programme was developed by UNICEF in the 1990s as an international household survey programme to support countries in the collection of internationally comparable data on a wide range of indicators on the situation of children and women. MICS surveys measure key indicators that allow countries to generate data for use in policies and programmes, and to monitor progress towards the Millennium Development Goals (MDGs) and other internationally agreed upon commitments. Suggested citation: Central Bureau of Statistics, 2015. Nepal Multiple Indicator Cluster Survey 2014, Final Report. Kathmandu, Nepal: Central Bureau of Statistics and UNICEF Nepal. Cover Photo: ©UNICEF Nepal/2015/CSKarki NEPAL MULTIPLE INDIC ATOR CLUSTER SURVEY 2014 III Summary Table of Survey Implementation and Survey Population Multiple Indicator Cluster Survey, Nepal, 2014 Survey implementation Sample frame -­‐ Updated National Population and Housing Census, 2011 September–October, 2013 Questionnaires Household Women (aged 15–49) Children under five Water quality testing Interviewer training January–February, 2014 Fieldwork February–June, 2014 Survey sample Households -­‐ Sampled -­‐ Occupied -­‐ Interviewed -­‐ Response rate (percent) 13,000 12,598 12,405 98.5 Children under five -­‐ Eligible -­‐ Mothers/caretakers interviewed -­‐ Response rate (percent) 5,663 5,349 94.5 Women -­‐ Eligible for interviews -­‐ Interviewed -­‐ Response rate (percent) 14,936 14,162 94.8 Water quality testing for households -­‐ Selected for testing -­‐ Occupied -­‐ Tested -­‐ Response rate (percent) 1,560 1,511 1,492 98.7 Household population Average household size 4.6 Percentage of population living in -­‐ Urban areas -­‐ Rural areas 17.2 82.8 Percentage of population under: -­‐ Age 5 -­‐ Age 18 10.1 40.2 Percentage of women aged 15–49 years with at least one live birth in the last 2 years 14.5 Housing characteristics Household or personal assets Percentage of households with -­‐ Electricity -­‐ Finished floor -­‐ Finished roofing -­‐ Finished walls 84.9 34.9 85.3 41.2 Percentage of households that own -­‐ A television -­‐ A refrigerator -­‐ Agricultural land -­‐ Farm animals/livestock 51.5 13.6 75.5 68.8 Mean number of persons per room used for sleeping 2.4 Percentage of households where at least a member has or owns a -­‐ Mobile phone -­‐ Car or truck 91.2 1.9 NEPAL MULTIPLE INDIC ATOR CLUSTER SURVEY 2014IV 1See Appendix E for a detailed description of MICS indicators CHILD MORTALITY Early childhood mortality* MICS Indicator Indicator Description Value 1.1 Neonatal mortality rate Probability of dying within the first month of life 23 1.2 MDG 4.2 Infant mortality rate Probability of dying between birth and the first birthday 33 1.3 Post-neonatal mortality rate Difference between infant and neonatal mortality rates 11 1.4 Child mortality rate Probability of dying between the first and the fifth birthdays 5 1.5 MDG 4.1 Under-five mortality rate Probability of dying between birth and the fifth birthday 38 * Rates refer to the five-year period preceding the survey NUTRITION Nutritional status MICS Indicator Indicator Description Value 2.1a 2.1b MDG 1.8 Underweight prevalence (a) Moderate and severe (b) Severe Percentage of children under age 5 who fall below (a) minus two standard deviations (moderate and severe) (b) minus three standard deviations (severe) of the median weight-for-age of the WHO standard 30.1 8.6 2.2a 2.2b Stunting prevalence (a) Moderate and severe (b) Severe Percentage of children under age 5 who fall below (a) minus two standard deviations (moderate and severe) (b) minus three standard deviations (severe) of the median height-for-age of the WHO standard 37.4 15.8 2.3a 2.3b Wasting prevalence (a) Moderate and severe (b) Severe Percentage of children under age 5 who fall below (a) minus two standard deviations (moderate and severe) (b) minus three standard deviations (severe) of the median weight-for-height of the WHO standard 11.3 3.2 2.4 Overweight prevalence Percentage of children under age 5 who are above two standard deviations of the median weight-for-height of the WHO standard 2.1 Breastfeeding and infant feeding 2.5 Children ever breastfed Percentage of women with a live birth in the last 2 years who breastfed their last live-born child at any time 97.3 2.6 Early initiation of breastfeeding Percentage of women with a live birth in the last 2 years who put their last newborn to the breast within one hour of birth 48.7 2.7 Exclusive breastfeeding under 6 months Percentage of infants under 6 months of age who are exclusively breastfed 56.9 2.8 Predominant breastfeeding under 6 months Percentage of infants under 6 months of age who received breast milk as the predominant source of nourishment during the previous day 74.9 2.9 Continued breastfeeding at 1 year Percentage of children aged 12–15 months who received breast milk during the previous day 93.6 2.10 Continued breastfeeding at 2 years Percentage of children aged 20–23 months who received breast milk during the previous day 86.7 2.11 Median duration of breastfeeding The age in months when 50 percent of children aged 0–35 months did not receive breast milk during the previous day 36 2.12 Age-appropriate breastfeeding Percentage of children aged 0–23 months appropriately fed during the previous day 79.3 2.13 Introduction of solid, semi- solid or soft foods Percentage of infants aged 6–8 months who received solid, semi-solid or soft foods during the previous day 73.5 2.14 Milk feeding frequency for non-breastfed children Percentage of non-breastfed children aged 6–23 months who received at least 2 milk feedings during the previous day 59.5 2.15 Minimum meal frequency Percentage of children aged 6–23 months who received solid, semi-solid and soft foods (plus milk feeds for non-breastfed children) the minimum number of times or more during the previous day 74.4 Multiple Indicator Cluster Surveys (MICS) and Millennium Development Goals (MDG) Indicators, Nepal, 2014 Summary Table of Findings1 NEPAL MULTIPLE INDIC ATOR CLUSTER SURVEY 2014 V Breastfeeding and infant feeding: continued MICS Indicator Indicator Description Value 2.16 Minimum dietary diversity Percentage of children aged 6–23 months who received foods from 4 or more food groups during the previous day 37.0 2.17a 2.17b Minimum acceptable diet (a) Percentage of breastfed children aged 6–23 months who had at least the minimum dietary diversity and the minimum meal frequency during the previous day (b) Percentage of non-breastfed children aged 6–23 months who received at least 2 milk feedings and had at least the minimum dietary diversity not including milk feeds and the minimum meal frequency during the previous day 32.3 22.8 2.18 Bottle feeding Percentage of children aged 0–23 months who were fed with a bottle during the previous day 11.5 Salt iodization 2.19 Iodized salt consumption Percentage of households with salt testing 15 parts per million or more of iodide/iodate 81.5 Low birth weight 2.20 Low-birth-weight infants Percentage of most recent live births in the last 2 years weighing below 2,500 grams at birth 24.2 2.21 Infants weighed at birth Percentage of most recent live births in the last 2 years who were weighed at birth 60.0 CHILD HEALTH Vaccinations MICS Indicator Indicator Description Value 3.1 Tuberculosis immunization coverage Percentage of children aged 12–23 months who received BCG vaccine by their first birthday 87.5 3.2 Polio immunization coverage Percentage of children aged 12–23 months who received the third dose of OPV vaccine (OPV3) by their first birthday 85.2 3.3 Diphtheria, pertussis and tetanus (DPT) immunization coverage Percentage of children aged 12–23 months who received the third dose of DPT vaccine (DPT3) by their first birthday 83.1 3.4 MDG 4.3 Measles immunization coverage Percentage of children aged 12–23 months who received measles vaccine by their first birthday 84.5 3.5 Hepatitis B immunization coverage Percentage of children aged 12–23 months who received the third dose of Hepatitis B vaccine (HepB3) by their first birthday 83.1 3.6 Haemophilus influenzae type B (Hib) immunization coverage Percentage of children aged 12–23 months who received the third dose of Hib vaccine (Hib3) by their first birthday 83.1 3.8 Full immunization coverage Percentage of children aged 12–23 months who received all vaccinations recommended in the national immunization schedule by their first birthday (measles by second birthday) 67.1 Tetanus toxoid 3.9 Neonatal tetanus protection Percentage of women aged 15–49 years with a live birth in the last 2 years who were given at least two doses of tetanus toxoid vaccine within the appropriate interval prior to the most recent birth 77.3 Diarrhoea - Children with diarrhoea Percentage of children under age 5 with diarrhoea in the last 2 weeks 12.0 3.10 Care-seeking for diarrhoea Percentage of children under age 5 with diarrhoea in the last 2 weeks for whom advice or treatment was sought from a health facility or provider 47.2 3.11 Diarrhoea treatment with oral rehydration salts (ORS) and zinc Percentage of children under age 5 with diarrhoea in the last 2 weeks who received ORS and zinc 18.2 3.12 Diarrhoea treatment with oral rehydration therapy (ORT) and continued feeding Percentage of children under age 5 with diarrhoea in the last 2 weeks who received ORT (ORS packet, pre-packaged ORS fluid, recommended homemade fluid or increased fluids) and continued feeding during the episode of diarrhoea 45.9 NEPAL MULTIPLE INDIC ATOR CLUSTER SURVEY 2014VI Acute respiratory infection (ARI) symptoms MICS Indicator Indicator Description Value - Children with ARI symptoms Percentage of children under age 5 with ARI symptoms in the last 2 weeks 6.7 3.13 Care-seeking for children with ARI symptoms Percentage of children under age 5 with ARI symptoms in the last 2 weeks for whom advice or treatment was sought from a health facility or provider 50.1 3.14 Antibiotic treatment for children with ARI symptoms Percentage of children under age 5 with ARI symptoms in the last 2 weeks who received antibiotics 74.9 Solid fuel use 3.15 Use of solid fuels for cooking Percentage of household members in households that use solid fuels as the primary source of domestic energy to cook 74.7 Malaria/fever - Children with fever Percentage of children under age 5 with fever in the last 2 weeks 20.1 3.20 Care-seeking for fever Percentage of children under age 5 with fever in the last 2 weeks for whom advice or treatment was sought from a health facility or provider 46.4 WATER AND SANITATION MICS Indicator Indicator Description Value 4.1 MDG 7.8 Use of improved drinking water sources Percentage of household members using improved sources of drinking water 93.3 4.2 Water treatment Percentage of household members in households using unimproved drinking water who use an appropriate treatment method 13.6 4.3 MDG 7.9 Use of improved sanitation Percentage of household members using improved sanitation facilities which are not shared 60.1 4.4 Safe disposal of child’s faeces Percentage of children aged 0–2 years whose last stools were disposed of safely 48.0 4.5 Place for handwashing Percentage of households with a specific place for handwashing where water and soap or other cleansing agent are present 72.5 4.6 Availability of soap or other cleansing agent Percentage of households with soap or other cleansing agent 94.9 4.C1 E.coli concentration in household drinking water Percentage of household members with E.coli risk level in household water ≥ 1 cfu/100ml 82.2 4.C2 E.coli concentration in source water Percentage of households with E.coli risk level in source water ≥ 1 cfu/100ml 71.1 REPRODUCTIVE HEALTH Contraception and unmet need MICS Indicator Indicator Description Value - Total fertility rate Total fertility rate for women aged 15–49 years 2.3 5.1 MDG 5.4 Adolescent birth rate Age-specific fertility rate for women aged 15–19 years 71 5.2 Early childbearing Percentage of women aged 20–24 years who had at least one live birth before age 18 16.0 5.3 MDG 5.3 Contraceptive prevalence rate Percentage of women aged 15–49 years currently married or in union who are using (or whose partner is using) a (modern or traditional) contraceptive method 49.7 5.4 MDG 5.6 Unmet need Percentage of women aged 15–49 years who are currently married or in union who are fecund and want to space their births or limit the number of children they have and who are not currently using contraception 25.2 NEPAL MULTIPLE INDIC ATOR CLUSTER SURVEY 2014 VII Maternal and newborn health MICS Indicator Indicator Description Value 5.5a 5.5b MDG 5.5 MDG 5.5 Antenatal care coverage Percentage of women aged 15–49 years with a live birth in the last 2 years who were attended during their last pregnancy that led to a live birth (a) at least once by skilled health personnel (b) at least four times by any provider 68.3 59.5 5.6 Content of antenatal care Percentage of women aged 15–49 years with a live birth in the last 2 years who had their blood pressure measured and gave urine and blood samples during the last pregnancy that led to a live birth 61.2 5.7 MDG 5.2 Skilled attendant at delivery Percentage of women aged 15–49 years with a live birth in the last 2 years who were attended by skilled health personnel during their most recent live birth 55.6 5.8 Institutional deliveries Percentage of women aged 15–49 years with a live birth in the last 2 years whose most recent live birth was delivered in a health facility 55.2 5.9 Caesarean section Percentage of women aged 15–49 years whose most recent live birth in the last 2 years was delivered by caesarean section 8.6 Postnatal health checks 5.10 Post-partum stay in health facility Percentage of women aged 15–49 years who stayed in the health facility for 12 hours or more after the delivery of their most recent live birth in the last 2 years 76.0 5.11 Postnatal health check for the newborn Percentage of last live births in the last 2 years who received a health check while in facility or at home following delivery, or a postnatal care visit within 2 days after delivery 57.6 5.12 Postnatal health check for the mother Percentage of women aged 15–49 years who received a health check while in facility or at home following delivery, or a post- natal care visit within 2 days after delivery of their most recent live birth in the last 2 years 57.9 CHILD DEVELOPMENT MICS Indicator Indicator Description Value 6.1 Attendance to early childhood education Percentage of children aged 36–59 months who are attending an early childhood education programme 50.7 6.2 Support for learning Percentage of children aged 36–59 months with whom an adult has engaged in four or more activities to promote learning and school readiness in the last 3 days 67.2 6.3 Father’s support for learning Percentage of children aged 36–59 months whose biological father has engaged in four or more activities to promote learning and school readiness in the last 3 days 10.1 6.4 Mother’s support for learning Percentage of children aged 36–59 months whose biological mother has engaged in four or more activities to promote learning and school readiness in the last 3 days 30.4 6.5 Availability of children’s books Percentage of children under age 5 who have three or more children’s books 4.8 6.6 Availability of playthings Percentage of children under age 5 who play with two or more types of playthings 59.2 6.7 Inadequate care Percentage of children under age 5 left alone or in the care of another child younger than 10 years of age for more than one hour at least once in the last week 20.6 6.8 Early child development index Percentage of children aged 36–59 months who are developmentally on track in at least three of the following four domains: literacy–numeracy, physical, social–emotional, and learning 64.4 NEPAL MULTIPLE INDIC ATOR CLUSTER SURVEY 2014VIII LITERACY AND EDUCATION MICS Indicator Indicator Description Value 7.1 MDG 2.3 Literacy rate among young women Percentage of young women aged 15–24 years who are able to read a short simple statement about everyday life or who attended secondary or higher education 84.0 7.2 School readiness Percentage of children in first grade of primary school who attended pre-school during the previous school year 74.2 7.3 Net intake rate in primary education Percentage of children of school-entry age who enter the first grade of primary school 57.3 7.4 MDG 2.1 Primary school net attendance ratio (adjusted) Percentage of children of primary-school age currently attending primary or secondary school 85.9 7.5 Secondary school net attendance ratio (adjusted) Percentage of children of secondary-school age currently attending secondary school or higher 66.1 7.9 MDG 3.1 Gender parity index (primary school) Primary school net attendance ratio (adjusted) for girls divided by primary school net attendance ratio (adjusted) for boys 0.99 7.10 MDG 3.1 Gender parity index (secondary school) Secondary school net attendance ratio (adjusted) for girls divided by secondary school net attendance ratio (adjusted) for boys 1.02 CHILD PROTECTION Birth registration MICS Indicator Indicator Description Value 8.1 Birth registration Percentage of children under age 5 whose births are reported registered 58.1 Child labour 8.2 Child labour Percentage of children aged 5–17 years who are involved in child labour 37.4 Child discipline 8.3 Violent discipline Percentage of children aged 1–14 years who experienced psychological aggression or physical punishment during the last one month 81.7 Early marriage and polygyny 8.4 Marriage before age 15 Percentage of women aged 15–49 years who were first married or in union before age 15 15.5 8.5 Marriage before age 18 Percentage of women aged 20–49 years who were first married or in union before age 18 48.5 8.6 Young women aged 15–19 years currently married or in union Percentage of women aged 15–19 years who are married or in union 24.5 8.7 Polygyny Percentage of women aged 15–49 years who are in a polygynous union 4.1 8.8a 8.8b Spousal age difference Percentage of young women who are married or in union and whose spouse is 10 or more years older (a) among women aged 15–19 years (b) among women aged 20–24 years 6.3 7.5 Attitudes towards domestic violence 8.12 Attitudes towards domestic violence Percentage of women aged 15–49 years who state that a husband is justified in hitting or beating his wife in at least one of the following circumstances: (1) she goes out without telling him, (2) she neglects the children, (3) she argues with him, (4) she refuses sex with him, (5) she burns the food 42.9 62.3 1.00 1.00 76.3 41.6 NEPAL MULTIPLE INDIC ATOR CLUSTER SURVEY 2014 IX Children’s living arrangements MICS Indicator Indicator Description Value 8.13 Children’s living arrangements Percentage of children aged 0–17 years living with neither biological parent 4.8 8.14 Prevalence of children with one or both parents dead Percentage of children aged 0–17 years with one or both biological parents dead 4.3 8.15 Children with at least one parent living abroad Percentage of children 0–17 years with at least one biological parent living abroad 18.2 HIV/AIDS AND SEXUAL BEHAVIOUR HIV/AIDS knowledge and attitudes MICS Indicator Indicator Description Value - Have heard of AIDS Percentage of women aged 15–49 years who have heard of AIDS 78.4 9.1 MDG 6.3 Knowledge about HIV prevention among young women Percentage of young women aged 15–24 years who correctly identify ways of preventing the sexual transmission of HIV, and who reject major misconceptions about HIV transmission 26.4 9.2 Knowledge of mother-to- child transmission of HIV Percentage of women aged 15–49 years who correctly identify all three means of mother-to-child transmission of HIV 38.4 9.3 Accepting attitudes towards people living with HIV Percentage of women aged 15–49 years expressing accepting attitudes on all four questions toward people living with HIV 48.6 HIV testing 9.4 Women who know where to be tested for HIV Percentage of women aged 15–49 years who state knowledge of a place to be tested for HIV 57.9 9.5 Women who have been tested for HIV and know the results Percentage of women aged 15–49 years who have been tested for HIV in the last 12 months and who know their results 2.7 9.7 HIV counselling during antenatal care Percentage of women aged 15–49 years who had a live birth in the last 2 years and received antenatal care during the pregnancy of their most recent birth, reporting that they received counselling on HIV during antenatal care 14.1 9.8 HIV testing during antenatal care Percentage of women aged 15–49 years who had a live birth in the last 2 years and received antenatal care during the pregnancy of their most recent birth, reporting that they were offered and accepted an HIV test during antenatal care and received their results 13.7 ACCESS TO MASS MEDIA AND ICT Access to mass media MICS Indicator Indicator Description Value 10.1 Exposure to mass media Percentage of women aged 15–49 years who, at least once a week, read a newspaper or magazine, listen to the radio, and watch television 11.1 Use of information/communication technology 10.2 Use of computers Percentage of young women aged 15–24 years who used a computer during the last 12 months 21.7 10.3 Use of internet Percentage of young women aged 15–24 years who used the internet during the last 12 months 19.6 36.4 NEPAL MULTIPLE INDIC ATOR CLUSTER SURVEY 2014X SUBJECTIVE WELL-BEING MICS Indicator Indicator Description Value 11.1 Life satisfaction Percentage of young women aged 15–24 years who are very or somewhat satisfied with their life, overall 80.8 11.2 Happiness Percentage of young women aged 15–24 years who are very or somewhat happy 82.3 11.3 Perception of a better life Percentage of young women aged 15–24 years whose life improved during the last one year, and who expect that their life will be better after one year 57.0 TOBACCO AND ALCOHOL USE Tobacco use MICS Indicator Indicator Description Value 12.1 Tobacco use Percentage of women aged 15–49 years who smoked cigarettes, or used smoked or smokeless tobacco products at any time during the last one month 9.2 12.2 Smoking before age 15 Percentage of women aged 15–49 years who smoked a whole cigarette before age 15 3.9 Alcohol use 12.3 Use of alcohol Percentage of women aged 15–49 years who had at least one alcoholic drink at any time during the last one month 9.5 12.4 Use of alcohol before age 15 Percentage of women aged 15–49 years who had at least one alcoholic drink before age 15 6.8 XI XII XIII XIV XV NEPAL MULTIPLE INDIC ATOR CLUSTER SURVEY 2014XVI TABLE OF CONTENTS Summary Table of Survey Implementation and Survey Population Summary Table of Findings Preface Acknowledgements Foreword Table of Contents List of Tables List of Figures List of Abbreviations Map of Nepal Showing Nepal MICS Sample Domains and Corresponding Districts Executive Summary III IV XI XIII XV XVI XVIII XXII XXIII XXIV XXV I. Introduction Background Survey Objectives II. Sample and Survey Methodology Sample Design Questionnaires Training and Fieldwork Data Processing III. Sample Coverage and the Characteristics of Households and Respondents Sample Coverage Characteristics of Households Characteristics of Female and Male Respondents 15–49 Years of Age and Children Under Five Housing Characteristics, Asset Ownership, and Wealth Quintiles IV. Child Mortality V. Nutrition Low Birth Weight Nutritional Status Breastfeeding and Infant and Young Child Feeding Salt Iodization Micronutrient Intake Children’s Vitamin A Supplementation VI. Child Health Vaccinations Japanese Encephalitis Neonatal Tetanus Protection Care of Illness Diarrhoea Acute Respiratory Infection Solid Fuel Use Malaria/Fever VII. Water and Sanitation Use of Improved Water Sources Use of Improved Sanitation Handwashing Water Quality 1 1 2 3 3 4 5 5 6 6 8 11 14 19 24 24 26 31 42 46 47 49 49 51 55 56 58 68 73 76 82 83 92 101 109 NEPAL MULTIPLE INDIC ATOR CLUSTER SURVEY 2014 XVII VIII. Reproductive Health Fertility Contraception Unmet Need Antenatal Care Assistance at Delivery Place of Delivery Postnatal Health Checks Newborn Care Practices Experience of Discrimination during Menstruation (Chhaupadi) Spousal Separation IX. Early Childhood Development Early Childhood Care and Education Quality of Care Developmental Status of Children Perception on Minimum Years of Schooling X. Literacy and Education Literacy among Young Women School Readiness Primary and Secondary School Participation Participation in Non-Formal Education XI. Child Protection Birth Registration Child Labour Child Discipline Early Marriage and Polygyny Attitudes toward Domestic Violence Children’s Living Arrangements XII. HIV and AIDS Knowledge about HIV Transmission and Misconceptions about HIV/AIDS Accepting Attitudes toward People Living with HIV/AIDS Knowledge of a Place for HIV Testing, Counselling and Testing during Antenatal Care HIV Indicators for Young Women XIII. Access to Mass Media and Use of Information/Communication Technology Access to Mass Media Use of Information/Communication Technology XIV. Subjective Well-being XV. Tobacco and Alcohol Use Tobacco Use Alcohol Use Appendices Appendix A. Sample Design Appendix B. List of Personnel Involved in the Survey Appendix C. Estimates of Sampling Errors Appendix D. Data Quality Tables Appendix E. MICS5 Indicators: Numerators and Denominators Appendix F. MICS Questionnaires 113 113 118 122 124 131 134 136 148 151 151 153 153 155 161 163 165 165 166 167 176 178 178 181 186 190 196 199 203 203 208 210 213 216 216 218 220 226 226 230 233 238 242 281 299 310 NEPAL MULTIPLE INDIC ATOR CLUSTER SURVEY 2014XVIII Results of household, women’s, and under-5 interviews Household age distribution by sex Household composition Women’s background characteristics Under-5s background characteristics Housing characteristics Household assets Wealth quintiles Early childhood mortality rates Early childhood mortality rates by socioeconomic characteristics Early childhood mortality rates by demographic characteristics Low birth weight infants Nutritional status of children Initial breastfeeding Breastfeeding Duration of breastfeeding Age-appropriate breastfeeding Introduction of solid, semi-solid, or soft foods Infant and young child feeding practices Bottle feeding Iodized salt consumption Type of salt used in households Micronutrient intake among mothers Children’s vitamin A supplementation Vaccinations in the first years of life Vaccinations against Japanese encephalitis Vaccinations by background characteristics Neonatal tetanus protection Reported disease episodes Care-seeking during diarrhoea Feeding practices during diarrhoea Oral rehydration solution and zinc Oral rehydration therapy with continued feeding and other treatments Source of ORS and zinc Care-seeking for acute respiratory infection (ARI) and treatment of symptoms with antibiotics Knowledge of the two danger signs of pneumonia Solid fuel use Solid fuel use by place of cooking Care-seeking during fever Treatment of children with fever Diagnostics and antimalarial treatment of children Use of improved water sources Household water treatment Time to source of drinking water Person collecting water Types of sanitation facilities Use and sharing of sanitation facilities Table HH.1: Table HH.2: Table HH.3: Table HH.4: Table HH.5: Table HH.6: Table HH.7: Table HH.8: Table CM.1: Table CM.2: Table CM.3: Table NU.1: Table NU.2: Table NU.3: Table NU.4: Table NU.5: Table NU.6: Table NU.7: Table NU.8: Table NU.9: Table NU.10: Table NU.11: Table NU.12: Table NU.13: Table CH.1: Table CH.1JE: Table CH.2: Table CH.3: Table CH.4: Table CH.5: Table CH.6: Table CH.7: Table CH.8: Table CH.9: Table CH.10: Table CH.11: Table CH.12: Table CH.13: Table CH.14: Table CH.15: Table CH.16: Table WS.1: Table WS.2: Table WS.3: Table WS.4: Table WS.5: Table WS.6: LIST OF TABLES 7 8 10 11 13 15 17 18 20 21 22 25 28 33 35 37 38 39 40 42 43 45 47 48 50 52 53 56 57 59 60 62 64 66 69 71 74 75 77 78 81 84 87 90 91 93 95 NEPAL MULTIPLE INDIC ATOR CLUSTER SURVEY 2014 XIX Drinking water and sanitation ladders Disposal of child’s faeces Water and soap at place for handwashing Availability of soap or other cleansing agent Distance between latrine and place for handwashing Critical times for handwashing Description of E. coli risk categories Household drinking water quality Source drinking water quality Fertility rates Adolescent birth rate and total fertility rate Early childbearing Trends in early childbearing Use of contraception Unmet need for contraception Antenatal care coverage Number of antenatal care visits and timing of first visit Content of antenatal care Assistance during delivery and Caesarean section Place of delivery Postpartum stay in health facility Postnatal health checks for newborns Postnatal care visits for newborns within one week of birth Postnatal health checks for mothers Postnatal care visits for mothers within one week of birth Postnatal health checks for mothers and newborns Newborn care practices in non-institutional deliveries First-time bathing of newborns Discrimination practices during menstruation period Spousal separation Early childhood education Support for learning Learning materials Inadequate care Early child development index Perception on minimum years of education for child Literacy (young women) School readiness Primary school entry Primary school attendance and out-of-school children Secondary school attendance and out-of-school children Education gender parity Out-of-school gender parity Participation in non-formal education Birth registration Children’s involvement in economic activities Children’s involvement in household chores Child labour Child discipline Attitudes toward physical punishment Early marriage and polygyny (women) Trends in early marriage (women) Table WS.7: Table WS.8: Table WS.9: Table WS.10: Table WS.11: Table WS.12: Table WQ.A: Table WQ.1: Table WQ.2: Table RH.1: Table RH.2: Table RH.3: Table RH.4: Table RH.5: Table RH.6: Table RH.7: Table RH.8: Table RH.9: Table RH.10: Table RH.11: Table RH.12: Table RH.13: Table RH.14: Table RH.15: Table RH.16: Table RH.17: Table RH.18: Table RH.19: Table RH.20: Table RH.21: Table CD.1: Table CD.2: Table CD.3: Table CD.4: Table CD.5: Table CD.6: Table ED.1: Table ED.2: Table ED.3: Table ED.4: Table ED.5: Table ED.6: Table ED.7: Table ED.8: Table CP.1: Table CP.2: Table CP.3: Table CP.4: Table CP.5: Table CP.6: Table CP.7: Table CP.8: 97 99 102 104 107 108 110 111 112 114 115 116 117 119 123 125 128 130 132 135 137 139 141 143 145 147 148 149 150 152 154 156 159 160 162 164 166 167 169 170 172 174 175 177 179 182 184 185 187 189 191 192 NEPAL MULTIPLE INDIC ATOR CLUSTER SURVEY 2014XX Table CP.9: Table CP.10: Table CP.11: Table CP.12: Table CP.13: Table CP.14: Table HA.1: Table HA.2: Table HA.3: Table HA.4: Table HA.5: Table HA.6: Table MT.1: Table MT.2: Table SW.1: Table SW.2: Table SW.3: Table TA.1: Table TA.2: Table TA.3: Spousal age difference Attitudes toward domestic violence Attitudes towards abusive behaviour by mothers-in-law Children’s living arrangements and orphanhood Children with parents living abroad Children living away from their biological mother Knowledge about HIV transmission, misconceptions about HIV, and comprehensive knowledge about HIV transmission (women) Knowledge of mother-to-child HIV transmission (women) Accepting attitudes toward people living with HIV (women) Knowledge of a place for HIV testing (women) HIV counselling and testing during antenatal care Key HIV and AIDS indicators (young women) Exposure to mass media (women) Use of computers and internet (women) Domains of life satisfaction (women) Overall life satisfaction and happiness (women) Perception of a better life (women) Current and ever use of tobacco (women) Age at first use of cigarettes and frequency of use (women) Use of alcohol (women) 194 197 198 200 201 202 204 207 209 211 212 214 217 219 221 224 225 227 229 231 NEPAL MULTIPLE INDIC ATOR CLUSTER SURVEY 2014 XXI APPENDICES: Table SD.1: Table SE.1: Table SE.2: Table SE.3: Table SE.4: Table SE.5: Table SE.6: Table SE.7: Table SE.8: Table SE.9: Table SE.10: Table SE.11: Table SE.12: Table SE.13: Table SE.14: Table SE.15: Table SE.16: Table SE.17: Table SE.18: Table SE.19: Table DQ.1: Table DQ.2: Table DQ.3: Table DQ.4: Table DQ.5: Table DQ.6: Table DQ.7: Table DQ.8: Table DQ.9: Table DQ.10: Table DQ.11: Table DQ.12: Table DQ.13: Table DQ.14: Table DQ.15: Table DQ.16: Table DQ.17: Table DQ.18: Table DQ.19: Table DQ.20: Table DQ.21: Table DQ.22: Table DQ.23: Table DQ.24: Allocation of sample clusters (primary sampling units) to sampling strata Indicators selected for sampling error calculations Sampling errors: Total sample Sampling errors: Urban Sampling errors: Rural Sampling errors: Eastern Mountains Sampling errors: Eastern Hills Sampling errors: Eastern Terai Sampling errors: Central Mountains Sampling errors: Central Hills Sampling errors: Central Terai Sampling errors: Western Mountains Sampling errors: Western Hills Sampling errors: Western Terai Sampling errors: Mid-Western Mountains Sampling errors: Mid-Western Hills Sampling errors: Mid-Western Terai Sampling errors: Far Western Mountains Sampling errors: Far Western Hills Sampling errors: Far Western Terai Age distribution of household population Age distribution of eligible and interviewed women Age distribution of children in household and under-5 questionnaires Birth date reporting: Household population Birth date and age reporting: Women Birth date and age reporting: Under-5s Birth date reporting: Children, adolescents and young people Birth date reporting: First and last births Completeness of reporting Completeness of information for anthropometric indicators: Underweight Completeness of information for anthropometric indicators: Stunting Completeness of information for anthropometric indicators: Wasting Heaping in anthropometric measurements Observation of birth certificates Observation of vaccination cards Observation of women’s health cards Observation of places for handwashing Respondents to under-5 questionnaire Selection of children aged 1–17 years for the child labour and child discipline modules School attendance by single age Sex ratio at birth among children ever born and living Births by calendar years Reporting of age at death in days Reporting of age at death in months 235 243 245 247 249 251 253 255 257 259 261 263 265 267 269 271 273 275 277 279 283 284 284 285 286 286 287 287 288 288 289 289 289 290 291 292 293 293 294 295 296 296 297 298 NEPAL MULTIPLE INDIC ATOR CLUSTER SURVEY 2014XXII Age and sex distribution of household population Early child mortality rates Under-5 mortality rates by area Trend in under-5 mortality rates Underweight, stunted, wasted and overweight children under five (moderate and severe) Initiation of breastfeeding Infant feeding patterns by age Use of iodized salt Vaccinations by age of 12 months for children aged 12–23 months and 24–35 months Children under five with diarrhoea who received ORS Children under five with diarrhoea receiving ORT and continued feeding Percentage of household members by source of drinking water Percentage of household members by use and sharing of sanitation facilities Use of improved drinking water sources and improved sanitation facilities by household members Age-specific fertility rates by area Differentials in contraceptive use Person assisting at delivery Education indicators by sex Children under five whose births are registered Child disciplining methods, children aged 1–14 years Early marriage among women Women with comprehensive knowledge of HIV transmission Accepting attitudes towards people living with HIV/AIDS Ever and current smokers Number of household population by single ages Weight and height/length measurements by digits reported for the decimal points Figure HH.1: Figure CM.1: Figure CM.2: Figure CM.3: Figure NU.1: Figure NU.2: Figure NU.3: Figure NU.4: Figure CH.1: Figure CH.2: Figure CH.3: Figure WS.1: Figure WS.2: Figure WS.3: Figure RH.1: Figure RH.2: Figure RH.3: Figure ED.1: Figure CP.1: Figure CP.2: Figure CP.3: Figure HA.1: Figure HA.2: Figure TA.1: APPENDIX: Figure DQ.1: Figure DQ.2: LIST OF FIGURES 9 20 21 23 30 34 36 44 51 63 65 86 96 98 114 121 134 176 180 188 193 206 210 228 281 282 NEPAL MULTIPLE INDIC ATOR CLUSTER SURVEY 2014 XXIII ACT Artemisinin-based combination therapy AIDS acquired immune deficiency syndrome ANC antenatal care ARI acute respiratory infection ASFR age-specific fertility rate BCG Bacillis-Cereus-Geuerin (tuberculosis) CBR crude birth rate CPR contraceptive prevalence rate CRC Convention on the Rights of the Child CSPro Census and Survey Processing System DK don’t know DPT diphteria pertussis tetanus EC Escherichia coli (E. coli) ECD early childhood development ECDI early child development index ENPHO Environment and Public Health Organization EPI Expanded Programme on Immunization GFR general fertility rate GPI gender parity index HIV human immunodeficiency virus ICT information/communication technology IDD iodine deficiency disorders I/NGO international (and national) non-governmental organization ITN insecticide-treated bednet IU International Unit IUD intrauterine device LAM lactational amenorrhea method MDG Millennium Development Goal MICS Multiple Indicator Cluster Survey MICS5 fifth global round of Multiple Indicator Cluster Survey programme MoHP Ministry of Health and Population NAR net attendance rate NDHS Nepal Demographic and Health Survey NVAP National Vitamin A Programme ORS oral rehydration salts ORT oral rehydration treatment PNC postnatal care ppm parts per million SPSS Statistical Package for Social Sciences 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 LIST OF ABBREVIATIONS NEPAL MULTIPLE INDIC ATOR CLUSTER SURVEY 2014XXIV M ap o f N ep al S ho w in g N ep al M IC S Sa m pl e D om ai ns a nd C or re sp on di ng D is tr ic ts NEPAL MULTIPLE INDIC ATOR CLUSTER SURVEY 2014 XXV Executive Summary The Nepal Multiple Indicator Cluster Survey (MICS 2014) was conducted by the Central Bureau of Statistics under the National Planning Commission from January to June 2014. Technical and financial support for the survey was provided by the United Nations Children’s Fund (UNICEF) Nepal. Nepal MICS 2014 provides valuable information and the latest evidence on the situation of children and women in Nepal before the country was hit by an earthquake of 7.8 magnitude on 25 April 2015. The survey presents data from an equity perspective by indicating disparities by sex, region, area, education, household wealth, and other characteristics. Nepal MICS 2014 is based on a sample of 12,405 households interviewed and provides a comprehensive picture of children and women in the 15 sub-regions of the country. Child Mortality The 2014 MICS provides various measures of childhood calculated from information collected through birth histories of women aged 15–49. According to survey results, in the most recent five-year period prior to the survey, the under-5 mortality rate in Nepal is 38 deaths per 1,000 live births, the infant mortality rate is 33 deaths per 1,000 live births, and the neonatal mortality rate is 23 deaths per 1,000 live births. There are substantial disparities in terms of urban–rural location, mother’s education and household wealth status as well as between regions. Infant and under-5 mortality rates in rural areas are both over 50 percent higher than in urban areas. Mortality rates decrease with an increase in the education level of the mother. Children in the poorest households are twice as likely to die before reaching one and five years of age compared to children living in the richest households. Nutritional Status and Breastfeeding Some 60 percent of newborns were weighed at birth. For all births, 24 percent of infants were estimated to weigh less than 2,500 grams. There was some regional variation, ranging from 20 percent in the Eastern Terai to 33 percent in the Mid-Western Mountains. One in three (30 percent) children under five in Nepal were moderately or severely underweight, with 9 percent classified as severely underweight. More than one-third (37 percent) were moderately or severely stunted, with 16 percent severely stunted, and 11 percent were moderately or severely wasted, with 3 percent severely wasted. Only 2 percent of children were moderately or severely overweight. Children in rural areas were more likely than those in urban areas to be underweight, stunted or wasted. Those children whose mother has secondary or higher education were the least likely to be underweight, stunted or wasted compared to children of mothers with no education. Older children were more likely than younger children to be underweight and/or stunted but less likely to be wasted. Almost all (97 percent) newborns in Nepal were breastfed at some point after birth. However, only 49 percent started breastfeeding at the recommended time (i.e., within one hour of birth). Some 57 percent of infants under six months of age were exclusively breastfed and 75 percent received breast milk as the predominant source of nourishment during the day prior to the survey. Boys were more likely than girls to be exclusively breastfed. A cultural dimension partially explains this difference, as boys are usually introduced to semi-solid food at six months as compared to girls at five months. Mother’s education level was negatively associated with exclusive breastfeeding. Some 94 percent of children aged 12–15 months and 87 percent of children aged 20–23 months were still being breastfed. Approximately 79 percent of all children aged 0–23 months were receiving age-appropriate breastfeeding. Overall, 74 percent of infants aged 6–8 months had received solid, semi-solid or soft foods at least once during the previous day. Boys were more likely than girls to receive solid, semi-solid or soft foods. NEPAL MULTIPLE INDIC ATOR CLUSTER SURVEY 2014XXVI Of children aged 6–23 months, 74 percent had adequate meal frequency and 37 percent had adequate dietary diversity. Overall, 32 percent received a minimum acceptable diet. Some 12 percent of children aged 0–23 months in Nepal were fed using a bottle with a nipple. Urban children were much more likely than rural children to be bottle fed, and bottle feeding was positively correlated with mother’s education level and household wealth status. Adequately iodized salt, defined as containing 15 or more parts per million (15+ ppm), is used in 82 percent of households, with considerably higher consumption in urban areas (96 percent) and among the richest households (98 percent) than in rural areas (78 percent) and among the poorest households (64 percent). Use of iodized salt was lowest in the Far Western Hills (54 percent) and highest in the Central Hills (92 percent). Child Health and Care of Illness Four in every five mothers who gave birth in the two years prior to the survey were adequately protected against neonatal tetanus (77 percent). Regionally, the highest percentage was in the Eastern Terai (86 percent) and the lowest was in the Far Western Hills (60 percent). The likelihood of protection against neonatal tetanus increased with a woman’s level of education and household wealth status. Only 67 percent of women with no education were protected compared to 90 percent with higher than secondary education. Further, only 61 percent of women living in the poorest households were protected compared to 88 percent of women living in the richest households. Twelve percent of children under five had experienced diarrhoea during the two weeks preceding the survey. Of children with diarrhoea, 47 percent were taken to a qualified health care provider for advice or treatment. Mother’s education level was positively associated with seeking care: 43 percent of women with no education sought care from a health facility or health provider compared to 58 percent of women with higher education. Some 18 percent were treated with oral rehydration salts (ORS) and zinc as recommended. Children aged 0–11 months (11 percent) were the least likely to receive ORS and zinc. Overall, 46 percent of children received oral rehydration therapy (ORT) and continued feeding during the episode of diarrhoea. Older children (48–59 months), urban children and children whose mother had higher education were much more likely than their counterparts to receive ORT and continued feeding. Seven percent of children under five showed symptoms of acute respiratory infection (ARI) in the two weeks preceding the survey, of whom 50 percent were taken to a qualified health provider. Although appropriate medical care was sought for only 25 percent of children with ARI symptoms, antibiotic treatment was given to 75 percent of these children. Children in poorer households were less likely than others to be taken to a qualified provider for treatment of ARI, and to be given antibiotics. Additionally, only 46 percent of mothers or caretakers recognized at least one of two danger signs of pneumonia (fast and/or difficulty in breathing). Women living in households in the poorest wealth quintile were least likely to recognize the danger signs of pneumonia. Overall, three-quarters (75 percent) of all households in Nepal used solid fuels for cooking, with the primary source of fuel being wood (65 percent). Use of solid fuels was low in urban areas (24 percent), while only 1 percent of households in Kathmandu Valley used solid fuels for cooking. Differentials with respect to household wealth and the education level of the household head were also important. In households where the head had no education, 89 percent of household members used solid fuels for cooking. Almost all households in the poorest wealth quintile used solid fuels for cooking. Twenty percent of under-5s had an episode of fever in the two weeks preceding the survey. Of these, 46 percent were taken to a qualified provider for advice or treatment. However, no advice or treatment was sought in 29 percent of cases. Younger children (0–11 months) were more likely than their counterparts to receive care from a qualified provider (55 percent). Mother’s education level and household wealth status were both positively correlated with seeking care from a qualified provider. Less than 1 percent of children with fever were treated with Artemisinin-based combination therapy (ACT) and an additional 1 percent received an antimalarial other than ACT. NEPAL MULTIPLE INDIC ATOR CLUSTER SURVEY 2014 XXVII Water and Sanitation Drinking water was used from an improved drinking water source almost universally (93 percent of the population). Among those who did not have access to an improved drinking water source, only 14 percent used an appropriate water treatment method. About 67 percent of users of improved drinking water sources had a water source directly on their premises. In addition, 22 percent used an improved drinking water source with a round trip of less than 30 minutes. In total, 7 percent of household members took more than 30 minutes to collect water. Rural households were more likely than urban households to spend more than 30 minutes collecting water. Some 30 percent of households in the Mid-Western Hills took 30 minutes or more to collect water. Water was usually collected by adult women (84 percent) in the household. The education level of the household head and the household’s wealth status were both positively associated with having a water source on the premises. Approximately 72 percent of the population of Nepal is living in households using improved sanitation facilities. However, only 60 percent are using improved sanitation facilities that are not shared. Some 26 percent still practiced open defecation. Urban areas were much more likely than rural areas to use improved sanitation facilities (94 percent cf. 67 percent), and the use of improved sanitation facilities is strongly correlated with the education level of the household head. Strikingly, the poorest households were less likely than households in the second and middle wealth quintiles to practice open defecation, possibly as a result of recent targeted interventions that provide the poorest with sanitation facilities. Overall, 56 percent of the household population used an improved drinking water source as well as an improved sanitation facility. Child faeces were disposed of in a safe manner for 48 percent of children under the age of two years. This was twice as common in urban areas as rural areas (81 percent cf. 43 percent), and there were significant regional differences (24 percent in the Far Western Terai cf. 78 percent in the Eastern Hills). In households where a place for handwashing was observed, 73 percent had water and soap or another cleansing agent present at that place. The proportion of households with water and soap or cleansing agent available at the handwashing place varied by region, being highest in the Eastern Terai (81 percent) and the lowest in the Mid-Western and Far Western Mountains (41 percent each). It was lower in rural areas than urban areas (69 percent cf. 85 percent). It was positively associated with the education level of the household head and household wealth status. A water quality testing questionnaire was included in the Nepal MICS for the first time, aiming to collect data on the quality of water actually consumed throughout Nepal through the use of a test for microbiological parameters such as E. coli and total coliform. Overall, more than four-fifths (82 percent) of household members were at the risk of E. coli concentration ≥ 1 cfu/100 ml in their household water. People living in the richest households were less likely than those living in the poorest households to have E. coli in their drinking water (64 percent cf. 91 percent). Likewise, the quality of drinking water at source was also measured. In total, almost three-quarters (71 percent) of the household population were at risk of E. coli due to its concentration in their source of drinking water. The poorest households were more likely than the richest households to have E. coli in their source of drinking water (88 percent cf. 58 percent). Eight out of 10 households (84 percent) with unimproved sources of drinking water had E. coli, whereas it dropped to 70 percent for those households that had an improved source of drinking water. Unimproved sources were much more likely than improved sources to fall into the very high risk category. NEPAL MULTIPLE INDIC ATOR CLUSTER SURVEY 2014XXVIII Reproductive Health The total fertility rate in Nepal is 2.3, meaning that a Nepali women, by the end of her reproductive years, will have given birth to an average of 2.3 children. The adolescent birth rate is 71 births per 1,000 women aged 15–19 years. Early childbearing is relatively common, with about one in six (16 percent) women aged 20–24 years having had a live birth before the age of 18. About 50 percent of women aged 15–49 years and currently married or in a marital union were using some form of contraception, with 47 percent using a modern method and 3 percent using a traditional method. However, contraceptive prevalence was relatively low among women aged 15–19 years (19 percent). Interestingly, women’s education level was negatively associated with contraceptive use. Some 25 percent of women had an unmet need for contraception, with 10 percent requiring it for spacing and 15 percent requiring it for limiting. Notably, unmet need was higher among younger women than older women, ranging from 48 percent for women aged 15–19 years to 11 percent for women aged 45–49 years. Education level was positively associated with unmet need, with only 19 percent of women with no education expressing an unmet need compared to 32 percent of women with higher education. About 68 percent of women aged 15–49 years with a live birth in the two years preceding the survey received antenatal care from skilled health personnel at least once, and 60 percent had the recommended four antenatal care visits by any provider. Some 61 percent had received all elements of the antenatal checkup (blood pressure checked, urine sample taken and blood sample taken). Urban women were much more likely than rural women to receive all recommended antenatal care practices. Education level and household wealth status were both strongly associated with the likelihood of a woman receiving appropriate antenatal care. Around 55 percent of women aged 15–49 years with a live birth in the two years preceding the survey delivered at a health facility and 56 percent were attended by a skilled health provider. Importantly, women who had received at least four antenatal care visits were much more likely to deliver in a health facility (73 percent) than those who had 1–3 visits (38 percent) or no visits (10 percent). Urban women were much more likely than rural women to be attended by a skilled provider (90 percent cf. 51 percent). Furthermore, 95 percent of women who gave birth in a health facility were attended by a skilled provider, while only 7 percent of women who gave birth at home were attended by a skilled provider—a 14-fold difference. Women with higher levels of education and those living in the richest households were much more likely than their counterparts to deliver in a health facility and to be assisted by a skilled provider at delivery. Some 9 percent of women were delivered by Caesarean section. Around 76 percent of women who gave birth in a health facility stayed 12 hours or more in the facility after delivery. Urban women were more likely than rural women to stay for 12 hours or more (86 percent cf. 74 percent). Postnatal checkups were given to 58 percent of newborns and 58 percent of mothers within two days after delivery. Newborns delivered in a health facility were much more likely than those delivered at home to receive a postnatal health check (91 percent cf. 17 percent). An increase in the mother’s education level and the household wealth status increased the likelihood of a postnatal health check for both newborns and mothers. Early Childhood Development Half of all children (51 percent) aged 36–59 months were attending early childhood education programmes. Four-year-olds were more likely than three-year-olds to be attending (65 percent cf. 37 percent). Children in urban areas were much more likely than those in rural areas to attend (78 percent cf. 47 percent). In addition, two-thirds of children (67 percent) also lived in households where NEPAL MULTIPLE INDIC ATOR CLUSTER SURVEY 2014 XXIX adults had engaged with them in four or more activities that promote learning and school readiness during the three days prior to the survey. Father’s involvement in such activities was somewhat limited, with only 10 percent of children having a father who had engaged with them in four or more activities compared to 30 percent of children whose mother had done so. In Nepal, only 5 percent of children aged 0–59 months lived in a household where at least three children’s books were present, and less than 1 percent lived in a household with 10 or more children’s books. Urban children were much more likely than rural children to live in a household with at least three children’s books (15 percent cf. 3 percent), with 31 percent of children in Kathmandu valley living in a household with at least three children’s books. The presence of children’s books was positively correlated with mother’s education and household wealth levels. Some 59 percent of under-5s had access to two or more types of playthings. One in five (21 percent) children under five was left with inadequate care during the week preceding the survey (either left alone or in the care of another child under the age of 10). Rural children were more likely than urban children to have inadequate care (21 percent cf. 15 percent). Mother’s education level and household wealth status were both negatively associated with a child being left with inadequate care. Overall, 64 percent of children aged 36–59 months were developmentally on track according to the early child development index (ECDI). The score is based on the percentage of children who are developmentally on track in at least three of the following four domains: literacy–numeracy, physical, social–emotional and learning. Urban children, children who are attending early childhood education, and children of better educated mothers and from wealthier households have slightly higher development index scores. Literacy and Education Some 84 percent of women aged 15–24 years were literate. As expected, literacy was strongly associated with education level: just 5 percent of young women with no education were literate. However, only 62 percent of young women with primary education were considered literate, suggesting major shortcomings in the quality of primary education in the country since such a significant proportion of young women were still unable to read a short simple statement. Almost three-quarters (74 percent) of children in first grade of primary school had attended preschool during the previous school year. The net intake rate in primary education, i.e., the percentage of children of school-entry age who enter the first grade of primary school, was low at 42 percent. Household wealth status was not correlated with net intake rate; notably, the proportion of children in this age group who were living in households in the poorest wealth quintile and were attending first grade was nine percentage points higher than that of their counterparts living in the richest households (52 percent cf. 43 percent). The primary school adjusted net attendance ratio was 76 percent. Younger children had lower primary school net attendance ratios than older children, and were more likely to be in preschool or out of school. Some 62 percent of children of secondary-school age were currently attending secondary school or higher, 27 percent were still attending primary school, and 11 percent were out of school. Older children were more likely than younger counterparts to be out of school, with some 22 percent of children who started the school year at age 16 out of school. Mother’s education and household wealth status were both positively correlated with secondary school attendance ratios. The gender parity index (GPI) for both primary and secondary school was 1.00, indicating virtually no difference in the attendance of girls and boys at primary and secondary school. The primary GPI was NEPAL MULTIPLE INDIC ATOR CLUSTER SURVEY 2014XXX higher for rural children than urban children, and the secondary GPI was lower for rural children than urban children. Child Protection Although a high proportion of mothers or caretakers of children under five (86 percent) know how to register a birth in Nepal, registration is still not widely practiced, with only 58 percent of births registered. The difference between knowledge and practice persists across all background dimensions. In total, 37 percent of children aged 5–17 years were involved in child labour, with 30 percent working under hazardous condition. Children from rural areas were much more likely than children from urban areas to be involved in child labour (41 percent cf. 16 percent). Children attending school were less likely than children not attending school to be involved in child labour (36 percent cf. 47 percent). Mother’s education and household wealth status were negatively correlated with child labour. The majority (81 percent) of children aged 1–14 years in Nepal had been subjected to at least one form of psychological or physical punishment by household members in the month prior to the survey. Around 14 percent had experienced severe physical punishment (hitting child on the head, ears or face or hitting child hard and repeatedly). Interestingly, this does not match well with only 35 percent of respondents believing that physical punishment is a necessary part of child-rearing. Almost one in six (16 percent) women aged 15–49 years was first married before the age of 15, and nearly half (49 percent) of women aged 20–49 years were married before the age of 18. Of women aged 15–19 years, 25 percent were already married. Early marriage is widely practiced in Nepal and is prevalent across all background dimensions; however, trends based on other data sources suggest that it has declined in recent years. Among currently married women aged 15–49 years, 4 percent were in a polygynous marriage. Spousal age difference is generally not large in Nepal and marriage to a much older husband is not very common. Some 6 percent of women aged 15–19 years and 8 percent of women aged 20–24 years were married to a spouse who is 10 or more years older. Interestingly, marriage to an older spouse was more common for women with better education and living in richer households. Overall, 43 percent of women felt that a husband was justified in hitting or beating his wife in at least one of five situations (wife neglects the children, wife goes out without telling husband, wife argues with husband, wife refuses to have sex with husband, wife burns the food). Such agreement was more likely in rural areas than urban areas (46 percent cf. 29 percent). Younger women tended to show lower agreement than older women. Agreement was highest among women with no education and those living in households in the poorest wealth quintile. Around 5 percent of children aged 0–17 years were living with neither of their biological parents, and 4 percent reported that one or both of their biological parents had passed away. About 18 percent of children had at least one biological parent living abroad. HIV/AIDS and Orphanhood More than three in four (78 percent) women aged 15–49 years in Nepal had heard of AIDS, but only one in four (26 percent) had comprehensive knowledge, meaning they can correctly identify two ways of preventing HIV infection (know that a healthy looking person can have HIV, and reject the two most common misconceptions about HIV transmission). Only two in five (38 percent) women correctly identified all three means of mother-to-child transmission of HIV. Overall, 49 percent of women NEPAL MULTIPLE INDIC ATOR CLUSTER SURVEY 2014 XXXI expressed an accepting attitude towards people living with HIV. On all HIV/AIDS-related indicators, urban women were more likely than rural women to have knowledge and accepting attitudes. Education level and household wealth status were both positively correlated with knowledge and accepting attitudes. Around 58 percent of women aged 15–49 years knew of a place where they can be tested for HIV. Knowledge about a place to get tested had a strong positive correlation with both education level and household wealth status. Of women who had received antenatal care during their last pregnancy, 14 percent reported that they had received counselling on HIV during antenatal care, while 9 percent received HIV counselling, were offered an HIV test, were tested, and received the result. Again, education level and household wealth status were strongly associated with the likelihood of being tested and receiving the result. Finally, as over half of new adult HIV infections are among people aged 15–24 years, changing their behaviour is especially important to reduce new infections. Results for this age group are generally better than for the population aged 15–49 years as a whole. Some 36 percent of young women had comprehensive knowledge, 45 percent knew all three means of HIV transmission from mother to child, and 68 percent knew of a place to get tested for HIV. Access to Mass Media and ICT Of all women aged 15–49 years in Nepal, one-fifth (19 percent) read a newspaper or magazine at least once a week, 41 percent listened to the radio, and 57 percent watched television. In total, 11 percent were exposed to all three types of media on a weekly basis. For young women aged 15–24 years, 22 percent had used a computer and 20 percent had used the internet during the 12 months prior to the survey. Access to mass media and information/communication technology was more prevalent among younger women, women who live in urban areas, those with better education and those living in richer households. Subjective Well-being In the Nepal MICS 2014, a set of questions related to subjective well-being were asked to women aged 15–24 years to understand how satisfied this group of young people is in different areas of their lives. Life satisfaction is a measure of an individual’s level of well-being. Life satisfaction is measured in categories ‘very satisfied’, ‘somewhat satisfied‘, ‘neither satisfied nor unsatisfied’, ‘somewhat unsatisfied’ and ‘very unsatisfied’. They were also measured for happiness and for the question on happiness, the same scale was used, ranging from ‘very happy’ to ‘very unhappy’, in the same fashion. For three domains, satisfaction with school, job and income, the denominators are confined to those who are currently attending school, have a job, and have an income. Of the different domains, young women were the most satisfied with their family life (85 percent), their friendships (82 percent), the way they look (81 percent), and their health (78 percent). The proportions were lower for living environment (75 percent) and treatment by others (70 percent). Some 89 percent of young women were satisfied with school, 79 percent were satisfied with their job, and 77 percent were satisfied with their income. More educated women tended to have higher levels of satisfaction than women with little or no education, and women living in households in richer wealth quintiles tended to have higher levels of satisfaction than those living in households in poorer wealth quintiles. Overall, 81 percent of young women expressed satisfaction with their life. In addition, 82 percent of young women said they were very or somewhat happy. NEPAL MULTIPLE INDIC ATOR CLUSTER SURVEY 2014XXXII Respondents were also asked whether they thought their life had improved during the year preceding the survey, and whether they thought their life would be better in one year subsequent to the survey. Three in five (60 percent) young women thought their life had improved and four in five (82 percent) expected their life to get better; some 57 percent thought both. Tobacco and Alcohol Use In Nepal, 9 percent of women aged 15–49 years reported that they had smoked cigarettes or used other tobacco products on one or more days during the month preceding the survey. Cigarettes were the most commonly used tobacco product. Tobacco use was higher among older, less educated and poorer women. Some 4 percent of women had smoked a whole cigarette before the age of 15 years. Some 10 percent of women aged 15–49 years had at least one drink of alcohol on one or more days during the month preceding the survey, and 7 percent reported that they had first drunk alcohol before the age of 15. There was great regional variation, ranging from 1 percent of women in the Far Western Hills to 51 percent of women in the Eastern Mountains. Women with no education and those from the poorest household population were about three times more likely than women with higher education and those from the richest household population to have drunk alcohol during the previous month. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 1 Introduction C H A P T E R1 Background This report is based on the Nepal Multiple Indicator Cluster Survey (MICS), conducted in 2014 by the Central Bureau of Statistics, Government of Nepal, with technical support from UNICEF. The survey provides statistically sound and internationally comparable data essential for developing evidence- based policies and programmes, and for monitoring progress toward national goals and global commitments. Among these global commitments are those emanating from the World Fit for Children Declaration and Plan of Action, the goals of the United Nations General Assembly Special Session on HIV/AIDS, the Education for All Declaration and the Millennium Development Goals (MDGs). A Commitment to Action: National and International Reporting Responsibilities The governments that signed the Millennium Declaration and the World Fit for Children Declaration and Plan of Action also committed themselves to monitoring progress towards the goals and objectives they contained: “We will monitor regularly at the national level and, where appropriate, at the regional level and assess progress towards the goals and targets of the present Plan of Action at the national, regional and global levels. Accordingly, we will strengthen our national statistical capacity to collect, analyse and disaggregate data, including by sex, age and other relevant factors that may lead to disparities, and support a wide range of child-focused research. We will enhance international cooperation to support statistical capacity-building efforts and build community capacity for monitoring, assessment and planning.” (A World Fit for Children, paragraph 60) “…We will conduct periodic reviews at the national and sub-national levels of progress in order to address obstacles more effectively and accelerate actions.…” (A World Fit for Children, paragraph 61) NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 20142 The Plan of Action of the World Fit for Children (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.” This survey has also generated information on indicators that are comparable with the ecological sub- regions defined in previous national surveys (e.g. the Nepal Demographic and Health Surveys). The results will contribute to monitoring progress made over the past decade on children’s and women’s issues. They will also help in identifying the regional and geographic disparities that exist within the country. The Nepal MICS results will be critically important for final MDG reporting in 2015, and are expected to form part of the baseline data for the post-2015 era. The Nepal MICS is expected to contribute to the evidence base of several other important initiatives, including Committing to Child Survival: A Promise Renewed, a global movement to end child deaths from preventable causes, and the accountability framework proposed by the Commission on Information and Accountability for the Global Strategy for Women’s and Children’s Health. This final report presents the results of the indicators and topics covered in the survey. Survey Objectives The Nepal MICS 2014 has as its primary objectives: • To provide up-to-date information for assessing the situation of children and women in Nepal; • To generate data for the critical assessment of the progress made in various areas, and to put additional efforts in those areas that require more attention; • 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 collect disaggregated data for the identification of disparities, to allow for evidence-based policy-making aimed at social inclusion of the most vulnerable; • To contribute to the generation of baseline data for the post-2015 agenda; • To validate data from other sources and the results of focused interventions. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 3 Sample and Survey Methodology C H A P T E R2 Sample Design The sample for the Nepal MICS was designed 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 the following 15 sub-regions: • Eastern Mountains • Central Terai • Mid-Western Hills • Eastern Hills • Western Mountains • Mid-Western Terai • Eastern Terai • Western Hills • Far Western Mountains • Central Mountains • Western Terai • Far Western Hills • Central Hills • Mid-Western Mountains • Far Western Terai The urban and rural areas within each sub-region were identified as the main sampling strata and the sample was selected in two stages. Within each stratum, a specified number of census enumeration areas were selected systematically with probability proportional to size. After a household listing was carried out within the selected enumeration areas, a systematic sample of 25 households was drawn in each sample enumeration area. The total sample size consisted of 13,000 households in 520 sample enumeration areas. One of these enumeration areas was not visited because it was inaccessible due to high altitude and heavy snowfall during the field work period. The sample was stratified by region, urban and rural areas, and is not self- weighting. For reporting national level results, sample weights are used. A more detailed description of the sample design can be found in Appendix A, Sample Design. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 20144 Questionnaires Four sets of questionnaires were used in the survey: (1) a household questionnaire which was used to collect basic demographic information on all de jure household members (usual residents), the household, and the dwelling; (2) a questionnaire for individual women administered in each household to all women aged 15–49 years; (3) an under-5 questionnaire, administered to mothers (or caretakers) for all children under five years of age living in the household; and (4) a water quality testing questionnaire to test for bacteria and measure E. coli content in household drinking water and water source in a sub- sample of the households. The Household Questionnaire included the following modules: • List of Household Members • Education • Child Labour • Child Discipline • Household Characteristics • Water and Sanitation • Handwashing • Salt Iodization The Questionnaire for Individual Women was administered to all women aged 15–49 years living in the households, and included the following modules: • Woman’s Background • Access to Mass Media and Use of Information/Communication Technology • Fertility/Birth History • Desire for Last Birth • Maternal and Newborn Health • Postnatal Health Checks • Illness Symptoms • Contraception • Unmet Need • Attitudes Toward Domestic Violence • Marriage/Union • HIV/AIDS • Tobacco and Alcohol Use • Life Satisfaction The Questionnaire for Children Under Five was administered to mothers (or caretakers) of children under five years of age1 living in the households. Normally, the questionnaire was administered to mothers of under-5s; in cases when the mother was not listed in the household roster, a primary caretaker for the child was identified and interviewed. The questionnaire included the following modules: • Age • Birth Registration • Early Childhood Development • Breastfeeding and Dietary Intake • Immunization • Care of Illness • Anthropometry 1 The terms ‘children under five’, ‘children aged 0–4 years’, and ‘children aged 0–59 months’ are used interchangeably in this report. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 5 The Questionnaire for Water Quality Testing was administered to a sub-sample of selected households for measuring E. coli content in the household drinking water and included only one module: • Water Quality The questionnaires are based on the MICS5 model questionnaire2. From the MICS5 model English version, the questionnaires were customized and translated into Nepali, Maithili and Bhojpuri. Pre-test training was conducted in Dhulikhel, Kavre District, from 25 October to 2 November 2013. Pre-test fieldwork was conducted in 25 households of both urban and rural locations in Sindhupalchowk District (Mountains), Tanahun District (Hills) and Dhanusa District (Terai) during November 2013. Based on the results of the pre-test, modifications were made to the wording and translation of the questionnaires. A copy of the Nepal MICS questionnaires is provided in Appendix F. In addition to the administration of questionnaires, fieldwork teams tested the salt used for cooking in the households for iodine content, observed the place for handwashing, and measured the weights and heights of children under five. Details and findings of these observations and measurements are provided in the respective sections of the report. In each cluster, water from three households and one source of drinking water were tested for E. coli. Testing was conducted by the team measurer. As a routine quality control measure, the supervisor regularly observed the measurer in the testing of blanks. In addition, professional laboratory technicians from an external agency were engaged for the purpose. They visited field teams during the survey and observed the measurers during testing, giving corrective support as needed. Training and Fieldwork Master training of trainers was held 12–20 January 2014. This was followed by three weeks of residential training for fieldworkers from 30 January to 19 February 2014 in Banepa, Kavre District. Training included lectures on interviewing techniques and the contents of the questionnaires, mock interviews between trainees to gain practice in asking questions, and demonstration on anthropometric measurement and water quality test. Towards the end of the training period, trainees spent four days in practice interviewing in villages near to Banepa. The data were collected by 15 teams; each comprised three female interviewers, one editor, one measurer and one supervisor. Fieldwork began in February 2014 and concluded in June 2014. Data Processing Data were entered using CSPro software, Version 5.0. Data were entered on 10 laptop computers by 10 data-entry operators, one questionnaire administrator, overseen by one data-entry supervisor with two secondary editors. For quality assurance purposes, all questionnaires were double-entered and internal consistency checks were performed. Procedures and standard programs developed under the global MICS programme and adapted to the Nepal questionnaire were used throughout. Data processing began simultaneously with data collection in March 2014 and was completed in July 2014. Data were analysed using the Statistical Package for Social Sciences (SPSS) software, Version 21.0. Model syntax and tabulation plans developed by UNICEF were customized and used for this purpose. 2The model MICS5 questionnaires can be found at http://mics.unicef.org/tools NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 20146 Sample Coverage and the Characteristics of Households and Respondents C H A P T E R3 Sample Coverage Of the 13,000 households selected for the sample, 12,598 were found to be occupied. Of these, 12,405 were successfully interviewed for a household response rate of 98.5 percent. One cluster was dropped due to remote location and heavy snowfall. In the interviewed households, 14,936 women (aged 15–49 years) were identified. Of these, 14,162 were successfully interviewed, yielding a response rate of 94.8 percent for women within the interviewed households. There were 5,663 children under five listed in the household questionnaires. Questionnaires were completed for 5,349 of these children, which corresponds to a response rate of 94.5 percent for children under five within interviewed households. Overall response rates of 93.4 percent and 93.0 percent are calculated for the individual interviews of women and children under five, respectively (Table HH.1). The household response rates were similar across regions and areas, with a slightly lower rate in the Far Western Terai. The response rates for women and children under five show a similar pattern, with the exception of the Western Mountains, where the women’s overall response rate was 85.8 percent. Ta bl e HH .1 : R es ul ts o f h ou se ho ld , w om en ’s a nd u nd er -5 in te rv ie ws Nu m be r o f h ou se ho lds , w om en a nd ch ild re n un de r f ive b y i nt er vie w re su lts , a nd h ou se ho ld, w om en ’s an d un de r-5 s’ re sp on se ra te s, Ne pa l, 2 01 4 To ta l Ar ea Re gio n Ur ba n Ru ra l Ea ste rn M ou n- ta ins Ea ste rn Hi lls Ea ste rn Te ra i Ce nt ra l M ou n- ta ins Ce nt ra l Hi lls Ce nt ra l Te ra i W es te rn M ou n- ta ins W es te rn Hi lls W es te rn Te ra i M id- W es te rn M ou n- ta ins M id- W es te rn Hi lls M id- W es te rn Te ra i Fa r W es te rn M ou n- ta ins Fa r W es te rn Hi lls Fa r W es te rn Te ra i To ta l Ur ba n Ka th - m an du va lle y Ot he r ur ba n Ho us eh ol ds Sa m ple d 13 ,0 00 3, 15 0 80 0 2, 35 0 9, 85 0 80 0 80 0 1, 00 0 80 0 1, 60 0 1, 00 0 40 0 1, 00 0 80 0 80 0 80 0 80 0 80 0 80 0 80 0 Oc cu pie d 12 ,5 98 3, 05 8 76 9 2, 28 9 9, 54 0 77 8 78 1 98 1 77 8 1, 54 8 97 1 38 0 97 7 78 7 75 2 78 0 77 2 77 5 75 7 78 1 In te rv iew ed 12 ,4 05 2, 99 2 73 9 2, 25 3 9, 41 3 77 6 77 7 97 4 77 1 1, 50 3 95 6 37 4 97 3 78 2 74 3 77 8 75 9 75 9 73 6 74 4 Ho us eh old re sp on se ra te 98 .5 97 .8 96 .1 98 .4 98 .7 99 .7 99 .5 99 .3 99 .1 97 .1 98 .5 98 .4 99 .6 99 .4 98 .8 99 .7 98 .3 97 .9 97 .2 95 .3 W om en El igi ble 14 ,9 36 3, 66 8 88 8 2, 78 0 11 ,2 68 85 7 87 7 1, 16 0 74 8 1, 73 9 1, 22 0 29 6 1, 08 1 1, 10 8 85 3 92 5 99 8 98 7 98 0 1, 10 7 In te rv iew ed 14 ,1 62 3, 47 9 84 3 2, 63 6 10 ,6 83 84 0 85 5 1, 09 7 72 0 1, 65 5 1, 11 8 25 8 1, 00 0 1, 04 9 81 7 88 3 94 9 96 5 92 7 1, 02 9 W om en ’s re sp on se ra te 94 .8 94 .8 94 .9 94 .8 94 .8 98 .0 97 .5 94 .6 96 .3 95 .2 91 .6 87 .2 92 .5 94 .7 95 .8 95 .5 95 .1 97 .8 94 .6 93 .0 W om en ’s ov er all re sp on se ra te 93 .4 92 .8 91 .2 93 .3 93 .5 97 .8 97 .0 93 .9 95 .4 92 .4 90 .2 85 .8 92 .1 94 .1 94 .6 95 .2 93 .5 95 .8 92 .0 88 .6 Ch ild re n un de r f iv e El igi ble 5, 66 3 95 6 18 4 77 2 4, 70 7 33 6 29 3 41 5 24 1 44 0 56 1 82 38 7 41 6 54 9 43 1 31 6 43 4 46 9 29 3 M ot he rs / ca re ta ke rs int er vie we d 5, 34 9 90 7 17 6 73 1 4, 44 2 32 5 28 4 38 4 23 8 41 8 50 4 77 35 8 38 9 51 7 41 4 30 3 42 0 43 5 28 3 Un de r-5 s re sp on se ra te 94 .5 94 .9 95 .7 94 .7 94 .4 96 .7 96 .9 92 .5 98 .8 95 .0 89 .8 93 .9 92 .5 93 .5 94 .2 96 .1 95 .9 96 .8 92 .8 96 .6 Un de r-5 s o ve ra ll re sp on se ra te 93 .0 92 .8 91 .9 93 .2 93 .1 96 .5 96 .4 91 .9 97 .9 92 .2 88 .5 92 .4 92 .1 92 .9 93 .0 95 .8 94 .3 94 .8 90 .2 92 .0 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 7 Ta bl e HH .1 : R es ul ts o f h ou se ho ld , w om en ’s a nd u nd er -5 in te rv ie ws Nu m be r o f h ou se ho lds , w om en a nd ch ild re n un de r f ive b y i nt er vie w re su lts , a nd h ou se ho ld, w om en ’s an d un de r-5 s’ re sp on se ra te s, Ne pa l, 2 01 4 To ta l Ar ea Re gio n Ur ba n Ru ra l Ea ste rn M ou n- ta ins Ea ste rn Hi lls Ea ste rn Te ra i Ce nt ra l M ou n- ta ins Ce nt ra l Hi lls Ce nt ra l Te ra i W es te rn M ou n- ta ins W es te rn Hi lls W es te rn Te ra i M id- W es te rn M ou n- ta ins M id- W es te rn Hi lls M id- W es te rn Te ra i Fa r W es te rn M ou n- ta ins Fa r W es te rn Hi lls Fa r W es te rn Te ra i To ta l Ur ba n Ka th - m an du va lle y Ot he r ur ba n Ho us eh ol ds Sa m ple d 13 ,0 00 3, 15 0 80 0 2, 35 0 9, 85 0 80 0 80 0 1, 00 0 80 0 1, 60 0 1, 00 0 40 0 1, 00 0 80 0 80 0 80 0 80 0 80 0 80 0 80 0 Oc cu pie d 12 ,5 98 3, 05 8 76 9 2, 28 9 9, 54 0 77 8 78 1 98 1 77 8 1, 54 8 97 1 38 0 97 7 78 7 75 2 78 0 77 2 77 5 75 7 78 1 In te rv iew ed 12 ,4 05 2, 99 2 73 9 2, 25 3 9, 41 3 77 6 77 7 97 4 77 1 1, 50 3 95 6 37 4 97 3 78 2 74 3 77 8 75 9 75 9 73 6 74 4 Ho us eh old re sp on se ra te 98 .5 97 .8 96 .1 98 .4 98 .7 99 .7 99 .5 99 .3 99 .1 97 .1 98 .5 98 .4 99 .6 99 .4 98 .8 99 .7 98 .3 97 .9 97 .2 95 .3 W om en El igi ble 14 ,9 36 3, 66 8 88 8 2, 78 0 11 ,2 68 85 7 87 7 1, 16 0 74 8 1, 73 9 1, 22 0 29 6 1, 08 1 1, 10 8 85 3 92 5 99 8 98 7 98 0 1, 10 7 In te rv iew ed 14 ,1 62 3, 47 9 84 3 2, 63 6 10 ,6 83 84 0 85 5 1, 09 7 72 0 1, 65 5 1, 11 8 25 8 1, 00 0 1, 04 9 81 7 88 3 94 9 96 5 92 7 1, 02 9 W om en ’s re sp on se ra te 94 .8 94 .8 94 .9 94 .8 94 .8 98 .0 97 .5 94 .6 96 .3 95 .2 91 .6 87 .2 92 .5 94 .7 95 .8 95 .5 95 .1 97 .8 94 .6 93 .0 W om en ’s ov er all re sp on se ra te 93 .4 92 .8 91 .2 93 .3 93 .5 97 .8 97 .0 93 .9 95 .4 92 .4 90 .2 85 .8 92 .1 94 .1 94 .6 95 .2 93 .5 95 .8 92 .0 88 .6 Ch ild re n un de r f iv e El igi ble 5, 66 3 95 6 18 4 77 2 4, 70 7 33 6 29 3 41 5 24 1 44 0 56 1 82 38 7 41 6 54 9 43 1 31 6 43 4 46 9 29 3 M ot he rs / ca re ta ke rs int er vie we d 5, 34 9 90 7 17 6 73 1 4, 44 2 32 5 28 4 38 4 23 8 41 8 50 4 77 35 8 38 9 51 7 41 4 30 3 42 0 43 5 28 3 Un de r-5 s re sp on se ra te 94 .5 94 .9 95 .7 94 .7 94 .4 96 .7 96 .9 92 .5 98 .8 95 .0 89 .8 93 .9 92 .5 93 .5 94 .2 96 .1 95 .9 96 .8 92 .8 96 .6 Un de r-5 s o ve ra ll re sp on se ra te 93 .0 92 .8 91 .9 93 .2 93 .1 96 .5 96 .4 91 .9 97 .9 92 .2 88 .5 92 .4 92 .1 92 .9 93 .0 95 .8 94 .3 94 .8 90 .2 92 .0 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 20148 Characteristics of Households The weighted age and sex distribution of the survey population is provided in Table HH.2. This distribution is also used to produce the population pyramid in Figure HH.1. In the 12,405 households successfully interviewed for the survey, 56,539 household members were listed. Of these, 26,983 were males and 29,556 were females. Table HH.2 shows the age–sex structure of the household population. The proportions of child, working and old-age age groups (0–14 years, 15–64 years, and 65 years and over) in the household population of the sample were 34.0 percent, 60.1 percent and 5.9 percent, respectively. In the Nepal National Population and Housing Census 2011, these figures were 34.9 percent, 59.8 percent and 5.3 percent, respectively. More significantly, the proportion of children aged 0–4 years was 10.1 percent in this survey compared to 9.7 percent in the 2011 census. The surveyed population indicated a sex ratio of 90.0, lower than the 94.2 indicated in the 2011 census. However, the dependency ratio was 66.5 percent, consistent with the 67.1 percent found in the 2011 census. Similarly, the proportion of children aged 0–17 years was 40.2 percent in this survey, close to the 41.8 percent in the 2011 census. Complete reporting of birth year and month was 93.1 percent among the surveyed population, while 4.9 percent were able to report year only. Among women aged 15–49 years, it was 96.8 percent, and for children, it was 100 percent. Table HH.2: Household age distribution by sex Percentage and frequency distribution of household population by five-year age groups, dependency age groups, and by child (aged 0–17 years) and adult populations (aged 18 or more), by sex, Nepal, 2014 Total Males Females Number Percent Number Percent Number Percent Total 56,824 100.0 26,917 100.0 29,907 100.0 Age (years) 0–4 5,715 10.1 2,951 11.0 2,764 9.2 5–9 6,332 11.1 3,176 11.8 3,157 10.6 10–14 7,293 12.8 3,553 13.2 3,740 12.5 15–19 5,836 10.3 2,866 10.6 2,970 9.9 20–24 4,551 8.0 1,946 7.2 2,604 8.7 25–29 4,288 7.5 1,718 6.4 2,570 8.6 30–34 3,695 6.5 1,597 5.9 2,098 7.0 35–39 3,498 6.2 1,532 5.7 1,966 6.6 40–44 3,085 5.4 1,434 5.3 1,651 5.5 45–49 2,499 4.4 1,308 4.9 1,191 4.0 50–54 2,775 4.9 1,159 4.3 1,616 5.4 55–59 2,034 3.6 1,035 3.8 999 3.3 60–64 1,870 3.3 940 3.5 930 3.1 65–69 1,406 2.5 702 2.6 704 2.4 70–74 917 1.6 465 1.7 451 1.5 75–79 457 0.8 246 0.9 211 0.7 80–84 366 0.6 197 0.7 169 0.6 85+ 205 0.4 89 0.3 115 0.4 DK/ Missing 3 0.0 1 0.0 2 0.0 Dependency age groups 0–14 19,341 34.0 9,680 36.0 9,660 32.3 15–64 34,131 60.1 15,536 57.7 18,595 62.2 65+ 3,349 5.9 1,699 6.3 1,650 5.5 DK/ Missing 3 0.0 1 0.0 2 0.0 Child and adult populations Children aged 0–17 years 22,862 40.2 11,462 42.6 11,400 38.1 Adults aged 18+ years 33,958 59.8 15,454 57.4 18,505 61.9 DK/ Missing 3 0.0 1 0.0 2 0.0 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 9 Figure HH.1 shows age and sex distribution of the household population. Figure HH.1: Age and sex distribution of household population, Nepal, 2014 Tables HH.3, HH.4 and HH.5 provide basic information on the households, female respondents aged 15–49 years, and children under five. Both unweighted and weighted numbers are presented. Such information is essential for the interpretation of findings presented later in the report and provides background information on the representativeness of the survey sample. The remaining tables in this report are presented only with weighted numbers.1 Table HH.3 provides basic background information on the households, including the sex of the household head, region, area, number of household members, and education of household head. These background characteristics are used in subsequent tables in this report; the figures in the table are also intended to show the numbers of observations by major categories of analysis in the report. 1See Appendix A: Sample Design, for more details on sample weights. Note: Four household members with missing age and/or sex are excluded Percent NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201410 The weighted and unweighted total numbers of households are equal, since sample weights were normalized. The table also shows the weighted mean household size estimated by the survey. The weighted and unweighted numbers indicate over-sampling in all five Mountain regions, the Far Western Hills and the Terai. Under-sampling was found in the Eastern Terai, Central Hills, Central Terai and Western Hills. Overall, the urban areas, except Kathmandu valley, are over-sampled and the rural areas are under-sampled. More than two-thirds (71 percent) of surveyed households were headed by a male; this was a decrease from the 74 percent found in the 2011 census. Only one in five households (20 percent) was located in urban areas, with 6 percent in Kathmandu valley and 14 percent in other urban areas. Around half (50 percent) of households had 2–4 members, and 46 percent had five or more members. However, a few (5 percent) had a single member. The average household size was 4.6 members, a reduction from the 4.9 found in the 2011 census. Some 42 percent of households were headed by a person with no education. The remaining households were headed by a person with primary education (20 percent), secondary education (20 percent) and higher education (19 percent). Table HH.3: Household composition Percentage and frequency distribution of households by selected characteristics, Nepal, 2014 Weighted percent Number of households Weighted Unweighted Total 100.0 12,405 12,405 Sex of household head Male 70.6 8,762 8,943 Female 29.4 3,643 3,462 Region Eastern Mountains 1.4 179 776 Eastern Hills 6.2 767 777 Eastern Terai 14.9 1,845 974 Central Mountains 2.4 299 771 Central Hills 17.6 2,182 1,503 Central Terai 15.5 1,924 956 Western Mountains 0.1 10 374 Western Hills 13.1 1,628 973 Western Terai 7.5 924 782 Mid-Western Mountains 1.3 156 743 Mid-Western Hills 6.2 763 778 Mid-Western Terai 5.4 672 759 Far Western Mountains 1.5 185 759 Far Western Hills 2.8 346 736 Far Western Terai 4.2 524 744 Area Urban 20.0 2,476 2,992 Kathmandu valley 6.3 782 739 Other urban 13.7 1,694 2,253 Rural 80.0 9,929 9,413 Number of household members 1 4.6 575 651 2 12.2 1,518 1,533 3 16.6 2,058 2,002 4 20.9 2,598 2,493 5 17.7 2,192 2,228 6 12.4 1,538 1,528 7+ 15.5 1,924 1,970 Education of household head None 41.9 5,202 5,267 Primary 19.5 2,419 2,441 Secondary 19.7 2,446 2,422 Higher 18.7 2,314 2,249 DK/ Missing 0.2 24 26 Mean household size (persons) 4.6 12,405 12,405 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 11 Characteristics of Female Respondents 15–49 Years of Age and Children Under Five Tables HH.4 and HH.5 provide information on the background characteristics of female respondents aged 15–49 years and children under five. In both tables, the total number of weighted and unweighted observations are equal, since sample weights have been normalized (standardized). The tables also 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 and frequency distribution of women aged 15–49 years by selected characteristics, Nepal, 2014 Weighted percent Number of women Weighted Unweighted Total 100.0 14,162 14,162 Region Eastern Mountains 1.3 186 840 Eastern Hill 5.7 807 855 Eastern Terai 14.6 2,071 1,097 Central Mountains 1.9 274 720 Central Hills 16.4 2,320 1,655 Central Terai 16.4 2,327 1,118 Western Mountains 0.1 8 258 Western Hills 11.7 1,659 1,000 Western Terai 8.7 1,236 1,049 Mid-Western Mountains 1.2 169 817 Mid-Western Hills 6.0 856 883 Mid-Western Terai 6.0 855 949 Far Western Mountains 1.6 225 965 Far Western Hills 3.1 433 927 Far Western Terai 5.2 735 1,029 Area Urban 19.7 2,792 3,479 Kathmandu valley 6.1 868 843 Other urban 13.6 1,924 2,636 Rural 80.3 11,370 10,683 Age (years) 15–19 19.2 2,721 2,781 20–24 17.0 2,402 2,475 25–29 17.0 2,414 2,322 30–34 14.1 2,003 1,922 35–39 13.4 1,901 1,871 40–44 11.2 1,582 1,598 45–49 8.0 1,139 1,193 Marital/union status Currently married/in union 76.5 10,830 10,688 Widowed 1.8 248 271 Divorced 0.1 19 15 Separated 0.2 28 36 Never married/in union 21.4 3,037 3,152 Motherhood and recent births Never gave birth 28.9 4,086 4,209 Ever gave birth 71.1 10,076 9,953 Gave birth in last two years 14.5 2,048 2,086 No birth in last two years 56.8 8,038 7,876 Education None 37.4 5,294 5,510 Primary 14.2 2,004 1,969 Secondary 27.0 3,830 3,779 Higher 21.4 3,032 2,903 DK/ Missing 0.0 1 1 Wealth index quintile Poorest 17.3 2,453 4,000 Second 19.2 2,720 2,873 Middle 19.4 2,752 2,141 Fourth 21.3 3,020 2,402 Richest 22.7 3,218 2,746 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201412 Table HH.4 provides background characteristics of female respondents aged 15–49 years. The table includes information on the distribution of women according to region, area, age, marital/union status, motherhood status, births in last two years, education2 and wealth index quintiles3,4. Like the household sample, there was over-sampling of female respondents in all Mountain and Far Western regions, and the Western Mountains had it to an extreme degree. On the other hand, there was under-sampling in the Eastern Terai, Central Hills, Central Terai and Western Hills. Women living in households in the poorest quintile were highly over-sampled while those living in households in the fourth and the richest quintiles were under-sampled. Women with no education were also over-sampled. Overall, 80 percent of female respondents were from rural areas compared to 20 percent from urban areas (6 percent in Kathmandu valley and 14 percent in other urban areas). The proportion of female respondents in the youngest age group (15–19 years) was 19 percent and it gradually decreased to 8 percent in the oldest age group (45–49 years). A large proportion of surveyed women (77 percent) were married or in a marital union, and slightly over one-fifth (21 percent) had never been married. Over two-thirds of women (71 percent) had given birth at least once in their lifetime, and 15 percent had given birth in the two years preceding the survey. Over one-third of female respondents (37 percent) had never been to school, while 14 percent had completed primary education, 27 percent had completed secondary education and 21 percent had completed higher education. The distribution of women by wealth index quintile shows the smallest proportion in households in the poorest quintile (17 percent) increasing gradually to the largest proportion in households in the richest quintile (23 percent). Background characteristics of children under five are presented in Table HH.5. These include the distribution of children by sex, region and area, age in months, respondent type, mother’s (or caretaker’s) education, and wealth. The proportion of boys (52 percent) was slightly higher than that of girls (48 percent). In total, 87 percent of children under five lived in rural areas and 13 percent lived in urban areas, of which 3 percent lived in Kathmandu valley. However, urban areas were over-sampled, except for Kathmandu valley. 2Throughout this report, unless otherwise stated, ‘education’ refers to highest educational level ever attended by the respondent when it is used as a back- ground variable. 3The wealth index is a composite indicator of wealth. To construct the wealth index, principal components analysis is 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 generate weights (factor scores) for each of the items used. First, initial factor scores are calculated for the total sample. Then, separate factor scores are calculated for households in urban and rural areas. Finally, the urban and rural factor scores are regressed on the initial factor scores to obtain the combined, final factor scores for the total sample. This is carried out to minimize the urban bias in the wealth index values. Each household in the total sample is then assigned a wealth score based on the assets owned by that household and on the final factor scores obtained as described above. The survey household population is then ranked according to the wealth score of the household they are living in, and is finally divided into five equal parts (quintiles) from lowest (poorest) to highest (richest). In the Nepal MICS, the following assets were used in these calculations: radio, television, non-mobile telephone, refrigerator, table and chair set, sofa, fan, desktop computer, improved cooking stove, wardrobe, wall clock, microwave oven, dhiki/janto, washing machine, car or truck, boat, mobile telephone, bicycle/rickshaw, motorbike/scooter, animal-drawn cart, laptop computer, ownership of dwelling, agricultural land, bank account and animals/livestock. The wealth index is assumed to capture the underlying long-term wealth through information on the household‘s 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 dataset 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 expendi- ture data - or tears: An application to educational enrolments in states of India. Demography 38(1): 115–132; Rutstein, S.O. and Johnson, K., 2004. The DHS Wealth Index. DHS Comparative Report No. 6. Calverton, Maryland: ORC Macro; and Rutstein, S.O., 2008. The DHS Wealth Index: Approaches for Rural and Urban Areas. DHS Working Paper No. 60. Calverton, Maryland: Macro International Inc. 4When describing survey results by wealth quintiles, appropriate terminology is used when referring to individual household members, such as ‘women in the richest household population’, which is used interchangeably with ‘women in the wealthiest survey population’ and similar. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 13 The proportion of children under five with an uneducated mother was 42 percent. In terms of wealth quintile, 15 percent of under-5s with an uneducated mother were living in households in the richest quintile, while between 20 percent and 22 percent were living in households in each of the other wealth quintiles. As evident from the unweighted numbers of children, over-sampling occurred in all Mountain regions, and the Far Western Hills and Far Western Terai. Under-sampling occurred in the Eastern Terai, Central Hills, Central Terai and Western Hills. Table HH.5: Under-5s background characteristics Percentage and frequency distribution of children under five by selected characteristics, Nepal, 2014 Weighted percent Number of children under five Weighted Unweighted Total 100.0 5,349 5,349 Sex Male 51.7 2,766 2,801 Female 48.3 2,583 2,548 Region Eastern Mountains 1.4 72 325 Eastern Hills 5.1 272 284 Eastern Terai 14.5 775 384 Central Mountains 1.8 95 238 Central Hills 11.6 620 418 Central Terai 21.1 1,131 504 Western Mountains 0.0 2 77 Western Hills 11.2 601 358 Western Terai 8.8 469 389 Mid-Western Mountains 2.0 108 517 Mid-Western Hills 7.6 409 414 Mid-Western Terai 5.4 291 303 Far Western Mountains 1.9 100 420 Far Western Hills 3.9 210 435 Far Western Terai 3.7 197 283 Area Urban 13.1 699 907 Kathmandu valley 3.4 181 176 Other urban 9.7 518 731 Rural 86.9 4,650 4,442 Age 0–5 months 8.5 455 452 6–11 months 9.8 523 527 12–23 months 18.8 1,008 1,029 24–35 months 20.2 1,079 1,062 36–47 months 21.3 1,137 1,123 48–59 months 21.5 1,147 1,156 Respondent to under-5 questionnaire Mother 98.7 5,279 5,271 Other primary caretaker 1.3 70 78 Mother’s education [a] None 42.3 2,265 2,396 Primary 17.2 921 908 Secondary 22.0 1,179 1,113 Higher 18.3 980 927 DK/ Missing 0.1 4 5 Wealth index quintile Poorest 22.1 1,183 1,994 Second 20.3 1,085 1,079 Middle 22.0 1,176 808 Fourth 20.3 1,086 809 Richest 15.3 819 659 [a] In this table and throughout the report, mother’s education refers to educational attainment of mothers as well as caretakers of children under five, who are the respondents to the under-5 questionnaire if the mother is deceased or is living elsewhere. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201414 Housing Characteristics, Asset Ownership, and Wealth Quintiles Tables HH.6, HH.7 and HH.8 provide further details on household characteristics. Table HH.6 presents characteristics of housing, disaggregated by area and region, distributed by whether the dwelling has electricity, the main materials of the flooring, roof and exterior walls, as well as the number of rooms used for sleeping. Some 85 percent of households had electricity (98 percent of urban households compared to 82 percent of rural households). Over 90 percent of households in the Central Hills, Central Mountains and Eastern Terai had access to electricity, while only 51 percent of households in the Mid-Western Hills and 69 percent in the Mid-Western Mountains had it. Some 64 percent of households had natural flooring; this was more common in rural areas (76 percent) than urban areas (17 percent). Finished flooring was found in 83 percent of urban households. The proportion of households with natural flooring was highest in the Far Western Hills (99 percent) and lowest in the Central Hills (34 percent). Most households had finished roofs (85 percent) with the highest proportion in the Central Hills (97 percent) and the lowest in the Mid-Western Mountains (24 percent). Exterior walls were rudimentary in 49 percent of households and finished in 41 percent. Rudimentary walls were most common in rural areas (58 percent) and finished walls were most common in urban areas (86 percent). Some 39 percent of households had two rooms for sleeping, while 31 percent had one and 29 percent had three or more. The average number of persons using each sleeping room was 2.4; it was higher in rural areas (2.5 persons) than urban areas (2.2 persons). The mean number ranged from 1.8 persons in the Western Mountains to 2.8 persons in the Far Western Hills. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 15 Ta bl e HH .6 : H ou si ng c ha ra ct er is tic s Pe rc en ta ge o f h ou se ho lds b y s ele cte d ho us ing ch ar ac te ris tic s, ac co rd ing to a re a of re sid en ce a nd re gio ns , N ep al, 2 01 4 To ta l Ar ea Re gio n Ur ba n Ka th - m an du va lle y Ot he r ur ba n Ru ra l Ea ste rn M ou n- ta ins Ea ste rn Hi lls Ea ste rn Te ra i Ce nt ra l M ou n- ta ins Ce nt ra l Hi lls Ce nt ra l Te ra i W es te rn M ou n- ta ins W es te rn Hi lls W es te rn Te ra i M id- W es te rn M ou n- ta ins M id- W es te rn Hi lls M id- W es te rn Te ra i Fa r W es te rn M ou n- ta ins Fa r W es te rn Hi lls Fa r W es te rn Te ra i El ec tri ci ty Ye s 84 .9 97 .7 99 .7 96 .8 81 .7 77 .7 83 .1 93 .0 92 .5 94 .4 81 .8 86 .5 88 .2 86 .8 69 .3 50 .9 79 .4 75 .6 70 .1 89 .8 No 15 .1 2. 3 0. 3 3. 2 18 .2 22 .3 16 .9 6. 9 7. 5 5. 6 18 .2 13 .5 11 .8 13 .2 30 .7 49 .1 20 .6 24 .4 29 .9 10 .2 M iss ing 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 Fl oo rin g Na tu ra l fl oo r 64 .1 17 .0 3. 1 23 .4 75 .8 85 .5 82 .4 61 .6 87 .9 33 .6 65 .0 37 .0 65 .8 49 .2 96 .8 92 .2 76 .2 95 .9 98 .7 69 .7 Ru dim en ta ry flo or 0. 8 0. 3 0. 5 0. 2 0. 9 8. 5 3. 0 1. 2 1. 0 0. 6 0. 5 52 .5 0. 2 0. 0 1. 7 0. 1 0. 0 0. 5 0. 0 0. 0 Fi nis he d flo or 34 .9 82 .5 95 .9 76 .4 23 .0 5. 1 14 .5 37 .1 9. 1 65 .5 34 .6 9. 8 33 .9 50 .8 1. 4 6. 5 23 .8 3. 3 1. 1 30 .3 Ot he r 0. 2 0. 2 0. 5 0. 1 0. 2 0. 4 0. 0 0. 1 1. 9 0. 3 0. 0 0. 4 0. 2 0. 0 0. 0 1. 2 0. 0 0. 3 0. 0 0. 0 DK / M iss ing 0. 0 0. 0 0. 0 0. 0 0. 0 0. 4 0. 2 0. 0 0. 0 0. 0 0. 0 0. 2 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 2 0. 0 Ro of Na tu ra l r oo fin g 13 .4 1. 9 0. 0 2. 7 16 .3 42 .8 33 .0 15 .1 2. 0 1. 5 9. 0 57 .8 9. 2 8. 2 64 .2 39 .4 21 .5 5. 8 8. 7 5. 5 Ru dim en ta ry ro of ing 0. 8 0. 2 0. 1 0. 3 0. 9 7. 4 0. 3 0. 1 2. 4 1. 3 1. 4 3. 1 0. 2 0. 1 5. 4 0. 1 0. 0 0. 1 0. 0 0. 4 Fi nis he d ro of ing 85 .3 97 .8 99 .9 96 .8 82 .2 46 .8 66 .5 84 .7 95 .5 97 .0 88 .8 25 .3 90 .7 91 .5 24 .2 59 .8 78 .4 90 .8 90 .9 93 .9 Ot he r 0. 5 0. 1 0. 0 0. 2 0. 5 3. 0 0. 1 0. 1 0. 1 0. 2 0. 8 13 .7 0. 0 0. 3 6. 2 0. 7 0. 2 3. 2 0. 5 0. 2 M iss ing /D K 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 Ex te rio r w al ls Na tu ra l w all s 8. 8 2. 7 0. 5 3. 7 10 .4 5. 1 4. 6 7. 2 4. 9 5. 2 3. 5 6. 8 21 .1 9. 0 4. 4 10 .1 25 .7 3. 1 1. 5 5. 9 Ru dim en ta ry w all s 48 .9 11 .3 1. 5 15 .8 58 .3 83 .0 73 .8 50 .9 85 .8 24 .6 53 .5 71 .1 42 .4 17 .5 94 .6 81 .3 28 .8 88 .0 96 .8 52 .7 Fi nis he d wa lls 41 .2 85 .5 97 .8 79 .8 30 .2 8. 5 17 .4 39 .6 8. 6 69 .8 43 .1 22 .1 36 .4 73 .5 0. 9 8. 4 43 .4 8. 6 1. 8 39 .6 Ot he r 0. 9 0. 5 0. 2 0. 7 1. 0 3. 5 4. 1 2. 2 0. 6 0. 4 0. 0 0. 0 0. 1 0. 0 0. 0 0. 2 2. 2 0. 3 0. 0 1. 7 DK / M iss ing 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 1 Ro om s us ed fo r s le ep in g 1 31 .4 38 .0 38 .5 37 .8 29 .7 47 .1 37 .9 32 .0 36 .1 33 .1 26 .5 43 .5 37 .4 22 .6 31 .0 35 .9 28 .3 19 .1 25 .7 24 .1 2 38 .7 32 .5 31 .2 33 .1 40 .2 35 .5 37 .0 41 .8 38 .8 34 .5 37 .3 31 .0 38 .8 36 .8 39 .5 40 .8 43 .9 42 .1 44 .9 41 .3 3 or m or e 29 .2 28 .5 28 .1 28 .6 29 .4 17 .1 24 .9 25 .6 25 .1 30 .4 35 .9 25 .4 23 .9 39 .7 29 .5 23 .3 27 .3 37 .5 29 .1 32 .4 DK / M iss ing 0. 7 1. 0 2. 2 0. 5 0. 7 0. 4 0. 3 0. 6 0. 0 2. 1 0. 2 0. 0 0. 0 0. 9 0. 0 0. 0 0. 5 1. 3 0. 3 2. 2 To ta l 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 Nu m be r o f ho us eh ol ds 12 ,4 05 2, 47 6 78 2 1, 69 4 9, 92 9 17 9 76 7 1, 84 5 29 9 2, 18 2 1, 92 4 10 1, 62 8 92 4 15 6 76 3 67 2 18 5 34 6 52 4 M ea n nu m be r o f pe rs on s pe r r oo m us ed fo r s le ep in g 2. 4 2. 2 2. 1 2. 2 2. 5 2. 8 2. 3 2. 4 2. 1 2. 1 2. 5 1. 8 2. 2 2. 4 2. 8 2. 7 2. 6 2. 6 2. 8 2. 5 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201416 Table HH.7 shows distribution of households by ownership of assets and ownership of dwelling. Some 40 percent of households owned a radio and 52 percent owned a television. No urban–rural difference was observed in possession of a radio, while 80 percent of urban households owned a television compared to 44 percent of rural households. Ownership of a television was highest in the Central Hills (72 percent) and lowest in the Far Western Hills (7 percent). Some 14 percent of households possessed a refrigerator; this was five times more likely in urban areas (38 percent) than in rural areas (8 percent). The majority of households owned agricultural land (76 percent) and farm animals/livestock (69 percent). More households in rural areas owned these assets (83 percent and 80 percent, respectively) than in urban areas (48 percent and 25 percent, respectively). The highest proportion of households with agricultural land was in the Far Western Mountains (97 percent) and the lowest proportion was in the Central Terai (64 percent). In 91 percent of households at least one person owned a mobile phone (97 percent in urban areas and 90 percent in rural areas). The highest proportion was in the Central and Western Hills (94 percent) and the lowest proportion was in the Mid-Western Mountains (70 percent). In 57 percent of households at least one person had a bank account (79 percent in urban areas and 52 percent in rural areas). It was highest in the Central Hills (71 percent) and lowest in the Mid-Western Mountains (19 percent). Most households (87 percent) owned their dwelling. It was more common in rural areas (93 percent) than urban areas (59 percent), where 39 percent of households rented their accommodation. Ownership of the dwelling was the highest in Far Western Hills and Mountains (99 percent) and lowest in the Central Hills (66 percent). NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 17 Ta bl e HH .7 : H ou se ho ld a ss et s Pe rc en ta ge o f h ou se ho lds b y o wn er sh ip of a ss et s a nd o wn er sh ip of d we llin g, N ep al, 2 01 4 To ta l Ar ea Re gio n Ur ba n Ka th - m an du va lle y Ot he r ur ba n Ru ra l Ea ste rn M ou n- ta ins Ea ste rn Hi lls Ea ste rn Te ra i Ce nt ra l M ou n- ta ins Ce nt ra l Hi lls Ce nt ra l Te ra i W es te rn M ou n- ta ins W es te rn Hi lls W es te rn Te ra i M id- W es te rn M ou n- ta ins M id- W es te rn Hi lls M id- W es te rn Te ra i Fa r W es te rn M ou n- ta ins Fa r W es te rn Hi lls Fa r W es te rn Te ra i Ho us eh ol ds th at o wn a Ra dio 40 .4 41 .9 42 .0 41 .8 40 .0 54 .1 51 .4 31 .9 50 .9 42 .0 37 .5 38 .6 52 .5 29 .3 30 .6 37 .6 34 .9 60 .6 42 .1 34 .7 Te lev isi on 51 .5 80 .2 88 .7 76 .3 44 .3 22 .1 33 .6 63 .6 39 .7 72 .4 55 .9 51 .4 55 .8 57 .7 11 .2 15 .0 42 .2 8. 5 6. 7 46 .0 No n- m ob ile p ho ne 9. 0 25 .8 37 .9 20 .2 4. 8 4. 5 4. 8 8. 7 2. 8 24 .1 4. 9 13 .2 7. 1 7. 1 3. 4 1. 5 3. 9 5. 6 1. 8 6. 7 Re fri ge ra to r 13 .6 38 .3 47 .3 34 .2 7. 5 2. 2 1. 9 14 .4 2. 7 31 .0 10 .4 9. 4 13 .5 19 .2 1. 0 1. 8 8. 8 0. 0 0. 1 9. 9 Im pr ov ed st ov e 9. 0 2. 3 1. 9 2. 5 10 .7 8. 3 19 .7 6. 3 8. 9 5. 0 1. 6 75 .1 22 .1 1. 9 50 .2 17 .0 5. 8 3. 0 3. 8 3. 4 Ta ble 57 .7 83 .5 85 .8 82 .4 51 .3 42 .4 60 .5 75 .2 25 .6 69 .0 65 .8 65 .8 51 .9 55 .3 14 .5 24 .4 56 .7 21 .3 12 .6 67 .3 Ch air 57 .4 77 .0 77 .0 77 .0 52 .5 29 .6 46 .9 73 .9 35 .3 63 .7 76 .4 55 .7 46 .3 60 .0 17 .0 25 .8 53 .0 32 .6 21 .8 67 .2 Be d/ co t 92 .4 98 .4 99 .4 97 .9 90 .9 85 .2 94 .5 95 .7 95 .4 97 .4 95 .0 81 .8 93 .0 99 .2 69 .7 74 .5 92 .8 77 .0 54 .0 96 .7 So fa 15 .9 40 .2 55 .8 33 .0 9. 9 1. 9 4. 3 17 .4 3. 9 37 .6 11 .0 6. 4 15 .4 17 .6 2. 6 3. 1 9. 4 0. 7 0. 9 12 .4 W ar dr ob e 45 .4 74 .4 86 .3 68 .9 38 .1 27 .6 34 .5 48 .0 45 .7 73 .5 40 .2 51 .6 48 .9 48 .8 20 .7 14 .3 36 .9 12 .5 3. 7 45 .2 Co m pu te r ( de sk to p) 8. 6 25 .2 42 .2 17 .3 4. 5 1. 3 2. 8 8. 0 3. 3 24 .9 4. 0 5. 9 5. 6 8. 5 1. 3 2. 1 4. 9 1. 2 0. 6 8. 3 W all cl oc k 45 .7 71 .9 82 .1 67 .2 39 .1 33 .9 41 .0 53 .9 25 .9 64 .2 40 .3 42 .5 44 .2 48 .5 8. 5 15 .6 48 .3 43 .5 18 .3 51 .3 El ec tri c f an 40 .6 69 .2 55 .3 75 .6 33 .5 2. 7 7. 2 65 .8 1. 8 39 .6 60 .7 0. 0 24 .1 70 .1 .5 8. 0 45 .2 0. 3 0. 7 61 .2 Dh iki / ja nt o 31 .6 11 .8 3. 5 15 .6 36 .6 67 .7 53 .3 25 .1 34 .0 12 .2 24 .9 9. 3 52 .4 23 .2 29 .9 51 .3 31 .7 49 .3 46 .0 21 .1 M icr ow av e ov en 1. 8 6. 5 16 .4 1. 9 0. 6 0. 1 0. 1 0. 5 0. 0 7. 9 0. 4 3. 2 1. 1 0. 6 0. 0 0. 1 0. 4 0. 0 0. 3 0. 7 W as hin g m ac hin e 1. 5 6. 0 13 .2 2. 7 0. 4 0. 1 0. 0 1. 1 0. 2 5. 9 0. 3 2. 1 0. 9 0. 8 0. 0 0. 1 0. 3 0. 0 0. 0 0. 8 Ho us eh ol ds th at o wn Ag ric ult ur al lan d 75 .5 47 .6 44 .5 49 .1 82 .5 92 .7 91 .9 65 .3 95 .7 67 .0 63 .7 71 .1 77 .9 77 .1 88 .5 94 .0 83 .3 96 .9 94 .7 78 .1 Fa rm a nim als / liv es to ck 68 .8 25 .1 7. 3 33 .4 79 .6 92 .2 88 .7 69 .6 87 .8 41 .3 61 .9 63 .3 72 .0 65 .3 84 .5 88 .0 78 .4 96 .5 94 .4 81 .7 Ho us eh ol ds w he re a t l ea st o ne m em be r o wn s or h as a W at ch 75 .0 86 .0 90 .9 83 .8 72 .2 77 .0 83 .4 72 .8 76 .1 85 .1 72 .0 83 .6 80 .7 68 .1 60 .5 67 .2 63 .6 75 .7 68 .4 66 .2 M ob ile p ho ne 91 .2 96 .8 98 .3 96 .1 89 .8 83 .3 92 .4 92 .3 86 .4 94 .0 91 .6 87 .9 94 .0 92 .4 70 .1 85 .3 90 .3 79 .2 83 .3 93 .2 Bi cy cle / r ick sh aw 38 .1 33 .8 15 .8 42 .2 39 .2 1. 4 9. 0 72 .2 0. 7 12 .5 70 .5 0. 5 5. 3 74 .5 0. 1 6. 0 68 .6 0. 0 0. 0 78 .0 M ot or cy cle / s co ot er 15 .6 34 .6 45 .6 29 .5 10 .8 1. 5 5. 1 17 .6 3. 6 31 .2 16 .7 12 .9 10 .4 20 .9 0. 6 2. 6 11 .7 0. 1 0. 3 16 .0 An im al- dr aw n ca rt 3. 0 1. 3 0. 2 1. 8 3. 4 0. 1 0. 4 4. 1 0. 0 0. 4 4. 7 0. 0 0. 0 5. 8 0. 0 0. 0 3. 6 0. 0 0. 0 21 .7 Ca r o r t ru ck 1. 9 5. 1 9. 9 2. 8 1. 2 0. 3 1. 1 0. 8 0. 3 6. 2 1. 0 2. 4 1. 7 1. 5 0. 4 0. 2 0. 8 0. 1 0. 0 2. 4 Bo at 0. 1 0. 1 0. 0 0. 2 0. 0 0. 1 0. 0 0. 1 0. 0 0. 1 0. 0 0. 0 0. 1 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 0. 2 La pt op co m pu te r 8. 4 23 .9 38 .5 17 .2 4. 6 1. 8 3. 9 8. 2 2. 9 22 .3 5. 1 6. 5 8. 6 7. 3 1. 2 1. 3 4. 3 0. 2 0. 1 3. 2 Ba nk a cc ou nt 56 .9 78 .5 85 .5 75 .3 51 .5 33 .6 54 .6 67 .1 43 .5 71 .1 52 .8 53 .1 66 .8 54 .6 18 .5 33 .2 44 .6 29 .9 30 .6 56 .9 Ho us eh ol ds b y ow ne rs hi p of d we lli ng Ow ne d 86 .5 59 .4 43 .6 66 .7 93 .2 90 .6 92 .4 89 .4 95 .5 65 .9 91 .1 70 .0 83 .4 89 .5 94 .8 96 .4 94 .0 99 .1 98 .8 94 .5 No t o wn ed 13 .5 40 .6 56 .4 33 .3 6. 8 9. 3 7. 6 10 .3 4. 5 34 .1 8. 9 30 .0 16 .6 10 .5 5. 2 3. 6 6. 0 0. 9 1. 2 5. 5 Re nt ed 12 .1 38 .9 55 .4 31 .3 5. 4 6. 0 6. 6 8. 5 3. 7 32 .8 7. 8 17 .7 14 .2 9. 9 2. 8 2. 5 5. 1 0. 5 0. 4 4. 3 Ot he r 1. 4 1. 7 1. 0 2. 0 1. 3 3. 3 1. 0 1. 8 0. 8 1. 3 1. 1 12 .3 2. 4 0. 6 2. 5 1. 1 0. 9 0. 4 0. 8 1. 2 DK / M iss ing 0. 0 0. 0 0. 0 0. 0 0. 0 0. 1 0. 0 0. 2 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 To ta l 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 Nu m be r o f ho us eh ol ds 12 ,4 05 2, 47 6 78 2 1, 69 4 9, 92 9 17 9 76 7 1, 84 5 29 9 2, 18 2 1, 92 4 10 1, 62 8 92 4 15 6 76 3 67 2 18 5 34 6 52 4 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201418 Table HH.8 shows the distribution of household members by wealth index quintiles, according to area of residence and regions. The proportions of households were evenly distributed between wealth index quintiles (20 percent in each quintile). Most urban households (67 percent) were in the richest quintile, with 89 percent of Kathmandu valley households and 57 percent of other urban households falling into this category. Urban households were 6.5 times more likely than rural households to be in the richest quintile. Some 23 percent of rural households were in the poorest quintile. Rural households were 5.8 times more likely than urban households to be in the poorest quintile. Table HH.8: Wealth quintiles Percentage of the household population by wealth index quintiles, according to area of residence and regions, Nepal, 2014 Wealth index quintile Total Number of household members Poorest Second Middle Fourth Richest Total 20.0 20.0 20.0 20.0 20.0 100.0 56,824 Area Urban 4.0 5.1 5.6 18.4 66.8 100.0 9,753 Kathmandu valley 0.0 0.1 0.4 10.2 89.3 100.0 2,971 Other urban 5.8 7.4 7.8 22.0 57.0 100.0 6,782 Rural 23.3 23.1 23.0 20.3 10.3 100.0 47,071 Region Eastern Mountains 58.7 27.6 7.1 5.9 0.7 100.0 9,753 Eastern Hills 35.1 33.6 18.2 9.4 3.7 100.0 2,971 Eastern Terai 1.2 16.1 31.4 30.9 20.3 100.0 6,782 Central Mountains 31.4 48.5 11.1 5.2 3.8 100.0 47,071 Central Hills 9.3 13.5 7.2 18.6 51.4 100.0 8,746 Central Terai 1.4 19.7 35.1 26.5 17.3 100.0 10,248 Western Mountains 16.7 30.9 21.3 24.2 7.0 100.0 32 Western Hills 30.9 27.2 10.8 9.9 21.2 100.0 6,371 Western Terai 5.5 14.3 22.4 34.0 23.8 100.0 4,825 Mid-Western Mountains 79.5 15.3 3.8 1.4 0.0 100.0 798 Mid-Western Hills 74.3 14.3 5.4 3.7 2.3 100.0 3,591 Mid-Western Terai 8.7 29.2 28.4 22.8 10.9 100.0 3,276 Far Western Mountains 71.8 20.6 5.9 1.6 0.1 100.0 1,014 Far Western Hills 85.3 12.0 1.8 0.9 0.0 100.0 1,880 Far Western Terai 8.5 20.2 28.0 31.3 11.9 100.0 2,697 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 19 Child Mortality C H A P T E R4 One of the overarching goals of the MDGs is to reduce infant and under-5 mortality. Specifically, the MDGs call for the reduction of under-5 mortality by two-thirds between 1990 and 2015. Monitoring progress towards this goal is an important but difficult objective. Mortality rates presented in this chapter are calculated from information collected in the birth histories of the Questionnaire for Individual Women. All interviewed women were asked whether they had ever given birth, and if yes, they were asked to report the number of sons and daughters who live with them, the number who live elsewhere, and the number who have died. In addition, they were asked to provide a detailed birth history of live births of children in chronological order starting with the firstborn. Women were asked whether births were single or multiple, the sex of the children, the date of birth (month and year), and survival status. Further, for children still alive, they were asked the current age of the child and, if not alive, the age at death. Childhood mortality rates are expressed by conventional age categories and are defined as follows: • Neonatal mortality (NN): probability of dying within the first month of life • Post-neonatal mortality (PNN): difference between infant and neonatal mortality rates • Infant mortality (1q0): probability of dying between birth and the first birthday • Child mortality (4q1): probability of dying between the first and fifth birthdays • Under-5 mortality (5q0): the probability of dying between birth and the fifth birthday Rates are expressed as deaths per 1,000 live births, except in the case of child mortality, which is expressed as deaths per 1,000 children surviving to age 1, and post-neonatal mortality, which is the difference between infant and neonatal mortality rates. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201420 The table and figure also show a declining trend at the national level over the last 15 years, with under-5 mortality at 56 deaths per 1,000 live births during the 10–14 year period preceding the survey, and 38 deaths per 1,000 live births during the most recent five-year period, roughly referring to the years 2009–2014. A similar pattern is observed in all other indicators. Table CM.1: Early childhood mortality rates Neonatal, post-neonatal, infant, child and under-5 mortality rates for five-year periods preceding the survey, Nepal, 2014 Neonatal mortality rate [1] Post-neonatal mortality rate [2] [a] Infant mortality rate [3] Child mortality rate [4] Under-5 mortality rate [5] Years preceding the survey 0–4 23 11 33 5 38 5–9 29 15 44 6 51 10–14 27 17 44 13 56 [1] MICS indicator 1.1 – Neonatal mortality rate [2] MICS indicator 1.3 – Post-neonatal mortality rate [3] MICS indicator 1.2; MDG indicator 4.2 – Infant mortality rate [4] MICS indicator 1.4 – Child mortality rate [5] MICS indicator 1.5; MDG indicator 4.1 – Under-5 mortality rate [a] Post-neonatal mortality rates are computed as the difference between the infant and neonatal mortality rates Table CM.2: Early childhood mortality rates by socioeconomic characteristics Neonatal, post-neonatal, infant, child and under-5 mortality rates for the five-year period preceding the survey, by socioeconomic characteristics, Nepal, 2014 Neonatal mortality rate [1] Post-neonatal mortality rate [2] [a] Infant mortality rate [3] Child mortality rate [4] Under-5 mortality rate [5] Total 23 11 33 5 38 Area Urban 15 6 21 5 26 Rural 24 11 35 5 40 Mother’s education None 26 15 41 7 48 Primary 26 8 33 5 38 Secondary 22 7 28 3 31 Higher 12 7 19 1 20 Wealth index quintile Poorest 32 16 48 10 57 Second 22 14 36 7 42 Middle 20 8 28 3 31 Fourth 21 7 29 2 31 Richest 14 5 20 2 22 [1] MICS indicator 1.1 – Neonatal mortality rate [2] MICS indicator 1.3 – Post-neonatal mortality rate [3] MICS indicator 1.2; MDG indicator 4.2 – Infant mortality rate [4] MICS indicator 1.4 – Child mortality rate [5] MICS indicator 1.5; MDG indicator 4.1 – Under-5 mortality rate [a] Post-neonatal mortality rates are computed as the difference between the infant and neonatal mortality rates Nepal&MICS&2014&& 2" Figure'CM.1:'Early'childhood'mortality'rates,'Nepal,'2014' " The"table"and"figure"also"show"a"declining"trend"at"the"national"level"over"the"last"15"years,"with" under:five"mortality"at"56"deaths"per"1,000"live"births"during"the"10–14:year"period"preceding"the" survey,"and"38"deaths"per"1,000"live"births"during"the"most"recent"five:year"period,"roughly"referring" to"the"years"2009–2014."A"similar"pattern"is"observed"in"all"other"indicators." Table"CM.2"provides"estimates"of"child"mortality"by"socioeconomic"characteristics."Mortality"rates" are"higher"among"rural"children"than"urban"children."Mother’s"education"level"and"household"wealth" status"are"both"negatively"associated"with"mortality"rates:"the"likelihood"of"dying"decreases"with"an" increase"in"each"of"these"two"variables."" 27 17 44 13 56 29 15 44 6 51 23 11 33 5 38 Neonatal mortality rate Post-neonatal mortality rate Infant mortality rate Child mortality rate Under-five mortality rate Years'preceding'the' survey 10:14 5:9 0:4 Early childhood mortality rates per 1,000 live births Table CM.1 and Figure CM.1 present neonatal, post-neonatal, infant, child, and under-5 mortality rates for the three most recent five-year periods before the survey. Neonatal mortality in the most recent five- year period was estimated at 23 deaths per 1,000 live births, while the post-neonatal mortality rate was estimated at 11 deaths per 1,000 live births. The infant mortality rate in the five years preceding the survey was 33 deaths per 1,000 live births and under-5 mortality was 38 deaths per 1,000 live births for the same period, indicating that 87 percent of under-5 deaths were infant deaths. Figure CM.1: Early childhood mortality rates, Nepal, 2014 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 21 Figure CM.2 provides under-5 mortality rates by area. Figure CM.2: Under-5 mortality rates by area, Nepal, 2014 Nepal MICS 2014 3 Table CM.2: Early childhood mortality rates by socioeconomic characteristics Neonatal, post-neonatal, infant, child and under-five mortality rates for the five-year period preceding the survey, by socioeconomic characteristics, Nepal, 2014 Neonatal mortality rate [1] Post-neonatal mortality rate [2] [a] Infant mortality rate [3] Child mortality rate [4] Under-five mortality rate [5] Total 23 11 33 5 38 Area Urban 15 6 21 5 26 Rural 24 11 35 5 40 Mother’s education None 26 15 41 7 48 Primary 26 8 33 5 38 Secondary 22 7 28 3 31 Higher 12 7 19 1 20 Wealth index quintile Poorest 32 16 48 10 57 Second 22 14 36 7 42 Middle 20 8 28 3 31 Fourth 21 7 29 2 31 Richest 14 5 20 2 22 [1] MICS indicator 1.1 – Neonatal mortality rate [2] MICS indicator 1.3 – Post-neonatal mortality rate [3] MICS indicator 1.2; MDG indicator 4.2 – Infant mortality rate [4] MICS indicator 1.4 – Child mortality rate [5] MICS indicator 1.5; MDG indicator 4.1 – Under-five mortality rate [a] Post-neonatal mortality rates are computed as the difference between the infant and neonatal mortality rates Figure CM.2 provides under-five mortality rates by area. Figure CM.2: Under-five mortality rates by area, Nepal, 2014 38 26 40 0 10 20 30 40 50 Nepal Area Urban Rural Under-5 Mortality Rates per 1,000 Births Table CM.2 provides estimates of child mortality by socioeconomic characteristics. Mortality rates are higher among rural children than urban children. Mother’s education level and household wealth status are both negatively associated with mortality rates: the likelihood of dying decreases with an increase in each of these two variables. Table CM.1: Early childhood mortality rates Neonatal, post-neonatal, infant, child and under-5 mortality rates for five-year periods preceding the survey, Nepal, 2014 Neonatal mortality rate [1] Post-neonatal mortality rate [2] [a] Infant mortality rate [3] Child mortality rate [4] Under-5 mortality rate [5] Years preceding the survey 0–4 23 11 33 5 38 5–9 29 15 44 6 51 10–14 27 17 44 13 56 [1] MICS indicator 1.1 – Neonatal mortality rate [2] MICS indicator 1.3 – Post-neonatal mortality rate [3] MICS indicator 1.2; MDG indicator 4.2 – Infant mortality rate [4] MICS indicator 1.4 – Child mortality rate [5] MICS indicator 1.5; MDG indicator 4.1 – Under-5 mortality rate [a] Post-neonatal mortality rates are computed as the difference between the infant and neonatal mortality rates Table CM.2: Early childhood mortality rates by socioeconomic characteristics Neonatal, post-neonatal, infant, child and under-5 mortality rates for the five-year period preceding the survey, by socioeconomic characteristics, Nepal, 2014 Neonatal mortality rate [1] Post-neonatal mortality rate [2] [a] Infant mortality rate [3] Child mortality rate [4] Under-5 mortality rate [5] Total 23 11 33 5 38 Area Urban 15 6 21 5 26 Rural 24 11 35 5 40 Mother’s education None 26 15 41 7 48 Primary 26 8 33 5 38 Secondary 22 7 28 3 31 Higher 12 7 19 1 20 Wealth index quintile Poorest 32 16 48 10 57 Second 22 14 36 7 42 Middle 20 8 28 3 31 Fourth 21 7 29 2 31 Richest 14 5 20 2 22 [1] MICS indicator 1.1 – Neonatal mortality rate [2] MICS indicator 1.3 – Post-neonatal mortality rate [3] MICS indicator 1.2; MDG indicator 4.2 – Infant mortality rate [4] MICS indicator 1.4 – Child mortality rate [5] MICS indicator 1.5; MDG indicator 4.1 – Under-5 mortality rate [a] Post-neonatal mortality rates are computed as the difference between the infant and neonatal mortality rates NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201422 Table CM.3 provides estimates of child mortality by demographic characteristics. Younger and older mothers had an increased likelihood of her child dying compared to mothers aged 20–34 years. Firstborn children had an increased chance of dying, especially during the neonatal period, and children whose birth order was seven or greater were more likely than other children to die by the age of five years. A short birth interval also greatly increased mortality rates. Table CM.3: Early childhood mortality rates by demographic characteristics Neonatal, post-neonatal, infant, child and under-5 mortality rates for the five-year period preceding the survey, by demographic characteristics, Nepal, 2014 Neonatal mortality rate [1] Post-neonatal mortality rate [2] [a] Infant mortality rate [3] Child mortality rate [4] Under-5 mortality rate [5] Total 23 11 33 5 38 Sex of child Male 24 11 35 6 40 Female 21 10 32 4 36 Mother’s age at birth Less than 20 years 29 13 42 2 44 20–34 years 21 9 30 4 34 35–49 years 26 19 46 22 67 Birth order 1 27 10 37 3 40 2–3 21 8 28 2 31 4–6 19 13 31 11 42 7+ 20 66 86 41 124 Previous birth interval [b] < 2 years 45 24 69 8 77 2 years 18 8 25 5 30 3 years 11 11 22 10 32 4+ years 13 5 18 3 21 [1] MICS indicator 1.1 – Neonatal mortality rate [2] MICS indicator 1.3 – Post-neonatal mortality rate [3] MICS indicator 1.2; MDG indicator 4.2 – Infant mortality rate [4] MICS indicator 1.4 – Child mortality rate [5] MICS indicator 1.5; MDG indicator 4.1 – Under-5 mortality rate [a] Post-neonatal mortality rates are computed as the difference between the infant and neonatal mortality rates [b] Excludes first-order births NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 23 Figure CM.3 compares the findings of the Nepal MICS 2014 on under-5 mortality rates with those from other data sources. The Nepal MICS findings are obtained from Table CM.1. The MICS estimates indicate a decline in mortality during the last 15 years. The most recent U5MR estimate (38 deaths per 1,000 live births) from the MICS is about 16 points lower than the estimate from the Nepal Demographic and Health Survey 20111. The mortality trend depicted by the Nepal Demographic and Health Survey 2011 is also a declining one; however, the MICS results are lower. Further qualification of these apparent declines and differences as well as its determinants should be taken up in a more detailed and separate analysis. 1Ministry of Health and Population, New ERA, and ICF International Inc., 2012. Nepal Demographic and Health Survey 2011. Kathmandu: Ministry of Health and Population, New ERA, and ICF International, Calverton, Maryland. Figure CM.3: Trend in under-5 mortality rates, Nepal, 2014 Nepal&MICS&2014&& 5" " Figure'CM.3:'Trend'in'under0five'mortality'rates,'Nepal,'2014 ' " " 0 20 40 60 80 100 120 140 160 180 1986 1990 1994 1998 2002 2006 2010 2014 Per"1,000"live" births Year NDHS"2011 NDHS"2006 NDHS"2001 MICS"2014 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201424 Nutrition C H A P T E R5 Low Birth Weight Weight at birth is a good indicator not only of a mother’s health and nutritional status but also the newborn’s chances for survival, growth, long-term health and psychosocial development. Low birth weight (defined as 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 days, months and years. Those who survive may have impaired immune function and increased risk of disease; they are likely to remain undernourished, with reduced muscle strength, throughout their lives, and suffer a higher incidence of diabetes and heart disease in later life. Children born with low birth weight also risk 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 the most impact: the mother’s poor nutritional status before conception, short stature (due mostly to undernutrition and infections during her childhood), and poor nutrition during pregnancy. Inadequate weight gain during pregnancy is particularly important since it accounts for a large proportion of foetal growth retardation. Moreover, diseases such as diarrhoea and malaria, which are common in many developing countries, can significantly impair foetal growth if the mother becomes infected while pregnant. In the industrialized world, 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 a higher risk of bearing low birth weight babies. One of the major challenges in measuring the incidence of low birth weight is that more than half of infants in the developing world are not weighed at birth. In the past, most estimates of low birth weight for developing countries were based on data compiled from health facilities. However, these estimates are biased for most developing countries because the majority of newborns are not delivered 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 2,500 grams is estimated from two items in the questionnaire: the mother’s assessment of the child’s size at birth (i.e., very small, smaller than average, average, larger than average, very large) and the mother’s recall of the child’s weight or the weight as recorded on a health card if the child was weighed at birth.1 1For a detailed description of the methodology, see Boerma, J. T., Weinstein, K. I., Rutstein, S.O., and Sommerfelt, A. E., 1996. Data on Birth Weight in Developing Countries: Can Surveys Help? Bulletin of the World Health Organization, 74(2): 209–16. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 25 Ne pa l&M IC S&2 01 4& 2" " Ta bl e NU .1 : L ow b irt h we ig ht in fa nt s Pe rc en ta ge o f la st liv e- bo rn ch ild re n bo rn in th e tw o ye ar s p re ce din g th e su rv ey th at a re e sti m at ed to h av e we igh ed b elo w 2, 50 0 gr am s a t b irt h an d pe rc en ta ge o f li ve b irt hs w eig he d at b irt h, N ep al, 20 14 Pe rc en t o f b irt hs b y m ot he r’s a ss es sm en t o f s ize a t b irt h: To ta l Pe rc en t o f li ve b irt hs : Nu m be r o f la st liv e- bo rn ch ild re n in th e las t t wo ye ar s Ve ry sm all Sm all er th an av er ag e Av er ag e La rg er th an av er ag e or ve ry lar ge DK Be low 2 ,5 00 gr am s [ 1] W eig he d at bir th [2 ] To ta l 0. 9 12 .9 61 .4 23 .0 1. 8 10 0. 0 24 .2 60 .0 2, 04 8 Re gi on Ea ste rn M ou nt ain s 0. 4 16 .7 51 .4 30 .1 1. 4 10 0. 0 24 .4 30 .3 32 Ea ste rn H ills 1. 7 19 .0 48 .1 29 .4 1. 8 10 0. 0 26 .6 41 .5 12 3 Ea ste rn T er ai 0. 8 6. 2 64 .5 26 .3 2. 2 10 0. 0 20 .3 72 .4 27 7 Ce nt ra l M ou nt ain s 0. 8 9. 7 55 .4 33 .4 0. 7 10 0. 0 21 .0 52 .7 38 Ce nt ra l H ills 0. 8 13 .2 57 .3 27 .3 1. 4 10 0. 0 23 .7 76 .8 24 1 Ce nt ra l T er ai 0. 0 9. 8 75 .4 13 .1 1. 7 10 0. 0 23 .8 47 .8 40 0 W es te rn M ou nt ain s (0 .0 ) (1 7. 7) (5 7. 6) (2 1. 9) (2 .8 ) 10 0. 0 (2 6. 1) (5 6. 2) 1 W es te rn H ills 0. 7 12 .7 59 .4 25 .5 1. 7 10 0. 0 23 .3 66 .6 22 2 W es te rn T er ai 0. 4 9. 6 67 .6 22 .4 0. 0 10 0. 0 22 .3 69 .7 17 8 M id- W es te rn M ou nt ain s 3. 5 27 .3 43 .0 25 .6 0. 6 10 0. 0 32 .5 37 .6 43 M id- W es te rn H ills 2. 0 14 .0 47 .9 33 .2 3. 0 10 0. 0 23 .8 43 .7 16 6 M id- W es te rn T er ai 1. 0 19 .8 49 .5 29 .6 0. 1 10 0. 0 26 .5 73 .5 11 3 Fa r W es te rn M ou nt ain s 0. 6 16 .0 71 .4 10 .7 1. 3 10 0. 0 27 .2 36 .9 33 Fa r W es te rn H ills 1. 4 21 .4 72 .9 2. 2 2. 1 10 0. 0 32 .1 49 .3 75 Fa r W es te rn T er ai 2. 4 19 .2 53 .7 19 .5 5. 3 10 0. 0 28 .5 74 .2 10 6 Ar ea Ur ba n 0. 3 7. 6 65 .0 26 .0 1. 1 10 0. 0 20 .8 90 .4 26 2 Ka th m an du va lle y 0. 0 1. 5 76 .1 22 .4 0. 0 10 0. 0 18 .5 10 0. 0 65 Ot he r u rb an 0. 4 9. 7 61 .3 27 .1 1. 5 10 0. 0 21 .6 87 .2 19 7 Ru ra l 1. 0 13 .7 60 .8 22 .6 1. 9 10 0. 0 24 .7 55 .6 1, 78 6 M ot he r’s a ge a t b irt h Le ss th an 2 0 ye ar s 0. 7 17 .4 59 .4 19 .7 2. 7 10 0. 0 26 .6 62 .3 34 9 20 –3 4 ye ar s 0. 9 11 .3 62 .5 23 .8 1. 4 10 0. 0 23 .3 61 .0 1, 58 0 35 –4 9 ye ar s 0. 9 22 .0 51 .6 21 .8 3. 7 10 0. 0 28 .8 41 .2 11 9 Bi rth o rd er 1 0. 8 13 .6 59 .8 24 .2 1. 5 10 0. 0 24 .2 74 .5 76 8 2– 3 0. 6 11 .7 63 .4 22 .6 1. 8 10 0. 0 23 .4 56 .6 95 3 4– 5 2. 6 14 .0 62 .2 19 .3 1. 9 10 0. 0 26 .6 40 .4 24 8 6+ 0. 0 18 .2 50 .4 28 .1 3. 2 10 0. 0 25 .3 22 .0 79 Ne pa l&M IC S&2 01 4& 3" " Ta bl e NU .1 : L ow b irt h we ig ht in fa nt s Pe rc en ta ge o f la st liv e- bo rn ch ild re n bo rn in th e tw o ye ar s p re ce din g th e su rv ey th at a re e sti m at ed to h av e we igh ed b elo w 2, 50 0 gr am s a t b irt h an d pe rc en ta ge o f li ve b irt hs w eig he d at b irt h, N ep al, 20 14 Pe rc en t o f b irt hs b y m ot he r’s a ss es sm en t o f s ize a t b irt h: To ta l Pe rc en t o f li ve b irt hs : Nu m be r o f la st liv e- bo rn ch ild re n in th e las t t wo ye ar s Ve ry sm all Sm all er th an av er ag e Av er ag e La rg er th an av er ag e or ve ry lar ge DK Be low 2 ,5 00 gr am s [ 1] W eig he d at bir th [2 ] M ot he r’s e du ca tio n No ne 0. 7 16 .7 62 .4 18 .2 2. 1 10 0. 0 26 .5 39 .6 75 4 Pr im ar y 1. 0 13 .8 64 .1 19 .6 1. 5 10 0. 0 25 .3 55 .9 34 6 Se co nd ar y 1. 3 11 .8 58 .1 27 .2 1. 7 10 0. 0 23 .2 71 .7 50 3 Hi gh er 0. 8 7. 3 61 .2 29 .2 1. 5 10 0. 0 20 .5 84 .8 44 5 W ea lth in de x qu in til e Po or es t 2. 3 19 .4 54 .5 20 .9 2. 8 10 0. 0 28 .5 37 .7 45 8 Se co nd 0. 3 16 .8 58 .8 22 .7 1. 4 10 0. 0 25 .5 46 .8 42 5 M idd le 1. 2 10 .3 67 .5 19 .9 1. 0 10 0. 0 23 .8 60 .7 44 8 Fo ur th 0. 4 10 .4 64 .4 23 .0 1. 8 10 0. 0 22 .5 72 .0 40 5 Ri ch es t 0. 0 5. 3 62 .1 31 .0 1. 5 10 0. 0 18 .8 94 .3 31 2 [1 ] M IC S in di ca to r 2 .2 0 – Lo w bi rth w ei gh t i nf an ts [2 ] M IC S in di ca to r 2 .2 1 – In fa nt s we ig he d at b irt h ( ) F igu re s t ha t a re b as ed o n 25 –4 9 un we igh te d ca se s NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201426 2http://www.who.int/childgrowth/standards/technical_report Overall, 60 percent of live births were weighed at birth and approximately 24 percent of infants were estimated to weigh less than 2,500 grams (Table NU.1). There was some regional variation, ranging from 20 percent in the Eastern Terai to 33 percent in the Mid-Western Mountains. Mother’s education level and household wealth status were both positively correlated with the likelihood of having a child with low birth weight. Nutritional Status Children’s nutritional status is a reflection of their overall health. When children have access to an adequate and nutritious food supply, are not exposed to repeated illness, and are well cared for, they reach their growth potential and are considered well nourished. Undernutrition is associated with more than half of all child deaths worldwide. Under-nourished children are more likely to die from common childhood ailments, and for those who survive, have recurring sicknesses and faltering growth. Three-quarters of children who die from causes related to malnutrition were only mildly or moderately malnourished—showing no outward sign of their vulnerability. 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 malnutrition will also assist in the goal to reduce child mortality. In a well-nourished population, there is a reference distribution of height and weight for children under age 5. Under-nourishment in a population can be gauged by comparing children to a reference population. The reference population used in this report is based on the WHO growth standards2. Each of the three nutritional status indicators—weight-for-age, height-for-age, and weight-for-height—can be expressed in standard deviation units (z-scores) from the median of the reference population. Weight-for-age is a measure of both acute and chronic malnutrition. Children whose weight-for-age is more than two standard deviations below the median of the reference population are considered moderately or severely underweight while those whose weight-for-age is more than three standard deviations below the median are classified as severely underweight. Height-for-age is a measure of linear growth. Children whose height-for-age is more than two standard deviations below the median of the reference population are considered short for their age and are classified as moderately or severely stunted. Those whose height-for-age is more than three standard deviations below the median are classified as severely stunted. Stunting is a reflection of chronic malnutrition as a result of failure to receive adequate nutrition over a long period and recurrent or chronic illness. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 27 3See MICS Supply Procurement Instructions here: http://mics.unicef.org/tools#survey-design Weight-for-height can be used to assess wasting and overweight status. 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 of wasting may exhibit significant seasonal shifts associated with changes in the availability of food or disease prevalence. Children whose weight-for-height is more than two standard deviations above the median reference population are classified as moderately or severely overweight. In MICS, weights and heights of all children under five were measured using the anthropometric equipment recommended3 by UNICEF. Findings in this section are based on the results of these measurements. Table NU.2 shows percentages of children classified into each of the above-described categories, based on the anthropometric measurements that were taken during fieldwork. Additionally, the table includes mean z-scores for all three anthropometric indicators. Children whose full birth date (month and year) were not obtained and children whose measurements were outside a plausible range are excluded from Table NU.2. Children were excluded from one or more of the anthropometric indicators when their weight or height had not been measured, whichever was applicable. For example, if a child had been weighed but his/her height had not been measured, the child was included in underweight calculations, but not in the calculations for stunting and wasting. Percentages of children by age and reasons for exclusion are shown in the data quality Tables DQ.12, DQ.13, and DQ.14 in Appendix D. The tables show that due to incomplete dates of birth, implausible measurements, and/or missing weight and/or height, 2 percent of children have been excluded from calculations of the weight-for-age indicator, 4 percent from the height-for-age indicator, and 4 percent for the weight-for-height indicator. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201428 Ta bl e NU .2 : N ut rit io na l s ta tu s of c hi ld re n Pe rc en ta ge o f c hil dr en u nd er fiv e by n ut rit ion al sta tu s a cc or din g to th re e an th ro po m et ric in dic es : w eig ht -fo r-a ge , h eig ht -fo r-a ge , a nd w eig ht -fo r-h eig ht , N ep al, 2 01 4 W eig ht -fo r-a ge He igh t-f or -a ge W eig ht -fo r-h eig ht Un de rw eig ht M ea n z- sc or e (S D) Nu m be r o f ch ild re n St un te d M ea n z- sc or e (S D) Nu m be r o f ch ild re n W as te d Ov er we igh t M ea n z- sc or e (S D) Nu m be r o f ch ild re n un de r f ive Pe rc en t b elo w Pe rc en t b elo w Pe rc en t b elo w Ab ov e - 2 S D [1 ] - 3 S D [2 ] - 2 S D [3 ] - 3 S D [4 ] - 2 SD [5 ] - 3 S D [6 ] + 2 SD [7 ] To ta l 30 .1 8. 6 -1 .4 5, 20 6 37 .4 15 .8 -1 .6 5, 11 4 11 .3 3. 2 2. 1 -0 .6 5, 11 3 Se x M ale 28 .8 7. 8 -1 .3 2, 68 6 36 .2 15 .6 -1 .5 2, 63 7 11 .6 3. 7 2. 2 -0 .6 2, 64 6 Fe m ale 31 .5 9. 4 -1 .4 2, 52 0 38 .6 16 .0 -1 .6 2, 47 7 10 .9 2. 7 2. 1 -0 .6 2, 46 6 Re gi on Ea ste rn M ou nt ain s 17 .2 3. 0 -0 .9 71 30 .9 10 .1 -1 .3 70 5. 9 1. 7 1. 7 -0 .2 70 Ea ste rn H ills 20 .1 5. 8 -0 .9 26 8 26 .9 9. 9 -1 .2 26 8 10 .8 4. 2 1. 6 -0 .3 2, 64 Ea ste rn T er ai 27 .4 7. 7 -1 .2 75 8 25 .0 9. 5 -1 .2 74 3 13 .3 4. 9 3. 0 -0 .7 7, 40 Ce nt ra l M ou nt ain s 19 .4 6. 3 -1 .1 94 36 .6 16 .4 -1 .4 93 7. 3 2. 0 1. 2 -0 .5 93 Ce nt ra l H ills 16 .7 1. 6 -0 .8 60 4 27 .7 11 .5 -1 .2 59 0 5. 9 2. 1 4. 4 -0 .1 59 3 Ce nt ra l T er ai 40 .7 13 .2 -1 .7 1, 09 2 41 .6 19 .1 -1 .6 1, 07 5 17 .0 3. 8 1. 6 -1 .0 1, 07 2 W es te rn M ou nt ain s 15 .5 6. 4 -0 .8 2 45 .6 22 .6 -2 .1 2 2. 5 0. 0 8. 4 0. 3 2 W es te rn H ills 25 .3 9. 0 -1 .3 56 0 37 .6 12 .9 -1 .7 55 4 7. 4 3. 8 1. 2 -0 .5 55 0 W es te rn T er ai 32 .8 8. 4 -1 .6 46 5 36 .0 12 .9 -1 .5 46 1 13 .1 2. 9 0. 2 -0 .9 46 3 M id- W es te rn M ou nt ain s 45 .2 15 .7 -1 .9 10 6 64 .2 38 .9 -2 .5 10 4 9. 0 2. 4 1. 9 -0 .6 10 5 M id- W es te rn H ills 33 .5 8. 6 -1 .5 40 7 50 .3 21 .7 -2 .0 40 5 6. 9 1. 0 2. 2 -0 .5 40 6 M id- W es te rn T er ai 31 .2 5. 8 -1 .5 28 3 41 .6 15 .0 -1 .8 28 1 10 .3 2. 2 1. 1 -0 .7 28 7 Fa r W es te rn M ou nt ain s 29 .0 7. 4 -1 .6 98 47 .8 19 .7 -1 .9 95 8. 6 2. 7 1. 8 -0 .6 95 Fa r W es te rn H ills 43 .7 17 .8 -1 .9 20 7 62 .7 37 .2 -2 .5 19 9 11 .0 3. 7 1. 8 -0 .7 19 9 Fa r W es te rn T er ai 22 .5 4. 8 -1 .1 18 9 30 .5 10 .1 -1 .2 17 4 12 .6 2. 4 5. 0 -0 .6 17 3 Ar ea Ur ba n 16 .5 3. 2 -0 .9 68 8 23 .7 7. 5 -1 .1 68 3 6. 0 1. 6 1. 9 -0 .3 67 7 Ka th m an du va lle y 6. 7 1. 5 -0 .5 17 6 19 .0 5. 6 -1 .0 17 5 5. 7 2. 4 3. 6 0. 1 17 5 Ot he r u rb an 19 .9 3. 8 -1 .0 51 2 25 .4 8. 2 -1 .2 50 7 6. 1 1. 4 1. 3 -0 .5 50 2 Ru ra l 32 .2 9. 4 -1 .4 4, 51 7 39 .4 17 .0 -1 .6 4, 43 1 12 .1 3. 5 2. 2 -0 .7 4, 43 5 Ag e 0– 5 m on th s 20 .9 7. 2 -1 .0 44 5 15 .1 7. 2 -0 .6 43 1 17 .3 8. 5 4. 9 -0 .7 42 4 6– 11 m on th s 18 .4 6. 3 -1 .0 51 0 15 .6 4. 7 -0 .8 50 9 14 .1 5. 4 2. 6 -0 .7 50 7 12 –1 7 m on th s 25 .2 6. 3 -1 .2 47 6 28 .9 8. 5 -1 .2 46 8 15 .5 3. 9 1. 5 -0 .8 46 9 18 –2 3 m on th s 34 .3 9. 1 -1 .5 51 1 39 .6 15 .6 -1 .7 50 0 16 .2 3. 1 1. 2 -0 .9 50 0 24 –3 5 m on th s 31 .0 7. 4 -1 .4 1, 04 8 41 .3 18 .0 -1 .7 1, 01 4 9. 5 2. 1 1. 9 -0 .6 1, 02 0 36 –4 7 m on th s 33 .5 10 .9 -1 .5 1, 10 5 48 .7 22 .2 -2 .0 1, 09 0 7. 9 2. 5 2. 1 -0 .5 1, 09 4 48 –5 9 m on th s 35 .1 9. 7 -1 .5 1, 11 1 43 .8 19 .0 -1 .8 1, 10 1 8. 5 1. 6 1. 8 -0 .6 1, 09 9 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 29 Ta bl e NU .2 : N ut rit io na l s ta tu s of c hi ld re n Pe rc en ta ge o f c hil dr en u nd er fiv e by n ut rit ion al sta tu s a cc or din g to th re e an th ro po m et ric in dic es : w eig ht -fo r-a ge , h eig ht -fo r-a ge , a nd w eig ht -fo r-h eig ht , N ep al, 2 01 4 W eig ht -fo r-a ge He igh t-f or -a ge W eig ht -fo r-h eig ht Un de rw eig ht M ea n z- sc or e (S D) Nu m be r o f ch ild re n St un te d M ea n z- sc or e (S D) Nu m be r o f ch ild re n W as te d Ov er we igh t M ea n z- sc or e (S D) Nu m be r o f ch ild re n un de r f ive Pe rc en t b elo w Pe rc en t b elo w Pe rc en t b elo w Ab ov e - 2 S D [1 ] - 3 S D [2 ] - 2 S D [3 ] - 3 S D [4 ] - 2 SD [5 ] - 3 S D [6 ] + 2 SD [7 ] M ot he r’s e du ca tio n No ne 39 .0 13 .0 -1 .7 2, 19 6 48 .3 22 .1 -1 .9 2, 16 5 13 .0 3. 6 1. 8 -0 .8 2, 17 2 Pr im ar y 34 .7 7. 0 -1 .5 90 3 41 .4 18 .6 -1 .7 88 6 12 .0 3. 5 2. 3 -0 .7 88 6 Se co nd ar y 23 .7 6. 3 -1 .2 1, 15 7 29 .7 9. 1 -1 .3 1, 13 1 11 .3 3. 6 1. 4 -0 .6 1, 12 3 Hi gh er 12 .7 2. 7 -0 .8 94 5 17 .3 6. 4 -1 .0 92 9 6. 2 1. 5 3. 6 -0 .3 92 8 W ea lth in de x qu in til e Po or es t 37 .1 12 .5 -1 .6 1, 15 5 54 .7 27 .2 -2 .1 1, 12 9 8. 6 2. 6 1. 9 -0 .6 1, 13 0 Se co nd 34 .0 9. 9 -1 .5 1, 04 2 41 .8 17 .2 -1 .7 1, 02 9 12 .3 2. 5 1. 5 -0 .7 1, 02 8 M idd le 37 .7 10 .0 -1 .6 1, 15 4 39 .6 15 .5 -1 .6 1, 12 8 16 .8 5. 5 2. 8 -0 .9 1, 13 3 Fo ur th 24 .6 6. 2 -1 .2 1, 05 1 28 .6 10 .2 -1 .3 1, 03 3 10 .8 3. 3 1. 5 -0 .7 1, 02 9 Ri ch es t 11 .3 2. 2 -0 .7 80 4 15 .2 5. 2 -0 .9 79 6 6. 4 1. 6 3. 0 -0 .3 79 2 [1 ] M IC S in di ca to r 2 .1 a an d M DG in di ca to r 1 .8 – U nd er we ig ht p re va le nc e (m od er at e an d se ve re ) [2 ] M IC S in di ca to r 2 .1 b – Un de rw ei gh t p re va le nc e (s ev er e) [3 ] M IC S in di ca to r 2 .2 a – St un tin g pr ev al en ce (m od er at e an d se ve re ) [4 ] M IC S in di ca to r 2 .2 b – St un tin g pr ev al en ce (s ev er e) [5 ] M IC S in di ca to r 2 .3 a – W as tin g pr ev al en ce (m od er at e an d se ve re ) [6 ] M IC S in di ca to r 2 .3 b – W as tin g pr ev al en ce (s ev er e) [7 ] M IC S in di ca to r 2 .4 – O ve rw ei gh t p re va le nc e No te : 3 ca se s o f m iss ing ‘m ot he r’s e du ca tio n’ no t s ho wn C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201430 One in three children under five in Nepal were moderately or severely underweight (30 percent) and 9 percent were classified as severely underweight (Table NU.2). More than one-third (37 percent) were moderately or severely stunted or too short for their age and 16 percent were severely stunted, and 11 percent were moderately or severely wasted or too thin for their height and 3 percent were severely wasted. Only 2 percent of children were moderately or severely overweight. Children in the Mid-Western Mountains were more likely to be underweight and stunted than other children. In contrast, the percentage wasted is highest in the Central Terai. Children in rural areas were more likely than those in urban areas to be underweight, stunted or wasted. Those children whose mothers have secondary or higher education were the least likely to be underweight, stunted or wasted compared to children of mothers with no education. Older children were more likely than younger children to be underweight and/or stunted but less likely to be wasted. Figure NU.1 shows that a higher percentage of children aged 18–59 months were underweight or stunted in comparison to younger children. This pattern is expected and is related to the age at which many children cease to be breastfed and are exposed to contamination in water, food, and the environment. Both underweight and stunting gradually increases with age until the age of 23 months and then more or less plateaus in contrast of wasting where it peaks at 23 months and gradually decreases. This signifies that the nutrition interventions need to reach the children as soon as possible in their infancy, within the critical window of 1,000 days. Figure NU.1: Underweight, stunted, wasted and overweight children under five (moderate and severe), Nepal, 2014 P er ce nt NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 31 Breastfeeding and Infant and Young Child Feeding Proper feeding of infants and young children can increase their chances of survival; it can also promote optimal growth and development, especially in the critical window from conception to two years of age. Breastfeeding for the first few years of life protects children from infection, provides an ideal source of nutrients, and is economical and safe. However, many mothers don’t start to breastfeed early enough, and do not breastfeed exclusively for the recommended six months or stop breastfeeding too soon. There are often tendencies to switch to infant formula, which can contribute to growth faltering and micronutrient malnutrition and can be unsafe if hygienic conditions, including safe drinking water, are not readily available. Studies have shown that, in addition to continued breastfeeding, consumption of nutrient dense, adequate and safe solid, semi-solid and soft foods from the age of six months onwards leads to better health and growth outcomes, with potential to reduce stunting during the first two years of life.4 UNICEF and WHO recommend that infants be breastfed within one hour of birth, are breastfed exclusively for the first six months of life, and continue to be breastfed for up to two years of age and beyond.5 Starting at six months, breastfeeding should be combined with nutrient dense and diverse, safe, age-appropriate feeding of solid, semi-solid and soft foods.6 A summary of key guiding principles7,8, for feeding 6–23-month-olds is provided in the table below along with proximate measures for these guidelines collected in this survey. The guiding principles for which proximate measures and indicators exist are: • continued breastfeeding; • appropriate frequency of meals (but not energy density); and • appropriate dietary diversity and nutrient content of food. Feeding frequency is used as proxy for energy intake, requiring children to receive a minimum number of meals/snacks (and milk feeds for non-breastfed children) for their age. Diet diversity is used to ascertain the adequacy of the nutrient content of the food (not including iron) consumed. For diet diversity, seven food groups were created for which a child consuming at least four of these is considered to have a better quality diet. In most populations, consumption of at least four food groups means that the child has a high likelihood of consuming at least one animal-source food and at least one fruit or vegetable, in addition to a staple food (grain, root or tuber).9 4Bhuta Z. et al., 2013. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? The Lancet June 6, 2013. 5WHO, 2003. Implementing the Global Strategy for Infant and Young Child Feeding. Meeting Report Geneva, 3–5 February 2003. 6WHO, 2003. Global strategy for infant and young child feeding. 7PAHO, 2003. Guiding principles for complementary feeding of the breastfed child. 8WHO, 2005. Guiding principles for feeding non-breastfed children 6–24 months of age 9WHO, 2008. Indicators for assessing infant and young child feeding practices. Part 1: Definitions. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201432 These three dimensions of child feeding are combined into an assessment of the children who received appropriate feeding, using the indicator of ‘minimum acceptable diet’. To have a minimum acceptable diet in the previous day, a child must have received: • the appropriate number of meals/snacks/milk feeds; • food items from at least four food groups; and • breast milk or at least two milk feeds (for non-breastfed children). Nepal MICS 2014 9 Guiding principle (aged 6–23 months) Proximate measures Table Continue frequent, on-demand breastfeeding for two years and beyond Breastfed in the last 24 hours NU.4 Appropriate frequency and energy density of meals Breastfed children: Depending on age, two or three meals/snacks provided in the last 24 hours Non-breastfed children: Four meals/snacks and/or milk feeds provided in the last 24 hours NU.6 Appropriate nutrient content of food Four food groups* eaten in the last 24 hours NU.6 Appropriate amount of food No standard indicator exists Na Appropriate consistency of food No standard indicator exists Na Use of vitamin–mineral supplements or fortified products for infant and mother No standard indicator exists Na Practice good hygiene and proper food handling While it was not possible to develop indicators to fully capture programme guidance, one standard indicator does cover part of the principle: Not feeding with a bottle with a nipple NU.9 Practice responsive feeding, applying the principles of psycho-social care No standard indicator exists Na Note: * Food groups used for assessment of this indicator are: (1) grains, roots and tubers; (2) legumes and nuts; (3) dairy products (milk, yogurt, cheese); (4) flesh foods (meat, fish, poultry and liver/organ meats); (5) eggs; (6) vitamin-A rich fruits and vegetables; and (7) other fruits and vegetables. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 33 Table NU.3: Initial breastfeeding Percentage of last live-born children born in the two years preceding the survey who were ever breastfed, breastfed within one hour of birth and within one day of birth, and percentage who received a prelacteal feed, Nepal, 2014 Percent who were ever breastfed [1] Percent who were first breastfed: Percent who received a prelacteal feed Number of last live-born children in the last two years Within one hour of birth [2] Within one day of birth Total 97.3 48.7 85.9 15.9 2,048 Region Eastern Mountains 98.6 42.4 88.6 13.3 32 Eastern Hills 96.4 43.9 82.2 9.1 123 Eastern Terai 97.2 29.6 80.3 26.7 277 Central Mountains 98.6 74.6 95.9 1.9 38 Central Hills 97.4 45.6 83.5 20.8 241 Central Terai 97.1 58.2 82.5 18.8 400 Western Mountains (97.2) (41.9) (77.1) (27.1) 1 Western Hills 98.3 45.3 88.8 18.3 222 Western Terai 96.7 49.0 85.7 16.6 178 Mid-Western Mountains 96.2 67.5 88.9 3.8 43 Mid-Western Hills 96.3 51.1 92.0 4.9 166 Mid-Western Terai 99.9 41.4 84.9 15.8 113 Far Western Mountains 100.0 48.4 98.6 2.2 33 Far Western Hills 97.9 65.2 96.7 0.6 75 Far Western Terai 95.5 59.3 92.0 10.6 106 Area Urban 97.4 44.6 84.1 27.4 262 Kathmandu valley 98.6 36.8 80.0 43.5 65 Other urban 97.0 47.3 85.5 22.1 197 Rural 97.3 49.3 86.2 14.2 1,786 Months since last birth 0–11 97.8 48.5 85.7 17.0 995 12–23 96.9 48.8 86.2 14.9 1,053 Assistance at delivery Skilled attendant 98.5 48.7 86.9 16.5 1,138 Other health workers 98.9 55.5 85.8 18.1 122 Other 98.4 49.0 86.7 15.9 729 No one/ Missing 58.3 29.6 57.1 0.4 59 Place of delivery Home 98.9 49.8 87.0 15.6 872 Health facility 98.2 49.1 86.8 16.5 1,130 Public 98.2 53.5 89.4 13.5 915 Private 98.9 31.5 76.5 27.8 188 NGO (*) (*) (*) (*) 27 Other/ Missing 47.1 18.1 44.5 7.8 47 Mother’s education None 97.5 54.0 85.3 15.9 754 Primary 96.7 49.9 88.2 13.3 346 Secondary 97.2 48.5 88.5 13.8 503 Higher 97.6 38.8 82.4 20.4 445 Wealth index quintile Poorest 96.2 52.6 90.0 6.7 454 Second 98.9 53.6 87.2 15.7 436 Middle 97.4 49.5 83.7 14.4 441 Fourth 96.6 45.2 86.0 19.0 401 Richest 97.4 39.7 81.3 27.7 316 [1] MICS indicator 2.5 – Children ever breastfed [2] MICS indicator 2.6 – Early initiation of breastfeeding ( ) Figures that are based on 25–49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201434 Table NU.3 is based on mothers’ reports of what their last-born child, born in the two years preceding the survey, was fed in the first few days of life. It indicates the proportion who were ever breastfed, those who were first breastfed within one hour and one day of birth, and those who received a prelacteal feed.10 Some 97 percent of children were ever breast fed. Although a very important step in management of lactation and establishment of a physical and emotional relationship between the baby and the mother, only 49 percent of babies were breastfed for the first time within one hour of birth, while 86 percent of newborns started breastfeeding within one day of birth. Some 16 percent received a prelacteal feed. There was considerable variation in initiation of breastfeeding by region, with the highest proportion of children breastfed within one hour of birth in the Central Mountains. In contrast, nearly one in three babies received a prelacteal feed in the Western Mountains. Children born to mothers with higher education and in the richest households were least likely to initiate early breastfeeding and most likely to receive a prelacteal feed. Figure NU.2 shows variation in initiation of breastfeeding by region and area. Figure NU.2: Initiation of breastfeeding, Nepal, 2014 10Prelacteal feed refers to the provision any liquid or food, other than breastmilk, to a newborn during the period when breastmilk flow is generally being established (estimated here as the first 3 days of life). Nepal  MICS  2014   14     Figure  NU.2  shows  variation  in  initiation  of  breastfeeding  by  region  and  area.   Figure  NU.2:  Initiation  of  breastfeeding,  Nepal,  2014       The  set  of  infant  and  young  child  feeding  indicators  reported  in  Tables  NU.4  through  NU.8  are  based   on  the  mother’s  report  of  consumption  of  food  and  fluids  during  the  day  or  night  prior  to  being   interviewed.  Data  are  subject  to  a  number  of  limitations,  some  are  related  to  the  respondent’s   ability  to  provide  a  full  report  on  the  child’s  liquid  and  food  intake  due  to  recall  errors  as  well  as  lack   of  knowledge  in  cases  where  the  child  was  fed  by  other  individuals.   In  Table  NU.4,  breastfeeding  status  is  presented  for  both  exclusively  breastfed  and  predominantly   breastfed;  this  refers  to  infants  aged  less  than  six  months  who  are  breastfed,  distinguished  by  the   former  only  allowing  vitamins,  mineral  supplements  and  medicine,  and  the  latter  allowing  also  plain   water  and  non-­‐milk  liquids.  The  table  also  shows  continued  breastfeeding  of  children  at  12–15   months  and  20–23  months  of  age.   89 82 80 96 84 83 77 89 86 89 92 85 99 97 92 84 86 86 42 44 30 75 46 58 42 45 49 68 51 41 48 65 59 45 49 49 0 20 40 60 80 100 Pe r  c en t Within  one  day Within  one  hour P er ce nt NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 35 The set of infant and young child feeding indicators reported in Tables NU.4 through NU.8 are based on the mother’s report of consumption of food and fluids during the day or night prior to being interviewed. Data are subject to a number of limitations, some are related to the respondent’s ability to provide a full report on the child’s liquid and food intake due to recall errors as well as lack of knowledge in cases where the child was fed by other individuals. In Table NU.4, breastfeeding status is presented for both exclusively breastfed and predominantly breastfed; this refers to infants aged less than six months who are breastfed, distinguished by the former only allowing vitamins, mineral supplements and medicine, and the latter allowing also plain water and non-milk liquids. The table also shows continued breastfeeding of children at 12–15 months and 20–23 months of age. Table NU.4: Breastfeeding Percentage of living children according to breastfeeding status at selected age groups, Nepal, 2014 Children aged 0–5 months Children aged 12–15 months Children aged 20–23 months Percent exclusively breastfed [1] Percent predomi- nantly breastfed [2] Number of children Percent breastfed (continued breastfee- ding at one year) [3] Number of children Percent breastfed (continued breastfee- ding at two years) [4] Number of children Total 56.9 74.9 455 93.6 318 86.7 338 Sex Male 63.8 76.8 251 92.3 178 90.0 173 Female 48.6 72.5 204 95.3 140 83.3 165 Region Eastern Mountains (46.4) (70.5) 8 (*) 5 (*) 4 Eastern Hills (*) (*) 21 (*) 16 (*) 23 Eastern Terai (56.0) (65.7) 59 (*) 39 (*) 39 Central Mountains (*) (*) 6 (*) 6 (*) 5 Central Hills (54.3) (66.9) 52 (93.1) 40 (*) 37 Central Terai 65.1 89.5 110 (94.6) 58 (79.2) 98 Western Mountains (*) (*) (*) (*) Western Hills (68.9) (86.8) 50 (*) 36 (*) 35 Western Terai (33.5) (66.0) 37 (*) 31 (*) 25 Mid-Western Mountains (69.6) (78.4) 9 (95.0) 8 (96.5) 6 Mid-Western Hills (53.6) (57.5) 27 (100.0) 24 (*) 18 Mid-Western Terai (*) (*) 22 (96.6) 21 (*) 15 Far Western Mountains (49.9) (66.3) 8 (*) 5 (86.1) 6 Far Western Hills (59.6) (70.5) 16 (*) 11 (96.5) 14 Far Western Terai (72.2) (80.2) 30 (*) 16 (*) 13 Area Urban 53.9 73.6 59 81.7 38 (92.1) 35 Kathmandu valley (*) (*) 18 (*) 12 (*) 9 Other urban 58.1 79.7 40 (77.0) 27 (93.8) 26 Rural 57.4 75.1 396 95.3 279 86.1 303 Mother’s education None 61.1 77.7 162 96.3 114 82.0 150 Primary 52.2 64.8 75 92.5 60 92.5 57 Secondary 58.8 79.5 132 97.3 66 86.7 71 Higher 50.4 71.1 86 87.1 76 92.9 60 Wealth index quintile Poorest 43.3 62.3 86 99.0 67 94.1 63 Second 70.8 83.0 106 96.5 67 83.5 81 Middle 57.5 80.4 111 97.8 67 (86.2) 75 Fourth 56.0 68.3 77 (90.8) 70 85.8 75 Richest 52.9 76.4 75 (80.1) 47 (84.7) 45 [1] MICS indicator 2.7 – Exclusive breastfeeding under 6 months [2] MICS indicator 2.8 – Predominant breastfeeding under 6 months [3] MICS indicator 2.9 – Continued breastfeeding at 1 year [4] MICS indicator 2.10 – Continued breastfeeding at 2 years Note: 3 cases of missing ‘mother’s education’ not shown ( ) Figures that are based on 25–49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases   NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201436 Some 57 percent of children aged less than six months were exclusively breastfed; however, 75 percent were predominantly breastfed, suggesting that a substantial proportion were receiving water- based liquids instead of breastmilk to some degree. Some 94 percent of children aged 12–15 months and 87 percent of children aged 20–23 months were still being breastfed. Boys were much more likely than girls to be exclusively breastfed. A cultural dimension partially explains this difference, as boys are usually introduced to semi-solid food at six months as compared to girls at five months. Mother’s education level was negatively associated with exclusive breastfeeding. Figure NU.3 shows the detailed pattern of breastfeeding by the child’s age in months. Even at the earliest ages (0–1 months), over 20 percent of children were receiving liquids or foods other than breast milk, with water being of the highest prevalence followed by milk formula. At the age of 4–5 months, the proportion of children exclusively breastfed fell below 40 percent. More than 80 percent of children were still receiving some breast milk at the age of two years. Figure NU.3: Infant feeding patterns by age, Nepal, 2014 Nepal  MICS  2014   16     dimension partially explains this difference, as boys are usually introduced to semi-solid food at six months as compared to girls at five months. Mother’s education level was negatively associated with exclusive breastfeeding. Figure NU.3 shows the detailed pattern of breastfeeding by the child’s age in months. Even at the earliest ages (0–1 months), over 20 percent of children were receiving liquids or foods other than breast milk, with water being of the highest prevalence followed by milk formula. At the age of 4–5 months, the proportion of children exclusively breastfed fell below 40 percent. More than 80 percent of children were still receiving some breast milk at the age of two years. Figure NU.3: Infant feeding patterns by age, Nepal, 2014 Table NU.5 shows the median duration of breastfeeding by selected background characteristics. Among children aged less than three years, the median duration was more than 36 months for any breastfeeding, 3.2 months for exclusive breastfeeding, and 4.8 months for predominant breastfeeding. Variation in median duration of any breastfeeding was unremarkable, as most children received breast milk for at least 36 months. Exclusive breastfeeding varied somewhat and was generally around 2–4 months; in no disaggregation did it reach six months. Interestingly, it was only 1.3 months for children in the poorest household population. Exclusively breastfed Breastfed and complementary foods Weaned (not breastfed) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0-­‐1 2-­‐3 4-­‐5 6-­‐7 8-­‐9 10-­‐11 12-­‐13 14-­‐15 16-­‐17 18-­‐19 20-­‐21 22-­‐23 Age in months Exclusively breastfed Breastfed and plain water only Breastfed and non-milk liquids Breastfed and other milk / formula Breastfed and complementary foods Weaned (not breastfed) NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 37 Table NU.5 shows the median duration of breastfeeding by selected background characteristics. Among children aged less than three years, the median duration was more than 36 months for any breastfeeding, 3.2 months for exclusive breastfeeding, and 4.8 months for predominant breastfeeding. Variation in median duration of any breastfeeding was unremarkable, as most children received breast milk for at least 36 months. Exclusive breastfeeding varied somewhat and was generally around 2–4 months; in no disaggregation did it reach six months. Interestingly, it was only 1.3 months for children in the poorest household population. Table NU.5: Duration of breastfeeding Median duration (in months) of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children aged 0–35 months, Nepal, 2014 Median duration (in months) of Number of children aged 0–35 monthss Any breastfeeding [1] Exclusive breastfeeding Predominant breastfeeding Median 36+ 3.2 4.8 3,065 Sex Male 36+ 3.8 4.8 1,609 Female 34.4 2.4 4.8 1,455 Region Eastern Mountains 36+ 2.4 4.6 44 Eastern Hills 36+ 1.9 3.9 168 Eastern Terai 32.6 3.0 3.9 431 Central Mountains 36+ 2.2 2.3 57 Central Hills 33.2 2.9 3.9 369 Central Terai 36+ 4.6 6.2 626 Western Mountains (36+) (5.9) (7.0) 1 Western Hills 33.8 3.9 5.1 341 Western Terai 36+ 1.5 3.4 280 Mid-Western Mountains 36+ 4.8 5.3 61 Mid-Western Hills 36+ 2.9 3.4 223 Mid-Western Terai 36+ 2.2 4.9 166 Far Western Mountains 36+ 2.5 4.4 55 Far Western Hills 36+ 4.6 6.2 112 Far Western Terai 36+ 5.0 5.8 129 Area Urban 32.3 2.8 4.2 397 Kathmandu valley 29.1 2.0 3.2 105 Other urban 33.2 3.0 4.6 292 Rural 36+ 3.3 4.8 2,667 Mother’s education None 36+ 3.9 5.6 1,151 Primary 36+ 2.7 4.3 537 Secondary 36+ 3.2 4.5 741 Higher 32.7 2.5 4.2 632 Wealth index quintile Poorest 36+ 1.3 4.0 647 Second 36+ 4.1 5.2 652 Middle 36+ 3.9 6.0 653 Fourth 36+ 3.0 3.7 622 Richest 30.2 2.7 4.2 490 Mean 30.7 3.8 5.1 3,065 [1] MICS indicator 2.11 – Duration of breastfeeding ( ) Figures that are based on 25–49 unweighted cases NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201438 The age-appropriateness of breastfeeding of children aged less than 24 months is provided in Table NU.6. Different criteria of feeding are used depending on the age of the child. For infants aged 0–5 months, exclusive breastfeeding is considered as age-appropriate feeding, while children aged 6–23 months are considered to be appropriately fed if they are receiving breast milk and solid, semi-solid or soft food. As a result of feeding patterns, only 86 percent of children aged 6–23 months were being appropriately breastfed and age-appropriate breastfeeding among all children aged 0–23 months dropped to 79 percent. Boys aged 0–23 months were more likely than girls aged 0–23 months to be appropriately breastfed (83 percent compared to 76 percent). There was some regional variation, with the highest proportion of appropriately breastfed under-2s living in the Mid-Western Hills (88 percent) and the lowest proportion in the Eastern Terai (74 percent). Table NU.6: Age-appropriate breastfeeding Percentage of children aged 0–23 months who were appropriately breastfed during the previous day, Nepal, 2014 Children aged 0–5 months Children aged 6–23 months Children aged 0–23 months Percent exclusively breastfed [1] Number of children Percent currently breastfeeding and receiving solid, semi- solid or soft foods Number of children Percent appropriately breastfed [2] Number of children Total 56.9 455 85.9 1,531 79.3 1,986 Sex Male 63.8 251 88.4 810 82.6 1,061 Female 48.6 204 83.1 720 75.5 925 Region Eastern Mountains 46.4 8 91.3 23 79.8 31 Eastern Hills 35.5 21 91.6 93 81.1 114 Eastern Terai 56.0 59 78.8 212 73.9 271 Central Mountains 38.9 6 91.4 30 82.4 36 Central Hills 54.3 52 89.7 175 81.5 227 Central Terai 65.1 110 79.6 295 75.7 405 Western Mountains (78.2) 0 (81.3) 1 (80.8) 1 Western Hills 68.9 50 90.0 173 85.3 223 Western Terai 33.5 37 90.9 142 79.0 179 Mid-Western Mountains 69.6 9 87.5 31 83.6 40 Mid-Western Hills 53.6 27 95.6 121 88.0 147 Mid-Western Terai 45.5 22 82.7 85 75.0 108 Far Western Mountains 49.9 8 82.7 25 75.0 33 Far Western Hills 59.6 16 86.6 60 80.9 76 Far Western Terai 72.2 30 79.2 65 77.0 96 Area Urban 53.9 59 85.5 190 78.0 248 Kathmandu valley 44.6 18 91.3 40 76.7 59 Other urban 58.1 40 83.9 149 78.4 190 Rural 57.4 396 86.0 1,341 79.4 1,737 Mother’s education None 61.1 162 81.3 586 76.9 748 Primary 52.2 75 87.5 255 79.5 330 Secondary 58.8 132 88.9 351 80.6 483 Higher 50.4 86 89.5 336 81.5 422 Wealth index quintile Poorest 43.3 86 91.9 330 81.8 416 Second 70.8 106 87.0 332 83.1 438 Middle 57.5 111 83.3 311 76.5 422 Fourth 56.0 77 82.4 330 77.4 407 Richest 52.9 75 84.3 228 76.6 303 [1] MICS indicator 2.7 – Exclusive breastfeeding under 6 months [2] MICS indicator 2.12 – Age-appropriate breastfeeding Note: 3 cases of missing ‘mother’s education’ not shown ( ) Figures that are based on 25–49 unweighted cases NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 39 Table NU.7 shows information on the introduction of solid, semi-solid or soft foods. Sample sizes were very small, so data are only available for a limited number of indicators. Overall, 74 percent of infants aged 6–8 months had received solid, semi-solid or soft foods at least once during the previous day. Boys were more likely than girls to receive solid, semi-solid or soft foods (83 percent compared to 65 percent). Table NU.8 shows infant and young child feeding practices for children aged 6–23 months. Overall, one-third of children (32 percent) were receiving solid, semi-solid and soft foods the minimum number of times. A slightly higher proportion of males (77 percent) were achieving the minimum meal frequency compared to females (72 percent). The proportion of children receiving the minimum dietary diversity, or foods from at least four food groups, was much lower than that for minimum meal frequency, indicating the need to focus on improving diet quality and nutrient intake among this vulnerable group. A higher proportion of older (18–23 months) children (48 percent) were achieving the minimum dietary diversity compared to younger (6–8 months) children (15 percent). The overall assessment using the indicator of minimum acceptable diet revealed that only 32 percent of all children were benefiting from a diet sufficient in both diversity and frequency. Breastfeeding children were more likely than non-breastfeeding children to receive a minimum acceptable diet (32 percent compared to 23 percent). Table NU.7: Introduction of solid, semi-solid, or soft foods Percentage of infants aged 6–8 months who received solid, semi-solid, or soft foods during the previous day, Nepal, 2014 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 foods [1] Number of children aged 6–8 months Total 73.5 278 (*) 10 73.5 288 Sex Male 82.2 137 (*) 3 82.6 141 Female 65.0 141 (*) 7 64.9 147 Area Urban (73.7) 41 (*) 1 (74.1) 41 Kathmandu valley (*) 6 (*) 1 (*) 6 Other urban (69.4) 35 0 0 (69.4) 35 Rural 73.5 238 (*) 9 73.5 247 [1] MICS indicator 2.13 – Introduction of solid, semi-solid or soft foods ( ) Figures that are based on 25–49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201440 Ta bl e NU .8 : I nf an t a nd y ou ng c hi ld fe ed in g pr ac tic es Pe rc en ta ge o f c hil dr en a ge d 6– 23 m on th s w ho re ce ive d ap pr op ria te liq uid s a nd so lid , s em i-s oli d or so ft fo od s t he m ini m um n um be r o f t im es o r m or e du rin g th e pr ev iou s d ay , b y b re as tfe ed ing st at us , N ep al, 20 14 Cu rre nt ly br ea stf ee din g Cu rre nt ly no t b re as tfe ed ing Al l Pe rc en t o f c hil dr en w ho re ce ive d Nu m be r o f ch ild re n ag ed 6 –2 3 m on th s Pe rc en t o f c hil dr en w ho re ce ive d Nu m be r o f ch ild re n ag ed 6 –2 3 m on th s Pe rc en t o f c hil dr en w ho re ce ive d: Nu m be r o f ch ild re n ag ed 6 –2 3 m on th s M ini m um die ta ry div er sit y [a ] M ini m um m ea l fre qu en cy [b ] M ini m um ac ce pt ab le die t [1 ] [ c] M ini m um die ta ry div er sit y [a ] M ini m um m ea l fre qu en cy [b ] M ini m um ac ce pt ab le die t [2 ] [ c] At le as t 2 m ilk fe ed s [3 ] M ini m um die ta ry div er sit y [4 ] [ a] M ini m um m ea l fre qu en cy [5 ] [ b] M ini m um ac ce pt ab le die t [c] To ta l 36 .1 74 .3 32 .3 1, 43 9 60 .4 76 .5 22 .8 59 .5 69 37 .0 74 .4 31 .9 1, 53 1 Se x M ale 36 .3 76 .8 32 .4 77 0 (*) (*) (*) (*) 24 36 .1 77 .0 31 .9 81 0 Fe m ale 35 .8 71 .3 32 .1 66 9 (6 6. 0) (7 4. 1) (2 6. 6) (5 0. 7) 45 37 .9 71 .5 31 .8 72 0 Re gi on Ea ste rn M ou nt ain s 42 .4 79 .1 38 .3 23 (*) (*) (*) (*) 0 42 .6 79 .3 38 .9 23 Ea ste rn H ills 47 .5 86 .8 47 .5 88 (*) (*) (*) (*) 4 46 .2 85 .6 46 .8 93 Ea ste rn T er ai 35 .9 64 .9 29 .7 20 1 (*) (*) (*) (*) 5 35 .0 64 .6 29 .0 21 2 Ce nt ra l M ou nt ain s 20 .5 81 .5 20 .5 30 (*) (*) (*) (*) 0 20 .3 81 .7 20 .3 30 Ce nt ra l H ills 46 .4 74 .1 40 .0 16 2 (*) (*) (*) (*) 9 46 .4 75 .0 38 .6 17 5 Ce nt ra l T er ai 22 .2 69 .3 19 .6 26 3 (*) (*) (*) (*) 22 24 .6 68 .9 18 .4 29 5 W es te rn M ou nt ain s (5 0. 4) (8 8. 1) (5 0. 4) 1 (*) (*) (*) (*) 1 (5 6. 1) (8 5. 3) (5 0. 2) 1 W es te rn H ills 42 .0 89 .5 39 .9 16 0 (*) (*) (*) (*) 13 46 .4 90 .3 41 .5 17 3 W es te rn T er ai 45 .6 83 .3 43 .8 13 6 (*) (*) (*) (*) 5 47 .9 83 .8 42 .8 14 2 M id- W es te rn M ou nt ain s 29 .1 70 .1 26 .1 30 (*) (*) (*) (*) 1 28 .8 69 .1 25 .2 31 M id- W es te rn H ills 36 .1 84 .3 35 .5 12 1 (*) (*) (*) (*) 0 36 .1 84 .3 35 .5 12 1 M id- W es te rn T er ai 33 .6 50 .1 16 .3 83 (*) (*) (*) (*) 2 33 .9 51 .4 17 .1 85 Fa r W es te rn M ou nt ain s 62 .7 81 .3 59 .5 23 (*) (*) (*) (*) 2 62 .3 80 .7 58 .3 25 Fa r W es te rn H ills 23 .9 52 .2 22 .1 59 (*) (*) (*) (*) 1 25 .2 53 .0 23 .4 60 Fa r W es te rn T er ai 28 .9 77 .8 28 .9 60 (*) (*) (*) (*) 4 28 .2 75 .6 28 .2 65 Ar ea Ur ba n 54 .6 82 .5 51 .2 17 4 (*) (*) (*) (*) 14 57 .2 83 .1 52 .8 19 0 Ka th m an du va lle y (7 1. 0) (8 5. 6) (6 3. 2) 37 (*) (*) (*) (*) 4 (7 0. 0) (8 4. 6) (6 0. 6) 40 Ot he r u rb an 50 .1 81 .7 48 .0 13 7 (*) (*) (*) (*) 10 53 .7 82 .7 50 .6 14 9 Ru ra l 33 .5 73 .1 29 .7 1, 26 5 (5 3. 8) (7 3. 0) (1 0. 5) (5 4. 8) 55 34 .1 73 .1 28 .9 1, 34 1 Ag e 6– 8 m on th s 15 .4 66 .0 15 .0 27 8 (*) (*) (*) (*) 8 14 .9 65 .4 14 .6 28 8 9– 11 m on th s 26 .2 66 .6 22 .7 23 2 (*) (*) (*) (*) 3 26 .7 66 .6 22 .4 23 5 12 –1 7 m on th s 42 .5 79 .6 38 .3 45 7 (*) (*) (*) (*) 16 42 .8 79 .9 38 .8 48 4 18 –2 3 m on th s 46 .9 77 .8 41 .4 47 2 (6 6. 2) (7 8. 2) (1 7. 1) (5 4. 9) 42 48 .3 77 .9 39 .4 52 4 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 41 Ta bl e NU .8 : I nf an t a nd y ou ng c hi ld fe ed in g pr ac tic es Pe rc en ta ge o f c hil dr en a ge d 6– 23 m on th s w ho re ce ive d ap pr op ria te liq uid s a nd so lid , s em i-s oli d or so ft fo od s t he m ini m um n um be r o f t im es o r m or e du rin g th e pr ev iou s d ay , b y b re as tfe ed ing st at us , N ep al, 20 14 Cu rre nt ly br ea stf ee din g Cu rre nt ly no t b re as tfe ed ing Al l Pe rc en t o f c hil dr en w ho re ce ive d Nu m be r o f ch ild re n ag ed 6 –2 3 m on th s Pe rc en t o f c hil dr en w ho re ce ive d Nu m be r o f ch ild re n ag ed 6 –2 3 m on th s Pe rc en t o f c hil dr en w ho re ce ive d: Nu m be r o f ch ild re n ag ed 6 –2 3 m on th s M ini m um die ta ry div er sit y [a ] M ini m um m ea l fre qu en cy [b ] M ini m um ac ce pt ab le die t [1 ] [ c] M ini m um die ta ry div er sit y [a ] M ini m um m ea l fre qu en cy [b ] M ini m um ac ce pt ab le die t [2 ] [ c] At le as t 2 m ilk fe ed s [3 ] M ini m um die ta ry div er sit y [4 ] [ a] M ini m um m ea l fre qu en cy [5 ] [ b] M ini m um ac ce pt ab le die t [c] M ot he r’s e du ca tio n No ne 25 .7 65 .9 22 .8 54 0 (5 6. 0) (7 2. 5) (8 .9 ) (5 5. 9) 38 27 .6 66 .3 21 .9 58 6 Pr im ar y 29 .0 75 .0 27 .7 24 3 (*) (*) (*) (*) 5 29 .9 74 .8 27 .6 25 5 Se co nd ar y 40 .0 79 .9 34 .9 33 7 (*) (*) (*) (*) 11 40 .2 79 .7 34 .2 35 1 Hi gh er 54 .4 82 .4 49 .3 31 6 (*) (*) (*) (*) 14 54 .8 82 .8 50 .0 33 6 W ea lth in de x qu in til e Po or es t 32 .5 74 .3 30 .8 32 3 (*) (*) (*) (*) 10 32 .8 74 .1 30 .6 33 0 Se co nd 33 .2 76 .1 29 .2 31 1 (*) (*) (*) (*) 14 35 .1 76 .6 28 .4 33 2 M idd le 27 .4 69 .5 24 .0 29 5 (*) (*) (*) (*) 9 29 .6 69 .2 23 .5 31 1 Fo ur th 39 .5 70 .9 33 .5 30 4 (*) (*) (*) (*) 21 38 .2 71 .4 31 .9 33 0 Ri ch es t 53 .1 83 .3 49 .3 20 7 (*) (*) (*) (*) 16 54 .1 83 .0 50 .2 22 8 [1 ] M IC S in di ca to r 2 .1 7a – M in im um a cc ep ta bl e di et (b re as tfe d) [2 ] M IC S in di ca to r 2 .1 7b – M in im um a cc ep ta bl e di et (n on -b re as tfe d) [3 ] M IC S in di ca to r 2 .1 4 – M ilk fe ed in g fre qu en cy fo r n on -b re as tfe d ch ild re n [4 ] M IC S in di ca to r 2 .1 6 – M in im um d ie ta ry d iv er si ty [5 ] M IC S in di ca to r 2 .1 5 – M in im um m ea l f re qu en cy [a ] M ini m um d iet ar y d ive rs ity is d ef ine d as re ce ivi ng fo od s f ro m a t le as t f ou r o f s ev en fo od g ro up s: (1 ) g ra ins , r oo ts an d tu be rs ; ( 2) le gu m es a nd n ut s; (3 ) d air y p ro du cts (m ilk , y og ur t, ch ee se ); (4 ) f les h fo od s (m ea t, fis h, p ou ltr y a nd liv er /o rg an m ea ts) ; ( 5) e gg s; (6 ) f ru its a nd ve ge ta ble s r ich in vi ta m in A; a nd (7 ) o th er fr uit s a nd ve ge ta ble s [b ] M ini m um m ea l fr eq ue nc y a m on g cu rre nt ly br ea stf ee din g ch ild re n is de fin ed a s c hil dr en w ho a lso re ce ive d so lid , s em i-s oli d or so ft fo od s t wo tim es o r m or e da ily fo r c hil dr en a ge d 6– 8 m on th s a nd th re e tim es or m or e da ily fo r c hil dr en a ge d 9– 23 m on th s. Fo r n on -b re as tfe ed ing ch ild re n ag ed 6 –2 3 m on th s, it i s d ef ine d as re ce ivi ng so lid , s em i-s oli d or so ft fo od s, or m ilk fe ed s, at le as t f ou r t im es a d ay . [c] T he m ini m um a cc ep ta ble d iet fo r b re as tfe d ch ild re n ag ed 6 –2 3 m on th s i s d ef ine d as re ce ivi ng th e m ini m um d iet ar y d ive rs ity a nd th e m ini m um m ea l fr eq ue nc y, wh ile fo r n on -b re as tfe d ch ild re n, it re qu ire s a t lea st tw o m ilk fe ed ing s a nd th at th e m ini m um d iet ar y d ive rs ity is a ch iev ed w ith ou t c ou nt ing m ilk fe ed s. No te : 3 ca se s o f m iss ing ‘m ot he r’s e du ca tio n’ no t s ho wn ( ) F igu re s t ha t a re b as ed o n 25 –4 9 un we igh te d ca se s (*) F igu re s t ha t a re b as ed o n fe we r t ha n 25 u nw eig ht ed ca se s C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201442 The continued practice of bottle-feeding is a concern because of possible contamination due to unsafe water and lack of hygiene in preparation. Table NU.9 shows that 12 percent of children aged 0–23 months in Nepal were fed using a bottle with a nipple. Urban children were much more likely than rural children to be bottle fed with a nipple (24 percent compared to 10 percent). Bottle feeding with a nipple was positively correlated with mother’s education and household wealth status. Salt Iodization Iodine deficiency disorders (IDD) is the world’s leading cause of preventable mental retardation and impaired psychomotor development in young children. In its most extreme form, iodine deficiency causes cretinism. It also increases the risks of stillbirth and miscarriage in pregnant women. Iodine deficiency is most commonly and visibly associated with goitre. IDD takes its greatest toll in impaired mental growth and development, contributing in turn to poor school performance, reduced intellectual Table NU.9: Bottle feeding Percentage of children aged 0–23 months who were fed with a bottle with a nipple during the previous day, Nepal, 2014 Percent fed with a bottle with a nipple [1] Number of children aged 0–23 months Total 11.5 1,986 Sex Male 11.5 1,061 Female 11.6 925 Region Eastern Mountains 4.9 31 Eastern Hills 6.8 114 Eastern Terai 14.5 271 Central Mountains 1.8 36 Central Hills 21.1 227 Central Terai 7.8 405 Western Mountains (11.6) 1 Western Hills 11.4 223 Western Terai 9.9 179 Mid-Western Mountains 5.2 40 Mid-Western Hills 14.9 147 Mid-Western Terai 18.9 108 Far Western Mountains 7.1 33 Far Western Hills 4.7 76 Far Western Terai 7.6 96 Area Urban 24.0 248 Kathmandu valley 36.4 59 Other urban 20.1 190 Rural 9.8 1,737 Age 0–5 months 4.9 455 6–11 months 14.4 523 12–23 months 13.1 1,008 Mother’s education None 7.3 748 Primary 9.2 330 Secondary 11.1 483 Higher 21.5 422 Wealth index quintile Poorest 6.4 416 Second 8.6 438 Middle 5.2 422 Fourth 15.8 407 Richest 26.1 303 [1] MICS indicator 2.18 – Bottle feeding Note: 3 cases of missing ‘mother’s education’ not shown ( ) Figures that are based on 25–49 unweighted cases NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 43 ability, and impaired work performance. The indicator is the percentage of households consuming adequately iodized salt (≥15 parts per million). In Nepal, three major subnational surveys (1965, 1979–82 and 1985–86) found a high prevalence of IDD. This provided an impetus for the establishment of the national IDD programme in 1998. The primary intervention implemented in Nepal to control IDD is the universal iodization of all edible salt. Other strategies include advocacy at national and district levels, mass media campaigns to promote the use of packet iodized salt with the ‘two-child logo’, demand creation for crushed salt and other varieties of packed salt, and awareness-raising among health workers and the general public. In nearly 100 percent of surveyed households, salt used for cooking was tested for iodine content by using salt test kits and testing for the presence of potassium iodate. Table NU.10 shows that in less than 1 percent of households, there was no salt available. These households are included in the denominator of the indicator. In 82 percent of households, salt was found to contain 15 parts per million (ppm) or more of iodine. Use of iodized salt was lowest in the Far Western Hills (54 percent) and highest in the Central Hills (92 percent). Almost all (96 percent) of urban households were found to be using adequately iodized salt as compared to only 78 percent in rural areas. Interestingly, the difference between the richest and poorest households in terms of iodized salt consumption is much greater than expected, varying from 64 percent for the poorest households to 98 percent for the richest households. Table NU.10: Iodized salt consumption Percentage of households by consumption of iodized salt, Nepal, 2014 Percent in which salt was tested Number of house- holds Percent with: Total Number of house- holds in which salt was tested or with no salt No salt Salt test result Not iodized 0 ppm >0 and <15 ppm 15+ ppm [1] Total 99.6 12,405 0.2 3.9 14.4 81.5 100.0 12,379 Region Eastern Mountains 99.4 179 0.1 4.4 19.6 75.9 100.0 178 Eastern Hills 99.8 767 0.2 2.7 23.1 74.0 100.0 767 Eastern Terai 99.3 1,845 0.3 2.3 22.6 74.8 100.0 1,837 Central Mountains 99.6 299 0.4 1.3 25.9 72.4 100.0 299 Central Hills 99.7 2,182 0.2 3.2 4.4 92.2 100.0 2,179 Central Terai 99.5 1,924 0.2 2.1 10.6 87.2 100.0 1,918 Western Mountains 98.6 10 0.5 21.5 5.4 72.6 100.0 10 Western Hills 99.6 1,628 0.3 2.8 5.5 91.4 100.0 1,626 Western Terai 99.7 924 0.1 2.0 14.0 83.9 100.0 923 Mid-Western Mountains 99.6 156 0.3 18.7 18.6 62.5 100.0 156 Mid-Western Hills 99.8 763 0.1 10.3 20.7 68.9 100.0 763 Mid-Western Terai 99.6 672 0.2 9.2 13.6 76.9 100.0 671 Far Western Mountains 99.2 185 0.1 2.4 17.7 79.8 100.0 184 Far Western Hills 99.9 346 0.1 2.6 43.8 53.5 100.0 346 Far Western Terai 99.2 524 0.4 9.3 18.0 72.3 100.0 522 Area Urban 99.3 2,476 0.3 0.6 2.6 96.4 100.0 2,467 Kathmandu valley 99.6 782 0.2 0.3 1.1 98.4 100.0 780 Other urban 99.2 1,694 0.4 0.8 3.4 95.5 100.0 1,686 Rural 99.6 9,929 0.2 4.7 17.3 77.8 100.0 9,912 Wealth index quintile Poorest 99.6 2,376 0.3 8.9 27.3 63.5 100.0 2,374 Second 99.4 2,558 0.4 5.1 18.0 76.5 100.0 2,551 Middle 99.8 2,289 0.0 3.6 18.0 78.4 100.0 2,285 Fourth 99.3 2,441 0.3 2.0 9.1 88.7 100.0 2,430 Richest 99.7 2,742 0.1 0.4 1.5 98.0 100.0 2,739 [1] MICS indicator 2.19 – Iodized salt consumption NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201444 Figure NU.4: Use of iodized salt, Nepal, 2014 For the Nepal MICS, country-specific information was collected on the type of salt used by households. Salt is sold in three main varieties: large crystal salt; powder salt either loose or packaged; and Tibetan salt. Although it can be iodized, large crystal salt has poor iodine retention, and during transportation, storage and handling, much of the iodine evaporates, often leaving a too-low content at the time of consumption. Powder salt can be iodized and retains iodine well if it is packaged. However, not all packaged salt is adequately iodized; therefore, the government runs a two-child logo campaign that endorses the iodine content of packaged salt bearing the logo. All salt supplied by Nepal’s Salt Trading Corporation is iodized at the level of 50 ppm so that it contains at least 15 ppm by the time it is used for household consumption. Table NU.11 shows the type of salt used by households. Some 76 percent of households used packaged salt with the two-child logo endorsing it as adequately iodized. An additional 7 percent used packaged salt with no logo and 4 percent used loose powder salt. Large crystal salt was used by 12 percent of households and a very small proportion used Tibetan salt (less than 1 percent). The type of salt used is closely linked to the type that is commonly available as well as most affordable; consequently, there is great regional variation in the type of salt used. Further, households are willing to use packaged salt with the two-child logo when it is available at an affordable price. When this is not the case, large crystal salt is most commonly used. Rural households were less likely than urban households to use packaged salt with the two-child logo. Household wealth was positively associated the use of packaged salt with the two-child logo. Figure NU.4 shows the variations by region, area and wealth quintile in the use of iodized salt and adequately iodized salt. Nepal  MICS  2014   25     Figure NU.4: Use of iodized salt, Nepal, 2014 For the Nepal MICS, country-specific information was collected on the type of salt used by households. Salt is sold in three main varieties: large crystal salt; powder salt either loose or packaged; and Tibetan salt. Although it can be iodized, large crystal salt has poor iodine retention, and during transportation, storage and handling, much of the iodine evaporates, often leaving a too-low content at the time of consumption. Powder salt can be iodized and retains iodine well if it is packaged. However, not all packaged salt is adequately iodized; therefore, the government runs a two-child logo campaign that endorses the iodine content of packaged salt bearing the logo. All salt supplied by Nepal’s Salt Trading Corporation is iodized at the level of 50 ppm so that it contains at least 15 ppm by the time it is used for household consumption. Table NU.11 shows the type of salt used by households. Some 76 percent of households used packaged salt with the two-child logo endorsing it as adequately iodized. An additional 7 percent used packaged salt with no logo and 4 percent used loose powder salt. Large crystal salt was used by 12 percent of households and a very small proportion used Tibetan salt (less than 1 percent). The type of salt used is closely linked to the type that is commonly available as well as most affordable; consequently, there is great regional variation in the 95 97 97 98 97 98 78 97 98 81 90 91 97 97 90 99 100 99 95 91 94 96 98 100 96 76 74 75 72 92 87 73 91 84 62 69 77 80 54 72 96 98 96 78 64 76 78 89 98 82 0 20 40 60 80 100 Pe r  c en t Any iodine 15+ PPM of iodine P er ce nt NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 45 Ne pa l&M IC S&2 01 4& 20 # # Ta bl e NU .1 1: T yp e of s al t u se d in h ou se ho ld s Pe rc en ta ge o f h ou se ho lds b y t yp e of sa lt u se d to co ok m ea ls, N ep al, 2 01 4 Pe rc en t in wh ich sa lt wa s o bs er ve d Nu m be r o f ho us eh old s Pe rc en t b y t yp e of sa lt To ta l Nu m be r o f ho us eh old s i n wh ich sa lt wa s o bs er ve d La rg e cr ys ta l sa lt Lo os e po wd er sa lt Pa ck ag ed po wd er sa lt wi th ou t lo go Pa ck ag ed po wd er w ith log o Ti be ta n sa lt Ot he r To ta l 97 .8 12 ,4 05 12 .4 3. 8 6. 9 76 .4 0. 1 0. 3 10 0. 0 12 ,1 33 Re gi on Ea ste rn M ou nt ain s 99 .4 17 9 15 .5 18 .9 2. 1 62 .0 1. 4 0. 0 10 0. 0 17 8 Ea ste rn H ills 99 .8 76 7 17 .3 22 .1 2. 3 58 .2 0. 0 0. 0 10 0. 0 76 5 Ea ste rn T er ai 98 .8 1, 84 5 0. 1 8. 1 20 .2 71 .4 0. 0 0. 1 10 0. 0 1, 82 2 Ce nt ra l M ou nt ain s 91 .1 29 9 38 .7 0. 5 2. 0 58 .8 0. 0 0. 0 10 0. 0 27 3 Ce nt ra l H ills 93 .5 2, 18 2 8. 9 0. 6 0. 8 89 .7 0. 0 0. 0 10 0. 0 2, 04 1 Ce nt ra l T er ai 99 .2 1, 92 4 0. 3 1. 0 10 .9 85 .9 0. 0 1. 9 10 0. 0 1, 90 9 W es te rn M ou nt ain s 97 .5 10 0. 6 0. 0 3. 5 75 .8 20 .1 0. 0 10 0. 0 10 W es te rn H ills 98 .7 1, 62 8 9. 3 0. 5 0. 4 89 .7 0. 1 0. 0 10 0. 0 1, 60 7 W es te rn T er ai 98 .0 92 4 5. 3 3. 1 15 .3 76 .3 0. 0 0. 0 10 0. 0 90 5 M id- W es te rn M ou nt ain s 99 .3 15 6 21 .0 2. 0 4. 0 70 .7 2. 3 0. 0 10 0. 0 15 5 M id- W es te rn H ills 99 .5 76 3 39 .4 0. 4 0. 6 59 .6 0. 0 0. 0 10 0. 0 76 0 M id- W es te rn T er ai 98 .3 67 2 22 .9 2. 8 2. 6 71 .2 0. 3 0. 2 10 0. 0 66 1 Fa r W es te rn M ou nt ain s 99 .3 18 5 24 .3 0. 2 12 .3 63 .0 0. 2 0. 0 10 0. 0 18 4 Fa r W es te rn H ills 99 .9 34 6 59 .4 0. 4 2. 2 38 .1 0. 0 0. 0 10 0. 0 34 5 Fa r W es te rn T er ai 98 .8 52 4 23 .8 3. 1 2. 6 70 .5 0. 0 0. 0 10 0. 0 51 7 Ar ea Ur ba n 97 .1 2, 47 6 1. 8 1. 0 1. 9 95 .1 0. 1 0. 0 10 0. 0 2, 40 4 Ka th m an du va lle y 95 .4 78 2 0. 3 0. 0 1. 0 98 .5 0. 1 0. 1 10 0. 0 74 6 Ot he r u rb an 97 .9 1, 69 4 2. 4 1. 5 2. 3 93 .6 0. 1 0. 0 10 0. 0 1, 65 8 Ru ra l 98 .0 9, 92 9 15 .1 4. 5 8. 1 71 .8 0. 1 0. 4 10 0. 0 9, 73 0 W ea lth in de x qu in til e Po or es t 98 .1 2, 37 6 41 .4 5. 0 2. 5 50 .9 0. 2 0. 0 10 0. 0 2, 33 0 Se co nd 96 .6 2, 55 8 14 .2 6. 2 10 .3 68 .8 0. 1 0. 3 10 0. 0 2, 47 0 M idd le 98 .2 2, 28 9 6. 2 5. 1 13 .5 74 .5 0. 0 0. 7 10 0. 0 2, 24 9 Fo ur th 98 .3 2, 44 1 2. 0 2. 7 7. 6 87 .0 0. 1 0. 6 10 0. 0 2, 39 8 Ri ch es t 98 .0 2, 74 2 0. 2 0. 5 1. 5 97 .7 0. 1 0. 0 10 0. 0 2, 68 6 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201446 Micronutrient Intake Nepal has made considerable progress in the control of micronutrient deficiencies; for example, vitamin A supplementation for children aged 6–59 months has been maintained at above 90-percent coverage over the last 15 years. Anaemia among women and children under five dropped significantly for a decade; however, the rate of decline has slowed over the last five years. Iron supplementation for pregnant and lactating women is one of the strategies adopted by the Ministry of Health and Population (MoHP) to prevent anaemia. It is recommended that women take iron/folic acid tablets for at least 180 days during pregnancy, preferably starting in the first trimester. Women need to continue taking iron/ folic acid tablets for 45 days after delivery to meet overall compliance of 225 tablets for pregnant and lactating women. It is also recommended that women receive deworming medication during pregnancy. Therefore, country-specific questions on whether women had taken iron folic tablets during pregnancy were asked to women with a live birth in the past two years. Of women aged 15–49 years with a live birth in the two years preceding the survey, 41 percent took iron/folic acid tablets for at least 180 days during their pregnancy and 34 percent took them for 90–179 days, giving a total of 75 percent of women taking tablets for at least 90 days. Another 8 percent took some tablets but for fewer than 90 days and 16 percent of women did not take any iron/ folic acid tablets. There were significant regional variations in the proportion of women taking iron/folic acid tablets for at least 180 days, ranging from 10 percent in the Mid-Western Mountains to 53 percent in the Central Terai. Urban women were more likely than rural women to take iron/folic acid tablets for at least 180 days (51 percent compared to 40 percent). Mother’s education and household wealth status were both positively correlated with the likelihood of taking iron/folic acid tablets for at least 180 days. Some 63 percent of women also received deworming medication. There was wide regional variation from 38 percent of women in the Central Hills to 82 percent of women in the Far Western Terai. Education level was positively associated with taking deworming medication. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 47 Children’s Vitamin A Supplementation Vitamin A is essential for eye health and proper functioning of the immune system. It is found in foods such as milk, liver, eggs, red and orange fruits, red palm oil and green leafy vegetables, although the amount of vitamin A readily available to the body from these sources varies widely. In developing areas of the world, where vitamin A is largely consumed in the form of fruits and vegetables, daily per capita intake is often insufficient to meet dietary requirements. Inadequate intakes are further compromised by increased requirements for the vitamin as children grow or during periods of illness, as well as increased losses during common childhood infections. Table NU.12: Micronutrient intake among mothers Percentage of women aged 15–49 years with a live birth in the two years preceding the survey by number of days they took iron/folic acid tablets during pregnancy for the last birth, and percentage who took deworming tablets during pregnancy for the last birth, Nepal, 2014 Percent who took iron/folic acid tablets by number of days Total Percent who took deworm- ing medica- tion Number of women with a live birth in the last two years None <60 60–89 90–179 180+ DK/ Missing Total 16.4 5.7 2.3 33.8 41.1 0.7 100.0 62.8 2,048 Region Eastern Mountains 22.6 9.5 7.8 31.4 28.7 0.0 100.0 68.1 32 Eastern Hills 20.8 11.0 1.0 25.2 42.0 0.0 100.0 78.9 123 Eastern Terai 11.8 2.9 0.3 32.2 52.8 0.0 100.0 61.3 277 Central Mountains 19.5 1.5 2.4 38.6 38.0 0.0 100.0 63.9 38 Central Hills 12.4 5.9 2.2 37.3 41.5 0.7 100.0 38.4 241 Central Terai 17.8 4.3 1.1 22.8 53.0 1.0 100.0 47.3 400 Western Mountains (9.2) (6.4) (3.1) (41.6) (39.7) (0.0) 100.0 (76.3) 1 Western Hills 10.9 9.7 1.3 24.6 52.6 0.8 100.0 79.4 222 Western Terai 13.5 3.1 5.6 47.7 27.8 2.3 100.0 64.9 178 Mid-Western Mountains 38.1 12.1 5.9 34.2 9.7 0.0 100.0 57.7 43 Mid-Western Hills 30.9 7.8 3.5 43.4 13.8 0.6 100.0 65.4 166 Mid-Western Terai 11.3 10.1 4.4 34.4 39.7 0.0 100.0 80.6 113 Far Western Mountains 17.4 0.8 2.8 32.9 44.6 1.5 100.0 80.3 33 Far Western Hills 16.5 1.0 1.3 52.9 28.2 0.0 100.0 80.3 75 Far Western Terai 14.0 2.2 3.0 47.7 31.5 1.6 100.0 82.2 106 Area Urban 5.2 8.9 2.1 32.2 51.1 0.5 100.0 58.9 262 Kathmandu valley 0.0 12.6 1.7 32.6 53.2 0.0 100.0 32.5 65 Other urban 7.0 7.7 2.2 32.1 50.4 0.6 100.0 67.7 197 Rural 18.0 5.2 2.3 34.1 39.6 0.7 100.0 63.3 1,786 Education None 26.9 6.7 3.3 31.9 30.0 1.1 100.0 53.1 754 Primary 19.9 6.0 2.5 33.4 37.2 1.0 100.0 61.5 346 Secondary 10.2 6.3 1.7 35.3 46.4 0.0 100.0 70.9 503 Higher 2.9 3.0 0.9 35.7 56.9 0.6 100.0 71.0 445 Wealth index quintile Poorest 34.3 6.2 2.3 35.4 20.9 0.9 100.0 60.6 454 Second 19.3 6.2 1.7 31.5 41.1 0.2 100.0 61.8 436 Middle 11.5 3.5 2.8 33.6 48.0 0.6 100.0 65.4 441 Fourth 9.7 8.3 2.9 34.4 44.1 0.6 100.0 67.0 401 Richest 2.0 4.0 1.5 34.4 56.5 1.4 100.0 58.2 316 ( ) Figures that are based on 25–49 unweighted cases NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201448 The National Vitamin A Programme (NVAP) in accordance with WHO guideline was initiated by the Government of Nepal in 1993. The primary activity of the NVAP, among other things, is supplementation of high-dose vitamin A capsule to 6–11-month-old children (100,000 IU) and 12–59-month-old children (200,000 IU) semi-annually. By 2002, the NVAP covered all 75 districts of the country and maintained a very high capsule coverage. Although vitamin A supplementation covers children aged 6–59 months, only children aged 6–35 months were used in this analysis due to the fact that the government has recently focused on younger children. The country-specific question on Vitamin A supplementation was asked to mothers/caretakers of children aged 6–35 months. Table NU.13 shows that 90 percent of children aged 6–35 months had received vitamin A supplementation during the six months preceding the survey. There was little variation by background characteristics. The most notable exceptions were that only 71 percent of children in the Mid-Western Mountains had received vitamin A supplementation; and only 78 percent of children aged 6–11 months had done so. Table NU.13: Children’s vitamin A supplementation Percentage of children aged 6–35 months by receipt of high-dose vitamin A supplementation during the six months preceding the survey, Nepal, 2014 Percent who received vitamin A Number of children aged 6–35 months Total 90.3 2,610 Sex Male 90.2 1,358 Female 90.4 1,251 Region Eastern Mountains 98.7 36 Eastern Hills 93.3 147 Eastern Terai 89.1 373 Central Mountains 95.6 51 Central Hills 91.1 316 Central Terai 85.4 515 Western Mountains (97.8) 1 Western Hills 97.9 291 Western Terai 95.1 243 Mid-Western Mountains 71.1 52 Mid-Western Hills 87.3 197 Mid-Western Terai 85.7 144 Far Western Mountains 93.4 47 Far Western Hills 92.6 96 Far Western Terai 92.6 99 Area Urban 93.5 338 Kathmandu valley 92.4 86 Other urban 93.9 252 Rural 89.8 2,271 Age 6–11 months 78.3 523 12–23 months 92.0 1,008 24–35 months 94.6 1,079 Mother’s education None 87.7 989 Primary 91.5 463 Secondary 91.9 609 Higher 92.5 547 Wealth index quintile Poorest 90.8 561 Second 88.3 545 Middle 91.5 542 Fourth 88.7 545 Richest 92.9 416 Note: 3 cases of missing ‘mother’s education’ not shown ( ) Figures that are based on 25–49 unweighted cases NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 49 Child Health C H A P T E R6 Vaccinations MDG 4 aims to reduce child mortality by two-thirds between 1990 and 2015. Immunization plays a key part in this goal. In addition, the Global Vaccine Action Plan (GVAP) was endorsed by the 194 Member States of the World Health Assembly in May 2012 to achieve the Decade of Vaccines vision by delivering universal access to immunization. Immunization has saved the lives of millions of children in the four decades since the launch of the Expanded Programme on Immunization (EPI) in 1974. However, worldwide there are still millions of children not reached by routine immunization and, as a result, vaccine-preventable diseases cause more than 2 million deaths every year. According to the MoHP, a child should receive a BCG vaccination to protect against tuberculosis, three doses of DPT-containing vaccine to protect against diphtheria, pertussis, and tetanus, three doses of polio vaccine, and a first dose of measles vaccination before his or her first birthday. The vaccination schedule followed by the Nepal National Immunization Programme provides all of the above-mentioned vaccinations as well as three doses of vaccine against Hepatitis B and three doses of Haemophilus influenzae type b (Hib) vaccine along with the DPT vaccine (together known as ‘PENTA’). All these vaccinations should be received during the first year of life. In addition, some children in at-risk areas are given a vaccination against Japanese encephalitis. Taking into consideration this vaccination schedule, the estimates for full immunization coverage from the Nepal MICS are based on children aged 12–23 months or 24–35 months. Information on vaccination coverage was collected for all children under three years of age. All mothers/caretakers were asked to provide vaccination cards. If the vaccination card for a child was available, interviewers copied vaccination information from the cards on to the MICS questionnaire. If no vaccination card was available for the child, the interviewer proceeded to ask the mother to recall whether or not the child had received each of the vaccinations, and for polio, DPT and Hepatitis B, how many doses were received. The final vaccination coverage estimates are based on information obtained from the vaccination card and the mother’s report of vaccinations received by the child. According to Table DQ.15 in Appendix D (page 291), 74 percent of children aged 12–23 months and 59 percent of those aged 24–35 months had a vaccination card; of these, cards were actually seen by the interviewer for 54 percent of children aged 12–23 months and 30 percent of those aged 24–35 months. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201450 Ta bl e CH .1 : V ac ci na tio ns in th e fir st y ea rs o f l ife Pe rc en ta ge o f c hil dr en a ge d 12 –2 3 m on th s a nd 2 4– 35 m on th s v ac cin at ed a ga ins t v ac cin e- pr ev en ta ble ch ild ho od d ise as es a t a ny tim e be fo re th e su rv ey a nd b y t he ir fir st bir th da y, Ne pa l, 2 01 4 Ch ild re n ag ed 1 2– 23 m on th s: Ch ild re n ag ed 2 4– 35 m on th s: Va cc ina te d at a ny tim e be fo re th e su rv ey a cc or din g to : Va cc ina te d by 1 2 m on th s o f a ge [a ] Va cc ina te d at a ny tim e be fo re th e su rv ey a cc or din g to : Va cc ina te d by 1 2 m on th s o f a ge Va cc ina tio n ca rd M ot he r’s re po rt Ei th er Va cc ina tio n ca rd M ot he r’s re po rt Ei th er BC G [1 ] 39 .4 56 .3 95 .7 87 .5 17 .3 77 .9 95 .2 85 .7 Po lio 1 39 .3 57 .1 96 .4 89 .1 17 .3 78 .3 95 .6 86 .6 2 38 .4 56 .7 95 .1 88 .6 16 .9 78 .2 95 .1 84 .9 3 [2 ] 37 .4 54 .3 91 .8 85 .2 16 .6 76 .8 93 .4 82 .4 PE NT A 1 39 .4 55 .9 95 .3 88 .7 17 .3 77 .6 94 .9 85 .9 2 38 .2 55 .2 93 .4 87 .2 16 .9 74 .9 91 .8 84 .0 3 [3 ] 37 .5 50 .8 88 .3 83 .1 16 .6 69 .5 86 .0 77 .3 He pB 1 39 .4 55 .9 95 .3 88 .7 17 .3 77 .6 94 .9 85 .9 2 38 .2 55 .2 93 .4 87 .2 16 .9 74 .9 91 .8 84 .0 3 [4 ] 37 .5 50 .8 88 .3 83 .1 16 .6 69 .5 86 .0 77 .3 Hi b 1 39 .4 55 .9 95 .3 88 .7 17 .3 77 .6 94 .9 85 .9 2 38 .2 55 .2 93 .4 87 .2 16 .9 74 .9 91 .8 84 .0 3 [5 ] 37 .5 50 .8 88 .3 83 .1 16 .6 69 .5 86 .0 77 .3 M ea sl es (M CV 1) [7 ] 38 .0 54 .6 92 .6 84 .5 16 .1 77 .7 93 .9 82 .2 Fu lly v ac ci na te d [8 ] [b ] 37 .0 47 .5 84 .5 67 .1 17 .1 68 .0 85 .1 66 .1 No v ac ci na tio ns 0. 0 3. 4 3. 4 5. 6 0. 0 4. 4 4. 4 6. 9 Nu m be r o f c hi ld re n 1, 00 8 1, 00 8 1, 00 8 1, 00 8 1, 07 9 1, 07 9 1, 07 9 1, 07 9 [1 ] M IC S in di ca to r 3 .1 – T ub er cu lo si s im m un iza tio n co ve ra ge [2 ] M IC S in di ca to r 3 .2 – P ol io im m un iza tio n co ve ra ge [3 ] M IC S in di ca to r 3 .3 – D ip ht he ria , p er tu ss is a nd te ta nu s (D PT ) i m m un iza tio n co ve ra ge [4 ] M IC S in di ca to r 3 .5 – H ep at iti s B im m un iza tio n co ve ra ge [5 ] M IC S in di ca to r 3 .6 – H ae m op hi lu s in flu en za e ty pe B (H ib ) i m m un iza tio n co ve ra ge [7 ] M IC S in di ca to r 3 .4 ; M DG in di ca to r 4 .3 – M ea sl es im m un iza tio n co ve ra ge [8 ] M IC S in di ca to r 3 .8 – F ul l i m m un iza tio n co ve ra ge [a ] A ll M IC S ind ica to rs re fe r t o re su lts in th is co lum n [b ] I nc lud es : B CG , P oli o3 , D PT 3, H ep B3 , H ib3 , a nd m ea sle s ( M CV 1) a s p er th e va cc ina tio n sc he du le in Ne pa l NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 51 The proportions of children aged 12–23 months and 24–35 months who had received each of the specified vaccinations by source of information (vaccination card and mother’s recall) are shown in Tables CH.1 and Figure CH.1. The denominators for the tables are comprised of children aged 12–23 months and 24–35 months so that only children who are old enough to be fully vaccinated are counted. In the first three columns in each panel of the table, the numerator includes all children who were vaccinated at any time before the survey according to the vaccination card or the vaccination records at health facilities or the mother’s report. In the last column in each panel, only those children who were vaccinated before their first birthday, as recommended, are included. For children without vaccination cards/records, the proportion of vaccinations given before the first birthday is assumed to be the same as for children with vaccination cards/records. In total, 67 percent of children aged 12–23 months had received all recommended vaccinations by their first birthday; this level of coverage is considered to be low. Some 88 percent of children had received a BCG vaccination by the age of 12 months. Similarly, 89 percent of children had received Polio 1 by the age of 12 months, and this declined to 85 percent for the third dose. PENTA 1 was given to 89 percent, declining to 87 percent for the second dose and 83 percent for the third dose. Coverage for the first dose of measles vaccine is 85 percent. Coverage figures for children aged 24–35 months are generally similar to those aged 12–23 months suggesting that immunization coverage has been stable between 2013 and 2014. In total, 66 percent of children aged 24–35 months had received all recommended vaccinations by their first birthday. Figure CH.1: Vaccinations by age of 12 months for children aged 12–23 months and 24–35 months, Nepal, 2014 Japanese Encephalitis Although Japanese encephalitis (JE) is endemic mainly in the tropical areas of Nepal, the existence and proliferation of encephalitis-causing viruses are also seen in the temperate and cold hills and val- leys of the country. The MoHP conducts both routine and campaign JE vaccination in selected districts1 of Nepal. The immunization schedule recommends that children aged 12–24 months receive JE vacci- nation once before the age of 24 months. A country-specific indicator on JE was included in the Nepal 1Banke, Bara, Bardiya, Bhaktapur, Chitawan, Dang, Dhading, Dhanusha, Jhapa, Kailali, Kanchanpur, Kapilbastu, Kaski, Kathmandu, Kavrepalanchok, Lalit- pur, Mahottari, Makwanpur, Morang, Nawalparasi, Palpa, Parsa, Rautahat, Rupandehi, Saptari, Sarlahi, Sindhuli, Siraha, Sunsari, Surkhet and Udayapur.   3   The  proportions  of  children  aged  12–23  months  and  24–35  months  who  had  received  each  of  the   specified  vaccinations  by  source  of  information  (vaccination  card  and  mother’s  recall)  are  shown  in   Tables  CH.1  and  Figure  CH.1.  The  denominators  for  the  tables  are  comprised  from  children  aged  12– 23  months  and  24–35  months  so  that  only  children  who  are  old  enough  to  be  fully  vaccinated  are   counted.  In  the  first  three  columns  in  each  panel  of  the  table,  the  numerator  includes  all  children   who  were  vaccinated  at  any  time  before  the  survey  according  to  the  vaccination  card  or  the   vaccination  records  at  health  facilities  or  the  mother’s  report.  In  the  last  column  in  each  panel,  only   those  children  who  were  vaccinated  before  their  first  birthday,  as  recommended,  are  included.  For   children  without  vaccination  cards/records,  the  proportion  of  vaccinations  given  before  the  first   birthday  is  assumed  to  be  the  same  as  for  children  with  vaccination  cards/records.   In  total,  67  percent  of  children  aged  12–23  months  had  received  all  recommended  vaccinations  by   their  first  birthday;  this  level  of  coverage  is  considered  to  be  low.  Some  88  percent  of  children  had   received  a  BCG  vaccination  by  the  age  of  12  months.  Similarly,  89  percent  of  children  had  received   Polio  1  by  the  age  of  12  months,  and  this  declined  to  85  percent  by  the  third  dose.  PENTA  1  was   given  to  89  percent,  declining  to  87  percent  for  the  second  dose  and  83  percent  for  the  third  dose.   Coverage  for  the  first  dose  of  measles  vaccine  is  at  85  percent.  Coverage  figures  for  children  aged   24–35  months  are  generally  similar  to  those  aged  12–23  months  suggesting  that  immunization   coverage  has  been  stable  between  2013  and  2014.  In  total,  66  percent  of  children  aged  24–35   months  had  received  all  recommended  vaccinations  by  their  first  birthday.   Figure  CH.1:  Vaccinations  by  age  of  12  months  for  children  aged  12–23  months  and  24–35  months,   Nepal,  2014         Table   CH.2   presents   vaccination   coverage   among   children   aged   12–23   months   by   background   characteristics.  The  figures  indicate  children  receiving  vaccinations  at  any  time  up  to  the  date  of  the   88 89 89 85 89 87 83 85 89 87 83 89 87 83 67 6 BCG Polio1 Polio2 Polio3 DPT1 DPT2 DPT3 Measles HepB1 HepB2 HepB3 Hib1 Hib2 Hib3 Fully vaccinated No vaccinations Per cent Children Aged 12-23 months 86 87 85 82 86 84 77 82 86 84 77 86 84 77 66 7 BCG Polio1 Polio2 Polio3 DPT1 DPT2 DPT3 Measles HepB1 HepB2 HepB3 Hib1 Hib2 Hib3 Fully vaccinated No vaccinations Children Aged 24-35 months Percent NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201452 Table CH.2 presents vaccination coverage among children aged 12–23 months by background characteristics. The figures indicate children receiving vaccinations at any time up to the date of the survey, and are based on information from both the vaccination cards and mothers’/caretakers’ reports. Vaccination cards were observed by the interviewer for 40 percent of children aged 12–23 months. Full immunization coverage was above 80 percent for all regions except the Mid-Western Mountains (57 percent) and Eastern Terai (71 percent); it was highest in the Eastern Mountains (91 percent). Children in urban areas were more likely than those in rural areas to receive all vaccinations (93 percent compared to 83 percent). Mother’s education and household wealth status were both positively associated with full immunization. Children whose mother had no education were less likely than children whose mother had higher education to receive all vaccinations (81 percent compared to 89 percent). Full coverage for children living in households in the bottom four quintiles was grouped around 80–85 percent, while for children living in households in the richest quintile it was 93 percent. MICS 2014 to assess the coverage of JE vaccination. Table CH.1JE presents JE coverage among children aged 15–35 months in selected districts by background characteristics. In total, nearly two- thirds (65 percent) of children had received vaccination against JE. Vaccination cards were observed by the interviewer for 26 percent of children aged 15–35 months. There was variation by region in JE vaccination coverage, ranging from 75 percent of children in the Central Terai to 54 percent of children in the Eastern Terai. Children born to mothers with no education were less likely than others to receive JE vaccination. Household wealth status was positively associated with JE vaccination: children living in the richest households were more likely than those living in the poorest households to be vaccinated against JE (70 percent compared to 60 percent). Table CH.1JE: Vaccinations against Japanese encephalitis Percentage of children aged 15–35 months currently vaccinated against Japanese encephalitis, Nepal, 2014 Percent who received: Percent with vaccination card seen Number of children Japanese encephalitis None Total 65.3 4.6 25.8 1,309 Sex Male 68.2 3.5 28.0 685 Female 62.2 5.8 23.5 624 Region Eastern Hills (*) (*) (*) 21 Eastern Terai 53.7 5.8 26.7 255 Central Hills 55.4 7.4 26.1 217 Central Terai 74.8 4.6 14.3 382 Western Hills (69.5) (0.0) (45.0) 65 Western Terai 66.7 1.4 30.6 175 Mid-Western Hills (85.2) (0.0) (28.5) 26 Mid-Western Terai 70.6 7.9 25.8 101 Far Western Terai 66.5 1.1 48.5 67 Area Urban 61.5 4.8 32.8 222 Kathmandu valley 49.2 11.8 25.4 71 Other urban 67.4 1.4 36.2 151 Rural 66.2 4.5 24.4 1,087 Mother’s education None 61.0 5.9 15.3 484 Primary 69.6 3.2 25.5 238 Secondary 67.5 2.0 34.7 309 Higher 66.7 6.3 34.8 276 Wealth index quintile Poorest 59.1 3.3 28.8 82 Second 62.4 6.5 18.2 252 Middle 61.4 3.4 22.1 341 Fourth 68.6 3.0 26.1 340 Richest 70.0 6.4 35.6 294 Note: 2 cases of missing ‘mother’s education’ not shown ( ) Figures that are based on 25–49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases     NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 53 Ta bl e CH .2 : V ac ci na tio ns b y ba ck gr ou nd c ha ra ct er is tic s Pe rc en ta ge o f c hil dr en a ge d 12 –2 3 m on th s c ur re nt ly va cc ina te d ag ain st va cc ine -p re ve nt ab le ch ild ho od d ise as es , N ep al, 2 01 4 Pe rc en t w ho re ce ive d: Pe rc en t wi th va cc i- na tio n ca rd se en Nu m be r of ch ild - re n ag ed 12 –2 3 m on th s BC G Po lio DP T He pB Hi b M ea sle s (M CV 1) Fu ll [a ] No ne 1 2 3 1 2 3 At b irt h 1 2 3 1 2 3 To ta l 95 .7 96 .4 95 .1 91 .8 95 .3 93 .4 88 .3 44 .0 95 .3 93 .4 88 .3 95 .3 93 .4 88 .3 92 .6 84 .5 3. 4 39 .7 1, 00 8 Se x M ale 96 .7 97 .3 96 .0 92 .6 96 .0 94 .4 89 .8 45 .5 96 .0 94 .4 89 .8 96 .0 94 .4 89 .8 94 .0 86 .3 2. 3 44 .6 54 1 Fe m ale 94 .7 95 .3 94 .1 90 .7 94 .6 92 .2 86 .5 42 .2 94 .6 92 .2 86 .5 94 .6 92 .2 86 .5 91 .1 82 .4 4. 7 34 .1 46 7 Re gi on Ea ste rn M ou nt ain s 10 0. 0 10 0. 0 10 0. 0 98 .4 10 0. 0 98 .6 95 .8 1. 0 10 0. 0 98 .6 95 .8 10 0. 0 98 .6 95 .8 96 .9 91 .1 0. 0 36 .7 15 Ea ste rn H ills 98 .1 98 .1 95 .9 94 .0 98 .1 95 .9 90 .3 15 .7 98 .1 95 .9 90 .3 98 .1 95 .9 90 .3 92 .2 82 .3 1. 9 54 .4 58 Ea ste rn T er ai 92 .0 93 .8 90 .5 84 .4 92 .0 87 .2 77 .5 46 .5 92 .0 87 .2 77 .5 92 .0 87 .2 77 .5 88 .6 71 .1 6. 2 53 .4 12 5 Ce nt ra l M ou nt ain s (1 00 ) (1 00 ) (1 00 ) (1 00 ) (1 00 ) (1 00 ) (1 00 ) (1 3. 0) (1 00 ) (1 00 ) (1 00 ) (1 00 ) (1 00 ) (1 00 ) (1 00 ) (1 00 ) (0 .0 ) (2 6. 6) 19 Ce nt ra l H ills 92 .2 95 .2 94 .3 92 .7 91 .5 92 .0 90 .6 48 .6 91 .5 92 .0 90 .6 91 .5 92 .0 90 .6 91 .8 84 .7 4. 3 42 .4 12 3 Ce nt ra l T er ai 96 .4 96 .4 95 .2 95 .2 96 .4 94 .3 91 .6 70 .3 96 .4 94 .3 91 .6 96 .4 94 .3 91 .6 93 .0 90 .5 3. 6 23 .4 21 2 W es te rn M ou nt ain s (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 1 W es te rn H ills 10 0. 0 10 0. 0 10 0. 0 90 .5 10 0. 0 98 .2 83 .5 21 .9 10 0. 0 98 .2 83 .5 10 0. 0 98 .2 83 .5 96 .9 83 .2 0. 0 44 .3 10 6 W es te rn T er ai 98 .4 98 .4 97 .1 94 .6 97 .1 95 .7 93 .1 51 .1 97 .1 95 .7 93 .1 97 .1 95 .7 93 .1 93 .0 88 .9 1. 6 48 .5 97 M id- W es te rn M ou nt ain s 90 .1 89 .1 89 .1 77 .6 90 .0 86 .9 70 .4 7. 9 90 .0 86 .9 70 .4 90 .0 86 .9 70 .4 79 .8 56 .5 8. 9 10 .3 21 M id- W es te rn H ills 97 .0 95 .8 94 .3 92 .8 97 .0 97 .0 97 .0 28 .9 97 .0 97 .0 97 .0 97 .0 97 .0 97 .0 93 .7 89 .4 3. 0 31 .4 73 M id- W es te rn T er ai 89 .4 91 .2 91 .2 87 .3 89 .1 85 .0 81 .1 65 .6 89 .1 85 .0 81 .1 89 .1 85 .0 81 .1 88 .9 81 .1 8. 6 40 .1 58 Fa r W es te rn M ou nt ain s 10 0. 0 10 0. 0 95 .8 87 .7 98 .5 95 .6 91 .1 10 .5 98 .5 95 .6 91 .1 98 .5 95 .6 91 .1 95 .4 83 .7 0. 0 35 .5 17 Fa r W es te rn H ills 97 .7 98 .9 97 .6 93 .0 97 .7 93 .8 91 .3 4. 1 97 .7 93 .8 91 .3 97 .7 93 .8 91 .3 97 .6 90 .1 1. 1 35 .9 41 Fa r W es te rn T er ai 96 .3 96 .3 96 .3 92 .5 92 .7 92 .7 87 .3 60 .3 92 .7 92 .7 87 .3 92 .7 92 .7 87 .3 92 .7 85 .3 3. 7 62 .6 43 Ar ea Ur ba n 98 .9 98 .4 98 .9 97 .9 98 .0 98 .5 95 .8 49 .9 98 .0 98 .5 95 .8 98 .0 98 .5 95 .8 96 .7 92 .7 1. 1 58 .0 12 5 Ka th m an du va lle y (9 7. 1) (9 5. 3) (9 7. 1) (9 7. 1) (9 4. 0) (9 5. 8) (9 0. 5) (5 9. 6) (9 4. 0) (9 5. 8) (9 0. 5) (9 4. 0) (9 5. 8) (9 0. 5) (9 3. 9) (8 5. 5) (2 .9 ) (5 3. 8) 34 Ot he r u rb an 99 .5 99 .5 99 .5 98 .2 99 .5 99 .5 97 .8 46 .3 99 .5 99 .5 97 .8 99 .5 99 .5 97 .8 97 .8 95 .4 0. 5 59 .6 91 Ru ra l 95 .3 96 .1 94 .6 90 .9 95 .0 92 .7 87 .2 43 .1 95 .0 92 .7 87 .2 95 .0 92 .7 87 .2 92 .1 83 .4 3. 7 37 .1 88 3 M ot he r’s e du ca tio n No ne 92 .0 93 .5 91 .7 89 .8 91 .5 89 .2 83 .9 42 .7 91 .5 89 .2 83 .9 91 .5 89 .2 83 .9 89 .2 80 .6 6. 4 25 .7 39 3 Pr im ar y 96 .6 97 .2 95 .5 92 .8 96 .7 95 .7 91 .5 44 .4 96 .7 95 .7 91 .5 96 .7 95 .7 91 .5 93 .9 87 .4 2. 3 42 .3 17 6 Se co nd ar y 98 .3 98 .2 97 .0 91 .7 97 .9 94 .6 90 .1 41 .2 97 .9 94 .6 90 .1 97 .9 94 .6 90 .1 93 .1 85 .2 1. 5 45 .2 21 9 Hi gh er 99 .1 99 .1 99 .1 94 .5 98 .5 98 .3 92 .3 48 .7 98 .5 98 .3 92 .3 98 .5 98 .3 92 .3 97 .2 89 .0 0. 9 57 .8 21 7 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201454 Ta bl e CH .2 : V ac ci na tio ns b y ba ck gr ou nd c ha ra ct er is tic s Pe rc en ta ge o f c hil dr en a ge d 12 –2 3 m on th s c ur re nt ly va cc ina te d ag ain st va cc ine -p re ve nt ab le ch ild ho od d ise as es , N ep al, 2 01 4 Pe rc en t w ho re ce ive d: Pe rc en t wi th va cc i- na tio n ca rd se en Nu m be r of ch ild - re n ag ed 12 –2 3 m on th s BC G Po lio DP T He pB Hi b M ea sle s (M CV 1) Fu ll [a ] No ne 1 2 3 1 2 3 At b irt h 1 2 3 1 2 3 W ea lth in de x qu in til e Po or es t 96 .9 96 .4 95 .8 92 .2 96 .6 95 .7 88 .7 18 .2 96 .6 95 .7 88 .7 96 .6 95 .7 88 .7 92 .0 83 .1 3. 0 30 .1 20 8 Se co nd 94 .6 95 .3 93 .7 87 .6 94 .9 91 .9 83 .6 36 .0 94 .9 91 .9 83 .6 94 .9 91 .9 83 .6 91 .4 80 .3 4. 6 31 .2 22 0 M idd le 94 .2 96 .2 93 .4 91 .8 93 .3 90 .3 87 .2 53 .1 93 .3 90 .3 87 .2 93 .3 90 .3 87 .2 90 .6 83 .9 3. 8 36 .7 21 4 Fo ur th 95 .7 96 .8 95 .6 91 .8 95 .2 92 .6 89 .3 53 .1 95 .2 92 .6 89 .3 95 .2 92 .6 89 .3 93 .2 85 .1 3. 2 48 .0 21 7 Ri ch es t 98 .0 97 .6 98 .0 97 .2 97 .3 97 .8 94 .7 64 .0 97 .3 97 .8 94 .7 97 .3 97 .8 94 .7 97 .3 92 .7 2. 0 58 .2 14 9 [a ] I nc lud es : B CG , p oli o3 , D PT 3, H ep B3 , H ib3 , a nd m ea sle s ( M CV 1) a s p er th e va cc ina tio n sc he du le in Ne pa l No te : 3 ca se s o f m iss ing ‘m ot he r’s e du ca tio n’ no t s ho wn ( ) F igu re s t ha t a re b as ed o n 25 –4 9 un we igh te d ca se s (*) F igu re s t ha t a re b as ed o n fe we r t ha n 25 u nw eig ht ed ca se s C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 55 Neonatal Tetanus Protection One of the MDGs on maternal health aims to reduce the maternal mortality ratio by three-quarters, with one strategy being to eliminate maternal tetanus. Following calls at the 42nd and 44th World Health Assembly for elimination of neonatal tetanus, the global community continues to work to reduce the incidence of neonatal tetanus to less than one case of neonatal tetanus per 1,000 live births in every district by 2015. The strategy for preventing maternal and neonatal tetanus is to ensure that all pregnant women receive at least two doses of tetanus toxoid vaccine. Even if a woman has not received at least two doses of tetanus toxoid during a particular pregnancy, both mother and newborn are considered to be protected against tetanus if the woman: • received at least two doses of tetanus toxoid vaccine, the last within the previous three years; • received at least three doses, the last within the previous five years; • received at least four doses, the last within the previous 10 years; or • received five or more doses anytime during her life2. To assess the status of tetanus vaccination coverage, women who had a live birth during the two years preceding the survey were asked if they had received tetanus toxoid injections during the pregnancy for their most recent birth, and if so, how many. Women who did not receive two or more tetanus toxoid vaccinations during this recent pregnancy were then asked about tetanus toxoid vaccinations they may have received previously. Interviewers also asked women to present their vaccination card on which dates of tetanus toxoid are recorded and referred to information from the cards when available. Table CH.3 shows the tetanus protection status for women aged 15–49 years with a live birth in the two years preceding the survey. Over three-quarters (77 percent) of women were protected against neonatal tetanus, with 65 percent receiving at least two doses of tetanus toxoid during the last pregnancy. Regionally, the lowest proportion was in the Far Western Hills (60 percent) and the highest was in the Eastern Terai (86 percent). Urban women were more likely than rural women to be protected (84 percent compared to 76 percent). The likelihood of protection against neonatal tetanus increased with a woman’s level of education and household wealth status. 2Deming, M.S. et al. 2002. Tetanus toxoid coverage as an indicator of serological protection against neonatal tetanus. Bulletin of the World Health Organiza- tion 80(9): 696–703 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201456 Care of Illness A key strategy for accelerating progress toward MDG 4 of reducing child mortality is to tackle the diseases that are the leading killers of children under five. Diarrhoea and pneumonia are two leading diseases. The Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) aims to end preventable pneumonia and diarrhoea deaths by reducing mortality from pneumonia to three deaths per 1,000 live births and mortality from diarrhoea to one death per 1,000 live births by 2025. Malaria is also a major killer of children under five, killing about 1,200 children every day, especially in sub-Saharan Africa. The Global Malaria Action Plan (GMAP) aims to reduce malaria deaths to near zero by 2015. Table CH.4 presents the percentage of children aged 0–59 months who were reported to have had an episode of diarrhoea, symptoms of acute respiratory infection (ARI), or fever during the two weeks preceding the survey. These results are not measures of true prevalence and should not be used as such; but rather, they provide a period-prevalence of these illnesses over a two-week window of time. The definition of a case of diarrhoea or fever in this survey was the mother’s (or caretaker’s) report that the child had such symptoms over the specified period; no other evidence was sought beside the Table CH.3: Neonatal tetanus protection Percentage of women aged 15–49 years with a live birth in the two years preceding the survey who were protected against neonatal tetanus, Nepal, 2014 Percent who received at least 2 doses during last pregnancy Percent who did not receive 2 or more doses during last pregnancy but received: Percent protected against tetanus [1] Number of women with a live birth in the last two years 2 doses, the last within prior 3 years 3 doses, the last within prior 5 years 4 doses, the last within prior 10 years 5 or more doses during lifetime Total 64.8 12.1 0.1 0.2 0.1 77.3 2,048 Region Eastern Mountains 59.8 15.6 0.0 0.0 0.0 75.4 32 Eastern Hills 65.7 12.9 0.8 0.0 0.0 79.5 123 Eastern Terai 68.0 17.8 0.0 0.0 0.0 85.8 277 Central Mountains 64.7 5.1 0.0 0.0 0.0 69.8 38 Central Hills 63.0 9.4 0.0 0.0 0.0 72.3 241 Central Terai 75.8 5.4 0.0 0.0 0.0 81.2 400 Western Mountains (60.0) (9.3) (0.0) (0.0) (0.0) (69.3) 1 Western Hills 65.7 15.3 0.0 1.6 0.0 82.5 222 Western Terai 63.5 12.5 0.0 0.0 0.7 76.8 178 Mid-Western Mountains 59.2 6.6 0.5 0.0 0.0 66.3 43 Mid-Western Hills 56.2 10.5 0.6 0.0 0.0 67.3 166 Mid-Western Terai 66.7 13.5 0.0 0.0 0.0 80.2 113 Far Western Mountains 57.1 16.6 0.0 0.0 0.0 73.6 33 Far Western Hills 48.1 11.4 0.0 0.0 0.0 59.5 75 Far Western Terai 48.3 23.6 0.0 0.7 0.0 72.6 106 Area Urban 71.7 12.4 0.0 0.0 0.0 84.1 262 Kathmandu valley 72.0 12.0 0.0 0.0 0.0 84.1 65 Other urban 71.6 12.5 0.0 0.0 0.0 84.1 197 Rural 63.8 12.0 0.1 0.2 0.1 76.3 1,786 Education None 54.7 12.1 0.2 0.1 0.0 67.1 754 Primary 63.0 12.4 0.3 0.0 0.4 76.1 346 Secondary 70.9 10.9 0.0 0.7 0.0 82.5 503 Higher 76.5 12.9 0.0 0.0 0.0 89.5 445 Wealth index quintile Poorest 49.0 9.5 0.3 0.0 0.0 58.9 454 Second 63.4 13.3 0.2 0.0 0.0 76.9 436 Middle 68.6 12.9 0.0 0.6 0.0 82.1 441 Fourth 69.2 14.2 0.0 0.4 0.3 84.2 401 Richest 78.6 10.1 0.0 0.0 0.0 88.7 316 [1] MICS indicator 3.9 – Neonatal tetanus protection ( ) Figures that are based on 25–49 unweighted cases NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 57 opinion of the mother. A child was considered to have had an episode of ARI if the mother or caretaker reported that the child had, over the specified period, an illness with a cough with rapid or difficult breathing, and whose symptoms were perceived to be due to a problem in the chest or both a problem in the chest and a blocked nose. While this approach is reasonable in the context of a MICS survey, these basically simple case definitions must be kept in mind when interpreting the results, as well as the potential for reporting and recall biases. Furthermore, diarrhoea, fever and ARI are not only seasonal but are also characterized by the often rapid spread of localized outbreaks from one area to another at different points in time. The timing of the survey and the location of the teams might thus considerably affect the results, which must consequently be interpreted with caution. For these reasons, although the period-prevalence over a two-week time window is reported, these data should not be used to assess the epidemiological characteristics of these diseases but rather to obtain denominators for the indicators related to use of health services and treatment. Overall, 12 percent of children under five were reported to have had an episode of diarrhoea in the preceding two weeks, 7 percent had the symptoms of ARI, and 20 percent had an episode of fever (Table CH.4). Period-prevalence ranges from 5 percent to 21 percent in the case of diarrhoea, 3 percent to 12 percent in the case of ARI, and 11 percent to 29 percent in the case of fever across the regions. Table CH.4: Reported disease episodes Percentage of children aged 0–59 months for whom the mother reported an episode of diarrhoea, symptoms of acute respiratory infection (ARI), and/or fever in the last two weeks, Nepal, 2014 Percent of children who in the preceding two weeks had: Number of children aged 0–59 months Episode of diarrhoea Symptoms of ARI Episode of fever Total 12.0 6.7 20.1 5,349 Sex Male 13.3 6.8 20.2 2,766 Female 10.6 6.5 19.9 2,583 Region Eastern Mountains 14.9 5.7 20.3 72 Eastern Hills 11.5 5.2 20.1 272 Eastern Terai 15.5 11.2 28.6 775 Central Mountains 6.0 3.2 11.0 95 Central Hills 10.4 4.1 21.2 620 Central Terai 7.6 4.8 15.9 1,131 Western Mountains 5.1 2.6 11.8 2 Western Hills 8.1 5.3 18.5 601 Western Terai 16.6 3.8 17.1 469 Mid-Western Mountains 21.2 4.8 19.8 108 Mid-Western Hills 17.8 12.2 21.4 409 Mid-Western Terai 13.2 11.4 20.7 291 Far Western Mountains 16.0 6.2 26.3 100 Far Western Hills 16.0 5.6 17.7 210 Far Western Terai 6.5 6.6 18.9 197 Area Urban 9.7 7.6 21.8 699 Kathmandu valley 9.9 6.2 22.5 181 Other urban 9.7 8.1 21.6 518 Rural 12.3 6.5 19.8 4,650 Age 0–11 months 12.2 7.7 18.6 978 12–23 months 19.1 7.3 25.7 1,008 24–35 months 11.0 5.2 21.7 1,079 36–47 months 11.2 7.5 18.6 1,137 48–59 months 7.2 5.8 16.3 1,147 Mother’s education None 13.9 5.9 18.3 2,265 Primary 11.5 6.8 21.1 921 Secondary 9.7 8.7 21.2 1,179 Higher 10.7 5.9 22.0 980 Wealth index quintile Poorest 15.4 7.6 19.6 1,183 Second 11.5 5.7 18.6 1,085 Middle 11.7 7.1 18.6 1,176 Fourth 12.1 6.9 23.4 1,086 Richest 7.9 5.6 20.5 819 Note: 4 cases of missing ‘mother’s education’ not shown NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201458 Diarrhoea Diarrhoea is a leading cause of death among children under five worldwide. Most diarrhoea-related deaths in children are due to dehydration. Management of diarrhoea—either through oral rehydration salts (ORS) or a recommended home fluid—can prevent many of these deaths. In addition, provision of zinc supplements has been shown to reduce the duration and severity of the illness as well as the risk of future episodes within the next two or three months. In the MICS, mothers or caretakers were asked whether their child under five years of age had had an episode of diarrhoea in the two weeks preceding the survey. In cases where mothers reported that the child had had diarrhoea, a series of questions were asked about the treatment of the illness, including what the child had been given to drink and eat during the episode and whether this was more or less than what was usually given to the child. The overall period-prevalence for diarrhoea in children under five is 12 percent and ranges from 5 percent in the Western Mountains to 21 percent in the Mid-Western Mountains (Table CH.4). The highest prevalence is seen among children aged 12–23 months (19 percent), which corresponds grossly to the weaning period. Table CH.5 shows the percentage of children with diarrhoea in the two weeks preceding the survey for whom advice or treatment was sought and from where. Overall, a health facility or provider was sought in 47 percent of cases. The private sector was used for 39 percent of children and the public sector for 30 percent. Community health providers were used for just 4 percent of children. Some 32 percent of children received no advice or treatment. There was some variation in seeking care from a health facility or health provider by region, although robust data are not available for most regions. For regions with sufficient data, the highest proportion was in the Far Western Mountains (79 percent) and the lowest was in the Mid-Western Hills (38 percent). There was no obvious trend by age of child, ranging from 37 percent of children aged 36–47 months to 52 percent of children aged 12–23 months and 48–59 months. Mother’s education level was positively associated with seeking care: 43 percent of women with no education sought care from a health facility or health provider compared to 58 percent of women with higher education. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 59 Table CH.5: Care-seeking during diarrhoea Percentage of children aged 0–59 months with diarrhoea in the two weeks preceding the survey for whom advice or treatment was sought, by source of advice or treatment, Nepal, 2014 Percent with diarrhoea for whom: Number of children aged 0–59 months with diarrhoea in the last two weeks Advice or treatment was sought from: No advice or treatment sought Health facilities or providers Other source Health facility or provider [1] [b] Public Private NGO Commu- nity health provider [a] Total 29.5 39.3 0.1 4.0 5.5 47.2 32.0 641 Sex Male 29.9 41.1 0.2 3.1 6.1 48.4 29.7 368 Female 28.8 36.9 0.0 5.3 4.6 45.6 35.0 273 Region Eastern Mountains (40.9) (8.9) (0.0) (9.8) (3.5) (47.8) (48.9) 11 Eastern Hills (20.9) (27.1) (0.0) (9.9) (3.2) (32.1) (48.8) 31 Eastern Terai 30.8 44.5 0.0 3.1 3.5 48.6 28.8 120 Central Mountains (*) (*) (*) (*) (*) (*) (*) 6 Central Hills (18.3) (45.3) (0.0) (0.0) (7.5) (36.7) (37.2) 64 Central Terai (33.1) (37.0) (0.0) (0.0) (12.1) (52.3) (29.8) 86 Western Mountains (*) (*) (*) (*) (*) (*) (*) Western Hills (35.3) (48.5) (0.0) (3.7) (15.7) (52.8) (19.0) 49 Western Terai 15.6 71.5 1.0 0.0 0.0 49.5 14.7 78 Mid-Western Mountains 27.4 24.7 0.0 10.0 6.4 41.9 44.2 23 Mid-Western Hills 26.3 25.6 0.0 5.6 1.4 38.1 48.3 73 Mid-Western Terai (16.2) (39.9) (0.0) (0.0) (6.7) (36.9) (38.3) 38 Far Western Mountains 76.4 4.3 0.0 13.8 6.0 79.2 16.4 16 Far Western Hills 61.3 3.0 0.0 14.3 1.4 62.7 34.3 34 Far Western Terai (*) (*) (*) (*) (*) (*) (*) 13 Area Urban 13.2 65.4 1.1 2.9 2.3 45.6 22.5 68 Kathmandu valley (*) (*) (*) (*) (*) (*) (*) 18 Other urban 18.0 62.3 1.5 3.9 1.1 50.3 21.3 50 Rural 31.4 36.2 0.0 4.2 5.8 47.4 33.1 573 Age 0–11 months 23.2 46.0 0.0 2.9 7.6 48.5 29.9 119 12–23 months 32.7 42.4 0.4 5.3 2.9 51.8 28.1 193 24–35 months 26.5 47.6 0.0 1.6 5.7 46.0 28.3 119 36–47 months 27.6 29.7 0.0 3.4 4.2 37.1 42.2 128 48–59 months 38.2 25.5 0.0 7.0 9.9 51.8 33.5 82 Mother’s education None 29.2 32.9 0.0 2.5 6.4 42.7 38.1 316 Primary 34.3 38.2 0.7 4.1 5.0 51.1 27.0 106 Secondary 29.0 40.3 0.0 7.2 4.7 46.2 31.5 114 Higher 25.8 58.8 0.0 4.9 3.8 57.6 19.2 105 Wealth index quintile Poorest 35.4 22.3 0.0 5.0 6.6 45.1 41.2 182 Second 35.0 32.3 0.0 6.3 4.7 55.0 33.2 124 Middle 28.9 39.3 0.0 3.3 6.8 43.6 29.9 138 Fourth 21.9 56.2 .6 1.8 5.9 43.6 24.5 132 Richest 18.5 66.6 0.0 2.7 0.0 53.0 23.4 65 [1] MICS indicator 3.10 – Care-seeking for diarrhoea [a] Community health providers includes both public (community health worker and mobile/outreach clinic) and private (mobile clinic) health facilities [b] Includes all public and private health facilities and providers, but excludes private pharmacy ( ) Figures that are based on 25–49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201460 Ta bl e CH .6 : F ee di ng p ra ct ic es d ur in g di ar rh oe a Pe rc en ta ge o f c hil dr en a ge d 0– 59 m on th s w ith d iar rh oe a in th e tw o we ek s p re ce din g th e su rv ey b y a m ou nt o f li qu ids a nd fo od g ive n du rin g ep iso de o f d iar rh oe a, N ep al, 2 01 4 Pe rc en t g ive n to d rin k: To ta l Pe rc en t g ive n to e at : To ta l Nu m be r of ch ild re n ag ed 0– 59 m on th s wi th dia rrh oe a in th e tw o we ek s M uc h les s So m e- wh at le ss Ab ou t t he sa m e M or e No th ing DK / M iss ing M uc h les s So m e- wh at le ss Ab ou t t he sa m e M or e No th ing DK / M iss ing To ta l 7. 2 37 .6 34 .9 18 .1 2. 1 0. 1 10 0. 0 4. 1 43 .4 36 .6 7. 9 7. 8 0. 1 10 0. 0 64 1 Se x M ale 8. 8 33 .4 37 .0 17 .9 2. 8 0. 1 10 0. 0 4. 8 43 .1 35 .1 8. 6 8. 1 0. 2 10 0. 0 36 8 Fe m ale 5. 1 43 .3 32 .1 18 .4 1. 2 0. 0 10 0. 0 3. 2 43 .7 38 .6 6. 9 7. 5 0. 0 10 0. 0 27 3 Re gi on Ea ste rn M ou nt ain s (1 3. 3) (2 3. 1) (4 8. 3) (1 3. 3) (2 .0 ) (0 .0 ) 10 0. 0 (5 .3 ) (2 8. 3) (5 5. 9) (8 .3 ) (2 .3 ) (0 .0 ) 10 0. 0 11 Ea ste rn H ills (4 .5 ) (5 2. 0) (3 0. 0) (1 3. 5) (0 .0 ) (0 .0 ) 10 0. 0 (4 .5 ) (5 0. 4) (3 2. 1) (6 .4 ) (6 .7 ) (0 .0 ) 10 0. 0 31 Ea ste rn T er ai 13 .1 26 .4 29 .4 27 .2 4. 0 0. 0 10 0. 0 2. 1 36 .8 40 .8 4. 2 16 .1 0. 0 10 0. 0 12 0 Ce nt ra l M ou nt ain s (*) (*) (*) (*) (*) (*) 10 0. 0 (*) (*) (*) (*) (*) (*) 10 0. 0 6 Ce nt ra l H ills (1 4. 2) (4 1. 0) (2 4. 8) (2 0. 0) (0 .0 ) (0 .0 ) 10 0. 0 (4 .5 ) (4 2. 7) (3 3. 0) (1 8. 1) (1 .6 ) (0 .0 ) 10 0. 0 64 Ce nt ra l T er ai (2 .7 ) (3 6. 5) (5 2. 9) (7 .9 ) (0 .0 ) (0 .0 ) 10 0. 0 (5 .8 ) (4 5. 0) (4 1. 3) (6 .0 ) (1 .9 ) (0 .0 ) 10 0. 0 86 W es te rn M ou nt ain s (*) (*) (*) (*) (*) (*) 10 0. 0 (*) (*) (*) (*) (*) (*) 10 0. 0 W es te rn H ills (0 .0 ) (3 4. 7) (4 9. 2) (1 6. 1) (0 .0 ) (0 .0 ) 10 0. 0 (3 .3 ) (3 4. 3) (5 2. 0) (7 .4 ) (3 .1 ) (0 .0 ) 10 0. 0 49 W es te rn T er ai 5. 6 44 .3 37 .0 11 .5 1. 7 0. 0 10 0. 0 6. 5 49 .2 36 .0 6. 5 1. 7 0. 0 10 0. 0 78 M id- W es te rn M ou nt ain s 17 .8 32 .2 29 .2 14 .1 4. 9 1. 9 10 0. 0 9. 4 28 .9 44 .1 6. 4 11 .1 0. 0 10 0. 0 23 M id- W es te rn H ills 6. 2 32 .6 35 .3 23 .1 2. 8 0. 0 10 0. 0 5. 3 37 .8 30 .2 10 .3 16 .4 0. 0 10 0. 0 73 M id- W es te rn T er ai (1 .9 ) (3 2. 4) (2 8. 3) (3 4. 2) (3 .1 ) (0 .0 ) 10 0. 0 (0 .3 ) (3 3. 3) (3 9. 0) (1 2. 8) (1 4. 6) (0 .0 ) 10 0. 0 38 Fa r W es te rn M ou nt ain s 4. 2 54 .7 23 .6 17 .6 0. 0 0. 0 10 0. 0 4. 3 73 .2 18 .5 1. 3 2. 8 0. 0 10 0. 0 16 Fa r W es te rn H ills 4. 8 61 .0 24 .8 9. 5 0. 0 0. 0 10 0. 0 1. 4 77 .8 14 .9 4. 5 1. 4 0. 0 10 0. 0 34 Fa r W es te rn T er ai (*) (*) (*) (*) (*) (*) 10 0. 0 (*) (*) (*) (*) (*) (*) 10 0. 0 13 Ar ea Ur ba n 6. 9 23 .5 38 .2 30 .4 0. 9 0. 0 10 0. 0 4. 3 36 .1 45 .8 10 .9 2. 9 0. 0 10 0. 0 68 Ka th m an du va lle y (*) (*) (*) (*) (*) (*) 10 0. 0 (*) (*) (*) (*) (*) (*) 10 0. 0 18 Ot he r u rb an 1. 8 27 .1 38 .8 31 .2 1. 2 0. 0 10 0. 0 3. 9 32 .3 50 .9 11 .0 1. 9 0. 0 10 0. 0 50 Ru ra l 7. 3 39 .3 34 .5 16 .6 2. 3 0. 1 10 0. 0 4. 1 44 .3 35 .5 7. 5 8. 4 0. 1 10 0. 0 57 3 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 61 Ta bl e CH .6 : F ee di ng p ra ct ic es d ur in g di ar rh oe a Pe rc en ta ge o f c hil dr en a ge d 0– 59 m on th s w ith d iar rh oe a in th e tw o we ek s p re ce din g th e su rv ey b y a m ou nt o f li qu ids a nd fo od g ive n du rin g ep iso de o f d iar rh oe a, N ep al, 2 01 4 Pe rc en t g ive n to d rin k: To ta l Pe rc en t g ive n to e at : To ta l Nu m be r of ch ild re n ag ed 0– 59 m on th s wi th dia rrh oe a in th e tw o we ek s M uc h les s So m e- wh at le ss Ab ou t t he sa m e M or e No th ing DK / M iss ing M uc h les s So m e- wh at le ss Ab ou t t he sa m e M or e No th ing DK / M iss ing Ag e 0– 11 m on th s 4. 8 37 .2 40 .1 14 .1 3. 6 0. 2 10 0. 0 2. 6 37 .9 39 .5 5. 8 14 .2 0. 0 10 0. 0 11 9 12 –2 3 m on th s 11 .1 38 .8 25 .0 22 .5 2. 5 0. 1 10 0. 0 5. 3 46 .6 30 .1 10 .6 7. 0 0. 4 10 0. 0 19 3 24 –3 5 m on th s 5. 9 38 .8 39 .4 13 .6 2. 4 0. 0 10 0. 0 2. 7 50 .0 32 .5 6. 3 8. 5 0. 0 10 0. 0 11 9 36 –4 7 m on th s 5. 4 38 .5 39 .0 16 .9 0. 2 0. 0 10 0. 0 3. 5 40 .4 42 .6 9. 2 4. 2 0. 0 10 0. 0 12 8 48 –5 9 m on th s 6. 5 32 .3 37 .9 21 .7 1. 6 0. 0 10 0. 0 6. 6 38 .9 44 .4 4. 8 5. 2 0. 0 10 0. 0 82 M ot he r’s e du ca tio n No ne 6. 3 45 .0 34 .5 12 .5 1. 6 0. 1 10 0. 0 3. 2 46 .1 37 .4 5. 1 8. 0 0. 3 10 0. 0 31 6 Pr im ar y 4. 6 30 .8 39 .7 23 .1 1. 8 0. 0 10 0. 0 2. 8 40 .1 39 .5 8. 7 8. 9 0. 0 10 0. 0 10 6 Se co nd ar y 8. 2 28 .8 40 .1 17 .3 5. 5 0. 2 10 0. 0 2. 0 43 .2 37 .1 6. 3 11 .5 0. 0 10 0. 0 11 4 Hi gh er 11 .6 31 .9 25 .7 30 .7 0. 2 0. 0 10 0. 0 10 .5 38 .8 30 .9 17 .2 2. 5 0. 0 10 0. 0 10 5 W ea lth in de x qu in til e Po or es t 5. 2 43 .7 35 .7 12 .1 3. 1 0. 2 10 0. 0 3. 5 47 .1 35 .4 6. 0 7. 9 0. 0 10 0. 0 18 2 Se co nd 4. 9 43 .7 33 .7 14 .9 2. 7 0. 0 10 0. 0 3. 9 46 .3 33 .0 5. 1 11 .0 0. 7 10 0. 0 12 4 M idd le 8. 6 37 .8 38 .0 13 .7 1. 9 0. 0 10 0. 0 5. 3 39 .7 38 .9 7. 9 8. 2 0. 0 10 0. 0 13 8 Fo ur th 8. 2 29 .3 32 .8 29 .2 0. 4 0. 0 10 0. 0 3. 1 44 .2 36 .6 9. 8 6. 4 0. 0 10 0. 0 13 2 Ri ch es t 12 .4 25 .2 32 .7 27 .6 2. 0 0. 0 10 0. 0 5. 9 33 .5 42 .2 14 .8 3. 6 0. 0 10 0. 0 65 ( ) F igu re s t ha t a re b as ed o n 25 –4 9 un we igh te d ca se s (*) F igu re s t ha t a re b as ed o n fe we r t ha n 25 u nw eig ht ed ca se s C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201462 Table CH.7 shows the percentage of children receiving ORS and zinc during diarrhoea. Since children may have been given more than one type of liquid, the percentages do not necessarily add up to 100. Some 44 percent received ORS, and 31 percent received zinc in one form or another. In total, 18 percent received the recommended treatment of both ORS and zinc. There was some variation in treatment of diarrhoea with a combination of ORS and zinc. Children aged 0–11 months (11 percent) were the least likely to receive ORS and zinc, and children aged 48–59 months (21 percent) were the most likely to do so. Table CH.6 provides statistics on drinking and feeding practices during diarrhoea. Only 18 percent of children under five with diarrhoea were given more than the usual amount to drink (increased fluids). Some 73 percent were given the same or somewhat less, but 9 percent were given much less or almost nothing. Only 8 percent of children were given more to eat than usual. Some 88 received continued feeding (somewhat less, the same or more), while 12 percent were given much less or nothing. Table CH.7: Oral rehydration solution and zinc Percentage of children aged 0–59 months with diarrhoea in the two weeks preceding the survey, by treatment with oral rehydration salts (ORS) and zinc, Nepal, 2014 Percent who received: Number of children aged 0–59 months with diarrhoea in the last two weeks ORS Zinc ORS and zinc [1] Tablet Syrup Any zinc Total 44.0 19.0 23.6 30.6 18.2 641 Sex Male 45.2 19.6 25.7 31.4 18.3 368 Female 42.3 18.2 20.8 29.5 18.0 273 Area Urban 46.8 16.2 23.6 29.6 15.2 68 Kathmandu valley (*) (*) (*) (*) (*) 18 Other urban 47.9 20.8 30.9 39.1 19.5 50 Rural 43.6 19.3 23.6 30.7 18.6 573 Age 0–11 months 28.0 14.5 21.1 27.7 11.2 119 12–23 months 46.0 21.0 24.2 33.3 19.9 193 24–35 months 50.2 17.9 28.9 34.0 19.0 119 36–47 months 41.8 19.6 19.6 25.5 19.5 128 48–59 months 56.6 21.4 24.7 31.5 21.2 82 Mother’s education None 43.0 22.6 26.7 33.3 20.2 316 Primary 40.9 22.5 27.1 34.4 19.4 106 Secondary 42.5 10.2 14.9 20.8 12.9 114 Higher 51.7 14.3 20.3 29.5 16.7 105 Wealth index quintile Poorest 49.4 20.3 21.9 29.6 21.0 182 Second 39.7 18.3 30.9 35.8 16.9 124 Middle 35.1 21.0 19.1 28.3 16.2 138 Fourth 47.5 19.2 24.5 31.0 18.5 132 Richest 48.4 12.1 22.4 27.6 16.4 65 [1] MICS indicator 3.11 – Diarrhoea treatment with oral rehydration salts (ORS) and zinc (*) Figures that are based on fewer than 25 unweighted cases NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 63 Figure CH.2 illustrates some variations for children under five with diarrhoea who received ORS. Figure CH.2: Children under five with diarrhoea who received ORS, Nepal, 2014 Table CH.8 shows the proportions of children aged 0–59 months with diarrhoea in the two weeks preceding the survey who received oral rehydration therapy (ORT) (i.e., ORS or increased fluids) with continued feeding, and the percentage of children with diarrhoea who received other treatments. Overall, 46 percent received ORT with continued feeding, while 52 percent received ORT. In addition, 11 percent received antibiotic; 5 percent received home remedy or herbal medicine; and less than 1 percent received intravenous fluids. Younger children were much less likely than older children to receive it, and children whose mother had higher education were much more likely to do so.   18   Figure  CH.2  illustrates  some  variations  for  children  under  five  with  diarrhoea  who  received  ORS.     Figure  CH.2:  Children  under  five  with  diarrhoea  who  received  ORS,  Nepal,  2014   47 44 44 Pe r c en t P er ce nt NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201464 Ta bl e CH .8 : O ra l r eh yd ra tio n th er ap y wi th c on tin ue d fe ed in g an d ot he r t re at m en ts Pe rc en ta ge o f c hil dr en a ge d 0– 59 m on th s w ith d iar rh oe a in th e tw o we ek s p re ce din g th e su rv ey w ho w er e giv en o ra l r eh yd ra tio n th er ap y w ith co nt inu ed fe ed ing , a nd p er ce nt ag e wh o we re g ive n ot he r tre at m en ts, N ep al, 2 01 4 Pe rc en t w ith d iar rh oe a wh o we re g ive n: No t g ive n an y tre at m en t or d ru g Nu m be r of ch ild re n ag ed 0 – 59 m on th s wi th dia rrh oe a in th e las t tw o we ek s Zi nc OR T [a ] OR T wi th co nt inu ed fe ed ing [1 ] Ot he r t re at m en ts Pi ll o r s yr up In jec tio n In tra - ve no us Ho m e re m ed y, he rb al m ed ici ne Ot he r An tib iot ic An ti- m ot ilit y Ot he r Un kn ow n An tib iot ic No n- an tib iot ic Un kn ow n To ta l 30 .6 51 .7 45 .9 8. 9 0. 6 4. 2 3. 1 2. 1 0. 2 0. 9 0. 2 5. 0 3. 1 27 .1 64 1 Se x M ale 31 .4 51 .8 45 .7 9. 1 0. 1 5. 1 3. 5 1. 8 0. 0 1. 3 0. 4 5. 8 4. 0 22 .1 36 8 Fe m ale 29 .5 51 .7 46 .1 8. 5 1. 3 3. 0 2. 5 2. 4 0. 4 0. 3 0. 0 4. 0 2. 0 33 .7 27 3 Ar ea Ur ba n 29 .6 63 .7 59 .4 8. 8 0. 5 8. 2 0. 2 2. 2 1. 5 0. 0 0. 0 5. 1 8. 1 17 .3 68 Ka th m an du va lle y (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 18 Ot he r u rb an 39 .1 65 .6 61 .8 4. 6 0. 7 7. 8 0. 3 3. 0 0. 0 0. 0 0. 0 5. 8 9. 1 15 .4 50 Ru ra l 30 .7 50 .3 44 .3 8. 9 0. 6 3. 7 3. 4 2. 0 0. 0 1. 0 0. 2 5. 0 2. 6 28 .3 57 3 Ag e 0– 11 m on th s 27 .7 33 .5 29 .1 6. 8 0. 0 3. 7 1. 0 2. 3 0. 0 0. 7 0. 0 5. 9 2. 6 38 .3 11 9 12 –2 3 m on th s 33 .3 54 .6 47 .4 19 .4 2. 1 6. 4 2. 4 1. 7 0. 5 0. 0 0. 7 3. 6 3. 6 20 .1 19 3 24 –3 5 m on th s 34 .0 58 .1 51 .1 6. 6 0. 0 3. 5 4. 2 2. 0 0. 0 1. 0 0. 0 5. 3 0. 0 21 .5 11 9 36 –4 7 m on th s 25 .5 49 .5 46 .2 1. 8 0. 0 3. 4 2. 6 1. 2 0. 0 2. 8 0. 0 6. 3 6. 0 35 .6 12 8 48 –5 9 m on th s 31 .5 65 .7 58 .5 1. 3 0. 0 2. 2 6. 7 4. 3 0. 0 0. 0 0. 0 4. 6 3. 1 21 .9 82 M ot he r’s e du ca tio n No ne 33 .3 49 .1 43 .9 6. 8 0. 6 2. 4 5. 0 2. 5 0. 0 1. 1 0. 0 2. 7 3. 2 31 .7 31 6 Pr im ar y 34 .4 48 .2 43 .9 8. 7 0. 0 3. 8 2. 9 0. 0 0. 0 0. 8 0. 0 11 .0 3. 2 25 .9 10 6 Se co nd ar y 20 .8 51 .2 42 .9 10 .5 1. 8 6. 8 0. 0 2. 8 0. 0 1. 0 0. 0 4. 2 0. 0 32 .6 11 4 Hi gh er 29 .5 63 .8 57 .1 13 .5 0. 0 7. 4 0. 9 2. 2 1. 0 0. 0 1. 3 7. 1 6. 2 8. 5 10 5 W ea lth in de x qu in til e Po or es t 29 .6 54 .1 48 .4 2. 9 0. 0 3. 3 3. 2 0. 2 0. 0 0. 6 0. 0 5. 9 2. 2 30 .8 18 2 Se co nd 35 .8 46 .8 42 .3 9. 4 0. 3 1. 1 4. 4 1. 9 0. 0 0. 0 1. 1 7. 5 2. 9 23 .8 12 4 M idd le 28 .3 43 .0 32 .5 9. 6 2. 6 2. 0 5. 6 1. 7 0. 0 2. 6 0. 0 5. 3 1. 7 32 .9 13 8 Fo ur th 31 .0 56 .2 53 .6 11 .2 0. 0 5. 8 0. 6 6. 2 0. 0 0. 6 0. 0 1. 7 4. 7 24 .9 13 2 Ri ch es t 27 .6 64 .2 58 .3 18 .2 0. 0 14 .7 0. 0 0. 0 1. 6 0. 0 0. 0 3. 9 6. 3 15 .0 65 [1 ] M IC S in di ca to r 3 .1 2 – Di ar rh oe a tre at m en t w ith o ra l r eh yd ra tio n th er ap y (O RT ) a nd c on tin ue d fe ed in g [a ] O RT (o ra l r eh yd ra tio n th er ap y) = O RS o r i nc re as ed flu ids (*) F igu re s t ha t a re b as ed o n fe we r t ha n 25 u nw eig ht ed ca se s NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 65 Figure CH.3 shows the proportions of children under five with diarrhoea who receive ORT and continued feeding in urban and rural areas of Nepal. Figure CH.3: Children under five with diarrhoea receiving ORT and continued feeding, Nepal, 2014 21 Figure CH.3 showsthe proportions of children under five with diarrhoea who receive ORT and continued feeding in urban and rural areas of Nepal. Figure CH.3: Children under five with diarrhoea receiving ORT and continued feeding,Nepal, 2014 59 44 46 0 10 20 30 40 50 60 70 Urban Rural Nepal Per centPercent NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201466 Ta bl e CH .9 : S ou rc e of O RS a nd zi nc Pe rc en ta ge o f c hil dr en a ge d 0– 59 m on th s w ith d iar rh oe a in th e tw o we ek s p re ce din g th e su rv ey w ho w er e giv en O RS , a nd p er ce nt ag e giv en zi nc , b y t he so ur ce o f O RS a nd zi nc , N ep al, 2 01 4 Pe rc en t w ho w er e giv en a s t re at m en t fo r d iar rh oe a Nu m be r of ch ild re n ag ed 0 – 59 m on th s wi th dia rrh oe a in th e las t t wo we ek s Pe rc en t f or w ho m th e so ur ce o f O RS w as : Nu m be r of ch ild re n ag ed 0– 59 m on th s wh o we re giv en OR S as tre at m en t fo r d iar - rh oe a in th e las t t wo we ek s Pe rc en t f or w ho m th e so ur ce o f z inc w as : Nu m be r of ch ild re n ag ed 0– 59 m on th s wh o we re giv en zi nc as tr ea t- m en t f or dia rrh oe a in th e las t tw o we ek s OR S Zi nc He alt h fa cil itie s o r p ro vid er s Ot he r so ur ce DK / M iss ing He alt h fa cil ity o r pr ov ide r [b ] He alt h fa cil itie s o r p ro vid er s Ot he r so ur ce He alt h fa cil ity o r pr ov ide r [b ] Pu bli c Pr iva te Co m m u- nit y he alt h pr ov ide r [a ] NG O Pu bli c Pr iva te Co m m u- nit y he alt h pr ov ide r [a ] To ta l 44 .0 30 .6 64 1 47 .0 49 .4 8. 9 0. 3 3. 2 0. 1 96 .4 28 2 46 .3 53 .6 5. 2 0. 1 99 .9 19 6 Se x M ale 45 .2 31 .4 36 8 42 .0 53 .6 6. 0 0. 4 3. 8 0. 1 95 .6 16 6 49 .8 50 .2 5. 4 0. 0 10 0. 0 11 6 Fe m ale 42 .3 29 .5 27 3 54 .2 43 .4 13 .2 0. 0 2. 4 0. 0 97 .6 11 6 41 .2 58 .5 5. 1 0. 3 99 .7 81 Ar ea Ur ba n 46 .8 29 .6 68 18 .6 77 .2 5. 5 2. 3 1. 6 0. 2 95 .8 32 (1 7. 5) (8 2. 5) (0 .0 ) (0 .0 ) (1 00 .0 ) 20 Ka th m an du va lle y (*) (*) 18 (*) (*) (*) (*) (*) (*) (*) 8 (*) (*) (*) (*) (*) 1 Ot he r u rb an 47 .9 39 .1 50 (2 4. 7) (6 9. 7) (7 .3 ) (3 .1 ) (2 .2 ) (0 .3 ) (9 4. 4) 24 (1 8. 0) (8 2. 0) (0 .0 ) (0 .0 ) (1 00 .0 ) 20 Ru ra l 43 .6 30 .7 57 3 50 .6 45 .9 9. 4 0. 0 3. 5 0. 1 96 .5 25 0 49 .6 50 .3 5. 9 0. 1 10 0. 0 17 6 Ag e 0– 11 m on th s 28 .0 27 .7 11 9 (4 1. 2) (5 6. 7) (9 .1 ) (0 .0 ) (2 .2 ) (0 .0 ) (9 7. 8) 33 (3 4. 9) (6 5. 1) (3 .2 ) (0 .0 ) (1 00 .0 ) 33 12 –2 3 m on th s 46 .0 33 .3 19 3 44 .3 54 .9 9. 6 .8 0. 0 0. 0 99 .2 89 50 .9 49 .1 9. 5 0. 0 10 0. 0 64 24 –3 5 m on th s 50 .2 34 .0 11 9 40 .2 59 .8 4. 5 0. 0 0. 0 0. 0 10 0. 0 60 (2 3. 5) (7 6. 5) (0 .0 ) (0 .0 ) (1 00 .0 ) 40 36 –4 7 m on th s 41 .8 25 .5 12 8 52 .2 39 .8 9. 4 0. 0 7. 9 0. 0 92 .1 53 65 .0 35 .0 4. 9 0. 0 10 0. 0 33 48 –5 9 m on th s 56 .6 31 .5 82 .0 58 .9 31 .6 12 .7 0. 0 8. 9 0. 5 90 .5 47 (6 0. 9) (3 8. 3) (5 .8 ) (0 .9 ) (9 9. 1) 26 M ot he r’s e du ca tio n No ne 43 .0 33 .3 31 6 50 .8 44 .4 7. 0 0. 0 4. 6 0. 1 95 .2 13 6 49 .0 50 .8 3. 5 0. 2 99 .8 10 5 Pr im ar y 40 .9 34 .4 10 6 47 .7 50 .4 9. 0 1. 7 0. 0 0. 2 98 .1 43 46 .0 54 .0 5. 0 0. 0 10 0. 0 36 Se co nd ar y 42 .5 20 .8 11 4 48 .3 50 .9 11 .3 0. 0 0. 8 0. 0 99 .2 49 38 .7 61 .3 2. 6 0. 0 10 0. 0 24 Hi gh er 51 .7 29 .5 10 5 35 .7 59 .7 11 .5 0. 0 4. 6 0. 0 95 .4 54 43 .0 57 .0 13 .5 0. 0 10 0. 0 31 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 67 Ta bl e CH .9 : S ou rc e of O RS a nd zi nc Pe rc en ta ge o f c hil dr en a ge d 0– 59 m on th s w ith d iar rh oe a in th e tw o we ek s p re ce din g th e su rv ey w ho w er e giv en O RS , a nd p er ce nt ag e giv en zi nc , b y t he so ur ce o f O RS a nd zi nc , N ep al, 2 01 4 Pe rc en t w ho w er e giv en a s t re at m en t fo r d iar rh oe a Nu m be r of ch ild re n ag ed 0 – 59 m on th s wi th dia rrh oe a in th e las t t wo we ek s Pe rc en t f or w ho m th e so ur ce o f O RS w as : Nu m be r of ch ild re n ag ed 0– 59 m on th s wh o we re giv en OR S as tre at m en t fo r d iar - rh oe a in th e las t t wo we ek s Pe rc en t f or w ho m th e so ur ce o f z inc w as : Nu m be r of ch ild re n ag ed 0– 59 m on th s wh o we re giv en zi nc as tr ea t- m en t f or dia rrh oe a in th e las t tw o we ek s OR S Zi nc He alt h fa cil itie s o r p ro vid er s Ot he r so ur ce DK / M iss ing He alt h fa cil ity o r pr ov ide r [b ] He alt h fa cil itie s o r p ro vid er s Ot he r so ur ce He alt h fa cil ity o r pr ov ide r [b ] Pu bli c Pr iva te Co m m u- nit y he alt h pr ov ide r [a ] NG O Pu bli c Pr iva te Co m m u- nit y he alt h pr ov ide r [a ] W ea lth in de x qu in til e Po or es t 49 .4 29 .6 18 2 63 .3 33 .5 14 .2 0. 0 3. 0 0. 2 96 .8 90 71 .9 27 .7 9. 0 0. 4 99 .6 54 Se co nd 39 .7 35 .8 12 4 60 .5 38 .2 10 .6 0. 0 1. 2 0. 2 98 .7 49 41 .6 58 .4 2. 0 0. 0 10 0. 0 45 M idd le 35 .1 28 .3 13 8 (4 5. 3) (4 7. 3) (4 .9 ) (0 .0 ) (7 .4 ) (0 .0 ) (9 2. 6) 49 (4 1. 5) (5 8. 5) (1 .0 ) (0 .0 ) (1 00 .0 ) 39 Fo ur th 47 .5 31 .0 13 2 (2 6. 9) (7 1. 9) (4 .9 ) (1 .2 ) (0 .0 ) (0 .0 ) (9 8. 8) 63 (3 6. 8) (6 3. 2) (1 0. 2) (0 .0 ) (1 00 .0 ) 41 Ri ch es t 48 .4 27 .6 65 (2 1. 5) (7 1. 2) (5 .6 ) (0 .0 ) (7 .3 ) (0 .0 ) (9 2. 7) 31 (*) (*) (*) (*) (*) 18 [a ] C om m un ity h ea lth p ro vid er in clu de s b ot h pu bli c ( co m m un ity h ea lth w or ke r a nd m ob ile /o ut re ac h cli nic ) a nd p riv at e (m ob ile cl ini c) h ea lth fa cil itie s [b ] I nc lud es a ll p ub lic a nd p riv at e he alt h fa cil itie s a nd p ro vid er s No te : R eg ion al re su lts a s n ot sh ow n ow ing to sm all sa m ple si ze s ( ) F igu re s t ha t a re b as ed o n 25 –4 9 un we igh te d ca se s (*) F igu re s t ha t a re b as ed o n fe we r t ha n 25 u nw eig ht ed ca se s C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201468 Table CH.9 provides information on the source of ORS and zinc for children who received these treatments. ORS was sourced from a health facility or health provider for 96 percent of children. It was most likely to be sourced from the private sector (49 percent). Zinc was sourced from a health facility or health provider for nearly 100 percent of children, and was also most likely to be sourced from the private sector (54 percent). Urban children were much more likely to use ORS and zinc sourced from the private sector than the public sector. Children living in poorer households were more likely than others to source treatments from a community health provider. Acute Respiratory Infection Information on symptoms of ARI is collected during the Nepal MICS to capture pneumonia disease, the leading cause of death in children under five. Once diagnosed, pneumonia is treated effectively with antibiotics. Studies have shown a limitation in the survey approach of measuring pneumonia because many of the suspected cases identified through surveys are in fact not true pneumonia3. While this limitation does not affect the level and patterns of care-seeking for suspected pneumonia, it limits the validity of the level of treatment of pneumonia with antibiotics, as reported through household surveys. The treatment indicator described in this report must therefore be taken with caution, keeping in mind that the accurate level is likely higher. Table CH.10 presents information on the proportions of children aged 0–59 months with symptoms of ARI in the two weeks preceding the survey4 for whom care was sought, by the source of that care and the proportions who received antibiotics and the source of those antibiotics. Some 50 percent of children with symptoms of ARI were taken to a qualified provider (all public and private health facilities and providers, excluding private pharmacy). Children were more likely to be taken to a private- sector facility/provider (51 percent) than a public-sector facility/provider (25 percent). Of children with symptoms of ARI, 75 percent were given antibiotics. These antibiotics more likely to be sourced from the private sector (75 percent) than the public sector (23 percent). Younger children were more likely than older children to be taken to a qualified provider for treatment of ARI, and to be given antibiotics. Children living in poorer households were less likely than others to be taken to a qualified provider for treatment of ARI, and to be given antibiotics. 3Campbell, H., el Arifeen, S., Hazir, T., O’Kelly, J., Bryce, J., et al., 2013. Measuring coverage in MNCH: challenges in monitoring the proportion of young children with pneumonia who receive antibiotic treatment. PLoSMed 10(5): e1001421. doi:10.1371/journal.pmed.1001421 47 percent of under-5s had symptoms of ARI in the two weeks preceding the survey. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 69 Ta bl e CH .1 0: C ar e- se ek in g fo r a cu te re sp ira to ry in fe ct io n (A RI ) a nd tr ea tm en t o f s ym pt om s wi th a nt ib io tic s Pe rc en ta ge o f c hil dr en a ge d 0– 59 m on th s w ith sy m pt om s o f A RI in th e tw o we ek s p re ce din g th e su rv ey fo r w ho m a dv ice o r t re at m en t w as so ug ht , b y s ou rc e of a dv ice o r t re at m en t, an d pe rc en ta ge o f c hil dr en w ith sy m pt om s w ho w er e giv en a nt ibi ot ics , N ep al, 2 01 4 Pe rc en t w ith sy m pt om s o f A RI fo r w ho m : Pe rc en t wi th sy m pt om s of A RI wh o we re giv en an tib iot ics [2 ] Nu m be r o f ch ild re n ag ed 0 – 59 m on th s wi th sy m pt om s of A RI Pe rc en t w ith sy m pt om s o f A RI fo r w ho m th e so ur ce o f a nt ibi ot ics w as : Nu m be r of ch ild re n ag ed 0– 59 m on th s wi th sy m p- to m s o f AR I w ho we re giv en an ti- bio tic s Ad vic e or tr ea tm en t w as so ug ht fr om : No a dv ice or tre at m en t so ug ht He alt h fa cil itie s o r p ro vid er s Ot he r so ur ce He alt h fa cil ity o r pr ov ide r [1 ] [ b] He alt h fa cil itie s o r p ro vid er s Ot he r so ur ce He alt h fa cil ity o r pr ov ide r [c] Pu bli c Pr iva te NG O Co m m un ity he alt h pr ov ide r [a ] Pu bli c Pr iva te Co m m u- nit y h ea lth pr ov ide r [a ] To ta l 24 .9 51 .1 0. 9 4. 4 4. 5 50 .1 22 .2 74 .9 35 7 22 .7 75 .1 5. 6 0. 7 99 .0 26 7 Se x M ale 23 .7 54 .5 0. 9 5. 7 5. 8 47 .4 20 .1 76 .3 18 8 18 .9 79 .9 6. 3 0. 0 99 .9 14 4 Fe m ale 26 .2 47 .3 0. 9 2. 9 3. 0 53 .2 24 .4 73 .3 16 8 27 .2 69 .5 4. 7 1. 5 98 .1 12 3 Ar ea Ur ba n 14 .7 74 .7 0. 0 0. 8 4. 1 54 .9 9. 6 87 .3 53 (1 0. 2) (8 9. 3) (1 .7 ) (0 .0 ) (9 9. 5) 46 Ka th m an du va lle y (*) (*) (*) (*) (*) (*) (*) (*) 11 (*) (*) (*) (*) (*) 9 Ot he r u rb an (1 0. 3) (8 1. 6) (0 .0 ) (1 .0 ) (0 .5 ) (5 6. 6) (7 .0 ) (8 9. 1) 42 (9 .3 ) (9 0. 1) (2 .2 ) (0 .0 ) (9 9. 4) 37 Ru ra l 26 .6 46 .9 1. 1 5. 0 4. 6 49 .3 24 .4 72 .7 30 4 25 .4 72 .1 6. 4 0. 9 98 .9 22 1 Ag e 0– 11 m on th s 27 .6 50 .5 4. 3 0. 4 3. 7 58 .7 17 .6 78 .0 76 (2 9. 6) (6 7. 4) (0 .4 ) (0 .0 ) (9 9. 7) 59 12 –2 3 m on th s 32 .7 53 .9 0. 0 7. 5 3. 4 59 .6 13 .4 77 .6 74 (2 0. 1) (7 7. 4) (8 .4 ) (0 .0 ) (1 00 .0 ) 57 24 –3 5 m on th s 15 .0 56 .1 0. 0 1. 0 3. 7 41 .9 25 .2 75 .2 56 (1 3. 8) (8 1. 7) (0 .0 ) (4 .4 ) (9 5. 6) 42 36 –4 7 m on th s 23 .1 51 .5 0. 0 5. 3 6. 5 49 .9 25 .4 73 .9 85 23 .0 76 .2 4. 4 0. 0 99 .6 63 48 –5 9 m on th s 23 .7 43 .7 0. 0 7. 4 4. 9 37 .1 30 .4 69 .3 66 (2 5. 1) (7 4. 4) (1 5. 6) (0 .0 ) (9 9. 5) 46 M ot he r’s e du ca tio n No ne 24 .3 49 .2 1. 1 5. 3 7. 1 45 .1 24 .1 71 .7 13 4 22 .8 75 .2 7. 1 0. 0 99 .5 96 Pr im ar y 20 .6 50 .1 0. 0 1. 6 3. 3 36 .1 26 .3 70 .4 63 14 .4 80 .3 0. 5 4. 3 95 .3 44 Se co nd ar y 27 .4 48 .7 1. 7 2. 1 2. 4 49 .9 22 .2 77 .5 10 2 26 .0 74 .0 3. 1 0. 0 10 0. 0 79 Hi gh er 26 .3 60 .5 0. 0 9. 4 3. 4 77 .5 13 .2 82 .6 58 25 .9 72 .0 11 .3 0. 0 10 0. 0 48 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201470 Ta bl e CH .1 0: C ar e- se ek in g fo r a cu te re sp ira to ry in fe ct io n (A RI ) a nd tr ea tm en t o f s ym pt om s wi th a nt ib io tic s Pe rc en ta ge o f c hil dr en a ge d 0– 59 m on th s w ith sy m pt om s o f A RI in th e tw o we ek s p re ce din g th e su rv ey fo r w ho m a dv ice o r t re at m en t w as so ug ht , b y s ou rc e of a dv ice o r t re at m en t, an d pe rc en ta ge o f c hil dr en w ith sy m pt om s w ho w er e giv en a nt ibi ot ics , N ep al, 2 01 4 Pe rc en t w ith sy m pt om s o f A RI fo r w ho m : Pe rc en t wi th sy m pt om s of A RI wh o we re giv en an tib iot ics [2 ] Nu m be r o f ch ild re n ag ed 0 – 59 m on th s wi th sy m pt om s of A RI Pe rc en t w ith sy m pt om s o f A RI fo r w ho m th e so ur ce o f a nt ibi ot ics w as : Nu m be r of ch ild re n ag ed 0– 59 m on th s wi th sy m p- to m s o f AR I w ho we re giv en an ti- bio tic s Ad vic e or tr ea tm en t w as so ug ht fr om : No a dv ice or tre at m en t so ug ht He alt h fa cil itie s o r p ro vid er s Ot he r so ur ce He alt h fa cil ity o r pr ov ide r [1 ] [ b] He alt h fa cil itie s o r p ro vid er s Ot he r so ur ce He alt h fa cil ity o r pr ov ide r [c] Pu bli c Pr iva te NG O Co m m un ity he alt h pr ov ide r [a ] Pu bli c Pr iva te Co m m u- nit y h ea lth pr ov ide r [a ] W ea lth in de x qu in til e Po or es t 28 .9 32 .9 1. 7 3. 3 4. 0 40 .3 33 .1 59 .6 90 32 .1 59 .8 3. 6 3. 5 95 .6 54 Se co nd 31 .7 44 .7 2. 8 5. 1 9. 1 54 .0 20 .7 77 .3 61 (2 0. 7) (7 8. 8) (1 .2 ) (0 .0 ) (1 00 .0 ) 47 M idd le 23 .3 55 .5 0. 0 2. 8 3. 0 44 .4 20 .6 75 .7 84 (2 3. 4) (7 6. 2) (3 .7 ) (0 .0 ) (9 9. 7) 63 Fo ur th 22 .9 56 .0 0. 0 7. 2 3. 3 54 .9 21 .1 80 .8 75 (2 4. 1) (7 4. 3) (1 3. 5) (0 .0 ) (1 00 .0 ) 61 Ri ch es t (1 3. 9) (7 8. 9) (0 .0 ) (4 .1 ) (4 .3 ) (6 7. 0) (7 .2 ) (9 0. 6) 46 (9 .9 ) (9 0. 1) (4 .5 ) (0 .0 ) (1 00 .0 ) 42 [1 ] M IC S in di ca to r 3 .1 3 – Ca re -s ee ki ng fo r c hi ld re n wi th a cu te re sp ira to ry in fe ct io n (A RI ) s ym pt om s [2 ] M IC S in di ca to r 3 .1 4 – An tib io tic tr ea tm en t f or c hi ld re n wi th A RI s ym pt om s [a ] C om m un ity h ea lth p ro vid er s i nc lud es b ot h pu bli c ( co m m un ity h ea lth w or ke r a nd m ob ile /o ut re ac h cli nic ) a nd p riv at e (m ob ile cl ini c) h ea lth fa cil itie s [b ] I nc lud es a ll p ub lic a nd p riv at e he alt h fa cil itie s a nd p ro vid er s, bu t e xc lud es p riv at e ph ar m ac y [c] In clu de s a ll p ub lic a nd p riv at e he alt h fa cil itie s a nd p ro vid er s No te : R eg ion al re su lts a s n ot sh ow n ow ing to sm all sa m ple si ze s ( ) F igu re s t ha t a re b as ed o n 25 –4 9 un we igh te d ca se s (*) F igu re s t ha t a re b as ed o n fe we r t ha n 25 u nw eig ht ed ca se s C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 71 Ta bl e CH .1 1: K no wl ed ge o f t he tw o da ng er s ig ns o f p ne um on ia Pe rc en ta ge o f w om en a ge d 15 –4 9 ye ar s w ho a re m ot he rs o r c ar et ak er s o f c hil dr en u nd er fiv e by sy m pt om s t ha t w ou ld ca us e th em to ta ke a ch ild u nd er fiv e im m ed iat ely to a h ea lth fa cil ity , a nd p er ce nt ag e of m ot he rs w ho re co gn ize fa st or d iffi cu lt b re at hin g as si gn s f or se ek ing im m ed iat e ca re , N ep al, 2 01 4 Pe rc en t w ho th ink th at a ch ild sh ou ld be ta ke n im m ed iat ely to a h ea lth fa cil ity if th e ch ild : Pe rc en t w ho re co gn ize a t lea st on e of tw o da ng er sig ns o f pn eu m on ia [a ] Nu m be r o f wo m en a ge d 15 –4 9 ye ar s wh o ar e m ot he rs / ca re ta ke rs o f ch ild re n un de r f ive Is no t a ble to dr ink o r br ea stf ee d Be co m es sic ke r De ve lop s a fe ve r Ha s f as t br ea th ing Ha s d iffi cu lty in br ea th ing Ha s b loo d in sto ol Is dr ink ing po or ly Ha s o th er sy m pt om s To ta l 22 .6 41 .5 89 .1 25 .1 32 .2 14 .5 11 .1 46 .1 45 .5 4, 26 7 Re gi on Ea ste rn M ou nt ain s 28 .7 36 .9 94 .1 21 .6 32 .0 12 .3 23 .3 63 .4 42 .1 59 Ea ste rn H ills 32 .9 44 .0 85 .6 26 .6 27 .7 18 .1 24 .7 50 .6 38 .7 22 0 Ea ste rn T er ai 29 .2 43 .6 89 .2 27 .0 44 .0 21 .6 27 .8 40 .0 53 .8 60 3 Ce nt ra l M ou nt ain s 29 .4 56 .8 91 .5 24 .3 20 .5 14 .0 14 .3 54 .1 40 .0 78 Ce nt ra l H ills 14 .4 44 .1 88 .0 21 .1 29 .2 14 .3 9. 1 48 .3 42 .5 55 6 Ce nt ra l T er ai 20 .8 48 .1 85 .2 31 .5 29 .7 7. 4 4. 3 34 .6 45 .8 82 0 W es te rn M ou nt ain s 21 .9 29 .5 93 .4 24 .4 19 .7 3. 0 8. 4 70 .5 35 .6 2 W es te rn H ills 21 .5 27 .5 93 .1 28 .4 26 .5 5. 8 10 .6 68 .3 46 .3 50 6 W es te rn T er ai 35 .8 72 .6 90 .6 29 .0 50 .7 28 .5 7. 3 29 .2 65 .0 36 6 M id- W es te rn M ou nt ain s 5. 3 14 .3 93 .1 10 .8 20 .4 10 .2 4. 0 57 .9 26 .0 78 M id- W es te rn H ills 22 .2 25 .8 93 .8 23 .3 38 .5 13 .8 3. 2 51 .6 48 .1 32 3 M id- W es te rn T er ai 17 .0 35 .8 89 .3 15 .6 26 .9 20 .1 4. 6 43 .7 36 .8 24 0 Fa r W es te rn M ou nt ain s 22 .4 30 .2 89 .7 18 .7 31 .6 24 .8 17 .4 63 .9 42 .8 79 Fa r W es te rn H ills 16 .2 38 .8 89 .1 18 .0 19 .0 15 .0 9. 1 36 .1 28 .1 16 1 Fa r W es te rn T er ai 15 .1 19 .9 86 .2 15 .3 14 .4 8. 1 4. 8 58 .7 26 .3 17 7 Ar ea Ur ba n 22 .0 42 .1 87 .9 26 .1 34 .6 13 .3 14 .0 47 .3 48 .5 62 3 Ka th m an du va lle y 15 .9 42 .7 89 .0 21 .0 38 .9 10 .5 8. 0 43 .5 49 .0 17 5 O th er u rb an 24 .3 41 .8 87 .5 28 .0 32 .9 14 .4 16 .3 48 .8 48 .3 44 8 Ru ra l 22 .8 41 .4 89 .3 24 .9 31 .7 14 .8 10 .6 45 .9 44 .9 3, 64 4 Ed uc at io n No ne 21 .0 42 .7 88 .3 21 .9 30 .9 13 .2 9. 5 39 .7 42 .5 1, 68 0 Pr im ar y 20 .1 45 .2 89 .0 27 .2 31 .5 16 .5 9. 6 47 .4 47 .1 74 1 Se co nd ar y 24 .8 39 .2 89 .2 26 .1 31 .7 15 .2 12 .2 50 .3 45 .8 99 7 Hi gh er 25 .7 38 .8 90 .6 28 .3 35 .8 14 .7 14 .4 52 .6 49 .4 84 9 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201472 Ta bl e CH .1 1: K no wl ed ge o f t he tw o da ng er s ig ns o f p ne um on ia Pe rc en ta ge o f w om en a ge d 15 –4 9 ye ar s w ho a re m ot he rs o r c ar et ak er s o f c hil dr en u nd er fiv e by sy m pt om s t ha t w ou ld ca us e th em to ta ke a ch ild u nd er fiv e im m ed iat ely to a h ea lth fa cil ity , a nd p er ce nt ag e of m ot he rs w ho re co gn ize fa st or d iffi cu lt b re at hin g as si gn s f or se ek ing im m ed iat e ca re , N ep al, 2 01 4 Pe rc en t w ho th ink th at a ch ild sh ou ld be ta ke n im m ed iat ely to a h ea lth fa cil ity if th e ch ild : Pe rc en t w ho re co gn ize a t lea st on e of tw o da ng er sig ns o f pn eu m on ia [a ] Nu m be r o f wo m en a ge d 15 –4 9 ye ar s wh o ar e m ot he rs / ca re ta ke rs o f ch ild re n un de r f ive Is no t a ble to dr ink o r br ea stf ee d Be co m es sic ke r De ve lop s a fe ve r Ha s f as t br ea th ing Ha s d iffi cu lty in br ea th ing Ha s b loo d in sto ol Is dr ink ing po or ly Ha s o th er sy m pt om s W ea lth in de x qu in til e Po or es t 21 .4 33 .4 91 .4 19 .6 26 .9 12 .8 9. 3 51 .5 37 .6 91 1 Se co nd 20 .1 39 .6 88 .7 24 .9 30 .1 15 .6 11 .9 47 .3 42 .8 83 5 M idd le 25 .0 45 .4 87 .6 27 .4 33 .8 13 .9 9. 9 39 .4 48 .4 92 7 Fo ur th 22 .4 46 .9 87 .8 26 .6 34 .0 13 .9 11 .7 44 .0 48 .1 87 0 Ri ch es t 24 .5 42 .5 90 .2 27 .5 36 .9 17 .2 13 .3 49 .0 51 .4 72 3 [a ] f as t a nd /o r d iffi cu lty in b re at hin g C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 73 Mothers’ knowledge of danger signs is an important determinant of care-seeking behaviour. In the Nepal MICS, mothers or caretakers were asked to report symptoms that would cause them to take a child under five for care at a health facility immediately. Knowledge of danger signs of pneumonia and other symptoms of illness are presented in Table CH.11. Overall, 46 percent of women would take a child to a health facility immediately for at least one of the two danger signs of pneumonia (fast and/or difficulty in breathing). Some 25 percent identified fast breathing and 32 percent identified difficulty in breathing as symptoms that would prompt them to take a child to a health facility. The symptom most commonly identified by women as a cause of concern was ‘develop a fever’ (89 percent). Recognition of at least one of the two danger signs of pneumonia varied considerably by region from 26 percent of women in the Mid-Western Mountains to 65 percent of women in the Western Terai. Women living in households in the poorest quintile were least likely to recognize them (38 percent). Solid Fuel Use More than 3 billion people around the world rely on solid fuels for their basic energy needs, including cooking and heating. Solid fuels include biomass fuels, such as wood, charcoal, crops or other agricultural waste, dung, shrubs and straw, and coal. Cooking and heating with solid fuels leads to high levels of indoor smoke which contains a complex mix of health-damaging pollutants. The main problem with the use of solid fuels is their incomplete combustion, which produces toxic elements such as carbon monoxide, polyaromatic hydrocarbons, and sulphur dioxide (SO2), among others. Use of solid fuels increases the risks of incurring acute respiratory illness, pneumonia, chronic obstructive lung disease, cancer, and possibly tuberculosis, asthma, or cataracts, and may contribute to low birth weight of babies born to pregnant women exposed to smoke. The primary indicator for monitoring use of solid fuels is the proportion of the population using solid fuels as the primary source of domestic energy for cooking, as shown in Table CH.12. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201474 ! 24 # Ta bl e CH .1 2: S ol id fu el u se Pe rc en ta ge o f h ou se ho ld m em be rs a cc or din g to ty pe o f c oo kin g fu el m ain ly us ed b y t he h ou se ho ld, a nd p er ce nt ag e of h ou se ho ld m em be rs liv ing in h ou se ho lds u sin g so lid fu els fo r c oo kin g, N ep al, 2 01 4 Pe rc en t m ain ly us ing : Nu m - be r o f ho us e- ho ld m em - be rs El ec tri - cit y Liq ue - fie d pe tro - leu m ga s Na tu ra l ga s Bi og as Ke ro - se ne So lid fu els No fo od co ok ed in ho us e- ho ld Ot he r fu el To ta l So lid fu els fo r co ok ing [1 ] Co al/ lig nit e Ch ar - co al W oo d St ra w/ sh ru bs / gr as s An im al du ng Ag ric ul- tu ra l cr op re sid ue To ta l 0. 1 22 .4 0. 5 2. 0 0. 1 0. 0 0. 1 65 .2 2. 1 7. 1 0. 3 0. 0 0. 1 10 0. 0 74 .7 56 ,8 24 Re gi on Ea ste rn M ou nt ain s 0. 0 2. 9 0. 2 0. 4 0. 0 0. 0 0. 3 95 .7 0. 0 0. 6 0. 0 0. 0 0. 0 10 0. 0 96 .5 77 9 Ea ste rn H ills 0. 0 7. 1 0. 2 0. 9 0. 0 0. 2 0. 2 90 .5 0. 2 0. 9 0. 0 0. 0 0. 0 10 0. 0 91 .9 3, 16 9 Ea ste rn T er ai 0. 2 21 .5 1. 0 3. 2 0. 0 0. 0 0. 0 40 .1 2. 0 31 .4 0. 3 0. 1 0. 3 10 0. 0 73 .8 8, 25 1 Ce nt ra l M ou nt ain s 0. 5 6. 2 0. 0 0. 0 0. 0 0. 2 0. 0 93 .1 0. 0 0. 0 0. 0 0. 0 0. 0 10 0. 0 93 .3 1, 14 8 Ce nt ra l H ills 0. 2 62 .5 0. 2 0. 9 0. 3 0. 0 0. 1 35 .4 0. 2 0. 0 0. 1 0. 0 0. 0 10 0. 0 35 .8 8, 74 6 Ce nt ra l T er ai 0. 2 16 .8 0. 5 0. 6 0. 0 0. 0 0. 1 65 .8 9. 8 6. 0 0. 2 0. 0 0. 0 10 0. 0 81 .9 10 ,2 48 W es te rn M ou nt ain s 0. 0 21 .9 0. 3 0. 3 0. 0 0. 0 0. 0 64 .1 0. 0 12 .9 0. 0 0. 4 0. 0 10 0. 0 77 .1 32 W es te rn H ills 0. 1 24 .1 0. 8 1. 7 0. 0 0. 0 0. 0 73 .1 0. 0 0. 0 0. 1 0. 0 0. 0 10 0. 0 73 .2 6, 37 1 W es te rn T er ai 0. 2 22 .7 0. 6 4. 2 0. 1 0. 0 0. 3 57 .7 0. 2 12 .9 0. 9 0. 0 0. 2 10 0. 0 72 .0 4, 82 5 M id- W es te rn M ou nt ain s 0. 1 0. 6 0. 0 0. 0 0. 0 0. 0 0. 1 95 .6 0. 2 3. 3 0. 1 0. 0 0. 0 10 0. 0 99 .3 79 8 M id- W es te rn H ills 0. 1 2. 7 0. 1 0. 3 0. 0 0. 0 0. 0 96 .8 0. 0 0. 0 0. 0 0. 0 0. 0 10 0. 0 96 .8 3, 59 1 M id- W es te rn T er ai 0. 0 11 .9 1. 3 4. 1 0. 0 0. 0 0. 3 78 .8 0. 0 3. 0 0. 5 0. 0 0. 2 10 0. 0 82 .6 3, 27 6 Fa r W es te rn M ou nt ain s 0. 0 0. 2 0. 1 0. 0 0. 0 0. 0 0. 1 99 .5 0. 0 0. 0 0. 0 0. 0 0. 0 10 0. 0 99 .6 1, 01 4 Fa r W es te rn H ills 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 0. 0 99 .9 0. 0 0. 0 0. 0 0. 0 0. 0 10 0. 0 99 .9 1, 88 0 Fa r W es te rn T er ai 0. 1 12 .8 0. 0 9. 8 0. 0 0. 0 0. 0 75 .6 0. 0 0. 4 1. 3 0. 0 0. 0 10 0. 0 77 .2 2, 69 7 Ar ea Ur ba n 0. 5 73 .2 0. 6 2. 0 0. 1 0. 0 0. 0 21 .5 0. 2 1. 1 0. 6 0. 2 0. 0 10 0. 0 23 .5 9, 75 3 Ka th m an du va lle y 0. 3 98 .0 0. 1 0. 0 0. 3 0. 0 0. 0 1. 0 0. 2 0. 0 0. 0 0. 1 0. 0 10 0. 0 1. 2 2, 97 1 Ot he r u rb an 0. 5 62 .3 0. 8 2. 8 0. 0 0. 0 0. 1 30 .5 0. 3 1. 6 0. 9 0. 2 0. 0 10 0. 0 33 .3 6, 78 2 Ru ra l 0. 1 11 .9 0. 5 2. 0 0. 1 0. 0 0. 1 74 .2 2. 5 8. 3 0. 2 0. 0 0. 1 10 0. 0 85 .3 47 ,0 71 Ed uc at io n of h ou se ho ld he ad No ne 0. 1 8. 9 0. 4 1. 5 0. 0 0. 0 0. 1 75 .0 3. 6 10 .2 0. 2 0. 0 0. 0 10 0. 0 89 .1 24 ,6 91 Pr im ar y 0. 1 17 .3 0. 3 1. 8 0. 2 0. 0 0. 2 74 .2 0. 9 4. 5 0. 4 0. 0 0. 1 10 0. 0 80 .2 11 ,5 23 Se co nd ar y 0. 3 28 .4 0. 7 3. 6 0. 0 0. 0 0. 1 59 .9 1. 3 5. 2 0. 3 0. 0 0. 1 10 0. 0 66 .8 11 ,1 79 Hi gh er 0. 2 57 .3 0. 8 1. 8 0. 0 0. 1 0. 0 34 .5 0. 8 4. 1 0. 2 0. 1 0. 2 10 0. 0 39 .7 9, 28 1 W ea lth in de x qu in til es Po or es t 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 99 .1 0. 2 0. 5 0. 1 0. 0 0. 0 10 0. 0 99 .9 11 ,3 66 Se co nd 0. 0 0. 2 0. 0 0. 5 0. 0 0. 0 0. 0 87 .1 3. 5 8. 5 0. 1 0. 0 0. 0 10 0. 0 99 .2 11 ,3 66 M idd le 0. 1 2. 1 0. 2 1. 8 0. 1 0. 1 0. 3 74 .7 5. 1 15 .2 0. 2 0. 1 0. 0 10 0. 0 95 .6 11 ,3 66 Fo ur th 0. 2 24 .1 1. 2 5. 1 0. 2 0. 0 0. 1 56 .2 1. 7 10 .1 0. 8 0. 2 0. 1 10 0. 0 69 .0 11 ,3 48 Ri ch es t 0. 3 85 .7 1. 1 2. 7 0. 0 0. 0 0. 1 8. 8 0. 0 0. 9 0. 1 0. 1 0. 1 10 0. 0 9. 9 11 ,3 77 [1 ] M IC S in di ca to r 3 .1 5 – Us e of s ol id fu el s fo r c oo ki ng No te : 1 50 ca se s o f m iss ing ‘m ot he r’s e du ca tio n’ no t s ho wn NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 75 Overall, three in four household members (75 percent) lived in a house where solid fuels were used for cooking. Most household members used wood (65 percent). This was followed by liquefied petroleum gas (22 percent). Use of solid fuels varied by region. The highest proportion was in the Far Western Hills and Mountains (nearly all households) and the lowest was in the Central Hills (36 percent). Urban households were much less likely than rural households to use solid fuels (24 percent compared to 85 percent). Use of solid fuels is negatively associated with the education level of the household head and household wealth status. In households where the head had no education, 89 percent of household members used solid fuels for cooking. Almost all households in the poorest quintile used solid fuel for cooking. The presence and extent of indoor pollution are dependent on cooking practices, places used for cooking, as well as types of fuel used. Solid fuel use by place of cooking is shown in Table CH.13. Some 60 percent of household members using solid fuels for cooking used a separate room in the house as a kitchen. In addition, 29 percent cooked within the house but not in a separate kitchen. The proportion of household members that cooked within a kitchen was highest in the Central Mountains (76 percent) and lowest in the Eastern Mountains (41 percent). Higher levels of education of the household head and the household wealth status both increased the likelihood that household members used a separate kitchen for cooking. Table CH.13: Solid fuel use by place of cooking Percentage of household members in households using solid fuels by place of cooking, Nepal, 2014 Percent of household members by place of cooking: Number of household members using solid fuels for cooking In the house In a separate building Outdoors Other place Total In separate room used as kitchen Elsewhere in the house Total 60.0 28.6 7.4 3.6 0.1 100.0 42,458 Region Eastern Mountains 40.6 49.9 8.5 1.0 0.0 100.0 752 Eastern Hills 52.3 32.7 14.5 0.4 0.0 100.0 2,913 Eastern Terai 74.0 11.4 6.0 7.8 0.0 100.0 6,085 Central Mountains 76.2 23.2 0.2 0.4 0.0 100.0 1,071 Central Hills 67.2 30.3 1.8 0.6 0.0 100.0 3,135 Central Terai 57.5 28.4 9.7 4.4 0.0 100.0 8,395 Western Mountains 67.7 30.2 2.1 0.0 0.0 100.0 25 Western Hills 61.6 32.9 3.3 1.9 0.0 100.0 4,666 Western Terai 47.8 29.7 9.7 12.2 0.0 100.0 3,475 Mid-Western Mountains 46.0 53.5 0.1 0.4 0.0 100.0 792 Mid-Western Hills 55.2 41.9 2.9 0.0 0.0 100.0 3,475 Mid-Western Terai 57.3 26.1 11.4 3.5 0.8 100.0 2,705 Far Western Mountains 73.9 23.9 2.0 0.1 0.0 100.0 1,010 Far Western Hills 58.9 39.5 1.1 0.4 0.0 100.0 1,877 Far Western Terai 54.9 19.5 22.4 1.5 0.0 100.0 2,082 Area Urban 62.6 23.1 9.4 3.9 0.0 100.0 2,293 Kathmandu valley (*) (*) (*) (*) (*) 100.0 35 Other urban 62.3 23.2 9.6 3.9 0.0 100.0 2,258 Rural 59.8 28.9 7.3 3.6 0.1 100.0 40,164 Education of household head None 54.9 34.0 6.4 4.3 0.0 100.0 21,987 Primary 61.5 28.2 7.3 2.6 0.2 100.0 9,238 Secondary 65.6 20.0 9.8 3.9 0.0 100.0 7,469 Higher 74.5 15.4 8.3 1.6 0.0 100.0 3,684 Wealth index quintiles Poorest 50.2 46.5 2.2 0.8 0.2 100.0 11,357 Second 56.4 32.6 6.8 4.0 0.0 100.0 11,270 Middle 63.8 20.5 10.1 5.1 0.0 100.0 10,866 Fourth 70.7 12.3 11.5 4.9 0.0 100.0 7,833 Richest 82.4 1.3 10.8 4.7 0.0 100.0 1,131 Note: 79 cases of missing ‘mother’s education’ not shown (*) Figures that are based on fewer than 25 unweighted cases NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201476 Malaria/Fever Malaria is a major cause of death of children under five worldwide. Preventive measures and treatment with an effective antimalarial can dramatically reduce malaria mortality rates among children. In areas where malaria is common, WHO recommends indoor residual spraying (IRS), use of insecticide-treated bednets (ITNs) and prompt treatment of cases with recommended antimalarial drugs. Although malaria occurs in some parts of Nepal, it is rarely attributed as the major cause of death among children under five. In 2010, WHO issued a recommendation for universal use of diagnostic testing to confirm malaria infection and apply appropriate treatment based on the results. According to the guidelines, treatment solely on the basis of clinical suspicion should only be considered when a parasitological diagnosis is not accessible. This recommendation was based on studies that showed substantial reduction in the proportion of fevers associated with malaria5. This recommendation implies that the indicator on proportion of children with fever that received antimalarial treatment is no longer an acceptable indicator of the level of treatment of malaria in the population of children under five. However, as it remains the MDG indicator and for purposes of comparisons, as well assessment of patterns across socio- demographic characteristics, the indicator remains a standard MICS indicator. Children with severe malaria symptoms, such as fever and convulsions, should be taken to a health facility. Furthermore, children recovering from malaria should be given extra liquids and food, and younger children should continue breastfeeding. Table CH.14 provides information on care-seeking behaviour for children aged 0–59 months with an episode of fever in the two weeks preceding the survey6. Advice was sought from a health facility or a qualified provider for 46 percent of children with fever; these services were provided mainly by the public sector (47 percent). However, no advice or treatment was sought in 29 percent of cases. Regionally, the proportion of children seeking care from a health facility or qualified provider was highest in the Far Western Hills (55 percent) and lowest in the Mid-Western Mountains (30 percent). By age, children aged 0–11 months were most likely to receive care from a health facility or qualified provider (55 percent). Mother’s education level and household wealth status were both positively correlated with seeking care from a health facility or qualified provider. 5D’Acremont, V., Lengeler, C. and Genton, B., 2010. Reduction in the proportion of fevers associated with Plasmodium falciparum parasitaemia in Africa: a systematic review. Malaria Journal, 9(240). 620 percent of under-5s had an episode of fever in the two weeks preceding the survey. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 77 Table CH.14: Care-seeking during fever Percentage of children aged 0–59 months with fever in the two weeks preceding the survey for whom advice or treatment was sought, by source of advice or treatment, Nepal, 2014 Percent for whom Number of children aged 0–59 months with fever in the last two weeks Advice or treatment was sought from No advice or treatment sought Health facilities or providers Other source Health facility or provider [1] [b] Public Private NGO Community health provider [a] Total 22.8 46.8 0.3 4.0 4.0 46.4 29.0 1,074 Sex Male 22.8 46.3 0.3 3.7 3.3 45.7 30.2 559 Female 22.8 47.4 0.3 4.3 4.8 47.2 27.6 514 Region Eastern Mountains 49.4 7.9 0.0 9.0 0.0 54.7 43.7 15 Eastern Hills 33.5 25.4 0.0 5.8 0.0 51.3 41.1 55 Eastern Terai 23.8 59.2 0.0 6.6 4.7 54.1 14.3 221 Central Mountains 51.0 16.4 0.0 15.0 (2.7) (59.0) (32.7) 10 Central Hills 9.9 51.3 0.0 0.0 7.0 35.8 36.2 132 Central Terai 17.5 55.1 0.0 4.1 8.6 49.0 28.0 179 Western Mountains (*) (*) (*) (*) (*) (*) (*) Western Hills 26.0 47.5 2.9 3.0 3.4 45.0 21.9 111 Western Terai 8.6 75.8 0.0 0.0 0.0 49.0 15.6 80 Mid-Western Mountains 25.0 10.1 0.0 3.5 1.1 30.2 63.8 21 Mid-Western Hills 24.1 29.3 0.0 1.6 1.2 33.5 47.7 88 Mid-Western Terai 21.3 41.4 0.0 3.8 3.0 41.6 32.3 60 Far Western Mountains 46.7 6.2 0.0 4.6 0.0 48.4 48.9 26 Far Western Hills 53.2 6.4 0.0 13.5 2.2 57.0 40.2 37 Far Western Terai 26.4 49.0 0.0 2.1 0.0 46.4 26.7 37 Area Urban 11.0 69.9 0.0 0.2 3.4 50.8 19.6 153 Kathmandu valley (7.8) (66.1) (0.0) (0.0) (8.6) (48.0) (27.1) 41 Other urban 12.1 71.3 0.0 0.3 1.5 51.8 16.9 112 Rural 24.8 43.0 0.4 4.6 4.1 45.7 30.6 921 Age 0–11 months 25.8 56.0 1.8 5.0 3.5 54.9 16.3 182 12–23 months 26.5 45.2 0.0 5.2 4.8 46.8 27.2 259 24–35 months 21.4 43.5 0.0 2.7 2.3 41.9 33.3 234 36–47 months 20.0 48.9 0.0 3.2 6.2 47.7 29.7 212 48–59 months 19.7 42.0 0.0 3.8 3.1 41.7 37.7 187 Mother’s education None 22.8 39.4 0.4 5.0 4.6 39.9 36.6 415 Primary 26.1 41.4 0.0 2.9 6.2 43.4 30.1 194 Secondary 21.2 53.2 0.7 3.7 0.9 46.4 25.2 250 Higher 21.9 58.6 0.0 3.3 4.6 61.7 17.7 215 Wealth index quintiles Poorest 29.0 24.5 0.7 4.4 2.6 35.8 45.5 231 Second 31.8 33.8 0.9 4.5 4.2 49.6 32.1 201 Middle 22.5 49.5 0.0 6.4 4.4 47.3 25.4 219 Fourth 18.5 60.4 0.0 1.9 3.5 49.3 22.3 254 Richest 10.5 69.4 0.0 2.8 5.9 51.6 17.2 168 [1] MICS indicator 3.20 – Care-seeking for fever [a] Community health providers include both public (Female Community Health Volunteer, Village Health Worker and mobile/outreach clinic) and private (mobile clinic) health facilities [b] Includes all public and private health facilities and providers as well as shops ( ) Figures that are based on 25–49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201478 Ta bl e CH .1 5: T re at m en t o f c hi ld re n wi th fe ve r Pe rc en ta ge o f c hil dr en a ge d 0– 59 m on th s w ho h ad a fe ve r i n th e tw o we ek s p re ce din g th e su rv ey , b y t yp e of m ed ici ne g ive n fo r t he ill ne ss , N ep al, 2 01 4 Pe rc en t w ho w er e giv en : Nu m be r o f ch ild re n ag ed 0 –5 9 m on th s wi th fe ve r in th e las t tw o we ek s An tim ala ria ls Ot he r m ed ica tio ns Ot he r DK / M iss ing SP / Fa ns ida r Ch lor o- qu ine Am od ia- qu ine Qu ini ne Ar te m isi nin -b as ed co m bin a- tio n th er ap y (A CT ) Ot he r a nt i- m ala ria l An tib iot ic pil l o r sy ru p An tib iot ic inj ec tio n Pa ra ce t- am ol/ pa na do l/ ac et am in- op he n As pir in Ib up ro fe n To ta l 0. 2 0. 2 0. 0 0. 0 0. 3 0. 2 59 .6 1. 3 22 .1 0. 0 1. 1 3. 3 1. 9 1, 07 4 Se x M ale 0. 0 0. 5 0. 0 0. 1 0. 1 0. 4 60 .8 1. 0 20 .5 0. 0 1. 8 2. 9 1. 2 55 9 Fe m ale 0. 4 0. 0 0. 0 0. 0 0. 4 0. 0 58 .2 1. 6 23 .8 0. 0 0. 4 3. 7 2. 6 51 4 Re gi on Ea ste rn M ou nt ain s 1. 5 0. 0 0. 0 0. 0 0. 0 0. 0 40 .7 0. 0 24 .4 0. 0 4. 7 2. 8 3. 0 15 Ea ste rn H ills 0. 0 0. 8 0. 0 0. 8 1. 5 0. 0 57 .8 0. 0 16 .3 0. 0 3. 5 1. 5 0. 0 55 Ea ste rn T er ai 0. 8 0. 9 0. 0 0. 0 0. 0 0. 0 73 .6 1. 6 22 .9 0. 0 1. 0 6. 3 1. 3 22 1 Ce nt ra l M ou nt ain s (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (5 9. 9) (0 .0 ) (3 .5 ) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) 10 Ce nt ra l H ills 0. 0 0. 0 0. 0 0. 0 0. 0 1. 2 58 .2 0. 0 15 .0 0. 0 0. 0 6. 4 1. 1 13 2 Ce nt ra l T er ai 0. 0 0. 0 0. 0 0. 0 1. 2 0. 0 60 .4 3. 5 27 .5 0. 0 0. 0 2. 5 3. 3 17 9 W es te rn M ou nt ain s (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) W es te rn H ills 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 55 .7 1. 3 45 .4 0. 0 0. 0 1. 6 1. 8 11 1 W es te rn T er ai 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 79 .8 0. 0 30 .3 0. 0 9. 3 0. 0 0. 0 80 M id- W es te rn M ou nt ain s 0. 0 0. 0 0. 0 0. 0 0. 0 1. 9 25 .8 0. 7 7. 7 0. 0 0. 0 1. 0 0. 9 21 M id- W es te rn H ills 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 47 .9 2. 5 3. 8 0. 0 0. 0 0. 4 0. 0 88 M id- W es te rn T er ai 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 55 .2 0. 0 10 .1 0. 0 0. 0 3. 8 1. 8 60 Fa r W es te rn M ou nt ain s 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 28 .7 0. 0 25 .2 0. 0 0. 0 1. 7 6. 0 26 Fa r W es te rn H ills 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 29 .6 0. 0 19 .8 0. 0 0. 0 2. 9 11 .7 37 Fa r W es te rn T er ai 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 60 .6 0. 0 11 .7 0. 0 0. 0 2. 0 0. 0 37 Ar ea Ur ba n 0. 0 0. 3 0. 0 0. 3 0. 0 1. 1 68 .2 1. 0 34 .4 0. 0 0. 0 4. 4 1. 1 15 3 Ka th m an du va lle y (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (4 .0 ) (5 9. 6) (0 .0 ) (2 1. 6) (0 .0 ) (0 .0 ) (5 .1 ) (0 .0 ) 41 Ot he r u rb an 0. 0 0. 4 0. 0 0. 4 0. 0 0. 0 71 .3 1. 4 39 .0 0. 0 0. 0 4. 1 1. 5 11 2 Ru ra l 0. 2 0. 2 0. 0 0. 0 0. 3 0. 0 58 .1 1. 3 20 .0 0. 0 1. 3 3. 1 2. 0 92 1 Ag e 0– 11 m on th s 1. 0 0. 2 0. 0 0. 2 0. 0 0. 0 73 .7 2. 4 20 .7 0. 0 2. 3 5. 0 1. 6 18 2 12 –2 3 m on th s 0. 0 0. 0 0. 0 0. 0 0. 0 0. 2 59 .6 0. 0 22 .0 0. 0 1. 4 3. 4 1. 8 25 9 24 –3 5 m on th s 0. 1 0. 0 0. 0 0. 0 0. 3 0. 7 57 .1 1. 2 26 .3 0. 0 0. 5 1. 9 1. 1 23 4 36 –4 7 m on th s 0. 0 0. 0 0. 0 0. 0 1. 0 0. 0 57 .0 3. 0 20 .4 0. 0 0. 0 5. 7 2. 9 21 2 48 –5 9 m on th s 0. 0 1. 1 0. 0 0. 0 0. 0 0. 0 51 .8 0. 0 20 .0 0. 0 1. 7 0. 3 2. 0 18 7 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 79 Ta bl e CH .1 5: T re at m en t o f c hi ld re n wi th fe ve r Pe rc en ta ge o f c hil dr en a ge d 0– 59 m on th s w ho h ad a fe ve r i n th e tw o we ek s p re ce din g th e su rv ey , b y t yp e of m ed ici ne g ive n fo r t he ill ne ss , N ep al, 2 01 4 Pe rc en t w ho w er e giv en : Nu m be r o f ch ild re n ag ed 0 –5 9 m on th s wi th fe ve r in th e las t tw o we ek s An tim ala ria ls Ot he r m ed ica tio ns Ot he r DK / M iss ing SP / Fa ns ida r Ch lor o- qu ine Am od ia- qu ine Qu ini ne Ar te m isi nin -b as ed co m bin a- tio n th er ap y (A CT ) Ot he r a nt i- m ala ria l An tib iot ic pil l o r sy ru p An tib iot ic inj ec tio n Pa ra ce t- am ol/ pa na do l/ ac et am in- op he n As pir in Ib up ro fe n M ot he r's E du ca tio n No ne Pr im ar y Se co nd ar y Hi gh er 0. 0 0. 1 0. 7 0. 0 0. 1 1. 1 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 0. 5 0. 0 0. 0 0. 4 0. 0 0. 0 0. 0 0. 9 54 .4 59 .2 62 .2 66 .8 2. 2 0. 0 0. 7 1. 2 19 .5 19 .3 99 .6 20 .8 0. 0 0. 0 0. 0 0. 0 0. 5 1. 7 1. 6 1. 4 2. 0 2. 2 5. 1 4. 6 0. 9 1. 9 1. 5 4. 2 41 5 19 4 25 0 21 5 W ea lth in de x qu in til es Po or es t 0. 0 0. 0 0. 0 0. 0 0. 4 0. 1 43 .3 1. 2 12 .0 0. 0 0. 0 1. 3 3. 7 23 1 Se co nd 0. 1 0. 0 0. 0 0. 0 1. 1 0. 1 58 .9 0. 0 27 .9 0. 0 0. 5 1. 7 0. 0 20 1 M idd le 0. 8 0. 2 0. 0 0. 2 0. 0 0. 0 63 .5 4. 2 23 .2 0. 0 1. 6 2. 4 2. 1 21 9 Fo ur th 0. 0 0. 8 0. 0 0. 0 0. 0 0. 0 65 .5 0. 6 20 .3 0. 0 2. 0 5. 1 1. 7 25 4 Ri ch es t 0. 0 0. 0 0. 0 0. 0 0. 0 1. 0 68 .7 0. 0 30 .2 0. 0 1. 6 6. 3 1. 5 16 8 ( ) F igu re s t ha t a re b as ed o n 25 –4 9 un we igh te d ca se s (*) F igu re s t ha t a re b as ed o n fe we r t ha n 25 u nw eig ht ed ca se s C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201480 Mothers were asked to report all medicines given to a child to treat fever, including medicines given both at home and those given or prescribed at a health facility. Artemisinin-based combination therapy (ACT) is the first-line antimalarial recommended by the WHO and used in Nepal. In addition, confirmation of malaria is done on all fever cases through rapid diagnostic test. Table CH.15 shows the treatment of children with fever. Less than 1 percent of children were treated with an ACT and an additional 1 percent received an antimalarial other than ACT. Among other treatments provided were ‘antibiotic pill or syrup’ (60 percent) and ‘paracetamol/panadol/ acetaminophen’ (22 percent). No trends by background characteristics could be observed in treatment with antimalarials as sample sizes were very small. Table CH.16 shows the proportion of children aged 0–59 months with a fever in the two weeks preceding the survey who had a finger or heel stick for malaria testing, as well as treatment with antimalarial. Overall, 5 percent of children with a fever had blood taken from a finger or heel for testing. Of children who received antimalarials, the number who received ACT was too small for analysis. Only 10 of 1,074 children with fever received any antimalarials. Due to low number of observations, no results are presented in the table. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 81 Table CH.16: Diagnostics and antimalarial treatment of children Percentage of children aged 0–59 months who had a fever in the two weeks preceding the survey who had a finger or heel stick for malaria testing, Nepal, 2014 Percent who: Number of children aged 0–59 months with fever in the last two weeks Had blood taken from a finger or heel for testing [1] Were given: Artemisinin- based combination treatment (ACT) ACT on the same or next day Any antimalarial drugs [2] Any antimalarial drugs on the same or next day Total 4.8 0.3 0.2 0.9 0.5 1,074 Sex Male 4.3 0.1 0.0 1.0 0.7 559 Female 5.4 0.4 0.4 0.8 0.4 514 Region Eastern Mountains 1.4 0.0 0.0 1.5 0.0 15 Eastern Hills 4.0 1.5 0.0 2.3 0.0 55 Eastern Terai 9.1 0.0 0.0 1.8 0.9 221 Central Mountains (2.7) (0.0) (0.0) (0.0) (0.0) 10 Central Hills 2.0 0.0 0.0 1.2 1.2 132 Central Terai 3.2 1.2 1.2 1.2 1.2 179 Western Mountains (*) (*) (*) (*) (*) Western Hills 6.8 0.0 0.0 0.0 0.0 111 Western Terai 3.2 0.0 0.0 0.0 0.0 80 Mid-Western Mountains 6.1 0.0 0.0 1.9 0.0 21 Mid-Western Hills 2.7 0.0 0.0 0.0 0.0 88 Mid-Western Terai 7.5 0.0 0.0 0.0 0.0 60 Far Western Mountains 3.7 0.0 0.0 0.0 0.0 26 Far Western Hills 2.9 0.0 0.0 0.0 0.0 37 Far Western Terai 0.0 0.0 0.0 0.0 0.0 37 Area Urban 6.4 0.0 0.0 1.3 1.1 153 Kathmandu valley 6.6 0.0 0.0 4.0 4.0 41 Other urban 6.3 0.0 0.0 0.4 0.0 112 Rural 4.6 0.3 0.2 0.8 0.5 921 Age (months) 0–11 2.6 0.0 0.0 1.3 0.0 182 12–23 6.2 0.0 0.0 0.2 0.0 259 24–35 3.6 0.3 0.0 1.1 0.7 234 36–47 4.3 1.0 1.0 1.0 1.0 212 48–59 7.0 0.0 0.0 1.1 1.1 187 Mother’s education None 4.0 0.5 0.5 0.7 0.5 415 Primary 4.9 0.0 0.0 1.2 1.1 194 Secondary 4.3 0.0 0.0 0.7 0.0 250 Higher 7.0 0.4 0.0 1.2 0.8 215 Wealth index quintiles Poorest 2.9 0.4 0.0 0.4 0.0 231 Second 3.4 1.1 1.1 1.3 1.1 201 Middle 6.6 0.0 0.0 1.0 0.0 219 Fourth 4.2 0.0 0.0 0.8 0.8 254 Richest 7.8 0.0 0.0 1.0 1.0 168 [1] MICS indicator 3.21 — Malaria diagnostics usage [2] MICS indicator 3.22; MDG indicator 6.8 — Antimalarial treatment of children under age 5 ( ) Figures that are based on 25–49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201482 Water and Sanitation C H A P T E R7 Safe drinking water is a basic necessity for good health. Unsafe drinking water can be a significant carrier of diseases such as cholera, typhoid, and schistosomiasis. Drinking water can also be tainted with chemical and physical contaminants with harmful effects on human health. In addition to its association with disease, access to drinking water may be particularly important for women and children, especially in rural areas, who bear the primary responsibility for carrying water, often for long distances.1 Inadequate disposal of human excreta and personal hygiene are associated with a range of diseases including diarrhoeal diseases and polio and are important determinants of stunting. Improved sanitation can reduce diarrhoeal disease by more than a third2, and can substantially lessen the adverse health impacts of other disorders among millions of children in many countries. The MDG target (7C) is to reduce by half, between 1990 and 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation. For more details on water and sanitation and to access some reference documents, please visit data. unicef.org3 or the website of the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation4 . 1WHO/UNICEF. 2012. Progress on Drinking water and Sanitation: 2012 update. 2Cairncross, S et al. 2010. Water, sanitation and hygiene for the prevention of diarrhoea. International Journal of Epidemiology 39: i193–i205. 3http://data.unicef.org/water-sanitation/sanitation 4http://www.wssinfo.org NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 83 Use of Improved Water Sources The population using improved sources of drinking water are those using any of the following types of supply: piped water (into dwelling, compound, yard or plot, to neighbour, public tap/standpipe), tubewell/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 handwashing and cooking. The distribution of household members by main source of drinking water is shown in Table WS.1. Overall, 93 percent of household members used an improved source of drinking water. Most used a tubewell/borehole (43 percent), public tap/standpipe (19 percent), and water piped into yard or plot (16 percent). Some 9 percent had piped water into their dwelling. Of unimproved sources, the most common was unprotected spring (3 percent). Of household members using improved water sources, the highest proportion was in the Eastern Terai (99 percent) and the lowest was in the Mid-Western Mountains (73 percent). The education level of the household head had no association with use of improved water source. Households in the poorest quintile were least likely to use improved sources (83 percent). NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201484 Ta bl e W S. 1: U se o f i m pr ov ed w at er s ou rc es Pe rc en ta ge o f h ou se ho ld m em be rs a cc or din g to m ain so ur ce o f d rin kin g wa te r, an d pe rc en ta ge u sin g im pr ov ed d rin kin g wa te r s ou rc es , N ep al, 2 01 4 Pe rc en t b y m ain so ur ce o f d rin kin g wa te r To ta l Pe rc en t us ing im pr ov e -e d so ur ce s of dr ink ing wa te r [ 1] Nu m be r of ho us e- ho ld m em - be rs Im pr ov ed so ur ce s Un im pr ov ed so ur ce s Pi pe d wa te r Tu be - we ll/ bo re - ho le Pr o- te cte d we ll Pr o- te cte d sp rin g Ra in- wa te r co lle c- tio n Bo ttle d wa te r [a ] Un pr o- te cte d we ll Un pr o- te cte d sp rin g Ta nk er tru ck Su rfa ce wa te r Bo ttle d wa te r [a ] Ot he r In to dw ell ing In to ya rd / plo t To ne igh - bo ur Pu bli c ta p/ sta nd - pip e To ta l 8. 7 16 .2 1. 6 18 .7 43 .4 1. 4 2. 1 0. 0 1. 2 1. 3 2. 7 0. 4 1. 8 0. 2 0. 4 10 0. 0 93 .3 56 ,8 24 Re gi on Ea ste rn M ou nt ain s 2. 1 54 .5 5. 1 18 .9 0. 0 0. 2 11 .8 0. 0 0. 0 0. 0 7. 0 0. 0 0. 3 0. 0 0. 0 10 0. 0 92 .7 77 9 Ea ste rn H ills 6. 4 38 .1 1. 4 21 .5 7. 7 2. 0 10 .2 0. 1 0. 0 4. 1 7. 3 0. 0 1. 2 0. 0 0. 0 10 0. 0 87 .5 3, 16 9 Ea ste rn T er ai 6. 5 7. 4 0. 3 1. 2 83 .3 0. 4 0. 1 0. 0 0. 4 0. 5 0. 1 0. 0 0. 0 0. 0 0. 0 10 0. 0 99 .4 8, 25 1 Ce nt ra l M ou nt ain s 6. 9 36 .2 7. 1 41 .2 0. 3 0. 1 2. 0 0. 0 0. 0 0. 2 3. 5 0. 0 2. 6 0. 0 0. 0 10 0. 0 93 .8 1, 14 8 Ce nt ra l H ills 26 .1 18 .8 2. 0 20 .4 6. 3 4. 0 1. 7 0. 0 7. 1 2. 3 1. 7 2. 2 5. 0 1. 0 1. 4 10 0. 0 86 .3 8, 74 6 Ce nt ra l T er ai 4. 0 7. 0 0. 5 1. 0 86 .3 0. 4 0. 0 0. 0 0. 0 0. 3 0. 3 0. 0 0. 0 0. 1 0. 0 10 0. 0 99 .3 10 ,2 48 W es te rn M ou nt ain s 16 .9 31 .9 1. 7 46 .2 0. 0 0. 0 0. 3 0. 0 0. 0 0. 0 0. 3 0. 0 2. 6 0. 0 0. 0 10 0. 0 97 .1 32 W es te rn H ills 11 .9 36 .1 1. 2 43 .1 0. 1 0. 6 3. 2 0. 0 0. 7 0. 0 2. 1 0. 3 0. 7 0. 0 0. 0 10 0. 0 96 .9 6, 37 1 W es te rn T er ai 6. 6 16 .5 1. 4 4. 0 69 .2 0. 5 0. 3 0. 0 0. 0 0. 1 1. 3 0. 0 0. 0 0. 0 0. 1 10 0. 0 98 .4 4, 82 5 M id- W es te rn M ou nt ain s 1. 1 3. 1 6. 4 48 .7 1. 0 0. 6 12 .4 0. 0 0. 0 1. 6 13 .6 0. 0 11 .2 0. 0 0. 3 10 0. 0 73 .3 79 8 M id- W es te rn H ills 4. 8 18 .0 5. 9 41 .1 0. 5 0. 5 5. 3 0. 2 0. 0 1. 2 17 .0 0. 0 5. 3 0. 0 0. 0 10 0. 0 76 .5 3, 59 1 M id- W es te rn T er ai 2. 8 2. 5 0. 2 7. 0 71 .5 5. 8 0. 6 0. 0 0. 1 7. 5 1. 5 0. 0 0. 7 0. 0 0. 0 10 0. 0 90 .3 3, 27 6 Fa r W es te rn M ou nt ain s 1. 3 17 .3 5. 1 67 .5 0. 3 0. 0 1. 7 0. 0 0. 0 0. 1 1. 2 0. 0 4. 0 0. 0 1. 5 10 0. 0 93 .2 1, 01 4 Fa r W es te rn H ills 0. 7 7. 2 0. 7 79 .6 0. 0 0. 1 1. 8 0. 0 0. 0 0. 7 1. 6 0. 0 4. 5 0. 0 3. 1 10 0. 0 90 .1 1, 88 0 Fa r W es te rn T er ai 2. 4 1. 5 0. 5 4. 8 89 .1 0. 0 0. 4 0. 0 0. 1 0. 1 0. 0 0. 0 0. 7 0. 0 0. 3 10 0. 0 98 .8 2, 69 7 Ar ea Ur ba n 27 .7 23 .9 1. 1 8. 3 27 .5 1. 5 1. 4 0. 0 4. 0 0. 4 0. 5 2. 1 0. 2 1. 0 0. 4 10 0. 0 95 .5 9, 75 3 Ka th m an du va lle y 40 .0 19 .4 1. 9 9. 6 4. 2 2. 1 1. 3 0. 0 11 .3 0. 3 0. 0 6. 1 0. 0 2. 7 1. 1 10 0. 0 89 .8 2, 97 1 Ot he r u rb an 22 .3 25 .8 0. 8 7. 7 37 .7 1. 3 1. 5 0. 0 0. 8 0. 4 0. 7 0. 3 0. 3 0. 2 0. 1 10 0. 0 97 .9 6, 78 2 Ru ra l 4. 8 14 .7 1. 7 20 .9 46 .6 1. 3 2. 2 0. 0 0. 7 1. 5 3. 1 0. 0 2. 1 0. 0 0. 4 10 0. 0 92 .9 47 ,0 71 Ed uc at io n of h ou se ho ld h ea d No ne 3. 8 12 .0 1. 8 20 .2 51 .4 1. 0 2. 0 0. 0 0. 2 1. 7 3. 1 0. 2 2. 1 0. 1 0. 4 10 0. 0 92 .5 24 ,6 91 Pr im ar y 7. 5 18 .0 2. 1 22 .8 36 .9 1. 4 2. 8 0. 0 0. 6 1. 4 3. 4 0. 2 2. 3 0. 2 0. 4 10 0. 0 92 .2 11 ,5 23 Se co nd ar y 9. 7 20 .5 1. 3 17 .3 40 .2 1. 4 1. 8 0. 0 1. 8 1. 1 2. 5 0. 4 1. 4 0. 2 0. 3 10 0. 0 94 .0 11 ,1 79 Hi gh er 22 .5 20 .1 0. 6 11 .6 33 .7 2. 1 1. 8 0. 0 4. 0 0. 4 0. 9 1. 1 0. 8 0. 4 0. 2 10 0. 0 96 .3 9, 28 1 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 85 Ta bl e W S. 1: U se o f i m pr ov ed w at er s ou rc es Pe rc en ta ge o f h ou se ho ld m em be rs a cc or din g to m ain so ur ce o f d rin kin g wa te r, an d pe rc en ta ge u sin g im pr ov ed d rin kin g wa te r s ou rc es , N ep al, 2 01 4 Pe rc en t b y m ain so ur ce o f d rin kin g wa te r To ta l Pe rc en t us ing im pr ov e -e d so ur ce s of dr ink ing wa te r [ 1] Nu m be r of ho us e- ho ld m em - be rs Im pr ov ed so ur ce s Un im pr ov ed so ur ce s Pi pe d wa te r Tu be - we ll/ bo re - ho le Pr o- te cte d we ll Pr o- te cte d sp rin g Ra in- wa te r co lle c- tio n Bo ttle d wa te r [a ] Un pr o- te cte d we ll Un pr o- te cte d sp rin g Ta nk er tru ck Su rfa ce wa te r Bo ttle d wa te r [a ] Ot he r In to dw ell ing In to ya rd / plo t To ne igh - bo ur Pu bli c ta p/ sta nd - pip e W ea lth in de x qu in til e Po or es t 1. 2 14 .6 3. 9 52 .0 4. 7 0. 4 5. 6 0. 1 0. 0 1. 6 9. 1 0. 0 5. 7 0. 0 1. 1 10 0. 0 82 .5 11 ,3 66 Se co nd 2. 8 19 .2 1. 8 20 .4 44 .9 1. 2 2. 4 0. 0 0. 0 2. 1 3. 0 0. 0 1. 9 0. 0 0. 4 10 0. 0 92 .7 11 ,3 66 M idd le 1. 4 11 .2 0. 8 8. 1 72 .9 1. 5 0. 8 0. 0 0. 1 1. 4 0. 7 0. 0 0. 9 0. 0 0. 1 10 0. 0 96 .9 11 ,3 66 Fo ur th 4. 7 14 .7 0. 9 7. 6 67 .2 1. 5 0. 8 0. 0 0. 5 1. 1 0. 4 0. 1 0. 3 0. 1 0. 1 10 0. 0 97 .9 11 ,3 48 Ri ch es t 33 .6 21 .5 0. 4 5. 6 27 .0 2. 1 0. 8 0. 0 5. 6 0. 2 0. 1 1. 8 0. 1 0. 8 0. 3 10 0. 0 96 .8 11 ,3 77 [1 ] M IC S in di ca to r 4 .1 ; M DG in di ca to r 7 .8 – U se o f i m pr ov ed d rin ki ng w at er s ou rc es [a ] H ou se ho lds u sin g bo ttle d wa te r a s t he m ain so ur ce o f d rin kin g wa te r a re cl as sif ied in to im pr ov ed o r u nim pr ov ed d rin kin g wa te r u se rs a cc or din g to th e wa te r s ou rc e us ed fo r o th er p ur po se s s uc h as co ok ing a nd h an dw as hin g. No te : 1 50 ca se s o f m iss ing ‘e du ca tio n of h ou se ho ld he ad ’ n ot sh ow n C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201486 Figure WS.1 shows percentage of household members by source of drinking water. Figure WS.1: Percentage of household members by source of drinking water, Nepal, 2014 Households were asked of ways they may be treating water at home to make it safer to drink. Boiling water, adding bleach or chlorine, using a water filter, and using solar disinfection are considered as proper treatment of drinking water. Table WS.2 shows water treatment by household members and proportion using unimproved water sources but using appropriate water treatment methods. Of household members living in households using an unimproved water source, only 14 percent used an appropriate method to treat the water. Common treatment methods were: use of water filter (12 percent) and boiling water (10 percent). Household members were most likely to live in households that did not treat water in any way (81 percent). Among the regions, water treatment was highest in the Western Mountains where 63 percent of household members boiled their water and lowest in the Far Western Hills where 99 percent did nothing. Household members in urban areas were more likely than those in rural areas to treat their water. The education level of the household head and the household’s wealth were both positively associated with the likelihood of treating water. Treating water was markedly higher in the richest households. Of household members using an unimproved water source, those in urban areas were much more likely than those in rural areas to treat it appropriately (57 percent compared to 8 percent). Education level of household head and household wealth status were both strongly correlated with the likelihood of appropriately treating water from an unimproved source. Nepal  MICS  2014   4     Figure  WS.1  shows  percentage  of  household  members  by  source  of  drinking  water.   Figure  WS.1:  Percentage  of  household  members  by  source  of  drinking  water,  Nepal,  2014     Households  were  asked  of  ways  they  may  be  treating  water  at  home  to  make  it  safer  to  drink.   Boiling  water,  adding  bleach  or  chlorine,  using  a  water  filter,  and  using  solar  disinfection  are   considered  as  proper  treatment  of  drinking  water.  Table  WS.2  shows  water  treatment  by  household   members  and  proportion  using  unimproved  water  sources  but  using  appropriate  water  treatment   methods.  Of  household  members  living  in  households  using  an  unimproved  water  source,  only  14   percent  use  an  appropriate  method  to  treat  the  water.  Common  treatment  methods  were:  use  of   water  filter  (12  percent)  and  boiling  water  (10  percent).  Household  members  were  most  likely  to  live   in  households  that  did  not  treat  water  in  any  way  (81  percent).   Among  the  regions,  water  treatment  was  highest  in  the  Western  Mountains  where  63  percent  of   household  members  boiled  their  water,  and  lowest  in  the  Far  Western  Hills  where  99  percent  did   nothing.  Household  members  in  urban  areas  were  more  likely  than  those  in  rural  areas  to  treat  their   water.  The  education  level  of  the  household  head  and  the  household’s  wealth  were  both  positively   associated  with  the  likelihood  of  treating  water.  Treating  water  was  markedly  higher  in  the  richest   households.     Of  household  members  using  an  unimproved  water  source,  those   in  urban  areas  were  much  more   likely   than   those   in   rural   areas   to   treat   it   appropriately   (57   percent   compared   to   8   percent).   Education  level  of  household  head  and  household  wealth  status  were  both  strongly  correlated  to  the   likelihood  of  appropriately  treating  water  from  an  unimproved  source.       Piped into dwelling, yard or plot 26% Public tap/standpipe 19% Tubewell/ borehole 43% Protected well or spring 4% Unprotected well or spring 4% Surface water 2% Other unimproved 0.4% NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 87 Ta bl e W S. 2: H ou se ho ld w at er tr ea tm en t Pe rc en ta ge o f h ou se ho ld m em be rs b y d rin kin g wa te r t re at m en t m et ho d us ed in th e ho us eh old , a nd fo r h ou se ho ld m em be rs liv ing in h ou se ho lds w he re a n un im pr ov ed d rin kin g wa te r s ou rc e is us ed , t he pe rc en ta ge w ho a re u sin g an a pp ro pr iat e tre at m en t m et ho d, N ep al, 2 01 4 Pe rc en t b y w at er tr ea tm en t m et ho d us ed in h ou se ho ld Nu m be r o f ho us eh old m em be rs Pe rc en t o f ho us eh old m em be rs us ing un im pr ov ed dr ink ing wa te r so ur ce s an d an ap pr op ria te wa te r tre at m en t m et ho d [1 ] Nu m be r o f ho us eh old m em be rs us ing un im pr ov ed dr ink ing wa te r so ur ce s No ne Bo il Ad d ble ac h/ ch lor ine St ra in th ro ug h a clo th Us e wa te r filt er So lar dis inf ec tio n Le t it st an d an d se ttle Ot he r To ta l 81 .2 9. 7 0. 4 1. 8 11 .8 0. 5 0. 6 0. 3 56 ,8 24 13 .6 3, 78 2 Re gi on Ea ste rn M ou nt ain s 82 .7 16 .0 0. 0 1. 0 1. 2 0. 2 0. 0 0. 0 77 9 6. 5 57 Ea ste rn H ills 75 .5 20 .6 0. 3 3. 2 4. 9 0. 3 0. 9 0. 1 3, 16 9 14 .2 39 7 Ea ste rn T er ai 81 .6 6. 0 0. 1 0. 4 13 .7 0. 4 2. 0 0. 3 8, 25 1 (*) 46 Ce nt ra l M ou nt ain s 91 .5 5. 8 0. 0 0. 6 3. 5 0. 2 0. 2 0. 0 1, 14 8 4. 1 72 Ce nt ra l H ills 51 .8 26 .6 1. 7 2. 8 37 .4 2. 2 0. 4 1. 0 8, 74 6 27 .0 1, 19 8 Ce nt ra l T er ai 98 .3 0. 7 0. 1 0. 2 1. 4 0. 0 0. 1 0. 0 10 ,2 48 (*) 72 W es te rn M ou nt ain s 35 .9 63 .4 0. 4 1. 6 4. 4 0. 6 0. 0 0. 0 32 (*) 1 W es te rn H ills 68 .4 19 .0 0. 3 1. 3 17 .6 0. 5 0. 0 0. 2 6, 37 1 (1 9. 0) 20 1 W es te rn T er ai 87 .6 4. 5 0. 2 0. 6 10 .4 0. 1 0. 4 0. 0 4, 82 5 (*) 75 M id- W es te rn M ou nt ain s 94 .5 3. 8 0. 0 1. 1 0. 4 0. 0 0. 0 0. 0 79 8 10 .7 21 3 M id- W es te rn H ills 92 .3 1. 4 0. 0 4. 0 2. 4 0. 0 0. 0 0. 2 3, 59 1 1. 9 84 5 M id- W es te rn T er ai 82 .4 4. 1 0. 6 10 .3 4. 7 0. 5 1. 2 0. 1 3, 27 6 14 .9 31 7 Fa r W es te rn M ou nt ain s 95 .9 3. 7 0. 0 0. 2 0. 0 0. 1 0. 8 0. 0 1, 01 4 2. 3 69 Fa r W es te rn H ills 99 .2 0. 5 0. 0 0. 2 0. 3 0. 0 0. 0 0. 0 1, 88 0 0. 7 18 7 Fa r W es te rn T er ai 93 .8 2. 8 0. 2 0. 0 4. 1 0. 1 0. 2 0. 0 2, 69 7 (*) 32 Ar ea Ur ba n 49 .5 25 .5 1. 7 1. 7 40 .1 1. 4 0. 8 1. 0 9, 75 3 57 .4 44 3 Ka th m an du va lle y 23 .0 49 .1 3. 8 2. 6 60 .3 2. 1 0. 3 2. 1 2, 97 1 73 .0 30 3 Ot he r u rb an 61 .2 15 .1 0. 8 1. 3 31 .2 1. 1 1. 0 0. 5 6, 78 2 23 .6 14 0 Ru ra l 87 .8 6. 4 0. 1 1. 8 6. 0 0. 3 0. 5 0. 1 47 ,0 71 7. 8 3, 33 9 M ai n so ur ce o f d rin ki ng wa te r Im pr ov ed 81 .2 9. 8 0. 4 1. 5 12 .1 0. 5 0. 5 0. 2 53 ,0 42 na na Un im pr ov ed 81 .4 8. 8 0. 3 5. 8 8. 0 0. 2 0. 7 0. 4 3, 78 2 13 .6 3, 78 2 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201488 Ta bl e W S. 2: H ou se ho ld w at er tr ea tm en t Pe rc en ta ge o f h ou se ho ld m em be rs b y d rin kin g wa te r t re at m en t m et ho d us ed in th e ho us eh old , a nd fo r h ou se ho ld m em be rs liv ing in h ou se ho lds w he re a n un im pr ov ed d rin kin g wa te r s ou rc e is us ed , t he pe rc en ta ge w ho a re u sin g an a pp ro pr iat e tre at m en t m et ho d, N ep al, 2 01 4 Pe rc en t b y w at er tr ea tm en t m et ho d us ed in h ou se ho ld Nu m be r o f ho us eh old m em be rs Pe rc en t o f ho us eh old m em be rs us ing un im pr ov ed dr ink ing wa te r so ur ce s an d an ap pr op ria te wa te r tre at m en t m et ho d [1 ] Nu m be r o f ho us eh old m em be rs us ing un im pr ov ed dr ink ing wa te r so ur ce s No ne Bo il Ad d ble ac h/ ch lor ine St ra in th ro ug h a clo th Us e wa te r filt er So lar dis inf ec tio n Le t it st an d an d se ttle Ot he r Ed uc at io n of h ou se ho ld he ad No ne 90 .8 4. 4 0. 1 1. 2 4. 8 0. 2 0. 3 0. 0 24 ,6 91 9. 1 1, 85 6 Pr im ar y 84 .2 8. 0 0. 2 2. 4 8. 6 0. 3 0. 7 0. 1 11 ,5 23 10 .7 90 3 Se co nd ar y 75 .3 12 .4 0. 4 2. 7 14 .8 0. 8 0. 9 0. 3 11 ,1 79 14 .1 66 8 Hi gh er 59 .4 22 .6 1. 4 1. 3 30 .6 1. 2 0. 5 1. 0 9, 28 1 42 .5 34 6 W ea lth in de x qu in til e Po or es t 95 .7 2. 8 0. 0 1. 2 0. 3 0. 1 0. 0 0. 0 11 ,3 66 1. 0 1, 98 4 Se co nd 89 .8 6. 7 0. 0 2. 1 1. 6 0. 0 0. 4 0. 0 11 ,3 66 14 .6 83 0 M idd le 90 .5 4. 2 0. 0 2. 3 3. 7 0. 1 1. 1 0. 1 11 ,3 66 16 .0 35 7 Fo ur th 83 .4 8. 1 0. 2 1. 8 9. 7 0. 4 0. 9 0. 2 11 ,3 48 (2 7. 3) 24 3 Ri ch es t 46 .7 26 .7 1. 8 1. 7 43 .8 1. 9 0. 4 1. 0 11 ,3 77 68 .2 36 8 [1 ] M IC S in di ca to r 4 .2 – W at er tr ea tm en t na : n ot a pp lic ab le No te : 8 ca se s o f m iss ing ‘e du ca tio n of h ou se ho ld he ad ’ n ot sh ow n ( ) F igu re s t ha t a re b as ed o n 25 –4 9 un we igh te d ca se s (*) F igu re s t ha t a re b as ed o n fe we r t ha n 25 u nw eig ht ed ca se s C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 89 The amount of time it takes household members to obtain water, including those with water on the premises, is presented in Table WS.3. The results refer to one round trip from home to drinking water source. Information on the number of trips made in one day was not collected. The availability of water on premises is associated with higher use, better family hygiene and better health outcomes. For a round trip of over 30 minutes, it has been observed that household members carry progressively less water and are more likely to compromise on minimal basic drinking water needs. The majority of households (67 percent) used an improved drinking water source on the premises. In addition, 22 percent used an improved drinking water source with a round trip of less than 30 minutes and 3 percent used an unimproved drinking water source with a round trip of less than 30 minutes. Some 5 percent of household members used an improved drinking water source with a round trip of 30 minutes or more and 3 percent used an unimproved drinking water source with a round trip of 30 minutes or more. In total, 7 percent of household members took more than 30 minutes to collect water. The highest proportion of household members taking 30 minutes or more to collect water was in the Mid-Western Hills (30 percent) and the lowest was in the Eastern Terai (less than 1 percent). Household members in households where the head had primary education were more likely than others to take 30 minutes or more to collect water (9 percent). Household members living in households in the poorest quintile were more likely than others to take 30 minutes or more to collect water. The education level of the household head and the household’s wealth status were both positively associated with having a water source on the premises. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201490 Ta bl e W S. 3: T im e to s ou rc e of d rin ki ng w at er Pe rc en ta ge o f h ou se ho ld m em be rs a cc or din g to tim e ta ke n to g o to so ur ce o f d rin kin g wa te r, ge t w at er a nd re tu rn , f or u se rs o f im pr ov ed a nd u nim pr ov ed d rin kin g wa te r s ou rc es , N ep al, 2 01 4 Ti m e to so ur ce o f d rin kin g wa te r To ta l Nu m be r o f ho us eh old m em be rs Pe rc en t o f u se rs o f im pr ov ed d rin kin g wa te r s ou rc es Pe rc en t o f u se rs o f u nim pr ov ed d rin kin g wa te r s ou rc es W at er o n pr em ise s Le ss th an 3 0 m inu te s 30 m inu te s o r m or e DK / M iss ing W at er o n pr em ise s Le ss th an 3 0 m inu te s 30 m inu te s o r m or e DK / M iss ing To ta l 66 .8 21 .9 4. 5 0. 2 0. 8 2. 9 2. 8 0. 1 10 0. 0 56 ,8 24 Re gi on Ea ste rn M ou nt ain s 68 .1 15 .4 9. 2 0. 0 1. 1 3. 9 2. 4 0. 0 10 0. 0 77 9 Ea ste rn H ills 58 .6 22 .7 6. 1 0. 0 1. 2 6. 6 4. 3 0. 4 10 0. 0 3, 16 9 Ea ste rn T er ai 88 .7 10 .2 0. 6 0. 0 0. 4 0. 1 0. 0 0. 0 10 0. 0 8, 25 1 Ce nt ra l M ou nt ain s 51 .7 39 .7 2. 3 0. 0 0. 1 4. 2 1. 9 0. 0 10 0. 0 1, 14 8 Ce nt ra l H ills 63 .3 18 .5 4. 1 0. 4 2. 8 6. 0 4. 4 0. 6 10 0. 0 8, 74 6 Ce nt ra l T er ai 77 .7 20 .1 1. 2 0. 3 0. 1 0. 6 0. 0 0. 0 10 0. 0 10 ,2 48 W es te rn M ou nt ain s 52 .7 37 .5 6. 4 0. 5 0. 0 2. 5 0. 4 0. 0 10 0. 0 32 W es te rn H ills 52 .0 38 .3 6. 4 0. 2 0. 2 0. 8 2. 1 0. 0 10 0. 0 6, 37 1 W es te rn T er ai 85 .8 11 .5 1. 0 0. 1 0. 1 1. 1 0. 3 0. 0 10 0. 0 4, 82 5 M id- W es te rn M ou nt ain s 13 .5 43 .4 15 .9 0. 5 0. 1 12 .3 14 .1 0. 2 10 0. 0 79 8 M id- W es te rn H ills 34 .5 28 .4 13 .6 0. 0 0. 8 6. 2 16 .3 0. 2 10 0. 0 3, 59 1 M id- W es te rn T er ai 75 .5 13 .9 0. 8 0. 2 2. 1 5. 6 1. 9 0. 1 10 0. 0 3, 27 6 Fa r W es te rn M ou nt ain s 25 .7 50 .5 16 .9 0. 1 0. 0 3. 8 2. 9 0. 1 10 0. 0 1, 01 4 Fa r W es te rn H ills 12 .1 53 .6 24 .3 0. 0 0. 0 5. 0 4. 7 0. 2 10 0. 0 1, 88 0 Fa r W es te rn T er ai 87 .8 9. 5 0. 9 0. 6 0. 3 0. 2 0. 7 0. 0 10 0. 0 2, 69 7 Ar ea Ur ba n 84 .7 7. 8 2. 6 0. 4 2. 0 1. 3 0. 8 0. 6 10 0. 0 9, 75 3 Ka th m an du va lle y 80 .1 5. 4 3. 3 1. 1 4. 8 2. 8 0. 9 1. 8 10 0. 0 2, 97 1 Ot he r u rb an 86 .7 8. 8 2. 3 0. 1 0. 7 0. 6 0. 7 0. 0 10 0. 0 6, 78 2 Ru ra l 63 .1 24 .8 4. 9 0. 2 0. 6 3. 2 3. 3 0. 1 10 0. 0 47 ,0 71 Ed uc at io n of h ou se ho ld he ad No ne 60 .5 26 .4 5. 3 0. 2 0. 8 3. 4 3. 3 0. 1 10 0. 0 24 ,6 91 Pr im ar y 62 .5 24 .2 5. 1 0. 3 0. 8 2. 8 4. 1 0. 1 10 0. 0 11 ,5 23 Se co nd ar y 72 .0 17 .8 4. 1 0. 1 0. 8 2. 8 2. 3 0. 1 10 0. 0 11 ,1 79 Hi gh er 82 .3 11 .9 2. 0 0. 1 1. 1 1. 5 0. 8 0. 4 10 0. 0 9, 28 1 W ea lth in de x qu in til e Po or es t 27 .1 41 .1 14 .2 0. 3 1. 0 6. 6 9. 8 0. 0 10 0. 0 11 ,3 66 Se co nd 56 .3 32 .2 3. 9 0. 3 0. 5 4. 1 2. 5 0. 2 10 0. 0 11 ,3 66 M idd le 76 .0 19 .2 1. 6 0. 1 0. 8 1. 5 0. 8 0. 0 10 0. 0 11 ,3 66 Fo ur th 84 .2 11 .9 1. 6 0. 1 0. 3 1. 1 0. 7 0. 1 10 0. 0 11 ,3 48 Ri ch es t 90 .3 4. 9 1. 3 0. 2 1. 5 1. 0 0. 3 0. 4 10 0. 0 11 ,3 77 No te : 1 50 ca se s o f m iss ing ‘e du ca tio n of h ou se ho ld he ad ’ n ot sh ow n NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 91 Ta bl e W S. 4: P er so n co lle ct in g wa te r Pe rc en ta ge o f h ou se ho lds w ith ou t d rin kin g wa te r o n th e pr em ise s, an d pe rc en ta ge o f h ou se ho lds w ith ou t d rin kin g wa te r o n th e pr em ise s a cc or din g to th e pe rs on u su all y c oll ec tin g dr ink ing w at er u se d in th e ho us eh old , N ep al, 2 01 4 Pe rc en t o f ho us eh old s wi th ou t dr ink ing w at er on th e pr em ise s Nu m be r o f ho us eh old s Pe rc en t b y p er so n us ua lly co lle cti ng d rin kin g wa te r Nu m be r o f ho us eh old s wi th ou t dr ink ing w at er on th e pr em ise s Ad ult w om an Ad ult m an Fe m ale ch ild un de r 1 5 ye ar s M ale ch ild un de r 1 5 ye ar s DK M iss ing To ta l To ta l 32 .9 12 ,4 05 84 .0 9. 2 4. 5 1. 7 0. 2 0. 4 10 0. 0 4, 08 5 Re gi on Ea ste rn M ou nt ain s 31 .7 77 6 74 .8 13 .0 8. 8 3. 4 0. 0 0. 0 10 0. 0 57 Ea ste rn H ills 40 .3 77 7 83 .1 12 .9 3. 2 0. 0 0. 0 0. 8 10 0. 0 30 9 Ea ste rn T er ai 11 .0 97 4 89 .0 5. 9 4. 1 1. 0 0. 0 0. 0 10 0. 0 20 4 Ce nt ra l M ou nt ain s 48 .7 77 1 88 .6 8. 3 2. 0 1. 1 0. 0 0. 0 10 0. 0 14 6 Ce nt ra l H ills 34 .3 1, 50 3 80 .2 15 .2 1. 7 1. 2 1. 1 0. 5 10 0. 0 74 8 Ce nt ra l T er ai 22 .9 95 6 88 .3 6. 5 4. 9 0. 0 0. 0 0. 3 10 0. 0 44 1 W es te rn M ou nt ain s 48 .4 37 4 79 .8 18 .5 1. 1 0. 0 0. 6 0. 0 10 0. 0 5 W es te rn H ills 46 .0 97 3 86 .0 8. 3 3. 7 2. 0 0. 0 0. 0 10 0. 0 74 9 W es te rn T er ai 14 .7 78 2 74 .7 10 .8 10 .4 3. 3 0. 0 0. 8 10 0. 0 13 5 M id- W es te rn M ou nt ain s 85 .6 74 3 77 .9 6. 8 12 .0 3. 1 0. 0 0. 1 10 0. 0 13 3 M id- W es te rn H ills 64 .7 77 8 82 .0 6. 6 7. 9 3. 0 0. 0 0. 4 10 0. 0 49 4 M id- W es te rn T er ai 23 .7 75 9 83 .8 4. 9 7. 0 3. 7 0. 0 0. 7 10 0. 0 15 9 Fa r W es te rn M ou nt ain s 72 .7 75 9 84 .4 7. 2 4. 7 3. 0 0. 2 0. 5 10 0. 0 13 5 Fa r W es te rn H ills 87 .7 73 6 92 .0 5. 2 1. 8 0. 7 0. 0 0. 3 10 0. 0 30 3 Fa r W es te rn T er ai 13 .0 74 4 72 .6 10 .9 6. 1 9. 2 0. 0 1. 1 10 0. 0 68 Ar ea Ur ba n 13 .1 2, 99 2 76 .1 15 .4 2. 1 2. 4 2. 6 1. 3 10 0. 0 32 3 Ka th m an du va lle y 14 .9 78 2 53 .6 28 .4 2. 6 5. 0 7. 3 3. 1 10 0. 0 11 7 Ot he r u rb an 12 .2 1, 69 4 88 .8 8. 1 1. 8 0. 9 0. 0 0. 4 10 0. 0 20 7 Ru ra l 37 .9 9, 41 3 84 .7 8. 6 4. 7 1. 7 0. 0 0. 3 10 0. 0 3, 76 2 Ed uc at io n of h ou se ho ld h ea d No ne 40 .8 5, 26 7 85 .2 8. 0 4. 8 1. 7 0. 0 0. 2 10 0. 0 2, 12 1 Pr im ar y 37 .5 2, 44 1 81 .7 10 .2 4. 9 2. 2 0. 4 0. 6 10 0. 0 90 7 Se co nd ar y 27 .3 2, 42 2 86 .9 7. 2 3. 7 1. 6 0. 2 0. 4 10 0. 0 66 9 Hi gh er 16 .5 2, 24 9 77 .9 16 .9 3. 5 0. 8 0. 6 0. 3 10 0. 0 38 2 W ea lth in de x qu in til e Po or es t 71 .5 2, 37 6 84 .8 7. 2 5. 3 2. 3 0. 0 0. 4 10 0. 0 1, 69 9 Se co nd 45 .1 2, 55 8 83 .7 10 .1 4. 0 1. 7 0. 0 0. 4 10 0. 0 1, 15 4 M idd le 25 .4 2, 28 9 87 .3 7. 7 4. 1 0. 7 0. 0 0. 2 10 0. 0 58 0 Fo ur th 17 .1 2, 44 1 83 .0 11 .4 4. 1 1. 4 0. 0 0. 0 10 0. 0 41 7 Ri ch es t 8. 6 2, 74 2 73 .4 18 .3 2. 8 0. 9 3. 6 1. 0 10 0. 0 23 5 No te : 2 4 ca se s o f m iss ing ‘e du ca tio n of h ou se ho ld he ad ’ n ot sh ow n NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201492 Table WS.4 shows information on the person who usually collected water in households without drinking water on the premises. Some 33 percent of households had no drinking water on the premises. An adult female was the person who usually collected water in 84 percent of these households. This was followed by an adult male (9 percent), a female child (5 percent) and a male child (2 percent). The highest proportion of households using an adult female was in the Far Western Hills (92 percent) and the lowest was in the Far Western Terai (73 percent). Households in urban areas were less likely than those in rural areas to use an adult female (76 percent compared to 85 percent) and more likely to use an adult male (15 percent compared to 9 percent). Households where the head had higher education were less likely than others to use an adult female. Households in the richest quintile were less likely than others to use an adult female. A female child was used most often in households where the head had primary education (5 percent) and those in the poorest quintile (5 percent). Use of Improved Sanitation An improved sanitation facility is defined as one that hygienically separates human excreta from human contact. Improved sanitation facilities for excreta disposal include flush or pour flush to a piped sewer system, septic tank or pit latrine; ventilated improved pit latrine; pit latrine with slab; and use of a composting toilet. Data on the use of improved sanitation facilities in Nepal are provided in Table WS.5. Some 72 percent of household members were living in households using improved sanitation facilities, with 43 percent using a septic tank and 15 percent using a pit latrine. However, 26 percent still practiced open defecation. Only 2 percent used unimproved sanitation facilities. In Nepal, the options tended to be between improved facilities or open defecation. The highest proportion of household members using improved sanitation facilities was in the Western Hills (94 percent) and the lowest was in the Central Terai (42 percent). Urban areas were much more likely than rural areas to use improved sanitation facilities (94 percent compared to 67 percent). The use of improved sanitation facilities is strongly correlated with the education level of the household head. There is no trend in the use of improved sanitation facilities by household wealth, probably as a result of targeted expansion of improved sanitation facilities in deprived areas. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 93 Ta bl e W S. 5: T yp es o f s an ita tio n fa ci lit ie s Pe rc en ta ge o f h ou se ho ld m em be rs a cc or din g to ty pe o f t oil et fa cil ity u se d by th e ho us eh old , N ep al, 2 01 4 Ty pe o f t oil et fa cil ity u se d by h ou se ho ld Op en de fe ca - tio n (n o fa cil ity , bu sh , fie ld) To ta l Nu m be r o f ho us eh old m em be rs Pe rc en t w ith im pr ov ed sa nit at ion fa cil ity Pe rc en t w ith u nim pr ov ed sa nit at ion fa cil ity Fl us h/ po ur flu sh to : Ve nt i- lat ed im pr ov ed pit la tri ne Pi t la tri ne wi th sl ab Co m po s- tin g to ile t Fl us h/ po ur flu sh to so m e- wh er e els e Pi t la tri ne wi th ou t sla b/ op en p it Bu ck et Ha ng ing to ile t/ lat rin e Ot he r Pi pe d se we r sy ste m Se pt ic ta nk Pi t la tri ne Un kn ow n pla ce / n ot su re / D K To ta l 6. 1 43 .4 15 .4 0. 1 1. 4 4. 0 1. 3 0. 2 0. 8 0. 0 1. 1 0. 0 26 .3 10 0. 0 56 ,8 24 Re gi on Ea ste rn M ou nt ain s 0. 5 21 .9 35 .0 0. 0 0. 6 15 .6 0. 1 0. 3 3. 0 0. 0 0. 1 0. 1 22 .8 10 0. 0 77 9 Ea ste rn H ills 0. 3 48 .0 31 .9 0. 0 0. 4 9. 8 0. 3 0. 1 0. 7 0. 0 0. 0 0. 0 8. 5 10 0. 0 3, 16 9 Ea ste rn T er ai 1. 8 36 .4 7. 3 0. 0 0. 6 4. 5 0. 4 0. 1 1. 6 0. 0 4. 4 0. 0 43 .0 10 0. 0 8, 25 1 Ce nt ra l M ou nt ain s 0. 0 77 .8 6. 8 0. 0 0. 6 0. 6 0. 3 0. 0 0. 8 0. 0 0. 2 0. 0 12 .9 10 0. 0 1, 14 8 Ce nt ra l H ills 36 .4 45 .1 4. 9 0. 3 1. 7 1. 0 0. 6 0. 1 0. 6 0. 0 0. 0 0. 0 9. 3 10 0. 0 8, 74 6 Ce nt ra l T er ai 1. 0 29 .8 6. 7 0. 0 3. 0 1. 1 0. 0 0. 0 0. 3 0. 0 0. 0 0. 0 58 .1 10 0. 0 10 ,2 48 W es te rn M ou nt ain s 0. 3 58 .7 7. 7 0. 0 0. 0 6. 8 0. 0 0. 0 0. 4 0. 0 0. 6 0. 0 25 .5 10 0. 0 32 W es te rn H ills 0. 0 53 .9 22 .8 0. 0 3. 3 11 .1 2. 9 0. 0 1. 0 0. 0 0. 8 0. 0 4. 2 10 0. 0 6, 37 1 W es te rn T er ai 0. 1 60 .2 9. 2 0. 0 0. 0 0. 2 0. 5 0. 0 0. 0 0. 0 0. 0 0. 2 29 .7 10 0. 0 4, 82 5 M id- W es te rn M ou nt ain s 0. 0 16 .6 47 .0 0. 0 2. 5 17 .2 0. 0 0. 2 0. 7 0. 2 0. 0 0. 0 15 .6 10 0. 0 79 8 M id- W es te rn H ills 0. 0 62 .2 22 .0 0. 0 0. 1 1. 8 0. 1 1. 3 0. 2 0. 0 0. 6 0. 0 11 .8 10 0. 0 3, 59 1 M id- W es te rn T er ai 0. 4 47 .9 19 .2 0. 1 0. 3 4. 0 2. 7 1. 5 0. 1 0. 2 4. 8 0. 0 18 .8 10 0. 0 3, 27 6 Fa r W es te rn M ou nt ain s 0. 2 44 .1 41 .1 0. 0 0. 2 1. 9 0. 0 0. 3 0. 3 0. 0 0. 1 0. 0 11 .8 10 0. 0 1, 01 4 Fa r W es te rn H ills 0. 0 12 .1 68 .2 0. 0 0. 0 1. 6 0. 0 0. 1 0. 8 0. 0 0. 2 0. 0 17 .0 10 0. 0 1, 88 0 Fa r W es te rn T er ai 0. 3 41 .4 10 .1 0. 0 0. 2 6. 3 12 .2 0. 0 2. 4 0. 0 0. 4 0. 0 26 .6 10 0. 0 2, 69 7 Ar ea Ur ba n 24 .9 61 .1 4. 8 0. 2 0. 5 1. 4 0. 9 0. 2 0. 2 0. 0 0. 2 0. 0 5. 6 10 0. 0 9, 75 3 Ka th m an du va lle y 77 .2 21 .8 0. 1 0. 4 0. 3 0. 0 0. 0 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 10 0. 0 2, 97 1 Ot he r u rb an 2. 0 78 .3 6. 9 0. 0 0. 6 1. 9 1. 3 0. 4 0. 3 0. 0 0. 2 0. 0 8. 0 10 0. 0 6, 78 2 Ru ra l 2. 2 39 .8 17 .6 0. 0 1. 5 4. 6 1. 4 0. 2 0. 9 0. 0 1. 3 0. 0 30 .6 10 0. 0 47 ,0 71 Ed uc at io n of h ou se ho ld h ea d No ne 2. 2 33 .1 16 .6 0. 0 1. 2 4. 3 1. 0 0. 3 1. 1 0. 0 1. 2 0. 0 39 .1 10 0. 0 24 ,6 91 Pr im ar y 4. 5 43 .8 18 .7 0. 0 1. 6 4. 3 1. 0 0. 3 0. 9 0. 1 1. 1 0. 0 23 .5 10 0. 0 11 ,5 23 Se co nd ar y 7. 3 50 .8 14 .6 0. 1 1. 7 5. 1 2. 0 0. 2 0. 4 0. 0 1. 1 0. 1 16 .6 10 0. 0 11 ,1 79 Hi gh er 17 .2 61 .1 9. 2 0. 1 0. 9 1. 5 1. 5 0. 0 0. 2 0. 0 0. 7 0. 0 7. 5 10 0. 0 9, 28 1 W ea lth in de x qu in til e Po or es t 0. 0 29 .6 36 .3 0. 0 1. 1 8. 9 0. 0 0. 5 1. 3 0. 0 0. 5 0. 0 21 .8 10 0. 0 11 ,3 66 Se co nd 0. 1 34 .6 16 .0 0. 0 1. 6 4. 4 0. 8 0. 2 1. 1 0. 0 0. 8 0. 0 40 .5 10 0. 0 11 ,3 66 M idd le 0. 4 27 .9 11 .9 0. 0 2. 2 3. 8 2. 0 0. 2 1. 2 0. 0 1. 7 0. 1 48 .5 10 0. 0 11 ,3 66 Fo ur th 4. 3 56 .2 10 .9 0. 1 1. 2 2. 6 2. 7 0. 2 0. 1 0. 1 1. 7 0. 0 19 .9 10 0. 0 11 ,3 48 Ri ch es t 25 .7 68 .9 1. 8 0. 2 0. 7 0. 3 0. 8 0. 0 0. 0 0. 0 0. 8 0. 0 0. 8 10 0. 0 11 ,3 77 No te : 1 50 ca se s o f m iss ing ‘e du ca tio n of h ou se ho ld he ad ’ n ot sh ow n NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201494 The MDGs and the WHO/UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation classify otherwise acceptable sanitation facilities that are public or shared between two or more households as unimproved. Therefore, ‘use of improved sanitation’ is used, both in the context of this report and as an MDG indicator, to refer to improved sanitation facilities that are not public or shared. Data on the use of improved sanitation by household members are presented in Tables WS.6. Some 60 percent of the household population used an improved sanitation facility. In addition, 10 percent used an improved sanitation facility shared by five households or fewer, 2 percent used an improved sanitation facility shared by more than five households, and less than 1 percent used an improved sanitation facility that was public. This is a total of 12 percent of the household population who used an improved sanitation facility that was either shared or public. The highest proportion of household members using a shared/public improved sanitation facility was in the Central Hills (26 percent) and the lowest was in the Far Western Hills (2 percent). Urban households were more likely than rural households to use a shared/public improved facility (31 percent compared to 7 percent). Both education level of household head and household wealth status were positively associated with use of a shared/public improved facility. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 95 Ta bl e W S. 6: U se a nd s ha rin g of s an ita tio n fa ci lit ie s Pe rc en ta ge o f h ou se ho ld m em be rs b y u se o f p riv at e an d pu bli c s an ita tio n fa cil itie s a nd u se o f s ha re d fa cil itie s, by u se rs o f im pr ov ed a nd u nim pr ov ed sa nit at ion fa cil itie s, Ne pa l, 2 01 4 Pe rc en t o f u se rs o f im pr ov ed sa nit at ion fa cil itie s Pe rc en t o f u se rs o f u nim pr ov ed sa nit at ion fa cil itie s Op en de fe ca tio n (n o fa cil ity , bu sh , f iel d) To ta l Nu m be r o f ho us eh old m em be rs No t s ha re d [1 ] Pu bli c fa cil ity Sh ar ed b y DK / M iss ing No t s ha re d Pu bli c fa cil ity Sh ar ed b y Fi ve ho us eh old s or fe we r M or e th an fiv e ho us eh old s Fi ve ho us eh old s or fe we r M or e th an fiv e ho us eh old s To ta l 60 .1 0. 3 9. 5 1. 7 0. 0 1. 7 0. 0 0. 3 0. 0 26 .3 10 0. 0 56 ,8 24 Re gi on Ea ste rn M ou nt ain s 66 .9 0. 0 5. 5 1. 2 0. 0 3. 3 0. 0 0. 0 0. 1 22 .8 10 0. 0 77 9 Ea ste rn H ills 82 .2 0. 4 6. 6 1. 3 0. 1 0. 8 0. 0 0. 0 0. 0 8. 5 10 0. 0 3, 16 9 Ea ste rn T er ai 41 .8 0. 0 7. 4 1. 6 0. 1 4. 7 0. 0 1. 3 0. 1 43 .0 10 0. 0 8, 25 1 Ce nt ra l M ou nt ain s 81 .0 0. 5 4. 3 0. 3 0. 0 0. 8 0. 0 0. 2 0. 0 12 .9 10 0. 0 1, 14 8 Ce nt ra l H ills 64 .4 1. 2 18 .7 5. 7 0. 0 0. 7 0. 0 0. 1 0. 0 9. 3 10 0. 0 8, 74 6 Ce nt ra l T er ai 36 .7 0. 1 4. 2 0. 6 0. 0 0. 3 0. 0 0. 0 0. 0 58 .1 10 0. 0 10 ,2 48 W es te rn M ou nt ain s 58 .3 0. 3 14 .0 0. 8 0. 0 0. 4 0. 0 0. 6 0. 0 25 .5 10 0. 0 32 W es te rn H ills 75 .2 0. 1 17 .8 0. 9 0. 0 1. 0 0. 1 0. 7 0. 0 4. 2 10 0. 0 6, 37 1 W es te rn T er ai 61 .7 0. 0 7. 7 0. 7 0. 0 0. 2 0. 0 0. 0 0. 0 29 .7 10 0. 0 4, 82 5 M id- W es te rn M ou nt ain s 78 .4 0. 2 4. 2 0. 5 0. 0 1. 0 0. 0 0. 0 0. 0 15 .6 10 0. 0 79 8 M id- W es te rn H ills 79 .5 0. 0 6. 5 0. 0 0. 0 2. 1 0. 0 0. 0 0. 0 11 .8 10 0. 0 3, 59 1 M id- W es te rn T er ai 65 .6 0. 0 8. 7 0. 2 0. 0 5. 9 0. 0 0. 7 0. 0 18 .8 10 0. 0 3, 27 6 Fa r W es te rn M ou nt ain s 85 .2 0. 0 1. 9 0. 5 0. 0 0. 7 0. 0 0. 0 0. 0 11 .8 10 0. 0 1, 01 4 Fa r W es te rn H ills 80 .1 0. 0 1. 8 0. 0 0. 0 1. 0 0. 0 0. 0 0. 1 17 .0 10 0. 0 1, 88 0 Fa r W es te rn T er ai 55 .3 0. 2 11 .9 3. 2 0. 0 2. 3 0. 0 0. 4 0. 2 26 .6 10 0. 0 2, 69 7 Ar ea Ur ba n 62 .8 0. 5 24 .5 5. 9 0. 1 0. 4 0. 0 0. 3 0. 0 5. 6 10 0. 0 9, 75 3 Ka th m an du va lle y 59 .5 0. 9 28 .0 11 .5 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 10 0. 0 2, 97 1 Ot he r u rb an 64 .3 0. 3 23 .0 3. 4 0. 1 0. 5 0. 0 0. 4 0. 0 8. 0 10 0. 0 6, 78 2 Ru ra l 59 .6 0. 2 6. 4 0. 8 0. 0 2. 0 0. 0 0. 3 0. 0 30 .6 10 0. 0 47 ,0 71 Ed uc at io n of h ou se ho ld h ea d No ne 52 .3 0. 1 5. 0 0. 9 0. 0 2. 1 0. 0 0. 4 0. 0 39 .1 10 0. 0 24 ,6 91 Pr im ar y 62 .2 0. 1 9. 6 2. 1 0. 1 2. 0 0. 0 0. 4 0. 0 23 .5 10 0. 0 11 ,5 23 Se co nd ar y 65 .6 0. 1 13 .6 2. 1 0. 0 1. 4 0. 0 0. 3 0. 1 16 .6 10 0. 0 11 ,1 79 Hi gh er 71 .4 1. 0 16 .5 2. 7 0. 0 0. 7 0. 0 0. 2 0. 0 7. 5 10 0. 0 9, 28 1 W ea lth in de x qu in til e Po or es t 72 .7 0. 0 3. 0 0. 2 0. 0 2. 1 0. 0 0. 2 0. 0 21 .8 10 0. 0 11 ,3 66 Se co nd 52 .4 0. 2 4. 7 0. 2 0. 0 1. 5 0. 0 0. 5 0. 1 40 .5 10 0. 0 11 ,3 66 M idd le 40 .7 0. 1 6. 5 0. 9 0. 0 2. 9 0. 0 0. 3 0. 0 48 .5 10 0. 0 11 ,3 66 Fo ur th 61 .1 0. 2 13 .7 2. 9 0. 1 1. 6 0. 0 0. 5 0. 0 19 .9 10 0. 0 11 ,3 48 Ri ch es t 73 .7 0. 8 19 .8 4. 1 0. 0 0. 6 0. 0 0. 2 0. 0 0. 8 10 0. 0 11 ,3 77 [1 ] M IC S in di ca to r 4 .3 ; M DG in di ca to r 7 .9 – U se o f i m pr ov ed s an ita tio n No te : 1 50 ca se s o f m iss ing ‘e du ca tio n of h ou se ho ld he ad ’ n ot sh ow n NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201496 Figure WS.2 shows the proportions of household members using improved and unimproved sanitation facilities by whether or not they are shared or public. Figure WS.2: Percentage of household members by use and sharing of sanitation facilities, Nepal, 2014 In its 2008 report5, the JMP developed a new way of presenting figures on access to drinking water and sanitation by disaggregating and refining the relevant data and reflecting them in a ‘ladder’ format. This ladder allows a disaggregated analysis of trends in a three-rung ladder for drinking water and a four- rung ladder for sanitation. For sanitation, this gives an understanding of the proportion of population with no sanitation facilities at all (i.e., those who revert to open defecation), the proportion who are reliant on technologies defined by JMP as ‘unimproved’, the proportion sharing sanitation facilities of otherwise acceptable technology, and the proportion using ‘improved’ sanitation facilities. Having access to both an improved drinking water source and an improved sanitation facility brings the largest public health benefits to a household. Table WS.7 presents the proportions of household members by drinking water and sanitation ladders. The table also shows the percentage of household members using both improved sources of drinking water6 and an improved sanitary means of excreta disposal. 5WHO/UNICEF JMP, 2008. MDG assessment report - http://www.wssinfo.org/fileadmin/user_upload/resources/1251794333-JMP_08_en.pdf 6Those indicating bottled water as the main source of drinking water are distributed according to the water source used for other purposes such as cooking and handwashing. Nepal  MICS  2014   19     Figure  WS.2  shows  the  proportions  of  household  members  using  improved  and  unimproved   sanitation  facilities  by  whether  or  not  they  are  shared  or  public.    Figure  WS.2:  Percentage  of  household  members  by  use  and  sharing  of  sanitation  facilities,  Nepal,   2014     In  its  2008  report5,  the  JMP  developed  a  new  way  of  presenting  figures  on  access  to  drinking  water   and  sanitation  by  disaggregating  and  refining  the  relevant  data  and  reflecting  them  in  a  ‘ladder’   format.  This  ladder  allows  a  disaggregated  analysis  of  trends  in  a  three-­‐rung  ladder  for  drinking   water  and  a  four-­‐rung  ladder  for  sanitation.  For  sanitation,  this  gives  an  understanding  of  the   proportion  of  population  with  no  sanitation  facilities  at  all  (i.e.,  those  who  revert  to  open   defecation),  the  proportion  who  are  reliant  on  technologies  defined  by  JMP  as  ‘unimproved’,  the   proportion  sharing  sanitation  facilities  of  otherwise  acceptable  technology,  and  the  proportion  using   ‘improved’  sanitation  facilities.     Having  access  to  both  an  improved  drinking  water  source  and  an  improved  sanitation  facility  brings   the  largest  public  health  benefits  to  a  household.  Table  WS.7  presents  the  proportions  of  household   members   by   drinking   water   and   sanitation   ladders.   The   table   also   shows   the   percentage   of   household   members   using   both   improved   sources   of   drinking   water6   and   an   improved   sanitary   means  of  excreta  disposal.                                                                                                                               5  WHO/UNICEF  JMP,  2008.  MDG  assessment  report  -­‐   http://www.wssinfo.org/fileadmin/user_upload/resources/1251794333-­‐JMP_08_en.pdf   6  Those  indicating  bottled  water  as  the  main  source  of  drinking  water  are  distributed  according  to  the  water   source  used  for  other  purposes  such  as  cooking  and  handwashing.   Improved sanitation facility - not shared 60.2% Improved public facility 0.3% Improved sanitation facility - shared 11.2% Unimproved sanitation facility - not shared 1.7% Unimproved sanitation facility - shared 0.3% Open defacation 26.3% NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 97 Ta bl e W S. 7: D rin ki ng w at er a nd s an ita tio n la dd er s Pe rc en ta ge o f h ou se ho ld m em be rs b y d rin kin g wa te r a nd sa nit at ion la dd er s, Ne pa l, 2 01 4 Pe rc en t u sin g: Nu m be r o f ho us eh old m em be rs Im pr ov ed d rin kin g wa te r [1 ] [ a] Un im pr ov ed dr ink ing wa te r To ta l Im pr ov ed sa nit at ion [2 ] Un im pr ov ed sa nit at ion To ta l Im pr ov ed dr ink ing wa te r so ur ce s a nd im pr ov ed sa nit at ion Pi pe d int o dw ell ing , p lot or ya rd Ot he r im pr ov ed Sh ar ed im pr ov ed fa cil itie s Un im pr ov ed fa cil itie s Op en de fe ca tio n To ta l 25 .6 67 .7 6. 7 10 0. 0 60 .1 11 .5 2. 1 26 .3 10 0. 0 55 .8 56 ,8 24 Re gi on Ea ste rn M ou nt ain s 56 .6 36 .1 7. 3 10 0. 0 66 .9 6. 8 3. 5 22 .8 10 0. 0 63 .1 77 9 Ea ste rn H ills 44 .6 42 .9 12 .5 10 0. 0 82 .2 8. 5 0. 8 8. 5 10 0. 0 73 .6 3, 16 9 Ea ste rn T er ai 14 .2 85 .2 0. 6 10 0. 0 41 .8 9. 1 6. 1 43 .0 10 0. 0 41 .7 8, 25 1 Ce nt ra l M ou nt ain s 43 .1 50 .6 6. 2 10 0. 0 81 .0 5. 1 1. 0 12 .9 10 0. 0 75 .7 1, 14 8 Ce nt ra l H ills 48 .0 38 .3 13 .7 10 0. 0 64 .4 25 .6 0. 7 9. 3 10 0. 0 55 .9 8, 74 6 Ce nt ra l T er ai 11 .0 88 .3 0. 7 10 0. 0 36 .7 4. 9 0. 3 58 .1 10 0. 0 36 .5 10 ,2 48 W es te rn M ou nt ain s 48 .8 48 .2 2. 9 10 0. 0 58 .3 15 .2 1. 0 25 .5 10 0. 0 57 .4 32 W es te rn H ills 48 .7 48 .1 3. 1 10 0. 0 75 .2 18 .8 1. 8 4. 2 10 0. 0 72 .8 6, 37 1 W es te rn T er ai 23 .0 75 .4 1. 6 10 0. 0 61 .7 8. 3 0. 2 29 .7 10 0. 0 61 .1 4, 82 5 M id- W es te rn M ou nt ain s 4. 2 69 .1 26 .7 10 0. 0 78 .4 4. 9 1. 0 15 .6 10 0. 0 62 .9 79 8 M id- W es te rn H ills 22 .9 53 .6 23 .5 10 0. 0 79 .5 6. 6 2. 1 11 .8 10 0. 0 61 .4 3, 59 1 M id- W es te rn T er ai 5. 3 85 .1 9. 7 10 0. 0 65 .6 9. 0 6. 6 18 .8 10 0. 0 58 .9 3, 27 6 Fa r W es te rn M ou nt ain s 18 .6 74 .6 6. 8 10 0. 0 85 .2 2. 3 0. 7 11 .8 10 0. 0 80 .4 1, 01 4 Fa r W es te rn H ills 7. 9 82 .2 9. 9 10 0. 0 80 .1 1. 8 1. 1 17 .0 10 0. 0 75 .5 1, 88 0 Fa r W es te rn T er ai 4. 0 94 .8 1. 2 10 0. 0 55 .3 15 .3 2. 8 26 .6 10 0. 0 54 .2 2, 69 7 Ar ea Ur ba n 53 .2 42 .2 4. 5 10 0. 0 62 .8 30 .9 0. 7 5. 6 10 0. 0 59 .8 9, 75 3 Ka th m an du va lle y 63 .4 26 .4 10 .2 10 0. 0 59 .5 40 .4 0. 1 0. 0 10 0. 0 52 .7 2, 97 1 Ot he r u rb an 48 .8 49 .1 2. 1 10 0. 0 64 .3 26 .8 0. 9 8. 0 10 0. 0 62 .9 6, 78 2 Ru ra l 19 .9 73 .0 7. 1 10 0. 0 59 .6 7. 5 2. 4 30 .6 10 0. 0 55 .0 47 ,0 71 Ed uc at io n of h ou se ho ld he ad No ne 15 .9 76 .6 7. 5 10 0. 0 52 .3 6. 1 2. 6 39 .1 10 0. 0 47 .6 24 ,6 91 Pr im ar y 25 .6 66 .5 7. 8 10 0. 0 62 .2 11 .8 2. 4 23 .5 10 0. 0 57 .1 11 ,5 23 Se co nd ar y 31 .2 62 .8 6. 0 10 0. 0 65 .6 15 .9 1. 8 16 .6 10 0. 0 61 .5 11 ,1 79 Hi gh er 44 .7 51 .5 3. 7 10 0. 0 71 .4 20 .2 0. 9 7. 5 10 0. 0 68 .6 9, 28 1 W ea lth in de x qu in til e Po or es t 15 .8 66 .8 17 .5 10 0. 0 72 .7 3. 2 2. 3 21 .8 10 0. 0 61 .6 11 ,3 66 Se co nd 22 .0 70 .7 7. 3 10 0. 0 52 .4 5. 0 2. 1 40 .5 10 0. 0 47 .6 11 ,3 66 M idd le 12 .7 84 .2 3. 1 10 0. 0 40 .7 7. 5 3. 2 48 .5 10 0. 0 38 .8 11 ,3 66 Fo ur th 19 .4 78 .4 2. 1 10 0. 0 61 .1 16 .9 2. 1 19 .9 10 0. 0 59 .7 11 ,3 48 Ri ch es t 58 .1 38 .7 3. 2 10 0. 0 73 .7 24 .8 0. 8 0. 8 10 0. 0 71 .2 11 ,3 77 [1 ] M IC S in di ca to r 4 .1 ; M DG in di ca to r 7 .8 – U se o f i m pr ov ed d rin ki ng w at er s ou rc es [2 ] M IC S in di ca to r 4 .3 ; M DG in di ca to r 7 .9 – U se o f i m pr ov ed s an ita tio n [a ] T ho se in dic at ing b ot tle d wa te r a s t he m ain so ur ce o f d rin kin g wa te r a re d ist rib ut ed a cc or din g to th e wa te r s ou rc e us ed fo r o th er p ur po se s s uc h as co ok ing a nd h an dw as hin g No te : 1 50 ca se s o f m iss ing ‘e du ca tio n of h ou se ho ld he ad ’ n ot sh ow n NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 201498 Overall, 93 percent of household members in Nepal used improved drinking water sources and 60 percent used improved sanitation facilities. The ladder shows that 56 percent were using both an improved drinking water source and an improved sanitation facility. The proportion using both an improved drinking water source and an improved sanitation facility was highest in the Far Western Mountains (80 percent) and lowest in the Central Terai (37 percent). Household members in urban areas were more likely than those in rural areas to do so (60 percent compared to 55 percent). The education of the household head was positively associated with the use of both an improved drinking water source and an improved sanitation facility. There was no consistent pattern associated with the wealth status of a household. This is presumably because of the higher number of poorer households with improved sanitation facilities as a result of recent government programmes targeting the expansion of such facilities for the poorest. Figure WS.3 shows use of improved drinking water sources and improved sanitation facilities by household wealth quintile. Figure WS.3: Use of improved drinking water sources and improved sanitation facilities by household members, Nepal, 2014 Safe disposal of a child’s faeces includes a child using the toilet or stools being rinsed down the toilet. Putting disposable diapers into the garbage, a very common practice throughout the world, is currently classified as an inadequate means of disposal as a result of concerns about the poor disposal of solid waste. This classification is under review. Disposal of the faeces of children aged 0–2 years is presented in Table WS.8. The stools of 48 percent of children were disposed of safely the last time the child passed stools, with the stools of 41 percent of children being rinsed down the toilet or the child using the toilet for 7 percent of children. In households with an improved sanitation facility, the stools of 69 percent of children were disposed of safely; in households with an unimproved sanitation facility, the stools of 35 percent of children were disposed of safely; and in households using open defecation, the stools of 2 percent of children were disposed of safely. The safe disposal of children’s stools was highest in the Eastern Hills (78 percent) and lowest in the Far Western Terai (24 percent). The stools of urban children were more likely than the stools of rural children to be disposed of safely (81 percent compared to 43 percent). The safe disposal of stools improved with the education level of mothers, ranging from 28 percent for women with no education to 78 percent for women with higher education. The safe disposal of stools by household wealth quintile reflected the use of improved sanitation facilities: the stools of children living in households in the middle quintile were the least likely to be disposed of safely. Nepal MICS 2014 22 Overall, 93 percent of household members in Nepal used improved drinking water sources and 60 percent used improved sanitation facilities. The ladder shows that 56percentwere using both an improved drinking water source and an improved sanitation facility. The proportion using both an improved drinking water source and an improved sanitation facility was highest in the Far Western Mountains (80 percent) and lowest in the Central Terai (37percent). Household members in urban areas were more likely than those in rural areas to do so (60percent compared to 55 percent). The education of the household head was positively associated with the use of both an improved drinking water source and an improved sanitation facility.There was no consistent pattern associated with the wealth status of a household. This is presumably because of the higher number of poorer households with improved sanitation facilities, as a result of recent government programmes targeting the expansion of such facilities for the poorest. Figure WS.3 shows use of improved drinking water sources and improved sanitation facilities by household wealth quintile. Figure WS.3: Use of improved drinking water sources and improved sanitation facilities by household members, Nepal, 2014 Safe disposal of a child’s faeces includes a child using the toilet or stools being rinsed down the toilet. Putting disposable diapers into the garbage, a very common practice throughout the world,is currently classified as an inadequate means of disposal as a result of concerns about the poor disposal of solid waste. This classification is under review. Disposal of the faeces of children aged 0–2 years is presented in Table WS.8. The stools of 48 percent of children were disposed of safely the last time the child passed stools, with the stools of 41 percent of children being rinsed down the toilet or the child using the toilet for 7percent of children. In households with an improved sanitation facility, the stools of 69percent of children were disposed of safely; in households with an 62 48 39 60 71 56 0 20 40 60 80 Poorest Second Middle Fourth Richest Nepal Pe r c en t Wealth Index Quintiles P er ce nt NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 99 Ta bl e W S. 8: D is po sa l o f c hi ld ’s fa ec es Pe rc en ta ge o f c hil dr en a ge d 0– 2 ye ar s a cc or din g to p lac e of d isp os al of ch ild ’s fa ec es , a nd p er ce nt ag e wh os e sto ols w er e dis po se d of sa fe ly th e las t t im e th e ch ild p as se d sto ols , N ep al, 2 01 4 Pe rc en t b y p lac e of d isp os al of ch ild ’s fa ec es Pe rc en t o f ch ild re n ag ed 0 –2 ye ar s w ho se las t s to ols we re dis po se d of sa fe ly [1 ] Nu m be r o f ch ild re n ag ed 0 –2 ye ar s Ch ild u se d to ile t/la tri ne Pu t/r ins ed int o to ile t o r lat rin e Pu t/r ins ed int o dr ain o r dit ch Th ro wn in to ga rb ag e Bu rie d Le ft in th e op en Ot he r DK / M iss ing To ta l To ta l 6. 6 41 .4 5. 5 16 .5 0. 9 24 .3 3. 4 1. 4 10 0. 0 48 .0 3, 08 0 Ty pe o f s an ita tio n fa ci lit y Im pr ov ed 9. 2 59 .5 4. 2 12 .7 0. 4 9. 6 3. 5 0. 9 10 0. 0 68 .7 2, 08 6 Un im pr ov ed 13 .5 21 .6 5. 7 15 .8 0. 0 33 .8 6. 2 3. 3 10 0. 0 35 .1 67 Op en d ef ec at ion 0. 1 2. 2 8. 5 25 .0 2. 1 56 .8 3. 1 2. 2 10 0. 0 2. 3 92 7 Re gi on Ea ste rn M ou nt ain s 2. 5 47 .3 3. 0 11 .2 0. 5 23 .2 8. 8 3. 6 10 0. 0 49 .8 44 Ea ste rn H ills 7. 3 70 .7 3. 7 8. 7 0. 0 7. 1 2. 5 0. 0 10 0. 0 78 .0 16 8 Ea ste rn T er ai 7. 9 30 .3 7. 7 23 .6 0. 5 26 .8 1. 8 1. 5 10 0. 0 38 .2 43 1 Ce nt ra l M ou nt ain s 5. 3 49 .9 5. 8 16 .0 0. 0 19 .1 1. 6 2. 3 10 0. 0 55 .1 58 Ce nt ra l H ills 15 .3 54 .9 4. 9 9. 3 0. 0 13 .5 1. 5 0. 6 10 0. 0 70 .2 37 1 Ce nt ra l T er ai 4. 4 27 .0 5. 0 14 .3 2. 6 44 .3 0. 5 1. 9 10 0. 0 31 .4 63 0 W es te rn M ou nt ain s (7 .3 ) (3 6. 7) (6 .0 ) (7 .8 ) (0 .0 ) (2 4. 9) (1 7. 3) (0 .0 ) 10 0. 0 (4 4. 0) 1 W es te rn H ills 5. 3 64 .9 1. 4 11 .7 0. 0 12 .2 4. 5 0. 0 10 0. 0 70 .2 34 1 W es te rn T er ai 1. 5 49 .6 2. 9 9. 9 2. 5 28 .6 3. 4 1. 5 10 0. 0 51 .1 28 2 M id- W es te rn M ou nt ain s 2. 7 35 .3 4. 3 12 .5 0. 9 32 .9 9. 8 1. 7 10 0. 0 38 .0 62 M id- W es te rn H ills 5. 5 34 .7 5. 4 27 .6 0. 0 18 .7 6. 4 1. 6 10 0. 0 40 .2 22 5 M id- W es te rn T er ai 7. 2 22 .6 6. 2 35 .5 0. 0 23 .3 5. 2 0. 0 10 0. 0 29 .9 16 9 Fa r W es te rn M ou nt ain s 18 .0 41 .8 7. 4 11 .7 0. 0 11 .9 7. 1 2. 1 10 0. 0 59 .8 55 Fa r W es te rn H ills 5. 1 45 .0 10 .6 12 .4 0. 0 13 .6 10 .0 3. 2 10 0. 0 50 .2 11 4 Fa r W es te rn T er ai 1. 9 22 .5 17 .3 26 .4 1. 3 19 .3 8. 0 3. 3 10 0. 0 24 .4 12 9 Ar ea Ur ba n 14 .0 67 .3 2. 6 8. 5 0. 0 5. 7 0. 9 1. 1 10 0. 0 81 .3 39 8 Ka th m an du va lle y 22 .6 72 .0 0. 4 2. 9 0. 0 0. 0 0. 0 2. 2 10 0. 0 94 .6 10 5 Ot he r u rb an 10 .9 65 .6 3. 4 10 .5 0. 0 7. 7 1. 2 0. 7 10 0. 0 76 .5 29 3 Ru ra l 5. 4 37 .6 6. 0 17 .6 1. 0 27 .1 3. 8 1. 4 10 0. 0 43 .1 2, 68 2 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014100 Ta bl e W S. 8: D is po sa l o f c hi ld ’s fa ec es Pe rc en ta ge o f c hil dr en a ge d 0– 2 ye ar s a cc or din g to p lac e of d isp os al of ch ild ’s fa ec es , a nd p er ce nt ag e wh os e sto ols w er e dis po se d of sa fe ly th e las t t im e th e ch ild p as se d sto ols , N ep al, 2 01 4 Pe rc en t b y p lac e of d isp os al of ch ild ’s fa ec es Pe rc en t o f ch ild re n ag ed 0 –2 ye ar s w ho se las t s to ols we re dis po se d of sa fe ly [1 ] Nu m be r o f ch ild re n ag ed 0 –2 ye ar s Ch ild u se d to ile t/la tri ne Pu t/r ins ed int o to ile t o r lat rin e Pu t/r ins ed int o dr ain o r dit ch Th ro wn in to ga rb ag e Bu rie d Le ft in th e op en Ot he r DK / M iss ing To ta l M ot he r’s e du ca tio n No ne 2. 8 25 .5 6. 1 18 .6 0. 7 40 .9 3. 4 2. 0 10 0. 0 28 .3 1, 15 8 Pr im ar y 7. 7 36 .8 5. 9 19 .6 1. 8 24 .0 3. 5 0. 6 10 0. 0 44 .5 54 0 Se co nd ar y 6. 0 49 .9 5. 9 18 .2 1. 1 13 .4 4. 5 1. 0 10 0. 0 55 .9 74 3 Hi gh er 13 .1 64 .6 3. 8 7. 6 0. 4 7. 1 2. 2 1. 2 10 0. 0 77 .7 63 6 W ea lth in de x qu in til e Po or es t 5. 0 37 .1 4. 9 20 .1 0. 8 22 .9 7. 4 0. 2 10 0. 0 42 .1 65 3 Se co nd 3. 1 30 .5 7. 2 15 .9 0. 7 37 .5 4. 0 0. 0 10 0. 0 33 .7 65 3 M idd le 3. 3 22 .5 6. 2 24 .6 0. 9 37 .2 2. 8 0. 3 10 0. 0 25 .7 65 6 Fo ur th 8. 3 54 .0 6. 1 13 .4 1. 1 15 .5 1. 3 0. 1 10 0. 0 62 .3 62 4 Ri ch es t 15 .3 70 .9 2. 7 5. 3 1. 1 2. 8 0. 9 0. 6 10 0. 0 86 .2 49 4 [1 ] M IC S in di ca to r 4 .4 – S af e di sp os al o f c hi ld ’s fa ec es No te : 3 ca se s o f m iss ing ‘m ot he r’s e du ca tio n’ no t s ho wn ( ) F igu re s t ha t a re b as ed o n 25 –4 9 un we igh te d ca se s C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 101 Handwashing Handwashing with water and soap is the most cost-effective health intervention to reduce both the incidence of diarrhoea and pneumonia in children under five7. It is most effective when done using water and soap after visiting a toilet or cleaning a child, before eating or handling food, and before feeding a child. Monitoring correct handwashing behaviour at these critical times is challenging. A reliable alternative to observations or self-reported behaviour is assessing the likelihood that correct handwashing behaviour takes place by observing whether a household has a specific place where people most often wash their hands and observing whether water and soap (or other local cleansing materials) are present at a specific place for handwashing8. In Nepal, 97 percent of households had a specific place for handwashing, while 2 percent could not indicate a specific place where household members usually washed their hands (Table WS.9). Among households where a place for handwashing was observed, two-thirds (67 percent) had both water and soap present at that place, and 6 percent had water and another cleansing agent present. In total, 73 percent of households with a specific place for handwashing had water and soap or another cleansing agent present at that place. In 13 percent of households only water was available at the handwashing place, while in 2 percent of households soap was available but no water. The remaining 9 percent of households had neither water nor soap or other cleansing agent available at the handwashing place. Regionally, the proportion of households with a specific place for handwashing where water and soap or other cleansing agents were present was the highest in the Eastern Terai (81 percent) and lowest in the Mid-Western Mountains (41 percent). Urban households were more likely than rural households to have water and a cleansing agent available at the handwashing place (85 percent compared to 69 percent). The proportion of households with water and a cleansing agent available at the handwashing place increases with an increase in the education level of the household head and with the household’s wealth. Only 46 percent of households in the poorest quintile had water and a cleansing agent available at the handwashing place compared to 93 percent of households in the richest quintile. 7Cairncross, S. and Valdmanis, V., 2006. Water supply, sanitation and hygiene promotion. Chapter 41.In ‘Disease Control Priorities in Developing Countries’. Second Edition. Jameson et al. The World Bank. Washington DC: National Institutes of Health. 8Ram, P., Halder, A., Granger, S., Hall, P., Jones, T., Hitchcock, D., Nygren, B., Islam, M., Molyneaux, J. and Luby, S. eds, 2008. Use of a Novel Method to Detect Reactivity to Structured Observation for Measurement of Handwashing Behavior. New Orleans, USA: American Society of Tropical Medicine and Hygiene. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014102 Ta bl e W S. 9: W at er a nd s oa p at p la ce fo r h an dw as hi ng Pe rc en ta ge o f h ou se ho lds w he re p lac e fo r h an dw as hin g wa s o bs er ve d, p er ce nt ag e wi th n o sp ec ific p lac e fo r h an dw as hin g, a nd p er ce nt ag e of h ou se ho lds b y a va ila bil ity o f w at er a nd so ap a t s pe cif ic pla ce fo r h an dw as hin g, N ep al, 2 01 4 Pe rc en t: of h ou se ho lds Nu m be r o f ho us eh old s Pe rc en t o f h ou se ho lds b y p lac e fo r h an dw as hin g ob se rv ed Pe rc en t o f ho us eh old s wi th n o sp ec ific pla ce fo r ha nd - wa sh ing in th e dw ell ing , ya rd o r p lot To ta l Pe rc en t o f ho us eh old s wi th a sp ec ific pla ce fo r ha nd - wa sh ing wh er e wa te r a nd so ap o r ot he r cle an sin g ag en t a re pr es en t [ 1] Nu m be r o f ho us eh old s wh er e pla ce fo r ha nd - wa sh ing wa s ob se rv ed or w ith n o sp ec ific pla ce fo r ha nd - wa sh ing W he re pla ce fo r ha nd - wa sh ing wa s ob se rv ed W ith n o sp ec ific pla ce fo r ha nd - wa sh ing in th e dw ell ing , ya rd o r p lot W at er is a va ila ble a nd : W at er is n ot a va ila ble a nd : So ap pr es en t No so ap : So ap pr es en t No so ap : As h, m ud , or sa nd pr es en t No o th er cle an sin g ag en t pr es en t As h, m ud , or sa nd pr es en t No o th er cle an sin g ag en t pr es en t To ta l 97 .1 2. 4 12 ,4 05 66 .7 5. 8 13 .0 1. 9 0. 9 9. 3 2. 4 10 0. 0 72 .5 12 ,3 37 Re gi on Ea ste rn M ou nt ain s 99 .9 0. 1 77 6 61 .5 2. 8 16 .0 2. 8 0. 7 16 .1 0. 1 10 0. 0 64 .3 17 9 Ea ste rn H ills 99 .8 0. 2 77 7 74 .8 3. 7 8. 7 0. 9 0. 9 10 .8 0. 2 10 0. 0 78 .5 76 7 Ea ste rn T er ai 99 .0 0. 9 97 4 71 .9 9. 4 15 .2 0. 4 0. 3 1. 9 0. 9 10 0. 0 81 .3 1, 84 3 Ce nt ra l M ou nt ain s 97 .3 2. 7 77 1 69 .9 5. 6 11 .4 1. 5 0. 3 8. 6 2. 7 10 0. 0 75 .5 29 9 Ce nt ra l H ills 95 .2 3. 2 1, 50 3 76 .6 2. 2 7. 0 2. 9 0. 5 7. 6 3. 2 10 0. 0 78 .8 2, 14 7 Ce nt ra l T er ai 97 .5 2. 2 95 6 60 .6 11 .5 17 .6 0. 3 0. 1 7. 8 2. 2 10 0. 0 72 .1 1, 91 8 W es te rn M ou nt ain s 93 .5 4. 4 37 4 78 .7 2. 0 3. 2 0. 8 0. 3 10 .6 4. 5 10 0. 0 80 .6 10 W es te rn H ills 96 .4 3. 5 97 3 73 .9 2. 7 10 .4 1. 7 0. 5 7. 4 3. 5 10 0. 0 76 .6 1, 62 6 W es te rn T er ai 94 .1 5. 9 78 2 63 .8 2. 7 21 .7 1. 0 0. 3 4. 6 5. 9 10 0. 0 66 .5 92 4 M id- W es te rn M ou nt ain s 90 .5 8. 4 74 3 36 .6 4. 2 6. 7 8. 9 5. 5 29 .5 8. 5 10 0. 0 40 .8 15 4 M id- W es te rn H ills 96 .4 1. 2 77 8 37 .6 11 .5 7. 6 7. 3 5. 9 28 .9 1. 3 10 0. 0 49 .1 74 5 M id- W es te rn T er ai 97 .3 2. 3 75 9 68 .5 2. 9 17 .5 2. 6 1. 0 5. 3 2. 3 10 0. 0 71 .4 66 9 Fa r W es te rn M ou nt ain s 98 .9 1. 1 75 9 36 .6 4. 2 18 .1 2. 7 1. 4 35 .8 1. 1 10 0. 0 40 .8 18 5 Fa r W es te rn H ills 99 .6 0. 4 73 6 41 .4 6. 2 10 .3 4. 2 1. 4 36 .0 0. 4 10 0. 0 47 .7 34 6 Fa r W es te rn T er ai 99 .0 1. 0 74 4 75 .8 2. 3 16 .6 0. 6 0. 2 3. 5 1. 0 10 0. 0 78 .2 52 4 Ar ea Ur ba n 97 .3 1. 8 2, 99 2 84 .4 0. 7 7. 8 1. 7 0. 2 3. 4 1. 8 10 0. 0 85 .1 2, 45 4 Ka th m an du va lle y 93 .7 4. 1 78 2 86 .4 0. 0 3. 3 3. 2 0. 0 2. 9 4. 2 10 0. 0 86 .4 76 4 Ot he r u rb an 99 .0 0. 8 1, 69 4 83 .6 1. 0 9. 8 1. 0 0. 3 3. 7 0. 8 10 0. 0 84 .6 1, 69 0 Ru ra l 97 .0 2. 5 9, 41 3 62 .3 7. 0 14 .3 2. 0 1. 0 10 .8 2. 5 10 0. 0 69 .3 9, 88 3 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 103 Ta bl e W S. 9: W at er a nd s oa p at p la ce fo r h an dw as hi ng Pe rc en ta ge o f h ou se ho lds w he re p lac e fo r h an dw as hin g wa s o bs er ve d, p er ce nt ag e wi th n o sp ec ific p lac e fo r h an dw as hin g, a nd p er ce nt ag e of h ou se ho lds b y a va ila bil ity o f w at er a nd so ap a t s pe cif ic pla ce fo r h an dw as hin g, N ep al, 2 01 4 Pe rc en t: of h ou se ho lds Nu m be r o f ho us eh old s Pe rc en t o f h ou se ho lds b y p lac e fo r h an dw as hin g ob se rv ed Pe rc en t o f ho us eh old s wi th n o sp ec ific pla ce fo r ha nd - wa sh ing in th e dw ell ing , ya rd o r p lot To ta l Pe rc en t o f ho us eh old s wi th a sp ec ific pla ce fo r ha nd - wa sh ing wh er e wa te r a nd so ap o r ot he r cle an sin g ag en t a re pr es en t [ 1] Nu m be r o f ho us eh old s wh er e pla ce fo r ha nd - wa sh ing wa s ob se rv ed or w ith n o sp ec ific pla ce fo r ha nd - wa sh ing W he re pla ce fo r ha nd - wa sh ing wa s ob se rv ed W ith n o sp ec ific pla ce fo r ha nd - wa sh ing in th e dw ell ing , ya rd o r p lot W at er is a va ila ble a nd : W at er is n ot a va ila ble a nd : So ap pr es en t No so ap : So ap pr es en t No so ap : As h, m ud , or sa nd pr es en t No o th er cle an sin g ag en t pr es en t As h, m ud , or sa nd pr es en t No o th er cle an sin g ag en t pr es en t Ed uc at io n of h ou se ho ld h ea d No ne 96 .5 3. 0 5, 26 7 53 .7 8. 8 17 .6 2. 2 1. 4 13 .2 3. 0 10 0. 0 62 .5 5, 17 5 Pr im ar y 97 .1 2. 3 2, 44 1 64 .9 5. 5 12 .9 2. 5 1. 0 10 .8 2. 3 10 0. 0 70 .4 2, 40 5 Se co nd ar y 97 .6 1. 9 2, 42 2 77 .1 3. 5 9. 8 1. 4 .3 6. 0 1. 9 10 0. 0 80 .6 2, 43 5 Hi gh er 97 .9 1. 4 2, 24 9 86 .7 1. 7 6. 3 1. 1 .1 2. 7 1. 5 10 0. 0 88 .4 2, 29 9 W ea lth in de x qu in til es Po or es t 95 .7 3. 5 2, 37 6 37 .5 8. 3 12 .5 5. 0 3. 4 29 .9 3. 5 10 0. 0 45 .8 2, 35 6 Se co nd 96 .1 3. 8 2, 55 8 57 .5 8. 3 18 .6 1. 7 0. 7 9. 3 3. 8 10 0. 0 65 .8 2, 55 4 M idd le 98 .1 1. 8 2, 28 9 64 .0 10 .2 17 .9 0. 9 0. 2 4. 9 1. 8 10 0. 0 74 .2 2, 28 5 Fo ur th 98 .4 1. 3 2, 44 1 78 .5 2. 9 13 .1 1. 2 0. 1 2. 9 1. 3 10 0. 0 81 .4 2, 43 4 Ri ch es t 97 .1 1. 6 2, 74 2 92 .4 0. 1 4. 0 1. 0 0. 0 0. 9 1. 6 10 0. 0 92 .5 2, 70 7 [1 ] M IC S in di ca to r 4 .5 – P la ce fo r h an dw as hi ng No te : 2 3 ca se s o f m iss ing ‘e du ca tio n of h ou se ho ld he ad ’ n ot sh ow n C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014104 Ta bl e W S. 10 : A va ila bi lit y of s oa p or o th er c le an si ng a ge nt Pe rc en ta ge o f h ou se ho lds b y a va ila bil ity o f s oa p or o th er cl ea ns ing a ge nt in th e dw ell ing , N ep al, 2 01 4 Pe rc en t o f h ou se ho lds b y p lac e fo r h an dw as hin g ob se rv ed Pe rc en t o f h ou se ho lds b y p lac e fo r h an dw as hin g no t o bs er ve d To ta l Pe rc en t o f ho us eh old s wi th so ap o r ot he r cle an sin g ag en t an yw he re in th e dw ell ing [1 ] Nu m be r o f ho us eh old s So ap o r o th er cle an sin g ag en t ob se rv ed So ap o r o th er cl ea ns ing a ge nt n ot o bs er ve d at p lac e fo r h an dw as hin g So ap o r o th er cle an sin g ag en t s ho wn No so ap o r ot he r cle an sin g ag en t in ho us eh old No t a ble / do es n ot w an t to sh ow so ap or o th er cle an sin g ag en t So ap o r o th er cle an sin g ag en t s ho wn No so ap o r ot he r cle an sin g ag en t in ho us eh old No t a ble / do es n ot w an t to sh ow so ap or o th er cle an sin g ag en t To ta l 74 .8 18 .1 3. 4 0. 6 2. 0 0. 6 0. 3 10 0. 0 94 .9 12 ,4 05 Re gi on Ea ste rn M ou nt ain s 67 .8 25 .3 6. 2 0. 1 0. 1 0. 0 0. 0 10 0. 0 93 .2 17 9 Ea ste rn H ills 80 .3 18 .2 1. 0 0. 2 0. 2 0. 0 0. 0 10 0. 0 98 .7 76 7 Ea ste rn T er ai 82 .0 12 .8 3. 9 0. 2 0. 9 0. 0 0. 1 10 0. 0 95 .7 1, 84 5 Ce nt ra l M ou nt ain s 77 .3 16 .5 2. 9 0. 6 1. 3 0. 8 0. 7 10 0. 0 95 .1 29 9 Ce nt ra l H ills 80 .9 12 .2 1. 1 0. 9 3. 0 0. 5 1. 2 10 0. 0 96 .0 2, 18 2 Ce nt ra l T er ai 72 .2 17 .2 7. 4 0. 4 0. 9 1. 5 0. 1 10 0. 0 90 .3 1, 92 4 W es te rn M ou nt ain s 80 .0 9. 8 1. 8 1. 6 1. 8 2. 6 2. 1 10 0. 0 91 .6 10 W es te rn H ills 78 .6 16 .9 0. 4 0. 2 3. 1 0. 5 0. 0 10 0. 0 98 .6 1, 62 8 W es te rn T er ai 67 .8 25 .6 0. 4 0. 2 4. 9 0. 7 0. 3 10 0. 0 98 .3 92 4 M id- W es te rn M ou nt ain s 54 .6 26 .8 7. 0 2. 0 7. 7 1. 5 0. 3 10 0. 0 89 .1 15 6 M id- W es te rn H ills 60 .8 28 .0 6. 6 0. 7 2. 4 1. 2 0. 0 10 0. 0 91 .2 76 3 M id- W es te rn T er ai 74 .7 15 .6 3. 7 2. 4 1. 3 1. 1 0. 3 10 0. 0 91 .6 67 2 Fa r W es te rn M ou nt ain s 45 .0 46 .5 6. 4 0. 1 0. 5 0. 6 0. 0 10 0. 0 92 .0 18 5 Fa r W es te rn H ills 53 .3 40 .4 5. 7 0. 2 0. 2 0. 2 0. 0 10 0. 0 93 .9 34 6 Fa r W es te rn T er ai 78 .9 14 .4 4. 0 1. 8 0. 7 0. 2 0. 1 10 0. 0 94 .0 52 4 Ar ea Ur ba n 86 .2 10 .0 0. 8 0. 1 1. 9 0. 1 0. 7 10 0. 0 98 .1 2, 47 6 Ka th m an du va lle y 87 .6 5. 4 0. 4 0. 0 4. 3 0. 2 1. 8 10 0. 0 97 .3 78 2 Ot he r u rb an 85 .6 12 .2 1. 0 0. 1 0. 7 0. 1 0. 1 10 0. 0 98 .5 1, 69 4 Ru ra l 72 .0 20 .1 4. 0 0. 7 2. 0 0. 8 0. 2 10 0. 0 94 .1 9, 92 9 Ed uc at io n of h ou se ho ld h ea d No ne 65 .8 24 .2 5. 5 0. 7 2. 2 1. 0 0. 3 10 0. 0 92 .2 5, 20 2 Pr im ar y 73 .5 19 .6 3. 1 0. 6 2. 0 0. 7 0. 1 10 0. 0 95 .1 2, 41 9 Se co nd ar y 81 .9 13 .2 2. 0 0. 3 1. 8 0. 2 0. 4 10 0. 0 96 .9 2, 44 6 Hi gh er 89 .0 7. 8 0. 4 0. 7 1. 7 0. 0 0. 4 10 0. 0 98 .5 2, 31 4 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 105 Ta bl e W S. 10 : A va ila bi lit y of s oa p or o th er c le an si ng a ge nt Pe rc en ta ge o f h ou se ho lds b y a va ila bil ity o f s oa p or o th er cl ea ns ing a ge nt in th e dw ell ing , N ep al, 2 01 4 Pe rc en t o f h ou se ho lds b y p lac e fo r h an dw as hin g ob se rv ed Pe rc en t o f h ou se ho lds b y p lac e fo r h an dw as hin g no t o bs er ve d To ta l Pe rc en t o f ho us eh old s wi th so ap o r ot he r cle an sin g ag en t an yw he re in th e dw ell ing [1 ] Nu m be r o f ho us eh old s So ap o r o th er cle an sin g ag en t ob se rv ed So ap o r o th er cl ea ns ing a ge nt n ot o bs er ve d at p lac e fo r h an dw as hin g So ap o r o th er cle an sin g ag en t s ho wn No so ap o r ot he r cle an sin g ag en t in ho us eh old No t a ble / do es n ot w an t to sh ow so ap or o th er cle an sin g ag en t So ap o r o th er cle an sin g ag en t s ho wn No so ap o r ot he r cle an sin g ag en t in ho us eh old No t a ble / do es n ot w an t to sh ow so ap or o th er cle an sin g ag en t W ea lth in de x qu in til e Po or es t 53 .7 34 .2 6. 8 0. 8 2. 9 1. 3 0. 1 10 0. 0 90 .7 2, 37 6 Se co nd 68 .1 22 .2 4. 9 0. 4 2. 7 1. 2 0. 0 10 0. 0 93 .1 2, 55 8 M idd le 75 .2 17 .6 4. 1 0. 9 1. 4 0. 5 0. 1 10 0. 0 94 .3 2, 28 9 Fo ur th 82 .4 13 .9 1. 4 0. 7 1. 1 0. 2 0. 3 10 0. 0 97 .4 2, 44 1 Ri ch es t 92 .3 4. 3 0. 1 0. 4 1. 8 0. 2 0. 9 10 0. 0 98 .4 2, 74 2 [1 ] M IC S in di ca to r 4 .6 – A va ila bi lit y of s oa p or o th er c le an si ng a ge nt No te : 2 4 ca se s o f m iss ing ‘e du ca tio n of h ou se ho ld he ad ’ n ot sh ow n C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014106 Table WS.10 shows the availability of soap or other cleansing agent anywhere in the household. Overall, 95 percent of households had soap available somewhere in the dwelling. Soap or another cleansing agent was observed at the handwashing place in 75 percent of households; in another 18 percent, soap or another cleansing agent was not observed at the handwashing place but was shown to interviewers and, in 2 percent of households, the handwashing place was not seen but soap or another cleansing agent was shown to interviewers. In addition, 1 percent of households were not able to or refused to show any soap or another cleansing agent present in the dwelling. In total, 4 percent of households did not have soap or another cleansing agent available in the dwelling. Regionally, the highest proportion of households with soap or another cleansing agent anywhere in the dwelling was in the Eastern Hills and Western Hills (99 percent) and the lowest proportion was in the Mid-Western Mountains (89 percent). Some 91 percent of households in the poorest quintile had soap or another cleansing agent available in the dwelling compared to 98 percent of households in the richest quintile. The closer the place for handwashing is to the toilet, the higher the likelihood that handwashing will be performed after defecation or urination. Country-specific data on the distance between the handwashing place and the latrine is shown in Table WS.11. In 40 percent of households the distance between the handwashing place and the latrine was less than 10 paces. However, in 40 percent of households the distance between the handwashing place and the latrine was 10 paces or more. In 21 percent of households there was no toilet in the dwelling, yard or plot, so distance could not be measured. The highest proportion of households with a handwashing place that was 10 paces or more from the toilet was in the Mid-Western Hills (69 percent) and the lowest proportion was in the Eastern Terai (24 percent). Households in rural areas were more likely than those in urban areas to have a handwashing place that was 10 paces or more from the toilet (43 percent compared to 25 percent). Households where the head had no education and those in the poorest quintile were more likely than other households to have a handwashing place that was 10 paces or more from the toilet. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 107 Country-specific data were collected on the proportion of respondents with knowledge about critical times for handwashing, as shown in Table WS.12. Some 92 percent of households knew they had to wash hands before eating and 87 percent knew they had to wash hands after eating. However, only 22 percent knew they had to wash hands before cooking or preparing food and only 6 percent knew they had to wash hands before breastfeeding or feeding a child. Some 87 percent knew they had to wash hands after defecation or urination, but only 6 percent knew they had to wash hands after cleaning a child’s bottom or changing a child’s nappy, and only 8 percent knew they had to wash hands after cleaning a toilet or potty. There was substantial variation in the levels of knowledge for washing hands before cooking or preparing food; washing hands before breastfeeding or feeding a child; and washing hands after cleaning a child’s bottom or changing a child’s nappy. Table WS.11: Distance between latrine and place for handwashing Percentage of households where a place for handwashing was observed by distance between latrine and place for handwashing, Nepal, 2014 Percent by distance to latrine: Total Number of households where place for handwashing was observed Less than 10 paces 10 paces or more Toilet not in dwelling/plot/ yard Total 39.6 39.7 20.7 100.0 12,041 Region Eastern Mountains 30.1 55.2 14.7 100.0 179 Eastern Hills 40.0 52.9 7.1 100.0 765 Eastern Terai 45.0 24.1 31.0 100.0 1,827 Central Mountains 56.8 35.6 7.6 100.0 291 Central Hills 67.4 25.8 6.8 100.0 2,078 Central Terai 20.3 27.4 52.3 100.0 1,876 Western Mountains (*) (*) (*) 100.0 10 Western Hills 38.9 56.1 5.0 100.0 1,569 Western Terai 39.5 35.3 25.2 100.0 869 Mid-Western Mountains 21.0 58.6 20.4 100.0 141 Mid-Western Hills 19.3 69.4 11.3 100.0 736 Mid-Western Terai 34.1 52.5 13.5 100.0 654 Far Western Mountains 40.3 50.6 9.1 100.0 183 Far Western Hills 40.7 42.6 16.6 100.0 344 Far Western Terai 13.7 61.6 24.6 100.0 519 Area Urban 71.1 25.0 3.9 100.0 2,409 Kathmandu valley 89.2 10.1 0.7 100.0 732 Other urban 63.1 31.5 5.4 100.0 1,677 Rural 31.7 43.4 24.9 100.0 9,632 Education of household head None 28.0 40.2 31.8 100.0 5,017 Primary 36.4 44.5 19.1 100.0 2,349 Secondary 45.1 42.2 12.7 100.0 2,388 Higher 62.7 31.0 6.3 100.0 2,265 Wealth index quintile Poorest 23.1 57.3 19.5 100.0 2,274 Second 27.3 40.9 31.8 100.0 2,457 Middle 23.2 36.7 40.1 100.0 2,244 Fourth 41.3 44.1 14.6 100.0 2,402 Richest 77.1 22.4 0.6 100.0 2,663 Note: 22 cases of missing ‘education of household head’ not shown (*) Figures that are based on fewer than 25 unweighted cases NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014108 Ta bl e W S. 12 : C rit ic al ti m es fo r h an dw as hi ng Pe rc en ta ge o f h ou se ho lds w ith kn ow led ge o n cr itic al tim es fo r h an dw as hin g, N ep al, 2 01 4 Pe rc en t w ith kn ow led ge o n wa sh ing h an ds a t c rit ica l ti m es : Nu m be r o f ho us eh old s Be fo re e at ing Af te r e at ing Be fo re co ok ing o r pr ep ar ing fo od Be fo re br ea stf ee din g or fe ed ing ch ild Af te r d ef ec at ion / ur ina tio n Af te r c lea nin g ch ild ’s bo tto m o r ch an gin g ch ild ’s na pp y Af te r c lea nin g to ile t o r p ot ty To ta l 92 .2 86 .8 22 .0 6. 0 86 .6 5. 5 7. 7 12 ,4 05 Re gi on Ea ste rn M ou nt ain s 96 .0 90 .1 28 .2 9. 0 85 .7 5. 1 7. 9 17 9 Ea ste rn H ills 96 .6 96 .2 30 .5 10 .6 86 .9 6. 5 14 .9 76 7 Ea ste rn T er ai 93 .9 90 .2 30 .8 12 .1 88 .3 9. 2 11 .8 1, 84 5 Ce nt ra l M ou nt ain s 93 .1 96 .7 31 .7 2. 9 87 .9 3. 5 5. 2 29 9 Ce nt ra l H ills 94 .4 84 .8 22 .6 5. 6 84 .2 5. 9 11 .4 2, 18 2 Ce nt ra l T er ai 89 .3 92 .3 8. 2 1. 6 81 .6 3. 9 3. 0 1, 92 4 W es te rn M ou nt ain s (*) (*) (*) (*) (*) (*) (*) 10 W es te rn H ills 95 .1 88 .5 21 .1 6. 7 91 .9 3. 4 2. 3 1, 62 8 W es te rn T er ai 95 .7 98 .6 29 .7 4. 3 90 .7 2. 3 7. 7 92 4 M id- W es te rn M ou nt ain s 80 .5 54 .0 17 .8 4. 0 80 .4 5. 4 7. 0 15 6 M id- W es te rn H ills 82 .3 70 .4 20 .4 5. 9 81 .5 6. 4 3. 4 76 3 M id- W es te rn T er ai 85 .4 72 .4 17 .1 3. 9 92 .0 7. 4 9. 5 67 2 Fa r W es te rn M ou nt ain s 97 .6 90 .8 29 .9 5. 0 84 .6 7. 5 13 .4 18 5 Fa r W es te rn H ills 93 .5 74 .6 24 .6 3. 9 79 .5 8. 2 7. 4 34 6 Fa r W es te rn T er ai 88 .0 75 .1 13 .0 2. 0 91 .4 3. 6 5. 4 52 4 Ar ea Ur ba n 95 .6 89 .4 29 .0 8. 3 88 .0 5. 6 13 .1 2, 47 6 Ka th m an du va lle y 96 .1 89 .6 34 .1 7. 4 83 .2 7. 1 19 .2 78 2 Ot he r u rb an 95 .4 89 .3 26 .6 8. 7 90 .2 4. 9 10 .3 1, 69 4 Ru ra l 91 .4 86 .2 20 .2 5. 4 86 .2 5. 5 6. 4 9, 92 9 Ed uc at io n of h ou se ho ld h ea d No ne 90 .3 85 .8 17 .2 4. 1 85 .4 4. 5 6. 0 5, 20 2 Pr im ar y 91 .3 84 .9 21 .3 5. 3 85 .1 5. 7 5. 9 2, 41 9 Se co nd ar y 93 .1 88 .1 26 .5 8. 3 87 .9 7. 1 9. 0 2, 44 6 Hi gh er 96 .5 89 .6 28 .6 8. 5 89 .5 6. 0 12 .1 2, 31 4 W ea lth in de x qu in til e Po or es t 89 .6 79 .6 19 .3 4. 3 83 .7 5. 3 5. 6 2, 37 6 Se co nd 91 .5 86 .9 17 .9 5. 1 87 .3 4. 4 6. 0 2, 55 8 M idd le 90 .0 89 .5 20 .3 5. 4 85 .6 6. 2 6. 2 2, 28 9 Fo ur th 93 .6 87 .7 23 .6 6. 7 87 .9 5. 7 6. 1 2, 44 1 Ri ch es t 95 .7 89 .9 28 .0 8. 3 88 .0 6. 0 13 .8 2, 74 2 No te : 2 4 ca se s o f m iss ing ‘e du ca tio n of h ou se ho ld he ad ’ n ot sh ow n (* ) F igu re s t ha t a re b as ed o n fe we r t ha n 25 u nw eig ht ed ca se s NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 109 Water Quality Hundreds of species of protozoa, bacteria, and viruses can cause disease in humans; many of these are transmitted through the faecal–oral pathway. Rather than monitor the presence of individual pathogens, faecal indicators are used to identify contamination. The bacteria species Escherichia coli (E. coli) is the most commonly recommended faecal indicator, and, following WHO Guidelines, many countries including Nepal have set a standard that no E. coli should be found in a 100 ml sample of drinking water. The Water Quality Testing module was included in the Nepal MICS for the first time, aiming to collect data on the quality of water actually consumed throughout Nepal through the use of a test for microbiological parameters such as E. coli (EC) and total coliform. Presence of E. coli was tested for by filtering 100 ml of water through a 0.45 micron filter (Millipore Microfil®) which was then placed on to Compact Dry EC growth media plates (Nissui, Japan). A 1-ml sample was also tested from the same source directly on to a second media plate. Incubation was done at ambient temperature, and field teams were given Environment and Public Health Organization (ENPHO) body-belt incubators and phase-changing incubators (from the University of Bristol) to maintain a temperature of ≥25°C even during the night. After 24 hours, the number of blue colonies, signifying the presence of E. coli colony forming units (cfu), and the number of red colonies, indicating presence of other coliform, were recorded separately on the MICS questionnaire. In cases where there were too many colonies on the plate, only colonies on one quarter of the plate were counted and multiplied by four. If there were more than 100 colonies on the plate and in cases where the plate turned pink, this would be recorded as ‘101’ to indicate ‘too numerous to count’. Counting of the colonies was done only in good light. The water quality testing was carried out in 519 clusters sampled for this survey. Three households were randomly selected from among the 25 households interviewed per cluster, yielding a total of 1,557 households for E. coli testing of drinking water. For one in three of these households (519), samples were also taken from a household’s source of drinking water. The samples of household drinking water were taken from a glass of water that would be given to a child to drink. However, in case of source samples, water was first collected in sterile Whirl-Pak® bags. Table WQ.A provides the critical water quality definitions and references to E. coli risk categories as cfu/100 ml. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014110 Overall, more than four-fifths (82 percent) of household members were at the risk of E. coli9 concentration ≥1 cfu/100 ml in their household water. Household members residing in urban areas were less likely those in rural areas to be at the risk of E. coli (72 percent compared to 84 percent). E. coli concentrations in household drinking water were found to be persistently around 80 percent across all level of education of household head except for households whose head had a higher education (64 percent). The quality of water varies with household wealth status. People living in the richest households were less likely than those living in the poorest households to have E. coli in their drinking water (64 percent compared to 91 percent). The chance of detecting E. coli in unimproved and improved sources of water was almost equal but water from unimproved sources was more likely to be very high risk (47 percent) compared with water from improved sources (20 percent). Furthermore, analysis of E. coli in the type of drinking water found that households using water piped into dwelling (65 percent) were less likely than households using other types of drinking water to be contaminated by E. coli. Households where the handwashing facility was not observed had a higher risk of E. coli in household drinking water than households where the handwashing facility was observed. 9Risk of E. coli is defined as the sum of moderate risk, high risk and very high risk Nepal&MICS&2014& 35# # Water Quality Hundreds of species of protozoa, bacteria, and viruses can cause disease in humans; many of these are transmitted through the faecal–oral pathway. Rather than monitor the presence of individual pathogens, faecal indicators are used to identify contamination. The bacteria species Escherichia coli (E. coli) is the most commonly recommended faecal indicator, and, following WHO Guidelines, many countries including Nepal have set a standard that no E. coli should be found in a 100 ml sample of drinking water. The Water Quality Testing module was included in the Nepal MICS for the first time, aiming to collect data on the quality of water actually consumed throughout Nepal through the use of a test for microbiological parameters such as E. coli (EC) and total coliform. Presence of E. coli was tested for by filtering 100 ml of water through a 0.45 micron filter (Millipore Microfil®) which was then placed on to Compact Dry EC growth media plates (Nissui, Japan). A 1-ml sample was also tested from the same source directly on to a second media plate. Incubation was done at ambient temperature, and field teams were given the Environment and Public Health Organization (ENPHO) body-belt incubators and phase- changing incubators (from the University of Bristol) to maintain a temperature of ≥25 °C even during the night. After 24 hours, the number of blue colonies, signifying the presence of E. coli colony forming units (cfu), and the number of red colonies, indicating presence of other coliform, were recorded separately on the MICS questionnaire. In cases where there were too many colonies on the plate, only colonies on one quarter of the plate were counted and multiplied by four. If there were more than 100 colonies on the plate and in cases where the plate turned pink, this would be recorded as ‘101’ to indicate ‘too numerous to count’. Counting of the colonies was done only in good light. The water quality testing was carried out in 519 clusters sampled for this survey. Three households were randomly selected from among the 25 households interviewed per cluster, yielding a total of 1,557 households for E. coli testing of drinking water. For one in three of these households (519), samples were also taken from a household’s source of drinking water. The samples of household drinking water were taken from a glass of water that would be given to a child to drink. However, in case of source samples, water was first collected in sterile Whirl-Pak® bags. Table WQ.A provides the critical water quality definitions and references to E. coli risk categories as cfu/100 ml. Table WQ.A: Description of E. coli risk categories E. coli [cfu/100 ml] Risk level Priority for action <1 Low None 1–10 Medium Low 11–100 High Higher >100 Very high Urgent Note: Adapted from WHO drinking water quality guidelines, 4th Ed. (2011), E. coli coliform counts are divided into risk categories based on probability of infection of diarrheal disease. This classification does not take account of the sanitary inspection. The Table WQ.1 shows the level of risk of E. coli concentration in drinking water. The Table WQ.1 shows the level of risk of E. coli concentration in drinking water. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 111 The quality of drinking water at source was also measured. Table WQ.2 presents the percentage of household members with E. coli in their source of drinking water. In total, almost three-quarters (71 percent) of the household population were at risk of E. coli due to its concentration in their source of drinking water. Households in rural areas were more likely than those in urban areas to have poor quality source water (73 percent compared to 63 percent). The education level of the household head and the household wealth status were positively associated with the quality of source water. The poorest households were more likely than the richest households to have E. coli in their source of drinking water (88 percent compared to 58 percent). Four in five households (84 percent) with unimproved sources of Table WQ.1: Household drinking water quality Percentage of household members by E. coli risk level in drinking water, Nepal, 2014 Percent of household members by E. coli risk level in drinking water Percent of household members with E. coli risk level in household water ≥ 1 cfu/100 ml [1] Number of house- hold members Low risk Moderate risk High risk Very high risk Total Total 17.8 23.6 37.0 21.6 100.0 82.2 6,507 Area Urban 27.8 22.1 34.4 15.8 100.0 72.3 1,116 Kathmandu valley 32.1 22.2 24.4 21.2 100.0 67.8 323 Other urban 26.0 22.0 38.4 13.6 100.0 74.0 792 Rural 15.8 24.0 37.5 22.7 100.0 84.2 5,391 Education of household head None 12.6 23.3 40.0 24.1 100.0 87.4 2,867 Primary 14.2 22.4 39.9 23.5 100.0 85.8 1,398 Secondary 20.4 28.5 32.3 18.8 100.0 79.6 1,336 Higher 35.9 19.5 29.8 14.7 100.0 64.0 898 Wealth index quintile Poorest 8.6 21.8 32.1 37.5 100.0 91.4 1,233 Second 10.9 22.7 44.1 22.3 100.0 89.1 1,460 Middle 13.3 24.6 43.0 19.1 100.0 86.7 1,279 Fourth 21.0 21.8 36.4 20.8 100.0 79.0 1,235 Richest 35.9 27.2 28.2 8.7 100.0 64.1 1,300 Source of drinking water Unimproved 10.6 13.2 28.9 47.2 100.0 89.3 475 Improved 18.4 24.5 37.6 19.5 100.0 81.6 6,032 Type of drinking water source Piped into dwelling 34.7 19.6 34.4 11.3 100.0 65.3 583 Piped into compound, yard or plot 20.0 27.7 33.7 18.6 100.0 80.0 986 Public tap/standpipe or piped to neighbour 9.2 25.4 35.4 32.8 100.0 90.8 1,257 Boreholes 18.6 22.6 40.5 15.5 100.0 81.4 2,931 Dug wells and springs 9.2 17.3 34.3 39.2 100.0 90.8 457 Other 20.1 15.0 28.1 36.9 100.0 80.0 293 Sanitation facility Unimproved 18.6 20.3 39.1 21.9 100.0 81.3 2,738 Improved 17.3 26.0 35.4 21.3 100.0 82.7 3,769 Handwashing facility with water and soap Not observed 7.9 23.8 35.2 33.2 100.0 92.2 1,744 Observed 21.7 23.6 37.8 16.9 100.0 78.3 4,731 [1] Country-specific indicator 4.C1 – E. coli concentration in household drinking water ≥1 cfu/100 ml Note: 8 cases of missing ‘education of household head’ not shown NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014112 drinking water had E. coli, whereas it dropped to 70 percent for those households that had an improved source of drinking water. Again, households with unimproved sources were much more likely than those with improved sources to have water at very high risk of E. coli. Households using boreholes as a source of drinking water were at lowest risk of detecting E. coli in their drinking water compared to household using other sources. Households where handwashing facilities were not observed had a higher risk of E. coli in their source of drinking water (81 percent) compared to sources used by households where the handwashing facility was observed (66 percent). Table WQ.2: Source drinking water quality Percentage of household members by E. coli risk level in source water, Nepal, 2014 Percent of household members by E. coli risk level in source water Percent of household members with E. coli risk level in source water ≥ 1 cfu/100 ml [1] Number of house- hold members Low risk Moderate risk High risk Very high risk Total Total 28.9 23.6 28.8 18.7 100.0 71.1 465 Area Urban 37.4 17.4 23.7 21.5 100.0 62.6 94 Kathmandu valley (43.3) (8.2) (18.7) (29.7) 100.0 (56.6) 31 Other urban 34.5 22.0 26.1 17.5 100.0 65.6 63 Rural 26.8 25.1 30.2 17.9 100.0 73.2 371 Education of household head None 25.3 24.5 30.4 19.7 100.0 74.6 199 Primary 21.8 28.6 30.0 19.6 100.0 78.2 107 Secondary 39.9 18.8 32.0 9.2 100.0 60.0 81 Higher 36.4 19.3 20.1 24.3 100.0 63.7 79 Wealth index quintile Poorest 11.6 16.6 46.7 25.0 100.0 88.3 88 Second 21.7 30.8 28.0 19.4 100.0 78.2 101 Middle 27.5 33.0 24.0 15.4 100.0 72.4 87 Fourth 40.3 20.0 22.5 17.1 100.0 59.6 85 Richest 42.3 17.5 23.8 16.5 100.0 57.8 104 Source of drinking water Unimproved (16.3) (9.5) (27.2) (47.1) 100.0 (83.8) 36 Improved 30.0 24.8 29.0 16.2 100.0 70.0 428 Type of drinking water source Piped into dwelling 23.0 16.7 36.5 23.9 100.0 77.1 217 Boreholes 41.0 33.4 19.0 6.7 100.0 59.1 182 Dug wells and springs (12.2) (20.2) (31.7) (35.8) 100.0 (87.7) 36 Other (18.7) (18.1) (30.0) (33.3) 100.0 (81.4) 30 Sanitation facility Unimproved 31.4 28.0 23.6 17.0 100.0 68.6 210 Improved 26.9 20.0 33.2 20.0 100.0 73.2 255 Handwashing facility with water and soap Not observed 19.1 27.2 27.4 26.2 100.0 80.8 145 Observed 33.7 22.1 28.9 15.4 100.0 66.4 317 [1] Country-specific indicator 4.C2 – E. coli concentration in source drinking water ≥1 cfu/100 ml ( ) Figures that are based on 25–49 unweighted cases NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 113 Reproductive Health C H A P T E R8 Fertility Measures of current fertility are presented in Table RH.1 for the three-year period preceding the survey. A three-year period was chosen for calculating these rates to provide the most current information while also allowing the rates to be calculated for a sufficient number of cases so as to meet statistical precision of the estimates. Age-specific fertility rates (ASFRs), expressed as the number of births per 1,000 women in a specified age group, show the age pattern of fertility. Numerators for ASFRs are calculated by identifying live births that occurred in the three-year period preceding the survey classified according to the age of the mother (in five-year age groups) at the time of the child’s birth. The denominators of the rates represent the number of woman-years lived by the survey respondents in each of the five-year age groups during the specified period. The total fertility rate (TFR) is a synthetic measure that denotes the number of live births a woman would have if she were subject to the current age-specific fertility rates throughout her reproductive age (15–49 years). The general fertility rate (GFR) is the number of live births occurring during the specified period per 1,000 women aged 15–49 years. The crude birth rate (CBR) is the number of live births per 1,000 of the population during the specified period. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014114 Nepal MICS 2014 2 1,000 women aged 15–19 years in rural areas. The overall age pattern of fertility, as reflected in the ASFRs, indicates that childbearing begins early. Fertilityspikes in the age group 20–24 years, and declines thereafter, as illustrated in Figure RH.1.The Nepal Health Sector Programme (2010–2015) target for total fertility rate,set at 2.5birth per woman, has been achieved and the target for the adolescent fertility rate,set at 70 births per 1,000 woman aged 15–19 years,has been nearly achieved. Figure RH.1: Age-specific fertility rates by area,Nepal,2014 Table RH.2 shows adolescent birth rates and total fertility rates. The adolescent birth rate (ASFR for women aged 15–19 years) is defined as the number of births to women aged 15–19 years during the three-year period preceding the survey, divided by the average number of women aged 15–19 years (number of women-years lived between the ages of 15 years and 19 years, inclusive) during the same period, expressed per 1,000 women. The adolescent birth rate in Nepal is 71 births per 1,000 women aged 15–19 years. It varies considerably between regions, with the highest in the Mid-Western Mountains (123births per 1,000 women) and the lowest in the Central Hills (29births per 1,000 women). It decreases with an increase in the education level of adolescent mothers.Interestingly,in terms of wealth quintile, it is highest for adolescent mothers living in householdsin the middle quintile (104). 0 20 40 60 80 100 120 140 160 180 200 15-19 20-24 25-29 30-34 35-39 40-44 45-49 P er 1 ,0 00 Age Urban Rural Total Rates refer to the three-year period preceding the survey Nepal&MICS&2014& 1" VIII. Reproductive Health Fertility Measures of current fertility are presented in Table RH.1 for the three-year period preceding the survey. A three-year period was chosen for calculating these rates to provide the most current information while also allowing the rates to be calculated for a sufficient number of cases so as to meet statistical precision of the estimates. Age-specific fertility rates (ASFRs), expressed as the number of births per 1,000 women in a specified age group, show the age pattern of fertility. Numerators for ASFRs are calculated by identifying live births that occurred in the three-year period preceding the survey classified according to the age of the mother (in five-year age groups) at the time of the child’s birth. The denominators of the rates represent the number of woman-years lived by the survey respondents in each of the five-year age groups during the specified period. The total fertility rate (TFR) is a synthetic measure that denotes the number of live births a woman would have if she were subject to the current age-specific fertility rates throughout her reproductive age (15–49 years). The general fertility rate (GFR) is the number of live births occurring during the specified period per 1,000 women aged 15–49 years. The crude birth rate (CBR) is the number of live births per 1,000 of the population during the specified period. Table RH.1: Fertility rates Adolescent birth rate, age-specific fertility rates, total fertility rate, general fertility rate, and crude birth rate for the three-year period preceding the survey, by area, Nepal, 2014 Urban Rural Total Age (years) 15–19 [1] 33 80 71 20–24 95 189 169 25–29 97 123 118 30–34 42 63 59 35–39 16 (29) 26 40–44 (*) (*) 10 45–49 (*) (*) 5 TFR [a] 1.4 2.5 2.3 GFR [b] 49.7 87.3 79.8 CBR [c] 14.6 21.5 20.3 [1] MICS indicator 5.1; MDG indicator 5.4 – Adolescent birth rate [a] TFR: Total fertility rate expressed per woman aged 15–49 years [b] GFR: General fertility rate expressed per 1,000 women aged 15–49 years [c] CBR: Crude birth rate expressed per 1,000 of the population ( ) Figures that are based on 25–49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Table RH.1 shows current fertility rates in Nepal at the national level and by urban or rural areas. The total fertility rate for the three years preceding the survey is 2.3 births per woman aged 15–49 years. Fertility is considerably higher in rural areas (2.5) than in urban areas (1.4). As the ASFRs show, the pattern of higher rural fertility is prevalent in all age groups. The urban–rural difference in fertility is most pronounced for younger women: 95 births per 1,000 women aged 20–24 years in urban areas compared to 189 births per 1,000 women Table RH.1 shows current fertility rates in Nepal at the national level and by urban or rural areas. The total fertility rate for the three years preceding the survey is 2.3 births per woman aged 15–49 years. Fertility is considerably higher in rural areas (2.5) than in urban areas (1.4). As the ASFRs show, the pattern of higher rural fertility is prevalent in all age groups. The urban–rural difference in fertility is most pronounced for younger women: 95 births per 1,000 women aged 20–24 years in urban areas compared to 189 births per 1,000 women aged 20–24 years in rural areas. It is even wider for adolescents: 33 births per 1,000 women aged 15–19 years in urban areas compared to 80 births per 1,000 women aged 15–19 years in rural areas. The overall age pattern of fertility, as reflected in the ASFRs, indicates that childbearing begins early. Fertility spikes in the age group 20–24 years, and declines thereafter, as illustrated in Figure RH.1.The Nepal Health Sector Programme (2010–2015) target for total fertility rate, set at 2.5 birth per woman, has been achieved and the target for the adolescent fertility rate, set at 70 births per 1,000 woman aged 15–19 years, has been nearly achieved. Figure RH.1: Age-specific fertility rates by area, Nepal, 2014 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 115 Table RH.2 shows adolescent birth rates and total fertility rates. The adolescent birth rate (ASFR for women aged 15–19 years) is defined as the number of births to women aged 15–19 years during the three-year period preceding the survey, divided by the average number of women aged 15–19 years (number of women-years lived between the ages of 15 and 19, inclusive) during the same period, expressed per 1,000 women. The adolescent birth rate in Nepal is 71 births per 1,000 women aged 15–19 years. It varies considerably between regions, with the highest in the Mid-Western Mountains (123 births per 1,000 women) and the lowest in the Central Hills (29 births per 1,000 women). It decreases with an increase in the education level of adolescent mothers. Interestingly, in terms of wealth quintile, it is highest for adolescent mothers living in households in the middle quintile (104). Childbearing early in life carries significant risks due to young women’s inadequate physiological advancement and reproductive knowledge. Table RH.3 presents some early childbearing indicators for women aged 15–19 years and 20–24 years, while Table RH.4 presents the trends for early childbearing. Table RH.2: Adolescent birth rate and total fertility rate Adolescent birth rates and total fertility rates for the three-year period preceding the survey, Nepal, 2014 Adolescent birth rate [1] (ASFR for women aged 15–19 years) Total fertility rate [a] Total 71 2.3 Region Eastern Mountains 67 2.9 Eastern Hills 67 2.3 Eastern Terai 86 2.1 Central Mountains 49 2.5 Central Hills 29 1.7 Central Terai 111 2.7 Western Mountains 87 2.2 Western Hills 62 2.2 Western Terai 64 2.4 Mid-Western Mountains 123 4.1 Mid-Western Hills 83 2.9 Mid-Western Terai 76 2.0 Far Western Mountains 63 2.6 Far Western Hills 60 3.0 Far Western Terai 53 1.9 Education None 176 3.3 Primary 122 2.7 Secondary 58 2.1 Higher 37 1.8 Wealth index quintile Poorest 76 3.1 Second 70 2.6 Middle 104 2.5 Fourth 78 2.1 Richest 30 1.5 [1] MICS indicator 5.1; MDG indicator 5.4 – Adolescent birth rate [a] TFR: Total fertility rate expressed per woman aged 15–49 years NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014116 As shown in Table RH.3, 10 percent of women aged 15–19 had already had a birth and 3 percent were pregnant with their first child, giving a total of 14 percent who had begun childbearing. Around 1 percent of these women had a live birth before the age of 15. Of women aged 20–24 years, 16 percent had a live birth before the age of 18. Early childbearing (before the age of 18) was highest among young women in the Mid-Western Mountains (30 percent) and lowest among young women in the Eastern Hills (9 percent). Rural young women were much more likely than urban young women to have had a live birth before the age of 18 (18 percent compared to 8 percent). Early childbearing decreases markedly with an increase in the level of a women’s education, and higher household wealth status also reduces the likelihood of early childbearing, especially for young women living in households in the richest quintile. Table RH.3: Early childbearing Percentage of women aged 15–19 years who have had a live birth, are pregnant with the first child, have begun childbearing, and who have had a live birth before the age of 15, and percentage of women aged 20–24 years who have had a live birth before the age of 18, Nepal, 2014 Percent of women aged 15–19 years who: Number of women aged 15– 19 years Percent of women aged 20– 24 years who have had a live birth before age 18 [1] Number of women aged 20– 24 years Have had a live birth Are pregnant with first child Have begun child- bearing Have had a live birth before age 15 Total 10.2 3.4 13.6 0.5 2,721 16.0 2,402 Region Eastern Mountains 9.1 4.4 13.5 0.0 43 16.9 34 Eastern Hills 11.7 1.9 13.6 0.6 178 8.8 150 Eastern Terai 12.0 3.5 15.5 1.1 378 15.8 321 Central Mountains 10.8 0.5 11.4 0.7 62 15.0 39 Central Hills 5.5 1.6 7.1 0.4 374 10.2 397 Central Terai 13.5 4.5 18.0 0.5 459 21.5 348 Western Mountains (*) (*) (*) (*) 1 (4.8) 1 Western Hills 7.6 2.7 10.3 0.0 294 18.3 289 Western Terai 8.9 5.4 14.3 0.0 228 12.8 226 Mid-Western Mountains 14.0 6.1 20.1 1.1 36 29.7 36 Mid-Western Hills 12.8 3.9 16.6 0.6 186 23.0 146 Mid-Western Terai 12.0 5.0 17.0 2.0 186 18.4 155 Far Western Mountains 6.8 2.0 8.8 0.5 45 15.3 33 Far Western Hills 5.3 1.7 7.1 0.0 104 22.1 79 Far Western Terai 10.3 4.4 14.8 0.0 148 11.4 148 Area Urban 6.3 2.7 9.0 0.4 442 8.2 513 Kathmandu valley 5.4 0.5 5.9 1.2 114 6.9 164 Other urban 6.6 3.5 10.1 0.1 329 8.8 349 Rural 10.9 3.6 14.5 0.6 2,279 18.2 1,888 Education None 30.8 7.7 38.6 2.5 228 35.1 389 Primary 17.8 4.9 22.7 0.8 274 26.8 335 Secondary 8.1 3.2 11.3 0.3 1,625 20.5 675 Higher 4.5 1.8 6.2 0.5 593 2.0 1,003 Wealth index quintile Poorest 10.7 3.2 13.8 0.6 556 21.5 391 Second 11.0 3.3 14.2 0.2 566 15.2 418 Middle 12.6 4.5 17.1 1.2 543 23.1 463 Fourth 12.1 4.3 16.4 0.4 580 17.9 546 Richest 3.6 1.7 5.3 0.3 477 5.5 584 [1] MICS indicator 5.2 – Early childbearing ( ) Figures that are based on 25–49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 117 Ta bl e RH .4 : T re nd s in e ar ly c hi ld be ar in g Pe rc en ta ge o f w om en w ho h av e ha d a liv e bir th , b y t he a ge o f 1 5 an d 18 , b y a re a an d ag e gr ou p, N ep al, 2 01 4 Al l Ur ba n Ru ra l Pe rc en t o f wo m en w ith a liv e bir th be fo re a ge 15 Nu m be r o f wo m en ag ed 1 5– 49 ye ar s Pe rc en t o f wo m en w ith a liv e bir th be fo re a ge 18 Nu m be r o f wo m en ag ed 2 0– 49 ye ar s Pe rc en t o f wo m en w ith a liv e bir th be fo re a ge 15 Nu m be r o f wo m en ag ed 1 5– 49 ye ar s Pe rc en t o f wo m en w ith a liv e bir th be fo re a ge 18 Nu m be r o f wo m en ag ed 2 0– 49 ye ar s Pe rc en t o f wo m en w ith a liv e bir th be fo re a ge 15 Nu m be r o f wo m en ag ed 1 5– 49 ye ar s Pe rc en t o f wo m en w ith a liv e bir th be fo re a ge 18 Nu m be r o f wo m en ag ed 2 0– 49 ye ar s To ta l 2. 9 14 ,1 62 21 .2 11 ,4 41 2. 2 2, 79 2 16 .0 2, 35 0 3. 1 11 ,3 70 22 .6 9, 09 1 Ag e (y ea rs ) 15 –1 9 0. 5 2, 72 1 na 0 0. 4 44 2 na 0 0. 6 2, 27 9 na 0 20 –2 4 1. 7 2, 40 2 16 .0 2, 40 2 0. 7 51 3 8. 2 51 3 1. 9 1, 88 8 18 .2 1, 88 8 25 –2 9 4. 1 2, 41 4 24 .8 2, 41 4 3. 1 46 5 18 .2 46 5 4. 3 1, 94 8 26 .4 1, 94 8 30 –3 4 4. 8 2, 00 3 25 .6 2, 00 3 3. 9 41 2 18 .2 41 2 5. 1 1, 59 1 27 .5 1, 59 1 35 –3 9 3. 7 1, 90 1 21 .6 1, 90 1 2. 9 40 2 18 .4 40 2 4. 0 1, 49 9 22 .5 1, 49 9 40 –4 4 4. 2 1, 58 2 21 .2 1, 58 2 2. 7 33 0 17 .7 33 0 4. 5 1, 25 2 22 .2 1, 25 2 45 –4 9 2. 6 1, 13 9 16 .3 1, 13 9 2. 3 22 8 18 .3 22 8 2. 3 91 2 18 .3 91 2 Ka th m an du va lle y Ot he r u rb an Pe rc en t o f w om en wi th a liv e bir th be fo re a ge 1 5 Nu m be r o f w om en ag ed 1 5– 49 ye ar s Pe rc en t o f w om en wi th a liv e bir th be fo re a ge 1 8 Nu m be r o f w om en ag ed 2 0– 49 ye ar s Pe rc en t o f w om en wi th a liv e bir th be fo re a ge 1 5 Nu m be r o f w om en ag ed 1 5– 49 ye ar s Pe rc en t o f w om en wi th a liv e bir th be fo re a ge 1 8 Nu m be r o f w om en ag ed 2 0– 49 ye ar s To ta l 2. 1 86 8 11 .1 75 4 2. 3 1, 92 4 18 .3 1, 59 5 Ag e (y ea rs ) 15 –1 9 1. 2 11 4 na 0 0. 1 32 9 na 0 20 –2 4 1. 9 16 4 6. 9 16 4 0. 2 34 9 8. 8 34 9 25 –2 9 2. 7 15 3 11 .9 15 3 3. 3 31 2 21 .3 31 2 30 –3 4 2. 8 12 3 15 .3 12 3 4. 3 28 9 19 .5 28 9 35 –3 9 2. 3 13 3 12 .4 13 3 3. 2 26 9 21 .4 26 9 40 –4 4 1. 6 11 0 11 .1 11 0 3. 2 22 0 21 .0 22 0 45 –4 9 1. 4 71 9. 5 71 2. 7 15 6 22 .3 15 6 na : n ot a pp lic ab le NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014118 1In this chapter, whenever reference is made to the use of a contraceptive by a woman, this may refer to her partner using a contraceptive method (such as male condom). 2All references to ‘married women’ in this chapter include women in a marital union as well. Table RH.4 suggests that early childbearing has declined markedly over the last 10 years, with a decrease in the proportion of women with a live birth before the age of 15 dropping from 4 percent for women aged 25–29 years to less than1 percent for women aged 15–19 years. This decline occurred in both urban and rural areas. The proportion of women with a live birth before the age of 18 dropped from 26 percent for women aged 30–34 years to 16 percent for women aged 20–24 years. This decline also occurred for women in both urban and rural areas. Contraception Appropriate family planning is important to the health of women and children by: (i) preventing too early or too late pregnancies; (ii) extending the period between births; and (iii) limiting the total number of children. Access by all couples to information and services to prevent pregnancies that are too early, too closely spaced, too late or too many is critical. Table RH.5 shows current use of contraception1 for women aged 15–49 years currently married or in a marital union2. In total, 50 percent of women were using some form of contraception, with 47 percent using a modern method and 3 percent using a traditional method. The most popular method was female sterilization, which was used by 18 percent of married women in Nepal. This was followed by injectables (13 percent), pill (5 percent), male sterilization (5 percent) and male condom (4 percent). Contraceptive prevalence ranged from 42 percent in the Far Western Hills to 64 percent in the Western Mountains. Adolescents were far less likely to use contraception than older women. Only 19 percent of married women aged 15–19 years used some method of contraception compared to 30 percent of 20–24-year-olds, and 44–65 percent of older women. Women with children were more likely than those without children to use contraception: only 15 percent of those without children used contraception compared to 33 percent of women with one child and 54 percent of women with two children. Interestingly, women’s education level was negatively associated with contraceptive use. In addition, the pattern of use by specific methods also varied with the level of education. Female sterilization was most commonly used by married women with no education or primary education, while injectables were most used by those with primary or secondary education. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 119 Ta bl e RH .5 : U se o f c on tra ce pt io n Pe rc en ta ge o f w om en a ge d 15 –4 9 ye ar s c ur re nt ly m ar rie d or in u nio n wh o ar e us ing (o r w ho se p ar tn er is u sin g) a co nt ra ce pt ive m et ho d, N ep al, 2 01 4 Pe rc en t o f w om en cu rre nt ly m ar rie d or in u nio n wh o ar e us ing (o r w ho se p ar tn er is u sin g) : Nu m be r of wo m en ag ed 15 –4 9 ye ar s cu rre nt ly m ar rie d or in un ion No m et ho d Fe m ale ste rili - za tio n M ale ste rili - za tio n IU D In jec t- ab les Im pla nt s Pi ll M ale co nd om Fe m ale co nd om Di a- ph ra gm / fo am / jel ly Pe rio dic ab sti n- en ce W ith - dr aw al Ot he r An y m od er n m et ho d An y tra di- tio na l m et ho d An y m et ho d [1 ] To ta l 50 .3 18 .0 4. 7 1. 7 13 .0 1. 3 4. 7 3. 7 0. 0 0. 1 0. 2 2. 2 0. 1 47 .1 2. 5 49 .7 10 ,8 30 Re gi on Ea ste rn M ou nt ain s 46 .6 0. 9 2. 1 1. 4 30 .5 2. 5 5. 7 2. 0 0. 0 0. 0 0. 3 7. 9 0. 0 45 .1 8. 3 53 .4 13 4 Ea ste rn H ills 54 .2 2. 3 2. 3 1. 7 20 .2 0. 0 9. 3 2. 9 0. 0 0. 0 0. 7 6. 2 0. 0 38 .9 6. 9 45 .8 57 7 Ea ste rn T er ai 47 .0 25 .9 1. 1 0. 6 9. 6 1. 6 5. 6 3. 5 0. 0 0. 0 0. 8 4. 1 0. 0 47 .9 4. 9 53 .0 1, 60 4 Ce nt ra l M ou nt ain s 48 .3 6. 6 10 .2 2. 0 21 .7 3. 3 6. 0 1. 4 0. 0 0. 0 0. 0 0. 5 0. 0 51 .2 0. 5 51 .7 20 1 Ce nt ra l H ills 49 .0 9. 4 7. 7 2. 7 15 .0 3. 2 6. 1 4. 7 0. 1 0. 3 0. 3 1. 2 0. 3 49 .2 1. 7 51 .0 1, 66 8 Ce nt ra l T er ai 54 .0 32 .2 2. 5 0. 2 8. 0 0. 1 1. 4 1. 5 0. 0 0. 0 0. 0 0. 0 0. 0 45 .9 0. 0 46 .0 1, 89 6 W es te rn M ou nt ain s 35 .8 8. 6 5. 3 5. 9 22 .8 8. 1 8. 1 5. 3 0. 0 0. 0 0. 0 0. 0 0. 0 64 .2 0. 0 64 .2 6 W es te rn H ills 55 .2 10 .7 7. 7 2. 2 9. 1 0. 7 6. 0 3. 4 0. 0 0. 1 0. 1 4. 8 0. 0 39 .8 4. 9 44 .8 1, 26 9 W es te rn T er ai 51 .8 19 .7 3. 4 1. 4 13 .7 1. 0 4. 6 1. 6 0. 0 0. 0 0. 0 2. 7 0. 1 45 .3 2. 8 48 .2 94 0 M id- W es te rn M ou nt ain s 52 .2 2. 8 20 .8 1. 8 14 .7 1. 1 1. 5 4. 0 0. 0 0. 2 0. 0 0. 8 0. 0 46 .9 0. 8 47 .8 13 6 M id- W es te rn H ills 50 .5 9. 2 8. 9 5. 0 14 .6 2. 2 3. 7 3. 9 0. 0 0. 0 0. 1 1. 7 0. 1 47 .4 2. 0 49 .5 68 6 M id- W es te rn T er ai 44 .2 23 .8 1. 2 3. 0 16 .1 0. 7 3. 9 6. 3 0. 1 0. 0 0. 1 0. 4 0. 0 55 .1 0. 5 55 .8 67 0 Fa r W es te rn M ou nt ain s 46 .2 6. 7 12 .9 0. 8 20 .1 0. 3 4. 4 8. 7 0. 0 0. 0 0. 0 0. 0 0. 0 53 .8 0. 0 53 .8 17 6 Fa r W es te rn H ills 57 .9 6. 7 5. 5 1. 0 17 .6 0. 6 5. 2 5. 3 0. 2 0. 0 0. 0 0. 1 0. 0 42 .0 0. 1 42 .1 32 5 Fa r W es te rn T er ai 38 .1 28 .5 1. 8 1. 3 15 .0 1. 4 3. 7 9. 4 0. 1 0. 2 0. 1 0. 2 0. 0 61 .6 0. 2 61 .9 54 0 Ar ea Ur ba n 47 .9 14 .7 4. 5 1. 7 12 .5 1. 4 5. 9 6. 7 0. 1 0. 1 0. 6 3. 9 0. 0 47 .5 4. 5 52 .1 1, 98 3 Ka th m an du va lle y 51 .8 7. 9 3. 7 2. 9 15 .3 2. 4 5. 5 7. 4 0. 0 0. 2 0. 8 2. 0 0. 0 45 .4 2. 8 48 .2 60 2 Ot he r u rb an 46 .1 17 .6 4. 8 1. 2 11 .2 1. 0 6. 1 6. 3 0. 1 0. 1 0. 5 4. 7 0. 1 48 .5 5. 3 53 .9 1, 38 1 Ru ra l 50 .8 18 .7 4. 7 1. 7 13 .1 1. 3 4. 4 3. 1 0. 0 0. 1 0. 1 1. 8 0. 1 47 .1 2. 0 49 .2 8, 84 6 Ag e (y ea rs ) 15 –1 9 80 .6 0. 3 0. 0 0. 8 4. 6 0. 3 3. 0 7. 7 0. 0 0. 0 0. 0 2. 6 0. 0 16 .6 2. 6 19 .4 65 9 20 –2 4 70 .3 1. 7 0. 3 1. 5 12 .4 0. 9 5. 0 5. 7 0. 0 0. 0 0. 2 1. 9 0. 0 27 .5 2. 2 29 .7 1, 70 1 25 –2 9 56 .3 12 .2 1. 6 1. 8 14 .3 1. 5 5. 3 3. 9 0. 1 0. 0 0. 3 2. 4 0. 0 40 .9 2. 7 43 .7 2, 20 9 30 –3 4 43 .2 19 .7 4. 5 2. 3 16 .4 1. 7 4. 8 4. 1 0. 0 0. 2 0. 5 2. 5 0. 0 53 .8 3. 0 56 .8 1, 90 9 35 –3 9 35 .7 27 .8 7. 2 2. 4 14 .2 1. 9 5. 8 2. 9 0. 0 0. 1 0. 2 1. 8 0. 1 62 .2 2. 0 64 .3 1, 81 0 40 –4 4 35 .4 30 .9 9. 9 1. 6 12 .7 1. 0 3. 9 1. 9 0. 0 0. 2 0. 0 2. 3 0. 1 62 .1 2. 5 64 .6 1, 49 9 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014120 Ta bl e RH .5 : U se o f c on tra ce pt io n Pe rc en ta ge o f w om en a ge d 15 –4 9 ye ar s c ur re nt ly m ar rie d or in u nio n wh o ar e us ing (o r w ho se p ar tn er is u sin g) a co nt ra ce pt ive m et ho d, N ep al, 2 01 4 Pe rc en t o f w om en cu rre nt ly m ar rie d or in u nio n wh o ar e us ing (o r w ho se p ar tn er is u sin g) : Nu m be r of wo m en ag ed 15 –4 9 ye ar s cu rre nt ly m ar rie d or in un ion No m et ho d Fe m ale ste rili - za tio n M ale ste rili - za tio n IU D In jec t- ab les Im pla nt s Pi ll M ale co nd om Fe m ale co nd om Di a- ph ra gm / fo am / jel ly Pe rio dic ab sti n- en ce W ith - dr aw al Ot he r An y m od er n m et ho d An y tra di- tio na l m et ho d An y m et ho d [1 ] 45 –4 9 45 .7 28 .9 9. 6 0. 3 8. 1 1. 0 3. 1 0. 9 0. 0 0. 0 0. 1 1. 9 0. 2 51 .9 2. 2 54 .3 1, 04 2 Nu m be r o f l iv in g ch ild re n 0 85 .1 0. 0 0. 3 0. 0 1. 4 0. 0 2. 0 8. 0 0. 0 0. 1 0. 4 2. 6 0. 0 11 .7 3. 0 14 .9 1, 07 3 1 67 .1 1. 6 1. 0 1. 4 13 .0 1. 0 5. 7 5. 6 0. 0 0. 1 0. 5 2. 9 0. 1 29 .3 3. 5 32 .9 2, 13 9 2 46 .5 16 .9 4. 6 2. 4 15 .3 1. 8 5. 5 3. 4 0. 1 0. 2 0. 2 2. 9 0. 1 50 .2 3. 3 53 .5 3, 17 0 3 35 .0 31 .3 8. 3 1. 6 13 .4 1. 8 4. 5 2. 6 0. 0 0. 1 0. 1 1. 1 0. 0 63 .6 1. 3 65 .0 2, 28 9 4+ 38 .2 30 .6 6. 7 1. 9 14 .7 1. 1 4. 1 1. 4 0. 0 0. 0 0. 1 1. 3 0. 0 60 .5 1. 3 61 .8 2, 15 9 Ed uc at io n No ne 44 .5 27 .5 5. 9 1. 4 13 .2 1. 3 3. 6 1. 4 0. 0 0. 0 0. 1 0. 9 0. 0 54 .4 1. 0 55 .5 4, 99 1 Pr im ar y 49 .1 15 .3 4. 8 1. 7 16 .6 1. 9 4. 8 3. 4 0. 0 0. 0 0. 1 2. 3 0. 0 48 .5 2. 3 50 .9 1, 71 6 Se co nd ar y 57 .0 9. 3 3. 7 1. 6 12 .2 1. 3 6. 5 4. 7 0. 1 0. 2 0. 0 3. 1 0. 2 39 .6 3. 4 43 .0 2, 28 5 Hi gh er 58 .8 5. 2 2. 3 2. 7 9. 9 .8 5. 5 9. 2 0. 0 0. 0 1. 0 4. 6 0. 0 35 .6 5. 5 41 .2 1, 83 6 W ea lth in de x qu in til e Po or es t 54 .1 7. 6 7. 6 2. 6 16 .7 1. 9 4. 4 3. 3 0. 1 0. 0 0. 2 1. 6 0. 0 44 .1 1. 8 45 .9 1, 87 1 Se co nd 51 .4 19 .1 4. 8 1. 5 13 .2 1. 4 4. 7 2. 1 0. 0 0. 0 0. 1 1. 5 0. 0 46 .8 1. 6 48 .6 2, 09 4 M idd le 48 .4 27 .2 2. 8 .8 11 .4 1. 1 3. 6 3. 2 0. 0 0. 0 0. 1 1. 2 0. 0 50 .1 1. 3 51 .6 2, 21 1 Fo ur th 48 .7 20 .9 3. 5 1. 3 13 .6 1. 4 4. 9 3. 2 0. 0 0. 0 0. 1 2. 3 0. 0 48 .9 2. 4 51 .3 2, 33 3 Ri ch es t 49 .6 13 .5 5. 2 2. 3 10 .6 0. 9 5. 8 6. 6 0. 1 0. 4 0. 7 4. 2 0. 2 45 .4 5. 0 50 .4 2, 32 1 [1 ] M IC S In di ca to r 5 .3 , M DG In di ca to r 5 .3 – C on tra ce pt iv e pr ev al en ce ra te No te : 1 ca se o f m iss ing ‘e du ca tio n’ no t s ho wn C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 121 Figure RH.2 shows variation in contraceptive prevalence by region, area and education level. Figure RH.2: Differentials in contraceptive use, Nepal, 2014 ! 45 39 48 51 49 46 64 40 45 47 47 55 54 42 62 48 47 44 47 50 49 45 47 Regions Eastern Mountains Eastern Hills Eastern Terai Central Mountains Central Hills Central Terai Western Mountains Western Hills Western Terai Mid-Western Mountains Mid-Western Hills Mid-Western Terai Far Western Mountains Far Western Hills Far Western Terai Area Urban Rural Woman's Education None Primary Secondary Higher Nepal Per cent Percent NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014122 Unmet Need Unmet need for contraception refers to fecund women who are married or in union and are not using any method of contraception, but wish to postpone the next birth (spacing) or wish to stop childbearing altogether (limiting). Unmet need is identified in MICS by using a set of questions eliciting current behaviours and preferences pertaining to contraceptive use, fecundity, and fertility preferences. Table RH.6 shows the levels of met need for contraception, unmet need, and the demand for contraception satisfied. Unmet need for spacing is defined as the percentage of women who are married or in union and are not using a method of contraception AND • are not pregnant, and not postpartum amenorrheic3, and are fecund4, and say they want to wait two or more years for their next birth OR • are not pregnant, and not postpartum amenorrheic, and are fecund, and unsure whether they want another child OR • are pregnant, and say that pregnancy was mistimed: would have wanted to wait OR • are postpartum amenorrheic, and say that the birth was mistimed: would have wanted to wait. Unmet need for limiting is defined as the percentage of women who are married or in union and are not using a method of contraception AND • are not pregnant, and not postpartum amenorrheic, and are fecund, and say they do not want any more children OR • are pregnant, and say they did not want to have a child OR • are postpartum amenorrheic, and say that they did not want the birth. Total unmet need for contraception is the sum of unmet need for spacing and unmet need for limiting. This indicator is also known as unmet need for family planning and is one of the indicators used to track progress toward the MDG 5 on improving maternal health. The Nepal Health Sector Programme (2010–2015) target for unmet need for family planning is 18 percent or below. Table RH.6 shows unmet need for contraception among women aged 15–49 years currently married or in union. Some 25 percent of women had an unmet need for contraception, with 10 percent requiring it for spacing and 15 percent requiring it for limiting. Regionally, unmet need ranged from 18 percent in the Far Western Terai to 31 percent in the Western Hills. Notably, unmet need was higher among younger women than older women, ranging from 48 percent for women aged 15–19 years to 11 percent for women aged 45–49 years. As expected, the unmet need for spacing was higher among younger women and the unmet need for limiting was higher among older women. Education level was positively associated with unmet need, with only 19 percent of women with no education expressing an unmet need compared to 32 percent of women with higher education. 3A women is postpartum amenorrheic if she had a birth in the last two years and is not currently pregnant, and her menstrual period has not returned since the birth of the last child. 4A women is considered infecund if she is neither pregnant nor postpartum amenorrheic, and (1a) has not had menstruation for at least six months, or (1b) never menstruated, or (1c) her last menstruation occurred before her last birth, or (1d) in menopause/has had hysterectomy, OR (2) she declares that she has had hysterectomy, or that she has never menstruated, or that she is menopausal, or that she has been trying to get pregnant for two or more years without result in response to questions on why she thinks she is not physically able to get pregnant at the time of survey, OR (3) she declares she cannot get pregnant when asked about desire for future birth, OR (4) she has not had a birth in the preceding five years, is currently not using contraception and is currently married and was continuously married during the five years preceding the survey. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 123 Table RH.6: Unmet need for contraception Percentage of women aged 15–49 years currently married or in union with an unmet need for family planning, and percentage of demand for contraception satisfied, Nepal, 2014 Met need for contraception Unmet need for contraception Number of women aged 15– 49 years currently married or in union Percent of demand for contra- ception satisfied Number of women currently married with need for contra- ception For spacing For limiting Total For spacing For limiting Total [1] Total 6.3 43.4 49.7 10.0 15.2 25.2 10,830 66.3 8,112 Region Eastern Mountains 10.7 42.7 53.4 7.2 13.0 20.2 134 72.5 99 Eastern Hills 10.5 35.3 45.8 11.8 16.6 28.4 577 61.7 428 Eastern Terai 6.3 46.7 53.0 11.2 15.0 26.2 1,604 66.9 1,270 Central Mountains 8.5 43.2 51.7 7.4 12.6 20.0 201 72.1 144 Central Hills 7.1 43.8 51.0 8.2 16.0 24.2 1,668 67.8 1,254 Central Terai 2.9 43.2 46.0 12.0 12.3 24.2 1,896 65.5 1,333 Western Mountains 9.7 54.5 64.2 6.1 12.1 18.2 6 77.9 5 Western Hills 5.6 39.2 44.8 8.4 22.9 31.3 1,269 58.9 965 Western Terai 5.6 42.6 48.2 10.4 13.5 23.9 940 66.8 678 Mid-Western Mountains 5.8 42.0 47.8 8.9 10.5 19.4 136 71.2 92 Mid-Western Hills 4.9 44.5 49.5 9.6 18.4 28.0 686 63.9 531 Mid-Western Terai 9.8 46.0 55.8 9.7 12.3 21.9 670 71.8 521 Far Western Mountains 7.0 46.9 53.8 8.8 11.3 20.1 176 72.8 130 Far Western Hills 6.2 36.0 42.1 13.1 15.7 28.9 325 59.3 231 Far Western Terai 10.4 51.5 61.9 7.6 10.4 18.0 540 77.5 431 Area Urban 8.4 43.7 52.1 7.2 15.7 22.9 1,983 69.5 1,488 Kathmandu valley 8.0 40.2 48.2 6.0 18.0 24.0 602 66.8 434 Other urban 8.6 45.3 53.9 7.7 14.7 22.4 1,381 70.6 1,054 Rural 5.9 43.3 49.2 10.6 15.1 25.7 8,846 65.6 6,624 Age (years) 15–19 17.5 1.8 19.4 42.9 4.8 47.7 659 28.9 442 20–24 16.3 13.4 29.7 26.4 12.5 39.0 1,701 43.2 1,168 25–29 9.0 34.8 43.7 12.1 19.3 31.4 2,209 58.3 1,659 30–34 4.0 52.9 56.8 2.5 19.3 21.8 1,909 72.3 1,502 35–39 0.9 63.3 64.3 1.5 16.3 17.8 1,810 78.3 1,485 40–44 0.2 64.4 64.6 0.5 13.7 14.2 1,499 82.0 1,181 45–49 0.0 54.3 54.3 0.0 10.4 10.5 1,042 83.8 675 Education None 2.4 53.1 55.5 5.3 13.6 19.0 4,991 74.5 3,715 Primary 5.4 45.4 50.9 9.1 18.7 27.8 1,716 64.7 1,350 Secondary 9.8 33.2 43.0 15.0 16.2 31.1 2,285 58.0 1,694 Higher 13.6 27.6 41.2 17.3 15.1 32.4 1,836 55.9 1,352 Wealth index quintiles Poorest 6.3 39.6 45.9 10.6 16.6 27.2 1,871 62.8 1,367 Second 5.0 43.6 48.6 9.5 15.6 25.1 2,094 65.9 1,543 Middle 5.3 46.2 51.6 11.6 13.3 24.9 2,211 67.4 1,690 Fourth 6.7 44.6 51.3 10.4 14.5 24.9 2,333 67.3 1,777 Richest 8.3 42.2 50.4 8.1 16.2 24.3 2,321 67.5 1,734 [1] MICS indicator 5.4; MDG indicator 5.6 – Unmet need Note: 1 case of missing ‘education ‘ not shown Met need for limiting includes women married or in union who are using (or whose partner is using) a contraceptive method, and who want no more children, are using male or female sterilization, or declare themselves as infecund. Met need for spacing includes women who are using (or whose partner is using) a contraceptive method, and who want to have another child, or are undecided whether to have another child. The total of met need for spacing and limiting adds up to the total met NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014124 need for contraception. In Nepal, the total percentage of women whose contraceptive needs were met is 50 percent, with 6 percent having a met need for spacing and 43 percent having a met need for limiting. The met need for contraception for spacing was higher among younger women, particularly those aged 15–19 years (18 percent), while the met need for limiting was higher among women aged 40–44 years (64 percent). Using information on contraception and unmet need, the percentage of demand for contraception satisfied is also estimated from MICS data. The percentage of demand satisfied is defined as the proportion of women currently married or in union who are currently using contraception, over the total demand for contraception. The total demand for contraception includes women who currently have an unmet need (for spacing or limiting), plus those who are currently using contraception. The percentage of demand for contraception that was satisfied was 66 percent. It was highest in the Western Mountains (78 percent) and lowest in the Western Hills (59 percent). It decreased with an increase in the level of a woman’s education. In Nepal, total met need is higher than total unmet need for family planning (50 percent compared to 25 percent). Antenatal Care The antenatal period presents important opportunities for reaching pregnant women with a number of interventions that may be vital to their health and well-being and that of their infants. Better understanding of foetal growth and development and its relationship to the mother’s health has resulted in increased attention to the potential of antenatal care as an intervention to improve both maternal and newborn health. For example, antenatal care can be used to inform women and families about risks and signs in pregnancy and about the risks of labour and delivery, and therefore, it may provide the route for ensuring that pregnant women do, in practice, deliver with the assistance of a skilled health care provider that includes medical doctor, nurse/midwife and auxiliary nurse midwife. Antenatal visits also provide an opportunity to supply information on birth spacing, which is recognized as an important factor in improving infant survival. Tetanus immunization during pregnancy can be life-saving for both the mother and the infant. The prevention and treatment of malaria among pregnant women, management of anaemia during pregnancy and treatment of sexually transmitted infections (STIs) can significantly improve birth outcomes and improve maternal health. Adverse outcomes can be reduced through a combination of interventions and early detection of danger signs. More recently, the potential of antenatal care as an entry point for HIV prevention and care, in particular for the prevention of HIV transmission from mother to child, has led to renewed interest in access to and use of antenatal services. WHO recommends a minimum of four antenatal visits based on a review of the effectiveness of different models of antenatal care. WHO guidelines are specific on the content of antenatal care visits, which include: • Blood pressure measurement • Urine testing for bacteriuria and proteinuria • Blood testing to detect syphilis and severe anaemia • Weight/height measurement (optional). Antenatal care coverage indicators (at least one visit with a skilled provider and four or more visits with any providers) are used to track progress toward the MDG 5 on improving maternal health. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 125 Ta bl e RH .7 : A nt en at al c ar e co ve ra ge P er ce nt ag e of w om en a ge d 15 –4 9 ye ar s w ith a liv e bir th in th e tw o ye ar s p re ce din g th e su rv ey b y a nt en at al ca re p ro vid er d ur ing p re gn an cy fo r t he la st bir th , N ep al, 2 01 4 Pe rc en t o f w om en b y p ro vid er o f a nt en at al ca re [a ] To ta l An y sk ille d pr ov ide r [1 ] [ b] Nu m be r o f wo m en wi th a liv e bir th in th e las t t wo ye ar s Sk ille d pr ov ide r He alt h As sis ta nt / Au xil iar y He alt h W or ke r M at er na l Ch ild He alt h W or ke r Fe m ale Co m m un ity He alt h Vo lun te er Tr ad itio na l bir th at te nd an t Vi lla ge He alt h W or ke r Ot he r/ M iss ing No an te na ta l ca re M ed ica l do cto r Nu rs e / m idw ife Au xil iar y nu rs e m idw ife To ta l 38 .2 15 .3 14 .8 13 .8 1. 9 1. 2 0. 1 1. 0 0. 3 13 .3 10 0. 0 68 .3 2, 04 8 Re gi on Ea ste rn M ou nt ain s 9. 4 15 .9 26 .5 25 .7 2. 7 0. 0 0. 0 0. 0 1. 5 18 .3 10 0. 0 51 .8 32 Ea ste rn H ills 27 .5 13 .9 23 .5 22 .6 2. 8 0. 0 0. 0 0. 0 0. 0 9. 7 10 0. 0 64 .9 12 3 Ea ste rn T er ai 43 .8 18 .5 17 .6 8. 5 2. 3 0. 7 0. 7 0. 0 0. 0 8. 0 10 0. 0 79 .8 27 7 Ce nt ra l M ou nt ain s 32 .4 7. 1 16 .3 17 .0 5. 6 0. 0 0. 9 3. 6 0. 0 17 .0 10 0. 0 55 .8 38 Ce nt ra l H ills 67 .6 10 .3 4. 9 4. 8 0. 0 0. 0 0. 0 0. 0 0. 0 12 .4 10 0. 0 82 .8 24 1 Ce nt ra l T er ai 51 .5 14 .0 7. 9 7. 0 0. 6 0. 7 0. 0 2. 0 0. 6 15 .7 10 0. 0 73 .4 40 0 W es te rn M ou nt ain s (3 7. 4) (5 .1 ) (2 2. 0) (2 6. 2) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (9 .2 ) 10 0. 0 (6 4. 6) 1 W es te rn H ills 52 .2 4. 4 11 .1 18 .6 3. 0 0. 7 0. 0 0. 7 0. 5 8. 8 10 0. 0 67 .6 22 2 W es te rn T er ai 27 .2 28 .9 11 .0 19 .1 0. 0 0. 0 0. 0 0. 0 0. 9 13 .0 10 0. 0 67 .0 17 8 M id- W es te rn M ou nt ain s 6. 2 4. 2 32 .1 16 .5 2. 8 3. 5 0. 5 3. 1 0. 0 31 .1 10 0. 0 42 .4 43 M id- W es te rn H ills 5. 9 23 .2 18 .0 16 .9 6. 5 2. 4 0. 0 1. 9 0. 0 25 .2 10 0. 0 47 .1 16 6 M id- W es te rn T er ai 26 .6 32 .4 8. 4 11 .6 0. 0 9. 1 0. 4 3. 1 0. 0 8. 4 10 0. 0 67 .3 11 3 Fa r W es te rn M ou nt ain s 13 .3 2. 8 34 .1 25 .9 2. 8 2. 8 0. 0 0. 8 0. 0 17 .4 10 0. 0 50 .2 33 Fa r W es te rn H ills 15 .3 2. 0 29 .2 37 .9 1. 2 0. 0 0. 0 0. 0 0. 0 14 .4 10 0. 0 46 .5 75 Fa r W es te rn T er ai 19 .0 14 .8 35 .5 15 .6 3. 8 1. 4 0. 0 1. 1 0. 0 8. 7 10 0. 0 69 .3 10 6 Ar ea Ur ba n 76 .4 13 .3 2. 9 2. 5 0. 3 0. 0 0. 2 0. 4 0. 5 3. 7 10 0. 0 92 .5 26 2 Ka th m an du va lle y 96 .4 3. 6 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 10 0. 0 10 0. 0 65 Ot he r u rb an 69 .7 16 .5 3. 8 3. 3 0. 4 0. 0 0. 2 0. 6 0. 6 4. 9 10 0. 0 90 .0 19 7 Ru ra l 32 .6 15 .6 16 .6 15 .5 2. 2 1. 4 0. 1 1. 1 0. 2 14 .7 10 0. 0 64 .8 1, 78 6 M ot he r’s a ge a t b irt h Le ss th an 2 0 ye ar s 32 .0 19 .6 14 .0 12 .8 3. 0 0. 9 0. 0 2. 1 0. 7 14 .9 10 0. 0 65 .6 34 9 20 –3 4 ye ar s 40 .2 14 .8 15 .3 14 .1 1. 8 1. 3 0. 2 0. 7 0. 2 11 .5 10 0. 0 70 .3 1, 58 0 35 –4 9 ye ar s 29 .6 9. 1 11 .7 13 .3 0. 9 1. 2 0. 0 1. 6 0. 0 32 .6 10 0. 0 50 .4 11 9 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014126 Ta bl e RH .7 : A nt en at al c ar e co ve ra ge P er ce nt ag e of w om en a ge d 15 –4 9 ye ar s w ith a liv e bir th in th e tw o ye ar s p re ce din g th e su rv ey b y a nt en at al ca re p ro vid er d ur ing p re gn an cy fo r t he la st bir th , N ep al, 2 01 4 Pe rc en t o f w om en b y p ro vid er o f a nt en at al ca re [a ] To ta l An y sk ille d pr ov ide r [1 ] [ b] Nu m be r o f wo m en wi th a liv e bir th in th e las t t wo ye ar s Sk ille d pr ov ide r He alt h As sis ta nt / Au xil iar y He alt h W or ke r M at er na l Ch ild He alt h W or ke r Fe m ale Co m m un ity He alt h Vo lun te er Tr ad itio na l bir th at te nd an t Vi lla ge He alt h W or ke r Ot he r/ M iss ing No an te na ta l ca re M ed ica l do cto r Nu rs e / m idw ife Au xil iar y nu rs e m idw ife Ed uc at io n No ne 26 .6 12 .2 17 .7 15 .6 1. 9 2. 1 0. 4 0. 8 0. 3 22 .4 10 0. 0 56 .5 75 4 Pr im ar y 31 .5 19 .7 11 .7 16 .4 1. 7 0. 8 0. 0 2. 0 0. 0 16 .2 10 0. 0 62 .8 34 6 Se co nd ar y 35 .0 19 .7 17 .6 16 .7 2. 1 0. 9 0. 0 0. 6 0. 3 7. 1 10 0. 0 72 .3 50 3 Hi gh er 66 .8 12 .1 9. 3 5. 5 2. 0 0. 3 0. 0 1. 0 0. 4 2. 6 10 0. 0 88 .1 44 5 W ea lth in de x qu in til e Po or es t 11 .2 9. 3 19 .3 25 .5 3. 8 1. 3 0. 2 0. 6 0. 1 28 .8 10 0. 0 39 .7 45 4 Se co nd 29 .5 17 .7 15 .9 15 .9 2. 0 2. 5 0. 5 1. 3 0. 0 14 .6 10 0. 0 63 .1 43 6 M idd le 38 .4 16 .5 17 .6 13 .0 1. 3 0. 5 0. 0 2. 6 0. 5 9. 5 10 0. 0 72 .5 44 1 Fo ur th 48 .5 18 .6 13 .1 9. 6 1. 6 0. 9 0. 0 0. 0 0. 4 7. 3 10 0. 0 80 .2 40 1 Ri ch es t 75 .5 14 .8 5. 4 0. 8 0. 5 0. 6 0. 0 0. 0 0. 4 2. 0 10 0. 0 95 .7 31 6 [1 ] M IC S in di ca to r 5 .5 a; M DG in di ca to r 5 .5 – A nt en at al c ar e co ve ra ge [a ] O nly th e m os t q ua lifi ed p ro vid er is co ns ide re d in ca se s w he re m or e th an o ne p ro vid er w as re po rte d [b ] S kil led p ro vid er s i nc lud es m ed ica l d oc to r, nu rs e/ m idw ife , a nd a ux ilia ry n ur se m idw ife ( ) F igu re s t ha t a re b as ed o n 25 –4 9 un we igh te d ca se s C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 127 Table RH.7 presents information on the type of personnel providing antenatal care to women aged 15– 49 years with a live birth in the two years preceding the survey. Some 68 percent of women were seen by a skilled provider, with 38 percent seeing a medical doctor, 15 percent seeing a nurse/midwife and 15 percent seeing an auxiliary nurse midwife. In addition,14 percent were seen by a Health Assistant or Auxiliary Health Worker. Only 13 percent of women did not receive any antenatal care. Regionally, the highest proportion of women seeing a skilled provider was in the Central Hills (83 percent) and the lowest proportion was in the Mid-Western Mountains (42 percent). Urban women were more likely than rural women to see a skilled provider (93 percent compared to 65 percent). Younger and older women were less likely than women aged 20–34 years to see a skilled provider. Women with the higher education levels and/or living in households in richer quintiles were much more likely to receive antenatal care from a skilled provider than other women. UNICEF and WHO recommend a minimum of four antenatal care visits during pregnancy. It is of crucial importance for pregnant women to start attending antenatal care visits as early in pregnancy as possible in order to prevent and detect pregnancy conditions that could affect both the woman and her baby. Antenatal care should continue throughout the entire pregnancy. Nepal’s protocol for antenatal care provisions visits in the fourth, sixth, eighth and ninth months of pregnancy under the focused safe motherhood programme. As well as being observed in general, pregnant women routinely receive iron and folic acid supplementation, tetanus immunization and deworming; additional services are also available from specific locations. Table RH.8 shows the proportion of women aged 15–49 years with a live birth in the two years preceding the survey by the number of antenatal care visits and the timing of first visit. Some 60 percent of women received at least four antenatal care visits, and another 16 percent had three visits. The proportion of women receiving at least four visits was highest in the Central Hills (74 percent) and lowest in the Mid-Western Mountains (31 percent). Urban women were much more likely than rural women to have at least four visits (84 percent compared to 56 percent). Younger and older women were less likely than women aged 20–34 years to have at least four visits. Women with no education or living in the poorest households were least likely to have at least four visits. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014128 Ta bl e RH .8 : N um be r o f a nt en at al c ar e vi si ts a nd ti m in g of fi rs t v is it Pe rc en ta ge o f w om en a ge d 15 –4 9 ye ar s w ith a liv e bir th in th e tw o ye ar s p re ce din g th e su rv ey b y n um be r o f a nt en at al ca re (A NC ) v isi ts by a ny p ro vid er a nd b y t he tim ing o f f irs t a nt en at al ca re vi sit , N ep al, 20 14 Pe rc en t o f w om en w ho h ad : To ta l Pe rc en t o f w om en b y n um be r o f m on th s p re gn an t at th e tim e of fir st AN C vis it To ta l Nu m -b er of wo m en wi th a liv e bir th in th e las t t wo ye ar s M ed ian m on th s pr eg - na nt a t fir st AN C vis it Nu m -b er of wo m en wi th a liv e bir th in th e las t t wo ye ar s wh o ha d at le as t on e AN C vis it No A NC vis its On e vis it Tw o vis its Th re e vis its Fo ur o r m or e vis its [1 ] DK / M iss ing No A NC vis its Fi rs t t ri- m es te r 4– 5 m on th s 6– 7 m on th s 8+ m on th s DK / M iss ing To ta l 13 .3 3. 6 7. 0 15 .9 59 .5 0. 7 10 0. 0 13 .3 50 .8 29 .0 5. 6 1. 1 0. 0 10 0. 0 2, 04 8 3. 0 1, 77 5 Re gi on Ea ste rn M ou nt ain s 18 .3 7. 4 9. 8 22 .1 41 .7 0. 7 10 0. 0 18 .3 38 .4 32 .6 8. 5 2. 2 0. 0 10 0. 0 32 4. 0 26 Ea ste rn H ills 9. 7 4. 4 7. 9 23 .8 53 .3 0. 8 10 0. 0 9. 7 43 .0 38 .9 6. 8 1. 7 0. 0 10 0. 0 12 3 4. 0 11 1 Ea ste rn T er ai 8. 0 4. 6 10 .2 17 .0 60 .2 0. 0 10 0. 0 8. 0 53 .2 30 .5 5. 4 2. 9 0. 0 10 0. 0 27 7 3. 0 25 5 Ce nt ra l M ou nt ain s 17 .0 1. 5 9. 5 18 .2 53 .8 0. 0 10 0. 0 17 .0 48 .6 26 .2 6. 7 1. 5 0. 0 10 0. 0 38 3. 0 32 Ce nt ra l H ills 12 .4 0. 8 4. 8 6. 8 73 .6 1. 6 10 0. 0 12 .4 66 .7 17 .4 2. 7 0. 8 0. 0 10 0. 0 24 1 3. 0 21 1 Ce nt ra l T er ai 15 .7 4. 6 8. 8 21 .0 49 .2 0. 7 10 0. 0 15 .7 65 .5 12 .2 5. 3 1. 3 0. 0 10 0. 0 40 0 3. 0 33 7 W es te rn M ou nt ain s (9 .2 ) (5 .8 ) (9 .2 ) (1 7. 1) (5 8. 6) (0 .0 ) 10 0. 0 (9 .2 ) (4 9. 9) (3 1. 1) (9 .8 ) (0 .0 ) (0 .0 ) 10 0. 0 1 3. 0 1 W es te rn H ills 8. 8 4. 1 2. 8 18 .3 64 .3 1. 7 10 0. 0 8. 8 54 .4 29 .6 7. 2 0. 0 0. 0 10 0. 0 22 2 3. 0 20 2 W es te rn T er ai 13 .0 2. 1 4. 1 13 .4 67 .5 0. 0 10 0. 0 13 .0 53 .6 26 .6 6. 2 0. 6 0. 0 10 0. 0 17 8 3. 0 15 5 M id- W es te rn M ou nt ain s 31 .1 6. 0 12 .9 18 .9 30 .5 0. 5 10 0. 0 31 .1 20 .4 32 .0 14 .7 1. 3 0. 5 10 0. 0 43 4. 0 30 M id- W es te rn H ills 25 .2 5. 8 8. 3 11 .9 48 .9 0. 0 10 0. 0 25 .2 18 .8 47 .0 8. 5 0. 6 0. 0 10 0. 0 16 6 4. 0 12 4 M id- W es te rn T er ai 8. 4 3. 5 5. 9 11 .6 70 .7 0. 0 10 0. 0 8. 4 43 .3 42 .4 4. 6 1. 4 0. 0 10 0. 0 11 3 4. 0 10 3 Fa r W es te rn M ou nt ain s 17 .4 1. 3 10 .2 16 .4 54 .7 0. 0 10 0. 0 17 .4 31 .3 47 .1 4. 1 0. 0 0. 0 10 0. 0 33 4. 0 27 Fa r W es te rn H ills 14 .4 1. 4 7. 6 16 .3 59 .5 0. 8 10 0. 0 14 .4 30 .8 49 .6 3. 8 0. 6 0. 8 10 0. 0 75 4. 0 64 Fa r W es te rn T er ai 8. 7 1. 0 3. 5 11 .9 73 .4 1. 5 10 0. 0 8. 7 45 .5 42 .8 2. 5 0. 5 0. 0 10 0. 0 10 6 4. 0 97 Ar ea Ur ba n 3. 7 0. 6 2. 2 9. 3 84 .0 0. 3 10 0. 0 3. 7 69 .1 24 .3 2. 6 0. 3 0. 0 10 0. 0 26 2 2. 0 25 3 Ka th m an du va lle y 0. 0 0. 0 1. 7 0. 7 97 .7 0. 0 10 0. 0 0. 0 88 .7 11 .3 0. 0 0. 0 0. 0 10 0. 0 65 2. 0 65 Ot he r u rb an 4. 9 0. 7 2. 3 12 .2 79 .5 0. 4 10 0. 0 4. 9 62 .6 28 .7 3. 4 0. 5 0. 0 10 0. 0 19 7 3. 0 18 7 Ru ra l 14 .7 4. 0 7. 7 16 .9 55 .9 0. 7 10 0. 0 14 .7 48 .2 29 .7 6. 1 1. 3 0. 0 10 0. 0 1, 78 6 3. 0 1, 52 2 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 129 Ta bl e RH .8 : N um be r o f a nt en at al c ar e vi si ts a nd ti m in g of fi rs t v is it Pe rc en ta ge o f w om en a ge d 15 –4 9 ye ar s w ith a liv e bir th in th e tw o ye ar s p re ce din g th e su rv ey b y n um be r o f a nt en at al ca re (A NC ) v isi ts by a ny p ro vid er a nd b y t he tim ing o f f irs t a nt en at al ca re vi sit , N ep al, 20 14 Pe rc en t o f w om en w ho h ad : To ta l Pe rc en t o f w om en b y n um be r o f m on th s p re gn an t at th e tim e of fir st AN C vis it To ta l Nu m -b er of wo m en wi th a liv e bir th in th e las t t wo ye ar s M ed ian m on th s pr eg - na nt a t fir st AN C vis it Nu m -b er of wo m en wi th a liv e bir th in th e las t t wo ye ar s wh o ha d at le as t on e AN C vis it No A NC vis its On e vis it Tw o vis its Th re e vis its Fo ur o r m or e vis its [1 ] DK / M iss ing No A NC vis its Fi rs t t ri- m es te r 4– 5 m on th s 6– 7 m on th s 8+ m on th s DK / M iss ing M ot he r’s a ge a t b irt h Le ss th an 2 0 ye ar s 14 .9 3. 5 10 .9 18 .9 51 .8 0. 0 10 0. 0 14 .9 49 .5 28 .5 6. 4 0. 6 0. 1 10 0. 0 34 9 3. 0 29 6 20 –3 4 ye ar s 11 .5 3. 6 6. 3 15 .4 62 .6 0. 7 10 0. 0 11 .5 52 .3 29 .3 5. 5 1. 3 0. 0 10 0. 0 1, 58 0 3. 0 1, 39 8 35 –4 9 ye ar s 32 .6 3. 9 5. 4 14 .2 40 .7 3. 2 10 0. 0 32 .6 35 .8 26 .6 5. 0 0. 0 0. 0 10 0. 0 11 9 3. 0 80 Ed uc at io n No ne 22 .4 6. 5 10 .9 18 .4 40 .8 1. 1 10 0. 0 22 .4 40 .6 26 .7 8. 2 2. 2 0. 0 10 0. 0 75 4 3. 0 58 5 Pr im ar y 16 .2 2. 9 5. 3 13 .0 62 .1 0. 6 10 0. 0 16 .2 49 .3 27 .0 6. 4 0. 9 0. 2 10 0. 0 34 6 3. 0 29 0 Se co nd ar y 7. 1 2. 4 5. 8 19 .3 64 .7 0. 7 10 0. 0 7. 1 51 .6 35 .9 4. 6 0. 8 0. 0 10 0. 0 50 3 3. 0 46 7 Hi gh er 2. 6 0. 6 3. 2 10 .3 83 .2 0. 2 10 0. 0 2. 6 68 .5 26 .9 1. 9 0. 0 0. 0 10 0. 0 44 5 3. 0 43 3 W ea lth in de x qu in til e Po or es t 28 .8 5. 4 8. 0 15 .9 40 .6 1. 3 10 0. 0 28 .8 25 .7 36 .1 8. 4 0. 8 0. 1 10 0. 0 45 4 4. 0 32 2 Se co nd 14 .6 5. 5 9. 0 17 .7 52 .8 0. 4 10 0. 0 14 .6 44 .3 33 .4 5. 7 1. 8 0. 0 10 0. 0 43 6 3. 0 37 2 M idd le 9. 5 2. 8 8. 5 22 .5 56 .5 0. 2 10 0. 0 9. 5 58 .0 24 .7 6. 4 1. 4 0. 0 10 0. 0 44 1 3. 0 39 9 Fo ur th 7. 3 2. 0 5. 9 15 .5 68 .6 0. 7 10 0. 0 7. 3 58 .5 28 .8 4. 5 0. 9 0. 0 10 0. 0 40 1 3. 0 37 2 Ri ch es t 2. 0 1. 4 2. 4 5. 0 88 .4 0. 8 10 0. 0 2. 0 76 .1 19 .3 1. 9 0. 7 0. 0 10 0. 0 31 6 2. 0 31 0 [1 ] M IC S in di ca to r 5 .5 b; M DG in di ca to r 5 .5 – A nt en at al c ar e co ve ra ge ( ) F igu re s t ha t a re b as ed o n 25 –4 9 un we igh te d ca se s C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014130 Some 51 percent of women made their first antenatal care visit during the first trimester. An additional 29 percent made their first visit during months 4–5. The proportion of women receiving antenatal care during the first trimester was highest in the Central Hills (67 percent) and lowest in the Mid-Western Hills (19 percent). Urban women were more likely than rural women to make their first visit during the first trimester (69 percent compared to 48 percent). Younger and older women were less likely than women aged 20–34 years to make their first visit during the first trimester. Education level and household wealth status were strongly associated with the likelihood of a woman making her first antenatal care visit during the first trimester. Table RH.9: Content of antenatal care Percentage of women aged 15–49 years with a live birth in the two years preceding the survey who, at least once, had their blood pressure measured, urine sample taken, and blood sample taken as part of antenatal care, during the pregnancy for the last birth, Nepal, 2014 Percent of women who, during the pregnancy of their last birth, had: Number of women with a live birth in the last two years Blood pressure measured Urine sample taken Blood sample taken Blood pressure measured, urine and blood sample taken [1] Total 80.1 71.7 62.4 61.2 2,048 Region Eastern Mountains 71.0 56.1 25.5 24.7 32 Eastern Hills 78.3 68.1 46.7 46.7 123 Eastern Terai 89.7 80.4 71.5 71.5 277 Central Mountains 76.9 74.9 69.9 69.9 38 Central Hills 84.5 83.7 81.3 81.3 241 Central Terai 82.9 75.3 70.1 69.7 400 Western Mountains (85.1) (79.2) (73.3) (73.3) 1 Western Hills 88.7 74.3 70.8 69.8 222 Western Terai 71.0 69.4 50.7 50.7 178 Mid-Western Mountains 49.4 28.7 22.5 19.9 43 Mid-Western Hills 64.0 51.8 33.2 30.1 166 Mid-Western Terai 82.8 66.3 56.7 51.4 113 Far Western Mountains 74.6 61.3 50.1 45.8 33 Far Western Hills 74.4 71.0 61.1 55.1 75 Far Western Terai 77.6 72.6 68.4 66.3 106 Area Urban 94.4 93.4 89.4 88.5 262 Kathmandu valley 100.0 100.0 94.5 94.5 65 Other urban 92.6 91.2 87.7 86.5 197 Rural 78.0 68.5 58.5 57.2 1,786 Mother’s age at birth Less than 20 years 79.1 69.1 57.8 56.6 349 20–34 years 81.7 73.5 64.8 63.5 1,580 35–49 years 61.1 54.8 44.7 44.7 119 Education None 67.8 57.6 47.7 46.7 754 Primary 76.8 68.1 55.7 54.0 346 Secondary 87.2 79.2 70.2 69.2 503 Higher 95.3 90.0 83.9 82.6 445 Wealth index quintile Poorest 61.7 47.2 35.4 32.6 454 Second 78.2 70.6 57.6 56.9 436 Middle 82.5 73.1 65.0 64.3 441 Fourth 86.7 80.8 71.6 70.8 401 Richest 97.3 94.8 92.8 91.9 316 [1] MICS indicator 5.6 – Content of antenatal care ( ) Figures that are based on 25–49 unweighted cases NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 131 5Say, L et al. 2014. Global causes of maternal death: a WHO systematic analysis. The Lancet Global Health 2(6): e323–33. DOI: 10.1016/S2214- 109X(14)70227-X The coverage of key services that pregnant women are expected to receive during antenatal care are shown in Table RH.9. Among those women who had a live birth in the two years preceding the survey, 61 percent received all elements of the recommended content of antenatal care, with 80 percent having their blood pressure checked, 72 percent having a urine sample taken and 62 percent having a blood sample taken. The highest proportion of women who received all three elements was in the Central Hills (81 percent) and the lowest proportion was in the Mid-Western Mountains (20 percent). Urban women were much more likely than rural women to receive all three elements (89 percent compared to 57 percent). Younger and older women were less likely than women aged 20–34 years to receive all three elements. Education level and household wealth status were both strongly associated with the likelihood of a woman receiving all three elements. Assistance at Delivery About three-quarters of all maternal deaths occur due to direct obstetric causes5. The single most critical intervention for safe motherhood is to ensure that a competent health worker with midwifery skills is present at every birth and, in case of emergency, transportation is available to a referral facility for obstetric care. The skilled attendant at delivery indicator is used to track progress toward the MDG 5 on improving maternal health. The MICS includes a number of questions to assess the proportion of births attended by a skilled attendant. A skilled attendant or provider includes a medical doctor, nurse/midwife and auxiliary nurse midwife. The Nepal Health Sector Programme (2010–2015) target is that 60 percent of deliveries are attended by a skilled birth attendant. Table RH.10 shows the proportion of women aged 15–49 years with a live birth in the two years preceding the survey by person providing assistance at delivery, and the percentage of births delivered by Caesarean section (C-section). Some 56 percent of women were attended by a skilled provider, with 39 percent being attended by a doctor, 10 percent being attended by a nurse or midwife, and 7 percent being attended by an auxiliary nurse midwife. In addition, 5 percent were assisted by a traditional birth attendant and 33 percent were assisted by relatives or friends. Regionally, the highest proportion of women who were attended by a skilled provider was in the Central Hills (75 percent) and the lowest proportion was in the Mid-Western Mountains (20 percent). Urban women were much more likely than rural women to be attended by a skilled provider (90 percent compared to 51 percent). Women aged 35–49 years were much less likely than other women to be attended by a skilled provider. Some 95 percent of women who gave birth in a health facility were attended by a skilled provider, while only 7 percent of women who gave birth at home were attended by a skilled provider—a 14-fold difference. Women with higher levels of education and those living in the richest households were much more likely to have been assisted by a skilled provider at delivery. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014132 Ta bl e RH .1 0: A ss is ta nc e du rin g de liv er y an d Ca es ar ea n se ct io n Pe rc en ta ge o f w om en a ge d 15 –4 9 ye ar s w ith a liv e bir th in th e tw o ye ar s p re ce din g th e su rv ey b y p er so n pr ov idi ng a ss ist an ce a t d eli ve ry , a nd p er ce nt ag e of b irt hs d eli ve re d by C -s ec tio n, N ep al, 2 01 4 Pe rc en t o f w om en b y p er so n as sis tin g at d eli ve ry To ta l De liv er y as sis te d by a ny sk ille d at te n- da nt [1 ] [ a] Pe rc en t o f w om en d eli ve re d by C -s ec tio n Nu m be r of wo m en wi th a liv e bir th in th e las t t wo ye ar s Sk ille d pr ov ide r Tr ad i- tio na l bir th at te n- da nt Vi lla ge He alt h W or ke r Re la- tiv e/ fri en d He alt h As sis - ta nt / Au xil iar y He alt h W or ke r M at er - na l a nd Ch ild He alt h W or ke r Fe m ale Co m - m un ity He alt h Vo lun - te er Ot he r/ M iss ing No at te n- da nt De cid ed be fo re on se t o f lab ou r De cid ed af te r on se t o f lab ou r To ta l [2 ] M ed ica l do cto r Nu rs e/ m idw ife Au xil iar y nu rs e m idw ife To ta l 38 .6 9. 6 7. 4 4. 5 0. 7 33 .2 1. 5 0. 1 0. 7 2. 1 1. 6 10 0. 0 55 .6 4. 1 4. 5 8. 6 2, 04 8 Re gi on Ea ste rn M ou nt ain s 9. 8 6. 7 6. 7 4. 2 2. 0 60 .7 2. 9 0. 0 0. 0 2. 9 4. 2 10 0. 0 23 .2 1. 5 1. 2 2. 7 32 Ea ste rn H ills 31 .4 2. 6 8. 9 1. 7 0. 0 50 .3 1. 6 0. 0 0. 0 2. 6 0. 9 10 0. 0 42 .9 1. 7 4. 8 6. 5 12 3 Ea ste rn T er ai 54 .4 8. 2 4. 1 5. 5 0. 0 25 .5 1. 6 0. 0 0. 0 0. 7 0. 0 10 0. 0 66 .7 7. 6 11 .0 18 .6 27 7 Ce nt ra l M ou nt ain s 28 .7 8. 1 10 .8 2. 9 4. 2 38 .1 2. 7 0. 0 0. 0 3. 5 1. 0 10 0. 0 47 .7 1. 7 5. 4 7. 1 38 Ce nt ra l H ills 65 .1 9. 0 1. 2 2. 4 1. 4 17 .8 0. 0 0. 0 0. 0 2. 2 0. 8 10 0. 0 75 .4 11 .1 6. 0 17 .1 24 1 Ce nt ra l T er ai 39 .4 6. 4 3. 6 4. 9 1. 1 42 .4 0. 0 0. 0 0. 6 1. 7 0. 0 10 0. 0 49 .3 2. 3 3. 2 5. 6 40 0 W es te rn M ou nt ain s (4 0. 5) (7 .8 ) (1 7. 0) (2 .3 ) (0 .0 ) (2 9. 6) (0 .0 ) (0 .0 ) (0 .0 ) (2 .8 ) (0 .0 ) 10 0. 0 (6 5. 2) (1 3. 8) (3 .1 ) (1 6. 9) 1 W es te rn H ills 49 .4 4. 0 7. 0 5. 4 0. 7 29 .1 1. 5 0. 0 1. 4 1. 5 0. 0 10 0. 0 60 .5 5. 7 3. 1 8. 8 22 2 W es te rn T er ai 37 .7 19 .3 8. 2 2. 4 0. 0 29 .7 2. 1 0. 0 0. 0 0. 7 0. 0 10 0. 0 65 .1 4. 9 5. 2 10 .1 17 8 M id- W es te rn M ou nt ain s 3. 7 3. 9 12 .0 10 .9 1. 5 45 .3 2. 2 0. 0 6. 4 3. 1 11 .1 10 0. 0 19 .5 0. 9 0. 0 0. 9 43 M id- W es te rn H ills 8. 6 12 .1 11 .1 4. 8 0. 0 41 .2 1. 3 0. 6 2. 4 4. 9 13 .0 10 0. 0 31 .9 0. 6 1. 3 2. 0 16 6 M id- W es te rn T er ai 28 .6 29 .8 6. 4 8. 2 1. 0 24 .9 0. 0 0. 0 1. 0 0. 1 0. 0 10 0. 0 64 .8 0. 3 3. 3 3. 6 11 3 Fa r W es te rn M ou nt ain s 11 .2 2. 1 13 .7 2. 6 0. 0 61 .8 1. 6 2. 0 0. 8 0. 7 3. 5 10 0. 0 27 .0 0. 0 0. 6 0. 6 33 Fa r W es te rn H ills 12 .6 2. 6 20 .7 .8 0. 0 48 .5 12 .7 0. 0 0. 0 2. 1 0. 0 10 0. 0 35 .9 0. 0 1. 4 1. 4 75 Fa r W es te rn T er ai 32 .1 15 .4 23 .2 6. 8 1. 1 10 .9 1. 6 0. 8 0. 8 7. 3 0. 0 10 0. 0 70 .7 0. 4 2. 8 3. 1 10 6 Ar ea Ur ba n 79 .0 10 .2 1. 2 1. 2 0. 2 6. 8 0. 3 0. 0 0. 0 1. 1 0. 0 10 0. 0 90 .3 8. 1 10 .9 19 .0 26 2 Ka th m an du va lle y 89 .3 9. 0 0. 0 0. 0 0. 0 1. 7 0. 0 0. 0 0. 0 0. 0 0. 0 10 0. 0 98 .3 11 .2 13 .5 24 .7 65 Ot he r u rb an 75 .5 10 .5 1. 6 1. 6 0. 2 8. 6 0. 5 0. 0 0. 0 1. 5 0. 0 10 0. 0 87 .7 7. 0 10 .0 17 .1 19 7 Ru ra l 32 .7 9. 5 8. 3 5. 0 0. 8 37 .1 1. 6 0. 1 0. 8 2. 3 1. 8 10 0. 0 50 .5 3. 5 3. 6 7. 1 1, 78 6 M ot he r’s a ge a t b irt h Le ss th an 2 0 ye ar s 33 .2 15 .1 7. 8 3. 6 0. 6 34 .6 1. 4 0. 1 1. 0 1. 7 0. 8 10 0. 0 56 .1 2. 2 2. 1 4. 3 34 9 20 –3 4 ye ar s 40 .7 8. 6 7. 4 4. 2 0. 8 32 .8 1. 3 0. 1 0. 5 2. 0 1. 5 10 0. 0 56 .8 4. 4 5. 2 9. 6 1, 58 0 35 –4 9 ye ar s 25 .9 6. 1 6. 2 11 .0 0. 2 34 .8 3. 8 0. 9 2. 1 4. 6 4. 5 10 0. 0 38 .1 6. 2 2. 4 8. 6 11 9 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 133 Ta bl e RH .1 0: A ss is ta nc e du rin g de liv er y an d Ca es ar ea n se ct io n Pe rc en ta ge o f w om en a ge d 15 –4 9 ye ar s w ith a liv e bir th in th e tw o ye ar s p re ce din g th e su rv ey b y p er so n pr ov idi ng a ss ist an ce a t d eli ve ry , a nd p er ce nt ag e of b irt hs d eli ve re d by C -s ec tio n, N ep al, 2 01 4 Pe rc en t o f w om en b y p er so n as sis tin g at d eli ve ry To ta l De liv er y as sis te d by a ny sk ille d at te n- da nt [1 ] [ a] Pe rc en t o f w om en d eli ve re d by C -s ec tio n Nu m be r of wo m en wi th a liv e bir th in th e las t t wo ye ar s Sk ille d pr ov ide r Tr ad i- tio na l bir th at te n- da nt Vi lla ge He alt h W or ke r Re la- tiv e/ fri en d He alt h As sis - ta nt / Au xil iar y He alt h W or ke r M at er - na l a nd Ch ild He alt h W or ke r Fe m ale Co m - m un ity He alt h Vo lun - te er Ot he r/ M iss ing No at te n- da nt De cid ed be fo re on se t o f lab ou r De cid ed af te r on se t o f lab ou r To ta l [2 ] M ed ica l do cto r Nu rs e/ m idw ife Au xil iar y nu rs e m idw ife Pl ac e of d el iv er y Ho m e 2. 8 0. 8 3. 0 10 .0 1. 3 73 .6 1. 1 0. 2 1. 4 2. 1 3. 7 10 0. 0 6. 6 0. 0 0. 0 0. 0 87 2 He alt h fa cil ity 67 .7 16 .7 10 .9 0. 4 0. 2 2. 0 1. 8 0. 1 0. 2 0. 0 0. 0 10 0. 0 95 .4 7. 4 8. 2 15 .6 1, 13 0 Pu bli c 63 .7 17 .7 13 .1 0. 2 0. 2 2. 4 2. 2 0. 1 0. 3 0. 0 0. 0 10 0. 0 94 .5 4. 5 5. 6 10 .1 91 5 Pr iva te 86 .6 11 .9 1. 5 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 10 0. 0 10 0. 0 20 .6 19 .1 39 .7 18 8 NG O (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 10 0. 0 (*) (*) (*) (*) 27 Ot he r/ M iss ing 2. 6 0. 8 4. 1 0. 0 3. 2 35 .5 0. 0 0. 0 0. 0 53 .4 0. 5 10 0. 0 7. 5 0. 0 0. 0 0. 0 47 Ed uc at io n No ne 22 .7 6. 5 7. 0 6. 3 1. 0 47 .5 2. 0 0. 2 1. 2 2. 7 3. 0 10 0. 0 36 .2 1. 6 1. 9 3. 5 75 4 Pr im ar y 27 .6 11 .2 8. 6 5. 8 0. 7 40 .4 1. 6 0. 0 0. 6 2. 9 0. 8 10 0. 0 47 .3 0. 6 6. 0 6. 6 34 6 Se co nd ar y 44 .5 14 .0 8. 2 3. 8 0. 2 25 .4 0. 9 0. 2 0. 3 1. 8 0. 9 10 0. 0 66 .6 4. 2 2. 9 7. 1 50 3 Hi gh er 67 .5 8. 5 6. 3 1. 3 0. 9 12 .4 1. 1 0. 1 0. 4 1. 0 0. 6 10 0. 0 82 .3 11 .0 9. 6 20 .5 44 5 W ea lth in de x qu in til e Po or es t 9. 9 4. 5 11 .1 4. 3 0. 5 54 .4 3. 6 0. 2 1. 5 3. 8 6. 0 10 0. 0 25 .5 0. 1 0. 9 1. 0 45 4 Se co nd 28 .4 9. 4 7. 1 8. 7 1. 2 40 .1 0. 9 0. 1 0. 9 2. 2 0. 9 10 0. 0 45 .0 1. 7 1. 3 3. 0 43 6 M idd le 37 .4 10 .6 7. 7 4. 4 0. 7 35 .5 1. 4 0. 0 0. 6 1. 4 0. 2 10 0. 0 55 .7 3. 6 3. 8 7. 3 44 1 Fo ur th 51 .0 13 .1 7. 0 3. 4 0. 6 21 .8 0. 6 0. 2 0. 2 2. 0 0. 0 10 0. 0 71 .1 3. 8 7. 8 11 .6 40 1 Ri ch es t 79 .6 11 .2 2. 5 0. 4 0. 5 4. 8 0. 4 0. 0 0. 0 0. 6 0. 0 10 0. 0 93 .3 14 .3 11 .0 25 .3 31 6 [1 ] M IC S in di ca to r 5 .7 ; M DG in di ca to r 5 .2 – S ki lle d at te nd an t a t d el iv er y [2 ] M IC S in di ca to r 5 .9 – C ae sa re an s ec tio n [a ] S kil led a tte nd an ts inc lud es m ed ica l d oc to r, nu rs e/ m idw ife , a nd a ux ilia ry n ur se m idw ife ( ) F igu re s t ha t a re b as ed o n 25 –4 9 un we igh te d ca se s (*) F igu re s t ha t a re b as ed o n fe we r t ha n 25 u nw eig ht ed ca se s C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014134 Table RH.10 also shows information on women who delivered by C-section and provides additional information on the timing of the decision to conduct a C-section (before or after labour pains began) in order to better assess if such decisions are mostly driven by medical or non-medical reasons. The Nepal Health Sector Programme (2010–2015) has a target of 5 percent for delivery by C-section. Overall, 9 percent of women had a C-section, with 4 percent of women taking the decision before the onset of labour pains and 5 percent after. Women having a C-section were most likely to live in the Eastern Terai (19 percent) and Central Hills (17 percent). Women in urban areas were much more likely than women in rural areas to have a C-section (19 percent compared to 7 percent), with 25 percent of women in Kathmandu valley having one. Women aged less than 20 years were less likely than other women to have a C-section. Women who gave birth in a private health facility were the most likely to have a C-section (40 percent). Women with higher education and those living in households in the richest quintile were much more likely than other women to have a C-section (21 percent and 25 percent, respectively). The decision to have a C-section before the onset of labour pains was most common for women living the Central Hills and Kathmandu valley, women aged 35–49 years, women using a private health facility, women with higher education and women living in households in the richest quintile. Figure RH.3 shows the person assisting at delivery for women aged 15–49 years with a live birth in the preceding two years. Place of Delivery Increasing the proportion of births that are delivered in health facilities is an important factor in reducing the health risks to both the mother and the baby. Proper medical attention and hygienic conditions during delivery can reduce the risks of complications and infection that can cause morbidity and mortality to either the mother or the baby. Table RH.11 presents the percentage of women aged 15–49 years who had a live birth in the two years preceding the survey by place of delivery, and the percentage of births delivered in a health facility, according to background characteristics. Figure RH.3: Person assisting at delivery, Nepal, 2014 Nepal  MICS  2014   23       Figure  RH.3  shows  the  person  assisting  at  delivery  for  women  aged  15–49  years  with  a  live  birth  in   the  preceding  two  years.     Figure  RH.3:  Person  assisting  at  delivery,  Nepal,  2014     Table  RH.10  also  shows  information  on  women  who  delivered  by  C-­‐section  and  provides  additional   information  on  the  timing  of  the  decision  to  conduct  a  C-­‐section  (before  or  after  labour  pains  began)   in  order  to  better  assess  if  such  decisions  are  mostly  driven  by  medical  or  non-­‐medical  reasons.  The   Nepal  Health  Sector  Programme  (2010–2015)  has  a  target  of  5  percent  for  delivery  by  C-­‐section.   Overall,  9  percent  of  women  had  a  C-­‐section,  with  4  percent  of  women  taking  the  decision  before   the  onset  of  labour  pains  and  5  percent  after.  Women  having  a  C-­‐section  were  most  likely  to  live  in   the  Eastern  Terai  (19  percent)  and  Central  Hills  (17  percent).  Women  in  urban  areas  were  much   more  likely  than  women  in  rural  areas  to  have  a  C-­‐section  (19  percent  compared  to  7  percent),  with   25  percent  of  women  in  Kathmandu  valley  having  one.  Women  aged  less  than  20  years  were  less   likely  than  other  women  to  have  a  C-­‐section.  Women  who  gave  birth  in  a  private  health  facility  were   the  most  likely  to  have  a  C-­‐section  (40  percent).  Women  with  higher  education  and  those  living  in   households  in  the  richest  quintile  were  much  more  likely  than  other  women  to  have  a  C-­‐section  (21   percent  and  25  percent,  respectively).  The  decision  to  have  a  C-­‐section  before  the  onset  of  labour   pains  was  most  common  for  women  living  the  Central  Hills  and  Kathmandu  valley,  women  aged  35– 49  years,  women  using  a  private  health  facility,  women  with  higher  education  and  women  living  in   households  in  the  richest  quintile.     Place  of  Delivery   Increasing  the  proportion  of  births  that  are  delivered  in  health  facilities  is  an  important  factor  in   reducing  the  health  risks  to  both  the  mother  and  the  baby.  Proper  medical  attention  and  hygienic   1.6 2.1 0.7 0.1 1.5 33.2 0.7 4.5 7.4 9.6 38.6 0 5 10 15 20 25 30 35 40 45 No attendant Other Female community health volunter Maternal and child health worker HA/ assistant health worker Relative/ friend Village health worker Traditional birth attendant Auxiliary midwife Nurse/midwife Medical doctor Per centPercent NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 135 Around 55 percent of women delivered in a health facility; 45 percent used a public facility and 9 percent used a private facility. In addition, 43 percent of women gave birth at home. The proportion of institutional deliveries ranged from 24 percent in the Eastern Mountains to 75 percent in the Central Hills. Women in urban areas were much more likely than women in rural areas to deliver in a health facility (88 percent compared to 50 percent). Importantly, women who had received at least four antenatal care visits were much more likely to deliver in a health facility (73 percent) than those who had 1–3 visits (38 percent) or no visits (10 percent).Women with higher levels of education and those living in households in richer wealth quintiles were more likely to deliver in a health facility than other women. Table RH.11: Place of delivery Percentage of women aged 15–49 years with a live birth in the two years preceding the survey by place of delivery of their last birth, and percentage who delivered in a health facility, Nepal, 2014 Percent of women by place of delivery Total Percent of women delivered in health facility [1] Number of women with a live birth in the last two years Public sector health facility Private sector health facility NGO sector health facility Home Other Total 44.7 9.2 1.3 42.6 1.1 100.0 55.2 2,048 Region Eastern Mountains 19.6 2.7 1.3 72.9 2.1 100.0 23.6 32 Eastern Hills 32.8 5.8 1.9 58.6 0.0 100.0 40.5 123 Eastern Terai 48.3 14.6 2.2 31.4 2.8 100.0 65.1 277 Central Mountains 28.4 16.3 .8 52.4 1.5 100.0 45.4 38 Central Hills 56.8 15.0 3.0 22.6 1.0 100.0 74.9 241 Central Terai 32.5 11.6 1.0 53.2 0.0 100.0 45.1 400 Western Mountains (53.6) (5.7) (0.0) (37.8) (0.0) 100.0 (59.3) 1 Western Hills 46.2 9.5 2.3 39.5 1.7 100.0 58.0 222 Western Terai 56.6 8.0 0.8 34.6 0.0 100.0 65.4 178 Mid-Western Mountains 25.0 0.5 0.0 71.6 2.4 100.0 25.5 43 Mid-Western Hills 31.8 0.7 0.0 64.0 1.3 100.0 32.4 166 Mid-Western Terai 61.0 6.1 0.0 32.6 0.3 100.0 67.0 113 Far Western Mountains 30.2 2.4 0.0 66.5 0.8 100.0 32.7 33 Far Western Hills 47.2 2.8 0.0 46.0 1.9 100.0 50.0 75 Far Western Terai 71.0 3.6 0.0 21.2 1.6 100.0 74.5 106 Area Urban 67.0 20.0 1.3 10.4 0.5 100.0 88.3 262 Kathmandu valley 69.2 23.2 1.4 4.7 1.5 100.0 93.8 65 Other urban 66.2 18.9 1.3 12.2 0.2 100.0 86.5 197 Rural 41.4 7.6 1.3 47.3 1.2 100.0 50.3 1,786 Mother’s age at birth Less than 20 years 47.1 6.6 0.3 42.0 2.5 100.0 53.9 349 20–34 years 45.3 9.6 1.6 41.7 0.8 100.0 56.5 1,580 35–49 years 29.3 11.0 0.0 56.1 1.0 100.0 40.3 119 Percent of women who had: None 7.7 1.6 0.8 79.2 1.7 100.0 10.0 272 1–3 visits 32.9 4.6 0.9 60.8 0.8 100.0 38.4 543 4+ visits 58.2 12.8 1.6 26.3 1.1 100.0 72.6 1,218 Education None 32.1 4.3 0.3 60.9 1.1 100.0 36.6 754 Primary 38.6 6.7 0.5 51.1 1.5 100.0 45.8 346 Secondary 58.7 7.9 1.1 30.7 0.6 100.0 67.7 503 Higher 54.9 20.8 4.0 18.2 1.2 100.0 79.6 445 Wealth index quintile Poorest 25.9 1.0 1.0 68.8 3.3 100.0 27.9 454 Second 37.5 6.7 0.4 54.2 1.1 100.0 44.7 436 Middle 47.4 9.0 0.0 40.6 3.0 100.0 56.4 441 Fourth 59.0 7.3 1.8 29.7 2.2 100.0 68.1 401 Richest 59.5 27.0 4.2 7.8 1.5 100.0 90.7 316 [1] MICS indicator 5.8 – Institutional deliveries Note: 14 cases of missing ‘number of antenatal care visits’ not shown ( ) Figures that are based on 25–49 unweighted cases NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014136 Postnatal Health Checks The time of birth and immediately after is a critical window of opportunity to deliver lifesaving interventions for both the mother and newborn. Across the world, approximately 3 million newborns annually die in the first month of life6 and the majority of these deaths occur within a day or two of birth7, which is also the time when the majority of maternal deaths occur8. Despite the importance of the first few days following birth, large-scale, nationally representative household survey programmes have not systematically included questions on the postnatal period and care for the mother and newborn. In 2008, the Countdown to 2015 Initiative, which monitors progress on maternal, newborn and child health interventions, highlighted this data gap, and called not only for postnatal care programmes to be strengthened, but also for better data availability and quality9. Following the establishment and discussions of an Inter-Agency Group on Postnatal Care and drawing on lessons learned from earlier attempts at collecting postnatal care data, a new questionnaire module for MICS was developed and validated. Named the Postnatal Health Checks (PNHC) module, the objective is to collect information on newborns’ and mothers’ contact with a provider, not content of care. The rationale for this is that as postnatal care programmes scale up, it is important to measure the coverage of that scale up and ensure that the platform for providing essential services is in place. Content is considered more difficult to measure, particularly because the respondent is asked to recall services delivered up to two years preceding the interview. Data on postnatal care collected for MICS cover three main areas: duration of stay in health facility; postnatal health checks for newborns; and postnatal health checks for mothers. Table RH.12 presents information on the proportion of women aged 15–49 years who gave birth in a health facility in the two years preceding the survey according to the duration of their stay in the facility following delivery. Overall, 76 percent of women who gave birth in a health facility stayed 12 hours or more in the facility after delivery. Some 48 percent stayed 1–2 days, 25 percent stayed 3 days or more, and 15 percent stayed less than 6 hours. Regionally, the proportion of women who stayed 12 hours or more ranged from 29 percent in the Mid-Western Mountains to 93 percent in the Central Hills. Urban women were more likely than rural women to stay for 12 hours or more (86 percent compared to 74 percent). A higher proportion of women delivering in private facilities stayed 12 hours or more than those delivering in public facilities (90 percent compared to 73 percent). As expected, nearly all women (97 percent) giving birth through C-section stayed 12 hours or more. Women with lower education levels and those living in households in lower wealth quintiles were less likely than other women to stay for 12 hours or more. 6UN Interagency Group for Child Mortality Estimation, 2013. Levels and Trends in Child Mortality. 7Lawn, J.E., Cousens, S. and Zupan, J., 2005. Four million neonatal deaths: When? Where? Why? Lancet, 365:891–900. 8WHO, UNICEF, UNFPA and World Bank, 2012. Trends in Maternal Mortality: 1990–2010. Geneva: World Health Organization. 9UNICEF, 2008. Countdown to 2015: Tracking Progress in Maternal, Newborn & Child Survival. New York: UNICEF. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 137 Table RH.12: Postpartum stay in health facility Percentage of women aged 15–49 years with a live birth in the two years preceding the survey who had their last birth delivered in a health facility, by duration of stay in health facility, Nepal, 2014 Percent of women by duration of stay in health facility Total 12 hours or more [1] Number of women who had last birth deliver- ed in a health facility in the last two years Less than 6 hours 6–11 hours 12–23 hours 1–2 days 3 days or more DK/ Missing Total 15.0 8.2 3.1 47.6 25.3 0.8 100.0 76.0 1,130 Region Eastern Mountains (22.5) (21.2) (0.0) (28.4) (27.9) (0.0) 100.0 (56.4) 7 Eastern Hills 13.2 1.9 4.5 49.8 28.4 2.2 100.0 82.7 50 Eastern Terai 9.5 10.7 2.3 44.2 32.2 1.1 100.0 78.7 181 Central Mountains 18.5 2.1 0.0 46.8 30.9 1.7 100.0 77.7 17 Central Hills 5.7 .3 3.8 47.4 41.7 1.1 100.0 92.9 180 Central Terai 16.0 5.1 5.9 44.0 29.0 0.0 100.0 78.9 180 Western Mountains (*) (*) (*) (*) (*) (*) 100.0 (*) 1 Western Hills 11.5 5.8 0.0 58.1 23.2 1.4 100.0 81.4 129 Western Terai 10.5 13.6 2.1 52.6 20.0 1.2 100.0 74.6 116 Mid-Western Mountains 45.8 23.0 2.0 21.8 5.5 1.9 100.0 29.2 11 Mid-Western Hills 48.0 14.1 3.0 28.2 6.8 0.0 100.0 37.9 54 Mid-Western Terai 15.7 13.5 3.5 51.5 15.4 0.5 100.0 70.3 76 Far Western Mountains (17.8) (7.9) (2.1) (65.3) (6.9) (0.0) 100.0 (74.3) 11 Far Western Hills 25.9 6.9 2.8 61.1 3.3 0.0 100.0 67.2 38 Far Western Terai 25.5 16.8 3.6 44.8 9.4 0.0 100.0 57.8 79 Area Urban 6.2 6.8 2.9 55.6 27.5 0.9 100.0 86.0 232 Kathmandu valley 4.9 1.0 3.4 49.9 40.9 0.0 100.0 94.1 61 Other urban 6.7 8.9 2.7 57.7 22.7 1.3 100.0 83.1 170 Rural 17.3 8.5 3.1 45.6 24.7 0.8 100.0 73.5 898 Mother’s age at birth Less than 20 years 18.9 9.6 4.6 49.0 18.0 0.0 100.0 71.5 188 20–34 years 13.7 8.1 2.7 48.2 26.3 1.0 100.0 77.2 894 35–49 years 24.3 3.1 4.4 32.6 35.6 0.0 100.0 72.6 48 Type of health facility Public 17.2 9.1 3.5 49.4 20.1 0.7 100.0 73.0 915 Private 6.2 3.8 1.7 40.2 47.8 0.2 100.0 89.8 188 NGO (*) (*) (*) (*) (*) (*) 100.0 (*) 27 Type of delivery Vaginal birth 17.3 9.7 3.7 55.3 13.1 0.9 100.0 72.1 953 C-section 2.5 0.0 0.0 6.2 91.1 0.2 100.0 97.3 177 Education None 24.0 8.8 5.2 42.1 19.0 0.8 100.0 66.4 276 Primary 15.3 9.1 3.3 45.5 24.7 2.0 100.0 73.6 159 Secondary 15.8 11.1 2.1 49.8 20.7 0.5 100.0 72.6 341 Higher 7.0 4.5 2.3 50.8 35.0 0.5 100.0 88.0 354 Wealth index quintiles Poorest 32.1 7.7 3.6 45.3 9.6 1.7 100.0 58.5 127 Second 20.3 8.3 3.7 50.9 16.0 0.7 100.0 70.7 195 Middle 16.9 8.7 3.8 42.2 27.8 0.6 100.0 73.8 249 Fourth 13.9 10.4 3.0 45.4 25.9 1.4 100.0 74.3 273 Richest 3.2 5.6 1.9 53.3 35.9 0.1 100.0 91.0 287 [1] MICS indicator 5.10 – Postpartum stay in health facility ( ) Figures that are based on 25–49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014138 Safe motherhood programmes have recently increased emphasis on the importance of postnatal care. In accordance with WHO recommendations on postnatal care of the mother and newborn (2013), the Nepal recommendation is that women and newborns receive a health check within the first, third and seventh day of delivery. To assess the extent of postnatal care utilization, women were asked whether they and their newborn received a health check after the delivery, the timing of the first check, and the type of health provider. Table RH.13 shows the percentage of women with a live birth in the two years preceding the survey whose newborn received health checks and postnatal care visits from any health provider after birth. Please note that health checks for newborn following birth while in facility or at home refer to checks provided by any health provider regardless of timing, whereas postnatal care visits for newborn refer to a separate visit to check on the health of the newborn and provide preventive care services and therefore do not include health checks following birth while in facility or at home. The indicator postnatal health checks for newborn includes any health check after birth received while in the health facility and at home, regardless of timing, as well as postnatal care visits within two days of delivery. Overall, 57 percent of newborns received a health check immediately following birth while in the facility or at home. With regard to postnatal care visits in the following days, the vast majority of newborns did not receive any postnatal care visits (83 percent). When they did occur, they were either on the same day (1 percent), 3–6 days following birth (2 percent) or after the first week (9 percent). As a result, only 58 percent of all newborns received some form of postnatal health check. This percentage varied from 17 percent in the Mid-Western Mountains to 75 percent in the Central Hills. Urban newborns were much more likely than rural newborns to receive a postnatal health check (87 percent compared 53 percent). Newborns delivered in a health facility were much more likely than those delivered at home to receive a postnatal health check (91 percent compared to 17 percent); only 15 percent of newborns delivered at home received a health check immediately following birth and 90 percent did not receive any postnatal care visits in the following days. There was a positive correlation with both education and household wealth, with the likelihood of a postnatal health check for newborns increasing as mother’s education and household wealth increased. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 139 Ne pa l&M IC S&2 01 4& 31 #Ta bl e RH .1 3: P os tn at al h ea lth c he ck s fo r n ew bo rn s Pe rc en ta ge o f w om en a ge d 15 –4 9 ye ar s w ith a liv e bir th in th e tw o ye ar s p re ce din g th e su rv ey w ho se n ew bo rn re ce ive d a he alt h ch ec k w hil e in th e fa cil ity o r a t h om e fo llo wi ng b irt h, p er ce nt ag e wh os e ne wb or n re ce ive d po stn at al ca re vi sit s f ro m a ny h ea lth p ro vid er a fte r b irt h, b y t im ing o f v isi t, an d pe rc en ta ge w ho se w ho n ew bo rn re ce ive d so m e fo rm o f p os tn at al he alt h ch ec k, Ne pa l, 20 14 He alt h ch ec k fo r n ew bo rn fo llo wi ng bir th w hil e in fa cil ity o r a t ho m e [a ] Pe rc en t w ith p os tn at al ca re vi sit fo r n ew bo rn [b ] To ta l Po stn at al he alt h ch ec k f or ne wb or n [1 ] [c] Nu m be r o f las t li ve bir th s i n th e las t t wo ye ar s Sa m e da y 1 da y fo llo wi ng bir th 2 da ys fo llo wi ng bir th 3– 6 da ys fo llo wi ng bir th Af te r t he fir st we ek fo llo wi ng bir th No po stn at al ca re vi sit DK / M iss ing To ta l 56 .5 1. 4 0. 7 0. 9 2. 3 9. 0 83 .4 2. 3 10 0. 0 57 .6 2, 04 8 Re gi on Ea ste rn M ou nt ain s 29 .2 0. 7 0. 0 0. 0 1. 4 7. 8 90 .1 0. 0 10 0. 0 29 .2 32 Ea ste rn H ills 43 .0 1. 8 0. 0 0. 0 1. 5 7. 0 86 .9 2. 7 10 0. 0 43 .2 12 3 Ea ste rn T er ai 66 .6 3. 7 1. 5 2. 4 3. 0 9. 4 77 .5 2. 5 10 0. 0 69 .7 27 7 Ce nt ra l M ou nt ain s 58 .7 1. 5 0. 0 1. 8 0. 0 14 .9 81 .9 0. 0 10 0. 0 60 .1 38 Ce nt ra l H ills 73 .9 0. 4 2. 4 0. 2 2. 6 16 .6 71 .6 6. 1 10 0. 0 75 .1 24 1 Ce nt ra l T er ai 55 .4 1. 1 0. 0 0. 7 0. 6 11 .3 85 .0 1. 4 10 0. 0 55 .9 40 0 W es te rn M ou nt ain s (6 2. 2) (0 .0 ) (0 .0 ) (5 .8 ) (1 0. 9) (9 .1 ) (6 8. 4) (5 .7 ) 10 0. 0 (6 2. 2) 1 W es te rn H ills 66 .9 3. 0 0. 5 0. 0 2. 0 2. 5 90 .5 1. 5 10 0. 0 69 .3 22 2 W es te rn T er ai 62 .6 0. 7 0. 0 2. 1 3. 3 9. 9 82 .8 1. 3 10 0. 0 62 .6 17 8 M id- W es te rn M ou nt ain s 17 .3 0. 0 0. 5 0. 0 0. 5 0. 0 98 .0 1. 0 10 0. 0 17 .3 43 M id- W es te rn H ills 35 .2 1. 2 0. 7 0. 6 3. 3 4. 9 89 .3 0. 0 10 0. 0 36 .4 16 6 M id- W es te rn T er ai 56 .2 0. 4 1. 1 2. 1 5. 4 7. 6 77 .1 6. 4 10 0. 0 56 .2 11 3 Fa r W es te rn M ou nt ain s 37 .7 0. 0 0. 0 2. 0 3. 8 9. 7 80 .9 3. 5 10 0. 0 37 .7 33 Fa r W es te rn H ills 48 .0 0. 0 0. 0 0. 0 2. 5 7. 9 88 .7 0. 9 10 0. 0 48 .0 75 Fa r W es te rn T er ai 48 .0 0. 0 0. 7 0. 5 2. 7 6. 5 88 .5 1. 1 10 0. 0 48 .0 10 6 Ar ea Ur ba n 86 .6 1. 1 1. 1 1. 3 2. 9 13 .8 75 .7 4. 2 10 0. 0 87 .1 26 2 Ka th m an du va lle y 92 .5 1. 7 3. 0 0. 7 1. 8 23 .8 61 .3 7. 8 10 0. 0 94 .2 65 Ot he r u rb an 84 .6 0. 9 0. 5 1. 5 3. 2 10 .5 80 .5 3. 0 10 0. 0 84 .7 19 7 Ru ra l 52 .1 1. 4 0. 6 0. 9 2. 3 8. 3 84 .5 2. 0 10 0. 0 53 .3 1, 78 6 M ot he r’s a ge a t b irt h Le ss th an 2 0 ye ar s 57 .0 1. 5 0. 6 2. 1 2. 3 6. 5 85 .6 1. 3 10 0. 0 58 .2 34 9 20 –3 4 ye ar s 57 .7 1. 4 0. 8 0. 7 2. 4 9. 6 82 .7 2. 4 10 0. 0 58 .8 1, 58 0 35 –4 9 ye ar s 39 .6 0. 9 0. 0 0. 0 1. 5 7. 9 85 .9 3. 8 10 0. 0 39 .6 11 9 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014140 Ne pa l&M IC S&2 01 4& 32 #Ta bl e RH .1 3: P os tn at al h ea lth c he ck s fo r n ew bo rn s Pe rc en ta ge o f w om en a ge d 15 –4 9 ye ar s w ith a liv e bir th in th e tw o ye ar s p re ce din g th e su rv ey w ho se n ew bo rn re ce ive d a he alt h ch ec k w hil e in th e fa cil ity o r a t h om e fo llo wi ng b irt h, p er ce nt ag e wh os e ne wb or n re ce ive d po stn at al ca re vi sit s f ro m a ny h ea lth p ro vid er a fte r b irt h, b y t im ing o f v isi t, an d pe rc en ta ge w ho se w ho n ew bo rn re ce ive d so m e fo rm o f p os tn at al he alt h ch ec k, Ne pa l, 20 14 He alt h ch ec k fo r n ew bo rn fo llo wi ng bir th w hil e in fa cil ity o r a t ho m e [a ] Pe rc en t w ith p os tn at al ca re vi sit fo r n ew bo rn [b ] To ta l Po stn at al he alt h ch ec k f or ne wb or n [1 ] [c] Nu m be r o f las t li ve bir th s i n th e las t t wo ye ar s Sa m e da y 1 da y fo llo wi ng bir th 2 da ys fo llo wi ng bir th 3– 6 da ys fo llo wi ng bir th Af te r t he fir st we ek fo llo wi ng bir th No po stn at al ca re vi sit DK / M iss ing Pl ac e of d el iv er y Ho m e 15 .1 2. 3 0. 8 0. 6 1. 0 5. 2 89 .9 0. 2 10 0. 0 16 .8 87 2 He alt h fa cil ity 90 .6 0. 1 0. 6 1. 2 3. 5 12 .0 78 .6 4. 0 10 0. 0 90 .6 1, 13 0 Pu bli c 89 .5 0. 1 0. 6 0. 9 3. 6 11 .2 80 .0 3. 5 10 0. 0 89 .5 91 5 Pr iva te 96 .0 0. 0 0. 9 3. 0 2. 3 13 .9 73 .8 6. 0 10 0. 0 96 .0 18 8 NG O (*) (*) (*) (*) (*) (*) (*) (*) 10 0. 0 (*) 27 Ot he r/ M iss ing 4. 2 15 .5 0. 0 0. 0 0. 0 7. 2 77 .3 0. 0 10 0. 0 19 .8 47 Ed uc at io n No ne 39 .6 0. 6 0. 5 0. 0 2. 4 6. 4 88 .7 1. 4 10 0. 0 40 .2 75 4 Pr im ar y 47 .6 2. 2 1. 0 2. 1 1. 1 7. 6 85 .1 0. 9 10 0. 0 49 .1 34 6 Se co nd ar y 66 .3 1. 0 0. 5 1. 2 2. 9 7. 3 83 .5 3. 5 10 0. 0 67 .4 50 3 Hi gh er 81 .1 2. 6 1. 0 1. 2 2. 6 16 .3 72 .9 3. 3 10 0. 0 82 .5 44 5 W ea lth in de x qu in til e Po or es t 32 .0 1. 3 0. 3 0. 3 1. 9 4. 9 90 .1 1. 2 10 0. 0 32 .9 45 4 Se co nd 47 .0 0. 2 0. 0 1. 1 0. 6 4. 6 91 .9 1. 6 10 0. 0 47 .1 43 6 M idd le 54 .4 2. 7 1. 0 0. 7 3. 0 7. 5 83 .7 1. 4 10 0. 0 57 .2 44 1 Fo ur th 70 .1 1. 4 1. 5 0. 5 4. 0 11 .5 78 .8 2. 3 10 0. 0 70 .9 40 1 Ri ch es t 90 .5 1. 4 0. 9 2. 4 2. 3 19 .6 67 .5 5. 9 10 0. 0 91 .2 31 6 [1 ] M IC S in di ca to r 5 .1 1 – Po st na ta l h ea lth c he ck fo r t he n ew bo rn [a ] H ea lth ch ec ks b y a ny h ea lth p ro vid er fo llo wi ng fa cil ity b irt hs (b ef or e dis ch ar ge fr om fa cil ity ) o r f oll ow ing h om e bir th s ( be fo re d ep ar tu re o f p ro vid er fr om h om e) . [b ] P os tn at al ca re vi sit s r ef er to a se pa ra te vi sit b y a ny h ea lth p ro vid er to ch ec k o n th e he alt h of th e ne wb or n an d pr ov ide p re ve nt ive ca re se rv ice s. Po stn at al ca re vi sit s d o no t in clu de h ea lth ch ec ks fo llo wi ng b irt h wh ile in fa cil ity o r a t h om e (s ee n ot e [a ] a bo ve ). [c] P os tn at al he alt h ch ec ks in clu de a ny h ea lth ch ec k p er fo rm ed w hil e in th e he alt h fa cil ity o r a t h om e fo llo wi ng b irt h (s ee n ot e a ab ov e) , a s w ell a s p os tn at al ca re vi sit s ( se e no te [b ] a bo ve ) w ith in tw o da ys o f d eli ve ry . ( ) F igu re s t ha t a re b as ed o n 25 –4 9 un we igh te d ca se s (*) F igu re s t ha t a re b as ed o n fe we r t ha n 25 u nw eig ht ed ca se s C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 141 Ta bl e RH .1 4: P os tn at al c ar e vi si ts fo r n ew bo rn s wi th in o ne w ee k of b irt h Pe rc en ta ge o f w om en a ge d 15 –4 9 ye ar s w ith a liv e bir th in th e tw o ye ar s p re ce din g th e su rv ey w ho se n ew bo rn re ce ive d a po stn at al ca re vi sit w ith in on e we ek o f b irt h, b y l oc at ion a nd p ro vid er o f t he fir st po stn at al ca re vi sit , N ep al, 2 01 4 Lo ca tio n of fir st po stn at al ca re vi sit fo r n ew bo rn s Pr ov ide r o f f irs t p os tn at al ca re vi sit fo r n ew bo rn s Nu m be r o f las t li ve bir th s i n th e las t tw o ye ar s wi th a po stn at al ca re vi sit wi th in th e fir st we ek of lif e Ho m e Pu bli c se cto r Pr iva te se cto r NG O se cto r Ot he r loc at ion To ta l Do cto r/ nu rs e/ m idw ife Au xil iar y nu rs e m idw ife He alt h As sis ta nt / Au xil iar y He alt h W or ke r M at er na l Ch ild He alt h W or ke r Vi lla ge He alt h W or ke r To ta l To ta l 28 .3 50 .8 15 .0 4. 2 1. 7 10 0. 0 62 .6 10 .1 24 .4 2. 6 0. 2 10 0. 0 11 0 Ta bl e RH .1 6: P os tn at al c ar e vi si ts fo r m ot he rs w ith in o ne w ee k of b irt h Pe rc en ta ge o f w om en a ge d 15 –4 9 ye ar s w ith a liv e bir th in th e tw o ye ar s p re ce din g th e su rv ey w ho re ce ive d a po stn at al ca re vi sit w ith in on e we ek o f b irt h, b y l oc at ion a nd p ro vid er o f t he fir st po stn at al ca re vis it, Ne pa l, 2 01 4 Lo ca tio n of fir st po stn at al ca re vi sit fo r m ot he rs Pr ov ide r o f f irs t p os tn at al ca re vi sit fo r m ot he rs Nu m be r o f wo m en w ith a liv e bir th in th e las t t wo ye ar s w ho re ce ive d a po stn at al ca re vi sit wi th in on e we ek o f de liv er y Ho m e Pu bli c se cto r Pr iva te se cto r NG O se cto r Ot he r loc at ion To ta l Do cto r/ nu rs e/ m idw ife Au xil iar y nu rs e m idw ife He alt h As sis ta nt / Au xil iar y He alt h W or ke r M at er na l Ch ild H ea lth W or ke r To ta l To ta l 19 .1 63 .0 8. 1 6. 9 2. 9 10 0. 0 71 .8 9. 8 16 .7 1. 7 10 0. 0 67 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014142 Table RH.14 shows the location and provider of the first postnatal care visit for newborns for women aged 15–49 years with a live birth in the two years preceding the survey. As defined above, a visit does not include a check in the facility or at home following birth. Only a very small proportion of women received a postnatal care visit for their newborn. Of these, 51 percent occurred in a public health facility, 28 percent at home and 15 percent in a private health facility. Most postnatal care visits were provided by a doctor/nurse/midwife (63 percent), followed by a Health Assistant/Auxiliary Health Worker (24 percent) and an auxiliary nurse midwife (10 percent). The background variables are not presented due to the small sample sizes. Tables RH.15 and RH.16 present information collected on postnatal health checks and postnatal care visits for the mother and are identical to Tables RH.13 and RH.14 that presented the data collected for newborns. Overall, 57 percent of mothers received a health check immediately following birth while in the facility or at home. With regards to postnatal care visits, most women did not have any visits (88 percent). When they did occur, they tended to be at least one week following birth (7 percent). As a result, a total of 58 percent of all mothers received a postnatal health check. This varied from 16 percent in the Mid-Western Mountains to 76 percent in the Central Hills. Urban women were much more likely than rural women to receive a postnatal health check (88 percent compared 54 percent). Women delivering in a health facility were much more likely than those delivering at home to receive a postnatal health check (91 percent compared to 18 percent); only 17 percent of women delivering at home received a health check immediately following birth and 94 percent did not receive any postnatal care visits in the following days. An increase in both education level and household wealth status increased the likelihood of a postnatal health check for mothers. There was virtually no difference between the proportions of newborns and mothers receiving a postnatal health check. Table RH.16 shows the location and provider of the first postnatal care visit for women aged 15–49 years with a live birth in the two years preceding the survey. Only a very small proportion of women received a postnatal care visit within one week of delivery. Of these, 63 percent occurred in a public health facility, 19 percent at home, 8 percent in a private health facility and 7 percent in an NGO health facility. Most postnatal care visits were provided by a doctor/nurse/midwife (72 percent), followed by a Health Assistant/Auxiliary Health Worker (17 percent). NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 143 Ne pa l&M IC S&2 01 4& 35 #Ta bl e RH .1 5: P os tn at al h ea lth c he ck s fo r m ot he rs Pe rc en ta ge o f w om en a ge d 15 –4 9 ye ar s w ith a liv e bir th in th e tw o ye ar s p re ce din g th e su rv ey w ho re ce ive d a he alt h ch ec k w hil e in th e fa cil ity o r a t h om e fo llo wi ng b irt h, p er ce nt ag e wh o re ce ive d po stn at al ca re vi sit s f ro m a ny h ea lth p ro vid er a fte r b irt h, b y t im ing o f v isi t, an d pe rc en ta ge w ho re ce ive d so m e fo rm o f p os tn at al he alt h ch ec k, Ne pa l, 2 01 4 He alt h ch ec k f or m ot he r fo llo wi ng bir th w hil e in fa cil ity or a t h om e [a ] Pe rc en t w ith p os tn at al ca re vi sit fo r m ot he r [ b] To ta l Po stn at al he alt h ch ec k f or m ot he r [1 ] [ c] Nu m be r o f wo m en w ith a liv e bir th in th e las t tw o ye ar s Sa m e da y 1 da y fo llo wi ng bir th 2 da ys fo llo wi ng bir th 3– 6 da ys fo llo wi ng bir th Af te r t he fir st we ek fo llo wi ng bir th No po stn at al ca re vi sit DK / M iss ing To ta l 57 .0 0. 9 0. 6 0. 3 1. 5 7. 2 88 .1 1. 4 10 0. 0 57 .9 2, 04 8 Re gi on Ea ste rn M ou nt ain s 27 .9 0. 0 0. 0 0. 0 1. 3 4. 6 94 .0 0. 0 10 0. 0 27 .9 32 Ea ste rn H ills 43 .2 0. 2 0. 0 0. 0 0. 9 5. 3 91 .9 1. 8 10 0. 0 43 .4 12 3 Ea ste rn T er ai 68 .1 2. 2 1. 5 0. 7 1. 2 12 .8 80 .5 1. 0 10 0. 0 70 .5 27 7 Ce nt ra l M ou nt ain s 57 .5 1. 5 0. 0 0. 0 0. 0 10 .7 87 .8 0. 0 10 0. 0 59 .0 38 Ce nt ra l H ills 74 .6 0. 4 1. 7 0. 2 2. 3 15 .0 76 .8 3. 5 10 0. 0 75 .9 24 1 Ce nt ra l T er ai 55 .2 0. 6 0. 0 0. 0 0. 0 7. 5 90 .8 1. 1 10 0. 0 55 .2 40 0 W es te rn M ou nt ain s (6 2. 2) (0 .0 ) (0 .0 ) (0 .0 ) (8 .5 ) (1 0. 3) (7 8. 1) (3 .1 ) 10 0. 0 (6 2. 2) 1 W es te rn H ills 67 .8 2. 4 0. 7 0. 0 1. 5 0. 5 93 .5 1. 3 10 0. 0 70 .2 22 2 W es te rn T er ai 62 .4 0. 0 0. 0 0. 0 1. 8 8. 8 88 .4 1. 1 10 0. 0 62 .4 17 8 M id- W es te rn M ou nt ain s 16 .2 0. 0 0. 0 0. 0 0. 5 0. 0 99 .5 0. 0 10 0. 0 16 .2 43 M id- W es te rn H ills 32 .9 1. 2 0. 6 1. 3 2. 7 1. 3 92 .1 0. 8 10 0. 0 33 .5 16 6 M id- W es te rn T er ai 60 .0 0. 4 1. 0 1. 0 5. 4 5. 7 84 .2 2. 4 10 0. 0 61 .0 11 3 Fa r W es te rn M ou nt ain s 37 .9 0. 0 0. 0 0. 8 3. 8 6. 1 87 .9 1. 4 10 0. 0 37 .9 33 Fa r W es te rn H ills 48 .7 0. 0 0. 0 0. 0 0. 7 3. 5 94 .9 0. 9 10 0. 0 48 .7 75 Fa r W es te rn T er ai 51 .1 0. 0 0. 0 0. 5 0. 7 3. 9 94 .1 0. 8 10 0. 0 51 .1 10 6 Ar ea Ur ba n 87 .1 0. 6 0. 8 0. 4 3. 2 11 .2 81 .5 2. 4 10 0. 0 87 .6 26 2 Ka th m an du va lle y 95 .9 1. 7 3. 0 0. 7 0. 0 23 .2 67 .3 4. 2 10 0. 0 97 .5 65 Ot he r u rb an 84 .1 0. 3 0. 0 0. 2 4. 3 7. 2 86 .2 1. 8 10 0. 0 84 .2 19 7 Ru ra l 52 .6 0. 9 0. 6 0. 3 1. 2 6. 6 89 .1 1. 3 10 0. 0 53 .5 1, 78 6 M ot he r’s a ge a t b irt h Le ss th an 2 0 ye ar s 57 .3 1. 5 0. 9 0. 8 0. 7 4. 3 90 .4 1. 5 10 0. 0 58 .9 34 9 20 –3 4 ye ar s 58 .2 0. 8 0. 6 0. 2 1. 6 8. 0 87 .3 1. 5 10 0. 0 59 .0 1, 58 0 35 –4 9 ye ar s 40 .3 0. 0 0. 0 0. 0 1. 8 5. 7 91 .9 0. 6 10 0. 0 40 .3 11 9 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014144 Ne pa l&M IC S&2 01 4& 36 #Ta bl e RH .1 5: P os tn at al h ea lth c he ck s fo r m ot he rs Pe rc en ta ge o f w om en a ge d 15 –4 9 ye ar s w ith a liv e bir th in th e tw o ye ar s p re ce din g th e su rv ey w ho re ce ive d a he alt h ch ec k w hil e in th e fa cil ity o r a t h om e fo llo wi ng b irt h, p er ce nt ag e wh o re ce ive d po stn at al ca re vi sit s f ro m a ny h ea lth p ro vid er a fte r b irt h, b y t im ing o f v isi t, an d pe rc en ta ge w ho re ce ive d so m e fo rm o f p os tn at al he alt h ch ec k, Ne pa l, 2 01 4 He alt h ch ec k f or m ot he r fo llo wi ng bir th w hil e in fa cil ity or a t h om e [a ] Pe rc en t w ith p os tn at al ca re vi sit fo r m ot he r [ b] To ta l Po stn at al he alt h ch ec k f or m ot he r [1 ] [ c] Nu m be r o f wo m en w ith a liv e bir th in th e las t tw o ye ar s Sa m e da y 1 da y fo llo wi ng bir th 2 da ys fo llo wi ng bir th 3– 6 da ys fo llo wi ng bir th Af te r t he fir st we ek fo llo wi ng bir th No po stn at al ca re vi sit DK / M iss ing Pl ac e of d el iv er y Ho m e 16 .5 1. 4 1. 0 0. 2 0. 1 3. 0 94 .3 0. 0 10 0. 0 17 .7 87 2 He alt h fa cil ity 90 .5 0. 0 0. 3 0. 4 2. 6 10 .6 83 .6 2. 6 10 0. 0 90 .6 1, 13 0 Pu bli c 89 .9 0. 0 0. 3 0. 3 2. 4 8. 7 85 .8 2. 5 10 0. 0 90 .1 91 5 Pr iva te 94 .0 0. 0 0. 0 1. 1 2. 9 17 .6 75 .0 3. 5 10 0. 0 94 .0 18 8 NG O (*) (*) (*) (*) (*) (*) (*) (*) 10 0. 0 (*) 27 Ot he r/ DK / M iss ing 4. 2 13 .3 0. 0 0. 0 0. 5 5. 1 81 .2 0. 0 10 0. 0 17 .5 47 Ty pe o f d el iv er y Va gin al bir th 53 .1 1. 0 0. 5 0. 3 1. 3 5. 1 90 .8 1. 0 10 0. 0 54 .0 1, 87 2 C- se cti on 98 .8 0. 0 1. 8 0. 0 3. 0 29 .9 59 .3 5. 9 10 0. 0 99 .4 17 7 Ed uc at io n No ne 40 .0 0. 3 0. 5 0. 0 0. 6 4. 0 93 .8 0. 9 10 0. 0 40 .6 75 4 Pr im ar y 49 .4 2. 0 0. 0 1. 3 1. 3 6. 7 87 .8 0. 9 10 0. 0 50 .5 34 6 Se co nd ar y 66 .7 0. 2 0. 7 0. 2 2. 4 6. 7 88 .0 1. 9 10 0. 0 67 .6 50 3 Hi gh er 80 .9 1. 8 1. 1 0. 1 2. 2 13 .7 78 .9 2. 2 10 0. 0 82 .1 44 5 W ea lth in de x qu in til es Po or es t 32 .7 0. 7 0. 6 0. 5 1. 0 1. 9 94 .9 0. 4 10 0. 0 33 .4 45 4 Se co nd 46 .6 0. 4 0. 0 0. 0 1. 1 4. 0 93 .7 0. 8 10 0. 0 46 .8 43 6 M idd le 56 .2 1. 7 1. 0 0. 7 0. 2 6. 2 88 .8 1. 4 10 0. 0 58 .4 44 1 Fo ur th 71 .0 1. 4 1. 0 0. 1 2. 1 8. 8 84 .5 2. 1 10 0. 0 71 .7 40 1 Ri ch es t 89 .8 0. 0 0. 4 0. 1 3. 8 18 .6 74 .2 2. 9 10 0. 0 90 .2 31 6 [1 ] M IC S in di ca to r 5 .1 2 – Po st na ta l h ea lth c he ck fo r t he m ot he r [a ] H ea lth ch ec ks b y a ny h ea lth p ro vid er fo llo wi ng fa cil ity b irt hs (b ef or e dis ch ar ge fr om fa cil ity ) o r f oll ow ing h om e bir th s ( be fo re d ep ar tu re o f p ro vid er fr om h om e) . [b ] P os tn at al ca re vi sit s r ef er to a se pa ra te vi sit b y a ny h ea lth p ro vid er to ch ec k o n th e he alt h of th e m ot he r a nd p ro vid e pr ev en tiv e ca re se rv ice s. Po stn at al ca re vi sit s d o no t in clu de h ea lth ch ec ks fo llo wi ng b irt h wh ile in fa cil ity o r a t h om e (s ee n ot e [a ] a bo ve ). [c] P os tn at al he alt h ch ec ks in clu de a ny h ea lth ch ec k p er fo rm ed w hil e in th e he alt h fa cil ity o r a t h om e fo llo wi ng b irt h (s ee n ot e [a ] a bo ve ), as w ell a s p os tn at al ca re vi sit s ( se e no te [b ] a bo ve ) wi th in tw o da ys o f d eli ve ry . ( ) F igu re s t ha t a re b as ed o n 25 –4 9 un we igh te d ca se s (*) F igu re s t ha t a re b as ed o n fe we r t ha n 25 u nw eig ht ed ca se s C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 145 Ta bl e RH .1 4: P os tn at al c ar e vi si ts fo r n ew bo rn s wi th in o ne w ee k of b irt h Pe rc en ta ge o f w om en a ge d 15 –4 9 ye ar s w ith a liv e bir th in th e tw o ye ar s p re ce din g th e su rv ey w ho se n ew bo rn re ce ive d a po stn at al ca re vi sit w ith in on e we ek o f b irt h, b y l oc at ion a nd p ro vid er o f t he fir st po stn at al ca re vi sit , N ep al, 2 01 4 Lo ca tio n of fir st po stn at al ca re vi sit fo r n ew bo rn s Pr ov ide r o f f irs t p os tn at al ca re vi sit fo r n ew bo rn s Nu m be r o f las t li ve bir th s i n th e las t tw o ye ar s wi th a po stn at al ca re vi sit wi th in th e fir st we ek of lif e Ho m e Pu bli c se cto r Pr iva te se cto r NG O se cto r Ot he r loc at ion To ta l Do cto r/ nu rs e/ m idw ife Au xil iar y nu rs e m idw ife He alt h As sis ta nt / Au xil iar y He alt h W or ke r M at er na l Ch ild He alt h W or ke r Vi lla ge He alt h W or ke r To ta l To ta l 28 .3 50 .8 15 .0 4. 2 1. 7 10 0. 0 62 .6 10 .1 24 .4 2. 6 0. 2 10 0. 0 11 0 Ta bl e RH .1 6: P os tn at al c ar e vi si ts fo r m ot he rs w ith in o ne w ee k of b irt h Pe rc en ta ge o f w om en a ge d 15 –4 9 ye ar s w ith a liv e bir th in th e tw o ye ar s p re ce din g th e su rv ey w ho re ce ive d a po stn at al ca re vi sit w ith in on e we ek o f b irt h, b y l oc at ion a nd p ro vid er o f t he fir st po stn at al ca re vis it, Ne pa l, 2 01 4 Lo ca tio n of fir st po stn at al ca re vi sit fo r m ot he rs Pr ov ide r o f f irs t p os tn at al ca re vi sit fo r m ot he rs Nu m be r o f wo m en w ith a liv e bir th in th e las t t wo ye ar s w ho re ce ive d a po stn at al ca re vi sit wi th in on e we ek o f de liv er y Ho m e Pu bli c se cto r Pr iva te se cto r NG O se cto r Ot he r loc at ion To ta l Do cto r/ nu rs e/ m idw ife Au xil iar y nu rs e m idw ife He alt h As sis ta nt / Au xil iar y He alt h W or ke r M at er na l Ch ild H ea lth W or ke r To ta l To ta l 19 .1 63 .0 8. 1 6. 9 2. 9 10 0. 0 71 .8 9. 8 16 .7 1. 7 10 0. 0 67 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014146 Table RH.16 shows the location and provider of the first postnatal care visit for women aged 15–49 years with a live birth in the two years preceding the survey. Only a very small proportion of women received a postnatal care visit within one week of delivery. Of these, 63 percent occurred in a public health facility, 19 percent at home, 15 percent in a private health facility and 7 percent in an NGO health facility. Most postnatal care visits were provided by a doctor/nurse/midwife, auxiliary nurse midwife (82 percent), followed by a Health Assistant/Auxiliary Health Worker (17 percent). As the numbers are so small, it is not possible to make comparisons by background characteristics. Table RH.17 presents the distribution of women with a live birth in the two years preceding the survey by receipt of health checks or postnatal care visits within two days of birth for mother and newborn, thus combining the indicators presented in Tables RH.13 and RH.15. Some 55 percent of women received a postnatal health check for both themselves and their newborn, while 40 percent did not receive a postnatal health check for either. The highest proportion of women receiving a postnatal health check for both was in the Central Hills (72 percent) and the lowest proportion was in the Mid- Western Mountains (15 percent). Urban women were much more likely than rural women to receive a postnatal health check for both (85 percent compared 50 percent). Women delivering in a health facility were much more likely than those delivering at home to receive a postnatal health check for both (86 percent compared to 16 percent). Some 39 percent of women with no education received a postnatal health check for both compared to 78 percent of women with higher education, and only 31 percent of women living in the poorest households received same compared to 87 percent of women living in the richest households. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 147 Table RH.17: Postnatal health checks for mothers and newborns Percentage of women aged 15–49 years with a live birth in the two years preceding the survey by postnatal health checks for mother and newborn, within two days of the most recent birth, Nepal, 2014 Postnatal health checks within two days of birth for: Total Number of women with a live birth in the last two years Both mothers and newborns Mothers only Newborns only Neither mother nor newborn DK/ missing Total 54.6 2.3 1.9 40.1 1.0 100.0 2,048 Region Eastern Mountains 27.9 0.0 1.3 70.8 0.0 100.0 32 Eastern Hills 38.7 2.9 2.7 53.9 1.8 100.0 123 Eastern Terai 66.4 3.0 2.3 27.2 1.0 100.0 277 Central Mountains 59.0 0.0 1.1 39.9 0.0 100.0 38 Central Hills 71.6 1.7 1.0 23.2 2.6 100.0 241 Central Terai 53.4 0.6 1.4 43.5 1.1 100.0 400 Western Mountains (59.1) (0.0) (0.0) (37.8) (3.1) 100.0 1 Western Hills 67.7 1.7 0.8 29.0 0.8 100.0 222 Western Terai 61.4 0.6 0.7 36.8 0.4 100.0 178 Mid-Western Mountains 14.8 1.4 2.5 81.3 0.0 100.0 43 Mid-Western Hills 31.5 2.7 5.0 60.8 0.0 100.0 166 Mid-Western Terai 51.1 8.6 3.8 35.2 1.3 100.0 113 Far Western Mountains 36.4 0.8 0.6 61.5 0.8 100.0 33 Far Western Hills 47.0 0.8 0.0 51.3 0.9 100.0 75 Far Western Terai 43.7 7.4 4.2 44.7 0.0 100.0 106 Area Urban 85.1 1.6 1.1 11.3 0.9 100.0 262 Kathmandu valley 93.5 3.3 0.0 2.5 0.7 100.0 65 Other urban 82.3 1.0 1.5 14.3 1.0 100.0 197 Rural 50.2 2.4 2.1 44.3 1.0 100.0 1,786 Mother’s age at birth Less than 20 years 54.7 3.0 2.4 38.8 1.2 100.0 349 20–34 years 55.8 2.3 2.0 38.9 1.0 100.0 1,580 35–49 years 38.9 0.9 0.2 59.5 0.6 100.0 119 Place of delivery Home 16.2 1.6 0.6 81.6 0.0 100.0 872 Health facility 85.9 2.9 2.9 6.5 1.8 100.0 1,130 Public 84.9 3.4 2.8 7.1 1.8 100.0 915 Private 90.7 1.0 3.0 2.9 2.3 100.0 188 NGO (*) (*) (*) (*) (*) 100.0 27 Type of delivery Vaginal birth 51.0 2.4 2.1 43.9 0.7 100.0 1,872 C-section 93.2 1.7 0.6 0.0 4.5 100.0 177 Education None 38.5 1.3 1.0 58.4 0.7 100.0 754 Primary 47.3 3.1 1.3 47.8 0.5 100.0 346 Secondary 63.3 2.8 2.7 29.7 1.5 100.0 503 Higher 78.1 2.8 3.1 14.7 1.3 100.0 445 Wealth index quintiles Poorest 31.6 1.9 1.4 65.3 0.2 100.0 454 Second 43.9 2.2 2.5 50.7 0.8 100.0 436 Middle 54.1 3.1 1.9 39.6 1.2 100.0 441 Fourth 67.5 2.7 1.8 26.4 1.6 100.0 401 Richest 87.1 1.4 2.4 7.4 1.7 100.0 316 Note: 47 cases of missing ‘place of delivery’ not shown ( ) Figures that are based on 25–49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014148 Newborn Care Practices Proper care of newborns delivered at home has a large impact on maternal and neonatal mortality rates in Nepal where most births still do not occur at a health facility. Therefore, country-specific non-MICS data were collected on newborn care practices in non-institutional deliveries. Appropriate newborn care practices include use of a clean delivery kit or new/boiled blade to cut the umbilical cord; the placing of Chlorohexidine on the stump after cutting the umbilical cord; the newborn being dried before the placenta is delivered; the newborn being wrapped in a clean, dry cloth; and the newborn being placed on the mother’s belly or breast before the placenta is delivered. Table RH.18 shows newborn care practices in non-institutional deliveries for women aged 15–49 years. Almost four in every five women reported that a clean delivery kit or new/boiled blade was used to cut the umbilical cord, but only 2 percent reported that Chlorohexidine was placed on the stump after the umbilical cord was cut. Similarly seven in 10 women reported that the newborn was dried before the placenta was delivered and 78 percent reported that the newborn was wrapped in a clean, dry cloth. However, only 36 percent reported that the newborn was placed on the belly or breast before the Table RH.18: Newborn care practices in non-institutional deliveries Percentage of women aged 15–49 years with a non-institutional live birth in the two years preceding the survey by the application of appropriate newborn care practices, Nepal, 2014 Percent of women with: Number of women with non- institutional live birth in the last two years Clean delivery kit or new/ boiled blade used to cut umbilical cord Chlorohexi- dine placed on stump after cutting umbilical cord Newborn dried before placenta was delivered Newborn wrapped in clean, dry cloth Newborn placed on belly/breast before placenta was delivered Total 82.8 1.9 68.7 78.0 36.4 894 Region Eastern Mountains 69.9 0.0 71.5 85.0 53.0 24 Eastern Hills 81.4 0.0 61.3 74.0 48.5 72 Eastern Terai 96.5 0.0 48.0 68.2 33.9 95 Central Mountains 83.2 8.8 50.9 57.9 45.9 20 Central Hills 73.5 0.0 66.0 69.5 33.3 57 Central Terai 93.2 7.1 66.8 74.6 41.1 213 Western Mountains (*) (*) (*) (*) (*) 0 Western Hills 87.2 0.0 69.4 70.0 36.6 91 Western Terai 88.4 0.0 67.6 86.9 28.4 62 Mid-Western Mountains 49.7 0.0 71.7 86.1 19.4 32 Mid-Western Hills 64.7 0.0 78.4 85.8 23.0 108 Mid-Western Terai 84.4 0.0 85.0 90.2 57.2 37 Far Western Mountains 79.6 .9 92.9 96.9 17.7 22 Far Western Hills 74.7 0.0 96.4 97.2 22.5 36 Far Western Terai 81.2 0.0 73.1 86.5 59.2 24 Area Urban 84.6 0.0 71.8 87.3 43.6 29 Kathmandu valley (*) (*) (*) (*) (*) 4 Other urban 82.0 0.0 67.1 85.2 42.4 24 Rural 82.7 2.0 68.6 77.7 36.2 865 Education None 79.7 2.3 65.1 76.7 30.8 468 Primary 86.1 1.5 67.2 77.0 40.1 182 Secondary 83.4 2.2 73.6 77.8 44.5 158 Higher 90.9 0.0 82.9 87.8 44.3 86 Wealth index quintiles Poorest 69.8 0.1 72.8 79.6 32.2 319 Second 83.9 5.0 66.4 77.3 40.4 238 Middle 95.3 1.4 66.0 80.2 37.9 189 Fourth 91.7 1.9 70.3 76.8 39.2 120 Richest (*) (*) (*) (*) (*) 28 (*) Figures that are based on fewer than 25 unweighted cases NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 149 placenta was delivered. Women with higher levels of education were more likely than those with lower levels of education to report that any of these practices were performed. Women living in households in the richer quintiles were more likely than those living in households in poorer quintiles to report that a clean delivery kit or new/boiled blade was used to cut the umbilical cord. Delaying first-time bathing of newborns for 24 hours is an important newborn care practice that helps to prevent hypothermia, thus reducing a common cause of neonatal death. Therefore, country-specific non-MICS data were collected with respect to this practice. Table RH.19 shows first-time bathing of newborns for women aged 15–49 years with a non-institutional live birth in the two years preceding the survey. Half of the respondents reported that their newborn was bathed for the first time after 24 hours. However, 47 percent reported that their newborn was bathed 1–24 hours after delivery, and 2 percent reported that their newborn was bathed within the first hour of life. Regionally, the highest proportion of women reporting that their newborn was bathed for the first time after 24 hours was in the Central Terai (77 percent) and the lowest proportion was in the Mid-Western Hills (14 percent). Women living in richer households were more likely than those living in poorer households to report delayed bathing. Table RH.19: First-time bathing of newborns Percentage of women aged 15–49 years with non-institutional live births in the two years preceding the survey by time of first bathing of newborn, Nepal, 2014 Percent of women who reported their newborn was bathed for the first time: Total Number of women with non- institutional live birth in the last two years Within 1 hour 1–24 hours After 24 hours DK/ Missing Total 1.5 47.2 50.0 1.3 100.0 894 Region Eastern Mountains 3.9 48.6 47.5 0.0 100.0 24 Eastern Hills 0.0 49.0 49.4 1.5 100.0 72 Eastern Terai 0.0 44.3 53.6 2.2 100.0 95 Central Mountains 0.0 58.0 42.0 0.0 100.0 20 Central Hills (6.9) (45.1) (44.4) (3.6) 100.0 57 Central Terai 0.0 21.7 77.2 1.1 100.0 213 Western Mountains (*) (*) (*) (*) 100.0 Western Hills 0.0 39.8 58.5 1.8 100.0 91 Western Terai (0.0) (64.0) (36.0) (0.0) 100.0 62 Mid-Western Mountains 1.2 58.9 39.2 0.7 100.0 32 Mid-Western Hills 4.0 81.3 13.7 1.0 100.0 108 Mid-Western Terai (7.1) (40.2) (51.6) (1.1) 100.0 37 Far Western Mountains 2.1 77.0 18.8 2.1 100.0 22 Far Western Hills 2.7 61.2 36.0 0.0 100.0 36 Far Western Terai (0.0) (53.1) (46.9) (0.0) 100.0 24 Area Urban 1.5 35.0 62.0 1.5 100.0 29 Kathmandu valley (*) (*) (*) (*) 100.0 4 Other urban (1.7) (40.8) (55.8) (1.7) 100.0 24 Rural 1.5 47.6 49.6 1.3 100.0 865 Education None 0.8 47.5 50.6 1.1 100.0 468 Primary 3.3 44.4 50.3 2.0 100.0 182 Secondary 2.0 50.5 47.3 0.3 100.0 158 Higher 1.1 45.7 50.6 2.5 100.0 86 Wealth index quintiles Poorest 1.9 59.4 38.1 0.6 100.0 319 Second 0.9 49.8 48.6 0.7 100.0 238 Middle 1.2 32.3 64.6 1.8 100.0 189 Fourth 0.9 37.2 58.1 3.8 100.0 120 Richest (*) (*) (*) (*) 100.0 28 ( ) Figures that are based on 25–49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014150 Table RH.20: Discrimination practices during menstruation period Percentage of women aged 15–49 years who experience various types of discrimination during menstruation, Nepal, 2014 Percent of women who experience: Number of women aged 15– 49 years who have ever menstru- ated Severe discriminatory practices Moderate discriminatory practices Stay in separate, specific house/ chhaupadi Stay in animal shed Eat different food Absent from school/ work Stay in different room of home Bathe in separate place Avoid social gather- ings Total 2.9 2.7 2.8 2.3 25.0 8.8 57.6 14,108 Region Eastern Mountains 0.1 0.1 3.5 1.7 6.6 3.5 47.4 185 Eastern Hills 0.1 0.0 3.9 3.3 8.4 4.4 63.5 805 Eastern Terai 0.0 0.1 4.9 2.8 12.2 4.2 64.2 2,070 Central Mountains 0.7 0.3 0.0 0.2 28.1 1.2 66.7 272 Central Hills 0.3 0.0 0.1 0.5 16.5 1.3 54.9 2,307 Central Terai 0.5 0.2 0.2 1.2 6.1 2.4 71.3 2,322 Western Mountains 0.0 0.0 0.0 11.0 1.3 5.0 40.0 8 Western Hills 0.2 0.0 0.0 7.7 50.3 7.9 35.5 1,657 Western Terai 1.6 0.2 0.4 0.5 38.6 3.6 53.2 1,235 Mid-Western Mountains 71.2 55.6 52.4 11.3 61.8 62.7 72.3 168 Mid-Western Hills 4.8 6.6 7.9 0.7 44.7 12.4 65.6 839 Mid-Western Terai 3.1 2.7 1.6 0.7 17.8 9.6 55.3 852 Far Western Mountains 15.1 15.4 1.9 3.1 76.8 75.1 79.0 224 Far Western Hills 15.5 30.0 0.3 0.2 65.0 32.9 80.3 429 Far Western Terai 9.9 4.5 8.4 4.0 27.2 32.6 23.9 734 Area Urban 0.9 0.7 0.9 1.3 22.9 3.5 49.6 2,786 Kathmandu valley 0.3 0.1 0.3 0.9 13.5 1.4 42.9 864 Other urban 1.2 1.0 1.1 1.4 27.2 4.4 52.6 1,921 Rural 3.3 3.2 3.2 2.6 25.5 10.1 59.5 11,322 Age (years) 15–19 3.4 3.4 2.5 1.4 24.3 9.2 57.5 2,680 20–24 3.4 2.8 3.0 2.8 24.8 9.2 55.3 2,399 25–29 2.3 2.1 2.8 3.4 22.7 8.1 56.9 2,410 30–34 2.3 2.2 2.7 1.7 23.1 7.7 59.4 2,003 35–39 2.7 2.8 2.3 3.0 25.7 9.4 59.2 1,899 40–44 3.1 3.0 2.8 2.0 27.4 9.2 58.1 1,580 45–49 2.7 2.4 3.7 1.9 30.5 8.3 57.0 1,138 Education None 4.1 3.9 3.0 1.6 21.8 10.0 60.5 5,285 Primary 2.5 2.4 1.9 2.0 27.1 8.9 56.2 1,996 Secondary 2.7 2.4 3.0 2.7 27.4 8.9 56.5 3,801 Higher 1.2 1.0 2.6 3.4 26.0 6.3 54.7 3,025 Wealth index quintiles Poorest 9.9 10.9 6.1 2.7 37.2 18.9 62.4 2,429 Second 2.4 2.3 2.6 3.0 24.6 10.2 56.8 2,709 Middle 1.7 1.1 2.2 2.3 20.7 8.4 60.2 2,748 Fourth 1.1 0.5 2.1 2.4 20.7 5.8 57.3 3,013 Richest 0.6 0.2 1.5 1.6 23.8 2.9 52.5 3,209 Note: 1 case of missing ‘education’ not shown NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 151 Experience of Discrimination during Menstruation (Chhaupadi) The Nepal MICS 2014 included country-specific questions on women’s experience of discrimination during menstruation to assess the extent of harmful practices known locally as chhaupadi. Women aged 15–49 years were asked if they had faced any of the following discriminatory practices during their menstrual period: (i) having to stay in a separate, specific house (chhaupadi); (ii) having to stay in an animal shed; (iii) having to eat different types of food; (iv) having to be absent from school or work; (v) having to stay in a different room of the home; (vi) having to bath in a separate place; and (vii) having to avoid social gatherings. Table RH.20 indicates that most women in Nepal were more likely to face the moderate forms of discriminatory practice related to menstruation than the severe forms. Of moderate forms of discriminatory practice, 25 percent had to stay in a different room of their home, 9 percent had to bathe in a separate place, and 58 percent had to avoid social gatherings (the most common form of discrimination). Of severe forms of discriminatory practice, 3 percent had to stay in a separate, specific house (chhaupadi) whilst menstruating, 3 percent had to stay in an animal shed, 3 percent had to eat different food, and 2 percent had to be absent from school or work. Menstruation-related discrimination in its severest forms was most prevalent in the Mid-Western Mountains, where 71 percent of women experienced chhaupadi. Age did not seem to be correlated with the type of discrimination experienced: if a woman experienced menstruation-related discrimination, she would experience it consistently regardless of her age. Women’s education levels and household wealth status were both negatively associated with discriminatory practices. Spousal Separation Many men in Nepal, especially those aged 20–34 years, are migrants currently living away from home for substantial periods of time. This has resulted in significant levels of spousal separation, which may have reproductive, demographic, and health implications for the country. In the NDHS 2011, 32 percent of women reported that their husbands lived away from home; this was up from 26 percent in the NDHS 2006. Although the Crude Birth Rate (CBR) for Nepal is currently stable, the TFR is falling rapidly from 2.6 in 2011 (NDHS 2011) to 2.3 (see Table RH.1); one possible reason for this fall is temporary spousal separation. The contraceptive prevalence rate (CPR) for living-together couples is three times greater than for separated couples (NDHS 2011). Therefore, country-specific data were collected on spousal separation. Table RH.21 shows the percentage of married women aged 15–49 years whose husband was currently living away from home and the duration of that absence. One in four (26 percent) women reported their husband currently living away from home. This was highest in the Western Hills (43 percent) and lowest in the Mid-Western Mountains (8 percent). Younger women and those with 0, 1 or 2 children were more likely than other women to experience a husband living away. Women with primary or secondary education and women living in households in the middle three wealth quintiles were most likely to report this. Of women with an absent husband, 49 percent reported that he had been away for 12 months or more and 40 percent report that he had been away for less than seven months. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014152 Table RH.21: Spousal separation Percentage of women aged 15–49 years currently married or in union whose husband is living away from home, by duration away from home, Nepal, 2014 Percent of women currently married whose husband is living away from home Number of women currently married Duration away from home: Total Number of women currently married whose husband is living away from home <7 months 7–11 months 12+ months DK/ missing Total 26.2 10,830 40.2 10.3 49.3 0.2 100.0 2,833 Region Eastern Mountains 16.6 134 26.3 11.6 62.0 0.0 100.0 22 Eastern Hills 29.1 577 25.0 9.0 65.9 0.0 100.0 168 Eastern Terai 27.8 1,604 34.9 14.1 50.9 0.0 100.0 445 Central Mountains 26.2 201 44.0 3.8 51.7 0.5 100.0 53 Central Hills 18.8 1,668 42.5 8.5 48.7 0.3 100.0 314 Central Terai 22.6 1,896 44.4 10.5 45.1 0.0 100.0 428 Western Mountains 14.5 6 42.9 12.5 44.6 0.0 100.0 1 Western Hills 42.8 1,269 36.4 9.2 54.1 0.3 100.0 543 Western Terai 28.2 940 34.9 10.4 54.2 0.5 100.0 265 Mid-Western Mountains 8.0 136 51.8 8.2 40.1 0.0 100.0 11 Mid-Western Hills 31.9 686 48.8 11.3 39.9 0.0 100.0 219 Mid-Western Terai 23.2 670 51.3 8.2 39.9 0.7 100.0 155 Far Western Mountains 14.7 176 24.2 12.5 63.4 0.0 100.0 26 Far Western Hills 17.8 325 39.5 12.5 47.6 0.4 100.0 58 Far Western Terai 23.4 540 60.4 9.6 29.3 0.7 100.0 126 Area Urban 22.1 1,983 37.8 9.3 52.7 0.3 100.0 437 Kathmandu valley 14.9 602 31.0 8.6 59.4 1.1 100.0 90 Other urban 25.2 1,381 39.6 9.4 50.9 0.1 100.0 348 Rural 27.1 8,846 40.6 10.5 48.7 0.2 100.0 2,396 Age (years) 15–19 31.4 659 52.1 15.3 32.7 0.0 100.0 207 20–24 32.4 1,701 46.9 11.7 41.1 0.4 100.0 551 25–29 32.2 2,209 37.9 10.0 52.1 0.0 100.0 712 30–34 28.2 1,909 39.5 9.2 51.2 0.1 100.0 538 35–39 24.7 1,810 32.7 9.4 57.5 0.5 100.0 447 40–44 17.6 1,499 39.7 9.6 50.1 0.7 100.0 263 45–49 11.1 1,042 33.4 8.1 58.5 0.0 100.0 116 Number of living children 0 28.9 1,073 55.0 11.3 33.7 0.0 100.0 310 1–2 31.3 5,309 38.8 10.4 50.6 0.2 100.0 1,659 3–4 21.3 3,547 36.8 9.9 53.0 0.4 100.0 755 5+ 12.1 901 41.4 9.6 48.8 0.2 100.0 109 Education None 21.0 4,991 38.6 10.7 50.7 0.1 100.0 1,049 Primary 29.2 1,716 37.5 9.6 52.5 0.4 100.0 501 Secondary 34.8 2,285 41.3 9.5 49.0 0.2 100.0 795 Higher 26.6 1,836 44.4 11.7 43.5 0.4 100.0 488 Wealth index quintiles Poorest 24.1 1,871 41.6 10.8 47.6 0.0 100.0 451 Second 29.3 2,094 40.0 9.0 50.7 0.3 100.0 614 Middle 28.3 2,211 35.3 11.7 52.8 0.1 100.0 625 Fourth 28.8 2,333 42.2 10.5 47.1 0.2 100.0 671 Richest 20.3 2,321 42.4 9.7 47.5 0.4 100.0 472 Note: 1 case of missing ‘education’ not shown NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 153 Early Childhood Development C H A P T E R9 Early Childhood Care and Education Readiness of children for primary school can be improved through attendance in early childhood education (ECD) programmes or preschool. ECD programmes generally have organized learning components for children as opposed to baby-sitting and day-care that typically do not have organized education and learning. In Nepal, there are three types of programmes for early childhood care and education of children aged 3–4 years: • School-based programmes, run by public, community and private schools, which include nursery, kindergarten, day-care centres and pre-primary classes. • Community-based programmes, known as early childhood development centres, mostly run by I/NGOs and local bodies. • Home-based programmes, undertaken by some I/NGOs, which focus on supporting parents to develop their capacity to provide health, nutrition and early stimulation activities for young children at home1. The last decade has seen a massive expansion of ECD programmes in Nepal and gross enrolment is now six times higher than it was in the mid-2000s2. The government is working with partners and communities to improve the quality of ECD, including the rollout of minimum standards for ECD centres, and the introduction of ‘learning corners’ to support children to develop pre-literacy, numeracy and social, emotional and physical skills. Table CD.1 shows that around half (51 percent) of 3–4-year-olds were attending an organized ECD programme. Four-year-olds were more likely than three-year-olds to be attending (65 percent compared to 37 percent). Children in urban areas were much more likely than those in rural areas to attend (78 percent compared to 47 percent). Regionally, the highest proportion was in the Western Hills (80 percent) and the lowest was in the Far Western Hills (29 percent). Mother’s education and household wealth status both showed a strong positive association with attendance in ECD. 1Kishor Shrestha and Prem Narayan Aryal, 2007. ECCE in Nepal: Key Issues and Implications for Policy Development, A paper presented at: Regional Training Workshop on Early Childhood Policy Review 6–8 February 2007, Bangkok, Thailand, CERID, Tribhuvan University, Nepal. 2Government of Nepal, Consolidated Flash Report 2013–14. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014154 Table CD.1: Early childhood education Percentage of children aged 36–59 months who are attending an organized early childhood education programme, Nepal, 2014 Percent of children aged 36–59 months attending early childhood education [1] Number of children aged 36–59 months Total 50.7 2,284 Sex Male 51.9 1,157 Female 49.4 1,127 Region Eastern Mountains 37.6 28 Eastern Hills 64.2 104 Eastern Terai 49.0 344 Central Mountains 70.7 37 Central Hills 78.2 251 Central Terai 29.3 505 Western Mountains (67.2) 1 Western Hills 80.3 259 Western Terai 58.6 188 Mid-Western Mountains 36.7 47 Mid-Western Hills 41.8 185 Mid-Western Terai 39.3 124 Far Western Mountains 44.4 45 Far Western Hills 28.9 97 Far Western Terai 44.2 68 Area Urban 78.3 302 Kathmandu valley 85.3 76 Other urban 75.9 226 Rural 46.5 1,982 Age of child 36–47 months 36.6 1,137 48–59 months 64.6 1,147 Mother’s education None 32.7 1,114 Primary 53.2 384 Secondary 71.1 438 Higher 80.0 348 Wealth index quintile Poorest 41.2 535 Second 39.1 433 Middle 38.8 523 Fourth 62.7 464 Richest 83.5 328 [1] MICS indicator 6.1 – Attendance to early childhood education Note: 1 case of missing ‘mother’s education’ not shown ( ) Figures that are based on 25–49 unweighted cases NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 155 Quality of Care It is well recognized that a period of rapid brain development occurs in the first five years of life, and the quality of home care is a major determinant of the child’s development as 80 percent of brain development takes place during the first two years. In this context, engagement of adults in activities with children, the presence in the home of books and playthings for the child, and the conditions of care are important indicators of quality of home care. As set out in A World Fit for Children, “children should be physically healthy, mentally alert, emotionally secure, socially competent and ready to learn.”3 Information on a number of activities that support early learning was collected in the survey. These included the involvement of adults with children in the following activities: reading books or looking at picture books, telling stories, singing songs, taking children outside the home, compound or yard, playing with children, and spending time with children naming, counting or drawing things. Table CD.2 presents information on the proportion of children aged 36–59 months with whom adult household members engaged in activities that promote learning and school readiness in the three days preceding the survey. Some 67 percent of children lived in a household where an adult member engaged with them in four or more activities. The mean number of activities that adults engaged with children was 4.2. Father’s involvement in such activities was somewhat limited, with only 10 percent of children having a father who had engaged with them in four or more activities. Some 30 percent of children lived with a mother who had engaged with them in four or more activities. Boys were more likely than girls to live in a household where an adult member engaged with them in four or more activities (70 percent compared to 64 percent). The proportion of children living in a household where an adult member engaged with them in four or more activities ranged from 29 percent in the Far Western Hills to 87 percent in the Central Hills. Children in urban areas were much more likely than those in rural areas to live in a household where an adult member engaged with them in four or more activities (87 percent compared to 64 percent). Parents’ education level as well as household wealth status were both positively associated with the likelihood of children living in a household where an adult member engaged with them in four or more activities. 3UNICEF, A World Fit For Children, Adopted by the UN General Assembly at the 27th Special Session, 10 May 2002, p. 2. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014156 Ta bl e CD .2 : S up po rt fo r l ea rn in g Pe rc en ta ge o f c hil dr en a ge d 36 –5 9 m on th s w ith w ho m a du lt h ou se ho ld m em be rs e ng ag ed in a cti vit ies th at p ro m ot e lea rn ing a nd sc ho ol re ad ine ss d ur ing th e th re e da ys p re ce din g th e su rv ey , a nd en ga ge m en t in su ch a cti vit ies b y b iol og ica l fa th er s a nd m ot he rs , N ep al, 2 01 4 Pe rc en t o f ch ild re n wi th wh om a du lt ho us eh old m em be rs ha ve e ng ag ed in fo ur o r m or e ac tiv itie s [1 ] M ea n nu m be r of a cti vit ies wi th a du lt ho us eh old m em be rs Pe rc en t o f c hil dr en liv ing w ith th eir : Nu m be r o f ch ild re n ag ed 36 –5 9 m on th s Pe rc en t o f ch ild re n wi th wh om bio log ica l fa th er s h av e en ga ge d in fo ur o r m or e ac tiv itie s [2 ] M ea n nu m be r of a cti vit ies wi th b iol og ica l fa th er s Nu m be r o f ch ild re n ag ed 36 –5 9 m on th s liv ing w ith bio log ica l fa th er s Pe rc en t o f ch ild re n wi th wh om bio log ica l m ot he rs h av e en ga ge d in fo ur o r m or e ac tiv itie s [3 ] M ea n nu m be r of a cti vit ies wi th b iol og ica l m ot he rs Nu m be r o f ch ild re n ag ed 36 –5 9 m on th s liv ing w ith bio log ica l m ot he rs Bi olo gic al fa th er Bi olo gic al m ot he r To ta l 67 .2 4. 2 68 .0 97 .7 2, 28 4 10 .1 1. 1 1, 55 4 30 .4 2. 3 2, 23 3 Se x M ale 70 .1 4. 3 68 .0 98 .1 1, 15 7 9. 3 1. 0 78 7 31 .1 2. 4 1, 13 5 Fe m ale 64 .1 4. 1 68 .0 97 .4 1, 12 7 10 .8 1. 1 76 6 29 .7 2. 3 1, 09 8 Re gi on Ea ste rn M ou nt ain s 53 .5 3. 5 81 .3 97 .5 28 (*) (*) 23 27 .7 2. 2 27 Ea ste rn H ills 77 .0 4. 4 73 .2 96 .5 10 4 24 .9 1. 6 76 41 .5 2. 7 10 0 Ea ste rn T er ai 66 .9 4. 0 64 .6 99 .6 34 4 12 .6 1. 1 22 2 43 .0 2. 8 34 2 Ce nt ra l M ou nt ain s 82 .4 5. 1 66 .4 93 .3 37 (1 6. 7) (1 .6 ) 25 38 .5 3. 0 35 Ce nt ra l H ills 87 .1 5. 2 72 .8 98 .0 25 1 17 .9 1. 7 18 3 56 .3 3. 6 24 6 Ce nt ra l T er ai 64 .0 4. 2 67 .2 98 .8 50 5 4. 1 0. 8 33 9 15 .2 1. 7 49 9 W es te rn M ou nt ain s (6 6. 1) (4 .0 ) (8 0. 9) (9 3. 0) 1 (*) (*) 1 (3 3. 5) (2 .5 ) 1 W es te rn H ills 76 .6 4. 8 51 .9 94 .0 25 9 8. 7 0. 9 13 5 45 .4 3. 0 24 4 W es te rn T er ai 69 .7 4. 5 67 .4 96 .6 18 8 2. 4 0. 9 12 7 13 .9 1. 9 18 2 M id- W es te rn M ou nt ain s 47 .6 3. 4 92 .0 97 .2 47 (5 .8 ) (0 .6 ) 43 5. 5 .6 46 M id- W es te rn H ills 49 .5 3. 3 63 .8 97 .1 18 5 9. 0 1. 0 11 8 28 .7 2. 1 18 0 M id- W es te rn T er ai 63 .3 3. 8 77 .0 99 .7 12 4 10 .6 1. 2 96 25 .2 2. 0 12 4 Fa r W es te rn M ou nt ain s 80 .1 4. 8 80 .5 99 .0 45 (2 3. 5) (2 .0 ) 36 21 .8 2. 3 45 Fa r W es te rn H ills 29 .4 2. 6 83 .8 97 .8 97 7. 2 1. 0 82 10 .5 1. 5 95 Fa r W es te rn T er ai 71 .7 4. 3 71 .7 99 .2 68 (1 0. 2) (1 .0 ) 49 17 .3 1. 6 67 Ar ea Ur ba n 86 .5 5. 1 70 .0 95 .7 30 2 16 .7 1. 6 21 2 49 .7 3. 3 28 9 Ka th m an du va lle y 91 .8 5. 4 80 .4 97 .4 76 22 .6 1. 8 61 62 .0 3. 8 74 Ot he r u rb an 84 .7 5. 0 66 .5 95 .2 22 6 14 .7 1. 5 15 0 45 .6 3. 2 21 5 Ru ra l 64 .2 4. 1 67 .7 98 .0 1, 98 2 9. 0 1. 0 1, 34 2 27 .5 2. 2 1, 94 4 Ag e 36 –4 7 m on th s 63 .9 4. 1 67 .2 98 .4 1, 13 7 9. 3 1. 1 76 4 31 .0 63 .9 1, 11 9 48 –5 9 m on th s 70 .4 4. 4 68 .8 97 .1 1, 14 7 10 .8 1. 1 79 0 29 .8 70 .4 1, 11 4 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 157 Ta bl e CD .2 : S up po rt fo r l ea rn in g Pe rc en ta ge o f c hil dr en a ge d 36 –5 9 m on th s w ith w ho m a du lt h ou se ho ld m em be rs e ng ag ed in a cti vit ies th at p ro m ot e lea rn ing a nd sc ho ol re ad ine ss d ur ing th e th re e da ys p re ce din g th e su rv ey , a nd en ga ge m en t in su ch a cti vit ies b y b iol og ica l fa th er s a nd m ot he rs , N ep al, 2 01 4 Pe rc en t o f ch ild re n wi th wh om a du lt ho us eh old m em be rs ha ve e ng ag ed in fo ur o r m or e ac tiv itie s [1 ] M ea n nu m be r of a cti vit ies wi th a du lt ho us eh old m em be rs Pe rc en t o f c hil dr en liv ing w ith th eir : Nu m be r o f ch ild re n ag ed 36 –5 9 m on th s Pe rc en t o f ch ild re n wi th wh om bio log ica l fa th er s h av e en ga ge d in fo ur o r m or e ac tiv itie s [2 ] M ea n nu m be r of a cti vit ies wi th b iol og ica l fa th er s Nu m be r o f ch ild re n ag ed 36 –5 9 m on th s liv ing w ith bio log ica l fa th er s Pe rc en t o f ch ild re n wi th wh om bio log ica l m ot he rs h av e en ga ge d in fo ur o r m or e ac tiv itie s [3 ] M ea n nu m be r of a cti vit ies wi th b iol og ica l m ot he rs Nu m be r o f ch ild re n ag ed 36 –5 9 m on th s liv ing w ith bio log ica l m ot he rs Bi olo gic al fa th er Bi olo gic al m ot he r M ot he r’s e du ca tio n [a ] No ne 57 .1 3. 8 71 .8 97 .2 1, 11 4 6. 4 0. 9 80 0 16 .0 1. 6 1, 08 2 Pr im ar y 62 .1 4. 0 67 .3 97 .4 38 4 8. 8 1. 0 25 8 26 .8 2. 2 37 4 Se co nd ar y 78 .6 4. 7 59 .7 98 .9 43 8 13 .2 1. 1 26 2 45 .5 3. 1 43 3 Hi gh er 90 .9 5. 3 67 .0 98 .6 34 8 19 .3 1. 6 23 3 61 .5 3. 8 34 3 Fa th er ’s e du ca tio n No ne 52 .0 3. 5 10 0. 0 99 .8 37 1 8. 0 1. 1 37 1 16 .4 1. 5 37 0 Pr im ar y 56 .9 3. 8 10 0. 0 99 .2 39 6 9. 3 1. 3 39 6 20 .1 1. 9 39 3 Se co nd ar y 69 .3 4. 3 10 0. 0 99 .2 44 2 15 .3 1. 7 44 2 29 .7 2. 3 43 9 Hi gh er 87 .8 5. 0 10 0. 0 99 .5 34 4 26 .0 2. 2 34 4 44 .2 3. 0 34 3 Fa th er n ot in h ou se ho ld 69 .5 4. 3 0. 0 94 .2 73 1 0. 8 0. 1 0 37 .1 2. 6 68 8 W ea lth in de x qu in til es Po or es t 51 .4 3. 5 71 .8 97 .3 53 5 8. 5 1. 0 38 4 21 .1 1. 8 52 1 Se co nd 62 .5 3. 9 66 .3 97 .9 43 3 8. 2 0. 9 28 7 24 .6 1. 9 42 4 M idd le 62 .3 4. 1 65 .3 99 .0 52 3 7. 4 0. 9 34 2 24 .6 2. 1 51 8 Fo ur th 79 .1 4. 7 63 .6 96 .9 46 4 12 .1 1. 1 29 5 35 .8 2. 7 44 9 Ri ch es t 90 .0 5. 3 74 .6 97 .5 32 8 16 .4 1. 6 24 5 54 .9 3. 5 32 0 [1 ] M IC S in di ca to r 6 .2 – S up po rt fo r l ea rn in g [2 ] M IC S In di ca to r 6 .3 – F at he r’s s up po rt fo r l ea rn in g [3 ] M IC S In di ca to r 6 .4 – M ot he r’s s up po rt fo r l ea rn in g [a ] T he b ac kg ro un d ch ar ac te ris tic ‘m ot he r’s e du ca tio n’ re fe rs to th e ed uc at ion le ve l o f t he re sp on de nt to th e Qu es tio nn air e fo r C hil dr en U nd er F ive , a nd co ve rs b ot h m ot he rs a nd p rim ar y c ar et ak er s, wh o ar e int er vie we d wh en th e m ot he r i s n ot lis te d in th e sa m e ho us eh old . S inc e ind ica to r 6 .4 re po rts o n th e bio log ica l m ot he r’s su pp or t f or le ar nin g, th is ba ck gr ou nd ch ar ac te ris tic re fe rs to o nly th e ed uc at ion al lev els o f b iol og ica l m ot he rs w he n ca lcu lat ed fo r t he in dic at or in q ue sti on . No te : 1 ca se e ac h of m iss ing b ot h ‘m ot he r’s e du ca tio n’ an d ‘fa th er ’s ed uc at ion ’ n ot sh ow n ( ) F igu re s t ha t a re b as ed o n 25 –4 9 un we igh te d ca se s (*) F igu re s t ha t a re b as ed o n fe we r t ha n 25 u nw eig ht ed ca se s C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014158 Exposure to books in the early years not only provides a child with greater understanding of the nature of print, but may also give the child an opportunity to see others reading, such as older siblings doing school work. Presence of books is important for later school performance. Mothers of children under five were asked about the number of children’s books or picture books available for the child, and about the availability of playthings such as homemade toys, toys from a shop, household objects (such as pots and bowls) and objects found outside (such as sticks, rocks, animal shells, or leaves). Only 5 percent of children under five lived in a household where at least three children’s books were present, and less than 1 percent lived in a household with 10 or more children’s books (Table CD.3). Some 59 percent had access to two or more types of playthings, with 48 percent having homemade toys, 62 percent having toys from a shop, and 65 percent using household objects or objects found outside as playthings. The proportion of children living in a household with three or more children’s books varied substantially by region, ranging from 1 percent of children in the Mid-Western Hills to 13 percent of children in the Central Hills. Urban children were much more likely than rural children to live in a household with at least three children’s books (15 percent compared to 3 percent), with 31 percent of children in Kathmandu valley living in a household with at least three children’s books. The presence of children’s books was positively correlated with mother’s education and household wealth levels. The proportion of children with access to a variety of playthings was highest in the Central Mountains (81 percent) and lowest in the Mid-Western Mountains (36 percent). Children aged 24–59 months were much more likely than those aged 0–23 months to have access to a variety of playthings. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 159 Leaving children under five alone or in the presence of other young children is known to increase the risk of injuries.4 In the MICS, two questions were asked to find out whether children aged 0–59 months were left alone or in the care of children under 10 years of age for more than one hour at least once during the week preceding the survey. 4Grossman, David C., 2000. The History of Injury Control and the Epidemiology of Child and Adolescent Injuries. The Future of Children, 10(1), 23–52. Table CD.3: Learning materials Percentage of children under five by number of children’s books present in the household, and by playthings that child plays with, Nepal, 2014 Percent of children living in household that has for the child: Percent of children who play with: Number of children under five 3 or more children’s books [1] 10 or more children’s books Homemade toys Toys from a shop/ manufac- tured toys Household objects/ objects found outside Two or more types of playthings [2] Total 4.8 0.3 48.2 61.5 64.6 59.2 5,349 Sex Male 4.8 0.2 48.4 63.7 64.1 60.4 2,766 Female 4.8 0.3 48.1 59.1 65.2 57.9 2,583 Region Eastern Mountains 2.2 0.0 54.3 58.1 66.0 61.6 72 Eastern Hills 9.8 0.1 70.6 70.5 64.6 68.9 272 Eastern Terai 4.5 0.3 55.3 69.5 61.3 64.5 775 Central Mountains 3.1 0.0 75.1 77.5 80.5 81.1 95 Central Hills 13.1 1.3 50.4 69.3 60.8 64.0 620 Central Terai 1.8 0.0 36.4 47.7 55.2 42.0 1,131 Western Mountains 5.2 0.0 45.6 67.7 75.9 72.8 2 Western Hills 6.6 0.3 39.7 62.9 65.2 57.7 601 Western Terai 6.1 0.0 31.5 75.9 64.0 60.3 469 Mid-Western Mountains 1.8 0.0 33.9 16.9 71.8 36.3 108 Mid-Western Hills 0.6 0.0 65.4 64.9 84.6 75.0 409 Mid-Western Terai 2.6 0.4 55.3 74.8 78.6 72.3 291 Far Western Mountains 0.9 0.0 77.7 56.1 76.5 77.3 100 Far Western Hills 1.5 0.0 52.6 32.3 69.4 53.9 210 Far Western Terai 3.1 0.3 43.4 58.1 58.1 54.6 197 Area Urban 15.1 1.0 39.6 81.9 56.9 61.7 699 Kathmandu valley 31.1 2.3 37.3 85.4 47.2 61.8 181 Other urban 9.5 0.5 40.4 80.6 60.2 61.6 518 Rural 3.3 0.2 49.5 58.4 65.8 58.8 4,650 Age 0–23 months 0.3 0.0 32.4 49.2 39.4 38.2 1,986 24–59 months 7.5 0.4 57.6 68.7 79.5 71.5 3,363 Mother’s education None 2.2 0.0 47.7 47.8 67.1 53.5 2,265 Primary 2.5 0.1 50.2 64.3 68.6 64.5 921 Secondary 4.8 0.4 47.9 71.6 62.3 62.6 1,179 Higher 13.1 0.8 48.1 78.2 57.8 63.2 980 Wealth index quintiles Poorest 1.4 0.0 54.5 46.0 74.4 59.7 1,183 Second 1.6 0.0 52.3 56.2 67.3 59.4 1,085 Middle 2.4 0.0 47.3 57.4 62.9 55.8 1,176 Fourth 5.8 0.2 44.9 71.3 61.8 61.2 1,086 Richest 16.2 1.5 39.5 83.6 53.2 60.2 819 [1] MICS indicator 6.5 – Availability of children’s books [2] MICS indicator 6.6 – Availability of playthings Note: 4 cases of missing ‘mother’s education’ not shown NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014160 Table CD.4 shows that 13 percent of children were left alone during the preceding week and 14 percent were left in the care of another child younger than 10 years of age. Combining data on these two indicators showed that 21 percent of children were left with inadequate care during the week preceding the survey. The highest proportion of children under five with inadequate care was in the Mid-Western Mountains (40 percent) and the lowest proportion was in the Western Mountains (9 percent). Rural children were more likely than urban children to have inadequate care (21 percent compared to 15 percent). Older children were more likely than younger children to have inadequate care (26 percent compared to 12 percent). Mother’s education level and household wealth status were both negatively associated with a child being left with inadequate care. Table CD.4: Inadequate care Percentage of children under five left alone or left in the care of another child younger than 10 years of age for more than one hour at least once during the week preceding the survey, Nepal, 2014 Percent of children under five: Number of children under five Left alone in the past week Left in the care of another child younger than 10 years of age in the past week Left with inadequate care in the past week [1] Total 12.6 13.9 20.6 5,349 Sex Male 12.2 13.5 20.1 2,766 Female 12.9 14.3 21.2 2,583 Region Eastern Mountains 16.7 23.8 30.2 72 Eastern Hills 10.8 20.0 22.6 272 Eastern Terai 10.7 15.0 18.9 775 Central Mountains 12.0 18.3 22.8 95 Central Hills 11.4 7.2 15.9 620 Central Terai 9.5 9.5 15.8 1,131 Western Mountains 5.5 7.6 8.7 2 Western Hills 3.2 8.6 11.3 601 Western Terai 23.2 7.7 28.2 469 Mid-Western Mountains 19.7 35.2 39.6 108 Mid-Western Hills 25.6 27.9 37.6 409 Mid-Western Terai 24.9 25.7 32.9 291 Far Western Mountains 10.4 24.2 28.8 100 Far Western Hills 5.9 13.1 15.8 210 Far Western Terai 4.4 9.4 10.3 197 Area Urban 10.5 8.1 15.3 699 Kathmandu valley 14.1 6.8 17.0 181 Other urban 9.2 8.6 14.7 518 Rural 12.9 14.7 21.4 4,650 Age 0–23 months 6.4 8.1 11.8 1,986 24–59 months 16.2 17.3 25.8 3,363 Mother’s education None 15.9 20.5 27.5 2,265 Primary 12.6 12.8 20.4 921 Secondary 9.0 9.6 14.9 1,179 Higher 9.1 4.7 11.8 980 Wealth index quintiles Poorest 16.5 24.1 30.2 1,183 Second 12.3 15.6 21.6 1,085 Middle 13.7 12.3 20.6 1,176 Fourth 10.0 9.3 16.0 1,086 Richest 9.1 5.1 11.7 819 [1] MICS indicator 6.7 – Inadequate care Note: 4 cases of missing ‘mother’s education’ not shown NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 161 Developmental Status of Children Early childhood development is also defined as an orderly, predictable process along a continuous path, in which a child learns to handle more complicated levels of moving, thinking, speaking, feeling and relating to others. Physical growth, literacy and numeracy skills, socio–emotional development and readiness to learn are vital domains of a child’s overall development, which is a basis for overall human development5. A 10-item module was used to calculate the early child development index (ECDI). The primary purpose of the ECDI is to inform public policy regarding the developmental status of children in Nepal. The index is based on selected milestones that children are expected to achieve by the ages of 3 and 4. The 10 items are used to determine if children are developmentally on track in four domains: • Literacy–numeracy: Children are identified as being developmentally on track based on whether they can identify/name at least 10 letters of the alphabet, whether they can read at least four simple, popular words, and whether they know the name and recognize the symbols of all numbers from 1 to 10. If at least two of these are true, then the child is considered developmentally on track. • Physical: If the child can pick up a small object with two fingers, like a stick or a rock from the ground and/or the mother/caretaker does not indicate that the child is sometimes too sick to play, then the child is regarded as being developmentally on track in the physical domain. • Social–emotional: Children are considered to be developmentally on track if any two of the followings are true: (i) if the child gets along well with other children; (ii) if the child does not kick, bite, or hit other children; and (iii) if the child does not get distracted easily. • Learning: If the child follows simple directions on how to do something correctly and/or when given something to do, is able to do it independently, then the child is considered to be developmentally on track in this domain. ECDI is then calculated as the percentage of children who are developmentally on track in at least three of these four domains. 5Shonkoff, J. and Phillips, D. (eds), From neurons to neighbourhoods: the science of early childhood development, Committee on Integrating the Science of Early Childhood Development, National Research Council, 2000. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014162 Table CD.5: Early child development index Percentage of children aged 36–59 months who are developmentally on track in literacy–numeracy, physical, social–emotional, and learning domains, and the early child development index score, Nepal, 2014 Percent of children aged 36–59 months who are developmentally on track for indicated domains Early child development index score [1] Number of children of aged 36–59 months Literacy– numeracy Physical Social– emotional Learning Total 28.8 96.4 68.6 81.6 64.4 2,284 Sex Male 27.5 96.1 65.8 81.0 62.4 1,157 Female 30.2 96.6 71.4 82.2 66.6 1,127 Region Eastern Mountains 25.2 92.8 80.9 68.8 60.6 28 Eastern Hills 37.9 95.3 80.1 78.9 74.8 104 Eastern Terai 33.9 95.3 78.5 79.4 72.3 344 Central Mountains 28.8 97.6 69.6 87.2 73.8 37 Central Hills 50.2 97.0 77.5 90.9 84.2 251 Central Terai 14.9 95.9 63.2 64.7 45.7 505 Western Mountains (24.8) (93.2) (51.1) (93.2) (62.7) 1 Western Hills 45.9 99.3 73.6 97.3 81.6 259 Western Terai 36.5 98.6 71.3 75.8 64.7 188 Mid-Western Mountains 11.7 93.6 40.8 88.7 42.9 47 Mid-Western Hills 13.9 98.2 52.6 92.3 55.4 185 Mid-Western Terai 26.5 95.4 57.2 90.8 56.0 124 Far Western Mountains 12.3 89.7 78.7 83.5 69.7 45 Far Western Hills 7.7 89.6 62.8 79.5 56.2 97 Far Western Terai 27.0 100.0 60.7 95.9 68.4 68 Area Urban 57.3 99.2 79.0 89.7 83.6 302 Kathmandu valley 75.1 100.0 77.9 92.0 91.6 76 Other urban 51.3 98.9 79.4 89.0 80.8 226 Rural 24.5 95.9 67.0 80.3 61.5 1,982 Age 36–47 months 18.3 96.1 67.1 77.7 58.7 1,137 48–59 months 39.3 96.6 70.1 85.4 70.1 1,147 Attendance in early childhood education Attending 53.1 98.2 71.9 90.4 79.5 1,157 Not attending 3.9 94.5 65.2 72.5 48.9 1,127 Mother’s education None 12.0 96.3 67.4 77.3 55.7 1,114 Primary 26.1 97.6 69.2 81.7 64.9 384 Secondary 49.1 95.5 69.0 88.4 74.9 438 Higher 60.3 96.1 71.3 86.4 78.8 348 Wealth index quintiles Poorest 12.3 95.0 66.0 85.5 60.2 535 Second 19.1 97.7 65.8 77.9 56.3 433 Middle 21.3 95.9 69.3 73.7 57.0 523 Fourth 39.9 96.1 65.6 83.8 69.8 464 Richest 65.1 97.7 79.7 89.3 86.3 328 [1] MICS indicator 6.8 – Early child development index Note: 1 case of missing ‘mother’s education’ not shown ( ) Figures that are based on 25–49 unweighted cases NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 163 The results for ECDI are presented in Table CD.5. Overall, 64 percent of children aged 36–59 months were developmentally on track according to ECDI. Analysis of the four domains of child development shows that 96 percent of children were on track in the physical domain, 82 percent were on track in the learning domain, 69 percent were on track in the social–emotional domain, 29 percent were on track in the literacy–numeracy domain. ECDI varied considerably by region: the highest proportion of children developmentally on track was in the Central Hills (84 percent) and the lowest proportion was in the Mid-Western Mountains (43 percent). Urban children were more likely than rural children to be developmentally on track according to ECDI (84 percent compared to 62 percent). As expected, older children were more likely than younger children to be developmentally on track according to ECDI (70 percent compared to 59 percent). Children attending an early childhood education programme were much more likely than those not attending to be developmentally on track according to ECDI (80 percent compared to 49 percent). Some 56 percent of children whose mother had no education were developmentally on track according to ECDI compared to 79 percent of children whose mother had higher education. Some 60 percent of children in the poorest household population were developmentally on track according to ECDI compared to 86 percent of children in the richest household population. Perception on Minimum Years of Schooling In Nepal, the number of years of schooling that parents would like their children to achieve tends to reflect their perceptions on the importance and costs of education from secondary level onwards. Parents who can afford secondary school would like their children to complete eight years of basic education in order to progress to the next level. Therefore, a question was added to the standard MICS questionnaire to ask mothers and caretakers how many classes they would like their child to attend. Table CD.6 shows that 84 percent of mothers of children under five would like their child to attend at least eight grades of school. The proportion of women who would like their child to attend at least eight grades of school was highest in the Far Western Hills (almost 100 percent) and lowest in the Central Terai (68 percent). As expected, the proportion of mothers who would like their child to attend at least eight grades of school was highest among women with higher education (89 percent) and lowest for women with no education (81 percent). Interestingly, the proportion of mothers who would like their child to attend at least eight grades of school was highest for women living in households in the poorest (87 percent) and richest quintiles (89 percent) and lowest for women living in households in the middle quintile (79 percent). NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014164 Table CD.6: Perception on minimum years of education for child Percentage of mothers of children under five who would like their child to attend at least eight grades of education, Nepal, 2014 Percent of mothers who would like their child to attend at least eight grades Number of mothers with children under five Total 84.3 5,349 Sex Male 85.9 2,766 Female 82.6 2,583 Region Eastern Mountains 86.4 72 Eastern Hills 96.0 272 Eastern Terai 90.0 775 Central Mountains 76.2 95 Central Hills 83.0 620 Central Terai 68.2 1,131 Western Mountains 72.8 2 Western Hills 82.9 601 Western Terai 99.2 469 Mid-Western Mountains 83.3 108 Mid-Western Hills 94.3 409 Mid-Western Terai 79.9 291 Far Western Mountains 97.4 100 Far Western Hills 99.7 210 Far Western Terai 77.4 197 Area Urban 89.9 699 Kathmandu valley 90.9 181 Other urban 89.5 518 Rural 83.5 4,650 Age 36–47 months 83.6 1,986 48–59 months 84.7 3,363 Mother’s education None 81.2 2,265 Primary 82.4 921 Secondary 87.4 1,179 Higher 89.4 980 Wealth index quintiles Poorest 86.5 1,183 Second 82.9 1,085 Middle 78.7 1,176 Fourth 85.9 1,086 Richest 89.0 819 Note: 4 cases of missing ‘mother’s education’ not shown NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 165 Literacy and Education C H A P T E R10 Literacy among Young Women The youth literacy rate reflects the outcomes of primary education over the previous 10 years or so. As a measure of the effectiveness of the primary education system, it is often seen as a proxy measure of social progress and economic achievement. In the MICS, since only a women’s questionnaire was administered, the results are based only on females aged 15–24 years. Literacy is assessed on the ability of the respondent to read a short simple statement or based on school attendance. The proportion of women aged 15–24 years who were considered literate is presented in Table ED.1. Some 84 percent of young women were literate. As expected, literacy was strongly associated with education level: just 5 percent of young women with no education were literate. However, only 62 percent of young women with primary education were considered literate, suggesting major shortcomings in the quality of primary education in the country since such a significant proportion of young women were still unable to read a short simple statement. The highest proportion of literate young women was in the Western Hills (98 percent) and the lowest proportion was in the Mid-Western Mountains (58 percent). The literacy rate was higher among urban young woman than rural young woman (95 percent compared to 82 percent). Household wealth was also correlated with literacy: 80 percent of young women in the poorest household population were literate compared to 98 percent in the richest household population. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014166 School Readiness Attendance in preschool education is important for the readiness of children for first grade in primary school. Table ED.2 shows the proportion of children in the first grade of primary school (regardless of age) who had attended preschool in the previous year1. Overall, 74 percent of children who were currently attending the first grade of primary school had attended preschool in the previous year. Regionally, the highest proportion was in the Western Hills (91 percent) and lowest was in the Mid- Western Mountains (44 percent). Urban children were more likely than rural children to have attended preschool (84 percent compared to 73 percent). Mother’s education and household wealth status were strongly associated with the likelihood of having attended preschool. 1Computation of the indicator does not exclude repeaters and, therefore, is inclusive of both children who were attending primary school for the first time as well as those who were in the first grade of primary school in the previous school year and were repeating. Children repeating may have attended preschool prior to the school year during which they attended the first grade of primary school for the first time; these children were not captured in the numerator of the indicator. Table ED.1: Literacy (young women) Percentage of women aged 15–24 years who are literate, Nepal, 2014 Percent literate [1] Percent not known Number of women aged 15–24 years Total 84.0 0.2 5,123 Region Eastern Mountains 90.4 0.0 77 Eastern Hills 93.9 0.0 329 Eastern Terai 80.3 0.4 699 Central Mountains 86.9 0.0 101 Central Hills 92.5 0.0 771 Central Terai 69.1 0.0 807 Western Mountains 84.2 0.0 2 Western Hills 97.9 0.0 583 Western Terai 80.9 1.2 454 Mid-Western Mountains 58.3 0.0 71 Mid-Western Hills 83.2 0.0 332 Mid-Western Terai 78.3 0.3 341 Far Western Mountains 80.5 0.3 78 Far Western Hills 78.5 0.1 183 Far Western Terai 92.5 0.3 295 Area Urban 94.9 0.0 956 Kathmandu valley 97.1 0.0 278 Other urban 94.0 0.0 678 Rural 81.5 0.2 4,167 Education None 4.5 0.0 617 Primary 62.1 1.7 610 Secondary 100.0 0.0 2,300 Higher 100.0 0.0 1,596 Age (years) 15–19 88.3 0.2 2,721 20–24 79.1 0.2 2,402 Wealth index quintile Poorest 79.5 0.0 947 Second 79.8 0.5 984 Middle 72.5 0.1 1,005 Fourth 88.3 0.4 1,126 Richest 98.0 0.0 1,061 [1] MICS indicator 7.1; MDG indicator 2.3 – Literacy rate among young women NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 167 Primary and Secondary School Participation Universal access to basic education and achievement of primary education is one of the MDGs. Education is a vital prerequisite for combating poverty, empowering women, protecting children from exploitative labour and sexual exploitation, promoting human rights and democracy, protecting the environment, and influencing population growth. In Nepal, children currently enter primary school at age 5 and secondary school at age 10. There are five grades in primary school and five grades in secondary school. The school year runs from April of one year to March of the following year, with some variation from district to district due to seasonal and regional factors. The current School Sector Reform Programme includes plans for restructuring the education system from the former approach of primary (Grades 1–5) and three levels of secondary (Lower Secondary: Grades 6–8; Secondary: Grades 9–10; and Higher Secondary: Grades 11–12) to a system of early childhood development, basic education (Grades 1–8) and secondary education (Grades 9–12). For the Nepal MICS 2014, analysis of education indicators were aligned to the age Table ED.2: School readiness Percentage of children attending first grade of primary school who attended preschool the previous year, Nepal, 2014 Percent of children attending first grade who attended preschool in the previous year [1] Number of children attending first grade of primary school Total 74.2 1,570 Sex Male 75.1 821 Female 73.2 749 Region Eastern Mountains 76.9 24 Eastern Hills 90.6 79 Eastern Terai 77.6 231 Central Mountains 68.6 29 Central Hills 81.2 155 Central Terai 64.5 340 Western Mountains (*) 1 Western Hills 90.7 151 Western Terai 75.8 142 Mid-Western Mountains 44.0 33 Mid-Western Hills 68.8 132 Mid-Western Terai 77.2 80 Far Western Mountains 62.3 45 Far Western Hills 69.9 69 Far Western Terai 71.1 59 Area Urban 84.2 188 Kathmandu valley (80.2) 50 Other urban 85.7 138 Rural 72.8 1,382 Mother's education None 65.5 900 Primary 79.6 249 Secondary 90.3 247 Higher 91.5 164 Mother not in household (*) 8 Wealth index quintile Poorest 67.8 417 Second 73.0 289 Middle 73.4 346 Fourth 74.5 314 Richest 90.0 204 [1] MICS indicator 7.2 – School readiness Note: 1 case of missing ‘mother’s education’ not shown ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014168 ranges and school grades outlined in the International Standard Classification of Education (ISCED). Primary-school age is considered to be 5–9 years and covers five grades in Nepal. Secondary-school age is 10–16 years, covering seven grades. Owing to these changes in the primary- and secondary- school age classifications from those used in the Nepal MICS 2010, the results between the two survey reports are not strictly comparable.2 It should also be noted that the values of the education indicators in the Nepal MICS 2014 differ quite substantially from those reported by the Government of Nepal’s Education Management Information System (EMIS) and further investigation into the causes of these discrepancies is required. Table ED.3 shows that, of children who were of primary-school entry-age (i.e., age 5 at the beginning of the school year), 42 percent were attending the first grade of primary school.3 The highest proportion of children in this age group attending first grade was in the Western Hills (62 percent) and the lowest proportion was in the Central Terai (28 percent). Household wealth status was not correlated with the likelihood of children in this age group were attending first grade, ranging from 33 percent of those living in households in the middle quintile to 52 percent of those living in households in the poorest quintile; notably, the proportion of children in this age group who were living in households in the poorest wealth quintile and were attending first grade were nine percentage points higher than that of their counterparts living in the richest households (52 percent compared to 43 percent). Table ED.4 provides information on the percentage of children of primary-school age (5–9 years) who were attending primary or secondary school4 and those who were out of school. The majority of children of primary-school age were attending school (76 percent). However, 23 percent were out of school, although this is primarily due to a low attendance rate (44 percent) for children age 5 at the beginning of the school year, who appear to be starting school late, as seen by the relatively high percentage attending preschool. Regionally, the primary school net attendance ratio was highest in the Western Hills (89 percent) and lowest in the Central Terai (64 percent). Younger children had lower primary school net attendance ratios than older children, and were more likely to be in preschool or out of school. Mother’s education was positively correlated with primary school attendance ratios: 74 percent of children whose mother had no education attended school compared to 81 percent of children whose mother had higher education. The secondary school net attendance ratio is presented in Table ED.55. Among children of secondary- school age in Nepal, nearly two-thirds (62 percent) were attending secondary school or higher. Some 27 percent were still in primary school and 11 percent were out of school. Regionally, the secondary school net attendance ratio was highest in the Central Hills (74 percent) and lowest in the Central Terai (51 percent). The secondary school net attendance ratio was higher in urban areas than rural areas (74 percent compared to 60 percent). Younger children had lower net attendance ratios for secondary school than older children, and were more likely to be in primary school. However, older children were more likely to be out of school, with some 22 percent of children who started the school year at age 16 out of school. Mother’s education and household wealth status were both positively correlated with secondary school attendance ratios. 2 The Nepal MICS 2010 showed 58 percent of children in the Mid- and Far Western Regions who were of primary-school entry-age were attending Grade 1. However, if age 5 is used as the primary-school entry-age (as in the Nepal MICS 2014 analysis), this estimate would be brought down to 40 percent. 3 The Flash Report 2014/15 of the Ministry of Education (MoE) suggests that the net intake rate in Grade 1 for 2013/14 was 93 percent, which is more than double the estimate found in this survey. It is worth noting that whilst the primary school net intake rate found by the Nepal MICS 2014 is much lower than expected when compared to administrative sources, the situation is very similar in neighboring South Asian countries; in the most recent MICS undertaken in Bangladesh and the Pakistan Provinces of Punjab and Sindh, the rates were below 34 percent. The Nepal MICS was conducted just before the end of the school year, so most children who were age 5 at the beginning of the school year in April 2013 had turned age 6 by the start of the survey in February 2014 and were therefore excluded from the analysis. The finding shows 57 percent of six-year-olds were attending first grade. 4 Ratios presented in this table are ‘adjusted’ since they include not only primary school attendance, but also secondary school attendance in the numerator. 5 Ratios presented in this table are ‘adjusted’ since they include not only secondary school attendance, but also attendance in higher levels in the numerator. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 169 Table ED.3: Primary school entry Percentage of children of primary-school entry-age entering Grade 1 (net intake rate), Nepal, 2014 Percent of children of primary-school entry-age entering Grade 1 [1] Number of children of primary-school entry-age Total 41.6 1,249 Sex Male 40.2 626 Female 43.1 623 Region Eastern Mountains 49.4 19 Eastern Hills 61.1 63 Eastern Terai 37.2 152 Central Mountains (52.4) 15 Central Hills 48.1 155 Central Terai 27.6 295 Western Mountains (*) 0 Western Hills 61.6 107 Western Terai 41.3 102 Mid-Western Mountains 39.9 26 Mid-Western Hills 44.9 105 Mid-Western Terai 33.9 72 Far Western Mountains 52.8 28 Far Western Hills 45.3 54 Far Western Terai 40.9 55 Area Urban 43.0 161 Kathmandu valley (45.5) 45 Other urban 42.1 116 Rural 41.4 1,087 Mother's education None 40.2 681 Primary 45.1 207 Secondary 40.9 199 Higher 44.9 152 Mother not in household (*) 5 Wealth index quintile Poorest 52.1 294 Second 41.1 280 Middle 33.3 262 Fourth 37.8 243 Richest 42.9 169 [1] MICS indicator 7.3 – Net intake rate in primary education Note: 3 cases of missing ‘mother’s education’ not shown ( ) Figures that are based on 25–49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases The retention/drop-out/survival rate is an extremely important basic indicator to show the performance of an education system; at the same time, it shows the system’s efficiency and effectiveness. Due to methodological limitations of calculating these rates from survey data this is perhaps one of the few indicators that routine administrative data can provide a better idea about than survey data in Nepal. Nepal has a robust education information system that provides annual estimation on survival rates, therefore the two MICS tables (children reaching last grade of primary school, and primary school completion and transition to secondary school) have not been included in this report. The ratio of girls to boys attending primary and secondary education is provided in Table ED.6. These ratios are better known as the gender parity index (GPI). It should be noted that the ratios included here are obtained from net attendance ratios rather than gross attendance ratios. The latter provide an erroneous description of the GPI mainly because the majority of over-age children attending primary education tend to be boys. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014170 Ta bl e ED .4 : P rim ar y sc ho ol a tte nd an ce a nd o ut -o f-s ch oo l c hi ld re n Pe rc en ta ge o f c hil dr en o f p rim ar y- sc ho ol ag e at te nd ing p rim ar y o r s ec on da ry sc ho ol (a dju ste d ne t a tte nd an ce ra tio ), pe rc en ta ge a tte nd ing p re sc ho ol, a nd p er ce nt ag e ou t o f s ch oo l, N ep al, 2 01 4 M ale Fe m ale To ta l Ne t at te n- da nc e ra tio (a dju st- ed ) [ 1] Pe rc en t o f c hil dr en : Nu m be r of ch ild re n Ne t at te n- da nc e ra tio (a dju st- ed ) [ 1] Pe rc en t o f c hil dr en : Nu m be r of ch ild re n Ne t at te n- da nc e ra tio (a dju st- ed ) [ 1] Pe rc en t o f c hil dr en : Nu m be r of ch ild re n No t at te nd ing sc ho ol or pr e- sc ho ol At te nd ing pr e- sc ho ol Ou t o f sc ho ol [a ] No t at te nd ing sc ho ol or pr e- sc ho ol At te nd ing pr e- sc ho ol Ou t o f sc ho ol [a ] No t at te nd ing sc ho ol or pr e- sc ho ol At te nd ing pr e- sc ho ol Ou t o f sc ho ol [a ] To ta l 76 .4 6. 1 16 .7 22 .8 3, 30 3 76 .2 8. 3 14 .8 23 .0 3, 30 7 76 .3 7. 2 15 .7 22 .9 6, 61 0 Re gi on Ea ste rn M ou nt ain s 80 .9 11 .1 8. 0 19 .1 42 79 .9 7. 5 12 .2 19 .6 50 80 .4 9. 1 10 .3 19 .4 92 Ea ste rn H ills 85 .3 1. 5 12 .5 14 .0 16 7 87 .9 2. 7 9. 1 11 .7 14 9 86 .5 2. 1 10 .9 12 .9 31 6 Ea ste rn T er ai 77 .8 5. 2 16 .0 21 .3 46 2 75 .6 9. 5 13 .8 23 .3 50 7 76 .7 7. 5 14 .9 22 .3 96 9 Ce nt ra l M ou nt ain s 79 .0 1. 4 16 .5 17 .9 52 86 .3 1. 4 12 .3 13 .7 55 82 .7 1. 4 14 .3 15 .7 10 7 Ce nt ra l H ills 83 .2 2. 4 14 .4 16 .8 38 3 83 .3 1. 6 14 .1 15 .7 37 2 83 .3 2. 0 14 .3 16 .2 75 5 Ce nt ra l T er ai 64 .4 11 .8 22 .4 34 .2 73 7 63 .3 17 .7 18 .5 36 .2 72 4 63 .8 14 .7 20 .4 35 .2 1, 46 0 W es te rn M ou nt ain s (7 8. 5) (4 .1 ) (1 4. 5) (1 8. 6) 1 (9 0. 0) (0 .0 ) (1 0. 0) (1 0. 0) 1 83 .5 2. 4 12 .5 14 .9 2 W es te rn H ills 88 .5 2. 4 9. 1 11 .5 34 1 89 .5 0. 6 9. 3 10 .0 29 9 89 .0 1. 6 9. 2 10 .8 64 0 W es te rn T er ai 78 .8 4. 0 17 .2 21 .2 27 4 73 .0 5. 2 21 .7 27 .0 24 1 76 .1 4. 6 19 .3 23 .9 51 5 M id- W es te rn M ou nt ain s 71 .0 10 .1 15 .9 26 .0 65 77 .4 9. 9 11 .3 21 .2 56 73 .9 10 .0 13 .8 23 .8 12 1 M id- W es te rn H ills 76 .7 6. 0 15 .6 21 .6 25 0 80 .6 6. 9 10 .9 17 .8 28 0 78 .8 6. 5 13 .1 19 .6 53 0 M id- W es te rn T er ai 68 .0 4. 4 27 .6 32 .0 17 0 72 .1 7. 2 19 .6 26 .9 22 1 70 .3 6. 0 23 .1 29 .1 39 0 Fa r W es te rn M ou nt ain s 83 .1 5. 5 10 .5 15 .9 76 84 .9 5. 1 9. 7 14 .8 83 84 .0 5. 3 10 .1 15 .4 15 9 Fa r W es te rn H ills 73 .4 12 .6 11 .9 24 .6 13 3 77 .1 12 .7 9. 9 22 .5 12 6 75 .2 12 .6 10 .9 23 .6 25 9 Fa r W es te rn T er ai 80 .2 3. 1 16 .3 19 .4 15 0 77 .0 4. 7 17 .8 22 .5 14 3 78 .7 3. 9 17 .1 20 .9 29 3 Ar ea Ur ba n 80 .4 1. 1 18 .1 19 .2 44 4 78 .9 2. 5 18 .0 20 .5 41 7 79 .7 1. 8 18 .0 19 .9 86 1 Ka th m an du va lle y 83 .1 1. 3 15 .5 16 .9 10 3 81 .5 0. 0 18 .5 18 .5 11 5 82 .2 0. 6 17 .1 17 .8 21 8 Ot he r u rb an 79 .6 1. 1 18 .9 20 .0 34 1 77 .9 3. 5 17 .7 21 .3 30 2 78 .8 2. 2 18 .3 20 .6 64 3 Ru ra l 75 .8 6. 9 16 .4 23 .3 2, 85 9 75 .8 9. 1 14 .3 23 .4 2, 89 0 75 .8 8. 0 15 .4 23 .4 5, 74 9 Ag e at b eg in ni ng o f s ch oo l ye ar 5 41 .9 13 .3 42 .6 55 .8 62 6 46 .7 19 .3 31 .6 51 .0 62 3 44 .3 16 .3 37 .1 53 .4 1, 24 9 6 70 .0 7. 9 21 .6 29 .5 71 7 66 .3 9. 8 23 .3 33 .1 69 5 68 .2 8. 8 22 .5 31 .3 1, 41 2 7 85 .3 4. 6 9. 3 14 .0 65 8 83 .5 4. 9 11 .6 16 .5 65 7 84 .4 4. 8 10 .5 15 .3 1, 31 5 8 89 .2 2. 1 8. 3 10 .4 58 7 89 .0 4. 8 5. 5 10 .3 61 2 89 .1 3. 5 6. 9 10 .3 1, 19 9 9 94 .2 2. 8 2. 6 5. 4 71 5 93 .9 3. 2 2. 8 5. 9 72 1 94 .1 3. 0 2. 7 5. 7 1, 43 6 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 171 Ta bl e ED .4 : P rim ar y sc ho ol a tte nd an ce a nd o ut -o f-s ch oo l c hi ld re n Pe rc en ta ge o f c hil dr en o f p rim ar y- sc ho ol ag e at te nd ing p rim ar y o r s ec on da ry sc ho ol (a dju ste d ne t a tte nd an ce ra tio ), pe rc en ta ge a tte nd ing p re sc ho ol, a nd p er ce nt ag e ou t o f s ch oo l, N ep al, 2 01 4 M ale Fe m ale To ta l Ne t at te n- da nc e ra tio (a dju st- ed ) [ 1] Pe rc en t o f c hil dr en : Nu m be r of ch ild re n Ne t at te n- da nc e ra tio (a dju st- ed ) [ 1] Pe rc en t o f c hil dr en : Nu m be r of ch ild re n Ne t at te n- da nc e ra tio (a dju st- ed ) [ 1] Pe rc en t o f c hil dr en : Nu m be r of ch ild re n No t at te nd ing sc ho ol or pr e- sc ho ol At te nd ing pr e- sc ho ol Ou t o f sc ho ol [a ] No t at te nd ing sc ho ol or pr e- sc ho ol At te nd ing pr e- sc ho ol Ou t o f sc ho ol [a ] No t at te nd ing sc ho ol or pr e- sc ho ol At te nd ing pr e- sc ho ol Ou t o f sc ho ol [a ] M ot he r's e du ca tio n No ne 74 .6 9. 2 15 .1 24 .3 1, 89 9 73 .9 13 .0 12 .2 25 .2 1, 90 0 74 .2 11 .1 13 .6 24 .7 3, 79 9 Pr im ar y 79 .2 3. 7 16 .5 20 .2 49 4 77 .8 2. 5 19 .7 22 .2 54 7 78 .4 3. 1 18 .2 21 .2 1, 04 0 Se co nd ar y 79 .0 1. 3 19 .5 20 .7 55 3 79 .8 2. 0 17 .8 19 .8 51 8 79 .4 1. 6 18 .7 20 .3 1, 07 1 Hi gh er 76 .9 0. 2 22 .3 22 .5 33 4 82 .8 0. 1 16 .4 16 .5 31 4 79 .8 0. 2 19 .4 19 .6 64 8 M ot he r n ot in h ou se ho ld (*) (*) (*) (*) 21 (*) (*) (*) (*) 25 (8 0. 9) (3 .9 ) (1 0. 9) (1 4. 8) 45 W ea lth in de x qu in til e Po or es t 79 .2 8. 2 11 .5 19 .7 82 6 82 .4 7. 9 9. 0 16 .9 78 1 80 .7 8. 0 10 .3 18 .3 1, 60 7 Se co nd 74 .5 8. 7 15 .1 23 .8 67 0 72 .5 15 .8 11 .0 26 .8 77 2 73 .5 12 .5 12 .9 25 .4 1, 44 3 M idd le 71 .5 8. 1 20 .1 28 .1 71 4 71 .2 8. 6 19 .0 27 .6 68 0 71 .4 8. 3 19 .6 27 .9 1, 39 4 Fo ur th 76 .0 2. 6 21 .2 23 .7 60 4 73 .5 4. 7 20 .9 25 .6 61 2 74 .7 3. 6 21 .0 24 .7 1, 21 6 Ri ch es t 81 .9 0. 7 16 .8 17 .5 48 9 83 .0 0. 5 16 .6 17 .0 46 2 82 .4 0. 6 16 .7 17 .3 95 1 [1 ] M IC S in di ca to r 7 .4 ; M DG in di ca to r 2 .1 – P rim ar y sc ho ol n et a tte nd an ce ra tio (a dj us te d) [a ] T he p er ce nt ag e of ch ild re n of p rim ar y- sc ho ol ag e ou t o f s ch oo l a re th os e no t a tte nd ing sc ho ol an d th os e at te nd ing p re sc ho ol ( ) F igu re s t ha t a re b as ed o n 25 –4 9 un we igh te d ca se s (*) F igu re s t ha t a re b as ed o n fe we r t ha n 25 u nw eig ht ed ca se s C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014172 Ta bl e ED .5 : S ec on da ry s ch oo l a tte nd an ce a nd o ut -o f-s ch oo l c hi ld re n Pe rc en ta ge o f c hil dr en o f s ec on da ry -s ch oo l a ge a tte nd ing se co nd ar y s ch oo l o r h igh er (a dju ste d ne t a tte nd an ce ra tio ), pe rc en ta ge a tte nd ing p rim ar y s ch oo l, a nd p er ce nt ag e ou t o f s ch oo l, N ep al, 2 01 4 M ale Fe m ale To ta l Ne t at te nd an ce ra tio (a dju ste d) [1 ] Pe rc en t o f c hil dr en : Nu m be r o f ch ild re n Ne t at te nd an ce ra tio (a dju ste d) [1 ] Pe rc en t o f c hil dr en : Nu m be r o f ch ild re n Ne t at te nd an ce ra tio (a dju ste d) [1 ] Pe rc en t o f c hil dr en : Nu m be r o f ch ild re n At te nd ing pr im ar y sc ho ol Ou t o f sc ho ol [a ] At te nd ing pr im ar y sc ho ol Ou t o f sc ho ol [a ] At te nd ing pr im ar y sc ho ol Ou t o f sc ho ol [a ] To ta l 62 .4 28 .1 9. 3 4, 63 6 62 .3 25 .4 12 .1 4, 77 6 62 .3 26 .7 10 .7 9, 41 1 Re gi on Ea ste rn M ou nt ain s 56 .2 36 .1 7. 6 67 59 .7 34 .3 6. 0 77 58 .1 35 .2 6. 8 14 5 Ea ste rn H ills 66 .7 23 .4 9. 0 25 7 73 .0 21 .0 6. 0 27 1 69 .9 22 .2 7. 5 52 8 Ea ste rn T er ai 60 .6 27 .6 11 .4 63 0 57 .9 24 .9 16 .8 65 3 59 .2 26 .3 14 .2 1, 28 3 Ce nt ra l M ou nt ain s 61 .7 32 .4 5. 9 97 70 .3 23 .2 6. 5 10 2 66 .1 27 .7 6. 2 20 0 Ce nt ra l H ills 73 .3 18 .5 8. 2 61 9 75 .0 18 .8 6. 2 60 9 74 .2 18 .7 7. 2 1, 22 7 Ce nt ra l T er ai 54 .1 32 .6 13 .1 81 7 47 .6 27 .7 24 .7 83 3 50 .8 30 .1 19 .0 1, 65 0 W es te rn M ou nt ain s (6 4. 4) (2 8. 5) (7 .1 ) 1 (6 6. 1) (2 4. 5) (9 .4 ) 1 65 .3 26 .3 8. 4 2 W es te rn H ills 70 .3 24 .6 4. 4 49 7 75 .2 19 .6 5. 3 56 2 72 .9 21 .9 4. 9 1, 05 9 W es te rn T er ai 56 .8 32 .9 10 .3 44 6 53 .7 32 .0 14 .4 41 7 55 .3 32 .4 12 .3 86 3 M id- W es te rn M ou nt ain s 59 .0 35 .5 5. 5 69 55 .6 36 .0 8. 3 67 57 .3 35 .8 6. 9 13 6 M id- W es te rn H ills 63 .0 27 .8 9. 2 31 1 65 .5 25 .0 8. 7 37 0 64 .3 26 .3 9. 0 68 1 M id- W es te rn T er ai 54 .2 30 .4 15 .1 31 3 61 .7 25 .4 13 .0 28 4 57 .7 28 .0 14 .1 59 7 Fa r W es te rn M ou nt ain s 64 .4 33 .2 2. 4 97 62 .0 33 .3 4. 7 98 63 .2 33 .3 3. 6 19 5 Fa r W es te rn H ills 60 .3 35 .7 4. 1 15 9 51 .6 41 .4 7. 1 19 8 55 .4 38 .8 5. 7 35 6 Fa r W es te rn T er ai 69 .3 26 .7 4. 0 25 7 70 .5 22 .3 6. 5 23 3 69 .9 24 .6 5. 2 48 9 Ar ea Ur ba n 73 .4 19 .4 7. 2 74 9 75 .1 18 .7 5. 9 63 3 74 .2 19 .1 6. 6 1, 38 2 Ka th m an du va lle y 73 .8 14 .6 11 .6 19 3 79 .2 13 .9 6. 9 14 3 76 .1 14 .3 9. 6 33 6 Ot he r u rb an 73 .3 21 .0 5. 7 55 7 73 .9 20 .2 5. 6 48 9 73 .6 20 .6 5. 6 1, 04 6 Ru ra l 60 .2 29 .8 9. 7 3, 88 6 60 .4 26 .4 13 .1 4, 14 3 60 .3 28 .1 11 .4 8, 02 9 Ag e at b eg in ni ng o f s ch oo l y ea r 10 22 .6 71 .8 5. 7 66 3 23 .6 70 .6 5. 7 72 3 23 .1 71 .2 5. 7 1, 38 6 11 44 .1 53 .6 2. 0 74 8 46 .5 47 .7 5. 6 64 4 45 .2 50 .9 3. 7 1, 39 2 12 57 .5 36 .9 4. 7 68 8 65 .6 28 .0 6. 2 78 0 61 .8 32 .2 5. 5 1, 46 9 13 77 .5 14 .6 7. 9 69 8 72 .5 15 .6 11 .9 74 5 74 .9 15 .1 9. 9 1, 44 3 14 80 .7 7. 0 12 .0 68 8 78 .2 7. 1 14 .2 65 5 79 .5 7. 0 13 .1 1, 34 3 15 80 .3 2. 8 16 .7 59 0 78 .5 1. 7 19 .6 63 9 79 .4 2. 2 18 .2 1, 22 9 16 79 .5 0. 9 19 .6 56 0 74 .5 0. 6 24 .6 59 0 77 .0 0. 8 22 .1 1, 14 9 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 173 Ta bl e ED .5 : S ec on da ry s ch oo l a tte nd an ce a nd o ut -o f-s ch oo l c hi ld re n Pe rc en ta ge o f c hil dr en o f s ec on da ry -s ch oo l a ge a tte nd ing se co nd ar y s ch oo l o r h igh er (a dju ste d ne t a tte nd an ce ra tio ), pe rc en ta ge a tte nd ing p rim ar y s ch oo l, a nd p er ce nt ag e ou t o f s ch oo l, N ep al, 2 01 4 M ale Fe m ale To ta l Ne t at te nd an ce ra tio (a dju ste d) [1 ] Pe rc en t o f c hil dr en : Nu m be r o f ch ild re n Ne t at te nd an ce ra tio (a dju ste d) [1 ] Pe rc en t o f c hil dr en : Nu m be r o f ch ild re n Ne t at te nd an ce ra tio (a dju ste d) [1 ] Pe rc en t o f c hil dr en : Nu m be r o f ch ild re n At te nd ing pr im ar y sc ho ol Ou t o f sc ho ol [a ] At te nd ing pr im ar y sc ho ol Ou t o f sc ho ol [a ] At te nd ing pr im ar y sc ho ol Ou t o f sc ho ol [a ] M ot he r's e du ca tio n No ne 56 .5 32 .3 11 .1 2, 99 3 56 .6 29 .6 13 .6 3, 02 4 56 .5 30 .9 12 .3 6, 01 6 Pr im ar y 68 .2 25 .4 6. 4 61 9 72 .7 23 .2 3. 9 60 8 70 .4 24 .3 5. 2 1, 22 7 Se co nd ar y 77 .2 19 .9 2. 1 49 2 77 .6 21 .0 1. 3 49 9 77 .4 20 .4 1. 7 99 2 Hi gh er 76 .5 22 .2 0. 6 31 7 81 .6 17 .3 1. 1 29 2 78 .9 19 .9 0. 9 60 9 Ca nn ot b e de te rm ine d [b ] 73 .2 5. 1 21 .8 21 4 55 .2 6. 2 38 .3 35 0 62 .0 5. 8 32 .0 56 4 W ea lth in de x qu in til e Po or es t 55 .7 34 .2 9. 8 1, 03 3 56 .8 32 .1 10 .9 1, 14 7 56 .3 33 .1 10 .4 2, 17 9 Se co nd 55 .9 31 .1 12 .6 1, 00 8 55 .0 27 .4 17 .5 98 8 55 .4 29 .2 15 .0 1, 99 6 M idd le 58 .9 30 .2 10 .5 92 7 58 .7 23 .2 17 .8 98 6 58 .8 26 .6 14 .3 1, 91 3 Fo ur th 67 .8 25 .5 6. 7 89 6 66 .0 24 .8 9. 2 93 7 66 .9 25 .1 8. 0 1, 83 3 Ri ch es t 77 .6 16 .6 5. 8 77 2 81 .3 16 .0 2. 7 71 8 79 .4 16 .3 4. 3 1, 49 0 [1 ] M IC S in di ca to r 7 .5 – S ec on da ry s ch oo l n et a tte nd an ce ra tio (a dj us te d) [a ] T he p er ce nt ag e of ch ild re n of se co nd ar y- sc ho ol ag e ou t o f s ch oo l a re th os e wh o ar e no t a tte nd ing p rim ar y, se co nd ar y, or h igh er e du ca tio n [b ] C hil dr en a ge d 15 ye ar s o r h igh er a t t he tim e of th e int er vie w wh os e m ot he rs w er e no t li vin g in th e ho us eh old ( ) F igu re s t ha t a re b as ed o n 25 –4 9 un we igh te d ca se s C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014174 Table ED.6: Education gender parity Ratio of adjusted net attendance ratios of girls to boys, in primary and secondary school, Nepal, 2014 Primary school adjusted net attendance ratio (NAR), girls Primary school adjusted net attendance ratio (NAR), boys Gender parity index (GPI) for primary school adjusted NAR [1] Secondary school adjusted net attendance ratio (NAR), girls Secondary school adjusted net attendance ratio (NAR), boys Gender parity index (GPI) for secondary school adjusted NAR [2] Total 76.2 76.4 1.00 62.3 62.4 1.00 Region Eastern Mountains 79.9 80.9 0.99 59.7 56.2 1.06 Eastern Hills 87.9 85.3 1.03 73.0 66.7 1.09 Eastern Terai 75.6 77.8 0.97 57.9 60.6 0.96 Central Mountains 86.3 79.0 1.09 70.3 61.7 1.14 Central Hills 83.3 83.2 1.00 75.0 73.3 1.02 Central Terai 63.3 64.4 0.98 47.6 54.1 0.88 Western Mountains 90.0 78.5 1.15 66.1 64.4 1.03 Western Hills 89.5 88.5 1.01 75.2 70.3 1.07 Western Terai 73.0 78.8 0.93 53.7 56.8 0.94 Mid-Western Mountains 77.4 71.0 1.09 55.6 59.0 0.94 Mid-Western Hills 80.6 76.7 1.05 65.5 63.0 1.04 Mid-Western Terai 72.1 68.0 1.06 61.7 54.2 1.14 Far Western Mountains 84.9 83.1 1.02 62.0 64.4 0.96 Far Western Hills 77.1 73.4 1.05 51.6 60.3 0.86 Far Western Terai 77.0 80.2 0.96 70.5 69.3 1.02 Area Urban 78.9 80.4 0.98 75.1 73.4 1.02 Kathmandu valley 81.5 83.1 0.98 79.2 73.8 1.07 Other urban 77.9 79.6 0.98 73.9 73.3 1.01 Rural 75.8 75.8 1.00 60.4 60.2 1.00 Mother's education None 73.9 74.6 0.99 56.6 56.5 1.00 Primary 77.8 79.2 0.98 72.7 68.2 1.07 Secondary 79.8 79.0 1.01 77.6 77.2 1.01 Higher 82.8 76.9 1.08 81.6 76.5 1.07 Cannot be determined [a] 70.4 93.3 0.75 55.2 73.2 0.75 Wealth index quintile Poorest 82.4 79.2 1.04 56.8 55.7 1.02 Second 72.5 74.5 0.97 55.0 55.9 0.98 Middle 71.2 71.5 1.00 58.7 58.9 1.00 Fourth 73.5 76.0 0.97 66.0 67.8 0.97 Richest 83.0 81.9 1.01 81.3 77.6 1.05 [1] MICS indicator 7.9; MDG indicator 3.1 – Gender parity index (primary school) [2] MICS indicator 7.10; MDG indicator 3.1 – Gender parity index (secondary school) [a] Children aged 15 years or higher at the time of the interview whose mother was not living in the household The GPI for both primary and secondary school was 1.00, indicating no difference in the attendance of girls and boys at primary and secondary school. Regionally, the primary GPI was highest in the Western Mountains (1.15) and lowest in the Western Terai (0.93), and the secondary GPI was highest in the Central Mountains and Mid-Western Terai (1.14) and lowest in the Far Western Hills (0.86). The primary GPI was higher for rural children than urban children, and the secondary GPI was lower for rural children than urban children. Mother’s education had little correlation at primary level, but the secondary GPI was higher for children whose mother had primary or higher education (1.07). NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 175 Information on the percentage of girls in the total out-of-school population, in both primary and secondary school, is provided in Table ED.7. Girls accounted for 50 percent of the out-of-school population at primary level and 57 percent at secondary level. Regionally, the highest proportion was in the Eastern Mountains for primary level (55 percent) and in the Central Terai for secondary level (66 percent). The proportions were same for urban girls and rural girls at primary level, but higher for rural girls than for urban girls at secondary level. Interestingly, girls living in households in lower wealth quintiles made up a smaller proportion of the out-of-school population at primary level; this was not apparent at secondary level. Table ED.7: Out-of-school gender parity Percentage of girls in total out-of-school population, in primary and secondary school, Nepal, 2014 Primary school Secondary school Percentage of out-of- school children Number of children of primary school age Percentage of girls in the total out-of- school population of primary school age Number of children of primary school age out of school Percentage of out-of- school children Number of children of secondary school age Percentage of girls in the total out- of-school population of secondary school age Number of children of secondary school age out of schoo Total 22.9 6,610 50.3 1,514 10.7 9,411 57.3 1009 Region Eastern Mountains 19.4 92 54.7 18 6.8 145 (47.6) 10 Eastern Hills 12.9 316 (42.9) 41 7.5 528 (41.4) 39 Eastern Terai 22.3 969 54.6 216 14.2 1,283 60.3 182 Central Mountains 15.7 107 (45.0) 17 6.2 200 (53.9) 12 Central Hills 16.2 755 47.6 123 7.2 1,227 42.5 88 Central Terai 35.2 1,460 51.0 514 19.0 1,650 65.8 313 Western Mountains 14.9 2 - 0 8.4 2 - 0 Western Hills 10.8 640 (43.1) 69 4.9 1,059 (57.4) 52 Western Terai 23.9 515 52.9 123 12.3 863 56.6 106 Mid-Western Mountains 23.8 121 41.2 29 6.9 136 (59.3) 9 Mid-Western Hills 19.6 530 48.0 104 9.0 681 52.8 61 Mid-Western Terai 29.1 390 52.3 114 14.1 597 43.8 84 Far Western Mountains 15.4 159 50.4 24 3.6 195 (66.1) 7 Far Western Hills 23.6 259 46.5 61 5.7 356 (68.3) 20 Far Western Terai 20.9 293 52.4 61 5.2 489 (59.8) 25 Area Urban 19.9 861 50.0 171 6.6 1,382 40.7 91 Kathmandu valley 17.8 218 (55.2) 39 9.6 336 (30.7) 32 Other urban 20.6 643 48.5 132 5.6 1,046 46.3 59 Rural 23.4 5,749 50.4 1,343 11.4 8,029 59.0 918 Mother's education None 24.7 3,799 51.0 940 12.3 6,016 55.3 741 Primary 21.2 1,040 54.9 221 5.2 1,227 37.7 63 Secondary 20.3 1,071 47.2 217 1.7 992 (*) 17 Higher 19.6 648 40.8 127 0.9 609 (*) 5 Cannot be determined [a] (14.8) 45 (*) 7 32.0 564 74.2 181 Wealth index quintile Poorest 18.3 1,607 44.9 295 10.4 2,179 55.2 226 Second 25.4 1,443 56.4 367 15.0 1,996 57.6 300 Middle 27.9 1,394 48.3 389 14.3 1,913 64.4 273 Fourth 24.7 1,216 52.2 300 8.0 1,833 58.8 146 Richest 17.3 951 47.9 164 4.3 1,490 (30.2) 64 [a] Children aged 15 years or higher at the time of the interview whose mother was not living in the household Note: 6 cases of missing ‘mother’s education’ not shown ( ) Figures that are based on 25–49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014176 Participation in Non-Formal Education The Government of Nepal runs a number of non-formal education programmes to provide out-of- school children with learning opportunities, with the intention of giving them a pathway into mainstream education. Country-specific data were collected on participation by children aged 5–17 years in non- formal education, as shown in Table ED.8. The survey found show that some 6 percent of children had never had any formal education. Of these, 2 percent had participated in non-formal education. Girls were more likely than boys to have never had formal education but also to have participated in Figure ED.1 brings together all of the attendance- and progression-related education indicators covered in this chapter, by sex. Information on attendance in ECD is also included, which was covered in Chapter 9, in Table CD.1. School readiness was reported for three-quarters of children with little difference between boys and girls. Only half of children attended ECD (slightly higher among boys than girls). Net intake rate in Grade 1 indicates that two out of every five children were enrolled in Grade 1 at age 5, the official entry-age for school; no notable difference existed between boys and girls in this respect. Primary school attendance was the same for boys and girls, at 76 percent. Of children attending the last grade of primary school during the previous school year, most transitioned to secondary school. However, only three in five children of secondary-school age actually attended secondary school. Figure ED.1: Education indicators by sex, Nepal, 2014 School readiness 75 73 Net intake rate in primary education Transition rate to secondary school 40 43 97 98 Attendance to early childhood education Primary school attendance Secondary school attendance 52 49 76 76 62 62 Boys Girls Note: All indicator values are in percent NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 177 Table ED.8: Participation in non-formal education Percentage of children aged 5–17 years who have participated in non-formal education among those who have never attended formal education, Nepal, 2014 Percent of children who have never had formal education Number of children aged 5–17 years Percent of children who have participated in non- formal education Number of children aged 5–17 years who have never attended formal education Total 5.5 17,147 1.5 944 Sex Male 4.4 8,511 1.4 374 Female 6.6 8,636 1.6 570 Region Eastern Mountains 4.5 254 (0.0) 11 Eastern Hills 1.2 925 (*) 11 Eastern Terai 6.8 2,409 1.3 165 Central Mountains 1.7 330 (*) 6 Central Hills 1.0 2,107 (*) 22 Central Terai 14.2 3,329 1.0 474 Western Mountains 2.2 5 (*) 0 Western Hills 0.4 1,821 (*) 6 Western Terai 3.1 1,484 (2.8) 46 Mid-Western Mountains 6.6 271 1.2 18 Mid-Western Hills 4.1 1,289 5.8 53 Mid-Western Terai 4.9 1,043 (3.9) 51 Far Western Mountains 3.8 376 1.8 14 Far Western Hills 6.7 658 0.0 44 Far Western Terai 2.8 847 (3.5) 24 Area Urban 1.1 2,403 (4.7) 26 Kathmandu valley 0.7 594 (*) 4 Other urban 1.2 1,808 (5.5) 22 Rural 6.2 14,745 1.5 918 Mother's education None 7.7 10,436 1.5 805 Primary 2.4 2,418 2.2 58 Secondary 1.1 2,212 (*) 24 Higher 0.3 1,363 (*) 4 Mother not in household 7.1 709 (0.5) 51 Wealth index quintile Poorest 4.9 4,015 1.8 198 Second 9.9 3,672 1.0 364 Middle 7.8 3,577 1.6 278 Fourth 2.7 3,269 2.3 89 Richest 0.6 2,615 (*) 16 Note: 9 cases of missing ‘mother’s education’ not shown ( ) Figures that are based on 25–49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases non-formal education. Mother’s education was strongly associated with the likelihood of never having had formal education: 8 percent of children whose mother had no education had themselves never had formal education compared to less than 1 percent of children whose mother had higher education. Household wealth status was also associated with the likelihood of never having had formal education: children living in households in the bottom three quintiles were much more likely than children living in households in the top two quintiles to have never had formal education. The sample size for children who have never received formal education was too small to derive any information by background characteristics. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014178 Child Protection C H A P T E R11 Birth Registration A name and nationality is every child’s right, enshrined in the Convention on the Rights of the Child (CRC) and other international treaties. Yet the births of approximately 230 million children under five worldwide (around one in three) have never been recorded. This lack of formal identity by the State usually means that a child is unable to obtain a birth certificate. As a result, he or she may be denied health care or education. Later in life, the lack of official identification documents can mean that a child may enter into marriage or the labour market, or be conscripted into the armed forces, before the legal age. In adulthood, birth certificates may be required to obtain social assistance or a job in the formal sector, to buy or prove the right to inherit property, to vote and to obtain a passport. Registering children at birth is the first step in securing their recognition before the law, safeguarding their rights, and ensuring that any violation of these rights does not go unnoticed1. Nepal has had a civil (vital) registration programme since 1977, based on the Birth, Death and Other Personal Incident Act 1976, and the Birth, Death and Other Personal Incident Regulations 1977. Despite legal requirements that newborns are registered within 35 days of birth, children in Nepal are much more likely to be registered closer to their entry into school at five years of age, when a birth certificate is part of the documentation required for school enrolment, than during their first few years of life. Table CP.1 shows birth registration for children under five. Some 58 percent of children under five had been registered. Registration of birth becomes more likely as a child grows older, peaking in the highest age group (48–59 months) at 74 percent. Regionally, children in the Mid-Western Mountains were most likely to have had their birth registered (66 percent) and those in the Central Mountains were least likely to have had it done (25 percent). There were notable differences between the proportion of children whose births was reported as registered and those who actually had a birth certificate: the birth certificate of 41 percent of children was seen, while 12 percent claimed to have a certificate but it was not seen and 5 percent claimed to be registered but not to have a certificate. 1UNICEF, 2013. Every Child’s Birth Right: Inequities and Trends in Birth Registration. New York: UNICEF. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 179 Table CP.1: Birth registration Percentage of children under five by whether birth is registered and percentage of children not registered whose mothers/ caretakers know how to register birth, Nepal, 2014 Percent whose birth is registered with civil authorities Number of children under five Percent whose birth is not registered Has birth certificate No birth certificate Total registered [1] Percent whose mother/ caretaker knows how to register birth Number of children without birth registration Seen Not seen Total 41.3 11.6 5.2 58.1 5,349 86.4 2,240 Sex Male 41.9 12.1 5.1 59.2 2,766 86.7 1,130 Female 40.7 11.1 5.2 57.0 2,583 86.0 1,111 Region Eastern Mountains 36.0 3.0 2.5 41.6 72 79.6 42 Eastern Hills 54.6 5.7 6.3 66.6 272 94.7 91 Eastern Terai 50.6 8.0 1.3 59.9 775 81.1 311 Central Mountains 24.6 14.4 0.4 39.5 95 96.9 57 Central Hills 20.4 20.1 4.6 45.1 620 88.3 340 Central Terai 43.1 12.9 4.1 60.1 1,131 91.1 452 Western Mountains 45.0 10.9 2.7 58.7 2 (76.7) 1 Western Hills 38.9 15.1 5.8 59.8 601 94.6 242 Western Terai 42.9 8.3 19.3 70.6 469 97.0 138 Mid-Western Mountains 65.6 13.0 5.9 84.4 108 51.5 17 Mid-Western Hills 56.1 1.0 2.7 59.8 409 72.8 164 Mid-Western Terai 41.8 16.9 7.6 66.4 291 74.9 98 Far Western Mountains 27.3 13.6 0.8 41.7 100 80.9 58 Far Western Hills 28.0 11.2 1.4 40.7 210 72.0 124 Far Western Terai 32.2 11.9 2.0 46.2 197 89.6 106 Area Urban 34.8 15.7 6.1 56.6 699 89.1 304 Kathmandu valley 25.0 22.2 3.2 50.5 181 88.2 90 Other urban 38.3 13.4 7.1 58.7 518 89.5 214 Rural 42.3 11.0 5.0 58.3 4,650 85.9 1,937 Age 0–11 months 19.2 6.3 7.3 32.8 978 90.3 658 12–23 months 32.7 8.7 6.4 47.8 1,008 85.4 527 24–35 months 45.6 13.0 5.3 63.9 1,079 89.1 390 36–47 months 51.2 12.9 3.8 67.9 1,137 81.2 365 48–59 months 54.0 16.3 3.5 73.8 1,147 82.1 301 Mother’s education None 41.7 11.7 5.0 58.4 2,265 81.9 942 Primary 43.2 12.0 5.0 60.1 921 85.9 367 Secondary 39.9 10.6 6.3 56.8 1,179 90.1 509 Higher 40.6 12.4 4.3 57.3 980 92.4 418 Wealth index quintile Poorest 42.2 8.5 3.9 54.6 1,183 75.9 537 Second 40.3 12.3 5.6 58.1 1,085 89.6 454 Middle 46.9 10.1 5.0 62.0 1,176 90.1 447 Fourth 37.7 14.3 6.3 58.3 1,086 88.9 453 Richest 38.4 14.0 5.1 57.5 819 90.2 348 [1] MICS indicator 8.1 – Birth registration Note: 4 cases of missing ‘mother’s education’ not shown ( ) Figures that are based on 25–49 unweighted cases       NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014180 Lack of adequate knowledge on how to register a child can present a major obstacle to the fulfilment of a child’s right to identity. Data show that 86 percent of mothers of unregistered children appear to be aware of the registration process, which points to other barriers to birth registration. Knowledge about the registration process varied significantly across the regions, with the highest proportion of mothers having this knowledge in the Western Terai (97 percent) and the lowest in the Mid-Western Mountains (52 percent). Interestingly, mothers of younger children who were unregistered were more likely than mothers of older children who were unregistered to know how to register a child’s birth. Women with unregistered children who were living in households in the poorest wealth quintile were much less likely than other women to know how to register a child’s birth. Figure CP.1 shows the percentage of children under five whose births are registered by region, area and mother’s education. Figure CP.1: Children under five whose births are registered, Nepal, 2014 Nepal  MICS  2014   3     Figure CP.1: Children under five whose births are registered, Nepal, 2014 Child Labour Children around the world are routinely engaged in paid and unpaid forms of work that are not harmful to them. However, they are classified as child labourers when they are either too young to work or are involved in hazardous activities that may compromise their physical, mental, social or educational development. Article 32 (1) of the Convention on the Rights of the Child states: "State Parties recognize the right of the child to be protected from economic exploitation and from performing any work that is likely to be hazardous or to interfere with the child’s education, or to be harmful to the child’s health or physical, mental, spiritual, moral or social development". The Child Labour (Prohibition and Regulation) Act 2056 (2000) of Nepal prohibits children below the age of 14 years from engaging in work. The current act does not differentiate between domestic work and child labour; however, it states that children aged 15–18 years shall not be engaged in work for more than six hours a day and more than 36 hours a week, either with or without additional remuneration. The child labour module was administered for children aged 5–17 years and includes questions on the type of work a child does and the number of hours he or she is engaged in 3 6 1 0 5 4 3 6 19 6 3 8 1 1 2 6 3 7 5 5 5 6 4 5 80 95 81 97 88 91 77 95 97 52 73 75 81 72 90 89 88 90 86 82 86 90 92 86 Region Eastern Mountain Eastern Hill Eastern Terai Central Mountain Central Hill Central Terai Western Mountain Western Hill Western Terai MId-Western Mountain MId-Western Hill MId-WesternTerai Far-Western Mountain Far-Western Hill Far-WesternTerai Area Urban Kathmandu valley Other urban Rural Mother's education None Primary Secondary Higher Nepal Registered,  no  birth  certificate Birth  certificate Percent NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 181 Child Labour Children around the world are routinely engaged in paid and unpaid forms of work that are not harmful to them. However, they are classified as child labourers when they are either too young to work or are involved in hazardous activities that may compromise their physical, mental, social or educational de- velopment. Article 32 (1) of the Convention on the Rights of the Child states: “State Parties recognize the right of the child to be protected from economic exploitation and from performing any work that is likely to be hazardous or to interfere with the child’s education, or to be harmful to the child’s health or physical, mental, spiritual, moral or social development”. The Child Labour (Prohibition and Regulation) Act 2056 (2000) of Nepal prohibits children below the age of 14 years from engaging in work. The current act does not differentiate between domestic work and child labour; however, it states that children aged 15–17 years shall not be engaged in work for more than six hours a day and more than 36 hours a week, either with or without additional remuneration. The child labour module was administered for children aged 5–17 years and includes questions on the type of work a child does and the number of hours he or she is engaged in it. Data are collected on both economic activities (paid or unpaid work for someone who is not a member of the household, and work for a family farm or business) and domestic work (household chores, such as, cooking, cleaning or caring for children, as well as collecting firewood or fetching water). The module also collects information on hazardous working conditions2,3. Table CP.2 presents children’s involvement in economic activities. The methodology of the MICS indicator on child labour uses three age-specific thresholds for the number of hours a child can perform economic activity without it being classified as child labour. A child that performed economic activities during the week preceding the survey for more than the age-specific number of hours is classified as in child labour: • aged 5–11 years: 1 hour or more • aged 12–14 years: 14 hours or more • aged 15–17 years: 43 hours or more Overall, involvement in economic activity increases with age: 28 percent of children aged 5–11 years, 59 percent of children aged 12–14 years, and 64 percent of children aged 15–17 years were engaged in economic activities. However, the proportion engaged in economic activities above the age-specific threshold decreases with age: 28 percent of children aged 5–11 years, 15 percent of children aged 12– 14 years, and 3 percent of children aged 15–17 years were engaged in economic activities above the age-specific threshold. Regionally, children in the Mid-Western Hills and Mountains and the Eastern Hills and Mountains were most likely to be involved in economic activities above their age-specific threshold. Children in rural areas were much more likely than those in urban areas to be involved in economic activities above their age-specific threshold. Mother’s education and household wealth were strongly associated with the likelihood of being involved in economic activities above the age-specific threshold: for children aged 12–14 years, 18 percent of those whose mother had no education were involved compared to 6 percent of those whose mother had higher education, and 28 percent of those living in households in the poorest quintile were involved compared to 4 percent of those living in households in the richest quintile. 2UNICEF, 2012. How Sensitive are Estimates of Child Labour to Definitions? MICS Methodological Paper No. 1. New York: UNICEF. 3The Child Labour module and the Child Discipline module were administered using random selection of a single child in all households with one or more children aged 1–17 years (See Appendix F: Questionnaires). The Child Labour module was administered if the selected child was aged 5–17 years and the Child Discipline module if the child was aged 1–14 years. To account for the random selection, the household sample weight is multiplied by the total number of children aged 1–17 years in each household. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014182 Table CP.2: Children’s involvement in economic activities Percentage of children aged 5–17 years by involvement in economic activities during the week preceding the survey, according to age groups, Nepal, 2014 Percent of children aged 5–11 years involved in economic activity for at least one hour Number of children aged 5–11 years Percent of children aged 12–14 years involved in: Number of children aged 12– 14 years Percent of children aged 15–17 years involved in: Number of children aged 15– 17 years Economic activity less than 14 hours Economic activity for 14 hours or more Economic activity less than 43 hours Economic activity for 43 hours or more Total 27.9 9,023 44.2 15.2 4,488 61.3 2.6 3,808 Sex Male 29.2 4,498 43.4 12.3 2,103 58.5 2.1 1,889 Female 26.5 4,525 44.8 17.6 2,385 64.0 3.1 1,919 Region Eastern Mountains 48.1 135 29.9 52.5 61 64.4 15.1 56 Eastern Hills 43.9 452 47.4 32.7 208 78.9 4.9 267 Eastern Terai 21.5 1,295 41.5 14.0 629 46.9 1.9 507 Central Mountains 40.6 154 77.1 0.0 88 86.1 0.1 83 Central Hills 18.0 1,010 37.4 3.8 531 39.4 2.1 546 Central Terai 16.5 2,028 37.1 1.4 803 50.8 1.4 591 Western Mountains (30.5) 2 (43.6) (34.5) 2 (*) (*) 1 Western Hills 41.4 871 47.9 19.6 610 71.8 0.5 378 Western Terai 26.1 709 56.3 9.4 405 66.2 0.6 389 Mid-Western Mountains 38.2 159 40.9 37.5 60 72.1 7.6 47 Mid-Western Hills 44.7 743 40.6 45.1 318 84.3 10.6 249 Mid-Western Terai 29.2 500 29.7 22.7 274 62.4 4.1 295 Far Western Mountains 46.9 210 74.5 1.4 80 86.9 0.0 73 Far Western Hills 34.6 357 80.3 5.2 154 87.8 1.0 147 Far Western Terai 22.3 398 37.6 24.6 263 62.5 0.9 179 Area Urban 11.7 1,214 24.2 4.3 613 32.6 2.2 626 Kathmandu valley 8.8 294 15.5 4.8 150 18.0 5.5 173 Other urban 12.6 920 27.0 4.1 464 38.1 0.9 454 Rural 30.4 7,810 47.3 16.9 3,874 66.9 2.7 3,181 School attendance Yes 28.2 8,197 43.8 14.1 4,118 60.2 1.5 3,038 No 24.6 826 48.6 27.0 370 65.4 7.2 769 Mother’s education None 33.6 5,210 49.7 17.5 3,037 67.9 2.5 2,267 Primary 29.5 1,442 39.7 12.9 565 52.6 2.6 435 Secondary 19.5 1,405 34.3 7.8 482 48.5 0.3 369 Higher 6.5 918 13.7 6.4 316 27.5 0.0 144 Cannot be determined [a] 17.1 47 48.5 22.3 78 58.5 5.4 591 Wealth index quintile Poorest 47.9 2,140 55.8 27.6 1,065 84.8 5.7 827 Second 32.9 1,983 52.9 16.5 954 70.7 3.5 804 Middle 23.7 2,007 48.7 12.2 889 67.4 1.1 740 Fourth 17.8 1,580 34.8 10.3 904 49.0 1.5 762 Richest 6.2 1,314 20.1 3.9 675 28.3 0.8 675 [a] Children aged 15 years or more at the time of the interview whose mother was not living in the household Note: 12 cases of missing ‘mother’s education’ not shown ( ) Figures that are based on 25–49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 183 Table CP.3 presents children’s involvement in household chores. As for economic activity above, the methodology also uses age-specific thresholds for the number of hours a child can perform household chores without it being classified as child labour. A child that performed household chores during the week preceding the survey for more than the age-specific number of hours is classified as in child labour: • aged 5–11 years and aged 12–14 years: 28 hour or more • aged 15–17 years: 43 hours or more Older children were more likely than younger children to be involved in household chores: 77 percent of children aged 5–11 years, 89 percent of children aged 12–14 years, and 92 percent of children aged 15–17 years. In terms of working more hours than the age-specific threshold, 3 percent of children aged 5–11 years were doing so, 7 percent of children aged 12–14 years were doing so, and 3 percent of children aged 15–17 years were doing so. Girls tended to be more likely than boys to be involved in household chores for more hours than their age-specific threshold. Regionally, children in the Mid- Western Hills and Mountains and the Eastern Hills and Mountains were more likely than other children to be involved in household chores for more hours than their age-specific threshold. Children in rural areas were more likely than those in urban areas to be above their age-specific threshold. Some 15 percent of children aged 12–14 years who were not attending school were involved in household chores for more hours than the age-specific threshold. Mother’s education and household wealth were strongly correlated with the likelihood of being involved in household chores for more hours than the age-specific threshold. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014184 Table CP.4 combines the children working and performing household chores at or above and below the age-specific thresholds as detailed in the previous tables, as well as those children reported to be working under hazardous conditions, into the total child labour indicator. Table CP.3: Children’s involvement in household chores Percentage of children aged 5–17 years by involvement in household chores during the week preceding the survey, according to age groups, Nepal, 2014 Percent of children aged 5–11 years involved in: Number of children aged 5– 11 years Percent of children aged 12–14 years involved in: Number of children aged 12– 14 years Percent of children aged 15–17 years involved in: Number of children aged 15– 17 years House- hold chores less than 28 hours House- hold chores for 28 hours or more House- hold chores less than 28 hours House- hold chores for 28 hours or more House- hold chores less than 43 hours House- hold chores for 43 hours or more Total 73.9 2.7 9,023 82.4 7.0 4,488 88.8 2.8 3,808 Sex Male 75.3 1.6 4,498 81.0 3.2 2,103 84.9 2.2 1,889 Female 72.6 3.7 4,525 83.6 10.3 2,385 92.7 3.4 1,919 Region Eastern Mountains 75.7 8.9 135 74.3 25.1 61 91.7 5.9 56 Eastern Hills 79.9 7.1 452 83.5 14.9 208 90.8 6.7 267 Eastern Terai 84.8 0.8 1,295 86.2 5.4 629 88.3 0.0 507 Central Mountains 79.1 0.0 154 99.1 0.0 88 95.3 0.0 83 Central Hills 73.3 0.0 1,010 83.6 2.3 531 92.7 0.0 546 Central Terai 63.7 0.5 2,028 73.9 2.9 803 82.9 2.6 591 Western Mountains (76.4) (5.1) 2 (76.4) (19.2) 2 (*) (*) 1 Western Hills 73.6 2.1 871 85.6 4.9 610 92.8 1.1 378 Western Terai 78.1 0.0 709 90.4 3.7 405 95.8 0.0 389 Mid-Western Mountains 62.7 10.3 159 69.4 25.9 60 77.8 16.9 47 Mid-Western Hills 69.9 16.4 743 69.6 28.5 318 78.0 19.6 249 Mid-Western Terai 77.8 1.2 500 77.8 8.9 274 86.3 1.7 295 Far Western Mountains 86.4 0.0 210 97.2 1.4 80 98.4 0.0 73 Far Western Hills 83.8 0.0 357 95.7 4.3 154 94.8 3.3 147 Far Western Terai 68.5 3.0 398 83.0 4.9 263 80.5 0.0 179 Area Urban 69.8 0.4 1,214 74.8 0.6 613 89.2 0.6 626 Kathmandu valley 68.7 0.0 294 66.4 0.4 150 84.1 0.0 173 Other urban 70.1 0.6 920 77.5 0.7 464 91.1 0.9 454 Rural 74.6 3.0 7,810 83.6 8.0 3,874 88.7 3.2 3,181 School attendance Yes 75.6 2.7 8,197 83.4 6.3 4,118 89.1 2.2 3,038 No 57.7 2.1 826 71.3 14.7 370 87.7 5.2 769 Mother’s education None 76.2 3.5 5,210 83.0 8.4 3,037 89.1 2.4 2,267 Primary 76.0 2.0 1,442 87.5 3.8 565 89.5 2.5 435 Secondary 73.2 1.6 1,405 79.6 4.3 482 93.0 1.9 369 Higher 59.4 0.3 918 77.4 1.0 316 69.8 0.0 144 Cannot be determined [a] (74.8) (2.4) 47 56.6 14.1 78 89.1 5.9 591 Wealth index quintile Poorest 78.1 6.9 2,140 85.2 12.1 1,065 89.8 8.2 827 Second 76.8 3.3 1,983 83.1 7.6 954 90.7 1.8 804 Middle 74.1 1.3 2,007 84.0 7.7 889 87.3 1.0 740 Fourth 73.4 0.0 1,580 83.6 4.1 904 86.9 2.3 762 Richest 63.3 0.0 1,314 72.9 0.7 675 89.0 0.0 675 [a] Children aged 15 years or more at the time of the interview whose mother was not living in the household Note: 12 cases of missing ‘mother’s education’ not shown ( ) Figures that are based on 25–49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 185 Table CP.4: Child labour Percentage of children aged 5–17 years by involvement in economic activities or household chores during the week preceding the survey, percentage working under hazardous conditions during the week preceding the survey, and percentage engaged in child labour during the week preceding the survey, Nepal, 2014 Percent involved in economic activities for a total number of hours during preceding week: Percent involved in household chores for a total number of hours during preceding week: Percent working under hazardous conditions Total child labour [1] Number of children aged 5–17 years Below age- specific threshold At or above age-specific threshold Below age- specific threshold At or above age-specific threshold Total 26.4 19.0 79.4 3.8 30.0 37.4 17,319 Sex Male 25.2 19.0 78.8 2.1 28.5 36.5 8,490 Female 27.5 19.0 79.9 5.4 31.5 38.3 8,828 Region Eastern Mountains 22.0 41.9 78.9 12.1 48.1 60.0 252 Eastern Hills 34.6 30.2 83.9 8.7 46.3 56.6 928 Eastern Terai 22.6 15.4 85.9 1.8 16.3 26.2 2,431 Central Mountains 45.6 19.2 88.7 0.0 48.0 56.6 326 Central Hills 21.3 10.2 81.0 0.6 18.4 24.3 2,087 Central Terai 18.6 10.4 69.4 1.4 16.2 23.3 3,422 Western Mountains 36.9 25.2 77.6 12.0 51.0 58.8 5 Western Hills 30.8 25.9 81.4 2.8 39.5 47.3 1,859 Western Terai 32.5 15.0 86.0 1.0 29.2 36.8 1,502 Mid-Western Mountains 22.4 32.6 66.9 15.0 51.1 56.0 267 Mid-Western Hills 27.6 38.3 71.4 19.9 52.8 60.3 1,310 Mid-Western Terai 27.3 20.6 80.2 3.3 27.4 36.8 1,069 Far Western Mountains 35.5 27.4 91.2 0.3 56.2 59.2 363 Far Western Hills 43.9 20.2 89.0 1.8 56.5 58.8 658 Far Western Terai 25.5 18.4 75.6 2.9 33.9 37.2 840 Area Urban 15.7 7.4 76.0 0.5 13.0 16.2 2,453 Kathmandu valley 9.4 6.9 72.5 0.1 10.7 13.1 616 Other urban 17.8 7.6 77.2 0.7 13.8 17.3 1,837 Rural 28.1 21.0 80.0 4.3 32.8 40.9 14,865 Age (years) 5–11 2.8 27.9 73.9 2.7 17.5 29.3 9,023 12–14 44.2 15.2 82.4 7.0 41.9 46.2 4,488 15–17 61.3 2.6 88.8 2.8 45.7 46.5 3,808 School attendance Yes 25.2 19.1 80.3 3.6 28.8 36.2 15,353 No 35.6 18.3 72.0 5.7 39.6 47.0 1,965 Mother’s education None 30.6 22.2 80.9 4.7 35.5 44.0 10,514 Primary 20.1 20.9 81.0 2.5 27.2 35.5 2,443 Secondary 16.5 13.8 77.8 2.3 17.2 23.3 2,256 Higher 7.3 5.8 64.6 0.4 6.5 8.6 1,379 Cannot be determined [a] 53.6 8.0 84.6 6.6 44.7 48.4 716 Wealth index quintile Poorest 34.2 33.9 82.4 8.6 52.5 60.8 4,032 Second 30.3 22.4 81.4 4.1 35.0 45.2 3,741 Middle 27.1 16.3 79.2 2.8 27.2 34.4 3,636 Fourth 22.1 11.9 79.4 1.7 18.0 24.8 3,246 Richest 13.2 4.3 72.3 0.2 7.5 10.8 2,664 [1] MICS indicator 8.2 – Child labour [a] Children aged 15 years or more at the time of the interview whose mother was not living in the household Note: 11 cases of missing ‘mother’s education’ not shown NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014186 4Straus, M.A. and Paschall, M.J., 2009. Corporal punishment by mothers and development of children’s cognitive ability: a longitudinal study of two nationally representative age cohorts. Journal of Aggression, Maltreatment & Trauma, 18(5): 459–483; Erickson, M.F. and Egeland, B., 1987. ‘A developmental view of the psychological consequences of maltreatment. School Psychology Review, 16:156–168; Schneider, M.W., Ross, A., Graham, J.C. and Zielinski, A., 2005. Do allegations of emotional maltreatment predict developmental outcomes beyond that of other forms of maltreatment? Child Abuse & Neglect, 29(5): 513–532. Of children aged 5–17 years, 19 percent were involved in economic activities at or above the age- specific threshold, 4 percent were involved in household chores at or above the age-specific threshold, and 30 percent were working in hazardous conditions. In total, 37 percent of children aged 5–17 years were considered to be involved in child labour. The proportion of children involved in child labour was highest in the Mid-Western Hills (60 percent) and lowest in the Central Terai (23 percent). Children from rural areas were much more likely than children from urban areas to be involved in child labour (41 percent compared to 16 percent). Children aged 5–11 years were less likely than older children to be involved in child labour (29 percent compared to around 47 percent). Children attending school were less likely than children not attending school to be involved in child labour (36 percent compared to 47 percent). Mother’s education and household wealth status were negatively correlated with child labour: 44 percent of children whose mother had no education were involved in child labour compared to 9 percent of children whose mother had higher education, and 61 percent of children living in households in the poorest quintile were involved in child labour compared to 11 percent of children living in households in the richest quintile. Child Discipline Teaching children self-control and acceptable behaviour is an integral part of child discipline in all cultures. Positive parenting practices involve providing guidance on how to handle emotions or conflicts in manners that encourage judgement and responsibility and preserve children’s self-esteem, physical and psychological integrity, and dignity. Too often, however, children are raised through the use of punitive methods that rely on the use of physical force or verbal intimidation to obtain desired behaviours. Studies4 have found that exposing children to violent discipline has harmful consequences, which range from immediate impacts to long-term harm that children carry forward into adult life. Violence hampers children’s development, learning abilities and school performance; it inhibits positive relationships, provokes low self-esteem, emotional distress and depression; and, at times, it leads to risk-taking and self-harm. In the MICS, respondents to the household questionnaire were asked a series of questions on the methods used by adults in the household to discipline a selected child during the month preceding the survey. Table CP.5 shows the proportion of children aged 1–14 years who experienced various forms of discipline in the month preceding the survey. Some 82 percent had been subjected to at least one form of psychological or physical punishment by household members. Just 13 percent had experienced only non-violent discipline. For the most part, households employ a combination of violent disciplinary practices, reflecting caregivers’ motivation to control children’s behaviour by any means possible. Some 78 percent experienced psychological aggression and 53 percent experienced physical punishment, with 14 percent experiencing severe physical punishment (hitting child on the head, ears or face or hitting child hard and repeatedly). NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 187 The highest proportion of children experiencing violent discipline was in the Central Mountains (93 percent) and the lowest was in the Central Hills (74 percent). Rural children were more likely than urban children to experience violent discipline (83 percent compared to 75 percent). Children aged 1–2 years were least likely to experience it (67 percent); but over 80 percent of children aged 3–14 years experienced it, with 5–9-year-olds experiencing it the most (87 percent). Violent discipline was negatively correlated with mother’s education and household wealth status, although all levels were invariably high. Table CP.5: Child discipline Percentage of children aged 1–14 years by child disciplining methods experienced during the month preceding the survey, Nepal, 2014 Percent of children aged 1–14 years who experienced: Number of children aged 1–14 years Only non- violent discipline Psychological aggression Physical punishment Any violent discipline method [1] Any Severe Total 13.2 77.6 53.3 14.3 81.7 18,049 Sex Male 12.8 78.6 55.2 15.4 82.7 8,887 Female 13.6 76.7 51.4 13.2 80.7 9,163 Region Eastern Mountains 11.2 85.6 58.5 17.0 87.0 259 Eastern Hills 10.6 83.1 52.3 15.6 85.4 893 Eastern Terai 13.5 76.2 53.2 19.4 80.1 2,576 Central Mountains 5.4 90.8 59.4 6.5 92.9 331 Central Hills 19.5 71.3 40.4 8.2 74.3 2,113 Central Terai 10.0 77.6 57.2 12.2 83.3 3,743 Western Mountains 13.6 75.5 46.6 7.7 77.0 6 Western Hills 10.1 81.4 48.9 9.8 84.7 1,963 Western Terai 16.6 78.8 49.9 10.1 81.1 1,516 Mid-Western Mountains 8.8 84.2 69.7 26.3 87.9 319 Mid-Western Hills 10.9 80.6 67.6 16.0 85.8 1,400 Mid-Western Terai 18.4 72.9 56.1 22.1 76.7 1,011 Far Western Mountains 10.7 80.6 50.4 13.1 85.9 394 Far Western Hills 12.0 77.2 44.1 17.3 83.9 701 Far Western Terai 19.3 70.7 57.2 23.7 75.0 825 Area Urban 19.1 70.5 44.1 9.4 74.6 2,397 Kathmandu valley 29.4 56.5 38.7 6.3 62.1 586 Other urban 15.8 75.1 45.8 10.4 78.6 1,811 Rural 12.3 78.7 54.7 15.1 82.8 15,652 Age (years) 1–2 14.2 59.7 50.9 10.2 66.9 2,250 3–4 14.2 76.4 61.9 18.7 81.9 2,288 5–9 11.0 82.7 62.0 17.6 87.0 6,331 10–14 14.5 79.1 43.6 11.2 81.7 7,180 Education of household head None 10.1 80.9 58.1 17.8 84.6 8,168 Primary 11.0 80.9 56.7 14.0 85.4 3,868 Secondary 17.7 73.5 47.6 11.5 77.8 3,607 Higher 20.5 67.1 39.5 6.8 71.4 2,372 Wealth index quintile Poorest 9.4 82.2 58.6 17.3 86.6 4,255 Second 10.3 82.4 59.3 18.1 86.2 3,788 Middle 10.5 79.5 52.6 12.4 83.0 3,888 Fourth 16.5 73.9 50.4 13.6 78.2 3,469 Richest 23.1 65.5 40.8 7.8 70.1 2,650 [1] MICS indicator 8.3 – Violent discipline Note: 34 cases of missing ‘education of household head’ not shown NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014188 Figure CP.2 shows child disciplining methods for children aged 1–14 years. Figure CP.2: Child disciplining methods, children aged 1–14 years, Nepal, 2014 While violent methods are extremely common forms of discipline, Table CP. 6 reveals that only 35 percent of respondents believed that physical punishment is a necessary part of child-rearing. Belief that children should be physically punished was highest in the Far Western Mountains (60 percent) and the lowest in the Central Hills (22 percent). It was also more common in rural areas than urban areas (38 percent compared to 20 percent). Respondents with low educational attainment and those living in poorer households were more likely than others to believe that physical punishment is an acceptable method of disciplining children. Only 18 percent of respondents with higher education and 15 percent of those living in households in the richest quintile believed in punishing children physically. Nepal  MICS  2014   12     Figure CP.2 shows child disciplining methods for children aged 1–14 years. Figure CP.2: Child disciplining methods, children aged 1–14 years, Nepal, 2014 While violent methods are extremely common forms of discipline, Table CP.6 reveals that only 35 percent of respondents believed that physical punishment is a necessary part of child-rearing. Belief that children should be physically punished was highest in the Far Western Mountains (60 percent) and the lowest in the Central Hills (22 percent). It was also more common in rural areas than urban areas (38 percent compared to 20 percent). Respondents with low educational attainment and those living in poorer households were more likely than others to believe that physical punishment is an acceptable method of disciplining children. Only 18 percent of respondents with higher education and 15 percent of those living in households in the richest quintile believed in punishing children physically. 13 82 78 Other 39 Severe 14 Only non-violent discipline Any violent discipline Psychological aggression Physical punishment Per cent Percent NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 189 Table CP.6: Attitudes toward physical punishment Percentage of respondents to the child discipline module who believe that physical punishment is needed to bring up, raise or educate a child properly, Nepal, 2014 Respondent believes that a child needs to be physically punished Number of respondents Total 35.2 7,599 Sex Male 33.6 2,855 Female 36.1 4,744 Region Eastern Mountains 49.1 109 Eastern Hills 37.4 418 Eastern Terai 43.7 1,139 Central Mountains 39.6 149 Central Hills 22.3 1,113 Central Terai 34.8 1,341 Western Mountains 36.1 4 Western Hills 24.2 931 Western Terai 35.7 592 Mid-Western Mountains 47.2 115 Mid-Western Hills 39.3 541 Mid-Western Terai 40.9 426 Far Western Mountains 60.1 139 Far Western Hills 42.5 243 Far Western Terai 37.1 340 Area Urban 20.0 1,265 Kathmandu valley 13.0 363 Other urban 22.8 902 Rural 38.2 6,334 Age (years) <25 38.0 850 25–39 34.2 3,926 40–59 36.2 2,188 60+ 34.0 635 Respondent’s relationship to selected child Mother 36.0 3,788 Father 34.4 1,935 Other 34.4 1,876 Respondent’s education None 43.6 3,396 Primary 36.0 1,347 Secondary 30.3 1,580 Higher 17.9 1,275 Wealth index quintile Poorest 44.5 1,571 Second 41.6 1,563 Middle 39.9 1,527 Fourth 32.9 1,511 Richest 15.3 1,428 Note: 1 case of missing ‘respondent’s education’ not shown NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014190 Early Marriage and Polygyny Marriage before the age of 18 is a reality for many young girls. In many parts of the world parents encourage the marriage of their daughters while they are still children in the hope that the marriage will benefit them both financially and socially, while also relieving financial burdens on their family. In actual fact, child marriage is a violation of human rights, compromising the development of girls and often resulting in early pregnancy and social isolation, with little education and poor vocational training reinforcing the gendered nature of poverty. The right to ‘free and full’ consent to a marriage is recog- nized in the Universal Declaration of Human Rights—with the recognition that consent cannot be ‘free and full’ when one of the parties involved is not sufficiently mature to make an informed decision about a life partner. Closely related to the issue of child marriage is the age at which girls become sexually active. Women who are married before the age of 18 tend to have more children than those who marry later in life. Pregnancy-related deaths are known to be a leading cause of mortality for both married and unmarried girls between the ages of 15 and 19, particularly among the youngest of this age cohort. There is evidence to suggest that girls who marry at young ages are more likely to marry older men which puts them at increased risk of HIV infection. The demand for this young wife to reproduce and the power imbalance resulting from the age differential leads to very low condom use among such couples. Table CP.7 shows the proportions of women married before the ages of 15 and 18. Among women aged 15–49 years, 16 percent were married before the age of 15 and, among women aged 20–49 years, 49 percent were married before the age of 18. About one in four (25 percent) young women aged 15–19 years were currently married or in a marital union5. Among currently married women aged 15–49 years, 4 percent were in a polygynous marriage. The proportion of women aged 15–49 years who were married before the age of 15 varies significantly among regions, with the highest proportion in the Mid-Western Mountains (28 percent) and the lowest in the Eastern Hills (5 percent). Rural women were more likely than urban women to be married before the age of 15 (17 percent compared to 10 percent). There is a strong negative correlation between early marriage and a woman’s education level: 27 percent of women with no education were married before the age of 15 compared to 2 percent of women with higher education. Household wealth is also associated with early marriage: 15 percent of women in the poorest household population were married before the age of 15 compared to 9 percent of women in the richest household population. Among young women aged 15–19 years, the highest proportion currently married was again in the Mid-Western Mountains (36 percent) and the lowest was in the Central Hills (12 percent). Urban young women were much less likely to be married than rural young women (14 percent compared to 27 percent). Education level was strong associated with current marital status for young women: 63 percent with no education were married compared to 13 percent with higher education. While variation in household wealth did not seem to be associated with current marital status for young women living in households in the four lowest wealth quintiles (25–31 percent of these young women were married), only 9 percent of young women in the richest household population were married. For polygynous marriage, the highest proportion was in the Central Mountains (6 percent) and the lowest proportion (3 percent) was in the Eastern Terai, Central Terai, Mid-Western Mountains and Mid- Western Hills. There was little difference by other background characteristic. 5All references to ‘married women’ in this chapter include women in a marital union as well. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 191 Table CP.7: Early marriage and polygyny (women) Percentage of women aged 15–49 years who first married or entered a marital union before their 15th birthday, percentage of women aged 20–49 years who first married or entered a marital union before their 15th and 18th birthdays, percentage of women aged 15–19 years currently married or in union, and the percentage of women aged 15–49 years who are in a polygynous marriage or union, Nepal, 2014 Women aged 15–49 years Women aged 20–49 years Women aged 15–19 years Women aged 15–49 years Percent married before age 15 [1] Number of women aged 15– 49 years Percent married before age 15 Percent married before age 18 [2] Number of women aged 20– 49 years Percent currently married [3] Number of women aged 15– 19 years Percent in poly- gynous marriage [4] Number of women currently married Total 15.5 14,162 18.0 48.5 11,441 24.5 2,781 4.1 10,830 Region Eastern Mountains 8.0 186 9.8 34.5 143 22.7 196 5.1 134 Eastern Hills 4.5 807 4.9 29.7 629 26.5 184 4.4 577 Eastern Terai 15.5 2,071 17.5 44.3 1,693 23.2 201 2.9 1,604 Central Mountains 10.1 274 12.5 44.2 211 17.6 162 6.2 201 Central Hills 9.6 2,320 11.3 34.4 1,946 12.4 255 5.8 1,668 Central Terai 26.0 2,327 30.1 65.9 1,868 33.4 229 2.9 1,896 Western Mountains 6.9 8 6.8 30.3 7 (*) 23 3.9 6 Western Hills 10.9 1,659 12.8 47.7 1,365 17.9 178 4.5 1,269 Western Terai 17.3 1,236 20.5 54.2 1,008 22.4 192 3.8 940 Mid-Western Mountains 27.8 169 33.6 67.5 133 36.1 172 2.9 136 Mid-Western Hills 15.9 856 18.1 54.6 670 35.2 185 2.9 686 Mid-Western Terai 19.2 855 21.5 51.5 669 32.4 194 4.2 670 Far Western Mountains 17.3 225 20.7 56.2 181 20.0 195 3.0 176 Far Western Hills 14.4 433 18.3 55.8 329 23.9 217 4.0 325 Far Western Terai 17.2 735 20.9 48.7 588 24.0 198 6.1 540 Area Urban 10.1 2,792 11.5 34.7 2,350 14.2 580 4.0 1,983 Kathmandu valley 7.2 868 8.0 25.6 754 10.1 112 4.4 602 Other urban 11.4 1,924 13.1 39.1 1,595 15.6 468 3.7 1,381 Rural 16.8 11,370 19.7 52.1 9,091 26.5 2,201 4.1 8,846 Age (years) 15–19 4.9 2,721 na na 0 24.5 2,781 1.4 659 20–24 10.4 2,402 10.4 36.6 2,402 na 0 1.9 1,701 25–29 17.9 2,414 17.9 49.2 2,414 na 0 2.6 2,209 30–34 21.4 2,003 21.4 51.7 2,003 na 0 3.7 1,909 35–39 20.1 1,901 20.1 53.0 1,901 na 0 4.3 1,810 40–44 23.1 1,582 23.1 52.3 1,582 na 0 7.4 1,499 45–49 18.2 1,139 18.2 54.3 1,139 na 0 7.8 1,042 Education None 27.0 5,294 27.4 62.7 5,066 62.9 172 5.1 4,991 Primary 18.8 2,004 20.3 57.3 1,730 38.0 295 4.4 1,716 Secondary 8.3 3,830 11.8 44.0 2,205 21.0 1,726 3.5 2,285 Higher 2.4 3,032 2.7 16.9 2,439 12.9 588 1.6 1,836 Wealth index quintile Poorest 15.0 2,453 17.9 52.2 1,897 28.4 556 3.6 1,871 Second 16.1 2,720 19.0 51.5 2,154 24.8 566 4.0 2,094 Middle 20.0 2,752 23.3 57.8 2,209 30.7 543 3.7 2,211 Fourth 18.1 3,020 20.9 52.7 2,440 27.3 580 4.7 2,333 Richest 9.2 3,218 10.6 32.6 2,741 9.0 477 4.1 2,321 [1] MICS indicator 8.4 – Marriage before age 15 [2] MICS indicator 8.5 – Marriage before age 18 [3] MICS indicator 8.6 – Young women aged 15–19 years currently married or in union [4] MICS indicator 8.7 – Polygyny na: not applicable Note: 1 case of missing ‘education’ not shown (*) Figures that are based on fewer than 25 unweighted cases NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014192 Ta bl e CP .8 : T re nd s in e ar ly m ar ria ge (w om en ) Pe rc en ta ge o f w om en w ho w er e fir st m ar rie d or e nt er ed in to a m ar ita l u nio n be fo re th e ag ed o f 1 5 ye ar s a nd 1 8 ye ar s, by a re a an d ag e gr ou ps , N ep al, 2 01 4 Al l Ur ba n Ru ra l Pe rc en t o f wo m en m ar rie d be fo re a ge 15 Nu m be r o f wo m en ag ed 1 5– 49 ye ar s Pe rc en t o f wo m en m ar rie d be fo re a ge 18 Nu m be r o f wo m en ag ed 2 0– 49 ye ar s Pe rc en t o f wo m en m ar rie d be fo re a ge 15 Nu m be r o f wo m en ag ed 1 5– 49 ye ar s Pe rc en t o f wo m en m ar rie d be fo re a ge 18 Nu m be r o f wo m en ag ed 2 0– 49 ye ar s Pe rc en t o f wo m en m ar rie d be fo re a ge 15 Nu m be r o f wo m en ag ed 1 5– 49 ye ar s Pe rc en t o f wo m en m ar rie d be fo re a ge 18 Nu m be r o f wo m en ag ed 2 0– 49 ye ar s To ta l 15 .5 14 ,1 62 48 .5 11 ,4 41 10 .1 2, 79 2 34 .7 2, 35 0 16 .8 11 ,3 70 52 .1 9, 09 1 Ag e (y ea rs ) 15 –1 9 4. 9 2, 72 1 na 0 2. 8 44 2 na 0 5. 3 2, 27 9 na 0 20 –2 4 10 .4 2, 40 2 36 .6 2, 40 2 5. 1 51 3 21 .2 51 3 11 .9 1, 88 8 40 .7 1, 88 8 25 –2 9 17 .9 2, 41 4 49 .2 2, 41 4 10 .5 46 5 34 .6 46 5 19 .6 1, 94 8 52 .6 1, 94 8 30 –3 4 21 .4 2, 00 3 51 .7 2, 00 3 13 .1 41 2 33 .6 41 2 23 .5 1, 59 1 56 .4 1, 59 1 35 –3 9 20 .1 1, 90 1 53 .0 1, 90 1 14 .4 40 2 42 .4 40 2 21 .6 1, 49 9 55 .8 1, 49 9 40 –4 4 23 .1 1, 58 2 52 .3 1, 58 2 14 .6 33 0 40 .9 33 0 25 .3 1, 25 2 55 .3 1, 25 2 45 –4 9 18 .2 1, 13 9 54 .3 1, 13 9 15 .0 22 8 45 .2 22 8 19 .0 91 2 56 .6 91 2 Ka th m an du va lle y Ot he r u rb an Pe rc en t o f w om en m ar rie d be fo re a ge 15 Nu m be r o f w om en ag ed 1 5– 49 ye ar s Pe rc en t o f w om en m ar rie d be fo re a ge 18 Nu m be r o f w om en ag ed 2 0– 49 ye ar s Pe rc en t o f w om en m ar rie d be fo re a ge 15 Nu m be r o f w om en ag ed 1 5– 49 ye ar s Pe rc en t o f w om en m ar rie d be fo re a ge 18 Nu m be r o f w om en ag ed 2 0– 49 ye ar s To ta l 7. 2 86 8 25 .6 75 4 11 .4 1, 92 4 39 .1 1, 59 5 Ag e (y ea rs ) 15 –1 9 2. 3 11 4 na 0 3. 0 32 9 na 0 20 –2 4 4. 6 16 4 17 .6 16 4 5. 3 34 9 22 .8 34 9 25 –2 9 7. 4 15 3 25 .2 15 3 12 .0 31 2 39 .3 31 2 30 –3 4 11 .7 12 3 23 .7 12 3 13 .7 28 9 37 .8 28 9 35 –3 9 10 .7 13 3 33 .1 13 3 16 .3 26 9 47 .0 26 9 40 –4 4 9. 2 11 0 26 .4 11 0 17 .3 22 0 48 .2 22 0 45 –4 9 3. 7 71 32 .6 71 20 .2 15 6 51 .0 15 6 na : n ot a pp lic ab le NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 193 Tables CP.8 presents the proportion of women who were first married before the ages of 15 and 18 by age groups. This allows for trends in early marriage to be observed over time. Data suggest that the prevalence of early marriage has gradually declined: 54 percent of women aged 45–49 years were first married by the age of 18 compared to 37 percent of women aged 20–24 years. A similar trend was observed in marriage before the age of 15. The rate of decline has been steeper in urban areas than rural areas. Figure CP.3 illustrates the decline in early marriage among women aged 15–49 years over time. Figure CP.3: Early marriage among women, Nepal, 2014 Another component is spousal age difference, with the indicator being the percentage of married women who are 10 or more years younger than their current spouse. Table CP.9 presents spousal age difference for women aged 15–19 years and 20–24 years. Some 6 percent of women aged 15–19 years and 8 percent of women aged 20–24 years were currently married to a man who is older by 10 years or more. Women in the Eastern Terai were more likely to be married to a man who is older by 10 years or more. Women in richer households were more likely than other women to have older spouses. Nepal  MICS  2014   18     Figure CP.3 illustrates the decline in early marriage among women aged 15–49 years over time. Figure CP.3: Early marriage among women, Nepal, 2014 Another component is spousal age difference, with the indicator being the percentage of married women who are 10 or more years younger than their current spouse. Table CP.9 presents spousal age difference for women aged 15–19 years and 20–24 years. Some 6 percent of women aged 15–19 years and 8 percent of women aged 20–24 years were currently married to a man who is older by 10 years or more. Women in the Eastern Terai were more likely to be married to a man who is older by 10 years or more. Women in richer households were more likely than other women to have older spouses. 5 10 18 21 20 23 18 37 49 52 53 52 54 15-­‐19 20-­‐24 25-­‐29 30-­‐34 35-­‐39 40-­‐44 45-­‐49 Age Percentage married before age 15 Percentage married before age 18 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014194 Ta bl e CP .9 : S po us al a ge d iff er en ce Pe rc en ta ge o f w om en a ge d 15 –1 9 ye ar s a nd 2 0– 24 ye ar s w ho a re cu rre nt ly m ar rie d or in u nio n ac co rd ing to th e ag e dif fe re nc e wi th th eir h us ba nd o r p ar tn er , N ep al, 2 01 4 Pe rc en t o f w om en a ge d 15 –1 9 ye ar s c ur re nt ly m ar rie d/ in un ion wh os e hu sb an d or p ar tn er is : Nu m be r o f wo m en ag ed 1 5– 19 ye ar s cu rre nt ly m ar rie d/ in un ion Pe rc en t o f w om en a ge d 20 –2 4 ye ar s c ur re nt ly m ar rie d/ in un ion wh os e hu sb an d or p ar tn er is : Nu m be r o f wo m en ag ed 2 0– 24 ye ar s cu rre nt ly m ar rie d/ in un ion Yo un ge r 0– 4 ye ar s old er 5– 9 ye ar s old er 10 + ye ar s old er [1 ] Hu sb an d/ pa rtn er ’s ag e un kn ow n To ta l Yo un ge r 0– 4 ye ar s old er 5– 9 ye ar s old er 10 + ye ar s old er [2 ] Hu sb an d/ pa rtn er ’s ag e un kn ow n To ta l To ta l 6. 9 57 .7 28 .3 6. 3 0. 9 10 0. 0 65 9 7. 6 56 .0 27 .8 7. 5 1. 1 10 0. 0 1, 70 1 Re gi on Ea ste rn M ou nt ain s (6 .6 ) (5 6. 4) (3 2. 7) (4 .3 ) (0 .0 ) 10 0. 0 10 17 .7 49 .2 26 .7 6. 5 0. 0 10 0. 0 23 Ea ste rn H ills 6. 0 48 .3 32 .0 11 .7 2. 0 10 0. 0 47 5. 3 52 .9 32 .8 9. 0 0. 0 10 0. 0 92 Ea ste rn T er ai (2 .1 ) (5 0. 4) (3 8. 5) (9 .0 ) (0 .0 ) 10 0. 0 84 4. 6 47 .7 32 .2 14 .7 0. 8 10 0. 0 23 7 Ce nt ra l M ou nt ain s (*) (*) (*) (*) (*) 10 0. 0 10 17 .1 57 .0 19 .5 4. 3 2. 1 10 0. 0 26 Ce nt ra l H ills (5 .3 ) (5 2. 7) (3 5. 9) (6 .2 ) (0 .0 ) 10 0. 0 45 13 .7 55 .9 24 .2 5. 3 0. 9 10 0. 0 21 9 Ce nt ra l T er ai 10 .2 46 .3 34 .4 7. 8 1. 4 10 0. 0 15 3 4. 8 41 .8 39 .4 10 .7 3. 4 10 0. 0 27 8 W es te rn M ou nt ain s (*) (*) (*) (*) (*) 10 0. 0 0 (*) (*) (*) (*) (*) 10 0. 0 1 W es te rn H ills (2 .8 ) (5 7. 1) (3 1. 4) (8 .6 ) (0 .0 ) 10 0. 0 51 3. 7 49 .0 39 .1 8. 2 0. 0 10 0. 0 21 1 W es te rn T er ai (7 .7 ) (6 6. 4) (2 5. 9) (0 .0 ) (0 .0 ) 10 0. 0 51 2. 6 72 .4 22 .8 2. 2 0. 0 10 0. 0 15 9 M id- W es te rn M ou nt ain s 11 .0 66 .1 14 .9 6. 4 1. 6 10 0. 0 13 13 .7 56 .8 21 .5 6. 6 1. 4 10 0. 0 32 M id- W es te rn H ills 11 .9 69 .7 15 .2 3. 2 0. 0 10 0. 0 65 15 .1 66 .8 13 .3 4. 8 0. 0 10 0. 0 12 1 M id- W es te rn T er ai 3. 8 67 .2 17 .5 7. 5 4. 0 10 0. 0 60 10 .0 66 .3 18 .5 4. 2 1. 0 10 0. 0 11 6 Fa r W es te rn M ou nt ain s (9 .8 ) (7 7. 2) (1 0. 9) (2 .1 ) (0 .0 ) 10 0. 0 9 6. 1 77 .2 14 .7 2. 0 0. 0 10 0. 0 26 Fa r W es te rn H ills 5. 0 77 .4 17 .6 0. 0 0. 0 10 0. 0 25 5. 9 66 .6 21 .6 4. 0 2. 0 10 0. 0 61 Fa r W es te rn T er ai (6 .9 ) (7 2. 2) (2 0. 9) (0 .0 ) (0 .0 ) 10 0. 0 35 10 .6 71 .4 12 .6 4. 0 1. 4 10 0. 0 99 Ar ea Ur ba n 5. 0 46 .8 40 .9 7. 4 0. 0 10 0. 0 62 4. 9 53 .4 34 .4 7. 1 0. 3 10 0. 0 27 2 Ka th m an du va lle y (*) (*) (*) (*) (*) 10 0. 0 10 4. 6 61 .1 30 .1 4. 2 0. 0 10 0. 0 80 Ot he r u rb an 5. 1 46 .7 41 .1 7. 2 0. 0 10 0. 0 51 5. 0 50 .2 36 .2 8. 2 0. 4 10 0. 0 19 2 Ru ra l 7. 1 58 .8 27 .0 6. 2 1. 0 10 0. 0 59 7 8. 1 56 .5 26 .6 7. 6 1. 2 10 0. 0 1, 42 9 Ag e (y ea rs ) 15 –1 9 6. 9 57 .7 28 .3 6. 3 0. 9 10 0. 0 65 9 na na na na na 10 0. 0 0 20 –2 4 na na na na na 10 0. 0 0 7. 6 56 .0 27 .8 7. 5 1. 1 10 0. 0 1, 70 1 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 195 Ta bl e CP .9 : S po us al a ge d iff er en ce Pe rc en ta ge o f w om en a ge d 15 –1 9 ye ar s a nd 2 0– 24 ye ar s w ho a re cu rre nt ly m ar rie d or in u nio n ac co rd ing to th e ag e dif fe re nc e wi th th eir h us ba nd o r p ar tn er , N ep al, 2 01 4 Pe rc en t o f w om en a ge d 15 –1 9 ye ar s c ur re nt ly m ar rie d/ in un ion wh os e hu sb an d or p ar tn er is : Nu m be r o f wo m en ag ed 1 5– 19 ye ar s cu rre nt ly m ar rie d/ in un ion Pe rc en t o f w om en a ge d 20 –2 4 ye ar s c ur re nt ly m ar rie d/ in un ion wh os e hu sb an d or p ar tn er is : Nu m be r o f wo m en ag ed 2 0– 24 ye ar s cu rre nt ly m ar rie d/ in un ion Yo un ge r 0– 4 ye ar s old er 5– 9 ye ar s old er 10 + ye ar s old er [1 ] Hu sb an d/ pa rtn er ’s ag e un kn ow n To ta l Yo un ge r 0– 4 ye ar s old er 5– 9 ye ar s old er 10 + ye ar s old er [2 ] Hu sb an d/ pa rtn er ’s ag e un kn ow n To ta l Ed uc at io n No ne 7. 6 59 .0 25 .1 6. 6 1. 7 10 0. 0 14 2 8. 3 58 .9 22 .6 7. 6 2. 7 10 0. 0 37 2 Pr im ar y 6. 1 62 .4 27 .2 3. 2 1. 2 10 0. 0 10 4 10 .1 61 .1 23 .3 4. 4 1. 0 10 0. 0 28 6 Se co nd ar y 7. 8 56 .0 29 .6 6. 2 0. 4 10 0. 0 33 8 7. 3 56 .0 30 .5 6. 3 0. 0 10 0. 0 51 2 Hi gh er 2. 5 56 .2 29 .6 10 .5 1. 3 10 0. 0 76 6. 1 51 .3 31 .3 10 .3 1. 0 10 0. 0 53 1 W ea lth in de x qu in til e Po or es t 9. 6 64 .1 22 .5 3. 1 0. 7 10 0. 0 15 5 12 .1 58 .0 23 .5 5. 2 1. 2 10 0. 0 30 6 Se co nd 2. 5 65 .3 24 .2 5. 6 2. 4 10 0. 0 13 9 9. 2 60 .9 23 .7 4. 8 1. 4 10 0. 0 31 6 M idd le 7. 8 59 .5 26 .5 5. 5 0. 7 10 0. 0 16 5 5. 8 61 .7 24 .2 7. 2 1. 2 10 0. 0 37 2 Fo ur th 7. 7 44 .1 37 .5 10 .7 0. 0 10 0. 0 15 8 7. 6 53 .3 31 .0 6. 9 1. 2 10 0. 0 39 4 Ri ch es t (4 .5 ) (5 2. 6) (3 5. 4) (7 .5 ) (0 .0 ) 10 0. 0 42 3. 8 45 .8 36 .4 13 .7 0. 3 10 0. 0 31 3 [1 ] M IC S in di ca to r 8 .8 a – Sp ou sa l a ge d iff er en ce (a m on g wo m en a ge d 15 –1 9 ye ar s) [2 ] M IC S in di ca to r 8 .8 b – Sp ou sa l a ge d iff er en ce (a m on g wo m en a ge d 20 –2 4 ye ar s) na : n ot a pp lic ab le ( ) F igu re s t ha t a re b as ed o n 25 –4 9 un we igh te d ca se s (*) F igu re s t ha t a re b as ed o n fe we r t ha n 25 u nw eig ht ed ca se s C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014196 Attitudes toward Domestic Violence The MICS assessed the attitudes of women aged 15–49 years towards wife-beating6 by asking respondents whether they think that husbands are justified in hitting or beating their wives in a variety of situations. The purpose of these questions is to capture the social justification of violence (in contexts where women have a lower status in society) as a disciplinary action when a woman does not comply with certain expected gender roles. The responses to these questions can be found in Table CP.10. Overall, 43 percent of women felt that a husband was justified in hitting or beating his wife in at least one of the five situations. Women who justified a husband’s violence in most cases agreed and justified violence in instances when a wife neglects the children (32 percent), or if she demonstrates her autonomy, exemplified by going out without telling her husband (25 percent) or arguing with him (17 percent). In contrast, fewer believed that violence was justified if a woman refuses to have sex with her husband (3 percent) or if she burns the food (5 percent). Regionally, the highest percentage of agreement with at least one reason was in the Far Western Hills (63 percent) and the lowest was in the Central Mountains (23 percent). Such agreement was more likely in rural areas than urban areas (46 percent compared to 29 percent). Younger women tended to show lower agreement than older women: 35 percent of women aged 15–19 years agreed with at least one reason compared to 50 percent of women aged 45–49 years. Agreement was highest among women with no education and those living in households in the poorest wealth quintile. 6This also includes partners in a martial union. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 197 In Nepal, mothers-in-law have traditionally exerted a large degree of power over daughters-in-law. Table CP.11 presents data relating to the attitudes of women aged 15–49 years towards a mother-in- law’s justification in verbally abusing and threatening her daughter-in-law in various circumstances. Overall, most women in Nepal (64 percent) felt that a mother-in-law was justified in verbally abusing and threatening her daughter-in-law in at least one of six situations. In most cases they agreed and justified such behaviour in instances when a daughter-in-law neglects the children (49 percent), if she goes out without telling her mother-in-law (39 percent), if she refuses to obey her mother-in-law Table CP.10: Attitudes toward domestic violence Percentage of women aged 15–49 years who believe a husband is justified in beating his wife in various circumstances, Nepal, 2014 Percent of women who believe a husband is justified in beating his wife: Number of women aged 15– 49 years If she goes out without telling him If she neglects the children If she argues with him If she refuses sex with him If she burns the food For any of these five reasons [1] Total 25.4 31.5 16.9 2.9 5.0 42.9 14,162 Region Eastern Mountains 28.2 44.9 22.5 6.5 6.3 52.3 186 Eastern Hills 19.0 33.4 19.5 5.6 7.7 37.7 807 Eastern Terai 26.2 38.7 22.9 7.4 10.0 48.3 2,071 Central Mountains 10.6 20.4 11.3 0.5 0.5 22.5 274 Central Hills 12.8 20.6 9.5 1.3 2.4 29.0 2,320 Central Terai 38.8 28.1 16.8 0.2 5.8 55.8 2,327 Western Mountains 31.2 37.7 11.9 0.0 5.0 41.3 8 Western Hills 20.3 27.7 9.3 0.6 2.5 32.5 1,659 Western Terai 30.7 31.6 16.2 1.2 0.7 44.6 1,236 Mid-Western Mountains 32.7 45.1 34.0 7.8 7.2 56.0 169 Mid-Western Hills 24.4 38.4 23.0 6.0 6.3 43.6 856 Mid-Western Terai 24.2 35.2 25.5 3.8 3.4 46.5 855 Far Western Mountains 41.2 45.0 28.9 2.2 8.0 55.2 225 Far Western Hills 42.9 52.4 20.0 0.7 10.0 62.7 433 Far Western Terai 21.4 31.9 13.9 4.6 3.7 38.3 735 Area Urban 14.3 21.4 9.1 1.6 2.9 29.2 2,792 Kathmandu valley 8.4 18.8 6.1 1.1 1.5 24.1 868 Other urban 17.0 22.6 10.4 1.8 3.6 31.5 1,924 Rural 28.2 34.0 18.9 3.2 5.5 46.2 11,370 Age (years) 15–19 19.1 25.7 13.0 1.7 3.6 34.5 2,721 20–24 23.1 28.8 14.5 2.2 3.7 39.7 2,402 25–29 26.2 31.2 17.4 2.6 5.0 44.6 2,414 30–34 25.7 32.1 16.7 4.1 5.1 43.7 2,003 35–39 29.5 35.2 19.9 3.4 6.1 47.3 1,901 40–44 28.1 37.5 19.7 4.0 7.2 48.1 1,582 45–49 33.0 36.3 22.2 3.6 6.2 49.7 1,139 Marital status Currently married 28.1 33.7 18.7 3.4 5.5 46.2 10,830 Formerly married 30.1 39.0 19.2 2.4 5.9 46.7 296 Never married 15.4 23.1 10.5 1.1 3.2 30.5 3,037 Education None 38.1 42.9 26.7 5.0 7.9 58.2 5,294 Primary 25.6 31.5 16.8 2.9 4.5 43.2 2,004 Secondary 19.0 28.1 11.9 1.7 3.8 36.8 3,830 Higher 11.4 16.1 6.4 0.7 1.8 23.6 3,032 Wealth index quintile Poorest 32.3 43.0 22.9 4.7 7.1 49.7 2,453 Second 28.9 36.8 21.1 2.5 5.4 48.9 2,720 Middle 30.4 34.1 19.9 4.1 6.2 48.6 2,752 Fourth 24.8 30.0 15.6 2.6 4.1 43.4 3,020 Richest 13.6 17.6 7.6 1.1 2.9 27.1 3,218 [1] MICS indicator 8.12 – Attitudes towards domestic violence Note: 1 case of missing ‘mother’s education’ not shown NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014198 (35 percent), or if she argues with her mother-in-law (29 percent). A smaller proportion of women justified a mother-in-law’s abusive behaviour if the daughter-in-law does not complete her work on time (9 percent) or if she does not bring dowry (2 percent). The highest percentage of agreement with at least one reason was in the Mid-Western Mountains (75 percent) and the lowest was in the Eastern Hills (49 percent). Such agreement was higher in rural areas than urban areas (66 percent compared to 54 percent). Older women were more likely to justify it than younger ones. Justification was higher among less educated women and those living in poorer households. Table CP.11: Attitudes towards abusive behaviour by mothers-in-law Percentage of women aged 15–49 years who believe a mother-in-law is justified in verbally abusing and threatening her daughter-in-law in various circumstances, Nepal, 2014 Percent of women who believe a mother-in-law is justified in verbally abusing and threatening her daughter-in-law: Number of women aged 15– 49 years If she goes out without telling her If she neglects the children If she argues with her If she refuses to obey her If she does not bring dowry If she does not complete her work on time For any of these six reasons Total 38.8 48.6 29.2 35.4 2.4 8.5 63.7 14,162 Region Eastern Mountains 43.3 52.7 33.4 41.0 1.7 12.7 65.6 186 Eastern Hills 29.0 39.8 25.0 31.7 3.5 10.7 48.6 807 Eastern Terai 42.1 50.4 34.0 37.7 4.9 17.1 64.8 2,071 Central Mountains 29.1 48.3 36.4 30.5 2.1 5.4 53.1 274 Central Hills 29.5 43.7 26.1 30.7 0.8 5.7 57.0 2,320 Central Terai 45.6 48.7 23.8 18.8 2.4 7.9 65.9 2,327 Western Mountains 57.7 65.4 37.9 42.4 2.2 5.4 71.6 8 Western Hills 42.2 63.0 30.7 46.6 0.3 2.3 73.4 1,659 Western Terai 33.1 32.5 20.1 27.0 3.8 4.7 56.6 1,236 Mid-Western Mountains 52.1 59.1 48.7 54.2 3.3 15.1 75.4 169 Mid-Western Hills 46.8 59.5 40.7 59.6 3.2 11.6 72.3 856 Mid-Western Terai 38.4 49.8 39.0 43.9 2.4 6.2 70.2 855 Far Western Mountains 46.0 40.0 33.0 42.9 0.4 8.8 61.2 225 Far Western Hills 45.2 54.4 20.8 24.9 0.4 14.0 68.2 433 Far Western Terai 35.5 44.5 29.6 50.8 1.7 7.6 62.9 735 Area Urban 29.0 42.0 21.5 29.4 0.9 4.9 54.4 2,792 Kathmandu valley 19.4 36.1 16.2 23.3 0.6 3.1 46.6 868 Other urban 33.4 44.7 23.8 32.2 1.0 5.7 57.9 1,924 Rural 41.3 50.2 31.1 36.9 2.7 9.4 66.0 11,370 Age (years) 15–19 29.9 39.8 24.6 30.5 1.5 6.1 54.4 2,721 20–24 35.2 44.2 24.9 32.2 1.7 7.9 59.6 2,402 25–29 40.5 52.1 32.2 37.3 2.5 8.3 65.9 2,414 30–34 41.9 51.4 29.5 35.9 2.4 8.7 66.8 2,003 35–39 42.4 51.4 31.0 36.2 2.6 9.6 66.5 1,901 40–44 43.3 54.6 33.6 40.8 3.7 11.0 69.6 1,582 45–49 46.8 53.3 33.1 40.1 3.2 10.4 71.4 1,139 Marital status Currently married 42.6 51.8 31.5 38.0 2.7 9.6 67.7 10,830 Formerly married 40.8 53.1 32.1 36.1 3.6 6.1 65.6 296 Never married 25.1 36.8 20.7 26.1 0.9 4.9 49.2 3,037 Education None 49.7 57.0 36.8 40.7 4.6 13.6 74.1 5,294 Primary 42.5 52.3 31.5 37.8 1.8 7.1 67.5 2,004 Secondary 34.1 45.1 25.3 34.7 1.0 6.1 58.9 3,830 Higher 23.5 36.0 19.3 25.5 .5 3.6 49.2 3,032 Wealth index quintile Poorest 46.5 57.7 35.5 46.6 2.5 11.2 70.2 2,453 Second 42.2 52.7 32.9 38.7 2.6 10.0 67.0 2,720 Middle 42.9 50.5 32.0 35.2 3.9 10.1 67.6 2,752 Fourth 37.7 45.6 27.6 32.0 2.3 7.6 62.8 3,020 Richest 27.8 39.5 20.3 27.5 0.7 4.7 53.5 3,218 Note: 1 case of missing ‘mother’s education’ not shown NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 199 Children’s Living Arrangements The CRC recognizes that “the child, for the full and harmonious development of his or her personality, should grow up in a family environment, in an atmosphere of happiness, love and understanding”. Millions of children around the world grow up without the care of their parents for several reasons, including due to the premature death of the parents or their migration for work. In most cases, these children are cared for by members of their extended families, while in others, children may be living in households other than their own, for instance, as live-in domestic workers. Understanding the children’s living arrangements, including the composition of the households where they live and the relationships with their primary caregivers, is key to designing targeted interventions aimed at promoting a child’s care and well-being. Table CP.12 presents information on the living arrangements and orphanhood status of children under the age of 18. Some 69 percent of children aged 0–17 years lived with both their parents, while 24 percent lived with their mother only and 2 percent lived with their father only. Overall, 5 percent of children lived with neither of their biological parents while one or both of them were alive, and one or both parents of 4 percent of children were dead. The highest proportion of children living with neither of their biological parents was in the Western Mountains (8 percent) and lowest in the Far Western Mountains (2 percent). Older children were much more likely than younger children to be living with neither of their biological parents: 12 percent of 15–17-year-olds were not living with their biological parents. Interestingly, children from richer households were more likely than others to be living with neither of their biological parents even though both parents were still alive. The highest proportion of children to have one or both parents dead was in the Western Mountains (8 percent) and lowest was in the Central Terai (3 percent). Older children were more likely than younger children to have one or both parents dead (8 percent for 15–17-year-olds). NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014200 Ta bl e CP .1 2: C hi ld re n’ s liv in g ar ra ng em en ts a nd o rp ha nh oo d Pe rc en ta ge o f c hil dr en a ge d 0– 17 ye ar s a cc or din g to liv ing a rra ng em en ts, p er ce nt ag e no t li vin g wi th a b iol og ica l p ar en t, an d pe rc en ta ge w ho h av e on e or b ot h pa re nt s d ea d, N ep al, 2 01 4 Pe rc en t o f c hil dr en a ge d 0– 17 ye ar s l ivi ng w ith : To ta l Pe rc en t liv ing w ith ne ith er bio log ica l pa re nt [1 ] Pe rc en t wi th o ne o r bo th pa re nt s de ad [2 ] Nu m be r o f ch ild re n ag ed 0 –1 7 ye ar s Bo th pa re nt s Ne ith er b iol og ica l p ar en t M ot he r o nly Fa th er o nly M iss ing inf or m a- tio n on fa th er / m ot he r On ly fa th er ali ve On ly m ot he r ali ve Bo th a liv e Bo th d ea d Fa th er ali ve Fa th er de ad M ot he r ali ve M ot he r de ad To ta l 69 .4 0. 3 0. 3 4. 0 0. 2 21 .1 2. 5 0. 7 0. 9 0. 6 10 0. 0 4. 8 4. 3 22 ,8 62 Se x M ale 70 .2 0. 3 0. 2 3. 2 0. 2 21 .4 2. 5 0. 8 0. 8 0. 5 10 0. 0 3. 9 4. 0 11 ,4 62 Fe m ale 68 .6 0. 4 0. 4 4. 7 0. 2 20 .8 2. 6 0. 5 0. 9 0. 8 10 0. 0 5. 8 4. 6 11 ,4 00 Re gi on Ea ste rn M ou nt ain s 79 .7 0. 2 0. 5 4. 7 0. 3 10 .7 2. 0 1. 0 0. 5 0. 3 10 0. 0 5. 7 3. 6 33 2 Ea ste rn H ills 66 .5 0. 3 1. 1 5. 5 0. 5 18 .7 3. 2 1. 0 2. 0 1. 1 10 0. 0 7. 4 7. 2 1, 21 5 Ea ste rn T er ai 68 .4 0. 1 0. 1 2. 6 0. 6 23 .2 2. 7 0. 8 1. 0 0. 6 10 0. 0 3. 4 4. 4 3, 23 8 Ce nt ra l M ou nt ain s 66 .7 0. 3 0. 6 3. 5 0. 1 22 .6 1. 7 3. 2 0. 5 0. 8 10 0. 0 4. 5 3. 1 43 0 Ce nt ra l H ills 71 .3 0. 7 0. 4 5. 8 0. 2 17 .0 2. 3 1. 0 0. 9 0. 2 10 0. 0 7. 2 4. 6 2, 77 0 Ce nt ra l T er ai 74 .2 0. 1 0. 2 3. 2 0. 1 18 .8 1. 9 0. 4 0. 6 0. 6 10 0. 0 3. 6 2. 8 4, 53 9 W es te rn M ou nt ain s 73 .5 0. 0 0. 0 7. 5 0. 7 8. 3 4. 7 0. 0 1. 5 3. 7 10 0. 0 8. 3 7. 6 7 W es te rn H ills 55 .9 0. 4 0. 3 4. 9 0. 0 34 .5 2. 4 0. 5 0. 5 0. 6 10 0. 0 5. 6 3. 6 2, 46 2 W es te rn T er ai 70 .3 0. 5 0. 3 2. 8 0. 0 21 .8 2. 9 0. 7 0. 6 0. 2 10 0. 0 3. 5 4. 3 1, 98 2 M id- W es te rn M ou nt ain s 85 .9 0. 1 0. 2 1. 8 0. 4 4. 5 4. 9 0. 1 1. 6 0. 4 10 0. 0 2. 5 7. 3 38 6 M id- W es te rn H ills 66 .4 0. 8 0. 6 4. 1 0. 2 24 .0 2. 2 0. 2 0. 8 0. 8 10 0. 0 5. 7 4. 5 1, 72 5 M id- W es te rn T er ai 68 .6 0. 4 0. 9 4. 8 0. 2 20 .5 2. 3 0. 7 0. 8 0. 8 10 0. 0 6. 3 4. 6 1, 35 3 Fa r W es te rn M ou nt ain s 80 .9 0. 1 0. 0 2. 1 0. 2 11 .1 3. 4 0. 3 1. 2 0. 6 10 0. 0 2. 4 5. 0 48 3 Fa r W es te rn H ills 76 .9 0. 0 0. 4 2. 1 0. 4 14 .2 3. 7 0. 2 1. 5 0. 4 10 0. 0 3. 0 6. 1 88 4 Fa r W es te rn T er ai 66 .2 0. 0 0. 1 6. 3 0. 1 20 .8 3. 4 0. 7 1. 0 1. 4 10 0. 0 6. 4 4. 7 1, 05 7 Ar ea Ur ba n 70 .0 0. 2 0. 3 6. 7 0. 4 18 .4 2. 1 1. 0 0. 4 0. 6 10 0. 0 7. 6 3. 4 3, 14 9 Ka th m an du va lle y 76 .9 0. 1 0. 5 7. 4 0. 4 11 .3 1. 6 1. 5 0. 1 0. 1 10 0. 0 8. 5 2. 8 78 8 Ot he r u rb an 67 .7 0. 2 0. 3 6. 4 0. 3 20 .8 2. 2 0. 8 0. 4 0. 8 10 0. 0 7. 3 3. 6 2, 36 1 Ru ra l 69 .3 0. 3 0. 4 3. 5 0. 2 21 .5 2. 6 0. 6 0. 9 0. 6 10 0. 0 4. 4 4. 4 19 ,7 13 Ag e (y ea rs ) 0– 4 69 .2 0. 0 0. 0 0. 9 0. 0 28 .4 1. 0 0. 2 0. 1 0. 3 10 0. 0 0. 9 1. 1 5, 71 5 5– 9 70 .3 0. 3 0. 2 2. 8 0. 1 22 .6 1. 9 0. 6 0. 7 0. 4 10 0. 0 3. 4 3. 3 6, 33 2 10 –1 4 70 .1 0. 4 0. 5 4. 4 0. 3 18 .4 3. 3 1. 0 1. 2 0. 6 10 0. 0 5. 5 5. 6 7, 29 3 15 –1 7 66 .5 0. 6 0. 9 10 .2 0. 6 12 .2 4. 6 0. 9 1. 7 1. 7 10 0. 0 12 .4 8. 4 3, 52 2 W ea lth in de x qu in til e Po or es t 72 .3 0. 5 0. 5 3. 0 0. 3 17 .1 3. 9 0. 5 1. 3 0. 6 10 0. 0 4. 3 6. 5 5, 29 1 Se co nd 68 .8 0. 3 0. 4 3. 0 0. 2 22 .5 2. 7 0. 3 1. 1 0. 6 10 0. 0 3. 9 4. 7 4, 82 1 M idd le 69 .5 0. 2 0. 2 3. 0 0. 1 23 .7 1. 4 0. 5 0. 6 0. 6 10 0. 0 3. 6 2. 6 4, 83 5 Fo ur th 65 .4 0. 3 0. 4 5. 0 0. 3 24 .1 2. 2 0. 9 0. 9 0. 6 10 0. 0 5. 9 4. 1 4, 42 6 Ri ch es t 70 .8 0. 2 0. 3 6. 7 0. 3 17 .8 2. 0 1. 3 0. 2 0. 5 10 0. 0 7. 4 3. 0 3, 48 9 [1 ] M IC S in di ca to r 8 .1 3 – Ch ild re n’ s liv in g ar ra ng em en ts [2 ] M IC S in di ca to r 8 .1 4 – Pr ev al en ce o f c hi ld re n wi th o ne o r b ot h pa re nt s de ad NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 201 The Nepal MICS included a simple measure of one particular aspect of migration related to what is termed ‘children left behind’, i.e., those for whom one or both parents have moved abroad. While the amount of literature is growing, current evidence about the long-term effects of migration on children is somewhat inconsistent, with the benefits from remittances being matched against the potentially adverse psychosocial consequences of separation. Besides providing simple prevalence rates, the results presented in Table CP.13 will help to fill data gaps on the topic of migration. Overall, 18 percent of children aged 0–17 years had one or both parents living abroad. The highest proportion was in the Western Hills (31 percent) and the lowest was in the Western Mountains (2 percent). Only 9 percent of children in Kathmandu valley had one or both parents living abroad. Younger children were much more likely than older children to have one or both parents living abroad. Table CP.13: Children with parents living abroad Percentage of children aged 0–17 years by residence of parents in another country, Nepal, 2014 Percent of children: Percent of children with at least one parent living abroad [1] Number of children aged 0–17 years With at least one parent living abroad With neither parent living abroad Total Only mother abroad Only father abroad Both mother and father abroad Total 0.5 17.0 0.7 81.8 100.0 18.2 22,862 Sex Male 0.5 17.3 0.7 81.5 100.0 18.5 11,462 Female 0.5 16.8 0.7 82.1 100.0 17.9 11,400 Region Eastern Mountains 0.3 9.5 0.2 90.0 100.0 10.0 332 Eastern Hills 1.8 14.1 0.1 84.0 100.0 16.0 1,215 Eastern Terai 0.4 20.7 0.7 78.1 100.0 21.9 3,238 Central Mountains 2.7 12.3 0.4 84.6 100.0 15.4 430 Central Hills 0.6 12.1 0.5 86.8 100.0 13.2 2,770 Central Terai 0.2 14.1 0.2 85.6 100.0 14.4 4,539 Western Mountains 0.0 1.3 1.0 97.7 100.0 2.3 7 Western Hills 0.2 30.5 0.4 68.9 100.0 31.1 2,462 Western Terai 0.7 18.8 1.1 79.4 100.0 20.6 1,982 Mid-Western Mountains 0.0 2.9 0.1 97.0 100.0 3.0 386 Mid-Western Hills 0.1 20.6 1.0 78.3 100.0 21.7 1,725 Mid-Western Terai 0.9 14.2 1.4 83.5 100.0 16.5 1,353 Far Western Mountains 0.0 7.8 0.7 91.5 100.0 8.5 483 Far Western Hills 0.4 13.0 0.7 85.9 100.0 14.1 884 Far Western Terai 0.4 15.0 2.4 82.3 100.0 17.7 1,057 Area Urban 0.6 14.4 1.0 84.1 100.0 15.9 3,149 Kathmandu valley 0.6 8.1 0.3 90.9 100.0 9.1 788 Other urban 0.5 16.4 1.2 81.8 100.0 18.2 2,361 Rural 0.5 17.5 0.6 81.4 100.0 18.6 19,713 Age (years) 0–4 0.1 22.7 0.2 76.9 100.0 23.1 5,715 5–9 0.5 18.5 0.6 80.4 100.0 19.6 6,332 10–14 0.7 14.8 1.0 83.5 100.0 16.5 7,293 15–17 0.7 9.7 0.9 88.7 100.0 11.3 3,522 Wealth index quintile Poorest 0.3 14.7 0.5 84.6 100.0 15.4 5,291 Second 0.5 17.7 0.6 81.2 100.0 18.8 4,821 Middle 0.3 18.9 0.5 80.3 100.0 19.7 4,835 Fourth 0.8 19.0 1.1 79.1 100.0 20.9 4,426 Richest 0.7 14.6 0.8 83.9 100.0 16.1 3,489 [1] MICS indicator 8.15 – Children with at least one parent living abroad NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014202 Country-specific data were also collected on children living away from their biological mother for any reason including mothers’ death or living abroad, as shown in Table CP.14. In Nepal, migration has contributed to a rise in female-headed households in which children are not living with their biological mother; this is an important protection issue as these children may be more at risk of trafficking, child labour and sexual violence. A small proportion (5 percent) of children aged 0–17 years were found to be living away from their biological mother. There were no notable differences across groups of children in different regions, areas, ages or wealth quintiles, except for those in the Western Mountains, where 36 percent were not living with their biological mother, and among children aged 15–17 years, of whom 19 percent were not living with their biological mother. Table CP.14: Children living away from their biological mother Percentage of children aged 0–17 years living away from biological mother, Nepal, 2014 Percent of children living away from biological mother Number of children aged 0–17 years Total 5.0 20,161 Sex Male 5.1 10,211 Female 4.9 9,950 Region Eastern Mountains 7.2 284 Eastern Hills 6.4 1,010 Eastern Terai 4.1 2,894 Central Mountains 8.9 376 Central Hills 5.5 2,445 Central Terai 4.3 4,014 Western Mountains 35.6 10 Western Hills 7.9 2,266 Western Terai 3.1 1,722 Mid-Western Mountains 6.4 332 Mid-Western Hills 5.4 1,520 Mid-Western Terai 4.0 1,166 Far Western Mountains 5.4 430 Far Western Hills 2.8 764 Far Western Terai 4.5 926 Area Urban 4.4 2,795 Kathmandu valley 5.5 713 Other urban 4.0 2,082 Rural 5.1 17,366 Age group (years) 0–4 0.4 5,273 5–9 2.4 5,799 10–14 4.9 6,198 15–17 19.0 2,891 Wealth index quintile Poorest 5.1 4,499 Second 5.8 4,317 Middle 4.7 4,289 Fourth 5.0 3,937 Richest 4.5 3,118 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 203 HIV and AIDS C H A P T E R12 Knowledge about HIV Transmission and Misconceptions about HIV/AIDS One of the most important prerequisites for reducing the rate of HIV infection is accurate knowledge of how HIV is transmitted and strategies for preventing transmission. Correct information is the first step towards raising awareness and giving adolescents and young people the tools to protect themselves from infection. Misconceptions about HIV are common and can confuse adolescents and young people and hinder prevention efforts. Different regions are likely to have variations in misconceptions although some appear universal (for example, that sharing food or mosquito bites can transmit HIV). The UN General Assembly Special Session on HIV/AIDS (UNGASS) called on governments to improve the knowledge and skills of young people to protect themselves from HIV. The indicators to measure this goal as well as the MDG of reducing HIV infections by half include improving the level of knowledge of HIV and its prevention, and changing behaviours to prevent further spread of the disease. HIV module(s) were administered to women aged 15–49 years. Please note that the questions in this module often refer to ‘the AIDS virus’. This terminology is used strictly as a method of data collection to aid respondents, preferred over the correct terminology of ‘HIV’ that is used here in reporting the results, where appropriate. One indicator which is both an MDG and the Global AIDS Response Progress Reporting (GARPR; formerly UNGASS) indicator is the percentage of young people who have comprehensive and correct knowledge of HIV prevention and transmission. This is defined as: (1) knowing that consistent use of a condom during sexual intercourse and having just one uninfected faithful partner can reduce the chance of getting HIV; (2) knowing that a healthy-looking person can have HIV; and (3) rejecting the two most common local misconceptions about transmission/prevention of HIV. In the Nepal MICS, all women who have heard of AIDS were asked questions on all three components and the results are detailed in Table HA.1. In Nepal, most women aged 15–49 years (78 percent) had heard of AIDS. However, only 63 percent reported knowing that HIV transmission can be prevented by having only one faithful uninfected sex partner, and 55 percent reported knowing about using a condom every time; some 51 percent knew about both of these ways. Regionally, knowledge among women on prevention of HIV transmission (know both ways) ranged from 21 percent in the Mid-Western Mountains to 69 percent in the Central Hills. Knowledge (of both preventive ways) was higher among urban women than rural women (68 percent compared to 47 percent). Education and household wealth status were positively associated with knowledge: 23 percent of women with no education had knowledge of both preventive ways compared to 80 percent of women with higher education, and 38 percent of women in the poorest household population had knowledge of both preventive ways compared to 72 percent in the richest household population. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014204 Ta bl e HA .1 : K no wl ed ge a bo ut H IV tr an sm is si on , m is co nc ep tio ns a bo ut H IV , a nd c om pr eh en si ve k no wl ed ge a bo ut H IV tr an sm is si on (w om en ) Pe rc en ta ge o f w om en a ge d 15 –4 9 ye ar s w ho kn ow th e m ain w ay s o f p re ve nt ing H IV tr an sm iss ion , p er ce nt ag e wh o kn ow th at a h ea lth y- loo kin g pe rs on ca n be H IV -p os itiv e, p er ce nt ag e wh o re jec t c om m on m isc on ce pt ion s, an d pe rc en ta ge w ho h av e co m pr eh en siv e kn ow led ge a bo ut H IV tr an sm iss ion , N ep al, 2 01 4 Pe rc en t w ho ha ve h ea rd o f AI DS Pe rc en t w ho kn ow tr an sm iss ion ca n be pr ev en te d by : Pe rc en t w ho kn ow th at a he alt hy - loo kin g pe rs on ca n be HI V- po sit ive Pe rc en t w ho kn ow th at H IV ca nn ot b e tra ns m itte d by : Pe rc en t w ho re jec t t he tw o m os t c om m on m isc on ce p- tio ns a nd kn ow th at a he alt hy - loo kin g pe rs on ca n be HI V- po sit ive Pe rc en t w ith co m pr e- he ns ive kn ow led ge [1 ] Nu m be r o f wo m en a ge d 15 –4 9 ye ar s Ha vin g on ly on e fa ith fu l un inf ec te d se x p ar tn er Us ing a co nd om e ve ry tim e Bo th M os qu ito bit es Su pe rn at ur al m ea ns Sh ar ing fo od wi th so m eo ne wi th H IV To ta l 78 .4 63 .1 55 .1 51 .0 58 .6 46 .1 69 .2 56 .2 33 .1 26 .4 14 ,1 62 Re gi on Ea ste rn M ou nt ain s 74 .4 60 .6 51 .8 48 .7 59 .5 29 .7 64 .4 48 .2 19 .4 17 .2 18 6 Ea ste rn H ills 81 .2 68 .4 54 .9 52 .3 60 .3 44 .5 72 .0 56 .8 27 .5 22 .8 80 7 Ea ste rn T er ai 76 .3 59 .4 46 .8 42 .6 53 .1 44 .8 64 .5 51 .5 29 .1 21 .8 2, 07 1 Ce nt ra l M ou nt ain s 80 .7 58 .4 60 .0 53 .2 65 .0 41 .7 71 .9 52 .5 27 .8 24 .1 27 4 Ce nt ra l H ills 91 .2 77 .9 73 .2 68 .8 73 .6 61 .7 83 .3 74 .5 49 .4 42 .3 2, 32 0 Ce nt ra l T er ai 64 .5 48 .7 41 .5 38 .5 45 .3 45 .1 59 .6 44 .8 30 .1 21 .9 2, 32 7 W es te rn M ou nt ain s 67 .8 51 .2 45 .1 40 .9 38 .7 29 .2 58 .7 43 .7 19 .6 15 .8 8 W es te rn H ills 90 .0 71 .8 60 .6 56 .2 68 .1 39 .2 80 .6 63 .4 28 .5 22 .8 1, 65 9 W es te rn T er ai 88 .8 64 .5 56 .9 52 .3 59 .1 54 .2 68 .9 59 .6 38 .2 30 .3 1, 23 6 M id- W es te rn M ou nt ain s 43 .2 33 .1 24 .8 20 .6 30 .8 13 .8 26 .8 17 .3 8. 0 5. 5 16 9 M id- W es te rn H ills 64 .7 54 .9 45 .5 41 .2 52 .7 31 .6 59 .1 42 .7 21 .0 14 .7 85 6 M id- W es te rn T er ai 76 .0 63 .5 55 .8 50 .4 58 .3 45 .5 65 .4 55 .9 33 .6 25 .8 85 5 Fa r W es te rn M ou nt ain s 69 .0 61 .3 61 .4 57 .8 48 .8 37 .1 64 .3 47 .4 29 .8 28 .7 22 5 Fa r W es te rn H ills 74 .5 58 .6 58 .4 53 .6 55 .0 45 .1 68 .3 52 .7 36 .3 30 .6 43 3 Fa r W es te rn T er ai 74 .1 66 .4 61 .5 57 .6 60 .3 42 .5 68 .1 58 .4 33 .3 27 .5 73 5 Ar ea Ur ba n 93 .0 80 .6 71 .8 67 .8 76 .6 62 .1 86 .7 77 .1 49 .5 40 .8 2, 79 2 Ka th m an du va lle y 96 .9 86 .9 79 .8 76 .0 81 .6 68 .2 90 .5 86 .5 56 .2 48 .1 86 8 Ot he r u rb an 91 .3 77 .7 68 .3 64 .1 74 .4 59 .3 85 .0 72 .9 46 .5 37 .5 1, 92 4 Ru ra l 74 .8 58 .8 51 .0 46 .8 54 .1 42 .2 64 .9 51 .1 29 .0 22 .8 11 ,3 70 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 205 Ta bl e HA .1 : K no wl ed ge a bo ut H IV tr an sm is si on , m is co nc ep tio ns a bo ut H IV , a nd c om pr eh en si ve k no wl ed ge a bo ut H IV tr an sm is si on (w om en ) Pe rc en ta ge o f w om en a ge d 15 –4 9 ye ar s w ho kn ow th e m ain w ay s o f p re ve nt ing H IV tr an sm iss ion , p er ce nt ag e wh o kn ow th at a h ea lth y- loo kin g pe rs on ca n be H IV -p os itiv e, p er ce nt ag e wh o re jec t c om m on m isc on ce pt ion s, an d pe rc en ta ge w ho h av e co m pr eh en siv e kn ow led ge a bo ut H IV tr an sm iss ion , N ep al, 2 01 4 Pe rc en t w ho ha ve h ea rd o f AI DS Pe rc en t w ho kn ow tr an sm iss ion ca n be pr ev en te d by : Pe rc en t w ho kn ow th at a he alt hy - loo kin g pe rs on ca n be HI V- po sit ive Pe rc en t w ho kn ow th at H IV ca nn ot b e tra ns m itte d by : Pe rc en t w ho re jec t t he tw o m os t c om m on m isc on ce p- tio ns a nd kn ow th at a he alt hy - loo kin g pe rs on ca n be HI V- po sit ive Pe rc en t w ith co m pr e- he ns ive kn ow led ge [1 ] Nu m be r o f wo m en a ge d 15 –4 9 ye ar s Ha vin g on ly on e fa ith fu l un inf ec te d se x p ar tn er Us ing a co nd om e ve ry tim e Bo th M os qu ito bit es Su pe rn at ur al m ea ns Sh ar ing fo od wi th so m eo ne wi th H IV Ag e (y ea rs ) 15 –2 4 [1 ] 88 .2 77 .2 67 .5 64 .2 71 .0 57 .6 80 .8 68 .3 43 .8 36 .4 5, 12 3 15 –1 9 89 .6 78 .1 69 .5 65 .9 73 .2 58 .3 82 .8 69 .3 44 .8 37 .7 2, 72 1 20 –2 4 86 .6 76 .1 65 .3 62 .2 68 .5 56 .7 78 .5 67 .2 42 .6 34 .9 2, 40 2 25 –2 9 82 .0 65 .7 57 .7 53 .0 61 .0 49 .5 72 .6 59 .7 35 .7 27 .9 2, 41 4 30 –3 9 72 .9 56 .3 49 .0 44 .8 52 .8 40 .1 63 .1 49 .6 27 .5 21 .1 3, 90 4 40 –4 9 64 .7 44 .2 38 .1 33 .1 41 .3 30 .3 53 .0 39 .8 18 .5 13 .7 2, 72 1 M ar ita l s ta tu s Ev er m ar rie d 74 .2 57 .4 49 .7 45 .3 53 .0 41 .1 64 .1 50 .5 27 .9 21 .6 11 ,1 25 Ne ve r m ar rie d 93 .8 83 .9 74 .7 71 .6 78 .8 64 .4 87 .9 77 .0 51 .8 43 .7 3, 03 7 Ed uc at io n No ne 54 .4 32 .9 28 .1 23 .3 30 .9 22 .3 41 .5 27 .1 10 .8 6. 6 5, 29 4 Pr im ar y 79 .2 57 .3 50 .3 44 .8 53 .3 35 .3 65 .9 47 .8 21 .8 16 .1 2, 00 4 Se co nd ar y 94 .8 83 .9 72 .7 69 .3 75 .5 59 .9 87 .9 73 .4 43 .2 35 .5 3, 83 0 Hi gh er 99 .3 93 .5 83 .0 80 .2 89 .0 77 .5 96 .0 90 .7 66 .5 56 .2 3, 03 2 W ea lth in de x qu in til es Po or es t 66 .5 48 .5 43 .1 38 .2 46 .9 29 .8 55 .7 39 .1 19 .4 15 .0 2, 45 3 Se co nd 70 .6 52 .7 46 .3 41 .9 48 .8 34 .7 59 .9 45 .7 22 .0 17 .1 2, 72 0 M idd le 73 .1 56 .0 46 .5 42 .3 50 .9 40 .1 63 .2 47 .7 25 .0 18 .9 2, 75 2 Fo ur th 82 .5 67 .7 59 .0 54 .8 60 .2 51 .8 72 .6 60 .5 37 .1 29 .6 3, 02 0 Ri ch es t 94 .8 84 .9 75 .2 72 .2 80 .7 68 .1 89 .3 81 .4 55 .9 46 .1 3, 21 8 [1 ] M IC S in di ca to r 9 .1 ; M DG in di ca to r 6 .3 – K no wl ed ge a bo ut H IV p re ve nt io n am on g yo un g wo m en No te : 1 ca se o f m iss ing ‘e du ca tio n’ no t s ho wn C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014206 People with comprehensive knowledge about HIV prevention include those who know of the two main ways of HIV prevention (having only one faithful uninfected partner and using a condom every time), who know that a healthy-looking person can be HIV-positive, and who reject the two most common misconceptions. Comprehensive knowledge of HIV prevention methods and transmission was fairly low in Nepal, although there was considerable variation by background characteristics (Table HA.1). Overall, 26 percent of women were found to have comprehensive knowledge. Regionally, the highest proportion was in the Central Hills (42 percent) and lowest proportion was in the Mid-Western Mountains (6 percent). Urban women were more likely than rural women to have comprehensive knowledge (41 percent compared to 23 percent). Education and household wealth status were strongly correlated with comprehensive knowledge. Women with no education were much less likely than women with higher education to have comprehensive knowledge (7 percent compared to 56 percent), and women in the poorest household population were much less likely than women in the richest household population to have comprehensive knowledge (15 percent compared to 46 percent). Knowledge of mother-to-child transmission of HIV is also an important first step for women prior to seeking a test for HIV when they are pregnant to avoid infecting their baby. Women should know that HIV can be transmitted during pregnancy, during delivery and through breastfeeding. Knowledge among women aged 15–49 years concerning mother-to-child transmission is presented in Table Table HA.1 also presents the percentage of women who can correctly identify misconceptions concerning HIV. The indicator is based on the two most common and relevant misconceptions in Nepal, that HIV can be transmitted by supernatural means and by sharing food with someone with HIV. The table also provides information on whether women know that HIV cannot be transmitted by mosquito bites. Overall, 33 percent of women rejected the two most common misconceptions and knew that a healthy-looking person can be HIV-positive. Some 69 percent of women knew that HIV cannot be transmitted by supernatural means, 56 percent knew that HIV cannot be transmitted by sharing food with someone with HIV, and 46 percent knew that HIV cannot be transmitted by mosquito bites. In addition, 59 percent knew that a healthy-looking person can be HIV-positive. Figure HA.1 illustrates the proportions of women in Nepal with comprehensive knowledge of HIV transmission. Figure HA.1: Women with comprehensive knowledge of HIV transmission, Nepal, 2014 Nepal  MICS  2014   4   Table HA.1 also presents the percentage of women who can correctly identify misconceptions concerning HIV. The indicator is based on the two most common and relevant misconceptions in Nepal, that HIV can be transmitted by supernatural means and by sharing food with someone with HIV. The table also provides information on whether women know that HIV cannot be transmitted by mosquito bites. Overall, 33 percent of women rejected the two most common misconceptions and knew that a healthy-looking person can be HIV-positive. Some 69 percent of women knew that HIV cannot be transmitted by supernatural means, 56 percent knew that HIV cannot be transmitted by sharing food with someone with HIV, and 46 percent knew that HIV cannot be transmitted by mosquito bites. In addition, 59 percent knew that a healthy-looking person can be HIV- positive. Figure HA.1 illustrates the proportions of women in Nepal with comprehensive knowledge of HIV transmission. Figure HA.1: Women with comprehensive knowledge of HIV transmission, Nepal, 2014 People with comprehensive knowledge about HIV prevention include those who know of the two main ways of HIV prevention (having only one faithful uninfected partner and using a condom every time), who know that a healthy-looking person can be HIV-positive, and who reject the two most common misconceptions. Comprehensive knowledge of HIV prevention methods and transmission was fairly low in Nepal, although there was considerable variation by background characteristics (Table HA.1). Overall, 26 percent of women were found to have comprehensive knowledge. Regionally, the highest proportion was in the Central Hills (42 percent) and lowest proportion was in the Mid-Western Mountains (6 percent). Urban women were more likely than rural women to have comprehensive knowledge (41 percent compared to 23 percent). Education and household wealth status were strongly correlated with comprehensive knowledge. Women with no education were much less likely than 51 33 26 Knows 2 ways to prevent HIV Identify 2 most common misconceptions and know that a healthy looking person can be HIV- positive Comprehensive knowledge Per cent Women age 15-49 P er ce nt Women aged 15–49 years NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 207 HA.2. Some 69 percent of women knew that HIV can be transmitted from mother to child (i.e., identified at least one of the three means), with 67 percent knowing that HIV can be transmitted during pregnancy, 59 percent knowing it can be transmitted during delivery, and 42 percent knowing it can be transmitted by breast feeding. The percentage of women who knew all three means of mother-to-child transmission was 38 percent, while 9 percent of women had heard of AIDS but did not know of any specific means of transmission from mother to child. Table HA.2: Knowledge of mother-to-child HIV transmission (women) Percentage of women aged 15–49 years who correctly identify means of HIV transmission from mother to child, Nepal, 2014 Percent of women who have heard of AIDS and: Number of women aged 15–49 years Know HIV can be transmitted from mother to child: Do not know any of the specific means of HIV trans- mission from mother to child During pregnancy During delivery By breast- feeding By at least one of the three means By all three means [1] Total 66.7 58.5 42.3 69.4 38.4 9.0 14,162 Region Eastern Mountains 63.7 58.1 49.2 66.0 46.5 8.4 186 Eastern Hills 63.4 60.7 48.0 66.7 45.6 14.5 807 Eastern Terai 60.1 56.4 41.1 63.8 37.5 12.5 2,071 Central Mountains 75.6 73.2 62.8 76.3 62.1 4.4 274 Central Hills 78.5 68.6 47.5 82.0 42.2 9.2 2,320 Central Terai 54.8 38.2 26.9 56.0 24.3 8.4 2,327 Western Mountains 63.2 49.2 26.7 64.0 25.3 3.8 8 Western Hills 82.7 68.7 48.6 84.8 43.1 5.2 1,659 Western Terai 67.5 62.4 32.9 71.3 30.3 17.5 1,236 Mid-Western Mountains 38.7 35.8 35.5 39.7 33.6 3.5 169 Mid-Western Hills 57.8 54.7 43.8 61.4 39.1 3.3 856 Mid-Western Terai 66.9 61.9 47.6 70.1 41.1 5.9 855 Far Western Mountains 61.1 60.1 48.4 63.7 46.6 5.3 225 Far Western Hills 66.5 59.4 52.1 69.1 48.2 5.4 433 Far Western Terai 66.9 64.0 49.3 68.8 47.5 5.3 735 Area Urban 82.1 72.5 46.4 85.4 42.2 7.6 2,792 Kathmandu valley 84.1 73.2 45.0 88.1 38.6 8.7 868 Other urban 81.2 72.2 47.1 84.2 43.7 7.1 1,924 Rural 62.9 55.1 41.2 65.5 37.5 9.3 11,370 Age (years) 15–24 [1] 76.5 67.1 49.2 79.4 44.9 8.8 5,123 15–19 78.0 68.0 51.2 81.0 46.4 8.6 2,721 20–24 74.7 66.1 47.0 77.6 43.1 9.0 2,402 25–29 69.0 60.8 42.4 72.2 38.6 9.8 2,414 30–39 61.6 54.2 39.0 64.2 35.3 8.8 3,904 40–49 53.3 46.5 33.7 55.7 30.7 9.0 2,721 Marital status Ever married 62.5 55.0 39.9 65.2 36.4 9.1 11,125 Never married 81.7 71.5 51.0 85.0 46.1 8.8 3,037 Education None 42.9 36.6 28.7 44.7 26.4 9.7 5,294 Primary 65.9 58.4 42.3 68.7 38.6 10.5 2,004 Secondary 83.0 73.5 54.8 86.7 49.8 8.0 3,830 Higher 88.0 77.7 50.0 91.2 45.0 8.1 3,032 Wealth index quintiles Poorest 57.7 51.4 43.4 60.1 40.1 6.4 2,453 Second 60.0 53.5 41.9 61.9 39.4 8.7 2,720 Middle 59.2 52.4 38.5 61.8 34.7 11.2 2,752 Fourth 69.2 59.8 42.5 71.9 38.7 10.6 3,020 Richest 83.1 72.1 44.7 87.0 39.5 7.8 3,218 [1] MICS indicator 9.2 – Knowledge of mother-to-child transmission of HIV Note: 1 case of missing ‘education’ not shown NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014208 Regionally, the highest proportion of women who correctly identified all three means of mother-to- child transmission was in the Central Mountains (62 percent) and the lowest proportion was in the Central Terai (24 percent). Education had a strong association with the ability to correctly identify all three means: women with no education were less likely than women with higher education to correctly identify all three means (26 percent compared to 45 percent). Accepting Attitudes toward People Living with HIV/AIDS The indicators on attitudes toward people living with HIV measure stigma and discrimination in the community. Stigma and discrimination are considered low if respondents report an accepting attitude to the following four situations: (1) would care for a family member with AIDS in own home; (2) would buy fresh vegetables from a vendor who is HIV-positive; (3) thinks that a female teacher who is HIV- positive and not sick should be allowed to teach in school; and (4) would not want to keep it a secret if a family member is HIV-positive. Table HA.3 presents the attitudes of women towards people living with HIV. In Nepal, 97 percent of women who had heard of AIDS agreed with at least one accepting statement, with 87 percent being willing to care for a family member with AIDS in their own home, 81 percent believing that a female teacher who is HIV-positive but not sick should be allowed to continue teaching, 80 percent being willing to buy fresh vegetables from a shopkeeper who is HIV-positive, and 67 percent who would not to keep it secret that a family member was infected with the AIDS virus. Overall, 49 percent agreed with all four accepting statements. In terms of women who expressed an accepting attitude to all four statements, the highest proportion was in the Western Hills (57 percent) and the lowest proportion was in the Mid-Western Mountains (23 percent). Urban women were more likely than rural women to accept all four statements (59 percent compared to 45 percent). More educated women and those from richer households were more likely than other women to have accepting attitudes: 31 percent of women with no education accepted all four statements compared to 65 percent of women with higher education, and 39 percent of women in the poorest household population accepted all four statements compared to 61 percent of women in the richest household population. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 209 Table HA.3: Accepting attitudes toward people living with HIV (women) Percentage of women aged 15–49 years who have heard of AIDS who express an accepting attitude towards people living with HIV, Nepal, 2014 Percent of women who have heard of AIDS who: Number of women aged 15–49 years who have heard of AIDS Are willing to care for a family member with AIDS in own home Would buy fresh vegetables from a shopkeeper or vendor who is HIV- positive Believe that a female teacher who is HIV- positive but not sick should be allowed to continue teaching Would not want to keep secret that a family member is HIV-positive Agree with at least one accepting attitude Express accepting attitudes on all four indicators [1] Total 87.0 79.8 80.5 66.9 96.5 48.6 11,107 Region Eastern Mountains 86.4 73.8 74.0 79.4 95.7 53.3 139 Eastern Hills 85.6 80.1 80.1 68.6 94.4 52.0 655 Eastern Terai 89.8 80.1 81.0 70.4 96.9 54.0 1,581 Central Mountains 88.5 78.8 82.3 55.9 98.2 36.9 221 Central Hills 88.6 90.8 89.1 64.2 98.8 50.2 2,116 Central Terai 83.6 71.8 76.6 53.1 93.8 36.7 1,500 Western Mountains 91.2 76.3 77.1 69.9 95.9 53.6 5 Western Hills 91.6 78.1 78.1 79.9 97.3 57.2 1,494 Western Terai 85.9 75.3 73.2 66.0 92.3 50.7 1,098 Mid-Western Mountains 75.9 65.4 66.7 47.9 96.5 22.9 73 Mid-Western Hills 82.6 66.2 73.0 69.3 97.8 41.2 554 Mid-Western Terai 87.3 75.7 78.1 75.0 98.4 49.2 650 Far Western Mountains 90.3 80.4 80.2 62.2 96.2 53.5 156 Far Western Hills 91.9 88.2 83.3 65.5 98.1 56.0 323 Far Western Terai 75.0 89.2 90.1 63.6 98.8 35.7 545 Area Urban 92.1 89.3 89.3 71.6 98.4 59.1 2,597 Kathmandu valley 92.3 94.7 92.9 69.6 99.7 59.0 841 Other urban 92.0 86.8 87.6 72.5 97.8 59.2 1,756 Rural 85.5 76.9 77.8 65.5 96.0 45.4 8,510 Age (years) 15–24 87.5 84.3 85.1 66.9 97.7 51.0 4,520 15–19 87.4 84.5 85.8 66.6 97.9 49.9 2,439 20–24 87.6 84.0 84.3 67.3 97.5 52.2 2,081 25–29 88.1 80.7 81.6 67.5 96.8 50.8 1,980 30–39 86.5 76.6 77.6 66.9 96.1 47.2 2,847 40–49 85.4 72.4 72.2 66.3 94.0 42.5 1,760 Marital status Ever married 86.4 76.7 77.6 66.7 96.0 46.7 8,260 Never married 88.9 88.9 89.0 67.5 98.2 54.3 2,847 Education None 79.9 62.0 63.5 57.6 91.9 31.0 2,880 Primary 85.1 71.2 72.4 63.3 95.5 39.0 1,587 Secondary 88.0 85.1 85.2 70.6 98.3 52.9 3,629 Higher 93.7 95.0 95.3 73.4 99.5 65.4 3,010 Wealth index quintiles Poorest 82.4 68.7 70.2 63.5 95.3 38.8 1,632 Second 84.5 74.4 75.8 66.1 95.8 43.2 1,921 Middle 84.7 73.1 74.9 63.2 95.3 41.6 2,010 Fourth 86.9 81.8 81.5 66.6 96.1 49.5 2,491 Richest 92.7 91.9 91.9 72.0 98.8 61.2 3,052 [1] MICS indicator 9.3 – Accepting attitudes towards people living with HIV Note: 1 case of missing ‘education’ not shown NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014210 Figure HA.2 shows the proportion of women with accepting attitudes toward people living with HIV/AIDS by age groups. Figure HA.2: Accepting attitudes towards people living with HIV/AIDS, Nepal, 2014 Knowledge of a Place for HIV Testing, Counselling and Testing during Antenatal Care Another important indicator is knowledge of where to be tested for HIV and use of such services. In order to protect themselves and to prevent infecting others, it is important for individuals to know their HIV status. Knowledge of one’s own status is also a critical factor in the decision to seek treatment. Information related to knowledge of a facility for HIV testing and whether a person had ever been tested is presented in Table HA.4. Some 58 percent of women knew where to be tested. However, only 9 percent had actually been tested and slightly fewer (8 percent) knew the result of their most recent test. A small proportion had been tested in the 12 months preceding the survey (3 percent), and most of these women (i.e., slightly fewer than 3 percent of all women) knew the result of the test they had taken in the 12 months preceding the survey. Regionally, the highest proportion of women with knowledge of a place to get tested was in the Western Hills (74 percent) and the lowest proportion was in the Mid-Western Mountains (28 percent). Urban women were more likely than rural women to know of a place to get tested (73 percent compared to 54 percent). Knowledge about a place to get tested has a strong positive correlation with both education and household wealth status: 32 percent of women with no education knew of a place compared to 88 percent of women with higher education, and 44 percent of women in the poorest household population knew of a place compared to 77 percent of women in the richest household population. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 211 Although the percentage of women tested in the 12 months preceding the survey and knowing the result of their test was small, there was noticeable variation by background characteristics. The highest proportion was in the Western Hills (5 percent) and the lowest proportion was in the Eastern Mountains (1 percent). Younger women and ever married women were more likely than other women to have been recently tested and know the result, and more educated women and women living in households in richer quintiles were more likely than other women to have been recently tested and know the results. Table HA.4: Knowledge of a place for HIV testing (women) Percentage of women aged 15–49 years who know where to get an HIV test, percentage who have ever been tested, percentage who have ever been tested and know the result of the most recent test, percentage who have been tested in the 12 months preceding the survey, and percentage who have been tested in the 12 months preceding the survey and know the result, Nepal, 2014 Percent of women who: Number of women aged 15–49 years Know a place to get tested [1] Have ever been tested Have ever been tested and know the result of the most recent test Have been tested in the 12 months Have been tested in the 12 months and know the result [2] Total 57.9 8.8 8.2 2.9 2.7 14,162 Region Eastern Mountains 46.5 3.6 3.6 0.7 0.7 186 Eastern Hills 57.2 5.3 4.8 1.8 1.5 807 Eastern Terai 53.4 7.8 7.6 2.9 2.8 2,071 Central Mountains 61.6 2.2 1.9 1.1 1.1 274 Central Hills 68.4 12.4 11.8 4.2 4.1 2,320 Central Terai 49.4 6.1 5.8 2.0 1.9 2,327 Western Mountains 52.8 10.7 10.3 2.4 2.4 8 Western Hills 73.8 13.2 12.1 4.8 4.5 1,659 Western Terai 63.7 6.1 5.8 1.1 1.1 1,236 Mid-Western Mountains 27.8 3.8 3.5 1.8 1.7 169 Mid-Western Hills 35.2 8.3 7.8 2.0 1.9 856 Mid-Western Terai 53.2 9.7 8.6 3.7 3.4 855 Far Western Mountains 61.7 5.6 4.9 1.6 1.4 225 Far Western Hills 59.5 9.3 8.3 3.2 3.1 433 Far Western Terai 58.9 12.2 10.3 3.3 3.1 735 Area Urban 73.2 14.4 13.7 4.7 4.5 2,792 Kathmandu valley 70.3 14.2 13.7 4.5 4.2 868 Other urban 74.6 14.4 13.8 4.8 4.7 1,924 Rural 54.2 7.4 6.8 2.4 2.3 11,370 Age (years) 15–24 67.8 7.7 7.1 3.2 3.1 5,123 15–19 67.6 3.0 2.6 1.6 1.4 2,721 20–24 68.0 12.9 12.2 5.0 4.9 2,402 25–29 62.0 15.0 14.1 4.7 4.4 2,414 30–39 52.7 9.6 9.0 2.6 2.5 3,904 40–49 43.3 4.3 3.7 1.2 1.0 2,721 Marital status Ever married 53.7 10.4 9.7 3.3 3.2 11,125 Never married 73.6 3.0 2.6 1.3 1.2 3,037 Education None 32.4 3.6 3.1 1.2 1.1 5,294 Primary 52.5 8.1 6.9 2.4 2.2 2,004 Secondary 72.6 8.5 7.9 2.9 2.7 3,830 Higher 87.6 18.8 18.2 6.1 6.0 3,032 Wealth index quintiles Poorest 43.5 4.7 4.0 1.6 1.4 2,453 Second 49.6 6.1 5.5 2.1 2.0 2,720 Middle 51.6 7.2 6.2 2.2 2.0 2,752 Fourth 62.4 8.2 7.6 2.4 2.3 3,020 Richest 77.2 16.1 15.8 5.6 5.5 3,218 [1] MICS indicator 9.4 – Women who know where to be tested for HIV [2] MICS indicator 9.5 – Women who have been tested for HIV and know the results Note: 1 case of missing ‘education’ not shown NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014212 Table HA.5: HIV counselling and testing during antenatal care Percentage of women aged 15–49 years with a live birth in the two years preceding the survey who received antenatal care from a health professional during the last pregnancy, percentage who received HIV counselling, percentage who were offered and tested for HIV, percentage who were offered, tested and received the results of the HIV test, and percentage who received counselling and were offered, accepted and received the results of the HIV test, Nepal, 2014 Percent of women who: Number of women aged 15–49 years with a live birth in the last two years Received antenatal care from a health care professional for last pregnancy Received HIV counselling during antenatal care [1] Were offered an HIV test and were tested for HIV during antenatal care Were offered an HIV test and were tested for HIV during antenatal care, and received the results [2] Received HIV counselling, were offered an HIV test, accepted and received the results Total 68.3 14.1 14.4 13.7 9.1 2,048 Region Eastern Mountains 51.8 2.1 4.1 4.1 2.1 32 Eastern Hills 64.9 6.8 7.2 6.3 3.3 123 Eastern Terai 79.8 12.7 16.4 16.0 8.3 277 Central Mountains 55.8 8.8 5.3 2.9 2.9 38 Central Hills 82.8 21.8 27.1 25.4 16.2 241 Central Terai 73.4 15.3 12.4 12.4 11.4 400 Western Mountains (64.6) (6.3) (13.4) (13.4) (6.3) 1 Western Hills 67.6 12.7 22.0 21.2 10.6 222 Western Terai 67.0 6.1 4.4 4.4 3.2 178 Mid-Western Mountains 42.4 4.3 2.4 1.5 1.5 43 Mid-Western Hills 47.1 7.0 5.4 5.4 3.8 166 Mid-Western Terai 67.3 18.7 15.6 14.5 10.4 113 Far Western Mountains 50.2 33.6 5.5 5.5 4.2 33 Far Western Hills 46.5 27.4 16.2 16.2 13.9 75 Far Western Terai 69.3 19.9 21.8 19.1 11.8 106 Area Urban 92.5 23.8 30.8 30.2 19.2 262 Kathmandu valley 100.0 22.2 21.1 21.1 18.1 65 Other urban 90.0 24.3 34.0 33.3 19.5 197 Rural 64.8 12.6 11.9 11.3 7.6 1,786 Age (years) 15–24 70.2 13.1 12.8 12.4 8.5 931 15–19 62.5 12.5 9.3 9.3 6.7 215 20–24 72.5 13.3 13.9 13.3 9.0 716 25–29 71.6 16.8 16.1 15.7 10.9 677 30–39 61.3 12.7 15.5 14.2 8.1 385 40–49 46.2 6.1 9.8 8.1 4.3 55 Education None 56.5 7.6 5.6 5.2 3.9 754 Primary 62.8 9.6 12.2 10.7 5.2 346 Secondary 72.3 15.2 15.2 14.1 8.3 503 Higher 88.1 27.3 30.0 30.0 21.7 445 Wealth index quintiles Poorest 39.7 8.0 4.6 4.4 3.1 454 Second 63.1 11.3 11.3 10.1 6.7 436 Middle 72.5 11.8 11.4 10.1 6.5 441 Fourth 80.2 14.9 17.0 17.0 9.8 401 Richest 95.7 28.5 33.2 32.9 23.6 316 [1] MICS indicator 9.7 – HIV counselling during antenatal care [2] MICS indicator 9.8 – HIV testing during antenatal care ( ) Figures that are based on 25–49 unweighted cases NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 213 Among women who had given birth in the two years preceding the survey, the percentage who received counselling and HIV testing during antenatal care is presented in Table HA.5. Only 14 percent of women had received HIV counselling during antenatal care. Around the same proportion (14 percent) had been offered an HIV test and were tested during antenatal care, and slightly fewer than 14 percent had been offered a test, were tested, and had received the results as part of antenatal care. Finally, only 9 percent received HIV counselling, were offered a test, had a test and received the result of their test during antenatal care. In respect of women receiving HIV counselling during antenatal care, the highest proportion was in the Far Western Mountains (34 percent) and the lowest proportion was in the Eastern Mountains (2 percent). Urban women were much more likely than rural women to receive counselling (24 percent compared to 13 percent). Education and household wealth status were strongly associated with the likelihood of receiving HIV counselling. The highest proportion of women being tested and receiving their result during antenatal care was in the Central Hills (25 percent) and the lowest proportion was in the Mid-Western Mountains (2 percent). Urban women were much more likely than rural women to be tested and received their result (30 percent compared to 11 percent). Education and household wealth status were strongly associated with the likelihood of being tested and receiving a result. HIV Indicators for Young Women In many countries, over half of new adult HIV infections are among young people aged 15–24 years thus a change in behaviour among members of this age group is especially important to reduce new infections. Table HA.6 summarizes information on key HIV indicators for young women aged 15–24 years. Results in this age group are generally better than for the population aged 15–49 years as a whole. Some 36 percent of young women had comprehensive knowledge, 45 percent knew all three means of HIV transmission from mother to child, and 68 percent knew of a place to get tested for HIV. Furthermore, 7 percent had been tested for HIV in the 12 months preceding the survey and knew the result. Accepting attitudes towards people living with HIV are also more prevalent in this age group: 51 percent expressed accepting attitudes towards people living with HIV on all four indicators. Variations by background characteristics mirrored patterns for the population as a whole. Comprehensive knowledge among women in this age group was highest in the Central Hills (53 percent) and lowest in the Mid-Western Mountains (9 percent). Urban young women, never married young women, more educated young women and young women living in richer households all showed higher levels of comprehensive knowledge than other young women. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014214 Ta bl e HA .6 : K ey H IV a nd A ID S in di ca to rs (y ou ng w om en ) Pe rc en ta ge o f w om en a ge d 15 –2 4 ye ar s b y k ey H IV a nd A ID S ind ica to rs , N ep al, 2 01 4 Pe rc en t o f w om en a ge d 15 –2 4 ye ar s w ho : Nu m be r o f w om en ag ed 1 5– 24 ye ar s Pe rc en t o f w om en wh o ex pr es s ac ce pt ing a ttit ud es to wa rd s p eo ple liv ing wi th H IV o n all fo ur ind ica to rs [a ] Nu m be r o f w om en ag ed 1 5– 24 ye ar s wh o ha ve h ea rd o f AI DS Ha ve co m pr eh en siv e kn ow led ge [1 ] Kn ow a ll t hr ee m ea ns of H IV tr an sm iss ion fro m m ot he r t o ch ild Kn ow a p lac e to g et te ste d fo r H IV Ha ve b ee n te ste d fo r HI V in th e 12 m on th s pr ec ed ing th e su rv ey an d kn ow th e re su lt To ta l 36 .4 44 .9 67 .8 7. 1 5, 12 3 51 .0 4, 64 9 Re gi on Ea ste rn M ou nt ain s 25 .4 51 .3 57 .0 4. 2 77 56 .1 31 0 Ea ste rn H ills 32 .2 52 .4 67 .9 4. 5 32 9 51 .6 31 7 Ea ste rn T er ai 30 .1 40 .0 59 .3 5. 8 69 9 59 .1 31 6 Ce nt ra l M ou nt ain s 38 .6 74 .5 75 .8 2. 4 10 1 41 .7 25 1 Ce nt ra l H ills 52 .8 47 .5 78 .3 9. 2 77 1 47 .5 53 0 Ce nt ra l T er ai 37 .6 31 .5 60 .2 6. 1 80 7 41 .5 31 9 W es te rn M ou nt ain s 24 .8 32 .2 74 .8 9. 1 2 66 .7 53 W es te rn H ills 30 .1 48 .0 80 .1 11 .7 58 3 62 .2 34 4 W es te rn T er ai 42 .1 34 .5 74 .0 3. 0 45 4 56 .2 36 3 M id- W es te rn M ou nt ain s 9. 1 49 .6 46 .7 3. 9 71 25 .6 22 0 M id- W es te rn H ills 22 .2 46 .7 45 .4 4. 9 33 2 42 .6 26 7 M id- W es te rn T er ai 29 .2 46 .6 62 .2 8. 7 34 1 49 .7 31 3 Fa r W es te rn M ou nt ain s 51 .5 51 .9 80 .3 5. 3 78 62 .0 30 1 Fa r W es te rn H ills 47 .2 59 .5 75 .2 6. 1 18 3 60 .0 36 3 Fa r W es te rn T er ai 35 .4 59 .6 76 .2 12 .7 29 5 39 .5 38 2 Ar ea Ur ba n 48 .8 46 .7 80 .0 11 .0 95 6 60 .1 1, 18 0 Ka th m an du va lle y 57 .4 40 .4 74 .6 8. 3 27 8 57 .0 26 1 Ot he r u rb an 45 .3 49 .3 82 .2 12 .2 67 8 61 .4 91 9 Ru ra l 33 .5 44 .4 65 .0 6. 2 4, 16 7 48 .6 3, 46 9 Ag e (y ea rs ) 15 –1 9 37 .7 46 .4 67 .6 2. 6 2, 72 1 49 .9 2, 53 5 15 –1 7 36 .4 46 .2 66 .2 1. 2 1, 59 9 49 .3 1, 50 2 18 –1 9 39 .5 46 .8 69 .7 4. 7 1, 12 3 50 .9 1, 03 3 20 –2 4 34 .9 43 .1 68 .0 12 .2 2, 40 2 52 .2 2, 11 4 20 –2 2 33 .6 45 .4 67 .6 10 .8 1, 60 5 50 .7 1, 41 7 23 –2 4 37 .3 38 .5 68 .8 15 .0 79 7 55 .1 69 7 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 215 Ta bl e HA .6 : K ey H IV a nd A ID S in di ca to rs (y ou ng w om en ) Pe rc en ta ge o f w om en a ge d 15 –2 4 ye ar s b y k ey H IV a nd A ID S ind ica to rs , N ep al, 2 01 4 Pe rc en t o f w om en a ge d 15 –2 4 ye ar s w ho : Nu m be r o f w om en ag ed 1 5– 24 ye ar s Pe rc en t o f w om en wh o ex pr es s ac ce pt ing a ttit ud es to wa rd s p eo ple liv ing wi th H IV o n all fo ur ind ica to rs [a ] Nu m be r o f w om en ag ed 1 5– 24 ye ar s wh o ha ve h ea rd o f AI DS Ha ve co m pr eh en siv e kn ow led ge [1 ] Kn ow a ll t hr ee m ea ns of H IV tr an sm iss ion fro m m ot he r t o ch ild Kn ow a p lac e to g et te ste d fo r H IV Ha ve b ee n te ste d fo r HI V in th e 12 m on th s pr ec ed ing th e su rv ey an d kn ow th e re su lt M ar ita l s ta tu s Ev er m ar rie d 28 .4 42 .5 61 .7 13 .1 2, 37 9 47 .7 1, 96 2 Ne ve r m ar rie d 43 .3 46 .9 73 .1 1. 9 2, 74 4 53 .4 2, 68 7 Ed uc at io n No ne 6. 0 20 .0 30 .2 3. 9 61 7 21 .3 29 9 Pr im ar y 14 .3 36 .8 45 .5 5. 4 61 0 32 .2 49 3 Se co nd ar y 36 .8 52 .5 70 .5 5. 1 2, 30 0 49 .3 2, 28 5 Hi gh er 55 .9 46 .6 87 .0 11 .9 1, 59 6 64 .2 1, 57 2 W ea lth in de x qu in til es Po or es t 25 .9 51 .2 58 .3 3. 3 94 7 44 .1 78 0 Se co nd 27 .9 48 .6 64 .2 6. 9 98 4 48 .3 83 3 M idd le 29 .6 42 .9 61 .9 7. 1 1, 00 5 45 .8 84 0 Fo ur th 42 .2 41 .3 71 .2 7. 6 1, 12 6 53 .8 1, 03 1 Ri ch es t 53 .7 41 .5 81 .5 10 .2 1, 06 1 59 .7 1, 03 5 [1 ] M IC S in di ca to r 9 .1 ; M DG in di ca to r 6 .3 – K no wl ed ge a bo ut H IV p re ve nt io n am on g yo un g wo m en [a ] R ef er to T ab le HA .3 fo r t he fo ur in dic at or s C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014216 Access to Mass Media and Use of Information / Communication Technology C H A P T E R13 The Nepal MICS collected information on exposure to mass media and the use of computers and the internet. Information was collected on exposure to newspapers/magazines, radio and television among women aged 15–49 years, while questions on the use of computers and the use of the internet were asked to women aged 15–24 years. Access to Mass Media The proportion of women aged 15–49 years in Nepal who read a newspaper or magazine, listen to the radio and watch television at least once a week is shown in Table MT.1. About one fifth (19 percent) read a newspaper or magazine at least once a week, 41 percent listened to the radio, and 57 percent watched television. However, 29 percent did not have regular exposure to any of these three media. Some 71 percent were exposed to at least one and 11 percent to all three types of media on a weekly basis. In respect of exposure to all three types of mass media at least once a week, the highest proportion of women was in the Central Hills (23 percent) and the lowest proportion was in the Far Western Hills (2 percent). Urban women were much more likely than rural women to be exposed to all three types of mass media (27 percent compared to 7 percent). Younger women were more likely than older women to be exposed: 15 percent of women aged 20–24 years were exposed compared to 5 percent of women aged 45–49 years. Education level and household wealth status were also associated with the likelihood of at least weekly exposure to all three types of mass media. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 217 In respect of each media, reading newspapers was lowest in the Mid- and Far Western Hills and Mountains; listening to the radio was lowest in the Western Terai and Mid-Western Hills and Mountains; and watching television was lowest in the Mid- and Far Western Hills and Mountains. Women living in poorer households were more likely than women living in richer households to listen to the radio than to watch television. Table MT.1: Exposure to mass media (women) Percentage of women aged 15–49 years who are exposed to specific mass media on a weekly basis, Nepal, 2014 Percent of women aged 15–49 years who: All three media at least once a week [1] Any media at least once a week None of the media at least once a week Number of women aged 15–49 years Read a newspaper at least once a week Listen to the radio at least once a week Watch television at least once a week Total 18.6 41.3 56.9 11.1 70.6 29.2 14,162 Region Eastern Mountains 7.2 62.6 26.6 3.8 67.5 32.4 186 Eastern Hills 10.9 61.4 42.2 6.8 75.0 24.5 807 Eastern Terai 18.2 36.2 67.5 12.1 72.9 27.0 2,071 Central Mountains 11.2 52.6 51.6 7.0 72.3 27.6 274 Central Hills 44.8 44.4 80.2 23.4 87.6 12.2 2,320 Central Terai 8.8 30.1 55.3 5.8 64.2 35.8 2,327 Western Mountains 7.0 31.9 67.4 2.9 74.3 25.7 8 Western Hills 21.3 65.3 68.2 15.8 86.2 13.7 1,659 Western Terai 16.4 26.5 65.3 9.7 70.2 29.6 1,236 Mid-Western Mountains 4.1 26.8 14.2 2.0 33.5 66.3 169 Mid-Western Hills 5.0 29.9 17.2 2.6 38.8 60.8 856 Mid-Western Terai 14.1 38.8 50.3 8.4 65.2 34.3 855 Far Western Mountains 6.6 56.6 13.1 2.8 58.7 40.6 225 Far Western Hills 2.4 34.7 6.6 1.5 36.1 63.6 433 Far Western Terai 18.2 38.5 51.7 9.5 67.8 31.7 735 Area Urban 45.8 49.8 87.4 27.4 92.0 7.9 2,792 Kathmandu valley 61.5 48.3 94.2 32.7 96.7 3.3 868 Other urban 38.7 50.5 84.3 25.0 89.8 10.0 1,924 Rural 12.0 39.2 49.4 7.1 65.4 34.4 11,370 Age (years) 15–19 24.0 50.0 58.3 14.6 76.3 23.5 2,721 20–24 26.7 47.1 60.4 15.2 75.9 23.9 2,402 25–29 19.6 40.2 57.7 11.7 70.3 29.5 2,414 30–34 16.9 36.3 57.3 9.7 69.2 30.7 2,003 35–39 14.2 37.2 54.4 8.8 65.9 33.7 1,901 40–44 11.1 35.4 52.8 6.7 64.2 35.6 1,582 45–49 7.9 34.0 53.8 5.1 65.8 34.0 1,139 Education None 0.6 23.1 35.7 0.1 48.3 51.4 5,294 Primary 6.1 38.2 55.9 3.0 70.4 29.3 2,004 Secondary 20.6 51.9 64.9 12.0 81.8 18.1 3,830 Higher 56.0 61.5 84.6 34.4 95.7 4.1 3,032 Wealth index quintile Poorest 1.9 38.6 11.2 0.9 42.7 57.0 2,453 Second 5.6 39.4 33.0 3.0 54.1 45.6 2,720 Middle 7.3 34.6 54.2 4.4 65.6 34.3 2,752 Fourth 18.5 40.1 77.2 11.4 84.0 15.8 3,020 Richest 52.2 51.6 95.3 31.1 97.7 2.2 3,218 [1] MICS indicator 10.1 – Exposure to mass media Note: 1 case of missing 'education’ not shown NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014218 Use of Information/ Communication Technology Questions on use of computers and the internet were asked only to women aged 15–24 years, as shown in Table MT.2. Some 28 percent of young women had ever used a computer, 22 percent had used a computer during the preceding year, and 14 percent had used a computer at least once a week during the preceding month. In addition, 21 percent of young women had ever used the internet, 20 percent had used it during the preceding year, and 16 percent had used it at least once a week during the preceding month. Some 63 percent of young women had a mobile phone and 57 percent had used it during the preceding 24 hours. The proportion of young women who had used a computer during the preceding 12 months was highest in the Central Hills (52 percent) and lowest in the Far Western Hills (2 percent), and the proportion who had used the internet during the preceding 12 months was highest in the Central Hills (51 percent) and lowest in the Far Western Hills (2 percent). Urban young women were more likely than rural young women to have used a computer (55 percent compared to 14 percent) or the internet (52 percent compared to 12 percent) during the preceding 12 months. Education level and household wealth status were strongly correlated with use of a computer or the internet: no young women with no education had used a computer or the internet compared to over half of young women with higher education, and less than 3 percent of young women in the poorest household population had used a computer or the internet compared to over 60 percent of young women in the richest household population. Mobile phone use during the preceding 24 hours was highest for young women in the Eastern Hills (76 percent) and lowest for those in the Mid-Western Mountains (27 percent). Urban young women were more likely than rural young women to use a mobile phone (76 percent compared to 53 percent). Women aged 20–24 years were more likely than women aged 15–19 years to use a mobile phone (68 percent compared to 47 percent). Education level and household wealth status strongly correlated with the use of a mobile phone during the preceding 24 hours. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 219 Table MT.2: Use of computers and internet (women) Percentage of women aged 15–24 years who have ever used a computer and the internet, percentage who have used during the 12 months preceding the survey, and percentage who have used at least once weekly during the month preceding the survey, Nepal, 2014 Percent of women aged 15–24 years who have: Number of women aged 15–24 years Ever used a computer Used a computer during the last 12 months [1] Used a computer at least once a week during the last one month Ever used the internet Used the internet during the last 12 months [2] Used the internet at least once a week during the last one month Have mobile phone Used mobile phone during the last 24 hours Total 28.0 21.7 13.5 21.1 19.6 15.6 63.0 56.8 5,123 Region Eastern Mountains 14.0 10.6 2.0 10.5 9.3 5.8 66.0 57.5 77 Eastern Hills 22.3 16.4 3.3 19.0 16.1 11.3 83.0 75.5 329 Eastern Terai 30.7 22.5 12.5 24.0 21.4 16.6 65.5 58.2 699 Central Mountains 26.0 19.8 9.4 9.3 7.5 5.8 56.6 56.1 101 Central Hills 62.2 52.4 39.2 53.2 51.0 44.4 77.1 73.6 771 Central Terai 18.6 12.9 7.0 13.0 12.5 9.3 47.5 40.7 807 Western Mountains 18.3 16.8 6.8 16.8 15.2 7.7 74.5 63.4 2 Western Hills 32.2 27.2 19.2 26.1 24.3 18.8 79.6 75.4 583 Western Terai 25.3 18.2 11.9 18.9 18.7 13.2 63.4 62.8 454 Mid-Western Mountains 9.4 5.9 3.2 2.0 1.7 1.1 37.4 26.6 71 Mid-Western Hills 12.5 7.2 3.6 2.8 2.8 1.6 57.8 46.1 332 Mid-Western Terai 14.1 11.0 5.2 7.2 5.5 4.1 50.0 35.7 341 Far Western Mountains 5.8 4.7 1.6 2.3 2.3 0.8 42.7 40.5 78 Far Western Hills 2.8 1.9 0.8 2.3 1.9 1.3 36.8 33.3 183 Far Western Terai 25.0 17.7 8.4 12.4 10.9 8.6 56.9 49.6 295 Area Urban 63.9 54.8 38.7 54.9 52.4 43.8 78.9 75.5 956 Kathmandu valley 82.3 74.3 57.5 74.6 73.1 63.6 87.6 83.6 278 Other urban 56.3 46.7 31.0 46.8 43.9 35.6 75.4 72.2 678 Rural 19.8 14.2 7.8 13.3 12.1 9.1 59.3 52.5 4,167 Age (years) 15–19 27.2 21.9 13.3 18.9 17.8 13.6 52.9 46.8 2,721 20–24 29.0 21.6 13.7 23.5 21.7 17.9 74.4 68.1 2,402 Education None 0.0 0.0 0.0 0.0 0.0 0.0 38.6 32.4 617 Primary 1.8 1.2 0.3 0.4 0.3 0.3 48.8 42.5 610 Secondary 17.9 13.0 6.5 9.9 8.8 6.1 55.4 48.3 2,300 Higher 63.5 50.7 34.0 53.2 50.2 41.2 88.9 84.0 1,596 Wealth index quintile Poorest 5.2 3.1 0.9 1.2 0.8 0.3 50.8 43.4 947 Second 11.9 7.7 2.1 7.1 5.9 3.4 58.7 52.0 984 Middle 15.6 10.2 4.4 9.9 8.5 5.7 54.8 46.7 1,005 Fourth 30.0 20.4 11.7 19.7 18.0 13.9 65.3 59.9 1,126 Richest 73.2 63.8 45.9 63.8 61.4 51.6 83.2 79.5 1,061 [1] MICS indicator 10.2 – Use of computers [2] MICS indicator 10.3 – Use of internet NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014220 Subjective Well-being C H A P T E R14 Subjective perceptions of individuals of their incomes, health, living environments and the like, play a significant role in their lives and can impact their perception of well-being, irrespective of objective conditions such as actual income and physical health status1. In the MICS, a set of questions were asked to women aged 15–24 years to understand how satisfied they are with different areas of their lives, such as their family life, friendships, school, current job, health, where they live, how they are treated by others, how they look, and their current income. Life satisfaction is a measure of an individual’s perceived level of well-being. Understanding young women’s satisfaction in different areas of their lives can help to gain a comprehensive picture of their life situations. A distinction can also be made between life satisfaction and happiness. Happiness is a fleeting emotion that can be affected by numerous factors, including day-to-day factors, such as the weather, or a recent death in the family. It is possible for a person to be satisfied with job, income, family life, friends, and other aspects of life, but still be unhappy, or vice versa. In addition to the set of questions on life satisfaction, the survey also asked questions about happiness and the respondents’ perceptions of a better life. To assist respondents in answering the set of questions on happiness and life satisfaction, they were shown a card with smiling faces (and not so smiling faces) that corresponded to the response categories ‘very satisfied’, ‘somewhat satisfied‘, ‘neither satisfied nor unsatisfied’, ‘somewhat unsatisfied’ and ‘very unsatisfied’ (see the Questionnaires in Appendix F). For the question on happiness, the same scale was used, this time ranging from ‘very happy’ to ‘very unhappy’, in the same fashion. 1OECD, 2013. OECD Guidelines on Measuring Subjective Well Being, OECD Publishing, http://dx.doi.org/10.1787/9789264191655-en NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 221 Ta bl e SW .1 : D om ai ns o f l ife s at is fa ct io n (w om en ) Pe rc en ta ge o f w om en a ge d 15 –2 4 ye ar s w ho a re ve ry o r s om ew ha t s at isf ied in se lec te d do m ain s o f s at isf ac tio n, N ep al, 2 01 4 Pe rc en t o f w om en a ge d 15 –2 4 ye ar s w ho a re ve ry or so m ew ha t s at isf ied in se lec te d do m ain s: Pe rc en t o f w om en ag ed 1 5– 24 ye ar s w ho : Nu m be r of w om en ag ed 1 5– 24 ye ar s Pe rc en t of w om en ag ed 1 5– 24 ye ar s wh o ar e ve ry o r so m e- wh at sa tis fie d wi th sc ho ol Nu m be r of w om en at te nd ing sc ho ol Pe rc en t of w om en ag ed 1 5– 24 ye ar s wh o ar e ve ry o r so m e- wh at sa tis fie d wi th th eir job Nu m be r of w om en ag ed 1 5– 24 ye ar s wh o ha ve a job Pe rc en t of w om en ag ed 1 5– 24 ye ar s wh o ar e ve ry o r so m e- wh at sa tis fie d wi th th eir inc om e Nu m be r of w om en ag ed 1 5– 24 ye ar s wh o ha ve an inc om e Fa m ily life Fr ien d- sh ips He alt h Liv ing en vir on - m en t Tr ea t- m en t b y ot he rs Th e wa y th ey lo ok Ar e at te nd ing sc ho ol Ha ve a job Ha ve a n inc om e To ta l 84 .7 82 .1 78 .3 75 .4 69 .8 81 .2 46 .7 44 .7 27 .1 5, 12 3 88 .6 2, 39 4 79 .0 2, 29 1 77 .0 1, 38 8 Re gi on Ea ste rn M ou nt ain s 85 .0 81 .6 74 .2 66 .7 68 .6 82 .5 45 .5 42 .1 22 .0 77 83 .3 35 85 .1 32 78 .2 17 Ea ste rn H ills 82 .6 79 .3 73 .5 71 .6 68 .9 79 .7 47 .3 38 .9 27 .1 32 9 87 .5 15 6 83 .5 12 8 79 .5 89 Ea ste rn T er ai 81 .9 78 .4 79 .0 74 .1 68 .1 79 .2 38 .7 34 .9 25 .3 69 9 79 .5 27 1 78 .3 24 4 70 .2 17 7 Ce nt ra l M ou nt ain s 85 .1 89 .3 86 .0 82 .1 80 .4 85 .4 56 .6 30 .7 24 .0 10 1 90 .0 57 82 .1 31 69 .3 24 Ce nt ra l H ills 88 .3 85 .6 81 .6 79 .7 74 .7 86 .1 61 .0 42 .9 34 .8 77 1 90 .2 47 0 83 .5 33 1 80 .6 26 8 Ce nt ra l T er ai 81 .1 73 .0 71 .8 68 .5 56 .4 75 .5 36 .4 23 .4 18 .3 80 7 87 .2 29 4 79 .0 18 9 66 .0 14 8 W es te rn M ou nt ain s 88 .8 87 .7 82 .7 73 .5 71 .3 95 .0 24 .0 68 .8 55 .3 2 (*) 0 (7 8. 9) 1 (8 3. 4) 1 W es te rn H ills 90 .9 87 .1 81 .2 81 .8 70 .3 80 .4 54 .3 61 .4 27 .6 58 3 88 .8 31 6 67 .2 35 8 85 .3 16 1 W es te rn T er ai 85 .4 80 .5 80 .9 72 .6 70 .0 83 .5 39 .2 42 .9 31 .5 45 4 90 .3 17 8 83 .1 19 5 78 .2 14 3 M id- W es te rn M ou nt ain s 81 .2 87 .3 74 .9 67 .7 78 .3 85 .5 40 .9 39 .4 20 .6 71 95 .7 29 79 .1 28 70 .7 15 M id- W es te rn H ills 80 .1 79 .9 73 .0 67 .2 67 .7 81 .6 46 .2 88 .0 31 .6 33 2 90 .4 15 3 79 .8 29 2 80 .0 10 5 M id- W es te rn T er ai 83 .7 85 .4 83 .3 84 .1 71 .4 84 .4 41 .9 41 .2 18 .6 34 1 92 .7 14 3 79 .4 14 0 79 .9 63 Fa r W es te rn M ou nt ain s 78 .7 93 .3 68 .0 67 .4 83 .3 65 .4 60 .8 33 .7 9. 3 78 94 .6 47 86 .9 26 (4 9. 1) 7 Fa r W es te rn H ills 89 .9 92 .0 82 .4 76 .7 81 .6 81 .3 48 .1 54 .8 17 .5 18 3 93 .5 88 82 .5 10 0 77 .1 32 Fa r W es te rn T er ai 85 .7 87 .7 80 .5 85 .2 80 .7 86 .1 52 .7 66 .3 46 .9 29 5 90 .3 15 6 81 .0 19 6 77 .7 13 9 Ar ea Ur ba n 88 .9 83 .6 82 .2 81 .7 72 .5 84 .4 62 .3 42 .0 32 .8 95 6 85 .9 59 5 80 .8 40 1 81 .4 31 3 K at hm an du va lle y 90 .5 86 .2 82 .9 82 .2 78 .3 85 .8 63 .9 53 .2 45 .6 27 8 89 .4 17 7 83 .4 14 8 83 .4 12 7 O th er u rb an 88 .2 82 .5 82 .0 81 .5 70 .1 83 .9 61 .7 37 .4 27 .5 67 8 84 .4 41 8 79 .3 25 3 80 .1 18 7 Ru ra l 83 .7 81 .7 77 .4 74 .0 69 .1 80 .5 43 .2 45 .4 25 .8 4, 16 7 89 .5 1, 79 9 78 .6 1, 89 0 75 .7 1, 07 5 Ag e (y ea rs ) 15 –1 9 86 .0 84 .3 80 .5 75 .7 69 .8 81 .5 65 .7 39 .1 19 .8 2, 72 1 88 .4 1, 78 7 77 .7 1, 06 3 75 .0 54 0 20 –2 4 83 .2 79 .5 75 .8 75 .1 69 .7 81 .0 25 .3 51 .1 35 .3 2, 40 2 89 .3 60 8 80 .1 1, 22 8 78 .3 84 8 M ar ita l s ta tu s Ev er m ar rie d 81 .1 78 .4 74 .8 71 .9 68 .4 80 .5 12 .9 49 .6 32 .5 2, 37 9 89 .0 30 7 79 .8 1, 17 9 77 .4 77 3 Ne ve r m ar rie d 87 .7 85 .2 81 .3 78 .5 70 .9 81 .9 76 .1 40 .5 22 .4 2, 74 4 88 .6 2, 08 7 78 .1 1, 11 2 76 .5 61 5 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014222 Ta bl e SW .1 : D om ai ns o f l ife s at is fa ct io n (w om en ) Pe rc en ta ge o f w om en a ge d 15 –2 4 ye ar s w ho a re ve ry o r s om ew ha t s at isf ied in se lec te d do m ain s o f s at isf ac tio n, N ep al, 2 01 4 Pe rc en t o f w om en a ge d 15 –2 4 ye ar s w ho a re ve ry or so m ew ha t s at isf ied in se lec te d do m ain s: Pe rc en t o f w om en ag ed 1 5– 24 ye ar s w ho : Nu m be r of w om en ag ed 1 5– 24 ye ar s Pe rc en t of w om en ag ed 1 5– 24 ye ar s wh o ar e ve ry o r so m e- wh at sa tis fie d wi th sc ho ol Nu m be r of w om en at te nd ing sc ho ol Pe rc en t of w om en ag ed 1 5– 24 ye ar s wh o ar e ve ry o r so m e- wh at sa tis fie d wi th th eir job Nu m be r of w om en ag ed 1 5– 24 ye ar s wh o ha ve a job Pe rc en t of w om en ag ed 1 5– 24 ye ar s wh o ar e ve ry o r so m e- wh at sa tis fie d wi th th eir inc om e Nu m be r of w om en ag ed 1 5– 24 ye ar s wh o ha ve an inc om e Fa m ily life Fr ien d- sh ips He alt h Liv ing en vir on - m en t Tr ea t- m en t b y ot he rs Th e wa y th ey lo ok Ar e at te nd ing sc ho ol Ha ve a job Ha ve a n inc om e Ed uc at io n No ne 69 .6 66 .1 65 .4 60 .9 60 .2 70 .7 0. 3 38 .7 29 .0 61 7 (*) 2 68 .2 23 9 64 .3 17 9 Pr im ar y 80 .2 78 .3 75 .3 68 .0 61 .8 74 .9 10 .6 47 .0 28 .4 61 0 85 .9 65 74 .4 28 6 70 .4 17 3 Se co nd ar y 86 .8 84 .8 79 .2 77 .6 71 .4 83 .3 55 .4 45 .8 24 .3 2, 30 0 88 .6 1, 27 5 80 .0 1, 05 4 78 .7 55 9 Hi gh er 89 .1 85 .7 83 .1 80 .9 74 .1 84 .8 66 .0 44 .6 29 .9 1, 59 6 89 .0 1, 05 3 83 .0 71 1 82 .2 47 7 W ea lth in de x qu in til e Po or es t 82 .6 82 .2 74 .9 67 .2 69 .5 78 .7 43 .1 56 .4 24 .3 94 7 89 .5 40 8 73 .0 53 3 72 .0 23 0 Se co nd 83 .0 84 .3 76 .4 72 .9 68 .3 80 .4 40 .6 47 .2 27 .0 98 4 85 .4 39 9 79 .2 46 4 75 .9 26 6 M idd le 81 .4 78 .2 75 .2 76 .1 67 .2 78 .4 37 .9 37 .4 22 .6 1, 00 5 90 .9 38 1 76 .8 37 6 76 .4 22 8 Fo ur th 84 .8 81 .4 80 .3 78 .0 69 .9 81 .2 45 .3 42 .1 29 .9 1, 12 6 89 .9 51 0 81 .0 47 5 74 .4 33 7 Ri ch es t 91 .1 84 .2 83 .8 81 .9 73 .5 87 .0 65 .6 41 .7 30 .9 1, 06 1 87 .8 69 5 85 .8 44 3 84 .6 32 8 ( ) F igu re s t ha t a re b as ed o n 25 –4 9 un we igh te d ca se s (*) F igu re s t ha t a re b as ed o n fe we r t ha n 25 u nw eig ht ed ca se s   C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 223 Table SW.1 shows the proportion of young women aged 15–24 years who were very or somewhat satisfied in selected domains. Note that for three domains, satisfaction with school, job and income, the denominators are confined to those who were currently attending school, had a job, and had an income. Of the different domains, the proportions of satisfied young women were highest for family life (85 percent), friendships (82 percent), the way they look (81 percent), and health (78 percent). The proportions were lower for living environment (75 percent) and treatment by others (70 percent). Some 89 percent of young women were satisfied with school, 79 percent were satisfied with their job, and 77 percent were satisfied with their income. More educated women tended to have higher levels of satisfaction than women with little or no education, and women living in households in richer wealth quintiles tended to have higher levels of satisfaction than those living in households in poorer wealth quintiles. Proportions of women aged 15–24 years with overall life satisfaction are shown in Table SW.2. ‘Life satisfaction’ is defined as those who are very or somewhat satisfied with their life overall, and is based on a single question which was asked after the life satisfaction questions on all of the above-mentioned domains, with the exception of the question on satisfaction with income, which was asked later. Some 81 percent of young women were satisfied with their life overall. Regionally, the proportion ranged from 65 percent in the Far Western Mountains to 85 percent in the Central Hills and Western Hills. More educated women were more likely than women with little or no education to be satisfied with their life: 69 percent of women with no education were satisfied compared to 85 percent of women with higher education. Women living in households in richer wealth quintiles were more likely than women living in households in poorer wealth quintiles to be satisfied with their life: 77 percent of women in the poorest household population were satisfied compared to 86 percent of women in the richest household population. As a summary measure, the average life satisfaction score is also calculated and presented in Table SW.2. The score is simply calculated by averaging the responses to the question on overall life satisfaction, ranging from very satisfied (1) to very unsatisfied (5) (see questionnaires in Appendix F). Therefore, the lower the average score, the higher the life satisfaction level. The average life satisfaction score for young women in Nepal was 2.0. In addition, 82 percent of young women said they were very or somewhat happy. This proportion was highest in the Central Terai and Far Western Hills (86 percent) and lowest in the Far Western Mountains (70 percent). Education level and household wealth status was positively correlated with happiness: 71 percent of women with no education were happy compared to 87 percent of women with higher education, and 78 percent of women in the poorest household population were happy compared to 86 percent of women in the richest household population. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014224 In addition to the series of questions on life satisfaction and happiness, respondents were also asked two simple questions on whether they think their life improved during the year preceding the survey, and whether they think their life will be better in one year subsequent to the survey. Such information may contribute to our understanding of the desperation that may exist among young people, as well as their hopelessness and hopes for the future. Specific combinations of perceptions during the preceding year and expectations for the subsequent year may be valuable information to understand the general sense of well-being among young people. Table SW.2: Overall life satisfaction and happiness (women) Percentage of women aged 15–24 years who are very or somewhat satisfied with their life overall, the average overall life satisfaction score, and percentage of women aged 15–24 years who are very or somewhat happy, Nepal, 2014 Percent of women with overall life satisfaction [1] Average life satisfaction score Percent of women who are very or somewhat happy [2] Number of women aged 15–24 years Total 80.8 2.0 82.3 5,123 Region Eastern Mountains 80.4 2.0 82.7 77 Eastern Hills 79.8 2.0 85.1 329 Eastern Terai 80.3 2.0 78.7 699 Central Mountains 80.6 1.9 82.0 101 Central Hills 84.5 1.9 85.0 771 Central Terai 77.0 2.1 86.0 807 Western Mountains 70.5 2.0 83.9 2 Western Hills 84.5 2.0 82.2 583 Western Terai 78.2 1.9 85.4 454 Mid-Western Mountains 78.1 2.1 78.4 71 Mid-Western Hills 78.5 2.1 72.4 332 Mid-Western Terai 83.3 1.9 78.5 341 Far Western Mountains 65.4 2.1 69.5 78 Far Western Hills 82.2 1.9 86.0 183 Far Western Terai 84.1 1.7 83.3 295 Area Urban 83.8 1.9 83.7 956 Kathmandu valley 86.5 1.8 83.2 278 Other urban 82.7 1.9 83.9 678 Rural 80.1 2.0 81.9 4,167 Age (years) 15–19 82.1 1.9 83.7 2,721 20–24 79.3 2.0 80.7 2,402 Marital status Ever married 77.8 2.0 79.8 2,379 Never married 83.4 1.9 84.4 2,744 Education None 68.8 2.2 70.5 617 Primary 71.6 2.2 77.5 610 Secondary 83.3 1.9 83.6 2,300 Higher 85.3 1.8 86.7 1,596 Wealth index quintile Poorest 76.6 2.1 78.0 947 Second 81.0 2.0 80.9 984 Middle 79.1 2.0 81.9 1,005 Fourth 81.1 1.9 83.7 1,126 Richest 85.8 1.8 86.3 1,061 [1] MICS Indicator 11.1 – Life satisfaction [2] MICS indicator 11.2 – Happiness NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 225 Young women’s perceptions of a better life are shown in Table SW.3. The proportion of women aged 15–24 years who thought their life had improved during the preceding year was 60 percent and the proportion who expected their life to get better during the subsequent year was 82 percent; some 57 percent thought both. Regionally, the proportion who thought both was highest in the Western Terai (73 percent) and lowest in the Mid-Western Hills (43 percent). Education level and household wealth status were strongly associated with the likelihood of thinking both: 48 percent of women with no education thought both compared to 63 percent of women with higher education, and 47 percent of women in the poorest household population thought both compared to 62 percent of women in the richest household population. Table SW.3: Perception of a better life (women) Percentage of women aged 15–24 years who think that their lives improved during the year preceding the survey and those who expect that their lives will get better one year subsequent to the survey, Nepal, 2014 Percent of women aged 15–24 years who think their life: Number of women aged 15–24 years Improved during the preceding year Will get better in the subsequent year Both [1] Total 60.1 81.9 57.0 5,123 Region Eastern Mountains 61.6 79.7 57.6 77 Eastern Hills 58.2 79.3 53.7 329 Eastern Terai 56.6 78.6 52.5 699 Central Mountains 65.4 82.8 61.8 101 Central Hills 66.2 85.8 62.5 771 Central Terai 63.7 92.9 60.8 807 Western Mountains 64.2 79.7 57.3 2 Western Hills 46.2 72.6 43.9 583 Western Terai 74.6 85.5 73.4 454 Mid-Western Mountains 57.7 77.0 55.4 71 Mid-Western Hills 46.7 70.2 43.4 332 Mid-Western Terai 60.6 75.2 58.2 341 Far Western Mountains 47.6 79.8 44.2 78 Far Western Hills 60.6 80.7 57.6 183 Far Western Terai 66.2 89.6 62.8 295 Area Urban 64.7 82.7 59.9 956 Kathmandu valley 64.4 86.7 58.7 278 Other urban 64.9 81.0 60.3 678 Rural 59.1 81.8 56.4 4,167 Age (years) 15–19 61.4 83.5 58.2 2,721 20–24 58.7 80.2 55.7 2,402 Marital status Ever married 57.0 79.8 54.2 2,379 Never married 62.9 83.7 59.4 2,744 Education None 50.2 75.2 48.0 617 Primary 52.7 77.1 49.7 610 Secondary 61.1 81.6 57.4 2,300 Higher 65.5 86.9 62.7 1,596 Wealth index quintile Poorest 49.9 74.1 46.6 947 Second 57.5 82.3 55.3 984 Middle 60.9 82.0 59.0 1,005 Fourth 64.8 85.2 61.1 1,126 Richest 66.1 85.0 61.7 1,061 [1] MICS indicator 11.3 – Perception of a better life NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014226 Tobacco and Alcohol Use C H A P T E R15 Tobacco products are products made entirely or partly of leaf tobacco as raw material, which are intended to be smoked, sucked, chewed, or snuffed. All contain the highly addictive psychoactive ingredient, nicotine. Tobacco use is one of the main risk factors for a number of chronic diseases, including cancer, lung diseases, and cardiovascular diseases.1 The consumption of alcohol carries a risk of adverse health and social consequences related to its intoxicating, toxic and dependence-producing properties. In addition to the chronic diseases that may develop in those who drink large amounts of alcohol over a number of years, alcohol use is also associated with an increased risk of acute health conditions, such as injuries, including from traffic accidents2. Alcohol use also causes harm far beyond the physical and psychological health of the drinker. It harms the well-being and health of people around the drinker. An intoxicated person can harm others or put them at risk of traffic accidents or violent behaviour, or negatively affect co-workers, relatives, friends or strangers. Thus, the impact of the harmful use of alcohol reaches deep into society3. The Nepal MICS 2014 collected information on ever and current use of tobacco and alcohol and intensity of use among women aged 15–49 years. Tobacco Use Table TA.1 presents the current and ever use of tobacco products by women aged 15–49 years. In Nepal, 86 percent of women had never smoked cigarettes or used other tobacco products. Some 14 percent reported that they had used a tobacco product at some stage in their life, while 9 percent had smoked cigarettes or used other tobacco products on one or more days during the preceding month. Cigarettes were currently being used by 5 percent of women and other tobacco products were currently being used by 3 percent of women. The proportion of women who had used any tobacco product during the preceding month was highest in the Mid-Western Mountains (27 percent) and lowest was in the Central Terai (5 percent). Current use of tobacco increases with age: only 1 percent of women aged 15–19 years currently used tobacco compared to 27 percent of women aged 45–49 years. Current use of tobacco had a strongly negative association with level of education and household wealth status. Women with no education were much more likely to currently use tobacco compared to women with higher education (19 percent 1World Health Organization, http://www.who.int/topics/tobacco/en/ 2World Health Organization, http://www.who.int/topics/alcohol_drinking/en/ 3World Health Organization, http://www.who.int/mediacentre/factsheets/fs349/en/ NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 227 compared to 1 percent), and women living in households in the poorest quintile were much more likely to currently use tobacco than women living in households in the richest quintile (20 percent compared to 3 percent). Table TA.1: Current and ever use of tobacco (women) Percentage of women aged 15–49 years by pattern of use of tobacco, Nepal, 2014 Percent of women aged 15–49 years who: Number of women aged 15–49 years Never smoked ciga- rettes or used other tobacco prod- ucts Ever used: Used tobacco products at any time during the preceding month: Only ciga- rettes Ciga- rettes and other tobac- co prod- ucts Only other tobac- co prod- ucts Any tobac- co prod- uct Only ciga- rettes Ciga- rettes and other tobac- co prod- ucts Only other tobac- co prod- ucts Any tobac- co prod- uct [1] Total 86.2 7.6 2.6 3.4 13.7 4.8 1.4 3.0 9.2 14,162 Region Eastern Mountains 83.2 6.7 3.0 6.9 16.5 5.1 0.7 7.7 13.5 186 Eastern Hills 84.9 7.0 1.5 6.6 15.1 4.8 1.1 6.0 11.9 807 Eastern Terai 87.8 5.3 2.6 4.1 11.9 1.4 0.8 3.3 5.6 2,071 Central Mountains 82.5 13.4 1.6 2.3 17.2 10.8 1.2 2.3 14.2 274 Central Hills 85.1 11.4 1.7 1.8 14.8 5.7 0.6 0.4 6.7 2,320 Central Terai 93.8 3.0 1.1 2.1 6.2 2.3 0.8 1.9 5.0 2,327 Western Mountains 91.1 3.9 0.6 4.5 8.9 1.5 0.0 3.7 5.2 8 Western Hills 83.8 9.0 2.1 4.7 15.8 6.2 1.0 4.3 11.5 1,659 Western Terai 91.6 4.0 0.9 3.4 8.4 3.2 0.5 3.7 7.5 1,236 Mid-Western Mountains 65.8 14.5 13.4 6.2 34.2 10.8 10.6 5.6 27.0 169 Mid-Western Hills 76.8 12.2 8.5 2.3 23.1 9.1 5.6 2.7 17.4 856 Mid-Western Terai 79.2 8.3 5.1 7.3 20.7 4.3 1.8 6.4 12.6 855 Far Western Mountains 79.6 13.3 3.2 3.8 20.3 11.6 2.7 4.0 18.3 225 Far Western Hills 86.3 9.0 3.6 1.0 13.6 6.4 3.6 0.9 11.0 433 Far Western Terai 86.8 8.9 3.1 1.3 13.2 7.4 1.2 1.5 10.1 735 Area Urban 89.4 6.5 1.7 2.3 10.5 3.0 0.3 1.8 5.1 2,792 Kathmandu valley 89.8 8.2 1.2 0.8 10.2 2.8 0.2 0.4 3.4 868 Other urban 89.2 5.8 1.9 3.0 10.7 3.2 0.3 2.4 5.9 1,924 Rural 85.4 7.9 2.8 3.7 14.4 5.2 1.7 3.3 10.1 11,370 Age (years) 15–19 97.7 1.1 0.3 0.9 2.3 0.1 0.2 0.4 0.6 2,721 20–24 94.1 3.2 0.7 2.0 5.9 1.3 0.4 1.3 3.0 2,402 25–29 91.4 4.8 1.2 2.5 8.5 2.4 0.6 1.7 4.7 2,414 30–34 85.3 7.2 2.2 5.3 14.6 4.1 1.4 3.7 9.2 2,003 35–39 79.2 10.7 5.4 4.4 20.5 7.2 2.9 4.4 14.5 1,901 40–44 71.9 15.7 5.9 6.1 27.8 11.4 3.0 6.2 20.6 1,582 45–49 64.3 23.2 6.8 5.5 35.5 16.6 3.4 7.0 27.1 1,139 Under-5s in the same household At least one 86.9 6.8 2.6 3.5 12.9 4.5 1.6 2.8 9.0 5,813 None 85.7 8.2 2.6 3.3 14.2 5.0 1.2 3.1 9.3 8,349 Education None 75.2 14.4 5.3 4.8 24.6 10.6 3.0 5.3 18.9 5,294 Primary 84.6 7.6 2.8 5.0 15.4 4.4 1.2 4.2 9.8 2,004 Secondary 94.2 2.8 0.6 2.4 5.8 0.7 0.3 1.2 2.1 3,830 Higher 96.5 2.0 0.4 1.1 3.5 0.1 0.1 0.4 0.5 3,032 Wealth index quintile Poorest 75.8 13.4 5.9 4.8 24.0 11.1 4.2 5.1 20.4 2,453 Second 84.4 8.8 3.2 3.4 15.4 6.2 1.9 3.7 11.8 2,720 Middle 88.8 5.6 1.9 3.6 11.1 3.7 0.8 2.9 7.4 2,752 Fourth 89.1 5.5 1.9 3.4 10.8 2.4 0.6 2.5 5.5 3,020 Richest 90.7 6.1 0.9 2.2 9.2 1.9 0.1 1.2 3.2 3,218 [1] MICS indicator 12.1 – Tobacco use Note: 1 case of missing ‘education’ not shown NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014228 Figure TA.1 shows the similar patterns for women aged 15–49 years who have ever smoked tobacco and who currently smoke tobacco in Nepal. Figure TA.1: Ever and current smokers, Nepal, 2014 Table TA.2 presents the results on age at first use of cigarettes, as well as frequency of use, for women aged 15–49 years. Some 4 percent of women had smoked a whole cigarette for the first time before the age of 15. The proportion of women who had done so was highest in the Mid-Western Mountains (11 percent) and lowest in the Western Terai (1 percent). Education level and household wealth status were both associated with early initiation of smoking: 8 percent of women with no education started smoking at a young age compared to 1 percent of women with higher education, and 8 percent of women in the poorest household population started smoking at a young age compared to 2 percent of women in the richest household population. Among women who were current cigarette smokers, 54 percent had smoked fewer than five cigarettes in the preceding day, 24 percent had smoked 5–9 cigarettes, 15 percent had smoked 10–19 cigarettes, and 7 percent had smoked more than 20 cigarettes. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 229 Table TA.2: Age at first use of cigarettes and frequency of use (women) Percentage of women aged 15–49 years who smoked a whole cigarette before the age of 15, and percentage of current smokers by the number of cigarettes smoked in the 24 hours preceding the survey, Nepal, 2014 Percent of women who smoked a whole cigarette before age 15 [1] Number of women aged 15– 49 years Percent of women by number of cigarettes smoked in the last 24 hours Number of women aged 15–49 years who are current ciga- rette smokers Fewer than 5 5–9 10–19 20+ DK/ Missing Total Total 3.9 14,162 53.6 23.5 14.7 7.2 1.0 100.0 877 Region Eastern Mountains 4.0 186 51.8 30.9 17.2 0.0 0.0 100.0 11 Eastern Hills 4.3 807 44.0 32.7 15.4 7.9 0.0 100.0 48 Eastern Terai 3.5 2,071 (58.1) (30.0) (7.1) (4.8) (0.0) 100.0 47 Central Mountains 5.3 274 56.4 26.2 11.1 6.4 0.0 100.0 33 Central Hills 5.2 2,320 48.5 19.2 25.5 6.8 0.0 100.0 146 Central Terai 1.9 2,327 (47.3) (29.9) (1.3) (17.6) (3.8) 100.0 73 Western Mountains 2.2 8 (*) (*) (*) (*) (*) 100.0 0 Western Hills 2.4 1,659 61.0 18.3 12.5 5.5 2.8 100.0 119 Western Terai 0.9 1,236 (63.9) (23.6) (9.3) (3.3) (0.0) 100.0 47 Mid-Western Mountains 11.1 169 64.2 14.4 12.4 8.4 0.5 100.0 36 Mid-Western Hills 8.5 856 50.7 23.1 15.0 11.2 0.0 100.0 125 Mid-Western Terai 5.4 855 60.1 23.8 8.7 5.1 2.3 100.0 53 Far Western Mountains 7.7 225 37.7 23.4 33.3 5.7 0.0 100.0 32 Far Western Hills 5.2 433 46.0 28.2 21.4 4.5 0.0 100.0 43 Far Western Terai 4.4 735 61.6 23.2 11.2 1.3 2.7 100.0 64 Area Urban 3.0 2,792 55.8 26.7 12.3 5.2 0.0 100.0 94 Kathmandu valley 3.4 868 (38.0) (30.6) (19.4) (12.0) (0.0) 100.0 26 Other urban 2.8 1,924 62.5 25.2 9.7 2.7 0.0 100.0 69 Rural 4.2 11,370 53.3 23.1 14.9 7.5 1.2 100.0 783 Age (years) 15–19 0.7 2,721 (*) (*) (*) (*) (*) 100.0 6 20–24 1.5 2,402 (73.7) (12.1) (11.1) (3.1) 0.0 100.0 40 25–29 2.3 2,414 72.5 19.2 4.0 3.1 1.2 100.0 72 30–34 3.7 2,003 52.5 23.8 17.2 6.2 0.2 100.0 110 35–39 5.9 1,901 51.5 27.3 13.3 7.0 0.9 100.0 192 40–44 8.7 1,582 48.7 25.4 16.5 7.6 1.7 100.0 229 45–49 10.8 1,139 50.5 22.0 16.8 9.7 1.1 100.0 229 Under-5s in the same household At least one 3.6 5,813 56.7 23.6 11.2 7.0 1.5 100.0 357 None 4.2 8,349 51.5 23.3 17.0 7.4 0.7 100.0 521 Education None 7.9 5,294 52.1 23.5 14.8 8.6 1.0 100.0 722 Primary 3.4 2,004 60.6 24.8 13.9 0.7 0.0 100.0 112 Secondary 1.2 3,830 (60.4) (15.7) (17.0) (2.2) (4.7) 100.0 37 Higher 0.7 3,032 (*) (*) (*) (*) (*) 100.0 6 Wealth index quintile Poorest 7.8 2,453 52.2 24.3 16.2 7.2 0.1 100.0 375 Second 4.0 2,720 56.1 22.2 14.3 5.2 2.1 100.0 221 Middle 3.1 2,752 47.0 24.7 12.9 13.2 2.2 100.0 124 Fourth 3.0 3,020 58.6 23.9 7.8 8.0 1.7 100.0 93 Richest 2.4 3,218 58.6 19.6 20.1 1.7 0.0 100.0 66 [1] MICS indicator 12.2 – Smoking before age 15 Note: 1 case of missing ‘education’ not shown ( ) Figures that are based on 25–49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014230 Alcohol Use Table TA.3 shows the use of alcohol among women aged 15–49 years. Some 82 percent had never had an alcoholic drink, while 10 percent had had at least one drink of alcohol on one or more days during the month preceding the survey. In addition, 7 percent of women had had at least one alcoholic drink before the age of 15. Regionally, the proportion of women who had had at least one alcoholic drink before the age of 15 was highest in the Eastern Mountains (45 percent) and lowest in the Far Western Hills (less than 1 percent). Household wealth status was associated with early initiation of drinking: 14 percent of women in the poorest household population had done so compared to 4 percent of women in the richest household population. Among current drinkers, the proportion was highest in the Eastern Mountains (51 percent) and lowest in the Far Western Hills (1 percent). Older women were much more likely than younger women to currently drink: 3 percent of women aged 15–19 years were current drinkers compared to 18 percent of women aged 45–49 years. Education level and household wealth status were negatively correlated with the likelihood of currently drinking: 14 percent of women with no education were current drinkers compared to 4 percent of women with higher education, and 20 percent of women in the poorest household population were current drinkers compared to 6 percent of women in the richest household population. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 231 Table TA.3: Use of alcohol (women) Percentage of women aged 15–49 years who have never had an alcoholic drink, percentage who first had an alcoholic drink before the age of 15, and percentage who have had at least one alcoholic drink at any time during the month preceding the survey, Nepal, 2014 Percent of women aged 15–49 years who had: Number of women aged 15–49 years Never had an alcoholic drink Had at least one alcoholic drink before age 15 [1] Had at least one alcoholic drink at any time during the last one month [2] Total 82.2 6.8 9.5 14,162 Region Eastern Mountains 36.7 44.9 50.9 186 Eastern Hills 61.0 25.1 27.6 807 Eastern Terai 87.4 2.8 3.8 2,071 Central Mountains 60.5 13.4 28.0 274 Central Hills 67.9 11.5 15.2 2,320 Central Terai 97.9 0.5 0.8 2,327 Western Mountains 61.8 12.2 15.1 8 Western Hills 77.9 8.8 12.4 1,659 Western Terai 93.2 0.7 4.7 1,236 Mid-Western Mountains 93.3 3.2 4.4 169 Mid-Western Hills 84.9 3.6 9.4 856 Mid-Western Terai 73.1 10.0 11.3 855 Far Western Mountains 99.0 0.9 0.7 225 Far Western Hills 99.1 0.4 0.6 433 Far Western Terai 86.9 2.6 5.7 735 Area Urban 78.3 6.1 7.9 2,792 Kathmandu valley 66.1 9.3 11.4 868 Other urban 83.8 4.6 6.3 1,924 Rural 83.1 7.0 9.9 11,370 Age (years) 15–19 90.4 5.9 3.2 2,721 20–24 84.4 5.9 6.0 2,402 25–29 84.5 5.7 8.2 2,414 30–34 79.8 7.6 9.9 2,003 35–39 77.8 7.9 14.1 1,901 40–44 74.9 7.7 15.5 1,582 45–49 74.6 8.7 17.9 1,139 Education None 80.2 8.1 13.6 5,294 Primary 77.4 8.3 13.2 2,004 Secondary 85.5 6.4 6.2 3,830 Higher 84.6 4.0 4.0 3,032 Wealth index quintile Poorest 74.2 13.8 19.6 2,453 Second 79.1 8.6 12.4 2,720 Middle 88.3 4.8 6.5 2,752 Fourth 87.3 4.1 5.3 3,020 Richest 80.8 4.1 5.8 3,218 [1] MICS indicator 12.4 – Use of alcohol before age 15 [2] MICS indicator 12.3 – Use of alcohol Note: 1 case of missing ‘education’ not shown Appendices NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 233 Sample Design The major features of the sample design are described in this appendix. Sample design features include target sample size, sample allocation, sampling frame and listing, choice of domains, sampling stages, stratification, and the calculation of sample weights. The primary objective of the sample design for the Nepal MICS 2014 was to produce statistically reliable estimates of most indicators, at the national level, for urban and rural areas, and for the 15 ecological zones of the country: Eastern Mountains, Eastern Hills, Eastern Terai, Central Mountains, Central Hills, Central Terai, Western Mountains, Western Hills, Western Terai, Mid-Western Mountains, Mid-Western Hills, Mid-Western Terai, Far Western Mountains, Far Western Hills, Far Western Terai. Urban and rural areas in each of the 15 ecological zones were defined as the sampling strata. The Central Hills zone is further divided into two substrata as Kathmandu Valley and Other urban areas. A multi-stage, stratified cluster sampling approach was used for the selection of the survey sample. Water quality testing was carried out in each of the 519 clusters sampled for this survey. Three households were selected from the list of 25 households interviewed in each cluster using a random systematic selection procedure. This yielded a total of 1,557 households for E. coli testing in drinking water. For one of the three households in each cluster, a sample was also taken from the household’s source of drinking water, yielding 519 samples. Samples of household drinking water were taken from a glass of water that would be given to a child to drink, and each sample of source water was collected in a sterile Whirl-Pak® bag. A p p e n d i x A NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014234 Sample Size and Sample Allocation The sample size for the Nepal MICS 2014 was calculated as 13,000 households. For the calculation of the sample size, the key indicator used was the birth registration prevalence among children aged 0–4 years. The following formula was used to estimate the required sample size for this indicator: where, • n is the required sample size, expressed as number of households • 4 is a factor to achieve the 95 percent level of confidence • r is the predicted or anticipated value of the indicator, expressed in the form of a proportion • deff is the design effect for the indicator, estimated from a previous survey or using a default value of 1.5 • 0.12r is the margin of error to be tolerated at the 95 percent level of confidence, defined as 12 percent of r (relative margin of error of r) • pb is the proportion of the total population upon which the indicator, r, is based • AveSize is the average household size (number of persons per household) • RR is the predicted response rate For the calculation, r (birth registration) was assumed to be 42.3 percent. The value of deff (design effect) was taken as 2 based on estimates from previous surveys, pb (percentage of children aged 0–4 years in the total population) was taken as 9.7 percent, AveSize (average household size) was taken as 4.88 persons per household, and the response rate was assumed to be 95 percent, based on experience from previous surveys. Calculations of the required sample sizes indicated that 800 households per domain would be adequate to yield estimates with sufficient precision for most of the indicators, but in the case of three large domains (Eastern Terai, Central Terai, and Western Hills) the decision was made to increase the sample size to 1,000 households. One domain (Western Mountains) posed a particular problem because of its small size. The natural inclination would be to combine it with Mid-Western Mountains, but that was considered undesirable, because of the need to have a separate estimate for this latter domain (which is also known as Karnali). The decision was therefore made to keep Western Mountains as a separate domain. Only 400 households were allocated to it on the clear understanding that the resulting estimates were bound to have lower precision than corresponding estimates for other domains. The overall total sample size was 13,000 households. The number of households selected per cluster for the Nepal MICS 2014 was determined as 25 households, based on a number of considerations, including the design effect, the budget available, and the time that would be needed per team to complete one cluster. Dividing the total number of households by the number of sample households per cluster, it was calculated that 40, 32 or 16 sample clusters would need to be selected in each zone. Equal allocation of the total sample size to the 11 zones was used, while three zones had an allocation of 1,000 households and the Western Mountains had 400 households. Therefore, 40, 32 and 16 clusters respectively were allocated to each of the ecological zones, with the final sample size calculated as 13,000 households (32 clusters * 11 zones * 25 sample households per cluster + 40 )])()(()12.0[( )])(1)((4[ 2 RRAveSizepbr deffrrn = NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 235 clusters * 3 zones * 25 sample households per cluster + 16 clusters * 1 zone * 25 sample households per cluster). In each zone, the clusters (primary sampling units) were distributed to the urban and rural domains proportionally to the size of urban and rural populations in that zone. Table SD.1 shows the allocation of clusters to the sampling strata. Sampling Frame and Selection of Clusters The 2011 census frame was used for the selection of clusters. Census enumeration areas were defined as primary sampling units (PSUs), and were selected from each of the sampling strata by using systematic pps (probability proportional to size) sampling procedures, based on the number of households in each enumeration area from the 2011 Population and Housing Census frame. The first stage of sampling was thus completed by selecting the required number of enumeration areas from each of the fifteen ecological zones, separately for the urban and rural strata. Listing Activities Since the sampling frame (the 2011 census) was not up-to-date, a new listing of households was conducted in all the sample enumeration areas prior to the selection of households. For this purpose, listing teams were formed who visited all of the selected enumeration areas and listed all households in the enumeration areas. The listing was carried out by 30 teams: each comprised one listing person and one mapping person. Fieldwork for listing began in September 2013 and concluded in November 2013. As per CBS principles for segmentation, urban wards containing fewer than 225 households and rural wards containing fewer than 150 households will not be split. Wards were used as the PSU. In the case of larger wards, additional splits are made in steps of 150 households for urban areas and 100 households for rural areas. Thus an urban ward of 500 households will be split into three segments (for example, 500 = 225 + 150 + 125) whereas a rural ward of 500 households will be split into five seg- ments (for example, 500 = 150 + 100 + 100 + 100 + 50). Table SD.1: Allocation of sample clusters (primary sampling units) to sampling strata Population (2011 Estimates) Number of Clusters Total Urban Rural Total Urban Rural Total 5,423,297 1,045,575 4,377,722 520 126 394 Region Eastern Mountains 84,844 6,290 78,554 32 4 28 Eastern Hills 346,373 27,862 318,511 32 6 26 Eastern Terai 799,526 152,501 647,025 40 12 28 Central Mountains 122,034 6,076 115,958 32 4 28 Kathmandu Valley urban 366,255 366,255 0 32 32 0 Central Hills (rest of) 648,510 50,187 598,323 32 4 28 Central Terai 825,439 112,256 713,183 40 10 30 Western Mountains 4,753 0 4,753 16 0 16 Western Hills 676,987 133,678 543,309 40 12 28 Western Terai 383,859 52,261 331,598 32 8 24 Mid-Western Mountains 68,802 0 68,802 32 0 32 Mid-Western Hills 332,025 16,707 315,318 32 4 28 Mid-Western Terai 294,187 54,099 240,088 32 12 20 Far Western Mountains 83,265 0 83,265 32 0 32 Far Western Hills 161,891 14,059 147,832 32 6 26 Far Western Terai 224,547 53,344 171,203 32 12 20 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014236 hi hi f W 1= The term fhi, the sampling fraction for the i-th sample PSU in the h-th stratum, is the product of probabilities of selection at every stage in each sampling stratum: hihihihi pppf 321= Where pshi is the probability of selection of the sampling unit at stage s for the i-th sample PSU in the h-th sampling stratum. Based on the sample design, these probabilities were calculated as follows: p1hi= h hih M Mn Selection of Households Lists of households were prepared by the listing teams in the field for each enumeration area. The households were then sequentially numbered from 1 to N (the total number of households in each enumeration area) at the Central Bureau of Statistics, where the selection of 25 households in each enumeration area was carried out using random systematic selection procedures. Calculation of Sample Weights The Nepal MICS 2014 sample is not self-weighting. Essentially, by allocating equal numbers of households to each of 11 zones and another size to three zones and a high over-sampling in one more zone, different sampling fractions were used in each zone since the sizes of the ecological zones varied. For this reason, sample weights were calculated and these were used in the subsequent analyses of the survey data. The major component of the weight is the reciprocal of the sampling fraction employed in selecting the number of sample households in that particular sampling stratum (h) and PSU (i): where, • nh = number of sample PSUs selected in stratum h • Mhi = number of households in the 2011 census frame for the i-th sample PSU in stratum h • Mh = total number of households in the 2011 census frame for stratum h • p2hi = proportion of the PSU listed the i-th sample PSU stratum h (in the case of PSUs that were segmented); for non-segmented PSUs, p2hi = 1 • p3hi = • M’hi = number of households listed in the i-th sample PSU in stratum h hiM ' 25 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 237 hRR 1 hRR 1 Since the number of households in each enumeration area (PSU) from the 2011 census frame used for the first stage selection and the updated number of households in the enumeration area from the listing are generally different, individual overall probabilities of selection for households in each sample enumeration area (cluster) were calculated. A final component in the calculation of sample weights takes into account the level of non-response for the household and individual interviews. The adjustment for household non-response in each stratum is equal to: Where RRh is the response rate for the sample households in stratum h, defined as the proportion of the number of interviewed households in stratum h out of the number of selected households found to be occupied during the fieldwork in stratum h. Similarly, adjustment for non-response at the individual level (women, men, and under-5 children) for each stratum is equal to: where RRh is the response rate for the individual questionnaires in stratum h, defined as the proportion of eligible individuals (women, men, and under-5 children) in the sample households in stratum h who were successfully interviewed. After the completion of fieldwork, response rates were calculated for each sampling stratum. These were used to adjust the sample weights calculated for each cluster. Response rates in the Nepal MICS 2014 are shown in Table HH.1 in this report. The non-response adjustment factors for the individual women, men, and under-5 questionnaires were applied to the adjusted household weights. Numbers of eligible women, men and under-5 children were obtained from the roster of household members in the Household Questionnaire for households where interviews were completed. The design weights for the households were calculated by multiplying the inverse of the probabilities of selection by the non-response adjustment factor for each enumeration area. These weights were then standardized (or normalized), one purpose of which is to make the weighted sum of the interviewed sample units equal to the total sample size at the national level. Normalization is achieved by dividing the full sample weights (adjusted for non-response) by the average of these weights across all households at the national level. This is performed by multiplying the sample weights by a constant factor equal to the unweighted number of households at the national level divided by the weighted total number of households (using the full sample weights adjusted for non-response). A similar standardization procedure was followed in obtaining standardized weights for the individual women, men and under-5 questionnaires. Adjusted (normalized) weights varied between 0.02 and 4.93 in the 520 sample enumeration areas (clusters). Sample weights were appended to all datasets and analyses were performed by weighting households, women, men or under-5s with these sample weights. NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014238 List of Personnel Involved in the Survey NMICS 2014 STEERING COMMITTEE MEMBERS Honourable Member, National Planning Commission Chairperson Joint Secretary, Social Development Division, NPC Secretariat Member Joint Secretary, Economic Management Division, NPC Secretariat Member Joint Secretary, Monitoring and Evaluation Division, NPC Secretariat Member Joint Secretary, Ministry of Education Member Joint Secretary, Ministry of Health and Population Member Joint Secretary, Ministry of Federal Affairs and Local Development Member Joint Secretary, Ministry of Women, Children and Social Welfare Member Chief, Central Department of Statistics, T.U. Member Invitees (maximum 7 persons) Member Director General, CBS Member Secretary NMICS 2014 TECHNICAL COMMITTEE MEMBERS Deputy Director General, CBS Chairperson Director, Population Section, CBS Member Director, Planning, Coordination and Standardization Section, CBS Member Programme Director, National Planning Commission Secretariat Member Under Secretary, Department of Education Member Under Secretary, Department of Health Services Member Under Secretary, Department of Women’s Development Member Under Secretary, Ministry of Federal Affairs and Local Development Member Representative, Central Department of Statistics, T.U. Member Representative, United Nations Chidren’s Fund (UNICEF Nepal) Member Invitees (maximum 8 persons) Member Director, Social Statistics Section, CBS Member Secretary A p p e n d i x B NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 239 NEPAL MICS 2014 CORE TEAM MEMBERS Mr Uttam Narayan Malla Ex-Director General Mr Bikash Bista Ex-Director General Dr Rudra Suwal Deputy Director General Mr Krishna Tuladhar Director (Project Coordinator, NMICS 2014) Mr Suresh Basnyat Director Mr Shailendra Ghimire Director Mr Badri Kumar Karki Director Mr Paramanand Pant Statistics Officer Mr Kapil Dhital Statistics Officer Mr Vishwa Natha Tripathi Statistics Officer Mr Rishi Ram Pokharel Statistics Officer Ms Chhiring Yalmo Computer Officer FINANCIAL SUPPORT AND FACILITATION TEAM Mr Jib Narayan Baral Ex-Under Secretary (Account) Mr Prakash Subedi Account Officer Mr Yadav Kharel Accountant DATA PROCESSING TEAM Mr Pramod Sapkota Data Entry Supervisor Ms Sameeksha Ghimire Data Entry Supervisor Mr Siddhartha Shankar Chaudhary Data Entry Supervisor Ms Deena Shakya Data Entry Operator Ms Pratiksha Shakya Data Entry Operator Mr Sapan Shrestha Data Entry Operator Ms Lajina Manandhar Data Entry Operator Mr Nitesh Tamrakar Data Entry Operator Mr Prashant Shrestha Data Entry Operator Mr Sanjay Rajkarnikar Data Entry Operator Ms Reena Awal Data Entry Operator Ms Radha Budathoki Data Entry Operator Ms Binu Shrestha Data Entry Operator Ms Dambar Kumari Ghale Data Entry Operator NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014240 HOUSEHOLD LISTERS Mr Yam Bahadur Gurung Mr Prem Prakash Ghimire Mr Jaykisun Kumar Sonar Mr Dhata Ram Shrestha Mr Subas Rai Mr Tej Kumar Darlami Ms Sujata Chapagain Ms Sharada Sharma Mr Tek Bahadur Gharti Mr Padam Bahadur Khatri Mr Moti Ram Rokaya Mr Nirmal Regmi Mr Basant Nyaupane Mr Ram Bahadur Thapa Mr Hari Bahadur Gharti Mr Deepak Bhattarai Ms Renu Kumari Ghimire Mr Damodar Shrestha Mr Balram Dulal Mr Kiran Bista Mr Krishna Prasad Chaulagain Mr Hariom Prasad Chaudhary Mr Surya Giri Mr Nawaraj Pokhrel Mr Kanta Lal Chaudhary Mr Ram Chandra Wagle Mr Surendra Prasad Pant Ms Indrakala Subedi Mr Binod Raj Pant Mr Lang Bahadur Bam SUPERVISORS, EDITORS AND ENUMERATORS Mr Santosh Koirala Supervisor Ms Shanti Kumari Rana Supervisor Mr Deepak Bhattarai Supervisor Mr Krishna Prasad Chaulagain Supervisor Mr Shankar Thakur Supervisor Mr Ram Chandra Wagle Supervisor Mr Kiran Bista Supervisor Mr Pharamanda Ojha Supervisor Mr Kabindra Mahat Supervisor Mr Tek Bahadur Gharti Supervisor Mr Jagadish Sapkota Supervisor Ms Lila Adhikari Pandit Supervisor Mr Moti Ram Rokaya Supervisor Mr Shambhu Narayan Pant Supervisor Mr Damodar Subedi Supervisor Mr Madhav Gyawali Supervisor Mr Balram Sigdel Supervisor Ms Chandrakala Poudyal Ms Ganga Bhujel Ms Nima Sharma Ms Reeta Maharjan Ms Uma Kumari Ms Laxmi Pandey Mr Kabindra Mahat Ms Sangita Sigdel Ms Gita Kumari Adhaikari Mr Ras Lal Sada Ms Renu SinghThakur Mr Siddhartha Shankar Chaudhary Ms Anjana Kumari Shrestha Ms Bhagabati Karki Ms Laxmi Sapkota Ms Shrutika Gole Mr Uttam Paudel Ms Pushpa Sharma Ms Dambar Kumari Ghale Ms Archana Singh Tharu Ms Susma Adhikari Ms Saraswota Bhusal Mr Damodar Subedi Ms Gayatri Adhikari Mr Nabin Sapkota Mr Dipendra Aryal Mr Bishnu Datta Bhatta Ms Sharmila Kafle Ms Indira Niraula Ms Mahalaxmi Luitel NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 241 Mr Vishnu Prasad Sharma Supervisor Mr Subash Thapaliya Supervisor Ms Pushpa Sharma Editor Ms Pratima Gyawali Adhikari Editor Ms Babi Dejee Gupta Editor Ms Prabina Awal Editor Ms Rama Kaphle Editor Ms Subarna Regmi Editor Ms Sharada Pandey Editor Ms Manisha Shrestha Editor Ms Gita Rimal Editor Ms Archana Singh Tharu Editor Ms Shrijana Luitel Editor Ms Indira Niraula Editor Ms Shanta Khanal Editor Ms Bandana Paudel Editor Ms Anjana Kumari Shrestha Editor Mr Gopal Prasad Paudyal Measurer Mr Nabin Sapkota Measurer Mr Ras Lal Sada Measurer Mr Ashish Bhuju Measurer Mr Neeraj Dhungel Measurer Mr Bisnu Prasad Bhusal Measurer Mr Suresh Mudvari Measurer Ms Bipana Luitel Measurer Mr Dipendra Aryal Measurer Ms Susma Adhikari Measurer Mr Anash Joshi Measurer Mr Suman Thapa Measurer Ms Krishna Rokaya Measurer Mr Bishnu Datta Bhatta Measurer Ms Sabitri Kumari Tharu Measurer Ms Bindukala Shrestha Enumerator Ms Kopila Prasai Enumerator Ms Sewanta Gautam Enumerator Ms Ganga Bhujel Enumerator Ms Radhika Bastola Enumerator Ms Anita Adhikari Enumerator Ms Uma Kumari Enumerator Ms Sushila Kumari Sah Enumerator Ms Roji Rani Dev Enumerator Ms Pretty Raya Enumerator Ms Laxmi Shrestha Enumerator Ms Bijaya Joshi Enumerator Ms Chandrakala Poudyal Enumerator Ms Gayatri Adhikari Enumerator Ms Nargish Khatun Enumerator Ms Krishna Kumari Pradhan Enumerator Ms Kamala Sigdel Enumerator Ms Sunita Shrestha Enumerator Ms Laxmi Sapkota Enumerator Ms Gayatri Pudasaini Adhikari Enumerator Ms Yamuna Adhikari Enumerator Ms Sarmila khatri Enumerator Ms Kanti Baniya Enumerator Ms Cheena Pathak Enumerator Ms Rita Lamichhane Enumerator Ms Samira Dahal Enumerator Ms Sharmila Kafle Enumerator Ms Renu SinghThakur Enumerator Ms Sangita Sigdel Enumerator Ms Laxmi Pandey Enumerator Ms Shulakshana Luitel Enumerator Ms Kopila Pudasaini Enumerator Ms Nisha Kiran Luitel Enumerator Ms Shila Kumal Enumerator Ms Sukmaya Gurung Enumerator Ms Sanju Phuyal Enumerator Ms Bhagabati Karki Enumerator Ms Nima Sharma Enumerator Ms Sita Paudel Enumerator Ms Shanti Chand Enumerator Ms Archana Kumari Karki Enumerator Ms Mahalaxmi Luitel Enumerator Ms Reeta Maharjan Enumerator Ms Indira Birbal Enumerator Ms Parwati Karki Enumerator NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014242 1CMRJack is software developed by FAFO, an independent and multidisciplinary research foundation. CMRJack produces mortality estimates and standard errors for surveys with complete birth histories or summary birth histories. See http://www.fafo.no/ais/child_mortality/index.html Estimates of Sampling Errors The sample of respondents selected in the Nepal MICS 2014 is only one of the samples that could have been selected from the same population, using the same design and size. Each of these samples would yield results that differ somewhat from the results of the actual sample selected. Sampling errors are a measure of the variability between the estimates from all possible samples. The extent of variability is not known exactly, but can be estimated statistically from the survey data. The following sampling error measures are presented in this appendix for each of the selected indicators: • Standard error (se): Standard error is the square root of the variance of the estimate. For survey indicators that are means, proportions or ratios, the Taylor series linearization method is used for the estimation of standard errors. For more complex statistics, such as fertility and mortality rates, the Jackknife repeated replications method is used for standard error estimation. • Coefficient of variation (se/r) is the ratio of the standard error to the value (r) of the indicator, and is a measure of the relative sampling error. • Design effect (deff) is the ratio of the actual variance of an indicator, under the sampling method used in the survey, to the variance calculated under the assumption of simple random sampling based on the same sample size. The square root of the design effect (deft) is used to show the efficiency of the sample design in relation to the precision. A deft value of 1.0 indicates that the sample design of the survey is as efficient as a simple random sample for a particular indicator, while a deft value above 1.0 indicates an increase in the standard error due to the use of a more complex sample design. • Confidence limits are calculated to show the interval within which the true value for the population can be reasonably assumed to fall, with a specified level of confidence. For any given statistic calculated from the survey, the value of that statistic will fall within a range of plus or minus two times the standard error (r + 2.se or r – 2.se) of the statistic in 95 percent of all possible samples of identical size and design. For the calculation of sampling errors from MICS data, programs developed in CSPro Version 5.0, SPSS Version 21 Complex Samples module and CMRJack1 have been used. The results are shown in the tables that follow. In addition to the sampling error measures described above, the tables also include weighted and unweighted counts of denominators for each indicator. A p p e n d i xC NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 243 Given the use of normalized weights, by comparing the weighted and unweighted counts it is possible to determine whether a particular domain has been under-sampled or over-sampled compared to the average sampling rate. If the weighted count is smaller than the unweighted count, this means that the particular domain had been over-sampled. As explained later in the footnote of Table SE.1, there is an exception in the case of indicators 4.1 and 4.3, for which the unweighted count represents the number of sample households, and the weighted counts reflect the total population. Sampling errors are calculated for indicators of primary interest, for the national level, for urban and rural areas, and for all regions. Seven of the selected indicators are based on households and household members, 18 are based on women, and 17 are based on children under five. Table SE.1 shows the list of indicators for which sampling errors are calculated, including a description of the base population (denominator) for each indicator. Tables SE.2 to SE.18 show the calculated sampling errors for selected domains. Table SE.1: Indicators selected for sampling error calculations List of indicators selected for sampling error calculations, and base populations (denominators) for each indicator, Nepal, 2014 MICS5 Indicator Base Population HOUSEHOLDS 2.19 Iodized salt consumption Total number of households in which salt was tested or where there was no salt HOUSEHOLD MEMBERS 4.1 Use of improved drinking water sources All household members [a] 4.3 Use of improved sanitation All household members [a] 7.4 Primary school net attendance ratio (adjusted) Total number of children of primary school age 7.5 Secondary school net attendance ratio (adjusted) Total number of children of secondary school age 8.2 Child labour Total number of children aged 5–17 years [a] 8.3 Violent discipline Total number of children aged 1–14 years [a] WOMEN 1.2 Infant mortality rate Children of interviewed women exposed to the risk of mortality during the first year of life 1.4 Child mortality rate Children of interviewed women exposed to the risk of mortality during the second to fifth years of life 5.1 Adolescent birth rate Women years of exposure to childbirth during ages 15–19 years 5.3 Contraceptive prevalence rate Women aged 15–49 years who are currently married or in union 5.4 Unmet need Women aged 15–49 years who are currently married or in union 5.5a Antenatal care coverage (1+ times, skilled provider) Women aged 15–49 years with a live birth in the 2 years preceding the survey 5.5b Antenatal care coverage (4+ times, any provider) Women aged 15–49 years with a live birth in the 2 years preceding the survey 5.7 Skilled attendant at delivery Women aged 15–49 years with a live birth in the 2 years preceding the survey 7.1 Literacy rate (young women) Total number of women aged 15–24 years 9.1 Knowledge about HIV prevention (young women) - - Pregnant women - 5.8 Institutional delivery Women aged 15–49 years with a live birth in the 2 years preceding the survey 5.9 Caesarean section Total number of women aged 15–49 years with a live birth in the 2 years preceding the survey 8.5 Marriage before age 18 Total number of women aged 20–49 years 8.7 Polygyny Percentage of women aged 15–49 years who are in a polygynous union 9.2 Knowledge of mother-to-child transmission of HIV Total number of women aged 15–49 years 9.4 Accepting attitudes towards people living with HIV Total number of women aged 15–49 years who have heard of HIV 9.5 Women who have been tested for HIV and know the results Total number of women aged 15–49 years Table SE.1: Indicators selected for sampling error calculations UNDER-5s 2.1a Underweight prevalence (moderate and severe) Total number of children under 5 years of age 2.1 b Underweight prevalence (severe) Total number of children under 5 years of age 3.22 Anti-malarial treatment of children under age 5 Total number of children under 5 years of age with fever in the 2 weeks preceding the survey 2.7 Exclusive breastfeeding under 6 months Total number of infants under 6 months of age 2.12 Age-appropriate breastfeeding Total number of children aged 0–23 months - Diarrhoea in preceding 2 weeks Total number of children under 5 years of age - Illness with a cough in preceding 2 weeks Total number of children under 5 years of age - Fever in last two weeks Total number of children under 5 years of age 3.12 Oral rehydration therapy with continued feeding Total number of children under 5 years of age with diarrhoea in the 2 weeks preceding the survey 3.14 Antibiotic treatment of suspected pneumonia Total number of children under 5 years of age with ARI symptoms in the 2 weeks preceding the survey 6.2 Support for learning Total number of children aged 36–59 months 6.1 Attendance to early childhood education Total number of children aged 36–59 months 8.1 Birth registration Total number of children under 5 years of age - Total fertility rate (3 years) - 1.1 Neonatal mortality rate - 1.3 Post-neonatal mortality rate - 1.5 Under-five mortality rate Children of interviewed women exposed to the risk of mortality during the first five years of life [a] To calculate the weighted results of MICS indicators 4.1, 4.3, 8.2 and 8.3, the household weight is multiplied by the number of household members in each household. Therefore, the unweighted base population presented in the SE tables reflect the unweighted number of households, whereas the weighted numbers reflect the household population. Random selection of one child aged 1–17 years per household is carried out during fieldwork for administering the child labour and/or child discipline modules. The child labour module is administered for children aged 5–17 years from among those randomly selected, while violent discipline module is administered for children aged 1–14 years. To account for the random selection and calculate MICS Indicators 8.2 and 8.3, the household sample weight is multiplied by the total number of children in the age range in each household. Therefore the unweighted base population presented in the SE tables reflects the unweighted number of households with children in the age range, whereas the weighted numbers reflect the number of children in the age range. Continued NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 245 Ne pa l  M IC S  2 01 4   5   Ta bl e SE .2 : S am pl in g er ro rs : T ot al s am pl e St an da rd e rro rs , c oe ffic ien ts of va ria tio n, d es ign e ffe cts (d ef f), sq ua re ro ot o f d es ign e ffe cts (d ef t) an d co nf ide nc e int er va ls fo r s ele cte d ind ica to rs , N ep al, 2 01 4 M IC S In dic at or M DG In dic at or Va lue (r) St an da rd er ro r (s e) Co ef fic ien t of va ria tio n (s e/ r) De sig n ef fe ct (d ef f) Sq ua re ro ot o f de sig n ef fe ct (d ef t) W eig ht ed co un t Un we igh te d co un t Co nf ide nc e lim its r - 2 se r + 2 se HO US EH OL DS Io diz ed sa lt c on su m pt ion 2. 19 0. 81 52 0. 01 11 0. 01 4 10 .1 09 3. 17 9 12 37 9 12 37 7 0. 79 3 0. 83 7 HO US EH OL D M EM BE RS Us e of im pr ov ed d rin kin g wa te r s ou rc es 4. 1 7. 8 0. 93 35 0. 00 61 0. 00 7 7. 40 1 2. 72 1 56 82 4 12 40 5 0. 92 1 0. 94 6 Us e of im pr ov ed sa nit at ion 4. 3 7. 9 0. 60 13 0. 01 22 0. 02 0 7. 69 7 2. 77 4 56 82 4 12 40 5 0. 57 7 0. 62 6 Pr im ar y s ch oo l n et a tte nd an ce ra tio (a dju ste d) 7. 4 2. 1 0. 85 93 0. 00 85 0. 01 0 4. 04 2 2. 01 0 67 47 67 89 0. 84 2 0. 87 6 Se co nd ar y s ch oo l n et a tte nd an ce ra tio (a dju ste d) 7. 5 0. 66 07 0. 01 11 0. 01 7 3. 84 6 1. 96 1 68 76 69 41 0. 63 8 0. 68 3 Ch ild la bo ur 8. 2 0. 37 43 0. 00 93 0. 02 5 2. 66 2 1. 63 16 17 31 9 71 47 0. 35 6 0. 39 3 Vi ole nt d isc ipl ine 8. 3 0. 81 71 0. 00 66 0. 00 8 2. 18 9 1. 48 0 18 04 9 75 58 0. 80 4 0. 83 0 W OM EN In fa nt m or ta lity ra te 1. 2 4. 2 33 .1 05 1 3. 00 63 9. 03 8 na na na na 27 .0 92 39 .1 18 Un de r-f ive m or ta lity ra te 1. 5 4. 1 38 .0 24 5 3. 28 13 10 .7 67 na na na na 31 .4 62 44 .5 87 Ad ole sc en t b irt h ra te 5. 1 5. 4 71 .4 77 6 4. 10 95 16 .8 88 2 na na na na 63 .2 58 79 .6 97 Co nt ra ce pt ive p re va len ce 5. 3 5. 3 0. 49 63 0. 00 82 0. 01 7 2. 90 7 1. 70 5 10 83 0 10 68 8 0. 48 0 0. 51 3 Un m et n ee d 5. 4 5. 6 0. 25 21 0. 00 58 0. 02 3 1. 88 9 1. 37 4 10 83 0 10 68 8 0. 24 1 0. 26 4 An te na ta l c ar e co ve ra ge (1 + tim es , s kil led p ro vid er ) 5. 5a 5. 5 0. 53 48 0. 01 47 0. 27 0 1. 80 3 1. 34 3 20 48 20 86 0. 50 5 0. 56 4 An te na ta l c ar e co ve ra ge (4 + tim es , a ny p ro vid er ) 5. 5b 5. 5 0. 59 48 0. 01 69 0. 02 8 2. 46 8 1. 57 1 20 48 20 86 0. 56 1 0. 62 9 Sk ille d at te nd an t a t d eli ve ry 5. 7 5. 2 0. 55 56 0. 01 49 0. 02 7 1. 88 1 1. 37 2 20 48 20 86 0. 52 6 0. 58 5 Lit er ac y r at e (y ou ng w om en ) 7. 1 2. 3 0. 83 98 0. 01 08 0. 01 3 4. 53 1 2. 12 9 51 23 52 56 0. 81 8 0. 86 1 Kn ow led ge a bo ut H IV p re ve nt ion (y ou ng w om en ) 9. 1 6. 3 0. 36 36 0. 01 03 0. 02 8 2. 42 0 1. 55 6 51 23 52 56 0. 34 3 0. 38 4 Pr eg na nt w om en - 0. 04 07 0. 00 23 0. 05 7 1. 95 7 1. 39 9 14 16 2 14 16 2 0. 03 6 0. 04 5 In sti tu tio na l d eli ve rie s 5. 8 0. 55 15 0. 01 60 0. 02 9 2. 16 7 1. 47 2 20 48 20 86 0. 51 9 0. 58 4 Ca es ar ea n se cti on 5. 9 0. 08 62 0. 00 77 0. 08 9 1. 56 9 1. 25 3 20 48 20 86 0. 07 1 0. 10 2 M ar ria ge b ef or e ag e 18 8. 5 0. 48 54 0. 00 76 0. 01 6 2. 66 5 1. 63 2 11 44 1 11 38 1 0. 47 0 0. 50 1 Po lyg yn y 8. 7 0. 04 05 0. 00 30 0. 07 5 2. 52 9 1. 59 0 10 83 0 10 68 8 0. 03 4 0. 04 7 Kn ow led ge o f m ot he r-t o- ch ild tr an sm iss ion o f H IV 9. 2 0. 38 45 0. 00 73 0. 01 9 3. 20 4 1. 79 0 14 16 2 14 16 2 0. 37 0 0. 39 9 Ac ce pt ing a ttit ud es to wa rd s p eo ple liv ing w ith H IV 9. 3 0. 48 62 0. 00 86 0. 01 8 3. 26 9 1. 80 8 11 10 7 10 91 8 0. 46 9 0. 50 4 W om en w ho h av e be en te ste d fo r H IV a nd kn ow th e re su lts 9. 5 0. 02 74 0. 00 20 0. 07 1 2. 02 5 1. 42 3 14 16 2 14 16 2 0. 02 3 0. 03 1 UN DE R- 5s Un de rw eig ht p re va len ce (m od er at e an d se ve re ) 2. 1a 1. 8 0. 30 08 0. 01 01 0. 03 3 2. 51 6 1. 58 6 52 06 52 35 0. 28 1 0. 32 1 Un de rw eig ht p re va len ce (s ev er e) 2. 1b 1. 8 0. 08 59 0. 00 60 0. 07 0 2. 39 2 1. 54 7 52 06 52 35 0. 07 4 0. 09 8 An ti- m ala ria l tr ea tm en t o f c hil dr en u nd er a ge 5 3. 22 6. 8 0. 00 89 0. 00 34 0. 37 9 1. 38 9 1. 17 9 10 74 10 74 0. 00 2 0. 01 6 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014246 Ne pa l  M IC S  2 01 4   6   Ta bl e SE .2 : S am pl in g er ro rs : T ot al s am pl e St an da rd e rro rs , c oe ffic ien ts of va ria tio n, d es ign e ffe cts (d ef f), sq ua re ro ot o f d es ign e ffe cts (d ef t) an d co nf ide nc e int er va ls fo r s ele cte d ind ica to rs , N ep al, 2 01 4 M IC S In dic at or M DG In dic at or Va lue (r) St an da rd er ro r (s e) Co ef fic ien t of va ria tio n (s e/ r) De sig n ef fe ct (d ef f) Sq ua re ro ot o f de sig n ef fe ct (d ef t) W eig ht ed co un t Un we igh te d co un t Co nf ide nc e lim its r - 2 se r + 2 se Ex clu siv e br ea stf ee din g un de r 6 m on th s 2. 7 0. 56 93 0. 02 29 0. 04 0 0. 96 6 0. 98 3 45 5 45 2 0. 52 3 0. 61 5 Ag e- ap pr op ria te b re as tfe ed ing 2. 12 0. 79 26 0. 01 19 0. 01 5 1. 71 9 1. 31 1 19 86 20 08 0. 76 9 0. 81 6 Di ar rh oe a in th e pr ev iou s 2 w ee ks - 0. 11 99 0. 00 64 0. 05 4 2. 09 9 1. 44 9 53 49 53 49 0. 10 7 0. 13 3 Illn es s w ith a co ug h in th e pr ev iou s 2 w ee ks - 0. 06 67 0. 00 50 0. 07 5 2. 12 5 1. 45 8 53 49 53 49 0. 05 7 0. 07 7 Fe ve r i n las t t wo w ee ks - 0. 20 08 0. 00 77 0. 03 8 1. 97 7 1. 40 6 53 49 53 49 0. 18 5 0. 21 6 Or al re hy dr at ion th er ap y w ith co nt inu ed fe ed ing 3. 12 0. 45 86 0. 02 22 0. 04 8 1. 40 3 1. 18 4 64 1 71 0 0. 41 4 0. 50 3 An tib iot ic tre at m en t o f s us pe cte d pn eu m on ia 3. 14 0. 74 89 0. 01 85 0. 02 5 0. 60 9 0. 78 1 35 7 33 6 0. 71 2 0. 78 6 Su pp or t f or le ar nin g 6. 2 0. 67 16 0. 01 51 0. 02 2 2. 35 2 1. 53 4 22 84 22 79 0. 64 1 0. 70 2 At te nd an ce to e ar ly ch ild ho od e du ca tio n 6. 1 0. 50 67 0. 01 79 0. 03 5 2. 92 2 1. 70 9 22 84 22 79 0. 47 1 0. 54 2 Bi rth re gis tra tio n 8. 1 0. 58 12 0. 01 20 0. 02 1 3. 18 0 1. 78 3 53 49 53 49 0. 55 7 0. 60 5 To ta l fe rti lity ra te (3 ye ar s) - 2. 29 22 0. 06 53 0. 00 4 na na na na 2. 16 2 2. 42 3 Ne on at al m or ta lity ra te 1. 1 22 .5 31 5 2. 36 61 5. 59 8 na na na na 17 .7 99 27 .2 64 Po st- ne on at al m or ta lity ra te 1. 3 10 .5 73 5 1. 68 46 2. 83 8 na na na na 7. 20 4 13 .9 43 Ch ild m or ta lity ra te 1. 4 5. 08 78 0. 90 88 0. 82 6 na na na na 3. 27 0 6. 90 5 C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 247 Ne pa l  M IC S  2 01 4   7   Ta bl e SE .3 : S am pl in g er ro rs : U rb an St an da rd e rro rs , c oe ffic ien ts of va ria tio n, d es ign e ffe cts (d ef f), sq ua re ro ot o f d es ign e ffe cts (d ef t) an d co nf ide nc e int er va ls fo r s ele cte d ind ica to rs , N ep al, 2 01 4 M IC S In dic at or M DG In dic at or Va lue (r) St an da rd er ro r (s e) Co ef fic ien t of va ria tio n (s e/ r) De sig n ef fe ct (d ef f) Sq ua re ro ot o f de sig n ef fe ct (d ef t) W eig ht ed co un t Un we igh te d co un t Co nf ide nc e lim its r - 2 se r + 2 se HO US EH OL DS Io diz ed sa lt c on su m pt ion 2. 19 0. 96 44 0. 00 50 0. 00 5 2. 15 9 1. 46 9 24 67 29 84 0. 95 4 0. 97 4 HO US EH OL D M EM BE RS Us e of im pr ov ed d rin kin g wa te r s ou rc es 4. 1 7. 8 0. 95 46 0. 00 84 0. 00 9 4. 87 9 2. 20 9 97 53 29 92 0. 93 8 0. 97 1 Us e of im pr ov ed sa nit at ion 4. 3 7. 9 0. 62 80 0. 01 58 0. 02 5 3. 19 1 1. 78 6 97 53 29 92 0. 59 6 0. 66 0 Pr im ar y s ch oo l n et a tte nd an ce ra tio (a dju ste d) 7. 4 2. 1 0. 90 06 0. 00 99 0. 01 1 1. 24 3 1. 11 5 88 14 11 35 0. 88 1 0. 92 0 Se co nd ar y s ch oo l n et a tte nd an ce ra tio (a dju ste d) 7. 5 0. 74 66 0. 02 06 0. 02 8 2. 89 4 1. 70 1 99 1 12 94 0. 70 5 0. 78 8 Ch ild la bo ur 8. 2 0. 16 24 0. 01 34 0. 08 3 2. 10 3 1. 45 0 31 64 15 93 0. 13 6 0. 18 9 Vi ole nt d isc ipl ine 8. 3 0. 74 60 0. 01 48 0. 02 0 1. 82 1 1. 35 0 30 91 15 70 0. 71 6 0. 77 6 W OM EN In fa nt m or ta lity ra te 1. 2 4. 2 21 .2 15 3 5. 62 37 31 .6 26 na na na na 9. 96 8 32 .4 63 Un de r-f ive m or ta lity ra te 1. 5 4. 1 26 .2 24 3 6. 67 75 44 .5 89 na na na na 12 .8 69 39 .5 79 Ad ole sc en t b irt h ra te 5. 1 5. 4 33 .4 93 1 5. 24 89 27 .5 52 na na na na 22 .9 95 43 .9 91 Co nt ra ce pt ive p re va len ce 5. 3 5. 3 0. 52 05 0. 01 28 0. 02 5 1. 61 8 1. 27 2 19 83 24 77 0. 49 5 0. 54 6 Un m et n ee d 5. 4 5. 6 0. 22 91 0. 00 93 0. 04 0 1. 20 6 1. 09 8 19 83 24 77 0. 21 1 0. 24 8 An te na ta l c ar e co ve ra ge (1 + tim es , s kil led p ro vid er ) 5. 5a 5. 5 0. 89 63 0. 02 37 0. 02 6 2. 07 1 1. 43 9 26 2 34 3 0. 84 9 0. 94 4 An te na ta l c ar e co ve ra ge (4 + tim es , a ny p ro vid er ) 5. 5b 5. 5 0. 84 02 0. 02 62 0. 03 1 1. 75 5 1. 32 5 26 2 34 3 0. 78 8 0. 89 3 Sk ille d at te nd an t a t d eli ve ry 5. 7 5. 2 0. 90 34 0. 01 84 0. 02 0 1. 32 4 1. 15 1 26 2 34 3 0. 86 7 0. 94 0 Lit er ac y r at e (y ou ng w om en ) 7. 1 2. 3 0. 94 93 0. 00 73 0. 00 8 1. 36 6 1. 16 9 95 6 12 26 0. 93 5 0. 96 4 Kn ow led ge a bo ut H IV p re ve nt ion (y ou ng w om en ) 9. 1 6. 3 0. 48 82 0. 01 78 0. 03 7 1. 55 7 1. 24 8 95 6 12 26 0. 45 3 0. 52 4 Pr eg na nt w om en - 0. 03 49 0. 00 29 0. 08 3 0. 86 4 0. 93 0 27 92 34 79 0. 02 9 0. 04 1 In sti tu tio na l d eli ve rie s 5. 8 0. 88 30 0. 01 78 0. 02 0 1. 04 6 1. 02 3 26 2 34 3 0. 84 7 0. 91 9 Ca es ar ea n se cti on 5. 9 0. 18 97 0. 02 82 0. 14 9 1. 76 7 1. 32 9 26 2 34 3 0. 13 3 0. 24 6 M ar ria ge b ef or e ag e 18 8. 5 0. 34 74 0. 01 02 0. 02 9 1. 31 9 1. 14 8 23 50 28 99 0. 32 7 0. 36 8 Po lyg yn y 8. 7 0. 03 95 0. 00 52 0. 13 1 1. 75 5 1. 32 5 19 83 24 77 0. 02 9 0. 05 0 Kn ow led ge o f m ot he r-t o- ch ild tr an sm iss ion o f H IV 9. 2 0. 42 16 0. 01 25 0. 03 0 2. 23 1 1. 49 4 27 92 34 79 0. 39 7 0. 44 7 Ac ce pt ing a ttit ud es to wa rd s p eo ple liv ing w ith H IV 9. 3 0. 59 12 0. 01 57 0. 02 7 3. 23 4 1. 79 8 25 97 31 59 0. 56 0 0. 62 3 W om en w ho h av e be en te ste d fo r H IV a nd kn ow th e re su lts 9. 5 0. 04 53 0. 00 53 0. 11 7 2. 25 5 1. 50 2 27 92 34 79 0. 03 5 0. 05 6 UN DE R- 5s Un de rw eig ht p re va len ce (m od er at e an d se ve re ) 2. 1a 1. 8 0. 16 52 0. 01 77 0. 10 7 2. 01 4 1. 41 9 68 8 88 7 0. 13 0 0. 20 1 Un de rw eig ht p re va len ce (s ev er e) 2. 1b 1. 8 0. 03 22 0. 00 70 0. 21 7 1. 38 4 1. 17 6 68 8 88 7 0. 01 8 0. 04 6 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014248 Ne pa l  M IC S  2 01 4   8   Ta bl e SE .3 : S am pl in g er ro rs : U rb an St an da rd e rro rs , c oe ffic ien ts of va ria tio n, d es ign e ffe cts (d ef f), sq ua re ro ot o f d es ign e ffe cts (d ef t) an d co nf ide nc e int er va ls fo r s ele cte d ind ica to rs , N ep al, 2 01 4 M IC S In dic at or M DG In dic at or Va lue (r) St an da rd er ro r (s e) Co ef fic ien t of va ria tio n (s e/ r) De sig n ef fe ct (d ef f) Sq ua re ro ot o f de sig n ef fe ct (d ef t) W eig ht ed co un t Un we igh te d co un t Co nf ide nc e lim its r - 2 se r + 2 se An ti- m ala ria l tr ea tm en t o f c hil dr en u nd er a ge 5 3. 22 6. 8 0. 01 35 0. 00 29 0. 21 3 0. 11 3 0. 33 7 15 3 18 5 0. 00 8 0. 01 9 Ex clu siv e br ea stf ee din g un de r 6 m on th s 2. 7 0. 53 91 0. 04 01 0. 07 4 0. 51 7 0. 71 9 59 81 0. 45 9 0. 61 9 Ag e- ap pr op ria te b re as tfe ed ing 2. 12 0. 77 98 0. 02 73 0. 03 5 1. 42 8 1. 19 5 24 8 33 1 0. 72 5 0. 83 4 Di ar rh oe a in th e pr ev iou s 2 w ee ks - 0. 09 73 0. 01 02 0. 10 5 1. 08 2 1. 04 0 69 9 90 7 0. 07 7 0. 11 8 Illn es s w ith a co ug h in th e pr ev iou s 2 w ee ks - 0. 07 60 0. 01 54 0. 20 3 3. 07 5 1. 75 4 69 9 90 7 0. 04 5 0. 10 7 Fe ve r i n las t t wo w ee ks - 0. 21 83 0. 01 71 0. 07 8 1. 55 9 1. 24 9 69 9 90 7 0. 18 4 0. 25 3 Or al re hy dr at ion th er ap y w ith co nt inu ed fe ed ing 3. 12 0. 59 36 0. 03 08 0. 05 2 0. 36 6 0. 60 5 68 94 0. 53 2 0. 65 5 An tib iot ic tre at m en t o f s us pe cte d pn eu m on ia 3. 14 0. 87 27 0. 02 08 0. 02 4 0. 22 3 0. 47 2 53 58 0. 83 1 0. 91 4 Su pp or t f or le ar nin g 6. 2 0. 86 47 0. 02 05 0. 02 4 1. 42 9 1. 19 5 30 2 39 8 0. 82 4 0. 90 6 At te nd an ce to e ar ly ch ild ho od e du ca tio n 6. 1 0. 78 25 0. 02 91 0. 03 7 1. 97 7 1. 40 6 30 2 39 8 0. 72 4 0. 84 1 Bi rth re gis tra tio n 8. 1 0. 56 58 0. 01 85 0. 03 3 1. 26 0 1. 12 3 69 9 90 7 0. 52 9 0. 60 3 To ta l fe rti lity ra te (3 ye ar s) - 1. 43 27 0. 06 72 0. 00 5 na na na na 1. 29 8 1. 56 7 Ne on at al m or ta lity ra te 1. 1 15 .2 32 3 4. 98 43 24 .8 43 na na na na 5. 26 4 25 .2 01 Po st- ne on at al m or ta lity ra te 1. 3 5. 98 31 3. 14 99 9. 92 2 na na na na -0 .3 17 12 .2 83 Ch ild m or ta lity ra te 1. 4 5. 11 75 2. 55 25 6. 51 5 na na na na 0. 01 3 10 .2 22 C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 249 Ne pa l  M IC S  2 01 4   9   Ta bl e SE .4 : S am pl in g er ro rs : R ur al a re as St an da rd e rro rs , c oe ffic ien ts of va ria tio n, d es ign e ffe cts (d ef f), sq ua re ro ot o f d es ign e ffe cts (d ef t) an d co nf ide nc e int er va ls fo r s ele cte d ind ica to rs , N ep al, 2 01 4 M IC S In dic at or M DG In dic at or Va lue (r) St an da rd er ro r ( se ) Co ef fic ien t of va ria tio n (s e/ r) De sig n ef fe ct (d ef f) Sq ua re ro ot o f de sig n ef fe ct (d ef t) W eig ht ed co un t Un we igh te d co un t Co nf ide nc e lim its r - 2 se r + 2 se HO US EH OL DS Io diz ed sa lt c on su m pt ion 2. 19 0. 77 80 0. 01 37 0. 01 8 10 .1 56 3. 18 7 99 12 93 93 0. 75 1 0. 80 5 HO US EH OL D M EM BE RS Us e of im pr ov ed d rin kin g wa te r s ou rc es 4. 1 7. 8 0. 92 91 0. 00 72 0. 00 8 7. 30 2 2. 70 2 47 07 1 94 13 0. 91 5 0. 94 3 Us e of im pr ov ed sa nit at ion 4. 3 7. 9 0. 59 58 0. 01 43 0. 02 4 8. 03 3 2. 83 4 47 07 1 94 13 0. 56 7 0. 62 4 Pr im ar y s ch oo l n et a tte nd an ce ra tio (a dju ste d) 7. 4 2. 1 0. 85 31 0. 00 96 0. 01 1 4. 14 1 2. 03 5 58 66 56 54 0. 83 4 0. 87 2 Se co nd ar y s ch oo l n et a tte nd an ce ra tio (a dju ste d) 7. 5 0. 64 62 0. 01 25 0. 01 9 3. 85 8 1. 96 4 58 85 56 47 0. 62 1 0. 67 1 Ch ild la bo ur 8. 2 0. 40 93 0. 01 04 0. 02 6 2. 50 3 1. 58 2 14 17 4 55 54 0. 38 8 0. 43 0 Vi ole nt d isc ipl ine 8. 3 0. 82 80 0. 00 72 0. 00 9 2. 15 0 1. 46 6 14 92 5 59 88 0. 81 4 0. 84 2 W OM EN In fa nt m or ta lity ra te 1. 2 4. 2 34 .8 41 5 3. 35 37 11 .2 47 na na na na 28 .1 34 41 .5 49 Un de r-f ive m or ta lity ra te 1. 5 4. 1 39 .7 47 6 3. 64 49 13 .2 86 na na na na 32 .4 58 47 .0 37 Ad ole sc en t b irt h ra te 5. 1 5. 4 79 .7 34 7 4. 69 92 22 .0 82 na na na na 70 .3 36 89 .1 33 Co nt ra ce pt ive p re va len ce 5. 3 5. 3 0. 49 08 0. 00 97 0. 02 0 3. 08 4 1. 75 6 88 46 82 11 0. 47 1 0. 51 0 Un m et n ee d 5. 4 5. 6 0. 25 73 0. 00 68 0. 02 6 1. 96 1 1. 40 0 88 46 82 11 0. 24 4 0. 27 1 An te na ta l c ar e co ve ra ge (1 + tim es , s kil led p ro vid er ) 5. 5a 5. 5 0. 48 17 0. 01 55 0. 03 2 1. 68 3 1. 29 7 17 86 17 43 0. 45 1 0. 51 3 An te na ta l c ar e co ve ra ge (4 + tim es , a ny p ro vid er ) 5. 5b 5. 5 0. 55 88 0. 01 86 0. 03 3 2. 44 6 1. 56 4 17 86 17 43 0. 52 2 0. 59 6 Sk ille d at te nd an t a t d eli ve ry 5. 7 5. 2 0. 50 45 0. 01 60 0. 03 2 1. 78 1 1. 33 4 17 86 17 43 0. 47 3 0. 53 6 Lit er ac y r at e (y ou ng w om en ) 7. 1 2. 3 0. 81 47 0. 01 30 0. 01 6 4. 49 3 2. 12 0 41 67 40 30 0. 78 9 0. 84 1 Kn ow led ge a bo ut H IV p re ve nt ion (y ou ng w om en ) 9. 1 6. 3 0. 33 51 0. 01 19 0. 03 6 2. 57 7 1. 60 5 41 67 40 30 0. 31 1 0. 35 9 Pr eg na nt w om en - 0. 04 22 0. 00 28 0. 06 6 2. 08 0 1. 44 2 11 37 0 10 68 3 0. 03 7 0. 04 8 In sti tu tio na l d eli ve rie s 5. 8 0. 50 29 0. 01 74 0. 03 5 2. 10 2 1. 45 0 17 86 17 43 0. 46 8 0. 53 8 Ca es ar ea n se cti on 5. 9 0. 07 10 0. 00 78 0. 11 0 1. 59 9 1. 26 4 17 86 17 43 0. 05 5 0. 08 7 M ar ria ge b ef or e ag e 18 8. 5 0. 52 10 0. 00 90 0. 01 7 2. 78 2 1. 66 8 90 91 84 82 0. 50 3 0. 53 9 Po lyg yn y 8. 7 0. 04 07 0. 00 35 0. 08 7 2. 61 1 1. 61 6 88 46 82 11 0. 03 4 0. 04 8 Kn ow led ge o f m ot he r-t o- ch ild tr an sm iss ion o f H IV 9. 2 0. 37 53 0. 00 86 0. 02 3 3. 34 6 1. 82 9 11 37 0 10 68 3 0. 35 8 0. 39 2 Ac ce pt ing a ttit ud es to wa rd s p eo ple liv ing w ith H IV 9. 3 0. 45 42 0. 01 00 0. 02 2 3. 13 5 1. 77 1 85 10 77 59 0. 43 4 0. 47 4 W om en w ho h av e be en te ste d fo r H IV a nd kn ow th e re su lts 9. 5 0. 02 30 0. 00 21 0. 08 9 2. 00 4 1. 41 6 11 37 0 10 68 3 0. 01 9 0. 02 7 UN DE R- 5s Un de rw eig ht p re va len ce (m od er at e an d se ve re ) 2. 1a 1. 8 0. 32 15 0. 01 11 0. 03 5 2. 45 8 1. 56 8 45 17 43 48 0. 29 9 0. 34 4 Un de rw eig ht p re va len ce (s ev er e) 2. 1b 1. 8 0. 09 40 0. 00 68 0. 07 3 2. 37 5 1. 54 1 45 17 43 48 0. 08 0 0. 10 8 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014250 Ne pa l  M IC S  2 01 4   10   Ta bl e SE .4 : S am pl in g er ro rs : R ur al a re as St an da rd e rro rs , c oe ffic ien ts of va ria tio n, d es ign e ffe cts (d ef f), sq ua re ro ot o f d es ign e ffe cts (d ef t) an d co nf ide nc e int er va ls fo r s ele cte d ind ica to rs , N ep al, 2 01 4 M IC S In dic at or M DG In dic at or Va lue (r) St an da rd er ro r ( se ) Co ef fic ien t of va ria tio n (s e/ r) De sig n ef fe ct (d ef f) Sq ua re ro ot o f de sig n ef fe ct (d ef t) W eig ht ed co un t Un we igh te d co un t Co nf ide nc e lim its r - 2 se r + 2 se An ti- m ala ria l tr ea tm en t o f c hil dr en u nd er a ge 5 3. 22 6. 8 0. 00 82 0. 00 39 0. 47 9 1. 68 1 1. 29 7 92 1 88 9 0. 00 0 0. 01 6 Ex clu siv e br ea stf ee din g un de r 6 m on th s 2. 7 0. 57 38 0. 02 56 0. 04 5 0. 99 0 0. 99 5 39 6 37 1 0. 52 3 0. 62 5 Ag e- ap pr op ria te b re as tfe ed ing 2. 12 0. 79 44 0. 01 30 0. 01 6 1. 73 9 1. 31 9 17 37 16 77 0. 76 8 0. 82 0 Di ar rh oe a in th e pr ev iou s 2 w ee ks - 0. 12 33 0. 00 72 0. 05 9 2. 14 3 1. 46 4 46 50 44 42 0. 10 9 0. 13 8 Illn es s w ith a co ug h in th e pr ev iou s 2 w ee ks - 0. 06 53 0. 00 52 0. 08 0 1. 97 7 1. 40 6 46 50 44 42 0. 05 5 0. 07 6 Fe ve r i n las t t wo w ee ks - 0. 19 81 0. 00 84 0. 04 3 1. 99 1 1. 41 1 46 50 44 42 0. 18 1 0. 21 5 Or al re hy dr at ion th er ap y w ith co nt inu ed fe ed ing 3. 12 0. 44 26 0. 02 44 0. 05 5 1. 48 4 1. 21 8 57 3 61 6 0. 39 4 0. 49 1 An tib iot ic tre at m en t o f s us pe cte d pn eu m on ia 3. 14 0. 72 73 0. 02 05 0. 02 8 0. 58 6 0. 76 6 30 4 27 8 0. 68 6 0. 76 8 Su pp or t f or le ar nin g 6. 2 0. 64 21 0. 01 68 0. 02 6 2. 30 5 1. 51 8 19 82 18 81 0. 60 9 0. 67 6 At te nd an ce to e ar ly ch ild ho od e du ca tio n 6. 1 0. 46 46 0. 01 92 0. 04 1 2. 78 7 1. 67 0 19 82 18 81 0. 42 6 0. 50 3 Bi rth re gis tra tio n 8. 1 0. 58 35 0. 01 36 0. 02 3 3. 36 2 1. 83 4 46 50 44 42 0. 55 6 0. 61 1 To ta l fe rti lity ra te (3 ye ar s) - 2. 50 71 0. 07 58 0. 00 6 na na na na 2. 35 5 2. 65 9 Ne on at al m or ta lity ra te 1. 1 23 .5 99 6 2. 61 49 6. 83 8 na na na na 18 .3 70 28 .8 29 Po st- ne on at al m or ta lity ra te 1. 3 11 .2 41 8 1. 88 11 3. 53 8 na na na na 7. 48 0 15 .0 04 Ch ild m or ta lity ra te 1. 4 5. 08 32 0. 97 39 0. 94 8 na na na na 3. 13 5 7. 03 1 C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 251 Ne pa l  M IC S  2 01 4   11   Ta bl e SE .5 : S am pl in g er ro rs : E as te rn M ou nt ai ns R eg io n St an da rd e rro rs , c oe ffic ien ts of va ria tio n, d es ign e ffe cts (d ef f), sq ua re ro ot o f d es ign e ffe cts (d ef t) an d co nf ide nc e int er va ls fo r s ele cte d ind ica to rs , N ep al, 2 01 4 M IC S In dic at or M DG In dic at or Va lue (r) St an da rd er ro r ( se ) Co ef fic ien t of va ria tio n (s e/ r) De sig n ef fe ct (d ef f) Sq ua re ro ot o f de sig n ef fe ct (d ef t) W eig ht ed co un t Un we igh te d co un t Co nf ide nc e lim its r - 2 se r + 2 se HO US EH OL DS Io diz ed sa lt c on su m pt ion 2. 19 0. 75 92 0. 03 01 0. 04 0 3. 83 1 1. 95 7 17 8 77 2 0. 69 9 0. 81 9 HO US EH OL D M EM BE RS Us e of im pr ov ed d rin kin g wa te r s ou rc es 4. 1 7. 8 0. 92 67 0. 02 08 0. 02 2 4. 95 3 2. 22 6 77 9 77 6 0. 88 5 0. 96 8 Us e of im pr ov ed sa nit at ion 4. 3 7. 9 0. 66 93 0. 06 10 0. 09 1 13 .0 47 3. 61 2 77 9 77 6 0. 54 7 0. 79 1 Pr im ar y s ch oo l n et a tte nd an ce ra tio (a dju ste d) 7. 4 2. 1 0. 90 94 0. 01 63 0. 01 8 1. 35 4 1. 16 4 98 42 0 0. 87 7 0. 94 2 Se co nd ar y s ch oo l n et a tte nd an ce ra tio (a dju ste d) 7. 5 0. 63 90 0. 03 14 0. 04 9 1. 86 4 1. 36 5 10 2 43 8 0. 57 6 0. 70 2 Ch ild la bo ur 8. 2 0. 59 98 0. 03 74 0. 06 2 2. 56 0 1. 60 0 10 81 44 0 0. 52 5 0. 67 5 Vi ole nt d isc ipl ine 8. 3 0. 86 96 0. 01 75 0. 02 0 1. 27 1 1. 12 7 11 12 47 1 0. 83 5 0. 90 5 W OM EN In fa nt m or ta lity ra te 1. 2 4. 2 46 .4 87 0 10 .8 40 7 11 7. 52 1 na na na na 24 .8 06 68 .1 68 Un de r-f ive m or ta lity ra te 1. 5 4. 1 52 .5 62 6 11 .6 12 2 13 4. 84 4 na na na na 29 .3 38 75 .7 87 Ad ole sc en t b irt h ra te 5. 1 5. 4 66 .9 50 1 12 .6 80 4 16 0. 79 3 na na na na 41 .5 89 92 .3 11 Co nt ra ce pt ive p re va len ce 5. 3 5. 3 0. 53 40 0. 02 88 0. 05 4 2. 02 3 1. 42 2 13 4 60 6 0. 47 6 0. 59 2 Un m et n ee d 5. 4 5. 6 0. 20 23 0. 01 54 0. 07 6 0. 88 8 0. 94 2 13 4 60 6 0. 17 2 0. 23 3 An te na ta l c ar e co ve ra ge (1 + tim es , s kil led p ro vid er ) 5. 5a 5. 5 0. 25 38 0. 04 80 0. 18 9 1. 71 2 1. 30 8 32 14 2 0. 15 8 0. 35 0 An te na ta l c ar e co ve ra ge (4 + tim es , a ny p ro vid er ) 5. 5b 5. 5 0. 41 75 0. 05 93 0. 14 2 2. 03 9 1. 42 8 32 14 2 0. 29 9 0. 53 6 Sk ille d at te nd an t a t d eli ve ry 5. 7 5. 2 0. 23 16 0. 04 91 0. 21 2 1. 91 0 1. 38 2 32 14 2 0. 13 3 0. 33 0 Lit er ac y r at e (y ou ng w om en ) 7. 1 2. 3 0. 90 39 0. 03 13 0. 03 5 3. 90 7 1. 97 7 77 34 8 0. 84 1 0. 96 6 Kn ow led ge a bo ut H IV p re ve nt ion (y ou ng w om en ) 9. 1 6. 3 0. 25 44 0. 03 46 0. 13 6 2. 19 2 1. 48 0 77 34 8 0. 18 5 0. 32 4 Pr eg na nt w om en - 0. 04 29 0. 00 73 0. 16 9 1. 07 9 1. 03 9 18 6 84 0 0. 02 8 0. 05 7 In sti tu tio na l d eli ve rie s 5. 8 0. 23 59 0. 05 31 0. 22 5 2. 20 8 1. 48 6 32 14 2 0. 13 0 0. 34 2 Ca es ar ea n se cti on 5. 9 0. 02 70 0. 01 40 0. 52 0 1. 05 7 1. 02 8 32 14 2 0. 00 0 0. 05 5 M ar ria ge b ef or e ag e 18 8. 5 0. 34 50 0. 02 40 0. 06 9 1. 63 2 1. 27 8 14 3 64 4 0. 29 7 0. 39 3 Po lyg yn y 8. 7 0. 05 11 0. 00 51 0. 10 1 0. 32 9 0. 57 4 13 4 60 6 0. 04 1 0. 06 1 Kn ow led ge o f m ot he r-t o- ch ild tr an sm iss ion o f H IV 9. 2 0. 46 48 0. 02 76 0. 05 9 2. 57 8 1. 60 6 18 6 84 0 0. 40 9 0. 52 0 Ac ce pt ing a ttit ud es to wa rd s p eo ple liv ing w ith H IV 9. 3 0. 53 26 0. 02 16 0. 04 1 1. 18 0 1. 08 6 13 9 63 2 0. 48 9 0. 57 6 W om en w ho h av e be en te ste d fo r H IV a nd kn ow th e re su lts 9. 5 0. 00 66 0. 00 19 0. 29 5 0. 48 3 0. 69 5 18 6 84 0 0. 00 3 0. 01 0 UN DE R- 5s Un de rw eig ht p re va len ce (m od er at e an d se ve re ) 2. 1a 1. 8 0. 17 19 0. 02 13 0. 12 4 1. 00 9 1. 00 5 71 31 7 0. 12 9 0. 21 5 Un de rw eig ht p re va len ce (s ev er e) 2. 1b 1. 8 0. 03 05 0. 01 25 0. 41 1 1. 67 6 1. 29 4 71 31 7 0. 00 5 0. 05 6 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014252 Ne pa l  M IC S  2 01 4   12   Ta bl e SE .5 : S am pl in g er ro rs : E as te rn M ou nt ai ns R eg io n St an da rd e rro rs , c oe ffic ien ts of va ria tio n, d es ign e ffe cts (d ef f), sq ua re ro ot o f d es ign e ffe cts (d ef t) an d co nf ide nc e int er va ls fo r s ele cte d ind ica to rs , N ep al, 2 01 4 M IC S In dic at or M DG In dic at or Va lue (r) St an da rd er ro r ( se ) Co ef fic ien t of va ria tio n (s e/ r) De sig n ef fe ct (d ef f) Sq ua re ro ot o f de sig n ef fe ct (d ef t) W eig ht ed co un t Un we igh te d co un t Co nf ide nc e lim its r - 2 se r + 2 se An ti- m ala ria l tr ea tm en t o f c hil dr en u nd er a ge 5 3. 22 6. 8 0. 01 47 0. 00 18 0. 12 1 0. 01 4 0. 12 0 15 67 0. 01 1 0. 01 8 Ex clu siv e br ea stf ee din g un de r 6 m on th s 2. 7 0. 46 44 0. 05 82 0. 12 5 0. 46 3 0. 68 0 8 35 0. 34 8 0. 58 1 Ag e- ap pr op ria te b re as tfe ed ing 2. 12 0. 79 85 0. 02 62 0. 03 3 0. 58 3 0. 76 3 31 13 8 0. 74 6 0. 85 1 Di ar rh oe a in th e pr ev iou s 2 w ee ks - 0. 14 93 0. 02 88 0. 19 3 2. 11 8 1. 45 5 72 32 5 0. 09 2 0. 20 7 Illn es s w ith a co ug h in th e pr ev iou s 2 w ee ks - 0. 05 67 0. 02 01 0. 35 4 2. 44 0 1. 56 2 72 32 5 0. 01 7 0. 09 7 Fe ve r i n las t t wo w ee ks - 0. 20 33 0. 03 23 0. 15 9 2. 09 0 1. 44 6 72 32 5 0. 13 9 0. 26 8 Or al re hy dr at ion th er ap y w ith co nt inu ed fe ed ing 3. 12 0. 33 61 0. 05 54 0. 16 5 0. 65 9 0. 81 2 11 49 0. 22 5 0. 44 7 An tib iot ic tre at m en t o f s us pe cte d pn eu m on ia 3. 14 0. 57 25 0. 06 26 0. 10 9 0. 28 9 0. 53 7 4 19 0. 44 7 0. 69 8 Su pp or t f or le ar nin g 6. 2 0. 53 49 0. 06 39 0. 11 9 2. 06 8 1. 43 8 28 12 7 0. 40 7 0. 66 3 At te nd an ce to e ar ly ch ild ho od e du ca tio n 6. 1 0. 37 58 0. 05 65 0. 15 0 1. 71 7 1. 31 0 28 12 7 0. 26 3 0. 48 9 Bi rth re gis tra tio n 8. 1 0. 41 59 0. 03 36 0. 08 1 1. 50 4 1. 22 7 72 32 5 0. 34 9 0. 48 3 To ta l fe rti lity ra te (3 ye ar s) - 2. 91 41 0. 22 31 0. 05 0 na na na na 2. 46 8 3. 36 0 Ne on at al m or ta lity ra te 1. 1 30 .6 53 4 10 .5 63 9 11 1. 59 6 na na na na 9. 52 6 51 .7 81 Po st- ne on at al m or ta lity ra te 1. 3 15 .8 33 6 6. 31 68 39 .9 01 na na na na 3. 20 0 28 .4 67 Ch ild m or ta lity ra te 1. 4 6. 37 17 3. 83 26 14 .6 89 na na na na -1 .2 94 14 .0 37 C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 253 Ne pa l  M IC S  2 01 4   13   Ta bl e SE .6 : S am pl in g er ro rs : E as te rn H ill s Re gi on St an da rd e rro rs , c oe ffic ien ts of va ria tio n, d es ign e ffe cts (d ef f), sq ua re ro ot o f d es ign e ffe cts (d ef t) an d co nf ide nc e int er va ls fo r s ele cte d ind ica to rs , N ep al, 2 01 4 M IC S In dic at or M DG In dic at or Va lue (r) St an da rd er ro r (s e) Co ef fic ien t of va ria tio n (s e/ r) De sig n ef fe ct (d ef f) Sq ua re ro ot o f de sig n ef fe ct (d ef t) W eig ht ed co un t Un we igh te d co un t Co nf ide nc e lim its r - 2 se r + 2 se HO US EH OL DS Io diz ed sa lt c on su m pt ion 2. 19 0. 74 00 0. 04 80 0. 06 5 9. 29 0 3. 04 8 76 7 77 7 0. 64 4 0. 83 6 HO US EH OL D M EM BE RS Us e of im pr ov ed d rin kin g wa te r s ou rc es 4. 1 7. 8 0. 87 47 0. 03 11 0. 03 6 6. 84 3 2. 61 6 31 69 77 7 0. 81 2 0. 93 7 Us e of im pr ov ed sa nit at ion 4. 3 7. 9 0. 82 22 0. 04 05 0. 04 9 8. 71 7 2. 95 2 31 69 77 7 0. 74 1 0. 90 3 Pr im ar y s ch oo l n et a tte nd an ce ra tio (a dju ste d) 7. 4 2. 1 0. 93 57 0. 01 33 o. o1 4 0. 96 9 0. 98 5 32 5 32 6 0. 90 9 0. 96 2 Se co nd ar y s ch oo l n et a tte nd an ce ra tio (a dju ste d) 7. 5 0. 75 23 0. 03 99 0. 05 3 3. 31 9 1. 82 2 38 5 38 9 0. 67 2 0. 83 2 Ch ild la bo ur 8. 2 0. 56 64 0. 04 42 0. 07 8 3. 42 0 1. 84 9 93 0 43 1 0. 47 8 0. 65 5 Vi ole nt d isc ipl ine 8. 3 0. 85 37 0. 01 72 0. 02 0 1. 00 2 1. 00 1 89 4 42 4 0. 81 9 0. 88 8 W OM EN In fa nt m or ta lity ra te 1. 2 4. 2 22 .8 66 7 7. 79 86 60 .8 18 na na na na 7. 26 9 38 .4 64 Un de r-f ive m or ta lity ra te 1. 5 4. 1 31 .4 08 9 10 .3 90 0 10 7. 95 3 na na na na 10 .6 29 52 .1 89 Ad ole sc en t b irt h ra te 5. 1 5. 4 66 .7 70 6 9. 15 86 83 .8 81 na na na na 48 .4 53 85 .0 88 Co nt ra ce pt ive p re va len ce 5. 3 5. 3 0. 45 75 0. 02 80 0. 06 1 1. 93 7 1. 39 2 57 7 61 5 0. 40 2 0. 51 3 Un m et n ee d 5. 4 5. 6 0. 28 44 0. 02 07 0. 07 3 1. 28 7 1. 13 5 57 7 61 5 0. 24 3 0. 32 6 An te na ta l c ar e co ve ra ge (1 + tim es , s kil led p ro vid er ) 5. 5a 5. 5 0. 41 41 0. 05 65 0. 13 6 1. 61 6 1. 27 1 12 3 12 4 0. 30 1 0. 52 7 An te na ta l c ar e co ve ra ge (4 + tim es , a ny p ro vid er ) 5. 5b 5. 5 0. 53 34 0. 08 61 0. 16 1 3. 66 7 1. 91 5 12 3 12 4 0. 36 1 0. 70 6 Sk ille d at te nd an t a t d eli ve ry 5. 7 5. 2 0. 42 87 0. 05 22 0. 12 2 1. 36 9 1. 17 0 12 3 12 4 0. 32 4 0. 53 3 Lit er ac y r at e (y ou ng w om en ) 7. 1 2. 3 0. 93 90 0. 02 28 0. 02 4 3. 08 3 1. 75 6 32 9 34 0 0. 89 3 0. 98 5 Kn ow led ge a bo ut H IV p re ve nt ion (y ou ng w om en ) 9. 1 6. 3 0. 32 24 0. 02 78 0. 08 64 1. 20 35 1. 09 70 32 9 34 0. 00 00 0. 26 7 0. 37 8 Pr eg na nt w om en - 0. 03 16 0. 00 54 0. 17 0 0. 81 1 0. 90 0 80 7 85 5 0. 02 1 0. 04 2 In sti tu tio na l d eli ve rie s 5. 8 0. 40 52 0. 05 58 0. 13 8 1. 59 0 1. 26 1 12 3 12 4 0. 29 4 0. 51 7 Ca es ar ea n se cti on 5. 9 0. 06 53 0. 01 94 0. 29 7 0. 75 7 0. 87 0 12 3 12 4 0. 02 7 0. 10 4 M ar ria ge b ef or e ag e 18 8. 5 0. 29 73 0. 01 72 0. 05 79 0. 95 11 0. 97 52 62 9 67 1 0. 26 3 0. 33 2 Po lyg yn y 8. 7 0. 04 44 0. 01 13 0. 25 42 1. 84 58 1. 35 86 57 7 61 5 0. 02 2 0. 06 7 Kn ow led ge o f m ot he r-t o- ch ild tr an sm iss ion o f H IV 9. 2 0. 45 61 0. 02 76 0. 06 06 2. 63 01 1. 62 18 80 7 85 5. 00 00 0. 40 1 0. 51 1 Ac ce pt ing a ttit ud es to wa rd s p eo ple liv ing w ith H IV 9. 3 0. 51 96 0. 03 68 0. 07 09 3. 83 73 1. 95 89 65 5 70 7. 00 00 0. 44 6 0. 59 3 W om en w ho h av e be en te ste d fo r H IV a nd kn ow th e re su lts 9. 5 0. 01 52 0. 00 45 0. 29 45 1. 13 94 1. 06 74 80 7 85 5. 00 00 0. 00 6 0. 02 4 UN DE R- 5s Un de rw eig ht p re va len ce (m od er at e an d se ve re ) 2. 1a 1. 8 0. 20 13 0. 02 58 0. 12 8 1. 15 6 1. 07 5 26 8 28 0 0. 15 0 0. 25 3 Un de rw eig ht p re va len ce (s ev er e) 2. 1b 1. 8 0. 05 80 0. 01 24 0. 21 4 0. 78 3 0. 88 5 26 8 28 0 0. 03 3 0. 08 3 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014254 Ne pa l  M IC S  2 01 4   14   Ta bl e SE .6 : S am pl in g er ro rs : E as te rn H ill s Re gi on St an da rd e rro rs , c oe ffic ien ts of va ria tio n, d es ign e ffe cts (d ef f), sq ua re ro ot o f d es ign e ffe cts (d ef t) an d co nf ide nc e int er va ls fo r s ele cte d ind ica to rs , N ep al, 2 01 4 M IC S In dic at or M DG In dic at or Va lue (r) St an da rd er ro r (s e) Co ef fic ien t of va ria tio n (s e/ r) De sig n ef fe ct (d ef f) Sq ua re ro ot o f de sig n ef fe ct (d ef t) W eig ht ed co un t Un we igh te d co un t Co nf ide nc e lim its r - 2 se r + 2 se An ti- m ala ria l tr ea tm en t o f c hil dr en u nd er a ge 5 3. 22 6. 8 0. 02 25 0. 01 62 0. 71 70 0. 64 02 0. 80 01 55 55 0. 00 0 0. 05 5 Ex clu siv e br ea stf ee din g un de r 6 m on th s 2. 7 0. 35 52 0. 05 75 0. 16 19 0. 33 22 0. 57 64 21 24 0. 24 0 0. 47 0 Ag e- ap pr op ria te b re as tfe ed ing 2. 12 0. 81 08 0. 02 86 0. 03 53 0. 61 37 0. 78 34 11 4 11 6 0. 75 4 0. 86 8 Di ar rh oe a in th e pr ev iou s 2 w ee ks - 0. 11 52 0. 02 04 0. 17 72 1. 15 64 1. 07 54 27 2 28 4 0. 07 4 0. 15 6 Illn es s w ith a co ug h in th e pr ev iou s 2 w ee ks - 0. 05 18 0. 01 21 0. 23 43 0. 84 85 0. 92 11 27 2 28 4 0. 02 8 0. 07 6 Fe ve r i n las t t wo w ee ks - 0. 20 14 0. 02 44 0. 12 10 1. 04 54 1. 02 24 27 2 28 4 0. 15 3 0. 25 0 Or al re hy dr at ion th er ap y w ith co nt inu ed fe ed ing 3. 12 0. 36 45 0. 07 15 0. 19 63 0. 66 27 0. 81 41 31 31 0. 22 1 0. 50 8 An tib iot ic tre at m en t o f s us pe cte d pn eu m on ia 3. 14 0. 51 95 0. 07 54 0. 14 51 0. 29 58 0. 54 39 14 14 0. 36 9 0. 67 0 Su pp or t f or le ar nin g 6. 2 0. 76 96 0. 04 54 0. 05 89 1. 28 80 1. 13 49 10 4 11 2 0. 67 9 0. 86 0 At te nd an ce to e ar ly ch ild ho od e du ca tio n 6. 1 0. 64 24 0. 03 31 0. 05 15 0. 52 86 0. 72 71 10 4 11 2 0. 57 6 0. 70 9 Bi rth re gis tra tio n 8. 1 0. 66 57 0. 04 57 0. 06 86 2. 65 32 1. 62 89 27 2 28 4 0. 57 4 0. 75 7 To ta l fe rti lity ra te (3 ye ar s) - 2. 34 37 0. 18 82 0. 03 5 na na na na 1. 96 7 2. 72 0 Ne on at al m or ta lity ra te 1. 1 15 .1 28 6 6. 94 10 48 .1 78 na na na na 1. 24 7 29 .0 11 Po st- ne on at al m or ta lity ra te 1. 3 7. 73 80 5. 30 50 28 .1 43 na na na na -2 .8 72 18 .3 48 Ch ild m or ta lity ra te 1. 4 8. 74 22 6. 03 31 36 .3 98 na na na na -3 .3 24 20 .8 08 C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 255 Ne pa l  M IC S  2 01 4   15   Ta bl e SE .7 : S am pl in g er ro rs : E as te rn T er ai R eg io n St an da rd e rro rs , c oe ffic ien ts of va ria tio n, d es ign e ffe cts (d ef f), sq ua re ro ot o f d es ign e ffe cts (d ef t) an d co nf ide nc e int er va ls fo r s ele cte d ind ica to rs , N ep al, 2 01 4 M IC S In dic at or M DG In dic at or Va lue (r) St an da rd er ro r (s e) Co ef fic ien t of va ria tio n (s e/ r) De sig n ef fe ct (d ef f) Sq ua re ro ot o f de sig n ef fe ct (d ef t) W eig ht ed co un t Un we igh te d co un t Co nf ide nc e lim its r - 2 se r + 2 se HO US EH OL DS Io diz ed sa lt c on su m pt ion 2. 19 0. 74 79 0. 04 24 0. 05 7 9. 21 7 3. 03 6 18 37 97 0 0. 66 3 0. 83 3 HO US EH OL D M EM BE RS Us e of im pr ov ed d rin kin g wa te r s ou rc es 4. 1 7. 8 0. 99 44 0. 00 31 0. 00 3 1. 73 7 1. 31 8 82 51 97 4 0. 98 8 1. 00 0 Us e of im pr ov ed sa nit at ion 4. 3 7. 9 0. 41 80 0. 02 90 0. 06 9 3. 36 5 1. 83 5 82 51 97 4 0. 36 0 0. 47 6 Pr im ar y s ch oo l n et a tte nd an ce ra tio (a dju ste d) 7. 4 2. 1 0. 84 80 0. 01 77 0. 02 1 1. 26 5 1. 12 5 10 29 52 2 0. 81 3 0. 88 3 Se co nd ar y s ch oo l n et a tte nd an ce ra tio (a dju ste d) 7. 5 0. 66 38 0. 03 14 0. 04 7 2. 12 2 1. 45 7 92 5 48 0 0. 60 1 0. 72 7 Ch ild la bo ur 8. 2 0. 26 25 0. 02 72 0. 10 4 2. 14 3 1. 46 4 12 36 56 1 0. 20 8 0. 31 7 Vi ole nt d isc ipl ine 8. 3 0. 80 11 0. 02 33 0. 02 9 2. 01 1 1. 41 8 13 09 59 2 0. 75 5 0. 84 8 W OM EN In fa nt m or ta lity ra te 1. 2 4. 2 35 .8 98 0 10 .3 73 4 10 7. 60 8 na na na na 15 .1 51 56 .6 45 Un de r-f ive m or ta lity ra te 1. 5 4. 1 35 .8 98 0 10 .3 73 4 10 7. 60 8 na na na na 15 .1 51 56 .6 45 Ad ole sc en t b irt h ra te 5. 1 5. 4 86 .1 51 0 15 .1 78 3 23 0. 38 0 na na na na 55 .7 95 11 6. 50 8 Co nt ra ce pt ive p re va len ce 5. 3 5. 3 0. 52 84 0. 02 50 0. 04 7 2. 10 2 1. 45 0 16 04 84 0 0. 47 8 0. 57 8 Un m et n ee d 5. 4 5. 6 0. 26 22 0. 02 38 0. 09 1 2. 46 0 1. 56 8 16 04 84 0 0. 21 5 0. 31 0 An te na ta l c ar e co ve ra ge (1 + tim es , s kil led p ro vid er ) 5. 5a 5. 5 0. 62 23 0. 02 69 0. 04 3 0. 42 5 0. 65 2 27 7 13 9 0. 56 8 0. 67 6 An te na ta l c ar e co ve ra ge (4 + tim es , a ny p ro vid er ) 5. 5b 5. 5 0. 60 22 0. 05 32 0. 08 8 1. 62 8 1. 27 6 27 7 13 9 0. 49 6 0. 70 8 Sk ille d at te nd an t a t d eli ve ry 5. 7 5. 2 0. 66 65 0. 04 95 0. 07 4 1. 52 1 1. 23 3 27 7 13 9 0. 56 7 0. 76 6 Lit er ac y r at e (y ou ng w om en ) 7. 1 2. 3 0. 80 34 0. 03 26 0. 04 1 2. 47 4 1. 57 3 69 9 36 9 0. 73 8 0. 86 9 Kn ow led ge a bo ut H IV p re ve nt ion (y ou ng w om en ) 9. 1 6. 3 0. 30 09 0. 02 74 0. 09 1 1. 31 1 1. 14 5 69 9 36 9 0. 24 6 0. 35 6 Pr eg na nt w om en - 0. 03 95 0. 00 61 0. 15 4 1. 06 4 1. 03 2 20 71 10 97 0. 02 7 0. 05 2 In sti tu tio na l d eli ve rie s 5. 8 0. 65 13 0. 04 43 0. 06 8 1. 19 5 1. 09 3 27 7 13 9 0. 56 3 0. 74 0 Ca es ar ea n se cti on 5. 9 0. 18 60 0. 02 99 0. 16 1 0. 81 7 0. 90 4 27 7 13 9 0. 12 6 0. 24 6 M ar ria ge b ef or e ag e 18 8. 5 0. 44 26 0. 02 49 0. 05 6 2. 25 0 1. 50 0 16 93 89 6 0. 39 3 0. 49 2 Po lyg yn y 8. 7 0. 02 94 0. 00 76 0. 25 7 1. 68 2 1. 29 7 16 04 84 0 0. 01 4 0. 04 4 Kn ow led ge o f m ot he r-t o- ch ild tr an sm iss ion o f H IV 9. 2 0. 37 50 0. 01 74 0. 04 6 1. 42 1 1. 19 2 20 71 10 97 0. 34 0 0. 41 0 Ac ce pt ing a ttit ud es to wa rd s p eo ple liv ing w ith H IV 9. 3 0. 54 04 0. 03 05 0. 05 7 3. 23 9 1. 80 0 15 81 86 4 0. 47 9 0. 60 1 W om en w ho h av e be en te ste d fo r H IV a nd kn ow th e re su lts 9. 5 0. 02 76 0. 00 45 0. 16 2 0. 81 9 0. 90 5 20 71 10 97 0. 01 9 0. 03 7 UN DE R- 5s Un de rw eig ht p re va len ce (m od er at e an d se ve re ) 2. 1a 1. 8 0. 27 44 0. 02 79 0. 10 2 1. 46 6 1. 21 1 75 8 37 5 0. 21 9 0. 33 0 Un de rw eig ht p re va len ce (s ev er e) 2. 1b 1. 8 0. 07 69 0. 02 22 0. 28 9 2. 59 9 0. 61 2 75 8 37 5 0. 03 2 0. 12 1 An ti- m ala ria l tr ea tm en t o f c hil dr en u nd er a ge 5 3. 22 6. 8 0. 01 79 0. 01 25 0. 70 3 0. 99 6 0. 99 8 22 1 11 2 0. 00 0 0. 04 3 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014256 Ne pa l  M IC S  2 01 4   16   Ta bl e SE .7 : S am pl in g er ro rs : E as te rn T er ai R eg io n St an da rd e rro rs , c oe ffic ien ts of va ria tio n, d es ign e ffe cts (d ef f), sq ua re ro ot o f d es ign e ffe cts (d ef t) an d co nf ide nc e int er va ls fo r s ele cte d ind ica to rs , N ep al, 2 01 4 M IC S In dic at or M DG In dic at or Va lue (r) St an da rd er ro r (s e) Co ef fic ien t of va ria tio n (s e/ r) De sig n ef fe ct (d ef f) Sq ua re ro ot o f de sig n ef fe ct (d ef t) W eig ht ed co un t Un we igh te d co un t Co nf ide nc e lim its r - 2 se r + 2 se Ex clu siv e br ea stf ee din g un de r 6 m on th s 2. 7 0. 56 02 0. 07 95 0. 14 2 0. 69 3 0. 83 3 59 28 0. 40 1 0. 71 9 Ag e- ap pr op ria te b re as tfe ed ing 2. 12 0. 73 89 0. 04 78 0. 06 5 1. 57 6 1. 25 5 27 1 13 4 0. 64 3 0. 83 5 Di ar rh oe a in th e pr ev iou s 2 w ee ks - 0. 15 54 0. 02 21 0. 14 2 1. 43 1 1. 19 6 77 5 38 4 0. 11 1 0. 20 0 Illn es s w ith a co ug h in th e pr ev iou s 2 w ee ks - 0. 11 20 0. 01 86 0. 16 6 1. 33 3 1. 15 4 77 5 38 4 0. 07 5 0. 14 9 Fe ve r i n las t t wo w ee ks - 0. 28 58 0. 02 21 0. 07 7 0. 91 5 0. 95 7 77 5 38 4 0. 24 2 0. 33 0 Or al re hy dr at ion th er ap y w ith co nt inu ed fe ed ing 3. 12 0. 41 27 0. 04 31 0. 10 4 0. 43 0 0. 65 5 12 0 57 0. 32 6 0. 49 9 An tib iot ic tre at m en t o f s us pe cte d pn eu m on ia 3. 14 0. 81 76 0. 03 06 0. 03 7 0. 26 4 0. 51 4 87 43 0. 75 6 0. 87 9 Su pp or t f or le ar nin g 6. 2 0. 66 93 0. 04 51 0. 06 7 1. 55 2 1. 24 6 34 4 17 0 0. 57 9 0. 75 9 At te nd an ce to e ar ly ch ild ho od e du ca tio n 6. 1 0. 48 96 0. 04 57 0. 09 3 1. 41 4 1. 18 9 34 4 17 0 0. 39 8 0. 58 1 Bi rth re gis tra tio n 8. 1 0. 59 92 0. 03 04 0. 05 1 1. 47 3 1. 21 4 77 5 38 4 0. 53 8 0. 66 0 To ta l fe rti lity ra te (3 ye ar s) - 2. 14 46 0. 16 86 0. 02 8 na na na na 1. 80 7 2. 48 2 Ne on at al m or ta lity ra te 1. 1 23 .7 42 1 7. 78 71 60 .6 39 na na na na 8. 16 8 39 .3 16 Po st- ne on at al m or ta lity ra te 1. 3 12 .1 55 8 6. 48 16 42 .0 11 na na na na -0 .8 07 25 .1 19 Ch ild m or ta lity ra te 1. 4 0. 00 00 0. 00 00 0. 00 0 na na na na 0. 00 0 0. 00 0 C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 257 Ne pa l  M IC S  2 01 4   17   Ta bl e SE .8 : S am pl in g er ro rs : C en tra l M ou nt ai ns R eg io n St an da rd e rro rs , c oe ffic ien ts of va ria tio n, d es ign e ffe cts (d ef f), sq ua re ro ot o f d es ign e ffe cts (d ef t) an d co nf ide nc e int er va ls fo r s ele cte d ind ica to rs , N ep al, 2 01 4 M IC S In dic at or M DG In dic at or Va lue (r) St an da rd er ro r ( se ) Co ef fic ien t of va ria tio n (s e/ r) De sig n ef fe ct (d ef f) Sq ua re ro ot o f de sig n ef fe ct (d ef t) W eig ht ed co un t Un we igh te d co un t Co nf ide nc e lim its r - 2 se r + 2 se HO US EH OL DS Io diz ed sa lt c on su m pt ion 2. 19 0. 72 41 0. 04 38 0. 06 0 7. 38 3 2. 71 7 29 9 77 1 0. 63 7 0. 81 2 HO US EH OL D M EM BE RS Us e of im pr ov ed d rin kin g wa te r s ou rc es 4. 1 7. 8 0. 93 76 0. 01 75 0. 01 9 4. 01 5 2. 00 4 11 48 77 1 0. 90 3 0. 97 3 Us e of im pr ov ed sa nit at ion 4. 3 7. 9 0. 81 02 0. 04 23 0. 05 2 8. 96 4 2. 99 4 11 48 77 1 0. 72 6 0. 89 5 Pr im ar y s ch oo l n et a tte nd an ce ra tio (a dju ste d) 7. 4 2. 1 0. 89 62 0. 01 85 0. 02 1 1. 06 8 1. 03 3 12 2 29 2 0. 85 9 0. 93 3 Se co nd ar y s ch oo l n et a tte nd an ce ra tio (a dju ste d) 7. 5 0. 72 60 0. 03 44 0. 04 7 2. 13 4 1. 46 1 14 8 35 9 0. 65 7 0. 79 5 Ch ild la bo ur 8. 2 0. 56 63 0. 03 43 0. 06 1 1. 76 8 1. 33 0 78 5 37 0 0. 49 8 0. 63 5 Vi ole nt d isc ipl ine 8. 3 0. 92 93 0. 01 66 0. 01 8 1. 54 0 1. 24 1 79 6 36 9 0. 89 6 0. 96 2 W OM EN In fa nt m or ta lity ra te 1. 2 4. 2 16 .1 20 7 8. 72 26 76 .0 83 na na na na -1 .3 24 33 .5 66 Un de r-f ive m or ta lity ra te 1. 5 4. 1 19 .7 96 1 9. 47 07 89 .6 94 na na na na 0. 85 5 38 .7 38 Ad ole sc en t b irt h ra te 5. 1 5. 4 48 .5 69 5 10 .5 32 3 11 0. 93 0 na na na na 27 .5 05 69 .6 34 Co nt ra ce pt ive p re va len ce 5. 3 5. 3 0. 51 71 0. 03 19 0. 06 2 2. 08 5 1. 44 4 20 1 51 4 0. 45 3 0. 58 1 Un m et n ee d 5. 4 5. 6 0. 20 03 0. 01 97 0. 09 8 1. 23 9 1. 11 3 20 1 51 4 0. 16 1 0. 24 0 An te na ta l c ar e co ve ra ge (1 + tim es , s kil led p ro vid er ) 5. 5a 5. 5 0. 39 52 0. 07 52 0. 19 0 2. 13 2 1. 46 0 38 91 0. 24 5 0. 54 6 An te na ta l c ar e co ve ra ge (4 + tim es , a ny p ro vid er ) 5. 5b 5. 5 0. 53 85 0. 05 58 0. 10 4 1. 12 8 1. 06 2 38 91 0. 42 7 0. 65 0 Sk ille d at te nd an t a t d eli ve ry 5. 7 5. 2 0. 47 68 0. 06 11 0. 12 8 1. 34 7 1. 16 1 38 91 0. 35 5 0. 59 9 Lit er ac y r at e (y ou ng w om en ) 7. 1 2. 3 0. 86 89 0. 02 75 0. 03 2 1. 77 8 1. 33 3 10 1 26 9 0. 81 4 0. 92 4 Kn ow led ge a bo ut H IV p re ve nt ion (y ou ng w om en ) 9. 1 6. 3 0. 38 64 0. 04 06 0. 10 5 1. 86 1 1. 36 4 10 1 26 9 0. 30 5 0. 46 8 Pr eg na nt w om en - 0. 02 67 0. 00 59 0. 22 2 0. 97 4 0. 98 7 27 4 72 0 0. 01 5 0. 03 9 In sti tu tio na l d eli ve rie s 5. 8 0. 45 45 0. 06 50 0. 14 3 1. 53 5 1. 23 9 38 91 0. 32 4 0. 58 5 Ca es ar ea n se cti on 5. 9 0. 07 15 0. 02 61 0. 36 5 0. 92 5 0. 96 2 38 91 0. 01 9 0. 12 4 M ar ria ge b ef or e ag e 18 8. 5 0. 44 19 0. 02 62 0. 05 9 1. 55 4 1. 24 7 21 1 55 8 0. 38 9 0. 49 4 Po lyg yn y 8. 7 0. 06 16 0. 01 21 0. 19 6 1. 29 8 1. 13 9 20 1 51 4 0. 03 7 0. 08 6 Kn ow led ge o f m ot he r-t o- ch ild tr an sm iss ion o f H IV 9. 2 0. 62 09 0. 02 92 0. 04 7 2. 61 0 1. 61 5 27 4 72 0 0. 56 2 0. 67 9 Ac ce pt ing a ttit ud es to wa rd s p eo ple liv ing w ith H IV 9. 3 0. 36 94 0. 02 42 0. 06 6 1. 46 4 1. 21 0 22 1 58 3 0. 32 1 0. 41 8 W om en w ho h av e be en te ste d fo r H IV a nd kn ow th e re su lts 9. 5 0. 01 10 0. 00 44 0. 39 8 1. 27 1 1. 12 7 27 4 72 0 0. 00 2 0. 02 0 UN DE R- 5s Un de rw eig ht p re va len ce (m od er at e an d se ve re ) 2. 1a 1. 8 0. 19 43 0. 03 72 0. 19 1 2. 08 6 1. 44 4 94 23 7 0. 12 0 0. 26 9 Un de rw eig ht p re va len ce (s ev er e) 2. 1b 1. 8 0. 06 32 0. 01 32 0. 21 0 0. 69 9 0. 83 6 94 23 7 0. 03 7 0. 09 0 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014258 Ne pa l  M IC S  2 01 4   18   Ta bl e SE .8 : S am pl in g er ro rs : C en tra l M ou nt ai ns R eg io n St an da rd e rro rs , c oe ffic ien ts of va ria tio n, d es ign e ffe cts (d ef f), sq ua re ro ot o f d es ign e ffe cts (d ef t) an d co nf ide nc e int er va ls fo r s ele cte d ind ica to rs , N ep al, 2 01 4 M IC S In dic at or M DG In dic at or Va lue (r) St an da rd er ro r ( se ) Co ef fic ien t of va ria tio n (s e/ r) De sig n ef fe ct (d ef f) Sq ua re ro ot o f de sig n ef fe ct (d ef t) W eig ht ed co un t Un we igh te d co un t Co nf ide nc e lim its r - 2 se r + 2 se An ti- m ala ria l tr ea tm en t o f c hil dr en u nd er a ge 5 3. 22 6. 8 0. 00 00 0. 00 00 10 26 0. 00 0 0. 00 0 Ex clu siv e br ea stf ee din g un de r 6 m on th s 2. 7 0. 38 88 0. 09 17 0. 23 6 0. 46 0 0. 67 8 6 14 0. 20 5 0. 57 2 Ag e- ap pr op ria te b re as tfe ed ing 2. 12 0. 82 38 0. 04 53 0. 05 5 1. 21 8 1. 10 4 36 87 0. 73 3 0. 91 5 Di ar rh oe a in th e pr ev iou s 2 w ee ks - 0. 05 99 0. 01 60 0. 26 8 1. 08 2 1. 04 0 95 23 8 0. 02 8 0. 09 2 Illn es s w ith a co ug h in th e pr ev iou s 2 w ee ks - 0. 03 25 0. 01 41 0. 43 4 1. 50 1 1. 22 5 95 23 8 0. 00 4 0. 06 1 Fe ve r i n las t t wo w ee ks - 0. 11 05 0. 01 89 0. 17 1 0. 86 5 0. 93 0 95 23 8 0. 07 3 0. 14 8 Or al re hy dr at ion th er ap y w ith co nt inu ed fe ed ing 3. 12 0. 74 92 0. 07 97 0. 10 6 0. 44 0 0. 66 3 6 14 0. 59 0 0. 90 9 An tib iot ic tre at m en t o f s us pe cte d pn eu m on ia 3. 14 0. 88 90 0. 00 00 0. 00 0 0. 00 0 0. 00 0 3 8 0. 88 9 0. 88 9 Su pp or t f or le ar nin g 6. 2 0. 82 43 0. 06 88 0. 08 3 3. 03 8 1. 74 3 37 94 0. 68 7 0. 96 2 At te nd an ce to e ar ly ch ild ho od e du ca tio n 6. 1 0. 70 71 0. 10 35 0. 14 6 4. 81 1 2. 19 3 37 94 0. 50 0 0. 91 4 Bi rth re gis tra tio n 8. 1 0. 39 53 0. 04 22 0. 10 7 1. 76 3 1. 32 8 95 23 8 0. 31 1 0. 48 0 To ta l fe rti lity ra te (3 ye ar s) - 2. 45 66 0. 20 21 0. 04 1 na na na na 2. 05 2 2. 86 1 Ne on at al m or ta lity ra te 1. 1 8. 77 88 5. 11 34 26 .1 47 na na na na -1 .4 48 19 .0 06 Po st- ne on at al m or ta lity ra te 1. 3 7. 34 18 5. 23 48 27 .4 03 na na na na -3 .1 28 17 .8 11 Ch ild m or ta lity ra te 1. 4 3. 73 57 3. 78 68 14 .3 40 na na na na -3 .8 38 11 .3 09 C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 259 Ne pa l  M IC S  2 01 4   19   Ta bl e SE .9 : S am pl in g er ro rs : C en tra l H ill s Re gi on St an da rd e rro rs , c oe ffic ien ts of va ria tio n, d es ign e ffe cts (d ef f), sq ua re ro ot o f d es ign e ffe cts (d ef t) an d co nf ide nc e int er va ls fo r s ele cte d ind ica to rs , N ep al, 2 01 4 M IC S In dic at or M DG In dic at or Va lue (r) St an da rd er ro r (s e) Co ef fic ien t of va ria tio n (s e/ r) De sig n ef fe ct (d ef f) Sq ua re ro ot o f de sig n ef fe ct (d ef t) W eig ht ed co un t Un we igh te d co un t Co nf ide nc e lim its r - 2 se r + 2 se HO US EH OL DS Io diz ed sa lt c on su m pt ion 2. 19 0. 92 24 0. 01 92 0. 02 1 7. 76 1 2. 78 6 21 79 15 01 0. 88 4 0. 96 1 HO US EH OL D M EM BE RS Us e of im pr ov ed d rin kin g wa te r s ou rc es 4. 1 7. 8 0. 86 30 0. 02 96 0. 03 4 11 .1 16 3. 33 4 87 46 15 03 0. 80 4 0. 92 2 Us e of im pr ov ed sa nit at ion 4. 3 7. 9 0. 64 38 0. 02 60 0. 04 0 4. 44 1 2. 10 7 87 46 15 03 0. 59 2 0. 69 6 Pr im ar y s ch oo l n et a tte nd an ce ra tio (a dju ste d) 7. 4 2. 1 0. 93 04 0. 01 48 0. 01 6 1. 70 7 1. 30 7 77 0 50 3 0. 90 1 0. 96 0 Se co nd ar y s ch oo l n et a tte nd an ce ra tio (a dju ste d) 7. 5 0. 73 67 0. 02 33 0. 03 2 1. 59 5 1. 26 3 88 7 57 2 0. 69 0 0. 78 3 Ch ild la bo ur 8. 2 0. 24 29 0. 02 18 0. 09 0 1. 90 1 1. 37 9 13 63 73 9 0. 19 9 0. 28 6 Vi ole nt d isc ipl ine 8. 3 0. 74 32 0. 02 61 0. 03 5 2. 67 6 1. 63 6 13 80 75 3 0. 69 1 0. 79 5 W OM EN In fa nt m or ta lity ra te 1. 2 4. 2 27 .6 54 7 8. 82 88 77 .9 47 na na na na 9. 99 7 1. 00 0 Un de r-f ive m or ta lity ra te 1. 5 4. 1 30 .7 76 0 8. 94 23 79 .9 64 na na na na 12 .8 92 1. 00 0 Ad ole sc en t b irt h ra te 5. 1 5. 4 28 .9 44 0 7. 10 66 50 .5 04 na na na na 14 .7 31 43 .1 57 Co nt ra ce pt ive p re va len ce 5. 3 5. 3 0. 50 97 0. 02 09 0. 04 1 2. 06 3 1. 43 6 16 68 11 76 0. 46 8 0. 55 2 Un m et n ee d 5. 4 5. 6 0. 24 22 0. 01 37 0. 05 6 1. 19 5 1. 09 3 16 68 11 76 0. 21 5 0. 27 0 An te na ta l c ar e co ve ra ge (1 + tim es , s kil led p ro vid er ) 5. 5a 5. 5 0. 77 91 0. 05 36 0. 06 9 2. 61 8 1. 61 8 24 1 15 8 0. 67 2 0. 88 6 An te na ta l c ar e co ve ra ge (4 + tim es , a ny p ro vid er ) 5. 5b 5. 5 0. 73 63 0. 04 20 0. 05 7 1. 42 5 1. 19 4 24 1 15 8 0. 65 2 0. 82 0 Sk ille d at te nd an t a t d eli ve ry 5. 7 5. 2 0. 75 36 0. 05 50 0. 07 3 2. 55 4 1. 59 8 24 1 15 8 0. 64 4 0. 86 3 Lit er ac y r at e (y ou ng w om en ) 7. 1 2. 3 0. 92 52 0. 02 01 0. 02 2 3. 18 6 1. 78 5 77 1 54 6 0. 88 5 0. 96 5 Kn ow led ge a bo ut H IV p re ve nt ion (y ou ng w om en ) 9. 1 6. 3 0. 52 80 0. 02 30 0. 04 4 1. 16 1 1. 07 8 77 1 54 6 0. 48 2 0. 57 4 Pr eg na nt w om en - 0. 02 80 0. 00 40 0. 14 4 0. 98 8 0. 99 4 23 20 16 55 0. 02 0 0. 03 6 In sti tu tio na l d eli ve rie s 5. 8 0. 74 91 0. 05 96 0. 08 0 2. 96 4 1. 72 2 24 1 15 8 0. 63 0 0. 86 8 Ca es ar ea n se cti on 5. 9 0. 17 09 0. 03 48 0. 20 4 1. 34 4 1. 15 9 24 1 15 8 0. 10 1 0. 24 1 M ar ria ge b ef or e ag e 18 8. 5 0. 34 42 0. 01 50 0. 04 4 1. 39 2 1. 18 0 19 46 14 00 0. 31 4 0. 37 4 Po lyg yn y 8. 7 0. 05 79 0. 00 84 0. 14 5 1. 52 1 1. 23 3 16 68 11 76 0. 04 1 0. 07 5 Kn ow led ge o f m ot he r-t o- ch ild tr an sm iss ion o f H IV 9. 2 0. 42 23 0. 01 89 0. 04 5 2. 42 3 1. 55 7 23 20 16 55 0. 38 4 0. 46 0 Ac ce pt ing a ttit ud es to wa rd s p eo ple liv ing w ith H IV 9. 3 0. 50 22 0. 01 99 0. 04 0 2. 43 0 1. 55 9 21 16 15 34 0. 46 2 0. 54 2 W om en w ho h av e be en te ste d fo r H IV a nd kn ow th e re su lts 9. 5 0. 04 06 0. 00 66 0. 16 3 1. 86 5 1. 36 6 23 20 16 55 0. 02 7 0. 05 4 UN DE R- 5s Un de rw eig ht p re va len ce (m od er at e an d se ve re ) 2. 1a 1. 8 0. 16 70 0. 02 01 0. 12 0 1. 16 7 1. 08 0 60 4 40 4 0. 12 7 0. 20 7 Un de rw eig ht p re va len ce (s ev er e) 2. 1b 1. 8 0. 01 63 0. 00 67 0. 41 2 1. 13 7 1. 06 6 60 4 40 4 0. 00 3 0. 03 0 An ti- m ala ria l tr ea tm en t o f c hil dr en u nd er a ge 5 3. 22 6. 8 0. 01 24 0. 00 06 0. 05 0 0. 00 3 0. 05 2 13 2 88 0. 01 1 0. 01 4 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014260 Ne pa l  M IC S  2 01 4   20   Ta bl e SE .9 : S am pl in g er ro rs : C en tra l H ill s Re gi on St an da rd e rro rs , c oe ffic ien ts of va ria tio n, d es ign e ffe cts (d ef f), sq ua re ro ot o f d es ign e ffe cts (d ef t) an d co nf ide nc e int er va ls fo r s ele cte d ind ica to rs , N ep al, 2 01 4 M IC S In dic at or M DG In dic at or Va lue (r) St an da rd er ro r (s e) Co ef fic ien t of va ria tio n (s e/ r) De sig n ef fe ct (d ef f) Sq ua re ro ot o f de sig n ef fe ct (d ef t) W eig ht ed co un t Un we igh te d co un t Co nf ide nc e lim its r - 2 se r + 2 se Ex clu siv e br ea stf ee din g un de r 6 m on th s 2. 7 0. 54 28 0. 04 74 0. 08 7 0. 32 6 0. 57 1 52 37 0. 44 8 0. 63 8 Ag e- ap pr op ria te b re as tfe ed ing 2. 12 0. 81 52 0. 03 08 0. 03 8 0. 94 7 0. 97 3 22 7 15 1 0. 75 4 0. 87 7 Di ar rh oe a in th e pr ev iou s 2 w ee ks - 0. 10 37 0. 01 56 0. 15 1 1. 09 6 1. 04 7 62 0 41 8 0. 07 2 0. 13 5 Illn es s w ith a co ug h in th e pr ev iou s 2 w ee ks - 0. 04 08 0. 00 91 0. 22 3 0. 87 9 0. 93 7 62 0 41 8 0. 02 3 0. 05 9 Fe ve r i n las t t wo w ee ks - 0. 21 24 0. 01 60 0. 07 5 0. 64 1 0. 80 1 62 0 41 8 0. 18 0 0. 24 5 Or al re hy dr at ion th er ap y w ith co nt inu ed fe ed ing 3. 12 0. 53 55 0. 04 73 0. 08 8 0. 37 8 0. 61 5 64 43 0. 44 1 0. 63 0 An tib iot ic tre at m en t o f s us pe cte d pn eu m on ia 3. 14 0. 91 30 0. 00 12 0. 00 1 0. 00 0 0. 01 6 25 15 0. 91 1 0. 91 5 Su pp or t f or le ar nin g 6. 2 0. 87 10 0. 03 07 0. 03 5 1. 43 1 1. 19 6 25 1 17 2 0. 81 0 0. 93 2 At te nd an ce to e ar ly ch ild ho od e du ca tio n 6. 1 0. 78 24 0. 03 73 0. 04 8 1. 39 7 1. 18 2 25 1 17 2 0. 70 8 0. 85 7 Bi rth re gis tra tio n 8. 1 0. 45 11 0. 04 17 0. 09 2 2. 92 3 1. 71 0 62 0 41 8 0. 36 8 0. 53 4 To ta l fe rti lity ra te (3 ye ar s) - 1. 70 95 0. 13 41 0. 01 8 na na na na 1. 44 1 1. 00 0 Ne on at al m or ta lity ra te 1. 1 15 .5 39 6 7. 52 24 56 .5 86 na na na na 0. 49 5 1. 00 0 Po st- ne on at al m or ta lity ra te 1. 3 12 .1 15 1 5. 92 76 35 .1 37 na na na na 0. 26 0 1. 00 0 Ch ild m or ta lity ra te 1. 4 3. 21 01 2. 29 70 5. 27 6 na na na na 0. 00 0 1. 00 0 C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 261 Ne pa l  M IC S  2 01 4   21   Ta bl e SE .1 0: S am pl in g er ro rs : C en tra l T er ai R eg io n St an da rd e rro rs , c oe ffic ien ts of va ria tio n, d es ign e ffe cts (d ef f), sq ua re ro ot o f d es ign e ffe cts (d ef t) an d co nf ide nc e int er va ls fo r s ele cte d ind ica to rs , N ep al, 2 01 4 M IC S In dic at or M DG In dic at or Va lue (r ) St an da rd er ro r (s e) Co ef fic ien t of va ria tio n (s e/ r) De sig n ef fe ct (d ef f) Sq ua re ro ot o f de sig n ef fe ct (d ef t) W eig ht ed co un t Un we igh te d co un t Co nf ide nc e lim its r - 2 se r + 2 se HO US EH OL DS Io diz ed sa lt c on su m pt ion 2. 19 0. 87 17 0. 03 41 0. 03 9 9. 86 9 3. 14 1 19 18 95 3 0. 80 4 0. 94 0 HO US EH OL D M EM BE RS Us e of im pr ov ed d rin kin g wa te r s ou rc es 4. 1 7. 8 0. 99 29 0. 00 40 0. 00 4 2. 15 2 1. 46 7 10 24 8 95 6 0. 98 5 1. 00 0 Us e of im pr ov ed sa nit at ion 4. 3 7. 9 0. 36 66 0. 03 37 0. 09 2 4. 68 0 2. 16 3 10 24 8 95 6 0. 29 9 0. 43 4 Pr im ar y s ch oo l n et a tte nd an ce ra tio (a dju ste d) 7. 4 2. 1 0. 74 59 0. 02 80 0. 03 8 2. 78 1 1. 66 8 14 00 67 3 0. 69 0 0. 80 2 Se co nd ar y s ch oo l n et a tte nd an ce ra tio (a dju ste d) 7. 5 0. 53 38 0. 03 53 0. 06 6 2. 95 8 1. 72 0 12 26 59 3 0. 46 3 0. 60 4 Ch ild la bo ur 8. 2 0. 23 25 0. 02 06 0. 08 9 1. 42 3 1. 19 3 16 32 59 8 0. 19 1 0. 27 4 Vi ole nt d isc ipl ine 8. 3 0. 83 34 0. 01 36 0. 01 6 0. 85 8 0. 92 6 17 84 64 9 0. 80 6 0. 86 0 W OM EN In fa nt m or ta lity ra te 1. 2 4. 2 20 .0 27 0 7. 25 38 52 .6 17 na na na na 5. 51 9 34 .5 35 Un de r-f ive m or ta lity ra te 1. 5 4. 1 20 .0 27 0 7. 25 38 52 .6 17 na na na na 5. 51 9 34 .5 35 Ad ole sc en t b irt h ra te 5. 1 5. 4 11 0. 52 59 13 .0 72 4 17 0. 88 7 na na na na 84 .3 81 13 6. 67 1 Co nt ra ce pt ive p re va len ce 5. 3 5. 3 0. 45 91 0. 02 64 0. 05 7 2. 50 0 1. 58 1 18 96 89 4 0. 40 6 0. 51 2 Un m et n ee d 5. 4 5. 6 0. 24 25 0. 01 42 0. 05 9 0. 98 2 0. 99 1 18 96 89 4 0. 21 4 0. 27 1 An te na ta l c ar e co ve ra ge (1 + tim es , s kil led p ro vid er ) 5. 5a 5. 5 0. 65 51 0. 04 33 0. 06 6 1. 51 3 1. 23 0 40 0 18 3 0. 56 8 0. 74 2 An te na ta l c ar e co ve ra ge (4 + tim es , a ny p ro vid er ) 5. 5b 5. 5 0. 49 19 0. 04 15 0. 08 4 1. 25 6 1. 12 1 40 0 18 3 0. 40 9 0. 57 5 Sk ille d at te nd an t a t d eli ve ry 5. 7 5. 2 0. 49 32 0. 03 97 0. 08 0 1. 14 5 1. 07 0 40 0 18 3 0. 41 4 0. 57 3 Lit er ac y r at e (y ou ng w om en ) 7. 1 2. 3 0. 69 10 0. 04 55 0. 06 6 3. 83 7 1. 95 9 80 7 39 7 0. 60 0 0. 78 2 Kn ow led ge a bo ut H IV p re ve nt ion (y ou ng w om en ) 9. 1 6. 3 0. 37 60 0. 04 02 0. 10 7 2. 72 6 1. 65 1 80 7 39 7 0. 29 6 0. 45 6 Pr eg na nt w om en - 0. 05 46 0. 00 97 0. 17 8 2. 05 0 1. 43 2 23 27 11 18 0. 03 5 0. 07 4 In sti tu tio na l d eli ve rie s 5. 8 0. 45 08 0. 03 99 0. 08 9 1. 17 1 1. 08 2 40 0 18 3 0. 37 1 0. 53 1 Ca es ar ea n se cti on 5. 9 0. 05 56 0. 01 92 0. 34 5 1. 27 5 1. 12 9 40 0 18 3 0. 01 7 0. 09 4 M ar ria ge b ef or e ag e 18 8. 5 0. 65 89 0. 02 65 0. 04 0 2. 76 8 1. 66 4 18 68 88 9 0. 60 6 0. 71 2 Po lyg yn y 8. 7 0. 02 88 0. 00 94 0. 32 8 2. 85 2 1. 68 9 18 96 89 4 0. 01 0 0. 04 8 Kn ow led ge o f m ot he r-t o- ch ild tr an sm iss ion o f H IV 9. 2 0. 24 33 0. 02 66 0. 11 0 4. 30 8 2. 07 6 23 27 11 18 0. 19 0 0. 29 7 Ac ce pt ing a ttit ud es to wa rd s p eo ple liv ing w ith H IV 9. 3 0. 36 70 0. 02 19 0. 06 0 1. 54 7 1. 24 4 15 00 74 8 0. 32 3 0. 41 1 W om en w ho h av e be en te ste d fo r H IV a nd kn ow th e re su lts 9. 5 0. 01 87 0. 00 39 0. 20 8 0. 92 2 0. 96 0 23 27 11 18 0. 01 1 0. 02 7 UN DE R- 5s Un de rw eig ht p re va len ce (m od er at e an d se ve re ) 2. 1a 1. 8 0. 40 66 0. 02 70 0. 06 6 1. 46 9 1. 21 2 10 92 48 8 0. 35 3 0. 46 1 Un de rw eig ht p re va len ce (s ev er e) 2. 1b 1. 8 0. 13 17 0. 01 68 0. 12 8 1. 20 3 1. 09 7 10 92 48 8 0. 09 8 0. 16 5 An ti- m ala ria l tr ea tm en t o f c hil dr en u nd er a ge 5 3. 22 6. 8 0. 01 19 0. 01 19 0. 99 7 0. 98 5 0. 99 3 17 9 83 0. 00 0 0. 03 6 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014262 Ne pa l  M IC S  2 01 4   22   Ta bl e SE .1 0: S am pl in g er ro rs : C en tra l T er ai R eg io n St an da rd e rro rs , c oe ffic ien ts of va ria tio n, d es ign e ffe cts (d ef f), sq ua re ro ot o f d es ign e ffe cts (d ef t) an d co nf ide nc e int er va ls fo r s ele cte d ind ica to rs , N ep al, 2 01 4 M IC S In dic at or M DG In dic at or Va lue (r ) St an da rd er ro r (s e) Co ef fic ien t of va ria tio n (s e/ r) De sig n ef fe ct (d ef f) Sq ua re ro ot o f de sig n ef fe ct (d ef t) W eig ht ed co un t Un we igh te d co un t Co nf ide nc e lim its r - 2 se r + 2 se Ex clu siv e br ea stf ee din g un de r 6 m on th s 2. 7 0. 65 05 0. 05 91 0. 09 1 0. 75 4 0. 86 8 11 0 50 0. 53 2 0. 76 9 Ag e- ap pr op ria te b re as tfe ed ing 2. 12 0. 75 67 0. 02 77 0. 03 7 0. 76 1 0. 87 2 40 5 18 3 0. 70 1 0. 81 2 Di ar rh oe a in th e pr ev iou s 2 w ee ks - 0. 07 57 0. 01 47 0. 19 4 1. 54 8 1. 24 4 11 31 50 4 0. 04 6 0. 10 5 Illn es s w ith a co ug h in th e pr ev iou s 2 w ee ks - 0. 04 79 0. 01 23 0. 25 6 1. 65 8 1. 28 8 11 31 50 4 0. 02 3 0. 07 2 Fe ve r i n las t t wo w ee ks - 0. 15 86 0. 02 13 0. 13 4 1. 71 3 1. 30 9 11 31 50 4 0. 11 6 0. 20 1 Or al re hy dr at ion th er ap y w ith co nt inu ed fe ed ing 3. 12 0. 42 15 0. 02 76 0. 06 5 0. 11 3 0. 33 5 86 37 0. 36 6 0. 47 7 An tib iot ic tre at m en t o f s us pe cte d pn eu m on ia 3. 14 0. 80 39 0. 08 87 0. 11 0 1. 04 8 1. 02 4 54 22 0. 62 7 0. 98 1 Su pp or t f or le ar nin g 6. 2 0. 63 97 0. 04 43 0. 06 9 1. 87 0 1. 36 7 50 5 22 1 0. 55 1 0. 72 8 At te nd an ce to e ar ly ch ild ho od e du ca tio n 6. 1 0. 29 35 0. 04 61 0. 15 7 2. 25 8 1. 50 3 50 5 22 1 0. 20 1 0. 38 6 Bi rth re gis tra tio n 8. 1 0. 60 07 0. 03 20 0. 05 3 2. 14 2 1. 46 4 11 31 50 4 0. 53 7 0. 66 5 To ta l fe rti lity ra te (3 ye ar s) - 2. 69 29 0. 23 52 0. 05 5 na na na na 2. 22 2 3. 16 3 Ne on at al m or ta lity ra te 1. 1 16 .9 37 7 5. 32 33 28 .3 38 na na na na 6. 29 1 27 .5 84 Po st- ne on at al m or ta lity ra te 1. 3 3. 08 94 3. 11 04 9. 67 5 na na na na -3 .1 31 9. 31 0 Ch ild m or ta lity ra te 1. 4 0. 00 00 0. 00 00 0. 00 0 na na na na 0. 00 0 0. 00 0 C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 263 Ne pa l  M IC S  2 01 4   23   Ta bl e SE .1 1: S am pl in g er ro rs : W es te rn M ou nt ai ns R eg io n St an da rd e rro rs , c oe ffic ien ts of va ria tio n, d es ign e ffe cts (d ef f), sq ua re ro ot o f d es ign e ffe cts (d ef t) an d co nf ide nc e int er va ls fo r s ele cte d ind ica to rs , N ep al, 2 01 4 M IC S In dic at or M DG In dic at or Va lue (r) St an da rd er ro r ( se ) Co ef fic ien t of va ria tio n (s e/ r) De sig n ef fe ct (d ef f) Sq ua re ro ot o f de sig n ef fe ct (d ef t) W eig ht ed co un t Un we igh te d co un t Co nf ide nc e lim its r - 2 se r + 2 se HO US EH OL DS Io diz ed sa lt c on su m pt ion 2. 19 0. 72 56 0. 09 51 0. 13 1 16 .7 99 4. 09 9 10 37 1 0. 53 5 0. 91 6 HO US EH OL D M EM BE RS Us e of im pr ov ed d rin kin g wa te r s ou rc es 4. 1 7. 8 0. 97 08 0. 02 76 0. 02 8 10 .0 25 3. 16 6 32 37 4 0. 91 6 1. 00 0 Us e of im pr ov ed sa nit at ion 4. 3 7. 9 0. 58 32 0. 04 98 0. 08 5 3. 80 0 1. 94 9 32 37 4 0. 48 4 0. 68 3 Pr im ar y s ch oo l n et a tte nd an ce ra tio (a dju ste d) 7. 4 2. 1 0. 91 36 0. 04 00 0. 04 4 1. 39 9 1. 18 3 2 70 0. 83 4 0. 99 4 Se co nd ar y s ch oo l n et a tte nd an ce ra tio (a dju ste d) 7. 5 0. 70 76 0. 08 64 0. 12 2 2. 45 5 1. 56 7 2 69 0. 53 5 0. 88 0 Ch ild la bo ur 8. 2 0. 58 82 0. 06 59 0. 11 2 1. 88 2 1. 37 2 17 5 10 6 0. 45 6 0. 72 0 Vi ole nt d isc ipl ine 8. 3 0. 76 96 0. 04 09 0. 05 3 1. 25 4 1. 12 0 20 7 13 4 0. 68 8 0. 85 1 W OM EN In fa nt m or ta lity ra te 1. 2 4. 2 53 .9 14 6 24 .0 78 3 57 9. 76 2 na na na na 5. 75 8 10 2. 07 1 Un de r-f ive m or ta lity ra te 1. 5 4. 1 76 .4 52 6 28 .7 32 6 82 5. 56 5 na na na na 18 .9 87 13 3. 91 8 Ad ole sc en t b irt h ra te 5. 1 5. 4 86 .9 26 2 36 .3 88 1 13 24 .0 91 na na na na 14 .1 50 15 9. 70 2 Co nt ra ce pt ive p re va len ce 5. 3 5. 3 0. 64 22 0. 03 25 0. 05 1 0. 90 6 .9 52 6 19 8 0. 57 7 0. 70 7 Un m et n ee d 5. 4 5. 6 0. 18 18 0. 02 76 0. 15 2 1. 00 8 1. 00 4 6 19 8 0. 12 7 0. 23 7 An te na ta l c ar e co ve ra ge (1 + tim es , s kil led p ro vid er ) 5. 5a 5. 5 0. 42 51 0. 11 20 0. 26 4 1. 69 6 1. 30 2 1 34 0. 20 1 0. 64 9 An te na ta l c ar e co ve ra ge (4 + tim es , a ny p ro vid er ) 5. 5b 5. 5 0. 58 59 0. 11 56 0. 19 7 1. 81 7 1. 34 8 1 34 0. 35 5 0. 81 7 Sk ille d at te nd an t a t d eli ve ry 5. 7 5. 2 0. 65 25 0. 10 14 0. 15 5 1. 49 6 1. 22 3 1 34 0. 45 0 0. 85 5 Lit er ac y r at e (y ou ng w om en ) 7. 1 2. 3 0. 84 17 0. 04 50 0. 05 3 0. 89 5 .9 46 2 60 0. 75 2 0. 93 2 Kn ow led ge a bo ut H IV p re ve nt ion (y ou ng w om en ) 9. 1 6. 3 0. 24 85 0. 06 05 0. 24 3 1. 15 6 1. 07 5 2 60 0. 12 7 0. 36 9 Pr eg na nt w om en - 0. 03 11 0. 01 59 0. 51 1 2. 15 9 1. 46 9 8 25 8 0. 00 0 0. 06 3 In sti tu tio na l d eli ve rie s 5. 8 0. 59 34 0. 10 54 0. 17 8 1. 51 9 1. 23 2 1 34 0. 38 3 0. 80 4 Ca es ar ea n se cti on 5. 9 0. 16 90 0. 04 93 0. 29 2 0. 57 2 .7 56 1 34 0. 07 0 0. 26 8 M ar ria ge b ef or e ag e 18 8. 5 0. 30 34 0. 04 38 0. 14 4 2. 12 5 1. 45 8 7 23 5 0. 21 6 0. 39 1 Po lyg yn y 8. 7 0. 03 95 0. 01 52 0. 38 4 1. 19 3 1. 09 2 6 19 8 0. 00 9 0. 07 0 Kn ow led ge o f m ot he r-t o- ch ild tr an sm iss ion o f H IV 9. 2 0. 25 31 0. 03 78 0. 14 9 1. 93 9 1. 39 3 8 25 8 0. 17 8 0. 32 9 Ac ce pt ing a ttit ud es to wa rd s p eo ple liv ing w ith H IV 9. 3 0. 53 59 0. 05 90 0. 11 0 2. 43 3 1. 56 0 5 17 5 0. 41 8 0. 65 4 W om en w ho h av e be en te ste d fo r H IV a nd kn ow th e re su lts 9. 5 0. 02 39 0. 00 75 0. 31 3 0. 61 6 .7 85 8 25 8 0. 00 9 0. 03 9 UN DE R- 5s Un de rw eig ht p re va len ce (m od er at e an d se ve re ) 2. 1a 1. 8 0. 15 49 0. 02 69 0. 17 4 0. 41 0 0. 64 0 2 75 0. 10 1 0. 20 9 Un de rw eig ht p re va len ce (s ev er e) 2. 1b 1. 8 0. 06 37 0. 02 75 0. 43 2 0. 93 9 0. 96 9 2 75 0. 00 9 0. 11 9 An ti- m ala ria l tr ea tm en t o f c hil dr en u nd er a ge 5 3. 22 6. 8 0. 00 00 0. 00 00 0 10 0. 00 0 0. 00 0 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014264 Ne pa l  M IC S  2 01 4   24   Ta bl e SE .1 1: S am pl in g er ro rs : W es te rn M ou nt ai ns R eg io n St an da rd e rro rs , c oe ffic ien ts of va ria tio n, d es ign e ffe cts (d ef f), sq ua re ro ot o f d es ign e ffe cts (d ef t) an d co nf ide nc e int er va ls fo r s ele cte d ind ica to rs , N ep al, 2 01 4 M IC S In dic at or M DG In dic at or Va lue (r) St an da rd er ro r ( se ) Co ef fic ien t of va ria tio n (s e/ r) De sig n ef fe ct (d ef f) Sq ua re ro ot o f de sig n ef fe ct (d ef t) W eig ht ed co un t Un we igh te d co un t Co nf ide nc e lim its r - 2 se r + 2 se Ex clu siv e br ea stf ee din g un de r 6 m on th s 2. 7 0. 78 22 0. 00 00 0. 00 0 0. 00 0 0. 00 0 0 5 0. 78 2 0. 78 2 Ag e- ap pr op ria te b re as tfe ed ing 2. 12 0. 80 84 0. 05 73 0. 07 1 0. 69 9 0. 83 6 1 34 0. 69 4 0. 92 3 Di ar rh oe a in th e pr ev iou s 2 w ee ks - 0. 05 09 0. 02 32 0. 45 5 0. 84 4 0. 91 9 2 77 0. 00 5 0. 09 7 Illn es s w ith a co ug h in th e pr ev iou s 2 w ee ks - 0. 02 57 0. 01 83 0. 71 5 1. 02 3 1. 01 1 2 77 0. 00 0 0. 06 2 Fe ve r i n las t t wo w ee ks - 0. 11 85 0. 02 30 0. 19 4 0. 38 6 0. 62 1 2 77 0. 07 2 0. 16 5 Or al re hy dr at ion th er ap y w ith co nt inu ed fe ed ing 3. 12 0. 24 06 0. 00 48 0. 02 0 0. 00 0 0. 01 9 0 4 0. 23 1 0. 25 0 An tib iot ic tre at m en t o f s us pe cte d pn eu m on ia 3. 14 0. 52 34 0. 00 00 0. 00 0 0. 00 0 0. 00 0 0 2 0. 52 3 0. 52 3 Su pp or t f or le ar nin g 6. 2 0. 66 06 0. 07 79 0. 11 8 0. 75 8 0. 87 1 1 29 0. 50 5 0. 81 6 At te nd an ce to e ar ly ch ild ho od e du ca tio n 6. 1 0. 67 20 0. 05 15 0. 07 7 0. 33 7 0. 58 1 1 29 0. 56 9 0. 77 5 Bi rth re gis tra tio n 8. 1 0. 58 69 0. 05 62 0. 09 6 0. 99 1 0. 99 5 2 77 0. 47 4 0. 69 9 To ta l fe rti lity ra te (3 ye ar s) - 2. 21 25 0. 38 41 0. 14 8 na na na na 1. 44 4 2. 98 1 Ne on at al m or ta lity ra te 1. 1 20 .2 46 4 13 .9 20 7 19 3. 78 6 na na na na -7 .5 95 48 .0 88 Po st- ne on at al m or ta lity ra te 1. 3 33 .6 68 2 21 .3 39 7 45 5. 38 5 na na na na -9 .0 11 76 .3 48 Ch ild m or ta lity ra te 1. 4 23 .8 22 3 16 .5 33 8 27 3. 36 8 na na na na -9 .2 45 56 .8 90 C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 265 Ne pa l  M IC S  2 01 4   25   Ta bl e SE .1 2: S am pl in g er ro rs : W es te rn H ill s Re gi on St an da rd e rro rs , c oe ffic ien ts of va ria tio n, d es ign e ffe cts (d ef f), sq ua re ro ot o f d es ign e ffe cts (d ef t) an d co nf ide nc e int er va ls fo r s ele cte d ind ica to rs , N ep al, 2 01 4 M IC S In dic at or M DG In dic at or Va lue (r) St an da rd er ro r ( se ) Co ef fic ien t of va ria tio n (s e/ r) De sig n ef fe ct (d ef f) Sq ua re ro ot o f de sig n ef fe ct (d ef t) W eig ht ed co un t Un we igh te d co un t Co nf ide nc e lim its r - 2 se r + 2 se HO US EH OL DS Io diz ed sa lt c on su m pt ion 2. 19 0. 91 36 0. 01 84 0. 02 0 4. 18 9 2. 04 7 16 26 97 2 0. 87 7 0. 95 1 HO US EH OL D M EM BE RS Us e of im pr ov ed d rin kin g wa te r s ou rc es 4. 1 7. 8 0. 96 85 0. 01 09 0. 01 1 3. 78 5 1. 94 6 63 71 97 3 0. 94 7 0. 99 0 Us e of im pr ov ed sa nit at ion 4. 3 7. 9 0. 75 16 0. 01 98 0. 02 6 2. 03 6 1. 42 7 63 71 97 3 0. 71 2 0. 79 1 Pr im ar y s ch oo l n et a tte nd an ce ra tio (a dju ste d) 7. 4 2. 1 0. 94 64 0. 01 66 0. 01 8 2. 27 6 1. 50 9 68 8 42 0 0. 91 3 0. 98 0 Se co nd ar y s ch oo l n et a tte nd an ce ra tio (a dju ste d) 7. 5 0. 75 43 0. 03 29 0. 04 4 2. 61 3 1. 61 7 75 8 44 9 0. 68 9 0. 82 0 Ch ild la bo ur 8. 2 0. 47 26 0. 03 48 0. 07 4 2. 55 2 1. 59 8 11 07 52 5 0. 40 3 0. 54 2 Vi ole nt d isc ipl ine 8. 3 0. 84 74 0. 01 45 0. 01 7 0. 91 1 0. 95 5 11 69 56 5 0. 81 9 0. 87 6 W OM EN In fa nt m or ta lity ra te 1. 2 4. 2 35 .0 66 4 9. 47 29 89 .7 35 na na na na 16 .1 21 54 .0 12 Un de r-f ive m or ta lity ra te 1. 5 4. 1 38 .6 96 7 9. 68 84 93 .8 66 na na na na 19 .3 20 58 .0 74 Ad ole sc en t b irt h ra te 5. 1 5. 4 61 .6 61 5 11 .3 92 3 12 9. 78 5 na na na na 38 .8 77 84 .4 46 Co nt ra ce pt ive p re va len ce 5. 3 5. 3 0. 44 70 0. 02 01 0. 04 5 1. 23 9 1. 11 3 12 69 75 7 0. 40 7 0. 48 7 Un m et n ee d 5. 4 5. 6 0. 31 27 0. 01 46 0. 04 7 0. 74 8 0. 86 5 12 69 75 7 0. 28 4 0. 34 2 An te na ta l c ar e co ve ra ge (1 + tim es , s kil led p ro vid er ) 5. 5a 5. 5 0. 56 54 0. 05 72 0. 10 1 1. 78 6 1. 33 6 22 2 13 5 0. 45 1 0. 68 0 An te na ta l c ar e co ve ra ge (4 + tim es , a ny p ro vid er ) 5. 5b 5. 5 0. 64 26 0. 06 64 0. 10 3 2. 57 1 1. 60 3 22 2 13 5 0. 51 0 0. 77 5 Sk ille d at te nd an t a t d eli ve ry 5. 7 5. 2 0. 60 46 0. 04 93 0. 08 2 1. 36 1 1. 16 7 22 2 13 5 0. 50 6 0. 70 3 Lit er ac y r at e (y ou ng w om en ) 7. 1 2. 3 0. 97 89 0. 00 93 0. 01 0 1. 48 6 1. 21 9 58 3 35 6 0. 96 0 0. 99 7 Kn ow led ge a bo ut H IV p re ve nt ion (y ou ng w om en ) 9. 1 6. 3 0. 30 08 0. 02 30 0. 07 7 0. 89 7 0. 94 7 58 3 35 6 0. 25 5 0. 34 7 Pr eg na nt w om en - 0. 02 84 0. 00 37 0. 13 1 0. 49 8 0. 70 6 16 59 10 00 0. 02 1 0. 03 6 In sti tu tio na l d eli ve rie s 5. 8 0. 57 99 0. 06 33 0. 10 9 2. 20 2 1. 48 4 22 2 13 5 0. 45 3 0. 70 6 Ca es ar ea n se cti on 5. 9 0. 08 78 0. 02 44 0. 27 8 0. 99 4 0. 99 7 22 2 13 5 0. 03 9 0. 13 7 M ar ria ge b ef or e ag e 18 8. 5 0. 47 74 0. 02 18 0. 04 6 1. 56 6 1. 25 1 13 65 82 2 0. 43 4 0. 52 1 Po lyg yn y 8. 7 0. 04 46 0. 00 99 0. 22 3 1. 75 1 1. 32 3 12 69 75 7 0. 02 5 0. 06 5 Kn ow led ge o f m ot he r-t o- ch ild tr an sm iss ion o f H IV 9. 2 0. 43 13 0. 02 10 0. 04 9 1. 79 2 1. 33 9 16 59 10 00 0. 38 9 0. 47 3 Ac ce pt ing a ttit ud es to wa rd s p eo ple liv ing w ith H IV 9. 3 0. 57 22 0. 02 59 0. 04 5 2. 48 4 1. 57 6 14 94 91 1 0. 52 0 0. 62 4 W om en w ho h av e be en te ste d fo r H IV a nd kn ow th e re su lts 9. 5 0. 04 49 0. 00 88 0. 19 7 1. 81 7 1. 34 8 16 59 10 00 0. 02 7 0. 06 3 UN DE R- 5s Un de rw eig ht p re va len ce (m od er at e an d se ve re ) 2. 1a 1. 8 0. 25 27 0. 02 66 0. 10 5 1. 26 8 1. 12 6 56 0 33 9 0. 19 9 0. 30 6 Un de rw eig ht p re va len ce (s ev er e) 2. 1b 1. 8 0. 09 01 0. 01 58 0. 17 6 1. 03 4 1. 01 7 56 0 33 9 0. 05 8 0. 12 2 An ti- m ala ria l tr ea tm en t o f c hil dr en u nd er a ge 5 3. 22 6. 8 0. 00 00 0. 00 00 11 1 71 0. 00 0 0. 00 0 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014266 Ne pa l  M IC S  2 01 4   26   Ta bl e SE .1 2: S am pl in g er ro rs : W es te rn H ill s Re gi on St an da rd e rro rs , c oe ffic ien ts of va ria tio n, d es ign e ffe cts (d ef f), sq ua re ro ot o f d es ign e ffe cts (d ef t) an d co nf ide nc e int er va ls fo r s ele cte d ind ica to rs , N ep al, 2 01 4 M IC S In dic at or M DG In dic at or Va lue (r) St an da rd er ro r ( se ) Co ef fic ien t of va ria tio n (s e/ r) De sig n ef fe ct (d ef f) Sq ua re ro ot o f de sig n ef fe ct (d ef t) W eig ht ed co un t Un we igh te d co un t Co nf ide nc e lim its r - 2 se r + 2 se Ex clu siv e br ea stf ee din g un de r 6 m on th s 2. 7 0. 68 88 0. 06 36 0. 09 2 0. 54 7 0. 74 0 50 30 0. 56 2 0. 81 6 Ag e- ap pr op ria te b re as tfe ed ing 2. 12 0. 85 25 0. 03 63 0. 04 3 1. 42 5 1. 19 4 22 3 13 7 0. 78 0 0. 92 5 Di ar rh oe a in th e pr ev iou s 2 w ee ks - 0. 08 09 0. 01 70 0. 21 1 1. 39 2 1. 18 0 60 1 35 8 0. 04 7 0. 11 5 Illn es s w ith a co ug h in th e pr ev iou s 2 w ee ks - 0. 05 35 0. 01 41 0. 26 4 1. 40 9 1. 18 7 60 1 35 8 0. 02 5 0. 08 2 Fe ve r i n las t t wo w ee ks - 0. 18 52 0. 02 21 0. 11 9 1. 15 2 1. 07 4 60 1 35 8 0. 14 1 0. 22 9 Or al re hy dr at ion th er ap y w ith co nt inu ed fe ed ing 3. 12 0. 57 71 0. 08 85 0. 15 3 0. 93 1 0. 96 5 49 30 0. 40 0 0. 75 4 An tib iot ic tre at m en t o f s us pe cte d pn eu m on ia 3. 14 0. 94 57 0. 00 24 0. 00 3 0. 00 2 0. 04 6 32 20 0. 94 1 0. 95 0 Su pp or t f or le ar nin g 6. 2 0. 76 64 0. 03 64 0. 04 7 1. 11 6 1. 05 6 25 9 15 2 0. 69 4 0. 83 9 At te nd an ce to e ar ly ch ild ho od e du ca tio n 6. 1 0. 80 27 0. 03 63 0. 04 5 1. 25 3 1. 11 9 25 9 15 2 0. 73 0 0. 87 5 Bi rth re gis tra tio n 8. 1 0. 59 76 0. 03 47 0. 05 8 1. 78 3 1. 33 5 60 1 35 8 0. 52 8 0. 66 7 To ta l fe rti lity ra te (3 ye ar s) - 2. 17 51 0. 15 10 0. 02 3 na na na na 1. 87 3 2. 47 7 Ne on at al m or ta lity ra te 1. 1 29 .4 39 5 9. 30 84 86 .6 47 na na na na 10 .8 23 48 .0 56 Po st- ne on at al m or ta lity ra te 1. 3 5. 62 69 3. 95 25 15 .6 22 na na na na -2 .2 78 13 .5 32 Ch ild m or ta lity ra te 1. 4 3. 76 22 2. 74 60 7. 54 1 na na na na -1 .7 30 9. 25 4 C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 267 Ne pa l  M IC S  2 01 4   27   Ta bl e SE .1 3: S am pl in g er ro rs : W es te rn T er ai R eg io n St an da rd e rro rs , c oe ffic ien ts of va ria tio n, d es ign e ffe cts (d ef f), sq ua re ro ot o f d es ign e ffe cts (d ef t) an d co nf ide nc e int er va ls fo r s ele cte d ind ica to rs , N ep al, 2 01 4 M IC S In dic at or M DG In dic at or Va lue (r) St an da rd er ro r ( se ) Co ef fic ien t of va ria tio n (s e/ r) De sig n ef fe ct (d ef f) Sq ua re ro ot o f de sig n ef fe ct (d ef t) W eig ht ed co un t Un we igh te d co un t Co nf ide nc e lim its r - 2 se r + 2 se HO US EH OL DS Io diz ed sa lt c on su m pt ion 2. 19 0. 83 90 0. 04 54 0. 05 4 11 .8 78 3. 44 6 92 3 78 1 0. 74 8 0. 93 0 HO US EH OL D M EM BE RS Us e of im pr ov ed d rin kin g wa te r s ou rc es 4. 1 7. 8 0. 98 45 0. 01 01 0. 01 0 5. 21 7 2. 28 4 48 25 78 2 0. 96 4 1. 00 0 Us e of im pr ov ed sa nit at ion 4. 3 7. 9 0. 61 75 0. 05 78 0. 09 4 11 .0 40 3. 32 3 48 25 78 2 0. 50 2 0. 73 3 Pr im ar y s ch oo l n et a tte nd an ce ra tio (a dju ste d) 7. 4 2. 1 0. 86 99 0. 02 27 0. 02 6 2. 08 1 1. 44 3 55 3 46 0 0. 82 5 0. 91 5 Se co nd ar y s ch oo l n et a tte nd an ce ra tio (a dju ste d) 7. 5 0. 60 67 0. 03 82 0. 06 3 3. 19 0 1. 78 6 62 6 52 2 0. 53 0 0. 68 3 Ch ild la bo ur 8. 2 0. 36 76 0. 03 98 0. 10 8 3. 28 3 1. 81 2 12 48 48 2 0. 28 8 0. 44 7 Vi ole nt d isc ipl ine 8. 3 0. 81 08 0. 02 37 0. 02 9 1. 80 6 1. 34 4 12 60 49 5 0. 76 3 0. 85 8 W OM EN In fa nt m or ta lity ra te 1. 2 4. 2 30 .4 74 4 7. 95 29 63 .2 49 na na na na 14 .5 69 46 .3 80 Un de r-f ive m or ta lity ra te 1. 5 4. 1 37 .0 14 7 10 .4 37 2 10 8. 93 5 na na na na 16 .1 40 57 .8 89 Ad ole sc en t b irt h ra te 5. 1 5. 4 64 .0 67 6 10 .8 75 8 11 8. 28 3 na na na na 42 .3 16 85 .8 19 Co nt ra ce pt ive p re va len ce 5. 3 5. 3 0. 48 16 0. 02 47 0. 05 1 1. 94 4 1. 39 4 94 0 79 5 0. 43 2 0. 53 1 Un m et n ee d 5. 4 5. 6 0. 23 91 0. 01 68 0. 07 0 1. 23 2 1. 11 0 94 0 79 5 0. 20 6 0. 27 3 An te na ta l c ar e co ve ra ge (1 + tim es , s kil led p ro vid er ) 5. 5a 5. 5 0. 56 07 0. 05 18 0. 09 2 1. 62 3 1. 27 4 17 8 15 0 0. 45 7 0. 66 4 An te na ta l c ar e co ve ra ge (4 + tim es , a ny p ro vid er ) 5. 5b 5. 5 0. 67 46 0. 06 01 0. 08 9 2. 44 8 1. 56 5 17 8 15 0 0. 55 5 0. 79 5 Sk ille d at te nd an t a t d eli ve ry 5. 7 5. 2 0. 65 14 0. 04 26 0. 06 5 1. 18 8 1. 09 0 17 8 15 0 0. 56 6 0. 73 6 Lit er ac y r at e (y ou ng w om en ) 7. 1 2. 3 0. 80 86 0. 04 00 0. 04 9 3. 94 6 1. 98 7 45 4 38 3 0. 72 9 0. 88 9 Kn ow led ge a bo ut H IV p re ve nt ion (y ou ng w om en ) 9. 1 6. 3 0. 42 06 0. 04 59 0. 10 9 3. 30 9 1. 81 9 45 4 38 3 0. 32 9 0. 51 2 Pr eg na nt w om en - 0. 05 36 0. 00 74 0. 13 9 1. 14 4 1. 07 0 12 36 10 49 0. 03 9 0. 06 9 In sti tu tio na l d eli ve rie s 5. 8 0. 65 38 0. 04 99 0. 07 6 1. 63 7 1. 27 9 17 8 15 0 0. 55 4 0. 75 4 Ca es ar ea n se cti on 5. 9 0. 10 11 0. 02 38 0. 23 5 0. 92 6 0. 96 2 17 8 15 0 0. 05 4 0. 14 9 M ar ria ge b ef or e ag e 18 8. 5 0. 54 25 0. 02 52 0. 04 7 2. 19 8 1. 48 3 10 08 85 7 0. 49 2 0. 59 3 Po lyg yn y 8. 7 0. 03 78 0. 00 65 0. 17 2 0. 92 1 0. 96 0 94 0 79 5 0. 02 5 0. 05 1 Kn ow led ge o f m ot he r-t o- ch ild tr an sm iss ion o f H IV 9. 2 0. 30 30 0. 02 09 0. 06 9 2. 15 9 1. 47 0 12 36 10 49 0. 26 1 0. 34 5 Ac ce pt ing a ttit ud es to wa rd s p eo ple liv ing w ith H IV 9. 3 0. 50 75 0. 02 68 0. 05 3 2. 69 0 1. 64 0 10 98 94 0 0. 45 4 0. 56 1 W om en w ho h av e be en te ste d fo r H IV a nd kn ow th e re su lts 9. 5 0. 01 14 0. 00 33 0. 29 0 1. 02 1 1. 01 0 12 36 10 49 0. 00 5 0. 01 8 UN DE R- 5s Un de rw eig ht p re va len ce (m od er at e an d se ve re ) 2. 1a 1. 8 0. 32 77 0. 03 17 0. 09 7 1. 75 1 1. 32 3 46 5 38 6 0. 26 4 0. 39 1 Un de rw eig ht p re va len ce (s ev er e) 2. 1b 1. 8 0. 08 45 0. 01 88 0. 22 3 1. 76 6 1. 32 9 46 5 38 6 0. 04 7 0. 12 2 An ti- m ala ria l tr ea tm en t o f c hil dr en u nd er a ge 5 3. 22 6. 8 0. 00 00 0. 00 00 80 66 0. 00 0 0. 00 0 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014268 Ne pa l  M IC S  2 01 4   28   Ta bl e SE .1 3: S am pl in g er ro rs : W es te rn T er ai R eg io n St an da rd e rro rs , c oe ffic ien ts of va ria tio n, d es ign e ffe cts (d ef f), sq ua re ro ot o f d es ign e ffe cts (d ef t) an d co nf ide nc e int er va ls fo r s ele cte d ind ica to rs , N ep al, 2 01 4 M IC S In dic at or M DG In dic at or Va lue (r) St an da rd er ro r ( se ) Co ef fic ien t of va ria tio n (s e/ r) De sig n ef fe ct (d ef f) Sq ua re ro ot o f de sig n ef fe ct (d ef t) W eig ht ed co un t Un we igh te d co un t Co nf ide nc e lim its r - 2 se r + 2 se Ex clu siv e br ea stf ee din g un de r 6 m on th s 2. 7 0. 33 54 0. 06 47 0. 19 3 0. 58 3 0. 76 4 37 32 0. 20 6 0. 46 5 Ag e- ap pr op ria te b re as tfe ed ing 2. 12 0. 78 98 0. 03 09 0. 03 9 0. 84 5 0. 92 0 17 9 14 8 0. 72 8 0. 85 2 Di ar rh oe a in th e pr ev iou s 2 w ee ks - 0. 16 64 0. 02 77 0. 16 7 2. 15 3 1. 46 7 46 9 38 9 0. 11 1 0. 22 2 Illn es s w ith a co ug h in th e pr ev iou s 2 w ee ks - 0. 03 84 0. 01 12 0. 29 2 1. 32 5 1. 15 1 46 9 38 9 0. 01 6 0. 06 1 Fe ve r i n las t t wo w ee ks - 0. 17 13 0. 02 62 0. 15 3 1. 87 6 1. 37 0 46 9 38 9 0. 11 9 0. 22 4 Or al re hy dr at ion th er ap y w ith co nt inu ed fe ed ing 3. 12 0. 46 72 0. 10 54 0. 22 6 2. 85 7 1. 69 0 78 65 0. 25 6 0. 67 8 An tib iot ic tre at m en t o f s us pe cte d pn eu m on ia 3. 14 0. 91 87 0. 00 13 0. 00 1 0. 00 0 0. 01 8 18 14 0. 91 6 0. 92 1 Su pp or t f or le ar nin g 6. 2 0. 69 67 0. 04 06 0. 05 8 1. 23 0 1. 10 9 18 8 15 9 0. 61 6 0. 77 8 At te nd an ce to e ar ly ch ild ho od e du ca tio n 6. 1 0. 58 65 0. 04 56 0. 07 8 1. 35 5 1. 16 4 18 8 15 9 0. 49 5 0. 67 8 Bi rth re gis tra tio n 8. 1 0. 70 59 0. 03 26 0. 04 6 1. 98 2 1. 40 8 46 9 38 9 0. 64 1 0. 77 1 To ta l fe rti lity ra te (3 ye ar s) - 2. 39 18 0. 24 98 0. 06 2 na na na na 1. 89 2 2. 89 1 Ne on at al m or ta lity ra te 1. 1 22 .1 63 4 6. 22 97 38 .8 09 na na na na 9. 70 4 34 .6 23 Po st- ne on at al m or ta lity ra te 1. 3 8. 31 10 4. 62 25 21 .3 67 na na na na -0 .9 34 17 .5 56 Ch ild m or ta lity ra te 1. 4 6. 74 58 3. 84 39 14 .7 76 na na na na -0 .9 42 14 .4 34 C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 269 Ne pa l  M IC S  2 01 4   29   Ta bl e SE .1 4: S am pl in g er ro rs : M id -W es te rn M ou nt ai ns R eg io n St an da rd e rro rs , c oe ffic ien ts of va ria tio n, d es ign e ffe cts (d ef f), sq ua re ro ot o f d es ign e ffe cts (d ef t) an d co nf ide nc e int er va ls fo r s ele cte d ind ica to rs , N ep al, 2 01 4 M IC S In dic at or M DG In dic at or Va lue (r ) St an da rd er ro r (s e) Co ef fic ien t of va ria tio n (s e/ r) De sig n ef fe ct (d ef f) Sq ua re ro ot o f de sig n ef fe ct (d ef t) W eig ht ed co un t Un we igh te d co un t Co nf ide nc e lim its r - 2 se r + 2 se HO US EH OL DS Io diz ed sa lt c on su m pt ion 2. 19 0. 62 45 0. 04 23 0. 06 8 5. 66 4 2. 38 0 15 6 74 2 0. 54 0 0. 70 9 HO US EH OL D M EM BE RS Us e of im pr ov ed d rin kin g wa te r s ou rc es 4. 1 7. 8 0. 73 30 0. 05 37 0. 07 3 10 .9 32 3. 30 6 79 8 74 3 0. 62 6 0. 84 0 Us e of im pr ov ed sa nit at ion 4. 3 7. 9 0. 78 45 0. 04 35 0. 05 5 8. 31 6 2. 88 4 79 8 74 3 0. 69 7 0. 87 2 Pr im ar y s ch oo l n et a tte nd an ce ra tio (a dju ste d) 7. 4 2. 1 0. 84 84 0. 03 19 0. 03 8 4. 31 8 2. 07 8 11 6 54 7 0. 78 5 0. 91 2 Se co nd ar y s ch oo l n et a tte nd an ce ra tio (a dju ste d) 7. 5 0. 61 56 0. 03 17 0. 05 1 1. 97 4 1. 40 5 99 46 6 0. 55 2 0. 67 9 Ch ild la bo ur 8. 2 0. 55 98 0. 03 11 0. 05 6 1. 77 9 1. 33 4 12 55 45 3 0. 49 8 0. 62 2 Vi ole nt d isc ipl ine 8. 3 0. 87 85 0. 01 36 0. 01 5 0. 94 2 0. 97 1 15 00 54 5 0. 85 1 0. 90 6 W OM EN In fa nt m or ta lity ra te 1. 2 4. 2 10 0. 22 02 13 .9 86 4 19 5. 61 9 na na na na 72 .2 47 12 8. 19 3 Un de r-f ive m or ta lity ra te 1. 5 4. 1 11 8. 56 63 15 .1 14 9 22 8. 45 9 na na na na 88 .3 37 14 8. 79 6 Ad ole sc en t b irt h ra te 5. 1 5. 4 12 2. 89 14 16 .2 29 6 26 3. 39 90 na na na na 90 .4 32 15 5. 35 1 Co nt ra ce pt ive p re va len ce 5. 3 5. 3 0. 47 66 0. 03 02 0. 06 3 2. 39 3 1. 54 7 13 6 65 7 0. 41 6 0. 53 7 Un m et n ee d 5. 4 5. 6 0. 19 38 0. 01 90 0. 09 8 1. 52 3 1. 23 4 13 6 65 7 0. 15 6 0. 23 2 An te na ta l c ar e co ve ra ge (1 + tim es , s kil led p ro vid er ) 5. 5a 5. 5 0. 10 35 0. 03 06 0, 29 6 0. 01 6 1. 45 8 43 21 1 0. 04 2 0. 16 5 An te na ta l c ar e co ve ra ge (4 + tim es , a ny p ro vid er ) 5. 5b 5. 5 0. 30 55 0. 06 31 0. 20 6 3. 93 6 1. 98 4 43 21 1 0. 17 9 0. 43 2 Sk ille d at te nd an t a t d eli ve ry 5. 7 5. 2 0. 19 48 0. 04 02 0. 20 6 2. 16 4 1. 47 1 43 21 1 0. 11 4 0. 27 5 Lit er ac y r at e (y ou ng w om en ) 7. 1 2. 3 0. 58 30 0. 05 00 0. 08 6 3. 54 7 1. 88 3 71 34 6 0. 48 3 0. 68 3 Kn ow led ge a bo ut H IV p re ve nt ion (y ou ng w om en ) 9. 1 6. 3 0. 09 14 0. 02 23 0. 24 4 2. 06 4 1. 43 7 71 34 6 0. 04 7 0. 13 6 Pr eg na nt w om en - 0. 08 55 0. 01 06 0. 12 4 1. 17 1 1. 08 2 16 9 81 7 0. 06 4 0. 10 7 In sti tu tio na l d eli ve rie s 5. 8 0. 25 48 0. 05 44 0. 21 3 3. 27 1 1. 80 9 43 21 1 0. 14 6 0. 36 4 Ca es ar ea n se cti on 5. 9 0. 00 93 0. 00 68 0. 73 5 1. 06 2 1. 03 0 43 21 1 0. 00 0 0. 02 3 M ar ria ge b ef or e ag e 18 8. 5 0. 67 51 0. 02 80 0. 04 1 2. 29 9 1. 51 6 13 3 64 5 0. 61 9 0. 73 1 Po lyg yn y 8. 7 0. 02 90 0. 00 76 0. 26 1 1. 33 4 1. 15 5 13 6 65 7 0. 01 4 0. 04 4 Kn ow led ge o f m ot he r-t o- ch ild tr an sm iss ion o f H IV 9. 2 0. 33 57 0. 02 66 0. 07 9 2. 58 9 1. 60 9 16 9 81 7 0. 28 2 0. 38 9 Ac ce pt ing a ttit ud es to wa rd s p eo ple liv ing w ith H IV 9. 3 0. 22 92 0. 03 90 0. 17 0 3. 02 5 1. 73 9 73 35 3 0. 15 1 0. 30 7 W om en w ho h av e be en te ste d fo r H IV a nd kn ow th e re su lts 9. 5 0. 01 71 0. 00 56 0. 33 1 1. 55 0 1. 24 5 16 9 81 7 0. 00 6 0. 02 8 UN DE R- 5s Un de rw eig ht p re va len ce (m od er at e an d se ve re ) 2. 1a 1. 8 0. 45 25 0. 03 58 0. 07 9 2. 62 3 1. 61 9 10 6 50 9 0. 38 1 0. 52 4 Un de rw eig ht p re va len ce (s ev er e) 2. 1b 1. 8 0. 15 74 0. 02 10 0. 13 4 1. 69 3 1. 30 1 10 6 50 9 0. 11 5 0. 19 9 An ti- m ala ria l tr ea tm en t o f c hil dr en u nd er a ge 5 3. 22 6. 8 0. 01 94 0. 01 03 0. 52 9 0. 56 0 0. 74 8 21 10 2 0. 00 0 0. 04 0 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014270 Ne pa l  M IC S  2 01 4   30   Ta bl e SE .1 4: S am pl in g er ro rs : M id -W es te rn M ou nt ai ns R eg io n St an da rd e rro rs , c oe ffic ien ts of va ria tio n, d es ign e ffe cts (d ef f), sq ua re ro ot o f d es ign e ffe cts (d ef t) an d co nf ide nc e int er va ls fo r s ele cte d ind ica to rs , N ep al, 2 01 4 M IC S In dic at or M DG In dic at or Va lue (r ) St an da rd er ro r (s e) Co ef fic ien t of va ria tio n (s e/ r) De sig n ef fe ct (d ef f) Sq ua re ro ot o f de sig n ef fe ct (d ef t) W eig ht ed co un t Un we igh te d co un t Co nf ide nc e lim its r - 2 se r + 2 se Ex clu siv e br ea stf ee din g un de r 6 m on th s 2. 7 0. 69 64 0. 07 65 0. 11 0 1. 10 6 1. 05 2 9 41 0. 54 3 0. 84 9 Ag e- ap pr op ria te b re as tfe ed ing 2. 12 0. 83 57 0. 02 09 0. 02 5 0. 60 3 0. 77 6 40 19 1 0. 79 4 0. 87 7 Di ar rh oe a in th e pr ev iou s 2 w ee ks - 0. 21 17 0. 02 48 0. 11 7 1. 90 8 1. 38 1 10 8 51 7 0. 16 2 0. 26 1 Illn es s w ith a co ug h in th e pr ev iou s 2 w ee ks - 0. 04 83 0. 01 14 0. 23 5 1. 44 7 1. 20 3 10 8 51 7 0. 02 6 0. 07 1 Fe ve r i n las t t wo w ee ks - 0. 19 81 0. 02 29 0. 11 6 1. 71 0 1. 30 8 10 8 51 7 0. 15 2 0. 24 4 Or al re hy dr at ion th er ap y w ith co nt inu ed fe ed ing 3. 12 0. 36 89 0. 04 42 0. 12 0 0. 91 6 0. 95 7 23 11 0 0. 28 0 0. 45 7 An tib iot ic tre at m en t o f s us pe cte d pn eu m on ia 3. 14 0. 27 57 0. 05 55 0. 20 1 0. 37 1 0. 60 9 5 25 0. 16 5 0. 38 7 Su pp or t f or le ar nin g 6. 2 0. 47 62 0. 03 56 0. 07 5 1. 13 7 1. 06 6 47 22 5 0. 40 5 0. 54 7 At te nd an ce to e ar ly ch ild ho od e du ca tio n 6. 1 0. 36 71 0. 04 58 0. 12 5 2. 02 6 1. 42 3 47 22 5 0. 27 5 0. 45 9 Bi rth re gis tra tio n 8. 1 0. 84 43 0. 03 17 0. 03 8 3. 94 3 1. 98 6 10 8 51 7 0. 78 1 0. 90 8 To ta l fe rti lity ra te (3 ye ar s) - 4. 12 50 0. 40 48 0. 16 4 na na na na 3. 31 5 4. 93 5 Ne on at al m or ta lity ra te 1. 1 60 .5 47 0 12 .5 01 6 15 6. 29 1 na na na na 35 .5 44 85 .5 50 Po st- ne on at al m or ta lity ra te 1. 3 39 .6 73 2 7. 57 21 57 .3 37 na na na na 24 .5 29 54 .8 17 Ch ild m or ta lity ra te 1. 4 20 .3 89 6 6. 81 02 46 .3 79 na na na na 6. 76 9 34 .0 10 C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 271 Ne pa l  M IC S  2 01 4   31   Ta bl e SE .1 5: S am pl in g er ro rs : M id -W es te rn H ill s Re gi on St an da rd e rro rs , c oe ffic ien ts of va ria tio n, d es ign e ffe cts (d ef f), sq ua re ro ot o f d es ign e ffe cts (d ef t) an d co nf ide nc e int er va ls fo r s ele cte d ind ica to rs , N ep al, 2 01 4 M IC S In dic at or M DG In dic at or Va lue (r) St an da rd er ro r ( se ) Co ef fic ien t of va ria tio n (s e/ r) De sig n ef fe ct (d ef f) Sq ua re ro ot o f de sig n ef fe ct (d ef t) W eig ht ed co un t Un we igh te d co un t Co nf ide nc e lim its r - 2 se r + 2 se HO US EH OL DS Io diz ed sa lt c on su m pt ion 2. 19 0. 68 88 0. 03 57 0. 05 2 4. 60 3 2. 14 5 76 3 77 7 0. 61 7 0. 76 0 HO US EH OL D M EM BE RS Us e of im pr ov ed d rin kin g wa te r s ou rc es 4. 1 7. 8 0. 76 46 0. 03 78 0. 04 9 6. 15 7 2. 48 1 35 91 77 8 0. 68 9 0. 84 0 Us e of im pr ov ed sa nit at ion 4. 3 7. 9 0. 79 50 0. 04 62 0. 05 8 10 .1 65 3. 18 8 35 91 77 8 0. 70 3 0. 88 7 Pr im ar y s ch oo l n et a tte nd an ce ra tio (a dju ste d) 7. 4 2. 1 0. 89 15 0. 02 48 0. 02 8 3. 41 7 1. 84 8 53 7 54 0 0. 84 2 0. 94 1 Se co nd ar y s ch oo l n et a tte nd an ce ra tio (a dju ste d) 7. 5 0. 69 08 0. 03 37 0. 04 9 2. 64 9 1. 62 7 49 8 50 0 0. 62 3 0. 75 8 Ch ild la bo ur 8. 2 0. 60 27 0. 02 52 0. 04 2 1. 31 2 1. 14 5 13 11 49 7 0. 55 2 0. 65 3 Vi ole nt d isc ipl ine 8. 3 0. 85 84 0. 01 95 0. 02 3 1. 70 7 1. 30 7 14 01 54 7 0. 81 9 0. 89 7 W OM EN In fa nt m or ta lity ra te 1. 2 4. 2 41 .8 46 5 7. 86 55 61 .8 66 na na na na 26 .1 16 57 .5 78 Un de r-f ive m or ta lity ra te 1. 5 4. 1 54 .6 71 2 10 .4 01 8 10 8. 19 7 na na na na 33 .8 68 75 .4 75 Ad ole sc en t b irt h ra te 5. 1 5. 4 82 .7 17 5 9. 59 87 92 .1 35 na na na na 63 .5 20 10 1. 91 5 Co nt ra ce pt ive p re va len ce 5. 3 5. 3 0. 49 46 0. 03 13 0. 06 3 2. 76 6 1. 66 3 68 6 70 6 0. 43 2 0. 55 7 Un m et n ee d 5. 4 5. 6 0. 27 99 0. 02 24 0. 08 0 1. 76 2 1. 32 8 68 6 70 6 0. 23 5 0. 32 5 An te na ta l c ar e co ve ra ge (1 + tim es , s kil led p ro vid er ) 5. 5a 5. 5 0. 29 03 0. 04 33 0. 14 9 1. 50 0 1. 22 5 16 6 16 6 0. 20 4 0. 37 7 An te na ta l c ar e co ve ra ge (4 + tim es , a ny p ro vid er ) 5. 5b 5. 5 0. 48 87 0. 06 84 0. 14 0 3. 09 1 1. 75 8 16 6 16 6 0. 35 2 0. 62 6 Sk ille d at te nd an t a t d eli ve ry 5. 7 5. 2 0. 31 87 0. 04 97 0. 15 6 1. 87 4 1. 36 9 16 6 16 6 0. 21 9 0. 41 8 Lit er ac y r at e (y ou ng w om en ) 7. 1 2. 3 0. 83 24 0. 02 89 0. 03 5 2. 03 2 1. 42 6 33 2 34 0 0. 77 5 0. 89 0 Kn ow led ge a bo ut H IV p re ve nt ion (y ou ng w om en ) 9. 1 6. 3 0. 22 18 0. 02 85 0. 12 9 1. 59 6 1. 26 3 33 2 34 0 0. 16 5 0. 27 9 Pr eg na nt w om en - 0. 05 57 0. 00 91 0. 16 4 1. 40 2 1. 18 4 85 6 88 3 0. 03 7 0. 07 4 In sti tu tio na l d eli ve rie s 5. 8 0. 32 43 0. 05 60 0. 17 3 2. 36 0 1. 53 6 16 6 16 6 0. 21 2 0. 43 6 Ca es ar ea n se cti on 5. 9 0. 01 96 0. 01 42 0. 72 7 1. 74 3 1. 32 0 16 6 16 6 0. 00 0 0. 04 8 M ar ria ge b ef or e ag e 18 8. 5 0. 54 64 0. 02 02 0. 03 7 1. 15 0 1. 07 2 67 0 69 8 0. 50 6 0. 58 7 Po lyg yn y 8. 7 0. 02 90 0. 00 78 0. 27 0 1. 53 7 1. 24 0 68 6 70 6 0. 01 3 0. 04 5 Kn ow led ge o f m ot he r-t o- ch ild tr an sm iss ion o f H IV 9. 2 0. 39 10 0. 02 15 0. 05 5 1. 71 8 1. 31 1 85 6 88 3 0. 34 8 0. 43 4 Ac ce pt ing a ttit ud es to wa rd s p eo ple liv ing w ith H IV 9. 3 0. 41 21 0. 02 08 0. 05 1 1. 02 8 1. 01 4 55 4 57 5 0. 37 0 0. 45 4 W om en w ho h av e be en te ste d fo r H IV a nd kn ow th e re su lts 9. 5 0. 01 93 0. 00 56 0. 29 1 1. 46 7 1. 21 1 85 6 88 3 0. 00 8 0. 03 1 UN DE R- 5s Un de rw eig ht p re va len ce (m od er at e an d se ve re ) 2. 1a 1. 8 0. 33 49 0. 04 55 0. 13 6 3. 82 2 1. 95 5 40 7 41 2 0. 24 4 0. 42 6 Un de rw eig ht p re va len ce (s ev er e) 2. 1b 1. 8 0. 08 63 0. 01 57 0. 18 2 1. 28 3 1. 13 3 40 7 41 2 0. 05 5 0. 11 8 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014272 Ne pa l  M IC S  2 01 4   32   Ta bl e SE .1 5: S am pl in g er ro rs : M id -W es te rn H ill s Re gi on St an da rd e rro rs , c oe ffic ien ts of va ria tio n, d es ign e ffe cts (d ef f), sq ua re ro ot o f d es ign e ffe cts (d ef t) an d co nf ide nc e int er va ls fo r s ele cte d ind ica to rs , N ep al, 2 01 4 M IC S In dic at or M DG In dic at or Va lue (r) St an da rd er ro r ( se ) Co ef fic ien t of va ria tio n (s e/ r) De sig n ef fe ct (d ef f) Sq ua re ro ot o f de sig n ef fe ct (d ef t) W eig ht ed co un t Un we igh te d co un t Co nf ide nc e lim its r - 2 se r + 2 se An ti- m ala ria l tr ea tm en t o f c hil dr en u nd er a ge 5 3. 22 6. 8 0. 00 00 0. 00 00 88 88 0. 00 0 0. 00 0 Ex clu siv e br ea stf ee din g un de r 6 m on th s 2. 7 0. 53 56 0. 06 80 0. 12 7 0. 48 3 0. 69 5 27 27 0. 40 0 0. 67 2 Ag e- ap pr op ria te b re as tfe ed ing 2. 12 0. 87 98 0. 02 65 0. 03 0 0. 99 4 0. 99 7 14 7 15 1 0. 82 7 0. 93 3 Di ar rh oe a in th e pr ev iou s 2 w ee ks - 0. 17 84 0. 02 86 0. 16 0 2. 30 1 1. 51 7 40 9 41 4 0. 12 1 0. 23 6 Illn es s w ith a co ug h in th e pr ev iou s 2 w ee ks - 0. 12 20 0. 01 97 0. 16 1 1. 49 3 1. 22 2 40 9 41 4 0. 08 3 0. 16 1 Fe ve r i n las t t wo w ee ks - 0. 21 43 0. 01 87 0. 08 7 0. 85 3 0. 92 4 40 9 41 4 0. 17 7 0. 25 2 Or al re hy dr at ion th er ap y w ith co nt inu ed fe ed ing 3. 12 0. 36 92 0. 08 58 0. 23 2 2. 30 6 1. 51 9 73 74 0. 19 8 0. 54 1 An tib iot ic tre at m en t o f s us pe cte d pn eu m on ia 3. 14 0. 67 26 0. 06 00 0. 08 9 0. 75 3 0. 86 8 50 47 0. 55 3 0. 79 3 Su pp or t f or le ar nin g 6. 2 0. 49 53 0. 05 14 0. 10 4 1. 98 5 1. 40 9 18 5 18 9 0. 39 3 0. 59 8 At te nd an ce to e ar ly ch ild ho od e du ca tio n 6. 1 0. 41 75 0. 03 42 0. 08 2 0. 90 5 0. 95 1 18 5 18 9 0. 34 9 0. 48 6 Bi rth re gis tra tio n 8. 1 0. 59 76 0. 05 44 0. 09 1 5. 08 7 2. 25 5 40 9 41 4 0. 48 9 0. 70 6 To ta l fe rti lity ra te (3 ye ar s) - 2. 90 85 0. 22 08 0. 04 9 na na na na 2. 46 7 3. 35 0 Ne on at al m or ta lity ra te 1. 1 25 .3 96 5 6. 00 33 36 .0 40 na na na na 13 .3 90 37 .4 03 Po st- ne on at al m or ta lity ra te 1. 3 16 .4 50 0 6. 35 70 40 .4 11 na na na na 3. 73 6 29 .1 64 Ch ild m or ta lity ra te 1. 4 13 .3 84 8 5. 23 82 27 .4 38 na na na na 2. 90 8 23 .8 61 C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 273 Ne pa l  M IC S  2 01 4   33   Ta bl e SE .1 6: S am pl in g er ro rs : M id -W es te rn T er ai R eg io n St an da rd e rro rs , c oe ffic ien ts of va ria tio n, d es ign e ffe cts (d ef f), sq ua re ro ot o f d es ign e ffe cts (d ef t) an d co nf ide nc e int er va ls fo r s ele cte d ind ica to rs , N ep al, 2 01 4 M IC S In dic at or M DG In dic at or Va lue (r) St an da rd er ro r ( se ) Co ef fic ien t of va ria tio n (s e/ r) De sig n ef fe ct (d ef f) Sq ua re ro ot o f de sig n ef fe ct (d ef t) W eig ht ed co un t Un we igh te d co un t Co nf ide nc e lim its r - 2 se r + 2 se HO US EH OL DS Io diz ed sa lt c on su m pt ion 2. 19 0. 76 94 0. 02 90 0. 03 8 3. 57 6 1. 89 1 67 1 75 8 0. 71 1 0. 82 7 HO US EH OL D M EM BE RS Us e of im pr ov ed d rin kin g wa te r s ou rc es 4. 1 7. 8 0. 90 31 0. 02 79 0. 03 1 6. 76 5 2. 60 1 32 76 75 9 0. 84 7 0. 95 9 Us e of im pr ov ed sa nit at ion 4. 3 7. 9 0. 65 63 0. 03 86 0. 05 9 5. 01 5 2. 24 0 32 76 75 9 0. 57 9 0. 73 4 Pr im ar y s ch oo l n et a tte nd an ce ra tio (a dju ste d) 7. 4 2. 1 0. 80 85 0. 02 65 0. 03 3 1. 83 5 1. 35 5 38 3 40 7 0. 75 6 0. 86 1 Se co nd ar y s ch oo l n et a tte nd an ce ra tio (a dju ste d) 7. 5 0. 59 51 0. 03 60 0. 06 1 2. 62 0 1. 61 8 45 6 48 7 0. 52 3 0. 66 7 Ch ild la bo ur 8. 2 0. 36 78 0. 02 75 0. 07 5 1. 54 9 1. 24 5 11 28 47 8 0. 31 3 0. 42 3 Vi ole nt d isc ipl ine 8. 3 0. 76 72 0. 02 83 0. 03 7 2. 08 9 1. 44 5 10 67 46 8 0. 71 1 0. 82 4 W OM EN In fa nt m or ta lity ra te 1. 2 4. 2 30 .3 25 2 15 .6 05 5 24 3. 53 2 na na na na -0 .8 86 61 .5 36 Un de r-f ive m or ta lity ra te 1. 5 4. 1 41 .5 88 6 19 .8 34 4 39 3. 40 4 na na na na 1. 92 0 81 .2 57 Ad ole sc en t b irt h ra te 5. 1 5. 4 75 .5 35 9 14 .5 62 8 21 2. 07 5 na na na na 46 .4 10 10 4. 66 2 Co nt ra ce pt ive p re va len ce 5. 3 5. 3 0. 55 57 0. 02 80 0. 05 0 2. 35 8 1. 53 6 67 0 74 1 0. 50 0 0. 61 2 Un m et n ee d 5. 4 5. 6 0. 21 94 0. 02 04 0. 09 3 1. 79 5 1. 34 0 67 0 74 1 0. 17 9 0. 26 0 An te na ta l c ar e co ve ra ge (1 + tim es , s kil led p ro vid er ) 5. 5a 5. 5 0. 58 94 0. 05 46 0. 09 3 1. 41 4 1. 18 9 11 3 11 6 0. 48 0 0. 69 9 An te na ta l c ar e co ve ra ge (4 + tim es , a ny p ro vid er ) 5. 5b 5. 5 0. 70 65 0. 03 34 0. 04 7 .6 20 .7 87 11 3 11 6 0. 64 0 0. 77 3 Sk ille d at te nd an t a t d eli ve ry 5. 7 5. 2 0. 64 75 0. 06 40 0. 09 9 2. 06 4 1. 43 7 11 3 11 6 0. 52 0 0. 77 6 Lit er ac y r at e (y ou ng w om en ) 7. 1 2. 3 0. 78 26 0. 03 86 0. 04 9 3. 15 7 1. 77 7 34 1 36 1 0. 70 5 0. 86 0 Kn ow led ge a bo ut H IV p re ve nt ion (y ou ng w om en ) 9. 1 6. 3 0. 29 18 0. 03 05 0. 10 4 1. 61 6 1. 27 1 34 1 36 1 0. 23 1 0. 35 3 Pr eg na nt w om en - 0. 03 08 0. 00 75 0. 24 5 1. 80 1 1. 34 2 85 5 94 9 0. 01 6 0. 04 6 In sti tu tio na l d eli ve rie s 5. 8 0. 67 03 0. 05 79 0. 08 6 1. 74 3 1. 32 0 11 3 11 6 0. 55 5 0. 78 6 Ca es ar ea n se cti on 5. 9 0. 03 59 0. 01 46 0. 40 7 .7 11 .8 43 11 3 11 6 0. 00 7 0. 06 5 M ar ria ge b ef or e ag e 18 8. 5 0. 51 51 0. 02 21 0. 04 3 1. 47 2 1. 21 3 66 9 75 5 0. 47 1 0. 55 9 Po lyg yn y 8. 7 0. 04 18 0. 01 30 0. 31 1 3. 12 7 1. 76 8 67 0 74 1 0. 01 6 0. 06 8 Kn ow led ge o f m ot he r-t o- ch ild tr an sm iss ion o f H IV 9. 2 0. 41 06 0. 02 27 0. 05 5 2. 02 2 1. 42 2 85 5 94 9 0. 36 5 0. 45 6 Ac ce pt ing a ttit ud es to wa rd s p eo ple liv ing w ith H IV 9. 3 0. 49 23 0. 03 81 0. 07 7 4. 31 6 2. 07 8 65 0 74 5 0. 41 6 0. 56 8 W om en w ho h av e be en te ste d fo r H IV a nd kn ow th e re su lts 9. 5 0. 03 41 0. 00 83 0. 24 4 1. 99 8 1. 41 3 85 5 94 9 0. 01 7 0. 05 1 UN DE R- 5s Un de rw eig ht p re va len ce (m od er at e an d se ve re ) 2. 1a 1. 8 0. 31 22 0. 03 91 0. 12 5 2. 09 6 1. 44 8 28 3 29 6 0. 23 4 0. 39 0 Un de rw eig ht p re va len ce (s ev er e) 2. 1b 1. 8 0. 05 78 0. 02 57 0. 44 5 3. 58 1 1. 89 2 28 3 29 6 0. 00 6 0. 10 9 An ti- m ala ria l tr ea tm en t o f c hil dr en u nd er a ge 5 3. 22 6. 8 0. 00 00 0. 00 00 60 62 0. 00 0 0. 00 0 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014274 Ne pa l  M IC S  2 01 4   34   Ta bl e SE .1 6: S am pl in g er ro rs : M id -W es te rn T er ai R eg io n St an da rd e rro rs , c oe ffic ien ts of va ria tio n, d es ign e ffe cts (d ef f), sq ua re ro ot o f d es ign e ffe cts (d ef t) an d co nf ide nc e int er va ls fo r s ele cte d ind ica to rs , N ep al, 2 01 4 M IC S In dic at or M DG In dic at or Va lue (r) St an da rd er ro r ( se ) Co ef fic ien t of va ria tio n (s e/ r) De sig n ef fe ct (d ef f) Sq ua re ro ot o f de sig n ef fe ct (d ef t) W eig ht ed co un t Un we igh te d co un t Co nf ide nc e lim its r - 2 se r + 2 se Ex clu siv e br ea stf ee din g un de r 6 m on th s 2. 7 0. 45 46 0. 08 45 0. 18 6 0. 54 7 .7 40 22 20 0. 28 6 0. 62 4 Ag e- ap pr op ria te b re as tfe ed ing 2. 12 0. 74 98 0. 05 85 0. 07 8 2. 02 8 1. 42 4 10 8 11 2 0. 63 3 0. 86 7 Di ar rh oe a in th e pr ev iou s 2 w ee ks - 0. 13 20 0. 01 97 0. 14 9 1. 02 2 1. 01 1 29 1 30 3 0. 09 3 0. 17 1 Illn es s w ith a co ug h in th e pr ev iou s 2 w ee ks - 0. 11 36 0. 02 06 0. 18 1 1. 27 4 1. 12 9 29 1 30 3 0. 07 2 0. 15 5 Fe ve r i n las t t wo w ee ks - 0. 20 74 0. 03 60 0. 17 4 2. 38 4 1. 54 4 29 1 30 3 0. 13 5 0. 27 9 Or al re hy dr at ion th er ap y w ith co nt inu ed fe ed ing 3. 12 0. 40 78 0. 07 60 0. 18 6 0. 95 6 0. 97 8 38 41 0. 25 6 0. 56 0 An tib iot ic tre at m en t o f s us pe cte d pn eu m on ia 3. 14 0. 64 26 0. 03 67 0. 05 7 0. 21 1 0. 45 9 33 37 0. 56 9 0. 71 6 Su pp or t f or le ar nin g 6. 2 0. 63 25 0. 03 30 0. 05 2 0. 61 8 0. 78 6 12 4 13 3 0. 56 7 0. 69 8 At te nd an ce to e ar ly ch ild ho od e du ca tio n 6. 1 0. 39 30 0. 04 59 0. 11 7 1. 16 7 1. 08 0 12 4 13 3 0. 30 1 0. 48 5 Bi rth re gis tra tio n 8. 1 0. 66 41 0. 02 01 0. 03 0 0. 54 9 0. 74 1 29 1 30 3 0. 62 4 0. 70 4 To ta l fe rti lity ra te (3 ye ar s) - 2. 04 42 0. 24 18 0. 05 8 na na na na 1. 56 1 2. 52 8 Ne on at al m or ta lity ra te 1. 1 22 .3 35 9 9. 48 82 90 .0 27 na na na na 3. 35 9 41 .3 12 Po st- ne on at al m or ta lity ra te 1. 3 7. 98 93 7. 70 14 59 .3 12 na na na na -7 .4 14 23 .3 92 Ch ild m or ta lity ra te 1. 4 11 .6 15 7 6. 12 02 37 .4 57 na na na na -0 .6 25 23 .8 56 C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 275 Ne pa l  M IC S  2 01 4   35   Ta bl e SE .1 7: S am pl in g er ro rs : F ar W es te rn M ou nt ai ns R eg io n St an da rd e rro rs , c oe ffic ien ts of va ria tio n, d es ign e ffe cts (d ef f), sq ua re ro ot o f d es ign e ffe cts (d ef t) an d co nf ide nc e int er va ls fo r s ele cte d ind ica to rs , N ep al, 2 01 4 M IC S In dic at or M DG In dic at or Va lue (r) St an da rd er ro r ( se ) Co ef fic ien t of va ria tio n (s e/ r) De sig n ef fe ct (d ef f) Sq ua re ro ot o f de sig n ef fe ct (d ef t) W eig ht ed co un t Un we igh te d co un t Co nf ide nc e lim its r - 2 se r + 2 se HO US EH OL DS Io diz ed sa lt c on su m pt ion 2. 19 0. 79 78 0. 04 68 0. 05 9 10 .2 37 3. 20 0 18 4 75 4 0. 70 4 0. 89 1 HO US EH OL D M EM BE RS Us e of im pr ov ed d rin kin g wa te r s ou rc es 4. 1 7. 8 0. 93 24 0. 01 66 0. 01 8 3. 32 2 1. 82 3 10 14 75 9 0. 89 9 0. 96 6 Us e of im pr ov ed sa nit at ion 4. 3 7. 9 0. 85 16 0. 03 51 0. 04 1 7. 40 9 2. 72 2 10 14 75 9 0. 78 1 0. 92 2 Pr im ar y s ch oo l n et a tte nd an ce ra tio (a dju ste d) 7. 4 2. 1 0. 91 46 0. 01 18 0. 01 3 1. 18 7 1. 08 9 16 2 66 4 0. 89 1 0. 93 8 Se co nd ar y s ch oo l n et a tte nd an ce ra tio (a dju ste d) 7. 5 0. 69 41 0. 02 73 0. 03 9 2. 09 3 1. 44 7 14 5 59 6 0. 63 9 0. 74 9 Ch ild la bo ur 8. 2 0. 59 23 0. 02 90 0. 04 9 1. 77 5 1. 33 2 14 80 50 9 0. 53 4 0. 65 0 Vi ole nt d isc ipl ine 8. 3 0. 85 94 0. 01 41 0. 01 6 0. 92 9 0. 96 4 16 05 56 7 0. 83 1 0. 88 8 W OM EN In fa nt m or ta lity ra te 1. 2 4. 2 44 .0 50 3 10 .1 76 6 10 3. 56 4 na na na na 23 .6 97 64 .4 04 Un de r-f ive m or ta lity ra te 1. 5 4. 1 57 .8 49 4 11 .2 68 9 12 6. 98 7 na na na na 35 .3 12 80 .3 87 Ad ole sc en t b irt h ra te 5. 1 5. 4 62 .9 48 8 12 .6 75 1 16 0. 65 9 na na na na 37 .5 99 88 .2 99 0 Co nt ra ce pt ive p re va len ce 5. 3 5. 3 0. 53 85 0. 02 44 0. 04 5 1. 78 9 1. 33 7 17 6 74 9 0. 49 0 0. 58 7 Un m et n ee d 5. 4 5. 6 0. 20 15 0. 01 73 0. 08 6 1. 39 1 1. 17 9 17 6 74 9 0. 16 7 0. 23 6 An te na ta l c ar e co ve ra ge (1 + tim es , s kil led p ro vid er ) 5. 5a 5. 5 0. 16 14 0. 04 25 0. 26 3 1. 82 9 1. 35 2 33 13 8 0. 07 6 0. 24 6 An te na ta l c ar e co ve ra ge (4 + tim es , a ny p ro vid er ) 5. 5b 5. 5 0. 54 73 0. 06 28 0. 11 5 2. 18 1 1. 47 7 33 13 8 0. 42 2 0. 67 3 Sk ille d at te nd an t a t d eli ve ry 5. 7 5. 2 0. 27 04 0. 05 12 0. 19 0 1. 82 4 1. 35 1 33 13 8 0. 16 8 0. 37 3 Lit er ac y r at e (y ou ng w om en ) 7. 1 2. 3 0. 80 53 0. 02 46 0. 03 1 1. 28 7 1. 13 5 78 33 5 0. 75 6 0. 85 4 Kn ow led ge a bo ut H IV p re ve nt ion (y ou ng w om en ) 9. 1 6. 3 0. 51 51 0. 02 33 0. 04 5 0. 72 9 0. 85 4 78 33 5 0. 46 8 0. 56 2 Pr eg na nt w om en - 0. 03 87 0. 00 59 0. 15 3 0. 91 4 0. 95 6 22 5 96 5 0. 02 7 0. 05 1 In sti tu tio na l d eli ve rie s 5. 8 0. 32 66 0. 06 28 0. 19 2 2. 46 0 1. 56 9 33 13 8 0. 20 1 0. 45 2 Ca es ar ea n se cti on 5. 9 0. 00 62 0. 00 62 0. 99 9 0. 84 7 0. 92 1 33 13 8 0. 00 0 0. 01 8 M ar ria ge b ef or e ag e 18 8. 5 0. 56 17 0. 02 60 0. 04 6 2. 10 7 1. 45 2 18 1 77 0 0. 51 0 0. 61 4 Po lyg yn y 8. 7 0. 02 97 0. 00 76 0. 25 6 1. 50 1 1. 22 5 17 6 74 9 0. 01 4 0. 04 5 Kn ow led ge o f m ot he r-t o- ch ild tr an sm iss ion o f H IV 9. 2 0. 46 56 0. 01 38 0. 03 0 0. 73 8 0. 85 9 22 5 96 5 0. 43 8 0. 49 3 Ac ce pt ing a ttit ud es to wa rd s p eo ple liv ing w ith H IV 9. 3 0. 53 55 0. 02 74 0. 05 1 2. 02 2 1. 42 2 15 6 67 2 0. 48 1 0. 59 0 W om en w ho h av e be en te ste d fo r H IV a nd kn ow th e re su lts 9. 5 0. 01 38 0. 00 43 0. 31 5 1. 33 0 1. 15 3 22 5 96 5 0. 00 5 0. 02 2 UN DE R- 5s Un de rw eig ht p re va len ce (m od er at e an d se ve re ) 2. 1a 1. 8 0. 28 95 0. 03 88 0. 13 4 3. 00 8 1. 73 4 98 41 3 0. 21 2 0. 36 7 Un de rw eig ht p re va len ce (s ev er e) 2. 1b 1. 8 0. 07 35 0. 01 65 0. 22 5 1. 65 4 1. 28 6 98 41 3 0. 04 0 0. 10 7 An ti- m ala ria l tr ea tm en t o f c hil dr en u nd er a ge 5 3. 22 6. 8 0. 00 00 0. 00 00 26 11 1 0. 00 0 0. 00 0 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014276 Ne pa l  M IC S  2 01 4   36   Ta bl e SE .1 7: S am pl in g er ro rs : F ar W es te rn M ou nt ai ns R eg io n St an da rd e rro rs , c oe ffic ien ts of va ria tio n, d es ign e ffe cts (d ef f), sq ua re ro ot o f d es ign e ffe cts (d ef t) an d co nf ide nc e int er va ls fo r s ele cte d ind ica to rs , N ep al, 2 01 4 M IC S In dic at or M DG In dic at or Va lue (r) St an da rd er ro r ( se ) Co ef fic ien t of va ria tio n (s e/ r) De sig n ef fe ct (d ef f) Sq ua re ro ot o f de sig n ef fe ct (d ef t) W eig ht ed co un t Un we igh te d co un t Co nf ide nc e lim its r - 2 se r + 2 se Ex clu siv e br ea stf ee din g un de r 6 m on th s 2. 7 0. 49 88 0. 09 98 0. 20 0 1. 23 6 1. 11 2 8 32 0. 29 9 0. 69 8 Ag e- ap pr op ria te b re as tfe ed ing 2. 12 0. 75 03 0. 04 59 0. 06 1 1. 53 1 1. 23 7 33 13 7 0. 65 8 0. 84 2 Di ar rh oe a in th e pr ev iou s 2 w ee ks - 0. 16 02 0. 01 60 0. 10 0 0. 79 5 0. 89 1 10 0 42 0 0. 12 8 0. 19 2 Illn es s w ith a co ug h in th e pr ev iou s 2 w ee ks - 0. 06 21 0. 01 63 0. 26 2 1. 89 9 1. 37 8 10 0 42 0 0. 03 0 0. 09 5 Fe ve r i n las t t wo w ee ks - 0. 26 26 0. 02 00 0. 07 6 0. 86 8 0. 93 2 10 0 42 0 0. 22 3 0. 30 3 Or al re hy dr at ion th er ap y w ith co nt inu ed fe ed ing 3. 12 0. 82 70 0. 03 66 0. 04 4 0. 62 6 0. 79 1 16 68 0. 75 4 0. 90 0 An tib iot ic tre at m en t o f s us pe cte d pn eu m on ia 3. 14 0. 57 46 0. 05 53 0. 09 6 0. 30 1 0. 54 8 6 25 0. 46 4 0. 68 5 Su pp or t f or le ar nin g 6. 2 0. 80 13 0. 02 85 0. 03 6 0. 95 8 0. 97 9 45 18 9 0. 74 4 0. 85 8 At te nd an ce to e ar ly ch ild ho od e du ca tio n 6. 1 0. 44 37 0. 04 12 0. 09 3 1. 29 0 1. 13 6 45 18 9 0. 36 1 0. 52 6 Bi rth re gis tra tio n 8. 1 0. 41 71 0. 03 80 0. 09 1 2. 48 2 1. 57 5 10 0 42 0 0. 34 1 0. 49 3 To ta l fe rti lity ra te (3 ye ar s) - 2. 58 26 0. 19 16 0. 03 7 na na na na 2. 19 9 2. 96 6 Ne on at al m or ta lity ra te 1. 1 25 .3 45 5 7. 20 02 51 .8 43 na na na na 10 .9 45 39 .7 46 Po st- ne on at al m or ta lity ra te 1. 3 18 .7 04 8 6. 97 91 48 .7 08 na na na na 4. 74 7 32 .6 63 Ch ild m or ta lity ra te 1. 4 14 .4 34 9 4. 82 30 23 .2 62 na na na na 4. 78 9 24 .0 81 C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 277 Ne pa l  M IC S  2 01 4   37   Ta bl e SE .1 8: S am pl in g er ro rs : F ar W es te rn H ill s Re gi on St an da rd e rro rs , c oe ffic ien ts of va ria tio n, d es ign e ffe cts (d ef f), sq ua re ro ot o f d es ign e ffe cts (d ef t) an d co nf ide nc e int er va ls fo r s ele cte d ind ica to rs , N ep al, 2 01 4 M IC S In dic at or M DG In dic at or Va lue (r) St an da rd er ro r ( se ) Co ef fic ien t of va ria tio n (s e/ r) De sig n ef fe ct (d ef f) Sq ua re ro ot o f de sig n ef fe ct (d ef t) W eig ht ed co un t Un we igh te d co un t Co nf ide nc e lim its r - 2 se r + 2 se HO US EH OL DS Io diz ed sa lt c on su m pt ion 2. 19 0. 53 53 0. 03 95 0. 07 4 4. 61 8 2. 14 9 34 6 73 6 0. 45 6 0. 61 4 HO US EH OL D M EM BE RS Us e of im pr ov ed d rin kin g wa te r s ou rc es 4. 1 7. 8 0. 90 06 0. 03 19 0. 03 5 8. 36 1 2. 89 1 18 80 73 6 0. 83 7 0. 96 4 Us e of im pr ov ed sa nit at ion 4. 3 7. 9 0. 80 11 0. 06 12 0. 07 6 17 .2 90 4. 15 8 18 80 73 6 0. 67 9 0. 92 4 Pr im ar y s ch oo l n et a tte nd an ce ra tio (a dju ste d) 7. 4 2. 1 0. 85 77 0. 02 49 0. 02 9 2. 75 0 1. 65 8 26 7 54 2 0. 80 8 0. 90 8 Se co nd ar y s ch oo l n et a tte nd an ce ra tio (a dju ste d) 7. 5 0. 60 04 0. 03 25 0. 05 4 2. 26 1 1. 50 4 24 7 51 4 0. 53 5 0. 66 5 Ch ild la bo ur 8. 2 0. 58 85 0. 03 31 0. 05 6 2. 11 3 1. 45 4 13 48 46 8 0. 52 2 0. 65 5 Vi ole nt d isc ipl ine 8. 3 0. 83 92 0. 01 72 0. 02 0 1. 10 7 1. 05 2 14 36 50 8 0. 80 5 0. 87 4 W OM EN In fa nt m or ta lity ra te 1. 2 4. 2 49 .7 49 7 11 .8 70 9 14 0. 91 9 na na na na 26 .0 08 73 .4 92 Un de r-f ive m or ta lity ra te 1. 5 4. 1 59 .3 16 1 11 .9 07 1 14 1. 77 8 na na na na 35 .5 02 83 .1 30 Ad ole sc en t b irt h ra te 5. 1 5. 4 60 .2 27 2 12 .2 56 7 15 0. 22 7 na na na na 35 .7 14 84 .7 41 Co nt ra ce pt ive p re va len ce 5. 3 5. 3 0. 42 14 0. 01 98 0. 04 7 1. 10 8 1. 05 3 32 5 69 2 0. 38 2 0. 46 1 Un m et n ee d 5. 4 5. 6 0. 28 87 0. 01 60 0. 05 5 .8 59 .9 27 32 5 69 2 0. 25 7 0. 32 1 An te na ta l c ar e co ve ra ge (1 + tim es , s kil led p ro vid er ) 5. 5a 5. 5 0. 17 32 0. 02 59 0. 15 0 0. 73 8 0. 85 9 75 15 8 0. 12 1 0. 22 5 An te na ta l c ar e co ve ra ge (4 + tim es , a ny p ro vid er ) 5. 5b 5. 5 0. 59 46 0. 05 88 0. 09 9 2. 25 2 1. 50 1 75 15 8 0. 47 7 0. 71 2 Sk ille d at te nd an t a t d eli ve ry 5. 7 5. 2 0. 35 86 0. 04 25 0. 11 8 1. 23 1 1. 11 0 75 15 8 0. 27 4 0. 44 4 Lit er ac y r at e (y ou ng w om en ) 7. 1 2. 3 0. 78 50 0. 03 28 0. 04 2 2. 49 9 1. 58 1 18 3 39 3 0. 71 9 0. 85 1 Kn ow led ge a bo ut H IV p re ve nt ion (y ou ng w om en ) 9. 1 6. 3 0. 47 20 0. 02 72 0. 05 8 1. 16 6 1. 08 0 18 3 39 3 0. 41 7 0. 52 6 Pr eg na nt w om en - 0. 04 48 0. 00 69 0. 15 4 1. 03 1 1. 01 6 43 3 92 7 0. 03 1 0. 05 9 In sti tu tio na l d eli ve rie s 5. 8 0. 50 03 0. 05 55 0. 11 1 1. 93 4 1. 39 1 75 15 8 0. 38 9 0. 61 1 Ca es ar ea n se cti on 5. 9 0. 01 45 0. 00 85 0. 58 7 0. 79 5 0. 89 2 75 15 8 0. 00 0 0. 03 1 M ar ria ge b ef or e ag e 18 8. 5 0. 55 76 0. 02 08 0. 03 7 1. 24 1 1. 11 4 32 9 71 0 0. 51 6 0. 59 9 Po lyg yn y 8. 7 0. 04 01 0. 00 83 0. 20 7 1. 23 2 1. 11 0 32 5 69 2 0. 02 4 0. 05 7 Kn ow led ge o f m ot he r-t o- ch ild tr an sm iss ion o f H IV 9. 2 0. 48 21 0. 02 09 0. 04 3 1. 62 2 1. 27 4 43 3 92 7 0. 44 0 0. 52 4 Ac ce pt ing a ttit ud es to wa rd s p eo ple liv ing w ith H IV 9. 3 0. 56 00 0. 01 96 0. 03 5 1. 09 8 1. 04 8 32 3 70 5 0. 52 1 0. 59 9 W om en w ho h av e be en te ste d fo r H IV a nd kn ow th e re su lts 9. 5 0. 03 08 0. 00 73 0. 23 6 1. 63 7 1. 27 9 43 3 92 7 0. 01 6 0. 04 5 UN DE R- 5s Un de rw eig ht p re va len ce (m od er at e an d se ve re ) 2. 1a 1. 8 0. 43 75 0. 02 08 0. 04 8 0. 75 6 0. 86 9 20 7 43 1 0. 39 6 0. 47 9 Un de rw eig ht p re va len ce (s ev er e) 2. 1b 1. 8 0. 17 83 0. 01 97 0. 11 0 1. 13 9 1. 06 7 20 7 43 1 0. 13 9 0. 21 8 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014278 Ne pa l  M IC S  2 01 4   38   Ta bl e SE .1 8: S am pl in g er ro rs : F ar W es te rn H ill s Re gi on St an da rd e rro rs , c oe ffic ien ts of va ria tio n, d es ign e ffe cts (d ef f), sq ua re ro ot o f d es ign e ffe cts (d ef t) an d co nf ide nc e int er va ls fo r s ele cte d ind ica to rs , N ep al, 2 01 4 M IC S In dic at or M DG In dic at or Va lue (r) St an da rd er ro r ( se ) Co ef fic ien t of va ria tio n (s e/ r) De sig n ef fe ct (d ef f) Sq ua re ro ot o f de sig n ef fe ct (d ef t) W eig ht ed co un t Un we igh te d co un t Co nf ide nc e lim its r - 2 se r + 2 se An ti- m ala ria l tr ea tm en t o f c hil dr en u nd er a ge 5 3. 22 6. 8 0. 00 00 0. 00 00 37 80 0. 00 0 0. 00 0 Ex clu siv e br ea stf ee din g un de r 6 m on th s 2. 7 0. 59 62 0. 06 17 0. 10 3 0. 53 7 0. 73 3 16 35 0. 47 3 0. 72 0 Ag e- ap pr op ria te b re as tfe ed ing 2. 12 0. 80 92 0. 03 16 0. 03 9 1. 00 7 1. 00 3 76 15 7 0. 74 6 0. 87 2 Di ar rh oe a in th e pr ev iou s 2 w ee ks - 0. 16 04 0. 02 21 0. 13 8 1. 57 8 1. 25 6 21 0 43 5 0. 11 6 0. 20 5 Illn es s w ith a co ug h in th e pr ev iou s 2 w ee ks - 0. 05 65 0. 01 03 0. 18 3 0. 86 8 0. 93 1 21 0 43 5 0. 03 6 0. 07 7 Fe ve r i n las t t wo w ee ks - 0. 17 66 0. 01 73 0. 09 8 0. 89 2 0. 94 4 21 0 43 5 0. 14 2 0. 21 1 Or al re hy dr at ion th er ap y w ith co nt inu ed fe ed ing 3. 12 0. 64 32 0. 05 01 0. 07 8 0. 75 3 0. 86 8 34 70 0. 54 3 0. 74 3 An tib iot ic tre at m en t o f s us pe cte d pn eu m on ia 3. 14 0. 17 40 0. 05 34 0. 30 7 0. 47 6 0. 69 0 12 25 0. 06 7 0. 28 1 Su pp or t f or le ar nin g 6. 2 0. 29 42 0. 05 31 0. 18 1 2. 76 0 1. 66 1 97 20 4 0. 18 8 0. 40 0 At te nd an ce to e ar ly ch ild ho od e du ca tio n 6. 1 0. 28 92 0. 03 22 0. 11 1 1. 02 3 1. 01 2 97 20 4 0. 22 5 0. 35 4 Bi rth re gis tra tio n 8. 1 0. 40 68 0. 03 04 0. 07 5 1. 66 1 1. 28 9 21 0 43 5 0. 34 6 0. 46 8 To ta l fe rti lity ra te (3 ye ar s) - 2. 95 41 0. 24 41 0. 06 0 na na na na 2. 46 6 3. 44 2 Ne on at al m or ta lity ra te 1. 1 25 .6 04 5 8. 00 92 64 .1 47 na na na na 9. 58 6 41 .6 23 Po st- ne on at al m or ta lity ra te 1. 3 24 .1 45 3 7. 28 18 53 .0 24 na na na na 9. 58 2 38 .7 09 Ch ild m or ta lity ra te 1. 4 10 .0 67 2 5. 03 23 25 .3 24 na na na na 0. 00 3 20 .1 32 C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 279 Ne pa l  M IC S  2 01 4   39   Ta bl e SE .1 9: S am pl in g er ro rs : F ar W es te rn T er ai R eg io n St an da rd e rro rs , c oe ffic ien ts of va ria tio n, d es ign e ffe cts (d ef f), sq ua re ro ot o f d es ign e ffe cts (d ef t) an d co nf ide nc e int er va ls fo r s ele cte d ind ica to rs , N ep al, 2 01 4 M IC S In dic at or M DG In dic at or Va lue (r) St an da rd er ro r ( se ) Co ef fic ien t of va ria tio n (s e/ r) De sig n ef fe ct (d ef f) Sq ua re ro ot o f de sig n ef fe ct (d ef t) W eig ht ed co un t Un we igh te d co un t Co nf ide nc e lim its r - 2 se r + 2 se HO US EH OL DS Io diz ed sa lt c on su m pt ion 2. 19 0. 72 27 0. 03 99 0. 05 5 5. 88 3 2. 42 5 52 2 74 2 0. 64 3 0. 80 2 HO US EH OL D M EM BE RS Us e of im pr ov ed d rin kin g wa te r s ou rc es 4. 1 7. 8 0. 98 81 0. 00 83 0. 00 8 4. 39 8 2. 09 7 26 97 74 4 0. 97 1 1. 00 0 Us e of im pr ov ed sa nit at ion 4. 3 7. 9 0. 55 29 0. 05 17 0. 09 4 8. 03 4 2. 83 4 26 97 74 4 0. 45 0 0. 65 6 Pr im ar y s ch oo l n et a tte nd an ce ra tio (a dju ste d) 7. 4 2. 1 0. 89 37 0. 02 56 0. 02 9 2. 76 9 1. 66 4 29 6 40 3 0. 84 3 0. 94 5 Se co nd ar y s ch oo l n et a tte nd an ce ra tio (a dju ste d) 7. 5 0. 75 37 0. 02 43 0. 03 2 1. 61 0 1. 26 9 37 1 50 7 0. 70 5 0. 80 2 Ch ild la bo ur 8. 2 0. 37 23 0. 03 49 0. 09 4 2. 54 9 1. 59 7 11 41 49 0 0. 30 3 0. 44 2 Vi ole nt d isc ipl ine 8. 3 0. 75 01 0. 02 91 0. 03 9 2. 12 8 1. 45 9 11 20 47 1 0. 69 2 0. 80 8 W OM EN In fa nt m or ta lity ra te 1. 2 4. 2 51 .1 14 3 12 .9 98 6 16 8. 96 4 na na na na 25 .1 17 77 .1 12 Un de r-f ive m or ta lity ra te 1. 5 4. 1 58 .7 67 2 15 .6 84 8 24 6. 01 3 na na na na 27 .3 98 90 .1 37 Ad ole sc en t b irt h ra te 5. 1 5. 4 53 .0 76 7 10 .4 37 4 10 8. 94 0 na na na na 32 .2 02 73 .9 52 Co nt ra ce pt ive p re va len ce 5. 3 5. 3 0. 61 86 0. 01 97 0. 03 2 1. 22 5 1. 10 7 54 0 74 8 0. 57 9 0. 65 8 Un m et n ee d 5. 4 5. 6 0. 17 97 0. 01 27 0. 07 1 .8 18 0. 90 5 54 0 74 8 0. 15 4 0. 20 5 An te na ta l c ar e co ve ra ge (1 + tim es , s kil led p ro vid er ) 5. 5a 5. 5 0. 33 83 0. 05 71 0. 16 9 2. 03 9 1. 42 8 10 6 14 1 0. 22 4 0. 45 3 An te na ta l c ar e co ve ra ge (4 + tim es , a ny p ro vid er ) 5. 5b 5. 5 0. 73 39 0. 04 06 0. 05 5 1. 18 4 1. 08 8 10 6 14 1 0. 65 3 0. 81 5 Sk ille d at te nd an t a t d eli ve ry 5. 7 5. 2 0. 70 74 0. 03 04 0. 04 3 .6 26 0. 79 1 10 6 14 1 0. 64 7 0. 76 8 Lit er ac y r at e (y ou ng w om en ) 7. 1 2. 3 0. 92 52 0. 01 89 0. 02 0 2. 12 7 1. 45 8 29 5 41 3 0. 88 7 0. 96 3 Kn ow led ge a bo ut H IV p re ve nt ion (y ou ng w om en ) 9. 1 6. 3 0. 35 41 0. 03 12 0. 08 8 1. 75 1 1. 32 3 29 5 41 3 0. 29 2 0. 41 6 Pr eg na nt w om en - 0. 04 34 0. 00 84 0. 19 3 1. 72 8 1. 31 5 73 5 10 29 0. 02 7 0. 06 0 In sti tu tio na l d eli ve rie s 5. 8 0. 74 52 0. 04 17 0. 05 6 1. 28 3 1. 13 3 10 6 14 1 0. 66 2 0. 82 9 Ca es ar ea n se cti on 5. 9 0. 03 15 0. 01 64 0. 52 3 1. 24 2 1. 11 4 10 6 14 1 0. 00 0 0. 06 4 M ar ria ge b ef or e ag e 18 8. 5 0. 48 74 0. 02 38 0. 04 9 1. 88 2 1. 37 2 58 8 83 1 0. 44 0 0. 53 5 Po lyg yn y 8. 7 0. 06 13 0. 01 15 0. 18 7 1. 70 8 1. 30 7 54 0 74 8 0. 03 8 0. 08 4 Kn ow led ge o f m ot he r-t o- ch ild tr an sm iss ion o f H IV 9. 2 0. 47 51 0. 02 65 0. 05 6 2. 88 7 1. 69 9 73 5 10 29 0. 42 2 0. 52 8 Ac ce pt ing a ttit ud es to wa rd s p eo ple liv ing w ith H IV 9. 3 0. 35 71 0. 01 75 0. 04 9 1. 02 6 1. 01 3 54 5 77 4 0. 32 2 0. 39 2 W om en w ho h av e be en te ste d fo r H IV a nd kn ow th e re su lts 9. 5 0. 03 09 0. 00 70 0. 22 6 1. 66 8 1. 29 2 73 5 10 29 0. 01 7 0. 04 5 UN DE R- 5s Un de rw eig ht p re va len ce (m od er at e an d se ve re ) 2. 1a 1. 8 0. 22 48 0. 02 59 0. 11 5 1. 04 3 1. 02 1 18 9 27 3 0. 17 3 0. 27 7 Un de rw eig ht p re va len ce (s ev er e) 2. 1b 1. 8 0. 04 82 0. 01 87 0. 38 8 2. 07 6 1. 44 1 18 9 27 3 0. 01 1 0. 08 6 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014280 Ne pa l  M IC S  2 01 4   40   Ta bl e SE .1 9: S am pl in g er ro rs : F ar W es te rn T er ai R eg io n St an da rd e rro rs , c oe ffic ien ts of va ria tio n, d es ign e ffe cts (d ef f), sq ua re ro ot o f d es ign e ffe cts (d ef t) an d co nf ide nc e int er va ls fo r s ele cte d ind ica to rs , N ep al, 2 01 4 M IC S In dic at or M DG In dic at or Va lue (r) St an da rd er ro r ( se ) Co ef fic ien t of va ria tio n (s e/ r) De sig n ef fe ct (d ef f) Sq ua re ro ot o f de sig n ef fe ct (d ef t) W eig ht ed co un t Un we igh te d co un t Co nf ide nc e lim its r - 2 se r + 2 se An ti- m ala ria l tr ea tm en t o f c hil dr en u nd er a ge 5 3. 22 6. 8 0. 00 00 0. 00 00 37 53 0. 00 0 0. 00 0 Ex clu siv e br ea stf ee din g un de r 6 m on th s 2. 7 0. 72 22 0. 04 77 0. 06 6 0. 46 5 0. 68 2 30 42 0. 62 7 0. 81 8 Ag e- ap pr op ria te b re as tfe ed ing 2. 12 0. 76 97 0. 04 26 0. 05 5 1. 34 3 1. 15 9 96 13 2 0. 68 4 0. 85 5 Di ar rh oe a in th e pr ev iou s 2 w ee ks - 0. 06 50 0. 01 59 0. 24 5 1. 17 6 1. 08 5 19 7 28 3 0. 03 3 0. 09 7 Illn es s w ith a co ug h in th e pr ev iou s 2 w ee ks - 0. 06 59 0. 01 61 0. 24 4 1. 18 6 1. 08 9 19 7 28 3 0. 03 4 0. 09 8 Fe ve r i n las t t wo w ee ks - 0. 18 87 0. 03 25 0. 17 2 1. 95 1 1. 39 7 19 7 28 3 0. 12 4 0. 25 4 Or al re hy dr at ion th er ap y w ith co nt inu ed fe ed ing 3. 12 0. 33 59 0. 08 99 0. 26 8 0. 57 9 0. 76 1 13 17 0. 15 6 0. 51 6 An tib iot ic tre at m en t o f s us pe cte d pn eu m on ia 3. 14 0. 65 14 0. 06 30 0. 09 7 0. 33 3 0. 57 7 13 20 0. 52 5 0. 77 8 Su pp or t f or le ar nin g 6. 2 0. 71 71 0. 05 76 0. 08 0 1. 66 5 1. 29 0 68 10 3 0. 60 2 0. 83 2 At te nd an ce to e ar ly ch ild ho od e du ca tio n 6. 1 0. 44 25 0. 04 94 0. 11 2 1. 01 1 1. 00 5 68 10 3 0. 34 4 0. 54 1 Bi rth re gis tra tio n 8. 1 0. 46 17 0. 03 83 0. 08 3 1. 66 0 1. 28 8 19 7 28 3 0. 38 5 0. 53 8 To ta l fe rti lity ra te (3 ye ar s) - 1. 90 56 0. 15 74 0. 02 5 na na na na 1. 59 1 2. 22 0 Ne on at al m or ta lity ra te 1. 1 31 .8 27 1 12 .7 82 5 16 3. 39 4 na na na na 6. 26 2 57 .3 92 Po st- ne on at al m or ta lity ra te 1. 3 19 .2 87 2 8. 19 27 67 .1 20 na na na na 2. 90 2 35 .6 73 Ch ild m or ta lity ra te 1. 4 8. 06 51 5. 52 26 30 .4 99 na na na na -2 .9 80 19 .1 10 C on tin ue d NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 281 Data Quality Tables A p p e n d i xD Figure DQ.1: Household population by single ages, Nepal, 2014 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014282 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 283 Typical data quality issues: Heaping on ages with digits ending with 0 and 5. If age reporting is good, the distribution should be smooth. The table should also provide insights into over-reporting or under- reporting at certain age groups or intervals, and the extent of missing information on age. Deficits at ages 4, 15, and 49, excesses at ages 5 and 6, 14, and 50 might be indicative of out-transference of ages to avoid administering individual questionnaires. Nepal  MICS  2014   2   Table DQ.1: Age distribution of household population Single-year age distribution of household population by sex, Nepal, 2014 Age (years) Males Females Age (years) Males Females Number Percent Number Percent Number Percent Number Percent 0 588 2.2 528 1.8 45 447 1.7 399 1.3 1 589 2.2 492 1.6 46 250 0.9 259 0.9 2 571 2.1 567 1.9 47 184 0.7 191 0.6 3 589 2.2 616 2.1 48 247 0.9 217 0.7 4 614 2.3 561 1.9 49 180 0.7 125 0.4 5 605 2.2 575 1.9 50 362 1.3 506 1.7 6 647 2.4 652 2.2 51 173 0.6 294 1.0 7 703 2.6 692 2.3 52 275 1.0 378 1.3 8 687 2.6 658 2.2 53 167 0.6 225 0.8 9 534 2.0 580 1.9 54 181 0.7 213 0.7 10 808 3.0 846 2.8 55 350 1.3 334 1.1 11 625 2.3 579 1.9 56 182 0.7 210 0.7 12 756 2.8 793 2.7 57 173 0.6 149 0.5 13 651 2.4 724 2.4 58 184 0.7 174 0.6 14 713 2.6 798 2.7 59 146 0.5 132 0.4 15 645 2.4 535 1.8 60 391 1.5 419 1.4 16 604 2.2 676 2.3 61 121 0.4 145 0.5 17 533 2.0 529 1.8 62 151 0.6 141 0.5 18 671 2.5 749 2.5 63 145 0.5 117 0.4 19 414 1.5 481 1.6 64 132 0.5 107 0.4 20 519 1.9 698 2.3 65 212 0.8 274 0.9 21 379 1.4 461 1.5 66 140 0.5 123 0.4 22 377 1.4 577 1.9 67 96 0.4 107 0.4 23 330 1.2 442 1.5 68 120 0.4 95 0.3 24 341 1.3 426 1.4 69 133 0.5 106 0.4 25 437 1.6 726 2.4 70 201 0.7 223 0.7 26 332 1.2 572 1.9 71 62 0.2 58 0.2 27 296 1.1 421 1.4 72 81 0.3 85 0.3 28 392 1.5 525 1.8 73 57 0.2 50 0.2 29 261 1.0 326 1.1 74 65 0.2 36 0.1 30 494 1.8 707 2.4 75 92 0.3 96 0.3 31 271 1.0 332 1.1 76 57 0.2 42 0.1 32 350 1.3 453 1.5 77 30 0.1 18 0.1 33 214 0.8 290 1.0 78 48 0.2 28 0.1 34 268 1.0 317 1.1 79 19 0.1 27 0.1 35 556 2.1 690 2.3 80 92 0.3 97 0.3 36 274 1.0 363 1.2 81 26 0.1 24 0.1 37 202 0.7 295 1.0 82 27 0.1 26 0.1 38 298 1.1 405 1.4 83 20 0.1 5 0.0 39 203 0.8 213 0.7 84 32 0.1 16 0.1 40 484 1.8 590 2.0 85+ 89 0.3 115 0.4 41 191 0.7 252 0.8 DK/missing 1 0.0 2 0.0 42 368 1.4 350 1.2 43 201 0.7 222 0.7 44 189 0.7 237 0.8 Total 26,917 100.0 29,907 100.0   Typical  data  quality  issues:  Heaping  on  ages  with  digits  ending  with  0  and  5.  If  age  reporting  is   good,  the  distribution  should  be  smooth.  The  table  should  also  provide  insights  into  over-­‐ reporting  or  under-­‐reporting  at  certain  age  groups  or  intervals,  and  the  extent  of  missing   information  on  age.  Deficits  at  ages  4,  15,  and  49,  excesses  at  ages  5  and  6,  14,  and  50  might  be   indicative  of  out-­‐transference  of  ages  to  avoid  administering  individual  questionnaires.   NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014284 Typical data quality issues: In countries with growing populations, the percentages in each age group of women should decline with age (the second column). The last column shows whether the survey was equally effective in interviewing women in all age groups—typically, some surveys fail to interview the younger women, sometimes because of problems in sample implementation, sometimes because of interviewers’ reluctance to interview young women. These figures should be high, preferably over 95 percent, or at least 90 percent, and should not vary much by age. The distribution in the 3rd column should be similar to the distribution in the 2nd column. If completion rates vary greatly by age and fall below 85 percent in two or three groups say for groups aged 15 to 24, it may be necessary to re-calculate sample weights by taking age-specific non-response into account. Failure to do so may lead to biased estimates of indicators which typically vary by age of women. Weights used for both household population of women and interviewed women are household weights. Age is based on the household schedule. Nepal  MICS  2014   3   Table DQ.2: Age distribution of eligible and interviewed women Household population of women aged 10–54 years, interviewed women aged 15–49 years, and percentage of eligible women who were interviewed, by five-year age groups, Nepal, 2014 Household population of women aged 10–54 years Interviewed women aged 15–49 years Percent of eligible women interviewed (completion rate) Number Number Percent Age (years) 10–14 3,740 na na na 15–19 2,970 2,726 19.2 91.8 20–24 2,604 2,403 17.0 92.3 25–29 2,570 2,412 17.0 93.8 30–34 2,098 1,995 14.1 95.1 35–39 1,966 1,910 13.5 97.1 40–44 1,651 1,581 11.2 95.8 45–49 1,191 1,140 8.0 95.8 50–54 1,616 na na na Total (15–49 years) 15,050 14,168 100.0 94.1 Ratio of 50–54 to 45–49 1.36 na na na na: not applicable   Typical  data  quality  issues:  In  countries  with  growing  populations,  the  percentages  in  each  age   group  of  women  should  decline  with  age  (the  second  column).  The  last  column  shows  whether   the  survey  was  equally  effective  in  interviewing  women  in  all  age  groups—typically,  some   surveys  fail  to  interview  the  younger  women,  sometimes  because  of  problems  in  sample   implementation,  sometimes  because  of  interviewers’  reluctance  to  interview  young  women.   These  figures  should  be  high,  preferably  over  95  per  cent,  or  at  least  90  per  cent,  and  should  not   vary  much  by  age.  The  distribution  in  the  3rd  column  should  be  similar  to  the  distribution  in  the   2nd  column.    If  completion  rates  vary  greatly  by  age  and  fall  below  85  per  cent  in  two  or  three  groups  say  for   groups  aged  15  to  24,  it  may  be  necessary  to  re-­‐calculate  sample  weights  by  taking  age-­‐specific   non-­‐response  into  account.  Failure  to  do  so  may  lead  to  biased  estimates  of  indicators  which   typically  vary  by  age  of  women.     Weights  used  for  both  household  population  of  women  and  interviewed  women  are  household   weights.  Age  is  based  on  the  household  schedule.   Nepal  MICS  2014   4   Table DQ.3: Age distribution of children in household and under-5 questionnaires Household population of children aged 0–7 years, children aged 0–4 years whose mothers/caretakers were interviewed, and percentage of under-5 children whose mothers/caretakers were interviewed, by single years of age, Nepal, 2014 Household population of children aged 0–7 years Under-5s with completed interviews Percent of eligible under-5s with completed interviews (completion rate) Number Number Percent Age (years) 0 1,116 990 18.6 88.7 1 1,081 1,020 19.1 94.3 2 1,138 1,062 19.9 93.3 3 1,206 1,151 21.6 95.5 4 1,175 1,111 20.8 94.6 5 1,180 na na na 6 1,298 na na na 7 1,395 na na na Total (0–4 years) 5,715 5,333 100.0 93.3 Ratio of 5 to 4 1.00 na na na na: not applicable   Table DQ.4: Birth date reporting: Household population Percent distribution of household population by completeness of date of birth information, Nepal, 2014 Completeness of reporting of month and year of birth Total Number of household members Year and month of birth Year of birth only Month of birth only Both missing Total 92.6 5.2 0.6 1.6 100.0 56,824 Age 0–4 99.7 0.1 0.1 0.1 100.0 5,715 5–14 98.9 0.7 0.2 0.2 100.0 13,625 15–24 96.8 2.4 0.2 0.5 100.0 10,387 25–49 92.6 5.4 0.6 1.5 100.0 17,065 50–64 79.7 15.1 1.1 4.1 100.0 6,679 65–84 69.1 19.8 2.4 8.6 100.0 3,144 85+ 45.6 22.1 6.9 25.4 100.0 205 DK/missing 41.3 35.8 0.0 23.0 100.0 3 Region Eastern Mountains 98.2 1.6 0.0 0.2 100.0 779 Eastern Hills 98.1 1.9 0.0 0.0 100.0 3,169 Eastern Terai 92.1 6.3 0.1 1.5 100.0 8,251 Central Mountains 93.6 5.6 0.3 0.5 100.0 1,148 Central Hills 91.2 4.5 1.4 2.8 100.0 8,746 Central Terai 92.9 5.3 0.3 1.5 100.0 10,248 Western Mountains 90.5 8.4 0.2 0.8 100.0 32 Western Hills 95.3 2.2 0.8 1.6 100.0 6,371 Western Terai 90.4 9.2 0.0 0.4 100.0 4,825 Mid-Western Mountains 93.3 5.5 0.4 0.9 100.0 798 Mid-Western Hills 97.9 1.8 0.1 0.3 100.0 3,591 Mid-Western Terai 82.9 12.0 0.8 4.3 100.0 3,276 Far Western Mountains 95.1 2.5 1.1 1.3 100.0 1,014 Far Western Hills 93.1 2.9 1.7 2.3 100.0 1,880 Far Western Terai 89.8 7.6 0.5 2.1 100.0 2,697 Area Urban 92.9 4.0 0.8 2.2 100.0 9,753 Rural 92.5 5.5 0.5 1.5 100.0 47,071   Typical  data  quality  issues:  Completion  rates  by  socio-­‐economic  background  characteristics   should  be  similar  across  socio-­‐economic  groups.  In  cases  when  completion  rates  vary  greatly  by   background  characteristics,  the  sample  may  be  biased.     NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 285 Typical data quality issues: Completion rates by socio-economic background characteristics should be similar across socio-economic groups. In cases when completion rates vary greatly by background characteristics, the sample may be biased. Completion rates by regions and urban–rural areas are reflected in sample weights when the sample design is based on regions and urban–rural areas. While this ‘corrects’ for differential response rates by these characteristics, it does not necessarily mean that the sample is no longer biased in terms of other socio-economic characteristics. Weights for both household population of women and interviewed women are household weights. Nepal  MICS  2014   4   Table DQ.3: Age distribution of children in household and under-5 questionnaires Household population of children aged 0–7 years, children aged 0–4 years whose mothers/caretakers were interviewed, and percentage of under-5 children whose mothers/caretakers were interviewed, by single years of age, Nepal, 2014 Household population of children aged 0–7 years Under-5s with completed interviews Percent of eligible under-5s with completed interviews (completion rate) Number Number Percent Age (years) 0 1,116 990 18.6 88.7 1 1,081 1,020 19.1 94.3 2 1,138 1,062 19.9 93.3 3 1,206 1,151 21.6 95.5 4 1,175 1,111 20.8 94.6 5 1,180 na na na 6 1,298 na na na 7 1,395 na na na Total (0–4 years) 5,715 5,333 100.0 93.3 Ratio of 5 to 4 1.00 na na na na: not applicable   Table DQ.4: Birth date reporting: Household population Percent distribution of household population by completeness of date of birth information, Nepal, 2014 Completeness of reporting of month and year of birth Total Number of household members Year and month of birth Year of birth only Month of birth only Both missing Total 92.6 5.2 0.6 1.6 100.0 56,824 Age 0–4 99.7 0.1 0.1 0.1 100.0 5,715 5–14 98.9 0.7 0.2 0.2 100.0 13,625 15–24 96.8 2.4 0.2 0.5 100.0 10,387 25–49 92.6 5.4 0.6 1.5 100.0 17,065 50–64 79.7 15.1 1.1 4.1 100.0 6,679 65–84 69.1 19.8 2.4 8.6 100.0 3,144 85+ 45.6 22.1 6.9 25.4 100.0 205 DK/missing 41.3 35.8 0.0 23.0 100.0 3 Region Eastern Mountains 98.2 1.6 0.0 0.2 100.0 779 Eastern Hills 98.1 1.9 0.0 0.0 100.0 3,169 Eastern Terai 92.1 6.3 0.1 1.5 100.0 8,251 Central Mountains 93.6 5.6 0.3 0.5 100.0 1,148 Central Hills 91.2 4.5 1.4 2.8 100.0 8,746 Central Terai 92.9 5.3 0.3 1.5 100.0 10,248 Western Mountains 90.5 8.4 0.2 0.8 100.0 32 Western Hills 95.3 2.2 0.8 1.6 100.0 6,371 Western Terai 90.4 9.2 0.0 0.4 100.0 4,825 Mid-Western Mountains 93.3 5.5 0.4 0.9 100.0 798 Mid-Western Hills 97.9 1.8 0.1 0.3 100.0 3,591 Mid-Western Terai 82.9 12.0 0.8 4.3 100.0 3,276 Far Western Mountains 95.1 2.5 1.1 1.3 100.0 1,014 Far Western Hills 93.1 2.9 1.7 2.3 100.0 1,880 Far Western Terai 89.8 7.6 0.5 2.1 100.0 2,697 Area Urban 92.9 4.0 0.8 2.2 100.0 9,753 Rural 92.5 5.5 0.5 1.5 100.0 47,071   Typical  data  quality  issues:  Completion  rates  by  socio-­‐economic  background  characteristics   should  be  similar  across  socio-­‐economic  groups.  In  cases  when  completion  rates  vary  greatly  by   background  characteristics,  the  sample  may  be  biased.     NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014286 Nepal  MICS  2014   5   Completion  rates  by  regions  and  urban–rural  areas  are  reflected  in  sample  weights  when  the   sample  design  is  based  on  regions  and  urban–rural  areas.  While  this  ‘corrects’  for  differential   response  rates  by  these  characteristics,  it  does  not  necessarily  mean  that  the  sample  is  no  longer   biased  in  terms  of  other  socio-­‐economic  characteristics.     Weights  for  both  household  population  of  women  and  interviewed  women  are  household   weights.   Table DQ.5: Birth date and age reporting: Women Percent distribution of women aged 15–49 years by completeness of date of birth/age information, Nepal, 2014 Completeness of reporting of date of birth and age Total Number of women aged 15– 49 years Year and month of birth Year of birth and age Year of birth only Age only Other/DK/ Missing Total 96.6 2.7 0.0 0.3 0.5 100.0 14,162 Region Eastern Mountains 99.5 0.5 0.0 0.0 0.0 100.0 186 Eastern Hills 99.9 0.1 0.0 0.0 0.0 100.0 807 Eastern Terai 95.3 4.1 0.0 0.3 0.3 100.0 2,071 Central Mountains 99.2 0.6 0.0 0.0 0.2 100.0 274 Central Hills 96.3 1.8 0.0 0.5 1.4 100.0 2,320 Central Terai 97.1 2.4 0.0 0.2 0.3 100.0 2,327 Western Mountains 99.7 0.3 0.0 0.0 0.0 100.0 8 Western Hills 99.7 0.3 0.0 0.0 0.0 100.0 1,659 Western Terai 98.3 1.6 0.0 0.0 0.1 100.0 1,236 Mid-Western Mountains 94.5 4.2 0.0 0.7 0.6 100.0 169 Mid-Western Hills 98.8 0.9 0.0 0.4 0.0 100.0 856 Mid-Western Terai 85.9 13.0 0.0 0.9 0.2 100.0 855 Far Western Mountains 98.8 0.9 0.0 0.1 0.2 100.0 225 Far Western Hills 97.7 0.4 0.0 0.2 1.8 100.0 433 Far Western Terai 92.8 5.2 0.0 1.1 0.9 100.0 735 Area Urban 97.4 1.6 0.0 0.5 0.5 100.0 2,792 Rural 96.4 2.9 0.0 0.3 0.4 100.0 11,370     Nepal  MICS  2014   6   Table DQ.6: Birth date and age reporting: Under-5s Percentage of children under five by completeness of date of birth/age information, Nepal, 2014 Completeness of reporting of date of birth and age Total Number of children under five Year and month of birth Year of birth and age Year of birth only Age only Other/ DK/ missing Total 100.0 0.0 0.0 0.0 0.0 100.0 5,349 Region Eastern Mountains 100.0 0.0 0.0 0.0 0.0 100.0 325 Eastern Hills 100.0 0.0 0.0 0.0 0.0 100.0 284 Eastern Terai 100.0 0.0 0.0 0.0 0.0 100.0 384 Central Mountains 100.0 0.0 0.0 0.0 0.0 100.0 238 Central Hills 100.0 0.0 0.0 0.0 0.0 100.0 418 Central Terai 100.0 0.0 0.0 0.0 0.0 100.0 504 Western Mountains 100.0 0.0 0.0 0.0 0.0 100.0 77 Western Hills 100.0 0.0 0.0 0.0 0.0 100.0 358 Western Terai 100.0 0.0 0.0 0.0 0.0 100.0 389 Mid-Western Mountains 100.0 0.0 0.0 0.0 0.0 100.0 517 Mid-Western Hills 100.0 0.0 0.0 0.0 0.0 100.0 414 Mid-Western Terai 100.0 0.0 0.0 0.0 0.0 100.0 303 Far Western Mountains 100.0 0.0 0.0 0.0 0.0 100.0 420 Far Western Hills 100.0 0.0 0.0 0.0 0.0 100.0 435 Far Western Terai 100.0 0.0 0.0 0.0 0.0 100.0 283 Area Urban 100.0 0.0 0.0 0.0 0.0 100.0 907 Rural 100.0 0.0 0.0 0.0 0.0 100.0 4,442   Table DQ.7: Birth date reporting: Children, adolescents and young people Percent distribution of children, adolescents and young people aged 5–24 years by completeness of date of birth information, Nepal, 2014 Completeness of reporting of month and year of birth Total Number of children, adolescents and young people aged 5–24 years Year and month of birth Year of birth only Month of birth only Both missing Total 98.0 1.5 0.2 0.3 100.0 24,012 Region Eastern Mountains 99.9 0.1 0.0 0.0 100.0 348 Eastern Hills 99.7 0.3 0.0 0.0 100.0 1,335 Eastern Terai 97.7 2.1 0.0 0.2 100.0 3,360 Central Mountains 99.8 0.2 0.0 0.0 100.0 448 Central Hills 96.9 1.5 0.6 1.0 100.0 3,277 Central Terai 98.7 1.2 0.0 0.0 100.0 4,406 Western Mountains 96.5 3.5 0.0 0.0 100.0 8 Western Hills 99.8 0.2 0.0 0.0 100.0 2,517 Western Terai 98.6 1.3 0.0 0.1 100.0 2,110 Mid-Western Mountains 98.4 1.3 0.1 0.1 100.0 374 Mid-Western Hills 99.4 0.5 0.0 0.1 100.0 1,699 Mid-Western Terai 90.9 6.2 1.1 1.8 100.0 1,501 Far Western Mountains 98.6 0.5 0.7 0.1 100.0 480 Far Western Hills 97.6 0.7 0.9 0.8 100.0 889 Far Western Terai 97.8 1.9 0.1 0.1 100.0 1,260 Area Urban 98.0 1.2 0.2 0.6 100.0 3,860 Rural 98.0 1.5 0.2 0.3 100.0 20,152 NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 287 Nepal  MICS  2014   6   Table DQ.6: Birth date and age reporting: Under-5s Percentage of children under five by completeness of date of birth/age information, Nepal, 2014 Completeness of reporting of date of birth and age Total Number of children under five Year and month of birth Year of birth and age Year of birth only Age only Other/ DK/ missing Total 100.0 0.0 0.0 0.0 0.0 100.0 5,349 Region Eastern Mountains 100.0 0.0 0.0 0.0 0.0 100.0 325 Eastern Hills 100.0 0.0 0.0 0.0 0.0 100.0 284 Eastern Terai 100.0 0.0 0.0 0.0 0.0 100.0 384 Central Mountains 100.0 0.0 0.0 0.0 0.0 100.0 238 Central Hills 100.0 0.0 0.0 0.0 0.0 100.0 418 Central Terai 100.0 0.0 0.0 0.0 0.0 100.0 504 Western Mountains 100.0 0.0 0.0 0.0 0.0 100.0 77 Western Hills 100.0 0.0 0.0 0.0 0.0 100.0 358 Western Terai 100.0 0.0 0.0 0.0 0.0 100.0 389 Mid-Western Mountains 100.0 0.0 0.0 0.0 0.0 100.0 517 Mid-Western Hills 100.0 0.0 0.0 0.0 0.0 100.0 414 Mid-Western Terai 100.0 0.0 0.0 0.0 0.0 100.0 303 Far Western Mountains 100.0 0.0 0.0 0.0 0.0 100.0 420 Far Western Hills 100.0 0.0 0.0 0.0 0.0 100.0 435 Far Western Terai 100.0 0.0 0.0 0.0 0.0 100.0 283 Area Urban 100.0 0.0 0.0 0.0 0.0 100.0 907 Rural 100.0 0.0 0.0 0.0 0.0 100.0 4,442   Table DQ.7: Birth date reporting: Children, adolescents and young people Percent distribution of children, adolescents and young people aged 5–24 years by completeness of date of birth information, Nepal, 2014 Completeness of reporting of month and year of birth Total Number of children, adolescents and young people aged 5–24 years Year and month of birth Year of birth only Month of birth only Both missing Total 98.0 1.5 0.2 0.3 100.0 24,012 Region Eastern Mountains 99.9 0.1 0.0 0.0 100.0 348 Eastern Hills 99.7 0.3 0.0 0.0 100.0 1,335 Eastern Terai 97.7 2.1 0.0 0.2 100.0 3,360 Central Mountains 99.8 0.2 0.0 0.0 100.0 448 Central Hills 96.9 1.5 0.6 1.0 100.0 3,277 Central Terai 98.7 1.2 0.0 0.0 100.0 4,406 Western Mountains 96.5 3.5 0.0 0.0 100.0 8 Western Hills 99.8 0.2 0.0 0.0 100.0 2,517 Western Terai 98.6 1.3 0.0 0.1 100.0 2,110 Mid-Western Mountains 98.4 1.3 0.1 0.1 100.0 374 Mid-Western Hills 99.4 0.5 0.0 0.1 100.0 1,699 Mid-Western Terai 90.9 6.2 1.1 1.8 100.0 1,501 Far Western Mountains 98.6 0.5 0.7 0.1 100.0 480 Far Western Hills 97.6 0.7 0.9 0.8 100.0 889 Far Western Terai 97.8 1.9 0.1 0.1 100.0 1,260 Area Urban 98.0 1.2 0.2 0.6 100.0 3,860 Rural 98.0 1.5 0.2 0.3 100.0 20,152 Nepal  MICS  2014   7   Table DQ.8: Birth date reporting: First and last births Percent distribution of first and last births to women aged 15–49 years by completeness of date of birth, Nepal, 2014 Completeness of reporting of date of birth Date of first birth Total Num- ber of first births Date of last birth Total Num- ber of last births Year and month of birth Year of birth only Comp- leted years since first birth only Other/ DK/ Miss- ing Both month and year Year only Other/ DK/ Miss- ing Total 98.9 0.8 0.0 0.2 100.0 10,076 99.0 0.9 0.1 100.0 7,983 Region Eastern Mountains 99.4 0.4 0.0 0.2 100.0 124 100.0 0.0 0.0 100.0 96 Eastern Hills 100.0 0.0 0.0 0.0 100.0 518 99.7 0.3 0.0 100.0 386 Eastern Terai 98.1 1.6 0.0 0.3 100.0 1,501 98.6 1.4 0.0 100.0 1,185 Central Mountains 99.1 0.9 0.0 0.0 100.0 187 99.3 0.7 0.0 100.0 152 Central Hills 99.1 0.5 0.1 0.3 100.0 1,571 99.0 0.6 0.5 100.0 1,122 Central Terai 99.1 0.9 0.0 0.0 100.0 1,740 98.2 1.8 0.0 100.0 1,462 Western Mountains 97.7 2.3 0.0 0.0 100.0 6 98.0 2.0 0.0 100.0 4 Western Hills 99.6 0.2 0.0 0.1 100.0 1,228 100.0 0.0 0.0 100.0 956 Western Terai 99.4 0.3 0.0 0.3 100.0 871 99.6 0.4 0.0 100.0 701 Mid-Western Mountains 99.5 0.3 0.0 0.2 100.0 129 99.6 0.2 0.2 100.0 108 Mid-Western Hills 99.8 0.2 0.0 0.0 100.0 629 99.6 0.2 0.2 100.0 531 Mid-Western Terai 96.9 2.3 0.1 0.7 100.0 595 98.0 1.6 0.3 100.0 489 Far Western Mountains 98.9 0.9 0.0 0.2 100.0 169 99.5 0.3 0.2 100.0 147 Far Western Hills 98.9 1.1 0.0 0.1 100.0 297 99.6 0.3 0.1 100.0 254 Far Western Terai 97.9 1.8 0.0 0.3 100.0 510 98.5 1.5 0.0 100.0 389 Area Urban 99.0 0.9 0.0 0.1 100.0 1,834 99.0 0.9 0.1 100.0 1,307 Rural 98.9 0.8 0.0 0.2 100.0 8,242 99.0 0.9 0.1 100.0 6,677     DQ.9: Completeness of reporting Percentage of observations that are missing information for selected questions and indicators, Nepal, 2014 Questionnaire and type of missing information Reference group Percent with missing/ incomplete information [a] Number of cases Household Salt test result All households interviewed that have salt 0.1 12,405 Starting time of interview All households interviewed 0.1 12,405 Ending time of interview All households interviewed 0.1 12,405 Women Date of first marriage/union All ever married women aged 15–49 Only month 2.2 11,125 Both month and year 9.7 11,125 Age at first marriage/union All ever married women aged 15–49 with year of first marriage not known 3.2 11,125 Starting time of interview All women interviewed 0.1 14,162 Ending time of interview All women interviewed 0.0 14,162 Under-5 Starting time of interview All under-5 children 0.1 5,349 Ending time of interview All under-5 children 0.2 5,349 [a] Includes ‘don't know’ responses   Typical  data  quality  issues:  Surveys  always  have  cases  with  missing  information.  The  extent  of   missing  information  is  important,  because  it  can  result  in  biased  results  if  such  proportions  are   NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014288 Typical data quality issues: Surveys always have cases with missing information. The extent of missing information is important, because it can result in biased results if such proportions are high. Particularly informative about the quality of the survey is the extent of missing information on measurements, ages, and dates of events. Nepal  MICS  2014   7   Table DQ.8: Birth date reporting: First and last births Percent distribution of first and last births to women aged 15–49 years by completeness of date of birth, Nepal, 2014 Completeness of reporting of date of birth Date of first birth Total Num- ber of first births Date of last birth Total Num- ber of last births Year and month of birth Year of birth only Comp- leted years since first birth only Other/ DK/ Miss- ing Both month and year Year only Other/ DK/ Miss- ing Total 98.9 0.8 0.0 0.2 100.0 10,076 99.0 0.9 0.1 100.0 7,983 Region Eastern Mountains 99.4 0.4 0.0 0.2 100.0 124 100.0 0.0 0.0 100.0 96 Eastern Hills 100.0 0.0 0.0 0.0 100.0 518 99.7 0.3 0.0 100.0 386 Eastern Terai 98.1 1.6 0.0 0.3 100.0 1,501 98.6 1.4 0.0 100.0 1,185 Central Mountains 99.1 0.9 0.0 0.0 100.0 187 99.3 0.7 0.0 100.0 152 Central Hills 99.1 0.5 0.1 0.3 100.0 1,571 99.0 0.6 0.5 100.0 1,122 Central Terai 99.1 0.9 0.0 0.0 100.0 1,740 98.2 1.8 0.0 100.0 1,462 Western Mountains 97.7 2.3 0.0 0.0 100.0 6 98.0 2.0 0.0 100.0 4 Western Hills 99.6 0.2 0.0 0.1 100.0 1,228 100.0 0.0 0.0 100.0 956 Western Terai 99.4 0.3 0.0 0.3 100.0 871 99.6 0.4 0.0 100.0 701 Mid-Western Mountains 99.5 0.3 0.0 0.2 100.0 129 99.6 0.2 0.2 100.0 108 Mid-Western Hills 99.8 0.2 0.0 0.0 100.0 629 99.6 0.2 0.2 100.0 531 Mid-Western Terai 96.9 2.3 0.1 0.7 100.0 595 98.0 1.6 0.3 100.0 489 Far Western Mountains 98.9 0.9 0.0 0.2 100.0 169 99.5 0.3 0.2 100.0 147 Far Western Hills 98.9 1.1 0.0 0.1 100.0 297 99.6 0.3 0.1 100.0 254 Far Western Terai 97.9 1.8 0.0 0.3 100.0 510 98.5 1.5 0.0 100.0 389 Area Urban 99.0 0.9 0.0 0.1 100.0 1,834 99.0 0.9 0.1 100.0 1,307 Rural 98.9 0.8 0.0 0.2 100.0 8,242 99.0 0.9 0.1 100.0 6,677     DQ.9: Completeness of reporting Percentage of observations that are missing information for selected questions and indicators, Nepal, 2014 Questionnaire and type of missing information Reference group Percent with missing/ incomplete information [a] Number of cases Household Salt test result All households interviewed that have salt 0.1 12,405 Starting time of interview All households interviewed 0.1 12,405 Ending time of interview All households interviewed 0.1 12,405 Women Date of first marriage/union All ever married women aged 15–49 Only month 2.2 11,125 Both month and year 9.7 11,125 Age at first marriage/union All ever married women aged 15–49 with year of first marriage not known 3.2 11,125 Starting time of interview All women interviewed 0.1 14,162 Ending time of interview All women interviewed 0.0 14,162 Under-5 Starting time of interview All under-5 children 0.1 5,349 Ending time of interview All under-5 children 0.2 5,349 [a] Includes ‘don't know’ responses   Typical  data  quality  issues:  Surveys  always  have  cases  with  missing  information.  The  extent  of   missing  information  is  important,  because  it  can  result  in  biased  results  if  such  proportions  are   Nepal  MICS  2014   8   high.  Particularly  informative  about  the  quality  of  the  survey  is  the  extent  of  missing  information   on  measurements,  ages,  and  dates  of  events.   DQ.10: Completeness of information for anthropometric indicators: Underweight Percentage of children under five by completeness of information on date of birth and weight, Nepal, 2014 Valid weight and date of birth Reason for exclusion from analysis Total Percent of children excluded from analysis Number of children under five Weight not measured Incomplete date of birth Weight not measured and incomplete date of birth Flagged cases (outliers) Total 97.9 1.8 0.0 0.0 0.3 100.0 2.1 5,349 Age <6 months 97.3 2.0 0.0 0.0 0.7 100.0 2.7 452 6–11 months 97.7 2.1 0.0 0.0 0.2 100.0 2.3 527 12–23 months 98.8 1.2 0.0 0.0 0.0 100.0 1.2 1,029 24–35 months 97.7 1.9 0.0 0.0 0.4 100.0 2.3 1,062 36–47 months 97.9 1.8 0.0 0.0 0.4 100.0 2.1 1,123 48–59 months 97.4 2.2 0.0 0.0 0.3 100.0 2.6 1,156   Table DQ.11: Completeness of information for anthropometric indicators: Stunting Percent distribution of children under five by completeness of information on date of birth and length or height, Nepal, 2014 Valid length/ height and date of birth Reason for exclusion from analysis Total Percent of children excluded from analysis Number of children under five Length/ height not measured Incomplete date of birth Length/ height not measured, incomplete date of birth Flagged cases (outliers) Total 95.6 3.4 0.0 0.0 1.0 100.0 4.4 5,349 Child’s age <6 months 94.8 2.1 0.0 0.0 3.0 100.0 5.2 455 6–11 months 97.3 2.5 0.0 0.0 0.2 100.0 2.7 523 12–23 months 96.0 3.1 0.0 0.0 0.8 100.0 4.0 1,008 24–35 months 94.0 4.9 0.0 0.0 1.1 100.0 6.0 1,079 36–47 months 95.9 3.1 0.0 0.0 1.1 100.0 4.1 1,137 48–59 months 96.0 3.4 0.0 0.0 0.6 100.0 4.0 1,147   Table DQ.12: Completeness of information for anthropometric indicators: Wasting Percent distribution of children under five by completeness of information on weight and length or height, Nepal, 2014 Valid weight and length/ height Reason for exclusion from analysis Total Percent of children excluded from analysis Number of children under five Weight not measured Length/ height not measured Weight and length/ height not measured Flagged cases (outliers) Total 95.6 0.0 1.0 2.4 1.0 100.0 4.4 5,349 Child's age <6 months 93.2 0.0 0.6 1.5 4.6 100.0 6.8 455 6–11 months 96.9 0.0 0.2 2.3 0.7 100.0 3.1 523 12–23 months 96.1 0.0 1.0 2.1 0.8 100.0 3.9 1,008 24–35 months 94.6 0.0 2.4 2.5 0.5 100.0 5.4 1,079 36–47 months 96.2 0.0 0.6 2.4 0.8 100.0 3.8 1,137 48–59 months 95.8 0.0 0.6 2.8 0.8 100.0 4.2 1,147   NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 289 Typical data quality issues: Under normal circumstances, approximately 10 percent of anthropometric measurements should be reported for each of the digits for the decimals. Significant excesses over 10 percent are indicative of heaping, and therefore quality problems in anthropometric measurements, either due to truncation or rounding. Typically, more heaping is expected in height/length than weight measurements. Nepal  MICS  2014   8   high.  Particularly  informative  about  the  quality  of  the  survey  is  the  extent  of  missing  information   on  measurements,  ages,  and  dates  of  events.   DQ.10: Completeness of information for anthropometric indicators: Underweight Percentage of children under five by completeness of information on date of birth and weight, Nepal, 2014 Valid weight and date of birth Reason for exclusion from analysis Total Percent of children excluded from analysis Number of children under five Weight not measured Incomplete date of birth Weight not measured and incomplete date of birth Flagged cases (outliers) Total 97.9 1.8 0.0 0.0 0.3 100.0 2.1 5,349 Age <6 months 97.3 2.0 0.0 0.0 0.7 100.0 2.7 452 6–11 months 97.7 2.1 0.0 0.0 0.2 100.0 2.3 527 12–23 months 98.8 1.2 0.0 0.0 0.0 100.0 1.2 1,029 24–35 months 97.7 1.9 0.0 0.0 0.4 100.0 2.3 1,062 36–47 months 97.9 1.8 0.0 0.0 0.4 100.0 2.1 1,123 48–59 months 97.4 2.2 0.0 0.0 0.3 100.0 2.6 1,156   Table DQ.11: Completeness of information for anthropometric indicators: Stunting Percent distribution of children under five by completeness of information on date of birth and length or height, Nepal, 2014 Valid length/ height and date of birth Reason for exclusion from analysis Total Percent of children excluded from analysis Number of children under five Length/ height not measured Incomplete date of birth Length/ height not measured, incomplete date of birth Flagged cases (outliers) Total 95.6 3.4 0.0 0.0 1.0 100.0 4.4 5,349 Child’s age <6 months 94.8 2.1 0.0 0.0 3.0 100.0 5.2 455 6–11 months 97.3 2.5 0.0 0.0 0.2 100.0 2.7 523 12–23 months 96.0 3.1 0.0 0.0 0.8 100.0 4.0 1,008 24–35 months 94.0 4.9 0.0 0.0 1.1 100.0 6.0 1,079 36–47 months 95.9 3.1 0.0 0.0 1.1 100.0 4.1 1,137 48–59 months 96.0 3.4 0.0 0.0 0.6 100.0 4.0 1,147   Table DQ.12: Completeness of information for anthropometric indicators: Wasting Percent distribution of children under five by completeness of information on weight and length or height, Nepal, 2014 Valid weight and length/ height Reason for exclusion from analysis Total Percent of children excluded from analysis Number of children under five Weight not measured Length/ height not measured Weight and length/ height not measured Flagged cases (outliers) Total 95.6 0.0 1.0 2.4 1.0 100.0 4.4 5,349 Child's age <6 months 93.2 0.0 0.6 1.5 4.6 100.0 6.8 455 6–11 months 96.9 0.0 0.2 2.3 0.7 100.0 3.1 523 12–23 months 96.1 0.0 1.0 2.1 0.8 100.0 3.9 1,008 24–35 months 94.6 0.0 2.4 2.5 0.5 100.0 5.4 1,079 36–47 months 96.2 0.0 0.6 2.4 0.8 100.0 3.8 1,137 48–59 months 95.8 0.0 0.6 2.8 0.8 100.0 4.2 1,147   Nepal  MICS  2014   9   Table DQ.13: Heaping in anthropometric measurements Distribution of weight and height/length measurements by digits reported for the decimal points, Nepal, 2014 Weight Height Number Percent Number Percent Total 5,222 100.0 5,222 100.0 Digits 0 498 9.5 455 8.7 1 546 10.5 492 9.4 2 577 11.0 715 13.7 3 545 10.4 710 13.6 4 465 8.9 530 10.2 5 557 10.7 404 7.7 6 561 10.7 600 11.5 7 515 9.9 515 9.9 8 487 9.3 361 6.9 9 472 9.0 441 8.5 0 or 5 1,055 20.2 859 16.5     Typical  data  quality  issues:  Under  normal  circumstances,  approximately  10  percent  of   anthropometric  measurements  should  be  reported  for  each  of  the  digits  for  the  decimals.   Significant  excesses  over  10  percent  are  indicative  of  heaping,  and  therefore  quality  problems  in   anthropometric  measurements,  either  due  to  truncation  or  rounding.     Typically,  more  heaping  is  expected  in  height/length  than  weight  measurements.   NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014290 Typical data quality issues: Interviewers are required to ask and see the birth certificates of children. This is important for the completion of the Birth Registration module in the Under-5 Questionnaire, but may also be useful for obtaining accurate information on children’s dates of birth and ages. Percentage of birth certificates seen by the interviewer is desired to be as high as possible, preferably over 90 percent. Nepal  MICS  2014   10   Table DQ.14: Observation of birth certificates Percent distribution of children under five by presence of birth certificates, and percentage of birth certificates seen, Nepal, 2014 Child has birth certificate Child does not have birth certificate Missing/ DK Total Percent of birth certificates seen by the interviewer (1)/(1+2) *100 Number of children under five Seen by the interviewer (1) Not seen by the interviewer (2) Total 41.3 11.6 46.6 0.4 100.0 78.0 5,349 Region Eastern Mountains 36.0 3.0 59.6 1.3 100.0 92.3 72 Eastern Hills 54.6 5.7 39.7 0.0 100.0 90.6 272 Eastern Terai 50.6 8.0 40.5 0.8 100.0 86.3 775 Central Mountains 24.6 14.4 60.9 0.0 100.0 63.0 95 Central Hills 20.4 20.1 59.0 0.5 100.0 50.3 620 Central Terai 43.1 12.9 44.0 0.0 100.0 76.9 1,131 Western Mountains 45.0 10.9 44.1 0.0 100.0 80.5 2 Western Hills 38.9 15.1 44.9 1.1 100.0 72.1 601 Western Terai 42.9 8.3 48.5 0.3 100.0 83.7 469 Mid-Western Mountains 65.6 13.0 21.0 0.4 100.0 83.5 108 Mid-Western Hills 56.1 1.0 42.9 0.0 100.0 98.3 409 Mid-Western Terai 41.8 16.9 40.1 1.1 100.0 71.2 291 Far Western Mountains 27.3 13.6 59.1 0.0 100.0 66.8 100 Far Western Hills 28.0 11.2 60.5 0.3 100.0 71.4 210 Far Western Terai 32.2 11.9 55.7 0.2 100.0 73.0 197 Area Urban 34.8 15.7 49.0 0.5 100.0 68.9 699 Rural 42.3 11.0 46.3 0.4 100.0 79.3 4,650 Child’s age 0–5 months 13.6 3.5 82.7 0.3 100.0 79.7 455 6–11 months 24.1 8.7 67.1 0.1 100.0 73.5 523 12–23 months 32.7 8.7 58.0 0.6 100.0 79.1 1,008 24–35 months 45.6 13.0 41.1 0.3 100.0 77.7 1,079 36–47 months 51.2 12.9 35.6 0.3 100.0 79.9 1,137 48–59 months 54.0 16.3 29.1 0.6 100.0 76.9 1,147     Typical  data  quality  issues:  Interviewers  are  required  to  ask  and  see  the  birth  certificates  of   children.  This  is  important  for  the  completion  of  the  Birth  Registration  module  in  the  Under-­‐5   Questionnaire,  but  may  also  be  useful  for  obtaining  accurate  information  on  children’s  dates  of   birth  and  ages.  Percent  of  birth  certificates  seen  by  the  interviewer  is  desired  to  be  as  high  as   possible,  preferably  over  90  percent.     NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 291 Typical data quality issues: Interviewers are required to ask to see the vaccination cards of under-5s from the respondent, and copy the information on the cards to the Under-5 Questionnaire. Information on vaccination cards is believed to be more accurate than information that would be provided by mothers or caretakers in the absence of vaccination cards. Particularly important are the results for children aged one year, as immunization indicators are based on these children in most countries. Nepal  MICS  2014   11   Table DQ.15: Observation of vaccination cards Percent distribution of children aged 0–35 months by presence of a vaccination card, and the percentage of vaccination cards seen by the interviewers, Nepal, 2014 Child does not have vaccination card Child has vaccination card Missing/ DK Total Percent of vaccina- tion cards seen by the interview- er (1)/(1+2)*10 0 Number of children aged 0– 35 months Had vaccina- tion card previously Never had vaccina- tion card Seen by the interview- er (1) Not seen by the interview- er (2) Total 19.6 10.4 38.6 31.3 0.1 100.0 55.2 3,065 Region Eastern Mountains 22.6 22.2 41.3 13.9 0.0 100.0 74.8 44 Eastern Hills 17.3 12.5 55.9 14.3 0.0 100.0 79.6 168 Eastern Terai 18.9 13.2 42.1 25.7 0.2 100.0 62.1 431 Central Mountains 6.2 8.1 35.0 50.7 0.0 100.0 40.8 57 Central Hills 7.8 5.9 40.8 45.5 0.0 100.0 47.3 369 Central Terai 11.8 14.0 25.0 49.1 0.0 100.0 33.8 626 Western Mountains 12.6 2.2 20.6 64.7 0.0 100.0 24.2 1 Western Hills 16.6 1.8 44.9 36.7 0.0 100.0 55.1 341 Western Terai 38.8 5.0 44.1 12.2 0.0 100.0 78.3 280 Mid-Western Mountains 29.8 47.4 10.1 12.7 0.0 100.0 44.5 61 Mid-Western Hills 45.8 9.7 33.1 10.8 0.6 100.0 75.3 223 Mid-Western Terai 15.7 3.3 45.4 35.6 0.0 100.0 56.0 166 Far Western Mountains 27.9 19.8 25.1 27.2 0.0 100.0 48.0 55 Far Western Hills 29.2 18.9 33.1 18.3 0.5 100.0 64.4 112 Far Western Terai 10.3 6.0 61.4 21.1 1.2 100.0 74.4 129 Area Urban 13.8 4.2 48.3 33.4 0.3 100.0 59.1 397 Rural 20.5 11.3 37.2 31.0 0.1 100.0 54.5 2,667 Child’s age 0–5 months 4.4 20.9 60.1 14.6 0.0 100.0 80.5 455 6–11 months 10.2 9.5 61.3 18.9 0.1 100.0 76.4 523 12–23 months 17.9 8.1 39.7 34.2 0.1 100.0 53.7 1,008 24–35 months 32.2 8.4 17.5 41.6 0.3 100.0 29.6 1,079     Typical  data  quality  issues:  Interviewers  are  required  to  ask  to  see  the  vaccination  cards  of   under-­‐5s  from  the  respondent,  and  copy  the  information  on  the  cards  to  the  Under-­‐5   Questionnaire.  Information  on  vaccination  cards  is  believed  to  be  more  accurate  than   information  that  would  be  provided  by  mothers  or  caretakers  in  the  absence  of  vaccination   cards.  Particularly  important  are  the  results  for  children  aged  one  year,  as  immunization   indicators  are  based  on  these  children  in  most  countries.   NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014292 Typical data quality issues: Interviewers are required to ask respondents if they have health cards, and if so, ask to see these cards (MN5 in Women’s Questionnaire). These cards are then used by the interviewer to record information on tetanus toxoid vaccinations during pregnancy, or any other useful information on the card. Observation of cards is likely to improve the quality of information collected, as the data collected becomes less dependent on the recall of the respondent. Nepal  MICS  2014   12   Table DQ.16: Observation of women's health cards Percent distribution of women with a live birth in the last two years by presence of a health card, and the percentage of health cards seen by the interviewers, Nepal, 2014 Woman does not have health card Woman has health card Missing/ DK Total Percent of health cards seen by the interviewer (1)/(1+2) *100 Number of women with a live birth in the last two years Seen by the interviewer (1) Not seen by the interviewer (2) Total 47.3 22.4 28.1 2.2 100.0 44.3 2,048 Region Eastern Mountains 55.7 29.5 13.3 1.4 100.0 68.9 32 Eastern Hills 51.7 24.7 21.8 1.8 100.0 53.2 123 Eastern Terai 39.3 34.9 24.3 1.4 100.0 59.0 277 Central Mountains 54.7 23.7 19.2 2.4 100.0 55.2 38 Central Hills 37.4 15.8 43.3 3.5 100.0 26.8 241 Central Terai 47.3 15.4 34.6 2.7 100.0 30.8 400 Western Mountains 36.3 35.9 25.0 2.8 100.0 58.9 1 Western Hills 36.0 31.7 31.5 0.8 100.0 50.2 222 Western Terai 59.7 18.6 20.9 0.8 100.0 47.2 178 Mid-Western Mountains 79.6 9.1 8.2 3.1 100.0 52.5 43 Mid-Western Hills 70.1 22.4 3.3 4.2 100.0 87.1 166 Mid-Western Terai 40.3 18.5 41.1 0.1 100.0 31.0 113 Far Western Mountains 52.9 7.7 39.4 0.0 100.0 16.4 33 Far Western Hills 64.2 4.2 28.8 2.8 100.0 12.7 75 Far Western Terai 29.0 38.8 28.6 3.5 100.0 57.6 106 Area Urban 34.3 29.8 34.5 1.3 100.0 46.3 262 Rural 49.2 21.3 27.2 2.3 100.0 43.9 1,786 Age 15–24 47.2 23.5 27.6 1.7 100.0 46.0 931 25–34 45.3 22.3 29.8 2.6 100.0 42.9 954 35–49 59.7 16.1 21.4 2.7 100.0 42.9 164     Typical  data  quality  issues:  Interviewers  are  required  to  ask  respondents  if  they  have  health   cards,  and  if  so,  ask  to  see  these  cards  (MN5  in  Women’s  Questionnaire).  These  cards  are  then   used  by  the  interviewer  to  record  information  on  tetanus  toxoid  vaccinations  during  pregnancy,   or  any  other  useful  information  on  the  card.  Observation  of  cards  is  likely  to  improve  the  quality   of  information  collected,  as  the  data  collected  becomes  less  dependent  on  the  recall  of  the   respondent.   NEPAL MULTIPLE INDICATOR CLUSTER SURVEY 2014 293 Typical data quality issues: The Under-5 Questionnaire should be administered to the mother, if the mother is listed in the household roster. The table is informative on whether the questionnaire was administered to the right person during the fieldwork. Not all information will have been collected from mothers, but cases where the mother is in the household but somebody else was interviewed can be problematic. ‘Adult’ males and females are defined as those aged 15 years and above. Nepal  MICS  2014   13   Table DQ.17: Observation of places for handwashing Percent distribution of places for handwashing observed by the interviewers in all interviewed households, Nepal, 2014 Observation of places for handwashing: Observed Place for handwashing not in dwelling No permission to see Other Total Number of households interviewed Total 97.1 2.4 0.3 0.2 100.0 12,405 Region Eastern Mountains 99