Palestinian Multiple Indicator Cluster Survey 2014

Publication date: 2015

Final Report December 2015 Monitoring the situation of children and women Palestinian Central Bureau of Statistics United Nations Children’s Fund United Nations Population Fund Palestinian Multiple Indicator Cluster Survey 2014 Palestinian Central Bureau of Statistics Palestinian Multiple Indicator Cluster Survey 2014 Final Report December 2015   The Palestinian Multiple Indicator Cluster Survey (MICS) was carried out in 2014 by Palestinian Central Bureau of Statistics in collaboration with Ministry of Health, as part of the global MICS programme. Technical support was provided by the United Nations Children’s Fund (UNICEF). The survey was financially supported by the government of the State of Palestine, UNICEF and UNFPA. 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. The Palestinian Multiple Indicator Cluster Survey has as its primary objectives: To furnish data needed for monitoring progress toward goals established in the Millennium Declaration and other internationally agreed upon goals, as a basis for future action. To contribute to the improvement of data and monitoring systems in Palestine and to strengthen technical expertise in the design, implementation, and analysis of such systems. Suggested Citation: Palestinian Central Bureau of Statistics, 2015. Palestinian Multiple Indicator Cluster Survey 2014, Final Report, Ramallah, Palestine ii Palestinian Multiple Indicator Cluster Survey 2014   Table of Contents List of Tables . v List of Figures . viii List of Abbreviations . ix Acknowledgements . x Summary Table of Survey Implementation and the Survey Population, The Palestinian Multiple Indicator Cluster Survey, 2014 . xi Summary Table of Findings . xiii Executive Summary . xxiii I. Introduction Background . 2 Survey Objectives . 3 II. Sample and Survey Methodology . 6 Sample Design . 6 Questionnaires . 6 Training and Fieldwork . 7 Data Processing . 7 III. Sample Coverage and the Characteristics of Households and Respondents . 10 Sample Coverage . 10 Characteristics of Households . 11 Characteristics of Female Respondents 15-49 Years of Age and Children Under-5 . 14 Housing characteristics, asset ownership, and wealth quintiles . 19 IV. Child Mortality . 24 V. Nutrition Low Birth Weight . 32 Nutritional Status . 34 Breastfeeding and Infant and Young Child Feeding . 38 Salt Iodization . 50 VI. Child Health . 54 Vaccinations . 54 Care of Illness . 60 VII. Water and Sanitation . 80 Use of Improved Water Sources . 80 Use of Improved Sanitation . 88 VIII. Reproductive Health . 96 Fertility . 96 Contraception . 101 Unmet Need . 105 Antenatal Care . 108 Assistance at Delivery . 114 Place of Delivery . 117 Post-natal Health Checks . 119 iii   IX. Early Child Development . 136 Early Childhood Care and Education . 136 Quality of Care . 138 Developmental Status of Children . 145 X. Literacy and Education . 150 Literacy among Young Women . 150 School Readiness . 152 Basic and Secondary School Participation . 154 XI. Child Protection . 172 Birth Registration . 172 Child Discipline . 174 Early Marriage and Polygyny . 178 Children’s Living Arrangements . 185 XII. HIV/AIDS . 190 Knowledge about HIV Transmission and Misconceptions about HIV . 190 Accepting Attitudes toward People Living with HIV . 196 Knowledge of a Place for HIV Testing . 199 Appendices: Appendix A. Sample Design . 202 Appendix B. List of Personnel Involved in the Survey . 208 Appendix C. Estimates of Sampling Errors . 210 Appendix D. Data Quality Tables . 218 Appendix E. Palestinian MICS5 Indicators: Numerators and Denominators . 238 Appendix F. Questionnaires . 248 Appendix G. ISCED Tables . 315 iv Palestinian Multiple Indicator Cluster Survey 2014   List of Tables Table HH.1: Results of household, women's, men's and under-5 interviews . 10 Table HH.2: Age distribution of household population by sex . 11 Table HH.3: Household composition . 13 Table HH.4: Women's background characteristics . 14 Table HH.5: Under-5's background characteristics . 18 Table HH.6: Housing characteristics . 19 Table HH.7: Household and personal assets . 20 Table HH.8: Wealth quintiles . 22 Table CM.1: Early childhood mortality rates . 24 Table CM.2: Early childhood mortality rates by socioeconomic characteristics . 26 Table CM.3: Early childhood mortality rates by demographic characteristics . 27 Table NU.1: Low birth weight infants . 33 Table NU.2: Nutritional status of children . 36 Table NU.3: Initial breastfeeding . 40 Table NU.4: Breastfeeding . 42 Table NU.5: Duration of breastfeeding . 44 Table NU.6: Age-appropriate breastfeeding . 45 Table NU.7: Introduction of solid, semi-solid, or soft foods . 46 Table NU.8: Infant and young child feeding (IYCF) practices . 47 Table NU.9: Bottle feeding . 49 Table NU.10: Iodized salt consumption . 51 Table CH.1: Vaccinations in the first years of life . 55 Table CH.2: Vaccinations by background characteristics . 58 Table CH.4: Reported disease episodes . 61 Table CH.5: Care-seeking during diarrhoea . 63 Table CH.6: Feeding practices during diarrhoea . 65 Table CH.7: Oral rehydration solutions, recommended homemade fluids, . 67 Table CH.8: Oral rehydration therapy with continued feeding and other treatments . 69 Table CH.9: Source of ORS . 72 Table CH.10: Care-seeking for and antibiotic treatment of symptoms of acute respiratory infection (ARI) . 73 Table CH.12: Solid fuel use . 76 Table CH.13: Solid fuel use by place of cooking . 77 Table WS.1: Use of improved water sources . 81 Table WS.2: Household water treatment . 84 Table WS.3: Time to source of drinking water . 86 Table WS.4: Person collecting water . 87 Table WS.5: Types of sanitation facilities . 89 Table WS.6: Use and sharing of sanitation facilities . 90 Table WS.7: Drinking water and sanitation ladders . 92 Table RH.1: Fertility rates . 96 Table RH.2: Adolescent birth rate and total fertility rate . 98 Table RH.3: Early childbearing . 99 Table RH.4: Trends in early childbearing . 100 Table RH.5: Use of contraception . 102 Table RH.6: Unmet need for contraception . 106 Table RH.7: Antenatal care coverage . 110 Table RH.8: Number of antenatal care visits and timing of first visit . 111 Table RH.9: Content of antenatal care . 113 v   Table RH.10: Assistance during delivery and caesarian section . 115 Table RH.11: Place of delivery . 118 Table RH.12: Post-partum stay in health facility . 121 Table RH.13: Post-natal health checks for newborns . 123 Table RH.14: Post-natal care visits for newborns within one week of birth . 126 Table RH.15: Post-natal health checks for mothers . 128 Table RH.16: Post-natal care visits for mothers within one week of birth . 131 Table RH.17: Post-natal health checks for mothers and newborns . 133 Table CD.1: Early childhood education . 137 Table CD.2: Support for learning . 139 Table CD.3: Learning materials . 142 Table CD.4: Inadequate care . 144 Table CD.5: Early child development index . 146 Table ED.1: Literacy (young women) . 151 Table ED.2: School readiness . 153 Table ED.3: Basic school entry . 155 Table ED.4: Basic school attendance and out of school children . 157 Table ED.5: Secondary school attendance and out of school children . 160 Table ED.6: Children reaching last grade of basic school . 163 Table ED.7: Basic school completion and transition to secondary school . 166 Table ED.8: Education gender parity . 167 Table ED.9: Out of school gender parity . 168 Table CP.1: Birth registration . 173 Table CP.5: Child discipline . 175 Table CP.6: Attitudes toward physical punishment . 177 Table CP.7: Early marriage and polygyny (women) . 179 Table CP.8: Trends in early marriage (women) . 182 Table CP.9: Children's living arrangements and orphanhood . 184 Table CP.14: Children's living arrangements and orphanhood . 186 Table CP.15: Children with parents living abroad . 188 Table HA.1: Knowledge about HIV transmission, misconceptions about HIV, and comprehensive knowledge about HIV transmission (women) . 191 Table HA.2: Knowledge of mother-to-child HIV transmission (women) . 195 Table HA.3: Accepting attitudes toward people living with HIV (women) . 197 Table HA.4: Knowledge of a place for HIV testing (women) . 200 Appendices: Table SE.1: Indicators selected for sampling error calculations . 204 Table SE.2: Sampling errors: Total sample . 212 Table SE.3: Sampling errors: West Bank . 213 Table SE.4: Sampling errors: Gaza Strip . 214 Table SE.5: Sampling errors: Urban . 215 Table SE.6: Sampling errors: Rural . 216 Table SE.7: Sampling errors: Camp . 217 DQ.1: Age distribution of household population . 218 DQ.2: Age distribution of eligible and interviewed women . 219 DQ.4: Age distribution of children in household and under-5 questionnaires . 219 DQ.5: Birth date reporting: Household population . 220 DQ.6: Birth date and age reporting: Women . 221 DQ.8: Birth date and age reporting: Under-5s . 222 DQ.9: Birth date reporting: Children, adolescents and young people . 223 DQ.10: Birth date reporting: First and last births . 224 DQ.11: Completeness of reporting . 225 vi Palestinian Multiple Indicator Cluster Survey 2014   DQ.12: Completeness of information for anthropometric indicators: Underweight . 226 DQ.13: Completeness of information for anthropometric indicators: Stunting . 226 DQ.14: Completeness of information for anthropometric indicators: Wasting . 227 DQ.15: Heaping in anthropometric measurements . 227 DQ:16: Observation of birth certificates . 228 DQ.17: Observation of vaccination cards . 229 DQ.20: Respondent to the under-5 questionnaire . 230 DQ.21: Selection of children age 1-17 years for the child labour and child discipline modules . 231 DQ.22: School attendance by single age . 232 DQ.23: Sex ratio at birth among children ever born and living . 233 DQ.24: Births in years preceding the survey . 234 DQ.25: Reporting of age at death in days . 235 DQ.26: Reporting of age at death in months . 236 ED.4 (ISCED): Primary school attendance and out of school children . 316 ED.5 (ISCED) Secondary school attendance and out of school children . 318 ED.6 (ISCED) Children reaching last grade of primary school . 320 ED.7 (ISCED) Primary school completion and transition to secondary school . 321 ED.8(ISCED): Education gender parity . 322 ED.10(ISCED) Summary of education indicators . 323 vii   List of Figures Figure HH.1: Age and sex distribution of household population . 12 Figure CM.1: Early child mortality rates . 25 Figure CM.2: Under-5 mortality rates by area and region . 28 Figure CM.3: Trend in under-5 mortality rates . 29 Figure NU.1: Underweight, stunted, wasted and overweight children under age 5 (moderate and severe) . 38 Figure NU.2: Initiation of breastfeeding . 41 Figure NU.3: Infant feeding patterns by age . 43 Figure NU.4: Consumption of iodized salt . 52 Figure CH.1: Vaccinations by age 12 months (measles by 24 months) . 57 Figure CH.2: Children under-5 with diarrhoea who received ORS . 68 Figure CH.3: Children under-5 with diarrhoea receiving oral rehydration therapy (ORT) and continued feeding . 71 Figure WS.1: Percent distribution of household members by source of drinking water . 83 Figure WS.3: Use of improved drinking water sources and improved sanitation facilities by household members . 93 Figure RH.1: Age-specific fertility rates by region . 97 Figure RH.2: Differentials in contraceptive use . 104 Figure RH.3: Person assisting at delivery . 117 Figure RH.4: Continuum of reproductive and maternal health interventions . 119 Figure ED.1: Education indicators by sex . 169 Figure CP.1: Children under-5 whose births are registered . 174 Figure CP.2: Child disciplining methods, children age 1-14 years . 176 Figure CP.3: Early marriage among women . 183 Figure HA.1: Women and men with comprehensive knowledge of HIV transmission . 194 Figure HA.2: Accepting attitudes toward people living with HIV/AIDS . 199 viii Palestinian Multiple Indicator Cluster Survey 2014   List of Abbreviations AIDS Acquired Immune Deficiency Syndrome BCG Bacillus Calmette-Guérin (Tuberculosis) CSPro Census and Survey Processing System DPT Diphteria Pertussis Tetanus vaccine EPI Expanded Programme on Immunization GPI Gender Parity Index Hep.B Hepatitis B Hib Haemophilus influenzae type b HIV Human Immunodeficiency Virus IDD Iodine Deficiency Disorders IGME Inter-agency Group for Child Mortality Estimation IPV Inactivated Polio Vaccine ITN Insecticide Treated Net IUD Intrauterine Device LAM Lactational Amenorrhea Method MDG Millennium Development Goals MICS Multiple Indicator Cluster Survey MICS5 Fifth global round of Multiple Indicator Clusters Surveys programme MMR Measles Mumps and Rubella MoH Ministry of Health NAR Net Attendance Rate ORT Oral rehydration treatment PAPFAM Pan Arab Family Health Survey ppm Parts Per Million SPSS Statistical Package for Social Sciences 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 UNRWA The United Nations Relief and Works Agency for Palestine Refugees in the Near East WFFC World Fit for Children WHO World Health Organization ix   Acknowledgements The Palestinian Central Bureau of Statistics for Palestinian extends its gratitude to the Palestinian families living in Palestine for their cooperation and responsiveness with field workers during survey data collection. The Palestinian Central Bureau of Statistics also extends it thanks and appreciation to technical staff; the manager, supervisors, editors, field supervisors, fieldworkers, and the steering committee for their dedication and loyalty in performing their duties which led to the availability of high quality data. The Palestinian Bureau of Statistics also would like to extend its appreciation to the United Nations Children’s Fund (UNICEF) and the United Nations Fund for Population (UNFPA) on the technical and financial support which contributed greatly to the success of implementation of the survey. The Palestinian Central Bureau of statistics hopes to have contributed in providing reliable data on the situation of the Palestinians to planners and policy makers, in addition to providing data for researchers and academicians for further in-depth analysis on the reality of the Palestinian’s situation in Palestine. Ola Awad President, Palestinian Central Bureau of Statistics x Palestinian Multiple Indicator Cluster Survey 2014 P  a  g  e  |  xi   Summary Table of Survey Implementation and the Survey Population, Palestinian Multiple Indicator Cluster Survey, 2014 Survey implementation Sample frame -­‐ Updated Population Housing and Establishment Census 2007 Household Listing 2013 Questionnaires Household Women (age 15-49) Children under five Interviewer training February 2014 Fieldwork March-April 2014 Survey sample Households -­‐ Sampled -­‐ Occupied -­‐ Interviewed -­‐ Response rate (Per cent) 11, 125 10, 568 10, 182 96.3 Children under five -­‐ Eligible -­‐ Mothers/caretakers interviewed -­‐ Response rate (Per cent) 7, 919 7, 816 98.7 Women -­‐ Eligible for interviews -­‐ Interviewed -­‐ Response rate (Per cent) 13, 964 13, 367 95.7       Survey population Average household size 5.5 Percentage of population living in -­‐ West Bank -­‐ Gaza Strip -­‐ Urban -­‐ Rural -­‐ Camps   59.1   40.9     74.5   16.7   8.8   Percentage of population under: -­‐ Age 5 -­‐ Age 18   14.3   46.3   Percentage of women age 15-49 years with at least one live birth in the last 2 years 22.0               xi P  a  g  e  |  xii   HOUSEHOLD OR PERSONAL ASSETS HOUSING CHARACTERISTICS Palestine West Bank Gaza Strip Palestine West Bank Gaza Strip Percentage of households that own Percentage of households with -­‐ Radio -­‐ A television 38.6 80.1 44.6 75.2 28.6 88.2 -­‐ Electricity 99.9 99.9 99.9 -­‐ LCD /LED /3D TV 26.9 34.8 13.5 -­‐ Finished floor 99.9 99.9 99.8 -­‐ Non-mobile phone 36.2 40.1 29.7 -­‐ Finished roofing 99.8 99.9 99.8 -­‐ A refrigerator 95.5 97.0 93.0 -­‐ Finished walls 99.0 98.5 99.8 -­‐ Central heating 2.6 3.8 0.5 -­‐ Clothes Dryer 5.4 7.2 2.4 Mean number of persons per room used for sleeping 2.5 2.4 2.7 -­‐ Freezer 6.9 9.5 2.6 -­‐ Dishwasher 2.3 3.6 0.2 -­‐ Air Conditioner 16.9 22.5 7.5 -­‐ Play Station / X-Box 4.2 5.9 1.5 -­‐ Satellite Dish 94.7 95.3 93.6 -­‐ Solar Heater 59.0 65.4 48.2 -­‐ Vacuum Cleaner 37.0 49.9 15.4 -­‐ Washing Machine 95.1 96.2 93.2 -­‐ Agricultural land 17.6 22.1 10.0 -­‐ Farm animals/livestock 10.6 10.6 10.8 Percentage of households where at least a member has or owns a -­‐ I pad / Tablet 14.3 20.5 3.9 -­‐ A Smart Mobile telephone 48.2 58.6 30.8 -­‐ A Laptop 37.4 43.4 27.3 -­‐ Animal - Drawn cart 1.5 0.4 3.2 -­‐ A car or Truck 26.8 36.8 10.1 -­‐ Bank account 44.2 52.1 30.9 xii Palestinian Multiple Indicator Cluster Survey 2014 P  a  g  e  |  xiii   Summary Table of Findings1 Multiple Indicator Cluster Surveys (MICS) and Millennium Development Goals (MDG) Indicators, Palestinian Multiple Indicator Cluster Survey, 2014 CHILD MORTALITY Early childhood mortality MICS Indicator Indicator Description Value A Palestine West Bank Gaza Strip 1.1 Neonatal mortality rate Probability of dying within the first month of life 11 11 12 1.2 MDG 4.2 Infant mortality rate Probability of dying between birth and the first birthday 18 17 20 1.3 Post-neonatal mortality rate Difference between infant and neonatal mortality rates 7 6 8 1.4 Child mortality rate Probability of dying between the first and the fifth birthdays 4 3 4 1.5 MDG 4.1 Under-five mortality rate Probability of dying between birth and the fifth birthday 22 20 24 A Indicator values are per 1,000 live births and refer to the five-year period before the survey NUTRITION Nutritional status MICS Indicator Indicator Description Palestine West Bank Gaza Strip 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 1.4 0.2 1.5 0.3 1.3 0.2 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 7.4 1.8 7.7 2.4 7.1 1.1 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 1.2 0.3 1.7 0.6 0.7 0.1 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 8.2 9.8 6.5 1  See  Appendix  E  for  a  detailed  description  of  MICS  indicators   xiii P  a  g  e  |  xiv   Breastfeeding and infant feeding MICS Indicator Indicator Description Palestine West Bank Gaza Strip 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 96.6 95.8 97.6 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 40.8 40.7 41.0 2.7 Exclusive breastfeeding under 6 months Percentage of infants under 6 months of age who are exclusively breastfed 38.6 40.6 36.4 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 50.0 52.9 46.7 2.9 Continued breastfeeding at 1 year Percentage of children age 12-15 months who received breast milk during the previous day 52.9 48.4 58.7 2.10 Continued breastfeeding at 2 years Percentage of children age 20-23 months who received breast milk during the previous day 11.5 13.8 8.4 2.11 Median duration of breastfeeding The age in months when 50 percent of children age 0-35 months did not receive breast milk during the previous day 13.9 13.3 14.2 2.12 Age-appropriate breastfeeding Percentage of children age 0-23 months appropriately fed during the previous day 43.4 42.0 45.1 2.13 Introduction of solid, semi-solid or soft foods Percentage of infants age 6-8 months who received solid, semi-solid or soft foods during the previous day 89.6 87.7 91.6 2.14 Milk feeding frequency for non-breastfed children Percentage of non-breastfed children age 6-23 months who received at least 2 milk feedings during the previous day 69.6 79.1 57.6 2.15 Minimum meal frequency Percentage of children age 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 75.4 75.4 75.4 2.16 Minimum dietary diversity Percentage of children age 6–23 months who received foods from 4 or more food groups during the previous day 62.6 68.9 55.1 2.17a 2.17b Minimum acceptable diet (a) Percentage of breastfed children age 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 age 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 40.2 43.8 44.5 51.6 35.7 33.9 2.18 Bottle feeding Percentage of children age 0-23 months who were fed with a bottle during the previous day 42.4 47.5 36.3 Salt iodization 2.19 Iodized salt consumption Percentage of households with salt testing 15 parts per million or more of potassium iodide or potassium iodate 73.2 69.3 79.7 Low-birthweight 2.20 Low-birthweight infants Percentage of most recent live births in the last 2 years weighing below 2,500 grams at birth 8.3 8.4 8.3 2.21 Infants weighed at birth Percentage of most recent live births in the last 2 years who were weighed at birth 99.7 99.6 99.8 xiv Palestinian Multiple Indicator Cluster Survey 2014 P  a  g  e  |  xv   CHILD HEALTH Vaccinations MICS Indicator Indicator Description Palestine West Bank Gaza Strip 3.1 Tuberculosis immunization coverage Percentage of children age 12-23 months who received BCG vaccine by their first birthday 98.8 98.2 99.3 3.2 Polio immunization coverage Percentage of children age 12-23 months who received the third dose of OPV vaccine (OPV3) by their first birthday 97.9 97.6 98.2 3.3 3.5 3.6 Diphtheria, pertussis and tetanus (DPT), hepatitis B (HepB) and haemophilus influenza type B (Hib) immunization coverage (Pentavalent) Percentage of children age 12-23 months who received the third dose of Penta vaccine (diphtheria, pertussis, tetanus, hepatitis B and haemophilus influenza B) by their first birthday 96.9 96.6 97.2 3.4 MDG 4.3 Measles immunization coverage Percentage of children age 24-35 months who received measles vaccine by their second birthday 97.0 96.9 97.1 3.8 Full immunization coverage Percentage of children age 24-35 months who received all vaccinations recommended in the national immunization schedule by their first birthday (measles by second birthday) 89.9 89.8 90.0 Diarrhoea - Children with diarrhoea Percentage of children under age 5 with diarrhoea in the last 2 weeks 11.3 11.4 11.1 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 52.9 52.4 53.4 3.S1 Diarrhoea treatment with oral rehydration salts (ORS) Percentage of children under age 5 with diarrhoea in the last 2 weeks who received ORS 31.5 35.8 26.5 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, or increased fluids) and continued feeding during the episode of diarrhoea 38.2 41.4 34.4 Acute Respiratory Infection (ARI) symptoms - Children with ARI symptoms Percentage of children under age 5 with ARI symptoms in the last 2 weeks 10.7 11.0 10.4 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 76.5 78.6 74.0 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 70.3 72.7 67.4 xv P  a  g  e  |  xvi   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 1.8 0.5 3.7 WATER AND SANITATION MICS Indicator Indicator Description Palestine West Bank Gaza Strip 4.1 MDG 7.8 Use of improved drinking water sources Percentage of household members using improved sources of drinking water 61.5 96.8 10.4 4.2 Water treatment Percentage of household members in households using unimproved drinking water who use an appropriate treatment method 1.3 11.0 0.8 4.3 MDG 7.9 Use of improved sanitation Percentage of household members using improved sanitation facilities which are not shared 98.6 98.8 98.4 REPRODUCTIVE HEALTH Contraception and unmet need MICS Indicator Indicator Description Palestine West Bank Gaza Strip - Total fertility rate Total fertility rateA for women age 15-49 years 4.1 3.7 4.5 5.1 MDG 5.4 Adolescent birth rate Age-specific fertility rateA for women age 15-19 years 48 35 66 5.2 Early childbearing Percentage of women age 20-24 years who had at least one live birth before age 18 22.0 19.6 25.1 5.3 MDG 5.3 Contraceptive prevalence rate Percentage of women age 15-49 years currently married who are using (or whose partner is using) a (modern or traditional) contraceptive method 57.2 59.8 53.4 5.4 MDG 5.6 Unmet need Percentage of women age 15-49 years who are currently married who are fecund and want to space their births or limit the number of children they have and who are not currently using contraception 10.9 11.0 10.7 A The age-specific fertility rate is defined as the number of live births to women in a specific age group during a specified period, divided by the average number of women in that age group during the same period, expressed per 1,000 women. The age-specific fertility rate for women age 15-19 years is also termed as the adolescent birth rate. The total fertility rate (TFR) is calculated by summing the age-specific fertility rates calculated for each of the 5-year age groups of women, from age 15 through to age 49. The TFR denotes the average number of children to which a woman will have given birth by the end of her reproductive years (by age 50) if current fertility rates prevailed. xvi Palestinian Multiple Indicator Cluster Survey 2014 P  a  g  e  |  xvii   Maternal and newborn health MICS Indicator Indicator Description Palestine West Bank Gaza Strip 5.5a 5.5b MDG 5.5 MDG 5.5 Antenatal care coverage Percentage of women age 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 99.5 95.3 99.4 99.3 95.5 95.7 5.6 Content of antenatal care Percentage of women age 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 95.8 93.9 98.1 5.7 MDG 5.2 Skilled attendant at delivery Percentage of women age 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 99.6 99.6 99.5 5.8 Institutional deliveries Percentage of women age 15-49 years with a live birth in the last 2 years whose most recent live birth was delivered in a health facility 99.3 99.3 99.4 5.9 Caesarean section Percentage of women age 15-49 years whose most recent live birth in the last 2 years was delivered by caesarean section 20.3 22.7 17.4 Post-natal health checks MICS Indicator Indicator Description Palestine West Bank Gaza Strip 5.10 Post-partum stay in health facility Percentage of women age 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 58.5 81.3 31.0 5.11 Post-natal 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 post-natal care visit within 2 days after delivery 93.9 96.9 90.2 5.12 Post-natal health check for the mother Percentage of women age 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 90.7 89.7 91.8 xvii P  a  g  e  |  xviii   CHILD DEVELOPMENT MICS Indicator Indicator Description Palestine West Bank Gaza Strip 6.1 Attendance to early childhood education Percentage of children age 36-59 months who are attending an early childhood education programme 26.4 27.2 25.5 6.2 Support for learning Percentage of children age 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 77.5 82.7 71.5 6.3 Father’s support for learning Percentage of children age 36-59 months whose biological father has engaged in four or more activities to promote learning and school readiness in the last 3 days 12.0 14.1 9.7 6.4 Mother’s support for learning Percentage of children age 36-59 months whose biological mother has engaged in four or more activities to promote learning and school readiness in the last 3 days 54.4 59.2 48.9 6.5 Availability of children’s books Percentage of children under age 5 who have three or more children’s books 19.9 20.2 19.5 6.6 Availability of playthings Percentage of children under age 5 who play with two or more types of playthings 69.1 71.9 65.9 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 14.3 13.1 15.6 6.8 Early child development index Percentage of children age 36-59 months who are developmentally on track in at least three of the following four domains: literacy- numeracy, physical, social-emotional, and learning 72.0 76.0 67.5 xviii Palestinian Multiple Indicator Cluster Survey 2014 P  a  g  e  |  xix   LITERACY AND EDUCATION Survey Indicator Indicator Description Palestine West Bank Gaza Strip MICS 7.1 MDG 2.3 Literacy rate among young woman Percentage of young woman age 15-24 years who are able to read a short simple statement about everyday life or who attended secondary or higher education 97.2 97.6 96.5 7.2 School readiness Percentage of children in first grade of basic school who attended pre-school during the previous school year 94.1 91.9 97.2 7.3 Net intake rate in basic education Percentage of children of school-entry age who enter the first grade of basic school 96.9 97.3 96.5 7.4 MDG 2.1 Primary school net attendance ratio (adjusted) Percentage of children of primary school age currently attending primary or secondary school 98.8 98.9 98.7 7.5 Secondary school net attendance ratio (adjusted) Percentage of children of secondary school age currently attending secondary school or higher 89.8 89.5 90.2 7.6 MDG 2.2 Children reaching last grade of primary Percentage of children entering the first grade of primary school who eventually reach last grade 99.8 99.7 99.9 7.7 Primary completion rate Number of children attending the last grade of primary school (excluding repeaters) divided by number of children of primary school completion age (age appropriate to final grade of primary school) 99.6 98.6 101.0 7.8 Transition rate to secondary school Number of children attending the last grade of primary school during the previous school year who are in the first grade of secondary school during the current school year divided by number of children attending the last grade of primary school during the previous school year 98.3 99.9 96.3 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 1.00 1.00 1.00 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 1.06 1.12 1.08 7.S1 Basic school net attendance ratio (adjusted) Percentage of children of basic school age currently attending basic or secondary school 96.8 96.7 97.0 7.S2 Secondary school net attendance ratio (adjusted) Percentage of children of secondary school age currently attending secondary school or higher 71.7 70.7 73.2 7.S3 Children reaching last grade of basic Percentage of children entering the first grade of basic school who eventually reach last grade 92.1 92.1 92.0 7.S4 Basic completion rate Number of children attending the last grade of basic school (excluding repeaters) divided by number of children of basic school completion age (age appropriate to final grade of basic school) 88.7 90.7 85.4 7.S5 Transition rate to secondary school Number of children attending the last grade of basic school during the previous school year who are in the first grade of secondary school during the current school year divided by number of children attending the last grade of basic school during the previous school year 93.5 92.7 94.7 7.S6 Gender parity index (basic school) Basic school net attendance ratio (adjusted) for girls divided by basic school net attendance ratio (adjusted) for boys 1.03 1.04 1.02 P  a  g  e  |  xx   7.S7 Gender parity index (secondary school) Secondary school net attendance ratio (adjusted) for girls divided by secondary school net attendance ratio (adjusted) for boys 1.27 1.32 1.20 xix P  a  g  e  |  xxi   CHILD PROTECTION Birth registration MICS Indicator Indicator Description Palestine West Bank Gaza Strip 8.1 Birth registration Percentage of children under age 5 whose births are reported registered 99.3 99.1 99.6 Child discipline 8.3 Violent discipline Percentage of children age 1-14 years who experienced psychological aggression or physical punishment during the last one month 92.2 90.4 94.5 Early marriage and polygyny MICS Indicator Indicator Description Palestine West Bank Gaza Strip 8.4 Marriage before age 15 Percentage of women age 15-49 years who were first married before age 15 2.1 1.8 2.6 8.5 Marriage before age 18 Percentage of women age 20-49 years who were first married before age 18 24.2 21.4 28.6 8.6 Young Woman age 15-19 years currently married Percentage of young women age 15-19 years who are married 9.3 6.8 12.8 8.7 Polygyny Percentage of women age 15-49 years who are in a polygynous marriage 4.3 3.2 5.8 8.8a 8.8b Spousal age difference Percentage of women who are married and whose spouse is 10 or more years older, (a) among women age 15-19 years (b) among women age 20-24 years 13.2 11.9 15.1 14.5 11.8 8.9 Children’s living arrangements 8.13 Children’s living arrangements Percentage of children age 0-17 years living with neither biological parent 0.6 0.3 0.9 8.14 Prevalence of children with one or both parents dead Percentage of children age 0-17 years with one or both biological parents dead 2.3 2.0 2.6 8.15 Children with at least one parent living abroad Percentage of children 0-17 years with at least one biological parent living abroad 0.3 0.3 0.3 xx Palestinian Multiple Indicator Cluster Survey 2014 P  a  g  e  |  xxii   HIV/AIDS HIV/AIDS knowledge and attitudes MICS Indicator Indicator Description Palestine West Bank Gaza Strip - Have heard of AIDS Percentage of woman age 15-49 years who have heard of AIDS 95.0 96.4 92.9 Knowledge about HIV prevention among woman (15-49) Percentage of woman age 15-49 years who correctly identify ways of preventing the sexual transmission of HIV, and who reject major misconceptions about HIV transmission 7.7 9.9 4.5 9.1 MDG 6.3 Knowledge about HIV prevention among young woman Percentage of woman age 15-24 years who correctly identify ways of preventing the sexual transmission of HIV, and who reject major misconceptions about HIV transmission 6.2 8.2 4.6 9.2 Knowledge of mother-to-child transmission of HIV Percentage of woman age 15-49 years who correctly identify all three means of mother-to- child transmission of HIV 43.5 42.6 44.9 9.3 Accepting attitudes towards people living with HIV Percentage of woman age 15-49 years expressing accepting attitudes on all four questions toward people living with HIV 5.0 5.1 4.8 HIV testing MICS Indicator Indicator Description Palestine West Bank Gaza Strip 9.4 People who know where to be tested for HIV Percentage of Women age 15-49 years who state knowledge of a place to be tested for HIV 19.7 19.1 20.6 xxi P  a  g  e  |  xxiii   Executive Summary The Palestinian Multiple Indicator Cluster Survey (PMICS) was carried out in 2014 by Palestinian Central Bureau of Statistics in collaboration with Ministry of Health, as part of the global MICS programme. Technical and financial support was provided by the Palestinian Government, the United Nations Children’s Fund (UNICEF) and United Nations Population Fund (UNFPA). The findings pertain to March–April 2014, when the fieldwork was conducted. Findings from the survey are presented in this report. The Palestinian Multiple Indicator Cluster Survey, 2014 was conducted for a representative sample of Palestine. The survey was designed as a multi- stage cluster sample covering the entire country including two geographic regions; The West Bank which includes 11 governorates: (Jenin, Tubas, Tulkarm, Qalqiliya, Salfit, Nablus, Ramallah and Al Bireh, Jerusalem, Jericho and Al Aghwar, Bethlehem, Hebron) and Gaza Strip which includes 5 governorates (Gaza, Khan Yunis, Rafah, Deir El Balah and North Gaza) and was stratified according to urban, rural and camp areas. Of the 11,125 households selected in the sample, results showed that the number of occupied households were 10,568 of which 10,182 households were successfully interviewed during the survey, giving a response rate of 96 percent. There were 13,964 women in the 15-49 age group of which a total of 13,367 eligible women were successfully interviewed, achieving a response rate of 96 percent. In addition, the number of children was 7,919 child in the Household Questionnaire of which a total of 7,816 child were interviewed giving a response rate of 99 percent. The total households interviewed included 56,367 individual members who were listed. Of these, 28,542 were males and 27,825 were females with a sex ratio of 103 males per hundred females. It is noted that the Palestinian population is a young one. The percentage of individuals in the age group 0-17 years was 46 percent, whereas the percentage of individuals in the age group 18 and above was 54 percent. According to economic and social dependency categories, 39 percent individuals were in the age group 0-14 years, 58 percent in the age group 15-64 years which is the age category of economically active individuals; and 3 percent in the age group 65 years and over. The average household size in Palestine in 2014 was about 5.5 persons. About 91 percent of households are headed by men and about 9 percent of households are headed by women. Early Childhood Mortality The infant mortality rate in Palestine is 18 per 1,000 live births, with 17 per 1,000 live births in the West Bank compared to 20 per 1,000 live births in the Gaza Strip. The Under-Five Mortality rate in Palestine is 22 per 1,000 live births with 20 per 1,000 live births in the West Bank compared to 24 per 1,000 live births in the Gaza Strip. Mortality estimates is for the periods of five years preceding the survey; where differences appear in the mortality rates between male and female infants and children under 5. Among males, the infant mortality rate was 19 per 1000 live birth, with neonatal mortality rate of 11 per 1000 live birth, and the post neonatal mortality of 8 per 1000 live birth. These rates are higher among males than females as corresponding rates for infant mortality rate among girls is (17 per 1000 live birth, neonatal mortality is 11 per 1000 live birth; while the post neonatal mortality rate is 6 per 1000 live birth). Differences were also noted in the infant mortality rates according to area, where infant mortality rate in urban locations was around 19 per 1000 live births, 18 per 1,000 live births in rural areas and 12 per 1,000 live births in Camps. xxii Palestinian Multiple Indicator Cluster Survey 2014 P  a  g  e  |  xxiv   Malnutrition indicators Among the child survival indicators are the malnutrition indicators, which are expressed in anthropometric measurements (height, weight, age). Weights and height measurements were conducted for children under-five years of age in Palestinian households. Data results revealed that one percent of the children under-5 in Palestine are moderately underweight and a negligible proportion (0.2) are severely underweight, seven percent of children under-5 are moderately stunted i.e. too short for their age, and two percent are severely stunted. Results also show that one percent of children are also moderately wasted (short for their height). They also show that eight percent of children are suffering from overweight. Breastfeeding For monitoring the nutritional status, it is important to follow up the pattern of breast feeding and complementary feeding for children from birth to three years. WHO and the UNICEF recommend continued breastfeeding for two years or more. Although breastfeeding is an important factor in dealing with feeding and building a physical and emotional connection between mother and infant. Results show that only 41 percent of infants are breastfed for the first time within the first hour of birth; while results show that around 97 percent of children under five had been ever- breastfed. Results also show that no differences according to the region. Differences are noted according to the area where the highest percentage was among children in the rural areas reaching 45 percent compared to 40 percent of urban children and 43 percent of children in Camps. Moreover, it was noted that there are large differences in the results for early initiation of breast feeding at the governorate level, the lowest seem in 25 percent in Hebron governorate, followed by 33 percent in Gaza governorate. The highest percentage was in Jericho and Al Aghwar governorate with 66 percent followed by Rafah with 63 percent. It is also found that only 39 percent of children aged less than six months are exclusively breastfed (breast milk only, or with vitamins or medicine) which is considerably lower than the international standards Immunization Immunization coverage is an important health concern that helps to protect children from deadly diseases. Countries follow globally accepted programmes of vaccination where the child receives vaccinations within a specified period of time. These vaccinations include Bacillis-Cereus-Geuerin (BCG), a birth dose of Hepatitis B (Hep B) Inactivated Polio Vaccine(IPV), Pentavalent i.e. Diptheria, Pertussis and Tetanus (DPT); Hep B; Hemophilus Influenza type b (Hib), Polio, and measles. In the survey, vaccination cards were mainly used for recording vaccines received by the child, and if the child did not have a card, the mother was asked to recall whether or not the child had received each of the vaccinations and, they were also asked how many times. Percentage of measles vaccine and full immunization were been calculated to children aged 24-35 months who received measles by their second birthday. Overall, 94 percent of children age 12-23 months and 89 percent of those age 24-35 months have ever received a vaccination card, and that cards were actually seen by the interviewer in 93 percent and 84 percent of cases respectively for these two age groups. Approximately 99 percent of children age 12-23 months received a BCG vaccination by the age of 12 months and the first and second doses of Pentavalent vaccine (DPT-HepB-Hib) vaccine were given to 98 percent, the coverage was maintained at 97 percent for the third xxiii P  a  g  e  |  xxv   dose. Similarly, 99 percent of children received Polio 1 by age 12 months and this was maintained at 98 percent by the third dose. The coverage for measles vaccine for children 24-35 months by any time before the survey was 99 while 97 percent of children 24-35 months received the measles vaccine by the age of 12 months. As a result, the children who had received all the recommended vaccinations by their first birthday and measles by their second birthday, i.e. who were fully immunised was 90 percent Diarrhoeal disease, pneumonia and acute respiratory tract infections Diarrhoeal disease, pneumonia and acute respiratory tract infections are important risk factors that increase the risk of death of infants and children under-five. Mothers (or caretakers) were asked to report; whether their child had diarrhoea in the two weeks prior to the survey; the treatment methods used (by oral rehydration therapy, increased foods and liquids). Questions were also asked about symptoms of pneumonia. About 11 percent of children under-five years of age had diarrhoea in the two weeks preceding the survey. This percentage ranged from five percent in Qalqiliya governorate to 18 percent in Tubas governorate. The highest period-prevalence is seen among children age 12-23 months (18 percent) which grossly corresponds to the weaning period. The results showed differences between children who had diarrhea in the two weeks preceding the survey based on mother’s education; where only three percent of children who had diarrhea their mothers had basic education compared to 11 percent for mothers with higher education. Information on symptoms of ARI was collected during the Palestinian MICS to capture risk to pneumonia which was noted by a child who had rapid breathing or difficulty breathing which was accompanied by a cough. Results show that 11 percent of children aged 0-59 months were reported to have had symptoms of acute respiratory infections a during the two weeks preceding the survey. Seventy seven percent of children age 0-59 months with symptoms of ARI were taken to a qualified provider. (79 percent, males; 74 percent, females), the percentage was better in the West Bank; 79 percent compared to 74 percent in Gaza Strip, while it was 73 percent for rural children compared to 77 percent in camps and urban areas. Seventy percent of under-5 children with symptoms of ARI received antibiotics during the two weeks prior to the survey. The percentage was considerably higher in urban (72 percent) than in camps and rural areas, and ranges from 50 percent in Bethlehem governorate to 91 percent in Rafah. Water and Sanitation Use of unimproved sources of drinking water and sanitation, are considered to be major factors leading to disease and infection. Overall, 62 percent of the population living in Palestine has access to improved drinking water sources. This coverage does not indicate that the sources are necessarily safe. The situation is considerably worse in Gaza Strip region compared with the West Bank where only 10 percent of the population in Gaza Strip has access to improved drinking water sources compared to 97 percent in the West Bank. It should be noted that this percentage is low because 68 percent of Gaza Strip residents use tankered water which is not considered an improved source of water. Results also show that residents of the rural regions have better access to improved sources of drinking water compared to urban areas and Camps, 87 percent in rural areas compared to about 58 percent in urban regions and 42 percent in Camps. xxiv Palestinian Multiple Indicator Cluster Survey 2014 P  a  g  e  |  xxvi   Results show that about 89 percent of households that use unimproved drinking water source do not use any method for water treatment whereas eight percent of households use a water filter and one percent adds chlorine. The majority of the Palestinian households are using improved sanitation facilities (99 percent). Fifty six percent of the households are connected to piped sewer system; of which 38 percent are in the Gaza Strip and 82 percent in the West Bank. The lowest proportion of households connected to piped sewer system is in rural areas (only 10 percent) compared to 89 percent in Camps and 62 percent in urban areas. Ten percent of households use pit latrines which are considered as improved sanitation facility. Reproductive health: Governments seek to promote knowledge and provide reproductive health services for women, because such services have an effect on reducing maternal mortality rates and help avoid unsafe pregnancies which increase the likelihood of death among teenage mothers age 15-19. The survey addressed a number of reproductive health indicators. The Total Fertility Rate (TFR) for the three years preceding the Palestinian MICS 2014 is 4.1 births per woman. Results reveal that fertility rates differ according to region where it was 3.7 births per woman in the West Bank compared to 4.5 births per woman in Gaza Strip. Current use of contraception was reported by 57 percent of currently married women. The most popular method is the IUD which is used by 26 percent of married women in Palestine. The next most popular method is withdrawal, which accounts for nine percent of use among married couples. Contraceptive prevalence ranges from 60 percent in the West Bank to 53 percent in Gaza Strip. About 57 percent of married women in urban and 60 percent in rural areas and 58 in camps use a method of contraception. Adolescents are far less likely to use contraception than older women. Only about 16 percent of women age 15-19 married currently use a method of contraception compared to 38 percent of 20-24 year olds, while the use of contraception among older women ranges from 52 percent to 73 percent. The total of met need for spacing and limiting adds up to the total met need for contraception. Results show that met need for limiting is 36 percent and for spacing is 21 percent. The total demand for contraception includes women who currently have an unmet need (for spacing or limiting), plus those who are currently using contraception. Results show that unmet need for limiting is 5 percent and for spacing is 6 percent. About 96 percent of women who gave birth to their last child in the past two years from the survey on Palestinian households in 2014 received antenatal care from skilled personnel (doctor, nurse, midwife or auxiliary midwife), at least four times by visiting antenatal care centers. Among women who received antenatal care at least four times, about 96 percent were in the West Bank and 95 percent in Gaza Strip, this reflects women’s degree of awareness of the importance of consistency of care during the progress of pregnancy. About 99 percent of births in the two years preceding the survey were delivered in a health facility and by skilled personnel (Doctor, Nurse or Midwife). Twenty percent of births were delivered through Caesarean section. Overall, 59 percent of women who gave birth in a health facility stay 12 hours or more in the facility after delivery; 81 percent in the West Bank to 31 percent in Gaza Strip. A much higher proportion (78 percent) of women delivering in NGO's facilities stay 12 hours or more than those delivering in private facilities (65 percent). A similar disparity exists between rural xxv P  a  g  e  |  xxvii   (74 percent) and urban women (57 percent). As expected, nearly all women (99 percent) giving birth through C-section stay 12 hours or more in the facility after giving birth. Overall, 94 percent of newborns receive a health check following birth while in a facility or at home. With regards to PNC visits, these predominantly occur late, either after the first week or 3-6 days after the delivery (50 percent and 20 percent, respectively). As a result, a total of 94 percent of all newborns receive a post-natal health check. This percentage varies from 97 percent in the West Bank to 90 percent in Gaza Strip. Overall, 91 percent of mothers receive a health check following birth while in a facility or at home. With regards to PNC visits, the majority take place after the first week or 3-6 days after the delivery (32 percent and 11 percent, respectively). As a result, a total of 91 percent of all mothers receive a post-natal health check. This percentage varies from 90 percent in the West Bank to 92 percent in Gaza Strip. Education: Overall, 94 percent of children who are currently attending the first grade of primary school were attending pre-school the previous year. The proportion among females is slightly higher (96 percent) than males (93 percent). Also slight differential between West Bank and Gaza Strip is noticed (92 percent and 97 percent) respectively. Governorate differentials are also significant; first graders in Bethlehem governorate have attended pre-school by 82 percent compared to 100 percent in Deir El Balah and Khan Yunis governorates. Of children who are of basic school entry age (age 6), overall 97 percent are attending the first grade of basic school, with no differentials by any of the background characteristics. Only 72 percent of the children are attending secondary school, 63 percent for males compared to 80 percent for females. Gender parity for basic school is 1.03, and the gender parity for secondary school is 1.27, which is in favour for females. Inadequate care: Around 12 percent of children age 0-59 months were left in the care of other children, while 4 percent were left alone during the week preceding the interview. Combining the two care indicators, it is calculated that a total of 14 percent of children were left with inadequate care during the past week, either by being left alone or in the care of another child. No differences were observed by the sex of the child or between urban and rural and camps areas. Children age 48-59 months were left with inadequate care (17 percent) more than those who were age 36-47 months (9 percent). Early Childhood Development Around 72 percent of children age 36-59 months are developmentally on track. Early Child Development Index (ECDI) is higher among girls (77 percent) than boys (68 percent). ECDI is much higher in older age group (79 percent among 48-59 months old compared to 66 percent among 36-47 months old). Higher ECDI is seen in children attending to an early childhood education programme at 87 percent compared to 67 percent among those who are not attending. Children living in poorest households have lower ECDI (63 percent) compared to children living in richest households (81 percent of children developmentally on track). The analysis of four domains of child development shows that 96 percent of children are on track in the physical domain, but much less on track in literacy-numeracy (22 percent), learning (92 percent) and social-emotional (71 percent) domains. In each individual xxvi Palestinian Multiple Indicator Cluster Survey 2014 P  a  g  e  |  xxviii   domain the higher score is associated with children living in richest households, with children attending an early childhood education programme, older children, and among girls. Knowledge of AIDS: In Palestine, 95 percent of the women age 15-49 years have heard of AIDS. However, the percentage of those who know of both main ways of preventing HIV transmission – having only one faithful uninfected partner and using a condom every time – is only 34 percent. About 77 percent of women know of having one faithful uninfected sex partner and 38 percent of women know of using a condom every time as main ways of preventing HIV transmission. Overall, only eight percent of women age 15-49 years were found to have comprehensive knowledge. As expected, the percentage of women with comprehensive knowledge increases with their education level, the percentage is higher among women who have higher education (12 percent) compared with women with no education (1 percent). And the percentage of women with comprehensive knowledge is higher among women in the West Bank (10 percent) compared with women in Gaza Strip (5 percent), also a clear variation was noticed among governorates, with the lowest percentage in Deir El-Balah governorate (2 percent) while the highest was seen in Jericho and Al-Aghwar governorate (21 percent). xxvii I. Introduction 1 I. Introduction Background This report is based on the Palestinian Multiple Indicator Cluster Survey (PMICS), conducted in 2014 by the Palestinians Central Bureau of Statistics. 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 subnational levels of progress in order to address obstacles more effectively and accelerate actions.…” (A World Fit for Children, paragraph 61) The Plan of Action 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.” The global MICS programme was developed by UNICEF in the 1990s as an international household survey programme to collect 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 2 Palestinian Multiple Indicator Cluster Survey 2014 2 progress towards the Millennium Development Goals (MDGs) and other internationally agreed upon commitments. The Palestinian 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 Palestinian 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 2014 Palestinian MICS has as its primary objectives: • To provide up-to-date information for assessing the situation of children and women in Palestine • 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. 3 II. Sample and Survey Methodology 3 II. Sample and Survey Methodology Sample Design The sample for the Palestinian Multiple Indicator Cluster Survey was designed to provide estimates for a large number of indicators on the situation of children and women in the State of Palestine. The urban, rural and camps areas within each 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 (EAs) were selected systematically with probability proportional to size; a total of 445 sample EAs were selected at the first stage. After a household listing was carried out within the selected enumeration areas, a random systematic sample of 25 households was selected for each sample EA; this resulted in a total sample size of 11,125 households. The sample was stratified by region, urban, rural and refugee camps areas, and it is not self-weighting. For reporting national level results, sample weights are used. A more detailed description of the sample design can be found in Appendix A. Questionnaires Three 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 age 15-49 years; and 3) an under-5 questionnaire, administered to mothers (or caretakers) for all children under 5 years of age1 living in the household. The questionnaires included the following modules: The Household Questionnaire included the following modules: o List of Household Members o Education o Child Discipline o Household Characteristics o Water and Sanitation o Salt Iodization The Questionnaire for Individual Women was administered to all women age 15-49 years living in the households, and included the following modules: o Woman’s Background o Fertility/Birth History o Desire for Last Birth o Maternal and Newborn Health o Post-natal Health Checks o Contraception o Unmet Need o Marriage o HIV/AIDS The Questionnaire for Children Under Five was administered to mothers (or caretakers) of children under 5 years of age living in the households. Normally, the questionnaire was administered to mothers of under-5 children; in cases when the mother was not listed in the 1  The  terms  “children  under  5”,  “children  age  0-­‐4  years”,  and  “children  age  0-­‐59  months”  are  used   interchangeably  in  this  report.   6 Palestinian Multiple Indicator Cluster Survey 2014 4 household roster, a primary caretaker for the child was identified and interviewed. The questionnaire included the following modules: o Age o Birth Registration o Early Childhood Development o Breastfeeding and Dietary Intake o Immunization o Care of Illness o Anthropometry The questionnaires are based on the MICS5 model questionnaire2. From the MICS5 model English version, the questionnaires were customised and translated into Arabic and were pre-tested in December, 2013 in 4 clusters, out of each cluster 25 households were selected for interview, 25 households in Al-Bireh city and 25 households in Ramallah city (Urban), 25 households in Abu-Qash village (rural) and 25 in Al-Jalazoun refugee camp (refugee camps). The clusters were covered Ramallah governorate in the central of the West Bank. Based on the results of the pre-test, modifications were made to the wording and translation of the questionnaires. A copy of the Palestinian 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 age under 5 years. Details and findings of these observations and measurements are provided in the respective sections of the report. Training and Fieldwork Training for the fieldwork was conducted for 16 days in February /2014. Training included lectures on interviewing techniques and the contents of the questionnaires, and mock interviews between trainees to gain practice in asking questions. Towards the end of the training period, trainees spent 2 days in practice interviewing in Jenin, Tulkarm, Nablus, Ramallah, Jerusalem, Bethlehem and Hebron governorates in the West Bank, and Gaza, Deir El-Balah, Khan Yunis governorates in Gaza Strip. The data were collected by 28 teams; each was comprised of 4-5 interviewers, one editor, one measurer and a supervisor. Fieldwork began in March/2014 and concluded in April/2014. Data Processing Data were entered using the CSPro software, Version 5.0. All the questionnaires were entered by using desktop computers, this process was done by 46 data entry operators and 2 data entry supervisors. 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 Palestinian Multiple Indicator Cluster Survey questionnaire were used throughout. Data processing began simultaneously with data collection in February /2014 and was completed in July /2014. Data were analysed using the Statistical Package for Social Sciences (SPSS) software, Version 19. Model syntax and tabulation plans developed by UNICEF were customized and used for this purpose. 2  The  model  MICS5  questionnaires  can  be  found  at  http://mics.unicef.org/tools     7 III. Sample Coverage and the Characteristics of Households and Respondents 5 III. Sample Coverage and the Characteristics of Households and Respondents Sample Coverage Of the 11,125 households selected for the sample, 10,568 were found to be occupied. Of these, 10,182 were successfully interviewed for a household response rate of 96.3 percent. In the interviewed households, 13,964 women (age 15-49 years) were identified. Of these, 13,367 were successfully interviewed, yielding a response rate of 95.7 percent within the interviewed households. There were 7,919 children under age five listed in the household questionnaires. Questionnaires were completed for 7,816 of these children, which corresponds to a response rate of 98.7 percent within interviewed households. Overall response rates of 92.2 and 95.1 are calculated for the individual interviews of women and under-5s, respectively (Table HH.1). Table HH.1: Results of household, women's and under-5 interviews Number of households, women, and children under 5 by results of the household, women's and under-5's interviews, and household, women's and under-5's response rates, Palestine, 2014 Total Region Area West Bank Gaza Strip Urban Rural Camps Households Sampled 11125 7375 3750 8025 1975 1125 Occupied 10568 6986 3582 7615 1878 1075 Interviewed 10182 6687 3495 7290 1833 1059 Household response rate 96.3 95.7 97.6 95.7 97.6 98.5 Women Eligible 13964 8825 5139 9959 2483 1522 Interviewed 13367 8429 4938 9538 2375 1454 Women's response rate 95.7 95.5 96.1 95.8 95.7 95.5 Women's overall response rate 92.2 91.4 93.8 91.7 93.4 94.1 Children under 5 Eligible 7919 4508 3411 5765 1279 875 Mother/Caretaker Interviewed 7816 4453 3363 5698 1256 862 Response rate 98.7 98.8 98.6 98.8 98.2 98.5 Overall response rate 95.1 94.6 96.2 94.6 95.8 97.0 10 Palestinian Multiple Indicator Cluster Survey 2014 6 Characteristics of Households The weighted age and sex distribution of the survey population is provided in Table HH.2. The distribution is also used to produce the population pyramid in Figure HH.1. In the 10,182 households successfully interviewed in the survey, 56,367 household members were listed. Of these, 28,542 were males, and 27,825 were females. Table HH.2: Age distribution of household population by sex Percent and frequency distribution of the household population by five-year age groups, dependency age groups, and by child (age 0-17 years) and adult populations (age 18 or more), by sex, Palestine, 2014 Total Males Females Number Percent Number Percent Number Percent Total 56367 100.0 28542 100.0 27825 100.0 Region West Bank 33333 59.1 16884 59.2 16449 59.1 Gaza Strip 23034 40.9 11658 40.8 11376 40.9 Area Urban 41987 74.5 21209 74.3 20778 74.7 Rural 9439 16.7 4803 16.8 4636 16.7 Camp 4941 8.8 2530 8.9 2411 8.7 Age 0-4 8047 14.3 4174 14.6 3873 13.9 5-9 7391 13.1 3689 12.9 3702 13.3 10-14 6711 11.9 3424 12.0 3288 11.8 15-19 6608 11.7 3370 11.8 3237 11.6 20-24 6150 10.9 3183 11.2 2967 10.7 25-29 4243 7.5 2157 7.6 2086 7.5 30-34 3404 6.0 1691 5.9 1713 6.2 35-39 3083 5.5 1493 5.2 1589 5.7 40-44 2628 4.7 1315 4.6 1313 4.7 45-49 2274 4.0 1215 4.3 1060 3.8 50-54 1848 3.3 932 3.3 916 3.3 55-59 1285 2.3 655 2.3 630 2.3 60-64 905 1.6 473 1.7 432 1.6 65-69 696 1.2 312 1.1 384 1.4 70-74 438 0.8 193 0.7 244 0.9 75-79 321 0.6 142 0.5 179 0.6 80-84 199 0.4 80 0.3 119 0.4 85+ 132 0.2 42 0.1 90 0.3 Missing/DK 5 0.0 2 0.0 3 0.0 Dependency age groups 0-14 22149 39.3 11287 39.5 10863 39.0 15-64 32427 57.5 16484 57.8 15943 57.3 65+ 1785 3.2 769 2.7 1016 3.7 Missing/DK 5 0.0 2 0.0 3 0.0 Child and adult populations Children age 0-17 years 26105 46.3 13282 46.5 12823 46.1 Adults age 18+ years 30257 53.7 15258 53.5 14999 53.9 Missing/DK 5 0.0 2 0.0 3 0.0 11 7 The age structure shows that the Palestinian population is young. The percentage of individuals in the age group 0-17 years is about 46 percent, whereas the percentage of individuals in the age group 18 and above is 54 percent – distributed almost equally among males and females. Given the population distribution in the categories of economic and social dependency, it is noted that the age group 0-14 years account for 39 percent of the population and the group 65 years and over account for 3 percent. The economically active individuals in the age group 15-64 years account for about 58 percent of the population. In the age group 15-64 years, similarities in the age distribution between males and females i.e. around 58 percent for each sex are noted. On the contrary, a clear difference was observed in the age group 65 years and over with females constituting four percent compared to around three percent for males, while in the age group 0-14 years this percentage was 40 percent for the males compared to 39 percent of the females. Figure HH.1: Age and sex distr ibut ion of household populat ion, The Palest inian Mult iple Indicator Cluster Survey, 2014 Tables HH.3, HH.4 and HH.5 provide basic information on the households, female respondents age 15-49, male respondents 15-49, and children under-5. Both unweighted and weighted numbers are presented. Such information is essential for the interpretation of findings presented later in the report and provide 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 1  See  Appendix  A:  Sample  Design,  for  more  details  on  sample  weights.   10   8   6   4   2   0   2   4   6   8   0-­‐4   5-­‐9   10-­‐14   15-­‐19   20-­‐24   25-­‐29   30-­‐34   35-­‐39   40-­‐44   45-­‐49   50-­‐54   55-­‐59   60-­‐64   65-­‐69   70-­‐74   75-­‐79   80-­‐84   85+   Per  cent   Age   Males   Females   Note:  5  household  members  with  missing  age  are  excluded   12 Palestinian Multiple Indicator Cluster Survey 2014 8 report; the figures in the table are also intended to show the numbers of observations by major categories of analysis in the report. Table HH.3: Household composition Percent distribution of households by selected characteristics Palestine, 2014 Selected background characteristics Weighted percent Number of households Weighted Unweighted Total 100.0 10182 10182 Region West Bank 62.7 6385 6687 Gaza Strip 37.3 3797 3495 Sex of household head Male 90.8 9246 9220 Female 9.2 936 962 Governorate Jenin 7.3 743 762 Tubas 1.3 128 191 Tulkarm 4.1 421 430 Nablus 8.8 892 858 Qalqiliya 2.2 224 252 Salfit 1.6 164 191 Ramallah & Al-Bireh 7.6 770 782 Jericho and Al Aghwar 1.1 113 162 Jerusalem 9.7 988 1001 Bethlehem 4.9 497 532 Hebron 14.2 1446 1526 North Gaza 6.9 701 672 Gaza 13.1 1337 1161 Deir El-Balah 5.7 579 533 Khan Yunis 7.1 724 710 Rafah 4.5 455 419 Area Urban 74.7 7602 7290 Rural 17.1 1740 1833 camp 8.2 840 1059 Number of household members 1 3.3 335 350 2 9.2 935 929 3 10.6 1079 1083 4 13.5 1377 1377 5 14.5 1472 1476 6 15.4 1570 1568 7 12.7 1293 1290 8 9.3 951 951 9 5.6 574 570 10+ 5.9 596 588 Education of household head None 5.1 516 529 Basic 42.5 4327 4341 Secondary 25.8 2623 2619 Higher 26.7 2714 2691 Missing/DK 0.0 2 2 Mean household size 5.5 10182 10182 The weighted and unweighted total number of households are equal, since sample weights were normalized.1 The table also shows the weighted mean household size estimated by the survey. 13 9 Characteristics of Female Respondents 15-49 Years of Age and Children Under-5 Tables HH.4 and HH.5 provide information on the background characteristics of female and male respondents 15-49 years of age and of children under age 5. In all three tables, the total numbers of weighted and unweighted observations are equal, since sample weights have been normalized (standardized)1. In addition to providing useful information on the background characteristics of women and children under age five, the tables are also intended to show the number of observations in each background category. These categories are used in the subsequent tabulations of this report. Table HH.4: Women's background characteristics Percent and frequency distribution of women age 15-49 years by selected background characteristics, Palestine, 2014 Weighted percent Number of women Weighted Unweighted Total 100.0 13367 13367 Region West Bank 60.1 8032 8429 Gaza Strip 39.9 5335 4938 Governorate Jenin 6.9 921 947 Tubas 1.3 169 261 Tulkarm 3.9 518 551 Nablus 8.0 1072 1001 Qalqiliya 2.0 271 317 Salfit 1.6 211 252 Ramallah & Al-Bireh 6.9 927 941 Jericho and Al Aghwar 1.3 170 237 Jerusalem 9.0 1197 1118 Bethlehem 4.9 657 712 Hebron 14.4 1919 2092 North Gaza 7.1 945 928 Gaza 14.5 1942 1676 Deir El-Balah 6.3 842 776 Khan Yunis 7.6 1012 1002 Rafah 4.4 594 556 Area Urban 74.3 9938 9538 Rural 17.0 2272 2375 Camps 8.7 1157 1454 Age 15-19 22.8 3047 3061 20-24 21.0 2813 2812 25-29 14.9 1997 1980 30-34 12.3 1650 1629 35-39 11.6 1556 1558 40-44 9.5 1276 1282 45-49 7.7 1028 1045 14 Palestinian Multiple Indicator Cluster Survey 2014 10 Table HH.4 Continued: Women's background characteristics Percent and frequency distribution of women age 15-49 years by selected background characteristics, Palestine, 2014 Weighted percent Number of women Weighted Unweighted Marital status Currently married 59.6 7960 7900 Widowed 1.0 128 128 Divorced 1.4 181 178 Separated 0.0 5 6 Never married 38.1 5093 5155 Motherhood and recent births Never gave birth 43.7 5846 5888 Ever gave birth 56.3 7521 7479 Gave birth in last two years 22.0 2941 2891 No birth in last two years 34.3 4581 4589 Education None 0.6 85 87 Basic 35.7 4770 4776 Secondary 29.4 3931 3896 Higher 34.3 4580 4607 Missing/DK 0.0 1 1 Wealth index quintile Poorest 19.3 2580 2403 Second 19.8 2647 2512 Middle 19.8 2646 2817 Fourth 20.3 2719 2835 Richest 20.8 2775 2800 15 11 Table HH.4 provides background characteristics of female respondents, age 15-49 years. The table includes information on the distribution of women according to region, area, age, marital status, motherhood status, births in last two years, education2, wealth index quintiles3, 4. Women aged 15-49 years are distributed among the following age groups: about 59 percent in the age group 15-29 years, about 24 percent in the age group 30-39 years and 17 percent in the age group 40-49 years. Sixty percent of women 15-49 years were currently married, and around 38 percent never married. To assess their education, women were asked about highest level of school they attained. Less than one percent of all women did not attend any form of education. The majority of women have attained either secondary or higher education (65 percent). Sixty two percent of women were ever-married. Among the total women aged 15-49 years, 56 percent had ever given birth of which 22 percent had given birth in the past two years preceding the survey. Background characteristics of children under 5 are presented in Table HH.5. These include the distribution of children by several attributes: sex, region and area, age in months, respondent type, mother’s (or caretaker’s) education, and wealth. The percentage of male children under-five years is slightly higher than female (52 percent vs 48 percent respectively). About 19 percent of children were under one year of age, 20 2  Throughout this report, unless otherwise stated, “education” refers to highest educational level ever attended by the respondent when it is used as a background variable. 3 The 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 5 equal parts (quintiles) from lowest (poorest) to highest (richest). In Palestinian MICS, the following assets were used in these calculations: Electricity, radio, tube television, LCD /LED /3D TV, non-mobile telephone, refrigerator, central heating, clothes dryer, freezer, dish washer, air conditioner, play station/ xbox, satellite dish, solar heater, vacuum cleaner, clothes washer, iPad /Tablet, Smart mobile telephone, laptop, animal-drawn cart, and car or truck. The wealth index is assumed to capture the underlying long-term wealth through information on the household assets, and is intended to produce a ranking of households by wealth, from poorest to richest. The wealth index does not provide information on absolute poverty, current income or expenditure levels. The wealth scores calculated are applicable for only the particular data set they are based on. Further information on the construction of the wealth index can be found in Filmer, D. and Pritchett, L., 2001. “Estimating wealth effects without expenditure data – or tears: An application to educational enrolments in states of India”. Demography 38(1): 115-132. Rutstein, S.O. and Johnson, K., 2004. The DHS Wealth Index. DHS Comparative Reports No. 6. Calverton, Maryland: ORC Macro and Rutstein, S.O., 2008. The DHS Wealth Index: Approaches for Rural and Urban Areas. DHS Working Papers No. 60. Calverton, Maryland: Macro International Inc. 4 When describing survey results by wealth quintiles, appropriate terminology is used when referring to individual household members, such as for instance “women in the richest household population”, which is used interchangeably with “women in the wealthiest survey population” and similar. 16 Palestinian Multiple Indicator Cluster Survey 2014 12 percent were 12-23 months, 20 percent were 24-35 months, about 21 percent were 36-47 months and 20 percent were 48-59 months. Less than one percent of children’s mothers or care takers were uneducated, 30 percent had basic education, while the majority of them had secondary or higher education (70 percent). The percentage of poorest children were the highest quintile according to the wealth index (25 percent) while richest children were about 16 percent. It is noticed that the number of weighted and unweighted number of cases are generally similar within the education categories. 17 13 Table HH.5: Under-5's background characteristics Percent and frequency distribution of children under five years of age by selected characteristics, Palestine, 2014 Weighted percent Number of under-5 children Weighted Unweighted Total 100.0 7816 7816 Region West Bank 53.7 4201 4453 Gaza Strip 46.3 3615 3363 Sex Male 51.9 4058 4070 Female 48.1 3758 3746 Governorate Jenin 6.0 468 489 Tubas 0.8 65 99 Tulkarm 2.8 217 228 Nablus 6.7 523 509 Qalqiliya 2.0 157 175 Salfit 1.3 104 120 Ramallah & Al-Bireh 6.0 466 461 Jericho and Al Aghwar 1.2 94 139 Jerusalem 8.1 634 642 Bethlehem 4.3 340 368 Hebron 14.5 1132 1223 North Gaza 8.9 695 678 Gaza 16.5 1292 1122 Deir El-Balah 6.2 488 459 Khan Yunis 8.5 667 662 Rafah 6.1 473 442 Area Urban 76.0 5944 5698 Rural 15.2 1186 1256 Camps 8.8 686 862 Age 0-5 months 8.5 668 665 6-11 months 10.3 803 788 12-23 months 19.6 1530 1538 24-35 months 19.7 1540 1545 36-47 months 21.5 1677 1678 48-59 months 20.4 1597 1602 Respondent to the under-5 questionnaire Mother 99.4 7758 7758 Other primary caretaker 0.6 44 43 Mother’s education* None 0.5 37 37 Basic 30.0 2346 2340 Secondary 33.8 2641 2620 Higher 35.7 2792 2819 Wealth index quintile Poorest 24.8 1937 1804 Second 20.5 1601 1523 Middle 19.9 1555 1673 Fourth 19.1 1491 1550 Richest 15.8 1233 1266 * In this table and throughout the report, mother's education refers to educational attainment of mothers as well as caretakers of children under 5, who are the respondents to the under-5 questionnaire if the mother is deceased or is living elsewhere. 18 Palestinian Multiple Indicator Cluster Survey 2014 14 Housing characteristics, asset ownership, and wealth quintiles Tables HH.6, HH.7 and HH.8 provide further details on household level characteristics. 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. Table HH.6 shows similarities of the housing characteristics between West Bank and Gaza strip and between the area categories. Table HH.6: Housing characteristics Percent distribution of households by selected housing characteristics, according to area of residence and regions, Palestine, 2014 Total Region Area West Bank Gaza Strip Urban Rural Camps Electricity Yes 99.9 99.9 99.9 99.8 100.0 99.8 No 0.1 0.1 0.1 0.1 0.0 0.2 Missing/DK 0.0 0.1 0.0 0.1 0.0 0.0 Flooring Natural floor 0.1 0.0 0.2 0.1 0.1 0.1 Finished floor 99.9 99.9 99.8 99.9 99.9 99.9 Other 0.0 0.1 0.0 0.1 0.0 0.0 Missing/DK 0.0 0.0 0.0 0.0 0.0 0.0 Roof Natural roofing 0.0 0.0 0.0 0.0 0.0 0.0 Finished roofing 99.8 99.9 99.8 99.9 99.6 100.0 Other 0.1 0.1 0.2 0.1 0.3 0.0 Missing/DK 0.0 0.1 0.0 0.1 0.0 0.0 Exterior walls Natural walls 0.0 0.0 0.0 0.0 0.1 0.1 Rudimentary walls 0.8 1.2 0.0 0.7 1.5 0.2 Finished walls 99.0 98.5 99.8 99.2 97.9 99.7 Other 0.1 0.1 0.2 0.1 0.4 0.0 Missing/DK 0.1 0.1 0.0 0.1 0.2 0.0 Rooms used for sleeping 1 19.9 19.0 21.5 19.9 19.5 21.1 2 39.6 42.1 35.4 39.1 41.6 40.1 3 or more 40.4 38.7 43.1 40.9 38.9 38.7 Missing/DK 0.1 0.1 0.0 0.1 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 10182 6385 3797 7602 1740 840 Mean number of persons per room used for sleeping 2.54 2.44 2.70 2.52 2.51 2.74 19 15 In Table HH.7 households are distributed according to ownership of assets by households and by individual household members. This also includes ownership of dwelling. Table HH.7: Household and personal assets Percentage of households by ownership of selected household and personal assets, and percent distribution by ownership of dwelling, according to area of residence and regions, Palestine, 2014 Total Area Region West Bank Gaza Strip Urban Rural Camps Percentage of households that own a Radio 38.6 44.6 28.6 39.4 40.1 28.2 Television 80.1 75.2 88.2 79.1 81.8 85.2 LCD /LED /3D TV 26.9 34.8 13.5 27.9 25.8 19.5 Non-mobile phone 36.2 40.1 29.7 36.7 36.3 31.6 Refrigerator 95.5 97.0 93.0 95.5 96.2 93.8 Central heating 2.6 3.8 0.5 2.8 1.9 2.2 Clothes Dryer 5.4 7.2 2.4 5.8 3.1 6.4 Freezer 6.9 9.5 2.6 7.0 8.3 3.6 Dishwasher 2.3 3.6 0.2 2.7 1.4 1.1 Air Condition 16.9 22.5 7.5 17.3 17.1 13.1 Play Station / X-box 4.2 5.9 1.5 4.5 4.1 2.3 Satellite Dish 94.7 95.3 93.6 95.0 94.3 92.9 Solar Heater 59.0 65.4 48.2 58.7 66.6 45.8 Vacuum Cleaner 37.0 49.9 15.4 39.1 37.2 17.7 Washing Machine 95.1 96.2 93.2 95.3 95.0 93.2 Percentage of households that own Agricultural land 17.6 22.1 10.0 15.4 33.7 4.2 Farm animals/Livestock 10.6 10.6 10.8 9.4 18.9 4.7 Percentage of households where at least one member owns or has a Ipad / Tablet 14.3 20.5 3.9 14.5 16.4 7.9 A Smart Mobile telephone 48.2 58.6 30.8 47.9 53.6 40.2 A Laptop 37.4 43.4 27.3 37.4 40.1 30.9 Animal - drawn cart 1.5 0.4 3.2 1.6 1.5 0.4 A car or Truck 26.8 36.8 10.1 27.5 31.2 11.8 Bank account 44.2 52.1 30.9 44.6 47.0 34.8 Ownership of dwelling Owned by a household member 82.5 84.1 79.6 80.4 90.4 84.3 Not owned 17.5 15.8 20.4 19.5 9.6 15.7 Rented 9.1 10.3 7.0 10.3 4.4 7.4 Other 8.4 5.5 13.4 9.2 5.2 8.3 Missing/DK 0.1 0.1 0.0 0.1 0.0 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 10182 6385 3797 7602 1740 840 Table HH.7a presents the ownership of assets by households and by individual household members within each governorate. This also includes ownership of dwelling. 20 Palestinian Multiple Indicator Cluster Survey 2014 16 Ta bl e H H .7 : H ou se ho ld a nd p er so na l a ss et s P er ce nt ag e of h ou se ho ld s by o w ne rs hi p of s el ec te d ho us eh ol d an d pe rs on al a ss et s, a nd p er ce nt d is tri bu tio n by o w ne rs hi p of d w el lin g, a cc or di ng to g ov er no ra te s, P al es tin e, 20 14 G ov er no ra te Je ni n Tu ba s Tu lk ar m N ab lu s Q al qi liy a S al fit R am al la h & A l-B ire h Je ric ho & A l A gh w ar Je ru sa le m B et hl eh em H eb ro n N or th G az a G az a D ei r E l- B al ah K ha n Y un is R af ah Pe rc en ta ge o f h ou se ho ld s th at o w n a R ad io 39 .6 31 .3 31 .8 52 .8 33 .6 49 .1 46 .8 51 .4 42 .3 41 .9 48 .8 27 .2 33 .4 30 .4 24 .2 20 .9 Te le vi si on 86 .0 77 .2 82 .4 76 .2 82 .4 83 .1 62 .4 79 .8 54 .6 76 .7 84 .8 89 .9 85 .6 91 .2 88 .8 88 .3 LC D /L E D /3 D T V 23 .8 29 .1 30 .3 33 .0 28 .5 32 .4 52 .4 26 .5 56 .0 33 .9 21 .7 9. 6 17 .1 10 .8 12 .0 14 .8 N on -m ob ile p ho ne 36 .0 44 .1 47 .4 45 .5 45 .1 45 .2 59 .7 26 .5 36 .4 36 .2 29 .4 19 .5 33 .1 30 .4 28 .2 36 .3 R ef rig er at or 96 .5 97 .6 96 .2 98 .0 96 .5 97 .7 99 .5 95 .8 98 .3 94 .6 95 .3 89 .8 94 .5 93 .2 94 .6 90 .9 C en tra l h ea tin g 0. 8 0. 7 1. 6 3. 5 1. 1 1. 8 7. 3 2. 0 6. 5 6. 1 2. 7 0. 7 0. 6 0. 0 0. 1 1. 2 C lo th es D ry er 1. 7 3. 9 4. 1 3. 6 2. 5 2. 4 10 .8 7. 4 21 .8 7. 9 2. 7 1. 0 1. 7 2. 7 3. 5 3. 9 Fr ee ze r 4. 1 9. 5 11 .6 10 .6 9. 9 18 .4 15 .8 6. 6 15 .2 9. 1 2. 7 1. 5 2. 4 1. 8 3. 1 5. 4 D is hw as he r 1. 2 0. 6 3. 0 2. 0 0. 3 3. 6 6. 7 1. 8 5. 8 7. 4 2. 5 0. 0 0. 3 0. 4 0. 1 0. 0 A ir C on di tio n 21 .1 26 .0 67 .5 13 .3 36 .4 21 .3 17 .8 75 .2 28 .0 15 .7 10 .5 4. 3 10 .7 6. 3 5. 5 7. 3 P la y S ta tio n/ X -b ox 3. 5 4. 6 6. 1 6. 2 3. 6 4. 6 9. 7 10 .2 9. 5 4. 4 3. 1 0. 8 2. 0 1. 5 1. 4 1. 0 S at el lit e D is h 95 .5 93 .4 89 .6 96 .5 95 .7 94 .4 97 .5 93 .0 97 .2 95 .1 94 .1 93 .6 92 .7 94 .1 92 .6 97 .3 S ol ar H ea te r 65 .9 55 .7 68 .1 70 .3 64 .8 84 .4 81 .8 40 .2 55 .1 68 .5 59 .5 48 .8 46 .2 52 .8 47 .7 47 .9 V ac uu m C le an er 45 .3 44 .3 45 .4 52 .4 37 .0 43 .9 53 .6 27 .0 62 .3 33 .1 52 .4 5. 6 18 .8 14 .1 18 .0 17 .8 W as hi ng M ac hi ne 95 .5 95 .5 94 .0 96 .9 95 .5 94 .5 97 .4 98 .8 98 .2 93 .7 95 .8 90 .5 93 .6 94 .0 93 .0 95 .1 Pe rc en ta ge o f h ou se ho ld s th at o w n A gr ic ul tu ra l l an d 29 .9 20 .4 22 .6 20 .6 32 .3 52 .2 28 .2 3. 4 7. 4 22 .6 22 .1 12 .3 7. 3 13 .3 12 .3 6. 6 Fa rm an im al s/ Li ve st oc k 14 .8 13 .5 9. 3 9. 9 11 .3 14 .2 8. 7 15 .8 3. 8 15 .7 11 .9 9. 2 6. 8 15 .6 16 .1 10 .3 Pe rc en ta ge o f h ou se ho ld s w he re a t l ea st o ne m em be r o w ns o r h as a Ip ad / Ta bl et 14 .2 16 .9 18 .5 21 .6 23 .3 19 .9 29 .3 15 .4 34 .3 14 .2 11 .9 3. 1 4. 4 4. 1 4. 2 3. 0 A S m ar t M ob ile te le ph on e 58 .2 57 .1 58 .1 65 .5 56 .9 61 .2 68 .3 59 .3 68 .7 60 .0 42 .3 25 .6 34 .3 31 .5 26 .0 35 .2 A L ap to p 47 .1 45 .7 57 .9 54 .4 38 .0 46 .4 47 .2 35 .7 45 .7 38 .6 29 .3 21 .6 33 .3 24 .5 23 .5 28 .0 A ni m al - dr aw n ca rt 0. 6 1. 3 0. 9 0. 4 2. 3 0. 6 0. 4 0. 4 0. 2 0. 0 0. 1 4. 2 2. 4 4. 0 3. 6 2. 6 A c ar o r T ru ck 30 .1 30 .2 32 .2 32 .8 24 .7 28 .3 46 .1 29 .5 52 .2 35 .4 32 .9 7. 6 12 .2 8. 0 10 .2 10 .1 B an k ac co un t 54 .4 65 .2 39 .6 55 .0 55 .5 56 .5 64 .3 49 .7 59 .9 41 .9 42 .3 24 .3 29 .1 41 .4 32 .7 29 .7 O w ne rs hi p of d w el lin g O w ne d by a h ou se ho ld m em be r 94 .0 78 .4 85 .4 81 .7 89 .8 86 .2 78 .4 93 .8 77 .8 91 .7 83 .6 75 .1 73 .9 81 .9 86 .2 89 .9 N ot o w ne d 6. 0 20 .9 14 .6 18 .3 10 .2 13 .8 21 .5 6. 2 21 .8 8. 3 16 .3 24 .9 26 .1 18 .1 13 .8 10 .1 R en te d 1. 9 10 .2 10 .5 12 .2 9. 3 6. 2 18 .6 4. 1 21 .0 3. 2 5. 2 7. 1 8. 3 7. 5 3. 3 8. 4 O th er 4. 2 10 .7 4. 1 6. 1 0. 9 7. 6 2. 9 2. 1 0. 9 5. 1 11 .1 17 .8 17 .8 10 .6 10 .5 1. 7 M is si ng /D K 0. 0 0. 7 0. 0 0. 0 0. 0 0. 0 0. 1 0. 0 0. 3 0. 0 0. 1 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 N um be r o f h ou se ho ld s 74 3 12 8 42 1 89 2 22 4 16 4 77 0 11 3 98 8 49 7 14 46 70 1 13 37 57 9 72 4 45 5 21 17 Table HH.8 shows how the household populations in areas and regions are distributed according to household wealth quintiles. The data show that households in the Gaza Strip are poorer than in the West Bank, and with regard to the area of residence the camps are poorer than urban and rural areas. Table HH.8: Wealth quintiles Percent distribution of the household population by wealth index quintiles, according to area of residence, regions and governorates, Palestine,2014 Wealth index quintiles Total Number of household members Poorest Second Middle Fourth Richest Total 20.0 20.0 20.0 20.0 20.0 100.0 56366 Region West Bank 0.6 7.5 27.3 31.6 33.1 100.0 33333 Gaza Strip 48.0 38.2 9.5 3.3 1.1 100.0 23034 Area Urban 21.3 21.8 18.6 17.5 20.8 100.0 41987 Rural 3.3 10.9 27.0 35.7 23.2 100.0 9439 Camp 41.1 21.8 18.7 11.4 7.0 100.0 4941 Governorate Jenin 0.2 10.0 32.5 35.3 22.1 100.0 3773 Tubas 0.0 8.1 38.2 28.6 25.1 100.0 671 Tulkarm 0.6 5.6 28.7 31.4 33.8 100.0 2081 Nablus 0.4 5.1 28.7 32.9 32.9 100.0 4486 Qalqiliya 0.0 7.3 31.6 36.3 24.9 100.0 1174 Salfit 0.8 6.2 23.3 36.2 33.4 100.0 876 Ramallah & Al-Bireh 0.1 3.3 14.6 32.1 49.9 100.0 3744 Jericho and Al Aghwar 2.5 13.1 27.2 30.8 26.4 100.0 664 Jerusalem 0.2 2.5 18.5 27.0 51.8 100.0 5115 Bethlehem 2.3 4.1 30.0 34.6 28.9 100.0 2640 Hebron 0.9 13.8 33.1 29.9 22.3 100.0 8110 North Gaza 53.8 36.0 7.3 2.4 0.5 100.0 4307 Gaza 48.8 38.1 8.7 3.4 0.9 100.0 8341 Deir El-Balah 51.0 37.9 9.7 1.3 0.2 100.0 3419 Khan Yunis 39.4 42.3 11.2 5.0 2.1 100.0 4297 Rafah 46.5 35.6 11.9 3.9 2.1 100.0 2670 22 Palestinian Multiple Indicator Cluster Survey 2014 IV. Child Mortality 19 IV. Child Mortality One of the overarching goals of the Millennium Development Goals (MDGs) is to reduce infant and under-five mortality. Specifically, the MDGs call for the reduction of under-five 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 Women’s Questionnaires. 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 the fifth birthdays • Under-five 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 one, and post-neonatal mortality, which is the difference between infant and neonatal mortality rates. Table CM.1: Early childhood mortality rates Neonatal, post-neonatal, Infant, child and under-five mortality rates for five year periods preceding the survey, Palestine, 2014 Neonatal mortality rate1 Post-neonatal mortality rate2, a Infant mortality rate3 Child mortality rate4 Under-five mortality rate5 Years preceding the survey 0-4 11.2 7.1 18.2 3.6 21.7 5-9 11.8 8.6 20.3 3.8 24.1 10-14 12.9 8.4 21.3 2.2 23.4 15-19 13.2 9.6 22.8 5.9 28.6 20-24 20.3 11.5 31.9 10.0 41.5 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 Table CM.1 and Figure CM.1 present neonatal, post-neonatal, infant, child, and under-five mortality rates for the three most recent five-year periods before the survey. Neonatal mortality in the most recent 5-year period is estimated at 11 per 1,000 live births, while the 24 Palestinian Multiple Indicator Cluster Survey 2014 20 post-neonatal mortality rate is estimated at 7 per 1,000 live births. The table and figure also show a declining trend at the national level, during the last 15 years, with under-five mortality at 23 per 1,000 during the 10-14 year period preceding the survey, and 22 per 1,000 live births during the most recent 5-year period. A similar pattern is observed in all other early childhood mortality indicators. The tables show that some improvement has taken place during the last 15 years. Infant mortality rate in the five years preceding the survey was at 18 per 1,000 live births with 17 per 1000 live births in the West Bank compared to 20 per 1000 live births in the Gaza Strip. Estimates of under-five mortality were 22 per 1,000 live births for the same period, with 20 per 1000 live birth in the West Bank and 24 per 1000 live birth in the Gaza Strip. The estimates roughly refer to the most recent 5 year period, roughly referring to the years 2010-2014. F i g u r e C M . 1 : E a r l y c h i l d h o o d m o r t a l i t y r a t e s , P a l e s t i n e , 2 0 1 4 Tables CM.2 and CM.3 provide estimates of child mortality by socioeconomic and demographic characteristics. Differences were noted when comparing the mortality estimates of male and females, with infant mortality rate of 19 per 1000 live births (neonatal rate 12 per 1000 live births, post-neonatal 8 per 1000 live births) for males; and 17 per 1000 live births (neonatal 11 per 1000 live births, post-neonatal 7 per 1000 live births) among females. Difference in the infant mortality rate were also noted according to area where these were 19 per 1000 live births in urban areas , about 18 per 1000 live births in the rural areas and 12 per 1000 live births in the camps . Similarly, differences were noted in the under 5 mortality rates of children among males and females which are 23 per 1000 live births compared to 21 per 1000 live births respectively. 11   7   18   4   22   12   9   20   4   24   13   8   21   2   23   Neonatal   mortality  rate   Post-­‐neonatal   mortality  rate   Infant   mortality  rate   Child   mortality  rate   Under-­‐five   mortality  rate   Years  preceding  the   survey   Note:  Indicator  values  are  per  1,000  live  births   0-­‐4   5-­‐9   10-­‐14   25 21 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, Palestine, 2014 Neonatal mortality rate1 Post-neonatal mortality rate2, a Infant mortality rate3 Child mortality rate4 Under-five mortality rate5 Total 11.2 7.1 18.2 3.6 21.7 Region West Bank 10.9 6.2 17.1 3.0 20.0 Gaza Strip 11.5 8.1 19.6 4.2 23.7 Area Urban 12.0 7.0 19.1 3.2 22.2 Rural 8.0 9.7 17.7 3.4 21.0 Camps 9.4 2.7 12.1 6.9 18.9 Mother's education None (*) (*) (*) (*) (*) Basic 11.8 19.9 31.7 9.1 40.5 Secondary 14.7 7.3 22.0 2.0 24.0 Higher 10.4 6.3 16.7 3.5 20.1 Wealth index quintile Poorest 7.2 10.3 17.5 3.6 21.1 Second 17.9 5.3 23.2 4.9 28.0 Middle 15.9 6.2 22.2 4.4 26.5 Fourth 8.3 6.9 15.2 2.3 17.5 Richest 6.0 5.6 11.6 2.2 13.8 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 (*) Figures that are based on less than 250 unweighted exposed persons 26 Palestinian Multiple Indicator Cluster Survey 2014 22 Table CM.3: Early childhood mortality rates by demographic characteristics Neonatal, post-neonatal, Infant, child and under-five mortality rates for the five year period preceding the survey, by demographic characteristics, Palestine, 2014 Neonatal mortality rate1 Post-neonatal mortality rate2, a Infant mortality rate3 Child mortality rate4 Under-five mortality rate5 Total 11.2 7.1 18.2 3.6 21.7 Sex of child Male 11.5 7.7 19.2 3.4 22.5 Female 10.8 6.4 17.2 3.8 20.9 Mother's age at birth Less than 20 5.9 6.0 11.9 7.9 19.7 20-34 11.2 7.4 18.6 2.7 21.2 35-49 15.3 5.7 21.0 5.4 26.3 Birth order 1 10.4 4.5 14.9 5.2 20.0 2-3 10.9 8.0 19.0 4.0 22.9 4-6 10.3 8.0 18.3 2.1 20.3 7+ 16.8 6.4 23.2 3.5 26.6 Previous birth intervalb < 2 years 12.3 7.0 19.4 4.1 23.4 2 years 8.8 7.7 16.5 2.4 18.8 3 years 12.3 6.8 19.1 3.6 22.6 4+ years 9.8 6.4 16.2 3.6 19.7 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 b Excludes first order births 27 23 F i g u r e C M . 2 : U n d e r - 5 m o r t a l i t y r a t e s b y a r e a a n d r e g i o n , P a l e s t i n e , 2 0 1 4 Figure CM.3 compares the findings of Palestinian MICS on under-5 mortality rates with those from other data sources. Palestinian MICS 2014 findings are obtained from Table CM.1. The MICS estimates indicate a decline in mortality during the last 20 years. The most recent U5MR estimate from MICS is about 22 percent which is lower than the estimate from IGME for the same year (2012), while the trend indicated by the survey results are in broad agreement with those estimated in 2006 and 2007 in the previous MICS survey (PFS/MICS4). Further qualification of this apparent decline and differences as well as its determinants should be taken up in a more detailed and separate analysis. 22   20   24   22   21   19   0   5   10   15   20   25   30   PalesGne   West  Bank   Gaza  Strip   Urban   Rural   Camps   Under-­‐5  Mortality  Rates  per  1,000  Births   28 Palestinian Multiple Indicator Cluster Survey 2014 24 Figure CM.3: Trend in under -5 morta l i ty ra tes , Pa lest ine , 2014 PAPFAM: Pan Arab Family Health Survey UNRWA: The United Nations Relief and Works Agency for Palestine Refugees in the Near East IGME: Inter-agency Group for Child Mortality Estimation 0   10   20   30   40   50   60   70   1982   1986   1990   1994   1998   2002   2006   2010   2014   Per  1,000  live  births   Year    PFS/MICS4  2010   PAPFAM  2006   MICS  2014   IGME   29 V. Nutrition 25 V. Nutrition 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 most impact: the mother's poor nutritional status before conception, short stature (due mostly to under nutrition and infections during her childhood), and poor nutrition during 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 2500 grams is estimated from two items in the questionnaire: the mother’s assessment of the child’s size at birth (i.e., very small, smaller than average, average, larger than average, very large) and the mother’s recall of the child’s weight or the weight as recorded on a health card if the child was weighed at birth.1 1  For  a  detailed  description  of  the  methodology,  see  Boerma,  J.  T.,  Weinstein,  K.  I.,  Rutstein,  S.O.,  and   Sommerfelt,  A.  E.  ,  1996.  Data  on  Birth  Weight  in  Developing  Countries:  Can  Surveys  Help?  Bulletin  of  the  World   Health  Organization,  74(2),  209-­‐16   32 Palestinian Multiple Indicator Cluster Survey 2014 26 Table NU.1: Low birth weight infants Percentage of last live-born children in the last two years that are estimated to have weighed below 2,500 grams at birth and percentage of live births weighed at birth, Palestine, 2014 Percent distribution of births by mother's assessment of size at birth Total Percentage of live births: Number of last live-born children in the last two years Very small Smaller than average Average Larger than average or very large DK Below 2,500 grams1 Weighed at birth2 Total 3.8 9.9 68.2 18.0 0.2 100.0 8.3 99.7 2941 Region West Bank 3.5 10.3 69.1 16.8 0.4 100.0 8.4 99.6 1610 Gaza Strip 4.1 9.3 67.0 19.4 0.1 100.0 8.3 99.8 1331 Area Urban 4.1 9.5 68.4 17.8 0.2 100.0 8.4 99.7 2265 Rural 1.9 12.6 65.8 19.0 0.6 100.0 8.1 99.5 437 Camp 4.2 8.5 70.1 17.2 0.0 100.0 8.1 100.0 240 Governorate Jenin 4.1 13.1 69.1 13.6 0.0 100.0 9.5 100.0 186 Tubas (5.3) (5.4) (78.0) (11.3) (.0) (100.0) (8.0) (100.0) 25 Tulkarm 6.6 11.4 64.2 17.8 0.0 100.0 10.4 100.0 71 Nablus 1.6 13.2 73.5 11.7 0.0 100.0 8.0 99.4 189 Qalqiliya (10.8) (1.5) (76.0) (11.8) (0.0) (100.0) (10.4) (100.0) 48 Salfit (.0) (2.6) (79.6) (15.3) (2.6) (100.0) (5.0) (100.0) 34 Ramallah & Al-Bireh 6.3 11.4 61.1 20.2 0.9 100.0 10.6 99.5 190 Jericho and Al Aghwar (4.9) (5.8) (76.8) (12.5) (.0) (100.0) (7.9) (100.0) 44 Jerusalem 4.1 11.2 70.3 13.5 0.9 100.0 9.3 98.7 257 Bethlehem 1.9 10.4 70.7 16.2 0.7 100.0 7.6 99.3 137 Hebron 1.6 8.9 67.3 22.2 0.0 100.0 6.5 100.0 427 North Gaza 8.3 11.3 61.6 18.8 0.0 100.0 11.4 100.0 258 Gaza 2.7 8.5 68.6 20.3 0.0 100.0 7.1 99.7 471 Deir El-Balah 1.9 9.9 65.5 22.7 0.0 100.0 6.9 100.0 173 Khan Yunis 6.5 10.0 68.8 14.3 0.4 100.0 10.1 99.6 255 Rafah 0.6 7.3 69.7 22.3 0.0 100.0 5.4 100.0 178 Mother's age at birth Less than 20 years 4.0 10.4 69.1 16.3 0.2 100.0 8.6 99.6 1620 20-34 years 3.5 9.2 67.5 19.5 0.2 100.0 7.9 99.8 1270 35-49 years 1.8 9.4 56.4 32.4 0.0 100.0 6.4 100.0 50 Birth order 1 4.4 13.2 72.8 9.3 0.3 100.0 9.9 99.3 641 2-3 3.8 8.8 70.0 17.2 0.3 100.0 8.1 99.6 1142 4-5 2.1 9.2 67.3 21.2 0.1 100.0 7.0 100.0 683 6+ 5.3 8.9 58.8 26.8 0.2 100.0 8.7 100.0 474 Mother’s education None (*) (*) (*) (*) (*) (*) (*) (*) 9 Basic 3.6 9.5 67.7 19.2 .1 100.0 8.0 99.9 783 Secondary 4.7 11.0 65.9 18.4 .1 100.0 9.1 99.7 967 Higher 3.1 8.6 71.7 16.2 .4 100.0 7.7 99.6 1132 Wealth index quintile Poorest 4.9 10.2 67.3 17.7 0.0 100.0 9.0 100.0 728 Second 2.8 9.1 68.3 19.5 0.2 100.0 7.4 99.6 563 Middle 4.2 10.5 68.0 17.1 0.2 100.0 8.8 99.8 578 Fourth 3.6 10.2 69.1 16.8 0.3 100.0 8.4 99.7 606 Richest 2.9 9.0 68.2 19.2 0.7 100.0 7.7 99.3 466 1 MICS indicator 2.20 - Low-birthweight infants 2 MICS indicator 2.21 - Infants weighed at birth ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 33 27 Overall, nearly all children were weighed at birth of which approximately 8 percent of infants estimated to weigh less than 2500 grams at birth (Table NU.1). There are some variations by governorates. The highest prevalence of low birth weight infants was in North Gaza and Khan Yunis governorates at 11 percent and 10 percent respectively. As shown in table NU.1, no significant disparities were observed at the regional level or by area of residence but the prevalence of low birth weight was highest among first-borns and mothers aged less than 20 years Nutritional Status Children’s nutritional status is a reflection of their overall health. When children have access to an adequate food supply, are not exposed to repeated illness, and are well cared for, they reach their growth potential and are considered well nourished. Under-nutrition is associated with more than half of all child deaths worldwide. Undernourished 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 Millennium Development Goal 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 five. 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. 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 2  http://www.who.int/childgrowth/standards/technical_report   34 Palestinian Multiple Indicator Cluster Survey 2014 28 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 5 years of age 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. 3  See  MICS  Supply  Procurement  Instructions  here:  http://www.childinfo.org/mics5_planning.html   35 29 Ta bl e N U .2 : N ut rit io na l s ta tu s of c hi ld re n P er ce nt ag e of c hi ld re n un de r a ge 5 b y nu tri tio na l s ta tu s ac co rd in g to th re e an th ro po m et ric in di ce s: w ei gh t f or a ge , h ei gh t f or a ge , a nd w ei gh t f or h ei gh t, P al es tin e, 2 01 4 W ei gh t f or a ge N um be r o f ch ild re n un de r a ge 5 H ei gh t f or a ge N um be r o f ch ild re n un de r a ge 5 W ei gh t f or h ei gh t N um be r o f ch ild re n un de r a ge 5 U nd er w ei gh t M ea n Z- S co re (S D ) St un te d M ea n Z- S co re (S D ) W as te d O ve rw ei gh t M ea n Z- S co re (S D ) P er ce nt b el ow P er ce nt b el ow P er ce nt b el ow P er ce nt a bo ve - 2 S D 1 - 3 S D 2 - 2 S D 3 - 3 S D 4 - 2 S D 5 - 3 S D 6 + 2 S D 7 To ta l 1. 4 0. 2 0. 2 72 22 7. 4 1. 8 -0 .4 69 50 1. 2 0. 3 8. 2 0. 6 69 06 R eg io n W es t B an k 1. 5 0. 3 0. 3 37 29 7. 7 2. 4 -0 .3 35 30 1. 7 0. 6 9. 8 0. 6 34 89 G az a S tri p 1. 3 0. 2 0. 1 34 92 7. 1 1. 1 -0 .5 34 20 0. 7 0. 1 6. 5 0. 6 34 18 Se x M al e 1. 6 0. 3 0. 2 37 23 8. 1 1. 9 -0 .4 35 81 1. 2 0. 3 9. 1 0. 6 35 65 Fe m al e 1. 1 0. 1 0. 2 34 99 6. 6 1. 7 -0 .4 33 69 1. 2 0. 3 7. 1 0. 6 33 42 A re a U rb an 1. 3 0. 2 0. 2 54 98 7. 5 1. 9 -0 .4 53 08 1. 1 0. 3 7. 9 0. 6 52 78 R ur al 1. 6 0. 3 0. 3 10 71 7. 6 1. 6 -0 .3 10 17 1. 1 0. 6 10 .9 0. 6 10 05 C am p 1. 4 0. 2 0. 1 65 3 6. 4 1. 3 -0 .5 62 5 1. 8 0. 2 6. 1 0. 5 62 4 A ge 0- 5 m on th s 2. 5 0. 6 0. 2 62 9 9. 0 3. 2 -0 .2 60 9 2. 6 1. 2 13 .6 0. 7 60 8 6- 11 m on th s 1. 4 0. 5 0. 4 75 8 5. 0 0. 9 0. 1 74 3 1. 9 0. 7 7. 7 0. 5 74 4 12 -1 7 m on th s 1. 1 0. 3 0. 4 74 6 7. 8 2. 7 -0 .3 72 3 1. 7 0. 3 8. 5 0. 7 72 4 18 -2 3 m on th s 1. 2 0. 0 0. 3 71 2 8. 2 2. 2 -0 .4 66 8 0. 5 0. 2 10 .0 0. 7 66 6 24 -3 5 m on th s 1. 0 0. 1 0. 2 14 15 9. 4 2. 1 -0 .6 13 10 1. 1 0. 3 9. 1 0. 7 13 01 36 -4 7 m on th s 1. 4 0. 3 0. 1 15 22 7. 0 1. 4 -0 .5 14 72 0. 7 0. 1 6. 6 0. 6 14 59 48 -5 9 m on th s 1. 5 0. 1 0. 1 14 39 6. 0 0. 9 -0 .4 14 26 0. 8 0. 1 5. 8 0. 5 14 03 M ot he r’s e du ca tio n N on e (2 .9 ) (0 .0 ) (0 .1 ) 31 (2 1. 5) (6 .0 ) (- 0. 1) 30 (3 .1 ) (0 .0 ) (8 .5 ) (0 .6 ) 29 B as ic 2. 1 0. 5 0. 1 21 71 9. 3 1. 8 -0 .5 21 00 1. 2 0. 3 7. 9 0. 6 20 82 S ec on da ry 1. 0 0. 1 0. 2 24 53 7. 1 1. 7 -0 .4 23 64 1. 0 0. 3 8. 4 0. 6 23 56 H ig he r 1. 1 0. 1 0. 3 25 66 5. 9 1. 6 -0 .3 24 56 1. 3 0. 3 8. 2 0. 6 24 39 W ea lth in de x qu in til e P oo re st 1. 6 0. 3 0. 1 18 87 7. 6 1. 2 -0 .6 18 43 .2 0. 9 0. 1 6. 4 0. 6 18 40 S ec on d 1. 2 0. 3 0. 1 15 50 8. 2 1. 5 -0 .5 15 16 .2 0. 7 0. 0 6. 2 0. 6 15 11 M id dl e 1. 2 0. 3 0. 3 13 67 6. 8 1. 4 -0 .2 13 12 .4 1. 3 0. 6 11 .3 0. 6 13 04 Fo ur th 1. 2 0. 1 0. 3 13 33 7. 0 2. 3 -0 .2 12 63 .3 1. 7 0. 5 8. 0 0. 6 12 51 R ic he st 1. 6 0. 2 0. 3 10 85 7. 0 2. 9 -0 .2 10 14 .6 1. 8 0. 5 10 .3 0. 6 10 01 1 M IC S in di ca to r 2 .1 a an d M D G in di ca to r 1 .8 - U nd er w ei gh t p re va le nc e (m od er at e an d se ve re ) 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 ) 2 M IC S in di ca to r 2 .1 b - U nd er w ei gh t p re va le nc e (s ev er e) 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) 3 M IC S in di ca to r 2 .2 a - S tu nt in g pr ev al en ce (m od er at e an d se ve re ) 7 M IC S in di ca to r 2 .4 - O ve rw ei gh t p re va le nc e 4 M IC S in di ca to r 2 .2 b - S tu nt in g pr ev al en ce (s ev er e) ( ) Fi gu re s th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s 36 Palestinian Multiple Indicator Cluster Survey 2014 30 Children whose measurements are outside a plausible range are excluded from table NU.2. Children are excluded from one or more of the anthropometric indicators when their weights and heights have not been measured, whichever applicable. For example, if a child has been weighed but his/her height has not been measured, the child is included in underweight calculations, but not in the calculations for stunting and wasting. 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 implausible measurements, and/or missing weight and/or height, 7.8 percent of children have been excluded from calculations of the weight-for-age indicator, 11.2 percent from the height-for-age indicator, and 11.8 percent for the weight-for-height indicator. About one of 100 children under age five living in Palestine is moderately underweight (1.4 percent) and 0.2 percent are classified as severely underweight (Table NU.2). Seven percent of children are moderately stunted (or too short for their age) and two percent are severely stunted. Only one percent of children are moderately wasted (or too thin for their height) and 0.3 percent are severely wasted. Results also show that 8 in 100 Palestinian children in Palestine suffer from overweight (9 percent for males and 7 percent females, 10 percent in the West Bank and 7 percent in Gaza Strip). Results in Table NU.2 show differentials in the nutrition indicators according to some background characteristics. The data show differences among children suffering from malnutrition according to geographic areas and regions. Eight percent of children in urban and rural areas are stunted, while the lowest prevalence was noted in camps (6 percent). Children in the West Bank showed higher prevalence rates (8 percent) compared to Gaza Strip (7 percent). Children whose mothers have higher education are less likely to be stunted compared to children of mothers with basic education with 9 percent for children of mothers with basic education, compared to 7 percent for children of mothers with secondary education and 6 percent for children of mothers with higher education. It also seems that boys are more likely to underweight, and stunted than girls. The age pattern shows higher percentage in all three malnutrition indicators for children in the age group 12-30 months compared to children who are younger or older (Figure NU.1). 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 environment. 37 31 Figure NU.1: Underweight , s tunted, wasted and overweight ch i ldren under age 5 (moderate and severe) , Pa lest ine , 2014 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 birth to 2 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, do not breastfeed exclusively for the recommended 6 months or stop breastfeeding too soon. There are often pressures 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 appropriate, adequate and safe solid, semi-solid and soft foods from the age of 6 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, breastfed exclusively for the first six months of life and continue to be breastfed up to 2 years of age and beyond.5 Starting at 6 months, breastfeeding should be combined with 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. 4  Bhuta  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.   5  WHO  (2003).  Implementing  the  Global  Strategy  for  Infant  and  Young  Child  Feeding.  Meeting  Report  Geneva,   3-­‐5  February  2003.   6  WHO  (2003).  Global  Strategy  for  Infant  and  Young  Child  Feeding.   7  PAHO  (2003).  Guiding  principles  for  complementary  feeding  of  the  breastfed  child.   8  WHO  (2005).  Guiding  principles  for  feeding  non-­‐breastfed  children  6-­‐24  months  of  age   38 Palestinian Multiple Indicator Cluster Survey 2014 32 The guiding principles for which proximate measures and indicators exist are: (i) continued breastfeeding; (ii) appropriate frequency of meals (but not energy density); and (iii) appropriate 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 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: (i) the appropriate number of meals/snacks/milk feeds; (ii) food items form at least 4 food groups; and (iii) breastmilk or at least 2 milk feeds (for non-breastfed children). Guiding Principle (age 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 groups10 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 9  WHO  (2008).  Indicators  for  assessing  infant  and  young  child  feeding  practices.  Part  1:  Definitions.   10  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.   39 33 Table NU.3: Initial breastfeeding Percentage of last live-born children in the last two years who were ever breastfed, breastfed within one hour of birth, and within one day of birth, and percentage who received a prelacteal feed, Palestine, 2014 Percentage who were ever breastfed1 Percentage who were first breastfed: Percentage who received a prelacteal feed Number of last live- born children in the last two years Within one hour of birth2 Within one day of birth Total 96.6 40.8 85.2 38.6 2941 Region West Bank 95.8 40.7 83.9 33.3 1610 Gaza Strip 97.6 41.0 86.9 44.9 1331 Governorate Jenin 93.1 51.0 80.7 32.5 186 Tubas (100.0) (48.6) (86.3) (27.3) 25 Tulkarm 97.2 57.1 82.7 33.6 71 Nablus 94.9 37.6 79.2 41.1 190 Qalqiliya 92.2 33.7 79.8 38.0 48 Salfit (98.0) (35.9) (88.2) (23.7) 35 Ramallah & Al-Bireh 95.8 55.1 91.7 25.1 190 Jericho and Al Aghwar 91.8 66.4 82.4 15.4 44 Jerusalem 96.6 42.7 82.8 43.3 257 Bethlehem 95.6 42.0 85.6 34.5 137 Hebron 97.3 24.7 84.5 30.0 427 North Gaza 95.0 35.3 83.4 45.6 258 Gaza 98.8 33.0 86.1 40.3 471 Deir El-Balah 98.1 48.1 87.9 48.7 173 Khan Yunis 97.3 41.9 86.6 46.4 255 Rafah 98.3 62.9 93.5 50.8 175 Area Urban 96.9 39.8 85.2 39.4 2265 Rural 95.6 44.9 87.0 33.3 437 Camps 96.0 43.0 82.2 40.1 240 Months since last birth 0-11 months 96.5 41.0 84.5 34.7 204 12-23 months 96.0 40.0 85.2 36.1 230 Place of delivery Home (*) (*) (*) (*) 15 Public sector health facility 96.7 41.0 85.4 39.2 1788 Private sector health facility 96.7 42.7 85.8 36.1 749 NGO's sector health facility 97.1 35.4 84.5 37.8 271 UNRWA sector health facility (100.0) (63.6) (89.9) (17.2) 23 Israeli sector health facility 96.3 35.5 81.1 52.7 90 Other/Missing (*) (*) (*) (*) 5 Mother’s education None (*) (*) (*) (*) 9 Basic 96.9 40.1 84.4 36.2 798 Secondary 96.2 39.4 85.1 40.3 996 Higher 96.9 42.6 86.0 38.8 1139 Wealth index quintile Poorest 97.6 40.7 86.6 43.5 728 Second 97.5 40.1 87.4 42.4 563 Middle 96.5 42.3 85.3 32.6 578 Fourth 95.4 40.5 84.8 36.8 606 Richest 95.9 40.6 81.0 36.1 466 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 less than 25 unweighted cases 40 Palestinian Multiple Indicator Cluster Survey 2014 34 Table NU.3 is based on mothers’ reports of what their last-born child, born in the last two years, 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.11 Although a very important step in management of lactation and establishment of a physical and emotional relationship between the baby and the mother, only 41 percent of babies are breastfed for the first time within one hour of birth, while 85 percent of newborns in Palestine start breastfeeding within one day of birth. Moreover, among children born in the last two years preceding the survey, 97 percent were ever-breastfed. Table NU.3 show some differentials for ever-breast children by geographical regions, with the percentage being lower in the West Bank (96 percent) compared to Gaza Strip (98 percent). The proportions of children who fed within one hour differ according to area where the lowest percentage was observed among children in urban areas; 40 percent compared to 45 percent of rural children and 43 percent in Camps. Large variations were also noted at the governorate level with the lowest percentage in Hebron (25 percent) and the highest being 66 percent in Jericho and Al Aghwar. Figure NU.2: Ini t iat ion of breastfeeding, Palest ine, 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 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. 11  Prelacteal  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).     84   87   85   87   82   85   41   41   40   45   43   41   0   20   40   60   80   100   Pe r   ce nt   Within  one  day   Within  one  hour   41 35 In Table NU.4, breastfeeding status is presented for both Exclusively breastfed and Predominantly breastfed; referring to infants age less than 6 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 and 20-23 months of age. Table NU.4: Breastfeeding Percentage of living children according to breastfeeding status at selected age groups, Palestine, 2014 Children age 0-5 months Children age 12-15 months Children age 20-23 months Percent exclusively breastfed1 Percent predominantly breastfed2 Number of children Percent breastfed (Continued breastfeeding at 1 year)3 Number of children Percent breastfed (Continued breastfeeding at 2 years)4 Number of children Total 38.6 50.0 668 52.9 504 11.5 504 Region West Bank 40.6 52.9 356 48.4 284 13.8 290 Gaza Strip 36.4 46.7 312 58.7 219 8.4 214 Sex Male 38.9 50.0 370 56.6 253 14.1 264 Female 38.3 50.0 298 49.2 251 8.6 240 Governorate Jenin (52.5) (71.2) 37 (50.5) 29 15.1 26 Tubas (*) (*) 5 (*) 7 (*) 6 Tulkarm (*) (*) 16 (*) 10 (*) 14 Nablus (39.0) (44.5) 38 (48.1) 39 (*) 24 Qalqiliya 6.9 (*) 14 (*) 4 (*) 12 Salfit 39.9 (*) 11 (*) 4 (*) 9 Ramallah & Al-Bireh 24.8 34.7 50 (38.1) 26 (14.9) 46 Jericho and Al Aghwar 23.4 (*) 9 (*) 7 (*) 7 Jerusalem (38.6) (44.1) 43 40.0 53 (10.3) 38 Bethlehem (55.9) (76.0) 43 (*) 22 (*) 21 Hebron 45.6 59.5 88 55.3 83 9.8 86 North Gaza 37.1 48.7 68 63.5 51 (2.8) 37 Gaza 39.0 52.7 105 59.3 80 6.7 78 Deir El-Balah (40.2) (48.1) 42 (53.4) 30 (10.2) 30 Khan Yunis 40.9 47.7 66 (57.8) 34 (14.3) 40 Rafah (12.4) (18.3) 32 (*) 24 (9.9) 29 Area Urban 38.2 50.0 512 52.4 392 9.4 363 Rural 40.7 52.2 103 55.0 68 17.8 92 camp 39.1 45.2 53 (54.0) 43 (15.1) 49 Mother’s education None 61.9 (*) 5 (*) 1 (*) 1 Basic 43.7 56.7 156 53.2 133 15.6 134 Secondary 38.4 49.7 235 54.9 174 9.4 172 Higher 35.5 46.1 272 51.2 196 10.6 197 Wealth index quintile Poorest 37.2 49.2 169 65.6 114 6.7 121 Second 37.2 46.5 136 60.1 98 8.1 88 Middle 41.9 53.7 113 48.0 106 18.1 103 Fourth 36.8 51.2 147 41.8 111 12.5 106 Richest 41.8 50.0 103 47.2 74 12.5 86 [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 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 42 Palestinian Multiple Indicator Cluster Survey 2014 36 Table NU.4 show that only 39 percent of children aged less than six months are exclusively breastfed, a level considerably lower than recommended, with a noticeable variation between West Bank and Gaza Strip (41% and 36%) respectively. About 53 percent of the children are breastfed at one year, which is higher in Gaza Strip and among male children. Twelve percent of children continued to be breastfed at 2 years of age, which is higher in the West Bank and among male children. It is also observed that the incidence of exclusive breastfeeding decreases with increasing levels of mother’s education; the percentage of children whose mothers have no education and continued to be breastfed at age 2 is 62 percent compared to 36 percent of children whose mothers had higher level of education. F i g u r e N U . 3 : I n f a n t f e e d i n g p a t t e r n s b y a g e , P a l e s t i n e , 2 0 1 4 Exclusively   breas@ed   Breas@ed  and   complementary   foods   Weaned  (not   breas@ed)   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  breas@ed   Breas@ed  and  plain  water  only   Breas@ed  and  non-­‐milk  liquids   Breas@ed  and  other  milk  /  formula   Breas@ed  and  complementary  foods   Weaned  (not  breas@ed)   43 37 Table NU.5 shows the median duration of breastfeeding by selected background characteristics. Among children under age 3, the median duration is 14 months for any breastfeeding, almost 1 month for exclusive breastfeeding, and around 3 months for predominant breastfeeding. The data indicates that the median for any breastfeeding was the lowest in Salfit governorate (10 months) and generally similar in the other governorates (about 14 months) except for Jericho and Al Aghwar governorate where it was 16 months. The median duration of breastfeeding median is higher among males (15 months) compared to females (13 months). Table NU.5: Duration of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children age 0-35 months, Palestine, 2014 Median duration (in months) of Number of children age 0-35 months Any breastfeeding[1] Exclusive breastfeeding Predominant breastfeeding Total 13.9 0.8 2.5 4541 Region West Bank 13.3 1.6 2.8 2452 Gaza Strip 14.2 0.6 0.7 2090 Sex Male 14.5 1.1 2.5 2368 Female 13.2 0.7 2.5 2173 Governorate Jenin 14.7 2.7 3.8 281 Tubas 14.7 2.3 3.5 42 Tulkarm 14.4 0.6 0.6 123 Nablus 12.6 0.5 0.6 290 Qalqiliya 14.4 0.0 0.7 81 Salfit 10.2 2.2 2.4 53 Ramallah & Al-Bireh 11.4 0.6 0.7 291 Jericho and Al Aghwar 16.4 1.2 1.4 62 Jerusalem 12.0 1.4 1.7 369 Bethlehem 14.0 3.0 4.8 211 Hebron 14.9 2.1 3.6 648 North Gaza 14.8 0.6 0.7 420 Gaza 13.9 0.7 2.7 729 Deir El-Balah 14.4 0.5 0.6 271 Khan Yunis 14.1 0.7 0.7 405 Rafah 13.8 0.4 0.4 264 Area Urban 13.7 0.7 2.5 3476 Rural 14.6 2.0 2.7 682 Camps 14.3 0.7 0.7 384 Mother's education None (*) (*) (*) 19 Basic 14.1 1.9 3.2 1244 Secondary 13.8 0.7 2.4 1541 Higher 13.8 0.7 1.7 1738 Wealth index quintile Poorest 14.6 0.6 0.7 1143 Second 14.5 0.7 1.8 902 Middle 13.6 0.7 3.0 894 Fourth 12.1 1.6 2.6 899 Richest 12.4 1.8 2.5 703 [1] MICS indicator 2.11 - Duration of breastfeeding (*) Figures that are based on less than 25 unweighted cases The adequacy of infant feeding in children under the age of 24 months is provided in Table NU.6. Different criteria of feeding are used depending on the age of the child. For infants 44 Palestinian Multiple Indicator Cluster Survey 2014 38 aged 0-5 months, exclusive breastfeeding is considered as age-appropriate feeding, while infants aged 6-23 months are considered to be appropriately fed if they are receiving breast milk and solid, semi-solid or soft food. As a result of these feeding patterns, 45 percent percent of children age 6-23 months are being appropriately breastfed, where male children are more likely to be appropriately fed compared to female children (48% and 42% respectively) and children in the Gaza Strip compared to children in the West Bank (48% and 42%) respectively. Additionally, 43 percent of children aged 0-23 months are being appropriate fed, with some variations by region and sex and area of residence. Table NU.6: Age-appropriate breastfeeding Percentage of children age 0-23 months who were appropriately breastfed during the previous day, Palestine, 2014 Children age 0-5 months Children age 6-23 months Children age 0-23 months Percent exclusively breastfed1 Number of children Percent currently breastfeeding and receiving solid, semi- solid or soft foods Number of children Percent appropriately breastfed2 Number of children Total 38.6 668 44.8 2334 43.4 3002 Region West Bank 40.6 356 42.4 1264 42.0 1620 Gaza Strip 36.4 312 47.7 1069 45.1 1381 Sex Male 38.9 370 47.7 1207 45.7 1577 Female 38.3 298 41.7 1127 41.0 1424 Governorate Jenin (52.5) 37 50.9 145 51.2 182 Tubas (*) 5 (*) 21 (44.4) 26 Tulkarm (*) 16 47.2 58 45.6 74 Nablus (39.0) 38 44.8 146 43.6 184 Qalqiliya (*) 14 (37.7) 33 28.7 47 Salfit (*) 11 31.3 27 (33.9) 38 Ramallah & Al-Bireh 24.8 50 39.4 151 35.8 201 Jericho and Al Aghwar (*) 9 51.9 34 45.7 44 Jerusalem (38.6) 43 35.9 193 36.4 237 Bethlehem (55.9) 43 46.2 100 49.1 144 Hebron 45.6 88 41.3 355 42.1 443 North Gaza 37.1 68 46.4 200 44.1 268 Gaza 39.0 105 47.1 389 45.3 494 Deir El-Balah (40.2) 42 47.8 138 46.0 180 Khan Yunis 40.9 66 49.8 196 47.6 262 Rafah (12.4) 32 47.9 146 41.6 178 Area Urban 38.2 512 44.4 1798 43.0 2310 Rural 40.7 103 45.8 347 44.6 450 Camps 39.1 53 47.6 188 45.7 242 Mother’s education None (*) 5 (*) 7 (*) 12 Basic (43.6) 156 47.9 631 47.0 788 Secondary 38.4 235 44.2 806 42.9 1041 Higher 35.5 272 43.4 890 41.6 1161 Wealth index quintile Poorest 37.2 169 45.9 596 44.0 765 Second 37.2 136 50.6 447 47.5 583 Middle 41.9 113 46.1 463 45.3 576 Fourth 36.8 147 40.0 469 39.2 616 Richest 41.8 103 40.6 359 40.8 462 1 MICS indicator 2.7 - Exclusive breastfeeding under 6 months 2 MICS indicator 2.12 - Age-appropriate breastfeeding ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 45 39 Overall, 90 percent of infants age 6-8 months received solid, semi-solid, or soft foods at least once during the previous day of the interview (Table NU.7). Among currently breastfeeding infants this percentage is 89 percent while it is 92 percent among infants currently not breastfeeding. Data shows that 92 percent of infants in Gaza received solid, semi-solid, or soft foods at least once during the previous day compared to 88 percent among children in the West Bank. This percentage was higher among males compared to females at 91 percent and 89 percent respectively. Table NU.7: Introduction of solid, semi-solid, or soft foods Percentage of infants age 6-8 months who received solid, semi-solid, or soft foods during the previous day, Palestine, 2014 Currently breastfeeding Currently not breastfeeding All Percent receiving solid, semi- solid or soft foods Number of children age 6-8 months Percent receiving solid, semi- solid or soft foods Number of children age 6-8 months Percent receiving solid, semi- solid or soft foods1 Number of children age 6-8 months Total 89.2 365 91.6 74 89.6 439 Region West Bank 87.9 176 (86.9) 47 87.7 223 Gaza Strip 90.4 189 (100.0) 26 91.6 216 Sex Male 90.6 185 (90.8) 35 90.6 220 Female 87.8 181 (92.3) 39 88.6 219 Area Urban 89.5 285 93.1 59 90.1 344 Rural 89.4 56 (*) 12 88.1 68 camp (*) 24 (*) 3 (87.0) 27 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 less than 25 unweighted cases Overall, 75 percent of the children age 6-23 months were receiving solid, semi-solid and soft foods the minimum number of times. A slightly higher proportion of males (76 percent) were achieving the minimum meal frequency compared to females (75 percent). The proportion of children receiving the minimum diet diversity, or foods from at least 4 food groups, was 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 month old) children (80 percent) were achieving the minimum diet diversity compared to younger (6-8 month old) children (28 percent). The overall assessment using the indicator of minimum acceptable diet revealed that only 42 percent were benefitting from a diet sufficient in both diversity and frequency. Some differences are noted according to area of residence, a higher proportion of rural children (78 percent) achieving the minimum meal frequency compared to those living in urban areas and camps (75 percent each). 46 Palestinian Multiple Indicator Cluster Survey 2014 40 Ta bl e N U .8 : I nf an t a nd y ou ng c hi ld fe ed in g (IY C F) p ra ct ic es P er ce nt ag e of c hi ld re n ag e 6- 23 m on th s w ho re ce iv ed a pp ro pr ia te li qu id s an d so lid , s em i-s ol id , o r s of t f oo ds th e m in im um n um be r o f t im es o r m or e du rin g th e pr ev io us d ay , b y br ea st fe ed in g st at us , P al es tin e, 2 01 4 C ur re nt ly b re as tfe ed in g C ur re nt ly n ot b re as tfe ed in g A ll P er ce nt o f c hi ld re n w ho re ce iv ed : N um be r of ch ild re n ag e 6- 23 m on th s P er ce nt o f c hi ld re n w ho re ce iv ed : N um be r of ch ild re n ag e 6- 23 m on th s P er ce nt o f c hi ld re n w ho re ce iv ed : N um be r of ch ild re n ag e 6- 23 m on th s M in im um di et ar y di ve rs ity [a ] M in im um m ea l fre qu en cy [b ] M in im um ac ce pt ab le di et [1 ], [c ] M in im um di et ar y di ve rs ity [a ] M in im um m ea l fre qu en cy [b ] M in im um ac ce pt ab le di et [2 ], [c ] A t le as t 2 m ilk fe ed s [3 ] M in im um di et ar y di ve rs ity [4 ], [a ] M in im um m ea l fre qu en cy [5 ], [b ] M in im um ac ce pt ab le di et [c ] To ta l 49 .3 68 .6 40 .2 11 02 74 .5 81 .9 43 .8 69 .6 11 49 62 .6 75 .4 42 .1 23 34 R eg io n W es t B an k 57 .5 65 .3 44 .5 56 8 78 .6 84 .2 51 .6 79 .1 64 2 68 .9 75 .4 48 .3 12 64 G az a S tri p 40 .7 72 .2 35 .7 53 4 69 .4 78 .9 33 .9 57 .6 50 7 55 .1 75 .4 34 .8 10 70 Se x M al e 50 .2 68 .5 41 .4 60 5 75 .9 83 .5 47 .8 72 .6 56 0 63 .1 75 .7 44 .4 12 07 Fe m al e 48 .3 68 .8 38 .9 49 8 73 .2 80 .4 40 .1 66 .7 58 9 62 .0 75 .1 39 .5 11 27 A ge (m on th s) 6- 8 26 .2 70 .5 23 .7 36 5 38 .6 93 .7 20 .4 95 .3 65 28 .1 74 .0 23 .2 43 9 9- 11 47 .5 60 .3 36 .2 26 0 57 .5 91 .9 43 .5 91 .5 93 50 .8 68 .7 38 .1 36 4 12 -1 7 65 .7 71 .0 53 .3 35 8 74 .8 83 .0 47 .3 74 .8 38 3 70 .5 77 .2 50 .2 77 1 18 -2 3 75 .1 74 .2 60 .3 12 0 80 .8 78 .4 44 .2 60 .2 60 8 80 .0 77 .7 46 .8 75 9 G ov er no ra te Je ni n 74 .2 70 .4 52 .1 75 81 .5 80 .9 54 .9 76 .1 59 76 .5 75 .0 53 .3 14 5 Tu ba s (* ) (* ) (* ) 9 (* ) (* ) (* ) (* ) 12 (* ) (* ) (* ) 21 Tu lk ar m (5 3. 5) (6 7. 4) (4 4. 2) 27 (7 6. 0) (8 2. 7) (4 6. 0) (6 9. 9) 30 65 .8 75 .4 45 .1 58 N ab lu s 56 .1 73 .3 46 .9 65 77 .7 82 .6 50 .0 77 .2 70 66 .2 78 .1 48 .5 14 6 Q al qi liy a (* ) (* ) (* ) 13 (* ) (* ) (* ) (* ) 20 84 .4 86 .7 62 .9 33 S al fit (* ) (* ) (* ) 9 (* ) (* ) (* ) (* ) 15 77 .5 65 .1 50 .1 27 R am al la h & A l- B ire h 74 .1 74 .9 62 .1 61 84 .3 89 .6 60 .5 83 .9 87 80 .5 83 .5 61 .1 15 1 Je ric ho a nd A l A gh w ar (* ) (* ) (* ) 19 (* ) (* ) (* ) (* ) 12 60 .7 67 .8 47 .4 34 Je ru sa le m 60 .9 62 .3 44 .0 76 82 .8 94 .3 65 .5 89 .2 11 0 74 .4 81 .2 56 .7 19 3 B et hl eh em 40 .5 77 .0 34 .7 50 (7 5. 6) (8 6. 0) (4 0. 7) (7 6. 8) 45 57 .8 81 .3 37 .6 10 0 H eb ro n 47 .4 53 .2 36 .0 16 4 71 .5 78 .9 39 .4 72 .8 18 3 60 .7 66 .7 37 .8 35 5 N or th G az a 41 .4 78 .1 40 .4 10 4 71 .2 89 .3 38 .7 56 .3 84 55 .3 83 .1 39 .6 20 0 G az a 28 .0 61 .1 19 .4 18 6 54 .0 62 .8 26 .1 55 .4 19 2 42 .5 62 .0 22 .8 38 9 D ei r E l-B al ah 53 .1 81 .5 51 .5 69 88 .5 91 .7 38 .6 56 .6 67 71 .0 86 .6 45 .2 13 8 K ha n Y un is 47 .4 72 .5 41 .8 10 4 81 .1 85 .2 38 .8 63 .6 90 62 .9 78 .4 40 .4 19 6 R af ah 51 .1 82 .8 47 .1 71 75 .6 89 .7 38 .5 58 .2 73 62 .7 86 .3 42 .8 14 6 47 41 Ta bl e N U .8 C on tin ue d: In fa nt a nd y ou ng c hi ld fe ed in g (IY C F) p ra ct ic es P er ce nt ag e of c hi ld re n ag e 6- 23 m on th s w ho re ce iv ed a pp ro pr ia te li qu id s an d so lid , s em i-s ol id , o r s of t f oo ds th e m in im um n um be r o f t im es o r m or e du rin g th e pr ev io us d ay , b y br ea st fe ed in g st at us , P al es tin e, 2 01 4 C ur re nt ly b re as tfe ed in g C ur re nt ly n ot b re as tfe ed in g A ll P er ce nt o f c hi ld re n w ho re ce iv ed : N um be r of ch ild re n ag e 6- 23 m on th s P er ce nt o f c hi ld re n w ho re ce iv ed : N um be r of ch ild re n ag e 6- 23 m on th s P er ce nt o f c hi ld re n w ho re ce iv ed : N um be r o f ch ild re n ag e 6- 23 m on th s M in im um di et ar y di ve rs ity [a ] M in im um m ea l fre qu en cy [b ] M in im um ac ce pt ab le di et [1 ], [c ] M in im um di et ar y di ve rs ity [a ] M in im um m ea l fre qu en cy [b ] M in im um ac ce pt ab le di et [2 ] [ c] A t l ea st 2 m ilk fe ed s [3 ] M in im u m di et ar y di ve rs it y [4 ], [a ] M in im um m ea l fre qu en cy [5 ], [b ] M in im um ac ce pt ab le di et [c ] A re a U rb an 46 .7 69 .0 39 .2 84 2 71 .4 80 .5 41 .1 67 .7 89 9 59 .9 75 .0 40 .2 17 99 R ur al 60 .8 68 .5 46 .3 16 6 85 .9 87 .4 56 .0 79 .6 16 3 73 .1 77 .9 51 .1 34 7 ca m p 53 .0 65 .4 39 .3 95 86 .1 85 .9 49 .1 70 .2 86 68 .8 75 .2 44 .0 18 8 M ot he r’s e du ca tio n N on e (* ) (* ) (* ) 2 (* ) (* ) (* ) (* ) 4 (* ) (* ) (* ) 7 B as ic 41 .6 62 .9 31 .7 31 6 62 .4 77 .2 29 .7 64 .1 29 3 51 .4 69 .7 30 .8 63 1 S ec on da ry 46 .2 68 .5 37 .3 37 8 70 .6 80 .9 36 .6 65 .1 39 5 59 .5 74 .8 37 .0 80 6 H ig he r 58 .5 73 .6 49 .7 40 7 85 .5 86 .0 59 .0 77 .0 45 7 73 .1 80 .2 54 .6 89 0 W ea lth in de x qu in til e P oo re st 37 .0 66 .3 31 .7 29 2 65 .6 76 .7 30 .5 53 .9 28 8 51 .6 71 .4 31 .1 59 6 S ec on d 44 .9 72 .7 37 .4 23 3 70 .4 81 .2 36 .1 62 .7 20 2 57 .2 76 .7 36 .8 44 7 M id dl e 51 .1 64 .6 38 .9 22 8 81 .1 77 .0 42 .1 68 .7 21 5 65 .2 70 .6 40 .5 46 3 Fo ur th 56 .9 72 .4 47 .4 19 4 79 .0 84 .4 53 .3 79 .8 25 2 69 .8 79 .2 50 .7 46 9 R ic he st 67 .2 68 .3 53 .6 15 5 79 .2 92 .7 61 .5 88 .1 19 1 74 .5 81 .7 58 .0 35 9 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 in im um d ie ta ry d iv er si ty is d ef in ed a s re ce iv in g fo od s fro m a t l ea st 4 o f 7 fo od g ro up s: 1 ) G ra in s, ro ot s an d tu be rs , 2 ) l eg um es a nd n ut s, 3 ) d ai ry p ro du ct s (m ilk , y og ur t, ch ee se ), 4) fl es h fo od s (m ea t, fis h, p ou ltr y an d liv er /o rg an m ea ts ), 5) e gg s, 6 ) v ita m in -A ri ch fr ui ts a nd v eg et ab le s, a nd 7 ) o th er fr ui ts a nd v eg et ab le s. b M in im um m ea l f re qu en cy a m on g cu rr en tly b re as tfe ed in g ch ild re n is d ef in ed a s ch ild re n w ho a ls o re ce iv ed s ol id , s em i-s ol id , o r s of t f oo ds 2 ti m es o r m or e da ily fo r c hi ld re n ag e 6- 8 m on th s an d 3 tim es o r m or e da ily fo r c hi ld re n ag e 9- 23 m on th s. F or n on -b re as tfe ed in g ch ild re n ag e 6- 23 m on th s it is d ef in ed a s re ce iv in g so lid , s em i-s ol id o r s of t f oo ds , o r m ilk fe ed s, a t l ea st 4 ti m es . c Th e m in im um a cc ep ta bl e di et fo r b re as tfe d ch ild re n ag e 6- 23 m on th s is d ef in ed a s re ce iv in g th e m in im um d ie ta ry d iv er si ty a nd th e m in im um m ea l f re qu en cy , w hi le it fo r n on -b re as tfe d ch ild re n fu rth er re qu ire s at le as t 2 m ilk fe ed in gs a nd th at th e m in im um d ie ta ry d iv er si ty is a ch ie ve d w ith ou t c ou nt in g m ilk fe ed s. ( ) F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s (* ) F ig ur es th at a re b as ed o n le ss th an 2 5 un w ei gh te d ca se s 48 Palestinian Multiple Indicator Cluster Survey 2014 42 The continued practice of bottle-feeding is a concern because of the possible contamination due to unsafe water and lack of hygiene in preparation. Table NU.8 shows that bottle- feeding is still prevalent in among Palestinian children. Forty two percent of children aged 0- 23 months are fed using a bottle with a nipple. There is a higher proportion of bottle use was noted among children in the West Bank (48 percent) compared to 36 percent in Gaza Strip. Children in rural areas are more likely to bottle fed, than children in urban and Camps areas (49 percent and 41 percent respectively).The higher levels of bottle usage is found to be correlated with wealth, where this was 55 percent among children of the richest households compared to 32 percent among children of the poorest households. Table NU.9: Bottle feeding Percentage of children age 0-23 months who were fed with a bottle with a nipple during the previous day, Palestine, 2014 Percentage of children age 0-23 months fed with a bottle with a nipple [1] Number of children age 0-23 months: Total 42.4 3002 Region West Bank 47.5 1620 Gaza Strip 36.3 1382 Sex Male 41.6 1577 Female 43.2 1424 Age 0-5 months 42.1 668 6-11 months 43.7 803 12-23 months 41.8 1530 Governorate Jenin 49.6 182 Tubas (22.9) 26 Tulkarm 35.9 74 Nablus 52.9 184 Qalqiliya (53.7) 47 Salfit (51.5) 38 Ramallah & Al-Bireh 53.3 201 Jericho and Al Aghwar 48.3 44 Jerusalem 54.2 237 Bethlehem 46.8 144 Hebron 40.9 443 North Gaza 32.6 268 Gaza 29.2 494 Deir El-Balah 40.1 180 Khan Yunis 43.3 262 Rafah 47.7 178 Area Urban 41.2 2311 Rural 49.1 450 camp 41.2 241 Mother's education None (*) 12 Basic 36.0 788 Secondary 41.9 1041 Higher 47.1 1161 Wealth index quintile Poorest 31.7 765 Second 37.7 583 Middle 45.0 576 Fourth 48.5 616 Richest 54.5 462 1 MICS indicator 2.18 - Bottle feeding ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 49 43 Salt Iodization Iodine Deficiency Disorders (IDD) is the world’s leading cause of preventable mental retardation and impaired psychomotor development in young children. In its most extreme form, iodine deficiency causes cretinism. It also increases the risks of stillbirth and miscarriage in pregnant women. Iodine deficiency is most commonly and visibly associated with goitre. IDD takes its greatest toll in impaired mental growth and development, contributing in turn to poor school performance, reduced intellectual ability, and impaired work performance. The indicator is the percentage of households consuming adequately iodized salt (>15 parts per million). In almost all households (98 percent), salt used for cooking was tested for iodine content by using salt test kits and testing for the presence of either the potassium iodide or potassium iodate. Potassium iodide is an inorganic compound with the chemical formula KI. This kind of salt is the most commercially significant iodide compound, it’s the mostly salt use in Palestine, bust since Palestine have its own salt from different sources so some are potassium iodate Table NU.10 shows that in about one percent of households, there was no salt available. These households are included in the denominator of the indicator. In 73 percent of households, salt was found to contain 15 parts per million (ppm) or more of iodine. Use of iodized salt was lowest in West Bank (69 percent) and highest in Gaza Strip (80 percent). Approximately 80 percent of households in camps were found to be using adequately iodized salt as compared to only 72 percent of urban households and 75 percent of households in rural areas. A noticeable variation between governorates is also noted, as only 46 percent of households in Hebron governorate were found to be using adequately iodized salt, while this percent exceeded 90 percent in Tubas, Deir El Balah and Rafah governorates. 50 Palestinian Multiple Indicator Cluster Survey 2014 44 Table NU.10: Iodized salt consumption Percent distribution of households by consumption of iodized salt, Palestine, 2014 Percent of households in which salt was tested Number of households Percent of households with salt test result Total Number of households in which salt was tested or with no salt Percent of households with no salt Not iodized 0 PPM >0 and <15 PPM 15+ PPM [1] Total 97.5 10182 1.4 10.3 15.0 73.2 100.0 10074 Region West Bank 97.4 6386 1.3 13.2 16.3 69.3 100.0 6296 Gaza Strip 97.8 3796 1.7 5.6 13.0 79.7 100.0 3779 Governorate Jenin 98.9 744 0.0 0.9 25.2 73.9 100.0 736 Tubas 99.4 128 0.2 1.2 5.3 93.3 100.0 127 Tulkarm 96.6 421 1.6 3.6 24.8 70.1 100.0 413 Nablus 96.9 892 0.9 3.2 8.2 87.7 100.0 872 Qalqiliya 97.3 224 1.2 2.7 19.6 76.5 100.0 220 Salfit 99.4 164 0.0 6.3 9.5 84.2 100.0 163 Ramallah & Al-Bireh 94.7 770 2.7 3.3 13.2 80.9 100.0 749 Jericho and Al Aghwar 99.4 112 0.0 10.6 20.3 69.1 100.0 111 Jerusalem 98.1 988 0.9 20.9 12.5 65.7 100.0 978 Bethlehem 97.8 497 0.6 15.0 12.6 71.8 100.0 488 Hebron 97.3 1446 2.1 31.2 20.4 46.3 100.0 1437 North Gaza 98.4 701 1.5 9.1 13.8 75.6 100.0 701 Gaza 97.0 1336 2.6 7.6 17.4 72.4 100.0 1331 Deir El- Balah 98.1 581 1.3 2.6 5.6 90.5 100.0 578 Khan Yunis 98.4 723 1.2 3.7 16.1 78.9 100.0 721 Rafah 97.9 454 0.9 1.4 2.8 94.8 100.0 449 Area Urban 97.6 7600 1.5 11.6 15.0 72.0 100.0 7530 Rural 96.9 1741 1.2 7.1 16.3 75.4 100.0 1707 camp 98.1 841 1.4 5.9 12.8 79.9 100.0 837 Wealth index quintile Poorest 96.9 1896 2.6 7.4 13.5 76.5 100.0 1887 Second 97.6 1926 2.0 7.4 14.9 75.8 100.0 1916 Middle 97.2 2136 1.4 12.5 17.3 68.9 100.0 2104 Fourth 98.2 2162 0.9 11.2 15.2 72.8 100.0 2142 Richest 97.7 2063 0.5 12.9 14.1 72.6 100.0 2026 1 MICS indicator 2.19 - Iodized salt consumption 51 45 F i g u r e N U . 4 : C o n s u m p t i o n o f i o d i z e d s a l t , P a l e s t i n e , 2 0 1 4 86   93   87   92   93   90   91   86   88   87   88   69   80   72   75   80   77   76   69   73   73   73   0   20   40   60   80   100   West   Bank   Gaza   Strip   Urban   Rural   Camp   Poorest   Second   Middle   Fourth   Richest   PalesHne   Pe r   ce nt   Any  iodine   15+  PPM  of  iodine   52 Palestinian Multiple Indicator Cluster Survey 2014 VI. Child Health 46 VI. Child Health Vaccinations The Millennium Development Goal (MDG) 4 is to reduce child mortality by two thirds between 1990 and 2015. Immunization plays a key part in this goal. 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. 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. The WHO Recommended Routine Immunizations for Children1 recommends all children to be vaccinated against tuberculosis, diphtheria, pertussis, tetanus, polio, measles, hepatitis B, haemophilus influenzae type b, pneumonia/meningitis, rotavirus, and rubella. All doses in the primary series are recommended to be completed before the child’s first birthday, although depending on the epidemiology of disease in a country, the first doses of measles and rubella containing vaccines may be recommended at 12 months or later. The recommended number and timing of most other doses also vary slightly with local epidemiology and may include booster doses later in childhood. The vaccination schedule followed by the Palestinian National Immunization Programme provides the following vaccinations: a birth dose of Hepatitis B vaccine, BCG, two doses of Inactivated Polio Vaccine (IPV), three doses of Pentavalent 2 vaccine (Penta), three doses of Oral Polio Vaccine (OPV), administered by 12 months of age, three doses of Pneumococcal conjugate vaccine (PCV), the first dose of measles vaccine (administered as Measles Mumps and Rubella MMR1), by age of 12 months. Based on this vaccination schedule the estimates for full immunization coverage from the Palestinian MICS are based on children age 24-35 months to ensure that children receiving measles vaccination are included. Information on vaccination coverage was collected for all children under three years of age. All mothers or caretakers were asked to provide vaccination cards. If the vaccination card for a child was available, interviewers copied vaccination information from the cards onto 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, Penta and Hepatitis B and MMR, 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. 1  http://www.who.int/immunization/diseases/en.  Table  2  includes  recommendations  for  all  children  and  additional   antigens  recommended  only  for  children  residing  in  certain  regions  of  the  world  or  living  in  certain  high-­‐risk  population   groups.   2 According  to  the  Palestinian  national  immunization  schedule,  DPT,  Hepatitis,  Haemophilus  influenza  vaccines  are  part  of   the  Pentavalent  vaccine,  which  is  administered  in  three  doses,  at  age  two  months,  four  months  and  six  months,  as  follows:     Penta1  includes:  DPT1,  Hep1,  and  Haemophilus  influenza1,  Penta2  includes:  DPT2,  Hep2,  and  Haemophilus  influenza2,   Penta3  includes:  DPT3,  Hep3,  and  Haemophilus  influenza3 54 Palestinian Multiple Indicator Cluster Survey 2014 47 Ta bl e C H .1 : V ac ci na tio ns in th e fir st y ea rs o f l ife P er ce nt ag e of c hi ld re n ag e 12 -2 3 m on th s an d 24 -3 5 m on th s va cc in at ed a ga in st v ac ci ne p re ve nt ab le c hi ld ho od d is ea se s at a ny ti m e be fo re th e su rv ey a nd b y th ei r fir st b irt hd ay , P al es tin e, 2 01 4 C hi ld re n ag e 12 -2 3 m on th s: C hi ld re n ag e 24 -3 5 m on th s: Va cc in at ed a t a ny ti m e be fo re th e su rv ey a cc or di ng to : V ac ci na te d by 1 2 m on th s of ag ea Va cc in at ed a t a ny ti m e be fo re th e su rv ey ac co rd in g to : V ac ci na te d by 1 2 m on th s of a ge (m ea sl es b y 24 m on th s) a V ac ci na tio n ca rd M ot he r's re po rt E ith er V ac ci na tio n ca rd M ot he r's re po rt E ith er A nt ig en H ep B A t b irt h 91 .7 7. 9 99 .6 99 .1 83 .2 16 .0 99 .2 98 .9 B C G 1 92 .0 7. 6 99 .6 98 .8 83 .3 16 .0 99 .3 99 .1 Pe nt a 1 91 .4 8. 4 99 .8 98 .4 83 .1 16 .5 99 .6 98 .6 2 91 .0 8. 5 99 .5 97 .9 82 .7 16 .6 99 .3 98 .4 31 89 .4 9. 8 99 .3 96 .9 82 .4 16 .7 99 .0 97 .3 IP V 1 91 .1 8. 6 99 .8 99 .4 83 .6 16 .0 99 .6 99 .3 22 90 .6 9. 0 99 .6 98 .9 83 .1 16 .0 99 .1 98 .8 Po lio 1 91 .6 8. 4 10 0. 0 99 .2 83 .0 16 .4 99 .4 99 .0 2 91 .1 8. 6 99 .7 99 .0 82 .5 16 .5 99 .0 98 .6 32 89 .3 9. 6 99 .0 97 .9 81 .9 16 .7 98 .6 97 .4 M ea sl es (M C V 1) 7 na 81 .6 17 .5 99 .1 97 .0 Fu lly v ac ci na te d8 , b na na na na 82 .0 12 .8 94 .9 89 .9 N o va cc in at io ns 0. 0 0. 0 0. 0 0. 1 0. 0 0. 3 0. 3 0. 3 N um be r o f c hi ld re n 14 44 14 44 14 44 14 44 14 66 14 66 14 66 14 66 [1 ] M IC S in di ca to r 3 .1 - Tu be rc ul os is im m un iz at io n co ve ra ge [2 ] M IC S in di ca to r 3 .2 - P ol io im m un iz at io n co ve ra ge [a ] M IC S in di ca to rs 3 .1 , 3 .2 , 3 .3 , 3 .5 , 3 .6 , a nd re fe r t o re su lts o f t hi s co lu m n in th e le ft pa ne l; M IC S in di ca to rs 3 .4 a nd 3 .8 re fe r t o th is c ol um n in th e rig ht p an el [b ] I nc lu de s: B C G , H ep .B 0, IP V 1, IP V 2, p en ta 1, p en ta 2, p en ta 3, P ol io 1, P ol io 2, P ol io 3 by th e fir st b irt hd ay a nd m ea sl es b y th e se co nd b irt hd ay , a s pe r t he va cc in at io n sc he du le in P al es tin e 55 48 The percentage of children age 12-23 months and 24-35 months who have received each of the specific vaccinations by source of information vaccination card and mother’s recall is shown in Table CH.1 and Figure CH.1. The denominators for the table are comprised of children age 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 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, the proportion of vaccinations given before the first birthday is assumed to be the same as for children with vaccination cards. As indicated in Table DQ.17 in Appendix D, it is seen that 94 percent of children age 12-23 months and 89 percent of those age 24-35 months have ever received a vaccination card, and that cards were actually seen by the interviewer in 93 percent and 84 percent of cases respectively for these two age groups. Taking into consideration that 2 percent of children age 12-23 months and 5 percent of those age 24-35 months previously had a vaccination card but did not have one at the time of the survey. Approximately 99 percent of children age 12-23 months received a BCG vaccination by the age of 12 months and the first dose of Penta (DPT-HepB-Hib) vaccine was given to 98 percent. Coverage levels were sustained with 98 percent of children receiving the second dose of DPT- HepB-Hib, and 97 percent the third dose. Similarly, 99 percent of children received Polio 1 by age 12 months and this coverage is maintained at 98 percent by the third dose. The coverage for measles vaccine for children 24-35 months by any time before the survey was 99 while 97 percent of children 24-35 months received the measles vaccine by the recommended age of 12 months. As a result, the percentage of children who had all the recommended vaccinations by their second birthday was 90 percent. 56 Palestinian Multiple Indicator Cluster Survey 2014 49 Figure CH.1: Vaccinat ions by age 12 months (measles by 24 months) , Palest ine, 2014 Table CH.2 presents vaccination coverage estimates among children 12-23 and 24-35 months by background characteristics. The figures indicate children receiving the vaccinations at any time up to the date of the survey, and are based on information from both the vaccination cards and mothers’/caretakers’ reports. Vaccination cards have been seen by the interviewer for 93 percent of children age 12-23 months. No variation in vaccination coverage were noted among males and females, by area, mother’s education or wealth quintiles. 57 50 Ta bl e C H .2 : V ac ci na tio ns b y ba ck gr ou nd c ha ra ct er is tic s P er ce nt ag e of c hi ld re n ag e 12 -2 3 m on th s an d ag e 24 -3 5 m on th s cu rr en tly v ac ci na te d ag ai ns t v ac ci ne p re ve nt ab le c hi ld ho od d is ea se s, P al es tin e, 2 01 4 Pe rc en ta ge o f c hi ld re n ag e 12 -2 3 m on th s w ho re ce iv ed : Pe rc en ta ge o f c hi ld re n ag e 24 -3 5 m on th s w ho re ce iv ed : Hep.B0 (At birth) B C G IP V P en ta P ol io None P er ce nt ag e w ith va cc i na tio n ca rd se en N um be r o f ch ild re n ag e 12 -2 3 m on th s First dose of Measles Fu lla N on e P er ce nt ag e w ith va cc in at io n ca rd se en N um be r of ch ild re n ag e 24 - 35 m on th s 1 2 1 2 3 1 2 3 To ta l 99 .6 99 .6 99 .8 99 .6 99 .8 99 .5 99 .3 10 0. 0 99 .7 99 .0 0. 0 92 .9 14 44 99 .1 94 .9 0. 3 84 .3 14 66 R eg io n W es t B an k 99 .8 99 .4 99 .7 99 .4 99 .8 99 .1 98 .8 10 0. 0 99 .5 98 .6 0. 0 89 .8 74 6 98 .9 94 .2 0. 4 81 .5 75 7 G az a S tri p 99 .5 99 .8 99 .8 99 .8 99 .9 99 .9 99 .9 10 0. 0 10 0. 0 99 .4 0. 0 96 .3 69 8 99 .4 95 .6 0. 3 87 .4 70 9 G ov er no ra te Je ni n 10 0. 0 10 0. 0 10 0. 0 99 .0 98 .9 98 .9 10 0. 0 10 0. 0 10 0. 0 98 .9 0. 0 98 .0 91 98 .9 98 .9 1. 1 98 .9 98 Tu ba s (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 15 (* ) (* ) (* ) (* ) 16 Tu lk ar m (9 7. 7) (1 00 .0 ) (1 00 .0 ) (1 00 .0 ) (1 00 .0 ) (9 7. 9) (9 7. 2) (1 00 .0 ) (1 00 .0 ) (1 00 .0 ) (0 .0 ) (9 4. 3) 37 (9 8. 3) (8 7. 0) (1 .7 ) (9 6. 8) 49 N ab lu s 10 0. 0 99 .0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 99 .0 99 .0 0. 0 96 .3 97 10 0. 0 99 .1 0. 0 83 .7 10 6 Q al qi liy a (1 00 . 0) (1 00 .0 ) (1 00 .0 ) (1 00 .0 ) (1 00 .0 ) (1 00 .0 ) (1 00 .0 ) (1 00 .0 ) (1 00 .0 ) (1 00 .0 ) (0 .0 ) (9 6. 5) 25 (1 00 .0 ) (9 7. 8) (0 .0 ) (9 4. 0) 34 S al fit (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 17 (* ) (* ) (* ) (* ) 15 R am al la h & A l-B ire h 10 0. 0 10 0. 0 10 0. 0 99 .1 99 .1 96 .2 96 .2 10 0. 0 10 0. 0 99 .1 0. 0 83 .2 10 0 98 .8 92 .9 0. 0 73 .5 90 Je ric ho & A l A gh w ar (1 00 . 0) (1 00 .0 ) (1 00 .0 ) (1 00 . 0) (1 00 . 0) (1 00 . 0) (1 00 . 0) (1 00 . 0) (1 00 . 0) (1 00 . 0) 0. 0 (1 00 . 0) 22 (1 00 .0 ) (9 7. 5) 0. 0 (9 1. 8) 19 Je ru sa le m ** (1 00 . 0) (9 1. 7) (9 5. 5) (9 5. 5) (1 00 . 0) (1 00 . 0) (1 00 . 0) (1 00 . 0) (9 5. 5) (9 5. 5) (0 .0 ) (8 6. 8) 42 10 0. 0 81 .0 0. 0 77 .3 58 B et hl eh em 10 0. 0 10 0. 0 10 0. 0 98 .6 10 0. 0 10 0. 0 96 .2 10 0. 0 10 0. 0 95 .1 0. 0 98 .5 63 98 .5 93 .2 1. 5 89 .5 67 H eb ro n 99 .6 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 99 .6 10 0. 0 10 0. 0 99 .3 0. 0 83 .1 23 6 98 .4 96 .0 0. 0 70 .1 20 5 N or th G az a 99 .3 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 98 .3 0. 0 93 .0 13 5 99 .3 94 .7 0. 0 78 .9 15 2 G az a 99 .5 99 .5 10 0. 0 10 0. 0 99 .6 99 .6 99 .6 10 0. 0 10 0. 0 99 .6 0. 0 98 .7 24 9 10 0. 0 94 .8 0. 0 90 .2 23 6 D ei r E l-B al ah 10 0. 0 10 0. 0 98 .9 98 .9 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 0. 0 94 .6 97 10 0. 0 94 .3 0. 0 90 .6 91 K ha n Y un is 98 .9 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 99 .4 0. 0 98 .2 11 9 98 .3 98 .3 0. 8 89 .4 14 3 R af ah 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 0. 0 94 .0 98 98 .9 95 .7 1. 1 87 .8 87 [a ] In cl ud es : B C G , H ep .B 0, IP V 1, IP V 2, p en ta 1, p en ta 2, p en ta 3, P ol io 1, P ol io 2, P ol io 3 by th e fir st b irt hd ay a nd m ea sl es b y th e se co nd b irt hd ay , a s pe r t he v ac ci na tio n sc he du le in P al es tin e ( ) F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s (* ) F ig ur es th at a re b as ed o n le ss th an 2 5 un w ei gh te d ca se s ** : D oe s no t i nc lu de th os e pa rts o f J er us al em w hi ch w er e an ne xe d by Is ra el in 1 96 7, d ue to th e fa ct th at th e P al es tin ia n va cc in at io n sc he du le is d iff er en t f ro m th e Is ra el i v ac ci na tio n sc he du le . P al es tin ia n ch ild re n liv in g in E as t J er us al em re ce iv e th ei r v ac ci na tio ns fr om th e Is ra el i H ea lth c en te rs . 58 Palestinian Multiple Indicator Cluster Survey 2014 51 Ta bl e C H .2 C on tin ue d: V ac ci na tio ns b y ba ck gr ou nd c ha ra ct er is tic s P er ce nt ag e of c hi ld re n ag e 12 -2 3 m on th s cu rr en tly v ac ci na te d ag ai ns t v ac ci ne p re ve nt ab le c hi ld ho od d is ea se s, P al es tin e, 2 01 4 Pe rc en ta ge o f c hi ld re n ag e 12 -2 3 m on th s w ho re ce iv ed : Pe rc en ta ge o f c hi ld re n ag e 24 -3 5 m on th s w ho re ce iv ed : Hep.B0 (At birth) B C G IP V P en ta P ol io None P er ce nt ag e w ith va cc i na tio n ca rd se en N um be r o f ch ild re n ag e 12 -2 3 m on th s First dose of Measles Fu lla N on e P er ce nt ag e w ith va cc in at i on c ar d se en N um be r of ch ild re n ag e 24 - 35 m on th s 1 2 1 2 3 1 2 3 Se x M al e 99 .9 99 .6 99 .6 99 .5 99 .8 99 .4 99 .6 10 0. 0 99 .6 99 .1 0. 0 93 .3 75 5 98 .9 94 .0 0. 3 85 .3 75 4 Fe m al e 99 .3 99 .6 10 0. 0 99 .7 99 .9 99 .6 99 .0 10 0. 0 99 .8 98 .9 0. 0 92 .5 68 9 99 .3 95 .8 0. 4 83 .2 71 2 A re a U rb an 99 .6 99 .6 99 .7 99 .6 99 .8 99 .6 99 .5 10 0. 0 99 .8 99 .2 0. 0 92 .7 99 .6 98 .9 94 .6 0. 5 83 .7 10 96 R ur al 10 0. 0 99 .6 10 0. 0 99 .6 10 0. 0 99 .2 98 .2 10 0. 0 99 .1 98 .2 0. 0 92 .9 10 0. 0 99 .7 96 .1 0. 0 85 .1 23 3 C am p 99 .2 10 0. 0 10 0. 0 99 .3 99 .3 98 .7 99 .3 10 0. 0 10 0. 0 98 .7 0. 0 95 .0 99 .2 10 0. 0 95 .1 0. 0 88 .0 13 8 M ot he r's ed uc at io n N on e (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 5 (* ) (* ) (* ) (* ) 7 B as ic 99 .5 99 .3 10 0. 0 99 .8 99 .5 99 .5 99 .2 10 0. 0 10 0. 0 98 .7 0. 0 95 .2 39 6 98 .9 92 .8 0. 7 82 .2 42 6 S ec on da ry 99 .8 99 .6 99 .6 99 .4 10 0. 0 99 .7 99 .5 10 0. 0 99 .6 98 .7 0. 0 94 .0 49 4 99 .6 95 .8 0. 2 89 .5 47 4 H ig he r 99 .6 99 .8 99 .8 99 .7 99 .8 99 .2 99 .2 10 0. 0 99 .6 99 .5 0. 0 90 .3 55 0 98 .9 95 .6 0. 2 81 .6 55 9 W ea lth in de x qu in til e P oo re st 99 .7 99 .7 10 0. 0 10 0. 0 99 .7 99 .7 99 .7 10 0. 0 10 0. 0 99 .2 0. 0 96 .3 39 8 99 .3 97 .6 0. 3 85 .9 37 8 S ec on d 98 .9 10 0. 0 10 0. 0 99 .3 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 99 .6 0. 0 95 .1 28 1 99 .7 98 .3 0. 3 88 .9 31 9 M id dl e 99 .7 96 .2 99 .1 98 .8 99 .4 99 .1 98 .9 99 .5 97 .2 96 .4 0. 3 91 .5 30 0 98 .5 93 .0 0. 3 84 .7 31 8 Fo ur th 99 .4 93 .4 97 .6 97 .6 99 .4 98 .1 96 .9 98 .5 92 .5 91 .6 0. 3 90 .4 33 0 97 .7 88 .7 1. 0 82 .1 28 3 R ic he st 10 0. 0 85 .0 98 .2 96 .9 99 .6 98 .1 96 .6 98 .7 85 .0 82 .8 0. 0 85 .7 22 1 98 .4 82 .7 1. 3 74 .7 24 1 [a ] In cl ud es : B C G , H ep .B 0, IP V 1, IP V 2, p en ta 1, p en ta 2, p en ta 3, P ol io 1, P ol io 2, P ol io 3 by th e fir st b irt hd ay a nd m ea sl es b y th e se co nd b irt hd ay , a s pe r t he v ac ci na tio n sc he du le in P al es tin e ( ) F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s (* ) F ig ur es th at a re b as ed o n le ss th an 2 5 un w ei gh te d ca se s 59 52 Care of Illness A key strategy for accelerating progress toward MDG 4 is to tackle the diseases that are the leading killers of children under 5. Diarrhoea and pneumonia are two such diseases. The Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) aims to end preventable pneumonia and diarrhoea death by reducing mortality from pneumonia to 3 deaths per 1000 live births and mortality from diarrhoea to 1 death per 1000 live births by 2025. Table CH.4 presents the percentage of children under 5 years of age who were reported to have had an episode of diarrhoea, symptoms of acute respiratory infection (ARI), or fever during the 2 weeks preceding the survey. These results are not measures of true prevalence, and should not be used as such, but rather the period-prevalence of those illnesses over a two-week time window. The definition of a case of diarrhoea, in this survey, was the mother’s (or caretaker’s) report that the child had such symptoms over the specified period; no other evidence were sought beside the 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. Further, 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. 60 Palestinian Multiple Indicator Cluster Survey 2014 52 Care of Illness A key strategy for accelerating progress toward MDG 4 is to tackle the diseases that are the leading killers of children under 5. Diarrhoea and pneumonia are two such diseases. The Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) aims to end preventable pneumonia and diarrhoea death by reducing mortality from pneumonia to 3 deaths per 1000 live births and mortality from diarrhoea to 1 death per 1000 live births by 2025. Table CH.4 presents the percentage of children under 5 years of age who were reported to have had an episode of diarrhoea, symptoms of acute respiratory infection (ARI), or fever during the 2 weeks preceding the survey. These results are not measures of true prevalence, and should not be used as such, but rather the period-prevalence of those illnesses over a two-week time window. The definition of a case of diarrhoea, in this survey, was the mother’s (or caretaker’s) report that the child had such symptoms over the specified period; no other evidence were sought beside the 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. Further, 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. 53 Table CH.4: Reported disease episodes Percentage of children age 0-59 months for whom the mother/caretaker reported an episode of diarrhoea, fever, and/or symptoms of acute respiratory infection (ARI) in the last two weeks, Palestine, 2014 Percentage of children who in the last two weeks had: Number of children age 0-59 months An episode of diarrhoea Symptoms of ARI Total 11.3 10.7 7816 Region West Bank 11.4 11.0 4202 Gaza Strip 11.1 10.4 3614 Sex Male 12.2 11.7 4058 Female 10.3 9.6 3758 Governorate Jenin 11.4 9.6 469 Tubas 17.6 14.7 65 Tulkarm 9.5 15.9 217 Nablus 14.7 10.7 523 Qalqiliya 5.1 6.9 157 Salfit 5.8 3.4 104 Ramallah & Al-Bireh 11.5 9.2 466 Jericho and Al Aghwar 13.9 11.9 93 Jerusalem 12.1 9.1 635 Bethlehem 16.9 22.2 340 Hebron 8.8 10.1 1132 North Gaza 12.7 6.7 695 Gaza 10.5 9.9 1290 Deir El-Balah 10.1 12.2 489 Khan Yunis 10.8 11.3 667 Rafah 12.1 13.7 472 Area Urban 10.9 10.4 5942 Rural 11.9 12.1 1186 camp 13.1 11.3 688 Age 0-11 15.4 11.2 1471 12-23 17.8 11.7 1530 24-35 10.8 11.3 1540 36-47 7.0 9.0 1678 48-59 6.0 10.4 1597 Mother’s education None (10.2) (12.4) 37 Basic 11.0 12.0 2346 Secondary 11.4 10.4 2641 Higher 11.4 9.9 2792 Wealth index quintile Poorest 12.6 11.5 1937 Second 9.6 9.1 1601 Middle 11.8 12.2 1555 Fourth 11.7 11.9 1491 Richest 10.1 8.2 1233 ( ) Figures that are based on 25-49 unweighted cases Overall, 11 percent of under five children were reported to have had diarrhoea in the two weeks preceding the survey, and 11 percent of under five children were reported with symptoms of ARI (Table CH.4). The results showed differences between children who had diarrhea in the two weeks preceding the survey based on mother’s education; where only 3 percent of children who had diarrhea their mothers had basic education compared to 11 percent for mothers with higher education. 61 54 Diarrhoea Diarrhoea is a leading cause of death among children under five worldwide. Most diarrhoea- related deaths in children are due to dehydration from loss of large quantities of water and electrolytes from the body in liquid stools. Management of diarrhoea – either through oral rehydration salts (ORS) or a recommended home fluid (RHF) – can prevent many of these deaths. Preventing dehydration and malnutrition by increasing fluid intake and continuing to feed the child are also important strategies for managing diarrhoea. In the MICS, mothers or caretakers were asked whether their child under age five years had an episode of diarrhoea in the two weeks prior to the survey. In cases where mothers reported that the child 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 of diarrhoea in children under 5 years of age is 11 percent (Table CH.4) and ranges from 5 percent in Qalqiliya governorate to 18 percent in Tubas governorate. The highest period-prevalence is seen among children age 12-23 months (18 percent) which grossly corresponds to the weaning period. 62 Palestinian Multiple Indicator Cluster Survey 2014 54 Diarrhoea Diarrhoea is a leading cause of death among children under five worldwide. Most diarrhoea- related deaths in children are due to dehydration from loss of large quantities of water and electrolytes from the body in liquid stools. Management of diarrhoea – either through oral rehydration salts (ORS) or a recommended home fluid (RHF) – can prevent many of these deaths. Preventing dehydration and malnutrition by increasing fluid intake and continuing to feed the child are also important strategies for managing diarrhoea. In the MICS, mothers or caretakers were asked whether their child under age five years had an episode of diarrhoea in the two weeks prior to the survey. In cases where mothers reported that the child 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 of diarrhoea in children under 5 years of age is 11 percent (Table CH.4) and ranges from 5 percent in Qalqiliya governorate to 18 percent in Tubas governorate. The highest period-prevalence is seen among children age 12-23 months (18 percent) which grossly corresponds to the weaning period. 55 Table CH.5: Care-seeking during diarrhoea Percentage of children age 0-59 months with diarrhoea in the last two weeks for whom advice or treatment was sought, by source of advice or treatment, Palestine, 2014 Percentage of children with diarrhoea for whom: Number of children age 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 A health facility or provider [1] [a] Public Private NGOS UN Israeli Total 21.5 23.2 1.5 9.7 3.1 3.7 52.9 40.9 880 Region West Bank 15.4 30.3 1.1 3.8 5.8 4.6 52.4 42.3 478 Gaza Strip 28.6 14.9 1.9 16.7 0.0 2.7 53.4 39.3 402 Sex Male 22.5 22.0 1.6 10.8 3.0 4.6 53.3 40.4 494 Female 20.1 24.8 1.3 8.2 3.3 2.5 52.4 41.6 386 Governorate Jenin 24.8 48.0 0.0 0.0 0.0 3.6 65.1 29.2 54 Tubas 29.9 36.3 0.0 5.1 0.0 2.6 54.8 45.2 11 Tulkarm 18.3 31.2 0.0 3.8 0.0 0.0 49.1 43.1 21 Nablus 11.9 30.0 1.2 6.4 0.0 11.1 44.8 44.8 77 Qalqiliya 37.0 34.8 0.0 0.0 0.0 0.0 46.9 41.3 8 Salfit 0.0 58.7 0.0 0.0 0.0 0.0 58.7 41.3 6 Ramallah & Al-Bireh 19.0 36.6 0.0 2.4 0.0 3.4 55.9 40.7 54 Jericho and Al Aghwar 29.2 31.9 0.0 15.7 0.0 0.0 76.8 23.2 13 Jerusalem 4.1 7.6 2.6 3.0 35.9 2.1 51.6 46.8 77 Bethlehem 11.1 33.1 1.6 6.0 0.0 1.6 48.6 47.9 58 Hebron 17.5 30.1 1.7 2.5 0.0 6.8 49.8 43.6 100 North Gaza 36.0 4.7 1.3 16.3 0.0 0.0 54.8 41.6 88 Gaza 31.6 16.6 2.5 12.0 0.0 2.6 53.5 38.1 136 Deir El- Balah 29.3 27.5 0.0 25.4 0.0 0.0 60.6 31.1 49 Khan Yunis 21.1 11.9 2.7 13.7 0.0 4.7 45.2 48.7 72 Rafah 19.1 19.5 2.1 24.8 0.0 6.7 55.4 34.0 57 Area Urban 23.5 21.0 2.0 7.6 3.8 3.2 52.2 41.8 649 Rural 18.7 37.6 0.0 5.1 0.0 6.1 55.8 36.3 141 camp 11.0 16.8 0.0 31.9 3.4 3.8 53.5 41.6 90 Age in months 0-11 23.1 22.5 3.2 8.3 1.1 3.2 54.1 41.2 227 23-Dec 23.2 24.4 0.8 11.1 4.7 4.8 56.1 37.3 273 24-35 18.9 22.2 0.5 9.9 1.9 2.8 47.5 46.5 166 36-47 20.6 22.9 0.8 8.1 4.7 3.2 50.9 41.8 118 48-59 18.2 24.1 1.8 10.5 3.7 4.3 52.4 39.8 96 Mother’s education None 0.0 46.0 0.0 26.0 0.0 0.0 72.0 28.0 4 Basic 25.2 17.3 2.4 12.9 4.0 3.6 55.8 38.1 258 Secondary 20.9 21.8 1.0 8.5 3.7 3.5 49.9 42.9 301 Higher 19.2 29.1 1.2 8.0 1.9 4.1 53.2 41.5 317 Wealth index quintile Poorest 29.5 11.2 2.2 18.3 0.0 2.9 50.9 40.3 244 Second 26.4 15.6 0.6 13.8 0.0 4.1 51.2 44.4 154 Middle 25.5 24.7 1.2 6.0 1.5 5.5 55.1 38.1 183 Fourth 14.5 37.2 1.1 3.3 5.1 2.0 54.9 39.6 174 Richest 3.3 34.6 2.0 2.1 12.8 4.5 52.7 44.0 125 [1] MICS indicator 3.10 - Care-seeking for diarrhoea [a] Includes all public and private health facilities and providers, but excludes private pharmacy (*) Figures that are based on less than 25 unweighted cases 63 56 Table CH.5 presents the percentage of children under 5 years of age who were reported to have had an episode of diarrhoea during the 2 weeks preceding the survey. Of these children, 52 percent were taken to an appropriate provider (40 percent, males; 42 percent, females), the percentage was better in the West Bank 42 percent compared to 39 percent in Gaza Strip, while it was 54 percent for Camps children compared to 56 percent in rural and 52 percent in urban areas. 64 Palestinian Multiple Indicator Cluster Survey 2014 56 Table CH.5 presents the percentage of children under 5 years of age who were reported to have had an episode of diarrhoea during the 2 weeks preceding the survey. Of these children, 52 percent were taken to an appropriate provider (40 percent, males; 42 percent, females), the percentage was better in the West Bank 42 percent compared to 39 percent in Gaza Strip, while it was 54 percent for Camps children compared to 56 percent in rural and 52 percent in urban areas. 57 Ta bl e C H .6 : F ee di ng p ra ct ic es d ur in g di ar rh oe a P er ce nt d is tri bu tio n of c hi ld re n ag e 0- 59 m on th s w ith d ia rr ho ea in th e la st tw o w ee ks b y am ou nt o f l iq ui ds a nd fo od g iv en d ur in g ep is od e of d ia rr ho ea , P al es tin e, 2 01 4 D rin ki ng p ra ct ic es d ur in g di ar rh oe a: Ea tin g pr ac tic es d ur in g di ar rh oe a: N um be r o f ch ild re n ag ed 0 -5 9 m on th s w ith di ar rh oe a C hi ld w as g iv en to d rin k: C hi ld w as g iv en to e at : M uc h le ss S om ew ha t l es s A bo ut th e sa m e M or e N ot hi ng M is si ng /D K To ta l M uc h le ss S om e w ha t le ss A bo ut th e sa m e M or e N ot hi ng M is si ng / D K To ta l To ta l 7. 5 11 .9 38 .5 39 .4 2. 4 0. 3 10 0. 0 16 .2 31 .5 30 .8 9. 6 11 .6 0. 3 10 0. 0 88 0 R eg io n W es t B an k 8. 2 10 .0 39 .4 39 .7 2. 1 0. 6 10 0. 0 16 .1 29 .9 32 .9 10 .4 10 .0 0. 6 10 0. 0 47 8 G az a S tri p 6. 6 14 .2 37 .4 39 .0 2. 8 0. 0 10 0. 0 16 .2 33 .4 28 .3 8. 7 13 .5 0. 0 10 0. 0 40 2 Se x M al e 7. 8 11 .5 40 .1 38 .2 2. 1 0. 2 10 0. 0 14 .9 30 .7 33 .2 7. 8 13 .0 0. 4 10 0. 0 49 4 Fe m al e 7. 0 12 .4 36 .5 40 .8 2. 7 0. 5 10 0. 0 17 .8 32 .5 27 .8 11 .9 9. 7 0. 3 10 0. 0 38 6 G ov er no ra te Je ni n 3. 2 14 .0 32 .6 43 .2 5. 1 1. 9 10 0. 0 24 .9 27 .7 24 .3 3. 5 19 .5 0. 0 10 0. 0 54 Tu ba s (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 11 Tu lk ar m (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 21 N ab lu s 11 .7 5. 3 53 .5 29 .5 0. 0 0. 0 10 0. 0 14 .2 32 .8 37 .9 5. 4 9. 8 0. 0 10 0. 0 77 Q al qi liy a (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 8 S al fit (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 6 R am al la h & A l- B ire h 17 .8 10 .0 39 .5 32 .7 0. 0 0. 0 10 0. 0 25 .9 11 .1 35 .0 13 .0 15 .0 0. 0 10 0. 0 54 Je ric ho a nd A l A gh w ar (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 13 Je ru sa le m 12 .7 10 .8 38 .3 36 .9 0. 0 1. 3 10 0. 0 16 .0 39 .3 32 .5 7. 7 3. 4 1. 3 10 0. 0 77 B et hl eh em 1. 6 3. 1 54 .2 41 .1 0. 0 0. 0 10 0. 0 4. 8 26 .5 49 .7 19 .0 0. 0 0. 0 10 0. 0 58 H eb ro n 4. 5 10 .9 32 .2 46 .7 4. 8 1. 0 10 0. 0 15 .0 30 .6 26 .2 15 .3 11 .9 1. 0 10 0. 0 10 0 N or th G az a 4. 8 17 .4 35 .5 39 .9 2. 4 0. 0 10 0. 0 21 .9 28 .7 24 .8 8. 0 16 .6 0. 0 10 0. 0 88 G az a 8. 8 14 .7 35 .2 39 .9 1. 5 0. 0 10 0. 0 13 .5 39 .9 20 .5 12 .4 13 .7 0. 0 10 0. 0 13 6 D ei r E l-B al ah (4 .6 ) (1 1. 0) (3 6. 9) (4 5. 0) (2 .6 ) (0 .0 ) (1 00 .0 ) (2 1. 6) (2 0. 9) (3 6. 8) (3 .8 ) (1 6. 8) (0 .0 ) (1 00 .0 ) 49 K ha n Y un is 5. 7 10 .4 54 .3 29 .6 0. 0 0. 0 10 0. 0 14 .2 27 .9 39 .2 8. 7 10 .0 0. 0 10 0. 0 72 R af ah 7. 0 15 .6 25 .3 42 .1 10 .1 0. 0 10 0. 0 11 .6 42 .6 31 .3 4. 8 9. 7 0. 0 10 0. 0 57 ( ) F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s (* ) F ig ur es th at a re b as ed o n le ss th an 2 5 un w ei gh te d ca se s 65 58 Ta bl e C H .6 C on tin ue d: F ee di ng p ra ct ic es d ur in g di ar rh ea P er ce nt d is tri bu tio n of c hi ld re n ag e 0- 59 m on th s w ith d ia rr ho ea in th e la st tw o w ee ks b y am ou nt o f l iq ui ds a nd fo od g iv en d ur in g ep is od e of d ia rr ho ea , P al es tin e, 2 01 4 D rin ki ng p ra ct ic es d ur in g di ar rh oe a: Ea tin g pr ac tic es d ur in g di ar rh oe a: N um be r o f ch ild re n ag ed 0 -5 9 m on th s w ith di ar rh oe a C hi ld w as g iv en to d rin k: C hi ld w as g iv en to e at : M uc h le ss S om ew ha t l es s A bo ut th e sa m e M or e N ot hi ng M is si ng /D K To ta l M uc h le ss S om e w ha t le ss A bo ut th e sa m e M or e N ot hi n g M is si n g/ D K To ta l A re a U rb an 6. 3 12 .3 37 .6 40 .8 2. 6 0. 3 10 0. 0 15 .9 31 .7 30 .9 10 .0 11 .2 0. 3 10 0. 0 64 9 R ur al 11 .2 11 .2 40 .5 35 .7 0. 8 0. 7 10 0. 0 17 .2 31 .2 33 .0 7. 1 10 .8 0. 6 10 0. 0 14 1 ca m p 9. 8 10 .0 41 .9 35 .0 3. 3 0. 0 10 0. 0 16 .3 30 .5 27 .2 10 .8 15 .1 0. 0 10 0. 0 90 A ge in m on th s 0- 11 6. 1 18 .3 41 .8 27 .1 6. 7 0. 0 10 0. 0 7. 3 25 .7 29 .2 10 .2 27 .6 0. 0 10 0. 0 22 7 12 -2 3 6. 4 10 .2 36 .2 46 .1 0. 8 0. 4 10 0. 0 20 .9 31 .2 28 .7 9. 5 9. 0 0. 7 10 0. 0 27 3 24 -3 5 9. 4 10 .0 41 .7 38 .9 0. 0 0. 0 10 0. 0 17 .9 37 .2 35 .3 5. 3 4. 4 0. 0 10 0. 0 16 6 36 -4 7 11 .7 7. 9 34 .4 42 .7 2. 3 0. 8 10 0. 0 22 .7 34 .6 27 .4 11 .8 3. 4 0. 0 10 0. 0 11 8 48 -5 9 5. 2 9. 9 36 .8 45 .9 1. 1 1. 0 10 0. 0 12 .6 32 .2 37 .2 13 .4 3. 5 1. 0 10 0. 0 96 M ot he r’s ed uc at io n N on e (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 4 B as ic 7. 5 15 .6 38 .8 35 .0 2. 3 0. 8 10 0. 0 18 .1 31 .4 31 .7 6. 5 11 .8 0. 4 10 0. 0 25 8 S ec on da ry 7. 5 12 .0 37 .6 40 .1 2. 6 0. 3 10 0. 0 16 .9 35 .9 26 .3 8. 2 12 .4 0. 3 10 0. 0 30 1 H ig he r 7. 2 8. 9 39 .1 42 .4 2. 4 0. 0 10 0. 0 13 .8 27 .8 34 .2 13 .2 10 .7 0. 3 10 0. 0 31 7 W ea lth in de x qu in til e P oo re st 8. 9 15 .6 38 .9 32 .8 3. 9 0. 0 10 0. 0 16 .0 35 .7 26 .7 7. 4 14 .2 0. 0 10 0. 0 24 4 S ec on d 3. 3 12 .1 32 .6 50 .1 1. 9 0. 0 10 0. 0 14 .4 29 .3 30 .3 12 .6 13 .5 0. 0 10 0. 0 15 4 M id dl e 4. 9 11 .2 36 .6 42 .5 3. 8 1. 1 10 0. 0 14 .5 32 .1 31 .9 10 .3 10 .6 0. 6 10 0. 0 18 3 Fo ur th 12 .2 9. 1 42 .1 35 .5 0. 5 0. 6 10 0. 0 18 .3 28 .7 33 .3 7. 1 11 .6 1. 1 10 0. 0 17 4 R ic he st 7. 0 9. 5 43 .0 39 .6 0. 9 0. 0 10 0. 0 18 .1 29 .2 34 .7 12 .8 5. 3 0. 0 10 0. 0 12 5 ( ) F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s (* ) F ig ur es th at a re b as ed o n le ss th an 2 5 un w ei gh te d ca se s 66 Palestinian Multiple Indicator Cluster Survey 2014 59 Table CH.6 provides statistics on drinking and feeding practices during diarrhoea. About 39 percent of under-five children with diarrhoea given more than usual while 60 percent drank the same or less. About 63 percent were given somewhat less, same or more (continued feeding), but 28 percent were given much less or almost nothing. Table CH.7: Oral rehydration solutions Percentage of children age 0-59 months with diarrhoea in the last two weeks and treatment with oral rehydration salts (ORS), Palestine, 2014 Percentage of children with diarrhoea who received: Number of children aged 0-59 months with diarrhoea Oral rehydration salts (ORS) Fluid from packet Pre-packaged fluid Any ORS [1] Total 21.8 12.1 31.5 880 Region West Bank 25.8 12.8 35.8 478 Gaza Strip 17.0 11.4 26.5 402 Sex Male 22.8 11.2 31.4 494 Female 20.5 13.4 31.7 386 Governorate Jenin 18.4 7.3 25.7 54 Tubas (*) (*) (*) 11 Tulkarm (*) (*) (*) 21 Nablus 29.6 8.8 38.5 77 Qalqiliya (*) (*) (*) 8 Salfit (*) (*) (*) 6 Ramallah & Al-Bireh 21.2 19.3 34.1 54 Jericho and Al Aghwar (*) (*) (*) 13 Jerusalem 26.2 8.0 31.7 77 Bethlehem 24.1 11.6 35.7 58 Hebron 26.6 17.9 38.3 100 North Gaza 19.6 12.2 31.8 88 Gaza 19.0 16.4 33.5 136 Deir El-Balah (20.3) (4.1) (20.3) 49 Khan Yunis 7.7 7.0 13.3 72 Rafah 17.2 9.7 23.5 57 Area Urban 20.6 12.2 30.3 649 Rural 24.6 11.1 34.0 141 camp 25.7 13.3 36.5 90 Age in months 0-11 19.9 10.6 27.8 227 12-23 28.5 14.3 39.2 273 24-35 19.9 13.6 30.8 166 36-47 16.6 10.9 27.5 118 48-59 17.0 8.7 24.9 96 Wealth index quintile Poorest 15.1 9.9 23.4 244 Second 20.9 15.4 33.1 154 Middle 28.8 10.2 35.8 183 Fourth 24.5 15.9 37.3 174 Richest 21.8 9.9 31.1 125 [1] MICS indicator 3.S1 - Diarrhoea treatment with oral rehydration salts (ORS) ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 67 60 Table CH.7 shows the percentage of children receiving ORS during the episode of diarrhoea. Since children may have been given more than one type of liquid, the percentages do not necessarily add to 100. About one-third of children with diarrhoea in the last two weeks received fluids from ORS packets (22 percent) or pre-packaged ORS fluids (12 percent). Children with diarrhoea who received any ORS was higher in the West Bank (36 percent) compared to 27 percent in Gaza Strip. Also the results showed differences between children living in Camps, urban and rural areas, where it was 37 percent of children living in Camps compared to 30 percent in urban and 34 percent in rural areas. Meanwhile children with diarrhoea in Khan Yunis governorate were less likely to receive any ORS (13 percent) than the other governorates, and children with diarrhoea in Nablus governorate were the most likely to receive ORS (39 percent). Figure CH.2: Chi ldren under-5 with diarrhoea who received ORS, Palest ine, 2014 68 Palestinian Multiple Indicator Cluster Survey 2014 61 Table CH.8: Oral rehydration therapy with continued feeding and other treatments Percentage of children age 0-59 months with diarrhoea in the last two weeks who were given oral rehydration therapy with continued feeding and percentage who were given other treatments, Palestine, 2014 Children with diarrhoea who were given: Not given any treatm ent or drug Number of children age 0- 59 months with diarrhoe a in the last two weeks O R S or increased fluids O R T w ith continued feeding [1] Other treatment: P ill or syrup: A ntibiotic P ill or syrup: A ntim otility P ill or syrup: U nknow n Injection: A ntibiotic Injection: U nknow n Intravenous H om e rem edy, herbal m edicine O ther Total 55.7 38.2 19.0 14.1 2.1 2.1 0.7 0.8 28.7 8.1 19.2 880 Region West Bank 58.4 41.4 12.9 8.6 2.2 2.3 0.2 0.7 34.8 8.7 18.5 478 Gaza Strip 52.5 34.5 26.3 20.6 2.0 1.8 1.3 0.9 21.3 7.4 20.0 402 Sex Male 55.2 37.8 21.1 13.5 2.4 1.5 1.0 0.9 28.6 7.8 21.0 494 Female 56.3 38.8 16.3 14.8 1.8 2.7 0.3 0.7 28.7 8.6 16.9 386 Governorate Jenin 52.1 27.5 23.8 7.0 1.7 1.8 1.8 4.3 23.4 7.0 22.0 54 Tubas (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 11 Tulkarm (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 21 Nablus 52.8 34.8 9.1 5.7 0.0 1.3 0.0 0.0 35.0 18. 0 20.8 77 Qalqiliya (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 8 Salfit (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 6 Ramallah & Al-Bireh 53.9 28.2 7.3 12.1 8.6 0.0 0.0 0.0 33.2 5.1 16.3 54 Jericho and Al Aghwar (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 13 Jerusalem 52.2 40.5 4.7 10.2 1.3 1.3 0.0 0.0 35.5 12. 4 24.4 77 Bethlehem 65.0 60.3 13.2 14.0 2.7 0.0 0.0 0.0 30.2 6.1 17.2 58 Hebron 64.0 46.1 13.3 5.0 1.3 4.8 0.0 1.0 47.7 7.5 15.0 100 North Gaza 57.8 33.8 15.8 26.5 3.8 2.0 0.0 1.0 21.6 8.9 24.9 88 Gaza 56.2 36.8 22.5 15.0 0.0 2.0 1.6 0.0 22.1 4.1 18.1 136 Deir El-Balah (58.7 ) (38.0) (41.6) (17.3) (4.1) (0.0) (1.7) (2.0) (28.0) (27 .4) (10.7) 49 Khan Yunis 36.4 22.4 22.0 18.5 1.2 2.7 3.0 2.7 15.8 4.4 30.8 72 Rafah 49.7 41.8 43.4 30.1 3.3 1.4 0.0 0.0 20.1 0.0 11.6 57 [1] MICS indicator 3.12 - Diarrhoea treatment with oral rehydration therapy (ORT) and continued feeding 69 62 Table CH.8 Continued: Oral rehydration therapy with continued feeding and other treatments Percentage of children age 0-59 months with diarrhoea in the last two weeks who were given oral rehydration therapy with continued feeding and percentage who were given other treatments, Palestine, 2014 Children with diarrhoea who were given: N ot given any treatm ent or drug Number of children age 0-59 months with diarrhoea in the last two weeks O R S or increased fluids O R T w ith continued feeding [1] Other treatment: P ill or syrup: A ntibiotic P ill or syrup: A ntim otility P ill or syrup: U nknow n Injection: A ntibiotic Injection: U nknow n Intravenous H om e rem edy, herbal m edicine O ther Area Urban 55.8 38.2 20.0 14.9 2.6 1.8 0.9 0.7 29.9 7.5 19.5 649 Rural 56.7 39.2 14.8 9.7 0.0 3.3 0.0 0.6 32.9 10.6 16.8 141 camp 52.8 37.1 18.9 15.2 2.0 2.0 0.0 1.7 12.9 8.5 20.5 90 Age in months 0-11 45.0 28.9 18.9 12.5 3.3 1.3 0.4 0.7 21.3 5.0 26.6 227 12-23 62.7 40.2 17.2 16.1 1.9 1.1 0.4 1.4 31.1 7.3 15.8 273 24-35 55.8 40.9 16.2 10.8 1.0 2.7 0.7 0.0 28.4 14.5 21.3 166 36-47 55.2 39.3 23.4 19.5 0.9 1.9 0.7 0.8 32.9 8.2 14.1 118 48-59 61.2 48.5 23.8 11.2 3.3 5.5 2.1 0.9 34.0 6.8 14.0 96 Wealth index quintile Poorest 45.7 28.6 25.6 23.3 2.4 0.9 0.5 0.8 23.0 6.2 23.6 244 Second 64.6 46.2 25.1 14.5 2.0 2.7 2.6 1.2 21.6 6.3 14.2 154 Middle 60.4 45.3 17.8 11.0 1.3 3.3 0.0 1.3 26.4 8.7 17.2 183 Fourth 54.7 33.9 12.9 7.8 3.8 1.1 0.6 0.5 39.5 9.8 19.3 174 Richest 58.5 42.7 9.1 8.8 0.6 3.1 0.0 0.0 36.4 10.9 19.8 125 [1] MICS indicator 3.12 - Diarrhoea treatment with oral rehydration therapy (ORT) and continued feeding 70 Palestinian Multiple Indicator Cluster Survey 2014 62 Table CH.8 Continued: Oral rehydration therapy with continued feeding and other treatments Percentage of children age 0-59 months with diarrhoea in the last two weeks who were given oral rehydration therapy with continued feeding and percentage who were given other treatments, Palestine, 2014 Children with diarrhoea who were given: N ot given any treatm ent or drug Number of children age 0-59 months with diarrhoea in the last two weeks O R S or increased fluids O R T w ith continued feeding [1] Other treatment: P ill or syrup: A ntibiotic P ill or syrup: A ntim otility P ill or syrup: U nknow n Injection: A ntibiotic Injection: U nknow n Intravenous H om e rem edy, herbal m edicine O ther Area Urban 55.8 38.2 20.0 14.9 2.6 1.8 0.9 0.7 29.9 7.5 19.5 649 Rural 56.7 39.2 14.8 9.7 0.0 3.3 0.0 0.6 32.9 10.6 16.8 141 camp 52.8 37.1 18.9 15.2 2.0 2.0 0.0 1.7 12.9 8.5 20.5 90 Age in months 0-11 45.0 28.9 18.9 12.5 3.3 1.3 0.4 0.7 21.3 5.0 26.6 227 12-23 62.7 40.2 17.2 16.1 1.9 1.1 0.4 1.4 31.1 7.3 15.8 273 24-35 55.8 40.9 16.2 10.8 1.0 2.7 0.7 0.0 28.4 14.5 21.3 166 36-47 55.2 39.3 23.4 19.5 0.9 1.9 0.7 0.8 32.9 8.2 14.1 118 48-59 61.2 48.5 23.8 11.2 3.3 5.5 2.1 0.9 34.0 6.8 14.0 96 Wealth index quintile Poorest 45.7 28.6 25.6 23.3 2.4 0.9 0.5 0.8 23.0 6.2 23.6 244 Second 64.6 46.2 25.1 14.5 2.0 2.7 2.6 1.2 21.6 6.3 14.2 154 Middle 60.4 45.3 17.8 11.0 1.3 3.3 0.0 1.3 26.4 8.7 17.2 183 Fourth 54.7 33.9 12.9 7.8 3.8 1.1 0.6 0.5 39.5 9.8 19.3 174 Richest 58.5 42.7 9.1 8.8 0.6 3.1 0.0 0.0 36.4 10.9 19.8 125 [1] MICS indicator 3.12 - Diarrhoea treatment with oral rehydration therapy (ORT) and continued feeding 63 Table CH.8 provides the proportion of children age 0-59 months with diarrhoea in the last two weeks who received oral rehydration therapy with continued feeding, and the percentage of children with diarrhoea who were given other treatments. Overall, 56 percent of children with diarrhoea given ORS or increased fluids, 38 percent given ORT (ORS or recommended homemade fluids or increased fluids). Combining the information in Table CH.6 with that of Table CH.7 on oral rehydration therapy, it is observed that 38 percent of children given ORT and, at the same time, feeding was continued, as is the recommendation. There are notable differences in the home management of diarrhoea by background characteristics. The figures for ORT and continued feeding range from 22 percent in Khan Yunis to 60 percent in Bethlehem governorate. Table CH.8 also shows the percentage of children having had diarrhoea in the two weeks preceding the survey who were given various forms of treatment, leaving 42 percent of them without any treatment or drug. Generally, it is noted that children in Gaza Strip are more advantaged from treatments as compared to children in the West Bank with 38 percent not given any treatment compared to 45 percent in the West Bank. Figure CH.3: Chi ldren under-5 with diarrhoea who were given oral rehydrat ion therapy (ORT) and continued feeding, Palest ine, 2014 71 64 Table CH.9: Source of ORS Percentage of children age 0-59 months with diarrhoea in the last two weeks who were given ORS, by the source of ORS, Palestine, 2014 P ercentage of children w ho w ere given O R S as treatm ent for diarrhoea: Number of children age 0-59 months with diarrhoea in the last two weeks Percentage of children for whom the source of ORS was: Number of children age 0-59 months who were given ORS as treatment for diarrhoea in the last two weeks Health facilities or providers A health facility or provider [b] P ublic P rivate N G O S U N R W A Israeli O ther D K / M issing Total 31.5 880 26.7 51.1 0.8 17.4 1.6 1.8 0.6 97.6 278 Region West Bank 35.8 478 18.2 65.8 0.0 10.8 2.7 1.6 1.0 97.4 171 Gaza Strip 26.5 402 40.4 27.4 2.1 28.0 0.0 2.1 0.0 97.9 107 Sex Male 31.4 494 26.6 50.7 1.4 17.6 1.3 2.0 0.5 97.6 155 Female 31.7 386 26.8 51.6 0.0 17.1 2.1 1.6 0.8 97.6 122 Area Urban 30.3 649 33.3 49.6 1.1 11.6 2.0 1.5 0.9 97.6 197 Rural 34.0 141 (14.0) (69.3) (0.0) (12.7) (0.0) (4.0) (0.0) (96.0) 48 camp 36.5 90 (5.9) (33.6) (0.0) (58.7) (1.9) (0.0) (0.0) (100.0) 33 Age in months 0-11 27.8 227 23.8 53.8 0.0 20.7 0.0 1.7 0.0 98.3 63 12-23 39.2 273 30.4 44.9 2.1 15.6 1.8 3.6 1.6 94.8 107 24-35 30.8 166 23.0 52.3 0.0 21.5 3.1 0.0 0.0 100.0 51 36-47 27.5 118 (24.7) (64.6) (0.0) (10.7) (0.0) (0.0) (0.0) (100.0) 32 48-59 24.9 96 (*) (*) (*) (*) (*) (*) (*) (*) 24 Wealth index quintile Poorest 23.4 244 43.3 21.7 3.9 29.2 0.0 2.0 0.0 98.0 57 Second 33.1 154 39.1 31.6 0.0 27.3 0.0 2.0 0.0 98.0 51 Middle 35.8 183 20.7 58.5 0.0 15.3 1.5 2.9 1.1 96.0 66 Fourth 37.3 174 23.0 67.3 0.0 6.8 1.5 1.4 0.0 98.6 65 Richest 31.1 125 (2.4) (80.2) (0.0) (8.2) (6.6) (0.0) (2.5) (97.5) 39 [a] Includes all public and private health facilities and providers ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases Table CH.9 provides information on the source of ORS for children who benefitted from these treatments. The main source of ORS is the private sector (51 percent). Acute Respiratory Infections Symptoms of ARI are collected during the Palestinian 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 pneumonia.3 While this limitation does not affect the level and patterns of care-seeking for 3  Campbell  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.  PLoS  Med  10(5):   e1001421.  doi:10.1371/journal.pmed.1001421   72 Palestinian Multiple Indicator Cluster Survey 2014 65 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: Care-seeking for and antibiotic treatment of symptoms of acute respiratory infection (ARI) Percentage of children age 0-59 months with symptoms of ARI in the last two weeks for whom advice or treatment was sought, by source of advice or treatment, and percentage of children with symptoms who were given antibiotics, Palestine, 2014 Percentage of children with symptoms of ARI for whom: No advice or treatment sought Percentage of children with symptoms of ARI who were given antibiotics in the last two weeks [2] Number of children age 0-59 months with symptoms of ARI in the last two weeks Advice or treatment was sought from: Other source A health facility or provider [1], [b] Health facilities or providers Public Privat e NGOS UNRWA Israeli Total 29.3 33.4 1.0 18.0 2.7 2.0 76.5 18.1 70.3 836 Region West Bank 25.6 46.9 1.1 7.5 4.9 1.8 78.6 16.4 72.7 461 Gaza Strip 33.8 16.8 0.8 30.9 0.0 2.2 74.0 20.2 67.4 375 Area Urban 33.0 30.6 1.2 16.4 3.3 2.2 77.3 16.8 72.0 615 Rural 19.0 51.7 0.0 10.3 0.0 1.2 73.2 22.6 69.0 143 camp 18.6 21.6 0.9 44.6 3.1 2.0 76.5 20.3 59.4 78 Governorate Jenin (22.2) (56.9) (0.0) (3.9) (0.0) (0.0) (72.0) (21.1) (79.2) 45 Tubas (*) (*) (*) (*) (*) (*) (*) (*) (*) 10 Tulkarm 26.7 62.0 5.8 7.4 0.0 2.1 89.2 8.7 69.9 35 Nablus 21.7 58.5 0.0 6.1 0.0 7.5 78.7 12.1 75.8 56 Qalqiliya (*) (*) (*) (*) (*) (*) (*) (*) (*) 11 Salfit (*) (*) (*) (*) (*) (*) (*) (*) (*) 4 Ramallah & Al-Bireh (16.8) (65.2) (0.0) (2.0) (0.0) (2.0) (76.9) (16.1) (76.7) 43 Jericho and Al Aghwar (*) (*) (*) (*) (*) (*) (*) (*) (*) 11 Jerusalem 19.7 23.1 0.7 5.1 39.5 0.0 86.7 13.3 66.4 58 Bethlehem 17.9 30.6 1.2 19.8 0.0 0.0 66.1 30.5 50.3 75 Hebron 30.2 52.3 1.4 4.6 0.0 2.4 78.7 14.7 80.3 115 North Gaza (34.4) (23.2) (0.0) (21.0) (0.0) (4.3) (70.1) (19.1) (67.2) 46 Gaza 31.7 15.1 1.7 29.2 0.0 3.5 72.5 20.5 62.2 129 Deir El-Balah 30.5 16.3 0.0 43.9 0.0 0.0 74.8 20.0 54.8 60 Khan Yunis 36.0 14.3 1.3 26.6 0.0 0.6 73.1 22.1 65.9 75 Rafah 37.7 18.8 0.0 34.2 0.0 1.9 80.0 18.2 90.7 65 Sex Male 29.5 35.1 0.8 17.5 2.9 2.3 78.7 16.1 69.3 474 Female 28.9 31.2 1.2 18.6 2.5 1.6 73.7 20.6 71.6 363 Age in months 0-11 30.5 38.5 0.6 16.2 3.6 1.6 83.5 14.0 72.8 165 12-23 31.8 29.0 0.2 20.0 2.6 2.9 76.2 18.2 70.2 179 24-35 29.5 30.6 1.6 17.0 1.5 2.3 73.1 21.1 74.4 174 36-47 30.5 34.6 1.0 17.6 2.2 .6 76.4 17.2 67.3 152 48-59 24.0 34.9 1.7 18.8 3.8 2.4 73.7 19.7 66.5 166 Wealth index quintile Poorest 39.7 10.0 0.4 34.7 0.0 1.8 77.6 18.2 67.3 222.8 Second 25.9 24.3 1.5 24.0 0.0 2.5 66.5 26.8 66.6 146.0 Middle 24.9 43.2 0.2 11.0 3.6 2.2 76.6 18.0 67.9 189.5 Fourth 31.0 50.3 0.6 6.2 0.6 1.0 80.3 14.0 77.4 176.9 Richest 16.2 49.9 3.7 6.1 14.9 2.9 81.9 12.7 74.6 101.1 [1] MICS indicator 3.13 - Care-seeking for children with acute respiratory infection (ARI) symptoms [2] MICS indicator 3.14 - Antibiotic treatment for children with ARI symptoms [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 less than 25 unweighted cases 73 66 Table CH.10 Continued: Care-seeking for and antibiotic treatment of symptoms of acute respiratory infection (ARI) Percentage of children age 0-59 months with symptoms of ARI in the last two weeks for whom advice or treatment was sought, by source of advice or treatment, and percentage of children with symptoms who were given antibiotics, Palestine, 2014 Percentage of children with symptoms of ARI for whom the source of antibiotics was: Health facilities or providers Other source A health facility or provider [c] Number of children with symptoms of ARI who were given antibiotics in the last two weeks Public Private NGOs UNRWA Israeli Total 24.3 53.0 0.9 18.7 0.9 2.2 97.8 588 Region West Bank 22.2 68.5 0.7 6.5 1.5 0.6 99.4 335 Gaza Strip 27.0 32.4 1.2 35.0 0.0 4.4 95.6 252 Area Urban 27.1 50.1 0.9 18.4 1.0 2.5 97.5 443 Rural 16.7 71.8 1.1 8.5 0.8 1.0 99.0 99 camp (13.7) (40.0) (0.6) (43.8) (0.0) (2.0) (98.0) 46 Governorate Jenin (13.4) (78.8) (0.0) (4.9) (0.0) (2.9) (97.1) 36 Tubas (*) (*) (*) (*) (*) (*) (*) 7 Tulkarm (*) (*) (*) (*) (*) (*) (*) 24 Nablus (15.0) (76.1) (2.5) (4.2) (0.0) (2.2) (97.8) 43 Qalqiliya (*) (*) (*) (*) (*) (*) (*) 10 Salfit (*) (*) (*) (*) (*) (*) (*) 4 Ramallah & Al- Bireh (2.6) (94.8) (0.0) (2.6) (0.0) (0.0) (100.0) 33 Jericho and Al Aghwar (*) (*) (*) (*) (*) (*) (*) 11 Jerusalem (14.2) (68.8) (0.0) (3.4) (13.6) (0.0) (100.0) 38 Bethlehem (14.6) (63.8) (0.0) (21.6) (0.0) (0.0) (100.0) 38 Hebron 31.8 63.8 0.0 4.3 0.0 0.0 100.0 92 North Gaza (40.7) (38.9) (0.0) (16.5) (0.0) (3.8) (96.2) 31 Gaza 34.3 31.1 1.2 31.8 0.0 1.5 98.5 80 Deir El-Balah (21.6) (31.4) (0.0) (43.8) (0.0) (3.2) (96.8) 33 Khan Yunis 19.7 35.4 1.9 38.9 0.0 4.0 96.0 50 Rafah 18.9 28.5 2.0 40.9 0.0 9.7 90.3 59 Sex Male 25.9 52.3 0.6 18.6 0.3 2.4 97.6 328 Female 22.2 53.8 1.3 18.9 1.6 2.1 97.9 260 Age 0-11 19.5 64.7 1.8 14.0 0.0 0.0 100.0 120 12-23 25.3 45.3 0.2 24.2 2.2 2.7 97.3 126 24-35 23.6 51.2 0.8 20.0 0.0 4.5 95.5 130 36-47 30.5 48.6 1.0 17.1 1.0 1.8 98.2 102 48-59 23.4 55.0 1.0 17.6 1.3 1.8 98.2 111 Wealth index quintile Poorest 32.8 24.3 0.6 36.9 0.0 5.3 94.7 154 Second 25.7 42.6 2.3 27.5 0.0 1.9 98.1 95 Middle 25.3 58.4 0.8 12.8 1.3 1.4 98.6 141 Fourth 19.4 70.6 1.1 7.2 0.9 0.9 99.1 116 Richest 11.7 84.5 0.0 0.8 2.9 0.0 100.0 82 [c] Includes all public and private health facilities and providers ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 74 Palestinian Multiple Indicator Cluster Survey 2014 67 Table CH.10 presents the percentage of children with symptoms of ARI in the two weeks preceding the survey for whom care was sought, by source of care and the percentage who received antibiotics. 77 percent of children age 0-59 months with symptoms of ARI were taken to a qualified provider. (79 percent, males; 74 percent, females), the percentage was higher in the West Bank; 79 percent compared to 74 percent in Gaza Strip, while it was 73 percent for rural children compared to 77 percent in camps and urban areas. The data also shows that 33 percent of children were taken to private health facilities and 29 percent to governmental health facilities. Table CH.10 also presents the use of antibiotics for the treatment of children under 5 years with symptoms of ARI by sex, age, region, area, age, and socioeconomic factors. In Palestine, 70 percent of under-5 children with symptoms of ARI received antibiotics during the two weeks prior to the survey. The percentage was considerably higher in urban (72 percent) than in camps and rural areas, and ranges from 50 percent in Bethlehem governorate to 91 percent in Rafah. Table CH.10 also shows the point of treatment among children with symptoms of ARI who were treated with antibiotics. The treatment was received mostly from private health facilities (53 percent) followed by governmental health facilities with 24 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, shown in Table CH.12. Data in Table CH.12 shows that solid fuel use is uncommon in Palestine, only about 2 percent of households uses it, where 97 percent of all households are using Liquefied Petroleum Gas (LPG). Solid fuel use by place of cooking is depicted in Table CH.13. The presence and extent of indoor pollution are dependent on cooking practices, places used for cooking, as well as types of fuel used According to the Palestinian MICS, 10 percent of households cook in a separate room used as a kitchen. The percentage of households that cook within the dwelling unit is higher in urban (78 percent) than in rural areas (19 percent) and Camps (74 percent). 75 68 Table CH.12: Solid fuel use Percent distribution of household members according to type of cooking fuel mainly used by the household, and percentage of household members living in households using solid fuels for cooking, Palestine, 2014 Percentage of household members in households using: Solid fuels for cooking [1] Number of household members Electricity Liquefied Petroleum Gas Kerosene Solid fuels: Wood Solid fuels: Straw / Shrubs / Grass No food cooked in household Other Missing Total Total 1.3 96.6 0.1 1.4 0.4 0.1 0.0 0.0 100.0 1.8 56366 Region West Bank 0.7 98.5 0.1 0.5 0.0 0.1 0.0 0.1 100.0 0.5 33337 Gaza Strip 2.0 94.0 0.1 2.7 1.0 0.1 0.1 0.0 100.0 3.7 23029 Governorate Jenin 0.2 99.6 0.0 0.0 0.1 0.1 0.0 0.0 100.0 0.1 3777 Tubas 0.2 99.8 0.0 0.0 0.0 0.0 0.0 0.0 100.0 0.0 671 Tulkarm 0.9 98.4 0.0 0.5 0.0 0.2 0.0 0.0 100.0 0.5 2081 Nablus 0.2 99.5 0.0 0.1 0.2 0.0 0.0 0.0 100.0 0.2 4486 Qalqiliya 1.4 98.5 0.0 0.0 0.0 0.2 0.0 0.0 100.0 0.0 1175 Salfit 3.7 96.3 0.0 0.0 0.0 0.0 0.0 0.0 100.0 0.0 876 Ramallah & Al- Bireh 0.6 99.2 0.0 0.0 0.0 0.2 0.0 0.0 100.0 0.0 3744 Jericho and Al Aghwar 1.0 95.7 0.0 3.3 0.0 0.0 0.0 0.0 100.0 3.3 658 Jerusalem 0.5 99.1 0.2 0.0 0.0 0.0 0.0 0.2 100.0 0.0 5119 Bethlehem 0.4 98.1 0.0 1.2 0.0 0.3 0.0 0.0 100.0 1.2 2640 Hebron 1.1 97.2 0.2 1.1 0.0 0.3 0.0 0.1 100.0 1.1 8110 North Gaza 5.4 89.7 0.0 3.6 0.7 0.1 0.5 0.0 100.0 4.3 4307 Gaza 1.9 94.7 0.2 2.3 0.7 0.2 0.0 0.0 100.0 3.1 8334 Deir El-Balah 1.5 93.3 0.0 4.1 1.0 0.1 0.0 0.0 100.0 5.1 3431 Khan Yunis 0.6 95.7 0.0 1.2 2.3 0.2 0.0 0.0 100.0 3.5 4294 Rafah 0.0 96.6 0.0 2.8 0.6 0.1 0.0 0.0 100.0 3.3 2664 Area Urban 1.1 96.7 0.1 1.3 0.5 0.1 0.1 0.0 100.0 1.8 41978 Rural 1.0 96.7 0.0 1.7 0.4 0.1 0.0 0.0 100.0 2.2 9440 Camp 2.7 96.0 0.0 1.1 0.0 0.2 0.0 0.0 100.0 1.1 4948 Education of household head None 2.4 89.8 0.5 4.1 1.7 1.5 0.0 0.0 100.0 5.8 1761 Basic 1.3 96.1 0.1 1.8 0.5 0.1 0.1 0.0 100.0 2.3 25318 Secondary 1.3 96.8 0.1 1.4 0.3 0.0 0.0 0.1 100.0 1.7 14756 Higher 0.9 98.3 0.0 0.4 0.3 0.1 0.0 0.1 100.0 0.7 14518 Missing/DK (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 13 Wealth index quintile Poorest 3.8 88.3 0.1 5.4 2.0 0.3 0.1 0.0 100.0 7.4 11276 Second 0.9 97.3 0.0 1.2 0.2 0.2 0.1 0.0 100.0 1.4 11272 Middle 1.2 98.4 0.1 0.2 0.0 0.1 0.0 0.1 100.0 0.2 11270 Fourth 0.3 99.4 0.1 0.1 0.0 0.0 0.0 0.0 100.0 0.1 11278 Richest 0.1 99.8 0.0 0.0 0.0 0.0 0.0 0.1 100.0 0.0 11271 [1] MICS indicator 3.15 - Use of solid fuels for cooking (*) Figures that are based on less than 25 unweighted cases 76 Palestinian Multiple Indicator Cluster Survey 2014 69 Table CH.13: Solid fuel use by place of cooking Percent distribution of household members in households using solid fuels by place of cooking, Palestine, 2014 Place of cooking: Number of household members in households using solid fuels for cooking In the house: In a separate room used as kitchen In the house: Elsewhere in the house In a separate building Outdoors Other place Missing Total Total 9.7 56.3 9.1 23.0 1.0 1.0 100.0 1026 Region West Bank 14.4 15.5 15.2 48.9 0.0 5.9 100.0 171 Gaza Strip 8.7 64.4 7.8 17.8 1.2 0.0 100.0 855 Governorate Jenin (*) (*) (*) (*) (*) (*) (*) 4 Tulkarm (*) (*) (*) (*) (*) (*) (*) 11 Nablus (*) (*) (*) (*) (*) (*) (*) 11 Jericho and Al Aghwar (*) (*) (*) (*) (*) (*) (*) 22 Bethlehem (2.9) (53.0) (0.0) (44.0) (0.0) (0.0) (100.0) 32 Hebron 21.3 10.7 14.3 47.3 0.0 6.4 100.0 91 North Gaza 9.2 85.5 0.0 0.0 5.3 0.0 100.0 185 Gaza 2.7 70.7 17.4 9.3 0.0 0.0 100.0 259 Deir El-Balah 15.7 34.7 5.9 43.6 0.0 0.0 100.0 172 Khan Yunis 6.0 53.2 7.7 33.1 0.0 0.0 100.0 152 Rafah 16.8 79.2 0.0 4.0 0.0 0.0 100.0 88 Area Urban 9.9 68.2 4.6 16.0 1.3 0.0 100.0 768 Rural 7.0 11.6 22.8 53.8 0.0 4.9 100.0 205 camp 17.7 56.3 20.7 5.3 0.0 0.0 100.0 53 Education of household head None 20.8 23.9 10.7 40.4 0.0 4.2 100.0 102 Basic 6.8 60.3 10.5 20.7 1.7 0.0 100.0 572 Secondary 15.7 55.4 7.1 19.5 0.0 2.3 100.0 250 Higher 0.0 68.7 4.1 27.2 0.0 0.0 100.0 101 Wealth index quintile Poorest 9.1 59.3 8.3 20.9 1.2 1.2 100.0 832 Second 2.7 53.3 8.3 35.7 0.0 0.0 100.0 157 Middle (*) (*) (*) (*) (*) (*) (*) 23 Fourth (*) (*) (*) (*) (*) (*) (*) 13 Richest (*) (*) (*) (*) (*) (*) (*) 1 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 77 VII. Water and Sanitation 70 VII. Water and Sanitation 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. Inadequate disposal of human excreta and personal hygiene is associated with a range of diseases including diarrhoeal diseases and polio and is an important determinant for stunting. Improved sanitation can reduce diarrheal disease by more than a third1, and can significantly lessen the adverse health impacts of other disorders responsible for death and disease among millions of children in developing countries. The MDG goal (7, C) is to reduce by half, between 1990 and 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation. For more details on water and sanitation and to access some reference documents, please visit the UNICEF child info website2 or the website of the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation3. Use of Improved Water Sources The distribution of the population by main source of drinking water is shown in Table WS.1 and Figure WS.1. 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), tube well/borehole, protected well, protected spring, and rainwater collection. Bottled water is considered as an improved water source only if the household is using an improved water source for handwashing and cooking. 1 CHERG  2010.  Sandy  Cairncross,  Caroline  Hunt,  Sophie  Boisson,  Kristof  Bostoen,  Val  Curtis,  Isaac  CH  Fung,  and   Wolf-­‐Peter  Schmidt    Water,  sanitation  and  hygiene  for  the  prevention  of  diarrhoea.  Int.  J.  Epidemiology.  2010   39:  i193-­‐i205. 2 http://www.childinfo.org/wes.html   3 http:// www.wssinfo.org   80 Palestinian Multiple Indicator Cluster Survey 2014 71 Ta bl e W S. 1: U se o f i m pr ov ed w at er s ou rc es P er ce nt d is tri bu tio n of h ou se ho ld p op ul at io n ac co rd in g to m ai n so ur ce o f d rin ki ng w at er a nd p er ce nt ag e of h ou se ho ld p op ul at io n us in g im pr ov ed d rin ki ng w at er s ou rc es , P al es tin e, 2 01 4 M ai n so ur ce o f d rin ki ng w at er To ta l P er ce nt ag e us in g im pr ov ed so ur ce s of dr in ki ng w at er 1 N um be r o f ho us eh ol d m em be rs Im pr ov ed s ou rc es U ni m pr ov ed s ou rc es Pi pe d w at er Tube-well/ bore- hole Protected well Protected spring Rain-water collection Bottled watera Unprotected well Unprotected spring Tanker truck Cart with tank/ drum Bottled watera Other Into dwelling Into yard/plot Public tap/ stand-pipe To ta l 56 .7 0. 2 0. 2 0. 1 2. 4 0. 1 0. 5 1. 3 0. 0 0. 1 29 .4 8. 8 0. 0 0. 1 10 0. 0 61 .5 56 36 6 R eg io n W es t B an k 88 .9 0. 3 0. 2 0. 2 4. 0 0. 2 0. 9 2. 1 0. 0 0. 1 2. 8 0. 1 0. 1 0. 1 10 0. 0 96 .8 33 33 7 G az a S tri p 10 .1 0. 0 0. 2 0. 1 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 68 .0 21 .5 0. 0 0. 1 10 0. 0 10 .4 23 02 9 G ov er no ra te Je ni n 76 .3 0. 0 1. 1 0. 2 6. 3 0. 6 1. 8 1. 1 0. 0 0. 0 12 .5 0. 2 0. 0 0. 0 10 0. 0 87 .3 37 77 Tu ba s 94 .2 0. 0 0. 0 0. 0 0. 3 0. 0 5. 2 0. 3 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 10 0. 0 10 0. 0 67 1 Tu lk ar m 95 .8 0. 0 0. 2 0. 0 2. 3 0. 6 0. 0 0. 6 0. 0 0. 0 0. 0 0. 0 0. 0 0. 5 10 0. 0 99 .5 20 81 N ab lu s 91 .1 0. 2 0. 0 0. 0 4. 1 0. 0 0. 9 1. 0 0. 1 0. 0 2. 5 0. 0 0. 1 0. 0 10 0. 0 97 .3 44 86 Q al qi liy a 97 .0 0. 0 0. 0 0. 0 1. 8 0. 0 0. 0 1. 2 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 10 0. 0 10 0. 0 11 75 S al fit 99 .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 10 0. 0 10 0. 0 87 6 R am al la h & A l-B ire h 88 .5 0. 0 0. 0 0. 6 1. 2 1. 3 0. 1 7. 0 0. 0 0. 8 0. 4 0. 0 0. 2 0. 0 10 0. 0 98 .7 37 44 Je ric ho 95 .2 0. 2 0. 0 0. 0 0. 0 0. 0 0. 0 2. 0 0. 0 0. 0 1. 8 0. 0 0. 8 0. 0 10 0. 0 97 .4 65 8 Je ru sa le m 94 .4 0. 2 0. 1 0. 0 0. 5 0. 0 0. 0 4. 6 0. 0 0. 0 0. 0 0. 0 0. 0 0. 2 10 0. 0 99 .8 51 19 B et hl eh em 94 .8 0. 0 0. 8 0. 7 0. 9 0. 0 0. 0 2. 3 0. 0 0. 0 0. 3 0. 0 0. 0 0. 2 10 0. 0 99 .5 26 40 H eb ro n 83 .4 0. 9 0. 1 0. 0 9. 2 0. 0 1. 7 0. 3 0. 1 0. 0 4. 0 0. 2 0. 0 0. 0 10 0. 0 95 .7 81 10 N or th G az a 16 .0 0. 1 0. 5 0. 0 0. 0 0. 0 0. 0 0. 2 0. 2 0. 0 68 .9 14 .0 0. 0 0. 1 10 0. 0 16 .8 43 07 G az a 3. 8 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 78 .3 17 .7 0. 0 0. 0 10 0. 0 3. 9 83 34 D ie r E l-B al ah 3. 0 0. 0 0. 2 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 80 .2 16 .6 0. 0 0. 0 10 0. 0 3. 2 34 31 K ha n Y un is 20 .3 0. 0 0. 0 0. 4 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 42 .8 36 .1 0. 0 0. 3 10 0. 0 20 .8 42 94 R af ah 76 .3 0. 0 1. 1 0. 2 6. 3 0. 6 1. 8 1. 1 0. 0 0. 0 58 .9 28 .4 0. 0 0. 0 10 0. 0 12 .6 26 64 1 M IC S in di ca to r 4 .1 ; M D G 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 ld s us in g bo ttl ed w at er a s th e m ai n so ur ce o f d rin ki ng w at er a re c la ss ifi ed in to im pr ov ed o r u ni m pr ov ed d rin ki ng w at er u se rs a cc or di ng to th e w at er s ou rc e us ed fo r o th er p ur po se s su ch a s co ok in g an d ha nd w as hi ng . 81 72 Ta bl e W S. 1 C on tin ue d: U se o f i m pr ov ed w at er s ou rc es P er ce nt d is tri bu tio n of h ou se ho ld p op ul at io n ac co rd in g to m ai n so ur ce o f d rin ki ng w at er a nd p er ce nt ag e of h ou se ho ld p op ul at io n us in g im pr ov ed d rin ki ng w at er s ou rc es , P al es tin e, 2 01 4 M ai n so ur ce o f d rin ki ng w at er To ta l P er ce nt ag e us in g im pr ov ed so ur ce s of dr in ki ng w at er 1 N um be r o f ho us eh ol d m em be rs Im pr ov ed s ou rc es U ni m pr ov ed s ou rc es Pi pe d w at er Tube-well/ bore-hole Pro-tected well Pro-tected spring Rain-water collection Bottled watera Unprotected well Unprotected spring Tanker truck Cart with tank/ drum Bottled watera Other Into dwelling Into yard/plot Public tap/ stand- pipe A re a U rb an 56 .7 0. 6 1. 6 0. 1 1. 8 0. 0 0. 4 1. 4 0. 0 0. 0 32 .4 9. 4 0. 0 0. 1 10 0. 0 58 .1 41 97 8 R ur al 57 .6 0. 0 0. 0 0. 3 6. 2 0. 7 1. 3 0. 9 0. 0 0. 3 9. 7 2. 8 0. 1 0. 1 10 0. 0 86 .9 94 40 C am ps 57 .7 0. 2 0. 2 0. 0 0. 1 0. 0 0. 0 0. 7 0. 0 0. 0 42 .3 15 .3 0. 1 0. 0 10 0. 0 42 .3 49 48 Ed uc at io n of ho us eh ol d he ad N on e 56 .7 0. 6 1. 6 0. 4 4. 8 0. 0 1. 9 0. 4 0. 0 0. 0 22 .7 10 .9 0. 0 0. 0 10 0. 0 66 .4 17 61 P rim ar y 57 .6 0. 2 0. 2 0. 1 2. 6 0. 2 0. 5 0. 7 0. 1 0. 1 28 .3 9. 5 0. 0 0. 0 10 0. 0 62 .0 25 31 8 S ec on da ry 58 .2 0. 2 0. 2 0. 1 2. 1 0. 1 0. 4 1. 5 0. 0 0. 0 28 .7 8. 3 0. 0 0. 1 10 0. 0 62 .9 14 75 6 H ig he r 53 .5 0. 1 0. 1 0. 1 2. 0 0. 2 0. 5 2. 2 0. 0 0. 0 33 .1 8. 1 0. 1 0. 1 10 0. 0 58 .7 14 51 8 M is si ng / D K (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 10 0. 0 (* ) 13 W ea lth in de x qu in til e P oo re st 1. 2 0. 0 0. 4 0. 0 0. 2 0. 0 0. 1 0. 0 0. 0 0. 0 69 .4 28 .5 0. 0 0. 2 10 0. 0 2. 0 11 27 6 S ec on d 14 .2 0. 1 0. 3 0. 2 3. 0 0. 1 0. 7 0. 1 0. 1 0. 1 66 .9 14 .1 0. 0 0. 0 10 0. 0 18 .7 11 27 2 M id dl e 81 .4 0. 3 0. 3 0. 1 5. 4 0. 2 0. 9 0. 3 0. 0 0. 1 9. 4 1. 4 0. 0 0. 1 10 0. 0 89 .0 11 27 0 Fo ur th 93 .6 0. 3 0. 0 0. 1 2. 2 0. 3 0. 6 1. 2 0. 0 0. 1 1. 2 0. 1 0. 1 0. 0 10 0. 0 98 .4 11 27 8 R ic he st 93 .1 0. 1 0. 0 0. 1 1. 1 0. 2 0. 3 4. 7 0. 0 0. 0 0. 3 0. 0 0. 1 0. 0 10 0. 0 99 .6 11 27 1 1 M IC S in di ca to r 4 .1 ; M D G 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 ld s us in g bo ttl ed w at er a s th e m ai n so ur ce o f d rin ki ng w at er a re c la ss ifi ed in to im pr ov ed o r u ni m pr ov ed d rin ki ng w at er u se rs a cc or di ng to th e w at er s ou rc e us ed fo r o th er p ur po se s su ch a s co ok in g an d ha nd w as hi ng . 82 Palestinian Multiple Indicator Cluster Survey 2014 73 Overall, 62 percent of the population living in Palestine is using an improved source of drinking water – 58 percent in urban areas, 87 percent in rural areas and 42 percent in Camps. The situation in Gaza Strip is considerably worse compared with the West Bank where only 10 percent of the population in Gaza Strip gets its drinking water from an improved source, compared to 97 percent in the West Bank. The poorest segment of the population is most disadvantaged where only 2 percent of the population in this category gets its drinking water from an improved source. It should be noted that 68 percent of the population living in Gaza Strip are using tankered water (truck) and 22 percent are using cart with small tank / drum (both are unimproved sources) as their main source for drinking water. Figure WS.1 below shows that 57 percent of population in Palestine has water piped into the dwellings or yard, while 29 percent are using tanker-truck as a source of drinking water. Figure WS.1: Percent distr ibut ion of household members by source of dr inking water , Palest ine, 2014 The source of drinking water varies among geographical regions (Table WS.1). In the West Bank region about 89 percent of the population has water piped into their dwellings or yard, while this percentage is 10 percent in Gaza Strip region. In Palestine about one percent of the population uses bottled water for drinking. Use of in-house water treatment is presented in Table WS.2. Households were asked of ways they may be treating water at home to make it safer to drink – boiling, adding bleach or chlorine, using a water filter, and Strain through a cloth were considered as proper treatment of drinking water. The table shows water treatment by all households and the percentage of household members living in households using unimproved water sources but using appropriate water treatment methods. Only about one percent of Palestinian households; 11 percent in the West Bank and only about one percent in the Gaza Strip use appropriate water treatment methods when they use an unimproved drinking water source. Eighty nine percent of households in Palestine do not use any method for water treatment. About seven percent of households use water filter and about one percent add chlorine. 57.1   3.0   1.3   29.4   8.8   0.3   89.4   5.1   2.1   2.8   0.1   0.4   10.3   0.0   0.1   68.0   21.5   0.2   0.0   10.0   20.0   30.0   40.0   50.0   60.0   70.0   80.0   90.0   100.0   Piped  into   dwelling,    yard  or   plot   Protected  well,   spring,Rainwater   collec?on   BoAled  water   Tanker-­‐truck   Cart  with  small   tank  /  drum   Others   Pales?ne   West  Bank   Gaza  Strip   83 74 Table WS.2: Household water treatment Percentage of household population by drinking water treatment method used in the household, and for household members living in households where an unimproved drinking water source is used, the percentage who are using an appropriate treatment method, Palestine, 2014 Water treatment method used in the household Number of household members Percentage of household members in households using unimproved drinking water sources and using an appropriate water treatment method [1] Number of household members in households using unimproved drinking water sources None Boil Add bleach/ chlorine Strain through a cloth Use water filter Let it stand and settle Total 88.8 1.6 0.5 2.4 6.6 0.1 56366 1.3 21686 Region West Bank 85.5 2.2 0.8 4.0 7.3 0.2 33337 11.0 1051 Gaza Strip 93.6 0.7 0.0 0.1 5.6 0.0 23029 0.8 20635 Governorate Jenin 76.4 4.4 2.0 8.5 9.1 0.3 3777 15.8 480 Tubas 73.0 5.6 0.3 9.0 11.4 0.0 671 na na Tulkarm 70.9 1.6 1.3 13.2 12.7 0.4 2081 (*) 10 Nablus 91.8 1.2 0.4 2.1 4.2 0.1 4486 0.0 120 Qalqiliya 74.7 2.6 0.0 15.8 8.3 0.0 1175 na na Salfit 91.5 2.4 0.0 2.3 3.5 0.0 876 na na Ramallah and Al- Bireh 85.6 2.4 1.1 3.1 7.5 0.2 3744 4.3 50 Jericho & Al- Aghwar 96.0 .4 0.0 2.3 1.3 0.0 658 (*) 17 Jerusalem 78.6 5.2 0.0 1.9 14.5 0.1 5119 (*) 8 Bethlehem 93.3 .8 0.0 2.4 2.1 0.0 2640 (*) 14 Hebron 93.0 .4 1.2 0.9 4.4 0.4 8110 10.6 352 Gaza North 92.7 .3 0.0 0.0 7.0 0.0 4307 0.3 3582 Gaza 96.3 .3 0.1 0.1 3.3 0.0 8334 0.5 8006 Dier El-Balah 97.8 .3 0.0 0.0 1.8 0.0 3431 0.3 3320 Khan Yunis 90.3 1.2 0.0 0.2 8.4 0.0 4294 1.1 3400 Rafah 86.8 2.5 0.0 0.0 10.7 0.0 2664 2.9 2327 Main source of drinking water Improved 82.9 2.2 0.6 3.6 10.5 0.2 34680 na na Unimproved 98.3 0.7 0.3 0.3 0.3 0.0 21686 1.3 21686 Area Urban 89.0 1.6 0.3 1.8 7.1 0.1 41978 1.1 17595 Rural 86.0 1.7 1.3 5.5 5.4 0.3 9440 5.2 1236 Camps 93.0 1.4 0.0 1.1 4.3 0.2 4948 0.8 2855 Education of head of household No education 94.3 1.6 0.4 1.4 2.0 0.0 1761 1.8 591 Basic 91.5 1.4 0.4 2.3 4.3 0.1 25318 0.7 9620 Secondary 87.8 1.4 0.6 2.4 7.6 0.2 14756 1.5 5468 Higher 84.6 2.2 0.4 2.5 10.2 0.1 14518 1.8 6002 Missing/ DK (*) (*) (*) (*) (*) (*) 13 (*) 7 Wealth index quintiles Poorest 99.4 0.6 0.0 0.0 0.0 0.0 11276 0.6 11056 Second 95.8 1.0 0.5 0.8 1.9 0.0 11272 1.5 9160 Third 86.6 1.7 0.9 3.2 7.5 0.2 11270 4.7 1244 Fourth 85.5 2.7 0.4 3.5 7.8 0.1 11278 3.8 182 Richest 76.9 2.2 0.4 4.3 15.8 0.3 11271 (16.1) 48 [1] MICS indicator 4.2 - Water treatment na: not applicable ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 84 Palestinian Multiple Indicator Cluster Survey 2014 75 The amount of time it takes to obtain water is presented in Table WS.3 and the person who usually collected the water in Table WS.4. Note that for Table WS.3, household members using water on premises are also shown in this table and for others, the results refer to one roundtrip from home to drinking water source. Information on the number of trips made in one day was not collected. Table WS.3 shows that for 61 percent of households, the drinking water source is on the premises, in the West Bank region around 97 percent of the population has drinking water source is on their premises, while the coverage is only 10 percent in the Gaza Strip. The availability of water on premises is associated with higher use, better family hygiene and better health outcomes. For a water collection round trip of 30 minutes or more it has been observed that households carry progressively less water and are likely to compromise on the minimal basic drinking water needs of the household.4 The survey found that this was more common when households were using unimproved sources of water. In only one percent of the household population, it takes the household more than 30 minutes to get to the water source and bring water. Thirty six percent of households using an unimproved drinking water source spend less than 30 minutes per round trip. One striking finding is the high percentage of household members in Gaza Strip (87 percent), who live in households using an unimproved source of water are spending less than 30 minutes to go to source of drinking water while the corresponding percentage is one percent in the West Bank region as over 98 percent of households in the West Bank use improved sources and 97 percent have water available on their premises. In rural areas for 86 percent of households, the drinking water source is on the premises, compared to 58 percent in urban areas and 42 percent in Camps. 4  Cairncross,  S  and  Cliff,  JL.  1987.  Water  use  and  Health  in  Mueda,  Mozambique.  Transactions  of  the  Royal  Society  of   Tropical  Medicine  and  Hygiene  81:  51-­‐4. 85 76 Table WS.3: Time to source of drinking water Percent distribution of household population according to time to go to source of drinking water, get water and return, for users of improved and unimproved drinking water sources, Palestine, 2014 Time to source of drinking water Users of improved drinking water sources Users of unimproved drinking water sources Water on premises Less than 30 minutes 30 minutes or more Water on premises Less than 30 minutes 30 minutes or more Don’t know Total Number of household members Total 61.3 0.1 0.0 0.7 36.4 1.2 0.0 100.0 56366 Region West Bank 96.6 0.1 0.1 1.0 1.4 0.7 0.0 100.0 33333 Gaza Strip 10.3 0.1 0.0 0.4 87.2 2.0 0.0 100.0 23034 Governorate Jenin 87.3 0.0 0.0 2.7 7.2 2.8 0.0 100.0 3777 Tubas 100.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 671 Tulkarm 99.5 0.0 0.0 0.2 0.0 0.0 0.3 100.0 2081 Nablus 97.3 0.0 0.0 0.4 1.4 0.9 0.0 100.0 4486 Qalqiliya 99.8 0.2 0.0 0.0 0.0 0.0 0.0 100.0 1175 Salfit 100.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 876 Ramallah & Al- Bireh 97.4 0.8 0.5 0.4 0.2 0.8 0.0 100.0 3744 Jericho 97.4 0.0 0.0 0.0 0.0 2.2 0.4 100.0 658 Jerusalem 99.8 0.0 0.0 0.0 0.0 0.0 0.2 100.0 5119 Bethlehem 99.2 0.0 0.2 0.3 0.2 0.0 0.0 100.0 2640 Hebron 95.5 0.1 0.0 2.2 1.5 0.6 0.0 100.0 8110 North Gaza 16.5 0.3 0.0 0.2 81.2 1.5 0.2 100.0 4307 Gaza 3.9 0.0 0.0 0.2 95.5 0.4 0.0 100.0 8334 Dier El-Balah 3.2 0.0 0.0 0.0 94.5 2.2 0.0 100.0 3431 Khan Yunis 20.4 0.4 0.0 1.4 72.0 5.8 0.0 100.0 4294 Rafah 12.6 0.0 0.0 0.3 85.8 1.2 0.0 100.0 2664 Area Urban 58.0 0.1 0.0 0.6 40.3 1.0 0.0 100.0 41987 Rural 86.2 0.4 0.2 1.6 9.4 2.0 0.1 100.0 9439 Camps 42.3 0.0 0.0 0.2 55.6 1.7 0.2 100.0 4941 Education of household head None 66.0 0.5 0.0 0.8 31.7 0.9 0.1 100.0 1761 Basic 61.8 0.2 0.0 0.9 35.6 1.6 0.0 100.0 25318 Secondary 62.8 0.1 0.0 0.8 35.3 0.9 0.1 100.0 14756 Higher 58.5 0.0 0.1 0.5 39.7 1.0 0.1 100.0 14518 Missing/DK (*) (*) (*) (*) (*) (*) (*) (*) 13 Wealth index quintiles Poorest 1.8 0.1 0.1 0.2 95.4 2.4 0.1 100.0 11276 Second 18.4 0.3 0.0 1.9 76.8 2.5 0.0 100.0 11272 Middle 88.9 0.0 0.0 1.1 9.0 0.8 0.1 100.0 11270 Fourth 98.2 0.2 0.0 0.3 0.9 0.4 0.0 100.0 11278 Richest 99.5 0.0 0.1 0.2 0.2 0.1 0.0 100.0 11271 (*) Figures that are based on less than 25 unweighted cases 86 Palestinian Multiple Indicator Cluster Survey 2014 77 Table WS.4 shows that for the majority of households (82 percent), an adult man is the person usually collecting the water, when the source of drinking water is not on the premises. Adult woman collect water in only 10 percent of cases, while for the rest of the households, female or male children under age 15 collect water (2 percent, 6 percent, respectively). Table WS.4: Person collecting water Percentage of households without drinking water on premises, and percent distribution of households without drinking water on premises according to the person usually collecting drinking water used in the household, Palestine, 2014 Percentage of households without drinking water on premises Number of househo lds Person usually collecting drinking water Number of households without drinking water on premises Adult woman Adult man Female child under age 15 Male child under age 15 Missin g/DK Total Total 34.8 10182 9.6 81.5 1.7 6.4 0.9 100.0 3544 Region West Bank 2.5 6385 14.4 64.6 0.6 1.4 19.0 100.0 157 Gaza Strip 89.2 3797 9.3 82.3 1.8 6.6 0.0 100.0 3387 Area Urban 38.0 7602 9.6 82.8 1.6 5.8 0.2 100.0 2885 Rural 11.4 1740 10.4 71.0 .7 5.4 12.5 100.0 199 Camps 54.7 840 9.1 77.9 2.8 10.2 0.0 100.0 460 Wealth index quintiles Poorest 97.0 1896 10.7 78.2 2.5 8.6 0.1 100.0 1840 Second 76.7 1926 8.8 85.2 1.0 4.2 0.9 100.0 1478 Middle 8.8 2136 4.8 84.8 1.1 1.7 7.6 100.0 188 Fourth 1.4 2162 (7.1) (82.0) (0.0) (8.2) (2.7) 100.0 31 Richest 0.4 2063 (*) (*) (*) (*) (*) 100.0 7 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 87 78 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. The data on the use of improved sanitation facilities in Palestine are provided in this report in Table WS.5. All of the Palestinian population use improved sanitation facilities (Table WS.5). Fifty six percent of the households in Palestine is connected to piped sewer system; 38 percent in West Bank and 82 percent in the Gaza Strip. The lowest proportion of households connected to piped sewer system is in rural areas (only 10 percent) compared to 89 percent in Camps and 62 percent in urban areas. Around 10 percent of households use pit latrines which are considered as improved sanitation facility. Septic tanks are the most common form for waste water disposal in the West Bank and in rural areas. 88 Palestinian Multiple Indicator Cluster Survey 2014 79 Table WS.5: Types of sanitation facilities Percentage distribution of household population according to type of toilet facility used by the household, Palestine, 2014 Type of toilet facility used by the household Improved sanitation facility Unimproved sanitation facility Flush to Connected to elsewhere Other Don’t Know No sanitation facility Total Household members piped sewer system septic tank pit (latrine) unknown place / Not sure / DK where Total 55.7 34.1 9.7 0.1 0.2 0.0 0.1 0.0 100.0 56366 Region West Bank 37.7 46.2 15.4 0.2 0.4 0.0 0.2 0.0 100.0 33337 Gaza Strip 81.9 16.6 1.6 0.0 0.0 0.0 0.0 0.0 100.0 23029 Governorate Jenin 5.6 50.2 43.3 0.4 0.5 0.0 0.0 0.1 100.0 3777 Tubas 8.5 55.5 36.0 0.0 0.0 0.0 0.0 0.0 100.0 671 Tulkarm 41.3 51.5 6.5 0.6 0.2 0.0 0.0 0.0 100.0 2081 Nablus 50.6 38.0 11.4 0.0 0.0 0.0 0.0 0.0 100.0 4486 Qalqiliya 37.0 38.3 24.7 0.0 0.0 0.0 0.0 0.0 100.0 1175 Salfit 23.2 65.5 11.3 0.0 0.0 0.0 0.0 0.0 100.0 876 Ramallah & Al-Bireh 32.6 50.0 16.7 0.1 0.6 0.0 0.0 0.0 100.0 3744 Jericho & Al-Aghwar 0.0 79.6 20.4 0.0 0.0 0.0 0.0 0.0 100.0 658 Jerusalem 73.2 20.7 4.9 0.2 0.3 0.0 0.7 0.0 100.0 5119 Bethlehem 39.9 46.2 11.5 0.2 2.2 0.0 0.0 0.0 100.0 2640 Hebron 30.9 57.5 11.2 0.1 0.0 0.0 0.2 0.0 100.0 8110 Gaza North 94.1 3.6 2.2 0.0 0.1 0.1 0.0 0.0 100.0 4307 Gaza 97.2 2.5 0.3 0.0 0.0 0.0 0.0 0.0 100.0 8334 Deir El-Balah 87.5 9.9 2.6 0.0 0.0 0.0 0.0 0.0 100.0 3431 Khan Yunis 35.8 63.2 1.1 0.0 0.0 0.0 0.0 0.0 100.0 4294 Rafah 81.0 15.0 3.9 0.0 0.0 0.0 0.0 0.0 100.0 2664 Area Urban 62.1 29.7 7.9 0.1 0.2 0.0 0.1 0.0 100.0 41978 Rural 10.0 67.1 22.2 0.2 0.5 0.0 0.0 0.0 100.0 9440 Camps 89.1 8.8 2.1 0.0 0.0 0.0 0.0 0.0 100.0 4948 Education of head of household None 43.7 44.2 11.3 0.0 0.5 0.0 0.1 0.2 100.0 1761 Basic 55.4 33.8 10.5 0.0 0.2 0.0 0.0 0.0 100.0 25318 Secondary 53.3 35.5 10.6 0.2 0.2 0.0 0.2 0.0 100.0 14756 Higher 60.2 32.0 7.4 0.1 0.2 0.0 0.1 0.0 100.0 14518 Missing/DK (*) (*) (*) (*) (*) (*) (*) (*) (*) 13 Wealth index poorest 85.8 12.1 1.9 0.0 0.1 0.0 0.0 0.0 100.0 11276 Second 69.9 26.0 3.9 0.0 0.2 0.0 0.0 0.0 100.0 11272 Third 38.7 46.5 14.0 0.2 0.4 0.0 0.2 0.0 100.0 11270 Fourth 35.8 47.5 16.3 0.0 0.3 0.0 0.1 0.0 100.0 11278 Richest 48.4 38.4 12.6 0.3 0.1 0.0 0.2 0.0 100.0 11271 (*) Figures that are based on less than 25 unweighted cases 89 80 The MDGs and the WHO / UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation classify otherwise acceptable sanitation facilities which 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, which are not public or shared. Data on the use of improved sanitation are presented in Tables WS.6 and WS.7. As shown in Table WS.6, 99 percent of the household population is using an improved sanitation facility which is not shared; 98 in Gaza Strip and 99 percent in the West Bank. Only one percent of households use an improved toilet facility that is public or shared with other households. Table WS.6: Use and sharing of sanitation facilities Percent distribution of household population by use of private and public sanitation facilities and use of shared facilities, by users of improved and unimproved sanitation facilities, Palestine, 2014 Users of improved sanitation facilities Users of unimproved sanitation facilities No sanitation facility Total Household members Not shared [1] Public facility Shared by: 5 households or less Not shared Shared by: 5 households or less Total 98.6 0.1 1.0 0.3 0.0 0.0 100.0 56366 Region West Bank 98.8 0.1 0.6 0.5 0.0 0.0 100.0 33337 Gaza Strip 98.4 0.1 1.5 0.0 0.0 0.0 100.0 23029 Governorate Jenin 98.4 0.0 1.0 0.5 0.0 0.1 100.0 3777 Tubas 100.0 0.0 0.0 0.0 0.0 0.0 100.0 671 Tulkarm 99.4 0.1 0.3 0.2 0.0 0.0 100.0 2081 Nablus 99.7 0.0 0.3 0.0 0.0 0.0 100.0 4486 Qalqiliya 100.0 0.0 0.0 0.0 0.0 0.0 100.0 1175 Salfit 100.0 0.0 0.0 0.0 0.0 0.0 100.0 876 Ramallah & Al-Bireh 99.0 0.2 0.2 0.6 0.0 0.0 100.0 3744 Jericho & Al- Aghwar 96.4 0.0 3.6 0.0 0.0 0.0 100.0 658 Jerusalem 98.6 0.2 0.2 1.0 0.0 0.0 100.0 5119 Bethlehem 97.2 0.0 0.6 1.9 0.3 0.0 100.0 2640 Hebron 98.9 0.0 0.9 0.3 0.0 0.0 100.0 8110 Gaza North 97.2 0.3 2.4 0.1 0.1 0.0 100.0 4307 Gaza 97.8 0.0 2.2 0.0 0.0 0.0 100.0 8334 Deir El-Balah 99.0 0.0 1.0 0.0 0.0 0.0 100.0 3431 Khan Yunis 99.3 0.0 0.7 0.0 0.0 0.0 100.0 4294 Rafah 99.8 0.2 0.1 0.0 0.0 0.0 100.0 2664 Area Urban 98.7 0.1 1.0 0.3 0.0 0.0 100.0 41978 Rural 98.8 0.1 0.5 0.4 0.1 0.0 100.0 9440 Camps 98.3 0.1 1.6 0.0 0.0 0.0 100.0 4948 Education of head of household None 97.0 0.1 2.7 0.0 0.1 0.0 100.0 11276 Basic 98.7 0.1 0.9 0.3 0.0 0.0 100.0 11272 Secondary 98.5 0.2 0.8 0.6 0.0 0.0 100.0 11270 Higher 99.3 0.0 0.3 0.4 0.0 0.0 100.0 11278 Missing/DK (*) (*) (*) (*) (*) (*) (*) 11271 [1] MICS indicator 4.3; MDG indicator 7.9 - Use of improved sanitation (*) Figures that are based on less than 25 unweighted cases 90 Palestinian Multiple Indicator Cluster Survey 2014 81 Having access to both an improved drinking water source and an improved sanitation facility brings the largest public health benefits to a household. In its 2008 report5, the JMP developed a new way of presenting the access figures, by disaggregating and refining the data on drinking-water and sanitation and reflecting them in "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 – who revert to open defecation, of those reliant on technologies defined by JMP as "unimproved," of those sharing sanitation facilities of otherwise acceptable technology, and those using "improved" sanitation facilities Table WS.7 presents the percentages of household population 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. About 62 percent of households use improved drinking sources and 99 percent use improved sanitation. About 61 percent of households use both improved drinking sources and improved sanitation. This percentage varies among region, where approximately 97 percent of the population in the West Bank enjoys this access compared to 10 percent in the Gaza Strip. The results presented in figure WS.3 shows a wide variation by wealth quintiles, as it varies from 2 percent among poorest households to 99 percent among the richest. 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. 91 82 Table WS.7: Drinking water and sanitation ladders Percentage of household population by drinking water and sanitation ladders, Palestine, 2014 Percentage of household population using: Number of household members Improved drinking water [1] U nim proved drinking w ater Total Improved sanitation [2] Unimproved sanitation Total Improved drinking water sources and improved sanitation P iped into dw ellingplot or yard O ther im proved S hared im proved facilities U nim proved facilities O pen defecation Total 58.1 3.4 38.5 100.0 98.7 1.0 0.3 0.0 100.0 60.8 56366 Region West Bank 91.3 5.6 3.2 100.0 98.8 0.6 0.5 0.0 100.0 95.7 33337 Gaza Strip 10.2 0.2 89.6 100.0 98.4 1.6 0.0 0.0 100.0 10.2 23029 Governorate Jenin 77.3 10.0 12.7 100.0 98.4 1.0 0.5 0.1 100.0 85.8 3777 Tubas 94.4 5.6 0.0 100.0 100.0 0.0 0.0 0.0 100.0 100.0 671 Tulkarm 96.3 3.2 0.5 100.0 99.4 0.4 0.2 0.0 100.0 98.9 2081 Nablus 92.3 5.0 2.7 100.0 99.7 0.3 0.0 0.0 100.0 97.0 4486 Qalqiliya 98.2 1.8 0.0 100.0 100.0 0.0 0.0 0.0 100.0 100.0 1175 Salfit 99.0 1.0 0.0 100.0 100.0 0.0 0.0 0.0 100.0 100.0 876 Ramallah & Al-Bireh 95.5 3.2 1.3 100.0 99.0 0.4 0.6 0.0 100.0 97.7 3744 Jericho & Al- Aghwar 97.4 0.0 2.6 100.0 96.4 3.6 0.0 0.0 100.0 93.8 658 Jerusalem 99.2 0.6 0.2 100.0 98.6 0.4 1.0 0.0 100.0 98.6 5119 Bethlehem 97.1 2.4 0.5 100.0 97.2 0.6 2.2 0.0 100.0 96.7 2640 Hebron 84.5 11.1 4.3 100.0 98.9 0.9 0.3 0.0 100.0 94.5 8110 North Gaza 16.3 0.5 83.2 100.0 97.2 2.7 0.1 0.0 100.0 16.3 4307 Gaza 3.9 0.1 96.1 100.0 97.8 2.2 0.0 0.0 100.0 3.9 8334 Dier El-Balah 3.0 0.2 96.8 100.0 99.0 1.0 0.0 0.0 100.0 3.2 3431 Khan Yunis 20.4 0.4 79.2 100.0 99.3 0.7 0.0 0.0 100.0 20.7 4294 Rafah 12.6 0.0 87.4 100.0 99.8 0.2 0.0 0.0 100.0 12.6 2664 Area Urban 55.6 2.5 41.9 100.0 98.7 1.0 0.3 0.0 100.0 57.4 41978 Rural 78.0 8.9 13.1 100.0 98.8 0.6 0.5 0.0 100.0 85.9 9440 Camps 41.7 0.6 57.7 100.0 98.3 1.7 0.0 0.0 100.0 41.8 4948 Education of household head None 57.6 8.8 33.6 100.0 97.7 1.5 0.6 0.2 100.0 65.2 1761 Basic 58.5 3.6 38.0 100.0 98.5 1.2 0.3 0.0 100.0 61.4 25318 Secondary 60.0 3.0 37.1 100.0 98.3 1.3 0.4 0.0 100.0 61.9 14756 Higher 55.8 2.8 41.3 100.0 99.3 0.4 0.3 0.0 100.0 58.2 14518 Missing/DK (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 13 Wealth index quintiles Poorest 1.3 0.7 98.0 100.0 97.0 2.8 0.1 0.0 100.0 1.8 11276 Second 14.4 4.3 81.3 100.0 98.7 1.0 0.3 0.0 100.0 17.8 11272 Middle 82.1 6.9 11.0 100.0 98.5 1.0 0.6 0.0 100.0 87.5 11270 Fourth 95.1 3.3 1.6 100.0 99.3 0.3 0.4 0.0 100.0 97.7 11278 Richest 97.9 1.7 0.4 100.0 99.7 0.1 0.3 0.0 100.0 99.2 11271 [1] MICS indicator 4.1; MDG indicator 7.8 - Use of improved drinking water sources [2] MICS indicator 4.3; MDG indicator 7.9 - Use of improved sanitation [a] 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 (*) Figures that are based on less than 25 unweighted cases 92 Palestinian Multiple Indicator Cluster Survey 2014 83 Figure WS.3: Use of improved dr inking water sources and improved sanitat ion faci l i t ies by household members, Palest ine, 2014 3   23   83   95   99   61   0   20   40   60   80   100   Poorest   Second   Middle   Fourth   Richest   Pales?ne   Pe r   ce nt   93 VIII. Reproductive Health 84 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 not to compromise the 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 years (15-49 years). The general fertility rate (GFR) is the number of live births occurring during the specified period per 1,000 women age 15-49.The crude birth rate (CBR) is the number of live births per 1,000 population during the specified period. Table RH.1: Fertility rates Adolescent birth rate, age-specific and total fertility rates, the general fertility rate, and the crude birth rate for the three- year period preceding the survey, Palestine, 2014 Total Region Area West Bank Gaza Strip Urban Rural Camps Age 15-19 [1] 48 35 66 55 29 32 20-24 201 182 226 206 177 205 25-29 244 237 254 243 257 232 30-34 177 170 186 179 162 185 35-39 103 91 125 108 80 105 40-44 35 30 45 34 36 41 45-49 3 3 3 3 2 0 TFR [a] 4.1 3.7 4.5 4.1 3.7 4.0 GFR [b] 128.1 115.0 147.7 132.0 113.5 123.4 CBR [c] 31.5 28.6 35.8 32.4 28.4 29.8 1 MICS indicator 5.1; MDG indicator 5.4 - Adolescent birth rate [a] TFR: Total fertility rate expressed per woman age 15-49 [b] GFR: General fertility rate expressed per 1,000 women age 15-49 [c] CBR: Crude birth rate expressed per 1,000 population Table RH.1 shows current fertility in Palestine at the national level and region and area. The TFR for the three years preceding the Palestinian MICS is 4.1 births per woman. Results reveal that fertility rates differ according to region where it was 3.7 births per woman in the West Bank compared to 4.5 births per woman in Gaza Strip. 96 Palestinian Multiple Indicator Cluster Survey 2014 85 Figure RH.1: Age-specif ic fert i l i ty rates by region, Palest ine, 2014 The urban-rural-camps difference in fertility is most pronounced for women in the 25-29 age group: 243 births per 1,000 women in urban areas versus 257 births per 1,000 women in rural areas and 232 births per 1,000 women in camps. The overall age pattern of fertility, as reflected in the ASFRs, indicates that childbearing begins early. Fertility is low among adolescents, increases to a peak of 244 births per 1,000 among women age 25-29, and declines thereafter. Table RH.2 shows adolescent birth rates and total fertility rates. The adolescent birth rate (age-specific fertility rate for women age 15-19) is defined as the number of births to women age 15-19 years during the three year period preceding the survey, divided by the average number of women age 15-19 (number of women-years lived between ages 15 through 19, inclusive) during the same period, expressed per 1,000 women. Data presented in table RH.2 shows that the adolescent birth rate (Age-specific fertility rate for women age 15-19) in Palestine is 48 births per 1000 women. Results reveal that adolescent birth rate differ according to regions where it was 35 births per 1000 women in the West Bank compared to 66 births per 1000 women in Gaza Strip. 97 86 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, Palestine, 2014 Adolescent birth rate1 (Age- specific fertility rate for women age 15-19) [b] Total fertility rate [a] Total 48 4.1 Region West Bank 35 3.7 Gaza Strip 66 4.5 Wealth index quintiles Poorest 86 5.0 Second 51 4.0 Middle 40 4.2 Fourth 44 3.8 Richest 19 3.3 1 MICS indicator 5.1; MDG indicator 5.4 - Adolescent birth rate [a] TFR: Total fertility rate expressed per woman age 15-49 [b] Age-specific fertility rate expressed per 1000 women age (15-19) Sexual activity and childbearing early in life carry significant risks for young people all around the world. Table RH.3 presents some early childbearing indicators for women age 15-19 and 20-24 while Table RH.4 presents the trends for early childbearing. 98 Palestinian Multiple Indicator Cluster Survey 2014 87 Table RH.3: Early childbearing Percentage of women age 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 age 15, and percentage of women age 20-24 years who have had a live birth before age 18, Palestine, 2014 Percentage of women age 15-19 who: Number of women age 15-19 Percentage of women age 20-24 who have had a live birth before age 181 Number of women age 20- 24 Have had a live birth Are pregnant with first child Have begun childbearing Have had a live birth before age 15 Total 4.5 2.4 6.9 2.0 3047 22.0 2813 Region West Bank 3.1 1.9 5.0 1.4 1780 19.6 1597 Gaza Strip 6.5 3.1 9.6 2.8 1267 25.1 1216 Governorate Jenin 1.3 2.2 3.4 0.5 207 21.6 184 Tubas (2.4) (0.8) (3.1) (0.0) 39 (9.2) 41 Tulkarm 1.6 0.0 1.6 0.9 115 16.5 118 Nablus 1.3 4.1 5.4 0.0 219 18.9 188 Qalqiliya 1.1 0.0 1.1 0.0 62 16.1 63 Salfit 5.0 0.0 5.0 5.0 54 (8.0) 34 Ramallah & Al-Bireh 0.9 0.4 1.3 0.9 190 18.2 173 Jericho (4.2) (2.2) (6.5) (4.2) 34 (20.4) 38 Jerusalem 4.7 1.4 6.1 2.3 214 24.0 224 Bethlehem 2.5 1.7 4.3 1.1 166 26.7 139 Hebron 5.6 2.5 8.1 2.0 480 18.1 395 North Gaza 9.7 3.5 13.2 3.3 221 29.3 218 Gaza 7.7 2.8 10.5 3.6 479 27.7 438 Dier El-Balah 3.7 3.2 6.9 1.0 200 14.9 180 Khan Yunis 3.2 3.7 6.9 2.0 236 22.2 244 Rafah 7.0 2.4 9.3 2.9 132 28.4 136 Area Urban 5.2 2.3 7.5 2.2 2258 23.2 2105 Rural 1.7 1.6 3.3 1.2 521 17.8 477 Camps 4.5 4.7 9.2 1.3 268 19.3 232 Education of household head None (0.0) (0.0) (0.0) (0.0) 6 (0.0) 2 Basic 4.5 1.7 6.2 1.9 1585 42.3 356 Secondary 6.8 4.3 11.1 3.3 874 30.0 871 Higher 1.2 1.4 2.6 0.3 580 13.0 1585 Wealth index quintiles Poorest 9.6 4.5 14.1 4.0 616 26.7 595 Second 4.3 2.6 6.9 2.0 610 22.6 617 Middle 2.7 2.1 4.8 1.0 598 22.9 517 Fourth 4.7 1.7 6.4 1.9 583 21.2 580 Richest 1.4 1.1 2.5 0.9 640 15.7 505 1 MICS indicator 5.2 - Early childbearing ( ) Figures that are based on 25-49 unweighted cases 99 88 Ta bl e R H .4 : T re nd s in e ar ly c hi ld be ar in g P er ce nt ag e of w om en w ho h av e ha d a liv e bi rth b y ag e 15 a nd 1 8, b y re gi on a ge g ro up s an d ar ea , P al es tin e, 2 01 4 W es t B an k G az a St rip A ll P er ce nt ag e of w om en w ith a li ve bi rth be fo re a ge 15 N um be r o f w om en a ge 15 -4 9 ye ar s P er ce nt ag e of w om en w ith a li ve bi rth b ef or e ag e 18 N um be r o f w om en a ge 20 -4 9 ye ar s P er ce nt ag e of w om en w ith a liv e bi rth be fo re a ge 1 5 N um be r of w om en ag e 15 - 49 y ea rs P er ce nt ag e of w om en w ith a li ve bi rth b ef or e ag e 18 N um be r of w om en ag e 20 - 49 y ea rs P er ce nt ag e of w om en w ith a li ve bi rth b ef or e ag e 15 N um be r of w om en ag e 15 - 49 y ea rs P er ce nt ag e of w om en w ith a li ve bi rth b ef or e ag e 18 N um be r of w om en ag e 20 -4 9 ye ar s To ta l 8. 4 80 28 21 .3 62 49 9. 9 53 39 23 .7 40 71 9. 0 13 36 7 22 .2 10 32 0 A ge 15 -1 9 1. 4 17 79 na na 2. 8 12 68 na na 2. 0 30 47 na na 20 -2 4 9. 1 15 97 19 .6 15 97 12 .6 12 17 25 .0 12 17 10 .6 28 13 22 .0 28 13 25 -2 9 14 .7 11 55 28 .0 11 55 16 .0 84 2 30 .7 84 2 15 .2 19 97 29 .2 19 97 30 -3 4 12 .9 98 0 28 .0 98 0 12 .5 67 0 24 .9 67 0 12 .8 16 50 26 .7 16 50 35 -3 9 9. 5 99 7 19 .1 99 7 10 .3 55 9 18 .3 55 9 9. 8 15 56 18 .8 15 56 40 -4 4 8. 7 84 0 16 .0 84 0 9. 3 43 5 18 .0 43 5 8. 9 12 76 16 .7 12 76 45 -4 9 6. 0 68 1 13 .6 68 1 6. 7 34 7 15 .5 34 7 6. 2 10 28 14 .2 10 28 U rb an R ur al C am p P er ce nt ag e of w om en w ith a li ve bi rth b ef or e ag e 15 N um be r o f w om en a ge 15 -4 9 ye ar s P er ce nt ag e of w om en w ith a liv e bi rth be fo re a ge 1 8 N um be r o f w om en a ge 20 -4 9 ye ar s P er ce nt ag e of w om en w ith a li ve bi rth b ef or e ag e 15 N um be r of w om en ag e 15 - 49 y ea rs P er ce nt ag e of w om en w ith a li ve bi rth b ef or e ag e 18 N um be r of w om en ag e 20 - 49 y ea rs P er ce nt ag e of w om en w ith a li ve bi rth b ef or e ag e 15 N um be r of w om en ag e 15 - 49 y ea rs P er ce nt ag e of w om en w ith a li ve bi rth b ef or e ag e 18 N um be r of w om en ag e 20 - 49 ye ar s To ta l 9. 4 99 38 22 .7 76 80 7. 3 22 73 20 .1 17 51 8. 4 11 56 22 .1 88 9 A ge 15 -1 9 2. 2 22 58 na na 1. 2 52 1 na na 1. 3 26 8 na na 20 -2 4 11 .7 21 05 23 .2 21 05 6. 4 47 7 17 .7 47 7 9. 4 23 2 19 .3 23 2 25 -2 9 15 .7 14 98 29 .8 14 98 14 .3 31 7 27 .5 31 7 13 .1 18 2 26 .4 18 2 30 -3 4 12 .2 12 41 26 .2 12 41 13 .4 27 7 27 .6 27 7 16 .8 13 2 29 .9 13 2 35 -3 9 10 .6 11 53 19 .1 11 53 7. 4 26 6 17 .2 26 6 7. 4 13 7 19 .6 13 7 40 -4 4 9. 3 94 1 16 .9 94 1 8. 7 22 6 15 .3 22 6 6. 1 10 9 18 .2 10 9 45 -4 9 6. 1 74 1 14 .2 74 1 4. 6 18 9 12 .6 18 9 9. 8 97 18 .0 97 na : n ot a pp lic ab le 100 Palestinian Multiple Indicator Cluster Survey 2014 89 As shown in Table RH.3, around 5 percent of women age 15-19 have already had a birth, two percent are pregnant with their first child, seven percent have begun childbearing, and two percent have had a live birth before age 15. Twenty two percent of women age 20-24 who have had a live birth before age 18; 20 percent in the West Bank compared with 25 percent in Gaza Strip. As shown in Table RH.4, 9 percent of women age 15-49 with a live birth before age 15, 22 percent of women age 20-49 with a live birth before age 18. Contraception Appropriate family planning is important to the health of women and children by: 1) preventing pregnancies that are too early or too late; 2) extending the period between births; and 3) 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. 101 90 Ta bl e R H .5 : U se o f c on tr ac ep tio n P er ce nt ag e of w om en a ge 1 5- 49 y ea rs c ur re nt ly m ar rie d w ho a re u si ng (o r w ho se p ar tn er is u si ng ) a c on tra ce pt iv e m et ho d, P al es tin e, 2 01 4 P er ce nt o f w om en c ur re nt ly m ar rie d w ho a re u si ng (o r w ho se p ar tn er is u si ng ): No method Female sterilization Male sterilization IUD Injectables Implants Pill Male condom Female condom Diaphragm/ foam/jelly Lactational amenorrhoea method (LAM) Periodic abstinence/ Rhythm With drawal Other Any modern method Any traditional method Any method [1] Number of women currently married To ta l 42 .8 1. 8 0. 0 26 .2 0. 9 0. 0 8. 0 5. 5 0. 0 0. 1 1. 6 3. 7 9. 3 0. 1 44 .1 13 .1 57 .2 79 59 R eg io n W es t B an k 40 .2 2. 4 0. 0 31 .0 0. 5 0. 0 6. 5 4. 3 0. 1 0. 1 1. 5 4. 5 8. 8 0. 1 46 .3 13 .5 59 .8 47 39 G az a S tri p 46 .6 1. 0 0. 0 19 .1 1. 4 0. 1 10 .1 7. 4 0. 0 0. 0 1. 8 2. 4 10 .1 0. 1 40 .8 12 .6 53 .4 32 21 G ov er no ra te Je ni n 38 .4 3. 4 0. 0 28 .8 0. 6 0. 0 8. 9 3. 4 0. 0 0. 2 0. 7 6. 1 9. 3 0. 3 45 .9 15 .7 61 .6 54 7 Tu ba s 41 .8 4. 4 0. 0 25 .2 0. 0 0. 0 12 .8 4. 8 0. 0 0. 0 0. 3 5. 2 5. 4 0. 0 47 .5 10 .7 58 .2 90 Tu lk ar m 36 .6 5. 1 0. 0 26 .5 1. 1 0. 0 9. 4 3. 6 0. 0 0. 0 0. 4 1. 5 15 .9 0. 0 45 .9 17 .4 63 .4 28 0 N ab lu s 40 .4 4. 3 0. 0 31 .3 0. 1 0. 0 7. 0 4. 7 0. 2 0. 3 0. 4 4. 3 6. 8 0. 2 48 .3 11 .3 59 .6 65 1 Q al qi liy a 35 .5 2. 4 0. 0 26 .0 1. 2 0. 0 12 .0 5. 3 0. 0 0. 0 0. 6 10 .6 6. 5 0. 0 47 .4 17 .1 64 .5 14 2 S al fit 37 .9 0. 5 0. 0 31 .4 0. 0 0. 0 12 .7 3. 9 0. 0 0. 0 1. 6 4. 3 7. 7 0. 0 50 .1 12 .0 62 .1 11 6 R am al la h & A l-B ire h 35 .6 1. 0 0. 0 32 .9 0. 6 0. 0 5. 8 5. 2 0. 2 0. 0 1. 6 4. 6 12 .0 0. 5 47 .3 17 .1 64 .4 55 9 Je ric ho & A l-A gh w ar 53 .4 1. 9 0. 0 27 .6 0. 0 0. 0 8. 1 2. 5 0. 0 1. 6 2. 5 1. 0 .5 0. 0 44 .2 2. 4 46 .6 89 Je ru sa le m 38 .6 2. 5 0. 0 35 .2 0. 4 0. 0 5. 5 3. 8 0. 0 0. 0 0. 9 2. 6 10 .6 0. 0 48 .2 13 .2 61 .4 78 7 B et hl eh em 42 .8 1. 2 0. 0 27 .7 0. 2 0. 0 5. 6 5. 4 0. 0 0. 0 2. 8 4. 8 8. 9 0. 2 42 .8 14 .4 57 .2 37 2 H eb ro n 44 .1 1. 2 0. 1 31 .5 0. 7 0. 0 3. 6 4. 3 0. 1 0. 1 2. 8 5. 2 6. 2 0. 1 44 .4 11 .5 55 .9 11 04 G az a N or th 47 .6 0. 3 0. 0 23 .7 2. 6 0. 0 11 .7 4. 7 0. 0 0. 0 1. 9 0. 5 6. 8 0. 2 45 .0 7. 4 52 .4 62 3 G az a 46 .6 0. 4 0. 0 18 .6 1. 9 0. 0 11 .4 8. 0 0. 0 0. 0 1. 4 2. 6 8. 9 0. 1 41 .7 11 .7 53 .4 11 72 D ei r E l-B al ah 41 .7 1. 1 0. 0 18 .4 0. 7 0. 0 9. 9 8. 3 0. 0 0. 0 1. 3 5. 1 13 .7 0. 0 39 .5 18 .7 58 .3 46 0 K ha n Y un is 46 .6 2. 0 0. 0 15 .0 0. 5 0. 4 8. 9 7. 8 0. 0 0. 0 3. 2 3. 4 12 .1 0. 0 37 .9 15 .6 53 .4 59 0 R af ah 50 .9 2. 3 0. 0 20 .2 0. 0 0. 3 5. 6 7. 9 0. 0 0. 0 1. 0 0. 0 11 .3 0. 5 37 .3 11 .8 49 .1 37 5 [1 ] M IC S in di ca to r 5 .3 ; M D G in di ca to r 5 .3 - C on tra ce pt iv e pr ev al en ce ra te 102 Palestinian Multiple Indicator Cluster Survey 2014 91 T ab le R H .5 C on tin ue d: U se o f c on tr ac ep tio n P er ce nt ag e of w om en a ge 1 5- 49 y ea rs c ur re nt ly m ar rie d w ho a re u si ng (o r w ho se p ar tn er is u si ng ) a c on tra ce pt iv e m et ho d, P al es tin e, 2 01 4 P er ce nt o f w om en c ur re nt ly m ar rie d w ho a re u si ng (o r w ho se p ar tn er is u si ng ): Not method Female sterilization Male sterilization IUD Injectables Implants Pill Male condom Female condom Diaphragm/fo am/jelly Lactational amenorrhoea method (LAM) Periodic abstinence/R hythm Withdrawal Other Any modern method Any traditional method Any method [1] Number of women currently married A re a U rb an 43 .4 1. 7 0. 0 25 .7 0. 8 0. 1 8. 0 5. 5 0. 0 0. 0 1. 6 3. 6 9. 5 0. 1 43 .4 13 .2 56 .6 59 76 R ur al 40 .1 2. 4 0. 1 29 .3 0. 6 0. 0 7. 0 3. 9 0. 1 0. 1 1. 7 5. 0 9. 5 0. 2 45 .2 14 .7 59 .9 13 00 ca m p 42 .4 2. 2 0. 0 24 .0 1. 6 0. 0 9. 2 9. 2 0. 0 0. 2 1. 7 1. 8 7. 2 0. 3 48 .1 9. 5 57 .6 68 3 A ge 15 – 1 9 84 .4 0. 0 0. 0 2. 5 0. 0 0. 0 1. 6 2. 5 0. 0 0. 0 3. 5 0. 6 4. 9 0. 0 10 .1 5. 5 15 .6 27 8 20 – 2 4 62 .0 0. 0 0. 0 12 .8 0. 1 0. 0 7. 2 4. 1 0. 1 0. 0 2. 3 2. 4 8. 9 0. 0 26 .6 11 .4 38 .0 13 80 25 – 2 9 47 .7 0. 0 0. 0 19 .6 0. 4 0. 1 8. 5 7. 0 0. 0 0. 0 2. 0 4. 2 10 .3 0. 2 37 .6 14 .7 52 .3 15 57 30 – 3 4 39 .1 0. 7 0. 0 28 .5 1. 0 0. 1 10 .7 5. 9 0. 1 0. 1 2. 3 3. 3 8. 1 0. 0 49 .5 11 .5 60 .9 14 25 35 – 3 9 26 .7 2. 4 0. 0 37 .5 1. 1 0. 1 9. 4 7. 0 0. 0 0. 1 1. 3 4. 0 10 .4 0. 0 59 .0 14 .4 73 .3 13 42 40 – 4 4 27 .6 4. 3 0. 0 38 .3 2. 3 0. 0 7. 3 5. 9 0. 0 0. 1 0. 3 4. 1 9. 5 0. 3 58 .5 13 .9 72 .4 11 08 45 – 4 9 40 .6 6. 3 0. 0 29 .7 0. 7 0. 0 4. 3 3. 0 0. 1 0. 1 0. 0 5. 1 9. 5 0. 5 44 .3 15 .1 59 .4 87 0 N o. o f l iv e bi rt hs 0 99 .2 0. 0 0. 0 0. 0 0. 0 0. 0 0. 3 0. 2 0. 0 0. 0 0. 0 0. 0 0. 3 0. 0 0. 5 0. 3 0. 8 68 1 1 74 .5 0. 1 0. 0 1. 7 0. 0 0. 0 2. 9 5. 2 0. 1 0. 0 2. 9 2. 4 10 .0 0. 0 12 .9 12 .5 25 .5 88 5 2 50 .4 0. 2 0. 0 17 .7 0. 0 0. 0 8. 7 5. 9 0. 0 0. 1 1. 7 4. 9 10 .3 0. 1 34 .3 15 .2 49 .6 11 02 3 38 .1 0. 4 0. 1 29 .8 0. 1 0. 0 9. 3 5. 4 0. 0 0. 0 2. 1 4. 7 10 .0 0. 1 47 .1 14 .8 61 .9 11 50 +4 26 .0 3. 3 0. 0 36 .9 1. 6 0. 1 9. 7 6. 5 0. 1 0. 1 1. 4 3. 9 10 .1 0. 2 59 .7 14 .3 74 .0 41 42 W om en ’s e du ca tio n N on e (5 2. 0) (3 .7 ) (0 .0 ) (2 3. 5) (4 .4 ) (0 .0 ) (2 .1 ) (3 .1 ) (0 .0 ) (0 .0 ) (5 .4 ) (3 .7 ) (2 .0 ) (0 .0 ) (4 2. 3) (5 .7 ) (4 8. 0) 48 B as ic 38 .9 3. 3 0. 0 29 .2 1. 5 0. 0 8. 7 4. 4 0. 1 0. 1 1. 4 3. 0 9. 0 0. 3 48 .7 12 .3 61 .1 28 18 S ec on da ry 43 .3 1. 2 0. 0 26 .9 0. 7 0. 0 7. 8 5. 7 0. 0 0. 0 1. 3 3. 3 9. 7 0. 0 43 .7 13 .0 56 .7 26 27 H ig he r 46 .6 0. 8 0. 0 22 .0 0. 3 0. 1 7. 4 6. 8 0. 1 0. 0 2. 0 4. 8 9. 3 0. 1 39 .4 14 .1 53 .4 24 67 W ea lth in de x qu in til e P oo re st 51 .0 0. 8 0. 0 16 .2 2. 1 0. 0 9. 3 7. 3 0. 0 0. 0 1. 9 1. 8 9. 3 0. 2 37 .6 11 .4 49 .0 16 20 S ec on d 43 .8 1. 3 0. 0 22 .0 0. 7 0. 2 10 .1 7. 1 0. 0 0. 0 2. 0 2. 6 10 .1 0. 1 43 .3 12 .8 56 .2 15 17 M id dl e 44 .1 2. 0 0. 0 27 .1 0. 7 0. 0 6. 8 4. 4 0. 2 0. 0 1. 8 4. 2 8. 6 0. 0 43 .0 12 .8 55 .9 15 50 Fo ur th 41 .5 2. 4 0. 0 27 .3 0. 5 0. 1 6. 9 5. 4 0. 0 0. 2 1. 5 5. 0 9. 1 0. 1 44 .3 14 .2 58 .5 16 55 R ic he st 33 .7 2. 7 0. 0 37 .9 0. 4 0. 0 6. 7 3. 7 0. 0 0. 1 0. 8 4. 6 9. 3 0. 3 52 .2 14 .1 66 .3 16 18 [1 ] M IC S in di ca to r 5 .3 ; M D G in di ca to r 5 .3 - C on tra ce pt iv e pr ev al en ce ra te ( ) F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s 103 92 Current use of contraception was reported by 57 percent of currently married women (Table RH.5). The most popular method is the IUD which is used by 26 percent of married women in Palestine. The next most popular method is withdrawal, which accounts for nine percent of use among married couples. Between eight percent and four percent of married women reported that they or their husbands use other methods such as the pill, male condom and periodic abstinence/rhythm. Less than two percent use diaphragm/foam/jelly, injectables, female sterilization, or the lactational amenorrhea method (LAM). Contraceptive prevalence ranges from 60 percent in the West Bank to 53 percent in Gaza Strip. About 57 percent of married women in urban and 60 percent in rural areas and 58 in camps use a method of contraception. Adolescents are far less likely to use contraception than older women. Only about 16 percent of women age 15-19 married currently use a method of contraception compared to 38 percent of 20-24 year olds, while the use of contraception among older women ranges from 52 percent to 73 percent. Women’s education level is associated with contraceptive prevalence. The percentage of married women using any method of contraception rises from 48 percent among those with no education to 57 percent among those with secondary education. The most common contraceptive method for married women with basic education is the IUD (29 percent), 27 percent with secondary education and 22 percent with higher education. Figure RH.2: Dif ferent ia ls in contracept ive use, Palest ine, 2014 104 Palestinian Multiple Indicator Cluster Survey 2014 93 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 who wish to postpone the next birth (spacing) or who 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 amenorrheic1, and are fecund2, 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 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. Results show that total unmet need for contraception was 11 percent (unmet need for limiting is 5 percent and for spacing is 6 percent). This indicator is also known as unmet need for family planning and is one of the indicators used to track progress toward the Millennium Development Goal 5 of improving maternal health. 1  A  women  is  postpartum  amenorrheic  if  she  had  a  birth  in  last  two  years  and  is  not  currently  pregnant,  and  her   menstrual  period  has  not  returned  since  the  birth  of  the  last  child   2  A  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  2  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  5  years,  is  currently  not  using  contraception  and  is  currently   married  and  was  continuously  married  during  the  last  5  years  preceding  the  survey.   105 94 Ta bl e R H .6 : U nm et n ee d fo r c on tr ac ep tio n P er ce nt ag e of w om en a ge 1 5- 49 y ea rs c ur re nt ly m ar rie d w ith a n un m et n ee d fo r f am ily p la nn in g an d pe rc en ta ge o f d em an d fo r c on tra ce pt io n sa tis fie d, P al es tin e, 2 01 4 M et n ee d fo r c on tra ce pt io n U nm et n ee d fo r c on tra ce pt io n N um be r o f w om en cu rr en tly m ar rie d P er ce nt ag e of de m an d fo r co nt ra ce pt io n sa tis fie d N um be r o f w om en cu rr en tly m ar rie d w ith ne ed fo r co nt ra ce pt io n Fo r s pa ci ng Fo r l im iti ng To ta l Fo r s pa ci ng Fo r l im iti ng To ta l [ 1] To ta l 21 .0 36 .3 57 .2 6. 3 4. 6 10 .9 7, 95 9 84 .0 5, 41 9 R eg io n W es t B an k 20 .9 38 .9 59 .8 6. 1 4. 9 11 .0 4, 73 9 84 .5 3, 35 5 G az a S tri p 21 .0 32 .3 53 .4 6. 6 4. 1 10 .7 3, 22 1 83 .3 2, 06 4 G ov er no ra te Je ni n 20 .9 40 .7 61 .6 5. 1 5. 0 10 .2 54 7 85 .9 39 3 Tu ba s 21 .7 36 .5 58 .2 5. 8 5. 5 11 .3 90 83 .8 63 Tu lk ar m 20 .6 42 .8 63 .4 5. 3 2. 7 8. 1 28 0 88 .7 20 0 N ab lu s 17 .4 42 .2 59 .6 6. 1 6. 6 12 .7 65 1 82 .4 47 1 Q al qi liy a 22 .6 42 .0 64 .5 5. 9 5. 4 11 .2 14 2 85 .2 10 8 S al fit 21 .7 40 .4 62 .1 5. 6 2. 3 7. 8 11 6 88 .8 81 R am al la h & A l-B ire h 25 .9 38 .5 64 .4 5. 5 4. 1 9. 5 55 9 87 .1 41 4 Je ric ho & A l-A gh w ar 16 .2 30 .4 46 .6 10 .8 3. 1 13 .9 89 77 .0 54 Je ru sa le m 20 .5 40 .9 61 .4 6. 0 4. 8 10 .8 78 7 85 .0 56 9 B et hl eh em 19 .6 37 .7 57 .2 6. 1 7. 1 13 .1 37 2 81 .3 26 2 H eb ro n 21 .3 34 .6 55 .9 7. 0 4. 3 11 .3 1, 10 4 83 .1 74 2 G az a N or th 20 .6 31 .8 52 .4 7. 7 4. 6 12 .3 62 3 80 .9 40 3 G az a 18 .7 34 .7 53 .4 6. 4 4. 0 10 .4 1, 17 2 83 .6 74 8 D ei r E l-B al ah 20 .5 37 .8 58 .3 5. 1 4. 1 9. 2 46 0 86 .4 31 0 K ha n Y un is 24 .1 29 .3 53 .4 4. 8 4. 2 9. 0 59 0 85 .6 36 8 R af ah 25 .1 24 .0 49 .1 9. 6 3. 7 13 .3 37 5 78 .6 23 4 [1 ] M IC S in di ca to r 5 .4 ; M D G in di ca to r 5 .6 - U nm et n ee d 106 Palestinian Multiple Indicator Cluster Survey 2014 95 Ta bl e R H .6 C on tin ue d: U nm et n ee d fo r c on tr ac ep tio n P er ce nt ag e of w om en a ge 1 5- 49 y ea rs c ur re nt ly m ar rie d w ith a n un m et n ee d fo r f am ily p la nn in g an d pe rc en ta ge o f d em an d fo r c on tra ce pt io n sa tis fie d, P al es tin e, 2 01 4 M et n ee d fo r c on tra ce pt io n U nm et n ee d fo r c on tra ce pt io n N um be r o f w om en cu rr en tly m ar rie d P er ce nt ag e of de m an d fo r co nt ra ce pt io n sa tis fie d N um be r o f w om en cu rr en tly m ar rie d w ith ne ed fo r co nt ra ce pt io n Fo r s pa ci ng Fo r l im iti ng To ta l Fo r s pa ci ng Fo r l im iti ng To ta l [ 1] A re a U rb an 21 .7 34 .9 56 .6 6. 5 4. 3 10 .8 5, 97 6 84 .0 40 27 R ur al 19 .2 40 .7 59 .9 5. 0 5. 8 10 .8 1, 30 0 84 .8 91 9 ca m p 18 .2 39 .4 57 .6 7. 1 4. 7 11 .7 68 3 83 .1 47 3 A ge 15 – 1 9 15 .2 0. 4 15 .6 12 .1 0. 4 12 .5 27 8 55 .5 78 20 – 2 4 32 .6 5. 5 38 .0 14 .5 0. 8 15 .3 1, 38 0 71 .3 73 6 25 – 2 9 38 .6 13 .7 52 .3 10 .3 1. 3 11 .5 1, 55 7 82 .0 99 3 30 – 3 4 26 .4 34 .5 60 .9 5. 1 5. 0 10 .1 1, 42 5 85 .7 1, 01 3 35 – 3 9 11 .9 61 .4 73 .3 2. 2 5. 2 7. 4 1, 34 2 90 .8 1, 08 3 40 – 4 4 3. 1 69 .3 72 .4 0. 5 8. 1 8. 5 1, 10 8 89 .5 89 7 45 – 4 9 0. 6 58 .7 59 .4 0. 0 11 .8 11 .8 87 0 83 .4 61 9 W om en ’s e du ca tio n N on e (7 .6 ) (4 0. 4) (4 8. 0) (1 .6 ) (1 2. 7) (1 4. 3) 48 (7 7. 1) 30 B as ic 13 .3 47 .8 61 .1 4. 2 6. 9 11 .1 2, 81 8 84 .6 2, 03 5 S ec on da ry 21 .4 35 .4 56 .7 6. 8 4. 1 10 .9 2, 62 7 83 .9 1, 77 7 H ig he r 29 .5 23 .9 53 .4 8. 3 2. 2 10 .5 2, 46 7 83 .6 1, 57 7 W ea lth in de x qu in til e P oo re st 19 .6 29 .4 49 .0 7. 6 4. 1 11 .8 1, 62 0 80 .7 98 4 S ec on d 22 .6 33 .5 56 .2 5. 9 4. 4 10 .3 1, 51 7 84 .5 1, 00 9 M id dl e 21 .0 34 .9 55 .9 6. 7 5. 2 11 .9 1, 55 0 82 .5 1, 05 0 Fo ur th 21 .7 36 .8 58 .5 6. 6 4. 8 11 .4 1, 65 5 83 .6 1, 15 7 R ic he st 20 .0 46 .3 66 .3 4. 7 4. 3 9. 0 1, 61 8 88 .1 1, 21 9 ( ) F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s 107 96 Met need for limiting includes women married who are using (or whose partner is using) a contraceptive method3, 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 need for contraception. Results show that met need for limiting is 36 percent and for spacing is 21 percent. Using information on contraception and unmet need, the percentage of demand for contraception satisfied is also estimated from the 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. Results show that unmet need for limiting is 5 percent and for spacing is 6 percent. Table RH.6 shows that the total met need is higher than the total unmet need for family planning. While met need is associated as well with wealth, with the least wealthy women having the lowest level of met need and the richest women the highest. The table also highlights that the total demand for family planning satisfied is high (84%). 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 symptoms 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. 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 foetal outcomes and improve maternal health. Adverse outcomes such as low birth weight can be reduced through a combination of interventions to improve women's nutritional status and prevent infections (e.g., malaria and STIs) during pregnancy. More recently, the potential of the 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 on antenatal care visits, which include: • Blood pressure measurement • Urine testing for bateriuria and proteinuria • Blood testing to detect syphilis and severe anaemia • Weight/height measurement (optional). 3  In  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).   108 Palestinian Multiple Indicator Cluster Survey 2014 97 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. Antenatal care coverage indicators (at least one visit with a skilled provider and 4 or more visits with any providers) are used to track progress toward the Millennium Development Goal 5 of improving maternal health. 109 98 Table RH.7: Antenatal care coverage Percent distribution of women age 15-49 years with a live birth in the last two years by antenatal care provider during the pregnancy for the last birth, Palestine, 2014 Provider of antenatal care [a] Medical doctor Nurse / Midwife Traditional birth attendant Other No antenatal care Total Any skilled provider [1] Number of women with a live birth in the last two years Total 91.7 7.7 0.0 0.1 0.5 100.0 99.4 2940 Region West Bank 95.8 3.6 0.0 0.2 0.5 100.0 99.3 1609 Gaza Strip 86.8 12.7 0.1 0.0 0.4 100.0 99.5 1331 Governorate Jenin 93.6 5.5 0.0 0.0 1.0 100.0 99.0 186 Tubas (98.9) (1.1) (0.0) (0.0) (0.0) (100.0) (100.0) 25 Tulkarm 96.1 3.9 0.0 0.0 0.0 100.0 100.0 71 Nablus 99.5 0.5 0.0 0.0 0.0 100.0 100.0 190 Qalqiliya (100.0) (0.0) (0.0) (0.0) (0.0) (100.0) (100.0) 48 Salfit (97.1) (2.9) (0.0) (0.0) (0.0) (100.0) (100.0) 35 Ramallah & Al-Bireh 96.9 2.3 0.0 0.4 0.5 100.0 99.1 190 Jericho (87.6) (12.4) (0.0) (0.0) (0.0) (100.0) (100.0) 44 Jerusalem 95.0 3.1 0.0 0.4 1.5 100.0 98.1 256 Bethlehem 97.4 1.9 0.0 0.0 0.7 100.0 99.3 137 Hebron 94.5 5.1 0.0 0.2 0.2 100.0 99.6 427 North Gaza 84.7 15.0 0.3 0.0 0.0 100.0 99.7 258 Gaza 83.1 15.9 0.0 0.0 1.0 100.0 99.0 469 Dier El-Balah 87.4 12.6 0.0 0.0 0.0 100.0 100.0 174 Khan Yunis 92.9 6.6 0.0 0.0 0.5 100.0 99.5 255 Rafah 90.4 9.6 0.0 0.0 0.0 100.0 100.0 176 Area Urban 91.4 7.9 0.0 0.1 0.5 100.0 99.4 2265 Rural 96.6 3.0 0.0 0.0 0.4 100.0 99.6 436 Camps 85.3 14.2 0.0 0.0 0.5 100.0 99.5 239 Mother's age at birth Less than 20 92.0 7.5 0.1 0.0 0.4 100.0 99.5 1620 20-34 91.3 8.0 0.0 0.1 0.6 100.0 99.3 1270 35-49 92.8 5.5 0.0 0.0 1.7 100.0 98.3 50 Mother’s education None (*) (*) (*) (*) (*) (*) (*) 9 Basic 90.5 8.6 0.0 0.2 0.6 100.0 99.1 798 Secondary 89.9 9.7 0.0 0.1 0.3 100.0 99.6 996 Higher 94.2 5.3 0.1 0.0 0.5 100.0 99.4 1139 Wealth index quintiles Poorest 85.2 14.3 0.0 0.0 0.5 100.0 99.5 728 Second 87.8 11.7 0.1 0.0 0.4 100.0 99.4 563 Middle 93.5 5.6 0.0 0.1 0.7 100.0 99.1 578 Fourth 97.2 2.5 0.0 0.0 0.3 100.0 99.7 606 Richest 97.1 2.0 0.0 0.4 0.5 100.0 99.1 466 [1] MICS indicator 5.5a; MDG indicator 5.5 - Antenatal care coverage [a] Only the most qualified provider is considered in cases where more than one provider was reported. ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases The type of personnel providing antenatal care to women age 15-49 years who gave birth in the two years preceding is presented in Table RH.7. The results show that a relatively small percentage of women do not receive antenatal care. In Palestine, the majority of antenatal care is provided by medical doctors while a minority of women receive care from a traditional birth attendant. No clear differences were observed by background characteristics. 110 Palestinian Multiple Indicator Cluster Survey 2014 99 Table RH.8: Number of antenatal care visits and timing of first visit Percent distribution of women age 15-49 years with a live birth in the last two years by number of antenatal care visits by any provider and by the timing of first antenatal care visits, Palestine, 2014 Percent distribution of women who had: Total No antenatal care visits One visit Two visits Three visits 4 or more visits [1] DK Total 0.5 0.4 1.1 2.0 95.5 0.5 100.0 Region West Bank 0.6 0.2 0.6 2.3 95.7 0.7 100.0 Gaza Strip 0.4 0.6 1.6 1.8 95.3 0.3 100.0 Governorate Jenin 1.4 1.0 1.5 1.8 94.3 0.0 100.0 Tubas (0.0) (0.0) (0.0) (0.0) (100.0) (0.0) (100.0) Tulkarm 0.0 0.0 0.0 0.0 98.7 1.3 100.0 Nablus 0.0 0.0 0.0 3.1 96.3 0.7 100.0 Qalqiliya (0.0) (0.0) (1.5) (1.6) (96.9) (0.0) (100.0) Salfit (0.0) (0.0) (2.0) (4.9) (93.1) (0.0) (100.0) Ramallah & Al-Bireh 0.5 0.0 0.3 2.5 93.7 3.1 100.0 Jericho (0.0) (0.0) (0.0) (5.8) (94.2) (0.0) (100.0) Jerusalem 1.5 0.0 0.0 0.3 97.4 0.9 100.0 Bethlehem 0.7 0.0 0.8 1.7 96.1 0.7 100.0 Hebron 0.2 0.4 0.8 3.4 95.2 0.0 100.0 North Gaza 0.0 0.7 2.1 0.8 96.4 0.0 100.0 Gaza 1.0 1.2 1.5 1.0 94.8 0.5 100.0 Dier El-Balah 0.0 0.0 0.0 3.0 97.0 0.0 100.0 Khan Yunis 0.5 0.0 2.9 4.5 91.6 0.5 100.0 Rafah 0.0 0.0 1.2 0.0 98.8 0.0 100.0 Area Urban 0.5 0.4 1.0 1.7 95.8 0.5 100.0 Rural 0.6 0.4 0.8 2.7 94.7 0.7 100.0 Camps 0.5 0.0 1.5 3.7 94.3 0.0 100.0 Mother's age at birth Less than 20 0.4 0.4 0.9 2.1 95.7 0.5 100.0 20-34 0.6 0.4 1.2 1.8 95.5 0.6 100.0 35-49 1.7 0.0 1.8 6.1 90.3 0.0 100.0 Mother’s education None (*) (*) (*) (*) (*) (*) (*) Basic 0.8 1.3 1.3 2.5 93.8 0.4 100.0 Secondary 0.3 0.0 1.4 2.0 95.9 0.4 100.0 Higher 0.5 0.1 0.6 1.8 96.3 0.7 100.0 Wealth index quintiles Poorest 0.5 0.1 1.2 2.1 95.9 0.1 100.0 Second 0.6 1.4 2.5 1.5 93.8 0.2 100.0 Middle 0.7 0.2 0.4 2.5 96.1 0.2 100.0 Fourth 0.3 0.3 0.6 2.0 95.5 1.3 100.0 Richest 0.5 0.0 0.5 2.0 96.3 0.7 100.0 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 111 100 Table RH.8 Continued: Number of antenatal care visits and timing of first visit Percent distribution of women age 15-49 years with a live birth in the last two years by number of antenatal care visits by any provider and by the timing of first antenatal care visits, Palestine, 2014 Percent distribution of women by number of months pregnant at the time of first antenatal care visit Total Number of women with a live birth in the last two years Median months pregnant at first ANC visit Number of women with a live birth in the last two years who had at least one ANC visit N o antenatal care visits First trim ester 4-5 m onths 6-7 m onths 8+ m onths D K / M issing Total 0.5 85.4 12.5 1.3 0.2 0.1 100.0 2941 2.0 2923 Region West Bank 0.5 93.0 5.7 0.4 0.1 0.2 100.0 1609 1.0 1598 Gaza Strip 0.4 76.2 20.8 2.3 0.3 0.0 100.0 1331 2.0 1325 Governorate Jenin 1.0 91.7 7.1 0.0 0.3 0.0 100.0 186 1.0 184 Tubas (0.0) (95.5) (1.1) (0.0) (0.0) (3.4) (100.0) 25 1.0 24 Tulkarm 0.0 92.6 7.4 0.0 0.0 0.0 100.0 71 1.0 71 Nablus 0.0 93.6 5.8 0.0 0.0 0.6 100.0 190 1.0 189 Qalqiliya (0.0) (98.4) (1.6) (0.0) (0.0) (0.0) (100.0) 48 1.0 48 Salfit (0.0) (97.7) (0.0) (0.0) (0.0) (2.3) (100.0) 35 1.0 34 Ramallah & Al- Bireh 0.5 94.0 5.2 0.3 0.0 0.0 100.0 190 1.0 189 Jericho & Al- Aghwar (0.0) (92.6) (7.4) (0.0) (0.0) (0.0) (100.0) 44 (1.0) 44 Jerusalem 1.5 94.1 4.4 0.0 0.0 0.0 100.0 256 1.0 253 Bethlehem 0.7 96.7 0.7 1.3 0.0 0.6 100.0 137 1.0 135 Hebron 0.2 90.0 8.5 1.1 0.2 0.0 100.0 427 1.0 426 Gaza North 0.0 77.1 19.1 2.9 0.8 0.0 100.0 258 2.0 258 Gaza 1.0 74.5 23.0 1.5 0.0 0.0 100.0 469 2.0 466 Deir El-Balah 0.0 82.7 16.0 1.3 0.0 0.0 100.0 174 2.0 173 Khan Yunis 0.5 73.0 22.6 3.6 0.4 0.0 100.0 255 2.0 254 Rafah 0.0 77.5 19.3 2.5 0.7 0.0 100.0 176 2.0 175 Area Urban 0.5 84.7 13.4 1.1 0.2 0.1 100.0 2265 2.0 2251 Rural 0.4 91.7 6.6 1.0 0.0 0.3 100.0 436 1.0 434 Camps 0.5 80.7 14.8 3.8 0.2 0.0 100.0 239 2.0 238 Mother's age at birth Less than 20 0.4 86.6 11.8 0.9 0.2 0.1 100.0 1620 1.0 1612 20-34 0.6 84.0 13.4 1.7 0.1 0.2 100.0 1270 2.0 1261 35-49 1.7 80.9 13.5 2.0 1.8 0.0 100.0 50 2.0 49 Mother’s education None (*) (*) (*) (*) (*) (*) (*) 9 (*) 9 Basic 0.6 79.0 17.6 2.2 0.5 0.1 100.0 798 2.0 792 Secondary 0.3 86.6 11.8 1.0 0.1 0.1 100.0 996 2.0 991 Higher 0.5 88.7 9.6 0.9 0.1 0.1 100.0 1139 1.0 1131 Wealth index quintiles Poorest 0.5 76.6 20.8 2.0 0.1 0.0 100.0 728 2.0 725 Second 0.4 77.2 19.4 2.4 0.6 0.0 100.0 563 2.0 560 Middle 0.7 88.3 9.6 1.0 0.2 0.1 100.0 578 1.0 573 Fourth 0.3 93.1 6.2 0.3 0.1 0.0 100.0 606 1.0 604 Richest 0.5 95.3 3.1 0.4 0.0 0.6 100.0 466 1.0 461 [1] MICS indicator 5.5b; MDG indicator 5.5 - Antenatal care coverage ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 112 Palestinian Multiple Indicator Cluster Survey 2014 101 Table RH.8 shows the number of antenatal care visits during the latest pregnancy that took place within the two years preceding the survey, regardless of provider, by selected characteristics. Almost mothers (99 percent) received antenatal care more than once and (96 percent) mothers received antenatal care at least four times. No clear differences were observed by background characteristics. Table RH.8 also provides information about the timing of the first antenatal care visit. Overall, 85 percent of women with a live birth in the last two years had their first antenatal care visit during the first trimester of their last pregnancy, with a median of 2 months of pregnancy at the first visit among those who received antenatal care. Table RH.9: Content of antenatal care Percentage of women age 15-49 years with a live birth in the last two years 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, Palestine, 2014 Percentage 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 97.7 97.0 97.6 95.8 2940 Region 97.0 95.9 96.9 93.9 1609 West Bank 98.4 98.4 98.5 98.1 1331 Gaza Strip Governorate 97.5 94.3 97.6 93.7 186 Jenin (100.0) (98.8) (100.0) (98.8) 25 Tubas 92.7 93.1 94.6 86.1 71 Tulkarm 95.7 95.1 95.5 89.5 190 Nablus (96.6) (90.2) (96.8) (88.5) 48 Qalqiliya (98.0) (95.5) (95.5) (95.5) 35 Salfit 95.8 97.6 97.0 94.7 190 Ramallah & Al-Bireh (100.0) (100.0) (98.3) (98.3) 44 Jericho 98.3 98.1 98.5 97.8 256 Jerusalem 95.6 96.2 96.2 93.1 137 Bethlehem 97.9 95.4 96.4 94.3 427 Hebron 99.3 99.3 99.3 99.3 258 North Gaza 97.3 97.5 97.3 97.1 469 Gaza 99.5 99.5 99.5 99.5 174 Dier El-Balah 98.3 97.6 98.6 96.9 255 Khan Yunis 99.3 99.3 99.3 99.3 176 Rafah 97.5 94.3 97.6 93.7 186 Area Urban 97.6 97.0 97.5 95.9 2265 Rural 97.4 96.5 98.1 94.5 436 Camps 98.6 98.4 97.6 97.2 239 Mother's age at birth Less than 20 98.1 97.4 97.9 96.3 1620 20-34 97.1 96.5 97.1 94.9 1270 35-49 98.3 98.3 98.3 98.3 50 Mother’s education None (*) (*) (*) (*) 9 Basic 97.2 96.3 97.0 95.1 798 Secondary 97.6 97.1 97.9 95.7 996 Higher 98.0 97.4 97.7 96.3 1139 Wealth index quintiles Poorest 98.7 98.6 98.7 98.4 728 Second 98.0 97.5 98.2 97.2 563 Middle 96.8 95.7 96.4 93.8 578 Fourth 98.6 97.1 97.6 95.2 606 Richest 95.5 95.6 96.7 93.1 466 [1] MICS indicator 5.6 - Content of antenatal care ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 113 102 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 during the two years preceding the survey, 98 percent reported that a blood sample was taken during antenatal care visits, 98 percent that their blood pressure was checked, and 97 percent that urine specimen was taken. Approximately 96 percent reported that they received all three key services during their antenatal care i.e. their blood pressure was measured, urine and blood sample were taken. Assistance at Delivery About three quarters of all maternal deaths occur during delivery or the immediate post- partum period. 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 that transport is available to a referral facility for obstetric care. The skilled attendant at delivery indicator is used to track progress toward the Millennium Development Goal 5 of improving maternal health. The MICS included a number of questions to assess the proportion of births attended by a skilled attendant. A skilled attendant includes a doctor, nurse, or midwife. 114 Palestinian Multiple Indicator Cluster Survey 2014 10 3 T ab le R H .1 0: A ss is ta nc e du rin g de liv er y an d ca es ar ia n se ct io n P er ce nt d is tri bu tio n of w om en a ge 1 5- 49 y ea rs w ith a li ve b irt h in th e la st tw o ye ar s by p er so n pr ov id in g as si st an ce a t d el iv er y, a nd p er ce nt ag e of b irt hs d el iv er ed b y C -s ec tio n, P al es tin e, 2 01 4 Pe rs on a ss is tin g at d el iv er y N o at te nd an t To ta l D el iv er y as si st ed by a ny sk ill ed at te nd an t1 Pe rc en t d el iv er ed b y C -s ec tio n N um be r o f w om en w ho h ad a liv e bi rth in th e la st tw o ye ar s M ed ic al do ct or N ur se / M id w ife Tr ad iti on al bi rth at te nd an t R el at iv e/ Fr ie nd O th er D ec id ed be fo re o ns et of la bo ur pa in s D ec id ed af te r o ns et of la bo ur pa in s To ta l2 To ta l 75 .4 24 .1 0. 0 0. 2 0. 1 0. 1 10 0. 0 99 .6 14 .8 5. 5 20 .3 29 41 R eg io n W es t B an k 64 .4 35 .2 0. 0 0. 1 0. 3 0. 1 10 0. 0 99 .6 16 .3 6. 4 22 .7 16 10 G az a S tri p 88 .8 10 .7 0. 1 0. 3 0. 0 0. 1 10 0. 0 99 .5 13 .1 4. 4 17 .4 13 31 G ov er no ra te Je ni n 61 .5 38 .5 0. 0 0. 0 0. 0 0. 0 10 0. 0 10 0. 0 20 .3 6. 4 26 .7 18 6 Tu ba s (7 1. 8) (2 8. 2) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (1 00 .0 ) (1 00 .0 ) (1 1. 4) (1 2. 5) (2 3. 9) 25 Tu lk ar m 73 .0 27 .0 0. 0 0. 0 0. 0 0. 0 10 0. 0 10 0. 0 11 .8 4. 2 16 .0 71 N ab lu s 79 .8 20 .2 0. 0 0. 0 0. 0 0. 0 10 0. 0 10 0. 0 25 .2 7. 6 32 .7 19 0 Q al qi liy a (5 4. 6) (4 5. 4) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (1 00 .0 ) (1 00 .0 ) (2 5. 1) (5 .4 ) (3 0. 5) 48 S al fit (8 5. 5) (1 4. 5) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (1 00 .0 ) (1 00 .0 ) (1 7. 5) (1 4. 2) (3 1. 7) 35 R am al la h & A l-B ire h 68 .6 30 .5 0. 0 0. 0 0. 5 0. 5 10 0. 0 99 .1 16 .9 8. 4 25 .2 19 0 Je ric ho (8 7. 4) (1 2. 6) (0 .0 ) (0 .0 ) (0 .0 ) (0 . 0 ) (1 00 .0 ) (1 00 .0 ) (1 3. 0) (1 2. 8) (2 5. 9) 44 Je ru sa le m 73 .6 25 .2 0. 0 0. 3 0. 9 0. 0 10 0. 0 98 .9 18 .9 6. 0 24 .8 25 7 B et hl eh em 49 .9 49 .4 0. 0 0. 0 0. 7 0. 0 10 0. 0 99 .3 11 .7 5. 9 17 .6 13 7 H eb ro n 51 .1 48 .7 0. 0 0. 2 0. 0 0. 0 10 0. 0 99 .8 10 .6 4. 2 14 .9 42 7 N or th G az a 88 .9 10 .4 0. 0 0. 7 0. 0 0. 0 10 0. 0 99 .3 16 .0 2. 2 18 .3 25 8 G az a 89 .2 10 .6 0. 0 0. 2 0. 0 0. 0 10 0. 0 99 .8 12 .6 5. 3 17 .9 47 1 D ie r E l-B al ah 90 .2 9. 8 0. 0 0. 0 0. 0 0. 0 10 0. 0 10 0. 0 9. 9 5. 5 15 .4 17 3 K ha n Y un is 84 .4 15 .2 0. 4 0. 0 0. 0 0. 0 10 0. 0 99 .6 12 .2 4. 6 16 .8 25 5 R af ah 92 .9 5. 8 0. 0 0. 7 0. 0 0. 6 10 0. 0 98 .7 14 .4 3. 5 17 .9 17 5 A re a U rb an 75 .4 24 .2 0. 0 0. 2 0. 1 0. 0 10 0. 0 99 .6 14 .1 5. 3 19 .4 22 65 R ur al 72 .3 27 .3 0. 0 0. 0 0. 2 0. 2 10 0. 0 99 .6 17 .6 6. 5 24 .1 43 7 C am ps 81 .1 18 .2 0. 0 0. 7 0. 0 0. 0 10 0. 0 99 .3 16 .8 5. 6 22 .4 24 0 1 M IC S in di ca to r 5 .7 ; M D G in di ca to r 5 .2 - Sk ill ed a tte 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 ( ) F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s 115 10 4 T ab le R H .1 0 C on tin ue d: A ss is ta nc e du rin g de liv er y an d ca es ar ia n se ct io n P er ce nt d is tri bu tio n of w om en a ge 1 5- 49 y ea rs w ith a li ve b irt h in th e la st tw o ye ar s by p er so n pr ov id in g as si st an ce a t d el iv er y, a nd p er ce nt ag e of b irt hs d el iv er ed b y C -s ec tio n, P al es tin e, 2 01 4 Pe rs on a ss is tin g at d el iv er y N o at te nd an t To ta l D el iv er y as si st ed by a ny sk ill ed at te nd an t1 Pe rc en t d el iv er ed b y C -s ec tio n N um be r o f w om en w ho ha d a liv e bi rth in th e la st tw o ye ar s M ed ic al do ct or N ur se / M id w ife Tr ad iti on al bi rth at te nd an t R el at iv e/ Fr ie nd O th er D ec id ed be fo re o ns et of la bo ur pa in s D ec id ed af te r o ns et of la bo ur pa in s To ta l2 M ot he r's a ge a t b irt h Le ss th an 2 0 77 .4 22 .0 0. 1 0. 3 0. 2 0. 1 10 0. 0 99 .4 12 .8 5. 3 18 .1 16 20 20 -3 4 72 .7 27 .0 0. 0 0. 1 0. 1 0. 1 10 0. 0 99 .8 16 .8 5. 5 22 .4 12 70 35 -4 9 81 .1 18 .9 0. 0 0. 0 0. 0 0. 0 10 0. 0 10 0. 0 30 .1 10 .2 40 .3 50 Pl ac e of d el iv er y H om e (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 15 H ea lth fa ci lit y 76 .0 24 .0 0. 0 0. 0 0. 0 0. 0 10 0. 0 99 .9 14 .9 5. 5 20 .5 29 21 P ub lic 76 .0 24 .0 0. 0 0. 0 0. 0 0. 1 10 0. 0 99 .9 14 .9 5. 3 20 .2 17 88 P riv at e 79 .1 20 .9 0. 0 0. 0 0. 0 0. 0 10 0. 0 10 0. 0 14 .2 5. 6 19 .8 74 9 N G O s 67 .7 32 .3 0. 0 0. 0 0. 0 0. 0 10 0. 0 10 0. 0 15 .9 6. 6 22 .5 27 1 U N R W A (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 23 Is ra el i 73 .9 25 .3 0. 0 0. 8 0. 0 0. 0 10 0. 0 99 .2 15 .5 6. 1 21 .6 90 O th er /D K /M is si ng (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 5 Ed uc at io n N on e (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 9 P rim ar y 75 .0 24 .7 0. 0 0. 3 0. 0 0. 0 10 0. 0 99 .7 17 .4 4. 9 22 .3 79 8 S ec on da ry 75 .5 24 .0 0. 1 0. 2 0. 0 0. 2 10 0. 0 99 .5 13 .4 5. 5 18 .9 99 6 H ig he r 75 .8 23 .7 0. 0 0. 1 0. 4 0. 0 10 0. 0 99 .5 14 .3 5. 9 20 .2 11 39 W ea lth in de x qu in til es P oo re st 88 .5 11 .2 0. 1 0. 2 0. 0 0. 0 10 0. 0 99 .7 13 .8 3. 9 17 .7 72 8 S ec on d 81 .9 17 .4 0. 0 0. 5 0. 0 0. 2 10 0. 0 99 .3 11 .6 5. 3 16 .9 56 3 M id dl e 67 .7 31 .8 0. 0 0. 2 0. 2 0. 2 10 0. 0 99 .5 15 .1 5. 2 20 .3 57 8 Fo ur th 64 .7 35 .1 0. 0 0. 0 0. 1 0. 0 10 0. 0 99 .9 15 .4 6. 5 21 .9 60 6 R ic he st 70 .6 28 .7 0. 0 0. 1 0. 5 0. 0 10 0. 0 99 .4 19 .3 7. 3 26 .5 46 6 1 M IC S in di ca to r 5 .7 ; M D G in di ca to r 5 .2 - Sk ill ed a tte 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 (* ) F ig ur es th at a re b as ed o n le ss th an 2 5 un w ei gh te d ca se s 116 Palestinian Multiple Indicator Cluster Survey 2014 105 Nearly all births (99.6%) occurring in the two years preceding the MICS survey were delivered by skilled personnel (Table RH.10). No clear differences were observed by background characteristics. Approximately one in every four births in the two years preceding the MICS survey were delivered with assistance by a midwife/nurses. Doctors assisted with the delivery of 75 percent of births. Figure RH.3: Person assist ing at del ivery, Palest ine, 2014 Table RH.10 also shows information on women who delivered by caesarian section (C- section) and provides additional information on the timing of the decision to conduct a C- section (before labour pains began or after) in order to better assess if such decisions are mostly driven by medical or non–medical reasons. Overall, 20 percent of women who delivered in the last two years had a C-section; for 15 percent of women, the decision was taken before the onset of labour pains and for 6 percent after. Twenty three percent of women who delivered in the last two years had a C-section in the West Bank compared with 17 percent of women who delivered in the last two years had a C-section in Gaza Strip. 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 percent distribution of women age 15-49 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. 117 106 Table RH.11: Place of delivery Percent distribution of women age 15-49 years with a live birth in the last two years by place of delivery of their last birth, Palestine, 2014 Place of delivery Total Delivered in health facility [1] Number of women with a live birth in the last two years Health facility Other Missing/DK P ublic sector P rivate sector N G O 's sector U N R W A sector Israeli sector H om e Total 60.8 25.5 9.2 0.8 3.1 0.5 0.0 0.1 100.0 99.3 2941 Region West Bank 47.4 32.5 12.5 1.4 5.5 0.5 0.0 0.3 100.0 99.3 1610 Gaza Strip 77.0 16.9 5.2 0.1 0.1 0.6 0.1 0.0 100.0 99.4 1331 Governorate Jenin 69.4 29.0 0.0 0.0 0.5 1.2 0.0 0.0 100.0 98.8 186 Tubas (80.2) (19.8) (0.0) (0.0) (0.0) (0.0) (0.0) (0.0) (100.0) (100.0) 25 Tulkarm 51.4 37.8 6.1 1.4 0.0 3.3 0.0 0.0 100.0 96.7 71 Nablus 55.4 42.1 0.6 0.8 1.1 0.0 0.0 0.0 100.0 100.0 190 Qalqiliya (48.8) (17.4) (0.0) (28.3) (1.5) (4.0) (0.0) (0.0) (100.0) (96.0) 48 Salfit (76.9) (23.1) (0.0) (0.0) (0.0) (0.0) (0.0) (0.0) (100.0) (100.0) 35 Ramallah & Al-Bireh 43.9 33.0 21.5 1.1 0.0 0.0 0.0 0.5 100.0 99.5 190 Jericho & Al- Aghwar (66.7) (18.0) (10.4) (4.9) (0.0) (0.0) (0.0) (0.0) (100.0) (100.0) 44 Jerusalem 15.8 18.8 32.7 0.6 31.3 0.0 0.0 0.9 100.0 99.1 257 Bethlehem 36.2 52.1 10.4 0.0 0.5 0.0 0.0 0.7 100.0 99.3 137 Hebron 51.2 35.4 12.3 0.0 0.9 0.2 0.0 0.0 100.0 99.8 427 Gaza North 63.3 23.0 13.0 0.0 0.0 0.3 0.3 0.0 100.0 99.3 258 Gaza 72.1 21.9 5.5 0.0 0.0 0.5 0.0 0.0 100.0 99.5 471 Deir El- Balah 84.1 12.1 3.9 0.0 0.0 0.0 0.0 0.0 100.0 100.0 173 Khan Yunis 91.1 6.0 1.3 0.3 0.5 0.8 0.0 0.0 100.0 99.2 255 Rafah 83.3 15.4 0.0 0.0 0.0 1.3 0.0 0.0 100.0 98.7 175 Area Urban 59.3 25.8 9.9 0.6 3.7 0.5 0.0 0.1 100.0 99.3 2265 Rural 66.4 25.7 5.6 1.0 0.6 0.5 0.0 0.2 100.0 99.3 437 Camps 65.4 22.0 8.9 1.9 1.4 0.5 0.0 0.0 100.0 99.5 240 Mother's age at birth Less than 20 60.5 25.4 9.2 0.8 3.1 0.8 0.1 0.2 100.0 99.0 1620 20-34 61.2 25.7 9.1 0.7 2.9 0.2 0.0 0.1 100.0 99.7 1270 35-49 59.7 23.5 12.3 0.0 4.4 0.0 0.0 0.0 100.0 100.0 50 Number of antenatal care visits None (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 15 1-3 visits 66.5 27.1 4.3 1.5 0.7 0.0 0.0 0.0 100.0 100.0 102 4+ visits 60.8 25.4 9.3 0.8 3.2 0.5 0.0 0.0 100.0 99.4 2809 Mother’s education None (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 9 Basic 64.1 20.5 9.8 1.1 3.9 0.6 0.0 0.0 100.0 99.4 798 Secondary 65.2 21.7 8.4 0.6 3.4 0.7 0.0 0.0 100.0 99.3 996 Higher 54.8 32.3 9.4 0.6 2.2 0.3 0.1 0.4 100.0 99.3 1139 Wealth index quintiles Poorest 81.2 13.9 4.3 0.1 0.0 0.5 0.0 0.0 100.0 99.5 728 Second 72.4 20.1 6.3 0.0 0.2 0.8 0.2 0.0 100.0 99.1 563 Middle 65.8 22.5 6.9 2.2 1.9 0.6 0.0 0.2 100.0 99.3 578 Fourth 47.1 32.5 14.0 1.2 4.6 0.5 0.0 0.1 100.0 99.3 606 Richest 26.5 44.6 17.1 0.4 10.7 0.2 0.0 0.5 100.0 99.3 466 [1] MICS indicator 5.8 - Institutional deliveries ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 118 Palestinian Multiple Indicator Cluster Survey 2014 107 About 99 percent of births in Palestine are delivered in a health facility; 61 percent of deliveries occur in public sector facilities, 26 percent in private sector facilities, 9 percent in NGO's sector facilities, 1 percent in UNRWA sector facilities, 3 percent in Israeli health facilities. 1 percent of births take place at home. No clear differences were observed by background characteristics. Figure RH.4 shows the Continuum of reproductive and maternal health interventions, covering three periods: pre-pregnancy (% of demand for contraception satisfied) and Antenatal care coverage (% of pregnant women received at least one visit by skilled personnel, 4 visits or more, % of pregnant women who, at least once, had their blood pressure measured, urine sample taken, and blood sample taken as part of antenatal care or all three) and delivery care (% of deliveries assisted by any skilled attendant, and % of deliveries occurred in health facilities). Figure RH.4: Continuum of reproduct ive and maternal health intervent ions, Palest ine, 2014 Post-natal 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 life4 and the majority of these deaths occur within a day or two of birth5, which is also the time when the majority of maternal deaths occur6. 4  UN  Interagency  Group  for  Child  Mortality  Estimation,  2013.  Levels  and  Trends  in  Child  Mortality:  Report  2013   5  Lawn  JE,  Cousens  S,  Zupan  J.  4  million  neonatal  deaths:  When?  Where?  Why?  Lancet  2005;  365:891–900.   6  WHO,  UNICEF,  UNFPA,  The  World  Bank.  Trends  in  Maternal  Mortality:  1990-­‐2010.  Geneva:  World  Health   Organization  2012.     119 108 Despite the importance of the first few days following birth, large-scale, nationally representative household survey programmes have not systematically included questions on the post-natal 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 post-natal care (PNC) programmes to be strengthened, but also for better data availability and quality7. Following the establishment and discussions of an Inter-Agency Group on PNC and drawing on lessons learned from earlier attempts of collecting PNC data, a new questionnaire module for MICS was developed and validated. Named the Post-natal 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 PNC 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. Table RH.12 presents the percent distribution of women age 15-49 who gave birth in a health facility in the two years preceding the survey by duration of stay in the facility following the delivery, according to background characteristics. 7  Countdown  to  2015:  Tracking  Progress  in  Maternal,  Newborn  &  Child  Survival,  The  2008  Report.  New  York:   UNICEF  2008.   109 Table RH.12: Post-partum stay in health facility Percent distribution of women age 15-49 years with a live birth in the last two years who had their last birth delivered in a health facility by duration of stay in health facility, Palestine, 2014 Duration of stay in health facility Total 12 hours or more [1] Number of women who had their last birth delivered in a health facility in the last 2 years Less than 6 hours 6-11 hours 12-23 hours 1-2 days 3 days or more Total 31.2 10.2 2.4 40.9 15.2 100.0 58.5 2921 Region West Bank 9.2 9.5 3.1 60.0 18.2 100.0 81.3 1598 Gaza Strip 57.8 11.1 1.7 17.7 11.6 100.0 31.0 1322 Governorate Jenin 27.7 11.9 1.8 51.1 7.4 100.0 60.4 184 Tubas (17.6) (8.0) (9.9) (45.9) (18.9) (100.0) (74.5) 25 Tulkarm 23.8 18.7 1.3 39.5 16.6 100.0 57.4 69 Nablus 12.2 12.9 5.7 58.4 10.7 100.0 74.8 190 Qalqiliya (3.4) (18.9) (5.4) (51.3) (21.0) (100.0) (77.6) 46 Salfit (10.0) (7.7) (0.0) (63.3) (19.0) (100.0) (82.3) 35 Ramallah & Al- Bireh 2.1 6.4 3.5 77.1 10.9 100.0 91.4 189 Jericho (13.2) (6.3) (1.6) (58.5) (20.4) (100.0) (80.5) 44 Jerusalem 1.4 3.1 0.3 46.0 49.1 100.0 95.4 255 Bethlehem 3.5 7.7 6.6 67.2 15.0 100.0 88.8 136 Hebron 6.8 10.7 2.7 68.0 11.7 100.0 82.4 426 North Gaza 50.2 13.7 2.2 20.5 13.3 100.0 36.1 256 Gaza 59.0 9.4 1.2 17.1 13.3 100.0 31.6 468 Dier El-Balah 72.9 7.9 1.3 13.7 4.2 100.0 19.2 173 Khan Yunis 57.3 10.2 3.1 17.4 11.9 100.0 32.5 253 Rafah 51.8 16.5 0.5 19.8 11.5 100.0 31.8 172 Area 33.2 10.1 2.2 38.8 15.7 100.0 56.7 2249 Urban 16.0 10.5 3.9 57.6 11.9 100.0 73.5 434 Rural 40.7 10.9 2.3 29.7 16.3 100.0 48.3 238 Camps Mother's age at birth Less than 20 32.5 9.6 2.8 40.6 14.6 100.0 58.0 1604 20-34 29.9 11.2 2.1 41.2 15.6 100.0 58.9 1267 35-49 25.8 6.6 0.0 41.6 26.0 100.0 67.6 50 Type of health facility Public 36.8 12.2 2.9 35.7 12.3 100.0 51.0 1788 Private 27.6 7.9 1.3 53.0 10.2 100.0 64.5 749 NGO's 16.5 6.0 2.5 47.8 27.2 100.0 77.5 271 UNRWA (*) (*) (*) (*) (*) (*) (*) 23 Israeli 2.0 2.1 0.0 21.6 74.3 100.0 95.9 90 Type of delivery Vaginal birth 39.1 12.9 3.0 39.1 5.9 100.0 48.0 2322 C-section 0.7 0.0 0.3 47.7 51.3 100.0 99.3 599 Mother’s education None (*) (*) (*) (*) (*) (*) (*) 9 Basic 32.5 8.4 2.3 39.8 16.9 100.0 59.0 793 Secondary 31.9 10.8 2.2 39.0 16.1 100.0 57.3 988 Higher 29.8 11.0 2.8 43.3 13.3 100.0 59.3 1130 Wealth index quintiles Poorest 55.2 11.9 2.0 19.0 12.0 100.0 32.9 725 Second 52.2 10.2 1.6 25.6 10.4 100.0 37.6 558 Middle 22.3 10.5 3.4 49.3 14.4 100.0 67.2 574 Fourth 9.8 9.4 3.0 58.8 18.9 100.0 80.7 602 Richest 7.3 8.3 2.3 59.6 22.3 100.0 84.3 462 [1] MICS indicator 5.10 - Post-partum stay in health facility ( ) Figures that are based on 25-49 unweighted cases, (*) Figures that are based on less than 25 unweighted cases 120 Palestinian Multiple Indicator Cluster Survey 2014 109 Table RH.12: Post-partum stay in health facility Percent distribution of women age 15-49 years with a live birth in the last two years who had their last birth delivered in a health facility by duration of stay in health facility, Palestine, 2014 Duration of stay in health facility Total 12 hours or more [1] Number of women who had their last birth delivered in a health facility in the last 2 years Less than 6 hours 6-11 hours 12-23 hours 1-2 days 3 days or more Total 31.2 10.2 2.4 40.9 15.2 100.0 58.5 2921 Region West Bank 9.2 9.5 3.1 60.0 18.2 100.0 81.3 1598 Gaza Strip 57.8 11.1 1.7 17.7 11.6 100.0 31.0 1322 Governorate Jenin 27.7 11.9 1.8 51.1 7.4 100.0 60.4 184 Tubas (17.6) (8.0) (9.9) (45.9) (18.9) (100.0) (74.5) 25 Tulkarm 23.8 18.7 1.3 39.5 16.6 100.0 57.4 69 Nablus 12.2 12.9 5.7 58.4 10.7 100.0 74.8 190 Qalqiliya (3.4) (18.9) (5.4) (51.3) (21.0) (100.0) (77.6) 46 Salfit (10.0) (7.7) (0.0) (63.3) (19.0) (100.0) (82.3) 35 Ramallah & Al- Bireh 2.1 6.4 3.5 77.1 10.9 100.0 91.4 189 Jericho (13.2) (6.3) (1.6) (58.5) (20.4) (100.0) (80.5) 44 Jerusalem 1.4 3.1 0.3 46.0 49.1 100.0 95.4 255 Bethlehem 3.5 7.7 6.6 67.2 15.0 100.0 88.8 136 Hebron 6.8 10.7 2.7 68.0 11.7 100.0 82.4 426 North Gaza 50.2 13.7 2.2 20.5 13.3 100.0 36.1 256 Gaza 59.0 9.4 1.2 17.1 13.3 100.0 31.6 468 Dier El-Balah 72.9 7.9 1.3 13.7 4.2 100.0 19.2 173 Khan Yunis 57.3 10.2 3.1 17.4 11.9 100.0 32.5 253 Rafah 51.8 16.5 0.5 19.8 11.5 100.0 31.8 172 Area 33.2 10.1 2.2 38.8 15.7 100.0 56.7 2249 Urban 16.0 10.5 3.9 57.6 11.9 100.0 73.5 434 Rural 40.7 10.9 2.3 29.7 16.3 100.0 48.3 238 Camps Mother's age at birth Less than 20 32.5 9.6 2.8 40.6 14.6 100.0 58.0 1604 20-34 29.9 11.2 2.1 41.2 15.6 100.0 58.9 1267 35-49 25.8 6.6 0.0 41.6 26.0 100.0 67.6 50 Type of health facility Public 36.8 12.2 2.9 35.7 12.3 100.0 51.0 1788 Private 27.6 7.9 1.3 53.0 10.2 100.0 64.5 749 NGO's 16.5 6.0 2.5 47.8 27.2 100.0 77.5 271 UNRWA (*) (*) (*) (*) (*) (*) (*) 23 Israeli 2.0 2.1 0.0 21.6 74.3 100.0 95.9 90 Type of delivery Vaginal birth 39.1 12.9 3.0 39.1 5.9 100.0 48.0 2322 C-section 0.7 0.0 0.3 47.7 51.3 100.0 99.3 599 Mother’s education None (*) (*) (*) (*) (*) (*) (*) 9 Basic 32.5 8.4 2.3 39.8 16.9 100.0 59.0 793 Secondary 31.9 10.8 2.2 39.0 16.1 100.0 57.3 988 Higher 29.8 11.0 2.8 43.3 13.3 100.0 59.3 1130 Wealth index quintiles Poorest 55.2 11.9 2.0 19.0 12.0 100.0 32.9 725 Second 52.2 10.2 1.6 25.6 10.4 100.0 37.6 558 Middle 22.3 10.5 3.4 49.3 14.4 100.0 67.2 574 Fourth 9.8 9.4 3.0 58.8 18.9 100.0 80.7 602 Richest 7.3 8.3 2.3 59.6 22.3 100.0 84.3 462 [1] MICS indicator 5.10 - Post-partum stay in health facility ( ) Figures that are based on 25-49 unweighted cases, (*) Figures that are based on less than 25 unweighted cases 121 110 Overall, 59 percent of women who gave birth in a health facility stay 12 hours or more in the facility after delivery. Across the country, the percentage of women who stay 12 hours or more varies from 81 percent in the West Bank to 31 percent in Gaza Strip. A much higher proportion (78 percent) of women delivering in NGO's facilities stay 12 hours or more than those delivering in private facilities (65 percent) or public facilities (51 percent). A similar disparity exists between rural (74 percent) and urban women (57 percent). As expected, nearly all women (99 percent) giving birth through C-section stay 12 hours or more in the facility after giving birth. The woman’s age at delivery has a bearing on the length of stay where 68 percent of older women ages 35-49 years stay 12 hours or more compared to around 58 percent of women of of younger ages of less than 20-34 years. There are no clear patterns with regards to woman education. However, looking at the wealth of the household, there seems to be an alarmingly high proportion (55 percent) of women from the poorest of households that stay less than 6 hours after delivery. Safe motherhood programmes have recently increased emphasis on the importance of post- natal care, recommending that all women and newborns receive a health check within two days of delivery. To assess the extent of post-natal 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 for the woman’s last birth in the two years preceding the survey. Table RH.13 shows the percentage of newborns born in the last two years who received health checks and post-natal care visits from any health provider after birth. Please note that health checks following birth while in facility or at home refer to checks provided by any health provider regardless of timing (column 1), whereas post-natal care visits 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 Post-natal health checks includes any health check after birth received while in the health facility and at home (column 1), regardless of timing, as well as PNC visits within two days of delivery (columns 2, 3, and 4). 122 Palestinian Multiple Indicator Cluster Survey 2014 11 1 Ta bl e R H .1 3: P os t-n at al h ea lth c he ck s fo r n ew bo rn s P er ce nt ag e of w om en a ge 1 5- 49 y ea rs w ith a li ve b irt h in th e la st tw o ye ar s w ho se la st li ve b irt h re ce iv ed h ea lth c he ck s w hi le in fa ci lit y or a t h om e fo llo w in g bi rth , p er ce nt d is tri bu tio n w ho se la st li ve b irt h re ce iv ed p os t-n at al c ar e (P N C ) v is its fr om a ny h ea lth p ro vi de r a fte r b irt h, b y tim in g of v is it, a nd p er ce nt ag e w ho re ce iv ed p os t n at al h ea lth c he ck s, P al es tin e, 2 01 4 H ea lth c he ck fo llo w in g bi rth w hi le in fa ci lit y or a t ho m e [a ] PN C v is it fo r n ew bo rn s [b ] P os t-n at al he al th c he ck fo r t he ne w bo rn [1 ], [c ] N um be r o f la st li ve bi rth s in th e la st tw o ye ar s S am e da y 1 da y fo llo w in g bi rth 2 da ys fo llo w in g bi rth 3- 6 da ys fo llo w in g bi rth A fte r t he fi rs t w ee k fo llo w in g bi rth N o po st - na ta l c ar e vi si t D K To ta l To ta l 93 .6 0. 9 1. 2 2. 0 20 .4 50 .1 23 .5 1. 9 10 0. 0 93 .9 29 41 R eg io n W es t B an k 96 .7 0. 9 1. 2 2. 6 13 .1 38 .4 40 .5 3. 4 10 0. 0 96 .9 16 10 G az a S tri p 89 .9 0. 8 1. 1 1. 3 29 .3 64 .2 3. 1 0. 1 10 0. 0 90 .2 13 31 G ov er no ra te 10 0. 0 Je ni n 93 .4 2. 1 3. 9 2. 8 20 .6 35 .8 31 .6 3. 2 10 0. 0 94 .5 18 6 Tu ba s (9 5. 8) (0 .0 ) (0 .0 ) (7 .1 ) (1 7. 4) (3 8. 0) (3 3. 2) (4 .2 ) (1 00 .0 ) (9 5. 8) 25 Tu lk ar m 91 .3 2. 0 0. 0 6. 6 25 .5 23 .9 39 .7 2. 4 10 0. 0 91 .3 71 N ab lu s 92 .7 1. 2 2. 3 2. 4 20 .8 52 .4 19 .7 1. 1 10 0. 0 92 .7 19 0 Q al qi liy a (9 6. 7) (1 .9 ) (3 .8 ) (1 .6 ) (2 5. 3) (5 3. 0) (1 2. 7) (1 .6 ) (1 00 .0 ) (9 8. 4) 48 S al fit (9 0. 2) (0 .0 ) (0 .0 ) (6 .6 ) (1 0. 9) (4 5. 9) (1 6. 9) (1 9. 7) (1 00 .0 ) (9 0. 2) 35 R am al la h & A l-B ire h 99 .0 2. 4 0. 7 3. 5 8. 3 37 .7 41 .9 5. 5 10 0. 0 99 .0 19 0 Je ric ho (9 8. 3) (0 .0 ) (1 .6 ) (2 .1 ) (3 0. 2) (7 .2 ) (5 8. 9) (0 .0 ) (1 00 .0 ) (9 8. 3) 44 Je ru sa le m 98 .7 0. 0 0. 4 2. 1 8. 5 40 .2 41 .3 7. 5 10 0. 0 98 .7 25 7 B et hl eh em 98 .7 0. 0 1. 2 1. 0 4. 3 42 .1 50 .8 0. 6 10 0. 0 98 .7 13 7 H eb ro n 98 .4 0. 2 0. 1 1. 7 9. 0 34 .9 52 .8 1. 2 10 0. 0 98 .7 42 7 N or th G az a 97 .1 1. 6 1. 9 2. 5 29 .6 57 .7 6. 7 0. 0 10 0. 0 97 .8 25 8 G az a 92 .6 0. 8 1. 2 1. 1 20 .8 71 .9 3. 9 0. 4 10 0. 0 92 .6 47 1 D ie r E l-B al ah 84 .6 0. 6 0. 6 1. 7 39 .5 57 .5 0. 0 0. 0 10 0. 0 84 .6 17 3 K ha n Y un is 78 .0 0. 0 1. 3 .4 34 .3 61 .8 2. 2 0. 0 10 0. 0 78 .0 25 5 R af ah 94 .5 1. 3 0. 0 1. 3 34 .2 63 .1 0. 0 0. 0 10 0. 0 95 .8 17 5 A re a U rb an 93 .9 0. 8 1. 0 2. 0 20 .7 52 .2 21 .9 1. 5 10 0. 0 94 .2 22 65 R ur al 94 .1 1. 1 1. 5 2. 2 16 .8 38 .4 36 .0 4. 1 10 0. 0 94 .3 43 7 C am ps 90 .3 1. 1 1. 6 1. 4 25 .2 51 .6 16 .7 2. 3 10 0. 0 90 .3 24 0 [1 ] M IC S in di ca to r 5 .1 1 - P os t-n at al h ea lth c he ck fo r t he n ew bo rn [a ] H ea lth c he ck s by a ny h ea lth p ro vi de r f ol lo w in g fa ci lit y bi rth s (b ef or e di sc ha rg e fro m fa ci lit y) o r f ol lo w in g ho m e bi rth s (b ef or e de pa rtu re o f p ro vi de r f ro m h om e) . [b ] P os t-n at al c ar e vi si ts (P N C ) r ef er to a s ep ar at e vi si t b y an y he al th p ro vi de r t o ch ec k on th e he al th o f t he n ew bo rn a nd p ro vi de p re ve nt iv e ca re s er vi ce s. P N C v is its d o no t i nc lu de h ea lth c he ck s fo llo w in g bi rth w hi le in fa ci lit y or a t h om e (s ee n ot e a ab ov e) . [c ] P os t-n at al h ea lth c he ck s in cl ud e an y he al th c he ck p er fo rm ed w hi le in th e he al th fa ci lit y or a t h om e fo llo w in g bi rth (s ee n ot e a ab ov e) , a s w el l a s P N C v is its (s ee n ot e b ab ov e) w ith in tw o da ys o f d el iv er y. (* ) F ig ur es th at a re b as ed o n le ss th an 2 5 un w ei gh te d ca se s ( ) F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s 123 11 2 Ta bl e R H .1 3 C on tin ue d: P os t-n at al h ea lth c he ck s fo r n ew bo rn s P er ce nt ag e of w om en a ge 1 5- 49 y ea rs w ith a li ve b irt h in th e la st tw o ye ar s w ho se la st li ve b irt h re ce iv ed h ea lth c he ck s w hi le in fa ci lit y or a t h om e fo llo w in g bi rth , p er ce nt d is tri bu tio n w ho se la st li ve b irt h re ce iv ed p os t-n at al c ar e (P N C ) v is its fr om a ny h ea lth p ro vi de r a fte r b irt h, b y tim in g of v is it, a nd p er ce nt ag e w ho re ce iv ed p os t n at al h ea lth c he ck s, P al es tin e, 2 01 4 H ea lth c he ck fo llo w in g bi rth w hi le in fa ci lit y or a t ho m e [a ] PN C v is it fo r n ew bo rn s [b ] P os t-n at al he al th c he ck fo r t he ne w bo rn [1 ], [c ] N um be r o f la st li ve bi rth s in th e la st tw o ye ar s S am e da y 1 da y fo llo w in g bi rth 2 da ys fo llo w in g bi rth 3- 6 da ys fo llo w in g bi rth A fte r t he fi rs t w ee k fo llo w in g bi rth N o po st - na ta l c ar e vi si t D K To ta l M ot he r's a ge a t b irt h Le ss th an 2 0 93 .7 0. 7 1. 0 2. 1 21 .3 50 .2 22 .8 1. 9 10 0. 0 94 .1 16 20 20 -3 4 93 .7 1. 0 1. 4 2. 0 19 .2 49 .7 24 .6 2. 0 10 0. 0 93 .8 12 70 35 -4 9 90 .2 0. 0 0. 0 0. 0 24 .9 54 .9 20 .2 0. 0 10 0. 0 90 .2 50 Pl ac e of d el iv er y H om e (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 15 H ea lth fa ci lit y 94 .0 0. 6 1. 1 2. 0 20 .5 50 .3 23 .5 1. 9 10 0. 0 94 .1 29 21 P ub lic 91 .2 0. 8 1. 0 1. 6 23 .2 52 .8 19 .2 1. 5 10 0. 0 91 .4 17 88 P riv at e 98 .1 0. 4 1. 3 3. 4 18 .6 46 .4 28 .0 1. 9 10 0. 0 98 .1 74 9 N G O s 98 .0 0. 0 1. 2 0. 7 11 .8 45 .5 37 .4 3. 4 10 0. 0 98 .0 27 1 U N R W A (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 23 Is ra el i 10 0. 0 0. 0 0. 0 3. 6 9. 4 48 .0 31 .2 7. 7 10 0. 0 10 0. 0 90 O th er /D K /M is si ng (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 5 M ot he r’s e du ca tio n N on e (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 9 B as ic 93 .3 0. 4 1. 2 1. 6 18 .1 53 .6 24 .0 1. 1 10 0. 0 93 .4 79 8 S ec on da ry 94 .1 1. 2 1. 2 2. 0 21 .4 48 .6 23 .7 2. 0 10 0. 0 94 .5 99 6 H ig he r 93 .4 0. 9 1. 2 2. 3 21 .0 49 .1 23 .1 2. 4 10 0. 0 93 .7 11 39 W ea lth in de x qu in til es P oo re st 90 .7 0. 8 1. 5 1. 1 28 .2 64 .7 3. 4 0. 3 10 0. 0 90 .8 72 8 S ec on d 90 .2 1. 0 0. 9 1. 7 29 .1 55 .5 11 .4 0. 5 10 0. 0 91 .3 56 3 M id dl e 95 .2 1. 4 1. 4 2. 8 15 .1 41 .5 35 .1 2. 7 10 0. 0 95 .5 57 8 Fo ur th 96 .2 0. 7 0. 6 1. 4 14 .0 40 .9 38 .9 3. 4 10 0. 0 96 .7 60 6 R ic he st 97 .0 0. 4 1. 2 3. 6 12 .9 43 .3 35 .4 3. 2 10 0. 0 97 .0 46 6 [1 ] M IC S in di ca to r 5 .1 1 - P os t-n at al h ea lth c he ck fo r t he n ew bo rn [a ] H ea lth c he ck s by a ny h ea lth p ro vi de r f ol lo w in g fa ci lit y bi rth s (b ef or e di sc ha rg e fro m fa ci lit y) o r f ol lo w in g ho m e bi rth s (b ef or e de pa rtu re o f p ro vi de r f ro m h om e) . [b ] P os t-n at al c ar e vi si ts (P N C ) r ef er to a s ep ar at e vi si t b y an y he al th p ro vi de r t o ch ec k on th e he al th o f t he n ew bo rn a nd p ro vi de p re ve nt iv e ca re s er vi ce s. P N C v is its d o no t i nc lu de h ea lth c he ck s fo llo w in g bi rth w hi le in fa ci lit y or a t h om e (s ee n ot e a ab ov e) . [c ] P os t-n at al h ea lth c he ck s in cl ud e an y he al th c he ck p er fo rm ed w hi le in th e he al th fa ci lit y or a t h om e fo llo w in g bi rth (s ee n ot e a ab ov e) , a s w el l a s P N C v is its (s ee n ot e b ab ov e) w ith in tw o da ys o f d el iv er y. (* ) F ig ur es th at a re b as ed o n le ss th an 2 5 un w ei gh te d ca se s 124 Palestinian Multiple Indicator Cluster Survey 2014 113 Overall, 94 percent of newborns receive a health check following birth while in a facility or at home. With regards to PNC visits , these predominantly occur mainly in health facility deliveries (100 percent in Israeli health facility), (98 percent private and NGO's), (91 percent public). PNC visits, these predominantly occur 3-6 days after the delivery in 20 percent of cases and one week after birth in 50 percent of cases. In less than four percent of cases these occur either on the firs or second day after delivery. There are no follow up PNC visits for newborns in 24 percent of cases which is higher among woman whose age at birth is 20-34 years (25 percent), then young women, age less than 20, (23 percent). As a result, a total of 94 percent of all newborns receive a post-natal health check. This percentage varies from 97 percent in the West Bank to 90 percent in Gaza Strip. Urban and rural newborns are much more likely to receive a health check, (94 percent, both) than their camps counterparts in camps (90 percent). There is a very clear correlation on with household wealth, with the percentage of newborns receiving post-natal health checks of newborns increases with wealth. 125 114 Table RH.14: Post-natal care visits for newborns within one week of birth Percent distribution of women age 15-49 years with a live birth in the last two years whose last live birth received a post-natal care (PNC) visit within one week of birth, by location and provider of the first PNC visit, Palestine, 2014 Location of first PNC visit for newborns Total Provider of first PNC visit for newbor ns Total Number of last live births in the last two years with a PNC visit within the first week of life H om e P ublic sector P rivate sector N G O s sector U N R W A sector Israeli sector Doctor/ nurse/ midwife Total 1.6 38.6 13.2 1.8 42.8 1.9 100.0 100.0 100.0 719 Region West Bank 1.6 54.9 30.8 3.2 4.6 4.9 100.0 100.0 100.0 285 Gaza Strip 1.5 28.0 1.7 0.9 68.0 0.0 100.0 100.0 100.0 434 Governorate Jenin 0.0 65.4 30.8 0.0 3.8 0.0 100.0 100.0 100.0 55 Tubas (*) (*) (*) (*) (*) (*) (*) (*) (*) 6 Tulkarm (*) (*) (*) (*) (*) (*) (*) (*) (*) 24 Nablus 0.0 44.7 47.3 0.0 5.9 2.2 100.0 100.0 100.0 51 Qalqiliya (*) (*) (*) (*) (*) (*) (*) (*) (*) 16 Salfit (*) (*) (*) (*) (*) (*) (*) (*) (*) 6 Ramallah & Al- Bireh (0.0) (72.1) (16.9) (4.5) (6.5) (0.0) (100.0) (100.0) (100.0) 28 Jericho (*) (*) (*) (*) (*) (*) (*) (*) (*) 15 Jerusalem (0.0) (12.7) (21.4) (20.4) (0.0) (45.5) (100.0) (100.0) (100.0) 28 Bethlehem (*) (*) (*) (*) (*) (*) (*) (*) (*) 9 Hebron (6.2) (52.1) (37.7) (2.7) (1.3) (0.0) (100.0) (100.0) (100.0) 47 North Gaza 3.7 25.5 6.8 2.0 62.1 0.0 100.0 100.0 100.0 92 Gaza 2.0 44.8 0.0 0.9 52.3 0.0 100.0 100.0 100.0 112 Dier El-Balah 0.0 3.3 1.5 0.0 95.2 0.0 100.0 100.0 100.0 74 Khan Yunis 1.0 37.9 0.0 1.0 60.1 0.0 100.0 100.0 100.0 92 Rafah 0.0 16.0 0.0 0.0 84.0 0.0 100.0 100.0 100.0 64 Area Urban 1.9 37.8 13.2 2.3 42.5 2.3 100.0 100.0 100.0 555 Rural 0.8 61.6 16.7 0.0 20.8 0.0 100.0 100.0 100.0 94 Camps 0.0 14.4 8.9 0.0 74.8 1.9 100.0 100.0 100.0 70 Mother's age at birth Less than 20 2.4 38.7 12.1 1.1 43.9 1.9 100.0 100.0 100.0 407 20-34 0.6 39.0 15.0 2.2 41.6 1.7 100.0 100.0 100.0 300 35-49 (*) (*) (*) (*) (*) (*) (*) (*) (*) 12 Place of delivery Home (*) (*) (*) (*) (*) (*) (*) (*) (*) 12 Health facility 1.5 38.3 13.0 1.7 43.6 2.0 100.0 100.0 100.0 707 Public 0.7 44.3 6.9 0.4 47.7 0.0 100.0 100.0 100.0 475 Private 2.8 27.3 33.2 0.0 36.1 0.6 100.0 100.0 100.0 177 NGOs (5.7) (23.5) (0.0) (27.8) (40.0) (3.0) (100.0) (100.0) (100.0) 37 UNRWA (*) (*) (*) (*) (*) (*) (*) (*) (*) 5 Israeli (*) (*) (*) (*) (*) (*) (*) (*) (*) 12 Other/DK/Missing (*) (*) (*) (*) (*) (*) (*) (*) (*) 1 Mother’s education None (*) (*) (*) (*) (*) (*) (*) (*) (*) 5 Basic 1.2 51.0 6.7 .8 38.2 2.2 100.0 100.0 100.0 170 Secondary 2.5 38.1 11.5 1.8 43.6 2.4 100.0 100.0 100.0 256 Higher 1.0 32.5 18.7 2.1 44.3 1.4 100.0 100.0 100.0 289 Wealth index quintiles Poorest 0.5 29.2 1.3 0.9 68.1 0.0 100.0 100.0 100.0 230 Second 3.6 29.2 3.4 1.0 62.8 0.0 100.0 100.0 100.0 184 Middle 0.8 57.4 22.0 0.0 19.8 0.0 100.0 100.0 100.0 120 Fourth 0.0 54.9 23.6 4.5 11.9 5.1 100.0 100.0 100.0 101 Richest 3.1 38.8 42.1 5.5 0.0 10.5 100.0 100.0 100.0 84 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 126 Palestinian Multiple Indicator Cluster Survey 2014 115 In Table RH.14, the percentage of newborns who received the first PNC visit within one week of birth is shown by location and type of provider of service. As defined above, a visit does not include a check in the facility or at home following birth. Forty three percent of the first PNC visits for newborns occur in UNRWA facility, the percentage is the highest in Gaza Strip (68 percent) compared to 5 percent in the West Bank. Where the first PNC visits for newborns occur in public facility (39 percent), the percentage is the highest in the West Bank (55 percent) compared to 28 percent in Gaza Strip. However, when looking at the proportions taking place in private facilities, there are large differences according to region, the percentage is the highest in the West Bank (31 percent) compared to 2 percent in Gaza Strip. Note, for instance, that almost no newborns born at home attend a private facility for PNC visit, whereas almost all newborns born in a private facility also attend a private facility for the PNC visit. Also, it is quite clear that public facility visits are predominantly preferred by women from among the wealthiest households. All of the first PNC visits for newborns are provided by either a doctor/nurse/midwife in Palestine. Tables RH.15 and RH.16 present information collected on post-natal health checks and visits of the mother and are identical to Tables RH.13 and RH.14 that presented the data collected for newborns. 127 11 6 T ab le R H .1 5: P os t-n at al h ea lth c he ck s fo r m ot he rs P er ce nt ag e of w om en a ge 1 5- 49 y ea rs w ith a li ve b irt h in th e la st tw o ye ar s w ho re ce iv ed h ea lth c he ck s w hi le in fa ci lit y or a t h om e fo llo w in g bi rth , p er ce nt d is tri bu tio n w ho re ce iv ed p os t-n at al ca re (P N C ) v is its fr om a ny h ea lth p ro vi de r a fte r b irt h at th e tim e of la st b irt h, b y tim in g of v is it, a nd p er ce nt ag e w ho re ce iv ed p os t n at al h ea lth c he ck s, P al es tin e, 2 01 4 H ea lth c he ck fo llo w in g bi rth w hi le in fa ci lit y or a t ho m e [a ] PN C v is it fo r m ot he rs [b ] P os t-n at al he al th c he ck fo r t he m ot he r [ 1] , [ c] N um be r o f w om en w ho ga ve b irt h in th e tw o ye ar s pr ec ed in g th e su rv ey S am e da y 1 da y fo llo w in g bi rth 2 da ys fo llo w in g bi rth 3- 6 da ys fo llo w in g bi rth A fte r t he fi rs t w ee k fo llo w in g bi rth N o po st - na ta l c ar e vi si t D K To ta l To ta l 90 .5 0. 5 0. 4 0. 6 11 .0 31 .7 55 .0 0. 8 10 0. 0 90 .7 29 41 R eg io n W es t B an k 89 .5 0. 4 0. 3 0. 3 3. 3 21 .2 73 .0 1. 4 10 0. 0 89 .7 16 10 G az a S tri p 91 .6 0. 5 0. 6 0. 9 20 .3 44 .4 33 .3 0. 1 10 0. 0 91 .8 13 31 G ov er no ra te Je ni n 81 .8 1. 3 0. 6 0. 0 4. 3 29 .6 63 .7 0. 5 10 0. 0 82 .3 18 6 Tu ba s (7 6. 1) (0 .0 ) (0 .0 ) (0 .0 ) (7 .4 ) (4 1. 5) (5 1. 1) (0 .0 ) (1 00 .0 ) (7 6. 1) 25 Tu lk ar m 77 .5 0. 0 1. 0 0. 0 5. 1 19 .8 74 .1 0. 0 10 0. 0 78 .5 71 N ab lu s 84 .3 0. 0 0. 0 0. 8 5. 1 26 .3 67 .2 0. 6 10 0. 0 84 .3 19 0 Q al qi liy a (7 9. 9) (0 .0 ) (0 .0 ) (0 .0 ) (2 .3 ) (2 3. 9) (7 3. 9) (0 .0 ) (1 00 .0 ) (7 9. 9) 48 S al fit (8 8. 7) (0 .0 ) (2 .0 ) (0 .0 ) (0 .0 ) (1 7. 8) (6 5. 5) (1 4. 7) (1 00 .0 ) (8 8. 7) 35 R am al la h & A l-B ire h 95 .3 1. 9 0. 0 0. 0 4. 4 20 .7 70 .8 2. 1 10 0. 0 95 .3 19 0 Je ric ho (9 1. 8) (0 .0 ) (0 .0 ) (2 .1 ) (3 .3 ) (7 .2 ) (8 7. 3) (0 .0 ) (1 00 .0 ) (9 1. 8) 44 Je ru sa le m 94 .4 0. 0 0. 5 0. 3 2. 0 28 .4 64 .5 4. 3 10 0. 0 94 .7 25 7 B et hl eh em 94 .3 0. 0 0. 0 0. 6 1. 5 22 .7 75 .2 0. 0 10 0. 0 94 .3 13 7 H eb ro n 91 .7 0. 2 0. 2 0. 2 2. 9 11 .2 85 .2 0. 0 10 0. 0 91 .9 42 7 N or th G az a 94 .4 1. 5 0. 0 1. 9 25 .4 45 .0 26 .2 0. 0 10 0. 0 95 .0 25 8 G az a 93 .2 0. 3 0. 9 1. 0 13 .0 49 .6 35 .2 0. 0 10 0. 0 93 .2 47 1 D ie r E l-B al ah 97 .6 0. 0 0. 6 1. 1 34 .4 49 .4 14 .4 0. 0 10 0. 0 97 .6 17 3 K ha n Y un is 79 .9 0. 0 0. 8 0. 0 17 .4 32 .9 48 .5 0. 4 10 0. 0 79 .9 25 5 R af ah 94 .5 0. 7 0. 0 0. 0 22 .9 41 .4 35 .0 0. 0 10 0. 0 95 .2 17 5 A re a U rb an 90 .6 0. 2 0. 4 0. 6 11 .1 33 .0 54 .0 0. 6 10 0. 0 90 .8 22 65 R ur al 89 .6 1. 3 0. 2 0. 4 7. 6 23 .0 65 .8 1. 8 10 0. 0 89 .8 43 7 C am ps 91 .0 1. 2 0. 6 0. 7 16 .2 35 .4 45 .3 0. 6 10 0. 0 91 .3 24 0 M ot he r's a ge a t b irt h Le ss th an 2 0 90 .8 0. 5 0. 5 0. 6 12 .1 32 .1 53 .4 0. 8 10 0. 0 91 .1 16 20 20 -3 4 90 .0 0. 4 0. 4 0. 4 9. 8 31 .0 57 .4 0. 7 10 0. 0 90 .1 12 70 35 -4 9 90 .3 0. 0 0. 0 1. 8 8. 5 39 .7 47 .8 2. 2 10 0. 0 90 .3 50 [1 ] M IC S in di ca to r 5 .1 2 - P os t-n at al h ea lth c he ck fo r t he m ot he r [a ] H ea lth c he ck s by a ny h ea lth p ro vi de r f ol lo w in g fa ci lit y bi rth s (b ef or e di sc ha rg e fro m fa ci lit y) o r f ol lo w in g ho m e bi rth s (b ef or e de pa rtu re o f p ro vi de r f ro m h om e) . [b ] P os t-n at al c ar e vi si ts (P N C ) r ef er to a s ep ar at e vi si t t o ch ec k on th e he al th o f t he m ot he r a nd p ro vi de p re ve nt iv e ca re s er vi ce s. P N C v is its d o no t i nc lu de h ea lth c he ck s fo llo w in g bi rth w hi le in fa ci lit y or a t h om e (s ee n ot e a ab ov e) . [c ] P os t-n at al h ea lth c he ck s in cl ud e an y he al th c he ck p er fo rm ed w hi le in th e he al th fa ci lit y or a t h om e fo llo w in g bi rth (s ee n ot e a ab ov e) , a s w el l a s P N C v is its (s ee n ot e b ab ov e) w ith in tw o da ys o f d el iv er y. (* ) F ig ur es th at a re b as ed o n le ss th an 2 5 un w ei gh te d ca se s 128 Palestinian Multiple Indicator Cluster Survey 2014 11 7 T ab le R H .1 5 C on tin ue d: P os t-n at al h ea lth c he ck s fo r m ot he rs P er ce nt ag e of w om en a ge 1 5- 49 y ea rs w ith a li ve b irt h in th e la st tw o ye ar s w ho re ce iv ed h ea lth c he ck s w hi le in fa ci lit y or a t h om e fo llo w in g bi rth , p er ce nt d is tri bu tio n w ho re ce iv ed p os t-n at al c ar e (P N C ) v is its fr om a ny h ea lth p ro vi de r a fte r b irt h at th e tim e of la st b irt h, b y tim in g of v is it, a nd p er ce nt ag e w ho re ce iv ed p os t n at al h ea lth c he ck s, P al es tin e, 2 01 4 H ea lth c he ck fo llo w in g bi rth w hi le in fa ci lit y or a t ho m e [a ] PN C v is it fo r m ot he rs [b ] P os t-n at al he al th ch ec k fo r th e m ot he r [1 ], [c ] N um be r o f w om en w ho ga ve b irt h in th e tw o ye ar s pr ec ed in g th e su rv ey S am e da y 1 da y fo llo w in g bi rth 2 da ys fo llo w in g bi rth 3- 6 da ys fo llo w in g bi rth A fte r t he fi rs t w ee k fo llo w in g bi rth N o po st - na ta l ca re v is it D K To ta l Pl ac e of d el iv er y H om e (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 15 H ea lth fa ci lit y 90 .8 0. 3 0. 4 0. 6 11 .0 31 .9 55 .0 0. 8 10 0. 0 90 .9 29 21 P ub lic 87 .5 0. 3 0. 3 0. 7 12 .5 32 .6 53 .0 0. 5 10 0. 0 87 .6 17 88 P riv at e 96 .0 0. 5 0. 6 0. 3 10 .5 30 .8 56 .7 0. 7 10 0. 0 96 .0 74 9 N G O s 95 .6 0. 0 0. 4 0. 3 6. 1 31 .6 60 .1 1. 5 10 0. 0 95 .6 27 1 U N R W A (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 23 Is ra el i 98 .0 0. 0 0. 8 0. 8 1. 2 31 .6 60 .0 5. 7 10 0. 0 98 .8 90 O th er /D K /M is si ng (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 5 Ty pe o f d el iv er y V ag in al b irt h 88 .9 0. 5 0. 4 0. 6 11 .2 26 .8 59 .8 0. 6 10 0. 0 89 .2 23 43 C -s ec tio n 96 .4 0. 1 0. 3 0. 6 10 .3 50 .9 36 .4 1. 4 10 0. 0 96 .4 59 9 M ot he r’s e du ca tio n N on e (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 9 B as ic 90 .2 0. 3 0. 3 0. 6 10 .7 32 .3 55 .4 0. 6 10 0. 0 90 .3 79 8 S ec on da ry 89 .8 0. 5 0. 5 0. 5 10 .5 32 .9 54 .8 0. 3 10 0. 0 90 .1 99 6 H ig he r 91 .1 0. 6 0. 4 0. 6 11 .5 30 .6 54 .9 1. 4 10 0. 0 91 .4 11 39 W ea lth in de x qu in til es P oo re st 92 .2 0. 6 0. 6 1. 1 19 .3 46 .8 31 .5 0. 1 10 0. 0 92 .4 72 8 S ec on d 90 .8 0. 3 0. 2 0. 7 20 .6 36 .5 41 .6 0. 0 10 0. 0 91 .1 56 3 M id dl e 87 .9 0. 6 0. 8 0. 6 4. 6 21 .8 70 .5 1. 1 10 0. 0 88 .5 57 8 Fo ur th 89 .0 0. 3 0. 2 0. 1 3. 5 23 .6 70 .8 1. 4 10 0. 0 89 .2 60 6 R ic he st 92 .3 0. 4 0. 3 0. 2 4. 1 25 .1 68 .3 1. 6 10 0. 0 92 .5 46 6 [1 ] M IC S in di ca to r 5 .1 2 - P os t-n at al h ea lth c he ck fo r t he m ot he r [a ] H ea lth c he ck s by a ny h ea lth p ro vi de r f ol lo w in g fa ci lit y bi rth s (b ef or e di sc ha rg e fro m fa ci lit y) o r f ol lo w in g ho m e bi rth s (b ef or e de pa rtu re o f p ro vi de r f ro m h om e) . [b ] P os t-n at al c ar e vi si ts (P N C ) r ef er to a s ep ar at e vi si t t o ch ec k on th e he al th o f t he m ot he r a nd p ro vi de p re ve nt iv e ca re s er vi ce s. P N C v is its d o no t i nc lu de h ea lth c he ck s fo llo w in g bi rth w hi le in fa ci lit y or a t h om e (s ee n ot e a ab ov e) . [c ] P os t-n at al h ea lth c he ck s in cl ud e an y he al th c he ck p er fo rm ed w hi le in th e he al th fa ci lit y or a t h om e fo llo w in g bi rth (s ee n ot e a ab ov e) , a s w el l a s P N C v is its (s ee n ot e b ab ov e) w ith in tw o da ys o f de liv er y. (* ) F ig ur es th at a re b as ed o n le ss th an 2 5 un w ei gh te d ca se s 129 118 Table RH.15 presents a pattern somewhat similar to Table RH.13, but with some important differences. Overall, 91 percent of mothers receive a health check following birth while in a facility or at home. With regards to PNC visits, the majority take place after the first week or 3-6 days after the delivery (32 percent and 11 percent, respectively). As a result, a total of 91 percent of all mothers receive a post-natal health check. This percentage varies from 90 percent in the West Bank to 92 percent in Gaza Strip. Urban and camps mothers are much more likely to receive a health check, both following birth (91 percent), than their rural counterparts (90 percent). Health checks following birth occur mainly in health facility deliveries (98 percent Israeli, 96 percent private and NGOs, 88 percent public). The main difference between the table for newborns and the table for mothers is that the percentage with health checks, both following the birth and through a visit, is lower for mothers than for newborns. This is associated with much lower rates of timely PNC visits. Studying only those mothers that did not receive a PNC visit, the percentage is nearly twice as high for mothers (55 percent) as for newborns (24 percent). The age group of mothers have the same percentage receiving a health check through a timely visit. As was the case for the newborn, the age group of mothers age, 20-34 have the lowest percentage receiving a health check through a timely visit. 130 Palestinian Multiple Indicator Cluster Survey 2014 11 9 Ta bl e R H .1 6: P os t-n 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 P er ce nt d is tri bu tio n of w om en a ge 1 5- 49 y ea rs w ith a li ve b irt h in th e la st tw o ye ar s w ho re ce iv ed a p os t-n at al c ar e (P N C ) v is it w ith in o ne w ee k of b irt h, b y lo ca tio n an d pr ov id er o f t he fi rs t P N C v is it, P al es tin e, 2 01 4 Lo ca tio n of fi rs t P N C v is it fo r m ot he rs To ta l Pr ov id er o f f irs t P N C vi si t f or m ot he rs To ta l N um be r o f w om en w ho ga ve b irt h in th e tw o ye ar s pr ec ed in g su rv ey a nd re ce iv ed a P N C v is it w ith in o ne w ee k of de liv er y H om e P ub lic s ec to r P riv at e se ct or N G O s se ct or U N R W A s ec to r Is ra el i s ec to r D oc to r/ nu rs e/ m id w ife To ta l 3. 8 22 .8 7. 9 1. 9 62 .9 0. 7 10 0. 0 10 0. 0 10 0. 0 36 6 R eg io n W es t B an k 7. 6 48 .2 31 .5 4. 6 4. 6 3. 5 10 0. 0 10 0. 0 10 0. 0 71 G az a S tri p 2. 8 16 .8 2. 3 1. 2 76 .8 0. 0 10 0. 0 10 0. 0 10 0. 0 29 6 A re a U rb an 4. 5 23 .7 5. 4 2. 1 64 .0 0. 4 10 0. 0 10 0. 0 10 0. 0 28 0 R ur al (0 .0 ) (3 9. 1) (2 3. 6) (2 .5 ) (3 4. 8) (0 .0 ) (1 00 .0 ) (1 00 .0 ) (1 00 .0 ) 41 C am ps (2 .4 ) (2 .7 ) (9 .5 ) (0 .0 ) (8 2. 4) (3 .0 ) (1 00 .0 ) (1 00 .0 ) (1 00 .0 ) 45 M ot he r's a ge a t b irt h Le ss th an 2 0 4. 2 24 .5 9. 1 1. 2 60 .4 0. 5 10 0. 0 10 0. 0 10 0. 0 22 2 20 -3 4 3. 2 20 .3 6. 3 2. 2 67 .1 1. 0 10 0. 0 10 0. 0 10 0. 0 13 9 35 -4 9 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 5 Pl ac e of d el iv er y H om e (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 6 H ea lth fa ci lit y 3. 8 22 .0 7. 8 1. 7 63 .9 0. 7 10 0. 0 10 0. 0 10 0. 0 35 9 P ub lic 2. 6 26 .4 4. 5 0. 4 66 .2 0. 0 10 0. 0 10 0. 0 10 0. 0 24 8 P riv at e 6. 1 15 .0 18 .4 0. 0 59 .7 0. 8 10 0. 0 10 0. 0 10 0. 0 89 N G O s (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 18 U N R W A (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 1 Is ra el i (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 2 O th er /D K /M is si ng (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 1 Ty pe o f d el iv er y V ag in al b irt h 2. 7 22 .6 5. 8 1. 3 67 .0 0. 6 10 0. 0 10 0. 0 10 0. 0 29 9 C -s ec tio n 8. 2 24 .0 17 .3 4. 5 45 .1 1. 0 10 0. 0 10 0. 0 10 0. 0 68 M ot he r’s e du ca tio n N on e (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 3 B as ic 3. 6 35 .4 8. 3 1. 0 50 .7 1. 2 10 0. 0 10 0. 0 10 0. 0 94 S ec on da ry 3. 5 21 .3 4. 1 1. 7 68 .4 1. 1 10 0. 0 10 0. 0 10 0. 0 11 9 H ig he r 4. 2 16 .7 11 .0 2. 6 65 .6 0. 0 10 0. 0 10 0. 0 10 0. 0 15 0 W ea lth in de x qu in til es P oo re st 2. 7 20 .4 0. 6 1. 8 74 .5 0. 0 10 0. 0 10 0. 0 10 0. 0 15 7 S ec on d 2. 5 14 .5 4. 9 0. 7 77 .4 0. 0 10 0. 0 10 0. 0 10 0. 0 12 3 M id dl e (8 .3 ) (3 6. 0) (2 1. 5) (0 .0 ) (3 2. 4) (1 .9 ) (1 00 .0 ) (1 00 .0 ) (1 00 .0 ) 38 Fo ur th (4 .6 ) (3 2. 6) (2 5. 6) (1 3. 0) (2 4. 2) (0 .0 ) (1 00 .0 ) (1 00 .0 ) (1 00 .0 ) 25 R ic he st (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 23 ( ) F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s (* ) F ig ur es th at a re b as ed o n le ss th an 2 5 un w ei gh te d ca se s 131 120 Table RH.16 matches Table RH.14, but now deals with PNC visits for mothers by location and type of provider. As defined above, a visit does not include a check in the facility or at home following birth. Overall, 63 percent of the first PNC visits occur in a UNRWA facility, the percentage is the highest in Gaza Strip (77 percent) compared to 5 percent in the West Bank, 23 percent of the first PNC visits for newborns occur in public facility, the percentage is the highest in the West Bank (48 percent) compared to 17 percent in Gaza Strip, and 8 percent of the first PNC visits for newborns occur in private facility, the percentage is the highest in the West Bank (32 percent) compared to 2 percent in Gaza Strip. This proportion varies across background characteristics. All of the first PNC visits for mothers are provided by either a doctor/nurse/midwife in Palestine. 132 Palestinian Multiple Indicator Cluster Survey 2014 121 Table RH.17: Post-natal health checks for mothers and newborns Percent distribution of women age 15-49 years with a live birth in the last two years by post-natal health checks for the mother and newborn, within two days of the most recent birth, Palestine, 2014 Health checks or PNC visits within 2 days of birth for: DK/Missing Total Number of women age 15- 49 years who gave birth in the 2 years preceding the survey Both mothers and newborns Mothers only Newborns only Neither mother nor newborn Total 87.1 3.1 6.4 3.0 0.4 100.0 2941 Region West Bank 87.7 1.2 8.5 1.8 0.8 100.0 1610 Gaza Strip 86.4 5.5 3.8 4.3 0.0 100.0 1331 Governorate Jenin 79.2 2.7 14.8 2.8 0.5 100.0 186 Tubas (71.9) (4.2) (23.9) (0.0) (0.0) (100.0) 25 Tulkarm 76.6 2.0 14.8 6.7 0.0 100.0 71 Nablus 80.8 2.9 11.3 4.4 0.6 100.0 190 Qalqiliya (79.9) (0.0) (18.5) (1.6) (0.0) (100.0) 48 Salfit (71.5) (5.1) (6.6) (4.7) (12.2) (100.0) 35 Ramallah & Al-Bireh 94.2 0.0 3.7 1.0 1.1 100.0 190 Jericho (91.8) (0.0) (6.5) (1.7) (0.0) (100.0) 44 Jerusalem 92.4 0.4 4.4 0.9 1.8 100.0 257 Bethlehem 94.3 0.0 4.4 1.3 0.0 100.0 137 Hebron 91.0 0.9 7.6 0.5 0.0 100.0 427 North Gaza 94.2 0.8 3.5 1.5 0.0 100.0 258 Gaza 90.2 3.0 2.4 4.4 0.0 100.0 471 Dier El-Balah 82.8 14.8 1.7 0.6 0.0 100.0 173 Khan Yunis 69.2 10.6 8.8 11.3 0.0 100.0 255 Rafah 93.0 2.2 2.8 2.0 0.0 100.0 175 Area Urban 87.7 2.8 6.2 3.0 0.3 100.0 2265 Rural 85.4 3.2 7.7 2.5 1.1 100.0 437 Camps 84.6 6.2 5.2 3.5 0.6 100.0 240 Mother's age at birth Less than 20 87.6 3.0 6.0 2.9 0.5 100.0 1620 20-34 86.5 3.1 6.8 3.1 0.4 100.0 1270 35-49 83.2 7.1 7.0 2.7 0.0 100.0 50 Type of health facility Home (*) (*) (*) (*) (*) (*) 15 Health facility 87.3 3.2 6.3 2.8 0.4 100.0 2921 Public 82.9 4.3 8.1 4.3 0.3 100.0 1788 Private 94.1 1.5 3.6 0.4 0.4 100.0 749 NGOs 93.3 1.7 4.0 0.4 0.7 100.0 271 UNRWA (*) (*) (*) (*) (*) (*) 23 Israeli 95.5 0.0 1.2 0.0 3.2 100.0 90 Other/DK/Missing (*) (*) (*) (*) (*) (*) 5 Type of delivery Vaginal birth 85.1 3.7 7.3 3.5 0.4 100.0 2343 C-section 95.0 0.8 2.6 1.0 0.5 100.0 599 Mother’s education None (*) (*) (*) (*) (*) (*) 9 Basic 87.0 3.2 6.3 3.4 0.1 100.0 798 Secondary 87.2 2.7 7.0 2.9 0.2 100.0 996 Higher 87.0 3.6 5.9 2.7 0.8 100.0 1139 Wealth index quintiles Poorest 87.7 4.7 3.2 4.5 0.0 100.0 728 Second 85.8 5.3 5.4 3.5 0.0 100.0 563 Middle 85.8 2.1 9.1 2.4 0.6 100.0 578 Fourth 86.2 1.8 9.3 1.5 1.2 100.0 606 Richest 90.7 1.3 5.8 1.8 0.5 100.0 466 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 133 122 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 PNC visits within 2 days of birth for the mother and the newborn, thus combining the indicators presented in Tables RH.13 and RH.15. The Palestinian MICS shows that for 87 percent of live births, both the mothers and their newborns receive either a health check following birth or a timely PNC visit, whereas for 3 percent of births neither receive health checks or timely visits. There are quite discrepancies across the background characteristics. Urban births (88 percent) are better served with health checks or timely visits as compared to rural and camps births (85 percent, both). The figures between the regions vary from 88 percent in the West Bank to 86 percent in Gaza Strip. There are no clear correlations to the education of the woman, while there are increasing wealth tends to equate with better coverage. As expected, the opposite is true for births without health checks or timely visits. The picture is less clear when it comes to patterns on health checks or timely visits for either the mother or the newborn alone, although generally a higher level of coverage for newborns. 134 Palestinian Multiple Indicator Cluster Survey 2014 IX. Early Childhood Development 123 IX. Early Childhood Development Early Childhood Care and Education Readiness of children for primary school can be improved through attendance to early childhood education programmes or through pre-school attendance. Early childhood education programmes include programmes for children that have organised learning components as opposed to baby-sitting and day-care which do not typically have organised education and learning. Twenty six percent of children age 36-59 months are attending an organised early childhood education programme (Table CD.1). Among children aged 36-59 months, attendance to pre- school is higher in rural areas 31 percent than in urban areas (26 percent) and camps (25 percent, with no variations between the West Bank and Gaza Strip (27 and 26 percent respectively). Additionally there are no gender differentials in terms of attendance to pre- school (27 and 26 percent respectively), but clear variations were seen for pre-school attendance by governorates which is the lowest is in Hebron governorate at 11 percent and the highest was in Salfit and Tulkarm governorates (49 percent each). Significant differentials exist by socioeconomic status; 39 percent of children living in the richest households attend such programmes, while the figure drops to 21 percent among children in the poorest households. More children tend to attend early childhood education programmes at ages 48-59 months (46 percent) compared to those aged 36-47 months (8 percent). 136 Palestinian Multiple Indicator Cluster Survey 2014 124 Table CD.1: Early childhood education Percentage of children age 36-59 months who are attending an organized early childhood education programme, Palestine, 2014 Percentage of children age 36-59 months attending early childhood education1 Number of children aged 36-59 months Total 26.4 3274 Sex Male 27.2 1689 Female 25.6 1585 Region West Bank 27.2 1750 Gaza Strip 25.5 1525 Governorate Jenin 30.3 188 Tubas (*) 23 Tulkarm 48.7 94 Nablus 31.7 234 Qalqiliya 28.4 76 Salfit 49.0 51 Ramallah & Al-Bireh 41.7 174 Jericho and Al Aghwar (21.6) 31 Jerusalem 36.5 266 Bethlehem 13.9 129 Hebron 11.3 484 North Gaza 15.6 275 Gaza 27.8 561 Dier El-Balah 17.2 217 Khan Yunis 35.6 262 Rafah 28.0 209 Area Urban 25.7 2467 Rural 31.0 504 Camps 24.6 303 Age of child 36-47 months 8.2 1677 48-59 months 45.5 1597 Mother's education None (*) 18 Basic 19.2 1102 Secondary 24.7 1100 Higher 35.7 1054 Wealth index quintiles Poorest 20.6 794 Second 25.9 698 Middle 22.7 661 Fourth 28.8 592 Richest 37.8 529 1 MICS indicator 6.1 - Attendance to early childhood education ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 137 125 Quality of Care It is well recognized that a period of rapid brain development occurs in the first 3-4 years of life, and the quality of home care is a major determinant of the child’s development during this period. In this context, engagement of adults in activities with children, presence of books in the home 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.”1 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. For more than three-fourths (78 percent) of children age 36-59 months, an adult household member engaged in four or more activities that promote learning and school readiness during the 3 days preceding the survey (Table CD.2). The mean number of activities that adults engaged with children was 4.5. The table also indicates that the father’s involvement in such activities was somewhat limited. Father’s involvement in four or more activities was only 12 percent. Only 2.4 percent of children age 36-59 months live without their biological father. Mother’s involvement in four or more activities was 54 percent. Only 1.0 percent of children age 36-59 months live without their biological mother. 1  UNICEF,  A  World  Fit  For  Children,  Adopted  by  the  UN  General  Assembly  at  the  27th  Special  Session,  10  May   2002,  p.  2.   138 Palestinian Multiple Indicator Cluster Survey 2014 12 6 Ta bl e C D .2 : S up po rt fo r l ea rn in g P er ce nt ag e of c hi ld re n ag e 36 -5 9 m on th s w ith w ho m a du lt ho us eh ol d m em be rs e ng ag ed in a ct iv iti es th at p ro m ot e le ar ni ng a nd s ch oo l r ea di ne ss d ur in g th e la st th re e da ys , a nd e ng ag em en t i n su ch ac tiv iti es b y bi ol og ic al fa th er s an d m ot he rs , P al es tin e, 2 01 4 P er ce nt ag e of ch ild re n w ith w ho m a du lt ho us eh ol d m em be rs h av e en ga ge d in fo ur o r m or e ac tiv iti es 1 M ea n nu m be r o f ac tiv iti es w ith a du lt ho us eh ol d m em be rs P er ce nt ag e of c hi ld re n liv in g w ith th ei r: N um be r of ch ild re n ag e 36 - 59 m on th s P er ce nt ag e of ch ild re n w ith w ho m b io lo gi ca l fa th er s ha ve en ga ge d in fo ur or m or e ac tiv iti es 2 M ea n nu m be r o f ac tiv iti es w ith bi ol og ic al fa th er s N um be r o f ch ild re n ag e 36 - 59 m on th s liv in g w ith th ei r bi ol og ic al fa th er s P er ce nt ag e of ch ild re n w ith w ho m b io lo gi ca l m ot he rs h av e en ga ge d in fo ur or m or e ac tiv iti es 3 M ea n nu m be r o f ac tiv iti es w ith bi ol og ic al m ot he rs N um be r o f ch ild re n ag e 36 -5 9 m on th s liv in g w ith th ei r bi ol og ic al m ot he rs B io lo gi ca l fa th er B io lo gi c- al m ot he r To ta l 77 .5 4. 5 97 .6 99 .0 32 75 12 .0 1. 6 31 95 54 .4 3. 6 32 40 R eg io n W es t B an k 82 .7 4. 7 98 .5 99 .3 17 50 14 .1 1. 7 17 24 59 .2 3. 8 17 39 G az a S tri p 71 .5 4. 2 96 .5 98 .5 15 24 9. 7 1. 5 14 70 48 .9 3. 3 15 02 G ov er no ra te Je ni n 80 .1 4. 5 98 .9 98 .9 18 8 12 .9 1. 7 18 6 58 .8 3. 7 18 6 Tu ba s (* ) 4. 7 (* ) (* ) 23 (* ) 1. 1 22 (* ) 3. 1 22 Tu lk ar m 84 .6 4. 9 10 0. 0 10 0. 0 94 10 .7 1. 5 94 51 .8 3. 5 94 N ab lu s 71 .8 4. 2 99 .1 99 .2 23 4 16 .8 1. 8 23 2 53 .9 3. 6 23 2 Q al qi liy a 87 .0 4. 8 96 .5 10 0. 0 76 20 .2 1. 8 73 78 .1 4. 4 76 S al fit 85 .7 4. 8 10 0. 0 98 .7 51 6. 4 1. 4 51 59 .5 3. 7 51 R am al la h & A l- B ire h 88 .3 5. 0 97 .8 10 0. 0 17 4 30 .5 2. 4 17 0 74 .3 4. 4 17 4 Je ric ho & A l- A gh w ar 88 .8 5. 3 (1 00 .0 ) (9 5. 4) 30 (1 6. 2) 1. 9 30 (5 7. 9) 3. 9 29 Je ru sa le m 88 .8 5. 0 98 .3 10 0. 0 26 6 21 .1 2. 0 26 2 69 .3 4. 3 26 6 B et hl eh em 67 .7 4. 2 98 .7 98 .6 12 9 12 .5 1. 5 12 7 43 .1 3. 1 12 7 H eb ro n 85 .8 4. 8 98 .3 99 .4 48 4 4. 8 1. 2 47 6 54 .2 3. 6 48 1 G az a N or th 63 .9 4. 0 98 .9 97 .9 27 5 11 .5 1. 7 27 2 41 .3 3. 1 26 9 G az a 74 .0 4. 3 95 .9 99 .4 56 1 4. 3 1. 1 53 8 50 .2 3. 4 55 7 D ei r E l-B al ah 68 .4 4. 0 94 .1 99 .5 21 8 7. 3 1. 5 20 5 46 .8 3. 1 21 7 K ha n Y un is 70 .1 4. 2 96 .6 97 .5 26 2 15 .4 1. 7 25 3 47 .7 3. 2 25 5 R af ah 79 .9 4. 5 97 .1 97 .3 20 8 17 .2 2. 1 20 2 59 .4 3. 7 20 2 A re a U rb an 77 .6 4. 5 97 .5 98 .8 24 67 11 .4 1. 5 24 05 54 .5 3. 6 24 37 R ur al 81 .3 4. 6 98 .3 99 .6 50 4 15 .3 1. 8 49 5 59 .0 3. 7 50 2 C am ps 70 .5 4. 3 96 .6 99 .1 30 4 11 .4 1. 6 29 4 45 .6 3. 2 30 1 1 M IC S in di ca to r 6 .2 - Su pp or t f or le ar ni ng 2 M IC S In di ca to r 6 .3 - Fa th er ’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 io n le ve l o f t he re sp on de nt to th e Q ue st io nn ai re fo r C hi ld re n U nd er F iv e, a nd c ov er s bo th m ot he rs a nd p rim ar y ca re ta ke rs , w ho a re in te rv ie w ed w he n th e m ot he r i s no t l is te d in th e sa m e ho us eh ol d. S in ce in di ca to r 6 .4 re po rts o n th e bi ol og ic al m ot he r's s up po rt fo r l ea rn in g, th is b ac kg ro un d ch ar ac te ris tic re fe rs to o nl y th e ed uc at io na l l ev el s of b io lo gi ca l m ot he rs w he n ca lc ul at ed fo r t he in di ca to r i n qu es tio n. ( ) F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s (* ) F ig ur es th at a re b as ed o n le ss th an 2 5 un w ei gh te d ca se s 139 12 7 Ta bl e C D .2 C on tin ue d: S up po rt fo r l ea rn in g P er ce nt ag e of c hi ld re n ag e 36 -5 9 m on th s w ith w ho m a du lt ho us eh ol d m em be rs e ng ag ed in a ct iv iti es th at p ro m ot e le ar ni ng a nd s ch oo l r ea di ne ss d ur in g th e la st th re e da ys , a nd e ng ag em en t i n su ch ac tiv iti es b y bi ol og ic al fa th er s an d m ot he rs , P al es tin e, 2 01 4 P er ce nt ag e of c hi ld re n w ith w ho m ad ul t ho us eh ol d m em be rs ha ve en ga ge d in fo ur o r m or e ac tiv iti es 1 M ea n nu m be r o f ac tiv iti es w ith a du lt ho us eh ol d m em be rs Pe rc en ta ge o f c hi ld re n liv in g w ith th ei r: N um be r of ch ild re n ag e 36 - 59 m on th s P er ce nt ag e of c hi ld re n w ith w ho m bi ol og ic al fa th er s ha ve en ga ge d in fo ur o r m or e ac tiv iti es 2 M ea n nu m be r of ac tiv iti es w ith bi ol og ic al fa th er s N um be r o f ch ild re n ag e 36 -5 9 m on th s liv in g w ith th ei r bi ol og ic al fa th er s P er ce nt ag e of ch ild re n w ith w ho m bi ol og ic al m ot he rs h av e en ga ge d in fo ur o r m or e ac tiv iti es 3 M ea n nu m be r o f ac tiv iti es w ith bi ol og ic al m ot he rs N um be r o f c hi ld re n ag e 36 -5 9 m on th s liv in g w ith th ei r bi ol og ic al m ot he rs B io lo gi ca l fa th er B io lo gi ca l m ot he r Se x M al e 77 .4 4. 5 97 .7 99 .1 16 89 11 .9 1. 6 16 50 54 .2 3. 5 16 74 Fe m al e 77 .6 4. 5 97 .4 98 .8 15 85 12 .1 1. 5 15 45 54 .6 3. 6 15 66 A ge o f c hi ld 36 -4 7 m on th s 76 .3 4. 4 97 .5 99 .0 16 78 12 .9 1. 6 16 36 55 .5 3. 6 16 61 48 -5 9 m on th s 78 .7 4. 5 97 .6 98 .9 15 97 11 .1 1. 6 15 59 53 .2 3. 6 15 80 M ot he r's e du ca tio n N on e (* ) 3. 9 (* ) (* ) 18 (* ) 1. 3 17 (* ) 2. 4 14 B as ic 73 .2 4. 3 97 .2 98 .2 11 02 8. 9 1. 3 10 71 44 .6 3. 1 10 82 S ec on da ry 77 .2 4. 4 97 .6 99 .5 11 00 11 .5 1. 6 10 73 55 .5 3. 6 10 95 H ig he r 82 .4 4. 7 98 .0 99 .5 10 54 16 .0 1. 9 10 33 63 .7 4. 0 10 49 Fa th er 's e du ca tio n N on e (* ) 3. 9 (* ) (* ) 16 (* ) 1. 3 16 (* ) 3. 0 16 B as ic 74 .9 4. 3 10 0. 0 98 .7 13 29 9. 0 1. 4 13 29 50 .4 3. 4 13 12 S ec on da ry 77 .8 4. 5 10 0. 0 99 .6 94 1 12 .4 1. 7 94 1 53 .8 3. 6 93 8 H ig he r 82 .2 4. 7 10 0. 0 99 .4 90 8 17 .2 1. 9 90 8 61 .8 3. 9 90 2 Fa th er n ot in ho us eh ol d 68 .4 4. 2 .0 89 .9 80 1. 5 0. 2 0. 0 47 .6 3. 1 72 W ea lth in de x qu in til es P oo re st 68 .9 4. 1 95 .4 98 .5 79 4 7. 3 1. 4 75 7 45 .7 3. 2 78 2 S ec on d 74 .1 4. 3 97 .3 98 .7 69 8 11 .7 1. 5 68 0 51 .2 3. 4 68 9 M id dl e 80 .0 4. 5 97 .9 98 .7 66 1 12 .9 1. 6 64 7 53 .4 3. 5 65 2 Fo ur th 81 .5 4. 7 98 .8 99 .2 59 2 13 .7 1. 7 58 5 60 .4 3. 8 58 7 R ic he st 87 .3 5. 0 99 .3 10 0. 0 52 9 16 .7 1. 9 52 6 66 .1 4. 2 52 9 1 M IC S in di ca to r 6 .2 - Su pp or t f or le ar ni ng 2 M IC S In di ca to r 6 .3 - Fa th er ’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 io n le ve l o f t he re sp on de nt to th e Q ue st io nn ai re fo r C hi ld re n U nd er F iv e, a nd c ov er s bo th m ot he rs a nd p rim ar y ca re ta ke rs , w ho a re in te rv ie w ed w he n th e m ot he r i s no t l is te d in th e sa m e ho us eh ol d. S in ce in di ca to r 6 .4 re po rts o n th e bi ol og ic al m ot he r's s up po rt fo r l ea rn in g, th is b ac kg ro un d ch ar ac te ris tic re fe rs to o nl y th e ed uc at io na l l ev el s of b io lo gi ca l m ot he rs w he n ca lc ul at ed fo r t he in di ca to r i n qu es tio n. (* ) F ig ur es th at a re b as ed o n le ss th an 2 5 un w ei gh te d ca se s 140 Palestinian Multiple Indicator Cluster Survey 2014 128 There are no gender differentials in terms of engagement of adults, biological fathers and biological mothers in activities with children. However, among children living in rural areas (81 percent), larger proportions of adults engaged in learning and school readiness activities with children than in urban areas (78 percent) and in camps (71 percent). Large differentials by region and socio-economic status are also observed: adult engagement in activities with children was higher in the West bank (83 percent) and lower in the Gaza Strip (72 percent), while the proportion was 87 percent for children living in the richest households, as opposed to those living in the poorest households (69 percent). Father’s and mother’s involvement showed a similar pattern in terms of engagement in such activities. Exposure to books in early years not only provides the child with greater understanding of the nature of print, but may also give the child opportunities to see others reading, such as older siblings doing school work. Presence of books is important for later school performance. The mother/caretaker of all children under 5 were asked about number of children’s books or picture books they have for the child, household objects or outside objects, and homemade toys or toys that came from a shop that are available at home. In Palestine, only 20 percent of children age 0-59 months live in households where at least 3 children’s books are present for the child (Table CD.3). The proportion of children with 10 or more books declines to 4 percent. While no differentials were noted by gender and area of residence were noted, the presence of children’s books is positively correlated with the child’s age and mother’s education. In the homes of 29 percent of children age 48-59 months, there are 3 or more children’s books, while the figure is 5 percent for children age 36-47 months. Similarly, 3 or more children's books were found in 23 percent of cases where mothers had attained higher education compared to three percent where they had primary education. When children for whom there are 10 or more children’s books or picture books are taken into account, in the homes of six percent of children age 48-59 months, there are 10 or more children’s books, while the figure is one percent for children age 36-47 months. The availability of children’s books is also related to the socio-economic status of households where three of more books were available in 31 percent in the richest households compared to 13 percent among the poorest households. 141 129 Table CD.3: Learning materials Percentage of children under age 5 by numbers of children's books present in the household, and by playthings that child plays with, Palestine, 2014 Percentage of children living in households that have for the child: Percentage of children who play with: Number of children under age 5 3 or more children's books1 10 or more children's books Home made toys Toys from a shop/ manufact- ured toys Household objects/objects found outside Two or more types of playthings2 Total 19.9 4.1 16.5 86.0 70.6 69.1 7816 Sex Male 19.0 3.3 16.7 85.3 70.7 68.9 4058 Female 20.9 4.8 16.3 86.8 70.4 69.3 3758 Region West Bank 20.2 3.8 16.1 88.8 70.8 71.9 4202 Gaza Strip 19.5 4.3 17.0 82.8 70.3 65.9 3614 Governorate Jenin 23.8 2.7 16.7 89.7 72.3 74.0 469 Tubas 20.6 4.5 9.2 95.0 68.6 70.0 65 Tulkarm 21.2 1.7 15.7 90.5 65.2 65.4 217 Nablus 20.1 4.5 13.0 95.2 75.0 76.0 523 Qalqiliya 23.9 6.6 38.2 92.8 80.0 83.3 157 Salfit 35.8 6.0 27.0 83.6 67.2 68.2 104 Ramallah & Al-Bireh 25.6 6.1 12.3 87.7 68.9 70.1 466 Jericho 19.0 .0 18.6 89.7 69.6 73.9 93 Jerusalem 25.6 6.7 17.9 88.6 67.9 70.6 635 Bethlehem 17.0 4.3 19.5 85.0 74.9 72.9 340 Hebron 12.6 1.4 13.1 86.3 69.7 70.3 1132 North Gaza 17.1 3.6 13.1 81.9 67.5 62.0 695 Gaza 18.0 4.2 14.5 84.0 71.3 65.7 1290 Dier El-Balah 21.9 5.0 10.6 87.1 78.3 75.1 489 Khan Yunis 18.3 1.7 19.0 75.7 67.2 62.5 667 Rafah 26.4 8.7 33.1 86.1 67.8 67.1 472 Area Urban 19.7 4.1 16.3 85.6 70.2 68.6 5942 Rural 21.2 2.8 18.0 88.5 74.6 74.6 1186 Camps 19.9 5.6 15.9 85.3 66.6 64.2 688 Age of child 0-23 months 5.4 1.4 10.5 74.2 51.5 50.5 3002 24-59 months 28.9 5.7 20.3 93.3 82.4 80.7 4814 Mother’s education None (7.9) (0.0) (17.0) (64.3) (71.6) (53.3) 37 Basic 12.6 1.4 15.2 81.9 72.5 67.6 2346 Secondary 16.4 2.6 16.2 85.8 69.8 68.2 2641 Higher 29.6 7.8 17.9 89.9 69.7 71.4 2792 Wealth index quintiles Poorest 13.3 2.7 16.3 78.8 71.6 64.1 1937 Second 23.2 5.0 18.8 86.1 70.1 68.5 1601 Middle 15.0 2.1 16.7 87.7 69.7 70.5 1555 Fourth 21.1 3.9 17.0 88.9 70.5 72.7 1491 Richest 30.9 7.6 13.2 91.5 70.6 71.7 1233 1 MICS indicator 6.5 - Availability of children’s books 2 MICS indicator 6.6 - Availability of playthings ( ) Figures that are based on 25-49 unweighted cases 142 Palestinian Multiple Indicator Cluster Survey 2014 130 Table CD.3 also shows that 69 percent of children age 0-59 months had 2 or more types of playthings to play with in their homes. The types of playthings included in the questionnaires were homemade toys (such as dolls and cars, or other toys made at home), toys that came from a store, and household objects (such as pots and bowls) or objects and materials found outside the home (such as sticks, rocks, animal shells, or leaves). It is interesting to note that 86 percent of children play with toys that come from a store; however, 71 percent of children play with Household objects/objects found outside and, the percentages for other types of toys made at home is 17 percent. While no gender differentials are observed in this respect. The proportion of children who have 2 or more playthings to play with is lowest in Gaza Strip region (66 percent) compared to 72 percent in the West Bank. Similarly, the proportion of children who have 2 or more types of playthings to play with is 75 percent among children living in rural areas compared with 69 percent in urban areas and with 64 percent in camps. In terms of mother’s education – 71 percent of children whose mothers had higher education have 2 or more types of playthings, while the proportion is 67 percent for children whose mothers had basic education. Differentials are small by socioeconomic status of the households. Notable differences exist by governorates ranging from 83 percent in Qalqiliya to 62 percent in North Gaza. Differentials also exist in terms of socioeconomic status – 72 percent of children who live in richest households have 2 or more playthings, while the proportion is 64 percent for children who live in poorest households. Leaving children alone or in the presence of other young children is known to increase the risk of injuries.2 In MICS, two questions were asked to find out whether children age 0-59 months were left alone during the week preceding the interview, and whether children were left in the care of other children under 10 years of age. Table CD.4 shows that 12 percent of children age 0-59 months were left in the care of other children, while 4 percent were left alone during the week preceding the interview. Combining the two care indicators, it is calculated that a total of 14 percent of children were left with inadequate care during the past week, either by being left alone or in the care of another child. No differences were observed by the sex of the child or between urban and rural and camps areas. Children age 48-59 months were left with inadequate care (17 percent) more than those who were age 36-47 months (9 percent). In terms of socioeconomic status (12 percent) of children who live in richest households were left with inadequate care, less than children who live in poorest households (15 percent). 2  Grossman,  David  C.  (2000).  The  History  of  Injury  Control  and  the  Epidemiology  of  Child  and  Adolescent   Injuries.  The  Future  of  Children,  10(1),  23-­‐52.   143 131 Table CD.4: Inadequate care Percentage of children under age 5 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 past week, Palestine, 2014 Percentage of children under age 5: 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 week1 Number of children under age 5 Total 4.2 11.5 14.3 7816 Sex Male 3.8 11.1 13.5 4058 Female 4.5 11.8 15.1 3758 Region West Bank 4.6 10.4 13.1 4202 Gaza Strip 3.6 12.6 15.6 3614 Governorate Jenin 7.9 10.0 16.2 469 Tubas 4.3 10.1 12.6 65 Tulkarm 2.8 9.0 11.1 217 Nablus 1.7 9.4 10.5 523 Qalqiliya 1.9 9.5 10.0 157 Salfit 5.5 14.5 15.1 104 Ramallah & Al-Bireh 4.2 7.7 10.7 466 Jericho and Al Aghwar 5.0 6.7 9.2 93 Jerusalem 4.6 8.5 10.5 635 Bethlehem 4.1 6.8 9.0 340 Hebron 5.6 14.8 17.9 1132 North Gaza 1.2 14.5 15.3 695 Gaza 1.5 16.0 16.8 1290 Dier El-Balah 2.7 10.7 12.7 489 Khan Yunis 11.5 10.6 20.7 667 Rafah 3.1 5.4 8.3 472 Area Urban 3.9 11.1 14.0 5942 Rural 5.2 12.4 15.3 1186 Camps 4.4 12.5 15.0 688 Age of child 0-23 months 3.1 7.1 9.4 3002 24-59 months 4.9 14.2 17.3 4814 Mother’s education None (0.0) (7.5) (7.5) 37 Basic 4.1 15.3 17.8 2346 Secondary 3.9 11.1 13.9 2641 Higher 4.6 8.6 11.7 2792 Wealth index quintiles Poorest 2.7 12.3 14.8 1937 Second 4.6 13.1 16.5 1601 Middle 5.5 12.2 15.3 1555 Fourth 4.5 9.2 11.8 1491 Richest 3.8 9.7 12.2 1233 1 MICS indicator 6.7 - Inadequate care ( ) Figures that are based on 25-49 unweighted cases 144 Palestinian Multiple Indicator Cluster Survey 2014 132 Developmental Status of Children Early childhood development is 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 development.3 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 Palestine. The index is based on selected milestones that children are expected to achieve by ages 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 ten 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 two of the following are true: If the child gets along well with other children, if the child does not kick, bite, or hit other children and 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. 3  Shonkoff  J,  and  Phillips  D,  (eds),  From  neurons  to  neighborhoods:  the  science  of  early  childhood  development,   Committee  on  Integrating  the  Science  of  Early  Childhood  Development,  National  Research  Council,  2000.     145 133 Table CD.5: Early child development index Percentage of children age 36-59 months who are developmentally on track in literacy-numeracy, physical, social- emotional, and learning domains, and the early child development index score, Palestine, 2014 Percentage of children age 36-59 months who are developmentally on track for indicated domains Early child development index score1 Number of children age 36-59 months Literacy- numeracy Physical Social- Emotional Learning Total 22.0 96.1 71.3 91.7 72.0 3275 Sex Male 20.6 96.1 66.4 91.0 67.6 1689 Female 23.5 96.0 76.6 92.4 76.7 1585 Region West Bank 23.0 96.0 76.1 92.5 76.0 1750 Gaza Strip 20.9 96.2 65.9 90.7 67.5 1524 Governorate Jenin 20.9 95.5 76.9 93.6 75.6 188 Tubas (*) (*) (*) (*) (*) 23 Tulkarm 34.9 96.1 73.6 93.6 78.2 94 Nablus 25.0 98.6 76.0 95.2 75.7 234 Qalqiliya 18.6 99.0 72.0 96.3 74.7 76 Salfit 41.8 94.6 72.9 93.5 80.6 51 Ramallah & Al-Bireh 31.9 94.6 78.0 94.3 82.3 174 Jericho and Al Aghwar (24.9) (97.7) (84.7) (95.6) (83.0) 30 Jerusalem 31.6 97.6 76.8 94.7 79.7 266 Bethlehem 7.6 95.2 76.7 91.8 75.4 129 Hebron 15.3 94.3 75.7 88.1 71.2 484 North Gaza 12.8 96.8 73.3 93.4 72.0 275 Gaza 22.3 96.3 60.6 89.4 65.1 561 Dier El-Balah 15.0 91.6 64.6 92.4 62.6 218 Khan Yunis 23.9 96.7 74.8 92.2 75.1 262 Rafah 30.0 99.0 60.8 87.0 63.2 208 Area Urban 21.7 96.3 71.6 91.9 72.3 2467 Rural 22.6 95.4 74.8 91.8 75.6 504 Camps 23.8 95.7 63.5 89.6 63.5 304 Age of child 36-47 months 8.4 93.7 68.7 89.5 65.7 1678 48-59 months 36.3 98.6 74.2 93.9 78.7 1597 Attendance to early childhood education Attending 58.2 99.4 75.1 96.3 86.5 864 Not attending 9.0 94.9 70.0 90.0 66.8 2410 Mother’s education None (*) (*) (*) (*) (*) 18 Basic 16.2 97.2 68.4 90.0 67.6 1102 Secondary 22.0 95.3 69.0 92.0 70.7 1100 Higher 28.4 95.8 76.6 93.1 77.8 1054 Wealth index quintiles Poorest 17.3 96.5 61.6 89.2 63.0 794 Second 22.6 95.8 69.6 90.4 69.9 698 Middle 20.9 95.2 73.4 92.4 72.9 661 Fourth 22.8 96.3 75.5 92.7 76.6 592 Richest 28.9 96.5 81.0 94.9 82.0 529 1 MICS indicator 6.8 - Early child development index ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 146 Palestinian Multiple Indicator Cluster Survey 2014 134 The results are presented in Table CD.5. In Palestine, 72 percent of children age 36-59 months are developmentally on track. ECDI is higher among girls (77 percent) than boys (68 percent). As expected, ECDI is much higher in older age group (79 percent among 48-59 months old compared to 66 percent among 36-47 months old), since children mature and acquire more skills with increasing age. Higher ECDI is seen in children attending an early childhood education programme at 87 percent compared to 67 percent among those who did not attend. Children living in poorest households have lower ECDI (63 percent) compared to children living in richest households (82 percent of children developmentally on track). The analysis of four domains of child development shows that 96 percent of children are on track in the physical domain, but much less on track in literacy-numeracy (22 percent), learning (92 percent) and social-emotional (71 percent) domains. In each individual domain the higher score is associated with children living in richest households, with children attending an early childhood education programme, older children, and among girls. 147 X. Literacy and Education 135 X. Literacy and Education 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 Palestinian MICS 5, since only a women’s questionnaire was administered, the results are based only on females age 15-24. Literacy is assessed on the ability of the respondent to read a short simple statement or based on school attendance. The percent literate is presented in Table ED.1, which indicates that most of young women in Palestine are literate and that literacy status does not show any variations by area. Of women who stated that basic school was their highest level of education, around 92 percent were actually able to read the statement shown to them, with a slight variation between women living among the poorest households, compared to those who are living in the richest households (94 percent and 99 percent) respectively. 150 Palestinian Multiple Indicator Cluster Survey 2014 136 Table ED.1: Literacy (young women) Percentage of women age 15-24 years who are literate, Palestine, 2014 Percentage literate1 Percentage not known Number of women age 15-24 years Total 97.2 0.1 5860 Region West Bank 97.6 0.2 3377 Gaza Strip 96.5 0.0 2483 Governorate Jenin 99.0 0.2 391 Tubas 100.0 0.0 80 Tulkarm 97.6 0.3 233 Nablus 98.3 0.0 407 Qalqiliya 99.3 0.0 124 Salfit 100.0 0.0 88 Ramallah & Al-Bireh 99.2 0.2 363 Jericho and Al Aghwar 97.0 1.3 72 Jerusalem 99.3 0.0 438 Bethlehem 96.9 0.3 305 Hebron 94.9 0.3 875 North Gaza 94.1 0.0 439 Gaza 96.3 0.0 916 Deir El-Balah 97.3 0.0 379 Khan Yunis 97.7 0.0 480 Rafah 97.8 0.5 269 Area Urban 97.1 0.1 4363 Rural 97.3 0.3 998 Camp 97.1 0.2 499 Education None (*) (*) 8 Basic 91.9 0.4 1941 Secondary 100.0 0.0 1745 Higher 100.0 0.0 2165 Age 15-19 96.5 0.3 3047 20-24 97.8 0.0 2813 Wealth index quintile Poorest 94.1 0.1 1212 Second 96.6 0.2 1227 Middle 96.8 0.1 1114 Fourth 99.1 0.1 1162 Richest 99.3 0.2 1145 1 MICS indicator 7.1; MDG indicator 2.3 - Literacy rate among young women ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 151 137 Data shown in the tables ED.2-ED.9 are based on the classification of the Palestinian education system, where basic stage consists of grades 1-10, and secondary stage consists of grades 11-12. Table ED.10 showing the ISCED classification is presented in the end of this chapter. School Readiness Attendance to pre-school education is important for the readiness of children to school. Table ED.2 shows the proportion of children in the first grade of basic school (regardless of age) who attended pre-school the previous year1. Overall, 94 percent of children who are currently attending the first grade of basic school were attending pre-school the previous year. The proportion among females is slightly higher (96 percent) than males (93 percent). Also slight differential between West Bank and Gaza Strip is noticed (92 percent and 97 percent) respectively. Differentials at the governorate level are also significant; 82 percent of first graders in Bethlehem governorate have attended pre-school compared to 100 percent in Deir El Balah and Khan Yunis governorates. 1  The  computation  of  the  indicator  does  not  exclude  repeaters,  and  therefore  is  inclusive  of  both  children  who  are   attending  primary  school  for  the  first  time,  as  well  as  those  who  were  in  the  first  grade  of  primary  school  the  previous   school  year  and  are  repeating.  Children  repeating  may  have  attended  pre-­‐school  prior  to  the  school  year  during  which  they   attended  the  first  grade  of  primary  school  for  the  first  time;  these  children  are  not  captured  in  the  numerator  of  the   indicator   152 Palestinian Multiple Indicator Cluster Survey 2014 138 Table ED.2: School readiness Percentage of children attending first grade of basic school who attended pre-school the previous year, Palestine, 2014 Percentage of children attending first grade who attended preschool in previous year1 Number of children attending first grade of basic school Total 94.1 1528 Region West Bank 91.9 882 Gaza Strip 97.2 647 Sex Male 92.5 775 Female 95.8 753 Governorate Jenin 98.8 70 Tubas (*) 11 Tulkarm 98.0 53 Nablus 95.6 117 Qalqiliya 91.4 31 Salfit (*) 19 Ramallah & Al-Bireh 92.0 103 Jericho and Al Aghwar 83.9 20 Jerusalem 94.2 155 Bethlehem 81.7 72 Hebron 90.1 231 North Gaza 96.6 134 Gaza 95.0 232 Deir El-Balah 100.0 92 Khan Yunis 100.0 110 Rafah 97.8 80 Area Urban 94.7 1148 Rural 90.4 230 Camp 96.0 151 Mother's education None (*) 15 Basic 92.3 582 Secondary 96.0 507 Higher 95.3 425 Wealth index quintile Poorest 95.9 315 Second 97.1 292 Middle 90.8 318 Fourth 93.2 312 Richest 94.0 291 1 MICS indicator 7.2 - School readiness ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 153 139 Basic and Secondary School Participation Universal access to primary education and the completion of primary education by the world’s children is one of the Millennium Development Goals. Education is a vital prerequisite for combating poverty, empowering women, protecting children from hazardous and exploitative labour and sexual exploitation, promoting human rights and democracy, protecting the environment, and influencing population growth. In Palestine, children enter basic school at age 6 and enter secondary school at age 16. There are 10 grades in basic school and 2 grades in secondary school. In basic school, grades are referred to as grade 1 to grade 10. For secondary school, grades are referred to as grade 11 to grade 12. The school year typically runs from September of one year to June of the following year. Of children who are of basic school entry age (age 6) in Palestine, 97 percent are attending the first grade of basic school (Table ED.3). As access is almost universal, no differences were noted with regard to any of the background characteristics. 154 Palestinian Multiple Indicator Cluster Survey 2014 140 Table ED.3: Basic school entry Percentage of children of Basic school entry age entering grade 1 (net intake rate), Palestine, 2014 Percentage of children of basic school entry age entering grade 11 Number of children of basic school entry age Total 96.9 1473 Region West Bank 97.3 829 Gaza Strip 96.5 643 Sex Male 97.2 726 Female 96.7 747 Governorate Jenin 99.3 76 Tubas (*) 11 Tulkarm 95.4 53 Nablus 100.0 105 Qalqiliya 100.0 31 Salfit (*) 23 Ramallah & Al-Bireh 98.2 95 Jericho and Al Aghwar 97.4 19 Jerusalem 97.6 135 Bethlehem 100.0 53 Hebron 94.5 228 North Gaza 97.4 133 Gaza 97.5 225 Deir El-Balah 93.1 84 Khan Yunis 95.1 116 Rafah 97.5 85 Area Urban 96.8 1107 Rural 97.5 235 Camp 97.0 130 Mother's education None (*) 11 Basic 95.7 574 Secondary 96.3 479 Higher 99.5 409 Wealth index quintile Poorest 97.3 302 Second 95.0 312 Middle 96.5 301 Fourth 99.1 280 Richest 96.8 277 1 MICS indicator 7.3 - Net intake rate in basic education ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 155 141 Table ED.4 provides the percentage of children of basic school age 6 to 15 years who are attending basic or secondary school2 and those who are out of school. A large majority of children (97 percent) of basic school age are attending school. Differentials are noted by mother's education, as children with mothers with no education are least likely to attend basic school compared with mothers with higher education (85 percent and 99 percent) respectively. Also it might be worth noting differential by age, School attendance goes down after the age of 13. The low attendance rate among 15-year-old boys (80%) seems particularly noteworthy. 2  Ratios  presented  in  this  table  are  "adjusted"  since  they  include  not  only  primary  school  attendance,  but  also  secondary   school  attendance  in  the  numerator.   156 Palestinian Multiple Indicator Cluster Survey 2014 14 2 Ta bl e ED .4 : B as ic s ch oo l a tte nd an ce a nd o ut o f s ch oo l c hi ld re n P er ce nt ag e of c hi ld re n of B as ic s ch oo l a ge a tte nd in g ba si c or s ec on da ry s ch oo l ( ad ju st ed n et a tte nd an ce ra tio ), pe rc en ta ge a tte nd in g pr es ch oo l, an d pe rc en ta ge o ut o f s ch oo l, P al es tin e, 2 01 4 M al e Fe m al e To ta l N et at te nd an ce ra tio (a dj us te d) Pe rc en ta ge o f c hi ld re n: N um be r of ch ild re n N et at te nd an ce ra tio (a dj us te d) Pe rc en ta ge o f c hi ld re n: N um be r of ch ild re n N et at te nd an ce ra tio (a dj us te d) 1 Pe rc en ta ge o f c hi ld re n: N um be r of ch ild re n N ot at te nd in g sc ho ol o r pr es ch oo l A tte nd in g pr es ch oo l O ut o f sc ho ol a N ot at te nd in g sc ho ol o r pr es ch oo l A tte nd in g pr es ch oo l O ut o f sc ho ol a N ot at te nd in g sc ho ol o r pr es ch oo l A tte nd in g pr es ch oo l O ut o f sc ho ol a To ta l 95 .3 4. 4 0. 2 4. 7 69 40 98 .3 1. 5 0. 2 1. 7 68 12 96 .8 3. 0 0. 2 3. 2 13 75 2 R eg io n W es t B an k 95 .0 4. 8 0. 2 5. 0 40 66 98 .4 1. 4 0. 2 1. 6 40 01 96 .7 3. 1 0. 2 3. 3 80 67 G az a S tri p 95 .8 3. 9 0. 3 4. 2 28 74 98 .2 1. 6 0. 2 1. 8 28 11 97 .0 2. 7 0. 2 3. 0 56 85 G ov er no ra te Je ni n 94 .7 5. 0 0. 0 5. 0 42 0 99 .0 1. 0 0. 0 1. 0 44 1 96 .9 3. 0 0. 0 3. 0 86 1 Tu ba s 94 .9 3. 8 1. 3 5. 1 85 98 .1 1. 9 0. 0 1. 9 68 96 .3 3. 0 0. 7 3. 7 15 3 Tu lk ar m 93 .9 5. 8 0. 4 6. 1 22 4 99 .2 0. 4 0. 4 0. 8 22 2 96 .5 3. 1 0. 4 3. 5 44 7 N ab lu s 97 .3 2. 7 0. 0 2. 7 53 7 99 .4 0. 3 0. 0 0. 3 51 5 98 .3 1. 5 0. 0 1. 5 10 52 Q al qi liy a 97 .5 2. 5 0. 0 2. 5 13 3 97 .9 2. 1 0. 0 2. 1 13 9 97 .7 2. 3 0. 0 2. 3 27 1 S al fit 97 .9 2. 1 0. 0 2. 1 10 6 99 .3 0. 0 0. 7 0. 7 98 98 .5 1. 1 0. 3 1. 5 20 4 R am al la h & A l- B ire h 96 .0 4. 0 0. 0 4. 0 39 3 99 .0 0. 8 0. 2 1. 0 40 9 97 .5 2. 4 0. 1 2. 5 80 2 Je ric ho a nd A l A gh w ar 91 .9 8. 1 0. 0 8. 1 79 92 .3 7. 7 0. 0 7. 7 72 92 .1 7. 9 0. 0 7. 9 15 1 Je ru sa le m 96 .0 3. 5 0. 5 4. 0 68 1 98 .6 1. 4 0. 0 1. 4 63 8 97 .2 2. 5 0. 2 2. 8 13 19 B et hl eh em 95 .5 4. 5 0. 0 4. 5 31 3 97 .9 2. 1 0. 0 2. 1 36 8 96 .8 3. 2 0. 0 3. 2 68 1 H eb ro n 92 .6 7. 1 0. 3 7. 4 10 95 97 .7 1. 9 0. 4 2. 3 10 30 95 .0 4. 6 0. 3 5. 0 21 25 N or th G az a 95 .6 4. 0 0. 4 4. 4 55 8 97 .7 2. 1 0. 2 2. 3 55 8 96 .6 3. 0 0. 3 3. 4 11 16 G az a 95 .0 4. 9 0. 1 5. 0 10 78 98 .2 1. 6 0. 2 1. 8 10 44 96 .6 3. 3 0. 2 3. 4 21 21 D ei r E l-B al ah 95 .2 4. 1 0. 6 4. 8 40 6 98 .8 1. 2 0. 0 1. 2 43 0 97 .1 2. 6 0. 3 2. 9 83 5 K ha n Y un is 97 .5 2. 5 0. 0 2. 5 51 3 98 .5 1. 1 0. 4 1. 5 49 4 98 .0 1. 9 0. 2 2. 0 10 07 R af ah 97 .2 2. 1 0. 7 2. 8 31 9 98 .2 1. 8 0. 0 1. 8 28 6 97 .7 2. 0 0. 3 2. 3 60 5 A re a U rb an 95 .3 4. 4 0. 3 4. 7 51 71 98 .5 1. 3 0. 2 1. 5 50 66 96 .9 2. 9 0. 2 3. 1 10 23 7 R ur al 95 .2 4. 7 0. 0 4. 7 11 31 97 .8 2. 0 0. 2 2. 2 11 32 96 .5 3. 3 0. 1 3. 5 22 62 C am p 95 .3 4. 5 0. 2 4. 7 63 8 97 .9 1. 9 0. 2 2. 1 61 4 96 .6 3. 2 0. 2 3. 4 12 52 1 M IC S in di ca to r 7 .S 1 - B as ic s ch oo l n et a tte nd an ce ra tio (a dj us te d) a Th e pe rc en ta ge o f c hi ld re n of b as ic s ch oo l a ge o ut o f s ch oo l a re th os e no t a tte nd in g sc ho ol a nd th os e at te nd in g pr es ch oo l 157 14 3 Ta bl e ED .4 C on tin ue d: B as ic s ch oo l a tte nd an ce a nd o ut o f s ch oo l c hi ld re n P er ce nt ag e of c hi ld re n of B as ic s ch oo l a ge a tte nd in g ba si c or s ec on da ry s ch oo l ( ad ju st ed n et a tte nd an ce ra tio ), pe rc en ta ge a tte nd in g pr es ch oo l, an d pe rc en ta ge o ut o f sc ho ol , P al es tin e, 2 01 4 M al e Fe m al e To ta l N et at te nd an ce ra tio (a dj us te d) Pe rc en ta ge o f c hi ld re n: N um be r o f ch ild re n N et at te nd an ce ra tio (a dj us te d) Pe rc en ta ge o f c hi ld re n: N um be r of ch ild re n N et a tte nd an ce ra tio (a dj us te d) 1 Pe rc en ta ge o f c hi ld re n: N um be r of ch ild re n N ot at te nd in g sc ho ol o r pr es ch oo l A tte nd in g pr es ch oo l O ut o f sc ho ol a N ot a tte nd in g sc ho ol o r pr es ch oo l A tte nd in g pr es ch oo l O ut o f sc ho ol a N ot at te nd in g sc ho ol o r pr es ch oo l A tte nd in g pr es ch oo l O ut o f sc ho ol a A ge a t b eg in ni ng o f s ch oo l y ea r 6 97 .3 0. 7 2. 1 2. 7 72 6 97 .0 1. 4 1. 6 3. 0 74 7 97 .1 1. 0 1. 8 2. 9 14 73 7 99 .2 0. 8 0. 0 0. 8 77 1 99 .1 0. 9 0. 0 0. 9 72 9 99 .1 0. 9 0. 0 0. 9 15 00 8 99 .5 0. 5 0. 0 0. 5 70 2 99 .5 0. 5 0. 0 0. 5 74 3 99 .5 0. 5 0. 0 0. 5 14 45 9 99 .1 0. 9 0. 0 0. 9 72 1 99 .8 0. 2 0. 0 0. 2 71 1 99 .5 0. 5 0. 0 0. 5 14 31 10 98 .6 1. 4 0. 0 1. 4 66 0 99 .6 0. 4 0. 0 0. 4 67 8 99 .1 0. 9 0. 0 0. 9 13 38 11 98 .4 1. 4 0. 1 1. 6 67 8 99 .4 0. 6 0. 0 0. 6 64 7 98 .9 1. 0 0. 1 1. 1 13 25 12 96 .9 3. 1 0. 0 3. 1 64 4 99 .1 0. 9 0. 0 0. 9 62 9 98 .0 2. 0 0. 0 2. 0 12 73 13 94 .1 5. 9 0. 0 5. 9 72 1 97 .1 2. 9 0. 0 2. 9 67 6 95 .6 4. 4 0. 0 4. 4 13 97 14 88 .4 11 .6 0. 0 11 .6 64 1 97 .3 2. 7 0. 0 2. 7 60 4 92 .7 7. 3 0. 0 7. 3 12 45 15 80 .4 19 .4 0. 0 19 .4 67 5 95 .0 4. 8 0. 0 4. 8 65 0 87 .6 12 .3 0. 0 12 .3 13 25 M ot he r's e du ca tio n N on e 82 .7 16 .3 1. 0 17 .3 10 5 87 .5 12 .5 0. 0 12 .5 11 2 85 .2 14 .4 0. 5 14 .8 21 8 B as ic 93 .1 6. 6 0. 3 6. 9 32 83 98 .0 1. 8 0. 2 2. 0 31 99 95 .5 4. 2 0. 2 4. 5 64 82 S ec on da ry 97 .4 2. 4 0. 2 2. 6 21 02 99 .1 0. 6 0. 3 0. 9 20 88 98 .2 1. 5 0. 2 1. 8 41 90 H ig he r 98 .7 1. 1 0. 1 1. 2 14 29 99 .6 0. 4 0. 0 0. 4 13 77 99 .2 0. 8 0. 0 0. 8 28 06 C an no t b e de te rm in ed (* ) (* ) (* ) (* ) 20 (6 8. 3) (2 7. 6) (0 .0 ) (2 7. 6) 35 63 .5 33 .8 0. 0 33 .8 55 W ea lth in de x qu in til e P oo re st 94 .4 5. 4 0. 3 5. 6 13 74 97 .6 2. 4 0. 0 2. 4 13 62 96 .0 3. 9 0. 1 4. 0 27 36 S ec on d 94 .8 5. 0 0. 2 5. 2 13 73 97 .9 1. 5 0. 6 2. 1 13 61 96 .4 3. 3 0. 4 3. 6 27 33 M id dl e 93 .5 6. 2 0. 2 6. 4 14 05 97 .9 1. 9 0. 2 2. 1 13 58 95 .6 4. 1 0. 2 4. 3 27 63 Fo ur th 96 .1 3. 8 0. 1 3. 9 13 16 99 .1 0. 7 0. 1 0. 8 13 07 97 .6 2. 2 0. 1 2. 3 26 23 R ic he st 97 .7 1. 9 0. 4 2. 3 14 72 99 .1 0. 9 0. 1 0. 9 14 24 98 .4 1. 4 0. 2 1. 6 28 95 1 M IC S in di ca to r 7 .S 1 - B as ic s ch oo l n et a tte nd an ce ra tio (a dj us te d) a Th e pe rc en ta ge o f c hi ld re n of b as ic s ch oo l a ge o ut o f s ch oo l a re th os e no t a tte nd in g sc ho ol a nd th os e at te nd in g pr es ch oo l ( ) F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s (* ) F ig ur es th at a re b as ed o n le ss th an 2 5 un w ei gh te d ca se s 158 Palestinian Multiple Indicator Cluster Survey 2014 144 The secondary school net attendance ratio is presented in Table ED.53. More dramatic than seen for basic education, only 72 percent of the children are attending secondary school. A factor could be that secondary education is not compulsory in Palestine. Of the remaining 28 percent of children of secondary school age, a large majority (23 percent) are out of school and only five percent are attending basic school. Gender differentials also exist, as only 63 percent of males are attending secondary school compared to 80 percent of females. Differentials also exist among governorates which ranges from 59 percent in Jericho and Al Aghwar governorate to 86 percent in Tubas governorate, and by wealth index, as 62 percent of children living among the poorest households, compared to 82 percent among those who are living in the richest households. 3  Ratios  presented  in  this  table  are  "adjusted"  since  they  include  not  only  secondary  school  attendance,  but  also   attendance  to  higher  levels  in  the  numerator.   159 14 5 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 P er ce nt ag e of c hi ld re n of s ec on da ry s ch oo l a ge a tte nd in g se co nd ar y sc ho ol o r h ig he r ( ad ju st ed n et a tte nd an ce ra tio ), pe rc en ta ge a tte nd in g ba si c sc ho ol , a nd pe rc en ta ge o ut o f s ch oo l, P al es tin e, 2 01 4 M al e Fe m al e To ta l N et at te nd an ce ra tio (a dj us te d) Pe rc en ta ge o f ch ild re n: N um be r of ch ild re n N et at te nd an ce ra tio (a dj us te d) Pe rc en ta ge o f ch ild re n: N um be r of ch ild re n N et at te nd an ce ra tio (a dj us te d) 1 Pe rc en ta ge o f ch ild re n: N um be r of ch ild re n A tte nd in g ba si c sc ho ol O ut o f sc ho ol a A tte nd in g ba si c sc ho ol O ut o f sc ho ol a A tte nd in g ba si c sc ho ol O ut o f sc ho ol a To ta l 63 .3 4. 3 32 .3 13 66 80 .4 6. 1 13 .4 13 21 71 .7 5. 2 23 .0 26 87 R eg io n W es t B an k 61 .3 4. 7 34 .0 83 8 81 .0 7. 2 11 .7 76 2 70 .7 5. 9 23 .3 16 01 G az a S tri p 66 .5 3. 8 29 .7 52 8 79 .6 4. 6 15 .8 55 8 73 .2 4. 2 22 .6 10 86 G ov er no ra te Je ni n 63 .3 4. 5 32 .2 81 92 .8 3. 1 4. 1 89 78 .7 3. 8 17 .5 17 0 Tu ba s (* ) (* ) (* ) 14 (* ) (* ) (* ) 16 85 .7 0. 0 14 .3 30 Tu lk ar m 65 .7 1. 6 32 .8 57 86 .5 9. 9 3. 6 49 75 .3 5. 4 19 .3 10 7 N ab lu s 71 .0 2. 6 26 .4 12 9 79 .8 8. 3 12 .0 85 74 .5 4. 8 20 .7 21 4 Q al qi liy a (7 1. 8) (4 .9 ) (2 3. 3) 36 (* ) (* ) (* ) 19 75 .3 6. 8 18 .0 55 S al fit 55 .9 2. 5 41 .5 24 78 .1 10 .0 11 .9 26 67 .4 6. 4 26 .2 50 R am al la h & A l-B ire h 71 .0 1. 1 27 .9 91 85 .1 4. 3 9. 5 77 77 .5 2. 5 19 .5 16 8 Je ric ho a nd A l A gh w ar 40 .2 0. 0 59 .8 13 76 .9 0. 0 23 .1 14 59 .4 0. 0 40 .6 27 Je ru sa le m 53 .7 9. 1 36 .4 12 2 76 .3 9. 3 14 .4 11 7 64 .8 9. 2 25 .6 23 9 B et hl eh em 61 .0 2. 7 36 .3 59 80 .6 9. 9 9. 5 72 71 .8 6. 7 21 .6 13 1 H eb ro n 52 .7 7. 1 40 .2 21 1 75 .8 7. 2 17 .0 19 8 63 .9 7. 2 29 .0 41 0 N or th G az a 63 .1 6. 7 30 .3 10 9 74 .9 4. 5 20 .6 89 68 .4 5. 7 25 .9 19 8 G az a 65 .4 1. 8 32 .8 18 4 76 .6 6. 1 17 .3 21 2 71 .4 4. 1 24 .5 39 7 D ei r E l-B al ah 65 .7 1. 6 32 .6 80 85 .4 3. 3 11 .3 98 76 .6 2. 5 20 .9 17 8 K ha n Y un is 64 .1 4. 4 31 .4 96 83 .3 2. 1 14 .6 10 2 74 .0 3. 2 22 .7 19 8 R af ah 81 .2 6. 8 12 .0 58 81 .6 5. 4 13 .0 58 81 .4 6. 1 12 .5 11 6 1 M IC S in di ca to r 7 .S 2 - S ec on da ry s ch oo l n et a tte nd an ce ra tio (a dj us te d) a Th e pe rc en ta ge o f c hi ld re n of s ec on da ry s ch oo l a ge o ut o f s ch oo l a re th os e w ho a re n ot a tte nd in g ba si c, s ec on da ry , o r h ig he r e du ca tio n b C hi ld re n ag e 15 o r h ig he r a t t he ti m e of th e in te rv ie w w ho se m ot he rs w er e no t l iv in g in th e ho us eh ol d ( ) F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s (* ) F ig ur es th at a re b as ed o n le ss th an 2 5 un w ei gh te d ca se s 160 Palestinian Multiple Indicator Cluster Survey 2014 14 6 Ta bl e ED .5 C on tin ue d: 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 P er ce nt ag e of c hi ld re n of s ec on da ry s ch oo l a ge a tte nd in g se co nd ar y sc ho ol o r h ig he r ( ad ju st ed n et a tte nd an ce ra tio ), pe rc en ta ge a tte nd in g ba si c sc ho ol , a nd pe rc en ta ge o ut o f s ch oo l, P al es tin e, 2 01 4 M al e Fe m al e To ta l N et at te nd an ce ra tio (a dj us te d) Pe rc en ta ge o f c hi ld re n: N um be r of ch ild re n N et at te nd an ce ra tio (a dj us te d) Pe rc en ta ge o f c hi ld re n: N um be r of ch ild re n N et at te nd an ce ra tio (a dj us te d) 1 Pe rc en ta ge o f ch ild re n: N um be r of ch ild re n A tte nd in g ba si c sc ho ol O ut o f sc ho ol a A tte nd in g ba si c sc ho ol O ut o f sc ho ol a A tte nd in g ba si c sc ho ol O ut o f sc ho ol a A re a U rb an 63 .5 4. 6 31 .8 98 8 80 .6 5. 9 13 .5 98 7 72 .1 5. 2 22 .7 19 75 R ur al 63 .1 3. 8 33 .1 25 7 80 .6 7. 9 11 .1 21 9 71 .2 5. 7 23 .0 47 6 C am p 62 .2 3. 2 34 .6 12 1 78 .1 4. 5 17 .4 11 4 69 .9 3. 8 26 .3 23 6 A ge a t b eg in ni ng o f s ch oo l ye ar 16 63 .6 6. 8 29 .5 66 4 76 .4 10 .2 13 .3 66 5 70 .0 8. 5 21 .4 13 28 17 62 .9 2. 0 34 .9 70 2 84 .5 1. 9 13 .5 65 6 73 .3 1. 9 24 .6 13 58 M ot he r's e du ca tio n N on e (2 9. 6) (1 2. 6) (5 7. 8) 25 (5 6. 3) (1 5. 4) (2 8. 3) 29 43 .9 14 .1 42 .1 54 B as ic 54 .3 6. 8 38 .8 53 7 76 .0 11 .2 12 .6 47 3 64 .4 8. 9 26 .5 10 10 S ec on da ry 77 .7 4. 1 18 .3 29 3 90 .5 6. 4 3. 1 25 6 83 .7 5. 1 11 .2 54 9 H ig he r 85 .9 3. 7 10 .5 12 2 98 .1 1. 5 0. 5 15 7 92 .7 2. 4 4. 9 27 8 C an no t b e de te rm in ed b 60 .0 0. 8 39 .2 38 9 74 .1 1. 0 24 .9 40 7 67 .2 0. 9 31 .9 79 5 W ea lth in de x qu in til e P oo re st 51 .9 3. 9 44 .3 22 6 70 .5 6. 2 23 .3 26 0 61 .8 5. 1 33 .0 48 6 S ec on d 67 .7 4. 4 27 .9 28 9 79 .6 4. 7 15 .4 27 4 73 .5 4. 5 21 .8 56 3 M id dl e 53 .1 5. 6 41 .4 27 6 75 .3 8. 7 16 .0 23 8 63 .3 7. 0 29 .6 51 4 Fo ur th 64 .8 4. 0 31 .3 27 3 86 .4 5. 9 7. 7 25 6 75 .2 4. 9 19 .9 53 0 R ic he st 75 .6 3. 8 20 .2 30 1 89 .0 5. 2 5. 8 29 2 82 .2 4. 5 13 .1 59 3 1 M IC S in di ca to r 7 .S 2 - S ec on da ry s ch oo l n et a tte nd an ce ra tio (a dj us te d) a Th e pe rc en ta ge o f c hi ld re n of s ec on da ry s ch oo l a ge o ut o f s ch oo l a re th os e w ho a re n ot a tte nd in g ba si c, s ec on da ry , o r h ig he r e du ca tio n b C hi ld re n ag e 15 o r h ig he r a t t he ti m e of th e in te rv ie w w ho se m ot he rs w er e no t l iv in g in th e ho us eh ol d ( ) F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s (* ) F ig ur es th at a re b as ed o n le ss th an 2 5 un w ei gh te d ca se s 161 147 The percentage of children entering first grade who eventually reach the last grade of basic school is presented in Table ED.6. Of all children starting grade one, the majority (92 percent) will eventually reach grade 10. The MICS included only questions on school attendance in the current and previous year. Thus, the indicator is calculated synthetically by computing the cumulative probability of survival from the first to the last grade of basic school, as opposed to calculating the indicator for a real cohort which would need to be followed from the time a cohort of children entered basic school, up to the time they reached the last grade of basic school. Repeaters are excluded from the calculation of the indicator, because it is not known whether they will eventually graduate. As an example, the probability that a child will move from the first grade to the second grade is computed by dividing the number of children who moved from the first grade to the second grade (during the two consecutive school years covered by the survey) by the number of children who have moved from the first to the second grade plus the number of children who were in the first grade the previous school year, but dropped out. Both the numerator and denominator excludes children who repeated during the two school years under consideration. Differentials are noticed by sex, as 88 percent of males children entering first grade eventually reach the last grade of basic school compared to 96 percent of females. Differentials also exist by governorates which is ranges from 81 percent in Jericho and Al Aghwar governorate to 98 percent in Rafah governorate. Disparities with regard to wealth are also noted, as 89 percent of children living among the poorest households eventually reach the last grade of basic education, compared to 96 percent among those who are living in the richest households. 162 Palestinian Multiple Indicator Cluster Survey 2014 14 8 Ta bl e ED .6 : C hi ld re n re ac hi ng la st g ra de o f b as ic s ch oo l P er ce nt ag e of c hi ld re n en te rin g fir st g ra de o f b as ic s ch oo l w ho e ve nt ua lly re ac h th e la st g ra de o f b as ic s ch oo l ( S ur vi va l r at e to la st g ra de o f b as ic s ch oo l), P al es tin e, 2 01 4 P er ce nt at te nd in g gr ad e 1 la st sc ho ol y ea r w ho a re in gr ad e 2 th is sc ho ol y ea r P er ce nt at te nd in g gr ad e 2 la st sc ho ol y ea r w ho a re at te nd in g gr ad e 3 th is sc ho ol y ea r P er ce nt at te nd in g gr ad e 3 la st sc ho ol y ea r w ho a re at te nd in g gr ad e 4 th is sc ho ol y ea r P er ce nt a tte nd in g gr ad e 4 la st sc ho ol y ea r w ho ar e at te nd in g gr ad e 5 th is sc ho ol y ea r P er ce nt at te nd in g gr ad e 5 la st sc ho ol y ea r w ho a re at te nd in g gr ad e 6 th is sc ho ol y ea r P er ce nt a tte nd in g gr ad e 6 la st s ch oo l ye ar w ho a re at te nd in g gr ad e 7 th is s ch oo l y ea r P er ce nt at te nd in g gr ad e 7 la st sc ho ol y ea r w ho a re at te nd in g gr ad e 8 th is sc ho ol y ea r P er ce nt at te nd in g gr ad e 8 la st sc ho ol y ea r w ho a re at te nd in g gr ad e 9 th is sc ho ol y ea r P er ce nt at te nd in g gr ad e 9 la st s ch oo l ye ar w ho a re at te nd in g gr ad e 10 th is s ch oo l ye ar P er ce nt w ho re ac h gr ad e 10 o f th os e w ho en te r g ra de 1 [1 ] To ta l 99 .9 99 .9 99 .9 10 0. 0 99 .8 99 .3 98 .8 97 .9 96 .3 92 .1 R eg io n W es t B an k 99 .9 99 .9 99 .9 10 0. 0 10 0. 0 99 .3 98 .7 98 .0 96 .2 92 .1 G az a S tri p 10 0. 0 10 0. 0 99 .9 10 0. 0 99 .5 99 .3 99 .0 97 .7 96 .5 92 .0 Se x M al e 99 .9 10 0. 0 99 .8 10 0. 0 99 .5 99 .1 98 .4 96 .5 94 .1 87 .8 Fe m al e 10 0. 0 99 .9 10 0. 0 10 0. 0 10 0. 0 99 .5 99 .3 99 .3 98 .3 96 .4 G ov er no ra te Je ni n 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 96 .8 10 0. 0 97 .8 97 .6 92 .4 Tu ba s 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 96 .8 96 .8 Tu lk ar m 98 .3 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 96 .1 93 .3 93 .8 82 .7 N ab lu s 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 99 .0 99 .2 99 .3 96 .0 93 .6 Q al qi liy a 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 97 .5 96 .9 97 .0 91 .7 S al fit 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 97 .0 97 .0 R am al la h & A l- B ire h 10 0. 0 10 0. 0 99 .2 10 0. 0 10 0. 0 10 0. 0 99 .1 96 .4 97 .5 92 .3 Je ric ho a nd A l A gh w ar 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 96 .1 10 0. 0 84 .0 80 .7 Je ru sa le m 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 98 .8 98 .4 97 .2 B et hl eh em 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 98 .7 98 .6 95 .0 92 .4 H eb ro n 10 0. 0 99 .5 10 0. 0 10 0. 0 10 0. 0 99 .4 97 .5 98 .2 95 .4 90 .3 N or th G az a 10 0. 0 10 0. 0 10 0. 0 10 0. 0 99 .3 99 .1 98 .0 98 .8 93 .8 89 .3 G az a 10 0. 0 10 0. 0 10 0. 0 10 0. 0 99 .5 99 .3 98 .8 95 .6 96 .7 90 .2 D ei r E l-B al ah 10 0. 0 10 0. 0 10 0. 0 10 0. 0 98 .6 98 .7 10 0. 0 10 0. 0 95 .0 92 .5 K ha n Y un is 10 0. 0 10 0. 0 99 .2 10 0. 0 10 0. 0 10 0. 0 99 .1 99 .1 97 .5 94 .9 R af ah 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 98 .1 10 0. 0 98 .1 1 M IC S in di ca to r 7 .S 3 - C hi ld re n re ac hi ng la st g ra de o f b as ic na : n ot a pp lic ab le 163 14 9 Ta bl e ED .6 C on tin ue d: C hi ld re n re ac hi ng la st g ra de o f b as ic s ch oo l P er ce nt ag e of c hi ld re n en te rin g fir st g ra de o f b as ic s ch oo l w ho e ve nt ua lly re ac h th e la st g ra de o f b as ic s ch oo l ( S ur vi va l r at e to la st g ra de o f b as ic s ch oo l), P al es tin e, 2 01 4 P er ce nt at te nd in g gr ad e 1 la st sc ho ol y ea r w ho a re in gr ad e 2 th is sc ho ol y ea r P er ce nt at te nd in g gr ad e 2 la st sc ho ol y ea r w ho a re at te nd in g gr ad e 3 th is sc ho ol y ea r P er ce nt at te nd in g gr ad e 3 la st s ch oo l ye ar w ho a re at te nd in g gr ad e 4 th is s ch oo l ye ar P er ce nt at te nd in g gr ad e 4 la st sc ho ol y ea r w ho a re at te nd in g gr ad e 5 th is sc ho ol y ea r P er ce nt at te nd in g gr ad e 5 la st sc ho ol y ea r w ho a re at te nd in g gr ad e 6 th is sc ho ol y ea r P er ce nt at te nd in g gr ad e 6 la st s ch oo l ye ar w ho a re at te nd in g gr ad e 7 th is s ch oo l ye ar P er ce nt at te nd in g gr ad e 7 la st sc ho ol y ea r w ho a re at te nd in g gr ad e 8 th is sc ho ol y ea r P er ce nt at te nd in g gr ad e 8 la st sc ho ol y ea r w ho a re at te nd in g gr ad e 9 th is sc ho ol y ea r P er ce nt at te nd in g gr ad e 9 la st s ch oo l ye ar w ho a re at te nd in g gr ad e 10 th is s ch oo l ye ar P er ce nt w ho re ac h gr ad e 10 o f th os e w ho en te r g ra de 1 [1 ] A re a U rb an 10 0. 0 99 .9 99 .9 10 0. 0 99 .7 99 .4 98 .9 98 .1 96 .4 92 .6 R ur al 99 .6 10 0. 0 10 0. 0 10 0. 0 10 0. 0 98 .6 98 .6 97 .6 95 .3 90 .1 C am p 10 0. 0 10 0. 0 99 .4 10 0. 0 10 0. 0 10 0. 0 98 .6 97 .1 96 .7 92 .0 M ot he r's e du ca tio n N on e 10 0. 0 10 0. 0 10 0. 0 10 0. 0 96 .7 10 0. 0 92 .7 96 .2 91 .3 78 .7 B as ic 99 .8 10 0. 0 99 .9 10 0. 0 99 .6 99 .1 98 .4 97 .7 95 .0 89 .9 S ec on da ry 10 0. 0 10 0. 0 99 .8 10 0. 0 10 0. 0 99 .2 99 .5 97 .4 97 .8 93 .9 H ig he r 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 99 .6 10 0. 0 10 0. 0 99 .6 C an no t b e de te rm in ed na na na na na na 10 0. 0 87 .5 84 .6 . W ea lth in de x qu in til e P oo re st 10 0. 0 10 0. 0 99 .7 10 0. 0 99 .2 98 .5 98 .6 96 .6 96 .0 89 .1 S ec on d 99 .6 99 .7 10 0. 0 10 0. 0 99 .7 99 .6 98 .6 97 .7 95 .1 90 .3 M id dl e 10 0. 0 10 0. 0 99 .7 10 0. 0 10 0. 0 99 .6 97 .3 97 .4 96 .3 90 .7 Fo ur th 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 98 .8 10 0. 0 98 .2 96 .7 93 .8 R ic he st 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 99 .3 99 .1 97 .0 95 .5 1 M IC S in di ca to r 7 .S 3 - C hi ld re n re ac hi ng la st g ra de o f b as ic na : n ot a pp lic ab le 164 Palestinian Multiple Indicator Cluster Survey 2014 150 The basic school completion rate and transition rate to secondary education are presented in Table ED.7. The basic completion rate is the ratio of the total number of students, regardless of age, entering the last grade of basic school for the first time, to the number of children of the basic graduation age at the beginning of the current (or most recent) school year. Table ED.7 shows that the basic school completion rate is 89 percent; 91 percent in the West Bank compared to 85 percent in Gaza Strip. This rate is higher among females compared to males (96 percent and 81 percent) respectively, with a clear variation by wealth index, as 79 percent of children living among the poorest households complete basic school, compared to 103 percent of those living in the richest quintile. Around 94 percent of the children who were attending the last grade of basic school in the previous school year were found to be attending the first grade of secondary school in the school year of the survey, with a slight variations by region and sex. The table also provides “effective” transition rate which takes account of the presence of repeaters in the final grade of basic school. This indicator better reflects situations in which pupils repeat the last grade of basic education but eventually make the transition to the secondary level. The simple transition rate tends to underestimate pupils’ progression to secondary school as it assumes that the repeaters never reach secondary school. However, in the case of Palestine, the percentage of repeaters is low and as such the difference in these two rates is minimal and the same cohort is expected to move on to secondary school. 165 151 Table ED.7: Basic school completion and transition to secondary school Basic school completion rates and transition and effective transition rates to secondary school, Palestine, 2014 Basic school completion rate [1] Number of children of basic school completion age Transition rate to secondary school [2] Number of children who were in the last grade of basic school the previous year Effective transition rate to secondary school Number of children who were in the last grade of basic school the previous year and are not repeating that grade in the current school year Total 88.7 1325.2 93.5 1104 93.9 1100 Region West Bank 90.7 807.5 92.7 648 93.3 645 Gaza Strip 85.4 517.7 94.7 456 94.7 456 Sex Male 81.2 675.4 91.5 497 91.9 495 Female 96.4 649.9 95.2 607 95.5 605 Governorate Jenin 78.2 97.5 93.6 88 94.7 87 Tubas (*) 16.1 (*) 16 (*) 16 Tulkarm (103.2) 46.1 (95.6) 45 (95.6) 45 Nablus 89.2 92.7 90.5 88 91.6 87 Qalqiliya (87.8) 29.9 (94.4) 28 (94.4) 28 Salfit (*) 14.6 (*) 22 (*) 21 Ramallah & Al-Bireh 89.9 75.7 90.1 70 90.1 70 Jericho and Al Aghwar 72.6 16.7 94.0 9 94.0 9 Jerusalem 106.2 118.0 97.4 89 98.5 88 Bethlehem 98.2 70.2 94.0 49 94.0 49 Hebron 83.4 230.2 90.3 145 90.3 145 North Gaza 70.5 96.8 90.0 99 90.0 99 Gaza 83.1 205.2 96.6 172 96.6 172 Deir El-Balah 101.3 67.9 93.9 73 93.9 73 Khan Yunis 85.1 101.8 95.9 66 95.9 66 Rafah 104.9 46.0 97.5 46 97.5 46 Area Urban 89.1 993.4 94.0 804 94.1 803 Rural 91.7 212.9 90.9 204 92.3 201 Camp 79.7 119.0 94.9 96 94.9 96 Mother's education None (55.3) 36.5 (*) 20 (*) 20 Basic 84.9 698.7 92.9 495 93.2 494 Secondary 96.8 352.5 97.3 334 97.6 333 Higher 96.4 200.5 100.0 173 100.0 173 Cannot be determined (56.8) 37.1 (71.0) 37 (71.0) 37 Wealth index quintile Poorest 78.7 241 90.5 175 90.5 175 Second 77.6 265 96.0 245 96.0 245 Middle 94.6 268 91.2 203 92.1 201 Fourth 88.6 280 93.2 220 94.0 218 Richest 102.5 270 95.4 261 95.4 261 1 MICS indicator 7.S4 - Basic completion rate 2 MICS indicator 7.S5 - Transition rate to secondary school ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 166 Palestinian Multiple Indicator Cluster Survey 2014 152 The ratio of girls to boys attending basic and secondary education is provided in Table ED.8. These ratios are better known as the Gender Parity Index (GPI). Notice 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, in most cases, the majority of over-age children attending basic education tend to be boys. The table shows that GPI for basic school is 1.03, and the GPI for secondary school is 1.27, which is in favour of females. Table ED.8: Education gender parity Ratio of adjusted net attendance ratios of girls to boys, in basic and secondary school, Palestine, 2014 Basic school Secondary school Basic school adjusted net attendance ratio (NAR), girls Basic school adjusted net attendance ratio (NAR), boys Gender parity index (GPI) for basic school adjusted NAR1 Secondary school adjusted net attendance ratio (NAR), girls Secondary school adjusted net attendance ratio (NAR), boys Gender parity index (GPI) for secondary school adjusted NAR2 Total 98.3 95.3 1.03 80.4 63.3 1.27 Region West Bank 98.4 95.0 1.04 81.0 61.3 1.32 Gaza Strip 98.2 95.8 1.02 79.6 66.5 1.20 Governorate Jenin 99.0 94.7 1.04 92.8 63.3 1.46 Tubas 98.1 94.9 1.03 (*) (*) 1.27 Tulkarm 99.2 93.9 1.06 86.5 65.7 1.32 Nablus 99.4 97.3 1.02 79.8 71.0 1.12 Qalqiliya 97.9 97.5 1.00 (*) (71.8) 1.14 Salfit 99.3 97.9 1.01 (78.1) (*) 1.40 Ramallah & Al-Bireh 99.0 96.0 1.03 85.1 71.0 1.20 Jericho and Al Aghwar 92.3 91.9 1.00 (*) (*) 1.91 Jerusalem 98.6 96.0 1.03 76.3 53.7 1.42 Bethlehem 97.9 95.5 1.03 80.6 61.0 1.32 Hebron 97.7 92.6 1.05 75.8 52.7 1.44 North Gaza 97.7 95.6 1.02 74.9 63.1 1.19 Gaza 98.2 95.0 1.03 76.6 65.4 1.17 Deir El-Balah 98.8 95.2 1.04 85.4 65.7 1.30 Khan Yunis 98.5 97.5 1.01 83.3 64.1 1.30 Rafah 98.2 97.2 1.01 81.6 81.2 1.00 Area Urban 98.5 95.3 1.03 80.6 63.5 1.27 Rural 97.8 95.2 1.03 80.6 63.1 1.28 Camp 97.9 95.3 1.03 78.1 62.2 1.26 Mother's education None 87.5 82.7 1.06 (56.3) (29.6) 1.90 Basic 98.0 93.1 1.05 76.0 54.3 1.40 Secondary 99.1 97.4 1.02 90.5 77.7 1.17 Higher 99.6 98.7 1.01 98.1 85.9 1.14 Cannot be determineda (68.3) (*) 1.24 74.1 60.0 1.24 Wealth index quintile Poorest 97.6 94.4 1.03 70.5 51.9 1.36 Second 97.9 94.8 1.03 79.6 67.7 1.18 Middle 97.9 93.5 1.05 75.3 53.1 1.42 Fourth 99.1 96.1 1.03 86.4 64.8 1.33 Richest 99.1 97.7 1.01 89.0 75.6 1.18 1 MICS indicator 7.S6; MDG indicator 3.1 - Gender parity index (basic school) 2 MICS indicator 7.S7; MDG indicator 3.1 - Gender parity index (secondary school) a Children age 15 or higher at the time of the interview whose mothers were not living in the household ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 167 153 The percentages of girls in the total out of school population, in both basic and secondary school, are provided in Table ED.9. The table shows that at the basic level, girls account for more than one quarter (26 percent) of the out-of-school population. However, girls’ share increased to 29 percent at the secondary level. Table ED.9: Out of school gender parity Percentage of girls in the total out of school population, in basic and secondary school, Palestine, 2014 Basic school Secondary school Percentage of out of school children Number of children of basic school age Percentage of girls in the total out of school population of basic school age Number of children of basic 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 school Total 3.2 13752 25.9 437 23.0 2687 28.7 619 Region West Bank 3.3 8067 23.6 267 23.3 1601 23.8 374 Gaza Strip 3.0 5685 29.4 170 22.6 1086 36.1 245 Governorate Jenin 3.0 861 (17.3) 25 17.5 170 (12.2) 30 Tubas 3.7 153 (*) 6 (14.3) 30 (*) 4 Tulkarm 3.5 447 (*) 16 19.3 107 (*) 21 Nablus 1.5 1052 (*) 16 20.7 214 (23.0) 44 Qalqiliya 2.3 271 (*) 6 18.0 55 (*) 10 Salfit 1.5 204 (*) 3 26.2 50 (*) 13 Ramallah & Al-Bireh 2.5 802 (*) 20 19.5 168 (22.2) 33 Jericho and Al Aghwar 7.9 151 (*) 12 (40.6) 27 (*) 11 Jerusalem 2.8 1319 (24.6) 36 25.6 239 27.6 61 Bethlehem 3.2 681 (*) 22 21.6 131 (24.3) 28 Hebron 5.0 2125 22.9 105 29.0 410 28.4 119 North Gaza 3.4 1116 (34.2) 37 25.9 198 35.6 51 Gaza 3.4 2121 26.2 73 24.5 397 37.8 97 Deir El-Balah 2.9 835 (21.3) 25 20.9 178 (29.6) 37 Khan Yunis 2.0 1007 (*) 21 22.7 198 (33.1) 45 Rafah 2.3 605 (*) 14 12.5 116 (*) 14 Area Urban 3.1 10237 23.8 316 22.7 1975 29.7 447 Rural 3.5 2262 32.3 78 23.0 476 22.3 109 Camp 3.4 1252 (29.9) 43 26.3 236 32.1 62 Mother's education None 14.8 218 (43.6) 32 42.1 54 (*) 23 Basic 4.5 6482 22.5 290 26.5 1010 22.2 268 Secondary 1.8 4190 25.7 73 11.2 549 12.8 61 Higher 0.8 2806 (*) 22 4.9 278 (*) 14 Cannot be determineda na na na na 31.9 795 39.9 254 Wealth index quintile Poorest 4.0 2736 29.6 110 33.0 486 37.7 161 Second 3.6 2733 28.8 99 21.8 563 34.3 123 Middle 4.3 2763 24.4 120 29.6 514 25.0 152 Fourth 2.3 2623 16.0 61 19.9 530 18.8 105 Richest 1.6 2895 27.9 47 13.1 593 21.7 78 a Children age 15 or higher at the time of the interview whose mothers were not living in the household ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases na: not applicable 168 Palestinian Multiple Indicator Cluster Survey 2014 154 Figure ED.1 brings together all of the attendance and progression related education indicators covered in this chapter, by sex. Information on attendance to early childhood education is also included, which was covered in Chapter 9, in Table CD.1, The large difference between the ECE attendance rate (27/26) and the school readiness indicator (93/96) implies that most children go to ECE programs at the age of 5, or one year before basic school starts. Figure ED.1: Educat ion indicators by sex, Palest ine, 2014 School readiness 93 96 Net intake rate in basic education Basic school completion rate Transition rate to secondary school 97 97 81 96 92 95 Attendance to early childhood education Basic school attendance Secondary school attendance 27 26 95 98 63 80 Children reaching last grade of basic 88 96 Boys Girls Note: All indicator values are in percent 169 XI. Child Protection 154 XI. Child Protection 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 the age of five worldwide (around one in three) have never been recorded. This lack of formal recognition 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 unnoticed. 1 1  United  Nations  Children’s  Fund,  Every  Child’s  Birth  Right:  Inequities  and  trends  in  birth  registration,  UNICEF,  New  York,  2013.   172 Palestinian Multiple Indicator Cluster Survey 2014 154 XI. Child Protection 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 the age of five worldwide (around one in three) have never been recorded. This lack of formal recognition 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 unnoticed. 1 1  United  Nations  Children’s  Fund,  Every  Child’s  Birth  Right:  Inequities  and  trends  in  birth  registration,  UNICEF,  New  York,  2013.   155 Table CP.1: Birth registration Percentage of children under age 5 by whether birth is registered and percentage of children not registered whose mothers/caretakers know how to register birth, Palestine, 2014 Children under age 5 whose birth is registered with civil authorities Number of children under age 5 Has birth certificate No birth certificate Total registered1 Seen Not seen Total 70.8 27.7 0.8 99.3 7816 Sex Male 70.4 28.2 0.7 99.3 4058 Female 71.3 27.2 0.9 99.3 3758 Region West Bank 64.0 33.9 1.2 99.1 4202 Gaza Strip 78.7 20.5 0.3 99.6 3614 Governorate Jenin 74.2 23.6 1.8 99.6 469 Tubas 54.3 41.2 1.6 97.0 65 Tulkarm 73.3 26.2 0.0 99.5 217 Nablus 62.9 36.3 0.6 99.8 523 Qalqiliya 82.7 16.8 0.5 100.0 157 Salfit 88.5 10.0 1.0 99.4 104 Ramallah & Al-Bireh 63.6 33.3 1.4 98.3 466 Jericho and Al Aghwar 92.5 6.9 0.5 100.0 93 Jerusalem 42.0 53.8 1.8 97.5 635 Bethlehem 48.8 47.9 2.1 98.8 340 Hebron 69.0 29.9 0.8 99.7 1132 North Gaza 85.4 13.6 0.1 99.1 695 Gaza 67.6 31.6 0.6 99.8 1290 Dier El-Balah 67.2 32.2 0.4 99.8 489 Khan Yunis 88.3 10.9 0.2 99.4 667 Rafah 97.5 2.1 0.0 99.6 472 Area Urban 71.1 27.5 0.7 99.4 5942 Rural 68.7 29.7 1.2 99.6 1186 Camps 72.0 26.2 0.6 98.8 688 Age 0-11 months 70.2 24.1 3.7 98.0 1471 12-23 months 71.1 28.0 0.3 99.4 1530 24-35 months 73.2 26.2 0.0 99.4 1540 36-47 months 68.1 31.7 0.1 99.8 1678 48-59 months 71.7 28.2 0.1 99.9 1597 Mother’s education None (71.1) (24.9) (4.0) (100.0) 37 Basic 71.4 27.6 0.5 99.5 2346 Secondary 72.3 26.0 0.7 99.0 2641 Higher 69.0 29.5 1.0 99.5 2792 Wealth index quintile Poorest 78.5 20.6 0.5 99.5 1937 Second 78.2 21.5 0.1 99.8 1601 Middle 68.9 29.1 0.9 98.9 1555 Fourth 66.5 31.4 1.2 99.2 1491 Richest 56.9 40.9 1.4 99.2 1233 1 MICS indicator 8.1 - Birth registration ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 173 156 The births of 99 percent of children under five years in Palestine have been registered (Table CP.1). Registration of birth becomes more likely as a child grows older. There are no significant variations in birth registration depending on the sex of the child, geographical region, age of child, and socioeconomic status. Only one percent of the children were reported to not have a birth certificate; even though birth certificates were not observed in 28 percent of cases. F igure CP.1: Chi ldren under-5 whose bir ths are registered, Palest ine, 2014 The lack of adequate knowledge of how to register a child can present another major obstacle to the fulfilment of a child’s right to identity. Among children under 5 years who were not registered, data show that 17 percent of mothers reported not knowing how to register a child’s birth. Child Discipline Teaching children self-control and acceptable behavior 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 judgment 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 behaviors. Studies2 have found that exposing children to violent discipline 2  Straus,  M.A.,  and  M.J.  Paschall,  ‘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,   vol.   18,   no.   5,   2009,   pp.   459-­‐483;   Erickson,   M.F.,   and   B.   Egeland,   ‘A   Developmental   View   of   the   Psychological   Consequences  of  Maltreatment’,  School  Psychology  Review,  vol.  16,  1987,  pp.  156-­‐168;  Schneider,  M.W.,  A.  Ross,   J.C.  Graham  and  A.  Zielinski,  ‘Do  Allegations  of  Emotional  Maltreatment  Predict  Developmental  Outcomes  Beyond   that  of  Other  Forms  of  Maltreatment?’,  Child  Abuse  &  Neglect,  vol.  29,  no.  5,  2005,  pp.  513–532.   98   99   99   98   96   99   98   98   99   Region   West  Bank   Gaza  Strip   Area   Urban   Rural   Camp   Mother's  educaDon   None   Basic   Secondary   Higher   PalesDne   Registered,  no  birth  cerDficate   Birth  cerDficate   174 Palestinian Multiple Indicator Cluster Survey 2014 156 The births of 99 percent of children under five years in Palestine have been registered (Table CP.1). Registration of birth becomes more likely as a child grows older. There are no significant variations in birth registration depending on the sex of the child, geographical region, age of child, and socioeconomic status. Only one percent of the children were reported to not have a birth certificate; even though birth certificates were not observed in 28 percent of cases. F igure CP.1: Chi ldren under-5 whose bir ths are registered, Palest ine, 2014 The lack of adequate knowledge of how to register a child can present another major obstacle to the fulfilment of a child’s right to identity. Among children under 5 years who were not registered, data show that 17 percent of mothers reported not knowing how to register a child’s birth. Child Discipline Teaching children self-control and acceptable behavior 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 judgment 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 behaviors. Studies2 have found that exposing children to violent discipline 2  Straus,  M.A.,  and  M.J.  Paschall,  ‘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,   vol.   18,   no.   5,   2009,   pp.   459-­‐483;   Erickson,   M.F.,   and   B.   Egeland,   ‘A   Developmental   View   of   the   Psychological   Consequences  of  Maltreatment’,  School  Psychology  Review,  vol.  16,  1987,  pp.  156-­‐168;  Schneider,  M.W.,  A.  Ross,   J.C.  Graham  and  A.  Zielinski,  ‘Do  Allegations  of  Emotional  Maltreatment  Predict  Developmental  Outcomes  Beyond   that  of  Other  Forms  of  Maltreatment?’,  Child  Abuse  &  Neglect,  vol.  29,  no.  5,  2005,  pp.  513–532.   98   99   99   98   96   99   98   98   99   Region   West  Bank   Gaza  Strip   Area   Urban   Rural   Camp   Mother's  educaDon   None   Basic   Secondary   Higher   PalesDne   Registered,  no  birth  cerDficate   Birth  cerDficate   157 have 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 adults in the household used to discipline a selected child during the past month. Table CP.5: Child discipline Percentage of children age 1-14 years by child disciplining methods experienced during the last one month, Palestine, 2014 Percentage of children age 1-14 years who experienced: Number of children age 1-14 years Only non- violent discipline Psychological aggression Physical punishment Any violent discipline method [1] Any Severe Total 6.3 88.8 73.7 23.3 92.2 20256 Region West Bank 7.6 87.2 69.4 17.1 90.4 11435 Gaza Strip 4.5 90.9 79.2 31.2 94.5 8821 Sex Male 5.9 89.4 76.6 27.4 92.8 10388 Female 6.6 88.2 70.6 18.9 91.6 9868 Governorate Jenin 5.9 88.4 73.5 25.7 92.9 1237 Tubas 3.0 92.2 80.6 15.8 96.6 199 Tulkarm 6.5 88.0 73.2 24.7 91.7 618 Nablus 6.4 91.6 70.4 16.0 93.2 1525 Qalqiliya 6.6 83.4 58.5 12.1 86.3 412 Salfit 5.3 92.8 73.7 11.8 94.0 265 Ramallah & Al-Bireh 9.9 86.0 63.9 17.6 88.2 1148 Jericho and Al Aghwar 29.8 61.8 36.9 4.3 67.1 220 Jerusalem 6.3 87.5 70.6 12.3 92.4 1857 Bethlehem 6.9 88.2 67.1 26.3 91.8 908 Hebron 8.4 86.0 71.3 14.9 88.6 3048 North Gaza 4.9 91.4 79.7 35.4 93.7 1730 Gaza 3.8 91.5 79.5 32.7 95.2 3232 Dier El-Balah 4.8 92.4 78.1 34.5 94.8 1260 Khan Yunis 5.2 88.0 76.5 23.6 93.3 1562 Rafah 4.7 90.9 82.3 27.2 94.5 1037 Area Urban 6.4 88.3 73.1 23.4 91.9 15219 Rural 5.9 90.2 74.2 19.6 92.5 3196 Camps 5.6 90.7 77.2 28.1 93.7 1841 Age 1-2 6.3 82.7 75.8 18.7 89.8 3267 3-4 4.5 91.5 82.9 29.9 94.3 3209 5-9 5.4 91.2 78.2 26.9 94.0 7195 10-14 8.0 88.0 63.1 18.3 90.4 6585 Education of household head None 8.2 90.0 73.2 27.9 90.0 263 Basic 5.7 90.1 75.4 26.1 93.0 8923 Secondary 5.9 88.3 74.5 22.0 92.2 5791 Higher 7.6 87.3 69.7 19.6 90.9 5277 DK (*) (*) (*) (*) (*) 2 Wealth index quintile Poorest 3.8 91.4 82.1 35.5 95.1 4447 Second 4.9 90.8 77.0 27.3 94.2 4050 Middle 7.2 88.0 73.8 21.3 91.2 4071 Fourth 8.1 85.9 69.1 17.6 89.6 3848 Richest 7.8 87.6 64.8 12.6 90.3 3840 [1] MICS indicator 8.3 - Violent discipline (*) Figures that are based on less than 25 unweighted cases 175 158 In Palestine, 92 percent of children age 1-14 years were subjected to at least one form of psychological or physical punishment by household members during the past month. For the most part, households employ a combination of violent disciplinary practices, reflecting caregivers’ motivation to control children’s behaviour by any means possible. While 89 percent of children experienced psychological aggression, about 74 percent experienced physical punishment. The most severe forms of physical punishment (hitting the child on the head, ears or face or hitting the child hard and repeatedly) are overall less common: 23 percent of children were subjected to severe punishment. Male children were subjected to physical discipline (77 percent) more than female children (71 percent). Differentials with respect to many of the background variables were relatively small. Children living in camps areas, and those living in the poorest households were more likely to experience at least one violent psychological or physical punishment. Figure CP.2: Chi ld discipl ining methods, chi ldren age 1- 14 years, Palest ine, 2014 While violent methods are extremely common forms of discipline, Table CP.6 reveals that only 22 percent of respondents believed that children should be physically punished. There are large differentials across background variables of respondents. Overall, Gazan woman, and respondents with low educational attainment and those residing in poorer households are more likely to find physical punishment an acceptable method of disciplining children. Also there is a large differentials across governorates, where Jericho and Al-Aghwar is the lowest (I2 percent) Khan Yunis governorate reported the highest (32 percent), While the respondent’s relationship to the child is not a matters: 22 percent of mothers believed that children should be physically punished compared to 21 of fathers and 18 among other household members. Severe   23   Only  non-­‐violent   discipline   Any  violent  discipline   Psychological     aggression   Physical  punishment   Per  cent   176 Palestinian Multiple Indicator Cluster Survey 2014 158 In Palestine, 92 percent of children age 1-14 years were subjected to at least one form of psychological or physical punishment by household members during the past month. For the most part, households employ a combination of violent disciplinary practices, reflecting caregivers’ motivation to control children’s behaviour by any means possible. While 89 percent of children experienced psychological aggression, about 74 percent experienced physical punishment. The most severe forms of physical punishment (hitting the child on the head, ears or face or hitting the child hard and repeatedly) are overall less common: 23 percent of children were subjected to severe punishment. Male children were subjected to physical discipline (77 percent) more than female children (71 percent). Differentials with respect to many of the background variables were relatively small. Children living in camps areas, and those living in the poorest households were more likely to experience at least one violent psychological or physical punishment. Figure CP.2: Chi ld discipl ining methods, chi ldren age 1- 14 years, Palest ine, 2014 While violent methods are extremely common forms of discipline, Table CP.6 reveals that only 22 percent of respondents believed that children should be physically punished. There are large differentials across background variables of respondents. Overall, Gazan woman, and respondents with low educational attainment and those residing in poorer households are more likely to find physical punishment an acceptable method of disciplining children. Also there is a large differentials across governorates, where Jericho and Al-Aghwar is the lowest (I2 percent) Khan Yunis governorate reported the highest (32 percent), While the respondent’s relationship to the child is not a matters: 22 percent of mothers believed that children should be physically punished compared to 21 of fathers and 18 among other household members. Severe   23   Only  non-­‐violent   discipline   Any  violent  discipline   Psychological     aggression   Physical  punishment   Per  cent   159 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, Palestine, 2014 Respondent believes that a child needs to be physically punished Number of respondents to the child discipline module Total 21.6 7082 Region West Bank 17.3 4261 Gaza Strip 28.2 2821 Sex Male 21.2 426 Female 21.7 6656 Governorate Jenin 13.8 482 Tubas 15.9 84 Tulkarm 20.9 247 Nablus 21.1 579 Qalqiliya 12.3 152 Salfit 9.7 107 Ramallah & Al-Bireh 14.9 491 Jericho and Al Aghwar 1.6 77 Jerusalem 13.0 688 Bethlehem 8.0 334 Hebron 25.8 1020 North Gaza 28.9 540 Gaza 24.8 1001 Dier El-Balah 29.8 420 Khan Yunis 32.1 519 Rafah 29.1 341 Area Urban 22.1 5278 Rural 17.6 1179 Camps 25.6 624 Age <25 21.0 992 25-39 24.0 3936 40-59 17.5 2059 60+ 22.3 94 Respondent's relationship to selected child Mother 22.0 6188 Father 21.3 368 Other 17.5 526 Respondent's education None 29.5 90 Basic 20.9 2710 Secondary 21.5 2206 Higher 22.3 2075 Wealth index quintile Poorest 28.1 1377 Second 27.7 1341 Middle 20.3 1416 Fourth 16.1 1458 Richest 16.9 1490 177 160 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 hopes that the marriage will benefit them both financially and socially, while also relieving financial burdens on the 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 recognized 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 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 lead to very low condom use among such couples. The percentage of women married at before ages 15 and 18 years are provided in Table CP.7. Among women age 15-49 years, (2 percent) were married before age 15 and, among women age 20-49 years, (24 percent) women were married before age 18. Percentage of women aged 20-49 years who married before age of 18 is unexpectedly the lowest among women who reside in rural areas compared to those who reside in urban and camps areas (19 and 25 and 25 percent respectively). At the governorate level, the lowest prevalence was in Tubas governorate (12 percent) and the highest in North Gaza and Gaza governorates (36 percent). This percentage is also higher among women with lower levels of education and among those who live in poor households. Nine percent of young women age 15-19 years are currently married. This proportion does not vary much between urban (10 percent) and camps (11 percent) while the proportion was (5 percent) in rural areas, but is strongly related to the level of education. The percentage of women in a polygynous marriage is also provided in Table CP.7. Among all women age 15-49 years who are married, 4 percent are in polygynous marriage. The percentage of women in a polygynous marriage in Gaza Strip was 6 percent which is more prevalent than in the West Bank (3 percent). 178 Palestinian Multiple Indicator Cluster Survey 2014 160 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 hopes that the marriage will benefit them both financially and socially, while also relieving financial burdens on the 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 recognized 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 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 lead to very low condom use among such couples. The percentage of women married at before ages 15 and 18 years are provided in Table CP.7. Among women age 15-49 years, (2 percent) were married before age 15 and, among women age 20-49 years, (24 percent) women were married before age 18. Percentage of women aged 20-49 years who married before age of 18 is unexpectedly the lowest among women who reside in rural areas compared to those who reside in urban and camps areas (19 and 25 and 25 percent respectively). At the governorate level, the lowest prevalence was in Tubas governorate (12 percent) and the highest in North Gaza and Gaza governorates (36 percent). This percentage is also higher among women with lower levels of education and among those who live in poor households. Nine percent of young women age 15-19 years are currently married. This proportion does not vary much between urban (10 percent) and camps (11 percent) while the proportion was (5 percent) in rural areas, but is strongly related to the level of education. The percentage of women in a polygynous marriage is also provided in Table CP.7. Among all women age 15-49 years who are married, 4 percent are in polygynous marriage. The percentage of women in a polygynous marriage in Gaza Strip was 6 percent which is more prevalent than in the West Bank (3 percent). 16 1 T ab le C P. 7: E ar ly m ar ria ge a nd p ol yg yn y (w om en ) P er ce nt ag e of w om en a ge 1 5- 49 y ea rs w ho fi rs t m ar rie d or e nt er ed a m ar ita l u ni on b ef or e th ei r 1 5t h bi rth da y, p er ce nt ag es o f w om en a ge 2 0- 49 y ea rs w ho fi rs t m ar rie d or en te re d a m ar ita l u ni on b ef or e th ei r 1 5t h an d 18 th b irt hd ay s, p er ce nt ag e of w om en a ge 1 5- 19 y ea rs c ur re nt ly m ar rie d, a nd th e pe rc en ta ge o f w om en w ho a re in a po ly gy no us m ar ria ge , P al es tin e, 2 01 4 W om en a ge 1 5- 49 y ea rs W om en a ge 2 0- 49 y ea rs W om en a ge 1 5- 19 y ea rs W om en a ge 1 5- 49 y ea rs P er ce nt ag e m ar rie d be fo re a ge 15 [1 ] N um be r o f w om en ag e 15 -4 9 ye ar s P er ce nt ag e m ar rie d be fo re a ge 15 P er ce nt ag e m ar rie d be fo re a ge 18 [2 ] N um be r o f w om en ag e 20 -4 9 ye ar s P er ce nt ag e cu rr en tly m ar rie d [3 ] N um be r o f w om en ag e 15 -1 9 ye ar s P er ce nt ag e in po ly gy no us m ar ria ge [4 ] N um be r o f w om en a ge 1 5- 49 y ea rs cu rr en tly m ar rie d/ in u ni on To ta l 2. 1 13 36 7 2. 5 24 .2 10 32 0 9. 3 30 47 4. 3 79 60 R eg io n W es t B an k 1. 8 80 32 2. 2 21 .4 62 52 6. 8 17 80 3. 2 47 41 G az a S tri p 2. 6 53 35 3. 1 28 .6 40 68 12 .8 12 67 5. 8 32 20 G ov er no ra te Je ni n 1. 2 92 1 1. 6 20 .1 71 4 6. 5 20 7 1. 9 54 6 Tu ba s 1. 5 16 9 2. 0 12 .3 13 0 3. 1 39 0. 0 90 Tu lk ar m 1. 4 51 8 1. 8 16 .8 40 3 1. 6 11 5 3. 3 28 0 N ab lu s 1. 7 10 72 2. 0 21 .0 85 4 7. 3 21 9 1. 7 65 1 Q al qi liy a 0. 6 27 1 0. 7 17 .0 21 0 1. 1 62 3. 4 14 2 S al fit 2. 2 21 1 2. 3 16 .9 15 7 6. 7 54 2. 6 11 6 R am al la h & A l-B ire h 1. 2 92 7 1. 5 17 .0 73 7 1. 9 19 0 1. 8 55 9 Je ric ho a nd A l A gh w ar 1. 1 17 0 1. 0 18 .2 13 6 (9 .1 ) 34 7. 3 90 Je ru sa le m 1. 9 11 97 2. 3 25 .4 98 2 8. 7 21 4 2. 3 78 8 B et hl eh em 1. 7 65 7 2. 3 21 .7 49 1 6. 7 16 6 4. 4 37 2 H eb ro n 2. 7 19 19 3. 4 25 .3 14 39 10 .0 48 0 5. 8 11 05 N or th G az a 4. 4 94 5 4. 9 35 .9 72 4 19 .0 22 1 4. 3 62 3 G az a 3. 1 19 42 3. 8 35 .7 14 64 13 .8 47 9 5. 0 11 75 D ie r E l-B al ah 1. 3 84 2 1. 6 18 .0 64 3 9. 1 20 0 6. 2 45 7 K ha n Y un is 1. 6 10 12 2. 1 22 .7 77 6 8. 4 23 6 9. 0 59 1 R af ah 1. 2 59 4 1. 5 19 .0 46 2 12 .2 13 2 4. 9 37 3 1 M IC S in di ca to r 8 .4 - M ar ria ge b ef or e ag e 15 2 M IC S in di ca to r 8 .5 - M ar ria ge b ef or e ag e 18 3 M IC S in di ca to r 8 .6 - Yo un g w om en a ge 1 5- 19 y ea rs c ur re nt ly m ar rie d or in u ni on 4 M IC S in di ca to r 8 .7 - Po ly gy ny na : n ot a pp lic ab le ( ) F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s 179 16 2 T ab le C P. 7 C on tin ue d: E ar ly m ar ria ge a nd p ol yg yn y (w om en ) P er ce nt ag e of w om en a ge 1 5- 49 y ea rs w ho fi rs t m ar rie d or e nt er ed a m ar ita l u ni on b ef or e th ei r 1 5t h bi rth da y, p er ce nt ag es o f w om en a ge 2 0- 49 y ea rs w ho fi rs t m ar rie d or en te re d a m ar ita l u ni on b ef or e th ei r 1 5t h an d 18 th b irt hd ay s, p er ce nt ag e of w om en a ge 1 5- 19 y ea rs c ur re nt ly m ar rie d, a nd th e pe rc en ta ge o f w om en w ho a re in a po ly gy no us m ar ria ge , P al es tin e, 2 01 4 W om en a ge 1 5- 49 y ea rs W om en a ge 2 0- 49 y ea rs W om en a ge 1 5- 19 y ea rs W om en a ge 1 5- 49 y ea rs P er ce nt ag e m ar rie d be fo re a ge 15 [1 ] N um be r o f w om en ag e 15 -4 9 ye ar s P er ce nt ag e m ar rie d be fo re a ge 15 P er ce nt ag e m ar rie d be fo re a ge 18 [2 ] N um be r o f w om en ag e 20 -4 9 ye ar s P er ce nt ag e cu rr en tly m ar rie d [3 ] N um be r o f w om en ag e 15 -1 9 ye ar s P er ce nt ag e in po ly gy no us m ar ria ge [4 ] N um be r o f w om en a ge 1 5- 49 y ea rs cu rr en tly m ar rie d/ in u ni on A re a U rb an 2. 3 99 38 2. 8 25 .4 76 80 10 .1 22 58 4. 6 59 76 R ur al 1. 4 22 72 1. 6 18 .6 17 51 5. 0 52 1 2. 8 13 01 C am ps 1. 6 11 57 2. 0 25 .3 88 9 11 .0 26 8 4. 1 68 3 A ge 15 -1 9 0. 6 30 47 na na na 9. 3 30 47 0. 3 27 8 20 -2 4 1. 0 28 13 1. 0 15 .3 28 13 na na 0. 8 13 80 25 -2 9 1. 6 19 97 1. 6 18 .4 19 97 na na 2. 1 15 57 30 -3 4 2. 4 16 50 2. 4 30 .1 16 50 na na 4. 9 14 25 35 -3 9 5. 1 15 56 5. 1 31 .9 15 56 na na 5. 4 13 41 40 -4 4 3. 7 12 76 3. 7 33 .6 12 76 na na 7. 7 11 09 45 -4 9 3. 6 10 28 3. 6 27 .3 10 28 na na 7. 8 87 0 Ed uc at io n N on e 6. 6 85 7. 2 23 .8 79 (* ) 6 (1 7. 2) 48 B as ic 5. 3 47 70 7. 3 50 .7 31 85 8. 2 15 85 6. 5 28 18 S ec on da ry 0. 4 39 31 0. 6 22 .7 30 57 14 .8 87 4 3. 4 26 27 H ig he r 0. 1 45 80 0. 1 4. 3 40 00 4. 1 58 0 2. 3 24 67 M is si ng /D K (* ) 1 (* ) (* ) 0 (* ) 1 (* ) 0 W ea lth in de x qu in til e P oo re st 2. 9 25 80 3. 2 32 .0 19 64 18 .4 61 6 6. 8 16 20 S ec on d 2. 3 26 47 2. 9 24 .4 20 37 8. 9 61 0 5. 5 15 17 M id dl e 2. 0 26 46 2. 5 21 .9 20 48 7. 8 59 8 5. 1 15 50 Fo ur th 1. 6 27 19 2. 0 21 .8 21 37 8. 5 58 3 2. 4 16 55 R ic he st 1. 7 27 75 2. 2 21 .6 21 35 3. 1 64 0 1. 7 16 18 1 M IC S in di ca to r 8 .4 - M ar ria ge b ef or e ag e 15 2 M IC S in di ca to r 8 .5 - M ar ria ge b ef or e ag e 18 3 M IC S in di ca to r 8 .6 - Yo un g w om en a ge 1 5- 19 y ea rs c ur re nt ly m ar rie d 4 M IC S in di ca to r 8 .7 - Po ly gy ny na : n ot a pp lic ab le ( ) F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s (* ) F ig ur es th at a re b as ed o n le ss th an 2 5 un w ei gh te d ca se s 180 Palestinian Multiple Indicator Cluster Survey 2014 163 Tables CP.8 present respectively the proportion of women who were first married before age 15 and 18 by area, region and age groups. Examining the percentages married before age 15 and 18 by different age groups allow for trends to be observed in early marriage over time. Data show that the prevalence of the proportion of women married by age 15 and 18 has gradually declined/increased over time: in Palestine 27 percent of women age 45-49 years were first married by age 18 compared to 15 percent of women age 20-24 years. in the West Bank 24 percent of women age 45-49 years were first married by age 18 compared to 12 percent of women age 20-24 years, compared with Gaza Strip 34 percent of women age 45-49 years were first married by age 18 compared to 19 percent of women age 20-24 years. 181 16 4 Ta bl e C P. 8: T re nd s in e ar ly m ar ria ge (w om en ) P er ce nt ag e of 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 ni on b ef or e ag e 15 a nd 1 8, b y ar ea a nd a ge g ro up s, P al es tin e, 2 01 4 U rb an R ur al C am ps P er ce nt ag e of w om en m ar rie d be fo re a ge 15 N um be r o f w om en ag e 15 -4 9 ye ar s P er ce nt ag e of w om en m ar rie d be fo re a ge 18 N um be r o f w om en ag e 20 -4 9 ye ar s P er ce nt ag e of w om en m ar rie d be fo re a ge 15 N um be r o f w om en ag e 15 -4 9 ye ar s P er ce nt ag e of w om en m ar rie d be fo re a ge 18 N um be r o f w om en ag e 20 -4 9 ye ar s P er ce nt ag e of w om en m ar rie d be fo re a ge 15 N um be r o f w om en ag e 15 -4 9 ye ar s P er ce nt ag e of w om en m ar rie d be fo re a ge 18 N um be r o f w om en ag e 20 -4 9 ye ar s To ta l 2. 3 99 38 25 .4 76 80 1. 4 22 72 18 .6 17 51 1. 6 11 57 25 .3 88 9 A ge 15 -1 9 0. 6 22 58 na na 0. 5 52 1 na na 0. 3 26 8 na na 20 -2 4 1. 2 21 05 16 .2 21 05 0. 2 47 7 10 .8 47 7 0. 7 23 2 16 .7 23 2 25 -2 9 1. 7 14 98 19 .3 14 98 0. 6 31 7 13 .0 31 7 2. 3 18 2 20 .7 18 2 30 -3 4 2. 8 12 41 31 .4 12 41 0. 9 27 7 23 .2 27 7 1. 8 13 2 31 .7 13 2 35 -3 9 5. 2 11 53 34 .0 11 53 5. 5 26 5 25 .3 26 5 3. 3 13 7 28 .0 13 7 40 -4 4 4. 3 94 1 35 .6 94 1 1. 5 22 6 23 .9 22 6 3. 1 10 9 36 .4 10 9 45 -4 9 4. 1 74 2 27 .4 74 2 2. 8 18 9 25 .3 18 9 1. 7 97 30 .1 97 na : n ot a pp lic ab le Ta bl e C P. 8: T re nd s in e ar ly m ar ria ge (w om en ) P er ce nt ag e of 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 ni on b ef or e ag e 15 a nd 1 8, b y R eg io n an d ag e gr ou ps , P al es tin e, 2 01 4 W es t B an k G az a St rip A ll P er ce nt ag e of w om en m ar rie d be fo re a ge 15 N um be r o f w om en ag e 15 -4 9 ye ar s P er ce nt ag e of w om en m ar rie d be fo re a ge 18 N um be r o f w om en ag e 20 -4 9 ye ar s P er ce nt ag e of w om en m ar rie d be fo re a ge 15 N um be r o f w om en ag e 15 -4 9 ye ar s P er ce nt ag e of w om en m ar rie d be fo re a ge 18 N um be r o f w om en ag e 20 -4 9 ye ar s P er ce nt ag e of w om en m ar rie d be fo re a ge 15 N um be r o f w om en ag e 15 -4 9 ye ar s P er ce nt ag e of w om en m ar rie d be fo re a ge 18 N um be r o f w om en ag e 20 -4 9 ye ar s To ta l 1. 8 80 32 21 .4 62 52 2. 6 53 35 28 .6 40 68 2. 1 13 36 7 24 .2 10 32 0 A ge 15 -1 9 0. 3 17 80 na na 1. 0 12 67 na na 0. 6 30 47 na na 20 -2 4 0. 7 15 97 12 .3 15 97 1. 3 12 16 19 .2 12 16 1. 0 28 13 15 .3 28 13 25 -2 9 1. 7 11 55 16 .2 11 55 1. 5 84 2 21 .4 84 2 1. 6 19 97 18 .4 19 97 30 -3 4 1. 9 98 0 27 .9 98 0 3. 2 67 0 33 .3 67 0 2. 4 16 50 30 .1 16 50 35 -3 9 3. 6 99 7 27 .9 99 7 7. 8 55 8 39 .1 55 8 5. 1 15 56 31 .9 15 56 40 -4 4 2. 9 84 1 28 .3 84 1 5. 2 43 5 43 .8 43 5 3. 7 12 76 33 .6 12 76 45 -4 9 4. 2 68 1 24 .0 68 1 2. 4 34 7 33 .7 34 7 3. 6 10 28 27 .3 10 28 na : n ot a pp lic ab le 182 Palestinian Multiple Indicator Cluster Survey 2014 165 Figure CP.3: Ear ly marr iage among women, Palest ine , 2014. 1   1   2   3   5   4   4   16   19   31   34   36   27   19-­‐15   24-­‐20   29-­‐25   34-­‐30   39-­‐35   44-­‐40   49-­‐45   Age   Percentage  married  before   age  15   Percentage  married  before   age  18   183 166 Tables CP.9 present Percent distribution of women currently married age 15-19 and 20-24 years according to the age difference with their husband or partner. Data show that the 13 percent of currently married women age 15-19 years whose husband is 10 or over older than her, this percentage do not different in the age group 20-24. In West Bank is 15 percent which is more than Gaza Strip (12 percent) for the women in the age 15-19. Table CP.9: Spousal age difference Percent distribution of women currently married age 15-19 and 20-24 years according to the age difference with their husband, Palestine, 2014 Percentage of currently married women age 15-19 years whose husband is: Number of women age 15- 19 years currently married Percentage of currently married women age 20-24 years whose husband is: Number of women age 20- 24 years currently married Younger 0-4 years older 5-9 years older 10+ years older1 Total Younger 0-4 years older 5-9 years older 10+ years older2 Total Total 1.5 41.7 43.7 13.2 100.0 278 3.3 40.6 44.2 11.9 100.0 1380 Region West Bank 1.7 41.1 42.1 15.1 100.0 119 1.7 35.9 47.9 14.5 100.0 734 Gaza Strip 1.3 42.1 44.8 11.8 100.0 159 5.2 45.8 40.0 8.9 100.0 647 Area Urban 1.4 40.7 44.8 13.1 100.0 225 3.8 40.5 44.3 11.5 100.0 1066 Rural (*) (*) (*) (*) (*) 25 1.2 39.3 45.9 13.5 100.0 208 Camp (3.5) (47.8) (36.1) (12.6) 100.0 27 2.8 44.0 40.4 12.8 100.0 106 Age 15-19 1.5 41.7 43.7 13.2 100.0 278 na na na na na na 20-24 na na na na na na 3.3 40.6 44.2 11.9 100.0 1380 Education Basic 1.6 40.8 42.6 15.0 100.0 127 1.9 34.9 44.7 18.5 100.0 269 Secondary 1.6 40.9 45.3 12.2 100.0 129 2.9 40.3 45.8 11.0 100.0 561 Higher (0.0) (51.1) (39.9) (9.1) 100.0 23 4.4 43.6 42.3 9.7 100.0 551 Wealth index quintile Poorest 1.8 46.0 41.4 10.8 100.0 112 6.1 47.8 38.8 7.3 100.0 344 Second 3.8 38.1 46.2 12.0 100.0 53 4.1 44.3 41.8 9.8 100.0 310 Middle (0.0) (36.7) (42.6) (20.7) 100.0 45 2.0 33.4 47.7 16.9 100.0 270 Fourth (0.0) (37.4) (51.1) (11.4) 100.0 48 1.1 39.2 47.3 12.5 100.0 283 Richest (*) (*) (*) (*) (*) 20 2.0 33.2 48.9 15.8 100.0 173 1 MICS indicator 8.8a - Spousal age difference (among women age 15-19) 2 MICS indicator 8.8b - Spousal age difference (among women age 20-24) na: not applicable 184 Palestinian Multiple Indicator Cluster Survey 2014 166 Tables CP.9 present Percent distribution of women currently married age 15-19 and 20-24 years according to the age difference with their husband or partner. Data show that the 13 percent of currently married women age 15-19 years whose husband is 10 or over older than her, this percentage do not different in the age group 20-24. In West Bank is 15 percent which is more than Gaza Strip (12 percent) for the women in the age 15-19. Table CP.9: Spousal age difference Percent distribution of women currently married age 15-19 and 20-24 years according to the age difference with their husband, Palestine, 2014 Percentage of currently married women age 15-19 years whose husband is: Number of women age 15- 19 years currently married Percentage of currently married women age 20-24 years whose husband is: Number of women age 20- 24 years currently married Younger 0-4 years older 5-9 years older 10+ years older1 Total Younger 0-4 years older 5-9 years older 10+ years older2 Total Total 1.5 41.7 43.7 13.2 100.0 278 3.3 40.6 44.2 11.9 100.0 1380 Region West Bank 1.7 41.1 42.1 15.1 100.0 119 1.7 35.9 47.9 14.5 100.0 734 Gaza Strip 1.3 42.1 44.8 11.8 100.0 159 5.2 45.8 40.0 8.9 100.0 647 Area Urban 1.4 40.7 44.8 13.1 100.0 225 3.8 40.5 44.3 11.5 100.0 1066 Rural (*) (*) (*) (*) (*) 25 1.2 39.3 45.9 13.5 100.0 208 Camp (3.5) (47.8) (36.1) (12.6) 100.0 27 2.8 44.0 40.4 12.8 100.0 106 Age 15-19 1.5 41.7 43.7 13.2 100.0 278 na na na na na na 20-24 na na na na na na 3.3 40.6 44.2 11.9 100.0 1380 Education Basic 1.6 40.8 42.6 15.0 100.0 127 1.9 34.9 44.7 18.5 100.0 269 Secondary 1.6 40.9 45.3 12.2 100.0 129 2.9 40.3 45.8 11.0 100.0 561 Higher (0.0) (51.1) (39.9) (9.1) 100.0 23 4.4 43.6 42.3 9.7 100.0 551 Wealth index quintile Poorest 1.8 46.0 41.4 10.8 100.0 112 6.1 47.8 38.8 7.3 100.0 344 Second 3.8 38.1 46.2 12.0 100.0 53 4.1 44.3 41.8 9.8 100.0 310 Middle (0.0) (36.7) (42.6) (20.7) 100.0 45 2.0 33.4 47.7 16.9 100.0 270 Fourth (0.0) (37.4) (51.1) (11.4) 100.0 48 1.1 39.2 47.3 12.5 100.0 283 Richest (*) (*) (*) (*) (*) 20 2.0 33.2 48.9 15.8 100.0 173 1 MICS indicator 8.8a - Spousal age difference (among women age 15-19) 2 MICS indicator 8.8b - Spousal age difference (among women age 20-24) na: not applicable 167 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 with 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, as live-in domestic workers for instance. 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 design targeted interventions aimed at promoting child’s care and wellbeing. Table CP.14 presents information on the living arrangements and orphanhood status of children under age 18. 95 percent of children age 0-17 years in Palestine live with both their parents. Very few children have lost one or both parents. 2 percent of children live with their mother only while their father is alive while 1 percent of children live with their father only while their mother is alive. As expected, older children are less likely than younger children to live with both parents and slightly more likely than younger children to have lost one or both parents. Table CP.14 also shows that the percentage of children living with both parents is the highest in the Fourth's wealth quintile (98 percent) and lowest in the poorest quintile (93 percent). 3 percent of children in the poorest households live with their mother only while their father is alive. There are only small differences between urban and rural areas or among the regions in terms of orphanhood. 185 16 8 Ta bl e C P. 14 : C hi ld re n' s liv in g ar ra ng em en ts a nd o rp ha nh oo d P er ce nt d is tri bu tio n of c hi ld re n ag e 0- 17 y ea rs a cc or di ng to li vi ng a rr an ge m en ts , p er ce nt ag e of c hi ld re n ag e 0- 17 y ea rs n ot li vi ng w ith a b io lo gi ca l p ar en t a nd p er ce nt ag e of c hi ld re n w ho h av e on e or b ot h pa re nt s de ad , P al es tin e, 2 01 4 Li vi ng w ith bo th pa re nt s Li vi ng w ith n ei th er b io lo gi ca l pa re nt Li vi ng w ith m ot he r o nl y Li vi ng w ith fa th er on ly M is si ng in fo rm at io n on fa th er / m ot he r To ta l Li vi ng w ith ne ith er bi ol og ic al pa re nt 1 O ne o r bo th pa re nt s de ad 2 N um be r of ch ild re n ag e 0- 17 ye ar s O nl y fa th er al iv e O nl y m ot he r al iv e B ot h al iv e B ot h de ad Fa th er al iv e Fa th er de ad M ot he r al iv e M ot he r de ad To ta l 94 .8 0. 1 0. 1 0. 4 0. 0 1. 7 1. 7 0. 7 0. 4 0. 1 10 0. 0 0. 6 2. 3 26 10 5 Se x M al e 95 .4 0. 0 0. 1 0. 1 0. 0 1. 6 1. 6 0. 7 0. 4 0. 0 10 0. 0 0. 3 2. 2 13 28 2 Fe m al e 94 .3 0. 1 0. 1 0. 6 0. 0 1. 9 1. 8 0. 7 0. 4 0. 1 10 0. 0 0. 8 2. 4 12 82 3 R eg io n W es t B an k 95 .7 0. 0 0. 0 0. 2 0. 0 1. 5 1. 6 0. 5 0. 3 0. 1 10 0. 0 0. 3 2. 0 14 93 5 G az a S tri p 93 .7 0. 1 0. 1 0. 7 0. 1 2. 1 1. 8 1. 0 0. 6 0. 0 10 0. 0 0. 9 2. 6 11 17 0 G ov er no ra te 10 0. 0 Je ni n 96 .8 0. 1 0. 0 0. 1 0. 0 0. 4 1. 6 0. 7 0. 3 0. 0 10 0. 0 0. 2 1. 9 16 26 Tu ba s 94 .7 0. 0 0. 0 0. 9 0. 0 0. 1 3. 9 0. 5 0. 0 0. 0 10 0. 0 0. 9 3. 9 25 9 Tu lk ar m 96 .3 0. 0 0. 1 0. 0 0. 0 0. 7 1. 7 0. 5 0. 5 0. 1 10 0. 0 0. 1 2. 3 83 1 N ab lu s 94 .4 0. 0 0. 0 0. 3 0. 1 2. 1 2. 8 0. 2 0. 1 0. 1 10 0. 0 0. 4 3. 0 19 29 Q al qi liy a 95 .0 0. 0 0. 0 0. 0 0. 0 1. 3 3. 0 0. 5 0. 1 0. 0 10 0. 0 0. 0 3. 2 52 5 S al fit 97 .2 0. 0 0. 0 0. 3 0. 3 0. 2 1. 2 0. 2 0. 4 0. 3 10 0. 0 0. 5 1. 8 37 1 R am al la h & A l-B ire h 95 .2 0. 1 0. 0 0. 2 0. 0 2. 4 1. 2 0. 2 0. 7 0. 1 10 0. 0 0. 2 1. 9 15 43 Je ric ho a nd A l A gh w ar 94 .9 0. 0 0. 0 0. 4 0. 0 0. 9 1. 9 0. 5 1. 2 0. 2 10 0. 0 0. 4 3. 1 29 3 Je ru sa le m 96 .3 0. 0 0. 0 0. 1 0. 0 1. 3 1. 3 0. 8 0. 1 0. 0 10 0. 0 0. 2 1. 5 23 76 B et hl eh em 95 .7 0. 2 0. 0 0. 4 0. 1 2. 3 0. 5 0. 2 0. 4 0. 2 10 0. 0 0. 7 1. 2 12 12 H eb ro n 95 .7 0. 0 0. 1 0. 1 0. 0 1. 6 1. 5 0. 6 0. 2 0. 1 10 0. 0 0. 3 1. 9 39 69 N or th G az a 93 .8 0. 2 0. 0 1. 0 0. 0 1. 0 2. 2 0. 9 0. 9 0. 0 10 0. 0 1. 1 3. 3 21 73 G az a 93 .9 0. 1 0. 1 0. 7 0. 0 2. 4 1. 7 0. 8 0. 4 0. 0 10 0. 0 0. 9 2. 3 41 05 D ie r E l-B al ah 91 .7 0. 0 0. 2 0. 3 0. 3 3. 2 2. 4 1. 0 0. 9 0. 0 10 0. 0 0. 9 3. 9 16 00 K ha n Y un is 93 .3 0. 0 0. 3 0. 7 0. 0 2. 5 1. 8 0. 8 0. 7 0. 0 10 0. 0 0. 9 2. 7 20 11 R af ah 95 .8 0. 0 0. 1 0. 7 0. 0 1. 0 0. 6 1. 9 0. 0 0. 0 10 0. 0 0. 8 0. 6 12 81 1 M IC S in di ca to r 8 .1 3 - C hi ld re n’ s liv in g ar ra ng em en ts 2 M IC S in di ca to r 8 .1 4 - P re va le nc e of c hi ld re n w ith o ne o r b ot h pa re nt s de ad 186 Palestinian Multiple Indicator Cluster Survey 2014 16 9 Ta bl e C P. 14 C on tin ue d: C hi ld re n' s liv in g ar ra ng em en ts a nd o rp ha nh oo d P er ce nt d is tri bu tio n of c hi ld re n ag e 0- 17 y ea rs a cc or di ng to li vi ng a rr an ge m en ts , p er ce nt ag e of c hi ld re n ag e 0- 17 y ea rs n ot li vi ng w ith a b io lo gi ca l p ar en t a nd p er ce nt ag e of c hi ld re n w ho h av e on e or b ot h pa re nt s de ad , P al es tin e, 2 01 4 Li vi ng w ith bo th pa re nt s Li vi ng w ith n ei th er b io lo gi ca l pa re nt Li vi ng w ith m ot he r o nl y Li vi ng w ith fa th er on ly M is si ng in fo rm at io n on fa th er / m ot he r To ta l Li vi ng w ith ne ith er bi ol og ic al pa re nt 1 O ne o r bo th pa re nt s de ad 2 N um be r of ch ild re n ag e 0- 17 ye ar s O nl y fa th er al iv e O nl y m ot he r al iv e B ot h al iv e B ot h de ad Fa th er al iv e Fa th er de ad M ot he r al iv e M ot he r de ad A re a U rb an 94 .8 0. 1 0. 1 0. 4 0. 0 1. 8 1. 7 0. 8 0. 3 0. 1 10 0. 0 0. 6 2. 2 19 57 9 R ur al 95 .5 0. 1 0. 0 0. 3 0. 0 1. 7 1. 6 0. 3 0. 5 0. 1 10 0. 0 0. 3 2. 2 41 96 C am ps 94 .1 0. 0 0. 1 0. 5 0. 2 1. 6 1. 7 0. 7 1. 0 0. 0 10 0. 0 0. 9 3. 0 23 30 A ge 0- 4 97 .6 0. 0 0. 0 0. 1 0. 0 1. 3 0. 4 0. 4 0. 1 0. 0 10 0. 0 0. 2 0. 5 80 47 5- 9 95 .6 0. 0 0. 1 0. 2 0. 0 1. 8 1. 1 0. 8 0. 3 0. 0 10 0. 0 0. 3 1. 6 73 91 10 -1 4 93 .5 0. 1 0. 1 0. 3 0. 1 1. 9 2. 6 0. 8 0. 6 0. 0 10 0. 0 0. 5 3. 5 67 11 15 -1 7 89 .9 0. 1 0. 1 1. 6 0. 1 2. 2 3. 8 0. 8 0. 9 0. 3 10 0. 0 1. 9 5. 1 39 56 W ea lth in de x qu in til es P oo re st 93 .0 0. 1 0. 0 0. 9 0. 1 2. 8 1. 4 1. 2 0. 6 0. 0 10 0. 0 1. 1 2. 1 55 78 S ec on d 93 .8 0. 1 0. 2 0. 4 0. 0 1. 9 2. 2 0. 8 0. 5 0. 0 10 0. 0 0. 8 3. 0 52 13 M id dl e 93 .6 0. 0 0. 0 0. 2 0. 0 2. 5 2. 4 0. 7 0. 4 0. 1 10 0. 0 0. 3 2. 8 52 39 Fo ur th 96 .2 0. 0 0. 1 0. 1 0. 0 0. 7 1. 7 0. 6 0. 4 0. 1 10 0. 0 0. 3 2. 3 50 24 R ic he st 97 .9 0. 0 0. 0 0. 2 0. 0 0. 7 0. 7 0. 2 0. 3 0. 0 10 0. 0 0. 3 1. 1 50 51 1 M IC S in di ca to r 8 .1 3 - C hi ld re n’ s liv in g ar ra ng em en ts 2 M IC S in di ca to r 8 .1 4 - P re va le nc e of c hi ld re n w ith o ne o r b ot h pa re nt s de ad 187 170 The Palestinian MICS included a simple measure of one particular aspect of migration related to what is termed children left behind, i.e. for whom one or both parents have moved abroad. While the amount of literature is growing, the long-term effects of the benefits of remittances versus the potential adverse psycho-social effects are not yet conclusive, as there is somewhat conflicting evidence available as to the effects on children. Besides presenting simple prevalence rates, the results of the Palestinian MICS presented in Table CP.15 will greatly help fill the data gap on the topic of migration. As expected, only 0.3 percent of children age 0-17 have one or both parents living abroad. Table CP.15: Children with parents living abroad Percent distribution of children age 0-17 years by residence of parents in another country, Palestine, 2014 Percent distribution of children age 0-17 years: Percentage of children age 0-17 years with at least one parent living abroad¹ Number of children age 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 0.1 0.2 0.0 99.7 100.0 0.3 26105 Sex Male 0.1 0.2 0.0 99.8 100.0 0.2 13282 Female 0.1 0.2 0.0 99.6 100.0 0.4 12823 Region West Bank 0.1 0.2 0.0 99.7 100.0 0.3 14935 Gaza Strip 0.1 0.2 0.0 99.7 100.0 0.3 11170 Governorate 100.0 Jenin 0.0 0.2 0.0 99.8 100.0 0.2 1626 Tubas 0.7 0.1 0.0 99.1 100.0 0.9 259 Tulkarm 0.1 0.0 0.0 99.9 100.0 0.1 831 Nablus 0.0 0.4 0.0 99.6 100.0 0.4 1929 Qalqiliya 0.0 0.3 0.0 99.7 100.0 0.3 525 Salfit 0.0 0.0 0.0 100.0 100.0 0.0 371 Ramallah & Al- Bireh 0.1 0.5 0.0 99.4 100.0 0.6 1543 Jericho and Al Aghwar 0.0 0.0 0.0 100.0 100.0 0.0 293 Jerusalem 0.2 0.1 0.0 99.7 100.0 0.3 2376 Bethlehem 0.0 0.1 0.0 99.9 100.0 0.1 1212 Hebron 0.1 0.0 0.0 99.9 100.0 0.1 3969 North Gaza 0.2 0.1 0.0 99.7 100.0 0.3 2173 Gaza 0.0 0.2 0.0 99.7 100.0 0.3 4105 Dier El-Balah 0.2 0.2 0.1 99.5 100.0 0.5 1600 Khan Yunis 0.1 0.0 0.0 99.8 100.0 0.2 2011 Rafah 0.1 0.5 0.0 99.5 100.0 0.5 1281 Area Urban 0.1 0.1 0.0 99.7 100.0 0.3 19579 Rural 0.0 0.2 0.0 99.7 100.0 0.3 4196 Camps 0.2 0.3 0.0 99.4 100.0 0.6 2330 Age group 0-4 0.0 0.1 0.0 99.9 100.0 0.1 8047 5-9 0.1 0.1 0.0 99.8 100.0 0.2 7391 10-14 0.1 0.2 0.0 99.6 100.0 0.4 6711 15-17 0.2 0.4 0.0 99.3 100.0 0.7 3956 Wealth index quintile Poorest 0.1 0.2 0.0 99.7 100.0 0.3 5578 Second 0.2 0.2 0.0 99.6 100.0 0.4 5213 Middle 0.1 0.2 0.0 99.7 100.0 0.3 5239 Fourth 0.1 0.2 0.0 99.7 100.0 0.3 5024 Richest 0.0 0.1 0.0 99.8 100.0 0.2 5051 1 MICS indicator 8.15 - Children with at least one parent living abroad 188 Palestinian Multiple Indicator Cluster Survey 2014 XII. HIV/AIDS 171 XII. HIV/AIDS Knowledge about HIV Transmission and Misconceptions about HIV 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 15-49 years of age. 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. 190 Palestinian Multiple Indicator Cluster Survey 2014 17 2 Ta bl e H A .1 : K no w le dg e ab ou t 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 w le dg e ab ou t H IV tr an sm is si on (w om en ) P er ce nt ag e of w om en a ge 1 5- 49 y ea rs w ho k no w th e m ai n w ay s of p re ve nt in g H IV tr an sm is si on , p er ce nt ag e w ho k no w th at a h ea lth y lo ok in g pe rs on c an b e H IV -p os iti ve , p er ce nt ag e w ho re je ct c om m on m is co nc ep tio ns , a nd p er ce nt ag e w ho h av e co m pr eh en si ve k no w le dg e ab ou t H IV tr an sm is si on , P al es tin e, 2 01 4 P er ce nt ag e w ho h av e he ar d of A ID S Pe rc en ta ge w ho k no w tr an sm is si on c an b e pr ev en te d by : P er ce nt ag e w ho k no w th at a he al th y lo ok in g pe rs on c an be H IV - po si tiv e Pe rc en ta ge w ho k no w th at H IV c an no t b e tr an sm itt ed b y: P er ce nt ag e w ho re je ct th e tw o m os t co m m on m is co nc ep tio ns an d kn ow th at a he al th y lo ok in g pe rs on ca n be H IV - po si tiv e P er ce nt ag e w ith co m pr eh en si e kn ow le dg e1 N um be r o f w om en a ge 1 5- 49 H av in g on ly o ne fa ith fu l un in fe ct ed se x pa rtn er U si ng a co nd om ev er y tim e B ot h M os qu ito bi te s S up er na tu ra l m ea ns S ha rin g fo od w ith s om eo ne w ith H IV To ta l 95 .0 77 .1 37 .6 34 .1 52 .2 44 .6 75 .5 59 .9 17 .9 7. 7 13 36 7 R eg io n W es t B an k 96 .4 77 .3 41 .0 37 .3 55 .3 45 .4 79 .0 62 .7 20 .4 9. 9 80 32 G az a S tri p 92 .9 76 .8 32 .6 29 .2 47 .5 43 .4 70 .3 55 .7 14 .1 4. 5 53 35 G ov er no ra te Je ni n 97 .4 70 .0 36 .5 31 .8 58 .4 50 .8 80 .6 67 .8 24 .2 10 .6 92 1 Tu ba s 94 .0 83 .3 46 .9 45 .7 55 .4 47 .2 77 .6 65 .4 19 .8 11 .8 16 9 Tu lk ar m 98 .0 75 .8 39 .4 35 .2 55 .1 37 .6 69 .9 63 .5 17 .4 8. 0 51 8 N ab lu s 97 .8 81 .7 35 .7 32 .3 60 .2 46 .4 80 .9 61 .4 18 .7 6. 9 10 72 Q al qi liy a 97 .5 74 .8 42 .4 35 .7 62 .6 49 .7 84 .0 66 .6 28 .1 12 .0 27 1 S al fit 96 .6 81 .8 53 .7 49 .4 46 .9 61 .2 87 .7 62 .7 18 .4 13 .8 21 1 R am al la h & A l-B ire h 99 .0 83 .1 43 .4 41 .4 52 .0 52 .5 81 .0 64 .5 23 .1 12 .9 92 7 Je ric ho a nd A l A gh w ar 92 .2 77 .8 62 .9 56 .3 71 .9 45 .8 81 .4 55 .7 26 .7 20 .7 17 0 Je ru sa le m 96 .0 76 .1 39 .3 34 .9 50 .5 44 .4 81 .3 59 .7 18 .0 9. 9 11 97 B et hl eh em 95 .8 80 .6 40 .2 37 .6 61 .2 39 .0 79 .1 56 .9 19 .7 8. 5 65 7 H eb ro n 94 .3 75 .0 42 .7 39 .3 51 .9 41 .2 75 .5 63 .4 19 .5 8. 9 19 19 N or th G az a 90 .4 74 .7 32 .6 29 .6 44 .4 41 .5 70 .7 54 .4 14 .4 5. 5 94 5 G az a 93 .1 76 .6 35 .2 32 .1 47 .3 45 .9 74 .7 59 .1 15 .6 4. 8 19 42 D ie r E l- B al ah 94 .9 82 .5 29 .3 27 .1 41 .5 41 .8 74 .5 57 .4 10 .3 2. 3 84 2 K ha n Y un is 91 .9 71 .9 33 .6 29 .1 49 .4 44 .6 58 .7 51 .7 14 .3 5. 4 10 12 R af ah 95 .4 80 .6 26 .8 22 .2 58 .8 38 .5 68 .6 51 .1 13 .8 3. 3 59 4 1 M IC S in di ca to r 9 .1 ; M D G in di ca to r 6 .3 - K no w le dg e ab ou t H IV p re ve nt io n am on g yo un g w om en 191 17 3 Ta bl e H A .1 C on tin ue d: K no w le dg e ab ou t 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 w le dg e ab ou t H IV tr an sm is si on (w om en ) P er ce nt ag e of w om en a ge 1 5- 49 y ea rs w ho k no w th e m ai n w ay s of p re ve nt in g H IV tr an sm is si on , p er ce nt ag e w ho k no w th at a h ea lth y lo ok in g pe rs on c an b e H IV -p os iti ve , p er ce nt ag e w ho re je ct co m m on m is co nc ep tio ns , a nd p er ce nt ag e w ho h av e co m pr eh en si ve k no w le dg e ab ou t H IV tr an sm is si on , P al es tin e, 2 01 4 P er ce nt ag e w ho h av e he ar d of A ID S Pe rc en ta ge w ho k no w tr an sm is si on c an b e pr ev en te d by : P er ce nt ag e w ho kn ow th at a he al th y lo ok in g pe rs on c an b e H IV -p os iti ve Pe rc en ta ge w ho k no w th at H IV c an no t be tr an sm itt ed b y: P er ce nt ag e w ho re je ct th e tw o m os t co m m on m is co nc ep tio ns a nd kn ow th at a h ea lth y lo ok in g pe rs on c an be H IV -p os iti ve P er ce nt ag e w ith co m pr eh en si ve kn ow le dg e1 N um be r of w om en ag e 15 -4 9 H av in g on ly on e fa ith fu l un in fe ct ed se x pa rtn er U si ng a co nd om ev er y tim e B ot h M os qu ito bi te s S up er na tu ra l m ea ns S ha rin g fo od w ith so m eo ne w ith H IV A re a U rb an 94 .8 77 .2 37 .4 34 .0 52 .5 44 .5 75 .1 59 .6 18 .0 7. 6 99 38 R ur al 95 .0 75 .8 39 .2 35 .4 50 .5 44 .9 75 .9 59 .4 17 .7 8. 3 22 72 C am ps 96 .7 79 .0 36 .7 32 .4 53 .0 44 .9 78 .5 62 .9 17 .6 7. 4 11 57 A ge 15 -2 41 95 .2 73 .2 31 .2 27 .9 53 .7 46 .6 75 .9 56 .6 17 .8 6. 2 58 60 1 5- 19 94 .0 67 .2 25 .4 22 .2 52 .3 46 .9 74 .8 53 .1 16 .9 4. 7 30 47 2 0- 24 96 .4 79 .7 37 .6 34 .1 55 .3 46 .2 77 .1 60 .4 18 .8 7. 9 28 13 25 -2 9 96 .2 81 .8 42 .7 39 .3 53 .5 46 .3 78 .8 63 .6 19 .1 9. 4 19 97 30 -3 9 95 .1 79 .4 43 .2 39 .3 51 .4 43 .4 74 .5 63 .3 18 .3 9. 4 32 06 40 -4 9 93 .5 79 .7 41 .7 38 .0 48 .3 39 .8 73 .0 60 .3 16 .5 7. 8 23 04 M ar ita l s ta tu s E ve r m ar rie d 95 .4 81 .2 42 .7 39 .0 50 .5 42 .5 74 .8 62 .0 17 .0 8. 2 82 74 N ev er m ar rie d 94 .5 70 .4 29 .4 26 .0 54 .9 48 .1 76 .6 56 .5 19 .4 6. 9 50 93 Ed uc at io n N on e 52 .6 38 .5 19 .6 16 .2 27 .1 10 .3 25 .6 21 .5 3. 3 1. 1 85 B as ic 89 .9 67 .9 31 .4 27 .3 44 .2 39 .6 66 .8 52 .5 13 .6 5. 0 47 70 S ec on da ry 97 .0 79 .4 38 .4 35 .0 51 .4 45 .1 76 .1 59 .2 16 .6 6. 5 39 31 H ig he r 99 .4 85 .3 43 .9 40 .7 61 .7 50 .0 85 .0 68 .8 23 .8 11 .7 45 80 W ea lth in de x qu in til es P oo re st 90 .3 75 .3 32 .1 28 .4 45 .2 42 .9 66 .0 52 .2 13 .5 4. 5 25 80 S ec on d 93 .9 75 .8 33 .2 29 .5 47 .5 41 .8 71 .6 57 .4 13 .6 4. 7 26 47 M id dl e 94 .8 73 .9 38 .1 34 .0 52 .0 41 .9 73 .8 60 .3 17 .7 7. 7 26 46 Fo ur th 96 .8 78 .6 40 .6 37 .2 55 .7 45 .0 79 .5 61 .6 19 .7 9. 0 27 19 R ic he st 98 .9 81 .6 43 .8 40 .7 59 .8 51 .1 85 .9 67 .3 24 .5 12 .4 27 75 1 M IC S in di ca to r 9 .1 ; M D G in di ca to r 6 .3 - K no w le dg e ab ou t H IV p re ve nt io n am on g yo un g w om en 192 Palestinian Multiple Indicator Cluster Survey 2014 174 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 Palestinian MICS all women who have heard of AIDS were asked questions on all three components and the results are detailed in Tables HA.1. In Palestine, a large majority of the women age 15-49 years (95 percent) have heard of AIDS. However, the percentage of those who know of both main ways of preventing HIV transmission – having only one faithful uninfected partner and using a condom every time – is only 34 percent. About 77 percent of women know of having one faithful uninfected sex partner and 38 percent of women know of using a condom every time as main ways of preventing HIV transmission. Table HA.1 also present the percentage of women who can correctly identify misconceptions concerning HIV. The indicator is based on the two most common and relevant misconceptions in Palestine, that HIV can be transmitted by mosquito bites and sharing food with someone who has HIV. The tables also provide information on whether women know that HIV cannot be transmitted by supernatural means. Overall, 18 percent of women reject the two most common misconceptions and know that a healthy-looking person can be HIV- positive i.e. around 75 percent of women know that HIV cannot be transmitted by supernatural means while another 45 percent of women know that HIV cannot be transmitted by sharing food with someone with HIV, and 60 percent of women know that a healthy-looking person can be HIV-positive. Differences exist according to marital status and women’s education, the highest proportion of comprehensive knowledge was found among ever married or married women compared with those who are not married. Comprehensive knowledge levels increase with increasing levels of education ranging from 24 percent among women who have higher education compared with three percent among women with no education. 193 175 Figure HA.1: Women with comprehensive knowledge of HIV transmission, Palest ine, 2014 People who have 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 is fairly low although there are differences by area. Overall, 8 percent of women were found to have comprehensive knowledge, with no significant differences in urban and rural and camps areas (8 and 8 and 7 percent respectively). As expected, the percentage of women with comprehensive knowledge increases with their education level, the percentage is higher among women who have higher education (12 percent) compared with women with no education (1 percent). And the percentage of women with comprehensive knowledge is higher among women in the West Bank (10 percent) compared with women in Gaza Strip (5 percent). Clear disparities in knowledge exist at a governorate level, with the lowest percentage in Deir El-Balah governorate (2 percent) and the highest in Jericho and Al-Aghwar governorate (21 percent). 194 Palestinian Multiple Indicator Cluster Survey 2014 176 Table HA.2: Knowledge of mother-to-child HIV transmission (women) Percentage of women age 15-49 years who correctly identify means of HIV transmission from mother to child, Palestine, 2014 Percentage of women age 15-49 who have heard of AIDS and: Number of women age 15-49 Know HIV can be transmitted from mother to child: Do not know any of the specific means of HIV transmission from mother to child During pregnancy During delivery By breastfeeding By at least one of the three means By all three means1 Total 80.9 67.0 52.9 86.3 43.5 8.8 13367 Region West Bank 82.4 67.6 51.1 87.4 42.6 9.1 8032 Gaza Strip 78.7 66.1 55.8 84.6 44.9 8.3 5335 Governorate Jenin 83.0 71.9 50.7 89.3 41.7 8.1 921 Tubas 80.9 66.4 43.5 86.5 33.0 7.5 169 Tulkarm 78.8 60.0 41.4 85.3 33.3 12.7 518 Nablus 83.3 64.4 46.4 89.0 35.2 8.8 1072 Qalqiliya 80.4 66.6 45.5 85.7 36.0 11.8 271 Salfit 88.8 75.5 67.1 92.6 58.7 4.0 211 Ramallah & Al-Bireh 82.4 67.4 48.3 88.0 41.3 11.0 927 Jericho and Al Aghwar 83.4 81.7 64.4 87.3 60.1 4.9 170 Jerusalem 81.8 67.7 53.0 86.0 43.3 10.0 1197 Bethlehem 85.6 73.9 54.4 90.9 45.0 5.0 657 Hebron 81.5 65.2 53.9 85.1 47.5 9.2 1919 North Gaza 74.0 61.2 48.4 81.7 37.2 8.7 945 Gaza 82.7 71.8 62.0 86.9 53.7 6.2 1942 Dier El-Balah 79.7 62.7 52.2 85.4 39.5 9.5 842 Khan Yunis 73.7 63.0 55.0 81.3 41.6 10.6 1012 Rafah 79.8 65.1 53.5 86.5 41.8 8.9 594 Area Urban 81.1 66.9 53.1 86.3 44.0 8.5 9938 Rural 80.2 66.5 51.0 85.8 40.9 9.2 2272 Camps 80.3 68.5 54.9 86.6 44.4 10.0 1157 Age group 15-24 81.9 66.0 57.8 87.5 46.0 7.7 5860 15-19 80.3 63.9 57.1 86.0 45.6 8.0 3047 20-24 83.5 68.1 58.5 89.1 46.4 7.3 2813 25-29 81.2 67.6 52.4 87.1 43.5 9.1 1997 30-39 80.0 67.8 47.7 85.2 40.3 9.8 3206 40-49 79.4 67.9 48.4 83.9 41.9 9.6 2304 Marital status Ever married/in union 80.8 67.8 50.7 86.2 42.2 9.2 8274 Never married/in union 81.0 65.6 56.5 86.4 45.7 8.0 5093 Education None 40.8 38.1 28.5 47.0 23.3 5.6 85 Basic 74.2 60.1 49.9 78.9 41.1 11.0 4770 Secondary 82.5 67.1 55.3 88.4 44.1 8.7 3931 Higher 87.2 74.5 54.5 92.9 45.9 6.5 4580 Wealth index quintiles Poorest 76.7 64.9 56.6 82.7 45.5 7.7 2580 Second 78.7 64.3 53.9 84.5 43.2 9.4 2647 Middle 79.1 65.0 51.8 84.3 42.4 10.5 2646 Fourth 84.1 68.7 52.2 88.6 43.5 8.2 2719 Richest 85.5 71.6 50.4 90.9 43.2 7.9 2775 1 MICS indicator 9.2 - Knowledge of mother-to-child transmission of HIV 195 177 Knowledge of mother-to-child transmission of HIV is also an important first step for women to seek HIV testing when they are pregnant to avoid infection in the baby. Women should know that HIV can be transmitted during pregnancy, during delivery, and through breastfeeding. The level of knowledge among women age 15-49 years concerning mother-to-child transmission is presented in Tables HA.2. The percentage of women who know all three ways of mother-to-child transmission is 44 percent, while 9 percent of women did not know of any specific way. The percentage of women who know that HIV is transmitted during pregnancy was 81 percent, the knowledge levels that HIV can be transmitted during delivery and breastfeeding declines to 67 percent and 53 percent, respectively. There are no significant differences by geographical regions. The impact of education on this knowledge is also clear with the percentage rising from 23 percent among women who have no education and increasing dramatically to 44 percent among those with secondary education and to 46 percent with higher education. Accepting Attitudes toward People Living with HIV 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 on the following four questions: 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 should be allowed to teach in school; and 4) would not want to keep it a secret if a family member is HIV-positive. 196 Palestinian Multiple Indicator Cluster Survey 2014 178 Table HA.3: Accepting attitudes toward people living with HIV (women) Percentage of women age 15-49 years who have heard of AIDS who express an accepting attitude towards people living with HIV, Palestine, 2014 Percentage of women who: Number of women age 15-49 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 and is 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 indicators1 Total 92.6 23.8 36.1 29.8 96.7 5.0 12701 Region West Bank 91.4 24.4 36.7 26.8 96.0 5.1 7744 Gaza Strip 94.3 22.7 35.2 34.4 97.8 4.8 4957 Governorate Jenin 94.0 33.3 39.8 29.3 97.9 5.6 897 Tubas 89.1 33.6 34.9 33.1 95.6 3.9 159 Tulkarm 91.9 22.8 39.9 24.2 95.4 4.4 508 Nablus 89.6 26.2 40.0 31.8 96.0 6.7 1049 Qalqiliya 90.6 29.1 45.1 34.8 96.5 8.6 264 Salfit 84.3 24.8 30.5 36.6 91.0 6.8 204 Ramallah & Al-Bireh 94.2 25.5 38.9 29.9 97.1 7.9 918 Jericho and Al Aghwar 98.5 15.5 35.4 10.1 100.0 2.0 157 Jerusalem 91.1 23.8 32.8 26.4 96.1 5.9 1149 Bethlehem 90.1 16.7 32.2 29.2 94.7 3.5 630 Hebron 90.9 21.3 34.9 19.7 95.3 2.2 1811 North Gaza 96.2 23.5 34.8 37.0 98.7 4.0 854 Gaza 94.8 22.8 36.1 31.7 97.9 4.9 1808 Dier El-Balah 92.3 23.4 36.5 30.1 96.9 4.1 799 Khan Yunis 92.2 21.1 32.7 42.4 97.3 6.4 930 Rafah 96.3 22.7 35.3 32.0 98.1 4.4 567 Area Urban 92.8 23.7 36.2 29.5 96.9 4.8 9424 Rural 91.7 24.2 34.8 30.4 95.9 6.0 2159 Camps 92.1 23.5 37.5 30.4 96.9 4.4 1118 Age 15-24 91.3 24.2 38.0 30.6 96.1 5.0 5578 15-19 90.9 23.8 37.9 30.9 95.9 5.3 2865 20-24 91.8 24.5 38.1 30.2 96.3 4.7 2713 25-29 92.7 24.5 36.5 30.8 97.2 4.9 1920 30-39 93.3 23.3 34.7 29.8 96.9 5.4 3047 40-49 94.5 22.8 32.9 26.7 97.4 4.3 2155 Marital status Ever married/in union 93.2 23.0 34.1 30.3 97.0 4.8 7890 Never married/in union 91.5 25.0 39.4 28.8 96.3 5.3 4811 1 MICS indicator 9.3 - Accepting attitudes towards people living with HIV ( ) Figures that are based on 25-49 unweighted cases 197 179 Table HA.3 Continued: Accepting attitudes toward people living with HIV (women) Percentage of women age 15-49 years who have heard of AIDS who express an accepting attitude towards people living with HIV, Palestine, 2014 Percentage of women who: Number of women age 15-49 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 and is 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 indicators1 Education None (83.5) (10.0) (13.5) (27.1) (86.0) (0.0) 45 Basic 92.3 22.0 32.2 30.3 96.3 4.7 4287 Secondar y 92.1 22.8 34.2 32.1 96.9 4.7 3814 Higher 93.2 26.4 41.6 27.3 97.0 5.5 4554 Wealth index quintiles Poorest 93.9 22.1 33.7 35.4 97.4 4.9 2331 Second 93.6 23.1 34.5 32.4 97.1 4.3 2486 Middle 91.2 24.3 36.6 29.7 95.9 4.8 2508 Fourth 91.2 24.8 37.4 27.5 96.3 5.3 2633 Richest 93.0 24.3 38.0 24.8 96.8 5.5 2743 1 MICS indicator 9.3 - Accepting attitudes towards people living with HIV ( ) Figures that are based on 25-49 unweighted cases 198 Palestinian Multiple Indicator Cluster Survey 2014 180 Figure HA.2: Accepting att i tudes toward people l iv ing with HIV/AIDS, Palest ine, 2014 Tables HA.3 present the attitudes of women towards people living with HIV. In Palestine, 97 percent of women who have heard of AIDS agree with at least one accepting statement. The most common accepting attitude is willing to care for a family member with AIDS in own home (93 percent). More educated individuals and those from richest households have more accepting attitudes than the ones with lower education and a poorer wealth status. Five percent of women who have heard of AIDS express accepting attitudes on all four indicators. More description Knowledge of a Place for HIV Testing Another important indicator is the knowledge of where to be tested for HIV. In order to protect themselves and to prevent infecting others, it is important for individuals to know their HIV status. Knowledge of own status is also a critical factor in the decision to seek treatment. 199 181 Table HA.4: Knowledge of a place for HIV testing (women) Percentage of women age 15-49 years who know where to get an HIV test, Palestine, 2014 Percentage of women who: Number of women age 15-49 Know a place to get tested1 Total 19.7 13367 Region West Bank 19.1 8032 Gaza Strip 20.6 5335 Governorate Jenin 16.1 921 Tubas 17.7 169 Tulkarm 22.4 518 Nablus 21.8 1072 Qalqiliya 25.9 271 Salfit 37.0 211 Ramallah & Al-Bireh 19.0 927 Jericho and Al Aghwar 37.0 170 Jerusalem 23.9 1197 Bethlehem 10.1 657 Hebron 13.8 1919 North Gaza 12.7 945 Gaza 30.0 1942 Dier El-Balah 15.3 842 Khan Yunis 20.4 1012 Rafah 10.3 594 Area Urban 19.6 9938 Rural 20.0 2272 Camps 19.5 1157 Age 15-24 20.2 5860 15-19 20.8 3047 20-24 19.5 2813 25-29 19.6 1997 30-39 18.4 3206 40-49 20.4 2304 Marital status Ever married/in union 18.3 8274 Never married/in union 21.9 5093 Education None 3.5 85 Basic 17.1 4770 Secondary 18.7 3931 Higher 23.5 4580 Wealth index quintiles Poorest 19.8 2580 Second 20.7 2647 Middle 18.1 2646 Fourth 18.2 2719 Richest 21.6 2775 1 MICS indicator 9.4 - Women who know where to be tested for HIV Questions related to knowledge of a facility for HIV testing are presented in Table HA.4. Twenty percent of women knew where to be tested. The impact of education on this knowledge is also clear with the percentage rising from 4 percent among women who have no education and increasing to 19 percent among those with secondary education and to 24 percent with higher education. 200 Palestinian Multiple Indicator Cluster Survey 2014 APPENDICES 185 Appendix A. 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 Palestinian MICS was to produce statistically reliable estimates of most indicators, at the national level, for urban, rural and camps areas. Urban, rural and camps areas in each of the governorates were defined as the sampling strata. A multi-stage, stratified cluster sampling approach was used for the selection of the survey sample. Sample Size and Sample Allocation The sample size for the Palestinian MICS was calculated as 11,125 households. For the calculation of the sample size, the key indicator used was stunting prevalence among children age 0-4 years. The following formula was used to estimate the required sample size for this indicator: )])()(()15.0[( )])(1)((4[ 2 RRAveSizepbr deffrrn −= 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 • 0.15r is the margin of error to be tolerated at the 95 percent level of confidence, defined as 15 per cent 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 (stunting prevalence) was assumed to be 10.9 percent. The value of deff (design effect) was taken as 1.5 based on estimates from previous surveys, pb (percentage of children age 0-4 years in the total population) was taken as 14.8 percent, AveSize (average household size) was taken as 5.9 households, and the response rate was assumed to be 92 percent, based on experience from previous surveys. Finally , the sample size = 2713*4 region (north, middle, south west bank and Gaza strip) = 10852 HHs, there was additional 198 households from camps and 75 HHs for area C. so, the final sample size = 11125 HHs. 202 Palestinian Multiple Indicator Cluster Survey 2014 186 The number of households selected per cluster for the Palestinian MICS 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, we obtain a sample of 445 clusters. 203 18 7 Th e ta bl e be lo w s ho w s th e al lo ca tio n of c lu st er s to th e sa m pl in g st ra ta . Ta bl e SD .1 : A llo ca tio n of S am pl e C lu st er s (P rim ar y Sa m pl in g U ni ts ) t o Sa m pl in g St ra ta Po pu la tio n (2 01 4 Es tim at es ) N um be r o f C lu st er s To ta l U rb an R ur al C am p To ta l U rb an R ur al C am p To ta l 45 50 36 7 33 42 80 6 76 10 57 44 65 04 44 5 32 1 79 45 G ov er no ra te Je ni n 30 35 65 17 88 37 11 24 60 12 26 8 33 19 12 2 Tu ba s 62 62 7 41 73 9 13 77 1 71 17 8 4 2 2 Tu lk ar m 17 87 74 12 01 56 39 24 6 19 37 2 19 13 4 2 N ab lu s 37 26 21 20 56 81 13 11 30 35 81 0 39 22 13 4 Q al qi liy a 10 80 49 65 83 4 42 21 5 0 11 7 4 0 S al fit 69 17 9 25 10 0 44 07 9 0 8 3 5 0 R am al la h 33 83 83 17 55 41 14 31 83 19 65 9 37 20 15 2 Je ric ho 50 76 2 26 94 7 11 41 7 12 39 8 7 3 2 2 Je ru sa le m J 2 15 59 54 10 00 73 45 91 8 99 63 18 11 5 2 Je ru sa le m J 1 25 56 85 23 78 80 0 17 80 5 29 27 2 B et hl eh em 21 04 84 14 76 67 47 41 5 15 40 2 23 16 5 2 H eb ro n 68 42 47 58 38 68 82 42 9 17 95 0 63 53 8 2 N or th G az a 34 88 08 29 10 57 36 28 54 12 3 28 24 4 G az a 60 67 49 54 90 70 15 33 0 42 34 9 51 47 1 3 D ei r a l B al ah 25 57 05 16 05 51 23 30 92 82 4 23 14 1 8 K ha n Y un is 33 10 17 26 63 75 18 58 3 46 05 9 30 24 2 4 R af ah 21 77 58 16 64 30 79 23 43 40 5 18 14 4 204 Palestinian Multiple Indicator Cluster Survey 2014 188 Sampling Frame and Selection of Clusters The 2007 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 2007 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 sixteen governorates, separately for the urban, rural and camps strata. Listing Activities Since the sampling frame (the 2007 census) was not up-to-date, a listing of households was conducted in all the sample enumeration areas (EAs) 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 these enumeration areas. The listing was conducted in 416 enumeration areas; this excludes 29 sample EAs in Jerusalem within the barriers J1. A total of 266 EAs were updated in the West Bank area and 150 EAs in the Gaza Strip. A 5- day training took place during the first week of September in order to provide the fieldworkers with the skills needed for conducting the listing in the sample EAs for the Palestinian Multiple Indicator Survey 2014. The main listing field work was conducted during the period September - October, 2014. 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 Statistical Office, where the selection of 25 households in each enumeration area was carried out using random systematic selection procedures. Calculation of Sample Weights The Palestinian MICS sample is not self-weighting. Essentially, by allocating equal numbers of households to each of the regions, different sampling fractions were used in each region since the sizes of the regions 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 the particular sampling stratum (h) and PSU (i): 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: 205 189 p1hi = h hih M Mn × , nh = number of sample PSUs selected in stratum h Mhi = number of households in the 2010 Census frame for the i-th sample PSU in stratum h Mh = total number of households in the 2010 Census frame for stratum h p2hi = proportion of the PSU listed the i-th sample PSU in stratum h (in the case of PSUs that were segmented); for non-segmented PSUs, p2hi = 1 p3hi = hiM ' 25 M'hi = number of households listed in the i-th sample PSU in stratum h Since the number of households in each enumeration area (PSU) from the 2007 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: hRR 1 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: hRR 1 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 Palestinian MICS 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 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 206 Palestinian Multiple Indicator Cluster Survey 2014 190 level. Normalization is achieved by dividing the full sample weights (adjusted for nonresponse) 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 nonresponse). A similar standardization procedure was followed in obtaining normalized weights for the individual women, men, and under-5 questionnaires. Adjusted (normalized) household weights varied between 0.226 and 2.316 in the 445 sample enumeration areas (clusters). Sample weights were appended to all data sets and analyses were performed by weighting households, women, or under-5s with these sample weights. 207 191 Appendix  B.  List  of  Personnel  Involved  in  the  Survey     Project  Manager Rami  Al-­‐Dibs PCBS Project  Assistants   Isra'  Samoodi   PCBS Riham  Mousa     PCBS Field  Coordinators   Lubna  Sumoor   PCBS\  Main  office Suhair  Al-­‐Shafee   PCBS\  Nablus  office Dyaa'  Hamdan   PCBS\  Bethlehem  office Hamida  Idheedl   PCBS\  Hebron  Office Amal  Bekawe   PCBS\  Jenin  Office Mearie  Mesleah     PCBS\  Gaza  Office Data  Processing   Khalid  Hantoli     PCBS Sample  Design   Rabah  Al-­‐Jamal     PCBS Technical  Committee   Rami  Al-­‐Dibs   PCBS Isra'  Samoodi   PCBS Riham  Mousa   PCBS Lubna  Sumoor   PCBS Rabah  A L-­‐Jamal   PCBS Nafir  Massad   PCBS Khalid  Hantoli     PCBS Supervisory  Committee     Mohammad  Omari   PCBS Raed  Samarah   PCBS Dr.  Jawad  Bitar   MoH   Khalid  Hantoli   PCBS Rami  Al-­‐Dibs     PCBS Steering  Committee     Rami  Al-­‐Dibs   PCBS   Dr.  Jawad  Bitar   MoH   Dr.  Najwa  Rizkallah   UNICEF/SoP   Khalid  Abu  Khalid   UNICEF/SoP   208 Palestinian Multiple Indicator Cluster Survey 2014 192 Dr.  Motasem  Hamdan   Al-­‐Quds  University   Ms.  Sana  Asi   UNFPA   Dr.  Ali  Shaar   UNFPA   Buthaina  Ghanam   The  Palestinian  National  Institute  of  Public  Health   Mirna  Jabir   The  Ministry  of  Planning  and  Administrative   Development   Dr.  Elias  Habash     UNRWA   UNICEF/State  of  Palestine     Kumiko  Imai   Head  of  Social  Policy  Section   Khalid  Abu  Khalid     MICS  Coordinator   Preliminary  Review  of  the  report     Jawad  Al  –Saleh     PCBS   Final  Review  of  the  report     Inaya Zidan     PCBS   Overall  Supervision     Ola  Awad   President  of  PCBS   209 193 Appendix C. Estimates of Sampling Errors The sample of respondents selected in the Palestinian Multiple Indicator Cluster Survey 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. 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, rural and camps areas and for the West Bank and Gaza Strip. Three of the selected 1  CMRJack  is  a  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   210 Palestinian Multiple Indicator Cluster Survey 2014 194 indicators are based on households members, 10 are based on women, and 2 are based on children under 5. Table SE.1 shows the list of indicators for which sampling errors are calculated, including the base population (denominator) for each indicator. Tables SE.2 to SE.7 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, Palestine, 2014 MICS5 Indicator Base Population Household members 4.1 Use of improved drinking water sources All household membersa 4.3 Use of improved sanitation All household membersa 7.4 Basic school net attendance ratio (adjusted) Children of Basic school age (6-16 years) Women 1.2 Infant mortality rate Children of interviewed women exposed to the risk of mortality during the first year of life 1.5 Under five mortality rate Children of interviewed women exposed to the risk of mortality during the first five 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 age 15-49 years who are currently married 5.4 Unmet need Women age 15-49 years who are currently married 5.5a Antenatal care coverage (1+ times, skilled provider) Women age 15-49 years with a live birth in the last 2 years 5.5b Antenatal care coverage (4+ times, any provider) Women age 15-49 years with a live birth in the last 2 years 5.7 Skilled attendant at delivery Women age 15-49 years with a live birth in the last 2 years 7.1 Literacy rate (young women) Women age 15-24 years 9.1 Knowledge about HIV prevention (young women) Women age 15-24 years Under-5s 2.1a Underweight prevalence (moderate and severe) Children under age 5 years 2.1b Underweight prevalence (severe) Children under age 5 years a To calculate the weighted results of MICS Indicators 4.1 and 4.3, 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. 211 19 5 T ab le S E. 2: S am pl in g er ro rs : T ot al s am pl e S ta nd ar d er ro rs , c oe ffi ci en ts o f v ar ia tio n, d es ig n ef fe ct s (d ef f), s qu ar e ro ot o f d es ig n ef fe ct s (d ef t), a nd c on fid en ce in te rv al s fo r s el ec te d in di ca to rs , P al es tin e, 2 01 4 M IC S In di ca to r M D G In di ca to r V al ue (r ) S ta nd ar d er ro r ( se ) C oe ffi ci en t of v ar ia tio n (s e/ r) D es ig n ef fe ct (d ef f) S qu ar e ro ot of d es ig n ef fe ct (d ef t) W ei gh te d co un t U nw ei gh te d co un t C on fid en ce li m its Lo w er bo un d r - 2 se U pp er bo un d r + 2 se H ou se ho ld m em be rs U se o f i m pr ov ed d rin ki ng w at er s ou rc es 4. 1 7. 8 0. 61 52 0. 00 61 9 0. 01 0 1. 64 8 1. 28 4 10 18 2 10 18 2 0. 60 3 0. 62 8 U se o f i m pr ov ed s an ita tio n 4. 3 7. 9 0. 98 65 0. 00 12 7 0. 00 1 1. 23 8 1. 11 3 10 18 2 10 18 2 0. 98 4 0. 98 9 B as ic s ch oo l n et a tte nd an ce ra tio (a dj us te d) 7. 4 2. 1 0. 96 80 0. 00 27 4 0. 00 3 0. 87 9 0. 93 8 13 75 2 13 70 0 0. 85 9 0. 87 0 W om en In fa nt m or ta lit y ra te 1. 2 4. 2 18 .2 37 1 1. 74 22 8 0. 09 6 - - - - 14 .7 53 21 .7 22 U nd er fi ve m or ta lit y ra te 1. 5 4. 1 21 .7 30 6 1. 86 52 3 0. 08 6 - - - - 18 .0 00 25 .4 61 A do le sc en t b irt h ra te 5. 1 5. 4 48 .3 98 8 3. 00 41 4 0. 06 2 - - - - 42 .3 91 54 .4 07 C on tra ce pt iv e pr ev al en ce ra te 5. 3 5. 3 0. 57 19 0. 00 45 4 0. 01 3 1. 22 6 1. 10 7 13 36 7 13 36 7 0. 33 1 0. 34 9 U nm et n ee d 5. 4 5. 6 0. 10 88 0. 00 21 5 0. 05 7 1. 01 4 1. 00 7 79 60 79 00 0. 03 3 0. 04 2 A nt en at al c ar e co ve ra ge (1 + tim es , sk ill ed p ro vi de r) 5. 5a 5. 5 0. 99 40 0. 00 41 5 0. 01 9 1. 34 9 1. 16 1 13 36 7 13 36 7 0. 21 0 0. 22 7 A nt en at al c ar e co ve ra ge (4 + tim es , a ny pr ov id er ) 5. 5b 5. 5 0. 95 51 0. 00 40 1 0. 01 9 1. 29 3 1. 13 7 13 36 7 13 36 7 0. 20 3 0. 21 9 S ki lle d at te nd an t a t d el iv er y 5. 7 5. 2 0. 99 57 0. 00 41 5 0. 01 9 1. 34 8 1. 16 1 13 36 7 13 36 7 0. 21 1 0. 22 7 Li te ra cy ra te (y ou ng w om en ) 7. 1 2. 3 0. 97 16 0. 00 69 7 0. 01 1 1. 21 1 1. 10 0 58 60 58 73 0. 60 6 0. 63 4 K no w le dg e ab ou t H IV p re ve nt io n (y ou ng w om en ) 9. 1 6. 3 0. 06 23 0. 00 34 5 0. 05 5 1. 19 9 1. 09 5 58 60 58 73 0. 05 5 0. 06 9 U nd er -5 s U nd er w ei gh t p re va le nc e (m od er at e an d se ve re ) 2. 1a 1. 8 0. 01 38 0. 00 14 2 0. 10 3 1. 07 4 1. 03 6 72 22 72 09 0. 01 1 0. 01 7 U nd er w ei gh t p re va le nc e (s ev er e) 2. 1b 1. 8 0. 00 23 0. 00 05 9 0. 25 5 1. 08 2 1. 04 0 72 22 72 09 0. 00 1 0. 00 3 - 212 Palestinian Multiple Indicator Cluster Survey 2014 19 6 T ab le S E. 3: S am pl in g er ro rs : W es t B an k S ta nd ar d er ro rs , c oe ffi ci en ts o f v ar ia tio n, d es ig n ef fe ct s (d ef f), s qu ar e ro ot o f d es ig n ef fe ct s (d ef t), a nd c on fid en ce in te rv al s fo r s el ec te d in di ca to rs , P al es tin e, 2 01 4 M IC S In di ca to r M D G In di ca to r V al ue (r ) S ta nd ar d er ro r ( se ) C oe ffi ci en t of v ar ia tio n (s e/ r) D es ig n ef fe ct (d ef f) S qu ar e ro ot of d es ig n ef fe ct (d ef t) W ei gh te d co un t U nw ei gh te d co un t C on fid en ce li m its Lo w er bo un d r - 2 se U pp er bo un d r + 2 se H ou se ho ld m em be rs U se o f i m pr ov ed d rin ki ng w at er s ou rc es 4. 1 7. 8 0. 96 85 0. 00 40 3 0. 00 4 3. 55 3 1. 88 5 63 85 66 87 0. 96 0 0. 97 7 U se o f i m pr ov ed s an ita tio n 4. 3 7. 9 0. 98 85 0. 00 14 5 0. 00 1 1. 23 5 1. 11 2 63 85 66 87 0. 98 6 0. 99 1 B as ic s ch oo l n et a tte nd an ce ra tio (a dj us te d) 7. 4 2. 1 0. 85 83 0. 00 35 1 0. 00 4 0. 85 7 0. 92 6 80 67 84 79 0. 85 1 0. 86 5 W om en In fa nt m or ta lit y ra te 1. 2 4. 2 17 .0 58 3 2. 06 00 1 0. 12 1 - - - - 12 .9 38 21 .1 78 U nd er fi ve m or ta lit y ra te 1. 5 4. 1 20 .0 48 8 2. 27 39 4 0. 11 3 - - - - 15 .5 01 24 .5 97 A do le sc en t b irt h ra te 5. 1 5. 4 35 .1 54 5 3. 03 35 5 0. 08 6 - - - - 29 .0 87 41 .2 22 C on tra ce pt iv e pr ev al en ce ra te 5. 3 5. 3 0. 35 26 0. 00 55 0 0. 01 6 1. 11 5 1. 05 6 80 32 84 29 0. 34 2 0. 36 4 U nm et n ee d 5. 4 5. 6 0. 03 40 0. 00 26 0 0. 07 7 1. 01 6 1. 00 8 47 41 49 28 0. 02 9 0. 03 9 A nt en at al c ar e co ve ra ge (1 + tim es , sk ill ed p ro vi de r) 5. 5a 5. 5 0. 19 91 0. 00 44 5 0. 02 2 1. 04 9 1. 02 4 80 32 84 29 0. 19 0 0. 20 8 A nt en at al c ar e co ve ra ge (4 + tim es , a ny pr ov id er ) 5. 5b 5. 5 0. 19 32 0. 00 42 9 0. 02 2 0. 99 6 0. 99 8 80 32 84 29 0. 18 5 0. 20 2 S ki lle d at te nd an t a t d el iv er y 5. 7 5. 2 0. 19 96 0. 00 44 3 0. 02 2 1. 03 7 1. 01 8 80 32 84 29 0. 19 1 0. 20 8 Li te ra cy ra te (y ou ng w om en ) 7. 1 2. 3 0. 60 51 0. 00 86 7 0. 01 4 1. 12 5 1. 06 1 33 77 35 76 0. 58 8 0. 62 2 K no w le dg e ab ou t H IV p re ve nt io n (y ou ng w om en ) 9. 1 6. 3 0. 08 18 0. 00 51 1 0. 06 2 1. 24 1 1. 11 4 33 77 35 76 0. 07 2 0. 09 2 U nd er -5 s U nd er w ei gh t p re va le nc e (m od er at e an d se ve re ) 2. 1a 1. 8 0. 01 45 0. 00 19 2 0. 13 2 1. 01 5 1. 00 7 37 29 39 58 0. 01 1 0. 01 8 U nd er w ei gh t p re va le nc e (s ev er e) 2. 1b 1. 8 0. 00 27 0. 00 09 0 0. 32 6 1. 16 1 1. 07 7 37 29 39 58 0. 00 1 0. 00 5 213 19 7 T ab le S E. 4: S am pl in g er ro rs : G az a St rip S ta nd ar d er ro rs , c oe ffi ci en ts o f v ar ia tio n, d es ig n ef fe ct s (d ef f), s qu ar e ro ot o f d es ig n ef fe ct s (d ef t), a nd c on fid en ce in te rv al s fo r s el ec te d in di ca to rs , P al es tin e, 2 01 4 M IC S In di ca to r M D G In di ca to r V al ue (r ) S ta nd ar d er ro r (s e) C oe ffi ci en t of v ar ia tio n (s e/ r) D es ig n ef fe ct (d ef f) S qu ar e ro ot of d es ig n ef fe ct (d ef t) W ei gh te d co un t U nw ei gh te d co un t C on fid en ce li m its Lo w er bo un d r - 2 se U pp er bo un d r + 2 se H ou se ho ld m em be rs U se o f i m pr ov ed d rin ki ng w at er s ou rc es 4. 1 7. 8 0. 10 40 0. 00 77 3 0. 07 4 2. 24 0 1. 49 7 37 97 34 95 0. 08 9 0. 11 9 U se o f i m pr ov ed s an ita tio n 4. 3 7. 9 0. 98 36 0. 00 23 0 0. 00 2 1. 14 8 1. 07 1 37 97 34 95 0. 97 9 0. 98 8 B as ic s ch oo l n et a tte nd an ce ra tio (a dj us te d) 7. 4 2. 1 0. 87 31 0. 00 44 1 0. 00 5 0. 91 8 0. 95 8 56 85 52 21 0. 86 4 0. 88 2 W om en In fa nt m or ta lit y ra te 1. 2 4. 2 19 .6 22 8 2. 91 76 8 0. 14 9 - - - - 13 .7 87 25 .4 58 U nd er fi ve m or ta lit y ra te 1. 5 4. 1 23 .7 21 7 3. 04 43 7 0. 12 8 - - - - 17 .6 33 29 .8 10 A do le sc en t b irt h ra te 5. 1 5. 4 66 .4 76 2 5. 42 71 7 0. 08 2 - - - - 55 .6 22 77 .3 31 C on tra ce pt iv e pr ev al en ce ra te 5. 3 5. 3 0. 32 20 0. 00 77 1 0. 02 4 1. 34 5 1. 16 0 53 35 49 38 0. 30 7 0. 33 7 U nm et n ee d 5. 4 5. 6 0. 04 25 0. 00 36 8 0. 08 6 0. 98 6 0. 99 3 32 20 29 72 0. 03 5 0. 05 0 A nt en at al c ar e co ve ra ge (1 + tim es , sk ill ed p ro vi de r) 5. 5a 5. 5 0. 24 82 0. 00 78 9 0. 03 2 1. 64 8 1. 28 4 53 35 49 38 0. 23 2 0. 26 4 A nt en at al c ar e co ve ra ge (4 + tim es , a ny pr ov id er ) 5. 5b 5. 5 0. 23 84 0. 00 76 5 0. 03 2 1. 59 2 1. 26 2 53 35 49 38 0. 22 3 0. 25 4 S ki lle d at te nd an t a t d el iv er y 5. 7 5. 2 0. 24 84 0. 00 79 2 0. 03 2 1. 65 8 1. 28 8 53 35 49 38 0. 23 3 0. 26 4 Li te ra cy ra te (y ou ng w om en ) 7. 1 2. 3 0. 64 12 0. 01 13 5 0. 01 8 1. 28 5 1. 13 4 24 83 22 97 0. 61 8 0. 66 4 K no w le dg e ab ou t H IV p re ve nt io n (y ou ng w om en ) 9. 1 6. 3 0. 03 58 0. 00 41 7 0. 11 7 1. 15 9 1. 07 7 24 83 22 97 0. 02 7 0. 04 4 U nd er -5 s U nd er w ei gh t p re va le nc e (m od er at e an d se ve re ) 2. 1a 1. 8 0. 01 30 0. 00 21 2 0. 16 3 1. 14 1 1. 06 8 34 92 32 51 0. 00 9 0. 01 7 U nd er w ei gh t p re va le nc e (s ev er e) 2. 1b 1. 8 0. 00 18 0. 00 07 5 0. 40 9 0. 99 8 0. 99 9 34 92 32 51 0. 00 0 0. 00 3 214 Palestinian Multiple Indicator Cluster Survey 2014 19 8 T ab le S E. 5: S am pl in g er ro rs : U rb an S ta nd ar d er ro rs , c oe ffi ci en ts o f v ar ia tio n, d es ig n ef fe ct s (d ef f), s qu ar e ro ot o f d es ig n ef fe ct s (d ef t), a nd c on fid en ce in te rv al s fo r s el ec te d in di ca to rs , P al es tin e, 2 01 4 M IC S In di ca to r M D G In di ca to r V al ue (r ) S ta nd ar d er ro r (s e) C oe ffi ci en t of v ar ia tio n (s e/ r) D es ig n ef fe ct (d ef f) S qu ar e ro ot of d es ig n ef fe ct (d ef t) W ei gh te d co un t U nw ei gh te d co un t C on fid en ce li m its Lo w er bo un d r - 2 se U pp er bo un d r + 2 se H ou se ho ld m em be rs U se o f i m pr ov ed d rin ki ng w at er s ou rc es 4. 1 7. 8 0. 58 08 0. 00 73 8 0. 01 3 1. 63 2 1. 27 8 76 02 72 90 0. 56 6 0. 59 6 U se o f i m pr ov ed s an ita tio n 4. 3 7. 9 0. 98 65 0. 00 16 3 0. 00 2 1. 45 8 1. 20 8 76 02 72 90 0. 98 3 0. 99 0 B as ic s ch oo l n et a tte nd an ce ra tio (a dj us te d) 7. 4 2. 1 0. 86 45 0. 00 33 0 0. 00 4 0. 91 0 0. 95 4 10 23 7 97 69 0. 85 8 0. 87 1 W om en In fa nt m or ta lit y ra te 1. 2 4. 2 19 .0 61 4 2. 10 37 7 0. 11 0 - - - - 14 .8 54 23 .2 69 U nd er fi ve m or ta lit y ra te 1. 5 4. 1 22 .1 73 5 2. 25 15 2 0. 10 2 - - - - 17 .6 70 26 .6 77 A do le sc en t b irt h ra te 5. 1 5. 4 54 .6 21 8 3. 70 97 4 0. 06 8 - - - - 47 .2 02 62 .0 41 C on tra ce pt iv e pr ev al en ce ra te 5. 3 5. 3 0. 34 02 0. 00 56 3 0. 01 7 1. 34 7 1. 16 1 99 38 95 38 0. 32 9 0. 35 1 U nm et n ee d 5. 4 5. 6 0. 03 87 0. 00 26 3 0. 06 8 1. 05 9 1. 02 9 59 76 56 84 0. 03 3 0. 04 4 A nt en at al c ar e co ve ra ge (1 + tim es , sk ill ed p ro vi de r) 5. 5a 5. 5 0. 22 64 0. 00 50 8 0. 02 2 1. 40 4 1. 18 5 95 38 95 38 0. 21 6 0. 23 7 A nt en at al c ar e co ve ra ge (4 + tim es , a ny pr ov id er ) 5. 5b 5. 5 0. 21 94 0. 00 49 1 0. 02 2 1. 34 2 1. 15 9 95 38 95 38 0. 21 0 0. 22 9 S ki lle d at te nd an t a t d el iv er y 5. 7 5. 2 0. 22 70 0. 00 50 7 0. 02 2 1. 39 9 1. 18 3 95 38 95 38 0. 21 7 0. 23 7 Li te ra cy ra te (y ou ng w om en ) 7. 1 2. 3 0. 62 43 0. 00 80 9 0. 01 3 1. 17 2 1. 08 3 43 63 42 00 0. 60 8 0. 64 1 K no w le dg e ab ou t H IV p re ve nt io n (y ou ng w om en ) 9. 1 6. 3 0. 06 15 0. 00 41 8 0. 06 8 1. 27 3 1. 12 8 43 63 42 00 0. 05 3 0. 07 0 U nd er -5 s U nd er w ei gh t p re va le nc e (m od er at e an d se ve re ) 2. 1a 1. 8 0. 01 34 0. 00 16 4 0. 12 3 1. 07 5 1. 03 7 54 98 52 63 0. 01 0 0. 01 7 U nd er w ei gh t p re va le nc e (s ev er e) 2. 1b 1. 8 0. 00 23 0. 00 06 8 0. 29 5 1. 05 4 1. 02 7 54 98 52 63 0. 00 1 0. 00 4 215 19 9 T ab le S E. 6: S am pl in g er ro rs : R ur al S ta nd ar d er ro rs , c oe ffi ci en ts o f v ar ia tio n, d es ig n ef fe ct s (d ef f), s qu ar e ro ot o f d es ig n ef fe ct s (d ef t), a nd c on fid en ce in te rv al s fo r s el ec te d in di ca to rs , P al es tin e, 2 01 4 M IC S In di ca to r M D G In di ca to r V al ue (r ) S ta nd ar d er ro r ( se ) C oe ffi ci en t of v ar ia tio n (s e/ r) D es ig n ef fe ct (d ef f) S qu ar e ro ot of d es ig n ef fe ct (d ef t) W ei gh te d co un t U nw ei gh te d co un t C on fid en ce li m its Lo w er bo un d r - 2 se U pp er bo un d r + 2 se H ou se ho ld m em be rs U se o f i m pr ov ed d rin ki ng w at er s ou rc es 4. 1 7. 8 0. 86 92 0. 01 32 0 0. 01 5 2. 80 6 1. 67 5 17 40 18 33 0. 84 3 0. 89 6 U se o f i m pr ov ed s an ita tio n 4. 3 7. 9 0. 98 81 0. 00 18 7 0. 00 2 0. 54 6 0. 73 9 17 40 18 33 0. 98 4 0. 99 2 B as ic s ch oo l n et a tte nd an ce ra tio (a dj us te d) 7. 4 2. 1 0. 86 02 0. 00 62 9 0. 00 7 0. 78 3 0. 88 5 22 62 23 76 0. 84 8 0. 87 3 W om en In fa nt m or ta lit y ra te 1. 2 4. 2 17 .6 63 2 4. 00 47 8 0. 22 7 - - - - 9. 65 4 25 .6 73 U nd er fi ve m or ta lit y ra te 1. 5 4. 1 21 .0 31 2 4. 29 06 6 0. 20 4 - - - - 12 .4 50 29 .6 13 A do le sc en t b irt h ra te 5. 1 5. 4 29 .5 04 9 5. 59 13 8 0. 19 0 - - - - 18 .3 22 40 .6 88 C on tra ce pt iv e pr ev al en ce ra te 5. 3 5. 3 0. 34 19 0. 00 85 2 0. 02 5 0. 76 6 0. 87 5 22 72 23 75 0. 32 5 0. 35 9 U nm et n ee d 5. 4 5. 6 0. 03 22 0. 00 41 1 0. 12 7 0. 73 6 0. 85 8 91 8 13 61 0. 02 4 0. 04 0 A nt en at al c ar e co ve ra ge (1 + tim es , sk ill ed p ro vi de r) 5. 5a 5. 5 0. 19 14 0. 00 74 8 0. 03 9 0. 85 8 0. 92 6 22 72 23 75 0. 17 6 0. 20 6 A nt en at al c ar e co ve ra ge (4 + tim es , a ny pr ov id er ) 5. 5b 5. 5 0. 18 33 0. 00 76 5 0. 04 2 0. 92 7 0. 96 3 22 72 23 75 0. 16 8 0. 19 9 S ki lle d at te nd an t a t d el iv er y 5. 7 5. 2 0. 19 15 0. 00 74 5 0. 03 9 0. 85 1 0. 92 2 22 72 23 75 0. 17 7 0. 20 6 Li te ra cy ra te (y ou ng w om en ) 7. 1 2. 3 0. 60 20 0. 01 61 0 0. 02 7 1. 12 3 1. 06 0 99 8 10 39 0. 57 0 0. 63 4 K no w le dg e ab ou t H IV p re ve nt io n (y ou ng w om en ) 9. 1 6. 3 0. 06 84 0. 00 77 0 0. 11 3 0. 96 5 0. 98 2 99 8 10 39 0. 05 3 0. 08 4 U nd er -5 s U nd er w ei gh t p re va le nc e (m od er at e an d se ve re ) 2. 1a 1. 8 0. 01 58 0. 00 32 2 0. 20 4 0. 75 2 0. 86 7 10 71 11 31 0. 00 9 0. 02 2 U nd er w ei gh t p re va le nc e (s ev er e) 2. 1b 1. 8 0. 00 27 0. 00 15 9 0. 58 9 1. 06 2 1. 03 1 10 71 11 31 0. 00 0 0. 00 6 216 Palestinian Multiple Indicator Cluster Survey 2014 20 0 T ab le S E. 7: S am pl in g er ro rs : C am ps S ta nd ar d er ro rs , c oe ffi ci en ts o f v ar ia tio n, d es ig n ef fe ct s (d ef f), s qu ar e ro ot o f d es ig n ef fe ct s (d ef t), a nd c on fid en ce in te rv al s fo r s el ec te d in di ca to rs , P al es tin e, 2 01 4 M IC S In di ca to r M D G In di ca to r V al ue (r ) S ta nd ar d er ro r ( se ) C oe ffi ci en t of v ar ia tio n (s e/ r) D es ig n ef fe ct (d ef f) S qu ar e ro ot of d es ig n ef fe ct (d ef t) W ei gh te d co un t U nw ei gh te d co un t C on fid en ce li m its Lo w er bo un d r - 2 se U pp er bo un d r + 2 se H ou se ho ld m em be rs U se o f i m pr ov ed d rin ki ng w at er s ou rc es 4. 1 7. 8 0. 42 23 0. 01 30 1 0. 03 1 0. 73 4 0. 85 7 86 2 10 59 0. 39 6 0. 44 8 U se o f i m pr ov ed s an ita tio n 4. 3 7. 9 0. 98 32 0. 00 24 2 0. 00 2 0. 37 6 0. 61 3 86 2 10 59 0. 97 8 0. 98 8 B as ic s ch oo l n et a tte nd an ce ra tio (a dj us te d) 7. 4 2. 1 0. 87 10 0. 00 68 4 0. 00 8 0. 64 6 0. 80 4 12 52 15 55 0. 85 7 0. 88 5 W om en In fa nt m or ta lit y ra te 1. 2 4. 2 12 .0 54 8 3. 70 56 3 0. 30 7 - - - - 4. 64 4 19 .4 66 U nd er fi ve m or ta lit y ra te 1. 5 4. 1 18 .9 14 1 4. 10 86 1 0. 21 7 - - - - 10 .6 97 27 .1 31 A do le sc en t b irt h ra te 5. 1 5. 4 5. 31 12 3 3. 39 74 4 0. 16 6 - - - - 21 .3 82 42 .6 27 C on tra ce pt iv e pr ev al en ce ra te 5. 3 5. 3 0. 33 95 0. 01 13 8 0. 03 4 0. 84 0 0. 91 6 11 57 14 54 0. 31 7 0. 36 2 U nm et n ee d 5. 4 5. 6 0. 03 61 0. 00 59 9 0. 16 6 0. 88 2 0. 93 9 68 3 85 5 0. 02 4 0. 04 8 A nt en at al c ar e co ve ra ge (1 + tim es , sk ill ed p ro vi de r) 5. 5a 5. 5 0. 20 61 0. 01 35 5 0. 06 6 1. 63 0 1. 27 7 11 57 14 54 0. 17 9 0. 23 3 A nt en at al c ar e co ve ra ge (4 + tim es , a ny pr ov id er ) 5. 5b 5. 5 0. 19 55 0. 01 21 6 0. 06 2 1. 36 6 1. 16 9 11 57 14 54 0. 17 1 0. 22 0 S ki lle d at te nd an t a t d el iv er y 5. 7 5. 2 0. 20 56 0. 01 38 1 0. 06 7 1. 69 6 1. 30 2 11 57 14 54 0. 17 8 0. 23 3 Li te ra cy ra te (y ou ng w om en ) 7. 1 2. 3 0. 62 26 0. 02 53 0 0. 04 1 1. 72 4 1. 31 3 49 9 63 4 0. 57 2 0. 67 3 K no w le dg e ab ou t H IV p re ve nt io n (y ou ng w om en ) 9. 1 6. 3 0. 05 75 0. 00 83 4 0. 14 5 0. 81 3 0. 90 2 49 9 63 4 0. 04 1 0. 07 4 U nd er -5 s U nd er w ei gh t p re va le nc e (m od er at e an d se ve re ) 2. 1a 1. 8 0. 01 39 0. 00 53 7 0. 38 7 1. 71 7 1. 31 0 65 3 81 5 0. 00 3 0. 02 5 U nd er w ei gh t p re va le nc e (s ev er e) 2. 1b 1. 8 0. 00 17 0. 00 16 9 0. 99 5 1. 36 9 1. 17 0 65 3 81 5 0. 00 0 0. 00 5 na : n ot a va ila bl e 217 201 Appendix D. Data Quality Tables DQ.1: Age distribution of household population Single-year age distribution of household population by sex, Palestine, 2014 Males Females Males Females Number Percent Number Percent Number Percent Number Percent Age Age 0 845 3.0 733 2.6 45 257 0.9 221 0.8 1 810 2.8 758 2.7 46 238 0.8 193 0.7 2 814 2.9 781 2.8 47 239 0.8 208 0.7 3 902 3.2 832 3.0 48 224 0.8 219 0.8 4 804 2.8 768 2.8 49 256 0.9 219 0.8 5 763 2.7 750 2.7 50 232 0.8 257 0.9 6 777 2.7 781 2.8 51 178 0.6 209 0.8 7 752 2.6 751 2.7 52 180 0.6 172 0.6 8 710 2.5 721 2.6 53 178 0.6 137 0.5 9 687 2.4 700 2.5 54 165 0.6 140 0.5 10 714 2.5 709 2.5 55 158 0.6 162 0.6 11 671 2.4 650 2.3 56 151 0.5 123 0.4 12 656 2.3 638 2.3 57 114 0.4 109 0.4 13 693 2.4 659 2.4 58 116 0.4 126 0.5 14 689 2.4 632 2.3 59 116 0.4 111 0.4 15 661 2.3 616 2.2 60 118 0.4 92 0.3 16 663 2.3 696 2.5 61 100 0.4 92 0.3 17 671 2.4 649 2.3 62 95 0.3 97 0.3 18 660 2.3 665 2.4 63 76 0.3 71 0.3 19 714 2.5 612 2.2 64 83 0.3 80 0.3 20 737 2.6 647 2.3 65 74 0.3 104 0.4 21 654 2.3 641 2.3 66 67 0.2 88 0.3 22 637 2.2 652 2.3 67 66 0.2 87 0.3 23 594 2.1 535 1.9 68 63 0.2 46 0.2 24 560 2.0 492 1.8 69 42 0.1 60 0.2 25 456 1.6 482 1.7 70 48 0.2 69 0.2 26 477 1.7 458 1.6 71 30 0.1 39 0.1 27 429 1.5 388 1.4 72 44 0.2 68 0.2 28 389 1.4 403 1.4 73 39 0.1 32 0.1 29 406 1.4 356 1.3 74 32 0.1 36 0.1 30 391 1.4 345 1.2 75 27 0.1 65 0.2 31 343 1.2 354 1.3 76 19 0.1 22 0.1 32 339 1.2 346 1.2 77 45 0.2 59 0.2 33 290 1.0 315 1.1 78 30 0.1 13 0.0 34 328 1.1 354 1.3 79 20 0.1 20 0.1 35 296 1.0 345 1.2 80 21 0.1 40 0.1 36 331 1.2 308 1.1 81 19 0.1 21 0.1 37 300 1.0 321 1.2 82 18 0.1 29 0.1 38 294 1.0 293 1.1 83 8 0.0 10 0.0 39 273 1.0 322 1.2 84 14 0.0 18 0.1 40 304 1.1 309 1.1 85+ 42 0.1 90 0.3 41 260 0.9 274 1.0 42 250 0.9 247 0.9 DK/Missing 2 0.0 3 0.0 43 271 0.9 252 0.9 44 230 0.8 231 0.8 Total 28542 100.0 27825 100.0 218 Palestinian Multiple Indicator Cluster Survey 2014 202 DQ.2: Age distribution of eligible and interviewed women Household population of women age 10-54 years, interviewed women age 15-49 years, and percentage of eligible women who were interviewed, by five-year age groups, Palestine, 2014 Household population of women age 10-54 years Interviewed women age 15-49 years Percentage of eligible women interviewed (Completion rate) Number Number Percent Age 10-14 3288 na na na 15-19 3237 3056 22.9 94.4 20-24 2967 2818 21.1 95.0 25-29 2086 1997 14.9 95.7 30-34 1713 1650 12.3 96.3 35-39 1589 1551 11.6 97.5 40-44 1313 1273 9.5 97.0 45-49 1060 1023 7.7 96.5 50-54 916 na na na Total (15-49) 13965 13368 100.0 95.7 Ratio of 50-54 to 45-49 0.86 na na na na: not applicable DQ.4: Age distribution of children in household and under-5 questionnaires Household population of children age 0-7 years, children age 0-4 years whose mothers/caretakers were interviewed, and percentage of under-5 children whose mothers/caretakers were interviewed, by single years of age, Palestine, 2014 Household population of children 0-7 years Under-5s with completed interviews Percentage of eligible under-5s with completed interviews (Completion rate) Number Number Percent Age 0 1577 1556 19.6 98.6 1 1568 1545 19.5 98.6 2 1595 1574 19.8 98.7 3 1735 1711 21.6 98.6 4 1572 1552 19.6 98.8 5 1513 na na na 6 1557 na na na 7 1502 na na na Total (0-4) 8047 7939 100.0 98.7 Ratio of 5 to 4 0.96 na na na na: not applicable 219 203 DQ.5: Birth date reporting: Household population Percent distribution of household population by completeness of date of birth information, Palestine, 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 98.2 1.6 0.0 0.2 100.0 56197 Age 0-4 100.0 0.0 0.0 0.0 100.0 7919 5-14 99.9 0.1 0.0 0.0 100.0 14022 15-24 99.6 0.4 0.0 0.0 100.0 12752 25-49 99.2 0.7 0.0 0.1 100.0 15618 50-64 94.6 4.9 0.0 0.4 100.0 4062 65-84 68.6 28.5 0.1 2.9 100.0 1711 85+ 31.5 60.2 0.0 8.3 100.0 108 DK/missing na na 0.0 100.0 100.0 5 Governorate Jenin 97.5 2.4 0.0 0.2 100.0 3889 Tubas 95.8 4.2 0.0 0.0 100.0 1020 Tulkarm 97.8 1.5 0.1 0.5 100.0 2129 Nablus 98.2 1.5 0.0 0.2 100.0 4311 Qalqiliya 96.9 2.6 0.1 0.5 100.0 1324 Salfit 98.2 1.4 0.0 0.4 100.0 1013 Ramallah and Al-Bireh 97.3 2.6 0.0 0.1 100.0 3812 Jericho and Al Aghwar 96.8 2.9 0.0 0.3 100.0 967 Jerusalem 98.1 1.5 0.0 0.3 100.0 5177 Bethlehem 97.2 2.7 0.0 0.0 100.0 2803 Hebron 97.7 2.0 0.0 0.3 100.0 8557 North Gaza 99.4 .5 0.0 0.0 100.0 4137 Gaza 99.4 .5 0.0 0.1 100.0 7237 Deir El-Balah 98.7 1.2 0.0 0.1 100.0 3134 Khan Yunis 98.5 1.5 0.0 0.1 100.0 4205 Rafah 98.6 1.3 0.0 0.1 100.0 2482 Area Urban 98.4 1.4 0.0 0.2 100.0 40094 Rural 97.2 2.5 0.0 0.2 100.0 9941 Camp 97.9 1.9 0.0 0.2 100.0 6162 na: not applicable 220 Palestinian Multiple Indicator Cluster Survey 2014 204 DQ.6: Birth date and age reporting: Women Percent distribution of women age 15-49 years by completeness of date of birth/age information, Palestine, 2014 Completeness of reporting of date of birth and age Total Number of women age 15-49 years Year and month of birth Year of birth and age Year of birth only Age only Other/DK/ Missing Total 99.8 0.2 0.0 0.0 0.0 100.0 13367 Governorate Jenin 100.0 0.0 0.0 0.0 0.0 100.0 947 Tubas 100.0 0.0 0.0 0.0 0.0 100.0 261 Tulkarm 100.0 0.0 0.0 0.0 0.0 100.0 551 Nablus 99.9 0.1 0.0 0.0 0.0 100.0 1001 Qalqiliya 99.7 0.3 0.0 0.0 0.0 100.0 317 Salfit 99.6 0.4 0.0 0.0 0.0 100.0 252 Ramallah and Al-Bireh 100.0 0.0 0.0 0.0 0.0 100.0 941 Jericho and Al Aghwar 100.0 0.0 0.0 0.0 0.0 100.0 237 Jerusalem 99.6 0.4 0.0 0.0 0.0 100.0 1118 Bethlehem 100.0 0.0 0.0 0.0 0.0 100.0 712 Hebron 99.2 0.8 0.0 0.0 0.0 100.0 2092 North Gaza 99.9 0.1 0.0 0.0 0.0 100.0 928 Gaza 100.0 0.0 0.0 0.0 0.0 100.0 1676 Deir El-Balah 100.0 0.0 0.0 0.0 0.0 100.0 776 Khan Yunis 99.9 0.1 0.0 0.0 0.0 100.0 1002 Rafah 100.0 0.0 0.0 0.0 0.0 100.0 556 Area Urban 99.8 0.2 0.0 0.0 0.0 100.0 9538 Rural 99.7 0.3 0.0 0.0 0.0 100.0 2375 Camp 100.0 0.0 0.0 0.0 0.0 100.0 1454 221 205 DQ.8: Birth date and age reporting: Under-5s Percent distribution children under 5 by completeness of date of birth/age information, Palestine, 2014 Completeness of reporting of date of birth and age Total Number of under-5 children 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 7816 Governorate Jenin 100.0 0.0 0.0 0.0 0.0 100.0 489 Tubas 100.0 0.0 0.0 0.0 0.0 100.0 99 Tulkarm 100.0 0.0 0.0 0.0 0.0 100.0 228 Nablus 100.0 0.0 0.0 0.0 0.0 100.0 509 Qalqiliya 100.0 0.0 0.0 0.0 0.0 100.0 175 Salfit 100.0 0.0 0.0 0.0 0.0 100.0 120 Ramallah and Al-Bireh 100.0 0.0 0.0 0.0 0.0 100.0 461 Jericho and Al Aghwar 100.0 0.0 0.0 0.0 0.0 100.0 139 Jerusalem 100.0 0.0 0.0 0.0 0.0 100.0 642 Bethlehem 100.0 0.0 0.0 0.0 0.0 100.0 368 Hebron 100.0 0.0 0.0 0.0 0.0 100.0 1223 North Gaza 100.0 0.0 0.0 0.0 0.0 100.0 678 Gaza 100.0 0.0 0.0 0.0 0.0 100.0 1122 Deir El-Balah 100.0 0.0 0.0 0.0 0.0 100.0 459 Khan Yunis 100.0 0.0 0.0 0.0 0.0 100.0 662 Rafah 100.0 0.0 0.0 0.0 0.0 100.0 442 Area Urban 100.0 0.0 0.0 0.0 0.0 100.0 5698 Rural 100.0 0.0 0.0 0.0 0.0 100.0 1256 Camp 100.0 0.0 0.0 0.0 0.0 100.0 862 222 Palestinian Multiple Indicator Cluster Survey 2014 206 DQ.9: Birth date reporting: Children, adolescents and young people Percent distribution of children, adolescents and young people age 5-24 years by completeness of date of birth information, Palestine, 2014 Completeness of reporting of month and year of birth Total Number of children, adolescents and young people age 5- 24 years Year and month of birth Year of birth only Month of birth only Both missing Total 99.8 0.2 0.0 0.0 100.0 26774 Governorate Jenin 99.8 0.1 0.0 0.1 100.0 1809 Tubas 100.0 0.0 0.0 0.0 100.0 491 Tulkarm 99.8 0.0 0.1 0.1 100.0 998 Nablus 99.9 0.1 0.0 0.0 100.0 2001 Qalqiliya 99.8 0.2 0.0 0.0 100.0 616 Salfit 99.8 0.2 0.0 0.0 100.0 461 Ramallah and Al-Bireh 99.4 0.6 0.0 0.0 100.0 1668 Jericho and Al Aghwar 99.1 0.9 0.0 0.0 100.0 437 Jerusalem 99.7 0.3 0.0 0.0 100.0 2453 Bethlehem 99.5 0.5 0.0 0.0 100.0 1333 Hebron 99.5 0.5 0.0 0.0 100.0 4268 North Gaza 100.0 0.0 0.0 0.0 100.0 2072 Gaza 99.9 0.1 0.0 0.1 100.0 3547 Deir El-Balah 100.0 0.0 0.0 0.0 100.0 1500 Khan Yunis 99.9 0.1 0.0 0.0 100.0 1994 Rafah 100.0 0.0 0.0 0.0 100.0 1126 Area Urban 99.8 0.2 0.0 0.0 100.0 19105 Rural 99.5 0.4 0.0 0.0 100.0 4714 Camp 99.9 0.1 0.0 0.0 100.0 2955 223 207 DQ.10: Birth date reporting: First and last births Percent distribution of first and last births to women age 15-49 years by completeness of date of birth, Palestine, 2014 Completeness of reporting of date of birth Date of first birth Total Number of first births Date of last birth Total Numb er of last births Year and month of birth Year of birth only Completed years since first birth only Other/ DK/Mis sing Both month and year Year only Other/ DK/Mi ssing Total 0.0 0.0 0.0 100.0 100.0 7479 0.0 0.0 100.0 100.0 6560 Governorate Jenin 0.0 0.0 0.0 100.0 100.0 518 0.0 0.0 100.0 100.0 459 Tubas 0.0 0.0 0.0 100.0 100.0 129 0.0 0.0 100.0 100.0 115 Tulkarm 0.0 0.0 0.0 100.0 100.0 274 0.0 0.0 100.0 100.0 242 Nablus 0.0 0.0 0.0 100.0 100.0 584 0.0 0.0 100.0 100.0 522 Qalqiliya 0.0 0.0 0.0 100.0 100.0 161 0.0 0.0 100.0 100.0 150 Salfit 0.0 0.0 0.0 100.0 100.0 135 0.0 0.0 100.0 100.0 116 Ramallah & Al-Bireh 0.0 0.0 0.0 100.0 100.0 538 0.0 0.0 100.0 100.0 463 Jericho and Al Aghwar 0.0 0.0 0.0 100.0 100.0 118 0.0 0.0 100.0 100.0 105 Jerusalem 0.0 0.0 0.0 100.0 100.0 718 0.0 0.0 100.0 100.0 636 Bethlehem 0.0 0.0 0.0 100.0 100.0 388 0.0 0.0 100.0 100.0 331 Hebron 0.0 0.0 0.0 100.0 100.0 1126 0.0 0.0 100.0 100.0 1001 North Gaza 0.0 0.0 0.0 100.0 100.0 564 0.0 0.0 100.0 100.0 490 Gaza 0.0 0.0 0.0 100.0 100.0 952 0.0 0.0 100.0 100.0 840 Deir El-Balah 0.0 0.0 0.0 100.0 100.0 404 0.0 0.0 100.0 100.0 345 Khan Yunis 0.0 0.0 0.0 100.0 100.0 548 0.0 0.0 100.0 100.0 462 Rafah 0.0 0.0 0.0 100.0 100.0 322 0.0 0.0 100.0 100.0 283 Area Urban 0.0 0.0 0.0 100.0 100.0 5379 0.0 0.0 100.0 100.0 4702 Rural 0.0 0.0 0.0 100.0 100.0 1284 0.0 0.0 100.0 100.0 1133 Camp 0.0 0.0 0.0 100.0 100.0 816 0.0 0.0 100.0 100.0 725 224 Palestinian Multiple Indicator Cluster Survey 2014 208 DQ.11: Completeness of reporting Percentage of observations that are missing information for selected questions and indicators, Palestine, 2014 Questionnaire and type of missing information Reference group Percent with missing/incomplete informationa Number of cases Household Salt test result All households interviewed that have salt 0.1 10182 Starting time of interview All households interviewed 0.1 10182 Ending time of interview All households interviewed 0.1 10182 Women Date of first marriage All ever married women age 15-49 Only month 1.9 8274 Both month and year 1.2 8274 Age at first marriage All ever married women age 15-49 with year of first marriage not known 0.0 8274 Starting time of interview All women interviewed 0.0 13367 Ending time of interview All women interviewed 0.1 13367 Under-5 Starting time of interview All under-5 children 0.1 7816 Ending time of interview All under-5 children 0.1 7816 a Includes "Don't know" responses 225 209 DQ.12: Completeness of information for anthropometric indicators: Underweight Percent distribution of children under 5 by completeness of information on date of birth and weight, Palestine, 2014 Valid weight and date of birth Reason for exclusion from analysis Total Percent of children excluded from analysis Number of children under 5 Weight not measured Incomplete date of birth Weight not measured and incomplete date of birth Flagged cases (outliers) Total 92.2 7.7 0.0 0.0 0.0 100.0 7.8 7816 Age <6 months 93.8 5.9 0.0 0.0 0.3 100.0 6.2 665 6-11 months 94.3 5.7 0.0 0.0 0.0 100.0 5.7 788 12-23 months 95.3 4.7 0.0 0.0 0.0 100.0 4.7 1538 24-35 months 91.9 8.1 0.0 0.0 0.0 100.0 8.1 1545 36-47 months 90.5 9.5 0.0 0.0 0.1 100.0 9.5 1678 48-59 months 89.8 10.2 0.0 0.0 0.0 100.0 10.2 1602 DQ.13: Completeness of information for anthropometric indicators: Stunting Percent distribution of children under 5 by completeness of information on date of birth and length or height, Palestine, 2014 Valid length/ height and date of birth Reason for exclusion from analysis Total Percent of children excluded from analysis Number of children under 5 Length/ Height not measured Incomplet e date of birth Length/Height not measured, incomplete date of birth Flagged cases (outliers) Total 88.8 10.8 0.0 0.0 0.4 100.0 11.2 7816 Age <6 months 90.7 8.3 0.0 0.0 1.1 100.0 9.3 665 6-11 months 92.3 6.7 0.0 0.0 1.0 100.0 7.7 788 12-23 months 91.0 8.5 0.0 .0 0.5 100.0 9.0 1538 24-35 months 85.4 14.2 0.0 0.0 0.3 100.0 14.6 1545 36-47 months 87.4 12.4 0.0 0.0 0.2 100.0 12.6 1678 48-59 months 88.8 11.2 0.0 0.0 0.1 100.0 11.2 1602 226 Palestinian Multiple Indicator Cluster Survey 2014 210 DQ.14: Completeness of information for anthropometric indicators: Wasting Percent distribution of children under 5 by completeness of information on weight and length or height, Palestine, 2014 Valid weight and length/height Reason for exclusion from analysis Total Percent of children excluded from analysis Number of children under 5 Weight not measured Length/ Height not measured Weight and length/height not measured Flagged cases (outliers) Total 88.2 0.2 3.3 7.5 0.7 100.0 11.8 7816 Age <6 months 90.7 0.2 2.6 5.7 0.9 100.0 9.3 665 6-11 months 92.5 0.0 1.0 5.7 0.8 100.0 7.5 788 12-23 months 91.0 0.1 3.9 4.6 0.5 100.0 9.0 1538 24-35 months 84.9 0.3 6.5 7.8 0.6 100.0 15.1 1545 36-47 months 86.7 0.3 3.2 9.2 0.7 100.0 13.3 1678 48-59 months 87.4 0.2 1.2 10.0 1.2 100.0 12.6 1602 DQ.15: Heaping in anthropometric measurements Distribution of weight and height/length measurements by digits reported for the decimal points, Palestine, 2014 Weight Height or length Number Percent Number Percent Total 7212 100.0 100.0 100.0 Digits 0 828 11.5 1195 16.5 1 657 9.1 711 9.8 2 802 11.1 859 11.9 3 708 9.8 749 10.4 4 720 10.0 724 10.0 5 703 9.7 819 11.3 6 718 10.0 704 9.7 7 707 9.8 571 7.9 8 715 9.9 444 6.1 9 654 9.1 452 6.3 0 or 5 1531 21.2 2014 27.9 227 211 DQ:16: Observation of birth certificates Percent distribution of children under 5 by presence of birth certificates, and percentage of birth certificates seen, Palestine, 2014 Child has birth certificate Child does not have birth certificate DK/Missing Total Percentage of birth certificates seen by the interviewer (1)/(1+2)*100 Number of children under age 5 Seen by the interviewer (1) Not seen by the interviewer (2) Total 70.4 28.1 1.4 0.0 100.0 71.4 7816 Governorate Jenin 73.6 24.1 2.2 0.0 100.0 75.3 489 Tubas 55.6 41.4 3.0 0.0 100.0 57.3 99 Tulkarm 73.2 26.3 0.4 0.0 100.0 73.6 228 Nablus 63.3 36.0 0.8 0.0 100.0 63.8 509 Qalqiliya 82.9 16.6 0.6 0.0 100.0 83.3 175 Salfit 87.5 10.8 1.7 0.0 100.0 89.0 120 Ramallah and Al-Bireh 63.3 33.6 2.8 0.2 100.0 65.3 461 Jericho and Al Aghwar 91.4 7.9 0.7 0.0 100.0 92.0 139 Jerusalem 41.1 54.5 4.4 0.0 100.0 43.0 642 Bethlehem 48.6 48.4 3.0 0.0 100.0 50.1 368 Hebron 69.4 29.5 1.0 0.1 100.0 70.2 1223 North Gaza 85.0 14.2 0.9 0.0 100.0 85.7 678 Gaza 66.0 33.2 0.8 0.0 100.0 66.5 1122 Deir El-Balah 67.3 32.0 0.7 0.0 100.0 67.8 459 Khan Yunis 88.2 11.0 0.8 0.0 100.0 88.9 662 Rafah 97.1 2.5 0.5 0.0 100.0 97.5 442 Area Urban 70.6 28.0 1.4 0.0 100.0 71.6 5698 Rural 68.2 30.3 1.4 0.1 100.0 69.3 1256 Camp 72.3 25.8 2.0 0.0 100.0 73.7 862 Child's age 0-5 months 65.0 24.2 10.8 0.0 100.0 72.8 665 6-11 months 73.4 25.1 1.5 0.0 100.0 74.5 788 12-23 months 71.2 28.0 0.8 0.0 100.0 71.8 1538 24-35 months 72.5 26.9 0.6 0.1 100.0 73.0 1545 36-47 months 67.7 32.0 0.2 0.1 100.0 67.9 1678 48-59 months 71.3 28.6 0.1 0.0 100.0 71.4 1602 212 DQ.17: Observation of vaccination cards Percent distribution of children age 0-35 months by presence of a vaccination card, and the percentage of vaccination cards seen by the interviewers, Palestine, 2014 Child does not have vaccination card Child has vaccination card DK/ Missing Total Percentage of vaccination cards seen by the interviewer (1)/(1+2)*100 Number of children age 0-35 months Had vaccination card previously Never had vaccination card Seen by the interviewer (1) Not seen by the interviewer (2) Total 2.6 0.3 90.4 6.7 0.1 100.0 93.1 4536 Governorate Jenin 0.0 0.3 99.0 .7 0.0 100.0 99.3 290 Tubas 3.3 0.0 90.2 6.6 0.0 100.0 93.2 61 Tulkarm 2.3 0.0 96.2 .8 0.8 100.0 99.2 131 Nablus 0.7 0.0 91.4 7.9 0.0 100.0 92.1 280 Qalqiliya 0.0 0.0 96.7 3.3 0.0 100.0 96.7 91 Salfit 0.0 0.0 72.6 27.4 0.0 100.0 72.6 62 Ramallah and Al-Bireh 1.0 0.3 83.7 14.9 0.0 100.0 84.9 288 Jericho and Al Aghwar 0.0 0.0 96.8 3.2 0.0 100.0 96.8 93 Jerusalem 1.3 1.1 83.8 13.2 0.5 100.0 86.4 371 Bethlehem 1.8 0.0 96.0 2.2 0.0 100.0 97.8 227 Hebron 5.6 0.1 81.5 12.7 0.0 100.0 86.5 699 North Gaza 7.1 0.5 89.0 3.4 0.0 100.0 96.3 408 Gaza 1.3 0.0 95.9 2.8 0.0 100.0 97.1 634 Deir El-Balah 2.7 0.0 94.5 2.7 0.0 100.0 97.2 255 Khan Yunis 2.5 0.5 93.8 3.3 0.0 100.0 96.6 400 Rafah 2.0 0.4 92.3 5.3 0.0 100.0 94.6 246 Area Urban 2.8 0.3 90.0 6.8 0.1 100.0 93.0 3329 Rural 1.8 0.1 90.4 7.7 0.0 100.0 92.1 727 Camp 2.1 0.2 93.5 4.2 0.0 100.0 95.7 480 Child's age 0-5 months 0.5 0.8 95.6 3.2 0.0 100.0 96.8 665 6-11 months 1.0 0.5 94.7 3.8 0.0 100.0 96.1 788 12-23 months 1.5 0.0 92.5 6.0 0.0 100.0 93.9 1538 24-35 months 5.4 0.2 83.9 10.3 0.2 100.0 89.1 1545 228 Palestinian Multiple Indicator Cluster Survey 2014 212 DQ.17: Observation of vaccination cards Percent distribution of children age 0-35 months by presence of a vaccination card, and the percentage of vaccination cards seen by the interviewers, Palestine, 2014 Child does not have vaccination card Child has vaccination card DK/ Missing Total Percentage of vaccination cards seen by the interviewer (1)/(1+2)*100 Number of children age 0-35 months Had vaccination card previously Never had vaccination card Seen by the interviewer (1) Not seen by the interviewer (2) Total 2.6 0.3 90.4 6.7 0.1 100.0 93.1 4536 Governorate Jenin 0.0 0.3 99.0 .7 0.0 100.0 99.3 290 Tubas 3.3 0.0 90.2 6.6 0.0 100.0 93.2 61 Tulkarm 2.3 0.0 96.2 .8 0.8 100.0 99.2 131 Nablus 0.7 0.0 91.4 7.9 0.0 100.0 92.1 280 Qalqiliya 0.0 0.0 96.7 3.3 0.0 100.0 96.7 91 Salfit 0.0 0.0 72.6 27.4 0.0 100.0 72.6 62 Ramallah and Al-Bireh 1.0 0.3 83.7 14.9 0.0 100.0 84.9 288 Jericho and Al Aghwar 0.0 0.0 96.8 3.2 0.0 100.0 96.8 93 Jerusalem 1.3 1.1 83.8 13.2 0.5 100.0 86.4 371 Bethlehem 1.8 0.0 96.0 2.2 0.0 100.0 97.8 227 Hebron 5.6 0.1 81.5 12.7 0.0 100.0 86.5 699 North Gaza 7.1 0.5 89.0 3.4 0.0 100.0 96.3 408 Gaza 1.3 0.0 95.9 2.8 0.0 100.0 97.1 634 Deir El-Balah 2.7 0.0 94.5 2.7 0.0 100.0 97.2 255 Khan Yunis 2.5 0.5 93.8 3.3 0.0 100.0 96.6 400 Rafah 2.0 0.4 92.3 5.3 0.0 100.0 94.6 246 Area Urban 2.8 0.3 90.0 6.8 0.1 100.0 93.0 3329 Rural 1.8 0.1 90.4 7.7 0.0 100.0 92.1 727 Camp 2.1 0.2 93.5 4.2 0.0 100.0 95.7 480 Child's age 0-5 months 0.5 0.8 95.6 3.2 0.0 100.0 96.8 665 6-11 months 1.0 0.5 94.7 3.8 0.0 100.0 96.1 788 12-23 months 1.5 0.0 92.5 6.0 0.0 100.0 93.9 1538 24-35 months 5.4 0.2 83.9 10.3 0.2 100.0 89.1 1545 229 213 DQ.20: Respondent to the under-5 questionnaire Distribution of children under five by respondent to the under-5 questionnaire, Palestine, 2014 Mother in the household Mother not in the household and primary caretaker identified: Total Number of children under 5 Father Other adult female Total 99.2 0.0 100.0 100.0 8047 Age 0 99.7 0.0 0.3 100.0 1577 1 99.6 0.0 0.4 100.0 1568 2 99.0 0.0 1.0 100.0 1595 3 99.0 0.1 0.9 100.0 1735 4 99.0 0.1 0.9 100.0 1572 230 Palestinian Multiple Indicator Cluster Survey 2014 214 DQ.21: Selection of children age 1-17 years for the child labour and child discipline modules Percent distribution of households by the number of children age 1-17 years, and the percentage of households with at least two children age 1-17 years where correct selection of one child for the child labour and child discipline modules was performed, Palestine, 2014 Number of children age 1-17 years Total Number of households Percentage of households where correct selection was performed Number of households with 2 or more children age 1-17 years None One Two or more Total 30.2 15.0 54.8 100.0 10182 99.1 5582 Governorate Jenin 34.1 16.5 49.3 100.0 762 98.7 376 Tubas 32.5 15.2 52.4 100.0 191 100.0 100 Tulkarm 40.7 14.7 44.7 100.0 430 98.4 192 Nablus 35.0 14.3 50.7 100.0 858 99.5 435 Qalqiliya 32.5 14.7 52.8 100.0 252 100.0 133 Salfit 30.9 17.3 51.8 100.0 191 91.9 99 Ramallahand Al- Bireh 35.5 19.1 45.4 100.0 782 97.7 355 Jericho and Al Aghwar 31.5 17.9 50.6 100.0 162 100.0 82 Jerusalem 29.8 15.4 54.8 100.0 1001 98.9 549 Bethlehem 32.9 15.8 51.3 100.0 532 98.9 273 Hebron 28.8 12.7 58.5 100.0 1526 98.4 893 North Gaza 22.9 14.3 62.8 100.0 672 100.0 422 Gaza 25.1 13.3 61.7 100.0 1161 99.9 716 Deir El-Balah 27.2 14.1 58.7 100.0 533 100.0 313 Khan Yunis 28.2 17.0 54.8 100.0 710 100.0 389 Rafah 24.3 14.8 60.9 100.0 419 100.0 255 Area Urban 30.4 14.9 54.7 100.0 7290 99.2 3986 Rural 31.6 15.4 52.9 100.0 1833 98.6 970 Camp 25.7 15.2 59.1 100.0 1059 99.4 626 Wealth index quintiles Poorest 25.5 14.8 59.7 100.0 1718 99.7 1025 Second 30.9 13.8 55.3 100.0 1871 99.5 1035 Middle 34.0 12.7 53.3 100.0 2204 99.0 1174 Fourth 31.3 16.0 52.7 100.0 2243 99.1 1183 Richest 28.1 17.6 54.3 100.0 2146 98.4 1165 231 215 DQ.22:School attendance by single age Distribution of household population age 5-24 years by educational level and grade attended in the current (or most recent) school year, Palestine, 2014 Currently attending DK /Missing Total Number of household members Not attending school Preschool Primary school Grade Secondary school Grade Higher than secondary 1 2 3 4 5 6 1 2 3 Age at beginning of school year 5 10.3 55.8 33.1 .7 .0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 1586 6 1.0 1.8 64.5 32.4 .2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 1473 7 0.9 0.0 2.9 66.7 29.3 0.3 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 1500 8 0.5 .0 0.1 2.9 61.9 33.6 1.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 1445 9 0.5 0.0 0.0 0.1 2.6 62.7 33.5 0.5 0.0 0.0 0.0 0.0 0.0 100.0 1431 10 0.9 0.0 0.1 0.0 0.3 3.3 61.2 33.6 0.4 0.1 0.1 0.0 0.0 100.0 1338 11 1.0 0.1 0.1 0.0 0.1 1.1 4.3 60.9 31.2 1.2 0.0 0.0 0.0 100.0 1325 12 2.0 0.0 0.0 0.1 0.1 0.0 0.7 6.2 56.9 32.7 1.2 0.0 0.0 100.0 1273 13 4.4 0.0 0.0 0.0 0.0 0.1 0.2 1.3 6.8 57.7 29.1 0.5 0.0 100.0 1397 14 7.3 0.0 0.0 0.0 0.0 0.0 0.2 0.3 1.1 6.3 56.0 28.8 0.0 100.0 1245 15 14.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.3 1.3 6.0 78.5 0.0 100.0 1325 16 21.4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.2 0.5 77.9 0.0 100.0 1328 17 28.6 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.3 56.5 14.5 100.0 1358 18 46.4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 12.1 41.4 100.0 1304 19 53.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 3.0 43.8 100.0 1400 20 60.9 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.6 38.4 100.0 1295 21 65.4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.4 34.1 100.0 1311 22 74.9 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.3 24.7 100.0 1177 23 84.3 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.4 15.3 100.0 1134 24a 46.6 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 5.6 100.0 937 a Those age 25 at the time of interview who were age 24 at beginning of school year are excluded as current attendance was only collected for those age 5-24 at the time of interview 232 Palestinian Multiple Indicator Cluster Survey 2014 216 DQ.23: Sex ratio at birth among children ever born and living Sex ratio (number of males per 100 females) among children ever born (at birth), children living, and deceased children, by age of women, Palestine, 2014 Children Ever Born Children Living Children Deceased Number of women Sons Daugthers Sex ratio at birth Sons Daugthers Sex ratio Sons Daugthers Sex ratio Total 16365 15452 1.06 15841 15045 1.05 527 407 1.29 13367 Age 15-19 90 72 1.25 89 71 1.25 1 1 1.00 3061 20-24 1058 981 1.08 1029 963 1.07 29 18 1.61 2812 25-29 2153 2089 1.03 2090 2040 1.02 63 49 1.29 1980 30-34 2991 2848 1.05 2914 2789 1.04 77 59 1.31 1629 35-39 3644 3385 1.08 3564 3314 1.08 80 71 1.13 1558 40-44 3395 3288 1.03 3262 3187 1.02 133 101 1.32 1282 45-49 3034 2789 1.09 2893 2681 1.08 141 108 1.31 1045 233 21 7 D Q .2 4: B irt hs b y pe rio ds p re ce di ng th e su rv ey N um be r o f b irt hs , p er ce nt ag e w ith c om pl et e bi rth d at e, s ex ra tio a t b irt h, a nd c al en da r y ea r r at io b y ca le nd ar y ea r, ac co rd in g to li vi ng , d ec ea se d, an d to ta l c hi ld re n (w ei gh te d, im pu te d) , a s re po rte d in th e bi rth h is to rie s, P al es tin e, 2 01 4 N um be r o f b irt hs Pe rc en t w ith c om pl et e bi rt h da te a Se x ra tio a t b irt hb Pe rio d ra tio c Li vi ng D ec ea se d To ta l Li vi ng D ec ea se d To ta l Li vi ng D ec ea se d To ta l Li vi ng D ec ea se d To ta l To ta l 31 08 1 94 3 32 02 4 99 .7 88 .9 99 .4 10 5. 2 12 8. 8 10 5. 8 na na na Ye ar s 0 14 88 26 15 14 10 0. 0 96 .2 99 .9 11 4. 4 30 6. 0 11 6. 1 na na na 1 15 50 39 15 89 10 0. 0 95 .2 99 .9 10 7. 4 96 .3 10 7. 2 10 2. 0 12 4. 5 10 2. 5 2 15 50 37 15 88 10 0. 0 96 .6 99 .9 10 5. 0 77 .3 10 4. 2 95 .6 10 4. 8 95 .8 3 16 92 32 17 24 99 .9 97 .7 99 .9 10 8. 9 14 7. 1 10 9. 5 10 9. 1 95 .0 10 8. 8 4 15 53 30 15 83 10 0. 0 97 .2 99 .9 10 3. 4 11 9. 2 10 3. 6 97 .7 10 6. 6 97 .8 5 14 88 24 15 13 99 .9 93 .2 99 .8 10 4. 6 10 1. 8 10 4. 6 96 .5 82 .6 96 .3 6 15 30 29 15 59 99 .9 90 .8 99 .8 98 .9 24 5. 4 10 0. 5 10 4. 2 10 4. 8 10 4. 3 7 14 47 31 14 78 99 .8 83 .5 99 .4 99 .9 12 7. 5 10 0. 4 10 0. 1 96 .4 10 0. 0 8 13 62 35 13 97 99 .7 94 .7 99 .6 10 2. 7 14 9. 1 10 3. 6 97 .6 89 .2 97 .4 9 13 44 48 13 91 99 .8 90 .3 99 .5 96 .8 14 9. 0 98 .2 15 .4 14 .8 15 .4 10 + 16 07 6 61 2 16 68 8 99 .6 86 .4 99 .1 10 6. 1 12 5. 9 10 6. 8 na na na Fi ve - ye ar pe rio ds 0- 4 78 34 16 4 79 98 10 0. 0 96 .5 99 .9 10 7. 7 12 1. 9 10 8. 0 na na na 5- 9 71 71 16 7 73 38 99 .8 90 .5 99 .6 10 0. 6 14 8. 2 10 1. 5 na na na 10 -1 4 61 20 17 5 62 95 99 .8 84 .9 99 .4 10 4. 1 11 2. 1 10 4. 3 na na na 15 -1 9 51 05 16 2 52 68 99 .7 86 .5 99 .3 10 2. 9 14 2. 7 10 4. 0 na na na 20 + 48 50 27 5 51 25 99 .1 87 .4 98 .4 11 2. 3 12 5. 9 11 3. 0 na na na na : n ot a pp lic ab le a B ot h m on th a nd y ea r o f b irt h gi ve n. T he in ve rs e of th e pe rc en t r ep or te d is th e pe rc en t w ith in co m pl et e an d th er ef or e im pu te d da te o f b irt h b (B m /B f) x 10 0, w he re B m a nd B f a re th e nu m be rs o f m al e an d fe m al e bi rth s, re sp ec tiv el y c (2 x B t/( B t-1 + B t+ 1) ) x 1 00 , w he re B t i s th e nu m be r o f b irt hs in y ea r t p re ce di ng th e su rv ey 234 Palestinian Multiple Indicator Cluster Survey 2014 218 DQ.25: Reporting of age at death in days Distribution of reported deaths under one month of age by age at death in days and the percentage of neonatal deaths reported to occur at ages 0-6 days, by 5-year periods preceding the survey (weighted, imputed), Palestine, 2014 Number of years preceding the survey Total (0–19) 0–4 5–9 10–14 15–19 Age at death (days) 0 3 10 6 4 24 1 28 25 20 23 96 2 8 9 13 7 36 3 9 10 10 11 39 4 3 2 3 3 11 5 4 1 3 0 8 6 2 6 2 0 10 7 7 8 6 5 26 8 2 1 2 0 5 9 0 1 0 1 2 10 4 1 6 1 12 11 1 0 1 0 2 12 0 2 1 1 3 13 1 0 0 0 1 14 3 2 1 3 8 15 3 2 4 3 13 16 0 1 0 0 1 17 5 0 0 3 8 18 19 1 0 0 0 1 20 4 1 3 1 8 21 0 0 0 1 1 22 23 0 0 1 0 1 24 25 0 1 0 1 3 26 0 1 1 0 2 27 28 29 0 1 0 0 1 30 1 0 0 0 1 Total 0–30 days 88 86 82 68 324 Percent early neonatala 63.6 75.0 68.3 70.6 69.3 a Deaths during the first 7 days (0-6), divided by deaths during the first month (0-30 days) 235 219 DQ.26: Reporting of age at death in months Distribution of reported deaths under two years of age by age at death in months and the percentage of infant deaths reported to occur at age under one month, by 5-year periods preceding the survey (weighted, imputed), Palestine, 2014 Number of years preceding the survey Total (0-19) 0–4 5–9 10–14 15–19 Age at death (months) 0 88 86 82 68 324 1 15 15 10 16 57 2 10 11 8 10 39 3 8 6 2 11 26 4 2 9 8 5 24 5 4 2 1 2 8 6 7 8 3 1 19 7 0 4 6 5 14 8 2 3 2 1 9 9 2 2 1 5 10 10 2 1 2 0 5 11 4 1 1 2 7 12 13 5 8 8 33 14 0 0 0 1 1 18 1 0 0 0 1 24 1 0 0 0 1 Reported as 1 year 0 0 0 0 0 Total 0-11 125 137 115 112 490 Percent neonatal* 61.7 58.3 64.8 54.0 59.7 [a] Includes deaths under one month reported in days [b] Deaths under one month, divided by deaths under one year 236 Palestinian Multiple Indicator Cluster Survey 2014 237 22 1 A pp en di x E. Pa le st in ia n M IC S5 In di ca to rs : N um er at or s an d D en om in at or s M IC S IN D IC A TO R M od ul e1 N um er at or D en om in at or M D G In di ca to r R ef er en ce 2 M O R TA LI TY 3 1. 1 N eo na ta l m or ta lit y ra te B H P ro ba bi lit y of d yi ng w ith in th e fir st m on th o f l ife 1. 2 In fa nt m or ta lit y ra te C M - B H P ro ba bi lit y of d yi ng b et w ee n bi rth a nd th e fir st b irt hd ay M D G 4 .2 1. 3 P os t-n eo na ta l m or ta lit y ra te B H D iff er en ce b et w ee n in fa nt a nd n eo na ta l m or ta lit y ra te s 1. 4 C hi ld m or ta lit y ra te B H P ro ba bi lit y of d yi ng b et w ee n th e fir st a nd th e fif th b irt hd ay s 1. 5 U nd er -fi ve m or ta lit y ra te C M - B H P ro ba bi lit y of d yi ng b et w ee n bi rth a nd th e fif th b irt hd ay M D G 4 .1 N U TR IT IO N 2. 1a 2. 1b U nd er w ei gh t p re va le nc e A N N um be r o f c hi ld re n un de r a ge 5 w ho fa ll be lo w (a ) m in us tw o st an da rd d ev ia tio ns (m od er at e an d se ve re ) (b ) m in us th re e st an da rd d ev ia tio ns (s ev er e) of th e m ed ia n w ei gh t f or a ge o f t he W H O s ta nd ar d To ta l n um be r o f c hi ld re n un de r a ge 5 M D G 1 .8 2. 2a 2. 2b S tu nt in g pr ev al en ce A N N um be r o f c hi ld re n un de r a ge 5 w ho fa ll be lo w (a ) m in us tw o st an da rd d ev ia tio ns (m od er at e an d se ve re ) (b ) m in us th re e st an da rd d ev ia tio ns (s ev er e) of th e m ed ia n he ig ht fo r a ge o f t he W H O s ta nd ar d To ta l n um be r o f c hi ld re n un de r a ge 5 2. 3a 2. 3b W as tin g pr ev al en ce A N N um be r o f c hi ld re n un de r a ge 5 w ho fa ll be lo w (a ) m in us tw o st an da rd d ev ia tio ns (m od er at e an d se ve re ) (b ) m in us th re e st an da rd d ev ia tio ns (s ev er e) of th e m ed ia n w ei gh t f or h ei gh t o f t he W H O s ta nd ar d To ta l n um be r o f c hi ld re n un de r a ge 5 2. 4 O ve rw ei gh t p re va le nc e A N N um be r o f c hi ld re n un de r a ge 5 w ho a re a bo ve tw o To ta l n um be r o f c hi ld re n un de r a ge 5 1 S om e in di ca to rs a re c on st ru ct ed b y us in g qu es tio ns in s ev er al m od ul es in th e M IC S q ue st io nn ai re s. In s uc h ca se s, o nl y th e m od ul e( s) w hi ch c on ta in s m os t o f t he n ec es sa ry in fo rm at io n is in di ca te d. 2 M ill en ni um D ev el op m en t G oa ls (M D G ) i nd ic at or s, e ffe ct iv e 15 J an ua ry 2 00 8 - h ttp :// m dg s. un .o rg /u ns d/ m dg /H os t.a sp x? C on te nt =I nd ic at or s/ O ffi ci al Li st .h tm , a cc es se d 10 J un e 20 13 . 3 W he n th e B irt h H is to ry m od ul e is u se d, m or ta lit y in di ca to rs a re c al cu la te d fo r t he la st 5 -y ea r p er io d. W he n th e in di ca to rs a re e st im at ed in di re ct ly (u si ng th e Fe rti lit y m od ul e on ly ), th e ra te s re fe r t o da te s as e st im at ed b y th e in di re ct te ch ni qu e. 238 Palestinian Multiple Indicator Cluster Survey 2014 22 2 M IC S IN D IC A TO R M od ul e1 N um er at or D en om in at or M D G In di ca to r R ef er en ce 2 st an da rd d ev ia tio ns o f t he m ed ia n w ei gh t f or h ei gh t o f t he W H O s ta nd ar d 2. 5 C hi ld re n ev er b re as tfe d M N N um be r o f w om en w ith a li ve b irt h in th e la st 2 y ea rs w ho br ea st fe d th ei r l as t l iv e- bo rn c hi ld a t a ny ti m e To ta l n um be r o f w om en w ith a li ve b irt h in th e la st 2 ye ar s 2. 6 E ar ly in iti at io n of b re as tfe ed in g M N N um be r o f w om en w ith a li ve b irt h in th e la st 2 y ea rs w ho pu t t he ir la st n ew bo rn to th e br ea st w ith in o ne h ou r o f b irt h To ta l n um be r o f w om en w ith a li ve b irt h in th e la st 2 ye ar s 2. 7 E xc lu si ve b re as tfe ed in g un de r 6 m on th s B D N um be r o f i nf an ts u nd er 6 m on th s of a ge w ho a re ex cl us iv el y br ea st fe d4 To ta l n um be r o f i nf an ts u nd er 6 m on th s of a ge 2. 8 P re do m in an t b re as tfe ed in g un de r 6 m on th s B D N um be r o f i nf an ts u nd er 6 m on th s of a ge w ho re ce iv ed br ea st m ilk a s th e pr ed om in an t s ou rc e of n ou ris hm en t5 du rin g th e pr ev io us d ay To ta l n um be r o f i nf an ts u nd er 6 m on th s of a ge 2. 9 C on tin ue d br ea st fe ed in g at 1 y ea r B D N um be r o f c hi ld re n ag e 12 -1 5 m on th s w ho re ce iv ed b re as t m ilk d ur in g th e pr ev io us d ay To ta l n um be r o f c hi ld re n ag e 12 -1 5 m on th s 2. 10 C on tin ue d br ea st fe ed in g at 2 y ea rs B D N um be r o f c hi ld re n ag e 20 -2 3 m on th s w ho re ce iv ed b re as t m ilk d ur in g th e pr ev io us d ay To ta l n um be r o f c hi ld re n ag e 20 -2 3 m on th s 2. 11 D ur at io n of b re as tfe ed in g B D Th e ag e in m on th s w he n 50 p er ce nt o f c hi ld re n ag e 0- 35 m on th s di d no t r ec ei ve b re as t m ilk d ur in g th e pr ev io us da y 2. 12 A ge -a pp ro pr ia te b re as tfe ed in g B D N um be r o f c hi ld re n ag e 0- 23 m on th s ap pr op ria te ly fe d6 du rin g th e pr ev io us d ay To ta l n um be r o f c hi ld re n ag e 0- 23 m on th s 2. 13 In tro du ct io n of s ol id , s em i-s ol id o r s of t fo od s B D N um be r o f i nf an ts a ge 6 -8 m on th s w ho re ce iv ed s ol id , se m i-s ol id o r s of t f oo ds d ur in g th e pr ev io us d ay To ta l n um be r o f i nf an ts a ge 6 -8 m on th s 2. 14 M ilk fe ed in g fre qu en cy fo r n on -b re as tfe d ch ild re n B D N um be r o f n on -b re as tfe d ch ild re n ag e 6- 23 m on th s w ho re ce iv ed a t l ea st 2 m ilk fe ed in gs d ur in g th e pr ev io us d ay To ta l n um be r o f n on -b re as tfe d ch ild re n ag e 6- 23 m on th s 2. 15 M in im um m ea l f re qu en cy B D N um be r o f c hi ld re n ag e 6- 23 m on th s w ho re ce iv ed s ol id , To ta l n um be r o f c hi ld re n ag e 6- 23 m on th s 4 In fa nt s   re ce iv in g   br ea st  m ilk ,  a nd  n ot  r ec ei vi ng  a ny  o th er  fl ui ds  o r   fo od s,  w it h   th e   ex ce pt io n   of  o ra l  r eh yd ra ti on  s ol ut io n,  v it am in s,  m in er al  s up pl em en ts  a nd  m ed ic in es   5   In fa nt s   w ho  r ec ei ve  b re as t   m ilk  a nd  c er ta in  fl ui ds  (w at er  a nd  w at er -­‐b as ed  d ri nk s,  fr ui t   ju ic e,  r it ua l  f lu id s,  o ra l  r eh yd ra ti on  s ol ut io n,  d ro ps ,  v it am in s,  m in er al s,  a nd  m ed ic in es ),   bu t   do  n ot  r ec ei ve  a ny th in g   el se  (i n   pa rt ic ul ar ,  n on -­‐h um an  m ilk  a nd  fo od -­‐b as ed  fl ui ds )   6   In fa nt s   ag e   0-­‐ 5   m on th s   w ho  a re  e xc lu si ve ly  b re as tf ed ,  a nd  c hi ld re n   ag e   6-­‐ 23  m on th s w ho a re b re as tfe d an d at e so lid , s em i-s ol id o r s of t f oo ds 239 22 3 M IC S IN D IC A TO R M od ul e1 N um er at or D en om in at or M D G In di ca to r R ef er en ce 2 se m i-s ol id a nd s of t f oo ds (p lu s m ilk fe ed s fo r n on - br ea st fe d ch ild re n) th e m in im um n um be r o f t im es 7 o r m or e du rin g th e pr ev io us d ay 2. 16 M in im um d ie ta ry d iv er si ty B D N um be r o f c hi ld re n ag e 6– 23 m on th s w ho re ce iv ed fo od s fro m 4 o r m or e fo od g ro up s8 d ur in g th e pr ev io us d ay To ta l n um be r o f c hi ld re n ag e 6– 23 m on th s 2. 17 a 2. 17 b M in im um a cc ep ta bl e di et B D (a ) N um be r o f b re as tfe d ch ild re n ag e 6– 23 m on th s w ho ha d at le as t t he m in im um d ie ta ry d iv er si ty a nd th e m in im um m ea l f re qu en cy d ur in g th e pr ev io us d ay (b ) N um be r o f n on -b re as tfe d ch ild re n ag e 6– 23 m on th s w ho re ce iv ed a t l ea st 2 m ilk fe ed in gs a nd h ad a t l ea st th e m in im um d ie ta ry d iv er si ty n ot in cl ud in g m ilk fe ed s an d th e m in im um m ea l f re qu en cy d ur in g th e pr ev io us da y (a ) N um be r o f b re as tfe d ch ild re n ag e 6– 23 m on th s (b ) N um be r o f n on -b re as tfe d ch ild re n ag e 6– 23 m on th s 2. 18 B ot tle fe ed in g B D N um be r o f c hi ld re n ag e 0- 23 m on th s w ho w er e fe d w ith a bo ttl e du rin g th e pr ev io us d ay To ta l n um be r o f c hi ld re n ag e 0- 23 m on th s 2. 19 Io di ze d sa lt co ns um pt io n S I N um be r o f h ou se ho ld s w ith s al t t es tin g 15 p ar ts p er m ill io n or m or e of io di de /io da te To ta l n um be r o f h ou se ho ld s in w hi ch s al t w as te st ed or w he re th er e w as n o sa lt 2. 20 Lo w -b irt h w ei gh t i nf an ts M N N um be r o f m os t r ec en t l iv e bi rth s in th e la st 2 y ea rs w ei gh in g be lo w 2 ,5 00 g ra m s at b irt h To ta l n um be r o f m os t r ec en t l iv e bi rth s in th e la st 2 ye ar s 2. 21 In fa nt s w ei gh ed a t b irt h M N N um be r o f m os t r ec en t l iv e bi rth s in th e la st 2 y ea rs w ho w er e w ei gh ed a t b irt h To ta l n um be r o f m os t r ec en t l iv e bi rth s in th e la st 2 ye ar s C H IL D H EA LT H 3. 1 Tu be rc ul os is im m un iz at io n co ve ra ge IM N um be r o f c hi ld re n ag e 12 -2 3 m on th s w ho re ce iv ed B C G va cc in e by th ei r f irs t b irt hd ay To ta l n um be r o f c hi ld re n ag e 12 -2 3 m on th s 3. 2 P ol io im m un iz at io n co ve ra ge IM N um be r o f c hi ld re n ag e 12 -2 3 m on th s w ho re ce iv ed th e th ird d os e of O P V v ac ci ne (O P V 3) b y th ei r f irs t b irt hd ay To ta l n um be r o f c hi ld re n ag e 12 -2 3 m on th s 3. 3 D ip ht he ria , p er tu ss is a nd te ta nu s (D P T) im m un iz at io n co ve ra ge IM N um be r o f c hi ld re n ag e 12 -2 3 m on th s w ho re ce iv ed th e th ird d os e of D P T va cc in e (D P T4 ) b y th ei r f irs t b irt hd ay To ta l n um be r o f c hi ld re n ag e 12 -2 3 m on th s 7 Br ea st fe ed in g   ch ild re n:  S ol id ,  s em i-­‐s ol id ,  o r   so ft  fo od s,  t w o   ti m es  fo r   in fa nt s   ag e   6-­‐ 8   m on th s,  a nd  t hr ee  t im es  fo r   ch ild re n   9-­‐ 23  m on th s;  N on -­‐b re as tf ee di ng  c hi ld re n:  S ol id ,  s em i-­‐s ol id ,  o r   so ft  fo od s,  o r   m ilk  fe ed s,   fo ur  t im es  fo r   ch ild re n   ag e   6-­‐ 23  m on th s   8   Th e   in di ca to r   is  b as ed  o n   co ns um pt io n   of  a ny  a m ou nt  o f  f oo d   fr om  a t   le as t   4   ou t   of  t he  7  fo llo w in g   fo od  g ro up s:  1 )  g ra in s,  r oo ts  a nd  t ub er s,  2 )  l eg um es  a nd  n ut s,  3 )  d ai ry  p ro du ct s   (m ilk ,  y og ur t,  c he es e) ,  4 )  f le sh   fo od s   (m ea t, fis h,  p ou lt ry  a nd  li ve r/ or ga n   m ea ts ),   5)  e gg s,  6 )  v it am in -­‐A  r ic h   fr ui ts  a nd  v eg et ab le s,  a nd  7 )  o th er  fr ui ts  a nd  v eg et ab le s   240 Palestinian Multiple Indicator Cluster Survey 2014 22 4 M IC S IN D IC A TO R M od ul e1 N um er at or D en om in at or M D G In di ca to r R ef er en ce 2 3. 4 M ea sl es (M M R ) i m m un iz at io n co ve ra ge IM N um be r o f c hi ld re n ag e 24 -3 5 m on th s w ho re ce iv ed th e fir st d os e of m ea sl es , m um ps , a nd ru be lla v ac ci ne b y th ei r se co nd b irt hd ay To ta l n um be r o f c hi ld re n ag e 12 -2 3 m on th s M D G 4 .3 3. 5 H ep at iti s B im m un iz at io n co ve ra ge IM N um be r o f c hi ld re n ag e 12 -2 3 m on th s w ho re ce iv ed th e th ird d os e of H ep at iti s B v ac ci ne (H ep B 3) b y th ei r f irs t bi rth da y To ta l n um be r o f c hi ld re n ag e 12 -2 3 m on th s 3. 6 H ae m op hi lu s in flu en za e ty pe B (H ib ) im m un iz at io n co ve ra ge IM N um be r o f c hi ld re n ag e 12 -2 3 m on th s w ho re ce iv ed th e th ird d os e of H ib v ac ci ne (H ib 3) b y th ei r f irs t b irt hd ay To ta l n um be r o f c hi ld re n ag e 12 -2 3 m on th s 3. 8 Fu ll im m un iz at io n co ve ra ge IM N um be r o f c hi ld re n ag e 24 -3 5 m on th s w ho re ce iv ed a ll va cc in at io ns re co m m en de d in th e na tio na l i m m un iz at io n sc he du le b ef or e th ei r f irs t b irt hd ay m ea sl es v ac ci ne b y th ei r s ec on d bi rth da y To ta l n um be r o f c hi ld re n ag e 24 -3 5 3. 10 C ar e- se ek in g fo r d ia rr ho ea C A N um be r o f c hi ld re n un de r a ge 5 w ith d ia rr ho ea in th e la st 2 w ee ks fo r w ho m a dv ic e or tr ea tm en t w as s ou gh t f ro m a he al th fa ci lit y or p ro vi de r To ta l n um be r o f c hi ld re n un de r a ge 5 w ith d ia rr ho ea in th e la st 2 w ee ks 3. S 1 D ia rr ho ea tr ea tm en t w ith o ra l r eh yd ra tio n th er ap y (O R T) a nd c on tin ue d fe ed in g C A N um be r o f c hi ld re n un de r a ge 5 w ith d ia rr ho ea in th e la st 2 w ee ks w ho re ce iv ed O R T (O R S p ac ke t, pr e- pa ck ag ed O R S fl ui d, o r i nc re as ed fl ui ds ) a nd c on tin ue d fe ed in g du rin g th e ep is od e of d ia rr ho ea To ta l n um be r o f c hi ld re n un de r a ge 5 w ith d ia rr ho ea in th e la st 2 w ee ks 3. 12 D ia rr ho ea tr ea tm en t w ith o ra l r eh yd ra tio n th er ap y (O R T) a nd c on tin ue d fe ed in g C A P er ce nt ag e of c hi ld re n un de r a ge 5 w ith d ia rr ho ea in th e la st 2 w ee ks w ho re ce iv ed O R T (O R S p ac ke t, pr e- pa ck ag ed O R S fl ui d, o r i nc re as ed fl ui ds ) a nd c on tin ue d fe ed in g du rin g th e ep is od e of d ia rr ho ea To ta l n um be r o f c hi ld re n un de r a ge 5 w ith d ia rr ho ea in th e la st 2 w ee ks 3. 13 C ar e- se ek in g fo r c hi ld re n w ith a cu te re sp ira to ry in fe ct io n (A R I) sy m pt om s C A N um be r o f c hi ld re n un de r a ge 5 w ith A R I s ym pt om s in th e la st 2 w ee ks fo r w ho m a dv ic e or tr ea tm en t w as s ou gh t fro m a h ea lth fa ci lit y or p ro vi de r To ta l n um be r o f c hi ld re n un de r a ge 5 w ith A R I sy m pt om s in th e la st 2 w ee ks 3. 14 A nt ib io tic tr ea tm en t f or c hi ld re n w ith ch ild re n w ith a cu te re sp ira to ry in fe ct io n (A R I) sy m pt om s C A N um be r o f c hi ld re n un de r a ge 5 w ith A R I s ym pt om s in th e la st 2 w ee ks w ho re ce iv ed a nt ib io tic s To ta l n um be r o f c hi ld re n un de r a ge 5 w ith A R I sy m pt om s in th e la st 2 w ee ks 3. 15 U se o f s ol id fu el s fo r c oo ki ng H C N um be r o f h ou se ho ld m em be rs in h ou se ho ld s th at u se so lid fu el s as th e pr im ar y so ur ce o f d om es tic e ne rg y to co ok To ta l n um be r o f h ou se ho ld m em be rs 241 22 5 M IC S IN D IC A TO R M od ul e1 N um er at or D en om in at or M D G In di ca to r R ef er en ce 2 W A TE R A N D S A N IT A TI O N 4. 1 U se o f i m pr ov ed d rin ki ng w at er s ou rc es W S N um be r o f h ou se ho ld m em be rs u si ng im pr ov ed s ou rc es o f dr in ki ng w at er To ta l n um be r o f h ou se ho ld m em be rs M D G 7 .8 4. 2 W at er tr ea tm en t W S N um be r o f h ou se ho ld m em be rs in h ou se ho ld s us in g un im pr ov ed d rin ki ng w at er w ho u se a n ap pr op ria te tre at m en t m et ho d To ta l n um be r o f h ou se ho ld m em be rs in h ou se ho ld s us in g un im pr ov ed d rin ki ng w at er s ou rc es 4. 3 U se o f i m pr ov ed s an ita tio n W S N um be r o f h ou se ho ld m em be rs u si ng im pr ov ed s an ita tio n fa ci lit ie s w hi ch a re n ot s ha re d To ta l n um be r o f h ou se ho ld m em be rs M D G 7 .9 R EP R O D U C TI VE H EA LT H 5. 1 A do le sc en t b irt h ra te 9 C M - B H A ge -s pe ci fic fe rti lit y ra te fo r w om en a ge 1 5- 19 y ea rs M D G 5 .4 5. 2 E ar ly c hi ld be ar in g C M - B H N um be r o f w om en a ge 2 0- 24 y ea rs w ho h ad a t l ea st o ne liv e bi rth b ef or e ag e 18 To ta l n um be r o f w om en a ge 2 0- 24 y ea rs 5. 3 C on tra ce pt iv e pr ev al en ce ra te C P N um be r o f w om en a ge 1 5- 49 y ea rs c ur re nt ly m ar rie d w ho ar e us in g (o r w ho se p ar tn er is u si ng ) a (m od er n or tra di tio na l) co nt ra ce pt iv e m et ho d To ta l n um be r o f w om en a ge 1 5- 49 y ea rs w ho a re cu rr en tly m ar rie d. M D G 5 .3 5. 4 U nm et n ee d1 0 U N N um be r o f w om en a ge 1 5- 49 y ea rs w ho a re c ur re nt ly m ar rie d w ho a re fe cu nd a nd w an t t o sp ac e th ei r b irt hs o r lim it th e nu m be r o f c hi ld re n th ey h av e an d w ho a re n ot cu rr en tly u si ng c on tra ce pt io n To ta l n um be r o f w om en a ge 1 5- 49 y ea rs w ho a re cu rr en tly m ar rie d. M D G 5 .6 5. 5a 5. 5b A nt en at al c ar e co ve ra ge M N N um be r o f w om en a ge 1 5- 49 y ea rs w ith a li ve b irt h in th e la st 2 y ea rs w ho w er e at te nd ed d ur in g th ei r l as t p re gn an cy th at le d to a li ve b irt h (a ) at le as t o nc e by s ki lle d he al th p er so nn el (b ) at le as t f ou r t im es b y an y pr ov id er (c ) P la ce o f r ec ei vi ng A nt en at al c ar e To ta l n um be r o f w om en a ge 1 5- 49 y ea rs w ith a li ve bi rth in th e la st 2 y ea rs M D G 5 .5 5. 6 C on te nt o f a nt en at al c ar e M N N um be r o f w om en a ge 1 5- 49 y ea rs w ith a li ve b irt h in th e la st 2 y ea rs w ho h ad th ei r b lo od p re ss ur e m ea su re d an d ga ve u rin e an d bl oo d sa m pl es d ur in g th e la st p re gn an cy th at le d to a li ve b irt h To ta l n um be r o f w om en a ge 1 5- 49 y ea rs w ith a li ve bi rth in th e la st 2 y ea rs 9 W he n th e B irt h H is to ry m od ul e is u se d, th e in di ca to r i s ca lc ul at ed fo r t he la st 3 -y ea r p er io d. W he n es tim at ed u si ng th e Fe rti lit y m od ul e on ly , t he ra te re fe rs to th e la st o ne y ea r 10  S ee  t he  M IC S   ta bu la ti on  p la n   fo r   a   de ta ile d   de sc ri pt io n 242 Palestinian Multiple Indicator Cluster Survey 2014 22 6 M IC S IN D IC A TO R M od ul e1 N um er at or D en om in at or M D G In di ca to r R ef er en ce 2 5. 7 S ki lle d at te nd an t a t d el iv er y M N N um be r o f w om en a ge 1 5- 49 y ea rs w ith a li ve b irt h in th e la st 2 y ea rs w ho w er e at te nd ed b y sk ill ed h ea lth p er so nn el du rin g th ei r m os t r ec en t l iv e bi rth To ta l n um be r o f w om en a ge 1 5- 49 y ea rs w ith a li ve bi rth in th e la st 2 y ea rs M D G 5 .2 5. 8 In st itu tio na l d el iv er ie s M N N um be r o f w om en a ge 1 5- 49 y ea rs w ith a li ve b irt h in th e la st 2 y ea rs w ho se m os t r ec en t l iv e bi rth w as d el iv er ed in a he al th fa ci lit y To ta l n um be r o f w om en a ge 1 5- 49 y ea rs w ith a li ve bi rth in th e la st 2 y ea rs 5. 9 C ae sa re an s ec tio n M N N um be r o f w om en a ge 1 5- 49 y ea rs w ho se m os t r ec en t liv e bi rth in th e la st 2 y ea rs w as d el iv er ed b y ca es ar ea n se ct io n To ta l n um be r o f w om en a ge 1 5- 49 y ea rs w ith a li ve bi rth in th e la st 2 y ea rs 5. 10 P os t-p ar tu m s ta y in h ea lth fa ci lit y P N N um be r o f w om en a ge 1 5- 49 y ea rs w ho s ta ye d in th e he al th fa ci lit y fo r 1 2 ho ur s or m or e af te r t he d el iv er y of th ei r m os t r ec en t l iv e bi rth in th e la st 2 y ea rs To ta l n um be r o f w om en a ge 1 5- 49 y ea rs w ith a li ve bi rth in th e la st 2 y ea rs 5. 11 P os t-n at al h ea lth c he ck fo r t he n ew bo rn P N N um be r o f l as t l iv e bi rth s in th e la st 2 y ea rs w ho re ce iv ed a he al th c he ck w hi le in fa ci lit y or a t h om e fo llo w in g de liv er y, or a p os t-n at al c ar e vi si t w ith in 2 d ay s af te r d el iv er y To ta l n um be r o f l as t l iv e bi rth s in th e la st 2 y ea rs 5. 12 P os t-n at al h ea lth c he ck fo r t he m ot he r P N N um be r o f w om en a ge 1 5- 49 y ea rs w ho re ce iv ed a h ea lth ch ec k w hi le in fa ci lit y or a t h om e fo llo w in g de liv er y, o r a po st -n at al c ar e vi si t w ith in 2 d ay s af te r d el iv er y of th ei r m os t r ec en t l iv e bi rth in th e la st 2 y ea rs To ta l n um be r o f w om en a ge 1 5- 49 y ea rs w ith a li ve bi rth in th e la st 2 y ea rs C H IL D D EV EL O PM EN T 6. 1 A tte nd an ce to e ar ly c hi ld ho od e du ca tio n E C N um be r o f c hi ld re n ag e 36 -5 9 m on th s w ho a re a tte nd in g an e ar ly c hi ld ho od e du ca tio n pr og ra m m e To ta l n um be r o f c hi ld re n ag e 36 -5 9 m on th s 6. 2 S up po rt fo r l ea rn in g E C N um be r o f c hi ld re n ag e 36 -5 9 m on th s w ith w ho m a n ad ul t ha s en ga ge d in fo ur o r m or e ac tiv iti es to p ro m ot e le ar ni ng an d sc ho ol re ad in es s in th e la st 3 d ay s To ta l n um be r o f c hi ld re n ag e 36 -5 9 m on th s 6. 3 Fa th er ’s s up po rt fo r l ea rn in g E C N um be r o f c hi ld re n ag e 36 -5 9 m on th s w ho se b io lo gi ca l fa th er h as e ng ag ed in fo ur o r m or e ac tiv iti es to p ro m ot e le ar ni ng a nd s ch oo l r ea di ne ss in th e la st 3 d ay s To ta l n um be r o f c hi ld re n ag e 36 -5 9 m on th s 6. 4 M ot he r’s s up po rt fo r l ea rn in g E C N um be r o f c hi ld re n ag e 36 -5 9 m on th s w ho se b io lo gi ca l m ot he r h as e ng ag ed in fo ur o r m or e ac tiv iti es to p ro m ot e le ar ni ng a nd s ch oo l r ea di ne ss in th e la st 3 d ay s To ta l n um be r o f c hi ld re n ag e 36 -5 9 m on th s 6. 5 A va ila bi lit y of c hi ld re n’ s bo ok s E C N um be r o f c hi ld re n un de r a ge 5 w ho h av e th re e or m or e To ta l n um be r o f c hi ld re n un de r a ge 5 243 22 7 M IC S IN D IC A TO R M od ul e1 N um er at or D en om in at or M D G In di ca to r R ef er en ce 2 ch ild re n’ s bo ok s 6. 6 A va ila bi lit y of p la yt hi ng s E C N um be r o f c hi ld re n un de r a ge 5 w ho p la y w ith tw o or m or e ty pe s of p la yt hi ng s To ta l n um be r o f c hi ld re n un de r a ge 5 6. 7 In ad eq ua te c ar e E C N um be r o f c hi ld re n un de r a ge 5 le ft al on e or in th e ca re o f an ot he r c hi ld y ou ng er th an 1 0 ye ar s of a ge fo r m or e th an on e ho ur a t l ea st o nc e in th e la st w ee k To ta l n um be r o f c hi ld re n un de r a ge 5 6. 8 E ar ly c hi ld d ev el op m en t i nd ex E C N um be r o f c hi ld re n ag e 36 -5 9 m on th s w ho a re de ve lo pm en ta lly o n tra ck in a t l ea st th re e of th e fo llo w in g fo ur d om ai ns :li te ra cy -n um er ac y, p hy si ca l, so ci al - em ot io na l, an d le ar ni ng To ta l n um be r o f c hi ld re n ag e 36 -5 9 m on th s LI TE R A C Y A N D E D U C A TI O N 7. 1 Li te ra cy ra te a m on g yo un g w om en W B N um be r o f w om en a ge 1 5- 24 y ea rs w ho a re a bl e to re ad a sh or t s im pl e st at em en t a bo ut e ve ry da y lif e or w ho at te nd ed s ec on da ry o r h ig he r e du ca tio n To ta l n um be r o f w om en a ge 1 5- 24 y ea rs M D G 2 .3 7. 2 S ch oo l r ea di ne ss E D N um be r o f c hi ld re n in fi rs t g ra de o f p rim ar y sc ho ol w ho at te nd ed p re -s ch oo l d ur in g th e pr ev io us s ch oo l y ea r To ta l n um be r o f c hi ld re n at te nd in g th e fir st g ra de o f pr im ar y sc ho ol 7. 3 N et in ta ke ra te in p rim ar y ed uc at io n E D N um be r o f c hi ld re n of s ch oo l-e nt ry a ge w ho e nt er th e fir st gr ad e of p rim ar y sc ho ol To ta l n um be r o f c hi ld re n of s ch oo l-e nt ry a ge 7. 4 P rim ar y sc ho ol n et a tte nd an ce ra tio (a dj us te d) E D N um be r o f c hi ld re n of p rim ar y sc ho ol a ge c ur re nt ly at te nd in g pr im ar y or s ec on da ry s ch oo l To ta l n um be r o f c hi ld re n of p rim ar y sc ho ol a ge M D G 2 .1 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) E D N um be r o f c hi ld re n of s ec on da ry s ch oo l a ge c ur re nt ly at te nd in g se co nd ar y sc ho ol o r h ig he r To ta l n um be r o f c hi ld re n of s ec on da ry s ch oo l a ge 7. 6 C hi ld re n re ac hi ng la st g ra de o f p rim ar y E D P ro po rti on o f c hi ld re n en te rin g th e fir st g ra de o f p rim ar y sc ho ol w ho e ve nt ua lly re ac h la st g ra de M D G 2 .2 7. 7 P rim ar y co m pl et io n ra te E D N um be r o f c hi ld re n at te nd in g th e la st g ra de o f p rim ar y sc ho ol (e xc lu di ng re pe at er s) To ta l n um be r o f c hi ld re n of p rim ar y sc ho ol co m pl et io n ag e (a ge a pp ro pr ia te to fi na l g ra de o f pr im ar y sc ho ol ) 7. 8 Tr an si tio n ra te to s ec on da ry s ch oo l E D N um be r o f c hi ld re n at te nd in g th e la st g ra de o f p rim ar y sc ho ol d ur in g th e pr ev io us s ch oo l y ea r w ho a re in th e fir st gr ad e of s ec on da ry s ch oo l d ur in g th e cu rr en t s ch oo l y ea r To ta l n um be r o f c hi ld re n at te nd in g th e la st g ra de o f pr im ar y sc ho ol d ur in g th e pr ev io us s ch oo l y ea r 244 Palestinian Multiple Indicator Cluster Survey 2014 22 8 M IC S IN D IC A TO R M od ul e1 N um er at or D en om in at or M D G In di ca to r R ef er en ce 2 7. 9 G en de r p ar ity in de x (p rim ar y sc ho ol ) E D P rim ar y sc ho ol n et a tte nd an ce ra tio (a dj us te d) fo r g irl s P rim ar y sc ho ol n et a tte nd an ce ra tio (a dj us te d) fo r bo ys M D G 3 .1 7. 10 G en de r p ar ity in de x (s ec on da ry s ch oo l) E D S ec on da ry s ch oo l n et a tte nd an ce ra tio (a dj us te d) fo r g irl s S ec on da ry s ch oo l n et a tte nd an ce ra tio (a dj us te d) fo r b oy s M D G 3 .1 7. S 1 B as ic s ch oo l n et a tte nd an ce ra tio (a dj us te d) E D N um be r o f c hi ld re n of b as ic s ch oo l a ge c ur re nt ly a tte nd in g ba si c or s ec on da ry s ch oo l To ta l n um be r o f c hi ld re n of b as ic s ch oo l a ge 7. S 2 S ec on da ry s ch oo l n et a tte nd an ce ra tio (a dj us te d) E D N um be r of c hi ld re n of s ec on da ry s ch oo l a ge c ur re nt ly at te nd in g se co nd ar y sc ho ol o r h ig he r To ta l n um be r o f c hi ld re n of s ec on da ry s ch oo l a ge 7. S 3 C hi ld re n re ac hi ng la st g ra de o f b as ic E D P ro po rti on o f c hi ld re n en te rin g th e fir st g ra de o f b as ic s ch oo l w ho e ve nt ua lly re ac h la st g ra de 7. S 4 B as ic c om pl et io n ra te E D N um be r o f c hi ld re n at te nd in g th e la st g ra de o f b as ic s ch oo l (e xc lu di ng re pe at er s) To ta l n um be r o f c hi ld re n of b as ic s ch oo l c om pl et io n ag e (a ge a pp ro pr ia te to fi na l g ra de o f b as ic s ch oo l) 7. S 5 Tr an si tio n ra te to s ec on da ry s ch oo l E D N um be r o f c hi ld re n at te nd in g th e la st g ra de o f b as ic s ch oo l du rin g th e pr ev io us s ch oo l y ea r w ho a re in th e fir st g ra de of s ec on da ry s ch oo l d ur in g th e cu rr en t s ch oo l y ea r To ta l n um be r o f c hi ld re n at te nd in g th e la st g ra de o f ba si c sc ho ol d ur in g th e pr ev io us s ch oo l y ea r 7. S 6 G en de r p ar ity in de x (b as ic s ch oo l) E D B as ic s ch oo l n et a tte nd an ce ra tio (a dj us te d) fo r g irl s B as ic s ch oo l n et a tte nd an ce ra tio (a dj us te d) fo r bo ys 7. S 7 G en de r p ar ity in de x (s ec on da ry sc ho ol ) E D S ec on da ry s ch oo l n et a tte nd an ce ra tio (a dj us te d) fo r g irl s. S ec on da ry s ch oo l n et a tte nd an ce ra tio (a dj us te d) fo r b oy s 245 22 9 M IC S IN D IC A TO R M od ul e1 N um er at or D en om in at or M D G In di ca to r R ef er en ce 2 C H IL D P R O TE C TI O N 8. 1 B irt h re gi st ra tio n B R N um be r o f c hi ld re n un de r a ge 5 w ho se b irt hs a re re po rte d re gi st er ed To ta l n um be r o f c hi ld re n un de r a ge 5 8. 3 V io le nt d is ci pl in e C D N um be r o f c hi ld re n ag e 1- 14 y ea rs w ho e xp er ie nc ed ps yc ho lo gi ca l a gg re ss io n or p hy si ca l p un is hm en t d ur in g th e la st o ne m on th To ta l n um be r o f c hi ld re n ag e 1- 14 y ea rs 8. 4 M ar ria ge b ef or e ag e 15 M A N um be r o f w om en a ge 1 5- 49 y ea rs w ho w er e fir st m ar rie d be fo re a ge 1 5 To ta l n um be r o f w om en a ge 1 5- 49 y ea rs 8. 5 M ar ria ge b ef or e ag e 18 M A N um be r o f w om en a ge 2 0- 49 y ea rs w ho w er e fir st m ar rie d be fo re a ge 1 8 To ta l n um be r o f w om en a ge 2 0- 49 y ea rs 8. 6 Y ou ng w om en a ge 1 5- 19 y ea rs c ur re nt ly m ar rie d M A N um be r o f w om en a ge 1 5- 19 y ea rs w ho a re m ar rie d To ta l n um be r o f w om en a ge 1 5- 19 y ea rs 8. 7 P ol yg yn y M A N um be r o f w om en a ge 1 5- 49 y ea rs w ho a re in a po ly gy no us m ar ria ge To ta l n um be r o f w om en a ge 1 5- 49 y ea rs w ho a re m ar rie d 8. 8a 8. 8b S po us al a ge d iff er en ce M A N um be r o f w om en w ho a re m ar rie d an d w ho se s po us e is 10 o r m or e ye ar s ol de r, (a ) am on g w om en a ge 1 5- 19 y ea rs , (b ) am on g w om en a ge 2 0- 24 y ea rs To ta l n um be r o f w om en w ho a re m ar rie d (a ) ag e 15 -1 9 ye ar s, (b ) ag e 20 -2 4 ye ar s 8. 13 C hi ld re n’ s liv in g ar ra ng em en ts H L N um be r o f c hi ld re n ag e 0- 17 y ea rs li vi ng w ith n ei th er bi ol og ic al p ar en t To ta l n um be r o f c hi ld re n ag e 0- 17 y ea rs 8. 14 P re va le nc e of c hi ld re n w ith o ne o r b ot h pa re nt s de ad H L N um be r o f c hi ld re n ag e 0- 17 y ea rs w ith o ne o r b ot h bi ol og ic al p ar en ts d ea d To ta l n um be r o f c hi ld re n ag e 0- 17 y ea rs 8. 15 C hi ld re n w ith a t l ea st o ne p ar en t l iv in g ab ro ad H L N um be r o f c hi ld re n 0- 17 y ea rs w ith a t l ea st o ne b io lo gi ca l pa re nt li vi ng a br oa d To ta l n um be r o f c hi ld re n 0- 17 y ea rs H IV /A ID S A N D S EX U A L B EH A VI O U R 9. 1 K no w le dg e ab ou t H IV p re ve nt io n am on g yo un g w om en H A N um be r o f w om en a ge 1 5- 24 y ea rs w ho c or re ct ly id en tif y w ay s of p re ve nt in g th e se xu al tr an sm is si on o f H IV 11 , a nd w ho re je ct m aj or m is co nc ep tio ns a bo ut H IV tr an sm is si on To ta l n um be r o f w om en a ge 1 5- 24 y ea rs M D G 6 .3 9. 2 K no w le dg e of m ot he r- to -c hi ld H A N um be r o f w om en a ge 1 5- 49 y ea rs w ho c or re ct ly id en tif y To ta l n um be r o f w om en a ge 1 5- 49 y ea rs 11   U si ng  c on do m s   an d   lim it in g   se x   to  o ne  fa it hf ul ,  u ni nf ec te d   pa rt ne r   246 Palestinian Multiple Indicator Cluster Survey 2014 23 0 M IC S IN D IC A TO R M od ul e1 N um er at or D en om in at or M D G In di ca to r R ef er en ce 2 tra ns m is si on o f H IV al l t hr ee m ea ns 12 o f m ot he r- to -c hi ld tr an sm is si on o f H IV 9. 3 A cc ep tin g at tit ud es to w ar ds p eo pl e liv in g w ith H IV H A N um be r o f w om en a ge 1 5- 49 y ea rs e xp re ss in g ac ce pt in g at tit ud es o n al l f ou r q ue st io ns 13 to w ar d pe op le li vi ng w ith H IV To ta l n um be r o f w om en a ge 1 5- 49 y ea rs w ho h av e he ar d of H IV 9. 4 W om en w ho k no w w he re to b e te st ed fo r H IV H A N um be r o f w om en a ge 1 5- 49 y ea rs w ho s ta te k no w le dg e of a p la ce to b e te st ed fo r H IV To ta l n um be r o f w om en a ge 1 5- 49 y ea rs 12 T ra ns m is si on  d ur in g   pr eg na nc y,  d ur in g   de liv er y,  a nd  b y   br ea st fe ed in g   13   W om en  (1 )  w ho  t hi nk  t ha t   a   fe m al e   te ac he r   w it h   th e   A ID S   vi ru s   sh ou ld  b e   al lo w ed  t o   te ac h   in  s ch oo l,   (2 )  w ho  w ou ld  b uy  fr es h   ve ge ta bl es  fr om  a  s ho pk ee pe r   or  v en do r   w ho  h as  t he  A ID S   vi ru s,  (3 )  w ho  w ou ld  n ot  w an t   to  k ee p   it  a s   a   se cr et  if  a  fa m ily  m em be r   be ca m e   in fe ct ed  w it h   th e   A ID S   vi ru s,  a nd  (4 )  w ho  w ou ld  b e   w ill in g   to  c ar e   fo r   a   fa m ily  m em be r   w ho  b ec am e   si ck  w it h   th e   A ID S   vi ru s     247 18 Feb 2014 231 Appendix F. Palestinian MICS Questionnaires Household questionnaires: State of Palestine Palestinian Central Bureau of Statistics HOUSEHOLD QUESTIONNAIRE Palestinian Multiple Indicator Cluster Survey, 2014 HOUSEHOLD INFORMATION PANEL HH HH1. Cluster number: ___ ___ ___ HH2. Household number: ___ ___ HH3. Interviewer’s name and number: HH4. Supervisor’s name and number: Name ________________ ___ ___ ___ ___ ___ Name ________________ ___ ___ ___ ___ ___ HH5. Day / Month / Year of interview: ___ ___ /___ ___ / 2 014 HH7. GOVERNORATE name and code Name__________________________ ___ ___ HH6. AREA: Urban . 1 Rural . 2 CAMP . 3 WE ARE FROM PALESTINIAN CENTRAL BUREAU OF STATISTICS . WE ARE CONDUCTING A SURVEY ABOUT THE SITUATION OF CHILDREN, FAMILIES AND HOUSEHOLDS. I WOULD LIKE TO TALK TO YOU ABOUT THESE SUBJECTS. THE INTERVIEW WILL TAKE ABOUT 25 MINUTES. ALL THE INFORMATION WE OBTAIN WILL REMAIN STRICTLY CONFIDENTIAL AND ANONYMOUS. MAY I START NOW?  Yes, permission is given  Go to HH18 to record the time and then begin the interview.  No, permission is not given  Circle 04 in HH9. Discuss this result with your supervisor. HH9. Result of household interview: Completed . 01 No household member or no competent respondent at home at time of visit . 02 Entire household absent for extended period of time . 03 Refused . 04 Dwelling vacant / Address not a dwelling . 05 Dwelling destroyed . 06 Dwelling not found . 07 Other (specify) _____________________________________________________________________________________ 96 After the household questionnaire has been completed, fill in the following information: HH10. Respondent to Household Questionnaire: Name _______________________ ___ ___ HH11. Total number of household members: ___ ___ After all questionnaires for the household have been completed, fill in the following information: HH12. Number of women age 15-49 years: ___ ___ HH13. Number of women’s questionnaires completed: ___ ___ HH14. Number of children under age 5: ___ ___ HH15. Number of under-5 questionnaires completed: ___ ___ HH16. Field editor’s name and number: Name___________________ ___ ___ ___ __ __ HH17. Main data entry clerk’s name and number: Name____________________ ___ ___ __ __ __ 248 Palestinian Multiple Indicator Cluster Survey 2014 18 F eb 2 01 4 23 2 H H 18 . R ec or d th e tim e. H ou r . . . . . . . . _ _ __ M in ut es . . . . . . _ _ __ LI ST O F H O U SE H O LD M EM B ER S H L FI R S T, P LE A S E T E LL M E T H E N A M E O F E A C H P E R S O N W H O U S U A LL Y L IV E S H E R E , S TA R TI N G W IT H T H E H EA D O F TH E H O U S E H O LD . Li st th e he ad o f t he h ou se ho ld in li ne 0 1. L is t a ll ho us eh ol d m em be rs (H L2 ), th ei r r el at io ns hi p to th e ho us eh ol d he ad (H L3 ), an d th ei r s ex (H L4 ) Th en a sk : A R E T H E R E A N Y O TH E R S W H O L IV E H E R E , E V E N IF T H E Y A R E N O T A T H O M E N O W ? If y es , c om pl et e lis tin g fo r q ue st io ns H L2 -H L4 . T he n, a sk q ue st io ns s ta rti ng w ith H L5 fo r e ac h pe rs on a t a ti m e. U se a n ad di tio na l q ue st io nn ai re if a ll ro w s in th e Li st o f H ou se ho ld M em be rs h av e be en u se d. Fo r w om en ag e 15 -4 9 Fo r ch ild re n ag e 0- 4 Fo r c hi ld re n ag e 0- 17 y ea rs Fo r ch ild re n ag e 0- 14 H L1 . Li ne no . H L2 . N am e H L3 . W H A T IS TH E R E LA TI O N - S H IP O F (n am e) TO T H E H E A D O F H O U S E - H O LD ? H L4 . IS (n am e) M A LE O R FE M A LE ? 1 M al e 2 Fe m al e H L5 . W H A T IS (n am e) ’S D A TE O F B IR TH ? H L6 . H O W O LD IS (n am e) ? R ec or d in co m pl et e d ye ar s. If ag e is 9 5 or a bo ve , re co rd ‘9 5’ H L7 . C irc le lin e no . if w om an ag e 15 -4 9 H L7 B . C irc le lin e no . if ag e 0- 4 H L1 1. IS (n am e) ’S N A TU R A L M O TH E R A LI V E ? 1 Y es 2 N o H L1 3 8 D K  H L1 3 H L1 2. D O E S (n am e) ’S N A TU R A L M O TH E R LI V E IN TH IS H O U S E - H O LD ? If “Y es ” R ec or d lin e no . o f m ot he r an d go to H L1 3. If “N o” R ec or d 00 . H L1 2A . W H E R E D O E S (n am e) ’S N A TU R A L M O TH E R LI V E ? 1 In an ot he r ho us eh ol d in th is co un try 2 In st itu tio n in th is co un try 3 A br oa d 8 D K H L1 3. IS (n am e) ’ S N A TU R A L FA TH E R A LI V E ? 1 Y es 2 N o H L1 5 8 D K  H L1 5 H L1 4. D O E S (n am e) ’S N A TU R A L FA TH E R LI V E IN TH IS H O U S E - H O LD ? If “Y es ” R ec or d lin e no . o f m ot he r an d go to H L1 5. If “N o” R ec or d 00 H L1 4A . W H E R E D O E S (n am e) ’S N A TU R A L FA TH E R LI V E ? 1 In a no th er ho us eh ol d in th is c ou nt ry 2 In st itu tio n in th is c ou nt ry 3 A br oa d 8 D K H L1 5. R ec or d lin e no . o f m ot he r fro m H L1 2 if in di ca te d. If H L1 2 is bl an k, o r “ 00 ” as k: W H O IS T H E P R IM A R Y C A R E TA K E R O F (n am e) ? 98 D K 99 98 D K Li ne N am e R el at io n* M F M on th Y ea r A ge 15 -4 9 0- 4 Y N D K M ot he r Y N D K Fa th er M ot he r 01 0 1 1 2 __ _ _ __ _ _ __ _ _ __ _ _ 01 01 1 2 8 __ _ _ __ 1 2 3 8 1 2 8 __ _ _ __ 1 2 3 8 __ _ _ __ 02 __ _ _ __ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ 02 02 1 2 8 __ _ _ __ 1 2 3 8 1 2 8 __ _ _ __ 1 2 3 8 __ _ _ __ 03 __ _ _ __ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ 03 03 1 2 8 __ _ _ __ 1 2 3 8 1 2 8 __ _ _ __ 1 2 3 8 __ _ _ __ 04 __ _ _ __ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ 04 04 1 2 8 __ _ _ __ 1 2 3 8 1 2 8 __ _ _ __ 1 2 3 8 __ _ _ __ 05 __ _ _ __ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ 05 05 1 2 8 __ _ _ __ 1 2 3 8 1 2 8 __ _ _ __ 1 2 3 8 __ _ _ __ 06 __ _ _ __ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ 06 06 1 2 8 __ _ _ __ 1 2 3 8 1 2 8 __ _ _ __ 1 2 3 8 __ _ _ __ 07 __ _ _ __ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ 07 07 1 2 8 __ _ _ __ 1 2 3 8 1 2 8 __ _ _ __ 1 2 3 8 __ _ _ __ 08 __ _ _ __ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ 08 08 1 2 8 __ _ _ __ 1 2 3 8 1 2 8 __ _ _ __ 1 2 3 8 __ _ _ __ 09 __ _ _ __ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ 09 09 1 2 8 __ _ _ __ 1 2 3 8 1 2 8 __ _ _ __ 1 2 3 8 __ _ _ __ 249 18 F eb 2 01 4 23 3 Fo r w om en ag e 15 -4 9 Fo r ch ild re n ag e 0- 4 Fo r c hi ld re n ag e 0- 17 y ea rs Fo r ch ild re n ag e 0- 14 H L1 . Li ne no . H L2 . N am e H L3 . W H A T IS TH E R E LA TI O N - S H IP O F (n am e) TO T H E H E A D O F H O U S E - H O LD ? H L4 . IS (n am e) M A LE O R FE M A LE ? 1 M al e 2 Fe m al e H L5 . W H A T IS (n am e) ’S D A TE O F B IR TH ? H L6 . H O W O LD IS (n am e) ? R ec or d in co m pl et e d ye ar s. If ag e is 9 5 or a bo ve , re co rd ‘9 5’ H L7 . C irc le lin e no . if w om an ag e 15 -4 9 H L7 B . C irc le lin e no . if ag e 0- 4 H L1 1. IS (n am e) ’S N A TU R A L M O TH E R A LI V E ? 1 Y es 2 N o H L1 3 8 D K  H L1 3 H L1 2. D O E S (n am e) ’S N A TU R A L M O TH E R LI V E IN TH IS H O U S E - H O LD ? If “Y es ” R ec or d lin e no . o f m ot he r an d go to H L1 3. If “N o” R ec or d 00 . H L1 2A . W H E R E D O E S (n am e) ’S N A TU R A L M O TH E R LI V E ? 1 In an ot he r ho us eh ol d in th is co un try 2 In st itu tio n in th is co un try 3 A br oa d 8 D K H L1 3. IS (n am e) ’ S N A TU R A L FA TH E R A LI V E ? 1 Y es 2 N o H L1 5 8 D K  H L1 5 H L1 4. D O E S (n am e) ’S N A TU R A L FA TH E R LI V E IN TH IS H O U S E - H O LD ? If “Y es ” R ec or d lin e no . o f m ot he r an d go to H L1 5. If “N o” R ec or d 00 H L1 4A . W H E R E D O E S (n am e) ’S N A TU R A L FA TH E R LI V E ? 1 In a no th er ho us eh ol d in th is c ou nt ry 2 In st itu tio n in th is c ou nt ry 3 A br oa d 8 D K H L1 5. R ec or d lin e no . o f m ot he r fro m H L1 2 if in di ca te d. If H L1 2 is bl an k, o r “ 00 ” as k: W H O IS T H E P R IM A R Y C A R E TA K E R O F (n am e) ? 98 D K 99 98 D K Li ne N am e R el at io n* M F M on th Y ea r A ge 15 -4 9 0- 4 Y N D K M ot he r Y N D K Fa th er M ot he r 10 __ _ _ __ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ 10 10 1 2 8 __ _ _ __ 1 2 3 8 1 2 8 __ _ _ __ 1 2 3 8 __ _ _ __ 11 __ _ _ __ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ 11 11 1 2 8 __ _ _ __ 1 2 3 8 1 2 8 __ _ _ __ 1 2 3 8 __ _ _ __ 12 __ _ _ __ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ 12 12 1 2 8 __ _ _ __ 1 2 3 8 1 2 8 __ _ _ __ 1 2 3 8 __ _ _ __ 13 __ _ _ __ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ 13 13 1 2 8 __ _ _ __ 1 2 3 8 1 2 8 __ _ _ __ 1 2 3 8 __ _ _ __ 14 __ _ _ __ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ 14 14 1 2 8 __ _ _ __ 1 2 3 8 1 2 8 __ _ _ __ 1 2 3 8 __ _ _ __ 15 __ _ _ __ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ 15 15 1 2 8 __ _ _ __ 1 2 3 8 1 2 8 __ _ _ __ 1 2 3 8 __ _ _ __ Ti ck h er e if ad di tio na l q ue st io nn ai re u se d  P ro be fo r a dd iti on al h ou se ho ld m em be rs . P ro be e sp ec ia lly fo r a ny in fa nt s or s m al l c hi ld re n no t l is te d, a nd o th er s w ho m ay n ot b e m em be rs o f t he fa m ily (s uc h as s er va nt s ,o th er re la tiv es , f rie nd s) b ut w ho u su al ly li ve in th e ho us eh ol d. In se rt na m es o f a dd iti on al m em be rs in th e ho us eh ol d lis t a nd c om pl et e fo rm a cc or di ng ly . N ow fo r e ac h w om an a ge 1 5- 49 y ea rs , w rit e he r n am e an d lin e nu m be r a nd o th er id en tif yi ng in fo rm at io n in th e in fo rm at io n pa ne l o f a s ep ar at e In di vi du al W om en ’s Q ue st io nn ai re . Fo r e ac h ch ild u nd er a ge 5 , w rit e hi s/ he r n am e an d lin e nu m be r A N D th e lin e nu m be r o f h is /h er m ot he r o r c ar et ak er in th e in fo rm at io n pa ne l o f a s ep ar at e U nd er -5 Q ue st io nn ai re . Y ou s ho ul d no w h av e a se pa ra te q ue st io nn ai re fo r e ac h el ig ib le w om an , an d ea ch c hi ld u nd er fi ve in th e ho us eh ol d. 250 Palestinian Multiple Indicator Cluster Survey 2014 18 F eb 2 01 4 23 4 * C od es fo r H L3 : R el at io ns hi p to h ea d of ho us eh ol d: 01 H ea d 02 S po us e/ P ar tn er 03 S on / D au gh te r 04 S on -In -L aw / D au gh te r- In -L aw 05 G ra nd ch ild 06 P ar en t 07 P ar en t-I n- La w 08 B ro th er / S is te r 09 B ro th er -In -L aw / S is te r- In -L aw 10 U nc le / A un t 11 N ie ce / N ep he w 12 O th er re la tiv e 13 A do pt ed / Fo st er / S te pc hi ld 14 S er va nt (L iv e- in ) 96 O th er (N ot re la te d) 98 D K 251 18 F eb 2 01 4 23 5 ED U C A TI O N ED ED Fo r h ou se ho ld m em be rs a ge 5 a nd a bo ve Fo r h ou se ho ld m em be rs a ge 5 -2 4 ye ar s ED 1. Li ne nu m be r ED 2. N am e an d ag e C op y fro m H L2 a nd H L6 ED 3. H A S (n am e) E V E R A TT E N D E D S C H O O L O R P R E - S C H O O L? 1 Y es 2 N O  N ex t L in e ED 4A . W H A T IS T H E H IG H E S T LE V E L O F S C H O O L (n am e) H A S A TT E N D E D ? Le ve l: 0 P re sc ho ol 1 E le m en ta ry 2 P re pa ra to ry 3 S ec on da ry 4 H ig he r 8 D K If le ve l= 0, sk ip to E D 5 ED 4B . W H A T IS T H E H IG H E S T G R A D E (n am e) C O M P LE TE D A T TH IS LE V E L? G ra de : 98 D K If th e fir st gr ad e at th is le ve l i s no t co m pl et ed , en te r “ 00 ”. ED 5. D U R IN G TH E C U R R E N T S C H O O L Y E A R , T H A T IS 2 01 3- 20 14 , D ID (n am e) A TT E N D S C H O O L O R P R E S C H O O L A T A N Y TI M E ? 1 Y es 2 N o  E D 7 ED 6. D U R IN G T H IS S C H O O L Y E A R , W H IC H L E V E L A N D G R A D E IS /W A S (n am e) A TT E N D IN G ? ED 7. D U R IN G T H E P R E V IO U S S C H O O L Y E A R , TH A T IS 2 01 2- 20 13 , D ID (n am e) A TT E N D S C H O O L O R P R E S C H O O L A T A N Y T IM E ? 1 Y es 2 N o  N ex t L in e 8 D K  N ex t L in e ED 8. D U R IN G T H A T P R E V IO U S S C H O O L Y E A R , W H IC H L E V E L A N D G R A D E D ID (n am e) A TT E N D ? Le ve l: 0 P re sc ho ol 1 E le m en ta ry 2 P re pa ra to ry 3 S ec on da ry 4 H ig he r 8 D K If le ve l= 0, sk ip to E D 7 G ra de : 98 D K Le ve l: 0 P re sc ho ol 1 E le m en ta ry 2 P re pa ra to ry 3 S ec on da ry 4 H ig he r 8 D K If le ve l= 0, g o to n ex t l in e. G ra de : 98 D K Li ne N am e A ge Y es N o Le ve l G ra de Y e s N o Le ve l G ra de Y es N o D K Le ve l G ra de 01 __ _ __ _ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 8 0 1 2 3 4 8 __ _ _ __ 02 __ _ __ _ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 8 0 1 2 3 4 8 __ _ _ __ 03 __ _ __ _ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 8 0 1 2 3 4 8 __ _ _ __ 04 __ _ __ _ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 8 0 1 2 3 4 8 __ _ _ __ 05 __ _ __ _ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 8 0 1 2 3 4 8 __ _ _ __ 06 __ _ __ _ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 8 0 1 2 3 4 8 __ _ _ __ 07 __ _ __ _ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 8 0 1 2 3 4 8 __ _ _ __ 08 __ _ __ _ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 8 0 1 2 3 4 8 __ _ _ __ 09 __ _ __ _ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 8 0 1 2 3 4 8 __ _ _ __ 10 __ _ __ _ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 8 0 1 2 3 4 8 __ _ _ __ 11 __ _ __ _ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 8 0 1 2 3 4 8 __ _ _ __ 12 __ _ __ _ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 8 0 1 2 3 4 8 __ _ _ __ 13 __ _ __ _ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 8 0 1 2 3 4 8 __ _ _ __ 14 __ _ __ _ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 8 0 1 2 3 4 8 __ _ _ __ 15 __ _ __ _ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 8 0 1 2 3 4 8 __ _ _ __ 252 Palestinian Multiple Indicator Cluster Survey 2014 18 Feb 2014 236 SELECTION OF ONE CHILD FOR CHILD DISCIPLINE SL SL1. Check HL6 in the List of Household Members and write the total number of children age 1-14 years. Total number . __ SL2. Check the number of children age 1-14 years in SL1:  Zero  Go to HOUSEHOLD CHARACTERISTICS module  One  Go to SL9 and record the rank number as ‘1’, enter the line number, child’s name and age  Two or more  Continue with SL2A SL2A. List each of the children age 1-14 years below in the order they appear in the List of Household Members. Do not include other household members outside of the age range 1-14 years. Record the line number, name, sex, and age for each child. SL3. Rank number SL4. Line number from HL1 SL5. Name from HL2 SL6. Sex from HL4 SL7. Age from HL6 Rank Line Name M F Age 1 __ __ 1 2 ___ ___ 2 __ __ 1 2 ___ ___ 3 __ __ 1 2 ___ ___ 4 __ __ 1 2 ___ ___ 5 __ __ 1 2 ___ ___ 6 __ __ 1 2 ___ ___ 7 __ __ 1 2 ___ ___ 8 __ __ 1 2 ___ ___ o SL8. Check the last digit of the household number (HH2) from the cover page. This is the number of the row you should go to in the table below. Check the total number of children age 1-14 years in SL1 above. This is the number of the column you should go to in the table below Find the box where the row and the column meet and circle the number that appears in the box. This is the rank number (SL3) of the selected child. Last Digit of Household Number (from HH2) Total Number of Eligible Children in the Household (from SL1) 2 3 4 5 6 7 8+ 0 2 2 4 3 6 5 4 1 1 3 1 4 1 6 5 2 2 1 2 5 2 7 6 3 1 2 3 1 3 1 7 4 2 3 4 2 4 2 8 5 1 1 1 3 5 3 1 6 2 2 2 4 6 4 2 7 1 3 3 5 1 5 3 8 2 1 4 1 2 6 4 9 1 2 1 2 3 7 5 SL9. Record the rank number (SL3), line number (SL4), name (SL5) and age (SL7) of the selected child Rank number . __ Line number . __ __ Name_______________________________ Age . __ __ 253 18 Feb 2014 237 CHILD DISCIPLINE CD CD2. Write the line number and name of the child from SL9. Line number . __ __ Name _____________________________ CD3. ADULTS USE CERTAIN WAYS TO TEACH CHILDREN THE RIGHT BEHAVIOUR OR TO ADDRESS A BEHAVIOUR PROBLEM. I WILL READ VARIOUS METHODS THAT ARE USED. PLEASE TELL ME IF YOU OR ANYONE ELSE IN YOUR HOUSEHOLD HAS USED THIS METHOD WITH (name) IN THE PAST MONTH. [A] TOOK AWAY PRIVILEGES, FORBADE SOMETHING (name) LIKED OR DID NOT ALLOW HIM/HER TO LEAVE THE HOUSE. [B] EXPLAINED WHY (name)’S BEHAVIOUR WAS WRONG. [C] SHOOK HIM/HER. [D] SHOUTED, YELLED AT OR SCREAMED AT HIM/HER. [E] GAVE HIM/HER SOMETHING ELSE TO DO. [F] SPANKED, HIT OR SLAPPED HIM/HER ON THE BOTTOM WITH BARE HAND. [G] HIT HIM/HER ON THE BOTTOM OR ELSEWHERE ON THE BODY WITH SOMETHING LIKE A BELT, HAIRBRUSH, STICK OR OTHER HARD OBJECT. [H] CALLED HIM/HER DUMB, LAZY, OR ANOTHER NAME LIKE THAT. [I] HIT OR SLAPPED HIM/HER ON THE FACE, HEAD OR EARS. [J] HIT OR SLAPPED HIM/HER ON THE HAND, ARM, OR LEG. [K] BEAT HIM/HER UP, THAT IS HIT HIM/HER OVER AND OVER AS HARD AS ONE COULD. Yes No Took away privileges . 1 2 Explained wrong behaviour . 1 2 Shook him/her . 1 2 Shouted, yelled, screamed . 1 2 Gave something else to do . 1 2 Spanked, hit, slapped on bottom with bare hand . 1 2 Hit with belt, hairbrush, stick, or other hard object . 1 2 Called dumb, lazy, or another name . 1 2 Hit / slapped on the face, head or ears . 1 2 Hit / slapped on hand, arm or leg . 1 2 Beat up, hit over and over as hard as one could . 1 2 CD4. DO YOU BELIEVE THAT IN ORDER TO BRING UP, RAISE, OR EDUCATE A CHILD PROPERLY, THE CHILD NEEDS TO BE PHYSICALLY PUNISHED? Yes . 1 No . 2 DK / No opinion . 8 254 Palestinian Multiple Indicator Cluster Survey 2014 18 Feb 2014 238 HOUSEHOLD CHARACTERISTICS HC HC2. HOW MANY ROOMS IN THIS HOUSEHOLD ARE USED FOR SLEEPING? Number of rooms . __ __ HC2A. WHAT KIND OF DWELLING UNIT DOES THE FAMILY LIVE IN? Record observation. Villa . 11 House . 12 Apartment . 13 Separate Room . 14 Tent . 15 Marginal “Barrakeyah” . 16 Other (specify) ____________________ 96 HC3. Main material of the dwelling floor. Record observation. Natural floor Earth / Sand . 11 Finished floor Parquet or polished wood . 31 Ceramic tiles . 33 Cement . 34 Carpet . 35 Tiles (Balady) . 36 Other (specify) ____________________ 96 HC4. Main material of the roof. Record observation. Natural roofing No Roof . 11 Palm leaf . 12 Finished roofing Metal / Tin . 31 Wood . 32 Calamine / Cement fibre . 33 Cement . 35 Other (specify) ____________________ 96 HC5. Main material of the exterior walls. Record observation. Natural walls No walls . 11 Dirt . 13 Rudimentary walls Stone with mud . 22 Finished walls Cement . 31 Stone with lime / cement . 32 Bricks . 33 Covered adobe . 35 Other (specify) ____________________ 96 HC6. WHAT TYPE OF FUEL DOES YOUR HOUSEHOLD MAINLY USE FOR COOKING? Electricity . 01 Liquefied Petroleum Gas (LPG) . 02 Kerosene . 05 Wood . 08 Straw / Shrubs / Grass . 09 No food cooked in the household . 95 Other (specify) ____________________ 96 01HC8 02HC8 05HC8 95HC8 255 18 Feb 2014 239 HC7. IS THE COOKING USUALLY DONE IN THE HOUSE, IN A SEPARATE BUILDING, OR OUTDOORS? If ‘In the house’, probe: IS IT DONE IN A SEPARATE ROOM USED AS A KITCHEN? In the house In a separate room used as kitchen . 1 Elsewhere in the house . 2 In a separate building . 3 Outdoors . 4 Other (specify) _____________________ 6 HC8. DOES YOUR HOUSEHOLD HAVE: [A] ELECTRICITY? [B] A RADIO? [C] A TUBE TELEVISION? [L] LCD /LED /3D TV? [D] A NON-MOBILE TELEPHONE? [E] A REFRIGERATOR? [F] CENTRAL HEATING? [G] CLOTHES DRYER ? [H] FREEZER? [I] DISH WASHER? [J] AIR CONDITION? [K] PLAY STATION/ XBOX? [M] SATELLITE DISH? [N] SOLAR HEATER? [O] VACUUM CLEANER? [P] CLOTH WASHER? Yes No Electricity . 1 2 Radio . 1 2 Tube Television . 1 2 LCD /LED /3D TV . 1 2 Non-mobile telephone . 1 2 Refrigerator . 1 2 Central heating . 1 2 Clothes dryer . 1 2 Freezer . 1 2 Dishwasher . 1 2 Air condition . 1 2 Play station/ Xbox . 1 2 Satellite dish . 1 2 Solar heater . 1 2 Vacuum cleaner . 1 2 Cloth washer . 1 2 HC9. DOES ANY MEMBER OF YOUR HOUSEHOLD OWN: [H] IPAD /TABLET? [B] A SMART MOBILE TELEPHONE? [I] A LAPTOP? [E] ANIMAL-DRAWN CART? [F] A CAR OR TRUCK? Yes No iPad /Tablet . 1 2 Smart Mobile telephone . 1 2 Laptop . 1 2 Animal-drawn cart . 1 2 Car / Truck . 1 2 HC10. DO YOU OR SOMEONE LIVING IN THIS HOUSEHOLD OWN THIS DWELLING? If “No”, then ask: DO YOU RENT THIS DWELLING FROM SOMEONE NOT LIVING IN THIS HOUSEHOLD? If “Rented from someone else”, circle “2”. For other responses, circle “6”. Own . 1 Rent . 2 Other (specify) ______________________ 6 18 Feb 2014 240 HC11. DOES ANY MEMBER OF THIS HOUSEHOLD OWN ANY LAND THAT CAN BE USED FOR AGRICULTURE? Yes . 1 No . 2 2HC13 HC12. HOW MANY DONUM OF AGRICULTURAL LAND DO MEMBERS OF THIS HOUSEHOLD OWN? If less than 1, record “00”. If 95 or more, record ‘95’. If unknown, record ‘98’. Donum . ___ ___ HC13. DOES THIS HOUSEHOLD OWN ANY LIVESTOCK, HERDS, OTHER FARM ANIMALS, OR POULTRY? Yes . 1 No . 2 2HC15 HC14. HOW MANY OF THE FOLLOWING ANIMALS DOES THIS HOUSEHOLD HAVE? [A] CATTLE, MILK COWS, OR BULLS? [B] HORSES, DONKEYS, OR MULES? [C] GOATS? [D] SHEEP? [E] CHICKENS? [G] CAMELS? If none, record ‘00’. If 95 or more, record ‘95’. If unknown, record ‘98’. Cattle, milk cows, or bulls . ___ ___ Horses, donkeys, or mules . ___ ___ Goats . ___ ___ Sheep . ___ ___ Chickens . ___ ___ Camels . ___ ___ HC15. DOES ANY MEMBER OF THIS HOUSEHOLD HAVE A BANK ACCOUNT? Yes . 1 No . 2 256 Palestinian Multiple Indicator Cluster Survey 2014 18 Feb 2014 240 HC11. DOES ANY MEMBER OF THIS HOUSEHOLD OWN ANY LAND THAT CAN BE USED FOR AGRICULTURE? Yes . 1 No . 2 2HC13 HC12. HOW MANY DONUM OF AGRICULTURAL LAND DO MEMBERS OF THIS HOUSEHOLD OWN? If less than 1, record “00”. If 95 or more, record ‘95’. If unknown, record ‘98’. Donum . ___ ___ HC13. DOES THIS HOUSEHOLD OWN ANY LIVESTOCK, HERDS, OTHER FARM ANIMALS, OR POULTRY? Yes . 1 No . 2 2HC15 HC14. HOW MANY OF THE FOLLOWING ANIMALS DOES THIS HOUSEHOLD HAVE? [A] CATTLE, MILK COWS, OR BULLS? [B] HORSES, DONKEYS, OR MULES? [C] GOATS? [D] SHEEP? [E] CHICKENS? [G] CAMELS? If none, record ‘00’. If 95 or more, record ‘95’. If unknown, record ‘98’. Cattle, milk cows, or bulls . ___ ___ Horses, donkeys, or mules . ___ ___ Goats . ___ ___ Sheep . ___ ___ Chickens . ___ ___ Camels . ___ ___ HC15. DOES ANY MEMBER OF THIS HOUSEHOLD HAVE A BANK ACCOUNT? Yes . 1 No . 2 257 241 WATER AND SANITATION WS WS1. WHAT IS THE MAIN SOURCE OF DRINKING WATER FOR MEMBERS OF YOUR HOUSEHOLD? Piped water Piped into dwelling . 11 Piped into compound, yard or plot . 12 Public tap / standpipe . 14 Tube Well, Borehole . 21 Dug well Protected well . 31 Unprotected well . 32 Water from spring Protected spring . 41 Unprotected spring . 42 Rainwater collection . 51 Tanker-truck . 61 Cart with small tank / drum . 71 Bottled water . 91 Other (specify) ____________________ 96 11WS6 12WS6 14WS3 21WS3 31WS3 32WS3 41WS3 42WS3 51WS3 61WS3 71WS3 96WS3 WS2. WHAT IS THE MAIN SOURCE OF WATER USED BY YOUR HOUSEHOLD FOR OTHER PURPOSES SUCH AS COOKING AND HANDWASHING? Piped water Piped into dwelling . 11 Piped into compound, yard or plot . 12 Public tap / standpipe . 14 Tube Well, Borehole . 21 Dug well Protected well . 31 Unprotected well . 32 Water from spring Protected spring . 41 Unprotected spring . 42 Rainwater collection . 51 Tanker-truck . 61 Cart with small tank / drum . 71 Other (specify) ____________________ 96 11WS6 12WS6 WS3. WHERE IS THAT WATER SOURCE LOCATED? In own dwelling . 1 In own yard / plot . 2 Elsewhere . 3 1WS6 2WS6 WS4. HOW LONG DOES IT TAKE TO GO THERE, GET WATER, AND COME BACK? Number of minutes . __ __ __ DK . 998 258 Palestinian Multiple Indicator Cluster Survey 2014 242 WS5. WHO USUALLY GOES TO THIS SOURCE TO COLLECT THE WATER FOR YOUR HOUSEHOLD? Probe: IS THIS PERSON UNDER AGE 15? WHAT SEX? Adult woman (age 15+ years) . 1 Adult man (age 15+ years) . 2 Female child (under 15) . 3 Male child (under 15) . 4 DK . 8 WS6. DO YOU DO ANYTHING TO THE WATER TO MAKE IT SAFER TO DRINK? Yes . 1 No . 2 DK . 8 2WS8 8WS8 WS7. WHAT DO YOU USUALLY DO TO MAKE THE WATER SAFER TO DRINK? Probe: ANYTHING ELSE? Record all items mentioned. Boil . A Add bleach / chlorine . B Strain it through a cloth . C Use water filter (ceramic, sand, composite, etc.) . D Other (specify) ____________________ X DK . Z WS8. WHAT KIND OF TOILET FACILITY DO MEMBERS OF YOUR HOUSEHOLD USUALLY USE? If “flush” or “pour flush”, probe: WHERE DOES IT FLUSH TO? If not possible to determine, ask permission to observe the facility. Flush / Pour flush Flush to piped sewer system . 11 Flush to septic tank . 12 Flush to pit (latrine) . 13 Flush to somewhere else . 14 Flush to unknown place / Not sure / DK where . 15 No facility, Bush, Field . 95 Other (specify) ____________________ 96 95WS12 WS9. DO YOU SHARE THIS FACILITY WITH OTHERS WHO ARE NOT MEMBERS OF YOUR HOUSEHOLD? Yes . 1 No . 2 2WS12 WS10. DO YOU SHARE THIS FACILITY ONLY WITH MEMBERS OF OTHER HOUSEHOLDS THAT YOU KNOW, OR IS THE FACILITY OPEN TO THE USE OF THE GENERAL PUBLIC? Other households only (not public) . 1 Public facility . 2 2WS12 WS11. HOW MANY HOUSEHOLDS IN TOTAL USE THIS TOILET FACILITY, INCLUDING YOUR OWN HOUSEHOLD? Number of households (if less than 10) 0 __ Ten or more households . 10 DK . 98 WS12. DOES YOUR HOUSEHOLD CONNECTED TO PIPED WATER NETWORK? Yes . 1 No . 2 259 243 HH19. Record the time. Hour and minutes . __ __ : __ __ SALT IODIZATION SI SI1. WE WOULD LIKE TO CHECK WHETHER THE SALT USED IN YOUR HOUSEHOLD IS IODIZED. MAY I HAVE A SAMPLE OF THE SALT USED TO COOK MEALS IN YOUR HOUSEHOLD? Once you have tested the salt, circle number that corresponds to test outcome. Not iodized - 0 PPM . 1 More than 0 PPM & less than 15 PPM . 2 15 PPM or more . 3 No salt in the house . 4 Salt not tested (specify reason) __________________ 5 HH20. Thank the respondent for his/her cooperation and check the List of Household Members:  A separate Questionnaire for Individual Women has been issued for each woman age 15-49 years in the List of Household Members (HL7)  A separate QUESTIONNAIRE FOR CHILDREN UNDER FIVE has been issued for each child under age 5 years in the List of Household Members (HL7B) Return to the cover page and make sure that all information is entered, including the number of eligible women (HH12), and under-5s (HH14) Make arrangements for the administration of the remaining questionnaire(s) in this household. 260 Palestinian Multiple Indicator Cluster Survey 2014 244 Interviewer’s Observations Field Editor’s Observations Supervisor’s Observations 261 245 State of Palestine Palestinian Central Bureau of Statistics QUESTIONNAIRE FOR INDIVIDUAL WOMEN Palestinian Multiple Indicator Cluster Survey, 2014 WOMAN’S INFORMATION PANEL WM This questionnaire is to be administered to all women age 15 through 49 (see List of Household Members, column HL7). A separate questionnaire should be used for each eligible woman. WM1. Cluster number: WM2. Household number: ___ ___ ___ ___ ___ WM3. Woman’s name: WM4. Woman’s line number: Name ___ ___ WM5. Interviewer’s name and number: WM6. Day / Month / Year of interview: Name ___ ___ ___ ___ ___ ___ ___ /___ ___ / 2 0 14 Repeat greeting if not already read to this woman: WE ARE FROM PALESTINIAN CENTRAL BUREAU OF STATISTICS. WE ARE CONDUCTING A SURVEY ABOUT THE SITUATION OF CHILDREN, FAMILIES AND HOUSEHOLDS. I WOULD LIKE TO TALK TO YOU ABOUT THESE SUBJECTS. THE INTERVIEW WILL TAKE ABOUT 30 MINUTES. ALL THE INFORMATION WE OBTAIN WILL REMAIN STRICTLY CONFIDENTIAL AND ANONYMOUS. If greeting at the beginning of the household questionnaire has already been read to this woman, then read the following: NOW I WOULD LIKE TO TALK TO YOU MORE ABOUT YOUR HEALTH AND OTHER TOPICS. THIS INTERVIEW WILL TAKE ABOUT 30 MINUTES. AGAIN, ALL THE INFORMATION WE OBTAIN WILL REMAIN STRICTLY CONFIDENTIAL AND ANONYMOUS. MAY I START NOW?  Yes, permission is given  Go to WM10 to record the time and then begin the interview.  No, permission is not given  Circle ‘03’ in WM7. Discuss this result with your supervisor. WM7. Result of woman’s interview Completed . 01 Not at home . 02 Refused . 03 Partly completed . 04 Incapacitated . 05 Other (specify) ___________________________ 96 WM8. Field editor’s name and number: Name ___ ___ ___ ___ ___ WM9. Main data entry clerk’s name and number: Name_________________ ___ ___ ___ ___ __ 262 Palestinian Multiple Indicator Cluster Survey 2014 246 WM10. Record the time. Hour and minutes . __ __ : __ __ WOMAN’S BACKGROUND WB WB1. IN WHAT MONTH AND YEAR WERE YOU BORN? Date of birth Month . __ __ DK month . 98 Year . __ __ __ __ DK year . 9998 WB2. HOW OLD ARE YOU? Probe: HOW OLD WERE YOU AT YOUR LAST BIRTHDAY? Compare and correct WB1 and/or WB2 if inconsistent Age (in completed years) . __ __ WB3. HAVE YOU EVER ATTENDED SCHOOL OR PRESCHOOL? Yes . 1 No . 2 2WB7 WB4. WHAT IS THE HIGHEST LEVEL OF SCHOOL YOU ATTENDED? Preschool . 0 Elementary……………………………………1 Preparatory………………….……………….2 Secondary . 3 Higher . 4 0WB7 WB5. WHAT IS THE HIGHEST GRADE YOU COMPLETED AT THAT LEVEL? If the first grade at this level is not completed, enter “00” Grade . __ __ WB6. Check WB4:  Secondary or higher (WB4=3 or 4)  Go to Next Module Elementary or preparatory (WB4=1,2)  Continue with WB7 263 247 WB7. NOW I WOULD LIKE YOU TO READ THIS SENTENCE TO ME. Show sentence on the card to the respondent. If respondent cannot read whole sentence, probe: CAN YOU READ PART OF THE SENTENCE TO ME? Cannot read at all . 1 Able to read only parts of sentence . 2 Able to read whole sentence . 3 No sentence in required language _________________ 4 (specify language) Blind / visually impaired . 5 264 Palestinian Multiple Indicator Cluster Survey 2014 248 MARRIAGE MA MA1. ARE YOU CURRENTLY MARRIED? Yes, currently married . 1 No, not married . 3 3MA5 MA2. HOW OLD IS YOUR HUSBAND? Probe: HOW OLD WAS YOUR HUSBAND ON HIS LAST BIRTHDAY? Age in years . __ __ DK . 98 MA3. BESIDES YOURSELF, DOES YOUR HUSBAND HAVE ANY OTHER WIVES? Yes . 1 No . 2 2MA7 MA4. HOW MANY OTHER WIVES DOES HE HAVE? Number . __ __ DK . 98 MA7 98MA7 MA5. HAVE YOU EVER BEEN MARRIED? Yes, ever been married . 1 No . 3 3  HIV/AID S MODULE MA6. WHAT IS YOUR MARITAL STATUS NOW: ARE YOU WIDOWED, DIVORCED OR SEPARATED? Widowed . 1 Divorced . 2 Separated . 3 MA7. HAVE YOU BEEN MARRIED ONLY ONCE OR MORE THAN ONCE? Only once . 1 More than once . 2 1 MA8A 2 MA8B MA8A. IN WHAT MONTH AND YEAR DID YOU MARRY? MA8B. IN WHAT MONTH AND YEAR DID YOU FIRST MARRY? Date of (first) marriage Month . __ __ DK month . 98 Year . __ __ __ __ DK year . 9998 Next Module MA9. HOW OLD WERE YOU WHEN YOU FIRST STARTED LIVING WITH YOUR (FIRST) HUSBAND? Age in years . __ __ 265 249 FERTILITY/BIRTH HISTORY CM CM0. NOW I WOULD LIKE TO ASK ABOUT ALL THE PREGNANCIES AND THE BIRTHS YOU HAVE HAD DURING YOUR LIFE. HAVE YOU EVER BEEN PREGNANT? Yes . 1 No . 2 2 CONTRAC EPTION MODULE. CM0A. HOW OLD WERE YOU AT YOUR FIRST PREGNANCY? Age in years . __ __ DK . 98 CM1. HAVE YOU EVER GIVEN BIRTH? Yes . 1 No . 2 2CM8 CM4. DO YOU HAVE ANY SONS OR DAUGHTERS TO WHOM YOU HAVE GIVEN BIRTH WHO ARE NOW LIVING WITH YOU? Yes . 1 No . 2 2CM6 CM5. HOW MANY SONS LIVE WITH YOU? HOW MANY DAUGHTERS LIVE WITH YOU? If none, record ‘00’. Sons at home . __ __ Daughters at home . __ __ CM6. DO YOU HAVE ANY SONS OR DAUGHTERS TO WHOM YOU HAVE GIVEN BIRTH WHO ARE ALIVE BUT DO NOT LIVE WITH YOU? Yes . 1 No . 2 2CM8 CM7. HOW MANY SONS ARE ALIVE BUT DO NOT LIVE WITH YOU? HOW MANY DAUGHTERS ARE ALIVE BUT DO NOT LIVE WITH YOU? If none, record ‘00’. Sons elsewhere . __ __ Daughters elsewhere . __ __ CM8. HAVE YOU EVER GIVEN BIRTH TO A BOY OR GIRL WHO WAS BORN ALIVE BUT LATER DIED? If “No” probe by asking: I MEAN, TO A CHILD WHO EVER BREATHED OR CRIED OR SHOWED OTHER SIGNS OF LIFE – EVEN IF HE OR SHE LIVED ONLY A FEW MINUTES OR HOURS? Yes . 1 No . 2 2CM10 266 Palestinian Multiple Indicator Cluster Survey 2014 250 CM9. HOW MANY BOYS HAVE DIED? HOW MANY GIRLS HAVE DIED? If none, record ‘00’. Boys dead . __ __ Girls dead . __ __ CM10. Sum answers to CM5, CM7, and CM9. Sum . __ __ CM11. JUST TO MAKE SURE THAT I HAVE THIS RIGHT, YOU HAVE HAD IN TOTAL (total number in CM10) LIVE BIRTHS DURING YOUR LIFE. IS THIS CORRECT?  Yes. Check below:  No live births  Go to CM12B  One or more live births  Continue with the BIRTH HISTORY module  No.  Check responses to CM1-CM10 and make corrections as necessary before proceeding to the BIRTH HISTORY Module or CM12B 267 25 1 B IR TH H IS TO R Y B H N O W I W O U LD L IK E T O R E C O R D T H E N A M E S O F A LL O F Y O U R B IR TH S , W H E TH E R S TI LL A LI V E O R N O T, S TA R TI N G W IT H T H E F IR S T O N E Y O U H A D . R ec or d na m es o f a ll of th e bi rth s in B H 1. R ec or d tw in s an d tri pl et s on s ep ar at e lin es . I f t he re a re m or e th an 1 4 bi rth s, u se a n ad di tio na l q ue st io nn ai re . B H Li ne N o. B H 1. W H A T N A M E W A S G IV E N T O Y O U R (fi rs t/n ex t) B A B Y ? B H 2. W E R E A N Y O F TH E S E B IR TH S TW IN S ? 1 S in gl e 2 M ul tip le B H 3. IS (n am e) A B O Y O R A G IR L ? 1 B oy 2 G irl B H 4. IN W H A T M O N TH A N D Y E A R W A S (n am e) B O R N ? P ro be : W H A T IS H IS /H E R B IR TH D A Y ? B H 5. IS (n am e) S TI LL A LI V E ? 1 Y es 2 N o B H 6. H O W O LD W A S (n am e) A T H IS /H E R LA S T B IR TH D A Y ? R ec or d ag e in co m pl et ed ye ar s. B H 7. IS (n am e) LI V IN G W IT H Y O U ? 1 Y es 2 N o B H 8. R ec or d ho us eh ol d lin e nu m be r of c hi ld (fr om H L1 ) R ec or d “0 0” if ch ild is no t l is te d. B H 9. If de ad : H O W O LD W A S (n am e) W H E N H E /S H E D IE D ? If “1 y ea r” , p ro be : H O W M A N Y M O N TH S O LD W A S (n am e) ? R ec or d da ys if le ss th an 1 m on th ; r ec or d m on th s if le ss th an 2 y ea rs ; o r ye ar s B H 10 . W E R E T H E R E A N Y O TH E R L IV E B IR TH S B E TW E E N (n am e of p re vi ou s bi rth ) A N D (n am e) , IN C LU D IN G A N Y C H IL D R E N W H O D IE D A FT E R B IR TH ? 1 Y es 2 N o Li ne N am e S M B G M on th Y ea r Y N A ge Y N Li ne N o U ni t N um be r Y N 01 1 2 1 2 __ _ _ __ __ _ _ __ _ __ _ __ 1 2  B H 9 __ _ _ __ 1 2 __ _ _ __  N ex t L in e D ay s . . . . 1 M on th s . . . . 2 Y ea rs . . . . 3 __ _ _ __ 02 1 2 1 2 __ _ _ __ __ _ _ __ _ __ _ __ 1 2  B H 9 __ _ _ __ 1 2 __ _ _ __  B H 10 D ay s . . . . 1 M on th s . . . . 2 Y ea rs . . . . 3 __ _ _ __ 1 2 A dd N ex t B irt h B irt h 03 1 2 1 2 __ _ _ __ __ _ _ __ _ __ _ __ 1 2  B H 9 __ _ _ __ 1 2 __ _ _ __  B H 10 D ay s . . . . 1 M on th s . . . . 2 Y ea rs . . . . 3 __ _ _ __ 1 2 A dd N ex t B irt h B irt h 04 1 2 1 2 __ _ _ __ __ _ _ __ _ __ _ __ 1 2  __ _ _ __ 1 2 __ _ _ __  B H 10 D ay s . . . . 1 M on th s . . . . 2 __ _ _ __ 1 2 A dd N ex t B irt h B irt h 268 Palestinian Multiple Indicator Cluster Survey 2014 25 2 B H Li ne N o. B H 1. W H A T N A M E W A S G IV E N T O Y O U R (fi rs t/n ex t) B A B Y ? B H 2. W E R E A N Y O F TH E S E B IR TH S TW IN S ? 1 S in gl e 2 M ul tip le B H 3. IS (n am e) A B O Y O R A G IR L ? 1 B oy 2 G irl B H 4. IN W H A T M O N TH A N D Y E A R W A S (n am e) B O R N ? P ro be : W H A T IS H IS /H E R B IR TH D A Y ? B H 5. IS (n am e) S TI LL A LI V E ? 1 Y es 2 N o B H 6. H O W O LD W A S (n am e) A T H IS /H E R LA S T B IR TH D A Y ? R ec or d ag e in co m pl et ed ye ar s. B H 7. IS (n am e) LI V IN G W IT H Y O U ? 1 Y es 2 N o B H 8. R ec or d ho us eh ol d lin e nu m be r of c hi ld (fr om H L1 ) R ec or d “0 0” if ch ild is no t l is te d. B H 9. If de ad : H O W O LD W A S (n am e) W H E N H E /S H E D IE D ? If “1 y ea r” , p ro be : H O W M A N Y M O N TH S O LD W A S (n am e) ? R ec or d da ys if le ss th an 1 m on th ; r ec or d m on th s if le ss th an 2 y ea rs ; o r ye ar s B H 10 . W E R E T H E R E A N Y O TH E R L IV E B IR TH S B E TW E E N (n am e of p re vi ou s bi rth ) A N D (n am e) , IN C LU D IN G A N Y C H IL D R E N W H O D IE D A FT E R B IR TH ? 1 Y es 2 N o Li ne N am e S M B G M on th Y ea r Y N A ge Y N Li ne N o U ni t N um be r Y N B H 9 Y ea rs . . . . 3 05 1 2 1 2 __ _ _ __ __ _ _ __ _ __ _ __ 1 2  B H 9 __ _ _ __ 1 2 __ _ _ __  B H 10 D ay s . . . . 1 M on th s . . . . 2 Y ea rs . . . . 3 __ _ _ __ 1 2 A dd N ex t B irt h B irt h 06 1 2 1 2 __ _ _ __ __ _ _ __ _ __ _ __ 1 2  B H 9 __ _ _ __ 1 2 __ _ _ __  B H 10 D ay s . . . . 1 M on th s . . . . 2 Y ea rs . . . . 3 __ _ _ __ 1 2 A dd N ex t B irt h B irt h 07 1 2 1 2 __ _ _ __ __ _ _ __ _ __ _ __ 1 2  B H 9 __ _ _ __ 1 2 __ _ _ __  B H 10 D ay s . . . . 1 M on th s . . . . 2 Y ea rs . . . . 3 __ _ _ __ 1 2 A dd N ex t B irt h B irt h 269 25 3 B H Li ne N o. B H 1. W H A T N A M E W A S G IV E N T O Y O U R (fi rs t/n ex t) B A B Y ? B H 2. W E R E A N Y O F TH E S E B IR TH S TW IN S ? 1 S in gl e 2 M ul tip le B H 3. IS (n am e) A B O Y O R A G IR L ? 1 B oy 2 G irl B H 4. IN W H A T M O N TH A N D Y E A R W A S (n am e) B O R N ? P ro be : W H A T IS H IS /H E R B IR TH D A Y ? B H 5. IS (n am e) S TI LL A LI V E ? 1 Y es 2 N o B H 6. H O W O LD W A S (n am e) A T H IS /H E R LA S T B IR TH D A Y ? R ec or d ag e in co m pl et ed ye ar s. B H 7. IS (n am e) LI V IN G W IT H Y O U ? 1 Y es 2 N o B H 8. R ec or d ho us eh ol d lin e nu m be r of c hi ld (fr om H L1 ) R ec or d “0 0” if ch ild is no t l is te d. B H 9. If de ad : H O W O LD W A S (n am e) W H E N H E /S H E D IE D ? If “1 y ea r” , p ro be : H O W M A N Y M O N TH S O LD W A S (n am e) ? R ec or d da ys if le ss th an 1 m on th ; r ec or d m on th s if le ss th an 2 y ea rs ; o r ye ar s B H 10 . W E R E T H E R E A N Y O TH E R L IV E B IR TH S B E TW E E N (n am e of p re vi ou s bi rth ) A N D (n am e) , IN C LU D IN G A N Y C H IL D R E N W H O D IE D A FT E R B IR TH ? 1 Y es 2 N o Li ne N am e S M B G M on th Y ea r Y N A ge Y N Li ne N o U ni t N um be r Y N 08 1 2 1 2 __ _ _ __ __ _ _ __ _ __ _ __ 1 2  B H 9 __ _ _ __ 1 2 __ _ _ __  B H 10 D ay s . . . . 1 M on th s . . . . 2 Y ea rs . . . . 3 __ _ _ __ 1 2 A dd N ex t B irt h B irt h 09 1 2 1 2 __ _ _ __ __ _ _ __ _ __ _ __ 1 2  B H 9 __ _ _ __ 1 2 __ _ _ __  B H 10 D ay s . . . . 1 M on th s . . . . 2 Y ea rs . . . . 3 __ _ _ __ 1 2 A dd N ex t B irt h B irt h 10 1 2 1 2 __ _ _ __ __ _ _ __ _ __ _ __ 1 2  B H 9 __ _ _ __ 1 2 __ _ _ __  B H 10 D ay s . . . . 1 M on th s . . . . 2 Y ea rs . . . . 3 __ _ _ __ 1 2 A dd N ex t B irt h B irt h 11 1 2 1 2 __ _ _ __ __ _ _ __ _ __ _ __ 1 2  B H 9 __ _ _ __ 1 2 __ _ _ __  B H 10 D ay s . . . . 1 M on th s . . . . 2 Y ea rs . . . . 3 __ _ _ __ 1 2 A dd N ex t B irt h B irt h 12 1 2 1 2 __ _ _ __ __ _ _ __ _ __ _ __ 1 2  __ _ _ __ 1 2 __ _ _ __  B H 10 D ay s . . . . 1 M on th s . . . . 2 Y ea rs . . . . 3 __ _ _ __ 1 2 A dd N ex t B irt h B irt h 270 Palestinian Multiple Indicator Cluster Survey 2014 25 4 B H Li ne N o. B H 1. W H A T N A M E W A S G IV E N T O Y O U R (fi rs t/n ex t) B A B Y ? B H 2. W E R E A N Y O F TH E S E B IR TH S TW IN S ? 1 S in gl e 2 M ul tip le B H 3. IS (n am e) A B O Y O R A G IR L ? 1 B oy 2 G irl B H 4. IN W H A T M O N TH A N D Y E A R W A S (n am e) B O R N ? P ro be : W H A T IS H IS /H E R B IR TH D A Y ? B H 5. IS (n am e) S TI LL A LI V E ? 1 Y es 2 N o B H 6. H O W O LD W A S (n am e) A T H IS /H E R LA S T B IR TH D A Y ? R ec or d ag e in co m pl et ed ye ar s. B H 7. IS (n am e) LI V IN G W IT H Y O U ? 1 Y es 2 N o B H 8. R ec or d ho us eh ol d lin e nu m be r of c hi ld (fr om H L1 ) R ec or d “0 0” if ch ild is no t l is te d. B H 9. If de ad : H O W O LD W A S (n am e) W H E N H E /S H E D IE D ? If “1 y ea r” , p ro be : H O W M A N Y M O N TH S O LD W A S (n am e) ? R ec or d da ys if le ss th an 1 m on th ; r ec or d m on th s if le ss th an 2 y ea rs ; o r ye ar s B H 10 . W E R E T H E R E A N Y O TH E R L IV E B IR TH S B E TW E E N (n am e of p re vi ou s bi rth ) A N D (n am e) , IN C LU D IN G A N Y C H IL D R E N W H O D IE D A FT E R B IR TH ? 1 Y es 2 N o Li ne N am e S M B G M on th Y ea r Y N A ge Y N Li ne N o U ni t N um be r Y N B H 9 13 1 2 1 2 __ _ _ __ __ _ _ __ _ __ _ __ 1 2  B H 9 __ _ _ __ 1 2 __ _ _ __  B H 10 D ay s . . . . 1 M on th s . . . . 2 Y ea rs . . . . 3 __ _ _ __ 1 2 A dd N ex t B irt h B irt h 14 1 2 1 2 __ _ _ __ __ _ _ __ _ __ _ __ 1 2  B H 9 __ _ _ __ 1 2 __ _ _ __  B H 10 D ay s . . . . 1 M on th s . . . . 2 Y ea rs . . . . 3 __ _ _ __ 1 2 A dd N ex t B irt h B irt h B H 11 . H A V E Y O U H A D A N Y L IV E B IR TH S S IN C E T H E B IR TH O F (n am e of la st b irt h in B IR TH H IS TO R Y M od ul e) ? Y es . . . . . . . . . . . . . . . . . . . . . . . . . 1 N o . . . . . . . . . . . . . . . . . . . . . . . . . 2 1 R ec or d bi rth (s ) i n B irt h H is to ry 271 255 CM12A. Compare number in CM10 with number of births in the BIRTH HISTORY Module above and check:  Numbers are same  Continue with CM12B  Numbers are different  Probe and reconcile CM12B. SOME PREGNANCIES MAY END PREMATURELY, SUCH AS MISCARRIAGE OR ABORTION, AND SOME OTHER PREGNANCIES END BY A STILLBIRTH. HAVE YOU EVER HAD ANY PREGNANCY THAT WAS MISCARRIED, ENDED IN A STILLBIRTH, OR THAT WAS TERMINATED PREMATURELY (ABORTED)? Yes . 1 No . 2 2CM13 CM12C. HOW MANY MISCARRIAGES HAVE YOU HAD DURING YOUR LIFETIME? BY MISCARRIAGE, I MEAN AN EARLY AND INVOLUNTARY END OF PREGNANCY WITHIN THE FIRST 5 MONTHS OF PREGNANCY. None . 00 Number of miscarriages . _ _ CM12D. IN HOW MANY CASES HAVE YOUR PREGNANCIES ENDED WITH A STILLBIRTH? BY STILLBIRTH, I MEAN A BIRTH THAT TOOK PLACE AFTER THE 5TH MONTH OF PREGNANCY, BUT THE CHILD DID NOT SHOW ANY SIGNS OF LIFE. None . 00 Number of still births . _ _ CM12E. AND HOW MANY EARLY TERMINATIONS OF PREGNANCY (ABORTIONS) HAVE YOU HAD DURING YOUR LIFETIME? BY EARLY TERMINATION OF PREGNANCY (ABORTION), I MEAN A PREGNANCY THAT WAS VOLUNTARILY TERMINATED WITHIN THE FIRST 5 MONTHS OF PREGNANCY. None . 00 Number of early terminations of pregnancies (abortions) . _ _ 00CM13 CM12F WHEN DID YOUR (LAST) ABORTION TAKE PLACE? Month and year must be recorded. Date of (last) abortion Month. __ __ Year .__ __ __ __ CM12G. Check CM12F. Last abortion occurred within the last 2 years, that is, since (month of interview) in 2012 (if the month of interview and the month the abortion took place are the same, and the year the abortion took place is 2012, consider this as an abortion within the last 2 years)  Last abortion occurred in the month of interview in 2012 or later  Go to CM12I  Last abortion occurred before the month of interview in 2012  Go to CM13 272 Palestinian Multiple Indicator Cluster Survey 2014 256 CM12I. DID YOU DO ANY OF THE FOLLOWING IN ORDER TO END THIS PREGNANCY? [A] TAKE PILLS? [B] CARRIED HEAVY WEIGHT? [C] HIT/STRUCK ABDOMEN? [X] OTHER PROBE: DID YOU TRY ANYTHING ELSE? Yes No Take pill . 1 2 Carried heavy weight . 1 2 Hit/struck abdomen . 1 2 Other (specify)_________________ 1 2 CM12IA: CHECK CM12I  At least one “Yes”.  Continue with CM12J.  All “No”.  Return to CM12E and ask the women again to check whether the termination of pregnancy was voluntary (abortion) or involuntary (miscarriage). If involuntary Return to CM12D and CM12I and correct the answer where necessary. And continue to CM12K CM12J. WHY DID YOU TRIED TO END THIS PREGNANCY? Didn’t want to get pregnant . 1 Economic circumstances . 2 Didn’t want the sex of the fetus . 3 Other (specify) . 6 CM12K. WHERE DID THIS ABORTION TAKE PLACE? Hospital . 1 PHC Center . 2 Private Clinic . 3 My home/Other home . 4 Other (specify)_______________________6 CM13. Check BH4 in BIRTH HISTORY Module: Last birth occurred within the last 2 years, that is, since the month of interview in 2012 (if the month of interview and the month of birth are the same, and the year of birth is 2012, consider this as a birth within the last 2 years)  No live birth in last 2 years.  Go to Contraception Module.  One or more live births in last 2 years.  Record name of last born child and continue with Next Module Name of last-born child_______________________ If child has died, take special care when referring to this child by name in the following modules. 273 257 DESIRE FOR LAST BIRTH DB This module is to be administered to all women with a live birth in the 2 years preceding the date of interview. Record name of last-born child from CM13 here _____________________. Use this child’s name in the following questions, where indicated. DB1. WHEN YOU GOT PREGNANT WITH (name), DID YOU WANT TO GET PREGNANT AT THAT TIME? Yes . 1 No . 2 1Next Module DB2. DID YOU WANT TO HAVE A BABY LATER ON, OR DID YOU NOT WANT ANY (MORE) CHILDREN? Later . 1 No more . 2 2Next Module DB3. HOW MUCH LONGER DID YOU WANT TO WAIT? Record the answer as stated by respondent. Months . 1 __ __ Years . 2 __ __ DK . 998 274 Palestinian Multiple Indicator Cluster Survey 2014 258 MATERNAL AND NEWBORN HEALTH MN This module is to be administered to all women with a live birth in the 2 years preceding the date of interview. Record name of last-born child from CM13 here _____________________. Use this child’s name in the following questions, where indicated. MN1. DID YOU SEE ANYONE FOR ANTENATAL CARE DURING YOUR PREGNANCY WITH (name)? Yes . 1 No . 2 2MN17 MN2. WHOM DID YOU SEE? Probe: ANYONE ELSE? Probe for the type of person seen and circle all answers given. Health professional: Doctor . A Nurse / Midwife . B Other person Traditional birth attendant (Daya) . F Other (specify) . X MN2A. HOW MANY WEEKS OR MONTHS PREGNANT WERE YOU WHEN YOU FIRST RECEIVED ANTENATAL CARE FOR THIS PREGNANCY? Record the answer as stated by respondent. Weeks . 1 __ __ Months . 2 0 __ DK . 998 MN3. HOW MANY TIMES DID YOU RECEIVE ANTENATAL CARE DURING THIS PREGNANCY? Probe to identify the number of times antenatal care was received. If a range is given, record the minimum number of times antenatal care received. Number of times . __ __ DK . 98 275 259 MN3A. WHERE DID YOU GO MOSTLY TO RECEIVE THE ANTENATAL CARE FOR YOUR PREGNANCY WITH (NAME)? Home Respondent’s home . 11 Other home . 12 Public Sector Government hospital . 21 Government clinic / health centre . 22 Private Sector Private hospital . 31 Private clinic . 32 Private maternity home . 33 NGO's Sector NGO's hospital . 41 NGO's Clinic . 42 UNRWA sector UNRWA hospital/ health centre . 51 Israeli sector Israeli hospital/ health centre . 61 Other (specify) _____________________ 96 MN4. AS PART OF YOUR ANTENATAL CARE DURING THIS PREGNANCY, WERE ANY OF THE FOLLOWING DONE AT LEAST ONCE: [A] WAS YOUR BLOOD PRESSURE MEASURED? [B] DID YOU GIVE A URINE SAMPLE? [C] DID YOU GIVE A BLOOD SAMPLE? Yes No Blood pressure . 1 2 Urine sample . 1 2 Blood sample . 1 2 276 Palestinian Multiple Indicator Cluster Survey 2014 260 MN4A. HAVE YOU HAD ANY OF THE FOLLOWING COMPLICATIONS AT ANY TIME DURING THIS PREGNANCY? [A] Severe vaginal bleeding [B] Hypertension [C] Swelling in the face or body [D] Severe headache [E] Upper abdominal pain [F] High fever [G] Non-fever convulsions [H] Painful micturition [I] Severe difficulty breathing [J] Anaemia [K] Urinary tract infection or genital [L] Rheumatic conditions Yes No Severe vaginal bleeding . 1 2 Hypertension . 1 2 Swelling in the face or body . 1 2 Severe headache . 1 2 Upper abdominal pain . 1 2 High fever . 1 2 Non-fever convulsions . 1 2 Painful micturition . 1 2 Severe difficulty breathing . 1 2 Anaemia . 1 2 Urinary tract infection or genital . 1 2 Rheumatic conditions . 1 2 MN17. WHO ASSISTED WITH THE DELIVERY OF (name)? Probe: ANYONE ELSE? Probe for the type of person assisting and circle all answers given. If respondent says no one assisted, probe to determine whether any adults were present at the delivery. Health professional: Doctor . A Nurse/ Midwife . B Other person Traditional birth attendant (Daya) . F Relative / Friend . H Other (specify) ______________________ X No one . Y 277 261 MN18. WHERE DID YOU GIVE BIRTH TO (name)? Probe to identify the type of source. If unable to determine whether public or private, write the name of the place. (Name of place) Home Respondent’s home . 11 Other home . 12 Public Sector Government hospital . 21 Government clinic / health centre . 22 Private Sector Private hospital . 31 Private clinic . 32 Private maternity home . 33 NGO's Sector NGO's hospital . 41 UNRWA sector UNRWA hospital/ health centre . 51 Israeli sector Israeli hospital/ health centre . 61 Other (specify) _____________________ 96 11MN19C 12MN19C 96MN19C MN19. WAS (name) DELIVERED BY CAESAREAN SECTION? THAT IS, DID THEY CUT YOUR BELLY OPEN TO TAKE THE BABY OUT? Yes . 1 No . 2 2MN19C MN19A. WHEN WAS THE DECISION MADE TO HAVE THE CAESAREAN SECTION? WAS IT BEFORE OR AFTER YOUR LABOUR PAINS STARTED? Before . 1 After . 2 278 Palestinian Multiple Indicator Cluster Survey 2014 262 MN19B. WHY WAS THE DECISION MADE TO HAVE THE CAESAREAN SECTION? Probe ANY OTHER DECISION? Probe for the reasons and circle all answers given Reasons associated with respondent's health . A Reasons associated with fetus's health . B Respondent’s Choice . C Husband's Choice . D Other (specify) ____________________ X MN19C. DID YOU HAVE ANY OF THE FOLLOWING SYMPTOMS DURING OR IMMEDIATELY AFTER DELIVERY? [A] than 12 hours [B] High fever [C] Convulsions without fever [D] Severe vaginal bleeding [X] Other Yes No Prolonged labor for more Than 12 hours . 1 2 High fever . 1 2 Convulsions without fever . 1 2 Severe vaginal bleeding . 1 2 Other (specify)_______________ 1 2 MN19D. DID YOU SUFFER FROM ANY OF THE FOLLOWING SYMPTOMS AT ANY TIME DURING THE FIRST SIX WEEKS FOLLOWING THE DELIVERY? [A] Severe vaginal bleeding [B] Swelling and pain in the legs [C] Foul-smelling vaginal discharge with fever [D] Lower abdominal pain with fever [E] Sever Lower back pain with fever [F] Painful during urination [G] Breast swelling and pain with fever [H] Hypertension [I] Severe headache [X] Other (specify) Yes No Severe vaginal bleeding . 1 2 Swelling and pain in the legs . 1 2 Foul-smelling vaginal discharge with fever . 1 2 Lower abdominal pain with fever . 1 2 Sever Lower back pain with fever . 1 2 Painful during urination……………1 2 Breast swelling and pain with fever . 1 2 Hypertension . 1 2 Severe headache . 1 2 Other (specify)_______________ 1 2 279 263 MN20. WHEN (name) WAS BORN, WAS HE/SHE VERY LARGE, LARGER THAN AVERAGE, AVERAGE, SMALLER THAN AVERAGE, OR VERY SMALL? Very large . 1 Larger than average . 2 Average . 3 Smaller than average . 4 Very small . 5 DK . 8 MN21. WAS (name) WEIGHED AT BIRTH? Yes . 1 No . 2 DK . 8 2MN23 8MN23 MN22. HOW MUCH DID (name) WEIGH? If a card is available, record weight from card. From card . 1 (kg) __ . __ __ __ From recall . 2 (kg) __ . __ __ __ DK . 99998 MN23. HAS YOUR MENSTRUAL PERIOD RETURNED SINCE THE BIRTH OF (name)? Yes . 1 No . 2 MN24. DID YOU EVER BREASTFEED (name)? Yes . 1 No . 2 2MN27A MN25. HOW LONG AFTER BIRTH DID YOU FIRST PUT (name) TO THE BREAST? If less than 1 hour, record ‘00’ hours. If less than 24 hours, record hours. Otherwise, record days. Immediately . 000 Hours . 1 __ __ Days . 2 __ __ DK/ remember . 998 MN26. IN THE FIRST THREE DAYS AFTER DELIVERY, WAS (name) GIVEN ANYTHING TO DRINK OTHER THAN BREAST MILK? Yes . 1 No . 2 2MN27A 280 Palestinian Multiple Indicator Cluster Survey 2014 264 MN27. WHAT WAS (name) GIVEN TO DRINK? Probe: ANYTHING ELSE? Milk (other than breast milk) . A Plain water . B Sugar or glucose water . C Gripe water . D Sugar-salt-water solution . E Fruit juice . F Infant formula . G Tea / Infusions . H Honey . I Other (specify) _____________________ X MN27A DID YOU HEAR ABOUT MOTHER AND CHILD HEALTH HANDBOOK? Yes . 1 No . 2 2NEXT MODULE MN27B. DO YOU USE THE MOTHER AND CHILD HEALTH HANDBOOK? Yes . 1 No . 2 281 265 POST-NATAL HEALTH CHECKS PN This module is to be administered to all women with a live birth in the 2 years preceding the date of interview. Record name of last-born child from CM13 here _____________________. Use this child’s name in the following questions, where indicated. PN1. Check MN18: Was the child delivered in a health facility?  Yes, the child was delivered in a health facility (MN18=21-61)  Continue with PN2  No, the child was not delivered in a health facility (MN18=11-12 or 96)  Go to PN6 PN2. NOW I WOULD LIKE TO ASK YOU SOME QUESTIONS ABOUT WHAT HAPPENED IN THE HOURS AND DAYS AFTER THE BIRTH OF (name). YOU HAVE SAID THAT YOU GAVE BIRTH IN (name or type of facility in MN18). HOW LONG DID YOU STAY THERE AFTER THE DELIVERY? If less than one day, record hours. If less than one week, record days. Otherwise, record weeks. Hours . 1 __ __ Days . 2 __ __ Weeks . 3 __ __ DK/ Don’t remember . 998 PN3. I WOULD LIKE TO TALK TO YOU ABOUT CHECKS ON (name)’S HEALTH AFTER DELIVERY – FOR EXAMPLE, SOMEONE EXAMINING (name), CHECKING THE CORD, OR SEEING IF (name) IS OK. BEFORE YOU LEFT THE (name or type of facility in MN18), DID ANYONE CHECK ON (name)’S HEALTH? Yes . 1 No . 2 282 Palestinian Multiple Indicator Cluster Survey 2014 266 PN4. AND WHAT ABOUT CHECKS ON YOUR HEALTH – I MEAN, SOMEONE ASSESSING YOUR HEALTH, FOR EXAMPLE ASKING QUESTIONS ABOUT YOUR HEALTH OR EXAMINING YOU? DID ANYONE CHECK ON YOUR HEALTH BEFORE YOU LEFT (name or type or facility in MN18)? Yes . 1 No . 2 PN5. NOW I WOULD LIKE TO TALK TO YOU ABOUT WHAT HAPPENED AFTER YOU LEFT (name or type of facility in MN18). DID ANYONE CHECK ON (name)’S HEALTH AFTER YOU LEFT (name or type of facility in MN18)? Yes . 1 No . 2 1PN11 2PN16 PN6. Check MN17: Did a health professional, traditional birth attendant (Daya), assist with the delivery?  Yes, delivery assisted by a health professional, traditional birth attendant (Daya), (MN17=A-F)  Continue with PN7  No, delivery not assisted by a health professional, traditional birth attendant (Daya), (A-F not circled in MN17)  Go to PN10 PN7. YOU HAVE ALREADY SAID THAT (person or persons in MN17) ASSISTED WITH THE BIRTH. NOW I WOULD LIKE TO TALK TO YOU ABOUT CHECKS ON (name)’S HEALTH AFTER DELIVERY, FOR EXAMPLE EXAMINING (name), CHECKING THE CORD, OR SEEING IF (name) IS OK. AFTER THE DELIVERY WAS OVER AND BEFORE (person or persons in MN17) LEFT YOU, DID (person or persons in MN17) CHECK ON (name)’S HEALTH? Yes . 1 No . 2 283 267 PN8. AND DID (person or persons in MN17) CHECK ON YOUR HEALTH BEFORE LEAVING? BY CHECK ON YOUR HEALTH, I MEAN ASSESSING YOUR HEALTH, FOR EXAMPLE ASKING QUESTIONS ABOUT YOUR HEALTH OR EXAMINING YOU. Yes . 1 No . 2 PN9. AFTER THE (person or persons in MN17) LEFT YOU, DID ANYONE CHECK ON THE HEALTH OF (name)? Yes . 1 No . 2 1PN11 2PN18 PN10. I WOULD LIKE TO TALK TO YOU ABOUT CHECKS ON (name)’S HEALTH AFTER DELIVERY – FOR EXAMPLE, SOMEONE EXAMINING (name), CHECKING THE CORD, OR SEEING IF THE BABY IS OK. AFTER (name) WAS DELIVERED, DID ANYONE CHECK ON HIS/HER HEALTH? Yes . 1 No . 2 2PN19 PN11. DID SUCH A CHECK HAPPEN ONLY ONCE, OR MORE THAN ONCE? Once . 1 More than once . 2 1PN12A 2PN12B PN12A. HOW LONG AFTER DELIVERY DID THAT CHECK HAPPEN? PN12B. HOW LONG AFTER DELIVERY DID THE FIRST OF THESE CHECKS HAPPEN? If less than one day, record hours. If less than one week, record days. Otherwise, record weeks. Hours . 1 __ __ Days . 2 __ __ Weeks . 3 __ __ DK/ Don’t remember . 998 284 Palestinian Multiple Indicator Cluster Survey 2014 268 PN13. WHO CHECKED ON (name)’S HEALTH AT THAT TIME? Health professional Doctor . A Nurse / Midwife . B Other person Traditional birth attendant (Daya) . F Relative / Friend . H Other (specify) _____________________ X PN14. WHERE DID THIS CHECK TAKE PLACE? Probe to identify the type of source. If unable to determine whether public or private, write the name of the place. (Name of place) Home Respondent’s home . 11 Other home . 12 Public sector Government hospital . 21 Government clinic / health centre . 22 Private Sector Private hospital . 31 Private clinic . 32 Private maternity home . 33 NGO's Sector NGO's hospital/ health centre . 41 UNRWA Sector UNRWA hospital/ health centre . 51 Israeli Sector Israeli hospital/ health centre . 61 Other (specify) _____________________ 96 PN15. Check MN18: Was the child delivered in a health facility?  Yes, the child was delivered in a health facility (MN18=21-61)  Continue with PN16  No, the child was not delivered in a health facility (MN18=11-12 or 96)  Go to PN17 PN16. AFTER YOU LEFT (name or type of facility in MN18), DID ANYONE CHECK ON YOUR HEALTH? Yes . 1 No . 2 1PN20 2PN23A 285 269 PN17. Check MN17: Did a health professional, traditional birth attendant (Daya), assist with the delivery?  Yes, delivery assisted by a health professional, traditional birth attendant (Daya), (MN17=A-F)  Continue with PN18  No, delivery not assisted by a health professional, traditional birth attendant (Daya), (A-F not circled in MN17)  Go to PN19 PN18. AFTER THE DELIVERY WAS OVER AND (person or persons in MN17) LEFT, DID ANYONE CHECK ON YOUR HEALTH? Yes . 1 No . 2 1PN20 2PN23A PN19. AFTER THE BIRTH OF (name), DID ANYONE CHECK ON YOUR HEALTH? I MEAN SOMEONE ASSESSING YOUR HEALTH, FOR EXAMPLE ASKING QUESTIONS ABOUT YOUR HEALTH OR EXAMINING YOU. Yes . 1 No . 2 2PN23A PN20. DID SUCH A CHECK HAPPEN ONLY ONCE, OR MORE THAN ONCE? Once . 1 More than once . 2 1PN21A 2PN21B PN21A. HOW LONG AFTER DELIVERY DID THAT CHECK HAPPEN? PN21B. HOW LONG AFTER DELIVERY DID THE FIRST OF THESE CHECKS HAPPEN? If less than one day, record hours. If less than one week, record days. Otherwise, record weeks. Hours . 1 __ __ Days . 2 __ __ Weeks . 3 __ __ DK/ Don't remember . 998 286 Palestinian Multiple Indicator Cluster Survey 2014 270 PN22. WHO CHECKED ON YOUR HEALTH AT THAT TIME? Health professional Doctor . A Nurse / Midwife . B Other person Traditional birth attendant (Daya) . F Relative / Friend . H Other (specify) _____________________ X PN23. WHERE DID THIS CHECK TAKE PLACE? Probe to identify the type of source. If unable to determine whether public or private, write the name of the place. (Name of place) Home Respondent’s home . 11 Other home . 12 Public Sector Government hospital . 21 Government clinic / health centre . 22 Private Sector Private hospital . 31 Private clinic . 32 Private maternity home . 33 NGO's Sector NGO's hospital/ health centre . 41 UNRWA Sector UNRWA hospital/ health centre . 51 Israeli Sector Israeli hospital/ health centre . 61 Other (specify) _____________________ 96 11Next Module 12Next Module 21Next Module 22Next Module 31Next Module 32Next Module 33Next Module 41Next Module 51Next Module 61Next Module 96Next Module 287 271 PN23A. WHAT IS THE MAIN REASON FOR NOT SEEKING FOR THE POSTNATAL CARE? There were no problems . 11 Has previous experience . 12 Not aware of the importance of check-up . 13 Service unavailable . 14 Service expensive . 15 Was busy . 16 Husband was busy . 17 Israeli measures were a barrier . 18 Other (specify) _____________________ 96 288 Palestinian Multiple Indicator Cluster Survey 2014 272 CONTRACEPTION CP CP0. Check MA1. Currently Married?  Yes, currently married  Continue with CP1  No  Go to HIV/AIDS Module CP1. I WOULD LIKE TO TALK WITH YOU ABOUT ANOTHER SUBJECT – FAMILY PLANNING. ARE YOU PREGNANT NOW? Yes, currently pregnant . 1 No . 2 Unsure or DK . 8 1CP2A CP2. COUPLES USE VARIOUS WAYS OR METHODS TO DELAY OR AVOID A PREGNANCY. ARE YOU CURRENTLY DOING SOMETHING OR USING ANY METHOD TO DELAY OR AVOID GETTING PREGNANT? Yes . 1 No . 2 1CP3 CP2AA. WHAT IS YOUR MAIN REASON FOR NOT CURRENTLY USING A FAMILY PLANNING METHOD? Desire to have a child . 11 I object family planning . 12 Husband objected . 13 Fear of side effects . 14 Availability/accessibility . 15 Expensive . 16 Inconvenient to use . 17 Menopause . 18 Infrequent sex / No sex . 19 Religious beliefs . 20 Infertile Husband/Wife . 21 Fatalistic . 22 Husband/Wife is sick . 23 Breastfeeding . 24 Too old . 25 Other (specify) ____________________ 96 CP2A. HAVE YOU EVER DONE SOMETHING OR USED ANY METHOD TO DELAY OR AVOID GETTING PREGNANT? Yes . 1 No . 2 1Next Module 2Next 289 273 Module CP3. WHAT ARE YOU DOING TO DELAY OR AVOID A PREGNANCY? Do not prompt. If more than one method is mentioned, circle each one. Female sterilization . A Male sterilization . B IUD . C Injectables . D Implants . E Pill . F Male condom . G Female condom . H Diaphragm . I Foam / Jelly . J Lactational amenorrhoea method (LAM) . K Periodic abstinence / Rhythm . L Withdrawal . M Other (specify) _____________________ X ACP4A BCP4A KCP5 L CP5 M CP5 X CP5 CP4. FROM WHERE DID YOU GET (CURRENT METHOD'S NAME) LAST TIME? CP4A: IN WHAT FACILITY DID THE STERILIZATION TAKE PLACE? Public sector Government hospital . 21 Government clinic / MCH centre . 22 Private Sector Private hospital . 31 Private clinic . 32 Pharmacy . 33 NGO's Sector NGO's hospital/ health centre . 41 UNRWA sector UNRWA hospital/ health centre . 51 Israeli sector Israeli hospital/ health centre . 61 Other (specify)_____________________ 96 CP5. DID YOU FACE ANY PROBLEMS WITH USING (CURRENT METHOD)? Yes . 1 No . 2 2Next Module 290 Palestinian Multiple Indicator Cluster Survey 2014 274 CP6. WHAT PROBLEMS DID YOU FACE? Probe: Any other problems? Side effects . A Method not effective . B Husband objected . C Availability/accessibility . D Expensive . E Inconvenient to use . F Other (specify) _____________________ X 291 275 UNMET NEED UN UN1. Check CP1. Currently pregnant?  Yes, currently pregnant  Continue with UN2  No, unsure or DK  Go to UN5 UN2. NOW I WOULD LIKE TO TALK TO YOU ABOUT YOUR CURRENT PREGNANCY. WHEN YOU GOT PREGNANT, DID YOU WANT TO GET PREGNANT AT THAT TIME? Yes . 1 No . 2 1UN4 UN3. DID YOU WANT TO HAVE A BABY LATER ON OR DID YOU NOT WANT ANY (MORE) CHILDREN? Later . 1 No more . 2 UN4. NOW I WOULD LIKE TO ASK SOME QUESTIONS ABOUT THE FUTURE. AFTER THE CHILD YOU ARE NOW EXPECTING, WOULD YOU LIKE TO HAVE ANOTHER CHILD, OR WOULD YOU PREFER NOT TO HAVE ANY MORE CHILDREN? Have another child . 1 No more / None . 2 Undecided / DK . 8 1UN7 2UN13 8UN13 UN5. Check CP3. Currently using “Female sterilization”?  Yes  Go to UN13  No  Continue with UN6 UN6. NOW I WOULD LIKE TO ASK YOU SOME QUESTIONS ABOUT THE FUTURE. WOULD YOU LIKE TO HAVE (A/ANOTHER) CHILD, OR WOULD YOU PREFER NOT TO HAVE ANY (MORE) CHILDREN? Have (a/another) child . 1 No more / None . 2 Says she cannot get pregnant . 3 Undecided / DK . 8 2UN9 3UN11 8UN9 UN7. HOW LONG WOULD YOU LIKE TO WAIT BEFORE THE BIRTH OF (A/ANOTHER) CHILD? Record the answer as stated by respondent. Months . 1 __ __ Years . 2 __ __ Does not want to wait (soon/now) . 993 Says she cannot get pregnant . 994 After marriage . 995 Other . 996 DK . 998 994UN11 UN8. Check CP1. Currently pregnant?  Yes, currently pregnant  Go to UN13  No, unsure or DK  Continue with UN9 292 Palestinian Multiple Indicator Cluster Survey 2014 276 UN9. Check CP2. Currently using a method?  Yes  Go to UN13  No  Continue with UN10 UN10. DO YOU THINK YOU ARE PHYSICALLY ABLE TO GET PREGNANT AT THIS TIME? Yes . 1 No . 2 DK . 8 1 UN13 8 UN13 UN11. WHY DO YOU THINK YOU ARE NOT PHYSICALLY ABLE TO GET PREGNANT? Infrequent sex / No sex . A Menopausal . B Never menstruated . C Hysterectomy (surgical removal of uterus) . D Has been trying to get pregnant for 2 years or more without result . E Postpartum amenorrhea . F Breastfeeding . G Too old . H Fatalistic . I Other (specify) _____________________ X DK . Z UN12. Check UN11. “Never menstruated” mentioned?  Mentioned  Go to Next Module  Not mentioned  Continue with UN13 UN13. WHEN DID YOUR LAST MENSTRUAL PERIOD START? Record the answer using the same unit stated by the respondent Days ago . 1 __ __ Weeks ago . 2 __ __ Months ago . 3 __ __ Years ago . 4 __ __ In menopause / Has had hysterectomy . 994 Before last birth . 995 Never menstruated . 996 293 277 HIV/AIDS HA HA1. NOW I WOULD LIKE TO TALK WITH YOU ABOUT SOMETHING ELSE. HAVE YOU EVER HEARD OF AN ILLNESS CALLED AIDS? Yes . 1 No . 2 2  WM11 HA2. CAN PEOPLE REDUCE THEIR CHANCE OF GETTING THE AIDS VIRUS BY HAVING JUST ONE UNINFECTED SEX PARTNER WHO HAS NO OTHER SEX PARTNERS? Yes . 1 No . 2 DK . 8 HA3. CAN PEOPLE GET THE AIDS VIRUS BECAUSE OF WITCHCRAFT OR OTHER SUPERNATURAL MEANS? Yes . 1 No . 2 DK . 8 HA4. CAN PEOPLE REDUCE THEIR CHANCE OF GETTING THE AIDS VIRUS BY USING A CONDOM EVERY TIME THEY HAVE SEX? Yes . 1 No . 2 DK . 8 HA5. CAN PEOPLE GET THE AIDS VIRUS FROM MOSQUITO BITES? Yes . 1 No . 2 DK . 8 HA6. CAN PEOPLE GET THE AIDS VIRUS BY SHARING FOOD WITH A PERSON WHO HAS THE AIDS VIRUS? Yes . 1 No . 2 DK . 8 HA7. IS IT POSSIBLE FOR A HEALTHY-LOOKING PERSON TO HAVE THE AIDS VIRUS? Yes . 1 No . 2 DK . 8 HA8. CAN THE VIRUS THAT CAUSES AIDS BE TRANSMITTED FROM A MOTHER TO HER BABY: [A] DURING PREGNANCY? [B] DURING DELIVERY? [C] BY BREASTFEEDING? Yes No DK During pregnancy . 1 2 8 During delivery . 1 2 8 By breastfeeding . 1 2 8 HA9. IN YOUR OPINION, IF A FEMALE TEACHER HAS THE AIDS VIRUS BUT IS NOT SICK, SHOULD SHE BE ALLOWED TO CONTINUE TEACHING IN SCHOOL? Yes . 1 No . 2 DK / Not sure / Depends . 8 294 Palestinian Multiple Indicator Cluster Survey 2014 278 HA10. WOULD YOU BUY FRESH VEGETABLES FROM A SHOPKEEPER OR VENDOR IF YOU KNEW THAT THIS PERSON HAD THE AIDS VIRUS? Yes . 1 No . 2 DK / Not sure / Depends . 8 HA11. IF A MEMBER OF YOUR FAMILY GOT INFECTED WITH THE AIDS VIRUS, WOULD YOU WANT IT TO REMAIN A SECRET? Yes . 1 No . 2 DK / Not sure / Depends . 8 HA12. IF A MEMBER OF YOUR FAMILY BECAME SICK WITH AIDS, WOULD YOU BE WILLING TO CARE FOR HER OR HIM IN YOUR OWN HOUSEHOLD? Yes . 1 No . 2 DK / Not sure / Depends . 8 HA27. DO YOU KNOW OF A PLACE WHERE PEOPLE CAN GO TO GET TESTED FOR THE AIDS VIRUS? Yes . 1 No . 2 WM11. Record the time. Hour and minutes . __ __ : __ __ WM12. Check List of Household Members, columns HL7 and HL15. Is the respondent the mother or caretaker of any child age 0-4 living in this household?  Yes  Proceed to complete the result of woman’s interview (WM7)on the cover and then go to QUESTIONNAIRE FOR CHILDREN UNDER FIVE for that child and start the interview with this respondent.  No  End the interview with this respondent by thanking her for her cooperation and proceed to complete the result of woman’s interview (WM7) on the cover page. 295 279 Interviewer’s Observations Field Editor’s Observations Supervisor’s Observations 296 Palestinian Multiple Indicator Cluster Survey 2014 280 State of Palestine Palestinian Central Bureau of Statistics QUESTIONNAIRE FOR CHILDREN UNDER FIVE Palestinian Multiple Indicator Cluster Survey, 2014 UNDER-FIVE CHILD INFORMATION PANEL UF This questionnaire is to be administered to all mothers or caretakers (see List of Household Members, column HL15) who care for a child that lives with them and is under the age of 5 years (see List of Household Members, column HL7B). A separate questionnaire should be used for each eligible child. UF1. Cluster number: UF2. Household number: ___ ___ ___ ___ ___ UF3. Child’s name: UF4. Child’s line number: Name ___ ___ UF5. Mother’s / Caretaker’s name: UF6. Mother’s / Caretaker’s line number: Name ___ ___ UF7. Interviewer’s name and number: UF8. Day / Month / Year of interview: Name ___ ___ ___ ___ ___ ___ ___ /___ ___ / 2014 Repeat greeting if not already read to this respondent: WE ARE FROM PALESTINIAN CENTRAL BUREAU OF STATISTICS. WE ARE CONDUCTING A SURVEY ABOUT THE SITUATION OF CHILDREN, FAMILIES AND HOUSEHOLDS. I WOULD LIKE TO TALK TO YOU ABOUT (child’s name from UF3)’S HEALTH AND WELL-BEING. THE INTERVIEW WILL TAKE ABOUT 25 MINUTES. ALL THE INFORMATION WE OBTAIN WILL REMAIN STRICTLY CONFIDENTIAL AND ANONYMOUS. If greeting at the beginning of the household questionnaire has already been read to this person, then read the following: NOW I WOULD LIKE TO TALK TO YOU MORE ABOUT (child’s name from UF3)’S HEALTH AND OTHER TOPICS. THIS INTERVIEW WILL TAKE ABOUT 25 MINUTES. AGAIN, ALL THE INFORMATION WE OBTAIN WILL REMAIN STRICTLY CONFIDENTIAL AND ANONYMOUS. MAY I START NOW?  Yes, permission is given  Go to UF12 to record the time and then begin the interview.  No, permission is not given  Circle ‘03’ in UF9. Discuss this result with your supervisor UF9. Result of interview for children under 5 Codes refer to mother/caretaker. Completed . 01 Not at home . 02 Refused . 03 Partly completed . 04 Incapacitated . 05 Other (specify) __________________________ 96 UF10. Field editor’s name and number: Name ___ ___ ___ ___ ___ UF11. Main data entry clerk’s name and number: Name . ___ ___ ___ ___ ___ 297 281 UF12. Record the time. Hour and minutes . __ __ : __ __ AGE AG AG1. NOW I WOULD LIKE TO ASK YOU SOME QUESTIONS ABOUT THE DEVELOPMENT AND HEALTH OF (name). ON WHAT DAY, MONTH AND YEAR WAS (name) BORN? Probe: WHAT IS HIS / HER BIRTHDAY? If the mother/caretaker knows the exact birth date, also enter the day; otherwise, circle 98 for day Month and year must be recorded. Date of birth Day . __ __ DK day . 98 Month . __ __ Year . 2 0 __ __ AG2. HOW OLD IS (name)? Probe: HOW OLD WAS (name) AT HIS / HER LAST BIRTHDAY? Record age in completed years. Record ‘0’ if less than 1 year. Compare and correct AG1 and/or AG2 if inconsistent. Age (in completed years) . __ 298 Palestinian Multiple Indicator Cluster Survey 2014 282 BIRTH REGISTRATION BR BR1. DOES (name) HAVE A BIRTH CERTIFICATE? If yes, ask: MAY I SEE IT? Yes, seen . 1 Yes, not seen . 2 No . 3 DK . 8 1Next Module 2Next Module BR2. HAS (name)’S BIRTH BEEN REGISTERED IN THE MINISTRY OF INTERIOR? Yes . 1 No . 2 DK . 8 1Next Module BR3. DO YOU KNOW HOW TO REGISTER (name)’S BIRTH? Yes . 1 No . 2 299 283 EARLY CHILDHOOD DEVELOPMENT EC EC1. HOW MANY CHILDREN’S BOOKS OR PICTURE BOOKS DO YOU HAVE FOR (name)? None . 00 Number of children’s books . 0 __ Ten or more books . 10 EC2. I AM INTERESTED IN LEARNING ABOUT THE THINGS THAT (name) PLAYS WITH WHEN HE/SHE IS AT HOME. DOES HE/SHE PLAY WITH: [A] HOMEMADE TOYS (SUCH AS DOLLS, CARS, OR OTHER TOYS MADE AT HOME)? [B] TOYS FROM A SHOP OR MANUFACTURED TOYS? [C] HOUSEHOLD OBJECTS (SUCH AS BOWLS OR POTS) OR OBJECTS FOUND OUTSIDE (SUCH AS STICKS, ROCKS, ANIMAL SHELLS OR LEAVES)? If the respondent says “YES” to the categories above, then probe to learn specifically what the child plays with to ascertain the response Y N DK Homemade toys . 1 2 8 Toys from a shop . 1 2 8 Household objects or outside objects . 1 2 8 EC3. SOMETIMES ADULTS TAKING CARE OF CHILDREN HAVE TO LEAVE THE HOUSE TO GO SHOPPING, WASH CLOTHES, OR FOR OTHER REASONS AND HAVE TO LEAVE YOUNG CHILDREN. ON HOW MANY DAYS IN THE PAST WEEK WAS (name): [A] LEFT ALONE FOR MORE THAN AN HOUR? [B] LEFT IN THE CARE OF ANOTHER CHILD, THAT IS, SOMEONE LESS THAN 10 YEARS OLD, FOR MORE THAN AN HOUR? If ‘none’ enter’ 0’. If ‘don’t know’ enter’8’ Number of days left alone for more than an hour . __ Number of days left with other child for more than an hour . __ EC4. Check AG2: Age of child  Child age 0, 1 or 2  Go to Next Module  Child age 3 or 4  Continue with EC5 EC5. DOES (name) ATTEND ANY ORGANIZED LEARNING OR EARLY CHILDHOOD EDUCATION PROGRAMME, SUCH AS A PRIVATE OR GOVERNMENT FACILITY, INCLUDING KINDERGARTEN OR COMMUNITY CHILD CARE? Yes . 1 No . 2 DK . 8 300 Palestinian Multiple Indicator Cluster Survey 2014 284 EC7. IN THE PAST 3 DAYS, DID YOU OR ANY HOUSEHOLD MEMBER AGE 15 OR OVER ENGAGE IN ANY OF THE FOLLOWING ACTIVITIES WITH (name): If yes, ask: WHO ENGAGED IN THIS ACTIVITY WITH (name)? Circle all that apply. Mother Father Other No one [A] READ BOOKS TO OR LOOKED AT PICTURE BOOKS WITH (name)? Read books A B X Y [B] TOLD STORIES TO (name)? Told stories A B X Y [C] SANG SONGS TO (name) OR WITH (name), INCLUDING LULLABIES? Sang songs A B X Y [D] TOOK (name) OUTSIDE THE HOME, COMPOUND, YARD OR ENCLOSURE? Took outside A B X Y [E] PLAYED WITH (name)? Played with A B X Y [F] NAMED, COUNTED, OR DREW THINGS TO OR WITH (name)? Named/counted A B X Y EC8. I WOULD LIKE TO ASK YOU SOME QUESTIONS ABOUT THE HEALTH AND DEVELOPMENT OF (name). CHILDREN DO NOT ALL DEVELOP AND LEARN AT THE SAME RATE. FOR EXAMPLE, SOME WALK EARLIER THAN OTHERS. THESE QUESTIONS ARE RELATED TO SEVERAL ASPECTS OF (name)’S DEVELOPMENT. CAN (name) IDENTIFY OR NAME AT LEAST TEN LETTERS OF THE ALPHABET? Yes . 1 No . 2 DK . 8 EC9. CAN (name) READ AT LEAST FOUR SIMPLE, POPULAR WORDS? Yes . 1 No . 2 DK . 8 EC10. DOES (name) KNOW THE NAME AND RECOGNIZE THE SYMBOL OF ALL NUMBERS FROM 1 TO 10? Yes . 1 No . 2 DK . 8 EC11. CAN (name) PICK UP A SMALL OBJECT WITH TWO FINGERS, LIKE A STICK OR A ROCK FROM THE GROUND? Yes . 1 No . 2 DK . 8 EC12. IS (name) SOMETIMES TOO SICK TO PLAY? Yes . 1 No . 2 DK . 8 EC13. DOES (name) FOLLOW SIMPLE DIRECTIONS ON HOW TO DO SOMETHING CORRECTLY? Yes . 1 No . 2 301 285 DK . 8 EC14. WHEN GIVEN SOMETHING TO DO, IS (name) ABLE TO DO IT INDEPENDENTLY? Yes . 1 No . 2 DK . 8 EC15. DOES (name) GET ALONG WELL WITH OTHER CHILDREN? Yes . 1 No . 2 DK . 8 EC16. DOES (name) KICK, BITE, OR HIT OTHER CHILDREN OR ADULTS? Yes . 1 No . 2 DK . 8 EC17. DOES (name) GET DISTRACTED EASILY? Yes . 1 No . 2 DK . 8 302 Palestinian Multiple Indicator Cluster Survey 2014 286 BREASTFEEDING AND DIETARY INTAKE BD BD1. Check AG2: Age of child  Child age 0, 1 or 2 years  Continue with BD2  Child age 3 or 4 years  Go to CARE OF ILLNESS Module BD2. HAS (name) EVER BEEN BREASTFED? Yes . 1 No . 2 DK . 8 2BD4 8BD4 BD3. IS (name) STILL BEING BREASTFED? Yes . 1 No . 2 DK . 8 BD4. YESTERDAY, DURING THE DAY OR NIGHT, DID (name) DRINK ANYTHING FROM A BOTTLE WITH A NIPPLE? Yes . 1 No . 2 DK . 8 BD5. DID (name) DRINK ORS (ORAL REHYDRATION SOLUTION) YESTERDAY, DURING THE DAY OR NIGHT? Yes . 1 No . 2 DK . 8 BD6. DID (name) DRINK OR EAT VITAMIN OR MINERAL SUPPLEMENTS OR ANY MEDICINES YESTERDAY, DURING THE DAY OR NIGHT? Yes . 1 No . 2 DK . 8 BD7. NOW I WOULD LIKE TO ASK YOU ABOUT (OTHER) LIQUIDS THAT (name) MAY HAVE HAD YESTERDAY DURING THE DAY OR THE NIGHT. I AM INTERESTED TO KNOW WHETHER (name) HAD THE ITEM EVEN IF COMBINED WITH OTHER FOODS. PLEASE INCLUDE LIQUIDS CONSUMED OUTSIDE OF YOUR HOME. DID (name) DRINK (Name of item) YESTERDAY DURING THE DAY OR THE NIGHT: Yes No DK [A] PLAIN WATER? Plain water 1 2 8 [B] JUICE DRINKS? like orange juice juice drinks 1 2 8 [C] Maraka? Like clear chicken, or clear meat Maraka. Clear Maraka (without any chicken or meat pieces) 1 2 8 [D] MILK SUCH AS TINNED, POWDERED, OR FRESH ANIMAL MILK? Milk 1 2 8 If yes: HOW MANY TIMES DID (name) DRINK MILK? If 7 or more times, record '7'. If unknown, record ‘8’. Number of times drank milk . __ [E] INFANT FORMULA? Infant formula 1 2 8 If yes: HOW MANY TIMES DID (name) DRINK INFANT FORMULA? If 7 or more times, record '7'. If unknown, record ‘8’. Number of times drank infant formula . __ [F] ANY OTHER LIQUIDS? SUCH AS DRINKING HERBS AND TEA. Other liquids (specify)______________ 1 2 8 303 287 . BD8. NOW I WOULD LIKE TO ASK YOU ABOUT (OTHER) FOODS THAT (name) MAY HAVE HAD YESTERDAY DURING THE DAY OR THE NIGHT. AGAIN, I AM INTERESTED TO KNOW WHETHER (name) HAD THE ITEM EVEN IF COMBINED WITH OTHER FOODS. PLEASE INCLUDE FOODS CONSUMED OUTSIDE OF YOUR HOME. DID (name) EAT (Name of food) YESTERDAY DURING THE DAY OR THE NIGHT: Yes No DK [A] YOGURT? Yogurt 1 2 8 If yes: HOW MANY TIMES DID (name) DRINK OR EAT YOGURT? If 7 or more times, record '7'. If unknown, record ‘8’. Number of times drank/ate yogurt . __ [B] CERELAC, OR NINOLAC? Cerelac, Ninolac 1 2 8 [C] BREAD, RICE, NOODLES, PORRIDGE, BULGUR OR OTHER FOODS MADE FROM GRAINS ? Foods made from grains 1 2 8 [D] CARROTS, SQUASH OR SWEET POTATOES THAT ARE YELLOW OR ORANGE INSIDE? Pumpkin, carrots, squash, etc. 1 2 8 [E] WHITE POTATOES, OR ANY OTHER FOODS MADE FROM ROOTS? White potatoes, white yams, manioc, cassava, etc. 1 2 8 [F] ANY DARK GREEN, SPINACH, MALLOW (KHUBAZEH) OR ANY LEAFY VEGETABLES? Dark green, leafy vegetables 1 2 8 [G] RIPE MANGOES, OR APRICOT? Ripe mangoes, or apricot 1 2 8 [H] ANY OTHER FRUITS OR VEGETABLES? LIKE PARSLEY, MINT OR GRAPE LEAVES,OR APPLE, BANANA Other fruits or vegetables 1 2 8 [I] LIVER, KIDNEY, HEART OR OTHER ORGAN MEATS? Liver, kidney, heart or other organ meats 1 2 8 [J] ANY MEAT, SUCH AS BEEF, LAMB, GOAT, CHICKEN, OR DUCK? Meat, such as beef, pork, lamb, goat, etc. 1 2 8 [K] EGGS? Eggs 1 2 8 [L] FRESH OR DRIED FISH OR SHELLFISH? Fresh or dried fish 1 2 8 [M] ANY FOODS MADE FROM BEANS, PEAS, LENTILS, OR NUTS? LIKE HUMOS Foods made from beans, peas, etc. 1 2 8 [N] CHEESE OR OTHER FOOD MADE FROM MILK, DRIED YOGURT (LABANEH), KASTARED? Cheese or other food made from milk 1 2 8 [P] ANY OTHER FOOD MADE WITH MILK? LIKE KASTARAD, SEMOLINA WITH MILK. Any other food made with Milk 1 2 8 [O] ANY OTHER SOLID, SEMI-SOLID, OR SOFT FOOD THAT I HAVE NOT MENTIONED? Other solid, semi-solid, or soft food (specify)_____________ 1 2 8 BD9. Check BD8 (Categories “A” through “O” )  At least one “Yes” or all “DK”  Go to BD11  Else  Continue with BD10 BD10. Probe to determine whether the child ate any solid, semi-solid or soft foods yesterday during the day or night  The child did not eat or the respondent does not know  Go to Next Module  The child ate at least one solid, semi-solid or soft food item mentioned by the respondent  Go back to BD8 and record food eaten yesterday [A to O]. When finished, continue with BD11 BD11. HOW MANY TIMES DID (name) EAT ANY SOLID, SEMI-SOLID OR SOFT FOODS YESTERDAY DURING Number of times . __ 288 THE DAY OR NIGHT? If 7 or more times, record '7'. DK . 8 304 Palestinian Multiple Indicator Cluster Survey 2014 289 IMMUNIZATION IM If an immunization (child health) card is available, copy the dates in IM3 for each type of immunization recorded on the card. IM6- IM17B will only be asked if a card is not available. IM1. DO YOU HAVE A CARD WHERE (name)’S VACCINATIONS ARE WRITTEN DOWN? If yes: MAY I SEE IT PLEASE? Yes, seen . 1 Yes, not seen . 2 No card . 3 1IM3 2IM6 IM2. DID YOU EVER HAVE A VACCINATION (child health) CARD FOR (name)? Yes . 1 No . 2 1IM6 2IM6 IM3. (a) Copy dates for each vaccination from the card. (b) Write ‘44’ in day column if card shows that vaccination was given but no date recorded. Date of Immunization Day Month Year HEP.B 1(HEPB AT BIRTH) HEP.B 1 BCG BCG IPV 1 IPV1 IPV 2 IPV2 PENTA1 DPT1+ HIB1 + HEP. B2 PENTA2 DPT2+ HIB2 + HEP. B3 PENTA3 DPT3+ HIB3 + HEP. B4 POLIO 1 OPV1 POLIO 2 OPV2 POLIO 3 OPV3 POLIO 4 OPV4 PNEUMOCOCCAL CONJUGATE PCV 1 PNEUMOCOCCAL CONJUGATE PCV 2 PNEUMOCOCCAL CONJUGATE PCV 3 MMR1 MMR1 MMR2 MMR2 DPT 4 DPT 4 IM4. Check IM3. Are all vaccines (HepB 1 to DPT4) recorded?  Yes Go to Next Module  No  Continue with IM5 305 290 IM5. IN ADDITION TO WHAT IS RECORDED ON THIS CARD, DID (name) RECEIVE ANY OTHER VACCINATIONS – INCLUDING VACCINATIONS RECEIVED IN CAMPAIGNS OR IMMUNIZATION DAYS OR CHILD HEALTH DAY?  Yes  Go back to IM3 and probe for these vaccinations and write ‘66’ in the corresponding day column for each vaccine mentioned. When finished, skip to Next Module  No/DK  Go to Next Module IM6. HAS (name) EVER RECEIVED ANY VACCINATIONS TO PREVENT HIM/HER FROM GETTING DISEASES, INCLUDING VACCINATIONS RECEIVED IN A CAMPAIGN OR IMMUNIZATION DAY OR CHILD HEALTH DAY? Yes . 1 No . 2 DK . 8 2 Next Module 8 Next Module IM7. HAS (name) EVER RECEIVED A BCG VACCINATION AGAINST TUBERCULOSIS – THAT IS, AN INJECTION IN THE ARM OR SHOULDER THAT USUALLY CAUSES A SCAR? Yes . 1 No . 2 DK . 8 IM7A. HAS (name) EVER RECEIVED A IPV INJECTION VACCINATION THAT IS A SHOT IN THE ARM AT THE AGE OF 1 MONTHS OR OLDER - TO PROTECT HIM/HER FROM POLIO? Yes . 1 No . 2 DK . 8 2IM8 8IM8 IM7B. HOW MANY TIMES WAS THE IPV VACCINE RECEIVED? Number of times . __ IM8. HAS (name) EVER RECEIVED ANY VACCINATION DROPS IN THE MOUTH TO PROTECT HIM/HER FROM POLIO0 Yes . 1 No . 2 DK . 8 2IM11 8IM11 IM9. WAS THE FIRST POLIO VACCINE RECEIVED IN THE AGE OF TWO MONTHS? Yes . 1 No . 2 IM10. HOW MANY TIMES WAS THE POLIO VACCINE RECEIVED? Number of times . __ IM11. HAS (name) EVER RECEIVED A PENTA (DPT+ HIB1 + HEPB2) VACCINATION – THAT IS, AN INJECTION IN THE THIGH TO PREVENT HIM/HER FROM GETTING TETANUS, WHOOPING COUGH, DIPHTHERIA AND TO PREVENT HIM/HER FROM GETTING HAEMOPHILUS INFLUENZAE TYPE B AND HEPATITIS B? Probe by indicating that DPT & Hib vaccination is sometimes given at the same time as Polio Yes . 1 No . 2 DK . 8 2IM12B 8IM12B IM12. HOW MANY TIMES WAS THE DPT & HIB VACCINE RECEIVED? Number of times . __ IM12B. HAS (name) EVER RECEIVED THE FOURTH DOOSE OF DPT VACCINATION – THAT IS, AN INJECTION IN THE THIGH TO PREVENT HIM/HER FROM GETTING TETANUS, WHOOPING COUGH, DIPHTHERIA ? Yes . 1 No . 2 DK . 8 IM14. WAS THE FIRST HEPATITIS B VACCINE RECEIVED WITHIN 24 HOURS AFTER BIRTH? Yes . 1 No . 2 DK . 8 IM16A. HAS (name) EVER RECEIVED A MMR INJECTION – THAT IS, A SHOT IN THE ARM AT THE AGE OF 12 MONTHS OR OLDER - TO PREVENT Yes . 1 No . 2 2 IM17A 306 Palestinian Multiple Indicator Cluster Survey 2014 291 HIM/HER FROM GETTING MEASLES, MUMPS AND RUBELLA? DK . 8 8 IM17A IM16B. HOW MANY TIMES WAS A MMR RECEIVED? Number of times . __ IM17A: HAS (name) EVER RECEIVED A PCV INJECTION – THAT IS, A SHOT IN THE ARM AT THE AGE OF 2 MONTHS, 4 MONTHS AND 12 MONTHS - TO PREVENT HIM/HER FROM GETTING PNEUMOCOCCAL CONJUGATE? Yes . 1 No . 2 DK . 8 2 Next Module 8 Next Module IM17B: HOW MANY TIMES WAS A PCV RECEIVED? Number of times . __ 307 292 CARE OF ILLNESS CA CA1. IN THE LAST TWO WEEKS, HAS (name) HAD DIARRHOEA? Yes . 1 No . 2 DK . 8 2CA7 8CA7 CA2. I WOULD LIKE TO KNOW HOW MUCH (name) WAS GIVEN TO DRINK DURING THE DIARRHOEA (INCLUDING BREASTMILK). DURING THE TIME (name) HAD DIARRHOEA, WAS HE/SHE GIVEN LESS THAN USUAL TO DRINK, ABOUT THE SAME AMOUNT, OR MORE THAN USUAL? If ‘less’, probe: WAS HE/SHE GIVEN MUCH LESS THAN USUAL TO DRINK, OR SOMEWHAT LESS? Much less . 1 Some what less . 2 About the same . 3 More . 4 Nothing to drink . 5 DK . 8 CA3. DURING THE TIME (name) HAD DIARRHOEA, WAS HE/SHE GIVEN LESS THAN USUAL TO EAT, ABOUT THE SAME AMOUNT, MORE THAN USUAL, OR NOTHING TO EAT? If ‘less’, probe: WAS HE/SHE GIVEN MUCH LESS THAN USUAL TO EAT OR SOMEWHAT LESS? Much less . 1 Somewhat less . 2 About the same . 3 More . 4 Stopped food . 5 Never gave food . 6 DK . 8 CA3A. DID YOU SEEK ANY ADVICE OR TREATMENT FOR THE DIARRHOEA FROM ANY SOURCE? Yes . 1 No . 2 DK . 8 2CA4 8CA4 CA3B. FROM WHERE DID YOU SEEK ADVICE OR TREATMENT? Probe: ANYWHERE ELSE? Circle all providers mentioned, but do NOT prompt with any suggestions. Probe to identify each type of source. If unable to determine if public or private sector, write the name of the place. (Name of place) Public sector Government hospital . A Government health centre/clinic . B Mobile / Outreach clinic . E Private medical sector Private hospital / clinic . I Private physician . J Private pharmacy . K Other source Relative / Friend . P Traditional practitioner . R NGO's Medical Sector NGO's hospital/ health clinic . S UNRWA Medical sector UNRWA hospital/ health centre . T Israeli Medical sector Israeli hospital/ health centre . U Other (specify) _____________________ X 308 Palestinian Multiple Indicator Cluster Survey 2014 292 CARE OF ILLNESS CA CA1. IN THE LAST TWO WEEKS, HAS (name) HAD DIARRHOEA? Yes . 1 No . 2 DK . 8 2CA7 8CA7 CA2. I WOULD LIKE TO KNOW HOW MUCH (name) WAS GIVEN TO DRINK DURING THE DIARRHOEA (INCLUDING BREASTMILK). DURING THE TIME (name) HAD DIARRHOEA, WAS HE/SHE GIVEN LESS THAN USUAL TO DRINK, ABOUT THE SAME AMOUNT, OR MORE THAN USUAL? If ‘less’, probe: WAS HE/SHE GIVEN MUCH LESS THAN USUAL TO DRINK, OR SOMEWHAT LESS? Much less . 1 Some what less . 2 About the same . 3 More . 4 Nothing to drink . 5 DK . 8 CA3. DURING THE TIME (name) HAD DIARRHOEA, WAS HE/SHE GIVEN LESS THAN USUAL TO EAT, ABOUT THE SAME AMOUNT, MORE THAN USUAL, OR NOTHING TO EAT? If ‘less’, probe: WAS HE/SHE GIVEN MUCH LESS THAN USUAL TO EAT OR SOMEWHAT LESS? Much less . 1 Somewhat less . 2 About the same . 3 More . 4 Stopped food . 5 Never gave food . 6 DK . 8 CA3A. DID YOU SEEK ANY ADVICE OR TREATMENT FOR THE DIARRHOEA FROM ANY SOURCE? Yes . 1 No . 2 DK . 8 2CA4 8CA4 CA3B. FROM WHERE DID YOU SEEK ADVICE OR TREATMENT? Probe: ANYWHERE ELSE? Circle all providers mentioned, but do NOT prompt with any suggestions. Probe to identify each type of source. If unable to determine if public or private sector, write the name of the place. (Name of place) Public sector Government hospital . A Government health centre/clinic . B Mobile / Outreach clinic . E Private medical sector Private hospital / clinic . I Private physician . J Private pharmacy . K Other source Relative / Friend . P Traditional practitioner . R NGO's Medical Sector NGO's hospital/ health clinic . S UNRWA Medical sector UNRWA hospital/ health centre . T Israeli Medical sector Israeli hospital/ health centre . U Other (specify) _____________________ X 293 CA4. DURING THE TIME (name) HAD DIARRHOEA, WAS (name) GIVEN TO DRINK: [A] A FLUID MADE FROM A SPECIAL PACKET CALLED ORS PACKET SOLUTION? [B] A PRE-PACKAGED ORS FLUID FOR DIARRHOEA IF ANY PRE-PACKAGED ORS FLUID? Y N DK Fluid from ORS packet . 1 2 8 Pre-packaged ORS fluid . 1 2 8 CA4A. Check CA4: ORS  Child was given ORS (‘Yes’ circled in ‘A’ or ‘B’ in CA4)  Continue with CA4B  Child was not given ORS  Go to CA5 309 294 CA4B. WHERE DID YOU GET THE ORS? Probe to identify the type of source. If unable to determine whether public or private, write the name of the place. (Name of place) Public sector Government hospital . 11 Government health centre/clinic . 12 Mobile / Outreach clinic . 15 Private medical sector Private hospital / clinic . 21 Private physician . 22 Private pharmacy . 23 Other source Relative / Friend . 31 Traditional practitioner . 33 Already had at home . 40 NGO's Medical Sector NGO's hospital/ health clinic . 41 UNRWA Medical sector UNRWA hospital/ health centre . 51 Israeli Medical sector Israeli hospital/ health centre . 61 Other (specify) _____________________ 96 CA5. WAS ANYTHING (ELSE) GIVEN TO TREAT THE DIARRHOEA? Yes . 1 No . 2 DK . 8 2CA7 2CA7 CA6. WHAT (ELSE) WAS GIVEN TO TREAT THE DIARRHOEA? Probe: ANYTHING ELSE? Record all treatments given. Write brand name(s) of all medicines mentioned. (Name) Pill or Syrup Antibiotic . A Antimotility . B Unknown pill or syrup . H Injection Antibiotic . L Unknown injection . N Intravenous . O Home remedy / Herbal medicine . Q Other (specify) ______________________ X CA7. AT ANY TIME IN THE LAST TWO WEEKS, HAS (name) HAD AN ILLNESS WITH A COUGH? Yes . 1 No . 2 DK . 8 2UF13 8UF13 CA8. WHEN (name) HAD AN ILLNESS WITH A COUGH, DID HE/SHE BREATHE FASTER THAN USUAL WITH SHORT, RAPID BREATHS OR HAVE DIFFICULTY BREATHING? Yes . 1 No . 2 DK . 8 2CA10 8CA10 310 Palestinian Multiple Indicator Cluster Survey 2014 294 CA4B. WHERE DID YOU GET THE ORS? Probe to identify the type of source. If unable to determine whether public or private, write the name of the place. (Name of place) Public sector Government hospital . 11 Government health centre/clinic . 12 Mobile / Outreach clinic . 15 Private medical sector Private hospital / clinic . 21 Private physician . 22 Private pharmacy . 23 Other source Relative / Friend . 31 Traditional practitioner . 33 Already had at home . 40 NGO's Medical Sector NGO's hospital/ health clinic . 41 UNRWA Medical sector UNRWA hospital/ health centre . 51 Israeli Medical sector Israeli hospital/ health centre . 61 Other (specify) _____________________ 96 CA5. WAS ANYTHING (ELSE) GIVEN TO TREAT THE DIARRHOEA? Yes . 1 No . 2 DK . 8 2CA7 2CA7 CA6. WHAT (ELSE) WAS GIVEN TO TREAT THE DIARRHOEA? Probe: ANYTHING ELSE? Record all treatments given. Write brand name(s) of all medicines mentioned. (Name) Pill or Syrup Antibiotic . A Antimotility . B Unknown pill or syrup . H Injection Antibiotic . L Unknown injection . N Intravenous . O Home remedy / Herbal medicine . Q Other (specify) ______________________ X CA7. AT ANY TIME IN THE LAST TWO WEEKS, HAS (name) HAD AN ILLNESS WITH A COUGH? Yes . 1 No . 2 DK . 8 2UF13 8UF13 CA8. WHEN (name) HAD AN ILLNESS WITH A COUGH, DID HE/SHE BREATHE FASTER THAN USUAL WITH SHORT, RAPID BREATHS OR HAVE DIFFICULTY BREATHING? Yes . 1 No . 2 DK . 8 2CA10 8CA10 295 CA9. WAS THE FAST OR DIFFICULT BREATHING DUE TO A PROBLEM IN THE CHEST OR A BLOCKED OR RUNNY NOSE? Problem in chest only . 1 Blocked or runny nose only . 2 Both . 3 Other (specify) ______________________ 6 DK . 8 CA10. DID YOU SEEK ANY ADVICE OR TREATMENT FOR THE ILLNESS FROM ANY SOURCE? Yes . 1 No . 2 DK . 8 2CA12 8CA12 CA11. FROM WHERE DID YOU SEEK ADVICE OR TREATMENT? Probe: ANYWHERE ELSE? Circle all providers mentioned, but do NOT prompt with any suggestions. Probe to identify each type of source. If unable to determine if public or private sector, write the name of the place. (Name of place) Public sector Government hospital . A Government health centre/clinic . B Mobile / Outreach clinic . E Private medical sector Private hospital / clinic . I Private physician . J Private pharmacy . K Other source Relative / Friend . P Traditional practitioner . R NGO's Medical Sector NGO's hospital/ health clinic . S UNRWA Medical sector UNRWA hospital/ health centre . T Israeli Medical sector Israeli hospital/ health centre . U Other (specify) ______________________ X CA12. AT ANY TIME DURING THE ILLNESS, WAS (name) GIVEN ANY MEDICINE FOR THE ILLNESS? Yes . 1 No . 2 DK . 8 2UF13 8UF13 CA13. WHAT MEDICINE WAS (name) GIVEN? Probe: ANY OTHER MEDICINE? Circle all medicines given. Write brand name(s) of all medicines mentioned. (Names of medicines) Antibiotic: Pill / Syrup . I Injection . J Other medications: Paracetamol/ Panadol /Acamol . P Ibuprofen . R Other (specify) ______________________ X DK . Z CA13A. Check CA13: Antibiotic mentioned (codes I or J)?  Yes  Continue with CA13B  No  Go to UF13 311 296 CA13B. WHERE DID YOU GET THE (NAME OF MEDICINE FROM CA13)? Probe to identify the type of source. If unable to determine whether public or private, write the name of the place. (Name of place) Public sector Government hospital . 11 Government health centre/clinic . 12 Mobile / Outreach clinic . 15 Private medical sector Private hospital / clinic . 21 Private physician . 22 Private pharmacy . 23 Other source Relative / Friend . 31 Traditional practitioner . 33 Already had at home . 40 NGO's Medical Sector NGO's hospital/ health clinic . 41 UNRWA Medical sector UNRWA hospital/ health centre . 51 Israeli Medical sector Israeli hospital/ health centre . 61 Other (specify) _____________________ 96 UF13. Record the time. Hour and minutes . __ __ : __ __ UF14. Check List of Household Members, columns HL7B and HL15. Is the respondent the mother or caretaker of another child age 0-4 living in this household?  Yes  Indicate to the respondent that you will need to measure the weight and height of the child later. Go to the next QUESTIONNAIRE FOR CHILDREN UNDER FIVE to be administered to the same respondent  No  End the interview with this respondent by thanking her/him for her/his cooperation and tell her/him that you will need to measure the weight and height of the child before you leave the household Check to see if there are other woman’s, man’s or under-5 questionnaires to be administered in this household. 312 Palestinian Multiple Indicator Cluster Survey 2014 297 ANTHROPOMETRY AN After questionnaires for all children are complete, the measurer weighs and measures each child. Record weight and length/height below, taking care to record the measurements on the correct questionnaire for each child. Check the child’s name and line number in the List of Household Members before recording measurements. AN1. Measurer’s name and number: Name ___ ___ AN2. Result of height / length and weight measurement Either or both measured . 1 Child not present . 2 Child or mother/caretaker refused . 3 Other (specify) ______________________ 6 2AN6 3AN6 6AN6 AN3. Child’s weight Kilograms (kg) . __ __ . __ Weight not measured . 99.9 AN3A. Was the child undressed to the minimum?  Yes  No, the child could not be undressed to the minimum AN3B. Check age of child in AG2:  Child under 2 years old.  Measure length (lying down).  Child age 2 or more years.  Measure height (standing up). AN4. Child’s length / height (cm) Length / Height . __ __ __ . __ Length / Height not measured . 999.9  AN6 AN4A. How was the child actually measured? Lying down or standing up? Lying down . 1 Standing up . 2 AN6. Is there another child in the household who is eligible for measurement?  Yes  Record measurements for next child.  No  Check if there are any other individual questionnaires to be completed in the household. 313 298 Interviewer’s Observations Field Editor’s Observations Supervisor’s Observations Measurer’s Observations 298 Interviewer’s Observations Field Editor’s Observations Supervisor’s Observations Measurer’s Observations 314 Palestinian Multiple Indicator Cluster Survey 2014 298 Interviewer’s Observations Field Editor’s Observations Supervisor’s Observations Measurer’s Observations 297 Appendix G. ISCED Tables Education in Palestine according to the International Standard Classification of Education (ISCED) The methodology applied in MICS5 is designed to respond to the needs and standards of the country in which the survey is being implemented and to respond to global reporting criteria on the situation of women, and children. For this reason, the 2014 Palestinian MICS presents data on education based on the national standards for preschool, primary and secondary education and relevant data on education according to ISCED. In order to present data on education in Palestine according to ISCED the following criteria were used: The classification of primary school and secondary school education in Palestine according to ISCED 2011 comprises of the following: (i) ISCED 1 — primary school, corresponding to grades 1-4 of primary school (typically for ages 6-9 years); (ii) ISCED 2 — lower secondary school, corresponding to grades 5-10 of primary school within the national education system (typically for ages 10-15 years); and (iii) ISCED 3 — upper secondary school, corresponding to grades 11-12 of secondary school within the national education system (typically for ages 16-17 years). For global reporting purposes, lower secondary school and upper secondary school are combined as secondary school education. 315 29 8 Ta bl e ED .4 (I SC ED ): Pr im 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 P er ce nt ag e of c hi ld re n of p rim ar y sc ho ol a ge a tte nd in g pr im ar y or s ec on da ry s ch oo l ( ad ju st ed n et a tte nd an ce ra tio ), pe rc en ta ge a tte nd in g pr es ch oo l, an d pe rc en ta ge o ut o f sc ho ol , P al es tin e, 2 01 4 M al e Fe m al e To ta l N et at te nd an ce ra tio (a dj us te d) Pe rc en ta ge o f c hi ld re n: N um be r of ch ild re n N et at te nd an ce ra tio (a dj us te d) Pe rc en ta ge o f c hi ld re n: N um be r of ch ild re n N et at te nd an ce ra tio (a dj us te d) 1 Pe rc en ta ge o f c hi ld re n: N um be r of ch ild re n N ot at te nd in g sc ho ol o r pr es ch oo l A tte nd in g pr es ch oo l O ut o f sc ho ol a N ot at te nd in g sc ho ol o r pr es ch oo l A tte nd in g pr es ch oo l O ut o f sc ho ol a N ot at te nd in g sc ho ol o r pr es ch oo l A tte nd in g pr es ch oo l O ut o f sc ho ol a To ta l 98 .8 0. 7 0. 5 1. 2 29 20 98 .8 0. 7 0. 4 1. 2 29 29 98 .8 0. 7 0. 5 1. 2 58 49 R eg io n W es t B an k 98 .7 0. 9 0. 4 1. 3 16 72 99 .1 0. 5 0. 4 0. 9 16 80 98 .9 0. 7 0. 4 1. 1 33 52 G az a S tri p 98 .8 0. 5 0. 6 1. 2 12 48 98 .5 1. 1 0. 5 1. 5 12 49 98 .7 0. 8 0. 5 1. 3 24 97 G ov er no ra te Je ni n 99 .4 0. 6 0. 0 0. 6 16 4 10 0. 0 0. 0 0. 0 0. 0 19 4 99 .7 0. 3 0. 0 0. 3 35 9 Tu ba s 96 .8 0. 0 3. 2 3. 2 34 (1 00 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) 28 98 .2 0. 0 1. 8 1. 8 62 Tu lk ar m 96 .9 2. 3 0. 8 3. 1 10 1 99 .0 0. 0 1. 0 1. 0 88 97 .9 1. 2 0. 9 2. 1 18 9 N ab lu s 10 0. 0 0. 0 0. 0 0. 0 23 8 99 .5 0. 5 0. 0 0. 5 21 1 99 .8 0. 2 0. 0 0. 2 44 9 Q al qi liy a 10 0. 0 0. 0 0. 0 0. 0 51 96 .4 3. 6 0. 0 3. 6 54 98 .2 1. 8 0. 0 1. 8 10 5 S al fit 98 .8 1. 2 0. 0 1. 2 49 (9 8. 4) (0 .0 ) (1 .6 ) (1 .6 ) 44 98 .6 0. 7 0. 8 1. 4 93 R am al la h & A l- B ire h 98 .4 1. 6 0. 0 1. 6 14 8 99 .6 0. 0 0. 4 0. 4 17 1 99 .0 0. 8 0. 2 1. 0 31 9 Je ric ho a nd A l A gh w ar 10 0. 0 0. 0 0. 0 0. 0 37 (9 8. 4) (1 .6 ) (0 .0 ) (1 .6 ) (3 1) 99 .3 0. 7 0. 0 0. 7 68 Je ru sa le m 98 .0 1. 2 0. 8 2. 0 28 3 99 .2 0. 8 0. 0 0. 8 25 3 98 .6 1. 0 0. 4 1. 4 53 5 B et hl eh em 10 0. 0 0. 0 0. 0 0. 0 11 4 99 .4 0. 6 0. 0 0. 6 15 3 99 .7 0. 3 0. 0 0. 3 26 7 H eb ro n 98 .4 1. 0 0. 6 1. 6 45 3 98 .6 0. 4 0. 9 1. 4 45 3 98 .5 0. 7 0. 8 1. 5 90 6 N or th G az a 98 .7 0. 4 0. 9 1. 3 23 8 98 .7 0. 8 0. 5 1. 3 26 8 98 .7 0. 6 0. 7 1. 3 50 6 G az a 99 .5 0. 2 0. 2 0. 5 47 5 98 .7 0. 8 0. 5 1. 3 44 7 99 .1 0. 5 0. 4 0. 9 92 2 D ei r E l-B al ah 96 .1 2. 3 1. 6 3. 9 16 3 98 .9 1. 1 0. 0 1. 1 19 3 97 .7 1. 6 0. 7 2. 3 35 5 K ha n Y un is 10 0. 0 0. 0 0. 0 0. 0 22 0 97 .2 1. 8 1. 0 2. 8 20 7 98 .7 0. 9 0. 5 1. 3 42 7 R af ah 97 .9 0. 8 1. 4 2. 1 15 3 98 .6 1. 4 0. 0 1. 4 13 4 98 .2 1. 1 0. 7 1. 8 28 7 A re a U rb an 98 .6 0. 8 0. 6 1. 4 21 68 99 .0 0. 6 0. 4 1. 0 21 92 98 .8 0. 7 0. 5 1. 2 43 59 R ur al 99 .7 0. 3 0. 0 0. 3 48 5 98 .5 1. 0 0. 6 1. 5 46 4 99 .1 0. 6 0. 3 0. 9 94 9 C am p 98 .7 0. 8 0. 5 1. 3 26 7 98 .5 1. 1 0. 4 1. 5 27 4 98 .6 1. 0 0. 4 1. 4 54 1 [1 ] M IC S in di ca to r 7 .4 ; M D G 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 c hi ld re n of p rim ar y sc ho ol a ge o ut o f s ch oo l a re th os e no t a tte nd in g sc ho ol a nd th os e at te nd in g pr es ch oo l ( ) F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s 316 Palestinian Multiple Indicator Cluster Survey 2014 29 9 Ta bl e ED .4 (I SC ED ) C on tin ue d: 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 P er ce nt ag e of c hi ld re n of p rim ar y sc ho ol a ge a tte nd in g pr im ar y or s ec on da ry s ch oo l ( ad ju st ed n et a tte nd an ce ra tio ), pe rc en ta ge a tte nd in g pr es ch oo l, an d pe rc en ta ge o ut o f sc ho ol , P al es tin e, 2 01 4 M al e Fe m al e To ta l N et at te nd an ce ra tio (a dj us te d) Pe rc en ta ge o f c hi ld re n: N um be r of ch ild re n N et at te nd an ce ra tio (a dj us te d) Pe rc en ta ge o f c hi ld re n: N um be r of ch ild re n N et at te nd an ce ra tio (a dj us te d) 1 Pe rc en ta ge o f c hi ld re n: N um be r of ch ild re n N ot at te nd in g sc ho ol o r pr es ch oo l A tte nd in g pr es ch oo l O ut o f sc ho ol a N ot at te nd in g sc ho ol o r pr es ch oo l A tte nd in g pr es ch oo l O ut o f sc ho ol a N ot at te nd in g sc ho ol o r pr es ch oo l A tte nd in g pr es ch oo l O ut o f sc ho ol a A ge a t b eg in ni ng of s ch oo l y ea r 6 97 .3 0. 7 2. 1 2. 7 72 6 97 .0 1. 4 1. 6 3. 0 74 7 97 .1 1. 0 1. 8 2. 9 14 73 7 99 .2 0. 8 0. 0 0. 8 77 1 99 .1 0. 9 0. 0 0. 9 72 9 99 .1 0. 9 0. 0 0. 9 15 00 8 99 .5 0. 5 0. 0 0. 5 70 2 99 .5 0. 5 0. 0 0. 5 74 3 99 .5 0. 5 0. 0 0. 5 14 45 9 99 .1 0. 9 0. 0 0. 9 72 1 99 .8 0. 2 0. 0 0. 2 71 1 99 .5 0. 5 0. 0 0. 5 14 31 6 97 .3 0. 7 2. 1 2. 7 72 6 97 .0 1. 4 1. 6 3. 0 74 7 97 .1 1. 0 1. 8 2. 9 14 73 M ot he r's ed uc at io n N on e (9 6. 1) (0 .0 ) (3 .9 ) (3 .9 ) 27 91 .7 8. 3 0. 0 8. 3 24 (9 4. 0) (3 .9 ) (2 .1 ) (6 .0 ) 51 B as ic 98 .9 0. 5 0. 6 1. 1 12 74 98 .6 0. 9 0. 5 1. 4 12 58 98 .8 0. 7 0. 6 1. 2 25 32 S ec on da ry 98 .7 0. 8 0. 5 1. 3 93 5 99 .0 0. 4 0. 6 1. 0 93 4 98 .8 0. 6 0. 6 1. 2 18 68 H ig he r 98 .7 1. 2 0. 2 1. 3 68 4 99 .4 0. 6 0. 0 0. 6 71 4 99 .1 0. 9 0. 1 0. 9 13 98 C an no t b e de te rm in ed W ea lth in de x qu in til e P oo re st 98 .8 0. 7 0. 6 1. 2 63 7 98 .4 1. 6 0. 0 1. 6 60 0 98 .6 1. 1 0. 3 1. 4 12 37 S ec on d 99 .2 0. 4 0. 4 0. 8 55 6 97 .8 0. 9 1. 3 2. 2 60 8 98 .5 0. 6 0. 9 1. 5 11 64 M id dl e 98 .3 1. 2 0. 5 1. 7 60 1 98 .9 0. 6 0. 5 1. 1 58 9 98 .6 0. 9 0. 5 1. 4 11 90 Fo ur th 99 .0 0. 9 0. 1 1. 0 53 4 99 .9 0. 0 0. 1 0. 1 56 8 99 .4 0. 4 0. 1 0. 6 11 02 R ic he st 98 .6 0. 5 1. 0 1. 4 59 1 99 .4 0. 5 0. 1 0. 6 56 4 99 .0 0. 5 0. 6 1. 0 11 56 [1 ] M IC S in di ca to r 7 .4 ; M D G 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 c hi ld re n of p rim ar y sc ho ol a ge o ut o f s ch oo l a re th os e no t a tte nd in g sc ho ol a nd th os e at te nd in g pr es ch oo l ( ) F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s 317 30 0 Ta bl e ED .5 (I SC ED ): 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 P er ce nt ag e of c hi ld re n of s ec on da ry s ch oo l a ge a tte nd in g se co nd ar y sc ho ol o r h ig he r ( ad ju st ed n et a tte nd an ce ra tio ), pe rc en ta ge a tte nd in g pr im ar y sc ho ol , a nd p er ce nt ag e ou t o f s ch oo l, P al es tin e, 2 01 4 M al e Fe m al e To ta l N et a tte nd an ce ra tio (a dj us te d) Pe rc en ta ge o f c hi ld re n: N um be r o f ch ild re n N et a tte nd an ce ra tio (a dj us te d) Pe rc en ta ge o f c hi ld re n: N um be r o f ch ild re n N et a tte nd an ce ra tio (a dj us te d) 1 Pe rc en ta ge o f c hi ld re n: N um be r o f ch ild re n A tte nd in g pr im ar y sc ho ol O ut o f sc ho ol a A tte nd in g pr im ar y sc ho ol O ut o f sc ho ol a A tte nd in g pr im ar y sc ho ol O ut o f sc ho ol a To ta l 85 .3 0. 8 13 .8 53 86 94 .4 0. 5 5. 0 52 03 89 .8 0. 7 9. 5 10 58 9 R eg io n W es t B an k 84 .5 0. 5 14 .9 32 32 94 .8 0. 5 4. 6 30 83 89 .5 0. 5 9. 9 63 15 G az a S tri p 86 .6 1. 2 12 .3 21 53 93 .9 0. 5 5. 6 21 21 90 .2 0. 8 9. 0 42 74 G ov er no ra te Je ni n 84 .6 0. 6 14 .6 33 7 97 .3 0. 0 2. 7 33 6 90 .9 0. 3 8. 6 67 3 Tu ba s 88 .0 0. 7 11 .3 65 96 .4 0. 0 3. 6 56 91 .9 0. 4 7. 8 12 2 Tu lk ar m 83 .8 0. 0 16 .2 18 1 98 .6 0. 0 1. 4 18 3 91 .2 0. 0 8. 8 36 4 N ab lu s 88 .0 0. 2 11 .8 42 8 96 .3 0. 5 2. 8 38 9 91 .9 0. 4 7. 5 81 7 Q al qi liy a 90 .1 0. 0 9. 9 11 7 97 .6 0. 0 2. 4 10 4 93 .6 0. 0 6. 4 22 1 S al fit 85 .7 0. 0 14 .3 81 96 .2 0. 0 3. 8 80 90 .9 0. 0 9. 1 16 1 R am al la h & A l-B ire h 86 .9 1. 0 12 .1 33 6 96 .3 0. 0 3. 4 31 5 91 .5 0. 5 7. 9 65 1 Je ric ho a nd A l A gh w ar 74 .5 0. 0 25 .5 55 83 .9 0. 9 15 .1 55 79 .2 0. 5 20 .3 11 0 Je ru sa le m 85 .9 0. 6 13 .3 52 0 94 .5 0. 8 4. 8 50 3 90 .1 0. 7 9. 1 10 23 B et hl eh em 85 .8 0. 4 13 .8 25 8 94 .9 0. 0 5. 1 28 8 90 .6 0. 2 9. 2 54 5 H eb ro n 80 .2 0. 8 19 .0 85 3 91 .8 1. 3 6. 9 77 5 85 .7 1. 0 13 .2 16 28 N or th G az a 85 .8 1. 2 13 .0 42 9 91 .5 1. 2 7. 3 37 9 88 .5 1. 2 10 .3 80 8 G az a 84 .2 1. 4 14 .4 78 8 93 .3 0. 5 6. 2 80 8 88 .8 1. 0 10 .2 15 96 D ei r E l-B al ah 86 .4 1. 4 12 .1 32 3 95 .8 0. 0 4. 2 33 5 91 .2 0. 7 8. 1 65 8 K ha n Y un is 88 .4 0. 5 11 .1 38 9 95 .5 0. 2 4. 3 38 9 91 .9 0. 4 7. 7 77 8 R af ah 93 .5 0. 9 5. 6 22 4 94 .1 0. 8 5. 1 20 9 93 .8 0. 8 5. 4 43 4 [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 c hi ld re n of s ec on da ry s ch oo l a ge o ut o f s ch oo l a re th os e w ho a re n ot a tte nd in g pr im ar y, s ec on da ry , o r h ig he r e du ca tio n [b ] C hi ld re n ag e 15 o r h ig he r a t t he ti m e of th e in te rv ie w w ho se m ot he rs w er e no t l iv in g in th e ho us eh ol d 318 Palestinian Multiple Indicator Cluster Survey 2014 30 1 Ta bl e ED .5 (I SC ED ) C on tin ue d: 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 P er ce nt ag e of c hi ld re n of s ec on da ry s ch oo l a ge a tte nd in g se co nd ar y sc ho ol o r h ig he r ( ad ju st ed n et a tte nd an ce ra tio ), pe rc en ta ge a tte nd in g pr im ar y sc ho ol , a nd p er ce nt ag e ou t o f s ch oo l, P al es tin e, 2 01 4 M al e Fe m al e To ta l N et at te nd an ce ra tio (a dj us te d) Pe rc en ta ge o f c hi ld re n: N um be r of ch ild re n N et at te nd an ce ra tio (a dj us te d) Pe rc en ta ge o f c hi ld re n: N um be r of ch ild re n N et at te nd an ce ra tio (a dj us te d) 1 Pe rc en ta ge o f c hi ld re n: N um be r of ch ild re n A tte nd in g pr im ar y sc ho ol O ut o f sc ho ol a A tte nd in g pr im ar y sc ho ol O ut o f sc ho ol a A tte nd in g pr im ar y sc ho ol O ut o f sc ho ol a A re a U rb an 63 .5 4. 6 31 .8 98 8 80 .6 5. 9 13 .5 98 7 72 .1 5. 2 22 .7 19 75 R ur al 63 .1 3. 8 33 .1 25 7 80 .6 7. 9 11 .1 21 9 71 .2 5. 7 23 .0 47 6 C am p 62 .2 3. 2 34 .6 12 1 78 .1 4. 5 17 .4 11 4 69 .9 3. 8 26 .3 23 6 A ge a t b eg in ni ng o f s ch oo l y ea r 10 94 .8 3. 7 1. 4 66 0 96 .1 3. 5 0. 4 67 8 95 .5 3. 6 0. 9 13 38 11 96 .3 2. 1 1. 6 67 8 98 .9 0. 5 0. 6 64 7 97 .6 1. 4 1. 1 13 25 12 96 .5 0. 4 3. 1 64 4 99 .1 0. 0 0. 9 62 9 97 .8 0. 2 2. 0 12 73 13 94 .0 0. 1 5. 9 72 1 97 .1 0. 0 2. 9 67 6 95 .5 0. 1 4. 4 13 97 14 88 .4 0. 0 11 .6 64 1 97 .3 0. 0 2. 7 60 4 92 .7 0. 0 7. 3 12 45 15 78 .0 0. 0 21 .8 67 5 94 .4 0. 0 5. 4 65 0 86 .0 0. 0 13 .8 13 25 16 70 .5 0. 0 29 .5 66 4 86 .7 0. 0 13 .3 66 5 78 .6 0. 0 21 .4 13 28 17 64 .9 0. 0 34 .9 70 2 86 .3 0. 0 13 .5 65 6 75 .3 0. 0 24 .6 13 58 M ot he r's e du ca tio n N on e 67 .4 0. 8 31 .7 10 3 80 .7 2. 0 17 .3 11 7 74 .5 1. 5 24 .1 22 1 B as ic 81 .7 1. 2 17 .0 25 46 94 .8 0. 6 4. 5 24 14 88 .1 0. 9 10 .9 49 60 S ec on da ry 92 .7 0. 6 6. 7 14 61 98 .4 0. 4 1. 2 14 10 95 .5 0. 5 4. 0 28 71 H ig he r 97 .2 0. 1 2. 5 86 7 99 .3 0. 5 0. 2 82 0 98 .2 0. 3 1. 4 16 87 C an no t b e de te rm in ed b 60 .5 0. 0 39 .5 40 8 74 .1 0. 0 25 .5 44 2 67 .6 0. 0 32 .2 85 1 W ea lth in de x qu in til e P oo re st 80 .5 1. 8 17 .7 96 3 90 .9 0. 9 8. 2 10 22 85 .8 1. 4 12 .8 19 85 S ec on d 85 .7 0. 8 13 .5 11 06 94 .0 0. 2 5. 7 10 26 89 .7 0. 5 9. 7 21 32 M id dl e 81 .2 0. 7 18 .0 10 81 93 .2 0. 7 6. 1 10 07 87 .0 0. 7 12 .3 20 88 Fo ur th 86 .4 0. 3 13 .3 10 55 96 .4 0. 5 3. 0 99 6 91 .2 0. 4 8. 3 20 51 R ic he st 91 .8 0. 5 7. 6 11 81 97 .3 0. 4 2. 4 11 52 94 .5 0. 4 5. 0 23 33 [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 c hi ld re n of s ec on da ry s ch oo l a ge o ut o f s ch oo l a re th os e w ho a re n ot a tte nd in g pr im ar y, s ec on da ry , o r h ig he r e du ca tio n [b ] C hi ld re n ag e 15 o r h ig he r a t t he ti m e of th e in te rv ie w w ho se m ot he rs w er e no t l iv in g in th e ho us eh ol d 319 302 Table ED.6 (ISCED): Children reaching last grade of primary school Percentage of children entering first grade of primary school who eventually reach the last grade of primary school (Survival rate to last grade of primary school), Palestine, 2014 Percent attending grade 1 last school year who are in grade 2 this school year Percent attending grade 2 last school year who are attending grade 3 this school year Percent attending grade 3 last school year who are attending grade 4 this school year Percent who reach grade 4 of those who enter grade 1 [1] Total 99.9 99.9 99.9 99.8 Region West Bank 99.9 99.9 99.9 99.7 Gaza Strip 100.0 100.0 99.9 99.9 Sex Male 99.9 100.0 99.8 99.7 Female 100.0 99.9 100.0 99.9 Governorate Jenin 100.0 100.0 100.0 100.0 Tubas 100.0 100.0 100.0 100.0 Tulkarm 98.3 100.0 100.0 98.3 Nablus 100.0 100.0 100.0 100.0 Qalqiliya 100.0 100.0 100.0 100.0 Salfit 100.0 100.0 100.0 100.0 Ramallah & Al-Bireh 100.0 100.0 99.2 99.2 Jericho and Al Aghwar 100.0 100.0 100.0 100.0 Jerusalem 100.0 100.0 100.0 100.0 Bethlehem 100.0 100.0 100.0 100.0 Hebron 100.0 99.5 100.0 99.5 North Gaza 100.0 100.0 100.0 100.0 Gaza 100.0 100.0 100.0 100.0 Deir El-Balah 100.0 100.0 100.0 100.0 Khan Yunis 100.0 100.0 99.2 99.2 Rafah 100.0 100.0 100.0 100.0 Area Urban 100.0 99.9 99.9 99.8 Rural 99.6 100.0 100.0 99.6 Camp 100.0 100.0 99.4 99.4 Mother's education None 100.0 100.0 100.0 100.0 Basic 99.8 100.0 99.9 99.7 Secondary 100.0 100.0 99.8 99.8 Higher 100.0 100.0 100.0 100.0 Wealth index quintile Poorest 100.0 100.0 99.7 99.7 Second 99.6 99.7 100.0 99.3 Middle 100.0 100.0 99.7 99.7 Fourth 100.0 100.0 100.0 100.0 Richest 100.0 100.0 100.0 100.0 [1] MICS indicator 7.6 - Children reaching last grade of primary 320 Palestinian Multiple Indicator Cluster Survey 2014 303 Table ED.7 (ISCED): Primary school completion and transition to secondary school Primary school completion rates and transition and effective transition rates to secondary school, Palestine, 2014 Primary school completion rate [1] Number of children of primary school completion age Transition rate to secondary school [2] Number of children who were in the last grade of primary school the previous year Effective transition rate to secondary school Number of children who were in the last grade of primary school the previous year and are not repeating that grade in the current school year Total 99.6 1431 98.3 1383 100.0 1360 Region West Bank 98.6 836 99.9 786 100.0 785 Gaza Strip 101.0 595 96.3 598 100.0 575 Sex Male 100.2 721 97.6 675 100.0 659 Female 99.0 711 99.0 709 100.0 701 Governorate Jenin 82.9 113 98.9 89 100.0 88 Tubas (*) 12 (100.0) 16 (100.0) 16 Tulkarm (104.5) 42 (100.0) 40 (100.0) 40 Nablus 113.8 98 100.0 102 100.0 102 Qalqiliya (*) 22 (*) 19 (*) 19 Salfit (*) 17 (*) 24 (*) 24 Ramallah & Al-Bireh 101.5 86 100.0 74 100.0 74 Jericho and Al Aghwar (*) 16 (*) 13 (*) 13 Jerusalem 85.6 136 100.0 141 100.0 141 Bethlehem 93.3 75 100.0 71 100.0 71 Hebron 104.2 220 100.0 196 100.0 196 North Gaza 99.0 124 96.8 117 100.0 113 Gaza 102.3 228 94.6 216 100.0 204 Deir El-Balah 98.2 86 98.5 89 100.0 87 Khan Yunis 98.4 98 96.4 116 100.0 111 Rafah 109.0 59 98.1 60 100.0 59 Area Urban 99.7 1057 98.1 1024 100.0 1004 Rural 101.1 239 99.5 220 100.0 219 Camp 95.9 135 98.3 139 100.0 137 Mother's education None (*) 16 (*) 15 (*) 15 Basic 101.8 663 97.9 659 100.0 645 Secondary 93.6 458 98.5 436 100.0 430 Higher 104.2 294 99.1 274 100.0 272 Cannot be determined Wealth index quintile 99.3 298 94.0 311 100.0 292 Poorest 100.7 286 98.7 263 100.0 259 Second 100.3 288 99.6 274 100.0 273 Middle 92.4 271 100.0 265 100.0 265 Fourth 105.0 289 100.0 270 100.0 270 Richest 98.6 836 99.9 786 100.0 785 [1] MICS indicator 7.7 [2] MICS indicator 7.8 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 321 304 Table ED.8 (ISCED): Education gender parity Ratio of adjusted net attendance ratios of girls to boys, in primary and secondary school, Palestine, 2014 Primary school Secondary school Primary school adjusted net attendance ratio (NAR), girls Primary school adjusted net attendance ratio (NAR), boys Gender parity index (GPI) for primary school adjusted NAR1 Secondary school adjusted net attendance ratio (NAR), girls Secondary school adjusted net attendance ratio (NAR), boys Gender parity index (GPI) for secondary school adjusted NAR2 Total 98.8 98.8 1.00 94.4 85.3 1.11 Region West Bank 99.1 98.7 1.00 94.8 84.5 1.12 Gaza Strip 98.5 98.8 1.00 93.9 86.6 1.08 Governorate Jenin 100.0 99.4 1.01 97.3 84.6 1.15 Tubas 100.0 96.8 1.03 (*) (*) 1.10 Tulkarm 99.0 96.9 1.02 98.6 83.8 1.18 Nablus 99.5 100.0 1.00 96.3 88.0 1.09 Qalqiliya 96.4 100.0 0.96 (*) (90.1) 1.08 Salfit 98.4 98.8 1.00 (96.2) (*) 1.12 Ramallah & Al-Bireh 99.6 98.4 1.01 96.3 86.9 1.11 Jericho and Al Aghwar 98.4 100.0 0.98 83.9 74.5 1.13 Jerusalem 99.2 98.0 1.01 94.5 85.9 1.10 Bethlehem 99.4 100.0 .99 94.9 85.8 1.11 Hebron 98.6 98.4 1.00 91.8 80.2 1.14 North Gaza 98.7 98.7 1.00 91.5 85.8 1.07 Gaza 98.7 99.5 0.99 93.3 84.2 1.11 Deir El-Balah 98.9 96.1 1.03 95.8 86.4 1.11 Khan Yunis 97.2 100.0 0.97 95.5 88.4 1.08 Rafah 98.6 97.9 1.01 94.1 93.5 1.01 Area Urban 99.0 98.6 1.00 94.6 85.7 1.10 Rural 98.5 99.7 0.99 94.7 83.9 1.13 Camp 98.5 98.7 1.00 92.6 85.0 1.09 Mother's education None 91.7 96.1 0.95 (80.7) (67.4) 1.20 Basic 98.6 98.9 1.00 94.8 81.7 1.16 Secondary 99.0 98.7 1.00 98.4 92.7 1.06 Higher 99.4 98.7 1.01 99.3 97.2 1.02 Cannot be determineda (*) (*) (*) 74.1 60.5 1.23 Wealth index quintile Poorest 98.4 98.8 1.00 90.9 80.5 1.13 Second 97.8 99.2 0.99 94.0 85.7 1.10 Middle 98.9 98.3 1.01 93.2 81.2 1.15 Fourth 99.9 99.0 1.01 96.4 86.4 1.12 Richest 99.4 98.6 1.01 97.3 91.8 1.06 [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 age 15 or higher at the time of the interview whose mothers were not living in the household ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 322 Palestinian Multiple Indicator Cluster Survey 2014 305 Table ED.10 ISCED shows key education indicators for Palestine according to the ISCED 2011 education classification Table ED.10 (ISCED): Summary of education indicators (ISCEDa) Summary of education indicators classified according to the International Standard Classification of Education (ISCED), Palestine 2014 Primary school (ISCED 1) Transition (ISCED 1 to 2) Secondary school (ISCED 2+3) Percentage of children of primary school entry age entering grade 11 Net attendance ratio (adjusted)2 Percent who reach grade 4 of those who enter grade 13 Primary school completion rate4 Transition rate to secondary school5 Net attendance ratio (adjusted)6 Total 96.9 98.8 99.5 99.6 98.3 94.4 Sex Male 97.2 98.8 99.2 100.2 97.6 91.8 Female 96.7 98.8 99.9 99.0 99.0 97.2 Gender parity index (GPI) 7, 8 na 1.00 na na na 1.06 1 MICS indicator 7.3 - Net intake rate in primary education 2 MICS indicator 7.4; MDG indicator 2.1 - Primary school net attendance ratio (adjusted) 3 MICS indicator 7.6; MDG indicator 2.2 - Children reaching last grade of primary 4 MICS indicator 7.7 - Primary completion rate 5 MICS indicator 7.8 - Transition rate to secondary school 6 MICS indicator 7.5 - Secondary school net attendance ratio (adjusted) 7 MICS indicator 7.9; MDG indicator 3.1 - Gender parity index (primary school) 8 MICS indicator 7.10; MDG indicator 3.1 - Gender parity index (secondary school) a ISCED 1 are grades 1-4, ISCED 2 are grades 5-10, and ISCED 3 are grades 11-12 based on Palestinian educational system. na: not applicable 323 Palestinian Multiple Indicator Cluster Survey 2014

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