Punjab Multiple Indicator Cluster Survey 2014

Publication date: 2015

Punjab Final Report Monitoring the situation of children and women Multiple Indicator Cluster Survey 2014 Bureau of Statistics Planning & Development Department Government of the Punjab United Nations Children’s Fund Title page picture is taken by Ms. Shagufta (UNICEF) with the permission from Ms. Rukhsana with her one month daughter Mahnoor, in her house at basti nandanpura near Kacha Pakka in Kasur district, Punjab. Punjab Multiple Indicator Cluster Survey 2014 Final Report December, 2015* *Report was endorsed by MICS Steering Committee, Punjab in December, 2015 and disseminated in March, 2016 The Multiple Indicator Cluster Survey (MICS) Punjab, 2014 [Pakistan] was carried out in 2014 by Bureau of Statistics Punjab in collaboration with United Nations Children’s Fund (UNICEF). It was conducted as part of the fifth global round of MICS. Major funding was provided by Government of the Punjab through Annual Development Programme 2014-15 and the technical support was provided by the UNICEF. The global MICS programme was developed by UNICEF in the 1990s as an international household survey programme to support countries in the collection of internationally comparable data on a wide range of indicators on the situation of children and women. MICS surveys measure key indicators that allow countries to generate data for use in policies and programmes, and to monitor progress towards the Millennium Development Goals (MDGs) and other internationally agreed upon commitments. MICS Punjab, 2014 is the fourth MICS in Punjab since 2004. Information on the global MICS may be obtained from mics.unicef.org and information about Bureau of Statistics, Punjab from bos.gop.pk and pndpunjab.gov.pk Suggested citation Bureau of Statistics Punjab, Planning & Development Department, Government of the Punjab and UNICEF Punjab. Year of publication 2016. Multiple Indicator Cluster Survey, Punjab 2014, Final Report. Lahore, Pakistan. Bureau of Statistics Punjab, Planning & Development Department, Government of the Punjab and UNICEF Punjab. P a g e | iii SUMMARY TABLE OF SURVEY IMPLEMENTATION AND THE SURVEY POPULATION, MICS PUNJAB, 2014 Survey implementation Sample frame - Updated 1998 census 2010 Questionnaires Household Women (age 15-49) Children under five Interviewer training June-July, 2014 Fieldwork June to September 2014 Survey sample Households - Sampled - Occupied - Interviewed - Response rate (Percent) 41,413 39,333 38,405 97.6 Children under five - Eligible - Mothers/caretakers interviewed - Response rate (Percent) 31,083 27,495 88.5 Women - Eligible for interviews - Interviewed - Response rate (Percent) 61,286 53,668 87.6 Survey population Average household size 6.4 Percentage of population living in - Urban areas - Rural areas - Bahawalpur - D.G. Khan - Faisalabad - Gujranwala - Lahore - Multan - Sahiwal - Rawalpindi - Sargodha 33.4 66.6 10.7 8.9 12.7 14.5 17.3 12.1 6.9 9.4 7.5 Percentage of population under: - Age 5 - Age 18 12.7 43.3 Percentage of ever married women age 15-49 years with at least one live birth in the last 2 years 30.6 Housing characteristics Household or personal assets Percentage of households with - Electricity - Finished floor - Finished roofing - Finished walls 95.4 63.3 82.2 86.6 Percentage of households that own - A television - A refrigerator - Agricultural land - Farm animals/livestock 67.6 53.1 30.5 45.5 Mean number of persons per room used for sleeping 3.91 Percentage of households where at least a member has or owns a - Mobile phone - Car or Van 92.6 5.8 P a g e | iv SUMMARY TABLE OF FINDINGS1 Multiple Indicator Cluster Surveys (MICS) and Millennium Development Goals (MDGs) Indicators, Punjab, 2014 Indicator No. Indicator Description ValueA MICS MDG CHILD MORTALITY Early childhood mortality 1.2 MDG 4.2 Infant mortality rate Probability of dying between birth and the first birthday 75.0 1.5 MDG 4.1 Under-five mortality rate Probability of dying between birth and the fifth birthday 93.0 A Indicator values are per 1,000 live births and rates refer to April, 2011. The East Model was assumed to approximate the age pattern of mortality in Punjab, Pakistan and calculations are based on the Time Since First Birth (TSFB) version of the indirect children ever born/children surviving method. Indicator No. Indicator Description Value MICS MDG NUTRITION Nutritional status 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 33.7 11.3 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 33.5 13.3 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 17.5 4.4 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 0.8 Breastfeeding and infant feeding 2.5 Children ever breastfed Percentage of women with a live birth in the last 2 years who breastfed their last live-born child at any time 93.7 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 10.6 2.7 Exclusive breastfeeding under 6 months Percentage of infants under 6 months of age who are exclusively breastfed 16.8 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 47.8 2.9 Continued breastfeeding at 1 year Percentage of children age 12-15 months who received breast milk during the previous day 65.6 2.10 Continued breastfeeding at 2 years Percentage of children age 20-23 months who received breast milk during the previous day 34.5 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 17.4 months 2.12 Age-appropriate breastfeeding Percentage of children age 0-23 months appropriately fed during the previous day 41.2 1 See Appendix F for a detailed description of MICS indicators P a g e | v Indicator No. Indicator Description Value MICS MDG 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 61.1 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 90.8 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 65.3 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 17.3 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 11.2 7.3 2.18 Bottle feeding Percentage of children age 0-23 months who were fed with a bottle during the previous day 57.7 Salt iodization 2.19 Iodized salt consumption Percentage of households with salt testing 15 parts per million or more of iodate 49.2 Low-birthweight 2.20 Low-birth weight infants Percentage of most recent live births in the last 2 years weighing below 2,500 grams at birth 29.4 2.21 Infants weighed at birth Percentage of most recent live births in the last 2 years who were weighed at birth 25.6 Vitamin A 2.S1 Vitamin A supplementation Percentage of children age 6-59 months who received at least one high-dose vitamin A supplement in the 6 months preceding the survey 64.8 CHILD HEALTH Vaccinations 3.1 Tuberculosis immunization coverage Percentage of children age 12-23 months who received BCG vaccine by their first birthday 92.8 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 84.8 3.3 3.5 3.6 Diphtheria, pertussis and tetanus (DPT), hepatitis B (HepB) and haemophilus influenza type B (Hib) (PENTA) immunization coverage 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 71.7 3.4 MDG 4.3 Measles immunization coverage Percentage of children age 12-23 months who received measles vaccine by their first birthday 71.6 3.8 Full immunization coverage Percentage of children age 12-23 months who received all vaccinations recommended in the national immunization schedule by their first birthday 56.6 Tetanus toxoid 3.9 Neonatal tetanus protection Percentage of women age 15-49 years with a live birth in the last 2 years who were given at least two doses of tetanus toxoid vaccine within the appropriate interval prior to the most recent birth 76.4 P a g e | vi Indicator No. Indicator Description Value MICS MDG Diarrhoea - Children with diarrhoea Percentage of children under age 5 with diarrhoea in the last 2 weeks 17.4 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 72.1 3.11 Diarrhoea treatment with oral rehydration salts (ORS) and zinc Percentage of children under age 5 with diarrhoea in the last 2 weeks who received ORS and zinc 9.7 3.12 Diarrhoea treatment with oral rehydration therapy (ORT) and continued feeding Percentage of children under age 5 with diarrhoea in the last 2 weeks who received ORT (ORS packet, pre-packaged ORS fluid, recommended homemade fluid or increased fluids) and continued feeding during the episode of diarrhoea 38.9 Acute Respiratory Infection (ARI) symptoms - Children with ARI symptoms Percentage of children under age 5 with ARI symptoms in the last 2 weeks 2.5 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 77.1 3.14 Antibiotic treatment for children with ARI symptoms Percentage of children under age 5 with ARI symptoms in the last 2 weeks who received antibiotics 39.1 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 61.1 Malaria / Fever - Children with fever Percentage of children under age 5 with fever in the last 2 weeks 20.8 3.20 Care-seeking for fever Percentage of children under age 5 with fever in the last 2 weeks for whom advice or treatment was sought from a health facility or provider 79.3 3.21 Malaria diagnostics usage Percentage of children under age 5 with fever in the last 2 weeks who had a finger or heel stick for malaria testing 4.0 3.22 MDG 6.8 Anti-malarial treatment of children under age 5 Percentage of children under age 5 with fever in the last 2 weeks who received any antimalarial treatment 1.3 3.23 Treatment with Artemisinin-based Combination Therapy (ACT) among children who received anti-malarial treatment Percentage of children under age 5 with fever in the last 2 weeks who received ACT (or other first-line treatment according to national policy) 9.4* 3.25 Intermittent preventive treatment for malaria during pregnancy Percentage of women age 15-49 years who received three or more doses of SP/Fansidar, at least one of which was received during an ANC visit, to prevent malaria during their last pregnancy that led to a live birth in the last 2 years 0.4 *Indicator denominator based on 25-49 unweighted cases - only shown here in summary table and not in main report chapter. WATER AND SANITATION 4.1 MDG 7.8 Use of improved drinking water sources Percentage of household members using improved sources of drinking water 94.4 4.2 Water treatment Percentage of household members in households using unimproved drinking water who use an appropriate treatment method 2.1 4.3 MDG 7.9 Use of improved sanitation (Not shared) Percentage of household members using improved sanitation facilities which are not shared 66.2 P a g e | vii Indicator No. Indicator Description Value MICS MDG 4.S1 Use of improved sanitation Percentage of household members using improved sanitation facilities whether shared or not shared 75.1 4.4 Safe disposal of child’s faeces Percentage of children age 0-2 years whose last stools were disposed of safely 71.4 4.5 Place for handwashing Percentage of households with a specific place for hand washing where water and soap or other cleansing agent are present 79.6 4.6 Availability of soap or other cleansing agent Percentage of households with soap or other cleansing agent available anywhere in the household 92.8 REPRODUCTIVE HEALTH Contraception and unmet need - Total fertility rate Total fertility rateA for women age 15-49 years 3.5 5.1 MDG 5.4 Adolescent birth rate Age-specific fertility rateA for women age 15-19 years 34.0 5.2 Early childbearing Percentage of ever married women age 20-24 years who had at least one live birth before age 18 11.8 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 38.7 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 17.5 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. Maternal and newborn health 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 78.8 48.0 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 45.3 5.S1 Content of antenatal care (All four) Percentage of women age 15-49 years with a live birth in the last 2 years who had their blood pressure measured, weight measured and gave urine and blood samples during the last pregnancy that led to a live birth 36.3 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 64.7 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 60.8 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 23.6 Post-natal health checks 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 52.0 P a g e | viii Indicator No. Indicator Description Value MICS MDG 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 88.8 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 86.3 CHILD DEVELOPMENT 6.1 Attendance to early childhood education Percentage of children age 36-59 months who are attending an early childhood education programme 25.7 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 35.0 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 2.6 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 11.8 6.5 Availability of children’s books Percentage of children under age 5 who have three or more children’s books 7.6 6.6 Availability of playthings Percentage of children under age 5 who play with two or more types of playthings 52.5 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 6.8 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 67.2 LITERACY AND EDUCATION 7.1 MDG 2.3 Literacy rate among young women Percentage of young women age 15-24 years who are able to read a short simple statement about everyday life or who attended secondary or higher education 72.6 7.S1 Literacy rate 10+ (reported) Percentage of household members age 10 years or older where it is reported that they are able to both read & write with understanding in any language excluding quranic reading, if this was the only response 60.8 7.S2 Literacy rate 15+ (reported) Percentage of household members age 15 years or older where it is reported that they are able to both read & write with understanding in any language excluding quranic reading, if this was the only response 58.0 7.S3 Literacy rate 15-24 years (reported) Percentage of household members age 15-24 years where it is reported that they are able to both read & write with understanding in any language excluding quranic reading, if this was the only response 75.9 7.2 School readiness Percentage of children in first grade of primary school who attended preschool during the previous school year 92.5 7.3 Net intake rate in primary education Percentage of children of school-entry age who enter the first grade of primary school 23.4 7.4 MDG 2.1 Primary school net attendance ratio (adjusted) Percentage of children of primary school age currently attending primary or secondary school 57.9 7.S4 Primary school gross attendance ratio (adjusted) Percentage of children of all age currently attending primary or secondary school 86.1 P a g e | ix Indicator No. Indicator Description Value MICS MDG 7.5 Secondary school net attendance ratio (adjusted) Percentage of children of secondary school age currently attending secondary school or higher 42.1 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 95.8 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) 74.9 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 91.4 7.9 MDG 3.1 Gender parity index (primary school) Primary school net attendance ratio (adjusted) for girls divided by primary school net attendance ratio (adjusted) for boys 0.97 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 0.98 7.S5 Government school attendance rate (primary) Percentage of children aged 5-9 years attending Government primary schools 54.2 CHILD PROTECTION Birth registration 8.1 Birth registration Percentage of children under age 5 whose births are reported registered 72.7 Child labour 8.2 Child labour Percentage of children age 5-17 years who are involved in child labour2 16.4 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 80.7 Early marriage and polygyny 8.4 Marriage before age 15 Percentage of women age 15-49 years who were first married before age 15 5.2 8.5 Marriage before age 18 Percentage of women age 20-49 years who were first married before age 18 20.8 8.6 Young women age 15-19 years currently married Percentage of women age 15-19 years who are married 9.2 8.7 Polygyny Percentage of women age 15-49 years who are in a polygynous marriage 2.5 8.8a 8.8b Spousal age difference Percentage of young 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 18.8 14.6 Attitudes towards domestic violence 8.12 Attitudes towards domestic violence Percentage of women age 15-49 years who state that a husband is justified in hitting or beating his wife in at least one of the following circumstances: (1) she goes out without telling him, (2) she neglects the children, (3) she argues with him, (4) she refuses sex with him, (5) she burns the food 39.8 2 Children involved in child labour are defined as children involved in economic activities at or above the age-specific thresholds, children involved in household chores at or above the age-specific thresholds, and children involved in hazardous work P a g e | x Indicator No. Indicator Description Value MICS MDG Children’s living arrangements 8.13 Children’s living arrangements Percentage of children age 0-17 years living with neither biological parent 1.4 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 4.8 8.15 Children with at least one parent living abroad Percentage of children 0-17 years with at least one biological parent living abroad 3.9 HIV/AIDS HIV/AIDS knowledge and attitudes - Have heard of AIDS Percentage of ever married3 women age 15-49 years who have heard of AIDS 39.0 9.S1 Knowledge about HIV prevention among young women Percentage of ever married young women age 15-24 years who correctly identify ways of preventing the sexual transmission of HIV, and who reject major misconceptions about HIV transmission 3.3 9.S2 Knowledge of mother-to- child transmission of HIV Percentage of ever married women age 15-49 years who correctly identify all three means of mother-to-child transmission of HIV 23.6 9.S3 Accepting attitudes towards people living with HIV Percentage of ever married women age 15-49 years expressing accepting attitudes on all four questions toward people living with HIV 19.0 HIV testing 9.S4 Women who know where to be tested for HIV Percentage of ever married women age 15-49 years who state knowledge of a place to be tested for HIV 8.5 9.S5 Women who have been tested for HIV and know the results Percentage of ever married women age 15-49 years who have been tested for HIV in the last 12 months and who know their results 0.6 9.S7 HIV counselling during antenatal care Percentage of ever married women age 15-49 years who had a live birth in the last 2 years and received antenatal care during the pregnancy of their most recent birth, reporting that they received counselling on HIV during antenatal care 1.3 9.S8 HIV testing during antenatal care Percentage of ever married women age 15-49 years who had a live birth in the last 2 years and received antenatal care during the pregnancy of their most recent birth, reporting that they were offered and accepted an HIV test during antenatal care and received their results 1.1 9.16 MDG 6.4 Ratio of school attendance of orphans to school attendance of non- orphans Proportion attending school among children age 10-14 years who have lost both parents divided by proportion attending school among children age 10-14 years whose parents are alive and who are living with one or both parents (0.83)* *Indicator denominator based on 25-49 unweighted cases - only shown here in summary table and not in main report chapter. ACCESS TO MASS MEDIA AND ICT Access to mass media 10.1 Exposure to mass media Percentage of women age 15-49 years who, at least once a week, read a newspaper or magazine, listen to the radio, and watch television 1.3 Use of information/communication technology 10.2 Use of computers Percentage of women age 15-24 years who used a computer during the last 12 months 21.4 3 The modules of “Individual questionnaire for women” i.e. “Fertility”, “Desire for last birth”, “Maternal and newborn health”, “Post-natal health checks”, “Contraception”, “Unmet Need” &“HIV/AIDS” were asked to ever married women (age 15-49 years) only. P a g e | xi Indicator No. Indicator Description Value MICS MDG 10.3 Use of internet Percentage of women age 15-24 years who used the internet during the last 12 months 12.4 SUBJECTIVE WELL-BEING 11.1 Life satisfaction Percentage of young women age 15-24 years who are very or somewhat satisfied with their life, overall 90.5 11.2 Happiness Percentage of young women age 15-24 years who are very or somewhat happy 90.9 11.3 Perception of a better life Percentage of young women age 15-24 years whose life improved during the last one year, and who expect that their life will be better after one year 59.2 TOBACCO USE Tobacco use 12.1 Tobacco use Percentage of women age 15-49 years who smoked cigarettes, or used smoked or smokeless tobacco products at any time during the last one month 4.1 12.2 Smoking before age 15 Percentage of women age 15-49 years who smoked a whole cigarette before age 15 0.2 ADULT HEALTH AND HEALTH CARE Adult health care 13.S1 Care provided by Lady Health Worker (LHW) Number of ever married women aged 15–49 years who have given birth in the previous 2 years and were visited by a Lady Health Worker (LHW) in the last month 37.6 13.S2 Prevalence of chronic cough Number of household members with cough that lasted for the past 3 weeks 3.2 13.S3 Reported tuberculosis Number of household members that were diagnosed with tuberculosis in the past year 0.5 13.S4 Reported hepatitis Number of household members that were diagnosed with hepatitis in the past year 1.5 SOCIO-ECONOMIC DEVELOPMENT Assets 14.S1 Ownership of assets: House, land, livestock Percentage of household members living in a household that own a house, land or livestock a) House b) Agriculture land c) Livestock 87.0 30.5 45.5 Unemployment 14.S2 Unemployment rate (10+ years) Percent of household members aged 10 years or older who are unemployed and are seeking jobs 7.1 Housing4 14.S10 Mean household size Average members in a household 6.4 14.S11 Currently married population Percentage of household members of age 10 years and above currently married 51.4 14.S12 Mean number of persons per room Average members sleeping in one room 3.91 14.S13a 14.S13b 14.S13c Household characteristics Main material of floor, roof and wall a) finished floor (pacca) b) finished roof (pacca) c) finished wall (pacca)] 63.4 82.2 86.6 4 The information related to provincial indicator 14.S10 and 14.S12 & 14.S13 is given in chapter III “sample coverage and the characteristics of households and respondents” at Table HH.3 and HH.6 respectively. P a g e | xii Indicator No. Indicator Description Value MICS MDG Remittances and zakat 14.S3 Population working outside village/city/country Percentage of family members working outside village/city/country 12.0 14.S4 Receiving remittances from within Pakistan Percentage of household members who received remittances from within Pakistan during the year preceding the survey 3.1 14.S5 Receiving remittances from abroad Percentage of household members living in a household that received remittances from abroad during the year preceding the survey 7.3 14.S6 Receiving cash donation Percentage of household members living in a household that received cash donation such as zakat or other means during the year preceding the survey 1.2 Social benefits and Subsidies 14.S7 Safety nets (getting benefits from government schemes of social protection) Percentage of household members living in a household that got benefits from government schemes of social protection [Benefits include: zakat, dearness allowance, health subsidy, education subsidy, marriage grant, subsidized food, others] 7.2 14.S8a Purchasing goods from government utility stores Percentage of household members living in a household that purchase goods from government utility stores 18.0 14.S8b Regular purchase from utility stores Percentage of household members who purchase goods from government utility stores regularly 29.5 14.S9 Receiving pensions Percentage of household who received pension during the year preceding the survey 8.1 P a g e | xiii Table of Contents SUMMARY TABLE OF SURVEY IMPLEMENTATION AND THE SURVEY POPULATION, MICS PUNJAB, 2014 . iii SUMMARY TABLE OF FINDINGS . iv LIST OF TABLES . xvi LIST OF FIGURES . xx LIST OF ABBREVIATIONS . xxi FOREWORD . xxii ACKNOWLEDGEMENTS . xxiii EXECUTIVE SUMMARY . xxiv MAP OF THE PUNJAB . xxx I. INTRODUCTION . 1 Background . 1 Survey Objectives . 2 Report Structure . 2 II. SAMPLE AND SURVEY METHODOLOGY . 3 Sample Design . 3 List of Indicators . 3 Questionnaires . 4 Pretesting of Questionnaires . 5 Appointment of Regional Supervisors . 5 Training . 5 Field Work . 6 Monitoring Mechanism . 6 Data Processing . 7 International Review . 8 III. SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS . 9 Sample Coverage . 9 Characteristics of Households . 11 Characteristics of Female Respondents 15-49 Years of Age and Children Under-5 . 13 Housing Characteristics, Asset Ownership, and Wealth Quintiles . 17 IV. CHILD MORTALITY . 21 V. NUTRITION . 26 Low Birth Weight . 26 Nutritional Status . 28 Breastfeeding and Infant and Young Child Feeding . 33 Salt Iodization . 45 Children’s Vitamin A Supplementation. 47 VI. CHILD HEALTH . 50 Vaccinations . 50 Neonatal Tetanus Protection . 53 Care of Illness. 55 Diarrhoea . 57 P a g e | xiv Acute Respiratory Infections . 68 Solid Fuel Use. 71 Malaria/Fever . 73 VII. WATER AND SANITATION . 80 Use of Improved Water Sources . 80 Use of Improved Sanitation . 86 Handwashing . 95 VIII. REPRODUCTIVE HEALTH . 98 Fertility . 98 Contraception . 103 Unmet Need . 106 Antenatal Care . 108 Assistance at Delivery . 113 Place of Delivery . 116 Post-natal Health Checks . 118 IX. EARLY CHILDHOOD DEVELOPMENT . 128 Early Childhood Care and Education . 128 Quality of Care . 129 Developmental Status of Children . 135 X. LITERACY AND EDUCATION . 138 Literacy among Young Women . 138 School Readiness . 139 Preschool Attendance. 140 Primary and Secondary School Participation . 141 Literacy Rate . 153 Literacy Rate (10+ years) . 153 Literacy Rate (15+ years) . 155 Literacy Rate (15-24 years) . 156 Public and private primary school attendance rate . 157 XI. CHILD PROTECTION . 159 Birth Registration . 159 Child Labour . 161 Child Discipline. 166 Early Marriage and Polygyny . 170 Attitudes toward Domestic Violence . 176 Children’s Living Arrangements . 178 XII. HIV/AIDS . 181 Knowledge about HIV Transmission and Misconceptions about HIV . 181 Accepting Attitudes toward People Living with HIV . 185 Knowledge of a Place for HIV Testing, Counselling and Testing during Antenatal Care . 186 HIV Indicators for Young Women . 189 XIII. ACCESS TO MASS MEDIA AND USE OF INFORMATION/COMMUNICATION TECHNOLOGY . 191 Access to Mass Media . 191 Use of Information/Communication Technology . 192 XIV. SUBJECTIVE WELL-BEING. 194 XV. TOBACCO USE . 200 Tobacco Use . 200 P a g e | xv XVI. ADULT HEALTH AND HEALTH CARE . 204 Chronic Cough, Tuberculosis and Hepatitis . 204 Lady Health Worker Visits. 205 XVII. SOCIO ECONOMIC DEVELOPMENT . 206 Introduction . 206 Ownership Status of Household . 206 Remittances and Cash Donations . 207 Remittances . 208 Cash Donations . 211 Social Benefits, Subsidies and Family Support Programmes . 212 Possession of Bank Account . 215 Marital Status . 215 Unemployment . 217 APPENDICES . 219-480 Appendix A. District Tables . 219 Appendix B. Sample Design . 350 Appendix C. List of Personnel Involved in the Survey/survey committees . 356 Appendix D. Estimates of Sampling Errors . 366 Appendix E. Data Quality Tables . 380 Appendix F. MICS5 Indicators: Numerators and Denominators . 398 Appendix G. Questionnaires . 410 P a g e | xvi LIST OF TABLES Table HH.1: Results of household, women's and children under-5 interviews . 10 Table HH.2: Household age distribution 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 . 16 Table HH.6: Housing characteristics . 18 Table HH.7: Household and personal assets . 19 Table HH.8: Wealth quintiles . 20 Table CM.1: Children ever born, children surviving and proportion dead . 21 Table CM.2: Infant and under-5 mortality rates by age groups of women . 22 Table CM.3: Infant and under-5 mortality rates by background characteristics . 22 Table NU.1: Low birth weight infants . 27 Table NU.2: Nutritional status of children . 31 Table NU.3: Initial breastfeeding . 35 Table NU.4: Breastfeeding. 37 Table NU.5: Duration of breastfeeding . 39 Table NU.6: Age-appropriate breastfeeding . 40 Table NU.7: Introduction of solid, semi-solid, or soft foods . 41 Table NU.8: Infant and young child feeding (IYCF) practices . 42 Table NU.9: Bottle feeding . 44 Table NU.10: Iodized salt consumption . 45 Table NU.11: Children's vitamin A supplementation . 48 Table CH.1: Vaccinations in the first years of life. 51 Table CH.2: Vaccinations by background characteristics . 53 Table CH.3: Neonatal tetanus protection . 54 Table CH.4: Reported disease episodes . 56 Table CH.5: Care-seeking during diarrhoea . 58 Table CH.6: Feeding practices during diarrhoea . 59 Table CH.7: Oral rehydration solutions, recommended homemade fluids, and zinc . 61 Table CH.8: Oral rehydration therapy with continued feeding and other treatments . 63 Table CH.9: Source of ORS and zinc . 66 Table CH.10: Care-seeking for and antibiotic treatment of symptoms of acute respiratory infection (ARI) . 69 Table CH.11: Knowledge of the two danger signs of pneumonia . 70 Table CH.12: Solid fuel use. 72 Table CH.13: Solid fuel use by place of cooking . 73 Table CH.14: Care-seeking during fever . 74 Table CH.15: Treatment of children with fever . 76 Table CH.16: Diagnostics and anti-malarial treatment of children . 77 Table CH.17: Source of anti-malarial . 78 Table CH.18: Intermittent preventive treatment for malaria . 79 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 . 85 Table WS.4: Person collecting water . 86 Table WS.5: Types of sanitation facilities . 88 Table WS.6: Use and sharing of sanitation facilities . 90 Table WS.7: Drinking water and sanitation ladders . 93 Table WS.8: Disposal of child's faeces . 94 Table WS.9: Water and soap at place for handwashing . 96 Table WS.10: Availability of soap or other cleansing agent. 97 Table RH.1: Fertility rates. 98 P a g e | xvii Table RH.2: Adolescent birth rate and total fertility rate . 100 Table RH.3: Early childbearing . 101 Table RH.4: Trends in early childbearing . 102 Table RH.5: Use of contraception . 104 Table RH.6: Unmet need for contraception . 107 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 . 112 Table RH.10: Assistance during delivery and cesarean section . 114 Table RH.11: Place of delivery. 117 Table RH.12: Post-partum stay in health facility . 119 Table RH.13: Post-natal health checks for newborns . 120 Table RH.14: Post-natal care visits for newborns within one week of birth . 122 Table RH.15: Post-natal health checks for mothers . 123 Table RH.16: Post-natal care visits for mothers within one week of birth . 125 Table RH.17: Post-natal health checks for mothers and newborns . 127 Table CD.1: Early childhood education . 128 Table CD.2: Support for learning . 130 Table CD.3: Learning materials . 133 Table CD.4: Inadequate care . 135 Table CD.5: Early child development index . 137 Table ED.1: Literacy (young women) . 138 Table ED.2: School readiness . 139 Table ED.2A: Pre-school attendance . 140 Table ED.3: Primary school entry . 142 Table ED.4: Primary school net attendance and out of school children . 143 Table ED.4B: Primary school gross attendance ratio of school children (5-9) years . 145 Table ED.5: Secondary school attendance and out of school children . 146 Table ED.6: Children reaching last grade of primary school . 148 Table ED.7: Primary school completion and transition to secondary school . 149 Table ED.8: Education gender parity index (GPI) . 151 Table ED.9: Out of school gender parity . 152 Table ED.10: Literacy rate 10+ . 154 Table ED.11: Literacy rate 15+ . 155 Table ED.12: Literacy rate 15-24 years . 157 Table ED.13: Public and private primary school attendance rate . 158 Table CP.1: Birth registration . 159 Table CP.2: Children's involvement in economic activities . 163 Table CP.3: Children's involvement in household chores. 164 Table CP.4: Child labour . 165 Table CP.5: Child discipline . 167 Table CP.6: Attitudes toward physical punishment . 169 Table CP.7: Early marriage and polygyny (women) . 171 Table CP.8: Trends in early marriage (women) . 173 Table CP.9: Spousal age difference . 175 Table CP.10: Attitudes toward domestic violence (women) . 177 Table CP.11: Children's living arrangements and orphanhood . 179 Table CP.12: Children with parents living abroad . 180 Table HA.1: Knowledge about HIV transmission, misconceptions about HIV/AIDS, and comprehensive knowledge about HIV transmission (women) . 182 Table HA.2: Knowledge of mother-to-child HIV transmission (women) . 184 Table HA.3: Accepting attitudes toward people living with HIV/AIDS (women) . 185 Table HA.4: Knowledge of a place for HIV testing (women) . 187 P a g e | xviii Table HA.5: HIV counselling and testing during antenatal care . 188 Table HA.6: Key HIV/AIDS indicators (young women) . 190 Table MT.1: Exposure to mass media (women) . 191 Table MT.2: Use of computers and internet (women) . 193 Table SW.1: Domains of life satisfaction (women) . 195 Table SW.2: Overall life satisfaction and happiness (women) . 198 Table SW.3: Perception of a better life (women) . 199 Table TA.1: Current and ever use of tobacco (women) . 201 Table TA.2: Age at first use of cigarettes and frequency of use (women) . 203 Table HC.1: Prevalence of Cough, TB and Hepatitis . 204 Table HC.2: Care provided by lady health worker (LHW) . 205 Table SED.1: House, agricultural land and livestock ownership . 206 Table SED.2: Working outside village / city/country . 208 Table SED.3: Receiving remittance from within Pakistan . 209 Table SED.4: Receiving remittance from abroad . 210 Table SED.5: Received zakat/donations . 211 Table SED.6: Pension Benefits . 212 Table SED.7: Safety nets (social protection) . 213 Table SED.8: Safety nets (utility store) . 214 Table SED.9: Possession of Bank Account . 215 Table SED.10: Marital status of household members . 216 Table SED.11: Un-employment rate 10 years and above . 218 Tables in Appendices: District Tables . 219 Table SD.1: Allocation of Sample Clusters (Primary Sampling Units) to Sampling Strata . 352 Table SE.1: Indicators selected for sampling error calculations. 367 Table SE.2: Sampling errors: Total sample . 368 Table SE.3: Sampling errors: Urban . 369 Table SE.4: Sampling errors: Rural . 370 Table SE.5: Sampling errors: Bahawalpur division . 371 Table SE.6: Sampling errors: DG Khan division . 372 Table SE.7: Sampling errors: Faisalabad division . 373 Table SE.8: Sampling errors: Gujranwala division . 374 Table SE.9: Sampling errors: Lahore division . 375 Table SE.10: Sampling errors: Multan division . 376 Table SE.11: Sampling errors: Rawalpindi division . 377 Table SE.12: Sampling errors: Sahiwal division . 378 Table SE.13: Sampling errors: Sargodha division . 379 Table DQ.1: Age distribution of household population . 380 Table DQ.2: Age distribution of eligible and interviewed women . 381 Table DQ.3: Age distribution of children in household and under-5 questionnaires . 381 Table DQ.4: Birth date reporting: Household population . 382 Table DQ.5: Birth date and age reporting: Women . 383 Table DQ.6: Birth date and age reporting: Under-5s . 384 Table DQ.7: Birth date reporting: Children, adolescents and young people . 385 Table DQ.8: Birth date reporting: First and last births . 386 Table DQ.9: Completeness of reporting . 387 P a g e | xix Table DQ.10: Completeness of information for anthropometric indicators: Underweight . 387 Table DQ.11: Completeness of information for anthropometric indicators: Stunting . 388 Table DQ.12: Completeness of information for anthropometric indicators: Wasting . 388 Table DQ.13: Heaping in anthropometric measurements . 388 Table DQ.14: Observation of birth certificates . 389 Table DQ.15: Observation of vaccination cards . 390 Table DQ.16: Observation of women's health cards . 391 Table DQ.17: Observation of the place for handwashing . 392 Table DQ.18: Respondent to the under-5 questionnaire . 393 Table DQ.19: Selection of children age 1-17 years for the child labour and child discipline modules . 394 Table DQ.20: School attendance by single age . 395 Table DQ.21: Sex ratio at birth among children ever born and living . 396 P a g e | xx LIST OF FIGURES Figure HH.1: Age and sex distribution of household population. 12 Figure CM.1: Under-5 mortality rates by area and region . 24 Figure CM.2: Trend in under-5 mortality and Infant Mortality rates . 25 Figure NU.1: Underweight, stunted, wasted and overweight children under age 5 (moderate and severe) . 30 Figure NU.2: Initiation of breastfeeding . 36 Figure NU.3: Infant feeding patterns by age . 38 Figure NU.4: Consumption of iodized salt . 47 Figure CH.1: Vaccinations by age 12 months (measles by 24 months) . 52 Figure CH.2: Children under-5 with diarrhoea who received ORS or recommended homemade liquids . 62 Figure CH.3: Children under-5 with diarrhoea receiving oral rehydration therapy (ORT) and continued feeding . 65 Figure WS.1: Percent distribution of household members by source of drinking water . 83 Figure WS.2: Percent distribution of household members by use and sharing of sanitation facilities . 89 Figure WS.3: Use of improved drinking water sources and improved sanitation facilities by household members . 92 Figure RH.1: Age-specific fertility rates by area . 99 Figure RH.2: Differentials in contraceptive use . 103 Figure RH.3: Person assisting at delivery . 116 Figure ED.1: Education indicators by sex . 153 Figure CP.1: Children under-5 whose births are registered . 161 Figure CP.2: Child disciplining methods, children age 1-14 years . 168 Figure CP.3: Early marriage among women . 172 Figure HA.1: Women and men with comprehensive knowledge of HIV transmission . 183 Figure HA.2: Accepting attitudes toward people living with HIV/AIDS . 186 Figure TA.1: Ever and current smokers by age group . 201 Figures in Appendix: Figure DQ.1: Household population by single ages . 397 Figure DQ.2: Weight and height/length measurements by digits reported for the decimal points . 397 P a g e | xxi LIST OF ABBREVIATIONS AIDS Acquired Immune Deficiency Syndrome BCG Bacillus-Calmette-Guerin (Tuberculosis) BHU Basic Health Unit BoS Bureau of Statistics CSPro Census and Survey Processing System DPT Diphtheria Pertussis Tetanus ECDI Early Child Development Index EOBI Employees Old-Age Benefits Institution EPI Expanded Programme on Immunization GPI Gender Parity Index GAR Gross Attendance Rate HIV Human Immunodeficiency Virus IDD Iodine Deficiency Disorders IMR Infant Mortality Rate IUD Intrauterine Device LAM Lactational Amenorrhea Method LHV Lady Health Visitor LHW Lady Health Worker MDGs Millennium Development Goals MICS Multiple Indicator Cluster Survey MICS5 Fifth global round of Multiple Indicator Clusters Surveys programme NAR Net Attendance Rate ORT Oral Rehydration Treatment PBS Pakistan Bureau of Statistics P&DD Planning and Development Department PENTA Combination of 5 Vaccines (Diphtheria, Pertussis, Tetanus, Haemophilu influenzae B (HIB) and Hepatitis B) PNC Post-natal Care PNHC Post-natal Health Checks ppm Parts Per Million PSUs Primary Sampling Units ROSA Regional Office for South Asia – UNICEF SDGs Sustainable Development Goals SPSS Statistical Package for Social Sciences SSUs Secondary Sampling Units TBAs Traditional Birth Attendants TFR Total Fertility Rate U5MR Under 5 Mortality Rate UN United Nations UNAIDS United Nations Programme on HIV/AIDS UNGASS United Nations General Assembly Special Session on HIV/AIDS UNICEF United Nations Children’s Fund WFFC World Fit for Children WHO World Health Organization ASFR Age Specific Fertility Rate P a g e | xxii FOREWORD Social sector has remained a priority area for the Government of Punjab. Development outlays for the sector have grown manifold over the last few years. Government of the Punjab, along with the national and international partners, is committed to achieve the Sustainable Development Goals (SDGs)/Millennium Development Goals (MDGs) vis-a-vis education, health, water supply, sanitation, poverty etc. This would require not only provision of adequate resources but also a very robust system for ascertaining the area specific needs, efficient use of resources and regular monitoring of the results and impacts. The first district based Multiple Indicator Cluster Survey (MICS) was conducted 2003-04. This survey provided benchmark for a number of indicators at district level and created a culture for using data for planning purposes. The raw data was shared with academia, research organizations and development partners for carrying out further research. Second and third round of MICS Punjab took place in 2007-08 and 2011. These surveys proved to be the most imperative tools in determining government budgetary outlays, particularly for the social sector. Besides many international papers, various students have completed their M.Phil/Ph.D theses by using the MICS data. MICS Punjab, 2014 is a district based survey covering 125 indicators, and is the largest on this account. It is a matter of immense satisfaction that the survey has been completed within a stipulated time period. The results of MICS Punjab, 2014 will enable the government to measure progress made on key social indicators. It also provides a baseline for a number of new social indicators which were not covered earlier. Planning & Development Department, UNICEF, and other stakeholders at the provincial and district level richly deserve all the credit for coming up with an excellent report. Special credit goes to Bureau of Statistics (BoS) Punjab for their untiring efforts and hard work. This present round of MICS, like the other three rounds, allows the provincial and district governments to monitor their respective status of human and social development with precise data on variety of key indicators. It will assist the decision-makers to move towards new avenues of human and social development. I am confident that this report will prove to be a valuable source for planning efforts of Government of Punjab and development partners, and a reference for academia and research organizations. MOHAMMAD JEHANZEB KHAN Chairman Planning and Development Board, Punjab P a g e | xxiii ACKNOWLEDGEMENTS The Punjab Multiple Indicator Cluster Survey (MICS) 2014 is the result of devoted efforts of different departments and organisations. Major funding for the survey was provided by Government of the Punjab through the Punjab Annual Development Programme (ADP) and a moderate contribution by UNICEF. Field work was conducted by the Bureau of Statistics (BoS), like in all previous rounds of MICS in Punjab. It is remarkable that for the first time, data processing of the current MICS Punjab which was outsourced in all previous rounds was carried out by BOS. This really was an exceptional achievement and the staff involved deserves special appreciation. The Global MICS team provided technical support throughout the survey process. Pakistan Bureau of Statistics (PBS) provided the sample design which was reviewed by an international expert on sampling engaged by UNICEF. The Chairman, Planning & Development Board who heads the Provincial Steering Committee extended his fullest support throughout the process. Mr. Shamim Rafique, the Director General of BoS and his team worked hard for the timely completion of the survey. Keen interest and contribution made by members of the Steering Committee, Technical and Planning and Coordination groups are also acknowledged. The continuous coordination efforts of Mr. Khalid Sultan, focal person from Planning & Development Department, are commendable. Ms. Pashmina Naz Ali (Ex-Chief Planning, Monitoring, Evaluation and Reporting, UNICEF, Islamabad), Mr. Nouman Ghani (Planning, Monitoring, Evaluation and Reporting Specialist), Rana Muhammad Sarwar (UNICEF MICS Consultant) and Mr. Faateh ud din Ahmad (Data Processing Consultant) played an active role in the process of MICS Punjab, 2014. All district governments and administrative departments provided valuable support and facilitation in the field work. Communities, local leaders and members of the selected households devoted their precious time. They need to be applauded for their confidence in sharing personal information and enriching this survey. The information provided by respondents remains in trust and will not be used for any purposes other than for their own benefit. IFTIKHAR ALI SAHOO Secretary Planning & Development Department, Punjab P a g e | xxiv EXECUTIVE SUMMARY The Punjab Multiple Indicator Cluster Survey (MICS), 2014 is a household survey covering 38,405 households to provide estimates of around 125 indicators for the province, 9 divisions and 36 districts. The results will be used to update indicators used for monitoring the situation of children and women in Punjab. MICS Punjab, 2014 was conducted as part of the fifth global round of MICS. The survey was planned, designed and implemented by Punjab Bureau of Statistics. The sample design was provided by Pakistan Bureau of Statistics. Technical support was provided by UNICEF through the Global MICS team. Fieldwork was carried out from June to September 2014. The survey collected information on standard MICS topics such as housing characteristics, child and maternal health, HIV/AIDS, domestic violence, child discipline, child protection and use of Information/Communication Technology among other topics. Additional information was also collected on income and employment, remittances, safety nets, tuberculosis, hepatitis and life satisfaction. The findings on most of the indicators presented in this summary show significant variations by some of the background characteristics. Infant and Under-five Child Mortality Under-five child mortality rate is estimated at 93 deaths per thousand live births and the Infant mortality rate at 75 deaths per thousand live births. Among divisions, infant mortality rates and under- 5 mortality rates are lowest in Rawalpindi division (72 and 59 deaths per thousand live births respectively) and highest in DG Khan division (118 and 91 deaths per thousand live births respectively). By wealth quintile, the data show that the probability of dying before age 5 for children living in the households in the highest quintile is lower at 53 deaths per thousand live births and this rises to 137 deaths per thousand live births in the lowest quintile. Nutritional Status Information collected on nutrition of children shows that 34 percent of children under 5 are underweight. The same proportion of children is stunted while 18 percent are wasted. The three anthropometric indicators vary by household wealth. Nearly half of children living in the households in the lowest quintile are stunted (49%) and 48 percent are underweight compared to 17 percent for stunting and underweight in the highest quintile. Underweight, stunting and wasting is less common among children in Rawalpindi division compared to the other divisions. Breastfeeding Ninety-four percent of the children under 2 years have are ever been breastfed. Early initiation of the breastfeeding is only 11 percent that is children that were put to breast within one hour of birth. Only 17 percent of children aged 0–5 months are exclusively breastfed as recommended by WHO guidelines while 48 percent of children age 6-23 months are predominantly breastfed. The median duration of any breastfeeding is 17.4 months and this declines to 0.6 months for exclusive breastfeeding. Sixty- one percent of the infants age 6-8 months have been introduced to solid, semi-solid and soft food. Overall, 65 percent of the children age 6-23 months are receiving solid, semi-solid and soft foods the minimum number of times. However, only 10 percent of these children are benefitting from a diet sufficient in both diversity and frequency. P a g e | xxv The findings also show that 58 percent of the children age 0-23 months are being fed through a bottle with a nipple. By education of the mother, 72 percent of children whose mothers have higher education are bottle fed compared to 49 percent of children whose mother have pre-school or no education. The findings further show that the practice of bottle feeding with a nipple among children age under six months is not uncommon even though it is discouraged, as 45 percent of the children are fed using a bottle with a nipple. Results from MICS Punjab, 2014 show that 49 percent of the households are found to be using adequately iodized salt. Use of iodized salt is lowest in Sargodha division (33%) and highest in Gujranwala division (63%). Child Health Information on child vaccination shows that 62 percent of the children are fully vaccinated and only 56 percent of children were vaccinated by their first birthday as recommended. About three in four children living in the households in the highest quintile are fully vaccinated (74%) compared to 42 percent living in the households in lowest quintile. Approximately 93 percent of children age 12-23 months received a BCG vaccination by their first birthday and the first dose of PENTA vaccine was given to 85 percent of children. The percentage declines to 81 percent for the second dose of PENTA, and to 72 percent for the third dose. Similarly, 95 percent of children received Polio 1 by first birthday and this declines to 85 percent by the third dose. For the first dose of measles vaccine, 72 percent of children received the vaccine by first birthday. In Punjab, 65 percent of children aged 6–59 months received a high dose Vitamin A supplement in the 6 months preceding the survey. Information collected on childhood diseases shows that 17 percent of children under 5 had diarrhoea in the 2 weeks preceding the survey. Out of these children, 47 percent were given Oral Rehydration Therapy (ORT) whereas 39 percent were treated with ORT with continued feeding. About 3 percent of the children had symptoms of ARI in the two weeks preceding the survey. Of these, 77 percent were taken to a health facility or provider, and 39 percent of the children were given antibiotics. The results also show that 21 percent of children were found to have an episode of fever, of which 79 percent were taken to a health facility or provider. Only 1 percent of children with fever were treated with anti-malarial drug; Of these, 9 percent were given Artemisinin-based Combination Therapy. Use of solid fuel is of concern regarding health as it increases risk of diseases such as acute respiratory illness. The findings reveal that 61 percent of the households use solid fuels for cooking, most of which is wood (33%). Majority (83%) of the households in rural areas use solid fuel compared to only 17 percent in urban areas. All of the population living in the households in the lowest quintile use solid fuel for cooking compared to only 4 percent of population in the highest quintile. Water and Sanitation In Punjab, 94 percent of the population is using improved sources of drinking water and 81 percent have water in their premises. The main sources of improved drinking water are motorized pump (42%) and hand pump (31%). Seventy five percent of the population is using improved sanitation facilities; higher in urban (92%) and lower in rural (67%). Most commonly used facilities are flush toilets connected to septic tanks (44%) and facilities connected to a sewerage system (21%). In Punjab, 18 percent of the population still has no access to toilet facilities and this proportion rises to 25 percent in rural areas. P a g e | xxvi One other issue of interest is disposal of children’s stool. The results show that stools of 71 percent of the children under 2 years were disposed of safely. The most commonly reported method of children’s stool disposal was rinsing into toilet or latrine (65%). For 17 percent of children, stool was thrown into garbage. Safe disposal of child’s faeces is found to be higher in urban (89%) compared to rural areas (64%). Information collected on handwashing shows that at the time of the survey, 80 percent of households with a place for handwashing had both water and soap (or another cleansing agent) present at the handwashing place. In 17 percent of the households, only water was available at the handwashing place. However 93 percent of households had soap or other cleansing agent available somewhere in the household. Reproductive Health Total Fertility Rate (TFR) as a measure of current fertility is estimated at 3.5 children per woman. Fertility is slightly higher in rural areas compared to urban areas. TFR among women having pre-school or no education is 4.2 and declines to 2.7 children per woman among women with higher education. Current use of a contraceptive method is reported by 39 percent of currently married women. The most popular modern method is the male condom (11%) followed by female sterilization (10%). Unmet need for contraception is 17 percent. Out of the total women with a live birth in the last two years, 79 percent received antenatal care at least once during their pregnancy from a skilled personnel whereas 17 percent received no antenatal care. Further to that, 48 percent of the women had at least four antenatal care visits. During the antenatal visits, 45 percent of the women had their blood pressure measured, urine and blood sample taken. Sixty-five percent of deliveries were attended by skilled personnel. Sixty-one percent of the births were delivered in a health facility: mostly (43%) in private health facility compared to 18 percent in public health facility. Traditional birth attendants delivered 33 percent of the babies; 40 percent in rural and 19 percent in urban. Eighty-six percent of the mothers had a postnatal check-up and 41 percent of the first PNC visits occurred in a private facility. MICS Punjab, 2014 also collected information on visits by Lady Health Workers. About 38 percent of women aged 15-49 years, who had given birth in two years preceding the survey, reported having been visited by a Lady Health Worker (LHW). The proportion of women visited by a LHW is higher in rural (43%) than urban areas (26%). More than half of the women visited by LHW reported that they received health education or advice. Child Development Among children aged 36-59 months, 26 percent were attending an early childhood education programme. Children who got support for learning from their father was 3 percent while 12 percent of children got support from the mother. Among children under 5, only 8 percent had at least three children's books and 53 percent had two or more types of playthings in their homes. Early Child Development Index was calculated to measure the developmental status of children within four domains namely: literacy-numeracy, physical, social-emotional development and learning. Overall, 67 percent of children age 36-59 months were developmentally on track in at least three of the four domains. P a g e | xxvii Literacy and Education In Punjab, 61 percent of the population age 10 years and above is able to read and write. Literacy rate among young women age 15-24 is 76 percent. Literacy is higher among males than females. By age, only 19 percent of population age 75 years or older is literate compared to 78 percent of population age 15-19. School readiness, that is percentage of children attending first grade at the time of the survey who attended pre-school in previous year is 93 percent and 26 percent of children of primary school entry age have entered the first grade. The Net Attendance Rate (NAR) i.e. children age 5-9 years who attend primary or secondary school, is 58 percent. Four percent of children age 5-9 years are attending government schools and 46 percent private schools. It is interesting to note that of all children starting grade 1, the majority (96%) eventually reach the last grade of primary school. In case of secondary school children (10–14 years), 42 percent are attending secondary school, with a lower percentage in rural areas (36%) compared to urban (54%). There is only a small difference in the attendance of girls and boys in primary and secondary schools. The Gender Parity Index (GPI), that is the ratio of girls to boys attending school is 0.97 for primary school and 0.98 for secondary school. The GPI is lower in rural areas, 0.94 for primary and 0.88 for secondary schools. Child Protection The findings from MICS Punjab, 2014 show that 73 percent of children under 5 years were registered at birth. Birth registration ranges from 31 percent in D.G Khan division to 90 percent in Gujranwala division. There is variation by wealth quintile; 90 percent of children living in the households in the highest quintile are registered compared to 46 percent of children living in the households in the lowest quintile. Sixteen percent of children age 5–17 years are involved in child labour. A higher proportion of male children (20%) is involved in child labour compared to female children (12%). Similarly, child labour is more prevalent in rural (20%) than urban areas (8%). As a form of child discipline, 81 percent of children age 1-14 experienced violent discipline in form of psychological aggression or physical punishment, during the last one month. The most severe forms of physical punishment which include hitting the child on the head, ears or face or hitting the child hard and repeatedly were given to 27 percent of children. Information collected on early marriages shows that 5 percent of the women age 15-49 were married before age 15 while 21 percent of women age 20-49 were married before age 18. There is a decline in early marriage over the years as 31 percent of women age 45-49 reported being first married by age 18 compared to 15 percent of women age 20-24. The data further show that 19 percent of the currently married women age 15-19 are married to a man that is older by 10 years or more. MICS Punjab, 2014 results on attitudes towards domestic violence show that 40 percent of women believe that a husband is justified in hitting or beating his wife if she goes out without telling him, neglects the children, argues with him, refuses sex with him or burns the food. Twenty seven percent of women agree and justify violence in instances when a wife neglects the children and 26 percent of women justify violence if a wife goes out without telling her husband or argues with him. P a g e | xxviii HIV/ AIDS In Punjab, 39 percent of the ever married women have heard of AIDS and it drops to 28 percent in rural areas compared to 60 percent in urban. Only 16 percent of women know that using a condom every time during sexual intercourse and having only one faithful uninfected are the main ways of HIV prevention. Comprehensive knowledge among the women about HIV transmission is even lower (5%) and it falls to 3 percent among young women age 15-24. About 24 percent of ever married women age 15-49 years know that the HIV can be transmitted from mother to child during pregnancy, delivery and breastfeeding. Out of the ever married women who have heard about HIV/AIDS, 19 percent express accepting attitude towards people living with HIV/AIDS. While 9 percent of ever married women know a place where one can get tested for HIV, almost 2 percent of women have actually been tested and about the same proportion of women know the result of their most recent test. Access to mass media and ICT Information collected on access to mass media shows that 11 percent of the women read newspapers, 5 percent listen to the radio and 64 percent watch television at least once a week. While 66 percent of women use any of the three media types at least once a week, 34 percent do not have regular exposure to any of the three types of media. Twenty-one percent of young women age 15-24 used a computer during the last 12 months and fewer women (14 percent) used a computer during the last month. Use of internet is lower, with 12 percent of young women reporting use of internet during the last 12 months. At division level, only 9 percent of young women in DG Khan division used a computer during the last year compared with 32 percent of women in Lahore division during that same period. Subjective well-being The survey included a module on life satisfaction for women age 15-24 years to understand how satisfied this group of young people is in different areas of their lives, such as their family life, friendships, school, current job, health, where they live, how they are treated by others, how they look, and their current income. The data show that 91 percent of the women age 15-24 are satisfied on overall with their lives and about the same proportion of women is happy with their life. Six out of ten young women (59%) think that their life has improved over the last one year and expect that life will get better in the coming year. Overall, only 8 percent of young women have an income and of those with income, 67 percent are satisfied with their current income. Tobacco Use Four percent of women smoked cigarettes or used smoked or smokeless tobacco products at any time in the last one month. In D.G Khan division, 13 percent of women used tobacco, a proportion much higher than the other divisions. There is also notable variation by age, with a higher proportion of older women using tobacco compared to younger women; 13 percent among women age 45-49 compared to less than 1 percent among women age 15-19. The proportion of women who smoked a cigarette before age 15 is less than 1 percent. P a g e | xxix Adult health Three percent of household members were reported to have had a cough for the past 3 weeks. Almost 6 percent of the population in Sahiwal division was reported to have had a cough, a proportion much higher than the other divisions. Furthermore, less than 1 percent of the household population was reported to have been diagnosed with tuberculosis and 2 percent was diagnosed with hepatitis. Socio-economic development The unemployment rate among population age 10 years and over is 7 percent. In Punjab, 87 percent of the population is living in a household that owns a house, 30 percent own agricultural land and 45 percent own livestock. Ownership of agricultural land and livestock is higher amongst the rural population. The survey also collected information on remittances. The results reveal that 3 percent of the respondents reported having received remittances from within the country while 7 percent reported receiving remittances from outside the country. In addition, 7 percent of household members are living in a household that received benefits such as zakat, dearness allowance, health and education subsidy from government schemes of social protection P a g e | xxx MAP OF THE PUNJAB P a g e | 1 I. INTRODUCTION Background This report is based on the Multiple Indicator Cluster Survey (MICS), conducted in 2014 by the Bureau of Statistics (BoS) Punjab, Planning and Development Department (P&DD), Government of the Punjab, in collaboration with UNICEF. It is the fourth report in the MICS series since 2004 in Punjab. These surveys provide statistically sound and internationally comparable data essential for developing evidence-based policies and programmes and for monitoring progress towards national goals and global commitments. These commitments emanate 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) (See box below). The MICS Punjab, 2014 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. MICS Punjab, 2014 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. 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.” P a g e | 2 Survey Objectives The MICS Punjab, 2014 has as its primary objectives:  To provide up-to-date information for assessing the situation of children and women  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 towards 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; Report Structure This final report presents the results of the indicators and topics covered in the survey. Preliminary findings of MICS Punjab, 2014 were shared with the government in May, 2015. The description for each chapter is based on tables within the text that contain provincial level results by background characteristics including divisional level results. District level tables are placed in Appendix – A of the report. The report comprises 17 chapters, focusing on different socio-economic features of the survey. The first three chapters explain about the survey background and objective, methodology (sample design, questionnaires, training and fieldwork) and sample coverage, characteristics of the households, asset ownership, and wealth quintiles. The remaining 14 chapters present the findings on child mortality, nutrition, child health, water and sanitation, reproductive health, early child development, literacy and education, child protection, HIV/AIDS knowledge, access to mass media and use of information/communication technology, subjective wellbeing, tobacco use, adult health and health care and socio economic development. P a g e | 3 II. SAMPLE AND SURVEY METHODOLOGY Sample Design The sample for the MICS Punjab, 2014 was designed by the Pakistan Bureau of Statistics (PBS) to provide estimates for a large number of indicators, on the situation of women and children including the socio-economic indicators at the provincial level, 9 divisions, 36 districts, and urban and rural areas at the provincial level. The total sample size was 41,000 households, located in 2050 sample clusters (enumeration areas). For the calculation of the sample size, the key indicator used was the underweight prevalence among children age 0-4 years. The detail of districts under each division is as follows: Bahawalpur: Bahawalpur, Bahawalnagar and Rahim Yar Khan DG Khan: DG Khan, Layyah, Muzaffargarh and Rajanpur Faisalabad: Faisalabad, Chiniot, Jhang and TT Singh Gujranwala: Gujranwala, Gujrat, Hafizabad, Mandi Bahauddin, Narowal and Sialkot Lahore: Lahore, Kasur, Nankana Sahib and Sheikhupura Multan: Multan, Khanewal, Lodhran and Vehari Sahiwal: Sahiwal, Pakpattan and Okara Rawalpindi: Rawalpindi, Attock, Chakwal and Jhelum Sargodha: Sargodha, Bhakkar, Khushab and Mianwali The urban and rural areas within each district were identified as the main sampling strata and the sample was selected in two stages. Eight large cities (Lahore, Faisalabad, Rawalpindi, Gujranwala, Multan, Sargodha, Sialkot and Bahawalpur) were also treated as separate strata within their respective districts. Within each stratum, a specified number of census enumeration areas were selected systematically with probability proportional to size. After a households listing in the selected urban and rural enumeration areas, a systematic sample of 20 households was drawn in each sample enumeration area. All sample enumeration areas were covered except for three enumeration areas which were substituted for technical reasons in consultation with PBS. Within each district the sample was proportionally allocated to urban and rural areas. The sampling rates vary by stratum and cluster, so the sample is not self-weighting. For reporting all results from the survey data, sample weights are used. The sample design including weights were reviewed for adequacy and soundness by an international consultant engaged by UNICEF Pakistan. The sample design and weighting procedures are described in more detail in Appendix B, which includes a summary of the sample size by divisions and districts. List of Indicators The fifth round of the Multiple Indicator Cluster Survey (MICS5), being a standard methodology, has limited space for additional indicators but is flexible enough to adapt indicators to local environment. The Punjab MICS Technical Group followed a comprehensive plan for the finalization of list of indicators for the Punjab MICS, 2014. The group held sectoral consultations with key social sector departments and development partners. Based on these consultations, the group made recommendations to finalize the list of indicators. The recommendations were approved by the Punjab MICS Steering Committee. The final list of indicators approved by the Steering Committee is presented in Appendix – F. P a g e | 4 Questionnaires A set of the following three questionnaires was used in the survey instead of the four available with the MICS5 methodology. 1. Household Questionnaire which was used to collect basic demographic information on all de jure household members (usual residents), the household, and the dwelling with the following modules; o List of Household Members5 o Education6 o Child Discipline o Child Labour o Child Discipline o Household Characteristics o Water and Sanitation o Handwashing o Salt Iodization Non-Global Standard MICS Modules o Income and Employment o Remittances o Pension Benefits o Safety Nets 2. Questionnaire for Individual Women administered in each household to all women age 15- 49 years and included the following modules; o Woman’s Background o Access to Mass Media and Use of Information/Communication Technology o Marriage o Fertility o Desire for Last Birth o Maternal and Newborn Health7 o Post-natal Health Checks o Illness Symptoms o Contraception o Unmet Need o Attitudes Toward Domestic Violence o HIV/AIDS o Tobacco Use o Life Satisfaction 3. Questionnaire for Children Under-Five, administered to mothers (or caretakers) for all children under 5 years of age8 living in the household. Normally, the questionnaire was administered to mothers of children; in cases when the mother was not listed in the 5 The module also includes non-standard MICS questions on cough, TB and Hepatitis 6 It also includes non-MICS questions on type of schools 7 It also includes non-MICS questions on Lady Health Worker (LHW) 8 The terms “children under 5”, “children age 0-4 years”, and “children age 0-59 months” are used interchangeably in this report for children age less than 5 years. P a g e | 5 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 Non-Global Standard MICS Modules o Vitamin A Supplementation The questionnaires were based on the MICS5 model questionnaires and translated from English to Urdu language for data collection and again retranslated into English to ensure accuracy and quality of the translation. Pretesting of Questionnaires The Questionnaires were pretested in Southern, Central and Northern zones of the Punjab. For this purpose, one district was selected randomly in each zone and within it, one urban site and one rural site (20 households), called cluster, was enumerated as per guidelines of MICS5 methodology. Based on findings from the pretest, modifications were made to the wording and translation of the questionnaires. A copy of the MICS questionnaires is provided in Appendix – G. In addition to the administration of questionnaires, field teams tested salt used for cooking in the households for iodine content, observed the place for handwashing, and measured the weights and heights of children under 5 years. Findings of these observations and measurements are provided in the respective sections of this report. Appointment of Regional Supervisors To manage huge fieldwork operation while assuring quality and proper supervision, the province was divided into 10 regions of 3–5 districts each: Bahawalpur, DG Khan, Faisalabad, Gujranwala, Lahore I, Lahore II, Multan, Rawalpindi, Sahiwal and Sargodha. Ten senior officers of BOS were designated as regional supervisors - one for each region. They were responsible for all aspects of the field work in their respective regions (See list of field staff in Appendix – C). Training Training of Trainers (ToT) was conducted for 10 days in Lahore including two days of field practice. A total of 35 field teams were recruited for field data collection, each team comprising one team supervisor, two field editors (one male and one female), two measurers (both female), three male interviewers, and five female interviewers. The field teams were given 18 days training in two phases. In the first phase, the trainings were held at Multan, Faisalabad and Rawalpindi for field teams belonging to Multan, Bahawalpur, DG Khan, Faisalabad, Sargodha, Rawalpindi and Gujranwala divisions. During this phase, 312 field staff including regional supervisors, team supervisors, field P a g e | 6 editors, measurers and interviewers were trained at Multan (126), Faisalabad (99), and Rawalpindi (97). The rest of the teams were trained in second phase, wherein trainings were held at Sahiwal (51) and Lahore (104). During this phase, altogether 155 field staff were trained. During the trainings, about 9 percent additional staff were also trained to be deployed in case of dropout during the field work. Trainings included sessions on contents of the questionnaires along with the survey theoretical concepts, survey ethics, interviewing techniques, and mock interviews to practice in asking questions. The whole training took 18 days, including three days of practice in the field. All trained staff overwhelmingly participated in the hands on sessions. Moreover, measurers received three days exclusive hands on training for height and weight measurement of children at Basic Health Units (BHUs). Field Work The field teams who received training in the first phase started field work in their respective divisions immediately after the completion of training session in June 2014. The rest of the teams, however were deployed into the field in July 2014 after the completion of the second phase of training. A total of 33 teams were deployed into the field to collect the information on prescribed questionnaire (Household, Woman and Child). Each team was comprised of one supervisor, two field editors (male and female), two measurers, and eight interviewers (3 males and 5 females). Twenty households were interviewed from an urban or rural cluster by each team in a day. One android cellular was provided to each team supervisor for the purpose of sending key information (i.e. GPS Coordinates, Cluster Control Sheet) of the enumerated cluster. The information was compiled at BoS office headquarters and shared with Secretary, Director General/Project Director through a dash board. The field monitoring was also carried out extensively by the technical team, Deputy Project Director, Project Director and representative of UNICEF to achieve the quality milestone. During the field visits, necessary support and feedback was provided to each field team by the technical monitors. In addition, consistency tables were examined and evaluated weekly in respect of each field team and in case of any issue, the concerned team supervisor was notified immediately. The whole field work exercise was completed in about three months. Monitoring Mechanism The monitoring of field work for quality data included conventional as well as innovative system known as Online Monitoring Mechanism (OMM). Under the conventional method, the nominated monitors from BoS and other stakeholders visited field teams. All the monitoring activities were planned in such a way that each field team could be visited more than once. As regards to the innovative method (OMM), a GPS device was given to each team supervisor through which they sent GPS coordinates of the cluster to BoS headquarters in Lahore twice a day, firstly when the team reached the cluster and secondly at the time of leaving the cluster. To share the latest information received from the field with the stakeholders, a dashboard was designed. The information sent by the field supervisors was used not only to observe duration of their stay in the cluster, but also to update the dashboard on daily basis. The dashboard was shared with all concerned stakeholders on a daily basis to give updates on progress on the cluster completion. P a g e | 7 Another monitoring tool was the use of field check tables. These tables were produced on weekly basis using latest field data entered in computers. These tables were regularly shared with the regional supervisors who in turn had discussions with the team supervisors in their respective regions. In this way, a number of data collection weaknesses were addressed before it is too late. The field check tables were also shared with operational teams who then issued instructions immediately to the concerned regional supervisors/ team supervisors through email, text messages, telephone calls and personal visits. These tables included descriptive statistics on key variables for each team. Moreover, to enhance data quality, other corrective steps were also taken including reshuffling of team(s) member(s) reporting inadequately and conducting additional trainings in the field where felt necessary. Data Processing Data were entered using the CSPro software version 5.0 on 22 desktop computers by 44 data entry operators under the supervision of 2 data entry (DE) supervisors. There were four assistant DE supervisors who were monitoring the data entry process and helping data entry operators (DEOs) in rectifying the problems. For quality assurance purposes, all questionnaires were double-entered and the differences thereof resolved by referring back to the questionnaires. Internal consistency checks were also performed and the secondary editors fixed those inconsistencies according to the secondary editing manual. Procedures and standard programs developed under the global MICS programme and adapted to the MICS Punjab, 2014 questionnaire were used throughout. Data processing began simultaneously with data collection at the beginning of July 2014 (after one week of data collection) and was completed in October 2014 (one week after completion of field work). Data were analysed using the Statistical Package for Social Sciences (SPSS) software, version 22. Model syntax and tabulation plans developed by UNICEF were customized and used for this purpose. Initial analysis, for cleaning purpose, was carried out by examining frequency distribution of all variables and looking at possible errors in data entry and otherwise. Dummy tables reflecting cross- tables between dependent and independent variables were generated focusing on presenting frequencies and simple bivariate tables. After cleaning, the final data was exported from CSPro to SPSS software tabulation programme for construction of analysis files (comprising HH: Household, HL: Online Monitoring Mechanism Online Monitoring Mechanism (OMM) was especially designed and implemented for effective online monitoring of field teams. It was used to detect:  Location of survey teams through Global Positioning System (GPS)  Entering and leaving time in the Cluster  Time spent in the Cluster Open Data Kit (ODK) Aggregate server (https://bos-punjab.appspot.com) was set-up at google. Two ODK forms were programmed for updating data about GPS coordinates and cluster summary information. Android based smart phones with internet connectivity through U fone SIM were provided to team supervisors. By using the above facility following, two reports were generated on daily basis:  Time spent in the field by survey team  Dash board for easy review/monitoring of the field work P a g e | 8 Household listing, WM: Women and CH: Children), production of tabulations, analysis of sampling errors/ confidence intervals; and production of datasets and tabulations for report writing. International Review All stages of the survey were closely monitored by the UNICEF global MICS team. Before the start of survey, UNICEF reviewed the sample design, survey tools and trainings through international consultants. The software used for data entry and analysis was adapted from the MICS5 recommended methodology which was also reviewed by the national and international consultants. The data files, syntax files and tabulations were shared with the global MICS team. The data and software review inputs received from these organizations were addressed before the finalization of the tables and report. P a g e | 9 III. SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS Sample Coverage Initially 41,000 households were selected for the sample and distributed equally in 2050 selected clusters. Following MICS5 guidelines, if a selected household was untraceable or unreachable or refused to be interviewed, there was no replacement. Further to that, if there was more than one household identified in the selected dwelling at the time of data collection and these households were not listed then all of them were to be interviewed. As a result, the final sample size was 41,413 households. Of the 41,413 households selected for the sample, 39,333 were found to be occupied. Of these, 38,405 were successfully interviewed achieving household response rate of 98 percent. In the interviewed households, 61,286 eligible women (age 15-49 years) were identified. Of these, 53,668 were successfully interviewed, yielding a response rate of 88 percent within the interviewed households. There were 31,083 children under age five listed in the household questionnaires. Questionnaires were completed for 27,495 of these children, which corresponds to a response rate of 89 percent within interviewed households. Overall response rate of households i.e. 98 percent is 12 percent higher than the response rates of individual women and children under 5s (85.5 and 86.4 percent) due to the reason that the children and women were not at home at the time of interview (Table HH.1). P a g e | 10 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 and women's and under-5's response rates, Punjab, 2014. Punjab Area of residence Division Rural All Urban Major Cities Other Urban Bahawalpur D.G. Khan Faisalabad Gujranwala Lahore Multan Rawalpindi Sahiwal Sargodha Households Sampled 41,413 25,769 15,644 4,847 10,797 4,016 4,356 4,830 6,715 5,564 4,745 4,092 3,316 3,779 Occupied 39,333 24,617 14,716 4,554 10,162 3,801 4,127 4,689 6,381 5,137 4,596 3,891 3,127 3,584 Interviewed 38,405 24,241 14,164 4,295 9,869 3,690 4,051 4,647 6,254 4,874 4,526 3,756 3,054 3,553 Household response rate 97.6 98.5 96.2 94.3 97.1 97.1 98.2 99.1 98.0 94.9 98.5 96.5 97.7 99.1 Women Eligible 61,286 38,002 23,284 7,015 16,269 5,575 6,180 7,303 10,582 8,064 6,675 5,932 4,883 6,092 Interviewed 53,668 33,584 20,084 5,786 14,298 4,847 5,446 6,724 9,232 6,630 5,953 5,169 4,347 5,320 Women's response rate 87.6 88.4 86.3 82.5 87.9 86.9 88.1 92.1 87.2 82.2 89.2 87.1 89.0 87.3 Women's overall response rate 85.5 87.0 83.0 77.8 85.4 84.4 86.5 91.2 85.5 78.0 87.8 84.1 86.9 86.6 Children under 5 Eligible 31,083 20,486 10,597 3,147 7,450 3,112 4,085 3,443 5,145 4,016 3,300 2,527 2,587 2,868 Mothers/caretakers interviewed 27,495 18,220 9,275 2,663 6,612 2,705 3,700 3,067 4,504 3,449 2,934 2,264 2,345 2,527 Under-5's response rate 88.5. 88.9 87.5 84.6 88.8 86.9 90.6 89.1 87.5 85.9 88.9 89.6 90.6 88.1 Under-5's overall response rate 86.4 87.6 84.2 79.8 86.2 84.4 88.9 88.3 85.8 81.5 87.6 86.5 88.5 87.3 P a g e | 11 Response rates were higher in rural than urban areas. Across divisions, the household response rate was found to be lowest in Lahore division (95%), which is highly urban. In this division, non-availability of eligible women at home at the time of the survey resulted in low response rates for both women and children under 5 (78% and 82% respectively). 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 38,405 households successfully interviewed, 246,396 household members were listed. Of these, 124,711 are males, and 121,684 are females. Table HH.2: Household age distribution by sex Percent and frequency distribution of the household population by five-year age groups, dependency age groups, and by child (age 0-17 years) and adult populations (age 18 or more), by sex, Punjab, 2014. Total Males Females Number Percent Number Percent Number Percent Punjab 246,396 100.0 124,711 100.0 121,684 100.0 Age 0-4 31,324 12.7 15,861 12.7 15,463 12.7 5-9 31,473 12.8 16,203 13.0 15,270 12.5 10-14 28,665 11.6 14,815 11.9 13,849 11.4 15-19 25,999 10.6 13,284 10.7 12,715 10.4 20-24 22,985 9.3 11,399 9.1 11,586 9.5 25-29 20,194 8.2 9,483 7.6 10,711 8.8 30-34 16,764 6.8 8,305 6.7 8,458 7.0 35-39 13,580 5.5 6,632 5.3 6,948 5.7 40-44 11,392 4.6 5,752 4.6 5,640 4.6 45-49 10,685 4.3 5,578 4.5 5,107 4.2 50-54 9,099 3.7 4,388 3.5 4,711 3.9 55-59 7,078 2.9 3,544 2.8 3,533 2.9 60-64 6,023 2.4 3,146 2.5 2,877 2.4 65-69 4,254 1.7 2,418 1.9 1,836 1.5 70-74 3,180 1.3 1,816 1.5 1,363 1.1 75-79 1,608 0.7 903 0.7 706 0.6 80-84 1,192 0.5 674 0.5 518 0.4 85+ 891 0.4 504 0.4 387 0.3 Missing/DK 13 0.0 7 0.0 6 0.0 Dependency age groups 0-14 91,461 37.1 46,879 37.6 44,582 36.6 15-64 143,797 58.4 71,511 57.3 72,286 59.4 65+ 11,124 4.5 6,314 5.1 4,810 4.0 Missing/DK 13 0.0 7 0.0 6 0.0 Child and adult populations Children age 0-17 years 106,585 43.3 54,610 43.8 51,975 42.7 Adults age 18+ years 139,798 56.7 70,094 56.2 69,703 57.3 Missing/DK 13 0.0 7 0.0 6 0.0 Table HH.2 shows that 37 percent of the population is under 15 years and 4 percent is age 65 or over, showing a high dependent population. The largest age cohorts are the following age groups: 5 – 9 and 0 – 4 (13% each). As expected, the proportion of the population in the 5 year age group decreases with increase in age. In MICS Punjab, 2014, particular efforts were made to minimise age reporting errors by training interviewers in age probing techniques. Reference calendars of major local and P a g e | 12 national events were provided to assist in determining approximate age of respondents who could not recall accurate age or date of birth. Resultantly, errors in recording ages and date of births were controlled to a great extent, however, some age heaping still remains at ages ending with digits zero and five (Table DQ.1 in Appendix – E). The population pyramid is presented in Figure HH.1. Figure HH.1: Age and sex d istr ibut ion of household populat ion , MICS Punjab , 2014 Tables HH.3, HH.4 and HH.5 provide basic information on the households, eligible women age 15-49 years, and children under 5. Both unweighted and weighted numbers are presented in the tables. 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 show only weighted numbers.9 Table HH.3 presents basic background information on the households, including sex of the household head, division, area of residence, number of household members and education of household head. These background characteristics are used in subsequent tables in this report. The figures in the table are also intended to show the number of observations by major categories of analysis in the report. The weighted and unweighted total number of households are equal, since sample weights were normalized.10 The table also shows the weighted mean household size estimated by the survey which is 6.4 persons. In Punjab, 92 percent of households are headed by males and the rest are headed by females. About 67 percent of households are in rural areas, while the rest are in urban. More than half of households 9 See Appendix B: Sample Design, for more details on sample weights. 10 ibid 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+ Percent Age Males Females P a g e | 13 (59%) have 4 to 7 members, while one-member households are at about 1 percent. Forty percent of the household heads have no education or only have pre-school followed by those with secondary education (18%) and primary education (17%). Table HH.3: Household composition Percent and frequency distribution of households by selected characteristics, Punjab, 2014. Weighted percent Number of households Weighted Unweighted Punjab 100.0 38,405 38,405 Area of residence Rural 66.6 25,577 24,241 All Urban 33.4 12,828 14,164 Major Cities 52.4 6,717 4,295 Other Urban 47.6 6,111 9,869 Sex of household head Male 92.1 35,375 35,341 Female 7.9 3,030 3,064 Number of household members 1 1.0 372 389 2 4.6 1,762 1,749 3 7.5 2,866 2,891 4 11.8 4,518 4,516 5 16.1 6,193 6,175 6 17.0 6,527 6,504 7 14.1 5,410 5,359 8 9.7 3,722 3,756 9 6.5 2,479 2,461 10+ 11.9 4,555 4,605 Education of household head None/pre-school 40.1 15,399 15,179 Primary 17.3 6,639 6,671 Middle 12.7 4,863 4,964 Secondary 18.3 7,022 7,058 Higher 11.6 4,472 4,522 Missing/DK 0.0 10 11 At least one child age < 5 years 48.5 38,405 38,405 At least one child age 0-17 years 84.7 38,405 38,405 At least one woman age 15-49 years 93.1 38,405 38,405 Division Bahawalpur 10.7 4,091 3,690 D.G. Khan 8.9 3,436 4,051 Faisalabad 12.7 4,889 4,647 Gujranwala 14.5 5,569 6,254 Lahore 17.3 6,631 4,874 Multan 12.1 4,633 4,526 Rawalpindi 9.5 3,633 3,756 Sahiwal 6.9 2,638 3,054 Sargodha 7.5 2,885 3,553 Mean household size1 6.4 38,405 38,405 1 MICS indicator 14.S10 - Mean household size Characteristics of Female Respondents 15-49 Years of Age and Children Under-5 Tables HH.4 and HH.5 show information on the background characteristics of female respondents 15-49 years of age and of children under age 5. In both tables, total number of weighted and unweighted observations are equal, since sample weights have been normalized. In addition to providing useful information on the background characteristics of women and children under age five, P a g e | 14 the tables are also showing the number of observations in each background category. These categories are used in the subsequent tables of this report. Table HH.4: Women's background characteristics Percent and frequency distribution of women age 15-49 years by selected background characteristics, Punjab, 2014. Weighted percent Number of women Weighted Unweighted Punjab 100.0 53,668 53,668 Area of residence Rural 65.3 35,043 33,584 All Urban 34.7 18,625 20,084 Major Cities 52.5 9,781 5,786 Other Urban 47.5 8,844 14,298 Age 15-19 20.8 11,158 11,298 20-24 18.6 9,960 9,943 25-29 17.0 9,114 9,106 30-34 14.1 7,558 7,513 35-39 11.6 6,251 6,158 40-44 9.5 5,078 5,028 45-49 8.5 4,548 4,622 Marital status Currently married 61.6 33,047 32,854 Widowed 2.0 1,047 1,014 Divorced 0.8 451 465 Separated 0.6 310 320 Never married 35.1 18,813 19,015 Motherhood and recent births Never gave birth 42.6 22,888 23,127 Ever gave birth 57.4 30,780 30,541 Gave birth in last two years 19.9 10,653 10,602 No birth in last two years 37.5 20,130 19,942 Women’s education None/pre-school 38.9 20,887 20,878 Primary 17.3 9,296 9,427 Middle 10.6 5,714 5,613 Secondary 16.5 8,837 8,656 Higher 16.6 8,916 9,079 Missing/DK 0.0 19 15 Wealth index quintile Lowest 17.3 9,271 9,265 Second 19.3 10,353 10,456 Middle 20.3 10,898 11,478 Fourth 21.5 11,528 11,859 Highest 21.6 11,617 10,610 Division Bahawalpur 10.0 5,369 4,847 D.G. Khan 8.5 4,563 5,446 Faisalabad 12.7 6,796 6,724 Gujranwala 15.5 8,328 9,232 Lahore 18.0 9,685 6,630 Multan 11.0 5,887 5,953 Rawalpindi 9.5 5,086 5,169 Sahiwal 6.9 3,685 4,347 Sargodha 8.0 4,270 5,320 P a g e | 15 Table HH.4 includes information on the distribution of women according to area, age, marital status, motherhood status, births in last two years, education11, and wealth index quintiles12, 13. The area of residence of eligible women is almost similar to the household, as expected. The highest proportion of the women, i.e., 21 percent, is of age group 15-19 years, which declines with increase in age. About 62 percent of the women are currently married and 35 percent have never married. Fifty seven percent of ever married women have ever given birth, of which 20 percent gave birth during last 2 years. About 39 percent of women have only pre-school or no education followed by primary education (17%), secondary education (16%) and higher education (17%). There is, however, only small difference based on household wealth. 11 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. 12 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 MICS Punjab, 2014 the following assets are used in these calculations: Main material of the dwelling floor, Main material of the roof, Main material of the exterior walls, type of fuel used for cocking, Household possessions (Electricity, Radio, Television, Non-mobile telephone, Refrigerator/Freezer, Gas, Computer, Air conditioner, Washing machine/Dryer, Air cooler/ Fan, Cooking Range/Micro wave, Sewing/knitting machine, Iron, Water Filter and Dunky pump/Turbine), utilities owned by household members (Watch, Mobile telephone, Bicycle, Motorcycle / Scooter, Animal drawn-cart, Bus / Truck, Boat with motor, Car / Van, Tractor/Trolley), household ownership, ownership of land, having animals (Cattle, milk cows, Buffaloes or bulls, Horses, donkeys, mules or camels, Goats, Sheep and Chickens/ Ducks/ Turkey), possession of bank account, main source of drinking water and type of toilet. 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 lowest to highest. 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 mstates 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. 13 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 population quintile”, which is used interchangeably with “women in the wealthiest survey population”, “women living in households in the highest population wealth quintile”, and similar. P a g e | 16 Table HH.5 provides the distribution of children by several attributes including sex, area of residence, division, age in months, respondent type, mother’s (or caretaker’s) education, and wealth quintiles. The proportion of boys under 5 is 51 percent against 49 percent for girls, which is similar to the total population composition in the selected households. Sixty nine percent of these children reside in rural areas. As regards the share of various age groups, the smallest proportion (9%) is in age group of 0-5 months which increases in each subsequent five months age group with the highest (21%) in age group of 36–47 months. Majority of the children under 5 years (48%) have mothers with only pre-school or no education followed by 18 percent whose mothers have primary education and 24 percent have mothers with secondary education or higher. About 1 percent of children are looked after by primary caretakers and the rest by their mothers. As regards to distribution of children with respect to household wealth, there are more children living in the households in the lowest quintile (23%) compared to 18 percent in the highest quintile. Table HH.5: Under-5's background characteristics Percent and frequency distribution of children under five years of age by selected characteristics, Punjab, 2014. Weighted percent Number of under-5 children Weighted Unweighted Punjab 100.0 27,495 27,495 Area of residence Rural 69.1 19,002 18,220 All Urban 30.9 8,493 9,275 Major Cities 51.4 4,364 2,663 Other Urban 48.6 4,129 6,612 Sex Male 50.6 13,915 14,003 Female 49.4 13,580 13,492 Age 0-5 months 8.5 2,333 2,302 6-11 months 10.9 3,010 3,008 12-23 months 19.3 5,300 5,350 24-35 months 19.4 5,326 5,302 36-47 months 21.4 5,894 5,908 48-59 months 20.5 5,633 5,625 Respondent to the under-5 questionnaire Mother 98.8 27,170 27,158 Other primary caretaker 1.2 325 337 Mother’s educationa None/pre-school 47.8 13,140 13,133 Primary 18.2 4,991 5,106 Middle 10.0 2,740 2,687 Secondary 13.0 3,563 3,449 Higher 11.1 3,062 3,120 Wealth index quintile Lowest 23.0 6,316 6,286 Second 20.2 5,560 5,612 Middle 19.4 5,335 5,621 Fourth 19.6 5,380 5,496 Highest 17.8 4,904 4,480 P a g e | 17 Table HH.5: Under-5's background characteristics Percent and frequency distribution of children under five years of age by selected characteristics, Punjab, 2014. Weighted percent Number of under-5 children Weighted Unweighted Division Bahawalpur 11.2 3,080 2,705 D.G. Khan 11.5 3,151 3,700 Faisalabad 11.9 3,272 3,067 Gujranwala 14.9 4,100 4,504 Lahore 17.0 4,670 3,449 Multan 11.0 3,019 2,934 Rawalpindi 7.9 2,165 2,264 Sahiwal 7.4 2,032 2,345 Sargodha 7.3 2,005 2,527 a 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. Housing Characteristics, Asset Ownership, and Wealth Quintiles Tables HH.6, HH.7 and HH.8 provide further details on household level characteristics. Table HH.6 presents characteristics of housing by area of residence and divisions. The characteristics include the availability of electricity, main materials of the flooring, roof, and exterior walls, as well as the number of rooms used for sleeping. It can be observed from Table HH.6 that 95 percent of households have electricity (100% in urban and 93% in rural). Sixty-three percent of households have finished (pacca) floor and 36 percent have rudimentary/natural (katcha) floor. More houses have “pacca” roofing (82%) than “pacca” floors (63%). Eighty-seven percent of households have “pacca” walls; urban houses are more likely to have pacca walls (97%) than rural houses (81%). Forty-one percent of households have one room for sleeping, whereas the mean number of persons per sleeping room is 3.9. In Table HH.7 households are distributed according to ownership of assets and dwelling. Sixty-eight percent of the households have a television, 53 percent have a refrigerator, 16 percent have a computer and 55 percent have a washing machine or dryer. Thirty one percent of households own agricultural land and 46 percent own livestock, while 87 percent own a house. Ownership of agricultural land and livestock is mostly in the rural areas. Ninety-three percent of households have at least a member owning a mobile phone and about 46 percent own a watch. Thirty-three percent of households have a member who owns a bicycle, 48 percent own a motorcycle or scooter, 6 percent have a car or van and 11 percent own an animal cart. P a g e | 18 Table HH.6: Housing characteristics Percent distribution of households by selected housing characteristics, according to area of residence and regions, Punjab, 2014. Punjab Area Division Rural All Urban Major Cities Other Urban Bahawalpur D.G. Khan Faisalabad Gujranwala Lahore Multan Rawalpindi Sahiwal Sargodha Electricity Yes 95.4 93.3 99.5 99.7 99.3 91.9 79.6 96.8 99.7 99.3 95.0 99.3 95.6 95.2 No 4.5 6.6 0.4 0.2 0.6 8.0 20.4 3.2 0.3 0.5 4.9 0.7 4.4 4.8 Missing/DK 0.0 0.0 0.1 0.1 0.1 0.0 0.0 0.0 0.0 0.1 0.1 0.0 0.0 0.0 Flooring Natural floor 36.4 51.4 6.5 2.4 11.0 49.1 67.6 36.2 21.1 14.9 48.2 12.7 53.5 55.7 Finished floor1 63.4 48.4 93.3 97.3 88.9 50.8 31.5 63.6 78.8 84.7 51.7 87.2 46.3 44.3 Other 0.2 0.2 0.1 0.1 0.0 0.1 0.9 0.2 0.1 0.2 0.0 0.1 0.1 0.0 Missing/DK 0.1 0.0 0.1 0.2 0.1 0.0 0.0 0.1 0.0 0.2 0.0 0.0 0.0 0.1 Roof Natural roofing 0.2 0.3 0.0 0.0 0.1 0.5 0.9 0.1 0.0 0.0 0.1 0.1 0.0 0.1 Rudimentary roofing 17.0 21.8 7.3 3.9 11.1 16.3 32.6 12.1 24.0 11.6 17.0 8.2 13.9 20.1 Finished roofing1 82.2 77.4 91.9 95.4 88.0 83.0 64.3 87.4 75.4 87.8 82.6 91.3 85.1 79.6 Other 0.5 0.5 0.7 0.5 0.8 0.2 2.2 0.5 0.5 0.3 0.2 0.4 1.0 0.1 Missing/DK 0.0 0.0 0.1 0.2 0.1 0.0 0.0 0.0 0.0 0.2 0.0 0.0 0.0 0.1 Exterior walls Natural walls 11.4 16.7 0.8 0.1 1.5 17.5 38.5 7.4 1.5 1.6 15.0 7.6 8.4 20.5 Rudimentary walls 1.3 1.8 0.3 0.4 0.3 2.5 2.7 0.7 0.2 1.2 2.0 1.5 1.0 0.4 Finished walls1 86.6 81.2 97.4 97.2 97.6 80.0 58.4 91.5 98.1 94.8 83.1 90.5 89.7 78.8 Other 0.6 0.2 1.5 2.3 0.6 0.0 0.4 0.4 0.2 2.3 0.0 0.4 1.0 0.2 Missing/DK 0.0 0.0 0.1 0.1 0.0 0.0 0.0 0.0 0.0 0.2 0.0 0.0 0.0 0.0 Rooms used for sleeping 1 41.1 43.5 36.3 34.8 38.0 47.6 54.2 35.6 32.9 39.9 49.2 27.0 50.4 40.5 2 40.6 39.9 42.1 41.9 42.3 38.1 34.5 43.5 43.1 40.9 38.4 47.1 35.7 41.0 3 or more 18.1 16.4 21.4 23.1 19.5 14.1 10.8 20.6 23.9 18.9 12.1 25.5 13.9 18.5 Missing/DK 0.2 0.3 0.2 0.2 0.2 0.2 0.5 0.3 0.1 0.3 0.3 0.4 0.1 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 38,405 25,577 12,828 6,717 6,111 4,091 3,436 4,889 5,569 6,631 4,633 3,633 2,638 2,885 Mean number of persons per room used for sleeping2 3.91 4.03 3.67 3.58 3.78 4.19 4.66 3.69 3.61 3.96 4.03 3.14 4.26 3.89 1 MICS indicator 14.S13 - Household characteristics 2 MICS indicator 14.S12 - Mean number of persons per room P a g e | 19 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, Punjab, 2014. Punjab Area Division Rural All Urban Major Cities Other Urban Bahawalpur D.G. Khan Faisalabad Gujranwala Lahore Multan Rawalpindi Sahiwal Sargodha Percentage of households that own a Radio 4.4 4.8 3.7 3.8 3.6 4.1 8.3 3.3 2.7 2.7 4.7 9.9 1.9 4.7 Television 67.6 58.0 86.9 91.0 82.5 52.3 39.2 70.2 79.4 82.7 56.8 81.0 63.9 65.9 Non-mobile telephone 6.2 2.6 13.2 17.5 8.6 3.3 1.9 5.9 7.9 11.0 2.3 12.4 2.3 3.2 Refrigerator 53.1 42.8 73.7 79.3 67.6 38.7 26.7 53.4 65.3 67.9 42.9 75.7 41.6 45.8 Computer 16.1 8.6 31.1 36.9 24.8 9.1 5.4 16.1 18.8 26.5 9.7 26.4 10.0 12.6 Washing machine/ Dryer 54.8 41.1 82.0 87.3 76.3 34.3 26.0 56.4 76.1 73.5 42.7 69.7 38.2 46.7 Air conditioner 7.7 2.6 17.7 23.4 11.5 3.1 2.7 7.1 8.0 17.4 5.4 8.1 4.5 3.9 Percentage of households that own Agricultural land 30.5 41.1 9.3 6.2 12.6 37.8 43.7 29.3 31.4 15.3 30.1 30.9 33.0 37.3 Farm animals/ Livestock 45.5 62.5 11.6 6.4 17.4 60.4 71.9 40.1 39.3 23.4 49.3 37.8 54.2 60.4 Percentage of households where at least one member owns or has a Watch 46.4 42.3 54.4 56.7 51.8 36.2 53.9 44.5 49.6 48.1 48.7 67.5 29.1 30.2 Mobile telephone 92.6 90.6 96.7 97.2 96.1 89.2 86.4 93.8 95.7 94.8 91.1 96.7 87.9 93.3 Bicycle 32.8 34.9 28.6 26.8 30.7 29.4 33.4 44.5 31.2 25.0 42.3 17.2 37.5 37.7 Motorcycle or scooter 48.5 44.3 56.9 63.3 49.8 48.2 41.4 49.7 51.2 55.4 49.1 39.9 46.2 46.3 Animal-drawn cart 10.8 15.1 2.4 1.2 3.6 10.1 9.9 14.7 8.7 8.7 8.2 2.3 23.0 19.3 Bus or truck 0.4 0.3 0.4 0.5 0.3 0.2 0.4 0.3 0.2 0.5 0.3 0.3 0.4 0.5 Boat with a motor 0.1 0.1 0.1 0.2 0.0 0.0 0.1 0.1 0.0 0.2 0.1 0.0 0.0 0.0 Car / van 5.8 3.6 10.2 13.4 6.7 3.2 2.2 4.9 5.5 9.4 4.4 11.7 3.7 4.3 Bank account 31.6 25.3 44.4 46.8 41.8 20.3 18.2 32.8 36.9 37.7 25.8 44.9 25.4 36.0 Ownership of dwelling Owned by a household member 87.0 91.6 77.9 73.8 82.4 90.0 93.0 86.3 91.1 82.9 87.9 79.2 84.7 88.9 Not owned 12.9 8.4 22.0 26.0 17.5 9.9 7.0 13.6 8.9 16.9 12.1 20.6 15.3 11.1 Rented 7.8 3.0 17.5 20.9 13.8 3.5 2.7 7.6 6.6 13.1 6.0 16.1 5.4 5.5 Other 5.1 5.4 4.4 5.1 3.7 6.5 4.3 6.1 2.3 3.8 6.1 4.5 9.9 5.6 Missing/DK 0.1 0.0 0.2 0.2 0.1 0.0 0.0 0.1 0.0 0.2 0.0 0.2 0.0 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 38,405 25,577 12,828 6,717 6,111 4,091 3,436 4,889 5,569 6,631 4,633 3,633 2,638 2,885 P a g e | 20 Table HH.8 shows the distribution of household population according to household wealth quintiles. In urban population positive correlation can be observed with wealth quintiles; the highest proportion of population is living in households in the highest quintile. In contrast, a higher proportion of rural population is living in the households in the lowest quintile. Lahore division which is highly urban, has 40 percent of its population living in the households in the highest quintile and less than 5 percent living in the households in the lowest quintile. In contrast, 57 percent of the population in DG Khan division is living in the households in the lowest quintile compared to 3 percent of population living in the households in the highest quintile. Table HH.8: Wealth quintiles Percent distribution of the household population by wealth index quintiles, according to area of residence and regions, Punjab, 2014. Wealth index quintiles Total Number of household members Lowest Second Middle Fourth Highest Total 20.0 20.0 20.0 20.0 20.0 100.0 246,396 Area Rural 28.5 26.8 23.0 15.4 6.3 100.0 165,174 All Urban 2.7 6.2 13.9 29.4 47.8 100.0 81,222 Major Cities 0.5 1.9 8.7 27.8 61.0 100.0 42,289 Other Urban 5.0 10.9 19.6 31.2 33.4 100.0 38,933 Division Bahawalpur 37.6 25.6 17.8 10.9 8.2 100.0 25,956 D.G. Khan 56.6 22.0 11.1 6.9 3.4 100.0 23,418 Faisalabad 16.4 19.7 21.6 23.2 19.1 100.0 30,970 Gujranwala 4.7 14.1 25.5 29.9 25.7 100.0 36,313 Lahore 4.6 12.6 17.5 25.5 39.8 100.0 43,847 Multan 24.6 25.2 22.5 16.3 11.3 100.0 27,788 Rawalpindi 5.9 13.9 20.6 26.9 32.7 100.0 21,767 Sahiwal 19.9 30.4 22.8 16.5 10.4 100.0 17,255 Sargodha 31.0 28.6 19.6 12.5 8.3 100.0 19,082 P a g e | 21 IV. CHILD MORTALITY One of the overarching goals of the Millennium Development Goals (MDGs) is the reduction of infant and under-five mortality. The infant mortality rate is the probability of dying before the first birthday, while the under-five mortality rate is the probability of dying before the fifth birthday. The MDGs call for the reduction in under-five mortality by two-thirds between 1990 and 2015. Monitoring progress towards this goal is an important but difficult objective. In MICS Punjab, 2014 an indirect method, known as the Brass method14, was used. Robust estimates of the aforementioned indicators are produced by this method, and generally are comparable with those obtained by applying direct methods. The data used by the indirect method are: the mean number of children ever born for the five-year time-since-first-birth (TSFB) groups of women age 15 to 49 years, and the proportion of these children who are dead, also for five-year time-since-first-birth groups of women (Table CM.1). The technique converts the proportions dead among children of women in each time-since-first-birth group into probabilities of dying by taking into account the approximate length of exposure of children to the risk of dying, assuming a particular model age pattern of mortality. Based on previous information on mortality in Pakistan, the “East Model” life table was selected as most appropriate. Table CM.1: Children ever born, children surviving and proportion dead Mean and total numbers of children ever born, children surviving and proportion dead by age of women, Punjab, 2014. Children ever born Children surviving Proportion dead Number of women age 15-49 years Mean Total Mean Total Punjab 3.7 104,444 3.4 94,193 0.1 28,106 Time since first birth 0-4 1.7 11,636 1.5 10,773 0.1 6,996 5-9 3.2 21,681 2.9 19,838 0.1 6,775 10-14 4.3 25,158 3.9 22,769 0.1 5,794 15-19 5.1 24,596 4.6 22,012 0.1 4,803 20-24 5.7 21,374 5.0 18,800 0.1 3,738 Table CM.2 provides estimates of infant and under-five mortality rates derived from proportion dead among children of women in various time-since-first-birth groups from 0-4 to 20-24. This table provides estimates of infant and under-5 mortality rates for various points in time prior to the survey. These estimates are later used in Figure CM.2 to compare the trend indicated by these rates with those from other data sources. 14 United Nations, 1983. Manual X: Indirect Techniques for Demographic Estimation (United Nations publication, Sales No. E.83.XIII.2). United Nations, 1990a. QFIVE, United Nations Program for Child Mortality Estimation. New York, UN Pop Division. United Nations, 1990b. Step-by-step Guide to the Estimation of Child Mortality. New York, UN. International Union for the Scientific Study of Population, 2013. Tools for Demographic Estimation. Paris, UNFPA. P a g e | 22 Table CM.2: Infant and under-5 mortality rates by age groups of women Indirect estimates of infant and under-5 mortality rates by age of women, and reference dates for estimates, East model, Punjab 2014. Reference date Infant mortality rate Under-5 mortality rate Time since first birth 0-4 2012.7 76 95 5-9 2010.2 74 92 10-14 2007.3 76 95 15-19 2004.1 79 100 20-24 2000.5 84 107 To obtain the most recent single estimates of the two indicators by background characteristics, estimates from time since first birth groups 0-4 and 5-9 are averaged and presented in Table CM.3. Table CM.3: Infant and under-5 mortality rates by background characteristics Indirect estimates of infant and under-five mortality rates by selected background characteristics, age version, (by using East Model), Punjab, 2014. Infant mortality rate1 Under-five mortality rate2 Punjab 75 93 Area of residence Rural 83 105 All Urban 57 69 Major Cities 46 55 Other Urban 68 85 Sex Male 84 104 Female 65 82 Mother's education None/pre-school 96 124 Primary 73 91 Middle 58 71 Secondary 50 60 Higher 46 54 Wealth index quintile Lowest 105 137 Second 88 112 Middle 73 91 Fourth 61 75 Highest 45 53 Division Bahawalpur 91 116 D.G. Khan 91 118 Faisalabad 74 92 Gujranwala 68 85 Lahore 64 79 Multan 74 92 Rawalpindi 59 72 Sahiwal 89 114 Sargodha 72 89 1 MICS indicator 1.2; MDG indicator 4.2 - Infant mortality rate 2 MICS indicator 1.5; MDG indicator 4.1 - Under-five mortality rate Rates refer to April 2011. The East Model was assumed to approximate the age pattern of mortality in Pakistan. The infant mortality rate is estimated at 75 deaths per thousand live births, while the probability of dying under age 5 (U5MR) is 93 deaths per thousand live births. Probability of dying during childhood among males is higher than females. The infant mortality rate for males is 84 deaths per thousand live births compared to 65 deaths per thousand for females, similarly the child mortality for males is 104 P a g e | 23 deaths per thousand live births compared with 82 deaths per thousand for females (Table CM.3). Among divisions, infant mortality rates and under-5 mortality rates are lowest in Rawalpindi division (72 and 59 deaths per thousand live births respectively) and highest in DG Khan division (118 and 91 deaths per thousand live births respectively). Infant mortality rate in rural areas is 83 deaths per thousand live births compared to 57 deaths per thousand live births in urban areas. Similarly, under-5 mortality rate is higher in rural areas compared to urban areas (105 and 69 deaths per thousand live births respectively). There is a considerable difference in child mortality in terms of mother's educational levels and wealth. Under-5 mortality for children whose mothers have pre-school or no education is high (124 deaths per thousand live births) and the rates decline as the mother’s educational level increases. Similarly, infant mortality rate for children whose mothers have pre-school or no education is much higher compared to children whose mothers have higher secondary education (96 versus 46 deaths per thousand live births). Furthermore, the probability of dying before age 5 for children living in households in the highest quintile is much lower (53 deaths per thousand live births) compared to children living in the households in the lowest quintile (137 deaths per thousand live births). Similarly, infant mortality rate is 105 deaths per thousand live births for children living in the households in the lowest quintile compared to 45 deaths per thousand live births for those living in the households in the highest quintile. Figure CM.1 provides a graphical presentation of the differences of child mortality rates. P a g e | 24 Figure CM.1: Under -5 mortal i t y rates by area and div is ion , MICS Punjab , 2014 Figure CM.2 compares the findings of the current MICS Punjab, 2014 with MICS Punjab, 2011 and Pakistan Demographic and Health Survey (PDHS) 2012-13. The MICS estimates indicate a decline in mortality during the last four years. 53 75 91 112 137 54 60 71 91 124 69 105 116 118 92 85 79 92 72 114 89 93 0 50 100 150 Wealth index quintile Highest Fourth Middle Second Lowest Mother's education Higher Secondary Middle Primary None/pre-school Area Urban Rural Division Bahawalpur D.G.Khan Faisalabad Gujranwala Lahore Multan Rawalpindi Sahiwal Sargodha Punjab Under-5 Mortality Rates per 1,000 Births P a g e | 25 Figure CM.2: Trend in under -5 mortal i ty and In fant mortal i ty rates , 1990-2014 133 97 104 105 9591 78 82 74 75 0 20 40 60 80 100 120 140 PDHS 1990-91 PDHS 2006-07 MICS 2011 PDHS 2012-13 MICS 2014 Deaths per 1,000 live births Under-5 mortality Infant mortality P a g e | 26 V. NUTRITION Low Birth Weight Weight at birth is a good indicator not only of a mother's health and nutritional status but also for the new-born’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 shoots 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 developing countries like Pakistan, 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 countries like Pakistan (developing countries) 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.15 15 For a detailed description of the methodology, see Boerma, J. T., Weinstein, K. I., Rutstein, S.O., and Sommerfelt, A. E. , 1996. Source of Data on Birth Weight in Developing Countries in “Bulletin of the World Health Organization”, P a g e | 27 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, Punjab, 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 Punjab 3.9 16.6 70.2 8.4 0.8 100.0 29.4 25.6 10,653 Area of residence Rural 3.9 17.7 69.9 7.5 1.1 100.0 29.9 18.8 7,369 All Urban 4.1 14.4 70.9 10.3 0.3 100.0 28.3 41.0 3,284 Major Cities 4.1 12.6 71.9 11.2 0.2 100.0 27.4 49.1 1,692 Other Urban 4.1 16.3 69.9 9.3 0.5 100.0 29.3 32.3 1,592 Mother’s age at birth Less than 20 years 4.2 17.5 69.5 7.7 1.1 100.0 30.1 19.0 694 20-34 years 3.9 16.2 70.5 8.6 0.8 100.0 29.2 26.9 8,660 35-49 years 4.1 19.1 68.5 7.5 0.9 100.0 30.8 20.3 1,299 Birth order 1 4.2 15.9 70.8 8.3 0.8 100.0 29.3 32.5 2,431 2-3 3.9 16.1 71.2 8.2 0.7 100.0 29.2 28.3 4,392 4-5 3.7 17.2 69.5 8.6 1.1 100.0 29.5 21.0 2,448 6+ 4.1 18.8 67.3 8.8 1.1 100.0 30.4 13.0 1,382 Mother’s educationa None/pre-school 4.1 19.0 68.7 7.2 1.0 100.0 30.8 10.5 4,816 Primary 4.1 16.8 70.9 7.4 0.7 100.0 29.7 20.4 1,961 Middle 3.8 16.0 71.7 7.6 0.8 100.0 29.1 35.8 1,096 Secondary 4.0 11.8 72.7 10.9 0.6 100.0 27.0 42.8 1,467 Higher 3.0 13.7 70.6 12.1 0.6 100.0 27.1 61.2 1,311 Wealth index quintile Lowest 3.7 22.2 67.4 5.6 1.1 100.0 32.2 6.0 2,327 Second 4.4 18.0 68.8 8.0 0.9 100.0 30.4 12.3 2,166 Middle 4.1 15.1 72.0 7.6 1.1 100.0 28.8 21.6 2,144 Fourth 4.5 13.6 72.4 8.9 0.6 100.0 28.3 35.2 2,065 Highest 2.9 13.5 70.7 12.5 0.4 100.0 27.0 58.0 1,951 Division Bahawalpur 4.7 21.5 61.4 10.3 1.9 100.0 31.9 15.5 1,068 D.G. Khan 3.6 28.0 62.1 5.9 0.4 100.0 34.8 6.0 1,181 Faisalabad 2.7 11.6 77.9 7.4 0.4 100.0 26.5 22.2 1,237 Gujranwala 4.8 15.4 72.3 7.3 0.2 100.0 29.6 30.7 1,578 Lahore 6.1 14.8 66.2 12.1 0.8 100.0 29.5 35.8 1,914 Multan 1.6 13.8 75.4 7.9 1.4 100.0 26.6 20.7 1,162 Rawalpindi 3.9 14.1 70.5 9.9 1.6 100.0 27.9 50.8 882 Sahiwal 3.7 16.9 72.0 7.2 0.3 100.0 29.5 21.4 827 Sargodha 1.8 14.9 77.5 4.5 1.2 100.0 27.8 22.7 804 1 MICS indicator 2.20 - Low-birthweight infants 2 MICS indicator 2.21 - Infants weighed at birth a Total includes 2 unweighted cases of mother's education missing Overall, about 26 percent of births were weighed at birth and approximately 29 percent of infants are estimated to weigh less than 2,500 grams at birth (Table NU.1). Among divisions, Rawalpindi had the lowest proportion of low birth weight babies (27%) and the highest proportion was in DG Khan division (35%). The prevalence of low birth weight does not vary considerably by urban and rural areas or mother’s education. P a g e | 28 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 MDG target is to reduce by half the proportion of people who suffer from hunger between 1990 and 2015. A reduction in the prevalence of malnutrition will also assist in the goal to reduce child mortality. In a well-nourished population, there is a reference distribution of height and weight for children under age 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 standards16. 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 weight 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 height 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 weight of the reference population are classified as moderately or severely wasted, while those who fall more than three standard deviations below the median are classified as severely wasted. Wasting is usually the result of a recent nutritional deficiency. The indicator of wasting may exhibit significant seasonal shifts associated with changes in the availability of food or disease prevalence. Children whose weight-for-height is more than two standard deviations above the median reference population are classified as moderately or severely overweight. In MICS5, weights and heights of all children under 5 years of age were measured using the anthropometric equipment recommended17 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 and mean z-scores for all three anthropometric indicators. 16 http://www.who.int/childgrowth/standards/technical_report 17 MICS Supply Procurement Instructions: http://mics.unicef.org/tools#survey-design P a g e | 29 Children whose full birth date (month and year) were not obtained, and children whose measurements were outside a plausible range are excluded from Table NU.2. Children 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.10, DQ.11, and DQ.12 in Appendix – E. These tables show that due to incomplete dates of birth, implausible measurements, and/or missing weight and/or height, 3.4 percent of children have been excluded from calculations of the weight-for-age, 4.2 percent from the height-for- age, and 3.8 percent for the weight-for-height. Percentage of interviews completed for eligible children is shown in Table DQ.3. The completeness of reporting of both year and month is 99 percent for interviews conducted for children under 5 (Table DQ.4). There was no heaping in the weight measurements, however, a slight heaping was observed in the height measurements where interviewers preferred the digits zero, two and five (DQ.13). Almost one in three children under age five are moderately or severely underweight (34%) and 11 percent are classified as severely underweight (Table NU.2). Thirty four percent of children are moderately or severely stunted or too short for their age and 18 percent of children are moderately or severely wasted or too thin for their height, whereas less than 1 percent are overweight or too heavy for their height. Boys appear to be slightly more likely to be underweight, stunted, and wasted than girls. Children in rural areas are more likely to be underweight and stunted than in other urban areas and major cities. Among divisions, children in DG Khan division are twice more likely to be underweight and stunted (44% and 47%) than children in Rawalpindi division (21% respectively). All three anthropometric indicators are found to be better in Rawalpindi division. Underweight, stunting and wasting indicators are inversely correlated with mother’s education and wealth. Among women with higher education, 13 percent of children are stunted, 15 percent are underweight and 12 percent are wasted compared to more than 40 percent for stunting and underweight among children whose mother have pre-school or no education. Nearly half of children living in the households in the lowest quintile are stunted and the same proportion of children is underweight compared to 17 percent of children living in the households in the highest quintile that are stunted and underweight. The age pattern shows that a higher percentage of children age 36-47 months are undernourished as prevalence of underweight and stunting is higher in this age group in comparison to children who are younger (Figure NU.1). P a g e | 30 Figure NU.1: Under weight , s tunted, wasted and overweight ch i ldren under age 5 (moderate and severe) , MICS Punjab , 2014 Underweight Stunted Wasted Overweight 0 5 10 15 20 25 30 35 40 45 0 12 24 36 48 60 P e rc e n t Age in months P a g e | 31 Table NU.2: Nutritional status of children Percentage of children under age 5 by nutritional status according to three anthropometric indices: weight for age, height for age, and weight for height, Punjab, 2014. Weight for age Number of children under age 5 Height for age Number of children under age 5 Weight for height Number of children under age 5 Underweight Mean Z- Score (SD) Stunted Mean Z- Score (SD) Wasted Overweight Mean Z- Score (SD) Percent below Percent below Percent below Percent above - 2 SD1 - 3 SD2 - 2 SD3 - 3 SD4 - 2 SD5 - 3 SD6 + 2 SD7 Punjaba 33.7 11.3 -1.6 26,490 33.5 13.3 -1.4 26,280 17.5 4.4 0.8 -1.0 26,421 Area of residence Rural 36.3 12.9 -1.6 18,343 36.7 15.1 -1.6 18,195 18.2 4.8 0.8 -1.0 18,284 All Urban 27.7 7.7 -1.3 8,147 26.3 9.2 -1.2 8,085 16.1 3.6 1.0 -0.9 8,137 Major Cities 26.3 6.9 -1.3 4,162 25.0 8.4 -1.1 4,143 15.5 3.3 1.1 -0.9 4,166 Other Urban 29.2 8.7 -1.4 3,985 27.7 10.2 -1.2 3,942 16.6 4.0 0.9 -1.0 3,971 Sex Male 33.9 11.4 -1.6 13,410 33.9 13.5 -1.4 13,290 18.8 5.0 0.9 -1.0 13,356 Female 33.4 11.1 -1.6 13,080 33.1 13.2 -1.4 12,990 16.2 3.8 0.7 -1.0 13,065 Age 0-5 months 30.9 12.8 -1.5 2,263 17.5 6.8 -0.7 2,238 30.6 11.9 1.6 -1.3 2,165 6-11 months 30.8 11.0 -1.4 2,947 22.0 7.9 -1.0 2,926 22.6 6.6 1.4 -1.1 2,941 12-23 months 33.8 12.3 -1.6 5,170 33.0 13.2 -1.4 5,116 20.7 5.5 0.7 -1.1 5,159 12-17 months 32.9 11.7 -1.5 2,583 30.3 11.3 -1.3 2,562 22.4 5.9 0.6 -1.2 2,580 18-23 months 34.7 12.9 -1.6 2,587 35.7 15.0 -1.6 2,554 18.9 5.1 0.8 -1.1 2,580 24-35 months 35.4 12.3 -1.6 5,150 38.6 16.5 -1.7 5,101 16.2 3.9 0.6 -1.0 5,132 36-47 months 35.8 11.5 -1.6 5,637 41.6 16.1 -1.7 5,601 13.0 2.0 0.8 -0.9 5,688 48-59 months 32.3 8.6 -1.5 5,324 33.7 13.2 -1.5 5,298 12.6 2.2 0.6 -0.9 5,336 Mother’s education None/pre-school 42.2 16.2 -1.8 12,646 43.0 19.2 -1.8 12,529 20.0 5.4 0.7 -1.1 12,639 Primary 33.8 10.2 -1.6 4,820 33.3 11.5 -1.4 4,782 17.7 3.9 0.5 -1.0 4,798 Middle 26.9 6.7 -1.4 2,658 27.4 8.9 -1.3 2,642 15.2 4.3 1.0 -0.9 2,658 Secondary 23.3 5.4 -1.2 3,440 21.2 6.2 -1.0 3,414 14.5 3.1 1.1 -0.9 3,418 Higher 14.8 3.0 -0.9 2,927 12.9 3.2 -0.7 2,914 12.3 2.6 1.5 -0.7 2,908 Wealth index quintile Lowest 47.7 20.3 -2.0 6,072 49.4 24.1 -2.0 5,993 21.4 6.1 0.6 -1.2 6,045 Second 39.0 13.3 -1.7 5,362 39.4 15.9 -1.7 5,323 18.7 5.1 0.6 -1.1 5,350 Middle 32.2 9.5 -1.5 5,162 31.1 10.9 -1.4 5,126 18.5 4.1 0.7 -1.0 5,153 Fourth 28.0 7.0 -1.4 5,212 26.3 8.3 -1.2 5,186 15.7 3.9 1.0 -0.9 5,199 Highest 17.3 4.1 -1.0 4,682 16.9 4.7 -0.8 4,652 12.2 2.4 1.4 -0.7 4,673 P a g e | 32 Table NU.2: Nutritional status of children Percentage of children under age 5 by nutritional status according to three anthropometric indices: weight for age, height for age, and weight for height, Punjab, 2014. Weight for age Number of children under age 5 Height for age Number of children under age 5 Weight for height Number of children under age 5 Underweight Mean Z- Score (SD) Stunted Mean Z- Score (SD) Wasted Overweight Mean Z- Score (SD) Percent below Percent below Percent below Percent above - 2 SD1 - 3 SD2 - 2 SD3 - 3 SD4 - 2 SD5 - 3 SD6 + 2 SD7 Division Bahawalpur 42.6 16.6 -1.8 2,940 41.3 19.2 -1.7 2,900 20.8 6.0 1.0 -1.2 2,932 D.G. Khan 43.9 17.3 -1.9 3,012 46.6 23.0 -1.9 2,977 18.8 4.4 1.0 -1.1 3,017 Faisalabad 33.8 10.7 -1.5 3,210 29.5 10.7 -1.3 3,193 21.0 6.7 1.2 -1.1 3,173 Gujranwala 24.5 6.8 -1.3 4,006 28.5 8.8 -1.3 3,985 13.2 3.2 0.8 -0.8 3,984 Lahore 31.2 9.6 -1.5 4,452 31.7 11.8 -1.4 4,414 15.2 3.4 0.8 -0.9 4,465 Multan 36.8 12.6 -1.7 2,884 34.7 14.8 -1.5 2,856 20.5 5.0 0.9 -1.1 2,878 Rawalpindi 21.4 5.5 -1.2 2,079 21.4 6.6 -1.0 2,069 13.3 2.6 1.1 -0.8 2,076 Sahiwal 36.0 12.2 -1.6 1,980 34.0 13.2 -1.5 1,971 18.3 4.3 0.2 -1.1 1,977 Sargodha 34.8 11.3 -1.6 1,927 33.3 11.8 -1.5 1,916 18.5 4.1 0.3 -1.1 1,919 Punjaba 33.7 11.3 -1.6 26,490 33.5 13.3 -1.4 26,280 17.5 4.4 0.8 -1.0 26,421 1 MICS indicator 2.1a and MDG indicator 1.8 - Underweight prevalence (moderate and severe) 2 MICS indicator 2.1b - Underweight prevalence (severe) 3 MICS indicator 2.2a - Stunting prevalence (moderate and severe) 4 MICS indicator 2.2b - Stunting prevalence (severe) 5 MICS indicator 2.3a - Wasting prevalence (moderate and severe) 6 MICS indicator 2.3b - Wasting prevalence (severe) 7 MICS indicator 2.4 - Overweight prevalence a Number of children under age 5 in each case differ as children are excluded from one or more anthropometric indicators when their weights or heights have not been measured P a g e | 33 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.18 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.19 Starting at 6 months, breastfeeding should be combined with safe, age-appropriate feeding of solid, semi-solid and soft foods.20 A summary of key guiding principles21, 22 for feeding 6-23 month olds is provided in the table on next page along with proximate measures for these guidelines. 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. Dietary diversity is used to ascertain the adequacy of the nutrient content of the food (not including iron) consumed. For dietary 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).23 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 from at least 4 food groups; and (iii) breastmilk or at least 2 milk feeds (for non-breastfed children). 18 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. 19 WHO (2003). Implementing the Global Strategy for Infant and Young Child Feeding. Meeting Report Geneva, 3-5 February 2003. 20 WHO (2003). Global Strategy for Infant and Young Child Feeding. 21 PAHO (2003). Guiding principles for complementary feeding of the breastfed child. 22 WHO (2005). Guiding principles for feeding non-breastfed children 6-24 months of age 23 WHO (2008). Indicators for assessing infant and young child feeding practices. Part 1: Definitions. P a g e | 34 Table Guiding Principle (age 6-23 months) Proximate measures NU.4 Continue frequent, on-demand breastfeeding for two years and beyond Breastfed in the last 24 hours NU.6 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 groups24 eaten in the last 24 hours na 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 NU.9 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 na Practice responsive feeding, applying the principles of psycho-social care No standard indicator exists Table NU.3 is based on mothers’ report 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.25 Although a very important step in management of lactation and establishment of a physical and emotional relationship between the baby and the mother, only 11 percent of babies are breastfed for the first time within one hour of birth, while 45 percent of newborns start breastfeeding within one day of birth. By division, 66 percent of babies in Rawalpindi division were breastfed within one day of birth compared to only 28 percent of babies in Sahiwal. The data also show that 75 percent of newborns receive prelacteal feed. The findings are presented in Figure NU.2 by division and area of residence. 24 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. 25 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). P a g e | 35 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, Punjab, 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 Punjab 93.7 10.6 45.2 74.5 10,653 Area of residence Rural 93.9 10.3 44.3 74.4 7,369 All Urban 93.3 11.2 47.3 74.8 3,284 Major Cities 93.8 11.9 50.3 73.2 1,692 Other Urban 92.8 10.5 44.1 76.5 1,592 Months since last birth 0-11 months 93.4 10.0 42.5 74.6 5,546 12-23 months 94.0 11.3 48.2 74.4 5,107 Assistance at delivery Skilled attendant 93.4 9.8 42.3 75.9 6,894 Traditional birth attendant 95.4 11.9 50.9 73.3 3,535 Other 97.3 19.5 59.5 65.5 173 No one/Missing (7.3) (0.0) (3.6) (7.3) 52 Place of delivery Home 95.6 12.9 51.8 73.3 4,125 Health facility 93.2 9.2 41.4 75.9 6,473 Public 93.7 11.8 49.9 70.9 1,909 Private 93.0 8.1 37.8 77.9 4,565 Other/DK/Missing 12.7 4.0 8.6 9.0 55 Mother’s educationa None/pre-school 93.7 11.5 45.4 71.7 4,816 Primary 94.6 9.1 45.0 77.7 1,961 Middle 93.0 8.7 45.9 77.4 1,096 Secondary 93.8 10.4 45.8 76.4 1,467 Higher 93.1 11.3 43.8 75.6 1,311 Wealth index quintile Lowest 94.2 12.4 45.5 69.2 2,327 Second 94.7 10.9 45.3 75.2 2,166 Middle 93.6 8.8 44.9 77.6 2,144 Fourth 92.8 8.4 44.0 76.2 2,065 Highest 93.0 12.4 46.5 74.8 1,951 Division Bahawalpur 95.1 11.2 39.7 69.4 1,068 D.G. Khan 95.7 22.2 56.4 57.6 1,181 Faisalabad 93.6 6.2 40.8 82.7 1,237 Gujranwala 91.8 5.5 42.4 85.4 1,578 Lahore 92.8 10.4 42.0 74.9 1,914 Multan 94.2 9.5 47.4 63.9 1,162 Rawalpindi 92.8 17.6 66.4 69.8 882 Sahiwal 93.8 4.5 27.5 84.1 827 Sargodha 95.1 10.2 48.3 81.9 804 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 a Total includes 2 unweighted cases of mother's education missing P a g e | 36 Figure NU.2: In i t iat ion of breastfeeding, MICS Punjab, 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 the interview. 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. In Table NU.4, breastfeeding status is presented for both Exclusively breastfed and Predominantly breastfed; referring to infant’s 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. Approximately 17 percent of children age less than six months are exclusively breastfed. With 48 percent predominantly breastfed, it is evident that water-based liquids are displacing feeding of breastmilk to the greatest degree. By age 12-15 months, 66 percent of children are breastfed, and by age 20-23 months, 35 percent continue to be breastfed. Exclusive breastfeeding for children age less than six months is slightly higher in rural areas than urban areas. In Bahawalpur division, fewer children (7%) are exclusively breastfed compared to children in the other divisions. Predominant breastfeeding ranges from 37 percent in Gujranwala division to 60 percent in Multan division. 40 56 41 42 42 47 66 27 48 47 44 45 11 22 6 6 10 9 18 4 10 11 10 11 0 20 40 60 80 100 P er ce n t Within one day Within one hour P a g e | 37 Table NU.4: Breastfeeding Percentage of living children according to breastfeeding status at selected age groups, Punjab, 2014. Children age 0-3 months Children age 0-5 months Children age 12-15 months Children age 20-23 months Percent ever breastfed Percent exclusively breastfed1 Percent predominantly breastfed2 Number of children Percent ever breastfed 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 Punjab 96.6 22.6 55.5 1,583 96.5 16.8 47.8 2,333 65.6 1,854 34.5 1,728 Area of residence Rural 96.3 24.6 59.9 1,113 96.3 18.3 51.1 1,627 67.3 1,299 34.0 1,188 All Urban 97.5 17.8 45.0 470 96.9 13.4 40.0 706 61.5 555 35.7 540 Major Cities 99.1 14.8 41.7 236 98.4 11.5 38.6 373 56.9 251 33.3 284 Other Urban 95.9 20.8 48.4 234 95.2 15.4 41.5 333 65.4 304 38.3 256 Sex Male 95.7 22.9 55.9 757 95.7 16.7 47.8 1,138 64.4 963 35.4 903 Female 97.5 22.3 55.1 825 97.3 16.9 47.7 1,195 66.9 891 33.5 825 Mother’s education None/pre-school 96.2 22.6 63.1 727 96.1 16.6 54.4 1,075 68.9 839 40.2 738 Primary 96.8 23.4 56.6 277 96.9 18.6 50.7 391 66.7 369 33.9 309 Middle 96.2 22.1 47.0 155 96.4 16.3 39.5 229 62.5 192 28.5 210 Secondary 96.9 21.6 45.3 231 96.5 16.0 38.7 330 60.6 249 32.7 237 Higher 97.8 22.9 44.2 192 97.6 16.5 36.5 307 58.9 205 24.6 234 Wealth index quintile Lowest 95.3 20.5 66.2 356 96.4 15.0 56.8 515 72.9 406 37.8 336 Second 97.1 24.0 60.8 350 96.9 17.4 51.9 527 69.5 382 36.8 340 Middle 96.9 23.8 56.5 307 97.4 18.3 50.1 431 63.5 395 39.5 351 Fourth 95.7 25.4 50.3 309 94.7 19.2 44.4 460 62.0 347 30.5 344 Highest 98.5 18.7 38.6 262 97.4 13.8 32.0 400 58.2 323 28.3 358 Division Bahawalpur 99.7 9.8 56.6 149 99.8 7.4 49.5 224 71.3 201 34.5 151 D.G. Khan 95.6 21.3 62.5 170 96.4 15.3 51.0 257 72.0 205 43.1 153 Faisalabad 94.7 15.2 47.3 168 95.6 10.0 42.3 277 68.7 200 34.5 228 Gujranwala 94.6 26.4 45.8 216 95.2 19.3 37.3 323 61.4 297 27.0 302 Lahore 97.9 18.9 48.9 290 97.1 14.1 43.2 406 55.2 315 32.3 268 Multan 96.0 24.3 66.6 210 96.5 20.1 60.2 286 64.0 203 36.3 203 Rawalpindi 97.0 34.4 57.6 120 94.6 24.1 46.9 194 63.1 128 34.5 138 Sahiwal 97.4 30.9 56.7 130 96.3 24.3 49.2 175 69.6 164 39.3 150 Sargodha 97.4 28.2 65.2 130 97.3 21.5 57.7 192 75.7 142 38.1 133 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 P a g e | 38 Figure NU.3 shows the detailed pattern of breastfeeding by the child’s age in months. Even at the earliest ages, the majority of children are receiving liquids or foods other than breastmilk, with other milk formula being of highest prevalence, even at the early age of 0-1 months. At age 4-5 months old, the percentage of children exclusively breastfed is only 5 percent. About 30 percent of children are receiving breastmilk at age 2 years. Figure NU.3: Infant feeding patterns by age, MICS Punjab, 2014 Table NU.5 shows the median duration of breastfeeding by selected background characteristics. Among children under age 3, the median duration is 17.4 months for any breastfeeding, 0.6 months for exclusive breastfeeding, and 2.2 months for predominant breastfeeding. There is no difference in median duration of exclusive breastfeeding according to background characteristics, while slight differentials are observed for predominant breastfeeding. Exclusively breastfed Breastfed and complementary foods Weaned (not breastfed) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0-1 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-17 18-19 20-21 22-23 Age in months Exclusively breastfed Breastfed and plain water only Breastfed and non-milk liquids Breastfed and other milk / formula Breastfed and complementary foods Weaned (not breastfed) P a g e | 39 Table NU.5: Duration of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children age 0-35 months, Punjab, 2014. Median duration (in months) of: Number of children age 0-35 months Any breastfeeding1 Exclusive breastfeeding Predominant breastfeeding Median (Punjab) 17.4 0.6 2.2 15,968 Area of residence Rural 17.6 0.6 2.6 11,061 All Urban 16.8 0.5 0.7 4,908 Major Cities 16.0 0.5 0.6 2,524 Other Urban 17.7 0.5 1.4 2,384 Sex Male 17.5 0.6 2.2 8,106 Female 17.3 0.6 2.2 7,863 Mother’s education None/pre-school 18.2 0.5 3.1 7,277 Primary 18.3 0.6 2.6 2,960 Middle 15.1 0.5 1.5 1,657 Secondary 17.9 0.6 0.7 2,164 Higher 15.7 0.6 0.8 1,910 Wealth index quintile Lowest 18.9 0.5 3.4 3,480 Second 18.1 0.6 2.8 3,246 Middle 17.4 0.6 2.5 3,216 Fourth 16.6 0.6 1.9 3,149 Highest 15.8 0.5 0.6 2,877 Division Bahawalpur 18.7 0.5 2.5 1,682 D.G. Khan 20.0 0.5 2.6 1,767 Faisalabad 17.0 0.5 1.4 1,920 Gujranwala 15.8 0.6 1.1 2,398 Lahore 14.8 0.6 1.1 2,739 Multan 18.6 0.5 3.8 1,771 Rawalpindi 19.2 0.8 2.2 1,267 Sahiwal 16.9 0.6 2.4 1,218 Sargodha 18.2 0.6 3.4 1,206 Mean (Punjab) 16.7 1.0 3.6 15,968 1 MICS indicator 2.11 - Duration of breastfeeding The age-appropriateness of breastfeeding of children under age 24 months is provided in Table NU.6. Different criteria of feeding are used depending on the age of the child. For infants age 0-5 months, exclusive breastfeeding is considered as age-appropriate feeding, while children age 6-23 months are considered to be appropriately fed if they are receiving breastmilk and solid, semi-solid or soft food. As a result of feeding patterns, only 48 percent of children age 6-23 months are being appropriately breastfed and age-appropriate breastfeeding among all children age 0-23 months, drops to 41 percent. At divisional level, age-appropriate breastfeeding among all children age 0-23 months ranges from 36 percent in Bahawalpur to 49 percent in Rawalpindi. P a g e | 40 Table NU.6: Age-appropriate breastfeeding Percentage of children age 0-23 months who were appropriately breastfed during the previous day, Punjab, 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 Punjab 16.8 2,333 48.0 8,310 41.2 10,642 Area of residence Rural 18.3 1,627 48.2 5,756 41.6 7,383 All Urban 13.4 706 47.6 2,553 40.2 3,259 Major Cities 11.5 373 44.9 1,298 37.5 1,671 Other Urban 15.4 333 50.4 1,255 43.1 1,588 Sex Male 16.7 1,138 48.0 4,254 41.4 5,392 Female 16.9 1,195 48.0 4,056 40.9 5,251 Mother’s education None/pre-school 16.6 1,075 47.7 3,730 40.7 4,806 Primary 18.6 391 49.5 1,529 43.2 1,921 Middle 16.3 229 44.0 887 38.3 1,116 Secondary 16.0 330 50.1 1,139 42.4 1,469 Higher 16.5 307 48.3 1,024 41.0 1,331 Wealth index quintile Lowest 15.0 515 47.3 1,794 40.1 2,308 Second 17.4 527 48.9 1,646 41.2 2,173 Middle 18.3 431 49.7 1,690 43.3 2,122 Fourth 19.2 460 46.7 1,634 40.7 2,094 Highest 13.8 400 47.5 1,546 40.6 1,946 Division Bahawalpur 7.4 224 43.0 849 35.6 1,073 D.G. Khan 15.3 257 54.5 906 45.9 1,163 Faisalabad 10.0 277 50.6 1,033 42.0 1,310 Gujranwala 19.3 323 45.2 1,296 40.0 1,620 Lahore 14.1 406 43.9 1,418 37.3 1,824 Multan 20.1 286 46.9 892 40.4 1,177 Rawalpindi 24.1 194 56.4 656 49.0 850 Sahiwal 24.3 175 46.2 651 41.6 825 Sargodha 21.5 192 51.3 609 44.1 801 1 MICS indicator 2.7 - Exclusive breastfeeding under 6 months 2 MICS indicator 2.12 - Age-appropriate breastfeeding Overall, 61 percent of infants age 6-8 months received solid, semi-solid, or soft foods at least once during the previous day (Table NU.7). Among currently breastfeeding infants this percentage is 59 while it is 72 among infants currently not breastfeeding. The proportion is higher (70%) in urban compared to 58 percent in rural areas. Similarly, the percentage of children receiving solid, semi-solid or soft food shows a positive relation with household wealth. P a g e | 41 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, Punjab, 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 Punjab 58.7 1,295 72.4 282 61.1 1,577 Area of residence Rural 56.4 948 64.5 172 57.7 1,120 All Urban 64.7 347 84.6 110 69.5 457 Major Cities 63.2 157 (87.4) 63 70.2 220 Other Urban 66.0 190 81.0 47 69.0 238 Sex Male 58.7 645 70.9 134 60.8 779 Female 58.7 650 73.7 149 61.5 799 Mother’s education None/pre-school 49.1 629 54.9 101 49.9 730 Primary 60.0 229 70.7 51 61.9 280 Middle 61.8 135 (74.1) 34 64.3 169 Secondary 67.0 162 (89.0) 41 71.4 203 Higher 86.6 140 92.7 55 88.3 195 Wealth index quintile Lowest 44.6 336 (54.0) 50 45.9 386 Second 56.9 259 (58.7) 41 57.1 301 Middle 59.2 274 70.2 58 61.1 332 Fourth 63.4 237 76.5 55 65.8 292 Highest 79.3 189 90.1 78 82.5 267 Division Bahawalpur 44.9 147 (*) 22 48.4 168 D.G. Khan 55.1 172 (63.8) 23 56.2 196 Faisalabad 65.3 173 (83.1) 42 68.8 215 Gujranwala 66.7 169 (69.4) 49 67.3 218 Lahore 53.0 213 76.1 61 58.1 274 Multan 54.8 150 (*) 24 55.9 174 Rawalpindi 83.9 98 (*) 26 83.8 123 Sahiwal 52.3 83 (*) 22 55.2 105 Sargodha 58.6 90 (*) 13 57.7 103 1 MICS indicator 2.13 - Introduction of solid, semi-solid or soft foods ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Overall, 65 percent of the children age 6-23 months are receiving solid, semi-solid and soft foods the minimum number of times (Table NU.8). A slightly higher proportion of children in urban areas (71%) were achieving the minimum meal frequency compared to children in rural areas (63%). The proportion of children (17%), receiving the minimum dietary diversity or foods from at least 4 food groups, was much lower than that for minimum meal frequency indicating the need to focus on improving diet quality and nutrients intake among this vulnerable group. A higher proportion of older (18-23 month) children (26%) were achieving the minimum dietary diversity compared to younger (6-8 month old) children (6%). The overall assessment using the indicator of minimum acceptable diet revealed that only 10 percent of children are benefitting from a diet sufficient in both diversity and frequency. The proportion is slightly higher in urban areas (14%) compared to rural areas (8%). Children living in the households in highest wealth quintile, those whose mothers have higher education and from Rawalpindi division are most likely to receive as recommended the minimum meal frequency, minimum dietary diversity, and minimum acceptable diet. P a g e | 42 Table NU.8: Infant and young child feeding (IYCF) practices Percentage of children age 6-23 months who received appropriate liquids and solid, semi-solid, or soft foods the minimum number of times or more during the previous day, by breastfeeding status, Punjab, 2014. Currently breastfeeding Currently not breastfeeding All Percent of children who received: Number of children age 6-23 months Percent of children who received: Number of children age 6-23 months Percent of children who received: Number of children age 6-23 months Minimum dietary diversitya Minimum meal frequencyb Minimum acceptable diet1, c Minimum dietary diversitya Minimum meal frequencyb Minimum acceptable diet2, c At least 2 milk feeds3 Minimum dietary diversity4, a Minimum meal frequency5, b Minimum acceptable dietc Punjab 12.5 49.8 11.2 4,992 25.2 92.2 7.3 90.8 2,866 17.3 65.3 9.7 8,310 Area of residence Rural 9.8 47.3 8.9 3,558 22.7 91.7 6.0 90.5 1,930 14.6 62.9 7.9 5,756 All Urban 19.0 56.1 16.7 1,434 30.5 93.2 9.9 91.4 937 23.6 70.8 14.0 2,553 Major Cities 20.7 55.9 17.6 687 33.1 91.9 12.2 90.3 501 26.3 71.1 15.3 1,298 Other Urban 17.5 56.3 15.8 748 27.4 94.8 7.3 92.6 435 20.8 70.5 12.7 1,255 Sex Male 12.7 49.3 11.1 2,546 27.3 91.8 9.1 90.8 1,484 18.3 64.9 10.4 4,254 Female 12.2 50.4 11.3 2,446 23.0 92.6 5.3 90.8 1,382 16.3 65.6 9.1 4,056 Age 6-8 months 5.0 44.4 4.6 1,295 7.6 84.5 2.3 90.4 209 5.6 49.9 4.3 1,577 9-11 months 8.3 39.9 7.1 1,035 16.6 93.1 4.9 96.6 323 10.2 52.6 6.5 1,433 12-17 months 16.3 53.9 14.8 1,606 22.9 93.3 7.3 92.8 890 19.1 67.9 12.1 2,640 18-23 months 19.8 60.1 17.6 1,056 31.1 92.4 8.5 88.3 1,445 26.4 78.8 12.3 2,660 Mother’s education None/pre-school 7.9 42.9 7.1 2,397 17.7 88.8 3.8 87.4 1,158 11.3 57.9 6.0 3,730 Primary 12.5 49.9 11.9 934 23.4 94.9 4.8 91.7 527 16.4 66.1 9.3 1,529 Middle 12.5 54.2 11.9 486 27.4 94.9 9.7 92.8 336 18.8 70.8 11.0 887 Secondary 18.2 56.4 13.9 656 29.7 94.6 7.8 94.2 427 23.1 71.5 11.5 1,139 Higher 26.0 69.3 24.3 519 41.9 93.3 17.5 93.9 419 33.0 80.0 21.3 1,024 Wealth index quintile Lowest 6.4 37.9 5.5 1,204 14.6 85.0 3.5 85.1 516 8.9 52.0 4.9 1,794 Second 8.1 45.1 7.4 1,043 18.5 90.8 3.8 88.7 540 11.6 60.7 6.2 1,646 Middle 11.5 52.6 10.7 1,029 22.9 95.2 6.4 92.0 583 15.8 68.0 9.1 1,690 Fourth 16.3 56.2 14.3 915 30.5 95.1 8.5 94.3 607 21.7 71.7 12.0 1,634 Highest 24.2 62.9 21.6 801 36.9 93.7 13.0 92.7 621 30.3 76.3 17.8 1,546 P a g e | 43 Table NU.8: Infant and young child feeding (IYCF) practices Percentage of children age 6-23 months who received appropriate liquids and solid, semi-solid, or soft foods the minimum number of times or more during the previous day, by breastfeeding status, Punjab, 2014. Currently breastfeeding Currently not breastfeeding All Percent of children who received: Number of children age 6-23 months Percent of children who received: Number of children age 6-23 months Percent of children who received: Number of children age 6-23 months Minimum dietary diversitya Minimum meal frequencyb Minimum acceptable diet1, c Minimum dietary diversitya Minimum meal frequencyb Minimum acceptable diet2, c At least 2 milk feeds3 Minimum dietary diversity4, a Minimum meal frequency5, b Minimum acceptable dietc Division Bahawalpur 5.3 32.1 4.4 546 12.6 82.5 2.1 85.3 271 7.6 48.8 3.7 849 D.G. Khan 11.8 44.1 9.6 639 26.9 88.9 8.7 87.8 239 15.9 56.3 9.3 906 Faisalabad 13.9 62.7 13.6 623 24.7 97.7 8.3 94.6 348 18.0 75.2 11.7 1,033 Gujranwala 11.3 58.6 10.2 682 24.1 94.9 6.2 92.1 514 17.7 74.2 8.5 1,296 Lahore 16.0 52.7 15.2 773 34.5 93.9 9.1 91.3 556 23.5 69.9 12.6 1,418 Multan 5.8 38.8 5.1 553 19.7 88.1 3.8 93.0 296 11.1 56.0 4.6 892 Rawalpindi 25.9 57.8 20.5 399 35.6 92.8 15.2 86.4 214 29.4 70.0 18.7 656 Sahiwal 10.8 52.7 10.6 389 20.6 92.9 7.4 88.9 231 14.3 67.6 9.4 651 Sargodha 13.8 47.1 12.6 388 20.9 92.3 5.3 93.9 199 16.1 62.4 10.2 609 Punjab 12.5 49.8 11.2 4,992 25.2 92.2 7.3 90.8 2,866 17.3 65.3 9.7 8,310 1 MICS indicator 2.17a - Minimum acceptable diet (breastfed) 2 MICS indicator 2.17b - Minimum acceptable diet (non-breastfed) 3 MICS indicator 2.14 - Milk feeding frequency for non-breastfed children 4 MICS indicator 2.16 - Minimum dietary diversity 5 MICS indicator 2.15 - Minimum meal frequency a Minimum dietary diversity is defined as receiving foods from at least 4 of 7 food groups: 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. b Minimum meal frequency among currently breastfeeding children is defined as children who also received solid, semi-solid, or soft foods 2 times or more daily for children age 6-8 months and 3 times or more daily for children age 9-23 months. For non-breastfeeding children age 6-23 months it is defined as receiving solid, semi-solid or soft foods, or milk feeds, at least 4 times daily. c The minimum acceptable diet for breastfed children age 6-23 months is defined as receiving the minimum dietary diversity and the minimum meal frequency, while it for non-breastfed children further requires at least 2 milk feedings and that the minimum dietary diversity is achieved without counting milk feeds. P a g e | 44 The continued practice of bottle-feeding is a matter of concern because of the possible contamination due to unsafe water and lack of hygiene in preparation. Table NU.9 shows that 58 percent of children under 2 years are fed using a bottle with a nipple. More than two-third (68%) of the children under 2 years are bottle fed in Gujranwala division compared to 44 percent in Bahawalpur division. The practice of bottle feeding is higher in urban (66%) compared to rural areas (54%). Bottle feeding has a positive relation with education of the mother and household wealth. For example, bottle feeding is 49 percent for children whose mother have pre-school or no education compared to 72 percent of children whose mothers have higher education. The data further show that 45 percent of children age less than six months are fed using a bottle with a nipple even though the children are expected to be exclusively breastfed at that age. 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, Punjab, 2014. Percentage of children age 0-23 months fed with a bottle with a nipple1 Number of children age 0- 23 months Punjab 57.7 10,642 Area of residence Rural 54.1 7,383 All Urban 65.7 3,259 Major Cities 68.2 1,671 Other Urban 63.1 1,588 Sex Male 58.0 5,392 Female 57.3 5,251 Age 0-5 months 45.0 2,333 6-11 months 58.3 3,010 12-23 months 62.9 5,300 Mother’s education None/pre-school 49.1 4,806 Primary 58.5 1,921 Middle 64.8 1,116 Secondary 66.3 1,469 Higher 71.8 1,331 Wealth index quintile Lowest 44.1 2,308 Second 50.8 2,173 Middle 60.6 2,122 Fourth 63.1 2,094 Highest 72.4 1,946 Division Bahawalpur 44.4 1,073 D.G. Khan 51.1 1,163 Faisalabad 57.6 1,310 Gujranwala 68.4 1,620 Lahore 66.5 1,824 Multan 53.0 1,177 Rawalpindi 61.3 850 Sahiwal 54.3 825 Sargodha 49.4 801 1 MICS indicator 2.18 - Bottle feeding P a g e | 45 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. The 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 Pakistan iodine deficiency disorders have been recognized as a public health problem for nearly 50 years. Various surveys have reflected that Pakistan is a country with more than half of the population estimated to be at risk for IDD (Iodine Deficiency Disorders). The situation is worse especially in the northern districts of Pakistan which is considered to be one of the most severely endemic areas in the world for IDD. A National IDD Control Program was initiated in 1989 with a focus on elimination of IDD through Universal Salt Iodization (USI). The Program has been implemented by Government of Pakistan with the support for national USI partners including UNICEF, the Micronutrient Initiative and GAIN (Global Alliance for Improved Nutrition). The Program is being implemented in all provinces with the objective to improve the availability and accessibility of adequately iodized salt to the entire population including the most vulnerable. Table NU.10: Iodized salt consumption Percent distribution of households by consumption of iodized salt, Punjab, 2014. Percentage of households in which salt was tested Number of households Percent of households with: Total Number of households in which salt was tested or with no salt No salt Salt test result Not iodized 0 PPM >0 and <15 PPM 15+ PPM1 Punjab 98.2 38,405 1.1 30.2 19.6 49.2 100.0 38,119 Area of residence Rural 98.4 25,577 1.1 32.5 20.8 45.6 100.0 25,445 All Urban 97.7 12,828 1.1 25.4 17.1 56.3 100.0 12,675 Major Cities 97.2 6,717 1.1 27.9 16.2 54.8 100.0 6,605 Other Urban 98.2 6,111 1.1 22.8 18.2 57.9 100.0 6,070 Education of household heada None/pre-school 98.2 15,399 1.3 34.2 20.8 43.7 100.0 15,311 Primary 98.4 6,639 1.2 31.7 20.0 47.1 100.0 6,607 Middle 98.5 4,863 0.8 30.4 20.4 48.3 100.0 4,829 Secondary 98.0 7,022 1.0 26.5 18.9 53.6 100.0 6,953 Higher 97.8 4,472 0.8 19.2 14.9 65.0 100.0 4,410 Wealth index quintile Lowest 97.7 8,027 1.9 39.3 22.5 36.3 100.0 7,991 Second 98.4 7,721 1.1 33.7 21.1 44.0 100.0 7,687 Middle 98.6 7,508 0.9 30.6 20.2 48.3 100.0 7,469 Fourth 98.3 7,551 0.8 27.7 19.2 52.4 100.0 7,479 Highest 97.9 7,598 0.8 18.8 14.7 65.8 100.0 7,494 P a g e | 46 Table NU.10: Iodized salt consumption Percent distribution of households by consumption of iodized salt, Punjab, 2014. Percentage of households in which salt was tested Number of households Percent of households with: Total Number of households in which salt was tested or with no salt No salt Salt test result Not iodized 0 PPM >0 and <15 PPM 15+ PPM1 Division Bahawalpur 98.2 4,091 1.4 33.1 21.6 43.8 100.0 4,077 D.G.Khan 98.5 3,436 1.2 41.0 24.0 33.9 100.0 3,424 Faisalabad 98.8 4,889 0.8 29.0 17.9 52.3 100.0 4,867 Gujranwala 98.4 5,569 0.9 19.6 16.9 62.6 100.0 5,527 Lahore 97.5 6,631 1.1 26.4 16.4 56.1 100.0 6,537 Multan 97.6 4,633 1.6 38.7 15.0 44.6 100.0 4,596 Rawalpindi 97.4 3,633 1.1 24.4 29.0 45.5 100.0 3,579 Sahiwal 98.6 2,638 1.3 22.1 19.6 57.0 100.0 2,636 Sargodha 99.1 2,885 0.6 44.7 22.2 32.6 100.0 2,874 Punjab 98.2 38,405 1.1 30.2 19.6 49.2 100.0 38,119 1 MICS indicator 2.19 - Iodized salt consumption a Total includes 11 unweighted cases of household head's education missing In 98 percent of households, salt used for cooking was tested for iodine content by using salt test kits to test the presence of potassium iodate content in the salt. Table NU.10 shows that in about 1 percent of households, there is no salt available. These households are, however, included in the denominator of the indicator. In 49 percent of households, salt is found to contain 15 parts per million (ppm) or more of iodine. Use of iodized salt was lowest in Sargodha division (33%) and highest in Gujranwala division (63%). More urban households (56%) were found to be using adequately iodized salt compared to 46 percent in rural areas. Similarly, 66 percent of households in the highest wealth quintile are using adequately iodized salt compared to 36 percent of households in the lowest quintile. The consumption of adequately iodized salt is graphically presented in Figure NU.4. P a g e | 47 Figure NU.4: Consumption of iodized sa lt , MICS Punjab, 2014 Children’s Vitamin A Supplementation Vitamin A is essential for eye health and proper functioning of the immune system. It is found in foods such as milk, liver, eggs, red and orange fruits, red palm oil and green leafy vegetables, although the amount of vitamin A readily available to the body from these sources varies widely. In developing areas of the world, where vitamin A is largely consumed in the form of fruits and vegetables, daily per capita intake is often insufficient to meet dietary requirements. Inadequate intakes are further compromised by increased requirements for vitamin as children grow or during periods of illness, as well as increased losses during common childhood infections. As a result, vitamin A deficiency is quite prevalent in developing world and particularly in countries with highest burden of under-five deaths. The 1990 World Summit for Children set the goal of virtual elimination of vitamin A deficiency and its consequences, including blindness, by the year 2000. This goal was also endorsed at the Policy Conference on Ending Hidden Hunger in 1991, the 1992 International Conference on Nutrition, and the UN General Assembly's Special Session on Children in 2002. The critical role of vitamin A in child health and immune function makes control of deficiency a primary component of child survival efforts, and therefore critical to the achievement of the fourth Millennium Development Goal: a two-thirds reduction in under-five mortality by the year 2015. 65 58 70 80 73 60 74 77 55 73 66 59 65 69 72 80 69 44 34 52 63 56 45 45 57 33 56 46 36 44 48 52 66 49 0 20 40 60 80 100 P er ce n t Any iodine 15+ PPM of iodine P a g e | 48 For countries where vitamin A deficiency is common, current international recommendations call for high- dose supplementation every 4–6 months for all children aged 6–59 months living in affected areas. Providing young children with two high-dose vitamin A capsules a year is a safe, cost-effective, efficient strategy for eliminating vitamin A deficiency and improving child survival. Giving vitamin A to new mothers helps protect their children during the first months of life and helps to replenish the mother's own stores of vitamin A which are depleted during pregnancy and lactation. Under Pakistan's National Health Policy 2001, vitamin A supplements are to be provided annually to all children aged 6-59 months on National Immunisation Days through the Expanded Programme on Immunization (EPI) network. This survey uses as an indicator the percentage of children 6–35 months of age who receive at least one high-dose of vitamin A supplement in the preceding 6 months. MICS Punjab, 2014 finds that about 65 percent of children aged 6–59 months received at least one dose of vitamin A supplement during the 6 months period prior to the interview (Table NU.11). Children age 6– 11 months have least coverage (53%) compared to older children age 36-47 months who have highest coverage (67%). Among divisions, nine in ten children (91%) in Bahawalpur division received Vitamin A dose during the last 6months compared to only four in ten children in Multan division (45%). Table NU.11: Children's vitamin A supplementation Percent distribution of children age 6-59 months by receipt of a high dose vitamin A supplement in the last 6 months, Punjab, 2014. Percentage of children who received Vitamin A during the last 6 months1 Number of children age 6-59 months Punjab 64.8 24,706 Area of residence Rural 65.2 17,086 All Urban 64.0 7,620 Major Cities 57.9 3,896 Other Urban 70.4 3,723 Sex Male 65.2 12,533 Female 64.4 12,172 Age 6-11 months 52.9 3,010 12-23 months 65.0 5,300 24-35 months 66.5 5,326 36-47 months 67.3 5,894 48-59 months 67.1 5,176 Mother’s education None/pre-school 63.9 11,885 Primary 66.6 4,508 Middle 64.6 2,471 Secondary 64.5 3,139 Higher 66.9 2,703 Wealth index quintile Lowest 63.2 5,728 Second 66.8 4,966 Middle 67.1 4,821 Fourth 63.8 4,810 Highest 63.4 4,381 P a g e | 49 Table NU.11: Children's vitamin A supplementation Percent distribution of children age 6-59 months by receipt of a high dose vitamin A supplement in the last 6 months, Punjab, 2014. Percentage of children who received Vitamin A during the last 6 months1 Number of children age 6-59 months Division Bahawalpur 90.9 2,807 D.G. Khan 46.9 2,859 Faisalabad 70.7 2,937 Gujranwala 69.4 3,673 Lahore 59.0 4,191 Multan 44.8 2,691 Rawalpindi 60.4 1,924 Sahiwal 73.8 1,837 Sargodha 72.9 1,787 Punjab 64.8 24,706 1 MICS indicator 2.S1 - Vitamin A supplementation P a g e | 50 VI. CHILD HEALTH Vaccinations The Millennium Development Goal 4 (MDG 4) is to reduce child mortality by two thirds between 1990 and 2015. Immunization plays a key part in achieving 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 Children26 aims at 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. Pakistan National Immunization Programme provides all the above mentioned vaccinations with birth doses of BCG, Polio, and Hepatitis B vaccines, three doses of the Pentavalent vaccine containing DPT, Hepatitis B, and Haemophilus influenzae type b (Hib) antigens, three doses of Polio vaccine, three doses of Pneumococcal (conjugate) vaccine, two or three doses of rotavirus vaccine (depending on vaccine used), two doses of the MMR vaccine containing measles, mumps, and rubella antigens. All vaccinations should be received during the first year of life except the doses of MMR at 12 and 15 months. Taking into consideration this vaccination schedule, the estimates for full immunization coverage from the MICS Punjab, 2014 are based on children age 12-23 months. 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, DPT/HEPB/HIB and PENTA, 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. 26 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. P a g e | 51 Table CH.1: Vaccinations in the first years of life Percentage of children age 12-23 months and 24-35 months vaccinated against vaccine preventable childhood diseases at any time before the survey and by their first birthday, Punjab, 2014. Children age 12-23 months: Children age 24-35 months: Vaccinated at any time before the survey according to: Vaccinated by 12 months of agea Vaccinated at any time before the survey according to: Vaccinated by 12 months of age Vaccination card Mother's report Either Vaccination card Mother's report Either Antigen BCG1 58.4 34.7 93.1 92.8 36.7 55.3 92.0 90.3 Polio At birth 57.6 33.8 91.4 91.2 36.2 52.3 88.6 87.2 1 58.0 37.4 95.3 94.7 36.4 57.2 93.6 91.1 2 56.9 33.9 90.8 89.7 35.9 53.1 89.0 85.5 32 55.3 31.2 86.6 84.8 35.2 49.9 85.1 80.8 PENTA 1 58.2 27.5 85.7 85.2 36.7 45.3 82.0 79.8 2 57.1 24.8 81.8 80.9 36.2 41.4 77.6 74.7 33,4,5 55.6 17.7 73.3 71.7 35.5 31.8 67.3 63.9 Measles 16 50.9 26.9 77.8 71.6 33.9 49.1 83.0 71.8 2 28.7 0.5 29.2 na 29.8 0.0 0.0 na Fully vaccinated7, b 50.3 11.9 62.3 56.0 33.9 24.8 58.7 48.7 No vaccinations 0.0 3.5 3.5 3.5 0.0 4.5 4.5 5.2 Number of children 5,300 5,300 5,300 5,300 5,326 5,326 5,326 5,326 1 MICS indicator 3.1 - Tuberculosis immunization coverage 2 MICS indicator 3.2 - Polio immunization coverage 3 MICS indicator 3.3 - Diphtheria, pertussis and tetanus (DPT) immunization coverage 4 MICS indicator 3.5 - Hepatitis B immunization coverage 5 MICS indicator 3.6 - Haemophilus influenzae type B (Hib) immunization coverage 6 MICS indicator 3.4; MDG indicator 4.3 - Measles immunization coverage 7 MICS indicator 3.8 - Full immunization coverage a All MICS indicators refer to results in this column b Includes: BCG, Polio3, PENTA3, and Measles-1 (MCV1) as per the vaccination schedule in Punjab na: not applicable 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, mother’s recall or either) is shown in Table CH.1 and Figure CH.1. The denominators for the table are number of children age 12-23 months and 24-35 months so that only those 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, mother’s recall or either. 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. Approximately 93 percent of children age 12-23 months received a BCG vaccination by the age of 12 months and the first dose of PENTA vaccine was given to 85 percent. The percentage declines to 81 percent for the second dose of PENTA, and to 72 percent for the third dose. Similarly, 95 percent of P a g e | 52 children received Polio 1 by age 12 months and this declines to 85 percent by the third dose. The coverage for the first dose of measles vaccine by 12 months is 72 percent although 78 percent of children 12-23 months received the measles vaccine. As a result, the percentage of children who had all the recommended vaccinations by their first birthday is low at 56 percent. The coverage figures for children age 24-35 months are generally similar to those age 12-23 months suggesting that immunization coverage has been on average stagnant in Punjab between 2012 and 201427. Figure CH.1: Vacc inat ions by age 12 months (measles by 24 months) MICS Punjab, 2014 Table CH.2 presents vaccination coverage estimates among children age 12-23 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’ report. Vaccination cards have been seen by the interviewer for 59 percent of children age 12-23 months. About 62 percent of the children aged 12-23 months are fully vaccinated, the rates being higher in urban (68%) compared to rural (60%). At division level, children age 12-23 months that are fully vaccinated are lowest (39%) in DG Khan division and highest (75%) in Gujranwala division. Vaccination is positively associated with mother’s education as it is highest (76%) for the children whose mothers have higher education and lowest (51%) for those whose mothers have only pre-school or no education. About three 27 It is important to note that data recorded on the vaccination cards was not universally endorsed by the mothers/ caretakers. In some places the field teams received comments from the mothers that sometimes cards were filled without vaccination to show progress. Since this was not in the scope of the survey, it is therefore suggested that health department may initiate a study through a neutral agency to find out the extent of such happenings. It is important to achieve 100 percent coverage of immunization in real. 93 91 95 90 85 85 81 72 72 56 4 BCG Polio at birth Polio1 Polio2 Polio3 PENTA-1 PENTA-2 PENTA-3 Measles-I Fully vaccinated No vaccinations Percent Children Age 12-23 months 90 87 91 86 81 80 75 64 72 30 49 5 BCG Polio at birth Polio1 Polio2 Polio3 PENTA-1 PENTA-2 PENTA-3 Measles-I Measles-II Fully vaccinated No vaccinations Children Age 24-35 months P a g e | 53 in four children living in the households in the highest quintile are fully vaccinated (74%) compared to 42 percent of children living in the households in lowest quintile. Table CH.2: Vaccinations by background characteristics Percentage of children age 12-23 months currently vaccinated against vaccine preventable childhood diseases, Punjab, 2014. Percentage of children age 12-23 months who received: Percentage with vaccination card seen Number of children age 12-23 months BCG Polio PENTA Measles-1 (MCV1) Fulla None At birth 1 2 3 1 2 3 Punjab 93.1 91.4 95.3 90.8 86.6 85.7 81.8 73.3 77.8 62.3 3.5 58.5 5,300 Area of residence Rural 92.4 90.4 95.3 91.1 86.6 83.8 79.8 70.9 76.7 59.8 3.5 57.7 3,682 All Urban 94.4 93.6 95.3 89.9 86.4 90.1 86.5 78.7 80.3 68.0 3.6 60.4 1,618 Major Cities 94.1 93.8 94.6 86.0 83.1 93.2 88.3 78.2 79.1 68.1 3.9 59.5 813 Other Urban 94.8 93.4 96.1 93.9 89.8 86.9 84.7 79.2 81.5 67.8 3.2 61.4 804 Sex Male 93.2 92.3 95.5 90.5 86.9 86.7 83.0 74.0 79.1 63.7 3.4 58.3 2,766 Female 92.9 90.5 95.1 91.0 86.1 84.7 80.6 72.5 76.4 60.7 3.7 58.7 2,534 Mother’s education None/pre-school 88.9 87.3 93.4 88.8 83.7 78.8 74.2 63.5 68.2 51.2 5.1 50.4 2,388 Primary 96.4 94.6 96.4 94.0 89.9 89.2 85.9 80.2 84.2 70.1 2.3 66.3 978 Middle 94.6 93.1 96.5 90.6 87.0 91.3 87.4 79.7 82.4 67.9 2.7 66.3 581 Secondary 96.2 93.9 96.9 92.3 89.2 92.6 89.7 83.4 83.7 71.8 2.8 64.9 725 Higher 98.6 97.7 97.8 91.7 88.7 93.8 90.3 82.4 93.4 75.9 0.8 62.7 628 Wealth index quintile Lowest 85.2 83.4 92.4 87.0 81.1 73.0 67.1 55.4 59.2 42.2 6.0 42.3 1,136 Second 93.5 91.3 95.0 90.8 86.6 84.2 79.7 70.5 76.4 58.8 3.5 60.8 1,047 Middle 94.8 92.7 95.6 92.7 88.4 88.5 86.1 77.7 82.6 67.8 3.2 63.4 1,084 Fourth 95.5 94.1 96.5 92.3 88.9 90.7 88.2 82.5 84.6 70.5 2.8 64.1 1,040 Highest 97.0 96.4 97.5 91.3 88.3 93.7 89.5 82.3 88.3 74.1 1.7 63.4 993 Division Bahawalpur 89.4 88.0 95.3 90.6 84.6 85.9 81.1 67.7 64.0 51.6 2.6 44.5 544 D.G. Khan 81.2 81.3 89.1 84.7 80.1 75.6 67.0 52.1 56.1 38.6 8.9 42.7 557 Faisalabad 93.8 91.9 95.5 91.1 87.4 91.4 88.8 78.4 78.6 66.2 3.5 58.3 617 Gujranwala 97.1 96.0 96.5 93.2 88.7 91.7 88.9 84.3 89.8 75.2 2.2 70.8 851 Lahore 93.5 92.1 95.9 89.0 83.8 85.7 82.4 71.0 76.0 61.3 3.4 54.9 886 Multan 93.6 90.0 95.0 91.6 89.6 90.1 86.9 78.2 78.3 66.7 4.2 57.8 581 Rawalpindi 96.5 96.2 96.4 87.5 82.9 94.3 87.2 82.5 86.7 70.4 2.2 64.9 422 Sahiwal 97.9 95.8 98.5 96.6 93.7 75.4 73.4 71.6 86.4 65.1 1.0 69.8 433 Sargodha 94.1 90.4 95.8 93.6 90.2 73.9 72.8 69.1 84.4 60.4 3.3 63.7 408 a Includes: BCG, Polio3, PENTA3 and Measles-1 (MCV1) as per the vaccination schedule in Punjab Neonatal Tetanus Protection One of the MDGs is to reduce by three quarters the maternal mortality ratio, with one strategy to eliminate maternal tetanus. Following on the 42nd and 44th World Health Assembly calls for elimination of neonatal tetanus, the global community continues to work to reduce the incidence of neonatal tetanus to less than one case of neonatal tetanus per 1,000 live births by 2015. The strategy for preventing maternal and neonatal tetanus is to ensure that all pregnant women receive at least two doses of tetanus toxoid vaccine. If a woman has not received at least two doses of tetanus toxoid during a particular pregnancy, she (and her newborn) are also considered to be protected against tetanus if the woman: P a g e | 54  Received at least two doses of tetanus toxoid vaccine, the last within the previous 3 years;  Received at least 3 doses, the last within the previous 5 years;  Received at least 4 doses, the last within the previous 10 years;  Received 5 or more doses anytime during her life. 28 To assess the status of tetanus vaccination coverage, women who had a live birth during the two years before the survey were asked if they had received tetanus toxoid injections during the pregnancy for their most recent birth, and if so, how many. Women who did not receive two or more tetanus toxoid vaccinations during this recent pregnancy were then asked about tetanus toxoid vaccinations they may have previously received. Interviewers also asked women to present their vaccination card on which dates of tetanus toxoid are recorded and referred to information from the cards when available. Table CH.3: Neonatal tetanus protection Percentage of women age 15-49 years with a live birth in the last 2 years protected against neonatal tetanus, Punjab, 2014. Percentage of women who received at least 2 doses during last pregnancy Percentage of women who did not receive two or more doses during last pregnancy but received: Protected against tetanus1 Number of women with a live birth in the last 2 years 2 doses, the last within prior 3 years 3 doses, the last within prior 5 years 4 doses, the last within prior 10 years 5 or more doses during lifetime Punjab 70.5 4.7 0.8 0.4 0.1 76.4 10,653 Area of residence Rural 69.0 4.1 0.7 0.3 0.1 74.2 7,369 All Urban 73.6 5.9 1.2 0.6 0.1 81.4 3,284 Major Cities 74.4 5.9 1.4 0.3 0.1 82.3 1,692 Other Urban 72.8 5.8 0.9 0.8 0.1 80.4 1,592 Mother’s educationa None/pre-school 59.0 4.7 0.9 0.4 0.2 65.1 4,816 Primary 75.7 3.9 1.0 0.6 0.0 81.3 1,961 Middle 78.4 5.6 0.6 0.1 0.2 84.9 1,096 Secondary 81.5 5.1 0.9 0.4 0.0 87.9 1,467 Higher 85.7 4.4 0.3 0.2 0.1 90.7 1,311 Wealth index quintile Lowest 56.2 4.6 1.1 0.4 0.1 62.5 2,321 Second 64.3 4.1 0.8 0.3 0.2 69.8 2,198 Middle 74.0 5.3 0.5 0.5 0.1 80.4 2,118 Fourth 77.6 3.9 1.0 0.3 0.1 83.0 2,094 Highest 82.9 5.4 0.7 0.4 0.0 89.4 1,922 Division Bahawalpur 63.2 2.2 1.0 0.2 0.1 66.7 1,068 D.G. Khan 59.8 5.4 0.5 0.5 0.1 66.2 1,181 Faisalabad 71.4 5.0 0.8 0.3 0.1 77.6 1,237 Gujranwala 81.5 4.9 0.5 0.5 0.1 87.4 1,578 Lahore 69.3 4.9 1.5 0.6 0.2 76.4 1,914 Multan 68.4 2.9 0.6 0.2 0.2 72.3 1,162 Rawalpindi 79.4 5.1 0.5 0.1 0.1 85.1 882 Sahiwal 70.0 4.0 0.6 0.8 0.0 75.5 827 Sargodha 69.2 7.9 0.8 0.2 0.4 78.5 804 1 MICS indicator 3.9 - Neonatal tetanus protection a Total includes 2 unweighted cases of mother's education missing 28 Deming, M.S. et al. 2002. Tetanus toxoid coverage as an indicator of serological protection against neonatal tetanus. Bulletin of the World Health Organization 80(9):696-703 P a g e | 55 Table CH.3 shows the protection status from tetanus of women who have had a live birth within the last 2 years. Seventy six percent of the women are reported to be protected against tetanus, the proportion being higher in urban (81%) compared to rural (74%). At the divisional level, DG Khan had the lowest proportion of women protected against tetanus (60%) compared to Gujranwala (82%). Women with higher education are more likely to be protected against tetanus (91%) compared to women with only pre-school or no education (65%). Similarly, protection against tetanus is positively correlated with household wealth. 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 deaths from pneumonia and diarrhoea 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. Malaria is also a major killer of children under 5, killing about 900 children every day, especially in sub- Saharan Africa. The Global Malaria Action Plan (GMAP) aims to reduce deaths from malaria to near zero by 2015. Table CH.4 presents the percentage of children under 5 years of age who were reported against 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 these illnesses over a two-week time period. P a g e | 56 Table CH.4: Reported disease episodes Percentage of children age 0-59 months for whom the mother/caretaker reported an episode of diarrhoea, symptoms of acute respiratory infection (ARI), and/or fever in the last two weeks, Punjab, 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 An episode of fever Punjab 17.4 2.5 20.8 27,495 Area of residence Rural 17.4 2.8 20.8 19,002 All Urban 17.5 1.8 20.7 8,493 Major Cities 18.3 1.3 21.4 4,364 Other Urban 16.6 2.4 20.0 4,129 Sex Male 17.9 2.8 21.5 13,915 Female 16.9 2.1 20.1 13,580 Age 0-11 months 23.7 3.2 25.7 5,343 12-23 months 25.4 2.4 26.0 5,300 24-35 months 17.9 2.5 19.9 5,326 36-47 months 12.6 2.5 18.2 5,894 48-59 months 8.5 1.9 14.8 5,633 Mother’s education None/pre-school 17.5 3.1 21.0 13,140 Primary 18.5 2.7 22.9 4,991 Middle 18.7 1.7 21.5 2,740 Secondary 17.0 1.5 19.6 3,563 Higher 14.2 1.2 17.3 3,062 Wealth index quintile Lowest 18.7 4.2 21.7 6,316 Second 18.7 2.7 22.5 5,560 Middle 17.4 2.2 21.0 5,335 Fourth 16.1 1.8 20.2 5,380 Highest 15.7 1.0 18.2 4,904 Division Bahawalpur 12.5 2.7 14.8 3,080 D.G. Khan 19.2 4.8 24.0 3,151 Faisalabad 15.3 2.0 19.7 3,272 Gujranwala 18.9 2.1 23.7 4,100 Lahore 19.7 1.9 22.2 4,670 Multan 17.9 1.8 17.9 3,019 Rawalpindi 13.2 1.4 16.2 2,165 Sahiwal 20.5 3.2 24.4 2,032 Sargodha 17.9 2.9 23.2 2,005 The definition of a case of diarrhoea or fever, in this survey, was the mother’s (or caretaker’s) report that the child had such symptoms over the specified period; no other evidence 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 P a g e | 57 consequently be interpreted with caution. For these reasons, although the period-prevalence over a two- week time window is reported, these data should not be used to assess the epidemiological characteristics of these diseases but rather to obtain denominators for the indicators related to use of health services and treatment. Overall, 17 percent of under five children were reported to have had diarrhoea in the two weeks preceding the survey, 3 percent of children had symptoms of ARI, and 21 percent had an episode of fever (Table CH.4). Children age 12-23 months had the highest prevalence of diarrhoea (25%) and diarrhoea was reported to be lowest (9%) for children age 48-59 months. Similarly, the prevalence of an episode of fever was 26 percent for children age 0-11 month compared to 15 percent of children age 48-59 months. 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. In addition, provision of zinc supplements has been shown to reduce the duration and severity of the illness as well as the risk of future episodes within the next two or three months. 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 highest period-prevalence (25%) is seen among children age 12-23 months which grossly corresponds to the weaning period. Table CH.5 shows the percentage of children with diarrhoea in the two weeks preceding the survey for whom advice or treatment was sought and where. Overall, a health facility or provider was seen in 72 percent of cases for advice or treatment, predominantly in the private sector (64%). P a g e | 58 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, Punjab, 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 provider1, b Public Private Community health providera Punjab 11.1 63.6 0.4 8.1 72.1 18.8 4,784 Area of residence Rural 10.4 61.6 0.5 9.7 69.2 19.9 3,297 All Urban 12.4 67.9 0.2 4.5 78.6 16.4 1,487 Major Cities 13.3 70.8 0.0 2.6 82.7 13.9 801 Other Urban 11.4 64.5 0.4 6.7 73.7 19.2 686 Sex Male 11.8 64.5 0.4 7.3 73.8 18.0 2,491 Female 10.3 62.6 0.4 8.9 70.3 19.7 2,293 Age 0-11 months 9.8 67.2 0.3 6.9 74.9 17.8 1,266 12-23 months 10.9 67.2 0.5 6.9 75.8 16.6 1,348 24-35 months 12.1 60.6 0.4 9.2 69.9 19.8 954 36-47 months 11.0 58.6 0.3 9.9 66.3 21.9 740 48-59 months 12.9 57.7 0.4 9.5 68.0 20.9 477 Mother’s education None/pre-school 10.9 61.2 0.5 10.2 68.8 19.5 2,306 Primary 11.9 61.4 0.3 8.5 70.9 19.6 926 Middle 11.9 64.8 0.1 6.3 75.2 18.3 511 Secondary 10.9 72.7 0.5 3.1 81.2 14.9 605 Higher 9.7 66.9 0.3 4.5 76.1 19.6 436 Wealth index quintile Lowest 11.0 56.9 0.6 12.4 64.9 21.6 1,181 Second 10.9 58.7 0.3 10.6 67.1 21.6 1,038 Middle 10.8 65.4 0.4 7.4 72.7 18.2 931 Fourth 13.9 67.9 0.3 4.4 79.9 14.5 866 Highest 8.5 73.4 0.4 3.0 80.7 16.3 769 Division Bahawalpur 10.0 65.1 1.0 6.4 69.3 18.7 386 D.G. Khan 10.5 45.3 0.0 15.4 53.7 30.8 605 Faisalabad 10.4 70.5 0.4 9.2 78.3 11.4 500 Gujranwala 7.8 71.8 0.7 5.6 76.9 16.4 776 Lahore 13.5 65.4 0.1 6.0 76.8 17.0 918 Multan 13.3 64.2 0.3 9.5 75.2 15.5 540 Rawalpindi 16.8 55.6 0.8 3.1 71.6 25.0 285 Sahiwal 7.3 69.3 0.7 3.9 75.9 20.0 416 Sargodha 11.5 59.8 0.2 13.1 67.0 17.4 359 1 MICS indicator 3.10 - Care-seeking for diarrhoea a Community health providers includes both public (Lady health worker and Mobile/Outreach clinic) and private (Mobile clinic) health facilities b Includes all public and private health facilities and providers, but excludes private pharmacy Table CH.6 provides statistics on drinking and feeding practices during diarrhoea. Ten percent of under five children with diarrhoea were given more than usual, while 89 percent the same or less to drink. Overall, 4 percent of children were given more than usual to eat, while 89 percent of children were given the same or less and 7 percent of children ate nothing. P a g e | 59 Table CH.6: Feeding practices during diarrhoea Percent distribution of children age 0-59 months with diarrhoea in the last two weeks by amount of liquids and food given during episode of diarrhoea, Punjab, 2014. Drinking practices during diarrhoea Eating practices during diarrhoea Number of children aged 0-59 months with diarrhoea Child was given to drink: Total Child was given to eat: Total Much less Somewhat less About the same More Nothing Missing/ DK Much less Somewhat less About the same More Nothing Missing/ DK Punjab 7.6 30.0 51.3 9.6 1.3 0.2 100.0 9.2 32.3 47.3 3.6 7.4 0.1 100.0 4,784 Area of residence Rural 7.1 30.4 50.7 10.2 1.4 0.2 100.0 9.1 32.1 46.7 3.6 8.3 0.2 100.0 3,297 All Urban 8.6 29.2 52.7 8.4 0.9 0.1 100.0 9.6 32.7 48.7 3.6 5.4 0.0 100.0 1,487 Major Cities 10.1 27.9 51.7 9.4 0.9 0.0 100.0 10.7 34.7 46.3 3.1 5.1 0.0 100.0 801 Other Urban 7.0 30.7 53.9 7.3 1.0 0.1 100.0 8.3 30.4 51.5 4.2 5.7 0.0 100.0 686 Sex Male 7.3 30.4 51.9 9.0 1.3 0.2 100.0 9.1 33.6 47.4 3.4 6.4 0.1 100.0 2,491 Female 8.0 29.6 50.7 10.4 1.2 0.2 100.0 9.3 30.9 47.3 3.9 8.5 0.1 100.0 2,293 Age 0-11 months 7.8 28.8 53.1 8.5 1.5 0.1 100.0 9.2 25.2 42.0 3.3 20.3 0.1 100.0 1,266 12-23 months 7.4 29.2 51.8 11.3 0.3 0.1 100.0 9.8 31.4 49.2 3.9 5.3 0.3 100.0 1,348 24-35 months 8.1 32.5 48.9 8.2 2.0 0.2 100.0 10.8 37.4 47.0 3.2 1.5 0.1 100.0 954 36-47 months 9.0 30.8 49.5 9.0 1.3 0.4 100.0 8.3 38.0 49.2 4.1 0.4 0.0 100.0 740 48-59 months 4.3 29.3 53.0 11.8 1.6 0.0 100.0 5.8 34.9 53.8 3.8 1.7 0.0 100.0 477 Mother’s education None/pre-school 7.1 30.6 50.6 10.4 1.2 0.2 100.0 9.3 31.7 46.9 4.2 7.7 0.2 100.0 2,306 Primary 7.1 29.9 53.0 8.5 1.4 0.0 100.0 9.0 31.5 49.1 2.3 8.0 0.0 100.0 926 Middle 8.4 29.8 50.5 9.6 1.5 0.2 100.0 8.8 34.7 45.9 3.4 7.1 0.0 100.0 511 Secondary 10.1 28.6 52.2 7.6 1.0 0.5 100.0 9.7 32.4 49.1 2.1 6.5 0.3 100.0 605 Higher 6.8 29.4 51.6 10.9 1.0 0.2 100.0 9.0 34.3 44.7 6.1 5.9 0.0 100.0 436 Wealth index quintile Lowest 6.7 32.9 49.7 9.5 1.0 0.1 100.0 9.2 32.4 47.3 3.4 7.5 0.3 100.0 1,181 Second 6.6 27.6 53.1 10.7 1.8 0.2 100.0 8.1 30.7 48.8 2.8 9.4 0.2 100.0 1,038 Middle 7.6 30.7 51.4 8.9 1.1 0.2 100.0 9.9 34.3 44.7 4.3 6.6 0.1 100.0 931 Fourth 8.8 27.2 52.2 10.2 1.4 0.2 100.0 10.3 29.5 48.5 3.9 7.9 0.0 100.0 866 Highest 8.8 31.3 50.3 8.6 0.9 0.1 100.0 8.9 35.2 47.2 4.0 4.8 0.0 100.0 769 P a g e | 60 Table CH.6: Feeding practices during diarrhoea Percent distribution of children age 0-59 months with diarrhoea in the last two weeks by amount of liquids and food given during episode of diarrhoea, Punjab, 2014. Drinking practices during diarrhoea Eating practices during diarrhoea Number of children aged 0-59 months with diarrhoea Child was given to drink: Total Child was given to eat: Total Much less Somewhat less About the same More Nothing Missing /DK Much less Somewhat less About the same More Nothing Missing /DK Division Bahawalpur 1.9 22.5 51.9 23.2 0.6 0.0 100.0 8.2 25.3 48.3 8.8 9.4 0.0 100.0 386 D.G. Khan 7.8 44.5 42.4 4.7 0.6 0.0 100.0 9.2 43.8 41.0 2.7 3.2 0.0 100.0 605 Faisalabad 8.1 26.4 57.5 6.3 1.5 0.1 100.0 7.9 30.0 52.8 2.9 6.2 0.1 100.0 500 Gujranwala 8.5 30.0 52.8 7.0 1.6 0.0 100.0 9.0 31.6 51.0 2.4 6.0 0.0 100.0 776 Lahore 8.6 28.2 51.6 10.3 1.2 0.3 100.0 9.4 34.9 44.2 4.4 7.0 0.1 100.0 918 Multan 10.5 32.8 50.5 5.9 0.0 0.2 100.0 12.8 29.9 45.9 2.2 8.9 0.2 100.0 540 Rawalpindi 6.4 34.2 46.1 10.3 2.7 0.3 100.0 8.2 42.0 36.6 4.8 8.4 0.0 100.0 285 Sahiwal 1.8 22.5 54.1 18.3 2.9 0.5 100.0 5.2 21.3 56.6 3.5 12.9 0.6 100.0 416 Sargodha 11.4 24.7 55.5 7.2 1.0 0.3 100.0 12.4 27.2 49.0 2.5 8.5 0.4 100.0 359 Punjab 7.6 30.0 51.3 9.6 1.3 0.2 100.0 9.2 32.3 47.3 3.6 7.4 0.1 100.0 4,784 P a g e | 61 Table CH.7 shows the percentage of children receiving ORS, various types of recommended homemade fluids and zinc 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 37 percent of children with diarrhoea received fluids from any ORS source (ORS packets and pre-pack ORS fluids) and 17 percent of the children were given recommended homemade fluids (boiled water with sugar and salt including other fluids). Overall, 19 percent of children with diarrhoea received zinc in one form or another. Table CH.7: Oral rehydration solutions, recommended homemade fluids, and zinc Percentage of children age 0-59 months with diarrhoea in the last two weeks, and treatment with oral rehydration salts (ORS), recommended homemade fluids, and zinc, Punjab, 2014. Percentage of children with diarrhoea who received: Number of children aged 0-59 months with diarrhoea Oral rehydration salts (ORS) Recommended homemade fluids ORS or any recomme nded homema de fluid Zinc ORS and zinc1 Fluid from packet Pre- pack aged fluid Any ORS Homemade fluid (Boiled water, sugar & salt) O th e rs Any recomm ended homem ade fluid T a b le t S y ru p A n y z in c Punjab 33.6 5.8 37.2 11.4 6.5 17.3 45.2 3.8 17.8 19.1 9.7 4,784 Area of residence Rural 30.4 5.5 33.8 11.1 5.8 16.4 41.5 4.0 17.5 18.9 9.0 3,297 All Urban 40.6 6.4 44.7 12.1 8.2 19.3 53.3 3.5 18.4 19.6 11.1 1,487 Major Cities 44.2 7.0 48.9 10.8 7.3 17.1 56.1 2.9 18.1 19.0 11.3 801 Other Urban 36.4 5.7 39.8 13.6 9.2 22.0 49.9 4.2 18.8 20.3 10.9 686 Sex Male 35.0 6.7 39.2 11.5 6.6 17.4 46.6 3.8 17.3 18.7 10.2 2,491 Female 32.0 4.8 35.0 11.3 6.5 17.1 43.7 3.9 18.3 19.5 9.1 2,293 Age 0-11 months 31.3 5.9 35.5 11.0 5.1 15.3 42.7 3.4 17.5 18.4 9.6 1,266 12-23 months 35.1 7.2 39.6 12.9 6.6 19.0 47.6 4.0 19.8 21.3 11.0 1,348 24-35 months 34.1 4.3 36.3 8.9 6.8 15.6 42.8 3.8 14.8 16.3 7.9 954 36-47 months 33.9 5.3 37.4 12.1 7.9 18.9 47.3 3.6 19.9 20.9 10.7 740 48-59 months 33.5 5.3 36.4 12.4 7.4 18.6 46.2 4.8 15.4 17.5 8.2 477 Mother’s education None/pre-school 29.9 5.1 33.1 10.5 5.4 15.6 40.9 4.5 16.5 18.1 8.2 2,306 Primary 30.6 4.8 33.5 10.7 5.8 16.1 40.9 3.0 14.9 15.9 7.5 926 Middle 38.9 5.8 41.5 11.8 7.1 18.1 49.7 3.9 17.7 19.0 8.5 511 Secondary 40.1 6.0 44.2 13.6 6.9 19.3 53.0 3.7 19.9 21.3 12.1 605 Higher 43.9 11.1 52.0 14.3 12.6 25.0 61.0 1.8 27.7 28.3 20.0 436 Wealth index quintile Lowest 28.7 5.2 32.3 10.1 4.9 14.8 39.1 4.7 16.9 18.4 8.4 1,181 Second 28.3 4.0 30.8 10.5 6.3 16.5 40.4 4.2 15.2 16.8 7.2 1,038 Middle 31.6 4.4 33.7 11.2 6.5 16.8 41.0 3.7 17.3 18.7 8.2 931 Fourth 39.6 5.8 43.0 12.6 7.1 19.1 51.8 3.9 18.3 19.6 10.6 866 Highest 43.6 10.8 50.9 13.5 8.7 20.8 58.5 1.9 22.5 23.1 15.7 769 Division Bahawalpur 36.0 4.3 39.3 17.9 5.8 22.7 49.4 2.4 29.6 30.9 17.5 386 D.G. Khan 26.3 5.3 29.1 8.5 6.1 14.4 35.6 7.4 16.7 19.4 8.8 605 Faisalabad 40.6 5.9 45.2 12.1 8.3 20.2 54.4 10.7 32.1 34.0 17.6 500 Gujranwala 28.8 5.9 32.4 11.1 3.7 14.1 40.1 2.1 9.9 11.1 5.1 776 Lahore 38.3 4.3 41.7 8.1 4.7 12.7 48.6 3.4 21.2 22.1 10.8 918 Multan 43.3 6.7 47.0 16.4 5.1 20.9 53.8 1.9 17.0 17.6 9.0 540 Rawalpindi 46.5 13.4 53.2 26.4 23.2 45.3 68.8 2.7 23.2 23.8 16.6 285 Sahiwal 17.7 4.1 19.6 3.6 5.7 9.2 25.1 0.2 5.4 5.6 1.6 416 Sargodha 25.0 6.1 28.9 7.1 6.1 12.8 37.9 2.6 6.5 8.6 3.6 359 1 MICS indicator 3.11 - Diarrhoea treatment with oral rehydration salts (ORS) and zinc P a g e | 62 More than 45 percent of children with diarrhoea received one or more of the recommended home treatments (i.e., were treated with ORS or any recommended homemade fluid), while 10 percent received ORS and zinc. Across divisions, treatment with ORS or any recommended homemade fluid, ranged from 25 percent in Sahiwal division to 69 percent in Rawalpindi division. Children from mothers with higher education are more likely to receive ORS and zinc (20%) compared to children from mothers with only pre-school or no education (8%). Figure CH.2 shows the variation in prevalence of children under-5 with diarrhoea who received ORS or recommended homemade liquids among different division and with reference to education of mother/caretaker. Figure CH.2: Chi ldren under -5 with d iarrhoea who received ORS or r ecommended homemade l iquids , MICS Punjab, 2014 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 received other treatments. Overall, 42 percent of children with diarrhoea received ORS or increased fluids, 47 percent received 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 39 percent of children received ORT and, at the same time, feeding was continued, as is the recommendation. There are some differences in the home management of diarrhoea by background characteristics. The figures for ORT and continued feeding ranges from 30 percent in Sahiwal division to 53 percent in Rawalpindi division. Similarly, the percentage is higher in urban areas (45%) compared to rural areas(36%). Home management of diarrhoea is also more likely among children whose mothers have higher education and children living in the households in the highest quintile. 49 36 54 40 49 54 69 25 38 53 42 41 41 50 53 61 45 P er ce n t P a g e | 63 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, Punjab, 2014. Children with diarrhoea who were given: Not given any treatment or drug Number of children age 0-59 months with diarrhoea in the last two weeks Zinc ORS or increased fluids ORT (ORS or recommended homemade fluids or increased fluids) ORT with continued feeding1 Other treatments Pill or syrup Injection In tr a -v e n o u s Home remedy, herbal medicine O th e r A n ti - b io ti c A n ti - m o ti lit y O th e r U n k n o w n A n ti - b io ti c N o n - a n ti b io ti c U n k n o w n Punjab 19.1 42.1 46.7 38.9 4.0 14.5 0.5 21.7 1.6 0.2 4.3 1.5 2.7 6.7 17.7 4,784 Area of residence Rural 18.9 39.2 43.6 36.0 3.8 15.6 0.5 21.8 1.7 0.2 4.9 1.6 3.1 6.9 18.9 3,297 All Urban 19.6 48.5 53.5 45.3 4.6 12.0 0.5 21.4 1.6 0.2 2.8 1.4 1.7 6.2 15.0 1,487 Major Cities 19.0 53.2 57.0 47.2 3.6 8.7 0.4 21.2 1.4 0.1 1.5 0.9 1.2 4.4 15.7 801 Other Urban 20.3 43.0 49.3 43.2 5.7 15.9 0.6 21.5 1.9 0.3 4.3 2.1 2.3 8.2 14.3 686 Sex Male 18.7 43.6 47.7 40.6 4.2 14.6 0.7 22.1 1.3 0.3 4.5 1.4 2.9 6.6 17.1 2,491 Female 19.5 40.5 45.6 37.0 3.8 14.3 0.3 21.2 2.0 0.1 4.0 1.7 2.5 6.8 18.4 2,293 Age 0-11 months 18.4 39.1 43.4 30.7 4.5 13.4 0.6 20.9 2.1 0.3 3.3 1.6 2.3 7.4 20.1 1,266 12-23 months 21.3 45.9 50.4 42.0 4.6 15.6 0.4 20.8 1.9 0.0 4.2 2.3 2.5 7.0 15.0 1,348 24-35 months 16.3 40.2 43.2 38.1 3.4 14.6 0.5 23.8 1.2 0.2 6.0 1.3 3.4 6.1 18.0 954 36-47 months 20.9 42.0 48.0 44.1 3.9 14.0 0.7 21.0 0.9 0.1 5.1 0.5 3.1 6.8 17.6 740 48-59 months 17.5 43.5 49.4 45.1 2.7 14.6 0.6 22.9 1.5 0.5 2.4 1.4 2.1 5.1 18.9 477 Mother’s education None/pre-school 18.1 38.9 43.5 35.4 3.7 14.7 0.5 24.4 1.4 0.1 5.7 1.5 3.2 5.3 19.7 2,306 Primary 15.9 38.6 42.6 36.5 2.7 13.0 0.5 23.2 1.5 0.2 3.8 1.9 2.0 8.5 19.2 926 Middle 19.0 45.6 50.3 43.0 5.1 15.6 0.3 21.4 1.8 0.0 2.8 1.8 1.2 8.9 13.5 511 Secondary 21.3 47.3 52.2 43.1 4.9 15.7 0.7 15.7 2.5 0.4 3.0 1.0 2.7 7.6 14.9 605 Higher 28.3 55.5 60.2 51.4 6.0 13.4 0.7 12.3 1.7 0.7 1.0 1.4 3.0 6.8 13.1 436 Wealth index quintile Lowest 18.4 37.5 41.7 34.5 3.3 14.6 0.3 22.5 1.4 0.0 6.0 1.6 4.3 5.4 22.0 1,181 Second 16.8 37.6 42.3 35.3 3.0 15.2 0.4 22.2 1.3 0.1 6.2 1.3 3.3 8.2 20.2 1,038 Middle 18.7 38.3 42.6 35.4 3.2 14.3 1.0 25.3 1.9 0.4 3.2 2.0 1.9 6.5 16.7 931 Fourth 19.6 47.5 52.2 43.2 6.5 16.3 0.4 21.1 1.7 0.5 2.8 1.4 1.4 7.7 13.7 866 Highest 23.1 54.0 58.7 49.7 4.6 11.5 0.6 15.7 2.1 0.1 2.2 1.4 2.0 5.7 13.5 769 P a g e | 64 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, Punjab, 2014. Children with diarrhoea who were given: Not given any treatment or drug Number of children age 0-59 months with diarrhoea in the last two weeks Zinc ORS or increased fluids ORT (ORS or recommended homemade fluids or increased fluids) ORT with continued feeding1 Other treatments Pill or syrup Injection In tr a -v e n o u s Home remedy, herbal medicine O th e r A n ti - b io ti c A n ti - m o ti lit y O th e r U n k n o w n A n ti - b io ti c N o n - a n ti b io ti c U n k n o w n Division Bahawalpur 30.9 50.4 57.3 48.3 9.0 14.8 0.0 15.3 2.7 0.4 7.8 2.1 5.5 5.3 17.0 386 D.G. Khan 19.4 32.0 36.2 32.0 3.1 20.6 0.5 11.9 2.1 0.0 6.2 1.1 4.4 7.0 23.5 605 Faisalabad 34.0 46.6 52.2 45.7 0.8 8.6 0.4 19.9 1.3 0.0 2.2 1.7 4.2 3.4 12.2 500 Gujranwala 11.1 35.6 40.4 34.2 4.5 18.6 0.6 24.3 1.8 0.3 3.3 2.0 1.5 9.8 17.8 776 Lahore 22.1 46.0 49.5 41.5 5.4 11.1 0.9 23.3 2.5 0.1 2.5 1.0 1.3 3.7 17.7 918 Multan 17.6 49.4 54.4 40.2 3.2 20.8 0.9 27.0 0.2 0.1 3.6 0.9 2.7 4.4 12.9 540 Rawalpindi 23.8 57.6 64.4 52.8 2.7 11.7 0.2 3.6 2.4 0.7 0.2 1.3 1.0 8.1 17.7 285 Sahiwal 5.6 34.2 35.6 29.7 4.1 3.9 0.1 41.5 0.6 0.0 12.6 2.7 0.4 11.9 20.1 416 Sargodha 8.6 33.9 38.5 31.9 2.3 16.8 0.6 20.9 0.3 0.5 1.3 2.0 4.7 9.8 21.0 359 Punjab 19.1 42.1 46.7 38.9 4.0 14.5 0.5 21.7 1.6 0.2 4.3 1.5 2.7 6.7 17.7 4,784 1 MICS indicator 3.12 - Diarrhoea treatment with oral rehydration therapy (ORT) and continued feeding P a g e | 65 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 18 percent of them without any treatment or drug. The proportion of children without any treatment or drug is highest among those living in the households in the lowest quintile and in rural areas. Figure CH.3 shows the disparity among children with diarrhoea in taking ORT and continued feeding with respect to divisions, levels of mother’s education and area of residence. Figure CH.3: Chi ldr en under -5 with d iarrhoea receiv ing oral rehydrat ion therapy (ORT) and cont inued feeding , MICS Punjab , 2014 Table CH.9 provides information on the source of ORS and zinc for children who benefitted from these treatments. The main source of ORS is the private sector (68%) and the same applies for zinc (74%). 48 32 46 34 42 40 53 30 32 45 36 35 37 43 43 51 39 0.0 10.0 20.0 30.0 40.0 50.0 60.0 Divisions Bahawalpur D.G.Khan Faisalabad Gujranwala Lahore Multan Rawalpindi Sahiwal Sargodha Area Urban Rural Mother's Education None/pre-school Primary Middle Secondary Higher Punjab Percent P a g e | 66 Table CH.9: Source of ORS and zinc Percentage of children age 0-59 months with diarrhoea in the last two weeks who were given ORS, and percentage given zinc, by the source of ORS and zinc, Punjab, 2014. Percentage of children who were given as treatment for diarrhoea: N u m b e r o f c h ild re n a g e 0 -5 9 m o n th s w it h d ia rr h o e a i n t h e l a s t tw o w e e k s Percentage of children for whom the source of ORS was: N u m b e r o f c h ild re n a g e 0 -5 9 m o n th s w h o w e re g iv e n O R S a s tr e a tm e n t fo r d ia rr h o e a i n t h e l a s t tw o w e e k s Percentage of children for whom the source of zinc was: N u m b e r o f c h ild re n a g e 0 -5 9 m o n th s w h o w e re g iv e n z in c a s tr e a tm e n t fo r d ia rr h o e a i n t h e l a s t tw o w e e k s Health facilities or providers O th e r A h e a lt h fa c ili ty o r p ro v id e rb Health facilities or providers O th e r A h e a lt h fa c ili ty o r p ro v id e rb O R S z in c P u b lic P ri v a te C o m m u n it y h e a lt h p ro v id e ra P u b lic P ri v a te C o m m u n it y h e a lt h p ro v id e ra Punjab 37.2 19.1 4,784 13.8 67.7 2.1 18.3 81.5 1,779 15.1 74.3 1.2 10.1 89.5 914 Area of residence Rural 33.8 18.9 3,297 14.8 67.3 2.8 17.8 82.1 1,115 15.2 73.3 1.2 11.0 88.5 622 All Urban 44.7 19.6 1,487 12.1 68.3 0.9 19.2 80.4 665 15.0 76.5 1.0 8.2 91.5 291 Major Cities 48.9 19.0 801 13.7 66.1 0.8 19.7 79.8 392 9.9 79.4 0.7 10.1 89.3 152 Other Urban 39.8 20.3 686 9.8 71.4 1.0 18.6 81.1 273 20.5 73.4 1.3 6.1 93.9 139 Sex Male 39.2 18.7 2,491 13.8 68.5 1.4 17.4 82.3 977 14.9 75.6 1.5 9.4 90.5 465 Female 35.0 19.5 2,293 13.7 66.7 2.9 19.4 80.4 802 15.4 73.0 0.8 10.9 88.4 448 Age 0-11 months 35.5 18.4 1,266 10.9 73.6 1.4 15.5 84.4 449 12.1 80.4 1.2 7.2 92.5 233 12-23 months 39.6 21.3 1,348 13.7 69.1 2.2 17.2 82.8 534 15.1 76.3 0.8 8.3 91.5 288 24-35 months 36.3 16.3 954 12.1 62.6 2.4 24.4 74.6 346 16.8 68.6 1.1 13.0 85.5 155 36-47 months 37.4 20.9 740 18.7 64.0 1.9 17.3 82.7 277 15.3 72.1 1.5 12.5 87.5 155 48-59 months 36.4 17.5 477 17.3 64.2 3.5 18.5 81.5 174 20.3 65.1 1.5 14.6 85.4 83 Mother’s education None/pre-school 33.1 18.1 2,306 13.2 68.2 2.3 18.2 81.4 763 17.5 71.4 0.9 10.5 88.9 417 Primary 33.5 15.9 926 15.8 63.7 1.1 20.5 79.5 310 17.9 68.6 1.5 13.0 86.5 147 Middle 41.5 19.0 511 15.5 61.5 3.1 23.0 77.0 212 10.1 80.7 0.7 9.2 90.8 97 Secondary 44.2 21.3 605 16.0 68.2 2.1 15.7 84.3 268 14.7 74.1 3.0 10.5 88.8 129 Higher 52.0 28.3 436 8.5 76.7 1.8 14.3 85.2 227 8.1 86.3 0.0 5.5 94.5 123 Wealth index quintile Lowest 32.3 18.4 1,181 13.0 66.5 1.3 19.8 79.5 381 16.8 70.4 1.0 11.7 87.2 218 Second 30.8 16.8 1,038 16.5 62.5 3.6 21.1 78.9 320 19.8 66.9 0.0 13.3 86.7 174 Middle 33.7 18.7 931 17.0 65.7 3.1 17.3 82.7 314 16.7 76.6 2.2 5.8 93.3 174 Fourth 43.0 19.6 866 13.8 68.2 1.9 17.8 82.0 373 15.5 76.6 1.0 7.9 92.1 170 Highest 50.9 23.1 769 9.8 74.2 1.0 15.9 84.0 391 6.7 82.0 1.5 11.3 88.7 177 P a g e | 67 Table CH.9: Source of ORS and zinc Percentage of children age 0-59 months with diarrhoea in the last two weeks who were given ORS, and percentage given zinc, by the source of ORS and zinc, Punjab, 2014. Percentage of children who were given as treatment for diarrhoea: N u m b e r o f c h ild re n a g e 0 -5 9 m o n th s w it h d ia rr h o e a i n t h e l a s t tw o w e e k s Percentage of children for whom the source of ORS was: N u m b e r o f c h ild re n a g e 0 -5 9 m o n th s w h o w e re g iv e n O R S a s t re a tm e n t fo r d ia rr h o e a i n t h e l a s t tw o w e e k s Percentage of children for whom the source of zinc was: N u m b e r o f c h ild re n a g e 0 -5 9 m o n th s w h o w e re g iv e n z in c a s t re a tm e n t fo r d ia rr h o e a i n t h e l a s t tw o w e e k s Health facilities or providers O th e r A h e a lt h f a c ili ty o r p ro v id e rb Health facilities or providers O th e r A h e a lt h f a c ili ty o r p ro v id e rb O R S z in c P u b lic P ri v a te C o m m u n it y h e a lt h p ro v id e ra P u b lic P ri v a te C o m m u n it y h e a lt h p ro v id e ra Division Bahawalpur 39.3 30.9 386 9.8 78.1 1.9 10.8 87.9 152 8.5 87.4 1.7 4.2 95.8 119 D.G. Khan 29.1 19.4 605 16.1 55.9 0.9 27.6 72.0 176 20.2 54.1 1.3 25.0 74.4 117 Faisalabad 45.2 34.0 500 13.1 73.1 2.9 13.8 86.2 226 16.3 79.7 1.0 4.0 96.0 170 Gujranwala 32.4 11.1 776 11.4 82.6 2.8 5.7 93.9 252 20.8 77.8 2.1 1.4 98.6 86 Lahore 41.7 22.1 918 12.5 56.2 0.2 31.3 68.7 383 11.1 73.9 0.0 14.9 85.1 203 Multan 47.0 17.6 540 11.4 76.4 1.6 12.2 87.8 254 14.1 79.5 0.0 3.0 93.6 95 Rawalpindi 53.2 23.8 285 23.3 58.2 0.8 18.2 81.6 152 21.5 65.5 3.2 13.0 87.0 68 Sahiwal 19.6 5.6 416 23.5 60.3 15.0 16.2 83.8 81 (9.9) (82.7) (0.0) (7.4) (92.6) 23 Sargodha 28.9 8.6 359 11.9 65.4 0.9 22.7 77.3 104 (19.4) (60.7) (4.0) (19.9) (80.1) 31 Punjab 37.2 19.1 4,784 13.8 67.7 2.1 18.3 81.5 1,779 15.1 74.3 1.2 10.1 89.5 914 a Community health provider includes both public (Lady health worker and Mobile/Outreach clinic) and private (Mobile clinic) health facilities b Includes all public and private health facilities and providers ( ) Figures that are based on 25-49 unweighted cases P a g e | 68 Acute Respiratory Infections Symptoms of ARI are collected during the MICS Punjab, 2014 to capture suspected 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.29 While this limitation does not affect the level and patterns of care-seeking for suspected pneumonia, it limits the validity of the level of treatment of pneumonia with antibiotics, as reported through household surveys. The treatment indicator described in this report must therefore be taken with caution, keeping in mind that the accurate level is likely to be higher. 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. Seventy seven percent of children age 0-59 months with symptoms of ARI were taken to a health facility or provider. Slightly more children with ARI in urban areas visited a health facility or provider (82%) compared to rural areas (76%). More children were taken to private facility or provider (68%) compared to public facility or provider (11%). Table CH.10 also presents the use of antibiotics for the treatment of children under 5 years with symptoms of ARI by area and sex. Overall, 39 percent of under-5 children with symptoms of ARI received antibiotics during the two weeks prior to the survey. The treatment was received mostly from private health facilities (83%) followed by public (9%). The percentage was higher in rural (42%) than in urban areas (30%). 29 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 P a g e | 69 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, Punjab, 2014. Percentage of children with symptoms of ARI for whom: Percentage of children with symptoms of ARI in the last two weeks who were given antibiotics2 Number of children age 0-59 months with symptoms of ARI in the last two weeks Percentage of children with symptoms of ARI for whom the source of antibiotics was: Number of children with symptoms of ARI in the last two weeks who were given antibiotics Advice or treatment was sought from: No advice or treatment sought Health facilities or providers A health facility or provider1, b Health facilities or providers Other source A health facility or providerc Public Private Community health providera Other source Public Private Community health providera Punjab 10.9 68.2 1.0 9.5 77.1 12.0 39.1 683 9.4 82.8 0.2 6.1 92.1 267 Area of residence Rural 10.5 67.4 0.0 10.5 75.9 12.2 41.8 529 10.1 81.4 0.0 6.3 91.5 221 All Urban 12.4 71.0 4.2 6.0 81.6 11.2 30.1 153 6.2 89.0 1.2 4.8 95.2 46 Major Cities (20.8) (69.7) (9.8) (0.9) (90.5) (9.5) (36.0) 56 (*) (*) (*) (*) (*) 20 Other Urban 7.6 71.8 1.0 9.0 76.4 12.2 26.7 97 (10.9) (80.5) (2.2) (8.6) (91.4) 26 Sex Male 9.9 70.3 0.1 9.2 78.2 10.9 40.4 392 12.4 83.0 0.0 4.3 95.5 159 Female 12.2 65.3 2.0 9.8 75.7 13.4 37.5 290 5.0 82.3 0.5 8.7 87.3 109 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 a Community health providers includes both public (Lady health worker and Mobile/Outreach clinic) and private (Mobile clinic) health facilities b Includes all public and private health facilities and providers, but excludes private pharmacy c Includes all public and private health facilities and providers ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases P a g e | 70 Table CH.11: Knowledge of the two danger signs of pneumonia Percentage of women age 15-49 years who are mothers or caretakers of children under age 5 by symptoms that would cause them to take a child under age 5 immediately to a health facility, and percentage of mothers who recognize fast or difficult breathing as signs for seeking care immediately, Punjab, 2014. Percentage of mothers/caretakers who think that a child should be taken immediately to a health facility if the child: Mothers/careta kers who recognize at least one of the two danger signs of pneumonia (fast and/or difficult breathing) Number of mothers / caretakers of children age 0-59 months Is n o t a b le t o d ri n k o r b re a s tf e e d B e c o m e s s ic k e r D e v e lo p s a f e v e r H a s f a s t b re a th in g H a s d if fi c u lt b re a th in g H a s b lo o d i n s to o l Is d ri n k in g p o o rl y S u ff e re d f ro m l o s e m o ti o n H a s o th e r s y m p to m s Punjab 10.7 58.8 81.4 14.6 14.8 11.1 12.6 58.5 26.3 24.8 18,096 Area of residence Rural 11.6 57.8 81.4 15.0 15.8 12.2 13.1 57.8 24.8 25.7 12,253 All Urban 8.6 60.8 81.5 13.7 12.6 8.7 11.5 59.8 29.2 22.8 5,843 Major Cities 6.1 60.8 81.8 12.4 10.9 7.0 9.8 61.0 33.7 20.7 3,075 Other Urban 11.4 60.7 81.2 15.2 14.4 10.6 13.5 58.5 24.2 25.2 2,768 Women's educationa None/pre-school 12.9 59.3 81.5 16.1 17.4 14.1 14.4 58.3 23.7 27.4 8,447 Primary 8.7 59.2 82.9 12.5 12.2 8.6 11.0 59.5 28.0 21.7 3,283 Middle 8.5 56.9 81.0 13.6 12.6 9.5 10.2 58.3 27.3 22.8 1,787 Secondary 8.6 57.7 81.4 12.1 12.6 7.1 10.2 56.6 28.5 21.5 2,433 Higher 9.1 58.9 79.3 15.3 12.7 8.7 12.9 60.1 30.3 24.5 2,142 Wealth index quintile Lowest 17.1 59.9 82.3 18.7 20.3 16.9 17.1 58.8 22.0 30.4 3,939 Second 10.8 56.8 82.5 14.5 14.9 13.1 12.8 59.0 27.1 25.1 3,586 Middle 9.0 58.7 81.2 13.2 14.2 9.0 12.1 58.8 26.0 23.8 3,490 Fourth 7.9 58.7 80.6 12.9 11.5 8.4 10.4 57.8 27.4 21.4 3,658 Highest 7.7 59.7 80.4 13.2 12.2 7.2 10.1 58.1 29.3 22.5 3,423 Division Bahawalpur 19.3 44.7 69.1 16.9 22.7 16.5 18.3 54.3 5.3 36.8 1,938 D.G. Khan 33.2 73.2 89.1 35.8 35.9 29.2 28.7 62.6 21.7 48.6 2,024 Faisalabad 11.5 64.3 84.2 15.4 12.4 9.3 17.2 57.7 31.6 25.7 2,064 Gujranwala 4.9 58.3 78.5 8.4 9.8 5.6 8.0 57.1 24.9 16.2 2,672 Lahore 4.9 54.6 84.3 11.4 10.0 4.8 8.2 61.9 34.5 19.2 3,255 Multan 7.1 74.4 85.4 12.6 12.9 12.0 12.1 69.3 21.2 22.6 1,959 Rawalpindi 8.4 64.4 72.0 11.5 7.8 5.0 5.6 37.0 20.6 17.3 1,536 Sahiwal 2.6 45.1 79.6 12.1 12.2 15.2 8.0 57.4 32.4 22.0 1,292 Sargodha 4.1 44.2 88.8 6.8 9.7 6.3 6.2 64.0 45.8 15.1 1,355 a Total includes 4 unweighted cases of women's education missing Mothers’ knowledge of danger signs is an important determinant of care-seeking behaviour. In the MICS, mothers or caretakers were asked to report symptoms that would cause them to take a child under-five for care immediately at a health facility. The knowledge of mother/caretaker about danger signs of pneumonia are presented in Table CH.11. Overall, 25 percent of women know at least one of the two danger signs of pneumonia – fast and/or difficult breathing. The most commonly identified symptom for taking a child to a health facility is if a child develops a fever. About 15 percent of mothers identified fast breathing and difficult breathing as symptoms for taking children immediately to a health care provider. Almost half of the women in DG Khan division (49%) have knowledge of at least one of the two danger signs of pneumonia compared to only 15 percent of women in Sargodha division. P a g e | 71 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. Overall, 61 percent of the household population use solid fuels for cooking, consisting mainly of wood (33%). Use of solid fuels is low in urban areas (17%), but high in rural where they are used by 83 percent of the household population. Differentials with respect to household wealth and the educational level of the household head are also notable. All of the population living in the households in the lowest quintile use solid fuel and this proportion declines to only 4 percent of population living in the households in the highest quintile. The use of solid fuel 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 findings, 17 percent of the population living in households using solid fuels for cooking, cook food in a separate room that is used as a kitchen. Eighty two percent have food cooked within the dwelling unit elsewhere in the household. The use of separate room as kitchen is higher (42%) in the households in the highest quintile and vice versa. P a g e | 72 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, Punjab, 2014. Percentage of household members in households using: Number of household members E le c tr ic it y L iq u e fi e d P e tr o le u m G a s ( L P G ) N a tu ra l G a s B io g a s K e ro s e n e Solid fuels O th e r / M is s in g No food cooked in the household Total Solid fuels for cooking1 C o a l/ L ig n it e C h a rc o a l W o o d S tr a w / S h ru b s / G ra s s A n im a l d u n g A g ri c u lt u ra l c ro p re s id u e Punjab 0.0 3.6 34.9 0.2 0.0 0.1 0.3 33.2 1.5 15.0 11.1 0.2 0.1 100.0 61.1 246,396 Area of residence Rural 0.0 3.0 13.6 0.1 0.0 0.1 0.4 43.2 2.0 21.3 16.0 0.2 0.1 100.0 83.0 165,174 All Urban 0.0 4.8 78.2 0.2 0.0 0.0 0.1 12.8 0.4 2.3 1.1 0.2 0.1 100.0 16.6 81,222 Major Cities 0.0 2.2 91.4 0.2 0.0 0.0 0.1 4.7 0.4 0.6 0.0 0.1 0.1 100.0 5.9 42,289 Other Urban 0.0 7.5 63.9 0.1 0.0 0.0 0.0 21.6 0.3 4.1 2.2 0.2 0.1 100.0 28.2 38,933 Education of household heada None/pre-school 0.0 1.3 22.5 0.1 0.0 0.1 0.3 37.0 2.2 20.5 15.7 0.2 0.1 100.0 75.8 99,632 Primary 0.0 3.1 33.3 0.1 0.0 0.0 0.4 34.6 1.5 15.6 11.2 0.1 0.1 100.0 63.3 43,176 Middle 0.0 4.4 37.7 0.1 0.0 0.1 0.3 35.2 1.0 13.0 8.1 0.2 0.0 100.0 57.6 31,941 Secondary 0.0 5.9 45.3 0.3 0.0 0.1 0.2 30.0 0.9 10.2 6.9 0.2 0.0 100.0 48.3 44,624 Higher 0.1 8.3 62.6 0.4 0.0 0.0 0.0 20.0 0.3 4.0 4.1 0.1 0.1 100.0 28.5 26,950 Wealth index quintile Lowest 0.0 0.0 0.2 0.0 0.0 0.0 0.2 48.0 4.7 22.1 24.5 0.1 0.2 100.0 99.5 49,280 Second 0.0 0.3 4.3 0.0 0.0 0.0 0.6 50.0 1.4 25.6 17.6 0.1 0.1 100.0 95.1 49,278 Middle 0.1 2.0 22.6 0.2 0.0 0.1 0.4 43.9 0.9 18.9 10.6 0.3 0.1 100.0 74.8 49,279 Fourth 0.0 7.5 59.9 0.3 0.0 0.1 0.1 21.4 0.5 7.4 2.5 0.3 0.0 100.0 32.0 49,281 Highest 0.0 8.2 87.5 0.3 0.0 0.0 0.0 2.7 0.0 1.0 0.3 0.0 0.0 100.0 4.0 49,278 Division Bahawalpur 0.0 2.8 15.4 0.2 0.0 0.1 0.1 29.1 2.5 10.1 39.7 0.0 0.1 100.0 81.5 25,956 D.G. Khan 0.0 2.3 6.2 0.0 0.0 0.0 0.6 66.1 3.6 9.5 11.6 0.0 0.0 100.0 91.4 23,418 Faisalabad 0.0 3.2 37.7 0.2 0.0 0.0 0.4 38.0 4.6 13.0 2.3 0.4 0.1 100.0 58.4 30,970 Gujranwala 0.0 6.0 42.9 0.3 0.0 0.2 0.2 19.3 0.3 30.5 0.1 0.3 0.1 100.0 50.5 36,313 Lahore 0.0 3.1 62.8 0.1 0.0 0.0 0.3 15.6 0.2 17.4 0.2 0.2 0.1 100.0 33.7 43,847 Multan 0.0 2.8 26.6 0.2 0.0 0.0 0.0 23.1 1.2 4.7 41.2 0.0 0.1 100.0 70.3 27,788 Rawalpindi 0.0 6.6 52.0 0.1 0.0 0.0 0.2 38.8 0.2 1.8 0.1 0.0 0.0 100.0 41.2 21,767 Sahiwal 0.0 2.6 20.1 0.2 0.0 0.0 0.2 34.2 0.8 30.1 11.4 0.3 0.1 100.0 76.8 17,255 Sargodha 0.0 2.1 18.9 0.1 0.0 0.0 0.5 64.8 0.3 13.1 0.2 0.0 0.1 100.0 78.9 19,082 1 MICS indicator 3.15 - Use of solid fuels for cooking a Total includes 80 unweighted cases of household head's education missing P a g e | 73 Table CH.13: Solid fuel use by place of cooking Percent distribution of household members in households using solid fuels by place of cooking, Punjab, 2014. Place of cooking: Number of household members in households using solid fuels for cooking In the house In a separate building Outdoors Other place Missing Total In a separate room used as kitchen Elsewhere in the house Punjab 17.4 81.8 0.4 0.1 0.1 0.3 100.0 150,517 Area of residence Rural 17.1 82.1 0.4 0.1 0.1 0.2 100.0 137,039 All Urban 20.5 78.3 0.5 0.2 0.0 0.5 100.0 13,478 Major Cities 14.8 83.1 0.9 0.5 0.1 0.5 100.0 2,482 Other Urban 21.8 77.2 0.4 0.1 0.0 0.4 100.0 10,995 Education of household heada None/pre-school 12.3 86.8 0.5 0.1 0.1 0.2 100.0 75,542 Primary 18.2 81.3 0.3 0.1 0.0 0.1 100.0 27,325 Middle 21.9 77.4 0.3 0.1 0.1 0.3 100.0 18,412 Secondary 25.9 73.3 0.3 0.1 0.1 0.4 100.0 21,533 Higher 30.7 68.7 0.1 0.0 0.0 0.5 100.0 7,676 Wealth index quintile Lowest 8.0 91.1 0.4 0.1 0.1 0.2 100.0 49,038 Second 15.1 84.2 0.4 0.1 0.0 0.2 100.0 46,861 Middle 24.3 74.8 0.4 0.1 0.1 0.3 100.0 36,875 Fourth 34.3 65.0 0.2 0.1 0.0 0.3 100.0 15,765 Highest 41.8 56.9 0.0 0.0 0.0 1.2 100.0 1,978 Division Bahawalpur 8.5 91.0 0.2 0.0 0.0 0.2 100.0 21,148 D.G. Khan 17.2 82.0 0.4 0.0 0.2 0.2 100.0 21,402 Faisalabad 12.5 86.8 0.2 0.1 0.0 0.5 100.0 18,075 Gujranwala 24.6 74.7 0.1 0.2 0.0 0.4 100.0 18,340 Lahore 9.7 89.3 0.7 0.2 0.0 0.2 100.0 14,773 Multan 12.6 86.1 0.8 0.1 0.0 0.4 100.0 19,521 Rawalpindi 55.8 43.0 0.1 0.1 0.5 0.5 100.0 8,958 Sahiwal 7.9 91.7 0.3 0.0 0.0 0.1 100.0 13,246 Sargodha 26.9 72.7 0.4 0.0 0.0 0.0 100.0 15,054 a Total includes 47 unweighted cases of household head's education missing Malaria/Fever Malaria is a major cause of death of children under age five worldwide. Preventive measures and treatment with an effective antimalarial can dramatically reduce malaria mortality rates among children. In 2010 the World Health Organization issued a recommendation for universal use of diagnostic testing to confirm malaria infection and apply appropriate treatment based on the results. According to the guidelines, treatment solely on the basis of clinical suspicion should only be considered when a parasitological diagnosis is not accessible. This recommendation was based on studies that showed substantial reduction in the proportion of fever that are associated with malaria to a low level.30 This recommendation implies that the indicator on proportion of children with fever that received antimalarial treatment is no longer an acceptable indicator of the level of treatment of malaria in the population of children under age five. However, as it remains the MDG indicator and for purposes of comparisons, as well as assessment of patterns across socio-demographic characteristics, it remains a standard MICS indicator. 30 D'Acremont, V et al. 2010. Reduction in the proportion of fevers associated with Plasmodium falciparum parasitaemia in Africa: a systematic review. Malaria Journal 9(240). P a g e | 74 Table CH.14 provides information on care-seeking behaviour during an episode of fever in the past two weeks. As shown in Table CH.14, advice is sought from a health facility or a qualified health care provider for 79 percent of children with fever; 68 percent of these services are provided by the private sector and 10 percent by public. However, no advice or treatment is sought in 15 percent of the cases. No correlation is observed between care-seeking from health facility or provider and mother’s education. Table CH.14: Care-seeking during fever Percentage of children age 0-59 months with fever in the last two weeks for whom advice or treatment was sought, by source of advice or treatment, Punjab, 2014. Percentage of children for whom: Number of children with fever in last two weeks Advice or treatment was sought from: No advice or treatment sought Health facilities or providers Other source A health facility or provider1, b Public Private Community health providera Punjab 9.7 68.3 0.4 8.5 79.3 14.6 5,714 Area of residence Rural 11.5 69.2 0.8 4.8 80.8 15.7 933 All Urban 10.9 69.9 0.6 6.6 81.9 14.1 824 Major Cities 9.8 69.8 0.2 8.6 80.9 12.7 2,986 Other Urban 9.6 66.6 0.6 8.4 77.5 16.7 2,728 Sex Male 9.1 67.7 0.2 9.8 78.4 14.5 3,957 Female 11.2 69.5 0.7 5.7 81.3 15.0 1,757 Age 0-11 months 8.0 69.9 0.3 8.0 79.0 14.9 1,375 12-23 months 10.4 71.8 0.2 6.3 83.6 12.3 1,379 24-35 months 7.5 67.2 0.1 10.6 77.1 15.9 1,060 36-47 months 11.6 66.2 1.0 9.5 78.5 14.2 1,070 48-59 months 11.7 63.8 0.4 9.0 76.3 16.8 831 Mother’s education None/pre-school 9.2 65.8 0.3 11.2 76.8 14.8 2,754 Primary 10.9 69.8 0.6 6.6 81.1 14.4 1,144 Middle 10.6 69.4 0.3 6.7 80.9 14.0 590 Secondary 11.1 70.5 0.2 4.4 82.3 14.8 697 Higher 7.2 73.7 0.4 5.7 82.2 14.6 528 Wealth index quintile Lowest 9.2 62.0 0.2 14.1 73.0 15.6 1,368 Second 9.5 66.5 0.5 9.2 78.0 16.0 1,249 Middle 10.6 69.9 0.2 6.9 81.7 13.7 1,119 Fourth 11.9 70.9 0.7 5.2 83.4 12.9 1,085 Highest 7.1 75.1 0.3 5.1 82.6 14.5 893 Division Bahawalpur 7.3 74.5 0.9 6.3 84.8 12.7 455 D.G. Khan 10.3 52.5 0.1 16.5 63.8 21.9 757 Faisalabad 8.3 73.0 0.0 9.6 82.5 9.6 643 Gujranwala 6.5 74.6 0.1 7.4 82.6 12.4 972 Lahore 11.6 65.4 0.8 9.6 79.4 15.2 1,036 Multan 14.4 68.4 0.7 5.3 82.4 14.0 541 Rawalpindi 14.8 60.7 0.4 2.3 75.3 23.4 350 Sahiwal 6.8 78.3 0.0 4.1 86.6 11.2 495 Sargodha 9.3 69.4 0.4 9.1 78.8 12.5 465 1 MICS indicator 3.20 - Care-seeking for fever a Community health providers include both public (Lady health worker and Mobile/Outreach clinic) and private (Mobile clinic) health facilities b Includes all public and private health facilities and providers as well as shops P a g e | 75 Mothers were asked to report all of the medicines given to a child to treat the fever, including medicines given at home and/or prescribed at a health facility. Artemisinin-based Combination therapy (ACT) is the recommended first line antimalarial recommended by the World Health Organization. In addition, confirmation of malaria is done on all fever cases through rapid diagnostic test. More than one third (36%) of the children with fever were given Paracetamol, Panadol or Acetaminophen followed by 28 percent of children who received antibiotic pill or syrup. Children with fever in the last two weeks were rarely treated with an artemisinin-based combination therapy (ACT) or other antimalarial (Table CH.15). P a g e | 76 Table CH.15: Treatment of children with fever Percentage of children age 0-59 months who had a fever in the last two weeks, by type of medicine given for the illness, Punjab, 2014. Children with a fever in the last two weeks who were given: Number of children with fever in last two weeks Anti-malarials Other medications O th e r M is s in g /D K S P / F a n s id a r C h lo ro q u in e A m o d ia -q u in e Q u in in e A rt e m is in in -b a s e d C o m b in a ti o n T h e ra p y ( A C T ) O th e r a n ti -m a la ri a l A n ti b io ti c p ill o r s y ru p A n ti b io ti c i n je c ti o n P a ra c e ta m o l/ P a n a d o l/ A c e ta m in o p h e n A s p ir in Ib u p ro fe n Punjab 0.3 0.4 0.1 0.1 0.1 0.4 28.3 11.6 35.6 1.6 24.0 12.9 6.2 5,714 Area of residence Rural 0.2 0.3 0.1 0.0 0.1 0.4 27.0 12.2 35.9 1.8 24.3 12.3 6.4 3,957 All Urban 0.4 0.7 0.0 0.1 0.1 0.3 31.2 10.1 35.0 1.2 23.5 14.3 5.8 1,757 Major Cities 0.3 1.1 0.0 0.1 0.1 0.2 35.1 9.7 34.0 1.3 22.7 13.5 5.7 933 Other Urban 0.5 0.2 0.0 0.1 0.1 0.5 26.8 10.5 36.1 1.1 24.5 15.3 6.0 824 Sex Male 0.3 0.4 0.2 0.1 0.1 0.4 28.7 11.8 35.7 1.6 23.7 12.9 6.7 2,986 Female 0.2 0.4 0.0 0.0 0.1 0.4 27.9 11.3 35.6 1.6 24.4 13.0 5.6 2,728 Age 0-11 months 0.2 0.4 0.1 0.1 0.2 0.3 26.7 10.1 40.7 0.7 16.4 13.4 5.9 1,375 12-23 months 0.2 0.2 0.0 0.1 0.1 0.6 28.7 11.4 37.3 2.1 23.5 12.8 7.0 1,379 24-35 months 0.4 0.1 0.1 0.0 0.1 0.4 28.4 11.8 31.7 2.2 27.3 13.7 6.2 1,060 36-47 months 0.4 0.8 0.2 0.0 0.1 0.1 32.8 13.8 32.7 1.6 26.7 10.9 4.7 1,070 48-59 months 0.2 0.7 0.1 0.0 0.1 0.2 24.5 11.2 33.3 1.4 30.0 14.0 7.2 831 Mother’s education None/pre-school 0.2 0.3 0.1 0.0 0.0 0.3 27.5 13.5 30.5 1.9 25.9 11.9 7.7 2,754 Primary 0.8 0.3 0.1 0.0 0.1 0.5 26.1 9.0 36.6 1.5 21.9 14.1 6.9 1,144 Middle 0.0 0.0 0.0 0.1 0.3 0.3 31.0 11.0 40.8 1.1 23.2 10.6 5.8 590 Secondary 0.1 0.2 0.0 0.2 0.2 0.3 31.1 10.1 42.0 1.2 23.7 14.9 2.0 697 Higher 0.0 1.8 0.0 0.0 0.2 0.5 30.4 9.4 46.1 1.0 20.4 15.5 2.9 528 Wealth index quintile Lowest 0.2 0.4 0.1 0.1 0.1 0.3 24.1 14.5 29.9 2.8 28.2 11.1 7.5 1,368 Second 0.3 0.1 0.2 0.2 0.1 0.3 27.6 13.2 30.8 1.2 23.6 13.7 8.0 1,249 Middle 0.1 0.1 0.1 0.0 0.2 0.5 28.0 10.0 39.2 1.1 21.7 13.6 6.5 1,119 Fourth 0.5 0.5 0.0 0.0 0.0 0.6 30.7 8.7 39.2 1.1 21.1 13.7 5.3 1,085 Highest 0.2 0.9 0.0 0.0 0.2 0.0 33.3 10.1 42.2 1.4 24.9 12.6 2.5 893 Division Bahawalpur 0.4 0.6 0.7 0.0 0.0 0.2 20.2 13.2 30.4 2.9 38.0 9.8 6.5 455 D.G. Khan 0.4 0.5 0.3 0.0 0.2 0.1 21.6 14.3 39.5 3.6 28.8 10.3 4.7 757 Faisalabad 0.2 0.1 0.0 0.3 0.2 0.0 32.4 12.5 38.0 1.9 20.1 10.1 5.5 643 Gujranwala 0.6 0.2 0.0 0.0 0.2 0.6 29.5 6.3 33.5 0.9 18.7 14.4 7.4 972 Lahore 0.0 0.9 0.0 0.0 0.2 0.4 31.5 8.8 34.2 0.3 20.0 12.4 9.6 1,036 Multan 0.2 0.9 0.0 0.2 0.0 0.1 42.6 22.1 30.0 2.5 27.8 7.5 2.8 541 Rawalpindi 0.4 0.0 0.0 0.0 0.0 0.9 19.2 5.1 54.9 1.5 15.5 15.8 2.5 350 Sahiwal 0.0 0.0 0.0 0.0 0.0 0.2 35.9 20.5 30.2 0.3 26.7 14.0 2.6 495 Sargodha 0.1 0.0 0.0 0.1 0.0 0.8 14.1 4.5 36.4 1.4 27.6 24.9 10.0 465 Overall, 4 percent of children with a fever in the previous two weeks had blood taken from a finger or heel for testing. The responses are similar with respect to area of residence, mother’s education and wealth. Around 1 percent of the children were given any anti-malarial treatment (Table CH.16). Of the children who had fever and received an anti-malarial, only 9 percent were treated with an ACT, however this percentage should be interpreted with caution and has been removed from the tables because the total number of children in the entire sample who had fever in the last 2 weeks and who had received anti-malarial was only between 25-40 unweighted cases. P a g e | 77 Table CH.16: Diagnostics and anti-malarial treatment of children Percentage of children age 0-59 months who had a fever in the last two weeks who had a finger or heel stick for malaria testing, who were given Artemisinin-combination Treatment (ACT) and any anti-malarial drugs, Punjab, 2014. Percentage of children who: Number of children age 0-59 months with fever in the last two weeks Had blood taken from a finger or heel for testing1 Were given: Artemisinin- combination Treatment (ACT) ACT the same or next day Any antimalarial drugs2 Any antimalarial drugs same or next day Punjab 4.0 0.1 0.1 1.3 0.8 5,714 Area of residence Rural 4.0 0.1 0.1 1.1 0.7 3,957 All Urban 3.9 0.1 0.1 1.6 1.2 1,757 Major Cities 3.1 0.1 0.0 1.7 1.3 933 Other Urban 4.8 0.1 0.1 1.4 1.1 824 Sex Male 4.4 0.1 0.1 1.3 0.9 2,986 Female 3.6 0.1 0.0 1.2 0.8 2,728 Age 0-11 months 3.4 0.2 0.1 1.3 1.0 1,375 12-23 months 4.1 0.1 0.0 1.2 0.4 1,379 24-35 months 4.2 0.1 0.0 0.9 0.6 1,060 36-47 months 4.2 0.1 0.1 1.6 1.5 1,070 48-59 months 4.2 0.1 0.1 1.3 0.9 831 Mother’s education None/pre-school 3.4 0.0 0.0 1.1 0.6 2,754 Primary 3.4 0.1 0.1 1.6 1.2 1,144 Middle 5.9 0.3 0.3 0.7 0.6 590 Secondary 5.4 0.2 0.0 1.0 0.6 697 Higher 4.3 0.2 0.0 2.5 2.3 528 Wealth index quintile Lowest 3.5 0.1 0.1 1.1 0.4 1,368 Second 3.5 0.1 0.1 1.2 0.9 1,249 Middle 3.8 0.2 0.1 1.0 0.7 1,119 Fourth 5.4 0.0 0.0 1.5 1.1 1,085 Highest 3.9 0.2 0.1 1.4 1.3 893 Division Bahawalpur 4.8 0.0 0.0 1.9 1.3 455 D.G. Khan 3.7 0.2 0.1 1.5 1.1 757 Faisalabad 2.4 0.2 0.0 0.8 0.6 643 Gujranwala 3.5 0.2 0.1 1.5 0.9 972 Lahore 3.9 0.2 0.2 1.4 1.3 1,036 Multan 3.6 0.0 0.0 1.4 0.6 541 Rawalpindi 3.8 0.0 0.0 1.3 0.5 350 Sahiwal 7.1 0.0 0.0 0.2 0.0 495 Sargodha 4.1 0.0 0.0 1.0 0.6 465 1 MICS indicator 3.21 - Malaria diagnostics usage 2 MICS indicator 3.22 - MDG indicator 6.8 - Anti-malarial treatment of children under age 5 Table CH.17 presents the source of antimalarial for children under age five who were treated with an antimalarial. The treatment was obtained from a health facility or provider in 82 percent of the cases treated with antimalarials, mostly from the private sector (62%). Pregnant women living in places where malaria is highly prevalent are highly vulnerable to malaria. Once infected, pregnant women risk anemia, premature delivery and stillbirth. Their babies face increased risk of low birth weight, which carries an increased chance to die in infancy.31 WHO 31 Shulman CE, Dorman EK. Importance and prevention of malaria in pregnancy. Trans R Soc Trop Med Hyg. 2003; 97(1), 30–55 P a g e | 78 recommends that in areas of moderate-to-high malaria transmission, all pregnant women be provided an intermittent preventive treatment with sulfadoxine-Pyrimethamine (SP) at every scheduled antenatal care visit. In the MICS Punjab, 2014, women were asked of the medicines they had received to prevent malaria in their last pregnancy during the 2 years preceding the survey. Women are considered to have received intermittent preventive therapy if they have received at least 3 doses of SP/Fansidar during the pregnancy, at least one of which was taken during antenatal care. Table CH.17: Source of anti-malarial Percentage of children age 0-59 months with fever in the last two weeks who were given anti-malarial by the source of anti- malarial, Punjab, 2014. Percentage of children who were given anti- malarial Number of children age 0-59 months with fever in the last two weeks Percentage of children for whom the source of anti-malarial was: Number of children age 0-59 months who were given anti- malarial as treatment for fever in the last two weeks Health facilities or providers Other source A health facility or providerb Public Private Community health providera Punjab 1.3 5,714 14.6 61.7 0.0 18.2 81.5 72 a Community health providers include both public (Lady health worker and Mobile/Outreach clinic) and private (Mobile clinic) health facilities b Includes all public and private health facilities and providers as well as shops P a g e | 79 Table CH.18: Intermittent preventive treatment for malaria Percentage of women age 15-49 years who had a live birth during the two years preceding the survey and who received intermittent preventive treatment (IPT) for malaria during pregnancy at any antenatal care visit, Punjab, 2014. Percentage of women who received antenatal care (ANC) Number of women with a live birth in the last two years Percentage of pregnant women: Number of women with a live birth in the last two years and who received antenatal care Who took any medicine to prevent malaria at any ANC visit during pregnancy who took SP/Fansidar at least once during an ANC visit and in total took: At least once Two or more times Three or more times1 Four or more times Punjab 78.8 10,653 3.2 1.4 0.8 0.4 0.2 8,392 Area of residence Rural 74.4 7,369 3.1 1.1 0.7 0.3 0.2 5,480 All Urban 88.7 3,284 3.3 1.8 1.1 0.5 0.4 2,912 Major Cities 91.3 1,692 3.0 2.0 1.3 0.6 0.6 1,545 Other Urban 85.9 1,592 3.7 1.5 0.9 0.4 0.2 1,367 Women’s educationa None/pre-school 65.4 4,816 3.3 1.6 1.1 0.4 0.3 3,149 Primary 83.1 1,961 2.3 0.6 0.4 0.3 0.2 1,630 Middle 89.0 1,096 2.9 1.3 0.3 0.1 0.1 976 Secondary 93.4 1,467 3.8 1.7 1.1 0.6 0.4 1,370 Higher 96.5 1,311 3.3 1.5 0.8 0.3 0.2 1,265 Wealth index quintile Lowest 56.3 2,321 3.7 1.3 0.7 0.2 0.2 1,306 Second 72.3 2,198 2.7 1.1 0.8 0.3 0.0 1,589 Middle 84.6 2,118 3.2 1.3 1.0 0.6 0.4 1,790 Fourth 89.7 2,094 3.4 1.3 0.7 0.3 0.2 1,878 Highest 95.1 1,922 2.9 1.7 1.0 0.5 0.3 1,828 Division Bahawalpur 60.2 1,068 6.6 3.5 3.5 2.6 2.6 643 D.G. Khan 62.3 1,181 5.3 2.1 0.7 0.2 0.1 736 Faisalabad 85.2 1,237 3.3 2.1 1.0 0.6 0.1 1,054 Gujranwala 86.5 1,578 1.8 0.2 0.1 0.0 0.0 1,364 Lahore 82.1 1,914 2.0 0.6 0.2 0.1 0.0 1,571 Multan 79.8 1,162 3.2 1.9 1.4 0.0 0.0 927 Rawalpindi 88.3 882 5.0 2.6 1.6 0.7 0.3 779 Sahiwal 80.4 827 1.2 0.3 0.2 0.0 0.0 665 Sargodha 81.3 804 2.8 0.2 0.1 0.1 0.0 654 1 MICS indicator 3.25 - Intermittent preventive treatment for malaria a Total includes 2 unweighted cases of women's education missing Intermittent preventive treatment for malaria in pregnant women who gave birth in the two years preceding the survey is presented in Table CH.18. Less than 1 percent of the women took the Intermittent preventive treatment (three or more doses of SP/Fansidar) for malaria, whereas 3 percent took any medicine to prevent malaria at any ANC visit during pregnancy. P a g e | 80 VII. WATER AND SANITATION Safe drinking water is a basic necessity for good health. Unsafe drinking water can be a significant determinant of diseases such as cholera, typhoid, and schistosomiasis. Drinking water can be contaminated with chemical and physical contaminants with harmful effects on human health. In addition to preventing disease, improved 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.32 Inadequate disposal of human excreta and personal hygiene are associated with a range of diseases including diarrhoeal diseases and polio and are important determinants of stunting. Improved sanitation can reduce diarrhoeal disease by more than a third33, and can substantially lessen the adverse health impacts of other disorders among millions of children in many countries. The MDG target 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 data.unicef.org34 or the website of the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation35. Use of Improved Water Sources The distribution of the population by main source of drinking water is shown in Table WS.1. The population using improved sources of drinking water is that 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. 32 WHO/UNICEF. 2012. Progress on Drinking water and Sanitation: 2012 update. 33 Cairncross, S et al. 2010. Water, sanitation and hygiene for the prevention of diarrhoea. International Journal of Epidemiology 39: i193-i205. 34 http://data.unicef.org/water-sanitation 35 http:// www.wssinfo.org P a g e | 81 Table WS.1: Use of improved water sources Percent distribution of household population according to main source of drinking water and percentage of household population using improved drinking water sources, Punjab, 2014. Main source of drinking water Improved sources Unimproved sources Piped water T u b e -w e ll/ b o re - h o le H a n d p u m p ( ta p ) M o to ri z e d p u m p (d u n k y / t u rb in e ) P ro -t e c te d w e ll P ro -t e c te d s p ri n g R a in -w a te r c o lle c ti o n B o tt le d w a te ra U n p ro -t e c te d w e ll U n p ro -t e c te d s p ri n g T a n k e r tr u c k C a rt w it h s m a ll ta n k / d ru m S u rf a c e w a te r B o tt le d w a te ra O th e r M is s in g T o ta l Percentage using improved sources of drinking water1 Number of household members In to d w e lli n g In to y a rd /p lo t T o n e ig h -b o u r P u b lic t a p / s ta n d -p ip e Punjab 11.6 1.7 0.9 5.1 0.8 30.6 41.7 0.9 0.3 0.2 0.6 0.2 0.1 0.2 4.1 0.1 0.0 0.7 0.1 100.0 94.4 246,396 Area of residence Rural 4.6 1.7 0.8 2.6 0.7 41.5 43.4 1.1 0.4 0.3 0.1 0.3 0.2 0.1 1.7 0.2 0.0 0.4 0.0 100.0 97.0 165,174 All Urban 25.8 1.9 1.1 10.3 0.9 8.6 38.2 0.5 0.1 0.0 1.6 0.0 0.0 0.3 8.9 0.1 0.0 1.5 0.1 100.0 89.0 81,222 Major Cities 38.5 1.0 1.1 12.0 1.6 2.1 27.7 0.2 0.0 0.0 2.6 0.0 0.0 0.4 10.6 0.1 0.1 1.9 0.2 100.0 86.8 42,289 Other Urban 12.0 3.0 1.1 8.5 0.2 15.6 49.6 0.7 0.2 0.0 0.5 0.0 0.0 0.2 7.1 0.0 0.0 1.1 0.0 100.0 91.5 38,933 Education of household headb None/pre-school 7.8 1.8 1.1 3.5 0.7 42.7 37.7 0.6 0.1 0.3 0.1 0.2 0.2 0.1 2.4 0.1 0.0 0.5 0.0 100.0 96.5 99,632 Primary 11.0 2.1 0.8 4.1 0.7 31.5 43.1 0.9 0.5 0.0 0.1 0.2 0.1 0.1 3.7 0.1 0.0 0.9 0.1 100.0 94.7 43,176 Middle 13.7 2.1 0.7 5.6 0.9 23.6 44.8 1.3 0.4 0.2 0.5 0.5 0.1 0.2 4.1 0.2 0.0 0.9 0.0 100.0 93.9 31,941 Secondary 14.6 1.4 0.8 6.4 0.7 19.2 46.9 1.4 0.5 0.1 0.8 0.2 0.1 0.4 5.5 0.1 0.0 0.8 0.1 100.0 92.8 44,624 Higher 19.3 1.1 0.5 10.0 1.1 11.7 41.8 0.9 0.2 0.0 2.9 0.1 0.1 0.3 8.5 0.1 0.1 1.2 0.2 100.0 89.4 26,950 Wealth index quintile Lowest 0.8 1.5 0.9 1.5 0.9 80.4 9.9 0.5 0.3 0.9 0.0 0.6 0.5 0.1 0.6 0.3 0.0 0.2 0.0 100.0 97.6 49,280 Second 4.4 2.8 1.0 2.1 0.6 43.1 42.5 0.7 0.6 0.0 0.0 0.2 0.1 0.1 1.1 0.1 0.0 0.3 0.1 100.0 98.0 49,278 Middle 9.3 2.3 1.2 4.2 0.4 20.1 57.0 1.3 0.4 0.0 0.0 0.2 0.0 0.0 2.8 0.1 0.0 0.5 0.0 100.0 96.3 49,279 Fourth 15.8 1.5 0.9 7.1 0.6 7.6 56.6 1.3 0.1 0.0 0.0 0.1 0.0 0.2 6.8 0.1 0.0 1.0 0.1 100.0 91.6 49,281 Highest 27.8 0.6 0.4 10.7 1.5 1.8 42.2 0.8 0.0 0.0 2.7 0.0 0.0 0.5 9.1 0.0 0.1 1.7 0.1 100.0 88.4 49,278 P a g e | 82 Table WS.1: Use of improved water sources Percent distribution of household population according to main source of drinking water and percentage of household population using improved drinking water sources, Punjab, 2014. Main source of drinking water Improved sources Unimproved sources Piped water T u b e -w e ll/ b o re - h o le H a n d p u m p ( ta p ) M o to ri z e d p u m p (d u n k y / t u rb in e ) P ro -t e c te d w e ll P ro -t e c te d s p ri n g R a in -w a te r c o lle c ti o n B o tt le d w a te ra U n p ro -t e c te d w e ll U n p ro -t e c te d s p ri n g T a n k e r tr u c k C a rt w it h s m a ll ta n k / d ru m S u rf a c e w a te r B o tt le d w a te ra O th e r M is s in g T o ta l Percentage using improved sources of drinking water1 Number of household members In to d w e lli n g In to y a rd /p lo t T o n e ig h b o u r P u b lic t a p / s ta n d -p ip e Division Bahawalpur 7.6 6.2 1.1 6.5 0.2 46.4 26.6 0.2 0.0 0.0 0.2 0.0 0.0 0.0 4.6 0.1 0.0 0.1 0.0 100.0 95.1 25,956 D.G. Khan 1.2 0.7 0.4 3.5 0.3 76.9 12.0 0.0 0.0 1.1 0.0 0.3 0.4 0.3 2.4 0.4 0.0 0.0 0.0 100.0 96.1 23,418 Faisalabad 9.1 0.6 1.0 5.4 0.2 29.6 36.1 0.0 0.0 0.0 0.3 0.0 0.0 0.2 16.4 0.4 0.1 0.6 0.0 100.0 82.3 30,970 Gujranwala 6.0 0.0 0.5 4.3 0.1 22.9 60.9 0.0 0.0 0.0 0.1 0.0 0.0 0.0 2.0 0.0 0.0 2.9 0.0 100.0 94.9 36,313 Lahore 32.8 1.1 0.6 7.4 1.3 10.9 41.0 0.0 0.0 0.0 2.3 0.0 0.0 0.0 2.2 0.0 0.0 0.1 0.2 100.0 97.5 43,847 Multan 5.6 2.0 0.8 4.5 0.5 21.9 62.8 0.0 0.0 0.0 0.1 0.0 0.0 0.0 1.0 0.0 0.0 0.7 0.1 100.0 98.2 27,788 Rawalpindi 18.6 0.1 2.8 7.7 1.6 6.4 43.8 10.0 3.1 0.0 0.4 1.9 0.6 1.3 0.2 0.1 0.0 1.2 0.1 100.0 94.6 21,767 Sahiwal 3.0 4.5 0.6 1.6 2.4 19.0 65.9 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2.9 0.0 0.0 0.1 0.0 100.0 97.0 17,255 Sargodha 4.5 2.7 0.5 2.3 1.2 64.6 17.3 0.2 0.2 0.9 0.2 0.3 0.7 0.0 3.8 0.3 0.0 0.3 0.2 100.0 94.5 19,082 Punjab 11.6 1.7 0.9 5.1 0.8 30.6 41.7 0.9 0.3 0.2 0.6 0.2 0.1 0.2 4.1 0.1 0.0 0.7 0.1 100.0 94.4 246,396 1 MICS indicator 4.1; MDG indicator 7.8 - Use of improved drinking water sources a Households using bottled water as the main source of drinking water are classified into improved or unimproved drinking water users according to the water source used for other purposes such as cooking and handwashing. b Total includes 80 unweighted cases of household head's education missing P a g e | 83 Overall, 94 percent of the population uses an improved source of drinking water; 89 percent in urban areas and 97 percent in rural areas. At division level, it ranges from 82 percent in Faisalabad to 98 percent in Multan. The most common drinking water source is a motorized pump (42%) followed by a hand pump (31%). The source of drinking water for the population varies by division. More than 60 percent of the population in Gujranwala, Sahiwal and Multan are using drinking water from a motorized pump. In D.G Khan and Sargodha, a hand pump is the most commonly used source of drinking water. Lahore is the only division with more households (33%) having drinking water piped into the dwelling. The main water sources are depicted in Figure WS.1. Figure WS.1: Percent d istr ibut ion of household members by sour ce of dr inking wat er , MICS Punjab , 2014 Use of water treatment by households is presented in Table WS.2. Households were asked about ways they may be treating water at home to make it safer to drink. Boiling water, adding bleach or chlorine, using a water filter, and using solar disinfection are considered as effective treatment of drinking water. The table shows water treatment by all household members and the percentage of those living in households using unimproved water sources but using appropriate water treatment methods. Out of those household members who are using unimproved drinking water sources, only 2 percent are found using an appropriate water treatment. About 4 percent of the population boils the water and 2 percent uses a water filter. Piped into dwelling, yard or plot 13% Neighbour/public tap/standpipe 6% Tubewell/borehole 1% Protected well or spring 1% Rain-water collection & Bottled Water 1% Motorized pump 42% Hand Pump 31% Cart with small tank/ drum 4% Other unimproved 1% P a g e | 84 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, Punjab, 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 method1 Number of household members in households using unimproved drinking water sources N o n e B o il A d d b le a c h / c h lo ri n e S tr a in t h ro u g h a c lo th U s e w a te r fi lt e r S o la r d is -i n fe c ti o n L e t it s ta n d a n d s e tt le O th e r M is s in g /D K Punjab 93.6 4.1 0.0 0.9 1.8 0.0 0.3 0.1 0.0 246,396 2.1 13,808 Area of residence Rural 97.5 1.3 0.0 0.4 0.6 0.0 0.4 0.0 0.0 165,174 1.6 4,900 All Urban 85.6 10.0 0.0 1.8 4.3 0.0 0.2 0.1 0.0 81,222 2.4 8,908 Major Cities 79.1 15.4 0.0 2.9 5.7 0.1 0.2 0.1 0.0 42,289 2.6 5,588 Other Urban 92.7 4.1 0.0 0.5 2.7 0.0 0.1 0.0 0.0 38,933 2.1 3,320 Main source of drinking water Improved 93.3 4.3 0.0 0.9 1.9 0.0 0.3 0.1 0.0 232,588 na na Unimproved 97.2 1.3 0.0 0.6 0.7 0.0 0.3 0.0 0.0 13,808 2.1 13,808 Education of household heada None/pre-school 97.1 1.6 0.0 0.6 0.6 0.0 0.4 0.0 0.0 99,632 1.1 3,507 Primary 95.3 3.3 0.0 0.7 1.0 0.0 0.1 0.0 0.0 43,176 1.0 2,267 Middle 93.9 4.0 0.0 1.0 1.3 0.0 0.4 0.1 0.0 31,941 1.9 1,950 Secondary 90.8 6.4 0.0 1.1 2.4 0.0 0.2 0.1 0.0 44,624 2.7 3,226 Higher 82.1 11.2 0.1 1.5 7.1 0.0 0.1 0.0 0.0 26,950 3.6 2,844 Wealth index quintile Lowest 98.7 0.2 0.0 0.3 0.0 0.1 0.7 0.0 0.0 49,280 0.0 1,168 Second 98.8 0.5 0.0 0.3 0.0 0.0 0.3 0.0 0.0 49,278 0.5 991 Middle 98.1 1.1 0.0 0.3 0.3 0.0 0.2 0.0 0.0 49,279 0.1 1,812 Fourth 93.9 4.9 0.0 0.9 0.7 0.0 0.1 0.1 0.0 49,281 2.3 4,130 Highest 78.3 14.0 0.0 2.5 8.0 0.1 0.2 0.1 0.0 49,278 3.3 5,707 Division Bahawalpur 96.7 0.7 0.0 0.7 0.4 0.2 1.3 0.0 0.0 25,956 0.4 1,270 D.G. Khan 98.6 1.0 0.0 0.1 0.3 0.0 0.0 0.0 0.0 23,418 2.2 905 Faisalabad 96.7 2.0 0.0 0.3 0.9 0.0 0.1 0.0 0.0 30,970 2.3 5,469 Gujranwala 94.5 4.0 0.0 1.0 1.6 0.0 0.1 0.0 0.0 36,313 1.9 1,837 Lahore 83.2 12.3 0.0 2.5 4.7 0.1 0.2 0.1 0.0 43,847 1.3 1,079 Multan 95.6 1.7 0.0 0.1 2.2 0.0 0.4 0.0 0.0 27,788 2.6 500 Rawalpindi 89.9 7.2 0.0 1.2 1.5 0.0 0.1 0.4 0.0 21,767 2.4 1,186 Sahiwal 96.9 0.9 0.0 0.0 2.0 0.0 0.2 0.0 0.0 17,255 3.4 514 Sargodha 98.3 1.0 0.0 0.3 0.3 0.0 0.2 0.1 0.0 19,082 3.0 1,047 1 MICS indicator 4.2 - Water treatment na: not applicable a Total includes 80 unweighted cases of household head's education missing The amount of time it takes to fetch water is presented in Table WS.3 and the person who usually collects the water is included 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. The availability of water on premises is associated with greater use, better family hygiene and better health outcomes. Table WS.3 shows that for 83 percent of the household population, the drinking water source is on premises. 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 P a g e | 85 basic drinking water needs of the household.36 For 7 percent of the household population, it takes the household more than 30 minutes or more to get to the water source and bring water. In urban areas a higher percentage of household members live in households that spend this amount of time in collecting water compared to those in rural areas. 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, Punjab, 2014. Time to source of drinking water Number of household members Users of improved drinking water sources Users of unimproved drinking water sources Total Water on premises Less than 30 minutes 30 minutes or more Missing /DK Water on premises Less than 30 minutes 30 minutes or more Missing /DK Punjab 80.8 8.4 5.2 0.1 1.7 2.1 1.5 0.3 100.0 246,396 Area of residence Rural 84.3 7.9 4.8 0.1 0.5 1.2 1.1 0.1 100.0 165,174 All Urban 73.7 9.3 5.9 0.1 4.2 3.9 2.4 0.5 100.0 81,222 Major Cities 70.4 10.1 6.2 0.1 6.4 3.7 2.4 0.7 100.0 42,289 Other Urban 77.3 8.4 5.6 0.2 1.8 4.2 2.3 0.2 100.0 38,933 Education of household heada None/pre-school 83.9 7.4 5.1 0.1 1.0 1.3 1.2 0.1 100.0 99,632 Primary 82.1 7.5 5.1 0.1 1.8 1.8 1.4 0.3 100.0 43,176 Middle 79.3 9.0 5.4 0.1 1.6 2.3 2.0 0.2 100.0 31,941 Secondary 78.2 9.4 5.1 0.1 2.4 2.8 1.7 0.4 100.0 44,624 Higher 73.2 10.7 5.3 0.2 3.5 4.3 2.2 0.6 100.0 26,950 Wealth index quintile Lowest 84.3 7.0 6.3 0.1 0.1 0.5 1.8 0.0 100.0 49,280 Second 87.0 6.2 4.7 0.0 0.4 0.6 0.9 0.1 100.0 49,278 Middle 84.1 7.9 4.3 0.1 1.3 1.4 0.9 0.1 100.0 49,279 Fourth 77.0 9.4 5.0 0.2 2.5 3.2 2.2 0.4 100.0 49,281 Highest 71.5 11.3 5.5 0.1 4.3 4.7 1.9 0.6 100.0 49,278 Division Bahawalpur 81.5 6.1 7.5 0.0 0.2 2.1 2.4 0.2 100.0 25,956 D.G. Khan 88.6 2.5 5.0 0.1 0.4 1.2 2.2 0.1 100.0 23,418 Faisalabad 69.9 6.7 5.7 0.1 9.7 4.0 3.2 0.8 100.0 30,970 Gujranwala 77.8 14.9 2.2 0.0 0.2 4.0 0.7 0.1 100.0 36,313 Lahore 84.0 8.4 5.0 0.1 0.9 0.9 0.5 0.2 100.0 43,847 Multan 90.3 5.1 2.7 0.1 0.3 0.8 0.7 0.0 100.0 27,788 Rawalpindi 71.1 13.8 9.3 0.3 2.0 1.3 2.0 0.2 100.0 21,767 Sahiwal 84.8 7.5 4.6 0.0 0.1 1.8 1.1 0.0 100.0 17,255 Sargodha 79.9 8.1 6.5 0.0 0.5 2.2 1.9 0.9 100.0 19,082 a Total includes 80 unweighted cases of household head's education missing 36 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. P a g e | 86 Table WS.4 shows that for more than half of households (53%), an adult male usually collects drinking water when the source is not on the premises. Adult women collect water in 34 percent of cases, while for the rest of the households, female or male children under age 15 collect water (11%). In rural areas, an adult female usually collects drinking water (46%) in contrast to urban areas where mostly males (72%) collect the water. 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, Punjab, 2014. Percentage of households without drinking water on premises Number of households Person usually collecting drinking water Number of households without drinking water on premises Adult woman (age 15+ years) Adult man (age 15+ years) Female child (under 15) Male child (under 15) DK / Missing Total Punjab 17.8 38,405 33.7 53.2 3.5 7.5 2.2 100.0 6,831 Area of residence Rural 15.4 25,577 45.9 39.5 4.8 8.1 1.8 100.0 3,947 All Urban 22.5 12,828 16.9 72.0 1.8 6.6 2.7 100.0 2,884 Major Cities 23.7 6,717 16.8 72.1 1.8 6.2 3.1 100.0 1,595 Other Urban 21.1 6,111 17.1 71.9 1.8 7.0 2.2 100.0 1,289 Education of household heada None/pre-school 15.2 15,399 47.8 39.4 4.9 6.4 1.5 100.0 2,341 Primary 16.6 6,639 33.6 49.5 4.1 9.3 3.6 100.0 1,102 Middle 19.4 4,863 30.3 54.3 3.5 10.2 1.7 100.0 941 Secondary 19.9 7,022 26.0 62.0 2.5 7.7 1.9 100.0 1,398 Higher 23.4 4,472 15.2 75.2 1.4 5.3 2.9 100.0 1,045 Wealth index quintile Lowest 15.8 8,027 64.3 23.9 6.0 4.4 1.5 100.0 1,268 Second 12.9 7,721 49.6 34.3 4.1 9.2 2.8 100.0 996 Middle 15.1 7,508 34.0 49.8 3.9 10.9 1.4 100.0 1,133 Fourth 20.8 7,551 23.2 63.3 3.3 8.1 2.1 100.0 1,569 Highest 24.5 7,598 13.0 76.8 1.5 6.0 2.8 100.0 1,865 Division Bahawalpur 17.9 4,091 40.6 52.1 2.4 4.5 0.5 100.0 732 D.G. Khan 11.1 3,436 40.4 46.4 3.6 7.3 2.2 100.0 382 Faisalabad 20.9 4,889 22.6 66.9 1.6 7.3 1.7 100.0 1,019 Gujranwala 22.0 5,569 25.7 55.2 5.2 11.9 2.0 100.0 1,222 Lahore 15.6 6,631 16.6 67.1 3.9 8.4 4.1 100.0 1,036 Multan 9.8 4,633 33.1 56.8 3.1 4.7 2.3 100.0 453 Rawalpindi 27.1 3,633 52.3 35.6 3.9 5.7 2.4 100.0 983 Sahiwal 16.2 2,638 44.2 40.6 5.8 8.1 1.3 100.0 427 Sargodha 20.0 2,885 48.2 42.1 2.3 5.3 2.1 100.0 577 a Total includes 3 unweighted cases of household head's education missing Use of Improved Sanitation An improved sanitation facility is defined as one that hygienically separates human excreta from human contact. Improved sanitation facilities for excreta disposal include flush or pour flush to a piped sewer system, septic tank, or pit latrine; ventilated improved pit latrine, pit latrine with slab, and use of a composting toilet. The data on the use of improved sanitation facilities in Punjab are provided in Table WS.5. P a g e | 87 Seventy five percent of the population is living in households using improved sanitation facilities (Table WS.5), with a higher proportion in urban areas (92%) compared to rural areas (67%). Across divisions, use of improved sanitation facilities is most common in Lahore division (90%) and least common in Multan division (50%). The table indicates that use of improved sanitation facilities is strongly associated with wealth. Only 25 percent of the population living in the households in lowest quintile is using improved sanitation compared to 93 percent of the population living in the households in highest quintile. In Punjab, 18 percent of the population has no access to toilet facilities. In rural areas, the percentage of the population practicing open defecation is 25percent in contrast to only 1 percent of the population in urban areas. The population with no access to facilities is even higher among the population living in households in the lowest quintile (69%) and those in DG Khan division (41%). P a g e | 88 Table WS.5: Types of sanitation facilities Percent distribution of household population according to type of toilet facility used by the household, Punjab, 2014. Type of toilet facility used by household Open defecation (no facility, bush, field) Total Number of household members Improved sanitation facility Unimproved sanitation facility Flush/Pour flush to: Ventilated improved pit latrine Pit latrine with slab Compos- ting toilet Flush/ Pour flush to somewhere else Pit latrine without slab/ open pit Bucket Other DK/ Missing Piped sewer system Septic tank Pit latrine Unknown place/not sure/DK where Punjab 21.3 44.1 8.7 0.3 0.2 0.6 0.0 6.8 0.2 0.0 0.2 0.1 17.5 100.0 246,396 Area of residence Rural 4.1 49.1 12.2 0.3 0.3 0.8 0.0 7.2 0.3 0.0 0.3 0.0 25.4 100.0 165,174 All Urban 56.3 33.8 1.5 0.3 0.1 0.1 0.0 6.2 0.1 0.0 0.1 0.3 1.2 100.0 81,222 Major Cities 78.9 16.6 0.4 0.3 0.1 0.0 0.0 2.7 0.0 0.0 0.1 0.4 0.4 100.0 42,289 Other Urban 31.8 52.4 2.6 0.3 0.1 0.3 0.0 9.9 0.1 0.0 0.1 0.2 2.2 100.0 38,933 Education of household heada None/pre-school 13.1 38.1 9.4 0.3 0.3 0.7 0.0 7.5 0.3 0.1 0.3 0.1 29.8 100.0 99,632 Primary 18.8 46.8 9.4 0.4 0.2 0.6 0.0 8.0 0.2 0.0 0.1 0.2 15.2 100.0 43,176 Middle 22.3 48.5 10.3 0.2 0.2 0.5 0.0 6.5 0.1 0.0 0.3 0.1 11.0 100.0 31,941 Secondary 27.5 51.9 7.5 0.2 0.1 0.3 0.0 5.6 0.2 0.0 0.1 0.2 6.4 100.0 44,624 Higher 43.8 43.6 4.7 0.4 0.1 0.4 0.0 5.1 0.0 0.0 0.0 0.2 1.6 100.0 26,950 Wealth index quintile Lowest 0.6 12.2 10.1 0.3 0.4 1.0 0.0 4.9 0.5 0.1 0.4 0.1 69.4 100.0 49,280 Second 3.6 48.0 18.3 0.5 0.4 1.2 0.0 10.8 0.4 0.0 0.4 0.1 16.4 100.0 49,278 Middle 11.8 65.1 11.1 0.3 0.2 0.5 0.0 9.4 0.1 0.0 0.1 0.1 1.4 100.0 49,279 Fourth 30.2 58.9 3.4 0.3 0.0 0.1 0.0 6.7 0.0 0.0 0.0 0.2 0.1 100.0 49,281 Highest 60.3 36.2 0.6 0.2 0.0 0.0 0.0 2.4 0.0 0.0 0.0 0.3 0.0 100.0 49,278 Division Bahawalpur 18.2 11.9 27.4 0.5 0.3 1.5 0.0 10.6 0.5 0.0 0.4 0.0 28.7 100.0 25,956 D.G. Khan 2.6 45.2 5.5 0.4 0.3 2.6 0.1 1.5 1.0 0.1 0.2 0.0 40.6 100.0 23,418 Faisalabad 23.8 53.7 1.5 0.1 0.1 0.0 0.0 3.3 0.1 0.0 0.2 0.1 17.3 100.0 30,970 Gujranwala 8.8 80.4 0.1 0.0 0.0 0.0 0.0 1.7 0.0 0.0 0.3 0.1 8.4 100.0 36,313 Lahore 50.1 39.0 0.3 0.7 0.0 0.0 0.0 5.5 0.0 0.0 0.1 0.3 3.7 100.0 43,847 Multan 21.5 16.7 11.1 0.1 0.2 1.2 0.0 28.5 0.2 0.0 0.3 0.1 20.1 100.0 27,788 Rawalpindi 12.3 56.2 18.2 0.3 0.2 0.1 0.0 1.6 0.1 0.0 0.2 0.2 10.4 100.0 21,767 Sahiwal 22.5 39.6 8.8 0.7 0.0 0.1 0.0 7.8 0.1 0.0 0.0 0.0 20.5 100.0 17,255 Sargodha 10.6 43.5 19.7 0.1 1.0 0.1 0.0 0.5 0.1 0.0 0.0 0.1 24.3 100.0 19,082 a Total includes 80 unweighted cases of household head's education missing P a g e | 89 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, the term “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. Table WS.6 shows that 66 percent of the household population is using an improved sanitation facility which is not shared. Only 9 percent of households use an improved sanitation facility that is public or shared with other households. The population living in the households in the lowest quintile is less likely to use the improved sanitation that is not shared compared to the population residing in the households in the higher quintiles. Figure WS.2 presents the distribution of the survey population by use and sharing of sanitation facilities. Figure WS.2: Percent d istr ibut ion of household members by use and shar ing of sanitat ion fac i l i t ies , MICS Punjab , 2014 Improved sanitation facility - not shared 66% Improved sanitation facility - shared 9% Unimproved sanitation facility - not shared 6% Unimproved sanitation facility - shared 1% Open defacation 18% P a g e | 90 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, Punjab, 2014. Users of improved sanitation facilities Users of unimproved sanitation facilities Open defecation (no facility, bush, field) Total Number of household members Not shared1 Public facility Shared by Not shared Public facility Shared by 5 households or less More than 5 households 5 households or less More than 5 households Punjab 66.2 0.1 8.6 0.2 6.1 0.0 1.3 0.0 17.5 100.0 246,396 Area of residence Rural 57.4 0.0 9.1 0.3 6.3 0.0 1.4 0.0 25.4 100.0 165,174 All Urban 84.1 0.1 7.7 0.1 5.7 0.0 0.9 0.0 1.2 100.0 81,222 Major Cities 88.5 0.1 7.5 0.2 2.7 0.0 0.5 0.0 0.4 100.0 42,289 Other Urban 79.4 0.0 8.0 0.1 8.9 0.0 1.4 0.0 2.2 100.0 38,933 Education of household heada None/pre-school 52.9 0.0 8.8 0.2 6.8 0.0 1.4 0.0 29.8 100.0 99,632 Primary 65.9 0.1 10.0 0.3 7.0 0.0 1.4 0.0 15.2 100.0 43,176 Middle 71.9 0.1 10.0 0.1 5.5 0.0 1.4 0.0 11.0 100.0 31,941 Secondary 79.0 0.0 8.2 0.2 5.0 0.0 1.1 0.0 6.4 100.0 44,624 Higher 87.7 0.1 5.1 0.1 4.5 0.0 0.8 0.0 1.6 100.0 26,950 Wealth index quintile Lowest 16.7 0.1 7.4 0.5 4.3 0.0 1.6 0.0 69.4 100.0 49,280 Second 58.0 0.1 13.6 0.2 9.4 0.0 2.3 0.0 16.4 100.0 49,278 Middle 76.8 0.0 11.8 0.2 8.1 0.0 1.5 0.0 1.4 100.0 49,279 Fourth 84.5 0.0 8.1 0.1 6.2 0.0 0.8 0.0 0.1 100.0 49,281 Highest 95.0 0.1 2.2 0.0 2.5 0.0 0.2 0.0 0.0 100.0 49,278 Division Bahawalpur 54.0 0.1 5.5 0.2 10.5 0.0 0.9 0.0 28.7 100.0 25,956 D.G. Khan 44.9 0.1 10.7 0.9 1.8 0.0 0.9 0.1 40.6 100.0 23,418 Faisalabad 69.7 0.0 9.4 0.0 2.9 0.0 0.7 0.0 17.3 100.0 30,970 Gujranwala 80.6 0.1 8.6 0.1 1.8 0.0 0.4 0.0 8.4 100.0 36,313 Lahore 81.7 0.0 8.3 0.2 4.8 0.0 1.2 0.0 3.7 100.0 43,847 Multan 41.9 0.0 8.7 0.2 23.9 0.0 5.1 0.0 20.1 100.0 27,788 Rawalpindi 82.1 0.0 5.0 0.1 1.9 0.0 0.3 0.0 10.4 100.0 21,767 Sahiwal 61.8 0.0 9.8 0.1 6.4 0.0 1.5 0.0 20.5 100.0 17,255 Sargodha 61.4 0.1 13.1 0.4 0.4 0.0 0.2 0.0 24.3 100.0 19,082 1 MICS indicator 4.3; MDG indicator 7.9 - Use of improved sanitation a Total includes 80 unweighted cases of household head's education missing P a g e | 91 Having access to both an improved drinking water source and an improved sanitation facility brings the largest public health benefits to a household.37 In its 2008 report38, 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 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 these drinking water and sanitation ladders. The table also shows the percentage of household members using both improved sources of drinking water39 and an improved sanitary means of excreta disposal. Overall, 62 percent of the population is using both improved drinking water and improved sanitation. At divisional level, access to an improved drinking water source and improved sanitation facility is highest in Lahore (80%) followed by Rawalpindi (78%) and lowest in Multan division (41%). The population in urban areas is more likely to use improved drinking water sources and improved sanitation than in rural areas (74% and 55% respectively). There are also notable differences across wealth quintiles ranging from 17 percent of population living in the households in the lowest quintile to 84 percent of population living in the households in the highest quintile. The results are presented by area of residence and wealth quintiles in Figure WS.3. 37 Wolf, J et al. 2014. Systematic review: Assessing the impact of drinking water and sanitation on diarrhoeal disease in low- and middle-income settings: systematic review and meta-regression. Tropical Medicine and International Health 2014. DfID. 2013. Water, Sanitation and Hygiene: Evidence Paper. DfID: http://r4d.dfid.gov.uk/pdf/outputs/sanitation/WASH-evidence-paper-april2013.pdf 38 WHO/UNICEF JMP. 2008. MDG assessment report. http://www.wssinfo.org/fileadmin/user_upload/resources/1251794333-JMP_08_en.pdf 39 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. P a g e | 92 Figure WS.3: Use of improved dr inking water sour ces and improved san itat ion fac i l i t ies by household members , MICS Punjab , 2014 16 57 74 77 84 55 74 62 0 20 40 60 80 100 Lowest Second Middle Fourth Highest Rural Urban Punjab P er ce n t P a g e | 93 Table WS.7: Drinking water and sanitation ladders Percentage of household population by drinking water and sanitation ladders, Punjab, 2014. Percentage of household population using: Number of household members Improved drinking water1 Unimproved drinking water Total Improved sanitation2 Unimproved sanitation Total Improved drinking water sources and improved sanitation Piped into dwelling, plot or yard Other improved Shared improved facilities Unimproved facilities Open defecation Punjab 13.8 80.6 5.6 100.0 66.2 8.9 7.4 17.5 100.0 61.6 246,396 Area of residence Rural 6.3 90.7 3.0 100.0 57.4 9.4 7.8 25.4 100.0 55.4 165,174 All Urban 28.9 60.1 11.0 100.0 84.1 8.0 6.6 1.2 100.0 74.3 81,222 Major Cities 41.7 45.1 13.2 100.0 88.5 7.9 3.2 0.4 100.0 76.5 42,289 Other Urban 15.1 76.3 8.5 100.0 79.4 8.1 10.3 2.2 100.0 71.8 38,933 Education of household head b None/pre-school 9.6 86.9 3.5 100.0 52.9 9.1 8.2 29.8 100.0 50.6 99,632 Primary 13.1 81.6 5.3 100.0 65.9 10.4 8.5 15.2 100.0 61.8 43,176 Middle 16.2 77.6 6.1 100.0 71.9 10.2 6.9 11.0 100.0 66.8 31,941 Secondary 16.6 76.2 7.2 100.0 79.0 8.5 6.0 6.4 100.0 72.6 44,624 Higher 22.5 67.0 10.6 100.0 87.7 5.4 5.3 1.6 100.0 77.8 26,950 Wealth index quintile Lowest 2.4 95.3 2.4 100.0 16.7 8.0 5.9 69.4 100.0 16.5 49,280 Second 7.2 90.8 2.0 100.0 58.0 13.9 11.7 16.4 100.0 56.7 49,278 Middle 11.6 84.7 3.7 100.0 76.8 12.1 9.7 1.4 100.0 73.7 49,279 Fourth 17.3 74.3 8.4 100.0 84.5 8.4 7.0 0.1 100.0 77.3 49,281 Highest 30.3 58.1 11.6 100.0 95.0 2.3 2.7 0.0 100.0 83.9 49,278 Division Bahawalpur 13.9 81.2 4.9 100.0 54.0 5.8 11.5 28.7 100.0 50.2 25,956 D.G. Khan 1.9 94.2 3.9 100.0 44.9 11.7 2.8 40.6 100.0 42.9 23,418 Faisalabad 9.8 72.6 17.7 100.0 69.7 9.5 3.6 17.3 100.0 53.7 30,970 Gujranwala 6.0 88.9 5.1 100.0 80.6 8.7 2.2 8.4 100.0 75.8 36,313 Lahore 35.9 61.7 2.5 100.0 81.7 8.5 6.0 3.7 100.0 79.9 43,847 Multan 7.6 90.6 1.8 100.0 41.9 9.0 29.0 20.1 100.0 40.8 27,788 Rawalpindi 19.0 75.6 5.4 100.0 82.1 5.2 2.2 10.4 100.0 78.2 21,767 Sahiwal 7.5 89.6 3.0 100.0 61.8 9.9 7.9 20.5 100.0 59.3 17,255 Sargodha 7.3 87.2 5.5 100.0 61.4 13.6 0.6 24.3 100.0 57.4 19,082 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. b Total includes 80 unweighted cases of household head's education missing P a g e | 94 Safe disposal of a child’s faeces is disposing of the stool, by the child using a toilet or by rinsing it into a toilet or latrine. Putting disposable diapers with solid waste, a very common practice throughout the world has thus far been classified as an inadequate means of disposal of child faeces for concerns about poor disposal of solid waste itself. This classification is currently under review. Disposal of faeces of children 0-2 years of age is presented in Table WS.8. The stools of 71 percent of the children age 0-2 years were disposed of safely. The most commonly method of children’s stool disposal is putting or rinsing into toilet or latrine (65%). For 17 percent of children, stool was thrown into garbage and 6 percent of children used toilet or latrine. Safe disposal of child’s faeces is much more common in urban (89%) compared to rural areas (64%). Mothers with higher education are more likely to dispose of the stool safely (87%) compared to those having only pre-school or no education (55%). Table WS.8: Disposal of child's faeces Percent distribution of children age 0-2 years according to place of disposal of child's faeces, and the percentage of children age 0-2 years whose stools were disposed of safely the last time the child passed stools, Punjab, 2014. Place of disposal of child's faeces Percentage of children whose last stools were disposed of safely1 Number of children age 0-2 years Child used toilet/ latrine Put/ rinsed into toilet or latrine Put/ rinsed into drain or ditch Thrown into garbage (solid waste) Buried Left in the open Other DK / Missing Total Punjab 6.1 65.3 6.4 16.8 1.2 3.2 0.4 0.7 100.0 71.4 16,028 Area of residence Rural 5.0 58.8 7.6 21.3 1.6 4.6 0.5 0.7 100.0 63.8 11,097 All Urban 8.5 80.0 3.6 6.6 0.1 0.2 0.2 0.8 100.0 88.5 4,931 Major Cities 8.5 79.7 4.0 7.2 0.1 0.0 0.1 0.5 100.0 88.1 2,537 Other Urban 8.5 80.3 3.3 6.0 0.2 0.3 0.3 1.1 100.0 88.8 2,394 Type of sanitation facility used by household members Improved 7.5 78.2 3.9 8.5 0.3 0.8 0.2 0.6 100.0 85.7 11,827 Unimproved 6.4 75.4 5.4 8.9 0.5 2.3 0.2 0.9 100.0 81.8 1,182 Open defecation 0.4 10.8 16.3 52.4 4.8 13.1 1.3 0.9 100.0 11.2 3,019 Mother’s education None/pre-school 4.1 51.1 9.0 26.2 2.3 5.9 0.5 0.8 100.0 55.2 7,294 Primary 6.5 73.4 4.7 12.0 0.5 2.0 0.2 0.7 100.0 79.9 2,968 Middle 7.0 79.3 3.8 8.0 0.0 0.6 0.4 0.8 100.0 86.3 1,661 Secondary 9.1 79.8 2.9 6.8 0.2 0.5 0.2 0.5 100.0 88.9 2,182 Higher 8.7 78.1 4.9 7.4 0.1 0.0 0.2 0.5 100.0 86.8 1,923 Wealth index quintile Lowest 1.1 22.9 13.6 45.5 4.0 11.1 0.8 0.9 100.0 24.0 3,486 Second 5.1 64.6 7.3 17.3 1.2 3.3 0.4 0.7 100.0 69.8 3,254 Middle 7.1 82.0 3.4 5.9 0.2 0.5 0.1 0.7 100.0 89.1 3,228 Fourth 8.7 83.8 3.0 3.3 0.0 0.1 0.3 0.6 100.0 92.5 3,163 Highest 9.2 78.2 3.5 8.5 0.0 0.0 0.1 0.5 100.0 87.4 2,898 Division Bahawalpur 7.8 50.6 7.2 21.5 5.6 6.4 0.0 0.9 100.0 58.4 1,687 D.G. Khan 3.5 36.3 13.8 33.0 1.4 10.5 0.1 1.3 100.0 39.8 1,767 Faisalabad 4.4 75.4 2.4 15.3 0.5 1.2 0.4 0.3 100.0 79.8 1,928 Gujranwala 8.1 78.7 3.3 7.8 0.1 1.0 0.2 0.8 100.0 86.8 2,417 Lahore 9.1 80.2 2.5 6.2 0.3 1.2 0.1 0.4 100.0 89.4 2,746 Multan 3.5 65.5 6.8 19.1 0.4 3.3 0.1 1.2 100.0 69.0 1,777 Rawalpindi 10.3 48.9 14.2 20.0 0.8 2.6 2.6 0.6 100.0 59.3 1,274 Sahiwal 2.7 72.4 7.6 14.1 0.7 1.8 0.3 0.4 100.0 75.1 1,224 Sargodha 1.9 61.1 5.4 26.8 1.7 2.3 0.3 0.5 100.0 63.0 1,208 1 MICS indicator 4.4 - Safe disposal of child’s faeces P a g e | 95 Handwashing Handwashing with water and soap is the most cost effective health intervention to reduce both the incidence of diarrhoea and pneumonia in children under five40. It is most effective when done using water and soap after visiting a toilet or cleaning a child, before eating or handling food and, before feeding a child. Monitoring correct handwashing behaviour at these critical times is challenging. A reliable alternative to observations or self-reported behaviour is assessing the likelihood that correct handwashing behaviour takes place by asking if a household has a specific place where people wash their hands and, if yes, observing whether water and soap (or other local cleansing materials) are available at this place41. In Punjab, a specific place for handwashing is observed in 98 percent of the households while only less than 1 percent of households could not indicate a specific place where household members usually wash their hands (Table WS.9). Among households where a place for handwashing is observed, 80 percent had both water and soap (or another cleansing agent) present at the specific place. In 17 percent of the households, only water is available at the specific place, while in less than 1 percent of the households, the place has soap but no water. The remaining 2 percent of households have neither water nor soap available at the specific place for handwashing. Among divisions, 92 percent of households in Lahore have water and soap available at a place for handwashing compared to 57 percent of households in D.G Khan. There are also notable differences by wealth quintile. Percentage of households in the highest wealth quintile having water and soap available at a place for handwashing is more than twice as high compared to households in the lowest wealth quintile (98% and 45% respectively). Results presented in Table WS.10 show that 2 percent of the households were not able or refused to show any soap present in the household, whereas another 5 percent did not have any soap in the households, leaving the remaining 93 percent of households, in which either the soap was observed or shown to the interviewer. 40 Cairncross, S and Valdmanis, V. 2006. Water supply, sanitation and hygiene promotion Chapter 41 in Disease Control Priorities in Developing Countries. 2nd Edition, Edt. Jameson et al. The World Bank. 41 Ram, P et al. editors. 2008. Use of a novel method to detect reactivity to structured observation for measurement of handwashing behavior. American Society of Tropical Medicine and Hygiene. P a g e | 96 Table WS.9: Water and soap at place for handwashing Percentage of households where place for handwashing was observed, percentage with no specific place for handwashing, and percent distribution of households by availability of water and soap at specific place for handwashing, Punjab, 2014. Percentage of households: Number of households Place for handwashing observed No specific place for handwashing in the dwelling, yard, or plot Total Percentage of households with a specific place for handwashing where water and soap or other cleansing agent are present1 Number of households where place for handwashing was observed or with no specific place for handwashing Where place for handwashing was observed With no specific place for handwashing in the dwelling, yard, or plot Water is available and: Water is not available and: Soap present No soap: Soap present No soap: Ash, mud, or sand present No other cleansing agent present Ash, mud, or sand present No other cleansing agent present Punjab 97.9 0.5 38,405 78.3 1.3 16.9 0.6 0.0 2.4 0.5 100.0 79.6 37,790 Area of residence Rural 98.4 0.7 25,577 71.2 1.9 22.3 0.6 0.1 3.2 0.7 100.0 73.1 25,365 All Urban 96.8 0.1 12,828 92.8 0.1 5.7 0.6 0.0 0.7 0.1 100.0 92.9 12,425 Major Cities 95.1 0.2 6,717 95.3 0.0 3.5 0.6 0.0 0.3 0.2 100.0 95.4 6,397 Other Urban 98.6 0.0 6,111 90.1 0.2 8.1 0.5 0.0 1.0 0.0 100.0 90.3 6,028 Education of household heada None/pre-school 98.2 0.9 15,399 67.1 2.3 25.1 0.8 0.1 3.7 0.9 100.0 69.5 15,256 Primary 98.2 0.5 6,639 78.7 1.1 16.7 0.5 0.0 2.4 0.5 100.0 79.9 6,554 Middle 98.0 0.3 4,863 83.1 0.6 13.3 0.6 0.0 2.0 0.3 100.0 83.8 4,778 Secondary 97.7 0.1 7,022 89.2 0.4 9.0 0.6 0.0 0.8 0.1 100.0 89.5 6,866 Higher 96.6 0.2 4,472 94.2 0.2 4.8 0.3 0.0 0.3 0.2 100.0 94.3 4,327 Wealth index quintile Lowest 97.1 2.0 8,027 40.1 5.0 44.6 0.7 0.2 7.3 2.1 100.0 45.1 7,960 Second 99.2 0.2 7,721 73.7 1.1 21.3 1.0 0.0 2.7 0.2 100.0 74.8 7,675 Middle 99.2 0.1 7,508 89.2 0.1 9.2 0.6 0.0 0.9 0.1 100.0 89.3 7,451 Fourth 97.8 0.1 7,551 93.4 0.1 5.7 0.5 0.0 0.3 0.1 100.0 93.4 7,394 Highest 96.1 0.1 7,598 98.2 0.0 1.2 0.4 0.0 0.1 0.1 100.0 98.2 7,310 Division Bahawalpur 99.0 0.7 4,091 62.1 1.7 31.6 0.3 0.1 3.5 0.8 100.0 63.8 4,081 D.G. Khan 99.2 0.3 3,436 51.4 5.9 36.1 0.6 0.2 5.5 0.3 100.0 57.3 3,418 Faisalabad 98.9 0.5 4,889 83.8 1.6 12.3 0.3 0.0 1.5 0.5 100.0 85.5 4,861 Gujranwala 98.2 0.1 5,569 90.3 0.1 8.4 0.4 0.0 0.6 0.1 100.0 90.5 5,475 Lahore 97.0 0.4 6,631 91.2 0.3 6.5 0.9 0.0 0.8 0.4 100.0 91.4 6,458 Multan 98.3 0.8 4,633 72.1 1.4 22.9 0.3 0.1 2.4 0.8 100.0 73.5 4,591 Rawalpindi 93.6 0.4 3,633 86.8 0.0 6.7 1.6 0.0 4.4 0.4 100.0 86.8 3,414 Sahiwal 98.7 1.0 2,638 82.3 2.1 8.8 1.0 0.1 4.7 1.0 100.0 84.4 2,632 Sargodha 98.2 1.0 2,885 67.9 0.0 30.3 0.2 0.0 0.6 1.0 100.0 68.0 2,863 1 MICS indicator 4.5 - Place for handwashing a Total includes 11 unweighted cases of household head's education missing P a g e | 97 Table WS.10: Availability of soap or other cleansing agent Percent distribution of households by availability of soap or other cleansing agent in the dwelling, Punjab, 2014. Place for handwashing observed Place for handwashing not observed Total Percentage of households with soap or other cleansing agent anywhere in the dwelling1 Number of households Soap or other cleansing agent observed Soap or other cleansing agent not observed at place for handwashing Soap or other cleansing agent shown No soap or other cleansing agent in household Not able/Does not want to show soap or other cleansing agent Soap or other cleansing agent shown No soap or other cleansing agent in household Not able/Does not want to show soap or other cleansing agent Missing Punjab 78.9 13.2 4.3 1.2 0.2 0.6 0.4 1.1 100.0 92.8 38,405 Area of residence Rural 73.1 17.6 5.9 1.6 0.2 0.8 0.3 0.5 100.0 91.5 25,577 All Urban 90.6 4.4 1.2 0.5 0.1 0.4 0.4 2.4 100.0 95.3 12,828 Major Cities 91.4 2.5 0.8 0.3 0.1 0.6 0.6 3.7 100.0 94.5 6,717 Other Urban 89.6 6.4 1.7 0.8 0.1 0.2 0.2 1.0 100.0 96.2 6,111 Education of household heada None/pre-school 69.7 19.1 7.4 1.8 0.2 0.8 0.4 0.6 100.0 89.5 15,399 Primary 79.4 13.5 4.0 1.1 0.2 0.7 0.3 0.7 100.0 93.6 6,639 Middle 82.9 11.3 2.5 1.0 0.3 0.5 0.4 1.1 100.0 94.7 4,863 Secondary 88.1 7.1 1.6 0.7 0.2 0.4 0.2 1.7 100.0 95.6 7,022 Higher 91.6 4.0 0.5 0.4 0.0 0.4 0.3 2.6 100.0 96.0 4,472 Wealth index quintile Lowest 45.6 33.9 14.3 3.0 0.3 1.7 0.8 0.3 100.0 81.2 8,027 Second 75.3 17.6 4.6 1.5 0.2 0.4 0.1 0.2 100.0 93.3 7,721 Middle 89.2 7.6 1.3 0.8 0.2 0.2 0.1 0.5 100.0 97.0 7,508 Fourth 91.9 4.5 0.7 0.6 0.1 0.3 0.4 1.4 100.0 96.8 7,551 Highest 94.8 1.0 0.1 0.1 0.0 0.5 0.3 3.2 100.0 96.2 7,598 Division Bahawalpur 64.0 24.4 8.1 2.3 0.1 0.6 0.2 0.2 100.0 89.1 4,091 D.G. Khan 57.8 30.0 9.8 1.5 0.1 0.5 0.2 0.1 100.0 88.2 3,436 Faisalabad 85.3 8.5 3.8 1.3 0.1 0.4 0.3 0.3 100.0 94.2 4,889 Gujranwala 89.3 5.8 1.7 1.2 0.2 0.2 0.2 1.4 100.0 95.3 5,569 Lahore 89.9 4.1 1.9 1.0 0.1 0.5 0.6 1.8 100.0 94.5 6,631 Multan 73.2 18.0 5.8 1.1 0.2 1.0 0.3 0.5 100.0 92.1 4,633 Rawalpindi 83.1 7.2 1.9 1.0 0.3 1.2 0.6 4.6 100.0 91.5 3,633 Sahiwal 85.2 7.3 5.8 0.3 0.1 0.8 0.3 0.3 100.0 93.3 2,638 Sargodha 67.6 25.5 3.6 1.3 0.3 1.1 0.4 0.3 100.0 94.2 2,885 1 MICS indicator 4.6 - Availability of soap or other cleansing agent a Total includes 11 unweighted cases of household head's education missing P a g e | 98 VIII. REPRODUCTIVE HEALTH Fertility Questions regarding fertility were asked from ever married women only. Therefore, data in all the tables in this chapter pertain to this category of selected women. Measures of current fertility are presented in Table RH.1. In MICS, age specific and total fertility rates are calculated by using information on the date of last birth of each woman and are based on the one- year period (1-12 months) preceding the survey. Rates are underestimated by a very small margin due to absence of information on multiple births (twins, triplets, etc.) and on women who may have had multiple deliveries during the one year period preceding the survey. 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 49. 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 one-year period preceding the survey, by area, Punjab, 2014. Rural Urban Total Age 15-191 37 27 34 20-24 152 146 150 25-29 236 201 223 30-34 173 148 164 35-39 103 57 86 40-44 32 17 27 45-49 11 5 9 TFRa 3.7 3.0 3.5 GFRb 116.5 97.8 110.0 CBRc 28.2 25.7 27.4 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 Punjab at the provincial level and by area. The TFR for the one year preceding the MICS Punjab, 2014 is 3.5 births per woman. It is slightly higher in rural areas (3.7) than in urban (3.0). The data in the table show that age specific fertility rates (ASFRs) are higher for all age groups in rural areas compared to urban areas. The urban-rural difference in fertility is most pronounced for women in the 35-39 age group; 57 births per 1,000 women in urban versus 103 births per 1,000 in rural areas. The overall age pattern of fertility, as reflected in the ASFRs, indicates that childbearing begins early. Fertility among young women rapidly increases from 34 births per 1,000 for women age 15-19 to a peak of 223 births per 1,000 among women age 25-29, and declines thereafter (Figure RH.1). P a g e | 99 Figure RH.1: Age -speci f ic fert i l i t y rat es by area , MICS Punjab, 2014 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 one 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. 0 50 100 150 200 250 1 5 - 1 9 2 0 - 2 4 2 5 - 2 9 3 0 - 3 4 3 5 - 3 9 4 0 - 4 4 4 5 - 4 9 P ER 1 ,0 0 0 AGE Urban Rural Total P a g e | 100 Table RH.2: Adolescent birth rate and total fertility rate Adolescent birth rates and total fertility rates for the one-year period preceding the survey, Punjab, 2014. Adolescent birth rate1 (Age-specific fertility rate for women age 15-19) Total fertility rate Punjab 34 3.5 Area of residence Rural 37 3.7 All Urban 27 3.0 Major Cities 29 3.0 Other Urban 25 3.1 Women's Education None/pre-school 74 4.2 Primary 45 3.6 Middle 30 3.4 Secondary 18 3.0 Higher 4 2.7 Wealth index quintile Lowest 50 4.5 Second 42 3.8 Middle 30 3.4 Fourth 32 3.1 Highest 17 2.7 Division Bahawalpur 29 3.5 D.G. Khan 52 4.8 Faisalabad 32 3.4 Gujranwala 26 3.3 Lahore 31 3.5 Multan 38 3.4 Rawalpindi 23 2.9 Sahiwal 37 3.8 Sargodha 51 3.1 1 MICS indicator 5.1; MDG indicator 5.4 - Adolescent birth rate Total fertility rate (TFR) is highest (4.2) among women having only pre-school or no education and gradually declines as the woman’s education increases. Similar pattern is observed across wealth quintiles. At division level, total fertility rate ranges from 2.9 in Rawalpindi to 4.8 in DG Khan. Table RH.3 presents some early childbearing42 indicators for women age 15-19 and 20-24 while Table RH.4 presents the trends for early childbearing. As shown in Table RH.3, 38 percent of women age 15-19 have already had a birth, 21 percent are pregnant with their first child, and 3 percent have had a live birth before age 15. The table also indicates that 12 percent of women age 20-24 have had a live birth before age 18. At divisional level, early childbearing among women age 20-24 ranges from 7 percent in Gujranwala to 17 percent in D.G Khan. Education of woman and household wealth are negatively correlated with early childbearing. For example, early childbearing is highest (19%) among women with only pre-school or no education and declines to only 3 percent for women having higher education. 42 Childbearing is the process of giving birth to children. While early childbearing is defined as having had live births before specific young ages, for the purposes of Table RH.3, women age 15-19 years who have begun childbearing includes those who have had a live birth as well as those who have not had a live birth but are pregnant with their first child. P a g e | 101 Table RH.3: Early childbearing Percentage of ever married 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, Punjab, 2014. Percentage of women age 15-19 years who: Number of ever married women age 15-19 Percentage of women age 20-24 who have had a live birth before age 181 Number of ever married 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 Punjab 38.0 20.8 58.8 3.2 1,066 11.8 4,078 Area of residence Rural 39.7 19.8 59.5 3.8 819 12.4 2,816 All Urban 32.6 24.0 56.5 1.4 248 10.2 1,262 Major Cities 30.9 26.0 56.9 1.2 117 9.7 645 Other Urban 34.1 22.2 56.2 1.6 131 10.7 617 Women’s educationa None/pre-school 40.6 17.2 57.9 5.6 441 19.3 1,588 Primary 34.3 25.3 59.6 2.3 278 9.7 880 Middle 42.1 20.3 62.5 2.0 169 8.5 486 Secondary 40.1 21.2 61.3 0.0 135 5.2 658 Higher (13.8) (29.2) (43.0) (0.0) 41 2.7 464 Wealth index quintile Lowest 38.8 20.3 59.1 6.1 291 18.8 753 Second 41.7 19.6 61.3 3.4 287 14.9 900 Middle 33.2 19.9 53.0 2.7 218 10.5 849 Fourth 38.9 19.3 58.2 0.6 168 8.6 841 Highest 34.5 29.8 64.3 0.0 102 5.8 734 Division Bahawalpur 30.9 20.7 51.6 3.3 134 13.6 379 D.G. Khan 40.5 22.0 62.5 7.0 140 16.9 421 Faisalabad 31.2 19.6 50.8 0.8 124 11.1 480 Gujranwala 47.0 22.8 69.8 3.0 119 6.6 583 Lahore 37.8 17.5 55.3 3.6 154 11.9 763 Multan 40.3 23.6 63.9 2.8 130 15.6 448 Rawalpindi 32.0 19.7 51.6 1.6 74 8.2 360 Sahiwal 38.0 22.9 60.8 3.1 86 8.9 312 Sargodha 43.7 18.5 62.2 2.5 103 14.2 332 1 MICS indicator 5.2 - Early childbearing ( ) Figures that are based on 25-49 unweighted cases a Total includes 5 unweighted cases of women's education missing Table RH.4 displays the data of early childbearing with respect to the age groups of the ever married women. The table reveals that 2 percent of the women have a live birth before age 15 years, and 11 percent before age 18. P a g e | 102 Table RH.4: Trends in early childbearing Percentage of ever married women who have had a live birth, by age 15 and 18, by area and age group, Punjab, 2014. Rural Urban All P e rc e n ta g e o f e v e r m a rr ie d w o m e n w it h a l iv e b ir th b e fo re a g e 1 5 N u m b e r o f e v e r m a rr ie d w o m e n a g e 1 5 -4 9 y e a rs P e rc e n ta g e o f e v e r m a rr ie d w o m e n w it h a l iv e b ir th b e fo re a g e 1 8 N u m b e r o f e v e r m a rr ie d w o m e n a g e 2 0 -4 9 y e a rs P e rc e n ta g e o f e v e r m a rr ie d w o m e n w it h a l iv e b ir th b e fo re a g e 1 5 N u m b e r o f e v e r m a rr ie d w o m e n a g e 1 5 -4 9 y e a rs P e rc e n ta g e o f e v e r m a rr ie d w o m e n w it h a l iv e b ir th b e fo re a g e 1 8 N u m b e r o f e v e r m a rr ie d w o m e n a g e 2 0 -4 9 y e a rs P e rc e n ta g e o f e v e r m a rr ie d w o m e n w it h a l iv e b ir th b e fo re a g e 1 5 N u m b e r o f e v e r m a rr ie d w o m e n a g e 1 5 -4 9 y e a rs P e rc e n ta g e o f e v e r m a rr ie d w o m e n w it h a l iv e b ir th b e fo re a g e 1 8 N u m b e r o f e v e r m a rr ie d w o m e n a g e 2 0 -4 9 y e a rs Punjab 2.4 23,061 12.0 22,242 1.8 11,794 10.2 11,547 2.2 34,855 11.4 33,789 Age 15-19 3.8 819 na na 1.4 248 na na 3.2 1,066 na na 20-24 1.8 2,816 12.4 2,816 1.3 1,262 10.2 1,262 1.7 4,078 11.8 4,078 25-29 1.6 4,711 9.6 4,711 1.4 2,314 8.0 2,314 1.5 7,025 9.1 7,025 30-34 1.9 4,676 11.0 4,676 1.5 2,415 10.0 2,415 1.7 7,091 10.6 7,091 35-39 2.9 3,851 13.1 3,851 2.5 2,243 10.8 2,243 2.8 6,094 12.2 6,094 40-44 2.7 3,229 13.4 3,229 2.2 1,782 10.4 1,782 2.5 5,011 12.3 5,011 45-49 3.6 2,960 14.4 2,960 2.1 1,531 12.4 1,531 3.1 4,491 13.7 4,491 na: not applicable P a g e | 103 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. Current use of contraception is reported by 39 percent of currently married women43. (Table RH.5). Out of the women using contraception, 31 percent are using a modern method and 8 percent are using a traditional method. The most popular modern method is the male condom (11%). The next most popular method is female sterilization, which is reported by 10 percent of married women. As regards to other modern methods of contraception, about 3 percent of married women reported using IUD and injectables each, whereas, 2 percent of the women use pills. The results further show that 8 percent of married women are using a traditional method. Contraceptive prevalence ranges from 25 percent in D.G Khan division to 47 percent in Gujranwala division. About 45 percent of married women in urban areas and 35 percent in rural areas use a method of contraception. The findings by division and area of residence are depicted in Figure RH.2. Adolescents are far less likely to use contraception than older women; 9 percent of married women age 15-19 currently use a method of contraception compared to 19 percent of 20-24 year olds, while among older women contraceptive use ranges from 30 percent to 51 percent. Figure RH.2: Di f ferent ia ls in contracept ive use , MICS Punjab, 2014 43 All references to “married women” in this chapter include women who are married. 29 25 36 47 46 39 44 38 33 45 35 36 41 42 41 43 39 Divisions Bahawalpur D.G.Khan Faisalabad Gujranwala Lahore Multan Rawalpindi Sahiwal Sargodha Area Urban Rural Woman's Education None/pre-school Primary Middle Secondary Higher Punjab Percent P a g e | 104 Table RH.5: Use of contraception Percentage of women age 15-49 years currently married who are using (or whose husband is using) a contraceptive method, Punjab, 2014. Percent of women currently married who are using (or whose husband is using): Number of women age 15- 49 years currently married N o m e th o d F e m a le s te ri li- z a ti o n M a le s te ri li- z a ti o n IU D In je c ta b le s Im p la n ts P ill M a le c o n d o m F e m a le c o n d o m D ia p h ra g m P e ri o d ic a b s ti n e n c e W it h d ra w a l O th e r M is s in g Any modern method Any tradi- tional method Any method1 Punjab 61.3 10.4 0.1 3.4 3.4 0.1 1.9 10.6 0.1 0.7 2.3 5.5 0.1 0.0 30.8 7.9 38.7 33,047 Area of residence Rural 64.6 10.2 0.1 3.5 4.0 0.1 1.9 8.2 0.1 0.7 2.0 4.5 0.2 0.0 28.7 6.7 35.4 21,859 All Urban 54.9 10.9 0.1 3.3 2.4 0.2 2.0 15.2 0.2 0.6 2.8 7.4 0.1 0.0 34.8 10.3 45.1 11,188 Major Cities 53.3 11.4 0.0 3.2 2.7 0.2 1.8 16.0 0.1 0.5 2.7 8.0 0.0 0.0 36.0 10.8 46.7 5,978 Other Urban 56.7 10.3 0.2 3.4 2.2 0.1 2.1 14.3 0.2 0.8 2.9 6.8 0.1 0.0 33.5 9.8 43.3 5,210 Age 15-19 91.1 0.0 0.0 0.3 2.0 0.0 0.8 3.4 0.0 0.0 0.3 1.9 0.1 0.0 6.6 2.3 8.9 1,021 20-24 80.8 0.3 0.0 1.7 2.5 0.0 1.0 8.7 0.1 0.0 1.5 3.2 0.1 0.0 14.4 4.9 19.2 3,963 25-29 69.7 2.8 0.1 3.0 3.3 0.1 1.8 12.2 0.2 0.3 1.7 4.9 0.1 0.0 23.6 6.6 30.3 6,833 30-34 56.3 9.0 0.1 4.1 4.9 0.2 2.7 13.6 0.2 0.5 2.6 5.5 0.2 0.0 35.5 8.2 43.7 6,837 35-39 48.9 15.1 0.2 4.9 4.1 0.1 2.5 13.0 0.1 0.8 3.1 7.0 0.1 0.1 40.9 10.2 51.1 5,807 40-44 49.8 20.7 0.1 4.1 3.5 0.1 2.0 8.9 0.2 1.2 2.3 6.9 0.2 0.0 40.8 9.4 50.2 4,637 45-49 59.8 19.8 0.1 2.4 1.4 0.0 1.1 4.9 0.0 1.4 2.9 6.0 0.0 0.0 31.2 9.0 40.2 3,948 Number of living children 0 99.1 0.1 0.0 0.0 0.1 0.0 0.1 0.2 0.1 0.0 0.0 0.1 0.0 0.0 0.6 0.2 0.9 3,988 1 81.1 0.9 0.0 0.6 1.3 0.0 1.0 8.9 0.1 0.1 1.6 4.3 0.1 0.0 13.0 6.0 18.9 4,326 2 65.3 2.6 0.0 3.0 3.2 0.2 2.2 15.0 0.2 0.3 2.5 5.6 0.0 0.0 26.6 8.1 34.7 5,294 3 53.1 9.6 0.1 4.6 4.7 0.1 2.2 15.2 0.2 0.8 2.4 7.1 0.1 0.0 37.3 9.6 46.9 5,719 4+ 45.9 19.8 0.2 5.0 4.7 0.1 2.5 10.5 0.2 1.1 3.0 6.8 0.2 0.0 44.1 10.0 54.1 13,720 Women’s educationa None/pre-school 64.3 12.3 0.1 3.4 3.7 0.1 1.9 6.5 0.1 0.7 2.2 4.4 0.1 0.0 28.9 6.8 35.7 16,331 Primary 59.0 10.4 0.1 3.6 4.1 0.2 1.8 11.2 0.1 0.8 2.6 5.9 0.1 0.0 32.4 8.6 41.0 5,902 Middle 58.2 9.1 0.1 2.7 3.3 0.0 2.2 13.6 0.2 0.4 2.7 7.3 0.1 0.1 31.6 10.1 41.8 3,051 Secondary 58.6 7.8 0.0 3.4 2.4 0.2 1.4 15.9 0.3 0.5 2.2 7.1 0.2 0.0 32.0 9.5 41.4 4,109 Higher 57.2 6.0 0.0 3.6 2.5 0.1 2.4 19.5 0.2 0.3 1.8 6.4 0.1 0.0 34.5 8.4 42.8 3,640 Wealth index quintile Lowest 71.9 9.6 0.1 3.6 4.3 0.0 1.9 3.8 0.0 0.6 1.5 2.5 0.1 0.0 24.0 4.1 28.1 6,317 Second 63.7 10.4 0.1 3.6 4.0 0.1 2.5 7.7 0.1 0.8 2.1 4.6 0.1 0.0 29.4 6.9 36.3 6,439 Middle 58.7 11.4 0.1 3.6 3.7 0.1 1.6 11.3 0.2 0.9 2.4 5.7 0.2 0.0 33.0 8.3 41.3 6,529 Fourth 58.5 10.1 0.1 3.1 3.2 0.0 1.6 13.1 0.2 0.5 2.5 6.9 0.2 0.0 31.9 9.6 41.5 6,853 Highest 54.6 10.6 0.1 3.2 2.1 0.2 2.0 16.3 0.1 0.5 2.7 7.5 0.1 0.0 35.0 10.3 45.4 6,909 P a g e | 105 Table RH.5: Use of contraception Percentage of women age 15-49 years currently married who are using (or whose husband is using) a contraceptive method, Punjab, 2014. Percent of women currently married who are using (or whose husband is using): Number of women age 15- 49 years currently married N o m e th o d F e m a le s te ri li- z a ti o n M a le s te ri li- z a ti o n IU D In je c ta b le s Im p la n ts P ill M a le c o n d o m F e m a le c o n d o m D ia p h ra g m P e ri o d ic a b s ti n e n c e W it h d ra w a l O th e r M is s in g Any modern method Any tradi- tional method Any method1 Division Bahawalpur 71.0 8.7 0.2 3.4 3.6 0.1 2.4 5.6 0.3 2.0 1.0 1.6 0.1 0.0 26.2 2.8 29.0 3,358 D.G. Khan 74.7 8.0 0.2 4.0 4.8 0.1 2.3 3.9 0.0 0.1 0.4 1.4 0.1 0.0 23.5 1.9 25.3 3,175 Faisalabad 64.0 10.9 0.0 2.5 1.9 0.2 0.9 13.0 0.1 0.4 1.7 4.3 0.1 0.1 29.8 6.1 36.0 4,029 Gujranwala 53.1 9.9 0.1 3.0 3.9 0.1 1.9 10.9 0.0 0.9 5.0 10.9 0.2 0.0 30.8 16.1 46.9 4,901 Lahore 54.4 12.5 0.1 3.6 2.2 0.2 1.5 14.5 0.1 0.2 3.7 6.9 0.1 0.0 34.9 10.7 45.6 6,024 Multan 60.6 13.5 0.1 4.0 5.0 0.1 2.8 8.7 0.4 0.4 1.2 3.2 0.1 0.0 34.9 4.5 39.4 3,653 Rawalpindi 55.6 9.4 0.1 2.8 4.7 0.1 2.7 15.7 0.2 0.4 0.5 7.5 0.2 0.0 36.1 8.2 44.4 3,067 Sahiwal 62.3 11.8 0.1 4.5 2.6 0.1 1.5 9.5 0.1 0.2 3.4 3.8 0.2 0.1 30.2 7.5 37.7 2,265 Sargodha 66.7 6.7 0.0 3.4 3.0 0.0 1.7 9.4 0.3 1.4 1.1 6.3 0.1 0.0 25.9 7.4 33.3 2,574 Punjab 61.3 10.4 0.1 3.4 3.4 0.1 1.9 10.6 0.1 0.7 2.3 5.5 0.1 0.0 30.8 7.9 38.7 33,047 1 MICS indicator 5.3; MDG indicator 5.3 - Contraceptive prevalence rate a Total includes 11 unweighted cases of women's education missing P a g e | 106 Women’s education level is strongly associated with contraceptive prevalence. The percentage of married women using any method of contraception rises from 36 percent among those with only pre- school or no education to 43 percent with higher education. In addition, the pattern of use by specific methods also varies with the level of the woman’s education. The most common contraceptive method for married women with no education is female sterilization (12%), while the most commonly used method among women with higher education is the male condom (20%). Household wealth and number of living children also have a positive relationship with the use of contraception. Unmet Need Unmet need for contraception refers to fecund women who are married and are not using any method of contraception, but wish to postpone the next birth (spacing) or wish to stop childbearing altogether (limiting). Unmet need is identified in MICS by using a set of questions eliciting current behaviours and preferences pertaining to contraceptive use, fecundity, and fertility preferences. Table RH.6 shows the levels of met need, unmet need, and the demand for contraception satisfied. Unmet need for spacing is defined as the percentage of women who are married and are not using a method of contraception AND  are not pregnant, and not postpartum amenorrheic44, and are fecund45, 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 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. Unmet need for contraception is almost 18 percent, for limiting 8 percent and for spacing 9 percent. Unmet need is highest (23%) in the age group of 25-29 years and gradually decreases to 7 percent in the age group of 45-49 years (Table RH.6). This indicator is also known as unmet need for family 44 A woman 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 45 A woman 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. P a g e | 107 planning and is one of the indicators used to track progress toward the MDG 5 of improving maternal health. Table RH.6: Unmet need for contraception Percentage of women age 15-49 years currently married with an unmet need for family planning and percentage of demand for contraception satisfied, Punjab, 2014. Met need for contraception Unmet need for contraception Number of women currently married Percentage of demand for contraception satisfied Number of women currently married with need for contraception For spacing For limiting Total For spacing For limiting Total1 Punjab 9.6 29.1 38.7 9.1 8.3 17.5 33,047 68.9 18,572 Area of residence Rural 8.5 27.0 35.4 9.8 8.7 18.5 21,859 65.8 11,783 All Urban 11.7 33.4 45.1 7.9 7.7 15.6 11,188 74.3 6,790 Major Cities 12.0 34.7 46.7 7.7 7.8 15.5 5,978 75.1 3,719 Other Urban 11.2 32.0 43.3 8.2 7.5 15.7 5,210 73.4 3,070 Age 15-19 8.5 0.4 8.9 13.2 0.7 13.9 1,021 39.0 233 20-24 15.8 3.4 19.2 19.0 2.3 21.4 3,963 47.4 1,608 25-29 16.6 13.6 30.3 16.1 6.8 22.9 6,833 56.9 3,635 30-34 12.9 30.8 43.7 9.7 10.9 20.6 6,837 67.9 4,399 35-39 5.5 45.6 51.1 4.3 12.4 16.7 5,807 75.3 3,940 40-44 1.9 48.4 50.2 1.9 9.8 11.8 4,637 81.0 2,875 45-49 0.6 39.6 40.2 0.7 6.8 7.4 3,948 84.4 1,882 Women’s educationa None/pre-school 6.1 29.7 35.7 8.2 9.7 17.9 16,331 66.6 8,766 Primary 10.0 30.9 41.0 9.0 7.6 16.6 5,902 71.2 3,398 Middle 13.5 28.4 41.8 10.8 6.5 17.3 3,051 70.7 1,804 Secondary 13.9 27.5 41.4 10.9 7.0 17.8 4,109 69.9 2,436 Higher 16.4 26.4 42.8 10.1 6.4 16.5 3,640 72.1 2,162 Wealth index quintile Lowest 5.5 22.7 28.1 10.6 11.4 22.0 6,317 56.2 3,166 Second 7.9 28.5 36.3 9.2 8.4 17.6 6,439 67.3 3,475 Middle 10.8 30.5 41.3 9.1 7.9 17.0 6,529 70.9 3,804 Fourth 10.1 31.4 41.5 9.4 7.6 16.9 6,853 71.1 4,004 Highest 13.2 32.2 45.4 7.6 6.7 14.3 6,909 76.0 4,124 Division Bahawalpur 6.0 23.0 29.0 10.1 9.2 19.4 3,358 60.0 1,624 D.G. Khan 5.7 19.6 25.3 13.5 11.8 25.3 3,175 50.0 1,606 Faisalabad 8.9 27.1 36.0 9.2 8.5 17.7 4,029 67.1 2,163 Gujranwala 12.2 34.7 46.9 8.6 6.3 14.9 4,901 75.9 3,031 Lahore 10.5 35.2 45.6 8.2 8.2 16.4 6,024 73.6 3,737 Multan 11.0 28.4 39.4 9.3 6.9 16.2 3,653 70.8 2,034 Rawalpindi 12.4 32.0 44.4 6.8 7.8 14.5 3,067 75.3 1,806 Sahiwal 8.3 29.4 37.7 8.8 8.6 17.4 2,265 68.5 1,249 Sargodha 8.5 24.8 33.3 8.7 9.2 18.0 2,574 65.0 1,320 1 MICS indicator 5.4; MDG indicator 5.6 - Unmet need a Total includes 5 unweighted cases of women's education missing Met need for limiting includes married women who are using (or whose husband is using) a contraceptive method46, 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 husband 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. The table shows that the total met need for contraception is 39 percent; for spacing 10 percent and for limiting 29 percent. 46 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). P a g e | 108 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 who are currently using contraception, over the total demand for contraception. The total demand for contraception includes women who currently have an unmet need (for spacing or limiting), plus those who are currently using contraception. The findings show that the total demand for family planning satisfied is quite high (69%), though the demand satisfied in rural areas is still relatively low (66%) compared to urban areas (74%). Demand for contraception satisfied is 39 percent among women age 15-19, 47 percent for women age 20-24, and increases to 84 percent for women age 45-49 years. Table RH.6 also shows that the total met need is higher than the total unmet need for family planning. Unmet need is highest among rural women and is strongly associated with wealth; women living in households in the lowest quintile have the highest level of unmet need and vice versa. 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 of antenatal care visits, which include:  Blood pressure measurement;  Urine testing for bacteriuria and proteinuria;  Blood testing to detect syphilis and severe anaemia;  Weight/height measurement (optional). 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. P a g e | 109 Antenatal care coverage indicators (at least one visit with a skilled provider47 and 4 or more visits with any providers) are used to track progress toward the Millennium Development Goal 5 of improving maternal health. In Punjab, a skilled birth attendants include doctors, nurses, midwives and Lady Health Visitors (LHVs) whereas, traditional birth attendants (TBAs) and Lady Health Workers (LHWs) are not skilled birth attendants. The type of personnel providing antenatal care to ever married women age 15-49 years who gave birth in the two years preceding the survey is presented in Table RH.7. The results show that 17 percent of the women do not receive antenatal care. Coverage of antenatal care by a skilled birth attendant is 79 percent, marginally higher in urban (89%) than rural areas (74%). The majority of the women receive antenatal care from medical doctors (67%) while the traditional birth attendants (TBAs) provide antenatal care to a small proportion of women (2%). 47 An SBA is defined as “an accredited health professional such as a midwife, doctor or nurse who has been educated and trained to proficiency in the skills needed to manage normal (uncomplicated) pregnancies, childbirth and the immediate postnatal period, and in the identification, management and referral of complications in women and newborns” Ref: WHO. Geneva: World Health Organization (WHO). Department of Reproductive Health and Research (RHR); 2004. Making pregnancy safer the critical role of the skilled attendant: a joint statement by WHO, ICM and FIGO. The categories of SBA are 1. Doctor, 2. Nurse, 3. Midwife, 4. Lady Health Visitor (LHV) P a g e | 110 Table RH.7: Antenatal care coverage Percent distribution of ever married 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, Punjab, 2014. Provider of antenatal carea No antenatal care Total Any skilled provider1 Number of ever married women with a live birth in the last two years Medical doctor Nurse/ Midwife Lady health visitor (LHV) Lady health worker (LHW) Traditional birth attendant (TBA) Relatives/ Friends Other/ Missing Punjab 67.2 9.0 2.6 1.0 2.2 0.7 0.1 17.3 100.0 78.8 10,653 Area of residence Rural 60.8 10.5 3.1 1.2 2.7 0.7 0.1 21.0 100.0 74.4 7,369 All Urban 81.5 5.6 1.6 0.8 1.1 0.5 0.1 8.8 100.0 88.7 3,284 Major Cities 86.2 3.9 1.2 0.7 1.1 0.5 0.1 6.3 100.0 91.3 1,692 Other Urban 76.5 7.3 2.1 0.8 1.2 0.5 0.1 11.5 100.0 85.9 1,592 Mother's age at birth Less than 20 66.0 10.1 2.9 0.8 2.3 1.3 0.2 16.4 100.0 79.0 694 20-34 68.9 8.9 2.5 1.0 2.1 0.7 0.1 15.7 100.0 80.4 8,660 35-49 55.9 8.6 3.0 1.2 2.4 0.5 0.1 28.4 100.0 67.4 1,298 Women’s educationb None/pre-school 51.5 10.7 3.2 1.3 3.6 0.9 0.1 28.8 100.0 65.4 4,816 Primary 69.1 11.3 2.7 1.3 2.1 0.5 0.1 12.9 100.0 83.1 1,961 Middle 76.2 10.4 2.3 0.8 0.7 0.9 0.2 8.5 100.0 89.0 1,096 Secondary 86.4 4.8 2.2 0.6 0.7 0.4 0.0 4.9 100.0 93.4 1,467 Higher 92.8 2.5 1.2 0.4 0.2 0.4 0.1 2.5 100.0 96.5 1,311 Wealth index quintile Lowest 43.5 8.2 4.3 1.4 3.7 1.5 0.1 37.2 100.0 56.1 2,327 Second 56.9 12.5 3.4 1.3 3.9 0.5 0.0 21.5 100.0 72.9 2,166 Middle 68.5 12.4 2.4 0.6 1.8 0.4 0.1 13.8 100.0 83.3 2,144 Fourth 80.2 8.1 2.0 1.1 0.5 0.5 0.1 7.4 100.0 90.3 2,065 Highest 91.4 3.1 0.7 0.6 0.7 0.4 0.1 3.0 100.0 95.3 1,951 Division Bahawalpur 55.8 3.4 1.0 0.4 2.3 0.9 0.0 36.2 100.0 60.2 1,068 D.G. Khan 50.0 3.7 8.6 1.2 1.3 2.1 0.3 32.9 100.0 62.3 1,181 Faisalabad 69.7 12.8 2.7 0.7 2.8 0.2 0.0 11.2 100.0 85.2 1,237 Gujranwala 69.5 15.7 1.3 1.6 1.2 0.1 0.0 10.7 100.0 86.5 1,578 Lahore 71.9 9.2 0.9 0.3 2.8 0.2 0.1 14.5 100.0 82.1 1,914 Multan 65.7 9.7 4.4 2.1 3.1 1.4 0.1 13.6 100.0 79.8 1,162 Rawalpindi 86.3 1.2 0.8 0.5 2.1 0.4 0.1 8.6 100.0 88.3 882 Sahiwal 65.1 14.2 1.0 1.6 2.1 0.1 0.0 15.8 100.0 80.4 827 Sargodha 71.0 6.4 3.9 1.0 2.0 1.2 0.0 14.5 100.0 81.3 804 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. b Total includes 2 unweighted cases of women's education missing At division level, proportion of women who received antenatal care was lowest (60%) in Bahawalpur and highest (88%) in Rawalpindi division. Younger women are more likely to seek antenatal care than the older women. Receiving antenatal care increases markedly with woman’s education and household wealth. For example, 56 percent of women living in households in the lowest quintile, received antenatal care compared to 95 percent of women living in the households in the highest quintile. P a g e | 111 Table RH.8: Number of antenatal care visits and timing of first visit Percent distribution of ever married 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, Punjab, 2014. Percent distribution of women who had: Total 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 ever married women with a live birth in the last two years who had at least one ANC visit No antenatal care visits One visit Two visits Three visits 4 or more visits1 DK/ Missing No antenatal care visits First trimester 4-5 months 6-7 months 8+ months DK/ Missing Punjab 17.3 7.5 12.6 14.1 48.0 0.4 100.0 17.3 56.4 13.5 9.1 3.3 0.4 100.0 10,653 2.0 8,770 Area of residence Rural 21.0 9.0 14.8 15.4 39.3 0.5 100.0 21.0 49.6 14.7 10.5 3.9 0.3 100.0 7,369 3.0 5,798 All Urban 8.8 4.3 7.7 11.2 67.6 0.3 100.0 8.8 71.6 11.0 6.1 1.8 0.7 100.0 3,284 2.0 2,972 Major Cities 6.3 1.9 6.1 10.8 74.6 0.3 100.0 6.3 76.7 11.0 4.4 1.0 0.5 100.0 1,692 2.0 1,577 Other Urban 11.5 6.9 9.4 11.7 60.2 0.3 100.0 11.5 66.1 10.9 7.9 2.7 0.9 100.0 1,592 2.0 1,395 Mother's age at birth Less than 20 16.4 11.1 15.8 15.6 40.6 0.4 100.0 16.4 52.7 15.7 10.1 4.8 0.3 100.0 694 3.0 578 20-34 15.7 6.9 12.4 14.2 50.5 0.4 100.0 15.7 58.4 13.5 9.0 3.0 0.4 100.0 8,660 2.0 7,265 35-49 28.4 9.6 12.7 12.7 36.0 0.7 100.0 28.4 45.2 12.3 9.3 4.4 0.4 100.0 1,298 3.0 924 Women’s educationa None/pre-school 28.8 11.3 15.8 15.1 28.3 0.6 100.0 28.8 41.0 13.6 11.4 4.6 0.4 100.0 4,816 3.0 3,405 Primary 12.9 7.3 15.2 16.5 48.0 0.2 100.0 12.9 57.2 15.9 10.0 3.5 0.5 100.0 1,961 3.0 1,699 Middle 8.5 3.7 12.3 17.1 58.1 0.3 100.0 8.5 62.9 16.1 10.0 2.0 0.5 100.0 1,096 2.0 998 Secondary 4.9 3.3 7.5 11.3 72.7 0.4 100.0 4.9 76.6 11.7 4.9 1.6 0.3 100.0 1,467 2.0 1,391 Higher 2.5 2.1 3.1 7.7 84.6 0.1 100.0 2.5 83.4 9.5 3.5 0.8 0.3 100.0 1,311 2.0 1,274 Wealth index quintile Lowest 37.2 13.6 16.4 13.9 18.3 0.6 100.0 37.2 30.6 13.5 12.9 5.4 0.4 100.0 2,327 4.0 1,452 Second 21.5 9.9 18.0 17.9 32.4 0.3 100.0 21.5 44.8 17.0 11.8 4.5 0.4 100.0 2,166 3.0 1,692 Middle 13.8 7.7 14.6 16.2 47.2 0.5 100.0 13.8 57.9 14.3 10.0 3.4 0.6 100.0 2,144 3.0 1,835 Fourth 7.4 3.5 9.2 14.3 65.3 0.3 100.0 7.4 70.8 12.7 6.6 2.0 0.4 100.0 2,065 2.0 1,903 Highest 3.0 1.8 3.6 7.7 83.6 0.4 100.0 3.0 83.2 9.7 3.4 0.5 0.2 100.0 1,951 2.0 1,889 Division Bahawalpur 36.2 13.5 12.3 10.7 27.3 0.1 100.0 36.2 38.6 11.3 9.9 3.9 0.1 100.0 1,068 3.0 681 D.G. Khan 32.9 12.7 15.9 13.6 24.3 0.6 100.0 32.9 34.0 14.9 12.7 5.2 0.3 100.0 1,181 3.0 789 Faisalabad 11.2 4.4 11.7 15.4 56.8 0.5 100.0 11.2 66.4 11.3 7.4 3.1 0.7 100.0 1,237 2.0 1,091 Gujranwala 10.7 4.8 13.2 14.6 56.3 0.4 100.0 10.7 62.7 13.3 10.3 2.4 0.6 100.0 1,578 2.0 1,400 Lahore 14.5 5.0 7.8 11.8 60.7 0.3 100.0 14.5 63.5 12.5 7.0 2.0 0.4 100.0 1,914 2.0 1,629 Multan 13.6 8.8 16.0 16.8 44.5 0.3 100.0 13.6 62.8 14.9 6.7 2.0 0.1 100.0 1,162 2.0 1,004 Rawalpindi 8.6 1.8 7.0 11.7 70.4 0.7 100.0 8.6 71.8 13.3 5.2 0.8 0.4 100.0 882 2.0 802 Sahiwal 15.8 8.2 16.7 17.6 41.4 0.3 100.0 15.8 47.0 18.0 13.6 5.0 0.6 100.0 827 3.0 691 Sargodha 14.5 11.9 17.3 17.5 38.3 0.5 100.0 14.5 51.7 14.3 11.7 7.0 0.7 100.0 804 3.0 682 1 MICS indicator 5.5b; MDG indicator 5.5 - Antenatal care coverage a Total includes 2 unweighted cases of women's education missing P a g e | 112 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 eight in ten mothers (75%) received antenatal care more than once; almost half of women received antenatal care at least four times (48%) and 14 percent had three visits. Mothers from the poorest households and those with pre-school or no education are less likely than more advantaged mothers to receive antenatal care four or more times. For example, 18 percent of mothers living in the households in the lowest quintile reported four or more antenatal care visits compared to 84 percent of mothers living in the households in the highest quintile. Proportion of women having four or more antenatal care visits was lower in rural areas (39%) compared to urban area (68%). Table RH.8 also provides information about the timing of the first antenatal care visit. Overall, 56 percent of ever married 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 2.0 months of pregnancy at the first visit among those who received antenatal care. Table RH.9: Content of antenatal care Percentage of ever married 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, blood sample taken and weight measured as part of antenatal care, during the pregnancy for the last birth, Punjab, 2014. Percentage of women who, during the pregnancy of their last birth, had: Number of ever married women with a live birth in the last two years Blood pressure measured Urine sample taken Blood sample taken Weight measured Blood pressure measured, urine and blood sample taken1 All four, Blood pressure measured, urine & blood sample taken and weight measured2 Punjab 72.2 55.4 50.3 43.9 45.3 36.3 10,653 Area of residence Rural 66.3 47.4 41.3 34.8 36.2 27.2 7,369 All Urban 85.4 73.3 70.4 64.5 65.5 56.6 3,284 Major Cities 89.6 81.8 80.1 75.6 76.4 69.7 1,692 Other Urban 81.0 64.1 60.1 52.8 53.9 42.6 1,592 Mother's age at birth Less than 20 67.9 48.5 39.7 34.5 35.1 25.1 694 20-34 74.3 57.7 52.8 46.2 47.7 38.7 8,660 35-49 60.4 43.7 39.0 33.9 34.3 26.3 1,298 Women’s educationa None/pre-school 55.7 36.5 30.3 23.3 25.5 17.0 4,816 Primary 76.2 55.6 50.6 42.2 44.0 32.9 1,961 Middle 85.2 68.9 63.8 57.8 59.5 49.2 1,096 Secondary 90.0 77.9 73.5 69.4 68.3 59.8 1,467 Higher 95.9 87.8 85.6 82.4 82.0 75.2 1,311 Wealth index quintile Lowest 44.0 25.1 19.8 13.0 15.5 8.7 2,327 Second 63.6 42.0 35.5 27.4 29.6 19.5 2,166 Middle 76.8 56.7 49.8 43.6 44.8 34.3 2,144 Fourth 87.1 72.3 68.2 60.0 62.2 50.4 2,065 Highest 94.4 87.0 84.4 82.6 80.7 75.0 1,951 Division Bahawalpur 54.4 38.2 33.2 28.4 29.1 21.9 1,068 D.G. Khan 46.9 26.7 24.3 16.8 18.4 11.9 1,181 Faisalabad 78.6 65.6 57.3 45.4 54.1 40.6 1,237 Gujranwala 81.4 64.2 55.1 50.4 49.0 40.1 1,578 Lahore 77.1 62.3 57.6 58.5 52.9 48.2 1,914 Multan 74.8 46.6 41.5 37.2 35.4 25.0 1,162 Rawalpindi 88.0 84.4 82.4 78.9 81.4 75.9 882 Sahiwal 70.3 51.4 47.6 38.5 40.9 29.7 827 Sargodha 74.3 55.9 53.2 32.0 46.2 28.4 804 1 MICS indicator 5.6 - Content of antenatal care 2 MICS indicator 5.S1 - Contents of antenatal care (All four) a Total includes 2 unweighted cases of women's education missing P a g e | 113 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, 50 percent reported that a blood sample was taken during antenatal care visits, 72 percent reported that their blood pressure was checked, and 55 percent indicated that urine specimen was taken. All three tests were conducted for 45 percent of the women, higher in urban (66%) compared to rural areas (36%). A question was also asked about a fourth test i.e., measuring the weight of the women during the antenatal care. The findings show that 44 percent of the women had their weight s measured during antenatal care. However, 36 percent of the women reported that all four tests were conducted during their antenatal care visits (Table RH.9). Assistance at Delivery About three quarters of all maternal deaths occur due to direct obstetric causes.48 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. About 65 percent of births occurring in the two years preceding the survey were delivered by skilled personnel (Table RH.10). Across divisions, almost eight in ten women in Rawalpindi and Gujranwala divisions delivered their babies with the assistance of a skilled birth attendant compared to four in ten women in DG Khan division. The more educated a woman is, the more likely she is to have delivered with the assistance of a skilled attendant. Ninety three percent of the women with higher education delivered with the assistance of a skilled attendant compared to 46 percent of the women with only pre-school or no education. Similarly, women living in the households in the highest quintile are almost three times more likely to deliver by skilled birth attendant compared to women living in the households in lowest quintile (92% and 36% respectively). More than half of the births (52%) in the two years preceding the survey were delivered by a doctor. Nurse or midwife assisted with the delivery of 10 percent of births and Lady Health Visitor (LHV) assisted with 3 percent of births. Thirty three percent of the deliveries are still being assisted by traditional birth attendant (TBA), largely in rural areas (40%) compared to urban (19%). Type of assistance during delivery is also depicted in Figure RH.3. 48 Say, L et al. 2014. Global causes of maternal death: a WHO systematic analysis. The Lancet Global Health 2(6): e323-33. DOI: 10.1016/S2214-109X(14)70227-X P a g e | 114 Table RH.10: Assistance during delivery and caesarian section Percent distribution of ever married women age 15-49 years with a live birth in the last two years by person providing assistance at delivery, and percentage of births delivered by C-section, Punjab, 2014. Person assisting at delivery No attendant Total Delivery assisted by any skilled attendant1 Percent delivered by C-section Number of ever married women who had a live birth in the last two years Medical doctor Nurse/ Midwife Lady health visitor (LHV) Traditional birth attendant (TBA) Relative/ Friend Other/ Missing Decided before onset of labour pains Decided after onset of labour pains Total2 Punjab 52.3 9.6 2.8 33.2 1.5 0.6 0.0 100.0 64.7 14.8 8.8 23.6 10,653 Area of residence Rural 44.4 10.6 2.7 39.7 1.9 0.7 0.0 100.0 57.7 12.0 7.6 19.6 7,369 All Urban 70.1 7.4 2.9 18.7 0.6 0.2 0.0 100.0 80.4 20.9 11.7 32.6 3,284 Major Cities 78.5 4.9 1.9 13.8 0.6 0.2 0.1 100.0 85.3 24.4 12.0 36.4 1,692 Other Urban 61.1 10.1 4.0 23.9 0.6 0.2 0.0 100.0 75.2 17.2 11.4 28.6 1,592 Mother's age at birth Less than 20 48.5 9.5 3.0 36.9 1.9 0.2 0.0 100.0 61.0 8.4 11.5 19.9 694 20-34 54.1 9.6 2.7 31.5 1.5 0.6 0.0 100.0 66.3 15.7 9.1 24.8 8,660 35-49 42.6 10.1 3.1 42.1 1.4 0.6 0.0 100.0 55.9 11.9 5.9 17.8 1,298 Place of deliverya Public sector health facility 87.8 9.0 3.0 0.0 0.0 0.1 0.1 100.0 99.8 21.8 10.8 32.5 1,909 Private sector health facility 84.5 11.2 3.6 0.7 0.0 0.0 0.0 100.0 99.3 25.4 16.1 41.5 4,565 Home 0.9 8.3 1.8 84.9 3.9 0.2 0.1 100.0 11.0 0.0 0.0 0.0 4,125 Women’s educationb None/pre-school 33.0 10.7 2.7 50.2 2.6 0.8 0.0 100.0 46.3 8.5 4.9 13.5 4,816 Primary 51.8 12.0 2.8 32.0 1.2 0.3 0.1 100.0 66.6 13.7 7.5 21.1 1,961 Middle 65.2 10.4 3.6 19.7 0.5 0.6 0.0 100.0 79.2 17.9 11.8 29.7 1,096 Secondary 76.7 7.2 2.5 13.2 0.2 0.2 0.1 100.0 86.3 23.3 13.5 36.8 1,467 Higher 86.0 4.3 2.6 6.3 0.4 0.3 0.0 100.0 93.0 27.1 17.5 44.6 1,311 Wealth index quintile Lowest 24.4 9.0 2.9 58.7 4.1 1.0 0.0 100.0 36.3 5.3 4.1 9.4 2,327 Second 36.9 12.3 3.3 45.6 1.5 0.3 0.0 100.0 52.5 8.8 5.4 14.2 2,166 Middle 53.6 11.9 2.8 29.9 0.8 0.9 0.1 100.0 68.3 14.6 8.9 23.5 2,144 Fourth 67.7 9.8 2.4 19.3 0.5 0.3 0.0 100.0 79.9 20.3 11.5 31.8 2,065 Highest 84.9 4.8 2.4 7.3 0.4 0.2 0.1 100.0 92.1 27.0 15.4 42.4 1,951 P a g e | 115 Table RH.10: Assistance during delivery and caesarian section Percent distribution of ever married women age 15-49 years with a live birth in the last two years by person providing assistance at delivery, and percentage of births delivered by C-section, Punjab, 2014. Person assisting at delivery No attendant Total Delivery assisted by any skilled attendant1 Percent delivered by C-section Number of ever married women who had a live birth in the last two years Medical doctor Nurse/ Midwife Lady health visitor (LHV) Traditional birth attendant (TBA) Relative/Friend Other/ Missing Decided before onset of labour pains Decided after onset of labour pains Total2 Division Bahawalpur 37.8 3.9 0.6 55.8 0.7 1.2 0.1 100.0 42.3 12.6 7.3 19.9 1,068 D.G. Khan 24.7 8.8 7.0 53.5 5.5 0.4 0.1 100.0 40.5 4.1 4.4 8.5 1,181 Faisalabad 56.1 13.7 2.7 26.5 0.8 0.2 0.0 100.0 72.4 13.9 10.9 24.8 1,237 Gujranwala 58.0 15.1 2.1 24.2 0.4 0.2 0.0 100.0 75.2 16.0 10.6 26.6 1,578 Lahore 63.6 8.7 0.7 25.6 0.7 0.6 0.1 100.0 73.0 18.7 11.2 29.9 1,914 Multan 50.7 6.6 3.1 38.6 0.3 0.7 0.0 100.0 60.4 16.4 8.0 24.5 1,162 Rawalpindi 74.7 3.6 2.6 15.3 2.5 1.3 0.0 100.0 80.8 15.1 9.2 24.2 882 Sahiwal 48.5 14.7 2.1 33.8 0.7 0.3 0.0 100.0 65.3 22.6 7.9 30.5 827 Sargodha 49.8 9.8 6.2 30.5 3.5 0.3 0.0 100.0 65.7 12.0 7.1 19.1 804 Punjab 52.3 9.6 2.8 33.2 1.5 0.6 0.0 100.0 64.7 14.8 8.8 23.6 10,653 1 MICS indicator 5.7; MDG indicator 5.2 - Skilled attendant at delivery 2 MICS indicator 5.9 - Caesarean section a Total includes 53 unweighted cases of place of delivery missing b Total includes 2 unweighted cases of women's education missing P a g e | 116 Figure RH.3 : Person ass ist ing at de l ivery , MICS Punjab, 2014 Table RH.10 also shows information on women who delivered by caesarean 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, 24 percent of ever married 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 9 percent after the pains. The prevalence of C-section births is higher in urban (33%) compared to rural areas (20%). Women living in the households in the highest quintile are more likely to have a C-section (42%) compared to 9 percent for women living in the households in the lowest quintile. Similar trend can be seen with women’s education. 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. 2 33 3 10 52 0.0 10.0 20.0 30.0 40.0 50.0 60.0 Other/Relative, Friends Traditional birth attendant (TBA) Lady health visitor (LHV) Nurse/midwife Medical doctor Percent P a g e | 117 Table RH.11: Place of delivery Percent distribution of ever married women age 15-49 years with a live birth in the last two years by place of delivery of their last birth, Punjab, 2014. Place of delivery Total Delivered in health facility1 Number of ever married women with a live birth in the last two years Health facility Home Other Missing/ DK Public sector Private sector Punjab 17.9 42.8 38.7 0.1 0.4 100.0 60.8 10,653 Area of residence Rural 14.9 38.4 46.1 0.0 0.6 100.0 53.3 7,369 All Urban 24.6 52.9 22.2 0.1 0.1 100.0 77.5 3,284 Major Cities 30.1 54.1 15.7 0.1 0.0 100.0 84.2 1,692 Other Urban 18.8 51.6 29.2 0.1 0.2 100.0 70.5 1,592 Mother's age at birth Less than 20 16.6 40.4 42.6 0.1 0.2 100.0 57.0 694 20-34 18.5 44.1 36.9 0.1 0.5 100.0 62.6 8,660 35-49 15.0 35.9 48.6 0.1 0.5 100.0 50.8 1,298 Number of antenatal care visits None 7.9 16.5 73.1 0.0 2.6 100.0 24.3 1,838 1-3 visits 14.9 34.3 50.6 0.1 0.0 100.0 49.2 3,653 4+ visits 23.7 58.5 17.8 0.0 0.0 100.0 82.2 5,118 Women’s educationa None/pre-school 12.0 30.2 57.1 0.1 0.6 100.0 42.2 4,816 Primary 19.6 42.0 38.1 0.1 0.2 100.0 61.5 1,961 Middle 26.2 49.1 24.1 0.0 0.6 100.0 75.3 1,096 Secondary 24.0 58.3 17.5 0.0 0.1 100.0 82.3 1,467 Higher 23.7 67.8 8.2 0.0 0.3 100.0 91.5 1,311 Wealth index quintile Lowest 9.3 23.4 66.6 0.1 0.7 100.0 32.7 2,327 Second 13.7 34.5 51.4 0.1 0.3 100.0 48.2 2,166 Middle 18.5 44.2 36.3 0.1 0.8 100.0 62.7 2,144 Fourth 24.9 50.8 24.1 0.1 0.2 100.0 75.6 2,065 Highest 24.8 65.4 9.5 0.0 0.2 100.0 90.3 1,951 Division Bahawalpur 10.4 30.9 57.5 0.0 1.2 100.0 41.3 1,068 D.G. Khan 11.1 24.2 64.3 0.0 0.4 100.0 35.3 1,181 Faisalabad 11.5 57.9 30.3 0.1 0.2 100.0 69.4 1,237 Gujranwala 15.4 52.5 31.9 0.1 0.0 100.0 67.9 1,578 Lahore 28.0 43.0 28.5 0.1 0.4 100.0 71.0 1,914 Multan 12.4 44.3 42.5 0.0 0.7 100.0 56.8 1,162 Rawalpindi 40.3 36.9 21.5 0.3 1.1 100.0 77.2 882 Sahiwal 12.6 48.6 38.6 0.0 0.2 100.0 61.2 827 Sargodha 17.4 42.1 40.2 0.1 0.3 100.0 59.4 804 1 MICS indicator 5.8 - Institutional deliveries a Total includes 2 unweighted cases of women's education missing About 61 percent of births are delivered in a health facility; 18 percent occur in public sector facilities and 43 percent in private. The findings also show that 39 percent of births occur at home. The proportion of institutional deliveries varies from 35 percent in D.G Khan division to 77 percent in Rawalpindi division. Only 24 percent who did not receive antenatal delivered in a health facility compared to 82 percent of women who had at least four antenatal visits. Women with higher education are more than twice as likely to deliver in a health facility compared to their rural counterparts (92% compared to 42%). Similarly, women living in the households in the highest quintile are more likely to deliver in a health facility compared to women living in the households in the lowest quintile. P a g e | 118 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 the newborn. Across the world, approximately 3 million newborns annually die in the first month of life49 and the majority of these deaths occur within a day or two of birth50, which is also the time when the majority of maternal deaths occur51. 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 quality52. 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 displays 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. Overall, 52 percent of women, who gave birth in a health facility, stay 12 hours or more in the facility after delivery. A slightly higher proportion (56%) of urban women stay 12 hours or more than rural women (50%). As expected, nearly all women (98%) giving birth through C-section stay 12 hours or more in the facility after giving birth. A positive correlation can be observed between longer stay at facility after delivery and wealth ; 51 percent of the women living in the households in the lowest quintile stay at a facility for less than 6 hours (and 41% for 12 hours or more) compared to 63 percent of the women living in the households in the highest quintile who stay in a health facility for 12 hours or more. A similar trend on length of stay in a health facility after delivery is observed for women’s education. 49 UN Interagency Group for Child Mortality Estimation. 2013. Levels and Trends in Child Mortality: Report 2013 50 Lawn, JE et al. 2005. 4 million neonatal deaths: When? Where? Why? Lancet 2005; 365:891–900. 51 WHO, UNICEF, UNFPA, The World Bank. 2012. Trends in Maternal Mortality: 1990-2010. World Health Organization. 52 HMN, UNICEF, WHO. 2008. Countdown to 2015: Tracking Progress in Maternal, Newborn & Child Survival, The 2008 Report. UNICEF. P a g e | 119 Table RH.12: Post-partum stay in health facility Percent distribution of ever married 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, Punjab, 2014. Duration of stay in health facility Total 12 hours or more1 Number of ever married 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 DK/ Missing Punjab 39.8 7.9 1.6 15.3 35.1 0.3 100.0 52.0 6,473 Area of residence Rural 42.7 7.5 1.4 14.6 33.4 0.3 100.0 49.5 3,927 All Urban 35.4 8.6 1.9 16.4 37.6 0.1 100.0 55.9 2,547 Major Cities 29.8 10.2 2.9 18.2 38.8 0.1 100.0 59.9 1,425 Other Urban 42.4 6.6 0.7 14.0 36.1 0.1 100.0 50.8 1,122 Mother's age at birth Less than 20 41.3 9.7 0.9 14.7 33.2 0.2 100.0 48.7 396 20-34 39.3 7.8 1.7 15.4 35.6 0.2 100.0 52.6 5,418 35-49 43.2 7.6 1.6 15.0 32.2 0.3 100.0 48.8 660 Type of health facility Public 37.7 9.5 2.0 18.8 31.8 0.2 100.0 52.6 1,909 Private 40.7 7.3 1.5 13.8 36.4 0.3 100.0 51.8 4,565 Type of delivery Vaginal birth 63.9 12.9 2.7 17.2 3.0 0.4 100.0 22.9 3,949 C-section 2.1 0.2 0.0 12.3 85.3 0.1 100.0 97.6 2,525 Women’s educationa None/pre-school 47.2 8.2 1.8 12.3 30.0 0.4 100.0 44.1 2,033 Primary 43.7 8.7 1.8 13.0 32.6 0.3 100.0 47.3 1,206 Middle 39.9 5.9 1.7 15.8 36.3 0.4 100.0 53.9 826 Secondary 33.9 9.0 1.2 17.4 38.5 0.0 100.0 57.1 1,207 Higher 29.1 6.9 1.6 20.3 42.0 0.1 100.0 63.8 1,199 Wealth index quintile Lowest 51 8.0 2.1 11.3 27.1 0.5 100.0 40.5 760 Second 49.6 7.5 1.3 13.3 27.9 0.5 100.0 42.5 1,045 Middle 44.6 6.1 1.4 13.7 33.8 0.3 100.0 48.9 1,345 Fourth 37.3 8.5 1.4 13.8 38.8 0.1 100.0 54.0 1,562 Highest 27.8 9.0 2.1 20.6 40.5 0.0 100.0 63.2 1,761 Division Bahawalpur 31.2 8.8 1.2 20.8 37.8 0.2 100.0 59.8 441 D.G. Khan 61.1 7.1 1.7 11.2 18.5 0.3 100.0 31.5 417 Faisalabad 42.3 9.5 2.0 10.2 35.7 0.3 100.0 48.0 859 Gujranwala 39.6 7.9 1.8 15.0 35.4 0.3 100.0 52.3 1,072 Lahore 32.4 10.0 2.3 14.8 40.3 0.2 100.0 57.4 1,360 Multan 39.6 5.5 0.8 12.8 40.5 0.8 100.0 54.1 660 Rawalpindi 38.6 7.3 1.3 28.9 23.9 0.0 100.0 54.2 681 Sahiwal 36.0 5.7 1.0 11.9 45.3 0.1 100.0 58.2 506 Sargodha 52.5 6.0 1.1 12.5 27.9 0.0 100.0 41.5 478 1 MICS indicator 5.10 - Post-partum stay in health facility a Total includes 2 unweighted cases of women's education missing 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 describes the percentage of babies born in the last two years who received health checks and post-natal care visits from any health provider after birth. It may be noted that health checks following birth while in facility or at home refer to checks provided by any health provider regardless P a g e | 120 of timing, 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, regardless of timing, as well as PNC visits within two days of delivery. Table RH.13: Post-natal health checks for newborns Percentage of ever married women age 15-49 years with a live birth in the last two years whose last live birth received health checks while in facility or at home following birth, percent distribution whose last live birth received post-natal care (PNC) visits from any health provider after birth, by timing of visit, and percentage who received post-natal health checks, Punjab, 2014. Health check following birth while in facility or at homea PNC visit for newbornsb Post-natal health check for the newborn1, c Number of last live births in the last two years Same day 1 day following birth 2 days following birth 3-6 days following birth After the first week following birth No post- natal care visit DK/ Missing Total Punjab 88.3 5.5 2.5 2.0 4.7 10.2 72.7 2.4 100.0 88.8 10,653 Area of residence Rural 87.0 6.2 2.6 2.2 4.4 8.4 73.8 2.3 100.0 87.6 7,369 All Urban 91.2 3.8 2.2 1.5 5.2 14.4 70.3 2.5 100.0 91.7 3,284 Major Cities 89.8 2.7 1.6 1.7 4.5 14.1 72.5 2.8 100.0 90.1 1,692 Other Urban 92.6 4.9 2.8 1.4 6.0 14.8 67.9 2.2 100.0 93.3 1,592 Mother's age at birth Less than 20 87.9 6.3 2.4 2.9 4.5 7.1 73.2 3.6 100.0 88.5 694 20-34 88.5 5.4 2.5 2.0 4.8 10.8 72.2 2.3 100.0 89.0 8,660 35-49 87.1 5.4 2.6 1.6 3.8 8.5 75.8 2.4 100.0 87.8 1,298 Place of deliveryd Home 80.9 7.9 3.8 2.4 1.5 0.6 83.8 0.0 100.0 81.7 4,125 Health facility 93.7 4.0 1.7 1.7 6.8 16.5 65.5 3.9 100.0 94.1 6,473 Public 92.9 3.3 1.5 1.9 5.0 12.4 71.7 4.2 100.0 93.2 1,909 Private 94.0 4.2 1.8 1.6 7.5 18.2 62.9 3.8 100.0 94.5 4,565 Women’s educatione None/pre- school 84.1 6.2 2.7 1.7 3.6 5.4 78.7 1.6 100.0 84.6 4,816 Primary 89.3 5.1 2.7 2.4 4.7 10.1 73.2 1.9 100.0 90.3 1,961 Middle 92.1 5.0 2.9 2.8 4.5 12.2 69.0 3.6 100.0 92.5 1,096 Secondary 91.7 4.8 2.1 1.6 5.5 15.9 66.7 3.4 100.0 92.2 1,467 Higher 95.0 4.5 1.7 1.9 8.1 20.1 59.9 3.8 100.0 95.3 1,311 Wealth index quintile Lowest 82.7 7.6 2.9 2.2 3.1 3.8 79.3 1.2 100.0 83.6 2,327 Second 85.9 6.2 2.8 2.2 3.8 6.3 76.8 1.9 100.0 86.4 2,166 Middle 89.0 5.6 2.3 2.1 4.9 9.6 73.2 2.3 100.0 89.5 2,144 Fourth 91.5 3.8 2.7 1.7 5.0 13.4 69.7 3.6 100.0 92.1 2,065 Highest 93.4 3.7 1.7 1.7 6.9 19.7 63.1 3.1 100.0 93.6 1,951 Division Bahawalpur 95.1 7.0 6.9 3.2 7.0 7.6 65.8 2.5 100.0 95.4 1,068 D.G. Khan 76.5 16.4 2.3 1.7 2.6 2.7 71.3 3.1 100.0 77.7 1,181 Faisalabad 89.8 4.4 1.9 1.7 4.6 12.3 71.9 3.2 100.0 90.4 1,237 Gujranwala 93.2 2.1 2.6 1.2 3.8 15.8 73.1 1.5 100.0 93.7 1,578 Lahore 86.5 3.3 1.6 1.4 3.4 10.7 78.1 1.5 100.0 86.8 1,914 Multan 90.7 4.2 0.8 1.7 6.1 7.4 76.0 3.7 100.0 91.1 1,162 Rawalpindi 87.0 5.0 2.5 2.6 4.3 10.0 71.0 4.6 100.0 87.5 882 Sahiwal 83.7 3.4 1.3 3.9 6.7 12.9 71.6 0.3 100.0 84.6 827 Sargodha 91.0 5.3 3.5 2.1 5.9 11.2 70.2 1.8 100.0 91.6 804 1 MICS indicator 5.11 - Post-natal health check for the newborn a Health checks by any health provider following facility births (before discharge from facility) or following home births (before departure of provider from home). b Post-natal care visits (PNC) refer to a separate visit to check on the health of the newborn and provide preventive care services. PNC visits do not include health checks following birth while in facility or at home (see note a above). c Post-natal health checks include any health check performed while in the health facility or at home following birth (see note a above), as well as PNC visits (see note b above) within two days of delivery. d Total includes 53 unweighted cases of place of delivery missing e Total includes 2 unweighted cases of women's education missing P a g e | 121 Overall, 88 percent of newborns receive a health check following birth while in a facility or at home. With regard to PNC visits, they predominantly occur after the first week following the birth (10%) About three quarters of the newborns have no postnatal care visits. However, a total of 89 percent of all newborns receive a post-natal health check at any time after birth. This percentage varies from 77 percent in DG Khan division to 95 percent in Bahawalpur division. Urban newborns are more likely to receive both a health check following birth (91%) and a post-natal health check (92%) than their rural counterparts (87% and 88% respectively). Health checks following birth take place more frequently in institutional deliveries (94%), whereas for newborns delivered at home the figure is comparatively low (81%). 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 service provider. As defined above, a visit does not include a check in the facility or at home following birth. Out of those newborns whose PNC visits occur within one week of birth, about 43 percent are in a private facility and 42 percent at home. Looking at proportion of PNC visits taking place at home, there are notable differences according to background characteristics. Note, for instance, that only 7 percent of children born at home attend a private facility for PNC visit, whereas 87 percent of the babies born in a private facility also attend a private facility for the PNC visit. The private facility visits are predominantly by mothers in the wealthy households as well as by mothers with high education. About 61 percent of the first PNC visits for newborns are provided by a doctor, nurse or midwife. This however masks large differences across population groups. For example, the urban-rural distribution shows that three out of four first visits (78%) among urban newborns are attended by a doctor, nurse, or midwife compared to 54 percent among rural newborns. P a g e | 122 Table RH.14: Post-natal care visits for newborns within one week of birth Percent distribution of ever married 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, Punjab, 2014. Location of first PNC visit for newborns Total Provider of first PNC visit for newborns Total Number of last live births in the last two years with a PNC visit within the first week of life Home Public Sector Private sector Doctor/ nurse/ midwife Lady health visitor (LHV) Lady health worker (LHW) Traditional birth attendant Punjab 42.3 15.1 42.6 100.0 60.8 4.8 2.5 31.9 100.0 1,560 Area of residence Rural 48.3 13.2 38.5 100.0 54.3 5.1 2.9 37.6 100.0 1,141 All Urban 25.8 20.2 54.0 100.0 78.4 4.1 1.3 16.3 100.0 418 Major Cities 19.2 21.3 59.5 100.0 83.3 3.0 1.1 12.5 100.0 178 Other Urban 30.7 19.4 49.9 100.0 74.8 4.8 1.3 19.0 100.0 240 Mother's age at birth Less than 20 50.3 18.7 30.9 100.0 52.3 3.3 5.6 38.8 100.0 112 20-34 40.5 14.5 45.0 100.0 63.2 4.7 2.2 29.9 100.0 1,273 35-49 49.6 16.8 33.6 100.0 49.3 6.9 2.3 41.4 100.0 173 Place of deliverya Home 89.2 4.0 6.7 100.0 20.8 2.4 2.1 74.6 100.0 645 Health facility 9.2 22.8 68.0 100.0 88.9 6.5 2.8 1.8 100.0 914 Public 14.5 75.9 9.7 100.0 86.5 5.4 5.7 2.4 100.0 224 Private 7.5 5.5 87.0 100.0 89.7 6.9 1.9 1.6 100.0 690 Women's Education None/pre-school 57.1 12.7 30.2 100.0 42.9 5.9 3.3 47.9 100.0 684 Primary 44.9 15.5 39.6 100.0 61.7 4.5 2.4 31.4 100.0 291 Middle 33.4 23.1 43.4 100.0 71.0 5.3 2.4 21.4 100.0 167 Secondary 26.0 15.5 58.5 100.0 82.6 2.6 1.2 13.6 100.0 205 Higher 13.7 15.5 70.8 100.0 88.1 3.7 1.4 6.8 100.0 213 Wealth index quintile Lowest 64.9 10.9 24.2 100.0 35.5 6.0 3.3 55.3 100.0 366 Second 51.0 15.3 33.6 100.0 50.1 5.3 2.5 42.1 100.0 325 Middle 40.3 15.0 44.7 100.0 66.7 5.2 3.1 24.9 100.0 320 Fourth 29.0 18.6 52.4 100.0 74.3 3.5 2.8 19.4 100.0 274 Highest 17.2 16.9 65.8 100.0 86.9 3.5 0.3 9.3 100.0 274 Division Bahawalpur 58.1 11.9 30.0 100.0 45.3 1.3 1.3 52.2 100.0 258 D.G. Khan 56.9 10.7 32.3 100.0 33.5 14.1 1.1 51.3 100.0 271 Faisalabad 28.5 11.4 60.1 100.0 77.4 3.6 5.3 13.7 100.0 157 Gujranwala 35.3 16.2 48.5 100.0 72.1 1.5 3.7 22.7 100.0 152 Lahore 33.1 20.3 46.6 100.0 76.3 2.1 0.8 20.7 100.0 185 Multan 33.1 17.1 49.8 100.0 72.0 3.0 2.0 23.0 100.0 150 Rawalpindi 37.4 27.6 35.1 100.0 70.0 3.9 2.1 24.0 100.0 127 Sahiwal 35.3 12.7 52.1 100.0 67.7 1.8 6.0 24.5 100.0 125 Sargodha 40.5 14.0 45.5 100.0 64.2 7.5 2.9 25.4 100.0 135 a Total includes 1 unweighted case of place of delivery missing Tables RH.15 and RH.16 show information collected on post-natal health checks and visits of the mother and are identical to Tables RH.13 and RH.14. P a g e | 123 Table RH.15: Post-natal health checks for mothers Percentage of ever married women age 15-49 years with a live birth in the last two years who received health checks while in facility or at home following birth, percent distribution who received post-natal care (PNC) visits from any health provider after birth at the time of last birth, by timing of visit, and percentage who received post-natal health checks, Punjab, 2014. Health check following birth while in facility or at homea PNC visit for mothersb Post-natal health check for the mother1, c Number of ever married women who gave birth in the two years preceding the survey Same day 1 day following birth 2 days following birth 3-6 days following birth After the first week following birth No post- natal care visit DK/ Missing Total Punjab 86.0 2.2 1.8 1.7 4.0 17.0 71.8 1.5 100.0 86.3 10,653 Area of residence Rural 84.5 2.2 1.9 1.7 3.5 13.9 75.3 1.4 100.0 84.8 7,369 All Urban 89.5 2.0 1.6 1.7 5.0 23.9 63.9 1.9 100.0 89.7 3,284 Major Cities 88.8 1.5 0.9 1.7 4.8 25.6 63.1 2.4 100.0 89.0 1,692 Other Urban 90.2 2.5 2.3 1.7 5.3 22.2 64.7 1.4 100.0 90.5 1,592 Mother's age at birth Less than 20 84.3 2.9 1.9 0.9 4.7 12.2 75.5 1.9 100.0 84.7 694 20-34 86.5 2.3 1.7 1.8 4.0 18.1 70.7 1.5 100.0 86.9 8,660 35-49 83.6 1.1 2.1 1.9 3.5 12.7 77.2 1.5 100.0 83.7 1,298 Place of deliveryd Home 76.3 2.9 3.1 2.3 1.8 0.7 89.3 0.0 100.0 76.7 4,125 Health facility 92.9 1.7 0.9 1.4 5.4 27.6 60.4 2.5 100.0 93.2 6,473 Public 91.1 1.6 0.7 0.7 3.7 21.3 69.6 2.4 100.0 91.5 1,909 Private 93.7 1.8 1.1 1.7 6.1 30.2 56.6 2.6 100.0 93.9 4,565 Type of delivery Vaginal birth 82.4 2.7 2.3 2.1 2.4 2.8 87.3 0.4 100.0 82.8 8,129 C-section 97.8 0.4 0.2 0.6 9.0 62.8 21.7 5.3 100.0 97.8 2,525 Women’s educatione None/pre- school 81.0 2.3 2.0 1.6 3.1 9.2 80.8 1.0 100.0 81.3 4,816 Primary 86.7 1.9 1.7 1.9 2.9 16.7 73.2 1.6 100.0 87.6 1,961 Middle 90.0 2.0 2.3 1.4 4.2 22.6 65.0 2.6 100.0 90.1 1,096 Secondary 91.0 2.2 1.5 1.8 5.4 26.3 61.1 1.7 100.0 91.0 1,467 Higher 94.6 2.2 1.0 2.0 6.9 31.3 54.3 2.3 100.0 94.8 1,311 Wealth index quintile Lowest 78.3 2.2 2.5 2.3 2.7 6.2 83.3 1.0 100.0 78.8 2,327 Second 83.2 2.5 1.9 1.4 3.0 9.8 80.0 1.3 100.0 83.4 2,166 Middle 87.4 2.4 1.4 1.7 3.6 16.8 72.9 1.3 100.0 87.7 2,144 Fourth 90.0 2.1 1.8 1.4 5.0 23.5 63.7 2.5 100.0 90.3 2,065 Highest 92.7 1.6 1.2 1.8 6.1 31.4 56.3 1.7 100.0 92.9 1,951 Division Bahawalpur 91.4 3.2 6.2 3.2 5.4 11.8 68.6 1.6 100.0 91.8 1,068 D.G. Khan 69.0 2.8 0.8 1.1 3.4 3.5 86.2 2.1 100.0 69.5 1,181 Faisalabad 89.3 2.0 1.4 1.8 3.5 20.4 69.1 1.9 100.0 89.9 1,237 Gujranwala 92.0 1.2 1.4 1.3 2.9 23.8 68.4 1.0 100.0 92.4 1,578 Lahore 85.4 1.7 1.2 1.4 3.7 21.8 69.3 0.9 100.0 85.6 1,914 Multan 89.5 2.6 0.3 1.5 5.3 14.7 72.5 3.0 100.0 89.5 1,162 Rawalpindi 84.3 2.0 1.6 1.6 3.8 13.6 75.5 1.9 100.0 84.5 882 Sahiwal 82.4 1.1 0.2 2.5 3.0 19.9 72.7 0.6 100.0 82.7 827 Sargodha 89.0 3.8 4.0 1.8 5.8 18.0 65.6 1.0 100.0 89.4 804 1 MICS indicator 5.12 - Post-natal health check for the mother a Health checks by any health provider following facility births (before discharge from facility) or following home births (before departure of provider from home). b Post-natal care visits (PNC) refer to a separate visit to check on the health of the newborn and provide preventive care services. PNC visits do not include health checks following birth while in facility or at home (see note a above). c Post-natal health checks include any health check performed while in the health facility or at home following birth (see note a above), as well as PNC visits (see note b above) within two days of delivery. d Total includes 53 unweighted cases of place of delivery missing e Total includes 2 unweighted cases of women's education missing P a g e | 124 Table RH.15 displays a pattern somewhat similar to Table RH.13. Overall, 86 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 following birth (17%). As regards the postnatal health checks, it is reported by 86 percent of the mothers. Urban mothers are slightly more likely to receive a health check, both following birth (90%) and in total including PNC visits (90%), than their rural counterparts (85% respectively). There is a positive correlation to both education and household wealth, with the percentage of post-natal health checks of mothers increasing with education and wealth. Health checks following birth occur mainly in health facility (93%), whereas for mothers delivering at home the figure is lower at 76 percent. 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. The situation of mothers that did not receive a PNC visit is almost the same as that of newborns. Table RH.16 deals with PNC visits for mothers by location and type of provider and it matches with Table RH.14. As defined above, a visit does not include a check in the facility or at home following birth. Overall, 41 percent of the first PNC visits for mothers occur in a private facility. This proportion varies across background characteristics. The largest variation is found according to household wealth, where only 19 percent of the women living in the households in the lowest quintile have their first PNC visit in a private facility compared to 66% of women living in the households in the highest quintile. A similar distribution is found according to education of the women as well as their area of residence. With regards to provider of the first PNC visit for mothers, the variations across background characteristics are not large, although there is a higher prevalence among urban women of doctor/nurse/midwife at 77 percent against their rural counterparts at 51 percent. In contrast, traditional birth attendants among rural women are the most common providers (42%) compared to 18 percent among urban women. As expected, almost all women giving birth by C-section are seen by a doctor/nurse/midwife at their first PNC visit. P a g e | 125 Table RH.16: Post-natal care visits for mothers within one week of birth Percent distribution of ever married women age 15-49 years with a live birth in the last two years who received a post-natal care (PNC) visit within one week of birth, by location and provider of the first PNC visit, Punjab, 2014. Location of first PNC visit Total Provider of first PNC visit for mothers Total Number of ever married women who gave birth in the two years preceding survey and received a PNC visit within one week of delivery Home Public Sector Private sector Other location DK/ Missing Doctor/ nurse/ midwife Lady health visitor (LHV) Lady health worker (LHW) Traditional birth attendant Punjab 47.3 11.4 41.1 0.1 0.1 100.0 59.4 3.9 2.7 34.0 100.0 1,029 Area of residence Rural 56.0 8.9 35.0 0.1 0.0 100.0 50.9 3.6 3.5 42.0 100.0 691 All Urban 29.6 16.4 53.8 0.0 0.3 100.0 76.8 4.4 1.0 17.7 100.0 337 Major Cities 21.6 20.6 57.8 0.0 0.0 100.0 82.2 3.9 1.1 12.8 100.0 151 Other Urban 36.0 13.0 50.5 0.0 0.5 100.0 72.5 4.8 1.0 21.7 100.0 187 Mother's age at birth Less than 20 48.8 11.9 39.3 0.0 0.0 100.0 54.4 2.2 4.2 39.3 100.0 72 20-34 45.6 11.2 43.0 0.1 0.1 100.0 62.0 3.9 2.6 31.5 100.0 843 35-49 58.6 12.3 29.0 0.0 0.0 100.0 43.7 4.7 2.8 48.9 100.0 112 Duration of stay in health facility Less than 12 hours 21.3 16.3 62.1 0.3 0.0 100.0 78.8 7.4 3.8 9.9 100.0 320 12-23 hours (*) (*) (*) (*) (*) 100.0 (*) (*) (*) (*) 100.0 6 1-2 days 13.2 23.0 63.9 0.0 0.0 100.0 91.3 4.7 2.3 1.6 100.0 92 3 days or more 10.0 15.9 74.1 0.0 0.0 100.0 97.2 1.4 0.6 0.8 100.0 194 DK/Missing 92.3 2.9 4.5 0.0 0.2 100.0 19.8 2.2 2.6 75.5 100.0 418 Place of delivery Home 93.0 2.5 4.3 0.0 0.2 100.0 19.2 2.2 2.6 76.0 100.0 415 Health facility 16.5 17.2 66.1 0.2 0.0 100.0 86.5 5.0 2.8 5.7 100.0 613 Public 28.7 67.5 3.0 0.8 0.0 100.0 80.3 3.4 7.6 8.7 100.0 128 Private 13.3 3.9 82.8 0.0 0.0 100.0 88.2 5.4 1.5 4.9 100.0 485 Other/DK/Missing (*) (*) (*) (*) (*) 100.0 (*) (*) (*) (*) 100.0 1 Type of delivery Vaginal birth 59.3 9.4 31.1 0.1 0.1 100.0 47.0 4.6 3.3 45.1 100.0 773 C-section 11.2 17.5 71.3 0.0 0.0 100.0 96.8 1.7 0.7 0.7 100.0 256 Women's Education None/pre-school 61.6 9.0 28.9 0.2 0.2 100.0 42.8 3.6 4.0 49.6 100.0 437 Primary 52.9 10.1 37.0 0.0 0.0 100.0 56.6 1.9 2.7 38.8 100.0 167 Middle 43.2 11.3 45.5 0.0 0.0 100.0 70.2 3.7 1.8 24.4 100.0 107 Secondary 33.2 13.6 53.2 0.0 0.0 100.0 73.7 7.0 1.5 17.7 100.0 159 Higher 18.8 17.1 64.1 0.0 0.0 100.0 86.6 3.6 1.0 8.8 100.0 158 P a g e | 126 Table RH.16: Post-natal care visits for mothers within one week of birth Percent distribution of ever married women age 15-49 years with a live birth in the last two years who received a post-natal care (PNC) visit within one week of birth, by location and provider of the first PNC visit, Punjab, 2014. Location of first PNC visit Total Provider of first PNC visit for mothers Total Number of ever married women who gave birth in the two years preceding survey and received a PNC visit within one week of delivery Home Public Sector Private sector Other location DK/ Missing Doctor/ nurse/ midwife Lady health visitor (LHV) Lady health worker (LHW) Traditional birth attendant Wealth index quintile Lowest 73.7 7.1 18.7 0.5 0.0 100.0 33.1 0.9 4.7 61.3 100.0 222 Second 60.7 8.9 29.9 0.0 0.5 100.0 43.2 4.3 2.2 50.3 100.0 192 Middle 45.5 11.6 42.9 0.0 0.0 100.0 61.8 5.4 2.9 29.9 100.0 195 Fourth 38.4 13.0 48.6 0.0 0.0 100.0 72.1 4.2 3.2 20.4 100.0 212 Highest 17.4 16.3 66.3 0.0 0.0 100.0 87.4 4.8 0.3 7.5 100.0 207 Division Bahawalpur 63.9 4.5 31.2 0.0 0.5 100.0 38.4 0.5 1.3 59.9 100.0 192 D.G. Khan 58.1 14.7 26.2 1.1 0.0 100.0 45.2 3.9 2.4 48.5 100.0 96 Faisalabad 34.6 7.7 57.7 0.0 0.0 100.0 74.6 1.7 6.6 17.0 100.0 107 Gujranwala 52.3 12.0 35.7 0.0 0.0 100.0 63.0 0.6 3.8 32.7 100.0 108 Lahore 34.1 16.0 49.8 0.0 0.0 100.0 77.7 3.1 1.0 18.1 100.0 153 Multan 28.1 16.3 55.6 0.0 0.0 100.0 74.5 6.0 0.6 18.9 100.0 113 Rawalpindi 50.0 20.5 29.6 0.0 0.0 100.0 57.5 11.1 2.0 29.4 100.0 80 Sahiwal 53.6 7.8 38.6 0.0 0.0 100.0 49.1 0.0 8.0 42.9 100.0 56 Sargodha 49.1 7.7 43.2 0.0 0.0 100.0 56.3 9.8 2.8 31.0 100.0 124 Punjab 47.3 11.4 41.1 0.1 0.1 100.0 59.4 3.9 2.7 34.0 100.0 1,029 (*) Figures that are based on fewer than 25 unweighted cases P a g e | 127 Table RH.17 exhibits the distribution of women with a live birth in the two years preceding the survey by receipt of health checks within 2 days of birth for the mother and the newborn. The table indicates that for 84 percent of live births, both the mothers and their newborns, receive a health check following birth within 2 days of birth, whereas for 9 percent of births neither mother nor newborn received it. There are positive correlations of health checks with household wealth and the education of the woman, where increasing wealth and education tends to equate with better coverage and vice versa. As expected, the opposite is true for births without health checks. Table RH.17: Post-natal health checks for mothers and newborns Percent distribution of ever married 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, Punjab, 2014. Health checks or PNC visits within 2 days of birth for: DK/ Missing Total Number of ever married 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 Punjab 83.5 1.9 4.4 9.2 1.0 100.0 10,653 Area of residence Rural 82.0 1.9 4.6 10.5 1.0 100.0 7,369 All Urban 86.7 2.0 3.9 6.3 1.0 100.0 3,284 Major Cities 85.0 2.7 3.9 7.2 1.3 100.0 1,692 Other Urban 88.6 1.2 4.0 5.5 0.7 100.0 1,592 Mother's age at birth Less than 20 80.9 2.1 5.9 9.3 1.7 100.0 694 20-34 84.1 1.9 4.1 9.1 0.9 100.0 8,660 35-49 81.1 1.8 6.0 10.4 0.8 100.0 1,298 Place of delivery Home 75.2 1.5 6.5 16.8 0.0 100.0 4,125 Health facility 89.4 2.1 3.1 3.7 1.6 100.0 6,473 Public 87.8 2.1 3.9 4.6 1.6 100.0 1,909 Private 90.1 2.1 2.8 3.3 1.6 100.0 4,565 Other/DK/Missing 5.2 0.0 0.0 94.8 0.0 100.0 55 Type of delivery Vaginal birth 80.8 1.7 5.5 11.7 0.2 100.0 8,129 C-section 92.0 2.4 0.8 1.3 3.4 100.0 2,525 Women’s educationa None/pre-school 78.7 2.0 5.3 13.4 0.7 100.0 4,816 Primary 84.2 2.3 5.2 7.3 1.1 100.0 1,961 Middle 87.3 1.2 3.6 6.3 1.6 100.0 1,096 Secondary 87.9 2.1 3.4 5.7 1.0 100.0 1,467 Higher 92.1 1.4 1.8 3.4 1.4 100.0 1,311 Wealth index quintile Lowest 76.9 1.4 6.2 15.1 0.6 100.0 2,327 Second 80.2 2.1 5.2 11.3 1.1 100.0 2,166 Middle 84.8 2.2 4.0 8.3 0.7 100.0 2,144 Fourth 86.6 2.1 3.9 5.7 1.6 100.0 2,065 Highest 90.2 1.7 2.4 4.7 1.0 100.0 1,951 Division Bahawalpur 89.9 0.7 4.4 3.8 1.1 100.0 1,068 D.G. Khan 67.1 1.1 9.3 21.2 1.3 100.0 1,181 Faisalabad 86.4 1.8 2.7 7.4 1.7 100.0 1,237 Gujranwala 89.9 1.9 3.2 4.4 0.6 100.0 1,578 Lahore 82.3 3.0 4.1 10.2 0.4 100.0 1,914 Multan 85.4 2.0 3.6 6.9 2.1 100.0 1,162 Rawalpindi 81.0 2.5 5.4 10.1 1.0 100.0 882 Sahiwal 80.8 1.9 3.9 13.4 0.0 100.0 827 Sargodha 87.5 1.4 3.6 7.0 0.5 100.0 804 a Total includes 2 unweighted cases of women's education missing P a g e | 128 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. It can be observed from the Table CD.1 that 26 percent of children age 36-59 months are attending an organised early childhood education programme. Urban-rural differentials are notable; the figure is high in urban at 36 percent compared to 21 percent in rural areas. Among children age 36-59 months, attendance to early childhood education programmes is more prevalent in Rawalpindi division (47%), and lowest in the Bahawalpur, DG Khan and Multan divisions (14% each). No real gender differentials exists, but differentials by socioeconomic status seem to be significant. Forty four percent of children living in the households in the highest quintile attended such programmes and this proportion drops to 9 percent among children living in the households in the lowest quintile. Table CD.1: Early childhood education Percentage of children age 36-59 months who are attending an organized early childhood education programme, Punjab, 2014. Percentage of children age 36-59 months attending early childhood education1 Number of children age 36-59 months Punjab 25.7 11,527 Area of residence Rural 21.1 7,941 All Urban 35.9 3,585 Major Cities 36.4 1,841 Other Urban 35.4 1,744 Sex Male 24.9 5,809 Female 26.6 5,717 Age of child 36-47 months 13.5 5,894 48-59 months 38.6 5,633 Mother's education None/pre-school 14.8 5,863 Primary 29.7 2,031 Middle 36.0 1,083 Secondary 41.6 1,399 Higher 45.5 1,151 Wealth index quintile Lowest 8.9 2,835 Second 18.9 2,314 Middle 27.9 2,119 Fourth 35.9 2,231 Highest 43.7 2,027 Division Bahawalpur 13.7 1,398 D.G. Khan 14.4 1,384 Faisalabad 28.9 1,352 Gujranwala 34.3 1,702 Lahore 31.9 1,931 Multan 14.0 1,248 Rawalpindi 47.2 899 Sahiwal 24.3 814 Sargodha 23.4 799 1 MICS indicator 6.1 - Attendance to early childhood education P a g e | 129 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. 53 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.”54 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 almost one-third (35%) 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 is 2.8. The table also indicates that the father’s involvement in such activities is somewhat limited which is only 3 percent. About 9 percent of children age 36-59 months live without their biological father. As regards to mother’s involvement in four or more activities that promote learning and school readiness during the 3 days preceding the survey, it is 12 percent. Less than 2 percent of children age 36-59 months live without their biological mother. There are no gender differentials in terms of engagement of adults in activities with children. However differentials exists based on area of residence; a larger proportion of adults in urban (53%) engages in learning and school readiness activities with children than in rural areas (27%). Strong differences by mother’s education, socio-economic status and divisions are also observed. Adult engagement in activities with children was greatest in Rawalpindi and Faisalabad divisions (51% and 50% respectively) and lowest in Bahawalpur division (21%), while the proportion was 65 percent for children living in the households in the highest quintile, as opposed to children living in the households in the lowest quintile (10%). 53 Grantham-McGregor, S et al. 2007. Developmental Potential in the First 5 Years for Children in Developing Countries. The Lancet 369: 60–70 Belsky, J et al. 2006. Socioeconomic Risk, Parenting During the Preschool Years and Child Health Age 6 Years. European Journal of Public Health 17(5): 511–2. 54 UNICEF. 2002. A World Fit For Children adopted by the UN General Assembly at the 27th Special Session, 10 May 2002: 2. P a g e | 130 Table CD.2: Support for learning Percentage of children age 36-59 months with whom adult household members engaged in activities that promote learning and school readiness during the last three days, and engagement in such activities by biological fathers and mothers, Punjab, 2014. Percentage of children with whom adult household members have engaged in four or more activities1 Mean number of activities with adult household members Percentage of children living with their: Number of children age 36-59 months Percentage of children with whom biological fathers have engaged in four or more activities2 Mean number of activities with biological fathers Number of children age 36-59 months living with their biological fathers Percentage of children with whom biological mothers have engaged in four or more activities3 Mean number of activities with biological mothers Number of children age 36-59 months living with their biological mothers Biological father Biological mother Punjab 35.0 2.8 91.3 98.5 11,527 2.6 0.8 10,525 11.8 1.3 11,349 Area of residence Rural 27.0 2.5 90.9 98.4 7,941 2.0 0.8 7,219 7.5 1.0 7,816 All Urban 52.6 3.5 92.2 98.5 3,585 3.8 1.0 3,306 21.5 1.9 3,533 Major Cities 55.8 3.6 94.0 98.9 1,841 4.3 1.1 1,731 25.3 2.1 1,820 Other Urban 49.3 3.4 90.3 98.2 1,744 3.3 0.9 1,575 17.5 1.7 1,713 Sex Male 34.0 2.8 91.3 98.5 5,809 2.6 0.9 5,304 11.5 1.3 5,722 Female 36.0 2.8 91.3 98.4 5,717 2.5 0.8 5,220 12.2 1.3 5,627 Age of child 36-47 months 33.5 2.8 91.7 98.5 5,894 2.5 0.8 5,404 11.7 1.3 5,803 48-59 months 36.5 2.9 90.9 98.5 5,633 2.6 0.8 5,120 12.0 1.3 5,547 Mother's educationa None/Pre-school 18.3 2.2 93.4 98.0 5,863 1.3 0.7 5,478 2.2 0.6 5,747 Primary 35.9 2.8 89.6 98.8 2,031 2.2 0.8 1,820 9.0 1.2 2,007 Middle 51.5 3.5 90.3 98.9 1,083 3.2 0.9 978 19.4 1.9 1,071 Secondary 61.0 3.8 87.9 99.1 1,399 3.4 1.0 1,229 27.2 2.3 1,386 Higher 71.1 4.2 88.6 98.9 1,151 7.8 1.3 1,021 39.8 2.9 1,139 Father’s educationb None/pre-school 17.2 2.1 100.0 99.0 3,308 0.7 0.7 3,308 3.4 0.7 3,276 Primary 27.0 2.5 100.0 99.4 1,872 2.0 0.8 1,872 7.1 1.0 1,861 Middle 36.0 2.9 100.0 98.9 1,659 2.0 0.9 1,659 10.6 1.3 1,642 Secondary 45.8 3.3 100.0 99.2 2,245 3.0 1.0 2,245 15.9 1.6 2,228 Higher 63.0 3.9 100.0 99.5 1,438 8.8 1.4 1,438 27.8 2.2 1,432 Father not in the household 42.3 3.1 0.0 90.8 1,002 na na na 18.7 1.6 910 P a g e | 131 Table CD.2: Support for learning Percentage of children age 36-59 months with whom adult household members engaged in activities that promote learning and school readiness during the last three days, and engagement in such activities by biological fathers and mothers, Punjab, 2014. Percentage of children with whom adult household members have engaged in four or more activities1 Mean number of activities with adult household members Percentage of children living with their: Number of children age 36-59 months Percentage of children with whom biological fathers have engaged in four or more activities2 Mean number of activities with biological fathers Number of children age 36-59 months living with their biological fathers Percentage of children with whom biological mothers have engaged in four or more activities3 Mean number of activities with biological mothers Number of children age 36-59 months living with their biological mothers Biological father Biological mother Wealth index quintiles Lowest 10.4 1.8 94.7 98.7 2,835 0.7 0.6 2,686 1.6 0.5 2,798 Second 24.5 2.4 93.4 97.8 2,314 1.9 0.8 2,161 4.6 0.9 2,262 Middle 35.9 2.9 92.8 98.6 2,119 1.9 0.8 1,967 9.3 1.2 2,089 Fourth 48.5 3.3 88.4 98.4 2,231 2.9 0.9 1,971 16.4 1.7 2,194 Highest 65.4 4.0 85.8 99.0 2,027 6.2 1.1 1,740 31.9 2.5 2,006 Division Bahawalpur 21.2 2.6 94.6 98.5 1,398 1.2 0.9 1,323 3.4 0.8 1,377 D.G. Khan 22.2 2.2 89.6 98.4 1,384 2.5 0.6 1,239 6.8 0.7 1,362 Faisalabad 49.9 3.5 95.4 98.8 1,352 2.7 0.9 1,290 14.8 1.7 1,336 Gujranwala 42.1 3.1 79.4 98.9 1,702 2.3 0.7 1,352 15.2 1.5 1,683 Lahore 42.7 3.1 94.4 98.4 1,931 3.9 1.0 1,822 20.1 1.8 1,901 Multan 21.0 2.3 94.5 98.3 1,248 1.4 0.8 1,179 4.8 0.8 1,226 Rawalpindi 50.5 3.3 88.5 99.0 899 2.8 0.9 796 23.1 1.9 890 Sahiwal 35.3 2.7 92.8 97.5 814 3.2 0.9 755 5.4 1.0 794 Sargodha 26.1 2.3 96.1 97.7 799 2.9 0.8 768 7.8 1.1 781 Punjab 35.0 2.8 91.3 98.5 11,527 2.6 0.8 10,525 11.8 1.3 11,349 1 MICS indicator 6.2 - Support for learning 2 MICS Indicator 6.3 - Father’s support for learning 3 MICS Indicator 6.4 - Mother’s support for learning a The background characteristic "Mother's education" refers to the education level of the respondent to the Questionnaire for Children Under Five, and covers both mothers and primary caretakers, who are interviewed when the mother is not listed in the same household. Since indicator 6.4 reports on the biological mother's support for learning, this background characteristic refers to only the educational levels of biological mothers when calculated for the indicator in question. b Total includes 1 unweighted cases of father's education missing na: not applicable P a g e | 132 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 mothers/caretakers of all children under 5 were asked about number of children’s books or picture books they have for the child, and the types of playthings that are available at home. In Punjab, only 8 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 only less than 1 percent. Rawalpindi division has highest (21%) percentage of children who have three or more books at home as compared to the other divisions. While no gender differentials are observed, a higher percentage of urban children have access to children’s books than those living in rural households. The proportion of under-5 children who have 3 or more children’s books is 13 percent in urban areas, compared to 5 percent in rural areas. The presence of children’s books is positively correlated with the child’s age; in the homes of 11 percent of children age 24-59 months, there are 3 or more children’s books, while the figure is less than 1 percent for children age 0-23 months. There are also notable differences by mother’s education and wealth quintile. When children for whom there are 10 or more children’s books or picture books are taken into account, a similar pattern of the background characteristics is observed as in the case of at least 3 children’s books. P a g e | 133 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, Punjab, 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 Homemade toys Toys from a shop/manufactured toys Household objects/objects found outside Two or more types of playthings2 Punjab 7.6 0.3 27.3 64.7 61.5 52.5 27,495 Area of residence Rural 5.2 0.1 29.9 58.9 64.4 52.2 19,002 All Urban 12.9 0.5 21.5 77.8 55.0 53.1 8,493 Major Cities 15.9 0.7 19.7 79.9 50.3 49.7 4,364 Other Urban 9.8 0.3 23.3 75.7 60.0 56.7 4,129 Sex Male 7.2 0.3 26.7 66.4 61.1 52.6 13,915 Female 7.9 0.2 27.9 63.0 61.9 52.4 13,580 Age 0-23 months 0.8 0.1 19.0 54.0 46.2 38.2 10,642 24-59 months 11.8 0.4 32.5 71.5 71.2 61.5 16,853 Mother's education None/pre-school 2.7 0.1 30.8 50.9 65.6 48.8 13,140 Primary 5.8 0.1 26.3 68.7 62.7 54.9 4,991 Middle 10.4 0.2 25.4 76.6 58.6 57.3 2,740 Secondary 14.3 0.4 21.2 82.7 53.2 54.6 3,563 Higher 20.6 1.3 22.6 86.2 54.5 57.4 3,062 Wealth index quintile Lowest 0.9 0.0 35.1 36.6 68.4 44.9 6,316 Second 2.9 0.1 29.9 57.5 66.5 52.7 5,560 Middle 5.5 0.1 26.3 70.7 61.8 55.1 5,335 Fourth 10.9 0.2 22.1 78.7 56.6 55.3 5,380 Highest 19.9 1.0 21.1 87.4 52.1 56.1 4,904 Division Bahawalpur 2.0 0.1 12.7 47.2 60.6 33.1 3,080 D.G. Khan 2.9 0.1 57.5 42.6 66.9 57.2 3,151 Faisalabad 2.6 0.2 31.8 74.4 66.9 64.1 3,272 Gujranwala 12.9 0.2 25.4 77.2 60.4 57.2 4,100 Lahore 14.0 0.6 16.4 77.0 55.4 51.3 4,670 Multan 3.0 0.1 23.5 46.6 60.7 42.4 3,019 Rawalpindi 21.5 0.7 26.0 79.3 49.0 50.2 2,165 Sahiwal 3.7 0.2 34.8 68.9 75.6 63.9 2,032 Sargodha 1.4 0.0 23.8 64.2 62.8 54.9 2,005 1 MICS indicator 6.5 - Availability of children’s books 2 MICS indicator 6.6 - Availability of playthings Table CD.3 also shows that 53 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). A higher proportion of children (65%) play with toys that come from a store and 62 percent play with household objects or objects found outside the house; however, the percentage for homemade toys is 27 percent. By division, the proportion of children who have 2 or more types of playthings ranges from 33 percent in Bahawalpur to 64 percent each in Sahiwal and Faisalabad. P a g e | 134 Leaving children alone or in the presence of other young children is known to increase the risk of injuries.55 In the present survey, 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. This data is displayed in Table CD.4. The table shows that 4 percent of children age 0-59 months were left in the care of other children under 10 years of age, while 5 percent were left alone during the week preceding the interview. Combining the two care indicators, it is calculated that a total of 7 percent of children were left with inadequate care during the past week, either by being left alone or in the care of another child under 10 years of age. No differences are observed by sex of the child. More children living in the households in the lowest quintile were left with inadequate care (9%) than children living in the households in the highest quintile (5%). 55 Grossman, DC. 2000. The History of Injury Control and the Epidemiology of Child and Adolescent Injuries. The Future of Children, 10(1): 23-52. P a g e | 135 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, Punjab, 2014. Percentage of children under age 5: Number 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 Punjab 4.6 3.7 6.8 27,495 Area of residence Rural 5.0 4.3 7.5 19,002 All Urban 3.7 2.3 5.2 8,493 Major Cities 3.8 2.2 5.4 4,364 Other Urban 3.7 2.4 4.9 4,129 Sex Male 4.5 3.5 6.5 13,915 Female 4.7 3.8 7.0 13,580 Age 0-23 months 3.3 2.9 5.1 10,642 24-59 months 5.4 4.1 7.8 16,853 Mother's education None/pre-school 5.2 5.2 8.2 13,140 Primary 4.2 3.4 6.4 4,991 Middle 3.5 1.9 4.8 2,740 Secondary 4.2 1.3 4.8 3,563 Higher 4.3 1.6 5.4 3,062 Wealth index quintile Lowest 5.6 6.2 9.0 6,316 Second 5.0 4.4 7.6 5,560 Middle 4.1 3.3 6.2 5,335 Fourth 4.1 2.4 5.7 5,380 Highest 4.0 1.4 4.8 4,904 Division Bahawalpur 2.4 2.4 4.5 3,080 D.G. Khan 4.2 5.5 6.9 3,151 Faisalabad 3.5 2.4 4.5 3,272 Gujranwala 6.5 4.4 9.7 4,100 Lahore 2.7 2.5 4.2 4,670 Multan 3.1 2.7 4.5 3,019 Rawalpindi 8.8 2.8 10.5 2,165 Sahiwal 10.8 8.9 15.1 2,032 Sargodha 2.5 2.9 4.7 2,005 1 MICS indicator 6.7 - Inadequate care 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. 56 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 Punjab. 56 Shonkoff, J and Phillips, D (eds). 2000. From neurons to neighborhoods: the science of early childhood development. Committee on Integrating the Science of Early Childhood Development, National Research Council, 2000. P a g e | 136 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. The results are presented in Table CD.5. In Punjab, 67 percent of children age 36-59 months are developmentally on track. The ECDI is slightly lower among boys (65%) than girls (69%). As expected, ECDI is higher in the older children compared to those that are younger since children mature more skills with increasing age; 73 percent among children age 48-59 months and 62 percent among those age 36-47 months. Similarly, higher ECDI is seen in children attending to an early childhood education programme at 82 percent compared to 62 percent of children who are not attending. The analysis of four domains of child development shows that 98 percent of children are on track in physical domain and 94 percent in learning but much less on track in social-emotional (62%) and literacy-numeracy (25%). In each individual domain the higher score is associated with attending an early childhood education programme and older children age 48-59 months. P a g e | 137 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, Punjab, 2014. Percentage of children age 36-59 months who are developmentally on track for indicated domains Early child development index score1 Percentage of children not on track in any of the four domains Number of children age 36-59 months Literacy- numeracy Physical Social- Emotional Learning Punjab 25.1 97.7 62.2 93.6 67.2 1.0 11,527 Area of residence Rural 20.0 97.6 60.3 92.8 63.5 0.9 7,941 All Urban 36.5 97.8 66.2 95.5 75.6 1.0 3,585 Major Cities 39.1 98.0 69.2 96.7 79.6 0.7 1,841 Other Urban 33.8 97.6 63.1 94.2 71.3 1.3 1,744 Sex Male 23.8 97.4 60.3 93.3 65.2 1.0 5,809 Female 26.4 98.0 64.1 94.0 69.3 0.9 5,717 Age 36-47 months 14.5 96.7 61.4 92.1 61.8 1.7 5,894 48-59 months 36.2 98.7 63.0 95.2 72.9 0.2 5,633 Attendance to early childhood education Attending 57.8 99.1 64.7 96.4 81.8 0.0 2,967 Not attending 13.8 97.2 61.3 92.6 62.2 1.3 8,559 Mother's education None/pre-school 13.8 97.8 60.4 92.1 60.8 0.8 5,863 Primary 26.4 97.4 61.9 94.7 67.6 0.7 2,031 Middle 37.3 98.4 63.6 95.6 74.5 0.6 1,083 Secondary 39.1 97.3 65.5 95.4 76.2 1.8 1,399 Higher 51.7 97.2 66.5 95.3 81.6 1.4 1,151 Wealth index quintile Lowest 7.8 97.8 58.9 90.9 56.7 0.6 2,835 Second 16.8 97.7 62.3 92.8 63.3 1.0 2,314 Middle 25.9 97.6 60.2 94.3 66.6 1.0 2,119 Fourth 34.9 97.8 64.5 95.1 73.4 1.0 2,231 Highest 47.3 97.3 66.1 96.1 80.4 1.4 2,027 Division Bahawalpur 15.8 96.5 59.9 92.1 61.5 1.3 1,398 D.G. Khan 14.9 98.3 52.3 89.4 52.7 0.4 1,384 Faisalabad 25.7 98.2 68.9 94.4 73.0 1.3 1,352 Gujranwala 26.1 97.3 58.0 95.8 67.3 1.7 1,702 Lahore 32.9 98.3 67.2 95.7 74.1 0.6 1,931 Multan 21.3 97.1 60.7 95.5 64.0 0.8 1,248 Rawalpindi 41.3 95.6 61.5 93.3 72.7 1.0 899 Sahiwal 30.9 98.6 63.8 89.2 68.0 0.8 814 Sargodha 18.9 99.1 70.2 94.4 74.1 0.5 799 1 MICS indicator 6.8 - Early child development index P a g e | 138 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 MICS Punjab, 2014, since only a women’s questionnaire was administered, the results are based 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 proportion of literates are presented in Table ED.1. The data in the table indicate that 73 percent of young women in Punjab are literate. Literacy status varies by area of residence, 88 percent in urban compared to 65 percent in rural. Of women who stated that primary school was their highest level of education, 72 percent are actually able to read the statement shown to them. Among divisions, the proportion of literate women is highest in Rawalpindi and Gujranwala divisions (87% each) and lowest in D.G Khan division (50%).There is a strong association between household wealth and literacy. Women living in the households in the highest quintile are almost four times more likely to be literate living in households in the than are women living in the households in the lowest quintile. Table ED.1: Literacy (young women) Percentage of women age 15-24 years who are literate, Punjab, 2014. Percentage literate1 Percentage not known Number of women age 15-24 years Punjab 72.6 0.2 21,119 Area of residence Rural 64.6 0.1 13,886 All Urban 88.0 0.3 7,233 Major Cities 90.4 0.4 3,681 Other Urban 85.5 0.2 3,552 Educationa None/pre-school 1.9 0.1 4,801 Primary 71.9 0.6 3,831 Middle 100.0 0.0 2,882 Secondary 100.0 0.0 4,919 Higher 100.0 0.0 4,677 Age 15-19 74.9 0.2 11,158 20-24 70.0 0.2 9,960 Wealth index quintile Lowest 26.7 0.1 3,269 Second 58.6 0.1 4,238 Middle 78.7 0.3 4,553 Fourth 88.7 0.2 4,683 Highest 96.7 0.1 4,376 Division Bahawalpur 52.5 0.4 2,102 D.G. Khan 49.5 0.1 1,682 Faisalabad 76.3 0.1 2,732 Gujranwala 86.6 0.1 3,446 Lahore 82.0 0.2 3,883 Multan 67.1 0.2 2,307 Rawalpindi 86.8 0.3 1,885 Sahiwal 63.1 0.0 1,441 Sargodha 63.7 0.2 1,642 1 MICS indicator 7.1; MDG indicator 2.3 - Literacy rate among young women a Total includes 7 unweighted cases of education missing P a g e | 139 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 primary school (regardless of age) who attended pre-school the previous year57. Overall, 93 percent of children who are currently attending the first grade of primary school were attending pre-school the previous year. Background characteristics show that generally most first graders in Punjab have attended pre-school. Table ED.2: School readiness Percentage of children attending first grade of primary school who attended pre-school the previous year, Punjab, 2014. Percentage of children attending first grade who attended pre-school in previous year1 Number of children attending first grade of primary school Punjab 92.5 6,231 Area of residence Rural 91.9 4,187 All Urban 93.9 2,044 Major Cities 93.5 1,047 Other Urban 94.3 997 Sex Male 92.5 3,310 Female 92.6 2,921 Mother's education None/pre-school 91.1 3,186 Primary 91.7 1,205 Middle 95.4 570 Secondary 95.4 737 Higher 96.6 531 Wealth index quintile Lowest 90.0 1,103 Second 92.3 1,373 Middle 90.9 1,396 Fourth 94.9 1,280 Highest 94.8 1,078 Division Bahawalpur 90.0 607 D.G. Khan 93.0 503 Faisalabad 93.3 761 Gujranwala 94.9 998 Lahore 92.1 1,187 Multan 91.7 804 Rawalpindi 89.8 530 Sahiwal 95.4 386 Sargodha 92.7 454 1 MICS indicator 7.2 - School readiness 57 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 P a g e | 140 Preschool Attendance Thirty seven percent of children age 3–4 years are attending pre-school, with comparable attendance for boys and girls (37% for each) (Table ED.2A). In urban areas, pre-school attendance is higher (48%) compared to 33 percent in the rural. A much higher percentage of children age 4 years, attend pre- school (51%) compared to those age 3 years (25%). Pre-school attendance increases markedly with education of the household head and household wealth. It is observed that the percentage of 3 and 4 year olds attending pre-school is much lower than the percentage of children in grade 1 (of any age) who attended preschool the year before (as shown in ED.2). This is may be due to the fact that children start school usually later than the school entry of 5 (see table ED.4) therefore they may also participate in pre-school at an older age. Table ED.2A: Pre-school attendance Percentage of children of aged 36-59 months attending pre-school, Punjab, 2014. Male Female Total Pre-school attendance Number of children age 36-59 months Pre-school attendance Number of children age 36-59 months Pre-school attendance Number of children age 36-59 months Punjab 37.2 6,418 37.4 6,173 37.3 12,591 Area of residence Rural 32.3 4,540 32.8 4,165 32.6 8,705 All Urban 49.0 1,878 46.8 2,008 47.9 3,886 Major Cities 49.9 908 46.7 1,069 48.2 1,977 Other Urban 48.1 970 46.9 939 47.5 1,909 Age 3 23.7 3,224 25.3 3,258 24.5 6,482 4 50.8 3,194 50.9 2,915 50.9 6,109 Education of household heada None/pre-school 26.3 2,623 24.9 2,414 25.6 5,037 Primary 37.3 1,102 36.7 1,136 37.0 2,239 Middle 41.6 892 41.9 813 41.7 1,705 Secondary 50.1 1,148 49.9 1,133 50.0 2,281 Higher 52.1 651 56.4 675 54.3 1,326 Wealth index quintile Lowest 17.6 1,571 14.1 1,489 15.9 3,061 Second 29.0 1,421 32.5 1,151 30.6 2,572 Middle 39.7 1,146 40.8 1,206 40.3 2,352 Fourth 50.4 1,179 48.7 1,163 49.5 2,342 Highest 59.0 1,100 57.1 1,165 58.0 2,265 Division Bahawalpur 22.4 760 22.7 684 22.6 1,443 D.G. Khan 20.7 788 19.7 715 20.2 1,503 Faisalabad 37.7 770 40.2 710 38.9 1,480 Gujranwala 50.1 907 51.2 950 50.7 1,857 Lahore 44.4 1,017 42.2 1,065 43.3 2,083 Multan 28.9 751 27.7 693 28.3 1,444 Rawalpindi 56.7 490 51.6 488 54.2 978 Sahiwal 40.0 460 36.4 428 38.3 888 Sargodha 37.4 475 43.4 440 40.3 914 a Total includes 4 unweighted cases of household head's education missing P a g e | 141 Primary and Secondary School Participation Universal access to basic 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 Punjab, children enter primary school at age 5 and secondary school at age 12. There are 5 grades in primary school and 5 in secondary school. In primary school, grades are referred to as class 1 to class 5 and for secondary school, grades are referred to as class 6 to class 10. The school year typically runs from April of one year to March of the following year. Of children who are of primary school entry age (age 5) in Punjab, 23 percent are attending the first grade of primary school (Table ED.3); Sex differentials do not exist. However differentials are present by urban-rural areas. Children’s participation to primary school is timelier in urban areas (26%) than in rural (22%). A positive correlation in school participation with mother’s education and socioeconomic status is observed; for children age 5 whose mothers have higher education, 38 percent are attending the first grade compared to 16 percent of children whose mothers have no education or only pre-school. Of children living in the households in the highest quintile, the proportion is 32 percent, while it is only about 12 percent among children living in the households in the lowest quintile. Table ED.3 also provides information for children entering class 1 at the age of 6 years. In Punjab, 46 percent of children aged 6 years enter class 1 and this proportion is higher in urban (57%) than rural areas (42%). P a g e | 142 Table ED.3: Primary school entry Percentage of children of primary school entry age entering grade 1 (net intake rate) and percentage of children age 6 years entering grade 1, Punjab, 2014. Percentage of children of primary school entry age entering grade 11 Number of children of primary school entry age (5 years old) Percentage of children age 6 years entering grade 1 Number of children age 6 years Punjab 23.4 6,396 46.1 6,594 Area of residence Rural 22.2 4,407 41.6 4,667 All Urban 26.0 1,988 57.0 1,928 Major Cities 23.8 1,034 58.4 955 Other Urban 28.4 954 55.6 973 Sex Male 22.5 3,257 45.9 3,340 Female 24.3 3,139 46.4 3,254 Mother's education None/pre-school 16.2 3,385 33.9 3,809 Primary 26.5 1,158 56.8 1,069 Middle 32.4 549 56.4 542 Secondary 33.9 708 68.2 661 Higher 37.6 597 75.1 514 Wealth index quintile Lowest 11.9 1,506 20.2 1,750 Second 19.8 1,296 44.7 1,432 Middle 27.8 1,299 53.7 1,237 Fourth 29.1 1,200 60.8 1,163 Highest 31.8 1,096 66.8 1,011 Division Bahawalpur 18.2 645 31.9 817 D.G. Khan 10.5 715 24.5 848 Faisalabad 25.4 695 51.6 758 Gujranwala 29.9 950 62.5 926 Lahore 23.2 1,158 52.0 1,073 Multan 21.4 803 41.6 794 Rawalpindi 36.0 498 65.0 459 Sahiwal 19.8 454 42.2 475 Sargodha 28.0 478 48.2 445 1 MICS indicator 7.3 - Net intake rate in primary education P a g e | 143 Table ED.4: Primary school net attendance and out of school children Percentage of children of primary school age attending primary or secondary school (adjusted net attendance ratio), percentage attending preschool, and percentage out of school, Punjab, 2014. Male Female Total Net attendance ratio (adjusted) Percentage of children: Number of children Net attendance ratio (adjusted) Percentage of children: Number of children Net attendance ratio (adjusted)1 Percentage of children: Number of children Not attending school or preschool Attending preschool Out of schoola Not attending school or preschool Attending preschool Out of schoola Not attending school or preschool Attending preschool Out of schoola Punjab 58.9 16.8 24.2 41.0 16,255 56.8 21.5 21.4 42.9 15,392 57.9 19.1 22.9 41.9 31,647 Area of residence Rural 55.4 20.4 24.1 44.5 11,423 52.0 27.0 20.8 47.8 10,865 53.7 23.6 22.5 46.1 22,287 All Urban 67.1 8.3 24.5 32.8 4,832 68.4 8.4 23.0 31.4 4,527 67.8 8.3 23.8 32.1 9,359 Major Cities 66.7 7.3 26.0 33.3 2,378 68.0 7.3 24.4 31.7 2,281 67.3 7.3 25.2 32.5 4,659 Other Urban 67.5 9.4 23.0 32.4 2,454 68.9 9.5 21.6 31.1 2,246 68.2 9.4 22.3 31.7 4,700 Age at beginning of school year 5 23.4 24.2 52.3 76.5 3,257 25.0 26.4 48.3 74.7 3,139 24.2 25.3 50.3 75.6 6,396 6 46.8 18.2 34.7 53.0 3,340 47.2 23.4 29.0 52.5 3,254 47.0 20.8 31.9 52.7 6,594 7 66.7 14.8 18.3 33.1 3,409 64.7 19.4 15.8 35.2 3,199 65.7 17.0 17.1 34.1 6,607 8 77.2 13.4 9.3 22.8 3,158 72.8 18.8 8.2 27.0 3,019 75.0 16.1 8.7 24.8 6,177 9 81.8 13.1 5.0 18.1 3,091 77.7 19.0 3.2 22.2 2,781 79.9 15.8 4.2 20.0 5,872 Mother's education None/pre-school 50.9 25.5 23.4 48.9 9,515 45.0 33.6 21.2 54.8 8,902 48.1 29.4 22.3 51.7 18,416 Primary 64.1 7.0 28.8 35.8 2,626 69.0 7.5 23.3 30.8 2,569 66.6 7.2 26.1 33.4 5,195 Middle 70.3 3.9 25.7 29.7 1,289 71.8 4.6 23.2 27.8 1,214 71.0 4.3 24.5 28.8 2,503 Secondary 75.3 2.3 22.4 24.7 1,543 76.0 2.3 21.6 23.9 1,509 75.6 2.3 22.0 24.3 3,052 Higher 75.9 2.7 21.3 24.0 1,283 79.4 3.0 17.4 20.4 1,198 77.6 2.8 19.4 22.2 2,481 Wealth index quintile Lowest 38.4 38.2 23.3 61.5 4,224 29.0 53.4 17.4 70.8 3,964 33.8 45.5 20.5 66.0 8,188 Second 56.6 16.0 27.3 43.3 3,493 54.1 21.9 23.9 45.7 3,204 55.4 18.8 25.6 44.4 6,698 Middle 66.5 10.3 22.9 33.2 3,109 67.1 8.9 23.6 32.5 2,980 66.8 9.6 23.2 32.9 6,089 Fourth 69.9 5.2 24.9 30.1 2,874 72.1 5.4 22.3 27.7 2,859 71.0 5.3 23.6 28.9 5,732 Highest 74.2 3.4 22.4 25.8 2,555 75.6 3.0 21.2 24.2 2,385 74.9 3.2 21.8 25.0 4,940 Division Bahawalpur 47.8 31.6 20.5 52.1 1,932 40.2 43.0 16.7 59.7 1,749 44.2 37.0 18.7 55.7 3,682 D.G. Khan 39.9 33.0 27.0 60.0 1,999 33.5 46.0 20.4 66.4 1,878 36.8 39.3 23.8 63.1 3,877 Faisalabad 63.3 12.4 24.3 36.7 1,867 62.6 16.2 21.1 37.3 1,773 62.9 14.3 22.7 37.0 3,640 Gujranwala 70.9 6.3 22.8 29.1 2,257 71.0 5.5 23.4 28.9 2,195 70.9 5.9 23.1 29.0 4,452 Lahore 63.2 10.2 26.5 36.6 2,701 64.9 9.8 25.1 34.9 2,603 64.1 10.0 25.8 35.8 5,304 Multan 55.8 21.6 22.3 43.9 2,011 51.7 27.8 19.7 47.5 1,873 53.8 24.6 21.0 45.7 3,884 Rawalpindi 76.1 4.0 19.8 23.8 1,174 74.5 5.8 19.2 25.0 1,124 75.3 4.8 19.5 24.4 2,298 Sahiwal 54.2 17.2 28.5 45.7 1,172 54.5 21.4 23.9 45.3 1,100 54.4 19.2 26.3 45.5 2,272 Sargodha 62.1 11.1 26.5 37.6 1,141 59.4 19.1 21.5 40.6 1,097 60.8 15.0 24.0 39.1 2,238 1 MICS indicator 7.4; MDG indicator 2.1 - Primary school net attendance ratio (adjusted) a The percentage of children of primary school age out of school are those not attending school and those attending preschool P a g e | 144 Table ED.4 provides the percentage of children of primary school age 5 to 9 years who are attending primary or secondary school58 and those who are out of school. Fifty eight percent of children of primary school age are attending school, slightly higher for males (59%) compare to females (57%). About 42 percent of the children are defined as out of school which comprise 19 percent not attending school and 23 percent are attending pre-school. It may be noted that the children attending pre-school are appeared to be starting school late and are counted as out of school. In urban areas 68 percent of children attend school while in rural areas, attendance is at 54 percent. Similar relationship is observed with mother’s education and household wealth. For mothers with only pre-school or no education, 48 percent of the children are attending school compared to 78 percent for mothers with higher education. Similarly, only one-third of children living in the households in the lowest quintile (34%) are attending school and this increases to 75 percent in the children living in the households in the highest quintile. At division level, net attendance ratio of primary level in the children ranges from 37 percent in DG Khan division to 75 percent in Rawalpindi division. Table ED.4B presents the Gross Attendance Rate (GAR) for primary school, which considers the number of children of all ages who are attending primary or secondary school as a percentage of the total number of children of primary school age (5–9 years). 58 Ratios presented in this table are "adjusted" since they include not only primary school attendance, but also secondary school attendance in the numerator. P a g e | 145 Table ED.4B: Primary school gross attendance ratio (5-9) years Percentage of children of all ages attending primary school or secondary school (adjusted gross attendance), Punjab, 2014. Male Female Total Gross attendance ratio (adjusted) Number of children Gross attendance ratio (adjusted) Number of children Gross attendance ratio (adjusted)1 Number of children Punjab 89.8 16,255 82.1 15,392 86.1 31,647 Area of residence Rural 87.4 11,423 76.4 10,865 82.0 22,287 All Urban 95.5 4,832 95.8 4,527 95.6 9,359 Major Cities 94.5 2,378 95.5 2,281 95.0 4,659 Other Urban 96.5 2,454 96.1 2,246 96.3 4,700 Mother's education None/pre-school 86.0 9,515 72.1 8,902 79.3 18,416 Primary 96.0 2,626 98.5 2,569 97.3 5,195 Middle 96.1 1,289 93.0 1,214 94.6 2,503 Secondary 97.1 1,543 93.8 1,509 95.4 3,052 Higher 87.0 1,283 93.2 1,198 90.0 2,481 Wealth index quintile Lowest 65.9 4,224 46.9 3,964 56.7 8,188 Second 92.5 3,493 85.2 3,204 89.0 6,698 Middle 101.9 3,109 97.8 2,980 99.9 6,089 Fourth 101.8 2,874 97.8 2,859 99.8 5,732 Highest 97.3 2,555 98.1 2,385 97.7 4,940 Division Bahawalpur 77.3 1,932 60.7 1,749 69.4 3,682 D.G. Khan 67.7 1,999 52.7 1,878 60.4 3,877 Faisalabad 95.2 1,867 91.7 1,773 93.5 3,640 Gujranwala 102.8 2,257 101.8 2,195 102.3 4,452 Lahore 94.8 2,701 92.1 2,603 93.5 5,304 Multan 86.2 2,011 75.3 1,873 80.9 3,884 Rawalpindi 108.6 1,174 99.0 1,124 103.9 2,298 Sahiwal 83.6 1,172 78.8 1,100 81.3 2,272 Sargodha 96.5 1,141 85.5 1,097 91.1 2,238 1 MICS indicator 7.S4 - Primary school gross attendance ratio (adjusted) The gross attendance ratio (GAR) at the primary level in the Punjab is 86 percent. The rate varies by sex, area of residence, mother's education and household wealth. Boys have higher GAR (90%) than girls (82%) and the same is true for urban areas (96%) compared to rural (82%). Thus more boys than girls and more urban children than rural (of all ages) attend primary school. Gross primary attendance rate increases sharply with the wealth quintiles, from 57 percent in the lowest quintile to 98 percent in the highest quintile. The higher GAR (86%) than the NAR (58%) indicates that many children in primary school at the time of the survey were over the official primary school going age. The secondary school net attendance ratio is presented in Table ED.559. It is observed that only 42 percent of the children are attending secondary school. Of the remaining, most (31%) are still attending primary school, and the rest (27%) are out of school. Secondary school net attendance is higher in urban (54%) than rural areas (37%). It also has a positive relation with wealth status of the household and level of the mother’s education. 59 Ratios presented in this table are "adjusted" since they include not only secondary school attendance, but also attendance to higher levels in the numerator. P a g e | 146 Table ED.5: Secondary school attendance and out of school children Percentage of children of secondary school age attending secondary school or higher (adjusted net attendance ratio), percentage attending primary school, and percentage out of school, Punjab, 2014. Male Female Total Net attendance ratio (adjusted) Percentage of children: Number of children Net attendance ratio (adjusted) Percentage of children: Number of children Net attendance ratio (adjusted)1 Percentage of children: Number of children Attending primary school Out of schoola Attending primary school Out of schoola Attending primary school Out of schoola Punjab 42.6 33.5 23.8 14,454 41.7 27.5 30.7 13,560 42.1 30.6 27.2 28,014 Area of residence Rural 38.6 35.3 25.9 9,908 34.2 27.5 38.1 9,168 36.5 31.6 31.8 19,076 All Urban 51.1 29.6 19.2 4,545 57.2 27.4 15.3 4,392 54.1 28.5 17.3 8,938 Major Cities 52.6 28.3 19.0 2,294 59.8 26.7 13.3 2,256 56.2 27.5 16.2 4,550 Other Urban 49.6 31.0 19.3 2,251 54.5 28.0 17.4 2,137 52.0 29.6 18.4 4,388 Age at beginning of school year 10 14.3 67.4 18.2 3,099 16.2 60.7 23.1 2,884 15.2 64.2 20.6 5,983 11 35.6 45.0 19.2 2,755 37.7 36.2 26.0 2,548 36.6 40.8 22.4 5,304 12 47.4 29.8 22.7 3,016 45.8 22.7 31.5 2,834 46.6 26.4 27.0 5,850 13 59.3 14.4 26.2 2,812 54.2 10.0 35.6 2,684 56.8 12.3 30.8 5,496 14 58.8 7.8 33.4 2,771 56.5 5.3 38.0 2,610 57.7 6.5 35.7 5,381 Mother's education None/pre-school 33.8 35.1 31.0 9,204 28.4 27.7 43.7 8,449 31.2 31.6 37.1 17,653 Primary 51.1 35.1 13.8 2,303 54.5 32.7 12.8 2,211 52.7 33.9 13.3 4,513 Middle 55.5 33.7 10.9 926 62.9 28.8 8.2 887 59.1 31.3 9.6 1,813 Secondary 62.0 28.9 9.0 1,135 73.7 21.5 4.8 1,161 67.9 25.2 6.9 2,296 Higher 73.9 20.0 5.9 843 76.3 18.9 4.8 815 75.1 19.5 5.4 1,658 Cannot be determinedb 53.9 1.4 44.8 44 (32.3) (4.7) (62.9) 38 43.8 2.9 53.2 82 Wealth index quintile Lowest 21.0 34.3 44.5 3,218 9.3 22.6 67.9 2,988 15.4 28.7 55.8 6,206 Second 36.5 38.0 25.4 3,127 28.4 32.5 38.9 2,892 32.6 35.4 31.9 6,019 Middle 44.9 36.3 18.7 2,957 48.0 32.2 19.8 2,725 46.4 34.3 19.2 5,682 Fourth 52.0 32.3 15.7 2,765 60.6 27.5 11.9 2,615 56.2 29.9 13.9 5,381 Highest 65.7 24.7 9.6 2,386 71.0 22.0 6.9 2,339 68.3 23.4 8.3 4,726 P a g e | 147 Table ED.5: Secondary school attendance and out of school children Percentage of children of secondary school age attending secondary school or higher (adjusted net attendance ratio), percentage attending primary school, and percentage out of school, Punjab, 2014. Male Female Total Net attendance ratio (adjusted) Percentage of children: Number of children Net attendance ratio (adjusted) Percentage of children: Number of children Net attendance ratio (adjusted)1 Percentage of children: Number of children Attending primary school Out of schoola Attending primary school Out of schoola Attending primary school Out of schoola Division Bahawalpur 28.3 32.8 38.8 1,628 26.7 23.5 49.6 1,463 27.5 28.4 43.9 3,091 D.G. Khan 30.5 34.2 35.2 1,541 23.4 23.2 53.3 1,517 27.0 28.8 44.2 3,059 Faisalabad 47.5 31.2 21.3 1,847 43.2 29.9 26.8 1,655 45.5 30.6 23.9 3,503 Gujranwala 50.5 33.7 15.8 2,086 55.9 31.1 13.0 2,075 53.2 32.4 14.4 4,162 Lahore 47.1 33.4 19.5 2,506 51.9 28.3 19.6 2,352 49.4 30.9 19.5 4,859 Multan 35.9 36.2 27.8 1,654 33.7 26.6 39.7 1,619 34.8 31.4 33.7 3,273 Rawalpindi 57.0 32.3 10.6 1,116 58.3 25.4 15.9 1,033 57.6 29.0 13.1 2,149 Sahiwal 38.2 34.4 27.2 976 34.9 28.4 36.6 897 36.6 31.5 31.7 1,873 Sargodha 46.0 34.4 19.5 1,099 36.9 28.7 34.2 948 41.8 31.8 26.3 2,047 Punjab 42.6 33.5 23.8 14,454 41.7 27.5 30.7 13,560 42.1 30.6 27.2 28,014 1 MICS indicator 7.5 - Secondary school net attendance ratio (adjusted) a The percentage of children of secondary school age out of school are those who are not attending primary, secondary, or higher education b 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 P a g e | 148 The percentage of children entering first grade who eventually reach the last grade of primary school is presented in Table ED.6. Of all children starting grade one, the majority (96%) eventually reach the last grade of primary school. The MICS included only questions on school attendance in the current and previous year. Thus, the indicator was calculated synthetically by computing the cumulative probability of survival from the first to the last grade of primary 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 primary school, up to the time they reached the last grade of primary 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. Table ED.6: 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), Punjab, 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 attending grade 4 last school year who are attending grade 5 this school year Percent who reach grade 5 of those who enter grade 11 Punjab 99.5 99.2 98.7 98.3 95.8 Area of residence Rural 99.8 99.3 99.6 99.1 97.8 All Urban 99.9 99.5 98.6 98.5 96.5 Major Cities 99.3 99.4 98.4 98.6 95.8 Other Urban 99.7 98.9 99.1 98.0 95.7 Sex Male 99.3 99.0 98.5 98.1 95.1 Female 99.9 99.4 99.1 98.8 97.2 Mother's educationa None/pre-school 99.4 98.7 98.0 97.7 93.9 Primary 99.4 99.5 99.2 98.5 96.7 Middle 99.8 99.7 99.2 99.6 98.4 Secondary 99.8 100.0 100.0 99.9 99.7 Higher 100.0 100.0 99.9 99.0 98.9 Wealth index quintile Lowest 99.2 98.3 97.6 97.1 92.4 Second 99.2 98.9 99.0 97.1 94.3 Middle 99.7 99.4 98.8 98.3 96.2 Fourth 99.6 99.3 98.7 99.2 97.0 Highest 99.9 99.9 99.2 99.5 98.4 Division Bahawalpur 99.6 99.3 99.2 99.5 97.6 D.G. Khan 99.8 98.6 99.1 97.7 95.3 Faisalabad 99.5 99.7 97.8 98.7 95.8 Gujranwala 99.6 99.0 99.2 98.6 96.4 Lahore 99.4 99.5 98.2 98.6 95.8 Multan 99.2 98.5 98.7 98.0 94.6 Rawalpindi 99.6 99.8 99.2 98.4 97.1 Sahiwal 99.3 99.2 98.6 96.9 94.1 Sargodha 99.6 98.2 99.0 97.1 94.0 1 MICS indicator 7.6; MDG indicator 2.2 - Children reaching last grade of primary (*) Figures that are based on fewer than 25 unweighted cases a Total includes 1 unweighted cases of women's education missing P a g e | 149 The primary school completion rate and transition rate to secondary education are presented in Table ED.7. The primary completion rate is the ratio of the total number of students, regardless of age, entering the last grade of primary school for the first time, to the number of children of the primary graduation age at the beginning of the current (or most recent) school year. Table ED.7 shows that the primary school completion rate is 75 percent. About 91 percent of the children who were attending the last grade of primary school in the previous school year were found to be attending the first grade of secondary school in the school year of the survey. The table also provides “effective” transition rate which takes account of the presence of repeaters in the final grade of primary school. This indicator better reflects situations in which pupils repeat the last grade of primary 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. The table shows that in total 93 percent of the children in the last grade of primary school are expected to move on to secondary school. Table ED.7: Primary school completion and transition to secondary school Primary school completion rates and transition and effective transition rates to secondary school, Punjab, 2014. Primary school completion rate1 Number of children of primary school completion age Transition rate to secondary school2 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 Punjab 74.9 5,872 91.4 3,946 92.5 3,899 Area of residence Rural 69.3 4,076 90.7 2,523 91.9 2,490 All Urban 87.6 1,796 92.6 1,423 93.6 1,409 Major Cities 89.4 887 91.6 723 92.1 720 Other Urban 85.9 909 93.7 700 95.1 689 Sex Male 78.0 3,091 91.8 2,104 93.1 2,075 Female 71.4 2,781 90.9 1,842 91.8 1,824 Mother's education None/pre-school 64.3 3,575 89.3 2,053 90.8 2,019 Primary 88.8 952 93.1 770 94.1 762 Middle 92.2 430 92.3 317 92.7 316 Secondary 94.0 513 96.4 432 96.5 431 Higher 88.0 402 93.0 330 93.8 327 Wealth index quintile Lowest 40.7 1,509 86.3 450 87.9 442 Second 72.1 1,232 88.5 818 90.0 805 Middle 87.4 1,151 92.6 940 93.8 929 Fourth 94.2 1,051 93.6 907 94.5 899 Highest 96.8 928 93.1 830 93.8 824 Division Bahawalpur 57.6 672 91.1 291 93.1 285 D.G. Khan 51.9 711 94.6 309 94.9 309 Faisalabad 78.8 703 90.7 513 91.9 506 Gujranwala 91.9 838 93.3 717 94.6 708 Lahore 86.2 990 92.3 771 92.8 768 Multan 60.2 726 89.4 383 90.4 378 Rawalpindi 97.3 413 90.7 402 92.4 394 Sahiwal 69.1 427 89.2 258 90.5 254 Sargodha 84.4 391 87.8 301 89.1 297 1 MICS indicator 7.7 - Primary completion rate 2 MICS indicator 7.8 - Transition rate to secondary school P a g e | 150 The ratio of girls to boys attending primary 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 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 primary education tend to be boys. The table shows that gender parity for primary and secondary school is 0.97 and 0.98 respectively which is close to 1.00, indicating only small difference in the attendance of girls and boys in primary and secondary schools. The difference in gender parity also exits based on wealth of the households. Of the children living in households in the lowest quintile, the gender parity for primary schools is 0.76 and 0.44 for secondary schools. In contrast, the gender parity for both primary and secondary schools is more than 1.00 for children living in households in the highest quintile. There is considerable variations among divisions with regard to gender parity in secondary school ranging from from 0.77 in D.G. Khan division to 1.11 in Gujranwala and Lahore divisions. P a g e | 151 Table ED.8: Education gender parity index (GPI) Ratio of adjusted net attendance ratios of girls to boys, in primary and secondary school, Punjab, 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 Punjab 56.8 58.9 0.97 41.2 42.2 0.98 Area of residence Rural 52.0 55.4 0.94 33.9 38.4 0.88 All Urban 68.4 67.1 1.02 56.5 50.5 1.12 Major Cities 68.0 66.7 1.02 59.4 52.0 1.14 Other Urban 68.9 67.5 1.02 53.4 48.9 1.09 Mother's education None/pre-school 45.0 50.9 0.88 28.1 33.5 0.84 Primary 69.0 64.1 1.08 54.1 50.8 1.07 Middle 71.8 70.3 1.02 62.2 55.3 1.12 Secondary 76.0 75.3 1.01 73.3 61.7 1.19 Higher 79.4 75.9 1.05 74.5 72.1 1.03 Cannot be determineda na na na (22.8) 50.8 0.45 Wealth index quintile Lowest 29.0 38.4 0.76 9.3 20.9 0.44 Second 54.1 56.6 0.96 28.2 36.3 0.78 Middle 67.1 66.5 1.01 47.5 44.4 1.07 Fourth 72.1 69.9 1.03 59.9 51.6 1.16 Highest 75.6 74.2 1.02 69.9 64.9 1.08 Division Bahawalpur 40.2 47.8 0.84 25.9 27.8 0.93 D.G. Khan 33.5 39.9 0.84 23.1 29.9 0.77 Faisalabad 62.6 63.3 0.99 42.8 47.3 0.91 Gujranwala 71.0 70.9 1.00 55.6 50.2 1.11 Lahore 64.9 63.2 1.03 51.6 46.6 1.11 Multan 51.7 55.8 0.93 32.9 35.6 0.93 Rawalpindi 74.5 76.1 0.98 57.7 56.8 1.02 Sahiwal 54.5 54.2 1.00 34.3 37.6 0.91 Sargodha 59.4 62.1 0.96 36.7 45.8 0.80 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 na: not applicable ( ) Figures that are based on 25-49 unweighted cases The percentage of girls in the total out of school population, in both primary and secondary schools, is provided in Table ED.9. The table shows that at the primary level girls account for about half (50%) of the out-of-school population. However, at the secondary level, girls’ share increases to 55 percent. In rural areas, and among the households in the lowest quintile, girls compose the majority of the out-of-school population at both primary and secondary levels. In rural areas, girls constitute a larger proportion of the out-of-school population at both primary and secondary school levels i.e. girls in rural areas account for 51 percent of out of school population of primary school age compared to 47 percent in urban areas. Similarly, for secondary school level, 58 percent of girls in rural areas to 44 percent in urban areas. P a g e | 152 Table ED.9: Out of school gender parity Percentage of girls in the total out of school population, in primary and secondary school, Punjab, 2014. Primary school Secondary school Percentage of out of school children Number of children of primary school age Percentage of girls in the total out of school population of primary school age Number of children of primary school age out of school Percentage of out of school children Number of children of secondary school age Percentage of girls in the total out of school population of secondary school age Number of children of secondary school age out of school Punjab 41.9 31,647 49.8 13,274 27.2 28,014 54.8 7,609 Area of residence Rural 46.1 22,287 50.5 10,268 31.8 19,076 57.6 6,066 All Urban 32.1 9,359 47.3 3,006 17.3 8,938 43.6 1,543 Major Cities 32.5 4,659 47.7 1,513 16.2 4,550 40.7 736 Other Urban 31.7 4,700 46.8 1,492 18.4 4,388 46.2 807 Mother's educationa None/pre-school 51.7 18,416 51.2 9,527 37.1 17,653 56.4 6,544 Primary 33.4 5,195 45.7 1,733 13.3 4,513 47.1 602 Middle 28.8 2,503 46.9 720 9.6 1,813 41.9 173 Secondary 24.3 3,052 48.6 742 6.9 2,296 35.3 157 Higher 22.2 2,481 44.3 552 5.4 1,658 43.7 89 Wealth index quintile Lowest 66.0 8,188 51.9 5,404 55.8 6,206 58.6 3,462 Second 44.4 6,698 49.2 2,977 31.9 6,019 58.7 1,919 Middle 32.9 6,089 48.4 2,001 19.2 5,682 49.4 1,092 Fourth 28.9 5,732 47.8 1,656 13.9 5,381 41.6 746 Highest 25.0 4,940 46.7 1,237 8.3 4,726 41.5 390 Division Bahawalpur 55.7 3,682 50.9 2,051 43.9 3,091 53.4 1,358 D.G. Khan 63.1 3,877 51.0 2,446 44.2 3,059 59.9 1,350 Faisalabad 37.0 3,640 49.1 1,346 23.9 3,503 53.0 838 Gujranwala 29.0 4,452 49.1 1,291 14.4 4,162 45.0 598 Lahore 35.8 5,304 47.9 1,899 19.5 4,859 48.6 949 Multan 45.7 3,884 50.2 1,773 33.7 3,273 58.3 1,101 Rawalpindi 24.4 2,298 50.1 560 13.1 2,149 58.2 282 Sahiwal 45.5 2,272 48.2 1,034 31.7 1,873 55.3 594 Sargodha 39.1 2,238 50.9 874 26.3 2,047 60.2 538 a Total includes 41 unweighted cases of women’s education missing 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 IX, Table CD.1. P a g e | 153 Figure ED.1 : Educat ion indicators by sex , MICS, Punjab, 2014 School readiness 93 93 Net intake rate in primary education Primary school completion rate Transition rate to secondary school 23 25 78 73 92 91 Attendance to early childhood education Primary school attendance Secondary school attendance 25 27 60 58 43 42 Children reaching last grade of primary 96 96 Boys Girls Note: All indicator values are in percent Literacy Rate Literacy is an important indicator for monitoring progress towards universal education. It was assessed in MICS Punjab, 2014 by asking the respondent whether each household member had the ability to read and write with understanding in any language from a list of languages (Urdu, English, Punjabi, Saraiki and others), but excluding Quranic reading if this was the only response. Literacy rate for population age 10 years or older, 15 years or older and 15-24 years are derived from the survey through specific questions that are not the part of MICS5 standard questionnaires and this method is different from the method used to measure female literacy as discussed at the start of this chapter. Literacy Rate (10+ years) Literacy rate amongst household members age 10 years or older is presented in Table ED.10. More than half (61%) of the Punjab population age 10 or older is literate. There is marked variation between males (69%) and females (52%). Across divisions, literacy rate is highest in Rawalpindi where three-fourth of population is literate (75%) and lowest in Bahawalpur division (45%). Literacy among rural population is lower (54%) compared to urban population (75%) and population in major cities (78%). Gender disparities also exist by area of residence. In rural areas 64 percent males are literate compared to only 43 percent of females. Gender gap is slightly narrower in major cities (males 81%, females 74%) and in other urban areas (males 78%, females 66%). Literacy rate (10+ years) decreases with the increasing age. While only 19 percent of population age 75 years or older is literate, the corresponding figure is 78 percent among population age 15-19. However, a positive association between literacy rate (10+ years) and the education of household head and household wealth is observed. Literacy rate increases sharply from 28 percent of population living in the households P a g e | 154 in the lowest quintile to 86 percent of population living in the households in the highest quintile. Similarly, literacy rate markedly increases with education level of the head of the household from 38 percent for population whose household head has no education or only pre-school to 83 percent of population whose household head has higher education. The same trends are observed across the other background characteristics for literacy rate among population age 15 or above. Table ED.10: Literacy rate among population age 10 years or above Percentage of household members age 10 years or above who are literate, Punjab, 2014. Male Female Total Literacy rate Number of household members age 10 years or above Literacy rate Number of household members age 10 years or above Literacy rate1 Number of household members age 10 years or above Punjab 69.3 92,625 52.1 90,930 60.8 183,555 Area of residence Rural 63.8 61,177 43.0 60,166 53.5 121,342 All Urban 79.9 31,449 70.0 30,764 75.0 62,213 Major Cities 81.4 16,587 73.9 16,071 77.7 32,657 Other Urban 78.1 14,862 65.6 14,694 71.9 29,555 Education of household heada None/pre-school 41.3 37,697 33.9 36,497 37.6 74,194 Primary 77.5 16,169 51.9 15,766 64.9 31,935 Middle 89.8 11,764 60.0 11,739 74.9 23,503 Secondary 93.3 16,734 68.7 16,777 81.0 33,511 Higher 96.4 10,235 81.8 10,129 89.1 20,364 Age 10 - 14 77.8 14,813 73.3 13,848 75.6 28,660 15 - 19 80.0 13,283 74.9 12,709 77.5 25,992 20 - 24 78.5 11,397 69.6 11,583 74.0 22,980 25 - 29 74.8 9,480 60.1 10,708 67.0 20,188 30 - 34 72.3 8,302 51.6 8,455 61.9 16,757 35 - 39 69.4 6,630 43.8 6,948 56.3 13,578 40 - 44 65.0 5,752 35.6 5,639 50.4 11,391 45 - 49 57.3 5,575 26.4 5,106 42.5 10,680 50 - 54 56.6 4,386 23.7 4,711 39.6 9,096 55 - 59 54.9 3,544 17.6 3,531 36.3 7,075 60 - 64 49.6 3,146 14.9 2,877 33.0 6,023 65 - 69 45.3 2,415 8.6 1,836 29.5 4,251 70 - 74 39.2 1,816 6.2 1,362 25.0 3,179 75 + 30.3 2,087 4.4 1,617 19.0 3,704 Wealth index quintile Lowest 39.7 17,458 16.0 16,626 28.2 34,084 Second 61.4 18,587 37.1 17,749 49.5 36,335 Middle 71.8 18,827 54.0 18,314 63.0 37,141 Fourth 80.0 18,650 66.3 18,869 73.1 37,519 Highest 90.9 19,103 81.4 19,373 86.1 38,476 Division Bahawalpur 53.6 9,659 34.9 9,179 44.5 18,838 D.G. Khan 57.7 8,026 33.6 8,001 45.7 16,027 Faisalabad 72.6 12,170 55.6 11,475 64.3 23,645 Gujranwala 72.9 13,083 63.7 14,122 68.1 27,205 Lahore 73.9 17,043 63.4 16,144 68.8 33,186 Multan 64.0 10,345 43.8 10,102 54.0 20,447 Rawalpindi 84.6 8,428 64.8 8,552 74.7 16,980 Sahiwal 67.0 6,497 46.4 6,226 56.9 12,722 Sargodha 71.5 7,375 42.8 7,130 57.4 14,505 1 MICS indicator 7.S1 - Literacy rate 10+ (Reported) a Total includes 58 unweighted cases of household head's education missing P a g e | 155 Literacy Rate (15+ years) Table ED.11 shows the literacy rate (15+ years). In Punjab, 58 percent of the population age 15 years and above is literate with the disparity between males (68%) and females (48%). Patterns in literacy (15+ years) are similar to those in literacy (10+ years), however the rates are lower especially in rural areas (50%) and particularly for females (39%). The variation by sex is slightly narrower in major cities compared to other urban areas. Table ED.11: Literacy rate among population age 15 years or above Percentage of household members age 15 years or above who are literate, Punjab, 2014. Male Female Total Literacy rate Number of household members age 15 years or above Literacy rate Number of household members age 15 years or above Literacy rate1 Number of household members age 15 years or above Punjab 67.6 77,813 48.3 77,082 58.0 154,895 Area of residence Rural 61.8 51,038 38.7 50,779 50.3 101,817 All Urban 78.8 26,774 66.9 26,303 72.9 53,077 Major Cities 80.5 14,252 71.3 13,780 76.0 28,033 Other Urban 76.8 12,522 62.2 12,523 69.5 25,045 Education of household heada None/pre-school 36.4 31,423 29.4 30,692 33.0 62,115 Primary 77.0 13,488 47.8 13,368 62.5 26,856 Middle 90.7 9,900 55.7 9,932 73.2 19,832 Secondary 93.9 14,237 65.1 14,348 79.4 28,584 Higher 96.5 8,741 79.7 8,726 88.1 17,468 Age 15 - 19 80.0 13,283 74.9 12,709 77.5 25,992 20 - 24 78.5 11,397 69.6 11,583 74.0 22,980 25 - 29 74.8 9,480 60.1 10,708 67.0 20,188 30 - 34 72.3 8,302 51.6 8,455 61.9 16,757 35 - 39 69.4 6,630 43.8 6,948 56.3 13,578 40 - 44 65.0 5,752 35.6 5,639 50.4 11,391 45 - 49 57.3 5,575 26.4 5,106 42.5 10,680 50 - 54 56.6 4,386 23.7 4,711 39.6 9,096 55 - 59 54.9 3,544 17.6 3,531 36.3 7,075 60 - 64 49.6 3,146 14.9 2,877 33.0 6,023 65 - 69 45.3 2,415 8.6 1,836 29.5 4,251 70 - 74 39.2 1,816 6.2 1,362 25.0 3,179 75 + 30.3 2,087 4.4 1,617 19.0 3,704 Wealth index quintile Lowest 36.3 14,091 11.5 13,506 24.1 27,597 Second 58.5 15,399 30.8 14,771 44.9 30,171 Middle 69.9 15,822 48.5 15,554 59.3 31,376 Fourth 78.5 15,831 62.2 16,215 70.2 32,046 Highest 90.2 16,669 79.4 17,036 84.7 33,705 P a g e | 156 Table ED.11: Literacy rate among population age 15 years or above Percentage of household members age 15 years or above who are literate, Punjab, 2014. Male Female Total Literacy rate Number of household members age 15 years or above Literacy rate Number of household members age 15 years or above Literacy rate1 Number of household members age 15 years or above Division Bahawalpur 52.5 7,979 32.0 7,689 42.4 15,668 D.G. Khan 55.4 6,418 29.0 6,417 42.2 12,835 Faisalabad 70.7 10,305 51.4 9,779 61.3 20,084 Gujranwala 70.8 10,950 59.4 12,026 64.8 22,976 Lahore 72.0 14,474 59.8 13,739 66.1 28,213 Multan 62.3 8,635 39.5 8,439 51.0 17,074 Rawalpindi 83.7 7,302 61.5 7,528 72.4 14,831 Sahiwal 65.0 5,492 42.0 5,302 53.7 10,795 Sargodha 69.9 6,257 38.4 6,161 54.3 12,419 Punjab 67.6 77,813 48.3 77,082 58.0 154,895 1 MICS indicator 7.S2 - Literacy rate 15+ (Reported) a Total includes 51 unweighted cases of household head's education missing Literacy Rate (15-24 years) The self-reported adult literacy rate of 15–24 years also termed as youth literacy rate is presented in Table ED.12. This literacy rate is self-reported and therefore not comparable with the female literacy rate provided in table ED.1 whereby respondents were asked to read simple sentences.Adult literacy rate of 15–24 years also termed as youth literacy rate is presented in Table ED.12. Overall youth literacy rate is 76 percent; males 79 percent and females 72 percent. Youth literacy rate for urban is higher (87%) compared to rural areas (70%). The adult literacy rate has a positive association with wealth. Literacy rate among males living in the households in the highest quintile is 95 percent compared to 53 percent in the lowest quintile. Similarly, literacy rate for females living in the households in the highest quintile is 96 percent compared to 28 percent of females living in the households in the lowest wealth quintile. The results also show that population age 15–19 is slightly more literate (78%) than population age 20–24 (74%). P a g e | 157 Table ED.12: Literacy rate among population age 15-24 years Percentage of household members age 15-24 years who are literate, Punjab, 2014. Male Female Total Literacy rate Number of household members age 15-24 years Literacy rate Number of household members age 15-24 years Literacy rate1 Number of household members age 15-24 years Punjab 79.3 24,679 72.4 24,292 75.9 48,972 Area of residence Rural 75.7 16,198 64.7 15,937 70.2 32,136 All Urban 86.3 8,481 87.0 8,355 86.6 16,836 Major Cities 88.4 4,438 89.2 4,301 88.8 8,740 Other Urban 84.0 4,042 84.6 4,054 84.3 8,096 Education of household head None/pre-school 65.2 10,493 55.4 9,913 60.4 20,405 Primary 81.8 4,368 73.9 4,470 77.8 8,838 Middle 89.5 3,104 82.9 3,127 86.2 6,231 Secondary 94.0 4,250 89.0 4,366 91.5 8,616 Higher 97.0 2,459 95.4 2,414 96.2 4,873 Age 15 - 19 80.0 13,283 74.9 12,709 77.5 25,992 20 - 24 78.5 11,397 69.6 11,583 74.0 22,980 Wealth index quintile Lowest 53.0 4,287 27.6 3,782 41.1 8,070 Second 73.4 5,055 58.9 4,919 66.3 9,973 Middle 81.8 5,259 78.7 5,225 80.2 10,483 Fourth 89.0 5,067 88.2 5,257 88.6 10,325 Highest 95.3 5,011 95.7 5,110 95.5 10,121 Division Bahawalpur 63.7 2,487 52.9 2,405 58.4 4,892 D.G. Khan 69.0 2,133 52.2 1,961 60.9 4,094 Faisalabad 81.2 3,269 76.2 3,091 78.7 6,360 Gujranwala 85.3 3,519 86.0 3,926 85.7 7,445 Lahore 82.4 4,643 80.0 4,554 81.2 9,197 Multan 75.4 2,736 66.0 2,635 70.8 5,371 Rawalpindi 92.4 2,172 87.9 2,167 90.1 4,339 Sahiwal 76.7 1,710 65.1 1,660 71.0 3,370 Sargodha 82.4 2,012 62.5 1,893 72.8 3,905 1 MICS indicator 7.S3 - Literacy rate 15-24 years (Reported) Public and private primary school attendance rate Table ED.13 provides the percentage of children (5-9 years) attending primary schools by type of school. In Punjab, 54 percent of the children are attending government/public school and 46 percent are attending a private school. Children in rural areas and those living in the households in the lowest quintile are more likely to attend the government schools. The attendance in government schools declines from 83 percent for children living in the households in the lowest quintile to 20 percent of children living in the households in the highest quintile. About 64 percent of children in rural areas attend government schools while 36 percent attend private schools, the reverse is true for urban areas. P a g e | 158 Table ED.13: Public and private primary school attendance rate Percentage of children (5-9 years) attending primary schools by type of school, Punjab, 2014. Attending primary school Number of children 5-9 years attending primary school Attending Government / Public primary school1 Attending Private primary school Attending Others Attending primary school but DK / Missing type of school Total Punjab 54.2 45.6 0.1 0.1 100.0 18,310 Area of residence Rural 63.6 36.2 0.0 0.2 100.0 11,978 All Urban 36.3 63.5 0.2 0.1 100.0 6,332 Major Cities 29.3 70.6 0.1 0.0 100.0 3,128 Other Urban 43.1 56.6 0.3 0.1 100.0 3,205 Education of household heada None/pre-school 67.8 32.0 0.1 0.1 100.0 5,933 Primary 61.1 38.7 0.0 0.1 100.0 3,280 Middle 54.2 45.5 0.0 0.2 100.0 2,718 Secondary 43.1 56.7 0.1 0.1 100.0 3,898 Higher 29.8 69.9 0.2 0.1 100.0 2,475 Age at beginning of school year 5 49.3 50.3 0.1 0.3 100.0 1,554 6 51.5 48.1 0.1 0.2 100.0 3,104 7 52.6 47.2 0.1 0.1 100.0 4,349 8 55.0 44.8 0.1 0.1 100.0 4,636 9 58.2 41.7 0.1 0.0 100.0 4,666 Wealth index quintile Lowest 83.1 16.5 0.0 0.3 100.0 2,767 Second 75.3 24.6 0.0 0.1 100.0 3,710 Middle 60.0 39.8 0.1 0.2 100.0 4,074 Fourth 40.5 59.4 0.1 0.1 100.0 4,066 Highest 20.0 79.8 0.2 0.0 100.0 3,693 Division Bahawalpur 69.1 30.5 0.3 0.1 100.0 1,626 D.G. Khan 68.3 31.3 0.1 0.4 100.0 1,426 Faisalabad 53.4 46.3 0.2 0.1 100.0 2,284 Gujranwala 47.6 52.4 0.0 0.0 100.0 3,156 Lahore 36.8 63.0 0.0 0.2 100.0 3,396 Multan 65.4 34.3 0.0 0.2 100.0 2,095 Rawalpindi 49.7 50.2 0.0 0.1 100.0 1,732 Sahiwal 62.2 37.7 0.1 0.0 100.0 1,234 Sargodha 62.7 37.2 0.0 0.2 100.0 1,361 1 MICS indicator 7.S5 - Government school attendance rate (Primary) a Total includes 5 unweighted cases of household head's education missing P a g e | 159 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 around one in four children under the age of five years worldwide have never been recorded.60 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.61 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, Punjab, 2014. Children under age 5 whose birth is registered with civil authorities Number of children under age 5 Children under age 5 whose birth is not registered Has birth certificate No birth certificate Total registered1 Percent of children whose mother/caretaker knows how to register birth Number of children under age 5 without birth registration Seen Not seen Punjab 21.7 21.5 29.4 72.7 27,495 36.7 7,516 Area of residence Rural 17.3 17.3 33.6 68.2 19,002 32.3 6,034 All Urban 31.6 30.9 20.0 82.6 8,493 54.6 1,482 Major Cities 34.7 36.4 14.5 85.5 4,364 63.8 631 Other Urban 28.3 25.2 25.8 79.4 4,129 47.8 851 Sex Male 22.1 21.5 29.5 73.1 13,915 35.5 3,746 Female 21.3 21.6 29.3 72.2 13,580 37.9 3,769 Age 0-11 months 18.0 17.4 27.5 62.9 5,343 51.5 1,983 12-23 months 23.3 20.5 30.7 74.5 5,300 35.6 1,352 24-35 months 21.9 23.0 30.4 75.4 5,326 31.3 1,312 36-47 months 22.2 23.8 29.4 75.4 5,894 31.9 1,449 48-59 months 23.0 22.7 29.1 74.8 5,633 27.0 1,419 Mother’s education None/pre-school 12.2 16.4 30.9 59.5 13,140 27.6 5,321 Primary 24.7 20.4 34.1 79.1 4,991 52.0 1,043 Middle 30.5 24.5 28.8 83.8 2,740 55.3 445 Secondary 35.0 28.3 25.7 89.1 3,563 68.5 388 Higher 34.2 34.7 20.7 89.6 3,062 74.6 318 Wealth index quintile Lowest 4.6 11.2 30.0 45.8 6,316 21.4 3,423 Second 13.7 17.1 36.7 67.6 5,560 38.5 1,804 Middle 24.0 21.6 34.8 80.4 5,335 51.9 1,048 Fourth 32.5 26.2 26.9 85.7 5,380 58.5 770 Highest 38.4 34.7 17.3 90.4 4,904 71.5 471 60 UNICEF. 2014. The State of the World’s Children 2015. UNICEF. 61 UNICEF. 2013. Every Child’s Birth Right: Inequities and trends in birth registration. UNICEF. P a g e | 160 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, Punjab, 2014. Children under age 5 whose birth is registered with civil authorities Number of children under age 5 Children under age 5 whose birth is not registered Has birth certificate No birth certificate Total registered1 Percent of children whose mother/caretaker knows how to register birth Number of children under age 5 without birth registration Seen Not seen Division Bahawalpur 4.8 14.0 27.4 46.3 3,080 10.8 1,655 D.G. Khan 3.1 10.5 17.2 30.8 3,151 24.0 2,181 Faisalabad 19.7 27.8 36.2 83.6 3,272 55.3 536 Gujranwala 36.1 22.1 32.0 90.3 4,100 65.0 399 Lahore 29.5 35.9 17.5 82.9 4,670 60.9 798 Multan 14.4 16.5 34.6 65.5 3,019 41.1 1,043 Rawalpindi 53.2 20.3 14.6 88.1 2,165 65.5 258 Sahiwal 19.0 17.1 50.1 86.2 2,032 64.8 280 Sargodha 12.4 19.0 50.4 81.7 2,005 64.6 366 Punjab 21.7 21.5 29.4 72.7 27,495 36.7 7,516 1 MICS indicator 8.1 - Birth registration The births of 73 percent of children under five years in MICS Punjab, 2014 is observed to 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. Birth registration ranges from 31 percent in D.G Khan division to 90 percent in Gujranwala division. In urban areas, 83 percent of children are registered compared to 68 percent in rural areas. In addition, child registration is highly associated with household wealth and mother’s education. For example, 90 percent of children living in the households in the highest quintile are registered compared to 46 percent of children living in the households in the lowest quintile. There are significant differences between the proportion of children whose births are reported as registered and those who actually have a birth certificate. Overall, only 43 percent of children possess a birth certificate. These findings are also presented in Figure CP.1. P a g e | 161 Figure CP.1: Chi ldren under -5 whose bir ths ar e reg istered , MICS Punjab , 2014 The lack of adequate knowledge of how to register a child can present major obstacle to the fulfilment of a child’s right to identity. Data show that only that 63 percent of mothers of unregistered children report not knowing how to register a child’s birth, which points to presence of other barriers to birth registration. This proportion rises to 89 percent in Bahawalpur division. Child Labour Children around the world are routinely engaged in paid and unpaid forms of work that are not harmful to them. However, they are classified as child labourers when they are either too young to work or are involved in hazardous activities that may compromise their physical, mental, social or educational development. Article 32 (1) of the Convention on the Rights of the Child states: "States Parties recognize the right of the child to be protected from economic exploitation and from performing any work that is likely to be hazardous or to interfere with the child's education, or to be harmful to the child's health or physical, mental, spiritual, moral or social development". The child labour module was administered for children age 5-17 years and includes questions on the type of work a child does and the number of hours he or she is engaged in it. Data are collected on both economic activities – paid or unpaid work for someone who is not a member of the household, work for 27 17 36 32 18 35 15 50 50 20 34 31 34 29 26 21 29 19 14 47 58 65 31 74 36 31 63 35 29 45 55 63 69 43 Divisions Bahawalpur D.G.Khan Faisalabad Gujranwala Lahore Multan Rawalpindi Sahiwal Sargodha Area Urban Rural Mother's education None/pre-school Primary Middle Secondary Higher Punjab Percent Registered, no birth certificate Birth certificate P a g e | 162 a family farm or business and domestic work (household chores such as cooking, cleaning or caring for children, as well as collecting firewood or fetching water). The module also collects information on hazardous working conditions.62, 63 Table CP.2 describes children’s involvement in economic activities. The methodology of the MICS Indicator on Child Labour uses three age-specific thresholds for the number of hours a child can perform economic activity without it being classified as in child labour. A child that performed economic activities during the last week for more than the age-specific number of hours (see below) is classified as in child labour: i. age 5-11: 1 hour or more ii. age 12-14: 14 hours or more iii. age 15-17: 43 hours or more From the results, 8 percent of children age 5-11 are working for at least one hour, 9 percent of children age 12-14 years are engaged in economic activities for at least 14 hours while 5 percent of children age 15-17 worked for 43 hours or more. Child labour across all the three age groups is higher among boys than girls. Similarly child labour is much higher among children who are not attending school, those whose mother have pre-school or no education and those living in households in the lowest quintile. 62 UNICEF. 2012. How Sensitive Are Estimates of Child Labour to Definitions? MICS Methodological Paper No. 1. UNICEF. 63 The Child Labour module and the Child Discipline module were administered using random selection of a single child in all households with one or more children age 1-17 (See Appendix G: Questionnaires). The Child Labour module was administered if the selected child was age 5-17 and the Child Discipline module if the child was age 1-14 years old. To account for the random selection, the household sample weight is multiplied by the total number of children age 1-17 in each household. P a g e | 163 Table CP.2: Children's involvement in economic activities Percentage of children by involvement in economic activities during the last week, according to age groups, Punjab, 2014. Percentage of children age 5-11 years involved in economic activity for at least one hour Number of children age 5-11 years Percentage of children age 12-14 years involved in: Number of children age 12-14 years Percentage of children age 15-17 years involved in: Number of children age 15-17 years Economic activity less than 14 hours Economic activity for 14 hours or more Economic activity less than 43 hours Economic activity for 43 hours or more Punjab 8.4 42,013 13.3 9.1 17,779 25.4 5.2 15,176 Area of residence Rural 10.6 29,637 17.3 11.3 12,053 32.2 5.3 9,964 All Urban 3.2 12,376 5.0 4.5 5,727 12.3 5.2 5,212 Major Cities 2.9 6,186 3.8 5.1 2,907 12.5 5.1 2,690 Other Urban 3.5 6,190 6.1 3.9 2,820 12.1 5.2 2,522 Sex Male 10.6 21,785 15.6 12.5 9,243 31.3 9.3 7,633 Female 6.1 20,228 10.8 5.4 8,536 19.4 1.1 7,543 School attendance Yes 6.9 33,602 11.5 3.6 12,455 16.4 0.6 7,737 No 14.6 8,411 17.5 21.9 5,325 34.8 10.1 7,439 Mother’s education None/pre-school 11.4 24,632 17.0 12.0 11,530 31.5 6.1 9,519 Primary 6.0 6,837 8.8 5.3 2,892 16.6 5.2 2,121 Middle 4.5 3,277 7.3 3.6 1,152 13.9 4.6 853 Secondary 2.7 4,039 3.6 2.9 1,274 10.7 0.5 1,013 Higher 1.7 3,229 2.7 0.7 931 3.3 0.0 628 Cannot be determineda na na na na na 24.6 6.2 1,041 Wealth index quintile Lowest 16.4 10,612 22.8 19.6 3,929 46.2 9.0 2,728 Second 10.3 8,774 18.3 10.0 3,955 35.3 4.9 3,166 Middle 6.6 8,280 11.3 7.3 3,574 22.8 4.8 3,333 Fourth 3.7 7,622 6.8 4.0 3,402 15.5 6.0 3,062 Highest 1.0 6,725 3.7 1.9 2,919 8.4 1.8 2,886 Division Bahawalpur 5.7 4,559 10.2 9.2 2,098 24.3 4.0 1,457 D.G. Khan 17.4 5,020 24.6 16.3 1,885 45.4 8.6 1,446 Faisalabad 11.5 4,989 17.1 9.2 2,142 26.5 6.0 1,951 Gujranwala 6.5 6,017 9.8 7.6 2,621 25.2 5.2 2,397 Lahore 5.1 7,124 9.0 7.7 3,087 16.4 5.1 2,786 Multan 7.3 5,326 16.0 9.6 2,055 27.1 2.6 1,523 Rawalpindi 5.0 2,948 8.6 2.6 1,433 15.6 2.0 1,366 Sahiwal 9.2 2,968 12.3 11.7 1,168 26.9 8.4 1,057 Sargodha 8.8 3,062 14.8 8.6 1,291 29.7 6.1 1,193 a Children age 15 or higher at the time of the interview whose mothers were not living in the household na: not applicable Table CP.3 provides data on children’s involvement in household chores. As for economic activity above, the methodology also uses age-specific thresholds for the number of hours a child can perform household chores without it being classified as child labour. A child that performed household chores during the last week for more than the age-specific number of hours is classified as in child labour: i. age 5-11 and age 12-14: 28 hours or more per week ii. age 15-17: 43 hours or more per week P a g e | 164 Girls are more likely to perform household chores than boys across all three age groups. The percentage of children involved seem consistently higher for girls than boys. Generally, there is very low involvement of children in household chores for the number of hours classified for child labour. Table CP.3: Children's involvement in household chores Percentage of children by involvement in household chores during the last week, according to age groups, Punjab, 2014. Percentage of children age 5-11 years involved in: N u m b e r o f c h ild re n a g e 5 -1 1 y e a rs Percentage of children age 12-14 years involved in: N u m b e r o f c h ild re n a g e 1 2 -1 4 y e a rs Percentage of children age 15-17 years involved in: N u m b e r o f c h ild re n a g e 1 5 -1 7 y e a rs H o u s e h o ld c h o re s l e s s th a n 2 8 h o u rs H o u s e h o ld c h o re s f o r 2 8 h o u rs o r m o re H o u s e h o ld c h o re s l e s s th a n 2 8 h o u rs H o u s e h o ld c h o re s f o r 2 8 h o u rs o r m o re H o u s e h o ld c h o re s l e s s th a n 4 3 h o u rs H o u s e h o ld c h o re s f o r 4 3 h o u rs o r m o re Punjab 66.0 0.8 42,013 82.4 3.2 17,779 87.0 1.1 15,176 Area of residence Rural 66.9 0.9 29,637 81.9 4.0 12,053 86.8 1.3 9,964 All Urban 64.0 0.5 12,376 83.3 1.6 5,727 87.3 0.9 5,212 Major Cities 63.3 0.4 6,186 84.7 1.4 2,907 87.3 1.5 2,690 Other Urban 64.7 0.6 6,190 81.9 1.7 2,820 87.4 0.3 2,522 Sex Male 65.0 0.5 21,785 81.2 0.8 9,243 82.3 0.3 7,633 Female 67.2 1.1 20,228 83.6 5.8 8,536 91.7 2.0 7,543 School attendance Yes 68.0 0.4 33,602 84.8 1.2 12,455 88.9 0.4 7,737 No 58.4 2.4 8,411 76.6 7.8 5,325 85.0 1.9 7,439 Mother’s education None/pre-school 66.1 1.1 24,632 82.0 3.7 11,530 86.7 1.0 9,519 Primary 72.3 0.5 6,837 85.0 2.2 2,892 87.8 0.4 2,121 Middle 65.1 0.5 3,277 83.7 3.2 1,152 88.6 0.3 853 Secondary 65.3 0.1 4,039 78.3 3.2 1,274 88.7 1.1 1,013 Higher 54.6 0.1 3,229 82.1 0.4 931 87.2 1.4 628 Cannot be determineda na na na na na na 84.2 4.7 1,041 Wealth index quintile Lowest 63.0 1.9 10,612 79.9 5.3 3,929 83.7 1.7 2,728 Second 67.9 0.8 8,774 81.2 4.9 3,955 87.2 1.4 3,166 Middle 71.5 0.4 8,280 84.6 2.3 3,574 89.0 0.7 3,333 Fourth 67.2 0.4 7,622 84.0 1.3 3,402 86.4 0.7 3,062 Highest 60.5 0.0 6,725 82.6 1.3 2,919 88.0 1.4 2,886 Division Bahawalpur 49.0 0.9 4,559 76.4 3.7 2,098 86.8 0.3 1,457 D.G. Khan 54.7 2.0 5,020 74.8 4.3 1,885 81.6 0.8 1,446 Faisalabad 77.5 1.5 4,989 86.4 4.9 2,142 90.8 1.9 1,951 Gujranwala 78.4 0.1 6,017 89.9 2.4 2,621 92.7 0.4 2,397 Lahore 65.3 0.2 7,124 80.7 1.3 3,087 83.7 1.5 2,786 Multan 69.2 0.4 5,326 89.1 3.0 2,055 90.6 1.2 1,523 Rawalpindi 68.1 0.6 2,948 84.0 3.6 1,433 88.9 1.9 1,366 Sahiwal 58.3 1.6 2,968 73.7 2.7 1,168 77.9 1.4 1,057 Sargodha 69.1 0.3 3,062 80.1 4.3 1,291 84.5 0.7 1,193 a Children age 15 or higher at the time of the interview whose mothers were not living in the household na: not applicable Table CP.4 combines the children working and performing household chores at or above and below the age-specific thresholds as detailed in the previous tables, as well as those children reported working under hazardous conditions, into the total child labour indicator. P a g e | 165 Overall, 16 percent of the children 5-17 years are involved in child labour. Children are more likely to be involved in child labour as they grow older; 28 percent of children age 15-17 are involved in child labour compared to 9 percent among children age 5-11. At divisional level, 10 percent of children in Rawalpindi division are involved in child labour compared to 30 percent in DG Khan division. Child labour is also higher in rural areas (20%) than urban areas (8%). The survey results also show that boys are more likely to be involved in child labour than girls (19% and 10% respectively). As expected child labour is higher among children not currently attending school, those whose mother’s education is low and children living in the households in the lowest quintile. Table CP.4: Child labour Percentage of children age 5-17 years by involvement in economic activities or household chores during the last week, percentage working under hazardous conditions during the last week, and percentage engaged in child labour during the last week, Punjab, 2014. Children involved in economic activities for a total number of hours during last week: Children involved in household chores for a total number of hours during last week: Children working under hazardous conditions Total child labour1 Number of children age 5-17 years Below the age specific threshold At or above the age specific threshold Below the age specific threshold At or above the age specific threshold Punjab 8.6 7.9 74.1 1.4 14.3 16.4 74,968 Area of residence Rural 10.6 9.7 74.2 1.7 18.1 20.3 51,654 All Urban 4.2 4.0 74.0 0.8 6.0 7.6 23,315 Major Cities 4.1 3.9 74.1 0.9 5.0 6.7 11,783 Other Urban 4.4 4.0 73.9 0.8 7.0 8.4 11,532 Sex Male 10.2 10.8 72.3 0.5 18.8 20.3 38,661 Female 6.9 4.9 76.1 2.4 9.5 12.2 36,307 Age 5-11 0.6 8.4 66.0 0.8 7.4 9.3 42,013 12-14 13.3 9.1 82.4 3.2 19.8 22.9 17,779 15-17 25.4 5.2 87.0 1.1 27.0 28.2 15,176 School attendance Yes 5.4 5.2 74.9 0.6 8.7 10.1 53,794 No 16.8 14.9 72.3 3.6 28.6 32.3 21,174 Mother’s education None/pre-school 11.2 10.4 74.4 1.7 19.1 21.6 45,681 Primary 5.2 5.7 78.2 0.9 8.9 10.5 11,850 Middle 4.1 4.3 72.9 1.1 6.6 8.1 5,282 Secondary 2.8 2.4 71.7 0.9 3.8 5.2 6,326 Higher 1.4 1.3 64.2 0.3 1.5 2.2 4,788 Cannot be determineda 24.6 6.2 84.2 4.7 25.3 27.5 1,041 Wealth index quintile Lowest 12.9 15.9 70.1 2.7 26.5 29.8 17,269 Second 12.0 9.1 75.1 1.9 18.5 21.1 15,896 Middle 7.8 6.4 78.4 0.9 11.9 13.7 15,187 Fourth 5.4 4.3 75.4 0.7 7.5 8.8 14,087 Highest 3.0 1.4 72.0 0.6 2.8 3.6 12,530 Division Bahawalpur 7.1 6.3 62.9 1.5 12.4 14.5 8,114 D.G. Khan 14.0 15.6 63.9 2.3 27.5 30.1 8,352 Faisalabad 9.9 9.8 82.5 2.4 16.0 19.6 9,082 Gujranwala 8.1 6.5 84.2 0.7 12.4 14.0 11,034 Lahore 6.2 5.7 72.9 0.7 9.1 10.6 12,996 Multan 8.5 7.0 77.4 1.2 13.6 15.3 8,904 Rawalpindi 6.2 3.7 77.0 1.7 8.2 9.9 5,748 Sahiwal 8.4 9.6 65.8 1.8 16.2 18.3 5,193 Sargodha 10.5 8.2 75.0 1.3 16.3 18.0 5,546 1 MICS indicator 8.2 - Child labour a Children age 15 or higher at the time of the interview whose mothers were not living in the household P a g e | 166 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. Studies64 have found that exposing children to violent discipline 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.65 64 Straus, MA and Paschall MJ. 2009. Corporal Punishment by Mothers and Development of Children’s Cognitive Ability: A longitudinal study of two nationally representative age cohorts. Journal of Aggression, Maltreatment & Trauma 18(5): 459-83. Erickson, MF and Egeland, B. 1987. A Developmental View of the Psychological Consequences of Maltreatment. School Psychology Review 16: 156-68. Schneider, MW et al. 2005. Do Allegations of Emotional Maltreatment Predict Developmental Outcomes Beyond that of Other Forms of Maltreatment?. Child Abuse & Neglect 29(5): 513–32. 65 UNICEF. 2013. Every Child’s Birth Right: Inequities and trends in birth registration. UNICEF. P a g e | 167 Table CP.5: Child discipline Percentage of children age 1-14 years by child disciplining methods experienced during the last one month, Punjab, 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 method1 Any Severe Punjab 6.1 73.6 67.7 26.6 80.7 85,311 Area of residence Rural 5.5 73.6 67.8 25.6 80.6 59,176 All Urban 7.3 73.4 67.6 29.0 81.0 26,135 Major Cities 7.5 73.6 68.1 32.2 80.9 13,197 Other Urban 7.2 73.1 67.0 25.8 81.0 12,938 Sex Male 5.4 74.8 70.2 28.4 81.9 43,842 Female 6.8 72.2 65.1 24.8 79.4 41,470 Age 1-2 6.1 55.2 51.6 17.9 63.4 12,128 3-4 4.9 74.9 73.9 29.6 83.2 13,391 5-9 4.9 79.3 76.3 31.2 86.6 31,143 10-14 7.9 74.5 62.4 24.0 80.4 28,649 Education of household heada None/pre-school 4.7 74.0 68.4 26.9 81.1 35,109 Primary 6.1 75.8 69.9 28.5 81.8 15,204 Middle 6.4 74.3 68.9 26.9 81.5 11,287 Secondary 7.2 72.8 67.1 26.0 80.4 14,809 Higher 9.2 68.5 61.0 23.2 76.6 8,874 Wealth index quintile Lowest 4.5 72.2 66.0 22.6 78.8 20,400 Second 5.5 74.4 69.6 27.0 81.8 17,865 Middle 5.8 75.6 69.1 28.4 82.2 16,622 Fourth 6.2 75.3 69.3 29.7 82.5 16,034 Highest 9.2 70.2 64.5 26.5 78.2 14,390 Division Bahawalpur 7.0 68.7 59.4 17.5 78.9 9,762 D.G. Khan 4.2 63.4 58.0 13.6 70.2 9,876 Faisalabad 4.6 78.5 71.0 32.2 84.2 10,026 Gujranwala 4.3 82.0 76.4 34.0 88.4 12,379 Lahore 7.3 73.7 71.5 39.1 80.1 14,568 Multan 7.3 71.7 61.2 21.3 78.2 10,169 Rawalpindi 6.9 75.3 68.9 21.4 83.4 6,353 Sahiwal 8.7 70.1 71.8 30.4 80.0 5,984 Sargodha 5.4 76.8 70.4 19.3 82.8 6,194 1 MICS indicator 8.3 - Violent discipline a Total includes 26 unweighted cases of household head's education missing It is observed that majority (81%) of the children age 1-14 years were subjected to at least one form of psychological or physical punishment by household members during the past month (Table CP.5). 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 74 percent of children experienced psychological aggression, 68 percent of children received 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) were given to 27 percent of children. Male children were subjected to physical discipline more than female children (70% and 65% respectively). Figure CP.2 depicts the child discipline methods. P a g e | 168 Figure CP.2: Chi ld d isc ip l in ing methods, chi ldren age 1 -14 years , MICS Punjab , 2014 While violent methods are extremely common forms of discipline, Table CP.6 reveals that only 34 percent of respondents believe that physical punishment is a necessary part of child-rearing. No clear trend in this regard is found with respect to respondent’s education, age, sex and relationship with the child as well as household wealth. 6 81 74 Other 41 Severe 27 Only non-violent discipline Any violent discipline Psychological aggression Physical punishment Percent P a g e | 169 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, Punjab, 2014. Respondent believes that a child needs to be physically punished Number of respondents to the child discipline module Punjab 34.2 26,143 Area of residence Rural 37.2 17,650 All Urban 28.0 8,493 Major Cities 25.6 4,392 Other Urban 30.7 4,101 Sex Male 34.6 4,917 Female 34.1 21,226 Age <25 31.3 3,041 25-39 34.6 14,005 40-59 34.9 7,807 60+ 32.8 1,290 Respondent's relationship to selected child Mother 35.5 16,590 Father 34.1 3,350 Othera 30.9 6,203 Respondent's education None/pre-school 39.9 12,457 Primary 35.2 4,416 Middle 30.7 2,533 Secondary 26.7 3,570 Higher 21.7 3,168 Wealth index quintile Lowest 41.1 5,776 Second 39.2 5,310 Middle 35.6 5,089 Fourth 30.7 5,086 Highest 22.9 4,882 Division Bahawalpur 30.6 2,897 D.G. Khan 33.9 2,596 Faisalabad 43.0 3,231 Gujranwala 41.6 3,750 Lahore 27.6 4,522 Multan 32.4 3,195 Rawalpindi 29.7 2,231 Sahiwal 42.1 1,792 Sargodha 27.6 1,929 a The question is asked to a single respondent in all households where at least one child age 1-14 years is living. The respondent is not necessarily a parent or caretaker of such a child and may not necessarily have responded to the child discipline module about his/her own child. P a g e | 170 Early Marriage and Polygyny Marriage66 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.67 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.68 66 All references to marriage in this chapter include marital union as well. 67 Bajracharya, A ND Amin, S. 2010. Poverty, marriage timing, and transitions to adulthood in Nepal: A longitudinal analysis using the Nepal living standards survey. Poverty, Gender, and Youth Working Paper No. 19. Population Council. Godha, D et al. 2011. The influence of child marriage on fertility, fertility-control, and maternal health care utilization. MEASURE/Evaluation PRH Project Working paper 11-124. 68 Clark, S et al. 2006. Protecting young women from HIV/AIDS: the case against child and adolescent marriage. International Family Planning Perspectives 32(2): 79-88. Raj, A et al. 2009. Prevalence of child marriage and its effect on fertility and fertility-control outcomes of young women in India: a cross-sectional, observational study. The Lancet 373(9678): 1883–9. P a g e | 171 Table CP.7: Early marriage and polygyny (women) Percentage of women age 15-49 years who first married before their 15th birthday, percentages of women age 20-49 years who first married before their 15th and 18th birthdays, percentage of women age 15-19 years currently married, and the percentage of women who are in a polygynous marriage, Punjab, 2014. Women age 15-49 years Women age 20-49 years Women age 15-19 years Women age 15-49 years P e rc e n ta g e m a rr ie d b e fo re a g e 1 5 1 N u m b e r o f w o m e n a g e 1 5 -4 9 y e a rs P e rc e n ta g e m a rr ie d b e fo re a g e 1 5 P e rc e n ta g e m a rr ie d b e fo re a g e 1 8 2 N u m b e r o f w o m e n a g e 2 0 -4 9 y e a rs P e rc e n ta g e c u rr e n tl y m a rr ie d 3 N u m b e r o f w o m e n a g e 1 5 -1 9 y e a rs P e rc e n ta g e i n p o ly g y n o u s m a rr ia g e 4 N u m b e r o f w o m e n a g e 1 5 -4 9 y e a rs c u rr e n tl y m a rr ie d Punjab 5.2 53,668 6.1 20.8 42,510 9.2 11,158 2.5 33,047 Area of residence Rural 5.7 35,043 6.7 22.6 27,574 10.5 7,469 2.8 21,859 All Urban 4.2 18,625 5.0 17.7 14,935 6.5 3,690 1.9 11,188 Major Cities 4.0 9,781 4.7 16.8 7,955 6.3 1,826 1.8 5,978 Other Urban 4.4 8,844 5.3 18.7 6,981 6.7 1,863 2.1 5,210 Age 15-19 1.5 11,158 na na na 9.2 11,158 1.2 1,021 20-24 2.7 9,960 2.7 12.8 9,960 na na 1.7 3,963 25-29 4.6 9,114 4.6 17.3 9,114 na na 2.1 6,833 30-34 6.4 7,558 6.4 22.1 7,558 na na 2.5 6,837 35-39 8.2 6,251 8.2 25.4 6,251 na na 3.0 5,807 40-44 8.8 5,078 8.8 27.3 5,078 na na 3.4 4,637 45-49 9.9 4,548 9.9 30.1 4,548 na na 2.7 3,948 Women's educationa None/pre-school 9.7 20,887 10.3 31.2 18,675 19.1 2,213 3.2 16,331 Primary 4.2 9,296 5.0 21.1 7,231 12.9 2,065 2.1 5,902 Middle 3.1 5,714 3.9 17.4 3,945 8.9 1,769 1.8 3,051 Secondary 1.4 8,837 2.0 10.8 5,764 4.3 3,073 1.5 4,109 Higher 0.4 8,916 0.5 2.8 6,880 2.0 2,036 1.5 3,640 Wealth index quintile Lowest 8.5 9,264 9.8 29.4 7,346 14.6 1,918 3.4 6,328 Second 6.1 10,341 7.4 25.1 8,046 11.1 2,295 2.6 6,444 Middle 4.8 10,901 5.7 21.2 8,427 8.9 2,474 2.3 6,490 Fourth 3.9 11,569 4.7 17.6 9,184 6.9 2,385 2.1 6,908 Highest 3.2 11,593 3.8 13.4 9,506 4.8 2,087 2.1 6,876 Division Bahawalpur 5.7 5,369 6.9 24.1 4,142 9.9 1,227 3.1 3,358 D.G. Khan 9.0 4,563 10.7 30.7 3,608 14.2 955 6.0 3,175 Faisalabad 4.2 6,796 5.0 17.5 5,334 7.9 1,462 1.4 4,029 Gujranwala 3.6 8,328 4.3 16.8 6,551 6.4 1,776 1.5 4,901 Lahore 4.3 9,685 5.1 18.8 7,671 7.6 2,014 2.0 6,024 Multan 6.7 5,887 7.9 25.3 4,677 10.3 1,210 2.8 3,653 Rawalpindi 4.4 5,086 5.1 18.4 4,178 7.9 908 2.4 3,067 Sahiwal 5.2 3,685 5.9 20.5 2,945 11.2 740 2.9 2,265 Sargodha 5.6 4,270 6.5 21.2 3,403 11.7 867 1.7 2,574 1 MICS indicator 8.4 - Marriage before age 15 2 MICS indicator 8.5 - Marriage before age 18 3 MICS indicator 8.6 - Young women age 15-19 years currently married 4 MICS indicator 8.7 – Polygyny na: not applicable a Total includes 11 unweighted cases of women's education missing The percentage of women married at before ages 15 and 18 years are provided in Table CP.7. Among women age 15-49, 5 percent were married before age 15, and among women age 20-49 years, 21 percent were married before age 18. P a g e | 172 Nearly one in ten young women (9%) age 15-19 are currently married. This proportion is slightly higher in rural (11%) than urban areas (7%) but is strongly related to the level of woman’s education. The percentage of women in a polygamous marriage is also provided in Table CP.7. Among all currently married women age 15-49, 3 percent are in polygamous marriage. Table CP.8 presents the proportion of women who are first married before age 15 and 18 by area and age groups. Examining the percentages of women 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 over time: 31 percent of women age 45-49 were first married by age 18 compared to 15 percent of women age 20-24. Figure CP.3 illustrates the percentage of women married before 15 and 18 years respectively by age group. Figure CP.3: Ear ly marr iage among women, MICS Punjab , 2014 2 3 5 6 8 9 10 na 13 17 22 25 27 30 15-19 20-24 25-29 30-34 35-39 40-44 45-49 na: not applicable Age Percentage married before age 15 Percentage married before age 18 P a g e | 173 Table CP.8: Trends in early marriage (women) Percentage of women who were first married before age 15 and 18, by area and age groups, Punjab, 2014. Rural Urban All Percentage of women married before age 15 Number of women age 15-49 years Percentage of women married before age 18 Number of women age 20-49 years Percentage of women married before age 15 Number of women age 15-49 years Percentage of women married before age 18 Number of women age 20-49 years Percentage of women married before age 15 Number of women age 15-49 years Percentage of women married before age 18 Number of women age 20-49 years Punjab 5.7 35,043 22.6 27,574 4.2 18,625 17.7 14,935 5.2 53,668 20.8 42,510 Age 15-19 1.9 7,469 na na 0.8 3,690 na na 1.5 11,158 na na 20-24 3.2 6,417 14.5 6,417 1.9 3,544 9.8 3,544 2.7 9,960 12.8 9,960 25-29 5.1 5,965 19.5 5,965 3.8 3,149 13.1 3,149 4.6 9,114 17.3 9,114 30-34 6.9 4,968 23.7 4,968 5.5 2,590 19.0 2,590 6.4 7,558 22.1 7,558 35-39 9.1 3,947 27.5 3,947 6.7 2,304 21.9 2,304 8.2 6,251 25.4 6,251 40-44 9.5 3,278 28.6 3,278 7.7 1,800 24.8 1,800 8.8 5,078 27.3 5,078 45-49 10.8 2,998 30.9 2,998 8.1 1,549 28.5 1,549 9.9 4,548 30.1 4,548 na: not applicable P a g e | 174 Another component is the spousal age difference with the indicator being the percentage of married women 10 or more years younger than their current spouse. Table CP.9 presents the results of the age difference between husbands and wives. The results show that there are some important spousal age differences in MICS Punjab, 2014. Among currently married women age 20-24 years, 15 percent are married with a man who is older by ten years or more. For currently married women age 15-19 years, the corresponding figure is about 19 percent. P a g e | 175 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, Punjab, 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 Husband's age unknown Total Younger 0-4 years older 5-9 years older 10+ years older2 Husband's age unknown Total Punjab 4.3 46.3 29.4 18.8 1.3 100.0 1,021 8.3 47.9 27.9 14.6 1.3 100.0 3,963 Area of residence Rural 4.7 47.9 28.0 18.4 1.0 100.0 781 8.9 48.0 26.9 14.8 1.4 100.0 2,722 All Urban 2.9 41.0 33.8 20.2 2.1 100.0 241 6.8 47.8 30.1 14.2 1.2 100.0 1,241 Major Cities 2.5 43.3 31.3 20.4 2.5 100.0 115 6.2 47.8 32.3 12.6 1.1 100.0 634 Other Urban 3.2 38.8 36.1 20.1 1.8 100.0 125 7.4 47.7 27.8 15.9 1.2 100.0 607 Age 15-19 4.3 46.3 29.4 18.8 1.3 100.0 1,021 na na na na na na na 20-24 na na na na na na na 8.3 47.9 27.9 14.6 1.3 100.0 3,963 Women’s educationa None/pre-school 5.9 56.6 22.4 13.6 1.5 100.0 423 9.5 51.2 22.7 15.1 1.5 100.0 1,538 Primary 3.0 46.6 33.8 16.2 0.5 100.0 265 7.1 51.7 28.1 12.2 0.9 100.0 846 Middle 3.1 39.8 35.4 21.0 0.6 100.0 158 8.4 46.9 28.6 15.6 0.5 100.0 474 Secondary 4.5 25.0 34.5 32.7 3.2 100.0 132 8.3 45.7 29.5 15.5 1.0 100.0 643 Higher (0.0) (28.8) (34.8) (36.4) (0.0) 100.0 41 6.1 34.3 41.6 15.2 2.8 100.0 460 Wealth index quintile Lowest 6.3 55.3 23.7 13.8 0.9 100.0 280 11.5 53.0 19.5 14.3 1.6 100.0 724 Second 4.0 51.0 26.1 17.5 1.3 100.0 256 9.8 47.2 28.2 13.4 1.2 100.0 861 Middle 4.2 40.3 32.0 22.9 0.6 100.0 221 8.7 50.2 25.0 15.1 1.1 100.0 819 Fourth 1.7 40.0 38.4 18.9 1.1 100.0 165 5.8 46.3 31.0 15.7 1.2 100.0 852 Highest 3.9 32.2 33.0 26.8 4.1 100.0 99 5.5 42.9 35.7 14.5 1.4 100.0 708 Division Bahawalpur 6.8 61.3 18.3 13.6 0.0 100.0 122 7.9 55.9 25.4 10.3 0.5 100.0 365 D.G. Khan 5.5 53.7 26.0 13.8 1.0 100.0 136 11.5 51.0 23.2 13.5 0.8 100.0 413 Faisalabad 3.8 48.7 22.5 23.5 1.5 100.0 116 7.9 48.9 27.4 15.4 0.4 100.0 461 Gujranwala 1.5 46.8 31.2 19.0 1.5 100.0 114 7.9 49.6 29.2 12.1 1.2 100.0 564 Lahore 1.4 45.4 31.5 19.0 2.8 100.0 153 6.6 47.0 31.8 13.3 1.3 100.0 754 Multan 6.5 39.3 35.1 18.4 0.7 100.0 125 9.1 48.5 24.0 16.6 1.8 100.0 436 Rawalpindi 7.8 27.1 45.1 20.0 0.0 100.0 72 4.4 41.9 34.7 17.1 1.9 100.0 352 Sahiwal 3.7 48.7 26.8 20.3 0.6 100.0 83 10.7 40.1 28.3 19.5 1.4 100.0 297 Sargodha 3.0 36.5 33.7 24.3 2.5 100.0 101 10.1 45.5 23.7 17.6 3.1 100.0 322 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 ( ) Figures that are based on 25-49 unweighted cases a Total includes 2 unweighted cases of women's education missing P a g e | 176 Attitudes toward Domestic Violence MICS assessed the attitudes of women age 15-49 years towards wife beating by asking the respondents whether they think that husbands are justified to hit or beat their wives in a variety of situations. The purpose of these questions is to capture the social justification of violence (in contexts where women have a lower status in society) as a disciplinary action when a woman does not comply with certain expected gender roles. The responses to these questions can be found in Table CP.10. Overall, 40 percent of women age 15-49 years believe that a husband is justified in hitting or beating his wife for any one of five reasons that she; (i) goes out without telling him, (ii) neglects the children, (iii) argues with him, (iv) refuses sex with him, and (v) burns the food. Women who justify a husband’s violence, in most cases agree and justify violence in instances when a wife neglects the children (27%), or if she demonstrates her autonomy, exemplified by going out without telling her husband or arguing with him (26%). Around one in five (21%) of women believe that wife-beating is justified if the wife refuses to have sex with the husband and 15 percent favour wife-beating if she burns the food. The wife-beating in any of the five situations is justified by higher proportion of women living in the households in the lowest quintile, in rural areas and with less education. P a g e | 177 Table CP.10: Attitudes toward domestic violence (women) Percentage of women age 15-49 years who believe a husband is justified in beating his wife in various circumstances, Punjab, 2014. Percentage of women age 15-49 years who believe a husband is justified in beating his wife: Number of women age 15-49 years If she goes out without telling him If she neglects the children If she argues with him If she refuses sex with him If she burns the food For any of these five reasons1 Punjab 26.4 26.5 27.7 20.5 14.8 39.8 53,668 Area of residence Rural 31.7 31.8 33.0 25.1 18.6 46.5 35,043 All Urban 16.3 16.6 17.7 11.9 7.5 27.3 18,625 Major Cities 11.6 12.1 13.4 8.5 5.4 20.8 9,781 Other Urban 21.5 21.5 22.6 15.7 9.9 34.4 8,844 Age 15-19 21.9 22.4 22.7 12.1 12.4 34.8 11,158 20-24 23.0 23.1 24.5 16.1 12.3 35.9 9,960 25-29 26.0 26.3 27.1 21.8 14.3 39.8 9,114 30-34 28.0 28.5 29.6 23.7 15.2 41.9 7,558 35-39 29.6 29.4 30.8 25.3 16.4 43.1 6,251 40-44 31.0 30.6 33.1 27.1 18.6 45.3 5,078 45-49 32.9 33.0 35.1 29.2 19.6 46.6 4,548 Marital status Currently married 29.8 29.7 31.2 25.8 16.5 43.7 33,047 Formerly married 29.2 29.1 31.4 27.3 17.8 44.1 1,808 Never married 20.1 20.7 21.2 10.6 11.4 32.5 18,813 Educationa None/pre-school 37.1 37.5 39.2 31.7 23.2 52.9 20,887 Primary 29.2 29.3 30.4 21.7 15.3 43.4 9,296 Middle 22.8 22.4 23.3 15.4 11.3 35.7 5,714 Secondary 17.1 16.3 17.8 10.7 7.1 28.7 8,837 Higher 9.7 10.6 10.7 6.3 4.2 19.2 8,916 Wealth index quintile Lowest 40.3 41.2 41.3 34.2 27.4 56.6 9,264 Second 34.7 35.2 37.0 28.3 21.2 50.5 10,341 Middle 28.8 28.7 29.8 21.2 14.9 43.0 10,901 Fourth 21.0 20.5 22.4 14.6 9.2 33.7 11,569 Highest 10.8 11.1 12.0 7.9 4.3 20.0 11,593 Division Bahawalpur 37.6 39.3 37.5 34.7 23.3 62.1 5,369 D.G. Khan 30.4 29.1 26.2 20.0 19.3 40.3 4,563 Faisalabad 29.4 29.9 31.5 21.6 15.9 42.4 6,796 Gujranwala 29.5 27.0 28.7 18.2 10.4 41.9 8,328 Lahore 15.9 15.8 18.8 12.6 8.9 27.2 9,685 Multan 17.5 17.1 20.0 15.1 9.9 29.0 5,887 Rawalpindi 15.2 14.6 16.3 12.4 10.8 23.4 5,086 Sahiwal 42.4 46.3 46.7 41.0 23.8 59.5 3,685 Sargodha 32.3 35.9 37.5 23.7 22.7 49.2 4,270 1 MICS indicator 8.12 - Attitudes towards domestic violence a Total includes 15 unweighted cases of education missing P a g e | 178 Children’s Living Arrangements The CRC recognizes that “the child, for the full and harmonious development of his or her personality, should grow up in a family environment, in an atmosphere of happiness, love and understanding”. Millions of children around the world grow up without the care of their parents for several reasons, including due to the premature death of the parents or their migration for work. In most cases, these children are cared for by members of their extended families, while in others, children may be living in households other than their own, 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.11 presents information on the living arrangements and orphanhood status of children under age 18. Eighty eight percent of children age 0-17 years live with both their parents, 9 percent live with mothers only, 2 percent with fathers only, and less than 2 percent with neither of their biological parents. About 6 percent live with mothers only while the biological father is alive. Very few children have lost one or both parents. About 5 percent of children have one or both parents’ dead. As expected, older children are less likely than younger ones to live with both parents and slightly more likely than younger children to have lost one or both of the parents. Table CP.11 also shows that the percentage of children living with both parents ranges from 79 percent in Gujranwala to 91 percent each in Gujranwala and Bahawalpur division. Further to that, Gujranwala division has the highest percentage of children living with their mother only while the father is alive (16%). About 11 percent of children living in the wealthiest households live with their mother only while their father is alive. The corresponding proportion of such children living in the households in the lowest quintile is 3 percent. There are, however, only small differences between urban and rural areas in terms of living arrangements. P a g e | 179 Table CP.11: Children's living arrangements and orphanhood Percent distribution of children age 0-17 years according to living arrangements, percentage of children age 0-17 years not living with a biological parent and percentage of children who have one or both parents dead, Punjab, 2014. Living with both parents Living with neither biological parent Living with mother only Living with father only Missing information on father/ mother Total Living with neither biological parent1 One or both parents dead 2 Number of children age 0-17 years Only father alive Only mother alive Both alive Both dead Father alive Father dead Mother alive Mother dead Punjab 88.0 0.2 0.1 0.9 0.2 5.9 2.9 0.3 1.3 0.1 100.0 1.4 4.8 106,585 Area of residence Rural 87.6 0.2 0.1 0.9 0.1 6.3 2.8 0.4 1.4 0.1 100.0 1.4 4.7 73,372 All Urban 89.0 0.3 0.2 1.0 0.2 4.8 3.2 0.2 1.1 0.1 100.0 1.5 4.9 33,213 Major Cities 90.4 0.3 0.1 0.9 0.1 3.8 3.2 0.1 0.9 0.2 100.0 1.5 4.7 16,845 Other Urban 87.5 0.2 0.2 1.0 0.2 5.9 3.3 0.3 1.2 0.1 100.0 1.6 5.1 16,368 Sex Male 88.3 0.2 0.1 0.7 0.1 5.8 3.0 0.3 1.4 0.1 100.0 1.1 4.8 54,610 Female 87.8 0.3 0.1 1.2 0.2 5.9 2.8 0.3 1.3 0.2 100.0 1.8 4.7 51,975 Age 0-4 91.0 0.1 0.0 0.5 0.0 7.2 0.7 0.2 0.3 0.0 100.0 0.6 1.2 31,324 5-9 89.4 0.3 0.1 0.7 0.1 5.9 2.1 0.3 1.1 0.1 100.0 1.2 3.7 31,473 10-14 86.5 0.3 0.2 1.0 0.1 5.1 4.3 0.4 1.9 0.1 100.0 1.6 6.9 28,665 15-17 82.0 0.3 0.4 2.1 0.5 4.4 6.6 0.5 2.8 0.6 100.0 3.2 10.5 15,124 Wealth index quintile Lowest 90.9 0.2 0.2 0.8 0.2 3.2 2.7 0.3 1.4 0.1 100.0 1.3 4.7 24,430 Second 89.9 0.2 0.1 0.9 0.1 3.7 2.7 0.3 1.8 0.1 100.0 1.4 4.9 22,293 Middle 88.2 0.2 0.1 1.0 0.2 5.0 3.3 0.4 1.4 0.1 100.0 1.5 5.2 21,147 Fourth 85.8 0.3 0.1 0.9 0.1 8.0 3.3 0.2 1.0 0.2 100.0 1.5 4.8 20,305 Highest 84.0 0.2 0.2 1.0 0.2 10.5 2.7 0.3 0.9 0.2 100.0 1.6 4.1 18,411 Division Bahawalpur 91.4 0.3 0.1 0.8 0.2 2.5 2.9 0.2 1.5 0.1 100.0 1.3 5.0 11,843 D.G. Khan 88.1 0.2 0.1 0.9 0.1 7.0 2.2 0.2 1.2 0.1 100.0 1.3 3.8 11,995 Faisalabad 90.4 0.2 0.1 0.8 0.1 3.7 2.9 0.2 1.5 0.2 100.0 1.1 4.8 12,775 Gujranwala 78.8 0.2 0.1 0.9 0.2 15.5 2.9 0.4 1.0 0.1 100.0 1.4 4.4 15,697 Lahore 91.1 0.3 0.2 0.9 0.1 2.7 3.1 0.2 1.2 0.1 100.0 1.6 4.9 18,395 Multan 89.6 0.2 0.2 1.0 0.2 3.4 3.3 0.4 1.6 0.2 100.0 1.5 5.5 12,353 Rawalpindi 85.8 0.1 0.0 0.7 0.1 8.4 3.2 0.3 1.1 0.3 100.0 0.9 4.5 8,209 Sahiwal 88.3 0.3 0.2 1.8 0.2 4.0 2.9 0.5 1.7 0.1 100.0 2.4 5.3 7,484 Sargodha 89.8 0.3 0.1 0.9 0.2 3.6 3.1 0.4 1.3 0.1 100.0 1.6 5.0 7,833 1 MICS indicator 8.13 - Children’s living arrangements 2 MICS indicator 8.14 - Prevalence of children with one or both parents dead P a g e | 180 The survey 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 MICS Punjab, 2014 presented in Table CP.12 will greatly help fill the data gap on the topic of migration. About 4 percent of children age 0-17 have one or both parents living abroad. The proportion of children with at least one parent abroad is much higher for those living in the households in the highest quintile (9%) compared to those living in the households in the lowest quintile (1%). Table CP.12: Children with parents living abroad Percent distribution of children age 0-17 years by residence of parents in another country, Punjab, 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 Punjab 0.0 3.9 0.0 96.1 100.0 3.9 106,585 Area of residence Rural 0.0 4.1 0.0 95.9 100.0 4.1 73,372 All Urban 0.0 3.5 0.0 96.5 100.0 3.5 33,213 Major Cities 0.0 2.8 0.0 97.2 100.0 2.8 16,845 Other Urban 0.0 4.1 0.0 95.9 100.0 4.1 16,368 Sex Male 0.0 3.9 0.0 96.1 100.0 3.9 54,610 Female 0.0 3.9 0.0 96.1 100.0 3.9 51,975 Age 0-4 0.0 4.9 0.0 95.1 100.0 4.9 31,324 5-9 0.0 3.9 0.0 96.1 100.0 3.9 31,473 10-14 0.0 3.4 0.0 96.6 100.0 3.4 28,665 15-17 0.0 2.7 0.0 97.3 100.0 2.7 15,124 Wealth index quintile Lowest 0.0 1.1 0.0 98.9 100.0 1.1 24,430 Second 0.0 1.4 0.0 98.6 100.0 1.4 22,293 Middle 0.0 2.9 0.0 97.1 100.0 2.9 21,147 Fourth 0.0 6.2 0.0 93.8 100.0 6.2 20,305 Highest 0.0 9.3 0.0 90.7 100.0 9.3 18,411 Division Bahawalpur 0.0 1.3 0.0 98.7 100.0 1.3 11,843 D.G. Khan 0.0 3.9 0.0 96.1 100.0 3.9 11,995 Faisalabad 0.0 2.6 0.0 97.4 100.0 2.6 12,775 Gujranwala 0.0 11.6 0.0 88.4 100.0 11.6 15,697 Lahore 0.0 1.8 0.0 98.2 100.0 1.8 18,395 Multan 0.0 1.7 0.0 98.3 100.0 1.7 12,353 Rawalpindi 0.0 6.5 0.0 93.5 100.0 6.5 8,209 Sahiwal 0.0 2.1 0.0 97.9 100.0 2.1 7,484 Sargodha 0.0 2.0 0.0 98.0 100.0 2.0 7,833 1 MICS indicator 8.15 - Children with at least one parent living abroad P a g e | 181 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 the transmission. Correct information is the first step towards raising awareness and giving adolescents and young people the tools to protect themselves from the infection. Misconceptions about HIV are common and can confuse adolescents and young people and hinder prevention efforts. 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 was administered to ever married women 15-49 years of age. It may be noted that the questions in this module often refer to “the AIDS virus”. This terminology is used strictly as a method of data collection to aid respondents, preferred over the correct terminology of “HIV” that is used here in reporting the results, where appropriate. One indicator which is both an MDG and the Global AIDS Response Progress Reporting (GARPR; formerly UNGASS) is the percentage of young women 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 husband 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 MICS Punjab, 2014 all ever-married women who have heard of AIDS were asked questions on all three components and the results are detailed in Table HA.1.Due to cultural sensitivities around talking to unmarried women about issues relating to sexual behavior and the possibility that this may compromise survey team safety and increase survey non-response, the HIV module was only administered to ever-married women. In Punjab, 39 percent of the ever married women age 15-49 years have heard of AIDS, higher in urban (60%) than in rural areas (28%). However, the percentage of women who know of both main ways of preventing HIV transmission – using a condom every time during sexual intercourse and having only one faithful uninfected husband – is only 16 percent. About 24 percent of women know of having one faithful uninfected husband and 20 percent know about using a condom every time as main ways of preventing HIV transmission. More than half of women have heard of AIDS in Rawalpindi division compared to just over one in ten women in DG Khan division (52% and 14%). AIDS awareness is very low (only 8%) among women living in the households in the lowest quintile compared to 76 percent of women living in the households in the highest quintile. Similarly, awareness is low among women from rural areas (28%) and women with pre-school or no education (14%) compared to those from urban areas (60%) and women with higher education (94%). P a g e | 182 Table HA.1: Knowledge about HIV transmission, misconceptions about HIV, and comprehensive knowledge about HIV transmission Percentage of ever married women age 15-49 years who know the main ways of preventing HIV transmission, percentage who know that a healthy looking person can be HIV-positive, percentage who reject common misconceptions, and percentage who have comprehensive knowledge about HIV transmission, Punjab, 2014. Percentage who have heard of AIDS Percentage who know transmission can be prevented by: Percentage who know that a healthy looking person can be HIV- positive Percentage who know that HIV cannot be transmitted by: Percentage who reject the two most common misconceptions and know that a healthy looking person can be HIV-positive Percentage with comprehensive knowledge1 Number of ever married women age 15- 49 years Having only one faithful uninfected husband Using a condom every time Percentage of women who know both ways Mosquito bites Supernatural means Sharing food with someone with HIV Punjab 39.0 24.1 19.8 15.6 25.2 23.0 28.3 20.5 9.8 5.1 34,855 Area of residence Rural 28.2 16.9 13.6 10.8 18.1 15.0 19.6 13.1 5.9 2.9 23,061 All Urban 60.1 38.3 31.7 25.0 39.1 38.7 45.5 34.7 17.5 9.2 11,794 Major Cities 66.4 43.3 35.6 27.8 42.1 43.4 49.5 40.3 20.2 10.4 6,295 Other Urban 52.9 32.4 27.3 21.8 35.6 33.3 40.8 28.3 14.5 7.9 5,499 Age 15-241 32.4 18.7 15.5 11.5 20.8 20.0 23.4 15.0 7.5 3.3 5,144 15-19 21.0 10.9 10.4 7.1 13.5 12.7 13.6 8.4 4.9 1.8 1,066 20-24 35.3 20.7 16.9 12.7 22.7 21.9 26.0 16.7 8.2 3.7 4,078 25-29 44.4 26.9 22.6 17.5 29.0 26.4 32.0 22.8 11.1 5.7 7,025 30-39 43.3 27.5 22.7 18.3 28.0 25.9 32.1 24.1 11.7 6.3 13,185 40-49 32.8 20.3 15.9 12.6 20.8 18.1 23.0 16.6 7.5 3.8 9,501 Women’s educationa None/pre-school 13.5 7.1 5.5 4.2 7.7 5.4 7.6 4.8 1.6 0.6 17,377 Primary 39.6 20.9 16.5 12.5 24.6 18.8 25.6 16.5 6.5 2.9 6,209 Middle 58.6 34.8 27.4 20.6 35.6 34.2 41.6 28.5 11.4 4.8 3,215 Secondary 79.0 52.2 43.4 34.6 52.4 50.1 60.6 44.4 22.1 11.9 4,277 Higher 93.8 67.1 57.4 47.5 67.1 71.1 80.6 65.1 37.9 21.9 3,763 Wealth index quintile Lowest 7.9 4.7 3.8 3.1 4.2 2.9 3.8 2.1 0.9 0.4 6,686 Second 18.8 10.2 8.2 6.1 11.2 8.5 11.9 7.3 2.4 1.1 6,814 Middle 35.1 19.9 16.5 12.9 21.8 17.1 23.8 15.2 6.2 3.2 6,914 Fourth 53.7 32.5 26.2 20.5 35.4 31.4 38.8 28.3 13.3 6.3 7,197 Highest 76.0 50.9 42.1 33.7 50.8 52.6 60.4 47.0 25.0 13.8 7,244 Division Bahawalpur 30.3 21.2 19.5 16.0 17.6 18.7 21.8 11.8 5.2 2.9 3,529 D.G. Khan 13.9 7.6 6.4 5.1 8.3 7.9 10.0 6.2 3.2 1.7 3,286 Faisalabad 34.5 25.5 18.6 16.1 21.4 22.9 28.1 19.7 10.2 6.5 4,274 Gujranwala 55.3 34.0 25.3 21.1 38.1 28.8 39.1 26.0 11.6 5.6 5,154 Lahore 53.1 28.1 25.3 17.3 32.6 31.4 37.2 31.5 13.9 5.7 6,285 Multan 24.7 16.5 14.1 11.6 17.1 16.2 19.7 12.2 6.5 3.9 3,867 Rawalpindi 52.3 32.8 27.3 21.7 34.5 33.7 37.8 31.0 16.1 9.0 3,281 Sahiwal 29.3 19.8 16.9 13.2 20.8 16.4 21.4 15.1 8.0 4.7 2,435 Sargodha 37.2 21.9 16.4 12.8 23.9 19.4 25.7 17.6 9.0 4.6 2,745 1MICS indicator 9.S1 - Knowledge about HIV prevention among young women a Total includes 11 unweighted cases of women's education missing P a g e | 183 Table HA.1 also provides the percentage of women who can correctly identify misconceptions concerning HIV. The indicator is based on the two most common and relevant misconceptions in Punjab, that HIV can be transmitted by supernatural means and by mosquito bites. The table also provides information on whether the women know that HIV cannot be transmitted by sharing food with someone with AIDS. Overall, 10 percent of women reject the two most common misconceptions, and know that a healthy-looking person can be HIV-positive. About 28 percent of the women know that supernatural means, and 23 percent of women know that mosquito bites cannot spread HIV, while 25 percent of women know that a healthy-looking person can be HIV-positive. More women are able to correctly identify ways of HIV transmission and misconceptions concerning HIV in urban areas, with higher education and from households in the highest quintile. For example, only 8 percent of women with pre-school or no education know that a healthy looking person can be HIV-positive compared to 67 percent of women with higher education. Figure HA.1: Women with comprehensive knowledge of HIV t ransmiss ion , MICS Pu jab , 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 husband 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. The comprehensive knowledge of HIV prevention methods and transmission is quite low but with clear differences by area of residence. Overall, 5 percent of women were found to have comprehensive knowledge, which was higher in urban areas (9%) compared to rural areas (3%). The percentage of the women with comprehensive knowledge increases with their education level; lowest (less than 1%) for women with only pre-school or no education and highest (22%) among women with higher education. Figure HA.1 summarises the information on comprehensive knowledge of HIV transmission by area. 16 10 5 11 6 3 25 18 9 0 5 10 15 20 25 30 Knows 2 ways to prevent HIV Rejected 2 most common misconceptions and know that a healthy looking person can be HIV- positive Comprehensive knowledge PERCENT Punjab Rural Urban P a g e | 184 Table HA.2: Knowledge of mother-to-child HIV transmission Percentage of ever married women age 15-49 years who correctly identify means of HIV transmission from mother to child, Punjab, 2014. Percentage of women age 15-49 who have heard of AIDS and: Number of ever married women age 15- 49 years 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 Punjab 29.5 27.7 26.3 31.4 23.6 7.6 34,855 Area of residence Rural 21.4 19.9 19.5 22.9 17.3 5.4 23,061 All Urban 45.5 43.0 39.6 48.2 35.9 11.9 11,794 Major Cities 49.5 46.9 42.4 52.2 38.5 14.1 6,295 Other Urban 40.9 38.5 36.4 43.5 32.9 9.4 5,499 Age 15-24 24.8 22.8 22.7 26.5 19.9 5.8 5,144 15-19 15.3 14.0 13.8 17.2 11.2 3.8 1,066 20-24 27.2 25.1 25.0 29.0 22.2 6.3 4,078 25-29 33.6 31.5 30.2 35.7 27.3 8.6 7,025 30-39 32.7 30.7 28.9 34.8 25.8 8.4 13,185 40-49 24.8 23.5 21.8 26.2 19.9 6.6 9,501 Women’s educationa None/pre-school 9.8 9.3 9.3 10.5 8.3 3.0 17,377 Primary 29.2 26.5 26.9 31.2 23.4 8.4 6,209 Middle 44.3 41.5 39.2 46.9 35.2 11.7 3,215 Secondary 60.4 56.5 53.3 64.0 47.9 15.0 4,277 Higher 73.5 70.6 62.1 78.3 57.0 15.6 3,763 Wealth index quintile Lowest 6.0 5.7 5.8 6.6 5.2 1.3 6,686 Second 14.1 12.9 13.4 15.0 11.8 3.8 6,814 Middle 26.8 25.2 25.3 28.7 22.4 6.3 6,914 Fourth 40.3 37.5 35.7 42.9 31.8 10.8 7,197 Highest 57.7 54.8 49.0 61.1 44.7 14.9 7,244 Division Bahawalpur 24.3 24.4 23.7 26.9 21.2 3.4 3,529 D.G. Khan 9.0 7.4 7.7 9.7 6.3 4.2 3,286 Faisalabad 28.6 27.3 26.5 30.1 24.2 4.5 4,274 Gujranwala 42.3 37.7 36.0 44.4 32.0 10.9 5,154 Lahore 38.1 36.3 32.9 40.3 30.0 12.9 6,285 Multan 19.1 17.8 17.6 21.1 14.9 3.6 3,867 Rawalpindi 39.9 38.1 35.8 41.7 33.2 10.6 3,281 Sahiwal 21.9 21.0 18.6 23.5 16.5 5.8 2,435 Sargodha 28.0 26.4 26.0 30.2 23.0 7.0 2,745 1 MICS indicator 9.S2 - Knowledge of mother-to-child transmission of HIV a Total includes 11 unweighted cases of women's education missing 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. Overall, 31 percent of ever married women know that HIV can be transmitted from mother to child. The percentage of the women who know all three ways of mother-to-child transmission is 24 percent, while 8 percent did not know of any specific way. The proportion of women with knowledge of all the three ways of mother-to-child transmission is lowest in D.G Khan division (6%) and highest in Rawalpindi division (33%). In urban areas, the proportion of women with knowledge of all the three ways is twice as high (36%) compared to rural areas (17%). P a g e | 185 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. Table HA.3: Accepting attitudes toward people living with HIV Percentage of ever married women age 15-49 years who have heard of AIDS who express an accepting attitude towards people living with HIV, Punjab, 2014. Percentage of women who: Number of ever married women age 15-49 who have heard of AIDS Are willing to care for a family member who is HIV- positive 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 Punjab 68.2 50.0 58.5 61.6 95.7 19.0 13,601 Area of residence Rural 67.9 46.0 56.8 60.9 95.2 17.0 6,512 All Urban 68.6 53.6 60.1 62.2 96.1 20.8 7,089 Major Cities 69.0 55.1 60.1 62.5 96.1 21.2 4,178 Other Urban 68.1 51.6 60.1 61.8 96.1 20.3 2,911 Age 15-24 69.1 48.1 57.5 60.3 94.8 18.5 1,664 15-19 73.9 39.8 52.5 57.5 94.7 16.7 224 20-24 68.3 49.4 58.3 60.7 94.8 18.7 1,440 25-29 69.0 51.2 60.3 59.8 96.0 18.7 3,117 30-39 68.2 52.0 59.6 62.3 95.8 20.1 5,705 40-49 67.2 46.1 55.4 62.8 95.5 17.6 3,115 Marital Status Currently married 68.3 50.1 58.7 61.5 95.6 19.0 12,984 Formerly married 67.0 47.1 54.0 62.7 96.2 18.9 617 Women’s educationa None/pre-school 64.6 37.5 45.7 57.5 92.4 11.7 2,344 Primary 69.1 44.4 52.0 62.0 94.8 16.4 2,459 Middle 68.9 45.9 55.8 63.1 96.2 16.1 1,883 Secondary 67.7 53.3 61.7 63.5 96.7 21.1 3,377 Higher 70.2 61.3 70.0 61.4 97.1 25.2 3,532 Wealth index quintile Lowest 62.7 28.4 37.2 51.1 89.8 5.6 525 Second 69.2 37.7 48.8 58.5 94.3 12.8 1,284 Middle 67.9 44.0 54.0 61.0 95.3 15.4 2,426 Fourth 67.0 51.2 60.9 62.3 95.7 19.5 3,863 Highest 69.5 56.7 63.2 63.1 96.6 23.0 5,503 Division Bahawalpur 61.6 36.6 46.9 57.9 94.3 10.4 1,069 D.G. Khan 79.1 43.3 52.0 50.6 92.2 18.9 457 Faisalabad 45.0 46.2 54.7 64.9 92.9 12.7 1,477 Gujranwala 63.4 47.4 60.9 69.6 97.3 17.0 2,852 Lahore 76.1 58.7 61.9 61.8 96.1 26.4 3,340 Multan 72.3 41.0 55.1 55.4 95.6 14.5 954 Rawalpindi 70.0 55.6 60.7 60.6 96.2 21.2 1,717 Sahiwal 85.3 54.2 64.8 61.3 96.7 26.0 714 Sargodha 73.4 47.0 56.8 50.2 95.2 14.5 1,021 1 MICS indicator 9.S3 - Accepting attitudes towards people living with HIV a Total includes 5 unweighted cases of women's education missing P a g e | 186 Table HA.3 provides data on the attitudes of women towards people living with HIV. In Punjab, 96 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 the AIDS virus in own home (68%) followed by the women who would not want to keep secret that a family member got infected with the AIDS virus (62%). Overall, 19 percent of the women express accepting attitude on all four indicators, slightly higher in urban (21%) compared to rural (17%). More educated women and those living in the households in the highest quintile have more accepting attitudes than women with lower education and living in the households in the lowest quintile. Information on women’s accepting attitudes toward people living with HIV/AIDS by age is depicted in Figure HA.2. Figure HA.2: Accept ing att i tudes t oward people l i v ing with H IV/AIDS, MICS Punjab , 2014 Knowledge of a Place for HIV Testing, Counselling and Testing during Antenatal Care Another important indicator is the knowledge of the place for HIV testing and use of such services. In order to protect themselves and to prevent infecting others, it is important for individuals to know their HIV status. Knowledge of own status is also a critical factor in the decision to seek treatment. Questions related to knowledge of a facility for HIV testing and whether a person has ever been tested are presented in Table HA.4. About 9 percent of ever married women knew where to be tested for HIV, while almost 2 percent of women have actually been tested and about the same proportion of women know the result of their most recent test. A smaller proportion has been tested within the last 12 months and know the result (less than 1 percent respectively). 74 68 69 68 67 40 49 51 52 46 52 58 60 60 55 58 61 60 62 63 0 10 20 30 40 50 60 70 80 15-19 20-24 25-29 30-39 40-49 Are willing to care for a family member who is HIV- positive 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 P a g e | 187 Knowledge about the place to get tested for HIV is strongly associated with education of the women and wealth. Almost one-third of women with higher education, know a place to get tested (29%) compared to only 2 percent of women with pre-school or no education. Similarly, less than 1 percent of women living in the households in the lowest quintile know a place for HIV testing compared to more than 20 percent of women living in the households in the highest quintile. Table HA.4: Knowledge of a place for HIV testing Percentage of ever married women age 15-49 years who know where to get an HIV test, percentage who have ever been tested, percentage who have ever been tested and know the result of the most recent test, percentage who have been tested in the last 12 months, and percentage who have been tested in the last 12 months and know the result, Punjab, 2014 Percentage of women who: Number of ever married women age 15-49 Know a place to get tested1 Have ever been tested Have ever been tested and know the result of the most recent test Have been tested in the last 12 months Have been tested in the last 12 months and know the result2 Punjab 8.5 1.8 1.6 0.6 0.6 34,855 Area of residence Rural 6.1 1.1 0.9 0.5 0.4 23,061 All Urban 13.2 3.2 2.8 1.0 0.9 11,794 Major Cities 13.3 3.6 3.2 1.2 1.1 6,295 Other Urban 13.2 2.7 2.3 0.8 0.7 5,499 Age 15-24 7.5 1.3 1.1 0.6 0.6 5,144 15-19 3.7 0.1 0.0 0.0 0.0 1,066 20-24 8.5 1.6 1.4 0.8 0.7 4,078 25-29 9.7 2.2 1.9 0.9 0.8 7,025 30-39 9.6 2.2 1.9 0.8 0.7 13,185 40-49 6.7 1.3 1.1 0.3 0.3 9,501 Women’s educationa None/pre-school 1.9 0.3 0.3 0.2 0.1 17,377 Primary 6.1 1.3 1.1 0.5 0.4 6,209 Middle 10.9 2.1 1.7 0.7 0.6 3,215 Secondary 18.8 3.9 3.3 1.2 1.1 4,277 Higher 29.2 6.7 6.0 2.4 2.2 3,763 Wealth index quintile Lowest 0.9 0.1 0.1 0.1 0.1 6,686 Second 3.4 0.4 0.3 0.2 0.2 6,814 Middle 6.5 1.1 0.9 0.4 0.3 6,914 Fourth 10.4 2.0 1.7 0.9 0.8 7,197 Highest 20.4 5.1 4.6 1.6 1.5 7,244 Division Bahawalpur 8.3 1.2 0.9 0.4 0.4 3,529 D.G. Khan 3.5 0.6 0.6 0.2 0.2 3,286 Faisalabad 7.7 1.0 0.7 0.4 0.3 4,274 Gujranwala 14.0 4.4 4.1 1.5 1.5 5,154 Lahore 8.2 1.8 1.7 0.5 0.5 6,285 Multan 6.5 0.7 0.5 0.4 0.3 3,867 Rawalpindi 12.2 3.0 2.6 1.1 0.9 3,281 Sahiwal 8.7 1.4 1.1 0.6 0.6 2,435 Sargodha 4.5 0.6 0.5 0.2 0.2 2,745 1 MICS indicator 9.S4 - Women who know where to be tested for HIV 2 MICS indicator 9.S5 - Women who have been tested for HIV and know the results a Total includes 11 unweighted cases of women's education missing Among women who had given birth within the two years preceding the survey, the percentage who received counselling and HIV testing during antenatal care is presented in Table HA.5. About 80 percent of these women received antenatal care, but very few received HIV counselling during P a g e | 188 antenatal care (1%). About the same percentage of women were offered an HIV test, got tested during antenatal care and received results. Table HA.5: HIV counselling and testing during antenatal care Percentage of ever married women age 15-49 years with a live birth in the last 2 years who received antenatal care from a health professional during the last pregnancy, percentage who received HIV counselling, percentage who were offered and tested for HIV, percentage who were offered, tested and received the results of the HIV test, and percentage who received counselling and were offered, accepted and received the results of the HIV test, Punjab, 2014. Percentage of women who: Number of ever married women age 15-49 years with a live birth in the last 2 years Received antenatal care from a health care professional for last pregnancy Received HIV counselling during antenatal care1 Were offered an HIV test and were tested for HIV during antenatal care Were offered an HIV test and were tested for HIV during antenatal care, and received the results2 Received HIV counselling, were offered an HIV test, accepted and received the results Punjab 78.8 1.3 1.2 1.1 0.7 10,653 Area of residence Rural 74.4 0.9 0.7 0.7 0.4 7,369 All Urban 88.7 2.2 2.3 2.2 1.4 3,284 Major Cities 91.3 2.8 3.3 3.2 2.1 1,692 Other Urban 85.9 1.5 1.3 1.1 0.6 1,592 Age 15-24 81.9 0.9 1.0 1.0 0.6 2,538 15-19 78.7 0.0 0.0 0.0 0.0 348 20-24 82.4 1.0 1.1 1.1 0.7 2,190 25-29 80.8 1.2 1.2 1.1 0.7 3,746 30-39 76.8 1.7 1.5 1.3 0.9 3,924 40-49 61.3 0.2 0.5 0.5 0.1 446 Marital Status Currently married 78.8 1.3 1.2 1.1 0.7 10,534 Formerly married 72.4 0.7 0.7 0.7 0.7 119 Women’s educationa None/pre-school 65.4 0.1 0.1 0.1 0.0 4,816 Primary 83.1 0.5 0.4 0.4 0.2 1,961 Middle 89.0 1.4 0.6 0.5 0.4 1,096 Secondary 93.4 2.5 2.7 2.6 1.5 1,467 Higher 96.5 5.4 5.4 5.0 3.3 1,311 Wealth index quintile Lowest 56.1 0.1 0.0 0.0 0.0 2,327 Second 72.9 0.3 0.2 0.1 0.0 2,166 Middle 83.3 0.9 0.8 0.6 0.3 2,144 Fourth 90.3 1.3 0.9 0.8 0.6 2,065 Highest 95.3 4.2 4.7 4.5 2.9 1,951 Division Bahawalpur 60.2 1.2 1.3 1.2 0.5 1,068 D.G. Khan 62.3 0.4 0.3 0.3 0.1 1,181 Faisalabad 85.2 1.0 0.4 0.4 0.4 1,237 Gujranwala 86.5 3.6 3.6 3.3 2.8 1,578 Lahore 82.1 0.5 1.1 1.1 0.3 1,914 Multan 79.8 0.6 0.5 0.5 0.3 1,162 Rawalpindi 88.3 2.4 1.8 1.6 0.8 882 Sahiwal 80.4 1.1 0.9 0.8 0.7 827 Sargodha 81.3 0.2 0.0 0.0 0.0 804 1 MICS indicator 9.S7 - HIV counselling during antenatal care 2 MICS indicator 9.S8 - HIV testing during antenatal care a Total includes 2 unweighted cases of women's education missing P a g e | 189 HIV Indicators for Young Women In many countries, over half of new adult HIV infections are among young people age 15-24 years thus a change in behaviour among members of this age group is especially important to reduce new infections. The next tables present specific information on this age group. Table HA.6 summarizes information on key HIV indicators for ever married young women of age group 15-24 years. Results with respect to comprehensive knowledge about HIV prevention (3%), knowledge of mother to child transmission (20%), and knowledge of a place to get tested (7%) are generally lower compared to the ever married women population age 15-49 years as a whole. Accepting attitudes towards people living with HIV for all the four indicators (discussed in Table HA.3) are almost the same in this age group (19%). Overall, less than 1 percent of the ever married young women, have been tested for HIV in the last 12 months and know the result. P a g e | 190 Table HA.6: Key HIV and AIDS indicators (young women) Percentage of ever married women age 15-24 years by key HIV and AIDS indicators, Punjab, 2014. Percentage of ever married women age 15-24 years who: Number of ever married women age 15-24 years Percentage who express accepting attitudes towards people living with HIV on all four indicators Number of ever married women age 15-24 years who have heard of AIDS Have comprehensive knowledge1 Know all three means of HIV transmission from mother to child Know a place to get tested for HIV Have ever been tested and know the result of the most recent test Have been tested in the last 12 months and know the result Punjab 3.3 19.9 7.5 1.1 0.6 5,144 18.5 1,664 Area of residence Rural 2.2 16.3 6.3 0.7 0.3 3,634 17.0 964 All Urban 5.8 28.5 10.3 2.0 1.2 1,510 20.4 700 Major Cities 6.3 28.5 9.2 2.9 1.8 761 24.3 361 Other Urban 5.3 28.5 11.4 1.1 0.5 748 16.4 339 Age 15-241 1.8 11.2 3.7 0.0 0.0 1,066 16.7 224 15-19 1.3 7.1 3.0 0.0 0.0 201 21.7 29 20-24 1.9 12.2 3.8 0.0 0.0 865 16.0 195 25-29 3.7 22.2 8.5 1.4 0.7 4,078 18.7 1,440 30-39 2.4 18.4 6.9 0.8 0.6 2,258 17.6 686 40-49 5.3 26.9 10.4 2.1 1.0 1,820 19.7 754 Marital Status Currently married 3.3 20.1 7.6 1.0 0.5 4,984 18.7 1,626 Formerly married 1.7 15.0 5.5 2.8 1.7 160 (9.6) 39 Women’s educationa None/pre-school 0.3 4.6 1.2 0.0 0.0 2,029 11.1 168 Primary 1.2 13.4 4.0 0.4 0.2 1,158 13.8 263 Middle 2.0 24.0 8.0 0.7 0.4 655 16.6 258 Secondary 8.0 41.9 16.2 2.6 1.3 792 18.1 518 Higher 14.5 56.5 26.2 5.0 3.0 506 25.1 455 Wealth index quintile Lowest 0.6 5.2 0.7 0.0 0.0 1,045 3.1 83 Second 1.1 12.1 4.3 0.4 0.3 1,187 12.7 233 Middle 2.5 19.5 6.3 0.6 0.3 1,067 16.1 342 Fourth 3.5 28.0 9.4 0.9 0.5 1,009 21.4 465 Highest 10.4 40.1 19.6 4.3 2.2 836 22.3 541 Division Bahawalpur 2.4 20.5 9.3 0.3 0.1 514 13.4 163 D.G. Khan 0.5 4.8 3.1 0.2 0.0 561 19.3 63 Faisalabad 3.9 24.2 5.9 0.3 0.3 604 10.5 181 Gujranwala 5.5 28.3 12.5 3.5 1.8 703 16.1 326 Lahore 3.5 20.6 4.7 1.1 0.7 917 26.7 369 Multan 2.2 16.2 9.0 0.1 0.1 578 11.8 146 Rawalpindi 6.9 33.1 13.1 2.9 0.9 434 18.5 206 Sahiwal 1.5 11.8 7.8 0.6 0.4 398 33.5 82 Sargodha 2.6 16.7 2.9 0.5 0.5 435 15.8 129 1 MICS indicator 9.S1 - Knowledge about HIV prevention among young women ( ) Figures that are based on 25-49 unweighted cases a Total includes 2 unweighted cases of women's education missing P a g e | 191 XIII. ACCESS TO MASS MEDIA AND USE OF INFORMATION/COMMUNICATION TECHNOLOGY The MICS Punjab, 2014 collected information on exposure to mass media and the use of computers and the internet. The information was collected on exposure to newspapers, 1magazines, radio and television among women age 15-49 years, while the questions on the use of computers and the internet were asked to the age group of 15-24 years only. Access to Mass Media The proportion of women age 15-49 years who read a newspaper or magazine, listen to the radio and watch television at least once a week is shown in table MT.1. According to the data in the table, 11 percent of women in Punjab read a newspaper or magazine, 5 percent listen to the radio, and 64 percent watch television at least once a week. Overall, 34 percent do not have regular exposure to any of the three types of media, while 66 percent are exposed to at least one and 1 percent to all the three on a weekly basis. Table MT.1: Exposure to mass media Percentage of women age 15-49 years who are exposed to specific mass media on a weekly basis, Punjab, 2014. Percentage of women age 15-49 years who: All three media at least once a week1 Any media at least once a week None of the media at least once a week Number of women age 15- 49 years Read a newspaper at least once a week Listen to the radio at least once a week Watch television at least once a week Punjab 11.1 4.5 63.7 1.3 66.1 33.8 53,668 Area of residence Rural 7.4 3.7 54.0 0.8 56.3 43.5 35,043 All Urban 18.0 6.0 82.0 2.3 84.4 15.5 18,625 Major Cities 20.3 8.2 85.7 3.3 88.3 11.6 9,781 Other Urban 15.6 3.5 77.9 1.1 80.1 19.8 8,844 Age 15-19 14.3 6.9 69.1 2.0 72.5 27.4 11,158 20-24 15.0 7.2 70.3 2.4 73.3 26.6 9,960 25-29 11.6 4.1 65.1 1.1 67.8 32.2 9,114 30-34 8.7 2.8 59.9 0.9 61.5 38.4 7,558 35-39 8.6 2.7 60.0 0.7 61.6 38.2 6,251 40-44 6.9 1.9 56.1 0.3 57.7 42.1 5,078 45-49 5.3 1.8 52.9 0.3 54.2 45.8 4,548 Women’s educationa None/pre-school 0.2 1.7 42.7 0.0 43.5 56.4 20,887 Primary 6.0 3.0 65.8 0.3 68.2 31.4 9,296 Middle 12.3 5.1 75.1 1.2 78.4 21.5 5,714 Secondary 18.7 6.8 80.6 2.1 84.4 15.6 8,837 Higher 33.5 10.0 86.5 4.6 90.6 9.4 8,916 Wealth index quintile Lowest 1.1 1.8 22.2 0.1 24.0 75.8 9,271 Second 4.1 2.9 50.8 0.3 53.0 46.9 10,353 Middle 8.4 4.0 67.6 0.7 70.3 29.6 10,898 Fourth 12.5 5.1 79.2 1.3 81.8 18.1 11,528 Highest 26.3 8.0 89.3 3.7 91.8 8.2 11,617 P a g e | 192 Table MT.1: Exposure to mass media Percentage of women age 15-49 years who are exposed to specific mass media on a weekly basis, Punjab, 2014. Percentage of women age 15-49 years who: All three media at least once a week1 Any media at least once a week None of the media at least once a week Number of women age 15- 49 years Read a newspaper at least once a week Listen to the radio at least once a week Watch television at least once a week Division Bahawalpur 6.1 2.6 53.6 0.7 55.3 44.6 5,369 D.G. Khan 5.5 3.7 39.2 0.5 41.8 58.1 4,563 Faisalabad 9.4 4.2 64.8 1.0 66.7 33.2 6,796 Gujranwala 14.7 4.4 73.3 1.4 76.3 23.6 8,328 Lahore 14.7 6.9 78.1 2.5 80.1 19.7 9,685 Multan 9.5 5.1 54.3 1.2 57.1 42.7 5,887 Rawalpindi 14.9 6.1 72.5 1.5 75.8 24.2 5,086 Sahiwal 8.3 2.3 54.9 0.4 56.4 43.6 3,685 Sargodha 10.7 2.4 59.7 0.9 61.9 38.0 4,270 Punjab 11.1 4.5 63.7 1.3 66.1 33.8 53,668 1 MICS indicator 10.1 - Exposure to mass media a Total includes 15 unweighted cases of women's education missing Among divisions, exposure to any media was highest in Lahore (80%) followed by Rawalpindi division (76%) and lowest in DG Khan (42%). Women in households in the wealthiest quintile are most likely to be exposed to any type of media (92%). Strong differentials by area of residence and women’s education are also observed for exposure to any media at least once a week. Eighty four percent of urban women are exposed to any media compared to 56 percent of rural women. Women with higher education are more likely to be exposed to all the three types of media than women with primary education. Exposure to all three types of media is also higher among women from wealthier households and from urban areas. Use of Information/Communication Technology The questions on computer and internet use were asked only to women age 15-24. As shown in Table MT.2, 26 percent of women in this age group have ever used a computer, 21 percent during the last year and 14 percent at least once a week during the last month. Overall, 14 percent of the women have ever used the internet, while 12 percent of women used internet during the last year. The proportion of young women who used the internet “more frequently”, or “at least once a week” during the last month, is smaller, at about 9 percent. As expected, both the computer and internet use during the last 12 months is more widespread among women age 15-19. At division level, proportion of women using a computer during the last year being lowest (9%) in DG Khan division and highest (32%) in Lahore division. Use of a computer and the internet is also strongly associated with area of residence, women’s education and wealth status of the household. Only 4 percent of women of age group 15-24 with primary education reported using a computer during the last year, while more than half (57%) of the women with higher education during the same period used a computer. Similarly, higher utilization of the internet is observed among the women in urban areas (24%) compared to women in rural areas (6%). The proportion is higher (41%) for women P a g e | 193 living in households in the highest quintile compared to less than 1 percent of women living in the households in the lowest quintile. Table MT.2: Use of computers and internet Percentage of young women age 15-24 years who have ever used a computer and the internet, percentage who have used during the last 12 months, and percentage who have used at least once weekly during the last one month, Punjab, 2014. Percentage of women age 15-24 who have: Number of women age 15-24 years Ever used a computer Used a computer during the last 12 months1 Used a computer at least once a week during the last one month Ever used the internet Used the internet during the last 12 months2 Used the internet at least once a week during the last one month Punjab 26.4 21.4 13.6 13.7 12.4 8.9 21,119 Area of residence Rural 17.1 13.1 7.5 7.0 6.2 4.1 13,886 All Urban 44.3 37.5 25.4 26.4 24.2 18.2 7,233 Major Cities 49.9 42.4 29.4 31.9 29.6 22.6 3,681 Other Urban 38.6 32.3 21.2 20.7 18.6 13.6 3,552 Age 15-19 26.4 21.8 13.4 12.0 10.8 7.6 11,158 20-24 26.5 21.0 13.8 15.6 14.0 10.3 9,960 Women’s educationa None/pre-school 0.9 0.4 0.2 0.1 0.1 0.0 4,801 Primary 5.5 3.7 2.1 0.8 0.6 0.5 3,831 Middle 16.0 11.2 5.0 3.9 3.4 2.1 2,882 Secondary 35.7 28.2 15.8 14.3 12.5 7.7 4,919 Higher 66.5 56.8 39.7 43.5 40.0 30.5 4,677 Wealth index quintile Lowest 1.8 0.8 0.1 0.2 0.1 0.0 3,278 Second 6.5 4.1 1.7 0.8 0.6 0.3 4,273 Middle 17.8 12.7 6.3 5.0 4.0 2.1 4,523 Fourth 33.7 25.9 14.0 14.6 12.6 7.8 4,648 Highest 65.4 57.8 42.2 44.2 41.3 32.0 4,398 Division Bahawalpur 14.3 12.1 8.6 6.3 6.0 4.6 2,102 D.G. Khan 12.4 9.1 4.6 4.6 3.8 2.3 1,682 Faisalabad 23.1 18.8 12.9 11.4 10.2 7.9 2,732 Gujranwala 30.9 25.5 16.9 17.3 16.1 12.0 3,446 Lahore 39.1 32.4 19.7 21.3 19.0 13.8 3,883 Multan 22.0 17.9 9.5 9.7 8.7 5.4 2,307 Rawalpindi 38.9 31.2 21.4 23.3 21.1 15.4 1,885 Sahiwal 20.1 14.3 9.1 8.5 7.6 5.2 1,441 Sargodha 20.1 15.7 9.6 9.3 8.4 5.7 1,642 1 MICS indicator 10.2 - Use of computers 2 MICS indicator 10.3 - Use of internet a Total includes 7 unweighted cases of women's education missing P a g e | 194 XIV. SUBJECTIVE WELL-BEING Subjective perceptions of individuals of their incomes, health, living environments and the like, play a significant role in their lives and can impact their perception of well-being, irrespective of objective conditions such as actual income and physical health status69. In MICS Punjab, 2014 a set of questions were asked to women age 15-24 years to understand how satisfied this group of young people is in different areas of their lives, such as their family life, friendships, school, current job, health, where they live, how they are treated by others, how they look, and their current income. Life satisfaction is a measure of an individual’s perceived level of well-being. Understanding young women’s satisfaction in different areas of their lives can help to gain a comprehensive picture of young people’s life situations. A distinction can also be made between life satisfaction and happiness. Happiness is a fleeting emotion that can be affected by numerous factors, including day-to-day factors such as the weather, or a recent death in the family. It is possible for a person to be satisfied with job, income, family life, friends, and other aspects of life, but still be unhappy, or vice versa. In addition to the set of questions on life satisfaction, the survey also asked questions about happiness and the respondents’ perceptions of a better life. To assist respondents in answering the set of questions on happiness and life satisfaction they were shown a card with smiling faces (and not so smiling faces) that corresponded to the response categories (see ‘Questionnaires for individual women’ in Appendix–G) ‘very satisfied’, ‘somewhat satisfied‘, ‘neither satisfied nor unsatisfied’, ‘somewhat unsatisfied’ and ‘very unsatisfied’. For the question on happiness, the same scale was used, this time ranging from ‘very happy’ to ‘very unhappy’, in the same fashion. Table SW.1 shows the proportion of young women age 15-24, who are very or somewhat satisfied in selected domains. Note that for three domains, satisfaction with school, job and income, the denominators are confined to those who are currently attending school, have a job, and have an income. Of the different domains, young women are very or somewhat satisfied with their family life (90%), their health (86%), and the way they are treated by others (85%). Overall, 92 percent of young women do not have an income at all and out of those who have income, 67 percent are very or somewhat satisfied with their current income. 69 OECD. 2013. OECD Guidelines on Measuring Subjective Well Being. OECD. http://dx.doi.org/10.1787/9789264191655-en P a g e | 195 Table SW.1: Domains of life satisfaction Percentage of women age 15-24 years who are very or somewhat satisfied in selected domains of satisfaction, Punjab, 2014. Percentage of women age 15-24 who are very or somewhat satisfied with selected domains: Percentage of women age 15-24 years who: Number of women age 15-24 years Percentage of women age 15-24 years who are very or somewhat satisfied with school/educatio nal institute Number of women age 15-24 years attending school Percentage of women age 15-24 years who are very or somewhat satisfied with their job Number of women age 15-24 years who have a job Percentage of women age 15-24 years who are very or somewhat satisfied with their income Number of women age 15-24 years who have an income F a m ily l if e F ri e n d s h ip s H e a lt h L iv in g e n v ir o n m e n t T re a tm e n t b y o th e rs T h e w a y t h e y lo o k A re a tt e n d in g s c h o o l H a v e a j o b H a v e a n i n c o m e Punjab 89.7 82.5 85.6 81.3 85.3 92.0 26.1 6.6 8.3 21,119 91.6 5,505 70.3 1,404 66.9 1,755 Area of residence Rural 89.0 82.1 84.9 81.4 85.3 91.3 20.3 5.9 7.5 13,886 91.7 2,818 67.5 818 66.6 1,047 All Urban 91.2 83.2 87.2 81.0 85.4 93.3 37.1 8.1 9.8 7,233 91.6 2,687 74.3 586 67.3 708 Major Cities 92.0 82.3 88.1 81.2 86.3 93.4 37.3 8.9 10.4 3,681 91.8 1,374 75.8 328 66.2 382 Other Urban 90.4 84.0 86.2 80.7 84.4 93.2 37.0 7.3 9.2 3,552 91.3 1,313 72.4 258 68.6 325 Age 15-19 89.8 84.6 86.9 81.1 85.4 91.7 38.8 4.7 6.1 11,158 91.7 4,329 67.4 528 65.8 682 20-24 89.7 80.1 84.3 81.4 85.2 92.3 11.8 8.8 10.8 9,960 91.3 1,176 72.1 876 67.6 1,073 Marital Status Ever married 90.3 77.2 82.7 82.2 85.8 91.9 1.0 3.4 5.7 5,144 95.4 52 64.2 173 69.2 295 Never married 89.5 84.1 86.6 81.0 85.2 92.0 34.1 7.7 9.1 15,975 91.6 5,453 71.2 1,231 66.4 1,460 Women's Educationa None/pre-school 84.3 75.6 80.6 79.5 83.3 88.9 0.1 7.2 10.0 4,801 (*) 3 59.8 345 62.6 482 Primary 89.0 80.0 85.3 82.5 85.6 91.0 3.1 6.4 8.0 3,831 89.8 120 73.1 246 69.8 308 Middle 90.5 83.3 86.8 81.5 85.5 92.1 21.4 5.4 6.8 2,882 91.7 616 69.9 155 64.8 195 Secondary 91.6 84.9 87.9 81.9 85.9 93.5 41.8 4.6 5.8 4,919 92.2 2,057 71.5 228 68.8 287 Higher 93.5 88.5 88.0 81.2 86.4 94.3 57.9 9.1 10.3 4,677 91.3 2,709 76.7 426 68.8 480 Wealth index quintile Lowest 84.8 79.4 80.9 79.8 82.2 87.9 5.2 6.7 8.8 3,278 91.1 170 57.9 219 58.5 289 Second 86.4 80.4 84.0 81.1 84.4 91.0 14.2 7.2 9.2 4,273 93.7 607 68.3 307 69.6 392 Middle 89.8 81.6 85.6 81.6 85.3 91.9 25.6 6.0 7.8 4,523 90.8 1,160 67.6 273 62.4 353 Fourth 90.9 83.3 87.1 81.3 86.1 93.0 33.3 7.2 8.3 4,648 91.1 1,549 75.4 334 70.1 387 Highest 95.3 86.8 89.4 82.2 87.7 95.0 45.9 6.2 7.6 4,398 92.0 2,019 79.2 271 71.9 333 P a g e | 196 Table SW.1: Domains of life satisfaction Percentage of women age 15-24 years who are very or somewhat satisfied in selected domains of satisfaction, Punjab, 2014. Percentage of women age 15-24 who are very or somewhat satisfied with selected domains: Percentage of women age 15-24 years who: Number of women age 15-24 years Percentage of women age 15-24 years who are very or somewhat satisfied with school/educatio nal institute Number of women age 15-24 years attending school Percentage of women age 15-24 years who are very or somewhat satisfied with their job Number of women age 15-24 years who have a job Percentage of women age 15-24 years who are very or somewhat satisfied with their income Number of women age 15-24 years who have an income F a m ily l if e F ri e n d s h ip s H e a lt h L iv in g e n v ir o n m e n t T re a tm e n t b y o th e rs T h e w a y t h e y lo o k A re a tt e n d in g s c h o o l H a v e a j o b H a v e a n i n c o m e Division Bahawalpur 87.9 85.5 82.2 75.3 78.3 89.4 18.8 4.7 7.3 2,102 91.8 394 73.0 99 71.0 153 D.G. Khan 88.5 82.5 82.5 82.4 82.8 89.6 16.3 3.8 7.4 1,682 94.2 274 67.4 63 62.9 124 Faisalabad 87.0 74.2 84.0 73.8 76.5 89.2 27.0 6.3 7.1 2,732 92.2 738 63.6 173 57.4 194 Gujranwala 89.9 80.9 87.4 81.6 87.3 92.0 33.1 6.9 8.0 3,446 90.3 1,140 75.1 236 69.8 274 Lahore 91.4 85.1 86.7 84.1 89.3 92.7 29.2 7.9 8.6 3,883 90.6 1,134 67.4 306 64.1 335 Multan 89.5 77.9 86.5 78.9 86.2 93.8 20.4 10.4 12.1 2,307 91.8 470 59.4 240 58.2 279 Rawalpindi 90.4 83.7 84.4 84.0 85.6 92.5 39.4 4.1 6.5 1,885 91.7 742 80.6 77 67.0 123 Sahiwal 90.9 84.9 89.4 85.5 90.0 95.5 20.0 9.4 12.0 1,441 96.2 289 81.9 135 83.8 173 Sargodha 91.9 92.1 86.8 89.1 92.0 94.5 19.8 4.5 6.0 1,642 92.0 325 86.2 74 80.0 99 Punjab 89.7 82.5 85.6 81.3 85.3 92.0 26.1 6.6 8.3 21,119 91.6 5,505 70.3 1,404 66.9 1,755 a Total includes 7 unweighted cases of women's education missing (*) Figures that are based on fewer than 25 unweighted cases P a g e | 197 In Table SW.2, proportions of women age 15-24 years with overall life satisfaction are shown. The term “life satisfaction” is defined as those who are very or somewhat satisfied with their life overall, and is based on a single question which was asked after the life satisfaction questions on all of the previously mentioned domains, with the exception of the question on satisfaction with income, which was asked later. About 91 percent of women age 15-24 are satisfied with their life overall. There is a positive relationship between wealth and life satisfaction. The proportion of women that is satisfied ranges from 86 percent of women living in the households in the lowest quintile to 95 percent in the highest quintile. The proportion of women who are satisfied with life varies with educational level of the woman; 86 percent for women with pre-school or no education versus 94 percent for those with higher education. As a summary measure, the average life satisfaction score is also calculated and included in table SW.2. The score is calculated simply by averaging the responses to the question on overall life satisfaction, ranging from very satisfied (1) to very unsatisfied (5). Therefore, the lower the average score, the higher the life satisfaction levels. The table indicates very clearly that there is a strong relationship between the average life satisfaction score and the socioeconomic status of young women. The information in the table suggests that 91 percent of women age 15-24 years are very or somewhat happy. Differences by wealth quintiles can also be observed for this indicator; however, there is no difference between women age 15-19 and 20-24. P a g e | 198 Table SW.2: Overall life satisfaction and happiness Percentage of women age 15-24 years who are very or somewhat satisfied with their life overall, the average overall life satisfaction score, and percentage of women age 15-24 years who are very or somewhat happy, Punjab, 2014. Percentage of women with overall life satisfaction1 Average life satisfaction score Percentage of women who are very or somewhat happy 2 Number of women age 15-24 years Punjab 90.5 1.6 90.9 21,119 Area of residence Rural 90.1 1.7 90.1 13,886 All Urban 91.4 1.6 92.2 7,233 Major Cities 91.6 1.6 92.8 3,681 Other Urban 91.2 1.6 91.6 3,552 Age 15-19 90.9 1.6 91.1 11,158 20-24 90.1 1.7 90.6 9,960 Marital Status Ever married 90.0 1.7 91.4 5,144 Never married 90.7 1.6 90.7 15,975 Women’s educationa None/pre-school 85.9 1.8 87.2 4,801 Primary 89.2 1.7 90.1 3,831 Middle 90.5 1.6 91.2 2,882 Secondary 92.8 1.5 92.6 4,919 Higher 93.9 1.5 93.2 4,677 Wealth index quintile Lowest 86.0 1.8 86.8 3,278 Second 87.2 1.7 89.0 4,273 Middle 91.0 1.6 90.5 4,523 Fourth 91.9 1.6 91.6 4,648 Highest 95.1 1.4 95.2 4,398 Division Bahawalpur 86.4 1.7 90.2 2,102 D.G. Khan 88.5 1.8 90.7 1,682 Faisalabad 87.2 1.7 86.8 2,732 Gujranwala 91.6 1.6 91.8 3,446 Lahore 91.9 1.6 92.0 3,883 Multan 91.9 1.7 91.1 2,307 Rawalpindi 91.0 1.5 91.2 1,885 Sahiwal 93.8 1.5 92.7 1,441 Sargodha 92.4 1.6 91.7 1,642 1 MICS Indicator 11.1 - Life satisfaction 2 MICS indicator 11.2 - Happiness a Total includes 7 unweighted cases of women's education missing In addition to the series of questions on life satisfaction and happiness, respondents were also asked two simple questions on whether they think their life improved during the last one year, and whether they think their life will be better in one year’s time. Such information may contribute to our understanding of desperation that may exist among young people, as well as hopelessness and hopes for the future. Specific combinations of the perceptions during the last one year and expectations for the next one year may be valuable information to understand the general sense of well-being among young people. In Table SW.3, women’s perceptions of a better life are presented. The proportion of women age 15- 24 years who think that their lives improved during the last one year and who expect that their lives will get better after one year, is 59 percent. Differences in the perception of a better life can be observed by wealth; 45 percent of the women living in the households in the lowest quintile think that their lives improved during the last one year and expect that it will get better after one year, while the corresponding proportion of women living in the households in the highest quintile is 71 percent. P a g e | 199 Differences for perception of a better life also exist by area of residence, lower in rural areas (57%) compared to urban areas (65%). Table SW.3: Perception of a better life Percentage of women age 15-24 years who think that their lives improved during the last one year and those who expect that their lives will get better after one year, Punjab, 2014. Percentage of women who think that their life Number of women age 15-24 years Improved during the last one year Will get better after one year Both1 Punjab 61.2 89.8 59.2 21,119 Area of residence Rural 58.6 88.8 56.5 13,886 All Urban 66.1 91.8 64.5 7,233 Major Cities 66.7 91.3 64.9 3,681 Other Urban 65.6 92.2 64.2 3,552 Age 15-19 61.3 89.7 59.4 11,158 20-24 61.0 90.0 59.1 9,960 Marital Status Ever married 64.8 89.7 62.5 5,144 Never married 60.1 89.9 58.2 15,975 Women’s educationa None/pre-school 51.6 83.5 48.7 4,801 Primary 57.4 88.4 55.2 3,831 Middle 61.5 91.0 59.9 2,882 Secondary 66.4 93.2 64.7 4,919 Higher 68.6 93.2 67.2 4,677 Wealth index quintile Lowest 47.8 82.4 44.9 3,278 Second 54.8 87.3 52.8 4,273 Middle 62.5 91.0 60.5 4,523 Fourth 64.5 92.7 63.0 4,648 Highest 72.6 93.7 71.0 4,398 Division Bahawalpur 55.1 77.1 51.4 2,102 D.G. Khan 64.4 89.3 62.4 1,682 Faisalabad 54.2 88.8 53.2 2,732 Gujranwala 66.6 93.3 65.2 3,446 Lahore 65.3 90.9 63.2 3,883 Multan 53.0 90.7 50.6 2,307 Rawalpindi 65.1 90.1 63.1 1,885 Sahiwal 66.7 94.9 64.8 1,441 Sargodha 58.5 92.6 57.2 1,642 1 MICS indicator 11.3 - Perception of a better life a Total includes 7 unweighted cases of women's education missing P a g e | 200 XV. TOBACCO USE Tobacco products are made entirely or partly of leaf tobacco as raw material, which are intended to be smoked, sucked, chewed, or snuffed. All contain the highly addictive psychoactive ingredient, nicotine. Tobacco use is one of the main risk factors for a number of chronic diseases, including cancer, lung diseases, and cardiovascular diseases.70 The MICS Punjab, 2014 collected information on ever and current use of tobacco and intensity of use among women age 15-49 years. Tobacco Use The data on ever and current use of tobacco products by women age 15-49 is displayed in table TA.1. About 6 percent of women reported to have ever used a tobacco product, while 4 percent smoked cigarettes, or used smoked or smokeless tobacco products on one or more days during the last one month. Tobacco use among women, during the last one month, was highest in DG Khan (13%) compared to the other divisions. Use of tobacco was also more common in rural areas than in urban (7% and 3% respectively). Use of any tobacco product is higher among women with low education, older women and those living in the households in the lowest quintile. For example, while 13 percent of women age 45-49 use tobacco, the corresponding figure is less than 1 percent for young women age 15-19. Similarly, 12 percent of women living in the households in the lowest quintile use tobacco products compared to less than 1 percent of women living in the households in the highest quintile. Figure TA.1 illustrates ever and current smokers by age of the woman. 70 WHO. http://www.who.int/topics/tobacco/en/ P a g e | 201 Figure TA.1: Ever and current smokers by age groups , MICS Punjab , 2014 Table TA.1: Current and ever use of tobacco Percentage of women age 15-49 years by pattern of use of tobacco, Punjab, 2104. Never smoked cigarettes or used other tobacco products Ever users Users of tobacco products at any time during the last one month Number of women age 15-49 years Only cigar ettes Cigarettes and other tobacco products Only other tobacco products Any tobacco product Only cigare ttes Cigarettes and other tobacco products Only other tobacco products Any toba cco prod uct1 Punjab 94.2 1.1 0.6 4.0 5.7 0.7 0.3 3.2 4.1 53,668 Area of residence Rural 93.0 1.2 0.7 4.9 6.9 0.8 0.4 4.3 5.5 35,043 All Urban 96.5 0.9 0.3 2.2 3.3 0.4 0.1 1.1 1.6 18,625 Major Cities 96.3 1.0 0.2 2.2 3.4 0.4 0.0 0.7 1.1 9,781 Other Urban 96.7 0.7 0.3 2.2 3.2 0.4 0.1 1.6 2.1 8,844 Age 15-19 98.8 0.2 0.1 0.8 1.0 0.1 0.0 0.4 0.4 11,158 20-24 97.7 0.5 0.2 1.5 2.2 0.2 0.1 0.9 1.2 9,960 25-29 96.2 0.6 0.3 2.8 3.7 0.3 0.1 2.0 2.4 9,114 30-34 93.0 1.6 0.4 5.0 6.9 1.0 0.1 4.1 5.2 7,558 35-39 91.4 1.9 1.0 5.7 8.5 1.1 0.5 4.8 6.4 6,251 40-44 88.0 2.2 1.6 8.2 11.9 1.6 0.9 6.9 9.4 5,078 45-49 84.4 2.5 1.8 11.2 15.5 1.7 1.0 9.7 12.5 4,548 Under-5s in the same household At least one 94.1 1.2 0.5 4.0 5.8 0.7 0.3 3.3 4.2 26,867 None 94.3 1.0 0.6 4.0 5.6 0.7 0.3 3.1 4.1 26,801 Women's educationa None/pre-school 89.0 2.0 1.2 7.8 10.9 1.5 0.7 7.0 9.2 20,887 Primary 96.2 0.7 0.4 2.6 3.7 0.3 0.1 1.7 2.1 9,296 Middle 97.2 0.5 0.3 1.8 2.6 0.1 0.1 0.7 1.0 5,714 Secondary 98.3 0.5 0.0 1.0 1.6 0.0 0.0 0.4 0.4 8,837 Higher 98.4 0.4 0.1 1.0 1.5 0.1 0.0 0.2 0.2 8,916 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 45-49 40-44 35-39 30-34 25-29 20-24 15-19 Ever users Users during the last one month P a g e | 202 Table TA.1: Current and ever use of tobacco Percentage of women age 15-49 years by pattern of use of tobacco, Punjab, 2104. Never smoked cigarettes or used other tobacco products Ever users Users of tobacco products at any time during the last one month Number of women age 15-49 years Only cigar ettes Cigarettes and other tobacco products Only other tobacco products Any tobacco product Only cigare ttes Cigarettes and other tobacco products Only other tobacco products Any toba cco prod uct1 Wealth index quintile Lowest 86.8 2.0 1.4 9.7 13.1 1.6 0.9 9.3 11.8 9,271 Second 93.1 1.3 0.7 4.8 6.8 0.9 0.4 4.0 5.3 10,353 Middle 95.5 0.9 0.5 2.9 4.4 0.4 0.3 2.2 2.8 10,898 Fourth 96.7 0.7 0.2 2.2 3.2 0.3 0.1 1.3 1.7 11,528 Highest 97.5 0.7 0.2 1.5 2.3 0.2 0.0 0.5 0.7 11,617 Division Bahawalpur 95.2 1.5 0.4 2.8 4.7 1.3 0.3 2.4 4.0 5,369 D.G. Khan 86.0 0.9 1.1 11.9 13.9 0.8 0.5 11.3 12.6 4,563 Faisalabad 95.2 0.8 0.7 3.2 4.7 0.5 0.6 2.7 3.8 6,796 Gujranwala 96.3 1.0 0.5 2.2 3.6 0.5 0.2 1.3 2.0 8,328 Lahore 95.7 1.5 0.4 2.3 4.2 0.6 0.1 1.0 1.7 9,685 Multan 96.2 0.7 0.3 2.6 3.6 0.5 0.1 2.2 2.8 5,887 Rawalpindi 94.5 0.5 0.3 4.4 5.1 0.2 0.0 3.1 3.3 5,086 Sahiwal 93.6 2.1 1.3 3.0 6.3 1.5 0.7 2.4 4.6 3,685 Sargodha 90.1 1.0 0.6 8.2 9.8 0.6 0.3 7.1 8.0 4,270 Punjab 94.2 1.1 0.6 4.0 5.7 0.7 0.3 3.2 4.1 53,668 1 MICS indicator 12.1 - Tobacco use a Total includes 15 unweighted cases of women's education missing Table TA.2 presents data on age at first use of cigarettes, as well as frequency of use. The results show that less than 1 percent of women 15-49 years smoked a cigarette for the first time before age 15. Among the current cigarettes smokers, 70 percent of women smoked less than 5 cigarettes followed by 12 percent of women who smoked 5-9 cigarettes in the last 24 hours. P a g e | 203 Table TA.2: Age at first use of cigarettes and frequency of use Percentage of women age 15-49 years who smoked a whole cigarette before age 15, and percent distribution of current smokers by the number of cigarettes smoked in the last 24 hours, Punjab, 2104. Percentage of women who smoked a whole cigarette before age 151 Number of women age 15-49 years Number of cigarettes in the last 24 hours Number of women age 15-49 years who are current cigarette smokers Less than 5 5-9 10-19 20+ DK/ Missing Total Punjab 0.2 53,668 70.1 12.5 9.4 7.8 0.2 100.0 520 Area of residence Rural 0.2 35,043 70.4 11.8 10.1 7.5 0.2 100.0 435 All Urban 0.1 18,625 68.8 16.3 5.6 9.3 0.0 100.0 84 Major Cities 0.2 9,781 (*) (*) (*) (*) (*) 100.0 40 Other Urban 0.1 8,844 66.7 14.7 8.3 10.3 0.0 100.0 45 Age 15-19 0.1 11,158 (*) (*) (*) (*) (*) 100.0 7 20-24 0.1 9,960 (71.1) (10.6) (7.9) (10.4) (0.0) 100.0 29 25-29 0.1 9,114 (76.8) (16.7) (4.1) (2.3) (0.0) 100.0 36 30-34 0.1 7,558 71.0 12.6 8.5 7.9 0.0 100.0 88 35-39 0.4 6,251 70.0 11.3 10.5 7.7 0.5 100.0 100 40-44 0.4 5,078 71.8 12.3 10.1 5.3 0.4 100.0 131 45-49 0.4 4,548 64.9 12.8 10.6 11.8 0.0 100.0 129 Under-5s in the same household At least one 0.2 26,867 71.9 14.0 8.5 5.3 0.2 100.0 256 None 0.2 26,801 68.4 11.0 10.2 10.2 0.2 100.0 264 Women’s educationa None/pre-school 0.3 20,887 68.8 13.1 10.0 7.9 0.2 100.0 453 Primary 0.1 9,296 (78.7) (7.2) (1.9) (12.2) (0.0) 100.0 41 Middle 0.1 5,714 (*) (*) (*) (*) (*) 100.0 13 Secondary 0.2 8,837 (*) (*) (*) (*) (*) 100.0 5 Higher 0.1 8,916 (*) (*) (*) (*) (*) 100.0 7 Wealth index quintile Lowest 0.4 9,271 63.6 12.3 12.9 10.9 0.2 100.0 233 Second 0.2 10,353 73.4 9.4 10.6 6.2 0.4 100.0 139 Middle 0.1 10,898 78.8 17.1 0.7 3.3 0.0 100.0 77 Fourth 0.1 11,528 (65.8) (19.3) (5.6) (9.3) (0.0) 100.0 43 Highest 0.1 11,617 (*) (*) (*) (*) (*) 100.0 28 Division Bahawalpur 0.2 5,369 61.3 16.4 12.1 10.3 0.0 100.0 86 D.G. Khan 0.3 4,563 68.6 8.3 6.2 15.0 1.8 100.0 59 Faisalabad 0.3 6,796 68.4 13.2 14.0 4.4 0.0 100.0 73 Gujranwala 0.1 8,328 70.2 13.7 12.8 3.3 0.0 100.0 62 Lahore 0.2 9,685 81.2 10.7 3.8 4.3 0.0 100.0 72 Multan 0.1 5,887 (69.6) (9.2) (15.6) (5.6) (0.0) 100.0 36 Rawalpindi 0.1 5,086 (*) (*) (*) (*) (*) 100.0 10 Sahiwal 0.3 3,685 69.7 12.4 8.1 9.8 0.0 100.0 81 Sargodha 0.2 4,270 (75.5) (9.4) (3.4) (11.8) (0.0) 100.0 39 1 MICS indicator 12.2 - Smoking before age 15 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases a Total includes 15 unweighted cases of women's education missing P a g e | 204 XVI. ADULT HEALTH AND HEALTH CARE The findings presented in this chapter are based on the questions specifically included in MICS Punjab, 2014 questionnaire that was not part of the MICS5 standard questionnaire. Chronic Cough, Tuberculosis and Hepatitis Table HC.1 presents responses to questions in household questionnaire about chronic cough, tuberculosis and hepatitis. Recent chronic cough is not a necessary symptom for diagnostic of tuberculosis. The population reporting a cough for the last three weeks was 3 percent. There is slight variation at divisional level; ranging from 1 percent in Rawalpindi division to 6 percent in Sahiwal division. The proportion is slightly higher among women living in the households in the lowest quintile (5%) compared to women from households in the highest quintile (2%). Table HC.1: Reported cough and fever and diagnosis of tuberculosis and hepatitis Percentage of population for whom the household respondent reported had a cough and fever during the last three weeks, percentage of population diagnosed with tuberculosis during the last one year and percentage of the household population diagnosed hepatitis during the last one year, Punjab, 2014. Percentage of population having a cough and fever during the last three weeks1 Percentage of population diagnosed in the last one year with: Total number of household members tuberculosis 2 Hepatitis 3 Punjab 3.2 0.5 1.5 246,396 Area of residence Rural 3.6 0.5 1.6 165,174 All Urban 2.5 0.3 1.3 81,222 Major Cities 2.2 0.3 1.4 42,289 Other Urban 2.8 0.3 1.3 38,933 Sex Male 3.3 0.5 1.5 124,711 Female 3.2 0.4 1.6 121,684 Education of household heada None/pre-school 4.0 0.6 1.6 99,632 Primary 3.6 0.5 1.8 43,176 Middle 2.8 0.3 1.5 31,941 Secondary 2.3 0.3 1.5 44,624 Higher 1.9 0.2 1.1 26,950 Wealth index quintile Lowest 4.5 0.7 1.4 49,280 Second 3.9 0.5 1.5 49,278 Middle 3.5 0.5 1.8 49,279 Fourth 2.5 0.3 1.6 49,281 Highest 1.7 0.2 1.4 49,278 Division Bahawalpur 4.2 0.5 1.1 25,956 D.G. Khan 3.8 0.6 1.2 23,418 Faisalabad 3.0 0.4 1.8 30,970 Gujranwala 3.3 0.5 1.8 36,313 Lahore 2.9 0.3 1.7 43,847 Multan 3.8 0.5 1.8 27,788 Rawalpindi 1.3 0.5 1.3 21,767 Sahiwal 5.7 0.4 1.9 17,255 Sargodha 1.3 0.3 0.8 19,082 1 MICS indicator 13.S2 - Prevalence of chronic cough 2 MICS indicator 13.S3 - Reported tuberculosis 3 MICS indicator 13.S4 - Reported hepatitis a Total includes 80 unweighted cases of household head's education missing P a g e | 205 About 1 in 200 of the surveyed population (3%) reported to have a diagnosis of tuberculosis in the past year. No differences are observed by gender and area of residence (rural or urban) while lower percentages are observed amongst those that are more educated and living in the households in the highest quintile. Less than 2 percent of the population reported being diagnosed with hepatitis in the past year (Table HC.1). There is only a small difference between rural and urban areas in this regard. Lady Health Worker Visits Table HC.2 provides information in relation to the visit of Lady Health Workers (LHWs) during the past one month. Thirty-eight percent of the women age 15–49 years, who gave birth in last two years, reported a visit by a Lady Health Worker (LHW) in the past month; 43 percent in rural and 26 percent in urban areas. At division level, proportion of women visited by LHWs during past one month was highest in DG Khan (51%), followed by Sahiwal and Bahawalpur (44% each) and lowest in Lahore division (19%). Slightly more women from the households in the lowest quintile reported having a visit from LHW compared to women in the highest quintile. As regards to the purpose of LHW visits, 54 percent reported that they received health education or advice followed by 38 percent of women who received ORT, vitamins or medicines. Table HC.2: Care provided by Lady health worker (LHW) Percentage of ever married women with a live birth in the last 2 years who reported that a LHW visited the house during the past month and the purpose of visit, Punjab, 2014. HH visited by lady health worker (LHW) during past month1 Number of ever married women with a live birth in the last two years Purpose of Visit Number of ever married women visited by LHW ORT, vitamins, medicines To weigh child Education / advice Otherb DK Punjab 37.6 10,653 37.6 4.8 54 21.4 1.8 3,991 Area of residence Rural 42.6 7,369 37.4 4.9 53.9 21.7 1.9 3,130 All Urban 26.4 3,284 38.0 4.4 54.9 20.1 1.5 861 Major Cities 14.2 1,692 46.8 3.5 52.7 14.6 0.9 236 Other Urban 39.3 1,592 34.6 4.7 55.7 22.2 1.7 625 Women’s educationa None/pre-school 36.7 4,816 38.7 3.8 48.1 26.3 2.1 1,764 Primary 40.3 1,961 38.5 5.2 56.2 19.0 1.2 790 Middle 42.1 1,096 34.5 5.6 60.2 18.3 1.3 459 Secondary 35.1 1,467 36.2 5.6 63.3 14.1 2.4 513 Higher 35.7 1,311 36.2 5.9 57.5 17.4 1.7 464 Wealth index quintile Lowest 37.8 2,327 35.5 3.4 45.3 32.7 2.1 879 Second 42.3 2,166 39.5 4.2 50.5 22.7 2.3 916 Middle 39.6 2,144 38.3 5.4 58.5 16.1 1.5 846 Fourth 37.7 2,065 37.5 6.2 59.0 15.8 2.0 777 Highest 29.7 1,951 36.6 4.8 60.4 17.1 1.0 573 Division Bahawalpur 44.0 1,068 58.3 4.6 47.3 13.1 0.6 468 D.G. Khan 50.9 1,181 15.1 0.8 41.4 51.8 4.7 601 Faisalabad 30.6 1,237 30.7 2.6 69.3 7.4 2.4 379 Gujranwala 45.2 1,578 37.1 4.4 56.1 13.9 2.1 714 Lahore 19.0 1,914 39.5 4.7 56.9 20.1 2.4 358 Multan 39.1 1,162 45.9 3.7 60.9 18.0 0.3 451 Rawalpindi 38.5 882 44.9 11.8 51.6 20.6 0.4 337 Sahiwal 44.3 827 36.9 4.2 60.3 10.8 0.9 367 Sargodha 39.4 804 37.4 11.0 48.7 28.5 1.0 317 1 MICS indicator 13.S1 - Care provided by Lady Health Worker (LHW) a Total includes 2 unweighted cases of women's education missing b It includes special campaigns like polio, measles etc. P a g e | 206 XVII. SOCIO ECONOMIC DEVELOPMENT71 Introduction This chapter contains information on socio-economic variables, most of which, are not included in standard MICS questionnaire. The topics covered are; ‘remittances and cash donations’, ‘social benefits’, ‘subsides and family support programme’, ‘possession of bank account’, ‘unemployment’ and ‘marital status’. This module was included on request by Government of the Punjab to assess the immediate results of its social welfare programmes being implemented in the province. Ownership Status of Household Overall 87 percent of the household population in Punjab is living in their own houses (Table SED.1). The ownership of houses is higher in rural areas (92%) compared to urban areas (78%). In major cities, 21 percent of population is living in rented houses. Household wealth has no relation with ownership status of the households. Information about ownership of agricultural land and livestock are also presented in Table SED.1. Thirty one percent of the households own agriculture land, and 46 percent own livestock. The ownership of agriculture land and livestock is higher in rural (41% and 63% respectively) compared to urban areas (9% and 12% respectively). Ninety one percent own either a house, land or livestock. Table SED.1: House, agricultural land, and livestock ownership Percent distribution of household population living in households that own their property and percentages of household population who own agricultural land or livestock, Punjab, 2014. Percentage of household by house ownership Percentage of households who own agriculture land Percentage of households who own livestock Percentage of households own certain assets (house, land or livestock)1 Number of households Own Rent Other/ Missing Total Punjab 87.0 7.8 5.2 100.0 30.5 45.5 90.8 38,405 Area of residence Rural 91.6 3.0 5.4 100.0 41.1 62.5 95.6 25,577 All Urban 77.9 17.5 4.6 100.0 9.3 11.6 81.1 12,828 Major Cities 73.8 20.9 5.3 100.0 6.2 6.4 76.9 6,717 Other Urban 82.4 13.8 3.8 100.0 12.6 17.4 85.7 6,111 Education of household heada None/pre-school 88.1 5.6 6.3 100.0 30.4 58.0 92.7 15,399 Primary 87.1 7.6 5.3 100.0 27.1 45.2 90.3 6,639 Middle 87.2 8.2 4.6 100.0 31.4 41.3 90.0 4,863 Secondary 86.7 9.5 3.9 100.0 32.8 35.8 89.5 7,022 Higher 83.5 12.9 3.6 100.0 31.2 22.7 87.4 4,472 Wealth index quintile Lowest 88.4 1.4 10.2 100.0 37.2 80.0 96.2 8,027 Second 91.2 3.7 5.1 100.0 36.5 63.6 94.9 7,721 Middle 89.1 7.4 3.5 100.0 34.8 47.7 91.2 7,508 Fourth 82.9 13.4 3.6 100.0 24.9 24.7 85.1 7,551 Highest 83.2 13.7 3.0 100.0 18.6 9.1 85.9 7,598 71 Some of the socio-economic topics have already being covered in the chapter III. P a g e | 207 Table SED.1: House, agricultural land, and livestock ownership Percent distribution of household population living in households that own their property and percentages of household population who own agricultural land or livestock, Punjab, 2014. Percentage of household by house ownership Percentage of households who own agriculture land Percentage of households who own livestock Percentage of households own certain assets (house, land or livestock)1 Number of households Own Rent Other/ Missing Total Division Bahawalpur 90.0 3.5 6.5 100.0 37.8 60.4 94.9 4,091 D.G. Khan 93.0 2.7 4.3 100.0 43.7 71.9 97.1 3,436 Faisalabad 86.3 7.6 6.1 100.0 29.3 40.1 89.5 4,889 Gujranwala 91.1 6.6 2.4 100.0 31.4 39.3 92.9 5,569 Lahore 82.9 13.1 3.9 100.0 15.3 23.4 85.4 6,631 Multan 87.9 6.0 6.1 100.0 30.1 49.3 91.6 4,633 Rawalpindi 79.2 16.1 4.7 100.0 30.9 37.8 84.3 3,633 Sahiwal 84.7 5.4 9.9 100.0 33.0 54.2 91.2 2,638 Sargodha 88.9 5.5 5.6 100.0 37.3 60.4 94.0 2,885 Punjab 87.0 7.8 5.2 100.0 30.5 45.5 90.8 38,405 1 MICS indicator 14.S1 - Ownership of assets: House, land, livestock a Total includes 11 unweighted cases of household head's education missing Remittances and Cash Donations The findings presented in this section and the subsequent sections on remittances and cash donations, social benefits and unemployment are based on the questions specifically included in MICS Punjab, 2014 questionnaire that are not the part of the MICS5 standard questionnaire. Table SED.2 presents information about the population working outside their village, town or country. The population working either outside their village, town or country is found to be 12 percent; rural population (13%) is slightly more likely to work outside village, town or country compared to urban population (10%). P a g e | 208 Table SED.2: Working outside village/city/country Percentage of household members working outside village/city/country and percent distribution of the place of work for members working outside village/city, Punjab, 2014. Percentage of household members working outside village/ town/ overseas1 Number of household members Place of work of members working outside village/city Number of household members working outside village/ town Other village/city Other district Other province Overseas DK/ Missing Total Punjab 12.0 246,396 14.5 8.3 7.2 69.5 0.5 100.0 29,670 Area of residence Rural 12.9 165,174 15.7 8.9 8.5 66.4 0.4 100.0 21,234 All Urban 10.4 81,222 11.7 6.6 4.0 77.1 0.5 100.0 8,436 Major Cities 8.7 42,289 13.4 3.4 2.2 80.2 0.9 100.0 3,678 Other Urban 12.2 38,933 10.5 9.2 5.4 74.7 0.2 100.0 4,758 Education of household heada None/pre-school 12.3 99,632 17.8 9.7 9.6 62.7 0.2 100.0 12,258 Primary 11.8 43,176 14.1 7.9 7.6 69.4 1.1 100.0 5,096 Middle 12.4 31,941 12.2 7.7 7.0 73.0 0.1 100.0 3,962 Secondary 12.1 44,624 10.4 7.2 3.9 77.9 0.5 100.0 5,392 Higher 10.9 26,950 12.8 5.9 3.2 77.3 0.8 100.0 2,937 Wealth index quintile Lowest 5.9 49,280 29.6 14.6 20.8 34.9 0.1 100.0 2,889 Second 7.4 49,278 28.0 17.9 13.7 40.1 0.2 100.0 3,665 Middle 10.9 49,279 18.4 11.2 10.4 59.7 0.3 100.0 5,388 Fourth 16.1 49,281 11.5 5.6 4.3 77.8 0.8 100.0 7,928 Highest 19.9 49,278 5.4 3.4 1.5 89.2 0.5 100.0 9,799 Division Bahawalpur 6.3 25,956 17.0 14.1 10.6 58.3 0.0 100.0 1,638 D.G. Khan 14.2 23,418 24.1 6.7 20.8 48.3 0.1 100.0 3,317 Faisalabad 7.7 30,970 7.7 11.1 2.7 78.4 0.1 100.0 2,387 Gujranwala 28.5 36,313 10.5 8.0 2.7 78.2 0.6 100.0 10,342 Lahore 7.2 43,847 16.6 5.6 2.7 74.2 1.0 100.0 3,147 Multan 8.3 27,788 29.1 9.3 15.4 45.9 0.3 100.0 2,296 Rawalpindi 16.3 21,767 9.6 4.1 4.5 81.1 0.7 100.0 3,543 Sahiwal 8.3 17,255 16.6 12.9 13.4 56.9 0.2 100.0 1,440 Sargodha 8.2 19,082 12.7 12.4 9.8 64.8 0.3 100.0 1,561 1 MICS indicator 14.S3 - Proportion of population working outside village/city/country a Total includes 80 unweighted cases of household head's education missing Remittances Respondents were asked whether the household received any remittance (in cash) from within the country and/ or overseas during the last year which they did not have to repay. Information presented in Table SED.3 shows that only 3 percent of households received remittances from within the country with differentials existing in urban (2%) and rural areas (4%). Households in the lower wealth quintiles are more likely to have received remittances compared to households in the fourth and highest quintile. The median value of remittances received by the households is estimated to be Rs. 60,000. Table SED.4 shows the information on remittances received from abroad. About 7 percent of households received remittances from abroad, out of which half received below Rs.180,000 per year. P a g e | 209 Table SED.3: Receiving remittances from within Pakistan Percentage of households that received any remittance from within Pakistan during the last year and percent distribution of the value and median value of remittance received, Punjab, 2014. Percentage of households receiving remittances from Pakistan1 Number of households Percentage of households receiving the following value of remittance from within Pakistan Median value of remittances from within Pakistan (Rs.) Total number of households receiving remittances from Pakistan less than 3,000 3,000 to less than 5,000 5,000 to less than 10,000 10,000 to less than 20,000 20,000 or more Not specified Total Punjab 3.1 38,405 33.8 11.0 26.8 17.6 7.5 3.3 100.0 60,000 1,178 Area of residence Rural 3.7 25,577 33.7 10.7 27.0 18.5 7.6 2.6 100.0 60,000 952 All Urban 1.8 12,828 34.2 12.5 25.8 13.7 7.4 6.5 100.0 50,000 225 Major Cities 1.2 6,717 39.2 13.3 27.6 4.5 6.2 9.2 100.0 48,428 83 Other Urban 2.3 6,111 31.3 12.0 24.7 19.1 8.0 4.8 100.0 60,000 143 Education of household heada None/pre-school 4.1 15,399 37.5 12.9 25.4 16.8 5.7 1.8 100.0 50,000 628 Primary 3.0 6,639 27.8 8.7 32.5 16.5 11.6 3.0 100.0 70,000 199 Middle 2.6 4,863 29.7 6.9 27.9 26.3 7.9 1.3 100.0 60,000 125 Secondary 2.2 7,022 31.9 8.8 31.3 17.9 5.5 4.6 100.0 60,000 153 Higher 1.6 4,472 29.3 13.3 11.4 11.6 16.5 17.9 100.0 40,000 72 Wealth index quintile Lowest 3.3 8,027 48.8 16.7 24.9 8.0 0.7 0.8 100.0 36,000 267 Second 3.9 7,721 37.0 8.1 30.2 18.2 5.3 1.2 100.0 60,000 299 Middle 3.7 7,508 29.8 11.1 27.6 20.4 8.7 2.3 100.0 70,000 281 Fourth 2.8 7,551 20.7 7.7 27.8 26.4 13.4 3.9 100.0 93,517 211 Highest 1.6 7,598 24.6 11.1 18.5 15.3 15.2 15.4 100.0 60,000 120 Division Bahawalpur 2.2 4,091 63.6 8.5 18.7 6.6 2.7 0.0 100.0 20,000 91 D.G. Khan 5.6 3,436 44.6 12.7 26.4 11.1 3.4 1.7 100.0 40,000 192 Faisalabad 1.2 4,889 25.5 21.7 22.7 21.1 7.1 1.9 100.0 60,000 57 Gujranwala 5.8 5,569 13.4 5.9 29.7 30.7 14.2 6.1 100.0 100,000 324 Lahore 1.3 6,631 40.8 17.2 23.2 10.0 4.2 4.6 100.0 40,000 85 Multan 4.1 4,633 34.8 16.4 29.9 14.4 3.2 1.4 100.0 50,000 191 Rawalpindi 2.6 3,633 26.4 7.5 33.1 16.3 11.2 5.5 100.0 80,000 95 Sahiwal 3.1 2,638 49.8 11.0 23.6 9.9 3.6 2.1 100.0 35,000 81 Sargodha 2.1 2,885 48.0 6.9 17.3 14.9 10.7 2.1 100.0 40,309 60 1 MICS indicator 14.S4 - Receiving remittances from Pakistan a Total includes 11 unweighted cases of household head's education missing P a g e | 210 Table SED.4: Receiving remittance from abroad Percentage of households that received any remittance from abroad during the last year and percent distribution of the value and median value of remittance received, Punjab, 2014. Percentage of households receiving remittances from abroad1 Number of households Percentage of households receiving the following value of remittance from abroad: Median value of remittances from abroad (Rs.) Total number of households receiving remittances from abroad less than 3,000 3,000 to less than 5,000 5,000 to less than 10,000 10,000 to less than 20,000 20,000 or more Not specified Total Punjab 7.3 38,405 10.2 7.9 16.3 24.3 39.4 1.9 100.0 180,000 2,785 Area of residence Rural 7.4 25,577 9.7 7.4 18.4 25.9 36.8 1.8 100.0 158,803 1,888 All Urban 7.0 12,828 11.2 9.0 11.9 21.0 44.7 2.2 100.0 200,000 897 Major Cities 6.0 6,717 13.2 11.5 8.9 20.8 42.9 2.7 100.0 180,000 403 Other Urban 8.1 6,111 9.6 6.9 14.3 21.1 46.2 1.7 100.0 200,000 493 Education of household head None/pre-school 6.6 15,399 12.5 7.3 18.6 25.6 34.3 1.7 100.0 150,000 1,014 Primary 7.5 6,639 8.2 5.8 16.5 28.8 38.7 2.0 100.0 180,000 496 Middle 7.9 4,863 9.8 7.3 15.1 23.5 42.6 1.8 100.0 180,000 382 Secondary 8.1 7,022 8.9 8.8 15.8 22.4 42.1 1.9 100.0 180,000 569 Higher 7.3 4,472 9.0 12.2 11.2 17.5 47.6 2.5 100.0 200,000 325 Wealth index quintile Lowest 1.5 8,027 25.7 12.1 33.0 18.8 8.8 1.5 100.0 60,000 117 Second 2.4 7,721 21.9 15.1 27.0 23.2 10.8 2.0 100.0 68,916 186 Middle 6.0 7,508 12.3 8.8 21.9 31.9 22.2 2.8 100.0 120,000 453 Fourth 10.8 7,551 8.3 7.0 16.7 27.9 38.0 2.1 100.0 180,000 819 Highest 15.9 7,598 7.5 6.7 10.6 19.7 54.0 1.5 100.0 240,000 1,211 Division Bahawalpur 2.9 4,091 20.8 11.3 23.8 22.3 19.1 2.7 100.0 100,000 120 D.G. Khan 5.9 3,436 20.2 15.2 31.4 22.3 7.8 3.1 100.0 61,524 201 Faisalabad 5.2 4,889 7.6 9.7 16.9 19.3 46.3 0.1 100.0 200,000 253 Gujranwala 19.8 5,569 5.5 5.3 12.9 25.8 49.4 1.2 100.0 200,562 1,102 Lahore 4.7 6,631 14.5 11.7 14.6 20.0 36.3 2.9 100.0 150,000 313 Multan 3.3 4,633 15.1 4.5 21.8 25.7 28.3 4.5 100.0 120,000 153 Rawalpindi 11.8 3,633 9.4 6.8 13.0 27.8 41.1 1.9 100.0 180,000 428 Sahiwal 3.7 2,638 12.1 7.8 16.7 27.1 31.7 4.6 100.0 120,000 97 Sargodha 4.1 2,885 15.9 10.7 22.6 21.2 27.9 1.8 100.0 107,847 119 1 MICS indicator 14.S5 - Receiving remittances from abroad a Total includes 11 unweighted cases of household head's education missing P a g e | 211 Cash Donations In MICS Punjab, 2014 information was also collected on cash donations. Only slightly more than 1 percent of households received cash donations through zakat or other means during the one year period preceding the survey (Table SED.5). Out of these households that received cash donations, the majority (87 %) received less than Rs. 3,000 during the last year. Table SED.5: Received zakat/donations Percentage of households that received any zakat/donation during the last year and percent distribution of the amount of donation received and their median value, Punjab, 2014. Percentage of households receiving cash donations1 Number of households Percentage of households by the amount of Zakat/donation received Median value of zakat/ donati ons Total number of households receiving zakat/ donations less than 3,000 3,000 to less than 5,000 5,000 to less than 10,000 10,000 to less than 20,000 20,000 or more Not specified Total Punjab 1.2 38,405 86.9 5.2 3.3 2.4 0.4 1.1 100.0 6,000 460 Area of residence Rural 1.2 25,577 86.5 5.3 3.3 2.1 0.5 1.3 100.0 6,000 303 All Urban 1.2 12,828 87.8 4.9 3.3 3.0 0.3 0.7 100.0 7,000 158 Major Cities 1.0 6,717 (92.1) (3.6) (0.0) (2.7) (0.0) (1.7) 100.0 5,389 64 Other Urban 1.5 6,111 84.9 5.8 5.6 3.3 0.5 0.0 100.0 10,000 93 Education of household heada None/pre-school 1.8 15,399 89.7 3.3 3.2 1.3 0.0 1.5 100.0 5,000 275 Primary 1.2 6,639 83.0 11.1 3.0 2.9 0.0 0.0 100.0 6,000 81 Middle 0.9 4,863 (88.2) (7.8) (0.0) (4.0) (0.0) (0.0) 100.0 10,000 43 Secondary 0.6 7,022 (78.7) (3.3) (7.2) (7.5) (3.3) (0.0) 100.0 10,000 42 Higher 0.4 4,472 (*) (*) (*) (*) (*) (*) 100.0 11,303 20 Wealth index quintile Lowest 1.5 8,027 93.8 3.4 0.6 1.1 0.0 0.6 100.0 5,000 121 Second 1.6 7,721 88.1 5.1 3.6 1.2 0.0 2.1 100.0 5,000 122 Middle 1.4 7,508 86.2 6.1 4.5 1.1 0.0 0.0 100.0 5,000 108 Fourth 0.9 7,551 84.5 4.4 4.7 3.4 0.0 2.9 100.0 10,000 67 Highest 0.6 7,598 (69.9) (9.4) (5.0) (11.4) (4.2) (0.0) 100.0 10,000 43 Division Bahawalpur 1.0 4,091 (93.0) (1.2) (5.8) (0.0) (0.0) (0.0) 100.0 8,000 42 D.G. Khan 0.6 3,436 (76.7) (14.0) (9.3) (0.0) (0.0) (0.0) 100.0 15,880 21 Faisalabad 1.0 4,889 (89.9) (5.4) (2.5) (2.2) (0.0) (0.0) 100.0 5,000 47 Gujranwala 1.7 5,569 79.8 9.4 6.7 3.6 0.4 0.0 100.0 13,758 96 Lahore 0.8 6,631 (85.1) (3.9) (0.0) (0.0) (0.0) (6.7) 100.0 5,000 51 Multan 0.7 4,633 (86.1) (6.8) (0.0) (3.9) (0.0) (3.2) 100.0 10,000 35 Rawalpindi 2.2 3,633 84.6 4.4 3.4 5.0 1.7 0.0 100.0 5,000 81 Sahiwal 1.4 2,638 (98.4) (1.6) (0.0) (0.0) (0.0) (0.0) 100.0 4,938 37 Sargodha 1.8 2,885 94.6 0.7 0.9 2.5 0.0 1.3 100.0 3,000 52 1 MICS indicator 14.S6 - Receiving cash donation ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases a Total includes 11 unweighted cases of household head's education missing P a g e | 212 Social Benefits, Subsidies and Family Support Programmes Table SED.6 presents data on pension benefits received by the household members. Eight percent of the households are receiving pension benefits. The major sources are government (94%) and 4 percent from Employees Old-Age Benefits Institution (EOBI). Education of head of the household and wealth status is strongly associated with pension benefits. Of households where the household head had higher education, 16 percent received pension benefits compared to only 3 percent where the head had pre-school or no education. Fourteen percent of households in the highest quintile received pension benefits compared to only 2 percent in the lowest quintile. Table SED.6 Pension Benefits Percentage of households receiving pension and percent distribution of the source, Punjab, 2014. Percentage of households receiving pension1 Number of households Percentage of households receiving pension by source Number of households receiving pension Government EOBI Others DK Total Punjab 8.1 38,405 94.2 4.0 1.3 0.8 100.0 3,097 Area of residence Rural 7.3 25,577 95.3 3.2 1.4 0.4 100.0 1,865 All Urban 9.6 12,828 92.4 5.3 1.2 1.4 100.0 1,231 Major Cities 9.6 6,717 90.3 7.3 0.8 2.1 100.0 644 Other Urban 9.6 6,111 94.8 3.2 1.7 0.6 100.0 588 Education of household heada None/pre-school 3.2 15,399 93.6 4.0 1.8 0.8 100.0 491 Primary 5.6 6,639 92.9 4.9 1.9 0.6 100.0 372 Middle 10.5 4,863 93.7 4.2 1.1 1.1 100.0 509 Secondary 14.3 7,022 95.5 3.3 1.1 0.6 100.0 1,004 Higher 16.1 4,472 93.7 4.5 1.2 1.0 100.0 720 Wealth index quintile Lowest 1.8 8,027 94.7 1.5 1.2 2.6 100.0 148 Second 5.6 7,721 95.7 2.9 0.9 0.6 100.0 429 Middle 8.2 7,508 96.5 2.3 0.9 0.5 100.0 619 Fourth 10.9 7,551 93.4 4.9 0.9 0.9 100.0 824 Highest 14.2 7,598 92.8 5.1 2.1 0.7 100.0 1,077 Division Bahawalpur 3.4 4,091 95.8 2.3 1.2 0.7 100.0 137 D.G. Khan 3.2 3,436 96.3 0.7 2.5 0.4 100.0 110 Faisalabad 6.4 4,889 87.8 8.3 2.2 2.0 100.0 314 Gujranwala 8.0 5,569 97.0 0.9 2.1 0.4 100.0 444 Lahore 7.7 6,631 91.7 6.9 1.0 1.1 100.0 511 Multan 3.6 4,633 93.2 5.4 1.0 0.4 100.0 167 Rawalpindi 23.4 3,633 94.2 4.5 1.2 0.7 100.0 849 Sahiwal 5.6 2,638 94.7 2.5 1.8 1.0 100.0 148 Sargodha 14.4 2,885 98.1 1.0 0.3 0.6 100.0 416 1 MICS indicator 14.S9 - Receiving pensions a Total includes 11 unweighted cases of household head's education missing Around 7 percent of households benefitted from government schemes of social protection such as the subsidies on food, Benazir Income Support Programme (BISP) and Wattan Card (Table SED.7). More rural households (9%) benefitted from these initiatives than urban households (3%). P a g e | 213 Table SED.7: Safety nets (social protection) Percentage of households benefiting from government social protection schemes and percent distribution of type of source, Punjab, 2014. Percentage of households benefited from government social protection schemes1 Number of house- holds Percentage of households benefited from government social protection schemes by type of source Number of households getting benefits Zakat (Guzara allowance, health care, marriage grant, training from VTI Bait-ul- Maal Sasta ration Benazir Income Support Program (BISP) Watan Card Others DK Total Punjab 7.2 38,405 2.0 0.6 0.5 95.0 1.6 0.6 0.3 100.0 2,780 Area of residence Rural 9.2 25,577 1.6 0.4 0.5 95.5 1.7 0.6 0.3 100.0 2,347 All Urban 3.4 12,828 4.1 1.6 0.7 92.3 1.0 0.7 0.3 100.0 433 Major Cities 2.2 6,717 2.8 2.8 0.0 93.9 0.5 0.0 0.3 100.0 147 Other Urban 4.7 6,111 4.8 1.0 1.0 91.4 1.3 1.0 0.3 100.0 286 Education of household heada None/pre-school 11.2 15,399 1.7 0.5 0.5 95.6 2.1 0.3 0.2 100.0 1,722 Primary 8.0 6,639 3.4 0.5 0.6 94.3 0.9 0.7 0.2 100.0 529 Middle 5.9 4,863 1.6 0.4 0.3 95.9 0.7 0.6 0.6 100.0 287 Secondary 2.7 7,022 2.2 1.2 1.3 93.0 0.9 1.8 0.0 100.0 192 Higher 1.1 4,472 0.0 6.8 0.0 85.6 0.0 3.5 4.2 100.0 50 Wealth index quintile Lowest 17.0 8,027 1.2 0.3 0.2 96.4 2.4 0.5 0.0 100.0 1,364 Second 10.3 7,721 1.3 0.4 0.8 96.1 0.9 0.4 0.4 100.0 792 Middle 5.1 7,508 3.5 1.0 0.7 93.6 1.0 0.4 0.2 100.0 382 Fourth 2.6 7,551 7.5 2.3 1.1 85.1 0.2 2.0 2.3 100.0 197 Highest 0.6 7,598 (0.0) (4.9) (0.0) (91.4) (1.4) (1.7) (0.6) 100.0 44 Division Bahawalpur 10.6 4,091 0.5 0.5 0.6 96.7 1.3 0.6 0.0 100.0 434 D.G. Khan 23.7 3,436 0.4 0.0 0.2 96.6 3.7 0.1 0.3 100.0 815 Faisalabad 3.4 4,889 6.0 2.1 0.3 87.7 2.7 0.5 0.7 100.0 168 Gujranwala 3.5 5,569 2.4 2.1 1.9 90.8 0.8 1.6 0.8 100.0 197 Lahore 4.0 6,631 3.5 0.0 1.0 95.6 0.0 0.5 0.4 100.0 265 Multan 8.5 4,633 1.6 0.8 0.0 97.9 0.0 0.0 0.0 100.0 394 Rawalpindi 2.9 3,633 4.0 3.5 2.6 81.5 1.2 6.1 1.1 100.0 105 Sahiwal 6.3 2,638 6.8 0.0 0.0 93.2 0.0 0.0 0.0 100.0 167 Sargodha 8.1 2,885 1.5 0.3 0.4 97.0 0.6 0.3 0.7 100.0 235 100.0 1 MICS indicator 14.S7 - Safety nets (Getting benefits from government schemes of social protection ( ) Figures that are based on 25-49 unweighted cases a Total includes 11 unweighted cases of household head's education missing P a g e | 214 Table SED.8: Safety nets (utility store) Percentage of households who are purchasing goods from government utility stores and percent distribution of households purchasing goods from government utility stores on regular or casual basis and household respondants who believe government initiatives are benefiting the low incomw groups, Punjab, 2014. Percentage of households purchasing goods from utility stores1 Total number of households Percentage of households purchasing goods from government utility stores Number of households purchasing goods from utility stores on a regular or casual basis: who believe government initiatives are benefiting the low income groups Regular2 Casual DK Missing Total Yes No DK Missing Total Punjab 18.0 38,405 29.5 70.3 0.2 0.1 100.0 26.5 65.1 8.1 0.3 100.0 6,902 Area of residence Rural 13.9 25,577 26.8 73.0 0.1 0.1 100.0 28.3 63.4 8.1 0.2 100.0 3,547 All Urban 26.2 12,828 32.3 67.4 0.3 0.1 100.0 22.8 68.5 8.2 0.5 100.0 3,355 Major Cities 25.0 6,717 33.3 66.2 0.5 0.0 100.0 18.2 72.6 8.5 0.6 100.0 1,679 Other Urban 27.4 6,111 31.3 68.5 0.0 0.1 100.0 27.9 64.0 7.8 0.3 100.0 1,676 Education of household heada None/pre-school 9.6 15,399 24.9 74.7 0.2 0.2 100.0 24.7 66.7 8.5 0.2 100.0 1,471 Primary 16.8 6,639 26.2 73.3 0.5 0.0 100.0 26.3 65.7 7.7 0.3 100.0 1,113 Middle 21.4 4,863 26.7 73.2 0.0 0.0 100.0 27.7 64.2 7.9 0.2 100.0 1,040 Secondary 25.2 7,022 31.3 68.5 0.1 0.1 100.0 27.4 63.7 8.6 0.3 100.0 1,771 Higher 33.5 4,472 36.3 63.6 0.1 0.1 100.0 30.2 62.3 7.1 0.4 100.0 1,499 Wealth index quintile Lowest 5.6 8,027 18.7 80.9 0.3 0.1 100.0 26.3 65.9 7.7 0.1 100.0 449 Second 11.8 7,721 22.0 77.9 0.0 0.1 100.0 27.5 65.0 7.3 0.2 100.0 912 Middle 17.4 7,508 27.0 72.9 0.0 0.1 100.0 26.8 64.1 8.9 0.2 100.0 1,310 Fourth 23.2 7,551 29.7 70.0 0.2 0.1 100.0 25.7 65.4 8.5 0.4 100.0 1,753 Highest 32.6 7,598 35.3 64.3 0.3 0.0 100.0 26.0 65.1 8.3 0.5 100.0 2,477 Division Bahawalpur 12.4 4,091 27.0 72.8 0.2 0.0 100.0 41.9 52.9 5.1 0.1 100.0 507 D.G. Khan 10.7 3,436 27.1 72.4 0.0 0.4 100.0 27.9 65.3 6.7 0.0 100.0 369 Faisalabad 21.6 4,889 22.4 77.3 0.3 0.0 100.0 22.6 69.1 8.1 0.1 100.0 1,055 Gujranwala 12.8 5,569 30.7 68.7 0.5 0.1 100.0 26.6 61.0 12.2 0.2 100.0 712 Lahore 15.4 6,631 27.5 71.8 0.5 0.2 100.0 17.8 73.0 8.6 0.6 100.0 1,021 Multan 14.7 4,633 29.5 70.5 0.0 0.0 100.0 26.4 65.4 8.1 0.2 100.0 683 Rawalpindi 35.7 3,633 38.6 61.3 0.0 0.1 100.0 24.2 68.6 6.5 0.7 100.0 1,298 Sahiwal 20.4 2,638 28.7 71.3 0.0 0.0 100.0 28.5 63.8 7.6 0.0 100.0 539 Sargodha 24.9 2,885 28.5 71.5 0.0 0.0 100.0 30.4 61.7 7.7 0.2 100.0 719 1 MICS indicator 14.S8 - Purchasing goods from government utility stores 2 MICS indicator 14.S8b - Regular purchase from utility stores a Total includes 11 unweighted cases of household head's education missing P a g e | 215 Information in table SED.8 shows that only 1 percent of households purchases goods from government utility stores. Of these, majority (70%) of households casually purchase goods from government utility stores and the rest (30%) regularly use the government utility stores. Possession of Bank Account MICS Punjab, 2014 also asked the respondents whether any member of the household has an account in a bank, post office, or national saving center. Thirty two percent of household had at least one member with a bank account (Table SED.9). Urban households are more likely to have a household member with a bank account (44%) compared to rural households (25%). There is a positive relationship between a household having a member with a bank account and education of the head of household and the household wealth. Table SED.9: Possession of bank account Percentage of households with at least one member who has a bank accounts, Punjab, 2014. Possession of Bank account Total number of households Punjab 31.6 38,405 Area of residence Rural 25.3 25,577 All Urban 44.4 12,828 Major Cities 46.8 6,717 Other Urban 41.8 6,111 Education of household heada None/pre-school 14.9 15,399 Primary 23.4 6,639 Middle 33.2 4,863 Secondary 47.5 7,022 Higher 75.1 4,472 Wealth index quintile Lowest 5.8 8,027 Second 14.5 7,721 Middle 27.2 7,508 Fourth 41.4 7,551 Highest 71.1 7,598 Division Bahawalpur 20.3 4,091 D.G. Khan 18.2 3,436 Faisalabad 32.8 4,889 Gujranwala 36.9 5,569 Lahore 37.7 6,631 Multan 25.8 4,633 Rawalpindi 44.9 3,633 Sahiwal 25.4 2,638 Sargodha 36.0 2,885 a Total includes 11 unweighted cases of household head's education missing Marital Status Table SED.10 presents information on marital status of the population. The majority (51%) of the total population 10 years and above is currently married and 43 percent of the population has never married. Only 5 percent of the population is widowed. This pattern is observed for all background characteristics except for age. As expected, a large majority of the younger population age below 25 has never been married. The proportion of population that is widowed increases with age, especially starting from age 55. P a g e | 216 Table SED.10: Marital status of household members Percent distribution of household members by marital status, Punjab, 2014. Marital Status Total number of household members aged 10 years and above Currently married1 Widowed Divorced Separated Never married DK/ Missing Total Punjab 51.4 4.8 0.5 0.4 42.8 0.1 100.0 183,599 Area of residence Rural 51.9 4.8 0.6 0.5 42.1 0.1 100.0 121,370 All Urban 50.3 4.8 0.4 0.3 44.1 0.1 100.0 62,229 Major Cities 50.7 4.8 0.4 0.2 43.7 0.2 100.0 32,666 Other Urban 49.9 4.7 0.5 0.3 44.5 0.1 100.0 29,563 Sex Males 49.5 2.9 0.4 0.3 46.8 0.1 100.0 92,648 Females 53.3 6.7 0.7 0.5 38.7 0.1 100.0 90,951 Age group 10-14 0.2 0.0 - 0.0 99.5 0.2 100.0 28,665 15-19 6.1 0.0 0.1 0.1 93.4 0.1 100.0 25,999 20-24 30.7 0.2 0.4 0.4 68.2 0.2 100.0 22,985 25-29 64.9 0.5 0.7 0.6 33.2 0.1 100.0 20,194 30-34 85.7 0.9 1.0 0.7 11.6 0.1 100.0 16,764 35-39 92.0 1.9 1.1 0.7 4.3 0.0 100.0 13,580 40-44 92.8 3.3 1.0 0.7 2.1 0.0 100.0 11,392 45-49 91.2 5.8 0.9 0.6 1.6 0.0 100.0 10,685 50-54 88.2 8.8 0.8 0.7 1.4 0.1 100.0 9,099 55-59 84.4 13.6 0.7 0.4 0.9 0.0 100.0 7,078 60-64 76.8 20.9 0.6 0.5 1.1 0.1 100.0 6,023 65-69 72.7 25.2 0.3 0.4 1.3 0.2 100.0 4,254 70-74 62.2 35.8 0.4 0.4 1.1 0.2 100.0 3,180 75-79 53.9 44.1 0.4 0.5 0.9 0.2 100.0 1,608 80-84 41.5 56.9 0.2 0.5 0.5 0.4 100.0 1,192 85+ 33.7 64.4 0.1 0.1 1.2 0.5 100.0 891 Missing/DK (*) (*) (*) (*) (*) (*) 100.0 13 Education of household heada None/pre-school 50.7 5.0 0.6 0.5 43.0 0.1 100.0 74,207 Primary 51.3 4.6 0.6 0.4 43.0 0.1 100.0 31,948 Middle 52.0 4.5 0.5 0.4 42.5 0.1 100.0 23,510 Secondary 52.2 4.6 0.5 0.3 42.4 0.1 100.0 33,520 Higher 52.1 4.9 0.3 0.3 42.2 0.2 100.0 20,366 Wealth index quintile Lowest 53.4 4.6 0.7 0.6 40.6 0.1 100.0 34,087 Second 50.8 4.7 0.7 0.6 43.1 0.1 100.0 36,348 Middle 50.5 4.8 0.6 0.4 43.7 0.1 100.0 37,155 Fourth 50.7 4.8 0.3 0.3 43.7 0.1 100.0 37,526 Highest 51.7 4.9 0.5 0.2 42.6 0.1 100.0 38,483 Division Bahawalpur 52.7 4.2 0.3 0.5 42.1 0.2 100.0 18,844 D.G. Khan 53.4 3.4 0.3 0.3 42.6 0.1 100.0 16,031 Faisalabad 50.5 4.9 0.6 0.5 43.4 0.1 100.0 23,655 Gujranwala 50.3 5.1 0.5 0.3 43.6 0.1 100.0 27,206 Lahore 51.1 4.7 0.4 0.2 43.4 0.1 100.0 33,197 Multan 51.3 4.8 0.5 0.4 42.9 0.1 100.0 20,453 Rawalpindi 52.2 5.3 0.7 0.4 41.3 0.1 100.0 16,982 Sahiwal 51.2 5.4 1.0 0.7 41.6 0.0 100.0 12,725 Sargodha 51.1 5.2 0.9 0.5 42.3 0.1 100.0 14,507 1 MICS indicator 14.S11 - Currently married population (*) Figures that are based on fewer than 25 unweighted cases a Total includes 58 unweighted cases of household head's education missing P a g e | 217 Unemployment Employment information is presented for all household members age 10 years and above who worked for at least one hour during the reference period (one week prior to the date of interview) whether paid or self-employed. Persons employed on permanent or regular footings, who had not worked for any reason during the reference period, are also categorized as employed, regardless of the duration of the absence or whether workers continued to receive a salary during the absence. Unemployment rate is the percentage of those in active labour force who are unemployed and seeking jobs. In MICS Punjab, 2014, information on employment status was extracted from data collected on sources of income for persons age 5 years or older. Active labour force consists of government and private sector employees, self-employed, labourers, those working in agriculture, livestock, poultry and fishery, etc. About 7 percent of the population age 10 years or older is unemployed (Table SED.11). Differentials according to divisions show that unemployment is higher in Rawalpindi, Bahawalpur and Sargodha (9% in each division) and lowest in Sahiwal (4%). Unemployment is slightly lower among females than males (5% and 8% respectively). Table SED.11 also provides information of unemployment for population 15 years and above. About 7 percent of population age 15 years and above is unemployed. The pattern of the background variables is similar to that of unemployment of population age 10 years and above. P a g e | 218 Table SED.11: Unemployment rate among population age 10 years or above Percentage of population of age 10 years or above who are currently employed or unemployed and seeking work, Punjab, 2014. Employment rate among population age 10 years or above Unemployment rate among population age 10 years or above1 Number of household members age 10 years or above (employed or unemployed, but seeking for job) in active labour force Unemployment rate among population age 15 years or above Number of household members age 15 years or above (employed or unemployed, but seeking for job) in active labour force Punjab 92.9 7.1 69,468 6.7 67,995 Area of residence Rural 93.1 6.9 45,154 6.3 44,083 All Urban 92.4 7.6 24,314 7.3 23,912 Major Cities 93.0 7.0 13,009 6.8 12,803 Other Urban 91.8 8.2 11,305 7.8 11,109 Sex Male 92.5 7.5 60,918 7.0 59,739 Female 95.1 4.9 8,550 4.4 8,256 Education of household heada None/pre-school 93.5 6.5 28,954 5.8 27,939 Primary 92.7 7.3 12,057 6.6 11,806 Middle 92.0 8.0 8,646 7.8 8,545 Secondary 92.1 7.9 12,138 7.7 12,053 Higher 93.0 7.0 7,650 7.0 7,629 Wealth index quintile Lowest 94.5 5.5 13,519 4.2 12,887 Second 93.0 7.0 13,710 6.4 13,346 Middle 92.2 7.8 13,835 7.4 13,583 Fourth 92.2 7.8 14,096 7.6 13,933 Highest 92.3 7.7 14,308 7.6 14,244 Division Bahawalpur 91.3 8.7 6,817 7.3 6,591 D.G. Khan 94.0 6.0 5,646 5.3 5,491 Faisalabad 93.4 6.6 9,268 6.3 9,087 Gujranwala 93.3 6.7 9,516 6.6 9,382 Lahore 92.4 7.6 13,053 7.2 12,800 Multan 93.8 6.2 8,555 5.6 8,293 Rawalpindi 90.6 9.4 6,408 9.1 6,368 Sahiwal 95.9 4.1 4,886 3.8 4,748 Sargodha 91.5 8.5 5,319 8.1 5,235 1 MICS indicator 14.S2 - Unemployment rate (10+ years) a Total includes 31 unweighted cases of household head's education missing P a g e | 219 APPENDIX A: DISTRICT TABLES Table D.HH.1: Results of household, women's and children under-5 interviews . 222 Table D.HH.3: Household composition . 223 Table D.HH.4: Women's background characteristics . 224 Table D.HH.5: Under-5's background characteristics . 225 Table D.HH.8: Wealth quintiles . 226 Table D.CM.3: Infant and under-5 mortality rates by background characteristics . 227 Table D.NU.1: Low birth weight infants . 228 Table D.NU.2: Nutritional status of children . 229 Table D.NU.3: Initial breastfeeding . 231 Table D.NU.4: Breastfeeding . 232 Table D.NU.5: Duration of breastfeeding . 234 Table D.NU.6: Age-appropriate breastfeeding . 235 Table D.NU.8: Infant and young child feeding (IYCF) practices . 236 Table D.NU.9: Bottle feeding . 238 Table D.NU.10: Iodized salt consumption . 239 Table D.NU.11: Children's vitamin A supplementation . 240 Table D.CH.2: Vaccinations by background characteristics . 241 Table D.CH.3: Neonatal tetanus protection . 243 Table D.CH.4: Reported disease episodes . 244 Table D.CH.5: Care-seeking during diarrhoea . 245 Table D.CH.6: Feeding practices during diarrhoea . 246 Table D.CH.7: Oral rehydration solutions, recommended homemade fluids, and zinc . 248 Table D.CH.8: Oral rehydration therapy with continued feeding and other treatments . 250 Table D.CH.11: Knowledge of the two danger signs of pneumonia . 252 Table D.CH.12: Solid fuel use . 254 Table D.CH.13: Solid fuel use by place of cooking . 256 Table D.CH.14: Care-seeking during fever . 257 Table D.CH.15: Treatment of children with fever . 258 Table D.CH.16: Diagnostics and anti-malarial treatment of children . 259 Table D.CH.18: Intermittent preventive treatment for malaria . 260 Table D.WS.1: Use of improved water sources . 261 Table D.WS.2: Household water treatment . 263 Table D.WS.3: Time to source of drinking water . 264 Table D.WS.4: Person collecting water . 265 Table D.WS.5: Types of sanitation facilities . 266 Table D.WS.6: Use and sharing of sanitation facilities . 268 Table D.WS.7: Drinking water and sanitation ladders . 270 Table D.WS.8: Disposal of child's faeces . 272 Table D.WS.9: Water and soap at place for handwashing . 273 Table D.WS.10: Availability of soap or other cleansing agent . 275 Table D.RH.2: Adolescent birth rate and total fertility rate . 277 Table D.RH.5: Use of contraception . 278 Table D.RH.6: Unmet need for contraception . 280 Table D.RH.7: Antenatal care coverage . 281 Table D.RH.8: Number of antenatal care visits and timing of first visit . 282 Table D.RH.9: Content of antenatal care . 284 Table D.RH.10: Assistance during delivery and caesarian section . 285 Table D.RH.11: Place of delivery . 287 Table D.RH.12: Post-partum stay in health facility . 288 P a g e | 220 Table D.RH.13: Post-natal health checks for newborns . 289 Table D.RH.15: Post-natal health checks for mothers . 290 Table D.RH.17: Post-natal health checks for mothers and newborns . 291 Table D.CD.1: Early childhood education . 292 Table D.CD.2: Support for learning . 293 Table D.CD.3: Learning materials . 295 Table D.CD.4: Inadequate care . 296 Table D.CD.5: Early child development index . 297 Table D.ED.1: Literacy (young women) . 298 Table D.ED.2: School readiness . 299 Table D.ED.2A: Pre-school attendance . 300 Table D.ED.3: Primary school entry . 301 Table D.ED.4: Primary school net attendance and out of school children . 302 Table D.ED.4B: Primary school gross attendance ratio of school children (5-9) years. 304 Table D.ED.5: Secondary school attendance and out of school children . 305 Table D.ED.6: Children reaching last grade of primary school . 307 Table D.ED.7: Primary school completion and transition to secondary school. 308 Table D.ED.8: Education gender parity index (GPI) . 309 Table D.ED.9: Out of school gender parity . 310 Table D.ED.10: Literacy rate 10+ . 311 Table D.ED.11: Literacy rate 15+ . 312 Table D.ED.12: Literacy rate 15-24 years . 313 Table D.ED.13: Public and private primary school attendance rate . 314 Table D.CP.1: Birth registration . 315 Table D.CP.2: Children's involvement in economic activities . 316 Table D.CP.3: Children's involvement in household chores . 317 Table D.CP.4: Child labour . 318 Table D.CP.5: Child discipline . 319 Table D.CP.6: Attitudes toward physical punishment . 320 Table D.CP.7: Early marriage and polygyny (women) . 321 Table D.CP.10: Attitudes toward domestic violence (women) . 322 Table D.CP.11: Children's living arrangements and orphanhood . 323 Table D.CP.12: Children with parents living abroad . 325 Table D.HA.1: Knowledge about HIV transmission, misconceptions about HIV/AIDS, and comprehensive knowledge about HIV transmission (women) . 326 Table D.HA.2: Knowledge of mother-to-child HIV transmission (women) . 328 Table D.HA.3: Accepting attitudes toward people living with HIV/AIDS (women) . 329 Table D.HA.4: Knowledge of a place for HIV testing (women) . 330 Table D.HA.5: HIV counselling and testing during antenatal care . 331 Table D.HA.6: Key HIV/AIDS indicators (young women) . 332 Table D.MT.1: Exposure to mass media (women). 333 Table D.MT.2: Use of computers and internet (women) . 334 Table D.SW.1: Domains of life satisfaction (women) . 335 Table D.SW.2: Overall life satisfaction and happiness (women) . 337 Table D.SW.3: Perception of a better life (women) . 338 Table D.TA.1: Current and ever use of tobacco (women) . 339 Table D.HC.1: Prevalence of Cough, TB and Hepatitis . 341 Table D.HC.2: Care provided by Lady health worker (LHW) . 342 Table D.SED.1: House, agricultural land, and livestock ownership . 343 P a g e | 221 Table D.SED.2: Working outside village/city/country . 344 Table D.SED.6: Pension Benefits . 345 Table D.SED.8: Safety nets (utility store) . 346 Table D.SED.9: Possession of Bank Account . 347 Table D.SED.10: Marital status of household members . 348 Table D.SED.11: Un-employment rate 10 years and above . 349 P a g e | 222 Table D.HH.1: Results of household, women's and under-5 interviews by Districts Number of households, women and children under 5 by results of the household, women's and under-5's interviews, and household and women’s and under-5's response rates, Punjab, 2014. Punjab Districts B a h a w a lp u r B a h a w a ln a g a r R Y K h a n D G K h a n L a y y a h M u z a ff a rg a rh R a ja n p u r F a is a la b a d C h in io t J h a n g T T S in g h G u jr a n w a la G u jr a t H a fi z a b a d M a n d i B a h a u d d in N a ro w a l S ia lk o t L a h o re Households Sampled 41,413 1,322 1,185 1,509 1,114 906 1,425 911 1,923 784 1,101 1,022 1,586 1,192 760 878 911 1,388 2,174 Occupied 39,333 1,246 1,121 1,434 1,050 875 1,352 850 1,869 763 1,073 984 1,512 1,125 707 826 886 1,325 2,009 Interviewed 38,405 1,224 1,099 1,367 1,020 862 1,333 836 1,853 762 1,059 973 1,473 1,100 690 799 883 1,309 1,837 Household response rate 97.6 98.2 98.0 95.3 97.1 98.5 98.6 98.4 99.1 99.9 98.7 98.9 97.4 97.8 97.6 96.7 99.7 98.8 91.4 Women Eligible 61,286 1,783 1,693 2,099 1,595 1,370 1,962 1,253 3,016 1,159 1,581 1,547 2,536 1,826 1,141 1,378 1,437 2,264 3,099 Interviewed 53,668 1,524 1,460 1,863 1,395 1,192 1,734 1,125 2,752 1,064 1,490 1,418 2,147 1,620 974 1,213 1,320 1,958 2,401 Women's response rate 87.6 85.5 86.2 88.8 87.5 87.0 88.4 89.8 91.2 91.8 94.2 91.7 84.7 88.7 85.4 88.0 91.9 86.5 77.5 Women's overall response rate 85.5 84.0 84.5 84.6 85.0 85.7 87.1 88.3 90.5 91.7 93.0 90.6 82.5 86.7 83.3 85.1 91.5 85.4 70.8 Children under 5 Eligible 31,083 980 861 1,271 1,082 800 1,269 934 1,363 577 818 685 1,284 873 530 606 829 1,023 1,456 Mothers/caretakers interviewed 27,495 849 728 1,128 1,006 709 1,140 845 1,196 493 761 617 1,088 765 462 555 761 873 1,186 Under-5's response rate 88.5 86.6 84.6 88.7 93.0 88.6 89.8 90.5 87.7 85.4 93.0 90.1 84.7 87.6 87.2 91.6 91.8 85.3 81.5 Under-5's overall response rate 86.4 85.1 82.9 84.6 90.3 87.3 88.6 89.0 87.0 85.3 91.8 89.1 82.5 85.7 85.1 88.6 91.5 84.3 74.5 Table D.HH.1: Results of household, women's and under-5 interviews by Districts Number of households, women and children under 5 by results of the household, women's and under-5's interviews, and household and women’s and under-5's response rates, Punjab, 2014. Punjab Districts K a s u r N a n k a n a S a h ib S h e ik h u p u ra M u lt a n K h a n e w a l L o d h ra n V e h a ri S a h iw a l P a k p a t ta n O k a ra R a w a lp in d i A tt o c k C h a k w a l J h e lu m S a rg o d h a B h a k k a r K h u s h a b M ia n w a li Households Sampled 41,413 1,295 835 1,260 1,460 1,181 904 1,200 1,115 979 1,222 1,520 927 844 801 1,302 860 764 853 Occupied 39,333 1,185 776 1,167 1,399 1,146 882 1,169 1,068 911 1,148 1,435 895 807 754 1,236 816 719 813 Interviewed 38,405 1,146 758 1,133 1,374 1,135 866 1,151 1,031 896 1,127 1,356 869 790 741 1,228 813 710 802 Household response rate 97.6 96.7 97.7 97.1 98.2 99.0 98.2 98.5 96.5 98.4 98.2 94.5 97.1 97.9 98.3 99.4 99.6 98.7 98.6 Women Eligible 61,286 1,805 1,219 1,941 1,958 1,639 1,291 1,787 1,705 1,398 1,780 2,182 1,396 1,188 1,166 1,939 1,444 1,199 1,510 Interviewed 53,668 1,561 1,020 1,648 1,683 1,474 1,157 1,639 1,514 1,259 1,574 1,815 1,233 1,079 1,042 1,672 1,266 1,062 1,320 Women's response rate 87.6 86.5 83.7 84.9 86.0 89.9 89.6 91.7 88.8 90.1 88.4 83.2 88.3 90.8 89.4 86.2 87.7 88.6 87.4 Women's overall response rate 85.5 83.6 81.7 82.4 84.4 89.1 88.0 90.3 85.7 88.6 86.8 78.6 85.8 88.9 87.8 85.7 87.4 87.5 86.2 Children under 5 Eligible 31,083 1,011 637 912 995 811 675 819 850 733 1,004 950 613 497 467 883 717 551 717 Mothers/caretakers interviewed 27,495 900 572 791 876 739 602 717 757 678 910 817 557 474 416 760 650 478 639 Under-5's response rate 88.5 89.0 89.8 86.7 88.0 91.1 89.2 87.5 89.1 92.5 90.6 86.0 90.9 95.4 89.1 86.1 90.7 86.8 89.1 Under-5's overall response rate 86.4 86.1 87.7 84.2 86.5 90.2 87.6 86.2 86.0 91.0 89.0 81.3 88.2 93.4 87.5 85.5 90.3 85.7 87.9 P a g e | 223 Table D.HH.3: Household composition Percent and frequency distribution of households Punjab, 2014. Weighted percent Number of households Weighted Unweighted Punjab 100.0 38,405 38,405 District Bahawalpur 3.4 1,299 1,224 Bahawalnagar 2.8 1,074 1,099 RY Khan 4.5 1,719 1,367 DG Khan 2.4 935 1,020 Layyah 1.6 597 862 Muzaffargarh 3.4 1,303 1,333 Rajanpur 1.6 600 836 Faisalabad 7.1 2,711 1,853 Chiniot 1.3 504 762 Jhang 2.3 893 1,059 TT Singh 2.0 780 973 Gujranwala 4.1 1,589 1,473 Gujrat 2.7 1,024 1,100 Hafizabad 1.1 433 690 Mandi Bahauddin 1.5 589 799 Narowal 1.7 634 883 Sialkot 3.4 1,299 1,309 Lahore 9.4 3,614 1,837 Kasur 3.0 1,171 1,146 Nankana Sahib 1.5 580 758 Sheikhupura 3.3 1,266 1,133 Multan 4.8 1,835 1,374 Khanewal 2.9 1,123 1,135 Lodhran 1.7 647 866 Vehari 2.7 1,028 1,151 Sahiwal 2.2 832 1,031 Pakpattan 1.9 718 896 Okara 2.8 1,088 1,127 Rawalpindi 5.0 1,923 1,356 Attock 1.8 689 869 Chakwal 1.5 568 790 Jhelum 1.2 452 741 Sargodha 3.4 1,324 1,228 Bhakkar 1.4 544 813 Khushab 1.2 471 710 Mianwali 1.4 545 802 P a g e | 224 Table D.HH.4: Women's background characteristics Percent and frequency distribution of women age 15-49 years by selected background characteristics, Punjab, 2014. Weighted percent Number of women Weighted Unweighted Punjab 100.0 53,668 53,668 District Bahawalpur 3.1 1,666 1,524 Bahawalnagar 2.6 1,421 1,460 RY Khan 4.3 2,282 1,863 DG Khan 2.4 1,273 1,395 Layyah 1.5 825 1,192 Muzaffargarh 3.2 1,705 1,734 Rajanpur 1.4 758 1,125 Faisalabad 7.2 3,880 2,752 Chiniot 1.3 672 1,064 Jhang 2.2 1,162 1,490 TT Singh 2.0 1,081 1,418 Gujranwala 4.5 2,401 2,147 Gujrat 2.8 1,521 1,620 Hafizabad 1.2 642 974 Mandi Bahauddin 1.6 884 1,213 Narowal 1.7 891 1,320 Sialkot 3.7 1,987 1,958 Lahore 10.0 5,357 2,401 Kasur 3.0 1,602 1,561 Nankana Sahib 1.5 821 1,020 Sheikhupura 3.6 1,905 1,648 Multan 4.2 2,263 1,683 Khanewal 2.6 1,412 1,474 Lodhran 1.5 826 1,157 Vehari 2.6 1,386 1,639 Sahiwal 2.2 1,205 1,514 Pakpattan 1.8 984 1,259 Okara 2.8 1,497 1,574 Rawalpindi 5.1 2,741 1,815 Attock 1.8 972 1,233 Chakwal 1.4 756 1,079 Jhelum 1.2 617 1,042 Sargodha 3.4 1,833 1,672 Bhakkar 1.5 824 1,266 Khushab 1.3 706 1,062 Mianwali 1.7 907 1,320 P a g e | 225 Table D.HH.5: Under-5's background characteristics Percent and frequency distribution of children under five years of age by selected characteristics, Punjab, 2014. Weighted percent Number of under-5 children Weighted Unweighted Punjab 100.0 27,495 27,495 District Bahawalpur 3.3 912 849 Bahawalnagar 2.7 751 728 RY Khan 5.2 1,417 1,128 DG Khan 3.3 898 1,006 Layyah 1.9 514 709 Muzaffargarh 4.1 1,118 1,140 Rajanpur 2.3 621 845 Faisalabad 6.6 1,807 1,196 Chiniot 1.2 335 493 Jhang 2.3 626 761 TT Singh 1.8 503 617 Gujranwala 4.4 1,210 1,088 Gujrat 2.7 744 765 Hafizabad 1.1 310 462 Mandi Bahauddin 1.5 401 555 Narowal 1.9 529 761 Sialkot 3.3 906 873 Lahore 9.0 2,467 1,186 Kasur 3.3 898 900 Nankana Sahib 1.5 418 572 Sheikhupura 3.2 887 791 Multan 4.3 1,179 876 Khanewal 2.6 720 739 Lodhran 1.6 451 602 Vehari 2.4 668 717 Sahiwal 2.3 628 757 Pakpattan 1.9 526 678 Okara 3.2 878 910 Rawalpindi 4.3 1,180 817 Attock 1.6 429 557 Chakwal 1.1 310 474 Jhelum 0.9 246 416 Sargodha 3.0 823 760 Bhakkar 1.5 416 650 Khushab 1.2 325 478 Mianwali 1.6 440 639 a 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. P a g e | 226 Table D.HH.8: Wealth quintiles Percent distribution of the household population by wealth index quintiles, according to divisions and districts, Punjab, 2014. Wealth index quintiles Total Number of household members Lowest Second Middle Fourth Highest Total 20.0 20.0 20.0 20.0 20.0 100.0 246,396 District Bahawalpur 31.5 24.5 20.4 14.9 8.8 100.0 8,013 Bahawalnagar 36.9 29.3 19.4 9.9 4.5 100.0 6,704 RY Khan 42.3 24.2 15.0 8.6 10.0 100.0 11,240 DG Khan 55.8 21.6 8.6 8.9 5.0 100.0 6,498 Layyah 49.8 25.6 16.5 5.3 2.9 100.0 3,927 Muzaffargarh 55.7 22.7 12.0 5.9 3.7 100.0 8,664 Rajanpur 65.6 17.9 8.2 7.4 0.9 100.0 4,329 Faisalabad 6.8 16.1 21.9 28.7 26.5 100.0 17,101 Chiniot 31.4 25.7 19.2 15.1 8.5 100.0 3,198 Jhang 40.8 22.9 18.4 12.5 5.5 100.0 5,787 TT Singh 11.4 24.6 26.1 21.9 16.1 100.0 4,885 Gujranwala 2.0 10.8 23.5 32.4 31.3 100.0 10,545 Gujrat 1.4 7.4 24.4 32.2 34.6 100.0 6,553 Hafizabad 14.4 23.5 27.3 23.5 11.2 100.0 2,855 Mandi Bahauddin 12.5 21.3 31.1 21.1 14.0 100.0 3,748 Narowal 9.7 27.9 33.9 22.9 5.6 100.0 4,028 Sialkot 1.6 10.7 22.0 34.3 31.5 100.0 8,584 Lahore 0.7 2.8 8.2 27.0 61.2 100.0 23,671 Kasur 11.4 30.9 30.0 18.0 9.8 100.0 7,752 Nankana Sahib 10.3 26.2 28.3 22.3 12.9 100.0 3,811 Sheikhupura 6.7 16.9 26.9 29.3 20.1 100.0 8,613 Multan 22.8 20.3 18.9 20.2 17.8 100.0 10,610 Khanewal 28.4 27.1 23.2 13.9 7.4 100.0 6,794 Lodhran 31.5 30.6 21.3 11.1 5.5 100.0 3,976 Vehari 19.2 28.1 28.6 15.8 8.3 100.0 6,409 Sahiwal 20.1 25.9 22.5 18.9 12.6 100.0 5,531 Pakpattan 17.5 40.0 25.6 12.1 4.8 100.0 4,520 Okara 21.3 27.8 21.2 17.6 12.1 100.0 7,204 Rawalpindi 4.2 9.5 13.3 27.7 45.4 100.0 11,568 Attock 9.7 22.2 23.9 21.4 22.7 100.0 4,214 Chakwal 5.9 20.2 35.3 27.7 10.9 100.0 3,285 Jhelum 7.1 12.2 29.1 31.2 20.3 100.0 2,700 Sargodha 20.8 25.6 22.5 17.4 13.7 100.0 8,167 Bhakkar 48.7 27.5 14.3 7.5 2.0 100.0 3,807 Khushab 40.3 25.6 17.0 11.0 6.0 100.0 3,104 Mianwali 27.4 38.3 20.7 8.6 5.1 100.0 4,004 P a g e | 227 Table D.CM.3: Infant and under-5 mortality rates by background characteristics Indirect estimates of infant and under-five mortality rates by selected background characteristics, age version, (by using East Model), Punjab, 2014. Infant mortality rate1 Under-five mortality rate2 Punjab 76 96 District Bahawalpur 92 119 Bahawalnagar 94 122 RY Khan 79 100 DG Khan 91 116 Layyah 77 97 Muzaffargarh 88 113 Rajanpur 86 109 Faisalabad 69 86 Chiniot 73 92 Jhang 77 98 TT Singh 95 123 Gujranwala 67 82 Gujrat 51 61 Hafizabad 95 122 Mandi Bahauddin 95 123 Narowal 63 78 Sialkot 66 82 Lahore 53 64 Kasur 109 143 Nankana Sahib 84 108 Sheikhupura 81 102 Multan 71 88 Khanewal 88 113 Lodhran 89 114 Vehari 72 90 Sahiwal 76 96 Pakpattan 97 126 Okara 97 125 Rawalpindi 53 64 Attock 60 73 Chakwal 41 48 Jhelum 63 77 Sargodha 67 83 Bhakkar 79 100 Khushab 70 88 Mianwali 53 63 1 MICS indicator 1.2; MDG indicator 4.2 - Infant mortality rate 2 MICS indicator 1.5; MDG indicator 4.1 - Under-five mortality rate Rates refer to January 2011. The East Model was assumed to approximate the age pattern of mortality in Pakistan. P a g e | 228 Table D.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, Punjab, 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 Punjab 3.9 16.6 70.2 8.4 0.8 100.0 29.4 25.6 10,653 District Bahawalpur 7.9 21.9 53.1 13.1 4.0 100.0 33.9 18.8 342 Bahawalnagar 4.8 23.7 63.1 8.2 0.2 100.0 33.2 13.7 254 RY Khan 2.4 20.2 66.6 9.4 1.4 100.0 29.8 14.1 472 DG Khan 3.7 30.3 59.1 6.2 0.6 100.0 35.9 7.4 361 Layyah 3.8 20.7 69.3 5.8 0.4 100.0 31.6 6.7 182 Muzaffargarh 2.5 28.2 61.9 6.9 0.5 100.0 34.1 6.3 414 Rajanpur 5.0 30.0 61.6 3.4 0.0 100.0 36.9 2.3 223 Faisalabad 3.9 8.6 78.3 8.7 0.4 100.0 25.7 29.3 692 Chiniot 1.8 9.0 87.1 1.5 0.6 100.0 25.3 19.4 123 Jhang 1.8 19.6 70.3 7.8 0.5 100.0 29.6 10.7 237 TT Singh 0.0 14.1 80.3 5.7 0.0 100.0 26.3 12.2 185 Gujranwala 6.9 14.3 72.1 6.7 0.0 100.0 30.4 34.4 481 Gujrat 2.5 16.7 73.9 6.7 0.3 100.0 28.8 41.4 258 Hafizabad 7.2 12.8 72.7 7.3 0.0 100.0 29.7 20.3 129 Mandi Bahauddin 1.9 14.0 74.6 9.5 0.0 100.0 26.9 17.5 173 Narowal 3.8 19.2 71.8 5.0 0.2 100.0 30.9 15.2 200 Sialkot 4.7 15.6 70.2 8.9 0.5 100.0 29.5 37.1 336 Lahore 5.0 12.8 68.0 14.2 0.0 100.0 27.8 48.5 988 Kasur 8.7 15.8 64.9 10.0 0.6 100.0 31.7 16.1 376 Nankana Sahib 6.8 13.9 72.1 6.6 0.6 100.0 29.9 25.4 182 Sheikhupura 6.2 19.3 60.0 11.5 3.0 100.0 31.7 27.1 369 Multan 2.0 11.6 75.7 9.2 1.5 100.0 25.7 26.5 465 Khanewal 1.1 12.3 77.2 7.6 1.8 100.0 25.5 19.6 289 Lodhran 1.7 14.0 76.4 6.7 1.3 100.0 27.0 11.9 176 Vehari 1.6 19.8 71.5 6.5 0.6 100.0 29.6 17.4 232 Sahiwal 2.4 18.4 72.0 6.8 0.4 100.0 29.5 29.9 261 Pakpattan 4.8 16.8 69.8 8.6 0.0 100.0 30.0 13.9 221 Okara 3.9 15.7 73.3 6.6 0.4 100.0 29.1 19.8 344 Rawalpindi 4.8 13.3 69.7 10.5 1.7 100.0 28.0 57.3 496 Attock 3.5 14.6 70.2 10.4 1.4 100.0 27.8 37.9 168 Chakwal 2.3 16.7 70.6 8.5 1.9 100.0 28.2 47.3 120 Jhelum 2.4 13.9 74.3 8.3 1.1 100.0 27.1 44.6 97 Sargodha 0.8 16.1 74.0 7.6 1.5 100.0 27.5 36.0 319 Bhakkar 1.4 16.4 78.2 2.2 1.8 100.0 28.7 13.9 174 Khushab 4.7 12.8 78.7 3.8 0.0 100.0 28.7 21.8 127 Mianwali 2.1 12.7 82.0 2.0 1.1 100.0 27.1 8.3 184 1 MICS indicator 2.20 - Low-birthweight infants 2 MICS indicator 2.21 - Infants weighed at birth P a g e | 229 Table D.NU.2: Nutritional status of children Percentage of children under age 5 by nutritional status according to three anthropometric indices: weight for age, height for age, and weight for height, Punjab, 2014. Weight for age Number of children under age 5 Height for age Number of children under age 5 Weight for height Number of children under age 5 Underweight Mean Z- Score (SD) Stunted Mean Z- Score (SD) Wasted Overweight Mean Z- Score (SD) Percent below Percent below Percent below Percent above - 2 SD1 - 3 SD2 - 2 SD3 - 3 SD4 - 2 SD5 - 3 SD6 + 2 SD7 Punjaba 33.7 11.3 -1.6 26,490 33.5 13.3 -1.4 26,280 17.5 4.4 0.8 -1.0 26,421 District Bahawalpur 35.9 13.3 -1.7 866 36.7 17.1 -1.5 861 18.9 5.8 1.0 -1.1 871 Bahawalnagar 42.7 15.9 -1.8 722 39.6 14.5 -1.6 716 21.7 4.5 0.5 -1.2 713 RY Khan 46.8 19.0 -1.9 1,352 45.3 23.1 -1.8 1,324 21.6 6.9 1.3 -1.2 1,348 DG Khan 48.7 20.9 -1.9 837 50.9 28.0 -2.0 827 21.4 5.3 0.5 -1.1 853 Layyah 37.0 14.2 -1.7 496 38.8 14.8 -1.6 489 18.9 3.8 1.4 -1.1 494 Muzaffargarh 42.4 16.0 -1.8 1,079 46.3 21.4 -1.9 1,064 18.0 3.8 1.4 -1.0 1,071 Rajanpur 45.7 17.2 -1.9 600 47.6 25.8 -2.0 596 16.3 4.6 0.7 -1.1 599 Faisalabad 30.8 8.6 -1.4 1,762 25.0 8.6 -1.1 1,756 21.1 6.8 1.7 -1.1 1,746 Chiniot 39.0 14.3 -1.7 333 35.5 12.9 -1.5 332 23.2 10.0 0.2 -1.2 328 Jhang 37.1 13.2 -1.7 614 36.9 15.8 -1.5 604 19.4 6.0 1.3 -1.1 606 TT Singh 36.9 12.8 -1.7 501 32.4 10.8 -1.4 500 21.2 5.0 0.1 -1.2 493 Gujranwala 22.9 6.7 -1.3 1,176 27.7 7.5 -1.2 1,167 11.7 3.0 0.6 -0.8 1,174 Gujrat 21.8 6.6 -1.2 739 27.7 7.7 -1.2 737 11.7 3.4 1.1 -0.7 736 Hafizabad 29.8 7.3 -1.5 300 34.0 11.4 -1.6 298 11.3 1.8 0.8 -0.8 298 Mandi Bahauddin 23.6 7.4 -1.3 392 33.3 11.5 -1.5 387 10.8 1.6 0.6 -0.6 385 Narowal 29.1 8.4 -1.5 519 32.3 11.7 -1.4 520 14.6 4.1 0.8 -0.9 520 Sialkot 24.5 5.9 -1.3 879 24.0 7.8 -1.1 876 17.5 4.1 0.9 -0.9 871 Lahore 28.3 7.9 -1.4 2,341 29.2 10.3 -1.3 2,326 13.5 2.3 0.9 -0.9 2,351 Kasur 36.4 11.7 -1.6 856 35.4 13.5 -1.5 848 17.9 5.4 0.5 -1.1 853 Nankana Sahib 34.4 10.5 -1.6 406 35.0 12.9 -1.5 403 16.8 4.5 0.2 -1.1 402 Sheikhupura 32.6 11.7 -1.5 849 33.2 13.7 -1.5 837 16.4 4.0 0.8 -0.9 858 Multan 38.0 12.9 -1.7 1,120 34.1 15.6 -1.5 1,103 23.1 5.0 1.2 -1.2 1,117 Khanewal 36.1 11.4 -1.6 693 34.5 13.5 -1.5 691 19.9 5.1 0.5 -1.1 698 Lodhran 35.6 13.2 -1.7 430 38.0 18.4 -1.7 427 17.0 5.0 0.7 -1.0 426 Vehari 36.4 12.9 -1.7 641 34.0 12.2 -1.5 635 19.1 4.9 0.8 -1.1 636 Sahiwal 33.9 11.2 -1.6 616 32.3 10.6 -1.4 615 18.7 4.3 0.3 -1.1 613 Pakpattan 38.1 12.6 -1.7 516 36.9 14.8 -1.6 511 17.6 4.2 0.2 -1.1 510 Okara 36.2 12.6 -1.6 848 33.5 14.1 -1.5 845 18.4 4.4 0.1 -1.1 854 P a g e | 230 Table D.NU.2: Nutritional status of children Percentage of children under age 5 by nutritional status according to three anthropometric indices: weight for age, height for age, and weight for height, Punjab, 2014. Weight for age Number of children under age 5 Height for age Number of children under age 5 Weight for height Number of children under age 5 Underweight Mean Z- Score (SD) Stunted Mean Z- Score (SD) Wasted Overweight Mean Z- Score (SD) Percent below Percent below Percent below Percent above - 2 SD1 - 3 SD2 - 2 SD3 - 3 SD4 - 2 SD5 - 3 SD6 + 2 SD7 Rawalpindi 18.5 5.0 -1.1 1,118 18.2 5.9 -0.9 1,115 13.6 2.5 1.5 -0.8 1,123 Attock 24.4 6.9 -1.3 415 23.9 7.6 -1.1 413 13.4 2.7 0.4 -0.9 413 Chakwal 25.1 5.5 -1.3 309 24.1 5.6 -1.2 307 13.4 2.2 0.1 -0.9 306 Jhelum 24.7 5.5 -1.2 238 28.8 9.2 -1.3 234 11.5 3.6 1.2 -0.8 234 Sargodha 36.6 11.8 -1.6 791 34.1 11.7 -1.5 787 20.6 5.4 0.5 -1.1 794 Bhakkar 36.5 13.8 -1.8 405 35.0 12.3 -1.5 399 19.7 3.8 0.5 -1.2 397 Khushab 35.0 10.2 -1.6 312 34.7 13.1 -1.5 312 16.6 3.8 0.1 -1.1 311 Mianwali 29.8 8.7 -1.5 419 28.9 10.7 -1.4 417 14.9 2.3 0.1 -1.0 416 Punjaba 33.7 11.3 -1.6 26,490 33.5 13.3 -1.4 26,280 17.5 4.4 0.8 -1.0 26,421 1 MICS indicator 2.1a and MDG indicator 1.8 - Underweight prevalence (moderate and severe) 2 MICS indicator 2.1b - Underweight prevalence (severe) 3 MICS indicator 2.2a - Stunting prevalence (moderate and severe) 4 MICS indicator 2.2b - Stunting prevalence (severe) 5 MICS indicator 2.3a - Wasting prevalence (moderate and severe) 6 MICS indicator 2.3b - Wasting prevalence (severe) 7 MICS indicator 2.4 - Overweight prevalence a Number of children under age 5 in each case differ as children are excluded from one or more anthropometric indicators when their weight heights have not been measured P a g e | 231 Table D.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, Punjab, 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 Punjab 93.7 10.6 45.2 74.5 10,653 District Bahawalpur 93.2 20.3 41.6 62.3 342 Bahawalnagar 97.6 9.7 37.2 74.0 254 RY Khan 95.2 5.5 39.6 72.1 472 DG Khan 95.5 22.8 62.6 48.9 361 Layyah 95.4 21.7 56.0 54.9 182 Muzaffargarh 95.7 19.4 48.1 64.7 414 Rajanpur 96.1 26.9 62.1 60.8 223 Faisalabad 93.4 6.0 40.4 81.5 692 Chiniot 92.2 7.9 33.2 78.4 123 Jhang 94.7 5.0 49.1 84.4 237 TT Singh 94.2 7.1 36.6 88.0 185 Gujranwala 89.3 3.3 40.5 82.6 481 Gujrat 91.2 8.4 47.6 85.2 258 Hafizabad 94.9 3.4 33.6 87.5 129 Mandi Bahauddin 93.5 8.3 50.0 85.1 173 Narowal 91.7 8.8 47.5 85.9 200 Sialkot 94.1 3.8 37.5 88.7 336 Lahore 94.6 14.6 47.4 72.1 988 Kasur 92.5 3.8 29.8 81.7 376 Nankana Sahib 93.6 9.7 36.6 81.8 182 Sheikhupura 88.0 6.5 42.5 71.8 369 Multan 94.8 8.3 51.6 59.2 465 Khanewal 92.0 11.6 42.8 65.1 289 Lodhran 95.7 7.5 41.9 63.5 176 Vehari 94.5 10.7 48.7 72.3 232 Sahiwal 94.9 2.9 29.0 84.8 261 Pakpattan 91.5 8.2 29.4 81.1 221 Okara 94.4 3.3 25.1 85.4 344 Rawalpindi 92.2 14.9 66.3 65.4 496 Attock 92.5 23.6 68.6 73.4 168 Chakwal 94.3 21.4 64.3 79.3 120 Jhelum 94.5 16.1 65.7 74.3 97 Sargodha 93.5 8.7 45.2 79.1 319 Bhakkar 96.3 10.8 43.4 87.5 174 Khushab 96.4 12.0 49.8 82.5 127 Mianwali 95.9 10.7 57.2 81.2 184 1 MICS indicator 2.5 - Children ever breastfed 2 MICS indicator 2.6 - Early initiation of breastfeeding P a g e | 232 Table D.NU.4: Breastfeeding Percentage of living children according to breastfeeding status at selected age groups, Punjab, 2014. Children age 0-3 months Children age 0-5 months Children age 12-15 months Children age 20-23 months Percent ever breastfed Percent exclusively breastfed1 Percent predominantly breastfed2 Number of children Percent ever breastfed 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 Punjab 96.6 22.6 55.5 1,583 96.5 16.8 47.8 2,333 65.6 1,854 34.5 1,728 District Bahawalpur (100.0) (3.7) (38.0) 35 100.0 5.6 35.7 61 (65.3) 51 38.0 54 Bahawalnagar (98.7) (8.3) (53.5) 40 99.1 5.8 45.7 57 72.8 55 (32.7) 29 RY Khan 100.0 13.4 66.9 74 100.0 9.4 59.6 106 73.6 95 32.5 67 DG Khan (97.8) (21.2) (60.7) 37 96.7 12.7 44.2 66 70.6 57 47.3 51 Layyah (94.7) (29.8) (72.6) 30 95.5 20.9 56.6 43 76.6 36 (37.3) 29 Muzaffargarh 96.2 13.2 55.7 67 97.5 9.5 46.7 103 72.7 75 (38.6) 44 Rajanpur 92.8 29.7 68.7 35 94.3 27.2 65.8 44 (67.9) 36 (48.4) 30 Faisalabad 96.1 11.7 38.9 90 96.1 8.0 38.3 157 69.8 103 35.2 139 Chiniot (98.0) (27.3) (72.7) 21 (96.9) (17.1) (62.1) 34 (62.2) 24 (26.7) 22 Jhang (97.1) (24.1) (58.6) 26 98.4 13.2 41.0 48 (64.9) 33 37.4 44 TT Singh (86.0) (9.5) (44.5) 31 (88.4) (7.9) (42.9) 37 73.2 39 (31.5) 23 Gujranwala (96.0) (12.2) (46.3) 52 93.9 7.3 34.7 86 63.7 86 30.3 100 Gujrat (93.9) (35.4) (40.8) 45 95.7 30.0 36.5 64 54.6 44 15.8 57 Hafizabad (92.0) (28.5) (45.0) 17 (94.2) (20.5) (40.4) 24 (49.9) 28 (31.0) 20 Mandi Bahauddin (100.0) (57.6) (73.4) 25 (99.0) (44.7) (61.4) 33 (58.3) 35 (26.7) 28 Narowal (94.9) (18.7) (53.5) 29 96.1 14.2 39.9 46 70.1 43 29.3 36 Sialkot (91.5) (20.7) (30.7) 48 94.2 15.6 26.9 70 63.7 61 29.6 61 Lahore 99.1 17.0 43.3 159 99.3 13.6 39.9 204 52.8 163 30.2 145 Kasur 99.2 12.8 59.6 66 97.1 9.0 52.1 104 54.8 49 (27.3) 39 Nankana Sahib (91.7) (23.1) (53.9) 26 90.3 15.8 41.6 39 65.4 39 (37.7) 27 Sheikhupura (95.0) (33.9) (50.3) 39 94.1 24.0 39.7 58 55.4 64 (38.5) 56 Multan 96.5 24.5 63.7 80 96.4 19.2 54.5 110 54.1 72 34.6 80 Khanewal (93.6) (16.7) (63.1) 42 95.8 11.1 54.0 63 61.4 52 47.0 49 Lodhran 93.6 17.4 62.1 45 93.8 17.7 64.3 55 71.8 36 (28.7) 30 Vehari (100.0) (38.4) (79.9) 44 100.0 34.2 74.4 57 77.1 43 32.8 44 Sahiwal 94.0 45.5 63.7 43 92.1 35.3 55.6 57 72.3 44 34.2 51 Pakpattan (97.8) (23.1) (48.2) 39 97.4 19.1 42.1 50 79.5 49 (42.6) 38 Okara (100.0) (24.4) (57.5) 48 98.9 18.9 48.9 68 61.0 71 41.5 61 P a g e | 233 Table D.NU.4: Breastfeeding Percentage of living children according to breastfeeding status at selected age groups, Punjab, 2014. Children age 0-3 months Children age 0-5 months Children age 12-15 months Children age 20-23 months Percent ever breastfed Percent exclusively breastfed1 Percent predominantly breastfed2 Number of children Percent ever breastfed 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 Rawalpindi (97.8) (23.8) (53.8) 59 93.7 15.6 42.8 116 62.5 75 33.9 69 Attock (91.7) (47.6) (56.6) 28 (90.8) (39.3) (48.6) 34 (64.0) 25 (38.0) 27 Chakwal (100.0) (29.4) (62.4) 20 (100.0) (23.9) (53.1) 27 (*) 10 (33.3) 25 Jhelum (*) (*) (*) 13 (100.0) (51.4) (62.1) 17 (75.0) 18 (32.8) 18 Sargodha (97.4) (30.6) (62.6) 44 98.4 22.0 51.8 73 70.7 55 34.7 60 Bhakkar (100.0) (21.2) (60.3) 27 97.4 15.0 57.1 38 (83.3) 34 (29.9) 22 Khushab (96.5) (29.5) (84.5) 27 (97.4) (26.9) (82.3) 37 (76.3) 20 (*) 16 Mianwali (96.2) (29.6) (56.5) 32 95.2 21.8 48.0 46 (76.0) 33 42.5 36 Punjab 96.6 22.6 55.5 1,583 96.5 16.8 47.8 2,333 65.6 1,854 34.5 1,728 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 fewer than 25 unweighted cases P a g e | 234 Table D.NU.5: Duration of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children age 0-35 months, Punjab, 2014. Median duration (in months) of: Number of children age 0-35 months Any breastfeeding1 Exclusive breastfeeding Predominant breastfeeding Median (Punjab) 17.4 0.6 2.2 15,968 District Bahawalpur 15.5 0.0 0.6 513 Bahawalnagar 17.8 0.4 2.2 408 RY Khan 19.3 0.5 5.1 762 DG Khan 20.1 0.6 2.1 511 Layyah 18.8 0.6 2.9 289 Muzaffargarh 19.8 0.4 1.6 624 Rajanpur 20.7 0.6 4.1 343 Faisalabad 16.7 0.4 0.6 1,078 Chiniot 17.9 0.5 3.6 188 Jhang 16.4 0.7 1.8 369 TT Singh 18.2 0.4 1.7 286 Gujranwala 15.3 0.5 1.3 711 Gujrat 13.5 1.3 1.7 433 Hafizabad 15.2 0.6 0.9 183 Mandi Bahauddin 16.7 2.1 3.8 229 Narowal 17.9 0.5 1.9 315 Sialkot 15.5 0.5 0.5 528 Lahore 14.0 0.6 0.6 1,422 Kasur 16.6 0.5 2.7 535 Nankana Sahib 15.9 0.5 1.9 260 Sheikhupura 15.2 0.7 1.3 522 Multan 19.4 0.5 3.4 711 Khanewal 16.3 0.5 2.9 432 Lodhran 18.0 0.5 5.0 260 Vehari 18.0 0.7 4.6 368 Sahiwal 17.4 1.6 3.0 397 Pakpattan 16.6 0.5 0.7 311 Okara 16.6 0.5 2.4 510 Rawalpindi 19.8 0.6 1.4 696 Attock 20.1 0.9 2.3 245 Chakwal 17.1 1.2 2.8 179 Jhelum 17.8 2.6 3.2 147 Sargodha 16.0 0.7 2.7 503 Bhakkar 19.5 0.5 3.2 244 Khushab 21.0 0.6 5.6 184 Mianwali 20.8 0.5 2.1 275 Mean (Punjab) 16.7 1.0 3.6 15,968 1 MICS indicator 2.11 - Duration of breastfeeding P a g e | 235 Table D.NU.6: Age-appropriate breastfeeding Percentage of children age 0-23 months who were appropriately breastfed during the previous day, Punjab, 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 Punjab 16.8 2,333 48.0 8,310 41.2 10,642 District Bahawalpur 5.6 61 42.1 274 35.4 335 Bahawalnagar 5.8 57 43.7 203 35.3 260 RY Khan 9.4 106 43.3 372 35.8 478 DG Khan 12.7 66 56.1 280 47.8 346 Layyah 20.9 43 52.4 139 44.9 182 Muzaffargarh 9.5 103 51.9 305 41.2 408 Rajanpur 27.2 44 58.2 182 52.2 226 Faisalabad 8.0 157 49.0 577 40.2 734 Chiniot (17.1) 34 47.7 101 40.0 135 Jhang 13.2 48 48.8 197 41.7 246 TT Singh (7.9) 37 60.3 158 50.3 195 Gujranwala 7.3 86 41.7 415 35.8 501 Gujrat 30.0 64 40.3 217 38.0 281 Hafizabad (20.5) 24 44.1 104 39.6 128 Mandi Bahauddin (44.7) 33 45.1 127 45.0 159 Narowal 14.2 46 50.3 154 41.9 200 Sialkot 15.6 70 51.7 281 44.5 350 Lahore 13.6 204 41.1 732 35.1 936 Kasur 9.0 104 48.5 258 37.1 362 Nankana Sahib 15.8 39 48.4 135 41.1 173 Sheikhupura 24.0 58 44.8 294 41.4 352 Multan 19.2 110 41.0 371 36.0 481 Khanewal 11.1 63 47.2 220 39.1 284 Lodhran 17.7 55 49.8 122 39.9 177 Vehari 34.2 57 57.0 179 51.5 235 Sahiwal 35.3 57 48.0 207 45.2 264 Pakpattan 19.1 50 51.7 161 44.0 210 Okara 18.9 68 41.8 283 37.3 351 Rawalpindi 15.6 116 57.7 366 47.6 482 Attock (39.3) 34 57.1 122 53.2 156 Chakwal (23.9) 27 50.7 86 44.3 114 Jhelum (51.4) 17 55.1 81 54.5 98 Sargodha 22.0 73 43.3 253 38.5 325 Bhakkar 15.0 38 55.6 134 46.7 171 Khushab (26.9) 37 59.1 88 49.6 125 Mianwali 21.8 46 56.9 134 48.0 180 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 P a g e | 236 Table D.NU.8: Infant and young child feeding (IYCF) practices Percentage of children age 6-23 months who received appropriate liquids and solid, semi-solid, or soft foods the minimum number of times or more during the previous day, by breastfeeding status, Punjab, 2014. Currently breastfeeding Currently not breastfeeding All Percent of children who received: Number of children age 6-23 months Percent of children who received: Number of children age 6-23 months Percent of children who received: Number of children age 6-23 months Minimum dietary diversitya Minimum meal frequencyb Minimum acceptable diet1, c Minimum dietary diversitya Minimum meal frequencyb Minimum acceptable diet2, c At least 2 milk feeds3 Minimum dietary diversity4, a Minimum meal frequency5, b Minimum acceptable dietc Punjab 12.5 49.8 11.2 4,992 25.2 92.2 7.3 90.8 2,866 17.3 65.3 9.7 8,310 District Bahawalpur 5.6 29.8 3.3 165 8.2 71.7 1.8 83.5 89 6.7 44.5 2.8 274 Bahawalnagar 3.2 28.1 2.5 136 8.1 84.6 0.0 85.2 62 4.6 45.8 1.7 203 RY Khan 6.2 35.9 6.2 245 18.1 89.4 3.4 86.7 119 9.9 53.4 5.3 372 DG Khan 11.3 40.6 9.5 199 22.3 85.5 6.4 88.2 71 13.9 52.4 8.7 280 Layyah 12.7 58.6 11.4 89 32.8 93.6 13.5 95.3 46 19.8 70.5 12.1 139 Muzaffargarh 12.9 38.3 9.8 216 27.8 89.2 9.4 86.9 79 17.1 51.9 9.7 305 Rajanpur 10.3 48.9 8.0 135 26.8 89.0 5.9 81.2 44 14.0 58.7 7.5 182 Faisalabad 14.0 58.9 13.4 341 27.5 98.4 10.1 94.5 196 19.6 73.3 12.2 577 Chiniot 15.8 61.0 15.8 61 24.9 97.7 11.7 93.6 33 18.2 73.8 14.4 101 Jhang 11.2 67.7 11.2 118 15.9 94.9 6.0 94.9 70 12.6 77.9 9.2 197 TT Singh 15.4 70.3 15.4 103 26.1 99.2 2.0 95.2 49 18.5 79.6 11.1 158 Gujranwala 7.8 47.4 5.7 208 24.1 95.0 5.7 90.5 161 16.8 68.2 5.7 415 Gujrat 9.6 66.2 9.6 100 18.8 96.8 7.2 98.3 95 15.7 81.0 8.4 217 Hafizabad 10.4 58.1 10.4 55 28.0 90.9 5.2 89.1 47 18.0 73.2 8.0 104 Mandi Bahauddin 14.9 65.9 14.9 67 25.2 91.6 4.6 86.9 57 19.2 77.8 10.1 127 Narowal 11.9 66.4 11.9 96 26.6 96.2 4.9 91.4 44 16.6 75.8 9.7 154 Sialkot 15.4 60.9 13.3 156 25.2 96.2 7.8 93.1 110 20.1 75.5 11.0 281 Lahore 19.9 54.1 18.6 380 37.6 92.1 10.0 90.9 303 27.8 70.9 14.8 732 Kasur 11.2 49.8 11.2 154 31.9 94.2 7.5 87.7 93 18.5 66.5 9.8 258 Nankana Sahib 12.0 53.3 11.3 80 33.2 93.6 6.1 92.9 49 20.1 68.6 9.3 135 Sheikhupura 13.2 52.0 13.2 159 28.5 98.8 9.1 94.5 111 18.8 71.3 11.5 294 Multan 5.5 26.2 4.2 222 13.5 84.3 3.4 94.3 125 9.5 47.2 3.9 371 Khanewal 5.4 45.4 4.9 139 24.5 86.9 4.1 90.3 67 11.9 59.0 4.6 220 Lodhran 8.7 43.4 8.2 78 23.1 94.0 3.5 98.1 42 14.0 61.1 6.6 122 Vehari 4.7 51.9 4.7 114 24.6 93.2 4.4 89.9 62 11.5 66.4 4.6 179 Sahiwal 8.8 58.6 8.8 123 25.5 97.8 9.0 88.4 78 14.9 73.8 8.9 207 Pakpattan 12.5 60.1 12.5 103 16.8 95.1 2.7 82.4 50 13.7 71.6 9.3 161 Okara 11.2 43.6 10.7 164 18.7 88.0 8.4 92.5 103 14.3 60.7 9.8 283 P a g e | 237 Table D.NU.8: Infant and young child feeding (IYCF) practices Percentage of children age 6-23 months who received appropriate liquids and solid, semi-solid, or soft foods the minimum number of times or more during the previous day, by breastfeeding status, Punjab, 2014. Currently breastfeeding Currently not breastfeeding All Percent of children who received: Number of children age 6-23 months Percent of children who received: Number of children age 6-23 months Percent of children who received: Number of children age 6-23 months Minimum dietary diversitya Minimum meal frequencyb Minimum acceptable diet1, c Minimum dietary diversitya Minimum meal frequencyb Minimum acceptable diet2, c At least 2 milk feeds3 Minimum dietary diversity4, a Minimum meal frequency5, b Minimum acceptable dietc Rawalpindi 28.4 54.8 23.2 225 31.7 90.4 14.2 85.6 113 29.5 66.7 20.2 366 Attock 25.5 60.2 16.6 78 33.3 96.6 15.3 89.4 41 27.3 72.7 16.1 122 Chakwal 22.4 59.6 19.3 47 47.8 95.8 21.7 84.2 33 34.2 74.4 20.3 86 Jhelum 18.3 65.9 15.8 49 39.9 93.2 11.5 88.4 27 26.7 75.7 14.3 81 Sargodha 17.4 44.2 15.1 144 21.5 92.2 7.7 97.0 93 18.4 63.1 12.2 253 Bhakkar 6.9 43.5 6.9 93 14.1 94.3 1.5 92.1 39 9.0 58.6 5.3 134 Khushab 18.3 52.9 18.3 62 (28.3) (94.7) (5.8) (94.7) 24 20.7 64.6 14.8 88 Mianwali 11.9 51.4 10.7 89 21.7 89.4 3.3 88.3 42 15.7 63.6 8.3 134 Punjab 12.5 49.8 11.2 4,992 25.2 92.2 7.3 90.8 2,866 17.3 65.3 9.7 8,310 1 MICS indicator 2.17a - Minimum acceptable diet (breastfed) 2 MICS indicator 2.17b - Minimum acceptable diet (non-breastfed) 3 MICS indicator 2.14 - Milk feeding frequency for non-breastfed children 4 MICS indicator 2.16 - Minimum dietary diversity 5 MICS indicator 2.15 - Minimum meal frequency a Minimum dietary diversity is defined as receiving foods from at least 4 of 7 food groups: 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. b Minimum meal frequency among currently breastfeeding children is defined as children who also received solid, semi-solid, or soft foods 2 times or more daily for children age 6-8 months and 3 times or more daily for children age 9-23 months. For non-breastfeeding children age 6-23 months it is defined as receiving solid, semi-solid or soft foods, or milk feeds, at least 4 times daily. c The minimum acceptable diet for breastfed children age 6-23 months is defined as receiving the minimum dietary diversity and the minimum meal frequency, while it for non-breastfed children further requires at least 2 milk feedings and that the minimum dietary diversity is achieved without counting milk feeds. ( ) Figures that are based on 25-49 unweighted cases P a g e | 238 Table D.NU.9: Bottle feeding Percentage of children age 0-23 months who were fed with a bottle with a nipple during the previous day, Punjab, 2014. Percentage of children age 0-23 months fed with a bottle with a nipple1 Number of children age 0-23 months Punjab 57.7 10,642 District Bahawalpur 51.8 335 Bahawalnagar 47.3 260 RY Khan 37.6 478 DG Khan 51.4 346 Layyah 58.1 182 Muzaffargarh 51.4 408 Rajanpur 44.6 226 Faisalabad 56.8 734 Chiniot 55.4 135 Jhang 58.7 246 TT Singh 60.8 195 Gujranwala 69.6 501 Gujrat 75.3 281 Hafizabad 57.3 128 Mandi Bahauddin 67.2 159 Narowal 64.7 200 Sialkot 68.1 350 Lahore 71.4 936 Kasur 57.8 362 Nankana Sahib 60.2 173 Sheikhupura 65.8 352 Multan 60.2 481 Khanewal 52.8 284 Lodhran 43.6 177 Vehari 45.4 235 Sahiwal 48.8 264 Pakpattan 52.8 210 Okara 59.3 351 Rawalpindi 64.0 482 Attock 53.4 156 Chakwal 59.0 114 Jhelum 63.1 98 Sargodha 56.5 325 Bhakkar 49.5 171 Khushab 35.9 125 Mianwali 45.9 180 1 MICS indicator 2.18 - Bottle feeding P a g e | 239 Table D.NU.10: Iodized salt consumption Percent distribution of households by consumption of iodized salt, Punjab, 2014. Percentage of households in which salt was tested Number of households Percent of households with: Total Number of households in which salt was tested or with no salt No salt Salt test result Not iodized 0 PPM >0 and <15 PPM 15+ PPM1 Punjab 98.2 38,405 1.1 30.2 19.6 49.2 100.0 38,119 District Bahawalpur 98.2 1,299 1.3 26.5 31.6 40.6 100.0 1,292 Bahawalnagar 98.6 1,074 0.9 17.8 20.2 61.1 100.0 1,069 RY Khan 98.1 1,719 1.8 47.7 15.0 35.5 100.0 1,717 DG Khan 99.1 935 0.5 47.4 21.6 30.5 100.0 931 Layyah 98.8 597 1.1 36.5 25.7 36.7 100.0 597 Muzaffargarh 98.1 1,303 1.4 30.6 25.8 42.2 100.0 1,296 Rajanpur 98.2 600 1.8 57.8 22.2 18.3 100.0 600 Faisalabad 98.6 2,711 0.8 27.9 15.7 55.5 100.0 2,695 Chiniot 98.8 504 0.7 28.3 22.5 48.6 100.0 502 Jhang 99.2 893 0.6 35.1 19.2 45.0 100.0 892 TT Singh 98.8 780 0.9 26.0 21.1 52.0 100.0 778 Gujranwala 98.5 1,589 0.4 20.7 18.1 60.8 100.0 1,572 Gujrat 98.6 1,024 0.8 18.4 18.2 62.5 100.0 1,018 Hafizabad 97.4 433 1.2 12.3 10.7 75.7 100.0 427 Mandi Bahauddin 97.9 589 1.2 22.0 18.4 58.3 100.0 584 Narowal 99.3 634 0.4 40.7 13.9 44.9 100.0 632 Sialkot 98.1 1,299 1.6 10.1 17.4 71.0 100.0 1,294 Lahore 97.1 3,614 1.0 31.0 15.3 52.8 100.0 3,544 Kasur 97.5 1,171 1.6 25.4 21.8 51.2 100.0 1,160 Nankana Sahib 98.7 580 0.8 6.0 15.0 78.2 100.0 577 Sheikhupura 98.3 1,266 1.0 23.8 15.2 60.0 100.0 1,257 Multan 97.1 1,835 1.5 55.0 10.1 33.4 100.0 1,809 Khanewal 97.2 1,123 2.2 31.3 20.2 46.3 100.0 1,116 Lodhran 98.7 647 1.3 30.4 19.9 48.4 100.0 647 Vehari 98.3 1,028 1.3 23.4 15.0 60.2 100.0 1,025 Sahiwal 98.4 832 1.5 10.7 16.4 71.5 100.0 831 Pakpattan 98.5 718 1.5 19.5 24.8 54.2 100.0 717 Okara 99.0 1,088 1.0 32.6 18.6 47.9 100.0 1,088 Rawalpindi 96.6 1,923 1.4 19.7 29.7 49.2 100.0 1,883 Attock 98.8 689 0.5 30.4 32.5 36.7 100.0 683 Chakwal 98.1 568 1.1 28.3 31.5 39.2 100.0 563 Jhelum 98.0 452 1.3 29.8 17.9 51.0 100.0 449 Sargodha 98.5 1,324 0.9 60.5 13.7 24.9 100.0 1,316 Bhakkar 99.5 544 0.5 21.3 35.4 42.9 100.0 544 Khushab 99.6 471 0.2 47.4 23.4 29.1 100.0 471 Mianwali 99.6 545 0.2 27.4 28.4 44.1 100.0 543 1 MICS indicator 2.19 - Iodized salt consumption P a g e | 240 Table D.NU.11: Children's vitamin A supplementation Percent distribution of children age 6-59 months by receipt of a high dose vitamin A supplement in the last 6 months, Punjab, 2014. Percentage of children who received Vitamin A during the last 6 months1 Number of children age 6-59 months Punjab 64.8 24,706 District Bahawalpur 81.7 846 Bahawalnagar 95.5 676 RY Khan 94.5 1,285 DG Khan 33.0 827 Layyah 65.5 467 Muzaffargarh 46.1 993 Rajanpur 53.3 572 Faisalabad 67.0 1,611 Chiniot 81.0 298 Jhang 68.5 566 TT Singh 79.7 462 Gujranwala 50.5 1,092 Gujrat 64.1 659 Hafizabad 82.2 281 Mandi Bahauddin 80.3 355 Narowal 87.1 475 Sialkot 79.7 811 Lahore 52.4 2,217 Kasur 64.7 788 Nankana Sahib 74.4 372 Sheikhupura 64.6 814 Multan 32.8 1,049 Khanewal 37.5 652 Lodhran 66.6 387 Vehari 59.8 603 Sahiwal 85.0 561 Pakpattan 81.6 471 Okara 61.5 805 Rawalpindi 56.6 1,043 Attock 63.0 381 Chakwal 61.4 276 Jhelum 72.2 224 Sargodha 68.8 744 Bhakkar 69.5 371 Khushab 71.5 283 Mianwali 84.8 389 1 MICS indicator 2.S1 - Vitamin A supplementation P a g e | 241 Table D.CH.2: Vaccinations by background characteristics Percentage of children age 12-23 months currently vaccinated against vaccine preventable childhood diseases, Punjab, 2014. Percentage of children age 12-23 months who received: Percentage with vaccination card seen Number of children age 12-23 months Percentage of children age 24-35 months who received: Percentage with vaccination card seen Number of children age 24-35 months BCG Polio DPT / PENTA Measle s-1 (MCV1) Fulla None Measles 2 Fulla None At birth 1 2 3 1 2 3 Punjab 93.1 91.4 95.3 90.8 86.6 85.7 81.8 73.3 77.8 62.3 3.5 58.5 5,300 30.7 58.7 4.5 36.8 5,326 District Bahawalpur 93.6 91.4 92.6 85.9 81.1 90.4 83.7 69.8 76.2 61.1 3.4 61.3 165 26.8 48.2 8.5 32.3 177 Bahawalnagar 86.3 86.6 96.4 92.4 83.2 81.0 78.0 63.1 65.0 50.9 0.6 45.0 120 28.2 67.3 1.3 39.3 148 RY Khan 88.2 86.5 96.4 92.8 87.5 85.3 80.9 68.5 55.9 45.9 2.9 33.5 259 13.3 55.8 2.3 16.1 284 DG Khan 68.9 75.3 79.4 75.8 69.0 59.8 51.1 43.1 46.6 29.6 16.5 36.3 175 10.0 21.5 23.5 16.2 165 Layyah 92.5 87.6 96.2 92.1 86.8 91.9 85.2 70.1 77.2 61.3 3.8 60.1 95 31.9 57.3 3.6 42.2 107 Muzaffargarh 87.3 87.7 92.7 86.9 84.5 84.6 75.5 56.5 62.6 42.0 5.8 45.8 184 10.7 33.7 10.5 18.3 216 Rajanpur 80.7 74.2 92.8 89.5 85.2 71.2 61.5 42.9 41.0 27.0 6.5 32.1 104 8.2 30.1 6.0 15.1 117 Faisalabad 95.1 92.7 95.8 89.7 88.5 93.6 90.9 82.6 82.2 71.2 2.7 64.8 353 30.1 71.3 2.2 36.6 343 Chiniot 94.1 88.9 95.2 92.8 88.7 93.2 89.5 71.6 82.9 65.7 4.8 43.7 62 28.4 82.6 1.2 32.9 53 Jhang 86.9 87.0 91.2 89.3 81.1 83.0 78.7 62.6 63.2 46.4 8.2 38.1 113 17.2 55.8 7.5 22.5 123 TT Singh 96.8 96.8 100.0 97.5 90.1 92.3 92.3 86.4 80.7 71.4 0.0 68.1 90 30.3 74.7 3.8 36.5 90 Gujranwala 92.4 91.7 90.7 85.5 78.9 91.6 87.1 77.4 80.7 65.2 6.2 64.3 278 38.7 65.6 3.7 47.7 210 Gujrat 100.0 98.9 100.0 98.6 93.8 100.0 100.0 97.5 98.1 90.8 0.0 85.6 140 65.0 91.6 0.0 69.1 152 Hafizabad 99.4 98.9 100.0 100.0 97.6 68.1 68.1 67.4 94.2 65.1 0.0 67.1 71 48.7 53.1 0.0 54.0 55 Mandi Bahauddin 99.6 99.6 98.6 97.8 95.3 77.6 77.6 75.3 87.9 68.7 0.4 72.5 91 38.7 46.4 3.1 44.9 69 Narowal 98.6 96.7 100.0 100.0 97.5 98.3 98.3 95.7 92.1 84.8 0.0 81.5 96 55.0 86.9 0.5 62.0 115 Sialkot 99.0 96.9 98.3 92.1 88.6 98.4 91.9 90.1 95.3 80.7 0.5 63.9 174 45.1 78.2 1.3 48.0 177 Lahore 94.9 94.4 96.8 87.4 83.5 91.6 89.1 73.0 75.5 63.3 2.7 50.6 462 21.5 62.3 2.6 26.4 486 Kasur 86.7 80.4 92.7 85.8 75.4 82.4 72.4 61.4 65.9 52.9 5.1 49.4 159 22.8 45.6 3.4 28.8 173 Nankana Sahib 100.0 98.9 100.0 100.0 98.9 78.1 78.1 78.1 92.5 70.0 0.0 76.7 90 41.7 49.6 2.2 44.1 87 Sheikhupura 92.7 93.2 94.3 90.5 84.4 77.0 76.3 71.0 77.9 59.0 5.7 60.0 175 27.7 48.0 10.0 33.7 170 Multan 89.3 85.4 90.9 87.1 84.5 85.8 80.4 73.7 76.8 66.7 8.0 62.3 222 26.1 53.5 9.6 35.5 230 Khanewal 93.6 88.2 96.3 91.2 88.7 88.9 86.6 71.8 78.2 57.0 3.7 51.3 150 21.6 50.8 6.6 30.1 148 Lodhran 96.9 91.5 98.3 97.2 94.6 93.5 91.4 79.1 71.4 58.7 1.7 36.5 82 18.2 71.6 1.7 21.7 83 Vehari 99.3 99.1 98.5 96.1 96.1 97.1 95.4 93.1 85.4 83.7 0.0 71.4 126 43.5 84.7 0.8 45.2 133 Sahiwal 98.8 95.6 99.2 96.5 93.3 66.1 65.4 65.4 87.0 59.1 0.8 65.5 132 56.2 59.8 0.0 59.4 133 Pakpattan 97.7 96.3 98.4 97.0 94.1 73.0 72.3 70.8 79.8 61.2 0.7 73.9 116 32.4 39.4 2.2 43.6 100 Okara 97.5 95.7 98.1 96.5 93.7 83.7 79.8 76.6 90.1 71.8 1.4 70.4 185 43.3 56.5 3.4 46.2 159 P a g e | 242 Table D.CH.2: Vaccinations by background characteristics Percentage of children age 12-23 months currently vaccinated against vaccine preventable childhood diseases, Punjab, 2014. Percentage of children age 12-23 months who received: Percentage with vaccination card seen Number of children age 12- 23 months Percentage of children age 24-35 months who received: Percentage with vaccination card seen Number of children age 24- 35 months BCG Polio DPT / PENTA Measle s-1 (MCV1) Fulla None Measles 2 Full [a] None At birth 1 2 3 1 2 3 Rawalpindi 93.9 95.2 94.6 82.5 77.3 92.4 82.1 79.7 84.9 64.9 3.8 61.4 236 31.5 56.7 5.9 34.9 215 Attock 100.0 96.9 98.2 91.5 85.9 96.8 91.0 82.3 84.9 72.0 0.0 70.5 75 48.1 74.2 2.4 54.2 89 Chakwal 99.0 97.6 97.9 93.6 90.4 93.8 91.9 86.1 91.8 80.2 1.0 68.2 56 48.1 87.2 0.0 50.5 65 Jhelum 100.0 97.8 100.0 97.1 94.9 100.0 98.8 91.0 91.4 81.8 0.0 69.0 56 51.4 88.1 1.3 55.8 49 Sargodha 92.1 91.4 93.2 90.1 88.0 82.8 81.8 77.9 87.7 70.7 5.6 62.4 180 39.4 61.2 4.3 45.9 178 Bhakkar 91.4 88.1 95.3 93.6 92.8 61.8 61.1 60.3 76.9 52.1 3.4 58.2 82 23.6 27.3 4.5 31.3 72 Khushab 96.2 86.6 98.7 97.4 90.9 69.5 68.2 62.9 87.3 50.1 1.3 66.4 53 42.2 50.2 4.7 53.4 60 Mianwali 99.0 92.9 99.5 98.2 91.8 69.4 68.1 63.2 83.0 53.7 0.0 69.4 94 37.0 45.3 1.2 51.3 95 Punjab 93.1 91.4 95.3 90.8 86.6 85.7 81.8 73.3 77.8 62.3 3.5 58.5 5,300 30.7 58.7 4.5 36.8 5,326 a Includes: BCG, Polio3, PENTA3 and Measles-1 (MCV1) as per the vaccination schedule in Punjab P a g e | 243 Table D.CH.3: Neonatal tetanus protection Percentage of women age 15-49 years with a live birth in the last 2 years protected against neonatal tetanus, Punjab, 2014. Percentage of women who received at least 2 doses during last pregnancy Percentage of women who did not receive two or more doses during last pregnancy but received: Protected against tetanus1 Number of women with a live birth in the last 2 years 2 doses, the last within prior 3 years 3 doses, the last within prior 5 years 4 doses, the last within prior 10 years 5 or more doses during lifetime Punjab 70.5 4.7 0.8 0.4 0.1 76.4 10,653 District Bahawalpur 67.0 4.0 0.7 0.7 0.3 72.8 342 Bahawalnagar 63.8 1.9 1.7 0.0 0.0 67.4 254 RY Khan 60.0 1.1 0.8 0.0 0.0 62.0 472 DG Khan 50.5 6.6 0.3 0.1 0.0 57.4 361 Layyah 77.1 4.4 1.1 0.2 0.0 82.9 182 Muzaffargarh 66.6 4.6 0.3 0.7 0.0 72.2 414 Rajanpur 48.0 5.6 1.0 0.8 0.4 55.7 223 Faisalabad 73.7 4.8 0.2 0.3 0.0 79.0 692 Chiniot 76.9 6.1 1.8 0.3 0.0 85.1 123 Jhang 62.9 4.1 1.6 0.5 0.3 69.5 237 TT Singh 70.1 6.5 1.0 0.0 0.0 77.7 185 Gujranwala 75.0 5.4 0.6 0.3 0.0 81.3 481 Gujrat 85.7 7.2 0.0 0.8 0.0 93.8 258 Hafizabad 71.9 9.3 0.6 0.3 0.0 82.1 129 Mandi Bahauddin 77.8 1.7 0.7 0.0 0.0 80.2 173 Narowal 85.2 7.0 1.8 1.7 0.5 96.1 200 Sialkot 90.7 1.1 0.0 0.2 0.0 92.0 336 Lahore 73.7 5.1 2.2 0.4 0.1 81.6 988 Kasur 51.9 6.9 1.3 0.8 0.3 61.3 376 Nankana Sahib 84.9 3.1 0.0 0.0 0.0 87.9 182 Sheikhupura 67.4 3.0 0.7 1.1 0.3 72.4 369 Multan 68.8 3.4 0.4 0.0 0.0 72.5 465 Khanewal 61.2 3.0 0.3 0.7 0.0 65.2 289 Lodhran 75.8 0.6 0.7 0.0 0.0 77.0 176 Vehari 70.9 3.6 1.6 0.0 0.9 77.0 232 Sahiwal 79.4 5.0 0.5 0.4 0.0 85.5 261 Pakpattan 71.6 4.5 0.4 1.3 0.0 77.8 221 Okara 61.9 3.0 0.9 0.7 0.0 66.4 344 Rawalpindi 79.0 5.6 0.6 0.2 0.0 85.4 496 Attock 77.4 2.9 0.0 0.0 0.0 80.3 168 Chakwal 79.1 5.6 0.0 0.0 0.7 85.4 120 Jhelum 84.7 5.8 1.1 0.0 0.0 91.5 97 Sargodha 69.2 5.2 0.3 0.3 0.2 75.2 319 Bhakkar 68.5 5.6 1.7 0.0 0.9 76.8 174 Khushab 62.9 12.7 1.0 0.4 0.0 77.0 127 Mianwali 74.4 11.5 0.8 0.0 0.4 87.1 184 1 MICS indicator 3.9 - Neonatal tetanus protection P a g e | 244 Table D.CH.4: Reported disease episodes Percentage of children age 0-59 months for whom the mother/caretaker reported an episode of diarrhoea, symptoms of acute respiratory infection (ARI), and/or fever in the last two weeks, Punjab, 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 An episode of fever Punjab 17.4 2.5 20.8 27,495 District Bahawalpur 15.1 2.6 15.3 912 Bahawalnagar 11.5 3.2 15.3 751 RY Khan 11.4 2.5 14.2 1,417 DG Khan 20.4 4.8 22.1 898 Layyah 13.6 3.5 20.3 514 Muzaffargarh 18.8 5.0 25.8 1,118 Rajanpur 22.8 5.5 26.7 621 Faisalabad 15.9 2.6 21.3 1,807 Chiniot 15.5 1.2 24.8 335 Jhang 12.9 1.4 12.1 626 TT Singh 15.8 1.3 19.8 503 Gujranwala 22.3 2.1 25.1 1,210 Gujrat 15.0 1.4 21.0 744 Hafizabad 23.5 2.5 31.7 310 Mandi Bahauddin 11.5 3.5 32.4 401 Narowal 16.1 1.1 19.1 529 Sialkot 21.0 2.4 20.2 906 Lahore 18.6 1.4 20.5 2,467 Kasur 20.5 2.7 24.6 898 Nankana Sahib 18.0 2.5 23.5 418 Sheikhupura 22.7 2.0 23.7 887 Multan 20.4 1.5 18.4 1,179 Khanewal 16.3 2.8 18.2 720 Lodhran 15.3 1.2 15.3 451 Vehari 16.8 1.5 18.5 668 Sahiwal 19.4 3.4 26.0 628 Pakpattan 19.4 3.8 26.1 526 Okara 21.8 2.8 22.2 878 Rawalpindi 15.9 1.9 17.5 1,180 Attock 10.5 1.1 15.9 429 Chakwal 7.5 0.8 11.0 310 Jhelum 11.7 0.7 16.7 246 Sargodha 20.3 3.4 21.6 823 Bhakkar 17.2 3.5 23.6 416 Khushab 11.9 1.9 18.9 325 Mianwali 18.6 2.3 29.0 440 P a g e | 245 Table D.CH.5: Care-seeking during diarrhea 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, Punjab, 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 provider1, b Public Private Community health providera Punjab 11.1 63.6 0.4 8.1 72.1 18.8 4,784 District Bahawalpur 13.5 56.7 0.0 2.0 65.3 27.9 138 Bahawalnagar 12.3 64.8 1.3 5.1 73.1 17.9 87 RY Khan 5.9 72.6 1.7 10.9 70.6 11.3 161 DG Khan 13.7 46.8 0.0 18.4 56.9 25.7 183 Layyah 5.9 52.5 0.0 11.7 58.4 31.0 70 Muzaffargarh 9.0 42.3 0.0 14.6 49.1 34.3 210 Rajanpur 10.7 44.0 0.0 14.6 53.9 32.1 142 Faisalabad 13.5 71.9 0.6 4.8 84.0 10.4 288 Chiniot 6.5 63.1 0.0 16.4 63.4 17.1 52 Jhang 6.3 67.6 0.0 17.6 70.3 12.0 81 TT Singh 5.8 73.1 0.0 12.1 75.6 11.0 80 Gujranwala 9.1 67.6 0.0 3.6 74.6 19.9 270 Gujrat 5.1 75.9 2.2 1.3 79.6 17.6 112 Hafizabad 4.9 77.4 0.9 6.9 81.0 11.6 73 Mandi Bahauddin 11.7 73.2 0.0 2.9 80.8 12.2 46 Narowal 6.3 72.7 1.1 17.8 73.6 12.7 85 Sialkot 8.4 72.4 0.6 5.5 77.5 15.2 190 Lahore 15.7 72.6 0.3 2.9 86.7 10.6 458 Kasur 14.5 58.8 0.0 10.8 69.9 20.4 184 Nankana Sahib 7.4 60.8 0.0 9.4 63.3 22.4 75 Sheikhupura 9.8 56.6 0.0 7.4 65.8 26.6 201 Multan 13.3 65.4 0.0 11.4 76.8 11.0 241 Khanewal 4.6 67.3 0.0 17.6 71.9 16.1 118 Lodhran 16.7 66.9 2.3 3.2 74.8 15.8 69 Vehari 20.2 56.4 0.0 0.5 75.6 24.4 112 Sahiwal 11.8 68.1 0.0 4.4 78.4 16.5 122 Pakpattan 3.3 67.0 0.0 7.9 70.3 22.2 102 Okara 6.5 71.4 1.5 1.5 77.3 21.0 192 Rawalpindi 15.4 55.8 0.8 3.2 70.8 25.6 188 Attock 15.8 53.4 1.6 4.4 69.3 26.3 45 Chakwal (16.8) (50.6) (0.0) (2.3) (67.4) (30.3) 23 Jhelum (27.9) (61.1) (0.0) (1.6) (84.0) (14.4) 29 Sargodha 14.7 60.1 0.0 12.6 70.4 15.8 167 Bhakkar 7.8 50.2 0.0 19.6 54.6 22.5 72 Khushab 6.7 56.7 0.0 17.4 59.7 20.5 39 Mianwali 10.6 69.1 0.8 6.6 74.3 14.8 82 1 MICS indicator 3.10 - Care-seeking for diarrhea a Community health providers includes both public (Community health worker and Mobile/Outreach clinic) and private (Mobile clinic) health facilities b Includes all public and private health facilities and providers, but excludes private pharmacy P a g e | 246 Table D.CH.6: Feeding practices during diarrhea Percent distribution of children age 0-59 months with diarrhoea in the last two weeks by amount of liquids and food given during episode of diarrhoea, Punjab, 2014. Drinking practices during diarrhoea Eating practices during diarrhoea Number of children aged 0-59 months with diarrhoea Child was given to drink: Total Child was given to eat: Total Much less Somewhat less About the same More Nothing Missing/DK Much less Somewhat less About the same More Nothing Missing/DK Punjab 7.6 30.0 51.3 9.6 1.3 0.2 100.0 9.2 32.3 47.3 3.6 7.4 0.1 100.0 4,784 District Bahawalpur 1.8 18.3 62.8 15.4 1.6 0.0 100.0 13.8 23.7 44.8 8.4 9.2 0.0 100.0 138 Bahawalnagar 1.9 39.0 38.0 21.1 0.0 0.0 100.0 6.1 34.8 42.4 4.5 12.2 0.0 100.0 87 RY Khan 1.9 17.1 50.0 31.0 0.0 0.0 100.0 4.5 21.6 54.4 11.4 8.1 0.0 100.0 161 DG Khan 8.0 45.3 34.5 11.8 0.5 0.0 100.0 7.1 46.7 38.1 5.1 3.1 0.0 100.0 183 Layyah 7.4 42.1 50.5 0.0 0.0 0.0 100.0 13.9 37.3 40.2 2.2 6.5 0.0 100.0 70 Muzaffargarh 7.1 56.6 34.7 1.2 0.4 0.0 100.0 8.3 54.1 33.2 1.6 2.8 0.0 100.0 210 Rajanpur 8.8 26.8 60.2 2.9 1.3 0.0 100.0 11.0 28.1 56.9 1.7 2.2 0.0 100.0 142 Faisalabad 9.7 24.8 58.6 4.4 2.4 0.0 100.0 9.5 30.6 50.9 0.6 8.3 0.0 100.0 288 Chiniot 1.3 25.6 68.8 2.8 0.0 1.4 100.0 4.4 22.9 65.6 0.0 5.7 1.4 100.0 52 Jhang 10.6 32.1 53.5 3.7 0.0 0.0 100.0 7.9 32.9 53.9 2.3 3.1 0.0 100.0 81 TT Singh 4.4 26.9 49.9 18.0 0.8 0.0 100.0 4.4 29.5 50.3 13.7 2.1 0.0 100.0 80 Gujranwala 11.8 21.3 57.1 7.8 1.9 0.0 100.0 9.5 24.5 58.9 2.5 4.6 0.0 100.0 270 Gujrat 5.7 35.9 55.0 3.5 0.0 0.0 100.0 4.9 40.0 52.4 0.0 2.8 0.0 100.0 112 Hafizabad 6.0 31.4 47.7 13.0 1.9 0.0 100.0 6.0 32.2 48.8 5.5 7.5 0.0 100.0 73 Mandi Bahauddin 2.6 34.0 53.0 10.4 0.0 0.0 100.0 2.6 33.9 55.1 1.9 6.4 0.0 100.0 46 Narowal 5.3 41.4 52.4 0.9 0.0 0.0 100.0 8.5 38.7 48.1 0.9 3.8 0.0 100.0 85 Sialkot 9.3 32.4 47.4 7.6 3.2 0.0 100.0 13.5 32.8 40.1 3.2 10.4 0.0 100.0 190 Lahore 10.2 34.0 46.6 9.0 0.2 0.0 100.0 11.1 38.2 41.5 2.0 7.2 0.0 100.0 458 Kasur 4.1 17.2 63.5 14.1 1.1 0.0 100.0 4.8 31.5 54.3 4.7 4.1 0.5 100.0 184 Nankana Sahib 8.1 25.6 59.1 6.3 0.9 0.0 100.0 10.6 29.4 46.8 4.4 8.7 0.0 100.0 75 Sheikhupura 9.0 25.9 49.0 11.2 3.6 1.3 100.0 9.3 32.6 40.2 9.5 8.4 0.0 100.0 201 Multan 13.5 32.2 46.1 8.0 0.0 0.1 100.0 14.0 33.2 39.5 1.9 11.3 0.0 100.0 241 Khanewal 7.7 43.3 49.0 0.0 0.0 0.0 100.0 13.6 28.1 48.3 3.0 7.0 0.0 100.0 118 Lodhran 7.2 25.5 58.7 8.6 0.0 0.0 100.0 3.0 24.6 59.8 2.9 9.8 0.0 100.0 69 Vehari 9.1 27.5 56.6 5.9 0.0 0.9 100.0 15.6 27.9 48.5 1.9 5.3 0.9 100.0 112 Sahiwal 0.0 18.0 52.5 22.8 5.8 1.0 100.0 3.5 13.8 53.6 5.5 23.7 0.0 100.0 122 Pakpattan 2.9 17.1 55.2 22.4 2.5 0.0 100.0 3.8 24.0 59.2 0.0 13.0 0.0 100.0 102 Okara 2.3 28.2 54.5 13.3 1.2 0.5 100.0 7.0 24.7 57.1 4.1 5.9 1.2 100.0 192 P a g e | 247 Table D.CH.6: Feeding practices during diarrhea Percent distribution of children age 0-59 months with diarrhoea in the last two weeks by amount of liquids and food given during episode of diarrhoea, Punjab, 2014. Drinking practices during diarrhoea Eating practices during diarrhoea Number of children aged 0-59 months with diarrhoea Child was given to drink: Total Child was given to eat: Total Much less Somewhat less About the same More Nothing Missing/DK Much less Somewhat less About the same More Nothing Missing/DK Rawalpindi 7.8 32.2 42.1 13.2 4.1 0.5 100.0 9.4 42.4 33.3 6.1 8.7 0.0 100.0 188 Attock 3.1 38.1 52.4 6.3 0.0 0.0 100.0 7.9 43.4 40.5 2.6 5.6 0.0 100.0 45 Chakwal 6.4 26.4 59.9 7.2 0.0 0.0 100.0 (2.8) (41.4) (48.5) (1.6) (5.7) (0.0) 100.0 23 Jhelum 2.3 47.0 50.8 0.0 0.0 0.0 100.0 (4.6) (37.8) (42.0) (2.2) (13.4) (0.0) 100.0 29 Sargodha 11.3 23.5 54.5 8.8 1.3 0.6 100.0 13.2 28.9 46.7 2.8 7.5 0.8 100.0 167 Bhakkar 11.1 29.1 53.2 5.5 1.1 0.0 100.0 11.1 23.8 50.6 0.0 14.5 0.0 100.0 72 Khushab 3.5 19.1 64.0 13.4 0.0 0.0 100.0 4.9 26.3 51.7 6.6 10.5 0.0 100.0 39 Mianwali 15.6 25.8 55.7 2.2 0.7 0.0 100.0 15.6 27.1 51.0 2.2 4.0 0.0 100.0 82 Punjab 7.6 30.0 51.3 9.6 1.3 0.2 100.0 9.2 32.3 47.3 3.6 7.4 0.1 100.0 4,784 ( ) Figures that are based on 25-49 unweighted cases P a g e | 248 Table D.CH.7: Oral rehydration solutions, recommended homemade fluids, and zinc Percentage of children age 0-59 months with diarrhoea in the last two weeks, and treatment with oral rehydration salts (ORS), recommended homemade fluids, and zinc, MICS Punjab, 2014. Percentage of children with diarrhoea who received: Number of children age 0- 59 months with diarrhoea in the last two weeks Oral rehydration salts (ORS) Recommended homemade fluids ORS or any recommended homemade fluid Zinc ORS and zinc1 Fluid from packet Pre- packaged fluid Any ORS Homemade fluid (Boiled water, sugar & salt) Other Any recommended homemade fluid Tablet Syrup Any zinc Punjab 33.6 5.8 37.2 11.4 6.5 17.3 45.2 3.8 17.8 19.1 9.7 4,784 District Bahawalpur 29.0 7.2 33.7 18.4 11.4 28.7 46.2 2.9 19.0 20.4 10.8 138 Bahawalnagar 43.0 3.5 46.5 20.9 5.8 24.8 56.6 3.4 41.3 43.7 24.5 87 RY Khan 38.2 2.3 40.2 15.8 1.2 16.4 48.2 1.5 32.3 33.0 19.3 161 DG Khan 33.2 4.5 34.6 10.6 13.3 23.6 44.3 10.7 17.7 21.0 11.8 183 Layyah 16.0 6.5 21.6 4.8 8.6 13.4 29.9 7.7 23.5 26.2 7.6 70 Muzaffargarh 19.3 4.5 22.8 9.6 1.6 11.0 27.7 4.2 13.9 16.4 5.3 210 Rajanpur 32.8 6.8 35.0 6.0 2.1 8.1 38.9 7.4 16.3 18.6 10.6 142 Faisalabad 40.4 5.1 44.2 14.0 8.0 21.6 52.9 13.9 37.0 38.4 19.1 288 Chiniot 21.4 7.1 28.4 5.8 2.8 8.6 35.2 5.2 28.8 28.8 11.4 52 Jhang 45.2 9.3 52.5 11.1 17.6 28.7 63.7 2.9 14.3 16.3 8.3 81 TT Singh 49.4 4.7 52.6 10.6 3.2 13.8 62.8 10.4 34.7 39.5 25.4 80 Gujranwala 22.6 5.1 26.8 14.6 5.9 19.5 38.1 2.6 9.5 11.2 3.2 270 Gujrat 23.1 4.8 26.9 12.3 2.2 13.6 31.6 1.4 8.6 9.5 4.5 112 Hafizabad 35.2 4.3 38.2 6.6 2.0 7.9 42.6 4.1 17.5 19.9 8.3 73 Mandi Bahauddin 40.2 3.3 42.9 13.1 3.7 14.8 50.5 0.0 7.0 7.0 5.6 46 Narowal 28.9 3.4 29.9 6.9 1.8 8.7 37.1 2.4 5.0 7.0 3.6 85 Sialkot 35.6 10.2 40.2 8.6 2.9 11.5 45.7 1.3 11.1 11.1 7.5 190 Lahore 44.3 4.8 48.5 6.2 4.1 10.3 53.5 2.2 16.9 17.2 11.0 458 Kasur 30.5 5.0 34.3 7.5 3.1 10.6 40.9 4.6 20.0 21.6 9.7 184 Nankana Sahib 28.2 4.2 31.4 8.1 2.9 11.0 39.1 4.5 15.2 16.5 4.4 75 Sheikhupura 35.5 2.6 37.1 13.0 8.4 20.7 48.2 4.5 34.2 35.9 13.8 201 Multan 53.9 5.7 56.7 16.2 6.7 21.8 61.0 2.3 24.3 25.4 12.4 241 Khanewal 40.3 5.2 42.9 25.0 6.0 31.0 55.9 3.7 11.4 12.2 5.5 118 Lodhran 34.6 6.6 39.3 16.3 0.0 16.3 46.4 0.0 19.8 19.8 13.5 69 Vehari 28.9 10.7 35.2 7.7 3.8 11.0 40.5 0.0 5.3 5.3 2.6 112 Sahiwal 17.1 4.5 19.9 4.6 4.1 8.6 27.3 0.0 4.7 4.7 0.7 122 Pakpattan 14.6 1.3 15.0 0.4 4.6 5.0 19.1 0.0 3.7 3.7 0.5 102 Okara 19.6 5.3 21.9 4.7 7.4 11.8 27.0 0.5 6.8 7.3 2.9 192 P a g e | 249 Table D.CH.7: Oral rehydration solutions, recommended homemade fluids, and zinc Percentage of children age 0-59 months with diarrhoea in the last two weeks, and treatment with oral rehydration salts (ORS), recommended homemade fluids, and zinc, MICS Punjab, 2014. Percentage of children with diarrhoea who received: Number of children age 0- 59 months with diarrhoea in the last two weeks Oral rehydration salts (ORS) Recommended homemade fluids ORS or any recommended homemade fluid Zinc ORS and zinc1 Fluid from packet Pre- packaged fluid Any ORS Homemade fluid (Boiled water, sugar & salt) Other Any recommended homemade fluid Tablet Syrup Any zinc Rawalpindi 48.9 15.0 56.2 32.9 25.4 51.8 74.1 2.9 25.0 25.8 19.1 188 Attock 42.2 13.0 49.2 15.2 19.5 34.7 62.2 1.7 22.8 22.8 14.7 45 Chakwal 48.2 9.2 52.5 22.6 15.6 38.2 57.5 0.0 17.3 17.3 13.0 23 Jhelum 36.2 7.0 40.9 4.6 20.6 25.3 53.4 5.1 17.4 17.4 6.6 29 Sargodha 27.0 10.6 33.4 7.9 5.5 13.3 42.1 3.5 7.8 10.8 5.2 167 Bhakkar 26.7 2.9 29.7 6.5 8.4 12.7 37.1 4.0 8.3 12.3 3.8 72 Khushab 21.4 1.7 21.4 8.8 8.2 17.0 37.5 1.8 6.9 6.9 0.0 39 Mianwali 21.1 1.6 22.7 5.1 4.5 9.6 30.1 0.0 1.9 1.9 1.9 82 Punjab 33.6 5.8 37.2 11.4 6.5 17.3 45.2 3.8 17.8 19.1 9.7 4,784 1 MICS indicator 3.11 - Diarrhoea treatment with oral rehydration salts (ORS) and zinc P a g e | 250 Table D.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, Punjab, 2014. Children with diarrhoea who were given: Not given any treatment or drug Number of children age 0-59 months with diarrhoea in the last two weeks Zinc ORS or increased fluids ORT (ORS or recommended homemade fluids or increased fluids) ORT with continued feeding1 Other treatments Pill or syrup Injection Intra- venous Home remedy, herbal medicine Other Anti- biotic Anti- motility Other Unknown Anti- biotic Non- antibiotic Unknown Punjab 19.1 42.1 46.7 38.9 4.0 14.5 0.5 21.7 1.6 0.2 4.3 1.5 2.7 6.7 17.7 4,784 District Bahawalpur 20.4 41.3 48.7 36.4 5.7 6.7 0.0 15.0 1.7 0.0 1.5 1.4 5.0 4.1 29.2 138 Bahawalnagar 43.7 53.9 61.0 52.5 5.5 12.5 0.0 11.8 3.4 0.0 3.9 0.0 8.5 7.3 11.9 87 RY Khan 33.0 56.3 62.7 56.2 13.6 22.8 0.0 17.4 3.2 1.0 15.2 3.7 4.3 5.3 9.3 161 DG Khan 21.0 42.1 47.4 43.1 3.0 26.5 1.5 7.3 2.3 0.0 7.8 0.0 1.0 4.4 23.6 183 Layyah 26.2 21.6 25.4 22.1 7.4 13.3 0.0 12.1 1.9 0.0 5.3 1.1 9.4 14.0 15.8 70 Muzaffargarh 16.4 22.8 26.6 23.6 1.8 18.6 0.0 14.7 2.2 0.0 5.8 1.3 5.9 6.6 28.0 210 Rajanpur 18.6 37.9 41.2 34.9 3.3 19.4 0.0 13.5 1.8 0.0 5.3 2.2 4.1 7.4 20.7 142 Faisalabad 38.4 45.5 50.4 42.3 0.0 8.7 0.0 20.5 1.2 0.0 2.5 1.5 1.7 4.0 10.2 288 Chiniot 28.8 29.5 33.5 29.8 0.0 10.8 1.8 24.4 0.0 0.0 0.0 1.5 0.7 0.8 24.6 52 Jhang 16.3 52.5 59.5 52.5 3.4 4.7 1.3 15.9 4.1 0.0 1.4 1.5 10.7 4.8 17.5 81 TT Singh 39.5 56.0 63.5 61.7 1.4 10.9 0.0 19.1 0.0 0.0 3.1 2.6 8.6 1.8 5.9 80 Gujranwala 11.2 32.0 38.9 33.7 4.4 7.5 0.2 15.9 0.4 0.0 1.1 0.2 0.8 10.1 27.8 270 Gujrat 9.5 28.2 32.6 30.9 5.8 13.3 2.8 24.2 1.8 0.0 1.6 0.8 2.7 18.1 19.4 112 Hafizabad 19.9 44.1 46.9 40.0 6.7 14.3 0.0 35.9 6.7 3.2 2.7 2.0 1.7 1.1 7.2 73 Mandi Bahauddin 7.0 44.2 50.2 44.2 3.9 5.6 0.0 34.0 2.7 0.0 0.6 0.0 0.0 9.9 16.2 46 Narowal 7.0 30.8 36.2 31.8 1.8 20.8 0.0 42.3 3.3 0.0 3.8 6.4 2.5 11.1 10.9 85 Sialkot 11.1 41.8 44.3 33.4 4.2 41.1 0.4 21.3 0.9 0.0 8.1 3.8 1.7 7.1 10.1 190 Lahore 17.2 52.6 55.0 43.7 5.4 8.2 0.3 26.3 2.2 0.0 1.7 0.4 0.6 4.0 15.4 458 Kasur 21.6 40.2 43.0 39.6 4.9 13.3 0.4 21.7 3.8 0.4 3.5 1.0 2.4 6.4 19.1 184 Nankana Sahib 16.5 33.1 38.7 34.4 8.2 9.3 0.7 25.1 1.1 0.0 3.5 1.3 0.0 2.3 24.2 75 Sheikhupura 35.9 41.3 46.9 41.0 4.7 16.3 2.6 16.9 2.7 0.0 3.2 2.2 2.6 0.9 19.2 201 Multan 25.4 59.1 62.1 45.4 1.8 14.6 1.1 15.8 0.0 0.3 0.7 1.1 2.8 6.5 12.8 241 Khanewal 12.2 42.9 52.5 37.5 5.4 25.3 0.8 29.6 0.0 0.0 3.8 0.5 2.1 4.4 10.8 118 Lodhran 19.8 44.4 50.3 45.3 5.1 30.4 1.9 31.1 1.8 0.0 5.2 1.6 1.1 1.5 8.9 69 Vehari 5.3 38.6 42.3 28.8 2.6 23.5 0.0 46.0 0.0 0.0 8.7 0.4 4.0 1.6 17.7 112 Sahiwal 4.7 36.1 39.3 31.4 5.1 2.3 0.5 41.7 0.7 0.0 16.4 3.0 0.0 15.6 20.2 122 Pakpattan 3.7 35.6 35.6 29.8 3.5 4.1 0.0 40.8 0.8 0.0 11.1 3.6 0.4 21.3 15.0 102 Okara 7.3 32.3 33.3 28.5 3.8 4.8 0.0 41.6 0.5 0.0 11.0 2.0 0.7 4.5 22.7 192 P a g e | 251 Table D.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, Punjab, 2014. Children with diarrhoea who were given: Not given any treatment or drug Number of children age 0-59 months with diarrhoea in the last two weeks Zinc ORS or increased fluids ORT (ORS or recommended homemade fluids or increased fluids) ORT with continued feeding1 Other treatments Pill or syrup Injection Intra- venous Home remedy, herbal medicine Other Anti- biotic Anti- motility Other Unknown Anti- biotic Non- antibiotic Unknown Rawalpindi 25.8 60.9 69.9 57.5 2.2 9.2 0.3 2.6 2.9 0.0 0.0 1.6 1.5 6.7 16.4 188 Attock 22.8 55.5 59.4 45.9 5.2 9.0 0.0 2.4 1.3 4.4 0.9 1.6 0.0 7.2 19.5 45 Chakwal 17.3 56.1 56.1 48.8 0.0 28.3 0.0 1.1 (3.6) (0.0) (1.3) (0.0) (0.0) (10.3) (20.4) 23 Jhelum 17.4 40.9 43.2 36.4 4.8 18.5 0.0 13.3 (0.0) (0.0) (0.0) (0.0) (0.0) (17.2) (21.2) 29 Sargodha 10.8 39.5 45.7 37.6 1.7 15.1 0.8 20.5 0.7 0.6 1.2 2.0 4.8 6.3 18.4 167 Bhakkar 12.3 33.8 34.5 28.5 3.0 13.8 0.0 17.2 0.0 0.0 0.0 1.5 2.3 6.0 32.2 72 Khushab 6.9 28.7 36.8 31.9 1.5 19.3 1.5 24.6 0.0 2.1 1.0 0.0 10.3 1.3 23.2 39 Mianwali 1.9 24.9 28.0 23.2 3.6 21.9 0.0 23.4 0.0 0.0 2.9 3.3 4.0 24.3 15.5 82 Punjab 19.1 42.1 46.7 38.9 4.0 14.5 0.5 21.7 1.6 0.2 4.3 1.5 2.7 6.7 17.7 4,784 1 MICS indicator 3.12 - Diarrhoea treatment with oral rehydration therapy (ORT) and continued feeding ( ) Figures that are based on 25-49 unweighted cases P a g e | 252 Table D.CH.11: Knowledge of the two danger signs of pneumonia Percentage of women age 15-49 years who are mothers or caretakers of children under age 5 by symptoms that would cause them to take a child under age 5 immediately to a health facility, and percentage of mothers who recognize fast or difficult breathing as signs for seeking care immediately, Punjab, 2014. Percentage of mothers/caretakers who think that a child should be taken immediately to a health facility if the child: Mothers/caretakers who recognize at least one of the two danger signs of pneumonia (fast and/or difficult breathing) Number of mothers / caretakers of children age 0-59 months Is not able to drink or breastfeed Becomes sicker Develops a fever Has fast breathing Has difficult breathing Has blood in stool Is drinking poorly Suffered from lose motion Has other symptoms Punjab 10.7 58.8 81.4 14.6 14.8 11.1 12.6 58.5 26.3 24.8 18,096 District Bahawalpur 17.4 50.8 72.1 15.4 20.9 15.2 18.8 57.1 13.9 33.8 610 Bahawalnagar 17.8 49.6 67.8 17.3 25.3 16.9 17.3 50.3 2.3 38.7 476 RY Khan 21.4 37.5 67.8 17.7 22.5 17.3 18.4 54.5 0.7 37.9 852 DG Khan 29.9 74.1 87.2 30.9 30.6 29.9 24.4 63.0 17.9 42.4 608 Layyah 35.1 76.0 91.7 38.0 36.1 29.8 33.5 60.6 22.6 49.9 319 Muzaffargarh 35.9 70.7 91.0 36.8 40.6 29.7 31.3 64.1 21.4 52.8 724 Rajanpur 31.8 73.9 86.3 40.0 35.2 26.3 26.6 60.6 27.6 49.5 372 Faisalabad 6.0 58.9 88.3 13.0 12.8 5.7 13.6 58.4 34.8 23.7 1,151 Chiniot 4.1 66.7 85.4 22.2 13.4 5.9 7.6 57.2 38.1 31.5 206 Jhang 27.4 77.5 74.6 17.9 11.1 18.1 28.3 61.1 22.3 26.8 391 TT Singh 16.6 65.8 80.1 16.6 12.0 13.9 22.6 51.0 27.1 28.0 316 Gujranwala 3.1 58.5 73.8 6.9 7.7 2.5 9.6 58.0 22.4 14.3 781 Gujrat 2.6 62.4 83.3 4.4 8.8 3.2 6.4 50.9 28.1 12.0 488 Hafizabad 5.3 53.5 83.8 6.5 14.0 4.5 11.9 53.8 31.1 20.1 205 Mandi Bahauddin 4.4 49.7 90.8 9.1 8.3 2.9 9.1 53.0 41.2 17.2 280 Narowal 7.6 60.3 77.9 13.0 12.0 14.7 8.6 61.9 19.6 18.8 325 Sialkot 7.6 59.3 73.5 11.4 11.4 8.4 5.0 61.4 18.5 18.7 593 Lahore 3.4 54.0 84.2 11.4 9.6 5.0 6.9 63.5 39.6 18.6 1,781 Kasur 4.4 60.4 92.8 9.1 9.1 2.0 10.8 70.4 32.5 16.8 579 Nankana Sahib 9.0 52.5 85.5 8.9 11.0 3.2 10.9 52.6 30.5 18.5 291 Sheikhupura 7.5 51.8 75.7 15.1 11.4 7.5 8.6 53.5 23.4 23.8 604 Multan 6.0 76.5 84.5 14.0 14.6 14.7 9.5 75.2 14.3 25.0 787 Khanewal 4.5 80.9 86.8 11.6 10.0 11.3 12.6 67.4 21.0 19.2 463 Lodhran 15.2 58.6 77.3 18.6 16.2 12.0 18.2 61.3 18.8 31.6 293 Vehari 6.3 74.3 91.6 6.7 10.3 7.6 12.0 66.0 36.0 15.6 416 P a g e | 253 Table D.CH.11: Knowledge of the two danger signs of pneumonia Percentage of women age 15-49 years who are mothers or caretakers of children under age 5 by symptoms that would cause them to take a child under age 5 immediately to a health facility, and percentage of mothers who recognize fast or difficult breathing as signs for seeking care immediately, Punjab, 2014. Percentage of mothers/caretakers who think that a child should be taken immediately to a health facility if the child: Mothers/caretakers who recognize at least one of the two danger signs of pneumonia (fast and/or difficult breathing) Number of mothers / caretakers of children age 0-59 months Is not able to drink or breastfeed Becomes sicker Develops a fever Has fast breathing Has difficult breathing Has blood in stool Is drinking poorly Suffered from lose motion Has other symptoms Sahiwal 2.2 37.6 82.2 9.8 10.7 12.6 10.1 54.0 39.2 19.1 401 Pakpattan 3.2 51.0 77.1 7.9 7.7 10.0 6.9 55.3 35.5 14.1 340 Okara 2.5 46.9 79.3 16.5 16.1 20.4 7.1 61.1 25.6 28.9 551 Rawalpindi 6.8 59.9 72.0 13.5 7.7 5.8 3.6 41.1 21.5 19.9 838 Attock 8.8 70.7 72.1 10.8 7.3 5.5 8.7 34.5 18.8 14.5 309 Chakwal 10.8 69.0 70.8 10.4 11.4 3.9 8.6 27.5 17.2 18.8 221 Jhelum 12.1 69.0 74.2 3.9 4.9 1.6 6.0 33.8 23.6 7.8 168 Sargodha 5.7 41.7 85.5 10.0 11.3 9.4 6.1 64.7 39.2 19.5 567 Bhakkar 4.7 41.8 91.3 5.0 9.6 6.0 7.3 62.5 50.4 13.3 268 Khushab 3.0 44.1 87.9 4.8 8.0 3.7 3.7 62.4 52.1 11.6 215 Mianwali 1.3 51.1 93.4 3.9 7.8 2.9 7.3 65.2 49.5 10.9 305 Punjab 10.7 58.8 81.4 14.6 14.8 11.1 12.6 58.5 26.3 24.8 18,096 P a g e | 254 Table D.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, Punjab, 2014. Percentage of household members in households using: Number of household members Electricity Liquefied Petroleum Gas (LPG) Natural Gas Biogas Kerosene Solid fuels Other / Missing No food cooked in the household Total Solid fuels for cooking1 Coal/ Lignite Char- coal Wood Straw/ Shrubs/ Grass Animal dung Agricultural crop residue Punjab 0.0 3.6 34.9 0.2 0.0 0.1 0.3 33.2 1.5 15.0 11.1 0.2 0.1 100.0 61.1 246,396 District Bahawalpur 0.1 2.4 19.4 0.5 0.0 0.0 0.3 57.8 1.5 4.7 13.3 0.0 0.0 100.0 77.6 8,013 Bahawalnagar 0.1 6.1 1.9 0.0 0.0 0.0 0.0 23.9 1.6 11.7 54.5 0.1 0.2 100.0 91.7 6,704 RY Khan 0.0 1.1 20.6 0.0 0.0 0.2 0.0 11.7 3.6 12.9 49.7 0.0 0.1 100.0 78.1 11,240 DG Khan 0.0 1.3 13.2 0.1 0.0 0.0 1.2 60.4 5.1 12.8 5.9 0.0 0.0 100.0 85.4 6,498 Layyah 0.0 3.7 1.7 0.0 0.0 0.0 0.4 71.0 2.7 8.6 11.8 0.0 0.0 100.0 94.6 3,927 Muzaffargarh 0.0 2.2 6.1 0.0 0.0 0.0 0.3 68.5 1.0 10.2 11.6 0.0 0.0 100.0 91.6 8,664 Rajanpur 0.0 2.8 0.0 0.0 0.0 0.0 0.2 65.6 7.4 4.1 19.9 0.0 0.0 100.0 97.2 4,329 Faisalabad 0.0 3.8 52.9 0.1 0.0 0.1 0.3 23.9 3.7 13.9 0.5 0.6 0.2 100.0 42.4 17,101 Chiniot 0.0 1.4 21.0 0.4 0.0 0.0 0.0 30.5 11.5 25.6 9.4 0.0 0.2 100.0 77.1 3,198 Jhang 0.0 1.8 11.9 0.2 0.0 0.0 1.3 72.8 3.5 8.4 0.0 0.0 0.0 100.0 86.1 5,787 TT Singh 0.0 4.3 25.9 0.4 0.0 0.0 0.0 51.1 4.5 6.8 6.8 0.1 0.1 100.0 69.2 4,885 Gujranwala 0.0 3.2 62.9 0.5 0.0 0.3 0.2 9.8 0.0 22.7 0.0 0.2 0.1 100.0 33.0 10,545 Gujrat 0.0 14.3 40.8 0.1 0.0 0.0 0.4 30.2 0.3 13.9 0.0 0.0 0.1 100.0 44.7 6,553 Hafizabad 0.0 1.3 50.4 0.0 0.0 0.0 0.5 24.4 0.7 22.0 0.0 0.6 0.1 100.0 47.6 2,855 Mandi Bahauddin 0.0 6.2 17.2 0.1 0.0 0.0 0.3 60.1 0.4 15.5 0.0 0.2 0.1 100.0 76.3 3,748 Narowal 0.0 7.4 0.7 0.1 0.0 0.0 0.0 13.6 1.3 75.9 0.4 0.6 0.0 100.0 91.3 4,028 Sialkot 0.0 3.8 48.3 0.5 0.0 0.6 0.1 5.6 0.0 40.6 0.1 0.3 0.1 100.0 47.0 8,584 Lahore 0.1 3.0 88.2 0.1 0.0 0.0 0.2 4.1 0.0 4.3 0.0 0.0 0.0 100.0 8.6 23,671 Kasur 0.0 4.7 19.9 0.0 0.0 0.0 0.1 34.5 0.6 38.5 1.1 0.5 0.1 100.0 74.8 7,752 Nankana Sahib 0.0 2.1 29.2 0.1 0.0 0.0 0.5 34.8 0.2 32.2 0.0 0.8 0.0 100.0 67.7 3,811 Sheikhupura 0.1 2.6 46.4 0.1 0.0 0.0 0.6 21.8 0.5 27.7 0.0 0.2 0.1 100.0 50.6 8,613 Multan 0.1 2.6 43.1 0.4 0.0 0.0 0.1 33.5 0.7 3.9 15.5 0.0 0.1 100.0 53.7 10,610 Khanewal 0.0 2.1 25.4 0.0 0.0 0.0 0.0 18.9 1.4 3.3 48.7 0.0 0.1 100.0 72.3 6,794 Lodhran 0.0 1.7 13.0 0.1 0.0 0.0 0.0 10.7 1.2 2.6 70.7 0.0 0.0 100.0 85.2 3,976 Vehari 0.0 4.6 9.1 0.1 0.0 0.0 0.0 18.1 1.6 9.0 57.4 0.0 0.1 100.0 86.1 6,409 Sahiwal 0.0 2.9 17.6 0.3 0.0 0.0 0.0 43.8 0.6 19.9 14.9 0.0 0.1 100.0 79.2 5,531 Pakpattan 0.0 3.1 6.5 0.2 0.0 0.0 0.0 37.2 0.7 40.8 11.2 0.1 0.1 100.0 90.0 4,520 Okara 0.1 2.0 30.5 0.0 0.0 0.1 0.5 24.8 1.0 31.3 9.0 0.7 0.1 100.0 66.6 7,204 P a g e | 255 Table D.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, Punjab, 2014. Percentage of household members in households using: Number of household members Electricity Liquefied Petroleum Gas (LPG) Natural Gas Biogas Kerosene Solid fuels Other / Missing No food cooked in the household Total Solid fuels for cooking1 Coal/ Lignite Char- coal Wood Straw/ Shrubs/ Grass Animal dung Agricultural crop residue Rawalpindi 0.0 5.2 70.0 0.1 0.0 0.0 0.1 23.4 0.1 1.0 0.0 0.0 0.0 100.0 24.7 11,568 Attock 0.0 1.2 48.4 0.1 0.0 0.0 0.2 48.0 0.3 1.5 0.1 0.1 0.0 100.0 50.2 4,214 Chakwal 0.0 8.7 21.1 0.3 0.0 0.0 0.3 66.5 0.1 3.0 0.0 0.0 0.0 100.0 69.9 3,285 Jhelum 0.0 18.4 18.7 0.1 0.1 0.0 0.5 56.8 0.8 4.2 0.3 0.1 0.1 100.0 62.5 2,700 Sargodha 0.0 1.5 34.9 0.2 0.0 0.0 0.6 54.1 0.2 8.4 0.0 0.0 0.1 100.0 63.2 8,167 Bhakkar 0.0 1.7 1.7 0.0 0.0 0.0 0.4 77.3 0.5 17.9 0.4 0.0 0.1 100.0 96.5 3,807 Khushab 0.0 5.2 11.1 0.2 0.0 0.0 0.6 68.6 0.1 14.3 0.0 0.0 0.0 100.0 83.6 3,104 Mianwali 0.0 1.0 8.4 0.0 0.0 0.0 0.2 72.1 0.5 17.2 0.5 0.0 0.1 100.0 90.5 4,004 Punjab 0.0 3.6 34.9 0.2 0.0 0.1 0.3 33.2 1.5 15.0 11.1 0.2 0.1 100.0 61.1 246,396 1 MICS indicator 3.15 - Use of solid fuels for cooking P a g e | 256 Table D.CH.13: Solid fuel use by place of cooking Percent distribution of household members in households using solid fuels by place of cooking, Punjab, 2014. Place of cooking: Number of household members in households using solid fuels for cooking In the house In a separate building Outdoors Other place Missing Total In a separate room used as kitchen Elsewhere in the house Punjab 17.4 81.8 0.4 0.1 0.1 0.3 100.0 150,517 District Bahawalpur 13.3 86.2 0.2 0.0 0.0 0.4 100.0 6,217 Bahawalnagar 6.5 93.1 0.3 0.1 0.0 0.0 100.0 6,148 RY Khan 6.6 93.0 0.2 0.0 0.0 0.1 100.0 8,783 DG Khan 18.7 79.4 0.8 0.1 0.5 0.6 100.0 5,550 Layyah 18.7 81.1 0.2 0.0 0.0 0.0 100.0 3,714 Muzaffargarh 16.6 82.9 0.3 0.0 0.1 0.1 100.0 7,933 Rajanpur 15.3 84.6 0.1 0.0 0.0 0.0 100.0 4,206 Faisalabad 14.7 84.2 0.2 0.0 0.0 0.9 100.0 7,248 Chiniot 11.8 87.3 0.2 0.2 0.0 0.5 100.0 2,464 Jhang 10.4 89.1 0.2 0.0 0.0 0.3 100.0 4,982 TT Singh 11.2 88.5 0.0 0.1 0.1 0.0 100.0 3,380 Gujranwala 21.7 77.1 0.1 0.3 0.0 0.9 100.0 3,485 Gujrat 29.8 69.5 0.2 0.1 0.0 0.3 100.0 2,928 Hafizabad 14.5 84.4 0.6 0.3 0.2 0.0 100.0 1,359 Mandi Bahauddin 24.0 75.3 0.1 0.2 0.0 0.4 100.0 2,860 Narowal 24.9 75.0 0.0 0.0 0.0 0.0 100.0 3,676 Sialkot 27.0 72.2 0.0 0.3 0.1 0.4 100.0 4,033 Lahore 9.4 88.4 1.2 0.9 0.0 0.0 100.0 2,036 Kasur 5.3 94.1 0.4 0.1 0.0 0.2 100.0 5,798 Nankana Sahib 8.8 89.8 1.3 0.1 0.0 0.1 100.0 2,581 Sheikhupura 16.2 82.9 0.5 0.0 0.0 0.4 100.0 4,358 Multan 12.9 83.8 2.2 0.2 0.0 1.0 100.0 5,701 Khanewal 15.4 84.0 0.5 0.1 0.0 0.1 100.0 4,913 Lodhran 9.4 90.6 0.0 0.0 0.0 0.0 100.0 3,390 Vehari 11.8 87.7 0.3 0.0 0.0 0.1 100.0 5,518 Sahiwal 12.5 86.7 0.6 0.0 0.0 0.2 100.0 4,378 Pakpattan 4.9 95.0 0.1 0.0 0.0 0.0 100.0 4,066 Okara 6.2 93.5 0.3 0.0 0.0 0.0 100.0 4,801 Rawalpindi 61.0 36.5 0.0 0.1 1.1 1.2 100.0 2,859 Attock 49.7 48.9 0.5 0.3 0.6 0.0 100.0 2,114 Chakwal 59.2 40.3 0.0 0.0 0.1 0.3 100.0 2,297 Jhelum 49.7 50.3 0.0 0.1 0.0 0.0 100.0 1,689 Sargodha 35.6 63.9 0.5 0.0 0.0 0.0 100.0 5,161 Bhakkar 21.0 78.8 0.2 0.0 0.0 0.0 100.0 3,672 Khushab 31.3 68.4 0.3 0.0 0.0 0.0 100.0 2,595 Mianwali 17.4 82.2 0.3 0.0 0.0 0.0 100.0 3,626 P a g e | 257 Table D.CH.14: Care-seeking during fever Percentage of children age 0-59 months with fever in the last two weeks for whom advice or treatment was sought, by source of advice or treatment, Punjab, 2014. Percentage of children for whom: Number of children with fever in last two weeks Advice or treatment was sought from: No advice or treatment sought Health facilities or providers Other source A health facility or provider1, b Public Private Community health providera Punjab 9.7 68.3 0.4 8.5 79.3 14.6 5,714 District Bahawalpur 10.0 68.1 0.8 5.0 80.2 18.0 140 Bahawalnagar 9.5 73.0 1.5 5.4 85.3 12.1 115 RY Khan 4.1 79.7 0.7 7.7 87.6 9.4 201 DG Khan 10.5 57.7 0.3 14.5 68.3 19.4 198 Layyah 6.8 56.0 0.0 15.0 63.6 22.5 104 Muzaffargarh 12.9 48.6 0.0 17.0 61.7 22.7 288 Rajanpur 7.8 50.9 0.0 18.8 62.3 23.0 166 Faisalabad 9.2 75.8 0.0 7.5 85.9 8.1 384 Chiniot 4.7 78.2 0.0 5.9 82.9 11.2 83 Jhang 7.9 59.8 0.0 25.1 69.3 8.8 76 TT Singh 8.3 67.8 0.0 9.1 78.7 14.9 100 Gujranwala 6.5 72.8 0.0 4.8 82.3 15.9 304 Gujrat 7.4 81.9 0.5 1.4 89.3 9.3 156 Hafizabad 8.3 67.1 0.0 14.0 76.9 10.7 98 Mandi Bahauddin 9.4 68.5 0.0 13.8 80.5 9.7 130 Narowal 4.7 76.6 0.6 13.6 81.8 11.3 101 Sialkot 3.5 78.9 0.0 5.5 82.5 12.9 183 Lahore 12.4 65.6 1.4 6.6 79.1 16.8 506 Kasur 11.7 63.8 0.6 8.2 78.0 18.2 221 Nankana Sahib 7.6 66.9 0.0 15.9 83.7 9.6 98 Sheikhupura 11.7 66.0 0.0 15.3 79.5 10.9 210 Multan 18.0 63.6 1.5 5.9 79.1 16.6 217 Khanewal 2.2 79.9 0.0 9.2 84.2 10.3 131 Lodhran 17.9 66.5 1.1 2.0 85.4 13.6 69 Vehari 19.0 65.7 0.0 2.1 84.8 13.6 123 Sahiwal 10.5 74.6 0.0 4.0 87.0 11.5 163 Pakpattan 2.8 77.5 0.0 5.0 83.3 14.7 137 Okara 6.4 81.9 0.0 3.5 88.6 8.6 195 Rawalpindi 12.4 61.7 0.0 1.3 73.0 25.3 206 Attock 22.1 53.7 1.0 4.9 79.5 20.5 68 Chakwal 11.5 66.5 0.0 3.5 78.0 18.5 34 Jhelum 17.5 62.6 1.6 1.5 77.4 22.6 41 Sargodha 7.2 71.9 0.0 6.2 79.1 14.9 178 Bhakkar 10.3 63.5 0.4 15.1 74.2 11.1 98 Khushab 5.7 64.7 1.5 18.3 70.5 12.7 62 Mianwali 13.3 72.7 0.2 4.0 85.9 10.0 128 1 MICS indicator 3.20 - Care-seeking for fever a Community health providers include both public (Lady / health worker and Mobile/Outreach clinic) and private (Mobile clinic) health facilities b Includes all public and private health facilities and providers as well as shops P a g e | 258 Table D.CH.15: Treatment of children with fever Percentage of children age 0-59 months who had a fever in the last two weeks, by type of medicine given for the illness, Punjab, 2014. Children with a fever in the last two weeks who were given: Number of children with fever in last two weeks Anti-malarials Other medications O th e r M is s in g /D K S P / F a n s id a r C h lo ro q u in e A m o d ia -q u in e Q u in in e A rt e m is in in -b a s e d C o m b in a ti o n T h e ra p y ( A C T ) O th e r a n ti -m a la ri a l A n ti b io ti c p ill o r s y ru p A n ti b io ti c i n je c ti o n P a ra c e ta m o l/ P a n a d o l/ A c e ta m in o p h e n A s p ir in Ib u p ro fe n Punjab 0.3 0.4 0.1 0.1 0.1 0.4 28.3 11.6 35.6 1.6 24.0 12.9 6.2 5,714 District Bahawalpur 0.7 0.7 0.2 0.0 0.0 0.0 19.5 6.0 27.2 0.8 28.7 5.0 13. 7 140 Bahawalnagar 0.0 1.4 1.0 0.0 0.0 0.0 21.7 6.2 28.6 1.0 38.4 6.7 6.9 115 RY Khan 0.5 0.0 0.8 0.0 0.0 0.5 19.8 22.2 33.6 5.4 44.2 14.9 1.2 201 DG Khan 0.5 0.7 0.4 0.0 0.9 0.2 19.9 14.9 31.5 1.1 21.2 8.4 10. 1 198 Layyah 1.3 0.0 0.0 0.0 0.0 0.0 24.0 20.8 51.6 7.3 24.8 10.1 0.3 104 Muzaffargarh 0.3 0.8 0.4 0.0 0.0 0.3 18.1 9.0 39.8 2.8 27.4 13.8 4.1 288 Rajanpur 0.0 0.0 0.0 0.0 0.0 0.0 28.1 18.4 41.1 5.9 42.8 6.6 2.0 166 Faisalabad 0.0 0.0 0.0 0.0 0.4 0.0 29.6 12.7 42.2 2.7 15.8 11.8 4.2 384 Chiniot 1.0 0.0 0.0 2.0 0.0 0.0 32.9 8.4 39.8 2.0 21.9 12.5 5.8 83 Jhang 0.4 0.0 0.0 0.0 0.0 0.0 41.3 8.2 17.6 0.0 27.2 5.7 14. 6 76 TT Singh 0.0 0.7 0.0 0.0 0.0 0.0 35.7 18.7 35.9 0.0 29.4 4.7 3.0 100 Gujranwala 0.9 0.0 0.0 0.0 0.0 0.9 32.2 5.3 32.3 0.0 14.9 14.9 5.0 304 Gujrat 0.0 0.9 0.0 0.0 0.0 0.0 29.2 6.6 43.3 3.0 19.4 12.5 5.4 156 Hafizabad 0.0 0.0 0.0 0.0 0.0 0.8 16.7 4.6 41.1 0.0 22.0 10.0 14. 4 98 Mandi Bahauddin 2.4 0.2 0.0 0.0 0.0 0.0 12.5 2.4 32.9 1.2 24.6 13.6 18. 4 130 Narowal 0.0 0.0 0.0 0.0 1.1 1.6 40.4 8.5 31.3 0.0 9.3 18.8 5.2 101 Sialkot 0.0 0.0 0.0 0.0 0.6 0.1 38.4 10.1 24.8 1.3 23.6 16.0 2.7 183 Lahore 0.0 1.6 0.0 0.0 0.0 0.3 36.6 8.0 35.4 0.2 23.2 13.3 4.5 506 Kasur 0.0 0.4 0.0 0.0 0.7 0.0 22.2 11.3 34.3 0.0 15.3 14.4 10. 8 221 Nankana Sahib 0.0 0.0 0.0 0.0 0.0 1.1 27.7 7.7 34.3 1.0 13.8 9.0 19. 7 98 Sheikhupura 0.0 0.0 0.0 0.0 0.0 0.7 30.9 8.5 31.2 0.5 20.2 9.8 15. 6 210 Multan 0.0 1.5 0.0 0.2 0.0 0.0 39.2 20.9 25.2 3.9 29.1 8.5 3.4 217 Khanewal 0.4 0.4 0.0 0.6 0.0 0.0 53.0 28.0 26.5 3.3 29.2 7.4 4.5 131 Lodhran 0.0 0.0 0.0 0.0 0.0 0.9 38.6 28.8 36.5 0.0 31.2 4.2 2.6 69 Vehari 0.6 0.8 0.0 0.0 0.0 0.0 39.9 14.1 38.7 0.7 22.0 7.9 0.0 123 Sahiwal 0.0 0.0 0.0 0.0 0.0 0.0 30.2 20.9 40.7 0.5 28.5 13.7 0.5 163 Pakpattan 0.0 0.0 0.0 0.0 0.0 0.6 34.3 21.0 32.8 0.0 28.8 19.6 2.0 137 Okara 0.0 0.0 0.0 0.0 0.0 0.0 41.7 19.8 19.7 0.3 23.6 10.3 4.9 195 Rawalpindi 0.5 0.0 0.0 0.0 0.0 1.6 20.7 4.2 51.8 1.9 15.5 12.2 4.0 206 Attock 0.7 0.0 0.0 0.0 0.0 0.0 19.8 8.1 64.3 0.9 11.0 16.7 0.0 68 Chakwal 0.0 0.0 0.0 0.0 0.0 0.0 12.6 2.5 59.3 0.0 16.6 23.2 0.0 34 Jhelum 0.0 0.0 0.0 0.0 0.0 0.0 16.1 6.8 51.2 1.8 22.2 26.3 1.5 41 Sargodha 0.2 0.0 0.0 0.0 0.0 1.2 17.6 8.1 31.4 1.5 32.6 20.9 12. 8 178 Bhakkar 0.0 0.0 0.0 0.0 0.0 1.9 7.3 2.1 49.9 1.9 14.1 19.0 13. 0 98 Khushab 0.0 0.0 0.0 0.0 0.0 0.0 26.6 4.4 36.8 3.0 19.9 19.2 6.3 62 Mianwali 0.0 0.0 0.0 0.2 0.0 0.0 8.4 1.3 33.0 0.0 35.0 37.7 5.4 128 P a g e | 259 Table D.CH.16: Diagnostics and anti-malarial treatment of children Percentage of children age 0-59 months who had a fever in the last two weeks who had a finger or heel stick for malaria testing, who were given Artemisinin-combination Treatment (ACT) and any anti-malarial drugs, Punjab, 2014. Percentage of children who: Number of children age 0- 59 months with fever in the last two weeks Had blood taken from a finger or heel for testing1 Were given: Artemisinin- combination Treatment (ACT) ACT the same or next day Any antimalarial drugs2 Any antimalarial drugs same or next day Punjab 4.0 0.1 0.1 1.3 0.8 5,714 District Bahawalpur 4.0 0.0 0.0 1.6 1.4 140 Bahawalnagar 5.8 0.0 0.0 2.4 1.0 115 RY Khan 4.8 0.0 0.0 1.9 1.4 201 DG Khan 4.4 0.9 0.4 2.7 1.5 198 Layyah 1.9 0.0 0.0 1.3 0.6 104 Muzaffargarh 3.8 0.0 0.0 1.7 1.7 288 Rajanpur 4.0 0.0 0.0 0.0 0.0 166 Faisalabad 1.7 0.4 0.0 0.4 0.0 384 Chiniot 5.5 0.0 0.0 3.0 3.0 83 Jhang 2.7 0.0 0.0 0.4 0.4 76 TT Singh 2.2 0.0 0.0 0.7 0.7 100 Gujranwala 3.2 0.0 0.0 1.5 1.3 304 Gujrat 4.9 0.0 0.0 0.9 0.9 156 Hafizabad 4.1 0.0 0.0 0.8 0.0 98 Mandi Bahauddin 2.4 0.0 0.0 2.6 0.4 130 Narowal 2.6 1.1 1.1 2.6 2.1 101 Sialkot 3.9 0.6 0.0 0.7 0.1 183 Lahore 2.9 0.0 0.0 1.9 1.9 506 Kasur 2.4 0.7 0.7 1.2 0.7 221 Nankana Sahib 3.8 0.0 0.0 1.1 1.1 98 Sheikhupura 8.0 0.0 0.0 0.7 0.7 210 Multan 4.0 0.0 0.0 1.8 1.0 217 Khanewal 7.5 0.0 0.0 1.0 0.4 131 Lodhran 0.0 0.0 0.0 0.9 0.9 69 Vehari 0.7 0.0 0.0 1.4 0.0 123 Sahiwal 4.7 0.0 0.0 0.0 0.0 163 Pakpattan 6.6 0.0 0.0 0.6 0.0 137 Okara 9.5 0.0 0.0 0.0 0.0 195 Rawalpindi 3.2 0.0 0.0 2.0 0.9 206 Attock 5.7 0.0 0.0 0.7 0.0 68 Chakwal 2.6 0.0 0.0 0.0 0.0 34 Jhelum 4.3 0.0 0.0 0.0 0.0 41 Sargodha 6.7 0.0 0.0 1.4 0.8 178 Bhakkar 2.9 0.0 0.0 1.9 1.1 98 Khushab 2.1 0.0 0.0 0.0 0.0 62 Mianwali 2.2 0.0 0.0 0.2 0.2 128 1 MICS indicator 3.21 - Malaria diagnostics usage 2 MICS indicator 3.22; MDG indicator 6.8 - Anti-malarial treatment of children under age 5 3 MICS indicator 3.23 - Treatment with Artemisinin-based Combination Therapy (ACT) among children who received anti-malarial treatment (*) Figures that are based on fewer than 25 unweighted cases P a g e | 260 Table D.CH.18: Intermittent preventive treatment for malaria Percentage of women age 15-49 years who had a live birth during the two years preceding the survey and who received intermittent preventive treatment (IPT) for malaria during pregnancy at any antenatal care visit, Punjab, 2014. Percentage of women who received antenatal care (ANC) Number of women with a live birth in the last two years Percentage of pregnant women: Number of women with a live birth in the last two years and who received antenatal care Who took any medicine to prevent malaria at any ANC visit during pregnancy who took SP/Fansidar at least once during an ANC visit and in total took: At least once Two or more times Three or more times1 Four or more times Punjab 78.8 10,653 3.2 1.4 0.8 0.4 0.2 8,392 District Bahawalpur 66.1 342 10.6 5.8 5.8 4.4 4.4 226 Bahawalnagar 64.5 254 7.6 4.0 4.0 4.0 4.0 164 RY Khan 53.6 472 2.3 1.3 1.3 0.0 0.0 253 DG Khan 57.0 361 4.2 1.9 0.4 0.4 0.4 206 Layyah 69.2 182 1.8 1.1 0.6 0.6 0.0 126 Muzaffargarh 66.2 414 6.7 2.7 0.6 0.0 0.0 274 Rajanpur 57.9 223 7.4 2.0 1.3 0.0 0.0 129 Faisalabad 90.4 692 3.0 2.4 1.2 0.8 0.0 626 Chiniot 90.1 123 3.2 1.3 0.0 0.0 0.0 110 Jhang 68.6 237 3.9 1.3 1.2 0.0 0.0 163 TT Singh 83.5 185 4.0 2.6 0.5 0.5 0.5 155 Gujranwala 76.7 481 3.6 0.5 0.2 0.0 0.0 369 Gujrat 91.1 258 1.8 0.0 0.0 0.0 0.0 235 Hafizabad 83.1 129 1.5 0.6 0.6 0.6 0.0 107 Mandi Bahauddin 80.3 173 2.1 0.6 0.0 0.0 0.0 139 Narowal 93.2 200 0.3 0.0 0.0 0.0 0.0 187 Sialkot 97.3 336 0.4 0.0 0.0 0.0 0.0 327 Lahore 87.9 988 1.7 0.6 0.2 0.0 0.0 869 Kasur 66.9 376 1.2 0.0 0.0 0.0 0.0 252 Nankana Sahib 84.6 182 1.1 0.4 0.4 0.0 0.0 154 Sheikhupura 80.6 369 3.8 1.1 0.3 0.3 0.0 297 Multan 79.8 465 4.2 3.2 2.4 0.0 0.0 371 Khanewal 82.4 289 4.1 2.1 1.5 0.0 0.0 239 Lodhran 70.2 176 1.8 1.0 0.7 0.0 0.0 124 Vehari 83.9 232 1.0 0.0 0.0 0.0 0.0 194 Sahiwal 85.7 261 0.7 0.0 0.0 0.0 0.0 224 Pakpattan 83.3 221 1.0 0.0 0.0 0.0 0.0 185 Okara 74.5 344 1.9 0.7 0.4 0.0 0.0 256 Rawalpindi 89.2 496 4.6 3.2 2.2 1.0 0.5 443 Attock 85.2 168 3.7 1.9 0.4 0.4 0.4 143 Chakwal 89.2 120 8.2 2.7 1.0 0.3 0.0 107 Jhelum 88.3 97 5.0 0.8 0.8 0.0 0.0 86 Sargodha 80.6 319 2.0 0.0 0.0 0.0 0.0 257 Bhakkar 76.5 174 1.3 0.0 0.0 0.0 0.0 133 Khushab 84.5 127 5.6 0.5 0.0 0.0 0.0 108 Mianwali 84.7 184 3.4 0.5 0.5 0.5 0.0 156 1 MICS indicator 3.25 - Intermittent preventive treatment for malaria P a g e | 261 Table D.WS.1: Use of improved water sources Percent distribution of household population according to main source of drinking water and percentage of household population using improved drinking water sources, Punjab, 2014. Main source of drinking water Total Percentage using improved sources of drinking water1 Number of household members Improved sources Unimproved sources Piped water T u b e -w e ll/ b o re - h o le H a n d p u m p (t a p ) M o to ri z e d p u m p (d u n k y / t u rb in e ) P ro -t e c te d w e ll P ro -t e c te d s p ri n g R a in -w a te r c o lle c ti o n B o tt le d w a te ra U n p ro -t e c te d w e ll U n p ro -t e c te d s p ri n g T a n k e r tr u c k C a rt w it h s m a ll ta n k / d ru m S u rf a c e w a te r B o tt le d w a te ra O th e r M is s in g In to d w e lli n g In to y a rd /p lo t T o n e ig h - b o u r P u b lic t a p / s ta n d -p ip e Punjab 11.6 1.7 0.9 5.1 0.8 30.6 41.7 0.9 0.3 0.2 0.6 0.2 0.1 0.2 4.1 0.1 0.0 0.7 0.1 100.0 94.4 246,396 District Bahawalpur 7.5 4.4 1.7 11.2 0.2 33.9 36.7 0.5 0.0 0.0 0.2 0.1 0.0 0.0 3.1 0.1 0.1 0.3 0.0 100.0 96.3 8,013 Bahawalnagar 14.5 15.9 1.7 9.9 0.1 37.8 17.6 0.0 0.0 0.0 0.3 0.1 0.0 0.0 2.2 0.0 0.0 0.0 0.1 100.0 97.6 6,704 RY Khan 3.7 1.7 0.2 1.2 0.2 60.6 24.9 0.0 0.0 0.0 0.2 0.0 0.0 0.0 7.1 0.1 0.0 0.0 0.0 100.0 92.7 11,240 DG Khan 4.0 2.4 1.1 8.6 0.7 62.9 8.1 0.0 0.0 2.4 0.0 1.0 1.6 1.1 5.6 0.5 0.1 0.0 0.0 100.0 90.2 6,498 Layyah 0.0 0.1 0.2 0.6 0.4 81.5 16.6 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.4 0.0 0.0 0.0 0.0 100.0 99.4 3,927 Muzaffargarh 0.2 0.0 0.1 1.7 0.1 83.7 12.3 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.8 0.0 0.0 0.0 0.0 100.0 98.2 8,664 Rajanpur 0.1 0.0 0.2 2.1 0.1 80.1 13.0 0.0 0.2 2.3 0.0 0.1 0.0 0.0 0.6 1.3 0.0 0.0 0.0 100.0 98.1 4,329 Faisalabad 10.1 0.5 1.3 6.4 0.1 21.9 28.9 0.0 0.0 0.0 0.6 0.0 0.0 0.2 28.3 0.7 0.1 1.0 0.0 100.0 69.7 17,101 Chiniot 0.9 0.0 0.3 7.0 0.3 45.7 44.3 0.0 0.0 0.0 0.1 0.0 0.0 0.0 1.2 0.0 0.0 0.2 0.0 100.0 98.6 3,198 Jhang 1.0 0.0 0.4 1.1 0.3 54.4 42.0 0.0 0.0 0.0 0.0 0.0 0.0 0.3 0.3 0.0 0.0 0.1 0.0 100.0 99.2 5,787 TT Singh 20.5 1.8 1.3 5.7 0.2 16.9 49.2 0.0 0.0 0.0 0.2 0.0 0.0 0.0 3.8 0.0 0.1 0.3 0.0 100.0 95.8 4,885 Gujranwala 5.9 0.0 0.6 4.8 0.1 14.9 68.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2.8 0.0 0.0 2.9 0.0 100.0 94.2 10,545 Gujrat 11.6 0.0 0.5 2.2 0.4 10.0 74.7 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.5 0.0 0.0 0.0 0.0 100.0 99.5 6,553 Hafizabad 0.6 0.0 0.0 3.5 0.0 53.5 39.4 0.0 0.0 0.0 0.4 0.0 0.0 0.0 2.2 0.0 0.0 0.0 0.4 100.0 97.4 2,855 Mandi Bahauddin 2.6 0.0 0.1 1.6 0.2 62.0 31.5 0.0 0.0 0.0 0.1 0.0 0.0 0.0 1.7 0.0 0.0 0.0 0.1 100.0 98.2 3,748 Narowal 1.5 0.0 0.2 9.3 0.3 21.9 66.8 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 100.0 4,028 Sialkot 7.2 0.2 1.1 4.3 0.0 15.9 58.7 0.0 0.0 0.0 0.3 0.0 0.0 0.0 3.3 0.0 0.1 8.9 0.0 100.0 87.8 8,584 Lahore 52.6 1.1 0.5 10.4 2.1 1.8 26.0 0.0 0.0 0.0 3.9 0.0 0.0 0.0 1.3 0.0 0.0 0.0 0.2 100.0 98.5 23,671 Kasur 17.1 2.4 1.2 3.3 0.3 18.7 55.1 0.0 0.0 0.0 0.1 0.0 0.0 0.0 1.8 0.0 0.0 0.0 0.1 100.0 98.1 7,752 Nankana Sahib 3.7 0.0 0.3 6.7 1.1 31.4 48.1 0.0 0.0 0.0 0.1 0.0 0.0 0.0 8.6 0.0 0.0 0.0 0.0 100.0 91.4 3,811 Sheikhupura 5.6 0.0 0.7 3.2 0.2 19.9 66.5 0.0 0.0 0.0 1.0 0.0 0.0 0.0 2.2 0.0 0.0 0.5 0.1 100.0 97.2 8,613 Multan 6.7 0.8 1.4 7.2 0.1 22.5 58.7 0.0 0.0 0.0 0.2 0.0 0.0 0.1 0.7 0.0 0.0 1.6 0.1 100.0 97.5 10,610 Khanewal 1.2 0.2 0.3 1.3 0.3 29.9 65.8 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.6 0.0 0.1 0.3 0.0 100.0 99.0 6,794 Lodhran 8.6 6.4 0.5 3.0 0.6 18.3 60.4 0.1 0.0 0.0 0.1 0.0 0.0 0.0 1.9 0.0 0.0 0.0 0.0 100.0 98.1 3,976 Vehari 6.7 3.2 0.4 4.2 1.6 14.4 68.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.5 0.0 0.0 0.0 0.0 100.0 98.5 6,409 Sahiwal 2.9 3.4 0.5 0.1 0.5 21.8 67.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 3.7 0.0 0.0 0.0 0.0 100.0 96.3 5,531 Pakpattan 5.6 7.1 0.4 0.3 2.6 10.9 70.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 3.0 0.0 0.0 0.0 0.0 100.0 97.0 4,520 Okara 1.4 3.6 0.8 3.6 3.8 22.0 62.4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2.2 0.0 0.0 0.2 0.0 100.0 97.6 7,204 P a g e | 262 Table D.WS.1: Use of improved water sources Percent distribution of household population according to main source of drinking water and percentage of household population using improved drinking water sources, Punjab, 2014. Main source of drinking water Total Percentage using improved sources of drinking water1 Number of household members Improved sources Unimproved sources Piped water T u b e -w e ll/ b o re - h o le H a n d p u m p ( ta p ) M o to ri z e d p u m p (d u n k y / t u rb in e ) P ro -t e c te d w e ll P ro -t e c te d s p ri n g R a in -w a te r c o lle c ti o n B o tt le d w a te ra U n p ro -t e c te d w e ll U n p ro -t e c te d s p ri n g T a n k e r tr u c k C a rt w it h s m a ll ta n k / d ru m S u rf a c e w a te r B o tt le d w a te ra O th e r M is s in g Rawalpindi 19.3 0.2 3.2 12.2 2.8 3.9 34.4 12.2 5.4 0.0 0.7 0.8 0.7 1.7 0.1 0.2 0.0 1.9 0.3 100.0 94.3 11,568 Attock 16.8 0.0 2.6 2.4 0.5 12.2 45.6 13.5 0.6 0.1 0.0 5.3 0.3 0.1 0.0 0.0 0.0 0.2 0.0 100.0 94.1 4,214 Chakwal 19.7 0.0 2.1 0.5 0.0 6.6 62.9 1.6 0.2 0.0 0.0 2.6 0.2 2.2 0.9 0.0 0.0 0.5 0.0 100.0 93.6 3,285 Jhelum 16.9 0.1 2.7 5.6 0.0 7.8 57.9 5.6 0.6 0.1 0.1 0.8 1.1 0.3 0.2 0.0 0.0 0.1 0.0 100.0 97.5 2,700 Sargodha 2.8 1.1 0.3 3.0 0.0 73.4 11.0 0.0 0.0 0.0 0.3 0.0 0.0 0.0 7.8 0.3 0.0 0.0 0.1 100.0 91.9 8,167 Bhakkar 0.5 0.1 0.0 0.1 0.0 76.8 22.4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 100.0 3,807 Khushab 10.9 6.0 0.9 4.1 1.1 53.1 10.5 0.6 0.0 5.3 0.1 0.2 3.1 0.0 2.9 1.2 0.0 0.0 0.0 100.0 92.6 3,104 Mianwali 7.0 6.1 1.0 1.6 4.8 44.1 30.5 0.4 0.7 0.0 0.0 1.1 0.8 0.0 0.0 0.0 0.0 1.4 0.6 100.0 96.1 4,004 Punjab 11.6 1.7 0.9 5.1 0.8 30.6 41.7 0.9 0.3 0.2 0.6 0.2 0.1 0.2 4.1 0.1 0.0 0.7 0.1 100.0 94.4 246,396 1 MICS indicator 4.1; MDG indicator 7.8 - Use of improved drinking water sources a Households using bottled water as the main source of drinking water are classified into improved or unimproved drinking water users according to the water source used for other purposes such as cooking and handwashing. P a g e | 263 Table D.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, Punjab, 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 method1 Number of household members in households using unimproved drinking water sources N o n e B o il A d d b le a c h / c h lo ri n e S tr a in t h ro u g h a c lo th U s e w a te r fi lt e r S o la r d is -i n fe c ti o n L e t it s ta n d a n d s e tt le O th e r M is s in g /D K Punjab 93.6 4.1 0.0 0.9 1.8 0.0 0.3 0.1 0.0 246,396 2.1 13,808 District Bahawalpur 95.9 1.3 0.1 0.6 0.9 0.1 1.2 0.0 0.0 8,013 0.0 295 Bahawalnagar 96.2 0.1 0.0 0.7 0.1 0.1 2.7 0.0 0.0 6,704 0.0 158 RY Khan 97.6 0.7 0.0 0.7 0.3 0.2 0.5 0.0 0.0 11,240 0.6 818 DG Khan 98.1 1.3 0.0 0.2 0.4 0.0 0.0 0.0 0.0 6,498 3.1 639 Layyah 99.5 0.4 0.0 0.0 0.1 0.0 0.0 0.0 0.0 3,927 0.0 23 Muzaffargarh 98.1 1.4 0.0 0.0 0.5 0.0 0.0 0.0 0.0 8,664 0.0 158 Rajanpur 99.5 0.1 0.0 0.3 0.0 0.0 0.0 0.0 0.0 4,329 0.0 84 Faisalabad 97.0 1.9 0.0 0.3 0.6 0.0 0.1 0.0 0.0 17,101 2.3 5,176 Chiniot 97.1 2.7 0.2 0.0 0.2 0.0 0.0 0.0 0.0 3,198 5.3 45 Jhang 98.5 0.8 0.0 0.0 0.3 0.0 0.3 0.0 0.1 5,787 0.0 46 TT Singh 93.4 2.9 0.1 0.5 3.0 0.0 0.0 0.1 0.1 4,885 2.2 203 Gujranwala 93.8 5.0 0.0 1.1 1.4 0.0 0.0 0.0 0.0 10,545 2.0 611 Gujrat 94.0 3.7 0.0 1.3 1.8 0.0 0.4 0.0 0.0 6,553 0.0 34 Hafizabad 97.2 1.8 0.1 0.0 0.9 0.0 0.0 0.0 0.0 2,855 6.1 73 Mandi Bahauddin 98.5 0.9 0.0 0.0 0.6 0.0 0.0 0.0 0.0 3,748 0.0 68 Narowal 99.3 0.2 0.0 0.0 0.5 0.0 0.0 0.0 0.0 4,028 0.0 0 Sialkot 90.7 6.8 0.0 1.9 2.8 0.0 0.3 0.0 0.0 8,584 1.7 1,051 Lahore 72.0 20.7 0.0 4.5 7.8 0.1 0.3 0.1 0.0 23,671 0.0 366 Kasur 98.0 1.3 0.0 0.2 0.4 0.0 0.1 0.2 0.0 7,752 1.5 144 Nankana Sahib 98.3 0.6 0.0 0.0 1.2 0.0 0.0 0.0 0.0 3,811 2.4 326 Sheikhupura 94.0 4.2 0.1 0.3 1.4 0.0 0.0 0.2 0.0 8,613 1.7 242 Multan 93.7 2.9 0.0 0.1 3.0 0.0 0.3 0.0 0.0 10,610 3.1 261 Khanewal 96.6 1.1 0.0 0.0 1.9 0.0 0.6 0.0 0.0 6,794 7.5 69 Lodhran 96.7 0.9 0.0 0.1 1.7 0.0 0.5 0.0 0.0 3,976 0.0 76 Vehari 97.1 0.9 0.0 0.1 1.5 0.0 0.4 0.0 0.0 6,409 0.0 94 Sahiwal 97.9 0.9 0.0 0.0 1.1 0.0 0.0 0.0 0.0 5,531 1.4 205 Pakpattan 99.3 0.4 0.0 0.0 0.3 0.0 0.0 0.0 0.0 4,520 0.0 137 Okara 94.5 1.1 0.0 0.1 3.8 0.0 0.5 0.0 0.0 7,204 8.5 173 Rawalpindi 85.4 10.8 0.0 1.6 1.9 0.0 0.0 0.8 0.0 11,568 4.1 662 Attock 94.8 3.2 0.0 1.0 1.2 0.0 0.0 0.0 0.0 4,214 0.8 247 Chakwal 96.0 2.8 0.0 0.7 0.2 0.2 0.0 0.0 0.0 3,285 0.0 210 Jhelum 94.3 3.0 0.0 0.4 2.1 0.0 0.3 0.0 0.0 2,700 0.0 67 Sargodha 97.9 1.4 0.0 0.0 0.6 0.0 0.0 0.1 0.0 8,167 3.9 664 Bhakkar 99.3 0.5 0.0 0.0 0.3 0.0 0.0 0.0 0.0 3,807 0.0 0 Khushab 96.6 1.0 0.2 1.7 0.1 0.0 0.9 0.0 0.0 3,104 2.3 228 Mianwali 99.3 0.7 0.0 0.0 0.0 0.0 0.0 0.0 0.0 4,004 0.0 155 1 MICS indicator 4.2 - Water treatment na: not applicable (*) Figures that are based on fewer than 25 unweighted cases P a g e | 264 Table D.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, Punjab, 2014. Time to source of drinking water Users of improved drinking water sources Users of unimproved drinking water sources Total Number of household members Water on premises Less than 30 minutes 30 minutes or more Missing /DK Water on premises Less than 30 minutes 30 minutes or more Missing/ DK Punjab 80.8 8.4 5.2 0.1 1.7 2.1 1.5 0.3 100.0 246,396 District Bahawalpur 84.6 4.9 6.8 0.0 0.1 1.2 2.1 0.3 100.0 8,013 Bahawalnagar 80.6 6.9 10.1 0.0 0.2 0.5 1.5 0.1 100.0 6,704 RY Khan 79.7 6.5 6.5 0.0 0.3 3.7 3.1 0.1 100.0 11,240 DG Khan 75.5 5.4 9.1 0.2 0.6 3.6 5.5 0.2 100.0 6,498 Layyah 98.3 0.7 0.4 0.0 0.2 0.3 0.1 0.0 100.0 3,927 Muzaffargarh 96.2 0.6 1.4 0.0 0.5 0.4 0.9 0.0 100.0 8,664 Rajanpur 84.4 3.4 10.2 0.0 0.0 0.1 1.8 0.0 100.0 4,329 Faisalabad 52.6 8.7 8.4 0.0 16.8 6.8 5.3 1.4 100.0 17,101 Chiniot 93.0 4.9 0.7 0.0 0.6 0.5 0.2 0.0 100.0 3,198 Jhang 94.8 2.6 1.6 0.3 0.0 0.2 0.5 0.1 100.0 5,787 TT Singh 85.4 5.6 4.6 0.2 1.8 1.4 0.9 0.0 100.0 4,885 Gujranwala 81.5 11.1 1.6 0.0 0.2 4.3 1.0 0.2 100.0 10,545 Gujrat 71.7 26.6 1.2 0.0 0.0 0.5 0.0 0.0 100.0 6,553 Hafizabad 85.4 8.5 3.5 0.0 0.5 1.1 0.5 0.4 100.0 2,855 Mandi Bahauddin 79.5 12.8 5.7 0.3 0.6 1.0 0.0 0.1 100.0 3,748 Narowal 74.9 22.5 2.6 0.0 0.0 0.0 0.0 0.0 100.0 4,028 Sialkot 76.1 10.2 1.4 0.0 0.3 10.4 1.5 0.0 100.0 8,584 Lahore 83.0 10.1 5.3 0.1 0.7 0.4 0.2 0.2 100.0 23,671 Kasur 86.9 5.5 5.5 0.2 1.5 0.0 0.2 0.1 100.0 7,752 Nankana Sahib 72.0 12.3 7.1 0.0 2.5 4.2 1.9 0.0 100.0 3,811 Sheikhupura 89.4 4.8 2.7 0.3 0.3 1.5 0.9 0.2 100.0 8,613 Multan 89.3 4.7 3.3 0.2 0.5 1.0 0.9 0.1 100.0 10,610 Khanewal 95.0 3.7 0.3 0.0 0.1 0.6 0.3 0.0 100.0 6,794 Lodhran 89.1 4.7 4.3 0.0 0.0 0.7 1.2 0.0 100.0 3,976 Vehari 87.8 7.5 3.2 0.0 0.1 0.6 0.7 0.0 100.0 6,409 Sahiwal 87.9 5.4 3.0 0.1 0.2 2.0 1.5 0.0 100.0 5,531 Pakpattan 87.7 8.3 1.0 0.0 0.0 1.9 1.0 0.1 100.0 4,520 Okara 80.6 8.7 8.2 0.0 0.0 1.5 0.9 0.0 100.0 7,204 Rawalpindi 62.4 17.7 13.6 0.5 2.0 1.5 1.8 0.4 100.0 11,568 Attock 79.2 9.1 5.8 0.1 2.6 1.3 2.0 0.0 100.0 4,214 Chakwal 83.6 6.8 3.1 0.1 2.4 1.2 2.8 0.0 100.0 3,285 Jhelum 80.8 12.7 4.0 0.1 0.3 0.5 1.7 0.0 100.0 2,700 Sargodha 76.8 9.5 5.5 0.0 0.6 3.8 2.0 1.7 100.0 8,167 Bhakkar 97.9 1.9 0.2 0.0 0.0 0.0 0.0 0.0 100.0 3,807 Khushab 59.4 13.6 19.6 0.0 0.7 2.1 4.6 0.0 100.0 3,104 Mianwali 84.7 6.9 4.5 0.0 0.7 0.9 1.7 0.6 100.0 4,004 P a g e | 265 Table D.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, Punjab, 2014. Percentage of households without drinking water on premises Number of households Person usually collecting drinking water Number of households without drinking water on premises Adult woman (age 15+ years) Adult man (age 15+ years) Female child (under 15) Male child (under 15) DK / Missing Total Punjab 17.8 38,405 33.7 53.2 3.5 7.5 2.2 100.0 6,831 District Bahawalpur 15.8 1,299 39.6 53.9 2.0 3.9 0.6 100.0 205 Bahawalnagar 18.1 1,074 48.4 41.2 3.6 5.5 1.3 100.0 195 RY Khan 19.3 1,719 36.6 57.3 1.8 4.2 0.0 100.0 332 DG Khan 25.1 935 36.0 50.5 3.8 7.6 2.1 100.0 235 Layyah 1.5 597 (*) (*) (*) (*) (*) 100.0 9 Muzaffargarh 3.8 1,303 24.0 59.8 2.0 11.7 2.5 100.0 49 Rajanpur 14.8 600 62.8 26.8 3.5 4.6 2.3 100.0 89 Faisalabad 30.6 2,711 19.9 70.1 1.4 7.2 1.3 100.0 830 Chiniot 6.7 504 33.4 45.9 9.0 9.6 2.0 100.0 34 Jhang 5.5 893 51.5 37.7 0.0 4.8 6.0 100.0 49 TT Singh 13.6 780 26.2 61.7 1.3 8.8 2.0 100.0 106 Gujranwala 17.9 1,589 11.6 63.7 6.2 15.6 2.9 100.0 284 Gujrat 27.5 1,024 30.1 54.9 3.0 11.1 0.9 100.0 282 Hafizabad 14.6 433 11.0 70.7 5.4 8.7 4.3 100.0 63 Mandi Bahauddin 19.2 589 29.0 59.5 2.1 6.2 3.2 100.0 113 Narowal 25.9 634 43.6 33.2 7.4 12.7 3.1 100.0 164 Sialkot 24.3 1,299 27.1 54.7 6.0 11.5 0.7 100.0 316 Lahore 16.8 3,614 10.4 75.8 1.4 8.4 4.1 100.0 607 Kasur 11.7 1,171 35.8 41.1 10.2 5.6 7.3 100.0 137 Nankana Sahib 26.8 580 18.9 71.4 1.6 7.5 0.5 100.0 155 Sheikhupura 10.8 1,266 22.6 49.2 11.2 12.0 5.0 100.0 137 Multan 10.2 1,835 19.0 67.9 4.2 5.2 3.7 100.0 187 Khanewal 5.2 1,123 51.8 30.9 9.2 8.1 0.0 100.0 59 Lodhran 11.4 647 42.8 51.2 0.0 2.5 3.6 100.0 74 Vehari 13.0 1,028 39.2 55.7 0.8 3.5 0.8 100.0 133 Sahiwal 13.1 832 38.3 44.9 9.1 5.9 1.8 100.0 109 Pakpattan 13.2 718 49.7 39.6 3.2 5.8 1.8 100.0 95 Okara 20.5 1,088 44.8 39.0 5.2 10.2 0.8 100.0 223 Rawalpindi 36.0 1,923 45.8 40.6 4.0 7.1 2.6 100.0 692 Attock 18.6 689 65.5 24.8 5.5 3.5 0.6 100.0 128 Chakwal 13.7 568 78.5 12.3 3.0 0.8 5.5 100.0 78 Jhelum 18.7 452 62.0 32.7 1.8 2.2 1.3 100.0 85 Sargodha 22.9 1,324 32.8 56.7 2.2 7.4 0.9 100.0 303 Bhakkar 2.4 544 (*) (*) (*) (*) (*) 100.0 13 Khushab 40.8 471 62.5 29.4 2.7 3.9 1.5 100.0 192 Mianwali 12.5 545 70.3 19.1 0.0 1.1 9.6 100.0 68 (*) Figures that are based on fewer than 25 unweighted cases P a g e | 266 Table D.WS.5: Types of sanitation facilities Percent distribution of household population according to type of toilet facility used by the household, Punjab, 2014. Type of toilet facility used by household Open defecation (no facility, bush, field) Total Number of household members Improved sanitation facility Unimproved sanitation facility Flush/Pour flush to: Ventilated improved pit latrine Pit latrine with slab Compos- ting toilet Flush/ Pour flush to somewhere else Pit latrine without slab/ open pit Bucket Other DK/ Missing Piped sewer system Septic tank Pit latrine Unknown place/not sure/DK where Punjab 21.3 44.1 8.7 0.3 0.2 0.6 0.0 6.8 0.2 0.0 0.2 0.1 17.5 100.0 246,396 District Bahawalpur 24.6 15.5 20.6 0.9 0.5 0.7 0.0 9.9 0.8 0.0 0.4 0.0 26.0 100.0 8,013 Bahawalnagar 8.6 15.9 30.7 0.5 0.3 1.3 0.0 12.0 0.0 0.0 0.0 0.1 30.6 100.0 6,704 RY Khan 19.4 7.0 30.2 0.1 0.2 2.2 0.0 10.2 0.5 0.0 0.5 0.0 29.6 100.0 11,240 DG Khan 6.1 36.8 8.3 0.8 0.6 3.6 0.3 2.1 2.8 0.0 0.0 0.1 38.6 100.0 6,498 Layyah 1.4 61.1 2.9 0.0 0.1 3.5 0.0 0.5 0.7 0.0 0.6 0.1 29.1 100.0 3,927 Muzaffargarh 1.4 45.6 4.7 0.3 0.2 2.6 0.0 1.9 0.2 0.2 0.1 0.0 42.8 100.0 8,664 Rajanpur 0.7 42.5 5.3 0.5 0.3 0.3 0.0 0.8 0.1 0.0 0.1 0.0 49.4 100.0 4,329 Faisalabad 38.1 53.2 0.4 0.0 0.2 0.0 0.0 0.8 0.1 0.0 0.1 0.1 6.9 100.0 17,101 Chiniot 3.6 54.7 0.1 0.1 0.2 0.0 0.0 1.9 0.0 0.0 0.1 0.0 39.2 100.0 3,198 Jhang 4.2 44.2 2.4 0.5 0.0 0.0 0.0 10.0 0.0 0.0 0.4 0.0 38.3 100.0 5,787 TT Singh 9.8 65.6 4.9 0.1 0.1 0.0 0.0 4.7 0.0 0.0 0.0 0.2 14.6 100.0 4,885 Gujranwala 19.8 76.1 0.1 0.0 0.0 0.0 0.0 2.1 0.0 0.0 0.2 0.3 1.3 100.0 10,545 Gujrat 3.7 89.3 0.0 0.0 0.0 0.0 0.0 1.0 0.0 0.1 0.1 0.0 5.8 100.0 6,553 Hafizabad 1.8 78.1 0.1 0.0 0.0 0.0 0.0 0.6 0.0 0.0 0.3 0.4 18.8 100.0 2,855 Mandi Bahauddin 3.0 71.9 0.4 0.3 0.0 0.0 0.0 2.4 0.0 0.0 0.3 0.1 21.5 100.0 3,748 Narowal 0.5 77.8 0.0 0.0 0.0 0.0 0.0 1.3 0.0 0.0 0.8 0.0 19.7 100.0 4,028 Sialkot 8.1 84.7 0.0 0.0 0.0 0.0 0.0 2.1 0.0 0.0 0.5 0.0 4.7 100.0 8,584 Lahore 84.3 10.8 0.3 1.3 0.1 0.0 0.0 2.1 0.0 0.0 0.0 0.5 0.5 100.0 23,671 Kasur 4.1 63.8 0.5 0.0 0.0 0.1 0.0 20.9 0.0 0.1 0.3 0.2 9.9 100.0 7,752 Nankana Sahib 5.9 83.1 0.2 0.0 0.0 0.0 0.0 1.5 0.1 0.0 0.3 0.0 9.0 100.0 3,811 Sheikhupura 17.1 74.5 0.2 0.1 0.0 0.0 0.0 2.8 0.0 0.0 0.3 0.2 4.8 100.0 8,613 Multan 34.8 12.1 4.2 0.0 0.3 0.8 0.0 27.2 0.5 0.1 0.3 0.1 19.6 100.0 10,610 Khanewal 10.2 23.9 10.0 0.1 0.1 1.5 0.0 34.6 0.0 0.0 0.2 0.2 19.3 100.0 6,794 Lodhran 14.3 12.6 24.7 0.1 0.0 2.7 0.0 15.3 0.1 0.0 0.5 0.1 29.7 100.0 3,976 Vehari 15.9 19.4 15.4 0.2 0.3 0.7 0.0 32.2 0.0 0.0 0.1 0.0 15.9 100.0 6,409 P a g e | 267 Table D.WS.5: Types of sanitation facilities Percent distribution of household population according to type of toilet facility used by the household, Punjab, 2014. Type of toilet facility used by household Open defecation (no facility, bush, field) Total Number of household members Improved sanitation facility Unimproved sanitation facility Flush/Pour flush to: Ventilated improved pit latrine Pit latrine with slab Compos- ting toilet Flush/ Pour flush to somewhere else Pit latrine without slab/ open pit Bucket Other DK/ Missing Piped sewer system Septic tank Pit latrine Unknown place/not sure/DK where Sahiwal 31.5 34.6 10.6 0.5 0.0 0.1 0.0 2.6 0.0 0.0 0.0 0.0 20.1 100.0 5,531 Pakpattan 8.1 48.6 14.2 0.5 0.0 0.2 0.0 11.5 0.1 0.0 0.0 0.0 17.0 100.0 4,520 Okara 24.5 37.9 4.1 0.9 0.0 0.0 0.0 9.5 0.1 0.0 0.0 0.0 22.9 100.0 7,204 Rawalpindi 20.2 55.9 14.5 0.5 0.2 0.1 0.0 1.2 0.2 0.0 0.2 0.4 6.5 100.0 11,568 Attock 5.0 53.3 23.3 0.0 0.2 0.0 0.0 2.7 0.2 0.2 0.1 0.0 15.0 100.0 4,214 Chakwal 1.6 53.1 28.3 0.0 0.0 0.2 0.0 1.6 0.0 0.1 0.5 0.2 14.6 100.0 3,285 Jhelum 2.9 65.9 14.0 0.2 0.3 0.0 0.0 1.4 0.0 0.0 0.0 0.0 15.2 100.0 2,700 Sargodha 16.9 58.6 1.0 0.1 0.0 0.1 0.0 0.8 0.0 0.0 0.0 0.1 22.3 100.0 8,167 Bhakkar 3.5 33.6 29.4 0.0 2.3 0.0 0.0 0.2 0.0 0.0 0.1 0.0 30.9 100.0 3,807 Khushab 6.2 41.1 16.6 0.0 0.6 0.0 0.0 0.2 0.4 0.0 0.0 0.0 34.9 100.0 3,104 Mianwali 8.2 24.0 51.0 0.0 1.9 0.4 0.0 0.2 0.0 0.0 0.1 0.1 14.0 100.0 4,004 Punjab 21.3 44.1 8.7 0.3 0.2 0.6 0.0 6.8 0.2 0.0 0.2 0.1 17.5 100.0 246,396 P a g e | 268 Table D.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, Punjab, 2014. Users of improved sanitation facilities Users of unimproved sanitation facilities Open defecation (no facility, bush, field) Total Number of household members Not shared1 Public facility Shared by Missing/DK Not shared Public facility Shared by Missing/DK 5 households or less More than 5 households 5 households or less More than 5 households Punjab 66.2 0.1 8.6 0.2 0.0 6.1 0.0 1.3 0.0 0.0 17.5 100.0 246,396 District Bahawalpur 57.1 0.2 5.3 0.1 0.1 10.5 0.0 0.5 0.0 0.1 26.0 100.0 8,013 Bahawalnagar 51.8 0.0 5.4 0.1 0.0 11.8 0.0 0.3 0.0 0.0 30.6 100.0 6,704 RY Khan 53.0 0.0 5.7 0.4 0.0 9.8 0.0 1.5 0.1 0.0 29.6 100.0 11,240 DG Khan 46.3 0.4 8.7 1.1 0.0 3.3 0.0 1.7 0.0 0.0 38.6 100.0 6,498 Layyah 55.3 0.1 12.9 0.8 0.0 1.1 0.0 0.6 0.1 0.0 29.1 100.0 3,927 Muzaffargarh 43.6 0.0 10.2 0.9 0.0 1.4 0.0 0.8 0.2 0.0 42.8 100.0 8,664 Rajanpur 36.2 0.0 12.8 0.6 0.0 0.6 0.0 0.4 0.0 0.0 49.4 100.0 4,329 Faisalabad 81.7 0.0 10.2 0.0 0.1 0.9 0.0 0.2 0.0 0.0 6.9 100.0 17,101 Chiniot 48.2 0.0 10.4 0.2 0.0 1.5 0.0 0.5 0.0 0.0 39.2 100.0 3,198 Jhang 44.5 0.0 6.8 0.1 0.0 8.1 0.1 2.3 0.0 0.0 38.3 100.0 5,787 TT Singh 71.6 0.0 8.8 0.0 0.0 4.3 0.0 0.6 0.0 0.0 14.6 100.0 4,885 Gujranwala 83.2 0.0 12.5 0.2 0.1 2.0 0.0 0.7 0.0 0.0 1.3 100.0 10,545 Gujrat 85.6 0.0 7.3 0.0 0.0 1.3 0.0 0.0 0.0 0.0 5.8 100.0 6,553 Hafizabad 73.5 0.0 6.5 0.0 0.0 0.9 0.0 0.3 0.0 0.0 18.8 100.0 2,855 Mandi Bahauddin 66.4 0.0 9.1 0.0 0.0 2.7 0.0 0.2 0.0 0.0 21.5 100.0 3,748 Narowal 71.6 0.0 6.6 0.0 0.0 1.2 0.0 0.9 0.0 0.0 19.7 100.0 4,028 Sialkot 86.4 0.2 6.1 0.0 0.0 2.3 0.0 0.3 0.0 0.0 4.7 100.0 8,584 Lahore 90.0 0.1 6.7 0.2 0.0 2.3 0.0 0.3 0.0 0.0 0.5 100.0 23,671 Kasur 57.9 0.0 10.7 0.0 0.0 16.8 0.0 4.7 0.0 0.0 9.9 100.0 7,752 Nankana Sahib 79.7 0.0 9.5 0.0 0.0 1.2 0.1 0.5 0.0 0.0 9.0 100.0 3,811 Sheikhupura 81.2 0.0 9.9 0.4 0.3 2.4 0.0 0.9 0.0 0.0 4.8 100.0 8,613 Multan 43.3 0.0 8.4 0.4 0.2 24.2 0.0 3.8 0.0 0.1 19.6 100.0 10,610 Khanewal 35.3 0.0 10.2 0.2 0.0 28.5 0.0 6.5 0.0 0.0 19.3 100.0 6,794 Lodhran 45.0 0.0 9.3 0.0 0.0 13.2 0.0 2.8 0.0 0.0 29.7 100.0 3,976 Vehari 44.7 0.0 7.1 0.0 0.0 25.2 0.0 7.1 0.0 0.0 15.9 100.0 6,409 Sahiwal 68.0 0.0 9.2 0.1 0.0 2.1 0.0 0.4 0.0 0.0 20.1 100.0 5,531 Pakpattan 57.2 0.0 14.2 0.0 0.0 8.9 0.0 2.7 0.0 0.0 17.0 100.0 4,520 Okara 60.0 0.0 7.4 0.1 0.0 8.2 0.0 1.5 0.0 0.0 22.9 100.0 7,204 P a g e | 269 Table D.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, Punjab, 2014. Users of improved sanitation facilities Users of unimproved sanitation facilities Open defecation (no facility, bush, field) Total Number of household members Not shared1 Public facility Shared by Missing/DK Not shared Public facility Shared by Missing/DK 5 households or less More than 5 households 5 households or less More than 5 households Rawalpindi 86.0 0.0 5.2 0.2 0.1 1.8 0.0 0.3 0.0 0.0 6.5 100.0 11,568 Attock 77.4 0.0 4.5 0.0 0.0 3.1 0.0 0.2 0.0 0.0 15.0 100.0 4,214 Chakwal 78.6 0.2 4.3 0.0 0.0 1.7 0.0 0.6 0.0 0.0 14.6 100.0 3,285 Jhelum 77.1 0.0 6.2 0.1 0.0 1.1 0.0 0.4 0.0 0.0 15.2 100.0 2,700 Sargodha 65.1 0.1 11.3 0.3 0.0 0.5 0.0 0.3 0.1 0.0 22.3 100.0 8,167 Bhakkar 51.4 0.5 16.3 0.6 0.0 0.2 0.0 0.1 0.0 0.0 30.9 100.0 3,807 Khushab 53.8 0.0 10.7 0.0 0.0 0.6 0.0 0.1 0.0 0.0 34.9 100.0 3,104 Mianwali 69.2 0.0 15.7 0.6 0.0 0.2 0.0 0.2 0.0 0.0 14.0 100.0 4,004 Punjab 66.2 0.1 8.6 0.2 0.0 6.1 0.0 1.3 0.0 0.0 17.5 100.0 246,396 1 MICS indicator 4.3; MDG indicator 7.9 - Use of improved sanitation P a g e | 270 Table D.WS.7: Drinking water and sanitation ladders Percentage of household population by drinking water and sanitation ladders, Punjab, 2014. Percentage of household population using: Number of household members Improved drinking water1 a Unimproved drinking water Total Improved sanitation2 Unimproved sanitation Total Improved drinking water sources and improved sanitation Piped into dwelling, plot or yard Other improved Shared improved facilities Unimproved facilities Open defecation Punjab 13.8 80.6 5.6 100.0 66.2 8.9 7.4 17.5 100.0 61.6 246,396 District Bahawalpur 11.9 84.4 3.7 100.0 57.1 5.7 11.1 26.0 100.0 54.6 8,013 Bahawalnagar 30.5 67.1 2.4 100.0 51.8 5.5 12.1 30.6 100.0 50.4 6,704 RY Khan 5.5 87.2 7.3 100.0 53.0 6.1 11.3 29.6 100.0 47.1 11,240 DG Khan 6.4 83.8 9.8 100.0 46.3 10.1 5.0 38.6 100.0 40.8 6,498 Layyah 0.1 99.3 0.6 100.0 55.3 13.8 1.8 29.1 100.0 54.7 3,927 Muzaffargarh 0.3 97.9 1.8 100.0 43.6 11.2 2.4 42.8 100.0 42.6 8,664 Rajanpur 0.2 97.9 1.9 100.0 36.2 13.4 1.0 49.4 100.0 35.9 4,329 Faisalabad 10.8 58.9 30.3 100.0 81.7 10.3 1.1 6.9 100.0 54.1 17,101 Chiniot 0.9 97.7 1.4 100.0 48.2 10.6 2.0 39.2 100.0 47.0 3,198 Jhang 1.0 98.2 0.8 100.0 44.5 6.8 10.4 38.3 100.0 44.2 5,787 TT Singh 22.4 73.5 4.2 100.0 71.6 8.8 4.9 14.6 100.0 67.7 4,885 Gujranwala 5.9 88.3 5.8 100.0 83.2 12.9 2.7 1.3 100.0 77.8 10,545 Gujrat 11.7 87.8 0.5 100.0 85.6 7.3 1.3 5.8 100.0 85.1 6,553 Hafizabad 0.6 96.9 2.6 100.0 73.5 6.5 1.2 18.8 100.0 71.3 2,855 Mandi Bahauddin 2.6 95.5 1.8 100.0 66.4 9.2 2.9 21.5 100.0 65.0 3,748 Narowal 1.5 98.5 0.0 100.0 71.6 6.6 2.0 19.7 100.0 71.6 4,028 Sialkot 7.5 80.3 12.2 100.0 86.4 6.3 2.6 4.7 100.0 74.5 8,584 Lahore 57.3 41.2 1.5 100.0 90.0 6.9 2.6 0.5 100.0 88.8 23,671 Kasur 19.5 78.6 1.9 100.0 57.9 10.7 21.5 9.9 100.0 57.2 7,752 Nankana Sahib 3.7 87.8 8.6 100.0 79.7 9.5 1.8 9.0 100.0 72.2 3,811 Sheikhupura 6.0 91.2 2.8 100.0 81.2 10.7 3.3 4.8 100.0 79.1 8,613 Multan 7.5 90.0 2.5 100.0 43.3 9.0 28.1 19.6 100.0 41.9 10,610 Khanewal 1.4 97.6 1.0 100.0 35.3 10.4 35.0 19.3 100.0 34.7 6,794 Lodhran 15.0 83.1 1.9 100.0 45.0 9.3 16.0 29.7 100.0 44.0 3,976 Vehari 9.9 88.6 1.5 100.0 44.7 7.2 32.3 15.9 100.0 43.6 6,409 Sahiwal 6.3 90.0 3.7 100.0 68.0 9.4 2.6 20.1 100.0 64.4 5,531 Pakpattan 12.7 84.2 3.0 100.0 57.2 14.2 11.6 17.0 100.0 54.6 4,520 Okara 5.0 92.6 2.4 100.0 60.0 7.5 9.7 22.9 100.0 58.3 7,204 P a g e | 271 Table D.WS.7: Drinking water and sanitation ladders Percentage of household population by drinking water and sanitation ladders, Punjab, 2014. Percentage of household population using: Number of household members Improved drinking water1 a Unimproved drinking water Total Improved sanitation2 Unimproved sanitation Total Improved drinking water sources and improved sanitation Piped into dwelling, plot or yard Other improved Shared improved facilities Unimproved facilities Open defecation Rawalpindi 20.0 74.2 5.7 100.0 86.0 5.4 2.1 6.5 100.0 81.3 11,568 Attock 16.8 77.4 5.9 100.0 77.4 4.5 3.2 15.0 100.0 74.1 4,214 Chakwal 19.7 73.9 6.4 100.0 78.6 4.5 2.3 14.6 100.0 73.8 3,285 Jhelum 17.0 80.6 2.5 100.0 77.1 6.3 1.4 15.2 100.0 76.5 2,700 Sargodha 3.9 88.0 8.1 100.0 65.1 11.6 0.9 22.3 100.0 58.1 8,167 Bhakkar 0.6 99.4 0.0 100.0 51.4 17.4 0.3 30.9 100.0 51.4 3,807 Khushab 16.9 75.7 7.4 100.0 53.8 10.7 0.6 34.9 100.0 51.1 3,104 Mianwali 13.0 83.1 3.9 100.0 69.2 16.3 0.5 14.0 100.0 66.5 4,004 Punjab 13.8 80.6 5.6 100.0 66.2 8.9 7.4 17.5 100.0 61.6 246,396 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 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. P a g e | 272 Table D.WS.8: Disposal of child's faeces Percent distribution of children age 0-2 years according to place of disposal of child's faeces, and the percentage of children age 0-2 years whose stools were disposed of safely the last time the child passed stools, Punjab, 2014. Place of disposal of child's faeces Percentage of children whose last stools were disposed of safely1 Number of children age 0-2 years Child used toilet/latrine Put/rinsed into toilet or latrine Put/rinsed into drain or ditch Thrown into garbage (solid waste) Buried Left in the open Other DK / Missing Total Punjab 6.1 65.3 6.4 16.8 1.2 3.2 0.4 0.7 100.0 71.4 16,028 District Bahawalpur 16.7 44.7 4.6 20.4 7.3 4.5 0.0 1.8 100.0 61.4 514 Bahawalnagar 5.7 54.4 6.5 22.9 5.5 5.0 0.0 0.0 100.0 60.2 412 RY Khan 2.9 52.6 9.3 21.5 4.6 8.3 0.0 0.7 100.0 55.5 762 DG Khan 5.5 32.9 14.7 31.6 1.8 12.2 0.0 1.4 100.0 38.4 511 Layyah 2.4 47.1 9.2 33.9 0.5 5.3 0.3 1.5 100.0 49.4 289 Muzaffargarh 3.6 39.7 13.7 30.7 1.5 9.2 0.2 1.4 100.0 43.2 624 Rajanpur 1.2 26.4 16.5 38.7 1.6 14.7 0.0 0.9 100.0 27.6 344 Faisalabad 5.3 84.5 2.0 7.2 0.1 0.1 0.8 0.0 100.0 89.8 1,083 Chiniot 3.4 62.0 3.8 30.3 0.0 0.4 0.0 0.0 100.0 65.5 188 Jhang 3.8 56.9 3.9 26.9 2.3 5.3 0.0 0.8 100.0 60.7 371 TT Singh 2.4 73.9 1.0 20.8 0.0 0.9 0.0 1.0 100.0 76.3 287 Gujranwala 7.0 86.4 1.2 4.5 0.0 0.3 0.0 0.6 100.0 93.5 717 Gujrat 13.8 76.1 3.5 5.0 0.0 0.1 0.2 1.4 100.0 89.8 438 Hafizabad 4.7 74.6 2.8 10.0 0.0 5.3 0.3 2.3 100.0 79.3 183 Mandi Bahauddin 8.3 64.4 5.6 16.0 0.3 5.1 0.0 0.3 100.0 72.7 229 Narowal 3.7 82.5 6.9 5.2 0.8 0.0 0.6 0.4 100.0 86.2 317 Sialkot 8.7 75.6 2.9 11.8 0.0 0.0 0.4 0.5 100.0 84.3 533 Lahore 9.0 83.5 2.7 4.6 0.0 0.3 0.0 0.0 100.0 92.5 1,429 Kasur 8.0 71.6 3.5 10.0 1.3 4.4 0.6 0.5 100.0 79.6 535 Nankana Sahib 6.8 80.9 1.8 6.6 0.0 2.4 0.0 1.6 100.0 87.7 260 Sheikhupura 11.7 79.9 1.1 6.5 0.0 0.1 0.0 0.7 100.0 91.7 522 Multan 6.6 63.0 6.7 18.6 0.0 3.4 0.0 1.7 100.0 69.5 716 Khanewal 2.7 64.7 10.4 17.8 0.0 3.6 0.3 0.5 100.0 67.4 432 Lodhran 1.3 59.0 7.1 25.9 2.7 2.6 0.0 1.4 100.0 60.3 261 Vehari 0.1 75.9 2.6 17.0 0.3 3.1 0.0 1.1 100.0 76.1 368 Sahiwal 1.3 72.4 10.2 12.2 0.2 3.3 0.2 0.3 100.0 73.8 398 Pakpattan 0.8 74.7 7.4 14.4 1.4 1.0 0.0 0.3 100.0 75.5 311 Okara 4.9 70.9 5.7 15.5 0.5 1.1 0.7 0.7 100.0 75.8 515 Rawalpindi 12.6 43.0 14.4 24.2 0.7 2.5 2.4 0.2 100.0 55.6 698 Attock 8.1 55.7 17.3 12.1 1.2 2.0 2.8 0.8 100.0 63.8 249 Chakwal 7.0 51.4 11.4 21.0 1.2 2.7 3.6 1.8 100.0 58.4 179 Jhelum 7.7 62.5 11.4 12.0 0.0 3.7 1.7 1.0 100.0 70.2 148 Sargodha 3.8 68.3 4.9 19.9 1.0 1.4 0.6 0.2 100.0 72.1 504 Bhakkar 0.4 49.9 3.4 38.2 4.3 3.0 0.0 0.8 100.0 50.3 244 Khushab 0.9 53.1 6.1 34.3 0.8 3.8 0.0 1.1 100.0 54.0 184 Mianwali 0.5 63.1 7.8 24.5 1.3 2.3 0.0 0.4 100.0 63.6 275 1 MICS indicator 4.4 - Safe disposal of child’s faeces P a g e | 273 Table D.WS.9: Water and soap at place for handwashing Percentage of households where place for handwashing was observed, percentage with no specific place for handwashing, and percent distribution of households by availability of water and soap at specific place for handwashing, Punjab, 2014. Percentage of households : Number of households Place for handwashing observed No specific place for handwashing in the dwelling, yard, or plot Total Percentage of households with a specific place for handwashing where water and soap or other cleansing agent are present1 Number of households where place for handwashing was observed or with no specific place for handwashing Where place for handwashing was observed With no specific place for handwashing in the dwelling, yard, or plot Water is available and: Water is not available and: Soap present No soap: Soap present No soap: Ash, mud, or sand present No other cleansing agent present Ash, mud, or sand present No other cleansing agent present Punjab 97.9 0.5 38,405 78.3 1.3 16.9 0.6 0.0 2.4 0.5 100.0 79.6 37,790 District Bahawalpur 98.6 0.7 1,299 62.1 1.2 31.0 0.6 0.1 4.3 0.7 100.0 63.3 1,290 Bahawalnagar 99.2 0.7 1,074 65.4 0.5 28.2 0.5 0.1 4.8 0.7 100.0 65.8 1,072 RY Khan 99.2 0.8 1,719 60.1 2.8 34.2 0.0 0.0 2.0 0.8 100.0 63.0 1,719 DG Khan 98.5 0.5 935 44.6 2.6 40.9 1.2 0.2 10.0 0.5 100.0 47.2 926 Layyah 99.7 0.0 597 64.3 6.1 27.9 0.5 0.0 1.1 0.0 100.0 70.5 596 Muzaffargarh 99.3 0.3 1,303 54.7 3.7 34.8 0.4 0.2 5.9 0.3 100.0 58.4 1,297 Rajanpur 99.7 0.1 600 42.2 15.3 39.6 0.0 0.4 2.4 0.1 100.0 57.5 600 Faisalabad 98.9 0.4 2,711 91.1 0.8 6.5 0.2 0.0 1.0 0.4 100.0 91.8 2,691 Chiniot 98.7 1.0 504 74.4 1.0 22.2 0.0 0.0 1.4 1.0 100.0 75.4 503 Jhang 99.1 0.3 893 72.7 3.5 21.0 0.2 0.0 2.2 0.3 100.0 76.2 888 TT Singh 99.1 0.7 780 77.6 2.8 15.9 0.8 0.1 2.2 0.7 100.0 80.4 779 Gujranwala 98.1 0.2 1,589 91.4 0.0 7.4 0.3 0.0 0.6 0.2 100.0 91.4 1,562 Gujrat 98.5 0.0 1,024 93.1 0.0 6.6 0.1 0.0 0.2 0.0 100.0 93.1 1,008 Hafizabad 99.4 0.2 433 87.3 0.0 11.9 0.5 0.0 0.1 0.2 100.0 87.3 432 Mandi Bahauddin 98.9 0.3 589 88.9 0.0 10.8 0.1 0.0 0.0 0.3 100.0 88.9 584 Narowal 99.6 0.0 634 85.6 0.9 11.3 0.6 0.0 1.6 0.0 100.0 86.5 632 Sialkot 96.7 0.0 1,299 90.9 0.2 7.4 0.7 0.0 0.9 0.0 100.0 91.0 1,256 Lahore 95.6 0.2 3,614 96.6 0.0 2.1 0.8 0.0 0.2 0.2 100.0 96.6 3,465 Kasur 98.5 0.8 1,171 76.2 1.2 17.4 1.4 0.0 3.0 0.8 100.0 77.4 1,163 Nankana Sahib 99.0 0.6 580 87.6 0.0 10.9 0.5 0.0 0.4 0.6 100.0 87.6 577 Sheikhupura 98.7 0.2 1,266 91.7 0.1 6.5 0.9 0.0 0.6 0.2 100.0 91.8 1,253 Multan 97.2 0.8 1,835 72.6 1.5 21.8 0.3 0.1 2.9 0.8 100.0 74.1 1,798 Khanewal 98.6 1.3 1,123 70.7 1.5 23.7 0.6 0.0 2.2 1.3 100.0 72.2 1,122 Lodhran 99.6 0.3 647 67.3 1.7 28.3 0.2 0.0 2.2 0.3 100.0 69.1 646 Vehari 99.0 0.7 1,028 75.6 0.9 20.6 0.2 0.0 2.0 0.7 100.0 76.5 1,026 P a g e | 274 Table D.WS.9: Water and soap at place for handwashing Percentage of households where place for handwashing was observed, percentage with no specific place for handwashing, and percent distribution of households by availability of water and soap at specific place for handwashing, Punjab, 2014. Percentage of households : Number of households Place for handwashing observed No specific place for handwashing in the dwelling, yard, or plot Total Percentage of households with a specific place for handwashing where water and soap or other cleansing agent are present1 Number of households where place for handwashing was observed or with no specific place for handwashing Where place for handwashing was observed With no specific place for handwashing in the dwelling, yard, or plot Water is available and: Water is not available and: Soap present No soap: Soap present No soap: Ash, mud, or sand present No other cleansing agent present Ash, mud, or sand present No other cleansing agent present Sahiwal 98.3 1.3 832 83.7 1.5 7.1 0.7 0.0 5.7 1.3 100.0 85.2 829 Pakpattan 99.4 0.6 718 81.9 2.0 10.5 0.9 0.0 4.0 0.6 100.0 84.0 718 Okara 98.6 1.1 1,088 81.5 2.5 9.1 1.3 0.3 4.3 1.1 100.0 84.0 1,085 Rawalpindi 90.7 0.6 1,923 84.4 0.0 8.2 2.1 0.0 4.7 0.6 100.0 84.4 1,756 Attock 95.7 0.1 689 88.4 0.1 4.9 1.3 0.0 5.1 0.2 100.0 88.5 660 Chakwal 98.0 0.5 568 88.2 0.0 5.3 1.5 0.0 4.5 0.5 100.0 88.2 559 Jhelum 96.8 0.0 452 92.5 0.0 5.0 0.3 0.0 2.2 0.0 100.0 92.5 438 Sargodha 98.5 0.2 1,324 76.8 0.0 22.5 0.1 0.0 0.4 0.2 100.0 76.8 1,308 Bhakkar 99.3 0.7 544 57.8 0.1 41.3 0.0 0.0 0.1 0.7 100.0 57.9 544 Khushab 96.4 3.4 471 62.4 0.0 33.0 0.4 0.0 0.8 3.4 100.0 62.4 470 Mianwali 98.1 1.2 545 61.6 0.0 35.9 0.2 0.0 1.2 1.2 100.0 61.6 541 Punjab 97.9 0.5 38,405 78.3 1.3 16.9 0.6 0.0 2.4 0.5 100.0 79.6 37,790 1 MICS indicator 4.5 - Place for handwashing P a g e | 275 Table D.WS.10: Availability of soap or other cleansing agent Percent distribution of households by availability of soap or other cleansing agent in the dwelling, Punjab, 2014. Place for handwashing observed Place for handwashing not observed Total Percentage of households with soap or other cleansing agent anywhere in the dwelling1 Number of households Soap or other cleansing agent observed Soap or other cleansing agent not observed at place for handwashing Soap or other cleansing agent shown No soap or other cleansing agent in household Not able/Does not want to show soap or other cleansing agent Missing Soap or other cleansing agent shown No soap or other cleansing agent in household Not able/Does not want to show soap or other cleansing agent Missing Punjab 78.9 13.2 4.3 1.2 0.2 0.6 0.4 1.1 0.0 100.0 92.8 38,405 District Bahawalpur 63.6 22.5 10.1 2.2 0.2 0.7 0.3 0.4 0.0 100.0 86.8 1,299 Bahawalnagar 66.2 23.5 7.3 2.2 0.0 0.4 0.2 0.2 0.0 100.0 90.1 1,074 RY Khan 63.0 26.5 7.1 2.5 0.1 0.7 0.1 0.0 0.0 100.0 90.2 1,719 DG Khan 48.1 29.3 18.1 2.7 0.3 1.2 0.2 0.1 0.0 100.0 78.7 935 Layyah 70.8 24.9 3.7 0.2 0.0 0.0 0.1 0.1 0.0 100.0 95.7 597 Muzaffargarh 58.7 29.9 8.9 1.6 0.1 0.3 0.5 0.0 0.0 100.0 88.9 1,303 Rajanpur 57.8 36.0 5.0 0.9 0.0 0.1 0.0 0.1 0.0 100.0 93.9 600 Faisalabad 91.4 4.8 2.1 0.5 0.1 0.4 0.3 0.3 0.1 100.0 96.5 2,711 Chiniot 75.2 18.0 4.6 0.8 0.1 0.8 0.3 0.2 0.0 100.0 93.9 504 Jhang 76.0 8.9 9.5 4.5 0.2 0.2 0.1 0.4 0.3 100.0 85.0 893 TT Singh 81.1 14.8 2.6 0.5 0.1 0.6 0.3 0.0 0.0 100.0 96.5 780 Gujranwala 90.2 4.0 2.3 1.6 0.0 0.0 0.1 1.8 0.0 100.0 94.2 1,589 Gujrat 91.8 4.7 0.8 0.9 0.3 0.2 0.1 1.2 0.0 100.0 96.7 1,024 Hafizabad 87.5 6.6 2.0 2.9 0.5 0.2 0.4 0.0 0.0 100.0 94.3 433 Mandi Bahauddin 88.2 8.5 1.1 0.9 0.2 0.4 0.2 0.5 0.0 100.0 97.1 589 Narowal 86.8 9.1 2.7 0.5 0.4 0.3 0.1 0.0 0.0 100.0 96.2 634 Sialkot 88.7 5.8 1.1 0.9 0.2 0.2 0.4 2.8 0.0 100.0 94.6 1,299 Lahore 93.4 1.3 0.9 0.1 0.0 0.5 0.8 3.0 0.0 100.0 95.2 3,614 Kasur 78.3 11.5 7.0 1.4 0.4 0.3 0.9 0.2 0.0 100.0 90.1 1,171 Nankana Sahib 87.7 5.9 1.1 3.8 0.4 0.4 0.1 0.5 0.0 100.0 94.1 580 Sheikhupura 91.7 4.5 0.5 2.0 0.0 0.6 0.1 0.5 0.1 100.0 96.8 1,266 Multan 73.0 15.3 6.4 2.1 0.4 1.3 0.5 1.1 0.0 100.0 89.6 1,835 Khanewal 72.7 18.3 7.0 0.4 0.1 1.2 0.1 0.0 0.1 100.0 92.3 1,123 Lodhran 69.1 25.0 4.6 0.6 0.2 0.3 0.1 0.0 0.0 100.0 94.4 647 Vehari 76.5 18.0 4.0 0.4 0.1 0.7 0.1 0.1 0.0 100.0 95.1 1,028 P a g e | 276 Table D.WS.10: Availability of soap or other cleansing agent Percent distribution of households by availability of soap or other cleansing agent in the dwelling, Punjab, 2014. Place for handwashing observed Place for handwashing not observed Total Percentage of households with soap or other cleansing agent anywhere in the dwelling1 Number of households Soap or other cleansing agent observed Soap or other cleansing agent not observed at place for handwashing Soap or other cleansing agent shown No soap or other cleansing agent in household Not able/Does not want to show soap or other cleansing agent Missing Soap or other cleansing agent shown No soap or other cleansing agent in household Not able/Does not want to show soap or other cleansing agent Missing Sahiwal 85.5 7.0 5.4 0.3 0.0 1.2 0.3 0.2 0.0 100.0 93.8 832 Pakpattan 84.9 7.6 6.5 0.4 0.0 0.5 0.1 0.0 0.0 100.0 93.0 718 Okara 85.3 7.3 5.6 0.3 0.2 0.6 0.3 0.5 0.0 100.0 93.1 1,088 Rawalpindi 79.0 8.1 2.0 1.3 0.4 1.5 0.9 6.8 0.0 100.0 88.5 1,923 Attock 86.1 6.0 1.9 1.2 0.4 0.9 0.5 2.9 0.0 100.0 93.0 689 Chakwal 88.3 7.2 2.0 0.3 0.2 0.7 0.1 1.2 0.0 100.0 96.2 568 Jhelum 89.9 5.4 0.9 0.4 0.3 0.7 0.3 2.2 0.0 100.0 96.0 452 Sargodha 76.0 15.2 4.6 2.4 0.4 0.4 0.5 0.5 0.0 100.0 91.6 1,324 Bhakkar 57.9 36.6 4.6 0.2 0.1 0.4 0.2 0.0 0.0 100.0 95.0 544 Khushab 62.7 29.1 3.2 0.8 0.6 2.9 0.3 0.4 0.0 100.0 94.7 471 Mianwali 61.3 36.2 0.4 0.0 0.1 1.8 0.2 0.0 0.0 100.0 99.2 545 Punjab 78.9 13.2 4.3 1.2 0.2 0.6 0.4 1.1 0.0 100.0 92.8 38,405 1 MICS indicator 4.6 - Availability of soap or other cleansing agent P a g e | 277 Table D.RH.2: Adolescent birth rate and total fertility rate Adolescent birth rates and total fertility rates for the one-year period preceding the survey, Punjab, 2014. Adolescent birth rate1 (Age-specific fertility rate for women age 15-19) Total fertility rate Punjab 34 3.5 District Bahawalpur 40 3.8 Bahawalnagar 25 3.4 RY Khan 25 3.3 DG Khan 78 4.9 Layyah 29 3.5 Muzaffargarh 48 4.6 Rajanpur 42 6.2 Faisalabad 27 3.4 Chiniot 58 3.2 Jhang 42 3.7 TT Singh 24 3.3 Gujranwala 19 3.3 Gujrat 9 2.9 Hafizabad 53 3.3 Mandi Bahauddin 48 3.1 Narowal 25 4.3 Sialkot 27 3.1 Lahore 28 3.1 Kasur 36 4.5 Nankana Sahib 49 3.5 Sheikhupura 25 3.5 Multan 51 3.6 Khanewal 32 3.4 Lodhran 23 3.9 Vehari 32 2.8 Sahiwal 50 3.9 Pakpattan 31 3.7 Okara 29 3.8 Rawalpindi 21 3.1 Attock 38 3.0 Chakwal 15 2.7 Jhelum 14 2.3 Sargodha 57 2.6 Bhakkar 52 3.9 Khushab 40 3.3 Mianwali 48 3.3 1 MICS indicator 5.1; MDG indicator 5.4 - Adolescent birth rate P a g e | 278 Table D.RH.5: Use of contraception Percentage of women age 15-49 years currently married who are using (or whose husband is using) a contraceptive method, Punjab, 2014. Percent of women currently married who are using (or whose husband is using): Number of women age 15- 49 years currently married N o m e th o d F e m a le s te ri li- z a ti o n M a le s te ri li- z a ti o n IU D In je c T a b le s Im p la n ts P ill M a le c o n d o m F e m a le c o n d o m D ia p h ra g m P e ri o d ic a b s ti n e n c e W it h d ra w a l O th e r M is s in g Any modern method Any tradi- tional method Any method1 Punjab 61.3 10.4 0.1 3.4 3.4 0.1 1.9 10.6 0.1 0.7 2.3 5.5 0.1 0.0 30.8 7.9 38.7 33,047 District Bahawalpur 74.3 8.2 0.1 1.3 3.1 0.0 2.1 5.8 0.2 2.4 1.1 1.1 0.2 0.0 23.3 2.4 25.7 1,090 Bahawalnagar 64.8 13.1 0.3 3.3 3.3 0.2 2.1 6.5 0.3 1.4 1.9 2.8 0.0 0.0 30.5 4.7 35.2 834 RY Khan 72.1 6.5 0.2 5.0 4.1 0.0 2.8 5.0 0.3 2.0 0.5 1.4 0.2 0.0 25.9 2.0 27.9 1,434 DG Khan 77.9 5.0 0.0 3.3 5.2 0.0 1.9 4.6 0.1 0.4 0.2 1.3 0.0 0.0 20.5 1.6 22.1 924 Layyah 69.4 11.4 0.2 5.0 4.9 0.0 1.7 5.2 0.0 0.1 0.3 1.8 0.1 0.0 28.4 2.2 30.6 533 Muzaffargarh 72.9 8.9 0.2 5.0 4.3 0.3 3.2 3.7 0.1 0.0 0.3 1.1 0.1 0.0 25.6 1.5 27.1 1,169 Rajanpur 78.2 7.9 0.3 2.1 5.1 0.1 1.5 2.0 0.0 0.0 1.2 1.6 0.0 0.0 19.0 2.8 21.8 549 Faisalabad 62.2 11.7 0.0 2.1 1.5 0.3 0.8 13.8 0.1 0.3 1.1 5.8 0.1 0.2 30.7 6.9 37.8 2,249 Chiniot 71.7 8.9 0.1 2.1 1.8 0.4 1.4 9.1 0.1 1.6 0.5 2.5 0.0 0.0 25.4 2.9 28.3 415 Jhang 68.3 10.2 0.1 3.3 1.8 0.1 0.9 9.6 0.1 0.2 3.5 1.8 0.2 0.0 26.3 5.4 31.7 740 TT Singh 60.0 10.0 0.0 2.9 3.3 0.0 0.9 16.6 0.0 0.0 2.5 3.4 0.3 0.0 33.8 6.1 40.0 626 Gujranwala 53.1 11.2 0.0 3.6 2.5 0.0 1.7 8.1 0.0 0.8 5.6 13.1 0.2 0.0 27.9 18.9 46.9 1,436 Gujrat 53.9 9.3 0.0 2.3 4.2 0.1 1.9 10.1 0.0 0.5 3.4 13.8 0.4 0.0 28.5 17.6 46.1 923 Hafizabad 49.7 13.4 0.1 1.5 3.1 0.2 0.9 13.4 0.0 1.0 7.5 9.1 0.2 0.0 33.5 16.8 50.3 393 Mandi Bahauddin 59.4 6.8 0.0 4.0 4.3 0.4 2.1 9.5 0.1 0.8 7.5 5.0 0.2 0.0 28.0 12.6 40.6 523 Narowal 49.0 9.9 0.1 1.9 7.5 0.0 2.9 14.5 0.0 0.7 4.9 8.5 0.0 0.1 37.5 13.4 51.0 525 Sialkot 52.4 9.0 0.3 3.5 4.0 0.1 1.9 13.3 0.0 1.6 3.4 10.2 0.3 0.0 33.7 13.9 47.6 1,102 Lahore 52.7 12.6 0.0 3.9 2.5 0.3 1.9 16.3 0.1 0.2 3.3 6.4 0.1 0.0 37.7 9.7 47.3 3,399 Kasur 57.7 12.2 0.0 4.0 1.1 0.0 1.5 10.4 0.0 0.5 4.6 7.8 0.2 0.0 29.8 12.5 42.3 989 Nankana Sahib 54.3 13.8 0.2 2.9 1.9 0.0 0.9 11.7 0.0 0.1 5.6 8.7 0.0 0.0 31.3 14.3 45.7 513 Sheikhupura 56.6 11.8 0.2 2.8 2.2 0.0 0.9 14.2 0.3 0.4 3.6 6.9 0.2 0.0 32.7 10.7 43.4 1,124 Multan 61.0 13.5 0.3 3.7 5.0 0.1 3.0 8.6 0.8 0.2 0.9 2.9 0.0 0.0 35.2 3.8 39.0 1,444 Khanewal 60.5 15.0 0.0 3.6 4.3 0.1 2.2 7.9 0.3 0.2 2.1 3.6 0.1 0.0 33.7 5.8 39.5 888 Lodhran 60.8 12.0 0.0 3.0 7.9 0.0 3.2 7.5 0.0 1.2 0.4 4.0 0.0 0.0 34.8 4.4 39.2 504 Vehari 59.6 12.7 0.0 5.4 3.9 0.1 2.7 10.6 0.0 0.5 1.4 2.9 0.2 0.0 35.8 4.5 40.4 816 Sahiwal 62.4 13.7 0.1 3.5 2.8 0.0 1.3 8.5 0.0 0.1 4.0 3.5 0.0 0.0 30.1 7.4 37.6 732 Pakpattan 61.4 10.6 0.0 4.4 3.0 0.0 1.0 9.9 0.0 0.1 3.6 5.9 0.1 0.0 29.0 9.5 38.6 599 Okara 62.6 10.9 0.1 5.3 2.2 0.2 1.9 9.9 0.3 0.2 3.0 2.8 0.4 0.2 31.0 6.2 37.4 934 P a g e | 279 Table D.RH.5: Use of contraception Percentage of women age 15-49 years currently married who are using (or whose husband is using) a contraceptive method, Punjab, 2014. Percent of women currently married who are using (or whose husband is using): Number of women age 15- 49 years currently married N o m e th o d F e m a le s te ri li- z a ti o n M a le s te ri li- z a ti o n IU D In je c ta b le s Im p la n ts P ill M a le c o n d o m F e m a le c o n d o m D ia p h ra g m P e ri o d ic a b s ti n e n c e W it h d ra w a l O th e r M is s in g Any modern method Any tradi- tional method Any method1 Rawalpindi 56.8 8.8 0.1 2.3 4.4 0.1 2.1 16.9 0.2 0.4 0.7 7.0 0.3 0.0 35.2 8.0 43.2 1,663 Attock 51.8 10.1 0.1 2.6 5.9 0.0 3.2 17.2 0.2 0.2 0.2 8.2 0.3 0.0 39.5 8.7 48.2 600 Chakwal 55.1 8.1 0.2 5.6 5.0 0.1 3.5 11.3 0.5 0.5 0.0 9.9 0.0 0.1 34.9 9.9 44.9 447 Jhelum 57.3 12.7 0.0 2.0 4.1 0.0 3.9 12.6 0.0 0.7 0.9 5.8 0.0 0.0 36.0 6.7 42.7 357 Sargodha 65.4 7.4 0.0 3.2 2.6 0.0 1.2 10.8 0.6 1.4 0.5 6.6 0.2 0.0 27.3 7.3 34.6 1,111 Bhakkar 68.1 6.0 0.1 3.3 3.5 0.0 1.6 8.4 0.0 0.5 1.5 7.0 0.0 0.0 23.3 8.5 31.9 487 Khushab 67.8 8.2 0.0 3.0 2.3 0.0 2.4 6.8 0.0 2.5 1.8 5.2 0.0 0.0 25.2 6.9 32.2 417 Mianwali 67.1 4.6 0.0 4.0 4.0 0.0 2.4 9.3 0.0 1.4 1.2 5.9 0.0 0.0 25.7 7.2 32.9 560 Punjab 61.3 10.4 0.1 3.4 3.4 0.1 1.9 10.6 0.1 0.7 2.3 5.5 0.1 0.0 30.8 7.9 38.7 33,047 1 MICS indicator 5.3; MDG indicator 5.3 - Contraceptive prevalence rate P a g e | 280 Table D.RH.6: Unmet need for contraception Percentage of women age 15-49 years currently married with an unmet need for family planning and percentage of demand for contraception satisfied, Punjab, 2014. Met need for contraception Unmet need for contraception Number of women currently married Percentage of demand for contraception satisfied Number of women currently married with need for contraception For spacing For limiting Total For spacing For limiting Total1 Punjab 9.6 29.1 38.7 9.1 8.3 17.5 33,047 68.9 18,572 District Bahawalpur 4.4 21.3 25.7 11.7 9.8 21.5 1,090 54.4 515 Bahawalnagar 5.7 29.5 35.2 8.5 7.8 16.4 834 68.2 430 RY Khan 7.4 20.5 27.9 9.9 9.6 19.5 1,434 58.9 679 DG Khan 6.7 15.4 22.1 15.7 11.5 27.3 924 44.7 456 Layyah 7.3 23.3 30.6 11.2 10.0 21.2 533 59.1 276 Muzaffargarh 5.4 21.7 27.1 13.3 12.9 26.2 1,169 50.9 623 Rajanpur 3.3 18.6 21.8 12.2 11.9 24.0 549 47.6 252 Faisalabad 9.0 28.8 37.8 8.8 8.7 17.6 2,249 68.3 1,244 Chiniot 6.2 22.1 28.3 7.7 9.2 16.9 415 62.5 187 Jhang 8.9 22.9 31.7 11.8 8.3 20.1 740 61.2 384 TT Singh 10.4 29.6 40.0 8.5 7.2 15.7 626 71.8 348 Gujranwala 12.2 34.7 46.9 11.0 6.8 17.7 1,436 72.5 928 Gujrat 11.6 34.6 46.1 8.2 6.4 14.5 923 76.0 560 Hafizabad 12.9 37.4 50.3 7.6 5.0 12.6 393 80.0 247 Mandi Bahauddin 13.5 27.2 40.6 7.7 7.1 14.8 523 73.4 290 Narowal 13.9 37.1 51.0 8.2 6.8 15.0 525 77.3 346 Sialkot 11.1 36.5 47.6 6.9 5.4 12.4 1,102 79.4 661 Lahore 10.2 37.2 47.3 7.6 8.3 15.9 3,399 74.8 2,150 Kasur 10.6 31.7 42.3 8.6 6.3 14.9 989 74.0 566 Nankana Sahib 12.9 32.7 45.7 10.1 6.9 17.0 513 72.8 321 Sheikhupura 10.1 33.3 43.4 8.5 10.2 18.8 1,124 69.8 699 Multan 11.6 27.4 39.0 9.4 7.2 16.6 1,444 70.2 803 Khanewal 9.8 29.7 39.5 8.4 7.3 15.7 888 71.6 490 Lodhran 11.2 28.0 39.2 10.6 5.1 15.7 504 71.4 277 Vehari 11.3 29.1 40.4 9.4 7.2 16.6 816 70.9 465 Sahiwal 9.8 27.7 37.6 8.9 6.7 15.6 732 70.7 389 Pakpattan 8.7 29.9 38.6 7.8 7.3 15.0 599 71.9 321 Okara 6.9 30.5 37.4 9.3 11.0 20.3 934 64.8 539 Rawalpindi 13.1 30.1 43.2 7.4 8.4 15.8 1,663 73.3 981 Attock 13.1 35.1 48.2 5.4 7.1 12.5 600 79.4 364 Chakwal 10.4 34.5 44.9 5.5 7.3 12.8 447 77.8 258 Jhelum 10.7 32.0 42.7 7.8 6.6 14.3 357 74.8 203 Sargodha 8.2 26.4 34.6 9.0 10.1 19.1 1,111 64.5 596 Bhakkar 8.6 23.3 31.9 9.2 8.5 17.6 487 64.4 241 Khushab 7.2 25.0 32.2 7.8 10.4 18.2 417 63.9 210 Mianwali 10.0 22.9 32.9 8.6 7.2 15.8 560 67.5 273 1 MICS indicator 5.4; MDG indicator 5.6 - Unmet need P a g e | 281 Table D.RH.7: Antenatal care coverage Percent distribution of ever married 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, Punjab, 2014. Provider of antenatal carea No antenatal care Total Any skilled provider1 Number of ever married women with a live birth in the last two years Medical doctor Nurse/ Midwife Lady health visiter (LHV) Lady health worker (LHW) Tradition al birth attendant (TBA) Relatives / Friends Other/ Missing Punjab 67.2 9.0 2.6 1.0 2.2 0.7 0.1 17.3 100.0 78.8 10,653 District Bahawalpur 59.2 5.5 1.5 0.4 3.5 2.5 0.0 27.5 100.0 66.1 342 Bahawalnagar 57.9 5.2 1.5 0.0 1.5 0.4 0.0 33.6 100.0 64.5 254 RY Khan 52.2 1.0 0.5 0.7 2.0 0.0 0.0 43.8 100.0 53.6 472 DG Khan 44.3 4.4 8.2 1.3 2.4 1.7 0.9 36.7 100.0 57.0 361 Layyah 52.5 6.2 10.5 1.0 1.4 4.0 0.0 24.5 100.0 69.2 182 Muzaffargarh 56.5 2.2 7.6 1.4 0.2 2.1 0.0 30.0 100.0 66.2 414 Rajanpur 45.0 3.5 9.4 0.8 1.3 1.0 0.0 39.0 100.0 57.9 223 Faisalabad 73.9 13.7 2.8 0.6 1.6 0.2 0.0 7.2 100.0 90.4 692 Chiniot 68.0 22.1 0.0 2.0 5.5 0.5 0.0 1.9 100.0 90.1 123 Jhang 56.9 7.8 3.9 0.3 4.5 0.1 0.0 26.5 100.0 68.6 237 TT Singh 71.3 9.7 2.4 0.5 3.6 0.0 0.0 12.4 100.0 83.5 185 Gujranwala 63.6 11.2 2.0 4.5 1.0 0.1 0.0 17.6 100.0 76.7 481 Gujrat 79.8 9.9 1.4 1.1 0.6 0.0 0.0 7.2 100.0 91.1 258 Hafizabad 71.3 11.6 0.3 0.0 1.7 0.0 0.0 15.1 100.0 83.1 129 Mandi Bahauddin 67.0 9.8 3.5 0.0 2.5 0.2 0.0 17.0 100.0 80.3 173 Narowal 58.2 34.9 0.1 0.2 1.8 0.2 0.0 4.7 100.0 93.2 200 Sialkot 77.4 19.9 0.0 0.2 0.6 0.0 0.0 1.9 100.0 97.3 336 Lahore 84.0 3.9 0.0 0.1 1.1 0.1 0.1 10.6 100.0 87.9 988 Kasur 48.5 15.1 3.3 0.8 7.3 0.0 0.4 24.6 100.0 66.9 376 Nankana Sahib 66.5 15.8 2.3 0.4 1.6 0.0 0.0 13.4 100.0 84.6 182 Sheikhupura 66.3 14.1 0.2 0.5 3.2 0.8 0.0 14.9 100.0 80.6 369 Multan 62.1 12.1 5.5 2.8 3.1 3.1 0.0 11.2 100.0 79.8 465 Khanewal 67.9 7.8 6.7 1.1 3.6 0.4 0.0 12.4 100.0 82.4 289 Lodhran 62.8 5.6 1.8 1.9 1.6 0.0 0.0 26.4 100.0 70.2 176 Vehari 72.4 10.1 1.4 2.2 3.5 0.2 0.4 9.9 100.0 83.9 232 Sahiwal 73.6 11.6 0.5 2.3 2.1 0.4 0.0 9.5 100.0 85.7 261 Pakpattan 64.0 18.5 0.9 1.2 1.4 0.0 0.0 14.1 100.0 83.3 221 Okara 59.5 13.6 1.4 1.3 2.5 0.0 0.0 21.7 100.0 74.5 344 Rawalpindi 88.0 0.4 0.8 0.0 2.2 0.6 0.0 8.1 100.0 89.2 496 Attock 84.2 0.6 0.4 1.1 1.8 0.0 0.0 11.9 100.0 85.2 168 Chakwal 86.0 1.3 1.8 1.2 1.6 0.3 0.7 6.9 100.0 89.2 120 Jhelum 81.3 6.4 0.7 1.3 2.7 0.6 0.0 7.1 100.0 88.3 97 Sargodha 69.5 5.9 5.2 2.2 3.7 2.2 0.0 11.3 100.0 80.6 319 Bhakkar 60.1 9.5 6.9 0.5 1.4 0.8 0.0 20.8 100.0 76.5 174 Khushab 79.7 4.5 0.3 0.0 1.3 0.0 0.0 14.2 100.0 84.5 127 Mianwali 77.7 5.9 1.2 0.2 0.0 0.8 0.0 14.2 100.0 84.7 184 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. P a g e | 282 Table D.RH.8: Number of antenatal care visits and timing of first visit Percent distribution of ever married 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, MICS Punjab, 2014. Percent distribution of women who had: Total 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 ever married women with a live birth in the last two years who had at least one ANC visit No antenetal care visits One visit Two visits Three visits 4 or more visits1 DK/ Missing No antenatal care visits First trimester 4-5 months 6-7 months 8+ months DK/ Missing Punjab 17.3 7.5 12.6 14.1 48.0 0.4 100.0 17.3 56.4 13.5 9.1 3.3 0.4 100.0 10,653 2.0 8,770 District Bahawalpur 27.5 14.5 13.7 10.5 33.4 0.4 100.0 27.5 44.9 12.4 11.9 3.3 0.0 100.0 342 3.0 248 Bahawalnagar 33.6 13.9 11.5 12.6 28.3 0.0 100.0 33.6 41.5 10.7 9.8 4.4 0.0 100.0 254 3.0 169 RY Khan 43.8 12.4 11.7 9.9 22.2 0.0 100.0 43.8 32.5 10.9 8.5 4.1 0.3 100.0 472 3.0 264 DG Khan 36.7 12.0 13.0 13.9 23.3 1.1 100.0 36.7 31.6 15.3 11.6 4.1 0.6 100.0 361 3.0 226 Layyah 24.5 21.8 18.8 12.8 21.5 0.6 100.0 24.5 34.8 16.9 15.4 8.5 0.0 100.0 182 4.0 138 Muzaffargarh 30.0 11.9 15.2 13.8 29.1 0.0 100.0 30.0 39.1 15.8 11.5 3.5 0.2 100.0 414 3.0 289 Rajanpur 39.0 7.7 19.7 13.5 19.1 0.9 100.0 39.0 28.0 10.7 14.6 7.6 0.0 100.0 223 4.0 136 Faisalabad 7.2 3.9 9.7 12.2 66.3 0.6 100.0 7.2 73.9 9.1 6.1 2.8 1.0 100.0 692 2.0 635 Chiniot 1.9 6.7 18.3 26.8 46.4 0.0 100.0 1.9 66.0 16.7 9.0 6.1 0.4 100.0 123 2.0 120 Jhang 26.5 4.0 12.7 13.8 42.3 0.7 100.0 26.5 52.7 10.5 9.2 1.2 0.0 100.0 237 2.0 174 TT Singh 12.4 5.4 13.5 22.1 46.4 0.2 100.0 12.4 56.3 17.3 8.8 4.7 0.5 100.0 185 3.0 162 Gujranwala 17.6 5.3 9.3 9.5 58.0 0.3 100.0 17.6 67.2 7.6 5.0 1.9 0.7 100.0 481 2.0 393 Gujrat 7.2 1.0 6.9 10.2 73.9 0.7 100.0 7.2 77.6 9.6 4.7 0.4 0.3 100.0 258 2.0 238 Hafizabad 15.1 2.5 13.9 17.9 50.3 0.3 100.0 15.1 43.1 18.3 18.3 3.0 2.2 100.0 129 3.0 107 Mandi Bahauddin 17.0 4.4 15.1 16.9 45.7 0.8 100.0 17.0 50.4 17.8 11.2 3.6 0.0 100.0 173 3.0 143 Narowal 4.7 10.0 21.0 22.6 41.7 0.0 100.0 4.7 47.1 19.4 23.5 5.2 0.2 100.0 200 4.0 191 Sialkot 1.9 5.2 17.6 18.1 56.9 0.4 100.0 1.9 68.0 16.5 10.9 2.2 0.7 100.0 336 2.0 328 Lahore 10.6 1.8 4.6 10.0 72.9 0.1 100.0 10.6 71.9 12.7 3.9 0.7 0.1 100.0 988 2.0 882 Kasur 24.6 11.9 12.6 13.9 36.5 0.4 100.0 24.6 45.9 12.2 12.5 4.1 0.7 100.0 376 3.0 281 Nankana Sahib 13.4 5.0 13.3 14.2 53.5 0.6 100.0 13.4 57.0 9.9 15.1 3.2 1.4 100.0 182 3.0 155 Sheikhupura 14.9 6.5 8.8 13.1 56.1 0.6 100.0 14.9 62.1 13.7 6.0 2.9 0.4 100.0 369 2.0 312 Multan 11.2 6.8 12.6 13.8 55.1 0.5 100.0 11.2 67.1 16.0 4.6 1.1 0.0 100.0 465 2.0 413 Khanewal 12.4 10.1 20.7 20.2 36.5 0.0 100.0 12.4 58.3 15.8 9.3 4.2 0.0 100.0 289 3.0 253 Lodhran 26.4 9.9 12.1 18.9 32.4 0.3 100.0 26.4 52.8 13.1 6.4 1.4 0.0 100.0 176 2.0 130 Vehari 9.9 10.5 19.9 16.7 42.5 0.5 100.0 9.9 67.5 12.9 7.8 1.7 0.3 100.0 232 2.0 208 Sahiwal 9.5 7.3 17.4 21.5 44.3 0.0 100.0 9.5 54.3 17.2 13.8 5.2 0.0 100.0 261 3.0 236 Pakpattan 14.1 6.8 19.0 19.5 39.7 0.8 100.0 14.1 33.8 26.4 20.0 5.1 0.5 100.0 221 4.0 189 Okara 21.7 9.8 14.7 13.4 40.2 0.3 100.0 21.7 49.9 13.2 9.2 4.8 1.2 100.0 344 3.0 266 P a g e | 283 Table D.RH.8: Number of antenatal care visits and timing of first visit Percent distribution of ever married 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, MICS Punjab, 2014. Percent distribution of women who had: Total 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 ever married women with a live birth in the last two years who had at least one ANC visit No antenetal care visits One visit Two visits Three visits 4 or more visits1 DK/ Missing No antenatal care visits First trimester 4-5 months 6-7 months 8+ months DK/ Missing Rawalpindi 8.1 0.2 6.9 11.6 72.9 0.4 100.0 8.1 72.4 13.1 5.6 0.2 0.6 100.0 496 2.0 453 Attock 11.9 4.4 7.5 14.4 59.4 2.3 100.0 11.9 62.7 16.9 6.2 2.2 0.0 100.0 168 3.0 148 Chakwal 6.9 2.8 6.3 10.0 73.9 0.0 100.0 6.9 77.6 11.0 2.7 1.3 0.6 100.0 120 2.0 111 Jhelum 7.1 4.2 7.2 9.2 72.3 0.0 100.0 7.1 77.0 11.0 4.0 0.8 0.0 100.0 97 2.0 90 Sargodha 11.3 12.3 15.5 17.0 43.6 0.4 100.0 11.3 62.7 11.4 7.1 6.3 1.2 100.0 319 2.0 279 Bhakkar 20.8 13.5 17.9 18.7 28.5 0.6 100.0 20.8 38.7 18.0 14.4 7.0 1.1 100.0 174 3.2 136 Khushab 14.2 9.7 21.7 15.0 39.4 0.0 100.0 14.2 50.3 13.4 13.5 8.6 0.0 100.0 127 3.0 109 Mianwali 14.2 11.2 16.7 19.1 37.7 1.1 100.0 14.2 45.9 16.4 16.1 7.4 0.0 100.0 184 3.0 158 Punjab 17.3 7.5 12.6 14.1 48.0 0.4 100.0 17.3 56.4 13.5 9.1 3.3 0.4 100.0 10,653 2.0 8,770 1 MICS indicator 5.5b; MDG indicator 5.5 - Antenatal care coverage P a g e | 284 Table D.RH.9: Content of antenatal care Percentage of ever married 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, blood sample taken and weight measured as part of antenatal care, during the pregnancy for the last birth, Punjab, 2014. Percentage of women who, during the pregnancy of their last birth, had: Number of ever married women with a live birth in the last two years Blood pressure measured Urine sample taken Blood sample taken Weight measured Blood pressure measured, urine and blood sample taken1 All four, Blood pressure measured, urine & blood sample taken and weight measured2 Punjab 72.2 55.4 50.3 43.9 45.3 36.3 10,653 District Bahawalpur 59.8 40.3 36.3 33.9 31.8 27.8 342 Bahawalnagar 58.9 40.7 37.5 30.8 32.5 25.1 254 RY Khan 48.0 35.3 28.5 23.0 25.2 15.8 472 DG Khan 37.3 23.5 21.2 14.8 15.5 10.3 361 Layyah 53.6 28.1 23.8 18.0 16.7 10.8 182 Muzaffargarh 53.0 31.1 29.7 17.7 23.7 15.2 414 Rajanpur 45.6 22.6 19.4 17.6 14.6 9.4 223 Faisalabad 82.5 74.0 67.6 56.1 63.5 50.5 692 Chiniot 77.4 59.7 46.2 34.8 43.6 31.7 123 Jhang 67.3 51.7 40.5 29.1 39.1 25.6 237 TT Singh 79.2 56.2 47.6 33.4 44.6 29.1 185 Gujranwala 77.8 64.2 58.6 50.8 51.9 41.9 481 Gujrat 90.5 71.4 68.5 69.6 62.5 56.6 258 Hafizabad 71.0 33.5 35.1 34.8 24.3 17.1 129 Mandi Bahauddin 75.9 49.6 45.6 36.9 39.4 27.5 173 Narowal 79.2 61.8 30.7 27.1 27.3 17.1 200 Sialkot 87.6 79.3 66.8 61.9 62.0 53.6 336 Lahore 84.4 77.3 73.8 73.9 70.5 67.0 988 Kasur 58.7 33.1 27.2 28.5 20.8 15.3 376 Nankana Sahib 77.5 55.1 51.5 49.8 41.7 31.5 182 Sheikhupura 76.1 55.6 48.5 52.0 43.9 39.5 369 Multan 77.2 51.0 49.9 45.0 42.0 33.3 465 Khanewal 74.9 46.0 41.5 33.7 35.9 23.4 289 Lodhran 64.7 45.9 35.8 32.3 32.7 20.3 176 Vehari 77.4 39.1 29.1 29.4 23.5 14.0 232 Sahiwal 76.7 57.6 57.5 44.8 50.5 35.2 261 Pakpattan 71.8 48.9 44.1 33.1 36.5 24.6 221 Okara 64.4 48.2 42.4 37.2 36.5 28.7 344 Rawalpindi 90.4 86.7 85.9 81.3 85.1 79.3 496 Attock 81.2 77.7 72.4 74.0 71.5 68.0 168 Chakwal 87.7 83.7 83.7 78.6 82.4 76.1 120 Jhelum 87.4 85.2 80.3 74.8 78.8 72.1 97 Sargodha 78.6 64.1 60.6 43.7 54.9 38.7 319 Bhakkar 64.9 46.3 45.6 19.4 36.2 17.2 174 Khushab 75.7 59.7 54.0 35.7 48.2 32.9 127 Mianwali 74.5 48.2 47.2 20.8 39.1 18.1 184 1 MICS indicator 5.6 - Content of antenatal care 2 MICS indicator 5.S1 - Contents of antenatal care (All four) P a g e | 285 Table D.RH.10: Assistance during delivery and caesarian section Percent distribution of ever married women age 15-49 years with a live birth in the last two years by person providing assistance at delivery, and percentage of births delivered by C-section, Punjab, 2014. Person assisting at delivery No attendant Total Delivery assisted by any skilled attendant1 Percent delivered by C-section Number of ever married women who had a live birth in the last two years Medical doctor Nurse/ Midwife Lady health visitor (LHV) Traditional birth attendant (TBA) Relative/ Friend Other/ Missing Decided before onset of labour pains Decided after onset of labour pains Total2 Punjab 52.3 9.6 2.8 33.2 1.5 0.6 0.0 100.0 64.7 14.8 8.8 23.6 10,653 District Bahawalpur 36.7 3.8 0.7 55.1 1.6 1.8 0.3 100.0 41.2 12.8 7.9 20.7 342 Bahawalnagar 37.6 3.7 1.4 56.8 0.4 0.2 0.0 100.0 42.6 14.0 5.9 19.9 254 RY Khan 38.6 4.1 0.2 55.7 0.2 1.2 0.0 100.0 42.9 11.7 7.6 19.3 472 DG Khan 23.5 8.3 7.9 49.2 10.6 0.6 0.0 100.0 39.6 2.6 3.7 6.3 361 Layyah 24.3 14.7 7.6 48.9 4.3 0.1 0.0 100.0 46.7 3.7 3.4 7.2 182 Muzaffargarh 28.9 9.4 6.2 53.7 1.2 0.5 0.3 100.0 44.5 5.9 6.2 12.1 414 Rajanpur 19.2 3.6 6.8 64.1 6.0 0.3 0.0 100.0 29.6 3.2 3.3 6.5 223 Faisalabad 61.1 14.0 1.9 22.3 0.5 0.2 0.0 100.0 77.0 15.2 11.6 26.8 692 Chiniot 51.8 19.6 2.5 24.7 1.4 0.0 0.0 100.0 73.9 13.7 9.0 22.6 123 Jhang 51.7 11.2 2.9 32.4 1.3 0.4 0.0 100.0 65.9 11.9 10.7 22.6 237 TT Singh 45.8 11.8 5.5 36.1 0.9 0.0 0.0 100.0 63.0 12.0 9.5 21.5 185 Gujranwala 59.0 19.1 4.4 16.8 0.6 0.1 0.0 100.0 82.5 18.8 7.8 26.6 481 Gujrat 72.1 12.4 0.5 14.6 0.0 0.4 0.0 100.0 85.0 25.4 13.0 38.4 258 Hafizabad 67.2 4.6 0.5 27.7 0.0 0.0 0.0 100.0 72.3 14.5 17.3 31.8 129 Mandi Bahauddin 40.6 7.9 2.4 48.5 0.5 0.0 0.0 100.0 50.9 8.1 12.8 20.9 173 Narowal 37.1 23.4 1.0 36.4 1.6 0.6 0.0 100.0 61.5 4.2 3.8 8.0 200 Sialkot 63.8 14.3 0.8 21.0 0.1 0.0 0.0 100.0 78.9 16.6 13.0 29.6 336 Lahore 76.8 4.2 0.0 17.8 0.8 0.4 0.0 100.0 81.1 26.6 11.8 38.5 988 Kasur 34.4 15.1 3.3 45.9 0.4 0.6 0.3 100.0 52.8 5.6 7.8 13.4 376 Nankana Sahib 64.3 9.5 0.0 25.3 0.9 0.0 0.0 100.0 73.8 13.7 10.3 24.0 182 Sheikhupura 57.8 13.6 0.4 26.1 0.7 1.4 0.0 100.0 71.8 13.3 13.3 26.7 369 Multan 54.5 7.6 4.6 32.0 0.3 0.9 0.0 100.0 66.8 17.3 7.8 25.1 465 Khanewal 47.4 9.1 3.2 38.7 0.4 1.2 0.0 100.0 59.7 16.1 9.3 25.4 289 Lodhran 43.3 1.6 0.7 53.3 0.6 0.4 0.0 100.0 45.6 12.5 6.3 18.8 176 Vehari 52.8 5.3 1.7 40.3 0.0 0.0 0.0 100.0 59.7 18.1 8.2 26.2 232 Sahiwal 56.3 11.1 1.0 30.5 0.3 0.7 0.0 100.0 68.5 25.6 9.9 35.5 261 Pakpattan 44.1 17.2 1.8 35.9 1.0 0.0 0.0 100.0 63.1 21.3 7.5 28.8 221 Okara 45.5 15.7 3.0 34.8 0.8 0.2 0.0 100.0 64.2 21.0 6.7 27.7 344 P a g e | 286 Table D.RH.10: Assistance during delivery and caesarian section Percent distribution of ever married women age 15-49 years with a live birth in the last two years by person providing assistance at delivery, and percentage of births delivered by C-section, Punjab, 2014. Person assisting at delivery No attendant Total Delivery assisted by any skilled attendant1 Percent delivered by C-section Number of ever married women who had a live birth in the last two years Medical doctor Nurse/ Midwife Lady health visitor (LHV) Traditional birth attendant (TBA) Relative/ Friend Other/ Missing Decided before onset of labour pains Decided after onset of labour pains Total2 Rawalpindi 80.1 2.8 2.4 10.8 2.8 1.1 0.0 100.0 85.3 14.6 11.2 25.7 496 Attock 63.5 2.6 2.0 25.5 3.8 2.7 0.0 100.0 68.1 13.2 6.9 20.0 168 Chakwal 69.5 3.3 5.1 20.2 1.0 0.9 0.0 100.0 77.9 14.7 6.4 21.2 120 Jhelum 72.3 9.2 1.9 14.6 1.2 0.7 0.0 100.0 83.5 21.5 6.3 27.9 97 Sargodha 53.6 9.9 6.4 28.2 1.8 0.0 0.0 100.0 70.0 16.0 9.2 25.3 319 Bhakkar 33.8 9.8 9.1 45.2 2.1 0.0 0.0 100.0 52.7 6.9 4.3 11.2 174 Khushab 55.7 9.4 3.6 24.4 6.8 0.0 0.0 100.0 68.7 13.5 9.6 23.1 127 Mianwali 54.0 9.6 4.9 24.9 5.5 1.1 0.0 100.0 68.5 9.0 4.2 13.1 184 Punjab 52.3 9.6 2.8 33.2 1.5 0.6 0.0 100.0 64.7 14.8 8.8 23.6 10,653 1 MICS indicator 5.7; MDG indicator 5.2 - Skilled attendant at delivery 2 MICS indicator 5.9 - Caesarean section P a g e | 287 Table D.RH.11: Place of delivery Percent distribution of ever married women age 15-49 years with a live birth in the last two years by place of delivery of their last birth, Punjab, 2014. Place of delivery Total Delivered in health facility1 Number of ever married women with a live birth in the last two years Health facility Home Other Missing/ DK Public sector Private sector Punjab 17.9 42.8 38.7 0.1 0.4 100.0 60.8 10,653 District Bahawalpur 10.8 29.9 57.5 0.0 1.8 100.0 40.7 342 Bahawalnagar 9.5 31.8 58.5 0.0 0.2 100.0 41.3 254 RY Khan 10.6 31.3 56.9 0.0 1.2 100.0 41.8 472 DG Khan 9.9 25.5 64.1 0.0 0.6 100.0 35.3 361 Layyah 13.4 22.6 63.8 0.0 0.1 100.0 36.0 182 Muzaffargarh 10.2 27.9 61.5 0.0 0.5 100.0 38.1 414 Rajanpur 13.1 16.4 70.5 0.0 0.0 100.0 29.5 223 Faisalabad 12.4 61.8 25.6 0.0 0.2 100.0 74.2 692 Chiniot 8.9 62.7 28.3 0.0 0.0 100.0 71.7 123 Jhang 10.5 52.2 36.6 0.3 0.4 100.0 62.7 237 TT Singh 11.5 47.4 41.1 0.0 0.0 100.0 58.9 185 Gujranwala 11.7 62.4 25.6 0.3 0.0 100.0 74.1 481 Gujrat 27.5 53.8 18.7 0.0 0.0 100.0 81.3 258 Hafizabad 16.7 53.2 30.0 0.0 0.0 100.0 70.0 129 Mandi Bahauddin 6.7 37.1 56.2 0.0 0.0 100.0 43.8 173 Narowal 11.4 41.3 47.1 0.0 0.2 100.0 52.7 200 Sialkot 17.8 51.7 30.5 0.0 0.0 100.0 69.5 336 Lahore 35.4 45.1 19.4 0.1 0.0 100.0 80.5 988 Kasur 16.4 32.1 50.9 0.0 0.6 100.0 48.5 376 Nankana Sahib 18.6 53.8 27.6 0.0 0.0 100.0 72.4 182 Sheikhupura 24.9 43.1 30.8 0.0 1.2 100.0 68.0 369 Multan 15.5 47.4 36.2 0.0 0.9 100.0 62.9 465 Khanewal 8.4 45.2 45.2 0.0 1.2 100.0 53.6 289 Lodhran 10.2 34.2 55.2 0.0 0.4 100.0 44.4 176 Vehari 12.9 44.9 42.2 0.0 0.0 100.0 57.8 232 Sahiwal 15.5 50.4 33.7 0.0 0.4 100.0 65.9 261 Pakpattan 7.8 50.0 42.2 0.0 0.0 100.0 57.8 221 Okara 13.5 46.4 39.9 0.0 0.2 100.0 59.9 344 Rawalpindi 46.1 36.6 16.2 0.0 1.1 100.0 82.7 496 Attock 27.6 34.9 35.0 1.2 1.4 100.0 62.4 168 Chakwal 35.2 39.4 24.2 0.3 0.9 100.0 74.5 120 Jhelum 39.0 38.7 21.6 0.0 0.7 100.0 77.7 97 Sargodha 16.3 48.1 35.6 0.0 0.0 100.0 64.4 319 Bhakkar 14.6 30.0 55.4 0.0 0.0 100.0 44.6 174 Khushab 15.5 44.3 40.2 0.0 0.0 100.0 59.8 127 Mianwali 23.2 41.4 33.7 0.6 1.1 100.0 64.6 184 1 MICS indicator 5.8 - Institutional deliveries P a g e | 288 Table D.RH.12: Post-partum stay in health facility Percent distribution of ever married 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, Punjab, 2014. Duration of stay in health facility Total 12 hours or more1 Number of ever married 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 DK/ Missing Punjab 39.8 7.9 1.6 15.3 35.1 0.3 100.0 52.0 6,473 District Bahawalpur 29.3 6.4 1.1 21.3 41.4 0.6 100.0 63.7 139 Bahawalnagar 36.0 7.1 1.8 21.6 33.4 0.0 100.0 56.9 105 RY Khan 30.1 11.4 0.9 20.0 37.6 0.0 100.0 58.5 198 DG Khan 66.1 5.6 1.0 12.3 13.9 1.1 100.0 27.2 128 Layyah 63.6 8.0 3.1 11.0 14.2 0.0 100.0 28.4 66 Muzaffargarh 53.8 8.0 1.8 13.1 23.3 0.0 100.0 38.2 158 Rajanpur 66.3 6.7 1.5 4.9 20.5 0.0 100.0 26.9 66 Faisalabad 39.9 9.7 2.1 11.8 36.0 0.5 100.0 49.9 513 Chiniot 45.5 11.6 1.4 9.4 32.2 0.0 100.0 42.9 88 Jhang 50.5 6.4 0.9 6.5 35.6 0.0 100.0 43.0 149 TT Singh 39.4 11.1 3.7 8.9 36.9 0.0 100.0 49.5 109 Gujranwala 45.3 7.9 1.9 12.0 32.5 0.3 100.0 46.5 357 Gujrat 34.4 9.1 2.4 11.3 42.8 0.0 100.0 56.5 210 Hafizabad 26.3 10.1 1.5 19.2 42.0 0.9 100.0 62.7 90 Mandi Bahauddin 38.9 2.7 3.3 11.2 42.9 1.1 100.0 57.4 76 Narowal 55.0 9.0 1.6 19.9 14.4 0.0 100.0 35.9 106 Sialkot 33.9 7.0 0.9 20.4 37.9 0.0 100.0 59.1 234 Lahore 22.1 12.9 3.6 15.7 45.7 0.0 100.0 65.0 796 Kasur 57.3 4.2 0.0 10.6 27.1 0.9 100.0 37.7 182 Nankana Sahib 47.6 6.2 1.6 15.3 29.3 0.0 100.0 46.2 131 Sheikhupura 38.8 7.0 0.3 14.9 38.4 0.6 100.0 53.6 251 Multan 40.8 5.7 0.8 15.4 36.9 0.5 100.0 53.0 292 Khanewal 36.4 1.3 0.5 15.0 45.7 1.1 100.0 61.2 155 Lodhran 37.1 10.6 0.0 11.3 41.1 0.0 100.0 52.3 78 Vehari 42.1 7.0 1.6 5.4 42.4 1.5 100.0 49.3 134 Sahiwal 31.9 4.6 1.5 12.0 49.9 0.0 100.0 63.5 172 Pakpattan 33.0 6.7 0.0 13.8 46.5 0.0 100.0 60.3 128 Okara 41.3 6.0 1.2 10.6 40.6 0.3 100.0 52.4 206 Rawalpindi 37.1 6.6 1.5 32.4 22.4 0.0 100.0 56.3 411 Attock 34.8 7.4 2.4 23.4 32.0 0.0 100.0 57.8 105 Chakwal 51.1 7.9 0.0 26.3 14.7 0.0 100.0 41.0 89 Jhelum 37.1 9.9 0.4 20.7 31.9 0.0 100.0 53.0 75 Sargodha 47.8 4.7 1.7 14.5 31.4 0.0 100.0 47.5 205 Bhakkar 59.2 4.9 0.0 14.5 21.4 0.0 100.0 35.9 78 Khushab 46.2 4.9 0.0 10.1 38.8 0.0 100.0 48.9 76 Mianwali 60.1 9.7 1.7 9.2 19.2 0.0 100.0 30.1 119 1 MICS indicator 5.10 - Post-partum stay in health facility P a g e | 289 Table D.RH.13: Post-natal health checks for newborns Percentage of ever married women age 15-49 years with a live birth in the last two years whose last live birth received health checks while in facility or at home following birth, percent distribution whose last live birth received post-natal care (PNC) visits from any health provider after birth, by timing of visit, and percentage who received post natal health checks, Punjab, 2014. Health check following birth while in facility or at homea PNC visit for newbornsb Post-natal health check for the newborn1, c Number of last live births in the last two years Same day 1 day following birth 2 days followin g birth 3-6 days following birth After the first week following birth No post- natal care visit DK/ Missing Total Punjab 88.3 5.5 2.5 2.0 4.7 10.2 72.7 2.4 100.0 88.8 10,653 District Bahawalpur 89.0 15.9 9.9 3.5 3.9 7.3 52.2 7.4 100.0 90.0 342 Bahawalnagar 98.1 7.1 8.3 3.6 7.7 6.3 66.4 0.6 100.0 98.1 254 RY Khan 97.8 0.4 4.1 2.8 8.8 8.6 75.3 0.0 100.0 97.8 472 DG Khan 69.7 16.1 1.3 1.3 1.6 3.0 72.9 3.8 100.0 71.7 361 Layyah 80.0 16.1 1.7 1.7 2.6 1.6 73.3 3.1 100.0 80.6 182 Muzaffargarh 78.3 15.0 2.8 1.7 2.8 2.9 72.2 2.7 100.0 79.4 414 Rajanpur 81.1 19.9 3.3 2.3 3.7 2.8 65.4 2.6 100.0 81.8 223 Faisalabad 87.8 2.4 2.0 1.7 5.2 12.4 73.4 2.9 100.0 88.8 692 Chiniot 97.1 2.3 2.0 0.9 2.6 14.5 76.0 1.8 100.0 97.1 123 Jhang 89.7 9.4 2.6 2.1 3.4 12.3 64.4 5.7 100.0 90.1 237 TT Singh 92.6 7.1 0.6 1.6 5.3 10.5 73.0 1.9 100.0 92.6 185 Gujranwala 90.1 3.1 3.4 1.4 4.9 15.3 68.5 3.3 100.0 91.0 481 Gujrat 95.4 2.6 2.6 0.9 4.6 29.8 59.2 0.2 100.0 95.4 258 Hafizabad 98.9 1.0 1.0 1.0 4.2 17.1 75.7 0.0 100.0 98.9 129 Mandi Bahauddin 95.2 1.6 3.2 1.2 3.8 10.2 78.7 1.2 100.0 95.2 173 Narowal 91.7 2.1 1.8 0.7 1.5 4.6 88.3 1.0 100.0 91.7 200 Sialkot 93.6 1.1 2.0 1.3 2.7 14.7 77.4 0.8 100.0 94.6 336 Lahore 89.8 2.1 1.0 1.9 4.4 13.1 76.3 1.2 100.0 89.9 988 Kasur 75.8 6.2 1.7 0.9 2.7 5.9 80.7 2.1 100.0 76.6 376 Nankana Sahib 95.7 1.1 2.5 1.2 1.1 9.1 84.1 0.9 100.0 96.1 182 Sheikhupura 84.2 4.5 2.9 0.7 2.6 10.0 77.3 2.1 100.0 84.4 369 Multan 86.9 6.3 1.0 1.6 5.4 8.0 69.4 8.3 100.0 87.6 465 Khanewal 89.9 5.0 0.0 1.9 8.5 6.1 77.1 1.5 100.0 90.5 289 Lodhran 95.7 0.2 0.9 3.2 6.2 9.4 80.1 0.0 100.0 95.7 176 Vehari 95.7 2.3 1.5 0.6 4.6 6.2 84.9 0.0 100.0 95.7 232 Sahiwal 88.7 1.8 2.1 4.6 8.8 19.7 62.9 0.0 100.0 89.2 261 Pakpattan 91.9 1.9 0.4 4.3 5.6 14.4 73.4 0.0 100.0 92.8 221 Okara 74.8 5.5 1.2 3.0 5.7 6.8 77.1 0.8 100.0 76.0 344 Rawalpindi 85.3 6.0 1.9 2.9 2.3 6.2 73.8 6.9 100.0 85.6 496 Attock 83.6 4.5 4.2 1.7 5.8 14.3 68.8 0.8 100.0 85.0 168 Chakwal 92.7 4.0 2.1 4.2 8.6 12.7 65.6 2.8 100.0 93.0 120 Jhelum 94.5 2.4 3.8 0.4 6.2 18.9 67.1 1.1 100.0 94.5 97 Sargodha 88.0 10.9 0.7 2.1 8.1 15.2 58.4 4.5 100.0 88.5 319 Bhakkar 95.6 1.4 7.5 2.2 5.0 6.8 77.3 0.0 100.0 95.9 174 Khushab 90.7 0.4 4.5 2.0 4.5 10.8 77.8 0.0 100.0 90.7 127 Mianwali 92.2 2.8 3.9 2.2 3.9 8.4 78.9 0.0 100.0 93.3 184 1 MICS indicator 5.11 - Post-natal health check for the newborn a Health checks by any health provider following facility births (before discharge from facility) or following home births (before departure of provider from home). b Post-natal care visits (PNC) refer to a separate visit to check on the health of the newborn and provide preventive care services. PNC visits do not include health checks following birth while in facility or at home (see note a above). c Post-natal health checks include any health check performed while in the health facility or at home following birth (see note a above), as well as PNC visits (see note b above) within two days of delivery. P a g e | 290 Table D.RH.15: Post-natal health checks for mothers Percentage of ever married women age 15-49 years with a live birth in the last two years who received health checks while in facility or at home following birth, percent distribution who received post-natal care (PNC) visits from any health provider after birth at the time of last birth, by timing of visit, and percentage who received post natal health checks, Punjab, 2014. Health check following birth while in facility or at homea PNC visit for mothersb Post-natal health check for the mother1, c Number of ever married women who gave birth in the two years preceding the survey Same day 1 day following birth 2 days following birth 3-6 days following birth After the first week following birth No post- natal care visit DK/ Missing Total Punjab 86.0 2.2 1.8 1.7 4.0 17.0 71.8 1.5 100.0 86.3 10,653 District Bahawalpur 85.4 6.8 10.6 3.2 3.4 10.8 60.4 4.8 100.0 86.5 342 Bahawalnagar 91.6 3.5 5.5 3.1 5.3 10.8 71.5 0.5 100.0 91.6 254 RY Khan 95.7 0.4 3.3 3.3 6.8 13.1 73.0 0.0 100.0 95.7 472 DG Khan 59.5 5.6 0.9 0.3 2.0 2.8 86.0 2.5 100.0 60.2 361 Layyah 77.6 0.2 0.3 2.8 1.0 3.4 90.2 2.1 100.0 78.1 182 Muzaffargarh 71.4 1.7 1.1 0.9 3.1 3.5 87.1 2.7 100.0 71.7 414 Rajanpur 72.9 2.5 0.6 1.4 8.3 4.9 81.7 0.6 100.0 73.4 223 Faisalabad 86.8 2.3 0.9 1.6 3.8 19.8 69.5 2.2 100.0 87.7 692 Chiniot 96.2 0.0 2.5 0.4 2.7 23.6 70.4 0.5 100.0 96.2 123 Jhang 90.9 2.5 1.8 3.0 3.9 17.5 67.9 3.4 100.0 91.2 237 TT Singh 92.3 1.4 1.9 2.2 2.3 24.0 68.1 0.0 100.0 92.3 185 Gujranwala 91.0 2.2 1.4 2.0 5.0 20.4 66.5 2.4 100.0 91.4 481 Gujrat 95.6 1.7 1.4 1.2 3.4 40.0 52.2 0.0 100.0 96.1 258 Hafizabad 97.5 0.0 1.8 1.0 2.1 30.9 62.9 1.2 100.0 97.5 129 Mandi Bahauddin 96.2 1.0 2.4 1.4 1.4 24.3 69.2 0.3 100.0 96.2 173 Narowal 89.3 0.2 1.3 1.2 0.4 7.0 89.5 0.4 100.0 89.3 200 Sialkot 87.9 0.3 1.1 0.4 2.1 23.2 72.5 0.3 100.0 89.0 336 Lahore 89.1 0.9 0.3 1.6 3.9 29.0 63.6 0.7 100.0 89.2 988 Kasur 73.5 4.2 1.4 0.8 2.3 10.4 80.4 0.5 100.0 74.3 376 Nankana Sahib 92.0 0.0 1.8 1.4 2.4 19.3 73.6 1.4 100.0 92.0 182 Sheikhupura 84.4 2.3 2.8 1.7 5.1 15.5 71.0 1.7 100.0 84.6 369 Multan 85.4 5.1 0.5 1.1 5.4 11.0 69.9 6.9 100.0 85.4 465 Khanewal 90.3 2.4 0.3 1.2 6.8 15.4 72.9 1.0 100.0 90.3 289 Lodhran 94.4 0.0 0.0 3.8 2.3 15.2 78.7 0.0 100.0 94.4 176 Vehari 93.3 0.0 0.4 0.7 5.5 20.7 72.7 0.0 100.0 93.3 232 Sahiwal 88.8 0.3 0.8 4.4 2.8 27.8 63.8 0.0 100.0 89.1 261 Pakpattan 91.9 0.4 0.0 2.7 4.9 26.3 65.2 0.5 100.0 91.9 221 Okara 71.4 2.1 0.0 0.8 1.9 9.8 84.4 1.1 100.0 71.9 344 Rawalpindi 81.3 1.7 1.5 1.9 3.6 10.0 78.7 2.7 100.0 81.6 496 Attock 81.9 2.4 1.0 1.5 4.6 13.3 76.8 0.4 100.0 81.9 168 Chakwal 93.4 3.2 2.3 1.3 3.0 18.8 69.6 1.9 100.0 93.4 120 Jhelum 92.8 1.9 2.0 0.9 4.9 26.5 63.8 0.0 100.0 92.8 97 Sargodha 83.1 7.5 2.6 2.2 8.2 19.1 57.9 2.6 100.0 83.8 319 Bhakkar 95.1 1.0 6.0 1.7 5.4 13.8 72.1 0.0 100.0 95.4 174 Khushab 90.1 0.3 5.0 1.6 5.6 22.3 65.2 0.0 100.0 90.1 127 Mianwali 92.5 2.4 3.9 1.4 2.3 16.9 73.1 0.0 100.0 93.1 184 1 MICS indicator 5.12 - Post-natal health check for the mother a Health checks by any health provider following facility births (before discharge from facility) or following home births (before departure of provider from home). b Post-natal care visits (PNC) refer to a separate visit to check on the health of the newborn and provide preventive care services. PNC visits do not include health checks following birth while in facility or at home (see note a above). c Post-natal health checks include any health check performed while in the health facility or at home following birth (see note a above), as well as PNC visits (see note b above) within two days of delivery. P a g e | 291 Table D.RH.17: Post-natal health checks for mothers and newborns Percent distribution of ever married 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, Punjab, 2014. Health checks or PNC visits within 2 days of birth for: DK/ Missing Total Number of ever married 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 Punjab 83.5 1.9 4.4 9.2 1.0 100.0 10,653 District Bahawalpur 80.7 2.2 6.1 7.4 3.5 100.0 342 Bahawalnagar 91.6 0.0 6.5 1.9 0.0 100.0 254 RY Khan 95.7 0.0 2.1 2.2 0.0 100.0 472 DG Khan 57.2 1.4 12.9 26.9 1.7 100.0 361 Layyah 74.2 2.0 4.5 17.4 1.9 100.0 182 Muzaffargarh 69.8 0.7 8.4 19.9 1.2 100.0 414 Rajanpur 72.1 0.6 9.0 17.6 0.6 100.0 223 Faisalabad 83.3 2.2 3.9 8.4 2.2 100.0 692 Chiniot 95.7 0.0 0.9 2.9 0.5 100.0 123 Jhang 86.4 2.6 1.5 7.3 2.2 100.0 237 TT Singh 91.8 0.5 0.8 6.9 0.0 100.0 185 Gujranwala 86.6 3.0 2.7 6.0 1.7 100.0 481 Gujrat 93.4 2.7 2.0 1.8 0.0 100.0 258 Hafizabad 97.1 0.5 1.8 0.7 0.0 100.0 129 Mandi Bahauddin 94.8 1.0 0.0 3.8 0.3 100.0 173 Narowal 89.0 0.0 2.4 8.3 0.2 100.0 200 Sialkot 87.2 1.8 7.4 3.6 0.0 100.0 336 Lahore 86.4 2.4 3.1 7.7 0.5 100.0 988 Kasur 70.5 3.5 5.8 19.9 0.2 100.0 376 Nankana Sahib 90.7 1.3 5.4 2.7 0.0 100.0 182 Sheikhupura 79.2 4.8 4.6 10.8 0.6 100.0 369 Multan 76.8 4.0 6.2 8.4 4.6 100.0 465 Khanewal 88.3 0.9 1.1 8.6 1.0 100.0 289 Lodhran 94.4 0.0 1.3 4.3 0.0 100.0 176 Vehari 92.4 0.9 3.3 3.4 0.0 100.0 232 Sahiwal 88.2 0.9 1.0 9.9 0.0 100.0 261 Pakpattan 90.9 0.9 1.9 6.3 0.0 100.0 221 Okara 68.6 3.3 7.4 20.7 0.0 100.0 344 Rawalpindi 76.7 3.2 7.2 11.2 1.6 100.0 496 Attock 80.0 1.9 5.0 13.1 0.0 100.0 168 Chakwal 91.0 1.6 1.3 5.4 0.8 100.0 120 Jhelum 92.4 0.4 2.1 5.1 0.0 100.0 97 Sargodha 80.1 2.3 7.0 9.2 1.3 100.0 319 Bhakkar 95.0 0.4 1.0 3.6 0.0 100.0 174 Khushab 88.8 1.3 2.0 7.9 0.0 100.0 127 Mianwali 92.2 0.9 1.1 5.8 0.0 100.0 184 P a g e | 292 Table D.CD.1: Early childhood education Percentage of children age 36-59 months who are attending an organized early childhood education programme, Punjab, 2014. Percentage of children age 36-59 months attending early childhood education1 Number of children age 36-59 months Punjab 25.7 11,527 District Bahawalpur 12.2 399 Bahawalnagar 14.0 343 RY Khan 14.5 656 DG Khan 12.1 387 Layyah 15.0 225 Muzaffargarh 14.5 494 Rajanpur 17.0 277 Faisalabad 32.9 729 Chiniot 16.4 148 Jhang 23.7 257 TT Singh 30.4 218 Gujranwala 34.7 499 Gujrat 29.8 311 Hafizabad 23.1 128 Mandi Bahauddin 29.0 173 Narowal 40.4 214 Sialkot 40.3 378 Lahore 34.3 1,044 Kasur 28.1 363 Nankana Sahib 35.4 158 Sheikhupura 27.4 366 Multan 15.4 468 Khanewal 13.9 288 Lodhran 10.2 191 Vehari 14.3 301 Sahiwal 22.5 231 Pakpattan 28.0 215 Okara 23.3 368 Rawalpindi 49.5 484 Attock 42.6 184 Chakwal 49.4 131 Jhelum 42.2 100 Sargodha 33.6 320 Bhakkar 14.5 173 Khushab 23.1 141 Mianwali 13.1 166 1 MICS indicator 6.1 - Attendance to early childhood education P a g e | 293 Table D.CD.2: Support for learning Percentage of children age 36-59 months with whom adult household members engaged in activities that promote learning and school readiness during the last three days, and engagement in such activities by biological fathers and mothers, Punjab, 2014. Percentage of children with whom adult household members have engaged in four or more activities1 Mean number of activities with adult household members Percentage of children living with their: Number of children age 36-59 months Percentage of children with whom biological fathers have engaged in four or more activities2 Mean number of activities with biological fathers Number of children age 36-59 months living with their biological fathers Percentage of children with whom biological mothers have engaged in four or more activities3 Mean number of activities with biological mothers Number of children age 36-59 months living with their biological mothers Biological father Biological mother Punjab 35.0 2.8 91.3 98.5 11,527 2.6 0.8 10,525 11.8 1.3 11,349 District Bahawalpur 30.5 2.8 93.9 97.8 399 2.5 1.1 375 6.0 1.1 390 Bahawalnagar 18.3 2.6 93.9 98.8 343 0.9 0.9 322 3.3 0.7 339 RY Khan 17.0 2.5 95.5 98.8 656 0.6 0.8 626 1.8 0.6 648 DG Khan 20.9 2.2 83.9 99.0 387 1.3 0.6 325 10.5 0.9 384 Layyah 23.1 2.2 93.1 99.3 225 2.8 0.7 209 4.8 0.6 223 Muzaffargarh 23.8 2.3 89.6 97.6 494 1.4 0.5 443 6.5 0.7 482 Rajanpur 20.3 2.1 94.7 98.2 277 6.1 0.7 263 3.9 0.5 272 Faisalabad 52.6 3.6 94.8 99.3 729 3.0 0.9 692 17.1 1.8 725 Chiniot 38.5 3.1 96.7 96.5 148 0.3 0.8 143 11.2 1.4 143 Jhang 41.0 3.1 97.9 99.0 257 2.1 0.8 251 9.1 1.3 254 TT Singh 58.9 3.9 93.7 98.3 218 3.9 1.1 204 15.9 2.0 214 Gujranwala 44.1 3.3 87.2 98.9 499 2.9 0.9 435 13.6 1.4 493 Gujrat 41.6 3.0 67.0 98.8 311 1.4 0.7 208 22.0 1.9 307 Hafizabad 26.0 2.4 92.1 100.0 128 1.2 0.6 118 8.2 0.9 128 Mandi Bahauddin 26.6 2.3 79.6 98.3 173 2.5 0.7 137 4.9 1.0 170 Narowal 48.0 3.4 72.9 98.0 214 0.7 0.6 156 18.2 1.7 210 Sialkot 49.1 3.3 78.7 99.3 378 3.7 0.6 298 17.3 1.6 376 Lahore 46.1 3.2 94.9 98.9 1,044 4.4 1.1 991 25.8 2.1 1,033 Kasur 42.4 2.9 96.5 98.9 363 3.6 1.1 351 19.6 1.7 359 Nankana Sahib 28.0 2.6 89.4 97.3 158 2.1 0.7 141 4.8 0.9 154 Sheikhupura 39.7 3.1 92.8 97.0 366 3.8 0.8 339 11.0 1.2 355 Multan 25.8 2.4 95.3 98.9 468 1.8 0.9 445 8.2 1.0 462 Khanewal 20.5 2.3 94.8 98.3 288 0.5 0.7 273 1.9 0.7 284 Lodhran 12.9 1.9 97.4 99.3 191 1.6 0.7 186 1.1 0.6 190 Vehari 19.2 2.2 91.3 96.7 301 1.5 0.8 274 4.6 0.9 290 P a g e | 294 Table D.CD.2: Support for learning Percentage of children age 36-59 months with whom adult household members engaged in activities that promote learning and school readiness during the last three days, and engagement in such activities by biological fathers and mothers, Punjab, 2014. Percentage of children with whom adult household members have engaged in four or more activities1 Mean number of activities with adult household members Percentage of children living with their: Number of children age 36-59 months Percentage of children with whom biological fathers have engaged in four or more activities2 Mean number of activities with biological fathers Number of children age 36-59 months living with their biological fathers Percentage of children with whom biological mothers have engaged in four or more activities3 Mean number of activities with biological mothers Number of children age 36-59 months living with their biological mothers Biological father Biological mother Sahiwal 38.8 2.8 91.1 96.8 231 4.7 1.0 211 7.0 1.0 224 Pakpattan 32.6 2.7 93.7 98.5 215 2.9 0.9 202 2.7 0.8 212 Okara 34.7 2.6 93.3 97.3 368 2.5 0.9 343 5.9 1.1 358 Rawalpindi 58.2 3.6 89.7 98.7 484 3.3 1.0 434 28.9 2.1 478 Attock 40.9 3.0 90.2 99.8 184 2.7 0.8 166 17.0 1.5 183 Chakwal 41.2 3.1 84.9 100.0 131 1.3 0.7 112 14.0 1.6 131 Jhelum 43.4 3.2 84.5 98.0 100 2.8 0.9 84 18.2 1.8 98 Sargodha 32.5 2.7 96.9 98.2 320 3.2 0.8 310 11.3 1.4 314 Bhakkar 17.8 1.8 98.8 99.3 173 2.2 0.8 170 4.8 1.0 171 Khushab 24.8 2.4 93.0 95.1 141 3.7 0.8 131 5.1 1.0 134 Mianwali 23.6 2.1 94.2 97.4 166 2.3 0.7 156 6.7 1.0 161 Punjab 35.0 2.8 91.3 98.5 11,527 2.6 0.8 10,525 11.8 1.3 11,349 1 MICS indicator 6.2 - Support for learning 2 MICS Indicator 6.3 - Father’s support for learning 3 MICS Indicator 6.4 - Mother’s support for learning a The background characteristic "Mother's education" refers to the education level of the respondent to the Questionnaire for Children Under Five, and covers both mothers and primary caretakers, who are interviewed when the mother is not listed in the same household. Since indicator 6.4 reports on the biological mother's support for learning, this background characteristic refers to only the educational levels of biological mothers when calculated for the indicator in question. P a g e | 295 Table D.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, Punjab, 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 Homemade toys Toys from a shop/ manufactured toys Household objects/objects found outside Two or more types of playthings2 Punjab 7.6 0.3 27.3 64.7 61.5 52.5 27,495 District Bahawalpur 3.1 0.4 14.9 48.2 53.9 30.4 912 Bahawalnagar 1.7 0.0 13.8 48.3 59.2 32.1 751 RY Khan 1.5 0.0 10.8 46.0 65.7 35.3 1,417 DG Khan 3.5 0.3 58.5 43.6 71.6 60.2 898 Layyah 3.4 0.0 60.1 47.2 63.9 59.8 514 Muzaffargarh 2.8 0.0 58.1 43.8 64.8 57.4 1,118 Rajanpur 1.8 0.0 52.7 35.0 66.2 50.4 621 Faisalabad 3.4 0.3 23.8 77.0 63.8 61.1 1,807 Chiniot 1.2 0.2 23.4 70.9 69.2 60.6 335 Jhang 0.9 0.0 45.9 68.7 73.7 70.8 626 TT Singh 2.7 0.1 48.9 74.1 67.8 69.3 503 Gujranwala 13.0 0.2 29.5 74.6 59.8 56.0 1,210 Gujrat 8.6 0.2 15.7 82.2 52.7 54.0 744 Hafizabad 5.1 0.0 16.0 67.1 69.9 55.4 310 Mandi Bahauddin 9.3 0.0 17.5 77.0 67.5 62.5 401 Narowal 14.6 0.0 32.1 74.2 58.8 56.5 529 Sialkot 19.6 0.4 30.6 81.8 62.0 59.9 906 Lahore 16.4 0.6 11.1 79.9 47.2 45.2 2,467 Kasur 10.8 1.0 27.7 65.8 65.9 54.7 898 Nankana Sahib 9.5 0.0 16.1 74.5 64.0 54.8 418 Sheikhupura 12.6 0.4 19.7 81.4 63.6 63.3 887 Multan 4.4 0.2 27.6 42.9 54.6 37.3 1,179 Khanewal 1.9 0.1 27.6 46.3 60.0 45.4 720 Lodhran 1.4 0.0 17.0 44.4 60.8 39.1 451 Vehari 2.7 0.0 16.3 54.8 71.9 50.2 668 Sahiwal 4.1 0.0 36.2 70.5 75.3 63.0 628 Pakpattan 2.6 0.2 34.2 70.4 78.6 66.5 526 Okara 4.1 0.3 34.1 66.8 74.1 62.9 878 Rawalpindi 23.3 0.9 26.8 81.0 44.7 46.0 1,180 Attock 19.0 0.6 28.1 74.7 54.7 56.8 429 Chakwal 21.1 0.0 22.7 80.4 52.4 50.7 310 Jhelum 17.8 0.3 22.5 77.9 55.8 57.7 246 Sargodha 1.9 0.0 24.5 68.6 52.0 52.0 823 Bhakkar 0.5 0.0 25.0 48.7 66.2 45.5 416 Khushab 1.7 0.2 21.2 65.0 70.8 61.6 325 Mianwali 1.1 0.0 23.2 70.1 73.7 64.3 440 1 MICS indicator 6.5 - Availability of children’s books 2 MICS indicator 6.6 - Availability of playthings P a g e | 296 Table D.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, Punjab, 2014. Percentage of children under age 5: Number 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 Punjab 4.6 3.7 6.8 27,495 District Bahawalpur 5.7 3.6 8.7 912 Bahawalnagar 2.5 3.5 5.9 751 RY Khan 0.2 1.0 1.1 1,417 DG Khan 4.1 4.8 5.5 898 Layyah 1.7 1.9 3.3 514 Muzaffargarh 3.3 5.9 7.6 1,118 Rajanpur 8.0 8.7 11.0 621 Faisalabad 4.5 2.3 5.3 1,807 Chiniot 0.4 1.1 1.3 335 Jhang 3.2 2.9 4.6 626 TT Singh 2.8 3.2 3.4 503 Gujranwala 7.6 6.2 11.8 1,210 Gujrat 1.6 1.2 2.4 744 Hafizabad 0.3 1.9 1.9 310 Mandi Bahauddin 0.9 0.2 1.1 401 Narowal 5.7 6.8 10.1 529 Sialkot 14.2 6.1 19.0 906 Lahore 1.6 2.2 3.1 2,467 Kasur 4.0 3.8 5.5 898 Nankana Sahib 1.3 3.2 3.5 418 Sheikhupura 4.9 1.7 6.2 887 Multan 3.6 2.4 5.0 1,179 Khanewal 2.9 2.7 3.8 720 Lodhran 0.9 2.1 2.6 451 Vehari 3.9 3.7 5.4 668 Sahiwal 11.5 9.2 16.3 628 Pakpattan 8.6 7.6 12.3 526 Okara 11.6 9.5 15.8 878 Rawalpindi 10.1 3.6 12.3 1,180 Attock 6.8 3.1 8.7 429 Chakwal 9.0 1.3 9.8 310 Jhelum 5.7 0.6 5.7 246 Sargodha 5.4 4.3 8.5 823 Bhakkar 0.4 3.0 3.0 416 Khushab 0.8 2.7 2.9 325 Mianwali 0.2 0.4 0.6 440 1 MICS indicator 6.7 - Inadequate care P a g e | 297 Table D.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, Punjab, 2014. Percentage of children age 36-59 months who are developmentally on track for indicated domains Early child development index score1 Percentage of children not on track in any of the four domains Number of children age 36-59 months Literacy- numeracy Physical Social- Emotional Learning Punjab 25.1 97.7 62.2 93.6 67.2 1.0 11,527 District Bahawalpur 23.8 94.8 60.8 90.4 65.1 1.2 399 Bahawalnagar 13.3 96.9 59.4 90.1 57.5 1.4 343 RY Khan 12.3 97.4 59.5 94.1 61.4 1.3 656 DG Khan 20.2 96.8 57.6 86.7 54.9 0.5 387 Layyah 11.3 99.0 51.7 90.2 53.8 0.3 225 Muzaffargarh 14.1 98.7 52.3 88.0 53.0 0.5 494 Rajanpur 11.8 98.8 45.6 95.1 48.0 0.1 277 Faisalabad 32.1 98.1 76.3 95.1 81.0 1.3 729 Chiniot 11.2 100.0 73.5 98.4 75.2 0.0 148 Jhang 20.8 98.2 54.9 91.3 58.3 1.0 257 TT Singh 20.0 97.5 57.6 93.0 62.0 2.5 218 Gujranwala 31.8 97.7 45.5 97.4 60.7 1.2 499 Gujrat 26.1 97.2 57.8 95.2 66.6 2.8 311 Hafizabad 20.3 98.1 63.5 96.6 68.4 0.3 128 Mandi Bahauddin 24.9 98.0 75.0 96.5 77.9 1.0 173 Narowal 12.0 98.2 69.2 94.7 70.0 1.0 214 Sialkot 29.0 95.8 58.7 94.1 70.0 2.5 378 Lahore 35.0 99.4 73.0 97.5 81.3 0.6 1,044 Kasur 23.8 99.0 56.8 93.1 61.0 0.2 363 Nankana Sahib 31.8 98.5 69.0 95.3 76.0 0.7 158 Sheikhupura 36.6 94.5 60.1 93.2 65.6 0.9 366 Multan 27.9 96.0 61.3 95.0 69.3 1.6 468 Khanewal 19.4 99.3 59.9 96.0 62.8 0.0 288 Lodhran 10.9 97.4 57.4 95.2 55.9 0.8 191 Vehari 19.4 96.5 62.7 96.2 62.1 0.4 301 Sahiwal 31.6 98.9 71.9 90.3 74.2 0.3 231 Pakpattan 27.6 99.4 66.1 87.0 70.0 0.2 215 Okara 32.4 97.9 57.3 89.7 62.9 1.5 368 Rawalpindi 49.3 94.5 63.1 94.5 75.1 0.4 484 Attock 34.8 95.3 62.2 89.9 71.7 2.7 184 Chakwal 33.3 97.9 54.6 91.6 65.5 0.8 131 Jhelum 25.0 98.5 61.4 95.9 72.2 0.8 100 Sargodha 31.1 98.6 62.7 92.3 72.3 0.6 320 Bhakkar 8.2 98.9 72.4 94.5 70.8 0.8 173 Khushab 13.5 100.0 63.2 96.3 65.5 0.0 141 Mianwali 10.9 99.3 88.3 96.7 88.3 0.7 166 1 MICS indicator 6.8 - Early child development index P a g e | 298 Table D.ED.1: Literacy (young women) Percentage of women age 15-24 years who are literate, Punjab, 2014. Percentage literate1 Percentage not known Number of women age 15-24 years Punjab 72.6 0.2 21,119 District Bahawalpur 52.3 1.1 624 Bahawalnagar 59.9 0.0 562 RY Khan 48.1 0.1 916 DG Khan 43.5 0.2 488 Layyah 65.2 0.0 311 Muzaffargarh 51.4 0.0 632 Rajanpur 37.1 0.0 252 Faisalabad 82.7 0.0 1,597 Chiniot 52.5 0.0 259 Jhang 61.9 0.6 441 TT Singh 81.2 0.0 435 Gujranwala 84.9 0.3 1,000 Gujrat 91.0 0.0 588 Hafizabad 76.8 0.5 253 Mandi Bahauddin 77.1 0.0 376 Narowal 85.5 0.0 384 Sialkot 93.1 0.0 844 Lahore 88.5 0.2 2,037 Kasur 70.0 0.0 685 Nankana Sahib 74.7 0.0 338 Sheikhupura 78.9 0.2 823 Multan 71.8 0.3 851 Khanewal 64.2 0.4 534 Lodhran 53.2 0.1 339 Vehari 71.1 0.2 583 Sahiwal 66.3 0.0 464 Pakpattan 58.8 0.0 402 Okara 63.4 0.0 575 Rawalpindi 89.0 0.4 983 Attock 77.3 0.0 364 Chakwal 90.8 0.3 286 Jhelum 87.6 0.0 252 Sargodha 70.0 0.2 699 Bhakkar 57.7 0.1 326 Khushab 61.7 0.0 279 Mianwali 58.4 0.3 338 1 MICS indicator 7.1; MDG indicator 2.3 - Literacy rate among young women P a g e | 299 Table D.ED.2: School readiness Percentage of children attending first grade of primary school who attended pre-school the previous year, Punjab, 2014. Percentage of children attending first grade who attended preschool in previous year1 Number of children attending first grade of primary school Punjab 92.5 6,231 District Bahawalpur 86.3 221 Bahawalnagar 88.3 161 RY Khan 94.8 225 DG Khan 90.2 144 Layyah 94.2 102 Muzaffargarh 93.8 175 Rajanpur 94.9 81 Faisalabad 92.3 436 Chiniot 91.7 66 Jhang 92.4 138 TT Singh 98.8 121 Gujranwala 92.8 264 Gujrat 96.2 203 Hafizabad 97.5 77 Mandi Bahauddin 96.3 111 Narowal 94.2 108 Sialkot 94.7 236 Lahore 95.2 621 Kasur 85.5 214 Nankana Sahib 91.4 111 Sheikhupura 90.1 240 Multan 88.6 328 Khanewal 89.8 180 Lodhran 96.0 115 Vehari 96.6 180 Sahiwal 96.8 112 Pakpattan 98.0 102 Okara 92.9 171 Rawalpindi 88.3 273 Attock 89.9 97 Chakwal 91.1 85 Jhelum 93.5 76 Sargodha 88.6 193 Bhakkar 97.9 86 Khushab 92.7 80 Mianwali 96.3 95 1 MICS indicator 7.2 - School readiness P a g e | 300 Table D.ED.2A: Pre-school attendance Percentage of children of aged 3-4 years attending pre-school, Punjab, 2014. Male Female Total Pre-school attendance Number of children age 3-4 years Pre-school attendance Number of children age 3-4 years Pre-school attendance Number of children age 3-4 years Punjab 37.2 6,418 37.4 6,173 37.3 12,591 District Bahawalpur 19.9 214 27.0 218 23.5 432 Bahawalnagar 26.5 204 18.1 161 22.8 364 RY Khan 21.6 341 22.1 305 21.9 647 DG Khan 11.3 212 17.0 201 14.1 413 Layyah 26.2 133 25.4 117 25.8 250 Muzaffargarh 21.5 287 19.9 267 20.7 554 Rajanpur 27.2 156 18.1 131 23.0 287 Faisalabad 42.9 423 45.0 388 43.9 810 Chiniot 25.0 77 35.6 72 30.2 149 Jhang 27.9 141 28.7 150 28.4 291 TT Singh 39.2 131 41.9 99 40.3 230 Gujranwala 47.5 268 48.2 286 47.9 554 Gujrat 54.5 159 60.6 169 57.6 327 Hafizabad 33.5 67 49.3 70 41.6 137 Mandi Bahauddin 49.3 111 51.5 88 50.3 199 Narowal 54.0 118 40.4 117 47.2 234 Sialkot 54.0 185 54.2 220 54.1 405 Lahore 46.8 538 46.9 572 46.8 1,109 Kasur 32.4 187 37.4 201 35.0 388 Nankana Sahib 53.6 93 41.2 95 47.3 188 Sheikhupura 45.0 200 34.0 197 39.5 397 Multan 28.9 295 24.6 279 26.8 575 Khanewal 27.3 167 26.1 168 26.7 336 Lodhran 21.9 114 27.8 84 24.4 199 Vehari 35.0 174 34.6 161 34.8 335 Sahiwal 41.8 104 38.1 139 39.7 243 Pakpattan 43.5 129 40.2 113 42.0 242 Okara 37.2 227 32.7 176 35.2 403 Rawalpindi 58.0 265 52.9 284 55.4 549 Attock 47.0 100 46.3 91 46.7 191 Chakwal 65.3 68 53.8 65 59.7 133 Jhelum 58.0 58 50.4 48 54.5 106 Sargodha 40.1 185 53.0 180 46.5 365 Bhakkar 30.4 99 31.4 102 30.9 201 Khushab 38.0 83 34.9 73 36.5 156 Mianwali 38.7 108 45.0 84 41.4 192 P a g e | 301 Table D.ED.3: Primary school entry Percentage of children of primary school entry age entering grade 1 (net intake rate) and percentage of children age 6 years entering grade 1, Punjab, 2014. Percentage of children of primary school entry age entering grade 11 Number of children of primary school entry age (5 years old) Percentage of children age 6 years entering grade 1 Number of children age 6 years Punjab 23.4 6,396 46.1 6,594 District Bahawalpur 21.6 217 38.0 261 Bahawalnagar 17.3 167 35.2 207 RY Khan 15.9 261 25.4 349 DG Khan 7.9 214 22.9 249 Layyah 14.8 102 37.8 132 Muzaffargarh 10.6 275 23.4 312 Rajanpur 10.9 124 18.0 156 Faisalabad 28.0 376 58.9 378 Chiniot 15.5 89 35.7 81 Jhang 19.7 140 39.9 176 TT Singh 33.4 90 56.2 123 Gujranwala 28.5 275 58.6 272 Gujrat 32.8 177 73.7 191 Hafizabad 24.4 73 51.5 68 Mandi Bahauddin 26.7 84 55.0 92 Narowal 29.0 126 54.6 104 Sialkot 32.7 215 68.3 198 Lahore 22.5 637 56.2 576 Kasur 24.8 210 45.9 210 Nankana Sahib 20.1 100 51.7 102 Sheikhupura 25.2 211 46.2 185 Multan 18.7 345 39.7 295 Khanewal 23.2 187 41.3 191 Lodhran 26.5 105 36.7 118 Vehari 21.6 166 47.9 189 Sahiwal 22.1 131 48.4 145 Pakpattan 18.1 117 40.7 123 Okara 19.3 205 38.9 207 Rawalpindi 29.8 259 62.0 236 Attock 40.2 97 58.4 93 Chakwal 45.1 77 70.8 70 Jhelum 43.7 65 79.7 61 Sargodha 35.5 202 49.0 173 Bhakkar 19.1 99 37.6 105 Khushab 25.6 71 55.6 83 Mianwali 23.8 106 52.8 84 1 MICS indicator 7.3 - Net intake rate in primary education P a g e | 302 Table D.ED.4: Primary school net attendance and out of school children Percentage of children of primary school age attending primary or secondary school (adjusted net attendance ratio), percentage attending preschool, and percentage out of school, Punjab, 2014. Male Female Total Net attendance ratio (adjusted) Percentage of children: Number of children Net attendance ratio (adjusted) Percentage of children: Number of children Net attendance ratio (adjusted)1 Percentage of children: Number of children Not attending school or preschool Attending preschool Out of schoola Not attending school or preschool Attending preschool Out of schoola Not attending school or preschool Attending preschool Out of schoola Punjab 58.9 16.8 24.2 41.0 16,255 56.8 21.5 21.4 42.9 15,392 57.9 19.1 22.9 41.9 31,647 District Bahawalpur 48.5 33.1 18.2 51.2 588 45.3 39.0 15.3 54.3 554 47.0 35.9 16.8 52.7 1,142 Bahawalnagar 54.9 18.8 26.3 45.1 490 45.2 34.8 20.0 54.8 449 50.3 26.4 23.3 49.7 939 RY Khan 43.2 38.0 18.9 56.8 855 33.4 50.9 15.7 66.6 746 38.6 44.0 17.4 61.4 1,601 DG Khan 33.9 40.1 25.7 65.8 601 32.2 49.0 18.8 67.7 517 33.1 44.2 22.5 66.7 1,119 Layyah 51.0 19.0 30.0 49.0 291 46.1 24.1 29.7 53.8 283 48.6 21.5 29.9 51.4 574 Muzaffargarh 39.3 32.8 27.9 60.7 730 36.0 43.5 20.6 64.0 703 37.7 38.0 24.3 62.3 1,433 Rajanpur 42.0 32.9 25.0 58.0 376 21.4 63.1 15.3 78.5 374 31.7 48.0 20.2 68.2 750 Faisalabad 65.5 11.1 23.4 34.5 989 70.9 8.5 20.5 29.0 896 68.1 9.8 22.0 31.9 1,885 Chiniot 55.4 19.0 25.6 44.6 208 46.0 29.9 24.1 54.0 214 50.6 24.5 24.9 49.4 422 Jhang 56.6 17.9 25.3 43.2 369 47.9 30.7 21.1 51.8 393 52.1 24.5 23.1 47.7 762 TT Singh 69.6 5.6 24.9 30.4 301 69.6 9.7 20.7 30.4 270 69.6 7.6 22.9 30.4 570 Gujranwala 71.8 5.3 22.8 28.2 679 67.8 6.4 25.8 32.2 626 69.9 5.8 24.3 30.1 1,305 Gujrat 71.2 5.3 23.5 28.8 409 79.3 2.0 18.7 20.7 395 75.2 3.7 21.1 24.8 804 Hafizabad 66.5 8.8 24.7 33.5 175 60.7 11.6 27.4 39.0 179 63.6 10.2 26.1 36.3 354 Mandi Bahauddin 67.3 7.5 25.3 32.7 193 68.7 7.4 23.9 31.3 209 68.0 7.4 24.5 32.0 402 Narowal 70.0 7.0 23.0 30.0 273 68.8 3.7 26.7 30.3 280 69.4 5.3 24.9 30.2 553 Sialkot 72.8 6.5 20.7 27.2 528 74.2 5.0 20.8 25.8 506 73.5 5.8 20.8 26.5 1,034 Lahore 65.1 6.8 28.1 34.9 1,372 64.8 8.1 27.0 35.2 1,379 64.9 7.5 27.5 35.0 2,751 Kasur 58.1 16.5 25.2 41.8 528 62.2 14.7 22.8 37.6 502 60.1 15.7 24.0 39.7 1,030 Nankana Sahib 64.6 9.8 25.6 35.4 245 66.6 8.9 24.5 33.4 240 65.6 9.4 25.1 34.4 484 Sheikhupura 62.8 12.6 24.1 36.7 557 67.5 10.0 22.2 32.3 482 65.0 11.4 23.3 34.6 1,039 Multan 53.5 22.2 24.0 46.2 779 52.3 25.8 20.3 46.1 725 52.9 23.9 22.2 46.2 1,504 Khanewal 58.6 20.5 20.7 41.2 501 50.7 29.1 19.7 48.8 461 54.8 24.6 20.2 44.8 962 Lodhran 53.1 26.0 20.6 46.6 287 44.8 36.3 18.9 55.2 283 49.0 31.1 19.8 50.9 570 Vehari 58.5 19.0 22.3 41.3 444 56.8 24.1 19.1 43.2 403 57.7 21.4 20.7 42.2 848 Sahiwal 56.3 15.6 28.1 43.7 343 61.7 18.7 19.6 38.3 327 59.0 17.1 23.9 41.0 670 Pakpattan 54.2 14.8 31.1 45.8 310 51.7 19.4 28.8 48.3 285 53.0 17.0 30.0 47.0 595 Okara 52.9 19.6 27.3 46.9 520 51.3 24.3 24.0 48.3 488 52.1 21.9 25.7 47.6 1,007 P a g e | 303 Table D.ED.4: Primary school net attendance and out of school children Percentage of children of primary school age attending primary or secondary school (adjusted net attendance ratio), percentage attending preschool, and percentage out of school, Punjab, 2014. Male Female Total Net attendance ratio (adjusted) Percentage of children: Number of children Net attendance ratio (adjusted) Percentage of children: Number of children Net attendance ratio (adjusted)1 Percentage of children: Number of children Not attending school or preschool Attending preschool Out of schoola Not attending school or preschool Attending preschool Out of schoola Not attending school or preschool Attending preschool Out of schoola Rawalpindi 73.7 3.1 22.8 26.0 612 72.7 5.7 20.7 26.4 577 73.2 4.4 21.8 26.2 1,189 Attock 75.3 7.9 16.8 24.7 243 72.5 7.9 19.6 27.5 220 74.0 7.9 18.1 26.0 463 Chakwal 81.3 2.9 15.9 18.7 175 78.9 3.7 17.5 21.1 175 80.1 3.3 16.7 19.9 350 Jhelum 80.9 2.3 16.8 19.1 143 79.7 5.3 15.0 20.3 153 80.3 3.8 15.9 19.7 296 Sargodha 63.9 8.5 27.0 35.5 454 67.3 11.5 21.0 32.6 449 65.6 10.0 24.1 34.1 903 Bhakkar 53.5 19.9 26.4 46.3 266 45.9 32.1 22.0 54.1 236 49.9 25.6 24.4 50.0 503 Khushab 68.0 10.1 21.8 31.9 185 61.1 16.1 22.9 38.9 173 64.6 13.0 22.3 35.3 358 Mianwali 63.8 7.1 29.1 36.2 236 56.5 22.6 20.9 43.5 239 60.1 14.9 25.0 39.9 475 Punjab 58.9 16.8 24.2 41.0 16,255 56.8 21.5 21.4 42.9 15,392 57.9 19.1 22.9 41.9 31,647 1 MICS indicator 7.4; MDG indicator 2.1 - Primary school net attendance ratio (adjusted) a The percentage of children of primary school age out of school are those not attending school and those attending preschool P a g e | 304 Table D.ED.4B: Primary school gross attendance ratio (5-9) years Percentage of children of all ages attending primary school or secondary school (adjusted gross attandance), Punjab, 2014. Male Female Total Gross attendance ratio (adjusted) Number of children Gross attendance ratio (adjusted) Number of children Gross attendance ratio (adjusted) Number of children Punjab 89.8 16,255 82.1 15,392 86.1 31,647 District Bahawalpur 80.6 588 64.2 554 72.6 1,142 Bahawalnagar 87.8 490 69.3 449 79.0 939 RY Khan 69.0 855 52.9 746 61.5 1,601 DG Khan 61.3 601 54.4 517 58.1 1,119 Layyah 86.1 291 71.2 283 78.8 574 Muzaffargarh 64.7 730 54.6 703 59.8 1,433 Rajanpur 69.5 376 32.6 374 51.1 750 Faisalabad 98.4 989 101.5 896 99.9 1,885 Chiniot 92.0 208 67.2 214 79.4 422 Jhang 86.9 369 76.3 393 81.4 762 TT Singh 97.0 301 101.4 270 99.1 570 Gujranwala 102.8 679 96.6 626 99.8 1,305 Gujrat 100.6 409 108.7 395 104.6 804 Hafizabad 106.9 175 88.7 179 97.7 354 Mandi Bahauddin 106.5 193 101.9 209 104.1 402 Narowal 97.4 273 106.4 280 102.0 553 Sialkot 104.6 528 105.0 506 104.8 1,034 Lahore 97.1 1,372 90.8 1,379 94.0 2,751 Kasur 89.8 528 86.7 502 88.3 1,030 Nankana Sahib 98.0 245 92.4 240 95.3 484 Sheikhupura 92.5 557 101.5 482 96.6 1,039 Multan 82.9 779 75.0 725 79.1 1,504 Khanewal 90.4 501 73.7 461 82.4 962 Lodhran 84.9 287 63.0 283 74.0 570 Vehari 87.9 444 86.2 403 87.1 848 Sahiwal 86.9 343 84.3 327 85.6 670 Pakpattan 85.7 310 78.1 285 82.1 595 Okara 80.3 520 75.6 488 78.0 1,007 Rawalpindi 105.3 612 95.9 577 100.7 1,189 Attock 109.4 243 102.3 220 106.0 463 Chakwal 109.3 175 102.6 175 106.0 350 Jhelum 120.2 143 102.0 153 110.8 296 Sargodha 98.4 454 98.9 449 98.6 903 Bhakkar 83.9 266 64.6 236 74.8 503 Khushab 104.0 185 85.8 173 95.2 358 Mianwali 100.9 236 80.9 239 90.8 475 P a g e | 305 Table D.ED.5: Secondary school attendance and out of school children Percentage of children of secondary school age attending secondary school or higher (adjusted net attendance ratio), percentage attending primary school, and percentage out of school, Punjab, 2014. Male Female Total Net attendance ratio (adjusted) Percentage of children: Number of children Net attendance ratio (adjusted) Percentage of children: Number of children Net attendance ratio (adjusted)1 Percentage of children: Number of children Attending primary school Out of schoola Attending primary school Out of schoola Attending primary school Out of schoola Punjab 42.6 33.5 23.8 14,454 41.7 27.5 30.7 13,560 42.1 30.6 27.2 28,014 District Bahawalpur 27.6 33.7 38.6 505 31.5 24.0 44.2 412 29.3 29.4 41.1 916 Bahawalnagar 32.1 35.6 32.3 418 31.3 26.7 41.6 377 31.7 31.4 36.7 795 RY Khan 26.6 30.5 42.9 705 21.2 21.5 57.3 675 23.9 26.1 50.0 1,379 DG Khan 26.0 33.6 40.0 434 20.9 25.4 53.6 422 23.5 29.6 46.7 856 Layyah 37.5 40.5 22.0 243 34.1 27.6 38.3 247 35.8 34.0 30.2 490 Muzaffargarh 35.2 32.2 32.6 559 24.9 24.5 50.6 550 30.1 28.4 41.5 1,109 Rajanpur 22.7 33.9 43.3 305 15.4 14.2 70.2 298 19.1 24.2 56.6 603 Faisalabad 50.0 30.4 19.6 1,008 51.0 29.6 19.3 902 50.5 30.0 19.5 1,910 Chiniot 38.0 39.2 22.8 191 26.0 27.7 46.3 154 32.7 34.0 33.3 344 Jhang 44.4 30.8 24.8 352 28.1 30.5 41.4 344 36.3 30.7 33.0 696 TT Singh 48.7 29.3 22.0 296 46.5 31.4 22.0 255 47.7 30.3 22.0 552 Gujranwala 47.3 34.2 18.6 598 56.5 30.3 13.1 575 51.8 32.3 15.9 1,173 Gujrat 57.2 31.7 11.1 386 61.4 31.6 7.0 349 59.2 31.7 9.2 735 Hafizabad 42.6 39.9 17.3 164 43.4 31.6 25.0 156 43.0 35.9 21.0 320 Mandi Bahauddin 39.7 36.8 23.5 190 50.0 29.0 21.0 207 45.1 32.7 22.2 397 Narowal 58.3 32.9 8.7 227 49.3 40.6 10.1 237 53.7 36.8 9.4 464 Sialkot 52.3 31.8 15.7 521 60.3 28.1 11.6 551 56.4 29.9 13.6 1,072 Lahore 50.9 31.4 17.6 1,358 58.2 27.5 14.1 1,239 54.4 29.6 16.0 2,597 Kasur 40.1 36.1 23.8 475 39.6 28.5 31.6 378 39.9 32.7 27.2 852 Nankana Sahib 36.6 37.4 26.1 202 46.6 29.8 23.3 201 41.6 33.6 24.7 403 Sheikhupura 47.9 34.4 17.7 472 47.9 29.7 22.4 535 47.9 31.9 20.2 1,006 Multan 37.2 36.3 26.2 625 33.8 27.0 39.2 615 35.5 31.7 32.6 1,241 Khanewal 35.0 38.5 26.5 409 34.4 24.9 40.4 404 34.7 31.8 33.4 812 Lodhran 33.3 33.3 32.8 253 23.8 22.2 54.0 232 28.7 28.0 42.9 484 Vehari 36.3 35.2 28.4 367 38.9 30.4 30.7 368 37.6 32.8 29.5 736 Sahiwal 40.7 32.8 26.5 321 40.8 24.6 34.4 291 40.7 28.9 30.3 612 Pakpattan 32.4 38.4 29.2 249 28.5 31.4 40.1 221 30.6 35.1 34.3 470 Okara 39.8 33.3 26.5 406 34.1 29.6 36.3 384 37.0 31.5 31.3 790 P a g e | 306 Table D.ED.5: Secondary school attendance and out of school children Percentage of children of secondary school age attending secondary school or higher (adjusted net attendance ratio), percentage attending primary school, and percentage out of school, Punjab, 2014. Male Female Total Net attendance ratio (adjusted) Percentage of children: Number of children Net attendance ratio (adjusted) Percentage of children: Number of children Net attendance ratio (adjusted)1 Percentage of children: Number of children Attending primary school Out of schoola Attending primary school Out of schoola Attending primary school Out of schoola Rawalpindi 56.6 32.4 11.0 574 61.5 23.1 15.1 533 59.0 27.9 13.0 1,107 Attock 57.6 33.2 8.8 224 44.4 30.6 24.3 206 51.2 31.9 16.3 430 Chakwal 60.2 30.0 9.1 160 67.0 24.0 8.6 170 63.7 26.9 8.9 330 Jhelum 54.3 33.0 12.7 159 56.1 28.5 15.3 123 55.1 31.1 13.8 282 Sargodha 44.3 31.0 24.3 484 43.6 33.9 22.0 407 44.0 32.3 23.3 891 Bhakkar 39.7 35.7 24.6 218 28.6 22.5 48.5 186 34.6 29.6 35.6 403 Khushab 46.2 39.8 14.0 166 38.1 24.9 37.0 155 42.3 32.6 25.1 321 Mianwali 55.2 36.4 8.4 232 29.8 26.9 43.3 201 43.4 32.0 24.6 432 Punjab 42.6 33.5 23.8 14,454 41.7 27.5 30.7 13,560 42.1 30.6 27.2 28,014 1 MICS indicator 7.5 - Secondary school net attendance ratio (adjusted) a The percentage of children of secondary school age out of school are those who are not attending primary, secondary, or higher education P a g e | 307 Table D.ED.6: 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), Punjab, 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 attending grade 4 last school year who are attending grade 5 this school year Percent who reach grade 5 of those who enter grade 11 Punjab 99.5 99.2 98.7 98.3 95.8 District Bahawalpur 99.6 98.5 99.2 100.0 97.3 Bahawalnagar 99.1 99.3 98.1 98.2 94.8 RY Khan 100.0 100.0 100.0 100.0 100.0 DG Khan 100.0 98.5 99.5 96.3 94.4 Layyah 100.0 99.2 100.0 100.0 99.2 Muzaffargarh 100.0 99.4 97.9 97.1 94.5 Rajanpur 98.8 96.4 100.0 100.0 95.2 Faisalabad 99.1 100.0 97.3 99.3 95.8 Chiniot 100.0 98.7 98.6 98.0 95.4 Jhang 99.5 99.3 97.0 96.2 92.3 TT Singh 100.0 100.0 100.0 100.0 100.0 Gujranwala 99.7 97.8 99.7 97.8 95.1 Gujrat 99.6 99.5 100.0 98.9 98.0 Hafizabad 99.3 99.1 99.4 97.7 95.5 Mandi Bahauddin 99.0 98.5 98.5 97.7 93.8 Narowal 100.0 100.0 99.4 100.0 99.4 Sialkot 99.5 100.0 98.0 99.1 96.6 Lahore 99.6 100.0 99.0 99.2 97.8 Kasur 99.3 98.5 98.5 96.8 93.2 Nankana Sahib 99.1 100.0 98.9 100.0 98.0 Sheikhupura 99.3 99.0 95.7 98.0 92.2 Multan 99.4 98.4 99.1 97.9 94.9 Khanewal 100.0 99.0 97.9 98.2 95.2 Lodhran 99.7 96.6 98.2 95.5 90.3 Vehari 97.7 99.0 99.6 99.1 95.5 Sahiwal 98.5 99.2 99.2 98.3 95.2 Pakpattan 100.0 100.0 97.1 97.4 94.6 Okara 99.5 98.7 99.1 95.6 93.0 Rawalpindi 99.6 100.0 99.2 98.8 97.7 Attock 99.1 100.0 98.4 96.6 94.3 Chakwal 100.0 98.5 100.0 99.0 97.5 Jhelum 100.0 100.0 99.1 99.3 98.4 Sargodha 99.5 97.8 98.8 96.9 93.1 Bhakkar 99.2 98.7 100.0 97.4 95.3 Khushab 100.0 97.1 98.4 95.7 91.5 Mianwali 100.0 99.6 98.8 98.5 97.0 1 MICS indicator 7.6; MDG indicator 2.2 - Children reaching last grade of primary P a g e | 308 Table D.ED.7: Primary school completion and transition to secondary school Primary school completion rates and transition and effective transition rates to secondary school, Punjab, 2014. Primary school completion rate1 Number of children of primary school completion age Transition rate to secondary school2 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 Punjab 74.9 5,872 91.4 3,946 92.5 3,899 District Bahawalpur 62.7 197 87.1 89 89.5 87 Bahawalnagar 66.6 174 88.8 105 91.1 102 RY Khan 49.2 301 97.1 97 98.3 96 DG Khan 55.8 192 95.3 69 95.3 69 Layyah 70.0 99 95.0 61 96.2 60 Muzaffargarh 55.1 264 92.4 123 92.4 123 Rajanpur 30.1 157 98.4 57 98.4 57 Faisalabad 83.3 382 91.3 294 92.6 290 Chiniot 64.8 77 91.6 33 91.6 33 Jhang 76.1 138 85.2 89 87.2 87 TT Singh 76.5 107 93.4 98 94.1 97 Gujranwala 75.9 255 89.3 192 91.7 187 Gujrat 92.2 148 97.0 149 98.4 146 Hafizabad 103.6 67 90.8 47 92.5 46 Mandi Bahauddin 91.2 79 92.8 63 94.7 62 Narowal 96.1 98 97.7 79 97.7 79 Sialkot 106.9 191 93.6 187 93.6 187 Lahore 93.6 504 94.2 405 94.2 405 Kasur 68.5 195 84.9 139 85.7 138 Nankana Sahib 81.9 84 95.9 66 96.8 66 Sheikhupura 86.6 206 92.5 161 93.6 159 Multan 62.4 277 84.9 142 85.9 141 Khanewal 48.5 196 92.2 94 92.7 93 Lodhran 49.8 106 90.0 50 93.4 48 Vehari 78.8 148 92.9 96 93.5 96 Sahiwal 78.4 126 92.3 87 94.2 86 Pakpattan 58.4 115 82.5 59 85.3 57 Okara 69.4 187 90.3 111 90.3 111 Rawalpindi 89.1 214 90.0 210 91.0 207 Attock 98.8 86 92.2 80 95.4 77 Chakwal 105.6 59 93.5 59 93.5 59 Jhelum 118.2 53 88.3 53 91.9 51 Sargodha 89.4 169 88.7 138 89.2 138 Bhakkar 70.2 78 94.2 49 96.4 48 Khushab 85.6 66 80.5 55 83.3 53 Mianwali 86.6 78 86.8 59 88.3 58 1 MICS indicator 7.7 - Primary completion rate 2 MICS indicator 7.8 - Transition rate to secondary school P a g e | 309 Table D.ED.8: Education gender parity index (GPI) Ratio of adjusted net attendance ratios of girls to boys, in primary and secondary school, Punjab, 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 Punjab 56.8 58.9 0.97 41.2 42.2 0.98 District Bahawalpur 45.3 48.5 0.93 30.8 27.4 1.12 Bahawalnagar 45.2 54.9 0.82 30.9 31.5 0.98 RY Khan 33.4 43.2 0.77 20.1 26.0 0.77 DG Khan 32.2 33.9 0.95 20.3 25.5 0.80 Layyah 46.1 51.0 0.90 34.1 37.4 0.91 Muzaffargarh 36.0 39.3 0.92 24.7 34.1 0.72 Rajanpur 21.4 42.0 0.51 14.9 22.6 0.66 Faisalabad 70.9 65.5 1.08 50.7 49.7 1.02 Chiniot 46.0 55.4 0.83 25.5 38.0 0.67 Jhang 47.9 56.6 0.85 28.1 44.4 0.63 TT Singh 69.6 69.6 1.00 45.3 48.6 0.93 Gujranwala 67.8 71.8 0.94 56.2 47.0 1.20 Gujrat 79.3 71.2 1.11 61.2 57.1 1.07 Hafizabad 60.7 66.5 0.91 42.5 42.2 1.01 Mandi Bahauddin 68.7 67.3 1.02 49.6 39.5 1.26 Narowal 68.8 70.0 0.98 49.0 57.7 0.85 Sialkot 74.2 72.8 1.02 60.2 51.8 1.16 Lahore 64.8 65.1 0.99 58.1 50.1 1.16 Kasur 62.2 58.1 1.07 39.1 39.9 0.98 Nankana Sahib 66.6 64.6 1.03 45.7 36.2 1.26 Sheikhupura 67.5 62.8 1.07 47.5 47.9 0.99 Multan 52.3 53.5 0.98 33.3 37.0 0.90 Khanewal 50.7 58.6 0.86 33.5 35.0 0.96 Lodhran 44.8 53.1 0.84 23.3 32.4 0.72 Vehari 56.8 58.5 0.97 37.7 36.0 1.05 Sahiwal 61.7 56.3 1.10 40.4 40.5 1.00 Pakpattan 51.7 54.2 0.96 27.4 31.4 0.88 Okara 51.3 52.9 0.97 33.7 39.1 0.86 Rawalpindi 72.7 73.7 0.99 60.8 56.6 1.07 Attock 72.5 75.3 0.96 43.4 57.2 0.76 Chakwal 78.9 81.3 0.97 67.0 60.2 1.11 Jhelum 79.7 80.9 0.98 55.6 53.2 1.04 Sargodha 67.3 63.9 1.05 43.6 44.1 0.99 Bhakkar 45.9 53.5 0.86 28.1 39.5 0.71 Khushab 61.1 68.0 0.90 37.7 46.2 0.82 Mianwali 56.5 63.8 0.89 29.8 55.2 0.54 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) P a g e | 310 Table D.ED.9: Out of school gender parity Percentage of girls in the total out of school population, in primary and secondary school, Punjab, 2014. Primary school Secondary school Percentage of out of school children Number of children of primary school age Percentage of girls in the total out of school population of primary school age Number of children of primary school age out of school Percentage of out of school children Number of children of secondary school age Percentage of girls in the total out of school population of secondary school age Number of children of secondary school age out of school Punjab 41.9 31,647 49.8 13,274 27.2 28,014 54.8 7,609 District Bahawalpur 52.7 1,142 50.0 602 41.1 916 48.3 376 Bahawalnagar 49.7 939 52.7 467 36.7 795 53.7 292 RY Khan 61.4 1,601 50.6 983 50.0 1,379 56.1 689 DG Khan 66.7 1,119 47.0 746 46.7 856 56.6 400 Layyah 51.4 574 51.6 295 30.2 490 63.8 148 Muzaffargarh 62.3 1,433 50.4 893 41.5 1,109 60.4 461 Rajanpur 68.2 750 57.4 512 56.6 603 61.3 341 Faisalabad 31.9 1,885 43.2 601 19.5 1,910 46.9 372 Chiniot 49.4 422 55.5 209 33.3 344 62.1 115 Jhang 47.7 762 56.1 363 33.0 696 62.0 230 TT Singh 30.4 570 47.3 173 22.0 552 46.3 121 Gujranwala 30.1 1,305 51.3 393 15.9 1,173 40.3 186 Gujrat 24.8 804 41.0 200 9.2 735 36.2 67 Hafizabad 36.3 354 54.3 128 21.0 320 57.9 67 Mandi Bahauddin 32.0 402 50.9 129 22.2 397 49.3 88 Narowal 30.2 553 51.0 167 9.4 464 54.7 44 Sialkot 26.5 1,034 47.6 274 13.6 1,072 43.8 145 Lahore 35.0 2,751 50.3 963 16.0 2,597 42.2 414 Kasur 39.7 1,030 46.1 409 27.2 852 51.4 232 Nankana Sahib 34.4 484 48.0 167 24.7 403 47.1 99 Sheikhupura 34.6 1,039 43.2 360 20.2 1,006 58.9 203 Multan 46.2 1,504 48.1 694 32.6 1,241 59.5 405 Khanewal 44.8 962 52.1 431 33.4 812 60.1 271 Lodhran 50.9 570 53.9 290 42.9 484 60.2 208 Vehari 42.2 848 48.8 358 29.5 736 52.0 217 Sahiwal 41.0 670 45.5 275 30.3 612 54.0 185 Pakpattan 47.0 595 49.3 280 34.3 470 55.0 161 Okara 47.6 1,007 49.2 479 31.3 790 56.5 247 Rawalpindi 26.2 1,189 48.9 311 13.0 1,107 55.9 144 Attock 26.0 463 50.2 120 16.3 430 71.8 70 Chakwal 19.9 350 52.9 70 8.9 330 (50.0) 29 Jhelum 19.7 296 53.1 58 13.8 282 48.5 39 Sargodha 34.1 903 47.5 308 23.3 891 43.2 208 Bhakkar 50.0 503 51.0 251 35.6 403 62.7 144 Khushab 35.3 358 53.3 126 25.1 321 71.1 81 Mianwali 39.9 475 54.9 189 24.6 432 81.7 106 P a g e | 311 Table D.ED.10: Literacy rate among population age 10 years or above Percentage of household members aged 10 years or above who are literate, Punjab, 2014. Male Female Total Literacy rate Number of household members age 10 years or above Literacy rate Number of household members age 10 years or above Literacy rate1 Number of household members age 10 years or above Punjab 69.3 92,625 52.1 90,930 60.8 183,555 District Bahawalpur 57.2 3,023 38.1 2,807 48.0 5,830 Bahawalnagar 57.6 2,495 39.8 2,426 48.8 4,921 RY Khan 48.7 4,141 29.6 3,946 39.3 8,087 DG Khan 56.2 2,139 31.3 2,233 43.5 4,372 Layyah 65.3 1,373 45.9 1,404 55.5 2,777 Muzaffargarh 59.2 3,027 34.5 2,948 47.0 5,975 Rajanpur 49.9 1,487 23.2 1,416 36.9 2,903 Faisalabad 75.3 6,771 63.1 6,404 69.4 13,174 Chiniot 63.1 1,240 35.8 1,160 49.9 2,399 Jhang 69.2 2,241 40.1 2,090 55.2 4,331 TT Singh 73.2 1,919 59.6 1,821 66.6 3,740 Gujranwala 71.0 3,921 64.1 3,940 67.5 7,861 Gujrat 78.4 2,289 68.4 2,646 73.0 4,935 Hafizabad 66.1 1,075 49.5 1,071 57.8 2,146 Mandi Bahauddin 67.7 1,386 55.4 1,501 61.3 2,887 Narowal 74.0 1,329 59.7 1,538 66.4 2,867 Sialkot 75.2 3,083 69.6 3,426 72.3 6,509 Lahore 79.4 9,274 71.7 8,827 75.7 18,100 Kasur 63.8 2,995 46.8 2,694 55.8 5,689 Nankana Sahib 70.0 1,451 53.9 1,388 62.1 2,839 Sheikhupura 69.2 3,322 58.4 3,236 63.9 6,558 Multan 66.1 3,902 49.1 3,835 57.6 7,736 Khanewal 64.0 2,558 40.9 2,452 52.7 5,011 Lodhran 57.1 1,473 31.2 1,440 44.3 2,912 Vehari 64.9 2,412 45.9 2,376 55.4 4,788 Sahiwal 72.0 2,129 51.5 2,050 61.9 4,179 Pakpattan 63.4 1,695 41.4 1,644 52.5 3,339 Okara 65.3 2,673 45.6 2,531 55.7 5,204 Rawalpindi 87.6 4,471 69.6 4,531 78.5 9,003 Attock 77.8 1,637 52.1 1,637 64.9 3,274 Chakwal 86.0 1,250 63.7 1,330 74.5 2,580 Jhelum 81.3 1,069 65.5 1,053 73.4 2,122 Sargodha 72.3 3,237 49.7 3,075 61.3 6,312 Bhakkar 62.9 1,450 34.9 1,367 49.3 2,817 Khushab 71.9 1,183 40.8 1,182 56.4 2,365 Mianwali 78.0 1,505 37.5 1,506 57.7 3,010 1 MICS indicator 7.S1. - Literacy rate 10+ (Reported) P a g e | 312 Table D.ED.11: Literacy rate among population age 15 years or above Percentage of household members aged 15 years or above who are literate, Punjab, 2014. Male Female Total Literacy rate Number of household members age 15 years or above Literacy rate Number of household members age 15 years or above Literacy rate1 Number of household members age 15 years or above Punjab 67.6 77,813 48.3 77,082 58.0 154,895 District Bahawalpur 55.9 2,511 34.2 2,379 45.3 4,890 Bahawalnagar 55.2 2,072 36.3 2,040 45.8 4,113 RY Khan 48.2 3,396 27.7 3,270 38.2 6,666 DG Khan 54.7 1,690 27.0 1,799 40.4 3,488 Layyah 62.3 1,124 39.3 1,147 50.7 2,272 Muzaffargarh 56.4 2,443 29.3 2,377 43.0 4,820 Rajanpur 47.6 1,161 20.5 1,094 34.5 2,255 Faisalabad 73.8 5,757 58.9 5,474 66.5 11,230 Chiniot 59.3 1,039 31.8 1,000 45.8 2,039 Jhang 67.1 1,885 34.6 1,739 51.5 3,624 TT Singh 71.3 1,624 56.0 1,567 63.8 3,191 Gujranwala 69.2 3,302 60.4 3,366 64.7 6,668 Gujrat 76.6 1,888 64.5 2,285 70.0 4,173 Hafizabad 63.0 908 44.9 909 53.9 1,817 Mandi Bahauddin 66.4 1,188 51.1 1,300 58.4 2,488 Narowal 70.8 1,096 54.3 1,300 61.8 2,396 Sialkot 73.3 2,569 65.0 2,867 68.9 5,436 Lahore 78.1 7,898 68.9 7,560 73.6 15,458 Kasur 60.9 2,512 42.2 2,299 51.9 4,811 Nankana Sahib 68.5 1,243 48.8 1,180 58.9 2,422 Sheikhupura 66.6 2,822 54.2 2,700 60.5 5,522 Multan 64.0 3,260 45.0 3,209 54.6 6,469 Khanewal 62.2 2,135 36.1 2,026 49.5 4,161 Lodhran 55.7 1,210 27.7 1,201 41.8 2,411 Vehari 63.3 2,029 41.2 2,003 52.3 4,032 Sahiwal 70.8 1,790 47.1 1,752 59.0 3,542 Pakpattan 60.9 1,439 37.4 1,411 49.3 2,850 Okara 63.0 2,264 40.9 2,139 52.3 4,403 Rawalpindi 87.1 3,897 67.0 4,001 76.9 7,898 Attock 75.3 1,408 47.5 1,426 61.3 2,834 Chakwal 84.9 1,088 59.3 1,167 71.6 2,254 Jhelum 80.2 910 62.2 934 71.1 1,844 Sargodha 70.7 2,745 45.0 2,659 58.1 5,403 Bhakkar 60.3 1,223 31.5 1,178 46.1 2,401 Khushab 70.5 1,013 35.3 1,024 52.8 2,037 Mianwali 76.7 1,276 33.7 1,301 55.0 2,577 1 MICS indicator 7.S2 - Literacy rate 15+ (Reported) P a g e | 313 Table D.ED.12: Literacy rate among population age 15-24 years Percentage of household members aged 15-24 years who are literate, Punjab, 2014. Male Female Total Literacy rate Number of household members age 15-24 years Literacy rate Number of household members age 15-24 years Literacy rate1 Number of household members age 15-24 years Punjab 79.3 24,679 72.4 24,292 75.9 48,972 District Bahawalpur 67.7 737 55.4 710 61.7 1,447 Bahawalnagar 67.2 641 60.3 650 63.7 1,291 RY Khan 59.0 1,109 46.6 1,045 52.9 2,154 DG Khan 67.8 582 46.4 566 57.2 1,148 Layyah 79.5 357 68.2 366 73.8 723 Muzaffargarh 68.9 790 53.2 730 61.4 1,520 Rajanpur 61.7 403 40.9 299 52.8 702 Faisalabad 82.8 1,878 82.1 1,796 82.5 3,674 Chiniot 72.9 318 52.4 293 63.0 611 Jhang 78.6 557 63.3 497 71.4 1,054 TT Singh 83.1 516 81.6 504 82.3 1,020 Gujranwala 82.4 1,046 83.9 1,137 83.1 2,183 Gujrat 89.2 588 91.0 658 90.2 1,246 Hafizabad 81.6 286 74.7 303 78.0 590 Mandi Bahauddin 83.3 380 77.9 432 80.4 812 Narowal 86.1 363 84.3 434 85.1 798 Sialkot 88.2 856 92.9 962 90.7 1,818 Lahore 87.3 2,470 85.0 2,408 86.2 4,878 Kasur 74.1 835 69.9 799 72.0 1,634 Nankana Sahib 81.9 384 75.0 393 78.4 777 Sheikhupura 77.0 953 78.0 955 77.5 1,907 Multan 78.5 987 71.5 982 75.0 1,969 Khanewal 73.4 694 62.0 618 68.0 1,312 Lodhran 71.6 377 52.0 379 61.8 756 Vehari 74.8 678 69.7 656 72.3 1,334 Sahiwal 81.3 538 69.9 524 75.7 1,062 Pakpattan 74.3 458 58.4 468 66.3 927 Okara 74.7 713 66.1 668 70.5 1,381 Rawalpindi 93.1 1,152 91.0 1,139 92.0 2,290 Attock 90.8 409 77.3 416 84.0 825 Chakwal 95.2 312 91.5 327 93.3 639 Jhelum 88.9 299 87.0 284 88.0 584 Sargodha 81.8 897 69.4 810 75.9 1,707 Bhakkar 75.9 400 55.8 378 66.1 778 Khushab 86.3 333 61.0 307 74.1 639 Mianwali 87.6 383 55.8 398 71.4 781 1 MICS indicator 7.S3 - Literacy rate 15-24 years (Reported) P a g e | 314 Table D.ED.13: Public and private primary school attendance rate Percentage of children (5-9 years) attending primary schools by type of school, Punjab, 2014. Attending primary school Number of children 5-9 years old Attending Government / Public primary school1 Attending Private primary school Attending Others Attending primary school but DK / Missing type of school Total Punjab 54.2 45.6 0.1 0.1 100.0 18,310 District Bahawalpur 61.3 38.4 0.2 0.1 100.0 538 Bahawalnagar 74.5 24.9 0.5 0.1 100.0 471 RY Khan 71.9 27.7 0.4 0.0 100.0 617 DG Khan 68.3 30.0 0.3 1.4 100.0 370 Layyah 70.9 29.1 0.0 0.0 100.0 279 Muzaffargarh 64.7 35.3 0.0 0.0 100.0 539 Rajanpur 73.4 26.6 0.0 0.0 100.0 238 Faisalabad 45.4 54.5 0.1 0.0 100.0 1,274 Chiniot 69.6 29.9 0.5 0.0 100.0 214 Jhang 61.5 37.5 0.3 0.6 100.0 399 TT Singh 62.3 37.4 0.3 0.0 100.0 397 Gujranwala 38.1 61.9 0.0 0.0 100.0 910 Gujrat 52.8 47.1 0.0 0.1 100.0 604 Hafizabad 59.1 40.9 0.0 0.0 100.0 226 Mandi Bahauddin 49.9 50.1 0.0 0.0 100.0 274 Narowal 61.8 38.2 0.0 0.0 100.0 384 Sialkot 43.3 56.7 0.0 0.0 100.0 759 Lahore 29.0 71.0 0.0 0.0 100.0 1,784 Kasur 52.3 47.4 0.0 0.3 100.0 620 Nankana Sahib 49.3 50.7 0.0 0.0 100.0 317 Sheikhupura 37.2 62.0 0.2 0.6 100.0 675 Multan 58.8 40.5 0.1 0.6 100.0 800 Khanewal 68.7 31.3 0.0 0.0 100.0 526 Lodhran 77.6 22.4 0.0 0.0 100.0 279 Vehari 65.7 34.3 0.0 0.0 100.0 490 Sahiwal 60.8 39.2 0.0 0.0 100.0 394 Pakpattan 65.8 34.2 0.0 0.0 100.0 315 Okara 61.2 38.6 0.2 0.0 100.0 525 Rawalpindi 39.7 60.2 0.0 0.1 100.0 872 Attock 63.0 37.0 0.0 0.0 100.0 342 Chakwal 58.9 40.9 0.0 0.1 100.0 281 Jhelum 56.6 43.4 0.0 0.0 100.0 238 Sargodha 55.3 44.5 0.0 0.2 100.0 592 Bhakkar 72.6 27.4 0.0 0.0 100.0 251 Khushab 55.4 44.3 0.0 0.3 100.0 231 Mianwali 75.1 24.9 0.0 0.0 100.0 286 1 MICS indicator 7.S4 - Government school attendance rate (Primary) P a g e | 315 Table D.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, Punjab, 2014. Children under age 5 whose birth is registered with civil authorities Number of children under age 5 Children under age 5 whose birth is not registered Has birth certificate No birth certificate Total registered1 Percent of children whose mother/caretaker knows how to register birth Number of children under age 5 without birth registration Seen Not seen Punjab 21.7 21.5 29.4 72.7 27,495 36.7 7,516 District Bahawalpur 6.2 14.8 21.3 42.3 912 12.8 526 Bahawalnagar 7.5 17.2 35.1 59.8 751 12.7 302 RY Khan 2.6 11.8 27.3 41.6 1,417 8.8 827 DG Khan 2.8 10.1 14.3 27.1 898 17.0 654 Layyah 4.9 20.3 33.5 58.7 514 40.7 212 Muzaffargarh 2.1 9.5 14.4 26.0 1,118 29.9 827 Rajanpur 3.9 4.7 12.9 21.6 621 16.0 487 Faisalabad 24.1 25.3 37.6 86.9 1,807 48.5 236 Chiniot 6.8 27.4 50.8 85.1 335 64.1 50 Jhang 13.4 33.6 21.1 68.1 626 56.9 200 TT Singh 20.2 29.9 40.1 90.1 503 72.3 50 Gujranwala 47.0 19.1 18.2 84.4 1,210 65.1 189 Gujrat 44.4 10.7 39.7 94.8 744 (74.2) 39 Hafizabad 15.7 22.5 47.6 85.8 310 39.3 44 Mandi Bahauddin 21.4 18.4 48.7 88.6 401 60.5 46 Narowal 29.9 21.5 43.0 94.5 529 83.6 29 Sialkot 32.0 37.3 24.9 94.2 906 72.7 52 Lahore 32.2 43.8 10.5 86.6 2,467 77.9 331 Kasur 21.6 22.7 33.6 77.9 898 52.5 199 Nankana Sahib 26.4 27.4 26.8 80.6 418 47.9 81 Sheikhupura 31.2 31.1 16.6 78.9 887 45.5 187 Multan 17.2 20.1 18.6 55.8 1,179 38.0 521 Khanewal 13.5 18.4 40.5 72.4 720 50.0 199 Lodhran 5.5 11.0 44.1 60.6 451 31.9 178 Vehari 16.4 11.7 50.2 78.2 668 51.6 146 Sahiwal 19.4 14.4 57.7 91.5 628 66.7 53 Pakpattan 14.1 8.8 66.7 89.6 526 77.8 54 Okara 21.6 24.0 34.8 80.3 878 60.1 173 Rawalpindi 54.0 22.9 8.1 85.0 1,180 67.3 177 Attock 58.4 17.4 13.4 89.3 429 51.7 46 Chakwal 55.0 18.9 20.1 93.9 310 (86.0) 19 Jhelum 38.1 14.8 40.6 93.5 246 (61.6) 16 Sargodha 17.0 28.6 39.0 84.6 823 61.6 127 Bhakkar 6.1 9.9 52.9 69.0 416 62.5 129 Khushab 10.3 21.9 55.0 87.2 325 52.8 42 Mianwali 11.1 7.4 65.8 84.4 440 81.3 69 1 MICS indicator 8.1 - Birth registration ( ) Figures that are based on 25-49 unweighted cases P a g e | 316 Table D.CP.2: Children's involvement in economic activities Percentage of children by involvement in economic activities during the last week, according to age groups, Punjab, 2014. Percentage of children age 5-11 years involved in economic activity for at least one hour Number of children age 5-11 years Percentage of children age 12-14 years involved in: Number of children age 12-14 years Percentage of children age 15-17 years involved in: Number of children age 15-17 years Economic activity less than 14 hours Economic activity for 14 hours or more Economic activity less than 43 hours Economic activity for 43 hours or more Punjab 8.4 42,013 13.3 9.1 17,779 25.4 5.2 15,176 District Bahawalpur 10.1 1,327 13.4 10.1 689 23.0 0.2 389 Bahawalnagar 6.4 1,187 8.3 11.8 488 24.7 4.1 408 RY Khan 2.5 2,046 8.8 7.2 922 24.9 6.1 660 DG Khan 17.7 1,531 18.1 17.6 477 57.9 9.3 377 Layyah 10.0 699 21.9 4.4 322 34.2 4.3 255 Muzaffargarh 18.1 1,835 31.5 16.8 764 41.2 11.9 507 Rajanpur 20.9 956 20.6 25.3 322 46.0 6.1 308 Faisalabad 7.3 2,689 12.9 7.8 1,121 17.7 7.8 1,147 Chiniot 17.5 554 23.4 8.1 232 44.4 3.8 148 Jhang 18.1 997 20.2 12.8 443 42.3 2.0 335 TT Singh 13.6 748 22.6 9.8 347 33.5 5.1 321 Gujranwala 4.3 1,677 8.0 5.0 731 21.2 7.0 725 Gujrat 4.2 1,108 2.6 0.7 425 7.8 6.3 375 Hafizabad 2.7 484 3.4 4.9 191 22.6 8.1 190 Mandi Bahauddin 2.2 514 4.8 5.6 251 18.9 4.4 245 Narowal 14.1 792 22.6 23.3 326 48.9 1.9 249 Sialkot 9.3 1,441 13.5 8.6 697 34.2 3.2 613 Lahore 1.1 3,831 2.7 6.4 1,571 10.2 5.6 1,441 Kasur 15.4 1,288 23.2 10.5 631 33.0 5.8 477 Nankana Sahib 3.8 612 11.2 10.6 268 14.8 7.1 243 Sheikhupura 7.1 1,394 9.3 7.1 618 18.9 2.7 624 Multan 7.4 2,072 9.5 12.5 787 26.2 1.6 548 Khanewal 9.4 1,367 24.5 5.7 498 22.3 3.9 326 Lodhran 3.7 780 15.7 11.1 305 28.7 3.7 228 Vehari 6.9 1,107 18.3 7.8 465 31.2 2.5 421 Sahiwal 10.8 940 13.3 14.3 394 33.7 9.2 272 Pakpattan 5.9 740 8.2 7.4 304 23.2 12.0 321 Okara 10.1 1,288 14.1 12.4 470 25.4 5.3 464 Rawalpindi 7.4 1,481 9.8 3.0 764 16.8 2.6 747 Attock 1.5 625 7.8 2.8 275 7.5 1.1 236 Chakwal 1.0 434 4.9 0.6 217 23.4 1.6 227 Jhelum 6.0 409 9.3 2.9 177 10.5 1.3 157 Sargodha 10.6 1,268 14.9 6.7 553 24.6 6.9 505 Bhakkar 8.0 683 11.7 17.3 241 36.4 10.4 242 Khushab 14.1 460 19.5 9.6 237 27.0 5.3 199 Mianwali 2.5 650 13.0 3.5 260 35.8 0.6 248 P a g e | 317 Table D.CP.3: Children's involvement in household chores Percentage of children by involvement in household chores during the last week, according to age groups, Punjab, 2014. Percentage of children age 5-11 years involved in: Number of children age 5-11 years Percentage of children age 12-14 years involved in: Number of children age 12-14 years Percentage of children age 15-17 years involved in: Number of children age 15- 17 years Household chores less than 28 hours Household chores for 28 hours or more Household chores less than 28 hours Household chores for 28 hours or more Household chores less than 43 hours Household chores for 43 hours or more Punjab 66.0 0.8 42,013 82.4 3.2 17,779 87.0 1.1 15,176 District Bahawalpur 58.5 0.8 1,327 75.9 1.1 689 79.6 0.0 389 Bahawalnagar 49.1 0.4 1,187 77.2 5.0 488 90.6 1.2 408 RY Khan 42.8 1.2 2,046 76.3 4.9 922 88.8 0.0 660 DG Khan 57.7 2.6 1,531 68.6 5.2 477 80.8 0.9 377 Layyah 52.2 0.3 699 72.2 1.8 322 85.4 0.8 255 Muzaffargarh 52.1 2.1 1,835 76.2 4.3 764 77.9 1.2 507 Rajanpur 56.6 2.0 956 83.2 5.6 322 85.4 0.0 308 Faisalabad 79.5 1.3 2,689 86.8 5.5 1,121 89.2 2.5 1,147 Chiniot 90.4 1.8 554 86.3 8.9 232 88.4 5.4 148 Jhang 66.4 2.7 997 85.3 1.7 443 92.3 0.2 335 TT Singh 75.6 0.6 748 86.8 4.2 347 96.4 0.0 321 Gujranwala 70.6 0.1 1,677 87.3 2.8 731 93.5 0.0 725 Gujrat 76.3 0.0 1,108 94.5 0.0 425 94.9 0.1 375 Hafizabad 67.2 0.0 484 91.5 0.7 191 84.9 0.0 190 Mandi Bahauddin 75.5 0.0 514 79.3 3.6 251 87.4 3.6 245 Narowal 94.0 0.0 792 96.5 1.4 326 97.3 0.3 249 Sialkot 85.2 0.4 1,441 90.2 4.0 697 92.9 0.0 613 Lahore 59.1 0.0 3,831 81.4 0.7 1,571 84.7 1.3 1,441 Kasur 75.1 0.9 1,288 85.4 1.6 631 82.9 1.8 477 Nankana Sahib 70.2 0.0 612 76.3 3.0 268 84.8 3.9 243 Sheikhupura 71.0 0.3 1,394 76.2 1.6 618 81.6 0.7 624 Multan 69.1 0.9 2,072 84.8 4.7 787 87.8 3.0 548 Khanewal 71.0 0.0 1,367 93.0 2.1 498 90.4 0.0 326 Lodhran 54.7 0.6 780 86.7 2.5 305 92.3 0.8 228 Vehari 77.2 0.0 1,107 93.8 1.7 465 93.4 0.1 421 Sahiwal 63.9 0.6 940 79.3 3.1 394 78.3 2.0 272 Pakpattan 54.4 1.2 740 70.8 5.1 304 76.0 2.0 321 Okara 56.6 2.7 1,288 71.0 0.8 470 79.1 0.6 464 Rawalpindi 61.9 1.2 1,481 81.9 4.8 764 85.3 3.0 747 Attock 74.7 0.0 625 83.5 3.5 275 93.9 0.0 236 Chakwal 69.8 0.0 434 87.9 2.3 217 90.9 1.2 227 Jhelum 78.5 0.0 409 88.9 0.3 177 96.1 0.0 157 Sargodha 71.8 0.2 1,268 79.9 2.4 553 85.1 0.4 505 Bhakkar 65.1 1.0 683 77.8 8.3 241 84.5 1.1 242 Khushab 67.5 0.0 460 78.2 7.7 237 78.6 0.0 199 Mianwali 69.1 0.0 650 84.2 1.6 260 88.2 1.3 248 P a g e | 318 Table D.CP.4: Child labour Percentage of children age 5-17 years by involvement in economic activities or household chores during the last week, percentage working under hazardous conditions during the last week, and percentage engaged in child labour during the last week, Punjab, 2014. Children involved in economic activities for a total number of hours during last week: Children involved in household chores for a total number of hours during last week: Children working under hazardous conditions Total child labour1 Number of children age 5-17 years Below the age specific threshold At or above the age specific threshold Below the age specific threshold At or above the age specific threshold Punjab 8.6 7.9 74.1 1.4 14.3 16.4 74,968 District Bahawalpur 7.8 8.5 66.9 0.8 13.6 16.3 2,404 Bahawalnagar 6.8 7.2 63.8 1.7 13.3 15.4 2,082 RY Khan 6.8 4.4 59.7 1.9 11.0 12.9 3,628 DG Khan 14.4 16.4 63.5 2.9 26.6 30.9 2,385 Layyah 12.4 7.5 63.9 0.8 19.4 20.2 1,276 Muzaffargarh 14.6 16.7 62.2 2.5 30.1 32.2 3,105 Rajanpur 13.1 18.9 67.6 2.3 30.1 32.7 1,586 Faisalabad 7.1 7.5 83.4 2.5 10.9 14.4 4,958 Chiniot 13.9 13.0 89.1 4.1 18.3 27.7 934 Jhang 13.1 13.7 76.0 2.0 23.8 26.3 1,775 TT Singh 13.1 10.7 83.1 1.4 22.6 24.1 1,415 Gujranwala 6.9 5.1 79.8 0.7 9.8 11.2 3,132 Gujrat 2.1 3.9 84.0 0.0 5.3 5.7 1,908 Hafizabad 6.1 4.4 76.5 0.1 8.6 9.3 865 Mandi Bahauddin 5.8 3.6 79.3 1.8 6.2 9.4 1,010 Narowal 14.3 14.1 95.2 0.4 27.0 27.9 1,367 Sialkot 11.9 7.8 88.2 1.2 16.7 19.0 2,751 Lahore 2.9 3.3 69.6 0.4 4.0 4.9 6,842 Kasur 14.4 12.2 79.4 1.3 22.1 24.3 2,395 Nankana Sahib 6.0 6.1 74.8 1.6 8.7 11.8 1,123 Sheikhupura 7.1 6.0 74.7 0.7 10.4 12.4 2,636 Multan 6.7 7.7 75.8 2.1 11.6 14.7 3,407 Khanewal 8.9 7.8 78.9 0.5 15.1 16.5 2,191 Lodhran 8.6 5.4 68.7 1.1 13.1 13.7 1,313 Vehari 10.9 6.2 84.5 0.4 15.6 16.1 1,992 Sahiwal 9.3 11.4 70.1 1.4 19.7 21.7 1,607 Pakpattan 7.3 7.7 63.1 2.2 14.0 16.2 1,365 Okara 8.5 9.6 64.3 1.8 15.0 17.1 2,222 Rawalpindi 7.2 5.1 72.9 2.6 10.2 12.8 2,991 Attock 3.4 1.7 80.8 0.9 4.3 5.2 1,136 Chakwal 7.3 1.0 79.7 0.9 7.1 7.7 878 Jhelum 4.6 4.3 84.7 0.1 7.3 8.4 742 Sargodha 10.4 8.9 76.6 0.8 17.1 18.8 2,326 Bhakkar 10.2 10.4 71.7 2.5 18.9 21.1 1,166 Khushab 11.3 11.0 72.8 2.0 18.8 20.5 896 Mianwali 10.6 2.3 76.6 0.6 10.0 11.1 1,158 1 MICS indicator 8.2 - Child labour P a g e | 319 Table D.CP.5: Child discipline Percentage of children age 1-14 years by child disciplining methods experienced during the last one month, Punjab, 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 method1 Any Severe Punjab 6.1 73.6 67.7 26.6 80.7 85,311 District Bahawalpur 10.7 67.8 60.3 15.7 78.0 2,973 Bahawalnagar 5.5 67.9 61.5 21.1 80.8 2,421 RY Khan 5.4 69.8 57.7 16.6 78.4 4,368 DG Khan 4.7 58.7 57.6 13.7 67.4 2,819 Layyah 3.6 63.7 57.8 8.8 68.7 1,572 Muzaffargarh 5.0 60.7 56.7 13.3 68.5 3,611 Rajanpur 2.5 75.4 61.0 18.3 78.8 1,874 Faisalabad 4.1 79.2 72.2 35.9 85.3 5,363 Chiniot 3.4 81.9 77.2 38.9 88.1 1,096 Jhang 5.6 73.5 63.2 23.2 79.8 2,010 TT Singh 6.2 79.9 72.6 26.6 83.5 1,556 Gujranwala 5.8 74.6 73.3 37.1 84.4 3,572 Gujrat 6.9 78.7 76.7 27.0 86.8 2,238 Hafizabad 5.7 81.7 68.6 32.0 83.1 961 Mandi Bahauddin 4.8 84.7 79.4 30.6 89.2 1,174 Narowal 0.3 92.3 83.0 44.0 96.2 1,518 Sialkot 1.7 87.3 78.0 32.3 91.8 2,916 Lahore 8.4 72.3 69.3 39.5 79.1 7,700 Kasur 3.3 80.8 79.2 48.7 86.0 2,750 Nankana Sahib 6.2 76.3 73.4 35.7 80.8 1,281 Sheikhupura 8.8 69.3 69.4 29.9 76.5 2,837 Multan 5.1 70.9 59.3 21.9 76.7 3,918 Khanewal 6.0 75.9 64.8 26.1 80.6 2,549 Lodhran 9.7 68.8 57.9 18.7 75.9 1,459 Vehari 11.3 70.2 62.7 16.5 79.6 2,243 Sahiwal 6.6 77.0 74.5 35.1 83.8 1,879 Pakpattan 3.7 76.1 78.9 34.1 85.4 1,525 Okara 13.1 61.5 65.6 24.8 74.0 2,580 Rawalpindi 6.5 74.3 67.2 21.3 81.7 3,325 Attock 6.1 74.2 70.8 22.2 83.9 1,286 Chakwal 7.7 76.5 71.9 19.7 86.1 935 Jhelum 8.8 80.0 69.8 22.3 86.5 807 Sargodha 7.4 71.4 67.1 21.4 79.2 2,589 Bhakkar 3.5 82.1 74.8 18.0 87.1 1,306 Khushab 6.3 76.4 70.4 16.8 82.0 970 Mianwali 2.6 82.3 72.7 18.5 86.4 1,329 1 MICS indicator 8.3 - Violent discipline P a g e | 320 Table D.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, Punjab, 2014. Respondent believes that a child needs to be physically punished Number of respondents to the child discipline module Punjab 34.2 26,143 District Bahawalpur 29.3 916 Bahawalnagar 28.9 745 RY Khan 32.5 1,236 DG Khan 26.3 725 Layyah 37.6 438 Muzaffargarh 34.9 976 Rajanpur 40.4 457 Faisalabad 44.5 1,771 Chiniot 54.2 353 Jhang 37.1 604 TT Singh 36.8 504 Gujranwala 41.3 1,086 Gujrat 42.3 685 Hafizabad 30.1 308 Mandi Bahauddin 33.3 389 Narowal 55.6 436 Sialkot 42.3 847 Lahore 17.6 2,449 Kasur 49.4 818 Nankana Sahib 35.3 399 Sheikhupura 31.6 857 Multan 26.9 1,266 Khanewal 34.1 798 Lodhran 36.2 451 Vehari 38.3 680 Sahiwal 44.9 563 Pakpattan 46.6 484 Okara 37.2 745 Rawalpindi 27.3 1,196 Attock 31.4 434 Chakwal 30.1 321 Jhelum 36.7 281 Sargodha 26.0 868 Bhakkar 33.7 380 Khushab 22.4 307 Mianwali 29.2 373 P a g e | 321 Table D.CP.7: Early marriage and polygyny (women) Percentage of women age 15-49 years who first married before their 15th birthday, percentages of women age 20-49 years who first married before their 15th and 18th birthdays, percentage of women age 15-19 years currently married, and the percentage of women who are in a polygynous marriage, Punjab, 2014. Women age 15-49 years Women age 20-49 years Women age 15-19 years Women age 15-49 years Percentag e married before age 151 Number of women age 15- 49 years Percentage married before age 15 Percentage married before age 182 Number of women age 20- 49 years Percentage currently married3 Number of women age 15- 19 years Percentage in polygynous marriage4 Number of women age 15-49 years currently married Punjab 5.2 53,668 6.1 20.8 42,510 9.2 11,158 2.5 33,047 District Bahawalpur 7.9 1,666 9.3 26.5 1,310 14.6 356 3.7 1,090 Bahawalnagar 4.0 1,421 4.7 21.8 1,121 6.0 300 3.0 834 RY Khan 5.2 2,282 6.6 23.8 1,711 9.1 571 2.6 1,434 DG Khan 11.9 1,273 13.7 36.4 1,016 20.1 258 8.2 924 Layyah 6.8 825 8.4 23.7 641 9.5 185 3.8 533 Muzaffargarh 8.9 1,705 10.7 30.1 1,353 13.3 352 4.4 1,169 Rajanpur 7.0 758 7.9 30.0 599 12.2 160 7.9 549 Faisalabad 3.3 3,880 4.2 15.1 3,024 7.0 857 1.0 2,249 Chiniot 5.7 672 6.5 21.1 539 10.8 133 2.5 415 Jhang 7.0 1,162 8.2 25.1 929 12.5 233 2.2 740 TT Singh 3.1 1,081 3.8 15.0 843 5.1 239 1.3 626 Gujranwala 3.7 2,401 4.6 16.7 1,889 6.2 512 1.5 1,436 Gujrat 3.4 1,521 4.1 15.4 1,225 4.4 296 1.3 923 Hafizabad 6.2 642 7.1 22.4 524 9.8 118 0.6 393 Mandi Bahauddin 4.1 884 4.7 19.0 692 11.0 192 1.7 523 Narowal 2.1 891 2.5 13.4 685 4.5 207 1.7 525 Sialkot 3.2 1,987 3.8 16.8 1,536 5.9 451 1.7 1,102 Lahore 4.1 5,357 4.9 18.0 4,349 6.7 1,007 1.8 3,399 Kasur 4.2 1,602 5.2 20.1 1,219 8.7 382 1.8 989 Nankana Sahib 3.5 821 3.9 18.5 633 11.3 189 2.2 513 Sheikhupura 5.0 1,905 6.2 20.2 1,470 7.2 435 2.6 1,124 Multan 8.1 2,263 9.5 29.6 1,825 9.5 438 3.1 1,444 Khanewal 6.8 1,412 8.2 23.4 1,127 10.7 285 2.6 888 Lodhran 5.4 826 6.2 19.9 645 10.5 181 3.5 504 Vehari 5.2 1,386 5.9 23.1 1,079 11.1 307 2.1 816 Sahiwal 3.9 1,205 4.5 16.4 964 11.4 241 1.7 732 Pakpattan 4.3 984 4.9 18.8 780 11.4 204 3.0 599 Okara 6.7 1,497 7.7 24.9 1,201 10.7 295 3.8 934 Rawalpindi 4.4 2,741 5.1 17.5 2,274 8.6 466 2.9 1,663 Attock 5.3 972 6.2 23.2 796 8.6 176 1.7 600 Chakwal 4.3 756 5.0 18.3 616 5.5 140 3.1 447 Jhelum 3.4 617 3.8 14.7 492 6.8 126 0.7 357 Sargodha 6.4 1,833 6.9 22.4 1,490 13.0 343 1.2 1,111 Bhakkar 5.0 824 6.2 20.8 643 9.6 181 2.6 487 Khushab 5.0 706 6.2 21.8 556 12.1 149 1.3 417 Mianwali 5.1 907 5.9 18.4 714 10.9 193 2.2 560 1 MICS indicator 8.4 - Marriage before age 15 2 MICS indicator 8.5 - Marriage before age 18 3 MICS indicator 8.6 - Young women age 15-19 years currently married 4 MICS indicator 8.7 - Polygyny P a g e | 322 Table D.CP.10: Attitudes toward domestic violence (women) Percentage of women age 15-49 years who believe a husband is justified in beating his wife in various circumstances, Punjab, 2014. Percentage of women age 15-49 years who believe a husband is justified in beating his wife: Number of women age 15-49 years If she goes out without telling him If she neglects the children If she argues with him If she refuses sex with him If she burns the food For any of these five reasons1 Punjab 26.4 26.5 27.7 20.5 14.8 39.8 53,668 District Bahawalpur 35.9 37.7 35.4 29.5 23.0 59.6 1,666 Bahawalnagar 34.6 39.8 36.8 37.7 24.6 61.8 1,421 RY Khan 40.8 40.3 39.4 36.6 22.8 64.2 2,282 DG Khan 28.1 26.1 27.8 19.1 21.3 39.8 1,273 Layyah 30.2 29.1 22.4 19.4 18.4 38.5 825 Muzaffargarh 28.9 29.3 24.5 19.3 17.5 38.3 1,705 Rajanpur 37.8 33.4 31.2 23.7 21.1 47.6 758 Faisalabad 29.4 29.3 31.8 20.0 15.1 42.6 3,880 Chiniot 45.8 45.3 48.4 39.2 29.2 60.4 672 Jhang 26.5 27.7 27.4 19.9 14.0 37.5 1,162 TT Singh 22.2 24.9 23.9 18.1 12.9 35.5 1,081 Gujranwala 25.9 25.7 25.1 17.9 11.8 37.8 2,401 Gujrat 23.9 24.3 22.1 16.0 8.4 33.9 1,521 Hafizabad 23.4 25.5 27.3 18.8 8.8 40.7 642 Mandi Bahauddin 28.1 25.8 28.3 21.7 13.5 41.7 884 Narowal 51.7 42.6 44.5 27.8 13.0 60.7 891 Sialkot 30.7 24.8 31.5 14.1 8.4 45.0 1,987 Lahore 8.1 8.8 12.1 6.5 3.4 17.4 5,357 Kasur 30.1 28.6 32.0 25.5 23.4 41.8 1,602 Nankana Sahib 23.8 23.1 23.5 17.0 11.6 38.3 821 Sheikhupura 22.6 21.6 24.6 17.1 11.2 37.7 1,905 Multan 13.1 12.8 15.6 11.2 7.6 23.9 2,263 Khanewal 18.7 19.5 20.4 17.9 11.3 29.3 1,412 Lodhran 28.7 27.2 31.1 23.6 16.7 45.4 826 Vehari 16.6 15.7 20.1 13.7 8.3 27.2 1,386 Sahiwal 43.8 48.7 47.0 40.5 26.6 59.5 1,205 Pakpattan 49.2 52.4 53.3 45.2 27.4 64.0 984 Okara 36.8 40.3 42.1 38.7 19.2 56.5 1,497 Rawalpindi 13.7 12.7 15.0 10.4 9.8 22.5 2,741 Attock 16.1 16.6 15.9 14.7 12.4 22.9 972 Chakwal 13.0 12.2 16.1 11.0 10.7 19.1 756 Jhelum 23.2 22.9 22.9 18.8 12.3 33.2 617 Sargodha 27.5 30.2 33.1 20.3 17.5 45.5 1,833 Bhakkar 36.4 41.3 43.3 26.6 29.2 53.3 824 Khushab 35.9 42.3 40.6 27.6 27.6 53.2 706 Mianwali 35.7 37.7 38.9 24.6 23.3 49.9 907 1 MICS indicator 8.12 - Attitudes towards domestic violence P a g e | 323 Table D.CP.11: Children's living arrangements and orphanhood Percent distribution of children age 0-17 years according to living arrangements, percentage of children age 0-17 years not living with a biological parent and percentage of children who have one or both parents dead, Punjab, 2014. Living with both parents Living with neither biological parent Living with mother only Living with father only Missing information on father/ mother Total Living with neither biological parent1 One or both parents dead 2 Number of children age 0- 17 years Only father alive Only mother alive Both alive Both dead Father alive Father dead Mother alive Mother dead Punjab 88.0 0.2 0.1 0.9 0.2 5.9 2.9 0.3 1.3 0.1 100.0 1.4 4.8 106,585 District Bahawalpur 90.0 0.5 0.0 1.1 0.1 2.5 3.3 0.5 1.7 0.4 100.0 1.7 5.7 3,569 Bahawalnagar 91.5 0.5 0.2 0.5 0.1 2.6 2.6 0.1 1.9 0.0 100.0 1.2 5.2 2,987 RY Khan 92.2 0.0 0.1 0.7 0.3 2.5 2.7 0.1 1.2 0.1 100.0 1.1 4.4 5,288 DG Khan 83.8 0.4 0.1 0.7 0.1 12.0 2.3 0.1 0.3 0.1 100.0 1.3 3.3 3,394 Layyah 90.6 0.0 0.1 1.4 0.1 4.4 1.9 0.3 1.1 0.0 100.0 1.6 3.3 1,923 Muzaffargarh 88.9 0.2 0.1 0.9 0.0 5.9 2.1 0.4 1.4 0.1 100.0 1.3 3.8 4,360 Rajanpur 90.8 0.0 0.2 0.6 0.1 3.7 2.4 0.1 2.0 0.1 100.0 0.9 4.7 2,318 Faisalabad 89.7 0.1 0.1 0.7 0.1 4.6 3.2 0.2 1.2 0.1 100.0 1.0 4.7 6,949 Chiniot 90.7 0.1 0.4 1.0 0.2 2.1 3.3 0.4 1.7 0.1 100.0 1.7 5.7 1,329 Jhang 92.2 0.3 0.1 0.5 0.1 2.1 2.1 0.2 2.0 0.3 100.0 1.0 4.6 2,496 TT Singh 90.5 0.3 0.0 1.1 0.1 3.7 2.3 0.1 1.7 0.1 100.0 1.5 4.5 2,001 Gujranwala 84.9 0.0 0.1 0.5 0.3 9.8 2.8 0.4 1.0 0.1 100.0 0.9 4.3 4,558 Gujrat 66.7 0.5 0.1 1.1 0.2 26.6 3.7 0.3 0.7 0.0 100.0 1.9 5.3 2,779 Hafizabad 87.3 0.0 0.0 1.5 0.2 6.6 2.7 0.6 1.0 0.0 100.0 1.8 4.0 1,223 Mandi Bahauddin 79.9 0.6 0.3 1.5 0.1 13.2 2.8 0.4 1.3 0.0 100.0 2.5 5.1 1,502 Narowal 75.9 0.2 0.1 0.8 0.1 19.9 2.1 0.2 0.6 0.0 100.0 1.3 3.1 1,888 Sialkot 78.5 0.1 0.1 0.6 0.2 15.8 2.9 0.5 1.2 0.1 100.0 1.0 4.4 3,746 Lahore 91.5 0.4 0.1 0.9 0.1 2.8 3.2 0.1 0.9 0.1 100.0 1.5 4.7 9,661 Kasur 91.9 0.4 0.1 0.7 0.1 2.0 2.7 0.3 1.5 0.2 100.0 1.4 4.8 3,454 Nankana Sahib 86.9 0.5 0.6 1.5 0.3 4.1 3.3 0.5 2.1 0.2 100.0 2.9 6.8 1,619 Sheikhupura 91.0 0.2 0.1 0.9 0.2 2.7 3.0 0.4 1.3 0.1 100.0 1.5 4.8 3,661 Multan 89.6 0.1 0.3 1.2 0.1 2.8 3.3 0.3 1.9 0.5 100.0 1.7 5.7 4,751 Khanewal 90.3 0.1 0.3 0.8 0.1 2.7 3.4 0.6 1.6 0.0 100.0 1.4 5.6 3,017 Lodhran 91.4 0.1 0.2 0.6 0.2 3.1 3.3 0.3 0.9 0.0 100.0 1.0 4.6 1,796 Vehari 87.6 0.4 0.0 1.1 0.2 5.4 3.4 0.3 1.6 0.0 100.0 1.6 5.6 2,789 Sahiwal 87.3 0.1 0.1 2.0 0.3 6.3 2.2 0.5 1.3 0.0 100.0 2.4 3.9 2,296 Pakpattan 88.4 0.5 0.3 1.8 0.2 2.5 3.6 0.8 1.9 0.1 100.0 2.7 6.4 1,952 Okara 88.9 0.3 0.3 1.7 0.1 3.3 3.0 0.4 1.9 0.2 100.0 2.3 5.5 3,236 P a g e | 324 Table D.CP.11: Children's living arrangements and orphanhood Percent distribution of children age 0-17 years according to living arrangements, percentage of children age 0-17 years not living with a biological parent and percentage of children who have one or both parents dead, Punjab, 2014. Living with both parents Living with neither biological parent Living with mother only Living with father only Missing information on father/ mother Total Living with neither biological parent1 One or both parents dead 2 Number of children age 0-17 years Only father alive Only mother alive Both alive Both dead Father alive Father dead Mother alive Mother dead Rawalpindi 86.3 0.1 0.0 0.7 0.1 7.6 3.3 0.3 1.1 0.4 100.0 0.9 4.6 4,352 Attock 87.0 0.0 0.1 0.5 0.1 8.3 2.8 0.2 0.7 0.3 100.0 0.6 3.7 1,615 Chakwal 85.9 0.1 0.1 0.6 0.1 8.3 3.5 0.2 0.9 0.4 100.0 0.8 4.6 1,227 Jhelum 81.8 0.1 0.0 0.9 0.3 11.7 2.6 0.4 2.2 0.0 100.0 1.3 5.2 1,014 Sargodha 87.3 0.5 0.2 1.0 0.2 4.2 3.9 0.7 1.7 0.2 100.0 1.9 6.6 3,260 Bhakkar 94.2 0.1 0.0 0.9 0.1 0.9 2.5 0.1 1.1 0.1 100.0 1.2 3.8 1,650 Khushab 90.1 0.3 0.1 0.6 0.2 4.9 2.9 0.2 0.6 0.1 100.0 1.2 4.2 1,250 Mianwali 90.3 0.3 0.1 1.1 0.1 4.2 2.3 0.4 1.1 0.1 100.0 1.6 3.9 1,674 Punjab 88.0 0.2 0.1 0.9 0.2 5.9 2.9 0.3 1.3 0.1 100.0 1.4 4.8 106,585 1 MICS indicator 8.13 - Children’s living arrangements 2 MICS indicator 8.14 - Prevalence of children with one or both parents dead P a g e | 325 Table D.CP.12: Children with parents living abroad Percent distribution of children age 0-17 years by residence of parents in another country, Punjab, 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 Punjab 0.0 3.9 0.0 96.1 100.0 3.9 106,585 District Bahawalpur 0.0 1.2 0.0 98.8 100.0 1.2 3,569 Bahawalnagar 0.0 1.4 0.0 98.6 100.0 1.4 2,987 RY Khan 0.0 1.5 0.0 98.5 100.0 1.5 5,288 DG Khan 0.0 9.3 0.0 90.7 100.0 9.3 3,394 Layyah 0.0 1.0 0.0 99.0 100.0 1.0 1,923 Muzaffargarh 0.0 1.9 0.0 98.1 100.0 1.9 4,360 Rajanpur 0.0 2.2 0.0 97.8 100.0 2.2 2,318 Faisalabad 0.0 3.4 0.0 96.6 100.0 3.4 6,949 Chiniot 0.0 0.7 0.0 99.3 100.0 0.7 1,329 Jhang 0.0 1.0 0.0 99.0 100.0 1.0 2,496 TT Singh 0.0 3.3 0.0 96.7 100.0 3.3 2,001 Gujranwala 0.0 8.2 0.0 91.8 100.0 8.2 4,558 Gujrat 0.0 20.3 0.1 79.6 100.0 20.4 2,779 Hafizabad 0.0 6.1 0.0 93.9 100.0 6.1 1,223 Mandi Bahauddin 0.0 11.1 0.0 88.9 100.0 11.1 1,502 Narowal 0.0 6.2 0.0 93.8 100.0 6.2 1,888 Sialkot 0.0 13.8 0.0 86.2 100.0 13.8 3,746 Lahore 0.0 2.1 0.0 97.9 100.0 2.1 9,661 Kasur 0.0 0.4 0.0 99.6 100.0 0.4 3,454 Nankana Sahib 0.0 3.4 0.0 96.6 100.0 3.4 1,619 Sheikhupura 0.0 1.6 0.0 98.4 100.0 1.6 3,661 Multan 0.0 1.4 0.0 98.6 100.0 1.4 4,751 Khanewal 0.1 1.0 0.0 98.9 100.0 1.1 3,017 Lodhran 0.0 0.9 0.0 99.1 100.0 0.9 1,796 Vehari 0.0 3.5 0.0 96.5 100.0 3.5 2,789 Sahiwal 0.0 4.0 0.0 96.0 100.0 4.0 2,296 Pakpattan 0.0 1.0 0.0 99.0 100.0 1.0 1,952 Okara 0.0 1.4 0.0 98.6 100.0 1.4 3,236 Rawalpindi 0.0 5.7 0.0 94.3 100.0 5.7 4,352 Attock 0.0 6.8 0.0 93.2 100.0 6.8 1,615 Chakwal 0.0 6.9 0.0 93.1 100.0 6.9 1,227 Jhelum 0.0 9.3 0.0 90.7 100.0 9.3 1,014 Sargodha 0.0 2.7 0.0 97.3 100.0 2.7 3,260 Bhakkar 0.0 0.2 0.0 99.8 100.0 0.2 1,650 Khushab 0.0 2.8 0.0 97.2 100.0 2.8 1,250 Mianwali 0.0 1.9 0.0 98.1 100.0 1.9 1,674 1 MICS indicator 8.15 - Children with at least one parent living abroad P a g e | 326 Table D.HA.1: Knowledge about HIV transmission, misconceptions about HIV, and comprehensive knowledge about HIV transmission (women) Percentage of ever married women age 15-49 years who know the main ways of preventing HIV transmission, percentage who know that a healthy looking person can be HIV-positive, percentage who reject common misconceptions, and percentage who have comprehensive knowledge about HIV transmission, Punjab, 2014. Percentage who have heard of AIDS Percentage who know transmission can be prevented by: Percentage who know that a healthy looking person can be HIV- positive Percentage who know that HIV cannot be transmitted by: Percentage who reject the two most common misconceptions and know that a healthy looking person can be HIV-positive Percentage with comprehensive knowledge1 Number of ever married women age 15- 49 years Having only one faithful uninfected husband Using a condom every time Percentage of women who know both ways Mosquito bites Supernatural means Sharing food with someone with HIV Punjab 39.0 24.1 19.8 15.6 25.2 23.0 28.3 20.5 9.8 5.1 34,855 District Bahawalpur 19.5 11.1 9.2 6.1 12.6 13.9 15.3 9.5 4.8 2.2 1,142 Bahawalnagar 25.6 17.0 15.5 11.8 14.8 16.3 19.6 10.9 4.5 2.7 887 RY Khan 41.3 31.4 29.7 26.1 22.9 23.8 27.9 14.1 5.8 3.6 1,499 DG Khan 16.3 7.2 7.2 4.7 9.2 9.5 11.5 8.0 4.0 2.0 949 Layyah 12.0 7.7 6.9 5.6 8.7 7.2 9.2 4.7 2.8 1.3 552 Muzaffargarh 12.8 7.2 5.6 5.1 7.9 7.6 9.6 5.7 3.1 1.7 1,218 Rajanpur 14.2 8.9 6.4 5.5 7.6 6.7 9.2 5.8 2.6 1.5 566 Faisalabad 40.9 30.6 21.4 18.7 26.2 26.4 33.4 23.7 12.8 8.1 2,397 Chiniot 21.4 17.4 13.4 11.5 13.8 15.5 17.8 13.6 7.1 5.1 447 Jhang 20.6 12.9 10.3 8.0 11.5 13.9 15.9 10.7 4.7 2.5 779 TT Singh 36.9 27.7 21.7 19.2 20.5 25.9 29.9 20.0 9.3 6.3 650 Gujranwala 49.2 27.4 22.4 18.1 34.6 26.5 34.0 24.9 12.1 5.8 1,504 Gujrat 61.4 40.1 25.6 22.6 43.6 34.7 44.1 29.7 14.2 6.4 977 Hafizabad 31.6 12.4 10.7 6.6 21.6 16.2 22.8 14.1 6.1 1.1 416 Mandi Bahauddin 40.4 21.1 17.6 13.3 26.5 22.2 31.1 18.6 8.6 3.2 554 Narowal 60.9 33.7 22.7 19.3 37.5 27.0 38.2 27.8 11.2 5.8 549 Sialkot 71.3 51.8 38.8 33.7 49.8 35.2 51.6 31.5 12.5 7.4 1,155 Lahore 66.7 39.8 35.2 25.4 40.1 41.4 46.9 41.7 18.8 8.4 3,553 Kasur 30.3 8.2 10.5 4.5 16.9 14.9 20.7 16.4 5.2 0.8 1,025 Nankana Sahib 32.7 11.3 10.2 5.4 23.7 17.2 20.4 15.5 7.2 1.7 535 Sheikhupura 41.3 17.7 15.1 9.5 27.7 22.1 29.9 21.2 9.7 3.6 1,172 Multan 30.7 20.0 17.2 14.3 20.8 20.5 24.8 16.8 8.9 5.3 1,523 Khanewal 17.2 12.2 10.9 8.9 13.5 11.9 14.0 9.1 5.7 3.6 944 Lodhran 26.4 18.4 15.6 13.5 16.2 16.1 19.8 9.1 3.0 2.0 525 Vehari 21.3 14.1 11.3 8.6 15.1 13.6 16.9 9.4 5.4 3.0 876 Sahiwal 33.3 23.2 19.5 15.3 22.7 17.9 23.6 17.4 8.7 4.5 784 Pakpattan 28.0 18.3 15.1 11.4 19.8 13.6 18.9 13.1 5.6 3.1 648 Okara 27.1 18.1 16.0 12.8 20.0 17.0 21.1 14.5 9.1 5.9 1,004 P a g e | 327 Table D.HA.1: Knowledge about HIV transmission, misconceptions about HIV, and comprehensive knowledge about HIV transmission (women) Percentage of ever married women age 15-49 years who know the main ways of preventing HIV transmission, percentage who know that a healthy looking person can be HIV-positive, percentage who reject common misconceptions, and percentage who have comprehensive knowledge about HIV transmission, Punjab, 2014. Percentage who have heard of AIDS Percentage who know transmission can be prevented by: Percentage who know that a healthy looking person can be HIV- positive Percentage who know that HIV cannot be transmitted by: Percentage who reject the two most common misconceptions and know that a healthy looking person can be HIV-positive Percentage with comprehensive knowledge1 Number of ever married women age 15- 49 years Having only one faithful uninfected husband Using a condom every time Percentage of women who know both ways Mosquito bites Supernatural means Sharing food with someone with HIV Rawalpindi 58.2 38.3 30.3 23.5 38.4 40.0 43.7 37.9 19.7 10.4 1,780 Attock 39.2 22.4 21.6 18.2 27.3 23.6 25.7 19.0 11.2 7.1 641 Chakwal 42.7 23.3 21.8 16.8 26.1 25.0 32.1 23.9 10.5 6.7 479 Jhelum 59.1 36.2 29.6 25.4 38.7 32.0 38.1 28.2 14.0 8.2 381 Sargodha 41.7 25.9 19.2 14.7 26.6 23.3 30.0 21.8 11.1 5.5 1,200 Bhakkar 23.3 13.2 11.6 9.3 15.7 12.3 16.7 11.2 5.8 4.0 509 Khushab 34.2 21.1 14.1 12.1 22.7 18.2 24.0 16.1 8.8 3.6 448 Mianwali 42.5 21.8 16.7 12.6 26.6 18.6 25.8 15.6 7.8 3.8 588 Punjab 39.0 24.1 19.8 15.6 25.2 23.0 28.3 20.5 9.8 5.1 34,855 1MICS indicator 9.S1 - Knowledge about HIV prevention among young women P a g e | 328 Table D.HA.2: Knowledge of mother-to-child HIV transmission (women) Percentage of ever married women age 15-49 years who correctly identify means of HIV transmission from mother to child, Punjab, 2014. Percentage of women age 15-49 who have heard of AIDS and: Number of ever married women age 15- 49 years 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 Punjab 29.5 27.7 26.3 31.4 23.6 7.6 34,855 District Bahawalpur 14.9 14.6 14.7 16.8 12.0 2.6 1,142 Bahawalnagar 21.2 21.3 19.4 22.5 18.6 3.2 887 RY Khan 33.3 33.8 33.2 37.1 29.8 4.2 1,499 DG Khan 10.8 8.3 8.7 11.5 7.0 4.8 949 Layyah 8.5 7.4 7.6 9.1 6.6 2.9 552 Muzaffargarh 7.8 6.6 7.1 8.8 5.4 4.0 1,218 Rajanpur 8.9 7.8 7.6 9.3 6.7 4.8 566 Faisalabad 33.3 31.3 29.4 34.8 26.9 6.1 2,397 Chiniot 16.8 16.9 15.0 17.6 14.4 3.8 447 Jhang 17.6 17.2 18.0 18.8 16.5 1.7 779 TT Singh 32.5 31.8 33.5 34.9 30.4 2.0 650 Gujranwala 33.4 29.7 26.9 35.2 23.4 14.0 1,504 Gujrat 47.8 44.1 41.3 49.9 36.9 11.4 977 Hafizabad 22.5 19.8 19.7 24.9 16.4 6.6 416 Mandi Bahauddin 32.5 30.6 30.6 33.4 29.1 7.1 554 Narowal 51.1 45.9 43.8 52.6 41.8 8.3 549 Sialkot 56.7 48.6 48.4 60.3 41.6 11.0 1,155 Lahore 47.4 45.7 40.7 49.9 37.5 16.9 3,553 Kasur 21.1 19.4 19.5 22.2 17.3 8.1 1,025 Nankana Sahib 25.3 23.4 21.8 26.3 19.9 6.3 535 Sheikhupura 30.9 28.5 26.1 33.4 22.9 7.9 1,172 Multan 23.4 21.1 21.2 25.9 17.1 4.7 1,523 Khanewal 14.3 13.5 12.8 15.2 11.4 2.0 944 Lodhran 19.8 19.7 19.1 22.2 17.1 4.2 525 Vehari 16.3 15.7 15.9 18.2 13.6 3.1 876 Sahiwal 26.0 24.3 22.2 27.4 19.8 5.9 784 Pakpattan 19.9 19.4 18.6 22.1 16.0 5.9 648 Okara 19.9 19.4 15.7 21.3 14.3 5.8 1,004 Rawalpindi 46.1 43.9 40.4 48.2 37.5 10.0 1,780 Attock 27.5 26.6 25.6 28.8 23.9 10.5 641 Chakwal 31.2 30.6 29.7 32.0 28.1 10.7 479 Jhelum 42.9 39.6 39.5 45.7 35.3 13.4 381 Sargodha 31.4 28.8 27.2 33.6 23.8 8.1 1,200 Bhakkar 16.1 15.3 15.3 18.1 13.3 5.2 509 Khushab 26.4 25.3 26.8 28.5 23.6 5.7 448 Mianwali 32.7 31.9 32.4 35.0 29.5 7.4 588 1 MICS indicator 9.S2 - Knowledge of mother-to-child transmission of HIV P a g e | 329 Table D.HA.3: Accepting attitudes toward people living with HIV (women) Percentage of ever married women age 15-49 years who have heard of AIDS who express an accepting attitude towards people living with HIV, Punjab, 2014. Percentage of women who: Number of ever married women age 15-49 who have heard of AIDS Are willing to care for a family member who is HIV-positive in own home Would buy fresh vegeD- Tables 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 Punjab 68.2 50.0 58.5 61.6 95.7 19.0 13,601 District Bahawalpur 70.7 30.0 39.8 56.9 93.1 10.7 222 Bahawalnagar 60.3 38.3 42.5 58.6 97.1 9.2 227 RY Khan 58.8 38.4 51.1 57.9 93.7 10.8 619 DG Khan 77.6 43.6 54.1 48.8 90.4 19.5 154 Layyah 84.3 50.1 60.5 61.4 94.4 27.5 67 Muzaffargarh 80.9 44.6 52.3 49.4 95.0 17.8 156 Rajanpur 74.1 34.4 40.1 47.1 88.2 12.4 80 Faisalabad 45.4 49.2 58.6 68.8 95.2 14.6 981 Chiniot 48.8 48.7 54.5 69.8 94.8 13.5 96 Jhang 42.2 38.0 46.8 46.3 85.1 6.8 160 TT Singh 43.5 38.8 44.2 59.5 87.8 8.3 240 Gujranwala 57.6 49.8 61.6 65.1 95.8 16.6 740 Gujrat 60.3 47.5 58.4 72.5 98.0 15.5 599 Hafizabad 62.0 55.9 62.0 78.3 97.1 22.6 131 Mandi Bahauddin 53.3 54.9 60.4 66.8 96.4 16.2 224 Narowal 66.3 39.3 59.1 81.1 99.7 16.2 334 Sialkot 72.5 45.1 62.7 66.3 97.4 18.0 824 Lahore 76.4 59.5 60.7 64.4 96.1 27.9 2,371 Kasur 81.0 54.0 63.1 45.2 92.6 21.6 311 Nankana Sahib 71.8 56.7 65.4 64.5 97.4 24.1 175 Sheikhupura 72.9 58.6 65.6 58.9 97.5 22.4 484 Multan 77.2 38.7 53.3 55.9 96.4 14.4 467 Khanewal 70.6 42.7 55.4 53.4 96.6 13.6 162 Lodhran 63.4 44.6 57.9 54.5 92.6 15.1 138 Vehari 68.4 42.3 57.2 56.3 94.9 15.3 187 Sahiwal 86.4 55.0 65.3 62.3 97.7 26.1 261 Pakpattan 86.4 49.7 61.3 67.7 97.8 27.6 181 Okara 83.4 56.5 66.8 56.1 94.9 25.0 272 Rawalpindi 72.2 59.4 64.1 58.2 96.8 21.5 1,036 Attock 65.5 54.4 55.9 68.6 94.3 23.5 252 Chakwal 72.7 53.3 60.9 50.4 95.3 18.5 205 Jhelum 62.8 41.7 50.4 72.1 96.7 19.3 225 Sargodha 75.7 48.0 58.3 43.8 94.6 14.8 500 Bhakkar 72.1 49.4 62.5 58.9 97.7 17.2 119 Khushab 75.6 45.5 54.3 53.6 95.6 13.4 153 Mianwali 68.0 44.9 52.7 57.0 95.0 13.4 249 1 MICS indicator 9.S3 - Accepting attitudes towards people living with HIV P a g e | 330 Table D.HA.4: Knowledge of a place for HIV testing (women) Percentage of ever married women age 15-49 years who know where to get an HIV test, percentage who have ever been tested, percentage who have ever been tested and know the result of the most recent test, percentage who have been tested in the last 12 months, and percentage who have been tested in the last 12 months and know the result, Punjab, 2014 Percentage of women who: Number of ever married women age 15-49 Know a place to get tested1 Have ever been tested Have ever been tested and know the result of the most recent test Have been tested in the last 12 months Have been tested in the last 12 months and know the result2, 3 Punjab 8.5 1.8 1.6 0.6 0.6 34,855 District Bahawalpur 4.1 1.1 0.8 0.4 0.4 1,142 Bahawalnagar 7.1 0.6 0.6 0.4 0.4 887 RY Khan 12.2 1.7 1.2 0.5 0.4 1,499 DG Khan 4.1 0.8 0.7 0.1 0.0 949 Layyah 3.8 0.6 0.4 0.3 0.3 552 Muzaffargarh 3.0 0.7 0.7 0.4 0.4 1,218 Rajanpur 3.4 0.2 0.2 0.0 0.0 566 Faisalabad 9.9 1.4 1.1 0.5 0.5 2,397 Chiniot 8.1 0.8 0.5 0.3 0.1 447 Jhang 2.3 0.1 0.1 0.1 0.1 779 TT Singh 5.9 0.6 0.3 0.1 0.0 650 Gujranwala 12.6 4.9 4.3 1.2 1.2 1,504 Gujrat 18.0 6.1 5.8 2.1 1.9 977 Hafizabad 6.0 1.2 1.1 0.4 0.4 416 Mandi Bahauddin 8.1 1.7 1.7 0.5 0.5 554 Narowal 8.5 1.2 1.2 0.3 0.3 549 Sialkot 21.0 6.4 6.0 3.0 2.8 1,155 Lahore 9.6 1.9 1.8 0.6 0.6 3,553 Kasur 3.4 1.0 0.8 0.4 0.2 1,025 Nankana Sahib 4.5 1.3 1.0 0.7 0.5 535 Sheikhupura 10.0 2.7 2.1 0.4 0.4 1,172 Multan 8.4 0.9 0.5 0.5 0.4 1,523 Khanewal 5.0 0.8 0.8 0.4 0.4 944 Lodhran 5.5 0.5 0.4 0.1 0.1 525 Vehari 5.5 0.4 0.3 0.3 0.3 876 Sahiwal 9.9 1.8 1.6 0.9 0.9 784 Pakpattan 8.3 1.1 0.7 0.4 0.3 648 Okara 7.9 1.1 0.9 0.6 0.5 1,004 Rawalpindi 14.8 3.8 3.4 1.5 1.3 1,780 Attock 7.7 2.1 1.6 0.1 0.1 641 Chakwal 8.8 1.6 1.0 0.9 0.7 479 Jhelum 11.5 2.5 2.5 1.0 1.0 381 Sargodha 6.9 1.1 1.0 0.5 0.5 1,200 Bhakkar 3.2 0.1 0.1 0.0 0.0 509 Khushab 2.4 0.1 0.0 0.0 0.0 448 Mianwali 2.2 0.4 0.0 0.2 0.0 588 1 MICS indicator 9.S4 - Women who know where to be tested for HIV 2 MICS indicator 9.S5 - Women who have been tested for HIV and know the results P a g e | 331 Table D.HA.5: HIV counselling and testing during antenatal care Percentage of ever married women age 15-49 years with a live birth in the last 2 years who received antenatal care from a health professional during the last pregnancy, percentage who received HIV counselling, percentage who were offered and tested for HIV, percentage who were offered, tested and received the results of the HIV test, and percentage who received counselling and were offered, accepted and received the results of the HIV test, Punjab, 2014. Percentage of women who: Number of ever married women age 15-49 years with a live birth in the last 2 years Received antenatal care from a health care professional for last pregnancy Received HIV counselling during antenatal care1 Were offered an HIV test and were tested for HIV during antenatal care Were offered an HIV test and were tested for HIV during antenatal care, and received the results2 Received HIV counselling, were offered an HIV test, accepted and received the results Punjab 78.8 1.3 1.2 1.1 0.7 10,653 District Bahawalpur 66.1 1.2 1.0 1.0 0.5 342 Bahawalnagar 64.5 1.4 0.2 0.2 0.2 254 RY Khan 53.6 1.2 2.2 1.8 0.6 472 DG Khan 57.0 1.0 0.7 0.7 0.2 361 Layyah 69.2 0.0 0.5 0.5 0.0 182 Muzaffargarh 66.2 0.3 0.0 0.0 0.0 414 Rajanpur 57.9 0.2 0.0 0.0 0.0 223 Faisalabad 90.4 1.3 0.5 0.5 0.5 692 Chiniot 90.1 0.4 0.4 0.4 0.4 123 Jhang 68.6 0.5 0.2 0.2 0.2 237 TT Singh 83.5 0.7 0.0 0.0 0.0 185 Gujranwala 76.7 3.3 3.2 2.4 2.1 481 Gujrat 91.1 4.0 4.8 4.5 2.5 258 Hafizabad 83.1 0.0 0.0 0.0 0.0 129 Mandi Bahauddin 80.3 0.5 0.5 0.5 0.5 173 Narowal 93.2 0.2 0.0 0.0 0.0 200 Sialkot 97.3 8.8 8.4 8.2 7.9 336 Lahore 87.9 0.6 1.7 1.7 0.6 988 Kasur 66.9 0.3 0.5 0.5 0.0 376 Nankana Sahib 84.6 0.0 0.2 0.2 0.0 182 Sheikhupura 80.6 0.7 0.6 0.6 0.0 369 Multan 79.8 0.7 0.9 0.9 0.3 465 Khanewal 82.4 0.9 0.5 0.5 0.5 289 Lodhran 70.2 0.5 0.2 0.2 0.2 176 Vehari 83.9 0.0 0.0 0.0 0.0 232 Sahiwal 85.7 1.5 1.4 1.4 1.3 261 Pakpattan 83.3 0.7 0.2 0.2 0.2 221 Okara 74.5 1.1 1.0 0.8 0.5 344 Rawalpindi 89.2 3.1 2.3 2.1 0.9 496 Attock 85.2 1.5 0.6 0.3 0.3 168 Chakwal 89.2 1.7 1.8 1.8 1.5 120 Jhelum 88.3 1.7 1.1 1.1 0.0 97 Sargodha 80.6 0.3 0.0 0.0 0.0 319 Bhakkar 76.5 0.0 0.0 0.0 0.0 174 Khushab 84.5 0.4 0.0 0.0 0.0 127 Mianwali 84.7 0.0 0.0 0.0 0.0 184 1 MICS indicator 9.S7 - HIV counselling during antenatal care 2 MICS indicator 9.S8 - HIV testing during antenatal care P a g e | 332 Table D.HA.6: Key HIV and AIDS indicators (young women) Percentage of ever married women age 15-24 years by key HIV and AIDS indicators, Punjab, 2014. Percentage of ever married women age 15-24 years who: Number of ever married women age 15-24 years Percentage who express accepting attitudes towards people living with HIV on all four indicators Number of ever married women age 15-24 years who have heard of AIDS Have comprehensive knowledge1 Know all three means of HIV transmission from mother to child Know a place to get tested for HIV Have ever been tested and know the result of the most recent test Have been tested in the last 12 months and know the result Punjab 3.3 19.9 7.5 1.1 0.6 5,144 18.5 1,664 District Bahawalpur 2.9 5.9 2.8 0.3 0.3 180 (10.6) 25 Bahawalnagar 1.3 23.7 7.8 0.0 0.0 110 (6.9) 35 RY Khan 2.5 30.8 15.4 0.5 0.0 223 16.3 103 DG Khan 1.3 5.6 4.7 0.5 0.0 192 (19.4) 29 Layyah 0.0 4.7 3.9 0.0 0.0 76 (*) 7 Muzaffargarh 0.0 4.9 2.1 0.0 0.0 209 (*) 21 Rajanpur 0.0 3.1 1.2 0.0 0.0 84 (*) 6 Faisalabad 5.4 24.4 9.3 0.6 0.6 316 13.5 100 Chiniot 1.6 14.6 3.9 0.0 0.0 77 (*) 13 Jhang 1.7 22.0 0.3 0.0 0.0 133 (4.7) 34 TT Singh 4.0 36.0 3.7 0.0 0.0 79 (6.9) 33 Gujranwala 5.1 15.0 8.7 3.4 1.8 217 9.0 69 Gujrat 6.2 34.9 16.4 4.2 1.5 128 13.4 70 Hafizabad 2.1 8.9 5.4 1.0 0.0 57 (*) 12 Mandi Bahauddin 1.4 25.7 6.1 0.8 0.8 94 (33.0) 33 Narowal 10.0 39.3 3.5 1.0 1.0 75 13.0 46 Sialkot 7.3 47.8 27.7 7.4 4.2 132 18.2 97 Lahore 5.8 23.1 4.9 1.2 0.8 479 35.0 226 Kasur 0.0 15.1 1.5 0.4 0.4 173 (3.4) 49 Nankana Sahib 0.8 16.8 4.3 1.4 1.4 84 (25.9) 23 Sheikhupura 2.0 21.0 7.6 1.2 0.5 182 16.9 71 Multan 2.2 18.7 12.5 0.0 0.0 220 12.1 69 Khanewal 2.3 9.3 4.3 0.0 0.0 136 (*) 17 Lodhran 1.7 19.8 6.5 0.0 0.0 82 (10.1) 25 Vehari 2.4 16.9 9.7 0.6 0.6 140 (10.7) 34 Sahiwal 0.9 11.2 6.7 0.5 0.0 121 (30.1) 26 Pakpattan 1.8 10.6 7.6 0.0 0.0 112 (43.3) 19 Okara 1.7 13.1 8.8 1.0 1.0 165 (31.0) 38 Rawalpindi 8.3 36.7 16.0 3.8 1.4 221 18.7 111 Attock 3.8 22.3 8.0 2.2 0.0 104 (22.3) 35 Chakwal 9.5 28.1 9.0 2.7 1.6 55 (21.2) 26 Jhelum 5.0 44.5 15.3 1.1 0.0 54 12.1 34 Sargodha 2.2 16.1 4.3 1.0 1.0 198 17.8 59 Bhakkar 4.2 11.3 1.9 0.0 0.0 78 (11.2) 15 Khushab 3.1 14.8 1.0 0.0 0.0 75 (20.1) 19 Mianwali 1.5 24.8 2.2 0.0 0.0 85 12.3 36 1 MICS indicator 9.S1 - Knowledge about HIV prevention among young women ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases P a g e | 333 Table D.MT.1: Exposure to mass media (women) Percentage of women age 15-49 years who are exposed to specific mass media on a weekly basis, Punjab, 2014. Percentage of women age 15-49 years who: All three media at least once a week1 Any media at least once a week None of the media at least once a week Number of women age 15-49 years Read a newspaper at least once a week Listen to the radio at least once a week Watch television at least once a week Punjab 11.1 4.5 63.7 1.3 66.1 33.8 53,668 District Bahawalpur 8.1 4.8 52.6 1.4 55.2 44.7 1,666 Bahawalnagar 7.0 1.3 44.7 0.3 46.6 53.2 1,421 RY Khan 4.0 1.8 59.9 0.4 60.8 39.2 2,282 DG Khan 6.1 3.2 36.3 0.3 38.7 61.3 1,273 Layyah 5.4 3.4 42.3 0.9 45.0 54.9 825 Muzaffargarh 6.3 4.9 40.9 0.6 44.0 55.8 1,705 Rajanpur 3.0 2.5 36.7 0.1 38.7 61.3 758 Faisalabad 10.7 4.7 71.3 1.3 73.4 26.6 3,880 Chiniot 5.7 1.8 55.0 0.4 56.4 43.5 672 Jhang 5.9 2.9 43.4 0.5 45.7 54.2 1,162 TT Singh 10.9 4.9 70.3 1.0 71.7 28.3 1,081 Gujranwala 17.1 5.2 68.4 1.4 72.8 27.0 2,401 Gujrat 17.1 5.0 78.3 2.1 81.0 18.9 1,521 Hafizabad 6.5 1.2 63.3 0.1 65.0 34.9 642 Mandi Bahauddin 12.7 7.1 72.3 2.0 74.7 25.3 884 Narowal 11.6 2.4 68.5 0.9 71.0 28.8 891 Sialkot 14.7 3.8 81.2 1.3 83.5 16.4 1,987 Lahore 19.0 9.0 87.9 3.8 89.7 10.2 5,357 Kasur 7.5 4.0 56.9 0.5 59.9 39.9 1,602 Nankana Sahib 8.9 1.8 72.4 0.6 74.5 25.4 821 Sheikhupura 11.1 5.5 70.9 1.2 72.6 27.3 1,905 Multan 11.2 9.3 59.1 2.1 62.4 37.4 2,263 Khanewal 7.0 2.7 45.2 0.6 48.1 51.4 1,412 Lodhran 8.0 2.4 55.5 1.1 57.3 42.6 826 Vehari 10.0 2.1 54.8 0.7 57.5 42.5 1,386 Sahiwal 8.6 2.4 55.3 0.6 56.7 43.3 1,205 Pakpattan 6.3 1.1 59.0 0.4 60.1 39.9 984 Okara 9.3 3.0 51.8 0.4 53.6 46.2 1,497 Rawalpindi 18.1 7.2 77.2 1.9 81.1 18.9 2,741 Attock 9.2 4.2 59.5 0.9 62.6 37.3 972 Chakwal 14.3 5.3 70.3 1.1 72.8 27.2 756 Jhelum 10.4 5.1 75.2 1.3 77.0 23.0 617 Sargodha 13.0 3.3 65.8 1.5 68.0 31.9 1,833 Bhakkar 8.0 1.4 49.5 0.0 51.6 48.0 824 Khushab 9.8 1.7 52.0 1.1 54.1 45.7 706 Mianwali 9.2 2.0 62.6 0.5 64.8 35.2 907 1 MICS indicator 10.1 - Exposure to mass media P a g e | 334 Table D.MT.2: Use of computers and internet (women) Percentage of young women age 15-24 years who have ever used a computer and the internet, percentage who have used during the last 12 months, and percentage who have used at least once weekly during the last one month, Punjab, 2014. Percentage of women age 15-24 who have: Number of women age 15-24 years Ever used a computer Used a computer during the last 12 months1 Used a computer at least once a week during the last one month Ever used the internet Used the internet during the last 12 months2 Used the internet at least once a week during the last one month Punjab 26.4 21.4 13.6 13.7 12.4 8.9 21,119 District Bahawalpur 15.9 13.1 7.9 7.4 6.8 5.0 624 Bahawalnagar 12.9 10.8 8.3 4.8 4.5 3.4 562 RY Khan 14.1 12.4 9.4 6.5 6.4 5.2 916 DG Khan 14.0 10.4 4.9 5.8 4.9 3.3 488 Layyah 11.8 7.8 4.8 2.8 2.1 1.3 311 Muzaffargarh 12.7 9.9 4.5 4.7 4.0 2.0 632 Rajanpur 9.4 6.6 4.0 4.4 3.5 2.4 252 Faisalabad 25.6 21.7 15.2 13.0 12.3 9.4 1,597 Chiniot 11.5 10.2 5.9 5.6 5.4 4.2 259 Jhang 14.0 9.3 5.2 6.0 3.5 1.8 441 TT Singh 29.9 23.2 16.5 14.3 12.6 10.8 435 Gujranwala 30.9 26.1 16.5 16.4 15.3 12.1 1,000 Gujrat 36.6 31.1 23.2 26.1 24.6 19.6 588 Hafizabad 26.5 20.5 10.5 12.3 11.4 6.8 253 Mandi Bahauddin 27.0 20.4 11.6 12.6 10.7 7.0 376 Narowal 19.0 16.0 11.7 8.2 7.5 6.3 384 Sialkot 35.3 29.1 19.8 20.1 18.9 13.1 844 Lahore 48.8 41.4 27.7 30.4 28.1 21.0 2,037 Kasur 23.3 18.7 10.1 8.2 7.0 4.4 685 Nankana Sahib 31.4 24.3 10.8 13.5 10.7 7.4 338 Sheikhupura 31.5 24.7 11.5 12.6 9.9 6.1 823 Multan 27.9 22.8 10.4 14.0 13.0 8.3 851 Khanewal 18.6 14.9 7.8 7.8 6.6 4.4 534 Lodhran 12.1 10.7 8.2 4.4 3.9 2.3 339 Vehari 22.3 17.7 10.6 8.5 7.2 3.8 583 Sahiwal 25.4 19.0 12.0 9.6 8.7 6.2 464 Pakpattan 11.8 7.2 3.9 5.0 4.3 3.0 402 Okara 21.7 15.4 10.3 10.1 8.9 6.0 575 Rawalpindi 49.1 39.6 28.6 31.5 28.1 21.5 983 Attock 22.3 15.8 10.7 9.6 8.9 6.2 364 Chakwal 30.0 23.6 11.6 13.4 12.1 5.9 286 Jhelum 33.7 29.6 20.2 22.7 21.4 16.1 252 Sargodha 25.6 20.3 12.5 13.8 12.4 9.1 699 Bhakkar 16.9 12.9 7.8 5.2 4.7 2.2 326 Khushab 16.9 13.4 7.5 6.4 5.7 2.9 279 Mianwali 14.5 10.9 7.2 6.5 6.0 4.4 338 1 MICS indicator 10.2 - Use of computers 2 MICS indicator 10.3 - Use of internet P a g e | 335 Table D.SW.1: Domains of life satisfaction (women) Percentage of women age 15-24 years who are very or somewhat satisfied in selected domains of satisfaction, Punjab, 2014. Percentage of women age 15-24 who are very or somewhat satisfied with selected domains: Percentage of women age 15-24 years who: Number of women age 15-24 years Percentage of women age 15-24 years who are very or somewhat satisfied with school/educational institute Number of women age 15-24 years attending school Percentage of women age 15-24 years who are very or somewhat satisfied with their job Number of women age 15-24 years who have a job Percentage of women age 15-24 years who are very or somewhat satisfied with their income Number of women age 15- 24 years who have an income F a m ily l if e F ri e n d s h ip s H e a lt h L iv in g e n v ir o n m e n t T re a tm e n t b y o th e rs T h e w a y t h e y lo o k A re a tt e n d in g s c h o o l H a v e a j o b H a v e a n i n c o m e Punjab 89.7 82.5 85.6 81.3 85.3 92.0 26.1 6.6 8.3 21,119 91.6 5,505 70.3 1,404 66.9 1,755 District Bahawalpur 85.4 83.4 82.9 78.9 80.0 89.2 23.7 10.7 18.1 624 90.4 148 76.5 67 72.0 113 Bahawalnagar 87.2 87.3 83.9 75.2 75.6 90.2 20.0 4.0 3.9 562 92.3 112 (55.2) 22 (64.3) 22 RY Khan 90.1 85.8 80.8 73.0 78.9 89.0 14.7 1.1 2.0 916 93.0 134 (*) 10 (*) 18 DG Khan 86.4 76.6 83.4 79.8 77.7 87.4 14.3 5.4 15.9 488 90.9 70 (69.4) 26 55.8 78 Layyah 93.1 88.7 86.3 87.7 89.3 92.4 16.7 1.8 2.2 311 96.8 52 (*) 5 (*) 7 Muzaffargarh 88.3 84.8 82.1 81.6 82.5 90.1 18.6 3.8 4.7 632 94.3 118 (57.7) 24 (69.6) 30 Rajanpur 87.6 80.7 76.7 82.7 85.7 88.9 13.6 3.0 4.0 252 96.5 34 (*) 7 (*) 10 Faisalabad 88.0 72.8 82.5 72.7 75.8 90.7 30.0 5.9 7.1 1,597 92.7 479 61.9 95 56.4 113 Chiniot 85.5 62.4 84.8 75.1 79.2 88.4 16.7 8.5 9.7 259 98.1 43 (71.5) 22 (57.7) 25 Jhang 84.3 75.4 83.2 75.7 75.6 86.1 17.8 6.0 6.2 441 88.5 79 (63.7) 27 (58.0) 27 TT Singh 86.8 85.2 89.7 75.4 78.3 87.2 31.4 6.9 6.7 435 90.9 137 (63.1) 30 (60.7) 29 Gujranwala 89.3 81.1 86.4 82.2 86.6 91.5 32.2 9.5 11.5 1,000 90.5 322 84.6 95 77.6 116 Gujrat 90.8 82.7 88.1 85.3 86.9 91.7 33.1 3.3 3.2 588 94.7 195 (59.0) 19 (52.1) 19 Hafizabad 89.3 89.4 93.0 86.2 92.4 96.6 19.5 4.2 6.0 253 96.7 49 (*) 11 (90.2) 15 Mandi Bahauddin 91.2 85.9 86.0 86.2 91.8 94.5 25.5 6.1 7.6 376 93.0 96 (75.4) 23 (81.0) 29 Narowal 87.3 76.7 86.7 76.9 87.5 89.1 30.6 5.5 6.2 384 87.0 118 (62.0) 21 (54.1) 24 Sialkot 90.8 76.6 87.5 77.1 84.6 91.5 42.6 8.0 8.5 844 87.2 360 67.0 67 58.2 72 Lahore 93.0 85.5 88.4 85.3 91.3 93.8 32.1 7.9 8.0 2,037 89.1 653 63.8 161 59.0 163 Kasur 87.1 82.3 82.7 78.3 82.5 89.7 24.3 9.0 11.1 685 94.1 167 64.8 62 60.6 76 Nankana Sahib 92.8 84.9 87.7 85.2 89.3 95.3 24.9 4.4 5.0 338 93.9 84 (*) 15 (*) 17 Sheikhupura 90.4 86.4 85.5 85.7 90.2 91.5 27.9 8.2 9.6 823 91.1 229 74.9 68 75.8 79 Multan 90.1 80.8 85.1 79.3 83.2 93.8 22.8 8.7 11.4 851 92.0 194 (59.7) 74 59.3 97 Khanewal 92.3 76.4 88.3 78.1 86.9 93.4 17.5 5.8 8.6 534 90.5 94 (64.4) 31 (64.7) 46 Lodhran 90.0 78.6 87.6 78.0 86.9 93.2 15.9 13.1 12.9 339 92.6 54 62.7 44 63.4 44 Vehari 85.9 74.7 86.2 79.4 89.6 94.8 21.9 15.7 15.8 583 91.9 128 55.7 91 51.2 92 Sahiwal 91.4 86.9 88.6 87.1 90.1 95.7 22.7 13.2 13.9 464 95.7 105 87.2 61 87.7 64 Pakpattan 90.7 81.3 88.2 87.8 94.2 96.4 14.4 8.2 8.9 402 97.2 58 (83.3) 33 (78.9) 36 Okara 90.7 85.9 90.8 82.6 86.8 94.9 21.9 7.2 12.7 575 96.1 126 (72.8) 41 82.8 73 P a g e | 336 Table D.SW.1: Domains of life satisfaction (women) Percentage of women age 15-24 years who are very or somewhat satisfied in selected domains of satisfaction, Punjab, 2014. Percentage of women age 15-24 who are very or somewhat satisfied with selected domains: Percentage of women age 15-24 years who: Number of women age 15-24 years Percentage of women age 15-24 years who are very or somewhat satisfied with school/educational institute Number of women age 15-24 years attending school Percentage of women age 15-24 years who are very or somewhat satisfied with their job Number of women age 15-24 years who have a job Percentage of women age 15-24 years who are very or somewhat satisfied with their income Number of women age 15- 24 years who have an income F a m ily l if e F ri e n d s h ip s H e a lt h L iv in g e n v ir o n m e n t T re a tm e n t b y o th e rs T h e w a y t h e y lo o k A re a tt e n d in g s c h o o l H a v e a j o b H a v e a n i n c o m e Rawalpindi 90.0 83.0 81.7 83.5 85.2 91.3 45.1 5.6 8.7 983 92.0 443 (82.1) 55 66.3 86 Attock 89.8 79.7 85.0 84.7 86.6 92.4 26.5 1.6 4.2 364 90.9 97 (*) 6 (*) 15 Chakwal 92.7 88.2 88.1 87.8 87.8 94.1 40.1 3.8 5.2 286 91.9 115 (*) 11 (*) 15 Jhelum 90.6 86.9 90.3 80.7 83.5 95.7 34.8 2.4 3.0 252 91.0 88 (*) 6 (*) 8 Sargodha 91.2 90.4 88.4 84.1 91.1 96.0 23.6 6.6 9.1 699 91.8 165 (82.2) 46 (78.8) 64 Bhakkar 94.0 93.5 86.7 93.0 93.8 93.2 18.5 4.2 5.1 326 91.3 60 (88.0) 14 (86.6) 17 Khushab 91.8 93.0 85.5 92.0 91.8 92.5 16.4 2.6 4.3 279 91.9 46 (*) 7 (*) 12 Mianwali 91.6 93.5 84.4 93.2 92.1 94.3 16.1 2.0 1.9 338 93.5 54 (*) 7 (*) 6 Punjab 89.7 82.5 85.6 81.3 85.3 92.0 26.1 6.6 8.3 21,119 91.6 5,505 70.3 1,404 66.9 1,755 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases P a g e | 337 Table D.SW.2: Overall life satisfaction and happiness (women) Percentage of women age 15-24 years who are very or somewhat satisfied with their life overall, the average overall life satisfaction score, and percentage of women age 15-24 years who are very or somewhat happy, Punjab, 2014. Percentage of women with overall life satisfaction1 Average life satisfaction score Percentage of women who are very or somewhat happy 2 Number of women age 15-24 years Punjab 90.5 1.6 90.9 21,119 District Bahawalpur 85.7 1.8 89.5 624 Bahawalnagar 86.5 1.8 88.4 562 RY Khan 86.7 1.7 91.7 916 DG Khan 87.3 1.8 87.5 488 Layyah 93.0 1.6 94.8 311 Muzaffargarh 88.1 1.8 90.2 632 Rajanpur 86.3 1.7 92.8 252 Faisalabad 87.9 1.7 86.6 1,597 Chiniot 86.8 1.8 81.1 259 Jhang 85.9 1.9 86.8 441 TT Singh 86.5 1.8 90.8 435 Gujranwala 90.6 1.7 91.6 1,000 Gujrat 91.1 1.6 90.5 588 Hafizabad 94.6 1.4 92.7 253 Mandi Bahauddin 92.6 1.5 91.8 376 Narowal 88.5 1.7 89.9 384 Sialkot 93.2 1.6 93.4 844 Lahore 92.6 1.5 93.4 2,037 Kasur 87.5 1.7 90.1 685 Nankana Sahib 92.6 1.6 90.6 338 Sheikhupura 93.8 1.6 90.7 823 Multan 91.2 1.7 91.3 851 Khanewal 92.6 1.8 92.8 534 Lodhran 93.1 1.7 92.5 339 Vehari 91.7 1.8 88.6 583 Sahiwal 94.2 1.4 92.8 464 Pakpattan 93.7 1.5 92.1 402 Okara 93.5 1.5 92.9 575 Rawalpindi 89.9 1.6 91.2 983 Attock 91.7 1.5 90.5 364 Chakwal 92.5 1.4 91.2 286 Jhelum 92.2 1.5 92.1 252 Sargodha 91.0 1.6 90.3 699 Bhakkar 94.4 1.6 94.6 326 Khushab 91.6 1.6 92.4 279 Mianwali 93.8 1.5 91.2 338 1 MICS Indicator 11.1 - Life satisfaction 2 MICS indicator 11.2 - Happiness P a g e | 338 Table D.SW.3: Perception of a better life (women) Percentage of women age 15-24 years who think that their lives improved during the last one year and those who expect that their lives will get better after one year, Punjab, 2014. Percentage of women who think that their life Number of women age 15-24 years Improved during the last one year Will get better after one year Both1 Punjab 61.2 89.8 59.2 21,119 District Bahawalpur 48.5 69.3 45.3 624 Bahawalnagar 55.9 79.5 53.2 562 RY Khan 59.2 80.9 54.4 916 DG Khan 63.0 85.1 59.2 488 Layyah 65.3 92.2 64.2 311 Muzaffargarh 68.3 92.9 66.6 632 Rajanpur 56.3 85.2 55.9 252 Faisalabad 57.5 89.8 56.5 1,597 Chiniot 55.6 86.9 55.4 259 Jhang 43.0 87.3 41.8 441 TT Singh 53.0 87.8 51.2 435 Gujranwala 71.5 95.9 69.9 1,000 Gujrat 67.3 95.1 66.6 588 Hafizabad 62.8 92.9 61.2 253 Mandi Bahauddin 63.3 92.3 62.1 376 Narowal 58.7 83.5 56.5 384 Sialkot 66.4 93.9 65.1 844 Lahore 67.8 91.3 66.0 2,037 Kasur 62.6 91.1 60.1 685 Nankana Sahib 65.3 92.6 64.1 338 Sheikhupura 61.4 88.8 58.6 823 Multan 53.2 91.4 50.1 851 Khanewal 55.3 92.7 52.7 534 Lodhran 53.1 85.9 50.3 339 Vehari 50.4 90.8 49.4 583 Sahiwal 70.0 94.2 68.0 464 Pakpattan 61.0 96.6 60.9 402 Okara 68.1 94.4 64.9 575 Rawalpindi 66.6 88.4 64.0 983 Attock 64.5 91.1 63.2 364 Chakwal 65.9 90.9 63.9 286 Jhelum 58.9 94.5 58.4 252 Sargodha 66.1 93.5 64.6 699 Bhakkar 52.5 91.3 51.6 326 Khushab 54.3 89.5 52.9 279 Mianwali 51.8 94.7 51.2 338 1 MICS indicator 11.3 - Perception of a better life P a g e | 339 Table D.TA.1: Current and ever use of tobacco (women) Percentage of women age 15-49 years by pattern of use of tobacco, Punjab, 2104. Never smoked cigarettes or used other tobacco products Ever users Users of tobacco products at any time during the last one month Number of women age 15-49 years Only cigarettes Cigarettes and other tobacco products Only other tobacco products Any tobacco product Only cigarettes Cigarettes and other tobacco products Only other tobacco products Any tobacco product1 Punjab 94.2 1.1 0.6 4.0 5.7 0.7 0.3 3.2 4.1 53,668 District Bahawalpur 95.1 1.3 0.5 2.5 4.3 1.1 0.5 1.7 3.3 1,666 Bahawalnagar 95.0 2.3 0.6 2.1 5.0 2.2 0.5 1.7 4.4 1,421 RY Khan 95.3 1.0 0.1 3.5 4.7 0.8 0.1 3.4 4.3 2,282 DG Khan 86.9 0.2 0.5 12.2 12.9 0.0 0.2 10.3 10.5 1,273 Layyah 85.1 1.5 1.1 12.3 14.9 1.2 0.9 11.9 14.0 825 Muzaffargarh 90.4 1.3 1.0 7.3 9.6 1.3 0.4 7.2 9.0 1,705 Rajanpur 75.8 0.5 2.2 21.5 24.2 0.3 1.0 21.4 22.7 758 Faisalabad 97.2 0.5 0.4 1.7 2.7 0.2 0.3 1.4 1.9 3,880 Chiniot 91.2 1.4 1.8 5.6 8.8 0.9 1.5 5.8 8.2 672 Jhang 90.8 1.1 1.1 6.8 8.9 0.8 0.8 5.9 7.6 1,162 TT Singh 95.2 1.0 1.0 2.8 4.7 0.8 0.7 2.3 3.8 1,081 Gujranwala 96.9 1.2 0.4 1.3 2.9 0.5 0.0 0.6 1.1 2,401 Gujrat 97.4 0.7 0.5 1.4 2.6 0.4 0.3 0.9 1.6 1,521 Hafizabad 93.8 0.9 1.0 4.3 6.2 0.7 0.5 3.3 4.4 642 Mandi Bahauddin 93.8 0.4 0.3 5.5 6.2 0.2 0.2 4.5 5.0 884 Narowal 96.6 1.2 0.6 1.5 3.3 0.7 0.2 0.7 1.7 891 Sialkot 96.7 1.0 0.4 1.9 3.3 0.7 0.2 0.7 1.6 1,987 Lahore 95.4 1.7 0.4 2.5 4.6 0.6 0.1 0.8 1.5 5,357 Kasur 95.7 1.4 0.5 2.4 4.3 0.6 0.2 2.1 2.9 1,602 Nankana Sahib 96.6 1.1 0.7 1.5 3.3 0.5 0.3 1.0 1.9 821 Sheikhupura 96.3 1.2 0.5 2.0 3.7 0.5 0.1 0.9 1.4 1,905 Multan 95.5 1.2 0.2 2.5 3.9 0.7 0.0 1.9 2.6 2,263 Khanewal 94.4 0.9 0.6 4.1 5.6 0.8 0.2 3.4 4.4 1,412 Lodhran 99.1 0.1 0.1 0.7 0.9 0.1 0.1 0.6 0.8 826 Vehari 97.2 0.2 0.3 2.3 2.8 0.2 0.1 2.2 2.5 1,386 Sahiwal 92.7 2.7 1.0 3.6 7.3 1.8 0.5 2.9 5.2 1,205 Pakpattan 95.0 1.5 1.7 1.7 5.0 1.3 1.3 1.6 4.1 984 Okara 93.5 2.0 1.2 3.3 6.5 1.4 0.5 2.6 4.5 1,497 P a g e | 340 Table D.TA.1: Current and ever use of tobacco (women) Percentage of women age 15-49 years by pattern of use of tobacco, Punjab, 2104. Never smoked cigarettes or used other tobacco products Ever users Users of tobacco products at any time during the last one month Number of women age 15-49 years Only cigarettes Cigarettes and other tobacco products Only other tobacco products Any tobacco product Only cigarettes Cigarettes and other tobacco products Only other tobacco products Any tobacco product1 Rawalpindi 93.5 0.7 0.3 5.0 6.0 0.3 0.1 3.3 3.6 2,741 Attock 95.9 0.1 0.1 3.5 3.7 0.0 0.0 2.4 2.4 972 Chakwal 94.8 0.1 0.2 4.7 5.1 0.0 0.0 3.9 3.9 756 Jhelum 96.5 0.4 0.4 2.7 3.4 0.2 0.1 2.4 2.7 617 Sargodha 91.8 1.2 0.8 6.0 8.1 0.9 0.4 4.4 5.7 1,833 Bhakkar 83.6 0.9 0.6 14.9 16.3 0.6 0.3 13.7 14.6 824 Khushab 92.3 0.6 0.7 6.2 7.5 0.4 0.3 5.6 6.3 706 Mianwali 91.0 0.9 0.1 8.1 9.0 0.1 0.0 7.7 7.8 907 Punjab 94.2 1.1 0.6 4.0 5.7 0.7 0.3 3.2 4.1 53,668 1 MICS indicator 12.1 - Tobacco use P a g e | 341 Table D.HC.1: Reported cough and fever and diagnosis of tuberculosis and hepatitis Percentage of population for whom the household respondent reported had a cough and fever during the last three week, percentage of population diagnosed with tuberculosis during the last one year and percentage of the household population diagnosed hepatitis during the last one year, Punjab, 2014. Percent of population having a cough and fever during the last three weeks1 Percentage of poluation diagnosed in the last one year with: Total number of household members Diagnosed with Tuberculosis during last one year2 Diagnosed with Hepatitis during last one year3 Punjab 3.2 0.5 1.5 246,396 District Bahawalpur 3.2 0.5 0.8 8,013 Bahawalnagar 3.4 0.3 0.8 6,704 RY Khan 5.5 0.6 1.4 11,240 DG Khan 3.9 0.6 1.4 6,498 Layyah 3.0 0.3 0.6 3,927 Muzaffargarh 4.6 0.7 1.6 8,664 Rajanpur 2.6 0.7 0.8 4,329 Faisalabad 3.3 0.4 2.0 17,101 Chiniot 4.3 0.5 1.6 3,198 Jhang 2.6 0.4 1.3 5,787 TT Singh 1.5 0.2 2.0 4,885 Gujranwala 2.6 0.5 1.8 10,545 Gujrat 1.0 0.4 1.6 6,553 Hafizabad 4.6 0.5 3.1 2,855 Mandi Bahauddin 3.6 0.8 2.2 3,748 Narowal 4.1 0.3 1.0 4,028 Sialkot 4.9 0.6 1.7 8,584 Lahore 1.4 0.3 1.5 23,671 Kasur 5.0 0.4 1.6 7,752 Nankana Sahib 4.0 0.4 2.6 3,811 Sheikhupura 4.7 0.4 1.8 8,613 Multan 4.0 0.7 2.0 10,610 Khanewal 3.3 0.4 1.8 6,794 Lodhran 3.5 0.5 1.0 3,976 Vehari 4.2 0.4 1.9 6,409 Sahiwal 5.3 0.3 2.1 5,531 Pakpattan 6.5 0.5 1.3 4,520 Okara 5.4 0.4 2.2 7,204 Rawalpindi 1.8 0.5 1.6 11,568 Attock 0.5 0.6 0.9 4,214 Chakwal 0.8 0.4 0.8 3,285 Jhelum 1.6 0.3 1.2 2,700 Sargodha 2.7 0.4 1.3 8,167 Bhakkar 0.3 0.3 0.4 3,807 Khushab 0.2 0.2 0.5 3,104 Mianwali 0.2 0.2 0.5 4,004 1 MICS indicator 13.S2 - Prevalence of chronic cough 2 MICS indicator 13.S3 - Reported tuberculosis 3 MICS indicator 13.S4 - Reported hepatitis P a g e | 342 Table D.HC.2: Care provided by Lady health worker (LHW) Percentage of ever married women with a live birth in the last 2 years who reported that a LHW visited the house during the past month, Punjab, 2014. HH visited by lady health worker (LHW) during past month1 Number of ever married women with a live birth in the last two years Purpose of Visit Number of ever married women visited by LHW ORT, vitamins, medicines To weigh child Educatio n / advice Other DK Punjab 37.6 10,653 37.6 4.8 54 21.4 1.8 3,991 District Bahawalpur 46.9 342 39.6 6.5 52.6 17.7 1.7 160 Bahawalnagar 42.3 254 58.4 7.8 53.7 13.6 107 RY Khan 42.7 472 73.2 1.3 39.7 9.3 201 DG Khan 51.5 361 19.1 0.9 42.0 51.4 4.2 186 Layyah 48.4 182 12.4 0.7 43.7 52.1 3.6 88 Muzaffargarh 53.1 414 14.8 1.1 41.5 47.2 7.8 220 Rajanpur 47.9 223 11.1 0.3 38.3 61.7 107 Faisalabad 28.9 692 32.1 4.6 64.9 9.3 3.8 200 Chiniot 39.0 123 45.0 1.0 72.3 1.7 48 Jhang 24.7 237 24.5 78.6 4.4 2.5 59 TT Singh 39.3 185 22.7 71.7 8.5 73 Gujranwala 36.1 481 41.3 6.3 50.1 14.4 2.1 174 Gujrat 51.7 258 28.4 8.8 67.3 2.6 1.9 133 Hafizabad 37.8 129 34.3 1.2 53.7 15.1 1.2 49 Mandi Bahauddin 44.7 173 37.2 3.5 64.8 12.5 2.2 77 Narowal 54.0 200 42.5 0.8 48.6 19.9 1.9 108 Sialkot 51.2 336 36.9 2.5 54.9 18.6 2.6 172 Lahore 13.5 988 38.2 5.0 62.5 15.3 2.0 129 Kasur 22.0 376 62.1 6.2 45.6 15.9 1.3 83 Nankana Sahib 29.1 182 29.1 2.0 58.3 22.4 3.3 53 Sheikhupura 25.4 369 27.1 4.4 58.6 29.3 3.4 93 Multan 33.8 465 41.8 6.0 63.8 21.4 0.5 157 Khanewal 44.7 289 39.7 1.8 64.3 17.5 127 Lodhran 43.6 176 64.3 3.8 47.6 17.5 77 Vehari 39.5 232 46.1 2.2 62.4 13.3 0.6 89 Sahiwal 49.5 261 36.3 4.8 58.7 13.9 1.4 129 Pakpattan 49.5 221 39.0 6.1 61.0 7.8 0.8 110 Okara 37.2 344 35.8 1.9 61.3 10.3 0.6 128 Rawalpindi 34.1 496 39.9 12.9 54.2 25.5 0.6 169 Attock 32.9 168 59.9 11.9 42.5 15.4 54 Chakwal 49.4 120 44.9 10.6 52.6 14.2 59 Jhelum 56.8 97 46.0 9.4 51.4 17.3 0.8 55 Sargodha 31.6 319 43.2 15.5 48.7 25.4 101 Bhakkar 31.8 174 43.7 23.0 49.2 10.5 4.1 55 Khushab 35.3 127 52.0 4.4 44.9 13.0 45 Mianwali 62.8 184 23.6 3.9 49.9 45.7 0.9 115 1 MICS indicator 13.S1 - Care provided by Lady Health Worker (LHW) P a g e | 343 Table D.SED.1: House, agricultural land, and livestock ownership Percent distribution of household population living in Households that own their property, and percentages of household population whp own: agricultural land or livestock, Punjab, 2014. Percent of household by house ownership Percentage of households who own agricluture land Percentage of households who own livestock Percentage of households own certain assets (house, land or livestock)1 Number of households Own Rent Other/ Missing Total Punjab 87.0 7.8 5.2 100.0 30.5 45.5 90.8 38,405 District Bahawalpur 90.0 4.3 5.7 100.0 34.2 53.1 94.4 1,299 Bahawalnagar 89.1 2.7 8.2 100.0 39.7 65.7 95.0 1,074 RY Khan 90.7 3.4 6.0 100.0 39.3 62.5 95.3 1,719 DG Khan 93.8 4.0 2.3 100.0 37.2 68.7 97.0 935 Layyah 93.6 1.9 4.5 100.0 48.0 78.3 97.8 597 Muzaffargarh 93.0 2.4 4.6 100.0 45.3 70.9 97.0 1,303 Rajanpur 91.2 2.0 6.8 100.0 46.3 72.5 96.7 600 Faisalabad 84.7 10.3 5.1 100.0 22.6 27.4 86.5 2,711 Chiniot 87.4 4.6 8.0 100.0 29.1 52.6 92.3 504 Jhang 88.6 3.0 8.4 100.0 42.9 62.4 94.5 893 TT Singh 88.8 5.3 6.0 100.0 36.9 50.6 92.6 780 Gujranwala 88.8 9.1 2.1 100.0 20.4 27.9 90.5 1,589 Gujrat 90.8 5.7 3.4 100.0 37.0 37.7 92.4 1,024 Hafizabad 93.1 3.0 3.9 100.0 30.0 48.2 94.8 433 Mandi Bahauddin 90.9 5.6 3.6 100.0 41.6 55.7 94.3 589 Narowal 97.8 1.7 0.5 100.0 42.1 57.9 98.6 634 Sialkot 90.1 8.3 1.7 100.0 31.3 35.0 92.1 1,299 Lahore 77.2 19.1 3.7 100.0 6.5 9.8 79.6 3,614 Kasur 90.0 5.5 4.5 100.0 26.8 40.7 92.4 1,171 Nankana Sahib 89.0 4.8 6.2 100.0 30.1 45.4 92.5 580 Sheikhupura 89.8 7.1 3.1 100.0 23.1 36.5 92.1 1,266 Multan 83.7 10.4 5.9 100.0 19.3 36.6 86.1 1,835 Khanewal 89.3 4.0 6.7 100.0 34.6 56.6 94.2 1,123 Lodhran 95.2 1.1 3.7 100.0 42.4 63.3 97.7 647 Vehari 89.1 3.7 7.3 100.0 36.6 55.1 94.6 1,028 Sahiwal 85.5 5.3 9.2 100.0 37.0 56.7 92.0 832 Pakpattan 87.8 3.6 8.6 100.0 34.1 54.9 93.2 718 Okara 81.9 6.7 11.4 100.0 29.2 51.9 89.3 1,088 Rawalpindi 69.5 24.3 6.2 100.0 25.8 28.2 76.4 1,923 Attock 88.2 8.7 3.1 100.0 32.8 48.6 92.6 689 Chakwal 93.2 4.2 2.6 100.0 47.5 55.7 96.2 568 Jhelum 89.1 7.7 3.2 100.0 29.1 39.5 90.9 452 Sargodha 86.6 7.9 5.6 100.0 24.7 47.9 91.4 1,324 Bhakkar 88.8 3.6 7.6 100.0 48.8 76.3 96.9 544 Khushab 90.7 4.0 5.4 100.0 45.8 64.4 95.1 471 Mianwali 93.0 3.0 4.0 100.0 48.9 71.4 96.4 545 1 MICS indicator 14.S1 - Ownership of assets: House, land, livestock P a g e | 344 Table D.SED.2: Working outside village/city/country Percentage of household members working outside village/city/country, and percent distribution of the place of work for members working outside village/city, Punjab, 2014. Percentage of households members working outside village/ town/ overseas1 Number of househol d members Place of work of members working outside village/city Number of household members working outside village/ town Other village/ city Other district Other province Overseas DK/ Missing Total Punjab 12.0 246,396 14.5 8.3 7.2 69.5 0.5 100.0 29,670 District Bahawalpur 7.5 8,013 21.0 13.1 12.3 53.7 - 100.0 600 Bahawalnagar 4.8 6,704 13.7 14.3 5.4 66.6 - 100.0 322 RY Khan 6.4 11,240 15.1 14.9 11.6 58.4 - 100.0 716 DG Khan 22.9 6,498 19.9 1.8 11.2 67.1 - 100.0 1,489 Layyah 9.7 3,927 17.4 25.4 33.9 23.3 - 100.0 382 Muzaffargarh 11.7 8,664 35.5 5.4 28.5 30.3 0.2 100.0 1,013 Rajanpur 10.0 4,329 18.0 9.9 24.3 47.8 - 100.0 433 Faisalabad 8.3 17,101 6.0 9.8 1.0 83.2 - 100.0 1,411 Chiniot 4.7 3,198 6.6 2.3 6.2 84.9 - 100.0 149 Jhang 6.0 5,787 21.1 30.7 9.3 38.9 - 100.0 346 TT Singh 9.8 4,885 3.3 3.7 1.8 90.6 0.7 100.0 481 Gujranwala 22.6 10,545 13.4 7.7 1.5 77.1 0.3 100.0 2,382 Gujrat 43.0 6,553 10.1 5.7 3.6 80.5 0.2 100.0 2,815 Hafizabad 13.3 2,855 7.3 5.1 3.3 71.3 13.1 100.0 379 Mandi Bahauddin 26.6 3,748 4.9 3.2 - 91.9 - 100.0 996 Narowal 31.2 4,028 21.9 33.0 6.2 39.0 - 100.0 1,258 Sialkot 29.3 8,584 5.4 0.7 2.0 91.9 - 100.0 2,511 Lahore 6.2 23,671 6.2 2.3 - 90.5 1.1 100.0 1,468 Kasur 5.4 7,752 53.2 5.0 6.1 32.1 3.5 100.0 420 Nankana Sahib 13.6 3,811 19.5 15.3 3.7 61.5 - 100.0 518 Sheikhupura 8.6 8,613 14.3 5.7 5.4 74.6 - 100.0 741 Multan 6.5 10,610 29.1 12.5 15.7 42.7 - 100.0 694 Khanewal 7.4 6,794 43.0 4.0 15.6 36.1 1.3 100.0 503 Lodhran 6.7 3,976 28.1 16.4 20.5 35.0 - 100.0 265 Vehari 13.0 6,409 21.0 7.5 13.5 58.0 - 100.0 834 Sahiwal 12.1 5,531 11.9 4.4 17.2 66.0 0.5 100.0 668 Pakpattan 6.9 4,520 27.0 20.3 11.3 41.4 - 100.0 314 Okara 6.4 7,204 16.3 20.2 9.2 54.4 - 100.0 459 Rawalpindi 15.8 11,568 12.6 2.7 2.1 81.7 0.9 100.0 1,828 Attock 14.7 4,214 8.1 5.4 4.4 80.7 1.4 100.0 618 Chakwal 16.1 3,285 10.0 7.7 13.2 69.1 - 100.0 529 Jhelum 21.0 2,700 1.3 4.1 4.2 90.4 - 100.0 567 Sargodha 10.9 8,167 17.0 9.9 8.0 64.6 0.5 100.0 894 Bhakkar 3.0 3,807 13.6 27.1 6.3 53.0 - 100.0 115 Khushab 7.7 3,104 6.3 6.4 12.7 74.6 - 100.0 238 Mianwali 7.8 4,004 4.8 18.6 14.1 62.6 - 100.0 314 1 MICS indicator 14.S3 - Proportion of population working outside village/city/country P a g e | 345 Table D.SED.6: Pension Benefits Percentage of households receiving pension and by percent distribution of the source, Punjab, 2014. Percentage of household receiving pension1 Number of households Percent of households receiving pension by source Number of households recieving pension Govern ment EOBI Others DK Total Punjab 8.1 38,405 94.2 4.0 1.3 0.8 100.0 3,097 District Bahawalpur 5.1 1,299 97.0 0.0 1.5 1.5 100.0 66 Bahawalnagar 3.2 1,074 (92.3) (5.8) (1.9) (0.0) 100.0 35 RY Khan 2.1 1,719 (96.8) (3.2) (0.0) (0.0) 100.0 37 DG Khan 4.1 935 (96.7) (2.1) (0.0) (1.2) 100.0 39 Layyah 2.7 597 (100.0) (0.0) (0.0) (0.0) 100.0 16 Muzaffargarh 3.2 1,303 93.4 0.0 6.6 0.0 100.0 42 Rajanpur 2.2 600 (100.0) (0.0) (0.0) (0.0) 100.0 13 Faisalabad 7.4 2,711 84.4 11.5 3.0 1.1 100.0 201 Chiniot 4.2 504 (91.6) (8.8) (2.8) (0.0) 100.0 21 Jhang 4.9 893 91.8 0.0 0.8 7.5 100.0 44 TT Singh 6.2 780 96.5 2.1 0.0 1.3 100.0 48 Gujranwala 5.0 1,589 94.8 1.1 3.8 2.1 100.0 80 Gujrat 14.8 1,024 97.1 0.5 2.9 0.0 100.0 152 Hafizabad 3.5 433 (*) (*) (*) (*) 100.0 15 Mandi Bahauddin 8.9 589 98.3 1.2 0.0 0.5 100.0 53 Narowal 10.8 634 100.0 0.0 0.0 0.0 100.0 69 Sialkot 5.9 1,299 95.2 2.5 2.3 0.0 100.0 76 Lahore 9.4 3,614 91.0 6.9 1.3 1.4 100.0 342 Kasur 4.4 1,171 99.2 0.0 0.8 0.0 100.0 51 Nankana Sahib 5.2 580 (94.9) (3.1) (0.0) (2.0) 100.0 30 Sheikhupura 7.0 1,266 88.9 12.4 0.0 0.0 100.0 88 Multan 3.8 1,835 92.5 7.5 0.0 0.0 100.0 70 Khanewal 5.2 1,123 95.0 3.8 0.0 1.1 100.0 59 Lodhran 1.4 647 (*) (*) (*) (*) 100.0 9 Vehari 2.9 1,028 (89.2) (5.1) (5.7) (0.0) 100.0 29 Sahiwal 8.0 832 98.2 0.9 0.9 0.0 100.0 67 Pakpattan 2.5 718 (98.0) (2.0) (0.0) (0.0) 100.0 18 Okara 5.9 1,088 90.2 4.4 3.2 2.2 100.0 64 Rawalpindi 22.6 1,923 93.0 5.5 1.4 1.2 100.0 434 Attock 18.8 689 95.2 4.0 0.8 0.0 100.0 129 Chakwal 35.5 568 94.9 3.8 1.0 0.3 100.0 202 Jhelum 18.5 452 96.9 2.0 1.2 0.0 100.0 84 Sargodha 11.8 1,324 97.2 2.0 0.0 0.8 100.0 156 Bhakkar 6.7 544 100.0 0.0 0.0 0.0 100.0 37 Khushab 17.6 471 99.4 0.0 0.6 0.0 100.0 83 Mianwali 25.7 545 97.7 0.9 0.6 0.8 100.0 140 1 MICS indicator 14.S9 - Receiving pensions ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases P a g e | 346 Table D.SED.8: Safety nets (utility store) Percentage of households who are purchasing goods from government utility stores, and percent distribution of households purchasing goods from government utiliy stores on a regular or casual basis, MICS Punjab, 2014. Percentage of households purchasing goods from utility stores1 Total number of households Percent of households purchasing goods from government utility stores Number of households purchasing goods from utility stores on a regular or casual basis: who believe government initiatives are benefiting the low income groups Regular2 Casual DK Missing Total Yes No DK Missing Total Punjab 18.0 38,405 29.5 70.3 0.2 0.1 100.0 26.5 65.1 8.1 0.3 100.0 6,902 District Bahawalpur 12.7 1,299 21.6 77.8 0.6 0.0 100.0 24.1 66.9 8.7 0.3 100.0 164 Bahawalnagar 17.6 1,074 27.5 72.5 0.0 0.0 100.0 39.8 54.3 5.7 0.2 100.0 189 RY Khan 8.9 1,719 32.1 67.9 0.0 0.0 100.0 56.6 41.4 1.9 0.0 100.0 153 DG Khan 12.0 935 32.7 66.8 0.0 0.5 100.0 29.0 58.7 12.2 0.0 100.0 113 Layyah 15.8 597 23.3 76.7 0.0 0.0 100.0 29.2 66.1 4.6 0.1 100.0 95 Muzaffargarh 9.3 1,303 23.9 75.2 0.0 0.9 100.0 25.6 69.6 4.8 0.0 100.0 121 Rajanpur 6.8 600 30.0 70.0 0.0 0.0 100.0 29.9 65.6 4.5 0.0 100.0 41 Faisalabad 21.0 2,711 24.5 75.1 0.4 0.0 100.0 25.4 66.9 7.5 0.2 100.0 568 Chiniot 17.6 504 20.6 79.4 0.0 0.0 100.0 27.3 67.6 5.1 0.0 100.0 89 Jhang 18.4 893 13.7 86.0 0.4 0.0 100.0 14.3 76.5 9.1 0.1 100.0 165 TT Singh 29.8 780 24.2 75.8 0.0 0.0 100.0 19.5 69.3 11.1 0.1 100.0 233 Gujranwala 9.3 1,589 28.7 69.8 1.5 0.0 100.0 26.0 61.5 12.4 0.2 100.0 148 Gujrat 16.7 1,024 32.2 67.8 0.0 0.0 100.0 31.1 57.2 11.5 0.2 100.0 171 Hafizabad 7.3 433 22.8 77.2 0.0 0.0 100.0 15.6 75.6 7.9 0.9 100.0 32 Mandi Bahauddin 17.9 589 29.0 71.0 0.0 0.0 100.0 27.7 66.5 5.6 0.2 100.0 106 Narowal 6.3 634 20.3 76.6 3.1 0.0 100.0 31.1 51.8 17.0 0.1 100.0 40 Sialkot 16.6 1,299 34.7 64.9 0.0 0.4 100.0 24.7 60.5 14.8 0.0 100.0 216 Lahore 19.3 3,614 30.6 68.6 0.7 0.0 100.0 14.1 75.0 10.2 0.7 100.0 699 Kasur 4.9 1,171 18.6 79.4 0.0 2.0 100.0 28.4 66.4 4.7 0.5 100.0 58 Nankana Sahib 12.6 580 17.8 81.3 0.0 0.9 100.0 22.2 70.2 7.5 0.1 100.0 73 Sheikhupura 15.1 1,266 22.4 77.6 0.0 0.0 100.0 16.7 74.8 8.1 0.4 100.0 191 Multan 16.7 1,835 37.3 62.7 0.0 0.0 100.0 23.7 68.8 7.3 0.2 100.0 306 Khanewal 12.5 1,123 21.3 78.7 0.0 0.0 100.0 20.9 68.5 10.2 0.5 100.0 141 Lodhran 8.3 647 29.9 70.1 0.0 0.0 100.0 40.9 53.6 5.5 0.1 100.0 54 Vehari 17.7 1,028 22.7 77.3 0.0 0.0 100.0 28.0 63.2 8.7 0.1 100.0 182 Sahiwal 22.9 832 27.3 72.7 0.0 0.0 100.0 29.0 65.8 5.2 0.0 100.0 191 Pakpattan 13.3 718 25.0 75.0 0.0 0.0 100.0 26.2 66.8 7.0 0.0 100.0 96 Okara 23.2 1,088 31.1 68.9 0.0 0.0 100.0 29.6 60.4 10.0 0.1 100.0 253 Rawalpindi 41.0 1,923 40.8 59.1 0.1 0.0 100.0 23.8 68.7 6.6 0.9 100.0 788 Attock 22.0 689 37.0 63.0 0.0 0.0 100.0 19.8 76.2 3.6 0.3 100.0 152 Chakwal 37.0 568 34.9 64.7 0.0 0.4 100.0 28.1 64.5 6.3 1.1 100.0 210 Jhelum 32.7 452 33.4 66.6 0.0 0.0 100.0 27.7 61.8 10.4 0.1 100.0 148 Sargodha 23.7 1,324 20.0 80.0 0.0 0.0 100.0 27.6 65.2 7.1 0.1 100.0 314 Bhakkar 17.5 544 34.4 65.6 0.0 0.0 100.0 30.3 59.7 9.4 0.6 100.0 95 Khushab 25.8 471 39.0 61.0 0.0 0.0 100.0 35.3 57.2 7.3 0.2 100.0 122 Mianwali 34.5 545 33.0 67.0 0.0 0.0 100.0 33.3 58.9 7.6 0.1 100.0 188 1 MICS indicator 14.S8 - Purchasing goods from government utility stores 2 MICS indicator 14.S8b - Regular purchase from utility stores P a g e | 347 Table D.SED.9: Possession of bank account Percentage of households with at least one member who has a bank accounts, Punjab, 2014. Possession of Bank account Total number of households Punjab 31.6 38,405 District Bahawalpur 22.8 1,299 Bahawalnagar 17.6 1,074 RY Khan 20.1 1,719 DG Khan 21.4 935 Layyah 17.5 597 Muzaffargarh 17.5 1,303 Rajanpur 15.1 600 Faisalabad 36.7 2,711 Chiniot 24.0 504 Jhang 23.0 893 TT Singh 36.3 780 Gujranwala 34.0 1,589 Gujrat 43.4 1,024 Hafizabad 25.5 433 Mandi Bahauddin 33.2 589 Narowal 35.7 634 Sialkot 41.5 1,299 Lahore 46.5 3,614 Kasur 23.6 1,171 Nankana Sahib 26.9 580 Sheikhupura 30.8 1,266 Multan 26.1 1,835 Khanewal 23.4 1,123 Lodhran 24.2 647 Vehari 28.8 1,028 Sahiwal 33.8 832 Pakpattan 17.5 718 Okara 24.2 1,088 Rawalpindi 47.2 1,923 Attock 35.4 689 Chakwal 46.0 568 Jhelum 48.4 452 Sargodha 33.6 1,324 Bhakkar 25.4 544 Khushab 37.6 471 Mianwali 51.0 545 P a g e | 348 Table D.SED.10: Marital status of household members Percent distribution of household members by marital status, Punjab, 2014. Marital Status Total number of households members aged 10 years and above Currently married1 Widowed Divorced Separated Never married DK/ Missing Total Punjab 51.4 4.8 0.5 0.4 42.8 0.0 100.0 183,599 District Bahawalpur 53.8 5.0 0.3 0.6 39.8 0.5 100.0 5,836 Bahawalnagar 51.2 4.3 0.3 0.9 43.3 0.0 100.0 4,921 RY Khan 52.7 3.7 0.3 0.3 43.0 0.0 100.0 8,087 DG Khan 54.9 2.9 0.1 0.3 41.6 0.2 100.0 4,374 Layyah 51.7 3.6 0.3 0.4 43.9 0.1 100.0 2,777 Muzaffargarh 53.4 3.7 0.4 0.3 42.2 0.0 100.0 5,978 Rajanpur 52.7 3.2 0.2 0.2 43.7 0.0 100.0 2,903 Faisalabad 49.6 4.7 0.6 0.4 44.5 0.2 100.0 13,180 Chiniot 52.3 5.8 1.1 1.1 39.7 0.1 100.0 2,399 Jhang 52.4 4.8 0.5 0.5 41.6 0.2 100.0 4,333 TT Singh 50.2 5.0 0.3 0.3 44.1 0.1 100.0 3,742 Gujranwala 50.5 4.7 0.4 0.3 44.0 0.1 100.0 7,861 Gujrat 50.2 6.1 1.0 0.2 42.4 0.1 100.0 4,935 Hafizabad 51.1 5.1 0.6 0.5 42.3 0.4 100.0 2,146 Mandi Bahauddin 51.7 5.7 0.6 0.3 41.4 0.2 100.0 2,887 Narowal 51.5 4.4 0.5 0.2 43.1 0.2 100.0 2,867 Sialkot 48.6 4.9 0.4 0.3 45.7 0.1 100.0 6,509 Lahore 51.2 5.0 0.4 0.2 43.1 0.2 100.0 18,101 Kasur 51.4 4.4 0.4 0.2 43.3 0.3 100.0 5,692 Nankana Sahib 51.8 5.2 0.6 0.3 42.1 0.1 100.0 2,844 Sheikhupura 50.3 4.0 0.5 0.4 44.8 0.1 100.0 6,559 Multan 52.0 5.0 0.3 0.4 42.2 0.2 100.0 7,739 Khanewal 50.6 4.8 0.6 0.6 43.3 0.1 100.0 5,013 Lodhran 52.5 3.9 0.1 0.4 42.9 0.1 100.0 2,912 Vehari 50.2 5.0 0.7 0.5 43.6 0.0 100.0 4,789 Sahiwal 50.5 5.8 0.8 0.9 41.9 0.0 100.0 4,179 Pakpattan 51.4 5.3 1.3 0.7 41.2 0.1 100.0 3,341 Okara 51.6 5.2 1.0 0.5 41.6 0.0 100.0 5,205 Rawalpindi 52.9 4.6 0.6 0.5 41.4 0.0 100.0 9,003 Attock 52.8 5.8 0.8 0.4 40.2 0.1 100.0 3,274 Chakwal 51.0 6.5 0.9 0.4 41.0 0.2 100.0 2,581 Jhelum 50.1 5.8 0.9 0.5 42.5 0.2 100.0 2,123 Sargodha 50.3 5.7 1.0 0.6 42.3 0.0 100.0 6,312 Bhakkar 50.9 4.3 0.4 0.2 43.9 0.2 100.0 2,817 Khushab 51.5 5.4 1.2 0.5 41.4 0.0 100.0 2,367 Mianwali 52.7 4.5 0.6 0.5 41.6 0.1 100.0 3,010 1 MICS indicator 14.S11 - Currently married population P a g e | 349 Table D.SED.11: Unemployment rate among population age 10 years or above Percentage of population of age 10 years or above who are currently employed or unemployed and seeking work, Punjab, 2014. Employment rate among population age 10 years or above Unemployment rate among population age 10 years or above1 Number of household members age 10 years or above (employed or unemployed, but seeking for job) in active labour force Unemployment rate among population age 15 years or above Number of household members age 15 years or above (employed or unemployed, but seeking for job) in active labour force Punjab 92.9 7.1 69,468 6.7 67,995 District Bahawalpur 88.9 11.1 2,260 9.6 2,184 Bahawalnagar 92.2 7.8 1,769 6.6 1,713 RY Khan 92.7 7.3 2,788 5.8 2,695 DG Khan 93.1 6.9 1,467 6.4 1,428 Layyah 94.0 6.0 968 5.5 956 Muzaffargarh 94.3 5.7 2,210 4.8 2,144 Rajanpur 94.4 5.6 1,001 4.4 962 Faisalabad 92.4 7.6 5,144 7.3 5,046 Chiniot 94.5 5.5 954 5.4 937 Jhang 95.3 4.7 1,687 4.3 1,647 TT Singh 94.1 5.9 1,485 5.8 1,458 Gujranwala 94.8 5.2 2,910 5.2 2,858 Gujrat 92.1 7.9 1,561 7.7 1,548 Hafizabad 91.3 8.7 797 8.5 784 Mandi Bahauddin 89.3 10.7 1,001 10.2 986 Narowal 95.3 4.7 970 4.6 959 Sialkot 93.9 6.1 2,277 6.2 2,247 Lahore 93.3 6.7 7,156 6.4 7,038 Kasur 93.3 6.7 2,214 6.1 2,152 Nankana Sahib 89.1 10.9 1,109 9.9 1,086 Sheikhupura 90.3 9.7 2,575 9.1 2,524 Multan 94.1 5.9 3,183 5.3 3,083 Khanewal 91.9 8.1 2,056 7.3 1,995 Lodhran 94.7 5.3 1,210 4.5 1,164 Vehari 94.5 5.5 2,105 5.0 2,051 Sahiwal 96.3 3.7 1,583 3.5 1,547 Pakpattan 96.6 3.4 1,316 3.2 1,278 Okara 95.1 4.9 1,987 4.6 1,923 Rawalpindi 91.5 8.5 3,442 8.2 3,422 Attock 91.2 8.8 1,199 8.6 1,190 Chakwal 88.2 11.8 999 11.7 996 Jhelum 88.9 11.1 767 10.7 760 Sargodha 92.1 7.9 2,420 7.4 2,367 Bhakkar 91.7 8.3 999 7.8 984 Khushab 90.0 10.0 848 9.6 840 Mianwali 90.9 9.1 1,052 8.9 1,044 1 MICS indicator 14.S2 - Unemployment rate (10+ years) P a g e | 350 APPENDIX B: 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 MICS Punjab, 2014 was to produce statistically reliable estimates of most of the indicators, at the provincial level, 36 districts and for urban and rural areas. Urban and rural areas in each of the 36 districts were defined as the sampling strata. Universe The universe of this Survey consists of all urban and rural areas of Punjab defined as such by Housing Census 2011. The military restricted areas and cantonment have been excluded from the scope of the survey. Sampling Frame Pakistan Bureau of Statistics (PBS) has developed its own sampling frame based upon Housing Census 2011. Each city/town/village/deh has been divided into enumeration blocks. Each enumeration block comprised of 200-250 households on the average with well-defined boundaries and maps. The urban area sampling frame was updated during 2013 and the rural area sampling frame consists of a list of villages/deh/blocks compiled during Housing Census 2011. In the updated sampling frame, enumeration blocks, both urban and rural, are considered as Primary Sampling Units (PSUs). The breakdown of enumeration blocks into urban and rural areas of Punjab are as below:- Province Urban Rural Total Punjab 22,415 58,063 80,478 Stratification Plan A. Urban Domain Large cities: There are eight Large cities (Lahore, Faisalabad, Rawalpindi, Gujranwala, Multan, Sargodha, Sialkot and Bahawalpur), having population five hundred thousand and above. The Pakistan Bureau of Statistics (PBS) is maintaining a separate frame for SRC/Major urban for the corresponding 8 districts. Therefore these 8 districts have been divided into three strata each, while the other 28 districts have two strata each. Therefore instead of 72 strata (36 districts into 2), 8 more strata for major urban were added and renumbered from 73 to 80. Each of these cities has further been sub-stratified into low, middle and high income groups. The weights are calculated at the cluster level. Other urban areas: After excluding the large cities from the eight administrative districts, the remaining urban areas of each administrative district has been taken as a separate independent stratum. B. Rural Domain All Rural areas of each administrative district, has been treated as an independent stratum. The sample selection has been undertaken independently in each district and stratum. P a g e | 351 Sample Size and Sample Allocation Keeping in view the key variables and main objectives of the survey, a sample of 41,000 households has been considered appropriate to yield reliable estimates of population parameters within acceptable reliability limits. For the estimation of the sample size, the key indicators used were the underweight prevalence among children age 0-4 years, immunization coverage, antenatal care and literacy rate. The following formula given in the MICS5 methodology was used to estimate the required sample size:- )])()(()15.0[( )])(1)((4[ 2 RRAveSizepbr deffrr n   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 2  0.15r is the margin of error to be tolerated at the 95 percent level of confidence, defined as 15 percent of r (relative margin of error of r)  pb is the proportion of the total population upon which the indicator, r, is based  AveSize is the average household size (number of persons per household)  RR is the predicted response rate For the calculation, r (underweight prevalence) was taken from the previous MICS i.e., 32.6 percent. The value of deff (design effect) was taken as 2.0 based on estimates from previous surveys, pb (percentage of children age 0-4 years in the total population) was taken as 12.6 percent, AveSize (average household size) was taken as 6.3, and the response rate was assumed to be 90 percent, based on experience from previous surveys. Furthermore the relative margin of error to be tolerated at the 95 percent level of confidence was taken as 15 percent. By using the above mentioned assumptions, the number of sample households was estimated for each of the 36 districts, and summed up to the total sample for the province. The total sample was then reallocated to all the districts in proportion to the square root of the population estimates of December 2012. The urban and rural allocation in each of the districts was made according to the proportion of urban-rural population, with slight oversampling for the urban stratum to obtain reliable urban estimates. The number of households selected per cluster for the MICS Punjab, 2014 was determined as 20 households, based on a number of considerations, including the design effect, the budget available, and the time that would be needed per team to complete one cluster. Dividing the total number of households by the number of sample households per cluster, it was calculated that 2050 sample clusters would need to be selected from the province. Therefore, the entire sample of households (SSUs) was drawn from 2050 Primary Sampling Units (PSUs), out of which 774 were urban and 1276 were rural. P a g e | 352 The total sample is allocated to 36 districts in proportion to the square root of the population estimates of December 2012. Therefore, each district had different clusters based on its population as of December 2012. Furthermore, in each district, the clusters (primary sampling units) were distributed to the urban and rural domains proportionally to the size of urban and rural populations in that district. The table below shows the allocation of clusters to the sampling strata. Table SD.1: Allocation of Sample Clusters (Primary Sampling Units) to Sampling Strata Estimated Population December 2012 (000’) Number of Clusters Total Urban Rural Total Urban Rural Total 96,676 30,803 65,598 2050 774 1276 Divisions/Districts Bahawalpur 10,339 2,271 8,068 200 69 131 Bahawalpur 3,337 912 2,425 66 25 41 Bahawalnagar 2,641 503 2,138 59 19 40 Rahim Yar Khan 4,361 856 3,505 75 25 50 D G Khan 9,120 1,227 7,894 215 62 153 Dera Ghazi Khan 2,308 321 1,987 55 16 39 Layyah 1,542 199 1,344 45 13 32 Muzaffargarh 3,726 483 3,243 70 19 51 Rajanpur 1,544 224 1,320 45 14 31 Faisalabad 12,585 4,301 8,284 241 97 144 Faisalabad City 7,029 3,029 4,000 96 44 52 Chiniot 1,184 318 866 39 15 24 Jhang 2,354 574 1,780 55 20 35 Toba Tek Singh 2,018 380 1,638 51 17 34 Gujranwala 14,651 4,647 10,004 328 125 203 Gujranwala City 4,555 2,323 2,232 77 39 38 Gujrat 2,577 715 1,862 58 22 36 Hafizabad 1,052 287 765 37 14 23 M. B. Din 1,408 214 1,194 43 13 30 Narowal 1,549 189 1,360 45 12 33 Sialkot 3,510 919 2,591 69 26 43 Lahore 16,363 9,176 6,911 274 134 140 Lahore City 9,015 7,397 1,618 108 74 34 Kasur 3,112 710 2,402 64 23 41 Nankana Sahib 1,256 190 1,066 40 12 28 Sheikhupura 2,980 879 1,825 62 25 37 Multan 11,102 2,880 8,222 237 84 153 Multan 4,127 1,742 2,385 73 34 39 Khanewal 2,662 469 2,193 59 18 41 Lodhran 1,554 226 1,328 45 14 31 Vehari 2,759 443 2,316 60 19 41 Sahiwal 6,832 1,274 5,558 163 52 111 Sahiwal 2,301 377 1,924 55 17 38 Okara 2,865 660 2,205 61 22 39 Pakpattan 1,666 237 1,429 47 14 33 Rawalpindi 8,563 3,322 5,241 203 83 120 Rawalpindi City 4,467 2,497 1,970 76 41 35 Attock 1,604 341 1,263 46 16 30 Chakwal 1,330 162 1,168 42 11 31 Jhelum 1,162 322 840 39 15 24 Sargodha 7,121 1,705 5,416 188 67 121 Sargodha 3,266 919 2,347 65 25 40 Bhakkar 1,390 223 1,167 43 13 30 Khushab 1,119 283 836 38 14 24 Mianwali 1,346 280 1,066 42 14 28 P a g e | 353 Sample Design A two-stage, stratified cluster sampling approach was used for the selection of the survey sample. Stage-1: Selection of Primary Sampling Units (PSUs) Enumeration blocks in urban and rural domains were taken as PSUs. In urban and rural domains sample PSUs from each stratum were selected by probability proportionate to size. The number of households in each PSU from the frame was considered as the measure of size for the urban and rural domains. Stage-2: Selection of Secondary Sampling Units (SSUs) Based on actual listing undertaken in respect of each sample PSU by the Field Staff, 20 households were selected from both rural and urban sample areas adopting systematic sampling technique with a random start. Households were considered as secondary sampling units (SSUs) for urban and rural domains. The sample households were selected within each sample PSU with equal probability. Sampling Frame and Selection of Clusters The 1998 census frame updated by PBS recently in 2011, during housing census, 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 updated frame. The first stage of sampling was thus completed by selecting the required number of enumeration areas from each of the 36 districts, separately for the urban and rural strata. Listing Activities For the selection of households i.e., SSUs, a new listing of households was conducted in all the sample enumeration areas prior to the selection of households since the sampling frame was not up-to-date. For this purpose, listing teams were formed who visited all of the selected enumeration areas and listed all households in each enumeration area. Selection of Households Lists of households were prepared by the listing teams in the field for each enumeration area selected in the sample. The households were then sequentially numbered from 1 up to the total number of households in each enumeration area, at the Divisional office of the BoS, where the selection of 20 households in each enumeration area was carried out using random systematic selection procedures. Calculation of Sample Weights The MICS Punjab, 2014 sample is not self-weighting. Essentially, by proportionally allocating the numbers of households to each of the districts, different sampling fractions were used. For this reason, sample weights were calculated and these were used in the subsequent analyses of the survey data. The major component of the weight is the reciprocal of the sampling fraction employed in selecting the number of sample households in that particular sampling stratum (h) and PSU (i): P a g e | 354 hi hi f W 1  The term fhi, the sampling fraction for the sample households in the i-th sample PSU in the h-th stratum, is the product of probabilities of selection at every stage in each sampling stratum: hihihihi pppf 321  where pshi is the probability of selection of the sampling unit at stage s for the i-th sample PSU in the h-th sampling stratum. Based on the sample design, these probabilities were calculated as follows: p1hi = h hih M Mn  , 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 stratum h (in the case of PSUs that were segmented); for non-segmented PSUs, p2hi = 1 p3hi = hiM ' 20 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 2010 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, and under-5 children) for each stratum is equal to: hRR 1 P a g e | 355 where RRh is the response rate for the individual questionnaires in stratum h, defined as the proportion of eligible individuals (women 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 MICS Punjab, 2014 are shown in Table HH.1 in this report. The non-response adjustment factors for the individual women, 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 unweighted total number of completed interviews at the provincial level. Normalization is achieved by dividing the full sample weights (adjusted for nonresponse) by the average of these weights across all households in the full (provincial) sample. This is performed by multiplying the sample weights by a constant factor equal to the unweighted number of households at the provincial 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 standardized weights for the individual women, and under-5 questionnaires. Adjusted (normalized) weights varied between 0.21 and 6.13 in the 2050 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. P a g e | 356 APPENDIX C: LIST OF PERSONNEL INVOLVED IN THE SURVEY/SURVEY COMMITTEES Project Director Ch. Shamim Rafique, Director General, BoS Deputy Project Director Mr. Sajid Rasul, Director, BoS Survey Planning, Questionnaire Designing and Survey Manuals Ch. Shamim Rafique, Director General, BoS Mr. Sajid Rasul, Director, BoS Mr. Mehmood Akhtar, Director BoS Mr. Muhammad Usman, Statistical Officer, BoS Questionnaire Translation Mr. Muhammad Ameen, Statistical Officer, BoS Mr. Abid Hussain, Stenographer, BoS Training of Trainers (ToTs) Ch. Shamim Rafique, Director General, BoS Mr. Sajid Rasul, Director, BoS Mr. Muhammad Usman, Statistical Officer, BoS Human Resource Manager Mr. Shahid Saleem, Deputy Director, BoS Finance and Logistics Mr. Akram Adeeb, Assistant Director, BoS Mr. Razzaq Shakir, Care Taker, BoS Mr. Bilal Javaid, Statistical Assistant, BoS Sample Design Mr. Peter K. Wingfield-Digby, Regional MICS Sampling Consultant, UNICEF ROSA Ch. Shamim Rafique, Director General, BoS Mr. Shoukat Zaman, Director Sample Design section, Pakistan Bureau of Statistics Mr. Sajid Rasul, Director, BoS Data Processing Mr. Muhammad Mumtaz Ahmad, DP Supervisor-I Mr. Muhammad Usman, DP Supervisor-II Mr. Sajid Rauf, Assistant DP Supervisor-I Mr. Masood Ali, Questionnaire Administrator (QA)/ Assistant DP Supervisor-II Mr. Muhammad Farooq, Assistant DP Supervisor-III Syed. Wasim Abbass Naqvi, Assistant DP Supervisor-IV Mr. Zaheer Babar, Secondary Editor-I Ms. Qurat-ul-Ain, Secondary Editor-II P a g e | 357 Ms. Sana Ashraf, Secondary Editor-III Mr. Muhammad Agha, Assistant Questionnaire Administrator - II Regional Supervisors Mr. M. Akhter Javed, Deputy Director, Bahawalpur Mr. Shahzad Kashif Farooq, Deputy Director, DG Khan Mr. Zafar Ali, Deputy Director, Faisalabad Mr. Abdul Rehman Akhtar, Deputy Director, Gujranwala Mr. M.Shakeel Ashraf, Deputy Director, Multan Mr. Shams-ul-Huda, Assistant Director, Rawalpindi Mr. Ali Amir Raza Bukhari, Deputy Director, Sahiwal Mr. Allaha Ditta, Assistant Director, Sargodha Mr. Bashir Ahmad, Deputy Director, Lahore-I Mr. Muhammad Arshad Shakir, Deputy Director, Lahore-II Project Consultants Rana Muhammad Sarwar, Consultant on MICS, UNICEF Mr. Faateh ud Din Ahmad, Data Processing Consultant, UNICEF UNICEF Regional Office/ROSA Ms. Rhiannon James, Regional MICS Coordinator Mr. Alexandru Nartea, Regional MICS Coordinator (Acting) Mr. Augustine Botwe, Regional MICS Household Survey Consultant Ms. Munkhzul Zookhuu, Regional MICS Data Processing Consultant UNICEF Country Office Ms. Janette Shaheen Hussain, Chief (PMER), UNICEF Country Office, Islamabad Ms. Pashmina Naz Ali, Ex-Chief (PMER), UNICEF Country Office, Islamabad Mr. Faateh ud Din Ahmad, PME Officer, UNICEF Country Office, Islamabad Mr. Nouman Ghani, PMER Specialist, UNICEF Regional Office, Lahore P a g e | 358 Field Formation Bahawalpur Division Team-1 Team-2 Mr. Tahir Riaz, Team Supervisor Mr. Zaheer Ahmad, Team Supervisor Mr. Zulfiqar Ali, Field Editor-1 Mr. Muhammad Rizwan, Field Editor-1 Ms. Adeela Kaleem, Field Editor-2 Ms. Samia Bilal, Field Editor-2 Ms. Sumera Iram, Measurer-1 Ms. Shahzia Parveen, Measurer-1 Ms. Ammara Shameem, Measurer-2 Ms. Brirah Ali, Measurer-2 Ms. Asma Waris, Female Interviewer-1 Ms. Shazia Satta, Female Interviewer-1 Ms. Samina Waris, Female Interviewer-2 Ms. Kehkshan Ansari, Female Interviewer-2 Ms. Shazia Mehnaz, Female Interviewer-3 Ms. Sadia Gillani, Female Interviewer-3 Ms. Safia Manzoor, Female Interviewer-4 Ms. Waheeda Sadaf, Female Interviewer-4 Ms. Nabeela Shehzadi, Female Interviewer-5 Ms. Najma Ghulam Muhammad, Female Interviewer-5 Syed Tanveer Hussain, Male Interviewer-1 Mr. Muhammad Akram, Male Interviewer-1 Mr. Faheem Arshad, Male Interviewer-2 Mr. Abdul Qayyum Khan, Male Interviewer-2 Mr. Abid Ali, Male Interviewer-3 Mr. M. Farooq Akram, Male Interviewer-3 Team-3 Mr. Tanveer Ahmad, Team Supervisor Mr. M. Bilal Shakir, Field Editor-1 Ms. Sobia Alam, Field Editor-2 Ms. Imtiaz Kausar, Measurer-1 Ms. Sonia Ali, Measurer-2 Ms. Mubshira Saleem, Female Interviewer-1 Ms. Rameeza Sana-Ullah, Female Interviewer-2 Ms. Maryam Majeed, Female Interviewer-3 Ms. Sabeen Sohail, Female Interviewer-4 Ms. Nazish Mustafa, Female Interviewer-5 Mr. Muhammad Tayyab, Male Interviewer-1 Mr. Kashif Ali, Male Interviewer-2 Mr. Amir Mahmood, Male Interviewer-3 DG Khan Division Team-1 Team-2 Mr. Arshad Bilal, Team Supervisor Mr. Haji Bilal Ahmad, Team Supervisor Mr. M. Arif Qurashi, Field Editor-1 Mr. Muhammad Ameeq, Field Editor-1 Ms. Amna Hayat, Field Editor-2 Ms. Amam Nazleem, Field Editor-2 Ms. Kanwal Zaidi, Measurer-1 Ms. Fozia Iram, Measurer-1 Ms. Frazia Abid, Measurer-2 Ms. Shanza Hafeez, Measurer-2 Ms. Rabia Rani, Female Interviewer-1 Ms. Abida Nawaz, Female Interviewer-1 Ms. Iram Shabbir, Female Interviewer-2 Ms. Mamoona Rajab, Female Interviewer-2 Syeda Irshad Munir, Female Interviewer-3 Ms. Sidra Mushtaq, Female Interviewer-3 Ms. Sumaira Bahsir, Female Interviewer-4 Ms. Sadaf Gul, Female Interviewer-4 Ms. Sadia Siraj, Female Interviewer-5 Ms. Aqeela Niazi, Female Interviewer-5 Mr. Akbar Ali, Male Interviewer-1 Mr. Muhammad Sadiq, Male Interviewer-1 Mr. Umar Munir, Male Interviewer-2 Mr. Shakir Ali Gujjar, Male Interviewer-2 Mr. M. Zeeshan Qadir, Male Interviewer-3 Mr. Naseer Ahmad, Male Interviewer-3 Team-3 Mr. Abdul Razzaq, Team Supervisor Mr. Muhammad Sabir, Field Editor-1 Ms. Sumaira Ansari, Field Editor-2 Ms. Ghazala Muneer, Measurer-1 Ms. Sadia Maqsood, Measurer-2 Ms. Farhat Shaheen, Female Interviewer-1 Ms. Faryal Atta, Female Interviewer-2 Ms. Habiba Shaheen, Female Interviewer-3 Ms. Asfa Tabasum, Female Interviewer-4 Ms. Ammara Meryum, Female Interviewer-5 Mr. Jamshed Hassan, Male Interviewer-1 Mr. Sarfraz Saleem Khan, Male Interviewer-2 Mr. Muhammad Iqbal, Male Interviewer-3 P a g e | 359 Faisalabad Division Team-1 Team-2 Mr. Mubarak Ali, Team Supervisor Mr. Abdul Hafeez, Team Supervisor Mr. Muhammad Rehan, Field Editor-1 Mr. Waseem Iqbal, Field Editor-1 Ms. Rubia Khursheed , Field Editor-2 Ms. Saher Jabeen, Field Editor-2 Ms. Misbah Yousaf, Measurer-1 Ms. Amina Fatima, Measurer-1 Ms. Humaira Saleem, Measurer-2 Ms. Ghulam Fatima, Measurer-2 Ms. Insha Noureen, Female Interviewer-1 Ms. Amna Saleem, Female Interviewer-1 Ms. Samina Akhtar, Female Interviewer-2 Ms. Maryam Shahid, Female Interviewer-2 Ms. Tahira Tabassam, Female Interviewer-3 Ms. Gulshan Shahzadi, Female Interviewer-3 Ms. Maria Noor, Female Interviewer-4 Ms. Nazia Rafique, Female Interviewer-4 Ms. Aneela Rani, Female Interviewer-5 Ms. Aroosa Younas, Female Interviewer-5 Mr. Irfan Ghani, Male Interviewer-1 Mr. Saifullah, Male Interviewer-1 Mr. Monwer Abbas, Male Interviewer-2 Mr. Muhammad Adnan, Male Interviewer-2 Mr. Muhammad Zahid Saeed, Male Interviewer-3 Mr. Aftab Ahmad, Male Interviewer-3 Team-3 Team-4 Mr. Muhammad Yunus Awan, Team Supervisor Mr. Manzoor Hussain, Team Supervisor Mr. Muhammad Saleem, Field Editor-1 Mr. Rab Nawaz, Field Editor-1 Ms. Anam Akhter, Field Editor-2 Ms. Sidra Shah, Field Editor-2 Ms. Anam Akhtar, Measurer-1 Ms. Shaher Bano, Measurer-1 Ms. Fareeha Mazhar, Measurer-2 Ms. Shakeela Ismail, Measurer-2 Ms. Sofia Parveen, Female Interviewer-1 Ms. Kalsoom Zahra, Female Interviewer-1 Ms. Sabiha Anjum, Female Interviewer-2 Ms. Farkhanda Amin, Female Interviewer-2 Ms. Shamim Akhtar, Female Interviewer-3 Ms. Ambreen Haidar, Female Interviewer-3 Ms. Hadia Masood, Female Interviewer-4 Ms. Saima Naz, Female Interviewer-4 Ms. Sonia Tariq, Female Interviewer-5 Ms. Shabana Noor, Female Interviewer-5 Mr. Sarfraz Ali, Male Interviewer-1 Mr. Manzoor Hussain Unsar, Male Interviewer-1 Mr. Muhammad Jahangir Zafar, Male Interviewer-2 Mr. Muhammad Rashid, Male Interviewer-2 Mr. Ali Raza , Male Interviewer-3 Mr. Muhammad Ilyas, Male Interviewer-3 Gujranwala Division Team-1 Team-2 Mr. Gulzar Ahmad, Team Supervisor Mr. Muhammad Arif Aziz, Team Supervisor Mr. Adil Mukhtar, Field Editor-1 Mr. Shoaib Ahmad, Field Editor-1 Ms. Ambreen Shafqat, Field Editor-2 Syeda Taskeen Muryam, Field Editor-2 Ms. Nobila Mukhtar, Measurer-1 Ms. Javaria Rafiq, Measurer-1 Ms. Iffat Tahira, Measurer-2 Ms. Rahat Abbas, Measurer-2 Ms. Bushra Riaz, Female Interviewer-1 Ms. Faiza Yousaf, Female Interviewer-1 Ms. Fakhra Bashir, Female Interviewer-2 Ms. Sabahat Abbas, Female Interviewer-2 Ms. Nabeela Khalid, Female Interviewer-3 Ms. Saira Kousar, Female Interviewer-3 Ms. Khadija Hanif, Female Interviewer-4 Ms. Samreen Naeem, Female Interviewer-4 Ms. Tazeela Akram, Female Interviewer-5 Ms. Asia Sahar, Female Interviewer-5 Mr. Zeeshan Qamar, Male Interviewer-1 Mr. Mehmoon Butt, Male Interviewer-1 Mr. Muhammad Adeel, Male Interviewer-2 Mr. Zia Ahmad Babar, Male Interviewer-2 Mr. Hafiz Muhammad Bilal, Male Interviewer-3 Mr. Muhammad Imran, Male Interviewer-3 Team-3 Team-4 Mr. Qaiser Iqbal, Team Supervisor Mr. Muhammad Mohsin, Team Supervisor Mr. Saif Ullah, Field Editor-1 Mr. Muhammad Nauman, Field Editor-1 Ms. Saima Safdar, Field Editor-2 Ms. Nousheen Rasheed, Field Editor-2 Ms. Taiba Rafique, Measurer-1 Ms. Tayyaba Noreen, Measurer-1 Ms. Aqsa Ayub, Measurer-2 Ms. Faiza Batool, Measurer-2 Ms. Mehwish Shahid, Female Interviewer-1 Ms. Maria Shaukat, Female Interviewer-1 Ms. Saima Kareem, Female Interviewer-2 Ms. Aqsa Zaheer, Female Interviewer-2 Ms. Maryam Rasheed, Female Interviewer-3 Ms. Amna Asif Bajwa, Female Interviewer-3 Ms. Hufsa Ghulam Rasool, Female Interviewer-4 Ms. Hajra Fida, Female Interviewer-4 Ms. Fatima Afeefa, Female Interviewer-5 Ms. Sundas Shaukat, Female Interviewer-5 Mr. Muhammad Shahbaz, Male Interviewer-1 Mr. Muhammad Nadeem Anjum, Male Interviewer-1 Mr. Abdul Ghafoor, Male Interviewer-2 Mr. Khalid Bashir, Male Interviewer-2 Mr. Munir Ahmed Nadeem, Male Interviewer-3 Syed. Imran Hussain, Male Interviewer-3 P a g e | 360 Lahore Division Team-1 Team-2 Mr. Manzoor Ahmed, Team Supervisor Mr. Abdul Shakoor, Team Supervisor Mr. Arshad Hussain, Field Editor-1 Mr. Furqan Ali Rana, Field Editor-1 Ms. Munazza Amin, Field Editor-2 Ms. Ezzah Batool, Field Editor-2 Ms. Tayyaba Shabbir, Measurer-1 Ms. Naveeda Hassan, Measurer-1 Ms. Mehnaz Kausar, Measurer-2 Ms. Mobeen Fatima, Measurer-2 Ms. Saira Amin, Female Interviewer-1 Ms. Fatima Shaheen, Female Interviewer-1 Ms. Zakia Kanwal, Female Interviewer-2 Ms. Falaq Naz, Female Interviewer-2 Ms. Syeda Seemab Zahra, Female Interviewer-3 Ms. Ayesha Qamar, Female Interviewer-3 Ms. Reena Shahzadi, Female Interviewer-4 Ms. Hina Tanveer, Female Interviewer-4 Ms. Nasreen Akhtar, Female Interviewer-5 Ms. Sehrish Ishtiaq, Female Interviewer-5 Mr. Saghir Hussain, Male Interviewer-1 Mr. Muhammad Qadeer, Male Interviewer-1 Mr. Tariq Hameed, Male Interviewer-2 Mr. Abdul Majeed, Male Interviewer-2 Mr. Hamid Ali, Male Interviewer-3 Mr. Abdul Sattar, Male Interviewer-3 Team-3 Team-4 Mr. Imran Lati, Team Supervisor Mr. Muhammad Hussain, Team Supervisor Mr. Najam-us-saqib, Field Editor-1 Mr. Farhan Hameed, Field Editor-1 Ms. Farhat Majeed, Field Editor-2 Ms. Neha Shakeel, Field Editor-2 Ms. Azra Parveen, Measurer-1 Ms. Raheela Riaz, Measurer-1 Ms. Azra Mnazoor, Measurer-2 Ms. Shiza Riaz, Measurer-2 Ms. Hafiza Iram Yaqoob, Female Interviewer-1 Ms. Sidra Ashiq, Female Interviewer-1 Ms. Hadia Zaheer, Female Interviewer-2 Ms. Fatima Nazim, Female Interviewer-2 Ms. Reema Talib, Female Interviewer-3 Ms. Sumaira Anjum, Female Interviewer-3 Ms. Uzma Rani, Female Interviewer-4 Ms. Mahem Arshad, Female Interviewer-4 Ms. Sobia Tabasum, Female Interviewer-5 Ms. Uzma Farid, Female Interviewer-5 Mr. Muhammad Waqas Hassian, Male Interviewer-1 Mr. Liaqat Ali, Male Interviewer-1 Mr. Hafiz Khadum Hussain, Male Interviewer-2 Mr. Muhammad Ramazan, Male Interviewer-2 Mr. Abbas Ali Awan, Male Interviewer-3 Mr. Sarfraz Ahmed, Male Interviewer-3 Team-5 Team-6 Mr. Basharat Ahmed, Team Supervisor Mr. Muhammad Akram, Team Supervisor Mr. Mudassar Hussain, Field Editor-1 Mr. Muhammad Asif Yousaf, Field Editor-1 Ms. Madiha Batool, Field Editor-2 Ms. Rabia, Field Editor-2 Ms. Humaira Naz, Measurer-1 Ms. Samra Khalil, Measurer-1 Ms. Kalsoom Aziz, Measurer-2 Ms. Sobia Riaz Khan, Measurer-2 Ms. Anum Tariq, Female Interviewer-1 Ms. Syeda Najaf Zahra, Female Interviewer-1 Ms. Sidrah Shahzadi, Female Interviewer-2 Ms. Hina Khaliq, Female Interviewer-2 Ms. Mehwish Iram, Female Interviewer-3 Ms. Hina Naz, Female Interviewer-3 Ms. Mahrukh Rasheed, Female Interviewer-4 Ms. Qudsia Khalil, Female Interviewer-4 Ms. Benish Rasheed, Female Interviewer-5 Ms. Hafsa Humayoun, Female Interviewer-5 Mr. Zahid Aftab, Male Interviewer-1 Mr. Salman Khan, Male Interviewer-1 Mr. Arshad Ali, Male Interviewer-2 Mr. Faisal Habib, Male Interviewer-2 Mr. Muhammad Shahid Jamil, Male Interviewer-3 Mr. Javid Iqbal Saleem, Male Interviewer-3 Team-7 Mr. Mushtaq Ahmed, Team Supervisor Mr. Hafiz Ghulam Mujaddad, Field Editor-1 Ms. Saba Shafique, Field Editor-2 Ms. Saira Shafaqat Ali, Measurer-1 Ms. Maria Akhtar, Measurer-2 Ms. Rafia Izhar, Female Interviewer-1 Ms. Shakeela Shaheen, Female Interviewer-2 Ms. Monazza Liaqat, Female Interviewer-3 Ms. Bushra Kalsoom, Female Interviewer-4 Ms. Azra Iqbal, Female Interviewer-5 Mr. Muhammad Amin, Male Interviewer-1 Mr. Arif Mehmood Akhtar, Male Interviewer-2 Mr. Farid Ahmed, Male Interviewer-3 P a g e | 361 Multan Division Team-1 Team-2 Mr. Nazar M. Nasir, Team Supervisor Mr. M. Husnain Haider, Team Supervisor Mr. Ahmad Nawaz, Field Editor-1 Mr. Shakeel Ahmad, Field Editor-1 Ms. Nadia, Field Editor-2 Ms. Iram Bashir, Field Editor-2 Ms. Keshwar Nisa, Measurer-1 Ms. Samia Naz, Measurer-1 Ms. Rabia Nisar, Measurer-2 Ms. Shumaila Ameer, Measurer-2 Ms. Faria Durani, Female Interviewer-1 Ms. Arifa Yousaf, Female Interviewer-1 Ms. Tasleem Asghar, Female Interviewer-2 Ms. Safia Sattar, Female Interviewer-2 Ms. Nabila Siddique, Female Interviewer-3 Ms. Romana Munir, Female Interviewer-3 Ms. Sana Javaid, Female Interviewer-4 Ms. Tayaba Karim, Female Interviewer-4 Ms. Shagufta Bibi, Female Interviewer-5 Ms. Qumar-un-Nissa, Female Interviewer-5 Mr. Ashraf Ali, Male Interviewer-1 Mr. M. Amjad Jamil, Male Interviewer-1 Mr. Kashif Khan, Male Interviewer-2 Mr. M. S. Mehmood-ul-Hassan, Male Interviewer-2 Mr. M. Atif Farooq, Male Interviewer-3 Mr. M. Imran Taj, Male Interviewer-3 Team-3 Mr. Muhammad Sarfaraz, Team Supervisor Mr. Jalil Ahmad, Field Editor-1 Ms. Sana Wahid, Field Editor-2 Ms. Shumaila Malik, Measurer-1 Ms. Raheela bibi, Measurer-2 Ms. Farhat Bibi, Female Interviewer-1 Ms. Asma Sadiq, Female Interviewer-2 Ms. Humaira Zafar, Female Interviewer-3 Ms. Shabana Mehtab, Female Interviewer-4 Ms. Zonish Baig, Female Interviewer-5 Mr. Muhammad Saqlain, Male Interviewer-1 Mr. Muhammad Naeem, Male Interviewer-2 Mr. Farukh Nawaz, Male Interviewer-3 Rawalpindi Division Team-1 Team-2 Mr. Muhammad Sharif Bhatti, Team Supervisor Mr. Muhammad Saeed Shakir, Team Supervisor Mr. Muhammad Pervez, Field Editor-1 Mr. Naeem Asghar, Field Editor-1 Ms. Naheed Akhtar, Field Editor-2 Ms. Asima Naz, Field Editor-2 Ms. Sadia Bibi, Measurer-1 Ms. Saima Andleeb, Measurer-1 Ms. Sumayya Rehman, Measurer-2 Ms. Saima Nazir, Measurer-2 Ms. Kausar Perveen, Female Interviewer-1 Ms. Ammtul Fatima, Female Interviewer-1 Ms. Saima Ikram, Female Interviewer-2 Ms. Maryam Bibi, Female Interviewer-2 Ms. Mussrat Naz, Female Interviewer-3 Ms. Sumaira Mughal, Female Interviewer-3 Ms. Sadia Safdar, Female Interviewer-4 Ms. Uzma Ayub, Female Interviewer-4 Ms. Basmena, Female Interviewer-5 Ms. Sumera Irshad, Female Interviewer-5 Mr. Raja Muhammad Hussain, Male Interviewer-1 Mr. Abid Hussain, Male Interviewer-1 Mr. Malik Hashim, Male Interviewer-2 Mr. Muddasar, Male Interviewer-2 Mr. Muhammad Waqas, Male Interviewer-3 Mr. Aitzaz Liaqat, Male Interviewer-3 Team-3 Mr. Rizwan Farooq, Team Supervisor Mr. Muhammad Usman, Field Editor-1 Ms. Nafees Manzoor, Field Editor-2 Ms. Shumaila Bibi, Measurer-1 Ms. Uzma Yasmeen, Measurer-2 Ms. Aneela Irum, Female Interviewer-1 Ms. Erum Hussnain, Female Interviewer-2 Ms. Rafia Bibi, Female Interviewer-3 Ms. Uzma Shehzadi, Female Interviewer-4 Ms. Nuzhat Jahan, Female Interviewer-5 Syed. Safdar Ali Shah, Male Interviewer-1 Mr. Sajid Rafiq, Male Interviewer-2 Mr. Mirza Muhmmad Afzal, Male Interviewer-3 P a g e | 362 Sahiwal Division Team-1 Team-2 Sh. Pervaiz Iqbal, Team Supervisor Mr. Muhammad Ameen, Team Supervisor Mr. Madassar Jamil, Field Editor-1 Mr. Irshad, Field Editor-1 Ms. Nazia Sadaf, Field Editor-2 Ms. Rabia Bashir, Field Editor-2 Ms. Saima Anwar, Measurer-1 Ms. Shgufta Shaheen, Measurer-1 Ms. Sidra Kashif, Measurer-2 Ms. Tasmia Nazar, Measurer-2 Ms. Afsheen Taj, Female Interviewer-1 Ms. Sanam Wasim, Female Interviewer-1 Ms. Gul Jabeen, Female Interviewer-2 Ms. Sidra Gulzar, Female Interviewer-2 Ms. Sidra Shamim, Female Interviewer-3 Ms. Hina Aslam, Female Interviewer-3 Ms. Bushra Anwar, Female Interviewer-4 Ms. Sobia Latif, Female Interviewer-4 Ms. Nadia Noreen, Female Interviewer-5 Ms. Shumila Bashir, Female Interviewer-5 Mr. Nafees Sabar, Male Interviewer-1 Mr. Abdul Razzaq, Male Interviewer-1 Mr. Muhammad Waqas Aslam, Male Interviewer-2 Mr. Irfan Ali, Male Interviewer-2 Mr. Muhammad Adnan Anjum, Male Interviewer-3 Mr. Ali Hassan Jillani, Male Interviewer-3 Team-3 Mr. Ghulam Yasin, Team Supervisor Mr. Khadim Hussain, Field Editor-1 Ms. Ayesha Intezar, Field Editor-2 Ms. Irshad, Measurer-1 Ms. Ismat Tahira, Measurer-2 Ms. Saima Tufail, Female Interviewer-1 Ms. Rabia Perveen, Female Interviewer-2 Ms. Maryam Fardous, Female Interviewer-3 Ms. Samina Sanaullah, Female Interviewer-4 Ms. Fatima Khan, Female Interviewer-5 Mr. Sultan Munir, Male Interviewer-1 Mr. Zohaib Ahmed, Male Interviewer-2 Mr. Muhammad Awais Bukhari, Male Interviewer-3 Sargodha Division Team-1 Team-2 Mr. Muhammad Azhar Saleem, Team Supervisor Mr. Irfan Haider, Team Supervisor Mr. Saif Ahmed Malik, Field Editor-1 Mr. Muhammad Nadeem, Field Editor-1 Ms. Aliya Riaz, Field Editor-2 Ms. Mariam Hamid , Field Editor-2 Ms. Abida Shaheen, Measurer-1 Ms. Huma Muneer, Measurer-1 Ms. Saima Ismail, Measurer-2 Ms. Kishwar Sajjad, Measurer-2 Ms. Samreen, Female Interviewer-1 Ms. Sara Riaz, Female Interviewer-1 Ms. Nusrat Ismail, Female Interviewer-2 Ms. Rukhsana Perveen, Female Interviewer-2 Ms. Sania Mehmood, Female Interviewer-3 Ms. Kasur Bibi, Female Interviewer-3 Ms. Shumaila Ambreen, Female Interviewer-4 Ms. Rabia Perveen, Female Interviewer-4 Ms. Tehmeena Riaz, Female Interviewer-5 Ms. Rukhsana Yameen, Female Interviewer-5 Mr. Rizwan Ghafoor, Male Interviewer-1 Mr. Ghulam Ghous, Male Interviewer-1 Mr. Abdul Qayyum, Male Interviewer-2 Mr. Hasan Ali, Male Interviewer-2 Mr. Haseeb Ishtiaq, Male Interviewer-3 Mr. Muhammad Ahmed Farooq, Male Interviewer-3 Team-3 Mr. Zahid Mehmood, Team Supervisor Mr. Aamir Hayat, Field Editor-1 Ms. Aamna Saleem Bajwa, Field Editor-2 Ms. Farhat Nasreen, Measurer-1 Ms. Sabahat Abbas, Measurer-2 Ms. Aisha Siddique, Female Interviewer-1 Ms. Nida Jabbar Kaini, Female Interviewer-2 Ms. Tehmeena Zaigham, Female Interviewer-3 Ms. Sughra Saleem, Female Interviewer-4 Ms. Bushra Batool, Female Interviewer-5 Mr. Inam Ullah Khan, Male Interviewer-1 Mr. Muhammad Naeem Shehzad, Male Interviewer-2 Mr. Zia-ur-Rehman, Male Interviewer-3 P a g e | 363 GOVERNMENT OF THE PUNJAB PLANNING & DEVELOPMENT DEPTT. Dated Lahore, the _____ March, 2013 N O T I F I C A T I O N No.85(1)Chief(R&D)/P&D/2011/MICS Vol-I. The Planning & Development Department, Government of the Punjab has decided to conduct District based Multiple Indicator Cluster Survey (MICS) Punjab, 2014. The following Steering Committee on MICS is hereby notified. Chairman, P&D Board Chairman, Secretary, Finance Member Secretary, P & D Member Secretary, Health Member Secretary, LG & CD Member Secretary, HUD & PHE Member Secretary, Social Welfare Member Secretary, Population Welfare Member Secretary, Schools Education Member Director, PERI Member Director General, BOS Member Programme Director, PRMP Member PME Officer, UNICEF Member Senior Chief (ME&PA) P&D Department Focal Person / Coordinator Terms of Reference (TORs) o Review and finalize indicators o Review and endorse the final report o Decide any case/issue referred to the committee. This issues with the approval of the Chairman, Planning & Development Board, Lahore. CHAIRMAN, PLANNING & DEVELOPMENT BOARD No. & Date Even A copy is forwarded for information to:- 1. Secretary, Finance, Government of Punjab, Lahore. 2. Secretary, Health, Government of Punjab, Lahore. 3. Secretary, LG & CD, Government of Punjab, Lahore. 4. Secretary, HUD & PHE, Government of Punjab, Lahore. 5. Secretary, Social Welfare, Government of Punjab, Lahore. 6. Secretary, Population Welfare, Government of Punjab, Lahore. 7. Secretary, Schools Education Department, Govt. of the Punjab, LHR. 8. Director, PERI, 48-Civic Centre, Johar Town, Lahore. 9. Director General, BOS, 2-Begum Road, Lahore. 10. Programme Director, Punjab Resource Management Programme 142-Jail Road, Lahore. 11. The Chief, UNICEF, Regional Office, Johar Town, Lahore. ( MUHAMMAD IJAZ HUSSAIN ) FOCAL PERSON ON MICS / SENIOR CHIEF (ME&PA) No. & Date Even A copy is forwarded for information to:- 1. PSO to Chairman, P&D Board, Lahore. 2. PS to Secretary, P&D Department, Lahore. 3. PS to Chief Economist, P&D Board, Lahore. ( MUHAMMAD IJAZ HUSSAIN ) FOCAL PERSON ON MICS / SENIOR CHIEF (ME&PA) P a g e | 364 GOVERNMENT OF THE PUNJAB PLANNING & DEVELOPMENT DEPTT. Dated Lahore, the _____ March, 2013 N O T I F I C A T I O N No.85(1)Chief(R&D)/P&D/2011/MICS Vol-I. The Planning & Development Department, Government of the Punjab has decided to conduct District based Multiple Indicator Cluster Survey (MICS) Punjab, 2014. The following technical group to provide technical support to the MICS steering committee and MICS planning & coordination group is hereby notified. Chief Economist, P&D Board Chairman, Representative of PBS Member Director General, BOS Member Director, PERI Member PME Officer, UNICEF Member Senior Chief (ME&PA) P&D Department Focal Person / Coordinator Terms of Reference (TORs) o To provide technical support to the MICS planning & coordination group and MICS steering committee. o Finalization of sample frame and technical review / approval of survey planning work. o Monitoring of listing as well as data collection process. o Questionnaire development, approval, translation and field testing. o Prepare and implement quality assurance plan and report on quality assurance of the survey and its completion. o Contribution to data analysis and report writing. This issues with the approval of the Chairman, Planning & Development Board, Lahore. CHAIRMAN, PLANNING & DEVELOPMENT BOARD No. & Date Even A copy is forwarded for information to:- 1. The Chief Statistician, Pakistan Bureau of Statistics, Statistics House, Islamabad. 2. The D.G, BOS, 2-Begum Road, Lahore. 3. The Director PERI, 48 Civic Centre, Johar Town, Lahore. 4. The PME Officer, UNICEF, Regional Office, Johar Town, Lahore. ( MUHAMMAD IJAZ HUSSAIN ) FOCAL PERSON ON MICS / SENIOR CHIEF (ME&PA) No. & Date Even A copy is forwarded for information to:- 1. PSO to Chairman, P&D Board, Lahore. 2. PS to Secretary, P&D Department, Lahore. 3. PS to Chief Economist, P&D Board, Lahore. ( MUHAMMAD IJAZ HUSSAIN ) FOCAL PERSON ON MICS / SENIOR CHIEF (ME&PA) P a g e | 365 GOVERNMENT OF THE PUNJAB PLANNING & DEVELOPMENT DEPTT. Dated Lahore, the _____ March, 2013 N O T I F I C A T I O N No.85(1)Chief(R&D)/P&D/2011/MICS Vol-I. The Planning & Development Department, Government of the Punjab has decided to conduct District based Multiple Indicator Cluster Survey (MICS) Punjab, 2014. The following Planning & Coordination group to provide technical support to the MICS steering committee is hereby notified. Chief Economist, P&D Board Chairman, Director General, PBS Member Director General, BOS Member Director, PERI Member Chief, Education, P&D Department Member Chief, Health, P&D Department Member Chief, LG&CD, P&D Department Member Technical Advisor HUD & PHE Member Director General, LG&CD Member Director General, Health Member Director General, Population Welfare Member Director General, Social Welfare Member