Republic of Macedonia Multiple Indicator Cluster Survey 2011

Publication date: 2011

Republic of Macedonia Multiple Indicator Cluster Survey 2011 Montoring the situation of children and women I Republic of Macedonia Multiple indicatoR clusteR suRvey 2011 II MultIple IndIcator cluster survey 2011 The Macedonia Multiple Indicator Cluster Survey (MICS) was carried out in 2011 in cooperation between the Ministry of Health, Ministry of Education and Science, and Ministry of Labour and Social Policy of the Gov- ernment of Republic of Macedonia. Data collection was conducted by private research company IPSOS Strategic Puls. Financial and technical support was provided by the United Nations Children’s Fund (UNICEF), with additional financial support from the United Nations Population Fund (UNFPA). MICS is an international household survey programme developed by UNICEF. The 2011 Macedonia MICS was conducted as part of the fourth global round of MICS surveys (MICS4). MICS provides up-to-date information on the situation of children and women and measures key indicators that allow countries to monitor progress towards the Millennium Development Goals (MDGs) and other internationally agreed upon commitments. Addi- tional information on the global MICS project may be obtained from www.childinfo.org. Republic of Macedonia Multiple indicatoR clusteR suRvey 2011 CIP – Каталогизација во публикација Национална и универзитетска библиотека „Св. Климент Охридски“, Скопје 316.346.2-053.2(497.7)»2011»(047.31) 316.346.2-055.2(497.7)»2011»(047.31) MULTIPLE indicator cluster survey : 2011. - Скопје : Министерство за здравство : Министерство за образование и наука : Министерство за труд и социјална политика, 2012. - 244 стр. : табели, граф. прикази ; 29 см ISBN 978-608-4518-41-9 (мин.здрав.) ISBN 978-608-226-361-8 (мин.образ.) ISBN 978-608-4595-21-2 (мин.труд.) а)Жени – Социјална положба – Македонија - 2011 – Истражувања б)Деца – Социјална положба – Македонија – 2011 - Истражувања COBISS.MK-ID 92995594 III summary table of findings Multiple indicatoR clusteR suRveys (Mics) and MillenniuM developMent Goals (MdG) indicatoRs, Macedonia, 2011 topic Mics4 indicator number MdG indicator number indicator value Macedonia Roma set-tlements CHILD MORTALITY Child Mortality 1.2 4.2 Infant mortality rate N/A 131 per thousand 1.1 4.1 Under five mortality rate N/A 142 per thousand NUTRITION Nutritional status 2.1a 2.1b 1.8 Underweight prevalence Moderate and Severe (- 2 SD) Severe (- 3 SD) 1.3 0.2 7.6 2.0 percent percent 2.2a 2.2b Stunting prevalence Moderate and Severe (- 2 SD) Severe (- 3 SD) 4.9 2.0 16.5 3.0 percent percent 2.3a 2.3b Wasting prevalence Moderate and Severe (- 2 SD) Severe (- 3 SD) 1.8 0.2 4.5 1.7 percent percent Breastfeeding and infant feeding 2.4 Children ever breastfed 93.9 95.5 percent 2.5 Early initiation of breastfeeding 21.0 38.6 percent 2.6 Exclusive breastfeeding under 6 months 23.0 (32.1) percent 2.7 Continued breastfeeding at 1 year 33.8 (52.8) percent 2.8 Continued breastfeeding at 2 years 12.8 (54.7) percent 2.9 Predominant breastfeeding under 6 months 44.1 (67.6) percent 2.10 Duration of breastfeeding 12.1 17.5 months 2.11 Bottle feeding 79.3 68.0 percent 2.12 Introduction of solid, semi-solid or soft foods 40.5 (*) percent 2.13 Minimum meal frequency 65.2 62.5 percent 2.14 Age-appropriate breastfeeding 22.4 42.9 percent 2.15 Milk feeding frequency for non-breastfed children 92.0 76.1 percent Low birth weight 2.18 Low-birth weight infants 5.5 11.2 percent 2.19 Infants weighed at birth 96.3 94.0 percent CHILD HEALTH Vaccinations 3.1 Tuberculosis immunization coverage 97.6 98.2 percent 3.2 Polio immunization coverage 96.7 91.0 percent 3.3 Immunization coverage for diphtheria, pertussis and tetanus (DPT) 95.2 90.9 percent 3.4 4.3 Measles immunization coverage 96.0 96.3 percent 3.5 Hepatitis B immunization coverage 95.5 91.7 percent Solid fuel use 3.11 Solid fuels 33.6 33.0 percent 1 Rate refers to 2005 2 Ibid Iv MultIple IndIcator cluster survey 2011 topic Mics4 indicator number MdG indicator number indicator value Macedonia Roma set-tlements WATER AND SANITATION Water and sanitation 4.1 7.8 Use of improved drinking water sources 99.6 99,1 percent 4.2 Water treatment 1.5 15,1 percent 4.3 7.9 Use of improved sanitation 92.9 91,1 percent 4.4 Safe disposal of child’s faeces 17.3 25,0 percent REPRODUCTIVE HEALTH Contraception and unmet need 5.1 5.4 Adolescent birth rate 13 (94)3 per 1,000 5.2 Early childbearing 1.6 27.3 percent 5.3 5.3 Contraceptive prevalence rate 40.4 37.0 Percent 5.4 5.6 Unmet need 17.2 22.2 percent Maternal and newborn health 5.5a 5.5b 5.5 Antenatal care coverage At least once by skilled personnel At least four times by any provider 98.6 93.9 94.0 85.9 percent percent 5.6 Content of antenatal care 94.1 82.7 percent 5.7 5.2 Skilled attendant at delivery 98.3 99.5 percent 5.8 Institutional deliveries 98.4 99.1 percent 5.9 Caesarean section 24.9 13.1 percent CHILD DEVELOPMENT Child devel- opment 6.1 Support for learning 91.5 61.8 percent 6.2 Father’s support for learning 71.1 56.8 percent 6.3 Learning materials: children’s books 52.4 27.1 percent 6.4 Learning materials: playthings 70.7 62.1 percent 6.5 Inadequate care 5.0 7.4 percent 6.6 Early child development index 92.7 72.2 percent 6.7 Attendance to early childhood education 21.8 3.9 percent EDUCATION Literacy and education 7.1 2.3 Literacy rate among young women age 15-24 years 97.4 76.6 percent 7.2 School readiness 40.0 36.1 percent 7.3 Net intake rate in primary education 91.2 84.3 percent 7.4 2.1 Primary school net attendance ratio (adjusted) 98.3 85.6 percent 7.5 Secondary school net attendance ratio (adjust- ed) 82.7 38.2 percent 7.6 2.2 Children reaching last grade of primary 98.6 89.2 percent 7.7 Primary completion rate 97.4 67.1 percent 7.8 Transition rate to secondary school 98.0 98.0 percent 7.9 Gender parity index (primary school) 1.00 1.00 ratio 7.10 Gender parity index (secondary school) .96 .80 ratio 3 Figure based on 125-259 person-years of exposure v topic Mics4 indicator number MdG indicator number indicator value Macedonia Roma set-tlements CHILD PROTECTION Birth registra- tion 8.1 Birth registration 99.7 98.4 percent Child labour 8.2 Child labour 16.6 10.3 percent 8.3 School attendance among child labourers 83.6 74.0 percent 8.4 Child labour among students 16.2 10.3 percent Child disci- pline 8.5 Violent discipline 69.3 82.0 percent Early marriage and polygyny 8.6 Marriage before age 15 among women age 15-49 years 1.4 11.9 percent 8.7 Marriage before age 18 among women age 20-49 years 10.7 47.0 percent 8.8 Young women age 15-19 years currently married or in union 4.3 22.4 percent 8.10.b Spousal age difference women age 20-24 years 8.4 5.1 percent Domestic violence 8.14 Attitudes towards domestic violence women age 15-49 years 14.5 25.4 percent Orphaned children 9.17 Children’s living arrangements 0.7 2.2 percent 9.18 Prevalence of children with one or both parents dead 1.9 3.3 percent SUBJECTIVE WELL-BEING Subjective well-being SW.1 Life satisfaction among women age 15-24 years 68.5 60.2 percent SW.2 Happiness among women age 15-24 years 91.2 81.4 percent SW.3 Perception of a better life among women age 15-24 years 54.6 39.0 percent TOBACCO AND ALCOHOL USE Tobacco use TA.1 Tobacco use among women age 15-49 years 30.0 42.1 percent TA.2 Smoking before age 15 among women age 15-49 years 5.2 22.7 percent Alcohol use TA.3 Alcohol use among women age 15-49 years 2.6 4.8 percent TA.4 Use of alcohol before age 15 among women age 15-49 years 28.5 11.2 percent ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases vI MultIple IndIcator cluster survey 2011 suMMaRy table of findinGs . iii list of tables .vii list of fiGuRes . Xiv list of abbReviations . Xv acKnoWledGeMents . Xvi eXecutive suMMaRy . Xvii i intRoduction . 2 Background . 2 Survey Objectives . 3 ii saMple and suRvey MethodoloGy . 4 Sample Design . 4 Questionnaires . 5 Training and Fieldwork . 6 Data Processing . 6 The Report Structure . 6 How to Read the Tables . 6 iii saMple coveRaGe and the chaRacteRistics of households and Respondents . 7 Sample Coverage . 7 Characteristics of Households . 8 Characteristics of Female Respondents 15-49 Years of Age and Children Under-5 . 10 Children Living Arrangements . 12 iv child MoRtality . 18 v nutRition . 19 Nutritional Status . 19 Breastfeeding and Infant and Young Child Feeding . 24 Low Birth Weight . 35 vi child health . 37 Vaccinations. 37 Prevalence of Diarrhoea . 42 Knowledge About the Signs of Pneumonia . 43 Solid Fuel Use . 45 Child Disability . 49 vii WateR and sanitation . 50 Use of Improved Water Sources . 50 Use of Improved Sanitation . 57 viii RepRoductive health . 64 Fertility and Early Childbearing . 64 Contraception . 66 Unmet Need . 72 Antenatal Care . 77 Assistance at Delivery . 82 Place of Delivery . 85 Abortions . 87 iX child developMent . 90 Early Childhood Education and Learning . 90 Early Childhood Development . 99 X liteRacy and education .102 Literacy Among Young Women . 102 School Readiness . 104 Primary and Secondary School Participation . 105 Xi child pRotection .114 Birth Registration . 114 Child Labour . 116 Child Discipline . 121 Early Marriage . 124 Attitudes toward Domestic Violence . 129 Xii tobacco and alcohol use . 132 Tobacco Use . 132 Alcohol Use . 137 Xiii subjective Well-beinG . 139 appendices . 146 Appendix A1. Sample Design - Macedonia . 147 Appendix A2. Sample Design – Roma Settlements. 151 Appendix B. List of Personnel Involved in the Survey . 154 Appendix C. Estimates of Sampling Errors. 157 Appendix D. Data Quality Tables . 172 Appendix E. MICS4 Indicators: Numerators and Denominators . 188 Appendix F. Questionnaires . 193 Appendix G. ISCED Tables . 238 Appendix H. Nutritional status of children based on NCHS/CDC/WHO International Reference Population . 241 Table of ConTenTs vII list of tables saMple coveRaGe and the chaRacteRistics of houshold Respondents 7 Table HH.1: Results of household, women’s and under-5 interviews, Macedonia, 2011 13 Table HH.1R: Results of household, women’s and under-5 inter- views, Roma settlements, 2011 8 Table HH.2: Household age distribution by sex, Macedo- nia, 2011 13 Table HH.2R: Household age distribution by sex, Roma settle- ments, 2011 9 Table HH.3: Household composition, Macedonia, 2011 14 Table HH.3R: Household composition, Roma settlements, 2011 10 Table HH.4: Women’s background characteristics, Mace- donia, 2011 15 Table HH.4R: Women’s background characteristics, Roma settlements, 2011 11 Table HH.5: Under-5’s background characteristics, Mace- donia, 2011 16 Table HH.5R: Under-5’s background characteristics, Roma settlements, 2011 12 Table HH.6: Children’s living arrangements and orphan- hood, Macedonia, 2011 17 Table HH.6R: Children’s living arrangements and orphanhood Roma settlements, 2011 child MoRtality 18 Table CM.1R: Children ever born, children surviving and propor- tion dead, Roma settlements, 2011 nutRition 20 Table NU.1: Nutritional status of children, Macedonia, 2011 22 Table NU.1R: Nutritional status of children, Roma settlements, 2011 25 Table NU.2: Initial breastfeeding, Macedonia, 2011 31 Table NU.2R: Initial breastfeeding, Roma settlements, 2011 26 Table NU.3: Breastfeeding, Macedonia 2011 31 Table NU.3R: Breastfeeding, Roma settlements 2011 27 Table NU.4: Duration of breastfeeding, Macedonia, 2011 32 Table NU.4R: Duration of breastfeeding, Roma settlements, 2011 28 Table NU.5: Age-appropriate breastfeeding, Macedonia, 2011 32 Table NU.5R: Age-appropriate breastfeeding, Roma settle- ments, 2011 29 Table NU.7: Minimum meal frequency, Macedonia, 2011 33 Table NU.7R: Minimum meal frequency, Roma settlements, 2011 vII Macedonia Roma settlements vIII MultIple IndIcator cluster survey 2011 30 Table NU.8: Bottle feeding, Macedonia, 2011 34 Table NU.8R: Bottle feeding, Roma settlements, 2011 35 Table NU.11: Low birth weight infants, Macedonia, 2011 36 Table NU.11R: Low birth weight infants, Roma settlements, 2011 child health 38 Table CH.1: Vaccinations in first year of life, Macedonia, 2011 40 Table CH.1R: Vaccinations in first year of life, Roma settle- ments, 2011 39 Table CH.2: Vaccinations by background characteristics, Macedonia, 2011 41 Table CH.2R: Vaccinations by background characteristics, Roma settlements, 2011 42 Table CH.4: Oral rehydration solutions and recommended homemade fluids, Macedonia, 2011 42 Table CH.4R: Oral rehydration solutions and recommended homemade fluids, Roma settlements, 2011 43 Table CH.8: Knowledge of the two danger signs of pneu- monia, Macedonia, 2011 44 Table CH.8R: Knowledge of the two danger signs of pneumo- nia, Roma settlements, 2011 45 Table CH.9: Solid fuel use, Macedonia, 2011 47 Table CH.9R: Solid fuel use, Roma settlements, 2011 46 Table CH.10: Solid fuel use by place of cooking, Macedo- nia, 2011 48 Table CH.10R: Solid fuel use by place of cooking, Roma settle- ments, 2011 WatteR and sanitation 51 Table WS.1: Use of improved water sources, Macedonia, 2011 55 Table WS.1R: Use of improved water sources, Roma settle- ments, 2011 52 Table WS.2: Household water treatment, Macedonia, 2011 56 Table WS.2R: Household water treatment, Roma settlements, 2011 53 Table WS.3: Time to source of drinking water, Macedonia 2011 56 Table WS.3R: Time to source of drinking water, Roma settle- ments 2011 54 Table WS.4: Person collecting water, Macedonia, 2011 57 Table WS.5: Types of sanitation facilities, Macedonia, 2011 61 Table WS.5R: Types of sanitation facilities, Roma settlements, 2011 58 Table WS.6: Use and sharing of sanitation facilities, Macedonia, 2011 62 Table WS.6R: Use and sharing of sanitation facilities, Roma settlements, 2011 59 Table WS.7: Disposal of child’s faeces, Macedonia, 2011 62 Table WS.7R: Disposal of child’s faeces, Roma settlements, 2011 60 Table WS.8: Drinking water and sanitation ladders, Mace- donia, 2011 63 Table WS.8R: Drinking water and sanitation ladders, Roma settlements, 2011 IX RepRoductive health 64 Table RH.1: Adolescent birth rate and total fertility rate, Macedonia, 2011 65 Table RH.2R: Early childbearing, Roma settlements, 2011 65 RH.3R: Trends in early childbeating 66 RH.3A: Knowledge of specific contraceptive methods, Macedonia, 2011 70 RH.3AR: Knowledge of specific contraceptive methods, Roma settlements, 2011 67 RH.3B: Knowledge of contraceptive methods by background characteristics, Macedonia, 2011 70 RH.3BR: Knowledge of contraceptive methods by back- ground characteristics, Roma settlements, 2011 68 Table RH.4: Use of contraception, Macedonia, 2011 71 Table RH.4R: Use of contraception, Roma settlements, 2011 73 Table RH.5: Unmet need for contraception, Macedonia, 2011 75 Table RH.5R: Unmet need for contraception, Roma settle- ments, 2011 77 Table RH.6: Antenatal care coverage, Macedonia, 2011 80 Table RH.6R: Antenatal care coverage, Roma settlements, 2011 78 Table RH.7: Number of antenatal care visits, Macedonia, 2011 81 Table RH.7R: Number of antenatal care visits, Roma settle- ments, 2011 79 Table RH.8: Content of antenatal care, Macedonia, 2011 81 Table RH.8R: Content of antenatal care, Roma settlements, 2011 83 Table RH.9: Assistance during delivery, Macedonia, 2011 84 Table RH.9R: Assistance during delivery, Roma settlements, 2011 85 Table RH.10: Place of delivery, Macedonia, 2011 86 Table RH.10R: Place of delivery, Roma settlements, 2011 87 Table RH.18: Lifetime experience with wasted pregnan- cies, Macedonia, 2011 89 Table RH.18R: Lifetime experience with wasted pregnancies, Roma settlements, 2011 88 Table RH.19: Induced abortion rates by area, Macedonia, 2011 89 Table RH.19R: Induced abortion rates by area, Roma settle- ments, 2011 88 Table RH.20: Induced abortion rates, Macedonia, 2011 child developMent 90 Table CD.1: Early childhood education, Macedonia, 2011 95 Table CD.1R: Early childhood education, Roma settlements, 2011 91 Table CD.2: Support for learning, Macedonia, 2011 96 Table CD.2R: Support for learning, Roma settlements, 2011 IX X MultIple IndIcator cluster survey 2011 93 Table CD.3: Learning materials, Macedonia, 2011 97 Table CD.3R: Learning materials, Roma settlements, 2011 94 Table CD.4: Inadequate care, Macedonia, 2011 98 Table CD.4R: Inadequate care, Roma settlements, 2011 100 Table CD.5: Early child development index, Macedonia, 2011 101 Table CD.5R: Early child development index, Roma settle- ments, 2011 liteRacy and education 102 Table ED.1: Literacy among young women, Macedonia, 2011 103 Table ED.1R: Literacy among young women, Roma settle- ments, 2011 104 Table ED.2: School readiness, Macedonia, 2011 105 Table ED.3: Primary school entry, Macedonia, 2011 106 Table ED.4: Primary school attendance, Macedonia, 2011 111 Table ED.4R: Primary school attendance, Roma settlements, 2011 107 Table ED.5: Secondary school attendance, Macedonia, 2011 112 Table ED.5R: Secondary school attendance, Roma settlements, 2011 108 Table ED.6: Children reaching last grade of primary school, Macedonia, 2011 109 Table ED.7: Primary school completion and transition to secondary school, Macedonia, 2011 110 Table ED.8: Education gender parity, Macedonia, 2011 113 Table ED.8R: Education gender parity, Roma settlements, 2011 child pRotection 114 Table CP.1: Birth registration, Macedonia, 2011 115 Table CP.1R: Birth registration, Roma settlements, 2011 117 Table CP.2: Child labour, Macedonia, 2011 119 Table CP.2R: Child labour, Roma settlements, 2011 118 Table CP.3: Child labour and school attendance, Macedonia, 2011 120 Table CP.3R: Child labour and school attendance, Roma settle- ments, 2011 121 Table CP.4: Child discipline, Macedonia, 2011 123 Table CP.4R: Child discipline, Roma settlements, 2011 125 Table CP.5: Early marriage, Macedonia, 2011 127 Table CP.5R: Early marriage, Roma settlements, 2011 126 Table CP.6: Trends in early marriage, Macedonia, 2011 128 Table CP.6R: Trends in early marriage, Roma settlements, 2011 126 Table CP.7: Spousal age difference, Macedonia, 2011 XI 130 Table CP.11: Attitudes toward domestic violence, Macedo- nia, 2011 131 Table CP.11R: Attitudes toward domestic violence, Roma settle- ments, 2011 tobacco and alcohol use 133 Table TA.1: Current and ever use of tobacco, Macedonia, 2011 135 Table TA.1R: Current and ever use of tobacco, Roma settle- ments, 2011 134 Table TA.2: Age at first use of cigarettes and frequency of use, Macedonia, 2011 136 Table TA.2R: Age at first use of cigarettes and frequency of use, Roma settlements, 2011 137 Table TA.3: Use of alcohol, Macedonia, 2011 138 Table TA.3R: Use of alcohol, Roma settlements, 2011 subjective Well-beinG 140 Table SW.1: Domains of life satisfaction, Macedonia, 2011 143 Table SW.1R: Domains of life satisfaction, Roma settlements, 2011 141 Table SW.2: Life satisfaction and happiness, Macedonia, 2011 144 Table SW.2R: Life satisfaction and happiness, Roma settle- ments, 2011 142 Table SW.3: Perception of a better life, Macedonia, 2011 145 Table SW.3R: Perception of a better life, Roma settlements, 2011 appendiX c: estiMates of eRRoRs 158 Table SE.1: Indicators selected for sampling error calcu- lations, Macedonia, 2011 170 Table SE.1R: Indicators selected for sampling error calcula- tions, Roma settlements, 2011 159 Table SE.2: Sampling errors: Total sample, Macedonia, 2011 171 Table SE.2R: Sampling errors: Total sample, Roma settlements, 2011 160 Table SE.3: Sampling errors: Urban areas, Macedonia, 2011 161 Table SE.4: Sampling errors: Rural areas, Macedonia, 2011 162 Table SE.5: Sampling errors: Vardar Region, Macedonia, 2011 163 Table SE.6: Sampling errors: East Region, Macedonia, 2011 164 Table SE.7: Sampling errors: Southwest Region, Macedo- nia, 2011 XI XII MultIple IndIcator cluster survey 2011 165 Table SE.8: Sampling errors: Southeast Region, Macedo- nia, 2011 166 Table SE.9: Sampling errors: Pelagonia Region, Macedo- nia, 2011 167 Table SE.10: Sampling errors: Polog Region, Macedonia, 2011 168 Table SE.11: Sampling errors: Northeast Region, Macedo- nia, 2011 169 Table SE.12: Sampling errors: Skopje Region, Macedonia, 2011 appendiX d: data quality tables 172 Table DQ.1: Age distribution of household population, Macedonia, 2011 180 Table DQ.1R: Age distribution of household population, Roma settlements, 2011 173 Table DQ.2: Age distribution of eligible and interviewed women, Macedonia, 2011 181 Table DQ.2R: Age distribution of eligible and interviewed women, Roma settlements, 2011 173 Table DQ.3: Age distribution of under-5s in household and under-5 questionnaires, Macedonia, 2011 181 Table DQ.3R: Age distribution of under-5s in household and under-5 questionnaires, Roma settlements, 2011 174 Table DQ.4: Women’s completion rates by socio-economic characteristics of households, Macedonia, 2011 182 Table DQ.4R: Women’s completion rates by socio-economic characteristics of households, Roma settlements, 2011 174 Table DQ.5: Completion rates for under-5 questionnaires by socio-economic characteristics of house- holds, Macedonia, 2011 182 Table DQ.5R: Completion rates for under-5 questionnaires by socio-economic characteristics of households, Roma settlements, 2011 175 Table DQ.6: Completeness of reporting, Macedonia, 2011 183 Table DQ.6R: Completeness of reporting, Roma settlements, 2011 176 Table DQ.7: Completeness of information for anthropo- metric indicators, Macedonia, 2011 184 Table DQ.7R: Completeness of information for anthropometric indicators, Roma settlements, 2011 177 Table DQ.8: Heaping in anthropometric measurements, Macedonia, 2011 185 Table DQ.8R: Heaping in anthropometric measurements, Roma settlements, 2011 177 Table DQ.11: Observation of under-5s birth certificates, Macedonia, 2011 185 Table DQ.11R: Observation of under-5s birth certificates, Roma settlements, 2011 XIII 178 Table DQ.12: Observation of vaccination cards, Macedonia, 2011 185 Table DQ.12R: Observation of vaccination cards, Roma settle- ments, 2011 178 Table DQ.13: Presence of mother in the household and the person interviewed for the under-5 question- naire, Macedonia, 2011 186 Table DQ.13R: Presence of mother in the household and the person interviewed for the under-5 questionnaire, Roma settlements, 2011 179 Table DQ.14: Selection of children age 2-14 years for the child discipline module, Macedonia, 2011 186 Table DQ.14R: Selection of children age 2-14 years for the child discipline module, Roma settlements, 2011 179 Table DQ.15: School attendance by single age, Macedonia, 2011 187 Table DQ.15R: School attendance by single age, Roma settle- ments, 2011 appendiX G: isced tables 238 Table ED.4 (a): Primary school attendance, Macedonia, 2011 240 Table ED.4R (a): Primary school attendance, Roma settlements, 2011 239 Table ED.5 (a): Lower secondary school attendance, Mace- donia, 2011 240 Table ED.5R (a): Lower secondary school attendance, Roma settlements, 2011 appendiX h: nutRitional status of childRen based on nchs/cdc/Who inteRnational RefeRence population 241 Table NU.1 (a): Nutritional status of children based on NCHS/CDC/WHO International Reference Population, Macedonia, 2011 242 Table NU.1R (a): Nutritional status of children based on NCHS/ CDC/WHO International Reference Population, Roma settlements, 2011 XIII XIv MultIple IndIcator cluster survey 2011 Macedonia Roma settlements list of figures 9 Figure HH.1: Age and sex distribution of household popu- lation, Macedonia, 2011 14 Figure HH.1R: Age and sex distribution of household population, Roma settlements, 2011 21 Figure NU.1: Percentage of children under age 5 who are underweight, stunted and wasted, Macedo- nia, 2011 23 Figure NU.1R: Percentage of children under age 5 who are underweight, stunted and wasted, Roma settle- ments, 2011 24 Figure NU.2: Percentage of mothers who started breast- feeding within one hour and within one day of birth, Macedonia, 2011 26 Figure NU.3: Infant feeding patterns by age, Macedonia, 2011 38 Figure CH.1: Percentage of children aged 18-29 months who received the recommended vaccinations by 12 months, Macedonia, 2011 41 Figure CH.1R: Percentage of children aged 18-29 months who received the recommended vaccinations by 12 months, Roma settlements, 2011 173 Figure DQ.1: Number of household population by single ages, Macedonia, 2011 181 Figure DQ.1R: Number of household population by single ages, Roma settlements, 2011 Xv list of abbreviations anc Antenatal Care bcG Bacillis-Cereus-Geuerin (Tuberculosis) cspro Census and Survey Processing System dpt Diphteria Pertussis Tetanus ecdi Early Child Development Index epi Expanded Programme on Immunization eu European Union GfR General Fertility rate Gpi Gender Parity Index hiv Human Immunodeficiency Virus ict Information/Communication Technology iMR Infant Mortality rate iud Intrauterine Device jMp Joint Monitoring Programme laM Lactational Amenorrhea Method MdG Millennium Development Goals Mics Multiple Indicator Cluster Survey Moh Ministry of Health naR Net Attendance Rate oRs Oral Rehydration Salts oRt Oral Rehydration Treatment ppm Parts Per Million ppp Preparatory Preschool Programme psu Primary Sampling Unit Rhf Recommended Home Fluid spss Statistical Package for Social Sciences tfR Total Fertility rate u5MR Under-Five Mortality Rate undp United Nations Development Programme undaf United Nations Development Assistance Framework unfpa United Nations Population Fund unicef United Nations Children’s Fund Wffc World Fit For Children Who World Health Organization XvI MultIple IndIcator cluster survey 2011 acknowledgements This survey would have not been possible without the participation of the citizens of the Republic of Macedonia. They contributed their hospitality, time, patience, and personal information, which is the essence of this report. Under the leadership of IPSOS Strategic Puls, the data collection teams carried out their work in a highly professional manner contributing to the quality and value of this report. UNICEF personnel in the Macedonia Country office, the CEE/CIS Regional office and the Global MICS team con- tributed in all stages of the survey and the development of the report through their knowledge, experience, enthusiasm and flexibility. A number of local and international experts provided critical support and inputs in the data collection process and during the preparation of the report. Members of the MICS4 Steering Committee provided valuable advice and comments during the preparation of the survey, the development of the questionnaires, and the drafting of the report. XvII eXecutive suMMaRy Introduction The Multiple Indicator Cluster Survey (MICS) is an international household survey programme developed by the United Nations Children’s Fund (UNICEF). The Republic of Macedonia MICS 2011 was conducted as part of the fourth global round of MICS surveys (MICS4). MICS provides up-to-date information on the situation of children and women and measures key indicators that allow countries to monitor progress towards the Millennium Development Goals (MDGs) and other internationally agreed upon commitments. The survey was conducted in cooperation between UNICEF and the Institute of Public Health of the Republic of Macedonia with the data collection being carried out by private research company IPSOS Strategic Puls. Financial and technical support was provided by UNICEF, with additional financial support from the United Nations Population Fund (UNFPA). In addition to conducting the MICS4 on a national scale, a separate sample of Roma settlements in Macedonia was also conducted. Results from both samples are presented jointly in this report. The following are major findings highlighted from each chapter of the report. Child Nutritional Status In Macedonia, 5 percent of children in the national sample and 17 percent of children from Roma settlements are stunted. The percentage of stunted children in Roma settlements decreases with the improvement of the material situation in the household. Stunting is nine times more frequent in children living in households from the poorest quintile. Roma boys (21 percent) are more likely to have stunted growth than Roma girls (12 percent). At the national level, 12 percent of children under the age of five are overweight. Breastfeeding In both samples, over 90 percent of children born within the last two years were breastfed. The percentage of children less than six months old who were exclusively breastfed is very low at 23 percent at the national level and 32 percent in Roma settlements. Child Health In both samples, over 90 percent of children were immunized. Children in Roma settlements, however, are less likely to receive the full round of vaccinations compared to children in the national level. Water and Sanitation More than 90 percent of the population in the country use both improved water sources and sanitation. 99.6 percent of the population has access to an improved drinking water source (if one uses a broad definition of access where improved drinking water sources include piped water, a public tap/standpipe, a tubewell/ borehole, a protected well or spring). The situation is similar in Roma settlements where 99 percent of the population uses an improved source of drinking water. 93 percent in the national sample and 91 percent in the Roma population use improved sanitation. However, approximately one third of the poorest households in Roma settlements do not have access to improved water sources and/or sanitation as compared to the rest of the population where over 90 percent have access to these two commodities. Reproductive Health In both samples, over 90 percent of women aged 15-49 years have heard of at least one modern contraceptive method. At the same time, only 13 percent of women in the national sample and 7 percent in the Roma sample use modern contraceptive methods, and 60 percent in the national sample and 63 percent in the Roma sample do not use any contraception. Traditional methods are used by 28 percent of women in the national sample and 30 percent in the Roma sample. One in every four babies born in Macedonia is delivered by cesarean section (C-section). C-section deliveries are more frequent as the wealth status of XvIII MultIple IndIcator cluster survey 2011 a woman increases. Pregnant women in the richest quintile will likely deliver by C-section four times more compared to pregnant women in the poorest quintile. Child Development Less than a quarter of pre-school aged children (36- 59 months) in the national sample attend some form of early childhood education while children in Roma settlements are five times less likely to attend. There is a strong correlation between the mother’s education level and the likelihood of her child’s early childhood education attendance. 47 percent of children whose mothers have completed higher education are attending some form of organized early childhood education programme. Meanwhile, only 1 percent of children whose mothers have completed primary or less education are included in such programmes. Literacy and Education Literacy among young women in the national sample is higher than in the Roma settlements. Considerable disparities exist within the women in Roma settlements, particularly in terms of wealth quintile. Only one in two Roma women aged 15-24 years and living in the poorest households are able to read. Over half of Roma youth at secondary school age do not attend secondary school. This situation contributes to the higher level of unemployment, social exclusion and poverty among the Roma population. Child Discipline There are a low percentage of respondents, from both samples, who believe that a child needs to be physically punished. In contrast, the percentage of parents or other adult household members who use violence as a way to discipline children is high. Among children aged 2-14 years, seven in ten children in the national sample and eight in ten in the Roma settlements have been violently punished either psychologically or physically by their parents or primary caretakers or another adult household member within a month preceding the survey. Domestic violence 15 percent of women aged 15-49 years believe that a husband is justified in beating the wife/partner in specific circumstances. The percentage is higher in the Roma population with 25 percent of women justifying the use of domestic violence by husbands. The contrast is even higher between ethnic Macedonians and Albanians within the national sample. Women in Albanian households justify a partner’s violent behavior in specific circumstances five times more than in Macedonian households (30 percent in Albanian households compared to 6 percent in Macedonian households). Acceptance of domestic violence is closely associated with a woman’s education level. Violence is seen as being acceptable ten times more by women with a primary or less education compared with those with a higher education. Tobacco and Alcohol use The prevalence of smoking, particularly during pregnancy, is a significant public health issue in the country. Smoking among women aged 15-49 years increases with the rise in household wealth. Among Roma women, however, smoking decreases with household wealth. The use of alcohol among women aged 15-49 also tends to increase with household wealth, with five times more women using alcohol in the richest quintile compared to the poorest quintile. Almost one in every four pregnant women from the national sample is a smoker. The percentage is slightly lower in the Roma community, where every fifth women smokes during pregnancy. 1 2 MultIple IndIcator cluster survey 2011 i intRoduction background This report is based on the Macedonia Multiple Indicator Cluster Survey, conducted in 2011 by the Institute of Public Health of the Republic of Macedonia and UNICEF. The survey provides valuable information on the situation of children and women in Macedonia, and was based in large part, on the needs to monitor progress towards goals and targets emanating from recent international agreements: the Millennium Declaration, adopted by all 191 United Nations Member States in September 2000, and the Plan of Action of A World Fit For Children, adopted by 189 Member States at the United Nations Special Session on Children in May 2002. Both of these commitments build upon promises made by the international community at the 1990 World Summit for Children. In signing these international agreements, governments committed themselves to improving conditions for their children and to monitoring progress towards that end. UNICEF was assigned a supporting role in this task (see table below). 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 (paragraph 61) also calls for the specific involvement of UNICEF in the preparation of period- ic 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.” 3 In Macedonia, commitment to these international agreements and priorities has been demonstrated through the development of national policies, strategies, and plans, and in conducting activities for their implementation. The most important are the following: National Plan for Action for Children 2006-2015; National Strategy on Integrated Education (2010); National Strategy on deinstitutionalization (2008); National Programme for Social Protection (2010); Social Inclusion Strategy (2011). The MICS4 Steering Committee was established to provide advice during the preparation of the report, implementation of the surveys, and the dissemination of the results of the report. Members from the following institutions were included in the Steering Committee: „ Institute of Public Health – Chair; „ Ministry of Health; „ Ministry of Education; „ Ministry of Labor and Social Policy; „ Institute for Social Activities; „ State Statistics Office; „ UNDP; „ UNFPA; „ WHO; „ UNICEF; „ IPSOS Strategic Puls. This final report presents the results of the indicators and topics covered in the survey. survey objectives The 2011 Macedonia Multiple Indicator Cluster Survey primary objectives are: „ To provide up-to-date information for assessing the situation of children and women in Macedonia; „ To furnish data needed for monitoring progress toward goals established in the Millennium Declaration and other internationally agreed upon goals, as a basis for future action; „ To contribute to the improvement of data and monitoring systems in Macedonia and to strengthen technical expertise in the design, implementation, and analysis of such systems; „ To generate data on the situation of children and women, including the identification of vulnerable groups and of disparities, to inform policies and interventions. 4 MultIple IndIcator cluster survey 2011 ii saMple and suRvey MethodoloGy The Macedonia MICS 2011 was conducted using two separate samples. One sample was designed to cover the general population (referred in the report as the national sample) and the other sample was developed specifically for the Roma population living in Roma settlements (referred in the report as the Roma sample). In Macedonia, the Roma population is among the most deprived and excluded groups in the country. To collect more accurate data on issues affecting this population a separate sample covering the Roma population in Roma settlements was included in the survey. sample design of the national sample The sample for the Macedonia MICS was designed to provide estimates for a large number of indicators on the situation of children and women at the national level, for both urban and rural areas and for eight regions: Vardar, East, Southwest, Southeast, Pelagonia, Polog, Northeast, and Skopje. The urban and rural areas within each region were identified as the main sampling strata and the sample was selected in two stages. Within each stratum, a specified number of census enumeration areas were selected systematically with probability proportional to size. After a household listing was carried out within the selected enumeration areas, the households were divided into two groups: households with children under age 5 and households without children under age 5. A separate systematic sample for each group of households was drawn in each sample enumeration area. A total of 300 enumeration areas were selected- 175 urban and 125 rural. In 17 of the selected enumeration areas distributed in three regions in the western part of the country, more than 20 percent of the selected households were empty during the data collection. As these households were occupied at the time of the listing, it is assumed that residents were engaged in seasonal work abroad. The empty households were replaced by selecting additional households from the same enumeration areas. The change of the selected households was reflected in the calculation of the sample weights after the data collection. The sample was stratified by region, urban and rural areas, and is not self-weighting. For reporting national level results, sample weights are used. sample Design of the Roma sample The sample for the Roma settlements Macedonia MICS was designed to provide estimates for a large number of indicators on the situation of Roma children and women at the national level. Roma settlements are situated in urban areas; therefore no urban-rural distinction is reflected in the sample. Similarly, being concentrated in major urban areas (with over 50 percent of Roma population living in Skopje) Roma settlements are not evenly distributed across the regions. Enumeration areas where Roma population was at least 15 percent of the total pop- ulation were identified as Roma enumeration areas (Roma settlements). There are a total of 204 such enumeration areas in the country, of which 70 were selected proportional to size and included in the sample. The sample is not self-weighting. For report- ing national level results, sample weights are used. As the national sample was designed using a random model, it also includes respondents of Roma ethnic- ity to the extent they are represented in the popula- tion. They are included in the category Other in the report. A more detailed description of the sample designs can be found in Appendix A1 and A2. 5 empty during the data collection. As these households were occupied at the time of the listing, it is assumed that residents were engaged in seasonal work abroad. The empty households were replaced by selecting additional households from the same enumeration areas. The change of the selected households was reflected in the calculation of the sample weights after the data collection. The sample was stratified by region, urban and rural areas, and is not self-weighting. For reporting national level results, sample weights are used. sample Design of the Roma sample The sample for the Roma settlements Macedonia MICS was designed to provide estimates for a large number of indicators on the situation of Roma children and women at the national level. Roma settlements are situated in urban areas; therefore no urban-rural distinction is reflected in the sample. Similarly, being concentrated in major urban areas (with over 50 percent of Roma population living in Skopje) Roma settlements are not evenly distributed across the regions. Enumeration areas where Roma population was at least 15 percent of the total pop- ulation were identified as Roma enumeration areas (Roma settlements). There are a total of 204 such enumeration areas in the country, of which 70 were selected proportional to size and included in the sample. The sample is not self-weighting. For report- ing national level results, sample weights are used. As the national sample was designed using a random model, it also includes respondents of Roma ethnic- ity to the extent they are represented in the popula- tion. They are included in the category Other in the report. A more detailed description of the sample designs can be found in Appendix A1 and A2. questionnaires Five questionnaires were used in the survey: 1) A Household Questionnaire, used to collect information on all de jure household members (usual residents), the household, and the dwelling; 2) A Women’s Questionnaire administered in each household to all women aged 15-49 years; 3) An Under 5 Questionnaire administered to mothers or caretakers for all children under 5 living in the household; 4) A Questionnaire for Child Disability administered to mothers or caretakers for all children aged 2-9 years; 5) A Questionnaire for Vaccinations at a health facility. The Household Questionnaire included the following modules: „ Household Listing Form „ Education „ Water and Sanitation „ Household Characteristics „ Child Labour „ Child Discipline The Questionnaire for Individual Women was administered to all women aged 15-49 years living in each household, and included the following modules: „ Women’s Background „ Child Mortality4 (full module for Roma sample only) „ Desire for Last Birth „ Maternal and Newborn Health „ Illness Symptoms „ Contraception „ Unmet Need „ Attitudes Towards Domestic Violence „ Marriage/Union „ Tobacco and Alcohol Use „ Life Satisfaction The Questionnaire for Children Under Five was administered to mothers or primary caretakers of 4 The module on child mortality also incorporates questions on abortion. These questions were answered by respondents in both samples. children under 5 years of age5 living in the households. The questionnaire was administered to mothers of under 5 children; in cases where the mother was not listed in the household roster, a primary caretaker for the child was identified and interviewed. The questionnaire included the following modules: „ Age „ Birth Registration „ Early Childhood Development „ Breastfeeding „ Care of Illness „ Immunization „ Anthropometry The Questionnaire Form For Child Disability contained the Ten Question Module for identifying children with an increased risk of disability. The Questionnaire Form for Vaccinations at Health Facility was used to check the consistency in recording the immunizations between the documents kept in the health facilities and the immunization cards in the households. The questionnaires were based on the MICS4 model questionnaire6. From the MICS4 model English version, the questionnaires were customized, translated into Macedonian and Albanian, back translated into English, and pre-tested in Skopje in March 2011. Based on the results of the pre-test, modifications were made to the wording and translation of the questionnaires. A copy of the Macedonia MICS questionnaires is provided in Appendix F. In addition to the administration of the questionnaires, fieldwork teams measured the weights and heights of children under 5 years of age. Details and findings of these measurements are provided in the respective sections of the report. 5 The terms “children under 5,” “children age 0-4 years,” and “children aged 0-59 months” are used interchangeably in this report. 6 The model MICS4 questionnaires can be found at www.childinfo.org 6 MultIple IndIcator cluster survey 2011 training and fieldwork Fieldwork training was conducted for 12 days in March/April 2011. Training included lectures on interviewing techniques and the contents of the questionnaires, and mock interviews between trainees to gain practice in asking questions. Towards the end of the training period, trainees spent two days practicing interviews in urban and rural areas near Struga city. 12 teams collected the data. Each team comprised of four interviewers, one editor, one measurer and a supervisor. Fieldwork began in April 2011 and concluded in July 2011. data processing Data were entered using the CSPro software. The data were entered on 12 microcomputers and carried out by 20 data entry operators and 10 data entry supervisors. In order to ensure quality control, all questionnaires were double entered and internal consistency checks were performed. Procedures and standard programs developed under the global MICS4 programme and adapted to the Macedonia questionnaire were used throughout. Data processing began almost simultaneously with data collection in May 2011 and was completed in August 2011. Data were analysed using the Statistical Package for Social Sciences (SPSS) software program, Version 18, and the model syntax and tabulation plans developed by UNICEF were used for this purpose. the Report structure This report presents findings from the MICS4 surveys carried out on two samples. Although they can be interpreted as two independent surveys, the findings are jointly presented in one report to ease data comparison between both samples. Each sub-chapter comprises of a common introduction and a description of the findings from the national sample and the Roma sample. In order to visually differentiate findings from the two samples, survey results from the Roma sample are shaded in a different colour. how to Read the tables Some of the data collected by the questionnaires are not shown in the tables but are discussed in the text because the number of cases in the disaggregated categories was not sufficient for making conclusions. The number of cases in the education category None within the national sample was too small to be reported separately. Thus the category None was merged with the category Primary and presented (except in HH tables) as Primary or Less. The education category Higher within the Roma sample was too small to be reported separately. As such, the category Higher was merged with the category Secondary and presented (except in HH tables) as Secondary+. Note: (R) — Letter R after a Table/Figure code indicates that it refers only to the Roma settlements sample. (*) — An asterisk in the tables indicates that the percentage or proportion has been suppressed because it is based on fewer than 25 unweighted cases. (Number) — Figure in parenthesis indicate that the percentage or proportion is based on just 25 to 49 unweight- ed cases and should be treated with caution. 7 iii saMple coveRaGe and the chaRacteRistics of households and Respondents sample coverage Of the 4703 households selected for the sample, 4397 were found to be occupied. Of these, 4018 were successfully interviewed for a household response rate of 91 percent. In the interviewed households, 4024 women (aged 15-49 years) were identified as eligible. Of these, 3831 were successfully interviewed, yielding a response rate of 95 percent within interviewed households. There were 1398 children under age 5 listed in the household questionnaire. Questionnaires were completed for 1376 of these children yielding a response rate of 98 percent within interviewed households. Overall, response rates of 87 percent and 90 percent are calculated for the interviews with women and children under age 5 (Table HH.1). table hh.1: Results of household, women’s and under-5 interviews number of households, women, and children under 5 by results of the household, women’s and under-5’s inter- views, and household, women’s and under-5’s response rates, Macedonia, 2011   Area Region To ta l    Urban Rural Vardar East South-west South- east Pelago- nia Polog North- east Skopje Households Sampled 2678 2025 358 444 507 369 551 742 408 1324 4703 Occupied 2517 1880 348 407 464 362 550 666 372 1228 4397 Interviewed 2206 1812 338 370 428 354 550 625 341 1012 4018 Household response rate 87.6 96.4 97.1 90.9 92.2 97.8 100.0 93.8 91.7 82.4 91.4 Women Eligible 1949 2075 263 261 450 314 500 802 362 1072 4024 Interviewed 1838 1993 257 254 417 299 490 779 353 982 3831 Women’s response rate 94.3 96.0 97.7 97.3 92.7 95.2 98.0 97.1 97.5 91.6 95.2 Women’s overall response rate 82.7 92.6 94.9 88.5 85.5 93.1 98.0 91.2 89.4 75.5 87.0 Children under 5 Eligible 758 640 139 132 137 118 199 220 95 358 1398 Mothers/caretakers interviewed 750 626 139 131 131 118 199 216 93 349 1376 Under-5’s response rate 98.9 97.8 100.0 99.2 95.6 100.0 100.0 98.2 97.9 97.5 98.4 Under-5’s overall response rate 86.7 94.3 97.1 90.2 88.2 97.8 100.0 92.1 89.7 80.3 89.9 8 MultIple IndIcator cluster survey 2011 There are differences in response rates by region and area, with significant differences in household response rates between Pelagonia region (100 percent) and Skopje (82 percent), and between rural (96 percent) and urban (88 percent) areas. In the responses from women and children under 5, similar differences are registered between region and area. The results for Skopje region should be interpreted with some caution since the household response rate was only 82 percent. Three regions were affected by empty households that were replaced during the data collection process. 32 households were replaced in the Southwest region, 47 households in the Polog region, and 22 in Northeast region. 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 4018 households successfully interviewed in the survey, 14764 household members were listed; of these, 7445 were males, and 7319 were 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, Macedonia, 2011 Males Females Total Number Percent Number Percent Number Percent age 0-4 432 5.8 427 5.8 859 5.8 5-9 444 6.0 401 5.5 846 5.7 10-14 449 6.0 407 5.6 856 5.8 15-19 592 7.9 493 6.7 1085 7.3 20-24 534 7.2 524 7.2 1058 7.2 25-29 580 7.8 554 7.6 1134 7.7 30-34 578 7.8 522 7.1 1100 7.5 35-39 524 7.0 503 6.9 1026 7.0 40-44 496 6.7 495 6.8 991 6.7 45-49 529 7.1 468 6.4 996 6.7 50-54 510 6.8 524 7.2 1034 7.0 55-59 500 6.7 536 7.3 1036 7.0 60-64 417 5.6 447 6.1 864 5.9 65-69 312 4.2 313 4.3 625 4.2 70-74 230 3.1 282 3.9 512 3.5 75-79 194 2.6 263 3.6 457 3.1 80-84 76 1.0 94 1.3 170 1.1 85+ 44 .6 62 .8 106 .7 Missing/DK 3 .0 4 .1 8 .1 Dependency age groups 0-14 1326 17.8 1235 16.9 2561 17.3 15-64 5259 70.6 5066 69.2 10326 69.9 65+ 857 11.5 1013 13.8 1869 12.7 Missing/DK 3 .0 4 .1 8 .1 Child and adult populations Children age 0-17 years 1680 22.6 1524 20.8 3204 21.7 Adults age 18+ years 5762 77.4 5791 79.1 11552 78.2 Missing/DK 3 .0 4 .1 8 .1 Total 7445 100.0 7319 100.0 14764 100.0 9 The age and sex distribution of the MICS4 survey household population is in accordance with the demographic estimates of the national population in 20107. For broad age groups, i.e. 0-14 years of age with 17 percent females and 18 percent males; 15-64 years of age with 69 percent females and 71 percent males; and 65+ years of age with 14 percent females and 12 percent males. The pyramid in Figure HH.1 shows the negative trend in the population growth with the proportion of population aged 0-17 (23 percent males and 21 percent females) is almost four times lower than the proportion of adults over 18 years and only twice as big as the group of 65+ years. figure hh.1: age and sex distribution of household population, Macedonia, 2011 Tables HH.3-HH.5 provide basic information on the households, female respondents aged 15-49, and children under 5, by presenting the unweighted and weighted numbers. Information on the basic characteristics of households, women, and children under-5 interviewed in the survey is essential for the interpretation of findings presented later in the report and can also provide an indication of the representativeness of the survey. The remaining tables in this report are presented only with weighted numbers. See Appendix A1 for more details about the weighting. Table HH.3 provides basic background information on the households. Within the households, the sex of the household head, region, area, number of household members, education of household head and ethnicity8 of the household head are shown in the table. These background characteristics are used in subsequent tables in this report; the figures in the table are also intended to show the numbers of observations by major categories of analysis in the report. 7 http://makstat.stat.gov.mk/pxweb2007bazi/temp/01Nas_reg_06_10_ PolVoz_mk2012426311420_1p1_1336891.gif 8 This was determined by asking respondents what ethnic group the head of household belonged to. The number of respondents with no education is too small to be reported as a separate category. Therefore the categories None and Primary education are presented separately only in Tables HH.3, HH.4 and HH.5, while in the remaining tables they are merged and marked as Primary or Less. table hh.3: household composition percent and frequency distribution of households by selected characteristics, Macedonia, 2011 Weighted percent Number of households Weighted Unweighted sex of household head Male 83.9 3372 3489 Female 16.1 646 529 Region Vardar 8.8 352 338 East 10.1 405 370 Southwest 8.4 339 428 Southeast 9.1 364 354 Pelagonia 13.9 560 550 Polog 10.7 429 625 Northeast 9.4 376 341 Skopje 29.7 1194 1012 number of household members 1 9.7 388 279 2 21.6 869 663 3 17.3 695 661 4 23.6 947 939 5 12.4 496 623 6 8.7 348 478 7 3.7 150 200 8 1.5 61 90 9 .9 36 41 10+ .7 28 44 education of household head None 2.4 94 103 Primary 36.7 1474 1606 Secondary 41.6 1670 1609 High 19.4 778 698 Missing/DK .0 1 2 ethnicity of household head Macedonian 72.7 2921 2606 Albanian 19.5 784 1071 Other 7.7 310 340 Missing/DK .1 3 1 Total 100.0 4018 4018 Households with at least One child age 0-4 years 16.9 4018 4018 One child age 2-9 years 24.3 4018 4018 One child age 0-17 years 44.4 4018 4018 One woman age 15-49 years 63.0 4018 4018 Mean household size 3.7 4018 4018 10 MultIple IndIcator cluster survey 2011 In Table HH.3, the weighted and unweighted numbers of households in total are equal (4018) since sample weights were normalized (see Appendix A). The table also shows the proportions of households with at least one child under 18, at least one child under 5, and at least one eligible woman aged 15-49. The table also shows the weighted average household size estimated by the survey. In 84 percent of the households, the household head was male, with the remaining 16 percent of households headed by a female. There are differences in frequency distribution of households by region with the highest frequency in Skopje (30 percent) and the lowest in the Southwest region (8 percent); this is similar to the population distribution by regions at the end of 2010. The mean household size is 3.7. 24 percent of households have four members, 17 percent have three, 22 percent have two and 12 percent consist of five members. Households with one member and with six members have similar frequencies- 10 percent and 9 percent respectively. 7 percent of households have seven or more members. Most of the household heads have a secondary (42 percent) or primary school (37 percent) education, compared to 19 percent with a higher education. Most of the household heads are Macedonians (73 percent), followed by Albanians (20 percent), and the remaining comprised of other ethnicities. 17 percent of households have at least one child aged 0-4 years, 44 percent with at least one child aged 0-17 years and 63 percent with one woman aged 15-49 years. characteristics of female Respondents 15-49 years of age and children under-5 Tables HH.4 and HH.5 provide information on the background characteristics of female respondents 15- 49 years of age and of children under age 5. In both tables, the total numbers of weighted and unweighted observations are equal since sample weights have been normalized (standardized). The tables present the numbers of observations in each background category. These categories are used in the subsequent tabulations of this report. table hh.4: Women’s background characteristics percent and frequency distribution of women age 15-49 years by selected background characteristics, Macedo- nia, 2011 Weighted percent Number of women Weighted Unweighted Region Vardar 6.3 243 257 East 6.7 258 254 Southwest 9.2 353 417 Southeast 8.3 317 299 Pelagonia 13.4 512 490 Polog 15.6 597 779 Northeast 10.0 385 353 Skopje 30.4 1166 982 area Urban 54.6 2092 1838 Rural 45.4 1739 1993 age 15-19 13.8 530 529 20-24 14.1 541 555 25-29 15.0 574 657 30-34 14.8 567 600 35-39 14.2 545 533 40-44 14.5 555 499 45-49 13.5 519 458 Marital/Union status Currently married/in union 66.2 2537 2675 Widowed 1.0 39 38 Divorced 1.4 54 43 Separated .6 25 21 Never married/in union 30.7 1175 1053 Missing .0 0 1 Motherhood status Ever gave birth 63.2 2423 2577 Never gave birth 36.8 1408 1254 births in last two years Yes 9.4 362 503 No 90.6 3469 3328 education None 1.2 46 55 Primary 29.4 11271 1312 Secondary 43.9 1682 1623 High 25.5 976 841 Wealth index quintile Poorest 18.1 695 784 Second 18.9 725 850 Middle 20.4 782 781 Fourth 20.6 791 713 Richest 21.9 839 703 ethnicity of household head Macedonian 60.8 2330 2042 Albanian 31.3 1199 1453 Other 7.9 302 336 Total 100.0 3831 3831 11 Table HH.4 provides background characteristics of female respondents 15-49 years of age. The table includes information on the distribution of women according to region, area, age, marital status, motherhood status, births in last two years, education9, wealth index quintiles10, and ethnicity of the household head. Distribution of women according to region varies from 6 percent in the Vardar region to 30 percent in the Skopje region, and from 55 percent in urban areas compared to 45 percent in rural areas. There are differences between the weighted and unweighted numbers in particular categories due to over-sampling or under-sampling such as the regional distribution in Southeast and Polog, some age groups, marital status, primary or less education, poorest and richest wealth index quintiles, and the ethnicity of the household head (Macedonian and Albanian). Some background characteristics of children under 5 are presented in Table HH.5. These include the distribution of children by several attributes: sex, region and area, age, mother’s/caretaker’s education, and wealth. 9 Unless otherwise stated, “education” refers to the educational level attend- ed by the respondent throughout this report when it is used as a background variable. 10 Principal components analysis was performed by using information on the ownership of consumer goods, dwelling characteristics, water and sanitation, and other characteristics that are related to the household’s wealth to assign weights (factor scores) to each of the household assets. Each household was then assigned a wealth score based on these weights and the assets owned by that household. The survey household population was then ranked according to the wealth score of the household they are living in, and was finally divided into 5 equal parts (quintiles) from lowest (poorest) to highest (richest). The assets used in these calculations were as follows: type of water and sanitation, number of rooms used for sleeping, main material of dwelling floor, roof and exterior walls; type of fuel used for cooking; presence in the household of electricity, radio, television, plasma/ LCD TV, landline telephone, refrigerator, washing machine, cooker, water boiler, air-conditioning, dish-washer, microwave-oven, dryer, sitting set/ sofa, sleeping bed, dining table; possesion by household members of watch, mobile phone, bicycle, motorcycle/scooter, cart pulled by animals, car/truck, motor boat, computer or laptop, caravan and ownership of bank account by the household members. The wealth index is assumed to capture the underlying long-term wealth through information on the household assets, and is intended to produce a ranking of households by wealth, from poorest to richest. The wealth index does not provide information on absolute poverty, current income or expenditure levels. The wealth scores calculated are applicable for only the particular data set they are based on. Further information on the construction of the wealth index can be found in Filmer, D. and Pritchett, L., 2001. “Estimating wealth effects without expenditure data – or tears: An application to educational enrolments in states of India”. Demography 38(1): 115-132.Gwatkin, D.R., Rutstein, S., Johnson, K. ,Pande, R. and Wagstaff. A., 2000.Socio-Economic Differences in Health, Nutrition, and Population. HNP/Poverty Thematic Group, Washington, DC: World Bank. Rutstein, S.O. and Johnson, K., 2004. The DHS Wealth Index. DHS Comparative Reports No. 6. Calverton, Maryland: ORC Macro. table hh.5: under-5’s background characteristics percent and frequency distribution of children under five years of age by selected characteristics, Macedo- nia, 2011 Weighted percent Number of under-5 children Weighted Unweight-ed sex Male 50.3 692 704 Female 49.7 684 672 Region Vardar 7.3 100 139 East 8.0 110 131 Southwest 8.8 121 131 Southeast 6.0 83 118 Pelagonia 11.3 156 199 Polog 18.6 256 216 Northeast 9.9 136 93 Skopje 30.1 415 349 area Urban 50.9 701 750 Rural 49.1 675 626 age 0-5 months 8.3 114 112 6-11 months 10.5 144 145 12-23 months 20.5 283 265 24-35 months 19.9 274 296 36-47 months 20.0 276 273 48-59 months 20.7 285 285 Mother’s education* None 1.5 20 20 Primary 38.1 525 447 Secondary 37.9 522 601 High 22.5 309 308 Wealth index quintile Poorest 23.0 316 248 Second 19.8 272 280 Middle 18.5 255 293 Fourth 18.9 261 267 Richest 19.8 272 288 ethnicity of household head Macedonian 51.4 708 846 Albanian 37.8 521 389 Other 10.7 148 141 Total 100.0 1376 1376 * Mother’s education refers to educational attainment of mothers and caretakers of children under 5. 12 MultIple IndIcator cluster survey 2011 Distribution of children under 5 according to region is similar with the distribution of women, varying from 7 percent in the Vardar region to 30 percent in the Skopje region. Distribution by area is similar in urban areas (51 percent) and rural areas (49 percent) and equally distributed by sex with 50 percent males and 50 percent females. Age groups older than 12 months are equally distributed with around 20 percent. There are children living arrangements Table HH.6 presents information on the living arrangements and orphanhood status of children under age 18. differences between the weighted and unweighted numbers in particular categories due to extensive over-sampling or under- sampling, such as regional distribution in Northeast and Skopje, primary or less and secondary education, poorest and fourth wealth index quintiles and ethnicity of the household head (Macedonian and Albanian). table hh.6: children’s living arrangements and orphanhood Percent and frequency distribution of children under five years of age by selected characteristics, Macedonia, 2011 Liv in g w ith b ot h pa re nt s Living with neither parent Living with mother only Living with father only Im po ss ib le to de te rm in e Total No t l ivi ng w ith a bi ol og ica l pa re nt 1 On e or b ot h pa re nt s d ea d 2 Nu m be r o f ch ild re n ag e 0- 17 ye ar s Only father alive Only mother alive Both alive Both dead Father alive Father dead Mother alive Mother dead sex Male 93.6 .1 .0 .6 .1 3.0 .9 1.0 .3 .4 100.0 .8 1.4 1680 Female 93.8 .1 .1 .4 .0 2.4 1.8 .7 .4 .3 100.0 .6 2.4 1524 Region Vardar 92.1 .5 .0 1.5 .0 3.8 .6 .2 .6 .7 100.0 2.0 1.7 193 East 91.5 .6 .0 .9 .5 3.8 .5 1.6 .4 .1 100.0 2.0 2.1 225 Southwest 95.5 .0 .0 .1 .0 1.7 .9 .9 .0 .8 100.0 .1 .9 312 Southeast 93.8 .0 .0 .8 .0 2.5 2.4 .5 .0 .0 100.0 .8 2.4 262 Pelagonia 94.6 .0 .0 .0 .0 2.1 .8 1.1 .6 .8 100.0 .0 1.4 392 Polog 93.5 .0 .0 .7 .1 3.5 1.8 .0 .1 .3 100.0 .8 2.0 513 Northeast 92.9 .0 .0 .4 .0 1.0 3.6 1.3 .1 .6 100.0 .4 3.8 352 Skopje 93.9 .0 .2 .5 .0 3.0 .6 1.2 .6 .0 100.0 .7 1.4 955 area Urban 92.0 .0 .0 .7 .1 3.5 1.6 1.4 .4 .3 100.0 .8 2.1 1604 Rural 95.4 .2 .1 .3 .0 1.9 1.0 .4 .3 .4 100.0 .6 1.6 1599 age 0-4 95.8 .0 .0 .2 .0 2.3 1.0 .5 .0 .1 100.0 .2 1.0 859 5-9 92.0 .1 .0 .2 .0 4.3 1.8 .5 .6 .3 100.0 .4 2.5 846 10-14 95.1 .0 .0 .4 .0 1.7 1.0 1.4 .4 .0 100.0 .4 1.4 856 15-17 91.1 .2 .3 1.5 .2 2.3 1.5 1.2 .6 1.1 100.0 2.2 2.8 643 Wealth index quintile Poorest 93.5 .3 .0 .6 .2 2.7 .8 .7 .4 .7 100.0 1.1 1.8 690 Second 93.3 .0 .3 .5 .1 2.1 3.0 .4 .1 .3 100.0 .8 3.4 651 Middle 91.5 .0 .0 1.2 .0 4.1 1.4 1.1 .6 .0 100.0 1.2 2.1 614 Fourth 94.1 .0 .0 .4 .0 1.9 1.0 1.4 .7 .5 100.0 .4 1.7 588 Richest 95.8 .0 .0 .1 .0 2.7 .4 .9 .0 .2 100.0 .1 .4 660 ethnicity of household head Macedonian 93.4 .1 .1 .6 .0 3.1 1.0 .9 .4 .3 100.0 .8 1.7 1758 Albanian 94.9 .0 .0 .3 .0 2.2 1.6 .5 .2 .3 100.0 .3 1.8 1161 Other 90.1 .0 .0 1.1 .4 2.2 2.1 2.6 .8 .7 100.0 1.5 3.4 285 Total 93.7 .1 .1 .5 .1 2.7 1.3 .9 .4 .3 100.0 .7 1.9 3204 1 MICS indicator 9.17 2 MICS indicator 9.18 Of the 3204 children covered in the survey, 94 percent live with both parents, 4 percent live with their mother only, and 1 percent with their father only. Less than 1 percent of children do not live with their biological parents and 2 percent have lost one or both parents. 13 sample coverage – Roma settlements Of the 1079 households selected for the sample, 997 were found to be occupied. Of these, 953 were successfully interviewed for a household response rate of 96 percent. In the interviewed households, 1134 women (aged 15-49 years) were identified. Of these, 1091 were successfully interviewed, yielding a response rate of 96 percent within interviewed households. There were 483 children under age 5 listed in the household questionnaire. Questionnaires were completed for 476 of these children, which correspond to a response rate of 99 percent within interviewed households. Overall, response rates of 92 and 94 percentages are calculated for the interviews with women and children under age 5 (Table HH.1R). table hh.1R: Results of house- hold, women’s, men’s and under-5 interviews number of households, women, men, and children under 5 by results of the household, women’s, men’s and under-5’s interviews, and household, women’s, men’s and under-5’s response rates, Roma settle- ments, 2011   Total Households Sampled 1079 Occupied 997 Interviewed 953 Household response rate 95.6 Women Eligible 1134 Interviewed 1091 Women’s response rate 96.2 Women’s overall response rate 92.0 Children under 5 Eligible 483 Mothers/caretakers interviewed 476 Under-5’s response rate 98.6 Under-5’s overall response rate 94.2 characteristics of households – Roma settlements The weighted age and sex distribution of the survey population is provided in Table HH.2R. The distribution is also used to produce the population pyramid in Figure HH.1R. In the 953 households successfully interviewed, 4229 household members were listed; of these, 2093 were males, and 2136 were females. table hh.2R: 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 pop- ulations (age 18 or more), by sex, Roma settlements, 2011 Males Females Total Num- ber Per- cent Num- ber Per- cent Num- ber Per- cent age 0-4 246 11.8 253 11.8 499 11.8 5-9 212 10.1 221 10.4 433 10.2 10-14 172 8.2 176 8.2 348 8.2 15-19 186 8.9 178 8.3 365 8.6 20-24 178 8.5 189 8.8 367 8.7 25-29 185 8.8 162 7.6 347 8.2 30-34 164 7.8 171 8.0 335 7.9 35-39 134 6.4 117 5.5 251 5.9 40-44 113 5.4 153 7.2 266 6.3 45-49 134 6.4 127 6.0 261 6.2 50-54 132 6.3 140 6.5 271 6.4 55-59 92 4.4 100 4.7 193 4.6 60-64 68 3.2 58 2.7 125 3.0 65-69 27 1.3 49 2.3 77 1.8 70-74 27 1.3 28 1.3 55 1.3 75-79 19 .9 8 .4 27 .6 80-84 0 .0 4 .2 4 .1 85+ 4 .2 3 .1 6 .1 Dependency age groups 0-14 630 30.1 650 30.4 1280 30.3 15-64 1385 66.2 1395 65.3 2780 65.7 65+ 78 3.7 92 4.3 170 4.0 Child and adult populations Children age 0-17 years 751 35.9 772 36.1 1523 36.0 Adults age 18+ years 1342 64.1 1364 63.9 2706 64.0 Total 2093 100.0 2136 100.0 4229 100.0 13 14 MultIple IndIcator cluster survey 2011 Data from Table HH.2R suggests a positive population growth among the Roma population. The proportion of children aged 0-4 year is the highest, consisting of almost 12 percent of the Roma population. Meanwhile, the proportion of the other age groups is decreasing by age. Children aged 0-17 years constitute 36 percent of Roma population in contrast to the group of 65 years and above, which constitute only 4 percent. figure hh.1R: age and sex distri- bution of household population, Roma settlements, 2011 Tables HH.3R - HH.5R provide basic information on the households, female respondents aged 15-49, and children under age 5, by presenting the unweighted and the weighted numbers. Information on the basic characteristics of households, women and children under 5 interviewed in the survey is essential for the interpretation of findings presented later in the report and can also provide an indication of the representativeness of the survey. The remaining tables in this report are presented only with weighted numbers. (See Appendix A2 for more details about the weighting). Table HH.3R provides basic background information on the households in Roma settlements. Within households, the sex of the household head, number of household members and education of household head are shown in the table. These background characteristics are used in subsequent tables in this report. The figures in the table are also intended to show the numbers of observations by major categories of analysis in the report. The number of respondents with a higher education is too small to be reported as a separate category. Therefore the categories Secondary and High education are presented separately only in Tables HH.3, HH.4 and HH.5, while in the remaining tables they are merged and marked as Secondary+. table hh.3R: household composi- tion percent and frequency distribution of households by selected characteristics, Roma settlements, 2011 Weighted percent Number of households Weighted Unweight-ed sex of household head Male 85.3 813 815 Female 14.7 140 138 number of household members 1 6.3 60 54 2 13.0 124 109 3 13.9 132 124 4 21.6 206 218 5 17.3 165 157 6 13.0 124 140 7 8.2 78 76 8 3.1 29 35 9 1.8 17 16 10+ 2.0 19 24 education of household head None 14.9 142 132 Primary 66.8 636 631 Secondary 16.9 161 179 High 1.5 14 11 Total 100.0 953 953 Households with at least One child age 0-4 years 38.0 953 953 One child age 2-9 years 46.7 953 953 One child age 0-17 years 69.7 953 953 One woman age 15-49 years 80.3 953 953 The weighted and unweighted numbers of households in total are equal (953) since sample weights were normalized (see Appendix A). The table also shows the proportions of households with at least one child under 18 years of age, at least one child under 5 years of age, and at least one eligible woman aged 15-49 years. The table also shows the weighted average household size estimated by the survey. In 85 percent of the households, the household head was male, with the remaining 15 percent of households headed by a female. A majority of household heads 15 (67 percent) have a primary education. The mean household size of 4.4 members reflects the structure of the households by the number of members, with four to five member households having the highest frequencies in the sample. Characteristics of female Respondents 15-49 Years of age and Children Under-5 – Roma settlements Tables HH.4R and HH.5R provide information on the background characteristics of female respondents 15-49 years of age and of children under age 5. In both tables, the total numbers of weighted and unweighted observations are equal since sample weights have been normalized (standardized). The tables present the numbers of observations in each background category that are used in the subsequent tabulations of this report. table hh.4R: Women’s background characteristics percent and frequency distribution of women age 15-49 years by selected background characteristics, Roma settlements, 2011 Weighted percent Number of women Weighted Unweighted age 15-19 15.8 173 175 20-24 17.4 190 199 25-29 15.2 166 166 30-34 15.7 172 161 35-39 10.3 112 113 40-44 13.7 149 148 45-49 11.9 129 129 Marital/Union status Currently married/in union 73.3 799 801 Widowed 2.0 22 21 Divorced 4.3 47 41 Separated 2.1 22 21 Never married/in union 18.3 200 207 Motherhood status Ever gave birth 76.7 837 824 Never gave birth 23.3 254 267 births in last two years Yes 16.7 182 174 No 83.3 909 917 education None 16.8 183 186 Primary 66.3 724 708 Secondary 14.1 153 165 High 2.8 31 32 Wealth index quintile Poorest 18.4 201 170 Second 18.5 202 201 Middle 19.4 212 206 Fourth 21.3 232 259 Richest 22.4 245 255 Total 100.0 1091 1091 16 MultIple IndIcator cluster survey 2011 Table HH.4R provides background characteristics of female respondents 15-49 years of age. The table includes information on the distribution of women according to age, marital status, motherhood status, births in last two years, education11, and wealth index quintiles. The majority of the women belong to the groups categorized as currently married/in union, with primary education, and with no birth in the last two years. Some background characteristics of children under age 5 are presented in Table HH.5R. These include the distribution of children by several attributes: sex, age, mother’s/caretaker’s education, and wealth. table hh.5R: under-5’s back- ground characteristics percent and frequency distribution of children under five years of age by selected characteristics, Roma settlements, 2011 Weighted percent Number of under-5 children Weighted Unweight-ed Sex Male 49.8 237 250 Female 50.2 239 226 age 0-5 months 7.5 36 37 6-11 months 9.1 43 44 12-23 months 20.7 99 102 24-35 months 21.0 100 105 36-47 months 19.4 92 83 48-59 months 22.1 105 105 Mother’s education* None 21.3 102 102 Primary 68.6 327 318 Secondary 10.1 48 56 High 2.3 11 9 Wealth index quintile Poorest 25.7 122 108 Second 22.7 108 107 Middle 19.5 93 90 Fourth 16.7 79 92 Richest 15.4 73 79 Total 100.0 476 476 * Mother’s education refers to educational attainment of mothers and caretakers of children under 5. 11 Unless otherwise stated, “education” refers to the educational level attend- ed by the respondent throughout this report when it is used as a background variable. Approximately 17 percent of children in the Roma population are less than one year old, with the remaining four age groups each comprising 19 to 22 percent. A majority of the children (69 percent) have mothers with a primary education, while the number of children whose mothers have no education is twice the number of those whose mothers have a secondary and higher education. In contrast to the distribution of women, the percentage of children under age 5 is highest in the poorest households (27 percent) and lowest in the richest (15 percent). 17 children living arrangements – Roma settlements Table HH.6R presents information on the living arrangements and orphanhood status of children under age 18 in Roma settlements. table hh.6R: children’s living arrangements and orphanhood Percent and frequency distribution of children under five years of age by selected characteristics, Roma settlements, 2011 Liv in g w ith b ot h pa re nt s Living with neither parent Living with mother only Living with father only Im po ss ib le to de te rm in e Total No t l ivi ng w ith a bi ol og ica l pa re nt 1 On e or b ot h pa re nt s d ea d 2 Nu m be r o f ch ild re n ag e 0- 17 ye ar s Only father alive Only mother alive Both alive Both dead Father alive Father dead Mother alive Mother dead sex Male 91.2 .0 .0 .8 .1 3.1 2.2 1.6 .2 .8 100.0 .9 2.5 751 Female 84.4 .1 .2 3.2 .1 5.0 3.6 1.8 .3 1.4 100.0 3.5 4.1 772 age 0-4 89.7 .0 .0 .2 .0 6.1 2.8 .7 .0 .5 100.0 .2 2.8 499 5-9 90.6 .0 .0 .7 .0 3.8 1.5 2.9 .0 .4 100.0 .7 1.5 433 10-14 87.0 .1 .1 2.9 .1 2.8 4.9 1.3 .2 .5 100.0 3.3 5.5 348 15-17 80.0 .0 .4 6.6 .4 2.2 2.5 2.2 1.3 4.5 100.0 7.4 4.5 244 Wealth index quintile Poorest 82.4 .0 .1 3.3 .2 2.8 5.8 2.7 .0 2.6 100.0 3.6 6.1 392 Second 87.6 .1 .3 2.7 .0 5.8 2.5 .4 .2 .4 100.0 3.1 3.1 315 Middle 90.0 .0 .0 .9 .2 2.6 1.5 2.4 1.1 1.2 100.0 1.1 2.8 292 Fourth 89.4 .0 .0 1.2 .0 3.9 2.6 2.3 .0 .7 100.0 1.2 2.6 280 Richest 92.1 .0 .0 1.2 .0 5.7 .8 .2 .0 .0 100.0 1.2 .8 245 Total 87.8 .0 .1 2.0 .1 4.1 2.9 1.7 .3 1.1 100.0 2.2 3.3 1523 1 MICS indicator 9.17 2 MICS indicator 9.18 Of the 1523 children in Roma settlements covered in the survey, 88 percent live with both parents. 7 percent live only with their mother, and 2 percent only with their father. 2 percent of children do not live with their biological parents and 3 percent have lost one or both parents. 18 MultIple IndIcator cluster survey 2011 iv child MoRtality One of the overarching goals of the Millennium Development Goals (MDGs) is the reduction of infant and under-five mortality. Specifically, 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. Measuring childhood mortality may seem easy, but attempts using direct questions, such as “Has anyone in this household died in the last year?” give inaccurate results. Using direct measures of child mortality from birth histories is time consuming, more expensive, and requires greater attention to training and supervision. Alternatively, indirect methods developed to measure child mortality produce robust estimates that are comparable with the ones obtained from other sources. Indirect methods minimize the pitfalls of memory lapses, inexact or misinterpreted definitions, and poor interviewing technique. The child mortality module was administered only in the sample from the Roma settlements. The infant and under-five mortality at the national level is too low to be measured through MICS questionnaire. The infant mortality rate is the probability of dying before the first birthday. The under-five mortality rate is the probability of dying before the fifth birthday. In MICS surveys, infant and under five mortality rates are calculated based on an indirect estimation technique known as the Brass method12. The data used in the estimation are: the mean number of children ever born for five year age groups of women from age 15 to 49, and the proportion of these children who are dead, also for five-year age groups of women (Table CM.1R). The technique converts the proportion of dead children among women in each age group into probabilities of dying by taking into account the approximate length of exposure of children to the risk of dying, assuming a particular model age pattern of mortality. Based on previous information on mortality in Roma settlements in Macedonia, the East model life table was selected as most appropriate. table cM.1R: 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, Roma settlements, 2011 Children ever born Children surviving Proportion dead Number of womenMean Total Mean Total age 15-19 .080 14 .080 14 .000 173 20-24 .608 115 .595 113 .022 190 25-29 1.106 183 1.094 181 .011 166 30-34 1.206 207 1.180 203 .022 172 35-39 1.501 168 1.412 158 .059 112 40-44 1.456 217 1.369 204 .060 149 45-49 1.676 217 1.573 204 .061 129 Total 1.029 1122 .987 1077 .040 1091 The infant mortality rate in Roma settlements is estimated at 13 per thousand live births, while the probability of dying under age 5 (U5MR) is around 14 per thousand13. These estimates have been calculated by averaging mortality estimates obtained from women aged 25-29 and 30-34 and refer to mid-2005. 12 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. 13 Table not shown due to the small number of cases for disaggregated categories. 18 MultIple IndIcator cluster survey 2011 19 v nutRition nutritional status Children’s nutritional status is a reflection of their overall health. When children have access to an adequate food supply, are not exposed to repeated illness, and are well cared for, they can reach their growth potential and are considered well nourished. Malnutrition 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, they are likely to have recurring sicknesses and faltering growth. Three- quarters of the children who die from causes related to malnutrition were only mildly or moderately malnourished – showing no outward sign of their vulnerability. The Millennium Development 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 standards14. Each of the three nutritional status indicators can be expressed in standard deviation units (z-scores) from the median of the reference population. Weight-for-age is a measure of both acute and chronic malnutrition. Children whose weight-for-age is more than two standard deviations below the median of the reference population are considered moderately underweight while those whose weight-for-age is more than three standard deviations below the median are classified as severely underweight. 14 http://www.who.int/childgrowth/standards/second_set/technical_re- port_2.pdf Height-for-age is a measure of linear growth. Children whose height-for-age is more than two standard deviations below the median of the reference population are considered short for their age and are classified as moderately 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. Finally, children whose weight-for-height is more than two standard deviations below the median of the reference population are classified as moderately wasted, while those who fall more than three standard deviations below the median are classified as severely wasted. Wasting is usually the result of a recent nutritional deficiency. The indicator may exhibit significant seasonal shifts associated with changes in the availability of food or disease prevalence. In the MICS, weights and heights of all children under 5 years of age were measured using anthropometric equipment recommended by UNICEF. Findings in this section are based on the results of these measurements. Table NU.1 shows percentages of children classified into each of the above described categories, based on the anthropometric measurements that were taken during fieldwork. Additionally, the table includes the percentage of children who are overweight, which takes into account those children whose weight for height is above 2 standard deviations from the median of the reference population, and mean z-scores for all three anthropometric indicators. 20 MultIple IndIcator cluster survey 2011 table nu.1: 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, Macedonia, 2011 Weight for age Nu m be r o f ch ild re n un de r ag e 5 Height for age Nu m be r o f ch ild re n un de r ag e 5 Weight for height Nu m be r o f ch ild re n un de r ag e 5Underweight M ea n Z- Sc or e (S D) Stunted M ea n Z- Sc or e (S D) Wasted Overweight M ea n Z- Sc or e (S D) percent below percent below percent below percent above - 2 SD1 - 3 SD2 - 2 SD3 - 3 SD4 - 2 SD5 - 3 SD6 + 2 SD sex Male 1.5 .2 .5 669 5.6 2.4 .1 667 2.2 .3 13.4 .6 653 Female 1.1 .2 .4 663 4.3 1.7 .0 652 1.4 .1 11.4 .6 646 Region Vardar 1.3 .0 .3 99 5.1 2.3 .1 98 3.8 .8 6.5 .3 98 East 3.3 .0 .1 110 6.3 2.7 -.3 110 2.8 .6 7.3 .4 109 Southwest 2.8 .7 .6 117 13.3 8.4 -.2 111 3.8 1.5 22.5 .8 103 Southeast .4 .0 .6 81 1.3 .0 .3 81 1.0 .0 12.8 .7 79 Pelagonia 1.8 1.3 .4 152 4.1 1.4 .0 152 2.3 .0 13.1 .6 152 Polog .5 .0 .2 251 5.0 1.7 .0 250 3.4 .0 6.0 .3 244 Northeast 1.5 .0 .9 135 5.0 3.1 .0 135 .4 .0 28.5 1.2 130 Skopje .6 .0 .5 388 3.1 .5 .1 382 .0 .0 10.9 .7 382 area Urban .8 .3 .6 671 4.1 1.5 .1 666 1.2 .2 15.8 .7 657 Rural 1.8 .1 .3 661 5.8 2.6 .0 653 2.4 .2 9.0 .4 642 age 0-5 months 5.1 1.3 -.1 110 7.3 2.3 -.2 108 1.7 .0 3.2 .2 107 6-11 months .4 .0 .3 141 2.5 1.5 .5 137 8.5 .0 3.5 .1 136 12-23 months .7 .5 .6 273 5.8 1.8 .0 270 1.9 .6 12.8 .7 265 24-35 months .3 .0 .6 268 3.6 1.0 .1 261 .3 .0 17.9 .8 261 36-47 months .6 .0 .5 268 5.3 3.0 -.1 270 .1 .0 15.6 .8 264 48-59 months 2.5 .0 .4 273 5.3 2.4 -.1 272 1.6 .6 11.8 .5 266 Mother’s education Primary or less 2.0 .3 .2 528 6.2 1.9 -.2 522 2.8 .3 8.5 .4 516 Secondary 1.0 .3 .5 507 5.1 2.0 .0 501 1.6 .2 15.1 .7 493 High .4 .0 .8 297 2.5 2.2 .4 295 .5 .2 14.9 .8 290 Wealth index quintile Poorest 1.9 .2 .0 308 7.2 1.9 -.3 303 3.5 .0 4.3 .3 301 Second 1.3 .0 .3 268 5.8 1.8 -.1 266 1.2 .0 9.6 .5 264 Middle 2.1 .3 .6 242 4.7 2.1 .1 241 2.3 .7 22.2 .8 235 Fourth 1.1 .5 .7 250 4.6 3.3 .2 251 1.3 .3 14.2 .7 242 Richest .0 .0 .7 264 2.0 1.2 .3 258 .6 .3 14.2 .7 256 ethnicity of household head Macedo- nian .9 .3 .6 683 3.6 1.3 .1 678 1.3 .2 14.6 .7 672 Albanian .7 .1 .4 508 5.4 2.3 .0 500 2.0 .0 10.7 .5 487 Other 5.0 .0 .0 141 9.6 4.4 -.4 141 3.7 1.1 7.9 .3 139 Total 1.3 .2 .4 1332 4.9 2.0 .0 1318 1.8 .2 12.4 .6 1299 1 MICS indicator 2.1a and MDG indicator 1.8 2 MICS indicator 2.1b 3 MICS indicator 2.2a, 4 MICS indicator 2.2b 5 MICS indicator 2.3a, 6 MICS indicator 2.3b 21 Children whose full birth date (month and year) were not obtained, and children whose measurements are outside a plausible range are excluded from Table NU.1. 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.6 and DQ.7. Overall, 94 percent of children had both valid weight and height measurements (Table DQ.7). All children have their date of birth recorded, meaning that no child was excluded from the calculations for that reason (Table DQ.6). Table DQ.7 shows that due to implausible measurements and missing weight and/or height, 3 percent of children have been excluded from calculations of the weight- for-age indicator, while the figures are 4 percent for the height-for-age indicator, and 6 percent for the weight- for-height indicator. In Macedonia, one percent of children under age five are underweight and 0.2 percent are classified as severely underweight (Table NU.1). Some 5 percent of children are stunted or too short for their age and 2 percent are wasted or too thin for their height. For both comparison with the MICS3 and for global reporting purposes, Table NU.1 (a), based on NCHS/ CDC/WHO ‘s International Reference Population, was created (see Appendix H). figure nu.1: percentage of children under age 5 who are underweight, stunted and wasted, Macedonia, 2011 22 MultIple IndIcator cluster survey 2011 nutritional status – Roma settlements Almost 8 percent of Roma children under age five in Macedonia are underweight and 2 percent are classified as severely underweight (Table NU.1R). Some 17 percent of children are stunted or too short for their age and 5 percent are wasted or too thin for their height. table nu.1R: 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, Roma settlements, 2011 Weight for age Num- ber of children under age 5 Height for age Num- ber of children under age 5 Weight for height Num- ber 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 SD sex Male 8.1 1.8 -.4 235 21.1 2.9 -.8 224 4.3 1.4 5.9 .1 224 Female 7.0 2.3 -.5 235 12.0 3.0 -.8 234 4.7 1.9 4.3 -.1 233 age 0-5 months (11.8) (7.5) (-.4) 36 (15.9) (9.9) (-.7) 34 (8.0) (6.4) (14.8) (.2_) 33 6-11 months (7.4) (1.5) (-.4) 43 (2.6) (.0) (-.2) 43 (8.8) (5.0) (4.4) (-.2) 43 12-23 months 7.5 1.5 -.4 98 16.1 4.2 -.9 95 3.6 .6 4.4 .0 96 24-35 months 3.0 .0 .0 96 14.9 1.6 -.5 92 .9 .0 3.6 .4 91 36-47 months 8.0 5.2 -.6 92 22.2 5.3 -1.0 89 5.2 2.1 6.9 -.2 89 48-59 months 9.9 .0 -.8 105 19.1 .0 -1.0 104 4.9 .9 2.7 -.3 104 Mother’s education None 5.9 .0 -.6 101 25.9 2.8 -1.1 100 2.0 .0 4.0 .0 100 Primary 8.7 2.8 -.5 321 14.9 3.5 -.8 311 4.4 1.8 3.7 -.1 310 Secondary+ 3.3 1.4 .1 48 6.8 .0 -.1 47 10.6 4.6 16.4 .3 47 Wealth index quintile Poorest 13.1 5.6 -.9 122 28.7 8.1 -1.3 122 6.9 1.5 4.7 -.2 122 Second 5.9 1.1 -.6 107 16.0 2.2 -.8 102 2.9 1.7 2.6 -.1 103 Middle 11.1 .9 -.5 91 15.0 1.7 -.7 87 3.1 1.2 4.8 -.2 86 Fourth 1.9 .0 -.1 79 11.2 .0 -.7 77 .8 .0 5.6 .2 75 Richest 2.2 1.0 .1 71 3.5 .0 -.1 70 8.2 4.2 9.3 .2 70 Total 7.6 2.0 -.5 470 16.5 3.0 -.8 458 4.5 1.7 5.1 .0 457 1 MICS indicator 2.1a and MDG indicator 1.8 2 MICS indicator 2.1b 3 MICS indicator 2.2a, 4 MICS indicator 2.2b 5 MICS indicator 2.3a, 6 MICS indicator 2.3b ( ) – figures based on 25–49 unweighted cases The percentage of stunted children is ten times higher in the poorest wealth quintile compared to the richest one. Similarly, there are nearly six times more underweighted children in the poorest quintile than in the richest. In regard to gender, boys appear to be more likely stunted than girls. For comparison with the MICS3 and for global reporting purposes, Table NU.1R (a), based on NCHS/CDC/WHO International Reference Population, was created (see Appendix H). 23 figure nu.1R: percentage of children under age 5 who are underweight, stunted and wasted, Roma settlements, 2011 * Figures for the age groups of 0-5 and 6-11 months are based on 25-49 unweighted cases 24 MultIple IndIcator cluster survey 2011 breastfeeding and infant and young child feeding 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 stop breastfeeding too soon and there are often pressures to switch to infant formula. This can contribute to growth faltering and micronutrient malnutrition, and it is also unsafe if clean water is not readily available. WHO/UNICEF have the following feeding recommendations: „ Exclusive breastfeeding for first six months „ Continued breastfeeding for two years or more „ Safe and age-appropriate complementary foods beginning at 6 months „ Frequency of complementary feeding: 2 times per day for 6-8 month olds; 3 times per day for 9-11 month olds It is also recommended that breastfeeding be initiated within one hour of birth. The indicators related to recommended child feeding practices are as follows: „ Early initiation of breastfeeding (within 1 hour of birth) „ Exclusive breastfeeding rate (< 6 months) „ Predominant breastfeeding (< 6 months) „ Continued breastfeeding rate (at 1 year and at 2 years) „ Duration of breastfeeding „ Age-appropriate breastfeeding (0-23 months) „ Introduction of solid, semi-solid and soft foods (6-8 months) „ Minimum meal frequency (6-23 months) „ Milk feeding frequency for non-breastfeeding chil- dren (6-23 months) „ Bottle feeding (0-23 months) Table NU.2 shows the proportion of children born in the two years preceding the survey who were ever breastfed, those who were first breastfed within one hour and one day of birth, and those who received a prelacteal feed. Although a very important step in management of lactation and establishment of a physical and emotional relationship between the baby and the mother, only 21 percent of babies are breastfed for the first time within one hour of birth, while 64 percent of newborns in Macedonia start breastfeeding within one day of birth. 94 percent of babies were ever breastfed while 34 percent received a prelacteal feed, which was more likely in urban areas and in the Skopje region, in households in the richest quintile, and households whose head is of Macedonian ethnicity. Mothers with a higher education were more likely to breastfeed their babies. figure nu.2: percentage of mothers who started breastfeeding within one hour and within one day of birth, Macedonia, 2011 In Table NU.3, breastfeeding status is based on the reports of mothers/caretakers of children’s consumption of food and fluids during the previous day or night prior to the interview. Exclusively breastfed refers to infants who received only breast milk (and vitamins, mineral supplements, or medicine). The table shows exclusive breastfeeding of infants during the first six months of life, as well as continued breastfeeding of children at 12-15 and 20-23 months of age. 25 table nu.2: initial breastfeeding percentage of last-born children in the 2 years preceding the survey who were ever breastfed, percentage who were breastfed within one hour of birth and within one day of birth, and percentage who received a prelacteal feed, Macedonia, 2011 Percentage who were ever breastfed1 Percentage who were first breastfed: Percentage who received a prelacteal feed Number of last-born children in the two years preceding the survey Within one hour of birth2 Within one day of birth Region Vardar (100.0) (24.6) (80.9) (31.7) 16 East (97.5) (32.0) (77.6) (21.9) 25 Southwest 97.8 18.1 58.9 16.3 39 Southeast (93.0) (21.6) (72.8) (25.6) 16 Pelagonia 91.3 29.0 51.6 37.5 42 Polog 93.7 15.4 71.2 14.1 69 Northeast (82.7) (46.6) (66.2) (22.3) 37 Skopje 95.6 11.3 59.1 56.3 118 area Urban 96.0 20.9 59.2 46.1 178 Rural 91.8 21.0 68.8 21.2 183 Months since last birth 0-11 months (89.9) (11.6) (56.4) (11.3) 35 12-23 months (88.0) (31.2) (61.6) (28.5) 37 assistance at delivery Skilled attendant 94.3 20.8 64.3 33.5 355 Traditional birth attendant (*) (*) (*) (*) 1 Other/Missing (*) (*) (*) (*) 5 Place of delivery Public sector health facility 94.6 20.9 65.7 30.8 332 Private sector health facility (*) (*) (*) (*) 23 Home (*) (*) (*) (*) 1 Other/Missing (*) (*) (*) (*) 5 Mother’s education Primary or less 90.7 18.2 66.7 21.6 146 Secondary 95.2 22.9 68.0 33.0 128 High 97.1 22.6 54.0 53.9 88 Wealth index quintile Poorest 89.5 17.4 67.9 15.9 84 Second 92.2 18.6 65.7 26.2 70 Middle 98.1 18.5 68.1 32.9 64 Fourth 94.8 21.8 59.5 41.3 75 Richest 96.0 29.0 58.9 54.3 68 ethnicity of household head Macedonian 95.8 20.9 62.8 45.2 171 Albanian 90.8 17.4 63.6 22.3 146 Other 96.1 32.7 70.5 24.9 45 Total 93.9 21.0 64.1 33.5 362 1 MICS indicator 2.4 2 MICS indicator 2.5 ( ) - Figures based on 25 - 49 unweighted cases (*) - Figures based on less than 25 unweighted cases 26 MultIple IndIcator cluster survey 2011 table nu.3: breastfeeding percentage of living children according to breastfeeding status at selected age groups, Macedonia, 2011   Children age 0-5 months Children age 12-15 months Children age 20-23 months   Percent exclusively breastfed1 Percent predominantly breastfed2 Number of children Percent breastfed (Continued breastfeeding at 1 year)3 Number of children Percent breastfed (Continued breastfeeding at 2 years)4 Number of children sex Male 31.1 47.2 53 (28.4) 49 (14.4) 39 Female 16.1 41.5 62 (38.6) 55 (11.4) 43 area Urban 21.1 45.6 58 (35.0) 53 (13.6) 40 Rural 25.0 42.5 56 (32.4) 51 (12.1) 42 Mother’s education Primary or less (26.4) (46.7) 49 (30.6) 47 (19.7) 32 Secondary (24.6) (36.0) 31 (49.3) 29 (6.7) 39 High (16.9) (47.6) 35 (23.3) 29 (*) 11 ethnicity of household head Macedonian 19.6 41.0 53 36.1 48 5.4 44 Albanian (23.0) (46.8) 46 (23.8) 41 (14.7) 31 Other (*) (*) 15 (*) 15 (*) 8 Total 23.0 44.1 114 33.8 104 12.8 82 1 MICS indicator 2.6 2 MICS indicator 2.9 3 MICS indicator 2.7 4 MICS indicator 2.8 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases Approximately 23 percent of children aged less than 6 months are exclusively breastfed, a level considerably lower than recommended. At the age of 12-15 months, 34 percent of children are still being breastfed and at 20-23 months, 13 percent are still breastfed. Four out of ten children in Macedonia are predominantly breastfed (44 percent) within the first six months. Figure NU.3 shows the detailed pattern of breastfeeding by the child’s age in months. Even at the earliest ages, 60 percent of children are receiving liquids or foods other than exclusively breast milk. By the end of the sixth month, none of the children are breastfed. Only about 8 percent of children are receiving breast milk after two years. figure nu.3: infant feeding patterns by age, Macedonia, 2011 * Data for the age groups 1-0, 2-3, 4-5, 6-7, 8-9, 12-13, 18-19, 20-21 and 22-23 is based on 25-49 unweighted cases Table NU.4 shows the median duration of breastfeeding by selected background characteristics. Among children aged 0-35 months the median duration is 12.1 months for any breastfeeding, 1.3 months for exclusive breastfeeding, and 2.8 months for predominant breastfeeding. There are differences by region, area and wealth index. 27 table nu.4: duration of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children age 0-35 months, Macedonia, 2011 Median duration (in months) of Number of children age 0-35 monthsAny breastfeeding1 Exclusive breast-feeding Predominant breastfeeding sex Male 8.1 1.2 2.2 399 Female 11.4 .5 .6 417 Region Vardar 4.0 1.2 2.8 50 East 10.4 2.2 2.2 60 Southwest 13.0 2.8 4.7 74 Southeast 16.5 2.5 2.5 49 Pelagonia 9.3 .5 2.1 98 Polog 7.6 .6 .7 154 Northeast 11.0 . . 78 Skopje 12.4 .6 .6 253 area Urban 10.2 .7 2.1 417 Rural 9.5 .6 .7 398 Mother’s education Primary or less 8.4 .6 .7 323 Secondary 6.8 1.5 2.0 300 High 11.4 .5 .7 192 Wealth index quintile Poorest 9.7 .5 .5 190 Second 5.9 .7 1.8 153 Middle 7.9 1.5 3.1 153 Fourth 10.2 .4 .5 158 Richest 10.5 1.7 2.7 161 ethnicity of household head Macedonian 9.8 .6 1.6 406 Albanian 8.4 .6 .6 314 Other 15.8 1.7 2.2 95 Median 10.0 .6 1.3 815 Mean for all children (0-35 months) 12.1 1.3 2.8 815 1 MICS indicator 2.10 The adequacy of infant feeding in children under 24 months is provided in Table NU.5. Different criteria of feeding are used depending on the age of the child. For infants aged 0-5 months, exclusive breastfeeding is considered as age-appropriate feeding, while infants aged 6-23 months are considered to be appropriately fed if they are receiving breast milk and solid, semi- solid or soft food. Of infants aged 0-5 months, 23 percent are exclusively breastfed, while 22 percent of the infants aged 6-23 months are receiving breast milk and solid, semi-solid or soft food. As a result of these feeding patterns, only 22 percent of children aged 0-23 months are being appropriately fed. There are no differences in the breastfeeding pattern by wealth index of households, and by the mother’s educational level. 28 MultIple IndIcator cluster survey 2011 table nu.5: age-appropriate breastfeeding percentage of children age 0-23 months who were appropriately breastfed during the previous day, Macedonia, 2011 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 sex Male 31.1 53 24.2 218 25.6 271 Female 16.1 62 20.2 208 19.3 270 area Urban 21.1 58 26.8 210 25.6 268 Rural 25.0 56 17.9 217 19.3 273 Mother’s education Primary or less (26.4) 49 20.7 167 22.0 216 Secondary (24.6) 31 23.4 166 23.6 197 High (16.9) 35 23.2 94 21.5 129 Wealth index quintile Poorest 30.2 28 21.2 94 23.3 122 Second 14.1 21 20.9 86 19.5 108 Middle 31.9 23 24.1 76 25.9 99 Fourth 6.7 20 20.6 91 18.1 111 Richest 28.1 22 25.2 79 25.8 101 ethnicity of household head Macedonian 19.6 53 28.2 204 26.4 257 Albanian (23.0) 46 8.2 170 11.3 216 Other (*) 15 44.7 53 42.5 68 Total 23.0 114 22.3 427 22.4 541 1 MICS indicator 2.6 2 MICS indicator 2.14 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases Appropriate complementary feeding of children from 6 months to 2 years of age is particularly important for growth and development and the prevention of under-nutrition. Continued breastfeeding beyond six months should be accompanied by consumption of nutritionally adequate, safe and appropriate complementary foods that help meet nutritional requirements when breast milk is no longer sufficient. This requires that for breastfed children, two or more meals of solid, semi-solid or soft foods are needed if they are six to eight months old, and three or more meals if they are 9-23 months of age. For children aged 6-23 months and older who are not breastfed, four or more meals of solid, semi-solid or soft foods or milk feeds are needed. In Macedonia, 41 percent of children aged 6-8 months received solid, semi-solid or soft food the day before the interview. Table NU.7 presents the proportion of children aged 6-23 months who received semi-solid or soft foods the minimum number of times or more during the day or night preceding the interview by breastfeeding status (see the note in Table NU.7 for a definition of minimum number of times for different age groups). Overall, two-thirds of all children aged 6-23 months (65 percent) were receiving solid, semi- solid and soft foods the minimum number of times. A higher proportion of males (71 percent) were achieving the minimum meal frequency as compared to females (59 percent). 29 table nu.7: Minimum meal frequency percentage of children age 6-23 months who received solid, semi-solid, or soft foods (and milk feeds for non-breastfeeding children) the minimum number of times or more during the previous day, according to breast- feeding status, Macedonia, 2011 Currently breastfeeding Currently not breastfeeding All Percent receiving solid, semi-solid and soft foods the minimum number of times Number of children age 6-23 months Percent receiving at least 2 milk feeds1 Percent receiving solid, semi- solid and soft foods or milk feeds 4 times or more Number of children age 6-23 months Percent with minimum meal frequency2 Number of children age 6-23 months sex Male 37.5 75 93.1 88.2 143 70.8 218 Female 23.7 85 90.8 83.8 123 59.2 208 age 6-8 months (28.2) 41 98.1 73.5 22 44.2 63 9-11 months (14.0) 41 96.3 96.1 40 54.0 81 12-17 months (42.6) 58 92.3 87.6 97 70.7 155 18-23 months (*) 20 88.9 83.8 108 75.8 128 area Urban 38.2 80 91.3 88.6 129 69.3 210 Rural 22.1 80 92.7 83.8 137 61.2 217 Mother’s education Primary or less 32.2 58 96.2 81.9 109 64.7 167 Secondary 32.1 60 87.8 88.1 106 67.8 166 High (24.7) 42 91.8 91.2 52 61.4 94 Wealth index quintile Poorest 38.8 32 98.3 85.0 62 69.1 94 Second 25.6 32 86.0 74.4 54 56.3 86 Middle 29.8 27 94.9 82.7 49 64.1 76 Fourth 30.0 36 87.9 93.5 55 68.5 91 Richest 26.6 33 92.6 96.4 46 67.4 79 ethnicity of household head Macedonian 40.2 76 89.6 91.3 128 72.2 204 Albanian 10.7 53 93.6 79.1 117 57.9 170 Other (38.5) 31 (*) (*) 22 61.2 53 Total 30.2 160 92.0 86.2 267 65.2 427 1 MICS indicator 2.15 2 MICS indicator 2.13 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases Among currently breastfeeding children age 6-8 months, minimum meal frequency is defined as children who also received solid, semi-solid or soft foods 2 times or more. Among currently breastfeeding children age 9-23 months, receipt of solid, semi-solid or soft foods at least 3 times constitutes minimum meal frequency. For non-breastfeeding children age 6-23 months, minimum meal frequency is defined as children receiving solid, semi-solid or soft foods, and milk feeds, at least 4 times during the previous day. Among currently breastfeeding children aged 6-23 months, nearly one-third (30 percent) were receiving solid, semi-solid and soft foods the minimum number of times. This proportion was higher among males (38 percent) as compared to females (24 percent); in urban areas than in rural areas; and among Macedonians. Among non-breastfeeding children, 86 percent of the children were receiving solid, semi-solid and soft foods or milk feeds four times or more. The continued practice of bottle-feeding is a concern because of the possible contamination due to unsafe water and/or lack of hygiene in preparation. Table NU.8 shows that bottle-feeding is still highly prevalent in Macedonia. 79 percent of children aged 0-23 months are fed using a bottle with a nipple. 30 MultIple IndIcator cluster survey 2011 table nu.8: bottle feeding percentage of children age 0-23 months who were fed with a bottle with a nipple during the previous day, Mace- donia, 2011 Percentage of children age 0-23 months fed with a bottle with a nipple1 Number of children age 0-23 months sex Male 82.2 271 Female 76.5 270 age 0-5 months 64.6 114 6-11 months 77.5 144 12-23 months 86.2 283 Region Vardar (87.0) 27 East (84.5) 37 Southwest 72.8 59 Southeast (*) 24 Pelagonia 81.7 62 Polog 75.1 103 Northeast 86.9 54 Skopje 78.6 175 area Urban 82.2 268 Rural 76.5 273 Mother’s education Primary or less 74.1 216 Secondary 85.1 197 High 79.2 129 Wealth index quintile Poorest 73.1 122 Second 81.2 108 Middle 78.4 99 Fourth 79.1 111 Richest 86.0 101 ethnicity of household head Macedonian 84.9 257 Albanian 74.9 216 Other 72.6 68 Total 79.3 541 1 MICS indicator 2.11 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases 31 breastfeeding and infant and young child feeding – Roma settlements Table NU.2R shows the proportion of children from Roma settlements born in the two years preceding the survey who were ever breastfed, those who were first breastfed within one hour and one day of birth, and those who received a prelacteal feed. Although a very important step in management of lactation and establishment of a physical and emotional relationship between the baby and the mother, only 39 percent of babies are breastfed for the first time within one hour of birth, while 75 percent of newborns from Roma settlements in Macedonia start breastfeeding within one day of birth. 96 percent of babies were ever breastfed while 18 percent received a prelacteal feed. table nu.2R: initial breastfeeding percentage of last-born children in the 2 years preced- ing the survey who were ever breastfed, percentage who were breastfed within one hour of birth and within one day of birth, and percentage who received a prelacteal feed, Roma settlements, 2011 Percent- age who were ever breast- fed1 Percentage who were first breastfed: Percent- age who received a prelac- teal feed Num- ber of last-born children in the two years preced- ing the survey Within one hour of birth2 Within one day of birth Months since last birth 0-11 months 94.1 43.8 78.2 18.6 82 12-23 months 96.6 35.5 73.6 17.8 97 assistance at delivery Skilled atten- dant 95.5 38.6 75.5 18.1 182 Other/Miss- ing (*) (*) (*) (*) 1 Place of delivery Public sector health facility 95.5 37.9 75.2 18.3 180 Other/Miss- ing (*) (*) (*) (*) 2 Mother’s education None (97.3) (36.6) (68.4) (13.9) 41 Primary 97.0 38.7 80.1 19.4 120 Secondary+ (84.2) (41.6) (61.7) (20.9) 22 Total 95.5 38.6 75.3 18.3 182 1 MICS indicator 2.4 2 MICS indicator 2.5 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases 31 In Table NU.3R15, breastfeeding status is based on the reports of mothers/caretakers of children’s consumption of food and fluids in the 24 hours prior to the interview. Exclusively breastfed refers to infants who received only breast milk (and vitamins, mineral supplements, or medicine). The table shows exclusive breastfeeding of infants during the first six months of life, as well as continued breastfeeding of children at 12- 15 and 20-23 months of age. Due to the small number of children in the specific age groups, the table presents the results for the total sample, without disaggregation by background characteristics. table nu.3R: breastfeeding percentage of living children according to breastfeeding status at selected age groups, Roma settlements, 2011   Children age 0-5 months Children age 12-15 months Children age 20-23 months Pe rce nt ex clu siv ely br ea stf ed 1 Pe rce nt pr ed om ina nt ly br ea stf ed 2 Nu m be r o f ch ild re n Pe rce nt br ea stf ed (C on tin ue d br ea stf ee din g a t 1 y ea r)3 Nu m be r o f ch ild re n Pe rce nt br ea stf ed (C on tin ue d br ea stf ee din g a t 2 y ea rs) 4 Nu m be r o f ch ild re n To ta l (32.1) (67.6) 36 (52.8) 43 (54.7) 28 1 MICS indicator 2.6 2 MICS indicator 2.9 3 MICS indicator 2.7 4 MICS indicator 2.8 ( ) – figures based on 25–49 unweighted cases Table NU.4R shows the median duration of breastfeeding by selected background characteristics. Among Roma children aged 0-35 months, the median duration is 18 months for any breastfeeding, 2 months for exclusive breastfeeding, and 5 months for predominant breastfeeding. Median duration of any breastfeeding among boys is 22 months compared to 14 among girls, while figures are comparable between boys and girls with respect to exclusive or predominant breastfeeding. 15 Background characteristics are not shown due to the small number of cases for disaggregated categories. 32 MultIple IndIcator cluster survey 2011 table nu.4R: duration of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children age 0-35 months, Roma settlements, 2011 Median duration (in months) of Nu m be r o f c hi ld re n ag e 0- 35 m on th s An y br ea st fe ed in g1 Ex clu siv e br ea st fe ed in g Pr ed om in an t br ea st fe ed in g sex Male 22.3 .6 2.7 137 Female 13.6 2.1 5.5 141 Mother’s education None 15.9 2.6 3.6 64 Primary 24.7 1.3 3.8 183 Secondary+ (12.8) (1.2) (3.2) 32 Wealth index quintile Poorest 20.4 1.0 3.0 68 Second 19.6 1.7 4.6 70 Middle 15.4 2.1 3.0 50 Fourth 16.0 2.6 4.8 46 Richest (14.3) (1.1) (4.9) 44 Median 17.9 1.6 3.8 278 Mean for all children (0-35 months) 17.5 1.8 4.8 278 1 MICS indicator 2.10 ( ) – figures based on 25–49 unweighted cases The adequacy of infant feeding in children under 24 months is provided in Table NU.5R. Different criteria of feeding are used depending on the age of the child. For infants aged 0-5 months, exclusive breastfeeding is considered as age-appropriate feeding, while infants aged 6-23 months are considered to be appropriately fed if they are receiving breast milk and solid, semi- solid or soft food. Of Roma infants aged 0-5 months, 32 percent are exclusively breastfed, while 46 percent of the infants aged 6-23 months are receiving breast milk and solid, semi-solid or soft food. As a result of these feeding patterns, only 43 percent of children aged 0-23 months are being appropriately fed. table nu.5R: age-appropriate breastfeeding percentage of children age 0-23 months who were ap- propriately breastfed during the previous day, Roma settlements, 2011 Children age 0-5 months Children age 6-23 months Children age 0-23 months Pe rc en t e xc lu siv el y br ea st fe d1 Nu m be r o f c hi ld re n Pe rc en t c ur re nt ly br ea st fe ed in g an d re ce ivi ng so lid , s em i- so lid o r s of t f oo ds Nu m be r o f c hi ld re n Pe rc en t a pp ro pr ia te ly br ea st fe d2 Nu m be r o f c hi ld re n sex Male (*) 21 52.0 74 46.8 95 Female (*) 15 38.7 68 38.4 83 Mother’s education None (*) 4 (45.2) 35 (46.1) 39 Primary (31.0) 27 50.5 92 46.1 119 Secondary+ (*) 5 (*) 15 (17.2) 20 Total (32.1) 36 45.6 142 42.9 178 1 MICS indicator 2.6 2 MICS indicator 2.14 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases Appropriate complementary feeding of children from 6 months to 2 years of age is particularly important for growth and development and the prevention of under-nutrition. Continued breastfeeding beyond six months should be accompanied by consumption of nutritionally adequate, safe and appropriate complementary foods that help meet nutritional requirements when breast milk is no longer sufficient. This requires that for breastfed children, two or more meals of solid, semi-solid or soft foods are needed if they are six to eight months old, and three or more meals if they are 9-23 months of age. For children aged 6-23 months and older who are not breastfed, four or more meals of solid, semi-solid or soft foods or milk feeds are needed. Table NU.7R presents the proportion of Roma children aged 6-23 months who received semi-solid or soft foods the minimum number of times or more during the day or night preceding the interview by breastfeeding status (see the note in Table NU.7R for a definition of minimum number of times for different age groups). Overall, two-thirds of all Roma children aged 6-23 months (63 percent) were receiving solid, semi-solid and soft foods the minimum number of times. 33 table nu.7R: Minimum meal frequency percentage of children age 6-23 months who received solid, semi-solid, or soft foods (and milk feeds for non-breastfeeding children) the minimum number of times or more during the previous day, according to breast- feeding status, Roma settlements, 2011 Currently breastfeeding Currently not breastfeeding All Percent receiving solid, semi-solid and soft foods the minimum number of times Number of children age 6-23 months Percent receiving at least 2 milk feeds1 Percent receiving solid, semi-solid and soft foods or milk feeds 4 times or more Number of children age 6-23 months Percent with minimum meal frequency2 Number of children age 6-23 months sex Male (53.2) 44 (83.9) (92.4) 30 68.9 74 Female (37.8) 38 (68.6) (77.6) 31 55.6 68 age 6-8 months (*) 9 (*) (*) 5 (*) 14 9-11 months (*) 22 (*) (*) 8 (46.3) 29 12-17 months (53.7) 31 84.9 90.3 29 71.1 60 18-23 months (*) 20 (*) (*) 19 (61.6) 39 Mother’s education None (*) 18 (*) (*) 17 (59.7) 35 Primary 45.7 59 77.3 (91.5) 33 62.3 92 Secondary+ (*) 5 (*) (*) 10 (*) 15 Wealth index quintile Poorest 58.1 22 (*) (*) 10 65.0 32 Second 35.9 25 (*) (*) 16 61.0 41 Middle 32.5 15 (*) (*) 14 52.2 29 Fourth 50.7 8 (*) (*) 11 69.4 19 Richest 61.1 11 (*) (*) 9 69.9 20 Total 46.1 82 76.1 84.9 60 62.5 142 1 MICS indicator 2.15 2 MICS indicator 2.13 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases Among currently breastfeeding children age 6-8 months, minimum meal frequency is defined as children who also received solid, semi-solid or soft foods 2 times or more. Among currently breastfeeding children age 9-23 months, receipt of solid, semi-solid or soft foods at least 3 times constitutes minimum meal frequency. For non-breastfeeding children age 6-23 months, minimum meal frequency is defined as children receiving solid, semi-solid or soft foods, and milk feeds, at least 4 times during the previous day. Among currently breastfeeding Roma children aged 6-23 months, nearly half of them (46 percent) were receiving solid, semi-solid and soft foods the minimum number of times; this proportion was higher among males. Among non-breastfeeding children, nearly 85 percent of the children were receiving solid, semi-solid and soft foods or milk feeds four times or more. The continued practice of bottle-feeding is a concern because of the possible contamination due to unsafe water and/or lack of hygiene in preparation. Table NU.8R shows that bottle-feeding is still highly prevalent in Roma population in Macedonia. 68 percent of Roma children aged 0-23 months are fed using a bottle with a nipple. There was no gender difference in this proportion. 34 MultIple IndIcator cluster survey 2011 table nu.8R: bottle feeding percentage of children age 0-23 months who were fed with a bottle with a nipple during the previous day, Roma settlements, 2011 Percentage of children age 0-23 months fed with a bottle with a nipple1 Number of children age 0-23 months sex Male 68.1 95 Female 67.9 83 age 0-5 months (48.2) 36 6-11 months (74.9) 43 12-23 months 72.2 99 Mother’s education None (75.2) 39 Primary 63.4 119 Secondary+ (*) 20 Wealth index quintile Poorest 60% 66.6 124 Richest 40% 71.3 54 Total 68.0 178 1 MICS indicator 2.11 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases 34 MultIple IndIcator cluster survey 2011 35 low birth Weight Weight at birth is a good indicator not only of a mother’s health and nutritional status but also the newborn’s chances for survival, growth, long-term health and psychosocial development. Low birth weight (less than 2,500 grams) carries a range of grave health risks for children. Babies who were undernourished in the womb face a greatly increased risk of dying during their early months and years. Those who survive have an impaired immune function and an 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 underweight also tend to have a lower IQ and cognitive disabilities, affecting their performance in school and their job opportunities as adults. Low birth weight stems primarily from the mother’s poor health and nutrition. In the industrialized world, cigarette smoking during pregnancy is the leading cause of low birth weight. Teenagers, who give birth when their own bodies have yet to finish growing, run the risk of bearing underweight babies. 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 birth16. Overall, 96 percent of births in Macedonia were weighed at birth and approximately 6 percent of infants are estimated to weigh less than 2500 grams at birth (Table NU.11). 16 For a detailed description of the methodology, see Boerma, J. T., Wein- stein, K. I., Rutstein, S.O., and Sommerfelt, A. E. 1996. Data on Birth Weight in Developing Countries: Can Surveys Help? Bulletin of the World Health Organization, 74(2), 209-16. table nu.11: low birth weight infants percentage of last-born children in the 2 years preced- ing the survey that are estimated to have weighed below 2500 grams at birth and percentage of live births weighed at birth, Macedonia, 2011 Percent of live births: Number of last-born children in the two years preceding the survey Below 2500 grams1 Weighed at birth2 Region Vardar (4.3) (97.3) 16 East (6.2) (97.5) 25 Southwest 4.0 98.6 39 Southeast (10.6) (100.0) 16 Pelagonia 8.2 98.7 42 Polog 6.2 91.3 69 Northeast (3.6) (95.2) 37 Skopje 4.6 97.3 118 area Urban 5.0 98.4 178 Rural 6.0 94.4 183 Mother’s education Primary or less 6.0 93.6 146 Secondary 5.9 98.1 128 High 4.2 98.3 88 Wealth index quintile Poorest 7.1 91.7 84 Second 5.2 93.6 70 Middle 5.0 99.7 64 Fourth 3.8 98.7 75 Richest 6.2 99.2 68 ethnicity of household head Macedonian 5.7 99.0 171 Albanian 5.5 92.1 146 Other 5.1 100.0 45 Total 5.5 96.3 362 1 MICS indicator 2.18 2 MICS indicator 2.19 ( ) – figures based on 25–49 unweighted cases 36 MultIple IndIcator cluster survey 2011 low birth Weight– Roma settlements 36 MultIple IndIcator cluster survey 2011 Among the Roma population, 94 percent of births were weighed at birth and approximately 11 percent of infants are estimated to weigh less than 2500 grams at birth (Table NU.11R) table nu.11R: low birth weight infants percentage of last-born children in the 2 years preced- ing the survey that are estimated to have weighed be- low 2500 grams at birth and percentage of live births weighed at birth, roma settlements, 2011 Percent of live births: Number of last-born children in the two years preceding the survey Below 2500 grams1 Weighed at birth2 Mother’s education None (12.9) (97.9) 41 Primary 10.8 92.2 120 Secondary+ (*) (*) 22 Wealth index quintile Poorest 60% 10.8 93.7 129 Richest 40% 12.0 94.9 54 Total 11.2 94.0 182 1 MICS indicator 2.18 2 MICS indicator 2.19 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases 37 vi child health vaccinations The Millennium Development Goal (MDG) 4 is to reduce child mortality by two thirds between 1990 and 2015. Immunization plays a key part in this goal. Immunizations have saved the lives of millions of children in the three decades since the launch of the Expanded Programme on Immunization (EPI) in 1974. Worldwide there are still 27 million children overlooked by routine immunization and as a result, vaccine-preventable diseases cause more than 2 million deaths every year. A World Fit for Children goal is to ensure full immunization of children under one year of age at 90 percent nationally, with at least 80 percent coverage in every district or equivalent administrative unit. According to UNICEF and WHO guidelines, a child should receive a BCG vaccination to protect against tuberculosis, three doses of a DPT vaccine to protect against diphtheria, pertussis, and tetanus, three doses of a polio vaccine, and a measles vaccination by the age of 12 months. The vaccination schedule (calendar for immunization) followed by the Macedonia National Immunization Programme provides all of the above mentioned vaccinations as well as three doses of vaccine against Hepatitis B and Haemophilus influenza type B (HiB), and one dose of rubella and mumps. All vaccinations should be received during the first year of life. Taking into consideration this vaccination schedule, the estimates for full immunization coverage from the Macedonia MICS are based on children aged 18-29 months. calendar for immunization age Disease Vaccination Revaccina- tion Up to 24 hours of birth, 1 and 6 months Hepatitis B (3 doses) Vaccination Up to 12 months tuberculosis (without testing) I dose Vaccination 2, 3 and 5 months Haemophilus influenza type B (Hib)(3 doses) Vaccination 2, 3 and 5 months diphtheria, pertussis, and tetanus (3 doses) Vaccination 2, 3 and 5 months polio (3 doses three type oral vaccine) Vaccination 12 months Measles, rubella, mumps (1 dose) Vaccination Information on vaccination coverage was collected for all children under five years of age. All mothers/ caretakers were asked to provide vaccination cards. If the vaccination card for a child was available, interviewers copied the vaccination information from the cards onto the MICS questionnaire. If no vaccination card was available, the interviewer asked the mother to recall whether or not the child had received each of the vaccinations, and how many doses were received for Polio, DPT and Hepatitis B. The interviewer also checked the medical records that were kept at the health facilities where the children were immunized. The final vaccination coverage estimates are based on the information obtained from the vaccination card, the mother’s report of vaccinations received by the child, and from the medical records at the health centres. 38 MultIple IndIcator cluster survey 2011 table ch.1: vaccinations in first year of life percentage of children age 18-29 months immunized against childhood diseases at any time before the survey and by the first birthday (by 18 months of age against measles), Macedonia, 2011 Vaccinated at any time before the survey according to: Va cc in at ed b y 1 2 m on th s o f a ge (1 8 m on th s o f a ge a ga in st m ea sle s) Va cc in at io n ca rd o r h ea lth fa cil ity re co rd s M ot he r’s re po rt Ei th er bCG1 95.9 1.8 97.6 97.0 Polio 1 96.2 1.8 97.9 97.9 2 96.2 1.8 97.9 97.2 32 94.9 1.8 96.7 92.5 DPT 1 96.2 1.8 97.9 97.9 2 96.2 1.8 97.9 97.9 33 94.3 .9 95.2 91.9 Measles4 94.3 1.8 96.0 91.6 Hepb At birth 96.1 1.8 97.8 97.4 1 92.1 4.8 96.9 96.5 2 90.7 4.8 95.5 90.6 HIb 1 97.0 .9 97.9 97.9 2 96.3 .9 97.2 96.8 3 94.4 .9 95.3 93.5 all vaccinations 84.7 6.6 91.3 79.2 no vaccinations .0 2.1 2.1 2.1 number of children age 18-29 months 270 270 270 270 1 MICS indicator 3.1; 2 MICS indicator 3.2; 3 MICS indicator 3.3 4 MICS indicator 3.4; MDG indicator 4.3 Table CH.1 presents the percentage of children aged 18 to 29 months who have received each of the specific vaccinations according to a vaccination card and/or mother’s recall. The denominator for the table is comprised of children aged 18-29 months so that only children who are old enough to be fully vaccinated are counted. In the first three columns of the table, the numerator includes all children who were vaccinated at any time before the survey according to the vaccination card or the mother’s report. In the last column, only those children who were vaccinated by their first birthday, as recommended, are included. For children without vaccination cards, the proportion of vaccinations given by the first birthday is assumed to be the same as for children with vaccination cards. Figure CH.1 presents the percentage of children who received the recommended vaccinations by the age of 12 months (and by 18 months for measles). Approximately 97 percent of children received a BCG vaccination by the age of 12 months - the first and second dose of DPT are given to 98 percent of children but the third dose of DPT is given to only 92 percent. Similarly, 98 percent of children received polio 1 by aged 12 months, but the coverage with polio vaccine declines to 92 percent by the third dose. Coverage for the measles vaccine by 18 months is lower than for the other vaccines. The primary reason is that although 96 percent of children received the vaccine, only 92 percent received it by the age of 18 months. There is also a slight decline in the Hepatitis B vaccination from 97 percent for the first and second dose, to 91 percent for the third dose, reflecting a small dropout rate of less than 6 percent. HiB was administered by the age of 12 months to approximately 98 percent of children aged 18-29 for the first dose, 97 percent for the second dose and 94 percent for the third dose. The percentage of children who had all the recommended vaccinations by their first birthday is low at only 79 percent. figure ch.1: percentage of children aged 18-29 months who received the recommended vaccinations by 12 months, Macedonia, 2012 39 Table CH.2 presents vaccination coverage estimates among children aged 18-29 months by background characteristics. The figures indicate children receiving the vaccinations at any time up to the date of the survey, and are based on information from both the vaccination cards and report by the mother/caretaker. The interviewer reviewed the vaccination cards for 89 percent of children. table ch.2: vaccinations by background characteristics percentage of children age 18-29 months currently vaccinated against childhood diseases according to vaccination cards or health facility records, Macedonia, 2011   Percentage of children who received:   Pe rc en ta ge w ith va cc in at io n ca rd se en Nu m be r o f c hi ld re n ag e 18 -2 9 m on th s BCG Polio DPT M ea sle s HepB HIB No ne Al l   1 2 3 1 2 3 At birth 1 2 1 2 3 sex Male 96.5 97.1 97.1 97.1 97.1 97.1 95.3 95.9 96.8 95.0 94.6 97.0 95.5 94.3 2.9 90.2 87.9 132 Female 98.8 98.8 98.8 96.3 98.8 98.8 95.1 96.1 98.8 98.8 96.3 98.8 98.8 96.2 1.2 92.4 90.8 138 area Urban 98.1 98.7 98.7 96.5 98.7 98.7 93.5 95.5 98.4 96.7 94.1 98.7 98.7 95.5 1.3 88.5 89.7 132 Rural 97.2 97.2 97.2 96.8 97.2 97.2 96.8 96.6 97.2 97.2 96.8 97.2 95.7 95.0 2.8 94.0 89.0 138 Mother’s education Primary or less 94.8 94.8 94.8 94.8 94.8 94.8 94.8 94.8 94.5 94.5 94.5 94.8 92.9 92.3 5.2 91.9 87.2 107 Secondary 100.0 100.0 100.0 99.2 100.0 100.0 99.2 96.4 100.0 100.0 100.0 100.0 100.0 99.2 .0 95.6 94.3 107 High 98.5 100.0 100.0 95.3 100.0 100.0 88.1 97.7 100.0 95.7 88.6 100.0 100.0 93.2 .0 81.9 84.2 55 Wealth index quintile Poorest 92.7 92.7 92.7 92.7 92.7 92.7 92.7 92.7 92.2 92.2 92.2 92.7 89.5 86.9 7.3 86.3 92.7 63 Second 100.0 100.0 100.0 98.9 100.0 100.0 98.9 94.2 100.0 100.0 100.0 100.0 100.0 98.9 .0 94.2 100.0 59 Middle 98.0 98.0 98.0 96.2 98.0 98.0 96.2 96.2 98.0 98.0 98.0 98.0 98.0 98.0 2.0 96.2 98.0 49 Fourth (100.0) (100.0) (100.0) (98.9) (100.0) (100.0) (94.0) (98.1) (100.0) (95.1) (91.0) (100.0) (100.0) (96.8) (.0) (89.1) (90.1) 48 Richest 98.4 100.0 100.0 97.1 100.0 100.0 94.0 100.0 100.0 100.0 96.1 100.0 100.0 97.1 .0 91.4 100.0 51 ethnicity of household head Macedonian 98.1 98.7 98.7 96.4 98.7 98.7 96.4 97.1 98.7 98.7 96.1 98.7 98.7 96.0 1.3 93.8 91.9 131 Albanian 97.7 97.7 97.7 97.2 97.7 97.7 93.7 95.0 97.4 95.3 94.8 97.7 95.8 94.9 2.3 87.9 87.1 111 Other (95.4) (95.4) (95.4) (95.4) (95.4) (95.4) (95.4) (95.4) (95.4) (95.4) (95.4) (95.4) (95.4) (93.2) (4.6) (93.2) (86.9) 28 Total 97.6 97.9 97.9 96.7 97.9 97.9 95.2 96.0 97.8 96.9 95.5 97.9 97.2 95.3 2.1 91.3 89.4 270 ( ) – figures based on 25–49 unweighted cases 40 MultIple IndIcator cluster survey 2011 vaccinations – Roma settlements The percentage of children aged 18 to 29 months in Roma settlements who have received each of the specific vaccinations by source of information (vaccination card and mother’s recall) is shown in Table CH.1R. The denominator for the table is comprised of children aged 18-29 months so that only children who are old enough to be fully vaccinated are counted. In the first three columns of the table, the numerator includes all children who were vaccinated at any time before the survey according to the vaccination card or the mother’s report. In the last column, only those children who were vaccinated before their first birthday, as recommended, are included. For children without vaccination cards, the proportion of vaccinations given by the first birthday is assumed to be the same as for children with vaccination cards. table ch.1R: vaccinations in first year of life percentage of children age 18-29 months immunized against childhood diseases at any time before the survey and by the first birthday (by 18 months of age against measles), Roma settlements, 2011 Vaccinated at any time before the survey according to: Vaccinated by 12 months of age (18 months of age against measles) Vaccination card or health facility records Mother’s report Eithe r bCG1 98.2 .0 98.2 96.6 Polio 1 98.2 .0 98.2 95.2 2 94.4 .0 94.4 85.9 32 91.0 .0 91.0 80.2 DPT 1 98.2 .0 98.2 95.2 2 95.4 .0 95.4 85.9 33 90.9 .0 90.9 77.9 Measles4 96.3 .0 96.3 88.9 Hepb At birth 97.7 1.2 98.9 98.9 1 94.4 2.7 97.0 95.8 2 90.4 1.3 91.7 85.3 HIb 1 98.2 .0 98.2 96.0 2 95.4 .0 95.4 91.3 3 94.3 .0 94.3 90.3 all vaccinations 83.6 5.6 89.2 63.1 no vaccinations .0 1.1 1.1 1.1 number of children age 18-29 months 86 86 86 86 1 MICS indicator 3.1; 2 MICS indicator 3.2; 3 MICS indicator 3.3 4 MICS indicator 3.4; MDG indicator 4.3 Figure CH.1R presents the percentage of children who received recommended vaccinations by the age of 12 months (and by 18 months for measles). Approximately 97 percent of the children in Roma settlements received a BCG vaccination by the age of 12 months – the first dose of DPT was given to 95 percent but the second and third dose of DPT declined to 86 percent and 78 percent respectively. Similarly, 95 percent of Roma children received Polio 1 by age 12 months and this declines to 80 percent by the third dose. 96 percent of Roma children received the measles vaccine, however, only 89 percent had received it by the age of 18 months. There is also a big decline in the Hepatitis B vaccination from 99 percent for the first dose given at birth to 96 percent for the second dose, and 85 percent for the third dose, reflecting a big dropout rate of 14 percent. HiB was administered by the age of 12 months to approximately 96 percent of Roma children aged 18-29 months (first dose), 91 percent for the second dose and 90 percent for the third dose. The percentage of Roma children who had all the recommended vaccinations by their first birthday is low at only 63 percent. 41 figure ch.1R: percentage of chil- dren aged 18-29 months who received the recommended vacci- nations by 12 months, Roma settle- ments, 2012 table ch.2R: vaccinations by background characteristics percentage of children age 18-29 months currently vaccinated against childhood diseases according to vaccina- tion cards or health facility records, Roma settlements, 2011   Percentage of children who received: Al l Pe rc en ta ge w ith va cc in at io n ca rd or fa cil ity re co rd se en Nu m be r o f ch ild re n ag e 18 -2 9 m on th s BC G Polio DPT M ea sle s HepB HIB No ne  1 2 3 1 2 3 At birth 1 2 1 2 3 sex Male (98.0) (98.0) (96.7) (96.7) (98.0) (96.7) (94.2) (97.0) (98.0) (98.0) (94.2) (98.0) (96.7) (96.7) (2.0) (93.3) (98.0) 45 Female (98.4) (98.4) (91.8) (84.8) (98.4) (94.0) (87.3) (95.5) (100.0) (96.1) (89.1) (98.4) (93.9) (91.6) (.0) (84.8) (100.0) 42 Total 98.2 98.2 94.4 91.0 98.2 95.4 90.9 96.3 98.9 97.0 91.7 98.2 95.4 94.3 1.1 89.2 98.9 86 ( ) – figures based on 25–49 unweighted cases Table CH.2R presents vaccination coverage estimates among children aged 18-29 months by background characteristics. The figures indicate children receiving the vaccinations at any time up to the date of the survey, and are based on information from the vaccination cards, mothers’/caretakers’ reports and health records. The interviewer reviewed the vaccination cards or facility records for 99 percent of Roma children (100 percent for females). Only 1 percent of Roma children were not vaccinated with any vaccine. At birth, 99 percent received the hepatitis B vaccine; 98 percent were vaccinated with BCG, and received a first dose of polio, DPT and HiB; and 96 percent received a measles vaccine. What is noticeable from Table CH.2R is the higher drop-off rate for girls although the figures are based on 25-49 unweighted cases. 42 MultIple IndIcator cluster survey 2011 prevalence of diarrhoea Diarrhoea is the second leading cause of death among children under five worldwide. Most diarrhoea-related deaths in children are due to dehydration from loss of large quantities of water and electrolytes from the body in liquid stools. Management of diarrhoea – either through oral rehydration salts (ORS) or a recommended home fluid (RHF) - can prevent many of these deaths. Preventing dehydration and malnutrition by increasing fluid intake and continuing to feed the child are also important strategies for managing diarrhoea. The goals of A World Fit for Children is to reduce by one half death due to diarrhoea among children under five by 2010 compared to 2000, and to reduce the incident of diarrhoea by 25 percent. The Millennium Development Goal is to reduce by two thirds the mortality rate among children under five by 2015 compared to 1990. In the MICS, prevalence of diarrhoea was estimated by asking mothers/caretakers whether their child under age five had an episode of diarrhoea in the two weeks prior to the survey. Overall, 6 percent of under five children had diarrhoea in the two weeks preceding the survey (Table CH.4). Diarrhoea prevalence in children from rural (7 percent) and urban areas (6 percent) are almost equal, indicating good water and sanitation conditions in rural areas. table ch.4: prevalence of diarrhoeal diseases percentage of children age 0-59 months with diarrhoea in the last two weeks, Macedonia, 2011 Had diarrhea in last two weeks Number of children age 0-59 months sex Male 7.0 692 Female 5.8 684 area Urban 5.9 701 Rural 6.9 675 age 0-11 months 7.8 258 12-23 months 9.6 283 24-35 months 7.8 274 36-47 months 3.1 276 48-59 months 3.9 285 Mother’s education Primary or less 8.1 545 Secondary 4.8 522 High 6.2 309 Wealth index quintile Poorest 8.7 316 Second 7.6 272 Middle 5.0 255 Fourth 6.3 261 Richest 4.1 272 ethnicity of household head Macedonian 5.1 708 Albanian 8.4 521 Other 5.8 148 Total 6.4 1376 prevalence of diarrhoea – Roma settlements Overall, 13 percent of children under five years in Roma settlements had diarrhoea in the two weeks preceding the survey (Table CH.4R17). 17 Background characteristics are not shown due to the small number of cases for disaggregated categories. table ch.4R: prevalence of diarrhoeal diseases percentage of children age 0-59 months with diarrhoea in the last two weeks, Roma settlements, 2011 Had diarrhoea in last two weeks Number of children age 0-59 months sex Male 13.4 237 Female 12.7 239 Total 13.1 476 43 Knowledge about the signs of pneumonia Pneumonia is the leading cause of death in children and the use of antibiotics in children under 5 years of age with suspected pneumonia is a key intervention. A World Fit for Children goal is to reduce by one-third the deaths due to acute respiratory infections. Issues related to knowledge of danger signs of pneumonia are presented in Table CH.8. The mothers’ knowledge of the danger signs is an important determinant of care-seeking behaviour. Overall, only 6 percent of women know of the two danger signs of pneumonia – fast and difficult breathing. The most commonly identified symptom for taking a child to a health facility is developed fever. 16 percent of mothers identified fast breathing and 21 percent of mothers identified difficult breathing as symptoms for taking children immediately to a health care provider. Mothers’ knowledge of the danger signs of pneumonia varies by region, education, wealth index and ethnicity. table ch.8: Knowledge of the two danger signs of pneumonia percentage of mothers and caretakers of children age 0-59 months by symptoms that would cause to take the child immediately to a health facility, and percentage of mothers who recognize fast and difficult breathing as signs for seeking care immediately, Macedonia, 2011 Percentage of mothers/caretakers of children age 0-59 months who think that a child should be taken immediately to a health facility if the child: M ot he rs / c ar et ak er s w ho re co gn ize th e tw o da ng er si gn s o f pn eu m on ia Nu m be r o f m ot he rs / ca re ta ke rs o f ch ild re n ag e 0- 59 m on th s Is no t a bl e to d rin k o r br ea st fe ed Be co m es sic ke r De ve lo ps a fe ve r Ha s f as t br ea th in g Ha s d iffi cu lty br ea th in g Ha s b lo od in st oo l Is dr in kin g po or ly Region Vardar 1.6 6.3 95.5 19.2 22.2 10.9 2.2 2.0 54 East 1.5 9.6 89.1 2.7 3.2 .7 8.2 .7 61 Southwest 33.0 36.3 92.5 22.5 24.2 15.1 25.0 11.3 72 Southeast 6.5 19.2 98.7 11.8 13.2 5.2 .9 2.9 48 Pelagonia 13.9 30.9 96.3 8.9 10.7 1.7 2.0 .6 83 Polog 16.4 32.8 88.4 23.0 26.0 12.2 17.5 9.7 140 Northeast 36.9 30.1 93.3 30.6 41.1 8.3 11.2 7.4 77 Skopje 5.4 11.5 88.1 12.3 18.7 2.9 4.7 6.3 234 area Urban 9.0 15.8 91.1 13.3 20.7 5.1 7.4 5.5 401 Rural 18.5 28.0 91.3 19.7 20.5 8.4 11.1 6.4 368 Mother’s education Primary or less 16.0 27.8 88.9 22.5 23.2 6.4 10.5 7.1 285 Secondary 9.0 17.9 94.1 13.9 19.3 4.9 8.9 4.8 292 High 17.0 18.1 90.4 11.0 18.6 9.9 7.6 5.8 192 Wealth index quintile Poorest 21.3 27.6 88.9 21.9 24.0 10.8 9.7 9.9 165 Second 13.2 23.5 90.9 23.6 18.0 7.1 11.2 7.6 150 Middle 14.8 25.6 90.4 15.6 22.2 4.7 10.8 5.6 136 Fourth 11.8 21.5 92.2 16.2 21.0 3.2 7.8 5.6 155 Richest 6.6 10.7 93.6 4.8 17.8 7.2 6.7 1.0 163 ethnicity of household head Macedonian 7.3 13.7 93.2 10.2 16.5 4.3 6.5 3.0 408 Albanian 24.0 34.7 88.3 25.8 27.3 9.6 13.3 10.1 285 Other 7.8 15.5 91.9 14.1 17.2 8.7 7.7 6.1 75 Total 13.6 21.6 91.2 16.4 20.6 6.7 9.2 5.9 768 44 MultIple IndIcator cluster survey 2011 Knowledge about signs of pneumonia – Roma settlements 19 percent of mothers identified difficult breathing as symptoms for taking children immediately to a health care provider. 20 percent of Roma mothers go to a health care provider when the child becomes sicker, while 19 percent of mothers go when the child is unable to drink or breastfeed. Knowledge of the danger signs of pneumonia is higher among mothers in the richest households compared to all other wealth quintiles. table ch.8R: Knowledge of the two danger signs of pneumonia percentage of mothers and caretakers of children age 0-59 months by symptoms that would cause to take the child immediately to a health facility, and percentage of mothers who recognize fast and difficult breathing as signs for seeking care immediately, Roma settlements, 2011 Percentage of mothers/caretakers of children age 0-59 months who think that a child should be taken immediately to a health facility if the child: M ot he rs / c ar et ak er s w ho re co gn ize th e tw o da ng er sig ns o f p ne um on ia Nu m be r o f m ot he rs / ca re ta ke rs o f c hi ld re n ag e 0- 59 m on th s Is no t a bl e to d rin k or b re as tfe ed Be co m es si ck er De ve lo ps a fe ve r Ha s f as t b re at hi ng Ha s d iffi cu lty br ea th in g Ha s b lo od in st oo l Is dr in kin g po or ly Mother’s education None 30.5 31.5 93.7 18.6 23.1 3.2 1.8 4.1 73 Primary 16.2 15.4 92.8 10.1 17.9 2.9 3.6 2.0 259 Secondary+ (12.4) (26.4) (89.6) (9.3) (16.9) (6.2) (13.9) (9.3) 43 Wealth index quintile Poorest 20.3 28.4 95.8 9.5 17.3 2.2 1.8 .0 89 Second 31.5 14.4 95.4 9.0 17.9 .8 3.6 3.7 77 Middle 11.7 17.4 91.3 10.5 16.2 8.9 1.1 1.1 77 Fourth 13.9 14.2 92.8 13.7 19.4 2.9 8.7 2.1 68 Richest 13.4 23.1 86.1 17.2 24.5 1.7 8.5 10.8 64 Total 18.5 19.8 92.6 11.6 18.8 3.3 4.4 3.2 375 ( ) – figures based on 25–49 unweighted cases 44 MultIple IndIcator cluster survey 2011 Issues related to knowledge of danger signs of pneumonia are presented in Table CH.8R. The mothers’ knowledge of the danger signs is an important determinant of care-seeking behaviour. Overall, only 3.2 percent of Roma women know of the two danger signs of pneumonia – fast and difficult breathing. The most commonly identified symptom for taking a child to a health facility is developed fever (93 percent). 12 percent of Roma mothers identified fast breathing and 45 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, among others. Use of solid fuels increases the risks of incurring acute respiratory illness, pneumonia, chronic obstructive lung disease, cancer, asthma, cataracts, and possibly tuberculosis, and may contribute to low birth weight of babies born to pregnant women exposed to smoke. The primary indicator for monitoring use of solid fuels is the proportion of the population using solid fuels as the primary source of domestic energy for cooking, as shown in Table CH.9. table ch.9: solid fuel use percent distribution of household members according to type of cooking fuel used by the household, and percentage of household members living in households using solid fuels for cooking, Macedonia, 2011 Percentage of household members in households using: El ec tri cit y Pe tro le um Bi og as Solid fuels Ot he r f ue l M iss in g No fo od co ok ed in th e ho us eh ol d To ta l So lid fu el s f or co ok in g1 Nu m be r o f ho us eh ol d m em be rs Ch ar co al W oo d St ra w, sh ru bs , gr as s Region Vardar 61.0 16.5 .0 .0 22.2 .2 .0 .0 .0 100.0 22.5 1064 East 30.2 16.1 .0 .0 53.0 .6 .0 .0 .1 100.0 53.6 1235 Southwest 38.6 5.3 .0 .0 56.1 .1 .0 .0 .0 100.0 56.1 1337 Southeast 61.1 8.9 .0 .0 29.9 .0 .0 .0 .1 100.0 29.9 1293 Pelagonia 55.3 10.2 .2 .0 33.9 .0 .4 .0 .0 100.0 33.9 1957 Polog 37.8 7.2 .0 .3 54.5 .0 .0 .2 .0 100.0 54.8 2059 Northeast 61.5 3.1 .0 .1 35.2 .0 .0 .0 .0 100.0 35.3 1466 Skopje 76.8 9.1 .0 .0 13.9 .1 .0 .0 .1 100.0 14.0 4353 area Urban 75.6 11.4 .0 .0 12.8 .1 .1 .0 .0 100.0 12.9 8202 Rural 34.0 6.4 .1 .1 59.2 .1 .0 .1 .1 100.0 59.4 6562 education of household head Primary or less 39.5 5.4 .1 .1 54.6 .2 .0 .1 .0 100.0 55.0 6047 Secondary 66.9 11.8 .0 .0 21.1 .0 .1 .0 .1 100.0 21.1 6143 High 75.4 11.8 .0 .0 12.8 .0 .0 .0 .0 100.0 12.8 2569 Wealth index quintiles Poorest 14.8 2.0 .0 .0 82.9 .1 .2 .0 .0 100.0 83.0 2955 Second 42.3 6.2 .0 .2 50.7 .4 .0 .0 .2 100.0 51.3 2950 Middle 63.9 9.6 .0 .1 26.1 .0 .0 .3 .0 100.0 26.2 2953 Fourth 76.9 16.2 .1 .0 6.8 .0 .0 .0 .0 100.0 6.8 2950 Richest 87.6 11.8 .0 .0 .6 .0 .0 .0 .0 100.0 .6 2955 ethnicity of household head Macedonian 65.0 12.1 .0 .0 22.7 .0 .1 .0 .1 100.0 22.7 9537 Albanian 39.1 2.7 .0 .2 57.7 .1 .0 .1 .0 100.0 58.0 4040 Other 54.5 7.6 .0 .0 37.3 .6 .0 .0 .0 100.0 37.9 1182 Total 57.1 9.2 .0 .0 33.4 .1 .1 .0 .0 100.0 33.6 14764 1 MICS indicator 3.11 46 MultIple IndIcator cluster survey 2011 Overall, more than a third (34 percent) of all households in Macedonia use solid fuels for cooking. Use of solid fuels is low in urban areas (13 percent), but very high in rural areas, where more than half of the households (59 percent) use solid fuels. Differentials in regard to household wealth and the educational level of the household head are also considerable. The findings show that use of solid fuels is very uncommon among households in the Skopje region and among the richest households. The table also shows that the overall percentage is high due to the common use of wood for cooking purposes. Solid fuel use by place of cooking is depicted in Table CH.10. The presence and extent of indoor pollution are dependent on cooking practices, places used for cooking, as well as types of fuel used. In most households solid fuel is used for cooking in a separate room such as a kitchen (77 percent). In 13 percent of households, it is used elsewhere in the house- 7 percent in a separate building and 3 percent outdoors. This distribution is similar through the country even though there are differences by region, area of living and wealth index of households, as well as the education and ethnicity of household head. table ch.10: solid fuel use by place of cooking percent distribution of household members in households using solid fuels by place of cooking, Macedonia, 2011 Place of cooking: In a se pa ra te ro om u se d as kit ch en El se w he re in th e ho us e In a se pa ra te bu ild in g Ou td oo rs At a no th er pl ac e M iss in g To ta l Nu m be r o f ho us eh ol d m em be rs in ho us eh ol ds us in g so lid fu el s f or co ok in g Region Vardar 48.4 9.3 26.1 14.5 .0 1.7 100.0 239 East 60.5 31.7 4.7 3.1 .0 .0 100.0 662 Southwest 93.9 2.9 .9 2.2 .0 .1 100.0 750 Southeast 77.3 5.4 13.1 3.6 .6 .0 100.0 386 Pelagonia 83.5 6.1 7.3 3.1 .0 .0 100.0 664 Polog 71.6 16.8 7.8 2.9 .0 .8 100.0 1128 Northeast 88.8 10.3 .0 .9 .0 .0 100.0 518 Skopje 79.5 11.0 5.9 3.4 .0 .2 100.0 610 area Urban 85.2 10.9 2.7 1.1 .0 .0 100.0 1058 Rural 75.0 13.1 7.5 3.9 .1 .4 100.0 3900 education of household head Primary or less 73.6 15.3 6.8 3.8 .1 .4 100.0 3325 Secondary 82.5 8.0 6.6 2.7 .0 .1 100.0 1298 High 91.9 4.2 3.0 1.0 .0 .0 100.0 330 Wealth index quintiles Poorest 67.4 18.5 8.1 5.5 .1 .5 100.0 2454 Second 84.8 7.3 6.0 1.7 .0 .2 100.0 1512 Middle 90.6 6.7 2.0 .7 .0 .0 100.0 773 Fourth 86.4 4.5 9.1 .0 .0 .0 100.0 201 Richest (*) (*) (*) (*) (*) (*) 100.0 17 ethnicity of household head Macedonian 73.4 14.9 8.6 3.0 .0 .2 100.0 2167 Albanian 81.1 11.5 4.9 2.0 .0 .5 100.0 2342 Other 75.1 7.3 4.9 12.3 .5 .0 100.0 448 Total 77.2 12.6 6.5 3.3 .0 .3 100.0 4957 (*) – figures based on less than 25 unweighted cases 47 solid fuel use – Roma settlements table ch.9R: solid fuel use percent distribution of household members according to type of cooking fuel used by the household, and percent- age of household members living in households using solid fuels for cooking, Roma settlements, 2011 Percentage of household members in households using: Nu m be r o f h ou se ho ld m em be rs El ec tri cit y Pe tro le um Bi og as Solid fuels Ot he r f ue l M iss in g No fo od co ok ed in th e ho us eh ol d To ta l So lid fu el s f or co ok in g1 Ch ar co al W oo d St ra w, sh ru bs , gr as s education of household head None 63.1 .0 .0 .0 34.6 2.1 .0 .0 .2 100.0 36.7 593 Primary 61.9 1.8 .0 .0 36.3 .0 .0 .0 .0 100.0 36.3 2887 Secondary+ 79.4 3.4 .0 .0 17.2 .0 .0 .0 .0 100.0 17.2 749 Wealth index quintiles Poorest 41.8 .1 .0 .0 56.6 1.5 .0 .0 .1 100.0 58.0 845 Second 58.4 1.0 .0 .0 40.6 .0 .0 .0 .0 100.0 40.6 842 Middle 63.1 1.7 .0 .0 35.2 .0 .0 .0 .0 100.0 35.2 848 Fourth 74.4 1.1 .0 .0 24.5 .0 .0 .0 .0 100.0 24.5 845 Richest 88.2 5.1 .0 .0 6.7 .0 .0 .0 .0 100.0 6.7 848 Total 65.2 1.8 .0 .0 32.7 .3 .0 .0 .0 100.0 33.0 4229 1 MICS indicator 3.11 Overall, a third (33 percent) of all households in Roma settlements in Macedonia use solid fuels for cooking. Use of solid fuels is very low in the richest households (7 percent) and high in the poorest households, where more than half of the households (58 percent) use solid fuels. Differentials with respect to the educational level of the household head are also considerable with more educated household heads using less solid fuels. The table also shows that the overall percentage is high (33 percent) due to the common use of wood for cooking purposes Solid fuel use alone is a poor proxy for indoor air pollution, since the concentration of the pollutants is different when the same fuel is burnt in different stoves or fires. Use of closed stoves with chimneys minimizes indoor pollution, while an open stove or fire with no chimney or hood means there is no protection from the harmful effects of solid fuels. Solid fuel use by place of cooking is depicted in Table CH.10R. In most Roma households, solid fuel is used for cooking in a separate room, such as a kitchen (75 percent). In 11 percent of households solid fuel is used elsewhere in the house, 9 percent outdoors, and 4 percent in a separate building. This distribution is similar throughout the country despite differences by wealth index of households and the education of the household head. 47 48 MultIple IndIcator cluster survey 2011 table ch.10R: solid fuel use by place of cooking percent distribution of household members in households using solid fuels by place of cooking, Roma settle- ments, 2011 Place of cooking: Nu m be r o f h ou se ho ld m em be rs in ho us eh ol ds u sin g so lid fu el s f or co ok in g In a se pa ra te ro om u se d as kit ch en El se w he re in th e ho us e In a se pa ra te bu ild in g Ou td oo rs At a no th er p la ce M iss in g To ta l education of household head None 72.7 9.0 8.3 8.3 1.7 .0 100.0 218 Primary 74.0 11.9 3.8 9.7 .0 .5 100.0 1048 Secondary+ 87.4 6.2 .0 .4 6.0 .0 100.0 129 Wealth index quintiles Poorest 58.7 13.7 9.1 16.1 2.3 .0 100.0 491 Second 83.3 4.1 2.6 10.1 .0 .0 100.0 342 Middle 88.8 8.9 .0 2.3 .0 .0 100.0 299 Fourth 83.1 11.9 2.2 .0 .0 2.7 100.0 207 Richest 65.8 34.2 .0 .0 .0 .0 100.0 57 Total 75.1 10.9 4.2 8.6 .8 .4 100.0 1395 48 MultIple IndIcator cluster survey 2011 49 child disability One of the World Fit for Children goals is to protect children against abuse, exploitation, and violence, including the elimination of discrimination against children with disabilities. In Macedonia there is a national preventive programme for mother and child health care and a programme for check-ups (including medical assessments) for school children. Disability assessment was conducted in two stages. In the first stage, a standard MICS module was used, asking mothers/caretakers of all children age 2 through 9 years, to assess a number of disabilities/impairments, such as sight impairment, deafness, and difficulties with speech. This approach rests in the concept of functional disability developed by WHO and aims to identify the implications of any impairment or disability for the development of the child (e.g. health, nutrition, education). The results from this stage were used for selecting children to be included in the second stage. All children that were assessed as positive (having at least one impairment) in the first stage, as well as an additional 10 percent of children whose mothers/care takers reported no impairment, were included and randomly selected in the survey. The second stage assessment took place in October- November 2011. Eleven teams were trained in September 2011 to conduct the medical assessment. Each team was composed of four members: pediatrician, ophthalmologist, audiologist and psychologist. Data collection was organized in kindergartens. Kindergartens provided a relaxed and friendly atmosphere where the child could be examined and observed with less stress and better reactions from both the children and parents. Health facilities could provoke negative reactions in children, while day care centers could increase refusal rate from parents who may be more reluctant to bring the child to that type of institution (In Macedonia, day care centers are for children with disabilities). All parents were contacted prior to the commencement of screening and informed of the procedure, date, etc. Overall, the response rate was 80 percent (85 percent for children with disabilities and 74 percent of those with no disability). Screening was scheduled to take place during the weekends. It was easier to convince parents to bring the child during the weekends as they were not working and generally had more time to participate in the process. Additionally, kindergartens were available during the weekends, which is not always the case for workdays. The following data collection tools were used for the screening: 1. Medical Assessment Form – used for collecting data on the child’s health status and on presence of physical impairment; 2. Psychological Development Test – for assessing the mental status/disability; 3. Sleeping assessment – for collecting data on sleeping problems; 4. M-Chat – used for checking the presence of autism; 5. ADHD Rating Scale – used for checking the presence of the Attention Deficit Hyperactivity Disorder. Medical Assessment Form and Psychological Development Test were used for all children; other instruments were administered only to the children for which there were an indication that the presence of the specific condition is possible. At the time of this report’s publication, the analysis of the data collected in the second stage assessment was still in process. As such, the results will be presented in a separate report on child disabilities. 50 MultIple IndIcator cluster survey 2011 vii WateR and sanitation Safe drinking water is a basic necessity for good health. Unsafe drinking water can be a significant carrier of diseases and/or can be tainted with chemical, physical and radiological contaminants with harmful effects on human health. In addition to its association with disease, access to drinking water may be particularly important for women and children, especially in rural areas, who bear the primary responsibility for carrying water, often for long distances. The MDG goal (7, C) is to reduce by half, between 1990 and 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation. The World Fit for Children goal calls for a reduction in the proportion of households without access to hygienic sanitation facilities and affordable and safe drinking water by at least one-third. The list of indicators used in MICS is as follows: Water „ Use of improved drinking water sources „ Use of adequate water treatment method „ Time to source of drinking water „ Person collecting drinking water Sanitation „ Use of improved sanitation „ Sanitary disposal of child’s faeces For more details on water and sanitation and to access some reference documents, please visit the UNICEF’s website at www.chilinfo.org/wes.html. Use of Improved Water sources The distribution of the population by main source of drinking water is shown in Table WS.1 and Figure WS.1. The population using improved sources of drinking water are those using any of the following types of supply: piped water (into dwelling, compound, yard or plot, to neighbour, public tap/standpipe), tubewell/borehole, protected well, protected spring and rainwater collection. Bottled water is considered as an improved water source only if the household is using an improved water source for hand washing and cooking. 51 table Ws.1: use of improved water sources percent distribution of household population according to main source of drinking water and percentage of house- hold population using improved drinking water sources, Macedonia, 2011 Main source of drinking water To ta l Pe rc en ta ge u sin g im pr ov ed so ur ce s o f d rin kin g w at er 1 Nu m be r o f h ou se ho ld m em be rs Improved sources Unimproved sources Piped water Tu be -w el l/ bo re -h ol e Pr ot ec te d w el l Pr ot ec te d sp rin g Bo ttl ed w at er Un pr ot ec te d w el l Un pr ot ec te d sp rin g In to d w el lin g In to ya rd /p lo t To n ei gh bo r Pu bl ic ta p/ st an d- pi pe Region Vardar 76.1 .9 .0 2.4 .8 8.3 5.1 6.4 .0 .0 100.0 100.0 1064 East 89.6 .5 .1 .0 .2 1.7 4.9 2.6 .3 .0 100.0 99.7 1235 Southwest 94.1 .1 .1 .4 .0 2.3 1.2 1.4 .0 .2 100.0 99.8 1337 Southeast 86.0 3.6 .0 .0 4.6 .4 .0 3.0 1.4 1.0 100.0 97.6 1293 Pelagonia 85.8 .4 .0 .0 2.2 1.1 3.9 6.6 .0 .0 100.0 100.0 1957 Polog 94.0 .0 .0 .1 1.6 1.0 1.5 1.5 .0 .3 100.0 99.7 2059 Northeast 70.1 .0 .0 4.1 3.0 14.6 4.5 2.6 .0 1.0 100.0 99.0 1466 Skopje 87.7 1.5 .3 .2 .0 1.0 2.7 6.4 .1 .1 100.0 99.8 4353 area Urban 91.3 .1 .0 .3 .1 .5 .9 6.6 .0 .0 100.0 100.0 8202 Rural 80.1 1.9 .2 1.1 2.7 6.1 5.3 1.4 .4 .6 100.0 99.0 6562 education of household head Primary or less 84.1 1.6 .3 .8 2.2 3.9 4.9 1.3 .3 .6 100.0 99.1 6047 Secondary 88.3 .6 .0 .6 .9 2.9 1.9 4.7 .1 .1 100.0 99.9 6143 High 87.0 .1 .0 .6 .1 1.3 .4 10.4 .0 .1 100.0 99.9 2569 Wealth index quintile Poorest 72.0 3.9 .5 2.5 3.0 7.7 8.7 .3 .7 .7 100.0 98.6 2955 Second 87.3 .7 .1 .2 2.4 4.8 2.7 .9 .2 .7 100.0 99.2 2950 Middle 93.4 .0 .0 .3 .9 1.0 1.9 2.3 .0 .0 100.0 100.0 2953 Fourth 93.4 .0 .0 .1 .1 1.0 .7 4.7 .0 .0 100.0 100.0 2950 Richest 85.6 .0 .0 .2 .0 .5 .3 13.4 .0 .0 100.0 100.0 2955 ethnicity of household head Macedonian 86.9 .8 .0 .8 1.5 2.0 2.3 5.3 .2 .2 100.0 99.6 9537 Albanian 86.5 1.1 .4 .4 .8 5.3 3.8 1.1 .1 .6 100.0 99.3 4040 Other 81.1 1.2 .1 .6 1.8 3.6 4.2 7.2 .2 .0 100.0 99.8 1182 Total 86.3 .9 .1 .7 1.3 3.0 2.9 4.3 .2 .3 100.0 99.6 14764 1 MICS indicator 4.1; MDG indicator 7.8 Overall, 99.6 percent of the population is using an improved source of drinking water – 100 percent in urban areas and 99 percent in rural areas. 52 MultIple IndIcator cluster survey 2011 Table WS.1 shows that the source of drinking water for the population varies strongly by region. In both the Southwest and Polog regions, 94 percent of the population uses drinking water that is piped into their dwelling. In contrast, only 76 percent of those residing in Vardar and 70 percent of those in Northeast have piped water into the dwelling. In Vardar and Northeast, the second most important source of drinking water is a protected well, while in Pelagonia and Skopje it is bottled water. Use of household water treatment is presented in Table WS.2. Households were asked of ways they may be treating water at home to make it safer to drink. Boiling water, adding bleach or chlorine, using a water filter, and using solar disinfection are considered as appropriate means for the proper treament of drinking water. 2 percent of household members living in households with unimproved water sources use appropriate water treatment methods (the respective column is not presented in the table due to the small number of unweighted cases by background characteristics). table Ws.2: household water treatment percentage of household population by drinking water treatment method used in the household, and for house- hold members living in households where an unimproved drinking water source is used, the percentage who are using an appropriate treatment method, Macedonia, 2011 Water treatment method used in the household Nu m be r o f ho us eh ol d m em be rs No ne Bo il Ad d bl ea ch / ch lo rin e St ra in th ro ug h a clo th Us e w at er fil te r So la r d is- in fe ct io n Le t i t s ta nd an d se ttl e Ot he r Region Vardar 98.0 .5 .2 .2 1.2 .0 .1 .0 1064 East 95.6 2.5 .0 .0 1.3 .0 .1 .6 1235 Southwest 92.2 5.3 .3 .0 1.7 .0 .3 .0 1337 Southeast 95.1 3.9 .0 .8 .5 .0 .2 .2 1293 Pelagonia 93.0 5.6 .0 .5 1.2 .0 .2 .5 1957 Polog 92.2 4.2 .0 2.6 2.0 .0 .2 .1 2059 Northeast 97.5 2.5 .0 .1 .3 .0 .0 .0 1466 Skopje 94.8 1.6 .0 .3 2.8 .0 .4 .8 4353 area Urban 94.8 2.3 .0 .0 2.4 .0 .0 .4 8202 Rural 94.2 4.1 .1 1.4 .8 .0 .4 .3 6562 education of household head Primary or less 95.9 2.9 .0 1.1 .5 .0 .3 .3 6047 Secondary 93.8 3.5 .1 .4 2.2 .0 .1 .4 6143 High 93.0 2.8 .0 .1 3.4 .0 .4 .7 2569 Wealth index quintile Poorest 95.4 3.6 .2 1.5 .2 .0 .5 .4 2955 Second 94.2 4.5 .0 1.1 .6 .0 .1 .0 2950 Middle 95.8 3.0 .0 .5 .7 .0 .2 .2 2953 Fourth 95.0 2.7 .0 .1 2.2 .0 .2 .3 2950 Richest 92.2 1.8 .0 .0 4.7 .0 .0 1.0 2955 ethnicity of household head Macedonian 94.5 3.0 .0 .2 2.2 .0 .1 .4 9537 Albanian 95.0 2.8 .0 1.5 .7 .0 .5 .4 4040 Other 93.1 5.3 .3 .7 1.2 .0 .3 .4 1182 Total 94.5 3.1 .0 .6 1.7 .0 .2 .4 14764 53 Table WS.3 presents the amount of time it takes to obtain water, and Table WS.4 shows who usually collected the water. These results refer to one round trip from home to drinking water source. Information on the number of trips made in one day was not collected. Table WS.3 shows that for 97 percent of the population live in households with drinking water source on the premises. For 1.6 percent of household population, it takes less than 30 minutes to get to the water source and bring water, while 0.5 percent of population spend 30 minutes or more for this purpose. One striking finding is the high percentage of households spending 30 minutes or more to go to the source of drinking water in Vardar region (3 percent). 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, Macedonia, 2011 Time to source of drinking water To ta l Users of improved drinking water sources Users of unimproved drinking water sources Nu m be r o f h ou se ho ld m em be rs W at er o n pr em ise s Le ss th an 3 0 m in ut es 30 m in ut es o r m or e M iss in g/ DK W at er o n pr em ise s Le ss th an 3 0 m in ut es 30 m in ut es o r m or e Region Vardar 89.9 7.3 2.6 .3 .0 .0 .0 100.0 1064 East 98.4 .5 .3 .4 .0 .3 .0 100.0 1235 Southwest 98.0 1.5 .0 .3 .0 .2 .0 100.0 1337 Southeast 97.0 .4 .0 .1 .0 2.4 .0 100.0 1293 Pelagonia 95.8 2.0 1.4 .8 .0 .0 .0 100.0 1957 Polog 99.4 .0 .3 .1 .3 .0 .0 100.0 2059 Northeast 93.8 4.2 .2 .8 .0 .0 1.0 100.0 1466 Skopje 99.1 .5 .0 .2 .1 .1 .0 100.0 4353 area Urban 98.5 .9 .4 .3 .0 .0 .0 100.0 8202 Rural 95.5 2.5 .6 .4 .1 .7 .2 100.0 6562 education of household head Primary or less 96.0 2.0 .7 .4 .1 .5 .2 100.0 6047 Secondary 97.7 1.3 .5 .4 .0 .1 .0 100.0 6143 High 98.6 1.2 .0 .1 .0 .1 .0 100.0 2569 Wealth index quintile Poorest 93.3 3.3 1.2 .9 .3 .6 .5 100.0 2955 Second 96.5 1.7 .5 .5 .0 .8 .0 100.0 2950 Middle 97.9 1.5 .3 .2 .0 .0 .0 100.0 2953 Fourth 98.8 .8 .3 .1 .0 .0 .0 100.0 2950 Richest 99.3 .6 .1 .1 .0 .0 .0 100.0 2955 ethnicity of household head Macedonian 97.1 1.5 .6 .4 .0 .4 .0 100.0 9537 Albanian 98.0 .8 .3 .3 .2 .1 .3 100.0 4040 Other 94.5 4.8 .4 .0 .0 .2 .0 100.0 1182 Total 97.2 1.6 .5 .3 .1 .3 .1 100.0 14764 54 MultIple IndIcator cluster survey 2011 Table WS.4 shows that for the majority of households (56 percent) an adult male is usually the person collecting the water when the source of drinking water is not on the premises. Adult females collect water in 41 percent of households, while male children under 15 years of age collect water in the rest of the households (2 percent). 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, Macedonia, 2011 Pe rc en ta ge o f h ou se ho ld s w ith ou t d rin kin g w at er o n pr em ise s Nu m be r o f h ou se ho ld s Person usually collecting drinking water Nu m be r o f h ou se ho ld s w ith ou t d rin kin g w at er on p re m ise s Ad ul t w om an Ad ul t m an Fe m al e ch ild u nd er ag e 15 M al e ch ild u nd er ag e 15 M iss in g/ DK To ta l area   Urban 1.6 2437 29.7 66.0 .0 4.3 .0 100.0 40 Rural 5.3 1581 47.1 51.1 .0 .9 .9 100.0 84 education of household head Primary or less 4.6 1568 47.3 49.5 .0 2.8 .3 100.0 73 Secondary 2.3 1670 32.5 65.2 .0 1.0 1.3 100.0 39 High 1.6 778 35.5 64.5 .0 .0 .0 100.0 12 ethnicity of household head Macedonian 3.2 2921 44.6 53.5 .0 1.9 .0 100.0 94 Albanian 1.7 784 36.7 51.9 .0 5.5 5.8 100.0 13 Other 5.5 310 27.6 72.4 .0 .0 .0 100.0 17 Total 3.1 4018 41.4 55.9 .0 2.0 .6 100.0 124 55 use of improved Water sources – Roma settlements The distribution of the population in Roma settlements by main source of drinking water is presented in Table WS.1R. table Ws.1R: 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, Macedonia, 2011 Main source of drinking water To ta l Pe rc en ta ge u sin g im pr ov ed so ur ce s o f d rin kin g w at er 1 Nu m be r o f h ou se ho ld m em be rs Improved sources Unimproved sources Piped water Tu be -w el l/ bo re -h ol e Pr ot ec te d w el l Bo ttl ed w at er Su rfa ce w at er (ri ve r, st re am , d am , la ke , p on d, ca na l, irr ig at io n ch an ne l Un pr ot ec te d sp rin g In to d w el lin g In to ya rd /p lo t To n ei gh bo r Pu bl ic ta p/ st an d- pi pe education of household head None 81.3 6.7 8.2 3.2 .0 .0 .0 .0 .6 100.0 99.4 593 Primary 92.4 3.0 .8 .4 1.2 .5 .5 .2 .9 100.0 98.9 2887 Secondary+ 96.8 .7 .0 .1 .0 .0 2.4 .0 .0 100.0 100.0 749 Wealth index quintile Poorest 69.2 13.1 8.4 2.6 2.8 .0 .3 .7 2.9 100.0 96.4 845 Second 91.9 2.0 .0 1.1 1.1 1.6 1.5 .0 .8 100.0 99.2 842 Middle 99.4 .3 .0 .0 .0 .3 .0 .0 .0 100.0 100.0 848 Fourth 98.9 .3 .0 .0 .0 .0 .8 .0 .0 100.0 100.0 845 Richest 98.6 .0 .0 .0 .0 .0 1.4 .0 .0 100.0 100.0 848 Total 91.6 3.1 1.7 .7 .8 .4 .8 .1 .7 100.0 99.1 4229 1 MICS indicator 4.1; MDG indicator 7.8 Overall, 99 percent of the population in Roma settlements uses an improved source of drinking water. What is noticeable from the data in Table WS.1R is that almost one in five household members (18 percent) in the poorest category does not have drinking water piped into their dwelling or yard/plot. Table WS.2R presents the use of household water treatment. 96 percent of all household members use water in the household without any treatment, while 3 percent treat water by boiling it. 55 56 MultIple IndIcator cluster survey 2011 table Ws.2R: household water treatment percentage of household population by drinking water treatment method used in the household, and for house- hold members living in households where an unimproved drinking water source is used, the percentage who are using an appropriate treatment method, Macedonia, 2011 Water treatment method used in the household Nu m be r o f ho us eh ol d m em be rs No ne Bo il Ad d bl ea ch / ch lo rin e St ra in th ro ug h a clo th Us e w at er fil te r So la r d is- in fe ct io n Le t i t st an d an d se ttl e Ot he r education of household head None 97.9 2.1 .0 .0 .0 .0 .0 .0 593 Primary 95.3 3.4 .0 .7 .1 .0 .0 .1 2887 Secondary+ 95.0 3.3 .4 .4 .8 .0 .0 .0 749 Wealth index quintile Poorest 94.3 5.1 .0 .6 .0 .0 .0 .0 845 Second 94.3 2.7 .0 1.4 .0 .0 .0 .0 842 Middle 97.3 2.2 .0 .3 .2 .0 .0 .0 848 Fourth 97.2 2.3 .0 .0 .1 .0 .0 .3 845 Richest 95.0 3.6 .3 .3 .7 .0 .0 .0 848 Total 95.6 3.2 .1 .5 .2 .0 .0 .1 4229 1 MICS indicator 4.2 The amount of time it takes to obtain water is presented in Table WS.3R and the person who usually collected the water is shown in Table WS.4R. These results refer to one round trip from home to drinking water source. Information on the number of trips made in one day was not collected. Table WS.3R shows that for 99 percent of Roma household members, the improved drinking water source is on the premises. For 0.3 percent, it takes less than 30 minutes to get to the improved water source and bring water. Only 0.7 percent of household members have unimproved drinking water source on premises while 0.2 percent spend less than 30 minutes to bring water from an unimproved source. table Ws.3R: 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, Macedonia, 2011 Time to source of drinking water To ta l Nu m be r o f h ou se ho ld m em be rs Users of improved drinking water sources Users of unimproved drinking water sources W at er on pr em ise s Le ss th an 3 0 m in ut es W at er on pr em ise s Le ss th an 3 0 m in ut es education of household head None 98.9 .4 .0 .6 100.0 593 Primary 98.5 .4 1.0 .1 100.0 2887 Secondary+ 100.0 .0 .0 .0 100.0 749 Wealth index quintile Poorest 95.9 .5 2.7 .8 100.0 845 Second 98.1 1.1 .8 .0 100.0 842 Middle 100.0 .0 .0 .0 100.0 848 Fourth 100.0 .0 .0 .0 100.0 845 Richest 100.0 .0 .0 .0 100.0 848 Total 98.8 .3 .7 .2 100.0 4229 Only 1 percent of the population in Roma settlements are without drinking water on premises. An adult woman is usually the person collecting the water when the source of drinking water is not on the premises. 56 MultIple IndIcator cluster survey 2011 57 use of improved sanitation Inadequate disposal of human excreta and personal hygiene is associated with a range of diseases including diarrhoeal diseases and polio. Improved sanitation can reduce diarrheal disease by more than a third, and can significantly lessen the adverse health impacts of other disorders responsible for death and disease among millions of children in developing countries. 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 Macedonia are provided in Tables WS.5 and WS.5R. However, sharing of sanitation facilities, even if those are improved, is assumed to compromise their safety. Therefore, “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 shared. Data on improved sanitation are presented in Tables WS.6, WS.6R, WS.8 and WS.8R in this report. In Macedonia, 94 percent of the population lives in households using improved sanitation facilities (Table WS.5) - 99.8 percent in urban areas and 88 percent in rural areas. Residents of Polog and East regions are less likely than others to use improved facilities. The most common facilities in urban areas and in the richest quintile are flush toilets with connection to a sewage system. Households with more educated household heads are more likely to use improved water sanitation facilities. table Ws.5: types of sanitation facilities percent distribution of household population according to type of toilet facility used by the household, Macedonia, 2011 Type of toilet facility used by household Op en d ef ec at io n (n o fa cil ity , b us h, fi el d) To ta l Nu m be r o f h ou se ho ld m em be rs Improved sanitation facility Unimproved sanitation facility Flush/pour flush to: Ve nt ila te d im pr ov ed p it la tri ne Pi t l at rin e w ith sl ab Co m po s- tin g to ile t Flu sh / p ou r flu sh to so m ew he re el se Pi t l at rin e w ith ou t s la b/ op en p it Ha ng in g to ile t/ ha ng in g la tri ne Ot he r M iss in g Pi pe d se w er sy st em Se pt ic ta nk Pi t l at rin e Un kn ow n pl ac e/ no t su re /D K w he re Region Vardar 83.4 1.2 .0 .0 2.0 8.5 .0 .0 4.2 .0 .6 .0 .0 100.0 1064 East 83.0 .4 .4 .9 .5 3.0 4.7 .0 3.7 .0 .4 .0 3.0 100.0 1235 Southwest 66.5 30.4 .8 .1 .1 1.1 .6 .1 .2 .0 .0 .0 .0 100.0 1337 Southeast 52.4 21.7 .0 .0 .1 19.7 .0 .0 5.7 .0 .0 .0 .4 100.0 1293 Pelagonia 81.7 4.4 1.8 .2 1.1 6.2 .0 3.3 1.0 .0 .0 .0 .3 100.0 1957 Polog 36.9 44.8 .3 .7 .0 .0 .0 16.6 .0 .0 .0 .7 .0 100.0 2059 Northeast 74.3 6.7 1.8 1.7 .9 11.0 .0 1.1 2.4 .0 .0 .0 .0 100.0 1466 Skopje 79.8 14.3 .5 .3 1.2 1.5 .0 1.1 .3 .1 .1 .0 .8 100.0 4353 area Urban 98.1 1.1 .0 .0 .2 .4 .0 .0 .1 .0 .1 .0 .0 100.0 8202 Rural 35.8 35.7 1.6 1.1 1.5 10.9 1.0 7.2 3.5 .1 .1 .2 1.3 100.0 6562 education of household head Primary or less 49.8 25.4 1.2 1.0 1.5 8.8 1.0 6.7 3.0 .0 .2 .2 1.1 100.0 6047 Secondary 82.6 11.2 .5 .1 .4 3.1 .1 .7 .9 .1 .0 .0 .3 100.0 6143 High 90.1 7.9 .1 .1 .0 .8 .1 .9 .0 .0 .0 .0 .0 100.0 2569 Wealth index quintile Poorest 20.7 29.4 1.9 1.8 3.2 18.1 2.1 11.7 7.7 .1 .5 .0 2.9 100.0 2955 Second 60.3 27.7 1.4 .5 .6 5.5 .0 3.4 .3 .0 .0 .3 .0 100.0 2950 Middle 81.5 15.6 .3 .1 .1 1.5 .1 .8 .0 .0 .0 .0 .0 100.0 2953 Fourth 91.5 8.2 .0 .0 .0 .0 .0 .1 .0 .0 .0 .2 .0 100.0 2950 Richest 98.3 1.6 .0 .0 .0 .1 .0 .1 .0 .0 .0 .0 .0 100.0 2955 ethnicity of household head Macedonian 79.2 9.4 .3 .1 .9 6.6 .6 .3 2.1 .0 .0 .0 .5 100.0 9537 Albanian 48.1 34.8 1.7 1.4 .1 1.4 .0 10.9 .1 .0 .2 .3 .9 100.0 4040 Other 76.2 11.4 .4 .0 1.7 5.2 1.0 .5 2.7 .0 .6 .0 .3 100.0 1182 Total 70.4 16.5 .7 .5 .8 5.0 .4 3.2 1.6 .0 .1 .1 .6 100.0 14764 58 MultIple IndIcator cluster survey 2011 The MDGs and the WHO / UNICEF Joint Monitoring Programme ( JMP) for Water Supply and Sanitation classify households as using an unimproved sanitation facility if they are using otherwise acceptable sanitation facilities but sharing a facility between two or more households or using a public toilet facility. As shown in Table WS.6, 94 percent of the household population are using an improved sanitation facility with 1 percent of them sharing the facility with other household. 5 percent of the household members use unimproved sanitation, and 0.1 percent of them share it with other households. table Ws.6: use and sharing of sanitation facilities percent distribution of household population by use of private and public sanitation facilities and use of shared facilities, by users of improved and unimproved sanitation facilities, Macedonia, 2011 Users of improved sanitation facilities Users of unimproved sanitation facilities Op en d ef ec at io n (n o fa cil ity , bu sh , fi el d) To ta l Nu m be r o f h ou se ho ld m em be rs No t s ha re d 1 Pu bl ic fa cil ity Shared by No t s ha re d Shared by M iss in g/ DK 5 ho us eh ol ds o r le ss M or e th an 5 ho us eh ol ds 5 ho us eh ol ds o r le ss M or e th an 5 ho us eh ol ds Region Vardar 93.1 .0 2.0 .0 3.2 1.4 .0 .3 .0 100.0 1064 East 88.5 .0 4.4 .0 3.8 .3 .0 .0 3.0 100.0 1235 Southwest 98.0 1.0 .0 .7 .3 .0 .0 .0 .0 100.0 1337 Southeast 92.7 .0 1.1 .0 5.7 .0 .0 .0 .4 100.0 1293 Pelagonia 94.1 .7 .6 .0 4.4 .0 .0 .0 .3 100.0 1957 Polog 81.4 .2 1.0 .1 17.3 .0 .0 .0 .0 100.0 2059 Northeast 94.1 .4 .9 1.0 3.5 .0 .0 .0 .0 100.0 1466 Skopje 97.1 .0 .5 .0 1.6 .0 .0 .0 .8 100.0 4353 area Urban 98.9 .1 .7 .1 .1 .1 .0 .0 .0 100.0 8202 Rural 85.4 .4 1.5 .3 10.9 .2 .0 .0 1.3 100.0 6562 education of household head Primary or less 85.9 .5 1.8 .4 9.9 .2 .0 .0 1.1 100.0 6047 Secondary 97.3 .0 .7 .0 1.7 .1 .0 .0 .3 100.0 6143 High 98.8 .2 .1 .0 .9 .0 .0 .0 .0 100.0 2569 Wealth index quintile Poorest 72.4 .5 3.6 .6 19.5 .5 .0 .1 2.9 100.0 2955 Second 94.1 .5 1.0 .3 3.9 .1 .0 .0 .0 100.0 2950 Middle 98.6 .2 .4 .0 .8 .0 .0 .0 .0 100.0 2953 Fourth 99.5 .0 .3 .0 .3 .0 .0 .0 .0 100.0 2950 Richest 99.9 .0 .0 .0 .1 .0 .0 .0 .0 100.0 2955 ethnicity of household head Macedonian 96.0 .1 .9 .1 2.3 .1 .0 .0 .5 100.0 9537 Albanian 86.1 .5 .6 .4 11.6 .0 .0 .0 .9 100.0 4040 Other 90.9 .6 4.2 .2 2.9 .7 .0 .2 .3 100.0 1182 Total 92.9 .2 1.1 .2 4.9 .1 .0 .0 .6 100.0 14764 1 MICS indicator 4.3; MDG indicator 7.9 59 Safe disposal of a child’s faeces is disposing of the stool, by the child using a toilet or by rinsing the stool into a toilet or latrine. Disposal of faeces of children 0-2 years of age is presented in Table WS.7. The most common place to dispose a child’s faeces is in the garbage as solid waste (80 percent of households), while 10 percent of children use toilet/latrine, and 7 percent put/rinse the faeces into toilet or latrine. 17 percent of children had their last stools disposed of safely. There are differences by regions in the percentage of children using toilet/ latrine; for example, the percentage is three times more in Skopje (15 percent) than in Polog (5 percent). table Ws.7: 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, Macedonia, 2011 Place of disposal of child’s faeces Pe rc en ta ge o f ch ild re n w ho se la st st oo ls w er e di sp os ed o f sa fe ly1 Nu m be r o f ch ild re n ag e 0- 2 ye ar s Ch ild u se d to ile t/l at rin e Pu t/r in se d in to to ile t o r l at rin e Pu t/r in se d in to dr ai n or d itc h Th ro w n in to ga rb ag e Bu rie d Le ft in th e op en Ot he r DK M iss in g To ta l Type of sanitation facility in dwelling Improved 10.3 7.6 1.1 79.8 .2 .2 .3 .1 .6 100.0 17.9 730 Unimproved (4.1) (2.9) (5.9) (85.7) (.0) (1.4) (.0) (.0) (.0) 100.0 (6.9) 80 Open defacation (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 6 Region Vardar 10.7 8.1 .0 81.1 .0 .0 .0 .0 .0 100.0 18.9 50 East 5.4 20.5 1.0 67.3 .0 5.7 .0 .0 .0 100.0 26.0 60 Southwest 8.6 23.8 .0 62.5 .0 .0 .0 .7 4.4 100.0 32.4 74 Southeast 7.6 12.0 .9 75.0 2.6 .0 1.9 .0 .0 100.0 19.6 49 Pelagonia 10.3 3.2 1.1 85.4 .0 .0 .0 .0 .0 100.0 13.5 98 Polog 5.0 6.5 2.1 85.9 .0 .0 .0 .0 .5 100.0 11.5 154 Northeast 10.1 .0 2.0 87.9 .0 .0 .0 .0 .0 100.0 10.1 78 Skopje 15.2 1.9 2.2 80.1 .0 .0 .5 .0 .0 100.0 17.2 253 area Urban 11.1 8.0 .8 79.9 .0 .0 .2 .0 .0 100.0 19.1 417 Rural 9.2 6.1 2.3 79.7 .3 .9 .3 .1 1.0 100.0 15.3 398 Mother’s education Primary or less 12.1 6.2 2.6 77.2 .0 1.1 .4 .2 .3 100.0 18.3 323 Secondary 9.3 8.4 .8 81.2 .4 .0 .0 .0 .0 100.0 17.6 300 High 8.4 6.5 1.0 82.0 .0 .0 .5 .0 1.6 100.0 14.9 192 Wealth index quintile Poorest 10.6 8.0 4.2 74.6 .0 1.8 .7 .0 .1 100.0 18.6 190 Second 15.4 5.2 .2 77.5 .8 .0 .0 .3 .5 100.0 20.6 153 Middle 8.4 13.3 1.3 76.4 .0 .0 .6 .0 .0 100.0 21.7 153 Fourth 6.8 3.2 .9 87.2 .0 .0 .0 .0 1.9 100.0 10.0 158 Richest 9.6 5.8 .6 84.0 .0 .0 .0 .0 .0 100.0 15.4 161 ethnicity of household head Macedonian 8.8 10.1 1.2 79.4 .3 .0 .2 .0 .0 100.0 18.9 406 Albanian 12.2 2.6 2.1 81.7 .0 .0 .0 .2 1.3 100.0 14.7 314 Other 9.2 9.4 1.4 75.1 .0 3.6 1.4 .0 .0 100.0 18.5 95 Total 10.2 7.1 1.5 79.8 .2 .4 .3 .1 .5 100.0 17.3 815 1 MICS indicator 4.4 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases 60 MultIple IndIcator cluster survey 2011 In its 2008 report18, the WHO/UNICEF Joint Monitoring Programme (JMP) developed a new way of presenting the access figures- by disaggregating and refining the data on drinking-water and sanitation and reflecting them in “ladder” format. This ladder allows a disaggregated analysis of trends in a three rung ladder for drinking water and a four-rung ladder for sanitation. For sanitation, this gives an understanding of the proportion of population with no sanitation facilities at all, 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.8 presents the percentages of household members by drinking water and sanitation ladders. The table also shows the percentage of household members using improved sources of drinking water and sanitary means of excreta disposal. Overall, as presented in Table WS.8, more 18 WHO/UNICEF JMP (2008), MDG assessment report - http://www.wssinfo.org/fileadmin/user_upload/resources/1251794333-JMP_08_en.pdf than 90 percent of the population in the country use both improved water sources and sanitation. Of all households, 99.6 percent use improved drinking water, 93 percent use improved sanitation, while 93 percent use improved drinking water sources and improved sanitation. However, more detailed analysis reveals disparities between the poorest quintile and the rest of the population in the national sample. Approximately, almost 30 percent of the poorest households do not have access to improved water sources and/or sanitation, unlike the rest of population where over 90 percent have access to these two commodities. Urban households and households from richest quintile are more likely to use improved drinking water sources and improved sanitation. There are differences by regions, education and ethnicity similar to those presented in the tables above. table Ws.8: drinking water and sanitation ladders percentage of household population by drinking water and sanitation ladders, Macedonia, 2011 Percentage of household population using: Nu m be r o f ho us eh ol d m em be rs Improved drinking water1 Un im pr ov ed dr in kin g w at er To ta l Im pr ov ed sa ni ta tio n2 Unimproved sanitation To ta l Im pr ov ed d rin kin g w at er so ur ce s an d im pr ov ed sa ni ta tio n Pi pe d in to dw el lin g, pl ot o r y ar d Ot he r im pr ov ed Sh ar ed im pr ov ed fa cil iti es Un im pr ov ed fa cil iti es Op en de fe ca tio n Region Vardar 83.4 16.6 .0 100.0 93.1 2.0 4.9 .0 100.0 93.1 1064 East 92.8 6.9 .3 100.0 88.5 4.4 4.1 3.0 100.0 88.5 1235 Southwest 95.5 4.2 .2 100.0 98.0 1.7 .3 .0 100.0 97.7 1337 Southeast 92.6 5.0 2.4 100.0 92.7 1.1 5.7 .4 100.0 90.3 1293 Pelagonia 92.7 7.3 .0 100.0 94.1 1.2 4.4 .3 100.0 94.1 1957 Polog 95.6 4.2 .3 100.0 81.4 1.3 17.3 .0 100.0 81.2 2059 Northeast 72.3 26.7 1.0 100.0 94.1 2.3 3.5 .0 100.0 94.1 1466 Skopje 95.5 4.3 .2 100.0 97.1 .5 1.6 .8 100.0 96.9 4353 area Urban 98.1 1.9 .0 100.0 98.9 .9 .2 .0 100.0 98.9 8202 Rural 83.3 15.7 1.0 100.0 85.4 2.2 11.2 1.3 100.0 84.7 6562 education of household head Primary or less 87.0 12.1 .9 100.0 85.9 2.8 10.2 1.1 100.0 85.4 6047 Secondary 93.4 6.4 .1 100.0 97.3 .7 1.7 .3 100.0 97.1 6143 High 97.5 2.4 .1 100.0 98.8 .3 .9 .0 100.0 98.7 2569 Wealth index quintile Poorest 76.0 22.6 1.4 100.0 72.4 4.7 20.0 2.9 100.0 71.7 2955 Second 88.7 10.5 .8 100.0 94.1 1.9 4.0 .0 100.0 93.3 2950 Middle 95.7 4.3 .0 100.0 98.6 .6 .8 .0 100.0 98.6 2953 Fourth 98.1 1.9 .0 100.0 99.5 .3 .3 .0 100.0 99.5 2950 Richest 98.9 1.1 .0 100.0 99.9 .0 .1 .0 100.0 99.9 2955 ethnicity of household head Macedonian 93.1 6.6 .4 100.0 96.0 1.0 2.4 .5 100.0 95.7 9537 Albanian 88.6 10.8 .7 100.0 86.1 1.5 11.6 .9 100.0 85.8 4040 Other 88.9 10.9 .2 100.0 90.9 5.1 3.8 .3 100.0 90.8 1182 Total 91.5 8.1 .4 100.0 92.9 1.5 5.0 .6 100.0 92.6 14764 1 MICS indicator 4.1; MDG indicator 7.8 2 MICS indicator 4.3; MDG indicator 7.9 61 use of improved sanitation – Roma settlements open pit (14 percent). In contrast, the most common facilities in the richest quintile are flush toilets with connection to a sewage system (97 percent) or septic tank (3 percent). Households with more educated household heads are more likely to use improved water sanitation facilities. table Ws.5R: types of sanitation facilities percent distribution of household population according to type of toilet facility used by the household, Roma settlements, 2011 Type of toilet facility used by household Op en d ef ec at io n (n o fa cil ity , b us h, fie ld ) To ta l Nu m be r o f h ou se ho ld m em be rs Improved sanitation facility Unimproved sanitation facility Flush/pour flush to: Ve nt ila te d im pr ov ed pi t l at rin e Pi t l at rin e w ith sl ab Flu sh / p ou r fl us h to so m ew he re e lse Pi t l at rin e w ith ou t sla b/ o pe n pi t Ot he r Pi pe d se w er sy st em Se pt ic ta nk Pi t l at rin e Un kn ow n pl ac e/ no t s ur e/ DK w he re education of household head None 59.0 6.1 .0 .6 5.7 14.2 2.2 9.0 2.5 .7 100.0 593 Primary 78.9 3.4 .5 .3 3.9 8.0 .7 2.6 1.6 .1 100.0 2887 Secondary+ 93.3 3.4 .0 .0 1.1 1.4 .0 .0 .8 .0 100.0 749 Wealth index quintile Poorest 32.6 3.2 1.0 .8 12.0 27.2 1.8 13.5 7.2 .7 100.0 845 Second 75.8 5.7 .6 .6 5.6 8.0 1.9 1.7 .2 .0 100.0 842 Middle 90.9 4.5 .0 .0 .7 2.8 .3 .0 .8 .0 100.0 848 Fourth 96.4 3.0 .0 .0 .0 .6 .0 .0 .0 .0 100.0 845 Richest 97.4 2.6 .0 .0 .0 .0 .0 .0 .0 .0 100.0 848 Total 78.7 3.8 .3 .3 3.7 7.7 .8 3.0 1.6 .1 100.0 4229 As shown in Table WS.6R, 94 percent of the Roma household population is using an improved sanitation facility. Use of a facility not shared is more common among household members using an unimproved facility. 3 percent of household members use an improved toilet facility that is shared with other households. Poorest households are more likely than richest households to use a shared improved toilet facility (8 percent and 0 percent respectively). The highest use of an unshared improved sanitation is among households in which the head has secondary education (98 percent, as compared to those with no education at 82 percent). 0.1 percent of all interviewed Roma household members do not have a sanitation facility and use open defecation (bush, field etc.). 61 In Macedonia, 94 percent of Roma population is living in households using improved sanitation facilities. Table WS.5R indicates that use of improved sanitation facilities is strongly correlated with the wealth index. In the poorest quintile, only 33 percent of the Roma population uses flush to piped sewer system, pit latrines with slabs (27 percent), or pit latrines without slab / 62 MultIple IndIcator cluster survey 2011 table Ws.6R: 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, Roma settlements, 2011 Users of improved sanitation facilities Users of unimproved sanitation facilities Op en d ef ec at io n (n o fa cil ity , b us h, fie ld ) To ta l Nu m be r o f ho us eh ol d m em be rs No t s ha re d 1 Pu bl ic fa cil ity Shared by No t s ha re d Shared by M iss in g/ DK 5 ho us eh ol ds or le ss DK /M iss in g 5 ho us eh ol ds or le ss M or e th an 5 ho us eh ol ds education of household head None 82.1 .0 3.5 .0 11.0 2.8 .0 .0 .7 100.0 593 Primary 91.3 .3 3.0 .5 4.0 1.0 .0 .0 .1 100.0 2887 Secondary+ 97.7 .4 1.1 .0 .7 .2 .0 .0 .0 100.0 749 Wealth index quintile Poorest 69.2 .0 7.6 .0 17.5 5.1 .0 .0 .7 100.0 845 Second 93.2 .0 3.1 .0 3.3 .4 .0 .0 .0 100.0 842 Middle 95.5 .0 1.8 1.6 1.1 .0 .0 .0 .0 100.0 848 Fourth 98.9 .0 1.1 .0 .0 .0 .0 .0 .0 100.0 845 Richest 98.7 1.3 .0 .0 .0 .0 .0 .0 .0 100.0 848 Total 91.1 .3 2.7 .3 4.4 1.1 .0 .0 .1 100.0 4229 1 MICS indicator 4.3; MDG indicator 7.9 Safe disposal of a child’s faeces is disposing of the stool, by the child using a toilet, or by rinsing the stool into a toilet or latrine. Disposal of faeces of children 0-2 years of age is presented in Table WS.7R. The most common place to dispose a child’s faeces is in the garbage as solid waste (74 percent of households), and put/rinsed into a toilet or latrine (17 percent of households). 8 percent of children use a toilet/latrine. 25 percent of children had their last stools disposed of safely. table Ws.7R: 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, Roma settle- ments, 2011 Place of disposal of child’s faeces Pe rc en ta ge of ch ild re n w ho se la st st oo ls w er e di sp os ed o f sa fe ly1 Nu m be r o f ch ild re n ag e 0- 2 ye ar s Ch ild u se d to ile t/ la tri ne Pu t/r in se d in to to ile t or la tri ne Pu t/r in se d in to d ra in o r di tc h Th ro w n in to ga rb ag e M iss in g To ta l Type of sanitation facility in dwelling Improved 8,1 18,1 ,8 72,1 ,8 100.0 26,2 262 Unimproved (*) (*) (*) (*) (*) (*) (*) 16 Mother’s education None 6,4 10,3 2,3 79,8 1,3 100.0 16,7 64 Primary 9,0 19,3 ,4 70,5 ,7 100.0 28,3 183 Secondary+ (4,2) (17,8) (,0) (77,9) (,0) 100.0 (22,1) 32 Wealth index quintile Poorest 3.1 18.2 .0 77.8 .9 100.0 21.3 68 Second 13.0 13.3 2.0 71.7 .0 100.0 26.2 70 Middle 7.5 17.3 .5 73.2 1.5 100.0 24.8 50 Fourth 10.4 22.4 1.1 64.3 1.7 100.0 32.8 46 Richest (5.1) (15.5) (.0) (79.4) (.0) 100.0 (20.6) 44 Total 7,9 17,1 ,8 73,5 ,8 100.0 25,0 278 1 MICS indicator 4.4 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases 62 MultIple IndIcator cluster survey 2011 63 Table WS.8R presents the percentages of household population by drinking water and sanitation ladders. The table also shows the percentage of household members using improved sources of drinking water and sanitary means of excreta disposal. Overall, as presented in Table WS.8R, more than 90 percent of the Roma population in the country use both improved water sources and sanitation. Of all household members, 99 percent use improved drinking water, 91 percent use improved sanitation, while 91 percent use improved drinking water sources and improved sanitation. However, more detailed analysis reveals disparities between the poorest quintile and the rest of the population in the Roma sample. Almost one third of population in the poorest households do not have access to improved water sources and/or sanitation, unlike the rest of population where over 90 percent have access to these two commodities. table Ws.8R: drinking water and sanitation ladders percentage of household population by drinking water and sanitation ladders, Roma settlements, 2011 Percentage of household population using: Nu m be r o f h ou se ho ld m em be rs Improved drinking water1 Un im pr ov ed d rin kin g w at er To ta l Im pr ov ed sa ni ta tio n2 Unimproved sanitation To ta l Im pr ov ed d rin kin g w at er so ur ce s a nd im pr ov ed sa ni ta tio n Pi pe d in to dw el lin g, p lo t o r ya rd Ot he r i m pr ov ed Sh ar ed im pr ov ed fa cil iti es Un im pr ov ed fa cil iti es Op en d ef ec at io n education of household head None 88,0 11,4 ,6 100,0 82,1 3,5 13,8 ,7 100,0 81,6 593 Primary 96,0 2,9 1,1 100,0 91,3 3,7 5,0 ,1 100,0 90,9 2887 Secondary+ 99,9 ,1 ,0 100,0 97,7 1,5 ,8 ,0 100,0 97,7 749 Wealth index quintile Poorest 82.7 13.8 3.6 100,0 69.2 7.6 22.5 .7 100,0 67.5 845 Second 95.4 3.8 .8 100,0 93.2 3.1 3.7 .0 100,0 93.2 842 Middle 99.7 .3 .0 100,0 95.5 3.4 1.1 .0 100,0 95.5 848 Fourth 100.0 .0 .0 100,0 98.9 1.1 .0 .0 100,0 98.9 845 Richest 100.0 .0 .0 100,0 98.7 1.3 .0 .0 100,0 98.7 848 Total 95,6 3,6 ,9 100,0 91,1 3,3 5,5 ,1 100,0 90,8 4229 1 MICS indicator 4.1; MDG indicator 7.8 2 MICS indicator 4.3; MDG indicator 7.9 63 64 MultIple IndIcator cluster survey 2011 viii RepRoductive health fertility and early childbearing In MICS4, adolescent birth rates 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 the absence of information on multiple births (twins, triplets, etc.) and on women having multiple deliveries during the one-year period preceding the survey. Table RH.1 shows adolescent birth rates and the total fertility rate. The adolescent birth rate (age-specific fertility rate for women aged 15-19) is defined as the number of births to women aged 15-19 years during the one-year period preceding the survey, divided by the average number of women aged 15-19 (number of women-years lived between ages 15 through 19, inclusive) during the same period, expressed per 1000 women. 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 TFR denotes the average number of children to which a woman will have given birth by the end of her reproductive years if current fertility rates prevailed. In Macedonia, total fertility rate is 2.1, while adolescent birth rate is 13 per 1000 women aged 15-19 years. table Rh.1: adolescent birth rate and total fertility rate adolescent birth rates and total fertility rates, Mace- donia, 2011 Adolescent birth rate1 (Age-specific fertility rate for women age 15-19) Total fertility rate area Urban (4) 2.0 Rural 21 2.3 ethnicity of household head Macedonian (5) 2.0 Albanian 13 2.3 Other (*) 2.1 Total 13 2.1 1 MICS indicator 5.1; MDG indicator 5.4 ( ) – figures based on 125–259 person-year of exposure (*) – figures based on less than 125 person-year of exposure 64 MultIple IndIcator cluster survey 2011 65 fertility and early childbearing – Roma settlements table Rh.2R: early childbearing percentage of women age 15-19 years who have had a live birth, are pregnant with the first child, and have begun childbearing, and those who have had a live birth before age 15, and percentage of women age 20-24 who have had a live birth before age 18, Roma settlements, 2011 Percentage of women age 15-19 who: Number of wom- en age 15-19 Percentage of women age 20-24 who have had a live birth before age 181 Number of wom- en age 20-24 Have had a live birth Are pregnant with first child Have begun childbearing Have had a live birth before age 15 education None (*) (*) (*) (*) 11 45.8 28 Primary 16.4 7.4 23.8 .0 89 31.2 125 Secondary+ 3.6 .5 4.2 .0 72 (.0) 37 Wealth index Poorest 60% 18.7 6.5 25.3 .8 108 38.4 106 Richest 40% 4.8 1.3 6.1 .0 65 13.2 84 Total 13.5 4.6 18.0 .5 173 27.3 190 1 MICS indicator 5.2 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases RH.3R presents the trends for early childbearing (tables RH2 and RH3 are not presented for the national sample because data on the first born child was not collected in the national survey). As shown in Table RH.2R, 18 percent have begun childbearing: 14 percent of Roma women aged 15-19 have already had a birth, while 5 percent are pregnant with their first child. 0.5 percent have had a live birth before age 15. Out of all Roma women aged 20-24, 27 percent had a live birth before the age of 18, with similar distribution as described for early childbearing before the age 15. Table RH.3R presents the trends in early childbearing. 3 percent of all Roma women aged 15-49 have had a live birth before age 15, with some differences across age groups. Out of all Roma women aged 20-49, 27 percent had a live birth before age 18. There are differences between different age groups, with the highest proportion at ages 40-44 (38 percent) and lowest at ages 30-34 (19 percent). table Rh.3R: trends in early childbearing percentage of women who have had a live birth, by age 15 and 18, by area and age group, Roma settle- ments, 2011 Percentage of women with a live birth before age 15 Number of women age 15-49 years Percentage of women with a live birth before age 18 Number of women age 20-49 years age 15-19 .5 173 Na Na 20-24 4.5 190 27.3 190 25-29 3.2 166 24.4 166 30-34 2.0 172 18.5 172 35-39 4.7 112 22.2 112 40-44 2.7 149 38.0 149 45-49 2.7 129 30.2 129 Total 2.9 1091 26.6 918 65 Total fertility rate in Roma settlements cannot be calculated as there are not sufficient person-years of exposure across all the age groups. Adolescent birth rate is 94 per 1000 women aged 15-19 years although this is based on 125-259 person-years of exposure; thus should be treated carefully. Sexual activity and childbearing early in life carry significant risks for young people all around the world. Table RH.2R presents some early childbearing indicators for women aged 15-19 and 20-24 while Table 66 MultIple IndIcator cluster survey 2011 Knowledge of contraceptive Methods In the Macedonia MICS, a set of questions was added to the questionnaire for individual women on their knowledge of contraceptive methods. Being aware of available contraceptive methods is an important step towards accessing and using a suitable method of contraception, which in turn allows choices about family planning to be made. Information was collected from all women aged 15-49 years on whether they have heard of the following family planning methods: female and male sterilization, IUD (intrauterine device), injectables, implants, pill, male condom, female condom, diaphragm, foam/jelly, periodic abstinence / rhythm method, withdrawal and emergency/postcoital contraception. Of these methods, periodic abstinence/rhythm method and withdrawal are considered traditional methods while the rest are considered modern methods of contraception. The respondents were also asked if they have heard of other ways or methods to avoid pregnancy in addition to those mentioned above. As shown in Table RH.3A, 99 percent of all women aged 15-49 years know at least one contraceptive method. The percentages are similar for both modern and traditional methods. The most widely known modern methods are the male condom (94 percent) and the pill (93 percent). Of the traditional methods, the withdrawal is the most widely known (92 percent). When comparing the knowledge of the currently married or in union women to that of all women, the results are similar. The mean number of different contraceptive methods known by all women is 9.5, and by currently married or in union women, the mean number known is 8.9. table Rh.3a Knowledge of specific contraceptive methods percentage of women age 15-49 and percentage of women age 15-49 ever married or in union who have heard of any contraceptive method, by specific meth- od, Macedonia, 2011   All Currently married or in union any method 98.8 98.9 any modern method 98.4 98.4 Female sterilization 78.2 78.1 Male sterilization 63.4 62.9 Pill 93.4 93.1 IUD 89.4 91.5 Injectables 71.9 72.4 Implants 40.4 40.8 Male condom 93.8 93.6 Female condom 55.0 52.7 Diaphragm 51.7 50.7 Foam/jelly 32.4 33.3 Emergency contraception 57.1 57.7 any traditional method 92.9 95.1 Rhythm 72.2 74.1 Withdrawal 91.6 94.3 Other 2.9 3.1 Mean number of meth- ods known by women 8.8 8.9 number of women 3831 2537 Table RH.3B presents women’s knowledge of contraception by background characteristics. The knowledge of contraception is high in Macedonia and few differences by background characteristics are observed. The knowledge increases slightly with improvement of the households’ wealth status. 67 table Rh.3b: Knowledge of contraceptive methods percentage of women age 15-49 currently married or in union who have heard of at least one contraceptive meth- od and who have heard of at least one modern method, by background characteristics, Macedonia, 2011 Any method Any modern method* Number of women currently married or in union Region Vardar 100.0 99.1 155 East 97.7 97.7 185 Southwest 97.3 96.5 253 Southeast 97.0 96.6 211 Pelagonia 100.0 99.5 339 Polog 97.5 96.7 409 Northeast 100.0 100.0 254 Skopje 100.0 99.5 730 area Urban 99.8 99.6 1333 Rural 97.9 97.1 1205 age 15-19 (94.7) (90.5) 23 20-24 95.3 94.0 173 25-29 99.2 98.5 376 30-34 99.6 99.5 484 35-39 99.2 98.7 492 40-44 98.9 98.9 510 45-49 99.2 98.4 479 Women’s education Primary or less 97.3 96.2 989 Secondary 99.9 99.7 1059 High 100.0 100.0 489 Wealth index quintile Poorest 96.1 94.4 460 Second 98.7 97.8 503 Middle 99.5 99.4 495 Fourth 99.8 99.8 513 Richest 100.0 100.0 567 ethnicity of household head Macedonian 99.5 99.3 1528 Albanian 98.8 97.8 804 Other 94.8 94.2 206 Total 98.9 98.4 2537 *Female sterilization, male sterilization, pill, IUD, injectables, implants, male condom, female condom, emergency contraception, and other modern methods. ( ) – figures based on 25–49 unweighted cases use of contraception Current use of contraception was reported by 40 percent of women currently married or in union, with less than 13 percent using modern methods (Table RH.4). The most popular method is the withdrawal method, which is used by one in four of these women in Macedonia. The second-most popular method is the male condom, which is used by 8 percent of these women. 2 percent of them reported use of the IUD and periodic abstinence, 2 percent use of pill, and 0.7 female sterilization. Less than 0.5 percent of them use injectables, implants, or male sterilization. 68 MultIple IndIcator cluster survey 2011 table Rh.4: use of contraception percentage of women age 15-49 years currently married or in union who are using (or whose partner is using) a contraceptive method, Macedonia, 2011 Not using any method percent of women (currently married or in union) who are using: Number of women currently married or in unionFe m al e st er il- iza tio n M al e st er ili za tio n IU D In je ct ab le s Im pl an ts Pi ll M al e co nd om Fe m al e co nd om Di ap hr ag m / Fo am /J el ly Pe rio di c a bs ti- ne nc e W ith dr aw al Ot he r An y m od er n m et ho d An y t ra di tio na l m et ho d An y m et ho d1 Region Vardar 61.9 .0 .0 3.0 .0 .0 1.7 10.6 .0 .0 7.9 14.6 .3 15.4 22.7 38.1 155 East 61.3 1.0 .0 .9 .0 .0 1.3 8.6 .0 .0 .7 26.2 .0 11.8 26.9 38.7 185 Southwest 79.3 .4 .0 2.7 .0 .0 3.1 5.4 .0 .0 .1 9.0 .0 11.6 9.1 20.7 253 Southeast 81.4 .0 .0 .6 .0 .0 .1 9.4 .0 .0 .0 8.1 .3 10.1 8.5 18.6 211 Pelagonia 23.5 .2 .0 3.6 .0 .0 1.5 10.0 .0 .0 4.1 57.1 .0 15.3 61.2 76.5 339 Polog 62.0 1.7 .0 2.0 1.2 .0 1.4 7.4 .0 .0 1.2 23.2 .0 13.7 24.3 38.0 409 Northeast 87.4 .0 .0 1.7 .0 .0 1.0 2.0 .0 .0 .2 7.4 .4 4.7 7.9 12.6 254 Skopje 52.0 .9 .0 1.5 .0 .0 2.1 10.2 .0 .0 2.6 30.5 .1 14.7 33.3 48.0 730 area Urban 57.3 .6 .0 2.1 .0 .0 1.5 10.9 .0 .0 2.9 24.5 .2 15.1 27.6 42.7 1333 Rural 62.6 .8 .0 1.8 .4 .0 1.8 5.4 .0 .0 1.2 26.0 .0 10.2 27.2 37.4 1205 age 15-19 (66.9) (.0) (.0) (.0) (2.3) (.0) (.0) (5.9) (.0) (.0) (.0) (24.9) (.0) (8.2) (24.9) (33.1) 23 20-24 70.9 .0 .0 .2 .0 .0 1.3 6.8 .0 .0 1.0 19.3 .5 8.3 20.8 29.1 173 25-29 62.4 .0 .0 1.3 .2 .0 1.2 8.6 .0 .0 1.4 24.5 .2 11.4 26.2 37.6 376 30-34 55.3 .6 .0 1.7 .0 .0 2.1 9.5 .0 .0 2.8 28.0 .0 13.9 30.8 44.7 484 35-39 56.5 .6 .0 2.0 .1 .0 1.9 12.0 .0 .0 2.6 24.3 .1 16.6 26.9 43.5 492 40-44 54.3 .7 .0 3.3 .2 .0 2.1 8.5 .0 .0 2.2 28.8 .0 14.7 31.0 45.7 510 45-49 67.3 1.7 .0 2.3 .4 .0 .9 3.2 .0 .0 1.6 22.5 .2 8.5 24.2 32.7 479 number of live bitrhs2 0 87.4 .0 .0 .0 .2 .0 .0 4.0 .0 .0 .3 8.1 .0 4.2 8.4 12.6 217 1 61.2 .4 .0 1.1 .2 .0 1.9 9.4 .0 .0 1.8 23.7 .3 13.0 25.9 38.8 509 2 56.0 .4 .0 2.0 .2 .0 1.6 9.6 .0 .0 2.9 27.3 .1 13.7 30.2 44.0 1254 3 57.8 2.1 .0 2.9 .0 .0 1.7 8.1 .0 .0 1.5 25.9 .0 14.7 27.5 42.2 389 4+ 52.7 1.2 .0 5.4 .3 .0 3.4 1.1 .0 .0 .4 35.5 .0 11.4 36.0 47.3 168 education Primary or less 63.6 .7 .0 2.3 .4 .0 1.3 3.2 .0 .0 1.0 27.4 .1 7.9 28.5 36.4 989 Secondary 60.9 .6 .0 2.0 .0 .0 1.5 9.2 .0 .0 1.9 23.7 .2 13.4 25.7 39.1 1059 High 49.8 .8 .0 1.5 .0 .0 2.5 16.4 .0 .0 4.6 24.4 .0 21.2 29.0 50.2 489 Wealth index quintile Poorest 65.2 .7 .0 1.5 .2 .0 1.9 3.1 .0 .0 .9 26.2 .2 7.5 27.3 34.8 460 Second 65.0 .8 .0 1.1 .4 .0 1.3 4.4 .0 .0 .7 26.3 .0 8.0 27.0 35.0 503 Middle 60.9 .4 .0 2.0 .4 .0 1.9 7.7 .0 .0 2.1 24.4 .1 12.5 26.6 39.1 495 Fourth 54.8 .6 .0 2.7 .0 .0 2.0 10.6 .0 .0 3.4 25.5 .3 16.0 29.2 45.2 513 Richest 54.5 .8 .0 2.5 .0 .0 1.1 14.1 .0 .0 2.9 24.1 .0 18.5 27.0 45.5 567 ethnicity of household head Macedonian 59.0 .5 .0 1.7 .0 .0 1.1 11.6 .0 .0 2.7 23.3 .1 14.9 26.0 41.0 1528 Albanian 60.5 1.0 .0 2.4 .3 .0 2.5 3.4 .0 .0 .9 28.8 .1 9.7 29.8 39.5 804 Other 62.9 .6 .0 2.4 1.1 .0 2.1 2.4 .0 .0 1.8 26.3 .4 8.6 28.5 37.1 206 total 59.8 .7 .0 2.0 .2 .0 1.6 8.3 .0 .0 2.1 25.3 .1 12.8 27.4 40.2 2537 1 MICS indicator 5.3; MDG indicator 5.3 2 Because the standard child mortality module was not included into the questionnaire, instead of ‘number of living children’ table RH.4 uses ‘number of live births’ for this background characteristic. ( ) – figures based on 25–49 unweighted cases 69 Contraceptive prevalence is highest in the Pelagonia region at 77 percent and in the Skopje region at 48 percent. 39 percent of married women in the Vardar and East regions use some method of contraception. In the Northeast region, contraceptive use is rare where only 13 percent of married women reported using any method. Adolescents and youth are far less likely to use contraception than older women. Only about 29 percent of married 20-24 year olds and 33 percent of married or in union women aged 15-19 currently use a method of contraception compared to 45 percent of older women aged 30-34. Women’s education level is associated with contraceptive prevalence. The percentage of women using any method of contraception rises from 36 percent among those with no education or with primary education, to 50 percent among women with higher education. About 3 percent of contraception users with no or primary education use the male condom, while condom use is more frequent among users with a higher education (16 percent). In contrast, use of IUD is not correlated to the education level and is generally at low level (2 percent of contraceptive users regardless of their education). Women in urban areas and who are from the richest households use contraceptive methods more. 70 MultIple IndIcator cluster survey 2011 Knowledge of contraceptive Methods – Roma settlements As shown in Table RH.3AR, 95 percent of all women aged 15-49 years know at least one contraceptive method. Modern methods are more widely known than traditional methods- 93 percent of all women have heard of at least one modern method while 79 percent know at least one traditional method. The most widely known modern method is the male condom (90 percent) followed by the pill (79 percent). Of the traditional methods, the most widely known method is the withdrawal (77 percent). Results are similar when comparing the knowledge of all women to those who are currently married or in union. The mean number of different contraceptive methods known by all women as well as by currently married or in union women, is 5.9. table Rh.3a R Knowledge of specific contraceptive methods percentage of women age 15-49 and percentage of women age 15-49 ever married or in union who have heard of any contraceptive method, by specific meth- od, Roma settlements, 2011   All Ever married or in union any method 94.9 95.3 any modern method 92.5 93.1 Female sterilization 53.1 52.8 Male sterilization 30.5 30.0 Pill 78.5 79.0 IUD 75.6 76.7 Injectables 52.4 52.6 Implants 16.1 15.9 Male condom 86.9 88.0 Female condom 28.5 28.1 Diaphragm 18.9 17.4 Foam/jelly 9.8 8.8 Emergency contraception 28.7 28.2 any traditional method 79.1 83.0 Rhythm 42.9 46.1 Withdrawal 77.4 82.0 Other 3.0 3.3 Mean number of meth- ods known by women 5.9 5.9 number of women 1091 799 Table RH.3BR presents women’s knowledge of contraception by background characteristics. The knowledge of contraception is high in the Roma settlements although some differences by background characteristics can be observed. Knowledge is higher among Roma women with secondary or higher education, compared to those with no official education. table Rh.3bR: Knowledge of contraceptive methods percentage of women age 15-49 currently married or in union who have heard of at least one contraceptive method and who have heard of at least one modern method, by background characteristics, Roma settle- ments, 2011 Any method Any modern method* Number of women current- ly married or in union age 15-19 (94.5) (92.8) 39 20-24 91.7 86.9 137 25-29 94.6 93.3 132 30-34 96.7 95.3 146 35-39 96.0 96.0 104 40-44 96.5 93.3 131 45-49 97.0 94.7 111 Women’s education None 90.7 85.1 148 Primary 96.0 94.4 573 Secondary + 98.7 98.7 79 Wealth index quintile Poorest 94.2 90.5 151 Second 91.0 88.5 156 Middle 95.5 91.3 154 Fourth 96.8 95.8 166 Richest 98.6 98.6 172 Total 95.3 93.1 799 *Female sterilization, male sterilization, pill, IUD, injectables, im- plants, male condom, female condom, emergency contraception, and other modern methods. ( ) – figures based on 25–49 unweighted cases Current use of contraception was reported by 37 percent of Roma women currently married or in union (Table RH.4R). The most popular method is the withdrawal, which is used by one in three married Roma women in Macedonia. The next most popular method is the male condom, which accounts for 3 percent of married women. 2 percent use female sterilization and 1 percent use the IUD. Less than 1 percent use the pill, periodic abstinence, injectables, implants, or male sterilization. 70 MultIple IndIcator cluster survey 2011 71 table Rh.4R: use of contraception percentage of women age 15-49 years currently married or in union who are using (or whose partner is using) a contraceptive method, Roma settlements, 2011 Not us- ing any method Percent of women (currently married or in union) who are using: Num- ber of women currently married or in union Fe m al e st er il- iza tio n M al e st er il- iza tio n IU D In je ct ab le s Im pl an ts Pi ll M al e co nd om Fe m al e co nd om Di ap hr ag m / Fo am /J el ly Pe rio di c ab st in en ce W ith dr aw al Ot he r An y m od er n m et ho d An y t ra di tio na l m et ho d An y m et ho d1 age 15-19 (76.5) (.0) (.0) (.0) (.0) (.0) (.0) (.0) (.0) (.0) (.0) (23.5) (.0) (.0) (23.5) (23.5) 39 20-24 66.5 .0 .4 .3 .0 .0 .4 5.9 .0 .0 .0 26.4 .0 7.0 26.4 33.5 137 25-29 70.9 .0 .0 .0 .0 .0 3.5 .4 .0 .0 .0 25.2 .0 3.9 25.2 29.1 132 30-34 46.3 .7 .5 .0 .0 .0 .3 5.8 .0 .0 2.8 43.6 .0 7.2 46.5 53.7 146 35-39 52.9 2.9 .0 2.7 .0 .0 .0 3.8 .0 .0 1.1 36.6 .0 9.4 37.7 47.1 104 40-44 65.2 3.1 .0 3.5 .0 .0 .4 2.2 .0 .0 .0 25.6 .0 9.2 25.6 34.8 131 45-49 73.4 3.4 .0 1.2 .0 .0 1.0 3.5 .0 .0 .0 17.5 .0 9.1 17.5 26.6 111 education None 63.9 2.1 .0 2.0 .0 .0 3.0 1.5 .0 .0 .0 27.4 .0 8.7 27.4 36.1 148 Primary 62.3 1.1 .1 1.0 .0 .0 .4 3.1 .0 .0 .9 31.0 .0 5.8 31.9 37.7 573 Second- ary + 66.3 3.0 .7 .6 .0 .0 .8 9.3 .0 .0 .0 19.4 .0 14.3 19.4 33.7 79 Wealth index quintile Poorest 65.0 .7 .0 .0 .0 .0 .0 3.5 .0 .0 2.1 28.8 .0 4.2 30.8 35.0 151 Second 58.7 .3 .0 .7 .0 .0 3.0 1.8 .0 .0 .0 35.5 .0 5.8 35.5 41.3 156 Middle 66.0 .5 .5 1.3 .0 .0 .0 3.3 .0 .0 .0 28.4 .0 5.6 28.4 34.0 154 Fourth 61.3 2.5 .0 .3 .0 .0 .6 3.9 .0 .0 .6 30.7 .0 7.3 31.3 38.7 166 Richest 64.1 3.0 .3 3.3 .0 .0 1.0 4.6 .0 .0 .7 22.9 .0 12.3 23.6 35.9 172 Total 63.0 1.5 .2 1.1 .0 .0 .9 3.4 .0 .0 .7 29.2 .0 7.2 29.8 37.0 799 1 MICS indicator 5.3; MDG indicator 5.3 ( ) – figures based on 25–49 unweighted cases Youngest and oldest age groups of Roma married or in union women currently use less contraception methods. 71 72 MultIple IndIcator cluster survey 2011 unmet need Unmet need for contraception refers to fecund women who are not using any method of contraception, but who wish to postpone the next birth (spacing) or who wish to stop childbearing altogether (limiting). Unmet need is identified in MICS by using a set of questions eliciting current behaviours and preferences pertaining to contraceptive use, fecundity, and fertility preferences. Table RH.5 shows the levels of met need for contraception, unmet need, and the demand for contraception satisfied. Unmet need for spacing is defined as the percentage of women who are not using a method of contraception AND „ are not pregnant and not postpartum amenorrheic19 and are fecund20 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 anoth- er 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 19A women is postpartum amenorrheic if she had a birth in the last two years and is not currently pregnant, and her menstrual period has not returned since the birth of the last child. 20 A women is considered infecund if she is neither pregnant nor postpartum amenorrheic, and (1a) has not had menstruation for at least six months, or (1b) never menstruated, or (1c) her last menstruation occurred before her last birth, or (1d) in meno- pause/has had hysterectomy OR (2) She declares that she has had a 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 her 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. Unmet need for limiting is defined as percentage of women who 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 do 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. 72 MultIple IndIcator cluster survey 2011 73 table Rh.5: unmet need for contraception percentage of women age 15-49 years currently married or in union with an unmet need for family planning and percentage of demand for contraception satisfied, Macedonia, 2011 Met need for contraception Unmet need for contraception Number of women currently married or in union Percentage of demand for con- traception satisfied Number of women cur- rently married or in union with need for contraceptionFor spacing For limiting Total For spacing For limiting Total1 Region Vardar 7.8 30.9 38.7 3.5 16.2 19.6 155 66.3 91 East 12.5 26.2 38.7 6.4 19.6 26.0 185 59.8 120 Southwest 6.2 15.9 22.0 8.0 15.8 23.8 253 48.0 116 Southeast 3.8 14.7 18.6 6.7 18.9 25.5 211 42.1 93 Pelagonia 17.0 59.7 76.6 .7 2.1 2.8 339 96.5 269 Polog 13.9 24.7 38.6 7.2 10.2 17.5 409 68.8 229 Northeast 1.7 10.9 12.6 8.3 19.7 28.0 254 31.0 103 Skopje 14.2 34.1 48.4 4.2 8.3 12.4 730 79.5 444 area Urban 12.8 30.1 42.9 5.2 11.4 16.6 1333 72.1 793 Rural 9.2 28.8 38.0 5.5 12.3 17.8 1205 68.1 672 age 15-19 (*) (*) (*) (*) (*) (*) (*) (*) 14 20-24 22.6 7.7 30.3 22.2 12.5 34.7 173 46.6 112 25-29 24.0 14.4 38.4 9.8 8.7 18.5 376 67.5 214 30-34 16.5 28.5 45.0 6.8 11.8 18.6 484 70.8 308 35-39 5.7 38.0 43.7 3.8 12.4 16.2 492 72.9 295 40-44 5.3 40.7 46.0 .5 14.5 15.0 510 75.4 311 45-49 2.3 30.6 32.9 .0 11.2 11.2 479 74.6 211 education Primary or less 8.1 28.6 36.7 3.6 12.4 16.0 989 69.6 521 Secondary 8.9 30.3 39.2 6.6 13.5 20.1 1059 66.2 628 High 22.0 29.3 51.4 6.1 7.1 13.2 489 79.5 316 Wealth index quintiles Poorest 9.7 25.3 35.0 4.5 15.5 20.0 460 63.7 253 Second 9.9 25.1 35.0 6.8 11.6 18.4 503 65.6 269 Middle 7.4 31.8 39.2 5.7 9.1 14.8 495 72.7 267 Fourth 12.6 33.8 46.4 4.3 10.7 14.9 513 75.6 315 Richest 15.2 30.7 45.9 5.4 12.5 17.9 567 71.9 362 ethnicity of household head Macedo- nian 10.8 30.5 41.3 5.1 12.9 18.0 1528 69.7 906 Albanian 12.0 28.0 40.1 5.4 9.3 14.8 804 73.0 441 Other 10.0 27.1 37.1 6.8 13.7 20.4 206 64.5 118 Total 11.1 29.5 40.6 5.3 11.8 17.2 2537 70.3 1465 1 MICS indicator 5.4; MDG indicator 5.6 (*) – figures based on less than 25 unweighted cases 74 MultIple IndIcator cluster survey 2011 Met need for limiting includes women who are using (or whose partner is using) a contraceptive method and who want no more children, are using male or female sterilization, or declare themselves as infecund. Met need for spacing includes women who are using (or whose partner is using) a contraceptive method and who want to have another child or are undecided whether to have another child. The total of met need for spacing and limiting adds up to the total met need for contraception. Out of all women currently married or in union, 41 percent reported met need for contraception, i.e. 11 percent for spacing and 30 percent for limiting. The proportion of women with contraception needs met is higher among women living in Pelagonia region, are from urban and richest households, who are older and more educated. Using information on contraception and unmet need, the percentage of demand for contraception satisfied is also estimated from the MICS data. The percentage of demand satisfied is defined as the proportion of women currently married or in a marital union who are currently using contraception, of 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. In total, 70 percent of women in Macedonia reported that their demand for contraception was satisfied. There are significant differences by region – highest in Pelagonia (97 percent) and lowest in Northeast (31 percent). 75 unmet need – Roma settlements Total unmet need for contraception is the sum of unmet need for spacing and unmet need for limiting. table Rh.5R: unmet need for contraception percentage of women age 15-49 years currently married or in union with an unmet need for family planning and percentage of demand for contraception satisfied, Roma settlements, 2011 Met need for contraception Unmet need for contraception Number of women currently married or in union Percent- age of demand for contraception satisfied Number of women currently married or in union with need for con- traception For spacing For limiting Total For spacing For limiting Total1 age 15-19 (19.4) (4.1) (23.5) (15.0) (1.0) (16.0) 39 (*) 15 20-24 18.7 14.8 33.5 21.0 17.8 38.8 137 46.3 99 25-29 12.6 17.0 29.6 7.0 32.8 39.8 132 42.7 91 30-34 8.3 45.4 53.7 5.5 17.7 23.2 146 69.8 112 35-39 4.4 42.7 47.1 3.4 10.6 13.9 104 77.2 63 40-44 .0 34.8 34.8 1.7 5.8 7.5 131 82.4 55 45-49 .0 26.6 26.6 .0 6.9 6.9 111 (79.4) 37 education None 11.8 24.2 36.1 3.5 15.7 19.3 148 65.2 82 Primary 6.9 30.9 37.8 6.9 14.5 21.4 573 63.8 339 Second- ary + 12.0 21.7 33.7 16.3 17.2 33.5 79 50.1 53 Wealth index quintiles Poorest 6.1 28.9 35.0 6.1 21.9 28.0 151 55.6 95 Second 6.7 34.6 41.3 6.1 13.4 19.5 156 67.9 95 Middle 10.9 23.6 34.5 7.1 14.0 21.1 154 62.0 85 Fourth 8.0 30.7 38.7 10.9 13.6 24.5 166 61.2 105 Richest 9.7 26.1 35.9 5.7 12.6 18.4 172 66.1 93 Total 8.3 28.8 37.1 7.2 15.0 22.2 799 62.5 474 1 MICS indicator 5.4; MDG indicator 5.6 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases Met need for limiting includes women who are using (or whose partner is using) a contraceptive method and who want no more children, are using male or female sterilization, or declare themselves as infecund. Met need for spacing includes women who are using (or whose partner is using) a contraceptive method and who want to have another child or are undecided whether to have another child. The total of met need for spacing and limiting adds up to the total met need for contraception. Of all the women in Roma settlements, 37 percent reported met need for contraception, i.e. 8 percent for spacing and 29 75 76 MultIple IndIcator cluster survey 2011 percent for limiting. The proportion of women with contraception needs met is not strongly correlated with the wealth index. Using information on contraception and unmet need, the percentage of demand for contraception satisfied is also estimated from the MICS data. The percentage of demand satisfied is defined as the proportion of women currently married or in a marital union who are currently using contraception, of 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. 63 percent of Roma women reported that their demand for contraception was satisfied. There are differences by wealth index and the education of Roma women with the lowest satisfaction among more educated women. Table RH.5R shows that the total met need among Roma women is higher than the total unmet need for family planning. Unmet need is correlated with education level, with 34 percent of women with secondary education compared to 19 percent with no education. The table also highlights that the total demand for family planning satisfied is relatively high. 76 MultIple IndIcator cluster survey 2011 77 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, if the antenatal period is used to inform women and families about the danger signs and symptoms and about the risks of labour and delivery, it may provide the route for ensuring that pregnant women do, in practice, deliver with the assistance of a skilled health care provider. The antenatal period also provides an opportunity to supply information on birth spacing, which is recognized as an important factor in improving infant survival. Management of anaemia during pregnancy and treatment of 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 period as an entry point for HIV prevention and care, in particular for the prevention of HIV transmission from mother to child, has led to renewed interest in access to and use of antenatal services. WHO recommends a minimum of four antenatal visits based on a review of the effectiveness of different models of antenatal care. WHO guidelines are specific on the content on antenatal care visits, which include: „ Blood pressure measurement „ Urine testing for bateriuria and proteinuria „ Blood testing to detect syphilis and severe anemia „ Weight/height measurement (optional) The type of personnel providing antenatal care to women aged 15-49 years who gave birth in the two years preceding is presented in Table RH.6. The results show that a relatively small percentage of women do not receive antenatal care. In Macedonia, the majority of antenatal care is provided by skilled personnel (99 percent), of which 93 percent are medical doctors, 5 percent obstetrical nurses, 0.2 percent midwives and nurses. The remaining 1 percent did not receive antenatal care. table Rh.6: antenatal care coverage percent distribution of women age 15-49 who gave birth in the two years preceding the survey by type of personnel providing antenatal care during the pregnancy for the last birth, Macedonia, 2011 Person providing antenatal care No antenatal care received Total Any skilled personnel1 Number of women who gave birth in the preceding two yearsDoctor Midwife Obstetrical nurse Nurse area Urban 98.4 .0 1.2 .0 .4 100.0 99.6 178 Rural 88.2 .4 8.6 .3 2.5 100.0 97.5 183 Mother’s age at birth Less than 20 (96.3) (.0) (3.7) (.0) (.0) 100.0 (100.0) 31 20-34 89.7 .4 7.4 .3 2.3 100.0 97.7 319 35-49 (*) (*) (*) (*) (*) 100.0 (*) 12 education Primary or less 88.4 .0 9.5 .4 1.7 100.0 98.3 146 Secondary 95.4 .5 1.9 .0 2.2 100.0 97.8 128 High 98.4 .0 1.6 .0 .0 100.0 100.0 88 Wealth index quintiles Poorest 87.2 .8 8.2 .7 3.0 100.0 97.0 84 Second 91.9 .0 6.1 .0 2.0 100.0 98.0 70 Middle 90.0 .0 8.3 .0 1.7 100.0 98.3 64 Fourth 98.3 .0 1.7 .0 .0 100.0 100.0 75 Richest 99.6 .0 .0 .0 .4 100.0 99.6 68 ethnicity of household head Macedonian 98.3 .4 .2 .0 1.0 100.0 99.0 171 Albanian 87.2 .0 10.7 .0 2.1 100.0 97.9 146 Other 93.7 .0 4.0 1.4 .9 100.0 99.1 45 Total 93.3 .2 4.9 .2 1.4 100.0 98.6 362 1 MICS indicator 5.5a; MDG indicator 5.5 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases 78 MultIple IndIcator cluster survey 2011 UNICEF and WHO recommend a minimum of four antenatal care visits during pregnancy. Table RH.7 shows the number of antenatal care visits during the last pregnancy over the two years preceding the survey, regardless of provider, by selected characteristics. About nine in ten mothers (94 percent) received antenatal care four or more times. Only 1 percent of women did not have antenatal visits, 0.1 percent had one visit, 0.5 percent had two, and 1 percent had three visits. table Rh.7: number of antenatal care visits percent distribution of women who had a live birth during the two years preceding the survey by number of ante- natal care visits by any provider, Macedonia, 2011 Percent distribution of women who had: Missing/DK Total Number of women who had a live birth in the preceding two years No antenatal care visits One visit Two visits Three visits 4 or more visits1 Region Vardar (.0) (.0) (.0) (2.1) (97.9) (.0) 100.0 16 East (2.9) (.0) (.0) (1.3) (95.8) (.0) 100.0 25 Southwest .6 .0 .0 1.2 85.6 12.6 100.0 39 Southeast (.0) (.0) (.0) (.0) (95.6) (4.4) 100.0 16 Pelagonia .0 1.0 .0 .0 99.0 .0 100.0 42 Polog .3 .0 .3 .8 95.2 3.3 100.0 69 Northeast (5.7) (.0) (.0) (.0) (89.7) (4.6) 100.0 37 Skopje 1.6 .0 1.3 2.9 94.2 .0 100.0 118 area Urban .4 .0 1.0 .6 95.8 2.3 100.0 178 Rural 2.5 .2 .0 2.2 92.0 3.0 100.0 183 Mother’s age at birth Less than 20 (1.0) (.0) (.0) (.0) (93.9) (5.1) 100.0 31 20-34 1.5 .1 .5 1.6 94.2 2.0 100.0 319 35-49 (*) (*) (*) (*) (*) (*) 100.0 12 education Primary or less 1.7 .3 .2 2.6 92.5 2.8 100.0 146 Secondary 2.2 .0 1.2 .6 93.4 2.6 100.0 128 High .0 .0 .0 .6 96.9 2.5 100.0 88 Wealth index quintile Poorest 3.0 .5 .3 4.1 90.7 1.4 100.0 84 Second 2.0 .0 .0 1.0 96.5 .5 100.0 70 Middle 1.7 .0 2.3 .9 91.3 3.8 100.0 64 Fourth .0 .0 .0 .6 97.3 2.1 100.0 75 Richest .4 .0 .0 .0 93.8 5.8 100.0 68 ethnicity of household head Macedonian 1.0 .0 .0 1.0 97.2 .8 100.0 171 Albanian 2.1 .3 1.2 2.4 88.4 5.7 100.0 146 Other .9 .0 .0 .0 99.1 .0 100.0 45 Total 1.4 .1 .5 1.4 93.9 2.6 100.0 362 1 MICS indicator 5.5b; MDG indicator 5.5 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases 79 The types of services pregnant women received during antenatal care are shown in Table RH.8. Among those women who had a live birth during the two years preceding the survey, 96 percent reported that a blood sample was taken during antenatal care visits, 97 percent reported that their blood pressure was checked, and 95 percent reported that a urine specimen was taken. Overall, blood pressure was measured, and urine and blood sample were taken from 94 percent of women. table Rh.8: content of antenatal care percentage of women age 15-49 years who had their blood pressure measured, urine sample taken, and blood sample taken as part of antenatal care, Macedonia, 2011 Percentage of pregnant women who had: Number of women who had a live birth in the preceding two years Blood pressure measured Urine sample taken Blood sample taken Blood pressure measured, urine and blood sample taken1 Region Vardar (100.0) (100.0) (100.0) (100.0) 16 East (93.8) (88.8) (89.7) (88.0) 25 Southwest 94.1 94.1 94.1 94.1 39 Southeast (100.0) (100.0) (97.6) (97.6) 16 Pelagonia 99.0 99.0 99.0 98.1 42 Polog 98.6 95.6 96.2 95.6 69 Northeast (91.1) (94.3) (94.3) (91.1) 37 Skopje 96.6 94.3 96.0 92.7 118 area Urban 97.3 98.2 98.9 96.4 178 Rural 95.7 92.2 92.8 91.8 183 Mother’s age at birth Less than 20 (99.0) (94.8) (96.3) (94.8) 31 20-34 96.3 95.0 95.6 93.9 319 35-49 (*) (*) (*) (*) 12 education Primary or less 94.7 92.1 92.5 90.9 146 Secondary 96.4 96.0 96.9 94.2 128 High 99.6 99.1 99.6 99.1 88 Wealth index quintile Poorest 95.2 88.7 89.5 88.7 84 Second 96.3 95.9 97.2 94.2 70 Middle 94.4 95.1 94.5 93.8 64 Fourth 100.0 99.4 99.7 99.2 75 Richest 96.5 97.8 99.1 95.2 68 ethnicity of household head Macedonian 98.0 97.9 98.4 96.8 171 Albanian 96.0 92.1 92.8 92.1 146 Other 92.7 94.5 95.4 89.9 45 Total 96.5 95.2 95.8 94.1 362 1 MICS indicator 5.6 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases 80 MultIple IndIcator cluster survey 2011 antenatal care – Roma settlements The type of personnel providing antenatal care to women aged 15-49 years who gave birth in the two years preceding the survey is presented in Table RH.6R. The results show that a relatively small percentage of women in Roma settlements do not receive antenatal care. A majority of antenatal care is provided by skilled personnel (94 percent). table Rh.6R: antenatal care coverage percent distribution of women age 15-49 who gave birth in the two years preceding the survey by type of person- nel providing antenatal care during the pregnancy for the last birth, Roma settlements, 2011 Person providing ante- natal care No antenatal care received Total Any skilled personnel 1 Number of women who gave birth in the preceding two yearsDoctor Mother’s age at birth Less than 20 (100.0) (.0) (100) (100.0) 31 20-34 92.8 7.2 100 92.8 143 35-49 (*) (*) (*) (*) 9 education None (88.4) (11.6) (100) (88.4) 41 Primary 94.9 5.1 100 94.9 120 Secondary + (100.0) (.0) (100) (100.0) 22 Wealth index quintiles Poorest 60% 92.2 7.8 100 92.2 128 Richest 40% 98.3 1.7 100 98.3 54 Total 94.0 6.0 100 94.0 182 1 MICS indicator 5.5a; MDG indicator 5.5 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases UNICEF and WHO recommend a minimum of four antenatal care visits during pregnancy. Table RH.7R shows the number of antenatal care visits during the last pregnancy during the two years preceding the survey, regardless of provider by selected characteristics. Almost nine in ten mothers (86 percent) received antenatal care four or more times. Out of all Roma women, 6 percent did not have antenatal visits, 2 percent had one visit, 2 percent had two, and 4 percent had three visits. For example, 81 percent of women living in the poorest 60 percent of households reported four or more antenatal care visits, compared with 95 percent of womenamong those living in the richest 40 percent of households. 80 MultIple IndIcator cluster survey 2011 81 table Rh.7R: number of antenatal care visits percent distribution of women who had a live birth during the two years preceding the survey by number of ante- natal care visits by any provider, Roma settlements, 2011 Percent distribution of women who had: Total Number of women who had a live birth in the preceding two years No antenetal care visits One visit Two visits Three visits 4 or more visits1 Mother’s age at birth Less than 20 (.0) (1.9) (.0) (5.4) (92.7) 100.0 31 20-34 7.2 1.6 2.8 4.4 84.1 100.0 143 35-49 (*) (*) (*) (*) (*) 100.0 9 education None (11.6) (1.4) (5.6) (2.3) (79.0) 100.0 41 Primary 5.1 1.9 .6 3.9 88.5 100.0 120 Secondary + (.0) (.0) (4.2) (10.6) (85.2) 100.0 22 Wealth index quintile Poorest 60% 7.8 2.6 3.4 5.2 81.0 100.0 128 Richest 40% 1.7 .0 1.7 1.7 94.8 100.0 54 Total 6.0 1.6 2.2 4.3 85.9 100.0 182 1 MICS indicator 5.5b; MDG indicator 5.5 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases The types of services pregnant women received during antenatal care are shown in Table RH.8R. Among Roma women who have had a live birth during the two years preceding the survey, 87 percent reported that a blood sample was taken during antenatal care visits, 86 percent reported that their blood pressure was checked, and 85 percent reported that their urine specimen was taken. In total, blood pressure was measured, and urine and blood samples were taken from 83 percent of Roma women. table Rh.8R: content of antenatal care percentage of women age 15-49 years who had their blood pressure measured, urine sample taken, and blood sample taken as part of antenatal care, Roma settlements, 2011 Percentage of pregnant women who had: Number of women who had a live birth in the preceding two years Blood pressure measured Urine sample taken Blood sample taken Blood pressure measured, urine and blood sample taken1 Mother’s age at birth Less than 20 (88.3) (95.0) (95.0) (88.3) 31 20-34 85.0 82.8 84.6 81.0 143 35-49 (*) (*) (*) (*) 9 education None (74.4) (74.4) (74.4) (74.4) 41 Primary 89.0 86.4 88.6 84.2 120 Secondary + (90.4) (100.0) (100.0) (90.4) 22 Wealth index quintile Poorest 60% 79.3 81.0 81.9 78.4 128 Richest 40% 94.8 94.8 98.3 91.4 54 Total 85.9 85.3 86.7 82.7 182 1 MICS indicator 5.6 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases 81 82 MultIple IndIcator cluster survey 2011 assistance at Delivery Three quarters of all maternal deaths occur during delivery and the immediate post-partum period. The single most critical intervention for safe motherhood is to ensure a competent health worker with midwifery skills is present at every birth, and transport is available to a referral facility for obstetric care in case of emergency. A World Fit for Children goal is to ensure that women have ready and affordable access to skilled attendance at delivery. The indicators are the proportion of births with a skilled attendant and the proportion of institutional deliveries. The skilled attendant at delivery indicator is also used to track progress toward the Millennium Development target of reducing the maternal mortality ratio by three quarters between 1990 and 2015. The MICS included a number of questions to assess the proportion of births attended by a skilled attendant. A skilled attendant includes a doctor, nurse, midwife or auxiliary midwife. About 98 percent of births that occurred in the two years preceding the MICS survey were delivered by skilled personnel (Table RH.9). Doctors assisted with the delivery of 87 percent of births and nurses assisted with 9 percent. Caesarean section (C-section) is one of the most common surgical procedures worldwide with an estimated prevalence rate of 33 percent. The prevalence of caesarean section ranges from 4 percent in developing countries to over 30 percent in the most developed countries. There are a rising number of such deliveries worldwide performed without any medical need. The intervention is a subject of affordability, with pregnant women from wealthier households being able to cover the costs of the procedure. Nationally, one in four children in Macedonia is delivered by C-section. The proportion of women who deliver by C-Section is high in urban areas and among women from the richest quintile, with a higher education, and whose household head is of Macedonian ethnicity. 83 table Rh.9: assistance during delivery percent distribution of women age 15-49 who had a live birth in the two years preceding the survey by person as- sisting at delivery and percentage of births delivered by c-section, Macedonia, 2011 Person assisting at delivery No attendant Total Delivery assisted by any skilled attendant1 Percent delivered by C-section2 Number of women who had a live birth in preceding two years Medical doctor Nurse/ Midwife Auxiliary midwife Traditional birth attendant Relative/ Friend Other Region Vardar (88.0) (3.7) (8.3) (.0) (.0) (.0) (.0) 100.0 (100.0) (17.4) 16 East (84.9) (.8) (3.3) (9.8) (.0) (1.2) (.0) 100.0 (98.8) (12.4) 25 Southwest 94.7 .0 4.5 .9 .0 .0 .0 100.0 100.0 30.3 39 Southeast (100.0) (.0) (.0) (.0) (.0) (.0) (.0) 100.0 (100.0) (49.2) 16 Pelagonia 97.0 1.8 .0 1.2 .0 .0 .0 100.0 100.0 27.1 42 Polog 69.5 3.2 24.4 2.9 .0 .0 .0 100.0 100.0 14.2 69 Northeast (87.6) (1.4) (1.6) (.0) (.0) (9.4) (.0) 100.0 (90.6) (22.5) 37 Skopje 89.7 2.9 3.7 1.7 .9 .4 .7 100.0 98.0 29.9 118 area Urban 91.5 1.8 3.8 1.1 .0 1.3 .5 100.0 98.3 33.8 178 Rural 82.6 2.4 10.3 2.9 .6 1.1 .0 100.0 98.3 16.3 183 Mother’s age at birth Less than 20 (93.1) (2.7) (.6) (2.6) (.0) (1.0) (.0) 100.0 (99.0) (9.4) 31 20-34 86.0 2.1 8.0 2.1 .3 1.3 .3 100.0 98.1 26.1 319 35-49 (*) (*) (*) (*) (*) (*) (*) 100.0 (*) (*) 12 Place of delivery Public sector health facility 87.9 1.5 7.5 2.1 .0 .7 .3 100.0 99.1 23.1 332 Private sector health facility (*) (*) (*) (*) (*) (*) (*) 100.0 (*) (*) 23 Other/Missing (*) (*) (*) (*) (*) (*) (*) 100.0 (*) (*) 6 education Primary or less 81.0 1.3 13.4 3.1 .0 1.2 .0 100.0 98.8 15.2 146 Secondary 89.3 2.2 4.1 .9 .8 2.0 .7 100.0 96.5 26.7 128 High 93.7 3.4 .9 2.0 .0 .0 .0 100.0 100.0 38.4 88 Wealth index quintiles Poorest 70.7 2.2 19.6 5.1 1.2 1.3 .0 100.0 97.5 10.9 84 Second 91.1 .8 3.0 1.2 .0 4.0 .0 100.0 96.0 21.2 70 Middle 94.7 2.1 2.1 1.1 .0 .0 .0 100.0 100.0 31.8 64 Fourth 90.2 1.7 6.8 1.3 .0 .0 .0 100.0 100.0 21.8 75 Richest 92.3 4.0 .9 .8 .0 .8 1.3 100.0 98.0 43.0 68 ethnicity of household head Macedonian 92.6 2.5 3.9 .5 .0 .5 .0 100.0 99.5 31.4 171 Albanian 80.9 2.0 11.6 2.4 .7 2.4 .0 100.0 96.9 18.7 146 Other 85.4 1.2 4.7 6.8 .0 .0 1.9 100.0 98.1 20.4 45 Total 87.0 2.1 7.1 2.0 .3 1.2 .2 100.0 98.3 24.9 362 1 MICS indicator 5.7; MDG indicator 5.2 2 MICS indicator 5.9 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases 84 MultIple IndIcator cluster survey 2011 assistance at delivery – Roma settlements births assisted by another person (eg. traditional birth attendant or relative/friend). Almost one in eight Roma women were delivered by C-section. table Rh.9R: assistance during delivery percent distribution of women age 15-49 who had a live birth in the two years preceding the survey by person as- sisting at delivery and percentage of births delivered by c-section, Roma settlements, 2011 Person assisting at delivery No attendant Total Delivery assisted by any skilled attendant1 Percent delivered by C-section2 Number of women who had a live birth in preceding two years Medical doctor Nurse/ Midwife Auxiliary midwife Traditional birth attendant Relative/ Friend Mother’s age at birth Less than 20 (94.9) (5.1) (.0) (.0) (.0) (.0) 100.0 (100.0) (6.6) 31 20-34 91.5 3.2 3.4 1.2 .4 .3 100.0 99.3 14.2 143 35-49 (*) (*) (*) (*) (*) (*) 100.0 (*) (*) 9 Place of delivery Public sector health facility 92.9 3.4 2.7 1.0 .0 .0 100.0 100.0 13.3 180 Other/Missing (*) (*) (*) (*) (*) (*) 100.0 (*) (*) 3 education None (92.3) (3.3) (.0) (2.1) (1.4) (.9) 100.0 (97.7) (10.5) 41 Primary 93.1 4.0 2.1 .8 .0 .0 100.0 100.0 13.6 120 Secondary + (89.4) (.0) (10.6) (.0) (.0) (.0) 100.0 (100.0) (15.4) 22 Wealth index quintiles Poorest 60% 91.4 3.4 1.7 1.7 .9 .9 100.0 98.3 12.9 128 Richest 40% 91.4 5.2 3.4 .0 .0 .0 100.0 100.0 19.0 54 Total 92.5 3.4 2.7 1.0 .3 .2 100.0 99.5 13.1 182 1 MICS indicator 5.7; MDG indicator 5.2 2 MICS indicator 5.9 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases 84 MultIple IndIcator cluster survey 2011 About 100 percent of births that occurred in the two years preceding the MICS survey were delivered by skilled personnel (Table RH.9R). Doctors assisted with the delivery of 93 percent of births; midwives and nurses assisted with 6 percent; and 1 percent of 85 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.10 presents the percent distribution of women aged 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. 98 percent of births in Macedonia are delivered in a health facility - 92 percent of deliveries occur in public sector facilities and 7 percent occur in private sector facilities. Only 0.3 percent occurs at home. The percentage is high in both urban (99 percent) and rural areas (98 percent), and among women who have a higher education level and comes from a wealthier household. table Rh.10: place of delivery percent distribution of women age 15-49 who had a live birth in two years preceding the survey by place of deliv- ery, Macedonia, 2011 Place of delivery Total Delivered in health facility1 Number of women who had a live birth in preceding two years Public sector health facility Private sector health facility Home Other Missing/DK Region Vardar (100.0) (.0) (.0) (.0) (.0) 100.0 (100.0) 16 East (98.8) (.0) (.0) (.0) (1.2) 100.0 (98.8) 25 Southwest 99.4 .0 .0 .0 .6 100.0 99.4 39 Southeast (92.3) (7.7) (.0) (.0) (.0) 100.0 (100.0) 16 Pelagonia 100.0 .0 .0 .0 .0 100.0 100.0 42 Polog 95.6 1.0 .0 .9 2.4 100.0 96.6 69 Northeast (95.2) (.0) (.0) (.0) (4.8) 100.0 (95.2) 37 Skopje 80.9 18.2 .9 .0 .0 100.0 99.1 118 area Urban 86.7 12.6 .0 .4 .4 100.0 99.3 178 Rural 97.1 .5 .6 .0 1.8 100.0 97.6 183 Mother’s age at birth Less than 20 (99.0) (.0) (.0) (.0) (1.0) 100.0 (99.0) 31 20-34 91.5 6.8 .3 .2 1.2 100.0 98.3 319 35-49 (*) (*) (*) (*) (*) 100.0 (*) 12 number of antenatal care visits None (*) (*) (*) (*) (*) 100.0 (*) 5 1-3 visits (*) (*) (*) (*) (*) 100.0 (*) 7 4+ visits 92.5 6.8 .0 .2 .5 100.0 99.3 339 Missing/DK (*) (*) (*) (*) (*) 100.0 (*) 10 education Primary or less 97.0 .0 .0 .4 2.5 100.0 97.0 146 Secondary 97.5 1.5 .8 .0 .2 100.0 99.0 128 High 75.4 24.6 .0 .0 .0 100.0 100.0 88 Wealth index quintiles Poorest 95.5 .0 1.2 .8 2.5 100.0 95.5 84 Second 97.0 1.5 .0 .0 1.5 100.0 98.5 70 Middle 99.7 .0 .0 .0 .3 100.0 99.7 64 Fourth 98.2 1.8 .0 .0 .0 100.0 100.0 75 Richest 68.3 30.8 .0 .0 .9 100.0 99.1 68 ethnicity of household head Macedonian 88.4 11.4 .0 .0 .2 100.0 99.8 171 Albanian 96.3 .5 .7 .0 2.5 100.0 96.8 146 Other 91.2 7.3 .0 1.4 .0 100.0 98.6 45 Total 91.9 6.5 .3 .2 1.1 100.0 98.4 362 1 MICS indicator 5.8 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases 86 MultIple IndIcator cluster survey 2011 place of delivery – Roma settlements by place of delivery and the percentage of births delivered in a health facility, according to background characteristics. 99 percent of births in Roma settlements in Macedonia are delivered in a health facility- 98 percent of deliveries occur in public sector facilities and 1 percent occurs in private sector facilities. Only 0.2 percent occurs at home. table Rh.10R: place of delivery percent distribution of women age 15-49 who had a live birth in two years preceding the survey by place of deliv- ery, Roma settlements, 2011 Place of delivery Total Delivered in health facility1 Number of women who had a live birth in preceding two years Public sector health facility Private sector health facility Home Other Missing/DK Mother’s age at birth Less than 20 (100.0) (.0) (.0) (.0) (.0) 100.0 (100.0) 31 20-34 97.9 .9 .3 .4 .5 100.0 98.8 143 35-49 (*) (*) (*) (*) (*) 100.0 (*) 9 number of antenatal care visits None (*) (*) (*) (*) (*) 100.0 (*) 11 1-3 visits (*) (*) (*) (*) (*) 100.0 (*) 15 4+ visits 98.1 .8 .2 .4 .5 100.0 98.9 157 education None (97.7) (.0) (.9) (1.4) (.0) 100.0 (97.7) 41 Primary 98.3 1.0 .0 .0 .6 100.0 99.4 120 Secondary + (100.0) (.0) (.0) (.0) (.0) 100.0 (100.0) 22 Wealth index quintiles Poorest 60% 97.4 .9 .9 .9 .0 100.0 98.3 128 Richest 40% 98.3 .0 .0 .0 1.7 100.0 98.3 54 Total 98.4 .7 .2 .3 .4 100.0 99.1 182 1 MICS indicator 5.8 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases 86 MultIple IndIcator cluster survey 2011 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.10R presents the percent distribution of women aged 15-49 who had a live birth in the two years preceding the survey 87 abortions In the Macedonia MICS, a set of questions was added to the questionnaire for individual women on miscarriages, stillbirths and abortions. The information was collected from all women aged 15-49 years. Women were asked whether they have ever had a pregnancy that was miscarried, ended in a stillbirth or was aborted, and, if yes, they were asked how many pregnancies were miscarried, ended in a stillbirth or were aborted. In addition, more detailed information was collected on induced abortions occurring in the last two years, including the duration of the pregnancy at the time of termination and the month and year of termination. Table RH.18 shows the mean number of live births, miscarriages, abortions and stillbirths per woman aged 15-49 years. The mean number of live births per woman is 1.3. The average number of miscarriages per woman is 0.2, while stillbirths are rare (close to 0 per woman). As also shown in Table RH.18, 11 percent of women aged 15-49 have had at least one induced abortion in their lifetime. No pronounced differentials in the experience of abortions are found when comparing area, wealth index quintiles and education of the woman. The percentage of women who have ever had an induced abortion increases with age. Some differentials by region are found; for example, women in Polog region are most likely to have had an abortion with almost one in six women having had at least one induced abortion. Rh.18: lifetime experience with wasted pregnancies Mean number of live births, miscarriages, induced abortions and stillbirths, and percentage of women who have ever had an induced abortion, Macedonia, 2011 Mean number of: Percentage of women with at least one induced abortion Number of womenLive births Miscarriages Induced Abortions Stillbirths age 15-19 .0 .0 .0 .0 .0 530 20-24 .3 .0 .0 .0 1.8 541 25-29 .9 .1 .0 .0 3.9 574 30-34 1.7 .2 .1 .0 7.9 567 35-39 1.9 .2 .2 .1 13.9 545 40-44 2.2 .2 .3 .1 20.0 555 45-49 2.3 .3 .5 .1 26.9 519 area Urban 1.2 .2 .2 .0 9.7 2092 Rural 1.5 .2 .2 .0 11.5 1739 Region Vardar 1.3 .2 .2 .0 10.3 243 East 1.3 .1 .1 .0 10.2 258 Southwest 1.5 .1 .1 .0 6.4 353 Southeast 1.4 .1 .2 .0 11.5 317 Pelagonia 1.2 .1 .1 .0 10.0 512 Polog 1.4 .2 .3 .1 17.2 597 Northeast 1.4 .2 .1 .0 5.1 385 Skopje 1.3 .2 .2 .0 10.2 1166 education Primary or less 2.0 .2 .3 .1 16.5 1174 Secondary 1.2 .1 .1 .0 9.2 1682 High .8 .1 .1 .0 5.7 976 Wealth index quintile Poorest 1.6 .2 .2 .1 10.1 695 Second 1.5 .2 .2 .0 12.4 725 Middle 1.3 .2 .2 .0 12.4 782 Fourth 1.2 .1 .1 .0 8.6 791 Richest 1.2 .1 .1 .0 9.4 839 Total 1.3 .2 .2 .0 10.5 3831 88 MultIple IndIcator cluster survey 2011 Table RH.19 shows age specific abortion rates, total abortion rates (TAR), and general abortion rates (GAR). All of the abortion rates refer to the two-year period preceding the survey. Age specific abortion rates express the average number of abortions per 1,000 women per 5-year age group. The total abortion rate (TAR), which is expressed per woman, is a summary measure of the age specific rates. The TAR is interpreted as the number of abortions a woman would have in her lifetime if she experienced the currently observed age-specific abortion rates during her childbearing years. The general abortion rate (GAR) is the number of abortions per 1,000 women age 15-49. The age specific abortion rates increase sharply after the age of 19 and are the highest among the 25-29 and 30- 34 age groups. Abortion rates are higher among women living in rural than those in urban areas. The total abortion rate in Macedonia is 0.2. The general abortion rate is 4 per 1000 women. Rh.19: induced abortion rates by area age-specific abortion rates (per 1000 women), total abortion rates (taR), and general abortion rate (GaR) for the two year period preceding the survey, by area, Macedonia, 2011 Area Total Urban Rural age 15-19 0 0 0 20-24 6 1 4 25-29 7 11 8 30-34 6 9 8 35-39 2 10 5 40-44 3 8 5 45-49 0 2 1 TaR 15-49 0.1 0.2 0.2 GaR 2.9 5.8 4.2 Table RH.20 shows the total induced abortion rates (TAR) by background characteristics. As seen in the table, the TAR in rural areas isnearly twice as high as that of urban areas. TAR decreases as the education level increases. Rh.20: induced abortion rates total abortion rates among women age 15-49 for the two years preceding the survey and mean number of abortions among women age 40-49, Macedonia, 2011 Total abortion rate among women age 15-49 Mean number of abortions among women age 40-49 area Urban .1 .4 Rural .2 .4 education Primary or less (.3) .5 Secondary (.1) (.4) High (.1) * Wealth index quintile Poorest 60% .2 .5 Richest 40% .1 .3 Total .2 .4 (*) – figures based on less than 25 unweighted cases ( ) – figures based on 25–49 unweighted cases 89 abortion – Roma settlements Table RH.18R shows the mean number of live births, miscarriages, abortions and stillbirths per Roma woman aged 15-49 years. The mean number of live births per woman is 2. While the average number of miscarriages per woman is 0.2, stillbirths are rare (0.03 per woman). As also shown in Table RH.18R, 23 percent of women aged 15-49 have had at least one induced abortion in their lifetime. There are no pronounced differentials in the experience of abortions with wealth index quintiles. Less educated Roma woman have higher induced abortion rates. The percentage of women who have ever had an induced abortion increases with age. Rh.18R: lifetime experience with wasted pregnancies Mean number of live births, miscarriages, induced abortions and stillbirths, and percentage of women who have ever had an induced abortion, Roma settlements, 2011 Mean number of: percentage of women with at least one induced abortion number of womenlive births Miscarriages induced abortions stillbirths age 15-19 .2 .1 .0 .0 1.0 173 20-24 1.2 .1 .1 .0 9.5 190 25-29 2.1 .2 .3 .0 16.7 166 30-34 2.6 .2 .6 .0 30.5 172 35-39 2.7 .3 .9 .0 38.5 112 40-44 3.0 .4 1.2 .1 37.8 149 45-49 3.0 .2 1.0 .1 39.6 129 education None 2.8 .2 .7 .0 25.9 183 Primary 2.2 .2 .6 .0 25.9 724 Secondary + .7 .1 .1 .0 8.8 184 Wealth index quintile Poorest 2.6 .2 .7 .0 24.2 200 Second 2.3 .3 .7 .0 22.0 202 Middle 1.9 .1 .5 .0 22.3 214 Fourth 1.8 .2 .4 .0 21.9 231 Richest 1.7 .2 .5 .0 24.4 244 Total 2.0 .2 .6 .0 23.0 1091 Table RH.19R shows age specific abortion rates, total abortion rates (TAR), and general abortion rates (GAR). All of the abortion rates refer to the two-year period preceding the survey. Age specific abortion rates express the average number of abortions per 1,000 women per 5-year age group. The total abortion rate (TAR), which is expressed per woman, is a summary measure of the age specific rates. The TAR is interpreted as the number of abortions a woman would have in her lifetime if she experienced the currently observed age-specific abortion rates during her childbearing years. The general abortion rate (GAR) is the number of abortions per 1,000 women aged 15-49. The age specific abortion rates increase sharply after the age of 19 and are the highest among the 25-29 and 30-34 age groups. The total abortion rate in the Roma settlements is 0.9 abortions per woman. The general abortion rate is 29 per 1000 women. Rh.19R: induced abortion rates age-specific abortion rates (per 1000 women), total abortion rates (taR), and general abortion rate (GaR) for the two year period preceding the survey, Roma settlements, 2011 Total age 15-19 6 20-24 30 25-29 39 30-34 67 35-39 (28) 40-44 14 45-49 (0) TaR 15-49 (.9) GaR 28.6 ( ) – figures based on 25–49 unweighted cases 89 90 MultIple IndIcator cluster survey 2011 iX child developMent early Childhood education and learning 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 educational and learning. In Macedonia, 22 percent of children aged 36-59 months attend an organised early childhood education programme (Table CD.1). Urban-rural differentials are considerable – the attendance in urban areas is 37 percent as compared to 6 percent in rural areas. 56 percent of children living in rich households attend such programmes, while the figure drops to 0.3 percent in poor households. It is interesting to note that the proportions of children attending early childhood education programmes at ages 36-47 months (23 percent) and 48-59 months (21 percent) are very similar. Children with mothers that have a higher education and who come from a household headed by a Macedonian are more likely to attend early childhood education programmes. table cd.1: early childhood education percentage of children age 36-59 months who are attending an organized early childhood education programme, Macedonia, 2011 Percentage of children age 36-59 months currently attending early childhood education1 Number of children age 36-59 months sex Male 24.5 293 Female 18.7 267 Region Vardar 44.3 51 East 24.0 49 Southwest 10.3 47 Southeast (29.8) 34 Pelagonia 21.2 58 Polog 5.9 102 Northeast (16.9) 58 Skopje 27.6 162 area Urban 37.2 284 Rural 5.9 277 age of child 36-47 months 22.9 276 48-59 months 20.6 285 Mother’s education Primary or less 1.4 222 Secondary 29.0 222 High 46.5 117 Wealth index quintile Poorest .3 126 Second 6.7 119 Middle 12.9 102 Fourth 37.4 102 Richest 55.9 112 ethnicity of household head Macedonian 36.5 302 Albanian 2.9 206 Other 10.8 52 Total 21.8 561 1 MICS indicator 6.7 ( ) – figures based on 25–49 unweighted cases It is well recognized that a period of rapid brain development occurs in the first three to four years of life, and the quality of home care is the major determinant of the child’s development during this period. In this context, engagements 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. Children should be physically healthy, mentally alert, emotionally secure, socially competent and ready to learn. 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. 91 For almost all (92 percent) of the children aged 36-59 months, an adult household member engaged in four or more activities that promoted learning and school readiness during the three days preceding the survey (Table CD.2). The average number of activities that adults engaged with children was five. The table also indicates that the father’s involvement in one or more activities was only 71 percent. 4 percent of children were living in a household without their fathers. table cd.2: support for learning percentage of children age 36-59 months with whom an adult household member engaged in activities that promote learning and school readiness during the last three days, Macedonia, 2011 Percentage of children age 36-59 months Mean number of activities Percentage of children not living with their natural father Number of children age 36-59 months With whom adult household members engaged in four or more activities1 With whom the father engaged in one or more activities2 Any adult household member engaged with the child The father engaged with the child sex Male 91.6 75.9 5.3 1.8 4.1 293 Female 91.3 65.8 5.3 1.9 3.5 267 Region Vardar 93.9 81.3 5.3 2.3 6.1 51 East 85.5 78.1 5.2 2.3 4.8 49 Southwest 91.5 75.9 5.5 2.2 2.8 47 Southeast (87.6) (66.1) (5.2) (1.4) (4.9) 34 Pelagonia 91.1 70.4 5.3 2.2 .6 58 Polog 91.4 53.4 5.2 1.1 6.1 102 Northeast (99.0) (92.9) (5.6) (2.5) (2.2) 58 Skopje 90.8 68.9 5.2 1.8 3.2 162 area Urban 94.1 78.5 5.5 2.2 4.3 284 Rural 88.8 63.5 5.1 1.5 3.3 277 age 36-47 months 92.8 71.1 5.3 1.9 2.8 276 48-59 months 90.1 71.0 5.3 1.8 4.8 285 Mother’s education Primary or less 84.9 58.4 4.9 1.2 4.2 222 Secondary 96.0 77.4 5.5 2.3 4.0 222 High 95.3 83.0 5.7 2.4 2.8 117 father’s education Primary or less 84.0 64.1 4.9 1.3 .0 170 Secondary 94.2 74.7 5.4 2.1 .0 275 High 96.7 87.5 5.6 2.7 .0 94 Father not in household (*) (*) (*) (*) (*) 21 Wealth index quintiles Poorest 81.3 58.2 4.8 1.2 4.1 126 Second 89.8 63.3 5.1 1.6 7.5 119 Middle 93.4 78.4 5.4 2.0 4.2 102 Fourth 98.6 80.1 5.6 2.2 1.0 102 Richest 96.3 78.8 5.7 2.5 2.0 112 ethnicity of household head Macedonian 94.6 79.2 5.5 2.3 3.0 302 Albanian 90.7 59.8 5.1 1.2 3.8 206 Other 76.5 68.4 4.8 1.7 9.1 52 Total 91.5 71.1 5.3 1.9 3.8 561 1 MICS indicator 6.1 2 MICS Indicator 6.2 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases 92 MultIple IndIcator cluster survey 2011 There are no gender differentials in terms of engagement of adults in activities with children; however, fathers engaged in more activities with male children (76 percent) than with female children (66 percent). Similarly, this percentage is higher in the richest households (96 percent) as opposed to those living in the poorest households (81 percent). There more educated are more likely to be engaged with their children. Exposure to books during the child’s early years not only provides the child with greater understanding of the nature of print, but may also give the child opportunities to see others reading, such as older siblings doing school work. Presence of books is important for later school performance. The mother/ caretaker of all children under age 5 were asked about the number of children’s books or picture books they have for the child, household objects or outside objects, and homemade toys or toys that came from a shop that are available at home. In Macedonia, only 52 percent of children aged 0-59 months live in households where at least three children’s books are present for the child (Table CD.3). The proportion of children with 10 or more books declines to 36 percent. While no gender differentials are observed, urban children appear to have more access to children’s books than those living in rural households. The proportion of under-5 children who have three or more children’s books is 66 percent in urban areas, compared to 38 percent in rural areas. The presence of children’s books is positively correlated with the child’s age- in the homes of 66 percent of children aged 24-59 months, there are 3 or more children’s books, while the figure is 32 percent for children aged 0-23 months. For households that have 10 or more children’s books or picture books, there are regional differentials with the highest proportion of 48 percent in Skopje and the lowest in Polog region at 11 percent. This is different than those based on three or more books where the highest proportion of children is in the Southwest and Southeast regions. Differences are also found, correlated with mother’s education (63 percent for mothers with high education vs. 8 percent for mothers with primary or less education); and with household head ethnicity (57 percent for Macedonians compared to 8 percent for Albanians). 93 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, Macedonia, 2011 Household has for the child: Child plays with: Two or more types of playthings2 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 sex Male 53.0 35.4 32.6 92.0 67.2 72.1 692 Female 51.8 35.7 30.2 91.8 64.5 69.2 684 Region Vardar 59.3 43.9 12.5 94.5 68.0 67.6 100 East 55.5 41.0 41.1 95.3 83.0 85.7 110 Southwest 66.1 34.6 47.6 87.3 66.9 68.0 121 Southeast 68.9 44.9 14.2 95.6 73.5 77.4 83 Pelagonia 55.9 41.7 47.6 89.5 71.2 76.5 156 Polog 31.5 11.1 16.0 89.8 53.4 58.5 256 Northeast 41.7 20.8 23.0 95.3 49.0 55.6 136 Skopje 57.7 48.0 38.2 91.9 70.2 77.1 415 area Urban 66.0 49.4 31.0 94.2 68.9 73.4 701 Rural 38.3 21.1 31.8 89.4 62.8 67.8 675 age 0-23 months 32.0 18.7 22.3 82.3 49.6 53.7 541 24-59 months 65.6 46.4 37.3 98.0 76.4 81.7 835 Mother’s education Primary or less 22.0 8.2 34.8 86.6 59.4 66.2 545 Secondary 68.0 47.8 29.0 95.2 69.2 73.8 522 High 79.7 63.0 29.4 95.5 71.7 73.2 309 Wealth index quintiles Poorest 18.4 5.0 35.6 85.2 65.8 70.4 316 Second 39.6 20.2 35.9 91.5 63.0 69.7 272 Middle 56.0 32.0 31.4 91.9 59.7 66.7 255 Fourth 74.0 60.1 24.3 96.7 64.7 67.4 261 Richest 80.8 66.2 28.7 95.3 75.7 78.8 272 ethnicity of household head Macedonian 75.4 57.4 29.3 95.8 74.8 77.6 708 Albanian 25.0 8.3 34.2 86.9 52.0 60.2 521 Other 39.1 26.8 31.6 90.3 72.1 74.4 148 Total 52.4 35.5 31.4 91.9 65.9 70.7 1376 1 MICS indicator 6.3 2 MICS indicator 6.4 Table CD.3 also shows that 71 percent of children aged 0-59 months had 2 or more types of playthings to play with in their homes. The type of playthings in MICS included homemade toys (such as dolls and cars, or other toys made at home), toys that came from a store, and household objects (such as pots and bowls) or objects and materials found outside the home (such as sticks, rocks, animal shells, or leaves). It is interesting to note that 92 percent of children play with toys that come from a store; however, the percentages for other types of toys is 31 percent. Differentials are small by socioeconomic status of the households, and regions. Leaving children alone or in the presence of other young children is known to increase the risk of accidents. In the MICS, two questions were asked to find out whether children aged 0-59 months were left 94 MultIple IndIcator cluster survey 2011 alone during the week preceding the interview, and whether children were left in the care of other children under 10 years of age. Table CD.4 shows that 4 percent of children aged 0-59 months were left in the care of other children, while 3 percent were left alone during the week preceding the interview. Combining the two care indicators, it is calculated that 5 percent of children were left with inadequate care during the week preceding the survey, either by being left alone or in the care of another child. No differences were observed by the sex of the child. On the other hand, inadequate care was more prevalent in rural areas (8 percent) compared to urban areas (2 percent), among children whose mothers had secondary education (3 percent), as opposed to children whose mothers had primary or no education (8 percent). Differentials by region are small, while notable differences are observed in regard to socioeconomic status of the household with highest prevalence of inadequate care in poorest households (11 percent) and lowest in richest households (1 percent), in regard to the ethnicity of household head with2 percent among Macedonians opposed to 9 percent among Albanians. 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, Macedonia, 2011 Percentage of children under age 5 Number of children under age 5Left 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 sex Male 2.2 3.5 5.2 692 Female 2.9 4.0 4.9 684 Region Vardar .0 2.3 2.3 100 East 1.5 3.3 4.2 110 Southwest 12.2 10.6 14.9 121 Southeast .0 1.7 1.7 83 Pelagonia 4.9 6.0 8.8 156 Polog .7 2.7 3.2 256 Northeast 4.5 1.1 5.6 136 Skopje .7 3.2 3.2 415 area Urban 1.2 1.6 2.4 701 Rural 3.9 5.9 7.8 675 age 0-23 months 1.8 3.3 3.7 541 24-59 months 3.0 4.0 6.0 835 Mother’s education Primary or less 3.2 5.9 7.9 545 Secondary 1.3 1.9 2.7 522 High 3.4 3.0 3.9 309 Wealth index quintiles Poorest 4.8 8.1 10.6 316 Second 2.6 3.3 5.2 272 Middle 1.3 1.7 3.0 255 Fourth 3.0 4.2 4.2 261 Richest .6 .6 1.2 272 ethnicity of household head Macedonian .5 1.3 1.8 708 Albanian 5.8 6.4 9.2 521 Other .8 6.0 6.0 148 Total 2.5 3.7 5.0 1376 1 MICS indicator 6.5 95 early childhood education and learning – Roma settlements It is well recognized that a period of rapid brain development occurs in the first three to four years of life, and the quality of home care is the major determinant of the child’s development during this period. In this context, engagements 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. Children should be physically healthy, mentally alert, emotionally secure, socially competent and ready to learn. 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 two thirds of Roma children aged 36-59 months (62 percent), an adult household member engaged in four or more activities that promoted learning and school readiness during the three days preceding the survey (Table CD.2R). The average number of activities that adults engaged with children was four. The table also indicates that the fathers’ involvement in one or more activities was only 57 percent. 10 percent of children were living in a household without their fathers. 95 Only 4 percent of children in Roma settlements aged 36-59 months are attending an organised early childhood education programme (Table CD.1R). table cd.1R: early childhood education percentage of children age 36-59 months who are attending an organized early childhood education programme, Roma settlements, 2011 Percentage of children age 36-59 months currently attending early childhood education1 Number of children age 36- 59 months sex Male 6.5 100 Female 1.1 98 age of child 36-47 months 5.3 92 48-59 months 2.6 105 Mother’s education None (1.2) 38 Primary 3.5 144 Secondary + (*) 16 Wealth index quintile Poorest 60% 3.3 135 Richest 40% 7.5 63 Total 3.9 198 1 MICS indicator 6.7 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases 96 MultIple IndIcator cluster survey 2011 table cd.2R: support for learning percentage of children age 36-59 months with whom an adult household member engaged in activities that promote learning and school readiness during the last three days, Roma settlements, 2011 Percentage of children age 36-59 months Mean number of activities Percentage of children not living with their natural father Number of children age 36-59 months With whom adult household members engaged in four or more activities1 With whom the father engaged in one or more activities2 Any adult household member engaged with the child The father engaged with the child sex Male 68.4 61.7 4.1 1.5 4.4 100 Female 55.1 51.9 3.5 1.2 15.9 98 age 36-47 months 62.8 61.1 3.9 1.6 10.3 92 48-59 months 61.0 53.1 3.8 1.2 9.9 105 Mother’s education None (68.0) (58.9) (4.0) (1.3) (7.9) 38 Primary 58.1 56.8 3.6 1.3 11.8 144 Secondary + (*) (*) (*) (*) (*) 16 father’s education None (*) (*) (*) (*) (*) 27 Primary 61.2 64.1 3.7 1.6 .0 128 Secondary + (91.3) (70.2) (5.3) (1.9) (.0) 23 Father not in household (*) (*) (*) (*) (*) 20 Wealth index Poorest 60% 55.4 55.4 3.5 1.2 5.8 135 Richest 40% 70.1 58.2 4.3 1.5 7.5 63 Total 61.8 56.8 3.8 1.3 10.1 198 1 MICS indicator 6.1 2 MICS Indicator 6.2 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases Exposure to books during the child’s early years not only provides the child with greater understanding of the nature of print, but may also give the child opportunities to see others reading, such as older siblings doing school work. Presence of books is important for later school performance. The mother/ caretaker of all children under age 5 were asked about the number of children’s books or picture books they have for the child, household objects or outside objects, and homemade toys or toys that came from a shop that are available at home. In Macedonia, only 27 percent of the children in Roma settlements aged 0-59 months live in households where at least three children’s books are present for the child (Table CD.3R). The proportion of children with 10 or more books declines to 12 percent. The presence of children’s books is positively correlated with the child’s age; in the homes of 34 percent of children aged 24-59 months, there are 3 or more children’s books, while the figure is 16 percent for children aged 0-23 months. When children for whom there are 10 or more children’s books or picture books are taken into account, notable differences are correlated with socio- economic status with the highest proportion of 29 percent in richest households and only 3 percent in poorest. 97 table cd.3R: 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, Roma settlements, 2011 Household has for the child: Child plays with: Two or more types of playthings2 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 sex Male 29.4 12.6 37.2 83.0 56.2 59.6 237 Female 24.8 10.6 36.5 87.5 62.7 64.6 239 age 0-23 months 15.5 7.9 28.8 78.1 43.0 46.6 178 24-59 months 34.0 13.8 41.7 89.5 69.3 71.4 298 Mother’s education None 19.4 6.5 58.8 76.4 55.3 64.5 102 Primary 25.0 10.1 32.4 86.4 61.5 62.6 327 Secondary + (57.4) (32.7) (20.9) (95.9) (54.7) (53.8) 48 Wealth index quintiles Poorest 16.1 3.4 40.6 74.2 62.7 66.9 122 Second 21.6 6.9 42.5 90.9 66.7 69.2 108 Middle 28.3 10.7 24.0 82.0 50.5 48.5 93 Fourth 29.5 15.7 45.0 92.6 56.4 65.3 79 Richest 49.5 28.8 29.7 91.4 58.3 57.3 73 Total 27.1 11.6 36.9 85.2 59.5 62.1 476 1 MICS indicator 6.3 2 MICS indicator 6.4 ( ) – figures based on 25–49 unweighted cases Table CD.3R also shows that 62 percent of children aged 0-59 months had two or more types of playthings to play with in their homes. The playthings surveyed in the MICS included homemade toys (such as dolls and cars, or other toys made at home), toys bought from a store, and household objects (such as pots and bowls) or objects and materials found outside the home (such as sticks, rocks, animal shells, or leaves). It is interesting to note that 85 percent of children play with toys that come from a store; however, the percentages for other types of toys is 37 percent. The proportion of children who have two or more types of playthings is 60 percent among male children and 65 percent among female children. Differentials are small by socioeconomic status of the households. Leaving children alone or in the presence of other young children is known to increase the risk of accidents. In the MICS, two questions were asked to find out whether children aged 0-59 months were left alone during the week preceding the interview, and whether children were left in the care of other children under 10 years of age. Table CD.4R shows that 6 percent of Roma children aged 0-59 months were left in the care of other children, while 2 percent were left alone during the week preceding the interview. Combining the two care indicators, it is calculated that 7 percent of children were left with inadequate care during the week preceding the survey, either by being left alone or in the care of another child. Differences were observed by the sex of the child, i.e. inadequate care was more prevalent in among females (11 percent) compared to males (4 percent). Children aged 24-59 months were left with inadequate care more (10 percent) than those who were aged 0-23 months (3 percent). Differences are observed in regard to socioeconomic status of the household with the highest prevalence of inadequate care in the poorest households (15 percent) and lowest in the richest households (1 percent). 98 MultIple IndIcator cluster survey 2011 table cd.4R: 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, Roma settlements, 2011 Percentage of children under age 5 Number of children under age 5Left 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 sex Male 1.7 3.7 4.2 237 Female 2.1 9.0 10.5 239 age 0-23 months .8 2.7 2.7 178 24-59 months 2.5 8.6 10.1 298 Mother’s education None 6.3 7.1 11.1 102 Primary .8 7.0 7.2 327 Secondary + .0 1.0 1.0 48 Wealth index quintiles Poorest 3.8 14.1 15.0 122 Second .0 3.2 3.2 108 Middle 1.6 8.0 8.7 93 Fourth 3.7 1.8 5.6 79 Richest .0 1.1 1.1 73 Total 1.9 6.4 7.4 476 1 MICS indicator 6.5 98 MultIple IndIcator cluster survey 2011 99 early childhood development Early child 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. A 10-item module that has been developed for the MICS programme was used to calculate the Early Child Development Index (ECDI). The indicator is based on benchmarks that children would be expected to have if they are developing as the majority of children in that age group. The primary purpose of the ECDI is to inform public policy regarding the developmental status of children in Macedonia. Each of the 10 items is used in one of the four domains, to determine if children are developmentally on track in that domain. The domains in question are: „ 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 recog- nize the symbols of all numbers from 1 to 10. If at least two of these are true, then the child is consid- ered 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. 100 MultIple IndIcator cluster survey 2011 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, Macedonia, 2011   Percentage of children age 36-59 months who are developmentally on track for indicated domains Early child development index score1 Number of children age 36-59 months  Literacy-numeracy Physical Social- Emotional Learning sex Male 43.9 99.7 90.4 98.9 92.6 293 Female 43.0 99.6 92.0 98.1 92.8 267 Region Vardar 39.1 98.2 88.8 98.2 87.3 51 East 40.8 100.0 76.8 97.6 81.9 49 Southwest 60.4 99.6 95.3 99.6 97.7 47 Southeast (36.0) (97.3) (79.9) (97.0) (82.8) 34 Pelagonia 56.9 100.0 89.5 100.0 95.7 58 Polog 36.0 100.0 91.6 99.2 94.3 102 Northeast (53.0) (100.0) (100.0) (95.2) (97.4) 58 Skopje 38.7 100.0 94.7 99.0 94.5 162 area Urban 45.2 99.7 89.0 98.7 91.7 284 Rural 41.6 99.6 93.4 98.2 93.7 277 age 36-47 months 30.5 99.3 89.8 97.5 89.1 276 48-59 months 56.0 99.9 92.6 99.5 96.1 285 attendance to early childhood education Attending 43.8 99.2 94.6 100.0 95.4 122 Not attending 43.3 99.8 90.3 98.1 91.9 439 Mother’s education Primary or less 38.6 99.9 90.3 96.7 91.4 222 Secondary 46.1 99.2 89.9 99.5 91.8 222 High 47.6 100.0 95.3 100.0 96.8 117 Wealth index quintiles Poorest 36.6 100.0 91.2 97.3 91.5 126 Second 44.1 99.1 92.1 96.4 90.7 119 Middle 46.4 100.0 84.7 99.2 90.8 102 Fourth 48.4 99.1 92.9 100.0 94.1 102 Richest 43.3 100.0 94.7 100.0 96.5 112 ethnicity of household head Macedonian 44.3 99.4 90.0 99.6 92.7 302 Albanian 44.5 99.9 94.0 98.6 94.6 206 Other 34.6 100.0 87.1 91.7 85.0 52 Total 43.4 99.6 91.2 98.5 92.7 561 1 MICS indicator 6.6 ( ) – figures based on 25–49 unweighted cases In Macedonia, 93 percent of children aged 36-59 months are developmentally on track (Table CD.5). ECDI is higher in older age group (96 percent among 48-59 months old compared to 89 percent among 36-47 months old), since children mature more skills with increasing age. Children living in the poorest households have lower ECDI (92 percent) compared to children living in richest households (97 percent of children are developmentally on track). The analysis of four domains of child development shows that all children are on track in the learning and in physical domain, but much less on track in literacy-numeracy (43 percent). Of all children, 91 percent are on track in social-emotional domains. 101 early childhood development – Roma settlements The analysis of four domains of child development shows that 92 percent of Roma children are on track in the learning domain and even more (98 percent) in physical, but significantly less on track in literacy- numeracy (16 percent). Of all Roma children, 72 percent are on track in social-emotional domains. In each individual domain the higher score is associated with older children. 101 table cd.5R: 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, Roma settlements, 2011   Percentage of children age 36-59 months who are developmentally on track for indicated domains Early child development index score1 Number of children age 36-59 months  Literacy-numeracy Physical Social- Emotional Learning sex Male 18.9 100.0 65.0 92.5 65.8 100 Female 12.5 95.8 78.8 91.4 78.8 98 age 36-47 months 8.8 95.6 70.6 87.6 69.6 92 48-59 months 21.8 100.0 73.0 95.8 74.6 105 attendance to early childhood education Attending (*) (*) (*) (*) (*) 8 Not attending 14.1 97.8 71.6 91.9 71.1 190 Mother’s education None (19.4) (100.0) (56.1) (81.2) (62.4) 38 Primary 13.2 97.2 74.6 93.9 73.2 144 Secondary + (*) (*) (*) (*) (*) 16 Wealth index quintiles Poorest 60% 12.4 99.2 76.0 95.0 76.0 135 Richest 40% 29.9 100.0 83.6 94.0 85.1 63 Total 15.7 97.9 71.9 92.0 72.2 198 1 MICS indicator 6.6 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases In Macedonia, 72 percent of the children in Roma settlements aged 36-59 months are developmentally on track (Table CD.5R). ECDI is lower among boys (66 percent) than girls (79 percent). ECDI is higher in the older age group (75 percent among 48-59 months old compared to 70 percent among 36-47 months old), since children mature more skills with increasing age. 102 MultIple IndIcator cluster survey 2011 X liteRacy and education literacy among young Women One of the World Fit for Children goals is to assure adult literacy. Adult literacy is also an MDG indicator. Literacy in the MICS is assessed on the ability of the respondent to read a short simple statement, or based on their school attendance. Literacy rates are presented in Table ED.1. Table ED.1 indicates that almost all women (97 percent) in Macedonia are literate. Literacy status is higher than 95 percent in all regions, except in the East region (89 percent). Of women who stated that primary school was their highest level of education or had no education, 87 percent were able to read the statement shown to them. Young women aged 15-19, living in urban areas, from the richest households, and who are Macedonians, are the most literate (99 – 100 percent). table ed.1: literacy among young women percentage of women age 15-24 years who are literate, Macedonia, 2011 Percentage literate1 Percentage not known Number of women age 15- 24 years Region Vardar 95.9 .0 58 East 88.9 .0 61 Southwest 95.8 .4 99 Southeast 96.4 2.8 88 Pelagonia 99.1 .0 144 Polog 97.2 .7 199 Northeast 100.0 .0 108 Skopje 98.5 .3 316 area Urban 99.0 .2 514 Rural 95.9 .8 557 education Primary or less 87.2 2.3 220 Secondary 100.0 .0 553 High 100.0 .0 299 age 15-19 98.6 .3 530 20-24 96.1 .6 541 Wealth index quintile Poorest 91.5 1.0 250 Second 97.7 1.1 210 Middle 99.7 .2 220 Fourth 99.5 .0 214 Richest 100.0 .0 177 ethnicity of household head Macedonian 99.7 .0 574 Albanian 96.8 .4 411 Other 84.6 3.8 87 Total 97.4 .5 1071 1 MICS indicator 7.1; MDG indicator 2.3 103 literacy among young Women – Roma settlements (54 percent) and highest in the richest quintile (90 percent). Of the women in Roma settlements who stated that primary school was their highest level of education, 78 percent were able to read the statement shown to them. table ed.1R: literacy among young women percentage of women age 15-24 years who are literate, Roma settlements, 2011 Percentage literate1 Percentage not known Number of women age 15-24 years education None (3.7) (.0) 39 Primary 78.2 1.2 215 Secondary + 100.0 .0 109 age 15-19 79.0 1.4 173 20-24 74.5 .0 190 Wealth index quintile Poorest 53.6 .0 68 Second 72.6 1.7 63 Middle 82.9 .0 83 Fourth 81.1 .0 72 Richest 89.2 1.8 77 Total 76.6 .7 363 1 MICS indicator 7.1; MDG indicator 2.3 ( ) – figures based on 25–49 unweighted cases 103 The percentage of women in Roma settlements that are literate is presented in Table ED.1R. Table ED.1R indicates that three quarters of the women in Roma settlements (77 percent) in Macedonia are literate and that literacy status varies greatly by wealth index, with the lowest literacy rate in the poorest quintile 104 MultIple IndIcator cluster survey 2011 school Readiness Attendance in pre-school education in an organised learning or child education programme is important for the readiness of children to school. Table ED.2 shows the proportion of children in the first grade of primary school that attended pre-school the previous year. Overall, 40 percent of children who are currently attending the first grade of primary school had attended pre-school the previous year. The proportion among females is higher (49 percent) than males (33 percent), while over half of children in urban areas (53 percent) had attended pre-school the previous year compared to 25 percent among children living in rural areas. table ed.2: school readiness percentage of children attending first grade of primary school who attended pre-school the previous year, Macedonia,2011 Percentage of children attending first grade who attended preschool in previous year1 Number of children attending first grade of primary school sex Male 32.9 83 Female 48.8 66 area Urban 52.7 79 Rural 25.4 70 Mother’s education Primary or less 30.5 56 Secondary 42.4 63 High (52.4) 30 ethnicity of household head Macedonian 45.8 87 Albanian 31.1 50 Other (*) 11 Total 40.0 149 1 MICS indicator 7.2 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases school Readiness – Roma settlements21 Attendance in pre-school education in an organised learning or child education programme is important for the readiness of children to school. Overall, 36 percent of the children in Roma settlements who are currently attending the first grade of primary school had attended pre- school the previous year. 21 Table ED.2R is not presented in the report due to the small num- ber of children by background characteristics. 105 primary and secondary school participation Universal access to basic education and the achievement of primary education by the world’s children is one of the most important goals of the Millennium Development Goals and A World Fit for Children. 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. The indicators for primary and secondary school attendance include: „ Net intake rate in primary education „ Primary school net attendance ratio (adjusted) „ Secondary school net attendance ratio (adjusted) „ Female to male education ratio (or gender parity index - GPI) in primary and secondary school The indicators of school progression include: „ Children reaching last grade of primary „ Primary completion rate „ Transition rate to secondary school In Macedonia, children enter primary school at age 6 and enter secondary school at age 14. There are 9 grades in primary school and 4 grades in secondary school. In primary school, grades are referred to as grade 1 to grade 9. For secondary school, grades are referred to as year 1 to year 4. The school year typically runs from September to June the following year. Of children who are of primary school entry age (age 6) in Macedonia, 91 percent are attending the first grade of primary school (Table ED.3). Sex differentials do not exist. In Macedonian households, the proportion is around 95 percent, while it is 88 percent among children living in the Albanian households. table ed.3: primary school entry percentage of children of primary school entry age entering grade 1 (net intake rate), Macedonia, 2011 Percentage of children of primary school entry age entering grade 11 Number of children of primary school entry age sex Male 90.8 93 Female 91.6 77 area Urban 92.4 95 Rural 89.6 75 Mother’s education Primary or less 86.7 68 Secondary 93.6 76 High (95.8) 26 ethnicity of household head Macedonian 95.3 98 Albanian 88.2 58 Other (*) 14 Total 91.2 170 1 MICS indicator 7.3 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases Table ED.4 provides the percentage of children of primary school age (6 to 14 years) who are attending primary or secondary school22. The majority of children who are of primary school age are currently attending school (98 percent). However, 2 percent of the children are out of school when they are expected to be participating in school. There are slight differences by region and no differences by gender, and between urban and rural areas. Net attendance ratio is higher among children living in the richest households. 22 Ratios presented in this table are “adjusted” since they include not only primary school attendance, but also secondary school attendance in the numerator. 105 106 MultIple IndIcator cluster survey 2011 table ed.4: primary school attendance percentage of children of primary school age attending primary or secondary school (adjusted net attendance ratio), Macedonia, 2011 Male Female Total Net attendance ratio (adjusted) Number of children Net attendance ratio (adjusted) Number of children Net attendance ratio (adjusted)1 Number of children Region Vardar 95.4 49 97.3 42 96.3 90 East 93.0 62 99.1 45 95.5 107 Southwest 98.8 86 95.8 77 97.4 163 Southeast 100.0 67 97.8 64 98.9 131 Pelagonia 99.7 100 98.8 93 99.2 192 Polog 98.5 129 98.1 89 98.3 219 Northeast 99.4 79 100.0 89 99.7 167 Skopje 99.2 238 98.2 214 98.7 452 area Urban 98.6 397 98.5 359 98.6 756 Rural 98.4 413 97.8 353 98.1 766 age at beginning of school year 6 93.1 93 91.6 77 92.4 170 7 100.0 85 97.9 67 99.1 152 8 99.6 83 100.0 72 99.8 154 9 98.9 88 100.0 76 99.4 164 10 99.6 105 100.0 88 99.8 193 11 99.1 108 99.6 76 99.3 184 12 98.5 73 97.9 77 98.2 150 13 99.3 77 97.3 86 98.3 163 14 98.5 98 99.1 94 98.8 192 Mother’s education Primary or less 97.2 378 97.5 300 97.3 678 Secondary 99.8 306 98.6 309 99.2 616 High 99.1 122 98.9 101 99.0 223 Cannot be determined (*) 3 (*) 2 (*) 5 Wealth index quintile Poorest 95.8 185 97.3 147 96.5 332 Second 98.4 164 97.3 154 97.9 318 Middle 99.5 164 99.8 138 99.7 302 Fourth 100.0 136 97.5 121 98.8 257 Richest 99.3 161 98.9 152 99.1 313 ethnicity of household head Macedonian 99.8 440 99.0 409 99.4 849 Albanian 98.4 302 97.8 244 98.1 545 Other 90.5 68 94.4 59 92.4 127 Total 98.5 810 98.2 712 98.3 1522 1 MICS indicator 7.4; MDG indicator 2.1 (*) – figures based on less than 25 unweighted cases The secondary school net attendance ratio is presented in Table ED.523. 83 percent of the children of secondary school age are attending secondary school. 23 Ratios presented in this table are “adjusted” since they include not only secondary school attendance, but also attendance to higher levels in the numerator. Of the remaining, some are either out of school or attending primary school. 1 percent of children of secondary school age are attending primary school when they should be attending secondary school, while the remaining 16 percent are not attending school at all. Children living in urban areas are more likely to 107 attend secondary school (92 percent) than in rural (76 percent). There are differences by socioeconomic status, with lowest net attendance ratio among children living in poorest households (62 percent) and highest in richest households (99 percent); and by ethnicity, attendance is higher among Macedonians (89 percent) than Albanians (77 percent). Net attendance ratio among males is 84 percent, and 81 percent for females. Age differentials are remarkable, with a higher ratio among children at age 15 at the beginning of school year (93 percent) compared to 64 percent at age 18. table ed.5: secondary school attendance percentage of children of secondary school age attending secondary school or higher (adjusted net attendance ratio) and percentage of children attending primary school, Macedonia, 2011 Male Female Total Ne t a tte nd an ce ra tio (a dj us te d) 1 Pe rc en t at te nd in g pr im ar y s ch oo l Nu m be r o f ch ild re n Ne t a tte nd an ce ra tio (a dj us te d) 1 Pe rc en t at te nd in g pr im ar y s ch oo l Nu m be r o f ch ild re n Ne t a tte nd an ce ra tio (a dj us te d) 1 Pe rc en t at te nd in g pr im ar y s ch oo l Nu m be r o f ch ild re n Region Vardar (79.8) (.0) 31 (*) (*) 16 (85.9) (.0) 47 East (*) (*) 20 (*) (*) 24 (86.0) (2.1) 45 Southwest 85.4 .0 57 67.0 .9 39 77.9 .4 96 Southeast (74.9) (.0) 48 (90.5) (.0) 34 81.3 .0 82 Pelagonia (93.6) (.0) 44 95.9 .0 61 95.0 .0 105 Polog 83.0 .0 75 67.3 .0 77 75.0 .0 152 Northeast 70.3 3.8 66 (83.4) (.0) 44 75.6 2.3 109 Skopje 91.3 .6 138 79.9 2.4 94 86.7 1.3 233 area Urban 91.4 1.3 221 91.9 .9 166 91.6 1.1 387 Rural 77.5 .6 257 73.2 .5 224 75.5 .6 481 age at beginning of school year 15 94.4 2.8 118 90.9 2.6 102 92.8 2.7 221 16 89.0 .8 124 88.8 .0 85 88.9 .5 208 17 82.0 .0 128 85.1 .0 112 83.5 .0 240 18 69.0 .0 108 58.0 .0 91 64.0 .0 199 Mother’s education Primary or less 83.7 2.5 137 84.2 .7 112 84.0 1.7 249 Secondary 98.9 1.1 90 97.5 2.5 73 98.3 1.7 163 High (100.0) (.0) 47 (*) (*) 25 100.0 .0 72 Cannot be determined (*) (*) 13 (*) (*) 13 (86.7) (.0) 26 Wealth index quintile Poorest 65.6 .9 97 57.9 .7 107 61.6 .8 204 Second 75.3 2.1 117 77.4 .0 71 76.1 1.3 188 Middle 89.3 .0 97 91.9 .4 89 90.5 .2 186 Fourth 94.9 1.2 81 92.7 2.4 62 94.0 1.7 142 Richest 100.0 .0 87 98.5 .0 61 99.4 .0 148 ethnicity of household head Macedonian 85.5 .0 256 92.7 1.1 205 88.7 .5 461 Albanian 85.1 1.4 178 67.9 .0 155 77.1 .7 333 Other (70.6) (4.2) 45 (69.8) (1.2) 30 70.3 3.0 74 Total 84.0 .9 478 81.1 .7 390 82.7 .8 868 1 MICS indicator 7.5 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases 108 MultIple IndIcator cluster survey 2011 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, almost all (99 percent) will eventually reach the last grade of primary school. This number includes children that repeat grades but will eventually reach the last grade. There are no differences based on gender, area or ethnicity. 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), Macedonia, 2011 Pe rc en t a tte nd in g gr ad e 1 la st sc ho ol ye ar w ho a re in gr ad e 2 th is sc ho ol ye ar Pe rc en t a tte nd in g gr ad e 2 la st sc ho ol ye ar w ho ar e at te nd in g gr ad e 3 th is sc ho ol ye ar Pe rc en t a tte nd in g gr ad e 3 la st sc ho ol ye ar w ho ar e at te nd in g gr ad e 4 th is sc ho ol ye ar Pe rc en t a tte nd in g gr ad e 4 la st sc ho ol ye ar w ho ar e at te nd in g gr ad e 5 th is sc ho ol ye ar Pe rc en t a tte nd in g gr ad e 5 la st sc ho ol ye ar w ho ar e at te nd in g gr ad e 6 th is sc ho ol ye ar Pe rc en t a tte nd in g gr ad e 6 la st sc ho ol ye ar w ho ar e at te nd in g gr ad e 7 th is sc ho ol ye ar Pe rc en t a tte nd in g gr ad e 7 la st sc ho ol ye ar w ho ar e at te nd in g gr ad e 8 th is sc ho ol ye ar Pe rc en t w ho re ac h gr ad e 8 of th os e w ho e nt er g ra de 1 1 sex Male 100.0 100.0 100.0 99.0 100.0 98.7 100.0 97.6 Female 100.0 100.0 100.0 100.0 100.0 100.0 99.5 99.5 area Urban 100.0 100.0 100.0 100.0 100.0 98.8 100.0 98.8 Rural 100.0 100.0 100.0 98.9 100.0 100.0 99.6 98.5 Mother’s education Primary or less 100.0 100.0 100.0 98.7 100.0 100.0 99.5 98.2 Secondary 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 High (*) (*) (*) (100.0) (*) 100.0 100.0 100.0 Wealth index quintile Poorest (100.0) (100.0) (100.0) 97.6 100.0 100.0 98.9 96.5 Second 100.0 (100.0) 100.0 100.0 (100.0) 97.2 100.0 97.2 Middle 100.0 (100.0) (100.0) 100.0 (100.0) 100.0 100.0 100.0 Fourth (100.0) (100.0) (100.0) 100.0 (100.0) 100.0 100.0 100.0 Richest (100.0) (100.0) (100.0) 100.0 (100.0) 100.0 100.0 100.0 ethnicity of household head Macedonian 100.0 100.0 100.0 99.4 100.0 100.0 100.0 99.4 Albanian 100.0 100.0 100.0 100.0 100.0 100.0 99.4 99.4 Other (*) (*) (*) 97.9 (*) 93.4 100.0 91.4 Total 100.0 100.0 100.0 99.5 100.0 99.4 99.8 98.6 1 MICS indicator 7.6; MDG indicator 2.2 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases 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. At the time of the survey, the primary school completion rate was 97 percent. 98 percent of the children that successfully completed the last grade of primary school were attending the first grade of secondary school, at the time of the survey. The transition rate to secondary school was 100 percent in urban area and among Macedonians. 109 table ed.7: primary school completion and transition to secondary school primary school completion rates and transition rate to secondary school, Macedonia, 2011 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 sex Male 102.8 98 98.9 95 Female 91.8 94 97.1 91 area Urban 98.1 87 100.0 85 Rural 96.9 105 96.4 101 Mother’s education Primary or less 88.9 104 96.2 98 Secondary 119.2 55 100.0 55 High (97.6) 28 (100.0) 27 Cannot be determined (*) 5 (*) 6 ethnicity of household head Macedonian 94.6 96 100.0 99 Albanian 104.7 79 95.2 77 Other (*) 17 (*) 10 Total 97.4 192 98.0 186 1 MICS indicator 7.7 2 MICS indicator 7.8 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases 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 ratios rather than gross attendance ratios. The last ratios provide an erroneous description of the GPI mainly because in most of the cases the majority of over-aged children attending primary education tend to be boys. The table shows that gender parity for primary school is 1, indicating no difference in the attendance of girls and boys to primary school. However, the indicator drops to 0.96 for secondary education. The disadvantage of girls is particularly pronounced in the Southwest and Polog regions, as well as among children living in the poorest households, in rural areas, and in Albanian households. 110 MultIple IndIcator cluster survey 2011 table ed.8: education gender parity Ratio of adjusted net attendance ratios of girls to boys, in primary and secondary school, Macedonia, 2011 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 Region Vardar (97.3) (95.4) (1.02) (97.3) (89.5) (1.09) East (99.1) 93.0 (1.07) (87.4) (84.4) (1.04) Southwest 95.8 98.8 .97 69.6 86.8 .80 Southeast (97.8) (100.0) (.98) 97.1 81.4 1.19 Pelagonia 98.8 99.7 .99 95.9 95.5 1.00 Polog 98.1 98.5 1.00 68.9 85.6 .81 Northeast 100.0 99.4 1.01 86.3 76.7 1.13 Skopje 98.2 99.2 .99 83.6 93.3 .90 area Urban 98.5 98.6 1.00 93.3 93.8 1.00 Rural 97.8 98.4 .99 76.3 82.0 .93 education of mother/caretaker Primary or less 97.5 97.2 1.00 84.2 83.7 1.01 Secondary 98.6 99.8 .99 97.5 98.9 .99 High 98.9 99.1 1.00 100.0 100.0 1.00 Cannot be determined na na na (*) (*) (*) Wealth index quintile Poorest 97.3 95.8 1.02 60.6 71.3 .85 Second 97.3 98.4 .99 78.7 79.9 .99 Middle 99.8 99.5 1.00 96.3 93.8 1.03 Fourth 97.5 100.0 .97 93.8 96.4 .97 Richest 98.9 99.3 1.00 100.0 100.0 1.00 ethnicity of household head Macedonian 99.0 99.8 .99 95.5 90.0 1.06 Albanian 97.8 98.4 .99 70.1 87.4 .80 Other (94.4) 90.5 (1.04) 70.7 73.0 .97 Total 98.2 98.5 1.00 83.5 87.4 .96 1 MICS indicator 7.9; MDG indicator 3.1 2 MICS indicator 7.10; MDG indicator 3.1 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases 111 primary and secondary school participation – Roma settlements 111 The majority of children of primary school age are attending school (86 percent). However, 14 percent of the children are out of school when they are expected to be participating in school. Net attendance ratio is higher among Roma children living in richest households. There are no gender differences. After the age of 6, primary school attendance tends to decrease with age. table ed.4R: primary school attendance percentage of children of primary school age attending primary or secondary school (adjusted net attendance ratio), Roma settlements, 2011 Male Female Total Net attendance ratio (adjusted) Number of children Net attendance ratio (adjusted) Number of children Net attendance ratio (adjusted)1 Number of children age at beginning of school year 6 (81.3) 36 (91.6) 38 86.6 74 7 (93.6) 44 90.9 56 92.1 101 8 (93.4) 37 (90.7) 38 92.0 75 9 (88.9) 35 (90.2) 43 89.6 78 10 (91.7) 37 (85.3) 27 89.0 64 11 (*) 27 (85.4) 39 86.0 66 12 (83.0) 31 (89.1) 30 86.0 61 13 (76.7) 36 (75.9) 42 76.3 78 14 (74.6) 40 (70.1) 39 72.4 79 Mother’s education  None 83.0 65 77.2 75 79.9 140 Primary 86.5 238 87.1 254 86.8 492 Secondary + (*) 19 (*) 23 (93.4) 43 Cannot be determined (*) 1 (*) 0 (*) 1 Wealth index quintile  Poorest 64.9 78 69 87 67.1 165 Second 92.1 60 93.2 87 92.8 147 Middle 91 68 75.7 55 84.2 123 Fourth 90.3 65 93.8 68 92.1 133 Richest 96.3 52 99.1 57 97.7 109 Total 85.7 323 85.6 353 85.6 676 1 MICS indicator 7.4; MDG indicator 2.1 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases The secondary school net attendance ratio is presented in Table ED.5R25. Only 38 percent of the Roma children of secondary school age are attending secondary school. Of the remaining, some are either out of school or attending primary school. 4 percent of the children of secondary school age are attending primary 25 Ratios presented in this table are “adjusted” since they include not only secondary school attendance, but also attendance to higher levels in the numerator. school when they should be attending secondary school, while the remaining half (58 percent) are not attending school at all. Differences were observed based on socioeconomic status, with the lowest net attendance ratio among children living in the poorest households (16 percent) and highest in the richest households (66 percent). Gender differences are slight with a higher net attendance ratio among males (42 percent) compared to females (35 percent). Of Roma children who are of primary school entry age (age 6) in Roma settlements, 84 percent are attending the first grade of primary school. Table ED.4R provides the percentage of the children in Roma settlements of primary school age (6 to 14 years) who are attending primary or secondary school24. 24 Ratios presented in this table are “adjusted” since they include not only primary school attendance, but also secondary school attendance in the numerator. 112 MultIple IndIcator cluster survey 2011 table ed.5R: secondary school attendance percentage of children of secondary school age attending secondary school or higher (adjusted net attendance ratio) and percentage of children attending primary school, Roma settlements, 2011 Male Female Total Ne t a tte nd an ce ra tio (a dj us te d) 1 Pe rc en t a tte nd in g pr im ar y s ch oo l Nu m be r o f c hi ld re n Ne t a tte nd an ce ra tio (a dj us te d) 1 Pe rc en t a tte nd in g pr im ar y s ch oo l Nu m be r o f c hi ld re n Ne t a tte nd an ce ra tio (a dj us te d) 1 Pe rc en t a tte nd in g pr im ar y s ch oo l Nu m be r o f c hi ld re n age at beginning of school year 15 (37.5) (19.5) 33 (35.4) (8.0) 34 36.4 13.7 66 16 54.0 2.7 55 39.3 2.7 51 46.9 2.7 106 17 (47.9) (2.2) 31 (23.9) .0 35 35.3 1.1 66 18 (17.9) (.0) 32 (*) (*) 24 27.0 .0 55 Mother’s education None (*) (*) 20 (*) (*) 12 (24.1) (16.7) 32 Primary 55.7 5.1 65 45.8 8.1 50 51.4 6.4 115 Secondary + (*) (*) 6 (*) (*) 3 (*) (*) 9 Cannot be determined (*) (*) 6 (12.4) (.0) 30 (15.6) (.0) 36 Wealth index quintile Poorest (14.0) (6.5) 34 (17.1) (4.6) 34 15.6 5.6 68 Second (44.6) (12.5) 22 (10.8) (.0) 28 25.9 5.6 50 Middle (28.9) (7.3) 26 (43.9) (1.6) 28 36.7 4.4 54 Fourth (56.8) (2.4) 31 (38.6) (5.0) 25 48.5 3.6 56 Richest (61.3) (2.5) 37 (66.8) (2.7) 28 63.7 2.6 65 Total 41.6 5.7 151 34.7 2.8 143 38.2 4.3 294 1 MICS indicator 7.5 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases The percentage of children entering first grade who eventually reach the last grade of primary school was calculated in the survey. Of all Roma children starting grade one, the majority (89 percent) eventually reach the last grade. This number includes children that repeat grades but eventually reach the last grade. The primary school completion rate and transition rate to secondary education was also calculated. 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. At the time of the survey, the primary school completion rate was 67 percent. 80 percent of the Roma children that successfully completed the last grade of primary school were attending the first grade of secondary school, at the time of the survey. The ratio of girls to boys attending primary and secondary education is provided in Table ED.8R. These ratios are better known as the Gender Parity Index (GPI). The ratios included here are obtained from net attendance ratios rather than gross attendance ratios. The last ratios provide an erroneous description of the GPI mainly because in most of the cases the majority of over-aged children attending primary education tend to be boys. The table shows that gender parity for primary school is 1, indicating no difference in the attendance of girls and boys to primary school. However, the indicator drops to 0.8 for secondary education. 113 table ed.8R: education gender parity Ratio of adjusted net attendance ratios of girls to boys, in primary and secondary school, Roma settlements, 2011 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 education of mother/caretaker None 77.2 83.0 .93 46.7 10.2 4.57 Primary 87.1 86.5 1.01 45.8 55.7 .82 Secondary + (*) (*) (*) (*) (*) (*) Cannot be determined na na na (12.4) (*) (*) Wealth index quintile Poorest 69.0 64.9 1.06 17.1 14.0 1.22 Second 93.2 (92.1) (1.01) (10.8) (44.6) (.24) Middle (75.7) 91.0 (.83) 43.9 (28.9) (1.52) Fourth 93.8 (90.3) (1.04) (38.6) 59.2 (.65) Richest (99.1) (96.3) (1.03) (66.8) 67.2 (.99) Total 85.6 85.7 1.00 34.7 43.5 .80 1 MICS indicator 7.9; MDG indicator 3.1 2 MICS indicator 7.10; MDG indicator 3.1 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases 114 MultIple IndIcator cluster survey 2011 Xi child pRotection birth Registration The International Convention on the Rights of the Child states that every child has the right to a name and a nationality and the right to protection from being deprived of his or her identity. Birth registration is a fundamental means of securing these rights for children. The World Fit for Children states the goal to develop systems to ensure the registration of every child at or shortly after birth, and fulfil his or her right to acquire a name and a nationality, in accordance with national laws and relevant international instruments. The MICS indicator related to birth registration is the percentage of children under 5 years of age whose birth is registered. In Macedonia, 99.7 percent of children were registered at birth, as presented in Table CP.1. No variations among different groups were found. Due to the small number of non-registered children (4 children in total), information on that group is not included in the table. Three of these children are from the rural area and one from the urban area; three are female, one male child. table cp.1: birth registration percentage of children under age 5 by whether birth is registered, Macedonia, 2011 Children under age 5 whose birth is registered with civil authorities Number of children Has birth certificate No birth certificate Total registered1Seen Not seen sex Male 65.2 33.2 1.5 99.9 692 Female 69.5 28.3 1.7 99.6 684 Region Vardar 85.8 13.1 1.1 100.0 100 East 68.4 30.5 1.1 100.0 110 Southwest 72.7 22.6 3.8 99.1 121 Southeast 54.6 45.4 .0 100.0 83 Pelagonia 56.9 41.5 1.3 99.7 156 Polog 73.6 22.7 3.5 99.7 256 Northeast 38.4 61.6 .0 100.0 136 Skopje 73.2 25.4 1.0 99.7 415 area Urban 68.1 31.2 .6 99.9 701 Rural 66.6 30.4 2.6 99.6 675 age 0-11 months 69.3 25.3 4.3 98.8 258 12-23 months 65.2 33.3 1.5 100.0 283 24-35 months 68.9 30.5 .6 100.0 274 36-47 months 68.9 30.4 .7 100.0 276 48-59 months 64.9 34.0 .9 99.8 285 Mother’s education Primary or less 61.4 35.6 2.5 99.5 545 Secondary 68.9 30.1 .8 99.9 522 High 75.3 23.4 1.4 100.0 309 Wealth index quintile Poorest 62.9 33.7 2.7 99.2 316 Second 65.9 32.2 1.7 99.8 272 Middle 62.5 35.3 2.0 99.7 255 Fourth 69.9 29.9 .2 100.0 261 Richest 76.1 22.8 1.1 100.0 272 ethnicity of household head Macedonian 71.0 28.4 .6 100.0 708 Albanian 62.7 34.1 3.1 99.8 521 Other 66.3 30.9 1.2 98.4 148 Total 67.4 30.8 1.6 99.7 1376 1 MICS indicator 8.1 115 birth Registration – Roma settlements In Roma settlements in Macedonia, the births of 98 percent of the children under five years old were registered (Table CP.1R). There are no variations in birth registration across sex, age, or education categories. Total number of non-registered children is eight. As such, the data for that group is not presented in the Table CP.1R. There are four boys and four girls; six are from the poorest quintile and six have mothers with no education. table cp.1R: birth registration percentage of children under age 5 by whether birth is registered, Roma settlements, 2011 Children under age 5 whose birth is registered with civil authorities Number of children Has birth certificate No birth certificate Total registered1Seen Not seen sex Male 64.2 32.9 1.4 98.5 237 Female 57.5 40.4 .4 98.3 239 age 0-11 months 63.1 30.5 3.1 96.7 79 12-23 months 61.2 36.0 1.5 98.7 99 24-35 months 55.2 41.6 .3 97.1 100 36-47 months 70.1 28.9 .0 99.0 92 48-59 months 56.0 44.0 .0 100.0 105 Mother’s education None 58.6 33.2 2.3 94.1 102 Primary 58.0 41.1 .6 99.7 327 Secondary + (84.9) (13.8) (.0) (98.7) 48 Wealth index quintile Poorest 43.0 50.6 1.5 95.1 122 Second 56.8 42.7 .5 100.0 108 Middle 66.6 31.0 1.3 98.9 93 Fourth 77.1 22.9 .0 100.0 79 Richest 71.6 26.6 1.0 99.2 73 Total 60.8 36.7 .9 98.4 476 1 MICS indicator 8.1 ( ) – figures based on 25–49 unweighted cases 115 116 MultIple IndIcator cluster survey 2011 child labour Article 32 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 World Fit for Children has nine strategies to combat child labour and the MDGs call for the protection of children against exploitation. In the MICS questionnaire, a number of questions addressed the issue of child labour, that is, children 5-14 years of age involved in labour activities. A child is considered to be involved in child labour activities at the moment of the survey if during the week preceding the survey: „ A child aged 5-11 is engaged in at least one hour of economic work or 28 hours of domestic work per week. „ A child aged 12-14 is engaged in at least 14 hours of economic work or 28 hours of domestic work per week. This definition allows differentiation between child labour and child work, and identifies the type of work that should be eliminated. As such, the estimate provided here is a minimum of the prevalence of child labour since some children may be involved in hazardous labour activities for a number of hours that could be less than the numbers specified in the criteria explained above. Table CP.2 presents the results of child labour by the type of work. Percentages do not add up to the total number of child labourers, as children may be involved in more than one type of work. In Macedonia, MICS 4 estimates there are 17 percent of children involved in child labour activities. As presented in the table, the percentage of children aged 5-11 involved in child labour is 23, while for children aged 12-14 it is 0.9 percent. Furthermore, all child labour in the younger group is related to the economic activity category for at least one hour. This means that almost all child labour recorded in the survey is due to the economic activity of at least one hour among children aged 5-11. The incidence is higher in rural settings (23 percent) compared to urban (10 percent); in the poorest quintile (27 percent); and for the children of less educated mothers. Child labour is lowest in Skopje and Vardar regions (less than 10 percent), while in Southeast and Polog it is above 30 percent. No gender differences were found. 117 table cp.2: child labour percentage of children by involvement in economic activity and household chores during the past week, according to age groups, and percentage of children age 5-14 involved in child labour, Macedonia, 2011   Percentage of children age 5-11 involved in: Percentage of children age 12-14 involved in: To ta l c hi ld la bo ur 1 Nu m be r o f c hi ld re n ag e 5- 14 ye ar s   Economic activity Ec on om ic ac tiv ity fo r a t l ea st on e ho ur Ho us eh ol d ch or es le ss th an 28 h ou rs Ho us eh ol d ch or es fo r 2 8 ho ur s o r m or e Ch ild la bo ur Nu m be r o f c hi ld re n ag e 5 -1 1 Economic activity Ec on om ic ac tiv ity le ss th an 14 h ou rs Ec on om ic ac tiv ity fo r 1 4 ho ur s or m or e Ho us eh ol d ch or es le ss th an 28 h ou rs Ho us eh ol d ch or es fo r 2 8 ho ur s o r m or e Ch ild la bo ur Nu m be r o f c hi ld re n ag e 12 -1 4   Working outside household W or kin g fo r f am ily bu sin es s Working outside household W or kin g fo r f am ily bu sin es s Pa id w or k Un pa id w or k Pa id w or k Un pa id w or k sex Male 3.5 11.9 11.4 22.1 44.6 .0 22.1 651 5.2 14.2 24.2 32.4 1.2 62.5 .2 1.4 243 16.4 894 Female 3.7 13.6 13.6 23.7 53.5 .0 23.7 571 4.8 10.7 16.9 26.1 .0 74.9 .5 .5 237 16.9 808 Region Vardar .0 3.8 6.6 7.9 76.1 .0 7.9 67 .0 18.1 28.7 33.1 5.9 91.5 .0 5.9 30 7.3 97 East 3.6 15.4 18.1 25.1 57.2 .0 25.1 94 9.3 17.0 17.2 30.2 .0 87.0 2.5 2.5 29 19.8 123 Southwest 10.1 17.1 24.2 34.6 56.1 .0 34.6 114 14.2 14.6 32.3 43.7 .0 77.4 .0 .0 57 23.0 171 Southeast 3.3 30.8 28.5 46.5 65.0 .0 46.5 103 .0 14.3 24.5 33.1 .0 74.7 .0 .0 39 33.6 142 Pelagonia .9 4.7 8.1 13.5 59.0 .0 13.5 155 1.1 3.5 17.4 20.9 .0 67.2 .6 .6 60 9.9 215 Polog 6.9 32.2 9.6 42.3 40.0 .0 42.3 171 3.7 17.6 18.7 33.0 1.6 55.5 .0 1.6 71 30.4 242 Northeast 4.9 10.5 17.1 26.0 24.0 .0 26.0 134 9.4 19.1 33.3 45.3 .0 62.0 .0 .0 56 18.3 190 Skopje 1.6 2.8 5.7 9.0 43.8 .0 9.0 384 3.3 7.5 10.8 16.3 .0 64.4 .3 .3 138 6.7 521 area Urban 2.1 8.4 7.2 13.8 50.4 .0 13.8 639 2.4 7.0 7.3 15.6 .0 66.1 .3 .3 221 10.3 860 Rural 5.2 17.4 18.2 32.7 46.9 .0 32.7 583 7.2 17.2 31.9 41.0 1.1 70.8 .3 1.4 259 23.1 842 school attendance Yes 3.9 12.8 12.9 23.4 53.5 .0 23.4 993 5.1 12.2 20.3 29.1 .5 69.2 .3 .8 473 16.2 1466 No 2.4 12.2 10.3 20.1 27.9 .0 20.1 229 .0 27.5 36.0 42.0 7.2 34.3 .0 7.2 8 19.6 236 Mother’s education Primary or less 5.6 16.8 15.3 30.6 40.5 .0 30.6 503 5.9 17.9 32.0 42.1 1.3 64.0 .0 1.3 223 21.6 726 Secondary 2.6 11.6 12.2 20.3 54.7 .0 20.3 515 4.4 7.8 11.0 19.0 .0 71.8 .8 .8 191 15.0 706 High 1.2 5.4 6.1 9.8 54.2 .0 9.8 204 3.4 7.8 9.8 15.8 .0 75.1 .0 .0 66 7.4 270 Wealth index quintile Poorest 6.0 20.7 19.1 37.3 45.8 .0 37.3 242 7.7 21.8 37.1 47.7 1.6 69.5 .7 2.4 109 26.5 350 Second 5.1 12.1 17.3 28.1 44.8 .0 28.1 259 7.3 15.5 30.7 41.7 .2 71.4 .7 1.0 100 20.5 359 Middle 4.0 14.8 14.5 24.2 46.2 .0 24.2 238 3.6 11.9 18.3 28.5 .0 60.7 .0 .0 76 18.3 314 Fourth .8 9.2 7.5 13.6 52.5 .0 13.6 221 .0 8.4 7.2 14.3 .0 62.1 .0 .0 89 9.7 310 Richest 1.9 7.1 3.8 10.7 54.5 .0 10.7 263 5.3 4.0 7.1 11.8 .9 76.4 .0 .9 106 7.9 368 ethnicity of household head Macedonian 2.8 9.4 12.1 19.0 57.8 .0 19.0 705 3.9 10.1 16.3 23.6 .5 76.9 .4 .9 258 14.2 963 Albanian 5.4 19.6 14.2 31.3 36.3 .0 31.3 420 7.1 16.7 26.1 38.1 .6 57.2 .2 .9 181 22.2 601 Other 1.6 7.0 7.3 13.4 36.9 .0 13.4 97 2.4 9.1 23.3 25.7 1.4 66.7 .0 1.4 42 9.8 138 Total 3.6 12.7 12.4 22.8 48.7 .0 22.8 1221 5.0 12.5 20.6 29.3 .6 68.6 .3 .9 480 16.6 1702 1 MICS indicator 8.2 118 MultIple IndIcator cluster survey 2011 Table CP.3 presents the percentage of children aged 5-14 years involved in child labour who are attending school and the percentage of children aged 5-14 years attending school who are involved in child labour. Of the 86 percent of the children aged 5-14 years attending school, 16 percent are also involved in child labour activities. The percentage is highest in the poorest households (25 percent) and for children with less educated mothers (21 percent). However, out of the 17 percent of children who are involved in child labour, the majority are also attending school (84 percent). This percentage is higher for boys (88 percent) than for girls (79 percent); higher in urban (93 percent) than in rural areas (79 percent): and higher for Macedonians (88 percent) than for Albanians (79 percent). table cp.3: child labour and school attendance percentage of children age 5-14 years involved in child labour who are attending school, and percentage of children age 5-14 years attending school who are involved in child labour, Macedonia, 2011 Percentage of children involved in child labour Percentage of children attending school Number of children age 5-14 years Percentage of child labourers who are attend- ing school1 Number of children age 5-14 years involved in child labour Percentage of chil- dren attending school who are involved in child labour2 Number of chil- dren age 5-14 years attending school sex Male 16.4 87.4 894 88.0 147 16.5 781 Female 16.9 84.7 808 78.9 136 15.7 685 area Urban 10.3 87.1 860 93.0 89 11.0 749 Rural 23.1 85.1 842 79.3 194 21.5 716 age 5-11 22.8 81.3 1221 83.5 279 23.4 993 12-14 .9 98.4 480 (*) 4 .8 473 Mother’s education Primary or less 21.6 84.8 726 80.6 157 20.5 616 Secondary 15.0 87.6 706 91.0 106 15.6 619 High 7.4 85.5 270 (*) 20 5.9 231 Wealth index quintile Poorest 26.5 82.9 350 77.6 93 24.8 290 Second 20.5 82.7 359 80.5 74 20.0 297 Middle 18.3 86.4 314 91.5 58 19.4 271 Fourth 9.7 88.4 310 (84.8) 30 9.3 274 Richest 7.9 90.4 368 (93.6) 29 8.2 333 ethnicity of household head Macedonian 14.2 87.6 963 88.4 136 14.3 844 Albanian 22.2 84.5 601 78.9 133 20.7 508 Other 9.8 82.5 138 (*) 14 9.7 114 Total 16.6 86.1 1702 83.6 283 16.2 1466 1 MICS indicator 8.3 2 MICS indicator 8.4 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases 119 child labour – Roma settlements Table CP.2R presents the results of child labour by the type of work. Percentages do not add up to the total number of child labourers, as children may be involved in more than one type of work. The prevalence of child labour among the children in Roma settlements at age 5 to 11 years was 14 percent. Child labour 119 prevalence is lower among older children at age 12 to 14 years (2 percent). Total child labour prevalence is 10 percent, with differences by sex, wealth index and mother/s education (higher among females, in poorest households and with lower mother’s education). table cp.2R: child labour percentage of children by involvement in economic activity and household chores during the past week, according to age groups, and percentage of children age 5-14 involved in child labour, Roma settlements, 2011   Percentage of children age 5-11 involved in: Percentage of children age 12-14 involved in: To ta l c hi ld la bo ur 1 Nu m be r o f c hi ld re n ag e 5 -1 4 ye ar s   Economic activity Ec on om ic ac tiv ity fo r a t le as t o ne h ou r Ho us eh ol d ch or es le ss th an 2 8 ho ur s Ho us eh ol d ch or es fo r 2 8 ho ur s o r m or e Ch ild la bo ur Nu m be r o f c hi ld re n ag e 5 -1 1 Economic activity Ec on om ic ac tiv ity le ss th an 14 h ou rs Ec on om ic ac tiv ity fo r 1 4 ho ur s o r m or e Ho us eh ol d ch or es le ss th an 2 8 ho ur s Ho us eh ol d ch or es fo r 2 8 ho ur s o r m or e Ch ild la bo ur Nu m be r o f c hi ld re n ag e 12 -1 4   Working outside household W or kin g fo r f am ily bu sin es s Working outside household W or kin g fo r f am ily bu sin es s Pa id w or k Un pa id w or k Pa id w or k Un pa id w or k sex Male 1.1 5.0 6.3 10.0 30.4 .0 10.0 279 4.6 7.8 11.3 17.1 3.6 39.7 .0 3.6 105 8.2 384 Female 3.0 5.7 12.1 16.9 36.6 .0 16.9 285 4.9 10.6 11.1 20.2 .0 54.7 .6 .6 112 12.3 397 school participation Yes 1.9 5.9 9.8 14.3 36.2 .0 14.3 404 3.9 8.6 9.8 17.4 1.1 51.6 .0 1.1 177 10.3 581 No 2.4 4.1 7.9 11.5 26.9 .0 11.5 160 (8.3) (12.3) (17.4) (24.6) (4.6) (29.1) (1.8) (6.3) 39 10.5 200 Mother’s education None 3.1 .9 16.3 17.2 25.7 .0 17.2 128 (2.8) (5.7) (16.2) (20.6) (.6) (45.2) (.0) (.6) 41 13.2 170 Primary 1.0 7.2 7.4 12.2 36.2 .0 12.2 401 4.7 10.0 10.4 17.6 2.2 48.2 .4 2.6 165 9.4 566 Secondary + (10.6) (.0) (4.5) (15.1) (32.1) (.0) (15.1) 35 (*) (*) (*) (*) (*) (*) (*) (*) 10 (11.7) 45 Wealth index quintiles Poorest 2.7 9.1 18.9 23.9 36.3 .0 23.9 144 2.8 17.6 18.1 31.3 .4 52.8 1.1 1.5 62 17.2 206 Second 1.3 3.4 10.0 10.9 27.4 .0 10.9 126 (4.7) (11.1) (11.1) (13.7) (4.7) (53.5) (.0) 4.7 38 9.5 164 Middle .0 5.4 3.5 7.9 35.2 .0 7.9 95 (3.3) (1.4) (11.1) (13.6) (2.2) (49.8) (.0) 2.2 43 6.1 137 Fourth 2.3 3.4 4.4 8.7 38.6 .0 8.7 107 (3.8) (4.7) (4.1) (8.5) (2.0) (42.3) (.0) 2.0 43 6.8 150 Richest 3.9 4.5 4.5 12.0 30.1 .0 12.0 92 (12.0) (7.4) (7.8) (20.9) (.0) (33.7) (.0) .0 31 8.9 124 Total 2.1 5.4 9.2 13.5 33.5 .0 13.5 564 4.7 9.2 11.2 18.7 1.8 47.5 .3 2.1 217 10.3 781 1 MICS indicator 8.2 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases Table CP.3R presents the percentage of children aged 5-14 years involved in child labour who are attending school and percentage of children aged 5-14 years attending school who are involved in child labour. Of the 74 percent of Roma children aged 5-14 years attending school, 10 percent are also involved in child labour activities. Of the 10 percent of the children who are involved in child labour, the majority of them are also attending school (74 percent). Children from the poorest households who are involved in child labour have a lower rate of school attendance. 120 MultIple IndIcator cluster survey 2011 table cp.3R: child labour and school attendance percentage of children age 5-14 years involved in child labour who are attending school, and percentage of children age 5-14 years attending school who are involved in child labour, Roma settlements, 2011 Percentage of children involved in child labour Percentage of children attending school Number of children age 5-14 years Percentage of child labourers who are attending school1 Number of children age 5-14 years involved in child labour Percentage of children attending school who are involved in child labour2 Number of children age 5-14 years attending school sex Male 8.2 72.3 384 (80.4) 32 9.2 277 Female 12.3 76.5 397 (69.9) 49 11.3 304 age 5-11 13.5 71.6 564 75.7 76 14.3 404 12-14 2.1 81.8 217 (*) 5 1.1 177 Mother’s education None 13.2 65.8 170 (*) 22 13.1 112 Primary 9.4 75.7 566 (75.0) 53 9.3 429 Secondary + 11.7 91.3 45 (*) 5 12.9 41 Wealth index quintile Poorest 17.2 52.5 206 (59.2) 35 19.4 108 Second 9.5 82.6 164 (*) 16 10.9 135 Middle 6.1 79.3 137 (*) 8 3.9 109 Fourth 6.8 79.0 150 (*) 10 7.4 118 Richest 8.9 89.1 124 (*) 11 10.0 110 Total 10.3 74.4 781 74.0 81 10.3 581 1 MICS indicator 8.3 2 MICS indicator 8.4 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases 120 MultIple IndIcator cluster survey 2011 121 child discipline As stated in A World Fit for Children, “children must be protected against any acts of violence.” In addition, the Millennium Declaration calls for the protection of children against abuse, exploitation and violence. In the Macedonia MICS survey, respondents to the household questionnaire were asked a series of questions on the ways adults in the household tend to to discipline children when they misbehave during the past month preceding the survey. Note that for the child discipline module, one child aged 2-14 per household was selected randomly during fieldwork. Out of these questions, the two indicators used to describe aspects of child discipline are: 1) the number of children aged 2-14 years that experience psychological aggression as punishment or minor physical punishment or severe physical punishment; and 2) the number of respondents who believe that in order to raise children properly, they need be physically punished. table cp.4: child discipline percentage of children age 2-14 years according to method of disciplining the child, Macedonia, 2011 Percentage of children age 2-14 years who experienced: Number of children age 2-14 years Respondent believes that the child needs to be physically punished Respondents to the child discipline module Only non- violent discipline Psychological aggression Physical punishment Any violent discipline method1Any Severe sex Male 26.7 57.2 54.3 6.4 71.0 1178 3.0 731 Female 29.9 55.4 50.0 2.9 67.4 1044 2.8 634 Region Vardar 20.3 69.6 50.6 3.9 79.7 143 4.8 93 East 36.2 55.8 54.4 13.3 63.8 168 5.2 113 Southwest 29.6 30.8 60.2 3.3 66.6 208 3.0 134 Southeast 32.0 57.9 45.6 3.7 65.2 179 2.3 104 Pelagonia 14.4 72.4 60.9 4.9 83.8 274 1.5 187 Polog 24.9 56.0 55.3 2.0 68.4 339 1.4 188 Northeast 32.8 55.1 39.3 4.3 65.7 240 1.3 143 Skopje 32.0 55.2 51.2 5.1 66.3 671 4.0 403 area Urban 31.6 52.0 50.0 4.7 66.7 1130 2.4 744 Rural 24.6 60.8 54.8 4.9 72.1 1091 3.5 621 age 2-4 years 28.7 52.8 56.6 5.1 68.8 506 4.3 336 5-9 years 25.2 58.0 59.6 4.7 73.3 877 3.1 496 10-14 years 31.1 56.8 42.1 4.7 65.5 838.7 1.9 533 education of household head Primary or less 24.5 61.1 54.7 6.0 72.2 952 na na Secondary 29.7 56.0 51.8 4.4 68.7 963 na na High 35.1 42.4 46.7 1.9 62.1 306 na na Respondent’s education Primary or less na na na na na na 4.2 530 Secondary na na na na na na 2.3 579 High na na na na na na 1.6 256 Wealth index quintile Poorest 17.8 69.0 58.8 6.7 77.8 469 5.9 249 Second 30.6 57.1 50.3 5.9 66.4 460 4.3 257 Middle 29.6 52.9 49.1 3.6 67.9 413 1.5 260 Fourth 34.3 50.3 49.9 4.6 64.8 404 1.1 276 Richest 29.7 51.3 52.7 2.9 68.9 475 2.3 322 ethnicity of household head Macedonian 29.7 53.7 52.9 4.2 69.4 1246 1.8 837 Albanian 25.6 60.7 50.5 4.2 69.3 789 4.2 417 Other 29.0 55.8 55.8 10.6 68.8 187 6.9 112 Total 28.2 56.3 52.3 4.8 69.3 2222 2.9 1365 1 MICS indicator 8.5 122 MultIple IndIcator cluster survey 2011 In Macedonia, almost 70 percent of children aged 2-14 years were subjected to at least one form of violent discipline method (psychological or physical) by their parents or other adult household members during the past month preceding the survey, and nearly 5 percent of children were subjected to severe physical punishment. Male children were more subjected to both minor and severe physical discipline (54 and 6 percents) than female children (50 and 3 percents). The differentials in physical punishment with respect to many of the background variables were relatively small. However, it was found that violent discipline methods are more present in households whose head has only primary or less education, and that children aged 5-9 years experience more violence than younger or older children. It is important to note that while only 3 percent of respondents believe that in order to raise their children properly, they need to be physically punished, while in practice 52 percent of household members use physical violence to discipline their children. 123 child discipline – Roma settlements 123 children were subjected to severe physical punishment. Although only 10 percent of Roma respondents to the household questionnaires believed that children should be physically punished, physical discipline was observed to be highly prevalent in Roma households. Although older children and those living in the poorest households were subjected to at least one psychological or physical punishment, overall differentials in terms of severe physical punishment were small. table cp.4R: child discipline percentage of children age 2-14 years according to method of disciplining the child, Roma settlements, 2011 Percentage of children age 2-14 years who experienced: Number of children age 2-14 years Respondent believes that the child needs to be physically punished Respondents to the child discipline module Only non- violent discipline Psychological aggression Physical punishment Any violent discipline method1Any Severe sex Male 16.5 72.3 62.7 18.5 80.9 545 10.9 285 Female 15.7 74.8 62.0 15.9 83.1 549 8.6 280 age 2-4 years 20.2 73.0 61.1 18.3 78.9 280 12.7 157 5-9 years 9.6 77.9 70.2 20.6 88.8 452 8.3 213 10-14 years 21.1 68.5 53.5 12.2 76.0 362 9.0 194 education of household head None 12.3 77.0 57.6 16.3 83.6 166 na na Primary 15.6 75.0 64.0 18.4 83.3 776 na na Secondary + 22.8 62.5 59.1 12.1 73.9 152 na na Respondent’s education None na na na na na na 12.7 102 Primary na na na na na na 10.2 402 Secondary + na na na na na na 2.0 61 Wealth index quintile Poorest 13.9 79.7 61.9 26.6 85.0 287 19.3 123 Second 16.3 68.0 66.4 9.6 80.3 229 7.3 122 Middle 16.1 73.3 60.6 15.5 82.9 199 9.5 109 Fourth 15.4 74.4 63.3 13.3 81.6 206 6.6 113 Richest 20.6 69.9 58.6 18.2 78.8 173 4.9 98 Total 16.1 73.6 62.4 17.2 82.0 1094 9.8 565 1 MICS indicator 8.5 In the Roma settlements in Macedonia, 82 percent of the children aged 2-14 years were subjected to at least one form of psychological or physical violent discipline method used by their parents or other adult household members. Notably, 17 percent of Roma 124 MultIple IndIcator cluster survey 2011 early Marriage Marriage before the age of 18 is a reality for many young girls. According to UNICEF’s worldwide estimates, over 64 million women aged 20-24 were married/in union before the age of 18. Factors that influence child marriage rates include: the state of the country’s civil registration system, which provides proof of age for children; the existence of an adequate legislative framework with an accompanying enforcement mechanism to address cases of child marriage; and the existence of customary or religious laws that condone the practice. 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. Child marriage, however, is a violation of human rights, compromising the mental and physical development of girls and often resulting in early pregnancy and social isolation, with little education and poor vocational training reinforcing the gendered nature of poverty. The right to ‘free and full’ consent to a marriage is recognized in the Universal Declaration of Human Rights - with the recognition that consent cannot be ‘free and full’ when one of the parties involved is not sufficiently mature to make an informed decision about a life partner. The legal age of marriage in Macedonia is 18 without parental consent. A competent court can in a non- contentious decision permit a person who has attained 16 years of age to enter into marriage, provided that the court is of the opinion that the person possesses the physical and psychological maturity required. 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. Parents seek to marry off their girls to protect their honour, and men often seek younger women as wives as a means to avoid choosing a wife who might already be infected. 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. Two of the indicators on child marriage are to estimate the percentage of women married before 15 years of age and percentage married before 18 years of age. The percentage of women married at various ages is provided in Table CP.5. At the national level, 1 percent of women aged 15-49 were married before the age of 15, and 11 percent of women aged 20-49 years were married before the age of 18. Marriage before 18 shows a declining trend over time, while the marriage before 15 is stable at below-2 percent over time. Both marriage before 18 and before 15 are associated with the education level and the wealth quintile. About 1 in 25 young women aged 15-19 years is currently married (4 percent). This proportion does not vary much between urban (3 percent) and rural areas (5 percent), but is strongly related to the level of education. 125 table cp.5: early marriage percentage of women age 15-49 years who first married or entered a marital union before their 15th birthday, percentages of women age 20-49 years who first married or entered a marital union before their 15th and 18th birthdays, and percentage of women age 15-19 years currently married or in union, Macedonia, 2011 Pe rc en ta ge m ar rie d be fo re a ge 1 51 Nu m be r o f w om en ag e 15 -4 9 ye ar s Pe rc en ta ge m ar rie d be fo re a ge 1 5 Pe rc en ta ge m ar rie d be fo re a ge 1 82 Nu m be r o f w om en ag e 20 -4 9 ye ar s Pe rc en ta ge o f w om en 1 5- 19 ye ar s cu rre nt ly m ar rie d/ in u ni on 3 Nu m be r o f w om en ag e 15 -1 9 ye ar s Region Vardar 2.3 243 2.4 18.8 219 2.0 23 East 2.3 258 2.6 13.9 228 11.6 31 Southwest 1.2 353 1.4 11.6 296 6.5 57 Southeast 1.9 317 2.3 15.4 263 .6 54 Pelagonia .6 512 .8 9.4 431 4.1 81 Polog 2.4 597 2.3 13.2 500 6.7 97 Northeast .8 385 1.0 14.1 327 1.7 58 Skopje .8 1166 .9 5.0 1037 3.0 129 area Urban .8 2092 .9 6.3 1854 3.1 239 Rural 2.0 1739 2.2 16.3 1447 5.2 291 age 15-19 .6 530 na na na 4.3 530 20-24 .9 541 .9 6.9 541 na na 25-29 1.6 574 1.6 6.9 574 na na 30-34 1.6 567 1.6 10.5 567 na na 35-39 1.7 545 1.7 13.4 545 na na 40-44 1.4 555 1.4 11.5 555 na na 45-49 1.7 519 1.7 15.3 519 na na education Primary or less 3.5 1174 3.5 23.5 1090 15.9 83 Secondary .5 1682 .6 7.1 1279 2.4 403 High .3 976 .3 .6 932 .0 44 Wealth index quintile Poorest 3.8 695 4.3 20.8 558 8.1 137 Second 1.0 725 1.1 15.9 630 7.0 94 Middle 1.0 782 1.2 9.8 671 4.3 111 Fourth .5 791 .5 6.4 690 .3 100 Richest .7 839 .8 3.5 751 .0 88 ethnicity of household head Macedonian .6 2330 .7 9.2 2047 1.5 283 Albanian 1.9 1199 2.0 10.7 993 6.1 206 Other 4.8 302 5.3 22.0 260 (14.3) 42 Total 1.4 3831 1.5 10.7 3301 4.3 530 1 MICS indicator 8.6 2 MICS indicator 8.7 3 MICS indicator 8.8 Table CP.6 presents the proportion of women who were first married or entered into a marital union before age 15 and 18 by area and age groups. Examining the percentages married before age 15 and 18 by different age groups shows the trends in early marriage over time. The trend of postponing the marriage is visible, especially in rural areas. 126 MultIple IndIcator cluster survey 2011 table cp.6: trends in early marriage percentage of women who were first married or entered into a marital union before age 15 and 18, by area and age groups, Macedonia, 2011 Urban Rural All Pe rc en ta ge o f w om en m ar rie d be fo re a ge 1 5 Nu m be r o f w om en a ge 15 -4 9 Pe rc en ta ge o f w om en m ar rie d be fo re a ge 1 8 Nu m be r o f w om en a ge 20 -4 9 Pe rc en ta ge o f w om en m ar rie d be fo re a ge 1 5 Nu m be r o f w om en a ge 15 -4 9 Pe rc en ta ge o f w om en m ar rie d be fo re a ge 1 8 Nu m be r o f w om en a ge 20 -4 9 Pe rc en ta ge o f w om en m ar rie d be fo re a ge 1 5 Nu m be r o f w om en a ge 15 -4 9 Pe rc en ta ge o f w om en m ar rie d be fo re a ge 1 8 Nu m be r o f w om en a ge 20 -4 9 age 15-19 .3 239 na na .9 291 na na .6 530 na na 20-24 .8 275 4.7 275 1.1 266 9.2 266 .9 541 6.9 541 25-29 .9 318 3.8 318 2.3 256 10.6 256 1.6 574 6.9 574 30-34 1.1 355 5.9 355 2.5 212 18.2 212 1.6 567 10.5 567 35-39 .6 312 6.2 312 3.1 234 22.9 234 1.7 545 13.4 545 40-44 .9 306 8.6 306 1.9 249 15.0 249 1.4 555 11.5 555 45-49 1.2 288 8.6 288 2.4 231 23.5 231 1.7 519 15.3 519 Total .8 2092 6.3 1854 2.0 1739 16.3 1447 1.4 3831 10.7 3301 Another component is the spousal age difference with an indicator being the percentage of married/in union women with a difference of 10 or more years younger than their current spouse. Table CP.7 presents the results of the age difference between husbands and wives. About one in ten women aged 20–24 is currently married to a man who is older by ten years or more (8 percent). This percentage is higher among women with a lower education (14 percent). Data on the age group 15-19 is not presented in the table due to the small number of cases in this category (29 women aged 15- 19 were currently married at the time of the survey). table cp.7: spousal age difference percent distribution of women currently married/in union age 20-24 years according to the age difference with their husband or partner, Macedonia, 2011 Percentage of currently married/in union women age 20-24 years whose husband or partner is: Nu m be r o f w om en a ge 2 0- 24 ye ar s c ur re nt ly m ar rie d/ in u ni on Yo un ge r 0- 4 ye ar s o ld er 5- 9 ye ar s o ld er 10 + ye ar s o ld er 1 Hu sb an d/ P ar tn er ’s ag e un kn ow n To ta l area Urban 5.2 50.6 38.5 5.8 .0 100.0 69 Rural 7.7 55.1 26.0 10.2 .9 100.0 104 education Primary or less 10.3 45.9 29.8 14.0 .0 100.0 78 Secondary 2.8 59.5 32.8 4.9 .0 100.0 76 High (*) (*) (*) (*) (*) 100.0 19 ethnicity of household head Macedonian 2.8 48.9 42.4 5.9 .0 100.0 78 Albanian 8.1 56.1 21.1 13.3 1.4 100.0 70 Other (15.0) (59.0) (23.2) (2.8) (.0) 100.0 25 Total 6.7 53.3 31.0 8.4 .6 100.0 173 1 MICS indicator 8.10b ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases 127 early Marriage – Roma settlements The percentage of Roma women married at various ages is provided in Table CP.5R. 12 percent of Roma women were married before the age of 15, and 47 percent before the age of 18. About one in five of young Roma women aged 15-19 years is currently married (22 percent). This proportion is strongly related to the level of education. table cp.5R: early marriage percentage of women age 15-49 years who first married or entered a marital union before their 15th birthday, percentages of women age 20-49 years who first married or entered a marital union before their 15th and 18th birthdays, percentage of women age 15-19 years currently married or in union, Roma settlements, 2011 Percentage marrie d 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 of women 15-19 years currently married/in union3 Number of women age 15-19 years age 15-19 6.8 173 na na na 22.4 173 20-24 15.2 190 15.2 43.0 190 na na 25-29 7.6 166 7.6 46.4 166 na na 30-34 4.7 172 4.7 33.7 172 na na 35-39 18.3 112 18.3 55.7 112 na na 40-44 18.3 149 18.3 58.7 149 na na 45-49 16.4 129 16.4 50.6 129 na na education   None 25.4 183 25.6 61.0 172 (*) 11 Primary 11.4 724 11.6 49.9 634 31.6 89 Secondary + .4 184 .7 9.3 112 6.6 72 Wealth index quintile Poorest 21.9 200 25.1 57.1 161 (36.6) 38 Second 14.3 202 13.2 54.1 169 (46.1) 33 Middle 10.0 214 12.0 49.4 177 (9.5) 37 Fourth 9.4 231 10.5 41.6 200 (7.2) 31 Richest 5.9 244 6.4 36.8 210 (11.5) 34 Total 11.9 1091 12.9 47.0 918 22.4 173 1 MICS indicator 8.6 2 MICS indicator 8.7 3 MICS indicator 8.8 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases 127 128 MultIple IndIcator cluster survey 2011 Table CP.6R presents the proportion of Roma women who were first married or entered into a marital union before age 15 and 18 by area and age groups. table cp.6R: trends in early marriage percentage of women who were first married or entered into a marital union before age 15 and 18, by age groups, Roma settlements,2011 Percentage of women married before age 15 Number of women age 15-49 Percentage of women married before age 18 Number of women age 20-49 age 15-19 6.8 173 na na 20-24 15.2 190 43.0 190 25-29 7.6 166 46.4 166 30-34 4.7 172 33.7 172 35-39 18.3 112 55.7 112 40-44 18.3 149 58.7 149 45-49 16.4 129 50.6 129 Total 11.9 1091 47.0 918 Another component is the spousal age difference with an indicator being the percentage of married/in union women with a difference of 10 or more years younger than their current spouse. The results show that there are some spousal age differences in the Roma settlements in Macedonia. About 5 percent of Roma women aged 20-24 is currently married to a man who is older by ten years or more. Two of three Roma women are married to a man older by 0-4 years while one in three to a man older by 5-9 years. 7 percent of women aged 20-24 years are married to a younger man. 128 MultIple IndIcator cluster survey 2011 129 attitudes toward domestic violence The MICS assessed the attitudes of women aged 15-49 years by asking them questions whether husbands are justified to hit or beat their wives/partners for a variety of scenarios. These questions were asked to gather indications of cultural beliefs that tend to be associated with the prevalence of violence against women by their husbands/partners. The main assumption here is that women who agree with the statements indicating that husbands/partners are justified to beat their wives/ partners under the situations described also tend to be abused by their own husbands/partners. The responses to these questions are found in Table CP.11. Overall, 15 percent of women in Macedonia feel that a husband/partner has a right to hit or beat his wife/ partner for at least one of a variety of reasons. Women who approve of a husband’s violence, in most cases, agree and justify violence in instances when the woman neglects her children (12 percent). Acceptance is much higher among those living in rural areas, from poorest households, are less educated, and among Albanian women. One in four women from Polog region justify violent behaviour by their partner, in contrast to the East region where one in twenty women expressed acceptance. 130 MultIple IndIcator cluster survey 2011 table cp.11: attitudes toward domestic violence percentage of women age 15-49 years who believe a husband is justified in beating his wife/partner in various circumstances, Macedonia, 2011 Percentage of women age 15-49 years who believe a husband is ustified in beating his wife/partner: 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 reasons1 Region Vardar 3.8 11.3 4.7 2.0 1.3 12.4 243 East 1.1 4.9 1.4 1.9 .9 5.4 258 Southwest 10.0 14.6 7.3 6.0 2.7 17.8 353 Southeast 2.8 11.7 3.2 .3 1.6 12.2 317 Pelagonia 3.6 6.1 3.3 2.2 1.7 7.1 512 Polog 15.5 20.5 12.1 9.5 5.0 24.9 597 Northeast 9.4 13.9 5.8 1.5 1.2 16.1 385 Skopje 6.6 10.7 7.0 5.1 2.7 13.9 1166 area Urban 2.6 5.0 2.5 1.6 1.0 6.6 2092 Rural 13.0 20.5 11.1 7.6 4.3 23.9 1739 age 15-19 5.9 11.9 4.8 2.7 1.7 13.7 530 20-24 5.7 12.0 7.0 3.6 2.4 15.1 541 25-29 4.4 10.3 3.7 3.4 1.9 11.6 574 30-34 5.6 9.2 5.5 3.8 1.5 11.5 567 35-39 8.2 11.1 6.8 4.7 3.1 13.7 545 40-44 11.0 15.3 8.0 5.3 2.7 17.9 555 45-49 10.8 14.6 8.9 6.7 4.1 18.2 519 Marital/Union status Currently married/in union 9.0 13.9 7.6 5.3 2.9 16.9 2537 Formerly married/in union 2.0 3.5 1.1 .0 .0 4.4 119 Never married/in union 4.2 8.8 4.3 2.6 1.8 10.3 1175 education Primary or less 20.4 27.6 17.5 11.7 6.8 33.3 1174 Secondary 2.4 7.0 2.0 1.4 .7 8.2 1682 High .2 1.9 .5 .4 .4 2.5 976 Wealth index quintile Poorest 21.3 29.8 18.3 12.7 7.5 35.5 695 Second 11.2 17.7 10.4 6.7 3.5 21.4 725 Middle 4.8 9.5 3.7 2.5 1.7 12.0 782 Fourth 1.2 4.6 1.4 .9 .2 5.2 791 Richest .5 1.7 .2 .2 .3 2.1 839 ethnicity of household head Macedonian 1.4 5.6 1.5 .5 .4 6.2 2330 Albanian 18.7 24.8 15.3 11.2 6.2 30.0 1199 Other 8.2 10.8 8.5 6.4 3.8 16.2 302 Total 7.3 12.0 6.4 4.3 2.5 14.5 3831 1 MICS indicator 8.14 131 attitudes toward domestic violence – Roma settlements 131 (11 percent). Around 9 percent of women believe that a husband has a right to hit or beat his wife/ partner if she refuses to have sex with him or if she argues with him. Finally, 3 percent of them approve of a husband’s violence if she burns the food. Women who accept violence more are likely less educated, are older and currently married, and come from the poorest households. table cp.11R: attitudes toward domestic violence percentage of women age 15-49 years who believe a husband is justified in beating his wife/partner in various circumstances, Roma settlements, 2011 Percentage of women age 15-49 years who believe a husband is justified in beating his wife/ partner: 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 reasons1 age 15-19 10.3 18.0 9.2 6.2 3.6 23.5 173 20-24 10.8 17.5 10.5 8.6 2.4 25.4 190 25-29 11.7 22.6 9.6 8.3 6.1 27.6 166 30-34 10.7 16.3 11.4 8.4 3.5 25.7 172 35-39 13.4 17.5 9.6 14.0 4.9 30.5 112 40-44 11.6 16.6 5.9 8.7 .0 24.6 149 45-49 12.3 15.7 8.6 8.1 2.3 20.9 129 Marital/Union status Currently married/in union 13.4 17.7 10.7 9.6 3.3 26.7 799 Formerly married/in union 6.7 22.6 5.0 9.0 2.5 27.2 92 Never married/in union 5.4 16.0 5.8 4.5 3.5 19.3 200 education None 19.3 26.2 16.1 12.1 5.4 37.9 183 Primary 11.8 17.4 9.0 9.7 3.4 25.0 724 Secondary + 1.8 11.2 3.7 1.3 .4 14.3 184 Wealth index quintile Poorest 18.4 24.7 14.0 11.6 5.4 32.6 200 Second 15.2 20.5 14.5 11.2 5.6 30.6 202 Middle 12.0 19.4 8.6 9.2 3.8 28.6 214 Fourth 7.1 13.7 6.0 6.9 1.2 19.9 231 Richest 6.0 12.6 5.0 5.4 1.0 17.5 244 Total 11.4 17.8 9.3 8.7 3.3 25.4 1091 1 MICS indicator 8.14 Overall, 25 percent of the women in Roma settlements in Macedonia feel that a husband/partner has a right to hit or beat his wife/partner for at least one of a variety of reasons (Table CP.11R). Women who approve a husband’s violence, in most cases, agree and justify violence in instances when the woman neglects their children (18 percent), or if she demonstrates their autonomy, e.g. goes out without telling her husband 132 MultIple IndIcator cluster survey 2011 Xii tobacco and alcohol use Tobacco use is a known risk factor for many deadly diseases. Smoking cigarettes, pipes, or cigars increases the risk of cardiovascular disease, respiratory illness and cause lung and other forms of cancer. Smokeless tobacco products are also known to cause cancer. Women of reproductive age who smoke are at increased risk for multiple adverse pregnancy-related health outcomes, including difficulty conceiving, infertility, spontaneous abortion, low birth weight, neonatal mortality, stillbirth and preterm delivery. Excessive alcohol use also increases the risk of many harmful health conditions. In the long-term, excessive drinking can lead to cardiovascular problems, neurological impairments, liver disease and social problems. Alcohol abuse is also associated with injuries and violence, including intimate partner violence and child maltreatment.26 The MICS collected information on tobacco and alcohol use among women aged 15-49 years to help under the following: „ ever and current use of cigarettes and the age at which cigarette smoking first started „ ever and current use of smoked and smokeless tobacco products „ the intensity of use, of cigarettes, and smoked and smokeless tobacco products „ ever and current use of alcohol, and intensity of use 26 US Center for Disease Control and Prevention, http://www.cdc.gov/ tobacco use Table TA.1 presents the current and ever use of tobacco products by women15-49 years old. In Macedonia, use of tobacco products is common among women with 51 percent of women reported to have ever used a tobacco product. 30 percent of women smoked cigarettes, or used smoked or smokeless tobacco products on one or more days during the last month preceding the survey. Tobacco use among women is more common in urban areas than in rural areas. The highest proportion of tobacco use by women is found in Vardar region (43 percent). Among current female users of tobacco, the tobacco product most commonly used is cigarettes (30 percent of women smoked only cigarettes in the last one month). Use of tobacco is higher among women from the richest quintile. Nearly 23 percent of pregnant women currently use tobacco. 133 table ta.1: current and ever use of tobacco percentage of women age 15-49 years by pattern of use of tobacco, Macedonia, 2011 Ne ve r s m ok ed cig ar et te s o r u se d ot he r t ob ac co pr od uc ts Ever users Used tobacco products on one or more days during the last one month Nu m be r o f w om en ag e 15 -4 9 ye ar s On ly cig ar et te s Ci ga re tte s an d ot he r to ba cc o pr od uc ts On ly ot he r to ba cc o pr od uc ts An y t ob ac co pr od uc t On ly cig ar et te s Ci ga re tte s an d ot he r to ba cc o pr od uc ts On ly ot he r to ba cc o pr od uc ts An y t ob ac co pr od uc t1 age 15-19 77.2 19.8 1.7 1.0 22.4 7.9 .1 .0 8.0 530 20-24 48.6 45.0 5.4 .9 51.3 24.4 .3 .7 25.3 541 25-29 46.5 46.9 5.8 .8 53.5 28.5 .3 .0 28.8 574 30-34 43.0 54.9 2.0 .0 56.9 36.9 .1 .0 37.0 567 35-39 39.9 57.7 2.4 .0 60.1 38.5 .4 .0 38.9 545 40-44 45.2 51.5 3.4 .0 54.8 31.6 .6 .0 32.2 555 45-49 39.7 57.6 2.7 .0 60.3 38.8 .3 .0 39.2 519 Region Vardar 36.3 61.2 1.8 .7 63.7 42.1 .7 .0 42.8 243 East 40.0 54.7 5.2 .0 60.0 36.0 .0 .0 36.0 258 Southwest 65.6 32.8 1.2 .2 34.2 20.3 .0 .0 20.3 353 Southeast 38.1 59.3 1.9 .0 61.2 40.5 .1 .0 40.6 317 Pelagonia 49.5 46.3 4.0 .3 50.5 27.6 .9 .1 28.6 512 Polog 66.3 31.8 1.5 .2 33.5 20.1 .3 .0 20.3 597 Northeast 57.1 42.1 .5 .2 42.9 27.5 .0 .0 27.5 385 Skopje 38.1 55.3 5.9 .8 61.9 31.8 .3 .2 32.3 1166 area Urban 38.3 55.6 5.5 .6 61.7 35.5 .4 .1 36.0 2092 Rural 60.8 38.2 .7 .1 39.0 22.4 .2 .0 22.7 1739 education Primary or less 64.3 34.7 1.0 .1 35.7 23.1 .3 .1 23.5 1174 Secondary 43.4 54.2 2.0 .2 56.4 34.5 .3 .0 34.8 1682 High 38.2 52.1 8.6 1.1 61.8 28.8 .4 .3 29.5 976 Maternity status Pregnant 46.9 50.9 2.1 .0 53.1 22.9 .0 .0 22.9 113 Breastfeeding (not pregnant) (*) (*) (*) (*) (*) (*) (*) (*) (*) 5 Neither 48.5 47.6 3.4 .4 51.4 29.8 .3 .1 30.2 3713 Wealth index quintile Poorest 63.2 36.0 .7 .1 36.8 23.9 .2 .1 24.2 695 Second 57.2 41.0 1.3 .0 42.3 25.0 .2 .0 25.1 725 Middle 49.9 48.0 2.0 .1 50.1 27.8 .3 .0 28.0 782 Fourth 41.7 54.3 3.4 .5 58.3 32.1 .6 .4 33.1 791 Richest 33.7 56.6 8.5 1.1 66.3 37.6 .2 .0 37.8 839 ethnicity of household head Macedonian 36.3 59.0 4.2 .4 63.6 37.4 .4 .1 37.9 2330 Albanian 69.7 28.4 1.3 .4 30.2 16.2 .1 .1 16.3 1199 Other 58.0 36.9 5.1 .0 42.0 22.7 .7 .0 23.4 302 Total 48.5 47.7 3.4 .4 51.4 29.6 .3 .1 30.0 3831 1 MICS indicator TA.1 (*) – figures based on less than 25 unweighted cases 5 percent of women aged 15-49 years old smoked a cigarette for the first time before age 15 (see Table TA.2). 134 MultIple IndIcator cluster survey 2011 16 percent of women that currently smoke cigarettes smoked more than 20 cigarettes in the last 24 hours. 49 percent of women smoked 10-19 cigarettes in the last 24 hours, opposed to 16 percent who smoked less than 5 cigarettes. There are differentials by region, area, and socioeconomic status of households. 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, Macedonia, 2011 Percentage of women who smoked a whole cigarette before age 15 1 Number of women age 15-49 years Number of cigarettes in the last 24 hours Nu m be r o f w om en a ge 1 5- 49 ye ar s w ho ar e cu rre nt cig ar et te sm ok er s Less than 5 5-9 10-19 20+ DK/ Missing Total age 15-19 4.6 530 (36.0) (41.2) (21.4) (1.3) (.0) 100.0 42 20-24 7.2 541 18.5 26.5 40.3 14.1 .6 100.0 133 25-29 3.6 574 16.2 21.8 48.0 13.6 .2 100.0 166 30-34 6.4 567 17.0 18.0 43.3 21.1 .6 100.0 209 35-39 4.0 545 12.8 18.1 52.1 16.9 .0 100.0 212 40-44 6.7 555 18.9 10.1 54.5 16.5 .0 100.0 179 45-49 3.5 519 8.7 14.7 60.5 16.2 .0 100.0 203 Region Vardar 12.9 243 7.4 15.4 51.3 25.9 .0 100.0 104 East 4.7 258 15.3 19.2 44.9 20.6 .0 100.0 93 Southwest 2.5 353 27.7 17.2 41.5 13.7 .0 100.0 72 Southeast 5.1 317 13.1 23.4 52.6 9.6 1.4 100.0 129 Pelagonia 5.7 512 18.9 17.6 41.9 21.6 .0 100.0 146 Polog 5.0 597 24.1 28.8 32.5 14.6 .0 100.0 122 Northeast 2.8 385 10.5 4.7 71.0 13.8 .0 100.0 106 Skopje 5.1 1166 14.5 18.9 52.3 14.0 .2 100.0 374 area Urban 5.3 2092 14.9 17.2 50.3 17.5 .1 100.0 751 Rural 5.0 1739 17.5 21.4 47.3 13.4 .4 100.0 394 education Primary or less 6.2 1174 17.0 16.8 47.2 19.0 .0 100.0 276 Secondary 4.8 1682 13.3 18.3 51.7 16.4 .3 100.0 585 High 4.6 976 19.9 20.9 46.2 12.7 .3 100.0 285 Maternity status Pregnant 3.3 113 (45.9) (13.5) (27.1) (13.5) (.0) 100.0 26 Breastfeeding (not pregnant) (*) 5 (*) (*) (*) (*) (*) (*) 1 Neither 5.2 3713 15.1 18.7 49.8 16.2 .2 100.0 1119 Wealth index quintile Poorest 8.3 695 22.2 19.8 41.8 16.2 .0 100.0 168 Second 4.9 725 20.5 15.7 48.4 15.1 .2 100.0 182 Middle 3.1 782 13.4 18.1 51.6 17.0 .0 100.0 220 Fourth 4.3 791 15.5 20.4 47.5 16.1 .5 100.0 259 Richest 5.5 839 11.7 18.5 53.5 16.1 .2 100.0 317 ethnicity of household head Macedonian 5.5 2330 12.8 17.8 53.1 16.1 .2 100.0 879 Albanian 3.5 1199 26.2 25.1 32.4 15.8 .4 100.0 195 Other 8.9 302 25.0 10.3 47.5 17.2 .0 100.0 71 Total 5.2 3831 15.8 18.6 49.3 16.1 .2 100.0 1145 1 MICS indicator TA.2 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases 135 tobacco use – Roma settlements Table TA.1R presents the current and ever use of tobacco products by the 15-49 years old women in Roma settlements. Use of tobacco products is common among the women in Roma settlements, with 54 percent reporting to have ever used a tobacco product. 42 percent of the women in Roma settlements smoked cigarettes, or used smoked or smokeless tobacco products on one or more days during the last month preceding the survey. The highest proportion of tobacco use by the women in Roma settlements is found in the poorest households (65 percent) as opposed to the richest households (49 percent). Using tobacco products is strongly associated with educational level of the respondents. The percentage of both ever users and current users are higher among the women with no education, compared to those with a primary or secondary education. table ta.1R: current and ever use of tobacco percentage of women age 15-49 years by pattern of use of tobacco, Roma settlements, 2011 Ne ve r s m ok ed cig ar et te s o r u se d ot he r t ob ac co p ro du ct s Ever users Used tobacco products on one or more days during the last one month Nu m be r o f w om en a ge 15 -4 9 ye ar s On ly cig ar et te s Ci ga re tte s a nd ot he r t ob ac co pr od uc ts On ly ot he r to ba cc o pr od uc ts An y t ob ac co pr od uc t On ly cig ar et te s Ci ga re tte s a nd ot he r t ob ac co pr od uc ts On ly ot he r to ba cc o pr od uc ts An y t ob ac co pr od uc t1 age 15-19 67.8 32.0 .2 .0 32.2 20.4 .0 .0 20.4 173 20-24 53.4 44.2 2.5 .0 46.6 34.4 .0 .0 34.4 190 25-29 45.1 52.8 2.1 .0 54.9 42.7 .0 .0 42.7 166 30-34 44.2 53.4 2.5 .0 55.8 41.1 .0 .0 41.1 172 35-39 42.4 55.3 1.2 1.1 57.6 45.8 1.2 .0 47.0 112 40-44 25.0 75.0 .0 .0 75.0 63.6 .0 .0 63.6 149 45-49 30.6 66.0 .0 .0 66.0 54.0 .0 .0 54.0 129 education None 31.3 68.0 .8 .0 68.7 57.8 .8 .0 58.5 183 Primary 45.6 52.7 .9 .2 53.8 43.1 .0 .0 43.1 724 Secondary + 57.9 38.7 3.3 .0 42.1 21.9 .0 .0 21.9 184 Maternity status Pregnant 55.5 44.5 .0 .0 44.5 19.1 .0 .0 19.1 57 Breastfeeding (not pregnant) (*) (*) (*) (*) (*) (*) (*) (*) (*) 1 Neither 44.7 53.3 1.4 .1 54.8 43.2 .1 .0 43.3 1032 Wealth index quintile    Poorest 32.9 64.2 .7 .0 64.9 55.7 .7 .0 56.4 200 Second 38.7 60.6 .0 .6 61.3 47.9 .0 .0 47.9 202 Middle 48.4 50.1 1.5 .0 51.6 41.2 .0 .0 41.2 214 Fourth 52.2 46.2 1.6 .0 47.8 35.8 .0 .0 35.8 231 Richest 51.5 46.2 2.4 .0 48.5 32.4 .0 .0 32.4 244 Total 45.2 52.9 1.3 .1 54.4 42.0 .1 .0 42.1 1091 1 MICS indicator TA.1 (*) – figures based on less than 25 unweighted cases 135 136 MultIple IndIcator cluster survey 2011 23 percent of the women aged 15-49 years old in Roma settlements smoked a cigarette for the first time before age 15 (see Table TA.2R). While 17 percent of women aged 15-19 years and 24 percent of women aged 20-24 years smoked a cigarette before the age 15, 36 percent of women aged 40-45 years smoked a cigarette before age 15. Smoking is prevalent among women in Roma settlements - 29 percent of women that currently smoke cigarettes smoked more than 20 cigarettes in the last 24 hours preceding the survey. 40 percent of women smoked 10-19 cigarettes in the last 24 hours, opposed to 15 percent who smoked less than 5 cigarettes. There are differentials by socioeconomic status of households; for example, there is a negative correlation between wealth index and smoking). table ta.2R: 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, Roma settlements, 2011 Percentage of women who smoked a whole cigarette before age 15 1 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 age 15-19 16.9 173 (15.0) (26.2) (38.3) (20.4) (.0) 100.0 35 20-24 24.2 190 25.5 22.1 33.2 19.2 .0 100.0 65 25-29 18.6 166 25.2 23.9 30.0 20.9 .0 100.0 71 30-34 19.8 172 6.5 18.7 46.9 27.9 .0 100.0 71 35-39 23.4 112 7.1 6.5 44.8 41.5 .0 100.0 53 40-44 35.7 149 10.5 10.7 42.1 35.5 1.1 100.0 95 45-49 22.1 129 14.3 8.6 45.3 31.9 .0 100.0 70 education None 32.6 183 17.4 12.8 40.5 28.3 1.0 100.0 107 Primary 24.6 724 14.4 15.9 39.7 30.0 .0 100.0 312 Secondary + 5.5 184 (11.2) (24.8) (43.5) (20.5) (.0) 100.0 40 Maternity status Pregnant 24.9 57 (*) (*) (*) (*) (*) 100.0 11 Breastfeeding (not pregnant) (*) 1 (*) (*) (*) (*) (*) 100.0 1 Neither 22.6 1032 14.0 16.2 40.6 29.0 .2 100.0 447 Wealth index quintile Poorest 30.8 200 18.4 12.1 31.1 38.3 .0 100.0 112 Second 29.3 202 11.4 9.9 48.5 29.1 1.1 100.0 97 Middle 23.3 214 21.2 22.0 37.0 19.8 .0 100.0 88 Fourth 18.4 231 11.8 16.9 45.8 25.5 .0 100.0 83 Richest 14.3 244 10.0 21.3 40.7 28.0 .0 100.0 79 Total 22.7 1091 14.8 16.0 40.2 28.7 .2 100.0 459 1 MICS indicator TA.2 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases 136 MultIple IndIcator cluster survey 2011 137 alcohol use Women’s use of alcohol is presented in Table TA.3. 29 percent of women aged15-49 years had at least one drink of alcohol on one or more days during the last month preceding the survey. 3 percent of women of the same age group first drank alcohol before the age of 15, while 53 percent of women never had one drink of alcohol. Among the younger age groups, the proportion of women who had at least one drink of alcohol before age 15 is higher than among the older age groups. The use of alcohol by women varies somewhat by wealth quintiles and by area. Alcohol use is more common in urban areas and among women belonging to the richest households and has a higher education. The lowest proportion of alcohol use is found in Polog (7 percent) and Northeast regions (14 percent). table ta.3: use of alcohol percentage of women age 15-49 who have never had one drink of alcohol, percentage who first had one drink of alcohol before age 15, and percentage of women who have had at least one drink of alcohol on one or more days during the last one month, Macedonia, 2011 Percentage of women who: Number of women age 15-49 years Never had one drink of alcohol Had at least one drink of alcohol before age 15 1 Had at least one drink of alcohol on one or more days during the last one month 2 age 15-19 63.4 7.7 23.2 530 20-24 50.8 3.9 33.3 541 25-29 47.2 2.3 27.7 574 30-34 45.9 .8 30.7 567 35-39 51.9 .5 30.1 545 40-44 55.6 1.8 26.8 555 45-49 54.3 1.4 27.5 519 Region Vardar 36.3 8.8 42.2 243 East 24.8 4.2 40.5 258 Southwest 68.8 1.2 20.9 353 Southeast 52.3 2.8 21.7 317 Pelagonia 35.0 2.5 42.1 512 Polog 86.8 1.2 7.3 597 Northeast 71.5 .5 14.0 385 Skopje 41.3 2.8 36.7 1166 area Urban 36.1 3.6 39.7 2092 Rural 72.4 1.4 15.0 1739 education Primary or less 86.4 .7 5.9 1174 Secondary 42.7 3.3 32.7 1682 High 29.0 3.7 48.4 976 Wealth index quintile Poorest 82.6 1.6 9.3 695 Second 71.6 1.1 15.3 725 Middle 49.9 2.5 27.1 782 Fourth 41.7 4.0 34.4 791 Richest 24.2 3.5 51.5 839 ethnicity of household head Macedonian 29.1 3.9 42.9 2330 Albanian 94.8 .3 3.0 1199 Other 66.5 1.8 18.5 302 Total 52.6 2.6 28.5 3831 1 MICS indicator TA.3 2 MICS indicator TA.4 138 MultIple IndIcator cluster survey 2011 alcohol use – Roma settlements The use of alcohol by the women in Roma settlements is presented in Table TA.3R. Only 11 percent of the women in Roma settlements aged15-49 years old had at least one drink of alcohol on one or more days during the last month preceding the survey. 5 percent of women of the same age group first drank alcohol before the age of 15, while 61 percent of women never had one drink of alcohol. The proportion of the women in Roma settlements who had at least one drink of alcohol before age 15 is higher in the youngest group (ages 15- 19) compared with all other age groups. The use of alcohol by women varies somewhat by the level of education. Alcohol use is more common among women with a higher education. table ta.3R: use of alcohol percentage of women age 15-49 who have never had one drink of alcohol, percentage who first had one drink of alcohol before age 15, and percentage of women who have had at least one drink of alcohol on one or more days during the last one month, Roma settlements, 2011 Percentage of women who: Number of women age 15-49 years Never had one drink of alcohol Had at least one drink of alcohol before age 15 1 Had at least one drink of alcohol on one or more days during the last one month 2 age 15-19 65.1 13.8 13.6 173 20-24 59.5 4.7 9.5 190 25-29 60.8 3.2 12.3 166 30-34 61.9 3.8 12.4 172 35-39 51.4 .5 12.5 112 40-44 65.0 3.1 7.8 149 45-49 59.6 2.3 10.2 129 education None 73.8 3.4 5.9 183 Primary 61.6 3.9 10.6 724 Secondary + 45.3 9.7 18.7 184 Wealth index quintile Poorest 69.6 8.9 9.6 200 Second 69.1 4.0 6.0 202 Middle 55.1 5.2 13.0 214 Fourth 57.3 3.4 14.5 231 Richest 55.5 3.2 12.0 244 Total 60.9 4.8 11.2 1091 1 MICS indicator TA.3 2 MICS indicator TA.4 138 MultIple IndIcator cluster survey 2011 139 Xiii subjective Well-beinG It is well-known that the 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 status. In the Macedonia MICS, a set of questions were asked to women between 15-24 years of age to understand how satisfied they are in different areas of their lives, such as their family life, friendships, school, current job, health, living environment, 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 satisfaction in different areas of their lives can help 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 her/his job, income, family life, friends, and other aspects of her life, but still be unhappy. In addition to the set of questions on life satisfaction, the 2011 Macedonia MICS 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 the Questionnaires in Appendix F). The indicators related to subjective well-being are as follows: „ Life satisfaction– the proportion of women aged 15-24 years who are very or somewhat satisfied with their family life, friendships, school, current job, health, where they live, how they are treated by others, and how they look „ Happiness – the proportion of women aged 15-24 years who are very or somewhat happy „ Perception of a better life– the proportion of women aged 15-24 years who think that their lives improved during the last one year and who expect that their lives will be better after one year Table SW.1 shows the proportion of young women aged 15-24 years, who are very or somewhat satisfied in selected domains. Of the different domains, young women are the most satisfied with their family life (96 percent), the way they look (96 percent), their health (96 percent), treatment by others (93 percent), and their friendships (91 percent). Among the domains, young women are the least satisfied with their current income (71 percent) and current job (74 percent). Meanwhile, 77 percent of young women aged 15-24 years do not have any income at all. 140 MultIple IndIcator cluster survey 2011 table sW.1: domains of life satisfaction percentage of women age 15-24 years who are very or somewhat satisfied in selected domains, Macedonia,2011 Percentage of women age 15-24 who are very or somewhat satisfied with selected domains: Percentage of women age 15-24 who: Number of women age 15-24 years Fa m ily li fe Fr ie nd sh ip s Sc ho ol Cu rre nt jo b He al th Liv in g en vir on m en t Tr ea tm en t b y ot he rs Th e w ay th ey lo ok Cu rre nt in co m e Ar e no t c ur re nt ly at te nd in g sc ho ol Do n ot h av e a jo b Do n ot h av e an y in co m e age 15-19 96.0 93.2 91.8 (86.4) 98.0 88.3 92.6 96.1 79.1 17.4 93.8 89.2 530 20-24 96.6 89.2 85.5 71.0 93.0 87.7 93.0 95.3 68.6 59.0 71.0 64.5 541 area Urban 96.6 92.0 89.9 64.8 96.1 92.6 94.7 95.6 76.6 26.3 82.3 74.2 514 Rural 96.0 90.4 89.4 81.9 94.9 83.8 91.1 95.7 64.6 49.6 82.2 79.1 557 Marital status Ever married/in union 94.6 88.6 (*) 75.3 90.1 89.2 94.2 93.7 72.4 92.2 73.2 70.5 199 Never married/in union 96.7 91.8 89.9 73.1 96.7 87.7 92.5 96.1 70.6 26.2 84.3 78.1 872 education Primary or less 95.5 88.7 (*) (53.0) 90.9 81.4 91.6 95.2 (51.9) 91.5 85.4 83.9 220 Secondary 95.8 91.5 92.3 82.2 97.1 89.7 91.7 95.9 77.6 31.3 83.0 79.3 553 High 97.8 92.5 85.8 71.7 95.8 89.7 95.8 95.6 70.3 12.4 78.5 66.6 299 Wealth index quintile Poorest 93.4 88.6 87.5 (63.7) 91.3 77.3 87.9 94.9 (46.6) 61.6 86.7 84.6 250 Second 96.0 93.0 91.2 (90.3) 96.7 88.7 92.2 98.2 (79.9) 51.8 81.1 78.8 210 Middle 96.7 89.1 95.3 (66.9) 96.3 91.5 93.0 95.8 67.3 35.2 80.7 77.0 220 Fourth 98.1 90.6 86.3 (70.8) 97.9 90.4 95.1 92.4 65.6 21.3 81.9 69.6 214 Richest 98.1 96.0 88.5 (75.8) 96.0 95.0 97.4 97.4 92.4 14.4 79.5 71.3 177 ethnicity of household head Macedonian 96.9 91.7 89.6 73.0 96.2 89.8 93.5 95.8 76.4 27.2 80.2 71.3 574 Albanian 96.2 91.3 91.3 74.6 95.2 84.7 92.3 95.2 60.9 51.4 83.1 81.7 411 Other 92.6 87.0 (83.4) (*) 92.1 92.0 90.6 96.6 (*) 50.7 91.6 89.3 87 Total 96.3 91.2 89.7 73.7 95.5 88.0 92.8 95.6 71.0 38.4 82.2 76.7 1071 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases Table SW.2 presents the proportion of women aged 15-24 years with “life satisfaction”. “Life satisfaction” is defined as those who are very or somewhat satisfied with their family life, friendships, school, current job, health, where they live, how they are treated by others, and how they look. 69 percent of 15-24 year old women are satisfied with life. 76 percent of women living in the richest households are satisfied with life as opposed to only 55 percent in the poorest households. The proportion of women that is satisfied with life is somewhat higher in urban areas (72 percent) than in rural areas (65 percent). The average life satisfaction score is the arithmetic mean of responses to questions included in the calculation of life satisfaction. Lower scores indicate higher satisfaction levels. According to Table SW.2, 91 percent of women aged 15-24 years are very or somewhat happy, with differences by wealth quintiles. Comparing 15-19 year old women to 20-24 year old women, the proportion of women who are very or somewhat happy is slightly different, 93 and 89 percent respectively. Differentials can also be observed by region with the lowest proportion of life satisfaction among women found in the East region. 49 percent of women aged 15-24 years are very or somewhat satisfied with their income. 141 table sW.2: life satisfaction and happiness percentage of women age 15-24 years who are very or somewhat satisfied with their family life, friendships, school, current job, health, living environment, treatment by others, and the way they look, the average life satisfaction score, percentage of women with life satisfaction who are also very or somewhat satisfied with their income, and percentage of women age 15-24 years who are very or somewhat happy, Macedonia, 2011   Percentage of women with life satisfaction1 Average life satisfaction score Missing / Cannot be calculated Women with life satisfaction who are very or somewhat satisfied with their income No income / Cannot be calculated Percentage who are very or somewhat happy 2 Number of women age 15-24 years age 15-19 73.4 1.4 .0 58.8 89.2 93.2 530 20-24 63.7 1.5 .4 46.4 64.8 89.2 541 Region  Vardar 56.2 1.7 .0 (*) 82.9 79.9 58 East 52.5 1.6 .0 (*) 83.2 91.1 61 Southwest 61.5 1.5 .0 (41.5) 66.4 88.9 99 Southeast 66.4 1.5 .0 (*) 74.6 85.6 88 Pelagonia 72.5 1.4 .0 (*) 83.9 93.3 144 Polog 71.6 1.4 .0 (49.9) 86.3 93.7 199 Northeast 78.3 1.4 .0 (*) 84.2 94.8 108 Skopje 69.6 1.4 .6 49.3 66.9 91.8 316 area  Urban 72.5 1.4 .4 53.7 74.5 92.0 514 Rural 64.9 1.5 .0 44.4 79.1 90.4 557 Marital status  Ever married/in union 64.1 1.5 .0 53.4 70.5 88.6 199 Never married/in union 69.6 1.4 .2 48.0 78.4 91.8 872 education  Primary or less 61.8 1.5 .0 (30.7) 83.9 88.7 220 Secondary 71.2 1.4 .0 56.0 79.3 91.5 553 High 68.5 1.4 .7 48.2 67.2 92.5 299 Wealth index quintile  Poorest 54.7 1.5 .0 (26.2) 84.6 88.6 250 Second 73.0 1.4 .0 (62.0) 78.8 93.0 210 Middle 68.3 1.4 .0 42.1 77.0 89.1 220 Fourth 74.4 1.4 .9 50.0 70.5 90.6 214 Richest 76.2 1.3 .0 62.1 71.3 96.0 177 ethnicity of household head  Macedonian 68.3 1.5 .0 53.6 71.3 91.7 574 Albanian 70.1 1.4 .5 40.6 82.1 91.3 411 Other 62.9 1.5 .0 (*) 89.3 87.0 87 Total 68.5 1.4 .2 49.3 76.9 91.2 1071 1 MICS Indicator SW.1 2 MICS indicator SW.2 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases Table SW.3 presents women’s perceptions of a better life. 55 percent of women aged 15-24 years think that their lives improved during the last one-year and expect their lives to get better after one year. Differences in the perception of a better life can be observed by wealth quintiles: 48 percent of young women that live in households in the poorest wealth 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 for young women that live in households in the richest wealth quintile is 66 percent. Younger women and those with an increased educational level have a higher perception of a better life. 142 MultIple IndIcator cluster survey 2011 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, Macedonia, 2011 Percentage of women who think that their life Number of women age 15-24 yearsImproved during the last one year Will get better after one year Both 1 age 15-19 63.2 84.2 58.9 530 20-24 54.0 82.8 50.5 541 Region Vardar 37.8 85.2 34.2 58 East 21.9 76.5 17.6 61 Southwest 47.4 73.2 46.9 99 Southeast 71.0 83.9 67.0 88 Pelagonia 60.4 83.4 54.5 144 Polog 65.0 87.3 61.9 199 Northeast 68.3 90.4 65.9 108 Skopje 61.3 82.9 56.1 316 area Urban 59.9 81.6 54.3 514 Rural 57.3 85.1 54.9 557 Marital status Currently married/in union 59.0 83.1 55.3 196 Never married/in union 58.5 83.5 54.5 872 education Primary or less 53.2 80.5 50.4 220 Secondary 59.3 84.5 55.3 553 High 61.2 83.8 56.4 299 Wealth index quintile Poorest 49.7 82.9 47.8 250 Second 60.3 82.2 55.7 210 Middle 52.3 78.5 46.7 220 Fourth 64.8 83.4 60.5 214 Richest 69.4 92.0 65.6 177 ethnicity of household head Macedonian 60.4 82.0 55.4 574 Albanian 58.2 86.9 55.5 411 Other 48.2 76.9 45.2 87 Total 58.6 83.5 54.6 1071 1 MICS indicator SW.3 143 subjective well-being – Roma settlements their living environment (85 percent). Among the domains, young women are the least satisfied with their current income (73 percent) and their current job (76 percent). Meanwhile, 82 percent of young women aged 15-24 years do not have any income. table sW.1R: domains of life satisfaction percentage of women age 15-24 years who are very or somewhat satisfied in selected domains, Roma settlements, 2011 Percentage of women age 15-24 who are very or somewhat satisfied with selected domains: Percentage of women age 15-24 who: Nu m be r o f w om en a ge 15 -2 4 ye ar s Fa m ily li fe Fr ie nd sh ip s Sc ho ol Cu rre nt jo b He al th Liv in g en vir on m en t Tr ea tm en t b y o th er s Th e w ay th ey lo ok Cu rre nt in co m e Ar e no t c ur re nt ly at te nd in g sc ho ol Do n ot h av e a jo b Do n ot h av e an y in co m e age 15-19 89.6 81.9 82.2 (*) 91.4 88.2 87.6 93.5 (*) 57.7 93.1 90.3 173 20-24 87.8 80.9 (*) 69.8 84.3 82.3 84.5 87.7 67.0 91.5 84.7 74.6 190 Marital status Ever married/in union 88.2 79.8 (*) (*) 85.0 82.2 84.3 87.9 71.4 98.1 88.6 79.5 191 Never married/in union 89.1 83.1 82.7 (*) 90.6 88.3 87.7 93.3 74.6 50.2 88.9 85.0 172 education None 82.0 70.9 (*) (*) 84.2 72.2 77.9 82.6 (*) 96.5 95.2 92.8 39 Primary 89.0 80.6 (*) 78.1 85.9 87.3 84.9 91.0 74.1 93.3 88.0 80.1 215 Secondary + 90.2 86.7 81.1 (*) 92.4 85.5 90.9 92.3 (*) 32.4 87.7 82.2 109 Wealth index quintile Poorest 77.5 70.2 (*) (*) 91.7 77.7 78.2 90.7 (*) 86.7 97.8 91.6 68 Second 88.3 75.5 (*) (*) 75.2 77.6 87.1 86.9 (*) 90.1 88.8 86.3 63 Middle 89.0 84.9 (*) (*) 90.2 87.8 89.2 92.6 (*) 76.7 93.7 85.0 83 Fourth 93.3 90.4 (*) (*) 95.3 87.7 86.1 93.2 (*) 75.6 86.6 77.9 72 Richest 93.9 83.6 90.0 (*) 84.5 92.5 88.2 88.3 (*) 51.9 77.3 71.2 77 Total 88.6 81.4 82.8 75.8 87.7 85.1 85.9 90.5 72.7 32.4 87.7 82.2 363 (*) – figures based on less than 25 unweighted cases Table SW.2R presents the proportion of Roma women aged 15-24 years with “life satisfaction”. “Life satisfaction” is defined as those who are very or somewhat satisfied with their family life, friendships, school, current job, health, living environment, how they are treated by others, and how they look. 60 percent of 15-24 year old Roma women are satisfied with life. 61 percent of women living in the richest households are satisfied with life as opposed to the 48 percent living in the poorest households. The average life satisfaction score is the arithmetic mean of responses to questions included in the calculation of life satisfaction. Lower scores indicate higher satisfaction levels. According to Table SW.2R, 81 percent of the women in Roma settlements aged 15-24 years are very or somewhat happy. At the same time, 45 percent of them are very or somewhat satisfied with their income. 143 Table SW.1R shows the proportion of young women aged 15-24 years in Roma settlements who are very or somewhat satisfied in selected domains. Of the different domains, they are the most satisfied with the way they look (91 percent), their family life (89 percent), their health (88 percent), treatment by others (86 percent), 144 MultIple IndIcator cluster survey 2011 table sW.2R: life satisfaction and happiness percentage of women age 15-24 years who are very or somewhat satisfied with their family life, friendships, school, current job, health, living environment, treatment by others, and the way they look, the average life satisfaction score, percentage of women with life satisfaction who are also very or somewhat satisfied with their income, and percentage of women age 15-24 years who are very or somewhat happy, Roma settlements, 2011   Percentage of women with life satisfaction1 Average life satisfaction score Missing / Cannot be calculated Women with life satisfaction who are very or somewhat satisfied with their income No income / Cannot be calculated Percentage who are very or somewhat happy 2 Number of women age 15-24 years age 15-19 62.8 1.5 .0 (*) 90.3 81.9 173 20-24 57.8 1.6 1.6 (39.6) 76.2 80.9 190 Marital status Ever married/in union 58.5 1.6 1.6 (45.6) 81.1 79.8 191 Never married/in union 62.1 1.6 .0 (44.7) 85.0 83.1 172 education None (58.9) (1.7) (3.5) (*) (96.3) (70.9) 39 Primary 60.9 1.6 .8 (46.4) 80.9 80.6 215 Secondary + 59.4 1.5 .0 (*) 82.2 86.7 109 Wealth index Poorest 48.2 1.8 .0 (*) 91.6 70.2 68 Second 57.1 1.7 2.2 (*) 88.5 75.5 63 Middle 62.6 1.5 1.0 (*) 86.1 84.9 83 Fourth 70.2 1.5 .0 (*) 77.9 90.4 72 Richest 61.4 1.5 1.0 (*) 72.3 83.6 77 Total 60.2 1.6 .8 45.3 82.9 81.4 363 1 MICS Indicator SW.1 2 MICS indicator SW.2 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases Table SW.3R presents Roma women’s perceptions of a better life. 39% of women in Roma settlements aged 15-24 years think that their lives improved during the last year and expect their lives to get better after a year. Differences in the perception of a better life can be observed by wealth quintiles: 28 percent of Roma young women that live in households in the poorest wealth 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 for young women that live in households in the richest wealth quintile is 43 percent. 145 table sW.3R: 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, Roma settlements, 2011 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 Both 1 age 15-19 43.8 77.8 40.3 173 20-24 42.9 70.2 37.8 190 Marital status Currently married/in union 47.3 71.5 40.3 176 Never married/in union 42.4 77.9 40.4 172 education None (42.5) (55.1) (40.0) 39 Primary 41.3 69.1 34.7 215 Secondary + 47.6 90.0 46.9 109 Wealth index quintile Poorest 32.1 59.2 27.7 68 Second 43.2 74.0 34.5 63 Middle 41.6 76.6 40.4 83 Fourth 50.6 79.5 47.1 72 Richest 48.3 78.2 43.3 77 Total 43.3 73.8 39.0 363 1 MICS indicator SW.3 ( ) – figures based on 25–49 unweighted cases 146 MultIple IndIcator cluster survey 2011 appendices 147 appendix a1. sample design - Macedonia The major features of the sample design are described in this appendix. Sample design features include target sample size, sample allocation, sampling frame and listing, choice of domains, sampling stages, stratification, and the calculation of sample weights. The primary objective of the sample design for the Macedonia Multiple Indicator Cluster Survey was to produce statistically reliable estimates of most indicators, at the national level, for urban and rural areas, and for the eight regions (Vardar, East, Southwest, Southeast, Pelagonia, Polog, Northeast, Skopje) of the country. Urban and rural areas in each of the eight regions were defined as the sampling strata. A multi-stage, stratified cluster sampling approach was used for the selection of the survey sample. sample size and sample allocation The target national sample size for the Macedonia MICS was 4703 households. For the calculation of the sample size, the key indicator used was the incidence of stunting among children aged 0-4 years. The following formula was used to estimate the required sample size for this indicator: where n is the required sample size, expressed as number of households 4 is a factor to achieve the 95 percent level of confidence r is the predicted or anticipated value of the indicator, expressed in the form of a proportion 1.1 is the factor necessary to raise the sample size by 10 percent for the expected non-response [the actual factor will be based on the non-response level experienced in previous surveys in the country] f is the shortened symbol for deff (design effect) 0.12r is the margin of error to be tolerated at the 95 percent level of confidence, defined as 12 percent of r (relative margin of error of r) p is the proportion of the total population upon which the indicator, r, is based is the average household size (number of persons per household). For the calculation, r (stunting prevalence) was assumed to be 8 percent. The value of deff (design effect) was taken as 1.5 based on estimates from previous surveys, p (percentage of children aged 0-4 years in the total population) was taken as 11 percent, (average household size) was taken as 3.4 members, and the response rate is assumed to be 90%. The resulting number of households from this exercise was 14520 households which is the sample size needed to provide sufficient number of children under 5 for drawing reliable conclusions. In order to reduce the sample size with keeping the estimation reliability for most of the indicators, the sample was divided into groups of households with children under 5 and households without children under 5. The average number of households selected per cluster for the Macedonia MICS was determined as 15 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. In total, 300 clusters were allocated to the regions with the number of sample clusters proportional to the population of the individual regions. 148 MultIple IndIcator cluster survey 2011 table sd.1: allocation of sample clusters (primary sampling units) to sampling strata Region Population (2002 Estimates) Number of Clusters Urban Rural Total Urban Rural Total Vardar 105846 48326 154172 16 7 23 East 118443 63411 181854 18 9 27 Southwest 104956 116539 221495 16 17 33 Southeast 77623 93570 171193 12 14 26 Pelagonija 162488 74982 237470 24 11 35 Polog 88755 215355 304110 13 32 45 Northeast 97624 75030 172654 15 11 26 Skopje 412657 164760 577417 61 24 85 Total 1168392 851973 2020365 175 125 300 sampling frame and selection of clusters The 2002 census frame was used for the selection of clusters. Census enumeration areas were defined as primary sampling units (PSUs), and were selected from each of the sampling strata by using systematic pps (probability proportional to size) sampling procedures, based on the estimated sizes of the enumeration areas from the 2002 Population Census. The first stage of sampling was completed by selecting the required number of enumeration areas from each of the eight regions separately by urban and rural strata. listing activities Since the sampling frame (the 2002 Population Census) was not up-to-date, a new listing of households was conducted in all the sample numeration areas prior to the selection of households. For this purpose, listing teams were formed, who visited each enumeration area, and listed the occupied households. Listing activities were conducted by the same company that was responsible for the data collection. The same teams that were selected for the data collection process were used for listing. The listing took place in February 2012. All teams were given the descriptions and maps of the selected clusters. The teams visited all households in the sample clusters asking for the number of members, number of women aged 15-49 and for number of children under age 5. selection of household Lists of households with household members were prepared by the listing teams for each enumeration area. The number of selected households per enumeration area was different, depending on the total number inhabitants in the enumeration area and the number of households with children under 5 found in the enumeration area. In the enumeration areas with less than 450 inhabitants, 5 households with children under 5 and 10 household without children under 5 were selected; in the enumeration areas with more than 450 but less than 600 inhabitants, 6 households with children under 5 and 11 households without children under 5 were selected; in the enumeration areas with more than 600 inhabitants, 7 households with children under 5 and 12 households without children under 5 were selected. In the enumeration areas where 5 or less households with children under 5 were found, regardless of the number of inhabitants in the enumeration area, all households with children under 5 and 8 of the households without children under 5 were included in the sample. The households within each second stage stratum (households with and without children under 5) were sequentially numbered from 1 to n (the total number of households in each enumeration area) by the responsible company. Selection of the households within each second stage stratum was carried out using random systematic selection procedures. The total number of households selected for the survey was 4397; of these 748 were households with children under 5. 149 calculation of sample Weights The Macedonia Multiple Indicator Cluster Survey sample is not self-weighting. Essentially, by allocating equal numbers of households to each of the regions, different sampling fractions were used in each region since the size of the regions varied. For this reason, sample weights were calculated and these were used in the subsequent analyses of the survey data. The major component of the weight is the reciprocal of the sampling fraction employed in selecting the number of sample households in that particular sampling stratum (h) and PSU (i): W =hi 1 ƒhi The term fhi, the sampling fraction for the i-th sample PSU in the h-th stratum, is the product of probabilities of selection at every stage in each sampling stratum: f p px=hi 1hi 2hi 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. Since the estimated number of households in each enumeration area (PSU) in the sampling frame used for the first stage selection and the updated number of households in the enumeration area from the listing were different, individual sampling fractions for households in each sample enumeration area (cluster) were calculated. The sampling fractions for households in each enumeration area (cluster) therefore included the first stage probability of selection of the enumeration area in that particular sampling stratum and the second stage probability of selection of a household in the sample enumeration area (cluster). A second 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 is equal to the inverse value of: RRh = Number of interviewed households in stratum h/ Number of occupied households listed in stratum h After the completion of fieldwork, the response rate was calculated for each sampling stratum. These were used to adjust the sample weights calculated for each cluster. Response rates in the Macedonia Multiple Indicator Cluster Survey are shown in Table HH.1 in this report. Similarly, the adjustment for non-response at the individual level (women and under-5 children) for each stratum is equal to the inverse value of: RRh = Completed women’s (or under-5’s) questionnaires in stratum h / Eligible women (or under-5s) in stratum h The non-response adjustment factors for women’s and under-5’s questionnaires are 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 for all sampling stages for the households in each enumeration area. These weights were then standardized (or normalized), one purpose of which was to make the weighted sum of the interviewed sample units equal the total sample size at the national level. Normalization was achieved by dividing the full sample weights (adjusted for nonresponse) by the average of these weights across all households at the national level. This is performed by multiplying the sample weights by a constant factor equal to the unweighted number of households at the national level divided by the weighted total number of households (using the full sample weights adjusted for nonresponse). A similar normalization procedure was followed in obtaining standardized weights for the women’s and under-5’s questionnaires. Adjusted (normalized) weights varied between 0.25 and 4.23 in the 300 sample enumeration areas (clusters). Sample weights were appended to all data sets and analyses were performed by weighting each household, woman or under-5 ,with these sample weights. During the data collection, in a number of clusters, the interviewers were not able to conduct the survey in some of the sampled households as the household members live outside of the country most of the year. In 17 clusters where more than 20% of empty households were identified, it was decided to replace these households with a random sample of in-scope 150 MultIple IndIcator cluster survey 2011 households selected from the same segment and second-stage stratum (with and without children). A total of 101 households were replaced in three regions: Southwest, Polog and Northeast region. The proposed sample replacement procedure affected the second stage component of the weights. The first stage component of the weight (calculated as the inverse of the probability of selection of the primary sampling unit) remained the same. Based on the sample design, a separate weight was calculated for the strata of households with and without children within each sample segment. Since the selected households that were out-of- scope in each stratum of these sample segments were replaced, it was possible to simplify the second stage component of the weight as follows for the households with children: W =2hi (wc) M`hi (wc) m`hi (wc) , where: W2hi(wc) = second-stage weight component for the sample households with children in the i-th sample segment in stratum h M’hi(wc) = number of in-scope households with children listed in the i-th sample segment in stratum h, after subtracting any households identified as residing outside of Macedonia most of the year m’hi(wc) = number of sample households with children that have completed questionnaires in the i-th sample segment in stratum h, including any replacement households It should be noted that this adjusted second stage component of the weight automatically adjusts the weight for any non-interviews as well as for any replacements for the households with children within the sample segment. Therefore it is not necessary to have a separate adjustment of the weights for household non-interviews. The second stage component of the weight for the households without children within the sample segment was be calculated in a similar way, as follows: W =2hi (woc) M`hi (woc) m`hi (woc) , where: W2hi(woc) = second-stage weight component for the sample households without children in the i-th sample segment in stratum h M’hi(woc) = number of in-scope households without children listed in the i-th sample segment in stratum h, after subtracting any households identified as residing outside of Macedonia most of the year m’hi(woc) = number of sample households without children that have completed questionnaires in the i-th sample segment in stratum h, including any replacement households 151 appendix a2. sample design – Roma settlements The major features of the sample design are described in this appendix. Sample design features include target sample size, sample allocation, sampling frame and listing, choice of domains, sampling stages, stratification, and the calculation of sample weights. The primary objective of the sample design for the Roma settlements in the Macedonia Multiple Indicator Cluster Survey was to produce statistically reliable estimates of most indicators, for the Roma population living in Roma settlements at the national level. A multi-stage, stratified cluster sampling approach was used for the selection of the survey sample. sample size and sample allocation The target national sample size for the Roma settlements in the Macedonia MICS was 1079 households. For the calculation of the sample size, the key indicator used was the incidence of stunting among children aged 0-4 years. The following formula was used to estimate the required sample size for this indicator: where n is the required sample size, expressed as number of households 4 is a factor to achieve the 95 percent level of confidence r is the predicted or anticipated value of the indicator, expressed in the form of a proportion 1.1 is the factor necessary to raise the sample size by 10 percent for the expected non-response [the actual factor will be based on the non-response level experienced in previous surveys in the country] f is the shortened symbol for deff (design effect) 0.12r is the margin of error to be tolerated at the 95 percent level of confidence, defined as 12 percent of r (relative margin oferror of r) p is the proportion of the total population upon which the indicator, r, is based is the average household size (number of persons per household). For the calculation, r (stunting prevalence) was assumed to be 16 percent. The value of deff (design effect) was taken as 1.5 based on estimates from previous surveys, p (percentage of children aged 0-4 years in the total population) was taken as 11 percent, (average household size) was taken as 4.4 members, and the response rate is assumed to be 90%. The resulting number of households from this exercise was 4972 households which is the sample size needed to provide a sufficient number of children under 5 for drawing reliable conclusions. This sample size was reduced to 1079 based on the original plan to stratify the listing in Roma sample PSUs by households with and without children under 5 for the second stage of selection. In this case a higher sampling rate would have been used for the households with children, similar to the sampling strategy for the national MICS. However, later it was decided that given the higher average number of children under 5 for the Roma households, the sampling procedure was simplified to select all households with equal probability in each Roma sample PSU at the second stage. The average number of households selected per cluster for the Macedonia Roma MICS was determined as 15 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. In total, 70 clusters were allocated to the regions with the number of clusters proportional to the population of the individual regions. 151 152 MultIple IndIcator cluster survey 2011 table sd.1R: allocation of sample clusters (primary sampling units) to sampling strata Region Roma population (2002 Estimates) Number of Clusters Urban Rural Total Urban Rural Total Vardar 633 709 1342 3 0 3 East 5196 301 5497 10 0 10 Southwest 1560 262 1822 3 0 3 Southeast 69 51 120 0 0 0 Pelagonija 6416 54 6470 11 0 11 Polog 2366 215 2581 4 0 4 Northeast 3406 107 3513 6 0 6 Skopje 19048 1207 20255 33 0 33 Total 38694 2906 41600 70 0 70 sampling frame and selection of clusters The 2002 census frame was used for the selection of clusters. Census enumeration areas were defined as primary sampling units (PSUs), and were selected from each of the sampling strata by using systematic pps (probability proportional to size) sampling procedures, based on the estimated sizes of the enumeration areas from the 2002 Population Census. The first stage of sampling was thus completed by selecting the required number of enumeration areas at the regional level. listing activities Since the sampling frame (the 2002 Population Census) was not up-to-date, a new listing of households was conducted in all the sample numeration areas prior to the selection of households. For this purpose, listing teams were formed, who visited each enumeration area, and listed the occupied households. Listing activities were conducted by the same company that was responsible for the data collection. The same teams that were selected for the data collection process were used for listing. The listing took place in February 2012. All teams were given the descriptions and maps of the selected clusters. The teams visited all households in the sample clusters asking for the number of members, number of women aged 15-49 and for number of children under age 5. selection of household Lists of households with household members were prepared by the listing teams for each enumeration area. The number of selected households per enumeration area was different, depending on the total number inhabitants in the enumeration area. In the enumeration areas with less than 400 inhabitants, 15 households were selected; in the enumeration areas with more than 400 but less than 500 inhabitants, 17 households were selected; in the enumeration areas with more than 500 inhabitants, 19 households were selected. The households were sequentially numbered from 1 to n (the total number of households in each enumeration area). Selection of the households was carried out using random systematic selection procedures. Total number of sampled Roma households was 1079 calculation of sample Weights The Macedonia Multiple Indicator Cluster Survey sample is not self-weighting. Essentially, by allocating equal numbers of households to each of the regions, different sampling fractions were used in each region since the size of the regions varied. For this reason, sample weights were calculated and these were used in the subsequent analyses of the survey data. The major component of the weight is the reciprocal of the sampling fraction employed in selecting the number of sample households in that particular sampling stratum (h) and PSU (i): 153 W =hi hi 1 f The term fhi, the sampling fraction for the i-th sample PSU in the h-th stratum, is the product of probabilities of selection at every stage in each sampling stratum: hi 1hi 2hif p x p= wherepshi is the probability of selection of the sampling unit at stages for the i-th sample PSU in the h-th sampling stratum. Since the estimated number of households in each enumeration area (PSU) in the sampling frame used for the first stage selection and the updated number of households in the enumeration area from the listing were different, individual sampling fractions for households in each sample enumeration area (cluster) were calculated. The sampling fractions for households in each enumeration area (cluster) therefore included the first stage probability of selection of the enumeration area in that particular sampling stratum and the second stage probability of selection of a household in the sample enumeration area (cluster). A second 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 is equal to the inverse value of: RRh = Number of interviewed households in stratum h/ Number of occupied households listed in stratum h 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 Macedonia Multiple Indicator Cluster Survey are shown in Table HH.1 in this report. Similarly, the adjustment for non-response at the individual level (women and under-5 children) for each stratum is equal to the inverse value of: RRh = Completed women’s (or under-5’s) questionnaires in stratum h / Eligible women (or under-5s) in stratum h The non-response adjustment factors for women’s and under-5’s questionnaires are 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 for all sampling stages for the households in each enumeration area. These weights were then standardized (or normalized), one purpose of which was to make the weighted sum of the interviewed sample units equal the total sample size at the national level. Normalization was achieved by dividing the full sample weights (adjusted for nonresponse) by the average of these weights across all households at the national level. This was performed by multiplying the sample weights by a constant factor equal to the unweighted number of households at the national level divided by the weighted total number of households (using the full sample weights adjusted for nonresponse). A similar normalization procedure was followed in obtaining standardized weights for the women’s and under-5’s questionnaires. Adjusted (normalized) weights varied between 0.24 and 4.39 in the 70 sample enumeration areas (clusters). Sample weights were appended to all data sets and analyses were performed by weighting each household, woman or under-5, with these sample weights. 154 MultIple IndIcator cluster survey 2011 appendix b. list of personnel involved in the survey Steering Committee Field Supervisors Institute of Public Health – Chair; Ministry of Education; Ministry of Labor and Social Policy; Institute for Social Activities; State Statistics Office; UNDP; UNFPA; WHO; UNICEF; IPSOS Strategic Puls; Ajhan Hani Dzila Borka Krsteva Gjorgje Spasov Irena Topalzoleva Ismet Bislimi Jadranka Danceva Katerina Cacorovska Katerina Krstevska Marina Ampova Naser Fetahi Project Manager Field Editors Gjorgji Mitrevski – IPSOS Strategic Puls Dragan Andovski Dragica Pejoska Florina Gasi Gjurgjica Jakimovska Igor Kostadinovski Laura Zuta Mitko Mitrev Natasa Simakoska Oliver Trpkovski Refik Tairi Romeo Kirilin Teuta-Tuse Lesi Questionnaire Design Tanja Ivanova – IPSOS Strategic Puls Zoran Stojanov – UNICEF Sample Design Dragisa Bjeloglav – IPSOS Strategic Puls Tanja Stojadinovic – IPSOS Strategic Puls Field Manager Jadranka Markoska – IPSOS Strategic Puls Field Coordinators Nevena Tashkovska – IPSOS Strategic Puls Measurers Valjbona Emini – IPSOS Strategic Puls Biljana Trajkova Blagica Jakimovska Desira Avdili Hamije Osmani Julijana Madzovska Lidija Stevanoska Ljupka Spasova Marija Corbevska Natasa Supeva Nora Nedzipi Valentina Labovik Violeta Jovanovska Data Processing Manager Ivica Sokolovski – IPSOS Strategic Puls UNICEF Sheldon Yett – Country Representative Foroogh Foyouzat – Deputy Representative Zoran Stojanov – Monitoring and Evaluation Officer 155 Medical teams Immunization data from health centres Medical teams Second stage disability assessment Aleksandra Srbinovska Biljana Trajkova Biljana Danilovska Filipovik Blagoja Aleksoski Jovanka Strulakova Korovesovska Natka Karanfilova Predrag GJorgjievski Silvana Petkoska Suzana Subasik Tatjana Stanimirovik Vladimir Spasenovski Aleksandra Proseva Ana Kedeva-Petrova Anica Angova Bekim Tatesi Beti Mihajlovik Dimovska Biljana Palanova Boris Milevski Daniela Dimovska Dusanka Malinkova Elena Bojadzievska Elica Stanislevik Elizabeta Spasik Elizabeta Zisovska Fadilj Maliki Fetah Elmazi Lidija GJurovska Lidija Markovska LJubica Kostova-Hristovska Magda Manojlovska Marija Hubreva Marija Ilijevska Marija Naneva Marijana Kosturanova Marijonka Vladimirovska Marina Gacova Meri Patce Natasa Despotovska Petre Krstev Roza Angelova Sandre GJorsevski Snezana Stankovska -Koceva Sonja Fileva Strahil Gazepov Sultana Asani Suzana Ristovska Suzana Tasevska Svetlana Demboska Tatjana Kocankovska Tirce Tnokovski Trajanka Lalevska Vera Krsteska Vesna Delovska Stojkova Violeta Koceva Zora Dimitrieska External Consultants Aleksandar Zoric Ivan Dvojakov Fimka Tozija Pierre Martel 156 MultIple IndIcator cluster survey 2011 Field Interviewers Data Entry Staff Afrodita Velioska Ajsegjilje Redzepi Aljmira Emsiu Aneta Ruseska Angjelina Gjureska Anica Stojanovska Ardione Ramadani Argjenta Saliu Bejtulj Eljezi Biljana GJorgijeska Biljana Ivanovska Biljana Karakasova Biljana Trajkovska Daniela Dimitrova Drita Huseini Elmedina Budzaku Gabriela Kamceva Indijana Elencevska Julija Stojkovska Karolina Arabadzieva Katica Dojcinova Kimet Ahmeti Kristina Anakieva Kristina Stojkova Krstana Kostoska Liridona Ramadani Lizabet Redzepi Ljaura Asani Ljubinka Pelovska Ljumturije Dervisoska Majlinda Ramadani Marija Eftimova Marija Marinkovska Marija Mihajlovska Marija Nikolova Marija Veselinova Martina Ristovska Milena Lazovska Milka Trajanova Nadire Redzepi Nadka Damjanova Nailja Redzep Natalija Cvetkovik Natasa Kanevceva Olivera Cavkar Pavlina Asenova Rabije Redzepi Sameda Memed Sanja Siljanoska Sara Ramadani Selda Bekiri Silvana Kujumdzieva Simona Radovska Sladjana Tosik Slavica Bozoska Slavica Dimoski-Ilievska Smilja Nikova Sofija Kotevska Sofija Krcova Sonja Velanovska Tanja Kostadinovska Teuta Aliji Teuta Asani Vanesa Ilijaz Vesna Atanasijevik Vljora Elmazi Zagorka Petruseva Zaklina Trajkovska Zaneta Atanasovska Atanas Serafimovski Harkan Memedi Ljubomir Pavlovik Maja Stojanoska Marina Nedelkovska Simona Naskovska Sumea Adzami Velimir Gjorgjijevski Vesna Misackovska Viktorija Marinova 157 appendix c. estimates of sampling errors The sample of respondents selected in the Macedonia Multiple Indicator Cluster Survey is only one of the samples that could have been selected from the same population, using the same design and size. Each of these samples would yield results that differ somewhat from the results of the actual sample selected. Sampling errors are a measure of the variability between the estimates from all possible samples. The extent of variability is not known exactly, but can be estimated statistically from the survey data. The following sampling error measures are presented in this appendix for each of the selected indicators: „ Standard error (se): Sampling errors are usually measured in terms of standard errors for particular indicators (means, proportions etc). Standard error is the square root of the variance of the estimate. The Taylor linearization method is used for the estimation of standard errors. „ Coefficient of variation (se/r) is the ratio of the standard error to the value of the indicator, and is a measure of the relative sampling error. „ Design effect (deff) is the ratio of the actual variance of an indicator, under the sampling method used in the survey, to the variance calculated under the assumption of simple random sampling. The square root of the design effect (deft) is used to show the efficiency of the sample design in relation to the precision. A deft value of 1.0 indicates that the sam- ple design is as efficient as a simple random sample, while a deft value above 1.0 indicates an increase in the standard error due to the use of a more complex sample design. „ Confidence limits are calculated to show the interval within which the true value for the population can be reasonably assumed to fall, with a specified level of confidence. For any given statistic calculated from the survey, the value of that statistic will fall within a range of plus or minus two times the standard error (r + 2.se or r – 2.se) of the statistic in 95 percent of all possible samples of identical size and design. For the calculation of sampling errors from MICS data, SPSS Version 18 Complex Samples module has been used. The results are shown in the tables that follow. In addition to the sampling error measures described above, the tables also include weighted and unweighted counts of denominators for each indicator. Sampling errors are calculated for indicators of primary interest, for the national level, for urban and rural areas, and for the regions. Six of the selected indicators are based on household members, 10 are based on women and 18 are based on children under 5. All indicators presented here are in the form of proportions. Table SE.1 shows the list of indicators for which sampling errors are calculated, including the base population (denominator) for each indicator. Tables SE.2 to SE.12 show the calculated sampling errors for selected domains. 158 MultIple IndIcator cluster survey 2011 table se.1: indicators selected for sampling error calculations, list of indicators selected for sampling error calculations, and base populations (denominators) for each indicator, Macedonia, 2011 MICS4 Indicator Base Population HOUSEHOLD MEMBERS 4.1 Use of improved drinking water sources All household members 4.3 Use of improved sanitation All household members 7.5 Secondary school net attendance ratio (adjusted) Children of secondary school age 8.2 Child labour Children age 5-14 years 9.18 Prevalence of children with one or both parents dead Children age 0-17 years 8.5 Violent discipline Children age 2-14 years WOMEN 5.2 Early childbearing Women age 20-24 years 5.3 Contraceptive prevalence rate Women age 15-49 years who are currently married or in union 5.4 Unmet need Women age 15-49 years who are currently married or in union 5.5a Antenatal care coverage - at least once by skilled personnel Women age 15-49 years with a live birth in the 2 years preceding the survey 5.5b Antenatal care coverage – at least four times by any provider Women age 15-49 years with a live birth in the 2 years preceding the survey 5.7 Skilled attendant at delivery Women age 15-49 years with a live birth in the 2 years preceding the survey 5.8 Institutional deliveries Women age 15-49 years with a live birth in the 2 years preceding the survey 5.9 Caesarean section Women age 15-49 years with a live birth in the 2 years preceding the survey 7.1 Literacy rate among young women Women age 15-24 years 8.7 Marriage before age 18 Women age 20-49 years UNDER-5s 2.1a Underweight prevalence Children under age 5 2.2a Stunting prevalence Children under age 5 2.3a Wasting prevalence Children under age 5 2.6 Exclusive breastfeeding under 6 months Total number of infants under 6 months of age 2.14 Age-appropriate breastfeeding Children age 0-23 months - Tuberculosis immunization coverage Children age 18-29 months  - Received polio immunization Children age 18-29months  - Received DPT immunization Children age 18-29months  - Received measles immunization Children age 18-29months  - Received Hepatitis B immunization Children age 18-29months  - Received HIB immunization Children under age 5 - Diarrhoea in the previous 2 weeks Children under age 5 - Illness with a cough in the previous 2 weeks Children under age 5 3.8 Oral rehydration therapy with continued feeding Children under age 5 with diarrhoea in the previous 2 weeks 3.10 Antibiotic treatment of suspected pneumonia Children under age 5 with suspected pneumonia in the previous 2 weeks 6.1 Support for learning Children age 36-59 months 6.7 Attendance to early childhood education Children age 36-59 months 8.1 Birth registration Children under age 5 159 table se.2: sampling errors: total sample, Macedonia, 2011 standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Macedonia, 2011 MICS Indicator Value (r) Standard error (se) Coefficient of variation (se/r) Design effect (deff) Square root of design effect (deft) Weighted count Unweighted count Confidence limits r - 2se r + 2se HOUSEHOLD MEMBERS Use of improved drinking water sources 4.1 0.996 0.00209 0.002 3.963 1.991 14764 4018 0.991 1.000 Use of improved sanitation 4.3 0.984 0.00247 0.003 1.504 1.226 13935 3814 0.979 0.989 Secondary school net attendance ratio (adjusted) 7.5 0.827 0.01324 0.016 1.148 1.071 868 939 0.800 0.853 Child labour 8.2 0.166 0.01017 0.061 1.482 1.218 1702 1990 0.146 0.187 Prevalence of children with one or both parents dead 9.18 0.019 0.00312 0.167 2.164 1.471 3204 4085 0.013 0.025 Violent discipline 8.5 0.693 0.01452 0.021 1.713 1.309 2222 1729 0.664 0.722 WOMEN Early childbearing 5.2 0.016 0.00369 0.227 0.471 0.686 541 555 0.009 0.024 Contraceptive prevalence 5.3 0.404 0.01350 0.033 2.024 1.423 2537 2675 0.377 0.431 Unmet need 5.4 0.172 0.00790 0.046 1.172 1.083 2537 2675 0.156 0.188 Antenatal care coverage - at least once by skilled personnel 5.5a 0.986 0.00429 0.004 0.649 0.806 362 503 0.977 0.994 Antenatal care coverage – at least four times by any provider 5.5b 0.939 0.00960 0.010 0.808 0.899 362 503 0.920 0.958 Skilled attendant at delivery 5.7 0.983 0.00415 0.004 0.512 0.715 362 503 0.975 0.991 Institutional deliveries 5.8 0.984 0.00462 0.005 0.694 0.833 362 503 0.975 0.994 Caesarean section 5.9 0.249 0.01991 0.080 1.063 1.031 362 503 0.209 0.289 Literacy rate among young women 7.1 0.974 0.00534 0.005 1.209 1.100 1071 1084 0.963 0.984 Marriage before age 18 8.7 0.107 0.00751 0.070 1.956 1.398 3301 3302 0.092 0.122 UNDER-5s Underweight prevalence 2.1a 0.013 0.00336 0.263 1.190 1.091 1332 1332 0.006 0.019 Stunting prevalence 2.2a 0.049 0.00727 0.147 1.478 1.216 1318 1317 0.035 0.064 Wasting prevalence 2.3a 0.018 0.00573 0.314 2.379 1.542 1299 1297 0.007 0.030 Exclusive breastfeeding under 6 months 2.6 0.230 0.01797 0.078 0.202 0.450 114 112 0.194 0.266 Age-appropriate breastfeeding 2.14 0.224 0.02207 0.098 1.458 1.208 541 522 0.180 0.268 Tuberculosis immunization coverage - 0.976 0.01097 0.011 1.472 1.213 270 282 0.955 0.998 Received polio immunization - 0.967 0.01132 0.012 1.115 1.056 270 282 0.944 0.989 Received DPT immunization - 0.952 0.01281 0.013 1.008 1.004 270 282 0.926 0.978 Received measles immunization - 0.960 0.01208 0.013 1.074 1.036 270 282 0.936 0.984 Received Hepatitis B immunization - 0.955 0.01172 0.012 0.895 0.946 270 282 0.931 0.978 Received HIB immunization - 0.953 0.01280 0.013 1.011 1.006 266 280 0.927 0.978 Diarrhoea in the previous 2 weeks - 0.064 0.00819 0.128 1.535 1.239 1376 1376 0.048 0.081 Illness with a cough in the previous 2 weeks - 0.023 0.00438 0.187 1.153 1.074 1376 1376 0.015 0.032 Oral rehydration therapy with continued feeding 3.8 0.666 0.01949 0.029 0.150 0.388 88 89 0.627 0.705 Antibiotic treatment of suspected pneumonia 3.10 * * * * * 32 37 * * Support for learning 6.1 0.915 0.01242 0.014 1.099 1.049 561 558 0.890 0.939 Attendance to early childhood education 6.7 0.218 0.02112 0.097 1.459 1.208 561 558 0.175 0.260 Birth registration 8.1 0.997 0.00115 0.001 0.708 0.841 1376 1376 0.995 1.000 160 MultIple IndIcator cluster survey 2011 table se.3: sampling errors: urban areas, Macedonia, 2011 standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Macedonia, 2011 MICS Indicator Value (r) Standard error (se) Coefficient of variation (se/r) Design effect (deff) Square root of design effect (deft) Weighted count Unweighted count Confidence limits r - 2se r + 2se HOUSEHOLD MEMBERS Use of improved drinking water sources 4.1 1.000 0.00000 0.000 NA NA 8202 2206 1.000 1.000 Use of improved sanitation 4.3 0.991 0.00224 0.002 1.214 1.102 8188 2199 0.986 0.995 Secondary school net attendance ratio (adjusted) 7.5 0.916 0.01701 0.019 1.279 1.131 387 341 0.882 0.950 Child labour 8.2 0.103 0.01246 0.121 1.464 1.210 860 874 0.078 0.128 Prevalence of children with one or both parents dead 9.18 0.021 0.00450 0.214 1.869 1.367 1604 1900 0.012 0.030 Violent discipline 8.5 0.667 0.02056 0.031 1.662 1.289 1130 875 0.626 0.708 WOMEN Early childbearing 5.2 0.017 0.00604 0.351 0.488 0.699 275 227 0.005 0.029 Contraceptive prevalence 5.3 0.429 0.01827 0.043 1.750 1.323 1333 1285 0.392 0.465 Unmet need 5.4 0.166 0.01049 0.063 1.020 1.010 1333 1285 0.145 0.187 Antenatal care coverage - at least once by skilled personnel 5.5a 0.996 0.00274 0.003 0.533 0.730 178 264 0.991 1.000 Antenatal care coverage – at least four times by any provider 5.5b 0.958 0.01351 0.014 1.201 1.096 178 264 0.931 0.985 Skilled attendant at delivery 5.7 0.983 0.00564 0.006 0.490 0.700 178 264 0.971 0.994 Institutional deliveries 5.8 0.993 0.00358 0.004 0.469 0.685 178 264 0.986 1.000 Caesarean section 5.9 0.338 0.02512 0.074 0.742 0.861 178 264 0.288 0.388 Literacy rate among young women 7.1 0.990 0.00533 0.005 1.146 1.071 514 415 0.979 1.000 Marriage before age 18 8.7 0.063 0.00692 0.110 1.338 1.157 1854 1650 0.049 0.077 UNDER-5s Underweight prevalence 2.1a 0.008 0.00325 0.429 1.008 1.004 671 718 0.001 0.014 Stunting prevalence 2.2a 0.041 0.00733 0.177 0.962 0.981 666 712 0.027 0.056 Wasting prevalence 2.3a 0.012 0.00390 0.313 0.865 0.930 657 701 0.005 0.020 Exclusive breastfeeding under 6 months 2.6 0.211 0.02322 0.110 0.185 0.430 58 58 0.165 0.257 Age-appropriate breastfeeding 2.14 0.256 0.02742 0.107 1.086 1.042 268 276 0.201 0.311 Tuberculosis immunization coverage - 0.981 0.01412 0.014 1.557 1.248 132 146 0.953 1.000 Received polio immunization - 0.965 0.01501 0.016 0.959 0.979 132 146 0.935 0.995 Received DPT immunization - 0.935 0.01910 0.020 0.867 0.931 132 146 0.897 0.973 Received measles immunization - 0.955 0.01718 0.018 0.988 0.994 132 146 0.920 0.989 Received Hepatitis B immunization - 0.941 0.01569 0.017 0.639 0.800 132 146 0.909 0.972 Received HIB immunization - 0.955 0.01670 0.017 0.930 0.964 129 145 0.921 0.988 Diarrhoea in the previous 2 weeks - 0.059 0.00944 0.159 1.197 1.094 701 750 0.040 0.078 Illness with a cough in the previous 2 weeks - 0.019 0.00425 0.223 0.721 0.849 701 750 0.011 0.028 Oral rehydration therapy with continued feeding 3.8 * * * * * 42 47 * * Antibiotic treatment of suspected pneumonia 3.10 * * * * * 13 17 * * Support for learning 6.1 0.941 0.01370 0.015 1.018 1.009 284 304 0.913 0.968 Attendance to early childhood education 6.7 0.372 0.03399 0.091 1.498 1.224 284 304 0.304 0.440 Birth registration 8.1 0.999 0.00077 0.001 0.576 0.759 701 750 0.998 1.000 161 table se.4: sampling errors: Rural areas, Macedonia, 2011 standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Macedonia, 2011 MICS Indicator Value (r) Standard error (se) Coefficient of variation (se/r) Design effect (deff) Square root of design effect (deft) Weighted count Unweighted count Confidence limits r - 2se r + 2se HOUSEHOLD MEMBERS Use of improved drinking water sources 4.1 0.990 0.00467 0.005 4.002 2.001 6562 1812 0.981 0.999 Use of improved sanitation 4.3 0.975 0.00507 0.005 1.693 1.301 5746 1615 0.965 0.985 Secondary school net attendance ratio (adjusted) 7.5 0.755 0.01996 0.026 1.286 1.134 481 598 0.715 0.795 Child labour 8.2 0.231 0.01504 0.065 1.421 1.192 842 1116 0.201 0.261 Prevalence of children with one or both parents dead 9.18 0.016 0.00433 0.262 2.522 1.588 1599 2185 0.008 0.025 Violent discipline 8.5 0.721 0.02032 0.028 1.748 1.322 1091 854 0.680 0.761 WOMEN Early childbearing 5.2 0.015 0.00415 0.271 0.374 0.611 266 328 0.007 0.024 Contraceptive prevalence 5.3 0.377 0.01956 0.052 2.262 1.504 1205 1390 0.338 0.416 Unmet need 5.4 0.178 0.01200 0.067 1.367 1.169 1205 1390 0.154 0.202 Antenatal care coverage - at least once by skilled personnel 5.5a 0.975 0.00819 0.008 0.659 0.812 183 239 0.959 0.992 Antenatal care coverage – at least four times by any provider 5.5b 0.920 0.01419 0.015 0.653 0.808 183 239 0.892 0.949 Skilled attendant at delivery 5.7 0.983 0.00607 0.006 0.525 0.724 183 239 0.971 0.995 Institutional deliveries 5.8 0.976 0.00855 0.009 0.745 0.863 183 239 0.959 0.993 Caesarean section 5.9 0.163 0.02584 0.158 1.164 1.079 183 239 0.111 0.215 Literacy rate among young women 7.1 0.959 0.00892 0.009 1.359 1.166 557 669 0.941 0.977 Marriage before age 18 8.7 0.163 0.01314 0.081 2.092 1.447 1447 1652 0.136 0.189 UNDER-5s Underweight prevalence 2.1a 0.018 0.00593 0.329 1.218 1.104 661 614 0.006 0.030 Stunting prevalence 2.2a 0.058 0.01278 0.221 1.813 1.347 653 605 0.032 0.083 Wasting prevalence 2.3a 0.024 0.01060 0.440 2.842 1.686 642 596 0.003 0.045 Exclusive breastfeeding under 6 months 2.6 0.250 0.02806 0.112 0.223 0.472 56 54 0.194 0.306 Age-appropriate breastfeeding 2.14 0.193 0.03305 0.171 1.715 1.309 273 246 0.127 0.260 Tuberculosis immunization coverage - 0.972 0.01675 0.017 1.397 1.182 138 136 0.939 1.000 Received polio immunization - 0.968 0.01682 0.017 1.248 1.117 138 136 0.935 1.000 Received DPT immunization - 0.968 0.01682 0.017 1.248 1.117 138 136 0.935 1.000 Received measles immunization - 0.966 0.01687 0.017 1.158 1.076 138 136 0.932 0.999 Received Hepatitis B immunization - 0.968 0.01682 0.017 1.248 1.117 138 136 0.935 1.000 Received HIB immunization - 0.950 0.01933 0.020 1.065 1.032 137 135 0.912 0.989 Diarrhoea in the previous 2 weeks - 0.069 0.01358 0.196 1.786 1.336 675 626 0.042 0.096 Illness with a cough in the previous 2 weeks - 0.028 0.00785 0.280 1.414 1.189 675 626 0.012 0.044 Oral rehydration therapy with continued feeding 3.8 * * * * * 47 42 * * Antibiotic treatment of suspected pneumonia 3.10 * * * * * 19 20 * * Support for learning 6.1 0.888 0.02101 0.024 1.123 1.060 277 254 0.846 0.930 Attendance to early childhood education 6.7 0.059 0.01045 0.176 0.495 0.704 277 254 0.038 0.080 Birth registration 8.1 0.996 0.00219 0.002 0.677 0.823 675 626 0.991 1.000 162 MultIple IndIcator cluster survey 2011 table se.5: sampling errors: vardar region, Macedonia, 2011 standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Macedonia, 2011 MICS Indicator Value (r) Standard error (se) Coefficient of variation (se/r) Design effect (deff) Square root of design effect (deft) Weighted count Unweighted count Confidence limits r - 2se r + 2se HOUSEHOLD MEMBERS Use of improved drinking water sources 4.1 1.000 0.00000 0.000 NA NA 1064 338 1.000 1.000 Use of improved sanitation 4.3 0.979 0.00926 0.009 1.326 1.152 1012 317 0.961 0.998 Secondary school net attendance ratio (adjusted) 7.5 0.859 0.04700 0.055 0.694 0.833 47 39 0.765 0.953 Child labour 8.2 0.073 0.02268 0.312 0.894 0.945 97 118 0.027 0.118 Prevalence of children with one or both parents dead 9.18 0.017 0.00954 0.555 1.525 1.235 193 284 0.000 0.036 Violent discipline 8.5 0.797 0.04849 0.061 1.951 1.397 143 135 0.700 0.894 WOMEN Early childbearing 5.2 0.026 0.00944 0.364 0.152 0.389 34 44 0.007 0.045 Contraceptive prevalence 5.3 0.387 0.05456 0.141 2.334 1.528 155 187 0.278 0.496 Unmet need 5.4 0.196 0.03202 0.163 1.209 1.099 155 187 0.132 0.260 Antenatal care coverage - at least once by skilled personnel 5.5a * * * * * 16 37 * * Antenatal care coverage – at least four times by any provider 5.5b * * * * * 16 37 * * Skilled attendant at delivery 5.7 * * * * * 16 37 * * Institutional deliveries 5.8 * * * * * 16 37 * * Caesarean section 5.9 * * * * * 16 37 * * Literacy rate among young women 7.1 0.959 0.02458 0.026 0.959 0.979 58 64 0.909 1.000 Marriage before age 18 8.7 0.188 0.02748 0.146 1.166 1.080 219 237 0.133 0.243 UNDER-5s Underweight prevalence 2.1a 0.013 0.01378 1.029 1.956 1.398 99 137 0.000 0.041 Stunting prevalence 2.2a 0.051 0.02613 0.508 1.891 1.375 98 136 0.000 0.104 Wasting prevalence 2.3a 0.038 0.01615 0.429 0.972 0.986 98 136 0.005 0.070 Exclusive breastfeeding under 6 months 2.6 * * * * * 7 11 * * Age-appropriate breastfeeding 2.14 * * * * * 27 42 * * Tuberculosis immunization coverage - * * * * * 20 30 * * Received polio immunization - * * * * * 20 30 * * Received DPT immunization - * * * * * 20 30 * * Received measles immunization - * * * * * 20 30 * * Received Hepatitis B immunization - * * * * * 20 30 * * Received HIB immunization - * * * * * 20 30 * * Diarrhoea in the previous 2 weeks - 0.040 0.01689 0.426 1.035 1.017 100 139 0.006 0.073 Illness with a cough in the previous 2 weeks - 0.024 0.01198 0.492 0.834 0.913 100 139 0.000 0.048 Oral rehydration therapy with continued feeding 3.8 * * * * * 4 7 * * Antibiotic treatment of suspected pneumonia 3.10 * * * * * 2 4 * * Support for learning 6.1 0.939 0.03791 0.040 1.525 1.235 51 62 0.863 1.000 Attendance to early childhood education 6.7 0.443 0.12733 0.288 4.008 2.002 51 62 0.188 0.697 Birth registration 8.1 1.000 0.00000 0.000 NA NA 100 139 1.000 1.000 163 table se.6: sampling errors: east region, Macedonia, 2011 standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Macedonia, 2011 MICS Indicator Value (r) Standard error (se) Coefficient of variation (se/r) Design effect (deff) Square root of design effect (deft) Weighted count Unweighted count Confidence limits r - 2se r + 2se HOUSEHOLD MEMBERS Use of improved drinking water sources 4.1 0.997 0.00252 0.003 0.671 0.819 1235 370 0.991 1.000 Use of improved sanitation 4.3 0.953 0.01474 0.015 1.655 1.287 1148 344 0.923 0.982 Secondary school net attendance ratio (adjusted) 7.5 * * * * * 45 39 * * Child labour 8.2 0.198 0.03206 0.162 0.906 0.952 123 141 0.134 0.262 Prevalence of children with one or both parents dead 9.18 0.021 0.01026 0.485 1.531 1.237 225 302 0.001 0.042 Violent discipline 8.5 0.638 0.05694 0.089 2.063 1.436 168 148 0.524 0.752 WOMEN Early childbearing 5.2 0.072 0.04280 0.592 0.956 0.978 30 36 0.000 0.158 Contraceptive prevalence 5.3 0.387 0.03114 0.080 0.805 0.897 185 198 0.325 0.449 Unmet need 5.4 0.260 0.03241 0.125 1.075 1.037 185 198 0.195 0.325 Antenatal care coverage - at least once by skilled personnel 5.5a * * * * * 25 41 * * Antenatal care coverage – at least four times by any provider 5.5b * * * * * 25 41 * * Skilled attendant at delivery 5.7 * * * * * 25 41 * * Institutional deliveries 5.8 * * * * * 25 41 * * Caesarean section 5.9 * * * * * 25 41 * * Literacy rate among young women 7.1 0.889 0.05313 0.060 1.694 1.301 61 60 0.783 0.996 Marriage before age 18 8.7 0.139 0.03519 0.254 2.375 1.541 228 230 0.068 0.209 UNDER-5s Underweight prevalence 2.1a 0.033 0.01749 0.533 1.252 1.119 110 131 0.000 0.068 Stunting prevalence 2.2a 0.063 0.02874 0.455 1.813 1.347 110 131 0.006 0.121 Wasting prevalence 2.3a 0.028 0.01601 0.568 1.207 1.099 109 130 0.000 0.060 Exclusive breastfeeding under 6 months 2.6 * * * * * 6 5 * * Age-appropriate breastfeeding 2.14 * * * * * 37 41 * * Tuberculosis immunization coverage - * * * * * 27 32 * * Received polio immunization - * * * * * 27 32 * * Received DPT immunization - * * * * * 27 32 * * Received measles immunization - * * * * * 27 32 * * Received Hepatitis B immunization - * * * * * 27 32 * * Received HIB immunization - * * * * * 27 32 * * Diarrhoea in the previous 2 weeks - 0.063 0.02148 0.342 1.020 1.010 110 131 0.020 0.106 Illness with a cough in the previous 2 weeks - 0.037 0.01592 0.432 0.928 0.963 110 131 0.005 0.069 Oral rehydration therapy with continued feeding 3.8 * * * * * 7 8 * * Antibiotic treatment of suspected pneumonia 3.10 * * * * * 4 4 * * Support for learning 6.1 0.855 0.06166 0.072 1.807 1.344 49 60 0.731 0.978 Attendance to early childhood education 6.7 0.240 0.06121 0.255 1.213 1.101 49 60 0.117 0.362 Birth registration 8.1 1.000 0.00000 0.000 NA NA 110 131 1.000 1.000 164 MultIple IndIcator cluster survey 2011 table se.7: sampling errors: southwest region, Macedonia, 2011 standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Macedonia, 2011 MICS Indicator Value (r) Standard error (se) Coefficient of variation (se/r) Design effect (deff) Square root of design effect (deft) Weighted count Unweighted count Confidence limits r - 2se r + 2se HOUSEHOLD MEMBERS Use of improved drinking water sources 4.1 0.998 0.00214 0.002 0.795 0.892 1337 428 0.993 1.000 Use of improved sanitation 4.3 0.983 0.00690 0.007 1.211 1.101 1332 425 0.969 0.997 Secondary school net attendance ratio (adjusted) 7.5 0.779 0.05370 0.069 2.025 1.423 96 122 0.671 0.886 Child labour 8.2 0.230 0.03346 0.145 1.447 1.203 171 230 0.163 0.297 Prevalence of children with one or both parents dead 9.18 0.009 0.00526 0.555 1.328 1.152 312 451 0.000 0.020 Violent discipline 8.5 0.666 0.04057 0.061 1.390 1.179 208 189 0.584 0.747 WOMEN Early childbearing 5.2 0.000 0.00000 . . . 43 51 0.000 0.000 Contraceptive prevalence 5.3 0.207 0.02642 0.128 1.258 1.122 253 297 0.154 0.260 Unmet need 5.4 0.238 0.03155 0.132 1.624 1.274 253 297 0.175 0.301 Antenatal care coverage - at least once by skilled personnel 5.5a 0.994 0.00590 0.006 0.312 0.559 39 52 0.982 1.000 Antenatal care coverage – at least four times by any provider 5.5b 0.856 0.05476 0.064 1.243 1.115 39 52 0.747 0.966 Skilled attendant at delivery 5.7 1.000 0.00000 0.000 NA NA 39 52 1.000 1.000 Institutional deliveries 5.8 0.994 0.00590 0.006 0.312 0.559 39 52 0.982 1.000 Caesarean section 5.9 0.303 0.06254 0.207 0.945 0.972 39 52 0.178 0.428 Literacy rate among young women 7.1 0.958 0.02674 0.028 2.095 1.447 99 120 0.904 1.000 Marriage before age 18 8.7 0.116 0.02147 0.185 1.557 1.248 296 348 0.073 0.159 UNDER-5s Underweight prevalence 2.1a 0.028 0.01670 0.595 1.278 1.130 117 126 0.000 0.061 Stunting prevalence 2.2a 0.133 0.04356 0.328 2.011 1.418 111 123 0.046 0.220 Wasting prevalence 2.3a 0.038 0.01977 0.525 1.252 1.119 103 117 0.000 0.077 Exclusive breastfeeding under 6 months 2.6 * * * * * 5 8 * * Age-appropriate breastfeeding 2.14 0.153 0.05224 0.342 1.140 1.067 59 55 0.048 0.257 Tuberculosis immunization coverage - * * * * * 20 26 * * Received polio immunization - * * * * * 20 26 * * Received DPT immunization - * * * * * 20 26 * * Received measles immunization - * * * * * 20 26 * * Received Hepatitis B immunization - * * * * * 20 26 * * Received HIB immunization - * * * * * 20 26 * * Diarrhoea in the previous 2 weeks - 0.041 0.01675 0.406 0.922 0.960 121 131 0.008 0.075 Illness with a cough in the previous 2 weeks - 0.001 0.00144 1.043 0.195 0.442 121 131 0.000 0.004 Oral rehydration therapy with continued feeding 3.8 * * * * * 5 8 * * Antibiotic treatment of suspected pneumonia 3.10 * * * * * 0 1 * * Support for learning 6.1 0.915 0.04572 0.050 1.346 1.160 47 51 0.824 1.000 Attendance to early childhood education 6.7 0.103 0.03335 0.324 0.603 0.776 47 51 0.036 0.169 Birth registration 8.1 0.991 0.00613 0.006 0.566 0.752 121 131 0.979 1.000 165 table se.8: sampling errors: southeast region, Macedonia, 2011 standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Macedonia, 2011 MICS Indicator Value (r) Standard error (se) Coefficient of variation (se/r) Design effect (deff) Square root of design effect (deft) Weighted count Unweighted count Confidence limits r - 2se r + 2se HOUSEHOLD MEMBERS Use of improved drinking water sources 4.1 0.976 0.02012 0.021 6.074 2.465 1293 354 0.936 1.000 Use of improved sanitation 4.3 0.988 0.00391 0.004 0.445 0.667 1213 337 0.981 0.996 Secondary school net attendance ratio (adjusted) 7.5 0.813 0.05434 0.067 1.401 1.184 82 73 0.705 0.922 Child labour 8.2 0.336 0.05499 0.163 2.072 1.440 142 154 0.226 0.446 Prevalence of children with one or both parents dead 9.18 0.024 0.01560 0.658 3.481 1.866 262 332 0.000 0.055 Violent discipline 8.5 0.652 0.05728 0.088 2.023 1.422 179 141 0.537 0.766 WOMEN Early childbearing 5.2 * * * * * 34 39 * * Contraceptive prevalence 5.3 0.186 0.03877 0.209 2.156 1.468 211 218 0.108 0.263 Unmet need 5.4 0.255 0.02960 0.116 1.001 1.000 211 218 0.196 0.314 Antenatal care coverage - at least once by skilled personnel 5.5a * * * * * 16 31 * * Antenatal care coverage – at least four times by any provider 5.5b * * * * * 16 31 * * Skilled attendant at delivery 5.7 * * * * * 16 31 * * Institutional deliveries 5.8 * * * * * 16 31 * * Caesarean section 5.9 * * * * * 16 31 * * Literacy rate among young women 7.1 0.964 0.00301 0.003 0.021 0.143 88 80 0.958 0.970 Marriage before age 18 8.7 0.154 0.02198 0.143 0.953 0.976 263 258 0.110 0.198 UNDER-5s Underweight prevalence 2.1a 0.004 0.00454 1.019 0.530 0.728 81 115 0.000 0.014 Stunting prevalence 2.2a 0.013 0.00090 0.072 0.007 0.086 81 114 0.011 0.014 Wasting prevalence 2.3a 0.010 0.00988 0.985 1.092 1.045 79 112 0.000 0.030 Exclusive breastfeeding under 6 months 2.6 * * * * * 6 8 * * Age-appropriate breastfeeding 2.14 * * * * * 24 33 * * Tuberculosis immunization coverage - * * * * * 20 30 * * Received polio immunization - * * * * * 20 30 * * Received DPT immunization - * * * * * 20 30 * * Received measles immunization - * * * * * 20 30 * * Received Hepatitis B immunization - * * * * * 20 30 * * Received HIB immunization - * * * * * 20 30 * * Diarrhoea in the previous 2 weeks - 0.049 0.02565 0.519 1.639 1.280 83 118 0.000 0.101 Illness with a cough in the previous 2 weeks - 0.044 0.01915 0.439 1.029 1.014 83 118 0.005 0.082 Oral rehydration therapy with continued feeding 3.8 * * * * * 4 5 * * Antibiotic treatment of suspected pneumonia 3.10 * * * * * 4 5 * * Support for learning 6.1 * * * * * 34 48 * * Attendance to early childhood education 6.7 * * * * * 34 48 * * Birth registration 8.1 1.000 0.00000 0.000 NA NA 83 118 1.000 1.000 166 MultIple IndIcator cluster survey 2011 table se.9: sampling errors: pelagonia region, Macedonia, 2011 standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Macedonia, 2011 MICS Indicator Value (r) Standard error (se) Coefficient of variation (se/r) Design effect (deff) Square root of design effect (deft) Weighted count Unweighted count Confidence limits r - 2se r + 2se HOUSEHOLD MEMBERS Use of improved drinking water sources 4.1 1.000 0.00000 0.000 NA NA 1957 550 1.000 1.000 Use of improved sanitation 4.3 0.987 0.00716 0.007 2.084 1.444 1866 523 0.973 1.000 Secondary school net attendance ratio (adjusted) 7.5 0.950 0.01747 0.018 0.593 0.770 105 94 0.915 0.985 Child labour 8.2 0.099 0.02274 0.230 1.371 1.171 215 237 0.053 0.144 Prevalence of children with one or both parents dead 9.18 0.014 0.00808 0.558 2.318 1.523 392 508 0.000 0.031 Violent discipline 8.5 0.838 0.03023 0.036 1.571 1.253 274 234 0.778 0.899 WOMEN Early childbearing 5.2 0.025 0.01099 0.439 0.307 0.554 62 63 0.003 0.047 Contraceptive prevalence 5.3 0.766 0.02770 0.036 1.526 1.235 339 357 0.711 0.822 Unmet need 5.4 0.028 0.01027 0.369 1.389 1.178 339 357 0.007 0.048 Antenatal care coverage - at least once by skilled personnel 5.5a * * * * * 42 78 * * Antenatal care coverage – at least four times by any provider 5.5b * * * * * 42 78 * * Skilled attendant at delivery 5.7 * * * * * 42 78 * * Institutional deliveries 5.8 * * * * * 42 78 * * Caesarean section 5.9 * * * * * 42 78 * * Literacy rate among young women 7.1 0.991 0.00626 0.006 0.524 0.724 144 126 0.978 1.000 Marriage before age 18 8.7 0.094 0.01486 0.158 1.105 1.051 431 427 0.064 0.124 UNDER-5s Underweight prevalence 2.1a 0.018 0.00977 0.556 1.067 1.033 152 194 0.000 0.037 Stunting prevalence 2.2a 0.041 0.01177 0.286 0.681 0.825 152 195 0.018 0.065 Wasting prevalence 2.3a 0.023 0.00987 0.434 0.847 0.920 152 194 0.003 0.042 Exclusive breastfeeding under 6 months 2.6 * * * * * 17 20 * * Age-appropriate breastfeeding 2.14 0.109 0.01708 0.156 0.236 0.486 62 80 0.075 0.144 Tuberculosis immunization coverage - * * * * * 34 42 * * Received polio immunization - * * * * * 34 42 * * Received DPT immunization - * * * * * 34 42 * * Received measles immunization - * * * * * 34 42 * * Received Hepatitis B immunization - * * * * * 34 42 * * Received HIB immunization - * * * * * 34 42 * * Diarrhoea in the previous 2 weeks - 0.048 0.01502 0.316 0.986 0.993 156 199 0.018 0.078 Illness with a cough in the previous 2 weeks - 0.049 0.01747 0.354 1.287 1.134 156 199 0.014 0.084 Oral rehydration therapy with continued feeding 3.8 * * * * * 7 11 * * Antibiotic treatment of suspected pneumonia 3.10 * * * * * 8 9 * * Support for learning 6.1 0.911 0.02937 0.032 0.785 0.886 58 75 0.852 0.969 Attendance to early childhood education 6.7 0.212 0.05532 0.261 1.358 1.165 58 75 0.101 0.322 Birth registration 8.1 0.997 0.00346 0.003 0.691 0.831 156 199 0.990 1.000 167 table se.10: sampling errors: polog region, Macedonia, 2011 standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Macedonia, 2011 MICS Indicator Value (r) Standard error (se) Coefficient of variation (se/r) Design effect (deff) Square root of design effect (deft) Weighted count Unweighted count Confidence limits r - 2se r + 2se HOUSEHOLD MEMBERS Use of improved drinking water sources 4.1 0.997 0.00184 0.002 0.825 0.908 2059 625 0.994 1.000 Use of improved sanitation 4.3 0.984 0.00600 0.006 1.268 1.126 1703 546 0.972 0.996 Secondary school net attendance ratio (adjusted) 7.5 0.750 0.03177 0.042 1.190 1.091 152 222 0.687 0.814 Child labour 8.2 0.304 0.02522 0.083 1.083 1.041 242 361 0.253 0.354 Prevalence of children with one or both parents dead 9.18 0.020 0.00938 0.474 3.383 1.839 513 747 0.001 0.039 Violent discipline 8.5 0.684 0.04092 0.060 2.240 1.497 339 290 0.603 0.766 WOMEN Early childbearing 5.2 0.007 0.00078 0.105 0.010 0.099 102 120 0.006 0.009 Contraceptive prevalence 5.3 0.384 0.02322 0.060 1.231 1.110 409 541 0.338 0.431 Unmet need 5.4 0.175 0.02016 0.115 1.523 1.234 409 541 0.134 0.215 Antenatal care coverage - at least once by skilled personnel 5.5a 0.997 0.00361 0.004 0.315 0.561 69 85 0.989 1.000 Antenatal care coverage – at least four times by any provider 5.5b 0.952 0.01729 0.018 0.550 0.742 69 85 0.917 0.987 Skilled attendant at delivery 5.7 1.000 0.00000 0.000 . . 69 85 1.000 1.000 Institutional deliveries 5.8 0.966 0.01873 0.019 0.904 0.951 69 85 0.929 1.000 Caesarean section 5.9 0.142 0.04564 0.321 1.433 1.197 69 85 0.051 0.234 Literacy rate among young women 7.1 0.972 0.01159 0.012 1.225 1.107 199 251 0.949 0.995 Marriage before age 18 8.7 0.132 0.01821 0.138 1.877 1.370 500 648 0.095 0.168 UNDER-5s Underweight prevalence 2.1a 0.005 0.00504 1.018 1.078 1.038 251 210 0.000 0.015 Stunting prevalence 2.2a 0.050 0.01792 0.356 1.375 1.173 250 206 0.015 0.086 Wasting prevalence 2.3a 0.034 0.02466 0.731 3.675 1.917 244 198 0.000 0.083 Exclusive breastfeeding under 6 months 2.6 * * * * * 23 19 * * Age-appropriate breastfeeding 2.14 0.195 0.06038 0.309 1.972 1.404 103 86 0.075 0.316 Tuberculosis immunization coverage - * * * * * 39 38 * * Received polio immunization - * * * * * 39 38 * * Received DPT immunization - * * * * * 39 38 * * Received measles immunization - * * * * * 39 38 * * Received Hepatitis B immunization - * * * * * 39 38 * * Received HIB immunization - * * * * * 38 37 * * Diarrhoea in the previous 2 weeks - 0.084 0.02556 0.306 1.833 1.354 256 216 0.033 0.135 Illness with a cough in the previous 2 weeks - 0.017 0.00909 0.532 1.057 1.028 256 216 0.000 0.035 Oral rehydration therapy with continued feeding 3.8 * * * * * 21 17 * * Antibiotic treatment of suspected pneumonia 3.10 * * * * * 4 4 * * Support for learning 6.1 0.914 0.03690 0.040 1.485 1.219 102 87 0.840 0.988 Attendance to early childhood education 6.7 0.059 0.01830 0.313 0.523 0.723 102 87 0.022 0.095 Birth registration 8.1 0.997 0.00039 0.000 0.013 0.115 256 216 0.997 0.998 168 MultIple IndIcator cluster survey 2011 table se.11: sampling errors: northeast region, Macedonia, 2011 standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Macedonia, 2011 MICS Indicator Value (r) Standard error (se) Coefficient of variation (se/r) Design effect (deff) Square root of design effect (deft) Weighted count Unweighted count Confidence limits r - 2se r + 2se HOUSEHOLD MEMBERS Use of improved drinking water sources 4.1 0.990 0.00944 0.010 3.187 1.785 1466 341 0.972 1.000 Use of improved sanitation 4.3 0.976 0.01272 0.013 2.293 1.514 1414 335 0.950 1.000 Secondary school net attendance ratio (adjusted) 7.5 0.756 0.03810 0.050 0.896 0.947 109 115 0.679 0.832 Child labour 8.2 0.183 0.04093 0.224 2.331 1.527 190 209 0.101 0.265 Prevalence of children with one or both parents dead 9.18 0.038 0.01192 0.315 1.482 1.217 352 381 0.014 0.062 Violent discipline 8.5 0.657 0.04666 0.071 1.439 1.200 240 150 0.563 0.750 WOMEN Early childbearing 5.2 0.024 0.02383 0.990 1.209 1.100 50 51 0.000 0.072 Contraceptive prevalence 5.3 0.126 0.03159 0.251 2.015 1.419 254 223 0.063 0.189 Unmet need 5.4 0.280 0.03765 0.134 1.560 1.249 254 223 0.205 0.356 Antenatal care coverage - at least once by skilled personnel 5.5a * * * * * 37 42 * * Antenatal care coverage – at least four times by any provider 5.5b * * * * * 37 42 * * Skilled attendant at delivery 5.7 * * * * * 37 42 * * Institutional deliveries 5.8 * * * * * 37 42 * * Caesarean section 5.9 * * * * * 37 42 * * Literacy rate among young women 7.1 1.000 0.00000 0.000 NA NA 108 112 1.000 1.000 Marriage before age 18 8.7 0.141 0.04569 0.325 5.023 2.241 327 292 0.049 0.232 UNDER-5s Underweight prevalence 2.1a 0.015 0.01235 0.814 0.919 0.959 135 91 0.000 0.040 Stunting prevalence 2.2a 0.050 0.02728 0.543 1.403 1.184 135 91 0.000 0.105 Wasting prevalence 2.3a 0.004 0.00419 1.043 0.386 0.621 130 89 0.000 0.012 Exclusive breastfeeding under 6 months 2.6 * * * * * 8 7 * * Age-appropriate breastfeeding 2.14 0.120 0.05617 0.467 1.222 1.105 54 42 0.008 0.233 Tuberculosis immunization coverage - * * * * * 38 23 * * Received polio immunization - * * * * * 38 23 * * Received DPT immunization - * * * * * 38 23 * * Received measles immunization - * * * * * 38 23 * * Received Hepatitis B immunization - * * * * * 38 23 * * Received HIB immunization - * * * * * 38 23 * * Diarrhoea in the previous 2 weeks - 0.051 0.02382 0.466 1.075 1.037 136 93 0.004 0.099 Illness with a cough in the previous 2 weeks - 0.000 0.00000 0.000 NA NA 136 93 0.000 0.000 Oral rehydration therapy with continued feeding 3.8 * * * * * 7 6 * * Antibiotic treatment of suspected pneumonia 3.10 * * * * * 0 0 * * Support for learning 6.1 0.990 0.01064 0.011 0.371 0.609 58 35 0.968 1.000 Attendance to early childhood education 6.7 0.169 0.04149 0.245 0.416 0.645 58 35 0.086 0.252 Birth registration 8.1 1.000 0.00000 0.000 NA NA 136 93 1.000 1.000 169 table se.12: sampling errors: skopje region, Macedonia, 2011 standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Macedonia, 2011 MICS Indicator Value (r) Standard error (se) Coefficient of variation (se/r) Design effect (deff) Square root of design effect (deft) Weighted count Unweighted count Confidence limits r - 2se r + 2se HOUSEHOLD MEMBERS Use of improved drinking water sources 4.1 0.998 0.00085 0.001 0.435 0.659 4353 1012 0.997 1.000 Use of improved sanitation 4.3 0.995 0.00221 0.002 0.944 0.972 4247 987 0.990 0.999 Secondary school net attendance ratio (adjusted) 7.5 0.867 0.02055 0.024 0.856 0.925 233 235 0.826 0.908 Child labour 8.2 0.067 0.01073 0.160 0.994 0.997 521 540 0.045 0.088 Prevalence of children with one or both parents dead 9.18 0.014 0.00485 0.339 1.798 1.341 955 1080 0.005 0.024 Violent discipline 8.5 0.663 0.02662 0.040 1.398 1.182 671 442 0.610 0.716 WOMEN Early childbearing 5.2 0.006 0.00032 0.054 0.003 0.051 186 151 0.005 0.006 Contraceptive prevalence 5.3 0.484 0.02585 0.053 1.748 1.322 730 654 0.432 0.535 Unmet need 5.4 0.124 0.01280 0.103 0.983 0.991 730 654 0.099 0.150 Antenatal care coverage - at least once by skilled personnel 5.5a 0.984 0.01134 0.012 1.115 1.056 118 137 0.961 1.000 Antenatal care coverage – at least four times by any provider 5.5b 0.942 0.01363 0.014 0.465 0.682 118 137 0.915 0.970 Skilled attendant at delivery 5.7 0.980 0.01208 0.012 0.996 0.998 118 137 0.956 1.000 Institutional deliveries 5.8 0.991 0.00864 0.009 1.190 1.091 118 137 0.974 1.000 Caesarean section 5.9 0.299 0.03171 0.106 0.652 0.808 118 137 0.236 0.362 Literacy rate among young women 7.1 0.985 0.00678 0.007 0.855 0.925 316 271 0.972 0.999 Marriage before age 18 8.7 0.050 0.00730 0.145 0.963 0.981 1037 862 0.036 0.065 UNDER-5s Underweight prevalence 2.1a 0.006 0.00467 0.730 1.122 1.059 388 328 0.000 0.016 Stunting prevalence 2.2a 0.031 0.01095 0.352 1.274 1.129 382 321 0.009 0.053 Wasting prevalence 2.3a 0.000 0.00000 . . . 382 321 0.000 0.000 Exclusive breastfeeding under 6 months 2.6 * * * * * 43 34 * * Age-appropriate breastfeeding 2.14 0.266 0.02787 0.105 0.565 0.751 175 143 0.210 0.322 Tuberculosis immunization coverage - 0.970 0.02163 0.022 0.975 0.987 71 61 0.927 1.000 Received polio immunization - 0.952 0.02047 0.021 0.550 0.742 71 61 0.911 0.993 Received DPT immunization - 0.919 0.02082 0.023 0.348 0.590 71 61 0.877 0.960 Received measles immunization - 0.933 0.02576 0.028 0.640 0.800 71 61 0.882 0.985 Received Hepatitis B immunization - 0.900 0.02289 0.025 0.350 0.592 71 61 0.855 0.946 Received HIB immunization - 0.929 0.02640 0.028 0.625 0.790 69 60 0.876 0.982 Diarrhoea in the previous 2 weeks - 0.079 0.01718 0.218 1.417 1.190 415 349 0.044 0.113 Illness with a cough in the previous 2 weeks - 0.024 0.00949 0.396 1.341 1.158 415 349 0.005 0.043 Oral rehydration therapy with continued feeding 3.8 * * * * * 33 27 * * Antibiotic treatment of suspected pneumonia 3.10 * * * * * 10 10 * * Support for learning 6.1 0.908 0.02038 0.022 0.692 0.832 162 140 0.867 0.949 Attendance to early childhood education 6.7 0.276 0.02855 0.103 0.567 0.753 162 140 0.219 0.334 Birth registration 8.1 0.997 0.00309 0.003 1.059 1.029 415 349 0.991 1.000 170 MultIple IndIcator cluster survey 2011 table se.1R: indicators selected for sampling error calculations, list of indicators selected for sampling error calculations, and base populations (denominators) for each indicator, Roma settlements, 2011 MICS4 Indicator Base Population HOUSEHOLD MEMBERS 4.1 Use of improved drinking water sources All household members 4.3 Use of improved sanitation All household members 7.5 Secondary school net attendance ratio (adjusted) Children of secondary school age 8.2 Child labour Children age 5-14 years 9.18 Prevalence of children with one or both parents dead Children age 0-17 years 8.5 Violent discipline Children age 2-14 years WOMEN 5.2 Early childbearing Women age 20-24 years 5.3 Contraceptive prevalence Women age 15-49 years who are currently married or in union 5.4 Unmet need Women age 15-49 years who are currently married or in union 5.5a Antenatal care coverage - at least once by skilled personnel Women age 15-49 years with a live birth in the 2 years preceding the survey 5.5b Antenatal care coverage – at least four times by any provider Women age 15-49 years with a live birth in the 2 years preceding the survey 5.7 Skilled attendant at delivery Women age 15-49 years with a live birth in the 2 years preceding the survey 5.8 Institutional deliveries Women age 15-49 years with a live birth in the 2 years preceding the survey 5.9 Caesarean section Women age 15-49 years with a live birth in the 2 years preceding the survey 7.1 Literacy rate among young women Women age 15-24 years 8.7 Marriage before age 18 Women age 20-49 years UNDER-5s 2.1a Underweight prevalence Children under age 5 2.2a Stunting prevalence Children under age 5 2.3a Wasting prevalence Children under age 5 2.6 Exclusive breastfeeding under 6 months Total number of infants under 6 months of age 2.14 Age-appropriate breastfeeding Children age 0-23 months - Tuberculosis immunization coverage Children age 18-29 months  - Received polio immunization Children age 18-29months  - Received DPT immunization Children age 18-29months  - Received measles immunization Children age 18-29months  - Received Hepatitis B immunization Children age 18-29months  - Received HIB immunization Children under age 5 - Diarrhoea in the previous 2 weeks Children under age 5 - Illness with a cough in the previous 2 weeks Children under age 5 3.8 Oral rehydration therapy with continued feeding Children under age 5 with diarrhoea in the previous 2 weeks 3.10 Antibiotic treatment of suspected pneumonia Children under age 5 with suspected pneumonia in the previous 2 weeks 6.1 Support for learning Children age 36-59 months 6.7 Attendance to early childhood education Children age 36-59 months 8.1 Birth registration Children under age 5 171 table se.2R: sampling errors: total sample, Roma settlements, 2011 standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Roma settlements, 2011 MICS Indicator Value (r) Standard error (se) Coefficient of variation (se/r) Design effect (deff) Square root of design effect (deft) Weighted count Unweighted count Confidence limits r - 2se r + 2se HOUSEHOLD MEMBERS Use of improved drinking water sources 4.1 .9913 .00338 .003 1.261 1.123 4229 953 0.985 0.998 Use of improved sanitation 4.3 .9652 .00714 .007 1.358 1.165 3992 896 0.951 0.979 Secondary school net attendance ratio (adjusted) 7.5 .3819 .03597 .094 1.655 1.286 294 303 0.310 0.454 Child labour 8.2 .1033 .01670 .162 2.449 1.565 781 814 0.070 0.137 Prevalence of children with one or both parents dead 9.18 .0334 .00950 .285 4.330 2.081 1523 1548 0.014 0.052 Violent discipline 8.5 .8203 .01868 .023 1.332 1.154 1094 564 0.783 0.858 WOMEN Early childbearing 5.2 .2728 .03291 .121 1.081 1.040 190 199 0.207 0.339 Contraceptive prevalence 5.3 .3708 .02927 .079 2.938 1.714 799 801 0.312 0.429 Unmet need 5.4 .2222 .01813 .082 1.521 1.233 799 801 0.186 0.258 Antenatal care coverage - at least once by skilled personnel 5.5a .9401 .02126 .023 1.390 1.179 182 174 0.898 0.983 Antenatal care coverage – at least four times by any provider 5.5b .8594 .03243 .038 1.506 1.227 182 174 0.795 0.924 Skilled attendant at delivery 5.7 .9948 .00378 .004 .479 .692 182 174 0.987 1.000 Institutional deliveries 5.8 .9906 .00573 .006 .609 .781 182 174 0.979 1.000 Caesarean section 5.9 .1312 .03681 .281 2.056 1.434 182 174 0.058 0.205 Literacy rate among young women 7.1 .7663 .02968 .039 1.835 1.354 363 374 0.707 0.826 Marriage before age 18 8.7 .4704 .02213 .047 1.798 1.341 918 916 0.426 0.515 UNDER-5s Underweight prevalence 2.1a .0756 .01422 .188 1.354 1.164 470 469 0.047 0.104 Stunting prevalence 2.2a .1647 .03016 .183 3.014 1.736 458 457 0.104 0.225 Wasting prevalence 2.3a .0448 .01016 .227 1.098 1.048 457 456 0.024 0.065 Exclusive breastfeeding under 6 months 2.6 .3208 .08170 .255 1.103 1.050 36 37 0.157 0.484 Age-appropriate breastfeeding 2.14 .4291 .04576 .107 1.556 1.247 178 183 0.338 0.521 Tuberculosis immunization coverage - .9817 .01269 .013 .853 .924 86 96 0.956 1.000 Received polio immunization - .9099 .03019 .033 1.056 1.028 86 96 0.849 0.970 Received DPT immunization - .9088 .03091 .034 1.095 1.046 86 96 0.847 0.971 Received measles immunization - .9629 .02271 .024 1.373 1.172 86 96 0.918 1.000 Received Hepatitis B immunization - .9173 .02733 .030 .936 .967 86 96 0.863 0.972 Received HIB immunization - .9429 .02209 .023 .852 .923 85 95 0.899 0.987 Diarrhoea in the previous 2 weeks - .1305 .01672 .128 1.169 1.081 476 476 0.097 0.164 Illness with a cough in the previous 2 weeks - .0521 .01239 .238 1.475 1.214 476 476 0.027 0.077 Oral rehydration therapy with continued feeding 3.8 .5285 .06578 .124 1.077 1.038 62 63 0.397 0.660 Antibiotic treatment of suspected pneumonia 3.10 * * * * * * 25 * * Support for learning 6.1 .6185 .05228 .085 2.166 1.472 198 188 0.514 0.723 Attendance to early childhood education 6.7 .0385 .01227 .318 .760 .872 198 188 0.014 0.063 Birth registration 8.1 .9839 .00760 .008 1.734 1.317 476 476 0.969 0.999 172 MultIple IndIcator cluster survey 2011 appendix d. data quality tables table dq.1: age distribution of household population single-year age distribution of household population by sex, Macedonia, 2011 Sex Sex Male Female Male Female Age Number Percent Number Percent Age Number Percent Number Percent 0 83 1.1 78 1.1 44 97 1.3 103 1.4 1 87 1.2 91 1.2 45 127 1.7 82 1.1 2 80 1.1 92 1.3 46 103 1.4 90 1.2 3 88 1.2 81 1.1 47 107 1.4 95 1.3 4 94 1.3 84 1.2 48 95 1.3 111 1.5 5 96 1.3 111 1.5 49 97 1.3 90 1.2 6 83 1.1 81 1.1 50 79 1.1 99 1.4 7 97 1.3 77 1.1 51 114 1.5 103 1.4 8 79 1.1 66 .9 52 97 1.3 120 1.6 9 90 1.2 67 .9 53 108 1.5 101 1.4 10 99 1.3 81 1.1 54 112 1.5 101 1.4 11 107 1.4 88 1.2 55 89 1.2 99 1.4 12 90 1.2 66 .9 56 99 1.3 126 1.7 13 66 .9 80 1.1 57 108 1.4 107 1.5 14 86 1.2 92 1.3 58 110 1.5 117 1.6 15 96 1.3 100 1.4 59 94 1.3 88 1.2 16 127 1.7 101 1.4 60 93 1.2 81 1.1 17 131 1.8 88 1.2 61 81 1.1 74 1.0 18 120 1.6 102 1.4 62 91 1.2 115 1.6 19 117 1.6 103 1.4 63 82 1.1 102 1.4 20 96 1.3 121 1.7 64 70 .9 75 1.0 21 126 1.7 104 1.4 65 76 1.0 77 1.1 22 96 1.3 92 1.3 66 56 .8 60 .8 23 101 1.4 95 1.3 67 71 1.0 68 .9 24 115 1.5 111 1.5 68 48 .6 45 .6 25 108 1.5 102 1.4 69 62 .8 63 .9 26 113 1.5 110 1.5 70 59 .8 65 .9 27 122 1.6 115 1.6 71 63 .8 61 .8 28 116 1.6 105 1.4 72 33 .4 57 .8 29 121 1.6 122 1.7 73 32 .4 54 .7 30 123 1.7 94 1.3 74 44 .6 44 .6 31 125 1.7 104 1.4 75 52 .7 57 .8 32 91 1.2 101 1.4 76 60 .8 62 .9 33 122 1.6 108 1.5 77 40 .5 51 .7 34 117 1.6 115 1.6 78 25 .3 47 .6 35 111 1.5 111 1.5 79 17 .2 45 .6 36 108 1.4 116 1.6 80 26 .4 22 .3 37 106 1.4 81 1.1 81 16 .2 28 .4 38 92 1.2 84 1.2 82 8 .1 15 .2 39 108 1.4 111 1.5 83 19 .3 9 .1 40 102 1.4 95 1.3 84 6 .1 20 .3 41 102 1.4 99 1.4 85+ 44 .6 62 .8 42 90 1.2 86 1.2 DK 3 .0 4 .1 43 106 1.4 111 1.5 Total 7445 100.0 7319 100.0 173 table dq.2: age distribution of eligible and interviewed women household population of women age 10-54, interviewed women age 15-49, and percentage of eligible women who were interviewed, by five-year age groups, Macedonia, 2011 Household population of women age 10-54 Interviewed women age 15-49 Percentage of eligible women interviewed (Completion rate) Number Number Percent Age 10-14 407 . . . 15-19 493 465 13.8 94.2 20-24 524 473 14.1 90.3 25-29 554 508 15.1 91.6 30-34 522 499 14.9 95.5 35-39 503 478 14.2 95.1 40-44 495 483 14.4 97.6 45-49 468 452 13.5 96.5 50-54 524 . . . Total (15-49) 3559 3357 100.0 94.3 table dq.3: age distribution of under-5s in household and under-5 questionnaires household population of children age 0-7, children age 0-4 whose mothers/caretakers were interviewed, and percentage of under-5 children whose mothers/caretakers were interviewed, by single ages, Macedonia, 2011 Household population of children 0-7 years Interviewed under-5 children Percentage of eligible under- 5s interviewed (Completion rate) Number Number Percent Age 0 161 158 18.7 98.1 1 178 173 20.5 97.2 2 172 169 20.0 98.1 3 169 169 20.0 100.0 4 178 175 20.7 98.2 5 207 . . . 6 164 . . . 7 174 . . . Total (0-4) 859 845 100.0 figure dq.1: number of household population by single ages, Macedonia, 2011 174 MultIple IndIcator cluster survey 2011 table dq.4: Women’s completion rates by socio-economic characteristics of households Household population of women age 15-49, interviewed women age 15- 49, and percentage of eligible women who were interviewed, by selected social and economic characteristics of the household, Macedonia, 2011 Household population of women age 15-49 years Interviewed women age 15-49 years Percent of eligible women interviewed (Completion rates)Number Percent Number Percent Region Vardar 225 6.3 218 6.5 96.9 East 240 6.8 233 6.9 96.8 Southwest 326 9.2 302 9.0 92.7 Southeast 294 8.3 278 8.3 94.5 Pelagonia 473 13.3 462 13.8 97.7 Polog 552 15.5 537 16.0 97.3 Northeast 355 10.0 349 10.4 98.2 Skopje 1093 30.7 978 29.1 89.4 Area Urban 1942 54.6 1805 53.8 92.9 Rural 1617 45.4 1552 46.2 96.0 Household size 1-3 1749 49.2 618 18.4 93.2 4-6 1615 45.4 2184 65.1 94.3 7+ 195 5.5 554 16.5 95.6 Education of household head Primary or less 1354 38.1 1308 39.0 96.6 Secondary 1570 44.1 1481 44.1 94.4 High 633 17.8 566 16.8 89.3 Wealth index quintiles Poorest 647 18.2 624 18.6 96.5 Second 690 19.4 667 19.9 96.7 Middle 716 20.1 681 20.3 95.1 Fourth 709 19.9 665 19.8 93.8 Richest 796 22.4 719 21.4 90.3 Ethnicity of household head Macedonian 2184 61.4 2034 60.6 93.1 Albanian 1089 30.6 1059 31.5 97.3 Other 286 8.0 263 7.8 92.2 Total 3559 100.0 3357 100.0 94.3 table dq.5: completion rates for under-5 questionnaires by socio-economic characteristics of households Household population of under-5 children, under-5 questionnaires completed, and percentage of under-5 children for whom interviews were completed, by selected socio-economic characteristics of the household, Macedonia, 2011 Household population of under-5 children Interviewed under-5 children Percent of eligible under-5s with completed under-5 questionnaires (Completion rates)Number Percent Number Percent Region Vardar 63 7.3 63 7.4 100.0 East 68 8.0 68 8.1 99.7 Southwest 75 8.7 72 8.5 96.3 Southeast 52 6.0 52 6.1 100.0 Pelagonia 98 11.4 98 11.5 100.0 Polog 161 18.7 157 18.6 97.4 Northeast 85 9.9 83 9.9 98.4 Skopje 259 30.1 253 29.9 97.7 Area Urban 437 50.9 433 51.2 98.9 Rural 422 49.1 412 48.8 97.7 Household size 1-3 100 11.7 92 10.8 97.5 4-6 519 60.4 502 59.4 98.8 7+ 240 27.9 252 29.8 97.6 Education of household head Primary or less 397 46.2 392 46.3 98.7 Secondary 328 38.2 321 38.0 97.9 High 134 15.6 132 15.6 98.4 Wealth index quintiles Poorest 195 22.7 193 22.8 98.9 Second 164 19.0 162 19.2 99.2 Middle 165 19.3 160 18.9 96.7 Fourth 160 18.6 156 18.5 97.6 Richest 175 20.4 174 20.6 99.1 Ethnicity of household head Macedonian 445 51.8 437 51.7 98.1 Albanian 322 37.4 317 37.6 98.6 Other 92 10.7 91 10.7 98.3 Total 859 100.0 845 100.0 98.3 175 table dq.6: completeness of reporting Percentage of observations that are missing information for selected questions and indicators, Macedonia, 2011 Questionnaire and type of missing information Reference group Percent with missing/ incomplete information* Number of cases Household Age All household members .1 16323 Starting time of interview All households interviewed .5 4018 Ending time of interview All households interviewed .5 4018 Women Woman’s date of birth All women age 15-49 Only month .1 3831 Both month and year .0 3831 Date of first birth All women age 15-49 with at least one live birth Only month .0 2423 Both month and year .0 2423 Completed years since first birth All women age 15-49 with at least one live birth with year of first birth unknown .0 0 Date of last birth All women age 15-49 with a live birth in last 2 years Only month .0 2423 Both month and year .0 2423 Date of first marriage/union All ever married women age 15-49 Only month 3.9 2656 Both month and year 2.4 2656 Age at first marriage/union All ever married women age 15-49 with year of first marriage not known .9 2656 Age at first intercourse All women age 15-24 who have ever had sex .0 1071 Time since last intercourse All women age 15-24 who have ever had sex .0 1071 Starting time of interview All women interviewed .8 3831 Ending time of interview All women interviewed .8 3831 Under-5 Date of birth All under-5 children Only month .0 1376 Both month and year .0 1376 Anthropometric measurements All under-5 children Weight 2.9 1376 Height 3.6 1376 Both weight and height 2.8 1376 Starting time of interview All under-5 children .3 1376 Ending time of interview All under-5 children .3 1376 176 MultIple IndIcator cluster survey 2011 table dq.7: completeness of information for anthropometric indicators Distribution of children under 5 by completeness of information for anthropometric indicators, Macedonia, 2011 Valid weight and date of birth Reason for exclusion from analysis Total Percent of children excluded from analysis Number of children under 5 Weight not measured Incomplete date of birth Weight not measured, incomplete date of birth Flagged cases (outliers) Weight by age <6 months 96.4 2.7 .0 .0 .9 100.0 3.6 112 6-11 months 97.2 2.8 .0 .0 .0 100.0 2.8 145 12-23 months 95.8 3.4 .0 .0 .8 100.0 4.2 265 24-35 months 98.0 2.0 .0 .0 .0 100.0 2.0 296 36-47 months 97.1 2.2 .0 .0 .7 100.0 2.9 273 48-59 months 96.1 3.5 .0 .0 .4 100.0 3.9 285 Total 96.8 2.8 .0 .0 .4 100.0 3.2 1376 Valid height and date of birth Reason for exclusion from analysis Total Percent of children excluded from analysis Number of children under 5 Height not measured Incomplete date of birth Height not measured, incomplete date of birth Flagged cases (outliers) Height by age <6 months 95.5 4.5 .0 .0 .0 100.0 4.5 112 6-11 months 95.2 2.8 .0 .0 2.1 100.0 4.8 145 12-23 months 95.1 3.4 .0 .0 1.5 100.0 4.9 265 24-35 months 94.3 5.1 .0 .0 .7 100.0 5.7 296 36-47 months 97.8 2.2 .0 .0 .0 100.0 2.2 273 48-59 months 96.1 3.9 .0 .0 .0 100.0 3.9 285 Total 95.7 3.6 .0 .0 .7 100.0 4.3 1376 Valid weight and height Reason for exclusion from analysis Total Percent of children excluded from analysis Number of children under 5 Weight not measured Height not measured Weight and height not measured Flagged cases (outliers) Weight by height <6 months 93.8 .0 1.8 2.7 1.8 100.0 6.3 112 6-11 months 93.8 .0 .0 2.8 3.4 100.0 6.2 145 12-23 months 93.2 .8 .8 2.6 2.6 100.0 6.8 265 24-35 months 94.6 .0 3.0 2.0 .3 100.0 5.4 296 36-47 months 96.3 .0 .0 2.2 1.5 100.0 3.7 273 48-59 months 93.3 .4 .7 3.2 2.5 100.0 6.7 285 Total 94.3 .2 1.1 2.5 1.9 5.7 1376 177 table dq.8: heaping in anthropometric measurements Distribution of weight and height/length measurements by digits reported for decimals, Macedonia, 2011 Weight Height or length Number Percent Number Percent Digits 0 173 12.9 297 22.1 1 140 10.5 126 9.4 2 147 11.0 145 10.8 3 115 8.6 122 9.1 4 113 8.4 105 7.8 5 149 11.1 161 12.0 6 123 9.2 115 8.6 7 132 9.9 100 7.5 8 123 9.2 93 6.9 9 123 9.2 77 5.7 0 or 5 322 24.1 458 34.2 Total 1338 100.0 1341 100.0 table dq.11: observation of under-5s birth certificates Percent distribution of children under 5 by presence of birth certificates,and percentage of birth calendar seen, Macedonia, 2011 Child does not have birth certificate Child has birth certificate Missing/ DK Total Percent of birth certificates seen by the interviewer (1)/ (1+2)*100 Number of children under age 5 Seen by the interviewer (1) Not seen by the interviewer (2) Region Vardar 1.4 83.5 15.1 .0 100.0 84.7 139 East .8 72.5 26.7 .0 100.0 73.1 131 Southwest 4.6 69.5 26.0 .0 100.0 72.8 131 Southeast .0 54.2 45.8 .0 100.0 54.2 118 Pelagonia 2.0 54.8 43.2 .0 100.0 55.9 199 Polog 3.7 67.6 28.7 .0 100.0 70.2 216 Northeast .0 50.5 49.5 .0 100.0 50.5 93 Skopje 1.1 73.4 25.5 .0 100.0 74.2 349 Area Urban .8 68.0 31.2 .0 100.0 68.5 750 Rural 3.0 66.1 30.8 .0 100.0 68.2 626 Child’s age 0 6.3 66.0 27.7 .0 100.0 70.4 256 1 1.1 65.0 33.8 .0 100.0 65.8 266 2 .7 68.9 30.4 .0 100.0 69.4 296 3 .4 70.6 29.0 .0 100.0 70.8 272 4 1.0 65.0 33.9 .0 100.0 65.7 286 Total 1.8 67.2 31.0 .0 100.0 68.4 1376 178 MultIple IndIcator cluster survey 2011 table dq.12: observation of vaccination cards Percent distribution of children under 5 by presence of a vaccination card, and the percentage of vaccination cards seen by the interviewers, Macedonia, 2011 Child does not have vaccination card Child has vaccination card Missing/ DK Total Percent of vaccination cards seen by the interviewer (1)/ (1+2)*100 Number of children under age 5Had vaccination card previously Never had vaccination card Seen by the interviewer (1) Not seen by the interviewer (2) Region Vardar .7 .7 91.4 7.2 .0 100.0 92.7 139 East .0 .8 91.6 7.6 .0 100.0 92.3 131 Southwest .8 2.3 89.3 7.6 .0 100.0 92.1 131 Southeast .8 .0 94.1 5.1 .0 100.0 94.9 118 Pelagonia 1.5 1.0 94.0 3.5 .0 100.0 96.4 199 Polog 2.8 3.2 80.6 13.4 .0 100.0 85.7 216 Northeast .0 1.1 91.4 7.5 .0 100.0 92.4 93 Skopje 1.4 .9 94.8 2.9 .0 100.0 97.1 349 Area Urban .9 .4 92.7 6.0 .0 100.0 93.9 750 Rural 1.6 2.4 89.0 7.0 .0 100.0 92.7 626 Child’s age 0 2.7 3.1 91.8 2.3 .0 100.0 97.5 256 1 .4 .4 92.1 7.1 .0 100.0 92.8 266 2 .7 .7 92.2 6.4 .0 100.0 93.5 296 3 1.8 .4 91.5 6.3 .0 100.0 93.6 272 4 .7 2.1 87.4 9.8 .0 100.0 89.9 286 Total 1.2 1.3 91.0 6.5 .0 100.0 93.4 1376 table dq.13: presence of mother in the household and the person interviewed for the under-5 questionnaire Distribution of children under five by whether the mother lives in the same household, and the person interviewed for the under-5 questionnaire, Macedonia, 2011 Mother in the household Mother not in the household Total Number of children under 5 Mother interviewed Father interviewed Other adult female interviewed Other adult male interviewed Father interviewed Other adult female interviewed Age 0 100.0 .0 .0 .0 .0 .0 100.0 161 1 100.0 .0 .0 .0 .0 .0 100.0 178 2 98.1 .0 .0 .0 1.9 .0 100.0 172 3 99.6 .0 .0 .0 .4 .0 100.0 169 4 98.6 .0 .0 .0 .6 .8 100.0 178 Total 99.3 .0 .0 .0 .6 .2 100.0 859 179 table dq.14: selection of children age 2-14 years for the child discipline module Percent of households with at least two children age 2-14 years where correct selection of one child for the child discipline module was performed, Macedonia, 2011 Percent of households where correct selection was performed Number of households with 2 or more children age 2-14 years Region Vardar 95.5 67 East 100.0 69 Southwest 95.7 92 Southeast 100.0 79 Pelagonia 98.1 106 Polog 90.8 141 Northeast 90.4 73 Skopje 98.3 231 Area Urban 97.9 390 Rural 94.7 468 Number of children age 2-14 years 2 96.8 660 3 95.9 148 4 89.5 38 5+ 83.3 12 Total 96.2 858 table dq.15: school attendance by single age Distribution of household population age 5-24 by educational level and grade attended in the current (or most recent) school year, Macedonia, 2011 Not attending school Currently attending Total Number of household membersPreschool Primary school Grade Secondary school Grade Higher than secondary1 2 3 4 5 6 7 8 1 2 3 4 Age at beginning of school year 5 62.0 15.0 22.6 .4 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 100.0 171 6 4.2 2.6 60.6 31.4 .9 .4 .0 .0 .0 .0 .0 .0 .0 .0 .0 100.0 170 7 .2 .0 4.1 73.9 21.4 .4 .0 .0 .0 .0 .0 .0 .0 .0 .0 100.0 152 8 .2 .0 1.1 2.8 67.7 27.0 1.2 .0 .0 .0 .0 .0 .0 .0 .0 100.0 154 9 .6 .0 .5 .2 2.9 52.1 41.8 1.9 .0 .0 .0 .0 .0 .0 .0 100.0 164 10 .2 .0 .0 .0 1.0 4.7 89.8 4.2 .0 .0 .0 .0 .0 .0 .0 100.0 193 11 .7 .0 .0 .0 .0 .3 43.9 51.2 3.4 .3 .0 .0 .2 .0 .0 100.0 184 12 1.8 .0 .0 .0 .0 .0 1.2 36.9 57.8 2.3 .0 .0 .0 .0 .0 100.0 150 13 1.7 .0 .0 .0 .0 .0 1.8 .3 40.6 53.4 1.5 .6 .0 .0 .0 100.0 163 14 3.2 .0 .0 .0 .0 .4 .0 .3 1.5 46.4 47.6 .3 .0 .2 .0 100.0 192 15 4.5 .0 .0 .0 .0 .0 .0 .0 .0 2.7 37.7 52.1 3.0 .0 .0 100.0 221 16 10.6 .0 .0 .0 .0 .0 .0 .5 .0 .0 2.1 49.4 36.4 1.0 .0 100.0 208 17 16.5 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 2.0 39.0 40.9 1.5 100.0 240 18 36.0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .5 .5 4.9 36.1 22.0 100.0 199 19 42.2 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 2.8 55.1 100.0 241 20 56.1 .0 .0 .7 .0 .0 .0 .0 .0 .0 .0 .4 .3 .0 42.5 100.0 216 21 56.0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 44.0 100.0 199 22 74.2 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .5 .0 25.3 100.0 192 23 73.2 .0 .0 .0 .0 .0 .0 .0 .0 .2 .0 .0 .1 .1 26.3 100.0 207 24 86.4 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 13.6 100.0 236 180 MultIple IndIcator cluster survey 2011 table dq.1R: age distribution of household population Single-year age distribution of household population by sex, Roma settlements, 2011 Sex Sex Male Female Male Female Age Number Percent Number Percent Age Number Percent Number Percent 0 47 2.2 37 1.7 44 20 1.0 33 1.6 1 53 2.5 49 2.3 45 20 1.0 25 1.2 2 43 2.1 62 2.9 46 31 1.5 24 1.1 3 45 2.2 53 2.5 47 25 1.2 31 1.5 4 58 2.8 53 2.5 48 30 1.4 24 1.1 5 47 2.2 44 2.1 49 28 1.3 23 1.1 6 48 2.3 36 1.7 50 23 1.1 24 1.1 7 46 2.2 48 2.2 51 35 1.7 30 1.4 8 37 1.8 46 2.1 52 26 1.2 19 .9 9 33 1.6 48 2.2 53 16 .8 29 1.4 10 33 1.6 35 1.6 54 32 1.5 38 1.8 11 35 1.7 29 1.3 55 14 .7 19 .9 12 35 1.7 39 1.8 56 29 1.4 21 1.0 13 35 1.7 32 1.5 57 20 1.0 23 1.1 14 35 1.7 41 1.9 58 20 1.0 18 .8 15 32 1.5 42 2.0 59 9 .4 19 .9 16 53 2.5 35 1.7 60 19 .9 13 .6 17 37 1.8 45 2.1 61 13 .6 15 .7 18 35 1.7 33 1.5 62 14 .7 13 .6 19 30 1.4 23 1.1 63 8 .4 8 .4 20 38 1.8 35 1.6 64 14 .7 8 .4 21 37 1.8 43 2.0 65 9 .4 11 .5 22 31 1.5 36 1.7 66 5 .2 10 .5 23 30 1.4 40 1.9 67 5 .3 6 .3 24 43 2.0 35 1.6 68 4 .2 10 .4 25 48 2.3 34 1.6 69 3 .1 13 .6 26 31 1.5 21 1.0 70 8 .4 8 .4 27 38 1.8 48 2.2 71 2 .1 3 .1 28 29 1.4 30 1.4 72 10 .5 3 .2 29 38 1.8 29 1.4 73 4 .2 13 .6 30 36 1.7 40 1.9 74 3 .1 2 .1 31 39 1.8 31 1.5 75 4 .2 4 .2 32 26 1.2 29 1.4 76 6 .3 3 .2 33 34 1.6 36 1.7 77 6 .3 0 .0 34 28 1.3 35 1.7 78 2 .1 0 .0 35 29 1.4 23 1.1 79 1 .1 0 .0 36 26 1.2 28 1.3 80 0 .0 3 .1 37 23 1.1 25 1.2 81 0 .0 0 .0 38 37 1.8 21 1.0 82 0 .0 1 .0 39 19 .9 20 .9 83 0 .0 0 .0 40 22 1.0 33 1.5 84 0 .0 0 .0 41 27 1.3 32 1.5 85+ 4 .2 3 .1 42 20 .9 27 1.3 DK 0 .0 0 .0 43 25 1.2 27 1.3 Total 2093 100.0 2136 100.0 181 table dq.2R: age distribution of eligible and interviewed women Household population of women age 10-54, interviewed women age 15-49, and percentage of eligible women who were interviewed, by five-year age groups, Roma settlements, 2011 Household population of women age 10-54 Interviewed women age 15-49 Percentage of eligible women interviewed (Completion rate) Number Number Percent Age 10-14 176 . . . 15-19 178 167 15.8 93.8 20-24 189 183 17.4 97.1 25-29 162 160 15.2 98.9 30-34 171 166 15.8 97.0 35-39 117 108 10.3 92.9 40-44 153 144 13.7 94.5 45-49 127 125 11.9 98.4 50-54 140 . . . Total (15-49) 1098 1055 100.0 96.2 figure dq.1R: number of household population by single ages, Roma settlements, 2011 table dq.3R: age distribution of under-5s in household and under-5 questionnaires Household population of children age 0-7, children age 0-4 whose mothers/caretakers were interviewed, and percentage of under-5 children whose mothers/caretakers were interviewed, by single ages, Roma settlements, 2011 Household population of children 0-7 years Interviewed under-5 children Percentage of eligible under- 5s interviewed (Completion rate)Number Number Percent Age 0 84 82 16.7 98.0 1 102 101 20.5 99.1 2 105 105 21.3 100.0 3 98 96 19.5 97.7 4 111 109 22.1 98.4 5 91 . . . 6 85 . . . 7 94 . . . Total (0-4) 499 492 100.0 98.7 182 MultIple IndIcator cluster survey 2011 table dq.4R: Women’s completion rates by socio-economic characteristics of households Household population of women age 15-49, interviewed women age 15-49, and percentage of eligible women who were interviewed, by selected social and economic characteristics of the household, Roma settlements, 2011 Household population of women age 15-49 years Interviewed women age 15-49 years Percent of eligible women interviewed (Completion rates)Number Percent Number Percent Household size 1-3 168 15.3 167 15.8 99.2 4-6 649 59.2 633 59.9 97.4 7+ 280 25.5 256 24.3 91.4 Education of household head Primary or less 132 12.0 128 12.2 97.2 Secondary 750 68.3 725 68.7 96.6 High 215 19.6 202 19.2 93.8 Wealth index quintiles Poorest 195 17.8 193 18.3 99.1 Second 199 18.2 196 18.5 98.2 Middle 222 20.2 207 19.6 93.3 Fourth 234 21.4 224 21.2 95.4 Richest 247 22.5 236 22.3 95.6 Total 1098 100.0 1055 100.0 96.2 table dq.5R: completion rates for under-5 questionnaires by socio- economic characteristics of households Household population of under-5 children, under-5 questionnaires completed, and percentage of under-5 children for whom interviews were completed, by selected socio-economic characteristics of the household, Roma settlements, 2011 Household population of under-5 children Interviewed under-5 children Percent of eligible under-5s with completed under-5 questionnaires (Completion rates)Number Percent Number Percent Household size 1-3 29 5.9 29 6.0 100.0 4-6 289 57.9 288 58.4 99.7 7+ 181 36.3 175 35.6 96.9 Education of household head Primary or less 86 17.2 86 17.4 100.0 Secondary 350 70.1 347 70.5 99.2 High 63 12.7 60 12.1 94.0 Wealth index quintiles Poorest 126 25.3 126 25.7 100.0 Second 113 22.6 112 22.8 99.4 Middle 97 19.5 96 19.5 99.0 Fourth 85 17.0 82 16.7 96.8 Richest 78 15.6 76 15.4 97.2 Total 499 100.0 492 100.0 98.7 183 table dq.6R: completeness of reporting Percentage of observations that are missing information for selected questions and indicators, Roma settlements, 2011 Questionnaire and type of missing information Reference group Percent with missing/ incomplete information* Number of cases Household Age All household members .0 4359 Starting time of interview All households interviewed .6 953 Ending time of interview All households interviewed .7 953 Women Woman’s date of birth All women age 15-49 Only month .1 1091 Both month and year .1 1091 Date of first birth All women age 15-49 with at least one live birth Only month .9 837 Both month and year 2.2 837 Completed years since first birth All women age 15-49 with at least one live birth with year of first birth unknown .0 21 Date of last birth All women age 15-49 with a live birth in last 2 years Only month .4 837 Both month and year .1 837 Date of first marriage/union All ever married women age 15-49 Only month 9.2 891 Both month and year 9.4 891 Age at first marriage/union All ever married women age 15-49 with year of first marriage not known .4 891 Age at first intercourse All women age 15-24 who have ever had sex .0 363 Time since last intercourse All women age 15-24 who have ever had sex .0 363 Starting time of interview All women interviewed .6 1091 Ending time of interview All women interviewed .8 1091 Under-5 Date of birth All under-5 children Only month .0 476 Both month and year .0 476 Anthropometric measurements All under-5 children Weight 1.1 476 Height 1.9 476 Both weight and height 1.0 476 Starting time of interview All under-5 children .9 476 Ending time of interview All under-5 children .9 476 184 MultIple IndIcator cluster survey 2011 table dq.7R: completeness of information for anthropometric indicators Distribution of children under 5 by completeness of information for anthropometric indicators, Roma settlements, 2011 Valid weight and date of birth Reason for exclusion from analysis Total Percent of children excluded from analysis Number of children under 5 Weight not measured Incomplete date of birth Weight not measured, incomplete date of birth Flagged cases (outliers) Weight by age <6 months 100.0 .0 .0 .0 .0 100.0 .0 37 6-11 months 97.7 2.3 .0 .0 .0 100.0 2.3 44 12-23 months 99.0 .0 .0 .0 1.0 100.0 1.0 102 24-35 months 96.2 3.8 .0 .0 .0 100.0 3.8 105 36-47 months 100.0 .0 .0 .0 .0 100.0 .0 83 48-59 months 99.0 1.0 .0 .0 .0 100.0 1.0 105 Total 98.5 1.3 .0 .0 .2 100.0 1.5 476 Valid height and date of birth Reason for exclusion from analysis Total Percent of children excluded from analysis Number of children under 5 Height not measured Incomplete date of birth Height not measured, incomplete date of birth Flagged cases (outliers) Height by age <6 months 94.6 5.4 .0 .0 .0 100.0 5.4 37 6-11 months 97.7 .0 .0 .0 2.3 100.0 2.3 44 12-23 months 95.1 2.9 .0 .0 2.0 100.0 4.9 102 24-35 months 94.3 3.8 .0 .0 1.9 100.0 5.7 105 36-47 months 96.4 1.2 .0 .0 2.4 100.0 3.6 83 48-59 months 98.1 1.0 .0 .0 1.0 100.0 1.9 105 Total 96.0 2.3 .0 .0 1.7 100.0 4.0 476 Valid weight and height Reason for exclusion from analysis Total Percent of children excluded from analysis Number of children under 5 Weight not measured Height not measured Weight and height not measured Flagged cases (outliers) Weight by height <6 months 89.2 .0 5.4 .0 5.4 100.0 10.8 37 6-11 months 97.7 2.3 .0 .0 .0 100.0 2.3 44 12-23 months 97.1 .0 2.9 .0 .0 100.0 2.9 102 24-35 months 93.3 .0 .0 3.8 2.9 100.0 6.7 105 36-47 months 96.4 .0 1.2 .0 2.4 100.0 3.6 83 48-59 months 98.1 .0 .0 1.0 1.0 100.0 1.9 105 Total 95.8 .2 1.3 1.1 1.7 100.0 4.2 476 185 table dq.8R: heaping in anthropometric measurements Distribution of weight and height/length measurements by digits reported for decimals, Roma settlements, 2011 Weight Height or length Number Percent Number Percent Digits 0 44 9.4 64 13.6 1 41 8.7 47 10.0 2 56 11.9 59 12.5 3 50 10.6 58 12.3 4 45 9.6 39 8.3 5 39 8.3 42 8.9 6 57 12.1 50 10.6 7 43 9.1 44 9.3 8 46 9.8 41 8.7 9 49 10.4 27 5.7 0 or 5 83 17.7 106 22.5 Total 470 100.0 471 100.0 table dq.11R: observation of under-5s birth certificates Percent distribution of children under 5 by presence of birth certificates, and percentage of birth calendar seen, Roma settlements, 2011 Child does not have birth certificate Child has birth certificate Missing/ DK Total Percent of birth certificates seen by the interviewer (1)/ (1+2)*100 Number of children under age 5 Seen by the interviewer (1) Not seen by the interviewer (2) Child’s age 0 7.4 63.0 29.6 .0 100.0 68.0 81 1 3.0 63.4 33.7 .0 100.0 65.3 101 2 3.8 53.8 42.5 .0 100.0 55.9 106 3 1.2 68.7 30.1 .0 100.0 69.5 83 4 .0 64.8 35.2 .0 100.0 64.8 105 Total 2.9 62.4 34.7 .0 100.0 64.3 476 table dq.12R: observation of vaccination cards Percent distribution of children under 5 by presence of a vaccination card, and the percentage of vaccination cards seen by the interviewers, Roma settlements, 2011 Child does not have vaccination card Child has vaccination card Missing/ DK Total Percent of vaccination cards seen by the interviewer (1)/ (1+2)*100 Number of children under age 5 Had vaccination card previously Never had vaccination card Seen by the interviewer (1) Not seen by the interviewer (2) Child’s age 0 2.5 3.7 84.0 8.6 1.2 100.0 90.7 81 1 .0 2.0 95.0 3.0 .0 100.0 97.0 101 2 2.8 1.9 87.7 7.5 .0 100.0 92.1 106 3 1.2 1.2 85.5 12.0 .0 100.0 87.7 83 4 1.0 1.0 93.3 4.8 .0 100.0 95.1 105 Total 1.5 1.9 89.5 6.9 .2 100.0 92.8 476 186 MultIple IndIcator cluster survey 2011 table dq.13R: presence of mother in the household and the person interviewed for the under-5 questionnaire Distribution of children under five by whether the mother lives in the same household, and the person interviewed for the under-5 questionnaire, Roma settlements, 2011 Mother in the household Mother not in the household Total Number of children under 5 Mother interviewed Father interviewed Other adult female interviewed Other adult male interviewed Father interviewed Other adult female interviewed Other adult male interviewed Age 0 100.0 .0 .0 .0 .0 .0 .0 100.0 84 1 100.0 .0 .0 .0 .0 .0 .0 100.0 102 2 98.1 .0 .0 .0 .9 1.0 .0 100.0 105 3 99.1 .0 .0 .0 .0 .0 .9 100.0 98 4 98.6 .0 .0 .0 .8 .6 .0 100.0 111 Total 99.1 .0 .0 .0 .4 .4 .2 100.0 499 table dq.14R: selection of children age 2-14 years for the child discipline module Percent of households with at least two children age 2-14 years where correct selection of one child for the child discipline module was performed, Roma settlements, 2011 Percent of households where correct selection was performed Number of households with 2 or more children age 2-14 years Number of children age 2-14 years 2 100.0 212 3 100.0 93 4 96.7 30 5+ 100.0 14 Total 99.7 349 187 table dq.15R: school attendance by single age Distribution of household population age 5-24 by educational level and grade attended in the current (or most recent) school year, Roma settlements, 2011 Not attending school Currently attending Total Number of household membersPreschool Primary school Grade Secondary school Grade Higher than secondary1 2 3 4 5 6 7 8 1 2 3 4 Age at beginning of school year 5 66.2 17.2 12.6 4.1 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 100.0 92 6 12.3 1.2 61.8 22.5 2.3 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 100.0 74 7 7.9 .0 5.4 65.3 21.4 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 100.0 101 8 8.0 .0 1.1 5.7 58.4 26.9 .0 .0 .0 .0 .0 .0 .0 .0 .0 100.0 75 9 10.4 .0 3.2 2.6 12.4 42.0 25.8 3.6 .0 .0 .0 .0 .0 .0 .0 100.0 78 10 11.0 .0 1.3 1.4 5.5 6.3 69.2 3.1 2.1 .0 .0 .0 .0 .0 .0 100.0 64 11 14.0 .0 1.0 .0 7.0 3.2 35.8 39.0 .0 .0 .0 .0 .0 .0 .0 100.0 66 12 14.0 .0 .0 .0 1.5 2.5 15.0 44.8 19.0 3.2 .0 .0 .0 .0 .0 100.0 61 13 23.7 .0 .0 .8 .0 1.5 1.2 4.9 42.5 23.0 2.5 .0 .0 .0 .0 100.0 78 14 32.6 .0 .0 .0 .0 .9 2.5 2.9 6.5 32.6 20.5 1.5 .0 .0 .0 100.0 79 15 49.9 .0 .0 2.2 .0 .0 .0 .0 2.7 8.8 23.7 12.7 .0 .0 .0 100.0 66 16 50.4 .0 .0 .5 .0 .0 .9 .0 .0 1.3 7.4 27.9 10.9 .7 .0 100.0 106 17 63.6 .0 .0 .0 .0 .0 .0 1.1 .0 .0 1.6 4.0 16.3 13.4 .0 100.0 66 18 73.0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 1.3 .0 24.0 1.8 100.0 55 19 89.4 .0 .0 .0 .0 .0 1.9 1.0 .0 .0 .0 .0 1.0 1.7 4.9 100.0 67 20 87.2 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 12.8 100.0 81 21 89.0 .0 1.0 .0 .0 .0 .0 .0 .0 .0 .0 .0 1.0 2.7 6.3 100.0 68 22 95.7 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .9 .0 3.4 100.0 72 23 100.0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 100.0 74 24 100.0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 100.0 82 188 MultIple IndIcator cluster survey 2011 appendix e. Mics indicators: numerators and denominators 1. MORTALITY 1.1 Under-five mortality rate CM Probability of dying by exact age 5 years MDG 4.1 1.2 Infant mortality rate CM Probability of dying by exact age 1 year MDG 4.2 2. NUTRITION 2.1a 2.1b Underweight prevalence AN Number of children under age 5 who (a) fall below minus two standard deviations (moderate and severe) (b) fall below minus three standard deviations (severe) from the median weight for age of the WHO standard Total number of children under age 5 MDG 1.8 2.2a 2.2b Stunting prevalence AN Number of children under age 5 who (a) fall below minus two standard deviations (moderate and severe) (b) fall below minus three standard deviations (severe) from the median height for age of the WHO standard Total number of children under age 5 2.3a 2.3b Wasting prevalence AN Number of children under age 5 who (a) fall below minus two standard deviations (moderate and severe) (b) fall below minus three standard deviations (severe) from the median weight for height of the WHO standard Total number of children under age 5 2.4 Children ever breastfed MN Number of women with a live birth in the 2 years preceding the survey who breastfed the child at any time Total number of women with a live birth in the 2 years preceding the survey 2.5 Early initiation of breastfeeding MN Number of women with a live birth in the 2 years preceding the survey who put the newborn infant to the breast within 1 hour of birth Total number of women with a live birth in the 2 years preceding the survey 2.6 Exclusive breastfeeding under 6 months BF Number of infants under 6 months of age who are exclusively breastfed27 Total number of infants under 6 months of age 2.7 Continued breastfeeding at 1 year BF Number of children age 12-15 months who are currently breastfeeding Total number of children age 12-15 months 2.8 Continued breastfeeding at 2 years BF Number of children age 20-23 months who are currently breastfeeding Total number of children age 20-23 months 2.9 Predominant breastfeeding under 6 months BF Number of infants under 6 months of age who received breast milk as the predominant source of nourishment28 during the previous day Total number of infants under 6 months of age 2.10 Duration of breastfeeding BF The age in months when 50 percent of children age 0-35 months did not receive breast milk during the previous day 2.11 Bottle feeding BF Number of children age 0-23 months who were fed with a bottle during the previous day Total number of children age 0-23 months 2.12 Introduction of solid, semi-solid or soft foods BF Number of infants age 6-8 months who received solid, semi-solid or soft foods during the previous day Total number of infants age 6-8 months 2.13 Minimum meal frequency BF Number of children age 6-23 months receiving solid, semi-solid and soft foods (plus milk feeds for non-breastfed children) the minimum times29 or more, according to breastfeeding status, during the previous day Total number of children age 6-23 months ___________________ 27 Infants receiving breast milk, and not receiving any other fluids or foods, with the exception of oral rehydration solution, vitamins, mineral supplements and medicines 28 Infants who receive breast milk and certain fluids (water and water-based drinks, fruit juice, ritual fluids, oral rehydration solution, drops, vitamins, minerals, and medicines), but do not receive anything else (in particular, non-human milk and food-based fluids) 29 Breastfeeding children: Solid, semi-solid, or soft foods, two times for infants age 6-8 months, 3 times for children 9-23 months; Non-breastfeeding children: Solid, semi-solid, or soft foods, or milk feeds, four times for children age 6-23 months 189 2.14 Age-appropriate breastfeeding BF Number of children age 0-23 months appropriately fed30 during the previous day Total number of children age 0-23 months 2.15 Milk feeding frequency for non- breastfed children BF Number of non-breastfed children age 6-23 months who received at least 2 milk feedings during the previous day Total number of non-breastfed children age 6-23 months 2.18 Low-birthweight infants MN Number of last live births in the 2 years preceding the survey weighing below 2,500 grams at birth Total number of last live births in the 2 years preceding the survey 2.19 Infants weighed at birth MN Number of last live births in the 2 years preceding the survey who were weighed at birth Total number of last live births in the 2 years preceding the survey 3. CHILD HEALTH 3.1 Tuberculosis immunization coverage IM Number of children age 18-29 months who received BCG vaccine before their first birthday Total number of children age 18-29 months 3.2 Polio immunization coverage IM Number of children age 18-29 months who received OPV3 vaccine before their first birthday Total number of children age 18-29 months 3.3 Immunization coverage for diphtheria, pertussis and tetanus (DPT) IM Number of children age 18-29 months who received DPT3 vaccine before their first birthday Total number of children age 18-29 months 3.4 Measles immunization coverage IM Number of children age 18-29 months who received measles vaccine before their first birthday Total number of children age 18-29 months MDG 4.3 3.5 Hepatitis B immunization coverage IM Number of children age 18-29 months who received the third dose of Hepatitis B vaccine before their first birthday Total number of children age 18-29 months 3.8 Oral rehydration therapy with continued feeding CA Number of children under age 5 with diarrhoea in the previous 2 weeks who received ORT (ORS packet or recommended homemade fluid or increased fluids) and continued feeding during the episode of diarrhoea Total number of children under age 5 with diarrhoea in the previous 2 weeks 3.9 Care-seeking for suspected pneumonia CA Number of children under age 5 with suspected pneumonia in the previous 2 weeks who were taken to an appropriate health provider Total number of children under age 5 with suspected pneumonia in the previous 2 weeks 3.10 Antibiotic treatment of suspected pneumonia CA Number of children under age 5 with suspected pneumonia in the previous 2 weeks who received antibiotics Total number of children under age 5 with suspected pneumonia in the previous 2 weeks 3.11 Solid fuels HC Number of household members in households that use solid fuels as the primary source of domestic energy to cook Total number of household members 4. WATER AND SANITATION 4.1 Use of improved drinking water sources WS Number of household members using improved sources of drinking water Total number of household members MDG 7.8 4.2 Water treatment WS Number of household members using unimproved drinking water who use an appropriate treatment method Total number of household members in households using unimproved drinking water sources 4.3 Use of improved sanitation WS Number of household members using improved sanitation facilities which are not shared Total number of household members MDG 7.9 4.4 Safe disposal of child’s faeces CA Number of children age 0-2 years whose last stools were disposed of safely Total number of children age 0-2 years 5. REPRODUCTIVE HEALTH 5.1 Adolescent birth rate CM Age-specific fertility rate for women age 15-19 years for the one year period preceding the survey MDG 5.4 5.2 Early childbearing CM Number of women age 20-24 years who had at least one live birth before age 18 Total number of women age 20-24 years 5.3 Contraceptive prevalence rate CP Number of women age 15-49 years currently married or in union who are using (or whose partner is using) a (modern or traditional) contraceptive method Total number of women age 15-49 years who are currently married or in union MDG 5.3 ___________________ 30 Infants age 0-5 who are exclusively breastfed, and children age 6-23 months who are breastfed and ate solid, semi-solid or soft foods 190 MultIple IndIcator cluster survey 2011 5.4 Unmet need31 UN Number of women age 15-49 years who are currently married or in union who are fecund and want to space their births or limit the number of children they have and who are not currently using contraception Total number of women age 15-49 years who are currently married or in union MDG 5.6 5.5a 5.5b Antenatal care coverage MN Number of women age 15-49 years who were attended during pregnancy in the 2 years preceding the survey (a) at least once by skilled personnel (b) at least four times by any provider Total number of women age 15-49 years with a live birth in the 2 years preceding the survey MDG 5.5 5.6 Content of antenatal care MN Number of women age 15-49 years with a live birth in the 2 years preceding the survey who had their blood pressure measured and gave urine and blood samples during the last pregnancy Total number of women age 15-49 years with a live birth in the 2 years preceding the survey 5.7 Skilled attendant at delivery MN Number of women age 15-49 years with a live birth in the 2 years preceding the survey who were attended during childbirth by skilled health personnel Total number of women age 15-49 years with a live birth in the 2 years preceding the survey MDG 5.2 5.8 Institutional deliveries MN Number of women age 15-49 years with a live birth in the 2 years preceding the survey who delivered in a health facility Total number of women age 15-49 years with a live birth in the 2 years preceding the survey 5.9 Caesarean section MN Number of last live births in the 2 years preceding the survey who were delivered by caesarean section Total number of last live births in the 2 years preceding the survey 6. CHILD DEVELOPMENT 6.1 Support for learning CE Number 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 past 3 days Total number of children age 36-59 months 6.2 Father’s support for learning CE Number of children age 36-59 months whose father has engaged in one or more activities to promote learning and school readiness in the past 3 days Total number of children age 36-59 months 6.3 Learning materials: children’s books CE Number of children under age 5 who have three or more children’s books Total number of children under age 5 6.4 Learning materials: playthings CE Number of children under age 5 with two or more playthings Total number of children under age 5 6.5 Inadequate care CE Number 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 past week Total number of children under age 5 6.6 Early child development Index CE Number of children age 36-59 months who are developmentally on track in literacy-numeracy, physical, social-emotional, and learning domains Total number of children age 36-59 months 6.7 Attendance to early childhood education CE Number of children age 36-59 months who are attending an early childhood education programme Total number of children age 36-59 months 7. LITERACY AND EDUCATION 7.1 Literacy rate among young women WB Number of women age 15-24 years who are able to read a short simple statement about everyday life or who attended secondary or higher education Total number of women age 15-24 years MDG 2.3 7.2 School readiness ED Number of children in first grade of primary school who attended pre-school during the previous school year Total number of children attending the first grade of primary school 7.3 Net intake rate in primary education ED Number of children of school-entry age who enter the first grade of primary school Total number of children of school- entry age 7.4 Primary school net attendance ratio (adjusted) ED Number of children of primary school age currently attending primary or secondary school Total number of children of primary school age MDG 2.1 ___________________ 31 See MICS4 manual for a detailed description 191 7.5 Secondary school net attendance ratio (adjusted) ED Number of children of secondary school age currently attending secondary school or higher Total number of children of secondary- school age 7.6 Children reaching last grade of primary ED Proportion of children entering the first grade of primary school who eventually reach last grade MDG 2.2 7.7 Primary completion rate ED Number of children (of any age) attending the last grade of primary school (excluding repeaters) Total number of children of primary school completion age (age appropriate to final grade of primary school) 7.8 Transition rate to secondary school ED 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 Total number of children who are attending the first grade of secondary school 7.9 Gender parity index (primary school) ED Primary school net attendance ratio (adjusted) for girls Primary school net attendance ratio (adjusted) for boys MDG 3.1 7.10 Gender parity index (secondary school) ED Secondary school net attendance ratio (adjusted) for girls Secondary school net attendance ratio (adjusted) for boys MDG 3.1 8. CHILD PROTECTION 8.1 Birth registration BR Number of children under age 5 whose births are reported registered Total number of children under age 5 8.2 Child labour CL Number of children age 5-14 years who are involved in child labour Total number of children age 5-14 years 8.3 School attendance among child labourers ED - CL Number of children age 5-14 years who are involved in child labour and are currently attending school Total number of children age 5-14 years involved in child labour 8.4 Child labour among students ED - CL Number of children age 5-14 years who are involved in child labour and are currently attending school Total number of children age 5-14 years attending school 8.5 Violent discipline CD Number of children age 2-14 years who experienced psychological aggression or physical punishment during the past month Total number of children age 2-14 years 8.6 Marriage before age 15 MA Number of women age 15-49 years who were first married or in union by the exact age of 15 Total number of women age 15-49 years 8.7 Marriage before age 18 MA Number of women age 20-49 years who were first married or in union by the exact age of 18 Total number of women age 20-49 years 8.8 Young women age 15-19 years currently married or in union MA Number of women age 15-19 years who are currently married or in union Total number of women age 15-19 years 8.10a 8.10b Spousal age difference MA Number of women currently married or in union whose spouse is 10 or more years older, (a) for women age 15-19 years, (b) for women age 20- 24 years Total number of women currently married or in union (a) age 15-19 years, (b) age 20-24 years 8.14 Attitudes towards domestic violence DV Number of women who state that a husband/ partner 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 Total number of women age 15-49 years 9.17 Children`s living arrangements HL Number of children age 0-17 years not living with a biological parent Total number of children age 0-17 years 9.18 Prevalence of children with one or both parents dead HL Number of children age 0-17 years with one or both parents dead Total number of children age 0-17 years 11. SUBJECTIVE WELL-BEING SW.1 Life satisfaction LS Number of women age 15-24 years who are very or somewhat satisfied with their family life, friendships, school, current job, health, where they live, how they are treated by others, and how they look Total number of women age 15-24 years SW.2 Happiness LS Number of women age 15-24 years who are very or somewhat happy Total number of women age 15-24 years 192 MultIple IndIcator cluster survey 2011 SW.3 Perception of a better life LS Number of 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 Total number of women age 15-24 years 12. TOBACCO AND ALCOHOL USE TA.1 Tobacco use TA Number of women age 15-49 years who smoked cigarettes, or used smoked or smokeless tobacco products on one or more days during the last one month Total number of women age 15-49 years TA.2 Smoking before age 15 TA Number of women age 15-49 years who smoked a whole cigarette before age 15 Total number of women age 15-49 years TA.3 Alcohol use] TA Number of women age 15-49 years who had at least one alcoholic drink on one or more days during the last one month Total number of women age 15-49 years TA.4 Use of alcohol before age 15 TA Number of women age 15-49 years who had at least one alcoholic drink before age 15 Total number of women age 15-49 years 193 appendix f. questionnaires 194 MultIple IndIcator cluster survey 2011 195 HoUseHolD qUesTIonnaIRe MaCeDonIa household infoRMation panel hh HH1. cluster number: HH2. household number: HH3. interviewer’s name and number: HH4. supervisor’s name and number: name name HH5. day / Month / year of interviewing: Day Month Year HH6. Area: Urban 1 Rural 2 HH7. Region: Vardar 1 East 2 Southwest 3 Southeast 4 Pelagonia 5 Polog 6 Northeast 7 Skopje 8 We are from ipsos strategic puls. We are working on a project related to family health and education. i would like to talk to you about these issues. the interview will last for about 30 minutes. all information obtained will remain strictly confidential and your answers will only be analysed as group data by the project team, without any direct correlations to your personal data. can we start now? Yes, permission is given ð Go to HH18 to record time and start the interview. No, permission is not given ð Complete HH9. Talk to your supervisor about this result. HH8. name of the head of household: HH9. Results from the household interview: completed 01 no household member or no competent respondent was found at home during all the 4 visits 02 the entire household is absent for a longer period 03 Refused 04 vacant dwelling / address is not a dwelling 05 Ruined dwelling 06 dwelling not found 07 other (specify) 96 HH10. the respondent who answers the household questionnaire: name: Row number: HH11. total number of household members: HH12. number of women aged between 15-49 years: HH13. number of women questionnaires completed: HH14. number of children aged 5 or less: HH15. number of under-5 children questionnaires completed: HH15A. number of children aged between 2-9 years: HH15B. number of questionnaires for child disability (children 2-9) completed: HH16. editor in the field (name and number): HH17. data entered by (name and number): name name 195 196 MultIple IndIcator cluster survey 2011 household list hl HH18. Record momentary time. As first, can you please tell me the name of each person who usually lives here, starting with the head of household? List the head of the household in row 01. List all household members (HL2), their relationship to the household head (HL3), and their gender (HL4) Then ask: Are there any other persons living here, even if they are not at home at the moment? If yes, fill in the list for questions HL2-HL4. Then, ask all the questions starting with HL5 for each person individually. Use an additional questionnaire if all the rows in the household roster form have been used. hour For women aged 15-49 For children aged 5-14 For children under 5 For children aged 2-9 For children aged 0-17 years Minutes HL1. Row number HL2. name HL3. What is the relation-ship of (name) to the head of house- hold? (See codes for re- lationship below the table) HL4. Is (name) male or female? 1 Male 2 Female HL5. What is (name)’s birth date? HL6. How old is (name)? Record full years. If the age is 95 or above, record ‘95’ HL7. Circle row number if the woman is aged 15-49 HL8. who is this child’s mother or primary guardian? Record row number for mother/ guardian HL9. who is this child’s mother or primary guardian? Record row number for mother/ guard- ian HL9a. Copy child’s mother or primary guardian raw number for each child between 2 and nine. Use the previous 2 columns – HL8 and HL9. don’t ask again HL11. Is (name)’s birth mother alive? 1 Yes 2 Noø HL13 8 DKø HL13 HL12. Does (name)’s birth mother live in this household? Record row number for the mother or 00 for “No” HL13. Is (name)’s natural father alive? 1 Yes 2 Noø Next Row 8 DKø Next Row HL14. Does (name)’s natural father live in this household? Record row number for the father or 00 for “No” 98 DK 9998 DK Row Name Relation* M F Month Year Age 15-49 Mother Mother Mother y n dk Mother y n dk Father 01 0 1 1 2 01 1 2 8 1 2 8 02 1 2 02 1 2 8 1 2 8 03 1 2 03 1 2 8 1 2 8 04 1 2 04 1 2 8 1 2 8 05 1 2 05 1 2 8 1 2 8 06 1 2 06 1 2 8 1 2 8 07 1 2 07 1 2 8 1 2 8 08 1 2 08 1 2 8 1 2 8 09 1 2 09 1 2 8 1 2 8 10 1 2 10 1 2 8 1 2 8 11 1 2 11 1 2 8 1 2 8 12 1 2 12 1 2 8 1 2 8 13 1 2 13 1 2 8 1 2 8 14 1 2 14 1 2 8 1 2 8 15 1 2 15 1 2 8 1 2 8 Tick this box if an additional questionnaire is used Check for additional household members. Probe in particular for any newborns or small children not listed above and other persons who are not family members (like for ex. retainers, friends) but they happen to live in the household. Insert the names of all the additional members in the household roster and complete the for each of them. Now, for each woman aged between 15 and 49, write the name and the row number and other information in the data panel of the separate Individual Women’s Questionnaire. For each child under 5 years of age, write his/her name and row number AND the raw number of his/her mother or guardian in the data panel of the separate Under-5 Questionnaire. And, for each child aged between 2 and 9, write his/her name and row number AND the raw number of his/her mother or guardian in the data panel of the separate Child Disability Questionnaire. Now, you should have a separate questionnaire per each eligible woman, per each child under five, and per each child aged between 2 and 9 in the household. If there are children aged from 0 to 5 within this household, inform the mother/guardian that these children will have to be measured after the inter- viewing process is complete. 197 household list hl HH18. Record momentary time. As first, can you please tell me the name of each person who usually lives here, starting with the head of household? List the head of the household in row 01. List all household members (HL2), their relationship to the household head (HL3), and their gender (HL4) Then ask: Are there any other persons living here, even if they are not at home at the moment? If yes, fill in the list for questions HL2-HL4. Then, ask all the questions starting with HL5 for each person individually. Use an additional questionnaire if all the rows in the household roster form have been used. hour For women aged 15-49 For children aged 5-14 For children under 5 For children aged 2-9 For children aged 0-17 years Minutes HL1. Row number HL2. name HL3. What is the relation-ship of (name) to the head of house- hold? (See codes for re- lationship below the table) HL4. Is (name) male or female? 1 Male 2 Female HL5. What is (name)’s birth date? HL6. How old is (name)? Record full years. If the age is 95 or above, record ‘95’ HL7. Circle row number if the woman is aged 15-49 HL8. who is this child’s mother or primary guardian? Record row number for mother/ guardian HL9. who is this child’s mother or primary guardian? Record row number for mother/ guard- ian HL9a. Copy child’s mother or primary guardian raw number for each child between 2 and nine. Use the previous 2 columns – HL8 and HL9. don’t ask again HL11. Is (name)’s birth mother alive? 1 Yes 2 Noø HL13 8 DKø HL13 HL12. Does (name)’s birth mother live in this household? Record row number for the mother or 00 for “No” HL13. Is (name)’s natural father alive? 1 Yes 2 Noø Next Row 8 DKø Next Row HL14. Does (name)’s natural father live in this household? Record row number for the father or 00 for “No” 98 DK 9998 DK Row Name Relation* M F Month Year Age 15-49 Mother Mother Mother y n dk Mother y n dk Father 01 0 1 1 2 01 1 2 8 1 2 8 02 1 2 02 1 2 8 1 2 8 03 1 2 03 1 2 8 1 2 8 04 1 2 04 1 2 8 1 2 8 05 1 2 05 1 2 8 1 2 8 06 1 2 06 1 2 8 1 2 8 07 1 2 07 1 2 8 1 2 8 08 1 2 08 1 2 8 1 2 8 09 1 2 09 1 2 8 1 2 8 10 1 2 10 1 2 8 1 2 8 11 1 2 11 1 2 8 1 2 8 12 1 2 12 1 2 8 1 2 8 13 1 2 13 1 2 8 1 2 8 14 1 2 14 1 2 8 1 2 8 15 1 2 15 1 2 8 1 2 8 Tick this box if an additional questionnaire is used Check for additional household members. Probe in particular for any newborns or small children not listed above and other persons who are not family members (like for ex. retainers, friends) but they happen to live in the household. Insert the names of all the additional members in the household roster and complete the for each of them. Now, for each woman aged between 15 and 49, write the name and the row number and other information in the data panel of the separate Individual Women’s Questionnaire. For each child under 5 years of age, write his/her name and row number AND the raw number of his/her mother or guardian in the data panel of the separate Under-5 Questionnaire. And, for each child aged between 2 and 9, write his/her name and row number AND the raw number of his/her mother or guardian in the data panel of the separate Child Disability Questionnaire. Now, you should have a separate questionnaire per each eligible woman, per each child under five, and per each child aged between 2 and 9 in the household. If there are children aged from 0 to 5 within this household, inform the mother/guardian that these children will have to be measured after the inter- viewing process is complete. 01 Head 02 Wife / Husband 03 Son / Daughter 04 Son-In-Law / Daughter-In-Law 05 Grandchild 06 Parent 07 Parent-In-Law 08 Brother / Sister 09 Brother-In-Law / Sister-In-Law 10 Uncle / Aunt 11 Niece / Nephew 12 Other relative 13 Adopted / Foster / Stepchild 14 Not related as a relative 98 Don’t know * Codes for HL3: Relationship to the head of household: 198 MultIple IndIcator cluster survey 2011 education eD for all the household members aged 5 and above, including the adult members as well for those household members aged 5-24 ED1. row num- ber ED2. Name and age Copy from the Household List, HL2 and HL6 ED3. Has (name) ever attended school or pre-school education? 1 Yes 2 No ø Next Row ED4a. What is the highest level of education (name) attended? ED4b. What is the highest grade (name) com- pleted at this level (ED4a)? ED5. During the school year (2010- 2011), has (name) attended school or preschool at any time? 1 Yes 2 No ø ED6. During this/that school year, which level and grade does/did (name) attend? ED7. During the previous school year, (2009-2010), did (name) attend school or preschool at any time? 1 Yes 2 No ø Next Row 8 DK ø Next Row ED8. During that previous school year, which level and grade did (name) attend? Level: 0 Preschool 1 Primary 2 Secondary 3 Higher 8 DK If level=0, skip to ED5 Grade/year: 98 DK If less than 1, enter 00. Level: 0 Preschool 1 Primary 2 Secondary 3 Higher 8 DK If level=0, skip to ED7 Grade/year: 98 DK Level: 0 Preschool 1 Primary 2 Secondary 3 Higher 8 DK If level=0, go to next person Grade/year: 98 DK Row Name Age Yes No Level Grade/year Yes No Level Grade/year y n dk Level Grade/year 01 1 2 0 1 2 3 4 8 1 2 0 1 2 3 4 8 1 2 8 0 1 2 3 4 8 02 1 2 0 1 2 3 4 8 1 2 0 1 2 3 4 8 1 2 8 0 1 2 3 4 8 03 1 2 0 1 2 3 4 8 1 2 0 1 2 3 4 8 1 2 8 0 1 2 3 4 8 04 1 2 0 1 2 3 4 8 1 2 0 1 2 3 4 8 1 2 8 0 1 2 3 4 8 05 1 2 0 1 2 3 4 8 1 2 0 1 2 3 4 8 1 2 8 0 1 2 3 4 8 06 1 2 0 1 2 3 4 8 1 2 0 1 2 3 4 8 1 2 8 0 1 2 3 4 8 07 1 2 0 1 2 3 4 8 1 2 0 1 2 3 4 8 1 2 8 0 1 2 3 4 8 08 1 2 0 1 2 3 4 8 1 2 0 1 2 3 4 8 1 2 8 0 1 2 3 4 8 09 1 2 0 1 2 3 4 8 1 2 0 1 2 3 4 8 1 2 8 0 1 2 3 4 8 10 1 2 0 1 2 3 4 8 1 2 0 1 2 3 4 8 1 2 8 0 1 2 3 4 8 11 1 2 0 1 2 3 4 8 1 2 0 1 2 3 4 8 1 2 8 0 1 2 3 4 8 12 1 2 0 1 2 3 4 8 1 2 0 1 2 3 4 8 1 2 8 0 1 2 3 4 8 13 1 2 0 1 2 3 4 8 1 2 0 1 2 3 4 8 1 2 8 0 1 2 3 4 8 14 1 2 0 1 2 3 4 8 1 2 0 1 2 3 4 8 1 2 8 0 1 2 3 4 8 15 1 2 0 1 2 3 4 8 1 2 0 1 2 3 4 8 1 2 8 0 1 2 3 4 8 199 education eD for all the household members aged 5 and above, including the adult members as well for those household members aged 5-24 ED1. row num- ber ED2. Name and age Copy from the Household List, HL2 and HL6 ED3. Has (name) ever attended school or pre-school education? 1 Yes 2 No ø Next Row ED4a. What is the highest level of education (name) attended? ED4b. What is the highest grade (name) com- pleted at this level (ED4a)? ED5. During the school year (2010- 2011), has (name) attended school or preschool at any time? 1 Yes 2 No ø ED6. During this/that school year, which level and grade does/did (name) attend? ED7. During the previous school year, (2009-2010), did (name) attend school or preschool at any time? 1 Yes 2 No ø Next Row 8 DK ø Next Row ED8. During that previous school year, which level and grade did (name) attend? Level: 0 Preschool 1 Primary 2 Secondary 3 Higher 8 DK If level=0, skip to ED5 Grade/year: 98 DK If less than 1, enter 00. Level: 0 Preschool 1 Primary 2 Secondary 3 Higher 8 DK If level=0, skip to ED7 Grade/year: 98 DK Level: 0 Preschool 1 Primary 2 Secondary 3 Higher 8 DK If level=0, go to next person Grade/year: 98 DK Row Name Age Yes No Level Grade/year Yes No Level Grade/year y n dk Level Grade/year 01 1 2 0 1 2 3 4 8 1 2 0 1 2 3 4 8 1 2 8 0 1 2 3 4 8 02 1 2 0 1 2 3 4 8 1 2 0 1 2 3 4 8 1 2 8 0 1 2 3 4 8 03 1 2 0 1 2 3 4 8 1 2 0 1 2 3 4 8 1 2 8 0 1 2 3 4 8 04 1 2 0 1 2 3 4 8 1 2 0 1 2 3 4 8 1 2 8 0 1 2 3 4 8 05 1 2 0 1 2 3 4 8 1 2 0 1 2 3 4 8 1 2 8 0 1 2 3 4 8 06 1 2 0 1 2 3 4 8 1 2 0 1 2 3 4 8 1 2 8 0 1 2 3 4 8 07 1 2 0 1 2 3 4 8 1 2 0 1 2 3 4 8 1 2 8 0 1 2 3 4 8 08 1 2 0 1 2 3 4 8 1 2 0 1 2 3 4 8 1 2 8 0 1 2 3 4 8 09 1 2 0 1 2 3 4 8 1 2 0 1 2 3 4 8 1 2 8 0 1 2 3 4 8 10 1 2 0 1 2 3 4 8 1 2 0 1 2 3 4 8 1 2 8 0 1 2 3 4 8 11 1 2 0 1 2 3 4 8 1 2 0 1 2 3 4 8 1 2 8 0 1 2 3 4 8 12 1 2 0 1 2 3 4 8 1 2 0 1 2 3 4 8 1 2 8 0 1 2 3 4 8 13 1 2 0 1 2 3 4 8 1 2 0 1 2 3 4 8 1 2 8 0 1 2 3 4 8 14 1 2 0 1 2 3 4 8 1 2 0 1 2 3 4 8 1 2 8 0 1 2 3 4 8 15 1 2 0 1 2 3 4 8 1 2 0 1 2 3 4 8 1 2 8 0 1 2 3 4 8 200 MultIple IndIcator cluster survey 2011 HoUseHolD CHaRaCTeRIsTICs HC HC1a. What is the religion the head of household practices? Orthodox Christian 01 Catholic 02 Muslim 03 Protestant 04 Other religion (specify) 06 None 07 HC1b. What is head household’s mother tongue? Macedonian 01 Albanian 02 Roma 03 Turkish 04 Serbian 05 Vlach 06 Bosnian 07 Other language (specify) 96 Does not want to specify 15 HC1c. What ethnic group does the head of household belong to? Macedonian 01 Albanian 02 Roma 03 Turkish 04 Serbian 05 Vlach 06 Bosnian 07 Other ethnic group (specify) 96 Does not want to specify 15 HC2. How many rooms in this household do you use for sleeping? Number of rooms . __ __ HC3. Main material the dwelling floor is made from. Record your own observation. Natural floor Soil/ Sand 11 Dung floor 12 Rudimentary floor Wood planks 21 Refined floor Parquet or polished wood 31 Vinyl or asphalt stripes 32 Ceramic tiles 33 Cement 34 Carpet 35 Laminate 36 Other (specify) 96 HC4. Main material the dwelling roof is made from. Record your own observation. Natural roofing No Roof at all 11 Thatch / Palm leaf roof 12 Sod 13 Stone slabs / leaf stone 14 Rudimentary Roofing Rustic rug 21 Wood planks 23 Cardboard 24 Refined roofing Metal 31 Wood 32 Calamine / Cement fibre 33 Ceramic tiles 34 Cement 35 Shingles 36 Salonit / Asbestos 37 Other (specify) 96 201 HC5. Main material the exterior walls are made from. Record your own observation. Natural walls No walls 11 Cane / Wood trunks 12 Soil 13 Rudimentary walls Hey and mud (plitar) 21 Stone and mud (‘clayed’) 22 Uncovered adobe 23 Plywood 24 Cardboard 25 Recycled wood/boards,planks 26 Refined walls Cement 31 Limestone/ cement (constructed) 32 Bricks 33 Cement blocks 34 Covered adobe 35 Wood planks / shingles 36 Other (specify) 96 HC6. What type of fuel does your household mostly utilise for cooking? Electricity 01 Liquefied Petroleum Gas (LPG) 02 Biogas 04 Coal / Lignite 06 Charcoal 07 Wood 08 Hay / Shrubs / Grass 09 Animal dung 10 Agricultural crop residue 11 No food is cooked in the household 95 Other (specify) 96 01ðHC8 02ðHC8 04ðHC8 95ðHC8 HC7. Does cooking usually take place in the house, in a separate construction, or outdoors? If ‘In the house’, check: does it take place in a separate room used as a kitchen? In the house In a separate room used as a kitchen 1 Elsewhere in the house 2 In a separate construction 3 Outdoors 4 Other (specify) 6 HC8. Is there in your household: [A] Electricity? [B] Radio? [C] Television – classical (CRT)? [D] Plasma/ LCD TV? [E] Landline telephone? [F] Refrigerator? [G] Washing machine? [H] Cooker? [I] Water boiler? [J] Air-conditioning? [K] Dish-washer? [L] Microwave-oven? [M] Dryer? [N] Sitting set/sofa? [O] sleeping bed? [P] Dining table? Yes No Electricity 1 2 Radio 1 2 Television – classical (CRT) 1 2 Plasma/ LCD TV 1 2 Landline telephone 1 2 Refrigerator 1 2 Washing machine 1 2 Cooker 1 2 Water boiler 1 2 Air-conditioning 1 2 Dish-washer 1 2 Microwave-oven 1 2 Dryer 1 2 Sitting set/sofa 1 2 Sleeping bed 1 2 Dining table 1 2 202 MultIple IndIcator cluster survey 2011 HC9. Does any member in your household own: [A] A watch? [B] A mobile phone? [C] A bicycle? [D] A motorcycle or a scooter? [E] A cart pulled by animals? [F] A car or a truck? [G] A motor boat? [H] Computer/PC [I] Laptop [J] Caravan Yes No Watch 1 2 Mobile phone 1 2 Bicycle 1 2 Motorcycle / Scooter 1 2 Cart pulled by animals 1 2 Car / Truck 1 2 Motor boat 1 2 Computer 1 2 Laptop 1 2 Caravan 1 2 HC10. Are you or someone else living in this household an owner of this dwelling? If the answer is “No”, ask: Do you rent this dwelling from someone who does not live in this household? If the answer is “Rented from someone else”, circle “2”. For other responses, circle “6”. Owner 1 Rented 2 Other (neither owned nor rented) 6 HC11. Does any member of this household own any land that can be utilized for agricultural purposes? Yes 1 No 2 2ðHC13 HC12. How many hectares of agricultural land do the members of this household possess? If less than 1, record “00”. If 95 or more, record ‘95’. If don’t know, record ‘98’. Hectares ___ ___ HC13. Does this household own any livestock herds, other animals, or poultry? Yes 1 No 2 2ðHC15 HC14. How many of the mentioned animals does this household have? [A] Cattle, milk cows or bulls? [B] Horses, donkeys or mules? [C] Goats? [D] Sheep? [E] Chickens? [F] Pigs? If none, record ‘00’. If 95 or more, record ‘95’. If unknown, record ‘98’. Cattle, milk cows or bulls ___ ___ Horses, donkeys or mules ___ ___ Goats ___ ___ Sheep ___ ___ Chickens ___ ___ Pigs ___ ___ HC15. Does any member of this household own a bank account? Yes 1 No 2 203 204 MultIple IndIcator cluster survey 2011 CHIlD laboUR Cl To be filled in for those children in the household aged 5-17. For those household members that are below 5 or above 17 years of age, leave rows as blank. Now I would like to ask you about each work that the children in this household may be doing. CL1. Row number CL2. Name and Age Copy from the Household Roster HL2 and HL6 CL3. During the last week, did (name) do any kind of work for a person who is not a member of this household? If yes: For payment in cash or in kind? 1 Yes, for payment (cash or kind) 2 Yes, but no payment 3 No ðCL5 CL4. Since last (day of the week), how many hours did he/ she work for the person who is not a member of this household? If more than one job, include all hours for all the jobs executed. CL5. During the last week, did (name) bring any water or collect firewood for the household’s use? 1 Yes 2 No ðCL7 CL6. Since last (day of the week), how many working hours did he/she spend to bring water or collect firewood for the household? CL7. During the last week, did (name) perform any paid or unpaid work on a family farm or in a family business or by selling goods in the street? Include also the work from a business run by the child, alone or with one or more partners. 1 Yes 2 No ðCL9 CL8. Since last (day of the week), working hours did he/she spend for his/her family or himself/ herself? CL9. During the last week, did (name) help with household chores such as shopping, cleaning, washing the clothes, cooking; or taking care for the children, older or sick people? 1 Yes 2 No ð Next child CL10. Since last (day of the week), how many working hours did he/she spend on these chores? Yes No Number Number Number Number Row Name Age Paid Unpaid of hours Yes No of hours Yes No of hours Yes No of hours 01 1 2 3 1 2 1 2 1 2 02 1 2 3 1 2 1 2 1 2 03 1 2 3 1 2 1 2 1 2 04 1 2 3 1 2 1 2 1 2 05 1 2 3 1 2 1 2 1 2 06 1 2 3 1 2 1 2 1 2 07 1 2 3 1 2 1 2 1 2 08 1 2 3 1 2 1 2 1 2 09 1 2 3 1 2 1 2 1 2 10 1 2 3 1 2 1 2 1 2 11 1 2 3 1 2 1 2 1 2 12 1 2 3 1 2 1 2 1 2 13 1 2 3 1 2 1 2 1 2 14 1 2 3 1 2 1 2 1 2 15 1 2 3 1 2 1 2 1 2 205 CHIlD laboUR Cl To be filled in for those children in the household aged 5-17. For those household members that are below 5 or above 17 years of age, leave rows as blank. Now I would like to ask you about each work that the children in this household may be doing. CL1. Row number CL2. Name and Age Copy from the Household Roster HL2 and HL6 CL3. During the last week, did (name) do any kind of work for a person who is not a member of this household? If yes: For payment in cash or in kind? 1 Yes, for payment (cash or kind) 2 Yes, but no payment 3 No ðCL5 CL4. Since last (day of the week), how many hours did he/ she work for the person who is not a member of this household? If more than one job, include all hours for all the jobs executed. CL5. During the last week, did (name) bring any water or collect firewood for the household’s use? 1 Yes 2 No ðCL7 CL6. Since last (day of the week), how many working hours did he/she spend to bring water or collect firewood for the household? CL7. During the last week, did (name) perform any paid or unpaid work on a family farm or in a family business or by selling goods in the street? Include also the work from a business run by the child, alone or with one or more partners. 1 Yes 2 No ðCL9 CL8. Since last (day of the week), working hours did he/she spend for his/her family or himself/ herself? CL9. During the last week, did (name) help with household chores such as shopping, cleaning, washing the clothes, cooking; or taking care for the children, older or sick people? 1 Yes 2 No ð Next child CL10. Since last (day of the week), how many working hours did he/she spend on these chores? Yes No Number Number Number Number Row Name Age Paid Unpaid of hours Yes No of hours Yes No of hours Yes No of hours 01 1 2 3 1 2 1 2 1 2 02 1 2 3 1 2 1 2 1 2 03 1 2 3 1 2 1 2 1 2 04 1 2 3 1 2 1 2 1 2 05 1 2 3 1 2 1 2 1 2 06 1 2 3 1 2 1 2 1 2 07 1 2 3 1 2 1 2 1 2 08 1 2 3 1 2 1 2 1 2 09 1 2 3 1 2 1 2 1 2 10 1 2 3 1 2 1 2 1 2 11 1 2 3 1 2 1 2 1 2 12 1 2 3 1 2 1 2 1 2 13 1 2 3 1 2 1 2 1 2 14 1 2 3 1 2 1 2 1 2 15 1 2 3 1 2 1 2 1 2 206 MultIple IndIcator cluster survey 2011 CHIlD DIsCIPlIne CD Table 1: CHIlDRen aGeD beTWeen 2-14 YeaRs aRe elIGIble foR THe CHIlD DIsCIPlIne qUesTIons y Record each of the children aged 2-14 years below according to the order they appear in the Household List. Do not include other household members who are outside the age range of 2-14 years. y Indicate the row number, the name, the sex, and the age for each child. y Then insert the total number of children aged between 2-14, in the appropriate box below (CD6). y If there are no children aged 2 to14 in this household, go to next module. CD1. Rank number CD2. Row number from HL1 CD3. Name from HL2 CD4. Sex from HL4 CD5. Age from HL6 Rank Row Name M F Age 1 2 3 4 5 6 7 8 CD6. Total number of children aged 2-14 years y If there is only one child in the household aged 2-14 years, skip table 2 and go to CD8; write down’1’ and carry on with CD9 Table 2: RanDoM seleCTIon of a CHIlD foR THe CHIlD DIsCIPlIne qUesTIons y Use Table 2 to select one child between the age of 2 and 14, if there is more than one child in the household belonging to this age group. y Check the last digit of the household number (HH2) from the front page. This is the number of the row you should move to in the table given below. y Check the total number of the eligible children (2-14) in CD6 above. This is the number of the column you should move to. y Find the box where the row and the column cross along and circle the number that appears in that box. This is the rank number of the child (CD1) that is going to be the subject of the questions you will be asking. CD7. Last digit from the household number (HH2) Total number of the eligible children in the household (CD6) 1 2 3 4 5 6 7 8+ 0 1 2 2 4 3 6 5 4 1 1 1 3 1 4 1 6 5 2 1 2 1 2 5 2 7 6 3 1 1 2 3 1 3 1 7 4 1 2 3 4 2 4 2 8 5 1 1 1 1 3 5 3 1 6 1 2 2 2 4 6 4 2 7 1 1 3 3 5 1 5 3 8 1 2 1 4 1 2 6 4 9 1 1 2 1 2 3 7 5 CD8. Record the rank number of the selected child (CD1) CD9. Write the name and the row number for the child selected for this module from CD3 and CD2, according to the rank number in CD8. Name(CD3) Row number (CD2) CD10. Adults exercise certain ways to teach children to proper behaviour or to approach a behavioural problem. I will read you some methods that are used and I would like you to tell me if you or any other person in your household has ever used this method with (name) in the past month. CD11. Took privileges, or have forbidden something (name) wanted to do or grounded him/her not to leave the house. Yes 1 No 2 CD12. Explained why (name)’s behavior was incorrect. Yes 1 No 2 CD13. Shook him/her with hands. Yes 1 No 2 207 CHIlD DIsCIPlIne CD Table 1: CHIlDRen aGeD beTWeen 2-14 YeaRs aRe elIGIble foR THe CHIlD DIsCIPlIne qUesTIons y Record each of the children aged 2-14 years below according to the order they appear in the Household List. Do not include other household members who are outside the age range of 2-14 years. y Indicate the row number, the name, the sex, and the age for each child. y Then insert the total number of children aged between 2-14, in the appropriate box below (CD6). y If there are no children aged 2 to14 in this household, go to next module. CD1. Rank number CD2. Row number from HL1 CD3. Name from HL2 CD4. Sex from HL4 CD5. Age from HL6 Rank Row Name M F Age 1 2 3 4 5 6 7 8 CD6. Total number of children aged 2-14 years y If there is only one child in the household aged 2-14 years, skip table 2 and go to CD8; write down’1’ and carry on with CD9 Table 2: RanDoM seleCTIon of a CHIlD foR THe CHIlD DIsCIPlIne qUesTIons y Use Table 2 to select one child between the age of 2 and 14, if there is more than one child in the household belonging to this age group. y Check the last digit of the household number (HH2) from the front page. This is the number of the row you should move to in the table given below. y Check the total number of the eligible children (2-14) in CD6 above. This is the number of the column you should move to. y Find the box where the row and the column cross along and circle the number that appears in that box. This is the rank number of the child (CD1) that is going to be the subject of the questions you will be asking. CD7. Last digit from the household number (HH2) Total number of the eligible children in the household (CD6) 1 2 3 4 5 6 7 8+ 0 1 2 2 4 3 6 5 4 1 1 1 3 1 4 1 6 5 2 1 2 1 2 5 2 7 6 3 1 1 2 3 1 3 1 7 4 1 2 3 4 2 4 2 8 5 1 1 1 1 3 5 3 1 6 1 2 2 2 4 6 4 2 7 1 1 3 3 5 1 5 3 8 1 2 1 4 1 2 6 4 9 1 1 2 1 2 3 7 5 CD8. Record the rank number of the selected child (CD1) CD9. Write the name and the row number for the child selected for this module from CD3 and CD2, according to the rank number in CD8. Name(CD3) Row number (CD2) CD10. Adults exercise certain ways to teach children to proper behaviour or to approach a behavioural problem. I will read you some methods that are used and I would like you to tell me if you or any other person in your household has ever used this method with (name) in the past month. CD11. Took privileges, or have forbidden something (name) wanted to do or grounded him/her not to leave the house. Yes 1 No 2 CD12. Explained why (name)’s behavior was incorrect. Yes 1 No 2 CD13. Shook him/her with hands. Yes 1 No 2 CD14. Shouted, or yelled at him/her. Yes 1 No 2 CD15. Gave him/her something else to do. Yes 1 No 2 CD16. Spanked, or slapped him/her on the bottom. Yes 1 No 2 CD17. Hit him/her on the bottom or somewhere else on the body with something like a belt, a hairbrush, a stick or another hard object. Yes 1 No 2 CD18. Called him/her stupid, lazy, or with similar adjectives. Yes 1 No 2 CD19. Hit or slapped him/her in the face, head, or ears. Yes 1 No 2 CD20. Hit or slapped him/her on his/her hand, arm, or leg. Yes 1 No 2 CD21. Beat him/her up, that is hit him/her over and over as hard as one could. Yes 1 No 2 CD22. Do you believe that for the purpose of properly bringing up, rising, or educating a child, one needs to physically punish the child? Yes 1 No 2 Don’t know / No opinion 8 HH19. Record the momentary time. Hour and minutes : HH20. Thank the respondent for his/her cooperation and check the Household List: ‡‡ One Questionnaire for Women is issued for each eligible woman listed in the Household List(HL7) ‡‡ One Questionnaire for Children Under 5 is issued for each eligible child under the age of 5 listed in the Household List(HL9) ‡‡ One Questionnaire for Child Disability is issued for each eligible child between the age of 2 and 9 listed in the Household List(HL9a) Return to the cover page and confirm that all the information about the number of eligible women (HH12), all children under 5 (HH14), and all children aged between 2 and 9 (HH15A) is properly entered. Make all the necessary steps for all the individual questionnaires to be filled in correctly for this household. Interviewer’s observations 208 MultIple IndIcator cluster survey 2011 field editor’s observations supervisor’s observations 209 qUesTIonnaIRe foR WoMen MaCeDonIa WoMen’s InfoRMaTIon Panel WM This questionnaire is to be filled for all women aged 15 to 49 (see Household List, column HL7). A separate questionnaire should be used for each woman qualified. WM1. Cluster number: WM2. Household number: WM3. Woman’s name: WM4. Woman’s line number: Name WM5. Interviewer’s name and number: WM6. Day / Month / Year of interviewing: Name Repeat the introduction if you haven’t read it to this woman already: We are from Ipsos Strategic Puls. We are working on a project related to family health and education. I would like to talk to you about these issues. The interview will last about 30 minutes. All information obtained will remain strictly confidential and your answers will only be analysed as group data by the project team without any direct correlations to your personal data. If you have already read it to this woman at the beginning from the household questionnaire, then read the following: We are working on a project related to family health and education. I would like to talk to you about these issues. This interview will last about 30 minutes. All information obtained will remain strictly confidential and your answers will only be analysed as group data by the project team without any direct correlations to your personal data. Can we start now? Yes, permission is given ð Go to WM10 to record time and start the interview. No, permission is not given ð Complete WM7. Talk to your supervisor about this result. WM7. Result of woman’s interview Completed 01 Not at home 02 Refused 03 Partly completed 04 Incapacitated 05 other (specify) 96 WM8. Editor in the field (Name and number): WM9. Data entered by (Name and number): Name Name WM10. Record the momentary time. Hour and minutes : WoMan’s baCKGRoUnD Wb WB1. In what month and year were you born? Birth date Month DK month 98 Year DK year 9998 WB2. How old are you? Probe: How old were you at your last birthday? Compare age with the given date and immediately correct WB1 and/or WB2 if the answers are not consistent Age (completed years) WB3. Have you ever attended school or preschool? Yes 1 No 2 2ðWB7 WB4. What is the highest level of education that you have attended? Preschool 0 Primary 1 Secondary 2 Higher 3 0ðWB7 210 MultIple IndIcator cluster survey 2011 WB5. What is the highest grade/year you completed at that level? If less than 1 grade, enter “00” Grade/year WB6. Check WB4: ‡‡ Secondary or higher. ð Go to Next Module ‡‡ Primary ð Continue with WB7 WB7. Now I would like you to read this sentence to me. Show the sentence on the card to the respondent. If the respondent cannot read whole sentence, probe: Can you read one part of the sentence to me? Cannot read at all 1 Able to read only parts of sentence 2 Able to read whole sentence 3 No sentence in the language she understands 4 (specify language) Blind / mute, visually / speech impaired 5 CHIlD MoRTalITY CM Questions CM0 – CM12 refer to LIVE BIRTHS only. CM0. Check in WM1, for cluster number: ‡‡ If the number of the cluster where you currently are interviewing belongs to the additional clusters with mostly Roma population ð Go to CM1 ‡‡ Other casesð Continue with CM0A CM0A. Now i want to ask you about the births you have had during your lifetime. How many live born children have you had in your entire life? What I mean is have you given birth to a child who ever breathed or cried or shown any signs of life – even if that child had lived for only few minutes or hours? If none, circle ‘00’. None 00 Number of live born children ðCM12A CM0B. When did you gave your last birth (even if the child has died)? Month and year must be recorded. Date of last birth Day Doesn’t know day 98 Month Year ðCM12A CM1. Now I‘d like to ask you about all the births you have given in your lifetime. Have you ever given any birth? Yes 1 No 2 2ðCM8 CM2. What is the date of your first birth? What I mean is the very first time you gave birth, even if the child is not alive anymore, or even if his/her father is not your current partner. Move to CM4 only if the year of her first birth is given, if not, continue with CM3. Date of first birth Day Doesn’t know day 98 Month DK month 98 Year Doesn’t know year 9998 ðCM4 CM3. How many years ago did you you first give birth to a child? Total completed years since first birth CM4. Are any sons or daughters you have given birth to living with you now? Yes 1 No 2 2ðCM6 211 CM5. How many sons are living with you? How many daughters are living with you? If none, record ‘00’. Sons at home Daughters at home CM6.Are there any sons or daughters you have given birth to who are alive but are not living with you? Yes 1 No 2 2ðCM8 CM7. How many sons are alive but are not living with you? How many daughters are alive but are not living with you? If none, record ‘00’. Sons living elsewhere Daughters living elsewhere CM8. Have you ever given birth to a boy or a girl that was born alive but died later? If the answer is “No” probe: What I mean is given birth to a child who breathed, or cried, or showed any other signs of life, even if it had lived for only a few minutes or hours? Yes 1 No 2 2ðCM10 CM9. How many boys have died? How many girls have died? If none, record ‘00’. Dead boys Dead girls CM10. Sum all the answers in CM5, CM7, and CM9 and write down the total number of live born children. Sum CM11. Let’s make sure I have understood you correctly, you have had (total number in CM10) live born children in total during your lifetime. Is this right? ‡‡ Yes. Check below: ‡‡ No live born children (i.e. the sum equals 0)ð Go to CM12A ‡‡ One or more live born children ð Continue with CM12 ‡‡ No ð Check the answers from CM1-CM10 and make any necessary corrections, before you proceed and move to CM12 CM12. Out of all these (total number in CM10) live born children you have had, tell me when did you deliver the last one (even if that child has died)? Month and year must be recorded. Date of last birth Day DK day 98 Month Year CM12A. Sometimes women have pregnancies that might not end with a live birth. Have you ever had any pregnancy that was miscarried, ended in a stillbirth, or that was aborted? Yes 1 No 2 2ðCM13 CM12B. How many miscarriages have you had during your lifetime? By miscarriage, I mean an early and involuntary end of pregnancy within the first 5th month of pregnancy None 00 Number of miscarriages CM12C. How many of your pregnancies have ended with a stillbirth? By stillbirth, I mean a birth that took place after the 5th month of pregnancy, but the child did not show any signs of life. None 00 Number of stillbirths CM12D. And how many abortions have you had during your lifetime? By abortion, i mean a pregnancy that was voluntarily terminated within the first 5 months of pregnancy None 00 Number of abortions 00ðCM13 212 MultIple IndIcator cluster survey 2011 CM12E. When did your (last) abortion took place? Month and year must be recorded. Date of (last) abortion Month Year CM12F. Check in CM12E when the last abortion took place and if: ‡‡ There are no abortions during the last 2 years. ð Go to CM13 ‡‡ The last abortion took place during the last 2 years, that is, since (the month of interviewing) in 2009, ð Continue with CM12G CM12G. If the respondent has mentioned more than one abortion, i.e. CM12D is higher than 1, then ask her for the exact month and year of each mentioned abortion that took place during the last 2 years, i.e. since (the month of interviewing) 2009.Write down month and year for each abortion in CM12H, starting from the last, and for each recorded abortion ask the respondent to tell you how many weeks/months she was pregnant when she aborted and record this appropriately. Last abortion Previous to the last abortion Second last from the last abortion Third last from the last abortion CM12H. What month and year your (last) abortion took place? Don’t ask, it is given in CM12E Month Year Month Year Month Year CM12I. How many Months (weeks) were you pregnant when your pregnancy was aborted? If the respondent answers in weeks, write down on the appropriate line for weeks, otherwise just record the given months Weeks 1 Months 2 Weeks 1 Months 2 Weeks 1 Months 2 Weeks 1 Months 2 CM13. Check CM0B or CM12: Her last birth occurred during the last 2 years, i.e., since (the day and month of interview) in 2009 ‡‡ No live births during the last 2 years. ð Go to ILLNESS SYMPTOMS Module. ‡‡ One or more live births during the last 2 years. ð Ask about the name of the last born child Child’s name_______________________ If the child has passed away, please be very careful when you are referring to this child by its name in the modules that follow. If the child has passed away right after it was given birth and it did not get any name at all, refer to this child as ‘the baby/the infant’ and be very careful in your approach. Continue with the next module. DesIRe foR lasT bIRTH Db This module is to be filled with all the women with a live birth in the last 2 years, preceding the date of the interview. Check the module for Child Mortality CM13 and record the name of the last-born child here _____________________. Use this child’s name in the questions that follow, where indicated. DB1. When you became pregnant with (name), did you want to get pregnant at that period? Yes 1 No 2 1ðNext Module DB2. Did you want to become pregnant sometime later, or you did not want to have any (more) children? Later 1 No more 2 2ðNext Module DB3. How much longer did you want to wait? Months 1 Years 2 DK 998 213 MaTeRnal anD neWboRn HealTH Mn This module is to be filled with all the women with live births during the last 2 years. Record the name of the last-born child here _____________________. Use this child’s name in the following questions, where indicated in brackets, like this: (name). MN1. Did you see anyone for care during your pregnancy with (name of child)? Yes 1 No 2 2ðMN17 MN2. Whom did you see? Probe: Anyone else? Probe until you are sure about the type of person seen and circle all the answers given, if more than one mentioned. Health professional: Doctor A Auxiliary midwife C Midwife D Nurse E Other person Non-medical person that traditionally attends birth in the local community F Community health worker G Other (specify) X MN3. How many times did you receive care during this pregnancy? Number of times __ __ DK 98 MN4. As part of your care during this pregnancy, were any of the following done at least once: [A] Was your blood pressure measured? [B] Did you give a urine sample? [C] Did you give a blood sample? Yes No Blood pressure 1 2 Urine sample 1 2 Blood sample 1 2 MN17. Who assisted you with the delivery of (name of child)? Probe: Anyone else? Probe for the type of person assisting and circle all answers given. If respondent says ’No one’ assisted, probe to determine whether any adults were present at the delivery and write down under ‘Other’if the given answer is not listed as an option. Health professional: Doctor A Auxiliary midwife C Midwife D Nurse E Other person Non-medical person that traditionally attends birth in the local community F Community health worker G Relative / Friend H other (specify) X No one Y 214 MultIple IndIcator cluster survey 2011 MN18. Where did you give birth to (name of child)? Probe to closely identify the type of place before you circle any of the given answer codes. If unable to determine whether it is a public or private institution, write the name of the place where birth was given on the line below. (Name of place) Home Your home 11 Other home 12 Public sector Clinical Hospital 21 General Hospital 22 Health post (birth post) 23 Clinical Centre – Skopje 24 Gynaecology Hospital – Chair 25 other public institution (specify) 26 Private Medical Sector Private hospital 31 Private clinic 32 Private maternity home 33 other private medical (specify) 36 other (specify) 96 11ðMN20 12ðMN20 96ðMN20 MN19. Was (name) delivered by caesarean section? That is, did they cut your belly open to take the baby out? Yes 1 No 2 MN20. When (name) was born, was he/she a very large, larger than average, average, smaller than average, or very small baby? Very large 1 Larger than average 2 Average 3 Smaller than average 4 Very small 5 DK 8 MN21. Was (name) weighed at birth? Yes 1 No 2 DK 8 2ðMN23 8ðMN23 MN22. How much did (name) weigh? If card is available, give it a priority and copy the answer from there. From card 1 (kg) From recall 2 (kg) DK 99998 MN23. Has your menstrual period returned since the birth of (name)? Yes 1 No 2 MN24. Did you ever breastfeed (name)? Yes 1 No 2 2ðNext Module MN25. How long after birth did you first put (name) on your breast for feeding? If less than 1 hour, record ‘00’ hours. If less than 24 hours, circle code 1 and write down the exact number of hours. Otherwise, record the number of days and circle code 2. Immediately 000 Hours 1 Days 2 Don’t know / remember 998 MN26. In the first three days after delivery, was (name) given anything to drink other than breast milk? Yes 1 No 2 2ðNext Module 215 MN27. What else was (name) given to drink? Probe: Anything else? Record all mentioned answers Milk (other than breast milk) A Plain water B Sugar or glucose water C Gripe water D Sugar-salt-water solution E Fruit juice F Infant formula (artificial milk) G Tea H Honey I Other (specify) X Illness sYMPToMs Is IS1. Check Household List, column HL9 in the Household Questionnaire Is the respondent the mother or guardian of at least one child aged under 5? ‡‡ Yes ð Continue with IS2. ‡‡ No ð Go to Next Module. IS2. Sometimes children have severe illnesses and should be taken immediately to a health facility. What types of symptoms would cause you to take your child to a health facility right away? Probe additionally: Any other symptoms? Keep asking for more signs or symptoms until the mother/ guardian cannot recall any additional symptoms. Circle all symptoms mentioned, but do NOT prompt with any suggestions and write down all additional answers not listed in the given answer options under ‘other’ Child not able to drink or breastfeed A Child becomes sicker B Child develops a fever C Child has fast breathing D Child has difficult breathing E Child has blood in stool F Child is drinking poorly G Child has a rush H other (specify) X other (specify) Y other (specify) Z 216 MultIple IndIcator cluster survey 2011 ConTRaCePTIon CP CP0. Couples use different ways or methods in order to postpone or avoid pregnancy. Have you heard of : [A]Sterilization of Female? Probe: Women can have an operation in order to avoid having more children. [B]Sterilization of Male? Probe: Men can have an operation in order to avoid having more children. [C]Coil? Probe: Women can have a coil placed inside them by a doctor or a nurse. [D] Injections? Probe: Women can use injections from a health provider, which have effects on their hormones and stop them from getting pregnant for one or more months. [E] Implants? Probe: Women can have one or more small rods implanted in their upper arm (by a doctor or a nurse) and thus prevent pregnancy for one or more years. [F] Pills? Probe: Women can take pills on every day basis to avoid getting pregnant. [G] Male Condom? Probe: Men can put a rubber cover on their penis before the sexual intercourse. [H] Female Condom? Probe: Women can put a cover in their vagina before the sexual intercourse. [I] Diaphragm? Probe: Women can insert a soft rubber cup in their vagina to block the sperm from entering their uterus or tubes [J] Foam, Jelly? Probe: Women may use spermicidal products (like for ex. foam, jelly, cream) that can kill or prevent the sperm from moving and reaching the egg. [K] Lactational Amenorrhea Method (LAM)? [L] Rhythm Method? Probe: Every month when the woman is sexually active, she can avoid pregnancy by not having a sexual intercourse on the fertile days in the month, i.e. days she is most likely to get pregnant. [M] Withdrawal? Probe: Men can be cautious and pull out before reaching climax. [N]Urgent Contraception? Probe: As an emergency measure, within a period of 3 days, after having unprotected sexual intercourse, women can take special pills to prevent getting pregnant. [X] Have you heard of any other ways or methods that men or women can utilise in order to avoid pregnancy? Yes 1 No 2 Yes 1 No 2 Yes 1 No 2 Yes 1 No 2 Yes 1 No 2 Yes 1 No 2 Yes 1 No 2 Yes 1 No 2 Yes 1 No 2 Yes 1 No 2 Yes 1 No 2 Yes 1 No 2 Yes 1 No 2 Yes 1 No 2 Yes 1 (specify) (specify) No 2 CP1. Now, I would like to talk to you about another topic – planning the family. Are you pregnant at the moment? Yes, she is pregnant 1 No 2 Not sure or don’t know 8 1ðNext Module 217 CP2. At the moment, are you doing anything or using any method to postpone or avoid pregnancy? Yes 1 No 2 2ðNext Module CP3. What are you doing to postpone or avoid pregnancy? If more than one method is mentioned, circle each one as appropriate. Female sterilization A Male sterilization B IUD C Injections D Implants E Pills F Male condom G Female condom H Diaphragm I Foam / Jelly J Lactational amenorrhoea method (LAM) K Rhythm / Periodic abstinence L Withdrawal M Other (specify) X UnfUlfIlleD neeD foR ConTRaCePTIon Un UN1. Check CP1. Is she currently pregnant? ‡‡ Yes, she is currently pregnant ð Continue with UN2 ‡‡ No, not sure or doesn’t know ð Go to UN5 UN2. Now I’d like to talk to you about your current pregnancy. When you got pregnant, did you want to get pregnant? Yes 1 No 2 1ðUN4 UN3. Did you want to have a baby sometime later or you did not want to have any (more) children? Later 1 No more 2 UN4. Now I’d like to ask a few questions about the future. After the child you are expecting right now, would you like to have another child, or you would rather not have any more children? To have another child 1 No more / None 2 Indecisive / Doesn’t know 8 1ðUN7 2ðUN13 8ðUN13 UN5. Check CP3. Currently using “Female sterilization”? ‡‡ Yes ð Go to UN13 ‡‡ No ð Continue with UN6 UN6. Now I would like to ask you about the future. Would you like to have (another) child, or you would rather not have any (more) children? Wants to have (other) children 1 Doesn’t want any/no more children 2 She says she cannot get pregnant 3 Indecisive / Doesn’t know 8 2ðUN9 3ðUN11 8ðUN9 UN7. For how long would you like to wait before you give birth to (another) child? Months 1 Years 2 Soon / Now 993 She says she cannot get pregnant 994 After the marriage 995 Other 996 Don’t know 998 994ðUN11 218 MultIple IndIcator cluster survey 2011 UN8. Check CP1. Currently pregnant? ‡‡ Yes, currently pregnant ð Go to UN13 ‡‡ No, not sure or doesn’t know ð Continue with UN9 UN9. Check CP2. At the moment is she using any method? ‡‡ Yes ð Go to UN13 ‡‡ No ð Continue with UN10 UN10. Do you think that you are physically able to get pregnant at the moment? Yes 1 No 2 Don’t know 8 1 ðUN13 8 ðUN13 UN11. Why do you think you are not physically able to get pregnant? Multiple answers are possible Irregular sex / No sex A Menopause B Never menstruated C Hysterectomy (surgical removal of uterus) D Trying to get pregnant for 2 years or more without any results E Postpartum amenorrhea F Breastfeeding G Too old H Fatalistic I Other (specify) X Don’t know Z UN12. Check UN11. “Never menstruated”- has it been mentioned? ‡‡ Mentioned ð Go to Next Module ‡‡ Not mentioned ð Continue with UN13 UN13. When did your last menstrual cycle start? Days ago 1 Weeks ago 2 Months ago 3 Years ago 4 In menopause / Has had hysterectomy 994 Before her last birth 995 Has never menstruated 996 219 aTTITUDes ToWaRD DoMesTIC VIolenCe DV DV1. Sometimes a husband can be annoyed or irritated by things that his wife does. In your opinion, is a husband justified to hit or beat his wife in the following situations: [A] If she goes out without telling him? [B] If she neglects the children? [C] If she argues with him? [D] If she refuses to have sex with him? [E] If she burns the food? Yes No DK Goes out without telling 1 2 8 Neglects children 1 2 8 Argues with him 1 2 8 Refuses sex 1 2 8 Burns food 1 2 8 MaRRIaGe/UnIon Ma MA1. Are you currently married or living together with a man as married? Yes, currently married 1 Yes, living with a man 2 No, not in union 3 3ðMA5 MA2. How old is your husband/partner? Probe additionally: How old was your husband/partner on his last birthday? Age in years DK 98 ðMA7 98ðMA7 MA5. Have you ever been married or lived together with a man as if married? Yes, formerly married 1 Yes, formerly lived with a man 2 No 3 3 ðNext Module MA6. What is your marital status now: are you widowed, divorced or separated? Widowed 1 Divorced 2 Separated 3 MA7. Have you been married or lived with a man only once or more than once? Only once 1 More than once 2 MA8. In what month and year did you first marry or start living with a man as if married? Date of first marriage/ living together Month DK month 98 Year DK year 9998 ðNext Module ðМА9 MA9. How old were you when you started living with your first husband/partner? Age in years TobaCCo anD alCHoHol ConsUMPTIon Ta TA1. have you ever tried smoking, at least one or two puffs? Yes 1 No 2 2ðTA6 TA2. At what age did you first smoke a whole cigarette? I have never smoked a whole cigarette 00 Age 00ðTA6 TA3. Do you smoke cigarettes today? Yes 1 No 2 2ðTA6 TA4. During the last 24 hours, how many cigarettes have you smoked? Number of cigarettes 220 MultIple IndIcator cluster survey 2011 TA5. During the last month, for how many days have you smoked cigarettes? If less than 10 days, write the number of days. If 10 days or more, circle „10“. If „every day“ or „almost every day“, circle „30“ Number of days 0 10 days or more 10 Every day/Almost every day 30 TA6. Have you ever tried to smoke tobacco products, except cigarettes, like for example, cigars, water pipe, cigarillo or dry tobacco? Yes 1 No 2 2ðTA10 TA7. During the last month, have you consumed any type of smoking tobacco products, excluding cigarettes? Yes 1 No 2 2ðTA10 TA8. What type of smoked tobacco product did you use or smoke during the last one month? Circle all mentioned. Cigars A Water pipe B Cigarillos C Pipe D Other (specify)( ) X TA9. During the last one month, on how many days did you use smoked tobacco products, excluding cigarettes? If less than 10 days, record the number of days. If 10 days or more but less than a month, circle “10”. If “everyday” or “almost every day”, circle “30” Number of days 0 10 days or more but less than a month 10 Everyday / Almost every day 30 A10. Have you ever tried any type of product made from tobacco, like for example tobacco chewing gum, burmut, or tobacco for soaking? Yes 1 No 2 2 ðTA14 TA11. During the last month, have you consumed any type of products from non-smoking tobacco? Yes 1 No 2 2 ðTA14 TA12. What type of smokeless tobacco product did you use during the last one month? Circle all mentioned. Chewing tobacco A Snuff B Dip C Other (specify) X TA13. During the last one month, on how many days did you use smokeless tobacco products? If less than 10 days, record the number of days. If 10 days or more but less than a month, circle “10”. If “everyday” or “almost every day”, circle “30” Number of days 0 10 days or more but less than a month 10 Everyday / Almost every day 30 TA14. Now a few questions about alcohol consumption. Have you ever tried consuming alcohol? Yes 1 No 2 2ðNEXT MODULE TA15. One intake of alcohol refers to one can or bottle of beer, one glass of wine or a glass of Rakia, cognac, vodka, whiskey, or rum. At what age did you drink your first glass of alcohol, excluding any time you had a few sips? I have never drank a whole glass 00 Age 221 TA16. During the last month, how many days have you had at least one glass of alcohol? If the respondent has drunk zero glasses, circle „00“ If less than 10 days, write the number of days. If 10 days or more, circle „10“. If „every day“ or „almost every day“, circle „30“ Has not drank any glass during the last month 00 Number of days 0 10 days or more 10 Every day/almost every day 30 00ð NEXT MODULE TA17. During the last month, on days you had alcohol, how many glasses have you mostly had? Number of glasses 222 MultIple IndIcator cluster survey 2011 lIfe saTIsfaCTIon ls LS1. Check WB2: Is respondent’s age between 15и 24? ‡‡ Aged 25-49 ð go to WM11 ‡‡ Aged 15-24 ð continue with LS2 LS2. Now, I would like to ask you a few simple questions about happiness and satisfaction. First, taking all things together, would you say you are very happy, somewhat happy, neither happy nor unhappy, somewhat unhappy or very unhappy? You can also look at these pictures to help you with your response. Show response card 1 to the respondent and explain what each symbol represents. Circle the answer pointed by the respondent. Very happy 1 Somewhat happy 2 Neither happy nor unhappy 3 Somewhat unhappy 4 Very unhappy 5 LS3. Now I’d like to ask a few simple questions about the level of your satisfaction from various fields. For any of the questions, we have five possible answers: please let me know, for each question, are you very or somewhat satisfied, neither satisfied nor unsatisfied, or somewhat or very unsatisfied? Once again, you can take a look at these images that might help you with your answer. Please hand the answer card 2 to the respondent and explain what each of the symbols represents. For each question from LS3 to LS13, circle the response given by the respondent how satisfied are you from your family life? Very satisfied 1 Somewhat satisfied 2 Neither satisfied nor unsatisfied 3 Somewhat unsatisfied 4 Very unsatisfied 5 LS4. How satisfied are you from your friendships? Very satisfied 1 Somewhat satisfied 2 Neither satisfied nor unsatisfied 3 Somewhat unsatisfied 4 Very unsatisfied 5 LS5. During the current (2010-2011) school year, have you attended school at all? Yes 1 No 2 2ðLS7 LS6. How satisfied are /were you from the school you have attended? Very satisfied 1 Somewhat satisfied 2 Neither satisfied nor unsatisfied 3 Somewhat unsatisfied 4 Very unsatisfied 5 LS7. How satisfied are you from your current job? If the respondent says that he/she does not have a job, circle “0” and continue with the next question. Do not probe to find out how she feels about not having a job, unless she tells you herself. Doesn’t have a job 0 Very satisfied 1 Somewhat satisfied 2 Neither satisfied nor unsatisfied 3 Somewhat unsatisfied 4 Very unsatisfied 5 223 LS8. How satisfied are you from your health? Very satisfied 1 Somewhat satisfied 2 Neither satisfied nor unsatisfied 3 Somewhat unsatisfied 4 Very unsatisfied 5 LS9. How satisfied are you with your place of living? If necessary, explain that the questions refer to their life environment, including their neighbourhood and dwelling. Very satisfied 1 Somewhat satisfied 2 Neither satisfied nor unsatisfied 3 Somewhat unsatisfied 4 Very unsatisfied 5 LS10. How satisfied are you from the treatment you receive by the people around you? Very satisfied 1 Somewhat satisfied 2 Neither satisfied nor unsatisfied 3 Somewhat unsatisfied 4 Very unsatisfied 5 LS11. How satisfied are you from your looks? Very satisfied 1 Somewhat satisfied 2 Neither satisfied nor unsatisfied 3 Somewhat unsatisfied 4 Very unsatisfied 5 LS12. How satisfied are you from your own life, in general? Very satisfied 1 Somewhat satisfied 2 Neither satisfied nor unsatisfied 3 Somewhat unsatisfied 4 Very unsatisfied 5 LS13. How satisfied are you from your current income? If the respondent responds that he/she does not have any income, circle “0” and continue with the next question. Do not probe to find out how she feels about not having any income, unless she tells you herself. No income 0 Very satisfied 1 Somewhat satisfied 2 Neither satisfied nor unsatisfied 3 Somewhat unsatisfied 4 Very unsatisfied 5 LS14. Compared to the same period last year, would you say that, in general, your life has improved or become worse? Improved 1 Remained the same, more or less 2 Got worse 3 LS15. And in a year time from now, do you expect that your life, in general, will be improved or will get worse? Will be improved 1 Remained the same, more or less 2 Will get worse 3 WM11. Record the momentary time. Hour and minutes : WM12. Check Household roster, column HL9, in the Household Questionnaire. Is the respondent a mother or a guardian to at least one child aged between 0 and 4 that lives in this household or is she a mother/guardian to at least one child aged between 2 and 9? ‡‡ Yes, she has a child aged between 0 and 4ð Go to the QUESTIONNAIRE FOR CHILDREN UNDER FIVE for that particular child and start the interview with this respondent – mother/guardian to this child. ‡‡ Yes, she has a child aged between 2 and 9ð Go to the QUESTIONNAIRE FOR CHILDREN DISABILITY for that particular child and start the interview with this respondent – mother/guardian to this child. ‡‡ No ð End the interview with this respondent by thanking her for the collaboration. Check if there is any the presence of any other suitable women, children under 5, or children aged between 2 and 9 in the household. 224 MultIple IndIcator cluster survey 2011 Interviewer’s observations field editor’s observations supervisor’s observations 225 qUesTIonnaIRe foR CHIlDRen UnDeR fIVe MaCeDonIa InfoRMaTIon Panel foR CHIlDRen UnDeR fIVe Uf This questionnaire is to be filled with all the mothers or guardians (see Household List, column HL9 in the Household Questionnaire) who take care for a child that lives with them and is less than 5 years old (see Household Roster Form, column HL6 in the Household Questionnaire). A separate questionnaire should be filled in for each eligible child, with the correspondent parent/guardian. UF1. Cluster number: UF2. Household number: UF3. Child’s name: UF4. Child’s row number: Name UF5. Mother’s / Guardian’s name: UF6. Mother’s / Guardian’s row number: Name UF7. Interviewer’s name and number: UF8. Day / Month / Year of interviewing: Name Repeat the introduction if you haven’t read it to this respondent already: We are from Ipsos Strategic Puls. We are working on a project related to family health and education. I would like to talk to you about these issues. The interview will last about 30 minutes. All information obtained will remain strictly confidential and your answers will never be shared with anyone outside the project team. If you have already read it to this woman at the beginning from the household questionnaire, then read the following: I would like to talk to you about (child’s name from UF3)’s health and other issues. The interview will last about 30 minutes. All information obtained will remain strictly confidential and your answers will never be shared with anyone outside the project team. Can we start now? ‡‡ Yes, permission is given ð Go to UF12 to record time and start the interview. ‡‡ No, permission is not given ð Complete UF9. Talk to your supervisor about this result. UF9. Result of interview for children under 5 Codes refer to mother/guardian. Completed 01 Not at home 02 Refused 03 Partly completed 04 Incapacitated 05 Other (specify) 96 UF10. Editor in the field (Name and number): UF11. Data entered by (Name and number): Name Name UF12. Record the momentary time. Hour and minutes : 226 MultIple IndIcator cluster survey 2011 aGe aG AG1. Now I would like to ask you some questions about the health of (name). In what month and year was (name) born? Probe: What is his / her birthday? If the mother/guardian knows the exact birth date, enter the day at the required place; otherwise, circle 98 for day Month and year must be recorded. Birth date Day DK day 98 Month Year AG2. How old is (name)? Probe: How old was (name) at his / her last birthday? Record age in completed years. Record ‘0’ if less than 1 year. Compare the age with the given date and immediately correct AG1 and/or AG2 if the answers are not consistent. Age (completed years) bIRTH ReGIsTRaTIon bR BR1. Does (name) have a birth certificate? If the answer is “ yes”, ask: May I see it? Yes, seen 1 Yes, not seen 2 No 3 DK 8 1ðNext Module 2ðNext Module BR2. Has (name)’s birth been registered with the registry department? Yes 1 No 2 DK 8 1ðNext Module BR3. Do you know how to report/register your child’s birth? Yes 1 No 2 eaRlY CHIlDHooD DeVeloPMenT eC EC1. How many children’s books or picture books do you have for (name)? None 00 Number of children’s books 0 __ Ten or more books 10 EC2. I am interested to learn about the things that (name) plays with when he/she is at home. Does he/she play with: [A] homemade toys (like dolls, cars, or other toys made at home)? [B] toys from a shop or manufactured toys? [C] household objects (like bowls or pots) or objects found outside (like sticks, rocks, shells or leaves)? If the respondent says “YES” to the categories above, then probe to learn specifically what the child plays with to ascertain the given response Y N DK Homemade toys 1 2 8 Toys from a shop 1 2 8 Household objects or outside objects 1 2 8 227 EC3. Sometimes adults that take care of children have to leave the house to go shopping, wash clothes, or for other reasons and then they have to leave young children alone. On how many days during the past week was (name): [A] left alone at home for more than an hour? [B] left in the care of another child (that is, someone under 10) for more than an hour? If “none” enter “0”. If “don’t know” enter”8”. Number of days left home alone for more than an hour Number of days left with other child for more than an hour EC4. Check AG2: Age of child ‡‡ Child age 3 or 4 ð Continue with EC5 ‡‡ Child age 0, 1 or 2 ð Go to Next Module EC5. Does (name) attend any organized learning or early childhood education programme, like a private or government facility, including kindergarten or community child care center? Yes 1 No 2 DK 8 2ðEC7 8ðEC7 EC6. Within the last seven days, about how many hours did (name) attend such learning programmes, i.e. attended kindergarten or community child care center? Number of hours EC7. In the past 3 days, did you or any of your adult household members aged 15 or more engage in any of the following activities with (name): I f the answer is “ yes”, ask for each given activity: who engaged in this activity with (name)? Circle all that apply and remind the respondent that you are talking about the last 3 days. Mother Father Other Over 15 No one [A] Read books to or looked at picture books with (name)? Read books A B X Y [B] Told stories to (name)? Told stories A B X Y [C] Sang songs to (name) or with (name), including lullabies? Sang songs A B X Y [D] Took (name) outside the home, compound, yard for a walk? Took outside A B X Y [E] Played with (name)? Played with A B X Y [F] Named, counted, or drew things to or with (name)? Named/counted A B X Y EC8. Now I would like to ask you some questions about the health and the development of your child. Children do not all develop and learn at the same rate. For example, some start walking earlier than others. These questions are related to several aspects of your child’s development. Can (name) identify or name at least ten letters of the alphabet? Yes 1 No 2 DK 8 EC9. Can (name) read at least four simple and popular words? Yes 1 No 2 DK 8 228 MultIple IndIcator cluster survey 2011 EC10. Does (name) know the name and recognize the symbols for all numbers from 1 to 10? Yes 1 No 2 DK 8 EC11. Can (name) pick up small objects with two fingers, like for example a stick or a rock from the ground? Yes 1 No 2 DK 8 EC12. Is (name) sometimes too sick to play? Yes 1 No 2 DK 8 EC13. Can (name) follow simple directions on how to do something correctly? Yes 1 No 2 DK 8 EC14. When given something to do, is (name) able to do it independently? Yes 1 No 2 DK 8 EC15. Does (name) get along well with other children? Yes 1 No 2 DK 8 EC16. Does (name) kick, bite, or hit other children or adults? Yes 1 No 2 DK 8 EC17. Does (name) get distracted easily? Yes 1 No 2 DK 8 bReasTfeeDInG bf BF1. Has (name) ever been breastfed? Yes 1 No 2 DK 8 2ðBF3 8ðBF3 BF2. Is he/she still being breastfed? Yes 1 No 2 DK 8 BF3. Could you tell me please about the liquids that (name) may have had yesterday during the day or the night. I am interested in whether (name) had the mentioned liquid even if it was combined with other foods. Did (name) drink plain water yesterday, during the day or night? Yes 1 No 2 DK 8 BF4. Did (name) drink infant formula/substitution for mother’s milk/ artificial milk yesterday, during the day or night? Yes 1 No 2 DK 8 2ðBF6 8ðBF6 BF5. How many times did (name) drink infant formula? Number of times BF6. Did (name) drink tetra pack milk, powdered or fresh animal milk yesterday, during the day or night? Yes 1 No 2 DK 8 2ðBF8 8ðBF8 BF7. How many times did (name) drink tetra pack, powdered or fresh animal milk? Number of times BF8. Did (name) drink juice yesterday, during the day or night? Yes 1 No 2 DK 8 BF9. Did (name) drink clear soup yesterday, during the day or night? Yes 1 No 2 DK 8 BF10. Did (name) drink or eat vitamin or mineral supplements or any medicines yesterday, during the day or night? Yes 1 No 2 DK 8 229 BF11. Did (name) drink oral rehydration solutions yesterday, during the day or night? Yes 1 No 2 DK 8 BF12. Did (name) drink any other liquids yesterday, during the day or night? Yes 1 No 2 DK 8 BF13. Did (name) drink or eat yogurt (sour milk) yesterday, during the day or night? Yes 1 No 2 DK 8 2ðBF15 8ðBF15 BF14. How many times did (name) drink or eat yogurt(sour milk) yesterday, during the day or night? Number of times BF15. Did (name) eat any porridge yesterday, during the day or night? Yes 1 No 2 DK 8 BF16. Did (name) eat solid or semi-solid (soft, mushy) food yesterday, during the day or night? Yes 1 No 2 DK 8 2ðBF18 8ðBF18 BF17. How many times did (name) eat solid or semi-solid (soft, mushy) food yesterday, during the day or night? Number of times BF18. Yesterday, during the day or night, did (name) drink anything from a bottle with a nipple? Yes 1 No 2 DK 8 CaRe of Illness Ca CA1. in the last two weeks, has (name) had diarrhoea (the squirts)? Yes 1 No 2 DK 8 2ðCA7 8ðCA7 CA2. I would like to know how much liquid (name) was given to drink during the diarrhoea (including breastmilk). During the time (name) had diarrhoea, was he/she given less than usual liquid to drink, about the same amount, or more than usual? If“ less”, probe: Was he/she given much less than usual to drink, or somewhat less? Much less 1 Somewhat less 2 About the same 3 More 4 Nothing to drink 5 DK 8 CA3. During the time (name) had diarrhoea, was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat? If “less”, probe: Was he/she given much less than usual to eat or somewhat less? Much less 1 Somewhat less 2 About the same 3 More 4 Stopped giving food 5 Wasn’t given any food at all 6 DK 8 CA4. During the episode of diarrhoea, was (name) given to drink any of the following: Read each item aloud and record response before proceeding to the next item. [A] A fluid prepared from rehidratation powder? [B] A pre-packaged fluid for rehidratation? [C] Homemade rehidratation fluid? Y N DK Fluid from packet 1 2 8 Pre-packaged fluid 1 2 8 Homemade fluid X 1 2 8 CA5. Was anything (else) given to treat/cure the diarrhoea? Yes 1 No 2 DK 8 2ðCA7 8ðCA7 230 MultIple IndIcator cluster survey 2011 CA6. What (else) was given to treat the diarrhoea? Probe: Anything else? Record all treatments given. Write brand name(s) of all medicines mentioned. (Names of all brands mentioned) Pill or Syrup Antibiotic A Antimotility B Zinc C Other (Not antibiotic, neither medicines for soothing peristaltics nor zinc) G Unknown pill or syrup H Injection (muscular) Antibiotic L Non-antibiotic M Unknown injection N Intravenous infusion O Home remedy / Herbal medicine Q Other (specify) X CA7. At any time in the last two weeks, has (name) had an illness with a cough? Yes 1 No 2 DK 8 2ðCA14 8ðCA14 CA8. When (name) had an illness with a cough, did he/she breathe faster than usual with short, fast breaths or had any difficulty breathing? Yes 1 No 2 DK 8 2ðCA14 8ðCA14 CA9. Was the fast or difficult breathing due to a problem in the chest or a blocked or runny nose? Problems in chest only 1 Blocked or runny nose only 2 Both 3 Other (specify) 6 DK 8 2ðCA14 6ðCA14 CA10. Did you seek any advice or treatment for the illness from anywhere/anybody? Yes 1 No 2 DK 8 2ðCA12 8ðCA12 CA11. Where/whom did you seek advice or treatment from? Probe: Anywhere else? Circle all providers mentioned, but do NOT prompt with any suggestions. Probe to identify each type of source and write down the mentioned name below. If unable to determine if public or private sector, write the name of the place on the line below. (Name of place) Public sector Hospital A Health centre B Health post C Village health worker D Mobile / Outreach clinic E Other public service(specify) H Private medical sector Private hospital / clinic I Private physician J Private pharmacy K Mobile clinic L Other private medical (specify) O Other source Relative / Friend P Shop Q Traditional practitioner R Other (specify) X CA12. Was (name) given any medicine to treat this illness? Yes 1 No 2 DK 8 2ðCA14 8ðCA14 231 CA13. What medicine was (name) given? Probe: Any other medicine? Circle all medicines given. Write brand name(s) of all medicines mentioned. (brand names of all mentioned medicines) Antibiotic Pill / Syrup A Injection B Paracetamol / Panadol / Acetaminophen P Aspirin Q Ibuprofen R Other (specify) X DK Z CA14. Check AG2: Child aged under 3? Ё CA15. The last time (name) defecated, how did you remove the stools? Child uses toilet / latrine 01 Thrown into toilet or latrine 02 Thrown into drain or ditch 03 Thrown into garbage (solid waste) 04 Buried 05 Left in the open 06 Other (specify) 96 DK 98 IMMUnIZaTIon IM If an immunization card is available, copy the dates in IM3 for each type of immunization recorded on the card. IM6- IM16B will only be asked when a card is not available. IM1. Do you have a card where (name)’s vaccinations are written down? (If yes) May I see it please? Yes, seen 1 Yes, not seen 2 No card 3 1ðIM3 2ðIM6 IM2. Did you ever have a vaccination card for (name)? Yes 1 No 2 1ðIM6 2ðIM6 IM3. (a) Copy dates for each vaccination from the card. (b) Write ‘44’ in day column if the card has a record that vaccination was given but no date has been entered. Date of Immunization Day Month Year BCG (tuberculosis) BCG DPT1(diphtheria, tetanus, pertusis) DPT1 DTP2 (diphtheria, tetanus, pertusis) DTP2 DTP3 (diphtheria, tetanus, pertusis) DTP3 DTP4 (diphtheria, tetanus , pertusis) DTP4 DTP 5 (pertusis) DTP5 Polio 1(child paralysis) OPV1 Polio 2(child paralysis) OPV2 Polio 3(child paralysis) OPV3 Polio 4(child paralysis) OPV4 MRP (measles/rubeola) HepB at birth H0 HepB1 (hepatitis B) H1 HepB2 (hepatitis B) H2 HIB1 (hemofilus influenca B) 232 MultIple IndIcator cluster survey 2011 HIB2 (hemofilus influenca B) HIB3 (hemofilus influenca B) HIB4 (hemofilus influenca B) IM4. Check IM3. Are all vaccines (from BCG to HIB4) recorded? ‡‡ Yesð Go to IM20 ‡‡ No ð Continue with IM5 IM5. In addition to what is recorded on this card, did (name) receive any other vaccinations – including vaccinations received in campaigns, during epidemic or immunization days? Record “Yes” only if respondent mentions vaccines shown in the previous table and record all extra mentioned according to the instructions on the right. Yes 1 (Probe for vaccinations and write ‘66’ in the corresponding day column for each vaccine mentioned. Then skip to IM19) No 2 DK 8 2ðIM19 8ð IM19 IM6. Has (name) ever received any vaccinations to prevent him/ her from getting diseases, including vaccinations received in a campaigns or immunization days? Yes 1 No 2 DK 8 2ð IM19 8ð IM19 IM7. Has (name) ever received a BCG vaccination against tuberculosis – i.e. an injection in the arm or shoulder that usually causes a blemish on the skin? Yes 1 No 2 DK 8 IM8. Has (name) ever received any “vaccine given as drops in the mouth or by spoon” to protect him/her from getting diseases – that is, polio? Yes 1 No 2 DK 8 2ðIM11 8ðIM11 IM10. How many times was the polio vaccine received? Number of times IM11. Has (name) ever received a DTP vaccination – i.e.an injection in the thigh or upper arm – to prevent him/her from getting diphtheria, tetanus, whooping cough, or? Probe by indicating that DTP vaccination is sometimes given at the same time as Polio Yes 1 No 2 DK 8 2ðIM13 8ðIM13 IM12. How many times was a DTP vaccine received? Number of times IM13. Has (name) ever been given a Hepatitis B vaccination – i.e.an injection in the thigh or upper arm – to prevent him/her from getting Hepatitis B, i.e. … Yes 1 No 2 DK 8 2ðIM16 8ðIM16 IM14. Was the first Hepatitis B vaccine received within 24 hours after birth, or later? Ask for a birth card in which this information should be recorded Within 24 hours 1 Later 2 IM15. How many times was a hepatitis B vaccine received? Number of times IM16. Has (name) ever received a Measles injection or an MRP injection – i.e.a shot in the arm at the age of 12 months or older - to prevent him/her from getting measles/rubeola? Yes 1 No 2 DK 8 IM16a. Has (name) ever received the hemophilus influence B (meningitis/lung inflammation) vaccination – that is, a shot in the arm or thigh - to prevent him/her from getting hemophilus influence B? Yes 1 No 2 DK 8 IM16b How many times has he/she got a hemophilus influenca vaccine? Number of times 233 IM19. Could you tell me please if (name) has been vaccinated in any of the following campaigns, national immunization days and/or vitamin A or child health days: [A] Immunization week – April [B] Parotitis (MrP) – Jan-Jun 2009 [C] Measles – Since Sept 2010 Y N DK Campaign A 1 2 8 Campaign B 1 2 8 Campaign C 1 2 8 IM20. Issue a Questionnaire for Vaccinations Occurring in Health Institutions for this particular child. Fill in the panel in that questionnaire and continue further on. . UF13. Record the momentary time. Hour and minutes : UF14. Is the respondent the mother or guardian of another child aged under 5 living in this household? ‡‡ Yes ð Indicate to the respondent that you will need to measure the weight and height of the child later. Go to the next QUESTIONNAIRE FOR CHILDREN UNDER FIVE and fill it in with the same respondent ‡‡ No ð End the interview with this respondent by thanking him/her for his/her cooperation and tell her/him that you will need to measure the weight and height of the child Check to see if there are any other members – women, children between 2 and 9 years of age, or children under-5 for which additional questionnaires should be administered in this household. Move to the next questionnaire for women, for child disability, or for children under-5, or, if there aren’t any, start making arrangements for anthropometric measurements of all the eligible children in the household. anTHRoPoMeTRY an After questionnaires for all children are complete, the measurer weights and measures each child. Record weight and height/length below, taking care to record the measurements in the correct questionnaire for each separate child. Check the child’s name and row number in the Household roster before recording the measurements. AN1. Measurer’s name and number: Name AN2. Result of height / length and weight measurement Either or both measured 1 Child not present 2 Child or guardian refused 3 Other (specify) 6 2ðAN6 3ðAN6 6ðAN6 AN3. Child’s weight Kilograms (kg) Weight not measured 99.9 AN4. Child’s length or height Check age of child in AG2: ‡‡ Child aged under 2. ð Measure length (lying down). ‡‡ Child aged 2 or more. ð Measure height (standing up). Length (cm) Lying down 1 Height (cm) Standing up 2 Length / Height not measured 9999.9 AN6. Is there another child in the household who is eligible for measurement? ‡‡ Yes ð Record measurements for the next child in the corresponding questionnaire filled for that particular child. ‡‡ No ð Check if there is any additional questionnaire to be filled in within this household. 234 MultIple IndIcator cluster survey 2011 Interviewer’s observations field editor’s observations supervisor’s observations 235 qUesTIonnaIRe foR VaCCInaTIons aT a HealTH faCIlITY InfoRMaTIon Panel foR CHIlDRen UnDeR fIVe Hf This questionnaire should be used at health facilities for recording information on the vaccinations performed on children aged between 0 and 4. A separate questionnaire is used for each eligible child. Before you fill in this Questionnaire, you must have completed the Questionnaire for Children Under Five. Moreover, this panel has to be completed before you visit the health facility. This questionnaire must be attached to the Questionnaire for Children Under Five for each child. HF1. Cluster number: HF2. Household number: HF3. Child’s name: HF4. Child’s line number: HF5. Mother’s /Guardian’s name: HF6. Mother’s /Guardian’s line number: Name HF7. Interviewer’s name and number: HF8. Day / Month / Year of visit to the facility: Name HF9. Day, month and year of birth (From AG1 in the Questionnaire Under-5) HF10. Name of health facility: HF11. Results from the visit to the health facility Vaccination record is seen 01 Vaccination record is not seen 02 other (specify) 96 IMMUnIZaTIon Hf HF12. Record the day, month and the year of birth as stated on the vaccination record HF13. (a) Copy dates for each vaccination from the card. (b) In the column ‘Day’, write ‘44’ if the card shows that the vaccination was given but there is no date properly recorded. Date of Immunization Day Month Year BCG (tuberculosis) BCG DPT 1 (diphtheria, tetanus, pertusis) DPT1 DTP 2 (diphtheria, tetanus, pertusis) DTP2 DTP 3 (diphtheria, tetanus, pertusis) DTP3 DTP 4 (diphtheria, tetanus, pertusis) DTP4 DTP 5 (pertusis) DTP5 Polio 1 (child paralysis) OPV1 Polio 2 (child paralysis) OPV2 Polio 3 (child paralysis) OPV3 Polio 4 (child paralysis) OPV4 MRP (measles/rubeola) 236 MultIple IndIcator cluster survey 2011 HepB at birth H0 HepB1 (hepatitis B) H1 HepB2 (hepatitis B) H2 HIB1 (hemofilus influenca B) HIB2 (hemofilus influenca B) HIB3 (hemofilus influenca B) HIB4 (hemofilus influenca B) qUesTIonnaIRe foRM foR CHIlDRen aGeD beTWeen 2 anD 9 InfoRMaTIon Panel foR CHIlDRen beTWeen 2 anD 9 Da DA1. Cluster number: DA2. Household number: DA3. Child’s name: DA4. Child’s line number: Name DA5. Mother’s / Caretaker’s name: DA6. Mother’s / Caretaker’s line number: Name DA7. Interviewer name and number: DA8. Day / Month / Year of interview: Name Repeat greeting if not already read to this respondent: We are from Ipsos Strategic Puls We are working on a project concerned with family health and education. I would like to talk to you about (name)’s health condition. This will take only a few minutes. All the information you give me will remain strictly confidential and your answers will never be shared with those outside of team. If greeting at the beginning of the household questionnaire has already been read to this respondent, then read the following: Now I would like to talk to you more about (child’s name)’s health condition. This will take only a few minutes. Again, all the information you give me will remain strictly confidential and your answers will never be shared with those outside our team. May I start now? ‡‡ Yes, permission is given ð Go to DA12 to begin the interview. ‡‡ No, permission is not given ð Complete DA9. Discuss this result with your supervisor DA9. Result of interview for child disability Codes refer to mother/caretaker. Completed 01 Not at home 02 Refused 03 Partly completed 04 Incapacitated 05 Other (specify) 96 DA10. Field edited by (Name and number): DA11. Data entry clerk (Name and number): Name Name 237 CHIlD DIsabIlITY Da To be administered to mothers or caretakers of children age 2-9 years. DA12. Copy child’s name and age from HL2 and HL6, from Household List. Name Age DA13. Compared to other children, did (name) have any serious delay in sitting standing, or walking? Yes 1 No 2 DA14. Compared with other children, does (name) have difficulty seeing, either in the daytime or at night? Yes 1 No 2 DA15. Does it seem that (name) has any difficulty hearing? (uses hearing aid, hears with difficulty or completely deaf)? Yes 1 No 2 DA16. When you tell (name) to do something, does he/she seem to understand what you are saying? Yes 1 No 2 DA17. Does (name) have difficulty in walking or moving the arms or does he/she have weakness and/or stiffness in the arms or legs? Yes 1 No 2 DA18. Does (name) sometimes become rigid, or lose consciousness? Yes 1 No 2 DA19. Does (name) learn to do things like other children his/her age? Yes 1 No 2 DA20. Does (name) speak at all (can he/she speak in understandable way; can he/she say any recognizable words)? Yes 1 No 2 DA21. Check DA12: Age of child ‡‡ Child aged 3 through 9 ð Continue with DA22 ‡‡ Child aged 2 ð Go to DA23 DA22. Is (name)’s speech in any way different from normal (not clear enough to be understood by people other than the immediate family)? Yes 1 No 2 1ðDA24 2ðDA24 DA23. Can (name) name at least one object (for example, an animal, a toy, a cup, a spoon)? Yes 1 No 2 DA24. Compared with other children of the same age, does (name) appear in any way mentally backward, dull or slow? Yes 1 No 2 DA25. As part of this survey, others in our team may visit you again to collect more information on some of the topics we have just talked about, concerning (name). Such a visit may take place within the next months. May I proceed and note that you would be fine with such a visit, if it occurs at all? Again, you may change your mind and decline to speak to our team if and when the visit happens. Respondent has no objections to additional visit 1 Respondent uncertain about additional visit/Depends 2 Refused additional visit 3 238 MultIple IndIcator cluster survey 2011 appendix G. isced tables table ed.4 (a): primary school attendance percentage of children of primary school age attending primary or secondary school (adjusted net attendance ratio), isced 1 standard classification, Macedonia,2011 Male Female Total Net attendance ratio (adjusted) Number of children Net attendance ratio (adjusted) Number of children Net attendance ratio (adjusted) Number of children Region Vardar 98.1 30 98.7 20 98.4 50 East 90.9 37 98.4 26 94.0 63 Southwest 97.8 48 97.3 39 97.6 87 Southeast 100.0 39 95.5 32 98.0 71 Pelagonia 99.4 56 97.7 50 98.6 106 Polog 98.8 74 97.1 43 98.2 117 Northeast 98.8 36 100.0 51 99.5 87 Skopje 98.9 134 98.1 118 98.5 252 Area Urban 98.1 236 98.1 193 98.1 429 Rural 98.3 218 97.7 187 98.0 405 Age at beginning of school year 6 95.3 88 97.0 77 96.1 165 7 97.2 91 98.3 83 97.7 174 8 99.7 89 97.3 80 98.5 169 9 100.0 85 96.7 58 98.7 143 10 98.9 101 100.0 81 99.4 182 Mother’s education Primary or less 96.6 191 97.6 162 97.1 353 Secondary 99.7 186 98.3 168 99.0 354 High 98.6 77 97.7 49 98.2 126 Wealth index quintile Poorest 95.7 96 96.8 73 96.2 169 Second 97.6 86 97.5 88 97.5 174 Middle 99.2 91 99.7 83 99.4 174 Fourth 100.0 82 94.9 59 97.9 141 Richest 98.9 99 100.0 76 99.4 175 Ethnicity of household head Macedonian 99.6 258 98.8 218 99.2 476 Albanian 97.6 158 97.2 133 97.4 290 Other 91.7 38 94.5 29 92.9 67 Total 98.2 454 97.9 379 98.1 833 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases 239 table ed.5 (a): lower secondary school attendance percentage of children of primary school age attending secondary school or higher (adjusted net attendance ratio) and percentage of children attending primary school, isced 2 standard classification, Macedonia,2011 Male Female Total Net attendance ratio (adjusted) Number of children Net attendance ratio (adjusted) Number of children Net attendance ratio (adjusted) Number of children Region Vardar 91.0 19 96.0 21 93.7 40 East 96.0 25 100.0 19 97.7 44 Southwest 100.0 38 94.2 38 97.1 76 Southeast 100.0 28 100.0 32 100.0 60 Pelagonia 100.0 43 100.0 43 100.0 86 Polog 98.1 56 99.0 46 98.5 102 Northeast 100.0 43 100.0 37 100.0 81 Skopje 99.6 104 98.3 96 99.0 200 Area Urban 99.4 161 99.0 166 99.2 327 Rural 98.4 195 97.9 166 98.2 361 Age at beginning of school year 11 99.1 108 99.6 76 99.3 184 12 98.5 73 97.9 77 98.2 150 13 99.3 77 97.3 86 98.3 163 14 98.5 98 99.1 94 98.8 192 Mother’s education Primary or less 97.8 187 97.5 137 97.6 325 Secondary 100.0 120 98.8 142 99.4 262 High 100.0 45 100.0 52 100.0 97 Mother not in the household 100.0 3 100.0 2 100.0 5 Wealth index quintile Poorest 95.9 88 97.8 74 96.8 163 Second 99.3 78 97.1 66 98.3 144 Middle 100.0 72 100.0 56 100.0 128 Fourth 100.0 55 100.0 61 100.0 116 Richest 100.0 63 97.8 75 98.8 138 Ethnicity of household head Macedonian 100.0 183 99.1 191 99.6 373 Albanian 99.4 144 98.4 111 98.9 255 Other 89.0 29 94.4 30 91.8 60 Total 98.8 356 98.5 332 98.7 688 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases 240 MultIple IndIcator cluster survey 2011 table ed.4R (a): primary school attendance percentage of children of primary school age attending primary or secondary school (adjusted net attendance ratio), isced 1 standard classification, Roma settlements,2011 Male Female Total Net attendance ratio (adjusted) Number of children Net attendance ratio (adjusted) Number of children Net attendance ratio (adjusted) Number of children Age at beginning of school year 6 81.3 36 91.6 38 86.6 74 7 93.6 44 90.9 56 92.1 101 8 93.4 37 90.7 38 92.0 75 9 88.9 35 90.2 43 89.6 78 10 91.7 37 85.3 27 89.0 64 Mother’s education None 91.0 41 83.3 40 87.2 81 Primary 89.1 140 91.4 146 90.3 286 Secondary + 100.0 8 95.0 17 96.6 25 Wealth index quintile Poorest (70.5) 44 (77.0) 49 73.9 93 Second (89.2) 41 (96.1) 48 92.9 88 Middle (99.0) 42 (92.4) 37 95.9 79 Fourth (99.1) 37 (89.6) 30 94.8 68 Richest (97.2) 25 (97.2) 40 97.2 64 Total 90.0 189 90.1 203 90.0 392 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases table ed.5R (a): lower secondary school attendance percentage of children of primary school age attending secondary school or higher (adjusted net attendance ratio) and percentage of children attending primary school, isced 2 standard classification, Roma settlements,2011 Male Female Total Net attendance ratio (adjusted) Number of children Net attendance ratio (adjusted) Number of children Net attendance ratio (adjusted) Number of children Age at beginning of school year 11 86.8 27 85.4 39 86.0 66 12 83.0 31 89.1 30 86.0 61 13 76.7 36 75.9 42 76.3 78 14 74.6 40 70.1 39 72.4 79 Mother’s education Primary or less 69.0 23 70.3 35 69.8 59 Secondary 82.7 98 81.3 108 82.0 207 High 82.4 11 100.0 6 88.6 17 Mother not in the household .0 1 100.0 0 17.5 1 Wealth index quintile Poorest (56.1) 32 (64.1) 41 60.6 74 Second (*) 24 (74.8) 31 (85.1) 54 Middle (71.2) 28 (84.0) 36 78.4 64 Fourth (89.3) 24 (90.5) 25 89.9 48 Richest (91.1) 27 (*) 17 (94.6) 44 Total 79.5 134 79.5 150 79.5 284 ( ) – figures based on 25–49 unweighted cases (*) – figures based on less than 25 unweighted cases 240 MultIple IndIcator cluster survey 2011 241 appendix h: nutritional status of children based on nchs/cdc/Who international Reference population table nu.1 (a): nutritional status of children based on nchs/cdc/Who international Reference population percentage of children under age 5 by nutritional status according to three anthropometric indices: weight for age, height for age, and weight for height, Macedonia, 2011 Weight for age Num- ber of children under age 5 Height for age Num- ber of children under age 5 Weight for height Num- ber 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 SD - 3 SD - 2 SD - 3 SD - 2 SD - 3 SD + 2 SD Sex Male 1.6 .0 .4 669 2.7 1.0 .2 657 2.2 .2 11.0 .4 654 Female 1.8 .2 .4 663 3.3 .9 .2 649 1.6 .0 9.9 .5 646 Region Vardar 1.3 .0 .2 99 4.2 2.3 .3 98 2.6 .0 5.8 .1 97 East 5.2 .0 .0 110 5.3 1.1 -.1 108 1.6 .0 3.8 .2 108 Southwest 2.8 .0 .5 117 7.6 3.8 .0 106 3.7 1.5 19.4 .6 104 Southeast 1.0 .0 .5 81 1.3 .0 .5 81 1.0 .0 11.9 .5 80 Pelagonia .9 .9 .3 152 2.0 .9 .1 152 1.7 .0 10.5 .4 151 Polog 1.7 .0 .1 251 3.6 .9 .1 248 4.4 .0 6.1 .1 248 Northeast 1.5 .0 .9 135 3.0 .0 .2 132 .4 .0 23.2 1.0 130 Skopje .9 .0 .4 388 1.2 .4 .3 382 .4 .0 9.3 .5 382 Area Urban 1.3 .2 .5 670 2.2 .8 .2 661 1.0 .0 13.3 .6 656 Rural 2.0 .0 .2 661 3.8 1.0 .1 645 2.8 .2 7.5 .3 644 Age 0-5 months 1.6 .0 .3 110 2.8 .0 -.1 108 .9 .0 3.8 .4 106 6-11 months .4 .0 .1 141 .0 .0 .4 135 8.0 .0 3.1 -.1 135 12-23 months 2.3 .5 .2 273 3.6 .7 .0 266 2.9 .0 10.8 .4 264 24-35 months .7 .0 .5 268 1.8 1.0 .4 260 .1 .0 10.2 .5 261 36-47 months 1.8 .0 .5 267 4.1 1.6 .2 267 .1 .0 14.7 .6 266 48-59 months 2.5 .0 .5 273 4.2 1.3 .1 270 1.6 .6 12.5 .5 268 Mother’s education Primary or less 2.8 .0 .1 528 4.1 1.2 .0 520 2.7 .3 7.1 .2 519 Secondary 1.1 .3 .5 506 3.4 .9 .2 497 1.4 .0 13.0 .5 492 High .4 .0 .7 297 .4 .4 .6 289 1.2 .0 12.2 .6 289 Wealth index quintile Poorest 2.1 .0 -.1 308 5.2 1.3 -.2 303 3.6 .0 4.6 .1 303 Second 1.9 .0 .2 268 3.8 .6 .0 264 1.0 .0 8.4 .3 264 Middle 1.8 .0 .5 241 2.6 1.2 .3 239 2.3 .7 15.3 .6 236 Fourth 2.5 .5 .6 250 2.0 1.0 .4 244 1.9 .0 13.0 .6 242 Richest .0 .0 .7 264 1.0 .6 .5 256 .2 .0 12.7 .6 256 Ethnicity of household head Macedonian 1.1 .2 .5 683 2.5 1.0 .3 676 1.0 .0 12.4 .5 672 Albanian 1.2 .0 .3 508 2.2 .3 .2 491 2.8 .0 9.0 .3 489 Other 5.8 .0 -.1 141 8.6 2.8 -.3 140 2.8 1.1 6.4 .1 140 Total 1.7 .1 .4 1331 3.0 .9 .2 1307 1.9 .1 10.5 .4 1301 242 MultIple IndIcator cluster survey 2011 table nu.1 (a) R: nutritional status of children based on nchs/cdc/Who international Reference percentage of children under age 5 by nutritional status according to three anthropometric indices: weight for age, height for age, and weight for height, Roma settlements, 2011 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 SD - 3 SD - 2 SD - 3 SD - 2 SD - 3 SD + 2 SD Sex Male 11.9 2.1 -.6 235 17.4 1.6 -.7 224 5.4 .0 4.1 -.2 224 Female 12.7 2.3 -.7 235 9.5 1.8 -.6 231 5.5 1.2 3.3 -.3 230 Age 0-5 months (7.5) (5.2) (.2) 36 (8.3) (5.8) (-.5) 32 (6.7) (.0) (8.4) (.6) 32 6-11 months (10.6) (1.5) (-.7) 43 (4.0) (1.5) (-.4) 43 (10.7) (5.0) (.0) (-.4) 43 12-23 months 15.5 3.0 -.8 98 16.0 1.0 -.9 95 8.8 .6 2.2 -.4 95 24-35 months 6.1 .0 -.2 96 7.1 .0 -.2 92 .9 .0 4.4 .1 92 36-47 months 15.9 5.2 -.7 92 18.8 4.6 -.8 88 4.1 .0 6.0 -.4 88 48-59 months 14.1 .0 -.8 105 17.4 .0 -.9 104 4.9 .0 2.7 -.4 104 Mother’s education None 11.1 .0 -.8 101 17.3 .0 -.9 100 3.5 .0 4.2 -.2 99 Primary 13.8 3.0 -.6 321 13.1 2.5 -.7 309 5.3 .2 1.9 -.3 308 Secondary+ 4.7 1.4 .0 48 6.8 .0 .0 47 10.6 4.6 14.5 .0 47 Wealth index quintile Poorest 17.5 5.6 -1.0 122 24.6 5.0 -1.1 121 7.2 .0 1.6 -.4 121 Second 11.6 1.1 -.8 107 11.6 1.6 -.7 103 5.8 .5 1.9 -.3 102 Middle 19.8 1.6 -.6 91 10.6 .0 -.6 85 4.2 .0 3.0 -.3 85 Fourth 4.5 .0 -.3 79 10.2 .0 -.5 77 .8 .0 7.6 .1 77 Richest 3.2 1.0 .0 71 3.5 .0 .1 70 8.2 3.1 6.8 .0 70 Total 12.3 2.2 -.6 470 13.4 1.7 -.7 455 5.4 .6 3.7 -.2 454 ( ) – figures based on 25–49 unweighted cases 242 MultIple IndIcator cluster survey 2011 243 244 MultIple IndIcator cluster survey 2011 Republic of Macedonia Multiple Indicator Cluster Survey 2011 Multiple Indicator Cluster Survey 2011 Cover page Citation Summary Table of Findings Table of Contents List of Figures List of Abbreviations Acknowledgements Executive Summary I Introduction II Sample and Survey Methodology III Sample Coverage and the Characteristics of Households and Respondents IV Child Mortality V Nutrition VI Child Health VII Water and Sanitation VIII. Reproductive Health IX Child Development X. Literacy and Education XI Child Protection XII Tobacco and Alcohol Use XIII Subjective Well-being Appendix A1. Sample Design - Macedonia Appendix A2. Sample Design - Roma Settlements Appendix B. List of Personnel Involved in the Survey Appendix C. Estimates of Sampling Errors Appendix D. Data Quality Tables Appendix E. MICS Indicators: Numerators and Denominators Appendix F. Questionnaires Appendix G. ISCED tables Appendix H: Nutritional status of children based on NCHS/CDC/WHO International Reference Population

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