Sao Tome and Principe Multiple Indicator Cluster Survey 2014

Publication date: 2016

Sao Tome and Principe Multiple Indicator Cluster Survey 2014 Final Report February, 2016 MINISTÉRIO DA SAÚDE CENTRO NACIONAL DE ENDEMIAS The Sao Tome and Principe Multiple Indicator Cluster Survey (MICS) was carried out in 2014 by the National Institute of Statistics (INE) in collaboration with the National Centre for Endemic Diseases (CNE) and the UNDP/Global Fund project, as part of the global MICS programme. Technical support was provided by the United Nations Children’s Fund (UNICEF) and ICF International. UNICEF, the Global Fund and the Government of the Democratic Republic of Sao Tome and Principe provided financial and logistical support. The global MICS programme was developed by UNICEF in the 1990s as an international household survey programme to support countries in the collection of internationally comparable data on a wide range of indicators on the situation of children and women. MICS surveys measure key indicators that allow countries to generate data for use in policies and programmes, and to monitor progress towards the Millennium Development Goals (MDGs) and other internationally agreed upon commitments. Suggested citation: National Institute of Statistics, 2016. Sao Tome and Principe Multiple Indicator Cluster Survey 2014, Final Report. São Tomé, Sao Tome and Principe. Sao Tome and Principe 2014 MICS, Final Report P a g e | iii Summary Table of Survey Implementation and the Survey Population, Sao Tome and Principe, 2014 Survey implementation Sample frame - Updated 2012 General Population and Habitat Census January 2014 Questionnaires Household Women (age 15-49) Men (age 15-49) Children under five Interviewer training March 2014 Fieldwork April to June 2014 Survey sample Households - Sampled - Occupied - Interviewed - Response rate (Per cent) 3,930 3,625 3,492 96.3 Children under five - Eligible - Mothers/caretakers interviewed - Response rate (Per cent) 2,062 2,030 98.4 Women - Eligible for interviews - Interviewed - Response rate (Per cent) 3,101 2,935 94.6 Men - Eligible for interviews - Interviewed - Response rate (Per cent) 2,772 2,267 81.8 Survey population Average household size 3.9 Percentage of population living in - Urban areas - Rural areas - Region Centre East - Region North West - Region South East - Autonomous Region of Principe 66.6 33.4 65.4 18.7 12.3 3.7 Percentage of population under: - Age 5 - Age 18 14.9 50.8 Percentage of women age 15-49 years with at least one live birth in the last 2 years 25.7 Housing characteristics Household or personal assets Percentage of households with - Electricity - Finished floor - Finished roofing - Finished walls 68.6 36.4 99.8 98.1 Percentage of households that own - A television - A refrigerator/freezer - Agricultural land - Farm animals/livestock 68.3 42.8 25.8 40.6 Mean number of persons per room used for sleeping 2.18 Percentage of households where at least a member has or owns a - Mobile phone - Car or truck 82.2 9.7 Sao Tome and Principe 2014 MICS, Final Report P a g e | iv Summary Table of Findingsi Multiple Indicator Cluster Surveys (MICS) and Millennium Development Goals (MDG) Indicators, Sao Tome and Principe, 2014 CHILD MORTALITY Early childhood mortalitya MICS Indicator Indicator Description Value 1.1 Neonatal mortality rate Probability of dying within the first month of life 22 1.2 MDG 4.2 Infant mortality rate Probability of dying between birth and the first birthday 38 1.3 Post-neonatal mortality rate Difference between infant and neonatal mortality rates 16 1.4 Child mortality rate Probability of dying between the first and the fifth birthdays 7 1.5 MDG 4.1 Under-five mortality rate Probability of dying between birth and the fifth birthday 45 a Rates refer to the 5-year period preceding the survey. NUTRITION Nutritional status MICS Indicator Indicator Description Value 2.1a 2.1b MDG 1.8 Underweight prevalence (a) Moderate and severe (b) Severe Percentage of children under age 5 who fall below (a) minus two standard deviations (moderate and severe) (b) minus three standard deviations (severe) of the median weight for age of the WHO standard 8.8 1.8 2.2a 2.2b Stunting prevalence (a) Moderate and severe (b) Severe Percentage of children under age 5 who fall below (a) minus two standard deviations (moderate and severe) (b) minus three standard deviations (severe) of the median height for age of the WHO standard 17.2 4.5 2.3a 2.3b Wasting prevalence (a) Moderate and severe (b) Severe Percentage of children under age 5 who fall below (a) minus two standard deviations (moderate and severe) (b) minus three standard deviations (severe) of the median weight for height of the WHO standard 4.0 0.8 2.4 Overweight prevalence Percentage of children under age 5 who are above two standard deviations of the median weight for height of the WHO standard 2.4 Breastfeeding and infant feeding 2.5 Children ever breastfed Percentage of women with a live birth in the last 2 years who breastfed their last live-born child at any time 97.4 2.6 Early initiation of breastfeeding Percentage of women with a live birth in the last 2 years who put their last newborn to the breast within one hour of birth 38.3 2.7 Exclusive breastfeeding under 6 months Percentage of infants under 6 months of age who are exclusively breastfed 73.8 2.8 Predominant breastfeeding under 6 months Percentage of infants under 6 months of age who received breast milk as the predominant source of nourishment during the previous day 85.1 2.9 Continued breastfeeding at 1 year Percentage of children age 12-15 months who received breast milk during the previous day 85.9 2.10 Continued breastfeeding at 2 years Percentage of children age 20-23 months who received breast milk during the previous day 24.1 2.11 Median duration of breastfeeding The age in months when 50 percent of children age 0-35 months did not receive breast milk during the previous day 17.0 2.12 Age-appropriate breastfeeding Percentage of children age 0-23 months appropriately fed during the previous day 62.3 i See Appendix E for a detailed description of MICS indicators Sao Tome and Principe 2014 MICS, Final Report P a g e | v 2.13 Introduction of solid, semi-solid or soft foods Percentage of infants age 6-8 months who received solid, semi-solid or soft foods during the previous day 74.1 2.14 Milk feeding frequency for non-breastfed children Percentage of non-breastfed children age 6-23 months who received at least 2 milk feedings during the previous day 26.4 2.15 Minimum meal frequency Percentage of children age 6-23 months who received solid, semi-solid and soft foods (plus milk feeds for non-breastfed children) the minimum number of times or more during the previous day 58.2 2.16 Minimum dietary diversity Percentage of children age 6–23 months who received foods from 4 or more food groups during the previous day 46.8 2.17a 2.17b Minimum acceptable diet (a) Percentage of breastfed children age 6–23 months who had at least the minimum dietary diversity and the minimum meal frequency during the previous day (b) Percentage of non-breastfed children age 6–23 months who received at least 2 milk feedings and had at least the minimum dietary diversity not including milk feeds and the minimum meal frequency during the previous day 28.5 10.9 2.18 Bottle feeding Percentage of children age 0-23 months who were fed with a bottle during the previous day 15.3 Salt iodization 2.19 Iodized salt consumption Percentage of households with salt testing 15 parts per million or more of iodine 88.1 Low-birthweight 2.20 Low-birthweight infants Percentage of most recent live births in the last 2 years weighing below 2,500 grams at birth 8.4 2.21 Infants weighed at birth Percentage of most recent live births in the last 2 years who were weighed at birth 94.0 CHILD HEALTH Vaccinations MICS Indicator Indicator Description Value 3.1 Tuberculosis immunization coverage Percentage of children age 12-23 months who received BCG vaccine by their first birthday 97.3 3.2 Polio immunization coverage Percentage of children age 12-23 months who received the third dose of OPV vaccine (OPV3) by their first birthday 88.8 3.3, 3.5, 3.6 Diphtheria, pertussis, tetanus, hepatitis B and Haemophilus influenzae type B (penta) immunization coverage Percentage of children age 12-23 months who received the third dose of diphtheria, pertussis, tetanus, hepatitis B and Haemophilus influenzae type B (penta3) by their first birthday 93.0 3.S1i Pneumococcal conjugate vaccine (PCV) Percentage of children age 12-23 months who received the third dose of PCV vaccine (PCV3) by their first birthday 82.0 3.4 MDG 4.3 Measles immunization coverage Percentage of children age 12-23 months who received measles vaccine by their first birthday 89.0 3.7 Yellow fever immunization coverage Percentage of children age 12-23 months who received yellow fever vaccine by their first birthday 89.3 3.8ii Full immunization coverage Percentage of children age 12-23 months who received all vaccinations recommended in the national immunization schedule by their first birthday 65.8 Tetanus toxoid 3.9 Neonatal tetanus protection Percentage of women age 15-49 years with a live birth in the last 2 years who were given at least two doses of tetanus toxoid vaccine within the appropriate interval prior to the most recent birth 72.1 i Specific indicator for Sao Tome and Principe ii Includes BCG, OPV3, penta3, PCV3, yellow fever and measles Sao Tome and Principe 2014 MICS, Final Report P a g e | vi Diarrhoea - Children with diarrhoea Percentage of children under age 5 with diarrhoea in the last 2 weeks 17.7 3.10 Care-seeking for diarrhoea Percentage of children under age 5 with diarrhoea in the last 2 weeks for whom advice or treatment was sought from a health facility or provider 54.2 3.S2i Diarrhoea treatment with oral rehydration salts (ORS) Percentage of children under age 5 with diarrhoea in the last 2 weeks who received ORS 49.1 3.12 Diarrhoea treatment with oral rehydration therapy (ORT) and continued feeding Percentage of children under age 5 with diarrhoea in the last 2 weeks who received ORT (ORS packet, pre-packaged ORS fluid, recommended homemade fluid or increased fluids) and continued feeding during the episode of diarrhoea 61.7 Acute Respiratory Infection (ARI) symptoms - Children with ARI symptoms Percentage of children under age 5 with ARI symptoms in the last 2 weeks 7.1 3.13 Care-seeking for children with ARI symptoms Percentage of children under age 5 with ARI symptoms in the last 2 weeks for whom advice or treatment was sought from a health facility or provider 68.9 3.14 Antibiotic treatment for children with ARI symptoms Percentage of children under age 5 with ARI symptoms in the last 2 weeks who received antibiotics 47.6 Solid fuel use 3.15 Use of solid fuels for cooking Percentage of household members in households that use solid fuels as the primary source of domestic energy to cook 41.8 Malaria / Fever MICS Indicator Indicator Description Value - Children with fever Percentage of children under age 5 with fever in the last 2 weeks 26.3 3.16a 3.16b Household availability of insecticide-treated nets (ITNs) Percentage of households with (a) at least one ITN (b) at least one ITN for every two people 77.8 55.1 3.17a 3.17b Household vector control Percentage of households (a) with at least one ITN or that have been sprayed by IRS in the last 12 months (b) with at least one ITN for every two people or that have been sprayed by IRS in the last 12 months 96.7 94.8 3.18 MDG 6.7 Children under age 5 who slept under an ITN Percentage of children under age 5 who slept under an ITN the previous night 61.1 3.19 Population that slept under an ITN Percentage of household members who slept under an ITN the previous night 56.1 3.20 Care-seeking for fever Percentage of children under age 5 with fever in the last 2 weeks for whom advice or treatment was sought from a health facility or provider 65.8 3.21 Malaria diagnostics usage Percentage of children under age 5 with fever in the last 2 weeks who had a finger or heel stick for malaria testing 42.0 3.22 MDG 6.8 Anti-malarial treatment of children under age 5 Percentage of children under age 5 with fever in the last 2 weeks who received any antimalarial treatment 1.4 3.23 Treatment with Artemisinin-based Combination Therapy (ACT) among children who received anti- malarial treatment Percentage of children under age 5 with fever in the last 2 weeks who received ACT (or other first-line treatment according to national policy) (*) 3.24 Pregnant women who slept under an ITN Percentage of pregnant women who slept under an ITN the previous night 60.9 i Specific indicator for Sao Tome and Principe Sao Tome and Principe 2014 MICS, Final Report P a g e | vii 3.25 Intermittent preventive treatment for malaria during pregnancy Percentage of women age 15-49 years who received three or more doses of SP/Fansidar, at least one of which was received during an ANC visit, to prevent malaria during their last pregnancy that led to a live birth in the last 2 years 12.3 (*) Figures that are based on fewer than 25 unweighted cases WATER AND SANITATION MICS Indicator Indicator Description Value 4.1 MDG 7.8 Use of improved drinking water sources Percentage of household members using improved sources of drinking water 93.9 4.2 Water treatment Percentage of household members in households using unimproved drinking water who use an appropriate treatment method 9.1 4.3 MDG 7.9 Use of improved sanitation Percentage of household members using improved sanitation facilities which are not shared 40.9 4.4 Safe disposal of child’s faeces Percentage of children age 0-2 years whose last stools were disposed of safely 28.9 4.5 Place for handwashing Percentage of households with a specific place for hand washing where water and soap or other cleansing agent are present 40.5 4.6 Availability of soap or other cleansing agent Percentage of households with soap or other cleansing agent 76.5 REPRODUCTIVE HEALTH Contraception and unmet need MICS Indicator Indicator Description Value - Total fertility rate Total fertility rate for women age 15-49 years 4.4 5.1 MDG 5.4 Adolescent birth rate Age-specific fertility rate for women age 15-19 years 92 5.2 Early childbearing Percentage of women age 20-24 years who had at least one live birth before age 18 27.3 5.3 MDG 5.3 Contraceptive prevalence rate Percentage 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 40.6 5.4 MDG 5.6 Unmet need Percentage 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 32.7 Maternal and newborn health 5.5a 5.5b MDG 5.5 “ “ Antenatal care coverage Percentage of women age 15-49 years with a live birth in the last 2 years who were attended during their last pregnancy that led to a live birth (a) at least once by skilled health personnel (b) at least four times by any provider 97.5 83.6 5.6 Content of antenatal care Percentage of women age 15-49 years with a live birth in the last 2 years who had their blood pressure measured and gave urine and blood samples during the last pregnancy that led to a live birth 94.2 5.7 MDG 5.2 Skilled attendant at delivery Percentage of women age 15-49 years with a live birth in the last 2 years who were attended by skilled health personnel during their most recent live birth 92.5 5.8 Institutional deliveries Percentage of women age 15-49 years with a live birth in the last 2 years whose most recent live birth was delivered in a health facility 91.0 Sao Tome and Principe 2014 MICS, Final Report P a g e | viii 5.9 Caesarean section Percentage of women age 15-49 years whose most recent live birth in the last 2 years was delivered by caesarean section 5.6 Post-natal health checks 5.10 Post-partum stay in health facility Percentage of women age 15-49 years who stayed in the health facility for 12 hours or more after the delivery of their most recent live birth in the last 2 years 98.8 5.11 Post-natal health check for the newborn Percentage of last live births in the last 2 years who received a health check while in facility or at home following delivery, or a post-natal care visit within 2 days after delivery 90.7 5.12 Post-natal health check for the mother Percentage of women age 15-49 years who received a health check while in facility or at home following delivery, or a post-natal care visit within 2 days after delivery of their most recent live birth in the last 2 years 86.8 Maternal mortality 5.13 MDG 5.1 Maternal mortality ratio Deaths during pregnancy, childbirth, or within two months after delivery or termination of pregnancy, per 100,000 births within the 7-year period preceding the survey (74) ( ) Unreliable estimate due to small sample size CHILD DEVELOPMENT MICS Indicator Indicator Description Value 6.1 Attendance to early childhood education Percentage of children age 36-59 months who are attending an early childhood education programme 36.4 6.2 Support for learning Percentage of children age 36-59 months with whom an adult has engaged in four or more activities to promote learning and school readiness in the last 3 days 62.7 6.3 Father’s support for learning Percentage of children age 36-59 months whose biological father has engaged in four or more activities to promote learning and school readiness in the last 3 days 3.0 6.4 Mother’s support for learning Percentage of children age 36-59 months whose biological mother has engaged in four or more activities to promote learning and school readiness in the last 3 days 15.7 6.5 Availability of children’s books Percentage of children under age 5 who have three or more children’s books 5.8 6.6 Availability of playthings Percentage of children under age 5 who play with two or more types of playthings 64.7 6.7 Inadequate care Percentage of children under age 5 left alone or in the care of another child younger than 10 years of age for more than one hour at least once in the last week 15.5 6.8 Early child development index Percentage of children age 36-59 months who are developmentally on track in at least three of the following four domains: literacy-numeracy, physical, social-emotional, and learning 54.5 Sao Tome and Principe 2014 MICS, Final Report P a g e | ix LITERACY AND EDUCATION MICS Indicator Indicator Description Value 7.1 “ “ MDG 2.3 “ “ Literacy rate among young people Percentage of young people age 15-24 years who are able to read a short simple statement about everyday life or who attended secondary or higher education (a) women (b) men 89.6 87.5 7.2 School readiness Percentage of children in first grade of primary school who attended pre-school during the previous school year 57.9 7.3 Net intake rate in primary education Percentage of children of school-entry age who enter the first grade of primary school 77.1 7.4 MDG 2.1 Primary school net attendance ratio (adjusted) Percentage of children of primary school age currently attending primary or secondary school 94.1 7.5 Secondary school net attendance ratio (adjusted) Percentage of children of secondary school age currently attending secondary school or higher 60.4 7.6 MDG 2.2 Children reaching last grade of primary Percentage of children entering the first grade of primary school who eventually reach last grade 91.6 7.7 Primary completion rate Number of children attending the last grade of primary school (excluding repeaters) divided by number of children of primary school completion age (age appropriate to final grade of primary school) 111.9 7.8 Transition rate to secondary school Number of children attending the last grade of primary school during the previous school year who are in the first grade of secondary school during the current school year divided by number of children attending the last grade of primary school during the previous school year 53.7 7.9 MDG 3.1 Gender parity index (primary school) Primary school net attendance ratio (adjusted) for girls divided by primary school net attendance ratio (adjusted) for boys 1.00 7.10 MDG 3.1 Gender parity index (secondary school) Secondary school net attendance ratio (adjusted) for girls divided by secondary school net attendance ratio (adjusted) for boys 1.18 CHILD PROTECTION Birth registration MICS Indicator Indicator Description Value 8.1 Birth registration Percentage of children under age 5 whose births are reported registered 95.2 Child labour 8.2 Child labour Percentage of children age 5-17 years who are involved in child labour 26.0 Child discipline 8.3 Violent discipline Percentage of children age 1-14 years who experienced psychological aggression or physical punishment during the last one month 79.6 Early marriage and polygyny 8.4 “ “ Marriage before age 15 Percentage of people age 15-49 years who were first married or in union before age 15 (a) Women (b) Men 5.1 1.4 Sao Tome and Principe 2014 MICS, Final Report P a g e | x 8.5 “ “ Marriage before age 18 Percentage of people age 20-49 years who were first married or in union before age 18 (a) Women (b) Men 32.2 7.5 8.6 “ “ Young people age 15-19 years currently married or in union Percentage of young people age 15-19 years who are married or in union (a) Women (b) Men 15.3 1.3 8.7 “ “ Polygyny Percentage of people age 15-49 years who are in a polygynous union (a) Women (b) Men 22.4 13.0 8.8a 8.8b Spousal age difference Percentage of young women who are married or in union and whose spouse is 10 or more years older, (a) among women age 15-19 years, (b) among women age 20-24 years 23.1 17.3 Attitudes towards domestic violence 8.12 “ “ Attitudes towards domestic violence Percentage of people age 15-49 years who state that a husband is justified in hitting or beating his wife in at least one of the following circumstances: (1) she goes out without telling him, (2) she neglects the children, (3) she argues with him, (4) she refuses sex with him, (5) she burns the food (a) Women (b) Men 19.1 13.8 Children’s living arrangements 8.13 Children’s living arrangements Percentage of children age 0-17 years living with neither biological parent 14.7 8.14 Prevalence of children with one or both parents dead Percentage of children age 0-17 years with one or both biological parents dead 5.4 8.15 Children with at least one parent living abroad Percentage of children 0-17 years with at least one biological parent living abroad 15.7 HIV/AIDS AND SEXUAL BEHAVIOUR HIV/AIDS knowledge and attitudes MICS Indicator Indicator Description Value - - Have heard of AIDS Percentage of people age 15-49 years who have heard of AIDS (a) Women (b) Men 99.2 99.5 9.1 “ “ MDG 6.3 “ “ Knowledge about HIV prevention among young people Percentage of young people age 15-24 years who correctly identify ways of preventing the sexual transmission of HIV, and who reject major misconceptions about HIV transmission (a) Women (b) Men 42.2 43.2 9.2 “ “ Knowledge of mother-to- child transmission of HIV Percentage of people age 15-49 years who correctly identify all three means of mother-to-child transmission of HIV (a) Women (b) Men 47.1 39.9 9.3 “ “ Accepting attitudes towards people living with HIV Percentage of people age 15-49 years expressing accepting attitudes on all four questions toward people living with HIV (a) Women (b) Men 13.4 22.5 Sao Tome and Principe 2014 MICS, Final Report P a g e | xi HIV testing 9.4 “ “ People who know where to be tested for HIV Percentage of people age 15-49 years who state knowledge of a place to be tested for HIV (a) Women (b) Men 92.3 89.9 9.5 “ “ People who have been tested for HIV and know the results Percentage of people age 15-49 years who have been tested for HIV in the last 12 months and who know their results (a) Women (b) Men 38.5 27.3 9.6 “ “ Sexually active young people who have been tested for HIV and know the results Percentage of young people age 15-24 years who have had sex in the last 12 months, who have been tested for HIV in the last 12 months and who know their results (a) Women (b) Men 48.0 21.6 9.7 HIV counselling during antenatal care Percentage of women age 15-49 years who had a live birth in the last 2 years and received antenatal care during the pregnancy of their most recent birth, reporting that they received counselling on HIV during antenatal care 77.2 9.8 HIV testing during antenatal care Percentage of women age 15-49 years who had a live birth in the last 2 years and received antenatal care during the pregnancy of their most recent birth, reporting that they were offered and accepted an HIV test during antenatal care and received their results 86.1 Sexual behaviour 9.9 “ “ Young people who have never had sex Percentage of never married young people age 15-24 years who have never had sex (a) Women (b) Men 58.2 41.2 9.10 “ “ Sex before age 15 among young people Percentage of young people age 15-24 years who had sexual intercourse before age 15 (a) Women (b) Men 9.2 18.2 9.11 Age-mixing among sexual partners Percentage of women age 15-24 years who had sex in the last 12 months with a partner who was 10 or more years older 17.6 9.12 “ “ Multiple sexual partnerships Percentage of people age 15-49 years who had sexual intercourse with more than one partner in the last 12 months (a) Women (b) Men 2.9 29.1 9.13 “ “ Condom use at last sex among people with multiple sexual partnerships Percentage of people age 15-49 years who report having had more than one sexual partner in the last 12 months who also reported that a condom was used the last time they had sex (a) Women (b) Men 46.0 49.0 9.14 “ “ Sex with non-regular partners Percentage of sexually active young people age 15-24 years who had sex with a non-marital, non-cohabitating partner in the last 12 months (a) Women (b) Men 24.7 46.9 9.15 “ “ MDG 6.2 “ “ Condom use with non- regular partners Percentage of young people age 15-24 years reporting the use of a condom during the last sexual intercourse with a non-marital, non-cohabiting sex partner in the last 12 months (a) Women (b) Men 65.2 82.5 Orphans 9.16 MDG 6.4 Ratio of school attendance of orphans to school attendance of non- orphans Proportion attending school among children age 10-14 years who have lost both parents divided by proportion attending school among children age 10-14 years whose parents are alive and who are living with one or both parents (*) Sao Tome and Principe 2014 MICS, Final Report P a g e | xii Male circumcision 9.17 Male circumcision Percentage of men age 15-49 years who report having been circumcised 3.2 (*) Figures that are based on fewer than 25 unweighted cases ACCESS TO MASS MEDIA AND ICT Access to mass media MICS Indicator Indicator Description Value 10.1 “ “ Exposure to mass media Percentage of people age 15-49 years who, at least once a week, read a newspaper or magazine, listen to the radio, and watch television (a) Women (b) Men 15.9 28.4 Use of information/communication technology 10.2 “ “ Use of computers Percentage of young people age 15-24 years who used a computer during the last 12 months (a) Women (b) Men 37.2 48.3 10.3 “ “ Use of internet Percentage of young people age 15-24 years who used the internet during the last 12 months (a) Women (b) Men 32.3 42.9 SUBJECTIVE WELL-BEING MICS Indicator Indicator Description Value 11.1 “ “ Life satisfaction Percentage of young people age 15-24 years who are very or somewhat satisfied with their life, overall (a) Women (b) Men 75.6 84.2 11.2 “ “ Happiness Percentage of young people age 15-24 years who are very or somewhat happy (a) Women (b) Men 74.4 77.3 11.3 “ “ Perception of a better life Percentage of young people age 15-24 years whose life improved during the last one year, and who expect that their life will be better after one year (a) Women (b) Men 59.4 63.4 TOBACCO AND ALCOHOL USE Tobacco use MICS Indicator Indicator Description Value 12.1 “ “ Tobacco use Percentage of people age 15-49 years who smoked cigarettes, or used smoked or smokeless tobacco products at any time during the last one month (a) Women (b) Men 1.1 8.9 12.2 “ “ Smoking before age 15 Percentage of people age 15-49 years who smoked a whole cigarette before age 15 (a) Women (b) Men 0.4 1.4 Sao Tome and Principe 2014 MICS, Final Report P a g e | xiii Alcohol use 12.3 “ “ Use of alcohol Percentage of people age 15-49 years who had at least one alcoholic drink at any time during the last one month (a) Women (b) Men 53.2 67.1 12.4 “ “ Use of alcohol before age 15 Percentage of people age 15-49 years who had at least one alcoholic drink before age 15 (a) Women (b) Men 7.5 11.9 Sao Tome and Principe 2014 MICS, Final Report P a g e | xiv Table of Contents Summary Table of Survey Implementation and the Survey Population, Sao Tome and Principe, 2014iii Summary Table of Findings . iv Table of Contents .xiv List of Tables xvi List of Figures xxii List of Abbreviations . xxiii Acknowledgements . xxiv ELSA MARIA CARDOSO . xxiv Executive Summary . xxv I. Introduction . 1 Background . 1 Survey Objectives . 2 II. Sample and Survey Methodology . 3 Sample Design . 3 Questionnaires . 3 Methodology and processes used when taking blood samples for anaemia, malaria and HIV testing . 5 Training and Fieldwork . 6 Data Processing . 6 III. Sample Coverage and the Characteristics of Households and Respondents . 7 Sample Coverage . 7 Characteristics of Households . 8 Characteristics of Female and Male Respondents 15-49 Years of Age and Children Under-5 . 12 Housing characteristics, asset ownership, and wealth quintiles . 16 IV. Child Mortality . 20 V. Nutrition . 26 Low Birth Weight . 26 Nutritional Status . 28 Breastfeeding and Infant and Young Child Feeding . 31 Salt Iodization . 43 VI. Child Health . 46 Vaccinations . 46 Neonatal Tetanus Protection . 50 Care of Illness . 51 Prevalence of malaria in children . 80 Prevalence of anaemia in children . 83 VII. Water and Sanitation . 85 Use of Improved Water Sources . 85 Use of Improved Sanitation . 91 Handwashing . 99 VIII. Reproductive Health . 102 Fertility . 102 Contraception . 107 Unmet Need . 109 Antenatal Care . 112 Assistance at Delivery . 116 Place of Delivery . 119 Sao Tome and Principe 2014 MICS, Final Report P a g e | xv Post-natal Health Checks . 120 Adult Mortality Rates . 128 Maternal Mortality . 129 Prevalence of anaemia in women . 131 IX. Early Childhood Development . 134 Early Childhood Care and Education . 134 Quality of Care . 135 Developmental Status of Children . 141 X. Literacy and Education . 144 Literacy among Young Women and Men. 144 School Readiness . 145 Primary and Secondary School Participation . 146 XI. Child Protection . 157 Birth Registration . 157 Child Labour . 158 Child Discipline . 163 Early Marriage and Polygyny . 166 Attitudes toward Domestic Violence . 173 Children’s Living Arrangements . 176 XII. HIV/AIDS and Sexual Behaviour . 179 Knowledge about HIV Transmission and Misconceptions about HIV . 179 Accepting Attitudes toward People Living with HIV . 186 Knowledge of a Place for HIV Testing, Counselling and Testing during Antenatal Care. 189 Sexual Behaviour Related to HIV Transmission . 193 HIV Indicators for Young Women and Young Men . 195 Orphans . 200 Male circumcision . 202 Prevalence of HIV in men and women . 203 XIII. Access to Mass Media and Use of Information/Communication Technology . 212 Access to Mass Media . 212 Use of Information/Communication Technology . 215 XIV. Subjective well-being . 218 XV. Tobacco and Alcohol Use . 226 Tobacco Use . 226 Alcohol Use . 231 Appendix A. Sample Design . 234 Sampling frame, study domains and strata . 234 Sample Size and Sample Allocation. 234 Sample distribution of clusters and households. 236 Sampling modalities . 237 Sampling of clusters or primary units . 237 Cartographic operations and household listing . 238 Selection of households . 239 Selection probability and initial sample weights for the sampling units . 239 Appendix B. List of Personnel Involved in the Survey . 242 Appendix C. Estimates of Sampling Errors . 249 Appendix D. Data Quality Tables . 264 Appendix E. Sao Tome and Principe MICS5 Indicators: Numerators and Denominators . 284 QUESTIONÁRIO INDIVIDUAL MULHER . 318 São Tomé e Príncipe, MICS 5, 2014 . 318 Sao Tome and Principe 2014 MICS, Final Report P a g e | xvi Sao Tome and Principe 2014 MICS, Final Report P a g e | xvii List of Tables Table HH.1: Results of household, women's, men's and under-5 interviews . 8 Table HH.2: Age distribution of household population by sex . 9 Table HH.3: Household composition . 11 Table HH.4: Women's background characteristics . 13 Table HH.4M: Men's background characteristics . 14 Table HH.5: Under-5's background characteristics . 16 Table HH.6: Housing characteristics . 17 Table HH.7: Household and personal assets . 18 Table HH.8: Wealth quintiles . 19 Table CM.1: Early childhood mortality rates . 20 Table CM.2: Early childhood mortality rates by socioeconomic characteristics . 22 Table CM.3: Early childhood mortality rates by demographic characteristics . 23 Table NU.1: Low birth weight infants . 27 Table NU.2: Nutritional status of children . 29 Table NU.3: Initial breastfeeding . 34 Table NU.4: Breastfeeding . 36 Table NU.5: Duration of breastfeeding . 38 Table NU.6: Age-appropriate breastfeeding . 39 Table NU.7: Introduction of solid, semi-solid, or soft foods . 39 Table NU.8: Infant and young child feeding (IYCF) practices by sex, age and area . 41 Table NU.8 (second part): Infant and young child feeding (IYCF) practices, by region, mother’s education and wealth index quintile . 42 Table NU.9: Bottle feeding . 43 Table NU.10: Iodized salt consumption . 44 Table CH.1: Vaccinations in the first years of life . 47 Table CH.2: Vaccinations by background characteristics . 49 Table CH.3: Neonatal tetanus protection . 51 Table CH.4: Reported disease episodes . 53 Table CH.5: Care-seeking during diarrhoea . 55 Table CH.6: Feeding practices during diarrhoea . 56 Table CH.7: Oral rehydration solutions, recommended homemade fluids, and zinc . 57 Table CH.8: Oral rehydration therapy with continued feeding and other treatments . 59 Table CH.9: Source of ORS . 61 Table CH.10: Care-seeking for and antibiotic treatment of symptoms of acute respiratory infection (ARI) . 62 Table CH.11: Knowledge of the two danger signs of pneumonia . 63 Table CH.12: Solid fuel use . 65 Table CH.13: Solid fuel use by place of cooking . 66 Table CH.14: Household availability of insecticide treated nets and protection by a vector control method . 68 Sao Tome and Principe 2014 MICS, Final Report P a g e | xviii Table CH.15: Access to an insecticide treated net (ITN) - number of household members . 69 Table CH.16: Access to an insecticide treated net (ITN) - background characteristics . 69 Table CH.17: Use of ITNs . 71 Table CH.18: Children sleeping under mosquito nets . 72 Table CH.19: Use of mosquito nets by the household population . 73 Table CH.20: Care-seeking during fever . 74 Table CH.21: Treatment of children with fever . 76 Table CH.22: Diagnostics and anti-malarial treatment of children. 77 Table CH.23: Pregnant women sleeping under mosquito nets . 78 Table CH.24: Intermittent preventive treatment for malaria . 80 Table CH.25: Coverage of testing for malaria in children (unweighted) . 81 Table CH.26: Results of the Rapid Diagnostic Test (RDT) and thick smear for the detection of malaria in children . 82 Table CH.27: Prevalence of anaemia in children . 84 Table WS.1: Use of improved water sources . 86 Table WS.2: Household water treatment . 88 Table WS.3: Time to source of drinking water . 90 Table WS.4: Person collecting water . 91 Table WS.5: Types of sanitation facilities . 92 Table WS.6: Use and sharing of sanitation facilities . 93 Table WS.7: Drinking water and sanitation ladders . 96 Table WS.8: Disposal of child's faeces . 98 Table WS.9: Water and soap at place for handwashing . 100 Table WS.10: Availability of soap or other cleansing agent . 101 Table RH.1: Fertility rates . 102 Table RH.2: Adolescent birth rate and total fertility rate . 104 Table RH.3: Early childbearing . 105 Table RH.4: Trends in early childbearing . 106 Table RH.5: Use of contraception . 108 Table RH.6: Unmet need for contraception . 111 Table RH.7: Antenatal care coverage . 113 Table RH.8: Number of antenatal care visits and timing of first visit . 114 Table RH.9: Content of antenatal care. 116 Table RH.10: Assistance during delivery and caesarian section . 118 Table RH.11: Place of delivery . 120 Table RH.12: Post-partum stay in health facility. 122 Table RH.13: Post-natal health checks for newborns . 123 Table RH.14: Post-natal care visits for newborns within one week of birth . 124 Table RH.15: Post-natal health checks for mothers . 126 Table RH.16: Post-natal care visits for mothers within one week of birth . 127 Table RH.17: Post-natal health checks for mothers and newborns . 128 Table RH.18: Adult mortality rates . 129 Sao Tome and Principe 2014 MICS, Final Report P a g e | xix Table RH.19: Adult mortality probabilities . 129 Table RH.21: Prevalence of anaemia in women . 132 Table CD.1: Early childhood education . 135 Table CD.2: Support for learning, by sex, region and area . 137 Table CD.2 (second part): Support for learning, by age, mother’s education, father’s education and wealth index . 138 Table CD.3: Learning materials . 139 Table CD.4: Inadequate care . 141 Table CD.5: Early child development index . 143 Table ED.1: Literacy (young women) . 144 Table ED.1M: Literacy (young men) . 145 Table ED.2: School readiness . 146 Table ED.3: Primary school entry . 147 Table ED.4: Primary school attendance and out of school children . 149 Table ED.5: Secondary school attendance and out of school children . 150 Table ED.6: Children reaching last grade of primary school . 152 Table ED.7: Primary school completion and transition to secondary school . 153 Table ED.8: Education gender parity . 154 Table ED.9: Out of school gender parity . 155 Table CP.1: Birth registration . 158 Table CP.2: Children's involvement in economic activities. 160 Table CP.3: Children's involvement in household chores . 161 Table CP.4: Child labour . 162 Table CP.5: Child discipline . 164 Table CP.6: Attitudes toward physical punishment . 166 Table CP.7: Early marriage and polygyny (women) . 168 Table CP.7M: Early marriage and polygyny (men) . 169 Table CP.8: Trends in early marriage (women) . 170 Table CP.8M: Trends in early marriage (men) . 170 Table CP.9: Spousal age difference . 172 Table CP.10: Attitudes toward domestic violence (women) . 174 Table CP.10M: Attitudes toward domestic violence (men) . 175 Table CP.11: Children's living arrangements and orphanhood . 177 Table CP.12: Children with parents living abroad . 178 Table HA.1: Knowledge about HIV transmission, misconceptions about HIV, and comprehensive knowledge about HIV transmission (women) . 180 Table HA.1M: Knowledge about HIV transmission, misconceptions about HIV, and comprehensive knowledge about HIV transmission (men) . 181 Table HA.2: Knowledge of mother-to-child HIV transmission (women) . 184 Table HA.2M: Knowledge of mother-to-child HIV transmission (men) . 185 Table HA.3: Accepting attitudes toward people living with HIV (women) . 187 Table HA.3M: Accepting attitudes toward people living with HIV (men) . 188 Table HA.4: Knowledge of a place for HIV testing (women) . 190 Sao Tome and Principe 2014 MICS, Final Report P a g e | xx Table HA.4M: Knowledge of a place for HIV testing (men) . 191 Table HA.5: HIV counselling and testing during antenatal care . 192 Table HA.6: Sex with multiple partners (women) . 193 Table HA.6M: Sex with multiple partners (men) . 194 Table HA.7: Key HIV and AIDS indicators (young women) . 196 Table HA.7M: Key HIV and AIDS indicators (young men) . 197 Table HA.8: Key sexual behaviour indicators (young women) . 198 Table HA.8M: Key sexual behaviour indicators (young men) . 199 Table HA.9: School attendance of orphans and non-orphans . 201 Table HA.10: Male circumcision . 202 Table HA.11: Coverage of HIV test by area and region . 205 Table HA.13: Prevalence of HIV by age . 208 Table HA.14: Prevalence of HIV by socio-economic characteristics . 209 Table HA.15: Prevalence of HIV by socio-demographic characteristics . 210 Table HA.16: Prevalence of HIV by sexual behaviour and prior HIV test . 211 Table MT.1: Exposure to mass media (women) . 213 Table MT.1M: Exposure to mass media (men) . 214 Table MT.2: Use of computers and internet (women) . 216 Table MT.2M: Use of computers and internet (men) . 217 Table SW.1: Domains of life satisfaction (women) . 219 Table SW.1M: Domains of life satisfaction (men). 220 Table SW.2: Overall life satisfaction and happiness (women) . 222 Table SW.2M: Overall life satisfaction and happiness (men) . 223 Table SW.3: Perception of a better life (women) . 224 Table SW.3M: Perception of a better life (men) . 225 Table TA.1: Current and ever use of tobacco (women) . 227 Table TA.1M: Current and ever use of tobacco (men) . 228 Table TA.2: Age at first use of cigarettes and frequency of use . 230 Table TA.2M: Age at first use of cigarettes and frequency of use . 231 Table TA.3: Use of alcohol (women) . 232 Table TA.3M: Use of alcohol (men). 233 Appendices: Table SD.1: Definition of study domains and strata . 235 Table SD.2: Calculation of the minimum required size of the household sample per study domain 236 Table SD.3: Distribution of the sample by study domain and stratum . 237 Table SD.4: Structure of the sampling frame and sample per study domain . 237 Table SD.5: List of EAs with a selection probability superior to 1 . 238 Table SD.6: Distribution of EAs purposely selected and of remaining EAs to be selected by stratum . 238 Table SE.1: Indicators selected for sampling error calculations . 250 Table SE.2: Sampling errors: Total sample . 251 Sao Tome and Principe 2014 MICS, Final Report P a g e | xxi Table SE.3: Sampling errors: Urban . 252 Table SE.4: Sampling errors: Rural . 253 Table SE.5: Sampling errors: Region Centre East . 254 Table SE.6: Sampling errors: Region North West . 255 Table SE.7: Sampling errors: Region South East . 256 Table SE.8: Sampling errors: Autonomous Region of Principe . 257 Table SE.9: Sampling errors: Education of household head – None . 258 Table SE.10: Sampling errors: Education of household head – Primary . 258 Table SE.11: Sampling errors: Education of household head – Secondary . 258 Table SE.12: Sampling errors: Education of household head – Higher . 259 Table SE.13: Sampling errors: Poorest . 259 Table SE.14: Sampling errors: Second wealth quintile . 260 Table SE.15: Sampling errors: Middle wealth quintile . 261 Table SE.16: Sampling errors: Fourth wealth quintile . 262 Table SE.17: Sampling errors: Wealthiest . 263 Table DQ.1: Age distribution of household population . 264 Table DQ.2: Age distribution of eligible and interviewed women . 265 Table DQ.3: Age distribution of eligible and interviewed men. 266 Table DQ.4: Age distribution of children in household and under-5 questionnaires . 266 Table DQ.5: Birth date reporting: Household population . 267 Table DQ.6: Birth date and age reporting: Women . 267 Table DQ.7: Birth date and age reporting: Men . 268 Table DQ.8: Birth date and age reporting: Under-5s . 268 Table DQ.9: Birth date reporting: Children, adolescents and young people . 269 Table DQ.10: Birth date reporting: First and last births . 270 Table DQ.11: Completeness of reporting . 271 Table DQ.12: Completeness of information for anthropometric indicators: Underweight . 272 Table DQ.13: Completeness of information for anthropometric indicators: Stunting . 272 Table DQ.14: Completeness of information for anthropometric indicators: Wasting . 273 Table DQ.15: Heaping in anthropometric measurements . 274 Table DQ.16: Observation of birth certificates . 275 Table DQ.17: Observation of vaccination cards . 275 Table DQ.18: Observation of women's health cards . 276 Table DQ.19: Observation of bednets and places for handwashing . 276 Table DQ.20: Respondent to the under-5 questionnaire . 277 Table DQ.21: Selection of children age 1-17 years for the child labour and child discipline modules . 277 Table DQ.22: School attendance by single age . 278 Table DQ.23: Sex ratio at birth among children ever born and living . 279 Table DQ.24: Births by periods preceding the survey . 280 Table DQ.25: Reporting of age at death in days . 281 Table DQ.26: Reporting of age at death in months . 282 Sao Tome and Principe 2014 MICS, Final Report P a g e | xxii Table DQ.27: Completeness of information on siblings . 283 Table DQ.28: Sibship size and sex ratio of siblings . 283 Sao Tome and Principe 2014 MICS, Final Report P a g e | xxiii List of Figures F i g u r e H H . 1 : 1 A g e a n d s e x d i s t r i b u t i o n o f h o u s e h o l d p o p u l a t i o n , S a o T o m e a n d P r i n c i p e , 2 0 1 4 . 10 F i g u r e C M . 1 : 2 E a r l y c h i l d h o o d m o r t a l i t y r a t e s . 21 F i g u r e C M . 3 : 3 T r e n d i n u n d e r - 5 m o r t a l i t y r a t e s . 25 F i g u r e N U . 1 : 4 U n d e r w e i g h t , s t u n t e d , w a s t e d a n d o v e r w e i g h t c h i l d r e n u n d e r a g e 5 ( m o d e r a t e a n d s e v e r e ) . 31 F i g u r e N U . 2 : 5 I n i t i a t i o n o f b r e a s t f e e d i n g . 35 F i g u r e N U . 3 : 6 I n f a n t f e e d i n g p a t t e r n s b y a g e . 37 F i g u r e N U . 4 : 7 C o n s u m p t i o n o f i o d i z e d s a l t . 45 F i g u r e C H . 1 : 8 V a c c i n a t i o n s b y a g e 1 2 m o n t h s . 48 F i g u r e C H . 2 : 9C h i l d r e n u n d e r - 5 w i t h d i a r r h o e a w h o r e c e i v e d O R S o r r e c o m m e n d e d h o m e m a d e l i q u i d s , S a o T o m e a n d P r i n c i p e , 2 0 1 4 . 58 F i g u r e C H . 3 : 10C h i l d r e n u n d e r - 5 w i t h d i a r r h o e a r e c e i v i n g o r a l r e h y d r a t i o n t h e r a p y ( O R T ) a n d c o n t i n u e d f e e d i n g , S a o T o m e a n d P r i n c i p e , 2 0 1 4 . 60 F i g u r e C H . 4 : 11P e r c e n t a g e o f h o u s e h o l d p o p u l a t i o n w i t h a c c e s s t o a n I T N i n t h e h o u s e h o l d , S a o T o m e a n d P r i n c i p e , 2 0 1 4 . 70 F i g u r e W S . 1 : 12P e r c e n t d i s t r i b u t i o n o f h o u s e h o l d m e m b e r s b y s o u r c e o f d r i n k i n g w a t e r , S a o T o m e a n d P r i n c i p e , 2 0 1 4 . 87 F i g u r e W S . 2 : 13P e r c e n t d i s t r i b u t i o n o f h o u s e h o l d m e m b e r s b y u s e a n d s h a r i n g o f s a n i t a t i o n f a c i l i t i e s , S a o T o m e a n d P r i n c i p e , 2 0 1 4 . 94 F i g u r e W S . 3 : 14U s e o f i m p r o v e d d r i n k i n g w a t e r s o u r c e s a n d i m p r o v e d s a n i t a t i o n f a c i l i t i e s b y h o u s e h o l d m e m b e r s , S a o T o m e a n d P r i n c i p e , 2 0 1 4 . 97 F i g u r e R H . 1 : 15A g e - s p e c i f i c f e r t i l i t y r a t e s b y a r e a , S a o T o m e a n d P r i n c i p e , 2 0 1 4 . 103 F i g u r e R H . 2 : 16D i f f e r e n t i a l s i n c o n t r a c e p t i v e u s e , S a o T o m e a n d P r i n c i p e , 2 0 1 4 . 109 F i g u r e R H . 3 : 1 7 P e r s o n a s s i s t i n g a t d e l i v e r y , S a o T o m e a n d P r i n c i p e , 2 0 1 4 119 F i g u r e E D . 1 : 18E d u c a t i o n i n d i c a t o r s b y s e x , S a o T o m e a n d P r i n c i p e , 2 0 1 4 . 156 F i g u r e C P . 1 : 1 9 C h i l d d i s c i p l i n i n g m e t h o d s , c h i l d r e n a g e 1 - 1 4 y e a r s , S a o T o m e a n d P r i n c i p e , 2 0 1 4 . 165 F i g u r e H A . 1 : 20W o m e n a n d m e n w i t h c o m p r e h e n s i v e k n o w l e d g e o f H I V t r a n s m i s s i o n , S a o T o m e a n d P r i n c i p e , 2 0 1 4 . 183 F i g u r e H A . 2 : 21A c c e p t i n g a t t i t u d e s t o w a r d p e o p l e l i v i n g w i t h H I V / A I D S , S a o T o m e a n d P r i n c i p e , 2 0 1 4 . 189 F i g u r e H A . 3 : 2 2 S e x u a l b e h a v i o u r t h a t i n c r e a s e s t h e r i s k o f H I V i n f e c t i o n , y o u n g p e o p l e a g e 1 5 - 2 4 , S a o T o m e a n d P r i n c i p e , 2 0 1 4 . 200 F i g u r e T A . 1 : 23E v e r a n d c u r r e n t s m o k e r s , S a o T o m e a n d P r i n c i p e , 2 0 1 4 . 229 F i g u r e D Q . 1 : 24H o u s e h o l d p o p u l a t i o n b y s i n g l e a g e s , . 265 F i g u r e D Q . 2 : 25W e i g h t a n d h e i g h t / l e n g t h m e a s u r e m e n t s b y d i g i t s r e p o r t e d f o r t h e d e c i m a l p o i n t s , S a o T o m e a n d P r i n c i p e , 2 0 1 4 . 274 Sao Tome and Principe 2014 MICS, Final Report P a g e | xxiv List of Abbreviations AIDS Acquired Immune Deficiency Syndrome ANC Antenatal Care BCG Bacillus Calmette-Guérin (Tuberculosis) CNE Centro Nacional de Endemias (National Centre for Endemic Diseases) CRC Convention on the Rights of the Child CSPro Census and Survey Processing System DHS Demographic and Health Survey DPT Diphtheria Pertussis Tetanus ECDI Early Child Development Index EPI Expanded Programme on Immunization GPI Gender Parity Index HIV Human Immunodeficiency Virus ICF ICF International IDD Iodine Deficiency Disorders INE Instituto Nacional de Estatísticas (National Institute of Statistics) IRS Indoor Residual Spraying ITN Insecticide Treated Net IUD Intrauterine Device MDG Millennium Development Goals MICS Multiple Indicator Cluster Survey MICS5 Fifth global round of Multiple Indicator Clusters Surveys programme NAR Net Attendance Rate NGO Non-Governmental Organization ORS Oral Rehydration Salts ORT Oral Rehydration Treatment PCV Pneumococcal Conjugate Vaccine Penta Pentavalent vaccine, which includes antigens for diphtheria, pertussis, tetanus, hepatitis B and Haemophilus influenzae type B RDT Rapid Diagnostic Test RHF Recommended Home Fluid ppm Parts Per Million SPSS Statistical Package for Social Sciences UNDP United Nations Development Programme UNGASS United Nations General Assembly Special Session on HIV/AIDS UNICEF United Nations Children’s Fund WFFC World Fit for Children WHO World Health Organization Sao Tome and Principe 2014 MICS, Final Report P a g e | xxv Acknowledgements It is with great pleasure that the Government of the Democratic Republic of Sao Tome and Principe, through the National Institute of Statistics (INE) and the National Centre for Endemic Diseases (CNE), presents the main results of the Multiple Indicator Cluster Survey (MICS) technically coordinated by UNICEF. The Multiple Indicator Cluster Survey (MICS5) of Sao Tome and Principe was implemented in 2014 by the National Institute of Statistics of Sao Tome and Principe in collaboration with the UNDP/Global Fund project. MICS5 is an instrument of utmost importance for the monitoring of programmes in Sao Tome and Principe as it gives access to the country to statistical information to orient policies and programmes implemented by the Government as well as other international commitments. The global MICS programme was developed by UNICEF in the 1990s as an international household survey programme to support countries in the collection of internationally comparable data on a wide range of indicators on the situation of children and women. MICS surveys measure key indicators that allow countries to generate data for use in policies and programmes, and to monitor progress towards the Millennium Development Goals (MDGs) and other internationally agreed upon commitments. Beside the estimation of socio-demographic and health variables, this survey also helps to shed some light on the social phenomenon of domestic violence against women or children. MICS revealed that the percentage of registered children below five years of age passed from 68.8 percent in 2006 to 95.2 percent in 2014. Infant mortality rates decreased from 45 per 1000 in 2006 to 36 per 1000 in 2014, and maternal mortality ratio from 267 per 100,000 to 74 per 100,000. An Ethics Committee was put in place to oversee ethical aspects that such a survey entails and to ensure the preservation of the rights of the users of this research. The Ethics Committee is an independent and multisectoral entity that was charged to preserve and guarantee the dignity of the rights, security and well-being of the survey participants who tested for HIV. The National Institute of Statistics expresses its sincere thanks to the Government of the Democratic Republic of Sao Tome and Principe, to UNICEF and to the UNDP/Global Fund. It is also grateful to the technicians of the National Institute of Statistics and of the Ministry of Health, as well as to the supervisors, editors, data typists and families who contributed towards the realization of this work. ELSA MARIA CARDOSO (General Director) Sao Tome and Principe 2014 MICS, Final Report P a g e | xxvi Executive Summary This report is based on the Sao Tome and Principe Multiple Indicator Cluster Survey (MICS), conducted in 2014 by the National Institute of Statistics. The survey provides statistically sound and internationally comparable data essential for developing evidence-based policies and programmes, and for monitoring progress toward national goals and global commitments. Among these global commitments are those emanating from the World Fit for Children Declaration and Plan of Action, the goals of the United Nations General Assembly Special Session on HIV/AIDS, the Education for All Declaration and the Millennium Development Goals (MDGs). The objective of the 2014 MICS is to update some of the results of previous surveys, to evaluate the progress made with the various programmes of cooperation, and to identify remaining challenges. The survey also permitted to get an update on the sero-prevalence of HIV among men and women, anaemia among children and women, and malaria among children, measurements that were added to the standard MICS. Methodology The sample was designed to provide estimates for a large number of indicators on the situation of children and women at the national level, for urban and rural areas, and for four regions of the country later on recast into: Region Centre East, Region North West, Region South East, and Autonomous Region of Principe. Five sets of questionnaires were used in the survey. The Household Questionnaire included the following modules: o List of Household Members o Education o Child Labour o Child Discipline o Household Characteristics o Insecticide Treated Nets o Indoor Residual Spraying o Water and Sanitation o Handwashing o Salt Iodization The Questionnaire for Individual Women was administered to all women age 15-49 years living in the households, and included the following modules: o Woman’s Background o Access to Mass Media and Use of Information/Communication Technology o Fertility/Birth History o Desire for Last Birth o Maternal and Newborn Health o Post-natal Health Checks o Illness Symptoms o Contraception Sao Tome and Principe 2014 MICS, Final Report P a g e | xxvii o Unmet Need o Attitudes Toward Domestic Violence o Marriage/Union o Sexual Behaviour o HIV/AIDS o Maternal Mortality o Tobacco and Alcohol Use o Life Satisfaction The Questionnaire for Individual Men was administered to all men age 15-49 years living in the households, and included the following modules: o Man’s Background o Access to Mass Media and Use of Information/Communication Technology o Fertility o Attitudes Toward Domestic Violence o Marriage/Union o Sexual Behaviour o HIV/AIDS o Circumcision o Tobacco and Alcohol Use o Life Satisfaction The Questionnaire for Children Under Five was administered to mothers (or caretakers) of children under 5 years of age living in the households, and included the following modules: o Age o Birth Registration o Early Childhood Development o Breastfeeding and Dietary Intake o Immunization o Care of Illness o Anthropometry The Blood Test Questionnaire was administered to all households and included the following modules: o Anaemia and malaria test for children age 6-59 months o Anaemia and HIV test for women age 15-49 years o HIV test for men age 15-49 years The implementation of blood testing in this survey provided a public health opportunity for the provision of information on malaria symptoms to mothers of young children, including sensitisation on the need to take the child to the nearest health facility in case of symptoms. Further, referral cards to Voluntary Counselling and Testing services were handed-over to all respondents, including those who refused to be tested for HIV. The protocol for HIV anonymous testing was approved by the International Review Board of ICF International as well as the MICS Ethics Committee. Analysis of the HIV blood samples-related data was only carried out once the MICS data had been “scrambled” and anonymized. Sao Tome and Principe 2014 MICS, Final Report P a g e | xxviii Sample coverage and characteristics of households and respondents Of the 3,930 households selected for the sample, 3,625 were found to be occupied. Of these, 3,492 were successfully interviewed which leads to a household response rate of 96 percent. The women’s response rate was 95 percent, the men’s response rate 82 percent, and the children’s response rate 98 percent. According to the results of this survey, children and youth less than 18 years of age constitute over half of the population of Sao Tome and Principe (51 percent), while 44 percent are below 15 and only 4 percent 65 or older, characterizing the nation’s population as predominantly young. These results are nearly identical to those of the 2012 census. Two-thirds of households (66 percent) are found in urban areas; one third (35 percent) are female headed. The mean household size is 3.9. The majority (56 percent) of women age 15-49 years are currently married or in union, but a notable proportion (18 percent) are separated. Nearly three- quarters (73 percent) of women in this age group have started child bearing, and 48 percent gave birth in the last two years. Nearly half (48 percent) of men age 15-49 years are currently married or in union, while 10 percent are separated. Overall, 93 percent of children below five years of age live with their biological mother. Over three-quarters of households (76 percent) have electricity in urban areas, compared with 55 percent in rural areas. Finished roofing (mostly corrugated iron) and walls (mostly wood planks) are nearly universal in Sao Tome and Principe. However, a majority of households (57 percent) have a floor made of rudimentary material (mostly wood planks). Mobile phones are very common in both urban (82 percent) and rural (78 percent) households. On the other hand, ownership of computers is still relatively rare even in urban households (15 percent). About two rural households in five (42 percent) own agricultural land. Child mortality For the most recent 5-year period neonatal mortality is estimated at 22 per 1,000 live births, post- neonatal mortality at 16 per 1,000 live births, infant mortality at 38 per 1,000 live births, and under- five mortality at 45 deaths per 1,000 live births. Comparing these findings with those of previous surveys (2000 MICS, 2006 MICS and 2008-2009 DHS), a smooth declining trend is observed over the last 15 to 20 years with a tendency to stabilize in most recent years. Nutrition Low birth weight Overall, 94 percent of newborns were weighed at birth and approximately 8 percent of infants are estimated to weigh less than 2,500 grams at birth (low birth weight). There is no evidence of meaningful differences in the prevalence of low birth weight by region, urban and rural areas or by mother’s education. Sao Tome and Principe 2014 MICS, Final Report P a g e | xxix Malnutrition It is estimated that 9 percent of children under age five in Sao Tome and Principe are underweight (2 percent are severely so), while 17 percent are stunted or too short for their age (5 percent are severely so). In addition, 4 percent are moderately or severely wasted or too thin for their height. A small proportion (2 percent) of children are overweight or too heavy for their height. There are no meaningful differences between urban and rural areas. Regions are also fairly similar with respect to these four indicators, except for stunting where the differences are larger, ranging from 11 percent in Region Autónoma de Principe to 23 percent in Region South East. Breastfeeding While 97 percent of children born in the last two years were breastfed, only 38 percent of babies are breastfed for the first time within one hour of birth, and 86 percent of newborns start breastfeeding within one day. Approximately three-quarters (74 percent) of children age less than six months are exclusively breastfed, while 85 percent are predominantly breastfed. At age 12-15 months, 86 percent of children are still being breastfed, which is remarkable, but breastfeeding drops drastically from that point to a mere 24 percent by age 20-23 months. As a result of feeding patterns, only 59 percent of children age 6-23 months are considered as being appropriately breastfed. Age- appropriate breastfeeding among all children age 0-23 months is of 62 percent, with a declining trend from the poorest quintile (71 percent) to the richest (58 percent). Feeding frequency and dietary diversity Overall, 74 percent of infants age 6-8 months received solid, semi-solid, or soft foods at least once the previous day, while 58 percent of the children age 6-23 months did so the minimum number of times. The proportion of children receiving the minimum dietary diversity, or foods from at least 4 food groups, is 47 percent, suggesting the need to focus on improving diet quality and nutrient intake. The overall assessment using the indicator of minimum acceptable diet reveals that only 22 percent of children age 6-23 months are benefitting from a diet sufficient in both diversity and frequency. Bottle-feeding The continued practice of bottle-feeding is a concern because of the possible contamination due to unsafe water and lack of hygiene in preparation. Of the children under 6 months, 10 percent are fed using a bottle with a nipple, but the proportion rises to 21 percent among children age 6-11 months. The prevalence is much higher in the children of mothers with secondary or higher education (25 percent) than with no formal or only primary education (10 percent), and in the wealthiest (32 percent) than the poorest (9 percent) households. Salt iodization In 88 percent of households, salt was found to contain 15 parts per million or more of iodine, the recommended proportion. Use of iodized salt ranges from 82 percent in Region South East to 93 percent in Autonomous Region of Principe. The difference between the richest (95 percent) and poorest (81 percent) households is significant. Sao Tome and Principe 2014 MICS, Final Report P a g e | xxx Child health Immunization The vaccination schedule followed by the Sao Tome and Principe’s National Immunization Programme includes birth doses of BCG and Polio, three doses of the Pentavalent vaccine , four doses of Polio vaccine, three doses of the Pneumococcal vaccine, two doses of the measles vaccine, and one dose of vaccine against yellow fever. All vaccinations should be received during the first year of life except the fourth dose of Polio (one year after the third dose) and the second dose of measles (between 18 and 23 months). The estimates for full immunization coverage are based on children age 12-23 months and exclude the fourth dose of Polio and the second dose of measles. Approximately 97 percent of children age 12-23 months received a BCG vaccination by the age of 12 months. The first dose of Penta was given to 95 percent and the third to 93 percent. For polio, the difference between the first and third dose is somewhat larger (95 and 89 percent respectively). As the pneumococcal conjugate vaccine (PCV), coverage for the first dose by the age of 12 months is notably lower at 87 percent and declines further to 82 percent for the third dose. The coverage is of 89 percent for both yellow fever and measles. There is a rather large gap between the antigen with the lowest coverage (82 percent for PCV3) and the percentage of children who had all the recommended vaccinations by their first birthday which is only 66 percent. This suggests that for a notable proportion of children there are one or several missed immunization opportunities before the age of 12 months. A total of 72 percent women who have had a live birth within the last 2 years and their newborns were protected against tetanus. Diarrhoea The percentage of children with diarrhoea in the two weeks preceding the survey is 18 percent. A health facility or provider was seen in 54 percent of cases. Advice or treatment was sought for a higher proportion of rural (64 percent) than urban (46 percent) children. As for drinking and feeding practices during diarrhoea, 42 percent of under five children with diarrhoea were given more to drink than usual while 56 percent were given the same quantity or less. The majority (87 percent) were given somewhat less, the same or more to eat (continued feeding), while 13 percent were given much less or almost nothing. Half of the children (49 percent) who had an episode of diarrhoea in the two weeks preceding the survey received fluids from ORS packets and one quarter (25 percent) of them received recommended homemade fluids (a water, sugar and salt mixture, and/or rice water). Overall, 73 percent of children with diarrhoea received oral rehydration therapy (ORT) (ORS or recommended homemade fluids or increased fluids). It is observed that 62 percent of children received ORT and, at the same time, feeding was continued, as is the recommendation. Acute respiratory infections (ARI) Overall, 69 percent of children age 0-59 months with symptoms of ARI in the two weeks preceding the survey were taken to a qualified provider and 48 percent received antibiotics. It appears that the use of antibiotics in such circumstances is more prevalent in rural (68 percent) than in urban (38 percent) areas. Overall, 33 percent of women know at least one of the two danger signs of pneumonia – fast and/or difficult breathing. This ranges from 28 percent in Region South East to 55 percent in Autonomous Region of Principe, but is otherwise fairly uniform among urban and rural, more or less educated, and poorer and wealthier mothers. Sao Tome and Principe 2014 MICS, Final Report P a g e | xxxi Solid fuel use Overall, 42 percent of the household population in Sao Tome and Principe uses solid fuels for cooking, consisting mainly of wood (33 percent). Use of solid fuels is substantial even in urban areas (33 percent), and predominant in rural areas, where they are used by 59 percent of household members. The findings show that use of solid fuels ranges from 27 percent in Region Centre East to 76 percent in Autonomous Region of Principe. Malaria and fever The results indicate that 78 percent of households have at least one insecticide treated net (ITN), and 55 percent at least one ITN for every two household members. Overall, 91 percent of households received indoor residual spraying during the last 12 months. Urban areas have higher coverage of ITN than their rural counterparts (82 and 69 percent respectively), and so do wealthiest households in relation to poorest ones (87 versus 65 percent respectively). Coverage of ITN by region ranges from 70 percent in Region South East to 86 percent in Autonomous Region of Principe. Overall, 31 percent of individuals are estimated to have access to ITNs, i.e. they could sleep under an ITN if each ITN in the household was used by two people. Access is higher in urban (34 percent) than in rural (24 percent) areas. Access decreases with poverty and ranges from 45 percent among the wealthiest to 20 percent among the poorest. Overall, 70 percent of ITNs were used during the night preceding the survey. As for children under the age of five years, 61 percent slept under an ITN the night preceding the survey. Of note is the very high proportion (96 percent) of children under five who the previous night slept either under an ITN or in a house that had indoor residual spraying (IRS) in the last 12 months. In terms of care-seeking behaviour during an episode of fever in the past two weeks, advice was sought from a health facility or a qualified health care provider for 66 percent of children with fever. However, no advice or treatment was sought in 33 percent of the cases. Figures also indicate that seeking advice in the case of fever is more likely for children of a younger age than older ones (73 and 62 percent respectively), and for children living in the wealthiest than in the poorest households (77 and 59 percent respectively). Overall, 42 percent of children with a fever in the previous two weeks had blood taken from a finger or heel for testing. Further, 0.2 percent of children with fever in the last two weeks were treated with an artemisinin-based combination therapy (ACT) and 1.4 percent received an antimalarial. Interpretation of these results must take into consideration the low prevalence of malaria in Sao Tome and Principe. The proportion of pregnant women who slept under a mosquito net during the previous night is 62 percent. It varies from 45 percent in Region South East to 65 percent in Region Centre East. It tends to be higher in urban (66 percent) than in rural (50 percent) areas. Of note is the very high proportion (94 percent) of pregnant women who the previous night slept either under an ITN or in a house that had indoor residual spraying (IRS) in the last 12 months. Overall, 90 percent of pregnant women who had a live birth in the two years preceding the survey, and who received antenatal care, took medicine at least once to prevent malaria at any of ANC visit; however, only 12 percent took medicine three or more times as recommended. Sao Tome and Principe 2014 MICS, Final Report P a g e | xxxii The results of blood tests show a low prevalence of malaria in children. Only 0.5 percent of the rapid diagnostic test (RDT) and 0.2 percent of the thick blood smears implemented in children gave positive results, which leads to the conclusion that the prevalence of malaria was extremely low in Sao Tome and Principe during the time of the survey (mid-2014). Anaemia in children Blood was also collected for the haemoglobin test from children age 6-59 months. Over six children in ten (67 percent) in the 6-59 months age group suffer from anaemia: light anaemia in 33 percent of cases, moderate in another 33 percent and severe in 1 percent. In the 6-23 months age group, over four children in five suffer from anaemia. The Region South East and Autonomous Region of Principe have a somewhat higher prevalence (74 and 72 percent respectively) than the rest of the country. With respect to the wealth quintiles, it can be seen that the lowest prevalence is in children from the wealthiest households. The prevalence of severe anaemia in children is low (1 percent). Water and sanitation Water Improved sources of drinking water include: piped water (into dwelling, compound, yard or plot, to neighbour, public tap/standpipe), tube well/borehole, protected well, protected spring, and rainwater collection. Overall, 94 percent of the population uses an improved source of drinking water98 percent in urban areas and 86 percent in rural areas. While such results are admirable, some areas require additional efforts, such as Autonomous Region of Principe where the indicator is considerably lower (74 percent). Countrywide, the indicator ranges from 91 percent among the poorest to nearly 100 percent among the wealthiest. The source of drinking water for the population varies strongly by region. Access to drinking water that is piped into the yard or dwelling ranges from 33 percent in Region Centre East to 13 percent in Region South East. Accessing drinking water through public taps ranges from 71 percent in Region South East to 39 percent in Autonomous Region of Principe. Drinking water mainly from rivers and streams (an unimproved source) is still prevalent in some regions, notably Autonomous Region of Principe (12 percent) and Region North West (8 percent), while unprotected springs are commonly used in Autonomous Region of Principe (13 percent). For 42 percent of the household population, the drinking water source is on premises. While 92 percent of the wealthiest have water on premises, only 10 percent of the poorest have this benefit. For nearly a quarter of the household population (23 percent), it takes the household more than 30 minutes to get to the water source and bring water. One finding of note is the comparatively high percentage of household members in Region South East (28 percent), who live in households spending 30 minutes or more to go to source of drinking water. For over two-thirds of households (69 percent), an adult female usually collects drinking water when the source is not on the premises. Adult men collect water in only 19 percent of cases, while for the rest of the households, female or male children under age 15 collect water (11 percent). Sao Tome and Principe 2014 MICS, Final Report P a g e | xxxiii Sanitation 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. Nearly half of the population (47 percent) lives in households using improved sanitation facilities, 53 percent in urban and 36 percent in rural areas. Residents of Region North West are less likely than others to use improved facilities (27 percent). Open defecation is prevalent, and is used by 61 percent of the rural and 42 percent of the urban population. After that, improved latrines with toilets are the most common sanitation facilities, used by 27 percent of the urban and 23 percent of the rural population. Modern bathrooms are used by 17 percent of the population, mostly in urban areas. The expression “use of improved sanitation” is used to refer to improved sanitation facilities, which are not public or shared. The survey found that 41 percent of the household population is using an improved sanitation facility, ranging from 25 percent in Region North West to 51 percent in Autonomous Region of Principe, and from 8 percent among the poorest to 89 percent among the wealthiest. Jointly, 40 percent of the household population has access to both improved drinking water and improved sanitation, 46 percent in urban and 27 percent in rural areas, and 89 percent of the wealthiest but only 7 percent of the poorest. 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. Overall, only 29 percent of last stools of children age 0-2 years were disposed safely according to the current criteria. Handwashing In Sao Tome and Principe, a specific place for handwashing was observed in about half of the households (51 percent). Overall, 40 percent of householdsi had a specific place for handwashing supplied with water and soap (or another cleansing agent). Soap or another cleansing agen could be observed anywhere in the dwelling In 76 percent of households. The percentage was similar in urban and rural areas, but ranged from 55 to 94 percent between the poorest and wealthiest households. The differences between regions were also substantial, ranging from 57 percent in Region South East to 88 percent in Autonomous Region of Principe. Reproductive health Fertility Age-specific fertility rates (ASFRs), expressed as the number of births per 1,000 women in a specified age group, show the age pattern of fertility. The total fertility rate (TFR) is a synthetic measure that denotes the number of live births a woman would have if she were subject to the current age- specific fertility rates throughout her reproductive years (15-49 years). i Households with a specific place for handwashing that was not observed by the interviewers are not included in the denominator. Sao Tome and Principe 2014 MICS, Final Report P a g e | xxxiv The overall age pattern of fertility, as reflected in the ASFRs, indicates that childbearing begins early in Sao Tome and Principe. Fertility is low among adolescents, increases to a peak of 221 births per 1,000 among women age 20-24, and declines thereafter. The adolescent birth rate (age-specific fertility rate for women age 15-19) is estimated at 92 and shows a large variation between the wealth quintiles, from 29 among the wealthiest to 154 among the poorest. A similar trend is seen in the total fertility rate which ranges from 3.7 among the wealthiest to 5.3 among the poorest, from 2.5 among women with higher education to 7.1 among women with no formal education. It is estimated that 16 percent of women age 15-19 have already had a birth, 5 percent are pregnant with their first child, and nearly 1 percent has had a live birth before age 15. The latter cases are almost exclusively seen among the 40 percent poorest. Results indicate that 27 percent of women age 20-24 have had a live birth before age 18. Here again, the poorest are more affected (35 percent) than the wealthiest (12 percent), as are those with no formal education or only primary level (42 percent) compared with those with secondary or higher education (18 percent). Contraception Current use of contraception was reported by 41 percent of women currently married (or in union). The most popular method is the pill which is used by 15 percent of married women. The next most popular method is injectables, used by 12 percent of married women, while male condom is used by 5 percent of them. Any of the other methods accounts for less than 3 percent individually. Contraceptive prevalence ranges from 38 percent in Region Centre East to 57 percent in Autonomous Region of Principe. About 46 percent of married women in urban and 38 percent in rural areas use a method of contraception. Women’s education level is strongly associated with contraceptive prevalence. The percentage of married women using any method of contraception rises from 25 percent among those with no education, to 39 percent among those with primary education, 43 percent among those with secondary education, and then 59 percent among those with higher education. Unmet need Unmet need for contraception refers to fecund women who are married or in union and are not using any method of contraception, but who wish to postpone the next birth (spacing) or who wish to stop childbearing altogether (limiting). Unmet need for contraception stands at 33 percent overall, and ranges from 21 percent in Autonomous Region of Principe to 36 percent in Region Centre East. There are no marked differences between women living in urban or rural areas, and the levels are roughly comparable as well between those of different education or wealth levels. Met need for limiting includes women married or in union who are using (or whose partner is using) a contraceptive method, and who want no more children, are using male or female sterilization, or declare themselves as infecund. Met need for spacing includes women who are using (or whose partner is using) a contraceptive method, and who want to have another child, or are undecided whether to have another child. The total of met need is estimated at 41 percent countrywide, with differences between regions ranging from 38 percent in Region Centre East to 57 percent in Autonomous Region of Principe. Using information on contraception and unmet need, the percentage of demand for contraception satisfied can be estimated. The total demand for contraception is estimated to be around 55 percent Sao Tome and Principe 2014 MICS, Final Report P a g e | xxxv countrywide, and ranges from 51 percent in Region Centre East to 73 percent in Autonomous Region of Principe. Antenatal care Antenatal care coverage indicators (at least one visit with a skilled provider and 4 or more visits with any providers) are used to track progress toward the Millennium Development Goal 5 of improving maternal health. Only a small percentage (2 percent) of women do not receive antenatal care in Sao Tome and Principe. The majority of antenatal care services are provided by nurses and midwives while a minority of women receive care from a medical doctor, both in urban and rural areas. Over nine in ten mothers (91 percent) received antenatal care more than once and 84 percent of mothers received antenatal care at least four times. Mothers from the poorest households and those with primary education are less likely than more advantaged mothers to receive antenatal care four or more times. For example, 73 percent of the women living in poorest households reported four or more antenatal care visits compared with 93 percent among those living in richest households. For 67 percent of women with a live birth in the last two years, their first antenatal care visit was during the first trimester of their last pregnancy. A larger proportion of women from wealthiest households had their first antenatal care visit during the first trimester than those from the poorest households (84 and 52 percent respectively). Assistance at delivery About 92 percent of births occurring in the two years preceding the MICS survey were delivered by skilled personnel. This percentage is fairly constant across regions except Region South East estimated at 82 percent; this is also the only region with a substantial proportion of deliveries assisted by traditional birth attendants (13 percent). The likelihood to be delivered by a skilled attendant increases with education and wealth, and is higher in the urban (95 percent) than in the rural (88 percent) areas. Deliveries are predominantly assisted by midwives and nurses (81 percent) and a much smaller proportion (12 percent) by medical doctors. Place of delivery About 91 percent of births are delivered in a health facility, nearly all of which are in public sector facilities. Home deliveries account for about 8 percent. The proportion of institutional deliveries is above 90 percent in all regions except Region South East where it is estimated at 77 percent and where 21 percent of deliveries take place at home. The proportion of births occurring in a health facility increases steadily with wealth, from 82 percent in the lowest wealth quintile to nearly 100 percent in the highest. Post-natal health checks Overall, 99 percent of women who gave birth in a health facility stay 12 hours or more in the facility after delivery. Three-quarters of women stay three days or more, and in Region North West this value increases to 88 percent. Overall, 89 percent of newborns receive a health check following birth while in a facility or at home. With regards to post-natal care visits (PNC), these predominantly occur after the first week following birth (60 percent). These results must be interpreted in the context of an environment in which three-quarters of the mothers stay 3 or more days at the health facility with their babies after Sao Tome and Principe 2014 MICS, Final Report P a g e | xxxvi delivery. Eventually, a total of 91 percent of all newborns receive a post-natal health check. Health checks following birth occur mainly in health facility deliveries (93 percent). It is estimated that 85 percent of mothers receive a health check following birth while in a facility or at home, not dissimilar to the 89 percent registered for newborns. With regards to PNC visits, they mostly occur after the first week following birth (44 percent), even though a small proportion occurs at different times over the first week. Overall, a total of 87 percent of all mothers receive a post- natal health check. With respect to the proportion of mothers and newborns who do not receive a PNC visit, the percentage is more than twice as high for mothers (46 percent) as for newborns (20 percent). Adult mortality rates Adult mortality rates are based on information collected in the Maternal Mortality module in the Women's Questionnaire. Overall mortality rates for adults age 15-49 years are estimated at 1.32 per 1,000 population in the case of males, and 1.35 per 1,000 population in the case of females. The probability of dying between exact ages 15 and 50 is estimated at 52 per 1,000 person-years in the case of males, and 49 per 1,000 person-years in the case of females. Maternal mortality The 2014 Sao Tome and Principe MICS asked women age 15-49 a series of questions designed with the explicit purpose of providing the necessary information to make direct estimates of maternal mortality. This estimation of maternal mortality is done using the direct sisterhood method. The maternal mortality ratio for Sao Tome and Principe for the 7-year period preceding the survey is estimated at 74 maternal deaths per 100,000 live births, while the maternal mortality rate is estimated at 0.11 per 1000 women-years of exposure. It must be taken into consideration however that in the 2014 MICS sample, only 3 cases of maternal deaths were identified in nearly 38,000 women-years of exposure. While the small number of maternal deaths is an encouraging finding, a larger number of cases would have been necessary for the calculation of reliable maternal mortality estimates. It is thus recommended that the estimates arrived at in this survey be considered only as indicative. Prevalence of anaemia in women Blood was collected for the haemoglobin test from women age 15-49 years living in the household who agreed voluntarily to the test. Results indicate that almost half of women (47 percent) are anaemic: light anaemia in 35 percent of cases, moderate in 10 percent, and severe in 1 percent. There is a higher prevalence of anaemia in pregnant (61 percent) than in non-pregnant women (46 percent). Over three pregnant women in ten (32 percent) have moderate anaemia, as compared with 8 percent in non-pregnant women. The prevalence of anaemia differs between age groups. In the 15-19 years group 55 percent are anaemic, as compared with 44 percent in the 40-49 years group. Between regions, prevalence ranges from 42 percent in Autonomous Region of Principe to 51 percent in Region North West. There are large differentials between educational levels, with a prevalence of 57 percent among those without formal education and of 32 percent among those with secondary education. Finally, anaemia ranges from 45 percent in women belonging to the poorest wealth quintile to 51 percent in the wealthiest. Sao Tome and Principe 2014 MICS, Final Report P a g e | xxxvii Early childhood development Early childhood care and education Overall, 36 percent of children age 36-59 months are attending an organised early childhood education programme. Boys and girls have similar opportunities, and the level of attendance is comparable in urban and rural areas. There are, however, large differences between children of wealthiest and poorest households (63 and 21 percent respectively), and those whose mothers have secondary education or higher as compared with their less privileged counterparts (52 and 29 percent respectively). Attendance between regions ranges from 34 percent in Region Centre East to 53 percent in Autonomous Region of Principe. Quality of care Information on a number of activities that support early learning was collected in the survey. These included the involvement of adults with children in the following activities: reading books or looking at picture books, telling stories, singing songs, taking children outside the home, compound or yard, playing with children, and spending time with children naming, counting, or drawing things. For almost two-thirds (63 percent) of children age 36-59 months, an adult household member engaged in four or more activities that promote learning and school readiness during the 3 days preceding the survey. The mean number of activities that adults engage with children is 4. Father’s involvement in four or more activities is merely 3 percent. Only a little over half (56 percent) of children age 36-59 months live with their biological father. Adult engagement in activities with children ranges from 78 percent in Autonomous Region of Principe to 56 percent in Region North West, while the proportion is 74 percent for children living in the richest households, against 48 percent for those living in the poorest. Only 6 percent of children age 0-59 months live in households where at least 3 children’s books are present for the child. The proportion of children with 10 or more books declines to less than 1 percent. Urban and rural areas are comparable. Further, 65 percent of children age 0-59 months have 2 or more types of playthings to play with in their homes. The types of playthings included in the questionnaires were homemade toys (such as dolls and cars, or other toys made at home), toys that came from a store, and household objects (such as pots and bowls) or objects and materials found outside the home (such as sticks, rocks, animal shells, or leaves). It is interesting to note that the proportion of children who play with household objects (66 percent) is similar to that of those who play with toys that come from a store (70 percent), while 55 percent of them play with homemade toys. It appears that in terms of proportion of children with 2 or more types of playthings, those of rural areas are at a slight advantage compared to those of urban areas (70 and 62 percent respectively). Overall, 13 percent of children age 0-59 months were left in the care of other children, while 7 percent were left alone during the week preceding the interview. Combining the two care indicators, it is estimated that a total of 16 percent of children were left with inadequate care during the past week, either by being left alone or in the care of another child. There are marked differences by socio-economic status as children from the poorest households are three times more exposed to inadequate care than those of the wealthiest households (26 and 8 percent respectively). Sao Tome and Principe 2014 MICS, Final Report P a g e | xxxviii Developmental status of children A 10-item module was used to calculate the Early Child Development Index (ECDI). The index is based on selected milestones that children are expected to achieve by ages 3 and 4. The results indicate that 55 percent of children age 36-59 months are developmentally on track. As expected, ECDI is substantially higher in the 48-59 months age group than in the younger children (61 and 48 percent respectively), since children mature more skills with increasing age. A higher ECDI of 64 percent is seen in children attending an early childhood education programme compared to 49 percent among those who are not attending. Children living in poorest households have a lower ECDI (51 percent) compared to children living in richest households (62 percent of children developmentally on track). The analysis shows that 94 percent of children are on track in the physical, 79 percent in the learning and 62 percent in the social-emotional domains. However, only 16 percent are on track in the literacy-numeracy domain. Literacy and education Literacy among young women and men Results indicate that 90 percent of young women in Sao Tome and Principe are literate. Of women who stated that primary school was their highest level of education (and the very few who declared to never have attended school), only 64 percent were actually able to read the statement shown to them. The situation, however, appears to be improving since 92 percent of young women age 15-19 are literate against 86 percent of those age 20-24. The literacy profile of young men is very similar to that of young women. School readiness Overall, 58 percent of children who are currently attending the first grade of primary school were attending pre-school the previous year. There is no gender difference and children from urban and rural areas have similar values. Socioeconomic status is correlated with school readiness; while the indicator is only 37 percent among the poorest households, it increases to 82 percent among those children living in the richest households. Primary and secondary school participation Of children who are of primary school entry age (age 6), 77 percent are attending the first grade of primary school. Attendance levels of children of both sexes, as well as those from urban and rural areas, are similar. The great majority of children of primary school age are attending school (94 percent). The net attendance ratio is similar for children of urban and rural areas and of the various regions. The secondary school net attendance ratio is only 60 percent. Of the remaining 40 percent, most are attending primary school, but 12 percent of children of secondary school age are completely out of school. The net attendance ratio for boys is lower (55 percent) than that of the girls (65 percent), mainly because a higher proportion of boys are still attending primary school. The percentage of children entering first grade who eventually reach the last grade of primary school is 92 percent. The data suggest that boys drop out more from primary school than girls, since 87 percent of boys reach the last grade compared to 96 percent of girls. Similarly, a smaller proportion of children from rural areas reach grade 6 than their urban counterparts (87 and 94 percent respectively). Finally, only 85 percent of children from the poorest households reach grade 6 Sao Tome and Principe 2014 MICS, Final Report P a g e | xxxix compared with 97 percent of those coming from the wealthiest households. The primary school completion rate is 112 percent. Gender parity for primary school is exactly 1.00, indicating no difference in the attendance of girls and boys to primary school. However, the indicator increases to 1.18 for secondary education. Girls are generally at an advantage in urban areas, with a gender parity index (GPI) of 1.24, while rural areas are closer to gender parity, with a GPI of 1.04. Child protection Birth registration The births of 95 percent of children under five years have been registered and less than one percent of children do not have a birth certificate. On the other hand, while virtually all children from wealthiest households are registered, that proportion goes down to 87 percent among the poorest. Child labour Nineteen percent of children age 5-11 years are engaged in any economic activities, while 6 percent of those age 12-14 years are engaged in such activities for at least 14 hours a week, and 3 percent of those age 15-17 years for at least 43 hours a week. With respect to household chores, girls are generally more likely to perform them than boys, and rural children tend to be more involved than their urban counterparts. Overall, 26 percent of children age 5-17 years are estimated to be in child labour, including 16 percent working in hazardous conditions. Rural children are more exposed to child labour (32 percent) than their urban counterparts (23 percent), and so are they to hazardous conditions of work (21 and 13 percent respectively). Child labour increases with age, from 24 percent in the 5-11 years to 32 percent in the 15-17 years; this last group also suffers the heaviest risk of exposure to hazardous conditions (30 percent). Child discipline For the most part, households employ a combination of violent disciplinary practices. While 64 percent of children experienced psychological aggression, more than 2 out of 3 (69 percent) experienced physical punishment during the past month. The most severe forms of physical punishment (hitting the child on the head, ears or face or hitting the child hard and repeatedly), if less common, are not rare: 10 percent of children were subjected to severe punishment the month prior to the survey. While violent methods are extremely common forms of discipline, only 6 percent of respondents believe that physical punishment is a necessary part of child-rearing. Early marriage and polygyny The percentage of women married before age 15 is 5 percent; among women age 20-49 years, about one third (32 percent) was married before age 18. Overall, 15 percent of young women age 15-19 years are currently married or in union. This proportion tends to be higher in rural (21 percent) than in urban (13 percent) areas, and is strongly related to the level of education and to the socio- economic status. Among all women age 15-49 years who are in union, 22 percent are in polygynous union. This condition is somewhat more prevalent in urban (24 percent) than in rural (19 percent) areas, and is less likely among the poorest (13 percent) than the wealthiest (25 percent). Sao Tome and Principe 2014 MICS, Final Report P a g e | xl The percentage of men married before age 15 is only 1 percent (8 percent before age 18). Only 1 percent of young men age 15-19 years are currently married or in union. Among currently married/in union women age 20-24 years, about 17 percent are married/in union with a man who is older by ten years or more. For currently married/in union women age 15-19 years, the corresponding figure is 23 percent. Attitudes toward domestic violence Overall, 19 percent of women in Sao Tome and Principe feel that a husband/partner is justified in hitting or beating his wife in at least one of the five situations presented: if she goes out without telling him, if she neglects the children, if she argues with him, if she refuses sex with him, or if she burns the food. Justification in any of the five situations is more present among those living in poorest households, and less educated. Men are less likely to justify violence than women. Overall, 14 percent of men justify wife-beating for any of the same five reasons. Men living in the poorest households are much more likely to agree with one of the five reasons (21 percent) than men living in the richest households (7 percent). Children’s living arrangements Overall, 46 percent of children age 0-17 years in Sao Tome and Principe live with both their parents, while 34 percent live with mothers only and 4 percent live with fathers only; the rest live with neither biological parents. Very few children (0.4 percent) have lost both parents, while 4 percent of children have only their mother alive and 1 percent of children have only their father alive. Overall, 16 per cent of children age 0-17 have one or both parents living abroad. The percentage of at least one parent abroad varies between 7 percent in Region South East and 19 percent in Region Centre East. It is more likely for a child living in an urban area to have at least one parent living abroad than for one living in a rural area (17 and 13 percent respectively), and there is a large difference in this indicator between children from the poorest (8 percent) and the wealthiest households (22 percent). HIV/AIDS and sexual behaviour Knowledge about HIV transmission and misconception about HIV Nearly all women and men age 15-49 years (over 99 percent) have heard of AIDS. However, the percentage of those who know of both main ways of preventing HIV transmissionhaving only one faithful uninfected partner and using a condom every timeis only 67percent for women and 73 percent for men. Overall, 55 percent of women and 62 percent of men reject the two most common misconceptions (that HIV can be transmitted by sharing food with someone with HIV or through mosquito bites) and know that a healthy-looking person can be HIV-positive. Comprehensive knowledge of HIV prevention methods and transmission is fairly low. Overall, 41 percent of women and 47 percent of men were found to have comprehensive knowledge, with little differences between the urban and rural areas. Overall, 91 percent of both women and men know that HIV can be transmitted from mother to child. The percentage of women and men who know all three ways of mother-to-child transmission is 47 percent and 40 percent, respectively, while 8 percent of women and men did not know of any specific way. Sao Tome and Principe 2014 MICS, Final Report P a g e | xli Accepting attitudes toward people living with HIV The indicators on attitudes toward people living with HIV measure stigma and discrimination in the community. Stigma and discrimination are considered low if respondents report an accepting attitude on the following four questions: 1) would care for a family member with AIDS in own home; 2) would buy fresh vegetables from a vendor who is HIV-positive; 3) thinks that a female teacher who is HIV-positive should be allowed to teach in school; and 4) would not want to keep it a secret if a family member is HIV-positive. Over 95 percent of women and men who have heard of AIDS agree with at least one accepting statement. The less commonly accepted attitude is buying fresh vegetables from a person who is HIV-positive (65 percent and 68 percent, respectively for women and men). Knowledge of a place for HIV testing, counselling and testing during antenatal care Overall, 92 percent of women and 90 percent of men knew where to be tested, while 74 percent and 52 percent, respectively, have actually been tested. Only 40 percent of women and 29 percent of men have been tested within the last 12 months. The highest proportion of tests is found in Autonomous Region of Principe. Among women who had given birth within the two years preceding the survey, 77 percent received counselling during their last pregnancy and 89 percent were offered an HIV test and were tested. There is generally a correlation between these interventions, education and socio-economic status. Sexual behaviour related to HIV transmission Overall, 3 percent of women and 29 percent of men 15-49 years of age report having sex with more than one partner in the last 12 months. Of those, only 46 percent of women and 49 percent of men reported using a condom when they had sex the last time. Among men who had sex with more than one partner in the last 12 months, a larger proportion of younger men age 15-24 years reported using a condom last time they had sex (71 percent) than older men (32 to 41 percent), and a larger proportion of wealthiest (60 percent) than poorest men (44 percent). HIV indicators for young women and young men In young women and young men age 15-24, results with respect to comprehensive knowledge (42 percent of young women and 43 percent of young men), knowledge of mother-to-child transmission (46 percent of young women and 38 of young men), and knowledge of a place to get tested (88 percent of young women and 85 of young men) are generally similar to that of the population age 15-49 years as a whole. Accepting attitudes towards people living with HIV with respect to the same four indicators that were previously discussed are also comparable in this age group (13 percent of young women and 19 percent of young men). Overall, 48 percent of young women and 22 percent of young men in this age group, who are sexually active, have been tested for HIV in the last 12 months and know the result. Overall, 65 percent of young women and 64 percent of young men age 15-24 years reported ever having sex; 9 percent and 18 percent, respectively, reported having sex for the first time before the age of 15. Further, 4 percent of young women and 22 percent of young men had sex with more than one partner in the last 12 months; of those approximately 58 percent of women and 71 percent of men reported using a condom the last time. On the other hand, 25 percent of the young women and 47 percent of the young men who had sex in the last 12 months reported that it involved a non- Sao Tome and Principe 2014 MICS, Final Report P a g e | xlii marital non-cohabiting partner; of those 65 percent of women and 83 percent of men used a condom the last time. About 18 percent of women age 15-24 years had sex with a man 10 or more years older in the last 12 months. Traditionally, circumcision does not form part of cultural practices in Sao Tome and Principe. However, an indicator on circumcision was introduced in the 2014 MICS as part of the CNE’s interest in promoting safe male circumcision as an HIV prevention method. According to the results of this survey, only 3 percent of men age 15-49 are circumcised. Prevalence of HIV in men and women Blood samples were taken from all eligible men and women who voluntarily accepted to be tested for HIV, with an effective coverage of 80 percent: 89 percent among women and 70 percent among men. The results indicate that the prevalence of HIV infection in the 15-49 years population is 0.5 percent in both men and women. They suggest a slight upward trend from the youngest to the oldest in both sexes. With such low HIV prevalence in both men and women, the differentials between various background characteristics are generally small. There seems to be a slightly higher prevalence among divorced or separated individuals (1.5 percent), while it is of 0.4 percent among those who are married or in union, and 0.2 percent among those who are single. HIV prevalence in the 15-24 age group is only 0.1 percent. Access to mass media and use of information/communication technology Access to mass media About 18 percent of women in Sao Tome and Principe read a newspaper or magazine, 77 percent listen to the radio, and 85 percent watch television at least once a week. Overall, 9 percent do not have regular exposure to any of the three media, while 91 percent are exposed to at least one and 16 to all the three types of media on a weekly basis. Men age 15-49 years report a notably higher level of exposure to all types of media than women. At least once a week, 32 percent of men read a newspaper or magazine, 83 percent listen to the radio, and 90 percent watch television. About 5 percent do not have regular exposure to any of the three media, while 95 percent are exposed to at least one and 28 to all the three types of media on a weekly basis. Use of information/communication technology It is estimated that 48 percent of 15-24 year old women ever used a computer, 37 percent used a computer during the last year, and 27 percent used one at least once a week during the last month. Overall, 37 percent of women age 15-24 ever used the internet, while 32 percent used it during the last year. The proportion of young women who used the internet more frequently, at least once a week during the last month, is smaller, at 24 percent. As expected, both the computer and internet use during the last 12 months is more widespread among the 15-19 year old women, but not by much. Higher utilisation of the internet last year is observed among young women in urban areas (36 percent) compared to those in rural areas (24 percent). The use of the internet during the last year ranges from 16 percent in Region North West to 39 percent in Region Centre East, while the Sao Tome and Principe 2014 MICS, Final Report P a g e | xliii proportion is 64 percent for young women in the richest households, as opposed to 10 percent in those living in the poorest households. It is estimated that 48 percent of 15-24 year old men used a computer during the last year while 43 percent used the internet in the same period. The differentials in terms of background characteristics generally go in the same direction as those observed among young women. For example, 12 percent of young men in the poorest households used the internet during the last year compared to 76 percent among the young men in the richest households. Subjective well-being Life satisfaction is a measure of an individual’s perceived level of well-being. Understanding young women and young men’s satisfaction in different areas of their lives can help to gain a comprehensive picture of young people’s life situations. Of the different domains, young women are the most satisfied with their look (82 percent), their family life (80 percent), and their friendships (79 percent). The results for young men are somewhat higher; they are the most satisfied with the way they look (89 percent,) their health (86 percent) and their friendships and family life (both 84 percent). Among the domains, both young women and young men are the least satisfied with their current income, with 71 percent of young women and 46 percent of young men not having an income at all. Overall, 76 percent of 15-24 year old women are satisfied with their life overall; the figures are remarkably similar between the various categories of wealth, but vary between regions from 73 percent, for Region Centre East, to 85 percent in Region North West. Urban and rural areas are similar. Young men are somewhat more satisfied with their life (84 percent) than young women (76 percent), and there is some evidence that life satisfaction is highest among the poorest (91 percent). It is estimated that 74 percent of women and 77 percent of men age 15-24 years are very or somewhat happy. Differences by wealth quintiles can be observed for this indicator and favour the poorest. The proportion of women age 15-24 years who think that their lives improved during the last one year and who expect that their lives will get better after one year, is 59 percent. The corresponding indicator for men age 15-24 years is similar at 63 percent. Tobacco and alcohol use Tobacco use In Sao Tome and Principe, ever and current use of tobacco products is more common among men than among women. Overall, 33 percent of men and 8 percent of women reported to have ever used a tobacco product, while 9 percent of men and only 1 percent of women smoked cigarettes, or used smoked or smokeless tobacco products on one or more days during the last one month. Results show that less than 1 percent of women and 1 percent of men 15-49 years old smoked a cigarette for the first time before age 15. Alcohol use Overall, 53 percent of women age 15-49 years had at least one drink of alcohol on one or more days during the last one month, 7 percent of women of the same age group first drank alcohol before the Sao Tome and Principe 2014 MICS, Final Report P a g e | xliv age of 15, and 21 percent of women never had an alcoholic drink. Among the younger age groups, the proportion of women who had at least one drink of alcohol before age 15 is higher (15 percent) than among the older age groups. The proportion of men that consume alcohol is considerably higher than that of women. Overall 67 percent of men 15-49 years old had at least one drink of alcohol on one or more days during the last one month. Use of alcohol before the age of 15 is also more common among men (12 percent) than among women (7 percent). As for young women, the proportion among young men who had at least one drink of alcohol before age 15 is higher among the younger age groups. Sao Tome and Principe 2014 MICS, Final Report P a g e | 1 I. Introduction Background This report is based on the Sao Tome and Principe Multiple Indicator Cluster Survey (MICS), conducted in 2014 by the National Institute of Statistics. The survey provides statistically sound and internationally comparable data essential for developing evidence-based policies and programmes, and for monitoring progress toward national goals and global commitments. Among these global commitments are those emanating from the World Fit for Children Declaration and Plan of Action, the goals of the United Nations General Assembly Special Session on HIV/AIDS, the Education for All Declaration and the Millennium Development Goals (MDGs). A Commitment to Action: National and International Reporting Responsibilities The governments that signed the Millennium Declaration and the World Fit for Children Declaration and Plan of Action also committed themselves to monitoring progress towards the goals and objectives they contained: “We will monitor regularly at the national level and, where appropriate, at the regional level and assess progress towards the goals and targets of the present Plan of Action at the national, regional and global levels. Accordingly, we will strengthen our national statistical capacity to collect, analyze and disaggregate data, including by sex, age and other relevant factors that may lead to disparities, and support a wide range of child- focused research. We will enhance international cooperation to support statistical capacity-building efforts and build community capacity for monitoring, assessment and planning.” (A World Fit for Children, paragraph 60) “…We will conduct periodic reviews at the national and subnational levels of progress in order to address obstacles more effectively and accelerate actions.…” (A World Fit for Children, paragraph 61) The Plan of Action of the World Fit for Children (paragraph 61) also calls for the specific involvement of UNICEF in the preparation of periodic progress reports: “… As the world’s lead agency for children, the United Nations Children’s Fund is requested to continue to prepare and disseminate, in close collaboration with Governments, relevant funds, programmes and the specialized agencies of the United Nations system, and all other relevant actors, as appropriate, information on the progress made in the implementation of the Declaration and the Plan of Action.” Similarly, the Millennium Declaration (paragraph 31) calls for periodic reporting on progress: “…We request the General Assembly to review on a regular basis the progress made in implementing the provisions of this Declaration, and ask the Secretary-General to issue periodic reports for consideration by the General Assembly and as a basis for further action.” The national statistical system experienced large reforms in the last decade with the adoption of the statutory law (law 5/98, decree 17/2001) of the National Institute of Statistics (INE). The implementation of the first Demographic and Health Survey (DHS) in 2008-2009 provided critical information to monitor and evaluate the impact of social programmes put into action by the government, including in the area of public health. In addition to measuring a range of socio- demographic indicators, particularly those related to reproductive health and child survival, it Sao Tome and Principe 2014 MICS, Final Report P a g e | 2 provided the opportunity to measure the prevalence of anaemia, the sero-prevalence of HIV in the sexually active population, as well as the prevalence of the hepatitis B virus. In addition to the DHS, the government of Sao Tome and Principe implemented, between 2009 and 2010, a national household survey to evaluate poverty (IOF), in view of a redefinition of the direction of its economic and social development policies, and to address existing constraints and challenges in terms of data availability. The results are being used to elaborate the report on the PRSP and the Millennium Development Goals (MDG). Statistics are available on a total of 51 indicators related to the National Strategy for the Reduction of Poverty and the MDG. The objective of the 2014 MICS is to update some of the results of previous surveys, to evaluate the progress made with the various programmes of cooperation, and to identify remaining challenges. The survey also permitted to get an update on the sero-prevalence of HIV, anaemia and malaria, measurements that were added to the standard MICS. The 2014 Sao Tome and Principe MICS is expected to contribute to the evidence base of several other important initiatives, including Committing to Child Survival: A Promise Renewed, a global movement to end child deaths from preventable causes, and the accountability framework proposed by the Commission on Information and Accountability for the Global Strategy for Women's and Children's Health. In relation to HIV and malaria, this report provides evidence to inform the country’s efforts towards AIDS and malaria elimination. It also contains up-to-date data required to support the country’s resource mobilization efforts vis-à-vis the Global Fund to fight AIDS, tuberculosis and malaria. This final report presents the results of the indicators and topics covered in the survey. Survey Objectives The 2014 Sao Tome and Principe MICS has as its primary objectives:  To provide up-to-date information for assessing the situation of children and women in Sao Tome and Principe;  To generate data for the critical assessment of the progress made in various areas, and to highlight the need for additional efforts in those areas that require more attention;  To furnish data needed for monitoring progress toward goals established in the Millennium Declaration and other internationally agreed upon goals, as a basis for future action;  To collect disaggregated data for the identification of disparities, to allow for evidence based policy-making aimed at social inclusion of the most vulnerable;  To contribute to the generation of baseline data for the post-2015 agenda;  To validate data from other sources and the results of focused interventions. Sao Tome and Principe 2014 MICS, Final Report P a g e | 3 II. Sample and Survey Methodology Sample Design The sample for the 2014 Sao Tome and Principe Multiple Indicator Cluster Survey was designed to provide estimates for a large number of indicators on the situation of children and women at the national level, for urban and rural areas, and for four regions: Água Grande, Mè Zochi, a southern region composed of the districts of Cantagalo and Cauée, and a northern region composed of the districts of Lembá and Lobata. The sampling frame was stratified by urban and rural areas within each region; a total of 13 strata were defined. The sample was selected in two stages. Within each stratum, a specified number of census enumeration areas were selected systematically with probability proportional to size. After a household listing was carried out within the selected enumeration areas, a systematic sample of 30 households was drawn in each sample enumeration area. All the selected enumeration areas were visited during the fieldwork period. The overall sampling probabilities vary by stratum, and the sample is not self-weighting. For reporting all survey results, sample weights are used. A more detailed description of the sample design can be found in Appendix A, Sample Design. Questionnaires Five sets of questionnaires were used in the survey: 1) a household questionnaire which was used to collect basic demographic information on all de jure household members (usual residents), the household, and the dwelling; 2) a questionnaire for individual women administered in each household to all women age 15-49 years; 3) a questionnaire for individual men administered in each household to all men age 15-49 years; 4) an under-5 questionnaire, administered to mothers (or caretakers) for all children under 5 living in the household; and 5) a blood test questionnaire used to collect information in each household on children, women and men eligible for blood testing. The questionnaires included the following modules: The Household Questionnaire included the following modules: o List of Household Members o Education o Child Labour o Child Discipline o Household Characteristics o Insecticide Treated Nets o Indoor Residual Spraying o Water and Sanitation o Handwashing o Salt Iodization The Questionnaire for Individual Women was administered to all women age 15-49 years living in the households, and included the following modules: o Woman’s Background o Access to Mass Media and Use of Information/Communication Technology Sao Tome and Principe 2014 MICS, Final Report P a g e | 4 o Fertility/Birth History o Desire for Last Birth o Maternal and Newborn Health o Post-natal Health Checks o Illness Symptoms o Contraception o Unmet Need o Attitudes Toward Domestic Violence o Marriage/Union o Sexual Behaviour o HIV/AIDS o Maternal Mortality o Tobacco and Alcohol Use o Life Satisfaction The Questionnaire for Individual Men was administered to all men age 15-49 years living in the households, and included the following modules: o Man’s Background o Access to Mass Media and Use of Information/Communication Technology o Fertility o Attitudes Toward Domestic Violence o Marriage/Union o Sexual Behaviour o HIV/AIDS o Circumcision o Tobacco and Alcohol Use o Life Satisfaction The Questionnaire for Children Under Five was administered to mothers (or caretakers) of children under 5 years of agei living in the households. Normally, the questionnaire was administered to mothers of under-5 children; in cases when the mother was not listed in the household roster, a primary caretaker for the child was identified and interviewed. The questionnaire included the following modules: o Age o Birth Registration o Early Childhood Development o Breastfeeding and Dietary Intake o Immunization o Care of Illness o Anthropometry i The terms “children under 5”, “children age 0-4 years”, and “children age 0-59 months” are used interchangeably in this report. Sao Tome and Principe 2014 MICS, Final Report P a g e | 5 The Blood Test Questionnaire was administered to all households and included the following modules: o Anaemia and malaria test for children 6-59 months of age o Anaemia and HIV test for women age 15-49 years o HIV test for men age 15-49 years All the questionnaires except that for the blood test are based on the MICS5 model questionnairei. From the MICS5 model versions, the questionnaires were customised and translated into Portuguese and were pre-tested in the city of Sao Tome during December 2013. Based on the results of the pre- test, modifications were made to the wording and translation of the questionnaires. A copy of the 2014 Sao Tome and Principe MICS questionnaires is provided in Appendix F. In addition to the administration of questionnaires, fieldwork teams tested the salt used for cooking in the households for iodine content, observed the place for handwashing, measured the weights and heights of children age under 5 years, and took blood samples from children under 5 years, as well as women and men age 15-49 years . Methodology and processes used when taking blood samples for anaemia, malaria and HIV testing Fieldwork teams took blood samples for haemoglobin tests of anaemia from all women age 15-49 years old who voluntarily accepted to do the test, as well as from all children age 6-59 months who lived in the household surveyed. Teams registered the test value in the questionnaire and communicated the test result to the respondent or to the parent in case of minors. Respondents with low levels of anaemia were advised to seek medical attention. Blood samples were also tested for malaria parasitaemia using both rapid diagnostic test (Paramax 3 test kit) and thick smear for laboratory-based microscopy. In the case of children testing positive with RDT and who were not presenting severe malaria symptoms, free ACT treatment was provided, according to the national treatment protocol. Mothers were provided information on malaria symptoms and were advised to go immediately to the nearest health facility in case of symptoms. Field work teams collected blood samples for HIV testing from all eligible respondents who voluntarily accepted to take the test. All women and men aged 15-49 years old surveyed were eligible for the test. The HIV testing protocol was based on an anonymous protocol, approved by ICF International Ethics Committee and the MICS Ethics Committee. A reference card to Voluntary Counselling and Testing services was provided to all respondents, including those who refused to be tested for HIV. A consent form was signed by the eligible respondent once the fieldworker has explained the blood sampling process, and confirmed the confidentiality and anonymity of the HIV testing. i The model MICS5 questionnaires can be found at http://www.mics.unicef.org/mics5_questionnaire.html Sao Tome and Principe 2014 MICS, Final Report P a g e | 6 Training and Fieldwork Training for the fieldwork was conducted for 15 days between 3 and 21 March 2014. The 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 7 days practicing interviewing in the district of Água Grande and Mè Zochi. The training also provided guidelines for the field-level collection and analysis of blood samples and biomarkers data, using a specifically designed manual and questionnaire. The data were collected by eight teams; each was comprised of four interviewers, two health technicians (for anthropometry and blood sample collection), one driver, one editor and a supervisor. Fieldwork began on 7 April 2014 and was concluded on 18 June of the same year. Data Processing Data were entered using the CSPro software, Version 5.0. The data were entered on ten desktop computers, procured specifically for the purposes of the 2014 MICS, and carried out by 20 data entry operators and two data entry supervisors working in two shifts (morning and afternoon). For quality assurance purposes, all questionnaires were double-entered and internal consistency checks were performed. Procedures and standard programmes developed under the global MICS programme and adapted to the 2014 Sao Tome and Principe questionnaires were used throughout. Data processing followed rapidly the start of data collection on 14 April and was completed on 28 June 2014. Data were analyzed using the Statistical Package for Social Sciences (SPSS) software, Version 21. Model syntax and tabulation plans developed by UNICEF were customized and used for this purpose. The processing of the blood samples was conducted from August to September 2014 for the malaria samples and from January to February 2015 for the HIV samples. The processing of the HIV samples was initiated after the scrambling and anonymization of the MICS data collected through the questionnaires. Blood samples were analyzed at the Hospital Ayres de Menezes Laboratory in Sao Tome and Principe. For HIV testing in particular, Elisa (Vironostika® VIH Ag/Ab) was used for all samples as a first test. Negative samples from this first testing were classified as negative whereas positive samples were subjected to a second ELISA test (Enzygnost® VIH Integral II). Positive samples from this second test were classified as positive. Discordant cases between the first and second ELISA test were reanalyzed using the two tests. Discordant cases were analyzed once again using Western Blot 2.2. Ten percent of negative cases were also subjected to another ELISA test for quality control purposes. At the end of the process, 261 samples, including all positive cases, were sent to the Centre Pasteur in Cameroon for external quality control (EQC). The results of the EQC, communicated in May 2014, coincided with those obtained in Sao Tome and Principe. Sao Tome and Principe 2014 MICS, Final Report P a g e | 7 III. Sample Coverage and the Characteristics of Households and Respondents Sample Coverage Of the 3,930 households selected for the sample, 3,625 were found to be occupied. Of these, 3,492 were successfully interviewed for a household response rate of 96 percent. In the interviewed households, 3,101 women (age 15-49 years) were identified. Of these, 2,935 were successfully interviewed, yielding a response rate of 95 percent within the interviewed households. The survey also sampled men (age 15-49). All men (age 15-49) in all selected households were identified. A total of 2,772 men (age 15-49 years) were listed in the household questionnaires. Questionnaires were completed for 2,267 men, which corresponds to a response rate of 82 percent within interviewed households. There were 2,062 children under age five listed in the household questionnaires. Questionnaires were completed for 2,030 of these children, which corresponds to a response rate of 98 percent within interviewed households. Overall response rates of 91, 79 and 95 percent are calculated for the individual interviews of women, men, and under-5s, respectively (Table HH.1). Sao Tome and Principe 2014 MICS, Final Report P a g e | 8 Table HH.1:1 Results of household, women's, men's and under-5 interviews Number of households, women, men, and children under 5 by interview results, and household, women's, men's and under-5's response rates, Sao Tome and Principe, 2014 Total Area Region Urban Rural Region Centre East Region North West Region South East Autonomous Region of Principe Households Sampled 3,930 2,340 1,590 1,800 900 900 330 Occupied 3,625 2,145 1,480 1,672 858 805 290 Interviewed 3,492 2,054 1,438 1,626 840 740 286 Household response rate 96.3 95.8 97.2 97.2 97.9 91.9 98.6 Women Eligible 3,101 1,895 1,206 1,482 774 636 209 Interviewed 2,935 1,810 1,125 1,389 756 582 208 Women's response rate 94.6 95.5 93.3 93.7 97.7 91.5 99.5 Women's overall response rate 91.2 91.5 90.6 91.1 95.6 84.1 98.1 Men Eligible 2,772 1,644 1,128 1,220 684 661 207 Interviewed 2,267 1,360 907 924 598 539 206 Men's response rate 81.8 82.7 80.4 75.7 87.4 81.5 99.5 Men's overall response rate 78.8 79.2 78.1 73.7 85.6 75.0 98.1 Children under 5 Eligible 2,062 1,225 837 937 531 442 152 Mothers/caretakers interviewed 2,030 1,210 820 916 526 436 152 Under-5's response rate 98.4 98.8 98.0 97.8 99.1 98.6 100.0 Under-5's overall response rate 94.8 94.6 95.2 95.1 97.0 90.7 98.6 Coverage rates in urban and rural areas are very similar. Most response rates are above 90 percent, and several above 95 percent, which generally reassures us with respect to the representativeness of the results of this survey. The overall men’s response rate, however, is 79 percent, and the reader should thus interpret men’s statistics in this report with some degree of caution. Many household surveys have struggled to achieve higher response rates for this group because men tend to be absent from home more often than women. It is noteworthy that the Autonomous Region of Principe managed coverage rates above 98 percent in all categories, including a surprising 100 percent for children under age five which may in part have to do with the relatively small sample for that region. Even with such high coverage, confidence intervals for the statistics of that region will tend to be wider than those for the other regions, given the smaller sample size, something that the reader will do well to keep in mind. 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 3,492 households successfully interviewed in the survey, 13,455 household members were listed. Of these, 6,423 were males, and 7,032 were females. Sao Tome and Principe 2014 MICS, Final Report P a g e | 9 Table HH.2:2 Age distribution of household population by sex Percent and frequency distribution of the household population by five-year age groups, dependency age groups, and by child (age 0-17 years) and adult populations (age 18 or more), by sex, Sao Tome and Principe, 2014 Total Males Females Number Percent Number Percent Number Percent Total 13,455 100.0 6,423 100.0 7,032 100.0 Age 0-4 2,010 14.9 1,010 15.7 1,001 14.2 5-9 2,151 16.0 1,111 17.3 1,040 14.8 10-14 1,815 13.5 859 13.4 956 13.6 15-19 1,382 10.3 641 10.0 741 10.5 20-24 947 7.0 456 7.1 491 7.0 25-29 953 7.1 435 6.8 518 7.4 30-34 898 6.7 423 6.6 475 6.8 35-39 721 5.4 343 5.3 378 5.4 40-44 545 4.1 235 3.7 310 4.4 45-49 410 3.0 199 3.1 211 3.0 50-54 501 3.7 220 3.4 281 4.0 55-59 325 2.4 131 2.0 194 2.8 60-64 257 1.9 130 2.0 127 1.8 65-69 155 1.1 66 1.0 89 1.3 70-74 130 1.0 56 0.9 74 1.1 75-79 147 1.1 64 1.0 83 1.2 80-84 63 0.5 28 0.4 35 0.5 85+ 38 0.3 14 0.2 24 0.3 DK/Missing 6 0.0 3 0.0 3 0.0 Dependency age groups 0-14 5,977 44.4 2,980 46.4 2,997 42.6 15-64 6,939 51.6 3,212 50.0 3,727 53.0 65+ 533 4.0 228 3.6 305 4.3 DK/Missing 6 0.0 3 0.0 3 0.0 Child and adult populations Children age 0-17 years 6,838 50.8 3,370 52.5 3,469 49.3 Adults age 18+ years 6,610 49.1 3,051 47.5 3,559 50.6 DK/Missing 6 0.0 3 0.0 3 0.0 According to the results of this survey, children and youth less than 18 years of age constitute over half of the population of Sao Tome and Principe (51 percent), while 44 percent are below 15 and only 4 percent 65 or older, characterizing the nation’s population as predominantly young. These results are nearly identical to those of the 2012 census. On the other hand, the fact that the 5-9 years age group is somewhat larger than the youngest, contrary to census results, suggests that children under five years of age might be under-reported in our data. This pattern is not infrequent in surveys with large children’s questionnaires and could be the result of out-transference of a number of eligible children to an older non-eligible age, potentially in addition to under-recording of very young children. Out-transference is also likely to be responsible for the steep downward step between age 14 and 15 observable in Table DQ.1 in Sao Tome and Principe 2014 MICS, Final Report P a g e | 10 Appendix D, related this time to women’s and men’s questionnaires, and similarly at the upper end of age eligibility as seen in Figure HH.1, particularly for women. Figure HH.1: 1 Age and sex d istr ibut ion of household populat ion , Sao Tome and Pr inc ipe , 2014 Tables HH.3, HH.4 and HH.5 provide basic information on the households, female respondents age 15-49, male respondents 15-49, and children under-5. Both unweighted and weighted numbers are presented. Such information is essential for the interpretation of findings presented later in the report and provides background information on the representativeness of the survey sample. The remaining tables in this report are presented only with weighted numbers.i Table HH.3 provides basic background information on the households, including the sex of the household head, region, area, number of household members and education of household head. These background characteristics are used in subsequent tables in this report; the figures in the table are also intended to show the numbers of observations by major categories of analysis in the report. i See Appendix A: Sample Design, for more details on sample weights. 10 8 6 4 2 0 2 4 6 8 10 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Per cent Age Males Females Note: 6 household members with missing age and/or sex are excluded Sao Tome and Principe 2014 MICS, Final Report P a g e | 11 Table HH.3:3 Household composition Percent and frequency distribution of households by selected characteristics, Sao Tome and Principe, 2014 Weighted percent Number of households Weighted Unweighted Total 100.0 3,492 3,492 Sex of household head Male 65.2 2,278 2,362 Female 34.8 1,214 1,130 Region Centre East 66.2 2,311 1,626 North West 17.5 612 840 South East 11.9 417 740 Autonomous of Principe 4.3 152 286 Area Urban 66.0 2,306 2,054 Rural 34.0 1,186 1,438 Number of household members 1 16.1 564 577 2 13.3 465 441 3 16.2 564 542 4 17.0 595 601 5 16.4 573 571 6 10.9 382 398 7 5.6 195 198 8 2.5 87 95 9 0.9 30 32 10+ 1.0 36 37 Education of household head 9.1 319 344 None 9.1 319 344 Primary 54.1 1,891 1,981 Secondary 31.9 1,113 1,038 Higher 4.2 148 109 DK/Missing 0.6 21 20 Mean household size 3.9 3,492 3,492 The weighted and unweighted total number of households are equal, since sample weights were normalized.i The table also shows the weighted mean household size estimated by the survey. It can be seen that the less populous regions of the country were over-sampled in order to provide better precision for their estimates; even so, the sample size of Autonomous Region of Principe remains relatively small as previously noted. Two-thirds of households (66 percent) are found in urban areas; one third (35 percent) are female headed. The mean household size is 3.9. The majority of household heads (54 percent) have only attended primary school, and merely 4 percent have higher education. i See Appendix A: Sample Design, for more details on sample weights. Sao Tome and Principe 2014 MICS, Final Report P a g e | 12 Characteristics of Female and Male Respondents 15-49 Years of Age and Children Under-5 Tables HH.4, HH.4M and HH.5 provide information on the background characteristics of female and male respondents 15-49 years of age and of children under age 5. In all three tables, the total numbers of weighted and unweighted observations are equal, since sample weights have been normalized (standardized).i In addition to providing useful information on the background characteristics of women, men, and children under age five, the tables are also intended to show the numbers of observations in each background category. These categories are used in the subsequent tabulations of this report. Table HH.4 provides background characteristics of female respondents, age 15-49 years. The table includes information on the distribution of women according to region, area, age, marital/union status, motherhood status, births in last two years, educationii, and wealth index quintilesiii, iv. i See Appendix A: Sample Design, for more details on sample weights. ii Throughout this report, unless otherwise stated, “education” refers to highest educational level ever attended by the respondent when it is used as a background variable. iii The wealth index is a composite indicator of wealth. To construct the wealth index, principal components analysis is performed by using information on the ownership of consumer goods, dwelling characteristics, water and sanitation, and other characteristics that are related to the household’s wealth, to generate weights (factor scores) for each of the items used. First, initial factor scores are calculated for the total sample. Then, separate factor scores are calculated for households in urban and rural areas. Finally, the urban and rural factor scores are regressed on the initial factor scores to obtain the combined, final factor scores for the total sample. This is carried out to minimize the urban bias in the wealth index values. Each household in the total sample is then assigned a wealth score based on the assets owned by that household and on the final factor scores obtained as described above. The survey household population is then ranked according to the wealth score of the household they are living in, and is finally divided into 5 equal parts (quintiles) from lowest (poorest) to highest (richest). In the 2014 Sao Tome and Principe MICS, the following assets were used in these calculations: number of persons per sleeping room; main material of which the roof, walls and floor are made; main cooking fuel; household has electricity, a radio, a television, a non-mobile telephone, a refrigerator or a freezer, a computer, a satellite dish, air conditioning, a wooden bed with a mattress, a plastic chair; household member owns a watch, a mobile phone, a bicycle, a motorcycle, a car or a pick-up truck, a boat with a motor, a boat without a motor, agricultural land, cattle, goats, sheep, chicken, pigs, other farm animals, a bank account; main source of water for cooking; location of the main source of water; type of toilet facility; shared or unshared toilet facility; water at the place used for handwashing; soap for handwashing; a household member living abroad. The wealth index is assumed to capture the underlying long-term wealth through information on the household assets, and is intended to produce a ranking of households by wealth, from poorest to richest. The wealth index does not provide information on absolute poverty, current income or expenditure levels. The wealth scores calculated are applicable for only the particular data set they are based on. Further information on the construction of the wealth index can be found in Filmer, D and Pritchett, L. 2001. Estimating wealth effects without expenditure data – or tears: An application to educational enrolments in states of India. Demography 38(1): 115-132; Rutstein, SO and Johnson, K. 2004. The DHS Wealth Index. DHS Comparative Reports No. 6; and Rutstein, SO. 2008. The DHS Wealth Index: Approaches for Rural and Urban Areas. DHS Working Papers No. 60. iv When describing survey results by wealth quintiles, appropriate terminology is used when referring to individual household members, such as for instance “women in the richest population quintile”, which is used interchangeably with “women in the wealthiest survey population”, “women living in households in the richest population wealth quintile”, and similar. Sao Tome and Principe 2014 MICS, Final Report P a g e | 13 Table HH.4:4 Women's background characteristics Percent and frequency distribution of women age 15-49 years by selected background characteristics, Sao Tome and Principe, 2014 Weighted percent Number of women Weighted Unweighted Total 100.0 2,935 2,935 Region Centre East 67.6 1,983 1,389 North West 17.8 524 756 South East 11.1 326 582 Autonomous of Principe 3.5 103 208 Area Urban 68.0 1,997 1,810 Rural 32.0 938 1,125 Age 15-19 23.9 702 688 20-24 15.9 467 462 25-29 16.5 484 486 30-34 15.2 446 459 35-39 11.9 349 341 40-44 9.9 290 293 45-49 6.7 198 206 Marital/Union status Currently married/in union 55.5 1,629 1,671 Widowed 0.5 15 13 Divorced 0.1 3 4 Separated 17.7 518 513 Never married/in union 26.1 767 733 DK/Missing 0.1 2 1 Motherhood and recent births Never gave birth 26.7 783 746 Ever gave birth 73.3 2,152 2,189 Gave birth in last two years 25.7 756 758 No birth in last two years 47.6 1,398 1,432 Education None 3.1 91 110 Primary 48.6 1,426 1,520 Secondary 44.9 1,318 1,234 Higher 3.4 99 71 Wealth index quintile Poorest 17.8 524 637 Second 19.8 581 625 Middle 19.3 566 595 Fourth 20.4 598 558 Richest 22.7 666 520 The majority (56 percent) of women age 15-49 years are currently married or in union, but a notable proportion (18 percent) are separated. Nearly three-quarters (73 percent) of women in this age group have started child bearing, and 48 percent gave birth in the last two years. Education patterns are similar to those of the heads of households. Table HH.4 shows that in our sample of 2,935 Sao Tome and Principe 2014 MICS, Final Report P a g e | 14 women age 15-49, the education status of one of them is unknown; this “DK/Missing” category will generally be omitted from the relevant tables of this report. Table HH.4M:5 Men's background characteristics Percent and frequency distribution of men age 15-49 years by selected background characteristics, Sao Tome and Principe, 2014 Weighted percent Number of men Weighted Unweighted Total 100.0 2,267 2,267 Region Centre East 63.9 1,449 924 North West 18.3 415 598 South East 13.6 309 539 Autonomous of Principe 4.1 93 206 Area Urban 66.5 1,508 1,360 Rural 33.5 759 907 Age 15-19 26.0 588 563 20-24 16.7 378 382 25-29 15.6 354 339 30-34 14.4 327 353 35-39 12.5 284 283 40-44 7.7 175 186 45-49 7.1 161 161 Marital/Union status Currently married/in union 47.7 1,081 1,106 Widowed 0.1 2 3 Divorced 0.0 1 1 Separated 10.1 229 231 Never married/in union 42.0 953 925 DK/Missing 0.0 1 1 Fatherhood status Has at least one living child 53.7 1,217 1,247 Has no living children 45.5 1,031 1,003 DK/Missing 0.9 20 17 Education None 1.0 22 28 Primary 42.0 951 1,043 Secondary 52.5 1,189 1,123 Higher 4.6 105 73 Wealth index quintile Poorest 20.4 462 560 Second 20.2 458 503 Middle 19.2 435 456 Fourth 20.1 455 396 Richest 20.1 456 352 Sao Tome and Principe 2014 MICS, Final Report P a g e | 15 Similarly, Table HH.4M provides background characteristics of male respondents 15-49 years of age. The table shows information on the distribution of men according to region, area, age, marital status, fatherhood status, education, and wealth index quintiles. Nearly half (48 percent) of men age 15-49 years are currently married or in union, while 10 percent are separated. Fifty-four percent have at least one living child; 57 percent have secondary or higher education. Table HH.4M shows that in our sample of 2,267 men age 15-49, the marital status of one of them is unknown; this “DK/Missing” category will generally be omitted from the relevant tables of this report; the same will apply to the 3 cases of widowed men. Background characteristics of children under 5 are presented in Table HH.5. These include the distribution of children by several attributes: sex, region and area, age in months, respondent type, mother’s (or caretaker’s) education, and wealth. Overall, 93 percent of children below five years of age live with their biological mother. The average level of education of the mothers/caretakers of under-five children is lower than that of the overall population of women age 15-49 years (66 and 52 percent respectively with primary or no education), and there is some suggestion that a larger proportion of children may live in poorest as opposed to wealthiest households. Sao Tome and Principe 2014 MICS, Final Report P a g e | 16 Table HH.5:6 Under-5's background characteristics Percent and frequency distribution of children under five years of age by selected characteristics, Sao Tome and Principe, 2014 Weighted percent Number of under-5 children Weighted Unweighted Total 100.0 2,030 2,030 Sex Male 50.4 1,023 1,027 Female 49.6 1,007 1,003 Region Centre East 64.9 1,317 916 North West 19.0 386 526 South East 12.1 245 436 Autonomous of Principe 4.0 82 152 Area Urban 65.9 1,339 1,210 Rural 34.1 691 820 Age 0-5 months 8.8 178 169 6-11 months 8.5 172 180 12-23 months 19.9 403 391 24-35 months 20.3 412 423 36-47 months 21.4 434 429 48-59 months 21.2 430 438 Respondent to the under-5 questionnaire Mother 93.2 1,893 1,893 Other primary caretaker 6.8 137 137 Mother’s educationa None 4.2 84 107 Primary 61.7 1,253 1,312 Secondary 31.9 647 578 Higher 2.2 46 33 Wealth index quintile Poorest 21.9 444 541 Second 21.1 428 462 Middle 20.3 411 404 Fourth 20.8 423 375 Richest 16.0 324 248 a In this table and throughout the report, mother's education refers to educational attainment of mothers as well as caretakers of children under 5, who are the respondents to the under-5 questionnaire if the mother is deceased or is living elsewhere. Housing characteristics, asset ownership, and wealth quintiles Tables HH.6, HH.7 and HH.8 provide further details on household level characteristics. HH.6 presents characteristics of housing, disaggregated by area and region, distributed by whether the dwelling has electricity, the main materials of the flooring, roof, and exterior walls, as well as the number of rooms used for sleeping. Sao Tome and Principe 2014 MICS, Final Report P a g e | 17 Over three-quarters of households (76 percent) have electricity in urban areas, compared with 55 percent in rural areas. Finished roofing (mostly corrugated iron) and walls (mostly wood planks) are nearly universal in Sao Tome and Principe. However, a majority of households (57 percent) have a floor made of rudimentary material, more so urban (61 percent) than rural (49 percent) households. What is here referred to as rudimentary floor is mostly wood planks, the commonest floor material in urban areas, while finished floors are most often made of cement (data not shown). Table HH.6:7 Housing characteristics Percent distribution of households by selected housing characteristics, according to area of residence and regions, Sao Tome and Principe, 2014 Total Area Region Urban Rural Region Centre East Region North West Region South East Autonomous Region of Principe Electricity Yes 68.6 75.8 54.8 74.8 54.8 51.8 76.2 No 31.3 24.2 45.1 25.2 45.0 48.2 23.8 DK/Missing 0.0 0.0 0.1 0.0 0.2 0.0 0.0 Flooring Natural floor 0.8 0.2 2.0 0.2 0.4 4.1 1.4 Rudimentary floor 56.7 60.7 49.0 59.8 49.9 58.1 34.1 Finished floor 42.4 39.0 49.0 39.9 49.7 37.4 64.6 Other 0.1 0.1 0.0 0.1 0.0 0.1 0.0 DK/Missing 0.0 0.0 0.0 0.0 0.0 0.3 0.0 Roof Natural roofing 0.0 0.0 0.1 0.0 0.1 0.0 0.4 Rudimentary roofing 0.2 0.2 0.2 0.1 0.0 0.4 1.3 Finished roofing 99.7 99.7 99.6 99.9 99.9 98.8 98.3 Other 0.1 0.1 0.2 0.0 0.0 0.6 0.0 DK/Missing 0.0 0.0 0.0 0.0 0.0 0.1 0.0 Exterior walls Rudimentary walls 1.5 1.8 1.0 1.6 2.0 0.5 1.5 Finished walls 98.1 97.7 98.7 98.0 97.9 99.3 95.7 Other 0.3 0.3 0.2 0.2 0.1 0.1 2.9 DK/Missing 0.1 0.2 0.0 0.2 0.0 0.1 0.0 Rooms used for sleeping 1 35.0 32.3 40.3 34.1 38.7 32.3 42.1 2 38.4 37.9 39.4 38.0 38.2 41.1 38.7 3 or more 22.9 25.7 17.2 24.2 21.5 19.5 17.3 DK/Missing 3.7 4.0 3.1 3.7 1.7 7.0 2.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 3,492 2,306 1,186 2,311 612 417 152 Mean number of persons per room used for sleeping 2.18 2.14 2.26 2.13 2.38 2.25 2.01 In Table HH.7 households are distributed according to ownership of assets by households and by individual household members. This also includes ownership of dwelling. Sao Tome and Principe 2014 MICS, Final Report P a g e | 18 Table HH.7 is a testimony of the phenomenal spread of mobile phones in both urban (82 percent) and rural (78 percent) households. One the other hand, ownership of computers is still relatively rare even in urban households (15 percent). About two rural households in five (42 percent) own agricultural land. Table HH.7:8 Household and personal assets Percentage of households by ownership of selected household and personal assets, and percent distribution by ownership of dwelling, according to area of residence and regions, Sao Tome and Principe, 2014 Total Area Region Urban Rural Region Centre East Region North West Region South East Autonomous Region of Principe Percentage of households that own a Radio 60.8 64.9 52.9 65.4 49.3 50.4 64.8 Television 68.3 73.2 58.6 74.4 55.5 52.5 69.7 Non-mobile telephone 7.3 9.9 2.2 9.4 2.5 3.4 5.4 Refrigerator/freezer 42.8 49.9 28.9 49.8 28.0 24.8 44.4 Computer 11.6 14.7 5.6 14.8 4.1 4.3 12.7 Satellite dish 25.8 30.8 16.1 29.7 14.9 15.7 37.9 Air conditioning 2.0 2.8 0.5 2.8 0.6 0.1 1.0 Wooden bed with a mattress 96.6 97.0 95.8 97.0 96.7 94.9 95.4 Dining table with wooden chairs 94.2 94.6 93.3 95.0 92.8 92.1 93.0 Plastic chair 10.6 12.6 6.7 12.1 8.8 6.3 7.4 Percentage of households that own Agricultural land 25.8 17.7 41.5 17.5 43.1 38.5 47.4 Farm animals/Livestock 40.6 36.9 47.9 34.9 48.9 52.6 61.3 Percentage of households where at least one member owns or has a Watch 36.1 39.0 30.5 38.7 28.7 34.1 31.7 Mobile telephone 82.2 84.4 77.8 87.8 69.7 69.5 82.7 Bicycle 8.6 10.0 6.0 10.3 4.6 5.5 7.0 Motorcycle 15.8 15.7 16.0 17.0 12.0 11.8 24.6 Animal-drawn cart 0.0 0.0 0.0 0.0 0.1 0.0 0.0 Car or pick-up truck 9.7 11.4 6.3 12.1 6.4 3.6 3.1 Boat with a motor 1.7 2.0 0.9 0.5 4.2 3.0 5.0 Boat without a motor 3.1 3.6 2.2 0.4 11.3 4.8 6.5 Bank account 44.2 49.0 34.8 49.7 31.0 22.7 73.2 Ownership of dwelling Owned by a household member 76.5 73.9 81.6 72.2 87.1 84.7 76.1 Not owned 23.5 26.1 18.4 27.8 12.9 15.2 23.9 Rented 14.2 16.1 10.6 17.0 6.1 10.5 15.4 Other 9.3 10.0 7.8 10.8 6.7 4.6 8.5 DK/Missing 0.0 0.0 0.0 0.0 0.0 0.1 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 3,492 2,306 1,186 2,311 612 417 152 Table HH.8 shows how the household populations in areas and regions are distributed according to household wealth quintiles. Sao Tome and Principe 2014 MICS, Final Report P a g e | 19 As expected, rural areas have a higher proportion of household members in the poorest quintile (27 percent) than the urban (17 percent). At the other end of the distribution, we find 26 percent of household members of urban areas in the richest quintile, but only 7 percent of those living in rural areas. At the regional level, the highest concentration of poorest population is found in Region North West and Region South East (37 percent each). Table HH.8:9 Wealth quintiles Percent distribution of the household population by wealth index quintile, according to area of residence and regions, Sao Tome and Principe, 2014 Wealth index quintile Total Number of household members Poorest Second Middle Fourth Richest Total 20.0 20.0 20.0 20.0 20.0 100.0 13,455 Area Urban 16.6 16.5 18.9 21.6 26.4 100.0 8,960 Rural 26.8 26.9 22.2 16.8 7.3 100.0 4,495 Region Centre East 12.4 18.1 20.6 22.7 26.2 100.0 8,799 North West 37.0 24.4 17.4 14.0 7.2 100.0 2,510 South East 37.0 25.4 18.4 11.5 7.7 100.0 1,651 Autonomous of Principe 12.7 13.5 26.7 30.2 16.9 100.0 495 Sao Tome and Principe 2014 MICS, Final Report P a g e | 20 IV. Child Mortality One of the overarching goals of the Millennium Development Goals (MDGs) is to reduce infant and under-five mortality. Specifically, the MDGs call for the reduction of under-five mortality by two- thirds between 1990 and 2015. Monitoring progress towards this goal is an important but difficult objective. Mortality rates presented in this chapter are calculated from information collected in the birth histories of the Women’s Questionnaires. All interviewed women were asked whether they had ever given birth, and if yes, they were asked to report the number of sons and daughters who live with them, the number of those who live elsewhere, and the number of those who have died. In addition, they were asked to provide a detailed birth history of live births of children in chronological order starting with the firstborn. Women were asked whether births were single or multiple, the sex of the children, the date of birth (month and year), and survival status. Further, for children still alive, they were asked the current age of the child and, if not alive, the age at death. Childhood mortality rates are expressed by conventional age categories and are defined as follows: • Neonatal mortality (NN): probability of dying within the first month of life • Post-neonatal mortality (PNN): difference between infant and neonatal mortality rates • Infant mortality (1q0): probability of dying between birth and the first birthday • Child mortality (4q1): probability of dying between the first and the fifth birthdays • Under-five mortality (5q0): the probability of dying between birth and the fifth birthday Rates are expressed as deaths per 1,000 live births, except in the case of child mortality, which is expressed as deaths per 1,000 children surviving to age one, and post-neonatal mortality, which is the difference between infant and neonatal mortality rates. Table CM.1:10Early childhood mortality rates Neonatal, post-neonatal, Infant, child and under-five mortality rates for five year periods preceding the survey, Sao Tome and Principe, 2014 Neonatal mortality rate1 Post-neonatal mortality rate2, a Infant mortality rate3 Child mortality rate4 Under-five mortality rate5 Years preceding the survey 0-4 22 16 38 7 45 5-9 13 11 24 17 41 10-14 17 14 31 29 59 1 MICS indicator 1.1 - Neonatal mortality rate 2 MICS indicator 1.3 - Post-neonatal mortality rate 3 MICS indicator 1.2; MDG indicator 4.2 - Infant mortality rate 4 MICS indicator 1.4 - Child mortality rate 5 MICS indicator 1.5; MDG indicator 4.1 - Under-five mortality rate a Post-neonatal mortality rates are computed as the difference between the infant and neonatal mortality rates Table CM.1 and Figure CM.1 present neonatal, post-neonatal, infant, child, and under-five mortality rates for the three most recent five-year periods before the survey. Neonatal mortality in the most recent 5-year period is estimated at 22 per 1,000 live births, while the post-neonatal mortality rate is estimated at 16 per 1,000 live births. Sao Tome and Principe 2014 MICS, Final Report P a g e | 21 Figure CM.1: 2 Ear ly chi ldhood mortal i t y rates Sao Tome and Pr inc ipe , 2014 The infant mortality rate in the five years preceding the survey is 38 per 1,000 live births and under- five mortality is 45 deaths per 1,000 live births for the same period, indicating that 853 out of 1,000 under-five deaths are infant deaths. The point estimate for under-five mortality is 59 per 1,000 live births during the 10-14 year period preceding the survey (centered on October 2001), which is 14 points higher than the estimate for the 0-4 year period preceding the survey (centered on October 2011). While this is reassuring, the width of the confidence intervals for these estimates does not allow us to categorically state that a decline in under-five mortality has actually taken place over that period. For a similar reason, it would be statistically incorrect, on the basis of the results of this survey alone, to speak of an increase in either neonatal or infant mortality. We can however be affirmative with respect to an actual decline in child mortality over the same period. The fluctuations seen in these indicators, particularly those related to the first year of life, may be the reflection of actual fluctuations in mortality patterns in the population over the referred periods, sampling variations, and/or data quality issues such as the likely under-reporting of young children discussed in the previous chapter of this report. Another aspect of data quality relates to heaping of age at death reported as 1 year (see DQ.26 in Appendix D), a rather common problem in birth histories, which may affect to some extent post-neonatal, infant and child mortality estimates. 17 14 31 29 59 13 11 24 17 41 22 16 38 7 45 Neonatal mortality rate Post-neonatal mortality rate Infant mortality rate Child mortality rate Under-five mortality rate Years preceding the survey Note: Indicator values are per 1,000 live births Whiskers represent confidence intervals ( standard error  2) 10-14 5-9 0-4 Sao Tome and Principe 2014 MICS, Final Report P a g e | 22 Table CM.2:11Early childhood mortality rates by socioeconomic characteristics Neonatal, post-neonatal, Infant, child and under-five mortality rates for the ten year period preceding the survey, by socioeconomic characteristics, Sao Tome and Principe, 2014 Neonatal mortality rate1 Post-neonatal mortality rate2, a Infant mortality rate3 Child mortality rate4 Under-five mortality rate5 Total 18 14 32 12 43 Region Centre East 15 14 30 11 41 North West 29 13 42 14 56 South East 10 15 25 11 36 Autonomous of Principe (25) 6 31 4 35 Area Urban 17 15 32 10 42 Rural 19 11 30 15 44 Mother's education None/Primary 16 15 31 15 45 Secondary/Higher 23 11 33 3 37 Wealth index quintile 60 percent poorest 18 16 35 15 50 40 percent richest 17 9 26 4 30 1 MICS indicator 1.1 - Neonatal mortality rate 2 MICS indicator 1.3 - Post-neonatal mortality rate 3 MICS indicator 1.2; MDG indicator 4.2 - Infant mortality rate 4 MICS indicator 1.4 - Child mortality rate 5 MICS indicator 1.5; MDG indicator 4.1 - Under-five mortality rate a Post-neonatal mortality rates are computed as the difference between the infant and neonatal mortality rates ( ) Figures that are based on 250-499 unweighted exposed persons Sao Tome and Principe 2014 MICS, Final Report P a g e | 23 Table CM.3:12Early childhood mortality rates by demographic characteristics Neonatal, post-neonatal, Infant, child and under-five mortality rates for the ten year period preceding the survey, by demographic characteristics, Sao Tome and Principe, 2014 Neonatal mortality rate1 Post-neonatal mortality rate2, a Infant mortality rate3 Child mortality rate4 Under-five mortality rate5 Total 18 14 32 12 43 Sex of child Male 23 13 36 14 50 Female 12 14 27 9 35 Mother's age at birth Less than 20 10 20 30 11 41 20-34 14 9 23 11 34 35-49 47 30 77 13 89 Birth order 1 12 14 26 8 34 2-3 15 12 27 5 32 4+ 26 16 42 24 64 Previous birth intervalb < 2 years 20 19 39 17 55 2 years 25 15 40 10 50 3 years 6 8 14 6 19 4+ years 17 10 28 8 35 1 MICS indicator 1.1 - Neonatal mortality rate 2 MICS indicator 1.3 - Post-neonatal mortality rate 3 MICS indicator 1.2; MDG indicator 4.2 - Infant mortality rate 4 MICS indicator 1.4 - Child mortality rate 5 MICS indicator 1.5; MDG indicator 4.1 - Under-five mortality rate a Post-neonatal mortality rates are computed as the difference between the infant and neonatal mortality rates b Excludes first order births Tables CM.2 and CM.3 provide estimates of child mortality by socioeconomic and demographic characteristics. In order to improve the stability and precision of the estimates, these two tables have been produced for a 10-year period preceding the survey. Even so, as can be seen in Figure CM.2 which provides a graphical presentation of some of the results, the confidence intervals of these estimates are still relatively wide and interpretation of differences between point estimates should be cautious. Many of the differences seen in these tables are in the expected direction. Under-five mortality estimates are higher:  for males (50) than for females (35) (not statistically significant)  for children from mothers age 35-49 years (89) than 20-34 years (34) (statistically significant)  for children from mothers with no more than primary education (45) than secondary or higher education (37) (not statistically significant)  for birth intervals of less than 2 years (55) than of 3 years (19) (statistically significant)  for children of a high birth order (64) than for second or third children (32) (statistically significant). Sao Tome and Principe 2014 MICS, Final Report P a g e | 24 Figure CM.2: Under -5 mortal i t y rates by area and regions , 10 year per iod preceding the survey, Sao Tome and Pr inc ipe , 2014 Figure CM.3 compares the national under-five mortality rates presented above with those from other data sources: the 2000 MICS, the 2006 MICS and the 2008-2009 DHS for Sao Tome and Principe. The results from the three most recent surveys are in broad agreement in terms of trend, although the 2008-2009 DHS results are considerably higher than those of the 2006 and 2014 MICS for the same years. Overall, these results show a smooth declining trend over the last 15 to 20 years with a tendency to stabilize in most recent years. Further qualification of these apparent declines and differences as well as its determinants should be taken up in a separate, more detailed, analysis. 43 41 56 36 35 42 44 0 20 40 60 80 100 Sao Tome and Principe Region Region Centre East Region North West Region South East Autonomous Region of Principe Area Urban Rural Under-5 Mortality Rates per 1,000 Births Note: Indicator values are per 1,000 live births Whiskers represent confidence intervals (± standard error  2) Sao Tome and Principe 2014 MICS, Final Report P a g e | 25 F igure CM.3: 3 Tr end in under -5 mortal i ty rates Sao Tome and Pr inc ipe , 2014 0 20 40 60 80 100 120 140 160 1986 1990 1994 1998 2002 2006 2010 2014 Per 1,000 live births Year MICS 2000 MICS 2006 DHS 2008-2009 MICS 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 26 V. Nutrition Low Birth Weight Weight at birth is a good indicator not only of a mother's health and nutritional status but also the newborn's chances for survival, growth, long-term health and psychosocial development. Low birth weight (defined as less than 2,500 grams) carries a range of grave health risks for children. Babies who were undernourished in the womb face a greatly increased risk of dying during their early days, months and years. Those who survive may have impaired immune function and increased risk of disease; they are likely to remain undernourished, with reduced muscle strength, throughout their lives, and suffer a higher incidence of diabetes and heart disease in later life. Children born with low birth weight also risk a lower intellectual quotient (IQ) and cognitive disabilities, affecting their performance in school and their job opportunities as adults. In the developing world, low birth weight stems primarily from the mother's poor health and nutrition. Three factors have most impact: the mother's poor nutritional status before conception, short stature (due mostly to under nutrition and infections during her childhood), and poor nutrition during pregnancy. Inadequate weight gain during pregnancy is particularly important since it accounts for a large proportion of foetal growth retardation. Moreover, diseases such as diarrhoea and malaria, which are common in many developing countries, can significantly impair foetal growth if the mother becomes infected while pregnant. In the industrialized world, cigarette smoking during pregnancy is the leading cause of low birth weight. In developed and developing countries alike, teenagers who give birth when their own bodies have yet to finish growing run a higher risk of bearing low birth weight babies. One of the major challenges in measuring the incidence of low birth weight is that more than half of infants in the developing world are not weighed at birth. In the past, most estimates of low birth weight for developing countries were based on data compiled from health facilities. However, these estimates are biased for most developing countries because the majority of newborns are not delivered in facilities, and those who are represent only a selected sample of all births. Because many infants are not weighed at birth and those who are weighed may be a biased sample of all births, the reported birth weights usually cannot be used to estimate the prevalence of low birth weight among all children. Therefore, the percentage of births weighing below 2500 grams is estimated from two items in the questionnaire: the mother’s assessment of the child’s size at birth (i.e., very small, smaller than average, average, larger than average, very large) and the mother’s recall of the child’s weight or the weight as recorded on a health card if the child was weighed at birth.i i For a detailed description of the methodology, see Boerma, JT et al. 1996. Data on Birth Weight in Developing Countries: Can Surveys Help? Bulletin of the World Health Organization 74(2): 209-16. Sao Tome and Principe 2014 MICS, Final Report P a g e | 27 Table NU.1:13Low birth weight infants Percentage of last live-born children in the last two years that are estimated to have weighed below 2,500 grams at birth and percentage of live births weighed at birth, Sao Tome and Principe, 2014 Percent distribution of births by mother's assessment of size at birth Total Percentage of live births: Number of last live- born children in the last two years Very small Smaller than average Average Larger than average or very large DK Below 2,500 grams1 Weighed at birth2 Total 3.4 8.9 70.1 16.5 1.1 100.0 8.4 94.0 756 Mother's age at birth Less than 20 years 5.0 18.7 64.1 11.8 0.5 100.0 12.5 97.6 120 20-34 years 2.2 7.0 73.1 16.8 0.9 100.0 7.2 93.9 519 35-49 years 7.1 7.2 63.0 20.2 2.6 100.0 9.6 90.7 116 Birth order 1 2.2 15.9 66.7 14.9 0.3 100.0 10.2 99.0 171 2-3 3.3 5.2 75.2 15.1 1.2 100.0 7.2 93.3 328 4-5 2.9 9.6 67.4 19.1 0.9 100.0 8.4 93.8 175 6+ 7.2 7.4 63.0 20.3 2.2 100.0 9.8 86.6 82 Region Centre East 3.2 8.8 67.9 19.5 0.6 100.0 8.3 95.9 514 North West 2.3 7.8 81.5 7.7 0.6 100.0 7.8 91.3 131 South East 5.6 12.5 65.2 11.8 4.9 100.0 10.8 84.7 86 Aut. of Principe (4.8) (3.2) (74.1) (17.9) (0.0) 100.0 (7.2) (100.0) 25 Area Urban 3.7 8.6 67.8 19.3 0.6 100.0 8.4 94.9 496 Rural 2.8 9.4 74.6 11.2 2.0 100.0 8.5 92.2 260 Mother’s education None/Primary 4.2 9.1 72.6 12.6 1.4 100.0 9.0 91.6 468 Secondary/Higher 2.0 8.5 66.1 22.9 0.5 100.0 7.5 97.9 288 Wealth index quintile Poorest 6.2 14.0 67.8 11.6 0.4 100.0 11.6 87.7 161 Second 1.2 7.4 73.2 15.0 3.4 100.0 6.9 93.0 158 Middle 3.7 9.3 73.9 12.0 1.1 100.0 8.8 93.9 149 Fourth 1.5 5.9 73.7 18.6 0.3 100.0 6.5 96.6 161 Richest 4.5 7.7 60.3 27.5 0.0 100.0 8.4 100.0 126 1 MICS indicator 2.20 - Low-birthweight infants 2 MICS indicator 2.21 - Infants weighed at birth ( ) Figures that are based on 25-49 unweighted cases Overall, 94 percent of newborns were weighed at birth and approximately 8 percent of infants are estimated to weigh less than 2,500 grams at birth (Table NU.1). There is no evidence of meaningful differences in the prevalence of low birth weight by, region, urban and rural areas or by mother’s education. Sao Tome and Principe 2014 MICS, Final Report P a g e | 28 Nutritional Status Children’s nutritional status is a reflection of their overall health. When children have access to an adequate food supply, are not exposed to repeated illness, and are well cared for, they reach their growth potential and are considered well nourished. Undernutrition is associated with more than half of all child deaths worldwide. Undernourished children are more likely to die from common childhood ailments, and for those who survive, have recurring sicknesses and faltering growth. Three-quarters of children who die from causes related to malnutrition were only mildly or moderately malnourished – showing no outward sign of their vulnerability. The Millennium Development Goal target is to reduce by half the proportion of people who suffer from hunger between 1990 and 2015. A reduction in the prevalence of malnutrition will also assist in the goal to reduce child mortality. In a well-nourished population, there is a reference distribution of height and weight for children under age five. Under-nourishment in a population can be gauged by comparing children to a reference population. The reference population used in this report is based on the WHO growth standardsi. Each of the three nutritional status indicators – weight-for-age, height-for-age, and weight-for-height - can be expressed in standard deviation units (z-scores) from the median of the reference population. Weight-for-age is a measure of both acute and chronic malnutrition. Children whose weight-for-age is more than two standard deviations below the median of the reference population are considered moderately or severely underweight while those whose weight-for-age is more than three standard deviations below the median are classified as severely underweight. Height-for-age is a measure of linear growth. Children whose height-for-age is more than two standard deviations below the median of the reference population are considered short for their age and are classified as moderately or severely stunted. Those whose height-for-age is more than three standard deviations below the median are classified as severely stunted. Stunting is a reflection of chronic malnutrition as a result of failure to receive adequate nutrition over a long period and recurrent or chronic illness. Weight-for-height can be used to assess wasting and overweight status. Children whose weight-for- height is more than two standard deviations below the median of the reference population are classified as moderately or severely wasted, while those who fall more than three standard deviations below the median are classified as severely wasted. Wasting is usually the result of a recent nutritional deficiency. The indicator of wasting may exhibit significant seasonal shifts associated with changes in the availability of food or disease prevalence. Children whose weight-for-height is more than two standard deviations above the median reference population are classified as moderately or severely overweight. i http://www.who.int/childgrowth/standards/technical_report Sao Tome and Principe 2014 MICS, Final Report P a g e | 29 Table NU.2:14Nutritional 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, Sao Tome and Principe, 2014 Weight for age Number of children under age 5 Height for age Number of children under age 5 Weight for height Number of children under age 5 Underweight Mean Z-Score (SD) Stunted Mean Z- Score (SD) Wasted Overweight Mean Z- Score (SD) Percent below Percent below Percent below Percent above - 2 SD1 - 3 SD2 - 2 SD3 - 3 SD4 - 2 SD5 - 3 SD6 + 2 SD7 Total 8.8 1.8 -0.6 1,938 17.2 4.5 -0.9 1,929 4.0 0.8 2.4 -0.1 1,935 Sex Male 10.6 2.7 -0.6 963 20.5 6.1 -1.0 960 4.7 0.7 2.6 -0.1 962 Female 6.9 1.0 -0.5 976 13.9 3.0 -0.8 969 3.3 0.8 2.2 -0.1 973 Region Centre East 8.4 1.5 -0.5 1,245 15.6 3.4 -0.8 1,238 3.9 0.7 2.5 -0.1 1,242 North West 9.6 2.0 -0.6 380 20.0 7.0 -1.1 379 4.0 1.0 2.4 0.0 379 South East 9.7 2.8 -0.7 232 23.3 6.3 -1.2 232 5.4 1.0 2.4 -0.1 233 Aut. of Principe 7.5 2.7 -0.6 81 10.5 4.9 -0.8 80 1.2 0.0 0.9 -0.3 81 Area Urban 8.3 1.7 -0.6 1,269 16.3 4.1 -0.9 1,267 4.1 0.7 2.8 -0.1 1,270 Rural 9.6 2.0 -0.6 669 18.9 5.3 -1.0 662 3.9 0.9 1.7 -0.1 665 Age 0-5 months 7.5 1.2 -0.1 163 13.8 2.2 -0.2 161 6.0 2.4 4.9 0.1 165 6-11 months 13.1 2.6 -0.6 168 13.8 1.5 -0.5 167 11.4 0.6 3.0 -0.4 169 12-17 months 14.5 2.8 -0.7 214 14.6 3.4 -0.9 213 5.3 1.9 2.5 -0.4 213 18-23 months 12.7 3.5 -0.6 170 24.2 11.3 -1.2 168 5.0 0.5 1.7 -0.1 168 24-35 months 8.9 1.9 -0.7 400 24.7 7.6 -1.3 396 1.6 0.4 3.1 0.0 396 36-47 months 6.8 1.0 -0.5 411 15.9 4.5 -0.9 411 2.4 0.0 2.0 0.1 411 48-59 months 4.8 1.2 -0.6 413 12.3 1.6 -0.8 413 3.0 0.9 1.2 -0.2 413 Mother’s education None 7.8 1.8 -0.7 83 18.1 2.0 -1.0 83 5.5 1.0 3.5 -0.2 83 Primary 9.7 1.9 -0.7 1,191 19.5 5.3 -1.0 1,184 4.1 0.8 1.6 -0.1 1,186 Secondary/Higher 7.2 1.6 -0.4 664 12.9 3.5 -0.7 662 3.6 0.7 3.7 -0.1 666 Wealth index quintile Poorest 12.6 2.7 -0.9 429 25.5 7.0 -1.3 428 5.8 1.5 1.9 -0.2 429 Second 9.4 1.5 -0.7 405 20.2 4.0 -1.1 404 3.0 0.6 1.8 -0.1 405 Middle 7.5 2.1 -0.5 397 18.3 6.8 -0.9 392 2.3 0.7 2.5 0.0 392 Fourth 5.9 1.1 -0.4 403 12.0 2.0 -0.7 401 4.1 0.4 3.4 0.0 403 Richest 8.0 1.5 -0.4 304 6.8 2.1 -0.4 303 4.9 0.6 2.4 -0.2 305 1 MICS indicator 2.1a and MDG indicator 1.8 - Underweight prevalence (moderate and severe) 2 MICS indicator 2.1b - Underweight prevalence (severe) 3 MICS indicator 2.2a - Stunting prevalence (moderate and severe) 4 MICS indicator 2.2b - Stunting prevalence (severe) 5 MICS indicator 2.3a - Wasting prevalence (moderate and severe) 6 MICS indicator 2.3b - Wasting prevalence (severe) 7 MICS indicator 2.4 - Overweight prevalence Sao Tome and Principe 2014 MICS, Final Report P a g e | 30 In MICS, weights and heights of all children under 5 years of age were measured using the anthropometric equipment recommendedi by UNICEF. Findings in this section are based on the results of these measurements. Table NU.2 shows percentages of children classified into each of the above described categories, based on the anthropometric measurements that were taken during fieldwork. Additionally, the table includes mean z-scores for all three anthropometric indicators. Children whose measurements are outside a plausible range are excluded from Table NU.2. Children are excluded from one or more of the anthropometric indicators when their weights and heights have not been measured, whichever applicable. For example, if a child has been weighed but his/her height has not been measured, the child is included in underweight calculations, but not in the calculations for stunting and wasting. Percentages of children by age and reasons for exclusion are shown in the data quality Tables DQ.12, DQ.13, and DQ.14 in Appendix D. The tables show that due to implausible measurements, and/or missing weight and/or height, 4 percent of children have been excluded from calculations of the weight-for-age, height-for-age and weight-for-height indicators. Further, Table DQ.15 shows that measurers had a tendency in some cases to round height measurements to the nearest centimetre (decimal 0) or half centimetre (decimal 5), but the extent to which this took place is unlikely to have had much impact on the quality of the results. We already referred in Chapter 3 to the issue of out-transference and the likely under-recording of young children which may affect to some extent the representativity of the anthropometric results. Table NU.2 shows that 9 percent of children under age five in Sao Tome and Principe are underweight (2 percent are severely so), while 17 percent are stunted or too short for their age (5 percent are severely so). In addition, 4 percent are moderately or severely wasted or too thin for their height. A small proportion (2 percent) of children are overweight or too heavy for their height. There are no meaningful differences between urban and rural areas, nor between various levels of education of the mother, except in the case of stunting where children of mothers having secondary or higher education tend to be less affected (13 percent) than those whose mothers have primary or no formal education (20 and 18 percent respectively). Regions are also fairly similar with respect to these four indicators, except once again for stunting where the differences are larger, ranging from 11 percent in Region Autónoma de Principe to 23 percent in Region South East. Boys tend to suffer more from underweight and stunting (11 and 21 percent respectively) than girls (7 and 14 percent respectively). However, the widest differences are seen between wealth categories in relation to stunting which ranges from 7 percent among the wealthiest to 26 percent amongst the poorest. The age pattern shows increasing levels of underweight becoming evident during the second half of the first year of life and then increasing levels of stunting manifesting themselves around 18 months of age. The same trends are visible in Figure NU.1. In addition, as will be seen later in Figure NU.3, for many infants complementary foods are initiated well before the recommended age of 6 months, and the proportion of weaned children increases rapidly after the age of 12 months. While it is not possible to demonstrate relationships of causality in such a study, it nonetheless seems plausible i See MICS Supply Procurement Instructions: http://www.mics.unicef.org/mics5_planning.html Sao Tome and Principe 2014 MICS, Final Report P a g e | 31 that the increasing proportions of undernourished children at the two periods indicated above are at least partly related to those two sets of events: the premature initiation of complementary feeding, followed by weaning at a later stage. As children cease to be breastfeed, they tend to be exposed to contamination in water, food, and environment which can lead to undernutrition. F igure NU.1: 4 Under weight , s tunted, wasted and overweight ch i ldren under age 5 (moderat e and sever e) Sao Tome and Pr inc ipe , 2014 Breastfeeding and Infant and Young Child Feeding Proper feeding of infants and young children can increase their chances of survival; it can also promote optimal growth and development, especially in the critical window from birth to 2 years of age. Breastfeeding for the first few years of life protects children from infection, provides an ideal source of nutrients, and is economical and safe. However, many mothers don’t start to breastfeed early enough, do not breastfeed exclusively for the recommended 6 months or stop breastfeeding too soon. There are often pressures to switch to infant formula, which can contribute to growth faltering and micronutrient malnutrition and can be unsafe if hygienic conditions, including safe drinking water are not readily available. Studies have shown that, in addition to continued breastfeeding, consumption of appropriate, adequate and safe solid, semi-solid and soft foods from the age of 6 months onwards leads to better health and growth outcomes, with potential to reduce stunting during the first two years of life.i i Bhuta, Z. et al. 2013. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? The Lancet June 6, 2013. Underweight Stunted Wasted Overweight 0 5 10 15 20 25 30 0 12 24 36 48 60 P e r ce n t Age in months Sao Tome and Principe 2014 MICS, Final Report P a g e | 32 UNICEF and WHO recommend that infants be breastfed within one hour of birth, breastfed exclusively for the first six months of life and continue to be breastfed up to 2 years of age and beyond.i Starting at 6 months, breastfeeding should be combined with safe, age-appropriate feeding of solid, semi-solid and soft foods.ii A summary of key guiding principlesiii, iv for feeding 6-23 month olds is provided in the table below along with proximate measures for these guidelines collected in this survey. The guiding principles for which proximate measures and indicators exist are: (i) continued breastfeeding; (ii) appropriate frequency of meals (but not energy density); and (iii) appropriate nutrient content of food. Feeding frequency is used as proxy for energy intake, requiring children to receive a minimum number of meals/snacks (and milk feeds for non-breastfed children) for their age. Dietary diversity is used to ascertain the adequacy of the nutrient content of the food (not including iron) consumed. For dietary diversity, seven food groups were created for which a child consuming at least four of these is considered to have a better quality diet. In most populations, consumption of at least four food groups means that the child has a high likelihood of consuming at least one animal-source food and at least one fruit or vegetable, in addition to a staple food (grain, root or tuber).v These three dimensions of child feeding are combined into an assessment of the children who received appropriate feeding, using the indicator of “minimum acceptable diet”. To have a minimum acceptable diet in the previous day, a child must have received: (i) the appropriate number of meals/snacks/milk feeds; (ii) food items from at least 4 food groups; and (iii) breastmilk or at least 2 milk feeds (for non-breastfed children). i WHO. 2003. Implementing the Global Strategy for Infant and Young Child Feeding. Meeting Report Geneva, 3-5 February, 2003. ii WHO. 2003. Global Strategy for Infant and Young Child Feeding. iii PAHO. 2003. Guiding principles for complementary feeding of the breastfed child. iv WHO. 2005. Guiding principles for feeding non-breastfed children 6-24 months of age. v WHO. 2008. Indicators for assessing infant and young child feeding practices. Part 1: Definitions. Sao Tome and Principe 2014 MICS, Final Report P a g e | 33 Guiding Principle (age 6-23 months) Proximate measures Table Continue frequent, on-demand breastfeeding for two years and beyond Breastfed in the last 24 hours NU.4 Appropriate frequency and energy density of meals Breastfed children Depending on age, two or three meals/snacks provided in the last 24 hours Non-breastfed children Four meals/snacks and/or milk feeds provided in the last 24 hours NU.6 Appropriate nutrient content of food Four food groupsi eaten in the last 24 hours NU.6 Appropriate amount of food No standard indicator exists na Appropriate consistency of food No standard indicator exists na Use of vitamin-mineral supplements or fortified products for infant and mother No standard indicator exists na Practice good hygiene and proper food handling While it was not possible to develop indicators to fully capture programme guidance, one standard indicator does cover part of the principle: Not feeding with a bottle with a nipple NU.9 Practice responsive feeding, applying the principles of psycho-social care No standard indicator exists na i Food groups used for assessment of this indicator are 1) Grains, roots and tubers, 2) legumes and nuts, 3) dairy products (milk, yogurt, cheese), 4) flesh foods (meat, fish, poultry and liver/organ meats), 5) eggs, 6) vitamin-A rich fruits and vegetables, and 7) other fruits and vegetables. Sao Tome and Principe 2014 MICS, Final Report P a g e | 34 Table NU.3:15Initial breastfeeding Percentage of last live-born children in the last two years who were ever breastfed, breastfed within one hour of birth, and within one day of birth, and percentage who received a prelacteal feed, Sao Tome and Principe, 2014 Percentage who were ever breastfed1 Percentage who were first breastfed: Percentage who received a prelacteal feed Number of last live-born children in the last two years Within one hour of birth2 Within one day of birth Total 97.4 38.3 85.7 7.7 756 Region Centre East 97.8 35.3 85.1 7.4 514 North West 97.3 64.1 87.9 7.4 131 South East 97.1 10.4 84.7 12.4 86 Aut. of Principe (91.8) (58.6) (89.3) (0.0) 25 Area Urban 97.3 35.3 85.2 7.9 496 Rural 97.6 43.8 86.5 7.4 260 Months since last birth 0-11 months 97.3 39.1 83.9 6.6 351 12-23 months 97.5 37.1 87.0 8.9 375 Assistance at delivery Skilled attendant 98.0 38.0 86.6 6.5 699 Traditional birth attendant (94.5) (41.7) (75.9) (26.0) 35 Other/DK/Missing (83.6) (42.3) (70.9) (16.5) 22 Place of delivery Home 96.8 50.1 80.1 21.1 60 Health facilitya 98.0 37.5 86.5 6.7 687 Other/DK/Missing (*) (*) (*) (*) 8 Mother’s education None/Primary 97.0 39.7 84.6 7.1 468 Secondary/Higher 98.2 35.8 87.4 8.8 288 Wealth index quintile Poorest 100.0 48.4 87.6 7.6 161 Second 96.9 35.6 83.8 8.7 158 Middle 97.3 38.7 87.1 5.7 149 Fourth 95.6 36.3 84.0 6.1 161 Richest 97.3 30.7 85.9 11.2 126 1 MICS indicator 2.5 - Children ever breastfed 2 MICS indicator 2.6 - Early initiation of breastfeeding a Since only 1 case was from a private health facility, all health facilities have been merged into one single category ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Table NU.3 is based on mothers’ reports of what their last-born child, born in the last two years, was fed in the first few days of life. It indicates the proportion who were ever breastfed, those who were first breastfed within one hour and one day of birth, and those who received a prelacteal feed.i Although a very important step in management of lactation and establishment of a physical and emotional relationship between the baby and the mother, only 38 percent of babies are breastfed for the first time within one hour of birth, while 86 percent of newborns in Sao Tome and Principe i Prelacteal feed refers to the provision any liquid or food, other than breastmilk, to a newborn during the period when breastmilk flow is generally being established (estimated here as the first 3 days of life). Sao Tome and Principe 2014 MICS, Final Report P a g e | 35 start breastfeeding within one day of birth. The findings are presented in Figure NU.2 by region and area. Initiation of breastfeeding within one hour varies widely between regions, from 10 percent in Region South East to 64 percent in Region North West; it is higher among the poorest (48 percent) than the wealthiest (31 percent), among those giving birth at home (50 percent) than in a health facility (38 percent), and among rural dwellers (44 percent) than urban dwellers (35 percent). On the other hand, initiation with one day is nearly uniform throughout the country and the various groups. About 8 percent of newborns receive a prelacteal feed; the practice appears to be more prevalent when the delivery occurs at home than in a health facility. Various fluids may be given to the newborn during the first three days, the most frequents being simple water, water mixed with sugar, water mixed with sugar and salt, herbal infusions, and the like (data not shown). F igure NU.2: 5 In i t iat ion of breastfeeding Sao Tome and Pr inc ipe , 2014 The set of Infant and Young Child Feeding indicators reported in tables NU.4 through NU.8 are based on the mother’s report of consumption of food and fluids during the day or night prior to being interviewed. Data are subject to a number of limitations, some related to the respondent’s ability to provide a full report on the child’s liquid and food intake due to recall errors as well as lack of knowledge in cases where the child was fed by other individuals. In Table NU.4, breastfeeding status is presented for both Exclusively breastfed and Predominantly breastfed; referring to infants age less than 6 months who are breastfed, distinguished by the former only allowing vitamins, mineral supplements, and medicine and the latter allowing also plain water 85 88 85 89 85 86 86 35 64 10 59 35 44 38 0 20 40 60 80 100 P er c en t Within one day Within one hour Sao Tome and Principe 2014 MICS, Final Report P a g e | 36 and non-milk liquids. The table also shows continued breastfeeding of children at 12-15 and 20-23 months of age. Table NU.4:16Breastfeeding Percentage of living children according to breastfeeding status at selected age groups, Sao Tome and Principe, 2014 Children age 0-5 months Children age 12-15 months Children age 20-23 months Percent exclusively breastfed1 Percent predominantly breastfed2 Number of children Percent breastfed (Continued breastfeeding at 1 year)3 Number of children Percent breastfed (Continued breastfeeding at 2 years)4 Number of children Total 73.8 85.1 178 85.9 139 24.1 124 Sex Male 77.6 87.6 90 84.3 64 17.9 57 Female 70.1 82.6 89 87.2 75 29.3 67 Region Centre East 73.4 84.3 128 82.6 90 21.4 77 North West (69.1) (85.9) 29 (89.9) 31 (22.5) 20 South East (82.2) (90.4) 14 (96.3) 15 (35.7) 23 Aut. of Principe (*) (*) 6 (*) 3 (*) 4 Area Urban 76.3 88.8 112 85.1 98 27.8 83 Rural 69.7 78.9 66 (87.7) 41 (16.4) 41 Mother’s education None/Primary 72.6 86.9 99 86.3 96 25.4 78 Second./Higher 75.3 82.8 79 (84.8) 44 (21.7) 46 Wealth index quintile 60% poorest 71.2 83.2 119 94.9 82 22.9 73 40% richest 79.2 89.0 59 72.8 57 (25.8) 51 1 MICS indicator 2.7 - Exclusive breastfeeding under 6 months 2 MICS indicator 2.8 - Predominant breastfeeding under 6 months 3 MICS indicator 2.9 - Continued breastfeeding at 1 year 4 MICS indicator 2.10 - Continued breastfeeding at 2 years ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Some caution is required when interpreting the results of Table NU.4 due to the generally small sample sizes. For this reason, we will focus only on the overall results. In Sao Tome and Principe, approximately three-quarters (74 percent) of children age less than six months are exclusively breastfed, while 85 percent are predominantly breastfed. At age 12-15 months, 86 percent of children are still being breastfed, which is remarkable, but breastfeeding drops drastically from that point to a mere 24 percent by age 20-23 months. Figure NU.3 shows the detailed pattern of breastfeeding by the child’s age in months. One of the most salient features is the early initiation of complementary feeding, as commented earlier. At age 4-5 months, only about half of the children are exclusively breastfed and nearly 20 percent are already receiving complementary foods, while recommendations are for children to be exclusively breastfed until they reach 6 months of age. Sao Tome and Principe 2014 MICS, Final Report P a g e | 37 Figure NU.3: 6 Infant feeding patterns by age Sao Tome and Pr inc ipe , 2014 Table NU.5 shows the median duration of breastfeeding by selected background characteristics. Among children under age 3, the median duration is 17.0 months for any breastfeeding, 4.8 months for exclusive breastfeeding, and 5.7 months for predominant breastfeeding. Variations between the various background characteristics are generally small, but worthy of note is the gradual shortening of the duration of any breastfeeding from the poorest quintile (18.1 months) to the wealthiest (14.7 months). Exclusively breastfed Breastfed and complementary foods Weaned (not breastfed) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0-1 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-17 18-19 20-21 22-23 Age in months Exclusively breastfed Breastfed and plain water only Breastfed and non-milk liquids Breastfed and other milk / formula Breastfed and complementary foods Weaned (not breastfed) Sao Tome and Principe 2014 MICS, Final Report P a g e | 38 Table NU.5:17Duration of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children age 0-35 months, Sao Tome and Principe, 2014 Median duration (in months) of: Number of children age 0-35 months Any breastfeeding1 Exclusive breastfeeding Predominant breastfeeding Median 17.0 4.8 5.7 1,166 Sex Male 16.5 5.0 6.0 588 Female 17.7 4.6 5.4 578 Region Centre East 16.2 4.9 5.8 762 North West 18.0 4.1 5.3 222 South East 19.2 5.0 5.9 135 Autonomous of Principe 17.9 5.0 5.7 47 Area Urban 17.0 4.7 5.6 765 Rural 17.0 4.8 5.9 401 Mother’s education None/Primary 17.4 4.2 5.5 736 Secondary/Higher 16.4 5.5 6.1 430 Wealth index quintile Poorest 18.1 4.3 5.1 258 Second 18.6 4.8 6.8 245 Middle 16.4 4.8 5.6 227 Fourth 16.9 4.9 5.9 236 Richest 14.7 5.0 5.0 201 Mean 17.6 4.6 5.9 1,166 1 MICS indicator 2.11 - Duration of breastfeeding The age-appropriateness of breastfeeding of children under age 24 months is provided in Table NU.6. Different criteria of feeding are used depending on the age of the child. For infants age 0-5 months, exclusive breastfeeding is considered as age-appropriate feeding, while children age 6-23 months are considered to be appropriately fed if they are receiving breastmilk and solid, semi-solid or soft food. As a result of feeding patterns, only 59 percent of children age 6-23 months are being appropriately breastfed. Age-appropriate breastfeeding among all children age 0-23 months is of 62 percent, with a declining trend from the poorest quintile (71 percent) to the richest (58 percent). Region Centre East, the most populous, is at the lowest end of the 59 to 70 percent range between the regions. Sao Tome and Principe 2014 MICS, Final Report P a g e | 39 Table NU.6:18Age-appropriate breastfeeding Percentage of children age 0-23 months who were appropriately breastfed during the previous day, Sao Tome and Principe, 2014 Children age 0-5 months Children age 6-23 months Children age 0-23 months Percent exclusively breastfed1 Number of children Percent currently breastfeeding and receiving solid, semi- solid or soft foods Number of children Percent appropriately breastfed2 Number of children Total 73.8 178 58.8 576 62.3 754 Sex Male 77.6 90 55.7 277 61.1 366 Female 70.1 89 61.6 299 63.5 388 Region Centre East 73.4 128 54.6 383 59.3 512 North West (69.1) 29 67.9 105 68.2 134 South East (82.2) 14 67.9 67 70.4 82 Aut. of Principe (*) 6 (58.8) 21 (65.2) 27 Area Urban 76.3 112 59.5 385 63.2 497 Rural 69.7 66 57.3 191 60.5 257 Mother’s education None/Primary 72.6 99 61.6 375 63.9 473 Secondary/Higher 75.3 79 53.4 201 59.6 281 Wealth index quintile Poorest (73.1) 34 69.8 132 70.5 166 Second (66.3) 38 58.8 118 60.6 156 Middle (73.7) 47 54.9 95 61.2 142 Fourth (80.0) 38 53.8 119 60.1 156 Richest (*) 22 54.1 112 58.0 134 1 MICS indicator 2.7 - Exclusive breastfeeding under 6 months 2 MICS indicator 2.12 - Age-appropriate breastfeeding ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Overall, 74 percent of infants age 6-8 months received solid, semi-solid, or soft foods at least once during the previous day (Table NU.7). Since only a very small proportion of children of this age group in Sao Tome and Principe are not breastfeeding, it is not meaningful in this case to present these results separately for breastfeeding and not breastfeeding children. Table NU.7:19Introduction of solid, semi-solid, or soft foods Percentage of infants age 6-8 months who received solid, semi-solid, or soft foods during the previous day, Sao Tome and Principe All Percent receiving solid, semi- solid or soft foods1 Number of children age 6- 8 months Total 74.1 81 Area Urban 74.6 55 Rural (73.1) 26 1 MICS indicator 2.13 - Introduction of solid, semi-solid or soft foods ( ) Figures that are based on 25-49 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 40 As seen in Table NU.8, 58 percent of the children age 6-23 months are receiving solid, semi-solid and soft foods the minimum number of times. Children from wealthiest households are more likely to have the required number of daily meals than those from poorest households (67 and 53 percent respectively). The proportion of children receiving the minimum dietary diversity, or foods from at least 4 food groups, is 47 percent, somewhat lower than that for minimum meal frequency, indicating the need to focus on improving diet quality and nutrient intake among this vulnerable group. The proportion of children with minimum dietary diversity improves with age, passing from 17 percent in the 6-8 month old to 60 percent in the 18-23 month old; a similar trend is found among children from the poorest (38 percent) to the wealthiest (54 percent) households. The overall assessment using the indicator of minimum acceptable diet reveals that only 22 percent are benefitting from a diet sufficient in both diversity and frequency. While the tables provide information for both breastfeeding and not breastfeeding children, the sample size in the latter group is rather small and should lead to cautious interpretation. Statistics for all children are based on a larger sample and have thus a better precision. Sao Tome and Principe 2014 MICS, Final Report P a g e | 41 Table NU.8:20Infant and young child feeding (IYCF) practices by sex, age and area Percentage of children age 6-23 months who received appropriate liquids and solid, semi-solid, or soft foods the minimum number of times or more during the previous day, by breastfeeding status, Sao Tome and Principe, 2014 Currently breastfeeding Currently not breastfeeding All Percent of children who received: Number of children age 6-23 months Percent of children who received: Number of children age 6-23 months Percent of children who received: Number of children age 6-23 months Minimum dietary diversitya Minimum meal frequencyb Minimum acceptable diet1, c Minimum dietary diversitya Minimum meal frequencyb Minimum acceptable diet2, c At least 2 milk feeds3 Minimum dietary diversi- ty4, a Minimum meal frequen- cy5, b Minimum accepta- ble dietc Total 40.4 60.6 28.5 372 60.7 53.5 10.9 26.4 195 46.8 58.2 22.5 576 Sex Male 40.1 55.8 25.8 174 55.3 54.5 10.8 24.2 98 44.9 55.3 20.4 277 Female 40.6 64.9 30.8 198 66.1 52.5 11.0 28.6 97 48.6 60.8 24.3 299 Age 6-8 months 18.2 54.1 12.8 74 (*) (*) (*) (*) 6 16.8 51.2 11.9 81 9-11 months 41.0 59.2 29.6 89 (*) (*) (*) (*) 2 42.5 60.3 28.9 92 12-17 months 46.2 65.3 32.2 157 (58.9) (59.9) (9.8) (31.3) 63 49.3 63.7 25.7 223 18-23 months 53.9 58.4 38.1 50 63.9 51.2 12.3 22.7 123 59.5 53.3 19.8 180 Area Urban 41.2 61.1 29.1 251 63.6 58.2 9.4 28.2 125 47.9 60.1 22.5 385 Rural 38.7 59.7 27.2 121 55.4 45.2 13.8 23.1 70 44.7 54.4 22.3 191 1 MICS indicator 2.17a - Minimum acceptable diet (breastfed) 2 MICS indicator 2.17b - Minimum acceptable diet (non-breastfed) 3 MICS indicator 2.14 - Milk feeding frequency for non-breastfed children 4 MICS indicator 2.16 - Minimum dietary diversity 5 MICS indicator 2.15 - Minimum meal frequency ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases a Minimum dietary diversity is defined as receiving foods from at least 4 of 7 food groups: 1) Grains, roots and tubers, 2) legumes and nuts, 3) dairy products (milk, yogurt, cheese), 4) flesh foods (meat, fish, poultry and liver/organ meats), 5) eggs, 6) vitamin-A rich fruits and vegetables, and 7) other fruits and vegetables. b Minimum meal frequency among currently breastfeeding children is defined as children who also received solid, semi-solid, or soft foods 2 times or more daily for children age 6-8 months and 3 times or more daily for children age 9-23 months. For non-breastfeeding children age 6-23 months it is defined as receiving solid, semi-solid or soft foods, or milk feeds, at least 4 times. c The minimum acceptable diet for breastfed children age 6-23 months is defined as receiving the minimum dietary diversity and the minimum meal frequency, while it for non-breastfed children further requires at least 2 milk feedings and that the minimum dietary diversity is achieved without counting milk feeds. Sao Tome and Principe 2014 MICS, Final Report P a g e | 42 Table NU.8 (second part):21Infant and young child feeding (IYCF) practices, by region, mother’s education and wealth index quintile Percentage of children age 6-23 months who received appropriate liquids and solid, semi-solid, or soft foods the minimum number of times or more during the previous day, by breastfeeding status, Sao Tome and Principe, 2014 Currently breastfeeding Currently not breastfeeding All Percent of children who received: Number of children age 6- 23 months Percent of children who received: Number of children age 6-23 months Percent of children who received: Number of chil- dren age 6-23 months Minimum dietary diversitya Minimum meal frequencyb Minimum accepta- ble diet1, c Minimum dietary diversitya Minimum meal frequencyb Minimum acceptable diet2, c At least 2 milk feeds3 Minimum dietary diversi- ty4, a Minimum meal frequen- cy5, b Minimum accepta- ble dietc Total 40.4 60.6 28.5 372 60.7 53.5 10.9 26.4 195 46.8 58.2 22.5 576 Region Centre East 37.5 58.8 26.0 230 63.3 58.0 10.2 28.4 148 46.9 58.5 19.9 383 North West 47.1 68.6 35.4 78 (61.3) (43.6) (11.2) (13.6) 26 50.3 62.3 29.4 105 South East 45.1 66.9 35.0 49 (40.1) (39.0) (15.8) (29.3) 17 44.5 59.8 30.1 67 Aut. of Principe (33.9) (26.8) (8.4) 15 (*) (*) (*) (*) 4 (36.0) (24.2) (9.9) 21 Mother’s education None/Primary 36.0 59.5 24.2 254 53.4 50.3 7.5 19.9 114 40.8 56.7 19.1 375 Secondary/Higher 49.8 63.1 37.7 118 70.9 58.0 15.7 35.4 81 58.1 61.0 28.7 201 Wealth index quintile Poorest 32.2 53.5 17.8 99 (55.6) (49.7) (4.6) (6.7) 32 38.0 52.5 14.6 132 Second 39.8 56.2 35.3 84 (47.2) (47.4) (1.6) (17.4) 33 41.4 53.7 25.8 118 Middle 38.5 65.6 26.7 56 (66.4) (48.0) (23.2) (26.3) 39 50.0 58.4 25.3 95 Fourth 44.8 63.9 31.3 69 (69.8) (54.4) (9.2) (18.3) 44 52.8 60.2 22.7 119 Richest 50.8 69.8 34.7 63 (60.2) (64.2) (13.3) (53.8) 47 53.9 67.4 25.6 112 1 MICS indicator 2.17a - Minimum acceptable diet (breastfed) 2 MICS indicator 2.17b - Minimum acceptable diet (non-breastfed) 3 MICS indicator 2.14 - Milk feeding frequency for non-breastfed children 4 MICS indicator 2.16 - Minimum dietary diversity 5 MICS indicator 2.15 - Minimum meal frequency ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 43 The continued practice of bottle-feeding is a concern because of the possible contamination due to unsafe water and lack of hygiene in preparation. Table NU.9 shows that bottle-feeding is not highly prevalent in Sao Tome and Principe. Of the children under 6 months, 10 percent are fed using a bottle with a nipple, but the proportion rises to 21 percent among children age 6-11 months. The prevalence is much higher in the children of mothers with secondary or higher education (25 percent) than with no formal or only primary education (10 percent), and in the wealthiest (32 percent) than the poorest (9 percent) households. Table NU.9:22Bottle feeding Percentage of children age 0-23 months who were fed with a bottle with a nipple during the previous day, Sao Tome and Principe, 2014 Percentage of children age 0-23 months fed with a bottle with a nipple1 Number of children age 0-23 months Total 15.3 754 Sex Male 12.9 366 Female 17.6 388 Age 0-5 months 9.8 178 6-11 months 21.4 172 12-23 months 15.1 403 Region Centre East 16.6 512 North West 11.3 134 South East 9.3 82 Aut. of Principe (28.0) 27 Area Urban 17.4 497 Rural 11.1 257 Mother’s education None/Primary 9.7 473 Secondary/Higher 24.6 281 Wealth index quintile Poorest 8.8 166 Second 5.0 156 Middle 15.8 142 Fourth 17.6 156 Richest 32.2 134 1 MICS indicator 2.18 - Bottle feeding ( ) Figures that are based on 25-49 unweighted cases Salt Iodization Iodine Deficiency Disorders (IDD) is the world’s leading cause of preventable mental retardation and impaired psychomotor development in young children. In its most extreme form, iodine deficiency causes cretinism. It also increases the risks of stillbirth and miscarriage in pregnant women. Iodine deficiency is most commonly and visibly associated with goitre. IDD takes its greatest toll in impaired Sao Tome and Principe 2014 MICS, Final Report P a g e | 44 mental growth and development, contributing in turn to poor school performance, reduced intellectual ability, and impaired work performance. The indicator is the percentage of households consuming adequately iodized salt (>15 parts per million). The prevention of illnesses due to iodine deficiency through the consumption of iodized salt is implemented in Sao Tome and Principe by CONTIS (Comissão Nacional Técnica de Iodização do Sal). The organization was created in 1996 (law 55/96, despatch 4/97). It oversees the programme of prevention and eradication of iodine deficiencies, and promotes quality control of all salt for human and animal consumption. The problems linked to iodine deficiency in Sao Tome and Principe were characterized as follows in 2001:  prevalence of goitre in children: 63 percent (0.4 percent visible from a distance);  prevalence of children with a urinary iodine concentration below 20 mcg/dl: 44 percent;  median urinary iodine concentration: 22.7 mcg/dl;  population not using iodized salt: 26 percent (67 percent of the salt being iodized but with levels much below the norm). In 2005-2006, the situation was considerably improved after a large advocacy campaign directed to the government and private businesses, and the availability of funds from UNICEF for the implementation of sentinel surveillance in ports and commercial networks. Table NU.10:23Iodized salt consumption Percent distribution of households by consumption of iodized salt, Sao Tome and Principe, 2014 Percentage of households in which salt was tested Number of househol ds Percent of households with: Total Number of households in which salt was tested or with no salt No salt Salt test result Not iodized 0 PPM >0 and <15 PPM 15+ PPM1 Total 87.4 3,492 7.6 1.7 2.7 88.1 100.0 3,302 Region Centre East 90.4 2,311 6.4 2.2 3.2 88.3 100.0 2,232 North West 83.5 612 8.5 .3 1.6 89.5 100.0 558 South East 73.4 417 15.1 .8 1.7 82.4 100.0 361 Aut. of Principe 95.1 152 4.0 1.2 1.9 92.9 100.0 150 Area Urban 89.6 2,306 7.0 1.7 2.2 89.2 100.0 2,221 Rural 83.1 1,186 8.8 1.5 3.8 85.8 100.0 1,081 Wealth index quintile Poorest 76.7 806 15.9 .8 2.5 80.8 100.0 735 Second 87.4 719 7.8 1.1 3.7 87.4 100.0 682 Middle 88.4 676 6.9 2.8 2.6 87.8 100.0 642 Fourth 91.5 658 4.2 1.5 3.0 91.3 100.0 629 Richest 95.6 633 1.5 2.3 1.6 94.6 100.0 614 1 MICS indicator 2.19 - Iodized salt consumption In 87 percent of households, salt used for cooking was tested for iodine content by using salt test kits. Table NU.10 shows that in 8 percent of households, there was no salt available. These households are included in the denominator of the indicator. In 88 percent of households, salt was found to contain 15 parts per million (ppm) or more of iodine. Use of iodized salt ranges from 82 Sao Tome and Principe 2014 MICS, Final Report P a g e | 45 percent in Region South East to 93 percent in Autonomous Region of Principe. The difference between the richest (95 percent) and poorest (81 percent) households in terms of iodized salt consumption is significant. The consumption of adequately iodized salt is graphically presented in Figure NU.4 together with the percentage of salt containing less the 15 ppm. Figure NU.4: 7 Consumption of iodized sa lt Sao Tome and Pr inc ipe , 2014 91 91 84 95 91 90 83 91 90 94 96 91 88 90 82 93 89 86 81 87 88 91 95 88 0 20 40 60 80 100 P er c en t Any iodine 15+ PPM of iodine Sao Tome and Principe 2014 MICS, Final Report P a g e | 46 VI. Child Health Vaccinations The Millennium Development Goal (MDG) 4 is to reduce child mortality by two thirds between 1990 and 2015. Immunization plays a key part in this goal. In addition, the Global Vaccine Action Plan (GVAP) was endorsed by the 194 Member States of the World Health Assembly in May 2012 to achieve the Decade of Vaccines vision by delivering universal access to immunization. Immunization has saved the lives of millions of children in the four decades since the launch of the Expanded Programme on Immunization (EPI) in 1974. Worldwide there are still millions of children not reached by routine immunization and as a result, vaccine-preventable diseases cause more than 2 million deaths every year. The WHO Recommended Routine Immunizations for Childreni recommends all children to be vaccinated against tuberculosis, diphtheria, pertussis, tetanus, polio, measles, hepatitis B, haemophilus influenzae type b, pneumonia/meningitis, rotavirus, and rubella. All doses in the primary series are recommended to be completed before the child’s first birthday, although depending on the epidemiology of disease in a country, the first doses of measles and rubella containing vaccines may be recommended at 12 months or later. The recommended number and timing of most other doses also vary slightly with local epidemiology and may include booster doses later in childhood. The vaccination schedule followed by the Sao Tome and Principe’s National Immunization Programme provides some of the above mentioned vaccinations with birth doses of BCG and Polio (at birth or as early as possible); three doses of the Pentavalent vaccine containing DPT, Hepatitis B, and Haemophilus influenzae type b (Hib) antigens; four doses of Polio vaccine; three doses of the Pneumococcal vaccine (PCV-13); two doses of the measles vaccine (MCV); and one dose of vaccine against yellow fever. All vaccinations should be received during the first year of life except the fourth dose of Polio (one year after the third dose) and the second dose of measles (between 18 and 23 months). Taking into consideration this vaccination schedule, the estimates for full immunization coverage from the 2014 Sao Tome and Principe MICS are based on children age 12-23 months and exclude the fourth dose of Polio and the second dose of measles. Information on vaccination coverage was collected for all children under three years of age. All mothers or caretakers were asked to provide vaccination cards. If the vaccination card for a child was available, interviewers copied vaccination information from the cards onto the MICS questionnaire. If no vaccination card was available for the child, the interviewer proceeded to ask the mother to recall whether or not the child had received each of the vaccinations and, for Polio, Pentavalent and PCV, how many doses were received. The final vaccination coverage estimates are i http://www.who.int/immunization/diseases/en. Table 2 includes recommendations for all children and additional antigens recommended only for children residing in certain regions of the world or living in certain high-risk population groups. Sao Tome and Principe 2014 MICS, Final Report P a g e | 47 based on information obtained from the vaccination card and the mother’s report of vaccinations received by the child. Table CH.1:24Vaccinations in the first years of life Percentage of children age 12-23 months and 24-35 months vaccinated against vaccine preventable childhood diseases at any time before the survey and by their first birthday, Sao Tome and Principe, 2014 Children age 12-23 months: Children age 24-35 months: Vaccinated at any time before the survey according to: Vaccinated by 12 months of agea Vaccinated at any time before the survey according to: Vaccinated by 12 months of age Vaccination card Mother's report Either Vaccination card Mother's report Either Antigen BCG1 91.2 6.1 97.3 97.3 85.7 8.1 93.8 93.7 Polio At birth 91.5 5.6 97.2 97.2 85.1 7.3 92.4 92.2 1 90.7 5.1 95.8 95.3 85.0 7.1 92.1 92.0 2 90.5 4.4 94.8 94.4 84.1 6.0 90.1 88.7 32 89.9 .4 90.4 88.8 82.9 1.1 84.0 81.0 Penta 1 91.7 5.5 97.2 95.4 87.3 6.8 94.1 93.6 2 91.5 5.3 96.7 95.6 85.5 6.3 91.7 90.6 33,4,5 90.5 4.0 94.5 93.0 83.7 4.9 88.5 85.8 PCV 1 83.0 5.0 88.0 86.8 41.9 7.2 49.1 47.8 2 82.1 4.7 86.8 85.1 39.4 6.5 45.9 38.0 3 81.0 3.8 84.8 82.0 36.4 5.6 42.0 27.6 Yellow fever6 85.1 5.2 90.3 89.3 78.0 7.7 85.8 81.2 Measles (MCV1)7 88.1 4.9 93.0 89.0 84.5 7.5 92.0 86.1 Fully vaccinated8, b 73.9 0.0 73.9 65.8 33.2 0.6 33.9 14.6 No vaccinations 0.0 1.9 1.9 1.9 0.2 4.4 4.6 4.6 Number of children 403 403 403 403 412 412 412 412 1 MICS indicator 3.1 - Tuberculosis immunization coverage 2 MICS indicator 3.2 - Polio immunization coverage 3 MICS indicator 3.3 - Diphtheria, pertussis and tetanus (DPT) immunization coverage 4 MICS indicator 3.5 - Hepatitis B immunization coverage 5 MICS indicator 3.6 - Haemophilus influenzae type B (Hib) immunization coverage 6 MICS indicator 3.7 - Yellow fever immunization coverage 7 MICS indicator 3.4; MDG indicator 4.3 - Measles immunization coverage 8 MICS indicator 3.8 - Full immunization coverage a All MICS indicators refer to results in this column b Includes: BCG, Polio3, Penta3, PCV3, Measles (MCV1) and Yellow fever as per the vaccination schedule in Sao Tome and Principe The percentage of children age 12-23 months and 24-35 months who have received each of the specific vaccinations by source of information (vaccination card and mother’s recall) is shown in Table CH.1 and Figure CH.1. The denominators for the table are comprised of children age 12-23 months and 24-35 months so that only children who are old enough to be fully vaccinated are counted. In the first three columns in each panel of the table, the numerator includes all children in the respective age group who were vaccinated at any time before the survey according to the vaccination card or the mother’s report. In the last column in each panel, only those children who Sao Tome and Principe 2014 MICS, Final Report P a g e | 48 were vaccinated before their first birthday, as recommended, are included. For children without vaccination cards, the proportion of vaccinations given before the first birthday is assumed to be the same as for children with vaccination cards. Approximately 97 percent of children age 12-23 months received a BCG vaccination by the age of 12 months. The first dose of Penta was given to 95 percent and the third to 93 percent. For polio, the difference between the first and third dose is somewhat larger (95 and 89 percent respectively). As for PCV, coverage for the first dose by the age of 12 months is notably lower at 87 percent and declines further to 82 percent for the third dose. The coverage is of 89 percent for both yellow fever and measles. There is a rather large gap between the antigen with the lowest coverage (82 percent for PCV3) and the percentage of children who had all the recommended vaccinations by their first birthday which is only 66 percent. This suggests that for a notable proportion of children there are one or several missed immunization opportunities before the age of 12 months. The individual coverage figures for children age 24-35 months are generally slightly lower than those of age 12-23 months, except in the case of PCV for which they are much lower. This is explained by the more recent introduction of that antigen in November 2012. The overall picture suggests that immunization coverage has been improving in Sao Tome and Principe between 2013 and 2014. Figure CH.1: 8 Vaccinat ions by age 12 months Sao Tome and Pr inc ipe , 2014 Table CH.2 presents vaccination coverage estimates among children age 12-23 months by background characteristics. The figures indicate children receiving the vaccinations at any time up to the date of the survey, and are based on information from both the vaccination cards and mothers’/caretakers’ reports. Vaccination cards have been seen by the interviewer for 92 percent of children age 12-23 months. 97 97 95 94 89 95 96 93 87 85 82 89 89 66 2 BCG Polio at birth Polio1 Polio2 Polio3 Penta1 Penta2 Penta3 PCV1 PCV2 PCV3 Yellow fever Measles Fully vaccinated No vaccinations Per cent Children Age 12-23 months 94 92 92 89 81 94 91 86 48 38 28 81 86 15 5 BCG Polio at birth Polio1 Polio2 Polio3 Penta1 Penta2 Penta3 PCV1 PCV2 PCV3 Yellow fever Measles Fully vaccinated No vaccinations Children Age 24-35 months Sao Tome and Principe 2014 MICS, Final Report P a g e | 49 Table CH.2:25Vaccinations by background characteristics Percentage of children age 12-23 months currently vaccinated against vaccine preventable childhood diseases, Sao Tome and Principe, 2014 Percentage of children who received: Percentage with vaccination card seen Number of children age 12-23 months BCG Polio Penta PCV Yellow fever Measles (MCV1) Fulla None At birth 1 2 3 1 2 3 1 2 3 Total 97.3 97.2 95.8 94.8 90.4 97.2 96.7 94.5 88.0 86.8 84.8 90.3 93.0 73.9 1.9 92.0 403 Sex Male 97.7 97.3 97.6 96.2 91.2 98.1 97.3 96.0 87.6 86.0 83.2 89.9 93.5 73.0 1.3 92.2 190 Female 96.9 97.1 94.2 93.6 89.6 96.4 96.2 93.1 88.3 87.5 86.1 90.6 92.5 74.8 2.5 91.8 214 Region Centre East 97.3 97.6 95.9 95.4 90.4 97.0 96.6 94.6 87.3 86.5 84.5 89.3 90.7 72.2 2.4 91.0 278 North West 98.6 97.2 95.6 93.8 92.0 99.0 99.0 96.8 93.6 91.3 89.3 90.4 99.0 83.4 1.0 94.9 67 South East 98.0 96.9 95.3 94.0 88.6 95.7 95.9 93.7 92.7 90.3 87.4 93.6 95.9 77.8 1.1 92.3 48 Aut. of Principe (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 10 Area Urban 99.1 98.7 96.7 96.5 92.6 97.9 98.0 96.2 89.9 88.5 86.4 90.9 92.9 75.2 0.7 93.5 271 Rural 93.6 94.2 94.1 91.4 85.9 95.6 94.2 90.9 84.2 83.3 81.3 89.0 93.1 71.3 4.4 89.0 132 Mother’s education None/Primary 96.3 96.1 94.2 93.3 90.3 96.1 95.4 92.1 86.4 84.8 81.8 87.9 91.9 71.3 2.8 92.2 258 Secondary/Higher 99.1 99.1 98.6 97.5 90.4 99.0 99.0 98.7 90.9 90.4 90.1 94.4 94.9 78.4 0.5 91.6 146 Wealth index quintile Poorest 97.7 97.9 92.5 93.0 89.5 98.6 98.0 91.8 91.4 88.9 84.1 89.4 95.2 72.7 1.4 90.1 91 Second 96.8 96.5 96.4 95.2 93.2 96.6 95.4 96.0 88.4 87.2 84.2 90.9 93.4 75.9 2.8 95.7 77 Middle 97.7 97.7 96.2 92.0 84.1 98.4 99.3 94.6 77.2 74.8 73.0 87.5 94.4 58.1 0.0 91.1 67 Fourth 98.8 98.5 99.0 98.1 92.8 96.8 95.7 94.7 90.8 90.8 90.3 89.5 89.8 77.2 0.6 92.0 82 Richest 95.5 95.5 95.5 95.5 91.3 95.5 95.5 95.5 89.9 89.9 89.9 93.5 92.3 82.5 4.5 91.3 86 a Includes: BCG, Polio3, Penta3, PCV3, Measles (MCV1) and Yellow fever as per the vaccination schedule in Sao Tome and Principe ( ) Figures that are based on 25-49 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 50 Table CH.2 generally shows much uniformity of immunization coverage against the various background characteristics. Nonetheless, full coverage is slightly higher in children whose mothers have secondary or higher education (78 percent) as compared with those with no formal education or primary level only (71 percent). Full coverage between regions ranges from 72 percent (Region Centre East) to 83 percent (Region North East). The results by wealth quintiles appear unstable due to a rather small sample size and should be interpreted with caution. Neonatal Tetanus Protection One of the MDGs is to reduce by three quarters the maternal mortality ratio, with one strategy to eliminate maternal tetanus. Following on the 42nd and 44th World Health Assembly calls for elimination of neonatal tetanus, the global community continues to work to reduce the incidence of neonatal tetanus to less than 1 case of neonatal tetanus per 1,000 live births in every district by 2015. The strategy for preventing maternal and neonatal tetanus is to ensure that all pregnant women receive at least two doses of tetanus toxoid vaccine. If a woman has not received at least two doses of tetanus toxoid during a particular pregnancy, she (and her newborn) are also considered to be protected against tetanus if the woman:  Received at least two doses of tetanus toxoid vaccine, the last within the previous 3 years;  Received at least 3 doses, the last within the previous 5 years;  Received at least 4 doses, the last within the previous 10 years;  Received 5 or more doses anytime during her life.i To assess the status of tetanus vaccination coverage, women who had a live birth during the two years before the survey were asked if they had received tetanus toxoid injections during the pregnancy for their most recent birth, and if so, how many. Women who did not receive two or more tetanus toxoid vaccinations during this recent pregnancy were then asked about tetanus toxoid vaccinations they may have previously received. Interviewers also asked women to present their vaccination card on which dates of tetanus toxoid are recorded and referred to information from the cards when available. i Deming, M.S. et al. 2002. Tetanus toxoid coverage as an indicator of serological protection against neonatal tetanus. Bulletin of the World Health Organization 80(9):696-703 Sao Tome and Principe 2014 MICS, Final Report P a g e | 51 Table CH.3:26Neonatal tetanus protection Percentage of women age 15-49 years with a live birth in the last 2 years protected against neonatal tetanus, Sao Tome and Principe, 2014 Percentage of women who received at least 2 doses during last pregnancy Percentage of women who did not receive two or more doses during last pregnancy but received: Protected against tetanus1 Number of women with a live birth in the last 2 years 2 doses, the last within prior 3 years 3 doses, the last within prior 5 years 4 doses, the last within prior 10 years 5 or more doses during lifetime Total 55.0 16.2 0.4 0.6 0.0 72.1 756 Region Centre East 56.0 15.4 0.4 0.5 0.0 72.3 514 North West 48.1 19.0 0.5 0.6 0.0 68.3 131 South East 57.6 17.0 0.0 1.0 0.0 75.6 86 Aut. of Principe (60.8) (13.8) (0.0) (0.0) (0.0) (74.6) 25 Area Urban 54.4 16.5 0.1 0.7 0.0 71.7 496 Rural 56.2 15.5 0.8 0.4 0.0 72.9 260 Education None/Primary 49.9 16.7 0.6 0.9 0.0 68.1 468 Secondary/Higher 63.3 15.3 0.0 0.0 0.0 78.5 288 Wealth index quintile Poorest 57.1 11.4 0.4 1.0 0.0 70.0 161 Second 54.2 17.8 0.0 0.0 0.0 72.0 158 Middle 57.7 13.3 0.7 0.0 0.0 71.7 149 Fourth 53.8 17.2 0.0 0.6 0.0 71.6 161 Richest 51.6 22.3 0.8 1.3 0.0 76.0 126 1 MICS indicator 3.9 - Neonatal tetanus protection ( ) Figures that are based on 25-49 unweighted cases Table CH.3 shows the protection status from tetanus of women who have had a live birth within the last 2 years. Overall, 72 percent of these women and their newborns were protected against tetanus. The protection level of women with secondary or higher education is somewhat higher (79 percent) than that of those with less education (68 percent). Care of Illness A key strategy for accelerating progress toward MDG 4 is to tackle the diseases that are the leading killers of children under 5. Diarrhoea and pneumonia are two such diseases. The Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) aims to end preventable pneumonia and diarrhoea death by reducing mortality from pneumonia to 3 deaths per 1000 live births and mortality from diarrhoea to 1 death per 1000 live births by 2025. Malaria is also a major killer of children under 5, killing about 1200 children every day, especially in sub-Saharan Africa. The Global Malaria Action Plan (GMAP) aims to reduce malaria deaths to near zero by 2015. Table CH.4 presents the percentage of children under 5 years of age who were reported to have had an episode of diarrhoea, symptoms of acute respiratory infection (ARI), or fever during the 2 weeks Sao Tome and Principe 2014 MICS, Final Report P a g e | 52 preceding the survey. These results are not measures of true prevalence, and should not be used as such, but rather indicate the period-prevalence of those illnesses over a two-week time window. The definition of a case of diarrhoea or fever, in this survey, was the mother’s (or caretaker’s) report that the child had such symptoms over the specified period; no other evidence were sought beside the opinion of the mother. A child was considered to have had an episode of ARI if the mother or caretaker reported that the child had, over the specified period, an illness with a cough with rapid or difficult breathing, and whose symptoms were perceived to be due to a problem in the chest or both a problem in the chest and a blocked nose. While this approach is reasonable in the context of a MICS survey, these basically simple case definitions must be kept in mind when interpreting the results, as well as the potential for reporting and recall biases. Further, diarrhoea, fever and ARI are not only seasonal but are also characterized by the often rapid spread of localized outbreaks from one area to another at different points in time. The timing of the survey and the location of the teams might thus considerably affect the results, which must consequently be interpreted with caution. For these reasons, although the period-prevalence over a two-week time window is reported, these data should not be used to assess the epidemiological characteristics of these diseases, but are essentially employed here to obtain denominators for the indicators related to use of health services and treatment. Overall, 22 percent of under five children were reported to have had diarrhoea in the two weeks preceding the survey, 7 percent symptoms of ARI, and 26 percent an episode of fever (Table CH.4). Between the regions, period-prevalence ranges from 17 to 21 percent in the case of diarrhoea, 6 to 13 percent in the case of ARI, and 17 to 34 percent in the case of fever. Children in the 12-23 month age group seem to have been more susceptible to these common illnesses during the period of the survey. Sao Tome and Principe 2014 MICS, Final Report P a g e | 53 Diarrhoea Diarrhoea is a leading cause of death among children under five worldwide. Most diarrhoea-related deaths in children are due to dehydration from loss of large quantities of water and electrolytes from the body in liquid stools. Management of diarrhoea – either through oral rehydration salts (ORS) or a recommended home fluid (RHF) – can prevent many of these deaths. In addition, provision of zinc supplements has been shown to reduce the duration and severity of the illness as well as the risk of future episodes within the next two or three months; however, supplementation with zinc was not assessed in this survey. Preventing dehydration and malnutrition by increasing fluid intake and continuing to feed the child are also important strategies for managing diarrhoea. Table CH.4:27Reported disease episodes Percentage of children age 0-59 months for whom the mother/caretaker reported an episode of diarrhoea, symptoms of acute respiratory infection (ARI), and/or fever in the last two weeks, Sao Tome and Principe, 2014 Percentage of children who in the last two weeks had: Number of children age 0-59 months An episode of diarrhoea Symptoms of ARI An episode of fever Total 17.7 7.1 26.3 2030 Sex Male 21.7 7.9 28.6 1023 Female 13.7 6.1 24.0 1007 Region Centre East 16.9 6.6 27.6 1317 North West 18.2 6.5 19.1 386 South East 21.1 8.4 33.8 245 Autonomous of Principe 17.7 12.5 17.0 82 Area Urban 18.6 7.2 26.6 1339 Rural 15.9 6.7 25.6 691 Age 0-11 months 20.0 5.1 26.7 351 12-23 months 26.5 6.3 33.9 403 24-35 months 17.6 7.5 26.1 412 36-47 months 12.3 8.8 22.9 434 48-59 months 13.1 7.2 22.4 430 Mother’s education None/Primary 19.4 7.6 25.8 1337 Secondary/Higher 14.4 6.0 27.3 693 Wealth index quintile Poorest 19.9 7.3 27.2 444 Second 21.0 6.6 27.6 428 Middle 14.0 7.0 21.9 411 Fourth 21.8 7.4 29.6 423 Richest 9.8 6.9 24.7 324 Sao Tome and Principe 2014 MICS, Final Report P a g e | 54 In the MICS, mothers or caretakers were asked whether their child under age five years had an episode of diarrhoea in the two weeks prior to the survey. In cases where mothers reported that the child had diarrhoea, a series of questions were asked about the treatment of the illness, including what the child had been given to drink and eat during the episode and whether this was more or less than what was usually given to the child. The overall period-prevalence of diarrhoea in children under 5 years of age is 18 percent (Table CH.4) and ranges from 17 percent in Region Centre East to 21 percent in Region South East. The highest period-prevalence is seen among children age 12-23 months which grossly corresponds to the weaning period. Table CH.5 shows the percentage of children with diarrhoea in the two weeks preceding the survey for whom advice or treatment was sought and where. Overall, a health facility or provider was seen in 54 percent of cases, almost exclusively in the public sector (53 percent). Advice or treatment was sought for a higher proportion of male (59 percent) than female (47 percent), of rural (64 percent) than urban (46 percent) children. Between regions, the same indicator varies from 49 percent in Region Centre East to 70 percent in Region South East. Sao Tome and Principe 2014 MICS, Final Report P a g e | 55 Table CH.5:28Care-seeking during diarrhoea Percentage of children age 0-59 months with diarrhoea in the last two weeks for whom advice or treatment was sought, by source of advice or treatment, Sao Tome and Principe, 2014 Percentage of children with diarrhoea for whom: Number of children age 0-59 months with diarrhoea in the last two weeks Advice or treatment was sought from: No advice or treatment sought Health facilities or providers Other source A health facility or provider1, b Public Private Community health providera Total 53.1 1.2 0.9 4.4 54.2 41.4 359 Sex Male 57.2 1.4 0.8 4.1 58.7 37.2 222 Female 46.3 0.8 1.2 4.7 47.1 48.2 138 Region Centre East 47.8 1.3 0.4 4.6 49.1 46.3 223 North West 57.3 1.2 0.0 5.6 58.5 36.0 70 South East 69.5 0.9 0.0 0.5 70.5 29.0 52 Aut. of Principe (54.5) (0.0) (17.7) (8.4) (54.5) (37.1) 15 Area Urban 48.2 1.7 0.0 4.1 49.9 46.0 250 Rural 64.0 0.0 3.1 5.0 64.0 31.0 110 Age 0-11 months 65.6 0.7 1.4 2.7 66.3 30.9 70 12-23 months 59.8 0.0 0.3 5.4 59.8 34.8 107 24-35 months 48.9 1.2 1.0 1.5 50.1 48.5 73 36-47 months 39.2 5.5 1.5 7.1 44.7 48.3 53 48-59 months 42.8 0.0 0.9 5.6 42.8 51.5 56 Mother’s education None/Primary 53.1 1.3 1.3 4.1 54.4 41.5 260 Secondary/Higher 52.9 0.9 0.0 5.1 53.7 41.2 100 Wealth index quintile Poorest 50.7 1.8 0.0 6.3 52.5 41.2 88 Second 54.4 0.0 0.6 2.3 54.4 43.3 90 Middle 54.5 3.1 1.3 3.3 57.6 39.1 57 Fourth 55.2 0.9 2.3 4.5 56.1 39.4 92 Richest (47.2) (0.0) (0.0) (6.0) (47.2) (46.8) 32 1 MICS indicator 3.10 - Care-seeking for diarrhoea a Community health providers includes both public (Community health worker and Mobile/Outreach clinic) and private (Mobile clinic) health facilities b Includes all public and private health facilities and providers, but excludes private pharmacy ( ) Figures that are based on 25-49 unweighted cases Table CH.6 provides statistics on drinking and feeding practices during diarrhoea. Overall, 42 percent of under five children with diarrhoea were given more to drink than usual while 56 percent were given the same quantity or less. The majority (87 percent) were given somewhat less, the same or more to eat (continued feeding), while 13 percent were given much less or almost nothing. Several of the denominators related to background characteristics are rather small in this table, so that interpretation of apparent differences should be cautious. Sao Tome and Principe 2014 MICS, Final Report P a g e | 56 Table CH.6:29Feeding practices during diarrhoea Percent distribution of children age 0-59 months with diarrhoea in the last two weeks by amount of liquids and food given during episode of diarrhoea, Sao Tome and Principe, 2014 Drinking practices during diarrhoea Eating practices during diarrhoea Number of children age 0-59 months with diarrhoea in the last two weeks Child was given to drink: Total Child was given to eat: Total Much less Somewhat less About the same More Nothing Missing/DK Much less Somewhat less About the same More Nothing Missing/DK Total 8.3 12.9 35.0 41.6 1.9 0.4 100.0 10.2 22.2 41.7 23.2 2.4 0.4 100.0 359 Sex Male 8.5 13.9 35.6 40.4 1.0 0.6 100.0 9.3 21.6 41.5 25.7 1.3 0.6 100.0 222 Female 8.1 11.2 34.0 43.3 3.3 0.0 100.0 11.6 23.3 42.0 19.1 4.1 0.0 100.0 138 Region Centre East 5.7 14.5 37.2 40.5 2.0 0.0 100.0 7.0 22.5 46.0 22.3 1.6 0.5 100.0 223 North West 7.0 1.2 28.8 60.1 1.9 1.0 100.0 17.0 21.0 28.7 30.1 3.1 0.0 100.0 70 South East 19.5 20.2 32.0 28.3 0.0 0.0 100.0 13.3 21.2 38.5 21.7 5.1 0.0 100.0 52 Aut. of Principe (14.9) (17.6) (41.1) (15.5) (6.6) (4.4) 100.0 (14.0) (27.7) (49.2) (6.9) (0.0) (2.2) 100.0 15 Area Urban 8.4 11.4 37.3 40.7 1.9 0.3 100.0 9.1 20.4 43.5 25.0 2.0 0.0 100.0 250 Rural 8.1 16.4 29.6 43.6 1.8 0.6 100.0 12.7 26.4 37.7 18.9 3.1 1.2 100.0 110 Age 0-11 months 8.2 15.2 36.5 40.1 0.0 0.0 100.0 5.2 9.4 50.0 30.1 5.2 0.0 100.0 70 12-23 months 8.1 15.9 29.5 45.0 0.9 0.6 100.0 11.8 21.0 37.0 27.4 2.5 0.3 100.0 107 24-35 months 6.3 5.5 38.1 44.5 4.6 1.0 100.0 12.3 23.3 43.6 20.1 0.7 0.0 100.0 73 36-47 months 7.4 16.7 34.1 39.0 2.8 0.0 100.0 11.6 26.3 39.7 20.4 2.0 0.0 100.0 53 48-59 months 12.5 10.3 40.0 35.3 1.8 0.0 100.0 9.2 35.4 39.6 13.0 0.9 1.8 100.0 56 Mother’s education None/Primary 8.1 11.7 37.0 40.1 2.6 0.4 100.0 10.3 20.8 42.3 24.1 2.5 0.0 100.0 260 Secondary/Higher 9.1 15.8 29.5 45.2 0.0 0.3 100.0 9.9 25.8 40.2 20.8 1.9 1.3 100.0 100 Wealth index quintile Poorest 5.4 14.2 34.5 43.9 2.0 0.0 100.0 5.6 29.8 41.0 20.5 3.1 0.0 100.0 88 Second 5.0 14.2 30.5 48.8 0.6 0.8 100.0 7.6 21.5 39.9 28.4 2.6 0.0 100.0 90 Middle 12.5 17.3 40.0 25.4 4.2 0.6 100.0 15.8 23.1 40.5 20.6 0.0 0.0 100.0 57 Fourth 10.8 8.9 38.3 39.4 2.2 0.3 100.0 11.5 14.5 48.4 22.3 1.8 1.4 100.0 92 Richest (11.3) (9.1) (29.9) (49.8) (0.0) (0.0) 100.0 (16.4) (23.9) (31.5) (22.9) (5.3) (0.0) 100.0 32 ( ) Figures that are based on 25-49 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 57 Table CH.7:30Oral rehydration solutions, recommended homemade fluids, and zinc Percentage of children age 0-59 months with diarrhoea in the last two weeks, and treatment with oral rehydration salts (ORS), recommended homemade fluids, and zinc, Sao Tome and Principe, 2014 Percentage of children with diarrhoea who received: Number of children age 0- 59 months with diarrhoea in the last two weeks Oral rehydration salts (ORS)1 Recommended homemade fluids ORS or any recommended homemade fluid Water, sugar and salt Rice water Any recommended homemade fluid Total 49.1 20.4 13.4 24.9 55.9 359 Sex Male 54.5 20.2 13.0 23.2 59.4 222 Female 40.6 20.9 14.0 27.5 50.4 138 Region Centre East 43.7 17.6 11.2 21.2 51.7 223 North West 46.4 23.1 16.1 27.2 51.2 70 South East 71.8 27.0 19.4 35.4 77.1 52 Aut. of Principe (64.7) (27.3) (12.4) (33.1) (67.7) 15 Area Urban 45.7 21.0 14.3 26.0 54.2 250 Rural 56.9 19.2 11.3 22.3 60.0 110 Age 0-11 months 52.4 13.5 12.5 16.3 57.2 70 12-23 months 60.3 25.0 11.0 29.7 66.3 107 24-35 months 43.3 20.5 14.5 24.1 48.0 73 36-47 months 44.7 20.0 16.4 27.6 58.1 53 48-59 months 35.6 20.8 14.7 24.8 42.8 56 Mother’s education None/Primary 49.8 22.5 14.9 27.5 58.0 260 Secondary/Higher 47.5 15.1 9.5 18.0 50.5 100 Wealth index quintile Poorest 50.8 22.6 21.1 35.7 61.0 88 Second 49.5 24.7 13.4 28.6 57.9 90 Middle 47.6 17.7 8.8 18.7 51.2 57 Fourth 48.7 13.1 8.5 13.1 50.0 92 Richest (47.6) (28.6) (14.2) (29.5) (61.9) 32 1 Indicator 3.S2 (country specific) - Diarrhoea treatment with oral rehydration salts (ORS) ( ) Figures that are based on 25-49 unweighted cases Table CH.7 shows the percentage of children receiving ORS and various types of recommended homemade fluids during the episode of diarrhoea. Since children may have been given more than one type of liquid, the percentages do not necessarily add to 100. Half of the children (49 percent) who had an episode of diarrhoea in the two weeks preceding the survey received fluids from ORS packets and one quarter (25 percent) of them received recommended homemade fluids (a water, sugar and salt mixture, and/or rice water). The use of ORS seems somewhat more predominant among male (54 percent) than female (41 percent) children. Since many of the denominators for the various background characteristics are small, interpretation of apparent differences should be cautious. The same applies to Figure CH.2. Sao Tome and Principe 2014 MICS, Final Report P a g e | 58 Figure CH.2: 9Chi ldren under -5 with d iarrhoea who received ORS or recommended homemade l iqu ids , Sao Tome and Pr inc ipe, 2014 Table CH.8 provides the proportion of children age 0-59 months with diarrhoea in the last two weeks who received oral rehydration therapy with continued feeding, and the percentage of children with diarrhoea who received other treatments. Overall, 70 percent of children with diarrhoea received ORS or increased fluids, 73 percent received ORT (ORS or recommended homemade fluids or increased fluids). Combining the information in Table CH.6 with that of Table CH.7 on oral rehydration therapy, it is observed that 62 percent of children received ORT and, at the same time, feeding was continued, as is the recommendation. Many of the numerators for the various background characteristics are relatively small, which should lead to caution in the interpretation of apparent differences. Table CH.8 also shows the percentage of children having had diarrhoea in the two weeks preceding the survey who were given various forms of treatment; 23 percent of them did not receive any treatment or drug. Part of the information in this table is reproduced in Figure CH.3. 52 51 77 68 54 60 59 50 58 50 56 P er c en t Sao Tome and Principe 2014 MICS, Final Report P a g e | 59 Table CH.8:31Oral rehydration therapy with continued feeding and other treatments Percentage of children age 0-59 months with diarrhoea in the last two weeks who were given oral rehydration therapy with continued feeding and percentage who were given other treatments, Sao Tome and Principe, 2014 Children with diarrhoea who were given: Not given any treatment or drug Number of children age 0-59 months with diarrhoea in the last two weeks ORS or increased fluids ORT (ORS or recommended homemade fluids or increased fluids) ORT with continued feeding1 Other treatments Pill or syrup Injection Intra- venous Home remedy, herbal medicine Other Anti- biotic Anti- moti- lity Other Unknown Anti- bio- tic Non- anti- biotic Unknown Total 70.3 73.1 61.7 9.7 0.0 0.2 4.0 0.4 0.0 0.0 0.0 14.1 6.7 23.1 359 Sex Male 72.3 74.6 64.5 9.9 0.0 0.0 3.2 0.4 0.0 0.0 0.0 17.0 6.0 21.2 222 Female 67.2 70.6 57.2 9.2 0.0 0.6 5.4 0.3 0.0 0.0 0.0 9.4 7.9 26.3 138 Region Centre East 64.6 68.2 60.8 11.5 0.0 0.0 2.0 0.4 0.0 0.0 0.0 11.9 7.4 28.6 223 North West 82.4 83.5 63.3 5.1 0.0 0.0 9.5 0.0 0.0 0.0 0.0 17.6 1.9 12.7 70 South East 80.2 81.4 64.0 7.4 0.0 1.6 4.6 0.8 0.0 0.0 0.0 20.3 10.8 12.3 52 Aut. of Principe (64.7) (67.7) (60.2) (11.2) (0.0) (0.0) (6.8) (0.0) (0.0) (0.0) (0.0) (9.6) (3.9) (28.4) 15 Area Urban 67.4 71.4 61.3 5.7 0.0 0.0 3.2 0.5 0.0 0.0 0.0 13.3 6.2 26.4 250 Rural 76.9 76.9 62.6 18.7 0.0 0.8 6.1 0.0 0.0 0.0 0.0 16.0 7.8 15.8 110 Age 0-11 months 80.0 80.0 69.6 9.1 0.0 0.0 4.7 0.0 0.0 0.0 0.0 11.8 2.5 20.0 70 12-23 months 77.1 79.9 66.5 4.9 0.0 0.0 2.1 0.0 0.0 0.0 0.0 20.7 9.6 16.8 107 24-35 months 62.0 62.6 50.9 10.2 0.0 0.0 6.7 0.0 0.0 0.0 0.0 4.9 11.0 33.1 73 36-47 months 68.4 76.3 63.7 8.4 0.0 0.0 4.6 1.6 0.0 0.0 0.0 19.5 6.2 18.5 53 48-59 months 57.9 62.1 54.8 20.0 0.0 1.5 2.8 0.8 0.0 0.0 0.0 11.1 1.4 30.7 56 Mother’s education None/Primary 70.3 74.1 62.0 8.9 0.0 0.3 3.7 0.2 0.0 0.0 0.0 16.1 6.2 21.8 260 Second./Higher 70.4 70.4 61.0 11.6 0.0 0.0 4.9 0.9 0.0 0.0 0.0 9.0 8.0 26.6 100 Wealth index quintile Poorest 72.0 75.2 66.4 9.5 0.0 0.9 4.5 0.0 0.0 0.0 0.0 22.1 2.3 18.8 88 Second 75.5 78.8 69.2 9.3 0.0 0.0 3.0 0.5 0.0 0.0 0.0 16.2 10.6 19.5 90 Middle 60.7 63.8 50.9 4.9 0.0 0.0 3.5 0.0 0.0 0.0 0.0 15.7 8.5 36.2 57 Fourth 68.5 68.5 56.3 13.0 0.0 0.0 4.9 0.0 0.0 0.0 0.0 7.8 5.7 26.0 92 Richest (73.8) (81.2) (62.7) (10.0) (0.0) (0.0) (4.3) (2.7) (0.0) (0.0) (0.0) (0.9) (7.2) (14.0) 32 1 MICS indicator 3.12 - Diarrhoea treatment with oral rehydration therapy (ORT) and continued feeding ( ) Figures that are based on 25-49 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 60 Figure CH.3: 10Chi ldren under -5 with d iarrhoea receiv ing oral rehydrat ion therapy (ORT) and cont inued feeding, Sao Tome and Pr inc ipe, 2014 Table CH.9 provides information on the source of ORS for children who benefitted from these treatments. The main source of ORS is the public sector (89 percent). Several of the usual background characteristics are not presented in this table due to insufficient sample size. 61 63 64 60 61 63 62 61 62 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 Regions R. Centre East R. North West R. South East A. Reg. of Principe Area Urban Rural Mother's Education None/Primary Secondary/Higher Sao Tome and Principe Per cent Sao Tome and Principe 2014 MICS, Final Report P a g e | 61 Table CH.9:32Source of ORS Percentage of children age 0-59 months with diarrhoea in the last two weeks who were given ORS, by the source of ORS, Sao Tome and Principe, 2014 Percen- tage of children who were given ORS for diar- rhoea Number of children age 0-59 months with diarrhoea in the last two weeks Percentage of children for whom the source of ORS was: Number of children age 0-59 months who were given ORS as treatment for diarrhoea in the last two weeks Health facilities or providers Other source A health facility or providerb Public Private Commu- nity health providera Total 49.1 359 88.9 4.5 1.2 6.5 93.5 177 Sex Male 54.5 222 89.7 3.4 .8 6.9 93.1 121 Female 40.6 138 87.3 7.0 1.9 5.8 94.2 56 Region Centre East 43.7 223 84.8 7.7 0.0 7.5 92.5 97 North West 46.4 70 (98.5) (0.0) (0.0) (1.5) (98.5) 33 South East 71.8 52 92.1 1.3 0.0 6.6 93.4 37 Aut. of Principe (64.7) 15 (*) (*) (*) (*) (*) 9 Area Urban 45.7 250 89.6 3.0 0.0 7.4 92.6 114 Rural 56.9 110 87.7 7.3 3.3 4.9 95.1 63 a Community health provider includes both public (Community health worker and Mobile/Outreach clinic) and private (Mobile clinic) health facilities b Includes all public and private health facilities and providers ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Acute Respiratory Infections Symptoms of ARI are collected during the 2014 Sao Tome and Principe MICS to capture pneumonia, the leading cause of death in children under five. Once diagnosed, pneumonia is treated effectively with antibiotics. Studies have shown a limitation in the survey approach of measuring pneumonia because many of the suspected cases identified through surveys are in fact, not true pneumonia.i While this limitation does not affect the level and patterns of care-seeking for suspected pneumonia, it limits the validity of the level of treatment of pneumonia with antibiotics, as reported through household surveys. The treatment indicator described in this report must therefore be taken with caution, keeping in mind that the accurate level is likely higher. Table CH.10 presents the percentage of children with symptoms of ARI in the two weeks preceding the survey for whom care was sought, by source of care and the percentage who received antibiotics. Overall, 69 percent of children age 0-59 months with symptoms of ARI in the two weeks preceding the survey were taken to a qualified provider and 48 percent received antibiotics. It appears that the use of antibiotics in such circumstances is more prevalent in rural (68 percent) than in urban (38 percent) areas. The source of the antibiotics is a health facility or provider in 83 percent of cases, of which 73 percent are public and 10 percent private (data not shown). Because of the relatively small number of cases of children with ARI symptoms in our sample, and the even smaller i Campbell, H. et al. 2013. Measuring Coverage in MNCH: Challenges in Monitoring the Proportion of Young Children with Pneumonia Who Receive Antibiotic Treatment. PLoS Med 10(5): e1001421. doi:10.1371/journal.pmed.1001421 Sao Tome and Principe 2014 MICS, Final Report P a g e | 62 number of those who received antibiotics, only a few background characteristics are presented in Table CH.10. Table CH.10:33Care-seeking for and antibiotic treatment of symptoms of acute respiratory infection (ARI) Percentage of children age 0-59 months with symptoms of ARI in the last two weeks for whom advice or treatment was sought, by source of advice or treatment, Sao Tome and Principe, 2014 Percentage of children with symptoms of ARI for whom: Percentage of children with symptoms of ARI in the last two weeks who were given antibiotics2 Number of children age 0-59 months with symptoms of ARI in the last two weeks Advice or treatment was sought from: No advice or treat- ment sought Health facilities or providers Other source A health facility or provi- der1, b Public Private Commu- nity health providera Total 60.1 8.8 0.0 2.1 68.9 30.2 47.6 143 Sex Male 57.2 13.5 0.0 0.3 70.7 29.0 49.4 81 Female 63.8 2.6 0.0 4.3 66.4 31.9 45.2 62 Region Centre East 56.7 11.7 0.0 1.9 68.4 31.6 42.3 87 North West (70.1) (5.6) (0.0) (4.1) (75.7) (20.2) (57.6) 25 South East (62.7) (0.0) (0.0) (0.0) (62.7) (37.3) (55.4) 21 Aut. of Principe (*) (*) (*) (*) (*) (*) (*) 10 Area Urban 56.4 10.3 0.0 2.0 66.6 33.1 37.8 97 Rural 67.9 5.6 0.0 2.2 73.5 24.3 68.0 46 1 MICS indicator 3.13 - Care-seeking for children with acute respiratory infection (ARI) symptoms 2 MICS indicator 3.14 - Antibiotic treatment for children with ARI symptoms a Community health providers includes both public (Community health worker and Mobile/Outreach clinic) and private (Mobile clinic) health facilities b Includes all public and private health facilities and providers, but excludes private pharmacy c Includes all public and private health facilities and providers Mothers’ knowledge of danger signs is an important determinant of care-seeking behaviour. In the MICS, mothers or caretakers were asked to report symptoms that would cause them to take a child under-five for care immediately at a health facility. Issues related to knowledge of danger signs of pneumonia are presented in Table CH.11. Overall, 33 percent of women know at least one of the two danger signs of pneumonia – fast and/or difficult breathing. This ranges from 28 percent in Region South East to 55 percent in Autonomous Region of Principe, but is otherwise fairly uniform among urban and rural, more or less educated, and poorer and wealthier mothers. The most commonly identified symptom for taking a child to a health facility is fever. Only 16 percent of mothers identified fast breathing and 25 percent difficult breathing as symptoms for taking children immediately to a health care provider. Sao Tome and Principe 2014 MICS, Final Report P a g e | 63 Table CH.11:34Knowledge of the two danger signs of pneumonia Percentage of women age 15-49 years who are mothers or caretakers of children under age 5 by symptoms that would cause them to take a child under age 5 immediately to a health facility, and percentage of mothers who recognize fast or difficult breathing as signs for seeking care immediately, Sao Tome and Principe, 2014 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: Mothers/caretakers who recognize at least one of the two danger signs of pneumonia (fast and/or difficult breathing) Number of women age 15-49 years who are mothers/caretakers of children under age 5 Is not able to drink or breastfeed Becomes sicker Develops a fever Has fast breathing Has difficult breathing Has blood in stool Is drinking poorly Has diarrhoea Has other symptoms Total 10.1 17.6 79.3 16.0 25.0 14.5 6.2 73.5 44.7 33.4 1,454 Region Centre East 8.9 15.7 78.7 13.8 24.1 12.9 5.6 70.9 48.8 30.4 940 North West 10.7 23.2 81.7 21.6 32.4 16.7 9.9 76.2 30.7 42.9 266 South East 10.1 9.7 77.0 16.0 12.6 5.9 1.3 75.8 52.6 28.3 187 Aut. of Principe 27.2 47.8 84.7 27.2 46.3 56.4 15.7 96.1 18.0 55.3 60 Area Urban 9.2 15.1 81.2 16.3 24.2 13.1 6.0 71.6 46.2 32.5 953 Rural 11.9 22.5 75.6 15.7 26.6 17.1 6.6 77.3 41.9 35.2 501 Education None/Primary 9.1 17.4 78.7 15.6 25.4 13.6 5.9 74.0 45.2 34.5 933 Secondary/Higher 11.9 18.1 80.3 16.9 24.3 15.9 6.8 72.6 43.8 31.5 521 Wealth index quintile Poorest 8.6 17.6 75.6 15.6 22.1 11.0 4.7 74.3 39.8 33.2 300 Second 10.9 16.2 76.1 17.2 24.7 14.8 7.4 76.2 39.5 33.8 316 Middle 11.1 18.7 79.3 16.1 28.1 19.0 7.1 72.5 47.1 35.1 294 Fourth 11.7 18.5 85.1 16.2 25.6 15.5 6.6 75.2 47.5 33.1 298 Richest 7.8 17.2 80.8 14.9 24.7 11.4 5.1 68.3 51.3 31.6 245 Sao Tome and Principe 2014 MICS, Final Report P a g e | 64 Solid Fuel Use More than 3 billion people around the world rely on solid fuels for their basic energy needs, including cooking and heating. Solid fuels include biomass fuels, such as wood, charcoal, crops or other agricultural waste, dung, shrubs and straw, and coal. Cooking and heating with solid fuels leads to high levels of indoor smoke which contains a complex mix of health-damaging pollutants. The main problem with the use of solid fuels is their incomplete combustion, which produces toxic elements such as carbon monoxide, polyaromatic hydrocarbons, and sulphur dioxide (SO2), among others. Use of solid fuels increases the risks of incurring acute respiratory illness, pneumonia, chronic obstructive lung disease, cancer, and possibly tuberculosis, asthma, or cataracts, and may contribute to low birth weight of babies born to pregnant women exposed to smoke. The primary indicator for monitoring use of solid fuels is the proportion of the population using solid fuels as the primary source of domestic energy for cooking, shown in Table CH.12. Overall, 42 percent of the household population in Sao Tome and Principe uses solid fuels for cooking, consisting mainly of wood (33 percent). Use of solid fuels is substantial even in urban areas (33 percent), but predominant in rural areas, where they are used by 59 percent of household members. Differentials with respect to household wealth, the educational level of the household head and the regions are large. The findings show that use of solid fuels ranges from 27 percent in Region Centre East to 76 percent in Autonomous Region of Principe. Sao Tome and Principe 2014 MICS, Final Report P a g e | 65 Table CH.12:35Solid fuel use Percent distribution of household members according to type of cooking fuel mainly used by the household, and percentage of household members living in households using solid fuels for cooking, Sao Tome and Principe, 2014 Percentage of household members in households mainly using: Number of household members Electricity Liquefied Petroleum Gas (LPG) Kerosene Solid fuels Other fuel No food cooked in the household Total Solid fuels for cooking1 Char- coal Wood Straw/ Shrubs/ Grass Agricultural crop residue Total 0.3 1.5 55.9 8.7 32.9 0.1 0.1 0.0 0.5 100.0 41.8 13,455 Region Centre East 0.4 2.1 70.0 5.5 21.5 0.0 0.2 0.0 0.3 100.0 27.3 8,799 North West 0.0 0.5 27.0 13.9 57.6 0.2 0.0 0.0 0.7 100.0 71.7 2,510 South East 0.1 0.1 35.6 8.4 55.2 0.0 0.0 0.0 0.7 100.0 63.6 1,651 Aut. of Principe 0.5 1.0 20.5 40.3 36.0 0.0 0.0 0.0 1.6 100.0 76.3 495 Area Urban 0.4 1.9 63.9 10.1 23.0 0.1 0.2 0.0 0.4 100.0 33.4 8,960 Rural 0.0 0.7 40.1 5.9 52.7 0.1 0.0 0.0 0.5 100.0 58.7 4,495 Education of household head None 0.0 0.0 41.1 6.8 51.6 0.0 0.0 0.0 0.4 100.0 58.4 1,056 Primary 0.3 0.4 49.1 9.7 39.8 0.1 0.1 0.0 0.5 100.0 49.7 7,461 Secondary 0.2 1.9 68.3 8.4 20.5 0.0 0.3 0.0 0.5 100.0 29.2 4,273 Higher 0.5 14.7 77.9 2.4 3.8 0.0 0.0 0.0 0.6 100.0 6.2 575 DK/Missing 0.8 10.9 70.1 1.9 16.3 0.0 0.0 0.0 0.0 100.0 18.2 90 Wealth index quintile Poorest 0.1 0.0 25.8 9.3 62.8 0.0 0.7 0.0 1.2 100.0 72.9 2,692 Second 0.0 0.0 41.3 11.1 47.0 0.2 0.0 0.0 0.4 100.0 58.3 2,691 Middle 0.4 0.7 56.8 9.2 32.4 0.1 0.0 0.0 0.4 100.0 41.7 2,691 Fourth 0.2 0.4 72.7 8.1 18.4 0.0 0.0 0.0 0.3 100.0 26.4 2,689 Richest 0.7 6.5 83.1 5.8 3.9 0.0 0.0 0.0 0.0 100.0 9.7 2,693 1 MICS indicator 3.15 - Use of solid fuels for cooking Sao Tome and Principe 2014 MICS, Final Report P a g e | 66 Table CH.13:36Solid fuel use by place of cooking Percent distribution of household members in households using solid fuels by place of cooking, Sao Tome and Principe, 2014 Place of cooking: Number of household members in households using solid fuels for cooking In the house In a separate building Outdoors Other place Missing Total In a separate room used as kitchen Elsewhere in the house Total 11.3 5.6 33.6 48.7 0.3 0.5 100.0 5,626 Region Centre East 8.6 5.2 27.7 57.5 0.1 0.8 100.0 2,398 North West 7.1 2.9 49.2 40.2 0.2 0.4 100.0 1,800 South East 18.3 9.7 17.3 53.9 0.8 0.0 100.0 1,050 Aut. of Principe 29.6 9.0 42.6 18.8 0.0 0.0 100.0 378 Area Urban 13.8 6.2 29.5 49.9 0.2 0.5 100.0 2,989 Rural 8.6 4.8 38.4 47.4 0.4 0.4 100.0 2,637 Education of household heada None 9.7 11.7 30.6 47.4 0.3 0.3 100.0 617 Primary 10.0 4.2 36.0 49.1 0.4 0.3 100.0 3,711 Secondary 16.4 6.8 28.4 47.4 0.0 1.0 100.0 1,246 Higher (0.0) (0.0) (36.1) (63.9) (0.0) (0.0) 100.0 36 Wealth index quintile Poorest 9.8 6.6 28.4 54.4 0.5 0.3 100.0 1,963 Second 9.4 4.4 33.2 52.4 0.1 0.4 100.0 1,568 Middle 12.1 8.0 38.1 41.5 0.3 0.0 100.0 1,122 Fourth 11.7 1.8 41.1 43.7 0.0 1.8 100.0 711 Richest 30.8 4.1 36.5 28.6 0.0 0.0 100.0 262 a 24 unweighted cases of DK/Missing not shown (*) Figures that are based on fewer than 25 unweighted cases Solid fuel use by place of cooking is depicted in Table CH.13. The presence and extent of indoor pollution are dependent on cooking practices, places used for cooking, as well as types of fuel used. According to the 2014 Sao Tome and Principe MICS, 11 percent of the population living in households using solid fuels for cooking, cook food in a separate room that is used as a kitchen. The percentage that have food cooked within the dwelling unit is higher in urban (20 percent) than in rural areas (13 percent), and among the wealthiest (31 percent) than the poorest (10 percent). It varies by region from 9 percent in Region Centre East to 30 percent in Autonomous Region of Principe. Malaria/Fever Malaria is a major cause of death of children under age five worldwide. In areas where malaria is common, WHO recommends indoor residual spraying (IRS), use of insecticide treated bednets (ITNs) and prompt treatment of cases with recommended anti-malarial drugs. In 2010 the World Health Organization issued a recommendation for universal use of diagnostic testing to confirm malaria infection and apply appropriate treatment based on the results. According to the guidelines, treatment solely on the basis of clinical suspicion should only be considered when Sao Tome and Principe 2014 MICS, Final Report P a g e | 67 a parasitological diagnosis is not accessible. This recommendation was based on studies that showed substantial reduction in the proportion of fever that are associated with malaria to a low level.i This recommendation implies that the indicator on proportion of children with fever that received antimalarial treatment is no longer an acceptable indicator of the level of treatment of malaria in the population of children under age five. However, as it remains the MDG indicator and for purposes of comparisons, as well assessment of patterns across socio-demographic characteristics, the indicator remains a standard MICS indicator. Children with severe malaria symptoms, such as fever and convulsions, should be taken to a health facility. Further, children recovering from malaria should be given extra liquids and food, and younger children should continue breastfeeding. Insecticide-treated mosquito nets, or ITNs, if used properly, are very effective in offering protection against mosquitoes and other insects. The use of ITNs is one of the main health interventions implemented to reduce malaria transmission in Sao Tome and Principe. The questionnaire incorporates questions on the availability and use of bed nets, both at household level and among children under five years of age and pregnant women. In addition, all households in the 2014 Sao Tome and Principe MICS were asked whether the interior dwelling walls were sprayed with an insecticide to kill mosquitoes that spread malaria during the 12 months preceding the survey. Malaria still presents great challenges to the national health system in Sao Tome and Principe, where the disease has been targeted for elimination since the XV century. The national malaria programme demonstrate the engagement of the government, assisted by various technical and financial partners, towards the integration of various measures of prevention (vector control), treatment, diagnostic, communication for behavioural change, institutional capacity building, environmental control, monitoring and evaluation, which have succeeded in recent years to lower the epidemiological levels of the illness. Over the last decade, the Government of Sao Tome and Principe and its partners have carried out a comprehensive range of malaria control interventions. Among these feature universal diagnosis and case management; community education; health systems strengthening; vector control through mass and routine distribution of long-lasting insecticide nets coupled with indoor residual spraying (IRS). Since 2009, IRS campaigns have been conducted under the UNDP/Global Fund Project once a year, with a coverage of 75 to 84 percent in the last 4 years. Vector control measures may have played a critical role in securing the positive impact data reported through this report. Malaria transmission takes place all year long in Sao Tome and Principe, with peak incidence between November and January, and from May to June. From 2001 to 2010, a 90 percent reduction in the number of reported cases was registered (from 43,493 to 3,340), and in the number of deaths (from 254 to 14). In the last five years, there was a reduction in the reported number of malaria cases (from 6,182 in 2009 to 1,754 in 2014), bringing mortality rate down to 0.14/1000 in 2009 to 0/1000 in 2014. i D'Acremont, V et al. 2010. Reduction in the proportion of fevers associated with Plasmodium falciparum parasitaemia in Africa: a systematic review. Malaria Journal 9(240). Sao Tome and Principe 2014 MICS, Final Report P a g e | 68 Table CH.14:37Household availability of insecticide treated nets and protection by a vector control method Percentage of households with at least one mosquito net, one insecticide treated net (ITN), and one long-lasting treated net, percentage of households with at least one mosquito net, one insecticide treated net (ITN) per two people, and one long-lasting treated net, percentage of households with at least one ITN and/or indoor residual spraying (IRS) in the last 12 months, and percentage of households with at least one ITN per two people and/or with indoor residual spraying (IRS) in the last 12 months, Sao Tome and Principe, 2014 Percentage of households with at least one mosquito net: Percentage of households with at least one net for every two personsa: Percentage of households with IRS in the past 12 months Percentage of households with at least one ITN and/or IRS during the last 12 months3 Percentage of households with at least one ITN for every 2 persons and/or IRS during the last 12 months4 Number of households Any mosquito net Insecticide treated mosquito net (ITN)1 Long-lasting insecticidal treated net (LLIN) Any mosquito net Insecticide treated mosquito net (ITN)2 Long-lasting insecticidal treated net (LLIN) Total 78.5 77.7 77.8 56.0 55.1 55.2 90.9 96.7 94.8 3,492 Region Centre East 79.8 79.4 79.4 58.7 57.9 58.0 89.4 96.2 94.0 2,311 North West 76.1 74.8 74.8 47.0 46.2 46.2 94.2 97.7 96.6 612 South East 71.2 69.5 70.1 49.8 48.2 48.5 93.8 96.6 95.3 417 Aut. of Principe 86.8 86.2 86.2 67.2 67.0 67.0 92.4 99.1 98.0 152 Area Urban 83.1 82.3 82.4 60.5 59.5 59.6 91.0 97.3 95.3 2,306 Rural 69.5 68.7 68.7 47.2 46.5 46.6 90.8 95.5 94.0 1,186 Education of household headb None 71.8 71.5 71.5 58.2 57.9 57.9 94.3 96.6 95.7 319 Primary 75.6 74.8 74.9 50.9 50.0 50.0 91.6 96.7 95.1 1,891 Secondary 84.3 83.4 83.4 62.0 61.1 61.2 89.6 96.5 94.0 1,113 Higher 85.5 85.2 85.2 68.6 68.3 68.3 87.4 98.2 96.3 148 Wealth index quintile Poorest 65.8 65.1 65.2 44.5 43.9 43.9 89.2 95.0 92.8 806 Second 74.3 73.7 73.7 48.4 47.6 47.6 90.9 96.1 94.8 719 Middle 80.6 79.8 79.8 53.6 52.9 52.9 91.7 97.4 95.3 676 Fourth 88.2 86.7 86.7 67.1 65.8 65.8 92.5 97.8 96.5 658 Richest 86.9 86.6 86.8 70.2 69.2 69.5 90.7 97.6 95.2 633 1 MICS indicator 3.16a - Household availability of insecticide-treated nets (ITNs) - One+ 2 MICS indicator 3.16b - Household availability of insecticide-treated nets (ITNs) - One+ per 2 people 3 MICS indicator 3.17a - Households covered by vector control - One+ ITNs 4 MICS indicator 3.17b - Households covered by vector control - One+ ITNs per 2 people a The numerators are based on number of usual (de jure) household members and does not take into account whether household members stayed in the household last night. MICS does not collect information on visitors to the household b 20 unweighted cases of DK/Missing not shown Sao Tome and Principe 2014 MICS, Final Report P a g e | 69 Table CH.15:38Access to an insecticide treated net (ITN) - number of household members Percentage of household population with access to an ITN in the household, Sao Tome and Principe, 2014 Number of ITNs owned by household: Total Percentage with access to an ITNa Number of household membersb 0 1 2 3 4 5 6 7 8 or more Total 22.2 20.8 29.5 22.8 2.9 1.1 0.6 0.0 0.0 100.0 30.7 13,455 Number of household members 1 35.3 47.4 13.1 3.8 0.3 0.1 0.0 0.0 0.0 100.0 64.7 564 2 22.1 33.1 35.7 8.8 0.4 0.0 0.0 0.0 0.0 100.0 44.8 929 3 17.8 25.1 37.6 18.2 1.0 0.2 0.1 0.0 0.0 100.0 57.0 1,693 4 19.0 12.8 41.0 25.0 1.9 0.3 0.0 0.0 0.0 100.0 27.2 2,381 5 17.5 9.2 31.5 34.3 5.8 1.8 0.0 0.0 0.0 100.0 41.9 2,867 6 21.9 4.5 25.0 38.4 6.3 2.0 1.8 0.0 0.0 100.0 10.2 2,291 7 21.3 4.1 20.0 43.6 3.5 5.2 2.2 0.0 0.0 100.0 10.9 1,368 8 or more 23.2 6.3 13.4 34.5 10.6 5.4 5.7 0.0 1.0 100.0 11.2 1,361 a Percentage of household population who could sleep under an ITN if each ITN in the household were used by up to two people b The denominator is number of usual (de jure) household members and does not take into account whether household members stayed in the household last night. MICS does not collect information on visitors to the household Table CH.16:39Access to an insecticide treated net (ITN) - background characteristics Percentage of household population with access to an ITN in the household, Sao Tome and Principe, 2014 Percentage with access to an ITNa Number of household membersb Total 30.7 13,455 Regions Centre East 33.2 8,799 North West 22.6 2,510 South East 27.1 1,651 Autonomous of Principe 39.8 495 Area Urban 33.8 8,960 Rural 24.4 4,495 Wealth index quintile Poorest 19.6 2,692 Second 20.6 2,691 Middle 28.7 2,691 Fourth 40.0 2,689 Richest 44.6 2,693 a Percentage of household population who could sleep under an ITN if each ITN in the household were used by up to two people b The denominator is number of usual (de jure) household members and does not take into account whether household members stayed in the household last night. MICS does not collect information on visitors to the household The 2014 Sao Tome and Principe MICS results indicate that 78 percent of households have at least one insecticide treated net (Table CH.14), and 55 percent at least one ITN for every two household members. Overall, 91 percent of households received indoor residual spraying during the last 12 months, with little variation between background characteristics. Urban areas have higher coverage of ITN than their rural counterparts (82 and 69 percent respectively), and so do wealthiest Sao Tome and Principe 2014 MICS, Final Report P a g e | 70 households in relation to poorest ones (87 versus 65 percent respectively). The other indicators follow a similar trend. Coverage of ITN by region ranges from 70 percent in Region South East to 86 percent in Autonomous Region of Principe. Tables CH.15 and CH.16 provide further insight on access to ITNs. Overall, 31 percent of individuals are estimated to have access to ITNs, i.e. they could sleep under an ITN if each ITN in the household was used by two people. Access varies from 23 percent in Region North West to 40 percent in Autonomous Region of Principe, and is higher in urban (34 percent) than in rural (24 percent) areas. Access decreases with poverty and ranges from 45 percent among the wealthiest to 20 percent among the poorest. Similarly, access to ITN tends to decrease as household size increases. Selected results are shown in Figure CH.4. Figure CH.4: 11Per centage of household populat ion with access to an ITN in the household , Sao Tome and Pr inc ipe , 2014 Overall, 70 percent of ITNs were used during the night preceding the survey, ranging from 57 percent in Region South East to 72 percent in Region Centre East. Use of ITN is higher in urban (74 percent) than in rural (61 percent) areas, and amongst the wealthiest (74 percent) than the poorest (63 percent). 33 23 27 40 34 24 31 R. Centre East R. North West R. South East A. Reg. of Principe Urban Rural Sao Tome and Principe P er c en t Sao Tome and Principe 2014 MICS, Final Report P a g e | 71 Table CH.17:40Use of ITNs Percentage of insecticide treated nets (ITNs) that were used by anyone last night, Sao Tome and Principe, 2014 Percentage of ITNs used last night Number of ITNs Total 70.0 5,914 Region Centre East 72.3 3,977 North West 70.4 982 South East 57.5 680 Aut. of Principe 67.1 275 Area Urban 73.8 4,201 Rural 60.8 1,712 Wealth index quintile Poorest 63.3 951 Second 65.9 1,044 Middle 72.0 1,162 Fourth 72.2 1,347 Richest 74.1 1,409 As for children under the age of five years, 61 percent slept under an ITN the night preceding the survey as shown in Table CH.18. This figure rises to 76 percent considering only children living in a household with at least one ITN. There are no meaningful gender disparities in ITN use among children under five. However, the proportion of those sleeping under an ITN the night preceding the survey is higher in urban than rural areas (68 and 48 percent respectively), among the wealthiest than the poorest (74 and 50 percent respectively), and among those whose mother has secondary education (64 percent) than no formal education (43 percent). Of note is the very high proportion (96 percent) of children under five who the previous night slept either under an ITN or in a house that had indoor residual spraying (IRS) in the last 12 months. Sao Tome and Principe 2014 MICS, Final Report P a g e | 72 Table CH.18:41Children sleeping under mosquito nets Percentage of children age 0-59 months who slept under a mosquito net last night, by type of net, Sao Tome and Principe, 2014 Percentage of children age 0-59 who spent last night in the interviewed households Number of children age 0-59 months Percentage of children under age five who the previous night slept under: Number of children age 0-59 months who spent last night in the interviewed households Percentage of children who slept under an ITN last night in households with at least one ITN Number of children age 0-59 living in households with at least one ITN Any mosquito net An insecticide treated net (ITN)1 A Long-lasting insecticidal treated net (LLIN) An ITN or in a dwelling which had IRS in the past 12 months Total 98.3 2,030 61.9 61.1 61.0 95.6 1,996 75.6 1,613 Sex Male 97.7 1,023 61.6 60.7 60.6 94.5 1,000 73.9 821 Female 98.9 1,007 62.3 61.5 61.5 96.8 996 77.3 792 Region Centre East 98.0 1,317 64.0 63.5 63.4 94.8 1,291 78.7 1,041 North West 98.6 386 62.4 60.5 60.5 97.9 380 72.2 319 South East 99.4 245 46.9 45.9 45.9 95.6 244 62.7 178 Aut. of Principe 98.4 82 71.7 71.7 71.7 97.6 81 77.0 75 Area Urban 98.6 1,339 68.3 67.6 67.5 96.3 1,320 79.3 1,126 Rural 97.8 691 49.5 48.4 48.4 94.4 676 67.1 488 Age 0-11 months 98.0 351 68.3 67.3 67.3 96.3 344 81.5 284 12-23 months 98.9 403 62.2 61.6 61.6 96.0 399 74.7 329 24-35 months 98.3 412 60.8 60.3 60.0 96.3 405 76.3 321 36-47 months 98.0 434 56.8 55.3 55.3 93.9 425 71.0 331 48-59 months 98.4 430 62.7 62.3 62.3 95.8 423 75.4 349 Mother's education None 99.4 84 43.6 43.4 43.4 94.9 84 59.2 62 Primary 98.4 1,253 61.4 60.5 60.5 95.6 1,232 75.1 992 Secondary 98.0 647 64.3 63.6 63.4 95.5 634 78.0 517 Higher (100.0) 46 (76.4) (76.4) (76.4) (100.0) 46 (80.4) 43 Wealth index quintile Poorest 97.6 444 50.3 50.2 50.2 91.5 434 71.6 304 Second 98.3 428 56.6 55.3 55.3 94.4 421 69.4 335 Middle 99.4 411 62.1 61.0 61.0 97.1 409 75.4 331 Fourth 97.7 423 69.8 68.4 68.4 96.9 413 78.4 360 Richest 98.7 324 74.4 74.4 74.0 99.2 320 83.8 284 1 MICS indicator 3.18; MDG indicator 6.7 - Children under age 5 sleeping under insecticide-treated nets (ITNs) ( ) Figures that are based on 25-49 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 73 Table CH.19:42Use of mosquito nets by the household population Percentage of household members who slept under a mosquito net last night, by type of net, Sao Tome and Principe, 2014 Percentage of household members who the previous night slept under: Number of household members who spent the previous night in the interviewed households Percentage who the previous night slept under an ITN in house- holds with at least one ITN Number of household members in households with at least one ITN Any mosquito net An insecticide treated net (ITN)1 A Long- lasting insecticidal treated net (LLIN) An ITN or in a dwelling which had IRS in the past 12 months Total 56.7 56.1 56.1 95.9 13,205 70.7 10,484 Sex Male 54.8 54.1 54.1 95.2 6,266 68.8 4,932 Female 58.4 57.9 57.9 96.4 6,939 72.4 5,553 Region Centre East 58.3 57.9 57.8 95.0 8,630 72.6 6,883 North West 56.4 55.3 55.3 98.1 2,458 69.8 1,947 South East 46.1 45.4 45.1 96.8 1,628 61.2 1,209 Aut. of Principe 65.1 65.1 65.1 96.7 489 71.5 445 Area Urban 62.7 62.2 62.1 96.2 8,790 74.5 7,340 Rural 44.7 44.0 44.0 95.1 4,415 61.8 3,144 Agea 0-4b 61.8 60.9 60.9 95.7 1,974 75.3 1,598 5-14 53.8 53.3 53.3 96.2 3,931 67.1 3,126 15-34 54.8 54.1 54.1 95.3 4,089 67.9 3,260 35-49 61.2 60.6 60.5 95.7 1,632 77.5 1,276 50+ 57.9 57.5 57.5 96.9 1,574 74.3 1,220 Education of household head None 42.2 42.0 42.0 97.6 1,049 56.5 780 Primary 55.3 54.8 54.7 96.0 7,302 70.8 5,649 Secondary 61.9 61.0 61.0 95.1 4,199 72.9 3,514 Higher 63.3 63.0 63.0 97.5 567 75.4 473 DK/Missing 55.7 55.7 55.7 86.4 89 72.9 68 Wealth index quintile Poorest 44.9 44.6 44.5 93.9 2,638 66.2 1,779 Second 50.8 49.9 49.9 95.1 2,635 65.6 2,006 Middle 58.6 57.8 57.8 97.0 2,652 71.4 2,148 Fourth 64.8 64.1 64.1 96.5 2,648 74.2 2,285 Richest 64.5 64.2 64.0 96.8 2,632 74.5 2,267 1 MICS indicator 3.19 - Population that slept under an ITN a 6 unweighted cases with missing age not shown b The results of the age group 0-4 years do not match those in Table CH.18, which is based on completed under-5 interviews only. The two tables are computed with different sample weights Table CH.19 gives further insight into the use of mosquito nets by household members of any age, 56 percent of whom slept under an ITN the night prior to the survey. This figure rises to 71 percent considering only household members living in a household with at least one ITN. Overall, 92 percent of household members slept under an ITN the previous night or in a dwelling which had IRS in the past 12 months. There are some regional differences, with 55 percent of the household members of Region South East having slept under an ITN the night prior to the survey, against 65 percent for Autonomous Region of Principe. The same indicator evaluates at 62 percent in urban areas against Sao Tome and Principe 2014 MICS, Final Report P a g e | 74 44 percent in rural areas, and 45 percent among the poorest against 64 percent among the wealthiest. Of note is the very high proportion (96 percent) of household members who the previous night slept either under an ITN or in a house that had indoor residual spraying (IRS) in the last 12 months. Table CH.20:43Care-seeking during fever Percentage of children age 0-59 months with fever in the last two weeks for whom advice or treatment was sought, by source of advice or treatment, Sao Tome and Principe, 2014 Percentage of children for whom: Number of children with fever in last two weeks Advice or treatment was sought from: No advice or treatment sought Health facilities or providers Other source A health facility or provider1, b Public Private Community health providera Total 58.9 5.9 1.9 2.6 65.8 33.2 534 Sex Male 61.3 5.7 1.7 1.8 67.8 31.5 293 Female 56.0 6.0 2.2 3.7 63.4 35.2 241 Region Centre East 54.7 7.9 2.2 2.3 63.6 35.9 363 North West 65.4 2.0 1.6 4.9 68.7 27.7 74 South East 70.6 1.3 0.0 1.3 72.5 26.8 83 Aut. of Principe (64.4) (0.0) (8.7) (6.2) (68.5) (29.5) 14 Area Urban 60.1 5.3 2.0 2.3 66.6 32.7 357 Rural 56.6 6.9 1.7 3.3 64.4 34.1 177 Age 0-11 months 69.5 1.9 0.0 1.9 73.3 26.7 94 12-23 months 64.4 4.2 1.0 3.6 69.9 29.5 137 24-35 months 58.0 9.4 4.8 1.6 68.0 31.8 108 36-47 months 45.3 8.6 1.5 3.8 54.9 42.3 99 48-59 months 55.8 5.3 2.3 2.0 61.6 36.9 96 Mother’s education None/Primary 59.9 3.8 2.4 3.1 65.0 33.7 345 Secondary/Higher 57.2 9.7 1.1 1.8 67.4 32.2 189 Wealth index quintile Poorest 55.3 2.9 1.4 1.6 58.7 40.2 121 Second 55.5 8.8 0.5 4.5 67.0 31.2 118 Middle 58.0 2.9 3.0 4.7 62.9 37.1 90 Fourth 60.1 6.6 2.6 1.5 66.6 31.9 125 Richest 68.8 8.2 2.6 0.8 76.9 23.1 80 1 MICS indicator 3.20 - Care-seeking for fever a Community health providers include both public (Community health worker and Mobile/Outreach clinic) and private (Mobile clinic) health facilities b Includes all public and private health facilities and providers as well as shops ( ) Figures that are based on 25-49 unweighted cases Table CH.20 provides information on care-seeking behaviour during an episode of fever in the past two weeks. As shown in Table CH.20, advice was sought from a health facility or a qualified health care provider for 66 percent of children with fever; these services were provided mainly by the Sao Tome and Principe 2014 MICS, Final Report P a g e | 75 public sector (59 percent). However, no advice or treatment was sought in 33 percent of the cases. Figures also indicate that seeking advice in the case of fever is more likely for children of a younger age than older ones (73 and 62 percent respectively), and for children living in the wealthiest than in the poorest households (77 and 59 percent respectively). Mothers were asked to report all of the medicines given to a child to treat the fever, including both medicines given at home and medicines given or prescribed at a health facility. Artemisinin-based Combination therapy (ACT) is the first line antimalarial recommended by the World Health Organization and used in the country. In addition, confirmation is done on all fever cases suspected to be malaria through rapid diagnostic test. As seen in Table CH.21, 0.2 percent of children with fever in the last two weeks were treated with an artemisinin-based combination therapy (ACT) and 1.4 percent received an antimalarial. Interpretation of the results of this table must take into consideration the low prevalence of malaria in Sao Tome and Principe. Overall, 42 percent of children with a fever in the previous two weeks had blood taken from a finger or heel for testing. This indicator ranges from 36 percent in Region North West to 54 percent in Region South East. The results also suggest that blood testing is more likely to be implemented in children issued from the wealthiest households (51 percent) than the poorest (39 percent). The proportion of children treated with an ACT the same day the fever started or the next is of 0.1 percent. Such a low percentage should be interpreted in the context of the low prevalence of malaria in Sao Tome and Principe. Because of the very small number of children in our sample who were treated for malaria (9), Table CH.22 doesn’t show statistics related to the proportion of children treated with anti-malarial who received an ACT (2 out of 9). For the same reason, the standard MICS table on the source of anti-malarials is not shown in this report. Sao Tome and Principe 2014 MICS, Final Report P a g e | 76 Table CH.21:44Treatment of children with fever Percentage of children age 0-59 months who had a fever in the last two weeks, by type of medicine given for the illness, Sao Tome and Principe, 2014 Children with a fever in the last two weeks who were given: Number of children with fever in last two weeks Anti-malarials Other medications Other Missing/DK SP/ Fansidar Amodia- quine Quinine Artemisinin- based Combination Therapy (ACT) Other anti- malarial Antibiotic pill or syrup Antibiotic injection Paracetamol/ Panadol/ Acetaminophen Aspirin Ibuprofen Total 0.3 0.3 0.5 0.2 0.0 37.6 1.6 43.0 1.6 0.7 20.7 3.8 534 Sex Male 0.6 0.2 0.0 0.2 0.0 39.8 2.1 42.6 1.7 1.2 21.4 5.2 293 Female 0.0 0.5 1.1 0.2 0.0 34.9 0.9 43.6 1.4 0.0 19.8 2.1 241 Region Centre East 0.5 0.0 0.0 0.0 0.0 36.3 1.6 40.3 1.6 0.5 22.4 5.0 363 North West 0.0 1.1 3.5 1.4 0.0 41.2 0.8 45.1 2.3 2.0 20.9 1.9 74 South East 0.0 1.2 0.0 0.0 0.0 41.8 1.8 49.2 0.0 0.0 15.2 1.0 83 Aut. of Principe (0.0) (0.0) (0.0) (0.0) (0.0) (27.3) (4.1) (66.0) (6.9) (0.0) (6.4) (0.0) 14 Area Urban 0.5 0.5 0.7 0.0 0.0 33.0 1.2 44.2 1.0 1.0 21.7 4.9 357 Rural 0.0 0.0 0.0 0.6 0.0 46.8 2.2 40.6 2.6 0.0 18.6 1.7 177 Age 0-11 months 0.0 0.0 0.0 0.6 0.0 30.2 3.6 39.5 2.2 0.0 24.5 5.0 94 12-23 months 0.0 0.4 1.9 0.0 0.0 41.1 1.7 34.1 1.3 0.0 18.5 5.6 137 24-35 months 0.0 0.0 0.0 0.0 0.0 41.5 1.6 50.6 0.8 0.9 20.2 1.0 108 36-47 months 1.9 0.8 0.0 0.5 0.0 36.1 0.4 46.4 2.6 2.6 17.2 4.9 99 48-59 months 0.0 0.5 0.0 0.0 0.0 36.9 0.5 47.1 1.2 0.0 24.2 2.0 96 Mother’s education None/Primary 0.5 0.5 0.7 0.0 0.0 37.0 1.4 44.1 2.2 0.7 18.0 5.1 345 Secondary/Higher 0.0 0.0 0.0 0.6 0.0 38.7 1.8 41.0 0.5 0.5 25.5 1.5 189 Wealth index quintile Poorest 0.0 1.5 2.1 0.9 0.0 32.6 0.5 37.7 3.1 0.0 20.5 2.2 121 Second 0.0 0.0 0.0 0.0 0.0 28.8 5.2 49.7 0.7 0.5 19.2 5.9 118 Middle 2.1 0.0 0.0 0.0 0.0 44.2 1.1 50.3 4.3 0.0 10.8 5.0 90 Fourth 0.0 0.0 0.0 0.0 0.0 43.6 0.5 40.5 0.0 0.8 16.9 2.1 125 Richest 0.0 0.0 0.0 0.0 0.0 41.1 0.0 36.8 0.0 2.5 40.2 4.3 80 ( ) Figures that are based on 25-49 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 77 Table CH.22:45Diagnostics and anti-malarial treatment of children Percentage of children age 0-59 months who had a fever in the last two weeks who had a finger or heel stick for malaria testing, who were given Artemisinin-combination Treatment (ACT) and any anti-malarial drugs, and percentage who were given ACT among those who were given anti-malarial drugs, Sao Tome and Principe, 2014 Percentage of children who: Number of children age 0- 59 months with fever in the last two weeks Had blood taken from a finger or heel for testing1 Were given: Artemisinin- combination Treatment (ACT) ACT the same or next day Any antimalarial drugs2 Any antimalarial drugs same or next day Total 42.0 0.2 0.1 1.4 1.1 534 Sex Male 42.5 0.2 0.2 1.0 1.0 293 Female 41.5 0.2 0.0 1.8 1.3 241 Region Centre East 40.7 0.0 0.0 0.5 0.5 363 North West 35.9 1.4 0.7 6.0 4.2 74 South East 54.1 0.0 0.0 1.2 1.2 83 Aut. of Principe (36.4) (0.0) (0.0) (0.0) (0.0) 14 Area Urban 42.3 0.0 0.0 1.8 1.5 357 Rural 41.3 0.6 0.3 0.6 0.3 177 Age 0-11 months 43.6 0.6 0.6 0.6 0.6 94 12-23 months 46.0 0.0 0.0 2.2 2.2 137 24-35 months 37.2 0.0 0.0 0.0 0.0 108 36-47 months 41.6 0.5 0.0 3.2 1.9 99 48-59 months 40.6 0.0 0.0 0.5 0.5 96 Mother’s education None/Primary 41.0 0.0 0.0 1.8 1.6 345 Second./Higher 43.8 0.6 0.3 0.6 0.3 189 Wealth index quintile Poorest 39.2 0.9 0.4 4.5 3.4 121 Second 43.3 0.0 0.0 0.0 0.0 118 Middle 31.4 0.0 0.0 2.1 2.1 90 Fourth 45.4 0.0 0.0 0.0 0.0 125 Richest 51.0 0.0 0.0 0.0 0.0 80 1 MICS indicator 3.21 - Malaria diagnostics usage 2 MICS indicator 3.22; MDG indicator 6.8 - Anti-malarial treatment of children under age 5 3 MICS indicator 3.23 - Treatment with Artemisinin-based Combination Therapy (ACT) among children who received anti-malarial treatment (see text for details) ( ) Figures that are based on 25-49 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 78 Table CH.23:46Pregnant women sleeping under mosquito nets Percentage of pregnant women age 15-49 years who slept under a mosquito net last night, by type of net, Sao Tome and Principe, 2014 Percentage of pregnant women who spent last night in the interviewed households Number of pregnant women age 15-49 years Percentage of pregnant women age 15-49 years who the previous night slept under: Number of pregnant women who spent last night in the interviewed households Percentage of pregnant women who slept under an ITN last night in households with at least one ITN Number of pregnant women age 15-49 years living in households with at least one ITN Any mosquito net An insecticide treated net (ITN)1 A Long-lasting insecticidal treated net (LLIN) An ITN or in a dwelling sprayed with IRS in the past 12 months Total 98.4 235 61.9 60.9 60.9 94.4 231 79.2 178 Region Centre East 98.7 151 65.2 64.6 64.6 93.1 149 82.1 117 North West 98.2 45 61.3 59.5 59.5 98.7 44 (78.5) 34 South East 98.6 33 46.2 44.5 44.5 93.9 32 (64.8) 22 Aut. of Principe (*) 6 (*) (*) (*) (*) 5 (*) 4 Area Urban 99.2 154 67.3 66.4 66.4 94.7 153 84.2 120 Rural 96.8 81 51.3 50.2 50.2 93.8 78 68.5 57 Age 15-19 97.2 53 (44.7) (44.7) (44.7) (93.2) 52 (60.1) 39 20-24 100.0 50 59.0 57.3 57.3 92.0 50 (78.6) 36 25-29 98.1 68 70.6 69.4 69.4 96.6 66 (83.6) 55 30-39 98.1 56 71.5 70.6 70.6 97.6 55 (89.0) 44 40-49 (*) 8 (*) (*) (*) (*) 8 (*) 4 Education None/Primary 97.5 136 62.4 60.8 60.8 93.6 132 81.9 98 Secondary/Higher 99.5 99 61.1 61.1 61.1 95.5 98 75.7 80 Wealth index quintile 60% poorest 97.8 157 59.0 58.2 58.2 94.2 154 78.5 114 40% richest 99.4 78 67.5 66.4 66.4 94.8 77 80.4 64 1 MICS indicator 3.24 - Pregnant women who slept under an insecticide treated net (ITN) ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 79 Pregnant women living in places where malaria is highly prevalent are highly vulnerable to malaria. Once infected, pregnant women risk anaemia, premature delivery and stillbirth. Their babies are at increased risk of low birth weight, which carries an increased risk to die in infancy.i For this reason, steps are taken to protect pregnant women by distributing insecticide-treated mosquito nets and treatment during antenatal check-ups with drugs that prevent malaria infection (Intermittent preventive treatment or IPT). WHO recommends that in areas of moderate-to-high malaria transmission, all pregnant women be provided an intermittent preventive treatment with Sulfadoxine-Pyrimethamine (SP) at every scheduled antenatal care visit. In the 2014 Sao Tome and Principe MICS, women were asked about the medicines they had received to prevent malaria in their last pregnancy during the 2 years preceding the survey. Women are considered to have received intermittent preventive therapy if they have received at least 3 doses of SP/Fansidar during the pregnancy, at least one of which was taken during antenatal care. Table CH.23 presents the proportion of pregnant women who slept under a mosquito net during the previous night. Overall, 62 percent of pregnant women slept under any mosquito net the night prior to the survey and nearly all of these (61 percent) slept under an insecticide treated net. This figure rises to 79 percent if we only consider those living in a household with at least one ITN. The proportion of pregnant women who slept under an ITN the night prior to the survey varies from 45 percent in Region South East to 65 percent in Region Centre East. It tends to be higher in urban (66 percent) than in rural (50 percent) areas. The apparent differences by background characteristics in Table CH.23 must be interpreted with caution given that many of the denominators are relatively small. Of note is the very high proportion (94 percent) of pregnant women who the previous night slept either under an ITN or in a house that had indoor residual spraying (IRS) in the last 12 months. Intermittent preventive treatment for malaria in pregnant women who gave birth in the two years preceding the survey is presented in Table CH.24. Overall, 90 percent of pregnant women who had a live birth in the two years preceding the survey, and who received antenatal care, took medicine at least once to prevent malaria at any of ANC visit; however, only 12 percent took medicine three or more times. This indicator varies from 7 percent in Region South East to 14 percent in Region North West. It is higher amongst women with secondary or higher education (16 percent) than among those with less education (10 percent). It is also higher among the wealthiest (16 percent) than the poorest (9 percent). However, it is important to keep in mind that the current malaria epidemiological profile in Sao Tome and Principe is in a low transmission stage. i Shulman, CE and Dorman, EK. 2003. Importance and prevention of malaria in pregnancy. Trans R Soc Trop Med Hyg 97(1): 30–55. Sao Tome and Principe 2014 MICS, Final Report P a g e | 80 Table CH.24:47Intermittent preventive treatment for malaria Percentage of women age 15-49 years who had a live birth during the two years preceding the survey and who received intermittent preventive treatment (IPT) for malaria during pregnancy at any antenatal care visit, Sao Tome and Principe, 2014 Percentage of women who received antenatal care (ANC) Number of women with a live birth in the last two years Percentage of pregnant women: Number of women with a live birth in the last two years and who received antenatal care Who took any medicine to prevent malaria at any ANC visit during pregnancy who took SP/Fansidar at least once during an ANC visit and in total took: At least once Two or more times Three or more times1 Four or more times Total 97.5 756 89.8 88.4 58.2 12.3 2.0 736 Region Centre East 97.7 514 90.3 88.8 59.7 13.1 2.3 502 North West 97.7 131 85.2 85.2 50.1 14.1 1.7 128 South East 95.0 86 92.6 89.7 57.9 6.6 0.6 81 Aut. of Principe (100.0) 25 (92.3) (92.3) (71.3) (6.4) (0.0) 25 Area Urban 97.9 496 90.4 89.5 58.1 12.9 1.9 485 Rural 96.6 260 88.5 86.2 58.4 11.3 2.0 251 Education None/Primary 96.1 468 88.4 87.1 53.4 9.8 2.4 449 Secondary/Higher 99.6 288 91.9 90.3 65.8 16.3 1.2 287 Wealth index quintile Poorest 94.8 161 86.1 83.8 46.1 9.5 3.2 152 Second 97.5 158 87.4 86.6 54.0 12.2 2.8 154 Middle 97.1 149 90.8 89.5 66.8 10.1 0.5 145 Fourth 98.4 161 89.9 88.8 64.9 14.7 1.8 159 Richest 100.0 126 95.8 94.3 59.8 15.5 1.4 126 1 MICS indicator 3.25 - Intermittent preventive treatment for malaria ( ) Figures that are based on 25-49 unweighted cases Prevalence of malaria in children Malaria tests were implemented in children age 6 to 59 months using a Rapid Diagnostic Test (RDT), as well as thick blood smear slides that were read microscopically in laboratory. The RDT used a test kit known as Paramax-3. This kit distinguishes three malaria types by detection of malaria antibodies in drops of capillary blood. The three malaria types detected by the kit are: Plasmodium (Pan) which is found in several species, specific typing for Plasmodium falciparum (Pf), and specific typing as well for Plasmodium vivax (Pv). The health technician field teams, which were responsible to implement the malaria tests and to collect and prepare the blood smears, also offered free artemisinin-combination treatment (ACT) to the mothers of the children needing treatment, when the malaria test result was positive. ACT is an artemisinin treatment for malaria which contains 25/50 mg of artemisinin and 67.5/135 mg of amodiaquine. The malaria test and the treatment protocol were approved by the MICS Ethics Committee. Sao Tome and Principe 2014 MICS, Final Report P a g e | 81 The mothers received information on the potential complication and side effects related to the use of ACT and were given the option to refuse the treatment. Further, all households received a pamphlet on anaemia and malaria on which were recorded all the relevant results of the anaemia and malaria tests in selected children, as well as the anaemia tests results in women. Malaria tests had a relatively high response rate of 96 percent in children age 6 to 59 months who had a RDT, and of 94 percent in those who had a thick smear for laboratory analysis. As can be seen in Table CH.24, there are no large differences in response rates as per the various socio-demographic characteristics, with the exception of the small number of children with a thick smear in Autonomous Region of Principe which has only 68 percent. Table CH.25:48Coverage of testing for malaria in children (unweighted) Percentage of eligible children age 6-59 months who had a Rapid Diagnostic Test and thick blood smear for the detection of malaria, by background characteristics (unweighted), Sao Tome and Principe, 2014 Percentage of children who had: Number of children age 0-59 months (unweighted) Malaria RDT Thick blood smear Total 96.3 94.0 1,861 Sex Male 95.4 93.1 945 Female 97.2 95.0 916 Region Centre East 95.6 95.5 827 North West 97.5 97.5 485 South East 95.8 95.8 408 Aut. of Principe 97.2 68.1 141 Area Urban 95.3 93.1 1,117 Rural 97.7 95.4 744 Age 6-11 months 91.7 86.7 180 12-23 months 96.9 95.4 391 24-35 months 97.2 94.8 423 36-47 months 97.0 94.6 429 48-59 months 96.1 94.5 438 Wealth index quintile Poorest 96.8 96.5 344 Second 96.0 95.5 401 Middle 96.6 94.0 384 Fourth 96.5 92.7 397 Richest 95.5 91.3 335 The results of the two tests show a low prevalence of malaria in children (Table CH.25). Only 0.5 percent of the RDT and 0.2 percent of the thick blood smears implemented in children gave positive Sao Tome and Principe 2014 MICS, Final Report P a g e | 82 results. This corresponds to only 7 unweighted cases of malaria in children, detected through the RDT, and 2 cases detected through the laboratory analysis of the blood smears. While it is possible to speculate on the different results given by the thick smears and the RDT, the number of positive cases is so low that doing so would not seem to be a fruitful exercise and would not permit any lesson to be drawn. The final conclusion is that the prevalence of malaria was extremely low in Sao Tome and Principe during the time of the survey (mid-2014), with a possible “maximum” of 0.5 percent of positive cases among children age 6 to 59 months. In fact, feedback during the testing period indicated that a very low prevalence was to be expected given the recent progress made in controlling malaria in Sao Tome and Principe. The 7 unweighted cases of malaria, as per the RDT, included 3 cases of Falciparum and 4 cases of mixed infections. Given the very low absolute number of malaria cases, apparent differences along socio-demographic characteristics are very small and should not be over-interpreted. Table CH.26:49Results of the Rapid Diagnostic Test (RDT) and thick smear for the detection of malaria in children Percentage of eligible children age 6-59 months with positive RDT and thick smear results, by background characteristics (unweighted), Sao Tome and Principe, 2014 Rapid Diagnostic Test (RDT) Thick smear Percent of children testing positive Number of children tested Percent of children testing positive Number of children tested Total 0.5 1,776 0.2 1,750 Sex Male 0.2 888 0.3 874 Female 0.7 888 0.0 876 Region Centre East 0.5 1,133 0.2 1,132 North West 0.3 347 0.0 347 South East 0.1 222 0.1 222 Autonomous of Principe 1.5 74 0.0 49 Area Urban 0.6 1,167 0.2 1,155 Rural 0.2 609 0.0 594 Age 6-11 months 0.1 157 0.1 151 12-23 months 0.5 388 0.0 386 24-35 months 0.2 402 0.0 395 36-47 months 0.8 417 0.0 411 48-59 months 0.5 411 0.6 407 Wealth index quintile Poorest 0.1 282 0.1 281 Second 0.2 328 0.0 326 Middle 0.7 361 0.0 353 Fourth 1.1 398 0.0 391 Richest 0.1 407 0.7 399 Sao Tome and Principe 2014 MICS, Final Report P a g e | 83 Since there are so few malaria cases in the survey, additional tables on the prevalence and determinants of malaria were not produced. Besides, data on important determinants of the prevalence of malaria, such as the use of bednets, must always be interpreted with caution, since it is possible that a “cause effect” relationship may be absent between the actual use of bednets and the prevalence of malaria. It was decided that to produce additional tables based the very few malaria cases that were detected in the survey would not be productive and would not permit any particular conclusion to be drawn. Prevalence of anaemia in children Blood was collected for the haemoglobin test from children age 6-59 months living in the household whose caretakers agreed voluntarily to the test. The blood was collected in the following way: a) capillary blood was obtained from a finger prick (or a heel prick in the case of children age 6-11 months) using a small self-retractable lancet; b) a small drop of blood was placed in a microcuvette which was then inserted in a portable haemoglobinometer (HemoCue), an instrument capable of measuring accurately haemoglobin levels in grams per decilitres of blood; and c) the value was recorded on the questionnaire and the result of the test communicated immediately to the caretaker of the child. Anaemia in children age 6-59 months can be classified in three categories according to the haemoglobin concentration in the blood. The anaemia is considered severe if haemoglobin is less than 7.0 grams per decilitre (g/dl), moderate if between 7.0 and 9.9 g/dl, and light if between 10.0 and 10.9 g/dl. Table CH.27 shows that over six children in ten (67 percent) in the 6-59 months age group in Sao Tome and Principe suffer from anaemia: light anaemia in 33 percent of cases, moderate in another 33 percent and severe in 1 percent. In the 6-23 months age group, over four children in five suffer from anaemia. The prevalence decreases from age 24 months and above, down to 52 percent in the 36-59 months age group. Anaemia is slightly more prevalent among boys than girls (69 and 65 percent respectively). There are no notable differences between areas of residence. The Region South East and Autonomous Region of Principe have a somewhat higher prevalence (74 and 72 percent respectively) than the rest of the country. With respect to the wealth quintiles, it can be seen that the lowest prevalence is in children from the wealthiest households. The prevalence of severe anaemia is low (1 percent) and no substantial differences are observed between the various population subgroups. Sao Tome and Principe 2014 MICS, Final Report P a g e | 84 Table CH.27:50Prevalence of anaemia in children Percentage of children age 6-59 months with anaemia, Sao Tome and Principe, 2014 Anaemia according to haemoglobin level Number of children age 6-59 months Any level of anaemia (<11.0 g/dl) Light anaemia (10.0-10.9 g/dl) Moderate anaemia (7.0-9.9 g/dl) Severe anaemia (<7.0 g/dl) Total 67.5 33.0 33.3 1.2 1773 Sex Male 69.5 30.9 37.5 1.1 886 Female 65.5 35.2 29.0 1.3 887 Region Centre East 66.4 31.9 33.2 1.2 1132 North West 66.1 34.9 30.8 0.4 347 South East 74.0 33.8 37.7 2.4 221 Autonomous of Principe 71.6 39.0 32.2 0.4 74 Area Urban 67.6 31.9 34.4 1.2 1167 Rural 67.2 35.1 31.0 1.1 606 Age 6-11 months 89.1 40.9 48.2 0.0 157 12-23 months 87.8 28.5 57.3 2.1 388 24-35 months 69.8 31.7 37.0 1.1 402 36-47 months 52.9 32.5 19.4 1.0 415 48-59 months 52.5 36.1 15.3 1.0 410 Wealth index quintile Poorest 69.0 35.8 31.7 1.5 280 Second 71.1 32.8 37.5 0.8 328 Middle 66.2 28.8 36.8 0.5 360 Fourth 69.0 35.9 30.7 2.4 398 Richest 63.2 32.2 30.3 0.6 406 Sao Tome and Principe 2014 MICS, Final Report P a g e | 85 VII. Water and Sanitation Safe drinking water is a basic necessity for good health. Unsafe drinking water can be a significant determinant of diseases such as cholera, typhoid, and schistosomiasis. Drinking water can also be contaminated with chemical and physical contaminants with harmful effects on human health. In addition to preventing disease, improved access to drinking water may be particularly important for women and children, especially in rural areas, who bear the primary responsibility for carrying water, often for long distances.i Inadequate disposal of human excreta and personal hygiene are associated with a range of diseases including diarrhoeal diseases and polio and are important determinants of stunting. Improved sanitation can reduce diarrhoeal disease by more than a thirdii, and can substantially lessen the adverse health impacts of other disorders among millions of children in many countries. The MDG target (7, C) is to reduce by half, between 1990 and 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation. For more details on water and sanitation and to access some reference documents, please visit data.unicef.orgiii or the website of the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitationiv. Use of Improved Water Sources The distribution of the population by main source of drinking water is shown in Table WS.1. The population using improved sources of drinking water are those using any of the following types of supply: piped water (into dwelling, compound, yard or plot, to neighbour, public tap/standpipe), tube well/borehole, protected well, protected spring, and rainwater collection. Bottled water is considered as an improved water source only if the household is using an improved water source for handwashing and cooking. Overall, 94 percent of the population uses an improved source of drinking water98 percent in urban areas and 86 percent in rural areas. While such results are admirable, some areas require additional efforts, such as Autonomous Region of Principe where the indicator is considerably lower (74 percent). Countrywide, the indicator ranges from 91 percent among the poorest to nearly 100 percent among the wealthiest. i WHO/UNICEF. 2012. Progress on Drinking water and Sanitation: 2012 update. ii Cairncross, S et al. 2010. Water, sanitation and hygiene for the prevention of diarrhoea. International Journal of Epidemiology 39: i193-i205. iii http://data.unicef.org/water-sanitation iv http:// www.wssinfo.org Sao Tome and Principe 2014 MICS, Final Report P a g e | 86 Table WS.1:51Use 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, Sao Tome and Principe, 2014 Main source of drinking water Total Percentage using improved sources of drinking water1 Number of household members Improved sources Unimproved sources Piped water Tube- well/ bore- hole Pro- tected well Pro- tected spring Rain- water collection Bottled watera Unpro- tected well Unpro- tected spring Tanker truck Cart with tank/ drum Surface water Bottled watera Other Into dwel- ling Into yard/ plot To neigh- bour Public tap/ stand- pipe Total 5.1 21.7 11.2 52.9 0.1 0.3 2.6 0.0 0.1 0.2 2.1 0.0 0.0 3.6 0.0 0.2 100 93.9 13,455 Region Centre East 6.4 26.3 13.5 46.3 0.0 0.2 3.0 0.0 0.1 0.1 2.0 0.0 0.0 1.8 0.0 0.2 100 95.8 8,799 North West 1.3 15.1 6.7 66.5 0.1 0.0 0.7 0.0 0.1 0.1 1.2 0.2 0.0 7.8 0.0 0.0 100 90.7 2,510 South East 3.4 10.0 8.3 71.2 0.1 0.3 1.1 0.0 0.0 0.4 0.6 0.0 0.0 4.0 0.1 0.4 100 94.5 1,651 A. of Principe 5.9 11.4 3.3 39.4 1.1 1.5 11.3 0.0 0.0 1.2 12.8 0.0 0.0 12.2 0.0 0.0 100 73.9 495 Area Urban 6.9 26.7 14.4 48.5 0.1 0.2 1.1 0.0 0.1 0.1 0.3 0.0 0.0 1.6 0.0 0.0 100 98.0 8,960 Rural 1.4 11.7 4.7 61.7 0.1 0.4 5.7 0.0 0.1 0.3 5.6 0.1 0.0 7.6 0.0 0.5 100 85.8 4,495 Education of household head None 0.8 10.1 14.6 63.5 0.2 0.4 2.0 0.0 0.0 0.1 2.5 0.0 0.1 5.7 0.0 0.1 100 91.6 1,056 Primary 1.3 19.0 10.2 58.5 0.1 0.3 3.1 0.0 0.0 0.2 2.4 0.1 0.0 4.5 0.0 0.3 100 92.6 7,461 Second. 9.5 25.9 12.8 45.3 0.0 0.2 2.2 0.0 0.1 0.2 1.7 0.0 0.0 1.9 0.1 0.1 100 96.0 4,273 Higher 26.9 48.0 7.2 15.6 0.0 0.0 0.7 0.0 0.5 0.0 0.0 0.0 0.0 1.0 0.2 0.0 100 98.9 575 DK/Miss. 15.9 7.1 9.9 63.9 0.0 0.0 3.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100 100.0 90 Wealth index quintile Poorest 0.0 1.1 1.6 84.8 0.1 0.6 2.6 0.0 0.0 0.2 2.0 0.2 0.0 6.5 0.0 0.2 100 90.9 2,692 Second 0.0 4.0 10.0 74.4 0.1 0.3 3.2 0.0 0.1 0.1 2.4 0.0 0.0 5.0 0.0 0.5 100 92.0 2,691 Middle 0.5 13.3 14.9 57.4 0.1 0.3 5.1 0.0 0.0 0.0 4.1 0.0 0.0 4.1 0.0 0.2 100 91.6 2,691 Fourth 1.7 32.2 19.1 40.6 0.2 0.0 1.5 0.0 0.1 0.5 1.7 0.0 0.0 2.4 0.0 0.1 100 95.3 2,689 Richest 23.2 57.7 10.5 7.3 0.0 0.1 0.7 0.0 0.2 0.0 0.2 0.0 0.0 0.0 0.1 0.0 100 99.7 2,693 1 MICS indicator 4.1; MDG indicator 7.8 - Use of improved drinking water sources a Households using bottled water as the main source of drinking water are classified into improved or unimproved drinking water users according to the water source used for other purposes such as cooking and handwashing. Sao Tome and Principe 2014 MICS, Final Report P a g e | 87 The source of drinking water for the population varies strongly by region (Table WS.1). Access to drinking water that is piped into the yard or dwelling ranges from 33 percent in Region Centre East to 13 percent in Region South East. Accessing drinking water through public taps ranges from 71 percent in Region South East to 39 percent in Autonomous Region of Principe. Drinking water mainly from rivers and streams (an unimproved source) is still prevalent in some regions, notably Autonomous Region of Principe (12 percent) and Region North West (8 percent), while unprotected springs are commonly used in Autonomous Region of Principe (13 percent). Figure WS.1: 12Percent d istr ibut ion of household members by sour ce of dr inking wat er , Sao Tome and Pr inc ipe , 2014 Use of household water treatment is presented in Table WS.2. Households were asked about ways they may be treating water at home to make it safer to drink. Boiling water, adding bleach or chlorine, using a water filter, and using solar disinfection are considered as effective treatment of drinking water. The table shows water treatment by all household members and the percentage of those living in households using unimproved water sources but using appropriate water treatment methods. Overall, 93 percent of household members drink water without treating it. This must be interpreted in the context of previous results indicating that 94 percent of household members drink water from an improved source. Only 9 percent of households’ members who are using water from an unimproved source drink water that is appropriately treated. Chlorine is the preferred treatment method (4 percent), followed by boiling (2 percent). Piped into dwelling, yard, plot or neighbour 38% Public tap/standpipe 53% Tubewell/ borehole 0.1% Protected well or spring, bottle water 3% Unprotected well or spring 2% Surface water 4% Other unimproved 0.3% Sao Tome and Principe 2014 MICS, Final Report P a g e | 88 Table WS.2:52Household water treatment Percentage of household population by drinking water treatment method used in the household, and for household members living in households where an unimproved drinking water source is used, the percentage who are using an appropriate treatment method, Sao Tome and Principe, 2014 Water treatment method used in the household Number of household members Percentage of household members in households using unimproved drinking water sources and using an appropriate water treatment method1 Number of household members in households using unimproved drinking water sources None Boil Add bleach/ chlorine Strain through a cloth Use water filter Solar dis- infection Let it stand and settle Other Missing/DK Total 93.0 1.7 4.4 0.7 0.1 0.0 0.5 0.1 0.0 13,455 9.1 820 Region Centre East 92.3 2.3 4.5 0.7 0.1 0.0 0.7 0.0 0.0 8,799 10.1 366 North West 95.0 0.4 4.0 0.4 0.2 0.0 0.0 0.3 0.0 2,510 12.4 235 South East 92.3 0.3 5.7 1.3 0.2 0.0 0.2 0.0 0.0 1,651 5.3 91 Aut. of Principe 97.4 0.6 1.6 0.6 0.0 0.0 0.3 0.0 0.0 495 3.3 129 Area Urban 93.9 2.2 3.3 0.5 0.1 0.0 0.4 0.0 0.0 8,960 8.1 182 Rural 91.2 0.5 6.7 1.3 0.0 0.0 0.7 0.1 0.0 4,495 9.4 638 Main source of drinking water Improved 93.4 1.7 4.2 0.7 0.1 0.0 0.3 0.0 0.0 12,635 na na Unimproved 86.7 0.5 8.6 1.7 0.0 0.0 2.8 0.8 0.0 820 9.1 820 Education of household head None 94.6 1.0 4.0 0.4 0.0 0.0 0.4 0.0 0.0 1,056 16.4 89 Primary 94.2 0.8 4.3 0.8 0.0 0.0 0.1 0.1 0.0 7,461 5.6 555 Secondary 92.4 2.0 4.2 0.5 0.1 0.0 1.0 0.0 0.0 4,273 17.1 170 Higher 78.9 11.8 8.4 2.5 1.3 0.0 1.5 0.4 0.0 575 (*) 7 DK/Missing 90.8 1.7 7.5 0.0 0.0 0.0 0.0 0.0 0.0 90 - - Wealth index quintile Poorest 94.7 0.5 3.5 0.7 0.1 0.0 0.5 0.0 0.0 2,692 4.0 245 Second 94.4 0.6 4.4 0.5 0.0 0.0 0.4 0.2 0.0 2,691 13.9 215 Middle 94.7 1.1 3.9 0.4 0.0 0.0 0.2 0.0 0.0 2,691 14.4 227 Fourth 93.1 1.2 4.4 1.3 0.1 0.0 0.2 0.0 0.0 2,689 2.2 126 Richest 88.0 5.0 5.9 0.7 0.4 0.0 1.1 0.1 0.0 2,693 (*) 7 1 MICS indicator 4.2 - Water treatment na: not applicable (*) Figures that are based on fewer than 25 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 89 The amount of time it takes to obtain water is presented in Table WS.3 and the person who usually collects the water in Table WS.4. Note that for Table WS.3, household members using water on premises are also shown in this table and for others, the results refer to one roundtrip from home to drinking water source. Information on the number of trips made in one day was not collected. Table WS.3 shows that for 42 percent of the household population, the drinking water source is on premises. While 92 percent of the wealthiest have water on premises, only 10 percent of the poorest have this benefit. The availability of water on premises is associated with greater use, better family hygiene and better health outcomes. For a water collection round trip of 30 minutes or more it has been observed that households carry progressively less water and are likely to compromise on the minimal basic drinking water needs of the household.i For nearly a quarter of the household population (23 percent), it takes the household more than 30 minutes to get to the water source and bring water; this is the case for 20 percent of those using an improved drinking water source. In rural areas a higher percentage of household members live in households that spend time in collecting water compared to those in urban areas. One finding of note is the comparatively high percentage of household members in Region South East (28 percent), who live in households spending 30 minutes or more to get water from an improved source of drinking water, while nearly one in three household members (31 percent) of the population of Autonomous Region of Principe spend as much time to get drinking water from any type of source. i Cairncross, S and Cliff, JL. 1987. Water use and Health in Mueda, Mozambique. Transactions of the Royal Society of Tropical Medicine and Hygiene 81: 51-4. Sao Tome and Principe 2014 MICS, Final Report P a g e | 90 Table WS.3:53Time 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, Sao Tome and Principe, 2014 Time to source of drinking water Users of improved drinking water sources Users of unimproved drinking water sources Total Number of household members Water on premises Less than 30 minu- tes 30 minu- tes or more Mis- sing/ DK Water on premises Less than 30 minu- tes 30 minu- tes or more Mis- sing/ DK Total 41.2 31.0 19.6 2.1 0.3 2.4 3.4 0.1 100.0 13,455 Region Centre East 47.2 27.6 18.6 2.5 0.1 1.3 2.6 0.1 100.0 8,799 North West 30.3 40.9 18.2 1.3 0.2 4.6 4.5 0.1 100.0 2,510 South East 29.3 35.4 28.0 1.8 0.1 2.8 2.4 0.2 100.0 1,651 Aut. of Principe 30.4 26.3 16.6 0.5 3.5 7.3 14.9 0.4 100.0 495 Area Urban 48.7 27.4 19.5 2.4 0.0 1.5 0.5 0.0 100.0 8,960 Rural 26.3 38.1 19.8 1.6 0.8 4.1 9.1 0.2 100.0 4,495 Education of household head None 26.3 39.2 23.6 2.4 0.1 2.4 5.8 0.1 100.0 1,056 Primary 34.8 34.0 21.4 2.3 0.4 2.8 4.1 0.1 100.0 7,461 Secondary 50.6 26.7 16.7 2.0 0.2 1.7 1.9 0.2 100.0 4,273 Higher 83.1 8.5 7.3 0.0 0.0 1.0 0.2 0.0 100.0 575 DK/Missing 32.9 26.7 40.4 0.0 0.0 0.0 0.0 0.0 100.0 90 Wealth index quintile Poorest 9.4 50.6 27.9 3.1 0.4 4.1 4.4 0.2 100.0 2,692 Second 18.4 45.7 23.5 4.3 0.4 3.2 4.2 0.2 100.0 2,691 Middle 32.3 33.9 24.1 1.2 0.4 2.7 5.3 0.1 100.0 2,691 Fourth 54.2 22.1 16.9 2.0 0.2 1.8 2.7 0.0 100.0 2,689 Richest 91.6 2.5 5.5 0.1 0.1 0.0 0.2 0.0 100.0 2,693 Table WS.4 shows that for over two-thirds of households (69 percent), an adult female usually collects drinking water when the source is not on the premises. Adult men collect water in only 19 percent of cases, while for the rest of the households, female or male children under age 15 collect water (11 percent). These trends are fairly constant over the various background characteristics, although it is interesting to note that in Autonomous Region of Principe adult men collect water in 31 percent of households where the source is not on premises. Sao Tome and Principe 2014 MICS, Final Report P a g e | 91 Table WS.4:54Person 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, Sao Tome and Principe, 2014 Percentage of households without drinking water on premises Number of households Person usually collecting drinking water Number of households without drinking water on premises Adult woman Adult man Female child under age 15 Male child under age 15 Missing/ DK Total Total 58.6 3,492 69.3 18.5 8.3 3.2 0.7 100.0 2,046 Region Centre East 52.5 2,311 71.8 17.9 6.9 2.7 0.7 100.0 1,214 North West 70.7 612 67.4 14.9 12.2 4.6 0.9 100.0 433 South East 71.5 417 67.9 21.6 6.6 3.1 0.8 100.0 298 Aut. of Principe 66.6 152 51.5 31.4 13.5 3.6 0.0 100.0 101 Area Urban 50.6 2,306 70.1 18.0 7.9 3.2 0.8 100.0 1,168 Rural 74.1 1,186 68.2 19.2 8.8 3.2 0.7 100.0 879 Education of household head None 70.5 319 70.8 13.4 9.3 5.0 1.6 100.0 225 Primary 65.7 1,891 67.8 19.4 8.2 3.8 0.9 100.0 1,242 Secondary 48.1 1,113 72.3 17.9 8.2 1.5 0.1 100.0 535 Higher 19.5 148 (66.4) (25.5) (8.1) (0.0) (0.0) 100.0 29 DK/Missing (*) 21 (*) (*) (*) (*) (*) 100.0 15 Wealth index quintile Poorest 89.0 806 66.0 22.0 6.8 3.8 1.3 100.0 717 Second 78.7 719 72.5 16.9 7.4 2.8 0.3 100.0 566 Middle 65.8 676 71.5 15.9 8.7 3.5 0.5 100.0 445 Fourth 41.0 658 68.9 14.1 13.7 2.7 0.6 100.0 270 Richest 7.7 633 61.5 32.9 5.6 0.0 0.0 100.0 49 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Use of Improved Sanitation An improved sanitation facility is defined as one that hygienically separates human excreta from human contact. Improved sanitation facilities for excreta disposal include flush or pour flush to a piped sewer system, septic tank, or pit latrine; ventilated improved pit latrine, pit latrine with slab, and use of a composting toilet. The data on the use of improved sanitation facilities in Sao Tome and Principe are provided in Table WS.5. Nearly half of the population (47 percent) lives in households using improved sanitation facilities (Table WS.5), 53 percent in urban and 36 percent in rural areas. Residents of Region North West are less likely than others to use improved facilities (27 percent). The table indicates that the use of improved sanitation facilities is strongly correlated with wealth. While there are important differences between urban and rural areas, open defecation remains the most common method, used by 61 percent of the rural and 42 percent of the urban population. After that, covered pit latrines with flushing toilets are the most common sanitation facilities, used by 27 percent of the urban and 23 percent of the rural population. Modern bathrooms are used by 17 percent of the population, mostly in urban areas. Sao Tome and Principe 2014 MICS, Final Report P a g e | 92 Table WS.5:55Types of sanitation facilities Percent distribution of household population according to type of toilet facility used by the household, Sao Tome and Principe, 2014 Type of toilet facility used by household Open defecation (no facility, bush, field) Total Number of household members Improved sanitation facility connected to sewer, septic tank or pit Unimproved sanitation facility Modern bathroom with flushing toilet Covered pit latrine with flushing toilet Covered pit latrine without toilet (septic tank) Dry pit without toilet/ open pit Bucket Other Missing Total 17.5 26.0 3.9 3.2 0.2 0.3 0.6 48.4 100.0 13,455 Region Centre East 22.3 28.5 4.0 2.8 0.2 0.2 0.7 41.2 100.0 8,799 North West 7.6 15.0 4.7 5.9 0.1 0.7 0.6 65.5 100.0 2,510 South East 6.6 25.4 3.1 1.5 0.0 0.1 0.0 63.2 100.0 1,651 Autonomous of Principe 17.4 38.1 0.7 1.5 1.6 0.3 0.0 40.5 100.0 495 Area Urban 21.4 27.3 4.4 3.9 0.3 0.2 0.6 41.9 100.0 8,960 Rural 9.6 23.3 2.8 1.9 0.2 0.5 0.5 61.3 100.0 4,495 Education of household head None 6.5 30.0 3.4 3.8 0.3 0.3 0.0 55.8 100.0 1,056 Primary 10.2 24.2 4.3 2.9 0.3 0.5 0.8 56.8 100.0 7,461 Secondary 26.7 28.6 3.2 3.8 0.1 0.0 0.1 37.5 100.0 4,273 Higher 63.2 23.7 2.5 2.5 0.0 0.0 3.0 5.1 100.0 575 DK/Missing 17.7 12.5 11.2 0.0 0.0 0.0 0.0 58.5 100.0 90 Wealth index quintile Poorest 1.6 7.3 2.8 1.8 0.6 0.7 0.9 84.4 100.0 2,692 Second 2.3 15.7 4.1 2.6 0.3 0.3 0.4 74.4 100.0 2,691 Middle 3.8 28.6 6.2 5.4 0.0 0.4 0.6 55.0 100.0 2,691 Fourth 18.2 47.1 5.2 5.7 0.3 0.1 0.5 22.9 100.0 2,689 Richest 61.3 31.2 1.1 0.5 0.0 0.1 0.7 5.2 100.0 2,693 Sao Tome and Principe 2014 MICS, Final Report P a g e | 93 Table WS.6:56Use 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, Sao Tome and Principe, 2014 Users of improved sanitation facilities Users of unimproved sanitation facilities Open defecation (no facility, bush, field) Total Number of household members Not shared1 Public facility Shared by Missing/DK Not shared Public facility Shared by Missing/DK 5 households or less More than 5 households 5 households or less More than 5 households Total 40.9 0.8 4.8 0.5 0.4 3.7 0.1 0.5 0.0 0.0 48.4 100.0 13,455 Region Centre East 46.5 0.6 6.6 0.6 0.6 3.3 0.0 0.6 0.0 0.0 41.2 100.0 8,799 North West 25.2 0.8 1.3 0.0 0.0 6.4 0.3 0.6 0.0 0.1 65.5 100.0 2,510 South East 31.6 1.5 1.3 0.7 0.0 1.7 0.0 0.0 0.0 0.0 63.2 100.0 1,651 Aut. of Principe 51.1 1.7 2.3 1.2 0.0 3.0 0.3 0.0 0.0 0.0 40.5 100.0 495 Area Urban 46.2 0.1 5.9 0.6 0.4 4.2 0.0 0.7 0.0 0.0 41.9 100.0 8,960 Rural 30.2 2.1 2.6 0.3 0.3 2.7 0.1 0.2 0.0 0.0 61.3 100.0 4,495 Education of household head None 30.0 0.7 7.7 1.5 0.0 3.1 0.3 0.7 0.3 0.0 55.8 100.0 1,056 Primary 33.0 1.0 3.8 0.3 0.6 4.2 0.0 0.2 0.0 0.0 56.8 100.0 7,461 Secondary 51.4 0.5 5.8 0.6 0.2 2.9 0.1 1.0 0.0 0.0 37.5 100.0 4,273 Higher 84.7 0.0 4.7 0.0 0.0 4.5 0.0 1.0 0.0 0.0 5.1 100.0 575 DK/Missing 41.5 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 58.5 100.0 90 Wealth index quintile Poorest 7.5 1.5 2.1 0.3 0.2 3.4 0.2 0.3 0.0 0.0 84.4 100.0 2,692 Second 18.1 1.3 2.0 0.4 0.3 3.1 0.0 0.4 0.0 0.1 74.4 100.0 2,691 Middle 31.1 0.0 6.6 0.3 0.5 5.1 0.1 1.0 0.1 0.1 55.0 100.0 2,691 Fourth 58.6 0.6 9.4 1.2 0.7 5.7 0.0 0.9 0.0 0.0 22.9 100.0 2,689 Richest 89.0 0.5 3.7 0.2 0.1 1.2 0.1 0.0 0.0 0.0 5.2 100.0 2,693 1 MICS indicator 4.3; MDG indicator 7.9 - Use of improved sanitation Sao Tome and Principe 2014 MICS, Final Report P a g e | 94 The MDGs and the WHO / UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation classify otherwise acceptable sanitation facilities which are public or shared between two or more households as unimproved. Therefore, “use of improved sanitation” is used both in the context of this report and as an MDG indicator to refer to improved sanitation facilities, which are not public or shared. Data on the use of improved sanitation are presented in Tables WS.6 and WS.7. As shown in Table WS.6, 41 percent of the household population is using an improved sanitation facility, ranging from 25 percent in Region North West to 51 percent in Autonomous Region of Principe, and from 8 percent among the poorest to 89 percent among the wealthiest. Only 1 percent of households use an improved toilet facility that is public or shared with other households. Shared toilet facilities of an improved type are mostly found in rural areas. Figure WS.2 presents the distribution of the survey population by use and sharing of sanitation facilities. Figure WS.2: 13Percent d istr ibut ion of household members by use and shar ing of sanitat ion fac i l i t ies , Sao Tome and Pr inc ipe, 2014 Having access to both an improved drinking water source and an improved sanitation facility brings the largest public health benefits to a household.i In its 2008 reportii, the JMP developed a new way of presenting the access figures, by disaggregating and refining the data on drinking-water and sanitation and reflecting them in "ladder" format. This ladder allows a disaggregated analysis of i Wolf, J et al. 2014. Systematic review: Assessing the impact of drinking water and sanitation on diarrhoeal disease in low- and middle-income settings: systematic review and meta-regression. Tropical Medicine and International Health 2014. DfID. 2013. Water, Sanitation and Hygiene: Evidence Paper. DfID: http://r4d.dfid.gov.uk/pdf/outputs/sanitation/WASH-evidence-paper-april2013.pdf ii WHO/UNICEF JMP. 2008. MDG assessment report. http://www.wssinfo.org/fileadmin/user_upload/resources/1251794333-JMP_08_en.pdf Improved sanitation facility - not shared 41% Improved public facility 1% Improved sanitation facility - shared (and missing) 6% Unimproved sanitation facility - not shared 4% Unimproved sanitation facility - shared 0.6% Unimproved public facility 0.1% Open defecation 48% Sao Tome and Principe 2014 MICS, Final Report P a g e | 95 trends in a three rung ladder for drinking-water and a four-rung ladder for sanitation. For sanitation, this gives an understanding of the proportion of population with no sanitation facilities at all – who revert to open defecation, of those reliant on technologies defined by JMP as "unimproved," of those sharing sanitation facilities of otherwise acceptable technology, and those using "improved" sanitation facilities. Table WS.7 presents the percentages of household population by these drinking water and sanitation ladders. The table also shows the percentage of household members using both improved sources of drinking wateri and an improved sanitary means of excreta disposal. In terms of improved drinking water, 94 percent of the household members have access to drinking water that is piped into the dwelling, plot or yard, or is otherwise improved; on the other hand, only 41 percent of the same population has access to improved (not shared) sanitation. Jointly, 40 percent of the household population has access to both improved drinking water and improved sanitation, 46 percent in urban and 27 percent in rural areas, and 89 percent of the wealthiest but only 7 percent of the poorest (see Figure WS.3). i Those indicating bottled water as the main source of drinking water are distributed according to the water source used for other purposes such as cooking and handwashing. Sao Tome and Principe 2014 MICS, Final Report P a g e | 96 Table WS.7:57Drinking water and sanitation ladders Percentage of household population by drinking water and sanitation ladders, Sao Tome and Principe, 2014 Percentage of household population using: Number of household members Improved drinking water1, a Unimproved drinking water Total Improved sanitation2 Unimproved sanitation Total Improved drinking water sources and improved sanitation Piped into dwelling, plot or yard Other improved Shared improved facilities Unimproved facilities Open defecation Total 26.8 67.1 6.1 100.0 40.9 6.4 4.3 48.4 100.0 39.8 13,455 Region Centre East 32.8 63.1 4.2 100.0 46.5 8.3 4.0 41.2 100.0 45.8 8,799 North West 16.6 74.0 9.3 100.0 25.2 2.1 7.3 65.5 100.0 24.5 2,510 South East 13.4 81.1 5.5 100.0 31.6 3.5 1.7 63.2 100.0 31.1 1,651 Autonomous of Principe 17.3 56.6 26.1 100.0 51.1 5.1 3.3 40.5 100.0 39.3 495 Area Urban 33.7 64.3 2.0 100.0 46.2 6.9 4.9 41.9 100.0 46.0 8,960 Rural 13.1 72.7 14.2 100.0 30.2 5.4 3.1 61.3 100.0 27.4 4,495 Education of household head None 10.8 80.8 8.4 100.0 30.0 9.9 4.4 55.8 100.0 29.0 1,056 Primary 20.4 72.2 7.4 100.0 33.0 5.8 4.4 56.8 100.0 31.7 7,461 Secondary 35.5 60.5 4.0 100.0 51.4 7.1 4.1 37.5 100.0 50.4 4,273 Higher 75.4 23.4 1.1 100.0 84.7 4.7 5.5 5.1 100.0 84.6 575 DK/Missing 23.0 77.0 0.0 100.0 41.5 0.0 0.0 58.5 100.0 41.5 90 Wealth index quintile Poorest 1.1 89.8 9.1 100.0 7.5 4.2 3.9 84.4 100.0 7.3 2,692 Second 4.0 88.0 8.0 100.0 18.1 4.0 3.5 74.4 100.0 17.3 2,691 Middle 13.8 77.8 8.4 100.0 31.1 7.5 6.4 55.0 100.0 29.3 2,691 Fourth 34.0 61.4 4.7 100.0 58.6 11.9 6.6 22.9 100.0 56.1 2,689 Richest 81.1 18.6 0.3 100.0 89.0 4.6 1.2 5.2 100.0 88.7 2,693 1 MICS indicator 4.1; MDG indicator 7.8 - Use of improved drinking water sources 2 MICS indicator 4.3; MDG indicator 7.9 - Use of improved sanitation a Those indicating bottled water as the main source of drinking water are distributed according to the water source used for other purposes such as cooking and handwashing. Sao Tome and Principe 2014 MICS, Final Report P a g e | 97 Figure WS.3: 14Use of improved dr inking water sources and improved sanitat ion fac i l i t ies by household members , Sao Tome and Pr inc ipe , 2014 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. Putting disposable diapers with solid waste, a very common practice throughout the world has thus far been classified as an inadequate means of disposal of child faeces for concerns about poor disposal of solid waste itself. This classification is currently under review. Disposal of faeces of children 0-2 years of age is presented in Table WS.8. Overall, only 29 percent of last stools of children age 0-2 years were disposed safely according to the current criteria. 7 17 29 56 89 40 Poorest Second Middle Fourth Richest Sao Tome and Principe Wealth Index Quintiles Sao Tome and Principe 2014 MICS, Final Report P a g e | 98 Table WS.8:58Disposal 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, Sao Tome and Principe, 2014 Place of disposal of child's faeces Percentage of children whose last stools were disposed of safely1 Number of children age 0-2 years Child used toilet/latrine Put/rinsed into toilet or latrine Put/rinsed into drain or ditch Thrown into garbage Buried Left in the open Other Missing/DK Total Total 8.2 20.7 20.7 22.6 6.0 19.1 2.0 0.7 100.0 28.9 1183 Type of sanitation facility used by household members Improved 18.6 41.4 12.0 16.1 4.2 6.8 0.8 0.1 100.0 60.1 511 Unimproved 3.1 17.6 23.2 44.2 6.1 5.7 0.0 0.0 100.0 20.8 42 Open defecation 0.1 4.1 27.5 26.4 7.4 30.0 3.1 1.3 100.0 4.2 630 Region Centre East 9.9 26.6 17.6 22.1 5.5 15.7 1.8 0.7 100.0 36.5 773 North West 4.4 6.6 40.1 22.5 9.2 15.8 1.0 0.4 100.0 11.0 225 South East 5.5 8.1 8.9 26.4 1.1 43.0 5.4 1.6 100.0 13.6 138 Aut. of Principe 7.3 27.8 12.1 18.9 12.8 21.1 0.0 0.0 100.0 35.1 47 Area Urban 9.5 24.5 15.8 24.1 4.6 18.3 2.5 0.7 100.0 34.0 777 Rural 5.7 13.4 29.9 19.6 8.7 20.8 1.0 0.8 100.0 19.1 406 Mother’s education None/Primary 5.4 14.8 22.9 24.4 6.7 22.3 2.5 1.0 100.0 20.2 746 Secondary/Higher 13.0 30.7 16.8 19.5 4.9 13.7 1.1 0.2 100.0 43.7 437 Wealth index quintile Poorest 1.4 3.8 28.4 25.9 5.7 30.1 3.7 1.1 100.0 5.2 261 Second 3.8 9.8 25.0 27.5 5.1 23.7 4.3 0.8 100.0 13.6 249 Middle 4.4 15.9 25.1 21.0 9.7 22.6 1.0 0.2 100.0 20.3 232 Fourth 14.6 35.5 13.7 14.7 7.2 12.7 0.4 1.1 100.0 50.1 236 Richest 19.3 43.8 8.5 23.2 1.9 3.0 0.0 0.3 100.0 63.1 204 1 MICS indicator 4.4 - Safe disposal of child’s faeces Sao Tome and Principe 2014 MICS, Final Report P a g e | 99 Handwashing Handwashing with water and soap is the most cost effective health intervention to reduce both the incidence of diarrhoea and pneumonia in children under fivei. It is most effective when done using water and soap after visiting a toilet or cleaning a child, before eating or handling food and, before feeding a child. Monitoring correct handwashing behaviour at these critical times is challenging. A reliable alternative to observations or self-reported behaviour is assessing the likelihood that correct handwashing behaviour takes place by asking if a household has a specific place where people wash their hands and, if yes, observing whether water and soap (or other local cleansing materials) are available at this placeii. In Sao Tome and Principe, a specific place for handwashing was observed in about half of the households (51 percent), while 44 percent of households could not indicate a specific place where household members usually wash their hands and 5 percent did not give permission to see the place used for handwashing (Table WS.9). Overall, 40 percent of householdsiii had a specific place for handwashing supplied with water and soap (or another cleansing agent). In 2 percent of the households only water was available at the specific place, while in 8 percent of the households the place had soap but no water. The remaining 3 percent of households had neither water nor soap available at the specific place for handwashing. Overall, 8 percent of the households were not able or refused to show any soap present in the household, whereas 15 percent did not have any soap in the households, leaving the remaining 76 percent of households in which either the soap was observed or shown to the interviewer (Table WS.10). The percentage of households with soap or cleansing agent anywhere in the dwelling was similar in urban and rural areas, but ranged from 55 to 94 percent between the poorest and wealthiest households. The differences between regions were also substantial, ranging from 57 percent in Region South East to 88 percent in Autonomous Region of Principe. i Cairncross, S and Valdmanis, V. 2006. Water supply, sanitation and hygiene promotion Chapter 41 in Disease Control Priorities in Developing Countries. 2nd Edition, Edt. Jameson et al. The World Bank. ii Ram, P et al. editors. 2008. Use of a novel method to detect reactivity to structured observation for measurement of handwashing behavior. American Society of Tropical Medicine and Hygiene. iii Households with a specific place for handwashing that was not observed by the interviewers are not included in the denominator. Sao Tome and Principe 2014 MICS, Final Report P a g e | 100 Table WS.9:59Water and soap at place for handwashing Percentage of households where place for handwashing was observed, percentage with no specific place for handwashing, and percent distribution of households by availability of water and soap at specific place for handwashing, Sao Tome and Principe, 2014 Percentage of households: Number of house- holds Place for handwashing observed No specific place for hand- washing in the dwelling, yard, or plot Total Percentage of households with a specific place for handwashing where water and soap or other cleansing agent are present1 Number of households where place for handwashing was observed or with no specific place for handwashing in the dwelling, yard, or plot Where place for hand- washing was observed With no specific place for hand- washing in the dwelling, yard, or plot Water is available and: Water is not available and: Soap present No soap: Soap pre- sent No soap: Ash, mud, or sand pre- sent No other clean- sing agent present Ash, mud, or sand present No other clean- sing agent present Total 51.4 43.6 3,492 40.3 0.2 2.3 8.0 0.1 3.3 45.9 100.0 40.5 3,316 Region Centre East 49.2 49.4 2,311 37.0 0.1 2.2 6.9 0.0 3.6 50.1 100.0 37.2 2,279 North West 65.0 28.6 612 49.0 0.2 2.0 15.3 0.2 2.8 30.6 100.0 49.2 573 South East 47.9 38.0 417 45.1 0.4 3.1 4.3 0.0 2.8 44.3 100.0 45.5 359 Aut. of Principe 39.6 30.1 152 47.3 0.0 4.2 4.8 0.0 0.5 43.2 100.0 47.3 106 Area Urban 48.6 48.1 2,306 38.3 0.1 1.9 7.7 0.1 2.1 49.8 100.0 38.4 2,228 Rural 57.0 34.7 1,186 44.4 0.3 3.1 8.6 0.0 5.8 37.9 100.0 44.7 1,087 Education of household head None 39.0 54.9 319 24.6 0.0 3.6 8.6 0.3 4.5 58.5 100.0 24.6 300 Primary 48.4 46.2 1,891 36.3 0.3 2.1 8.6 0.1 3.9 48.8 100.0 36.6 1,789 Secondary 57.3 38.1 1,113 48.0 0.0 2.4 7.5 0.0 2.2 39.9 100.0 48.0 1,062 Higher 68.8 28.8 148 66.9 0.0 0.0 3.6 0.0 0.0 29.5 100.0 66.9 144 DK/Missing (*) (*) 21 (*) (*) (*) (*) (*) (*) (*) 100.0 (*) 21 Wealth index quintile Poorest 38.0 52.2 806 21.1 0.2 3.3 11.0 0.1 6.5 57.8 100.0 21.3 727 Second 43.9 50.8 719 29.4 0.5 2.2 9.8 0.1 4.3 53.7 100.0 29.9 681 Middle 45.6 50.6 676 34.4 0.1 2.3 8.1 0.0 2.5 52.6 100.0 34.5 650 Fourth 56.2 40.4 658 48.0 0.0 1.8 6.5 0.0 1.8 41.9 100.0 48.0 636 Richest 78.2 20.1 633 73.0 0.0 1.6 4.0 0.0 1.0 20.4 100.0 73.0 622 1 MICS indicator 4.5 - Place for handwashing (*) Figures that are based on fewer than 25 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 101 Table WS.10:60Availability of soap or other cleansing agent Percent distribution of households by availability of soap or other cleansing agent in the dwelling, Sao Tome and Principe, 2014 Place for handwashing observed Place for handwashing not observed Total Percentage of households with soap or other cleansing agent anywhere in the dwelling1 Number of households Soap or other cleansing agent observed Soap or other cleansing agent not observed at place for handwashing Soap or other cleansing agent shown No soap or other cleansing agent in household Not able/Does not want to show soap or other cleansing agent Missing Soap or other cleansing agent shown No soap or other cleansing agent in household Not able/Does not want to show soap or other cleansing agent Missing Total 46.1 3.1 1.6 0.6 0.1 27.3 13.5 7.7 0.1 100.0 76.5 3,492 Region Centre East 43.5 4.3 0.7 0.6 0.2 32.7 12.6 5.5 0.1 100.0 80.5 2,311 North West 60.5 0.5 3.1 0.8 0.1 11.2 13.0 10.7 0.2 100.0 72.2 612 South East 42.8 0.7 4.2 0.3 0.0 13.1 23.2 15.4 0.4 100.0 56.6 417 Aut. of Principe 36.3 2.1 0.7 0.5 0.0 49.1 2.4 8.8 0.0 100.0 87.5 152 Area Urban 44.7 2.1 1.2 0.4 0.1 29.3 15.0 7.0 0.1 100.0 76.1 2,306 Rural 48.9 4.9 2.2 0.8 0.1 23.3 10.4 9.1 0.2 100.0 77.1 1,186 Education of household head None 31.4 3.2 3.4 0.7 0.4 29.9 22.6 8.5 0.0 100.0 64.5 319 Primary 42.8 3.1 1.7 0.8 0.1 27.6 15.6 8.4 0.1 100.0 73.4 1,891 Secondary 52.9 3.1 0.9 0.3 0.1 27.7 8.4 6.3 0.2 100.0 83.7 1,113 Higher 68.8 0.0 0.0 0.0 0.0 16.0 6.6 8.6 0.0 100.0 84.8 148 DK/Missing (*) (*) (*) (*) (*) (*) (*) (*) (*) 100.0 (*) 21 Wealth index quintile Poorest 29.2 2.7 4.2 1.6 0.2 23.5 26.5 11.7 0.3 100.0 55.4 806 Second 37.7 4.4 1.2 0.4 0.1 30.9 16.6 8.5 0.1 100.0 73.0 719 Middle 41.0 3.9 0.4 0.4 0.0 36.0 11.4 7.0 0.0 100.0 81.0 676 Fourth 52.6 2.5 0.8 0.2 0.0 29.0 8.0 6.9 0.0 100.0 84.1 658 Richest 75.7 1.7 0.6 0.0 0.3 17.1 1.3 3.4 0.1 100.0 94.5 633 1 MICS indicator 4.6 - Availability of soap or other cleansing agent (*) Figures that are based on fewer than 25 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 102 VIII. Reproductive Health Fertility Measures of current fertility are presented in Table RH.1 for the three-year period preceding the survey. A three-year period was chosen for calculating these rates to provide the most current information while also allowing the rates to be calculated for a sufficient number of cases so as not to compromise the statistical precision of the estimates. Age-specific fertility rates (ASFRs), expressed as the number of births per 1,000 women in a specified age group, show the age pattern of fertility. Numerators for ASFRs are calculated by identifying live births that occurred in the three- year period preceding the survey classified according to the age of the mother (in five-year age groups) at the time of the child’s birth. The denominators of the rates represent the number of woman-years lived by the survey respondents in each of the five-year age groups during the specified period. The total fertility rate (TFR) is a synthetic measure that denotes the number of live births a woman would have if she were subject to the current age-specific fertility rates throughout her reproductive years (15-49 years). The general fertility rate (GFR) is the number of live births occurring during the specified period per 1,000 women age 15-49.The crude birth rate (CBR) is the number of live births per 1,000 population during the specified period. Table RH.1:61Fertility rates Adolescent birth rate, age-specific and total fertility rates, the general fertility rate, and the crude birth rate for the three-year period preceding the survey, by area, Sao Tome and Principe, 2014 Urban Rural Total Age 15-191 80 116 92 20-24 209 249 221 25-29 213 204 210 30-34 152 193 167 35-39 132 108 124 40-44 57 73 61 45-49 16 5 13 TFRa 4.3 4.7 4.4 GFRb 137.0 156.2 143.2 CBRc 31.4 33.8 32.2 1 MICS indicator 5.1; MDG indicator 5.4 - Adolescent birth rate a TFR: Total fertility rate expressed per woman age 15-49 years b GFR: General fertility rate expressed per 1,000 women age 15-49 years c CBR: Crude birth rate expressed per 1,000 population Table RH.1 shows current fertility in Sao Tome and Principe at the national level and by urban-rural area. The TFR for the three years preceding the 2014 Sao Tome and Principe MICS is 4.4 births per woman. Fertility is somewhat higher in rural than in urban areas (4.7 and 4.3 births per woman respectively). These results are shown in Figure RH.1 as well. It can be observed that point estimates of ASFRs are not consistently higher in rural areas for all age groups as might have been expected. Sao Tome and Principe 2014 MICS, Final Report P a g e | 103 Besides issues related to a relatively small sample size of less than three thousand women of reproductive age in this survey, which can account for sizeable sampling variation in the age-specific estimates, there are also potential data quality issues, in particular with respect to the difficulty to obtain precise information on the date of birth of children who have passed away, as can be verified in Table DQ.24 of Appendix D. An irregular pattern was also found in the ASFRs of the 2008 Sao Tome and Principe DHS possibly for similar reasons. Figure RH.1: 15Age-speci f ic fert i l i t y rates by area , Sao Tome and Pr inc ipe, 2014 The overall age pattern of fertility, as reflected in the ASFRs, indicates that childbearing begins early. Fertility is low among adolescents, increases to a peak of 221 births per 1,000 among women age 20- 24, and declines thereafter. Table RH.2 shows adolescent birth rates and total fertility rates. The adolescent birth rate (age- specific fertility rate for women age 15-19) is defined as the number of births to women age 15-19 years during the three year period preceding the survey, divided by the average number of women age 15-19 (number of women-years lived between ages 15 through 19, inclusive) during the same period, expressed per 1,000 women. The adolescent birth rate is estimated at 92 and shows a large variation between the wealth quintiles, from 29 among the wealthiest to 154 among the poorest. A similar trend is seen in the total fertility rate which range from 3.7 among the wealthiest to 5.3 among the poorest, from 2.5 among women with higher education to 7.1 among women with no formal education. Differences between regions are less accentuated. 0 50 100 150 200 250 300 15-19 20-24 25-29 30-34 35-39 40-44 45-49 P er 1 ,0 0 0 Age Urban Rural Total Rates refer to the three years period preceding the survey Sao Tome and Principe 2014 MICS, Final Report P a g e | 104 Table RH.2:62Adolescent birth rate and total fertility rate Adolescent birth rates and total fertility rates for the three-year period preceding the survey, Sao Tome and Principe, 2014 Adolescent birth rate1 (Age-specific fertility rate for women age 15-19 years) Total fertility rate Total 92 4.4 Region Centre East 86 4.3 North West 102 4.6 South East (98) 4.8 Aut. of Principe (*) 4.6 Education None (*) 7.1 Primary 193 5.2 Secondary 59 3.9 Higher (*) 2.5 Wealth index quintile Poorest 154 5.3 Second 123 4.8 Middle 92 4.4 Fourth 87 4.1 Richest 29 3.7 1 MICS indicator 5.1; MDG indicator 5.4 - Adolescent birth rate ( ) Figures that are based on 125-249 unweighted exposed persons-years (*) Figures that are based on fewer than 125 unweighted exposed persons- years Table RH.3 presents some early childbearingi indicators for women age 15-19 and 20-24 while Table RH.4 presents the trends for early childbearing. i Childbearing is the process of giving birth to children. While early childbearing is defined as having had live births before specific young ages, for the purposes of Table RH.3, women age 15-19 years who have begun childbearing includes those who have had a live birth as well as those who have not had a live birth but are pregnant with their first child. Sao Tome and Principe 2014 MICS, Final Report P a g e | 105 Table RH.3:63Early childbearing Percentage of women age 15-19 years who have had a live birth, are pregnant with the first child, have begun childbearing, and who have had a live birth before age 15, and percentage of women age 20-24 years who have had a live birth before age 18, Sao Tome and Principe, 2014 Percentage of women age 15-19 years who: Number of women age 15-19 years Percentage of women age 20-24 years who have had a live birth before age 181 Number of women age 20- 24 years Have had a live birth Are pregnant with first child Have begun childbearing Have had a live birth before age 15 Total 16.0 4.5 20.6 0.7 702 27.3 467 Region Centre East 14.5 4.9 19.3 0.0 491 24.1 318 North West 18.4 2.9 21.3 1.6 123 32.0 82 South East 21.3 5.7 27.0 3.9 70 34.4 49 Aut. of Principe (20.8) (3.0) (23.7) (0.0) 18 (41.9) 18 Area Urban 14.0 4.0 18.0 0.5 478 26.4 326 Rural 20.3 5.6 26.0 0.9 224 29.2 141 Education None/Primary 41.4 7.2 48.6 1.7 145 41.6 188 Secondary/Higher 9.4 3.9 13.3 0.4 557 17.6 279 Wealth index quintile Poorest 30.7 8.2 38.9 2.8 107 35.0 71 Second 20.0 7.6 27.6 1.1 147 31.7 101 Middle 17.6 3.3 20.9 0.0 137 34.4 87 Fourth 14.3 3.6 17.9 0.0 133 25.4 118 Richest 4.0 1.6 5.5 0.0 178 11.9 91 1 MICS indicator 5.2 - Early childbearing ( ) Figures that are based on 25-49 unweighted cases As shown in Table RH.3, 16 percent of women age 15-19 have already had a birth, 5 percent are pregnant with their first child, and nearly 1 percent has had a live birth before age 15. The latter cases are almost exclusively seen among the 40 percent poorest. The table also indicates that 27 percent of women age 20-24 have had a live birth before age 18. Here again, the poorest are more affected (35 percent) than the wealthiest (12 percent), as are those with no formal education or only primary level (42 percent) compared with those with secondary or higher education (18 percent). Table RH.4 shows fluctuations in early childbearing over the past decades, with a suggestion that a downward trend in live births before age 18 some twenty years ago may have given place to an upward trend in the last ten years or so. However, a closer analysis of the data from this survey and other sources would be required to validate this proposition. Sao Tome and Principe 2014 MICS, Final Report P a g e | 106 Table RH.4:64Trends in early childbearing Percentage of women who have had a live birth, by age 15 and 18, by area and age group, Sao Tome and Principe, 2014 Urban Rural All 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 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 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 Total 1.7 1,997 23.0 1,519 2.2 938 28.2 714 1.9 2,935 24.6 2,233 Age 15-19 0.5 478 na na 0.9 224 na na 0.7 702 na na 20-24 3.1 326 26.4 326 2.3 141 29.2 141 2.9 467 27.3 467 25-29 1.7 329 24.1 329 0.6 155 29.8 155 1.3 484 25.9 484 30-34 1.4 283 18.5 283 2.0 163 20.2 163 1.6 446 19.1 446 35-39 1.0 236 18.7 236 2.7 113 26.6 113 1.6 349 21.2 349 40-44 2.7 207 21.9 207 4.3 83 29.3 83 3.2 290 24.0 290 45-49 3.4 138 30.4 138 8.2 60 44.6 60 4.9 198 34.7 198 na: not applicable Sao Tome and Principe 2014 MICS, Final Report P a g e | 107 Contraception Appropriate family planning is important to the health of women and children by: 1) preventing pregnancies that are too early or too late; 2) extending the period between births; and 3) limiting the total number of children. Access by all couples to information and services to prevent pregnancies that are too early, too closely spaced, too late or too many is critical. Current use of contraception was reported by 41 percent of women currently married or in unioni (Table RH.5). The most popular method is the pill which is used by 15 percent of married women in Sao Tome and Principe. The next most popular method is injectables, used by 12 percent of married women, while male condom is used by 5 percent of them. Any of the other methods accounts for less than 3 percent individually. Contraceptive prevalence ranges from 38 percent in Region Centre East to 57 percent in Autonomous Region of Principe. About 46 percent of married women in urban and 38 percent in rural areas use a method of contraception. The findings by region and area are depicted in Figure RH.2. Adolescents are less likely to use contraception than older women. About 30 percent of women age 15-19 married or in union currently use a method of contraception, while 39 to 45 percent of women age 20-44 use them. Women’s education level is strongly associated with contraceptive prevalence. The percentage of married women using any method of contraception rises from 25 percent among those with no education, to 39 percent among those with primary education, 43 percent among those with secondary education, and then 59 percent among those with higher education. In addition to differences in overall prevalence, the pattern of use by specific methods also varies with the level of education. Women with no formal education give preference to injectables (17 percent), those with secondary education prefer the pill (15 percent), while both methods are similarly prevalent among those with primary education. On the other hand, the male condom rises in popularity as the level of education of the woman (and presumably of the male partner as well) increases. i All references to “married women” in this chapter include women in marital union as well. Sao Tome and Principe 2014 MICS, Final Report P a g e | 108 Table RH.5:65Use 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, São Tomé e Príncipe, 2014 Percent of women currently married or in union who are using (or whose partner is using): Number of women age 15-49 years currently married or in union No method Female sterili- zation Male sterili- zation IUD Injec- tables Im- plants Pill Male condom Female condom Dia- phragm /Foam /Jelly Periodic absti- nence With- drawal Other Missing Any modern method Any tradi- tional method Any method1 Total 59.4 0.6 0.1 2.1 11.6 2.5 14.8 5.1 0.6 0.0 1.9 0.1 1.1 0.1 37.4 3.1 40.6 1629 Region Centre Este 62.4 0.5 0.0 2.3 7.9 2.6 13.1 6.7 1.0 0.0 2.3 0.0 1.0 0.1 34.2 3.3 37.6 1048 North Oeste 54.5 0.4 0.2 2.2 16.5 1.4 20.0 3.0 0.0 0.0 1.1 0.4 0.4 0.0 43.7 1.9 45.5 298 South Este 57.4 0.9 0.3 0.9 20.9 2.7 12.9 0.2 0.0 0.0 0.7 0.3 2.8 0.0 38.9 3.7 42.6 213 A. of Príncipe 42.6 0.4 0.0 1.0 18.5 6.1 23.6 4.7 0.0 0.0 3.1 0.0 0.0 0.0 54.4 3.1 57.4 70 Area Urban 62.0 0.6 0.0 2.2 9.7 2.7 13.2 5.7 0.8 0.0 2.3 0.0 0.7 0.1 34.8 3.1 38.0 1092 Rural 54.2 0.6 0.1 1.8 15.5 2.3 18.1 3.9 0.3 0.0 1.1 0.2 1.8 0.0 42.6 3.2 45.8 537 Age 15-19 70.0 0.0 0.0 0.9 8.7 2.1 14.1 1.8 0.0 0.0 0.0 0.0 2.4 0.0 27.6 2.4 30.0 107 20-24 57.4 0.4 0.0 1.7 15.2 3.3 13.5 6.7 0.0 0.0 0.5 0.0 1.2 0.0 40.9 1.7 42.6 267 25-29 55.2 0.3 0.2 1.4 14.7 3.3 13.5 7.8 0.8 0.0 2.5 0.2 0.1 0.0 42.0 2.8 44.8 337 30-34 55.0 0.0 0.0 2.3 8.6 4.2 18.1 5.5 1.2 0.0 3.5 0.0 1.7 0.0 39.8 5.1 45.0 331 35-39 57.5 1.3 0.2 1.7 11.4 1.1 15.8 4.6 1.0 0.0 3.1 0.4 1.3 0.6 37.1 4.8 42.5 259 40-44 60.5 1.2 0.0 5.2 11.1 1.1 16.1 3.2 0.5 0.0 0.0 0.0 1.1 0.0 38.4 1.1 39.5 206 45-49 80.6 1.0 0.0 0.7 7.5 0.0 8.5 0.0 0.0 0.0 1.2 0.0 0.6 0.0 17.7 1.7 19.4 122 Number of living children 0 94.1 0.0 0.0 0.0 0.7 0.0 1.3 3.9 0.0 0.0 0.0 0.0 0.0 0.0 5.9 0.0 5.9 79 1 60.2 0.4 0.0 1.3 7.5 1.8 15.5 8.6 0.3 0.0 2.7 0.0 1.8 0.0 35.3 4.5 39.8 270 2 56.3 0.3 0.2 1.8 12.9 3.8 17.0 5.0 1.2 0.0 1.5 0.0 0.2 0.0 42.0 1.7 43.7 338 3 56.3 0.1 0.0 1.9 12.1 3.5 14.3 7.1 0.2 0.0 2.9 0.0 1.3 0.4 39.2 4.2 43.7 391 4+ 58.2 1.3 0.1 3.1 14.2 1.8 15.4 2.2 0.8 0.0 1.3 0.3 1.3 0.0 38.9 2.9 41.8 551 Education None 74.7 1.6 0.0 0.0 17.3 0.0 4.4 0.0 0.0 0.0 1.1 0.0 1.1 0.0 23.2 2.1 25.3 64 Primary 61.0 0.7 0.0 1.8 13.5 2.0 15.4 3.5 0.0 0.0 1.0 0.2 0.9 0.0 36.9 2.1 39.0 963 Secondary 56.9 0.3 0.1 2.5 8.6 4.0 14.7 7.4 1.2 0.0 2.5 0.0 1.6 0.3 38.7 4.1 43.1 542 Higher (40.7) (0.0) (1.0) (5.0) (2.0) (1.0) (17.5) (15.8) (6.5) (0.0) (10.4) (0.0) (0.0) (0.0) (48.8) (10.4) (59.3) 59 Wealth index quintile Poorest 63.2 1.0 0.0 0.4 18.0 1.9 12.6 1.3 0.0 0.0 0.2 0.0 1.4 0.0 35.2 1.6 36.8 289 Second 61.3 0.6 0.0 1.9 14.5 0.7 16.2 2.6 0.3 0.0 0.8 0.0 1.1 0.0 36.8 1.9 38.7 328 Middle 57.2 0.0 0.0 2.6 12.2 4.2 16.9 4.1 0.3 0.0 1.2 0.5 0.9 0.0 40.2 2.6 42.8 313 Fourth 56.0 0.3 0.2 2.0 10.5 2.3 15.9 7.9 0.6 0.0 2.1 0.0 1.8 0.4 39.6 4.0 44.0 335 Richest 59.8 1.0 0.2 3.2 4.6 3.6 12.5 8.6 1.8 0.0 4.5 0.0 0.4 0.0 35.2 5.0 40.2 364 1 MICS indicator 5.3; MDG indicator 5.3 - Contraceptive prevalence rate ( ) Figures that are based on 25-49 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 109 Figure RH.2: 16Different ia ls in contracept ive use , Sao Tome and Pr inc ipe, 2014 Unmet Need Unmet need for contraception refers to fecund women who are married or in union and are not using any method of contraception, but who wish to postpone the next birth (spacing) or who wish to stop childbearing altogether (limiting). Unmet need is identified in MICS by using a set of questions eliciting current behaviours and preferences pertaining to contraceptive use, fecundity, and fertility preferences. Table RH.6 shows the levels of met need for contraception, unmet need, and the demand for contraception satisfied. 38 46 43 57 38 46 25 39 43 59 41 Regions Region Centre East Region North West Region South East Aut. Reg. of Principe Area Urban Rural Woman's Education None Primary Secondary Higher Sao Tome and Principe Per cent Sao Tome and Principe 2014 MICS, Final Report P a g e | 110 Unmet need for spacing is defined as the percentage of women who are married or in union and are not using a method of contraception AND  are not pregnant, and not postpartum amenorrheici, and are fecundii, and say they want to wait two or more years for their next birth OR  are not pregnant, and not postpartum amenorrheic, and are fecund, and unsure whether they want another child OR  are pregnant, and say that pregnancy was mistimed: would have wanted to wait OR  are postpartum amenorrheic, and say that the birth was mistimed: would have wanted to wait. Unmet need for limiting is defined as percentage of women who are married or in union and are not using a method of contraception AND  are not pregnant, and not postpartum amenorrheic, and are fecund, and say they do not want any more children OR  are pregnant, and say they did not want to have a child OR  are postpartum amenorrheic, and say that they did not want the birth. Total unmet need for contraception is the sum of unmet need for spacing and unmet need for limiting. This indicator is also known as unmet need for family planning and is one of the indicators used to track progress toward the Millennium Development Goal 5 of improving maternal health. As shown in Table RH.6, unmet need for contraception stands at 33 percent overall in Sao Tome and Principe, and ranged from 21 percent in Autonomous Region of Principe to 36 percent in Region Centre East. There are no marked differences between women living in urban or rural areas, and the levels are roughly comparable as well between those of different education or wealth levels. Met need for limiting includes women married or in union who are using (or whose partner is using) a contraceptive methodiii, 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, which is estimated at 41 percent countrywide, with differences between regions ranging from 38 percent in Region Centre East to 57 percent in Autonomous Region of Principe. The total met need is thus slightly higher than the total unmet need. 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 i A woman is postpartum amenorrheic if she had a birth in last two years and is not currently pregnant, and her menstrual period has not returned since the birth of the last child ii A woman is considered infecund if she is neither pregnant nor postpartum amenorrheic, and (1a) has not had menstruation for at least six months, or (1b) never menstruated, or (1c) her last menstruation occurred before her last birth, or (1d) in menopause/has had hysterectomy OR (2) She declares that she has had hysterectomy, or that she has never menstruated, or that she is menopausal, or that she has been trying to get pregnant for 2 or more years without result in response to questions on why she thinks she is not physically able to get pregnant at the time of survey OR (3) She declares she cannot get pregnant when asked about desire for future birth OR (4) She has not had a birth in the preceding 5 years, is currently not using contraception and is currently married and was continuously married during the last 5 years preceding the survey. iii In this chapter, whenever reference is made to the use of a contraceptive by a woman, this may refer to her partner using a contraceptive method (such as male condom). Sao Tome and Principe 2014 MICS, Final Report P a g e | 111 proportion of women currently married or in union who are currently using contraception, over the total demand for contraception. The total demand for contraception includes women who currently have an unmet need (for spacing or limiting), plus those who are currently using contraception. It is estimated to be around 55 percent countrywide, and ranges from 51 percent in Region Centre East to 73 percent in Autonomous Region of Principe. It appears to be strongly linked neither to the area of residence, nor to the education or wealth levels. Table RH.6:66Unmet 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, Sao Tome and Principe, 2014 Met need for contraception Unmet need for contraception Number of women currently married or in union Percentage of demand for contraception satisfied Number of women currently married or in union with need for contraception For spacing For limiting Total For spacing For limiting Total1 Total 20.1 20.5 40.6 17.1 15.6 32.7 1,629 55.4 1,193 Region Centre East 19.0 18.7 37.6 18.1 17.7 35.8 1,048 51.3 769 North West 22.0 23.5 45.5 15.2 12.5 27.8 298 62.1 218 South East 17.1 25.5 42.6 16.3 11.8 28.0 213 60.3 150 A. of Principe 37.9 19.5 57.4 12.3 8.9 21.3 70 73.0 55 Area Urban 19.0 19.0 38.0 18.0 16.0 34.0 1,092 52.8 787 Rural 22.2 23.6 45.8 15.1 14.9 30.0 537 60.4 407 Age 15-19 25.0 5.0 30.0 40.0 2.2 42.2 107 41.5 77 20-24 32.8 9.8 42.6 26.7 5.6 32.3 267 56.8 200 25-29 31.0 13.8 44.8 25.0 11.6 36.6 337 55.1 274 30-34 22.3 22.7 45.0 18.1 14.4 32.5 331 58.0 257 35-39 11.5 31.1 42.5 6.1 23.8 30.0 259 58.7 188 40-44 2.1 37.4 39.5 1.9 24.7 26.6 206 59.8 136 45-49 0.6 18.8 19.4 0.0 30.6 30.6 122 38.8 61 Education None/Primary 16.2 21.9 38.2 15.5 17.8 33.3 1,028 53.4 734 Second./High. 26.6 18.0 44.7 19.7 11.9 31.6 601 58.6 459 Wealth index quintile Poorest 16.7 20.1 36.8 17.2 16.4 33.6 289 52.3 204 Second 18.2 20.5 38.7 16.8 15.8 32.6 328 54.3 234 Middle 22.0 20.8 42.8 17.8 13.2 31.0 313 58.0 231 Fourth 24.7 19.2 44.0 18.1 14.2 32.3 335 57.6 256 Richest 18.5 21.7 40.2 15.6 18.1 33.7 364 54.4 269 1 MICS indicator 5.4; MDG indicator 5.6 - Unmet need Sao Tome and Principe 2014 MICS, Final Report P a g e | 112 Antenatal Care The antenatal period presents important opportunities for reaching pregnant women with a number of interventions that may be vital to their health and well-being and that of their infants. Better understanding of foetal growth and development and its relationship to the mother's health has resulted in increased attention to the potential of antenatal care as an intervention to improve both maternal and newborn health. For example, antenatal care can be used to inform women and families about risks and symptoms in pregnancy and about the risks of labour and delivery, and therefore it may provide the route for ensuring that pregnant women do, in practice, deliver with the assistance of a skilled health care provider. Antenatal visits also provide an opportunity to supply information on birth spacing, which is recognized as an important factor in improving infant survival. Tetanus immunization during pregnancy can be life-saving for both the mother and the infant. The prevention and treatment of malaria among pregnant women, management of anaemia during pregnancy and treatment of sexually transmitted infections (STIs) can significantly improve foetal outcomes and improve maternal health. Adverse outcomes such as low birth weight can be reduced through a combination of interventions to improve women's nutritional status and prevent infections (e.g., malaria and STIs) during pregnancy. More recently, the potential of the antenatal care as an entry point for HIV prevention and care, in particular for the prevention of HIV transmission from mother to child, has led to renewed interest in access to and use of antenatal services. WHO recommends a minimum of four antenatal visits based on a review of the effectiveness of different models of antenatal care. WHO guidelines are specific on the content on antenatal care visits, which include:  Blood pressure measurement  Urine testing for bacteriuria and proteinuria  Blood testing to detect syphilis and severe anaemia  Weight/height measurement (optional). It is of crucial importance for pregnant women to start attending antenatal care visits as early in pregnancy as possible in order to prevent and detect pregnancy conditions that could affect both the woman and her baby. Antenatal care should continue throughout the entire pregnancy. Antenatal care coverage indicators (at least one visit with a skilled provider and 4 or more visits with any providers) are used to track progress toward the Millennium Development Goal 5 of improving maternal health. Sao Tome and Principe 2014 MICS, Final Report P a g e | 113 Table RH.7:67Antenatal care coverage Percent distribution of women age 15-49 years with a live birth in the last two years by antenatal care provider during the pregnancy for the last birth, Sao Tome and Principe, 2014 Provider of antenatal carea No antenatal care Total Any skilled provider1,b Number of women with a live birth in the last two years Medical doctor Nurse/ Midwife Traditional birth attendant Other /Missing Total 7.3 90.2 0.0 0.2 2.3 100.0 97.5 756 Region Centre East 7.4 90.3 0.0 0.3 2.0 100.0 97.7 514 North West 4.1 93.5 0.2 0.0 2.1 100.0 97.7 131 South East 10.3 84.6 0.0 0.0 5.0 100.0 95.0 86 Aut. of Principe (10.5) (89.5) (0.0) (0.0) (0.0) 100.0 (100.0) 25 Area Urban 7.9 90.0 0.0 0.3 1.8 100.0 97.9 496 Rural 6.1 90.4 0.1 0.0 3.3 100.0 96.6 260 Mother's age at birth Less than 20 11.4 88.6 0.0 0.0 0.0 100.0 100.0 120 20-34 6.6 91.5 0.1 0.3 1.4 100.0 98.2 519 35-49 5.8 85.7 0.0 0.0 8.5 100.0 91.5 116 Education None/Primary 5.6 90.5 0.1 0.4 3.5 100.0 96.1 468 Secondary/Higher 10.0 89.6 0.0 0.0 0.4 100.0 99.6 288 Wealth index quintile Poorest 5.5 89.3 0.0 1.0 4.2 100.0 94.8 161 Second 5.0 92.5 0.0 0.0 2.5 100.0 97.5 158 Middle 10.1 87.1 0.2 0.0 2.7 100.0 97.1 149 Fourth 5.5 92.9 0.0 0.0 1.6 100.0 98.4 161 Richest 11.4 88.6 0.0 0.0 0.0 100.0 100.0 126 1 MICS indicator 5.5a; MDG indicator 5.5 - Antenatal care coverage a Only the most qualified provider is considered in cases where more than one provider was reported. b Skilled providers include Medical doctor and Nurse/Midwife. The type of personnel providing antenatal care to women age 15-49 years who gave birth in the two years preceding is presented in Table RH.7. The results show that only a small percentage (2 percent) of women do not receive antenatal care. In Sao Tome and Principe, the majority of antenatal care is provided by nurses and midwives while a minority of women receive care from a medical doctor, both in urban and rural areas. Sao Tome and Principe 2014 MICS, Final Report P a g e | 114 Table RH.8:68Number of antenatal care visits and timing of first visit Percent distribution of women age 15-49 years with a live birth in the last two years by number of antenatal care visits by any provider and by the timing of first antenatal care visits, Sao Tome and Principe, 2014 Percent distribution of women who had: Total Percent distribution of women by number of months pregnant at the time of first antenatal care visit Total Number of women with a live birth in the last two years Median months pregnant at first ANC visit Number of women with a live birth in the last two years who had at least one ANC visit No ante- natal care visits One visit Two visits Three visits 4 or more visits1 DK /Mis- sing No ante- natal care visits First trimes- ter 4-5 months 6-7 months 8+ months DK /Mis- sing Total 2.3 1.5 2.0 5.7 83.6 4.8 100.0 2.3 67.0 20.4 7.4 1.0 1.9 100.0 756 3.0 724 Region Centre East 2.0 1.8 1.4 3.9 84.5 6.3 100.0 2.0 70.0 19.1 5.4 0.9 2.6 100.0 514 3.0 491 North West 2.1 1.0 4.6 9.6 82.0 0.7 100.0 2.1 57.7 24.1 13.7 1.6 0.8 100.0 131 3.0 127 South East 5.0 0.5 1.7 12.0 80.8 0.0 100.0 5.0 59.6 24.9 9.8 0.7 0.0 100.0 86 3.0 81 A. Principe (0.0) (0.0) (2.5) (1.2) (84.4) (12.0) 100.0 (0.0) (78.1) (13.0) (8.9) (0.0) (0.0) 100.0 25 (3.0) 25 Area Urban 1.8 1.6 1.9 6.0 83.6 5.1 100.0 1.8 68.3 20.4 7.0 0.6 1.9 100.0 496 3.0 477 Rural 3.3 1.1 2.2 5.3 83.8 4.2 100.0 3.3 64.4 20.4 8.3 1.6 2.0 100.0 260 3.0 246 Mother's age at birth < 20 0.0 2.0 4.2 7.6 81.6 4.8 100.0 0.0 72.0 20.5 5.9 1.6 0.0 100.0 120 3.0 120 20-34 1.4 1.3 1.6 4.6 86.2 4.9 100.0 1.4 69.2 19.8 6.4 1.0 2.1 100.0 519 3.0 501 35-49 8.5 1.5 1.9 9.0 74.3 4.7 100.0 8.5 51.6 23.2 13.5 0.2 3.0 100.0 116 3.0 102 Education None (0.0) (0.0) (6.9) (20.3) (72.8) (0.0) 100.0 (0.0) (66.9) (13.1) (20.0) (0.0) (0.0) 100.0 25 (3.0) 25 Primary 3.7 2.2 2.4 7.1 79.0 5.7 100.0 3.7 59.0 24.3 8.8 1.6 2.6 100.0 443 3.0 415 Secondary 0.4 0.5 1.1 2.7 91.1 4.2 100.0 0.4 77.6 16.2 4.5 0.1 1.2 100.0 268 3.0 263 Higher (*) (*) (*) (*) (*) (*) 100.0 (*) (*) (*) (*) (*) (*) 100.0 20 (*) 20 Wealth index quintile Poorest 4.2 2.3 5.4 9.8 73.2 5.2 100.0 4.2 51.8 23.2 16.7 2.1 2.0 100.0 161 3.0 151 Second 2.5 2.4 2.2 7.3 81.9 3.6 100.0 2.5 65.8 21.1 6.5 0.9 3.2 100.0 158 3.0 149 Middle 2.7 2.4 1.3 6.9 83.5 3.1 100.0 2.7 67.9 20.8 6.4 1.7 0.5 100.0 149 3.0 144 Fourth 1.6 0.0 0.7 2.7 88.7 6.3 100.0 1.6 69.1 21.5 5.5 0.0 2.3 100.0 161 3.0 155 Richest 0.0 0.0 0.0 1.1 92.8 6.1 100.0 0.0 83.8 14.3 0.4 0.0 1.4 100.0 126 3.0 125 1 MICS indicator 5.5b; MDG indicator 5.5 - Antenatal care coverage ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 115 Table RH.8 shows the number of antenatal care visits during the latest pregnancy that took place within the two years preceding the survey, regardless of provider, by selected characteristics. Over nine in ten mothers (91 percent) received antenatal care more than once and 84 percent of mothers received antenatal care at least four times. Mothers from the poorest households and those with primary education are less likely than more advantaged mothers to receive antenatal care four or more times. For example, 73 percent of the women living in poorest households reported four or more antenatal care visits compared with 93 percent among those living in richest households. Nonetheless, mothers from rural areas are as likely to receive antenatal care four or more times as their urban counterparts. Table RH.8 also provides information about the timing of the first antenatal care visit. Overall, 67 percent of women with a live birth in the last two years had their first antenatal care visit during the first trimester of their last pregnancy, with a median of 3 months of pregnancy at the first visit among those who received antenatal care. A larger proportion of women from wealthiest households had their first antenatal care visit during the first trimester than those from the poorest households (84 and 52 percent respectively). Sao Tome and Principe 2014 MICS, Final Report P a g e | 116 Table RH.9:69Content of antenatal care Percentage of women age 15-49 years with a live birth in the last two years who, at least once, had their blood pressure measured, urine sample taken, and blood sample taken as part of antenatal care, during the pregnancy for the last birth, Sao Tome and Principe, 2014 Percentage of women who, during the pregnancy of their last birth, had: Number of women with a live birth in the last two years Blood pressure measured Urine sample taken Blood sample taken Blood pressure measured, urine and blood sample taken1 Total 97.1 96.0 95.6 94.2 756 Region Centre East 97.7 97.1 96.6 95.6 514 North West 97.3 95.2 94.7 93.2 131 South East 92.6 89.5 90.7 86.8 86 Aut. of Principe (100.0) (100.0) (96.4) (96.4) 25 Area Urban 97.8 97.1 97.2 95.7 496 Rural 95.8 94.0 92.5 91.3 260 Mother's age at birth Less than 20 98.3 95.9 93.8 91.1 120 20-34 98.1 97.6 97.3 96.0 519 35-49 91.5 89.1 89.8 89.1 116 Education None/Primary 95.7 94.0 93.8 91.9 468 Secondary/Higher 99.3 99.3 98.5 97.9 288 Wealth index quintile Poorest 94.1 90.7 91.5 87.5 161 Second 97.0 95.7 92.9 92.1 158 Middle 96.6 96.2 97.3 95.5 149 Fourth 98.4 98.4 97.1 97.1 161 Richest 100.0 100.0 100.0 100.0 126 1 MICS indicator 5.6 - Content of antenatal care The coverage of key services that pregnant women are expected to receive during antenatal care are shown in Table RH.9. Among those women who had a live birth during the two years preceding the survey, 96 percent reported that a blood sample was taken during antenatal care visits, 97 percent that their blood pressure was checked, and 96 percent that urine specimen was taken. At such a high level of coverage, differences between the various background characteristics are relatively small but in the expected direction. Assistance at Delivery About three quarters of all maternal deaths occur due to direct obstetric causes.i The single most critical intervention for safe motherhood is to ensure that a competent health worker with midwifery skills is present at every birth, and in case of emergency that transport is available to a i Say, L et al. 2014. Global causes of maternal death: a WHO systematic analysis. The Lancet Global Health 2(6): e323-33. DOI: 10.1016/S2214-109X(14)70227-X Sao Tome and Principe 2014 MICS, Final Report P a g e | 117 referral facility for obstetric care. The skilled attendant at delivery indicator is used to track progress toward the Millennium Development Goal 5 of improving maternal health. The MICS included a number of questions to assess the proportion of births attended by a skilled attendant. A skilled attendant includes a doctor, nurse, or midwife. About 92 percent of births occurring in the two years preceding the MICS survey were delivered by skilled personnel (Table RH.10). This percentage is fairly constant across regions except Region South East estimated at 82 percent; this is also the only region with a substantial proportion of deliveries assisted by traditional birth attendants (13 percent). The likelihood to be delivered by a skilled attendant increases with education and wealth, and is somewhat higher in the urban (95 percent) than in the rural (88 percent) areas. Deliveries are predominantly assisted by midwives and nurses (81 percent) and a much smaller proportion (12 percent) by medical doctors (see Figure RH.3). Only Region South East has a substantial proportion of deliveries attended by traditional birth attendants. Table RH.10 also shows information on women who delivered by caesarian section (C-section) and provides additional information on the timing of the decision to conduct a C-section (before labour pains began or after) in order to better assess if such decisions are mostly driven by medical or non– medical reasons. Overall, 6 percent of women who delivered in the last two years had a C-section; for 2 percent of women, the decision was taken before the onset of labour pains and for 4 percent after. C-sections tend to be more prevalent among older women (10 percent) and the wealthiest (12 percent). Sao Tome and Principe 2014 MICS, Final Report P a g e | 118 Table RH.10:70Assistance during delivery and caesarian section Percent distribution of women age 15-49 years with a live birth in the last two years by person providing assistance at delivery, and percentage of births delivered by C-section, Sao Tome and Principe, 2014 Person assisting at delivery No attendant Total Delivery assisted by any skilled attendant1,a Percent delivered by C-section Number of women who had a live birth in the last two years Medical doctor Nurse/ Midwife Traditional birth attendant Community health worker Relative/Friend Other Decided before onset of labour pains Decided after onset of labour pains Total2 Total 11.6 80.9 4.7 0.3 1.3 0.9 0.3 100.0 92.5 2.1 3.5 5.6 756 Region Centre East 11.9 81.9 3.4 0.5 1.3 0.9 0.2 100.0 93.8 1.7 3.8 5.5 514 North West 11.9 81.4 4.8 0.0 1.3 0.6 0.0 100.0 93.3 2.6 1.9 4.4 131 South East 10.9 71.5 12.9 0.0 1.7 1.9 1.1 100.0 82.4 3.7 4.1 7.8 86 Autonomous of Principe (5.3) (90.6) (2.0) (0.0) (2.1) (0.0) (0.0) 100.0 (95.9) (1.2) (3.6) (4.8) 25 Area Urban 12.4 82.2 4.4 0.0 0.5 0.5 0.0 100.0 94.7 2.6 4.3 6.9 496 Rural 9.9 78.4 5.2 1.0 3.0 1.8 0.7 100.0 88.3 1.1 2.0 3.1 260 Mother's age at birth Less than 20 15.2 79.3 4.5 0.0 1.1 0.0 0.0 100.0 94.5 0.5 1.8 2.3 120 20-34 10.0 83.4 3.8 0.5 1.4 0.8 0.2 100.0 93.4 1.9 3.4 5.3 519 35-49 14.8 71.3 8.9 0.0 1.5 2.6 0.8 100.0 86.1 4.3 5.9 10.2 116 Place of deliveryb Home 0.0 18.8 54.3 4.2 15.3 4.2 3.2 100.0 18.8 0.0 0.0 0.0 60 Health facilityc 12.7 86.8 0.4 0.0 0.0 0.1 0.0 100.0 99.5 2.3 3.9 6.1 687 Education None/Primary 10.1 79.3 6.7 0.5 1.9 1.0 0.4 100.0 89.5 2.4 2.0 4.3 468 Secondary/Higher 13.9 83.4 1.4 0.0 0.4 0.9 0.0 100.0 97.3 1.6 6.0 7.6 288 Wealth index quintile Poorest 7.4 77.5 10.5 0.8 3.1 0.0 0.6 100.0 85.0 2.4 1.7 4.1 161 Second 7.3 85.2 3.2 0.8 2.2 1.3 0.0 100.0 92.5 1.3 1.7 3.0 158 Middle 9.8 82.4 5.3 0.0 1.1 0.7 0.7 100.0 92.2 1.1 1.0 2.1 149 Fourth 13.2 82.9 2.0 0.0 0.0 1.9 0.0 100.0 96.2 1.4 6.1 7.5 161 Richest 22.1 75.4 1.7 0.0 0.0 0.8 0.0 100.0 97.5 4.4 7.7 12.2 126 1 MICS indicator 5.7; MDG indicator 5.2 - Skilled attendant at delivery 2 MICS indicator 5.9 - Caesarean section a Skilled attendants include Medical doctor and Nurse/Midwife. b 8 unweighted “other/DK/missing” cases excluded c All cases are in public health facilities except one recorded as private. ( ) Figures that are based on 25-49 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 119 Figure RH.3: 1 7 Person ass ist ing at de l ivery , Sao Tome and Pr inc ipe, 2014 Place of Delivery Increasing the proportion of births that are delivered in health facilities is an important factor in reducing the health risks to both the mother and the baby. Proper medical attention and hygienic conditions during delivery can reduce the risks of complications and infection that can cause morbidity and mortality to either the mother or the baby. Table RH.11 presents the percent distribution of women age 15-49 who had a live birth in the two years preceding the survey by place of delivery, and the percentage of births delivered in a health facility, according to background characteristics. About 91 percent of births in Sao Tome and Principe are delivered in a health facility, nearly all of which are in public sector facilities. Home deliveries account for about 8 percent. Women in the 35- 49 year age group are somewhat less likely to deliver in a health facility (85 percent) than younger ones, and so are women in rural areas as compared to their urban counterparts (85 and 94 percent respectively). The proportion of institutional deliveries is above 90 percent in all regions except Region South East where it is estimated at 77 percent and where 21 percent of deliveries take place at home. Women with higher levels of educational attainment are more likely to deliver in a health facility than women with less education or no formal education (96 and 88 percent respectively). The proportion of births occurring in a health facility increases steadily with wealth, from 82 percent in the lowest wealth quintile to nearly 100 percent in the highest. 0 2 0 5 81 12 0 10 20 30 40 50 60 70 80 90 No attendant Other Community health worker Traditional birth attendant Nurse/midwife Medical doctor Per cent Sao Tome and Principe 2014 MICS, Final Report P a g e | 120 Table RH.11:71Place of delivery Percent distribution of women age 15-49 years with a live birth in the last two years by place of delivery of their last birth, Sao Tome and Principe, 2014 Place of delivery Total Delivered in health facility1 Number of women with a live birth in the last two years Health facility Home Other Missing Public sector Private sector Total 90.9 0.1 8.0 0.6 0.5 100.0 91.0 756 Region Centre East 93.0 0.2 5.8 0.8 0.2 100.0 93.2 514 North West 90.9 0.0 8.5 0.0 0.6 100.0 90.9 131 South East 76.8 0.0 21.3 0.0 1.9 100.0 76.8 86 Aut. of Principe (94.7) (0.0) (4.1) (1.2) (0.0) 100.0 (94.7) 25 Area Urban 93.9 0.2 5.2 0.4 0.3 100.0 94.1 496 Rural 85.1 0.0 13.2 0.8 0.9 100.0 85.1 260 Mother's age at birth Less than 20 93.7 0.0 6.3 0.0 0.0 100.0 93.7 120 20-34 91.5 0.2 7.6 0.4 0.3 100.0 91.7 519 35-49 84.9 0.0 11.5 1.9 1.7 100.0 84.9 116 Number of antenatal care visits None (*) (*) (*) (*) (*) 100.0 (*) 17 1-3 visits 83.4 0.0 16.6 0.0 0.0 100.0 83.4 70 4+ visits 93.1 0.1 6.1 0.7 0.0 100.0 93.2 632 DK/Missing (93.0) (0.0) (7.0) (0.0) (0.0) 100.0 (93.0) 37 Education None/Primary 87.6 0.0 11.4 0.4 0.5 100.0 87.6 468 Secondary/Higher 96.1 0.3 2.4 0.8 0.4 100.0 96.4 288 Wealth index quintile Poorest 81.9 0.0 17.6 0.6 0.0 100.0 81.9 161 Second 90.0 0.0 8.7 0.0 1.3 100.0 90.0 158 Middle 91.3 0.0 7.8 0.2 0.7 100.0 91.3 149 Fourth 93.5 0.5 3.8 1.9 0.3 100.0 94.0 161 Richest 99.6 0.0 0.4 0.0 0.0 100.0 99.6 126 1 MICS indicator 5.8 - Institutional deliveries ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Post-natal Health Checks The time of birth and immediately after is a critical window of opportunity to deliver lifesaving interventions for both the mother and newborn. Across the world, approximately 3 million newborns annually die in the first month of lifei and the majority of these deaths occur within a day or two of birthii, which is also the time when the majority of maternal deaths occuriii. Despite the importance of the first few days following birth, large-scale, nationally representative i UN Interagency Group for Child Mortality Estimation. 2013. Levels and Trends in Child Mortality: Report 2013 ii Lawn, JE et al. 2005. 4 million neonatal deaths: When? Where? Why? Lancet 2005; 365:891–900. iii WHO, UNICEF, UNFPA, The World Bank. 2012. Trends in Maternal Mortality: 1990-2010. World Health Organization. Sao Tome and Principe 2014 MICS, Final Report P a g e | 121 household survey programmes have not systematically included questions on the post-natal period and care for the mother and newborn. In 2008, the Countdown to 2015 initiative, which monitors progress on maternal, newborn and child health interventions, highlighted this data gap, and called not only for post-natal care (PNC) programmes to be strengthened, but also for better data availability and qualityi. Following the establishment and discussions of an Inter-Agency Group on PNC and drawing on lessons learned from earlier attempts of collecting PNC data, a new questionnaire module for MICS was developed and validated. Named the Post-natal Health Checks (PNHC) module, the objective is to collect information on newborns’ and mothers’ contact with a provider, not content of care. The rationale for this is that as PNC programmes scale up, it is important to measure the coverage of that scale up and ensure that the platform for providing essential services is in place. Content is considered more difficult to measure, particularly because the respondent is asked to recall services delivered up to two years preceding the interview. Following the Cairo Conference on Population and Development, which reprioritized and redefined reproductive health, the government of Sao Tome and Principe took essential steps to reinforce reproductive health services through the creation in 1995 of a National Reproductive Health Programme (PNSR), introducing in all health units a minimum reproductive health package directed to the mother, the newborn and the adolescent in a continuum of care. A National Health Development Programme (PNDS) was elaborated and adopted for the 2001-2005 period and is currently under review. It comprises a number of sub-programmes targeting different age groups: children under five years of age, children age 5-14 years, adolescents, and women of reproductive age. Health services are essentially public in Sao Tome and Principe, and under the supervision of the Ministry of Health. Table RH.12 presents the percent distribution of women age 15-49 who gave birth in a health facility in the two years preceding the survey by duration of stay in the facility following the delivery, according to background characteristics. Overall, 99 percent of women who gave birth in a health facility stay 12 hours or more in the facility after delivery with negligible differences across the various background characteristics. Three- quarters of women stay three days or more, and in Region North West this value increases to 88 percent. i HMN, UNICEF, WHO. 2008. Countdown to 2015: Tracking Progress in Maternal, Newborn & Child Survival, The 2008 Report. UNICEF. Sao Tome and Principe 2014 MICS, Final Report P a g e | 122 Table RH.12:72Post-partum stay in health facility Percent distribution of women age 15-49 years with a live birth in the last two years who had their last birth delivered in a health facility by duration of stay in health facility, Sao Tome and Principe, 2014 Duration of stay in health facility Total 12 hours or more1 Number of women who had their last birth delivered in a health facility in the last 2 years Less than 6 hours 6-11 hours 12-23 hours 1-2 days 3 days or more DK/ Missing Total 0.7 0.1 0.1 23.3 75.3 0.4 100.0 98.8 687 Region Centre East 0.7 0.2 0.2 27.6 71.1 0.3 100.0 98.8 479 North West 0.0 0.0 0.0 11.1 87.6 1.3 100.0 98.7 119 South East 1.6 0.0 0.0 21.3 77.1 0.0 100.0 98.4 66 Aut. of Principe (1.2) (0.0) (0.0) (5.2) (93.6) (0.0) 100.0 (98.8) 24 Area Urban 0.7 0.2 0.2 27.3 70.9 0.7 100.0 98.4 466 Rural 0.5 0.0 0.0 14.9 84.6 0.0 100.0 99.5 221 Mother's age at birth Less than 20 0.3 0.0 0.0 19.7 80.1 0.0 100.0 99.7 113 20-34 0.9 0.2 0.2 24.7 73.9 0.2 100.0 98.8 476 35-49 0.0 0.0 0.0 20.9 76.7 2.4 100.0 97.6 98 Type of delivery Vaginal birth 0.7 0.1 0.2 24.7 73.9 0.5 100.0 98.7 645 C-section (0.0) (0.0) (0.0) (2.9) (97.1) (0.0) 100.0 (100.0) 42 Education None/Primary 0.9 0.0 0.2 19.6 78.6 0.7 100.0 98.4 410 Secondary/Higher 0.4 0.3 0.0 28.9 70.5 0.0 100.0 99.3 278 Wealth index quintile Poorest 0.0 0.0 0.8 18.7 79.3 1.2 100.0 98.8 132 Second 0.5 0.0 0.0 20.6 77.9 1.1 100.0 98.4 142 Middle 0.6 0.0 0.0 19.3 80.2 0.0 100.0 99.4 136 Fourth 1.0 0.6 0.0 25.2 73.2 0.0 100.0 98.5 151 Richest 1.3 0.0 0.0 33.4 65.3 0.0 100.0 98.7 126 1 MICS indicator 5.10 - Post-partum stay in health facility ( ) Figures that are based on 25-49 unweighted cases Safe motherhood programmes have recently increased emphasis on the importance of post-natal care, recommending that all women and newborns receive a health check within two days of delivery. To assess the extent of post-natal care utilization, women were asked whether they and their newborn received a health check after the delivery, the timing of the first check, and the type of health provider for the woman’s last birth in the two years preceding the survey. Table RH.13 shows the percentage of newborns born in the last two years who received health checks and post-natal care visits from any health provider after birth. Please note that health checks following birth while in facility or at home refer to checks provided by any health provider regardless of timing (column 1), whereas post-natal care visits refer to a separate visit to check on the health of the newborn and provide preventive care services and therefore do not include health checks following birth while in facility or at home. The indicator Post-natal health checks includes any health check after birth received while in the health facility and at home (column 1), regardless of timing, as well as PNC visits within two days of delivery (columns 2, 3, and 4). Sao Tome and Principe 2014 MICS, Final Report P a g e | 123 Table RH.13:73Post-natal health checks for newborns Percentage of women age 15-49 years with a live birth in the last two years whose last live birth received health checks while in facility or at home following birth, percent distribution whose last live birth received post-natal care (PNC) visits from any health provider after birth, by timing of visit, and percentage who received post natal health checks, Sao Tome and Principe, 2014 Health check following birth while in facility or at homea PNC visit for newbornsb Post-natal health check for the newborn1, c Number of last live births in the last two years Same day 1 day following birth 2 days following birth 3-6 days following birth After the first week following birth No post- natal care visit DK/Missing Total Total 88.9 7.4 3.6 1.8 5.5 60.3 20.4 1.0 100.0 90.7 756 Region Centre East 89.5 5.5 1.8 1.0 5.4 64.2 21.1 1.0 100.0 91.0 514 North West 93.0 15.6 5.5 3.0 7.3 49.9 17.8 .9 100.0 95.0 131 South East 80.4 6.6 5.5 4.0 3.9 56.6 22.7 .6 100.0 84.2 86 Autonomous of Principe (85.2) (8.8) (22.0) (2.8) (3.2) (46.9) (11.6) (4.8) 100.0 (85.2) 25 Area Urban 90.4 7.2 3.3 1.6 4.5 58.9 23.1 1.3 100.0 91.8 496 Rural 86.2 7.9 3.9 2.1 7.4 62.9 15.2 .6 100.0 88.7 260 Mother's age at birth Less than 20 91.4 4.7 2.2 1.3 4.7 68.6 17.5 1.0 100.0 91.7 120 20-34 88.8 8.3 3.7 1.9 5.2 61.0 19.3 .6 100.0 90.6 519 35-49 86.9 6.5 4.3 1.8 7.7 48.2 28.3 3.2 100.0 90.1 116 Place of deliveryd Home 49.3 18.9 6.3 6.5 14.6 28.5 23.3 2.0 100.0 66.7 60 Health facilitye 93.4 6.2 3.4 1.4 4.8 63.6 19.7 1.0 100.0 93.5 687 Education None/Primary 85.4 7.7 4.1 1.4 5.7 57.9 22.1 1.2 100.0 87.4 468 Secondary/Higher 94.7 7.1 2.6 2.4 5.1 64.1 17.7 .9 100.0 96.2 288 Wealth index quintile Poorest 87.8 5.7 4.2 2.0 9.3 61.7 15.5 1.6 100.0 89.6 161 Second 84.0 9.2 2.7 2.3 6.1 58.1 21.0 .6 100.0 86.1 158 Middle 91.9 8.8 3.7 .9 4.2 62.8 18.4 1.3 100.0 93.0 149 Fourth 88.1 8.2 4.6 1.2 4.3 52.9 28.8 0.0 100.0 91.6 161 Richest 94.2 4.9 2.3 2.7 3.2 67.4 17.6 2.0 100.0 94.2 126 1 MICS indicator 5.11 - Post-natal health check for the newborn a Health checks by any health provider following facility births (before discharge from facility) or following home births (before departure of provider from home). b Post-natal care visits (PNC) refer to a separate visit by any health provider to check on the health of the newborn and provide preventive care services. PNC visits do not include health checks following birth while in facility or at home (see note a above). c Post-natal health checks include health checks performed while in the health facility or at home following birth (see note a above), as well as PNC visits (see note b above) within 2 days of delivery. d 8 unweighted “other/DK/missing” cases excluded e All cases are in public health facilities except one recorded as private. ( ) Figures that are based on 25-49 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 124 Overall, 89 percent of newborns receive a health check following birth while in a facility or at home. With regards to PNC visits, these predominantly occur after the first week following birth (60 percent), although a small proportion occur either on the same day after the delivery or the following day (7 percent and 4 percent, respectively). These results must be interpreted in the context of an environment in which three-quarters of the mothers stay 3 or more days at the health facility with their babies after delivery. Eventually, a total of 91 percent of all newborns receive a post-natal health check. This percentage varies from 84 percent in Region South East to 95 percent in Region North West. There are no large differences between urban and rural areas, or between wealth categories; newborns of 96 percent of women with secondary or higher education have a post-natal health check, as compared with 87 percent for their less privileged counterparts. Health checks following birth occur mainly in health facility deliveries (93 percent), whereas for newborns delivered at home the figure is much lower (49 percent). Looking only at those newborns that did not receive a PNC visit, it can be seen that this problem is somewhat more prevalent in urban (23 percent) than rural (15 percent) areas, as well as among older women (28 percent) than among their younger counterparts (17-19 percent). Table RH.14:74Post-natal care visits for newborns within one week of birth Percent distribution of women age 15-49 years with a live birth in the last two years whose last live birth received a post-natal care (PNC) visit within one week of birth, by location and provider of the first PNC visit, Sao Tome and Principe, 2014 Location of first PNC visit for newborns Total Provider of first PNC visit for newborns Total Number of last live births in the last two years with a PNC visit within the first week of life Home Public health facility Doctor/ nurse/ midwife Traditional birth attendant Other /Missing Total 8.9 91.1 100.0 92.6 5.1 2.3 100.0 138 Region Centre East 6.0 94.0 100.0 94.0 6.0 0.0 100.0 71 North West 2.6 97.4 100.0 98.7 0.0 1.3 100.0 41 South East (28.0) (72.0) 100.0 (80.9) (16.7) (2.4) 100.0 17 Aut. of Principe (*) (*) 100.0 (*) (*) (*) 100.0 9 Area Urban 7.9 92.1 100.0 92.8 6.2 1.0 100.0 83 Rural 10.3 89.7 100.0 92.3 3.4 4.3 100.0 55 Mother's age at birth Less than 20 (*) (*) 100.0 (*) (*) (*) 100.0 16 20-34 8.2 91.8 100.0 92.3 6.7 1.0 100.0 99 35-49 (9.6) (90.4) 100.0 (94.4) (0.0) (5.6) 100.0 24 Place of delivery Home (32.2) (67.8) 100.0 (71.2) (25.4) (3.5) 100.0 28 Health facility 3.0 97.0 100.0 98.0 0.0 2.0 100.0 108 Education None/Primary 11.1 88.9 100.0 90.5 6.3 3.1 100.0 88 Second./Higher 4.9 95.1 100.0 96.2 3.0 0.8 100.0 50 Wealth index quintile Poorest 60% 11.3 88.7 100.0 90.9 5.6 3.4 100.0 92 Richest 40% (4.1) (95.9) 100.0 (95.9) (4.1) (0.0) 100.0 46 Sao Tome and Principe 2014 MICS, Final Report P a g e | 125 In Table RH.14, the percentage of newborns who received the first PNC visit within one week of birth is shown by location and type of provider of service. As defined above, a visit does not include a check in the facility or at home following birth. The table shows that the first PNC visits for newborns occurs mainly in public health facilities (91 percent) and are mostly attended by a doctor, nurse or midwife (93 percent). Because many of the statistics by background characteristics have small denominators, interpretation of apparent differences must be cautious. Tables RH.15 and RH.16 present information collected on post-natal health checks and visits of the mother and are identical to Tables RH.13 and RH.14 that presented the data collected for newborns. Table RH.15 presents a pattern somewhat similar to Table RH.13, but with some important differences. Overall, 85 percent of mothers receive a health check following birth while in a facility or at home, not dissimilar to the 89 percent registered for newborns. With regards to PNC visits, they mostly occur after the first week following birth (44 percent), even though a small proportion occurs at different times over the first week. These results must be interpreted in the context of an environment in which three-quarters of the mothers stay 3 or more days at the health facility after delivery. Overall, a total of 87 percent of all mothers receive a post-natal health check, all regions being within the 80-88 percent range, with little difference between urban (88 percent) and rural (84 percent) dwellers. There is again a clear correlation with both education and household wealth, with the percentage of post-natal health checks of mothers increasing with education and wealth. Health checks following birth occur mainly in health facility deliveries (91 percent), whereas for mothers delivering at home the figure is very low (37 percent). The main difference between the table for newborns and the table for mothers is with respect to health checks, particularly post-natal care visits. Studying only those that did not receive a PNC visit, the percentage is more than twice as high for mothers (46 percent) as for newborns (20 percent). Sao Tome and Principe 2014 MICS, Final Report P a g e | 126 Table RH.15:75Post-natal health checks for mothers Percentage of women age 15-49 years with a live birth in the last two years who received health checks while in facility or at home following birth, percent distribution who received post-natal care (PNC) visits from any health provider after birth at the time of last birth, by timing of visit, and percentage who received post natal health checks, Sao Tome and Principe, 2014 Health check following birth while in facility or at homea PNC visit for mothersb Post-natal health check for the mother1, c Number of women with a live birth in the last two years Same day 1 day following birth 2 days following birth 3-6 days following birth After the first week following birth No post- natal care visit DK/Missing Total Total 85.4 2.1 1.9 1.0 3.3 44.0 46.2 1.6 100.0 86.8 756 Region Centre East 86.8 1.4 1.4 0.6 3.1 44.5 47.8 1.2 100.0 88.3 514 North West 85.9 1.8 0.9 0.7 3.5 50.5 40.4 2.2 100.0 85.9 131 South East 77.2 4.0 4.3 2.3 3.3 35.1 50.4 0.6 100.0 80.4 86 Autonomous of Principe 82.5 10.0 7.4 7.2 4.9 30.6 30.2 9.6 100.0 83.5 25 Area Urban 86.6 1.6 1.7 1.0 3.2 44.9 46.9 0.7 100.0 88.2 496 Rural 83.1 3.0 2.1 1.0 3.4 42.3 45.0 3.2 100.0 84.2 260 Mother's age at birth Less than 20 83.1 1.8 0.9 0.5 4.9 36.0 54.5 1.3 100.0 83.3 120 20-34 86.7 2.0 2.0 1.1 3.3 47.1 43.0 1.5 100.0 88.3 519 35-49 81.9 2.6 2.3 1.1 1.4 38.3 51.9 2.4 100.0 83.9 116 Place of deliveryd Home 37.0 11.9 7.6 2.4 5.7 13.1 57.4 1.8 100.0 50.0 60 Health facilitye 90.6 0.9 1.4 0.9 3.1 47.1 45.1 1.6 100.0 90.7 687 Type of delivery Vaginal birth 84.7 1.9 1.7 1.1 3.5 43.2 47.1 1.5 100.0 86.2 714 C-section 97.1 4.6 3.8 0.0 0.0 58.5 30.7 2.5 100.0 97.1 42 Education None/Primary 82.2 2.3 2.0 1.0 2.3 42.1 48.4 1.8 100.0 84.0 468 Secondary/Higher 90.7 1.6 1.6 1.0 4.8 47.1 42.7 1.2 100.0 91.5 288 Wealth index quintile Poorest 80.9 3.4 2.1 0.3 3.0 40.8 49.3 1.1 100.0 81.7 161 Second 83.1 1.2 1.6 1.6 2.0 38.9 53.3 1.3 100.0 84.5 158 Middle 86.7 2.1 3.7 1.0 2.2 42.8 45.6 2.5 100.0 87.7 149 Fourth 85.2 3.2 1.4 1.9 5.3 42.7 43.1 2.4 100.0 88.7 161 Richest 92.8 0.0 0.2 0.0 3.8 57.5 38.0 0.4 100.0 93.0 126 1 MICS indicator 5.12 - Post-natal health check for the mother a Health checks by any health provider following facility births (before discharge from facility) or following home births (before departure of provider from home). b Post-natal care visits (PNC) refer to a separate visit by any health provider to check on the health of the mother and provide preventive care services. PNC visits do not include health checks following birth while in facility or at home (see note a above). c Post-natal health checks include any health check performed while in the health facility or at home following birth (see note a above), as well as PNC visits (see note b above) within two days of delivery. d 8 unweighted “other/DK/missing” cases excluded e All cases are in public health facilities except one recorded as private. Sao Tome and Principe 2014 MICS, Final Report P a g e | 127 Table RH.16:76Post-natal care visits for mothers within one week of birth Percent distribution of women age 15-49 years with a live birth in the last two years who received a post-natal care (PNC) visit within one week of birth, by location and provider of the first PNC visit, Sao Tome and Principe, 2014 Location of first PNC visit for mothers Total Provider of first PNC visit for mothers Total Number of women with a live birth in the last two years who received a PNC visit within one week of birth Home Public health facility Doctor/ nurse/ midwife Commu- nity health worker Traditio- nal birth atten- dant Other /Missing Total 23.6 76.4 100.0 81.3 0.9 8.8 9.0 100.0 62 Table RH.16 matches Table RH.14, but now deals with PNC visits for mothers by location and type of provider. As defined above, a visit does not include a check in the facility or at home following birth. Overall, 76 percent of the first PNC visits occur in a public facility and most (81 percent) are attended by a doctor, a nurse or a midwife. Given the small size of the denominator in this tablewhich relates to the small proportion of women who receive a PNC visit within one week of birthno statistics are presented by background characteristics in this case. Table RH.17 presents the distribution of women with a live birth in the two years preceding the survey by receipt of health checks or PNC visits within 2 days of birth for the mother and the newborn, thus combining the indicators presented in Tables RH.13 and RH.15. The 2014 Sao Tome and Principe MICS shows that for 83 percent of live births, both the mothers and their newborns receive either a health check following birth or a timely PNC visit, whereas for 5 percent of births neither receive health checks or timely visits. While there are some differences across background characteristics, most of these are not large. Urban and rural births have comparable results. Noteworthy differences include those between institutional and home deliveries (87 and 46 percent respectively), and between mothers with secondary or higher education and their less privileged counterparts (89 and 79 percent respectively). While there is a gradient across wealth quintiles, it is not pronounced. As expected, the opposite is true for births without health checks or timely visits. The picture is less clear when it comes to patterns on health checks or timely visits for either the mother or the newborn alone, although there is generally a higher level of coverage for newborns. Sao Tome and Principe 2014 MICS, Final Report P a g e | 128 Table RH.17:77Post-natal health checks for mothers and newborns Percent distribution of women age 15-49 years with a live birth in the last two years by post-natal health checks for the mother and newborn, within two days of the most recent birth, Sao Tome and Principe, 2014 Post-natal health checks within two days of birth for: DK/Missing Total Number of women with a live birth in the last two years Both mothers and newborns Mothers only Newborns only Neither mother nor newborn Total 82.7 3.9 7.8 5.4 0.2 100.0 756 Region Centre East 83.5 4.8 7.5 4.2 0.0 100.0 514 North West 84.9 1.0 10.0 4.0 0.0 100.0 131 South East 77.6 2.1 5.9 13.7 0.6 100.0 86 Aut. of Principe (72.8) (5.8) (7.5) (9.0) (4.8) 100.0 25 Area Urban 84.0 4.1 7.7 4.1 0.1 100.0 496 Rural 80.3 3.4 7.9 7.9 0.5 100.0 260 Mother's age at birth Less than 20 79.6 3.8 12.2 4.5 0.0 100.0 120 20-34 84.2 4.0 6.4 5.3 0.1 100.0 519 35-49 79.7 3.2 9.4 6.7 1.1 100.0 116 Place of deliverya Home 46.0 4.0 20.7 29.3 0.0 100.0 60 Health facilityb 86.5 3.9 6.7 2.6 0.3 100.0 687 Type of delivery Vaginal birth 82.4 3.7 8.0 5.7 0.2 100.0 714 C-section (89.2) (6.6) (2.9) (0.0) (1.3) 100.0 42 Education None/Primary 78.6 5.1 8.5 7.5 0.3 100.0 468 Secondary/Higher 89.4 1.9 6.5 1.9 0.2 100.0 288 Wealth index quintile Poorest 80.0 1.7 9.6 8.8 0.0 100.0 161 Second 78.6 5.6 7.2 8.4 0.3 100.0 158 Middle 83.5 3.8 9.0 3.3 0.5 100.0 149 Fourth 84.7 4.1 7.0 4.3 0.0 100.0 161 Richest 88.0 4.5 5.8 1.3 0.4 100.0 126 a 8 unweighted “other/DK/missing” cases excluded b All cases are in public health facilities except one recorded as private. ( ) Figures that are based on 25-49 unweighted cases Adult Mortality Rates Table RH.18 on adult mortality rates is based on information collected in the Maternal Mortality module in the Women's Questionnaire. Reported ages at death and years since death of the respondents' brothers and sisters are used to construct the numerators (number of deaths). The total number of years lived by all surviving and deceased brothers and sisters (that is, exposure years) during the 7 years preceding the survey are calculated to form the denominators for each age interval. The number of years lived by the respondents in the last 7 years is also taken into account. Mortality rates are expressed per 1,000 population. Sao Tome and Principe 2014 MICS, Final Report P a g e | 129 Table RH.18:78Adult mortality rates Direct estimates of female and male mortality rates for the seven years preceding the survey, by five-year age groups, Sao Tome and Principe, 2014 Female Male Number of Deaths Exposure years Mortality ratesa Number of Deaths Exposure years Mortality ratesa Total 15-49 49 37,964 1.32b 50 36,366 1.35b Age 15-19 8 5,969 1.27 4 5,773 0.76 20-24 5 7,332 0.72 7 7,273 0.96 25-29 5 7,414 0.66 10 7,160 1.41 30-34 13 6,360 2.03 8 6,220 1.24 35-39 8 4,978 1.56 9 4,517 2.01 40-44 4 3,494 1.13 6 3,103 2.06 45-49 7 2,417 2.77 5 2,321 2.32 a Expressed per 1,000 population b Age-adjusted (standardized) rate Overall mortality rates for adults age 15-49 years are estimated at 1.32 per 1,000 population in the case of females, and 1.35 per 1,000 population in the case of males. In both cases mortality rates tend to increase with age, even though the increase is markedly irregular in the case of females; this may in part be attributed to the small sample size in this survey for this type of estimates. Age-specific mortality rates shown in Table RH.18 are used to generate the probabilities of dying between exact ages 15 and 50 years, separately for males and females which are presented in Table RH.19. Synthetic period probabilities are calculated by assuming that a hypothetical cohort would be subject to the mortality rates at each age shown in Table RH.18. The probability of dying between exact ages 15 and 50 is estimated at 52 per 1,000 person-years in the case of males, and 49 per 1,000 person-years in the case of females. Table RH.19:79Adult mortality probabilities The probability of dying between the ages of 15 and 50 for women and men for the seven years preceding the survey, Sao Tome and Principe, 2014 Women 35q15 a Men 35q15 a Sao Tome and Principe, 2014 49 52 a The probability of dying between exact ages 15 and 50 per 1,000 Maternal Mortality The 2014 Sao Tome and Principe MICS asked women age 15-49 a series of questions designed with the explicit purpose of providing the necessary information to make direct estimates of maternal Sao Tome and Principe 2014 MICS, Final Report P a g e | 130 mortality. This estimation of maternal mortality is done using the direct sisterhood methodi and requires reasonably accurate reporting of the number of sisters the respondent ever had, the number who have died, and the number who died during pregnancy, childbirth, or within 2 months after the end of a pregnancy or childbirth. Each female respondent was asked to report all children born to her biological mother, including herself, in chronological order, starting with the first born. Information was then obtained on the survivorship of each of the siblings, the ages of surviving siblings, years since death of deceased siblings, and the age at death of deceased siblings. For each sister who died at age 12 or above, the respondent was asked additional questions to determine whether the death was maternity related, that is, whether the sister was pregnant when she died, whether the sister died during childbirth, or whether the sister died within two months of the termination of a pregnancy or childbirth. Listing all siblings in chronological order of their birth is done with the intention of improving the completeness of reporting. Direct estimates of maternal mortality are generally estimated for the seven year period prior to the survey. This period of time is chosen to reduce possible heaping of reported years since death on five-year intervals. Age-specific mortality rates are calculated by dividing the number of pregnancy- related deaths by years of exposure. To remove the effect of truncation bias (the upper boundary for eligibility is 49 years), the overall rate for women age 15-49 is standardized by the age distribution of the survey respondents. Pregnancy-related deaths are defined as any deathii that occurred during pregnancy, childbirth, or within two months after the birth or termination of a pregnancy. As can be seen in Table RH.20, the maternal mortality ratio for Sao Tome and Principe for the 7-year period preceding the survey is estimated at 74 maternal deaths per 100,000 live births, while the maternal mortality rate is estimated at 0.11 per 1000 women-years of exposure. It must be taken into consideration however that in the 2014 MICS sample, as shown in Table RH.20, only 3 cases of maternal deaths were identified in nearly 38,000 women-years of exposure. While the small number of maternal deaths is an encouraging finding, a larger number of cases would have been necessary for the calculation of a reliable maternal mortality estimate. In other words, the level of maternal mortality currently experienced in Sao Tome and Principe requires a larger sample size than that used in this survey in order to be measured reliably through the direct sisterhood method. In conclusion, given the unreliability of the maternal mortality estimates at such a sample size, it is recommended that they be considered only as indicative and to avoid quoting them in official publications until more reliable estimates are produced. i Rutenberg, N and Sullivan, JM. 1991. Direct and indirect estimates of maternal mortality from the sisterhood method. Demographic and Health Surveys World Conference Proceedings, August 5–7, 1991 Washington, DC. Volume III: 1669–96. ii This time-specific definition includes all deaths that occurred during pregnancy and two months after pregnancy even if the death is due to causes that are not pregnancy related. However, this definition is unlikely to result in over-reporting of maternal deaths because most deaths to women in the specified period are due to maternal causes, and maternal deaths in general are more likely to be underreported than over-reported. Sao Tome and Principe 2014 MICS, Final Report P a g e | 131 Table RH.20: Maternal mortality Direct estimates of maternal mortality rates for the 7 years preceding the survey, by five-year age groups, Sao Tome and Principe, 2014 Percentage of female deaths that are maternal Maternal Deaths Exposure (Years) Maternal mortality ratesa Total 15-49 6.7 3 37,964 (0.11) Age 15-19 25.9 2 5,969 (0.33) 20-24 0.0 0 7,332 (0.00) 25-29 26.8 1 7,414 (0.18) 30-34 0.0 0 6,360 (0.00) 35-39 0.0 0 4,978 (0.00) 40-44 0.0 0 3,494 (0.00) 45-49 0.0 0 2,417 (0.00) General fertility ratec 146b Maternal mortality ratio1, d (74) Lifetime risk of maternal deathe (0.003) 1 MICS indicator 5.13; MDG indicator 5.1 - Maternal mortality ratio a Expressed per 1,000 woman-years of exposure b Age-adjusted rate c Expressed per 1,000 women age 15-49 d Calculated as the maternal mortality rate divided by the general fertility rate, expressed per 100,000 live births e Calculated as 1-(1-MMR)TFR where MMR is the maternal mortality ratio, and TFR represents the total fertility rate for the seven years preceding the survey ( ) Unreliable estimates due to small sample size Prevalence of anaemia in women Blood was collected for the haemoglobin test from women age 15-49 years living in the household who agreed voluntarily to the test. The blood was collected in the following way: a) capillary blood was obtained from a finger prick using a small self-retractable lancet; b) a small drop of blood was placed in a microcuvette which was then inserted in a portable haemoglobinometer (HemoCue), an instrument capable of measuring accurately haemoglobin levels in grams per decilitres of blood; and c) the value was recorded on the questionnaire and the result of the test communicated immediately to the woman. Anaemia in women age 15-49 years can be classified in three categories according to the haemoglobin concentration in the blood. The anaemia is considered severe if haemoglobin is less than 7.0 grams per decilitre (g/dl), moderate if between 7.0 and 9.9 g/dl, and light if between 10.0 and 11.9 g/dl, except for pregnant women in which case it is between 10.0 and 10.9 g/dl. Sao Tome and Principe 2014 MICS, Final Report P a g e | 132 Table RH.21:80Prevalence of anaemia in women Percentage of women age 15-49 years with anaemia, Sao Tome and Principe, 2014 Anaemia according to haemoglobin level Number of women age 15-49 years Any level of anaemia Light anaemia (10.0-11.9 g/dl)a Moderate anaemia (7.0-9.9 g/dl) Severe anaemia (<7.0 g/dl) Total 47.0 35.4 10.4 1.2 2754 Region Centre East 46.1 33.6 11.2 1.3 1832 North West 51.4 41.9 8.4 1.0 511 South East 47.1 36.4 10.2 0.5 312 Autonomous of Principe 41.7 32.5 8.3 0.9 98 Area Urban 49.0 36.7 11.0 1.4 1872 Rural 42.8 32.7 9.4 0.8 882 Age 15-19 years 54.6 39.5 14.0 1.1 651 20-29 years 46.7 34.9 10.9 1.0 910 30-39 years 42.6 33.2 8.5 0.9 739 40-49 years 44.0 34.1 7.6 2.3 454 Education None 56.7 44.2 10.9 1.6 86 Primary 45.8 35.7 8.7 1.3 1348 Secondary 48.8 35.2 12.7 0.9 1228 Higher 32.4 25.7 4.6 2.1 92 Parity 0 child 55.3 39.3 14.7 1.3 718 1 child 50.3 36.6 12.5 1.1 376 2-3 children 40.5 31.6 7.6 1.4 889 4-5 children 46.2 36.4 8.7 1.0 479 6+ children 43.7 34.2 8.9 0.6 292 Pregnancy status Pregnant 61.4 28.5 32.6 0.3 228 Not pregnant 45.7 36.0 8.4 1.3 2526 Use of IUDb Yes (41.7) (30.3) (11.4) (0.0) 37 No 47.1 35.5 10.4 1.2 2717 Tobacco use Yes (smokes/uses tobacco) (*) (*) (*) (*) 6 No 47.1 35.4 10.5 1.2 2745 Missing (*) (*) (*) (*) 2 Wealth index quintile Poorest 51.1 38.0 9.9 3.1 342 Second 46.1 33.7 12.2 0.2 460 Middle 48.6 35.5 12.3 0.7 516 Fourth 47.3 37.4 9.4 0.5 596 Richest 44.7 33.8 9.3 1.7 840 a If the woman is pregnant, the range is 10.0-10.9 g/dl b Intrauterine device ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 133 Table RH.21 shows the anaemia results in women. Almost half of women (47 percent) are anaemic: light anaemia in 35 percent of cases, moderate in 10 percent, and severe in 1 percent. There are important differences between the socio-demographic groups. There is a higher prevalence of anaemia in pregnant (61 percent) than in non-pregnant women (46 percent). Over three pregnant women in ten (32 percent) have moderate anaemia, as compared with 8 percent in non-pregnant women. The prevalence of anaemia differs between age groups. In the 15-19 years group 55 percent are anaemic, as compared with 44 percent in the 40-49 years group. Prevalence tends to decrease with parity, from 55 percent in women without children to 44 percent in women with 6 or more children. Between regions, prevalence ranges from 42 percent in Autonomous Region of Principe to 51 percent in Region North West. It is of 49 percent in urban areas and 43 percent in rural areas. There are large differentials between educational levels, with a prevalence of 57 percent among those without formal education and of 32 percent among those with secondary education. Finally, anaemia ranges from 45 percent in women belonging to the poorest wealth quintile to 51 percent in the wealthiest. A similar pattern is generally observed within each category of anaemia. Sao Tome and Principe 2014 MICS, Final Report P a g e | 134 IX. Early Childhood Development Early Childhood Care and Education Readiness of children for primary school can be improved through attendance to early childhood education programmes or through pre-school attendance. Early childhood education programmes include programmes for children that have organised learning components as opposed to baby- sitting and day-care which do not typically have organised education and learning. The law in Sao Tome and Principe makes preschool optional for children under the age of 7 years. However, new orientations in the educational policies point at the possibility of eventually making preschool free, universal and compulsory. Currently, access for the younger children age 0-3 years is very limited, while it is reasonably good for children age 3-5 years, both in the public and private sectors. However, the content of the preschool programme varies widely, as well as the modalities in which the preschools function and are financed. In 2012, the government made attendance to a preschool educational programme compulsory for children completing 4 years of age by 31st December. In the same year, curricular references were elaborated in conjunction with the Universidade Católica of Rio de Janeiro and UNICEF, while the basic national curriculum for children age 4 and 5 years, with its manuals and guidelines, is currently being tested. In order to improve services, 3 new kindergartens have been built, as well as tens of class rooms. New initiatives have also multiplied through the private sector, NGOs, religious entities, as well as the local and regional authorities. Overall, 36 percent of children age 36-59 months are attending an organised early childhood education programme (Table CD.1). Boys and girls have similar opportunities, and the level of attendance is comparable in urban and rural areas. There are, however, large differences between children of wealthiest and poorest households (63 and 21 percent respectively), and those whose mothers have secondary education or higher as compared with their less privileged counterparts (52 and 29 percent respectively). Attendance between regions ranges from 34 percent in Region Centre East to 53 percent in Autonomous Region of Principe. Children in the 48-59 month age group are more likely to attend an early childhood education programme than younger ones (47 and 28 percent respectively). Sao Tome and Principe 2014 MICS, Final Report P a g e | 135 Table CD.1:81Early childhood education Percentage of children age 36-59 months who are attending an organized early childhood education programme, Sao Tome and Principe, 2014 Percentage of children age 36-59 months attending early childhood education1 Number of children age 36-59 months Total 36.4 864 Sex Male 34.2 435 Female 38.6 429 Region Centre East 34.3 555 North West 36.2 164 South East 41.9 110 Aut. of Principe 53.5 35 Area Urban 36.6 574 Rural 36.0 290 Age of child 36-47 months 28.2 434 48-59 months 44.6 430 Mother's education None/Primary 29.4 601 Secondary/Higher 52.3 263 Wealth index quintile Poorest 20.6 186 Second 24.9 183 Middle 29.8 184 Fourth 52.1 187 Richest 63.2 123 1 MICS indicator 6.1 - Attendance to early childhood education Quality of Care It is well recognized that a period of rapid brain development occurs in the first 3-4 years of life, and the quality of home care is a major determinant of the child’s development during this period. i In this context, engagement of adults in activities with children, presence of books in the home for the child, and the conditions of care are important indicators of quality of home care. As set out in A World Fit for Children, “children should be physically healthy, mentally alert, emotionally secure, socially competent and ready to learn.”ii 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 i Grantham-McGregor, S et al. 2007. Developmental Potential in the First 5 Years for Children in Developing Countries. The Lancet 369: 60–70 Belsky, J et al. 2006. Socioeconomic Risk, Parenting During the Preschool Years and Child Health Age 6 Years. European Journal of Public Health 17(5): 511–2. ii UNICEF. 2002. A World Fit For Children adopted by the UN General Assembly at the 27th Special Session, 10 May 2002: 2. Sao Tome and Principe 2014 MICS, Final Report P a g e | 136 at picture books, telling stories, singing songs, taking children outside the home, compound or yard, playing with children, and spending time with children naming, counting, or drawing things. For almost two-thirds (63 percent) of children age 36-59 months, an adult household member engaged in four or more activities that promote learning and school readiness during the 3 days preceding the survey (Table CD.2). The mean number of activities that adults engage with children is 4.0. The table also indicates that the father’s involvement in such activities is very limited. Father’s involvement in four or more activities is merely 3 percent. Only a little over half (56 percent) of children age 36-59 months live with their biological father. There are no gender differentials in terms of engagement of adults in activities with children, and values are similar for urban and rural areas as well. Notable differences by region and socio- economic status are observed: adult engagement in activities with children ranges from 78 percent in Autonomous Region of Principe to 56 percent in Region North West, while the proportion is 74 percent for children living in the richest households, against 48 percent for those living in the poorest. There is a slight tendency to engage more with children of the 48-59 months age group (67 percent) than with those who are younger (58 percent). Sao Tome and Principe 2014 MICS, Final Report P a g e | 137 Table CD.2:82Support for learning, by sex, region and area Percentage of children age 36-59 months with whom adult household members engaged in activities that promote learning and school readiness during the last three days, and engagement in such activities by biological fathers and mothers, Sao Tome and Principe, 2014 Percentage of children with whom adult household members have engaged in four or more activities1 Mean number of activities with adult household members Percentage of children living with their: Num- ber of children age 36-59 months Percentage of children with whom biological fathers have engaged in four or more activities2 Mean number of activities with biological fathers Number of children age 36-59 months living with their biological fathers Percentage of children with whom biological mothers have engaged in four or more activities3 Mean number of activities with biological mothers Number of children age 36-59 months living with their biological mothers Biolo- gical father Biolo- gical mother Total 62.7 4.0 55.8 87.9 864 3.0 0.5 482 15.7 1.5 759 Sex Male 62.7 4.0 56.0 88.7 435 2.8 0.4 244 16.8 1.6 386 Female 62.7 3.9 55.5 87.2 429 3.1 0.5 238 14.5 1.5 374 Region Centre East 62.7 4.0 54.0 86.8 555 2.2 0.4 300 17.4 1.7 482 North West 55.8 3.5 55.1 88.3 164 4.5 0.4 90 9.2 1.1 145 South East 68.2 4.4 63.7 89.8 110 4.2 0.6 70 11.0 1.2 99 Autonomous of Principe 77.8 4.6 61.2 97.5 35 (4.9) (0.6) 21 33.1 2.4 34 Area Urban 63.6 4.0 54.9 86.6 574 3.1 0.5 315 17.3 1.6 497 Rural 61.0 3.9 57.5 90.6 290 2.8 0.4 167 12.5 1.4 263 1 MICS indicator 6.2 - Support for learning 2 MICS Indicator 6.3 - Father’s support for learning 3 MICS Indicator 6.4 - Mother’s support for learning ( ) Figures that are based on 25-49 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 138 Table CD.2 (second part):83Support for learning, by age, mother’s education, father’s education and wealth index Percentage of children age 36-59 months with whom adult household members engaged in activities that promote learning and school readiness during the last three days, and engagement in such activities by biological fathers and mothers, Sao Tome and Principe, 2014 Percentage of children with whom adult household members have engaged in four or more activities1 Mean number of activities with adult household members Percentage of children living with their: Num- ber of children age 36-59 months Percentage of children with whom biological fathers have engaged in four or more activities2 Mean number of activities with biological fathers Number of children age 36-59 months living with their biological fathers Percentage of children with whom biological mothers have engaged in four or more activities3 Mean number of activities with biological mothers Number of children age 36-59 months living with their biological mothers Biolo- gical father Biolo- gical mother Total 62.7 4.0 55.8 87.9 864 3.0 0.5 482 15.7 1.5 759 Age 36-47 months 58.4 3.7 56.0 90.6 434 2.6 0.5 243 15.7 1.6 393 48-59 months 67.0 4.2 55.6 85.3 430 3.4 0.5 239 15.6 1.5 367 Mother's educationa None/Primary 60.7 3.9 55.9 87.8 601 2.4 0.4 336 13.1 1.4 528 Secondary/Higher 67.2 4.2 55.5 88.1 263 5.3 0.6 146 22.1 2.0 232 Father's educationb Secondary/Higher 59.4 3.8 100.0 94.9 264 3.1 0.5 264 14.2 1.5 251 Higher 66.3 4.2 100.0 93.2 212 8.3 1.0 212 20.3 1.9 198 Father not in household 62.7 3.9 na 80.0 382 na na na 13.9 1.4 306 Wealth index quintile Poorest 47.9 3.3 55.7 87.8 186 1.4 0.2 104 5.8 1.0 163 Second 61.0 3.9 58.7 91.2 183 2.7 0.5 107 10.8 1.3 167 Middle 61.8 3.9 48.7 87.2 184 2.8 0.5 90 19.2 1.7 161 Fourth 72.6 4.3 52.4 87.5 187 2.6 0.3 98 20.9 1.8 163 Richest 73.8 4.7 67.3 85.0 123 6.6 0.9 83 24.5 2.1 105 1 MICS indicator 6.2 - Support for learning 2 MICS Indicator 6.3 - Father’s support for learning 3 MICS Indicator 6.4 - Mother’s support for learning na: not applicable a The background characteristic "Mother's education" refers to the education level of the respondent to the Questionnaire for Children Under Five, and covers both mothers and primary caretakers, who are interviewed when the mother is not listed in the same household. Since indicator 6.4 reports on the biological mother's support for learning, this background characteristic refers to only the educational levels of biological mothers when calculated for the indicator in question. b 4 unweighted “DK/Missing” cases not shown Sao Tome and Principe 2014 MICS, Final Report P a g e | 139 Exposure to books in early years not only provides the child with greater understanding of the nature of print, but may also give the child opportunities to see others reading, such as older siblings doing school work. Presence of books is important for later school performance. The mothers/caretakers of all children under 5 were asked about number of children’s books or picture books they have for the child, and the types of playthings that are available at home. In Sao Tome and Principe, only 6 percent of children age 0-59 months live in households where at least 3 children’s books are present for the child (Table CD.3). The proportion of children with 10 or more books declines to less than 1 percent. No gender differentials are observed, and urban and rural areas are comparable. The presence of children’s books tends to increase with the child’s age; in the homes of 7 percent of children age 24-59 months, there are 3 or more children’s books, compared with 3 percent for children age 0-23 months. Table CD.3:84Learning materials Percentage of children under age 5 by numbers of children's books present in the household, and by playthings that child plays with, Sao Tome and Principe, 2014 Percentage of children living in households that have for the child: Percentage of children who play with: Number of children under age 5 3 or more children's books1 10 or more children's books Home- made toys Toys from a shop /manufac- tured toys Household objects /objects found outside 2 or more types of play- things2 Total 5.8 0.6 55.2 70.4 66.4 64.7 2,030 Sex Male 5.7 0.3 56.2 69.9 68.1 65.3 1,023 Female 6.0 0.8 54.1 71.0 64.7 64.1 1,007 Region Centre East 6.4 0.8 51.0 70.4 59.6 59.2 1,317 North West 3.8 0.2 63.1 74.4 86.1 78.0 386 South East 4.2 0.2 57.5 65.3 77.4 69.3 245 Aut. of Principe 10.9 0.0 77.8 67.4 50.2 76.5 82 Area Urban 6.7 0.5 52.8 70.4 63.2 62.0 1,339 Rural 4.0 0.6 59.7 70.4 72.6 69.8 691 Age 0-23 months 3.0 0.1 41.4 62.8 44.5 48.3 754 24-59 months 7.5 0.9 63.3 74.9 79.4 74.4 1,276 Mother’s education None 0.7 0.0 55.3 54.5 69.2 56.7 84 Primary 2.6 0.2 56.1 66.7 70.9 66.1 1,253 Secondary 10.2 0.9 53.4 78.4 58.5 63.4 647 Higher (41.2) (6.7) (54.1) (90.3) (50.2) (59.1) 46 Wealth index quintile Poorest 0.9 0.0 57.3 59.9 74.8 65.0 444 Second 3.7 0.0 58.1 67.6 71.8 66.1 428 Middle 1.2 0.2 55.8 69.7 67.7 67.6 411 Fourth 6.6 0.0 54.7 75.2 65.4 66.1 423 Richest 20.1 3.3 48.3 83.3 47.5 56.8 324 1 MICS indicator 6.5 - Availability of children’s books 2 MICS indicator 6.6 - Availability of playthings ( ) Figures that are based on 25-49 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 140 Table CD.3 also shows that 65 percent of children age 0-59 months had 2 or more types of playthings to play with in their homes. The types of playthings included in the questionnaires were homemade toys (such as dolls and cars, or other toys made at home), toys that came from a store, and household objects (such as pots and bowls) or objects and materials found outside the home (such as sticks, rocks, animal shells, or leaves). It is interesting to note that the proportion of children who play with household objects (66 percent) is similar to that of those who play with toys that come from a store (70 percent), while 55 percent of them play with homemade toys. There are no gender differences in terms of proportion of children with 2 or more types of playthings, and it appears that children from rural areas are at a slight advantage compared to those of urban areas (70 and 62 percent respectively). Values between regions range from 59 percent in Region Centre East to 78 percent in Region North West. Children from the wealthiest households more frequently have toys that come from a shop (83 percent) than those from the poorest households (60 percent), but these wealthier children also tend to have less diversity in the types of playthings then their poorer counterparts. Leaving children alone or in the presence of other young children is known to increase the risk of injuries.i In MICS, two questions were asked to find out whether children age 0-59 months were left alone during the week preceding the interview, and whether children were left in the care of other children under 10 years of age. Table CD.4 shows that 13 percent of children age 0-59 months were left in the care of other children, while 7 percent were left alone during the week preceding the interview. Combining the two care indicators, it is calculated that a total of 16 percent of children were left with inadequate care during the past week, either by being left alone or in the care of another child. No meaningful differences are observed by the sex of the child or between urban and rural areas. On the other hand, inadequate care is less prevalent among children whose mothers have secondary education (12 percent), as opposed to children whose mothers have primary education (18 percent). Children age 24-59 months are somewhat more likely to be left with inadequate care (18 percent) than those who age 0-23 months (12 percent). There are marked differences by socioeconomic status as children from the poorest households are three times more exposed to inadequate care than those of the wealthiest households (26 and 8 percent respectively). i Grossman, DC. 2000. The History of Injury Control and the Epidemiology of Child and Adolescent Injuries. The Future of Children, 10(1): 23-52. Sao Tome and Principe 2014 MICS, Final Report P a g e | 141 Table CD.4:85Inadequate 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, Sao Tome and Principe, 2014 Percentage of children under age 5: Left alone in the past week Left in the care of another child younger than 10 years of age in the past week Left with inadequate care in the past week1 Number of children under age 5 Total 6.7 13.4 15.5 2,030 Sex Male 6.7 14.7 16.9 1,023 Female 6.7 12.0 14.1 1,007 Region Centre East 4.3 10.3 11.2 1,317 North West 11.2 18.5 23.9 386 South East 9.7 18.8 21.5 245 Aut. of Principe 14.3 22.8 27.7 82 Area Urban 6.9 13.3 15.0 1,339 Rural 6.3 13.6 16.4 691 Age 0-23 months 4.3 10.8 11.9 754 24-59 months 8.1 14.9 17.7 1,276 Mother’s education None 3.5 13.6 14.6 84 Primary 7.6 15.1 17.9 1,253 Secondary 5.3 10.6 11.6 647 Higher (6.7) (6.7) (6.7) 46 Wealth index quintile Poorest 10.8 22.5 26.1 444 Second 7.2 12.7 15.8 428 Middle 6.2 13.3 14.7 411 Fourth 5.5 9.4 11.1 423 Richest 2.6 7.2 7.5 324 1 MICS indicator 6.7 - Inadequate care ( ) Figures that are based on 25-49 unweighted cases Developmental Status of Children Early childhood development is defined as an orderly, predictable process along a continuous path, in which a child learns to handle more complicated levels of moving, thinking, speaking, feeling and relating to others. Physical growth, literacy and numeracy skills, socio-emotional development and readiness to learn are vital domains of a child’s overall development, which is a basis for overall human development. i i Shonkoff, J and Phillips, D (eds). 2000. From neurons to neighborhoods: the science of early childhood development. Committee on Integrating the Science of Early Childhood Development, National Research Council, 2000. Sao Tome and Principe 2014 MICS, Final Report P a g e | 142 A 10-item module was used to calculate the Early Child Development Index (ECDI). The primary purpose of the ECDI is to inform public policy regarding the developmental status of children in Sao Tome and Principe. The index is based on selected milestones that children are expected to achieve by ages 3 and 4. The 10 items are used to determine if children are developmentally on track in four domains:  Literacy-numeracy: Children are identified as being developmentally on track based on whether they can identify/name at least ten letters of the alphabet, whether they can read at least four simple, popular words, and whether they know the name and recognize the symbols of all numbers from 1 to 10. If at least two of these are true, then the child is considered developmentally on track.  Physical: If the child can pick up a small object with two fingers, like a stick or a rock from the ground and/or the mother/caretaker does not indicate that the child is sometimes too sick to play, then the child is regarded as being developmentally on track in the physical domain.  Social-emotional: Children are considered to be developmentally on track if two of the following are true: If the child gets along well with other children, if the child does not kick, bite, or hit other children and if the child does not get distracted easily.  Learning: If the child follows simple directions on how to do something correctly and/or when given something to do, is able to do it independently, then the child is considered to be developmentally on track in this domain. ECDI is then calculated as the percentage of children who are developmentally on track in at least three of these four domains. The results are presented in Table CD.5. In Sao Tome and Principe, 55 percent of children age 36-59 months are developmentally on track. ECDI is similar between boys and girls. As expected, ECDI is substantially higher in the 48-59 months age group than in the younger children (61 and 48 percent respectively), since children mature more skills with increasing age. A higher ECDI of 64 percent is seen in children attending an early childhood education programme compared to 49 percent among those who are not attending. Children living in poorest households have a lower ECDI (51 percent) compared to children living in richest households (62 percent of children developmentally on track). The analysis of the four domains of child development shows that 94 percent of children are on track in the physical, 79 percent in the learning and 62 percent in the social-emotional domains. However, only 16 percent are on track in the literacy-numeracy domain. In each individual domain the higher score is associated with children living in richest households, except for the physical domain where results are comparable. Children attending an early childhood education programme tend to do better in each individual domain than those who don’t, and a similar observation can be made for older children in comparison with the younger ones. Sao Tome and Principe 2014 MICS, Final Report P a g e | 143 Table CD.5:86Early 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, Sao Tome and Principe, 2014 Percentage of children age 36-59 months who are developmentally on track for indicated domains Early child development index score1 Number of children age 36-59 months Literacy- numeracy Physical Social- Emotional Learning Total 16.5 94.0 62.4 79.1 54.5 864 Sex Male 15.8 93.7 63.4 76.4 53.7 435 Female 17.1 94.3 61.5 81.9 55.4 429 Region Centre East 16.7 94.2 63.5 78.4 56.0 555 North West 10.7 91.4 51.0 78.8 42.9 164 South East 23.8 95.8 71.1 81.9 62.5 110 Aut. of Principe 15.8 95.8 72.3 82.7 60.4 35 Area Urban 19.1 94.1 59.7 79.0 53.5 574 Rural 11.3 93.8 67.9 79.3 56.6 290 Age 36-47 months 10.3 91.4 61.9 74.2 48.2 434 48-59 months 22.7 96.5 63.0 84.1 60.9 430 Attendance to early childhood education Attending 26.9 97.1 69.4 85.3 64.0 314 Not attending 10.5 92.2 58.4 75.6 49.2 549 Mother’s education None/Primary 14.7 93.9 59.2 79.0 52.6 601 Secondary/Higher 20.6 94.2 69.8 79.5 59.1 263 Wealth index quintile Poorest 12.6 93.3 64.4 74.4 51.2 186 Second 16.2 94.5 60.6 82.9 56.2 183 Middle 17.0 92.2 54.8 78.2 52.1 184 Fourth 16.9 94.7 64.8 78.1 53.9 187 Richest 21.2 95.7 70.0 83.6 61.9 123 1 MICS indicator 6.8 - Early child development index Sao Tome and Principe 2014 MICS, Final Report P a g e | 144 X. Literacy and Education Literacy among Young Women and Men The Youth Literacy Rate reflects the outcomes of primary education over the previous 10 years or so. As a measure of the effectiveness of the primary education system, it is often seen as a proxy measure of social progress and economic achievement. Literacy is assessed on the ability of the respondent to read a short simple statement or based on school attendance. The percentage literate is presented in Table ED.1 and ED.1M. Table ED.1 indicates that 90 percent of young women in Sao Tome and Principe are literate and that literacy status varies moderately by area. Of women who stated that primary school was their highest level of education (and the very few who declared to never have attended school), only 64 percent were actually able to read the statement shown to them. The situation, however, appears to be improving since 92 percent of young women age 15-19 are literate against 86 percent of those age 20-24. The literacy profile of young men is very similar to that of young women. Table ED.1:87Literacy (young women) Percentage of women age 15-24 years who are literate, Sao Tome and Principe, 2014 Percentage literate1 Percentage not known Number of women age 15-24 years Total 89.6 0.2 1,169 Region Centre East 92.1 0.2 809 North West 84.1 0.0 205 South East 81.2 0.0 118 Autonomous of Principe 92.4 0.0 36 Area Urban 89.9 0.2 804 Rural 89.0 0.0 365 Education None/Primary 63.6 0.5 333 Secondary/Higher 100.0 0.0 836 Age 15-19 92.3 0.3 702 20-24 85.6 0.0 467 Wealth index quintile Poorest 78.6 0.0 177 Second 84.9 0.0 248 Middle 90.3 0.8 224 Fourth 93.3 0.0 250 Richest 97.2 0.0 269 1 MICS indicator 7.1; MDG indicator 2.3 - Literacy rate among young women Sao Tome and Principe 2014 MICS, Final Report P a g e | 145 Table ED.1M:88Literacy (young men) Percentage of men age 15-24 years who are literate, Sao Tome and Principe, 2014 Percentage literate1 Percentage not known Number of men age 15-24 years Total 87.5 1.0 966 Region Centre East 89.4 1.3 636 North West 80.7 0.9 170 South East 84.7 0.4 129 Autonomous of Principe 98.0 0.0 31 Area Urban 89.4 1.0 653 Rural 83.6 1.1 314 Education None/Primary 60.8 3.3 309 Secondary/Higher 100.0 0.0 657 Age 15-19 90.9 1.4 588 20-24 82.2 0.5 378 Wealth index quintile Poorest 76.4 0.5 180 Second 81.2 1.1 201 Middle 88.7 0.5 184 Fourth 94.7 1.1 206 Richest 95.4 1.8 195 1 MICS indicator 7.1; MDG indicator 2.3 - Literacy rate among young men[M] School Readiness Attendance to pre-school education is important for the readiness of children to school. Table ED.2 shows the proportion of children in the first grade of primary school (regardless of age) who attended pre-school the previous yeari. Overall, 58 percent of children who are currently attending the first grade of primary school were attending pre-school the previous year. There is no gender difference and children from urban and rural areas have similar values. Regional differentials appear to exist but interpretation should be cautious given the relatively small sample size outside Region Centre East. Socioeconomic status is correlated with school readiness; while the indicator is only 37 percent among the poorest households, it increases to 82 percent among those children living in the richest households. i The computation of the indicator does not exclude repeaters, and therefore is inclusive of both children who are attending primary school for the first time, as well as those who were in the first grade of primary school the previous school year and are repeating. Children repeating may have attended pre-school prior to the school year during which they attended the first grade of primary school for the first time; these children are not captured in the numerator of the indicator Sao Tome and Principe 2014 MICS, Final Report P a g e | 146 Table ED.2:89School readiness Percentage of children attending first grade of primary school who attended pre- school the previous year, Sao Tome and Principe, 2014 Percentage of children attending first grade who attended preschool in previous year1 Number of children attending first grade of primary school Total 57.9 378 Sex Male 58.7 196 Female 57.1 182 Region Centre East 60.8 232 North West 48.5 87 South East 50.0 43 Aut. of Principe (89.7) 16 Area Urban 57.3 260 Rural 59.2 118 Mother's education None/Primary 52.6 271 Secondary/Higher 71.3 107 Wealth index quintile Poorest 37.1 81 Second 47.5 68 Middle 56.4 80 Fourth 66.9 73 Richest 82.2 77 1 MICS indicator 7.2 - School readiness ( ) Figures that are based on 25-49 unweighted cases Primary and Secondary School Participation Universal access to basic education and the completion of primary education by the world’s children is one of the Millennium Development Goals. Education is a vital prerequisite for combating poverty, empowering women, protecting children from hazardous and exploitative labour and sexual exploitation, promoting human rights and democracy, protecting the environment, and influencing population growth. In Sao Tome and Principe, children enter primary school at age 6 and enter secondary school at age 12. There are 6 grades in primary school and 6 grades in secondary school. In primary school, grades are referred to as year 1 to year 6, or first to sixth grade. For secondary school, grades are referred to as seventh to twelfth grade. The school year typically runs from September of one year to July of the following year. Of children who are of primary school entry age (age 6) in Sao Tome and Principe, 77 percent are attending the first grade of primary school (Table ED.3). Attendance levels of children of both sexes, as well as those from urban and rural areas, are similar. While there are apparent differences Sao Tome and Principe 2014 MICS, Final Report P a g e | 147 between regions and socioeconomic status, these should be interpreted with caution given the relatively small size of several of the denominators. Table ED.3:90Primary school entry Percentage of children of primary school entry age entering grade 1 (net intake rate), Sao Tome and Principe, 2014 Percentage of children of primary school entry age entering grade 11 Number of children of primary school entry age Total 77.1 453 Sex Male 80.1 221 Female 74.2 232 Region Centre East 75.5 300 North West 83.8 89 South East 70.3 46 Aut. of Principe (86.8) 18 Area Urban 74.7 314 Rural 82.4 139 Mother's education None/Primary 78.7 313 Secondary/Higher 74.6 137 Wealth index quintile Poorest 70.3 83 Second 77.1 87 Middle 82.8 86 Fourth 71.0 98 Richest 83.6 100 1 MICS indicator 7.3 - Net intake rate in primary education ( ) Figures that are based on 25-49 unweighted cases Table ED.4 provides the percentage of children of primary school age 6 to 11 years who are attending primary or secondary schooli and those who are out of school. The great majority of children of primary school age are attending school (94 percent). However, 6 percent of the children are out of school, though primarily due to the lower attendance rate (81 percent) for children age 6, who appear to be starting late in school, as seen by a relatively high percentage attending pre- school. The net attendance ratio is similar for children of urban and rural areas and of the various regions. The secondary school net attendance ratio is presented in Table ED.5ii. More dramatic than in primary school, only 60 percent of the children are attending secondary school. Of the remaining 40 percent, most are attending primary school, but 12 percent of children of secondary school age are i Ratios presented in this table are "adjusted" since they include not only primary school attendance, but also secondary school attendance in the numerator. ii Ratios presented in this table are "adjusted" since they include not only secondary school attendance, but also attendance to higher levels in the numerator. Sao Tome and Principe 2014 MICS, Final Report P a g e | 148 completely out of school. The net attendance ratio for boys is lower (55 percent) than that of the girls (65 percent), mainly because a higher proportion of boys are still attending primary school. Sao Tome and Principe 2014 MICS, Final Report P a g e | 149 Table ED.4:91Primary school attendance and out of school children Percentage of children of primary school age attending primary or secondary school (adjusted net attendance ratio), percentage attending preschool, and percentage out of school, Sao Tome and Principe, 2014 Male Female Total Net atten- dance ratio (adjus- ted) Percentage of children: Num- ber of chil- dren Net atten- dance ratio (adjus- ted) Percentage of children: Num- ber of chil- dren Net atten- dance ratio (adjust- ted)1 Percentage of children: Num- ber of chil- dren Not atten- ding school or preschool Atten- ding pre- school Out of school a Not atten- ding school or preschool Atten- ding pre- school Out of school a Not atten- ding school or preschool Atten- ding pre- school Out of school a Total 94.1 3.8 1.9 5.7 1,179 94.1 3.1 2.7 5.8 1,175 94.1 3.5 2.3 5.8 2,355 Region Centre East 93.8 4.1 1.8 5.9 726 93.8 3.4 2.7 6.1 773 93.8 3.7 2.3 6.0 1,499 North West 95.1 2.9 1.7 4.6 257 94.9 2.9 2.2 5.1 220 95.0 2.9 1.9 4.8 477 South East 92.6 4.8 2.6 7.4 148 94.3 2.1 3.6 5.7 138 93.4 3.5 3.1 6.6 286 Aut. of Principe 96.3 1.1 2.6 3.7 48 95.0 2.4 2.6 5.0 44 95.7 1.7 2.6 4.3 92 Area Urban 94.8 2.8 2.0 4.9 761 93.9 3.4 2.6 6.0 781 94.3 3.1 2.3 5.4 1,542 Rural 92.7 5.6 1.7 7.3 418 94.5 2.6 3.0 5.5 395 93.6 4.1 2.3 6.4 813 Age at beginning of school year 6 85.3 6.1 8.2 14.3 221 77.0 10.1 12.9 23.0 232 81.0 8.2 10.6 18.8 453 7 97.7 1.0 1.0 1.9 228 96.9 1.5 1.1 2.6 198 97.3 1.2 1.0 2.3 426 8 96.6 2.9 0.4 3.4 204 99.9 0.1 0.0 0.1 218 98.3 1.5 0.2 1.7 422 9 97.1 1.8 0.7 2.5 205 98.6 1.4 0.0 1.4 185 97.8 1.6 0.4 2.0 389 10 94.2 5.8 0.0 5.8 156 98.8 1.2 0.0 1.2 163 96.5 3.5 0.0 3.5 319 11 93.8 6.2 0.0 6.2 166 97.1 2.9 0.0 2.9 180 95.5 4.5 0.0 4.5 346 Mother's educationb None 94.5 3.8 1.6 5.5 87 90.1 4.0 5.9 9.9 88 92.3 3.9 3.8 7.7 175 Primary 94.1 4.8 1.1 5.9 795 95.3 3.0 1.7 4.7 754 94.7 3.9 1.4 5.3 1,549 Second./Higher 94.2 0.7 4.3 4.9 293 92.7 3.4 3.6 7.0 317 93.4 2.1 3.9 6.0 609 Wealth index quintile Poorest 90.7 7.0 2.3 9.3 245 92.6 2.5 4.9 7.4 222 91.6 4.9 3.5 8.4 467 Second 93.5 5.1 1.4 6.5 247 93.8 4.7 1.5 6.2 225 93.7 4.9 1.4 6.3 472 Middle 93.9 2.9 2.4 5.3 233 95.4 3.3 0.9 4.2 249 94.7 3.1 1.6 4.7 481 Fourth 94.2 3.4 2.5 5.8 236 94.4 3.2 2.4 5.6 247 94.3 3.3 2.4 5.7 484 Richest 98.4 0.3 0.9 1.2 218 94.0 1.8 4.2 6.0 233 96.2 1.0 2.6 3.7 451 1 MICS indicator 7.4; MDG indicator 2.1 - Primary school net attendance ratio (adjusted) a The percentage of children of primary school age out of school are those not attending school and those attending preschool b 4 unweighted missing cases not shown Sao Tome and Principe 2014 MICS, Final Report P a g e | 150 Table ED.5:92Secondary school attendance and out of school children Percentage of children of secondary school age attending secondary school or higher (adjusted net attendance ratio), percentage attending primary school, and percentage out of school, Sao Tome and Principe, 2014 Male Female Total Net atten- dance ratio (adjusted) Percentage of children: Number of children Net atten- dance ratio (adjusted) Percentage of children: Number of children Net atten- dance ratio (adjusted)1 Percentage of children: Number of children Attending primary school Out of schoola Attending primary school Out of schoola Attending primary school Out of schoola Total 55.0 32.4 12.6 758 65.0 24.2 10.7 896 60.4 28.0 11.6 1,653 Region Centre East 55.6 31.7 12.8 490 69.4 21.6 8.9 604 63.2 26.1 10.6 1,094 North West 50.8 36.2 13.0 139 64.4 21.0 14.6 163 58.2 28.0 13.9 302 South East 58.7 28.8 12.4 103 44.9 38.7 16.4 107 51.7 33.9 14.5 209 Autonomous of Principe (53.2) (38.9) (7.9) 26 (45.7) (50.0) (4.3) 22 (49.7) (44.1) (6.2) 48 Area Urban 55.1 33.6 11.3 503 68.3 22.5 9.2 626 62.5 27.4 10.1 1,129 Rural 54.8 30.0 15.2 255 57.2 28.3 14.2 270 56.0 29.1 14.7 525 Age at beginning of school year 12 26.4 66.6 7.1 179 33.9 61.0 5.1 195 30.3 63.7 6.0 374 13 52.9 39.5 7.6 180 64.1 28.4 7.5 194 58.7 33.8 7.6 375 14 63.7 23.5 12.8 138 73.5 17.2 9.3 176 69.2 20.0 10.8 314 15 67.0 12.1 20.9 137 80.3 5.7 13.5 167 74.3 8.6 16.8 303 16 77.0 4.5 18.5 123 78.3 1.9 19.8 163 77.8 3.0 19.3 287 Mother's educationb None 40.1 39.5 20.5 81 49.8 35.5 14.7 80 44.9 37.5 17.6 161 Primary 51.3 35.6 13.1 486 63.2 26.3 10.6 551 57.6 30.6 11.8 1,037 Secondary/Higher 72.6 21.3 6.1 181 74.6 17.4 7.7 253 73.8 19.0 7.0 433 Cannot be determinedc (*) (*) (*) 7 (*) (*) (*) 10 (*) (*) (*) 16 Wealth index quintile Poorest 40.0 38.3 21.7 139 44.3 32.3 23.4 148 42.2 35.2 22.6 287 Second 44.5 37.4 18.1 157 48.5 37.7 13.8 164 46.5 37.6 15.9 321 Middle 47.6 38.4 14.0 161 64.1 28.1 7.8 178 56.3 33.0 10.8 340 Fourth 66.7 28.8 4.5 136 70.1 20.0 9.9 184 68.7 23.7 7.6 319 Richest 75.6 19.5 4.9 164 87.4 9.3 2.9 222 82.4 13.6 3.7 386 1 MICS indicator 7.5 - Secondary school net attendance ratio (adjusted) a The percentage of children of secondary school age out of school are those who are not attending primary, secondary, or higher education b 4 unweighted missing cases not shown. ( ) Figures that are based on 25-49 unweighted cases. (*) Figures that are based on fewer than 25 unweighted cases c Children age 15 or higher at the time of the interview whose mothers were not living in the household Sao Tome and Principe 2014 MICS, Final Report P a g e | 151 Lowe attendance to secondary school for children of the poorest households is striking; the poorest children are six times more likely to be out of school (23 percent) compared to their richest counterparts (3 percent). The percentage of children entering first grade who eventually reach the last grade of primary school is presented in Table ED.6. Of all children starting grade one, the overwhelming majority (92 percent) eventually reaches grade 6. The MICS included only questions on school attendance in the current and previous year. Thus, the indicator is calculated synthetically by computing the cumulative probability of survival from the first to the last grade of primary school, as opposed to calculating the indicator for a real cohort which would need to be followed from the time a cohort of children entered primary school, up to the time they reached the last grade of primary school. Repeaters are excluded from the calculation of the indicator, because it is not known whether they will eventually graduate. As an example, the probability that a child will move from the first grade to the second grade is computed by dividing the number of children who moved from the first grade to the second grade (during the two consecutive school years covered by the survey) by the number of children who have moved from the first to the second grade plus the number of children who were in the first grade the previous school year, but dropped out. Both the numerator and denominator exclude children who repeated during the two school years under consideration. Table ED.6 suggests that boys drop out more from primary school than girls, since 87 percent of boys reach the last grade compared to 96 percent of girls. Similarly, a smaller proportion of children from rural areas reach grade 6 than their urban counterparts (87 and 94 percent respectively). Finally, only 85 percent of children from the poorest households reach grade 6 compared with 97 percent of those coming from the wealthiest households. Sao Tome and Principe 2014 MICS, Final Report P a g e | 152 Table ED.6:93Children 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), Sao Tome and Principe, 2014 Percent attending grade 1 last school year who are in grade 2 this school year Percent attending grade 2 last school year who are attending grade 3 this school year Percent attending grade 3 last school year who are attending grade 4 this school year Percent attending grade 4 last school year who are attending grade 5 this school year Percent attending grade 5 last school year who are attending grade 6 this school year Percent who reach grade 6 of those who enter grade 11 Total 99.7 98.0 99.2 96.2 98.2 91.6 Sex Male 99.5 96.7 98.2 94.8 97.2 87.1 Female 100.0 99.4 100.0 97.7 99.1 96.3 Region Centre East 100.0 97.5 98.7 95.2 98.5 90.2 North West 100.0 99.0 100.0 100.0 97.4 96.4 South East 97.9 97.8 100.0 95.5 97.5 89.1 A. of Principe (100.0) (100.0) (100.0) (93.5) (100.0) (93.5) Area Urban 99.8 99.4 99.7 96.4 98.7 94.1 Rural 99.6 95.6 98.2 95.7 97.2 87.1 Mother's educationa None 97.8 95.2 100.0 86.3 98.2 78.9 Primary 99.9 97.6 98.8 98.1 99.2 93.7 Sec./Higher 100.0 100.0 100.0 100.0 99.2 99.2 Wealth index quintile Poorest 98.9 96.7 98.4 89.7 100.0 84.5 Second 100.0 98.9 99.2 96.9 96.6 91.8 Middle 100.0 95.0 98.6 96.1 97.9 88.1 Fourth 100.0 100.0 100.0 100.0 98.1 98.1 Richest 100.0 100.0 100.0 98.4 98.7 97.1 1 MICS indicator 7.6; MDG indicator 2.2 - Children reaching last grade of primary a 1 unweighted case where the mother does not live in the household, plus 3 missing cases not shown ( ) Figures that are based on 25-49 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. Table ED.7 shows that the primary school completion rate is 112 percent. Primary school completion rates may go well above 100 percent, as in this case, when there are many over-aged children in the last grade of primary school. Unfortunately, only 54 percent of the children who were attending the last grade of primary school in the previous school year were found to be attending the first grade of secondary school in the school year of the survey. The table also provides “effective” transition rate which takes account of the presence of repeaters in the final grade of primary school. This indicator better reflects situations in which pupils repeat the last grade of primary education but eventually make the transition to the secondary level. The simple transition rate tends to underestimate pupils’ progression to secondary school as it assumes that the repeaters never reach secondary school. The table shows that in total 91 percent of the children in the last grade of primary school are expected Sao Tome and Principe 2014 MICS, Final Report P a g e | 153 to move on to secondary school. The large difference between transition rate and effective transition rate suggests that there are lots of repeaters in the last grade of primary school (32 percent according to calculations; data not shown). Urban and rural areas show similar rates. Interpretation of apparent differences along other background characteristics should be cautious as many of the denominators are relatively small. Table ED.7:94Primary school completion and transition to secondary school Primary school completion rates and transition and effective transition rates to secondary school, Sao Tome and Principe, 2014 Primary school completion rate1 Number of children of primary school completion age Transition rate to secondary school2 Number of children who were in the last grade of primary school the previous year Effective transition rate to secondary school Number of children who were in the last grade of primary school the previous year and are not repeating that grade in the current school year Total 111.9 346 53.7 435 91.3 256 Sex Male 114.6 166 54.0 218 90.8 130 Female 109.3 180 53.4 217 91.7 126 Region Centre East 109.6 220 50.1 284 87.9 162 North West 104.2 70 72.9 82 100.0 60 South East 143.4 39 45.8 57 90.5 29 Aut. of Principe (99.6) 16 (47.7) 13 (*) 6 Area Urban 116.1 220 53.9 290 90.8 172 Rural 104.4 126 53.4 145 92.3 84 Mother's educationa None/Primary 108.6 249 52.0 295 92.1 167 Secondary/Higher 114.6 95 65.4 112 95.3 77 Wealth index quintile Poorest 116.5 63 54.0 57 (93.6) 33 Second 109.0 68 46.2 90 89.5 47 Middle 156.6 55 52.3 86 91.9 49 Fourth 105.1 84 51.6 94 (91.2) 53 Richest 85.5 76 62.9 108 91.0 75 1 MICS indicator 7.7 - Primary completion rate 2 MICS indicator 7.8 - Transition rate to secondary school a 1 unweighted case of mother not living in the household not shown ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer 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 latter provide an erroneous description of the GPI mainly because, in most cases, the majority of over-age children attending primary education tend to be boys. The table shows that gender parity for primary school is exactly 1.00, indicating no difference in the attendance of girls and boys to primary school. However, the indicator increases to 1.18 for secondary education. The advantage of girls is particularly pronounced in Region Centre East and Sao Tome and Principe 2014 MICS, Final Report P a g e | 154 Region North West, while in the two other regions the opposite situation is found and girls are at a disadvantage. Girls are generally at an advantage in urban areas, with a GPI of 1.24, while rural areas are closer to gender parity, with a GPI of 1.04. Table ED.8:95Education gender parity Ratio of adjusted net attendance ratios of girls to boys, in primary and secondary school, Sao Tome and Principe, 2014 Primary school Secondary school Primary school adjusted net attendance ratio (NAR), girls Primary school adjusted net attendance ratio (NAR), boys Gender parity index (GPI) for primary school adjusted NAR1 Secondary school adjusted net attendance ratio (NAR), girls Secondary school adjusted net attendance ratio (NAR), boys Gender parity index (GPI) for secondary school adjusted NAR2 Total 94.1 94.1 1.00 65.0 55.0 1.18 Region Centre East 93.8 93.8 1.00 69.4 55.6 1.25 North West 94.9 95.1 1.00 64.4 50.8 1.27 South East 94.3 92.6 1.02 44.9 58.7 .76 Autonomous of Principe 95.0 96.3 .99 45.7 53.2 .86 Area Urban 93.9 94.8 .99 68.3 55.1 1.24 Rural 94.5 92.7 1.02 57.2 54.8 1.04 Mother's education None 90.1 94.5 .95 49.8 40.1 1.24 Primary 95.3 94.1 1.01 63.2 51.3 1.23 Secondary/Higher 92.7 94.2 .98 74.6 72.6 1.03 Cannot be determineda na na na (*) (*) (*) Wealth index quintile Poorest 92.6 90.7 1.02 44.3 40.0 1.11 Second 93.8 93.5 1.00 48.5 44.5 1.09 Middle 95.4 93.9 1.02 64.1 47.6 1.35 Fourth 94.4 94.2 1.00 70.1 66.7 1.05 Richest 94.0 98.4 .96 87.4 75.6 1.16 1 MICS indicator 7.9; MDG indicator 3.1 - Gender parity index (primary school) 2 MICS indicator 7.10; MDG indicator 3.1 - Gender parity index (secondary school) a Children age 15 or higher at the time of the interview whose mothers were not living in the household na: not applicable (*) Figures that are based on fewer than 25 unweighted cases The percentage of girls in the total out of school population, in both primary and secondary school, are provided in Table ED.9. The table shows that, at the primary as at secondary levels, girls account for 50 percent of the out-of-school population. Interpretation of out of school gender parity results by background characteristics is problematical due to the generally small sample sizes. Sao Tome and Principe 2014 MICS, Final Report P a g e | 155 Table ED.9:96Out of school gender parity Percentage of girls in the total out of school population, in primary and secondary school, Sao Tome and Principe, 2014 Primary school Secondary school Percentage of out of school children Number of children of primary school age Percentage of girls in the total out of school population of primary school age Number of children of primary school age out of school Percentage of out of school children Number of children of secondary school age Percentage of girls in the total out of school population of secondary school age Number of children of secondary school age out of school Total 5.8 2,355 50.4 136 11.6 1,653 50.1 191 Region Centre East 6.0 1,499 52.5 90 10.6 1,094 46.1 116 North West 4.8 477 (48.7) 23 13.9 302 56.8 42 South East 6.6 286 (41.8) 19 14.5 209 (57.8) 30 Autonomous of Principe 4.3 92 (*) 4 6.2 48 (*) 3 Area Urban 5.4 1,542 55.8 84 10.1 1,129 50.2 114 Rural 6.4 813 41.9 52 14.7 525 49.8 77 Mother's education None/Primary 5.6 1724 45.8 96 12.6 1198 46.6 150 Secondary/Higher 6.0 609 (60.7) 37 7.0 433 (63.7) 30 Cannot be determineda na na na na (*) 16 (*) 10 Wealth index quintile Poorest 8.4 467 (41.9) 39 22.6 287 53.3 65 Second 6.3 472 (46.7) 30 15.9 321 44.3 51 Middle 4.7 481 (45.9) 23 10.8 340 (38.1) 37 Fourth 5.7 484 (*) 28 7.6 319 (*) 24 Richest 3.7 451 (*) 16 3.7 386 (*) 14 a Children age 15 or higher at the time of the interview whose mothers were not living in the household na: not applicable ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 156 Figure ED.1 brings together all of the attendance and progression related education indicators covered in this chapter, by sex. Information on attendance to early childhood education is also included, which was covered in Chapter 9, in Table CD.1. Figure ED.1: 18Educat ion indicators by sex , Sao Tome and Pr inc ipe, 2014 School readiness 59 57 Net intake rate in primary education Primary school completion rate Transition rate to secondary school 80 74 115 109 54 53 Attendance to early childhood education Primary school attendance Secondary school attendance 34 39 94 94 55 65 Children reaching last grade of primary 87 96 Boys Girls Note: All indicator values are in per cent Sao Tome and Principe 2014 MICS, Final Report P a g e | 157 XI. Child Protection Birth Registration A name and nationality is every child’s right, enshrined in the Convention on the Rights of the Child (CRC) and other international treaties. Yet the births of around one in four children under the age of five worldwide have never been recorded.i This lack of formal recognition by the State usually means that a child is unable to obtain a birth certificate. As a result, he or she may be denied health care or education. Later in life, the lack of official identification documents can mean that a child may enter into marriage or the labour market, or be conscripted into the armed forces, before the legal age. In adulthood, birth certificates may be required to obtain social assistance or a job in the formal sector, to buy or prove the right to inherit property, to vote and to obtain a passport. Registering children at birth is the first step in securing their recognition before the law, safeguarding their rights, and ensuring that any violation of these rights does not go unnoticed.ii In 2006-2007, the government of Sao Tome and Principe implemented, with the support of UNICEF, a national birth registration campaign for all children age 0 to 5 years. This campaign was a demonstration of the importance given by the government of Sao Tome and Principe to birth registration as the first fundamental individual right following birth. The government, in collaboration with UNICEF, launched in 2011 a campaign in maternities for birth registration immediately after birth, with the objective of reducing the number of small children without birth registration in the country. The country adopted a Permanent Birth Registration Strategy in 2010, providing a direct link between the Civil Registration directorate and the maternity ward and clinics. The government has committed to reaching 100 per cent birth registration by 2015. Barriers to birth registration include: babies born on weekends, formal and informal fees for birth registration and fines for late registration, as well as doubts regarding paternity on the part of the male. The births of 95 percent of children under five years in Sao Tome and Principe have been registered (Table CP.1) and less than one percent of children do not have a birth certificate. Registration takes place early as there are no meaningful differences in the percentage of registrations by age groups. On the other hand, while virtually all children from wealthiest households are registered, that proportion goes down to 87 percent among the poorest. Columns presenting disaggregated statistics for children that have not been registered have been suppressed in Table CP.1 due to the relatively small number of cases in this survey. i UNICEF. 2014. The State of the World’s Children 2015. UNICEF. ii UNICEF. 2013. Every Child’s Birth Right: Inequities and trends in birth registration. UNICEF. Sao Tome and Principe 2014 MICS, Final Report P a g e | 158 Table CP.1:97Birth registration Percentage of children under age 5 by whether birth is registered and percentage of children not registered whose mothers/caretakers know how to register birth, Sao Tome and Principe, 2014 Children under age 5 whose birth is registered with civil authorities Number of children under age 5 Has birth certificate No birth certificate Total registered1 Seen Not seen Total 85.0 9.7 0.5 95.2 2,030 Sex Male 85.5 9.5 0.5 95.5 1,023 Female 84.4 10.0 0.6 94.9 1,007 Region Centre East 86.3 9.1 0.7 96.0 1,317 North West 80.5 11.7 0.2 92.4 386 South East 86.3 7.6 0.4 94.3 245 Aut. of Principe 80.9 17.6 0.0 98.5 82 Area Urban 86.8 9.2 0.4 96.4 1,339 Rural 81.4 10.8 0.8 93.0 691 Age 0-11 months 86.5 8.1 0.0 94.5 351 12-23 months 86.0 8.7 0.2 94.9 403 24-35 months 84.7 10.2 0.4 95.4 412 36-47 months 83.8 10.8 1.4 95.9 434 48-59 months 84.1 10.6 0.5 95.2 430 Mother’s education None 77.1 13.4 0.0 90.5 84 Primary 84.5 9.0 0.6 94.2 1,253 Secondary 86.8 10.3 0.4 97.4 647 Higher (85.1) (14.9) (0.0) (100.0) 46 Wealth index quintile Poorest 74.1 12.9 0.5 87.5 444 Second 84.1 9.6 1.0 94.6 428 Middle 88.9 8.0 0.5 97.3 411 Fourth 87.2 10.5 0.5 98.2 423 Richest 93.2 6.8 0.0 100.0 324 1 MICS indicator 8.1 - Birth registration ( ) Figures that are based on 25-49 unweighted cases Child Labour Children around the world are routinely engaged in paid and unpaid forms of work that are not harmful to them. However, they are classified as child labourers when they are either too young to work or are involved in hazardous activities that may compromise their physical, mental, social or educational development. Article 32 (1) of the Convention on the Rights of the Child states: "States Parties recognize the right of the child to be protected from economic exploitation and from performing any work that is likely to be hazardous or to interfere with the child's education, or to be harmful to the child's health or physical, mental, spiritual, moral or social development". Sao Tome and Principe 2014 MICS, Final Report P a g e | 159 There is currently no specific definition of child labour in the law of Sao Tome and Principe. However, the law prohibits employment of children below the age of 14 years. Since the law defines all individuals below the age of 18 years as minor, it results that child labour can be regarded as the employment of any individual between the age of 14 and 17 years. The law also prohibits any individual below the age of 18 years to be involved in any work considered heavy, unhealthy or dangerous. It is also unlawful to employ a minor in night work, although individuals above the age of 16 are authorized to be involved in such work as long as it does not affect the physical and psychological development of the minor. At the international level, the government of Sao Tome and Principe has ratified the main conventions and protocols in the area of Protection and Promotion of the Right of the Childsuch as the Convention on the Right of the Childand has made efforts to implement the principles delineated in these instruments. Finally, the government of Sao Tome and Principe became member of the International Labour Organization (ILO) in 1982 and ratified three conventions of this organization related to forced labour, minimum working age and prohibition of the worst forms of child labour. The child labour module was administered for children age 5-17 and includes questions on the type of work a child does and the number of hours he or she is engaged in it. Data are collected on both economic activities (paid or unpaid work for someone who is not a member of the household, work for a family farm or business) and domestic work (household chores such as cooking, cleaning or caring for children, as well as collecting firewood or fetching water). The module also collects information on hazardous working conditions.i, ii Table CP.2 presents children’s involvement in economic activities. The methodology of the MICS Indicator on Child Labour uses three age-specific thresholds for the number of hours a child can perform economic activity without it being classified as in child labour. A child that performed economic activities during the last week for more than the age-specific number of hours is classified as in child labour: i. age 5-11: 1 hour or more ii. age 12-14: 14 hours or more iii. age 15-17: 43 hours or more Nineteen percent of children age 5-11 years are engaged in any economic activities, while 6 percent of those age 12-14 years are engaged in such activities for at least 14 hours a week, and 3 percent of those age 15-17 years for at least 43 hours a week. The involvement in economic activities for any period of time changes markedly with age: 19 percent for children age 5-11 years, 44 percent for children age 12-14 years, and 61 percent for children age 15-17 years. However, only 6 percent of children 12-14 years and 3 percent of children i UNICEF. 2012. How Sensitive Are Estimates of Child Labour to Definitions? MICS Methodological Paper No. 1. UNICEF. ii The Child Labour module and the Child Discipline module were administered using random selection of a single child in all households with one or more children age 1-17 (See Appendix F: Questionnaires). The Child Labour module was administered if the selected child was age 5-17 and the Child Discipline module if the child was age 1-14 years old. To account for the random selection, the household sample weight is multiplied by the total number of children age 1-17 in each household. Sao Tome and Principe 2014 MICS, Final Report P a g e | 160 15-17 years are performing such tasks for long hours. There are some urban/rural differentials but they are not large. The trends by socio-economic groups are not linear. Table CP.2:98Children's involvement in economic activities Percentage of children by involvement in economic activities during the last week, according to age groups, Sao Tome and Principe, 2014 Percentage of children age 5-11 years involved in economic activity for at least one hour Number of children age 5-11 years Percentage of children age 12-14 years involved in: Number of children age 12-14 years Percentage of children age 15-17 years involved in: Number of children age 15-17 years Economic activity less than 14 hours Economic activity for 14 hours or more Economic activity less than 43 hours Economic activity for 43 hours or more Total 18.6 2,847 38.3 6.1 1,144 57.5 3.2 892 Sex Male 16.9 1,437 39.3 4.1 550 52.0 5.9 413 Female 20.2 1,411 37.4 8.1 594 62.2 0.9 480 Region Centre East 16.1 1,866 33.1 4.7 713 55.9 3.1 539 North West 19.2 521 38.3 10.8 248 55.0 1.2 197 South East 26.4 357 59.5 7.0 139 66.3 7.4 125 Autonomous of Principe 31.6 103 (55.3) (0.0) 43 (64.5) (0.0) 31 Area Urban 17.1 1,926 36.1 6.1 754 57.6 4.6 589 Rural 21.6 922 42.6 6.2 390 57.3 0.4 303 School attendance Yes 20.0 2,478 37.1 6.2 1,066 56.6 2.3 722 No 8.8 369 54.4 5.9 78 61.2 6.9 171 Mother’s education None 20.7 184 51.8 6.0 103 62.8 2.6 105 Primary 21.1 1,820 41.2 5.6 742 56.3 3.9 590 Secondary 12.7 773 24.1 4.1 244 57.9 0.9 175 Higher 10.4 60 (29.0) (20.8) 43 (*) (*) 11 Cannot be determineda na na na na na (*) (*) 7 Missing (*) 5 (*) (*) 2 (*) (*) 3 Wealth index quintile Poorest 18.8 562 40.1 3.8 233 52.8 0.5 125 Second 17.1 541 47.1 4.8 194 49.4 4.8 233 Middle 20.4 660 44.8 3.7 212 53.9 5.4 155 Fourth 25.5 553 35.2 6.9 213 67.8 2.3 181 Richest 10.3 531 28.6 10.1 292 63.3 2.1 198 a Children age 15 or higher at the time of the interview whose mothers were not living in the household na: not applicable ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Table CP.3 presents children’s involvement in household chores. As for economic activity above, the methodology also uses age-specific thresholds for the number of hours a child can perform household chores without it being classified as child labour. A child that performed household chores during the last week for more than the age-specific number of hours is classified as in child labour: Sao Tome and Principe 2014 MICS, Final Report P a g e | 161 i. age 5-11: 28 hours or more ii. age 12-14: 28 hours or more iii. age 15-17: 43 hours or more Girls are generally more likely to perform household chores than boys, and rural children tend to be more involved than their urban counterparts. Differences by socio-economic groups are not clearly demarcated, except in the case of children in the wealthiest households who are less likely to perform household chores or do so for shorter periods of time. Table CP.3:99Children's involvement in household chores Percentage of children by involvement in household chores during the last week, according to age groups, Sao Tome and Principe, 2014 Percentage of children age 5-11 years involved in: Num- ber of chil- dren age 5-11 years Percentage of children age 12-14 years involved in: Num- ber of chil- dren age 12-14 years Percentage of children age 15-17 years involved in: Num- ber of chil- dren age 15-17 years House- hold chores less than 28 hours House- hold chores for 28 hours or more House- hold chores less than 28 hours House- hold chores for 28 hours or more House- hold chores less than 43 hours House- hold chores for 43 hours or more Total 69.1 4.4 2,847 83.4 9.2 1,144 90.6 4.4 892 Sex Male 68.2 4.3 1,437 82.3 5.7 550 85.4 4.8 413 Female 70.0 4.5 1,411 84.4 12.4 594 95.2 4.0 480 Region Centre East 66.8 2.6 1,866 81.4 8.6 713 90.8 2.3 539 North West 70.3 11.5 521 82.5 14.1 248 88.3 10.3 197 South East 75.5 4.0 357 90.4 5.6 139 91.3 5.3 125 Autonomous of Principe 83.2 2.6 103 (98.2) (1.8) 43 (100.0) (0.0) 31 Area Urban 66.5 3.6 1,926 81.5 9.2 754 90.7 4.3 589 Rural 74.5 6.1 922 87.1 9.1 390 90.6 4.6 303 School attendance Yes 72.8 4.7 2,478 83.7 9.2 1,066 89.9 4.9 722 No 44.5 2.4 369 78.8 9.5 78 93.9 2.1 171 Mother’s education None 73.0 5.1 184 79.5 8.1 103 91.7 3.6 105 Primary 72.0 5.6 1,820 81.9 11.6 742 91.9 5.2 590 Secondary 65.7 1.0 773 87.5 4.2 244 89.9 1.8 175 Higher 20.0 5.6 60 (89.9) (0.0) 43 (*) (*) 11 Cannot be determineda na na na na na 0 (*) (*) 7 Missing (*) (*) 5 (*) (*) 2 (*) (*) 3 Wealth index quintile Poorest 72.8 6.3 562 87.0 8.7 233 88.4 5.8 125 Second 72.7 6.1 541 86.4 9.2 194 91.4 6.7 233 Middle 69.7 4.6 660 83.6 11.4 212 90.8 2.7 155 Fourth 72.5 2.8 553 85.8 13.7 213 91.3 5.9 181 Richest 57.1 2.0 531 76.5 4.7 292 90.4 0.8 198 a Children age 15 or higher at the time of the interview whose mothers were not living in the household na: not applicable ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 162 Table CP.4:100Child labour Percentage of children age 5-17 years by involvement in economic activities or household chores during the last week, percentage working under hazardous conditions during the last week, and percentage engaged in child labour during the last week, Sao Tome and Principe, 2014 Children involved in economic activities for a total number of hours during last week: Children involved in household chores for a total number of hours during last week: Children working under hazardous conditions Total child labour1 Number of children age 5-17 years Below the age specific threshold At or above the age specific threshold Below the age specific threshold At or above the age specific threshold Total 26.0 12.8 76.4 5.5 16.0 26.0 4,883 Sex Male 24.4 12.1 74.4 4.7 16.2 24.6 2,399 Female 27.6 13.6 78.3 6.3 15.9 27.5 2,484 Region Centre East 24.0 11.3 74.3 3.9 12.9 21.3 3,117 North West 24.0 13.4 77.1 11.9 16.9 30.6 966 South East 36.5 18.2 82.0 4.6 22.5 36.3 622 Autonomous of Principe 35.7 18.4 89.8 1.9 43.2 48.3 178 Area Urban 24.7 12.3 74.3 5.0 13.3 23.3 3,269 Rural 28.5 13.9 80.5 6.5 21.5 31.6 1,614 Age 5-11 11.2 18.6 69.1 4.4 10.9 23.9 2,847 12-14 38.3 6.1 83.4 9.2 18.1 26.4 1,144 15-17 57.5 3.2 90.6 4.4 29.6 32.3 892 School attendance Yes 25.9 13.6 78.4 5.9 15.3 26.2 4,266 No 26.7 7.9 62.5 3.2 21.3 25.2 617 Mother’s education None 33.6 12.0 79.7 5.5 21.1 27.9 392 Primary 26.6 14.2 78.0 7.0 18.3 29.4 3,152 Secondary 22.2 9.2 73.7 1.8 9.4 16.8 1,191 Higher 20.8 13.3 47.6 3.0 2.9 19.2 114 Cannot be determineda (*) (*) (*) (*) (*) (*) 7 Missing (*) (*) (*) (*) (*) (*) 10 Wealth index quintile Poorest 23.7 12.5 78.5 6.8 15.9 27.1 920 Second 26.8 11.7 80.0 6.8 17.0 24.7 968 Middle 24.4 14.7 75.8 5.7 17.2 29.4 1,027 Fourth 27.2 16.9 79.1 5.8 20.5 31.3 947 Richest 27.8 8.6 69.1 2.6 10.0 18.0 1,021 1 MICS indicator 8.2 - Child labour a Children age 15 or higher at the time of the interview whose mothers were not living in the household (*) Figures that are based on fewer than 25 unweighted cases Table CP.4 combines the children working and performing household chores at or above and below the age-specific thresholds as detailed in the previous tables, as well as those children reported working under hazardous conditions, into the total child labour indicator. Overall, 26 percent of children age 5-17 years are estimated to be in child labour, including 16 percent working in hazardous conditions. Gender differentials are small. Rural children are more exposed to child labour Sao Tome and Principe 2014 MICS, Final Report P a g e | 163 (32 percent) than their urban counterparts (23 percent), and so are they to hazardous conditions of work (21 and 13 percent respectively). Child labour ranges from 21 percent in Region Centre East to 48 percent in Autonomous Region of Principe. It increases with age, from 24 percent in the 5-11 years to 32 percent in the 15-17 years; this last group also suffers the heaviest risk of exposure to hazardous conditions (30 percent). In terms of socio-economic groups, children from the wealthiest households show less likelihood of being involved in child labour and/or to work under hazardous conditions than the other categories. There is a clear tendency for the risk of exposure to hazardous working conditions to increase as the level of education of the mother decreases. Child Discipline Teaching children self-control and acceptable behavior is an integral part of child discipline in all cultures. Positive parenting practices involve providing guidance on how to handle emotions or conflicts in manners that encourage judgment and responsibility and preserve children's self- esteem, physical and psychological integrity and dignity. Too often however, children are raised through the use of punitive methods that rely on the use of physical force or verbal intimidation to obtain desired behaviors. Studiesi have found that exposing children to violent discipline have harmful consequences, which range from immediate impacts to long-term harm that children carry forward into adult life. Violence hampers children’s development, learning abilities and school performance; it inhibits positive relationships, provokes low self-esteem, emotional distress and depression; and, at times, it leads to risk taking and self-harm. In the MICS, respondents to the household questionnaire were asked a series of questions on the methods adults in the household used to discipline a selected child during the past month.ii In the 2014 Sao Tome and Principe MICS, 80 percent of children age 1-14 years were subjected to at least one form of psychological or physical punishment by household members during the past month. For the most part, households employ a combination of violent disciplinary practices. While 64 percent of children experienced psychological aggression, more than 2 out of 3 (69 percent) experienced physical punishment. The most severe forms of physical punishment (hitting the child on the head, ears or face or hitting the child hard and repeatedly), if less common, are not rare: 10 percent of children were subjected to severe punishment. Gender differentials are small, and differences between regions are relatively modest. Exposure to violent disciplinary practices is similar for boys and girls, and for urban and rural children. Younger children, age 1-2 years, tend to be less severely disciplined then older ones; so are those living in the wealthiest households as compared with other socio-economic categories, and those whose household head has higher education as compared with lower levels. i Straus, MA and Paschall MJ. 2009. Corporal Punishment by Mothers and Development of Children’s Cognitive Ability: A longitudinal study of two nationally representative age cohorts. Journal of Aggression, Maltreatment & Trauma 18(5): 459- 83. Erickson, MF and Egeland, B. 1987. A Developmental View of the Psychological Consequences of Maltreatment. School Psychology Review 16: 156-68. Schneider, MW et al. 2005. Do Allegations of Emotional Maltreatment Predict Developmental Outcomes Beyond that of Other Forms of Maltreatment?. Child Abuse & Neglect 29(5): 513–32. Sao Tome and Principe 2014 MICS, Final Report P a g e | 164 Table CP.5:101Child discipline Percentage of children age 1-14 years by child disciplining methods experienced during the last one month, Sao Tome and Principe, 2014 Percentage of children age 1-14 years who experienced: Number of children age 1-14 years Only non- violent discipline Psychological aggression Physical punishment Any violent discipline method1 Any Severe Total 9.6 63.9 68.5 10.0 79.6 5,700 Sex Male 10.1 66.5 68.6 11.7 79.9 2,889 Female 9.1 61.2 68.5 8.2 79.3 2,810 Region Centre East 10.6 62.3 66.3 8.6 77.8 3,720 North West 5.7 69.8 73.8 12.6 85.9 1,078 South East 9.2 67.2 73.5 12.9 81.4 696 Aut. of Principe 13.3 49.8 65.3 11.0 73.5 206 Area Urban 8.9 64.1 68.7 9.3 79.2 3,792 Rural 11.0 63.4 68.3 11.3 80.5 1,907 Age 1-2 7.5 40.2 64.4 4.0 67.9 866 3-4 9.0 61.1 75.4 7.9 82.0 843 5-9 8.4 69.5 74.7 12.4 84.4 2,144 10-14 12.3 69.8 60.2 10.9 78.5 1,846 Education of household head None 5.1 65.1 70.3 12.7 81.8 382 Primary 10.0 65.2 69.0 11.2 80.7 3,237 Secondary 9.5 61.3 69.1 8.5 78.3 1,822 Higher 14.1 64.3 57.1 0.9 72.1 226 Missing (5.2) (62.2) (51.8) (0.0) (80.4) 33 Wealth index quintile Poorest 6.7 62.5 72.0 13.1 81.7 1,176 Second 9.6 63.7 68.5 11.8 81.3 1,095 Middle 9.2 65.9 70.0 11.9 80.4 1,205 Fourth 9.0 62.9 71.4 9.0 80.0 1,130 Richest 14.0 64.4 60.4 3.6 74.7 1,094 1 MICS indicator 8.3 - Violent discipline ( ) Figures that are based on 25-49 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 165 Figure CP.1: 1 9 Chi ld d isc ip l in ing methods, chi ldren age 1 -14 years , Sao Tome and Pr inc ipe, 2014 While violent methods are extremely common forms of discipline, Table CP.6 reveals that only 6 percent of respondents believe that physical punishment is a necessary part of child-rearing. Differentials across background variables of respondents are either irrelevant or small. 10 80 64 Other 59 Severe 10 Only non-violent discipline Any violent discipline Psychological aggression Physical punishment Per cent Sao Tome and Principe 2014 MICS, Final Report P a g e | 166 Table CP.6:102Attitudes toward physical punishment Percentage of respondents to the child discipline module who believe that physical punishment is needed to bring up, raise, or educate a child properly, Sao Tome and Principe, 2014 Respondent believes that a child needs to be physically punished Number of respondents to the child discipline module Total 6.2 2197 Sex Male 5.3 599 Female 6.5 1599 Region Centre East 6.0 1465 North West 4.4 394 South East 11.2 253 Autonomous of Principe 3.2 86 Area Urban 6.8 1470 Rural 4.9 727 Age <25 4.8 381 25-39 5.6 1102 40-59 8.4 554 60+ 6.2 160 Respondent's relationship to selected child Mother 6.3 1198 Father 5.8 405 Other 6.2 594 Respondent's education None 6.8 142 Primary 7.7 1239 Secondary 3.7 748 Higher 5.2 69 Wealth index quintile Poorest 7.7 443 Second 5.2 428 Middle 5.5 464 Fourth 6.0 447 Richest 6.7 416 Early Marriage and Polygyny Marriagei before the age of 18 is a reality for many young girls. In many parts of the world parents encourage the marriage of their daughters while they are still children in hopes that the marriage will benefit them both financially and socially, while also relieving financial burdens on the family. In actual fact, child marriage is a violation of human rights, compromising the development of girls and i All references to marriage in this chapter include marital union as well. Sao Tome and Principe 2014 MICS, Final Report P a g e | 167 often resulting in early pregnancy and social isolation, with little education and poor vocational training reinforcing the gendered nature of poverty.i The right to 'free and full' consent to a marriage is recognized in the Universal Declaration of Human Rights - with the recognition that consent cannot be 'free and full' when one of the parties involved is not sufficiently mature to make an informed decision about a life partner. Closely related to the issue of child marriage is the age at which girls become sexually active. Women who are married before the age of 18 tend to have more children than those who marry later in life. Pregnancy related deaths are known to be a leading cause of mortality for both married and unmarried girls between the ages of 15 and 19, particularly among the youngest of this cohort. There is evidence to suggest that girls who marry at young ages are more likely to marry older men which puts them at increased risk of HIV infection. The demand for this young wife to reproduce and the power imbalance resulting from the age differential lead to very low condom use among such couples.ii The percentage of women married before ages 15 and 18 years are provided in Table CP.7. Among women age 15-49 years, 5 percent were married before age 15; among women age 20-49 years, about one third (32 percent) was married before age 18. Overall, 15 percent of young women age 15-19 years are currently married or in union. This proportion tends to be higher in rural (21 percent) than in urban (13 percent) areas, and is strongly related to the level of education and to the socio-economic status. The percentage of women in a polygynous unioniii is also provided in Table CP.7. Among all women age 15-49 years who are in union, 22 percent are in polygynous union. This condition is somewhat more prevalent in urban (24 percent) than in rural (19 percent) areas, and is less likely among the poorest (13 percent) than the wealthiest (25 percent). The percentage of men married before ages 15 and 18 years are provided in Table CP.7M. Among men age 15-49 years, only 1 percent were married before age 15 and, among men age 20-49 years, 8 percent were married before age 18. Only 1 percent of young men age 15-19 years are currently married or in union. Among all men age 15-49 years who are in union, 13 percent are in polygynous union, with similar results for rural and urban areas. The observable differences in this indicator between the various background characteristics are mostly related to the fact that older men are more likely to be in polygynous unions than younger men and boys. i Bajracharya, A ND Amin, S. 2010. Poverty, marriage timing, and transitions to adulthood in Nepal: A longitudinal analysis using the Nepal living standards survey. Poverty, Gender, and Youth Working Paper No. 19. Population Council. Godha, D et al. 2011. The influence of child marriage on fertility, fertility-control, and maternal health care utilization. MEASURE/Evaluation PRH Project Working paper 11-124. ii Clark, S et al. 2006. Protecting young women from HIV/AIDS: the case against child and adolescent marriage. International Family Planning Perspectives 32(2): 79-88. Raj, A et al. 2009. Prevalence of child marriage and its effect on fertility and fertility-control outcomes of young women in India: a cross-sectional, observational study. The Lancet 373(9678): 1883–9. iii In the MICS, the expression “polygynous union” refers to a woman who is married or in union with a man who is himself married or in union with more than one woman. Sao Tome and Principe 2014 MICS, Final Report P a g e | 168 Table CP.7:103Early marriage and polygyny (women) 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, and the percentage of women who are in a polygynous marriage or union, Sao Tome and Principe, 2014 Women age 15-49 years Women age 20-49 years Women age 15-19 years Women age 15-49 years Percentage married before age 151 Number of women age 15-49 years Percentage married before age 15 Percentage married before age 182 Number of women age 20-49 years Percentage currently married/in union3 Number of women age 15-19 years Percentage in polygynous marriage/ union4 Number of women age 15-49 years currently married/in union Total 5.1 2,935 5.8 32.2 2,233 15.3 702 22.4 1,629 Region Centre East 3.9 1,983 4.4 27.7 1,491 13.6 491 25.5 1,048 North West 6.6 524 7.5 40.4 401 16.3 123 17.2 298 South East 8.7 326 9.5 41.8 256 25.0 70 14.6 213 Aut. of Principe 7.6 103 9.3 43.1 85 (16.6) 18 21.6 70 Area Urban 4.5 1,997 5.1 29.7 1,519 12.9 478 24.1 1,092 Rural 6.3 938 7.1 37.5 714 20.5 224 19.0 537 Age 15-19 2.9 702 na na na 15.3 702 3.8 107 20-24 7.9 467 7.9 35.4 467 na na 14.5 267 25-29 6.3 484 6.3 32.1 484 na na 16.9 337 30-34 4.1 446 4.1 33.2 446 na na 23.7 331 35-39 3.8 349 3.8 28.9 349 na na 35.9 259 40-44 5.1 290 5.1 26.2 290 na na 26.5 206 45-49 7.4 198 7.4 36.9 198 na na 32.6 122 Education None 11.6 91 11.9 45.8 89 (*) 2 12.4 64 Primary 7.2 1,426 7.2 40.5 1,283 37.0 143 22.0 963 Secondary 2.7 1,318 3.4 20.0 764 9.8 554 26.4 542 Higher 0.0 99 0.0 5.8 97 (*) 3 (4.2) 59 Wealth index quintile Poorest 8.8 524 8.9 43.8 417 35.8 107 13.3 289 Second 7.7 581 8.7 41.1 434 17.7 147 21.6 328 Middle 4.7 566 5.6 35.2 429 15.8 137 21.6 313 Fourth 3.6 598 4.2 27.7 465 10.9 133 29.2 335 Richest 1.4 666 1.9 15.9 488 4.0 178 24.9 364 1 MICS indicator 8.4 - Marriage before age 15 2 MICS indicator 8.5 - Marriage before age 18 3 MICS indicator 8.6 - Young women age 15-19 years currently married or in union 4 MICS indicator 8.7 – Polygyny na: not applicable ( ) Figures that are based on 25-49 unweighted cases; (*) Figures that are based on fewer than 25 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 169 Table CP.7M:104Early marriage and polygyny (men) Percentage of men age 15-49 years who first married or entered a marital union before their 15th birthday, percentages of men age 20-49 years who first married or entered a marital union before their 15th and 18th birthdays, percentage of men age 15-19 years currently married or in union, and the percentage of men who are in a polygynous marriage or union, Sao Tome and Principe, 2014 Men age 15-49 years Men age 20-49 years Men age 15-19 years Men age 15-49 years Percentage married before age 151 Number of men age 15-49 years Percentage married before age 15 Percentage married before age 182 Number of men age 20-49 years Percentage currently married/in union3 Number of men age 15-19 years Percentage in polygynous marriage/ union4 Number of men age 15-49 years currently married/in union Total 1.4 2,267 1.8 7.5 1,679 1.3 588 13.0 1,081 Region Centre East 1.1 1,449 1.3 6.3 1,045 1.7 404 13.6 664 North West 1.6 415 2.0 9.6 318 0.6 97 12.7 216 South East 2.8 309 3.6 9.7 240 0.0 69 11.5 151 Aut. of Principe 1.8 93 2.2 9.5 75 (0.0) 18 12.5 50 Area Urban 1.3 1,508 1.6 6.9 1,100 0.9 408 13.0 713 Rural 1.7 759 2.3 8.8 579 2.0 181 13.1 368 Age 15-19 0.4 588 na na na 1.3 588 (*) 7 20-24 0.6 378 0.6 3.2 378 na na 7.5 86 25-29 0.9 354 0.9 7.8 354 na na 5.7 234 30-34 4.6 327 4.6 10.9 327 na na 9.1 273 35-39 1.9 284 1.9 7.7 284 na na 17.1 213 40-44 2.4 175 2.4 13.8 175 na na 20.4 147 45-49 0.2 161 0.2 3.2 161 na na 24.6 121 Education None (2.2) 22 (2.4) 24.3 20 (*) 2 (*) 10 Primary 1.9 951 2.3 8.6 798 1.6 153 10.9 514 Secondary 1.1 1,189 1.3 6.8 760 1.2 429 17.5 482 Higher 1.1 105 1.2 1.2 101 (*) 4 0.0 74 Wealth index quintile Poorest 2.5 462 3.1 11.2 368 3.4 95 15.2 224 Second 1.1 458 1.5 8.3 345 0.0 114 10.4 219 Middle 1.2 435 1.6 6.1 323 2.1 112 12.9 215 Fourth 1.9 455 2.0 7.6 318 1.4 136 13.4 205 Richest 0.5 456 0.7 3.9 325 0.0 132 13.3 218 1 MICS indicator 8.4 - Marriage before age 15 2 MICS indicator 8.5 - Marriage before age 18 3 MICS indicator 8.6 - Young men age 15-19 years currently married or in union 4 MICS indicator 8.7 – Polygyny na: not applicable ( ) Figures that are based on 25-49 unweighted cases; (*) Figures that are based on fewer than 25 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 170 Table CP.8:105Trends in early marriage (women) Percentage of women who were first married or entered into a marital union before age 15 and 18, by area and age groups, Sao Tome and Principe, 2014 Urban Rural All Percentage of women married before age 15 Number of women age 15-49 years Percentage of women married before age 18 Number of women age 20-49 years Percentage of women married before age 15 Number of women age 15-49 years Percentage of women married before age 18 Number of women age 20-49 years Percentage of women married before age 15 Number of women age 15-49 years Percentage of women married before age 18 Number of women age 20-49 years Total 4.5 1,997 29.7 1,519 6.3 938 37.5 714 5.1 2,935 32.2 2,233 Age 15-19 2.5 478 na na 3.7 224 na na 2.9 702 na na 20-24 7.5 326 33.4 326 8.9 141 40.2 141 7.9 467 35.4 467 25-29 5.6 329 28.5 329 7.9 155 39.7 155 6.3 484 32.1 484 30-34 3.3 283 30.8 283 5.3 163 37.5 163 4.1 446 33.2 446 35-39 2.4 236 24.9 236 6.8 113 37.3 113 3.8 349 28.9 349 40-44 4.9 207 26.8 207 5.6 83 24.7 83 5.1 290 26.2 290 45-49 7.1 138 33.9 138 8.1 60 43.7 60 7.4 198 36.9 198 na: not applicable Table CP.8M:106Trends in early marriage (men) Percentage of men who were first married or entered into a marital union before age 15 and 18, by area and age groups, Sao Tome and Principe, 2014 Urban Rural All Percentage of men married before age 15 Number of men age 15-49 years Percentage of men married before age 18 Number of men age 20-49 years Percentage of men married before age 15 Number of men age 15-49 years Percentage of men married before age 18 Number of men age 20-49 years Percentage of men married before age 15 Number of men age 15-49 years Percentage of men married before age 18 Number of men age 20-49 years Total 1.3 1,508 6.9 1,100 1.7 759 8.8 579 1.4 2,267 7.5 1,679 Age 15-19 0.6 408 na na 0.0 181 na na 0.4 588 na na 20-24 0.3 245 3.4 245 1.2 133 2.7 133 0.6 378 3.2 378 25-29 1.0 229 6.8 229 0.9 126 9.5 126 0.9 354 7.8 354 30-34 3.5 208 9.6 208 6.5 120 13.3 120 4.6 327 10.9 327 35-39 2.3 193 6.4 193 1.0 91 10.3 91 1.9 284 7.7 284 40-44 2.3 113 13.7 113 2.6 62 14.1 62 2.4 175 13.8 175 45-49 0.0 113 3.4 113 0.6 47 2.9 47 0.2 161 3.2 161 na: not applicable Sao Tome and Principe 2014 MICS, Final Report P a g e | 171 Tables CP.8 and CP8.M present respectively the proportion of women and men 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 allow for trends to be observed in early marriage over time. The data suggests the possibility of a slightly declining trend in recent years in the marriage of girls before age 15, although this is not apparent for marriages before age 18. For men it is unclear if there is a definite declining trend in early marriages. Another component is the spousal age difference with the indicator being the percentage of married/in union women 10 or more years younger than their current spouse. Table CP.9 presents the results of the age difference between husbands and wives. The results show that there are some important spousal age differences in Sao Tome and Principe. Among currently married/in union women age 20-24 years, about 17 percent are married/in union with a man who is older by ten years or more. For currently married/in union women age 15-19 years, the corresponding figure is 23 percent. Apparent differences by background characteristics should be interpreted with caution due the relatively small denominators. Sao Tome and Principe 2014 MICS, Final Report P a g e | 172 Table CP.9:107Spousal age difference Percent distribution of women currently married/in union age 15-19 and 20-24 years according to the age difference with their husband or partner, Sao Tome and Principe, 2014 Percentage of currently married/in union women age 15-19 years whose husband or partner is: Number of women age 15-19 years currently married/ in union Percentage of currently married/in union women age 20-24 years whose husband or partner is: Number of women age 20-24 years currently married/ in union Younger 0-4 years older 5-9 years older 10+ years older1 Husband/ Partner's age unknown Total Youn- ger 0-4 years older 5-9 years older 10+ years older2 Husband/ Partner's age unknown Total Total 1.6 33.0 37.9 23.1 4.4 100.0 107 3.5 41.7 35.8 17.3 1.7 100.0 267 Area Urban 2.8 32.8 32.4 28.4 3.6 100.0 61 3.6 37.6 36.8 20.2 1.8 100.0 178 Rural 0.0 33.3 45.2 16.0 5.6 100.0 46 3.3 50.0 33.7 11.4 1.5 100.0 88 Age 15-19 1.6 33.0 37.9 23.1 4.4 100.0 107 na na na na na na na 20-24 na na na na na na na 3.5 41.7 35.8 17.3 1.7 100.0 267 Educationa Primary 3.3 26.3 47.3 19.5 3.7 100.0 53 2.4 39.4 38.5 16.9 2.7 100.0 134 Secondary 0.0 39.8 28.9 26.2 5.2 100.0 54 4.3 43.8 33.2 18.4 0.2 100.0 127 1 MICS indicator 8.8a - Spousal age difference (among women age 15-19) 2 MICS indicator 8.8b - Spousal age difference (among women age 20-24) na: not applicable a 3 unweighted cases without education and 4 with higher education in the 20-24 years age group not shown Sao Tome and Principe 2014 MICS, Final Report P a g e | 173 Attitudes toward Domestic Violence MICS assessed the attitudes of women and men age 15-49 years towards wife/partner beating by asking the respondents whether they think that husbands/partners are justified to hit or beat their wives/partners in a variety of situations. The purpose of these questions are to capture the social justification of violence (in contexts where women have a lower status in society) as a disciplinary action when a woman does not comply with certain expected gender roles. The responses to these questions can be found in Table CP.10 for women and in Table CP.10M for men. Overall, 19 percent of women in Sao Tome and Principe feel that a husband/partner is justified in hitting or beating his wife in at least one of the five situations (excluding unfaithfulness to her husband). Besides unfaithfulness, women who justify a husband’s violence, agree and justify violence mostly in instances when a wife neglects the children (10 percent), if she argues with her husband (10 percent), or is she demonstrates her autonomy, exemplified by going out without telling her husband (7 percent). Justification in any of the five situations is more present among those living in poorest households, and less educated. The inter-regional range is 14 percent (Region Centre East) to 31 percent (Region North West). As shown in Table CP.10M, men are less likely to justify violence than women. Overall, 14 percent of men justify wife-beating for any of the five reasons (excluding unfaithfulness to her husband), as compared 19 percent of women. Besides unfaithfulness, the most frequently cited reason for which men justify wife-beating if a wife argues with him (8 percent), or is she neglects the children (5 percent). Men living in the poorest households are much more likely to agree with one of the five reasons (21 percent) than men living in the richest households (7 percent). The inter-regional range is 11 percent (Region Centre East) to 23 percent (Region North West). Sao Tome and Principe 2014 MICS, Final Report P a g e | 174 Table CP.10:108Attitudes toward domestic violence (women) Percentage of women age 15-49 years who believe a husband is justified in beating his wife in various circumstances, Sao Tome and Principe, 2014 Percentage of women age 15-49 years who believe a husband is justified in beating his wife: Number of women age 15- 49 years If she goes out without telling him If she neglects the children If she argues with him If she refuses sex with him If she burns the food For any of these five reasons1 If she is unfaithful to her husband Total 6.6 9.9 9.8 3.4 4.8 19.1 30.3 2,935 Region Centre East 4.1 7.2 6.4 2.5 2.4 14.0 24.2 1,983 North West 13.7 17.9 20.2 6.2 9.7 31.2 43.3 524 South East 9.8 11.5 13.6 4.7 12.0 29.4 45.6 326 Autonomous of Principe 7.8 14.6 10.9 4.7 4.6 22.2 34.7 103 Area Urban 6.8 9.8 10.0 3.8 4.6 19.0 29.4 1,997 Rural 6.2 10.0 9.3 2.8 5.4 19.2 32.3 938 Age 15-19 7.2 13.2 11.9 2.5 8.2 24.0 31.9 702 20-24 6.3 10.0 9.6 2.4 4.3 19.0 32.9 467 25-29 5.5 8.3 11.5 3.3 3.6 18.8 30.2 484 30-34 7.2 10.6 10.0 4.9 4.1 18.4 28.8 446 35-39 5.7 6.2 8.2 3.7 3.8 14.3 29.9 349 40-44 6.0 7.0 5.5 3.5 2.1 14.9 24.0 290 45-49 8.9 10.5 7.4 5.7 4.6 18.5 32.6 198 Marital/Union status Currently married/in union 6.9 9.3 9.8 3.6 4.3 18.3 31.4 1,629 Formerly married/in union 6.5 10.5 9.9 4.6 4.3 21.0 32.2 539 Never married/in union 6.0 10.6 9.7 2.4 6.4 19.4 26.8 767 Education None 12.3 11.3 15.5 5.9 9.0 26.4 39.9 91 Primary 8.6 11.4 11.9 4.6 5.1 22.6 35.9 1,426 Secondary 4.5 8.6 7.9 2.2 4.6 15.9 25.5 1,318 Higher 0.0 2.9 0.0 0.7 0.0 2.9 4.7 99 Wealth index quintile Poorest 11.3 13.3 18.7 6.8 10.4 29.8 40.2 524 Second 8.4 11.1 11.8 3.6 4.9 21.5 33.9 581 Middle 6.5 10.2 9.1 3.0 4.4 19.5 34.0 566 Fourth 5.7 9.5 7.8 3.0 3.7 18.2 29.1 598 Richest 2.2 6.1 3.5 1.4 1.8 8.9 17.5 666 1 MICS indicator 8.12 - Attitudes towards domestic violence Sao Tome and Principe 2014 MICS, Final Report P a g e | 175 Table CP.10M:109Attitudes toward domestic violence (men) Percentage of men age 15-49 years who believe a husband is justified in beating his wife in various circumstances, Sao Tome and Principe, 2014 Percentage of men age 15-49 years who believe a husband is justified in beating his wife: Number of men age 15- 49 years If she goes out without telling him If she neglects the children If she argues with him If she refuses sex with him If she burns the food For any of these five reasons1 If she is unfaithful to her husband Total 3.4 5.3 8.1 2.8 2.9 13.8 21.1 2,267 Region Centre East 3.0 4.3 5.7 2.7 2.1 10.8 17.6 1,449 North West 5.0 9.6 15.5 3.6 4.3 23.2 28.7 415 South East 3.5 4.2 9.4 2.5 4.3 16.0 26.6 309 Autonomous of Principe 2.7 6.0 8.0 2.3 3.8 12.2 24.9 93 Area Urban 3.4 5.6 8.3 2.8 2.6 13.7 20.7 1,508 Rural 3.4 4.8 7.8 2.7 3.5 14.0 22.0 759 Age 15-19 4.9 8.6 10.6 2.9 4.7 18.7 24.0 588 20-24 3.8 6.6 9.5 4.0 4.1 15.1 23.8 378 25-29 2.0 4.6 7.2 3.8 0.9 13.6 21.2 354 30-34 3.1 3.1 7.1 1.2 2.5 9.8 17.3 327 35-39 3.4 3.4 7.0 1.5 2.6 12.5 19.0 284 40-44 2.2 3.5 4.9 3.6 1.8 10.9 22.2 175 45-49 2.4 2.2 5.1 2.4 0.7 7.0 15.2 161 Marital/Union status Currently married/in union 3.3 3.7 6.6 3.2 1.9 11.4 18.9 1,081 Formerly married/in union 1.7 4.7 7.4 1.7 2.7 12.7 19.6 234 Never married/in union 3.9 7.4 10.0 2.6 4.1 16.8 24.0 953 Education None (7.1) (7.1) (3.9) (0.0) (4.9) (7.7) (35.3) 22 Primary 4.2 5.1 9.7 4.4 4.1 16.1 24.6 951 Secondary 3.0 5.9 7.6 1.8 2.2 13.2 19.2 1,189 Higher 0.0 0.0 0.8 0.0 0.0 0.8 9.5 105 Wealth index quintile Poorest 4.6 6.7 12.3 4.5 5.2 20.9 28.3 462 Second 4.6 5.5 9.8 5.0 4.6 17.3 26.4 458 Middle 2.9 5.6 7.8 1.9 2.0 13.0 16.5 435 Fourth 3.6 5.4 6.6 1.8 1.1 11.0 17.6 455 Richest 1.4 3.4 3.8 0.7 1.6 6.7 16.6 456 1 MICS indicator 8.12 - Attitudes towards domestic violence ( ) Figures that are based on 25-49 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 176 Children’s Living Arrangements The CRC recognizes that “the child, for the full and harmonious development of his or her personality, should grow up in a family environment, in an atmosphere of happiness, love and understanding”. Millions of children around the world grow up without the care of their parents for several reasons, including due to the premature death of the parents or their migration for work. In most cases, these children are cared for by members of their extended families, while in others, children may be living in households other than their own, as live-in domestic workers for instance. Understanding the children’s living arrangements, including the composition of the households where they live and the relationships with their primary caregivers, is key to design targeted interventions aimed at promoting child’s care and wellbeing. Table CP.11 presents information on the living arrangements and orphanhood status of children under age 18. Overall, 46 percent of children age 0-17 years in Sao Tome and Principe live with both their parents, while 34 percent live with mothers only and 4 percent live with fathers only, and 13 percent of children live with neither of their biological parents while both of them are alive. Finally, 31 percent live with mothers only while the biological father is alive. Very few children (0.4 percent) have lost both parents, while 4 percent of children have only their mother alive and 1 percent of children have only their father alive. As expected, older children are less likely than younger children to live with both parents and slightly more likely than younger children to have lost one or both parents. Table CP.14 also shows that the percentage of children living with their mother only while their father is alive is higher in the poorest households (33 percent) as compared with the wealthiest (21 percent). The reverse situation is found with respect to children living with neither biological parent, which is 11 percent among the poorest and 20 percent among the wealthiest. There are no meaningful differences between urban and rural areas or among the regions in terms of orphanhood. Sao Tome and Principe 2014 MICS, Final Report P a g e | 177 Table CP.11:110Children's living arrangements and orphanhood Percent distribution of children age 0-17 years according to living arrangements, percentage of children age 0-17 years not living with a biological parent and percentage of children who have one or both parents dead, Sao Tome and Principe, 2014 Living with both parents Living with neither biological parent Living with mother only Living with father only Missing information on father/ mother Total Living with neither biological parent1 One or both parents dead 2 Number of children age 0-17 years Only father alive Only mother alive Both alive Both dead Father alive Father dead Mother alive Mother dead Total 46.2 0.8 0.9 12.7 0.4 31.3 2.9 3.7 0.4 0.7 100.0 14.7 5.4 6,838 Sex Male 46.5 0.8 0.8 12.1 0.4 31.3 3.1 4.4 0.2 0.5 100.0 14.0 5.3 3,370 Female 45.9 0.7 1.0 13.3 0.4 31.4 2.6 2.9 0.7 1.0 100.0 15.5 5.5 3,469 Region Centre East 43.0 0.7 0.8 13.4 0.4 33.8 2.8 3.9 0.4 0.9 100.0 15.2 5.1 4,425 North West 50.7 1.0 1.0 11.4 0.4 28.2 2.8 3.2 0.6 0.6 100.0 13.8 5.8 1,322 South East 56.4 0.8 1.4 12.9 0.6 21.1 3.1 3.0 0.3 0.4 100.0 15.6 6.1 842 Aut. of Principe 45.0 1.1 0.0 6.6 0.5 38.2 3.5 4.6 0.6 0.0 100.0 8.1 5.6 250 Area Urban 45.3 0.7 1.0 13.4 0.4 31.2 2.8 3.8 0.5 0.8 100.0 15.5 5.4 4,540 Rural 47.9 0.9 0.6 11.3 0.4 31.6 3.0 3.4 0.4 0.6 100.0 13.2 5.3 2,298 Age 0-4 59.5 0.4 0.2 4.8 0.0 32.3 1.1 1.5 0.0 0.2 100.0 5.5 1.7 2,010 5-9 45.2 0.4 0.3 13.9 0.2 32.7 2.5 3.7 0.4 0.8 100.0 14.8 3.8 2,151 10-14 39.0 0.9 1.7 16.3 0.8 30.3 4.3 5.2 0.8 0.9 100.0 19.6 8.5 1,815 15-17 32.8 2.1 2.4 20.7 1.0 27.9 5.3 5.4 0.8 1.6 100.0 26.1 11.6 861 Wealth index quintile Poorest 46.6 0.5 0.5 9.1 0.7 32.8 4.3 3.3 0.9 1.3 100.0 10.8 6.9 1,358 Second 46.5 0.6 1.1 11.4 0.4 33.8 3.2 2.3 0.5 0.2 100.0 13.6 5.9 1,386 Middle 44.0 0.6 1.2 10.2 0.1 38.0 2.1 3.4 0.3 0.3 100.0 12.0 4.1 1,412 Fourth 45.2 1.2 0.4 15.6 0.2 30.6 2.1 3.7 0.2 0.8 100.0 17.4 4.2 1,362 Richest 48.9 0.9 1.2 17.5 0.7 20.8 2.7 5.9 0.4 1.0 100.0 20.3 6.0 1,321 1 MICS indicator 8.13 - Children’s living arrangements 2 MICS indicator 8.14 - Prevalence of children with one or both parents dead Sao Tome and Principe 2014 MICS, Final Report P a g e | 178 The 2014 Sao Tome and Principe MICS included a simple measure of one particular aspect of migration related to what is termed children left behind, i.e. for whom one or both parents have moved abroad. While the amount of literature is growing, the long-term effects of the benefits of remittances versus the potential adverse psycho-social effects are not yet conclusive, as there is somewhat conflicting evidence available as to the effects on children. Besides presenting simple prevalence rates, the results of the 2014 Sao Tome and Principe MICS given in Table CP.12 will greatly help fill the data gap on the topic of migration. Overall, 16 per cent of children age 0-17 have one or both parents living abroad. There are notable differences between groups of children, as the percentage of at least one parent abroad varies between 7 percent in Region South East and 19 percent in Region Centre East. It is more likely for a child living in an urban area to have at least one parent living abroad than for one living in a rural area (17 and 13 percent respectively), and there is a large difference in this indicator between children from the poorest (8 percent) and the wealthiest households (22 percent). Table CP.12:111Children with parents living abroad Percent distribution of children age 0-17 years by residence of parents in another country, Sao Tome and Principe, 2014 Percent distribution of children age 0-17 years: Percentage of children age 0-17 years with at least one parent living abroad¹ Number of children age 0-17 years With at least one parent living abroad With neither parent living abroad Total Only mother abroad Only father abroad Both mother and father abroad Total 2.5 10.6 2.5 84.3 100.0 15.7 6,838 Sex Male 2.8 10.2 2.7 84.3 100.0 15.7 3,370 Female 2.3 11.1 2.4 84.3 100.0 15.7 3,469 Region Centre East 3.0 12.6 3.1 81.3 100.0 18.7 4,425 North West 2.0 7.5 1.7 88.8 100.0 11.2 1,322 South East 0.4 4.9 1.6 93.0 100.0 7.0 842 Aut. of Principe 3.6 11.3 0.6 84.5 100.0 15.5 250 Area Urban 2.9 11.3 3.0 82.9 100.0 17.1 4,540 Rural 1.8 9.3 1.7 87.1 100.0 12.9 2,298 Age group 0-4 0.7 9.5 0.8 89.0 100.0 11.0 2,010 5-9 2.4 10.4 3.6 83.6 100.0 16.4 2,151 10-14 3.9 11.5 3.1 81.5 100.0 18.5 1,815 15-17 4.5 11.9 2.6 81.1 100.0 18.9 861 Wealth index quintile Poorest 1.1 6.8 0.6 91.6 100.0 8.4 1,358 Second 1.2 8.9 1.7 88.2 100.0 11.8 1,386 Middle 2.0 11.6 2.3 84.1 100.0 15.9 1,412 Fourth 2.2 14.1 4.1 79.6 100.0 20.4 1,362 Richest 6.4 11.7 4.1 77.9 100.0 22.1 1,321 1 MICS indicator 8.15 - Children with at least one parent living abroad Sao Tome and Principe 2014 MICS, Final Report P a g e | 179 XII. HIV/AIDS and Sexual Behaviour Knowledge about HIV Transmission and Misconceptions about HIV One of the most important prerequisites for reducing the rate of HIV infection is accurate knowledge of how HIV is transmitted and strategies for preventing transmission. Correct information is the first step towards raising awareness and giving adolescents and young people the tools to protect themselves from infection. Misconceptions about HIV are common and can confuse adolescents and young people and hinder prevention efforts. The UN General Assembly Special Session on HIV/AIDS (UNGASS) called on governments to improve the knowledge and skills of young people to protect themselves from HIV. The indicators to measure this goal as well as the MDG of reducing HIV infections by half include improving the level of knowledge of HIV and its prevention, and changing behaviours to prevent further spread of the disease. HIV module(s) were administered to women and men 15-49 years of age. Please note that the questions in this module often refer to “the AIDS virus”. This terminology is used strictly as a method of data collection to aid respondents, preferred over the correct terminology of “HIV” that is used here in reporting the results, where appropriate. Sao Tome and Principe 2014 MICS, Final Report P a g e | 180 Table HA.1:112Knowledge about HIV transmission, misconceptions about HIV, and comprehensive knowledge about HIV transmission (women) Percentage of women age 15-49 years who know the main ways of preventing HIV transmission, percentage who know that a healthy looking person can be HIV-positive, percentage who reject common misconceptions, and percentage who have comprehensive knowledge about HIV transmission, Sao Tome and Principe, 2014 Percentage who have heard of AIDS Percentage who know transmission can be prevented by: Percentage who know that a healthy looking person can be HIV- positive Percentage who know that HIV cannot be transmitted by: Percentage who reject the two most common misconceptions and know that a healthy looking person can be HIV-positive Percentage with compre- hensive knowledge1 Number of women age 15-49 Having only one faithful uninfected sex partner Using a condom every time Both Mosqui to bites Supernatural means Sharing food with someone with HIV Total 99.2 78.5 79.4 66.7 79.5 79.5 85.4 77.9 54.7 40.7 2,935 Region Centre East 99.2 74.6 77.3 61.6 81.9 80.5 86.4 77.4 55.9 38.9 1,983 North West 98.5 89.5 85.2 79.9 80.9 76.3 84.8 81.5 56.2 48.0 524 South East 99.5 78.5 78.1 68.4 61.0 75.3 81.2 72.4 41.7 32.9 326 Aut. of Principe 100.0 97.5 94.2 92.8 84.9 88.4 81.6 88.3 66.2 62.6 103 Area Urban 99.0 77.8 79.2 65.8 80.5 81.2 87.3 79.7 57.7 42.2 1,997 Rural 99.5 80.0 79.9 68.7 77.4 75.7 81.2 74.3 48.4 37.4 938 Age 15-241 99.1 78.6 80.1 67.5 79.2 82.7 85.9 79.9 57.1 42.2 1,169 15-19 98.9 78.0 81.7 68.1 78.3 82.7 85.9 79.5 55.1 40.5 702 20-24 99.4 79.5 77.6 66.6 80.5 82.7 85.9 80.6 60.1 44.8 467 25-29 99.7 84.8 79.0 69.7 80.9 81.3 88.6 80.3 57.4 41.9 484 30-39 99.5 78.9 80.6 67.8 82.2 80.3 86.3 77.3 55.3 41.7 795 40-49 98.2 71.6 76.2 60.3 74.4 68.5 79.4 71.8 45.4 34.2 488 Marital status Ever married/in union 99.3 77.8 78.4 65.6 78.7 77.8 84.5 76.5 53.4 40.0 2,168 Never married/in union 98.9 80.5 82.3 69.9 81.7 84.1 87.8 82.0 58.5 42.5 767 Education None 94.1 62.0 67.7 54.2 56.0 53.3 68.3 61.9 31.5 23.3 91 Primary 99.1 75.3 75.8 62.7 74.9 72.2 81.4 73.7 46.0 33.8 1,426 Secondary 99.5 82.7 83.1 71.1 84.7 88.2 89.9 83.3 64.3 48.1 1,318 Higher 100.0 84.3 91.5 77.9 97.6 92.9 97.4 82.8 73.2 57.4 99 Wealth index quintile Poorest 98.1 74.9 72.6 61.9 66.2 71.6 80.1 70.5 42.4 32.2 524 Second 98.7 76.1 76.0 62.4 74.1 75.1 81.0 72.7 47.4 32.1 581 Middle 99.2 78.2 79.4 66.5 80.0 75.9 83.9 81.1 53.1 39.2 566 Fourth 99.8 80.4 81.2 69.1 83.7 84.5 86.7 83.0 62.4 46.6 598 Richest 99.7 82.1 86.1 72.4 90.3 88.0 93.4 81.1 65.2 50.8 666 1MICS indicator 9.1; MDG indicator 6.3 - Knowledge about HIV prevention among young women Sao Tome and Principe 2014 MICS, Final Report P a g e | 181 Table HA.1M:113Knowledge about HIV transmission, misconceptions about HIV, and comprehensive knowledge about HIV transmission (men) Percentage of men age 15-49 years who know the main ways of preventing HIV transmission, percentage who know that a healthy looking person can be HIV-positive, percentage who reject common misconceptions, and percentage who have comprehensive knowledge about HIV transmission, Sao Tome and Principe, 2014 Percentage who have heard of AIDS Percentage who know transmission can be prevented by: Percentage who know that a healthy looking person can be HIV- positive Percentage who know that HIV cannot be transmitted by: Percentage who reject the two most common misconceptions and know that a healthy looking person can be HIV-positive Percentage with compre- hensive knowledge1 Number of men age 15-49 Having only one faithful uninfected sex partner Using a condom every time Both Mosqui to bites Supernatural means Sharing food with someone with HIV Total 99.5 81.8 84.0 72.6 82.6 82.6 91.0 85.8 61.8 47.3 2,267 Region Centre East 99.9 77.5 82.1 67.7 86.0 83.7 91.2 85.8 64.5 45.5 1,449 North West 99.4 91.7 87.6 82.4 76.8 79.4 90.5 86.1 56.0 49.3 415 South East 97.6 83.8 84.3 75.8 71.4 79.8 89.8 82.2 51.9 44.0 309 Aut. of Principe 100.0 98.4 95.5 94.8 91.8 89.9 92.8 95.9 80.0 76.1 93 Area Urban 99.5 79.7 82.3 69.9 84.5 83.0 92.2 85.9 63.2 46.1 1,508 Rural 99.5 85.9 87.2 78.1 78.7 81.8 88.5 85.5 59.2 49.5 759 Age 15-241 99.7 80.4 83.7 70.6 78.6 83.9 92.0 84.4 57.6 43.2 966 15-19 99.6 79.3 83.5 70.5 76.8 84.0 91.5 82.5 54.9 42.0 588 20-24 99.8 82.1 83.9 70.7 81.4 83.7 92.9 87.4 62.0 45.1 378 25-29 99.4 82.9 82.7 73.7 85.0 84.7 90.1 87.2 67.9 52.1 354 30-39 99.5 83.7 85.7 74.7 84.9 81.3 91.2 89.5 64.5 49.8 611 40-49 99.1 81.3 83.1 73.5 87.3 79.0 88.4 81.3 62.8 49.1 335 Marital status Ever married/in union 99.7 83.5 85.5 75.1 85.5 81.5 90.6 87.1 64.5 50.0 1,314 Never married/in union 99.3 79.4 81.9 69.1 78.6 84.1 91.5 84.0 58.2 43.5 953 Education None (93.3) (82.5) (72.0) (72.0) (61.1) (50.5) (68.2) (65.3) (30.4) (25.5) 22 Primary 99.2 80.4 81.5 70.7 75.5 76.1 87.7 81.1 50.8 39.2 951 Secondary 99.9 82.5 86.3 73.8 87.6 87.5 93.8 89.0 69.2 52.6 1,189 Higher 99.3 86.0 83.0 76.2 95.4 92.9 92.7 94.6 85.1 64.5 105 Wealth index quintile Poorest 98.8 78.7 81.6 70.3 70.2 73.6 85.0 80.8 47.0 36.8 462 Second 99.5 81.0 83.3 71.5 78.4 79.7 90.8 81.5 54.6 42.3 458 Middle 99.9 85.4 84.3 75.3 81.9 81.5 92.5 89.0 61.0 46.6 435 Fourth 99.8 82.8 83.7 73.0 90.4 90.5 93.6 86.7 71.5 53.9 455 Richest 99.6 81.3 87.0 73.3 92.2 87.8 93.1 91.0 75.3 56.8 456 1MICS indicator 9.1; MDG indicator 6.3 - Knowledge about HIV prevention among young men ( ) Figures that are based on 25-49 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 182 One indicator which is both an MDG and the Global AIDS Response Progress Reporting (GARPR; formerly UNGASS) indicator is the percentage of young people who have comprehensive and correct knowledge of HIV prevention and transmission. This is defined as 1) knowing that consistent use of a condom during sexual intercourse and having just one uninfected faithful partner can reduce the chance of getting HIV, 2) knowing that a healthy-looking person can have HIV, and 3) rejecting the two most common local misconceptions about transmission/prevention of HIV. In the 2014 Sao Tome and Principe MICS all women and men who have heard of AIDS were asked questions on all three components and the results are detailed in Tables HA.1 and HA.1M. In Sao Tome and Principe, nearly all women and men age 15-49 years (over 99 percent) have heard of AIDS. However, the percentage of those who know of both main ways of preventing HIV transmissionhaving only one faithful uninfected partner and using a condom every timeis only 67percent for women and 73 percent for men. About 79 percent of women and 82 percent of men know of having one faithful uninfected sex partner and 79 percent of women and 84 percent of men know of using a condom every time as main ways of preventing HIV transmission. Tables HA.1 and HA.1M also present the percentage of women and men who can correctly identify misconceptions concerning HIV. The indicator is based on the two most common and relevant misconceptions in Sao Tome and Principe, that HIV can be transmitted by sharing food with someone with HIV or through mosquito bites. The tables also provide information on whether women and men know that HIV cannot be transmitted by supernatural means. Overall, 55 percent of women and 62 percent of men reject the two most common misconceptions and know that a healthy-looking person can be HIV-positive. About 78 percent of women and 86 percent of men know that sharing food with someone with HIV, and 79 percent of women and 83 percent of men know that mosquito bites cannot transmit HIV, while 79 percent of women and 83 percent of men know that a healthy-looking person can be HIV-positive. There are meaningful differences between regions, with Autonomous Region of Principe generally being better informed than the others. Not surprisingly, there is also a correlation between correct knowledge, education and wealth. Sao Tome and Principe 2014 MICS, Final Report P a g e | 183 Figure HA.1: 20Women and men with comprehensive knowledge of HIV transmiss ion , Sao Tome and Pr inc ipe, 2014 People who have comprehensive knowledge about HIV prevention includes those who know of the two main ways of HIV prevention (having only one faithful uninfected partner and using a condom every time), who know that a healthy looking person can be HIV-positive, and who reject the two most common misconceptions. Comprehensive knowledge of HIV prevention methods and transmission is fairly low. Overall, 41 percent of women and 47 percent of men were found to have comprehensive knowledge, with little differences between the urban and rural areas. As expected, the percentage of women and men with comprehensive knowledge increases with their education level and socio-economic status. 67 55 41 73 62 47 Knows 2 ways to prevent HIV Identify 2 most common misconceptions and know that a healthy looking person can be HIV- positive Comprehensive knowledge Per cent Women age 15-49 Men age 15-49 Sao Tome and Principe 2014 MICS, Final Report P a g e | 184 Table HA.2:114Knowledge of mother-to-child HIV transmission (women) Percentage of women age 15-49 years who correctly identify means of HIV transmission from mother to child, Sao Tome and Principe, 2014 Percentage of women age 15-49 who have heard of AIDS and: Number of women age 15-49 Know HIV can be transmitted from mother to child: Do not know any of the specific means of HIV transmission from mother to child During pregnancy During deli- very By breast- feeding By at least one of the three means By all three means1 Total 58.9 70.8 84.1 91.1 47.1 8.1 2,935 Region Centre East 62.4 72.2 85.2 93.0 49.3 6.2 1,983 North West 55.6 67.4 82.6 87.1 46.5 11.4 524 South East 47.1 61.4 76.7 84.6 36.2 14.8 326 Autonomous of Principe 46.3 89.9 93.5 95.6 42.4 4.4 103 Area Urban 59.5 69.5 84.5 91.3 46.8 7.7 1,997 Rural 57.5 73.4 83.1 90.7 47.8 8.8 938 Age group 15-24 59.4 67.3 84.9 91.8 45.5 7.3 1,169 15-19 58.7 64.8 81.9 91.1 42.1 7.8 702 20-24 60.5 71.1 89.4 92.9 50.6 6.5 467 25-29 58.4 74.3 86.8 92.1 49.6 7.6 484 30-39 56.4 72.7 85.1 92.3 45.4 7.2 795 40-49 62.2 72.4 77.6 86.5 51.1 11.7 488 Marital status Ever married/in union 58.7 72.0 83.9 90.7 48.1 8.6 2,168 Never married/in union 59.5 67.5 84.5 92.4 44.2 6.5 767 Education None 55.2 68.4 69.1 78.0 43.1 16.2 91 Primary 57.6 69.5 81.4 88.5 47.6 10.6 1,426 Secondary 59.9 71.2 87.5 94.4 45.9 5.1 1,318 Higher 66.9 85.0 91.4 97.7 59.3 2.3 99 Wealth index quintile Poorest 52.9 62.9 77.7 84.5 43.5 13.6 524 Second 55.3 66.3 79.8 87.5 44.0 11.3 581 Middle 60.3 73.1 84.3 92.5 47.0 6.7 566 Fourth 60.9 74.7 89.6 93.9 50.6 5.9 598 Richest 63.8 75.4 87.6 95.7 49.6 4.0 666 1 MICS indicator 9.2 - Knowledge of mother-to-child transmission of HIV Sao Tome and Principe 2014 MICS, Final Report P a g e | 185 Table HA.2M:115Knowledge of mother-to-child HIV transmission (men) Percentage of men age 15-49 years who correctly identify means of HIV transmission from mother to child, Sao Tome and Principe, 2014 Percentage of men age 15-49 who have heard of AIDS and: Number of men age 15-49 Know HIV can be transmitted from mother to child: Do not know any of the specific means of HIV transmission from mother to child During pregnancy During deli- very By breast- feeding By at least one of the three means By all three means1 Total 54.9 66.1 80.6 91.1 39.9 8.4 2,267 Region Centre East 57.4 67.4 81.2 92.8 41.8 7.1 1,449 North West 55.5 64.1 77.5 86.2 42.9 13.1 415 South East 45.6 57.2 77.3 87.9 27.4 9.7 309 Autonomous of Principe 44.8 82.9 95.1 97.7 38.4 2.3 93 Area Urban 55.3 66.2 80.3 90.9 40.3 8.6 1,508 Rural 54.2 65.8 81.2 91.4 39.1 8.0 759 Age group 15-24 56.5 61.5 79.8 91.0 38.4 8.7 966 15-19 58.6 61.6 78.2 90.6 38.4 9.0 588 20-24 53.4 61.4 82.4 91.5 38.4 8.4 378 25-29 41.7 65.9 79.6 92.2 29.3 7.3 354 30-39 53.8 68.8 83.8 91.2 41.3 8.4 611 40-49 66.4 74.5 78.0 90.4 52.5 8.7 335 Marital status Ever married/in union 53.5 68.5 82.1 91.3 41.0 8.4 1,314 Never married/in union 56.9 62.8 78.5 90.8 38.3 8.5 953 Education None (42.8) (60.9) (66.7) (72.6) (34.4) (20.8) 22 Primary 52.4 60.8 78.3 87.7 38.1 11.5 951 Secondary 56.9 68.8 82.2 94.0 40.1 5.9 1,189 Higher 58.0 84.5 86.2 93.6 53.8 5.7 105 Wealth index quintile Poorest 51.3 58.2 71.6 82.5 33.9 16.3 462 Second 51.3 63.8 80.7 90.7 37.6 8.9 458 Middle 54.9 67.7 84.3 92.4 42.6 7.5 435 Fourth 58.3 67.9 81.3 95.9 39.4 3.9 455 Richest 58.9 73.0 85.2 94.4 46.0 5.2 456 1 MICS indicator 9.2 - Knowledge of mother-to-child transmission of HIV ( ) Figures that are based on 25-49 unweighted cases Knowledge of mother-to-child transmission of HIV is also an important first step for women to seek HIV testing when they are pregnant to avoid infection in the baby. Women and men should know that HIV can be transmitted during pregnancy, during delivery, and through breastfeeding. The level of knowledge among women and men age 15-49 years concerning mother-to-child transmission is presented in Tables HA.2 and HA.2M. Overall, 91 percent of both women and men know that HIV can be transmitted from mother to child. The percentage of women and men who know all three ways of mother-to-child transmission is 47 percent and 40 percent, respectively, while 8 percent of women and men did not know of any specific way. Here again, Autonomous Region of Principe appears to be better informed, and there is a clear positive relationship between knowledge of mother-to-child transmission, education and socio-economic status. Sao Tome and Principe 2014 MICS, Final Report P a g e | 186 Accepting Attitudes toward People Living with HIV The indicators on attitudes toward people living with HIV measure stigma and discrimination in the community. Stigma and discrimination are considered low if respondents report an accepting attitude on the following four questions: 1) would care for a family member with AIDS in own home; 2) would buy fresh vegetables from a vendor who is HIV-positive; 3) thinks that a female teacher who is HIV-positive should be allowed to teach in school; and 4) would not want to keep it a secret if a family member is HIV-positive. Sao Tome and Principe 2014 MICS, Final Report P a g e | 187 Table HA.3:116Accepting attitudes toward people living with HIV (women) Percentage of women age 15-49 years who have heard of AIDS who express an accepting attitude towards people living with HIV, Sao Tome and Principe, 2014 Percentage of women who: Num- ber of women age 15-49 who have heard of AIDS Are willing to care for a family member with AIDS in own home Would buy fresh vegetables from a shopkeeper or vendor who is HIV- positive Believe that a female teacher who is HIV- positive and is not sick should be allowed to continue teaching Would not want to keep secret that a family member is HIV-positive Agree with at least one accep- ting attitude Express accep- ting attitudes on all four indica- tors1 Total 76.1 65.4 77.6 33.2 96.3 13.4 2,910 Region Centre East 77.0 68.3 80.7 32.1 97.3 13.6 1,968 North West 77.0 60.2 73.6 31.2 95.2 10.0 516 South East 65.7 50.7 64.0 38.1 92.4 11.5 324 Aut. of Principe 87.0 81.3 81.5 50.5 96.9 31.0 103 Area Urban 74.8 66.6 79.2 32.6 96.4 12.9 1,977 Rural 78.8 62.7 74.2 34.7 96.3 14.4 933 Age 15-24 78.7 63.5 78.8 33.5 97.2 12.9 1,158 15-19 81.1 61.0 77.3 34.2 96.9 13.0 694 20-24 75.3 67.2 81.0 32.4 97.6 12.8 464 25-29 73.7 68.1 78.1 30.5 95.6 13.5 482 30-39 74.3 69.5 79.0 34.2 97.0 15.0 790 40-49 75.0 60.2 71.8 33.8 94.0 11.6 479 Marital status Ever married/in union 74.2 65.6 75.9 33.1 96.0 13.1 2,152 Never married/in union 81.5 64.7 82.4 33.6 97.3 14.3 759 Education None 60.9 42.9 57.2 29.4 89.0 7.1 86 Primary 69.8 58.7 70.7 36.3 94.6 11.3 1,413 Secondary 83.2 72.3 84.9 31.2 98.4 15.9 1,312 Higher 84.1 87.9 96.8 20.0 100.0 15.4 99 Wealth index quintile Poorest 63.8 51.4 63.3 37.4 91.6 10.5 514 Second 73.3 58.2 71.5 35.4 95.9 9.5 573 Middle 75.2 66.3 77.0 34.7 96.8 14.0 562 Fourth 80.8 70.7 83.5 35.7 98.6 18.0 597 Richest 84.4 76.7 89.0 24.7 98.0 14.3 665 1 MICS indicator 9.3 - Accepting attitudes towards people living with HIV Sao Tome and Principe 2014 MICS, Final Report P a g e | 188 Table HA.3M:117Accepting attitudes toward people living with HIV (men) Percentage of men age 15-49 years who have heard of AIDS who express an accepting attitude towards people living with HIV, Sao Tome and Principe, 2014 Percentage of women who: Num- ber of men age 15-49 who have heard of AIDS Are willing to care for a family member with AIDS in own home Would buy fresh vegetables from a shopkeeper or vendor who is HIV- positive Believe that a female teacher who is HIV- positive and is not sick should be allowed to continue teaching Would not want to keep secret that a family member is HIV-positive Agree with at least one accep- ting attitude Express accep- ting attitudes on all four indica- tors1 Total 83.7 67.6 79.7 41.4 97.2 22.5 2,256 Region Centre East 86.4 69.4 83.7 41.0 98.1 24.1 1,448 North West 77.0 61.6 72.4 39.7 95.4 16.6 413 South East 78.8 64.2 73.2 40.0 96.1 18.1 302 Aut. of Principe 88.7 77.3 70.7 59.4 93.8 39.0 93 Area Urban 82.7 69.2 82.6 40.3 97.4 22.5 1,501 Rural 85.8 64.3 74.1 43.6 96.7 22.5 755 Age 15-24 83.7 64.5 76.5 37.7 97.4 19.5 963 15-19 84.1 59.1 73.7 37.8 97.5 17.1 586 20-24 83.2 72.9 80.9 37.5 97.2 23.3 377 25-29 81.7 68.8 83.6 42.3 96.3 24.7 352 30-39 83.4 71.4 82.6 44.0 97.0 24.6 608 40-49 86.6 68.3 79.6 46.2 97.7 25.2 332 Marital status Ever married/in union 83.1 70.8 81.5 44.2 97.0 25.4 1,310 Never married/in union 84.7 63.1 77.2 37.4 97.4 18.6 946 Education None (56.9) (57.5) (49.8) (52.9) (85.6) (18.0) 20 Primary 77.5 58.0 70.6 41.5 95.3 17.5 944 Secondary 88.7 74.3 85.8 41.9 98.6 26.8 1,188 Higher 89.2 80.2 98.9 32.1 100.0 20.0 104 Wealth index quintile Poorest 73.4 56.7 66.0 45.8 95.1 16.5 457 Second 80.7 59.7 74.1 42.0 95.3 19.6 456 Middle 84.8 70.6 81.2 40.3 98.8 23.3 435 Fourth 91.1 73.8 85.5 42.3 97.3 29.4 454 Richest 88.8 77.3 91.8 36.4 99.6 23.8 455 1 MICS indicator 9.3 - Accepting attitudes towards people living with HIV ( ) Figures that are based on 25-49 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 189 Figure HA.2: 21Accept ing att i tudes toward people l iv ing with HIV/AIDS, Sao Tome and Pr inc ipe , 2014 Tables HA.3 and HA.3M present the attitudes of women and men towards people living with HIV. In Sao Tome and Principe, over 95 percent of women and men who have heard of AIDS agree with at least one accepting statement. The less commonly accepted attitude is buying fresh vegetables from a person who is HIV-positive (65 percent and 68 percent, respectively for women and men). More educated individuals and those from richest households have a somewhat more accepting attitude than the ones with lower education and a poorer wealth status, but the differences are not large. Here again, Autonomous Region of Principe appears to be in the forefront in terms of accepting attitude towards people living with HIV. Knowledge of a Place for HIV Testing, Counselling and Testing during Antenatal Care Another important indicator is the knowledge of where to be tested for HIV and use of such services. In order to protect themselves and to prevent infecting others, it is important for individuals to know their HIV status. Knowledge of own status is also a critical factor in the decision to seek treatment. Questions related to knowledge of a facility for HIV testing and whether a person has ever been tested are presented in Tables HA.4 and HA.4M. Overall, 92 percent of women and 90 percent of men knew where to be tested, while 74 percent and 52 percent, respectively, have actually been tested. Fewer, 71 percent of women and 48 percent of men, know the result of their most recent test. Would buy fresh vegetables from a shopkeeper or vendor who is HIV-positive Would not want to keep secret if a family member is HIV-positiveAre willing to care for a family member with AIDS in own home Believe that a female teacher who is HIV- positive and is not sick should be allowed to continue teaching 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0 15-19 20-24 25-29 30-39 40-49 15-19 20-24 25-29 30-39 40-49 15-19 20-24 25-29 30-39 40-49 15-19 20-24 25-29 30-39 40-49 P e r ce n t Age Women Men Sao Tome and Principe 2014 MICS, Final Report P a g e | 190 Table HA.4:118Knowledge of a place for HIV testing (women) Percentage of women age 15-49 years who know where to get an HIV test, percentage who have ever been tested, percentage who have ever been tested and know the result of the most recent test, percentage who have been tested in the last 12 months, and percentage who have been tested in the last 12 months and know the result, Sao Tome and Principe, 2014 Percentage of women who: Number of women age 15-49 Know a place to get tested1 Have ever been tested Have ever been tested and know the result of the most recent test Have been tested in the last 12 months Have been tested in the last 12 months and know the result2, 3 Total 92.3 73.6 70.5 39.6 38.5 2,935 Region Centre East 93.3 73.9 70.9 40.2 39.2 1,983 North West 88.9 70.8 68.8 31.3 30.9 524 South East 90.8 72.3 67.5 41.1 39.1 326 Autonomous of Principe 94.3 88.0 82.0 66.0 61.3 103 Area Urban 91.7 72.5 69.3 39.3 38.1 1,997 Rural 93.6 76.1 73.1 40.4 39.3 938 Age 15-24 88.2 51.6 49.5 33.3 32.3 1,169 15-19 82.8 32.3 30.4 23.2 22.1 702 20-24 96.4 80.7 78.1 48.6 47.6 467 25-29 97.0 93.7 89.1 53.3 51.9 484 30-39 96.2 91.5 87.7 46.5 45.0 795 40-49 91.0 77.4 74.5 30.0 29.4 488 Age and sexual activity in the last 12 months Sexually active 94.6 84.8 81.4 46.6 45.3 2,294 15-243 93.2 75.1 72.2 49.3 48.0 689 15-19 88.5 61.9 59.0 45.1 43.7 288 20-24 96.6 84.5 81.7 52.4 51.1 401 25-49 95.2 88.9 85.3 45.4 44.2 1,604 Sexually inactive 84.0 33.9 31.8 14.8 14.0 641 Marital status Ever married/in union 95.3 89.2 85.4 46.9 45.5 2,168 Never married/in union 83.9 29.6 28.5 19.2 18.5 767 Education None 79.6 64.5 60.7 30.0 29.0 91 Primary 92.7 83.0 78.4 42.0 40.5 1,426 Secondary 92.2 63.1 61.6 37.1 36.3 1,318 Higher 99.3 87.1 84.9 47.4 47.4 99 Wealth index quintile Poorest 88.1 74.4 70.2 39.7 38.1 524 Second 91.3 73.3 69.8 38.4 37.6 581 Middle 93.4 75.9 73.0 38.0 37.0 566 Fourth 92.8 74.1 71.2 41.7 40.5 598 Richest 95.1 71.0 68.7 40.2 38.9 666 1 MICS indicator 9.4 - Women who know where to be tested for HIV 2 MICS indicator 9.5 - Women who have been tested for HIV and know the results 3 MICS indicator 9.6 - Sexually active young women who have been tested for HIV and know the results Sao Tome and Principe 2014 MICS, Final Report P a g e | 191 Table HA.4M:119Knowledge of a place for HIV testing (men) Percentage of men age 15-49 years who know where to get an HIV test, percentage who have ever been tested, percentage who have ever been tested and know the result of the most recent test, percentage who have been tested in the last 12 months, and percentage who have been tested in the last 12 months and know the result, Sao Tome and Principe, 2014 Percentage of men who: Number of men age 15-49 Know a place to get tested1 Have ever been tested Have ever been tested and know the result of the most recent test Have been tested in the last 12 months Have been tested in the last 12 months and know the result2, 3 Total 89.9 52.0 48.4 29.1 27.3 2,267 Region Centre East 91.3 51.9 48.7 29.2 27.5 1,449 North West 84.7 49.9 45.8 25.9 24.6 415 South East 87.7 49.5 44.3 26.1 23.7 309 Autonomous of Principe 98.5 72.6 70.1 49.9 47.9 93 Area Urban 90.6 51.8 48.0 29.0 27.1 1,508 Rural 88.5 52.6 49.3 29.2 27.6 759 Age 15-24 85.3 27.4 24.3 15.5 14.0 966 15-19 79.2 14.6 12.0 9.5 8.0 588 20-24 94.9 47.2 43.4 24.9 23.4 378 25-29 93.8 68.3 64.0 37.4 35.4 354 30-39 94.2 72.8 69.0 39.6 38.3 611 40-49 90.9 68.1 64.2 40.1 36.7 335 Age and sexual activity in the last 12 months Sexually active 92.8 61.1 57.4 34.5 32.7 1,778 15-243 91.0 38.1 34.9 22.9 21.6 520 15-19 83.5 20.7 18.6 15.1 14.4 212 20-24 96.2 49.9 46.1 28.3 26.6 308 25-49 93.6 70.6 66.7 39.2 37.3 1,258 Sexually inactive 79.1 19.0 15.8 9.4 7.6 489 Marital status Ever married/in union 94.0 69.2 65.2 38.6 36.5 1,314 Never married/in union 84.1 28.4 25.3 15.9 14.6 953 Education None (75.6) (40.2) (36.5) (15.4) (15.4) 22 Primary 85.6 50.5 45.9 24.3 22.3 951 Secondary 92.7 50.6 47.5 31.0 29.1 1,189 Higher 99.3 85.4 84.8 53.1 53.1 105 Wealth index quintile Poorest 81.8 49.2 44.7 26.4 24.7 462 Second 85.9 45.4 40.7 23.7 21.2 458 Middle 94.8 51.4 47.6 28.6 26.7 435 Fourth 92.4 54.0 50.2 30.5 28.3 455 Richest 94.8 60.2 59.0 36.1 35.5 456 1 MICS indicator 9.4 - Men who know where to be tested for HIV 2 MICS indicator 9.5 - Men who have been tested for HIV and know the results 3 MICS indicator 9.6 - Sexually active young men who have been tested for HIV and know the results ( ) Figures that are based on 25-49 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 192 Only 40 percent of women and 29 percent of men have been tested within the last 12 months, and most of them (38 and 27 percent respectively) have been tested within the last 12 months and know the result. The highest proportion of tests is found in Autonomous Region of Principe. Table HA.5:120HIV counselling and testing during antenatal care Percentage of women age 15-49 with a live birth in the last 2 years who received antenatal care from a health professional during the last pregnancy, percentage who received HIV counselling, percentage who were offered and tested for HIV, percentage who were offered, tested and received the results of the HIV test, and percentage who received counselling and were offered, accepted and received the results of the HIV test, Sao Tome and Principe, 2014 Percentage of women who: Number of women age 15-49 with a live birth in the last 2 years Received antenatal care from a health care professional for last pregnancy Received HIV counselling during antenatal care1 Were offered an HIV test and were tested for HIV during antenatal care Were offered an HIV test and were tested for HIV during antenatal care, and received the results2 Received HIV counselling, were offered an HIV test, accepted and received the results Total 97.5 77.2 89.0 86.1 72.1 756 Region Centre East 97.7 78.2 89.5 87.3 73.2 514 North West 97.7 80.7 88.3 86.5 76.9 131 South East 95.0 62.6 83.6 77.7 56.6 86 Autonomous of Principe (100.0) (88.1) (100.0) (89.5) (77.5) 25 Area Urban 97.9 77.7 89.3 86.4 72.3 496 Rural 96.6 76.2 88.4 85.5 71.7 260 Age 15-24 98.8 76.2 90.9 88.0 72.2 265 15-19 100.0 76.4 89.1 85.6 72.8 94 20-24 98.1 76.1 91.9 89.4 71.9 171 25-29 97.8 78.4 92.8 90.8 75.4 187 30-39 98.0 78.7 87.3 83.3 71.2 255 40-49 86.0 69.2 72.7 72.7 62.8 48 Marital status Ever married/in union 97.3 77.0 89.4 86.4 72.3 723 Never married/in union (100.0) (82.1) (79.2) (79.2) (68.0) 32 Education None/Primary 96.1 74.5 86.0 82.0 67.5 468 Secondary/Higher 99.6 81.6 93.8 92.7 79.5 288 Wealth index quintile Poorest 94.8 71.3 82.6 79.8 65.1 161 Second 97.5 76.0 86.6 84.3 69.2 158 Middle 97.1 76.9 91.8 88.3 73.8 149 Fourth 98.4 82.2 90.7 87.8 76.0 161 Richest 100.0 80.1 94.5 91.8 77.6 126 1 MICS indicator 9.7 - HIV counselling during antenatal care 2 MICS indicator 9.8 - HIV testing during antenatal care ( ) Figures that are based on 25-49 unweighted cases Among women who had given birth within the two years preceding the survey, the percentage who received counselling and HIV testing during antenatal care is presented in Table HA.5. Overall, 77 percent of women received counselling during their last pregnancy and 89 percent were offered an Sao Tome and Principe 2014 MICS, Final Report P a g e | 193 HIV test and were tested; while 72 percent benefitted from both interventions. There is generally a correlation between these interventions, education and socio-economic status. Sexual Behaviour Related to HIV Transmission Promoting safer sexual behaviour is critical for reducing HIV prevalence. The use of condoms during sex, especially when non-regular or multiple partners are involved, is particularly important for reducing the spread of HIV. A set of questions was administered to all women and men 15-49 years of age to assess their risk of HIV infection. Table HA.6:121Sex with multiple partners (women) Percentage of women age 15-49 years who ever had sex, percentage who had sex in the last 12 months, percentage who had sex with more than one partner in the last 12 months, and mean number of sexual partners in lifetime for women who have ever had sex, Sao Tome and Principe, 2014 Percentage of women who: Number of women age 15-49 years Mean number of sexual partners in lifetime Number of women age 15- 49 years who have ever had sex Ever had sex Had sex in the last 12 months Had sex with more than one partner in last 12 months1 Total 86.0 78.1 2.9 2935 2 2,524 Region Centre East 85.4 76.6 3.3 1983 2 1,692 North West 85.7 80.0 1.5 524 2 449 South East 88.8 82.8 2.1 326 2 289 Aut. of Principe 90.7 84.6 4.2 103 2 93 Area Urban 85.8 77.8 3.4 1997 2 1,714 Rural 86.4 78.8 1.8 938 2 810 Age 15-24 64.9 59.0 4.0 1169 2 758 15-19 46.0 41.0 3.6 702 1 323 20-24 93.2 85.9 4.5 467 2 435 25-29 99.9 94.0 2.9 484 2 483 30-39 100.0 92.0 1.4 795 2 795 40-49 100.0 85.8 2.5 488 2 488 Marital status Ever married/in union 99.9 91.9 2.2 2168 2 2,165 Never married/in union 46.8 39.3 4.7 767 2 359 Education None 97.3 82.1 1.1 91 2 89 Primary 96.6 88.3 2.9 1426 2 1,377 Secondary 73.3 66.2 3.0 1318 2 966 Higher 92.0 86.9 2.2 99 2 91 Wealth index quintile Poorest 90.6 81.1 2.9 524 2 475 Second 87.7 78.2 2.5 581 2 509 Middle 86.4 80.1 4.1 566 2 489 Fourth 87.8 80.4 3.9 598 2 525 Richest 78.9 72.1 1.2 666 2 526 1 MICS indicator 9.12 - Multiple sexual partnerships 2 MICS indicator 9.13 - Condom use at last sex among people with multiple sexual partnerships (see text) Sao Tome and Principe 2014 MICS, Final Report P a g e | 194 Table HA.6M:122Sex with multiple partners (men) Percentage of men age 15-49 years who ever had sex, percentage who had sex in the last 12 months, percentage who had sex with more than one partner in the last 12 months, mean number of sexual partners in lifetime for men who have ever had sex, and among those who had sex with multiple partners in the last 12 months, the percentage who used a condom at last sex, Sao Tome and Principe, 2014 Percentage of men who: Number of men age 15- 49 years Mean number of sexual partners in lifetime Number of men age 15- 49 years who have ever had sex Percentage of men who had more than one sexual partner in the last 12 months reporting that a condom was used the last time they had sex2 Number of men age 15-49 years who had more than one sexual partner in the last 12 months Ever had sex Had sex in the last 12 months Had sex with more than one partner in last 12 months1 Total 84.5 78.4 29.1 2,267 8 1,915 49.0 660 Region Centre East 84.0 77.9 30.8 1,449 9 1,218 51.1 447 North West 85.4 79.6 24.0 415 7 355 43.3 100 South East 84.0 78.2 28.3 309 7 260 41.9 88 Aut. of Principe 88.6 82.8 27.8 93 6 82 58.2 26 Area Urban 84.5 78.6 30.6 1,508 9 1,275 51.5 462 Rural 84.3 78.0 26.0 759 7 640 43.1 198 Age 15-24 64.3 53.8 22.5 966 5 621 71.5 217 15-19 47.0 36.0 12.0 588 3 276 78.5 70 20-24 91.1 81.5 38.8 378 6 345 68.1 147 25-29 98.6 96.2 35.0 354 9 349 41.2 124 30-39 99.7 97.7 34.5 611 10 609 38.9 211 40-49 100.0 95.6 32.1 335 11 335 32.2 108 Marital status Ever married/in union 100.0 97.8 34.1 1,314 10 1,314 35.4 448 Never married/in union 63.1 51.7 22.2 953 5 601 77.7 211 Education None (90.3) (90.3) (22.4) 22 (*) 20 (*) 5 Primary 88.7 83.2 25.9 951 7 844 42.5 246 Secondary 79.7 72.9 31.3 1,189 9 948 52.4 372 Higher 98.9 95.0 34.9 105 7 104 (62.5) 37 Wealth index quintile Poorest 86.3 79.4 22.4 462 7 399 44.4 104 Second 84.5 77.4 26.2 458 7 387 34.5 120 Middle 79.7 76.8 28.0 435 7 347 47.9 122 Fourth 83.8 76.5 30.9 455 9 381 52.0 141 Richest 87.9 82.0 38.0 456 10 401 60.0 173 1 MICS indicator 9.12 - Multiple sexual partnerships[M] 2 MICS indicator 9.13 - Condom use at last sex among people with multiple sexual partnerships[M] ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases As shown in Tables HA.6 and HA.6M, 3 percent of women and 29 percent of men 15-49 years of age report having sex with more than one partner in the last 12 months. Of those, only 46 percent of women (data not shown) and 49 percent of men reported using a condom when they had sex the last time. Because of the small sample size of women who had sex with more than one partner in the last 12 months, the last two columns shown in HA.6M are not shown in HA.6. Among men who Sao Tome and Principe 2014 MICS, Final Report P a g e | 195 had sex with more than one partner in the last 12 months, a larger proportion of younger men age 15-24 years reported using a condom last time they had sex (71 percent) than older men (32 to 41 percent), and a larger proportion of wealthiest (60 percent) than poorest men (44 percent). HIV Indicators for Young Women and Young Men In many countries, over half of new adult HIV infections are among young people age 15-24 years thus a change in behaviour among members of this age group is especially important to reduce new infections. The next tables present specific information on this age group. Tables HA.7 and HA.7M summarize information on key HIV indicators for young women and young men. Results with respect to comprehensive knowledge (42 percent of young women and 43 percent of young men), knowledge of mother to child transmission (46 percent of young women and 38 of young men), and knowledge of a place to get tested (88 percent of young women and 85 of young men) are generally similar in this age group to that of the population age 15-49 years as a whole. Accepting attitudes towards people living with HIV with respect to the same four indicators that were previously discussed are also comparable in this age group (13 percent of young women and 19 percent of young men). Overall, 48 percent of young women and 22 percent of young men in this age group, who are sexually active, have been tested for HIV in the last 12 months and know the result. Trends by background characteristics are similar in this age group as those of the 15-49 years population as a whole. Sao Tome and Principe 2014 MICS, Final Report P a g e | 196 Table HA.7:123Key HIV and AIDS indicators (young women) Percentage of women age 15-24 years by key HIV and AIDS indicators, Sao Tome and Principe, 2014 Percentage of women age 15-24 years who: Number of wo- men age 15-24 years Percentage of sexually active young women who have been tested for HIV in the last 12 months and know the result2 Number of women age 15-24 years who had sex in the last 12 months Percentage who express accepting attitudes towards people living with HIV on all four indicatorsa Number of women age 15-24 years who have heard of AIDS Have compre- hensive know- ledge1 Know all three means of HIV transmission from mother to child Know a place to get tested for HIV Have ever been tested and know the result of the most recent test Have been tested for HIV in the last 12 months and know the result Had sex in the last 12 months Total 42.2 45.5 88.2 49.5 32.3 59.0 1,169 48.0 689 12.9 1,158 Region Centre East 40.3 47.7 88.8 48.7 33.0 57.6 809 49.5 466 12.9 803 North West 50.8 43.8 86.5 49.5 26.8 58.9 205 41.7 121 11.9 202 South East 34.2 35.2 87.6 49.7 33.8 66.4 118 48.3 79 11.0 118 Autonomous of Principe 63.8 41.0 87.1 65.7 42.2 64.7 36 (51.4) 23 25.1 36 Area Urban 43.2 45.3 87.2 47.1 31.9 58.4 804 47.3 470 12.9 797 Rural 40.2 46.1 90.6 54.6 33.2 60.1 365 49.6 219 12.9 361 Age 15-19 40.5 42.1 82.8 30.4 22.1 41.0 702 43.7 288 13.0 694 15-17 37.8 41.4 77.5 15.9 10.9 26.1 441 30.6 115 12.1 435 18-19 45.1 43.5 91.9 55.0 41.1 66.3 260 52.4 173 14.6 259 20-24 44.8 50.6 96.4 78.1 47.6 85.9 467 51.1 401 12.8 464 20-22 44.7 49.5 96.1 74.8 45.4 80.7 291 50.6 235 12.8 290 23-24 45.0 52.4 97.0 83.8 51.2 94.5 176 51.9 166 12.8 174 Marital status Ever married/in union 40.9 47.1 96.8 87.2 55.6 93.4 468 56.1 437 11.1 466 Never married/in union 43.1 44.5 82.5 24.3 16.7 36.0 701 34.0 252 14.2 692 Education None/Primary 29.3 42.4 87.0 66.0 41.7 78.9 333 48.8 263 7.9 327 Secondary/Higher 47.4 46.8 88.7 42.9 28.5 51.0 836 47.6 427 14.9 831 Wealth index quintile Poorest 39.0 38.9 83.5 56.7 37.5 68.3 177 51.2 121 8.4 173 Second 35.7 44.1 89.3 56.2 33.7 62.7 248 48.0 155 9.8 245 Middle 36.5 43.7 90.8 53.9 34.3 59.9 224 49.0 134 15.8 222 Fourth 46.8 52.4 87.3 50.8 35.2 64.3 250 49.5 161 14.9 250 Richest 51.0 46.3 89.1 33.6 23.1 43.6 269 41.6 118 14.6 268 1 MICS indicator 9.1; MDG indicator 6.3 - Knowledge about HIV prevention among young women 2 MICS indicator 9.6 - Sexually active young women who have been tested for HIV and know the results a Refer to Table HA.3 for the four indicators. ( ) Figures that are based on 25-49 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 197 Table HA.7M:124Key HIV and AIDS indicators (young men) Percentage of men age 15-24 years by key HIV and AIDS indicators, Sao Tome and Principe, 2014 Percentage of men age 15-24 years who: Number of wo- men age 15-24 years Percentage of sexually active young women who have been tested for HIV in the last 12 months and know the result2 Number of men age 15-24 years who had sex in the last 12 months Percentage who express accepting attitudes towards people living with HIV on all four indicatorsa Number of men age 15-24 years who have heard of AIDS Have compre- hensive know- ledge1 Know all three means of HIV transmission from mother to child Know a place to get tested for HIV Have ever been tested and know the result of the most recent test Have been tested for HIV in the last 12 months and know the result Had sex in the last 12 months Total 43.2 38.4 85.3 24.3 14.0 53.8 966 21.6 520 19.5 963 Region Centre East 40.6 41.0 86.4 22.4 13.3 52.6 636 20.8 335 21.4 636 North West 50.0 39.4 80.7 27.0 14.0 58.4 170 21.0 100 15.7 170 South East 38.5 25.0 83.5 25.2 14.4 52.7 129 21.9 68 11.2 127 Autonomous of Principe 80.0 36.5 95.5 42.8 26.6 56.3 31 (38.1) 18 35.0 31 Area Urban 42.0 39.3 86.4 22.9 13.0 53.6 653 20.6 349 19.5 650 Rural 45.8 36.5 83.1 27.1 16.2 54.2 314 23.6 170 19.4 313 Age 15-19 42.0 38.4 79.2 12.0 8.0 36.0 588 14.4 212 17.1 586 15-17 41.4 37.1 74.9 8.1 4.2 24.9 363 5.9 90 17.4 361 18-19 43.0 40.7 86.0 18.2 14.0 53.9 225 20.7 121 16.5 225 20-24 45.1 38.4 94.9 43.4 23.4 81.5 378 26.6 308 23.3 377 20-22 42.0 35.9 94.2 38.9 20.4 78.8 231 23.9 182 21.1 230 23-24 50.1 42.5 96.0 50.4 28.2 85.7 147 30.4 126 26.7 147 Marital status Ever married/in union 47.7 37.7 96.1 42.4 23.0 98.6 128 22.0 126 24.6 128 Never married/in union 42.6 38.6 83.7 21.5 12.6 46.9 838 21.5 393 18.7 835 Education None/Primary 32.1 35.3 78.3 21.6 13.2 56.5 309 18.5 174 13.9 306 Secondary/Higher 48.5 39.9 88.6 25.5 14.4 52.5 657 23.2 345 22.1 657 Wealth index quintile Poorest 37.6 32.2 79.0 27.5 15.8 57.3 180 24.4 103 13.4 178 Second 36.4 35.0 79.8 19.7 11.0 51.3 201 15.4 103 16.3 199 Middle 39.2 38.5 91.6 21.4 11.9 46.6 184 20.5 86 16.9 184 Fourth 46.9 40.2 87.0 27.9 18.5 51.0 206 28.9 105 28.4 206 Richest 55.5 45.8 89.2 24.9 12.9 62.7 195 18.9 123 21.3 195 1 MICS indicator 9.1; MDG indicator 6.3 - Knowledge about HIV prevention among young men 2 MICS indicator 9.6 - Sexually active young men who have been tested for HIV and know the results a Refer to Table HA.3 for the four indicators. ( ) Figures that are based on 25-49 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 198 Table HA.8:125Key sexual behaviour indicators (young women) Percentage of women age 15-24 years by key sexual behaviour indicators, Sao Tome and Principe, 2014 Percentage of women age 15-24 years who: Number of women age 15-24 years Percentage of women who never had sex2 Number of never- married women age 15-24 years Percentage of women age 15-24 years who in the last 12 months had sex with: Number of women age 15-24 years who had sex in the last 12 months Percentage reporting the use of a condom during the last sexual intercourse with a non-marital, non-cohabiting partner in the last 12 months5 Number of women age 15- 24 years who had sex with a non-marital, non-cohabiting partner in last 12 months Had sex before age 151 Ever had sex Had sex with more than one partner in last 12 months A man 10 or more years older3 A non-marital, non- cohabiting partner4 Total 9.2 64.9 4.0 1,169 58.2 701 17.6 24.7 689 65.2 289 Region Centre East 8.0 64.1 4.5 809 57.0 505 18.7 25.5 466 69.1 207 North West 9.0 63.8 2.6 205 63.5 117 14.4 24.0 121 58.8 49 South East 16.6 69.2 3.0 118 57.7 63 12.8 21.2 79 48.5 25 Autonomous of Principe 14.4 73.1 3.6 36 (58.7) 16 (30.2) (21.3) 23 (*) 8 Area Urban 8.9 64.8 4.7 804 55.7 505 19.1 26.8 470 66.0 215 Rural 10.0 65.1 2.3 365 64.6 196 14.6 20.1 219 63.0 73 Age 15-19 10.1 46.0 3.6 702 65.9 570 16.7 24.6 288 68.8 172 15-17 10.3 29.4 2.6 441 76.6 405 10.1 18.8 115 67.0 83 18-19 9.8 74.2 5.3 260 39.9 165 21.0 34.3 173 70.4 89 20-24 7.9 93.2 4.5 467 24.4 131 18.3 24.9 401 60.0 116 20-22 7.7 89.9 5.4 291 27.8 106 17.8 30.2 235 66.5 88 23-24 8.2 98.6 3.0 176 (*) 25 19.1 16.1 166 (39.8) 28 Marital status Ever married/in union 14.8 99.4 3.0 468 na na 19.3 8.3 437 (48.2) 39 Never married/in union 5.5 41.8 4.6 701 58.2 701 14.7 35.6 252 67.9 250 Education None/Primary 19.1 84.7 4.7 333 50.7 100 17.9 17.4 263 53.3 58 Secondary/Higher 5.3 57.0 3.7 836 59.4 601 17.4 27.8 427 68.2 230 Wealth index quintile Poorest 16.3 72.2 3.2 177 63.4 78 16.0 20.0 121 45.1 35 Second 11.8 71.2 2.5 248 55.7 125 16.0 22.4 155 54.1 56 Middle 9.5 65.9 5.3 224 59.5 128 19.9 23.5 134 66.3 53 Fourth 6.3 71.0 7.3 250 48.5 148 21.0 29.4 161 77.0 73 Richest 4.8 47.7 1.8 269 63.5 222 14.3 26.5 118 70.9 72 1 MICS indicator 9.10 - Sex before age 15 among young women 2 MICS indicator 9.9 - Young women who have never had sex 3 MICS indicator 9.11 - Age-mixing among sexual partners 4 MICS indicator 9.14 - Sex with non-regular partners 5 MICS indicator 9.15; MDG indicator 6.2 - Condom use with non-regular partners na: not applicable; ( ) Figures that are based on 25-49 unweighted cases; (*) Figures that are based on fewer than 25 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 199 Table HA.8M:126Key sexual behaviour indicators (young men) Percentage of men age 15-24 years by key sexual behaviour indicators, Sao Tome and Principe, 2014 Percentage of men age 15-24 years who: Num- ber of men age 15-24 years Percen- tage of men who never had sex2 Number of never- married men age 15-24 years Percentage who in the last 12 months had sex with a non-marital, non- cohabiting partner3 Number of men age 15- 24 years who had sex in the last 12 months Percentage reporting the use of a condom during the last sexual intercourse with a non-marital, non- cohabiting partner in the last 12 months4 Number of men age 15- 24 years who had sex with a non-marital, non- cohabiting partner in last 12 months Percentage reporting that a condom was used the last time they had sex Number of men age 15-24 years who had sex with more than one partner in the last 12 months Had sex before age 151 Ever had sex Had sex with more than one partner in last 12 months Total 18.2 64.3 22.5 966 41.2 838 46.9 520 82.5 453 71.5 217 Region Centre East 18.3 63.9 23.7 636 40.4 569 47.8 335 86.2 304 71.4 150 North West 21.0 65.5 21.6 170 42.9 137 46.1 100 74.0 79 71.2 37 South East 14.6 63.3 18.2 129 44.1 107 43.5 68 74.5 56 72.5 24 Autonomous of Principe 14.5 69.2 21.2 31 38.8 25 (44.8) 18 (83.6) 14 (*) 7 Area Urban 21.4 64.7 25.1 653 39.6 581 48.4 349 84.0 316 75.0 164 Rural 11.5 63.3 17.1 314 44.8 257 43.6 170 79.1 137 60.7 54 Age 15-19 17.6 47.0 12.0 588 54.0 578 35.1 212 79.2 207 78.5 70 15-17 18.3 34.6 6.1 363 65.4 363 24.9 90 78.7 90 (*) 22 18-19 16.5 66.9 21.5 225 34.7 215 51.7 121 79.6 116 (74.6) 48 20-24 19.0 91.1 38.8 378 12.9 260 65.1 308 85.3 246 68.1 147 20-22 19.6 89.9 39.2 231 13.6 172 66.7 182 84.1 154 64.9 90 23-24 18.0 93.1 38.3 147 11.5 88 62.6 126 87.3 92 73.1 56 Marital status Ever married/in union 20.1 100.0 40.1 128 na na 47.2 126 73.8 61 41.5 51 Never married/in union 17.9 58.8 19.8 838 41.2 838 46.8 393 83.9 392 80.7 166 Education None/Primary 14.7 66.0 22.4 309 42.8 246 45.2 174 71.9 139 59.9 69 Secondary/Higher 19.8 63.5 22.5 657 40.6 592 48.1 345 87.3 313 76.8 148 Wealth index quintile Poorest 16.3 65.9 20.1 180 46.1 133 42.3 103 72.8 76 (59.6) 36 Second 17.3 65.2 19.6 201 42.0 166 41.4 103 82.9 83 (53.1) 39 Middle 13.9 52.4 20.4 184 52.4 168 43.6 86 77.9 80 (74.6) 38 Fourth 19.7 64.6 21.5 206 38.8 188 45.4 105 92.1 94 (79.0) 44 Richest 23.1 72.5 30.6 195 29.2 184 61.2 123 84.0 120 (83.2) 60 1 MICS indicator 9.10 - Sex before age 15 among young men[M] 2 MICS indicator 9.9 - Young men who have never had sex[M] 3 MICS indicator 9.14 - Sex with non-regular partners[M] 4 MICS indicator 9.15; MDG indicator 6.2 - Condom use with non-regular partners[M] na: not applicable; ( ) Figures that are based on 25-49 unweighted cases; (*) Figures that are based on fewer than 25 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 200 Certain behaviour may create, increase, or perpetuate risk of exposure to HIV. For this young age group, such behaviour includes sex at an early age and women having sex with older men. Overall, 65 percent of young women and 64 percent of young men age 15-24 years reported ever having sex; 9 percent and 18 percent, respectively, reported having sex for the first time before the age of 15. Further, 4 percent of young women and 22 percent of young men had sex with more than one partner in the last 12 months; of those approximately 58 percent of women (data not shown due to small sample size) and 71 percent of men reported using a condom the last time. On the other hand, 25 percent of the young women and 47 percent of the young men who had sex in the last 12 months reported that it involved a non-marital non-cohabiting partner; of those 65 percent of women and 83 percent of men used a condom the last time. The use of condom under these circumstances tends to increase with education and socio-economic status. About 18 percent of women age 15-24 years had sex with a man 10 or more years older in the last 12 months. Figure HA.3 brings together two critical behaviours that are known to increase the risk of HIV infection, sex before age 15, and sex with multiple partners, from tables HA.8 and HA.6. It demonstrate that young men have more risky behaviours than young women, more so those of urban than rural areas. Figure HA.3: 2 2 Sexual behaviour that increases the r isk of H IV in fect ion, young people age 15 -24, Sao Tome and Pr inc ipe, 2014 Orphans While the number of children orphaned due to AIDS has stabilized globally since 2009, efforts to mitigate the impact of AIDS on households, communities, and children continues to be intensified by 9 10 5 2 21 11 25 17 Urban Rural Urban Rural Had sex before age 15 Had sex with multiple partners in the last 12 months P er c en t Women age 15-24 Men age 15-24 Sao Tome and Principe 2014 MICS, Final Report P a g e | 201 national programmes and global partners. Children who are orphaned may be at increased risk of neglect or exploitation when the parents are not available to assist them. Monitoring the variations in different outcomes for orphans and comparing them to their peers gives us a measure of how well communities and governments are responding to their needs. Fortunately, in Sao Tome and Principe the number of children orphaned due to AIDS is very small and Table HA.9 should be interpreted in the context of orphans in general without emphasis on children orphaned due to AIDS. Please refer to Table CP.11 on page 177 for detailed information on living conditions of children and overall prevalence of orphanhood. Table HA.9:127School attendance of orphans and non-orphans School attendance of children age 10-14 years by orphanhood, Sao Tome and Principe, 2014 Percen- tage of children whose mother and father have died (orphans) Percentage of children whose parents are still alive and who are living with at least one parent (non- orphans) Num- ber of child- ren age 10-14 years Percentage of children whose mother and father have died (orphans) and are attending school Total number of orphan child- ren age 10-14 years Percentage of children whose parents are still alive, who are living with at least one parent (non- orphans), and who are attending school Total number of non- orphan children age 10-14 years Orphans to non- orphans school atten- dance ratio1 Total 0.8 74.5 1,815 (*) 14 94.7 1,353 (*) Sex Male 0.8 74.1 859 (*) 7 94.0 636 (*) Female 0.8 74.9 956 (*) 7 95.4 716 (*) Area Urban 0.8 73.4 1,192 (*) 9 96.0 875 (*) Rural 0.8 76.7 623 (*) 5 92.4 478 (*) 1 MICS indicator 9.16; MDG indicator 6.4 - Ratio of school attendance of orphans to school attendance of non-orphans See Table CP.14 for further overall results related to children's living arrangements and orphanhood (*) Figures that are based on fewer than 25 unweighted cases Table HA.9 presents information on the orphanhood status of children age 10-14 years, and their school attendance. Overall, less than 1 percent of children age 10-14 years in Sao Tome and Principe are orphans and no reliable estimates can be produced with respect to the proportion that is attending school. Statistics in this table should be considered as only indicative due to insufficient sample size. Sao Tome and Principe 2014 MICS, Final Report P a g e | 202 Male circumcision Evidence has shown that male circumcision (the complete removal of the foreskin of the penis) reduces the risk of heterosexually acquired HIV infection in men by approximately 60 percenti and is safe when performed by well-trained health professionals in properly equipped settings. In countries and regions with heterosexual epidemics and high HIV and low male circumcision prevalence, male circumcision is being included in comprehensive HIV prevention packages. Alone, male circumcision is only partially protective, however, when combined with HIV testing and counselling services, condoms, safer sexual practices and treatment of sexually transmitted infections, it is highly effective. It may already be performed for religious, medical, or cultural reasons and can be carried out at birth, during adolescence, or at other times during a man’s life. Table HA.10:128Male circumcision Percentage of men age 15-49 years who report having been circumcised, Sao Tome and Principe, 2014 Percent circumcised1 Number of men age 15-49 years Total 3.2 2,267 Region Centre East 3.6 1,449 North West 2.4 415 South East 2.8 309 Autonomous of Principe 1.0 93 Area Urban 3.6 1,508 Rural 2.3 759 Age 15-24 3.0 966 15-19 3.6 588 20-24 2.2 378 25-29 2.7 354 30-39 4.0 611 40-49 2.4 335 Education None 3.6 22 Primary 2.6 951 Secondary 3.0 1,189 Higher 9.8 105 Wealth index quintile Poorest 1.8 462 Second 4.5 458 Middle 1.3 435 Fourth 2.7 455 Richest 5.4 456 1 MICS indicator 9.17 - Male circumcision i See for example: Bailey, RC et al. 2007. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. The Lancet 369: 643–56. Sao Tome and Principe 2014 MICS, Final Report P a g e | 203 The prevalence of male circumcision is presented in Table HA.10. Only 3 percent of men age 15-49 are circumcised and there are no major differences by background characteristics. Given the small sample size of circumcised men in our sample, more detailed statistics are not being presented in this report. Prevalence of HIV in men and women Introduction This section reports on the coverage of the HIV test, on HIV prevalence, as well as on factors associated with the infection. The reader who is interested in a more detailed analysis, including comparison with the results of the 2008-2009 Sao Tome and Principe DHS, is referred to the separate biomarker report already published by UNDP. The objective of HIV testing was to estimate the prevalence for the general population age 15-49 years. All men and women age 15-49 years in all sampled households were eligible for the test. Blood samples were taken from all eligible men and women who voluntarily accepted to be tested. The protocol for HIV detection is anonymous and was approved by the International Review Board of ICF International and by the Ethics Committee of the MICS. In line with the protocol, blood samples must be completely anonymous, to the effect that no name or other personal or geographical characteristic could lead to the identification of an individual from whom a blood sample was taken. The Ethics Committee approved the specific 2014 Sao Tome and Principe MICS anonymous protocol, as well as the final version of the statement for informed consent and voluntary test. Since HIV tests are anonymous, it was not possible to inform the participants about the result of their test. A card referring to a nearby voluntary counselling centre was given to all eligible individuals, whether they accepted or not to be submitted to the test, so that they could access counselling and free testing if they wished to do so. Each field team comprised at least one interviewer/health agent specifically designated for blood collection and HIV, malaria and anaemia testing. These health technicians received a special training on all aspects of the protocols for anaemia, malaria and HIV testing. The technician sought prior informed consent from each eligible individual after having explained the blood collection procedures, as well as the confidentiality and anonymous nature of the test. Operations for the extraction and analysis of blood samples in laboratory were implemented about eight months after the end of fieldwork. It was then necessary to wait for the cleaned dataset, before going ahead with the scrambling of the data and the destruction of the paper questionnaires, in order to guarantee the anonymity of the HIV tests results. The scrambling of the data was done by ICF International and concluded in January 2015. This involved suppressing district level geographical identifiers (enumerating district) from the informatics files, as well as any other information that could potentially be used to identify individuals. The blood samples were kept in laboratory at minus 20 degree Celsius. Anti-HIV antibody testing and result outputs were done by LHAR, the HIV reference laboratory in Sao Tome and Principe. Laboratory tests took place between 18 and 31 January 2015. Sao Tome and Principe 2014 MICS, Final Report P a g e | 204 Detection and confirmation The protocol specified the use of ELISA (Vironostika VIH Ag/Ab) as the first test for in laboratory detection of HIV. All dry blood spot samples received in the laboratory were tested in this manner. All negative ELISA tests were classified as “negative”. All positive cases were submitted to a second ELISA test (Enzygnost VIH Integral II). Further, 10 percent of the negative tests were submitted to yet another ELISA test for quality control. The samples with a positive second ELISA test were classified “positive”. All discordant results between the first and second ELISA tests were reanalyzed using both ELISA tests. Discordant results from this double set of procedures were analyzed with Western Blot 2.2. At the end of the process, 261 samples, including all positive samples, were sent to Centre Pasteur in Yaoundé, Cameroon, for external quality control. The results of the Centre Pasteur confirmed 100 percent of the results obtained in Sao Tome and Principe. Sao Tome and Principe 2014 MICS, Final Report P a g e | 205 Table HA.11:129Coverage of HIV test by area and region Percent distribution of men and women age 15-49 eligible for HIV testing, by testing status, Sao Tome and Principe, 2014 Blood sample collected Refused test Absent for blood collection Other/ Missing Total Number of eligible men and women age 15-49 years Surveyed Surveyed Surveyed Surveyed Yes No Yes No Yes No Yes No OVERALL Total 80.4 0.5 6.0 4.0 1.6 5.7 0.6 1.2 100.0 5,873 Region Centre East 75.6 0.5 6.8 3.9 2.6 9.0 0.6 1.0 100.0 2,702 North West 88.4 0.4 3.2 2.1 0.8 3.4 0.5 1.2 100.0 1,458 South East 78.6 0.9 6.6 7.2 0.9 3.3 0.3 2.1 100.0 1,297 Aut. of Principe 88.7 0.0 8.7 0.5 0.0 0.0 2.2 0.0 100.0 416 Area Urban 81.1 0.6 5.7 4.6 2.1 4.3 0.6 0.8 100.0 3,539 Rural 79.2 0.4 6.5 2.9 0.8 7.9 0.6 1.8 100.0 2,334 WOMEN Total 89.3 0.5 3.9 1.8 0.9 2.0 0.5 1.0 100.0 3,101 Region Centre East 86.2 0.3 5.5 2.0 1.6 3.2 0.5 0.8 100.0 1,482 North West 95.5 0.4 1.6 0.4 0.4 0.8 0.3 0.8 100.0 774 South East 88.1 1.1 2.8 3.8 0.5 1.4 0.2 2.2 100.0 636 Aut. of Principe 92.3 0.0 4.8 0.5 0.0 0.0 2.4 0.0 100.0 209 Area Urban 90.0 0.6 3.9 2.0 1.2 1.2 0.5 0.7 100.0 1,895 Rural 88.2 0.2 4.0 1.6 0.6 3.3 0.5 1.6 100.0 1,206 MEN Total 70.3 0.6 8.4 6.3 2.3 9.9 0.7 1.4 100.0 2,772 Region Centre East 62.6 0.7 8.5 6.3 3.9 16.1 0.7 1.1 100.0 1,220 North West 80.4 0.4 5.1 3.9 1.2 6.4 0.7 1.8 100.0 684 South East 69.4 0.8 10.3 10.6 1.4 5.1 0.5 2.0 100.0 661 Aut. of Principe 85.0 0.0 12.6 0.5 0.0 0.0 1.9 0.0 100.0 207 Area Urban 70.9 0.6 7.9 7.7 3.2 8.0 0.7 1.0 100.0 1,644 Rural 69.5 0.5 9.1 4.3 1.1 12.8 0.7 2.0 100.0 1,128 a Includes all dry blood spot samples tested in laboratory for which result is available, be it positive, negative or indeterminate. Indeterminate means that all tests were done on the sample in line with the algorithm, but the final result was inconclusive. b Includes: 1) other blood collection results (e.g. technical problems in the field), 2) lost samples, 3) unmatched bar codes, e 4) other laboratory results, e.g. blood not tested for technical reasons, blood sample too small to complete the algorithm, etc. A computer programme in CSPro, developed by ICF International and adapted to the specific algorithm used in this survey, was provided to LHAR to process the test results. Each blood sample submitted to LHAR was identified by a bar code. This was the only code inputted in CSPro that was directly related to the tests. This confidential file remained under the responsibility of LHAR until all blood analyzes had been completed. It was then merged with the survey file, through the bar codes, in order to permit the analysis of the prevalence data jointly with other information collected during the survey. As was previously stated, all individual identification variables had previously been scrambled in the survey file in order to preserve the complete anonymity of the survey results. Sao Tome and Principe 2014 MICS, Final Report P a g e | 206 Coverage of the HIV test Table HA.11 shows the coverage of the HIV tests in men and women age 15-49 years, by area of residence, and shows as well the reasons why blood collection was not done in some eligible individuals. Overall, 80 percent of individuals eligible for HIV testing were surveyed and their blood analyzed to determine the presence of HIV. This coverage figure is mostly related to the response rate of the survey. There were various reasons for not being able to obtain a blood sample: refusal (10 percent), absence at the time of blood collection (7 percent), as well as logistical and technical issues at the time of blood collection or testing (2 percent). There is a large difference in the coverage of the test between women (89 percent) and men (70 percent), as is typical of such surveys. The lowest coverage figures are seen in Region Centre East, for both women and men (86 and 63 percent respectively). Sao Tome and Principe 2014 MICS, Final Report P a g e | 207 Table HA.12: Coverage of HIV test by socio-demographic characteristics Percent distribution of men and women age 15-49 eligible for HIV testing, by testing status, Sao Tome and Principe, 2014 Blood sample collected Refused test Absent for blood collection Other/ Missing Total Number of eligible men and women age 15-49 years Surveyed Surveyed Surveyed Surveyed Yes No Yes No Yes No Yes No WOMEN Total 89.3 0.5 3.9 1.8 0.9 2.0 0.5 1.0 100.0 3,101 Age 15-19 years 88.1 0.7 3.6 1.6 1.5 1.9 0.8 1.8 100.0 732 20-24 years 90.5 0.4 3.3 1.2 0.6 1.9 0.6 1.4 100.0 486 25-29 years 90.3 0.6 2.9 2.9 1.2 1.4 0.4 0.4 100.0 513 30-34 years 89.4 0.4 5.2 1.5 0.8 1.9 0.0 0.8 100.0 481 35-39 years 88.2 0.6 4.7 1.4 0.8 3.0 0.3 1.1 100.0 363 40-44 years 89.0 0.3 4.9 1.6 0.3 2.9 0.6 0.3 100.0 309 45-49 years 90.8 0.0 3.2 3.2 0.5 1.4 0.5 0.5 100.0 217 Education None 82.7 3.1 3.1 1.6 0.8 0.8 0.0 7.9 100.0 127 Primary 90.4 0.3 3.4 2.4 0.8 1.5 0.5 0.8 100.0 1,600 Secondary 89.0 0.5 4.5 1.2 1.2 2.5 0.5 0.7 100.0 1,297 Higher 84.4 0.0 6.5 2.6 0.0 5.2 1.3 0.0 100.0 77 Missing - - - - - - - - 0.0 0 Wealth quintiles Poorest 92.4 0.2 2.2 1.8 0.4 1.3 0.0 1.6 100.0 450 Second 90.2 0.3 4.1 1.7 0.5 1.5 0.5 1.0 100.0 581 Middle 89.0 0.3 4.0 1.8 1.3 1.9 0.6 1.0 100.0 620 Fourth 88.6 0.7 4.5 2.1 0.7 1.9 0.7 0.7 100.0 674 Richest 87.8 0.6 4.1 1.8 1.4 2.8 0.4 1.0 100.0 776 MEN Total 70.3 0.6 8.4 6.3 2.3 9.9 0.7 1.4 100.0 2,772 Age 15-19 years 78.3 0.5 7.4 3.6 2.2 5.2 0.8 2.0 100.0 635 20-24 years 68.9 0.4 8.0 6.6 3.0 9.7 0.8 2.5 100.0 473 25-29 years 67.5 0.2 9.4 6.4 1.9 12.7 0.9 0.9 100.0 425 30-34 years 66.9 0.9 8.4 8.4 2.7 11.1 0.4 1.1 100.0 450 35-39 years 69.1 1.2 10.4 6.1 2.0 10.4 0.3 0.6 100.0 346 40-44 years 65.6 0.4 8.7 7.9 2.1 14.1 0.8 0.4 100.0 241 45-49 years 69.8 0.5 6.4 7.9 2.5 10.9 1.0 1.0 100.0 202 Education None 40.7 1.9 7.4 14.8 1.9 20.4 1.9 11.1 100.0 54 Primary 70.7 0.5 8.2 7.0 2.4 9.6 0.6 1.1 100.0 1,275 Secondary 72.7 0.5 8.7 4.7 2.4 8.7 0.8 1.4 100.0 1,327 Higher 61.6 1.0 10.1 8.1 2.0 17.2 0.0 0.0 100.0 99 Missing (*) (*) (*) (*) (*) (*) (*) (*) 100.0 17 Wealth quintiles Poorest 75.6 0.7 7.8 6.2 1.1 5.8 0.7 2.2 100.0 451 Second 72.4 0.0 7.2 5.9 2.4 10.1 0.2 1.8 100.0 543 Middle 69.5 0.4 9.7 6.6 2.2 9.7 1.1 0.7 100.0 544 Fourth 69.2 1.0 7.7 5.5 2.8 11.9 1.2 0.7 100.0 597 Richest 66.6 0.8 9.4 7.2 2.8 11.0 0.5 1.7 100.0 637 a Includes all dry blood spot samples tested in laboratory for which result is available, be it positive, negative or indeterminate. Indeterminate means that all tests were done on the sample in line with the algorithm, but the final result was inconclusive. b Includes: 1) other blood collection results (e.g. technical problems in the field), 2) lost samples, 3) unmatched bar codes, e 4) other laboratory results, e.g. blood not tested for technical reasons, blood sample too small to complete the algorithm, etc. (*) Figures that are based on fewer than 25 unweighted cases As shown in Table HA.12, differentials in test coverage figures between the various socio- demographic characteristics are not large. Among women, there appears to be a slightly declining Sao Tome and Principe 2014 MICS, Final Report P a g e | 208 trend in participation as wealth increases. Among men, there was a notably higher participation among the 15-19 years age group than in any others, and a clearer declining trend in participation as wealth increases than that seen among women. HIV prevalence The results of the 2014 MICS indicate that the prevalence of HIV infection in the 15-49 years population is 0.5 percent (see Table HA.13) in both men and women. The effect of non-response were taken into account and incorporated in the prevalence estimate. With such low HIV prevalence in both men and women, the differentials by age groups are generally small. Nonetheless, the results suggest a slight upward trend from the youngest to the oldest in both sexes. The apparent lower prevalence in men age 40-44 years is probably a simple manifestation of sampling variation and should not be over-interpreted. Table HA.13:130Prevalence of HIV by age Percentage of women and men age 15-49 years who were surveyed, had a HIV test and whose results were positive, Sao Tome and Principe, 2014 Women Men Overall Percent HIV positive Number of women age 15-49 years Percent HIV positive Number of men age 15- 49 years Percent HIV positive Number of individuals age 15-49 years Total 0.5 2518 0.5 2201 0.5 4719 Age 15-19 years 0.0 595 0.0 577 0.0 1172 20-24 years 0.3 408 0.0 356 0.1 764 25-29 years 0.5 422 0.2 342 0.4 765 30-34 years 0.4 379 0.5 327 0.4 705 35-39 years 0.4 296 1.2 271 0.8 567 40-44 years 1.2 247 0.3 170 0.8 417 45-49 years 1.7 171 3.0 158 2.3 330 Table HA.14 presents HIV prevalence by some socio-economic characteristics. Once again, at such a low prevalence, differentials are generally small and interpretation of such small differences should be cautious. The results suggest a slight upward trend in prevalence from the wealthiest to the poorest. Sao Tome and Principe 2014 MICS, Final Report P a g e | 209 Table HA.14:131Prevalence of HIV by socio-economic characteristics Percentage of women and men age 15-49 years who were surveyed, had a HIV test and whose results were positive, Sao Tome and Principe, 2014 Women Men Overall Percent HIV positive Number of women age 15-49 years Percent HIV positive Number of men age 15- 49 years Percent HIV positive Number of individuals age 15-49 years Total 0.5 2518 0.5 2201 0.5 4719 Area Urban 0.3 1727 0.4 1482 0.3 3209 Rural 0.8 791 0.7 719 0.8 1510 Region Centre East 0.4 1668 0.3 1312 0.3 2980 North West 0.6 482 0.7 473 0.6 955 South East 0.6 275 0.2 305 0.4 580 Autonomous of Principe 0.6 92 2.7 112 1.7 204 Education None 0.0 79 (*) 18 1.5 97 Primary 0.9 1230 0.5 929 0.7 2159 Secondary 0.0 1125 0.4 1155 0.2 2280 Higher 0.0 84 0.0 99 0.0 183 Wealth quintiles Poorest 2.0 313 1.0 323 1.5 635 Second 0.5 418 0.2 389 0.3 807 Middle 0.6 470 0.8 392 0.7 862 Fourth 0.1 545 0.6 491 0.3 1037 Richest 0.0 772 0.1 605 0.1 1378 (*) Figures that are based on fewer than 25 unweighted cases HIV prevalence by socio-demographic characteristics is presented in Table HA.15. The results suggest some variations by marital status, with a slightly higher prevalence among divorced or separated individuals (1.5 percent), while it is of 0.4 percent among those who are married or in union, and 0.2 percent among those who are single. Interpretation must be cautious with respect to other apparent small differences, many of which may result from sampling variation. Sao Tome and Principe 2014 MICS, Final Report P a g e | 210 Table HA.15:132Prevalence of HIV by socio-demographic characteristics Percentage of women and men age 15-49 years who were surveyed, had a HIV test and whose results were positive, Sao Tome and Principe, 2014 Women Men Overall Percent HIV positive Number of women age 15-49 years Percent HIV positive Number of men age 15- 49 years Percent HIV positive Number of individuals age 15-49 years Total 0.5 2518 0.5 2201 0.5 4719 Marital status Single 0.0 646 0.3 919 0.2 1565 Has had sexual intercourse 0.0 301 0.3 569 0.2 869 Never had sexual intercourse 0.0 345 0.2 350 0.1 695 Married/in union 0.4 1411 0.4 1055 0.4 2466 Divorced/separated 1.3 450 1.8 225 1.5 675 Widowed (*) 11 (*) 3 (*) 13 Type of union Polygynous 0.2 289 0.0 131 0.1 420 Monogamous 0.5 1098 0.5 922 0.5 2020 Not in union 0.5 1106 0.6 1146 0.5 2253 Missing (*) 25 (*) 1 (*) 27 Pregnancy status Pregnant 0.0 208 na na na na Not pregnant/DK 0.5 2287 na na na na Missing (1.8) 23 na na na na Male circumcision status Circumcised na na 0.0 72 na na Not circumcised na na 0.5 2128 na na Missing na na (*) 1 na na na: not applicable ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Certain sexual behaviours increase the risk of HIV infection. Table HA.16 shows HIV prevalence by a number of sexual behaviour characteristics and according to having or not done an HIV test prior to the survey. However, it is important to remember that questions related to sexual behaviour are very sensitive and it is quite possible that some risky behaviours were not reported during the interview. Further, the majority of the information that was recorded refers to practices over the 12- month period preceding the survey and may not reflect prior sexual behaviours. Consequently, interpretation of the results must be cautious. Overall, HIV prevalence among individuals who previously had sexual intercourse is 0.5 percent for both men and women. Age at first sex appears to be an important characteristic in women since women who had first sex before age 16 present a prevalence of 1.5 percent which is higher than those who had first sex at a later age; the same doesn’t appear to apply to men. With respect to the use of condom at the last sexual intercourse, the differences are small and do not allow to reach a specific conclusion. On the other hand, the results suggest a slight upward trend in prevalence as the number of lifetime sexual partners increase. Sao Tome and Principe 2014 MICS, Final Report P a g e | 211 Individuals who had an HIV test prior to the survey show an HIV prevalence of 0.6 percent, while it is 0.3 percent among those who did not do such a test. Table HA.16:133Prevalence of HIV by sexual behaviour and prior HIV test Percentage of women and men age 15-49 years who had prior sexual intercourse, who had a HIV test and whose results were positive, Sao Tome and Principe, 2014 Women Men Overall Percent HIV positive Number of women age 15-49 years Percent HIV positive Number of men age 15-49 years Percent HIV positive Number of individuals age 15-49 years Total 0.5 2169 0.5 1851 0.5 4020 Age at first sex <16 years 1.5 496 0.4 580 0.9 1077 16-17 years 0.2 743 0.5 600 0.3 1342 18-19 years 0.5 640 0.7 401 0.6 1040 >20 years 0.0 291 0.8 270 0.4 561 Use of condom at last sexual intercourse in last 12 months Used a condom 0.8 426 0.8 649 0.8 1075 Did not use a condom 0.5 1553 0.5 1002 0.5 2555 No sex in last 12 months 0.4 183 0.0 121 0.2 304 DK/Missing (*) 7 0.0 79 0.0 86 Number of lifetime sexual partners 1 0.1 899 0.0 226 0.1 1125 2 0.7 668 0.3 232 0.6 900 3-4 0.8 507 0.2 416 0.5 923 5-9 3.2 80 0.4 418 0.8 498 >10 (*) 4 1.2 430 1.2 434 DK/Missing (*) 11 1.3 129 1.2 140 HIV test prior to the survey Tested 0.6 1819 0.7 1114 0.6 2934 Knew the result 0.5 1770 0.5 1041 0.5 2811 Did not know the result 4.5 49 2.9 73 3.5 122 Never tested 0.4 323 0.3 735 0.3 1058 Missing (0.0) 27 (*) 1 (0.0) 28 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases HIV prevalence among youth age 15-24 years is an indirect indicator of recent infections in countries where the epidemic is generalized and sexual transmission dominates, which of course is not the situation of Sao Tome and Principe. According to this survey, HIV prevalence in this age group is only 0.1 percent (data not shown). The differentials between various background characteristics are small and not meaningful. This includes a prevalence of 0.3 and 0.2 percent in young women and young men respectively who did not use a condom at the last sexual intercourse in the previous 12 months, as compared with a prevalence of 0.0 percent among those who did. While the difference in the point estimates is in the expected direction, it is too small to be meaningfully interpreted at this sample size. Sao Tome and Principe 2014 MICS, Final Report P a g e | 212 XIII. Access to Mass Media and Use of Information/Communication Technology The 2014 Sao Tome and Principe MICS collected information on exposure to mass media and the use of computers and the internet. Information was collected on exposure to newspapers/magazines, radio and television among women and men age 15-49 years, while the questions on the use of computers and the use of the internet was asked to 15-24 year-olds. Access to Mass Media The proportion of women who read a newspaper or magazine, listen to the radio and watch television at least once a week is shown in table MT.1. About 18 percent of women in Sao Tome and Principe read a newspaper or magazine, 77 percent listen to the radio, and 85 percent watch television at least once a week. Overall, 9 percent do not have regular exposure to any of the three media, while 91 percent are exposed to at least one and 16 to all the three types of media on a weekly basis. Sao Tome and Principe 2014 MICS, Final Report P a g e | 213 Table MT.1:134Exposure to mass media (women) Percentage of women age 15-49 years who are exposed to specific mass media on a weekly basis, Sao Tome and Principe, 2014 Percentage of women age 15-49 years who: All three media at least once a week1 Any media at least once a week None of the media at least once a week Number of women age 15- 49 years Read a newspaper at least once a week Listen to the radio at least once a week Watch television at least once a week Total 18.3 76.9 85.3 15.9 90.7 9.0 2,935 Age 15-19 24.3 85.4 93.6 22.4 97.0 3.0 702 20-24 18.8 76.0 87.5 16.1 92.4 7.4 467 25-29 15.1 73.0 83.6 13.2 88.3 11.4 484 30-34 14.8 73.0 83.2 12.6 88.0 11.6 446 35-39 17.6 76.1 85.0 14.9 91.4 8.3 349 40-44 17.3 75.0 79.1 14.1 86.6 12.6 290 45-49 14.4 71.8 69.1 10.7 81.7 17.9 198 Region Centre East 15.2 76.6 87.8 13.1 91.9 7.8 1,983 North West 24.5 76.4 79.5 20.5 88.4 11.2 524 South East 17.6 74.5 76.3 16.0 84.6 15.1 326 Autonomous of Principe 48.9 94.0 95.7 45.9 99.2 0.8 103 Area Urban 17.8 77.1 87.5 15.6 91.6 8.1 1,997 Rural 19.4 76.6 80.6 16.5 88.9 10.7 938 Education None 0.9 62.0 57.0 0.9 71.7 26.6 91 Primary 11.0 71.3 78.7 8.9 86.1 13.6 1,426 Secondary 25.7 83.6 93.5 23.2 96.4 3.4 1,318 Higher 40.8 83.9 96.6 33.8 100.0 0.0 99 Wealth index quintile Poorest 12.5 59.3 54.1 8.1 70.5 29.1 524 Second 14.5 72.0 81.1 12.4 88.0 11.6 581 Middle 17.9 78.2 92.1 15.5 94.9 4.9 566 Fourth 18.2 83.8 95.1 17.1 97.2 2.3 598 Richest 26.5 87.9 98.9 24.3 99.6 0.2 666 1 MICS indicator 10.1 - Exposure to mass media Women under age 20 are slightly more likely than older women to report exposure to all three types of mass media. Strong differentials by region, education and socio-economic status are observed for exposure to all types of media. About 34 percent of women with higher education are exposed to all three types of media, as compared with 9 percent of women with primary education. Similarly, 24 percent of women in the richest households are exposed to all the three media forms, while the corresponding proportion of women in the poorest households is only 8 percent. On the other hand, the differentials between urban and rural areas are small. Exposure of women to all the three mass media ranges from 13 percent in Region Centre East to 46 percent in Autonomous Region of Principe. Sao Tome and Principe 2014 MICS, Final Report P a g e | 214 Men age 15-49 years report a notably higher level of exposure to all types of media than women as shown in Table MT.1M. At least once a week, 32 percent of men read a newspaper or magazine, 83 percent listen to the radio, and 90 percent watch television. About 5 percent do not have regular exposure to any of the three media, while 95 percent are exposed to at least one and 28 to all the three types of media on a weekly basis. The table shows that, for men, the relationships between exposure to mass media and background characteristics are generally similar to those observed among women. However, interestingly, men have a different pattern of media exposure by age than women. While younger women are more likely than older women to report exposure to all three types of media on a weekly basis, younger men are generally less likely than older men to be exposed to all three media, particularly because they are less likely to read a newspaper/magazine on a weekly basis. Table MT.1M:135Exposure to mass media (men) Percentage of men age 15-49 years who are exposed to specific mass media on a weekly basis, Sao Tome and Principe, 2014 Percentage of men age 15-49 years who: All three media at least once a week1 Any media at least once a week None of the media at least once a week Number of men age 15- 49 years Read a newspaper at least once a week Listen to the radio at least once a week Watch television at least once a week Total 32.0 83.3 90.2 28.4 95.0 5.0 2,267 Age 15-19 28.1 82.6 93.8 25.5 96.7 3.2 588 20-24 27.5 84.8 91.2 25.8 95.9 4.1 378 25-29 32.0 79.9 88.0 28.0 92.9 7.1 354 30-34 35.9 85.7 93.0 32.1 95.9 3.7 327 35-39 32.8 84.0 88.3 29.1 94.7 5.3 284 40-44 35.8 82.4 82.1 26.5 92.0 8.0 175 45-49 43.7 85.3 86.2 38.9 92.7 7.3 161 Region Centre East 30.0 82.7 92.2 26.8 95.2 4.8 1,449 North West 33.4 83.4 88.1 28.4 94.8 4.7 415 South East 33.6 82.7 82.2 28.8 93.0 7.0 309 Autonomous of Principe 52.1 94.4 95.9 50.9 98.2 1.8 93 Area Urban 33.8 83.9 92.7 30.2 96.1 3.9 1,508 Rural 28.4 82.2 85.2 24.6 92.6 7.2 759 Education None (0.0) (56.2) (66.5) (0.0) (77.1) (22.9) 22 Primary 22.6 79.3 84.3 18.9 91.6 8.3 951 Secondary 37.3 86.7 94.7 33.8 97.7 2.2 1,189 Higher 63.8 88.0 97.5 58.5 97.5 2.5 105 Wealth index quintile Poorest 24.0 68.7 74.0 17.5 85.2 14.4 462 Second 26.4 84.6 87.5 22.8 94.6 5.4 458 Middle 31.6 88.7 95.9 29.6 98.4 1.6 435 Fourth 37.0 87.2 96.7 35.7 97.6 2.4 455 Richest 41.2 88.0 97.6 36.5 99.4 0.6 456 1 MICS indicator 10.1 - Exposure to mass media[M] Sao Tome and Principe 2014 MICS, Final Report P a g e | 215 Use of Information/Communication Technology The questions on computer and internet use were asked only to 15-24 year old women and men. As shown in Table MT.2, 48 percent of 15-24 year old women ever used a computer, 37 percent used a computer during the last year, and 27 percent used one at least once a week during the last month. Overall, 37 percent of women age 15-24 ever used the internet, while 32 percent used it during the last year. The proportion of young women who used the internet more frequently, at least once a week during the last month, is smaller, at 24 percent. As expected, both the computer and internet use during the last 12 months is more widespread among the 15-19 year old women, but not by much. Use of a computer and the internet is strongly associated with education and wealth. Only 7 percent of women with primary education (or no formal education) report using a computer during the last year, while nearly half (49 percent) of those with secondary or higher education used a computer. Similarly higher utilisation of the internet last year is observed among young women in urban areas (36 percent) compared to those in rural areas (24 percent). The use of the internet during the last year ranges from 16 percent in Region North West to 39 percent in Region Centre East, while the proportion is 64 percent for young women in the richest households, as opposed to 10 percent in those living in the poorest households. Sao Tome and Principe 2014 MICS, Final Report P a g e | 216 Table MT.2:136Use of computers and internet (women) Percentage of young women age 15-24 years who have ever used a computer and the internet, percentage who have used during the last 12 months, and percentage who have used at least once weekly during the last one month, Sao Tome and Principe, 2014 Percentage of women age 15-24 years who have: Number of women age 15-24 years Ever used a computer Used a computer during the last 12 months1 Used a computer at least once a week during the last one month Ever used the internet Used the internet during the last 12 months2 Used the internet at least once a week during the last one month Total 47.9 37.2 27.1 36.9 32.3 24.3 1,169 Age 15-19 52.4 40.1 29.3 39.6 34.7 25.4 702 20-24 41.3 32.7 23.9 32.8 28.8 22.7 467 Region Centre East 54.3 43.3 32.2 43.2 39.1 29.7 809 North West 32.6 23.4 15.5 20.5 16.6 11.2 205 South East 32.5 21.3 14.2 22.1 15.9 11.3 118 Aut. of Principe 43.4 29.2 23.2 39.1 24.2 20.5 36 Area Urban 50.8 40.1 29.4 40.3 36.1 27.0 804 Rural 41.5 30.7 22.3 29.6 23.8 18.5 365 Education None/Primary 15.1 6.9 3.0 7.7 4.7 2.4 320 Secondary/Higher 61.0 49.2 36.8 48.6 43.3 33.1 780 Wealth index quintile Poorest 22.8 14.1 8.1 13.7 9.8 6.2 177 Second 29.9 20.0 11.9 19.2 13.6 9.3 248 Middle 43.1 29.3 21.1 27.0 22.2 17.5 224 Fourth 60.1 47.7 36.5 47.3 42.0 32.9 250 Richest 73.7 64.8 50.0 67.1 63.7 47.7 269 1 MICS indicator 10.2 - Use of computers 2 MICS indicator 10.3 - Use of internet Young men are more common users of computers and internet during the last year than young women. As shown in Table MT.2M, 48 percent of 15-24 year old men used a computer during the last year while 43 percent used the internet in the same period. As displayed in the table, for young men, the differentials in terms of background characteristics generally go in the same direction as those observed among young women. For example, 12 percent of young men in the poorest households used the internet during the last year compared to 76 percent among the young men in the richest households. Sao Tome and Principe 2014 MICS, Final Report P a g e | 217 Table MT.2M:137Use of computers and internet (men) Percentage of young men age 15-24 years who have ever used a computer and the internet, percentage who have used during the last 12 months, and percentage who have used at least once weekly during the last one month, Sao Tome and Principe, 2014 Percentage of men age 15-24 years who have: Number of men age 15-24 years Ever used a computer Used a computer during the last 12 months1 Used a computer at least once a week during the last one month Ever used the internet Used the internet during the last 12 months2 Used the internet at least once a week during the last one month Total 60.2 48.3 34.8 51.0 42.9 34.1 966 Age 15-19 61.3 48.1 33.3 50.4 42.0 33.6 588 20-24 58.4 48.7 37.0 51.9 44.2 34.9 378 Region Centre East 67.3 56.1 41.5 60.3 51.6 41.8 636 North West 43.1 32.4 20.5 31.6 24.8 17.9 170 South East 46.4 32.5 20.0 30.8 25.0 17.9 129 Aut. of Principe 64.5 42.8 35.7 51.7 37.5 33.4 31 Area Urban 67.8 55.9 40.4 59.3 50.0 40.5 653 Rural 44.3 32.7 23.1 33.9 27.9 20.9 314 Education None/Primary 22.0 15.2 7.8 14.8 10.5 6.6 301 Secondary/Higher 78.1 63.9 47.4 68.0 58.0 47.0 618 Wealth index quintile Poorest 27.5 16.8 7.5 18.8 12.3 8.9 180 Second 40.0 28.4 15.3 27.9 21.4 13.0 201 Middle 57.2 41.3 26.9 48.9 40.1 30.8 184 Fourth 86.1 71.0 53.0 71.9 61.7 49.6 206 Richest 86.3 80.6 68.1 84.3 75.7 65.8 195 1 MICS indicator 10.2 - Use of computers 2 MICS indicator 10.3 - Use of internet Sao Tome and Principe 2014 MICS, Final Report P a g e | 218 XIV. Subjective well-being Subjective perceptions of individuals of their incomes, health, living environments and the like, play a significant role in their lives and can impact their perception of well-being, irrespective of objective conditions such as actual income and physical health statusi. In the MICS, a set of questions were asked to women and men age 15-24 years to understand how satisfied this group of young people is in different areas of their lives, such as their family life, friendships, school, current job, health, where they live, how they are treated by others, how they look, and their current income. Life satisfaction is a measure of an individual’s perceived level of well-being. Understanding young women and young men’s satisfaction in different areas of their lives can help to gain a comprehensive picture of young people’s life situations. A distinction can also be made between life satisfaction and happiness. Happiness is a fleeting emotion that can be affected by numerous factors, including day-to-day factors such as the weather, or a recent death in the family. It is possible for a person to be satisfied with job, income, family life, friends, and other aspects of life, but still be unhappy, or vice versa. In addition to the set of questions on life satisfaction, the survey also asked questions about happiness and the respondents’ perceptions of a better life. To assist respondents in answering the set of questions on happiness and life satisfaction they were shown a card with smiling faces (and not so smiling faces) that corresponded to the response categories (see the Questionnaires in Appendix F) ‘very satisfied’, ‘somewhat satisfied‘, ‘neither satisfied nor unsatisfied’, ‘somewhat unsatisfied’ and ‘very unsatisfied’. For the question on happiness, the same scale was used, this time ranging from ‘very happy’ to ‘very unhappy’, in the same fashion. Respectively, Tables SW.1 and SW.1M show the proportion of young women and young men age 15- 24 years, who are very or somewhat satisfied in selected domains. Note that for three domains, satisfaction with school, job and income, the denominators are confined to those who are currently attending school, have a job, and have an income. Of the different domains, young women are the most satisfied with their look (82 percent), their family life (80 percent), and their friendships (79 percent). The results for young men are somewhat higher; they are the most satisfied with the way they look (89 percent,) their health (86 percent) and their friendships and family life (both 84 percent). Among the domains, both young women and young men are the least satisfied with their current income, with 71 percent of young women and 46 percent of young men not having an income at all. Findings are generally quite similar by region, area, level of education, and even remarkably so by socio-economic level (for results with sufficiently large sample sizes). i OECD. 2013. OECD Guidelines on Measuring Subjective Well Being. OECD. http://dx.doi.org/10.1787/9789264191655-en Sao Tome and Principe 2014 MICS, Final Report P a g e | 219 Table SW.1:138Domains of life satisfaction (women) Percentage of women age 15-24 years who are very or somewhat satisfied in selected domains of satisfaction, Sao Tome and Principe, 2014 Percentage of women age 15-24 years who are very or somewhat satisfied in selected domains: Percentage of women age 15-24 years who: Number of women age 15-24 years Percentage of women age 15-24 years who are very or somewhat satisfied with school Number of women age 15-24 years attending school Percentage of women age 15-24 years who are very or somewhat satisfied with their job Number of women age 15-24 years who have a job Percentage of women age 15-24 years who are very or somewhat satisfied with their income Number of women age 15-24 years who have an income Family life Friend- ships Health Living envi- ron- ment Treat- ment by others The way they look Are atten- ding school Have a job Have an income Total 79.7 78.9 75.1 68.8 65.2 81.7 55.0 20.2 28.9 1,169 75.5 643 71.4 237 51.2 337 Age 15-19 78.9 79.6 77.7 71.1 65.5 83.1 71.7 8.2 17.3 702 75.0 503 71.9 58 54.2 121 20-24 80.8 77.7 71.1 65.4 64.6 79.6 29.9 38.3 46.2 467 77.1 139 71.2 179 49.5 216 Region Centre East 76.0 77.1 72.4 64.3 62.4 79.3 57.5 20.8 30.7 809 72.6 465 70.5 169 48.1 249 North West 88.1 82.3 81.1 81.7 71.1 89.7 49.0 18.4 20.1 205 77.5 101 71.1 38 55.1 41 South East 88.1 85.6 78.1 77.5 70.7 83.1 48.5 16.1 26.5 118 93.2 57 74.7 19 71.3 31 Aut. of Principe 86.8 75.4 90.1 69.2 75.4 84.1 55.2 31.7 45.2 36 (81.2) 20 (*) 11 (49.9) 16 Area Urban 78.5 79.4 76.0 66.6 63.3 82.0 57.0 21.2 30.6 804 73.1 458 73.2 171 51.0 246 Rural 82.2 77.7 72.9 73.7 69.3 81.0 50.6 18.0 25.1 365 81.3 184 66.7 66 51.7 92 Marital Status Ever marrieda 80.2 77.8 76.4 64.6 65.4 80.7 14.2 34.2 43.9 468 82.7 67 74.1 160 50.5 205 Never married 79.3 79.6 74.2 71.7 65.0 82.3 82.2 10.9 18.8 701 74.6 576 65.8 76 52.2 132 Education None/Primary 81.9 78.3 76.3 67.3 65.9 82.1 9.4 29.1 38.8 333 (90.8) 31 74.1 97 49.7 129 Secondary/Higher 78.8 79.1 74.6 69.4 64.9 81.5 73.1 16.7 24.9 836 74.7 611 69.5 140 52.1 208 Wealth index quintile Poorest 84.6 76.4 79.5 65.3 69.3 84.0 32.0 27.2 32.1 177 87.9 57 72.7 48 44.4 57 Second 84.4 79.7 77.7 71.6 66.5 82.0 43.4 19.0 27.2 248 80.8 108 78.6 47 64.8 67 Middle 76.0 77.8 74.1 63.5 64.7 76.5 51.9 20.6 32.9 224 80.2 116 (61.1) 46 40.7 74 Fourth 74.6 79.5 74.5 68.7 57.1 82.5 59.3 21.1 30.3 250 70.2 149 (66.8) 53 47.0 76 Richest 79.7 80.0 71.1 73.3 69.1 83.3 79.3 15.6 23.6 269 70.6 214 (78.9) 42 60.0 63 a Married or in union ( ) Figures that are based on 25-49 unweighted cases; (*) Figures that are based on fewer than 25 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 220 Table SW.1M:139Domains of life satisfaction (men) Percentage of men age 15-24 years who are very or somewhat satisfied in selected domains of satisfaction, Sao Tome and Principe, 2014 Percentage of women age 15-24 years who are very or somewhat satisfied in selected domains: Percentage of women age 15-24 years who: Number of men age 15-24 years Percentage of men age 15-24 years who are very or somewhat satisfied with school Number of men age 15-24 years attending school Percentage of men age 15-24 years who are very or somewhat satisfied with their job Number of men age 15-24 years who have a job Percentage of men age 15-24 years who are very or somewhat satisfied with their income Number of men age 15-24 years who have an income Family life Friend- ships Health Living envi- ron- ment Treat- ment by others The way they look Are atten- ding school Have a job Have an income Total 83.7 84.0 86.0 81.1 77.2 89.0 58.2 48.1 54.3 966 78.3 563 79.9 465 64.0 525 Age 15-19 82.5 84.1 86.0 83.1 75.6 89.0 72.9 29.7 37.1 588 79.2 429 82.2 175 70.8 218 20-24 85.5 83.7 85.8 78.0 79.6 88.9 35.4 76.9 81.1 378 75.4 134 78.6 291 59.1 306 Region Centre East 80.9 82.5 84.1 77.8 75.3 88.8 62.0 42.9 50.1 636 77.5 394 74.9 273 59.4 319 North West 90.6 84.9 88.8 85.7 79.5 87.2 46.7 62.3 65.4 170 69.6 80 82.6 106 73.5 111 South East 86.4 88.8 89.3 89.8 81.4 90.9 55.3 53.0 56.9 129 90.3 71 93.3 68 70.7 73 Aut. of Principe 91.7 88.6 94.5 86.7 83.6 94.0 56.5 56.8 67.3 31 (85.9) 18 (89.6) 18 (59.8) 21 Area Urban 81.9 83.0 85.6 79.7 75.8 89.6 62.3 46.7 55.0 653 75.9 407 78.2 305 59.8 359 Rural 87.4 85.9 86.6 83.9 79.9 87.6 49.7 51.1 52.9 314 84.3 156 83.2 160 72.9 166 Marital Status Ever marrieda 87.4 81.2 87.1 73.3 70.0 84.6 12.5 92.0 93.4 128 (*) 16 75.5 118 64.5 120 Never married 83.1 84.4 85.8 82.3 78.3 89.6 65.2 41.4 48.3 838 78.1 546 81.4 347 63.8 405 Education None/Primary 88.4 83.9 85.3 79.5 75.5 88.7 17.2 74.0 75.1 309 85.8 53 83.1 228 65.8 232 Secondary/Higher 81.5 84.0 86.3 81.8 78.0 89.1 77.5 36.0 44.5 657 77.5 509 76.9 237 62.5 293 Wealth index quintile Poorest 87.7 84.3 86.6 79.9 74.1 90.3 32.0 66.9 69.4 180 89.2 58 85.0 121 68.0 125 Second 88.1 85.1 86.4 78.8 76.5 84.8 43.1 54.9 57.5 201 78.1 87 80.9 110 68.5 115 Middle 80.4 83.6 86.4 83.4 77.4 88.4 59.1 48.4 54.9 184 79.7 109 75.7 89 59.6 101 Fourth 81.0 85.8 85.2 78.0 74.9 91.2 74.1 40.0 49.4 206 77.6 153 80.6 82 69.0 102 Richest 81.4 80.8 85.3 85.6 82.9 90.2 80.3 32.3 41.6 195 74.0 157 73.8 63 50.6 81 a Married or in union ( ) Figures that are based on 25-49 unweighted cases; (*) Figures that are based on fewer than 25 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 221 In Tables SW.2 and SW.2M, proportions of women and men age 15-24 years with overall life satisfaction are shown. “Life satisfaction” is defined as those who are very or somewhat satisfied with their life overall, and is based on a single question which was asked after the life satisfaction questions on all of the above-mentioned domains, with the exception of the question on satisfaction with income, which was asked later. Overall, 76 percent of 15-24 year old women are satisfied with their life overall; the figures are remarkably similar between the various categories of wealth, but vary between regions from 73 percent, for Region Centre East, to 85 percent in Region North West. Urban and rural areas are similar, while life satisfaction among young women appears to be slightly higher than their older counterparts. Young men are somewhat more satisfied with their life (84 percent) than young women (76 percent), and there is some evidence that life satisfaction is highest among the poorest (91 percent). As a summary measure, the average life satisfaction score is also calculated and presented in Tables SW.2 and SW.2M. The score is simply calculated by averaging the responses to the question on overall life satisfaction, ranging from very satisfied (1) to very unsatisfied (5) (see questionnaires in Appendix F). Therefore, the lower the average score, the higher the life satisfaction levels. There is little variation in average life satisfaction score between the various background characteristics. The apparent larger variation by region must be interpreted cautiously due to the small sample size of Autonomous Region of Principe. The tables also show that 74 percent of women and 77 percent of men age 15-24 years are very or somewhat happy. Differences by wealth quintiles can be observed for this indicator and favour the poorest. Region Centre East shows the lowest value for this indicator both among young women and young men. Sao Tome and Principe 2014 MICS, Final Report P a g e | 222 Table SW.2:140Overall life satisfaction and happiness (women) Percentage of women age 15-24 years who are very or somewhat satisfied with their life overall, the average overall life satisfaction score, and percentage of women age 15-24 years who are very or somewhat happy, Sao Tome and Principe, 2014 Percentage of women with overall life satisfaction1 Average life satisfaction score Percentage of women who are very or somewhat happy 2 Number of women age 15-24 years Total 75.6 1.8 74.4 1,169 Age 15-19 78.0 1.8 74.4 702 20-24 71.9 1.9 74.3 467 Region Centre East 72.7 1.9 69.4 809 North West 84.9 1.7 86.2 205 South East 76.5 1.9 85.2 118 Autonomous of Principe 84.3 1.6 82.1 36 Area Urban 75.1 1.8 73.1 804 Rural 76.7 1.8 77.2 365 Marital Status Ever married/in union 71.5 1.9 77.5 468 Never married/in union 78.3 1.8 72.3 701 Education None/Primary 75.0 1.9 77.9 333 Secondary/Higher 75.8 1.8 72.9 836 Wealth index quintile Poorest 76.6 1.8 83.6 177 Second 73.4 1.9 77.0 248 Middle 75.3 1.9 71.2 224 Fourth 74.7 1.9 66.8 250 Richest 78.0 1.7 75.5 269 1 MICS Indicator 11.1 - Life satisfaction 2 MICS indicator 11.2 – Happiness Sao Tome and Principe 2014 MICS, Final Report P a g e | 223 Table SW.2M:141Overall life satisfaction and happiness (men) Percentage of men age 15-24 years who are very or somewhat satisfied with their life overall, the average overall life satisfaction score, and percentage of men age 15-24 years who are very or somewhat happy, Sao Tome and Principe, 2014 Percentage of men with overall life satisfaction1 Average life satisfaction score Percentage of men who are very or somewhat happy 2 Number of men age 15-24 years Total 84.2 1.7 77.3 966 Age 15-19 85.3 1.7 76.1 588 20-24 82.4 1.8 79.3 378 Region Centre East 81.1 1.8 73.4 636 North West 89.4 1.7 84.3 170 South East 90.5 1.6 84.2 129 Autonomous of Principe 91.7 1.4 89.6 31 Area Urban 83.6 1.7 75.8 653 Rural 85.2 1.7 80.5 314 Marital Status Ever married/in union 81.6 1.8 81.3 128 Never married/in union 84.5 1.7 76.7 838 Education None/Primary 82.2 1.8 78.7 309 Secondary/Higher 85.1 1.7 76.7 657 Wealth index quintile Poorest 90.9 1.7 84.2 180 Second 82.2 1.8 82.6 201 Middle 78.3 1.9 74.4 184 Fourth 84.9 1.7 70.9 206 Richest 84.7 1.6 75.0 195 1 MICS Indicator 11.1 - Life satisfaction[M] 2 MICS indicator 11.2 - Happiness[M] In addition to the series of questions on life satisfaction and happiness, respondents were also asked two simple questions on whether they think their life improved during the last one year, and whether they think their life will be better in one year’s time. Such information may contribute to our understanding of desperation that may exist among young people, as well as hopelessness and hopes for the future. Specific combinations of the perceptions during the last one year and expectations for the next one year may be valuable information to understand the general sense of well-being among young people. In Tables SW.3 and SW.3M, women’s and men’s perceptions of a better life are shown. The proportion of women age 15-24 years who think that their lives improved during the last one year and who expect that their lives will get better after one year, is 59 percent. The corresponding indicator for men age 15-24 years is similar at 63 percent. Differences in the perception of a better life among young women are generally small between the various background characteristics, except regions where variations may be somewhat larger but the small sample size of Autonomous Sao Tome and Principe 2014 MICS, Final Report P a g e | 224 Region of Principe must be taken into account. As for young men, 55 percent of those living 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 is 72 percent for those living in households in the richest wealth quintile. The same indicator varies between regions from 59 percent in Region North West to 86 in Autonomous Region of Principe, although interpretation must be cautious in the latter due to small sample size. Table SW.3:142Perception of a better life (women) Percentage of women age 15-24 years who think that their lives improved during the last one year and those who expect that their lives will get better after one year, Sao Tome and Principe, 2014 Percentage of women who think that their life Number of women age 15-24 years Improved during the last one year Will get better after one year Both1 Total 60.8 95.3 59.4 1,169 Age 15-19 58.7 94.7 56.7 702 20-24 64.0 96.2 63.5 467 Region Centre East 58.8 95.9 57.5 809 North West 61.9 94.9 60.8 205 South East 69.4 91.6 66.8 118 Autonomous of Principe 70.2 96.4 70.2 36 Area Urban 61.3 95.1 59.8 804 Rural 59.7 95.6 58.5 365 Marital Status Ever married/in union 61.1 95.1 59.9 468 Never married/in union 60.6 95.4 59.1 701 Education None/Primary 57.8 92.0 55.9 333 Secondary/Higher 62.0 96.6 60.8 836 Wealth index quintile Poorest 56.2 93.6 55.2 177 Second 63.0 94.5 61.1 248 Middle 56.2 95.1 55.2 224 Fourth 62.3 96.7 61.6 250 Richest 64.1 96.0 62.1 269 1 MICS indicator 11.3 - Perception of a better life Sao Tome and Principe 2014 MICS, Final Report P a g e | 225 Table SW.3M:143Perception of a better life (men) Percentage of men 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, Sao Tome and Principe, 2014 Percentage of men who think that their life Number of men age 15-24 years Improved during the last one year Will get better after one year Both1 Total 64.7 95.6 63.4 966 Age 15-19 66.0 94.9 64.6 588 20-24 62.7 96.7 61.6 378 Region Centre East 62.3 96.2 61.3 636 North West 61.1 94.6 59.1 170 South East 75.7 94.4 74.0 129 Aut. of Principe 86.1 93.7 86.1 31 Area Urban 65.7 95.9 64.3 653 Rural 62.5 94.9 61.5 314 Marital Status Ever married/in union 61.4 94.2 59.2 128 Never married/in union 65.2 95.8 64.1 838 Education None/Primary 63.0 95.1 61.7 309 Secondary/Higher 65.5 95.8 64.2 657 Wealth index quintile Poorest 56.5 94.2 54.6 180 Second 61.1 95.7 60.5 201 Middle 63.7 96.8 63.2 184 Fourth 67.9 93.9 66.2 206 Richest 73.4 97.4 71.8 195 1 MICS indicator 11.3 - Perception of a better life[M] Sao Tome and Principe 2014 MICS, Final Report P a g e | 226 XV. Tobacco and Alcohol Use Tobacco products are products made entirely or partly of leaf tobacco as raw material, which are intended to be smoked, sucked, chewed, or snuffed. All contain the highly addictive psychoactive ingredient, nicotine. Tobacco use is one of the main risk factors for a number of chronic diseases, including cancer, lung diseases, and cardiovascular diseases.i The consumption of alcohol carries a risk of adverse health and social consequences related to its intoxicating, toxic and dependence-producing properties. In addition to the chronic diseases that may develop in those who drink large amounts of alcohol over a number of years, alcohol use is also associated with an increased risk of acute health conditions, such as injuries, including from traffic accidents.ii Alcohol use also causes harm far beyond the physical and psychological health of the drinker. It harms the well-being and health of people around the drinker. An intoxicated person can harm others or put them at risk of traffic accidents or violent behaviour, or negatively affect co- workers, relatives, friends or strangers. Thus, the impact of the harmful use of alcohol reaches deep into society.iii The 2014 Sao Tome and Principe MICS collected information on ever and current use of tobacco and alcohol and intensity of use among women and men age 15-49 years. This section presents the main results. Tobacco Use Table TA.1 presents the current and ever use of tobacco products by women age 15-49 years, and Table TA.1M presents the corresponding information for men of the same age group. In Sao Tome and Principe, ever and current use of tobacco products is more common among men than among women. Overall, 33 percent of men and 8 percent of women reported to have ever used a tobacco product, while 9 percent of men and only 1 percent of women smoked cigarettes, or used smoked or smokeless tobacco products on one or more days during the last one month. At such low levels of use among women, differences between background characteristics are small. As for men, current use of tobacco produce increase with age from 2 percent in the 15-19 years group to 20 percent in the 45-49 group, but with much variation in between. There are also notable differences in the current use of tobacco products between levels of education, with 12 percent for men with primary education, down to 2 percent for men with higher education. Similarly, the level of current consumption is 15 percent among the poorest as compared with 5 percent among the wealthiest. i WHO. http://www.who.int/topics/tobacco/en/ ii WHO. http://www.who.int/topics/alcohol_drinking/en/ iii WHO. http://www.who.int/mediacentre/factsheets/fs349/en/ Sao Tome and Principe 2014 MICS, Final Report P a g e | 227 Table TA.1:144Current and ever use of tobacco (women) Percentage of women age 15-49 years by pattern of use of tobacco, Sao Tome and Principe, 2014 Never smoked cigarettes or used other tobacco products Ever users Users of tobacco products at any time during the last one month Number of women age 15-49 years Only cigarettes Cigarettes and other tobacco products Only other tobacco products Any tobacco product Only cigarettes Cigarettes and other tobacco products Only other tobacco products Any tobacco product1 Total 92.3 2.1 0.5 4.8 7.4 0.2 0.1 0.9 1.1 2,935 Age 15-19 91.6 1.2 0.5 5.9 7.5 0.0 0.0 1.0 1.0 702 20-24 91.7 3.2 0.6 4.5 8.3 0.0 0.4 0.4 0.8 467 25-29 93.3 0.8 0.8 5.1 6.7 0.2 0.0 0.6 0.8 484 30-34 91.0 2.6 1.0 5.1 8.7 0.0 0.0 1.8 1.8 446 35-39 95.0 2.3 0.0 2.8 5.0 0.0 0.0 0.6 0.6 349 40-44 92.6 3.9 0.0 3.5 7.4 0.2 0.0 0.9 1.1 290 45-49 92.1 1.7 0.4 5.5 7.6 1.5 0.0 1.3 2.8 198 Region Centre East 91.9 2.5 0.5 4.7 7.7 0.1 0.1 0.6 0.8 1,983 North West 92.2 0.7 0.7 6.2 7.7 0.4 0.0 2.1 2.5 524 South East 95.0 1.8 0.2 2.8 4.8 0.3 0.0 0.7 0.9 326 Autonomous of Principe 92.6 2.3 0.0 5.1 7.4 0.0 0.0 2.1 2.1 103 Area Urban 92.9 2.5 0.5 3.8 6.9 0.1 0.1 0.8 1.0 1,997 Rural 91.2 1.1 0.5 6.8 8.5 0.3 0.0 1.2 1.5 938 Education None 87.9 2.2 0.0 8.8 11.0 2.2 0.0 2.3 4.5 91 Primary 92.3 1.7 0.8 5.1 7.6 0.2 0.0 1.0 1.2 1,426 Secondary 92.5 2.3 0.3 4.6 7.1 0.0 0.1 0.8 0.9 1,318 Higher 95.8 4.2 0.0 0.0 4.2 0.0 0.0 0.0 0.0 99 Under-5s in the same household At least one 92.0 1.9 0.5 5.3 7.7 0.2 0.0 1.0 1.2 1,798 None 92.8 2.4 0.5 4.0 6.9 0.1 0.1 0.8 1.1 1,137 Wealth index quintile Poorest 92.8 1.2 1.0 4.7 6.9 0.4 0.0 1.5 2.0 524 Second 92.6 0.7 0.0 6.5 7.2 0.1 0.0 1.5 1.6 581 Middle 90.6 3.1 0.9 5.3 9.4 0.0 0.3 0.4 0.7 566 Fourth 92.6 1.7 0.5 5.0 7.3 0.0 0.0 1.1 1.1 598 Richest 93.0 3.5 0.2 2.7 6.4 0.2 0.0 0.2 0.5 666 1 MICS indicator 12.1 - Tobacco use Sao Tome and Principe 2014 MICS, Final Report P a g e | 228 Table TA.1M:145Current and ever use of tobacco (men) Percentage of men age 15-49 years by pattern of use of tobacco, Sao Tome and Principe, 2014 Never smoked cigarettes or used other tobacco products Ever users Users of tobacco products at any time during the last one month Number of men age 15-49 years Only cigarettes Cigarettes and other tobacco products Only other tobacco products Any tobacco product Only cigarettes Cigarettes and other tobacco products Only other tobacco products Any tobacco product1 Total 67.2 15.3 8.8 8.3 32.4 4.4 0.6 3.9 8.9 2,267 Age 15-19 85.3 4.4 1.0 8.8 14.2 0.2 0.0 1.9 2.1 588 20-24 66.4 16.4 8.6 8.1 33.1 3.2 0.5 3.5 7.2 378 25-29 57.7 19.4 13.5 8.9 41.8 7.0 2.3 4.3 13.6 354 30-34 59.2 16.8 13.5 10.5 40.8 2.8 0.2 5.2 8.2 327 35-39 61.1 20.7 9.1 8.6 38.4 8.9 0.2 4.8 14.0 284 40-44 62.8 21.1 9.9 6.2 37.2 3.6 0.5 4.5 8.6 175 45-49 55.8 23.9 16.1 3.1 43.0 13.0 1.3 6.1 20.5 161 Region Centre East 68.9 15.3 8.5 6.8 30.5 4.4 0.6 3.1 8.2 1,449 North West 60.8 12.1 11.9 15.3 39.2 4.1 0.8 8.3 13.2 415 South East 66.6 19.4 7.0 6.8 33.2 3.8 0.3 2.3 6.4 309 Autonomous of Principe 72.5 15.6 6.6 5.2 27.5 7.5 0.5 1.0 9.0 93 Area Urban 67.7 15.7 9.0 7.1 31.9 4.7 0.7 2.6 8.0 1,508 Rural 66.2 14.3 8.4 10.7 33.4 3.8 0.5 6.4 10.7 759 Education None (61.2) (28.3) (3.7) (6.9) (38.8) (17.0) (0.0) (6.9) (24.0) 22 Primary 61.5 16.4 11.1 10.6 38.1 5.4 0.9 5.2 11.5 951 Secondary 71.6 13.8 7.2 6.8 27.8 3.6 0.5 3.0 7.1 1,189 Higher 70.1 18.4 7.1 4.4 29.9 1.8 0.0 0.6 2.4 105 Under-5s in the same household At least one 65.1 15.4 9.7 9.4 34.6 3.3 0.7 4.9 8.8 1,045 None 69.1 15.1 8.0 7.4 30.5 5.4 0.5 3.1 9.0 1,222 Wealth index quintile Poorest 58.2 18.7 11.4 11.4 41.5 7.3 1.1 6.3 14.6 462 Second 64.9 15.3 9.2 10.2 34.7 5.4 0.2 4.0 9.5 458 Middle 67.6 13.8 9.3 9.3 32.4 3.8 1.1 4.7 9.6 435 Fourth 72.0 13.3 8.0 5.9 27.2 2.9 0.4 3.0 6.3 455 Richest 73.5 15.0 6.1 4.8 25.8 2.7 0.4 1.5 4.5 456 1 MICS indicator 12.1 - Tobacco use ( ) Figures that are based on 25-49 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 229 Figure TA.1: 23Ever and current smokers , Sao Tome and Pr inc ipe, 2014 Tables TA.2 and TA.2M present results on age at first use of cigarettes, for women and men respectively. The results show that less than 1 percent of women and 1 percent of men 15-49 years old smoked a cigarette for the first time before age 15. There is little variation by background characteristics. Ever users Users during the last one month 0 5 10 15 20 25 30 35 40 45 50 15-19 20-24 25-29 30-34 35-39 40-44 45-49 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Per cent Age Women Men Sao Tome and Principe 2014 MICS, Final Report P a g e | 230 Table TA.2:146Age at first use of cigarettes and frequency of use Percentage of women age 15-49 years who smoked a whole cigarette before age 15, Sao Tome and Principe, 2014 Percentage of women who smoked a whole cigarette before age 151 Number of women age 15-49 years Total 0.4 2,935 Age 15-19 0.7 702 20-24 0.0 467 25-29 0.0 484 30-34 0.7 446 35-39 0.0 349 40-44 1.0 290 45-49 0.2 198 Region Centre East 0.4 1,983 North West 0.3 524 South East 0.1 326 Autonomous of Principe 0.7 103 Area Urban 0.4 1,997 Rural 0.3 938 Education None 0.0 91 Primary 0.2 1,426 Secondary 0.4 1,318 Higher 2.2 99 Under-5s in the same household At least one 0.2 1,798 None 0.6 1,137 Wealth index quintile Poorest 0.3 524 Second 0.0 581 Middle 1.1 566 Fourth 0.0 598 Richest 0.4 666 1 MICS indicator 12.2 - Smoking before age 15 Sao Tome and Principe 2014 MICS, Final Report P a g e | 231 Table TA.2M:147Age at first use of cigarettes and frequency of use Percentage of men age 15-49 years who smoked a whole cigarette before age 15, Sao Tome and Principe, 2014 Percentage of men who smoked a whole cigarette before age 152 Number of men age 15- 49 years Total 1.4 2,267 Age 15-19 0.8 588 20-24 1.4 378 25-29 0.4 354 30-34 2.1 327 35-39 1.2 284 40-44 2.7 175 45-49 3.2 161 Region Centre East 1.3 1,449 North West 1.6 415 South East 1.4 309 Autonomous of Principe 2.9 93 Area Urban 1.4 1,508 Rural 1.4 759 Education None (0.0) 22 Primary 1.6 951 Secondary 1.1 1,189 Higher 3.1 105 Under-5s in the same household At least one 1.4 1,045 None 1.4 1,222 Wealth index quintile Poorest 2.2 462 Second 1.9 458 Middle 1.1 435 Fourth 0.2 455 Richest 1.7 456 1 MICS indicator 12.2 - Smoking before age 15 ( ) Figures that are based on 25-49 unweighted cases Alcohol Use Table TA.3 shows the use of alcohol among women. Overall, 53 percent of women age 15-49 years had at least one drink of alcohol on one or more days during the last one month, 7 percent of women of the same age group first drank alcohol before the age of 15, and 21 percent of women never had an alcoholic drink. Among the younger age groups, the proportion of women who had at least one drink of alcohol before age 15 is higher (15 percent) than among the older age groups. Sao Tome and Principe 2014 MICS, Final Report P a g e | 232 The proportion of men that consume alcohol is considerably higher that of women (see Table TA.3M). Overall 67 percent of men 15-49 years old had at least one drink of alcohol on one or more days during the last one month. Use of alcohol before the age of 15 is also more common among men (12 percent) than among women (7 percent). As for young women, the proportion among young men who had at least one drink of alcohol before age 15 is higher among the younger age groups. The use of alcohol varies somewhat by education level and wealth quintiles, with higher levels of consumption among those with primary than secondary education, both in men and women, and among the poorest in the case of men. Table TA.3:148Use of alcohol (women) Percentage of women age 15-49 years who have never had an alcoholic drink, percentage who first had an alcoholic drink before age 15, and percentage of women who have had at least one alcoholic drink at any time during the last one month, Sao Tome and Principe, 2014 Percentage of women who: Number of women age 15-49 years Never had an alcoholic drink Had at least one alcoholic drink before age 151 Had at least one alcoholic drink at any time during the last one month2 Total 21.1 7.5 53.2 2,935 Age 15-19 45.3 15.4 24.0 702 20-24 22.2 4.1 49.2 467 25-29 13.4 5.8 64.5 484 30-34 12.3 4.2 66.1 446 35-39 7.1 7.8 68.5 349 40-44 10.4 3.8 64.8 290 45-49 11.7 3.8 65.8 198 Region Centre East 19.4 7.4 52.4 1,983 North West 20.7 9.0 55.8 524 South East 31.1 7.1 51.9 326 Aut. of Principe 23.5 1.4 59.3 103 Area Urban 19.8 7.9 52.6 1,997 Rural 23.9 6.6 54.6 938 Education None 17.8 8.3 59.8 91 Primary 16.3 5.6 61.8 1,426 Secondary 27.2 9.7 43.3 1,318 Higher 12.2 4.5 56.0 99 Wealth index quintile Poorest 23.7 6.2 54.9 524 Second 23.1 10.0 55.9 581 Middle 19.5 7.7 54.2 566 Fourth 17.1 6.0 53.3 598 Richest 22.3 7.3 48.7 666 1 MICS indicator 12.4 - Use of alcohol before age 15 2 MICS indicator 12.3 - Use of alcohol Sao Tome and Principe 2014 MICS, Final Report P a g e | 233 Table TA.3M:149Use of alcohol (men) Percentage of men age 15-49 years who have never had an alcoholic drink, percentage who first had an alcoholic drink before age 15, and percentage of men who have had at least one alcoholic drink at any time during the last one month, Sao Tome and Principe, 2014 Percentage of men who: Number of men age 15-49 years Never had an alcoholic drink Had at least one alcoholic drink before age 151 Had at least one alcoholic drink at any time during the last one month2 Total 12.2 11.9 67.1 2,267 Age 15-19 36.2 17.7 29.5 588 20-24 8.1 11.0 65.5 378 25-29 4.4 11.3 80.3 354 30-34 1.9 8.4 89.8 327 35-39 2.4 11.0 81.5 284 40-44 0.8 9.8 87.8 175 45-49 1.5 5.7 86.0 161 Region Centre East 12.1 11.6 64.4 1,449 North West 8.8 16.2 73.3 415 South East 15.8 8.7 68.7 309 Aut. of Principe 16.3 7.8 76.5 93 Area Urban 11.9 11.9 66.2 1,508 Rural 12.8 12.0 69.1 759 Education None 7.6 19.5 (89.8) 22 Primary 9.2 13.7 73.8 951 Secondary 15.7 11.1 59.5 1,189 Higher 0.6 4.0 88.4 105 Wealth index quintile Poorest 9.6 13.9 74.1 462 Second 15.6 13.0 67.5 458 Middle 14.5 10.6 63.2 435 Fourth 11.7 11.2 63.4 455 Richest 9.6 10.8 67.2 456 1 MICS indicator 12.4 - Use of alcohol before age 15[M] 2 MICS indicator 12.3 - Use of alcohol[M] ( ) Figures that are based on 25-49 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 234 Appendix A. Sample Design The major features of the sample design are described in this appendix. Sample design features include sampling frame, domains of the study, strata, household sample size, the distribution of the sample at various levels, household listing in the selected primary sampling units, as well as the calculation of the household sample weights. The MICS5 survey was implemented using a stratified two-stage sample design. The primary objective of the sample design was to produce statistically reliable estimates of most indicators, at the national level, for urban and rural areas, for the Southern and Northern regions, and each one of the two districts of Agua Grande and Me Zochi in the Central region. Sampling frame, study domains and strata The first stage statistical units, or primary sampling units, are the enumeration areas (EAs) designed during the cartographic operations of the 2012 General Census of Population and Housing (GCPH). The list of EAs constitutes the first stage sampling frame of primary sampling units. A sample of EAs was drawn at the first stage within each stratum. The second stage sampling units are the households within the EAs drawn at the first stage. They define the secondary stage sampling frame. A study domain is a portion of the national territory for which valid results are sought, in other words individual estimates of sufficient precision. The districts were not chosen as study domains given their small size. Beside the urban and rural areas, four other study domains were identified. These are the district of Agua Grande, the district of Me Zochi, the Southern region comprising the districts of Cantagalo and Caue, and the Northern region comprising the districts of Lemba and Lobata. The region of Principe, which has only 11 EAs, was not regarded as a study domain. The stratification is defined as the urban/rural area of residence within each district, which led to 13 strata. Table SD.1 presents the strata as well as the four study domains. Sample Size and Sample Allocation The household sample size for the MICS5 survey was calculated as 3930 households. For the calculation of the sample size, the key indicator used was the immunization coverage of children age 12-23 months. The following formula was used to estimate the required sample size for this indicator in each study domain: )])()(()12.0[( )])(1)((4[ 2 RRAveSizepbr deffrr n   where  n is the required sample size, expressed as number of households  4 is a factor to achieve the 95 percent level of confidence Sao Tome and Principe 2014 MICS, Final Report P a g e | 235  r is the predicted or anticipated value of the indicator, expressed in the form of a proportion  deff is the design effect for the indicator, estimated from a previous survey or using a default value of 1.5  0.12r is the margin of error to be tolerated at the 95 percent level of confidence, defined as 12 per cent of r (relative margin of error of r)  pb is the proportion of the total population upon which the indicator, r, is based  AveSize is the average household size (number of persons per household)  RR is the predicted response rate The data from the most recent DHS survey of 2008 were used by the MICS5 National Technical Committee to calculate the household sample size. Table SD.2 shows the results obtained. Of the five immunization indicators, the full immunization coverage is the one that requires the largest sample, i.e. 804 households. This value of 804 households was taken as the minimum size required in each study domain. It was recommended to slightly increase the sample size to 900 households in each study domain in order to ensure that the desired precision of 12 percent relative margin of error is achieved. In the region of Principe, not regarded as a study domain, each one of the 11 primary units were allocated a sample of 30 households, which resulted in a national sample of 3930 households. Table SD.1:150Definition of study domains and strata Study domain1 Stratum Stratum code Number of EAs Number of households Relative size of district in domain Agua Grande Agua Grande 1 151 17, 494 1.00 Me Zochi Me Zochi Urban 2 33 3,725 0.42 Me Zochi Rural 3 45 7,062 0.58 Sub-total 78 10,787 1.00 Southern region Cantagalo Urban 4 20 2,486 0.45 Cantagalo Rural 5 9 1,872 0.20 Caue Urban 6 9 827 0.20 Caue Rural 7 6 614 0.14 Sub-total 44 5,799 1.00 Northern region Lemba Urban 8 17 2,299 0.31 Lemba Rural 9 6 1,206 0.11 Lobata Urban 10 15 1,871 0.28 Lobata Rural 11 16 3,080 0.30 Sub-total 54 8,456 1.00 Autonomous Region of Principe1 Principe Urban 12 5 695 0.45 Principe Rural 13 6 1,304 0.55 Sub-total 11 1,999 1.00 Overall 338 44,535 1 Region Autonomous of Principe was not considered as a study domain Sao Tome and Principe 2014 MICS, Final Report P a g e | 236 Table SD.2:151Calculation of the minimum required size of the household sample per study domain Variable Full immunization coverage BCG Polio 3 Measles DPT r 0.766 0.961 0.867 0.840 0.874 deff 1.636 1.020 1.182 1.208 1.129 RR 0.90 0.90 0.90 0.90 0.90 AveSize 5 5 5 5 5 pb 0.03 0.03 0.03 0.03 0.03 n 876 85 373 473 335 Formula: Sample distribution of clusters and households In order to estimate how many clusters or primary units would correspond to 900 households selected in each study domain, three options of cluster size were considered:  20 households per primary unit  25 households per primary unit  30 households per primary unit It was found that the first two cluster size options of 20 or 25 households did not provide the required number of clusters in certain strata. On the other hand the option of 30 households per primary unit allowed drawing the EAs in all the strata. In the Region Autonomous of Principe, which is not a study domain, all 11 EAs have been surveyed on the basis of 30 households each, giving a national sample of 3930 households. This results in a global sample of 131 primary sampling units or clusters, 30 per study domain and 11 for the region of Principe. Table SD.3 presents the repartition of the sampled clusters and households by study domain and stratum. Table SD.4 presents the structure of the household sample. Comparing columns 3 and 6 of that table, one notes that Agua Grande is under-sampled while the study domains of the Southern and Northern regions are over-sampled, while Me Zochi has an average sampling rate. The region of Principe, which is not a study domain, also corresponds to an over-sampled sub-domain. It is worth remembering that the structure defined by column 3 is the original distribution of the sampling frame. It is this distribution of frame, and not that of the sample, that will determine the relative weights of the data from each domain in the final weighted estimates. Table SD.3 shows the distribution of the sample between the strata of each study domain. A representative stratified sample is drawn within each domain, which results in a sample of primary sampling units in each study domain that is proportional to the size of the strata in terms of households. Given that 30 household will be drawn in each primary sampling unit, the distribution of the sample in a study domain is also proportional to the size of the strata. )])()(()13.0[( )])(1)((4[ 2 RRAveSizepbr deffrr n   Sao Tome and Principe 2014 MICS, Final Report P a g e | 237 Table SD.3:152Distribution of the sample by study domain and stratum Study domain1 Stratum Stra- tum code Number of EAs Number of house- holds Proportion of house- holds within domain Number of EAs to be drawn Adjusted number of sample EAs Number of households to be drawn Agua Grande Agua Grande 1 151 17, 494 1.00 30 30 900 Me Zochi Me Zochi Urban 2 33 3,725 0.35 10.36 10 300 Me Zochi Rural 3 45 7,062 0.65 19.64 20 600 Sub-total 78 10,787 1.00 30 30 900 Southern region Cantagalo Urban 4 20 2,486 0.43 12.86 13 390 Cantagalo Rural 5 9 1,872 0.32 9.68 9 270 Caue Urban 6 9 827 0.14 4.28 5 150 Caue Rural 7 6 614 0.11 3.18 3 90 Sub-total 44 5,799 1.00 30 30 900 Northern region Lemba Urban 8 17 2,299 0.27 8.16 8 240 Lemba Rural 9 6 1,206 0.14 4.28 4 120 Lobata Urban 10 15 1,871 0.22 6.64 7 210 Lobata Rural 11 16 3,080 0.36 10.93 11 330 Sub-total 54 8,456 1.00 30 30 900 Autonomous Region of Principe1 Principe Urban 12 5 695 0.35 5 5 150 Principe Rural 13 6 1,304 0.65 6 6 180 Sub-total 11 1,999 1.00 11 11 330 Overall 338 44,535 - 131 131 3,930 1 Region Autonomous of Principe was not considered as a study domain Table SD.4:153Structure of the sampling frame and sample per study domain Sampling frame Sample Study domain1 Number of households Structure of the sampling frame Number of EAs to be drawn Number of households to be drawn Structure of the sample Overall sampling rate Agua Grande 17,494 0.39 30 900 0.23 0.051 Me Zochi 10,787 0.24 30 900 0.23 0.083 Southern region 5,799 0.13 30 900 0.23 0.155 Northern region 8,456 0.19 30 900 0.23 0.106 Aut. Reg. of Principe1 1,999 0.04 11 330 0.08 0.165 Total 44,535 1.00 131 3,930 1.00 0.088 1 Region Autonomous of Principe was not considered as a study domain Sampling modalities The sample selection is implemented independently within each stratum. The primary sampling units or clusters are drawn systematically with probability proportional to size. The probability of selection of a cluster is proportional to the size of the cluster, the size being here defined as the number of households in the cluster from the frame. At the second sampling stage, i.e. the selection of the households, systematic sampling with equal probability is used. An equal number of households, 30 in this case, is drawn in each cluster selected at the first stage. Sampling of clusters or primary units The sampling of primary units is done independently one stratum at a time. As previously indicated, the EAs are drawn systematically with probability proportional to size. Sao Tome and Principe 2014 MICS, Final Report P a g e | 238 The drawing of the primary units is implemented with a computer software called TIRAGE 2.1 specially designed for random sampling. In preparation for the draw, it was first verified if any of the 13 strata included atypical EAs, i.e. EAs with a selection probability greater than 1. In order to do this, the selection probabilities  were calculated for each EA in each stratum. All satisfied the condition: 0 < r < 1 r = 1, 2, ……, Mh for the Mh primary units in each stratum h, with the exception of 6 strata comprising 11 EAs with a selection probability superior to 1 as shown in Table SD.5. Table SD.5:154List of EAs with a selection probability superior to 1 Number Stratum Name of stratum Sampling probability ID_EA Number of households 1 Stratum 3 Me Zochi Rural 1.02804 203000419 363 2 Stratum 3 Me Zochi Rural 1.04503 203000501 369 3 Stratum 4 Cantalago Urban 1.13476 105001001 217 4 Stratum 4 Cantalago Urban 1.00925 105001006 193 5 Stratum 4 Cantalago Urban 1.15567 105001011 221 6 Stratum 6 Caue Urban 1.17896 106001151 195 7 Stratum 7 Caue Rural 1.26059 206001109 258 8 Stratum 9 Lemba Rural 1.27695 202000865 385 9 Stratum 11 Lobata Rural 1.30357 201000659 365 10 Stratum 11 Lobata Rural 1.00357 201000809 281 11 Stratum 11 Lobata Rural 1.10714 201000810 310 Table SD.6:155Distribution of EAs purposely selected and of remaining EAs to be selected by stratum Stratum Name of stratum Number of EAs purposely selected Sample size of EAs Number of EAs remaining to be selected Stratum 3 Me Zochi Rural 2 20 18 Stratum 4 Cantalago Urban 3 13 10 Stratum 6 Caue Urban 1 5 4 Stratum 7 Caue Rural 1 3 2 Stratum 9 Lemba Rural 1 4 3 Stratum 11 Lobata Rural 3 11 8 In each stratum, the atypical EAs are purposely selected, i.e. they are selected with a probability equal to 1. The EAs remaining to be drawn are then drawn systematically with probability proportional to size. Table SD.6 presents, for each stratum, the number of atypical EAs purposely selected and the number of EAs remaining to be selected. Cartographic operations and household listing The objective of cartographic operations and household listing in the selected primary sampling units is to update the maps of the primary sampling units, as well as the listing and localization of the households in these primary units. The expected results from these two operations is a new map and a new list of residences (or living units) and households in each primary unit or EA. The final result is the creation of a new sampling frame of households for each EA. Sao Tome and Principe 2014 MICS, Final Report P a g e | 239 Selection of households The lists of households prepared by the listing teams in the field for each selected enumeration area or cluster constitute the second stage sampling frame. The selection of 30 households in each cluster was implemented through random systematic sampling with equal probability. Selection probability and initial sample weights for the sampling units The following notation is used in the formulae determining the selection probabilities and the sample weights of the sampling units for estimates within a stratum h.  h represents the stratum in the study domain;  mh is the number of PSUs (primary sampling units) drawn in the stratum h;  the stratum h is composed of Mh PSUs labeled 1, 2, …, Mh; the PSU i of stratum h is noted UPhi;  Nhi represents the size of PSU UPhi ;  The size Nhi is from the sampling frame being used, the number of households in the PSU UPhi;  Nh represents the sum of the sizes Nhi of the PSUs UPhi and is defined by the relation    hM i hih NN 1 (1)  n is the fixed number of households selected at the 2nd stage of the PSU UPhi in the stratum h. At the 1st stage, mh PSUs are drawn from stratum h systematically with probability proportional to size. At the 2nd stage, a fixed number n of households are drawn in each sampled PSU in stratum h for the three questionnaires of the survey related to the household, the women and the children below the age of 5 years.  Phi represents the selection probability of the PSU UPhi at the 1st stage;  Khi represents the number of households in PSU UPhi, number obtained during the household listing operations of that PSU;  Pj.hi represents the selection probability of household j in PSU UPhi ; Pj.hi actually is the conditional probability of selection of household j if PSU hi is drawn; probability Pj.hi can thus be equivalently defined by the relation hijhij PP /.  (2)  Phij represents the selection probability of household j of PSU i in stratum h in the survey sample Sao Tome and Principe 2014 MICS, Final Report P a g e | 240 It can be shown that the selection probability Phi is defined as ????ℎ???? = ????ℎ ????ℎ???? ????ℎ (3) It can further be shown that probabilities Pj.hi and Phij are respectively expressed as ????????.ℎ???? = ???? ????ℎ???? (4) and ????ℎ???????? = ????ℎ????????????.ℎ???? (5) Which results in ????ℎ???????? = ????ℎ ????ℎ???? ????ℎ ???? ????ℎ???? (6) It follows that the sample weight Whij of household j of PSU i of stratum h, is defined as the inverse of selection probability Phij, which is ????ℎ???????? = ????ℎ????ℎ???? ????ℎ???? ????ℎ???? (7) Special case of strata including atypical clusters Relation (3) is applicable only to clusters i of all strata h that do not include atypical clusters. It does not apply when stratum h includes atypical clusters. Two situations can be encountered. a) If cluster i of stratum h is an atypical cluster, then the selection probability Phi is expressed as 1hiP (8) since it was purposively selected. b) For all the other clusters in stratum h comprising at least one atypical cluster, the selection probability Phi is expressed as hh hi hhhi SN N nmP   )( (9) where nh and Sh represent respectively the number of atypical clusters and the overall sum of the size of the atypical clusters of stratum h. It is noteworthy that relation (9) simplifies to relation (3) if nh = 0 and Sh = 0, which is what is found in any stratum h that does not include an atypical cluster. It follows that selection probability Phij and sample weight Whij, are expressed as follows. a) In the case of an atypical cluster i in stratum h, we have : hi hij K n P  (10) and n K W hihij  (11) Sao Tome and Principe 2014 MICS, Final Report P a g e | 241 b) In the case of a typical cluster i of stratum h (which comprises atypical clusters), we get from relation (9) : hihh hi hhhij K n SN N nmP   )( (12) and n K Nnm SN W hi hihh hh hij )( )(    (13) Sao Tome and Principe 2014 MICS, Final Report P a g e | 242 Appendix B. List of Personnel Involved in the Survey Overall Coordination Elsa Maria Cardoso Technical Coordination Helder Salvaterra Jeudíger Lima do Nascimento Jedson Carvalho Administrative and Financial Coordination Mário Coelho Ethics Committee Fausto Matos Óscar Baia Dias Marques Maria do Céu Espírito Santo Data Processing Unit Idálio Luís Ivando de Ceita Catography and Geo-Information Unit N’Guaby Trindade Constâncio Advocacy/Communication Unit Sao Tome and Principe 2014 MICS, Final Report P a g e | 243 Heng dos Santos Administration and Logistics Ketty Borges Eugénia Fernandes Amélia F. Viegas Fieldwork Coordination and Supervision Team Maria da Glória Ten Jua Denise Gomes Adriana Carvalho Elminaide Moniz Constâncio Neto Data Entry Team Guilhermina Carvalho Elsa Afonso do Rosario Essame Samara Ramos Edilza Carvalho G Lima Joaquim Cardoso da Silva Lares Sebastião de Ceita Pires Elsa Encarnação Julião Jackson R de Araújo Lima Ulisses de Carvalho Espirito Santo Graça Abnildo Leite Almeida Heusinger S P Bonfim da Mata Odimilson da Mata dos Ramos Sao Tome and Principe 2014 MICS, Final Report P a g e | 244 Wanderley Lima Paixão Pereira Isaú Jesus de Carvalho Alex dos Anjos Jorge Pereira Elisio dos Reis Walker Bonfim Elandley Matias Maribela da Mata Nadia Kiss de Apresentação Jedney António Herman Nura D´Almeida Adelino Paquete Edson Quarresma Clayton Ferreira Edmilson Varela Laboratory Technicians for ELISA (HIV) Processing José dos Santos M. Viega Jorge Marçal Cristiano d’Abreu Suzete Carvalho Laboratory Technicians Cesaltina Fernandes Lazismino Barbosa Domingos Batista de Sousa Sao Tome and Principe 2014 MICS, Final Report P a g e | 245 Lucrécia Afonso Lázaro Gualmira Menezes Elnaúria Choi Nilza Sousa Dionísia Viegas Jorge Pedro de Sousa Pontes Jerciley Cravid Celmira Trindade Igualter Daio Amélia Nazaré Lima Cicília Serina Barreto Alda Maria Umbelina Ferreira Hidalgo A. da Graça Afonso Control Team Jucilay Fernandes Ekijercy d'A. Santiago Bondevert Paquete Damaide Tiny Fernanda Costa Alegre Erivalda Costa Abiudy da Costa Mapagera Anastácio A. P. Castilho Ramos Supervisors Fausmiro M. Bizarro Fernandes Sao Tome and Principe 2014 MICS, Final Report P a g e | 246 Vinicius dos Anjos Cassandra Guldylei do S. Conceição Wilker Barroso Danger Casimiro Lima Danilton Semedo Samila G. dos Santos Lima João Paulo de A. Cardoso Editors Jucilay Fernandes Ekijercy d'A. Santiago Bondevert Paquete Damaide Tiny Fernanda Costa Alegre Erivalda Costa Abiudy da Costa Mapagera Anastácio A. P. Castilho Ramos Interviewers Edmila da Conceição Célia Lima Welinde Santana Hotelo Bragança Joacila da Silva Fernandes Neya Pires Lima Amado Gil Quaresma de Castro Sao Tome and Principe 2014 MICS, Final Report P a g e | 247 Ladesley d'Almeida Neto Idalécio Monte Verde Selissiane Santos Hernane Casimiro Tiny Avidozia Vaz P. Carvalho Deignimarte Fernandes Zenaide Bandeira Anatácio Castilio Equice Sousa Pontes Yolanda Celly Lima de Sousa Abdulay P. Monte Verde Aida Pinho de Nazaré Elideler A. P. dos Santos Elísio Costa Alegre Julaique Ponces Gisela Amilcar Gercilene Lopes Quett de Carvalho Lia Ana Maria Lima Carlos Emanuel Lima Ceita Manuel Bento Casimiro Lima Viana Andrade Orfeu Gabriel A. R. Aurora Nilsa da Costa Loureiro Maria M. dos Sanches Sao Tome and Principe 2014 MICS, Final Report P a g e | 248 UNICEF Technical Assistance Fortunat Diener, MICS UNICEF Consultant Salif Ndiaye, Household Survey Expert Julien Amegandjin, Sampling Expert Martin Mba, Data Processing Expert Technical Assistance for Biomarkers ICF International Sao Tome and Principe 2014 MICS, Final Report P a g e | 249 Appendix C. Estimates of Sampling Errors The sample of respondents selected in the 2014 Sao Tome and Principe Multiple Indicator Cluster Survey is only one of the samples that could have been selected from the same population, using the same design and size. Each of these samples would yield results that differ somewhat from the results of the actual sample selected. Sampling errors are a measure of the variability between the estimates from all possible samples. The extent of variability is not known exactly, but can be estimated statistically from the survey data. The following sampling error measures are presented in this appendix for each of the selected indicators:  Standard error (se): Standard error is the square root of the variance of the estimate. For survey indicators that are means, proportions or ratios, the Taylor series linearization method is used for the estimation of standard errors. For more complex statistics, such as fertility and mortality rates, the Jackknife repeated replication method is used for standard error estimation.  Coefficient of variation (se/r) is the ratio of the standard error to the value (r) of the indicator, and is a measure of the relative sampling error.  Design effect (deff) is the ratio of the actual variance of an indicator, under the sampling method used in the survey, to the variance calculated under the assumption of simple random sampling based on the same sample size. The square root of the design effect (deft) is used to show the efficiency of the sample design in relation to the precision. A deft value of 1.0 indicates that the sample design of the survey is as efficient as a simple random sample for a particular indicator, while a deft value above 1.0 indicates an increase in the standard error due to the use of a more complex sample design.  Confidence limits are calculated to show the interval within which the true value for the population can be reasonably assumed to fall, with a specified level of confidence. For any given statistic calculated from the survey, the value of that statistic will fall within a range of plus or minus two times the standard error (r + 2.se or r – 2.se) of the statistic in 95 percent of all possible samples of identical size and design. For the calculation of sampling errors from MICS data, programs developed in CSPro Version 5.0, SPSS Version 21 Complex Samples module and CMRJacki have been used. The results are shown in the tables that follow. In addition to the sampling error measures described above, the tables also include weighted and unweighted counts of denominators for each indicator. Given the use of normalized weights, by comparing the weighted and unweighted counts it is possible to determine whether a particular domain has been under-sampled or over-sampled compared to the average sampling rate. If the weighted count is smaller than the unweighted count, this means that the particular domain had been over-sampled. As explained later in the footnote of Table SE.1, there is an exception in the case of indicators 4.1 and 4.3, for which the unweighted count represents the number of sample households, and the weighted counts reflect the total population. i CMRJack is a software developed by FAFO, an independent and multidisciplinary research foundation. CMRJack produces mortality estimates and standard errors for surveys with complete birth histories or summary birth histories. See http://www.fafo.no/ais/child_mortality/index.html Sao Tome and Principe 2014 MICS, Final Report P a g e | 250 Sampling errors are calculated for indicators of primary interest, for the national level, for urban and rural areas, and for all regions. Three of the selected indicators are based on households members, 8 are based on women, and 3 are based on men. 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.17 show the calculated sampling errors for selected domains. Table SE.1:156Indicators selected for sampling error calculations List of indicators selected for sampling error calculations, and base populations (denominators) for each indicator, Sao Tome and Principe, 2014 MICS5 Indicator Base Population Household members 4.1 Use of improved drinking water sources All household membersa 4.3 Use of improved sanitation All household membersa 7.4 Primary school net attendance ratio (adjusted) Children of primary school age Women 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 (1+ times, skilled provider) Women age 15-49 years with a live birth in the last 2 years 5.5b Antenatal care coverage (4+ times, any provider) Women age 15-49 years with a live birth in the last 2 years 5.7 Skilled attendant at delivery Women age 15-49 years with a live birth in the last 2 years 7.1 Literacy rate (young women) Women age 15-24 years 9.1 Knowledge about HIV prevention (young women) Women age 15-24 years 9.15 Condom use with non-regular partners Women age 15-24 years who had a non-marital, non- cohabiting partner in the last 12 months Men 7.1 Literacy rate (young men) Men age 15-24 years 9.1 Knowledge about HIV prevention (young men) Men age 15-24 years 9.15 Condom use with non-regular partners Men age 15-24 years who had a non-marital, non- cohabiting partner in the last 12 months Under-5s 2.1a Underweight prevalence (moderate and severe) Children under age 5 years 2.1b Underweight prevalence (severe) Children under age 5 years 3.18 Children under age 5 who slept under an ITN Children under age 5 years who spent the previous night in the household 3.22 Anti-malarial treatment of children under age 5 Children under age 5 years with fever in the last 2 weeks a To calculate the weighted results of MICS Indicators 4.1 and 4.3, the household weight is multiplied by the number of household members in each household. Therefore the unweighted base population presented in the SE tables reflect the unweighted number of households, whereas the weighted numbers reflect the household population. Sao Tome and Principe 2014 MICS, Final Report P a g e | 251 Table SE.2:157Sampling errors: Total sample Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft), and confidence intervals for selected indicators, Sao Tome and Principe, 2014 MICS Indicator MDG 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 Lower bound r - 2se Upper bound r + 2se Household members Use of improved drinking water sources 4.1 7.8 0.939 0.0147 0.016 13.089 3.618 13,455 3,492 0.910 0.968 Use of improved sanitation 4.3 7.9 0.409 0.0208 0.051 6.231 2.496 13,455 3,492 0.367 0.450 Primary school net attendance ratio (adjusted) 7.4 2.1 0.941 0.0066 0.007 1.874 1.369 2,355 2,418 0.928 0.954 Women Contraceptive prevalence rate 5.3 5.3 0.406 0.0156 0.038 1.689 1.300 1,629 1,671 0.375 0.437 Unmet need 5.4 5.6 0.327 0.0136 0.042 1.408 1.186 1,629 1,671 0.300 0.354 Antenatal care coverage (1+ times, skilled provider) 5.5a 5.5 0.975 0.0062 0.006 1.169 1.081 756 758 0.962 0.987 Antenatal care coverage (4+ times, any provider) 5.5b 5.5 0.836 0.0152 0.018 1.270 1.127 756 758 0.806 0.867 Skilled attendant at delivery 5.7 5.2 0.925 0.0111 0.012 1.333 1.154 756 758 0.902 0.947 Literacy rate (young women) 7.1 2.3 0.896 0.0106 0.012 1.378 1.174 1,169 1,150 0.875 0.917 Knowledge about HIV prevention (young women) 9.1 6.3 0.422 0.0197 0.047 1.823 1.350 1,169 1,150 0.383 0.462 Condom use with non-regular partners 9.15 6.2 0.652 0.0342 0.052 1.381 1.175 289 269 0.584 0.721 Men Literacy rate (young men) 7.1 2.3 0.875 0.0138 0.016 1.640 1.281 966 945 0.847 0.902 Knowledge about HIV prevention (young men) 9.1 6.3 0.432 0.0231 0.053 2.055 1.433 966 945 0.386 0.479 Condom use with non-regular partners 9.15 6.2 0.825 0.0206 0.025 1.278 1.130 453 436 0.784 0.866 Sao Tome and Principe 2014 MICS, Final Report P a g e | 252 Table SE.3:158Sampling errors: Urban Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft), and confidence intervals for selected indicators, Sao Tome and Principe, 2014 MICS Indicator MDG 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 Lower bound r - 2se Upper bound r + 2se Household members Use of improved drinking water sources 4.1 7.8 0.980 0.0101 0.010 10.601 3.256 8,960 2,054 0.959 1.000 Use of improved sanitation 4.3 7.9 0.462 0.0250 0.054 5.173 2.274 8,960 2,054 0.412 0.512 Primary school net attendance ratio (adjusted) 7.4 2.1 0.943 0.0083 0.009 1.807 1.344 1,542 1,408 0.927 0.960 Women Contraceptive prevalence rate 5.3 5.3 0.380 0.0193 0.051 1.602 1.266 1,092 1,013 0.341 0.419 Unmet need 5.4 5.6 0.340 0.0178 0.052 1.425 1.194 1,092 1,013 0.304 0.375 Antenatal care coverage (1+ times, skilled provider) 5.5a 5.5 0.979 0.0065 0.007 0.936 0.968 496 452 0.966 0.992 Antenatal care coverage (4+ times, any provider) 5.5b 5.5 0.836 0.0191 0.023 1.203 1.097 496 452 0.797 0.874 Skilled attendant at delivery 5.7 5.2 0.947 0.0122 0.013 1.334 1.155 496 452 0.922 0.971 Literacy rate (young women) 7.1 2.3 0.899 0.0132 0.015 1.373 1.172 804 720 0.873 0.925 Knowledge about HIV prevention (young women) 9.1 6.3 0.432 0.0256 0.059 1.916 1.384 804 720 0.380 0.483 Condom use with non-regular partners 9.15 6.2 0.660 0.0409 0.062 1.382 1.176 215 186 0.578 0.742 Men Literacy rate (young men) 7.1 2.3 0.894 0.0149 0.017 1.358 1.165 653 584 0.864 0.923 Knowledge about HIV prevention (young men) 9.1 6.3 0.420 0.0306 0.073 2.247 1.499 653 584 0.359 0.481 Condom use with non-regular partners 9.15 6.2 0.840 0.0260 0.031 1.385 1.177 316 276 0.788 0.892 Sao Tome and Principe 2014 MICS, Final Report P a g e | 253 Table SE.4:159Sampling errors: Rural Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft), and confidence intervals for selected indicators, Sao Tome and Principe, 2014 MICS Indicator MDG 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 Lower bound r - 2se Upper bound r + 2se Household members Use of improved drinking water sources 4.1 7.8 0.858 0.0347 0.040 14.183 3.766 4,495 1,438 0.789 0.927 Use of improved sanitation 4.3 7.9 0.302 0.0252 0.083 4.321 2.079 4,495 1,438 0.252 0.352 Primary school net attendance ratio (adjusted) 7.4 2.1 0.936 0.0107 0.011 1.911 1.382 813 1,010 0.914 0.957 Women Contraceptive prevalence rate 5.3 5.3 0.458 0.0241 0.053 1.542 1.242 537 658 0.410 0.506 Unmet need 5.4 5.6 0.300 0.0197 0.066 1.219 1.104 537 658 0.260 0.339 Antenatal care coverage (1+ times, skilled provider) 5.5a 5.5 0.966 0.0127 0.013 1.488 1.220 260 306 0.940 0.991 Antenatal care coverage (4+ times, any provider) 5.5b 5.5 0.838 0.0257 0.031 1.486 1.219 260 306 0.786 0.889 Skilled attendant at delivery 5.7 5.2 0.883 0.0210 0.024 1.298 1.139 260 306 0.841 0.925 Literacy rate (young women) 7.1 2.3 0.890 0.0187 0.021 1.532 1.238 365 430 0.853 0.927 Knowledge about HIV prevention (young women) 9.1 6.3 0.402 0.0311 0.077 1.726 1.314 365 430 0.340 0.464 Condom use with non-regular partners 9.15 6.2 0.630 0.0690 0.110 1.675 1.294 73 83 0.492 0.768 Men Literacy rate (young men) 7.1 2.3 0.836 0.0270 0.032 1.904 1.380 314 361 0.782 0.889 Knowledge about HIV prevention (young men) 9.1 6.3 0.458 0.0306 0.067 1.358 1.165 314 361 0.397 0.519 Condom use with non-regular partners 9.15 6.2 0.791 0.0294 0.037 0.832 0.912 137 160 0.733 0.850 Sao Tome and Principe 2014 MICS, Final Report P a g e | 254 Table SE.5:160Sampling errors: Region Centre East Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft), and confidence intervals for selected indicators, Sao Tome and Principe, 2014 MICS Indicator MDG 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 Lower bound r - 2se Upper bound r + 2se Household members Use of improved drinking water sources 4.1 7.8 0.958 0.0161 0.017 10.605 3.256 8,799 1,626 0.926 0.991 Use of improved sanitation 4.3 7.9 0.465 0.0261 0.056 4.449 2.109 8,799 1,626 0.413 0.517 Primary school net attendance ratio (adjusted) 7.4 2.1 0.938 0.0094 0.010 1.625 1.275 1,499 1,062 0.919 0.957 Women Contraceptive prevalence rate 5.3 5.3 0.376 0.0208 0.055 1.341 1.158 1,048 731 0.335 0.418 Unmet need 5.4 5.6 0.358 0.0195 0.055 1.209 1.100 1,048 731 0.319 0.397 Antenatal care coverage (1+ times, skilled provider) 5.5a 5.5 0.977 0.0082 0.008 1.096 1.047 514 367 0.960 0.993 Antenatal care coverage (4+ times, any provider) 5.5b 5.5 0.845 0.0190 0.022 1.007 1.004 514 367 0.807 0.883 Skilled attendant at delivery 5.7 5.2 0.938 0.0137 0.015 1.178 1.085 514 367 0.910 0.965 Literacy rate (young women) 7.1 2.3 0.921 0.0104 0.011 0.850 0.922 809 572 0.901 0.942 Knowledge about HIV prevention (young women) 9.1 6.3 0.403 0.0255 0.063 1.547 1.244 809 572 0.352 0.454 Condom use with non-regular partners 9.15 6.2 0.691 0.0398 0.058 1.015 1.007 207 138 0.612 0.771 Men Literacy rate (young men) 7.1 2.3 0.894 0.0171 0.019 1.233 1.110 636 402 0.859 0.928 Knowledge about HIV prevention (young men) 9.1 6.3 0.406 0.0305 0.075 1.546 1.243 636 402 0.345 0.467 Condom use with non-regular partners 9.15 6.2 0.862 0.0254 0.029 1.045 1.022 304 195 0.811 0.912 Sao Tome and Principe 2014 MICS, Final Report P a g e | 255 Table SE.6:161Sampling errors: Region North West Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft), and confidence intervals for selected indicators, Sao Tome and Principe, 2014 MICS Indicator MDG 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 Lower bound r - 2se Upper bound r + 2se Household members Use of improved drinking water sources 4.1 7.8 0.907 0.0487 0.054 23.512 4.849 2,510 840 0.809 1.000 Use of improved sanitation 4.3 7.9 0.252 0.0257 0.102 2.933 1.713 2,510 840 0.200 0.303 Primary school net attendance ratio (adjusted) 7.4 2.1 0.950 0.0106 0.011 1.541 1.241 477 650 0.929 0.971 Women Contraceptive prevalence rate 5.3 5.3 0.455 0.0298 0.066 1.532 1.238 298 428 0.396 0.515 Unmet need 5.4 5.6 0.278 0.0195 0.070 0.813 0.901 298 428 0.239 0.317 Antenatal care coverage (1+ times, skilled provider) 5.5a 5.5 0.977 0.0056 0.006 0.261 0.511 131 191 0.966 0.988 Antenatal care coverage (4+ times, any provider) 5.5b 5.5 0.820 0.0227 0.028 0.664 0.815 131 191 0.775 0.866 Skilled attendant at delivery 5.7 5.2 0.933 0.0163 0.017 0.807 0.899 131 191 0.900 0.965 Literacy rate (young women) 7.1 2.3 0.841 0.0323 0.038 2.318 1.522 205 297 0.777 0.906 Knowledge about HIV prevention (young women) 9.1 6.3 0.508 0.0485 0.095 2.782 1.668 205 297 0.411 0.604 Condom use with non-regular partners 9.15 6.2 0.588 0.0682 0.116 1.288 1.135 49 68 0.452 0.725 Men Literacy rate (young men) 7.1 2.3 0.807 0.0322 0.040 1.673 1.293 170 252 0.742 0.871 Knowledge about HIV prevention (young men) 9.1 6.3 0.500 0.0504 0.101 2.547 1.596 170 252 0.399 0.600 Condom use with non-regular partners 9.15 6.2 0.740 0.0362 0.049 0.784 0.885 79 116 0.667 0.812 Sao Tome and Principe 2014 MICS, Final Report P a g e | 256 Table SE.7:162Sampling errors: Region South East Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft), and confidence intervals for selected indicators, Sao Tome and Principe, 2014 MICS Indicator MDG 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 Lower bound r - 2se Upper bound r + 2se Household members Use of improved drinking water sources 4.1 7.8 0.945 0.0193 0.020 5.299 2.302 1,651 740 0.907 0.984 Use of improved sanitation 4.3 7.9 0.316 0.0428 0.136 6.266 2.503 1,651 740 0.230 0.401 Primary school net attendance ratio (adjusted) 7.4 2.1 0.934 0.0134 0.014 1.564 1.251 286 533 0.907 0.961 Women Contraceptive prevalence rate 5.3 5.3 0.426 0.0230 0.054 0.813 0.902 213 377 0.380 0.472 Unmet need 5.4 5.6 0.280 0.0212 0.076 0.836 0.914 213 377 0.238 0.323 Antenatal care coverage (1+ times, skilled provider) 5.5a 5.5 0.950 0.0196 0.021 1.222 1.105 86 153 0.910 0.989 Antenatal care coverage (4+ times, any provider) 5.5b 5.5 0.808 0.0288 0.036 0.811 0.900 86 153 0.750 0.865 Skilled attendant at delivery 5.7 5.2 0.824 0.0365 0.044 1.390 1.179 86 153 0.751 0.896 Literacy rate (young women) 7.1 2.3 0.812 0.0299 0.037 1.212 1.101 118 208 0.752 0.872 Knowledge about HIV prevention (young women) 9.1 6.3 0.342 0.0324 0.095 0.966 0.983 118 208 0.277 0.406 Condom use with non-regular partners 9.15 6.2 (0.485) (0.0915) (0.189) (1.473) (1.214) 25 45 (0.302) (0.667) Men Literacy rate (young men) 7.1 2.3 0.847 0.0240 0.028 0.987 0.994 129 224 0.799 0.895 Knowledge about HIV prevention (young men) 9.1 6.3 0.385 0.0322 0.084 0.979 0.989 129 224 0.320 0.449 Condom use with non-regular partners 9.15 6.2 0.745 0.0442 0.059 0.968 0.984 56 95 0.657 0.834 ( ) Figures that are based on 25-49 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 257 Table SE.8:163Sampling errors: Autonomous Region of Principe Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft), and confidence intervals for selected indicators, Sao Tome and Principe, 2014 MICS Indicator MDG 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 Lower bound r - 2se Upper bound r + 2se Household members Use of improved drinking water sources 4.1 7.8 0.739 0.0862 0.117 10.964 3.311 495 286 0.566 0.911 Use of improved sanitation 4.3 7.9 0.511 0.0580 0.113 3.832 1.958 495 286 0.395 0.627 Primary school net attendance ratio (adjusted) 7.4 2.1 0.957 0.0127 0.013 0.673 0.820 92 173 0.931 0.982 Women Contraceptive prevalence rate 5.3 5.3 0.575 0.0527 0.092 1.522 1.234 70 135 0.469 0.680 Unmet need 5.4 5.6 0.213 0.0316 0.148 0.799 0.894 70 135 0.150 0.276 Antenatal care coverage (1+ times, skilled provider) 5.5a 5.5 (1.000) (0.0000) (0.000) na na 25 47 na na Antenatal care coverage (4+ times, any provider) 5.5b 5.5 (0.844) (0.0323) (0.038) (0.365) (0.604) 25 47 (0.779) (0.908) Skilled attendant at delivery 5.7 5.2 (0.959) (0.0124) (0.013) (0.178) (0.422) 25 47 (0.934) (0.984) Literacy rate (young women) 7.1 2.3 0.924 0.0300 0.032 0.929 0.964 36 73 0.864 0.984 Knowledge about HIV prevention (young women) 9.1 6.3 0.635 0.0236 0.037 0.174 0.417 36 73 0.588 0.682 Condom use with non-regular partners 9.15 6.2 (*) (*) (*) (*) (*) 8 18 (*) (*) Men Literacy rate (young men) 7.1 2.3 0.980 0.0179 0.018 1.071 1.035 31 67 0.944 1.000 Knowledge about HIV prevention (young men) 9.1 6.3 0.733 0.0262 0.036 0.232 0.482 31 67 0.681 0.786 Condom use with non-regular partners 9.15 6.2 (0.836) (0.0402) (0.048) (0.342) (0.585) 14 30 (0.755) (0.916) na: not applicable ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 258 Table SE.9:164Sampling errors: Education of household head – None Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft), and confidence intervals for selected indicators, Sao Tome and Principe, 2014 MICS Indicator MDG 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 Lower bound r - 2se Upper bound r + 2se Household members Use of improved drinking water sources 4.1 7.8 0.916 0.0293 0.032 3.812 1.952 1,056 344 0.857 0.974 Use of improved sanitation 4.3 7.9 0.300 0.0362 0.121 2.140 1.463 1,056 344 0.228 0.373 Primary school net attendance ratio (adjusted) 7.4 2.1 0.906 0.0354 0.039 2.493 1.579 149 170 0.836 0.977 Table SE.10:165Sampling errors: Education of household head – Primary Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft), and confidence intervals for selected indicators, Sao Tome and Principe, 2014 MICS Indicator MDG 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 Lower bound r - 2se Upper bound r + 2se Household members Use of improved drinking water sources 4.1 7.8 0.926 0.0175 0.019 8.784 2.964 7,461 1,981 0.891 0.961 Use of improved sanitation 4.3 7.9 0.330 0.0211 0.064 3.992 1.998 7,461 1,981 0.288 0.372 Primary school net attendance ratio (adjusted) 7.4 2.1 0.946 0.0082 0.009 1.978 1.406 1,403 1,493 0.929 0.962 Table SE.11:166Sampling errors: Education of household head – Secondary Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft), and confidence intervals for selected indicators, Sao Tome and Principe, 2014 MICS Indicator MDG 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 Lower bound r - 2se Upper bound r + 2se Household members Use of improved drinking water sources 4.1 7.8 0.960 0.0114 0.012 3.544 1.883 4,273 1,038 0.937 0.983 Use of improved sanitation 4.3 7.9 0.514 0.0294 0.057 3.596 1.896 4,273 1,038 0.455 0.573 Primary school net attendance ratio (adjusted) 7.4 2.1 0.936 0.0119 0.013 1.639 1.280 713 686 0.913 0.960 Sao Tome and Principe 2014 MICS, Final Report P a g e | 259 Table SE.12:167Sampling errors: Education of household head – Higher Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft), and confidence intervals for selected indicators, Sao Tome and Principe, 2014 MICS Indicator MDG 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 Lower bound r - 2se Upper bound r + 2se Household members Use of improved drinking water sources 4.1 7.8 0.989 0.0100 0.010 0.965 0.983 575 109 0.969 1.000 Use of improved sanitation 4.3 7.9 0.847 0.0421 0.050 1.483 1.218 575 109 0.763 0.932 Primary school net attendance ratio (adjusted) 7.4 2.1 0.952 0.0210 0.022 0.534 0.731 75 56 0.910 0.994 Table SE.13:168Sampling errors: Poorest Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft), and confidence intervals for selected indicators, Sao Tome and Principe, 2014 MICS Indicator MDG 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 Lower bound r - 2se Upper bound r + 2se Household members Use of improved drinking water sources 4.1 7.8 0.909 0.0224 0.025 5.878 2.424 2,692 968 0.864 0.954 Use of improved sanitation 4.3 7.9 0.075 0.0141 0.187 2.748 1.658 2,692 968 0.047 0.104 Primary school net attendance ratio (adjusted) 7.4 2.1 0.916 0.0134 0.015 1.340 1.158 467 578 0.889 0.943 Women Contraceptive prevalence rate 5.3 5.3 0.368 0.0297 0.081 1.389 1.179 289 368 0.309 0.427 Unmet need 5.4 5.6 0.336 0.0300 0.089 1.476 1.215 289 368 0.276 0.396 Antenatal care coverage (1+ times, skilled provider) 5.5a 5.5 0.948 0.0160 0.017 1.046 1.023 161 202 0.916 0.980 Antenatal care coverage (4+ times, any provider) 5.5b 5.5 0.732 0.0317 0.043 1.031 1.015 161 202 0.668 0.795 Skilled attendant at delivery 5.7 5.2 0.850 0.0276 0.032 1.196 1.094 161 202 0.795 0.905 Literacy rate (young women) 7.1 2.3 0.786 0.0303 0.039 1.192 1.092 177 220 0.725 0.847 Knowledge about HIV prevention (young women) 9.1 6.3 0.390 0.0369 0.095 1.255 1.120 177 220 0.316 0.464 Condom use with non-regular partners 9.15 6.2 (0.451) (0.0929) (0.206) (1.430) (1.196) 35 42 (0.265) (0.637) Men Literacy rate (young men) 7.1 2.3 0.764 0.0388 0.051 1.793 1.339 180 216 0.687 0.842 Knowledge about HIV prevention (young men) 9.1 6.3 0.376 0.0379 0.101 1.313 1.146 180 216 0.300 0.452 Condom use with non-regular partners 9.15 6.2 0.728 0.0515 0.071 1.232 1.110 76 93 0.625 0.831 ( ) Figures that are based on 25-49 unweighted cases Sao Tome and Principe 2014 MICS, Final Report P a g e | 260 Table SE.14:169Sampling errors: Second wealth quintile Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft), and confidence intervals for selected indicators, Sao Tome and Principe, 2014 MICS Indicator MDG 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 Lower bound r - 2se Upper bound r + 2se Household members Use of improved drinking water sources 4.1 7.8 0.920 0.0221 0.024 5.106 2.260 2,691 768 0.876 0.964 Use of improved sanitation 4.3 7.9 0.181 0.0244 0.135 3.075 1.754 2,691 768 0.132 0.230 Primary school net attendance ratio (adjusted) 7.4 2.1 0.937 0.0151 0.016 2.060 1.435 472 540 0.906 0.967 Women Contraceptive prevalence rate 5.3 5.3 0.387 0.0390 0.101 2.338 1.529 328 366 0.309 0.465 Unmet need 5.4 5.6 0.326 0.0285 0.088 1.352 1.163 328 366 0.269 0.383 Antenatal care coverage (1+ times, skilled provider) 5.5a 5.5 0.975 0.0126 0.013 1.057 1.028 158 165 0.950 1.000 Antenatal care coverage (4+ times, any provider) 5.5b 5.5 0.819 0.0325 0.040 1.169 1.081 158 165 0.754 0.884 Skilled attendant at delivery 5.7 5.2 0.925 0.0218 0.024 1.124 1.060 158 165 0.881 0.969 Literacy rate (young women) 7.1 2.3 0.849 0.0266 0.031 1.417 1.190 248 257 0.796 0.903 Knowledge about HIV prevention (young women) 9.1 6.3 0.357 0.0384 0.108 1.646 1.283 248 257 0.280 0.433 Condom use with non-regular partners 9.15 6.2 0.541 0.0655 0.121 0.967 0.984 56 57 0.410 0.672 Men Literacy rate (young men) 7.1 2.3 0.813 0.0305 0.038 1.302 1.141 201 214 0.751 0.874 Knowledge about HIV prevention (young men) 9.1 6.3 0.364 0.0391 0.108 1.409 1.187 201 214 0.286 0.442 Condom use with non-regular partners 9.15 6.2 0.829 0.0500 0.060 1.571 1.253 83 90 0.729 0.929 Sao Tome and Principe 2014 MICS, Final Report P a g e | 261 Table SE.15:170Sampling errors: Middle wealth quintile Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft), and confidence intervals for selected indicators, Sao Tome and Principe, 2014 MICS Indicator MDG 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 Lower bound r - 2se Upper bound r + 2se Household members Use of improved drinking water sources 4.1 7.8 0.916 0.0227 0.025 4.568 2.137 2,691 684 0.870 0.961 Use of improved sanitation 4.3 7.9 0.311 0.0273 0.088 2.367 1.539 2,691 684 0.257 0.366 Primary school net attendance ratio (adjusted) 7.4 2.1 0.947 0.0120 0.013 1.453 1.205 481 509 0.923 0.971 Women Contraceptive prevalence rate 5.3 5.3 0.428 0.0311 0.073 1.331 1.154 313 339 0.366 0.490 Unmet need 5.4 5.6 0.310 0.0284 0.092 1.277 1.130 313 339 0.253 0.367 Antenatal care coverage (1+ times, skilled provider) 5.5a 5.5 0.971 0.0161 0.017 1.408 1.186 149 152 0.939 1.000 Antenatal care coverage (4+ times, any provider) 5.5b 5.5 0.835 0.0393 0.047 1.695 1.302 149 152 0.757 0.914 Skilled attendant at delivery 5.7 5.2 0.922 0.0247 0.027 1.281 1.132 149 152 0.873 0.972 Literacy rate (young women) 7.1 2.3 0.903 0.0195 0.022 0.977 0.989 224 226 0.864 0.942 Knowledge about HIV prevention (young women) 9.1 6.3 0.365 0.0408 0.112 1.620 1.273 224 226 0.283 0.446 Condom use with non-regular partners 9.15 6.2 0.663 0.0786 0.118 1.437 1.199 53 53 0.506 0.820 Men Literacy rate (young men) 7.1 2.3 0.887 0.0238 0.027 1.069 1.034 184 191 0.839 0.934 Knowledge about HIV prevention (young men) 9.1 6.3 0.392 0.0376 0.096 1.130 1.063 184 191 0.317 0.467 Condom use with non-regular partners 9.15 6.2 0.779 0.0543 0.070 1.460 1.208 80 86 0.671 0.888 Sao Tome and Principe 2014 MICS, Final Report P a g e | 262 Table SE.16:171Sampling errors: Fourth wealth quintile Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft), and confidence intervals for selected indicators, Sao Tome and Principe, 2014 MICS Indicator MDG 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 Lower bound r - 2se Upper bound r + 2se Household members Use of improved drinking water sources 4.1 7.8 0.953 0.0179 0.019 4.177 2.044 2,689 581 0.917 0.989 Use of improved sanitation 4.3 7.9 0.586 0.0268 0.046 1.719 1.311 2,689 581 0.532 0.640 Primary school net attendance ratio (adjusted) 7.4 2.1 0.943 0.0134 0.014 1.489 1.220 484 447 0.916 0.970 Women Contraceptive prevalence rate 5.3 5.3 0.440 0.0306 0.070 1.186 1.089 335 313 0.379 0.501 Unmet need 5.4 5.6 0.323 0.0259 0.080 0.957 0.978 335 313 0.272 0.375 Antenatal care coverage (1+ times, skilled provider) 5.5a 5.5 0.984 0.0107 0.011 1.013 1.007 161 141 0.963 1.000 Antenatal care coverage (4+ times, any provider) 5.5b 5.5 0.887 0.0262 0.030 0.961 0.981 161 141 0.835 0.939 Skilled attendant at delivery 5.7 5.2 0.962 0.0182 0.019 1.256 1.121 161 141 0.925 0.998 Literacy rate (young women) 7.1 2.3 0.933 0.0188 0.020 1.311 1.145 250 234 0.895 0.970 Knowledge about HIV prevention (young women) 9.1 6.3 0.163 0.0270 0.166 1.251 1.118 250 234 0.109 0.217 Condom use with non-regular partners 9.15 6.2 0.770 0.0531 0.069 1.020 1.010 73 65 0.664 0.876 Men Literacy rate (young men) 7.1 2.3 0.947 0.0208 0.022 1.499 1.224 206 174 0.905 0.989 Knowledge about HIV prevention (young men) 9.1 6.3 0.469 0.0401 0.086 1.118 1.058 206 174 0.389 0.549 Condom use with non-regular partners 9.15 6.2 0.921 0.0342 0.037 1.258 1.122 94 79 0.853 0.990 Sao Tome and Principe 2014 MICS, Final Report P a g e | 263 Table SE.17:172Sampling errors: Wealthiest Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft), and confidence intervals for selected indicators, Sao Tome and Principe, 2014 MICS Indicator MDG 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 Lower bound r - 2se Upper bound r + 2se Household members Use of improved drinking water sources 4.1 7.8 0.997 0.0019 0.002 0.645 0.803 2,693 491 0.994 1.000 Use of improved sanitation 4.3 7.9 0.890 0.0192 0.022 1.846 1.359 2,693 491 0.851 0.928 Primary school net attendance ratio (adjusted) 7.4 2.1 0.962 0.0093 0.010 0.809 0.900 451 344 0.943 0.980 Women Contraceptive prevalence rate 5.3 5.3 0.402 0.0249 0.062 0.732 0.855 364 285 0.352 0.452 Unmet need 5.4 5.6 0.338 0.0265 0.078 0.891 0.944 364 285 0.285 0.390 Antenatal care coverage (1+ times, skilled provider) 5.5a 5.5 1.000 0.0000 0.000 126 98 1.000 1.000 Antenatal care coverage (4+ times, any provider) 5.5b 5.5 0.928 0.0293 0.032 1.253 1.119 126 98 0.870 0.987 Skilled attendant at delivery 5.7 5.2 0.975 0.0156 0.016 0.971 0.985 126 98 0.944 1.000 Literacy rate (young women) 7.1 2.3 0.972 0.0111 0.011 0.968 0.984 269 213 0.950 0.995 Knowledge about HIV prevention (young women) 9.1 6.3 0.510 0.0360 0.071 1.100 1.049 269 213 0.438 0.582 Condom use with non-regular partners 9.15 6.2 0.709 0.0578 0.082 0.826 0.909 72 52 0.593 0.824 Men Literacy rate (young men) 7.1 2.3 0.954 0.0177 0.019 1.048 1.024 195 150 0.918 0.989 Knowledge about HIV prevention (young men) 9.1 6.3 0.555 0.0520 0.094 1.633 1.278 195 150 0.451 0.659 Condom use with non-regular partners 9.15 6.2 0.840 0.0352 0.042 0.799 0.894 120 88 0.769 0.910 Sao Tome and Principe 2014 MICS, Final Report P a g e | 264 Appendix D. Data Quality Tables Table DQ.1:173Age distribution of household population Single-year age distribution of household population by sex, Sao Tome and Principe, 2014 Males Females Males Females Number Percent Number Percent Number Percent Number Percent Age Age 0 182 2.8 180 2.6 45 51 0.8 42 0.6 1 193 3.0 210 3.0 46 41s 0.6 36 0.5 2 215 3.3 192 2.7 47 33 0.5 45 0.6 3 218 3.4 213 3.0 48 43 0.7 45 0.6 4 202 3.1 205 2.9 49 30 0.5 44 0.6 5 224 3.5 208 3.0 50 60 0.9 68 1.0 6 229 3.6 230 3.3 51 42 0.7 59 0.8 7 224 3.5 214 3.0 52 40 0.6 61 0.9 8 211 3.3 220 3.1 53 42 0.6 44 0.6 9 223 3.5 169 2.4 54 36 0.6 48 0.7 10 176 2.7 203 2.9 55 25 0.4 34 0.5 11 149 2.3 168 2.4 56 29 0.4 34 0.5 12 189 2.9 186 2.6 57 22 0.3 46 0.7 13 180 2.8 190 2.7 58 32 0.5 44 0.6 14 166 2.6 210 3.0 59 22 0.3 37 0.5 15 134 2.1 143 2.0 60 42 0.7 39 0.6 16 131 2.0 165 2.3 61 21 0.3 25 0.4 17 124 1.9 163 2.3 62 22 0.3 14 0.2 18 141 2.2 141 2.0 63 27 0.4 32 0.5 19 110 1.7 128 1.8 64 18 0.3 16 0.2 20 103 1.6 100 1.4 65 19 0.3 16 0.2 21 93 1.4 112 1.6 66 13 0.2 19 0.3 22 81 1.3 94 1.3 67 16 0.3 21 0.3 23 93 1.4 89 1.3 68 11 0.2 19 0.3 24 86 1.3 96 1.4 69 6 0.1 13 0.2 25 98 1.5 98 1.4 70 11 0.2 21 0.3 26 80 1.3 95 1.3 71 8 0.1 10 0.1 27 67 1.0 102 1.5 72 14 0.2 18 0.2 28 108 1.7 110 1.6 73 11 0.2 11 0.2 29 81 1.3 113 1.6 74 12 0.2 15 0.2 30 80 1.2 103 1.5 75 20 0.3 15 0.2 31 81 1.3 101 1.4 76 12 0.2 15 0.2 32 101 1.6 111 1.6 77 15 0.2 21 0.3 33 76 1.2 87 1.2 78 11 0.2 23 0.3 34 84 1.3 72 1.0 79 6 0.1 9 0.1 35 70 1.1 71 1.0 80 9 0.1 14 0.2 36 68 1.1 67 1.0 81 8 0.1 7 0.1 37 79 1.2 90 1.3 82 6 0.1 4 0.1 38 63 1.0 89 1.3 83 2 0.0 5 0.1 39 63 1.0 60 0.9 84 4 0.1 5 0.1 40 33 0.5 71 1.0 85+ 14 0.2 24 0.3 41 52 0.8 53 0.8 42 54 0.8 78 1.1 DK/Missing 3 0.0 3 0.0 43 47 0.7 57 0.8 44 49 0.8 51 0.7 Total 6423 100.0 7032 100.0 Sao Tome and Principe 2014 MICS, Final Report P a g e | 265 Figure DQ.1: 24Household populat ion by s ingle ages , Sao Tome and Pr inc ipe , 2014 * The figure excludes 6 household members with unknown age and/or sex Table DQ.2:174Age distribution of eligible and interviewed women Household population of women age 10-54 years, interviewed women age 15-49 years, and percentage of eligible women who were interviewed, by five-year age groups, Sao Tome and Principe, 2014 Household population of women age 10-54 years Interviewed women age 15-49 years Percentage of eligible women interviewed (Completion rate) Number Number Percent Age 10-14 956 na na na 15-19 741 706 23.9 95.3 20-24 491 471 15.9 95.9 25-29 518 487 16.5 94.1 30-34 475 448 15.2 94.3 35-39 378 351 11.9 92.8 40-44 310 291 9.9 93.9 45-49 211 200 6.8 94.7 50-54 281 na na na Total (15-49) 3,125 2,954 100.0 94.5 Ratio of 50-54 to 45-49 1.33 na na na 0 50 100 150 200 250 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85+ Number Age Males Females Sao Tome and Principe 2014 MICS, Final Report P a g e | 266 Table DQ.3:175Age distribution of eligible and interviewed men Household population of men age 10-54 years, in all households and in households selected for men's interviews, interviewed men age 15-49 years, and percentage of eligible men who were interviewed, by five-year age groups, Sao Tome and Principe, 2014 Household population of men age 10-54 years Interviewed men age 15-49 years Percentage of eligible men interviewed (Completion rate) All households Selected households Number Number Number Percent Age 10-14 859 859 na na na 15-19 641 641 564 25.7 88.0 20-24 456 456 366 16.7 80.2 25-29 435 435 340 15.5 78.2 30-34 423 423 322 14.7 76.1 35-39 343 343 275 12.5 80.1 40-44 235 235 171 7.8 72.6 45-49 199 199 157 7.1 78.6 50-54 220 220 na na na Total (15-49) 2,732 2,732 2,194 100.0 80.3 Ratio of 50-54 to 45-49 1.10 1.10 na na na na: not applicable Table DQ.4:176Age distribution of children in household and under-5 questionnaires Household population of children age 0-7 years, children age 0-4 years whose mothers/caretakers were interviewed, and percentage of under-5 children whose mothers/caretakers were interviewed, by single years of age, Sao Tome and Principe, 2014 Household population of children 0-7 years Under-5s with completed interviews Percentage of eligible under-5s with completed interviews (Completion rate) Number Number Percent Age 0 361 356 18.0 98.4 1 403 400 20.2 99.1 2 407 396 20.0 97.2 3 431 422 21.4 97.8 4 407 403 20.4 98.9 5 432 na na na 6 460 na na na 7 438 na na na Total (0-4) 2,010 1,976 100.0 98.3 Ratio of 5 to 4 1.06 na na na na: not applicable Sao Tome and Principe 2014 MICS, Final Report P a g e | 267 Table DQ.5:177Birth date reporting: Household population Percent distribution of household population by completeness of date of birth information, Sao Tome and Principe, 2014 Completeness of reporting of month and year of birth Total Number of household members Year and month of birth Year of birth only Month of birth only Both missing Total 97.6 1.6 0.2 0.6 100.0 13,567 Age 0-4 99.8 0.1 0.0 0.1 100.0 2,062 5-14 97.5 1.7 0.1 0.7 100.0 4,041 15-24 98.8 0.6 0.0 0.6 100.0 2,326 25-49 98.3 0.9 0.2 0.5 100.0 3,547 50-64 92.7 5.1 1.1 1.1 100.0 1,047 65-84 91.4 7.7 0.2 0.8 100.0 509 85+ 92.6 3.7 3.7 0.0 100.0 27 DK/Missing na na 0.0 100.0 100.0 8 Region R. Centre East 97.1 1.4 0.4 1.1 100.0 6,178 R. North West 99.1 0.8 0.0 0.1 100.0 3,457 R. South East 96.6 2.8 0.0 0.5 100.0 3,000 A. R. Principe 98.8 1.1 0.0 0.1 100.0 932 Area Urban 97.8 1.5 0.2 0.6 100.0 8,121 Rural 97.4 1.7 0.2 0.8 100.0 5,446 na: not applicable Table DQ.6:178Birth date and age reporting: Women Percent distribution of women age 15-49 years by completeness of date of birth/age information, Sao Tome and Principe, 2014 Completeness of reporting of date of birth and age Total Number of women age 15-49 years Year and month of birth Year of birth and age Year of birth only Age only Other/DK/Missing Total 99.9 0.1 0.0 0.0 0.0 100.0 2,935 Region R. Centre East 99.9 0.1 0.0 0.0 0.0 100.0 1,389 R. North West 99.7 0.1 0.0 0.1 0.0 100.0 756 R. South East 99.8 0.2 0.0 0.0 0.0 100.0 582 A. R. Principe 100.0 0.0 0.0 0.0 0.0 100.0 208 Area Urban 99.8 0.1 0.0 0.1 0.0 100.0 1,810 Rural 99.9 0.1 0.0 0.0 0.0 100.0 1,125 Sao Tome and Principe 2014 MICS, Final Report P a g e | 268 Table DQ.7:179Birth date and age reporting: Men Percent distribution of men age 15-49 years by completeness of date of birth/age information, Sao Tome and Principe, 2014 Completeness of reporting of date of birth and age Total Number of men age 15-49 years Year and month of birth Year of birth and age Year of birth only Age only Other/DK/Missing Total 99.6 0.3 0.0 0.0 0.0 100.0 2,267 Region R. Centre East 99.8 0.0 0.0 0.1 0.0 100.0 924 R. North West 100.0 0.0 0.0 0.0 0.0 100.0 598 R. South East 99.6 0.4 0.0 0.0 0.0 100.0 539 A. R. Principe 98.1 1.9 0.0 0.0 0.0 100.0 206 Area Urban 99.9 0.1 0.0 0.0 0.0 100.0 1,360 Rural 99.3 0.4 0.0 0.1 0.0 100.0 907 Table DQ.8:180Birth date and age reporting: Under-5s Percent distribution children under 5 by completeness of date of birth/age information, Sao Tome and Principe, 2014 Completeness of reporting of date of birth and age Total Number of under-5 children Year and month of birth Year of birth and age Year of birth only Age only Other/DK/Missing Total 100.0 0.0 0.0 0.0 0.0 100.0 2,030 Region R. Centre East 100.0 0.0 0.0 0.0 0.0 100.0 916 R. North West 100.0 0.0 0.0 0.0 0.0 100.0 526 R. South East 100.0 0.0 0.0 0.0 0.0 100.0 436 A. R. Principe 100.0 0.0 0.0 0.0 0.0 100.0 152 Area Urban 100.0 0.0 0.0 0.0 0.0 100.0 1,210 Rural 100.0 0.0 0.0 0.0 0.0 100.0 820 Sao Tome and Principe 2014 MICS, Final Report P a g e | 269 Table DQ.9:181Birth date reporting: Children, adolescents and young people Percent distribution of children, adolescents and young people age 5-24 years by completeness of date of birth information, Sao Tome and Principe, 2014 Completeness of reporting of month and year of birth Total Number of children, adolescents and young people age 5-24 years Year and month of birth Year of birth only Month of birth only Both missing Total 98.0 1.3 0.1 0.7 100.0 6,367 Region R. Centre East 97.4 1.2 0.1 1.3 100.0 2,867 R. North West 99.5 0.4 0.0 0.1 100.0 1,670 R. South East 96.8 2.9 0.0 0.3 100.0 1,425 A. R. Principe 99.5 0.5 0.0 0.0 100.0 405 Area Urban 98.2 1.3 0.1 0.5 100.0 3,813 Rural 97.7 1.3 0.1 0.9 100.0 2,554 Sao Tome and Principe 2014 MICS, Final Report P a g e | 270 Table DQ.10:182Birth date reporting: First and last births Percent distribution of first and last births to women age 15-49 years by completeness of date of birth, Sao Tome and Principe, 2014 Completeness of reporting of date of birth Date of first birth Total Number of first births Date of last birth Total Number of last births Year and month of birth Year of birth only Completed years since first birth only Other/DK/Missing Year and month of birth Year of birth only Other/DK/Missing Total 98.2 0.6 0.7 0.5 100.0 2,189 98.9 0.6 0.5 100.0 1,817 Region R. Centre East 98.5 0.3 0.6 0.6 100.0 993 99.0 0.4 0.6 100.0 807 R. North West 97.9 0.5 1.2 0.3 100.0 573 99.2 0.4 0.4 100.0 479 R. South East 97.3 1.5 0.4 0.7 100.0 452 98.2 1.3 0.5 100.0 393 A. R. Principe 99.4 0.6 0.0 0.0 100.0 171 99.3 0.7 0.0 100.0 138 Area Urban 98.1 0.8 0.5 0.6 100.0 1,325 98.9 0.7 0.4 100.0 1,092 Rural 98.3 0.3 1.0 0.3 100.0 864 98.9 0.4 0.7 100.0 725 Sao Tome and Principe 2014 MICS, Final Report P a g e | 271 Table DQ.11:183Completeness of reporting Percentage of observations that are missing information for selected questions and indicators, Sao Tome and Principe, 2014 Questionnaire and type of missing information Reference group Percent with missing/incomplete informationa Number of cases Household Salt test result All households interviewed that have salt 1.4 3,492 Starting time of interview All households interviewed 0.7 3,492 Ending time of interview All households interviewed 0.5 3,492 Women Date of first marriage/union All ever married women age 15-49 Only month 16.0 2,168 Both month and year 42.7 2,168 Age at first marriage/union All ever married women age 15-49 with year of first marriage not known 7.3 2,168 Age at first intercourse All women age 15-24 who have ever had sex 0.4 758 Time since last intercourse All women age 15-24 who have ever had sex 0.7 758 Starting time of interview All women interviewed 0.6 2,935 Ending time of interview All women interviewed 0.3 2,935 Men Date of first marriage/union All ever married men age 15-49 Only month 25.1 1,314 Both month and year 26.9 1,314 Age at first marriage/union All ever married men age 15-49 with year of first marriage not known 0.0 1,314 Age at first intercourse All men age 15-24 who have ever had sex 0.0 621 Time since last intercourse All men age 15-24 who have ever had sex 0.3 621 Starting time of interview All men interviewed 1.0 2,267 Ending time of interview All men interviewed 0.9 2,267 Under-5 Starting time of interview All under-5 children 1.4 2,030 Ending time of interview All under-5 children 1.1 2,030 a Includes "Don't know" responses Sao Tome and Principe 2014 MICS, Final Report P a g e | 272 Table DQ.12:184Completeness of information for anthropometric indicators: Underweight Percent distribution of children under 5 by completeness of information on date of birth and weight, Sao Tome and Principe, 2014 Valid weight and date of birth Reason for exclusion from analysis Total Percent of children excluded from analysis Number of children under 5 Weight not measured Incomplete date of birth Weight not measured and incomplete date of birth Flagged cases (outliers) Total 96.1 3.7 0.0 0.0 0.2 100.0 3.9 2,030 Age <6 months 92.9 6.5 0.0 0.0 0.6 100.0 7.1 169 6-11 months 97.8 1.7 0.0 0.0 0.6 100.0 2.2 180 12-23 months 95.7 4.3 0.0 0.0 0.0 100.0 4.3 391 24-35 months 96.9 3.1 0.0 0.0 0.0 100.0 3.1 423 36-47 months 95.6 4.2 0.0 0.0 0.2 100.0 4.4 429 48-59 months 96.6 3.2 0.0 0.0 0.2 100.0 3.4 438 Table DQ.13:185Completeness of information for anthropometric indicators: Stunting Percent distribution of children under 5 by completeness of information on date of birth and length or height, Sao Tome and Principe, 2014 Valid length/height and date of birth Reason for exclusion from analysis Total Percent of children excluded from analysis Number of children under 5 Length/Height not measured Incomplete date of birth Length/Height not measured, incomplete date of birth Flagged cases (outliers) Total 95.7 4.0 0.0 0.0 0.3 100.0 4.3 2,030 Age <6 months 91.7 6.5 0.0 0.0 1.8 100.0 8.3 169 6-11 months 97.2 1.7 0.0 0.0 1.1 100.0 2.8 180 12-23 months 95.1 4.9 0.0 0.0 0.0 100.0 4.9 391 24-35 months 96.0 4.0 0.0 0.0 0.0 100.0 4.0 423 36-47 months 95.8 4.0 0.0 0.0 0.2 100.0 4.2 429 48-59 months 96.6 3.2 0.0 0.0 0.2 100.0 3.4 438 Sao Tome and Principe 2014 MICS, Final Report P a g e | 273 Table DQ.14:186Completeness of information for anthropometric indicators: Wasting Percent distribution of children under 5 by completeness of information on weight and length or height, Sao Tome and Principe, 2014 Valid weight and length/height Reason for exclusion from analysis Total Percent of children excluded from analysis Number of children under 5 Weight not measured Length/Height not measured Weight and length/height not measured Flagged cases (outliers) Total 95.9 0.0 0.3 3.7 0.1 100.0 4.1 2,030 Age <6 months 92.3 0.0 0.0 6.5 1.2 100.0 7.7 169 6-11 months 98.3 0.0 0.0 1.7 0.0 100.0 1.7 180 12-23 months 95.1 0.0 0.5 4.3 0.0 100.0 4.9 391 24-35 months 96.0 0.0 0.9 3.1 0.0 100.0 4.0 423 36-47 months 95.8 0.2 0.0 4.0 0.0 100.0 4.2 429 48-59 months 96.8 0.0 0.0 3.2 0.0 100.0 3.2 438 Sao Tome and Principe 2014 MICS, Final Report P a g e | 274 Table DQ.15:187Heaping in anthropometric measurements Distribution of weight and height/length measurements by digits reported for the decimal points, Sao Tome and Principe, 2014 Weight Height or length Number Percent Number Percent Total 1,954 100.0 1,955 100.0 Digits 0 217 11.1 368 18.8 1 185 9.5 124 6.3 2 201 10.3 214 10.9 3 199 10.2 199 10.2 4 188 9.6 163 8.3 5 202 10.3 313 16.0 6 193 9.9 190 9.7 7 206 10.5 152 7.8 8 203 10.4 132 6.8 9 160 8.2 100 5.1 0 or 5 419 21.4 681 34.8 Figure DQ.2: 25Weight and height /length measurements by d igi ts reported for the decimal points , Sao Tome and Pr inc ipe, 2014 0 2 4 6 8 10 12 14 16 18 20 0 1 2 3 4 5 6 7 8 9 P er c en t Digits reported Weight Height or length Sao Tome and Principe 2014 MICS, Final Report P a g e | 275 Table DQ.16:188Observation of birth certificates Percent distribution of children under 5 by presence of birth certificates,and percentage of birth certificates seen, Sao Tome and Principe, 2014 Child has birth certificate Child does not have birth certificate DK/Missing Total Percentage of birth certificates seen by the interviewer (1)/(1+2)*100 Number of children under age 5 Seen by the interviewer (1) Not seen by the interviewer (2) Total 83.4 10.6 6.0 0.0 100.0 88.7 2,030 Region R. Centre East 85.3 9.3 5.3 0.1 100.0 90.2 916 R. North West 79.1 12.5 8.4 0.0 100.0 86.3 526 R. South East 85.8 8.5 5.7 0.0 100.0 91.0 436 A. R. Principe 80.3 17.8 2.0 0.0 100.0 81.9 152 Area Urban 85.7 9.3 5.0 0.1 100.0 90.3 1,210 Rural 80.0 12.6 7.4 0.0 100.0 86.4 820 Child's age 0-5 months 81.7 10.7 7.7 0.0 100.0 88.5 169 6-11 months 86.7 7.2 6.1 0.0 100.0 92.3 180 12-23 months 82.9 10.2 6.9 0.0 100.0 89.0 391 24-35 months 84.9 10.2 5.0 0.0 100.0 89.3 423 36-47 months 82.8 11.9 5.4 0.0 100.0 87.4 429 48-59 months 82.4 11.4 5.9 0.2 100.0 87.8 438 Table DQ.17:189Observation of vaccination cards Percent distribution of children age 0-35 months by presence of a vaccination card, and the percentage of vaccination cards seen by the interviewers, Sao Tome and Principe, 2014 Child does not have vaccination card Child has vaccination card DK/Missing Total Percentage of vaccination cards seen by the interviewer (1)/(1+2)*100 Number of children age 0-35 months Had vaccination card previously Never had vaccination card Seen by the interviewer (1) Not seen by the interviewer (2) Total 0.5 0.7 90.6 8.0 0.2 100.0 91.9 1,163 Region R. C. East 0.9 0.2 88.2 10.5 0.2 100.0 89.4 534 R. N. West 0.0 0.7 93.4 5.6 0.3 100.0 94.4 304 R. S. East 0.0 1.2 92.9 5.8 0.0 100.0 94.1 241 A. R. Principe 1.2 2.4 89.3 7.1 0.0 100.0 92.6 84 Area Urban 0.6 0.6 91.8 7.0 0.0 100.0 92.9 696 Rural 0.4 0.9 88.9 9.4 0.4 100.0 90.4 467 Child's age 0-5 months 0.6 1.8 91.1 6.5 0.0 100.0 93.3 169 6-11 months 0.0 1.1 94.4 4.4 0.0 100.0 95.5 180 12-23 months 0.5 0.3 91.3 7.9 0.0 100.0 92.0 391 24-35 months 0.7 0.5 88.2 10.2 0.5 100.0 89.7 423 Sao Tome and Principe 2014 MICS, Final Report P a g e | 276 Table DQ.18:190Observation of women's health cards Percent distribution of women with a live birth in the last 2 years by presence of a health card, and the percentage of health cards seen by the interviewers, Sao Tome and Principe, 2014 Woman does not have health card Woman has health card DK/Missing Total Percent of health cards seen by the interviewer (1)/(1+2)*100 Number of women with a live birth in the last two years Seen by the interviewer (1) Not seen by the interviewer (2) Total 3.5 76.3 19.6 0.5 100.0 79.5 367 Region R. Centre East 4.2 73.8 20.9 1.0 100.0 77.9 191 R. North West 3.9 69.9 24.2 2.0 100.0 74.3 153 R. South East 0.0 80.9 19.1 0.0 100.0 80.9 47 A. R. Principe 4.4 75.7 18.8 1.1 100.0 80.1 452 Area Urban 2.3 73.2 23.9 0.7 100.0 75.4 306 Rural 7.4 66.3 25.2 1.0 100.0 72.4 202 Wealth index quintile Poorest 3.0 72.7 23.0 1.2 100.0 75.9 165 Second 2.6 80.3 15.8 1.3 100.0 83.6 152 Middle 1.4 77.3 20.6 0.7 100.0 79.0 141 Fourth 1.0 82.7 16.3 0.0 100.0 83.5 98 Richest 3.6 74.7 20.8 0.9 100.0 78.2 758 Table DQ.19:191Observation of bednets and places for handwashing Percentage of bednets in all households observed by the interviewers, and percent distribution of places for handwashing observed by the interviewers in all interviewed households, Sao Tome and Principe, 2014 Percentage of bednets observed by interviewer Total number of bednets Place for handwashing Total Number of households interviewed Observed Not observed Not in the dwelling, plot or yard No permission to see Other reason Total 84.0 5,904 52.6 39.8 7.1 0.5 100.0 3,492 Region R. Centre East 79.1 2,725 50.8 47.8 1.2 0.2 100.0 1,626 R. North West 86.2 1,367 64.2 28.7 6.0 1.2 100.0 840 R. South East 91.7 1,283 48.1 38.6 12.6 0.7 100.0 740 A. R. Principe 85.3 529 40.2 29.7 30.1 0.0 100.0 286 Area Urban 83.9 3,813 50.0 44.4 5.0 0.6 100.0 2,054 Rural 84.3 2,091 56.2 33.3 10.1 0.4 100.0 1,438 Wealth index quintile Poorest 84.4 1,181 40.0 48.0 10.8 1.1 100.0 968 Second 84.3 1,172 48.2 43.6 7.6 0.7 100.0 768 Middle 86.8 1,198 52.2 42.5 5.3 0.0 100.0 684 Fourth 84.5 1,222 58.9 34.8 6.2 0.2 100.0 581 Richest 79.9 1,131 77.4 19.8 2.6 0.2 100.0 491 Sao Tome and Principe 2014 MICS, Final Report P a g e | 277 Table DQ.20:192Respondent to the under-5 questionnaire Distribution of children under five by respondent to the under-5 questionnaire, Sao Tome and Principe, 2014 Mother in the household Mother not in the household and primary caretaker identified: Total Number of children under 5 Father Other adult female Other adult male Total 93.0 1.3 4.9 0.8 100.0 2,010 Age 0 99.6 0.0 0.4 0.0 100.0 361 1 97.2 0.0 2.6 0.2 100.0 403 2 93.2 1.2 3.9 1.8 100.0 407 3 90.4 1.3 8.3 0.0 100.0 431 4 85.6 3.7 8.6 2.2 100.0 407 Table DQ.21:193Selection of children age 1-17 years for the child labour and child discipline modules Percent distribution of households by the number of children age 1-17 years, and the percentage of households with at least two children age 1-17 years where correct selection of one child for the child labour and child discipline modules was performed, Sao Tome and Principe, 2014 Number of children age 1-17 years Total Number of households Percentage of households where correct selection was performed Number of households with 2 or more children age 1-17 years None One Two or more Total 26.8 18.1 55.1 100.0 3,492 96.4 1,925 Region R. Centre East 26.6 20.0 53.3 100.0 1,626 95.5 867 R. North West 25.1 16.5 58.3 100.0 840 96.9 490 R. South East 26.2 15.5 58.2 100.0 740 96.8 431 A. R. Principe 34.3 17.8 47.9 100.0 286 99.3 137 Area Urban 25.3 18.9 55.7 100.0 2,054 95.7 1,145 Rural 28.9 16.8 54.2 100.0 1,438 97.4 780 Wealth index quintile Poorest 38.0 15.2 46.8 100.0 968 96.5 453 Second 27.3 17.1 55.6 100.0 768 96.3 427 Middle 20.8 19.3 59.9 100.0 684 97.6 410 Fourth 19.4 20.8 59.7 100.0 581 96.5 347 Richest 21.0 20.4 58.7 100.0 491 94.8 288 Sao Tome and Principe 2014 MICS, Final Report P a g e | 278 Table DQ.22:194School attendance by single age Distribution of household population age 5-24 years by educational level and and grade attended in the current (or most recent) school year, Sao Tome and Principe, 2014 Not atten- ding school Currently attending Not able to deter- mine Total Num- ber of hous ehold mem bers Pre- scho ol Primary school Grade Secondary 1 school Grade Secondary 2 school Grade 1 2 3 4 5 6 DK/ mis. 7 8 9 10 11 12 DK/ mis. 1 2 3 4 5 DK/ mis. Age at beginning of school year 5 37.5 43.7 15.5 2.3 1.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 463 6 8.4 10.6 58.7 18.4 2.8 0.3 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 453 7 1.6 1.0 6.9 69.3 18.9 1.6 0.1 0.5 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 426 8 1.5 0.2 1.3 17.4 57.7 18.2 3.6 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 422 9 1.8 0.4 0.2 7.4 16.3 52.9 18.6 1.8 0.0 0.6 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 389 10 3.5 0.0 0.6 2.4 5.4 19.6 48.8 19.3 0.0 0.4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 319 11 4.5 0.0 0.0 1.2 3.3 13.1 27.2 41.0 0.0 7.6 2.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 346 12 6.0 0.0 0.3 0.3 1.2 3.1 19.0 39.7 0.0 24.4 5.7 0.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 374 13 7.6 0.0 0.0 0.0 0.7 1.8 5.6 25.7 0.0 16.3 33.9 8.3 0.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 375 14 10.8 0.0 0.0 0.0 0.4 0.5 2.8 16.2 0.0 14.8 32.5 18.7 2.9 0.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 314 15 17.1 0.0 0.0 0.0 0.3 0.0 0.6 7.7 0.0 6.9 21.1 32.2 12.4 1.7 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 303 16 19.3 0.0 0.0 0.0 0.0 0.0 0.0 3.0 0.0 1.5 19.7 30.6 18.2 6.4 1.4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 287 17 28.8 0.0 0.0 0.0 0.0 0.1 0.0 2.6 0.0 2.1 6.4 34.4 14.8 6.2 4.4 0.0 0.2 0.0 0.0 0.0 0.0 0.0 0.0 100.0 286 18 43.2 0.0 0.0 0.0 0.6 0.0 1.2 0.7 0.0 1.0 2.9 14.3 20.7 7.8 5.1 0.0 1.3 1.0 0.0 0.0 0.0 0.3 0.0 100.0 254 19 54.9 0.7 0.0 0.4 0.0 0.0 0.9 2.9 0.0 2.8 2.4 6.4 16.8 7.3 3.5 0.0 0.6 0.4 0.0 0.0 0.0 0.0 0.0 100.0 217 20 56.0 0.5 0.0 0.0 0.0 0.0 1.1 2.2 0.0 1.1 3.2 8.4 5.7 5.4 9.9 0.0 4.1 0.8 0.9 0.8 0.0 0.0 0.0 100.0 211 21 67.1 0.0 0.0 0.0 0.0 0.0 0.7 0.6 0.0 0.4 5.5 7.8 2.7 4.1 4.9 0.0 2.4 1.4 0.9 1.3 0.0 0.0 0.0 100.0 172 22 76.1 0.6 0.0 0.5 0.0 0.0 0.0 1.0 0.0 1.4 1.9 2.7 5.4 3.1 1.3 0.0 1.5 1.8 1.0 0.0 1.8 0.0 0.0 100.0 176 23 81.2 1.1 0.0 0.0 0.0 1.9 0.2 1.2 0.0 1.1 1.7 3.6 0.7 2.6 0.3 0.0 0.6 0.8 1.1 1.8 0.3 0.0 0.0 100.0 201 24a 32.2 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 1.1 1.1 3.0 0.3 0.8 0.0 0.0 0.0 1.7 0.0 0.0 58.9 100.0 186 a Those age 25 at the time of interview who were age 24 at beginning of school year are excluded as current attendance was only collected for those age 5-24 at the time of interview Sao Tome and Principe 2014 MICS, Final Report P a g e | 279 Table DQ.23:195Sex ratio at birth among children ever born and living Sex ratio (number of males per 100 females) among children ever born (at birth), children living, and deceased children, by age of women, Sao Tome and Principe, 2014 Children Ever Born Children Living Children Deceased Number of women Sons Daughters Sex ratio at birth Sons Daughters Sex ratio Sons Daughters Sex ratio Total 3,781 3,711 1.02 3,536 3,509 1.01 245 202 1.21 2,935 Age 15-19 63 74 0.85 59 69 0.86 4 5 0.80 688 20-24 296 298 0.99 282 289 0.98 14 9 1.56 462 25-29 609 565 1.08 592 552 1.07 17 13 1.31 486 30-34 770 754 1.02 735 734 1.00 35 20 1.75 459 35-39 733 701 1.05 669 662 1.01 64 39 1.64 341 40-44 707 705 1.00 650 649 1.00 57 56 1.02 293 45-49 603 614 0.98 549 554 0.99 54 60 0.90 206 Sao Tome and Principe 2014 MICS, Final Report P a g e | 280 Table DQ.24:196Births by periods preceding the survey Number of births, sex ratio at birth, and period ratio by periods preceding the survey, according to living, deceased, and total children (imputed), as reported in the birth histories, Sao Tome and Principe, 2014 Number of births Percent with complete birth datea Sex ratio at birthb Period ratioc Living Deceased Total Living Deceased Total Living Deceased Total Living Deceased Total Total 6,682 438 7,119 98.0 84.6 97.2 100.5 127.0 101.9 na na na Years 0 336 19 355 99.6 86.1 98.9 97.2 90.1 96.8 na na na 1 384 17 401 99.6 100.0 99.6 91.2 164.4 93.5 109.1 98.8 108.6 2 368 16 384 98.2 94.1 98.0 118.3 193.4 120.7 95.0 115.4 95.7 3 391 11 402 99.6 100.0 99.6 110.6 107.6 110.5 110.2 63.8 108.1 4 342 17 359 99.5 95.8 99.3 98.3 518.9 105.0 91.2 156.1 93.1 5 358 12 369 100.0 93.0 99.8 116.1 92.9 115.3 98.9 59.4 96.9 6 382 22 404 99.4 76.1 98.2 105.4 126.6 106.5 107.9 197.8 110.6 7 350 10 360 98.8 73.2 98.0 108.3 230.4 110.5 94.9 65.7 93.7 8 356 10 366 99.2 79.1 98.6 96.4 56.9 95.1 108.7 84.4 107.9 9 305 13 317 98.6 53.4 96.8 136.4 95.0 134.4 17.6 8.5 16.8 10+ 3,109 292 3,401 96.6 84.0 95.6 93.8 121.5 95.9 na na na Five-year periods 0-4 1,822 80 1,902 99.3 94.6 99.1 102.8 169.0 104.9 na na na 5-9 1,750 66 1,816 99.2 74.7 98.3 111.0 110.1 111.0 na na na 10-14 1,313 82 1,394 98.1 88.3 97.5 93.2 141.0 95.5 na na na 15-19 896 98 994 96.5 82.5 95.1 95.6 104.3 96.5 na na na 20+ 901 112 1,013 94.7 82.2 93.3 92.7 124.9 95.8 na na na na: not applicable a Both month and year of birth given. The inverse of the percent reported is the percent with incomplete and therefore imputed date of birth b (Bm/Bf) x 100, where Bm and Bf are the numbers of male and female births, respectively c (2 x Bt/(Bt-1 + Bt+1)) x 100, where Bt is the number of births in year t preceding the survey Sao Tome and Principe 2014 MICS, Final Report P a g e | 281 Table DQ.25:197Reporting of age at death in days Distribution of reported deaths under one month of age by age at death in days and the percentage of neonatal deaths reported to occur at ages 0–6 days, by 5-year periods preceding the survey (imputed), Sao Tome and Principe, 2014 Number of years preceding the survey Total (0–19) 0–4 5–9 10–14 15–19 Age at death (days) 0 2 4 4 4 13 1 16 13 7 3 39 2 0 2 1 1 4 3 5 0 1 1 6 4 0 1 0 0 1 5 1 1 0 1 2 6 0 0 0 0 0 7 1 0 0 1 2 8 5 1 2 0 8 9 0 0 0 0 0 10 0 0 0 0 0 11 0 0 0 0 0 12 1 0 0 0 1 13 0 0 0 0 0 14 1 0 1 0 2 15 0 0 0 1 1 16 0 0 0 0 0 17 0 0 0 0 0 18 0 1 0 0 1 19 0 0 0 0 0 20 2 1 2 0 5 21 0 0 0 0 0 22 0 0 0 0 0 23 0 0 1 0 1 24 0 0 0 0 0 25 0 0 1 0 1 26 0 2 0 0 2 27 0 0 0 0 0 28 2 0 0 0 2 29 0 0 0 0 0 30 0 0 0 0 0 Total 0–30 days 36 25 19 12 93 Percent early neonatala 66.3 80.7 63.2 77.2 71.1 a Deaths during the first 7 days (0-6), divided by deaths during the first month (0-30 days) Sao Tome and Principe 2014 MICS, Final Report P a g e | 282 Table DQ.26:198Reporting of age at death in months Distribution of reported deaths under two years of age by age at death in months and the percentage of infant deaths reported to occur at age under one month, for the 5-year periods of birth preceding the survey (imputed), Sao Tome and Principe, 2014 Number of years preceding the survey Total (0-19) 0–4 5–9 10–14 15–19 Age at death (months) 0a 39 25 23 13 101 1 2 5 0 6 12 2 3 1 3 4 11 3 6 1 2 3 12 4 3 2 3 1 8 5 1 1 0 3 4 6 3 2 2 8 16 7 2 6 1 2 10 8 3 1 1 5 10 9 3 4 4 3 14 10 1 0 1 3 5 11 1 0 1 2 3 12 1 1 0 0 2 13 0 0 0 2 2 14 0 0 0 0 0 15 0 0 0 0 0 16 0 0 0 0 0 17 0 0 1 1 2 18 0 0 0 0 0 19 0 0 0 0 0 20 0 0 0 0 0 21 0 0 0 0 0 22 0 0 0 0 0 23 0 0 0 0 0 24 1 0 0 0 1 Reported as 1 year 3 3 11 9 26 Total 0–11 months 64 47 47 59 216 Percent neonatalb 59.2 53.2 55.8 24.9 48.6 a Includes deaths under one month reported in days b Deaths under one month, divided by deaths under one year Sao Tome and Principe 2014 MICS, Final Report P a g e | 283 Table DQ.27:199Completeness of information on siblings Completeness of information on the survival status of (all) siblings and age of living siblings reported by interviewed women, and age at death and years since death of siblings who have died (unweighted), Country, Year Sisters Brothers All siblings Number Percent Number Percent Number Percent Survival status of siblings Living 7,345 93.2 7,099 92.1 14,444 92.7 Dead 523 6.6 595 7.7 1,118 7.2 DK/Missing 13 .2 14 .2 27 .2 Total 7,881 100.0 7,708 100.0 15,589 100.0 Age of living siblings Reported 7,322 99.7 7,072 99.6 14,394 99.7 DK/Missing 23 .3 27 .4 50 .3 Total 7,345 100.0 7,099 100.0 14,444 100.0 Age at death and years since death for siblings who have died Both reported 498 95.2 566 95.1 1,064 95.2 Only years since death reported 12 2.3 17 2.9 29 2.6 Only age at death reported 10 1.9 6 1.0 16 1.4 DK/Missing both 3 .6 6 1.0 9 .8 Total 523 100.0 595 100.0 1,118 100.0 Table DQ.28:200Sibship size and sex ratio of siblings Mean sibship size and sex ratio of siblings at birth, Country, Year Mean sibship sizea Sex ratio of siblings at birthb Number of women age 15-49 years Total 6.2 .97 2885 Age 15-19 5.3 .92 693 20-24 5.9 .98 462 25-29 6.3 .93 472 30-34 6.5 1.00 438 35-39 6.9 1.04 342 40-44 7.3 1.01 285 45-49 6.6 .90 193 a Includes the respondent b Excludes the respondent Sao Tome and Principe 2014 MICS, Final Report P a g e | 284 Appendix E. Sao Tome and Principe MICS5 Indicators: Numerators and Denominators MICS INDICATOR [M] Modulei Numerator Denominator MDG Indicator Referenceii MORTALITY iii 1.1 Neonatal mortality rate BH Probability of dying within the first month of life 1.2 Infant mortality rate CM - BH Probability of dying between birth and the first birthday MDG 4.2 1.3 Post-neonatal mortality rate BH Difference between infant and neonatal mortality rates 1.4 Child mortality rate BH Probability of dying between the first and the fifth birthdays 1.5 Under-five mortality rate CM - BH Probability of dying between birth and the fifth birthday MDG 4.1 NUTRITION 2.1a 2.1b Underweight prevalence AN Number of children under age 5 who fall below (a) minus two standard deviations (moderate and severe) (b) minus three standard deviations (severe) of the median weight for age of the WHO standard Total number of children under age 5 MDG 1.8 2.2a 2.2b Stunting prevalence AN Number of children under age 5 who fall below (a) minus two standard deviations (moderate and severe) (b) below minus three standard deviations (severe) of 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 fall below (a) minus two standard deviations (moderate and severe) (b) minus three standard deviations (severe) of the median weight for height of the WHO standard Total number of children under age 5 [M] The indicator is also calculated for men, for the same age group, in surveys where the Questionnaire for Individual Men has been included. Calculations are carried out by using modules in the Questionnaire for Individual Men i Some indicators are constructed by using questions in several modules in the MICS questionnaires. In such cases, only the module(s) which contains most of the necessary information is indicated. ii Millennium Development Goals (MDG) indicators, effective 15 January 2008 - http://mdgs.un.org/unsd/mdg/Host.aspx?Content=Indicators/OfficialList.htm, accessed 10 June 2013. iii The Birth History module is used, and the mortality indicators are calculated for the last 5-year period Sao Tome and Principe 2014 MICS, Final Report P a g e | 285 MICS INDICATOR [M] Modulei Numerator Denominator MDG Indicator Referenceii 2.4 Overweight prevalence AN Number of children under age 5 who are above two standard deviations of the median weight for height of the WHO standard Total number of children under age 5 2.5 Children ever breastfed MN Number of women with a live birth in the last 2 years who breastfed their last live-born child at any time Total number of women with a live birth in the last 2 years 2.6 Early initiation of breastfeeding MN Number of women with a live birth in the last 2 years who put their last newborn to the breast within one hour of birth Total number of women with a live birth in the last 2 years 2.7 Exclusive breastfeeding under 6 months BD Number of infants under 6 months of age who are exclusively breastfedi Total number of infants under 6 months of age 2.8 Predominant breastfeeding under 6 months BD Number of infants under 6 months of age who received breast milk as the predominant source of nourishmentii during the previous day Total number of infants under 6 months of age 2.9 Continued breastfeeding at 1 year BD Number of children age 12-15 months who received breast milk during the previous day Total number of children age 12-15 months 2.10 Continued breastfeeding at 2 years BD Number of children age 20-23 months who received breast milk during the previous day Total number of children age 20-23 months 2.11 Duration of breastfeeding BD The age in months when 50 percent of children age 0-35 months did not receive breast milk during the previous day 2.12 Age-appropriate breastfeeding BD Number of children age 0-23 months appropriately fediii during the previous day Total number of children age 0-23 months 2.13 Introduction of solid, semi-solid or soft foods BD 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 2.14 Milk feeding frequency for non-breastfed children BD 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 i Infants receiving breast milk, and not receiving any other fluids or foods, with the exception of oral rehydration solution, vitamins, mineral supplements and medicines ii 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) iii Infants age 0-5 months who are exclusively breastfed, and children age 6-23 months who are breastfed and ate solid, semi-solid or soft foods Sao Tome and Principe 2014 MICS, Final Report P a g e | 286 MICS INDICATOR [M] Modulei Numerator Denominator MDG Indicator Referenceii 2.15 Minimum meal frequency BD Number of children age 6-23 months who received solid, semi-solid and soft foods (plus milk feeds for non- breastfed children) the minimum number of timesi or more during the previous day Total number of children age 6-23 months 2.16 Minimum dietary diversity BD Number of children age 6–23 months who received foods from 4 or more food groupsii during the previous day Total number of children age 6–23 months 2.17a 2.17b Minimum acceptable diet BD (a) Number of breastfed children age 6–23 months who had at least the minimum dietary diversity and the minimum meal frequency during the previous day (b) Number of non-breastfed children age 6–23 months who received at least 2 milk feedings and had at least the minimum dietary diversity not including milk feeds and the minimum meal frequency during the previous day (a) Number of breastfed children age 6–23 months (b) Number of non-breastfed children age 6–23 months 2.18 Bottle feeding BD 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 2.19 Iodized salt consumption SI Number of households with salt testing 15 parts per million or more of iodide Total number of households in which salt was tested or where there was no salt 2.20 Low-birthweight infants MN Number of most recent live births in the last 2 years weighing below 2,500 grams at birth Total number of most recent live births in the last 2 years 2.21 Infants weighed at birth MN Number of most recent live births in the last 2 years who were weighed at birth Total number of most recent live births in the last 2 years i Breastfeeding children: Solid, semi-solid, or soft foods, two times for infants age 6-8 months, and three 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 ii The indicator is based on consumption of any amount of food from at least 4 out of the 7 following food groups: 1) grains, roots and tubers, 2) legumes and nuts, 3) dairy products (milk, yogurt, cheese), 4) flesh foods (meat, fish, poultry and liver/organ meats), 5) eggs, 6) vitamin-A rich fruits and vegetables, and 7) other fruits and vegetables Sao Tome and Principe 2014 MICS, Final Report P a g e | 287 MICS INDICATOR [M] Modulei Numerator Denominator MDG Indicator Referenceii CHILD HEALTH 3.1 Tuberculosis immunization coverage IM Number of children age 12-23 months who received BCG vaccine by their first birthday Total number of children age 12-23 months 3.S1i Pneumococcal conjugate vaccine (PCV) IM Number of children age 12-23 months who received the third dose of PCV vaccine (PCV3) by their first birthday Total number of children age 12-23 months 3.2 Polio immunization coverage IM Number of children age 12-23 months who received the third dose of OPV vaccine (OPV3) by their first birthday Total number of children age 12-23 months 3.3 Diphtheria, pertussis and tetanus (DPT) immunization coverage IM Number of children age 12-23 months who received the third dose of DPT vaccine (DPT3) by their first birthday Total number of children age 12-23 months 3.4 Measles immunization coverage IM Number of children age 12-23 months who received measles vaccine by their first birthday Total number of children age 12-23 months MDG 4.3 3.5 Hepatitis B immunization coverage IM Number of children age 12-23 months who received the third dose of Hepatitis B vaccine (HepB3) by their first birthday Total number of children age 12-23 months 3.6 Haemophilus influenzae type B (Hib) immunization coverage IM Number of children age 12-23 months who received the third dose of Hib vaccine (Hib3) by their first birthday Total number of children age 12-23 months 3.7 Yellow fever immunization coverage IM Number of children age 12-23 months who received yellow fever vaccine by their first birthday Total number of children age 12-23 months 3.8ii Full immunization coverage IM Number of children age 12-23 months who received all vaccinations recommended in the national immunization schedule by their first birthday Total number of children age 12-23 months 3.9 Neonatal tetanus protection MN Number of women age 15-49 years with a live birth in the last 2 years who were given at least two doses of tetanus toxoid vaccine within the appropriate intervaliii prior to the most recent birth Total number of women age 15-49 years with a live birth in the last 2 years 3.10 Care-seeking for diarrhoea CA Number of children under age 5 with diarrhoea in the last 2 weeks for whom advice or treatment was sought from a health facility or provider Total number of children under age 5 with diarrhoea in the last 2 weeks i Specific indicator for Sao Tome and Principe ii Includes BCG, OPV3, penta3, PCV3, yellow fever and measles iii See the MICS tabulation plan for a detailed description Sao Tome and Principe 2014 MICS, Final Report P a g e | 288 MICS INDICATOR [M] Modulei Numerator Denominator MDG Indicator Referenceii 3.S2i Diarrhoea treatment with oral rehydration salts (ORS) CA Percentage of children under age 5 with diarrhoea in the last 2 weeks who received ORS Total number of children under age 5 with diarrhoea in the last 2 weeks 3.12 Diarrhoea treatment with oral rehydration therapy (ORT) and continued feeding CA Number of children under age 5 with diarrhoea in the last 2 weeks who received ORT (ORS packet, pre-packaged ORS fluid, recommended homemade fluid or increased fluids) and continued feeding during the episode of diarrhoea Total number of children under age 5 with diarrhoea in the last 2 weeks 3.13 Care-seeking for children with acute respiratory infection (ARI) symptoms CA Number of children under age 5 with ARI symptoms in the last 2 weeks for whom advice or treatment was sought from a health facility or provider Total number of children under age 5 with ARI symptoms in the last 2 weeks 3.14 Antibiotic treatment for children with ARI symptoms CA Number of children under age 5 with ARI symptoms in the last 2 weeks who received antibiotics Total number of children under age 5 with ARI symptoms in the last 2 weeks 3.15 Use of solid fuels for cooking 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 3.16a 3.16b Household availability of insecticide- treated nets (ITNs)ii TN Number of households with (a) at least one ITN (b) at least one ITN for every two people Total number of households 3.17a 3.17b Household vector controliii TN - IR Number of households (a) with at least one ITN or that have been sprayed by IRSiv in the last 12 months (b) with at least one ITN for every two people or that have been sprayed by IRS in the last 12 months Total number of households 3.18 Children under age 5 who slept under an ITN TN Number of children under age 5 who slept under an ITN the previous night Total number of children under age 5 who spent the previous night in the interviewed households MDG 6.7 3.19 Population that slept under an ITN TN Number of household members who slept under an ITN the previous night Total number of household members who spent the previous night in the interviewed households i Specific indicator for Sao Tome and Principe ii An ITN is (a) a conventionally treated net which has been soaked with an insecticide within the past 12 months, (b) factory treated net which does not require any treatment (LLIN), (c) a pretreated net obtained within the last 12 months, or (d) a net that has been soaked with or dipped in insecticide within the last 12 months iii (a) Households covered by vector control, (b) Universal coverage of vector control iv Indoor Residual Spraying Sao Tome and Principe 2014 MICS, Final Report P a g e | 289 MICS INDICATOR [M] Modulei Numerator Denominator MDG Indicator Referenceii 3.20 Care-seeking for fever CA Number of children under age 5 with fever in the last 2 weeks for whom advice or treatment was sought from a health facility or provider Total number of children under age 5 with fever in the last 2 weeks 3.21 Malaria diagnostics usage CA Number of children under age 5 with fever in the last 2 weeks who had a finger or heel stick for malaria testing Total number of children under age 5 with fever in the last 2 weeks 3.22 Anti-malarial treatment of children under age 5 CA Number of children under age 5 with fever in the last 2 weeks who received any antimalarial treatment Total number of children under age 5 with fever in the last 2 weeks MDG 6.8 3.23 Treatment with Artemisinin-based Combination Therapy (ACT) among children who received anti-malarial treatment CA Number of children under age 5 with fever in the last 2 weeks who received ACT (or other first-line treatment according to national policy) Total number of children under age 5 with fever in the last 2 weeks who received any anti-malarial drugs 3.24 Pregnant women who slept under an ITN TN – CP Number of pregnant women who slept under an ITN the previous night Total number of pregnant women 3.25 Intermittent preventive treatment for malaria during pregnancy MN Number of women age 15-49 years who received three or more doses of SP/Fansidar, at least one of which was received during an ANC visit, to prevent malaria during their last pregnancy that led to a live birth in the last 2 years Total number of women age 15-49 years with a live birth in the last 2 years Sao Tome and Principe 2014 MICS, Final Report P a g e | 290 MICS INDICATOR [M] Modulei Numerator Denominator MDG Indicator Referenceii 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 in households 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 4.5 Place for handwashing HW Number of households with a specific place for hand washing where water and soap or other cleansing agent are present Total number of households 4.6 Availability of soap or other cleansing agent HW Number of households with soap or other cleansing agent Total number of households REPRODUCTIVE HEALTH 5.1 Adolescent birth ratei CM - BH Age-specific fertility rate for women age 15-19 years MDG 5.4 5.2 Early childbearing CM - BH 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 5.4 Unmet needii 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 i The Birth History module is used, and the indicator is calculated for the last 3-year period ii See the MICS tabulation plan for a detailed description Sao Tome and Principe 2014 MICS, Final Report P a g e | 291 MICS INDICATOR [M] Modulei Numerator Denominator MDG Indicator Referenceii 5.5a 5.5b Antenatal care coverage MN Number of women age 15-49 years with a live birth in the last 2 years who were attended during their last pregnancy that led to a live birth (a) at least once by skilled health personnel (b) at least four times by any provider Total number of women age 15-49 years with a live birth in the last 2 years MDG 5.5 5.6 Content of antenatal care MN Number of women age 15-49 years with a live birth in the last 2 years who had their blood pressure measured and gave urine and blood samples during the last pregnancy that led to a live birth Total number of women age 15-49 years with a live birth in the last 2 years 5.7 Skilled attendant at delivery MN Number of women age 15-49 years with a live birth in the last 2 years who were attended by skilled health personnel during their most recent live birth Total number of women age 15-49 years with a live birth in the last 2 years MDG 5.2 5.8 Institutional deliveries MN Number of women age 15-49 years with a live birth in the last 2 years whose most recent live birth was delivered in a health facility Total number of women age 15-49 years with a live birth in the last 2 years 5.9 Caesarean section MN Number of women age 15-49 years whose most recent live birth in the last 2 years was delivered by caesarean section Total number of women age 15-49 years with a live birth in the last 2 years 5.10 Post-partum stay in health facility PN Number of women age 15-49 years who stayed in the health facility for 12 hours or more after the delivery of their most recent live birth in the last 2 years Total number of women age 15-49 years with a live birth in the last 2 years 5.11 Post-natal health check for the newborn PN Number of last live births in the last 2 years who received a health check while in facility or at home following delivery, or a post-natal care visit within 2 days after delivery Total number of last live births in the last 2 years 5.12 Post-natal health check for the mother PN Number of women age 15-49 years who received a health check while in facility or at home following delivery, or a post-natal care visit within 2 days after delivery of their most recent live birth in the last 2 years Total number of women age 15-49 years with a live birth in the last 2 years 5.13 Maternal mortality ratio MM Deaths during pregnancy, childbirth, or within two months after delivery or termination of pregnancy, per 100,000 births within the 7-year period preceding the survey MDG 5.1 Sao Tome and Principe 2014 MICS, Final Report P a g e | 292 MICS INDICATOR [M] Modulei Numerator Denominator MDG Indicator Referenceii CHILD DEVELOPMENT 6.1 Attendance to early childhood education EC Number of children age 36-59 months who are attending an early childhood education programme Total number of children age 36-59 months 6.2 Support for learning EC 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 last 3 days Total number of children age 36-59 months 6.3 Father’s support for learning EC Number of children age 36-59 months whose biological father has engaged in four or more activities to promote learning and school readiness in the last 3 days Total number of children age 36-59 months 6.4 Mother’s support for learning EC Number of children age 36-59 months whose biological mother has engaged in four or more activities to promote learning and school readiness in the last 3 days Total number of children age 36-59 months 6.5 Availability of children’s books EC Number of children under age 5 who have three or more children’s books Total number of children under age 5 6.6 Availability of playthings EC Number of children under age 5 who play with two or more types of playthings Total number of children under age 5 6.7 Inadequate care EC 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 last week Total number of children under age 5 6.8 Early child development index EC Number of children age 36-59 months who are developmentally on track in at least three of the following four domains: literacy-numeracy, physical, social- emotional, and learning Total number of children age 36-59 months LITERACY AND EDUCATION 7.1 Literacy rate among young women [M] 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 Sao Tome and Principe 2014 MICS, Final Report P a g e | 293 MICS INDICATOR [M] Modulei Numerator Denominator MDG Indicator Referenceii 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 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 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 attending the last grade of primary school during the previous school year 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 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 5-17 years who are involved in child labouri Total number of children age 5-17 years 8.3 Violent discipline CD Number of children age 1-14 years who experienced psychological aggression or physical punishment during the last one month Total number of children age 1-14 years 8.4 Marriage before age 15 [M] MA Number of women age 15-49 years who were first married or in union before age 15 Total number of women age 15-49 years i Children involved in child labour are defined as children involved in economic activities above the age-specific thresholds, children involved in household chores above the age-specific thresholds, and children involved in hazardous work. See the MICS tabulation plan for more detailed information on thresholds and classifications Sao Tome and Principe 2014 MICS, Final Report P a g e | 294 MICS INDICATOR [M] Modulei Numerator Denominator MDG Indicator Referenceii 8.5 Marriage before age 18 [M] MA Number of women age 20-49 years who were first married or in union before age 18 Total number of women age 20-49 years 8.6 Young women age 15-19 years currently married or in union [M] MA Number of women age 15-19 years who are married or in union Total number of women age 15-19 years 8.7 Polygyny [M] MA Number of women age 15-49 years who are in a polygynous union Total number of women age 15-49 years who are married or in union 8.8a 8.8b Spousal age difference MA Number of women who are married or in union and whose spouse is 10 or more years older, (a) among women age 15-19 years, (b) among women age 20-24 years Total number of women who are married or in union (a) age 15-19 years, (b) age 20-24 years 8.12 Attitudes towards domestic violence [M] DV Number of women who state that a husband is justified in hitting or beating his wife in at least one of the following circumstances: (1) she goes out without telling him, (2) she neglects the children, (3) she argues with him, (4) she refuses sex with him, (5) she burns the food Total number of women age 15-49 years 8.13 Children’s living arrangements HL Number of children age 0-17 years living with neither biological parent Total number of children age 0-17 years 8.14 Prevalence of children with one or both parents dead HL Number of children age 0-17 years with one or both biological parents dead Total number of children age 0-17 years 8.15 Children with at least one parent living abroad HL Number of children 0-17 years with at least one biological parent living abroad Total number of children 0-17 years Sao Tome and Principe 2014 MICS, Final Report P a g e | 295 MICS INDICATOR [M] Modulei Numerator Denominator MDG Indicator Referenceii HIV/AIDS AND SEXUAL BEHAVIOUR 9.1 Knowledge about HIV prevention among young women [M] HA Number of women age 15-24 years who correctly identify ways of preventing the sexual transmission of HIVi, and who reject major misconceptions about HIV transmission Total number of women age 15-24 years MDG 6.3 9.2 Knowledge of mother-to-child transmission of HIV [M] HA Number of women age 15-49 years who correctly identify all three meansii of mother-to-child transmission of HIV Total number of women age 15-49 years 9.3 Accepting attitudes towards people living with HIV [M] HA Number of women age 15-49 years expressing accepting attitudes on all four questionsiii toward people living with HIV Total number of women age 15-49 years who have heard of HIV 9.4 Women who know where to be tested for HIV [M] HA Number of women age 15-49 years who state knowledge of a place to be tested for HIV Total number of women age 15-49 years 9.5 Women who have been tested for HIV and know the results [M] HA Number of women age 15-49 years who have been tested for HIV in the last 12 months and who know their results Total number of women age 15-49 years 9.6 Sexually active young women who have been tested for HIV and know the results [M] HA Number of women age 15-24 years who have had sex in the last 12 months, who have been tested for HIV in the last 12 months and who know their results Total number of women age 15-24 years who have had sex in the last 12 months 9.7 HIV counselling during antenatal care HA Number of women age 15-49 years who had a live birth in the last 2 years and received antenatal care during the pregnancy of their most recent birth, reporting that they received counselling on HIV during antenatal care Total number of women age 15-49 years who had a live birth in the last 2 years 9.8 HIV testing during antenatal care HA Number of women age 15-49 years who had a live birth in the last 2 years and received antenatal care during the pregnancy of their most recent birth, reporting that they were offered and accepted an HIV test during antenatal care and received their results Total number of women age 15-49 years who had a live birth in the last 2 years 9.9 Young women who have never had sex [M] SB Number of never married women age 15-24 years who have never had sex Total number of never married women age 15-24 years i Using condoms and limiting sex to one faithful, uninfected partner ii Transmission during pregnancy, during delivery, and by breastfeeding iii Women (1) who think that a female teacher with the AIDS virus should be allowed to teach in school, (2) who would buy fresh vegetables from a shopkeeper or vendor who has the AIDS virus, (3) who would not want to keep it as a secret if a family member became infected with the AIDS virus, and (4) who would be willing to care for a family member who became sick with the AIDS virus Sao Tome and Principe 2014 MICS, Final Report P a g e | 296 MICS INDICATOR [M] Modulei Numerator Denominator MDG Indicator Referenceii 9.10 Sex before age 15 among young women [M] SB Number of women age 15-24 years who had sexual intercourse before age 15 Total number of women age 15-24 years 9.11 Age-mixing among sexual partners SB Number of women age 15-24 years who had sex in the last 12 months with a partner who was 10 or more years older Total number of women age 15-24 years who had sex in the last 12 months 9.12 Multiple sexual partnerships [M] SB Number of women age 15-49 years who had sexual intercourse with more than one partner in the last 12 months Total number of women age 15-49 years 9.13 Condom use at last sex among people with multiple sexual partnerships[M] SB Number of women age 15-49 years who report having had more than one sexual partner in the last 12 months who also reported that a condom was used the last time they had sex Total number of women age 15-49 years who reported having had more than one sexual partner in the last 12 months 9.14 Sex with non-regular partners [M] SB Number of sexually active women age 15-24 years who had sex with a non-marital, non-cohabitating partner in the last 12 months Total number of women age 15-24 years who had sex in the last 12 months 9.15 Condom use with non-regular partners [M] SB Number of women age 15-24 years reporting the use of a condom during the last sexual intercourse with a non- marital, non-cohabiting sex partner in the last 12 months Total number of women age 15-24 years who had sex with a non-marital, non-cohabiting partner in the last 12 months MDG 6.2 9.16 Ratio of school attendance of orphans to school attendance of non-orphans HL - ED Proportion attending school among children age 10-14 years who have lost both parents Proportion attending school among children age 10- 14 years whose parents are alive and who are living with one or both parents MDG 6.4 9.17 Male circumcision MMC Number of men age 15-49 years who report having been circumcised Total number of men age 15-49 years ACCESS TO MASS MEDIA AND USE OF INFORMATION/COMMUNICATION TECHNOLOGY 10.1 Exposure to mass media [M] MT Number of women age 15-49 years who, at least once a week, read a newspaper or magazine, listen to the radio, and watch television Total number of women age 15-49 years 10.2 Use of computers [M] MT Number of young women age 15-24 years who used a computer during the last 12 months Total number of women age 15-24 years 10.3 Use of internet [M] MT Number of young women age 15-24 who used the internet during the last 12 months Total number of women age 15-24 years Sao Tome and Principe 2014 MICS, Final Report P a g e | 297 MICS INDICATOR [M] Modulei Numerator Denominator MDG Indicator Referenceii SUBJECTIVE WELL-BEING 11.1 Life satisfaction [M] LS Number of women age 15-24 years who are very or somewhat satisfied with their life, overall Total number of women age 15-24 years 11.2 Happiness [M] LS Number of women age 15-24 years who are very or somewhat happy Total number of women age 15-24 years 11.3 Perception of a better life [M] 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 TOBACCO AND ALCOHOL USE 12.1 Tobacco use [M] TA Number of women age 15-49 years who smoked cigarettes, or used smoked or smokeless tobacco products at any time during the last one month Total number of women age 15-49 years 12.2 Smoking before age 15 [M] TA Number of women age 15-49 years who smoked a whole cigarette before age 15 Total number of women age 15-49 years 12.3 Use of alcohol [M] TA Number of women age 15-49 years who had at least one alcoholic drink at any time during the last one month Total number of women age 15-49 years 12.4 Use of alcohol before age 15 [M] 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 Sao Tome and Principe 2014 MICS, Final Report P a g e | 298 Appendix F. Sao Tome and Principe MICS Questionnaires Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 299 Depois de ter preenchido completamente o Questionário Agregado familiar, preencha as seguintes informações: HH9. Resultado da entrevista do agregado familiar: Completa . 01 Não havia membros no agregado familiar com competência para responder ao questionário . 02 Membros do agregado totalmente ausente por longa duração . 03 Recusa . 04 Alojamento vazio/endereço não é um alojamento . 05 Alojamento destruído . 06 Alojamento não encontrado . 07 Outro (especificar) __________________________________________________________________________ 96 Uma vez que o Questionário Agregado familiar tiver completado, preencha as seguintes informações: HH10. Quem respondeu ao questionário do agregado familiar? Nome ______________Nº. de linha: ___ ___ HH11. Nº total de membros no agregado familiar: ___ ___ Uma vez que todos os questionários do agregado tiverem completados, preencha as seguintes informações: HH12. Nº de mulheres de 15-49 anos: ___ ___ HH13. Nº de questionários Mulher completos: ___ ___ HH13A. Nº de homens de 15-49 anos: ___ ___ HH13B. Nº de questionários Homem completos: ___ ___ HH14. Nº de crianças com menos de 5 anos: ___ ___ HH15. Nº de questionários Crianças menores de 5 anos completos: ___ ___ HH16. Controlador/a (nome e número): Nome: ______________________ No. __ __ HH17. Digitador/a (nome e número): Nome: ______________________________ No. __ __ QUESTIONÁRIO AGREGADO FAMILIAR São Tomé e Príncipe, MICS 5, 2014 PAINEL DE INFORMAÇÃO DO AGREGADO FAMILIAR HH HH1. Número AE selecionada: ___ ___ ___ HH2. Número do agregado familiar: ___ ___ HH3. Inquiridor/a (nome e número): Nome ____________________________ No. ___ ___ HH4. Supervisor/a (nome e número) : Nome __________________________ No. ___ ___ HH5. Dia/mês/ano do inquérito: ___ ___ /___ ___ / 2 0 1 ___ HH7. REGIÃO: REGIÃO CENTRO ESTE . 1 REGIÃO NORTE ESTE . 2 REGIÃO SUL OESTE . 3 REGIÃO AUTÓNOMA DO PRÍNCIPE . 4 HH6. MEIO DE RESIDÊNCIA: Urbano . 1 Rural . 2 NÓS FAZEMOS PARTE DO INSTITUTO NACIONAL DE ESTATÍSTICAS (INE). ESTAMOS A REALIZAR UM INQUÉRITO SOBRE À SITUAÇÃO DAS CRIANÇAS, DAS FAMÍLIAS E DOS AGREGADOS FAMILIARES. GOSTARÍAMOS DE FALAR CONSIGO SOBRE ESTES ASPECTOS. A NOSSA CONVERSA TOMARÁ APROXIMADAMENTE 30 MINUTOS DO SEU TEMPO. TODAS INFORMAÇÕES RECOLHIDAS SERÃO TRATADAS DE MANEIRA ESTRITAMENTE CONFIDENCIL E ANÔNIMA. POSSO COMEÇAR AGORA ?  Sim, permissão concedida  Va à HH18 para registar a hora e começar a entrevista.  Não, permissão não concedida  Circule 4 em HH9. Discuta este resultado com seu chefe de equipa. Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 300 HH18. Registe a hora: Hora: __ __ Min.__ __ LISTA DOS MEMBROS DO AGREGADO FAMILIAR HL ANTES DE COMEÇAR, DIGA-ME POR FAVOR O NOME DE CADA PESSOA QUE VIVE HABITUALMENTE AQUI, COMEÇANDO PELO CHEFE DO AGREGADO. Registe o nome do chefe do agregado na linha 01. Registe todos os membros do agreado (HL2), suas relações com o chefe do agregado (HL3) e o seu sexo (HL4). Pergunte a seguir : HÁ OUTRAS PESSOAS QUE VIVEM AQUI, QUE NÃO ESTÃO EM CASA NESTE MOMENTO? Se sim, complete a lista para as questões HL2-HL4. Põe em seguida todas as questões pessoa por pessoa começando por HL5. Utilize um questionário suplementar se todas as linhas da folha do agregado familiar foram utilizadas. Mulheres 15-49 anos Homens 15-49 anos Crianças 0-4 anos CRIANÇAS DE 0-17 ANOS HL1. No.de linha HL2. Nome HL3. QUAL O GRAU DE PAREN- TESCO DE (nome) COM O CHEFE DO AGREGA- DO? HL4. (Nome) É DO SEXO MASCULINO OU FEMININO ? 1 Masc. 2 Fem. HL5. QUAL A DATA DE NASCIMENTO DE (nome)? HL6. QUAL A IDADE DE (nome)? Registar em anos comple- tos. Se a idade é igual ou superior a 95, escreva ‘95’ HL6A. O/A (nome) DORMIU AQUI NA NOITE PASSADA ? 1 Sim 2 Não HL7. Circule o número de linha se a mulher tem entre 15-49 anos HL7A. Circule o número de linha se o homem tem entre 15-49 anos HL7B. Circule o nº de linha se a criança tem entre 0-4 anos HL11. A MÃE BIOLÓGICA DE (nome) ESTÁ VIVA ? 1 Sim 2 Não HL13 8 NS HL13 HL12. A MÃE BIOLÓGICA DE (nome) VIVE NESTE AGREGADO? Se“sim”, anote o no. de linha da mãe e siga para HL13. Se “não”, anote “00”. HL12A. ONDE A MÃE BIOLÓ- GICA DE (nome) VIVE? 1 Outro agrega- do neste país 2 Institui- ção no país 3 Estran- geiro 8 NS HL13. O PAI BIOLÓGICO DE (nome) ESTÁ VIVO ? 1 Sim 2 Não HL15 8 NS HL15 HL14. O PAI BIOLÓGICO DE (nome) VIVE NESTE AGREGA- DO? Se “sim”, anote o no. de linha do pai e siga para HL15. Se “não”, anote “00”. HL14A. ONDE O PAI BIOLOGI CO DE (nome) VIVE? 1 Outro agrega- do neste país 2 Institui- ção no país 3 Estran- geiro 8 NS HL15. Registe o nº de linha da mãe conforme HL12. Se HL12 está em branco ou “00”, pergunte: QUEM É O/A ENCARREGA- DO/A PRINCIPAL DE (nome)? 98 NS 9998 NS Linha Nome Relação* M F Mês Ano Idade S N 15-49 15-49 0-4 S N NS Mãe S N NS Pai Mãe 01 01 1 2 __ __ __ __ __ __ __ __ 1 2 01 01 01 1 2 8 ___ ___ 1 2 3 8 1 2 8 ___ ___ 1 2 3 8 ___ ___ 02 ___ ___ 1 2 __ __ __ __ __ __ __ __ 1 2 02 02 02 1 2 8 ___ ___ 1 2 3 8 1 2 8 ___ ___ 1 2 3 8 ___ ___ 03 ___ ___ 1 2 __ __ __ __ __ __ __ __ 1 2 03 03 03 1 2 8 ___ ___ 1 2 3 8 1 2 8 ___ ___ 1 2 3 8 ___ ___ 04 ___ ___ 1 2 __ __ __ __ __ __ __ __ 1 2 04 04 04 1 2 8 ___ ___ 1 2 3 8 1 2 8 ___ ___ 1 2 3 8 ___ ___ 05 ___ ___ 1 2 __ __ __ __ __ __ __ __ 1 2 05 05 05 1 2 8 ___ ___ 1 2 3 8 1 2 8 ___ ___ 1 2 3 8 ___ ___ 06 ___ ___ 1 2 __ __ __ __ __ __ __ __ 1 2 06 06 06 1 2 8 ___ ___ 1 2 3 8 1 2 8 ___ ___ 1 2 3 8 ___ ___ 07 ___ ___ 1 2 __ __ __ __ __ __ __ __ 1 2 07 07 07 1 2 8 ___ ___ 1 2 3 8 1 2 8 ___ ___ 1 2 3 8 ___ ___ 08 ___ ___ 1 2 __ __ __ __ __ __ __ __ 1 2 08 08 08 1 2 8 ___ ___ 1 2 3 8 1 2 8 ___ ___ 1 2 3 8 ___ ___ 09 ___ ___ 1 2 __ __ __ __ __ __ __ __ 1 2 09 09 09 1 2 8 ___ ___ 1 2 3 8 1 2 8 ___ ___ 1 2 3 8 ___ ___ 10 ___ ___ 1 2 __ __ __ __ __ __ __ __ 1 2 10 10 10 1 2 8 ___ ___ 1 2 3 8 1 2 8 ___ ___ 1 2 3 8 ___ ___ 11 ___ ___ 1 2 __ __ __ __ __ __ __ __. 1 2 11 11 11 1 2 8 ___ ___ 1 2 3 8 1 2 8 ___ ___ 1 2 3 8 ___ ___ 12 ___ ___ 1 2 __ __ __ __ __ __ __ __ 1 2 12 12 12 1 2 8 ___ ___ 1 2 3 8 1 2 8 ___ ___ 1 2 3 8 ___ ___ Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 301 Mulheres 15-49 anos Homens 15-49 anos Crianças 0-4 anos CRIANÇAS DE 0-17 ANOS HL1. No.de linha HL2. Nome HL3. QUAL O GRAU DE PAREN- TESCO DE (nome) COM O CHEFE DO AGREGA- DO? HL4. (Nome) É DO SEXO MASCULINO OU FEMININO ? 1 Masc. 2 Fem. HL5. QUAL A DATA DE NASCIMENTO DE (nome)? HL6. QUAL A IDADE DE (nome)? Registar em anos comple- tos. Se a idade é igual ou superior a 95, escreva ‘95’ HL6A. O/A (nome) DORMIU AQUI NA NOITE PASSADA ? 1 Sim 2 Não HL7. Circule o número de linha se a mulher tem entre 15-49 anos HL7A. Circule o número de linha se o homem tem entre 15-49 anos HL7B. Circule o nº de linha se a criança tem entre 0-4 anos HL11. A MÃE BIOLÓGICA DE (nome) ESTÁ VIVA ? 1 Sim 2 Não HL13 8 NS HL13 HL12. A MÃE BIOLÓGICA DE (nome) VIVE NESTE AGREGADO? Se“sim”, anote o no. de linha da mãe e siga para HL13. Se “não”, anote “00”. HL12A. ONDE A MÃE BIOLÓ- GICA DE (nome) VIVE? 1 Outro agrega- do neste país 2 Institui- ção no país 3 Estran- geiro 8 NS HL13. O PAI BIOLÓGICO DE (nome) ESTÁ VIVO ? 1 Sim 2 Não HL15 8 NS HL15 HL14. O PAI BIOLÓGICO DE (nome) VIVE NESTE AGREGA- DO? Se “sim”, anote o no. de linha do pai e siga para HL15. Se “não”, anote “00”. HL14A. ONDE O PAI BIOLOGI CO DE (nome) VIVE? 1 Outro agrega- do neste país 2 Institui- ção no país 3 Estran- geiro 8 NS HL15. Registe o nº de linha da mãe conforme HL12. Se HL12 está em branco ou “00”, pergunte: QUEM É O/A ENCARREGA- DO/A PRINCIPAL DE (nome)? 98 NS 9998 NS Linha Nome Relação* M F Mês Ano Idade S N 15-49 15-49 0-4 S N NS Mãe S N NS Pai Mãe 13 ___ ___ 1 2 __ __ __ __ __ __ __ __ 1 2 13 13 13 1 2 8 ___ ___ 1 2 3 8 1 2 8 ___ ___ 1 2 3 8 ___ ___ 14 ___ ___ 1 2 __ __ __ __ __ __ __ __ 1 2 14 14 14 1 2 8 ___ ___ 1 2 3 8 1 2 8 ___ ___ 1 2 3 8 ___ ___ 15 ___ ___ 1 2 __ __ __ __ __ __ __ __ 1 2 15 15 15 1 2 8 ___ ___ 1 2 3 8 1 2 8 ___ ___ 1 2 3 8 ___ ___ Marque se tiver usado um questionário suplementar  Insista para saber se não existem outros membros no agregado familiar. Especialmente, pergunte se não existem bebés/crianças jovens que não foram listados e outras pessoas que não são membros da familia (como empregados e amigos) mais que vivem habitualmente no agregado. Regista o nome dos membros adicionais na lista do agregado e complete a folha de forma apropriada. Agora registe separadamente, para cada mulher de 15-49 anos, o seu nome, seu número de linha e outras informações de identificação dentro do painel de informação de um questionário individual Mulher. Para cada homem de 15-49 anos, registe separadamente o seu nome, seu número de linha e outras informações de identificação no painel de informação do questionário individual Homem. Para cada criança com menos de 5 anos, registe separadamente o seu nome, seu número de linha E o número de linha da sua mãe ou encarregado principal no painel de informação do questionário para crianças de menos de 5 anos. Agora deverá ter um questionário separado para cada mulher eligível, para cada homem eligivel e para cada criança com menos de 5 anos do agregado. * Códigos para HL3: relação com o chefe do agregado: 01 Chefe do agregado 02 Cônjuge 03 Filho/Filha 04 Genro/Nora 05 Neto/Neta 06 Mãe/Pai 07 Sogro/Sogra 08 Irmão/Irmã 09 Cunhado/Cunhada 10 Tio/Tia 11 Sobrinho/Sobrinha 12 Outro parente 13 Criança adotada/confiada/enteado(a) 14 Doméstica (se vive no agregado) 96 Outro (sem grau de parentesco) 98 NS Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 302 EDUCAÇÃO ED ED Para membros do agregado de 5 anos e mais Para membros do agregado de 5-24 anos ED1. No. de linha ED2. Nome e idade Copiar de HL2 e HL6 ED3. (Nome) JÁ FREQUENTOU ALGUMA VEZ UMA ESCOLA OU INSTITUIÇÃO PRÉ- ESCOLAR ? 1 Sim 2 Não  linha seguinte ED4A. QUAL O NÍVEL MAIS ELEVADO QUE (nome) ATINGIU? Nível : 0 Pré-escolar 1 Básico 2 Secundário 3 Superior 8 NS Se nível = 0, passar a ED5 ED4B. QUAL FOI A ÚLTIMA CLASSE QUE (nome) CONCLUIU NESTE NÍVEL ? Classe: 98 NS Se a 1ª classe a este nível não foi concluída, anotar “00”. ED5. DURANTE ESTE ANO LETIVO 2013-2014, (nome) FREQUENTOU EM ALGUM MOMENTO UMA ESCOLA OU INSTITUIÇÃO PRÉ- ESCOLAR ? 1 Sim 2 Não  ED7 ED6. DURANTE ESTE ANO LETIVO QUAL É O NÍVEL E A CLASSE QUE (nome) ESTÁ FREQUENTANDO OU FREQUENTOU? ED7. DURANTE O ANO LETIVO ANTERIOR 2012-2013, (nome) FREQUENTOU EM ALGUM MOMENTO UMA ESCOLA OU INSTI- TUIÇÃO PRÉ-ESCOLAR? 1 Sim 2 Não  linha seguinte 8 NS  linha seguinte ED8. DURANTE O ANO LETIVO ANTERIOR 2012-2013, QUAL É O NÍVEL E A CLASSE QUE (nome) FREQUENTOU? Nível : 0 Pré-escolar 1 Básico 2 Secundário 3 Superior 8 NS Se nível= 0, passar à ED7 Classe: 98 NS Nível: 0 Pré-escolar 1 Básico 2 Secundário 3 Superior 8 NS Se nível= 0, vá para a linha seguinte. Classe: 98 NS Linha Nome Idade Sim Não Nível Classe Sim Não Nível Classe Sim Não NS Nível Classe 01 ___ ___ 1 2 0 1 2 3 8 ___ ___ 1 2 0 1 2 3 8 ___ ___ 1 2 8 0 1 2 3 8 ___ ___ 02 ___ ___ 1 2 0 1 2 3 8 ___ ___ 1 2 0 1 2 3 8 ___ ___ 1 2 8 0 1 2 3 8 ___ ___ 03 ___ ___ 1 2 0 1 2 3 8 ___ ___ 1 2 0 1 2 3 8 ___ ___ 1 2 8 0 1 2 3 8 ___ ___ 04 ___ ___ 1 2 0 1 2 3 8 ___ ___ 1 2 0 1 2 3 8 ___ ___ 1 2 8 0 1 2 3 8 ___ ___ 05 ___ ___ 1 2 0 1 2 3 8 ___ ___ 1 2 0 1 2 3 8 ___ ___ 1 2 8 0 1 2 3 8 ___ ___ 06 ___ ___ 1 2 0 1 2 3 8 ___ ___ 1 2 0 1 2 3 8 ___ ___ 1 2 8 0 1 2 3 8 ___ ___ 07 ___ ___ 1 2 0 1 2 3 8 ___ ___ 1 2 0 1 2 3 8 ___ ___ 1 2 8 0 1 2 3 8 ___ ___ 08 ___ ___ 1 2 0 1 2 3 8 ___ ___ 1 2 0 1 2 3 8 ___ ___ 1 2 8 0 1 2 3 8 ___ ___ 09 ___ ___ 1 2 0 1 2 3 8 ___ ___ 1 2 0 1 2 3 8 ___ ___ 1 2 8 0 1 2 3 8 ___ ___ 10 ___ ___ 1 2 0 1 2 3 8 ___ ___ 1 2 0 1 2 3 8 ___ ___ 1 2 8 0 1 2 3 8 ___ ___ 11 ___ ___ 1 2 0 1 2 3 8 ___ ___ 1 2 0 1 2 3 8 ___ ___ 1 2 8 0 1 2 3 8 ___ ___ 12 ___ ___ 1 2 0 1 2 3 8 ___ ___ 1 2 0 1 2 3 8 ___ ___ 1 2 8 0 1 2 3 8 ___ ___ 13 ___ ___ 1 2 0 1 2 3 8 ___ ___ 1 2 0 1 2 3 8 ___ ___ 1 2 8 0 1 2 3 8 ___ ___ 14 ___ ___ 1 2 0 1 2 3 8 ___ ___ 1 2 0 1 2 3 8 ___ ___ 1 2 8 0 1 2 3 8 ___ ___ 15 ___ ___ 1 2 0 1 2 3 8 ___ ___ 1 2 0 1 2 3 8 ___ ___ 1 2 8 0 1 2 3 8 ___ ___ Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 303 SELEÇÃO DE UMA CRIANÇA PARA TRABALHO INFANTIL/DISCIPLINA INFANTIL SL SL1. Verifique HL6 na lista dos membros do agregado familiar e escreva o número total de crianças de 1-17 anos. Número total: . _____ SL2. Verifique o número total de crianças de 1-17anos em SL1:  Zero  Siga para o módulo CARACTERISTICAS DOS AGREGADOS  Um  Vá a SL9 e registe o número de classificação como “1“, entre o número de linha, o nome da criança e a sua idade  Dois ou mais  Continue com SL2A SL2A. Registe abaixo cada criança de 1-17 anos conforme a ordem na folha de registo do agregado familiar. Não inclua nenhum membro do agregado com idade fora desse intervalo. Registe na tabela o número de linha, o nome, o sexo e a idade para cada criança. SL3. Nº de classificação SL4. Número de linha HL1. SL5. Nome de HL2. SL6. Sexo de HL4. SL7. Idade de HL6. classificação linha nome M F idade 1 __ __ 1 2 ___ ___ 2 __ __ 1 2 ___ ___ 3 __ __ 1 2 ___ ___ 4 __ __ 1 2 ___ ___ 5 __ __ 1 2 ___ ___ 6 __ __ 1 2 ___ ___ 7 __ __ 1 2 ___ ___ 8 __ __ 1 2 ___ ___ SL8. Confira o útimo dígito do número do agregado (HH2) que figura na página de cobertura. Este é o número de linha que deve percorer na tabela abaixo. Verifique o número total de crianças de 1-17 anos na SL1 acima. Este é o número da coluna que deve seguir. Encontre o quadradinho onde a linha e a coluna se encontram e circule o número que aparece neste quadradinho. Este é o número de classificação da criança selecionada em SL3 que devera ser entrevistada. Número total de crianças eligíveis no agregado familiar (de SL1) Último dígito do número do agregado (HH2) 2 3 4 5 6 7 8+ 0 2 2 4 3 6 5 4 1 1 3 1 4 1 6 5 2 2 1 2 5 2 7 6 3 1 2 3 1 3 1 7 4 2 3 4 2 4 2 8 5 1 1 1 3 5 3 1 6 2 2 2 4 6 4 2 7 1 3 3 5 1 5 3 8 2 1 4 1 2 6 4 9 1 2 1 2 3 7 5 SL9. Registe o número de classificação (SL3), o número da linha (SL4), o nome (SL5) e a idade (SL7) da criança selecionada. Número de classificação . __ Número de linha . __ __ Nome______________________________ Idade . __ __ Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 304 TRABALHO INFANTIL CL CL1.Verifique a idade da criança seleccionada em SL9 :  1-4 anos  Vá ao módulo seguinte  5-17 anos  Continue com CL2 CL2. AGORA GOSTARIA DE FALAR SOBRE TODOS TRABALHOS QUE AS CRIANÇAS DESTE AGREGADO PODEM FAZER. DESDE A ÚLTIMA (dia da semana), (nome) FEZ ALGUMAS DAS SEGUINTES ACTIVIDADES, MESMO QUE FOSSE POR APENAS UMA HORA: [A] (Nome) FEZ ALGUM TRABALHO NO LOTE/QUINTAL/GLEBA/JARDIM/QUINTA DO AGREGADO OU CUIDOU DOS ANIMAIS? POR EXEMPLO: CULTIVOU OU COLHEU PRODUTOS, ALIMENTOU ANIMAIS, LEVOU-OS AO PASTO OU ORDENOU-OS, ETC.? [B] (Nome) AJUDOU NOS NEGÓCIOS DO AGREGADO OU DE OUTRES PARENTES, COM OU SEM PAGAMENTO, OU TRABALHOU NO SEU PRÓPRIO NEGÓCIO? [C] (Nome) PRODUZIU OU VENDEU PRODUTOS, ARTESANATO, ROUPA, COMIDA OU PRODUTOS AGRÍCOLAS? [D] DESDE A ÚLTIMA (dia da semana), (nome) EXERCEU QUALQUER OUTRA ATIVIDADE, EM TROCA DE RENDA EM DINHEIRO OU EM ESPÉCIE, MESMO QUE FOSSE POR APENAS UMA HORA? Se “não”, insista: POR FAVOR, INCLUA QUALQUER ATIVIDADE REALIZADA POR (nome) COMO EMPREGADO REGULAR OU OCASIONAL, POR CONTA PRÓPRIA OU COMO EMPREGADOR, OU COMO TRABALHADOR FAMILIAR NÃO REMUNERADO AFIM DE AJUDAR NO NEGÓCIO FAMILIAR OU NO LOTE. S N Trabalhou no lote/quintal/gleba/jardim ou cuidou dos animais . 1 2 Ajudou no negócio do agregado/outro parente/cuidou do próprio Negócio . 1 2 Produziu/vendeu artesanatos / roupas/ comida ou produtos agrícolas . 1 2 Qualquer outra atividade . 1 2 CL3. Verifique CL2, A até D:  Se houver pelo menos um ‘Sim’  Continue com CL4  Todas respostas são ‘Não’  Siga para CL8 CL4. DESDE A ÚLTIMA (dia da semana), APROXIMADAMENTE QUANTAS HORAS (nome) TRABALHOU NO TOTAL NESTA(S) ATIVIDADE(S)? Se menos de uma hora, anote “00”. Número de horas.__ __ CL5. ESTA(S) ATIVIDADE(S) IMPLICAM A NECESSIDADE DE TRANSPORTAR CARGAS PESADAS ? Sim . 1 Não . 2 1 CL8 CL6. ESTA(S) ATIVIDADE(S) REQUEREM TRABALHOS COM INSTRUMENTOS PERIGOSOS (FACAS, ETC.), OU IMPLICAM OPERAR MÁQUINAS PESADAS? Sim . 1 Não . 2 1 CL8 Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 305 CL7. COMO DESCREVERIA O AMBIENTE DE TRABALHO DE (nome): [A] O/A (nome) ESTÁ EXPOSTO/A À POEIRA, FUMAÇA OU GÁS? [B] O/A (nome) ESTÁ EXPOSTO/A À FRIO, CALOR OU HUMIDADE EXTREMA? [C] O/A (nome) ESTÁ EXPOSTO/A À BARULHO OU VIBRAÇÃO INTENSA? [D] O/A (nome) TEM NECESSIDADE DE TRABALHAR EM GRANDES ALTURAS? [E] O/A (nome) ESTÁ EXPOSTO/A À PRODUTOS QUÍMICOS (PESTICIDAS, RATICIDAS, COLAS, ETC.) OU EXPLOSIVOS? [F] O/A (nome) ESTÁ EXPOSTO/A A OUTROS TIPOS DE SITUAÇÕES, PROCESSOS OU CONDIÇÕES PREJUDICIAIS A SUA SAÚDE OU SUA SEGURANÇA ? Sim . 1 Não . 2 Sim . 1 Não . 2 Sim . 1 Não . 2 Sim . 1 Não . 2 Sim . 1 Não . 2 Sim . 1 Não . 2 CL8. DESDE A ÚLTIMA (dia da semana), O/A (nome) APANHOU ÁGUA OU ARRANJOU LENHA PARA O AGREGADO? Sim . 1 Não . 2 2 CL10 CL9. QUANTAS HORAS NO TOTAL O/A (nome) GASTOU PARA APANHAR ÁGUA OU ARRANJAR LENHA PARA O AGREGADO DESDE A ÚLTIMA (dia da semana)? Se menos que uma hora, marque “00” Número de horas.__ __ CL10. DESDE A ÚLTIMA (dia da semana), (nome) REALIZOU UMA DAS SEGUINTES TAREFAS PARA O AGREGADO: [A] FEZ COMPRAS PARA O AGREGADO? [B] REPAROU EQUIPAMENTOS DO AGREGADO? [C] COZINHOU, LAVOU LOIÇA OU LIMPOU A CASA? [D] LAVOU ROUPAS? [E] CUIDOU DE CRIANÇAS? [F] CUIDOU DE IDOSOS OU DOENTES? [G] OUTRAS TAREFAS DOMÉSTICAS? Sim Não Compras para o agregado. 1 2 Reparar equipamentos . 1 2 Cozinhar/limpar loiça/casa . 1 2 Lavar roupas . 1 2 Cuidar de crianças . 1 2 Cuidar de idosos/doentes . 1 2 Outras tarefas domésticas. 1 2 CL11. Verifique CL10, A até G:  Se houver pelo menos um ‘Sim’  Continue com CL12  Todas as respostas são ‘Não’  Siga para o módulo seguinte CL12. DESDE A ÚLTIMA (dia da semana), QUANTAS HORAS O/A (nome) TRABALHOU NESTA(S) ATIVIDADE(S)? Se menos de uma hora, anote “00”. Número de horas.__ __ Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 306 DISCIPLINA INFANTIL CD CD1. Verifique a idade da criança selecionada em SL9:  1-14 anos  Continue com CD2  15-17 anos  Siga para o próximo módulo CD2. Registe o número da linha e o nome da criança de SL9. Número de linha .__ __ Nome _________________________ CD3. ADULTOS USAM CERTOS MÉTODOS PARA ENSINAR ÀS CRIANÇAS A SE COMPORTAREM BEM OU PARA RESOLVER PROBLEMAS DE COMPORTAMENTO. VOU LER UMA LISTA DE MÉTODOS QUE SÃO UTILIZADOS E GOSTARIA QUE ME DISSESSE SE O/A SENHOR/A OU ALGUM OUTRO MEMBRO DO SEU AGREGADO UTILIZOU UM DESTES MÉTODOS COM O/A (nome) DURANTE O MÊS PASSADO: [A] RETIROU-LHE OS PRIVILÉGIOS, INTERDITOU QUALQUER COISA QUE O/A (nome) GOSTA DE FAZER OU NÃO LHE PERMITIU SAIR DE CASA? [B] EXPLICOU AO (nome) PORQUE SEU COMPORTAMENTO NÃO É ACEITAVEL? [C] SACUDIU-O/A? [D] GRITOU OU BERROU COM A ELE/A? [E] ATRIBUIU-LHE OUTRA TAREFA PARA DISTRAI-LO/A? [F] DEU UMA PALMADA, BATEU NO RABO COM AS MÃOS? [G] BATEU-LHE NO RABO OU OUTRA PARTE DO CORPO COM UM CINTO, CHICOTE, VARAPAU OU OUTRO OBJECTO DURO? [H] CHAMOU-LHE DE IDIOTA, PARVO, PREGUIÇOSO OU DE UM OUTRO NOME PARECIDO? [I] BATEU-LHE OU DEU-LHE CHAPADA NO ROSTO, NA CABEÇA OU NAS ORELHAS? [J] BATEU-LHE NAS MÃOS, BRAÇOS OU PERNAS? [K] BATEU REPETITIVAMENTE E TÃO FORTE QUÃO POSSÍVEL? [L] TRANCOU-O NO QUARTO? S N Retirou-lhe os privilégios . 1 2 Explicou mau comportamento . 1 2 Sacudiu-o/a . 1 2 Gritou Atribuiu outra tarefa . 1 2 Deu uma palmada . 1 2 Bateu-lhe com cinto, varapau ou outro objecto duro . 1 2 Chamou-lhe de idiota, preguiçoso ou outro nome . 1 2 Bateu-lhe no rosto, cabeça ou nas orelhas . 1 2 Bateu mão, braço ou pernas . 1 2 Bateu repetitivamente e fortemente . 1 2 Trancou-o no quarto . 1 2 CD4. ACREDITA QUE, PARA EDUCAR UMA CRIANÇA DEVIDAMENTE, ELA PRECISA SER CASTIGADA FÍSICAMENTE? Sim . 1 Não . 2 NS/sem opinião . 8 Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 307 CARACTERISTICAS DOS AGREGADOS FAMILIARES HC HC1A. QUAL É A RELIGIÃO DO RESPONSÁVEL DO AGREGADO FAMILIAR? Católica . 1 Nova apostólica . 2 Adventista . 3 Outra religião (especificar) _____________ 6 Sem religião . 7 HC1B. QUAL É A LÍNGUA MATERNA DO RESPONSÁVEL DO AGREGADO FAMILIAR? Português . 1 Forro . 2 Angolar . 3 Linguie . 4 Cabo-verdiano . 5 Outra língua (especificar) ______________ 6 HC2. NESSE AGREGADO FAMILIAR, QUANTOS COMPARTIMENTOS SÃO UTILIZADOS PARA DORMIR? Número de compartimentos . __ __ HC3. Material predominante do piso no alojamento? Registe a observação. Material natural: Terra batida/areia . 11 Material rudimentar: Tábuas de madeira . 21 Pedra (calçada) . .23 Material acabado: Soalho ou madeira polida . 31 Mosaicos. 33 Cimento . 34 Carpete (de tecido) . 35 Tapete (de plástico) . 36 Outro (especificar) __________________ 96 HC4. Material predominante da cobertura externa do alojamento? Registe a observação. Material natural: Pavo (folhas de palmeira ou coqueiro) . 12 Material rudimentar: Bambú . 22 Plástico . 25 Material acabado: Chapas de zinco . 31 Fibra de cimento/Lusalite . 33 Cimento/betão armado . 35 Telha . 36 Outro (especificar) __________________ 96 Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 308 HC5. Material predominante das paredes externas do alojamento. Registe a observação. Material rudimentar: Bambú . 21 Madeira recuperada . 26 Andala/pavo (folhas de palemeira ou coqueiro) . 27 Material acabado: Cimento . 31 Pedra com cimento . 32 Tijolos . 33 Blocos de cimento . 34 Tábuas de madeira . 36 Mosaicos . 37 Chapas de zinco . 38 Tijolos de barro . 39 Outro (especificar) __________________ 96 HC6. QUAL É O PRINCIPAL TIPO DE COMBUSTÍVEL UTILIZADO NO SEU AGREGADO PARA COZINHAR? Electricitdade . 01 Gas em botija . 02 Petróleo/querosene . 05 Carvão vegetal . 07 Lenha . 08 Palha/ramos/relva. 09 Resíduos agrícolas (casca de côco, caroço, etc . 11 Serradura . 12 Não se cozinha no agregado . 95 Outro (especificar) __________________ 96 01HC8 02HC8 05HC8 95HC8 HC7. A COMIDA USUALMENTE É PREPARADA DENTRO DE CASA, NUMA CONSTRUÇÃO SEPARADA OU FORA DE CASA (NO EXTERIOR)? Se “dentro da casa”, insistir: É FEITA NUM QUARTO SEPARADO USADO COMO COZINHA? Dentro de casa: Quarto separado usado como cozinha . 1 Outro lugar da casa . 2 Numa construção separada . 3 Fora de casa (no exterior) . 4 Outro (especificar) ___________________ 6 HC8. O SEU AGREGADO FAMILIAR TEM: [A] ELECTRICIDADE? [B] RÁDIO? [C] TELEVISÃO? [D] TELEFONE FIXO? [E] GELEIRA/ARCA? [F] COMPUTADOR/LAPTOP? [G] PARABÓLICA? [H] AR CONDICIONADO? [I] CAMA DE MADEIRA COM COLCHÃO? [J] MESA COM CADEIRAS EM MADEIRA? [K] CADEIRAS DE PLÁSTICO? Sim Não Electricidade . 1 2 Rádio . 1 2 Televisão . 1 2 Telefone fixo . 1 2 Geleira ou arca . 1 2 Computador/laptop . 1 2 Parabólica . 1 2 Ar condicionado . 1 2 Cama de madeira com colchão . 1 2 Mesa e cadeiras em madeira . 1 2 Cadeiras de plástico . 1 2 Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 309 HC9. UM DOS MEMBROS DO AGREGADO FAMILIAR POSSUI: [A] RELÓGIO DE PULSO? [B] TELEMÓVEL? [C] BICICLETA? [D] MOTORIZADA? [E] CARROÇA PUXADA POR UM ANIMAL? [F] CARRO OU CARRINHA? [G] BARCO/CANOA A MOTOR? [H] BARCO/CANOA SEM MOTOR? Sim Não Relógio de pulso . 1 2 Telemóvel . 1 2 Bicicleta . 1 2 Motorizada . 1 2 Carroça puxada por um animal . 1 2 Carro ou carrinha . 1 2 Barco/canoa a motor . 1 2 Barco/canoa sem motor . 1 2 HC10. O/A SENHOR/A, OU ALGUM OUTRO MEMBRO QUE VIVE NESTE AGREGADO, É O PROPRIETÁRIO DESTE ALOJAMENTO? Se “Não”, perguntar : ALUGARAM ESTE ALOJAMENTO DE UMA OUTRA PESSOA QUE NÃO VIVE AQUI NESTE AGREGADO? Se “Alugou de uma outra pessoa”, circule “2”. Para as outras respostas circule “6”. Propriétario . 1 Alugado . 2 Outro (especificar) _____________________ 6 HC11. ALGUM MEMBRO DESTE AGREGADO POSSUI TERRA QUE PODE SER USADA PARA AGRICULTURA? Sim . 1 Não . 2 2HC13 HC12. QUANTOS HECTARES DE TERRA AGRÍCOLA OS MEMBROS DESTE AGREGADO POSSUEM? (1 LOTE = 1 HECTAR E MEIO) Se menos que 1, marque “00”. Se 95 ou mais, marque‘95’. Se não sabe, marque ‘98’. Hectares . ___ ___ HC13. ESTE AGREGADO POSSUI GADO, CABRAS, PORCOS, GALINHAS OU OUTROS ANIMAIS DE CRIAÇÃO? Sim . 1 Não . 2 2HC15 HC14. QUANTOS DOS ABAIXO DESCRIMINADOS ANIMAIS O AGREGADO POSSUI : [A] GADO, VACA LEITEIRA OU TOURO? [B] CAVALOS, BURROS OU MULAS? [C] CABRAS OU CABRITOS? [D] OVELHAS? [E] GALINHAS, PATOS, PERÚS? [F] PORCOS? [G] OUTROS ANIMAIS DE CRIAÇÃO? Se nenhum, marque ‘00’. Se 95 ou mais, marque ‘95’. Se não sabe,marque ‘98’. Gado, vaca leiteira ou touro . ___ ___ Cavalos, burros ou mulas . ___ ___ Cabras ou cabritos . ___ ___ Ovelhas . ___ ___ Galinhas, patos, perús . ___ ___ Porcos . ___ ___ Outros (especificar _______________ ___ ___ HC15 ALGUM MEMBRO DO AGREGADO FAMILIAR TEM CONTA BANCÁRIA? Sim . 1 Não . 2 Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 310 MOSQUITEIROS IMPREGNADOS TN TN1. TEM EM SUA CASA MOSQUITEIROS QUE PODEM SER UTILIZADOS PARA DORMIR? Sim . 1 Não . 2 2 Módulo seguinte TN2. QUANTOS MOSQUITEIROS EXISTEM EM SUA CASA? Número de mosquiteiros . ___ ___ TN3. Peça ao inquirido para vos mostrar os mosquiteiros do agegado familiar. Se houver mais do que 3, utilize um ou mais questionários suplementares. 1º Mosquiteiro 2º Mosquiteiro 3º Mosquiteiro TN4. Mosquiteiro foi observado? Observado . 1 Não observado . 2 Observado . 1 Não observado . 2 Observado . 1 Não observado . 2 TN5. Observar ou solicitar a marca/tipo do mosquiteiro. A cor indicada aqui ao lado da marca, refere-se a embalagem e não ao mosquiteiro. Se a marca não é conhecida e o inquiridor não pode observar o mosquiteiro, mostre ao inquirido as fotos com as marcas/tipos correntes de mosquiteiros. Mosquiteiro impregnado de longa duração: Olyset (laranja) . 11 Interceptor (verde e branca) 12 Permanet 2 (brance e azul) 13 Dawa + (laranja/azul/branco) 14 Outro (especificar) ____ 16 NS a marca . 18 Outro mosquiteiro (especificar) __________36 NS marca/tipo . 98 Mosquiteiro impregnado de longa duração: Olyset (laranja) . 11 Interceptor (verde e branca) 12 Permanet 2 (brance e azul) 13 Dawa + (laranja/azul/branco) 14 Outro (especificar) ____ 16 NS a marca . 18 Outro mosquiteiro (especificar) __________36 NS marca/tipo . 98 Mosquiteiro impregnado de longa duração: Olyset (laranja) . 11 Interceptor (verde e branca) 12 Permanet 2 (brance e azul) 13 Dawa + (laranja/azul/branco) 14 Outro (especificar) ____ 16 NS a marca . 18 Outro mosquiteiro (especificar) __________36 NS marca/tipo . 98 TN6. HÁ QUANTO TEMPO O AGREGADO FAMILIAR TEM ESTE MOSQUITEIRO? Se menos que um mês, registe “00” Mês . ___ ___ Mais de 36 meses . 95 NS/não tem certeza . 98 Mês . ___ ___ Mais de 36 meses . 95 NS/não tem certeza . 98 Mês . ___ ___ Mais de 36 meses . 95 NS/não tem certeza . 98 TN7. Verifique o tipo do mosquiteiro em TN5  Impregrando de longa duração (11-18)  TN11  Outro (36) ou NS (98)  Continue  Impregrando de longa duração (11-18)  TN11  Outro (36) ou NS (98)  Continue  Impregrando de longa duração (11-18)  TN11  Outro (36) ou NS (98)  Continue TN8. QUANDO OBTEVE O MOSQUITEIRO, ELE JÁ HAVIA SIDO TRATADO COM UM INSECTICIDA PARA MATAR OU AFUGENTAR MOSQUITOS? Sim. 1 Não . 2 NS/não tem certeza . 8 Sim . 1 Não . 2 NS/não tem certeza . 8 Sim . 1 Não . 2 NS/não tem certeza . 8 TN9. DEPOIS QUE OBTEVE ESTE MOSQUITEIRO, FOI TRATADO COM UM LÍQUIDO QUE MATA OU AFUGENTA OS MOSQUITOS ? Sim. 1 Não . 2 TN11 NS/não estou seguro . 8  TN11 Sim . 1 Não . 2  TN11 NS/não estou seguro . 8  TN11 Sim . 1 Não . 2  TN11 NS/não estou seguro . 8  TN11 Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 311 TN10. QUANTOS MESES PASSARAM DESDE QUE O MOSQUITEIRO FOI TRATADO PELA ÚLTIMA VEZ? Si menos de um mês, marcar ‘00’. Meses . ___ ___ Mais de 24 meses . 95 NS/não seguro . 98 Meses . ___ ___ Mais de 24 meses . 95 NS/não seguro . 98 Meses . ___ ___ Mais de 24 meses . 95 NS/não seguro. 98 TN11. NA NOITE PASSADA, ALGUÉM DORMIU DEBAIXO DESTE MOSQUITEIRO? Sim. 1 Não . 2  TN13 NS/não tem certeza . 8  TN13 Sim . 1 Não . 2  TN13 NS/não tem certeza . 8  TN13 Sim . 1 Não . 2  TN13 NS/não tem certeza . 8  TN13 TN12. QUEM DORMIU DEBAIXO DESTE MOSQUITEIRO NA NOITE PASSADA? Registe o número de linha da pessoa a partir da lista de registo dos membros do agregado familiar. Se alguma pessoa que não consta na lista dos membros do agregado familiar dormiu debaixo do mosquiteiro, regite “00”. Nome _______________ Número de linha . ___ ___ Nome _______________ Número de linha . ___ ___ Nome _______________ Número de linha . ___ ___ Nome _______________ Número de linha . ___ ___ Nome _______________ Número de linha . ___ ___ Nome _______________ Número de linha . ___ ___ Nome _______________ Número de linha . ___ ___ Nome _______________ Número de linha . ___ ___ Nome ________________ Número de linha . ___ ___ Nome ________________ Número de linha . ___ ___ Nome ________________ Número de linha . ___ ___ Nome ________________ Número de linha . ___ ___ TN13. Retorne a TN4 para o próximo mosquiteiro. Se não houver mais mosquiteiros, siga para o módulo seguinte. Retorne a TN4 para o próximo mosquiteiro. Se não houver mais mosquiteiros, siga para o módulo seguinte. Retorne a TN4 da primeira coluna de um novo questionário para o próximo mosquiteiro. Se não houver mais mosquiteiros, siga para o módulo seguinte. Marque aqui se for usado um questionário adicional  Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 312 PULVERISAÇÃO INTRA-DOMICILIAR IR IR1. NOS ÚLTIMOS 12 MESES FOI FEITA A PULVERIZAÇÃO INTRA-DOMICILIAR NESTE ALOJAMENTO? Sim . 1 Não . 2 NS . 8 IR1A. NOS ÚLTIMOS 6 MESES FOI FEITA A PULVERIZAÇÃO INTRA-DOMICILIAR NESTE ALOJAMENTO? Sim . 1 Não . 2 NS . 8 1 Módulo seguinte 8 Módulo seguinte IR1B. QUAL É A PRINCIPAL RAZÃO PORQUE NÃO FOI FEITA A PULVERIZAÇÃO NO SEU ALOJAMENTO? Não foi informado/não tinha ninguém em casa . 1 Não deixou/não quis fazer . 2 Não houve pulverização nesta área . 3 Outro (especificar) ____________________ 6 NS . 8 1  Módulo seguinte 3  Módulo seguinte 6  Módulo seguinte 8  Módulo seguinte IR1C. POR QUE MOTIVO NÃO DEIXOU OU NÃO QUIS FAZER A PULVERIZAÇÃO? Registar todos os itens mencionados. Provoca alergias . A Faz mal à saúde . B Suja a parede/casa . C Não serve para nada. D Dá trabalho na arrumação da casa . E Outro (especificar ___________________ . X Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 313 ÁGUA E SANEAMENTO WS WS1. DE ONDE PROVÉM PRINCIPALMENTE A ÁGUA PARA BEBER UTILIZADA PELOS MEMBROS DO AGREGADO FAMILIAR ? Água da torneira: No alojamento . 11 No quintal . 12 No vizinho . 13 Do chafariz público . 14 Poço protegido . 21 Água perfurada: Poço protegido . 31 Poço desprotegido . 32 Água da nascente: Nascente protegida . 41 Nascente desprotegida . 42 Água da chuva . 51 Caminhão cisterna . 61 Carro com pequeno tanque/tambor . 71 Água de superfície (ribeira/rio/ barragem/lago/maré/canal/irrigação) . 81 Água engarrafada . 91 Outro (especificar) __________________ 96 11WS6 12WS6 13WS6 14WS3 21WS3 31WS3 32WS3 41WS3 42WS3 51WS3 61WS3 71WS3 81WS3 96WS3 WS2. DE ONDE PROVÉM PRINCIPALMENTE A ÁGUA UTILIZADA PELOS MEMBROS DO AGREGADO FAMILIAR PARA OUTROS FINS, TAIS COMO COZINHAR E LAVAR AS MÃOS? Água da torneira: No alojamento . 11 No quintal . 12 Na torneira do vizinho . 13 Do chafariz público/hidrante . 14 Poço protegido, perfuração . 21 Água perfurada: Poço protegido . 31 Poço desprotegido . 32 Água da nascente: Nascente protegida . 41 Nascente desprotegida . 42 Água da chuva . 51 Caminhão cisterna . 61 Carro com pequeno tanque/tambor . 71 Água de superfície (ribeira/rio/ barragem/lago/maré/canal/irigação) . 81 Outro (especificar) __________________ 96 11WS6 12WS6 13WS6 WS3. ONDE FICA LOCALIZADA ESTA FONTE DE ÁGUA? No alojamento . 1 No quintal/terreno . 2 Em outro lugar . 3 1WS6 2WS6 WS4. QUANTO TEMPO PRECISA PARA CHEGAR À FONTE DA ÁGUA, APANHAR A ÁGUA E VOLTAR AO ALOJAMENTO? Número de minutos . __ __ __ NS . 998 Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 314 WS5. QUEM SE DESLOCA HABITUALMENTE PARA A FONTE DE APROVISIONAMENTO PARA IR BUSCAR ÁGUA? Insista: ESTA PESSOA TEM MENOS DE 15 ANOS DE IDADE? QUAL É O SEXO DESTA PESSOA? Uma mulher adulta (de 15 anos ou mais) . 1 Um homem adulto (de 15 anos ou mais) . 2 Uma jovem (menos de 15 anos) . 3 Um jovem (menos de 15 anos) . 4 NS . 8 WS6. FAZ ALGUM TRATAMENTO NA ÁGUA ANTES DE BEBÊ-LA? Sim . 1 Não . 2 NS . 8 2WS8 8WS8 WS7. O QUE FAZ HABITUALMENTE PARA TORNAR A ÁGUA QUE BEBE POTÁVEL? Insistir: MAIS ALGUMA COISA? Registar todos os itens mencionados. Ferver . A Adicionar lixivia ou pastilha de cloro . B Filtrar com pano . C Usar filtro (cerâmica, areia, composto) . D Desinfecção solar . E Deixar repousar . F Outro (especificar) ___________________ X NS . Z WS8. QUE TIPO DE CASA DE BANHO É UTILIZADA HABITUALMENTE PELOS MEMBROS DO AGREGADO FAMILIAR? Se não for possível determinar o tipo de casa de banho, peça permissão para ve-la. Casa de banho (estilo “europeu”, com fossa sceptica, sanita e descarga manual ou automática): . 11 Latrina melhorada (com sanita e fossa coberta) . 21 Latina com fossa sceptica (com fossa sceptica coberta mas sem sanita) . 22 Latrina com fossa seca (buraco sem esgoto ou fossa sceptica) . 23 Balde (usados em casa) . 41 Não tem casa de banho/mato/praia . 95 Outro (especificar) . 96 95Módulo seguinte WS9. ESTA INSTALAÇÃO SANITÁRIA É COMPARTILHADA COM OUTRAS PESSOAS QUE NÃO FAZEM PARTE DESTE AGREGADO FAMILIAR? Sim . 1 Não . 2 2Módulo seguinte WS10. COMPARTILHA ESTA INSTALAÇÃO SANITÁRIA SOMENTE COM MEMBROS DE OUTROS AGREGADOS FAMILIARES QUE CONHECE OU A UTILIZAÇÃO É DE DOMÍNIO PÚBLICO? Somente outro agregado (não publico) . 1 Casa de banho pública . 2 2Módulo seguinte WS11. AO TOTAL, INCLUINDO O SEU, QUANTOS AGREGADOS FAMILIARES UTILIZAM ESTA INSTALAÇÃO SANITÁRIA? No. de agregados (se menos que 10).0__ 10 agregados ou mais . 10 NS . 98 Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 315 LAVAGEM DAS MÃOS HW HW1. GOSTARIA DE SABER QUAIS SÃO OS LUGARES QUE OS MEMBROS DO AGREGADO FAMILIAR UTILIZAM PARA LAVAR AS SUAS MÃOS. PODERIA MOSTRAR-ME POR FAVOR ONDE OS MEMBROS DO VOSSO AGREGADO FAMILIAR HABITUALMENTE LAVAM AS MÃOS ? Observado . 1 Não observado: Não existente na casa, no quintal ou na propriedade . 2 Sem permissão de ver . 3 Outra razão (especificar) ____________ 6 2 HW4 3 HW4 6 HW4 HW2. Observa a presença de água no local específico de lavagem das mãos. Verifique se tem água na torneira, bomba, bacia, balde, recipiente de água ou objetos semelhantes. Água disponível . 1 Água não disponível . 2 HW3A. Há sabonete, sabão, detergente ou cinza/ areia presente no lugar de lavagem das mãos ? Sim, existe . 1 Não, não existe . 2 2HW4 HW3B. Registe o observado. Circule tudo que se aplica. Sabonete/Barra de sabão . A Detergente (pó/líquido/pasta) . B Sabão líquido . C Cinza/ areia . D AHH19 BHH19 CHH19 DHH19 HW4. TEM SABONETE, SABÃO, DETERGENTE OU CINZA/AREIA NO VOSSO ALOJAMENTO PARA LAVAREM AS MÃOS? Sim . 1 Não . 2 2HH19 HW5A. PODE MOSTRAR-ME POR FAVOR? Sim, mostrou . 1 Não, não mostrou . 2 2HH19 HW5B. Registe o observado. Circule tudo que se aplica. Sabonete/Barra de sabão . A Detergente (pó/líquido/pasta) . B Sabão líquido . C Cinza/ areia . D Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 316 HH19. Registe a hora. Hora e minutos . __ __ : __ __ IODIZAÇÃO DO SAL SI SI1. GOSTARÍAMOS DE VERIFICAR SE O SAL UTILIZADO NO SEU AGREGADO FAMILIAR TEM IODO. POSSO OBTER UM POUCO DO SAL UTILIZADO PARA A PREPARAÇÃO DAS REFEIÇÕES DOS MEMBROS DO SEU AGREGADO FAMILIAR? Uma vez o sal testado, circule o número correspondente ao resultado do teste. Não iodizado - 0 PPM . 1 Mais que 0 PPM mas menos que 15 PPM . 2 15 PPM ou mais . 3 Não tem sal em casa. 4 Sal não foi testado (especificar a razão) __________________ 5 HH20. Agradeça o/a entrevistado/a pela sua colaboração e verifique a lista dos membros do agregado familiar:  Foi preenchido um QUESTIONÁRIO MULHER separado para cada mulher de 15-49 anos incluídas na lista dos membros do agregado familiar (HL7).  Foi preenchido um QUESTIONÁRIO HOMEN separado para cada homem de 15-49 incluído na lista dos membros do agregado familiar (HL7A).  Foi preenchido um QUESTIONÁRIO CRIANÇA COM MENOS DE 5 ANOS separado para cada criança com menos de cinco anos de idade incluída na lista dos membros do agregado familiar (HL7B). Volte para a página de cobertura e confirme que o resultado do inquérito do agregado (HH9), o nome e o número de linha do respondente ao questionário do agregado (HH10) e o número de mulheres elegíveis (HH12), de homens elegíveis (HH13A) e de crianças com menos de 5 anos (HH14) são registados. Tome as providencias necesárias para a administração do restante dos questionários a fazer neste agregado familiar. Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 317 Observações do/a inquiridor/a Observações do/a controlador/a Observações do/a supervisor/a Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 318 QUESTIONÁRIO INDIVIDUAL MULHER São Tomé e Príncipe, MICS 5, 2014 PAINEL DE INFORMAÇÃO SOBRE A MULHER WM Este questionário deve ser aplicado a todas as mulheres com idade compreendida entre 15 a 49 anos (ver coluna HL7 da lista de membros do agregado do Questionário Agregado familiar). Um questionário separado deve ser usado para cada mulher elegivel. WM1. Número AE selecionada: ___ ___ ___ WM2. Número do agregado familiar: ___ ___ WM3. Nome da mulher: _______________________ WM4. Número de linha da mulher: ___ ___ WM5. Inquiridor/a (nome e número): WM6. Dia/mês/ano da entrevista : Nome __________________________ No. ___ ___ ___ ___ /___ ___ / 2 0 1 ___ Se ainda não se apresentou, apresente-se à entrevistada: NOS FAZEMOS PARTE DO INSTITUTO NACIONAL DE ESTATÍSTICAS (INE) E ESTAMOS A TRABALHAR NUM PROJECTO RELACIONADO COM A SAÚDE DA FAMÍLIA E A EDUCAÇÃO. GOSTARIA DE FALAR CONSIGO SOBRE ISSO. A ENTREVISTA LEVARÁ CERCA DE 20 MINUTOS. TODAS AS INFORMAÇÕES RECOLHIDAS FICARÃO ESTRITAMENTE CONFIDENCIAIS E ANÔNIMAS. Se a apresentação a esta entrevistada já foi feita durante o Questionário Agregado familiar, leia a seguinte frase : AGORA, GOSTARIA DE FALAR SOBRE A SUA SAÚDE E OUTROS TÓPICOS. A ENTREVISTA DURARÁ CERCA DE 20 MINUTOS. MAIS UMA VEZ, TODAS AS INFORMAÇÕES RECOLHIDAS FICARÃO ESTRITAMENTE CONFIDENCIAIS E ANÔNIMAS. POSSO COMEÇAR AGORA ?  Sim, permissão concedida  Passar para WM10 para registar a hora e começar a entrevista  Não, permissão não concedida  Circule‘03’em WM7. Discuta este resultado com o chefe de equipa. Depois de ter preenchido completamente o Questionário individual Mulher, preencha as seguintes informações: WM7. Resultado do Questionário Mulher: Preenchido . 01 Ausente . 02 Recusa . 03 Parcialmente preenchido. 04 Pessoa sem capacidade de responder . 05 Outro (especificar ) . 96 WM8. Controlador/a (nome e número): Nome: __________________________ No. ___ ___ WM9. Digitador/a (nome e número): Nome: ______________________ No. ___ ___ Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 319 WM10. Registe a hora Hora e minutos __ __ : __ __ CARACTERÍSTICAS DA MULHER WB WB1. EM QUE MÊS E ANO NASCEU? Data de nascimento : Mês . __ __ Não sabe mês . 98 Ano . __ __ __ __ Não sabe ano . 9998 WB2. QUANTOS ANOS TEM? Insista : QUE IDADE TINHA NO SEU ÚLTIMO ANIVERSÁRIO? Compare e corrija WB1 e/ou WB2 se houver incoerências Idade (em anos completos) . __ __ WB3. JÁ FREQUENTOU ALGUMA VEZ UMA ESCOLA OU JARDIM DE INFÂNCIA/CRÊCHE? Sim . 1 Não . 2 2WB7 WB4. QUAL É O SEU NÍVEL ESCOLAR MAIS ALTO FREQUENTADO? Pré-escolar . 0 Básico . 1 Secundário . 2 Superior . 3 0WB7 WB5. QUAL É A ÚLTIMA CLASSE QUE TERMINOU NESTE NÍVEL? Se a 1ª classe deste nível não foi concluida, regista “00” Classe . __ __ WB6. Verificar WB4:  Secundário ou superior (WB4 = 2 ou 3) Passar ao módulo seguinte  Básico (WB4 = 1)  Continuar com WB7 WB7. AGORA, GOSTARIA QUE ME LÊSSE ESSA FRASE. Mostrar a frase da carta do inquérito para a entrevistada. Se a entrevistada não consegue ler a frase inteira, insista: PODE LER CERTAS PARTES DA FRASE? Não pode ler nada . 1 Pode ler certas partes . 2 Pode ler a frase inteira . 3 Não tem nenhuma frase na língua da entrevistada _____________________ 4 (especificar a língua) Cega/muda, problema de visão. . 5 Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 320 ACESSO À MÍDIA E UTILIZAÇÃO DAS TECNOLOGIAS DE INFORMAÇÕES/COMUNICAÇÃO MT MT1. Verifique WB7:  Questão deixada em branco (a entrevistada fez estudos secundários ou superiores)  Continue com MT2  É capaz de ler a frase inteira ou parcialmente na língua solicitada (WB7 = 2 ou 3) ou não se apresentou frase na língua da entrevistada (WB7 = 4)  Continue com MT2  Não consegue ler nada ou é cega (WB7 =1 ou 5)  Vá à MT3 MT2. COM QUE FREQUÊNCIA LÊ UM JORNAL OU UMA REVISTA: QUASE TODOS OS DIAS, PELO MENOS UMA VEZ POR SEMANA, MENOS DE UMA VEZ POR SEMANA OU NUNCA LÊ? Quase todos os dias . 1 Pelo menos uma vez por semana . 2 Menos de uma vez por semana . 3 Nunca . 4 MT3. COM QUE FREQUÊNCIA ESCUTA RÁDIO: QUASE TODOS OS DIAS, PELO MENOS UMA VEZ POR SEMANA, MENOS DE UMA VEZ POR SEMANA OU NUNCA ESCUTA? Quase todos os dias . 1 Pelo menos uma vez por semana . 2 Menos de uma vez por semana . 3 Nunca . 4 MT4 COM QUE FREQUÊNCIA VÊ TELEVISÃO: QUASE TODOS OS DIAS, PELO MENOS UMA VEZ POR SEMANA, MENOS DE UMA VEZ POR SEMANA OU NUNCA VÊ? Quase todos os dias . 1 Pelo menos uma vez por semana . 2 Menos de uma vez por semana . 3 Nunca . 4 MT5. Verifique WB2: idade da entrevistada?  15-24 anos  Continue com MT6  25-49 anos  Vá para o módulo seguinte MT6. JÁ UTILIZOU ALGUMA VEZ UM COMPUTADOR? Sim . 1 Não . 2 2MT9 MT7. INDEPENDENTEMENTE DO LOCAL, JÁ UTILIZOU UM COMPUTADOR NOS ÚLTIMOS 12 MESES? Sim . 1 Não . 2 2MT9 MT8. DURANTE O ÚLTIMO MÊS, COM QUE FREQUÊNCIA USOU UM COMPUTADOR: QUASE TODOS OS DIAS, UMA VEZ POR SEMANA, MENOS DE UMA VEZ POR SEMANA OU NUNCA? Quase todos os dias . 1 Pelo menos uma vez por semana . 2 Menos de uma vez por semana . 3 Nunca . 4 MT9. JÁ UTILIZOU INTERNET ALGUMA VEZ? Sim . 1 Não . 2 2Módulo seguinte MT10. NOS ÚLTIMOS 12 MESES, UTILIZOU INTERNET ALGUMA VEZ? Se necessário, insista para saber a utilização independentemente do local e do aparelho. Sim . 1 Não . 2 2Módulo seguinte MT11. NO ÚLTIMO MÊS, COM QUE FREQUÊNCIA UTILIZOU A INTERNET: QUASE TODOS OS DIAS, PELO MENOS UMA VEZ POR SEMANA, MENOS DE UMA VEZ POR SEMANA OU NENHUMA VEZ? Quase todos os dias . 1 Pelo menos uma vez por semana . 2 Menos de uma vez por semana . 3 Nunca . 4 Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 321 FECUNDIDADE/HISTÓRICO DOS NASCIMENTOS CM CM1. AGORA, GOSTARIA DE LHE PERGUNTAR SOBRE TODOS OS PARTOS QUE TEVE AO LONGO DA SUA VIDA. ALGUMA VEZ PARIU? Sim . 1 Não . 2 2CM8 CM4. TEM FILHOS E/OU FILHAS QUE PARIU E QUE ATUALMENTE VIVEM CONSIGO? Sim . 1 Não . 2 2CM6 CM5. QUANTOS FILHOS SEUS VIVEM CONSIGO? QUANTAS FILHAS SUAS VIVEM CONSIGO? Se nenhum(a), registe ‘00’. Filhos em casa . __ __ Filhas em casa . __ __ CM6. TEM ALGUM FILHO OU FILHA QUE PARIU E QUE ESTÁ VIVO/A, MAS QUE ACTUALMENTE NÃO VIVE CONSIGO? Sim . 1 Não . 2 2CM8 CM7. QUANTOS FILHOS SEUS ESTÃO VIVOS MAS NÃO VIVEM CONSIGO? QUANTAS FILHAS SUAS ESTÃO VIVAS MAS NÃO VIVEM CONSIGO? Se nenhum, regista ‘00’. Filhos fora de casa . __ __ Filhas fora de casa . __ __ CM8. TEVE ALGUM FILHO OU FILHA QUE NASCEU VIVO/A MAS QUE MORREU EM SEGUIDA? Se “Não”, insista em perguntar: QUERO DIZER UMA CRIANÇA QUE RESPIROU, CHOROU OU MOSTROU OUTROS SINAIS DE VIDA, MESMO QUE VIVEU SOMENTE POR ALGUNS MINUTOS OU ALGUMAS HORAS? Sim . 1 Não . 2 2CM10 CM9. QUANTOS FILHOS SEUS FALECERAM? QUANTAS FILHAS SUAS FALECERAM? Se nenhum(a), regista ‘00’. Filhos falecidos . __ __ Filhas falecidas . __ __ CM10. Some as respostas de CM5, CM7 e CM9. Soma . __ __ CM11. DEIXA VER SE COMPREENDI BEM: TEVE NO TOTAL (número total de CM10) CRIANÇAS SUAS QUE NASCERAM VIVAS DURANTE TODA A SUA VIDA. ESTÁ CORRECTO?  Sim  Verifique abaixo:  Nenhum nascimento vivo  Vá para o módulo SINTÓMAS DE DOENÇAS (IS)  Um ou mais nascimentos vivos  Continue com o módulo HISTÓRICO DOS NASCIMENTOS (BH)  Não  Verifique as respostas das questões CM1-CM10 e faça as correcções necessárias antes de continuar ou com o módulo SINTOMAS DE DOENÇAS (IS) ou com o módulo HISTÓRICO DOS NASCIMENTOS (BH), dependendo da resposta. Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 322 HISTÓRICO DOS NASCIMENTOS BH AGORA, GOSTARIA DE OBTER A LISTA DETALHADA DE TODAS AS CRIANÇAS SUAS QUE NASCERAM VIVAS, MESMO QUE AS CRIANÇAS JÁ NÃO ESTÃO MAIS VIVAS AGORA, COMEÇANDO PELO/A PRIMEIRO/A FILHO/A. Registe o nome de todos os filhos/as em BH1. Registe os gémeos/trigémeos em linhas separadas. Se mais de 13 partos, utilize um outro questionário. BH NO. DE LIN HA BH1. QUE NOME DEU AO SEU (primeiro/a ou próximo/a) FILHO/A? BH2. O PARTO FOI SIMPLES OU MÚLTIPLO? 1 Simples 2 Múltiplo BH3. (Nome) É UM RAPAZ OU UMA MENINA? 1 Rapaz 2 Menina BH4. EM QUE MÊS E ANO (nome) NASCEU? Insistir: QUAL É A DATA DE NASCIMENTO? BH5. (Nome) AINDA ESTÁ VIVO/A? 1 Sim 2 Não BH6. QUANTOS ANOS (nome) FEZ NO ÚLTIMO ANIVER- SÁRIO? Registar idade em anos completos BH7. (Nome) VIVE CON- SIGO? 1 Sim 2 Não BH8. Registar o número de linha da criança (de HL1) Anote “00” se a criança não consta na lista do agregado BH9. Se falecido : QUANTOS ANOS TINHA (nome) QUANDO FALECEU? Se “1 ano”, insistir : QUAL IDADE TINHA O/A (nome) EM MESES? Anote em dias, se menos de 1 mês. Anote em meses se menos de 2 anos. Caso contrário anote em anos. BH10. HOUVE OUTROS NASCIMENTOS VIVOS ENTRE O NASCIMENTO DE (nome do/a filho/a anterior) E (nome), INCLUINDO CRIANÇAS QUE FALECERAM LOGO APÓS O NASCIMENTO? 1 Sim 2 Não Linha Nome S M R M Mês Ano S N Idade S N Nº de linha Unidade Número S N 01 1 2 1 2 ___ ___ ___ ___ ___ ___ 1 2  BH9 ___ ___ 1 2 ___ ___  Linha seguinte Dia… . 1 Mês… . 2 Ano. . 3 ___ ___ 02 1 2 1 2 ___ ___ ___ ___ ___ ___ 1 2  BH9 ___ ___ 1 2 ___ ___  BH10 Dia… . 1 Mês… . 2 Ano. . 3 ___ ___ 1 2 Acrescentar Nascimento nascimento seguinte 03 1 2 1 2 ___ ___ ___ ___ ___ ___ 1 2  BH9 ___ ___ 1 2 ___ ___  BH10 Dia… . 1 Mês… . 2 Ano. . 3 ___ ___ 1 2 Acrescentar Nascimento nascimento seguinte 04 1 2 1 2 ___ ___ ___ ___ ___ ___ 1 2  BH9 ___ ___ 1 2 ___ ___  BH10 Dia… . 1 Mês… . 2 Ano. . 3 ___ ___ 1 2 Acrescentar Nascimento nascimento seguinte 05 1 2 1 2 ___ ___ ___ ___ ___ ___ 1 2  BH9 ___ ___ 1 2 ___ ___  BH10 Dia… . 1 Mês… . 2 Ano. . 3 ___ ___ 1 2 Acrescentar Nascimento nascimento seguinte 06 1 2 1 2 ___ ___ ___ ___ ___ ___ 1 2  BH9 ___ ___ 1 2 ___ ___  BH10 Dia… . 1 Mês… . 2 Ano. . 3 ___ ___ 1 2 Acrescentar Nascimento nascimento seguinte 07 1 2 1 2 ___ ___ ___ ___ ___ ___ 1 2  BH9 ___ ___ 1 2 ___ ___  BH10 Dia… . 1 Mês… . 2 Ano. . 3 ___ ___ 1 2 Acrescentar Nascimento nascimento seguinte Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 323 BH NO. DE LIN HA BH1. QUE NOME DEU AO SEU (primeiro/a ou próximo/a) FILHO/A? BH2. O PARTO FOI SIMPLES OU MÚLTIPLO? 1 Simples 2 Múltiplo BH3. (Nome) É UM RAPAZ OU UMA MENINA? 1 Rapaz 2 Menina BH4. EM QUE MÊS E ANO (nome) NASCEU? Insistir: QUAL É A DATA DE NASCIMENTO? BH5. (Nome) AINDA ESTÁ VIVO/A? 1 Sim 2 Não BH6. QUANTOS ANOS (nome) FEZ NO ÚLTIMO ANIVER- SÁRIO? Registar idade em anos completos BH7. (Nome) VIVE CON- SIGO? 1 Sim 2 Não BH8. Registar o número de linha da criança (de HL1) Anote “00” se a criança não consta na lista do agregado BH9. Se falecido : QUANTOS ANOS TINHA (nome) QUANDO FALECEU? Se “1 ano”, insistir : QUAL IDADE TINHA O/A (nome) EM MESES? Anote em dias, se menos de 1 mês. Anote em meses se menos de 2 anos. Caso contrário anote em anos. BH10. HOUVE OUTROS NASCIMENTOS VIVOS ENTRE O NASCIMENTO DE (nome do/a filho/a anterior) E (nome), INCLUINDO CRIANÇAS QUE FALECERAM LOGO APÓS O NASCIMENTO? 1 Sim 2 Não Linha Nome S M R M Mês Ano S N Idade S N Nº de linha Unidade Número S N 08 1 2 1 2 ___ ___ ___ ___ ___ ___ 1 2  BH9 ___ ___ 1 2 ___ ___  BH10 Dia… . 1 Mês… . 2 Ano. . 3 ___ ___ 1 2 Acrescentar Nascimento nascimento seguinte . 09 1 2 1 2 ___ ___ ___ ___ ___ ___ 1 2  BH9 ___ ___ 1 2 ___ ___  BH10 Dia… . 1 Mês… . 2 Ano. . 3 ___ ___ 1 2 Acrescentar Nascimento nascimento seguinte . 10 1 2 1 2 ___ ___ ___ ___ ___ ___ 1 2  BH9 ___ ___ 1 2 ___ ___  BH10 Dia… . 1 Mês… . 2 Ano. . 3 ___ ___ 1 2 Acrescentar Nascimento nascimento seguinte 11 1 2 1 2 ___ ___ ___ ___ ___ ___ 1 2  BH9 ___ ___ 1 2 ___ ___  BH10 Dia… . 1 Mês… . 2 Ano. . 3 ___ ___ 1 2 Acrescentar Nascimento nascimento seguinte 12 1 2 1 2 ___ ___ ___ ___ ___ ___ 1 2  BH9 ___ ___ 1 2 ___ ___  BH10 Dia… . 1 Mês… . 2 Ano. . 3 ___ ___ 1 2 Acrescentar Nascimento nascimento seguinte 13 1 2 1 2 ___ ___ ___ ___ ___ ___ 1 2  BH9 ___ ___ 1 2 ___ ___  BH10 Dia… . 1 Mês… . 2 Ano. . 3 ___ ___ 1 2 Acrescentar Nascimento nascimento seguinte BH11. TEVE OUTROS/AS FILHOS/AS QUE NASCERAM VIVOS/AS DEPOIS DO NASCIMENTO DE (nome do/a último/a filho/a que consta na tabela do histórico de nascimentos)? Sim . 1 Não . 2 1 Registar no histórico Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 324 CM12A. Compare o número em CM10 com o número de filhos registados no módulo HISTÓRICO DOS NASCIMENTOS acima e verifique:  Os números são iguais  Continue com CM13  Os números são diferentes Insista e corrija CM13. Verifique se o último parto com nascido vivo aconteceu durante os últimos 2 anos, quer dizer a partir de (mês de entrevista) 2012 (se o mês da entrevista e do parto são os mesmos e o ano do parto for 2012 por favor considerar como um parto que ocorreu ao longo dos últimos dois anos.)  Nenhum nascido vivo ao longo dos 2 últimos anos.  Vá para o módulo SINTÓMAS DE DOENÇAS (IS).  Um ou mais nascidos vivos ao longo dos 2 últimos anos.  Registe o nome do/a filho/a do último parto com nascido vivo e siga com o próximo módulo. Nome do/a filho/a do último parto com nascido vivo_______________________ Se a criança morreu, faz prova de tacto quando se referir a esta criança nos seguintes módulos. Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 325 DESEJO DO ÚLTIMO NASCIMENTO DB Este módulo deve ser administrado a todas as mulheres que tiveram filhos/as nascidos/as vivos/as nos últimos dois anos que antecederam a data da entrevista. Registar o nome da última criança nascida viva (CM13) aqui: _________________ Utilizar o nome desta criança nas perguntas seguintes no lugar indicado. DB1. QUANDO ENGRAVIDOU DE (nome), QUERIA FICAR GRÁVIDA NAQUELE MOMENTO? Sim . 1 Não . 2 1Módulo seguinte DB2. QUERIA ESPERAR MAIS OU NÃO QUERIA (MAIS) FICAR GRÁVIDA DE MANEIRA NENHUMA? Mais tarde . 1 Não queria (mais) engravidar . 2 2 Módulo seguinte DB3. QUANTO TEMPO GOSTARIA DE TER ESPERADO PARA ENGRAVIDAR? Nota a resposta tal como é dada pela entrevistada Mês . 1 __ __ Ano . 2 __ __ NS . 998 Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 326 SAÚDE MATERNA E INFANTIL MN Este módulo deve ser administrado a todas as mulheres que tiveram filhos/as nascidos/as vivos/as nos últimos dois anos antecedentes a data da entrevista. Registar o nome da última criança nascida viva aqui: _________________. Utilizar o nome desta criança nas perguntas seguintes no lugar indicado. MN1. DURANTE A GRAVIDEZ DE (nome), CONSULTOU QUALQUER PESSOA PARA CUIDADOS PRÉ-NATAIS? Sim . 1 Não . 2 2MN5 MN2. QUEM CONSULTOU? Insistir : ALGUÉM MAIS? Insistir para conhecer o tipo de pessoa consultada e registar todas as respostas dadas. Profissional da saúde: Médico . A AEnfermeira/parteira . B Outra pessoa: Parteira tradicional . F Agente de saúde comunitária . G Outro (especificar) . X MN2A. QUANDO FEZ A PRIMEIRA CONSULTA PRÉ- NATAL, DE QUANTAS SEMANAS OU MESES ESTAVA GRÁVIDA? Registe a resposta tal como dada pela entrevistada. Semanas . 1 __ __ Meses . 2 __ __ NS . 998 MN3. QUANTAS VEZES TEVE CONSULTAS PRÉ- NATAIS DURANTE ESTA GRAVIDEZ? Número de vezes . __ NSP . 98 MN4. NO QUADRO DOS CUIDADOS PRÉ-NATAIAS DESTA GRAVIDEZ, EFECTUOU ALGUM DOS SEGUINTES EXAMES PELO MENOS UMA VEZ: [A] MEDIU A TENSÃO ? [B] FEZ EXAME DE URINA? [C] FEZ EXAME DO SANGUE ? Sim Não Tensão . 1.2 Urina . 1.2 Sangue . 1.2 MN5. POSSUI UM CARTÃO DE VACINA OU UM OUTRO DOCUMENTO ONDE ESTÃO LISTADAS TODAS AS VACINAS ? POSSO VER, POR FAVOR ? Se um documento é apresentado, utilize-o para responder as questões seguintes. Sim (viu o documento . 1 Sim (não viu o documento . 2 Não. 3 NS . 8 MN6. DURANTE A GRAVIDEZ DE (nome), TOMOU ALGUMA INJEÇÃO NO BRAÇO PARA PREVENIR O BEBÉ CONTRA O TÉTANO, OU SEJA CONVULSÕES APÓS O NASCIMENTO? Sim . 1 Não. 2 NS. . .8 2MN9 8MN9 MN7. DURANTE A GRAVIDEZ DE (nome), QUANTAS INJEÇÕES CONTRA O TÉTANO RECEBEU? Se for 7 vezes ou mais, registar ‘7’. Número de vezes . .__ NS . 8 8MN9 Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 327 MN8. Quantas injeções contra o tétano foram declaradas em MN7 para a última gravidez ?  Pelo menos duas injeções contra o tétano durante a última gravidez  Passar à MN12  Apenas uma injeção contra o tétano durante a última gravidez  Continuar com MN9 MN9 A QUALQUER MOMENTO ANTES DA GRAVIDEZ DE (nome), RECEBEU ALGUMA INJEÇÃO CONTRA TÉTANO, QUER PARA PROTEGER A SI MESMA, QUER PARA PROTEGER OUTRO BEBÉ? Sim . 1 Não . 2 NS. 8 2MN12 8MN12 MN10. ANTES DA GRAVIDEZ DE (nome), QUANTAS VEZES RECEBEU UMA INJEÇÃO CONTRA O TÉTANO? Se for 7 vezes ou mais, registar ‘7’. Número de vezes . __ NS. 8 8MN12 MN11. QUANTOS ANOS ANTES DA GRAVIDEZ DE (nome) RECEBEU ESTA ÚLTIMA INJEÇÃO CONTRA TÉTANO? Se há menos de um ano, registar ‘00’. Número de anos . __ __ MN12. Verifique MN1 para ver se a mulher recebeu cuidados pré-natais durante esta gravidez:  Sim, recebeu cuidados pré-natais  Continue com MN13  Não recebeu cuidados pré-natais  Vá para MN17 MN13. DURANTE ALGUMA DESTAS VISITAS DE CUIDADOS PRÉ-NATAIS PARA A GRAVIDEZ DE (nome), TOMOU ALGUM MEDICAMENTO PARA EVITAR O PALUDISMO? Sim . 1 Não . 2 NS. 8 2MN17 8MN17 MN14. QUAL FOI O MEDICAMENTO QUE TOMOU PARA EVITAR O PALUDISMO? Registe todos medicamentos mencionados. Se o tipo de medicamento não pode ser determinado, mostre à inquirida os antipalúdicos comuns. SP/Fansidar . A Outro (especificar) . X NS. Z MN15. Verificar MN14 para o tipo de medicamento tomado :  Tomou SP/Fansidar. Continue com MN16  Não tomou SP/Fansidar  Vá à MN17 MN16. DURANTE A GRAVIDEZ DE (nome), QUANTAS VEZES NO TOTAL TOMOU SP/FANSIDAR? POR FAVOR INCLUI TUDO QUE RECEBEU DURANTE AS VISITAS PRÉ-NATAIS, DURANTE VISITAS A UM CENTRO DE SAÚDE OU QUALQUER OUTRO LUGAR. Número de vezes . __ __ NS. 98 MN17. QUEM LHE ASSISTIU DURANTE O PARTO DE (nome) ? Insistir : ALGUÉM MAIS AJUDOU ? Insistir para obter o tipo de pessoa que assistiu o parto. Registar todas as respostas mencionadas. Se a inquirida disser que ninguém a assistiu, insista para determinar se nenhum adulto esteve presente no parto. Profissional de saúde: Médico . A Enfermeira/parteira . B Outra pessoa: Parteira tradicional . F Agente de saúde comunitária. G Parente/amigo(a). H Outro (especificar) ____________________ X Ninguém . Y Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 328 MN18. ONDE TEVE O PARTO DE (nome) ? Insistir para determinar o tipo de lugar. Se não for possível determinar se o lugar é um estabelecimento público ou privado, inscreva o nome do lugar. (Nome do lugar) Casa: Em casa da inquirida . 11 Em outra casa . 12 Sector público: Hospital governamental . 21 Clínica/centro de saúde govern. 22 Posto de saúde governamental. 23 Outro público (especificar) . 26 Sector médico privado: Hospital privado . 31 Clínica privada . 32 Maternidade privada . 33 Outro privado (especificar) . 36 Outro (especificar) ___________________ 96 11MN20 12MN20 96MN20 MN19. O PARTO DE (nome) FOI ATRAVÉS DE CESARIANA, ISTO É DE OPERAÇÃO NO VENTRE? Sim . 1 Não . 2 2 MN20 MN19A. QUANDO A DECISÃO DE FAZER A CESARIANA FOI TOMADA: FOI ANTES OU DEPOIS QUE COMEÇARAM AS CONTRAÇÕES DO PARTO? Antes . 1 Depois . 2 MN20. QUANDO (nome) NASCEU, ERA MUITO GORDO/A, MAIS GORDO/A DO QUE A MÉDIA, NA MÉDIA, MENOR DO QUE A MÉDIA OU MUITO PEQUENO/A? Muito gordo/a . 1 Mais gordo/a do que a média . 2 Na média . 3 Menor que a média . 4 Muito pequeno/a . 5 NS. 8 MN21. (Nome) FOI PESADO AO NASCER ? Sim . 1 Não . 2 NS. 8 2MN23 8MN23 MN22. QUANTO PESAVA (nome)? Registar o peso que está na ficha de saúde, se estiver disponível. Da ficha de saúde . 1 (kg) __ , __ __ __ De memória . 2 (kg) __ , __ __ __ NS. 99998 MN23. SUA MENSTRUAÇÃO REGRESSOU DEPOIS DO NASCIMENTO DE (nome)? Sim . 1 Não . 2 MN24. AMAMENTOU O/A (nome)? Sim . 1 Não . 2 2 Módulo seguinte MN25 QUANTO TEMPO DEPOIS DE NASCER, DEU DE MAMAR A (nome ) PELA PRIMEIRA VEZ? Se menos de uma hora, marcar ‘00’ hora. Se menos de 24 horas, marcar a hora exacta. Senão marcar em dias. Imediatamente . 000 Horas . 1 __ __ Dias . 2 __ __ NS/não se lembra . 998 MN26. DURANTE OS TRÊS DIAS QUE SE SEGUIRAM O NASCIMENTO, FOI DADO A (nome) A BEBER OUTRA COISA QUE NÃO FOSSE LEITE MATERNO? Sim . 1 Não . 2 2 Módulo seguinte Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 329 MN27. O QUE FOI DADO DE BEBER A (nome) ? Insistir: DEU LHE MAIS ALGUMA COISA ? Leite fresco/de pacote (não materno) . A Água . B Água açucarada . C Calmante para cólicas . D Solução (salgada /açucarada) . E Sumo de frutas . F Leite em pó para bebé . G Chá/infusão . H Mel . I Outro (especificar) ____________________ X Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 330 EXAMES DE SAÚDE PÓS-NATAL PN Este módulo deve ser administrado a todas as mulheres que tiveram filhos/as nascidos/as vivos/as nos dois anos anteriores à data da entrevista. Regista o nome do último recém-nascido de CM13 aqui _____________________. Utilise o nome desta criança nas seguintes perguntas, no lugar indicado. PN1. Verifique MN18: a criança nasceu numa estrutura de saúde?  Sim, a criança nasceu numa estrutura de saúde (MN18=21-26 ou 31-36)  Continue com PN2  Não, a criança não nasceu numa estrutura de saúde (MN18=11-12 ou 96)  Vá para PN6 PN2. AGORA, GOSTARIA DE LHE FAZER ALGUMAS PERGUNTAS SOBRE O QUE ACONTECEU NAS HORAS E DIAS APÓS O NASCIMENTO DE (nome). DISSE QUE TEVE O PARTO EM (nome ou tipo de estrutura sanitária em MN18). QUANTO TEMPO APÓS O PARTO DE (nome) FICOU AÍ? Se for menos de um dia, registe em horas. Se for menos de uma semana, anote em dias. Caso contrário, anote em semanas. Horas . 1 __ __ Dias. 2 __ __ Semanas . 3 __ __ NS/não lembra . 998 PN3. GOSTARIA DE LHE FALAR SOBRE OS EXAMES DE SAÚDE APÓS O PARTO DE (nome), POR EXEMPLO, SE ALGUM PROFISSIONAL DE SAÚDE EXAMINOU O/A (nome), VERIFICOU O SEU CORDÃO UMBILICAL OU VIU SE O/A (nome) ESTAVA BEM: ANTES DE SAIR DE (nome ou tipo da estrutura sanitária de MN18), ALGUM PROFISSIONAL DE SAÚDE EXAMINOU O/A (nome)? Sim. 1 Não . 2 PN4. E EM RELAÇÃO AO EXAME DA SUA SAUDE? ALGUÉM FEZ O BALANÇO DO SEU ESTADO DE SAÚDE, POR EXEMPLO PONDO QUESTÕES SOBRE A SUA SAÚDE OU LHE EXAMINANDO? ALGUÉM CONTROLOU O SEU ESTADO DE SAÚDE ANTES DE SAIR DE (nome ou tipo da estrutura sanitária de MN18)? Sim. 1 Não . 2 PN5. AGORA, GOSTARIA DE FALAR SOBRE O QUE ACONTECEU QUANDO SAIU DE (nome ou tipo da estrutura sanitária de MN18): ALGUÉM TESTOU O ESTADO DE SAÚDE DE (nome) DEPOIS QUE SAIU DE (nome ou tipo da estrutura sanitária de MN18)? Sim. 1 Não . 2 1PN11 2PN16 PN6. Verificar MN17: um professional de saúde, parteira tradicional ou agente de saúde comunitária assistiu o parto?  Sim, parto assistido por professional de saúde, parteira tradicional ou agente de saúde comunitária (MN17=A-G)  Continue com PN7  Não, parto não assistido por professional de saúde, parteira tradicional ou agente de saúde comunitária (A-G sem resposta na questão MN17)  Vá para PN10 Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 331 PN7. JÁ DISSE QUE (a ou as pessoa(s) em MN17) ASSISTIU NO SEU PARTO. AGORA, GOSTARIA DE FALAR SOBRE OS EXAMES DE SAÚDE PÓS-PARTO DE (nome), POR EXEMPLO SE EXAMINARAM (nome), VERIFICARAM O SEU CORDÃO UMBILICAL OU SE VERIFICARAM SE (nome) ESTAVA BEM: DEPOIS DO PARTO E ANTES QUE (a ou as pessoa(s) em MN17) SAISSE, ESTA(S) PESSOA(S) CONTROLOU/ARAM A SAÚDE DE (nome) ? Sim.1 Não . 2 PN8. O(S) (a ou as pessoa(s) em MN17) CONTROLOU TAMBÉM A SUA SAÚDE ANTES DE PARTIR? POR CONTROLAR A SUA SAÚDE, QUERO DIZER FAZER UM BALANÇO DA SUA SAÚDE, POR EXEMPLO PÔR QUESTÕES SOBRE A SUA SAÚDE OU FAZER EXAMES. Sim.1 Não .2 PN9. DEPOIS DA PARTIDA DE (a ou as pessoa(s) da em MN17), UMA OUTRA PESSOA CONTROLOU A SAÚDE DE (nome)? Sim.1 Não . 2 1PN11 2PN18 PN10. GOSTARIA DE FALAR SOBRE OS EXAMES DE SAÚDE PÓS-PARTO DE (nome), POR EXEMPLO SE EXAMINARAM (nome), VERIFICARAM O SEU CORDÃO UMBILICAL OU SE VERIFICARAM SE (nome) ESTAVA BEM: DEPOIS DO NASCIMENTO DE (nome), ALGUÉM CONTROLOU A SAÚDE DELE/A? Sim.1 Não . 2 2PN19 PN11. ESTE CONTROLO FOI REALIZADO SÓ UMA VEZ OU MAIS DE UMA VEZ? Uma só vez . 1 Mais de uma vez . 2 1PN12A 2PN12B PN12A. QUANTO TEMPO DEPOIS DO PARTO ESSE CONTROLO FOI REALIZADO? PN12B. QUANTO TEMPO DEPOIS DO PARTO FOI REALIZADO O PRIMEIRO DESTES CONTROLOS? Se for menos do que um dia, registe em horas. Se for menos de uma semana, registe em dias. Caso contrario, registe em semanas. Horas . 1 __ __ Dias. 2 __ __ Semanas . 3 __ __ NS/não lembra. .998 PN13. QUEM CONTROLOU A SAUDE DE (nome) NAQUELE MOMENTO? Profissional de saúde: Médico . A AEnfermeira/parteira . B Outra pessoa: Parteira tradicional . F Agente de saúde comunitária . G Parente/amigo . H Outro (especificar) _________________ X Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 332 PN14. ONDE FOI REALIZADO ESSE CONTROLO? Insistir para determinar o tipo de lugar. Se não for possível determinar se é lugar público ou privado, registar o nome do lugar. (Nome do lugar) Casa: Em casa da inquirida . 11 Em outra casa. 12 Sector público: Hospital governamental . 21 Clínica/centro de saúde govern . 22 Posto de saúde governamental . 23 Outro público (especificar) _________ 26 Sector médico privado: Hospital privado . 31 Clínica privada . 32 Maternidade privada . 33 Outro privado (especificar) _________ 36 Outro (especificar) ________________ 96 PN15. Verificar MN18: a criança nasceu em uma unidade de saúde?  Sim, a criança nasceu em uma unidade de saúde (MN18=21-26 ou 31-36)  Continuar com PN16  Não, a criança não nasceu em uma unidade de saúde (MN18=11-12 ou 96)  Passar para PN17 PN16. DEPOIS DE TER DEIXADO (nome ou tipo de estrutura sanitária em MN18), ALGUÉM EXAMINOU A SUA SAÚDE? Sim. 1 Não . 2 1 PN20 2Módulo seguinte PN17. Verificar MN17: algum profissional de saúde, parteira tradicional ou agente de saúde comunitária assistiu o parto ?  Sim, parto assistido por profissional de saúde, parteira tradicional ou agente de saúde comunitária (MN17=A-G)  Continuar com PN18  Não, parto não assistido por profissional de saúde, parteira tradicional ou agente de saúde comunitária (A-G sem resposta na questão MN17) Passar para PN19 PN18. DEPOIS DO PARTO E ANTES DA PARTIDA DE (a ou as pessoa(s) em MN17), ALGUÉM EXAMINOU A SUA SAUDE ? Sim. 1 Não . 2 1PN20 2Módulo seguinte PN19. DEPOIS DO NASCIMENTO DE (nome), ALGUÉM CONTROLOU A SUA SAÚDE? POR CONTROLAR A SUA SAÚDE, QUERO DIZER FAZER UM BALANÇO DA SUA SAÚDE, POR EXEMPLO PÔR QUESTÕES SOBRE A SUA SAÚDE OU FAZER EXAMES. Sim. 1 Não . 2 2Módulo seguinte PN20. ESTES CONTROLOS FORAM REALIZADOS APENAS UMA VEZ OU MAIS DE UMA VEZ? Uma só vez . 1 Mais de uma vez . 2 1PN21A 2PN21B PN21A. QUANTO TEMPO DEPOIS DO PARTO ESSE CONTROLO FOI REALIZADO? PN21B. QUANTO TEMPO DEPOIS DO PARTO FOI REALIZADO O PRIMEIRO DESTES CONTROLOS? Se for menos do que um dia, registe em horas. Se for menos de uma semana, registe em dias. Caso contrario, registe em semanas. Horas . 1 __ __ Dias . 2 __ __ Semanas . 3 __ __ NSP/não lembra . 998 Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 333 PN22. QUEM CONTROLOU A SUA SAÚDE NAQUELE MOMENTO? Profissional de saúde: Médico . A Enfermeira/parteira. B Outra pessoa: Parteira tradicional . F Agente de saúde comunitária . G Parente/amigo. .H Outro (especificar) _________________ X PN23. ONDE TEVE LUGAR ESSE EXAME ? Insistir para determinar o tipo de o lugar. Se for impossível de determinar se é lugar público ou privado, escreva o nome do lugar. (Nome do lugar) Casa: Em casa da inquirida . 11 Em outra casa . 12 Sector público: Hospital governamental . 21 Clínica/centro de saúde govern . 22 Posto de saúde governamental . 23 Outro público (especificar) _________ 26 Sector médico privado: Hospital privado . 31 Clínica privada . 32 Maternidade privada . 33 Outro privado (especificar) _________ 36 Outro (especificar) ________________ 96 Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 334 SINTOMAS DE DOENÇAS IS IS1. Verificar a lista dos membros do agregado familiar, colunas HL7B e HL15: a entrevistada é a mãe ou a responsável da criança com menos de 5 anos ?  Sim  Continuar com IS2.  Não  Passar ao módulo seguinte. IS2. ÀS VEZES ACONTECE QUE UMA CRIANÇA ADOECE GRAVEMENTE E DEVE SER LEVADA IMEDIATAMENTE A UM ESTABELECIMENTO DE SAÚDE. QUE TIPO DE SINTOMAS FARIA COM QUE LEVARIA UMA CRIANÇA DE MENOS DE 5 ANOS IMEDIATAMENTE A UM ESTABELECIMENTO DE SAÚDE? Insistir : MAIS ALGUM SINTOMA ? Insistir para recolher outros sinais ou sintomas até que a mãe ou a responsável não pode mais citar outros sinais ou sintomas. Circule todos os sintomas mencionados, mas não sugere respostas. Criança incapaz de beber ou mamar . A Condição da criança piora . B Criança torna-se febril. C Criança respira muito rápido . D Criança tem dificuldade em respirar . E Criança tem sangue nas fezes . F Criança bebe dificilmente . G Criança com diarréia . H Outro (especificar) . X Outro (especificar) . Y Outro (especificar) . Z Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 335 CONTRACEPÇÃO CP CP1. GOSTARIA DE LHE FALAR DE UM OUTRO ASSUNTO, O PLANEAMENTO FAMILIAR . ESTÁ GRÁVIDA NESTE MOMENTO ? Sim, actualmente grávida .1 Não .2 Não tem certeza ou NS .8 1 CP2A CP2. ALGUNS CASAIS UTILIZAM DIFERENTES MEIOS OU MÉTODOS PARA RETARDAREM E EVITAREM A GRAVIDEZ. NESSE MOMENTO, FAZ ALGUMA COISA OU UTILIZA ALGUM MÉTODO PARA RETARDAR OU EVITAR UMA GRAVIDEZ? Sim . 1 Não . 2 1 CP3 CP2A. JÁ FEZ ALGUMA COISA OU UTILIZOU ALGUM MÉTODO PARA RETARDAR OU EVITAR QUE FICASSE GRAVIDA? Sim . 1 Não . 2 1 Módulo seguinte 2 Módulo seguinte CP3. O QUE FAZ ACTUALMENTE PARA RETARDAR OU EVITAR UMA GRAVIDEZ? Não sugere nenhuma resposta. Se mais de um método for mencionado, circule todos. Esterilização feminina . A Esterilização masculina . B DIU . C Injecções . D Implantes . E Pílulas . F Preservativo masculino . G Preservativo feminino . H Diafragma . I Espermicidas . J Abstinência periódica/tabelas . L Coito interrompido . M Outro (especificar) ___________________ X Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 336 NECESSIDADES NÃO-SATISFEITAS UN UN1. Verifique CP1: actualmente está grávida?  Sim, actualmente está grávida  Continue com UN2  Não, não está seguroa ou não sabe  Vá à UN5 UN2. AGORA, GOSTARIA DE FALAR SOBRE A SUA GRAVIDEZ ACTUAL: QUANDO ENGRAVIDOU, QUERIA FICAR GRÁVIDA NAQUELE MOMENTO? Sim . 1 Não . 2 1UN4 UN3. PREFERIA TER ESPERADO MAIS ALGUM TEMPO OU GOSTARIA DE NÃO TER TIDO (MAIS) FILHO(S)? Mais tarde . 1 Não queria filhos . 2 UN4. AGORA, TENHO ALGUMAS PERGUNTAS SOBRE O FUTURO: DEPOIS DESTE FILHO, GOSTARIA DE TER OUTRO FILHO OU GOSTARIA DE NÃO TER MAIS FILHOS? Ter outro filho . 1 Não ter mais filhos . 2 Não tem certeza/NS . 8 1UN7 2UN13 8UN13 UN5. Verifique CP3: utiliza a esterilização feminina ?  Sim  Vá para UN13  Não  Continue com UN6 UN6. AGORA TENHO ALGUMAS PERGUNTAS SOBRE O FUTURO: GOSTARIA DE TER UM (OUTRO) FILHO OU PREFERIA NÃO TER (MAIS) FILHO(S)? Ter outro filho . 1 Não ter (outro) filho(s) . 2 Diz que não consegue ficar grávida . 3 Indecisa/NS . 8 2UN9 3UN11 8UN9 UN7. QUANTO TEMPO GOSTARIA DE ESPERAR ANTES DO NASCIMENTO DE UM (OUTRO) FILHO ? Mês . 1 __ __ Anos . 2 __ __ Agora . 993 Diz que não consegue ficar grávida . 994 Depois do casamento . 995 Outro . 996 NS . 998 994UN11 UN8. Verificar CP1: actualmente está grávida ?  Sim, actualmente está grávida  Vá para UN13  Não, não tem certeza ou não sabe  Continue com UN9 UN9. Verifique CP2: utiliza um método actualmente ?  Sim  Vá para UN13  Não Continue com UN10 Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 337 UN10. ACHA QUE ESTÁ FÍSICAMENTE APTA PARA FICAR GRÁVIDA NESSE MOMENTO ? Sim . 1 Não . 2 NS . 8 1 UN13 8 UN13 UN11. PORQUE ACHA QUE NÃO ESTÁ APTA FÍSICAMENTE PARA FICAR GRÁVIDA NESSE MOMENTO ? Não tem relações sexuais/relações sexuais pouco frequentes . A Menopausa . B Nunca teve menstruação . C Histerectomia (útero removido) . D Há dois anos ou mais que tenta engravidar mas não consegue. E Amenorreia pós-parto . F Amamenta . G Demasiada velha . H Destino/vontade divina . I Outro (especificar) . X NS . Z UN12. Verifique UN11: “Nunca teve menstruação” mencionado?  Sim  Vá para o módulo seguinte  Não  Continue com UN13 UN13. QUANDO COMEÇOU A SUA ÚLTIMA MENSTRUAÇÃO? Registe a informação utilizando as unidades de tempo dadas pela inquirida. Dias . 1 __ __ Semanas . 2 __ __ Meses . 3 __ __ Anos . 4 __ __ Menopausa/teve uma histerectomia . 994 Antes do último parto . 995 Nunca teve menstruação . 996 Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 338 ATITUDES EM RELAÇÃO À VIOLENCIA DOMÉSTICA DV DV1. AS VEZES UM MARIDO FICA CHATEADO OU COM RAIVA POR CAUSA DE ALGUMAS ACÇÕES DA SUA ESPOSA. NA SUA OPINIÃO, ISTO JUSTIFICA QUE O MARIDO BATA OU ESPANCA A MULHER, EM ALGUMAS DAS SEGUINTES SITUAÇÕES: [A] SE ELA SAIR SEM O AVISAR? [B] SE ELA NEGLIGENCIAR AS CRIANÇAS? [C] SE ELA DISCUTIR COM ELE? [D] SE ELA RECUSAR A TER RELAÇÕES SEXUAIS? [E] SE ELA QUEIMAR A COMIDA? [F] SE ELA O TRAIR COM OUTRO HOMEM? Sim Não NS Sai sem o avisar . 1 2 8 Negligencia as crianças . 1 2 8 Discute . 1 2 8 Recusa sexo . 1 2 8 Queima a comida . 1 2 8 Trai marido . 1 2 8 Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 339 CASAMENTO/UNIÃO DE FACTO MA MA1. ACTUALMENTE É CASADA OU VIVE COM UM HOMEM COMO SE FOSSEM CASADOS (UNIÃO DE FACTO)? Sim, actualmente casada . 1 Sim, vive com um homem . 2 Não vive em união . 3 3MA5 MA2. QUANTOS ANOS TEM O SEU MARIDO/COMPANHEIRO? Insistir: QUANTOS ANOS COMPLETOU O SEU MARIDO/COMPANHEIRO NO SEU ÚLTIMO ANIVERSÁRIO? Idade completa . __ __ NS . 98 MA3. PARA ALÉM DE SI, O SEU MARIDO/PARCEIRO TEM OUTRAS ESPOSAS OU VIVE COM OUTRAS MULHERES COMO SE FOSSEM CASADOS (UNIÃO DE FACTO)? Sim. 1 Não . 2 2MA7 MA4. QUANTAS OUTRAS ESPOSAS OU COMPANHEIRAS ELE TEM ALÉM DE SI? Número . __ __ NS . 98 MA7 98MA7 MA5. JÁ FOI CASADA OU JÁ VIVEU COM UM HOMEM COMO SE FOSSE CASADA (UNIÃO DE FACTO)? Sim, já foi casada . 1 Sim, já viveu com um homem . 2 Não . 3 3Módulo seguint e MA6. QUAL É A SUA SITUAÇÃO MATRIMONIAL ACTUAL: É VIÚVA, DIVORCIADA OU SEPARADA? Viúva . 1 Divorciada . 2 Separada . 3 MA7. JÁ FOI, UMA OU MAIS DE UMA VEZ, CASADA OU VIVEU COM UM HOMEM COMO SE FOSSEM CASADOS? Uma vez . 1 Mais de uma vez . 2 1MA8A 2MA8B MA8A. EM QUE MÊS E ANO CASOU OU COMEÇOU A VIVER COM UM HOMEM COMO SE FOSSEM CASADOS (UNIÃO DE FACTO)? MA8B. EM QUE MÊS E ANO CASOU PELA PRIMEIRA VEZ OU COMEÇOU A VIVER PRIMEIRA VEZ COM UM HOMEM COMO SE FOSSEM CASADOS (UNIÃO DE FACTO)? Data do (primeiro) casamento/união: Mês . __ __ NS mês . 98 Ano . __ __ __ __ NS ano . 9998  Módulo seguint e MA9. QUANTOS ANOS TINHA QUANDO COMEÇOU A VIVER COM O SEU PRIMEIRO MARIDO/PARCEIRO? Idade em anos . __ __ Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 340 COMPORTAMENTO SEXUAL SB Verifique que não há presença de outras pessoas. Antes de continuar a entrevista, faça o possível para estar em privado com a entrevistada. SB1. AGORA, GOSTARIA DE FAZER ALGUMAS PERGUNTAS SOBRE A SUA VIDA SEXUAL, PARA ENTENDER MELHOR ALGUMAS QUESTÕES IMPORTANTES DA VIDA. AS INFORMAÇÕES QUE FORNECERÁ SERÃO MANTIDAS EM ESTRITA CONFIDENCIALIDADE: QUANTOS ANOS TINHA QUANDO TEVE A SUA PRIMEIRA RELAÇÃO SEXUAL? Nunca teve relação sexual . 00 Idade em anos . __ __ Primeira vez começando a viver com 1º marido/parceiro. 95 00Módulo seguinte SB2. A PRIMEIRA VEZ QUE TEVE RELAÇÕES SEXUAIS, USOU UM PRESERVATIVO ? Sim. 1 Não . 2 NS/não lembra . 8 SB3. QUANDO TEVE RELAÇÕES SEXUAIS PELA ÚLTIMA VEZ? Registar a resposta em número de dias, semanas ou meses, se menos de 12 meses (1 ano). Se 12 meses (1 ano) ou mais, a resposta será registado em anos. Há … dias . 1 __ __ Há … semanas . 2 __ __ Há … meses . 3 __ __ Há …anos . 4 __ __ 4SB15 SB4. A ÚLTIMA VEZ QUE TEVE RELAÇÕES SEXUAIS, USOU UM PRESERVATIVO? Sim. 1 Não . 2 SB5 QUAL ERA O SEU RELACIONAMENTO COM A PESSOA COM QUEM TEVE A SUA ÚLTIMA RELAÇÃO SEXUAL? Insista para assegurar que a resposta refere-se ao tipo de relacionamento no momento da relação sexual. Se 'namorado', pergunte: VIVIAM JUNTOS COMO SE FOSSEM CASADOS? Se sim, circule '2'. Se 'não', circule '3 '. Marido . 1 Parceiro de coabitação . 2 Namorado . 3 Encontro casual . 4 Outros (especificar) _____________________ 6 3SB7 4SB7 6SB7 SB6. Verifique MA1:  Actualmente é casada ou vive com homem em união (MA1 = 1 ou 2)  Vá para SB8  Não é casada ou não vive em união (MA1 = 3)  Continue com SB7 SB7. QUAL É A IDADE DESTA PESSOA? Se não sabe, insistir: QUAL É A IDADE APROXIMADA DESTA PESSOA? Idade do parceiro . __ __ NS . 98 SB8. TEVE RELAÇÕES SEXUAIS COM OUTRA PESSOA NOS ÚLTIMOS 12 MESES ? Sim. 1 Não . 2 2SB15 SB9 A ÚLTIMA VEZ QUE TEVE RELAÇÕES SEXUAIS COM ESTA OUTRA PESSOA, USOU UM PRESERVATIVO? Sim. 1 Não . 2 Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 341 SB10. QUAL É O SEU RELACIONAMENTO COM ESSA PESSOA? Certifique que a resposta refere-se ao tipo de relacionamento no momento da relação sexual. Se é o ‘namorado’, pergunte: VIVIAM JUNTOS COMO SE FOSSEM CASADOS? Se sim, circule '2'. Se 'não', circule '3'. Marido . 1 Parceiro de coabitação . 2 Namorado . 3 Encontro casual . 4 Outro (especificar) ___________________ 6 3SB12 4SB12 6SB12 SB11. Verifique MA1 e MA7:  Actualmente casada ou vive com um homem em união (MA1 = 1 ou 2) E já foi casada ou viveu com um homem em união somente uma vez (MA7 = 1)  Vá para SB13  Senão  Continue com SB12 SB12. QUE IDADE TEM ESTA PESSOA? Se não sabe, insistir : QUAL É A IDADE APROXIMADA DESTA PESSOA? Idade do parceiro . __ __ NS . 98 SB13. ALÉM DESTAS DUAS PESSOAS, TEVE RELAÇÕES SEXUAIS COM UMA OUTRA PESSOA NOS ÚLTIMOS 12 MESES? Sim. 1 Não . 2 2SB15 SB14. NO TOTAL, COM QUANTAS PESSOAS DIFERENTES TEVE RELAÇÕES SEXUAIS NOS ÚLTIMOS 12 MESES? Número de parceiros . __ __ SB15. NO TOTAL, COM QUANTAS PESSOAS DIFERENTES TEVE RELAÇÕES SEXUAIS DURANTE TODA A SUA VIDA? Em caso de resposta não numérica, insista para obter uma estimativa. Se o número de parceiros sexuais é 95 ou mais, introduzir '95'. Número de parceiros durante a vida . __ __ NS . 98 Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 342 VIH/SIDA HA HA1. AGORA, GOSTARIA DE FALAR SOBRE OUTRO ASSUNTO: JÁ OUVIU FALAR DE UMA DOENÇA CHAMADA SIDA? Sim. 1 Não . 2 2Módulo seguinte HA2. AS PESSOAS PODEM DIMINUIR O RISCO DE CONTRAIR O VÍRUS DO SIDA TENDO APENAS UM PARCEIRO SEXUAL QUE NÃO ESTÁ INFECTADO E QUE TAMBÉM NÃO TEM NENHUMA OUTRA PARCEIRA SEXUAL? Sim. 1 Não . 2 NS . 8 HA3. AS PESSOAS PODEM CONTRAIR O VÍRUS DO SIDA POR FEITIÇARIA OU OUTROS MEIOS SOBRENATURAIS? Sim. 1 Não . 2 NS . 8 HA4. AS PESSOAS PODEM REDUZIR O RISCO DE CONTRAIR O VÍRUS DO SIDA UTILIZANDO PRESERVATIVOS TODA VEZ QUE TEM RELAÇÕES SEXUAIS ? Sim. 1 Não . 2 NS . 8 HA5. AS PESSOAS PODEM CONTRAIR O VÍRUS DO SIDA POR PICADAS DE MOSQUITO? Sim. 1 Não . 2 NS . 8 HA6. AS PESSOAS PODEM CONTRAIR O VÍRUS DO SIDA POR PARTILHAREM ALIMENTOS COM PESSOAS CONTAMINADAS COM O VÍRUS DO SIDA? Sim. 1 Não . 2 NS . 8 HA7. É POSSÍVEL QUE UMA PESSOA QUE APARENTA TER BOA SAÚDE TENHA O VÍRUS DO SIDA? Sim. 1 Não . 2 NS . 8 HA8. O VÍRUS DO SIDA PODE SER TRANSMITIDO DA MÃE PARA SEU BEBÉ : Sim Não NS [A] DURANTE A GRAVIDEZ ? [B] DURANTE O PARTO ? [C] DURANTE O ALEITAMENTO ? Durante a gravidez . 1 2 8 Durante o parto . 1 2 8 Durante o aleitamento . 1 2 8 HA9. NA SUA OPINIÃO, SE UMA PROFESSORA TEM O VÍRUS DO SIDA MAS NÃO ESTÁ DOENTE DEVERIA SER AUTORIZADA A CONTINUAR A ENSINAR NA ESCOLA? Sim. 1 Não . 2 NS/não tem certeza/depende . 8 HA10 COMPRARIA LEGUMES FRESCOS DE UM COMERCIANTE OU DE UM VENDEDOR SE SOUBESSE QUE ELE/A TEM O VÍRUS DO SIDA? Sim. 1 Não . 2 NS/não tem certeza/depende . 8 HA11. SE UM MEMBRO DA SUA FAMÍLIA FOR INFECTADO PELO VÍRUS DO SIDA, GOSTARIA QUE ESTE FACTO PERMANECESSE SEGREDO? Sim. 1 Não . 2 NS/não tem certeza/depende . 8 HA12. SE UM MEMBRO DA SUA FAMÍLIA FOR INFECTADO PELO VÍRUS DO SIDA, ESTARIA PRONTA PARA CUIDAR DELE/A NA SUA PRÓPRIA CASA? Sim. 1 Não . 2 NS/não tem certeza/depende . 8 HA13. Verifique CM13: uma criança nascida viva nos últimos dois anos ?  Não, nenhuma criança nascida viva nos últimos dois anos (CM13= ‘Não’ ou em branco).  Vá para HA24.  Uma ou mais crianças nascidas vivas nos últimos dois anos  Continue com HA14 HA14. Verifique MN1: fez consultas pré-natais ?  Sim, fez consultas pré-natais  Continue com HA15  Não, não fez consultas pré-natais  Vá para à HA24 Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 343 HA15. EM UMA DAS CONSULTAS PRÉ-NATAIS DURANTE A GRAVIDEZ DE (nome), RECEBEU INFORMAÇÕES SOBRE : [A] BEBÉS QUE CONTRAEM O VÍRUS DO SIDA PELA MÃE? [B] AS MEDIDAS QUE SE PODE TOMAR PARA NÃO CONTRAIR O VÍRUS DO SIDA? [C] A POSSIBLIDADE DE FAZER UM TESTE PARA DETECTAR O VÍRUS DO SIDA? [D] LHE PROPUSERAM DE FAZER O TESTE DO SIDA? S N NS SIDA através da mãe 1 2 8 Medidas a tomar 1 2 8 Possibilidade do teste do SIDA 1 2 8 Propuseram um teste 1 2 8 HA16. NÃO QUERO SABER O RESULTADO, MAS FEZ UM TESTA DO SIDA NO QUADRO DO SEUS CUIDADOS PRÉ-NATAIS? Sim . 1 Não . 2 NS . 8 2HA19 8HA19 HA17. NÃO QUERO SABER O RESULTADO, MAS RECEBEU O RESULTADO DO TESTE? Sim . 1 Não . 2 NS . 8 2HA22 8HA22 HA18. QUALQUER QUE SEJA O RESULTADO DO TESTE, TODAS AS MULHERES QUE FAZEM O TESTE DO SIDA DEVERIAM RECEBER CONSELHOS DEPOIS DE TER RECEBIDO O RESULTADO. DEPOIS DE SER TESTADA, RECEBEU ALGUM CONSELHO? Sim . 1 Não . 2 NS . 8 1HA22 2HA22 8HA22 HA19. Verifique MN17: parto por um profissional de saúde (A ouB)?  Sim, parto por um profissional de saúde  Continue com HA20  Não, nenhum profissional de saúde assistiu o parto  Vá para HA24 HA20. NÃO QUERO SABER O RESULTADO DO TESTE, MAS FEZ O TESTE DO SIDA ENTRE O MOMENTO DA ENTRADA PARA O PARTO E ANTES DO NASCIMENTO DO BEBE? Sim . 1 Não . 2 2HA24 HA21. NÃO QUERO SABER O RESULTADO DO TESTE, MAS OBTEVE O RESULTADO DO TESTE ? Sim . 1 Não . 2 HA22. EFECTUOU OUTRO TESTE DO VIH/SIDA DESDE QUE FOI TESTADA DURANTE A SUA GRAVIDEZ? Sim . 1 Não . 2 1HA25 HA23. QUANDO EFECTUOU O TESTE DO VIH/SIDA PELA ÚLTIMA VEZ ? Há menos de 12 meses . 1 Há 12-23 meses . 2 Há 2 anos ou mais . 3 1 Módulo seguinte 2 Módulo seguinte 3 Módulo seguinte HA24. NÃO QUERO SABER O RESULTADO, MAS JÁ FEZ ALGUMA VEZ O TESTE PARA SABER SE TEM O VÍRUS DO SIDA? Sim. 1 Não . 2 2HA27 HA25. QUANDO FEZ O TESTE DO SIDA PELA ÚLTIMA VEZ? Há menos de 12 meses. 1 Há 12-23 meses . 2 Há 24 meses (2 anos) ou mais . 3 HA26. NÃO QUERO SABER O RESULTADO, MAS OBTEVE O RESULTADO DO TESTE? Sim. 1 Não . 2 NS . 8 1 Módulo seguinte 2 Módulo seguinte 8 Módulo seguinte Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 344 HA27. CONHECE ALGUM LUGAR ONDE AS PESSOAS PODEM FAZER O TESTE DO SIDA? Sim. 1 Não . 2 Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 345 MORTALIDADE MATERNA MM AGORA, GOSTARIA DE LHE FAZER ALGUMAS PERGUNTAS SOBRE OS SEUS IRMÃOS E IRMÃS, OU SEJA , SOBRE TODOS OS FILHOS E FILHAS DA SUA MÃE BIOLÓGICA, INCLUINDO TODOS OS IRMÃOS E IRMÃS QUE MORAM CONSIGO, QUE MORAM EM OUTRO LUGAR E OS QUE MORRERAM. MM1. A QUANTAS CRIANÇAS, INCLUINDO A SI MESMA, SUA MÃE DEU A LUZ? No. de nascimentos da mãe biológica: ___ ___ MM2. Verifique MM1:  Dois ou mais nascimentos  Continue com MM3  Apenas um nascimento (a própria inquirida)  Vá para o módulo seguinte MM3. QUANTOS DESTES FILHOS E DESTAS FILHAS DA SUA MÃE BIOLÓGICA NASCERAM ANTES DE SI? No. de nascimentos precedentes: ___ ___ [S1] Mais velho [S2] Seguinte [S3] Seguinte [S4] Seguinte MM4. QUAL É O NOME DO SEU (SEGUINTE) IRMÃO OU IRMÁ MAIS VELHO/A? ___________ ___________ ___________ Sim . 1 Não . 2 MM5. (Nome) É HOMEM OU MULHER? Homem . 1 Mulher . 2 Homem . 1 Mulher . 2 Homem . 1 Mulher . 2 Homem . 1 Mulher . 2 MM6. (Nome) AINDA ESTÁ VIVO/A? Sim . 1 Não . 2 MM8 NS . 8 [S2] Sim . 1 Não . 2 MM8 NS .8 [S3] Sim . 1 Não . 2 MM8 NS .8 [S4] Sim . 1 Não . 2 MM8 NS .8 [S5] MM7. QUAL É A IDADE DE (nome)? ___ ___  Vá para [S2] ___ ___  Vá para [S3] ___ ___  Vá para [S4] ___ ___  Vá para [S5] MM8. HÁ QUANTOS ANOS O/A (nome) FALECEU? ___ ___ ___ ___ ___ ___ ___ ___ MM9. QUE IDADE TINHA (nome) QUANDO FALECEU? ___ ___ ___ ___ ___ ___ ___ ___ MM9A. Verifique MM5 e MM9: Trata-se de um irmão? Ou trata-se de uma irmã que faleceu antes dos 12 anos de idade?  Sim  Vá para [S2]  Não  Conti- nue com MM10  Sim  Vá para [S3]  Não  Conti- nue com MM10 Sim  Vá para [S4]  Não  Conti- nue com MM10  Sim  Vá para [S5]  Não  Conti- nue com MM10 MM10. (Nome) ESTAVA GRÁVIDA QUANDO FALECEU? Sim . 1 MM13 Não . 2 Sim . 1 MM13 Não . 2 Sim . 1 MM13 Não . 2 Sim . 1 MM13 Não . 2 MM11. (Nome) FALECEU DURANTE O PARTO ? Sim . 1 MM13 Não . 2 Sim . 1 MM13 Não . 2 Sim . 1 MM13 Não . 2 Sim . 1 MM13 Não . 2 MM12. (Nome) FALECEU NOS DOIS MESES SEGUINTES AO FIM DA GRAVIDEZ OU DO PARTO ? Sim . 1 Não . 2 Sim . 1 Não . 2 Sim . 1 Não . 2 Sim . 1 Não . 2 MM13. QUANTOS FILHOS E FILHAS NASCIDOS VIVOS (nome) TEVE DURANTE TODA SUA VIDA? ___ ___ ___ ___ ___ ___ ___ ___ MM14. Sem mais irmãos/irmãs, vá ao módulo seguinte Sem mais irmãos/irmãs, vá ao módulo seguinte Sem mais irmãos/irmãs, vá ao módulo seguinte Sem mais irmãos/irmãs, vá ao módulo seguinte Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 346 [S5] Seguinte [S6] Seguinte [S7] Seguinte [S8] Seguinte MM4. QUAL É O NOME DO SEU (SEGUINTE) IRMÃO OU IRMÃ MAIS VELHO/A? ___________ ___________ ___________ ___________ MM5. (Nome) É HOMEM OU MULHER? Homem . 1 Mulher . 2 Homem . 1 Mulher . 2 Homem . 1 Mulher . 2 Homem . 1 Mulher . 2 MM6. (Nome) AINDA ESTÁ VIVO/A? Sim . 1 Não . 2 MM8 NS . 8 [S6] Sim . 1 Não . 2 MM8 NS .8 [S7] Sim . 1 Não . 2 MM8 NS .8 [S8] Sim . 1 Não . 2 MM8 NS .8  [S9] MM7. QUAL É A IDADE DE (nome)? ___ ___  Vá para [S6] ___ ___  Vá para [S7] ___ ___  Vá para [S8] ___ ___  Vá para [S9] MM8. HÁ QUANTOS ANOS O/A (nome) FALECEU? ___ ___ ___ ___ ___ ___ ___ ___ MM9. QUE IDADE TINHA (nome) QUANDO FALECEU? ___ ___ ___ ___ ___ ___ ___ ___ MM9A. Verifique MM5 e MM9: Trata-se de um irmão? Ou trata-se de uma irmã que faleceu antes dos 12 anos de idade?  Sim  Vá para [S6]  Não  Continue com MM10  Sim  Vá para [S7]  Não  Continue com MM10 Sim  Vá para [S8]  Não  Continue com MM10  Sim  Vá para [S9]  Não  Continue com MM10 MM10. (Nome) ESTAVA GRÁVIDA QUANDO FALECEU? Sim . 1 MM13 Não . 2 Sim . 1 MM13 Não . 2 Sim . 1 MM13 Não . 2 Sim . 1 MM13 Não . 2 MM11. (Nome) FALECEU DURANTE O PARTO? Sim . 1 MM13 Não . 2 Sim . 1 MM13 Não . 2 Sim . 1 MM13 Não . 2 Sim . 1 Sim . 1 Não . 2 Não . 2 MM12. (Nome) FALECEU NOS DOIS MESES SEGUINTES À GRAVIDEZ OU O PARTO? Sim . 1 Não . 2 Sim . 1 Não . 2 Sim . 1 Não . 2 Sim . 1 Não . 2 MM13. QUANTOS FILHOS/AS VIVOS/AS (nome) TEVE DURANTE TODA SUA VIDA? ___ ___ ___ ___ ___ ___ ___ ___ MM14. Sem mais irmãos/irmãs, vá ao módulo seguinte Sem mais irmãos/irmãs, vá ao módulo seguinte Sem mais irmãos/irmãs, vá ao módulo seguinte Sem mais irmãos/irmãs, vá ao módulo seguinte Coloque uma cruz aqui se outro questionário foi utilizado  Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 347 CONSUMO DE TABACO E ÁLCOOL TA TA1. JÁ EXPERIMENTOU FUMAR CIGARROS, MESMO UM OU DOIS SOPROS? Sim . 1 Não . 2 2TA6 TA2. QUANTOS ANOS TINHA QUANDO FUMOU UM CIGARRO INTEIRO PELA PRIMEIRA VEZ? Nunca fumou um cigarro inteiro . 00 Idade . ___ ___ 00TA6 TA3. ACTUALMENTE, FUMA CIGARROS? Sim . 1 Não . 2 2TA6 TA4. DURANTE AS ÚLTIMAS 24 HORAS, QUANTOS CIGARROS FUMOU ? Número de cigarros . ___ ___ TA5. DURANTE O ÚLTIMO MÊS, POR QUANTOS DIAS FUMOU CIGARROS? Se menos de 10 dias, anote o número de dias. Se 10 dias ou mais, mas menos de um mês, círculo "10". Se "todos os dias" ou "quase todos os dias," círcule "30" Número de dias . 0 ___ 10 dias ou mais, mas menos de um mês . 10 Diáriamente/quase todos os dias . 30 TA6. JÁ TENTOU FUMAR OUTROS PRODUTOS DE TABACO QUE NÃO SEJAM CIGARROS, TAIS COMO CHARUTOS, CACHIMBO, CIGARRILHAS? Sim . 1 Não . 2 2TA10 TA7. NO ÚLTIMO MÊS, CONSUMIU ALGUM DESSES PRODUTOS DE TABACO A FUMAR ? Sim . 1 Não . 2 2TA10 TA8. QUE TIPO DE PRODUTOS DE TABACO A FUMAR CONSUMIU NO ÚLTIMO MÊS? Circule tudo que for mencionado. Charutos . A Cigarrilha . C Cachimbo . D Outros (especificar) . X TA9. DURANTE O ÚLTIMO MÊS, POR QUANTOS DIAS FEZ USO DE PRODUTOS DE TABACO PARA FUMAR? Se menos de 10 dias, anote o número de dias. Se 10 dias ou mais, mas menos de um mês, círcule "10". Se "todos os dias" ou "quase todos os dias," círcule "30". Número de dias . 0 ___ 10 dias ou mais, mas menos de um mês . 10 Diáriamente/quase todos os dias . 30 TA10. JÁ TENTOU PRODUTOS DERIVADOS DO TABACO QUE NÃO SE FUMAM, TAIS COMO TABACO A MASCAR OU TABACO PARA CHEIRAR (CANCAN)? Sim . 1 Não . 2 2 TA14 TA11. DURANTE O ÚLTIMO MÊS, CONSUMIU PRODUTOS DE TABACO QUE NÃO SE FUMAM? Sim . 1 Não . 2 2 TA14 TA12. QUE TIPO DE PRODUTOS DE TABACO QUE NÃO SE FUMAM CONSUMIU DURANTE O ÚLTIMO MÊS? Circule tudo o que for mencionado. Tabaco de mascar . A Tabaco de cheirar (cancan) . B Outro (especificar) . X TA13. DURANTE O ÚLTIMO MÊS, POR QUANTOS DIAS FEZ USO DE PRODUTOS DE TABACO QUE NÃO SE FUMAM? Se menos de 10 dias, anote o número de dias. Se 10 dias ou mais, mas menos de um mês, círcule "10". Se "todos os dias" ou "quase todos os dias," círcule "30". Número de dias . 0 ___ 10 dias ou mais, mas menos de um mês . 10 Diáriamente/quase todos dias . 30 Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 348 TA14. AGORA, GOSTARIA DE LHE COLOCAR ALGUMAS QUESTÕES SOBRE O CONSUMO DE ÁLCOOL: JÁ BEBEU BEBIDAS ALCOÓLICAS? Sim . 1 Não . 2 2Módulo seguinte TA15. CONTAMOS COMO UMA DOSE DE ÁLCOOL UMA LATA OU GARRAFA DE CERVEJA, UM COPO DE VINHO, UMA DOSE DE AGUARDENTE, CONHAQUE, VODKA, WHISKEY OU RUM. QUANTOS ANOS TINHA QUANDO INGERIU ÁLCOOL PELA PRIMEIRA VEZ, MAIS QUE SIMPLESMENTE ALGUNS GOLES? Nunca bebeu álcool . 00 Idade . ___ ___ 00 Módulo seguinte TA16. DURANTE O ÚLTIMO MÊS, POR QUANTOS DIAS BEBEU PELO MENOS UMA DOSE DE ÁLCOOL? Se o entrevistado não ingere bebidas com álcool circule “00”. Se menos de 10 dias, anotar o número de dias. Se 10 dias ou mais, mais menos de um mês, circule “10”. Se “cada dia” ou “quase todos os dias”, circule “30” Não bebeu durante o mês passado . 00 Número de dias . 0 ___ 10 dias ou mais, masmenos de um mês . 10 Diáriamente/quase todos os dias . 30 00 Módulo seguinte TA17. DURANTE O MÊS PASSADO, NOS DIAS EM QUE BEBEU BEBIDAS ALCOÓLICAS, QUANTAS DOSES TOMOU? Número de doses . ___ ___ Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 349 SATISFAÇÃO NA VIDA LS LS1. Verifique WB2: idade da entrevistada entre 15 e 24 anos?  Idade 25 - 49 anos  Vá a WM11  Idade 15 - 24 anos  Continue com LS2 LS2. AGORA GOSTARIA DE COLOCAR ALGUMAS QUESTÕES SIMPLES SOBRE FELICIDADE E A SATISFAÇÃO. PRIMEIRAMENTE, NESTE MOMENTO DIRIA QUE DE MANEIRA GERAL ESTÁ MUITO FELIZ, BASTANTE FELIZ, NEM FELIZ NEM INFELIZ, BASTANTE INFELIZ OU MUITO INFELIZ ? PODE OLHAR PARA ESTAS IMAGENS PARA AUXILIÁ-LA NA SUA RESPOSTA. Mostre a lado 1 da carta resposta e explique o que representa cada símbolo. Circule a resposta mostrada pela entrevistada. Muito feliz . 1 Bastante feliz . 2 Nem feliz, nem infeliz . 3 Bastante infeliz . 4 Muito infeliz . 5 LS3. AGORA, GOSTARIA DE LHE FAZER ALGUMAS PERGUNTAS SOBRE O SEU NÍVEL DE SATISFAÇÃO EM VÁRIOS DOMÍNIOS. PARA CADA CASO, HÁ CINCO RESPOSTAS: DIGA-ME, POR FAVOR, PARA CADA QUESTÃO SE ESTÁ MUITO SATISFEITA, BASTANTE SATISFEITA, NEM SATISFEITA NEM INSATISFEITA, BASTANTE INSATISFEITA OU MUITO INSATISFEITA. TAMBÉM PODE OLHAR PARA ESTAS IMAGENS PARA AUXILIÁ-LA NAS SUAS RESPOSTAS. Mostrar o lado 2 do cartão de resposta e explique o que cada símbolo representa. Circule a resposta mostrada pela entrevistada para perguntas LS3 a LS13. EM QUE MEDIDA ESTÁ SATISFEITA COM A SUA VIDA FAMILIAR? Muito satisfeita . 1 Bastante satisfeita . 2 Nem satisfeita, nem insatisfeita. 3 Bastante insatisfeita . 4 Muito insatisfeita . 5 LS4. EM QUE MEDIDA ESTÁ SATISFEITA COM OS SEUS AMIGOS OU SUAS AMIGAS? Muito satisfeita . 1 Bastante satisfeita . 2 Nem satisfeita, nem insatisfeita. 3 Bastante insatisfeita . 4 Muito insatisfeita . 5 LS5. DURANTE O PRESENTE ANO LECTIVO (2013-2014),TEM IDO À ESCOLA? Sim . 1 Não . 2 2LS7 LS6. EM QUE MEDIDA ESTÁ SATISFEITA COM A SUA ESCOLA? Muito satisfeita . 1 Bastante satisfeita . 2 Nem satisfeita, nem insatisfeita. 3 Bastante insatisfeita . 4 Muito insatisfeita . 5 LS7 EM QUE MEDIDA ESTÁ SATISFEITA COM O SEU TRABALHO ACTUAL? Não tem trabalho . 0 Muito satisfeita . 1 Bastante satisfeita . 2 Nem satisfeita, nem insatisfeita. 3 Bastante insatisfeita . 4 Muito insatisfeita . 5 Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 350 LS8. EM QUE MEDIDA ESTÁ SATISFEITA COM A SUA SAÚDE? Muito satisfeita . 1 Bastante satisfeita . 2 Nem satisfeita, nem insatisfeita. 3 Bastante insatisfeita . 4 Muito insatisfeita . 5 LS9. EM QUE MEDIDA ESTÁ SATISFEITA COM O LUGAR ONDE VIVE? Explique que a questão faz referência ao meio onde ele vive, principalmente ou bairro ou a comunidade. Muito satisfeita . 1 Bastante satisfeita . 2 Nem satisfeita, nem insatisfeita. 3 Bastante insatisfeita . 4 Muito insatisfeita . 5 LS10. EM QUE MEDIDA ESTÁ SATISFEITA COM A FORMA COMO AS PESSOAS A SUA VOLTA A TRATAM? Muito satisfeita . 1 Bastante satisfeita . 2 Nem satisfeita, nem insatisfeita. 3 Bastante insatisfeita . 4 Muito insatisfeita . 5 LS11. EM QUE MEDIDA ESTÁ SATISFEITA COM A SUA APARÊNCIA FÍSICA? Muito satisfeita . 1 Bastante satisfeita . 2 Nem satisfeita, nem insatisfeita. 3 Bastante insatisfeita . 4 Muito insatisfeita . 5 LS12. EM QUE MEDIDA ESTÁ SATISFEITA COM A SUA VIDA DE FORMA GERAL? Muito satisfeita . 1 Bastante satisfeita . 2 Nem satisfeita, nem insatisfeita. 3 Bastante insatisfeita . 4 Muito insatisfeita . 5 LS13. EM QUE MEDIDA ESTÁ SATISFEITA COM SEU RENDIMENTO ACTUAL? Se a entrevistada responder que não tem rendimento circule o código “0”e vá a questão seguinte. Não insista em saber como ela sente com relação ao facto que ela não tem rendimento, ao menos que ela o diga dela mesma. Não tem rendimento . 0 Muito satisfeita . 1 Bastante satisfeita . 2 Nem satisfeita, nem insatisfeita. 3 Bastante insatisfeita . 4 Muito insatisfeita . 5 LS14. COMPARADO COM O ANO PASSADO, NA MESMA ÉPOCA, DIRIA QUE, DE MANEIRA GERAL, A SUA VIDA MELHOROU, PERMANECEU MAIS OU MENOS A MESMA OU PIOROU? Melhorou . 1 Mais ou menos a mesma . 2 Piorou . 3 LS15. E DENTRO DE UM ANO A PARTIR DESTE MOMENTO, PENSA QUE DE MANEIRA GERAL A SUA VIDA SERÁ MELHOR, CONTINUARÁ NA MESMA OU SERÁ PIOR? Melhorará . 1 Continuará na mesma . 2 Piorará . 3 WM11. Registe a hora Horas e minutos . __ __ : __ __ Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 351 WM12. Confira a lista dos membros do agregado familiar, colunas HL7B e HL15: a entrevistada é a mãe ou a responsável que cuida de uma criança de 0-4 anos no agregado?  Sim  Completar o resultado deste Questionário MULHER na página de cobertura (WM7) e depois vá para o QUESTIONÁRIO CRIANÇA COM MENOS DE 5 ANOS para esta criança e comece a entrevista deste questionário com a respondente.  Não  Termine a entrevista com a entrevistada com este respondente e agradece-lhe pela sua cooperação e complete o resultado do Questionário MULHER na página de cobertura (WM7). Avisa a inquirida que faremos mais tarde os testes de sangue para avaliar o nível de anemia e de VIH/SIDA na população de São Tomé e Príncipe. Explica também que mais tarde será explicado mais em detalhes e será peddio o seu consentimento para cada teste. Observações do/a inquiridor/a Observações do/a controlador/a Observações do/a supervisor/a Fevereiro2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 352 Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 353 QUESTIONÁRIO INDIVIDUAL HOMEM São Tomé e Príncipe, MICS 5, 2014 PAINEL DE INFORMAÇÃO SOBRE O HOMEM MWM Este questionário deve ser administrado a todos os homens com idade entre 15 e 49 anos (veja a coluna HL7A da lista dos membros do agregado no Questionário Agregado familiar). Um questionário separado deve ser usado para cada homem elegível. MWM1. Número AE selecionada: ___ ___ ___ MWM2. Número do agregado familiar: ___ ___ MWM3. Nome do homem: ______________________ MWM4. Número de linha do homem: ___ ___ MWM5. Inquiridor/a (nome e número) : MWM6. Dia/mês/ano da entrevista : Nome ___________________________ No. ___ ___ ___ ___ /___ ___ / 2 0 1 ___ Se ainda não se apresentou, apresente-se ao entrevistado : NÓS FAZEMOS PARTE DO INSTITUTO NACIONAL DE ESTATÍSTICAS (INE). ESTAMOS A TRABALHAR PARA UM INQUÉRITO SOBRE A SAÚDE FAMILIAR E A EDUCAÇÃO. GOSTARIA DE FALAR CONSIGO SOBRE ESTES ASSUNTOS. A ENTREVISTA DURARÁ APROXIMADAMENTE 10 MINUTOS. TODAS INFORMAÇÕES RECOLHIDAS FICARÃO ESTRITAMENTE CONFIDENCIAIS E ANÔNIMAS. Se a apresentação a este entrevistado já foi feita durante o Questionário Agregado familiar, leia a seguinte frase: AGORA, GOSTARIA DE FALAR SOBRE A SUA SAÚDE E OUTROS ASSUNTOS. A ENTREVISTA DURARÁ APROXIMADAMENTE 10 MINUTOS. TODAS AS INFORMAÇÕES RECOLHIDAS FICARÃO ESTRITAMENTE CONFIDENCIAIS E ANÔNIMAS. POSSO COMEÇAR AGORA?  Sim, permissão concedida  Vá a MWM10 para registar a hora e começar a entrevista.  Não, permissão não concedida  Circule ‘03’ em WM7. Discuta este resultado com o seu chefe de equipa. Depois de ter prenchido completamente o Questionário individual Homen, preencha as seguintes informações: MWM7. Resultado do Questionário Homem: Preenchido.01 Ausente.02 Recusa.03 Parcialmente preenchido.04 Pessoa sem capacidade de responder.05 Outro (especificar) _____________________ 96 MWM8. Controlador/a (nome e número): Nome_____________________________ No. __ __ MWM9. Digitador/a (nome e número): Nome________________________ No. __ __ Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 354 MWM10. Registe a hora Hora e minutos: __ __ : __ __ CARACTERÍSTICAS DO HOMEM MWB MWB1. EM QUE MÊS E ANO NASCEU? Data de nascimento: Mês . __ __ NS mês . 98 Ano . __ __ __ __ NS ano . 9998 MWB2. QUAL É A SUA IDADE? Insista: QUE IDADE TINHA NO ÚLTIMO ANIVERSÁRIO? Compare e corrija MWB1 e/ou MWB2 se houver incoerências Idade (em anos completos) . __ __ MWB3. JÁ FREQUENTOU ALGUMA ESCOLA OU JARDIM DE INFÂNCIA/CRÊCHE? Sim . 1 Não . 2 2MWB7 MWB4. QUAL É O SEU NÍVEL ESCOLAR MAIS ALTO FREQUENTADO? Pré-escolar . 0 Básico . 1 Secundário . 2 Superior . 3 0MWB7 MWB5. QUAL É A ÚLTIMA CLASSE QUE CONCLUI NESTE NÍVEL? Se o 1º ano deste nível não foi concluído, regista “00”. Classe . __ __ MWB6. Verifique MWB4:  Secundário ou superior (MWB4 = 2 ou 3)  Vá ao próximo módulo  Básico (MWB4 = 1)  Continue com MWB7 MWB7. AGORA, GOSTARIA QUE ME LÊSSE ESTA FRASE. Mostrar a frase da carta para o entrevistado. Se o entrevistado não consegue ler a frase inteira, insista: PODE LER CERTAS PARTES DA FRASE? Não pode ler nada . 1 Pode ler certas partes . 2 Pode ler a frase inteira . 3 Não tem frase na língua do entrevistado (especificar a língua) . 4 Cego/mudo/problema de vista . 5 Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 355 ACESSO À MÍDIA E UTILIZAÇÃO DAS TECNOLOGIAS DE INFORMAÇÃO/COMUNICAÇÃO MMT MMT1. Verifique MWB7:  Questão deixada em branco (o entrevistado fez estudos secundários ou superiores)  Continue com MMT2.  É capaz de ler a frase inteira ou parcial na língua solicitada (WB7 = 2 ou 3) ou não se apresentou frase na língua do entrevistado (WB7 = 4)  Continue com MMT2  Não consegue ler nada ou é cego (WB7 =1 ou 5)  Vá à MMT3 MMT2. COM QUE FREQUÊNCIA LÊ UM JORNAL OU UMA REVISTA: QUASE TODOS OS DIAS, PELO MENOS UMA VEZ POR SEMANA, MENOS DE UMA VEZ POR SEMANA OU NUNCA LÊ? Quase todos os dias . 1 Pelo menos uma vez por semana . 2 Menos de uma vez por semana . 3 Nunca . 4 MMT3. COM QUE FREQUÊNCIA ESCUTA RÁDIO: QUASE TODOS OS DIAS, PELO MENOS UMA VEZ POR SEMANA, MENOS DE UMA VEZ POR SEMANA OU NUNCA ESCUTA? Quase todos os dias . 1 Pelo menos uma vez por semana . 2 Menos de uma vez por semana . 3 Nunca . 4 MMT4. COM QUE FREQUÊNCIA VÊ TELEVISÃO: QUASE TODOS OS DIAS, PELO MENOS UMA VEZ POR SEMANA, MENOS DE UMA VEZ POR SEMANA OU NUNCA VÊ? Quase todos os dias . 1 Pelo menos uma vez por semana . 2 Menos de uma vez por semana . 3 Nunca . 4 MMT5. Verifique MWB2: idade do entrevistado?  Idade 15-24 anos  Continue com MMT6  Idade 25-49 anos  Vá para módulo seguinte MMT6. JÁ UTILIZOU ALGUMA VEZ UM COMPUTADOR? Sim . 1 Não. 2 2MMT9 MMT7. NOS ÚLTIMOS 12 MESSES, UTILIZOU ALGUMA VEZ UM COMPUTADOR, INDEPENDENTEMENTE DO LOCAL? Sim . 1 Não. 2 2MMT9 MMT8. DURANTE O ÚLTIMO MÊS, QUANTAS VEZES USOU UM COMPUTADOR: QUASE TODOS OS DIAS, PELO MENOS UMA VEZ POR SEMANA, MENOS DE UMA VEZ POR SEMANA OU NUNCA USOU? Quase todos os dias . 1 Pelo menos uma vez por semana . 2 Menos de uma vez por semana . 3 Nunca . 4 MMT9. JÁ UTILIZOU A INTERNET ALGUMA VEZ? Sim . 1 Não. 2 2 Módulo seguinte MMT10. NOS ÚLTIMOS 12 MESSES, UTILIZOU A INTERNET ALGUMA VEZ? Se necessário, insista para saber a utilização da internet, independementemente do local ou aparelho usado. Sim . 1 Não. 2 2 Módulo seguinte MMT11. DURANTE O ÚLTIMO MÊS, COM QUE FREQUÊNCIA UTILIZOU A INTERNET: QUASE TODOS OS DIAS, PELO MENOS UMA VEZ POR SEMANA, MENOS DE UMA VEZ POR SEMANA OU NUNCA USOU? Quase todos os dias . 1 Pelo menos uma vez por semana . 2 Menos de uma vez por semana . 3 Nunca . 4 Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 356 FECUNDIDADE MCM MCM1. AGORA, GOSTARIA DE FAZER ALGUMAS PERGUNTAS SOBRE TODOS OS FILHOS NASCIDOS VIVOS DURANTE TODA A SUA VIDA. ESTOU INTERESSADO EM TODAS AS CRIANÇAS QUE SÃO SUAS BIOLOGICAMENTE, MESMO QUE LEGALMENTE NÃO SÃO SUAS OU QUE NÃO TÊM SEU SOBRENOME. JÁ TEVE FILHOS OU FILHAS? Sim . 1 Não. 2 NS . 8 2MCM8 8MCM8 MCM3. QUANTOS ANOS TEVE QUANDO NASCEU SEU PRIMEIRO FILHO OU FILHA? Anos completos . __ __ MCM4. ALGUM FILHO OU FILHA BIOLÓGICO/A SEU/SUA VIVE ACTUALMENTE CONSIGO? Sim . 1 Não. 2 2MCM6 MCM5.QUANTOS FILHOS BIOLÓGICOS SEUS VIVEM CONSIGO ? QUANTAS FILHAS BIOLÓGICAS SUAS VIVEM CONSIGO ? Se nenhum/a, registe ‘00’. Filhos biológicos em casa . __ __ Filhas biológicas em casa . __ __ MCM6. TEM ALGUM FILHO OU FILHA BIOLÓGICO/A SEU/SUA VIVO/A, MAS QUE NÃO VIVE ACTUALMENTE CONSIGO? Sim . 1 Não. 2 2MCM8 MCM7. QUANTOS FILHOS BIOLÓGICOS SEUS ESTÃO VIVOS MAS NÃO VIVEM CONSIGO ? QUANTAS FILHAS BIOLÓGICAS SUAS ESTÃO VIVAS MAS NÃO VIVEM CONSIGO ? Se nenhum/a, registe ‘00’. Filhos biológicos fora de casa . __ __ Filhas biológicas fora de casa . __ __ MCM8. TEVE ALGUM FILHO OU FILHA BIOLÓGICO/A SEU/SUA QUE NASCEU VIVO/A MAS QUE DEPOIS MORREU ? Se “não” insista em perguntar: QUERO DIZER UMA CRIANÇA QUE RESPIROU, CHOROU OU MOSTROU OUTROS SINAIS DE VIDA, MESMO QUE VIVEU SOMENTE POR ALGUNS MINUTOS OU ALGUMAS HORAS? Sim . 1 Não. 2 2MCM10 MCM9. QUANTOS FILHOS BIOLÓGICOS SEUS FALECERAM? QUANTAS FILHAS BIOLÓGICAS SUAS FALECERAM? Se nenhuma, registe ‘00’. Filhos biológicos falecidos . __ __ Filhas biológicas falecidas . __ __ MCM10. Some as respostas de MCM5, MCM7 e MCM9. Soma . __ __ MCM11. DEIXA VER SE COMPREENDI BEM: TEVE NO TOTAL (número total de MCM10) FILHOS/AS BIOLÓGICOS/AS DURANTE TODA SUA VIDA. ESTÁ CORRETO ?  Sim  Verifique abaixo:  Nenhum filho/a  Vá para o módulo seguinte  Um/a ou mais filho/a  Continue com MCM11A  Não  Verifique as respostas das questões MCM1-MCM10 e faça as correcções necessárias Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 357 MCM11A. TODAS AS CRIANÇAS QUE SÃO SEUS FILHOS OU SUAS FILHAS BIOLÓGICOS/AS TÊM A MESMA MÃE? Sim . 1 Não. 2 1MCM12 MCM11B. NO TOTAL, COM QUANTAS MULHERES TEVE FILHOS/AS ? Número de mulheres . ___ ___ MCM12. QUANDO NASCEU A ÚLTIMA DAS (número total em MCM10) CRIANÇAS DAS QUAIS É O PAI BIOLÓGICO (MESMO SE A CRIANÇA JÁ FALECEU)? O mês e o ano devem ser registados. Data de nascimento do último filho/a biológico/a: Mês . ___ ___ Ano . ___ ___ ___ ___ Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 358 ATITUDES EM RELAÇÃO À VIOLÊNCIA DOMÉSTICA MDV MDV1. AS VEZES, O MARIDO FICA CHATEADO OU COM RAIVA POR CAUSA DE ALGUMAS ACÇÕES DA SUA ESPOSA. NA SUA OPINIÃO, ISTO JUSTIFICA QUE O MARIDO BATA OU ESPANCA A MULHER EM ALGUMA DAS SEGUINTES SITUAÇÕES: [A] SE ELA SAI SEM O AVISAR ? [B] SE ELA NEGLIGENCIA AS CRIANÇAS? [C] SE ELA DISCUTE COM ELE ? [D] SE ELA RECUSAR A TER RELAÇÕES SEXUAIS? [E] SE ELA QUEIMA A COMIDA? [F] SE ELA O TRAI COM OUTRO HOMEM? Sim Não NS Sai sem o avisar . 1 2 8 Negligencia as crianças. 1 2 8 Se discute . 1 2 8 Recusa sexo . 1 2 8 Queima a comida . 1 2 8 Trai marido . 1 2 8 Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 359 CASAMENTO/UNIÃO DE FACTO MMA MMA1. ACTUALMENTE É CASADO OU VIVE COM UMA MULHER COMO SE FOSSEM CASADOS (UNIÃO DE FACTO)? Sim, actualmente casado . 1 Sim, vive com uma mulher . 2 Não, não vive em união . 3 3MMA5 MMA3. VIVE COM OUTRAS ESPOSAS OU VIVE COM OUTRAS MULHERES COMO SE ESTIVESSEM CASADOS? Sim (mais de uma esposa) . 1 Não (somente uma esposa) . 2 2MMA7 MMA4. COM QUANTAS ESPOSAS/MULHERES VIVE COMO SE ESTIVESSE CASADO ? Número . __ __ MMA8B MMA5. JÁ FOI CASADO OU JÁ VIVEU COM UMA MULHER COMO SE FOSSEM CASADOS (UNIÃO DE FACTO)? Sim, já foi casado . 1 Sim, já viveu com uma mulher . 2 Não . 3 3  Módulo seguinte MMA6. QUAL É A SUA SITUAÇÃO MATRIMONIAL ACTUAL: VIÚVO, DIVORCIADO OU SEPARADO? Viúvo . 1 Divorciado . 2 Separado . 3 MMA7. JÁ FOI CASADO OU JÁ VIVEU COM UMA MULHER, UMA VEZ OU MAIS DE UMA VEZ? Uma única vez . 1 Mais de uma vez . 2 1MMA8A 2MMA8B MMA8A EM QUE MÊS E ANO CASOU OU COMEÇOU A VIVER COM UMA MULHER COMO SE ESTIVESSEM CASADOS? MMA8B EM QUE ANO CASOU PELA PRIMEIRA VEZ OU COMEÇOU A VIVER PELA PRIMEIRA VEZ COM UMA MULHER COMO SE ESTIVESSEM CASADOS? Data do primeiro casamento: Mês . __ __ NS mês .98 Ano . __ __ __ __ NS ano .9998  Módulo seguinte MMA9. QUANTOS ANOS TINHA QUANDO COMEÇOU A VIVER COM A SUA PRIMEIRA ESPOSA/PARCEIRA? Idade em anos . __ __ Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 360 COMPORTEMENTO SEXUAL MSB Verifique que não há presença de outras pessoas. Antes de continuar a entrevista, faça o possível para estar em privado com o entrevistado. MSB1. AGORA, GOSTARIA DE LHE FAZER ALGUMAS PERGUNTAS SOBRE A SUA VIDA SEXUAL PARA MELHOR ENTENDER ALGUMAS QUESTÕES IMPORTANTES DA VIDA. AS INFORMAÇÕES QUE NOS FORNECERÁ SERÃO MANTIDAS EM ESTRITA CONFIDENCIALIDADE. QUANTOS ANOS TINHA QUANDO TEVE A SUA PRIMEIRA RELAÇÃO SEXUAL? Nunca teve relações sexuais .00 Idade em anos .__ __ Primeira vez quando começou a viver com 1ª esposa/parceira .95 00 Módulo seguinte MSB2. A PRIMEIRA VEZ QUE TEVE RELAÇÕES SEXUAIS, USOU UM PRESERVATIVO? Sim . 1 Não . 2 NS/não lembra . 8 MSB3. QUANDO TEVE RELAÇÕES SEXUAIS PELA ÚLTIMA VEZ? Registar a resposta em número de dias, semanas ou meses, se for menos de 12 meses. Se 12 meses (1 ano) ou mais, a resposta será registado em anos. Há … dias . 1 __ __ Há … semanas . 2 __ __ Há … meses . 3 __ __ Há … anos . 4 __ __ 4MSB15 MSB4. A ÚLTIMA VEZ QUE TEVE RELAÇÕES SEXUAIS, USOU UM PRESERVATIVO ? Sim . 1 Não . 2 MSB5. QUAL ERA O SEU RELACIONAMENTO COM A PESSOA COM QUEM TEVE A SUA ÚLTIMA RELAÇÃO SEXUAL? Insista para assegurar que a resposta se refere ao tipo de relacionamento no momento da relação sexual. Se é a 'namorada', pergunte: VIVIAM JUNTOS, COMO SE FOSSEM CASADOS? Se 'sim', circule '2'. Se 'não', circule '3'. Esposa…………….………….……. 1 Parceira de coabitação .2 Namorada ………………….…………………3 Encontro casual……………………….….….4 Prostituta………….…………………….……. 5 Outro (especificar) ____________________ 6 MSB8. TEVE RELAÇÕES SEXUAIS COM OUTRA PESSOA NOS ÚLTIMOS 12 MESES ? Sim . 1 Não . 2 2MSB15 MSB9. A ÚLTIMA VEZ QUE TEVE RELAÇÕES SEXUAIS COM ESTA OUTRA PESSOA, USOU UM PRESERVATIVO? Sim . 1 Não . 2 MSB10. QUAL ERA O SEU RELACIONAMENTO COM ESTA PESSOA? Certifique que a resposta se refere ao tipo de relacionamento no momento da relação sexual. Se a 'namorada', pergunte: VIVIAM COMO SE FOSSEM CASADOS? Se 'sim', circule '2'. Se 'não', circule '3'. Esposa . 1 Parceira de coabitação . 2 Namorada . 3 Encontro casual . 4 Prostituta . 5 Outro (especificar _____________________ 6 Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 361 MSB13 ALÉM DESTAS DUAS PESSOAS, TEVE RELAÇÕES SEXUAIS COM OUTRA(S) PESSOA(S) NOS ÚLTIMOS 12 MESES? Sim . 1 Não . 2 2MSB15 MSB14. NO TOTAL, COM QUANTAS PESSOAS DIFERENTES TEVE RELAÇÕES SEXUAIS NOS ÚLTIMOS 12 MESES? Número de pessoas. __ __ MSB15. NO TOTAL, COM QUANTAS PESSOAS DIFERENTES TEVE RELAÇÕES SEXUAIS DURANTE TODA A SUA VIDA? Em caso de resposta não numérica, insista para obter uma estimativa. Se o número de parceiros é igual a 95 ou mais, introduzir '95'. Número de pessoas durante a vida . __ __ NS .98 Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 362 VIH/SIDA MHA MHA1. AGORA, GOSTARIA DE FALAR SOBRE OUTRO ASSUNTO: JÁ OUVIU FALAR DE UMA DOENÇA CHAMADA SIDA? Sim . 1 Não . 2 2 Módulo seguinte MHA2. AS PESSOAS PODEM DIMINUIR O RISCO DE CONTRAIR O VÍRUS DO SIDA TENDO APENAS UMA PARCEIRA SEXUAL QUE NÃO ESTÁ INFECTADO E QUE TAMBÉM NÃO TEM NENHUM OUTRO PARCEIRO? Sim . 1 Não . 2 NS . 8 MHA3. AS PESSOAS PODEM CONTRAIR O VÍRUS DO SIDA POR FEITIÇARIAS OU OUTROS MEIOS SOBRENATURAIS? Sim . 1 Não . 2 NS . 8 MHA4. AS PESSOAS PODEM REDUZIR O RISCO DE CONTRAIR O VÍRUS DO SIDA UTILIZANDO UM PRESERVATIVO TODA VEZ QUE TEM RELAÇÕES SEXUAIS? Sim . 1 Não . 2 NS . 8 MHA5. AS PESSOAS PODEM CONTRAIR O VÍRUS DO SIDA POR PICADAS DE MOSQUITO? Sim . 1 Não . 2 NS . 8 MHA6. AS PESSOAS PODEM CONTRAIR O VÍRUS DO SIDA PARTILHANDO ALIMENTOS COM UMA PESSOA CONTAMINADA COM O SIDA? Sim . 1 Não . 2 NS . 8 MHA7. É POSSÍVEL QUE UMA PESSOA QUE APARENTA TER BOA SAÚDE TENHA O VÍRUS DO SIDA? Sim . 1 Não . 2 NS . 8 MHA8. O VÍRUS DO SIDA PODE SER TRANSMITIDO DA MÃE PARA O SEU BEBÉ: S N NS [A] DURANTE A GRAVIDEZ ? [B] DURANTE O PARTO ? [C] DURANTE O ALEITAMENTO ? Durante a gravidez. 1 2 8 Durante o parto . 1 2 8 Durante o aleitamento . 1 2 8 MHA9. NA SUA OPINIÃO, SE UMA PROFESSORA TEM O VÍRUS DO SIDA MAS NÃO ESTÁ DOENTE, DEVERIA SER AUTORIZADA A CONTINUAR A ENSINAR NA ESCOLA? Sim . 1 Não . 2 NS/não tem certeza/depende . 8 MHA10. COMPRARIA LEGUMES FRESCOS DE UM COMERCIANTE OU UM VENDEDOR SE SOUBESSE QUE ELE TEM O VÍRUS DO SIDA? Sim . 1 Não . 2 NS/não tem certeza/depende . 8 MHA11. SE UM MEMBRO DA SUA FAMÍLIA FOR INFECTADO PELO VÍRUS DO SIDA, GOSTARIA QUE O SEU ESTADO PERMANECESSE SEGREDO? Sim . 1 Não . 2 NS/não tem certeza/depende . 8 MHA12. SE UM MEMBRO DA SUA FAMÍLIA FOR INFECTADO PELO VÍRUS DO SIDA, ESTARIA PRONTO PARA DE CUIDAR DELE/A NA SUA PRÓPRIA CASA? Sim . 1 Não . 2 NS/não tem certeza/depende . 8 MHA24. NÃO QUERO SABER O RESULTADO, MAS JÁ FEZ ALGUMA VEZ O TESTE PARA SABER SE TEM O VÍRUS DO SIDA? Sim . 1 Não . 2 2MHA27 Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 363 MHA25. QUANDO FEZ O TESTE DO SIDA PELA ÚLTIMA VEZ? Há menos de 12 meses . 1 Há 12 – 23 meses . 2 Há 2 anos ou mais . 3 MHA26. NÃO QUERO SABER O RESULTADO, MAS OBTEVE O RESULTADO DO TESTE? Sim . 1 Não . 2 NS . 8 1 Módulo seguinte 2 Módulo seguinte 8 Módulo seguinte MHA27. CONHECE ALGUM LUGAR ONDE AS PESSOAS PODEM SE DIRIGIR PARA FAZER O TESTE DO SIDA? Sim . 1 Não . 2 Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 364 CIRCUNCISÃO MMC MMC1. ALGUNS HOMENS SÃO CIRCUNCIDADOS, QUER DIZER QUE SEU PREPÚCIO FOI COMPLETAMENTE REMOVIDO DA GLANDE. O SENHOR FOI CIRCUNCIDADO? Sim . 1 Não. 2 2 Módulo seguinte MMC2. QUANTOS ANOS TINHA QUANDO FOI CIRCUNCIDADO? Idade em anos completos . __ __ NS . 98 MMC3. QUEM FEZ A SUA CIRCUNCISÃO? Curandeiro/familiar/amigo . 1 Agente de saúde/profissional de saúde. 2 Outro (especificar) . 6 NS . 8 MMC4. ONDE FOI FEITO A CIRCUNCISÃO? Hospital/estrutura de saúde . 1 Casa do agente de saúde/profissional . 2 Circuncisão feita em casa . 3 Local de ritual . 4 Outro (especificar) . 6 NS . 8 Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 365 CONSUMO DE TABACO E DE ÁLCOOL MTA MTA1. JÁ EXPERIMENTOU FUMAR CIGARRO, MESMO QUE SÓ UM OU DOIS SOPROS? Sim . 1 Não . 2 2MTA6 MTA2. QUANTOS ANOS TINHA QUANDO FUMOU UM CIGARRO INTEIRO PELA PRIMEIRA VEZ? Nunca fumou um cigarro inteiro . 00 Idade . ___ ___ 00MTA6 MTA3. ACTUALMENTE FUMA CIGARROS? Sim . 1 Não . 2 2MTA6 MTA4. DURANTE AS ÚLTIMAS 24 HORAS, QUANTOS CIGARROS FUMOU ? Número de cigarros . ___ ___ MTA5. DURANTE O ÚLTIMO MÊS, POR QUANTOS DIAS FUMOU CIGARROS? Se menos de 10 dias, anote o número de dias. Se 10 dias ou mais, mas menos de um mês, círcule "10". Se "todos os dias" ou "quase todos os dias," círcule "30". Número de dias . 0 ___ 10 dias ou mais, mas menos de um mês . 10 Diáriamente/quase todos os dias . 30 MTA6. JÁ TENTOU FUMAR OUTROS PRODUTOS DE TABACO QUE NÃO SEJAM CIGARROS, TAIS COMO CHARUTOS, CACHIMBO, CIGARRILHAS? Sim . 1 Não . 2 2MTA10 MTA7. DURANTE O ÚLTIMO MÊS, CONSUMIU ALGUM DESSES PRODUTOS DE TABACO PARA FUMAR ? Sim . 1 Não . 2 2MTA10 MTA8. QUE TIPO DE PRODUTO DE TABACO PARA FUMAR CONSUMIU DURANTE O ÚLTIMO MÊS? Circule tudo que for mencionado. Charutos . A Cigarrilha . C Cachimbo . D Outros (especificar) . X MTA9. NO ÚLTIMO MÊS, DURANTE QUANTOS DIAS FEZ USO DE PRODUTOS DE TABACO PARA FUMAR? Se menos de 10 dias, anote o número de dias. Se 10 dias ou mais, mas menos de um mês, círcule "10". Se "todos os dias" ou "quase todos os dias," círcule "30". Número de dias . 0 ___ 10 dias ou mais, mas menos de um mês . 10 Diáriamente/quase todos os dias . 30 MTA10. JÁ USOU PRODUTOS DE TABACO QUE NÃO SE FUMAM, COMO TABACO A MASCAR OU TABACO PARA CHEIRAR (CANCAN)? Sim . 1 Não . 2 2 MTA14 MTA11. DURANTE O ÚLTIMO MÊS, CONSUMIU ALGUM PRODUTO DE TABACO QUE NÃO SE FUMA? Sim . 1 Não . 2 2 MTA14 MTA12. QUE TIPO DE PRODUTO DE TABACO QUE NÃO SE FUMA CONSUMIU DURANTE O ÚLTIMO MÊS? Circule tudo o que for mencionado Tabaco de mascar . A Tabaco de cheirar (cancan) . B Outro (especificar) . X Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 366 MTA13. DURANTE O ÚLTIMO MÊS, DURANTE QUANTOS DIAS FEZ USO DE PRODUTOS DE TABACO QUE NÃO SE FUMAM? Se menos de 10 dias, anote o número de dias. Se 10 dias ou mais, mas menos de um mês, círcule "10". Se "todos os dias" ou "quase todos os dias," círcule "30" Número de dias . 0 ___ 10 dias ou mais, masmenos que um mês . 10 Diáriamente/quase todos os dias . 30 MTA14. AGORA, GOSTARIA DE FAZER ALGUMAS PERGUNTAS SOBRE O CONSUMO DE ÁLCOOL. JÁ BEBEU BEBIDAS ALCOÓLICAS ALGUMA VEZ? Sim . 1 Não . 2 2Módulo seguinte MTA15. CONTAMOS COMO UMA DOSE DE ÁLCOOL UMA GARRAFA OU LATA DE CERVEJA, UM COPO DE VINHO, UMA DOSE DE COGNAC, VODKA, WHISKEY OU RHUM. QUANTOS ANOS TINHA QUANDO INGERIU ÁLCOOL PELA PRIMEIRA VEZ SENDO MAIS DO QUE SIMPLEMENTE ALGUNS GOLES? Nunca bebeu álcool .00 Idade . ___ ___ 00 Módulo seguinte MTA16. NO ÚLTIMO MÊS, DURANTE QUANTOS DIAS BEBEU PELO MENOS UMA DOSE DE ÁLCOOL? Se o entrevistado não ingere bebidas com álcool circule “00”. Se menos de 10 dias, anotar o número de dias. Se 10 dias ou mais, mais menos de um mês , circule “10”. Se “cada dia” ou “quase todos os dias”, circule “30” Não bebeu durante o mês passado.00 Número de dias . 0 ___ 10 dias ou mais, mas menos que um mês .10 Diáriamente/quase todos os dias .30 00 Módulo seguinte MTA17. DURANTE O MÊS PASSADO, NOS DIAS EM QUE BEBEU BEBIDAS ALCOÓLICAS, QUANTAS DOSES TOMOU? Número de doses. ___ ___ Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 367 SATISFAÇÃO NA VIDA MLS MLS1. Verifique WMB2: idade do entrevistado entre 15 e 24 ?  Idade 25- 49  Vá a MWM11  Idade 15- 24  Continue com MLS2 MLS2. AGORA, GOSTARIA DE FAZER ALGUMAS PERGUNTAS SIMPLES SOBRE FELICIDADE E A SATISFAÇÃO. PRIMEIRAMENTE, NESTE MOMENTO DIRIA QUE ESTÁ MUITO FELIZ, BASTANTE FELIZ, NEM FELIZ NEM INFELIZ, BASTANTE INFELIZ, MUITO INFELIZ ? PODE OLHAR TAMBÉM PARA ESTAS IMAGENS PARA AUXILIÁ-LO NA SUA RESPOSTA. Mostre o lado 1 da carta de respostas e explique o que representa cada símbolo. Circule a resposta mostrada pelo entrevistado. Muito feliz . 1 Bastante feliz . 2 Nem feliz, nem infeliz . 3 Bastante infeliz . 4 Muito infeliz . 5 MLS3. AGORA, GOSTARIA DE LHE FAZER ALGUMAS PERGUNTAS SOBRE O SEU NÍVEL DE SATISFAÇÃO EM VÁRIOS DOMÍNIOS. PARA CADA CASO, HÁ CINCO RESPOSTAS POSSÍVEIS: DIGA-ME, POR FAVOR, PARA CADA QUESTÃO SE ESTÁ MUITO SATISFEITO, BASTANTE SATISFEITO, NEM SATISFEITO NEM INSATISFEITO, BASTANTE INSATISFEITO OU MUITO INSATISFEITO. TAMBÉM PODE OLHAR PARA ESTAS IMAGENS PARA AUXILIÁ-LO NAS SUAS RESPOSTAS. Mostrar o lado 2 do cartão de respostas e explique o que cada símbolo representa. Circule a resposta mostrada pelo entrevistado para perguntas MLS3 para MLS13. EM QUE MEDIDA ESTÁ SATISFEITO COM A SUA VIDA FAMILIAR? Muito satisfeito . 1 Bastante satisfeito . 2 Nem satisfeito, nem insatisfeito . 3 Bastante insatisfeito . 4 Muito insatisfeito. 5 MLS4. EM QUE MEDIDA ESTÁ SATISFEITO COM SEUS AMIGOS? Muito satisfeito . 1 Bastante satisfeito . 2 Nem satisfeito, nem insatisfeito . 3 Bastante insatisfeito . 4 Muito insatisfeito. 5 MLS5. DURANTE O PRESENTE ANO LECTIVO (2013-2014), TEM IDO A ESCOLA ? Sim . 1 Não . 2 2MLS7 MLS6. EM QUE MEDIDA ESTÁ/ESTAVA SATISFEITO COM A SUA ESCOLA? Muito satisfeito . 1 Bastante satisfeito . 2 Nem satisfeito, nem insatisfeito . 3 Bastante insatisfeito . 4 Muito insatisfeito. 5 Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 368 MLS7. EM QUE MEDIDA ESTÁ SATISFEITO COM SEU TRABALHO ACTUAL? Não tem trabalho . 0 Muito satisfeito . 1 Bastante satisfeito . 2 Nem satisfeito, nem insatisfeito . 3 Bastante insatisfeito . 4 Muito insatisfeito. 5 MLS8 EM QUE MEDIDA ESTÁ SATISFEITO COM A SUA SAÚDE ? Muito satisfeito . 1 Bastante satisfeito . 2 Nem satisfeito, nem insatisfeito . 3 Bastante insatisfeito . 4 Muito insatisfeito. 5 MLS9. EM QUE MEDIDA ESTÁ SATISFEITO COM A LUGAR ONDE VIVE? Explique que a questão faz referência ao ambiente onde ele vive, principalmente o bairro e a comunidade. Muito satisfeito . 1 Bastante satisfeito . 2 Nem satisfeito, nem insatisfeito . 3 Bastante insatisfeito . 4 Muito insatisfeito. 5 MLS10. EM QUE MEDIDA ESTÁ SATISFEITO COM A FORMA COMO AS PESSOAS A SUA VOLTA O TRATAM? Muito satisfeito . 1 Bastante satisfeito . 2 Nem satisfeito, nem insatisfeito . 3 Bastante insatisfeito . 4 Muito insatisfeito. 5 MLS11. EM QUE MEDIDA ESTÁ SATISFEITO COM A SUA APARÊNCIA FÍSICA? Muito satisfeito . 1 Satisfeito . 2 Nem satisfeito, nem insatisfeito . 3 Insatisfeito . 4 Muito insatisfeito. 5 MLS12. EM QUE MEDIDA ESTÁ SATISFEITO COM A SUA VIDA DE FORMA GERAL? Muito satisfeito . 1 Satisfeito . 2 Nem satisfeito, nem insatisfeito . 3 Insatisfeito . 4 Muito insatisfeito. 5 MLS13. EM QUE MEDIDA ESTÁ SATISFEITO COM SEU RENDIMENTO ACTUAL? Se o entrevistado responder que não tem rendimento, circule o código “0” e vá a questão seguinte. Não insista em saber como ele sente com relação ao facto de não ter rendimento, ao menos que ele o diga ele mesmo. Não tem rendimento . 0 Muito satisfeito . 1 Satisfeito . 2 Nem satisfeito, nem insatisfeito . 3 Insatisfeito . 4 Muito insatisfeito. 5 MLS14. COMPARADO COM O ANO PASSADO, NA MESMA ÉPOCA, DIRIA QUE EM GERAL A SUA VIDA MELHOROU, PERMANECEU MAIS OU MENOS A MESMA OU PIOROU? Melhorou . 1 Continuou na mesma . 2 Piorou . 3 MLS15. DENTRO DE UM ANO, A PARTIR DESTE MOMENTO, PENSA QUE DE MANEIRA GERAL SUA VIDA SERÁ MELHOR, CONTINUARÁ NA MESMA OU SERÁ PIOR ? Melhorará . 1 Continuará na mesma . 2 Piorará . 3 Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 369 MWM11. Registe a hora Hora e minuto __ __ : __ __ MWM12. Verifique a lista dos membros do agregado, coluna HL9: o entrevistado é responsável por alguma criança de 0-4 anos que vive neste agregado ?  Sim  Completar o resultado deste Questionário Homen na página de cobertura (MWM7) e depois vá para o Questionário Crianças menores de 5 anos para esta criança e comece a entrevista com este entrevistado.  Não  Termine a entrevista com este entrevistado, agradeça por sua colaboração e complete o resultado do Questionário Homen na página de cobertura (MWM7). Avisa o inquirido que faremos mais tarde os testes de sangue para avaliar o nível de VIH/SIDA na população de São Tomé e Príncipe. Explica também que mais tarde será explicado mais em detalhes e será peddio o seu consentimento para cada teste. Observações do/a inquiridor/a Observações do/a controlador/a Observações do/a supervisor/a Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 370 QUESTIONÁRIO CRIANÇAS MENORES DE 5 ANOS SÃO TOMÉ E PRÍNCIPE, MICS 5, 2014 PAINEL DE INFORMAÇÃO SOBRE A CRIANÇA MENOR DE 5 ANOS DE IDADE UF Este questionário deve ser administrado a todas as mães ou responsáveis (veja coluna HL15 da lista de membros do agregado do Questionário Agregado familiar) que cuidam de crianças menores de 5 anos que vivem com eles/as (veja coluna HL7B da lista de membros do agregado familiar). Um questionário separado deve ser usado para cada criança elegível. UF1. Número AE selecionada: ___ ___ ___ UF2. Número do agregado familiar: ___ ___ UF3. Nome da criança: ______________________ UF4. Número de linha da criança: ___ ___ UF5. Nome da mãe/encarregado/a: _____________ UF6. No. de linha da mãe/encarregado/a: __ __ UF7. Inquiridor/a (nome e número) : UF8. Dia/mês/ano da entrevista: Nome ________________________ No. ___ ___ ___ ___ /___ ___ / 2 0 1 ___ Se ainda não se apresentou, apresente-se ao ou à entrevistado/a : NÓS FAZEMOS PARTE DO INSTITUTO NACIONAL DE ESTATÍSTICAS (INE). ESTAMOS A TRABALHAR PARA UM INQUÉRITO SOBRE A SAÚDE FAMILIAR E A EDUCAÇÃO. GOSTARIA DE FALAR CONSIGO SOBRE A SAÚDE E O BEM- ESTAR DE (nome da criança em UF3). A ENTREVISTA DURARÁ APROXIMADAMENTE 20 MINUTOS. TODAS INFORMAÇÕES QUE NOS FORNECER FICARÃO ESTRITAMENTE CONFIDENCIAIS E ANÔNIMAS. Se a apresentação já foi feita a este/a entrevistado/a durante o Questionário Agregado familiar, leia a seguinte frase: AGORA, GOSTARIA DE FALAR SOBRE A SAÚDE E O BEM- ESTAR DE (nome da criança em UF3). A ENTREVISTA DURARÁ APROXIMADAMENTE 20 MINUTOS. TODAS AS INFORMAÇÕES QUE FORNECER FICARÃO ESTRITAMENTE CONFIDENCIAIS E ANÔNIMAS. POSSO COMEÇAR A ENTREVISTA AGORA?  Sim, permissão concedida  Siga para UF12 para registar a hora e e comece a entrevista.  Não, permissão negada  Circule ‘03’ em UF9. Discuta esse resultado com seu chefe de equipa. Depois de ter preenchido completamente o Questionário Crianças menores de 5 anos, preencha as seguintes informações: UF9. Resultado da entrevista com a criança menor de 5 anos: Os códigos referem-se a mãe/encarregado/a da criança. Preenchido . 01 Ausente . 02 Recusa . 03 Parcialmente preenchido . 04 Pessoa sem capacidade de responder . 05 Outro (especificar ) _______________________ 96 UF10. Controlador/a (nome e número): Nome___________________________ No. __ __ UF11. Digitador/a (nome e número): Nome_________________________ No. ___ __ Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 371 UF12. Registe a hora. Hora e minutos __ __ : __ __ IDADE AG AG1. AGORA, GOSTARIA FAZER ALGUMAS PERGUNTAS SOBRE O DESENVOLVIMENTO E A SAÚDE DE (nome). EM QUE DIA, MÊS E ANO (nome) NASCEU? Insista: QUAL É A DATA DE NASCIMENTO DE (nome)? Se a mãe/encarregado/a da criança sabe a data de nascimento exacta, introduzir também o dia, caso contrário, círculo 98 para o dia. O mês e o ano devem ser registrados obrigatoriamente. Data de nascimento: Dia . __ __ Não sabe dia.98 Mês . __ __ Ano . 2 0 __ __ AG2. QUANTOS ANOS O/A (nome) TEM? Insista: QUANTOS ANOS (nome) TINHA NO SEU ÚLTIMO ANIVERSÁRIO? Marque a idade em anos completos. Marque ‘0’ se menor que 1 ano. Compare e corrija AG1 e/ou AG2 se houver inconsistência. Idade (em anos completos) . __ Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 372 REGISTO DE NASCIMENTO BR BR1. O/A (nome) TEM CÉDULA PESSOAL? Se sim, pergunte: POSSO VÊ-LA? Sim, vi . 1 Sim, não vi . 2 Não . 3 NS. 8 1Módulo seguinte 2Módulo seguinte BR2. O/A (nome) FOI REGISTADO/A NO REGISTO CIVIL? Sim . 1 Não . 2 NS. 8 1 Módulo seguinte BR3. SABE COMO FAZER PARA REGISTAR O NASCIMENTO DE (nome)? Sim . 1 Não . 2 Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 373 DESENVOLVIMENTO NA PRIMEIRA INFÂNCIA EC EC1. QUANTOS LIVROS INFANTIS OU LIVROS DE DESENHOS TEM PARA (nome)? Não inclui livros ou cadernos escolares. Nenhum . 00 Número de livros infantis . 0 __ Dez ou mais livros . 10 EC2. GOSTARIA DE SABER COM QUE OBJETOS O/A (nome) BRINCA QUANDO ELE/A ESTÁ EM CASA. ELE/A BRINCA COM: [A] BRINQUEDOS CASEIROS (TAIS COMO BONECAS, CARROS OU OUTROS BRINQUEDOS FEITOS EM CASA)? [B] BRINQUEDOS INDUSTRIALIZADOS COMPRADOS NA LOJA OU EM OUTRO LUGAR? [C] OBJECTOS DE CASA (TAIS COMO TIGELAS OU VASOS) OU OBJECTOS ENCONTRADOS NA RUA (TAIS COMO PAUS, PEDRAS, ANIMAIS, CONCHAS OU FOLHAS)? Se o/a entrevistado/a diz “sim” às categorias mencionadas acima, então insista para saber especificamente com o que a criança brinca para ter certeza. S N NS Brinquedos caseiros . 1 2 8 Brinquedos industrializados . 1 2 8 Objectos de casa ou da rua . 1 2 8 EC3. ÀS VEZES, OS ADULTOS QUE CUIDAM DAS CRIANÇAS TÊM QUE SAIR PARA FAZER COMPRAS, LAVAR ROUPA OU POR OUTRAS RAZÕES E TÊM QUE DEIXAR CRIANÇAS MENORES SOZINHAS. DURANTE A SEMANA PASSADA, POR QUANTOS DIAS (nome) FOI: [A] DEIXADO SOZINHO/A POR MAIS DE UMA HORA? [B] DEIXADO AOS CUIDADOS DE OUTRA CRIANÇA MENOR DE 10 ANOS DE IDADE POR MAIS DE UMA HORA? Se ‘nunca’ marque’ 0’. Se não sabe, marque’8’. Número de dias deixada sozinha por mais de uma hora . __ Número de dias deixada aos cuidados de outro menor por mais de uma hora . __ EC4. Verifique AG2: idade da criança?  Idade da criança 0, 1 ou 2 anos  Vá ao módulo seguinte  Idade da criança 3 ou 4 anos  Continue com EC5 EC5. O/A (nome) ESTÁ NUM PROGRAMA DE APRENDIZAGEM EDUCATIVO, TAL COMO NUM ESTABELECIMENTO DE ENSINO PÚBLICO OU PRIVADO, INLUINDO JARDIM DE INFÂNCIA OU CENTRO COMUNITÁRIO ? Sim . 1 Não . 2 NS . 8 Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 374 EC7. DURANTE OS ÚLTIMOS TRÊS DIAS, O/A SENHOR/A OU OUTRO MEMBRO DO AGREGADO COM 15 ANOS OU MAIS PARTICIPOU COM (nome) EM UMA DAS SEGUINTES ACTIVIDADES: Se sim, perguntar: QUEM PARTICIPOU NESTA ACTIVIDADE COM (nome)? Circule tudo que for mencionado. Mãe Pai Outro Nin- guém [A] LER LIVROS OU VER LIVROS ILUSTRADOS COM (nome)? Livros A B X Y [B] CONTAR HISTÓRIAS A (nome)? Histórias A B X Y [C] CANTAR CANÇÕES COM (nome) OU PARA (nome), INCLUSÍVE CANÇÕES DE EMBALAR? Cantar A B X Y [D] PASSEAR COM (nome) FORA DE CASA OU DO RECINTO DO QUINTAL? Passear fora de casa A B X Y [E] BRINCAR COM (nome)? Brincar A B X Y [F] NOMEAR, CONTAR OU DESENHAR COISAS COM (nome) OU PARA (nome)? Nomear/ contar/ desenhar A B X Y EC8. AGORA, GOSTARIA DE LHE FAZER ALGUMAS PERGUNTAS SOBRE A SAÚDE E DESENVOLVIMENTO DE (nome). AS CRIANÇAS NÃO SE DESENVOLVEM TODAS DA MESMA MANEIRA, NEM APRENDEM NA MESMA VELOCIDADE. CERTAS, POR EXEMPLO, COMEÇAM A CAMINHAR MAIS CEDO QUE OUTRAS. AS QUESTÕES QUE SEGUEM TRATAM DOS DIVERSOS ASPECTOS DO DESENVOLVIMENTO DA (S) SUA(S) CRIANÇA(S): O/A (nome) CONHECE OU PODE CITAR PELO MENOS DEZ LETRAS DO ALFABETO? Sim . 1 Não . 2 NS . 8 EC9. O/A (nome) CONSEGUE LER PELO MENOS QUATRO PALAVRAS SIMPLES, COMUNS? Sim . 1 Não . 2 NS . 8 EC10. O/A (nome) SABE O NOME E RECONHECE TODOS OS NÚMEROS DE 1 A 10? Sim . 1 Não . 2 NS . 8 EC11. O/A (nome) PODE APANHAR NO CHÃO UM PEQUENO OBJECTO COM DOIS DEDOS, COMO POR EXEMPLO UM PEDAÇO DE PAU OU UMA PEDRA? Sim . 1 Não . 2 NS . 8 EC12. O/A (nome) POR VEZES ESTÁ DEMASIADO DOENTE PARA BRINCAR? Sim . 1 Não . 2 NS . 8 EC13. O/A (nome) CONSEGUE SEGUIR ORIENTAÇÕES SIMPLES SOBRE COMO FAZER ALGO CORRECTAMENTE? Sim . 1 Não . 2 NS . 8 Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 375 EC14. QUANDO É DADO ALGO PARA FAZER A (nome), ELE/A É CAPAZ DE FAZE-LO INDEPENDENTEMENTE? Sim . 1 Não . 2 NS . 8 EC15 O/A (nome) DÁ-SE BEM COM OUTRAS CRIANÇAS? Sim . 1 Não . 2 NS . 8 EC16. O/A (nome) CHUTA, BATE OU MORDE OUTRAS CRIANÇAS OU ADULTOS? Sim . 1 Não . 2 NS . 8 EC17. O/A (nome) SE DISTRAI FACILMENTE? Sim . 1 Não . 2 NS . 8 Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 376 ALEITAMENTO MATERNO E ALIMENTAÇÃO BD BD1. Verifique AG2: idade da criança?  Idade da criança 0, 1 ou 2 anos  Continue com BD2  Idade da criança 3 ou 4 anos  Vá para o módulo TRATAMENTO DE DOENÇAS (CA) BD2. AMAMENTOU O/A (nome)? Sim . 1 Não. 2 NS . 8 2BD4 8BD4 BD3. AINDA AMAMENTA O/A (nome)? Sim . 1 Não. 2 NS . 8 BD4. ONTEM, DURANTE O DIA OU NOITE, O/A (nome) BEBEU ALGO NUM BIBERON? Sim . 1 Não. 2 NS . 8 BD5. ONTEM, DURANTE O DIA OU NOITE, O/A (nome) BEBEU ALGUMA SRO (SOLUÇÃO DE REHIDRATAÇÃO ORAL)? Sim . 1 Não. 2 NS . 8 BD6. ONTEM, DURANTE O DIA OU A NOITE, O/A (nome) TOMOU VITAMINAS, SUPLEMENTOS MINERAIS OU QUAISQUER MEDICAMENTOS? Sim . 1 Não. 2 NS . 8 BD7. AGORA, GOSTARIA DE FAZER PERGUNTAS SOBRE OS (OUTROS) LÍQUIDOS QUE O/A (nome) PODERIA TER TOMADO ONTEM DURANTE O DIA OU A NOITE. GOSTARIA DE SABER SE O/A (nome) RECEBEU ESTES LÍQUIDOS MESMO QUE COMBINADOS COM OUTROS ALIMENTOS. POR FAVOR, INCLUA TAMBÉM TODOS OS LÍQUIDOS CONSUMIDOS FORA DE CASA. ONTEM, DURANTE O DIA OU A NOITE DE, O/A (nome) BEBEU: S N NS [A] ÁGUA SIMPLES? Água 1 2 8 [B] SUMOS NATURAIS OU OUTRAS BEBIDAS A BASE DE FRUTOS (P.EX. ÁGUA DE CÔCO)? Sumos naturais 1 2 8 [C] CANJA (CALDOS OU SOPAS A BASE DE ÁGUA, SEM SER ENGROSSADO E SEM PEDAÇOS SÓLIDOS) Canja 1 2 8 [D] LEITE DE PACOTE, LEITE EM PÓ OU LEITE FRESCO DO ANIMAL? Leite 1 2 8 Se sim: QUANTAS VEZES (nome) BEBEU LEITE? Se 7 ou mais vezes, marque ‘7’. Se não sabe, marque ‘8’. Número de vezes que bebeu leite __ Se não sabe, marque ‘8’. [E] LEITE EM PÓ PARA BEBÉ (FORTIFICADO OU NÃO, MAS NÃO INCLUI FÓRMULAS A BASE DE SOJA)? Leite em pó para bebé 1 2 8 Se sim: QUANTAS VEZES (nome) BEBEU A PREPARAÇÃO PARA BEBÉ? Se 7 ou mais vezes, marque '7'. Se não sabe, marque ‘8’. Número de vezes que bebeu preparação __ [E1] CHÁ? Chá 1 2 8 [E2] CAFÉ? Café 1 2 8 [E3] VUMBADA? Vumbada 1 2 8 [F] QUAISQUER OUTROS LÍQUIDOS? (especificar)____________________________________________ Outros líquidos 1 2 8 Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 377 BD8. AGORA, GOSTARIA DE FAZER PERGUNTAS SOBRE OS (OUTROS) ALIMENTOS QUE O/A (nome) PODERIA TER INGERIDO ONTEM, DURANTE O DIA OU A NOITE. NOVAMENTE, GOSTARIA DE SABER SE O/A (nome) INGERIU ESTES ALIMENTOS MESMO COMBINADO COM OUTROS ALIMENTOS. POR FAVOR, INCLUA TAMBÉM TODOS ALIMENTOS INGERIDOS FORA DE CASA. ONTEM, DURANTE O DIA OU NOITE, O/A (nome) COMEU: S N NS [A] IOGURTE ? Iogurte 1 2 8 Se sim: QUANTAS VEZES (nome) BEBEU OU COMEU IOGURTE? Se 7 vezes ou mais, marque ‘7’. Se não sabe, marque ‘8’. Número de vezes que bebeu/comeu iogurte __ [B] QUALQUER ALIMENTO FORTIFICADO, TAL COMO CERELAC, NAN, NESTUM, ETC.? Cerelac, Nan, Nestum 1 2 8 [C] PÃO, ARROZ, MACARRÃO/ESPARGUETE, PAPA OU OUTROS ALIMENTOS A BASE DE GRÃOS? Alimentos feitos com grãos 1 2 8 [D] ABÓBORA, CENOURA, BATATA DOCE OU OUTROS LEGUMES DE COR AMARELA OU LARANJA POR DENTRO? Abobora, cenoura, etc. 1 2 8 [E] INHAME, MATABALA, MANDIOCA OU OUTROS ALIMENTOS FEITOS COM TUBÉRCULOS? Batata, inhame, mandioca, etc. 1 2 8 [F] QUALQUER LEGUME COM FOLHAS DE COR VERDE ESCURA (ALFACE, AGRIÃO, COUVE, REPOLHO, ETC.)? Couves, repolhos, alface, agrião 1 2 8 [G] MANGA MADURA, MAMÃO, PAPAIA, CAJAMANGA, SAPE-SAPE, JACA, ANANÁS/ABACAXÍ, ÚNTUE, GOIABA, PÊSSEGO? Manga, mamão, papaia, etc. 1 2 8 [H] OUTROS FRUTOS OU LEGUMES? (SAFÚ, BANANA, FRUTA-PÃO, CACAU, ABACATE, ETC.) Outros frutos ou legumes 1 2 8 [I] FIGADO, RIM, CORAÇÃO OU OUTRAS VÍSCERAS ? Figado, rim, coração, etc. . 1 2 8 [J] CARNE DE BOI/VACA, DE PORCO, DE CORDEIRO OU CABRITO, DE GALINHA OU PATO OU CARNE DE CAÇA? Carne de boi/vaca, porco, etc. 1 2 8 [K] OVOS? Ovos 1 2 8 [L] PEIXE FRESCO OU SECO/SALGADO/DEFUMADO OU FRUTOS DO MAR (P.EX. BÚZIOS DO MAR), OU ESTES PRODUTOS ENLATADOS? Peixe ou frutos do mar 1 2 8 [M] QUALQUER ALIMENTO A BASE DE FEIJÃO, LENTILHAS, ERVILHAS OU NOZES? Alimentos feitos com feijão, etc. 1 2 8 [N] QUEIJO OU OUTROS ALIMENTOS A BASE DE LEITE (NÃO INCLUI PRODUTOS A BASE DE SOJA)? Queijo, etc. 1 2 8 [N1] COMIDAS A BASE DE ÓLEA DE PALMA (P.EX. CALULÚ, PEIXE COM BANANA, PIRÃO, ETC.)? Comida a base de óleo de palma 1 2 8 [N2] BÚZIOS DO MATO, CARACÓIS, ETC.? Búzios do mato, caracóis 1 2 8 [O] QUALQUER OUTRO ALIMENTO SÓLIDO, SEMI-SÓLIDO OU MOLE QUE NÃO FOI MENCIONADO? (especificar)____________________________________ Outros alimentos não mencionados 1 2 8 BD9. Verifique BD8 (categorias “A” a “O”):  Pelo menos um “Sim” ou todos ”NS”  Vá para BD11  Senão  Continue com BD10 Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 378 BD10. Insista para determinar se a criança comeu alimentos sólidos, semi-sólidos ou moles ontem, durante o dia ou noite?  A criança não comeu nada ou a entrevistada não sabe responder  Vá para o módulo seguinte  A criança comeu pelo menos um alimento solido, semi-sólido ou mole conforme mencionado pelo entrevistado  Volte a BD8 para registar o alimento ingerido ontem [A - O]. Assim que terminar, continue com BD11. BD11. QUANTAS VEZES (nome) COMEU ALIMENTOS SÓLIDOS, SEMI- SÓLIDOS OU MOLES ONTEM, DURANTE O DIA OU A NOITE? Se 7 ou mais vezes, marque '7'. Número de vezes . __ NS . 8 Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 379 VACINAÇÃO IM Se existir um cartão de vacina disponível, copie as datas marcadas no cartão em IM3 para cada tipo de vacina e vitamina A. As perguntas de IM6-IM17 são feitas somente quando não existe um cartão disponível. IM1. EXISTE UM CARTÃO DE VACINAS ONDE ESTÃO REGISTADAS AS VACINAS DE (nome)? Se sim: POSSO VER O CARTÃO POR FAVOR? Sim, cartão visto . 1 Sim, cartão não visto . 2 Não tem cartão . 3 1IM3 2IM6 IM2. JÁ TEVEA ALGUMA VEZ UM CARTÃO DE VACINA PARA (nome) ? Sim . 1 Não . 2 1IM6 2IM6 IM3. (a) Copiar as datas para cada vacina a partir do cartão ou ficha. (b) Escreva ‘44’ na coluna ‘dia’ se o cartão indicar que a vacina foi feita mas que a data não foi marcada. Data da vacinação Dia Mês Ano BCG BCG PÓLIO 0 (AO NASCER) OPV0 PÓLIO 1 OPV1 PÓLIO 2 OPV2 PÓLIO 3 OPV3 PENTA 1 PENTA 1 PENTA 2 PENTA 2 PENTA 3 PENTA 3 PCV 1 PCV 1 PCV 2 PCV 2 PCV 3 PCV 3 SARAMPO SARAMPO FEBRE AMARELA FA VITAMINA A (PRIMEIRA DOSE) VITA1 VITAMINA A (SEGUNDA DOSE) VITA2 IM4. Verifique IM3: todas as vacinas (de BCG à febre amarela) foram registadas ?  Sim vá para IM19  Não Continue com IM5 IM5. ALÉM DESTAS VACINAS REGISTADAS NO CARTÃO, O/A (nome) RECEBEU OUTRAS VACINAS, INCLUINDO VACINAS DURANTE AS CAMPANHAS DE VACINAÇÃO?  Sim  Volte para IM3 e insista sobre o tipo de vacina e escreva ‘66’ na coluna correspondente à cada vacina mencionada. Quando terminar siga para IM19.  Não/NS  Siga para IM19. IM6. O/A (nome) JÁ RECEBEU ALGUMA VEZ VACINAS QUE EVITAM A CONTAMINAÇÃO DE DOENÇAS, INCLUINDO VACINAS RECEBIDAS DURANTE CAMPANHAS NACIONAIS DE VACINAÇÃO? Sim . 1 Não . 2 NS . 8 2IM19 8IM19 Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 380 IM7. O/A (nome) JÁ RECEBEU ALGUMA VEZ A VACINA DO BCG CONTRA A TUBERCULOSE, QUER DIZER UMA INJECÇÃO NO BRAÇO QUE GERALMENTE DEIXA UMA CICATRIZ? Sim . 1 Não . 2 NS . 8 IM8. O/A (nome) RECEBEU ALGUMA VEZ UMA VACINA EM FORMA DE GOTAS NA BOCA PARA PROTEGE-LO/LA CONTRA A PÓLIO? Sim . 1 Não . 2 NS . 8 2IM11A 8IM11A IM9. O/A (nome) RECEBEU A PRIMEIRA DOSE CONTRA A PÓLIO NAS DUAS PRIMEIRAS SEMANAS APÓS O NASCIMENTO? Sim . 1 Não . 2 IM10. QUANTAS VEZES O/A (nome) RECEBEU A VACINA CONTRA A PÓLIO? Número de vezes. IM11A. O/A (nome) RECEBEU ALGUMA VEZ A VACINA DO PENTA, QUER DIZER UMA INJECÇÃO NA COXA PARA EVITAR DE CONTRAIR O TÉTANO, A COQUELUCHE, A DIFTERIA, A HEPATITE B E A HAEMOPHILUS INFLUENZA DE TIPO B? Insista precisando que a vacina do Penta é administrada muitas vezes ao mesmo tempo que a da pólio. Sim. . 1 Não . 2 NS . 8 2IM13A 8IM13A IM12A. QUANTAS VEZES O/A (nome) RECEBEU A VACINA DO PENTA? Número de vezes. ___ IM13A. O/A (nome) JÁ RECEBEU ALGUMA VEZ A VACINA DE PCV, QUER DIZER UMA INJECÇÃO NA COXA ESQUERDA PARA EVITAR DE CONTRAIR PNEUMONIA? Insista precisando que a vacina de PCV é muitas vezes dada ao mesmo tempo que a do Penta. Sim . 1 Não . 2 NS . 8 2IM16 8IM16 IM14A. QUANTAS VEZES O/A (nome) RECEBEU A VACINA DO PCV? Número de vezes. ___ IM16. O/A (nome) JÁ RECEBEU ALGUMA VEZ A VACINA CONTRA SARAMPO, QUER DIZER UMA INJECÇÃO NO BRAÇO NA IDADE DE 9 MESES OU MAIS PARA EVITAR APANHAR O SARAMPO? Sim . 1 Não . 2 NS. .8 IM17. O/A (nome) JÁ RECEBEU ALGUMA VEZ A VACINA CONTRA A FEBRE AMARELA, QUER DIZER UMA INJECÇÃO NO BRAÇO NA IDADE DE 9 MESES OU MAIS PARA PREVENIR CONTRA FEBRE AMARELA? Insista precisando que a vacina contra a febre amarela é dada algumas vezes ao mesmo tempo que a vacina do sarampo. Sim. .1 Não . 2 NS . 8 IM19. O/A (nome) PARTICIPOU NUMA DAS SEGUINTES CAMPANHAS DE VACINAÇÃO E/OU JORNADAS DE VACINAÇÃO: [A] CAMPANHA CONTRA SARAMPO DO 23-27 DE JULHO 2012? S N NS Campanha sarampo 2012 1 2 8 Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 381 TRATAMENTO DE DOENÇAS CA CA1. O/A (nome) TEVE DIARRÉIA NAS ÚLTIMAS DUAS SEMANAS? Sim . 1 Não . 2 NS . 8 2CA6A 8CA6A CA2. GOSTARIA DE SABER A QUANTIDADE DE LÍQUIDOS QUE FOI DADA A (nome) PARA BEBER DURANTE O PERÍODO DE DIARRÉIA (INCLUINDO O LEITE MATERNO): DURANTE O PERÍODO EM QUE (nome) TEVE DIARRÉIA, FOI DADO A ELE/ELA PARA BEBER MENOS QUE O HABITUAL, A MESMA QUANTIDADE OU MAIS QUE O HABITUAL? Se ‘menos’, insista: FOI DADO A ELE/A MUITO MENOS OU UM POUCO MENOS A BEBER DO QUE HABITUALMENTE? Muito menos . 1 Pouco menos . 2 A mesma quantidade . 3 Mais. . 4 Não foi dado nada para beber . 5 NS . 8 CA3. DURANTE O PERÍODO QUE (nome) TEVE DIARRÉIA, FOI DADO A ELE/A PARA COMER MENOS, A MESMA QUANTIDADE OU MAIS QUE O HABITUAL, OU NÃO FOI DADO NADA PARA COMER? Se ‘menos’, insista: FOI DADO A ELE/A MUITO MENOS OU POUCO MENOS A COMER DO QUE HABITUALMENTE? Muito menos . 1 Pouco menos . 2 A mesma quantidade . 3 Mais. . 4 Parou a alimentação . 5 Nunca recebeu alimento . 6 NS . 8 CA3A. PROCUROU ACONSELHAMENTOS OU TRATAMENTO PARA DIARREIA? Sim . 1 Não . 2 NS . 8 2CA4 8CA4 CA3B. ONDE PROCUROU ACONSELHAMENTOS OU TRATAMENTO? Insista: ALGUM OUTRO LUGAR? Circule todos os lugares mencionados, mas NÃO sugira respostas. Insista para identificar cada tipo de lugar. Se não for possível identificar se o lugar pertence ao sector público ou privado, escreva o nome do lugar. (Nome do lugar) Sector público: Hospital central . A Centro de saúde . B Posto de saúde . C Agente de saúde comunitária . D Outro público (especificar). H Sector de saúde privado: Clínica privada . I Médico privado . J Farmácia privadas . K Outro privado (especificar) . O Outra fonte: Parente/amigo . P Lojas . Q Curandeiros . R Outro (especificar) . X CA4. DURANTE O PERÍODO QUE (nome) TEVE DIARRÉIA, FOI DADO A ELE/A PARA BEBER UM LÍQUIDO PREPARADO A PARTIR DE UM PACOTE ESPECIAL CHAMADO SORO ORAL (OU SORO DE REHIDRATAÇÃO ORAL, SRO)? Sim . 1 Não . 2 NS . 8 1CA4B 2CA4C 2CA4C Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 382 CA4B. ONDE ADQUIRIU O SRO? Insista para identificar o tipo de lugar. Se não for possível identificar se o lugar pertence ao sector público ou privado, escreva o nome do lugar. (Nome do lugar) Sector público: Hospital central . 11 Centro de saúde . 12 Posto de saúde . 13 Agente de saúde comunitária . 14 Outro público (especificar). 16 Sector privado: Clínica privada . 21 Médico privado . 22 Farmácia privada . 23 Outro privado (especificar) . 26 Outras fontes: Parente/amigo . 31 Lojas . 32 Curandeiro . 33 Já tinha em casa.40 Outro (especificar) . 96 CA4F. DURANTE O PERÍODO QUE (nome) TEVE DIARRÉIA, FOI DADO A ELE/A PARA BEBER ALGUM DOS SEGUINTES PRODUTOS: Leia cada item claramente para a entrevistada e marque a resposta antes de seguir a próxima questão. [A] SORO CASEIRO (ÁGUA COM SAL E AÇUCAR)? [B] ÁGUA DE ARROZ (ARROZ FERVIDO E ESCOADO)? S N NS Soro caseiro . 1 2 8 Água de arroz. 1 2 8 CA5. FOI DADO ALGO MAIS PARA TRATAR A DIARRÉIA? Sim . 1 Não . 2 NS . 8 2CA6A 8CA6A CA6. O QUE FOI DADO A MAIS PARA TRATAR A DIARRÉIA? Insista: ALGO MAIS? Registe todos os tratamentos dados. Escreva a marca de todos os medicamentos mencionados. _________________________________________ (Nome de todos medicamentos mencionados) Comprimido ou xarope: Antibiótico . A Antimotilico . B Outro (não antibióticos, antimotílicos) . G Comprimidos ou xarope desconhecidos . H Injecção: Antibiótico . L Não antibiótico . M Injecção desconhecida. N Intravenosa . O Remédio caseiro/ervas medicinais . Q Outro (especificar) . X CA6A. NAS ÚLTIMAS DUAS SEMANAS, O/A (nome) ESTEVE COM FEBRE EM ALGUM MOMENTO? Sim . 1 Não . 2 NS . 8 2CA7 8CA7 CA6B. DURANTE O PERÍODO QUE ESTEVE DOENTE, O/A (nome) TEVE UMA AMOSTRA DE SANGUE TIRADO DO SEU DEDO OU CALCANHAR PARA EFECTUAR UM TESTE? Sim . 1 Não . 2 NSP . 8 Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 383 CA7. NAS ÚLTIMAS DUAS SEMANAS, O/A (nome) ESTEVE DOENTE COM TOSSE? Sim . 1 Não . 2 NS . 8 2CA9A 8CA9A CA8. QUANDO O/A (nome) TEVE DOENTE COM TOSSE, RESPIROU MAIS RÁPIDO QUE O HABITUAL E COM A RESPIRAÇÃO CURTA E RÁPIDA, OU TEVE DIFICULDADES PARA RESPIRAR? Sim . 1 Não . 2 NS . 8 2CA10 8CA10 CA9. ESTAS DIFICULDADES RESPIRATÓRIAS FORAM DEVIDAS A UM PROBLEMA DENTRO DO PEITO, OU A UM NARIZ ENTUPIDO OU QUE ESCORRIA? Problemas dentro do peito . 1 Nariz entupido/obstruído . 2 Ambos . 3 Outro (especificar) ____________________ 6 NS . 8 1CA10 2CA10 3CA10 6CA10 8CA10 CA9A. Verifique CA6A : teve febre?  A criança teve febre  Continue com CA10  A criança não teve febre  Vá para CA14 CA10. BUSCOU ACONSELHAMENTOS OU TRATAMENTO PARA A DOENÇA EM ALGUM LUGAR? Sim . 1 Não . 2 NS . 8 2CA12 8CA12 CA11. ONDE BUSCOU ACONSELHAMENTOS OU TRATAMENTO? Insista: ALGUM LUGAR MAIS? Circule todos lugares mencionados, mas NÃO sugere as respostas. Insista para identificar cada tipo de lugar. Se não for possível identificar se o lugar pertence ao sector público ou privado, escreva o nome do lugar. (Nome do lugar) Sector público: Hospital central . A Centro de saúde . B Posto de saúde . C Agente de saúde comunitária . D Outro público (especificar). H Sector privado: Clínica privada . I Médico privado . J Farmácia privada . K Outro privado (especificar) . O Outras fontes: Parente/amigo . P Lojas . Q Curandeiro . R Outro (especificar) ___________________ X CA12. EM ALGUM MOMENTO DURANTE O PERÍODO EM QUE ESTEVE DOENTE, O/A (nome) RECEBEU ALGUM MEDICAMENTO PARA TRATAR ESTA DOENÇA? Sim . 1 Não . 2 NS . 8 2CA14 8CA14 Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 384 CA13. QUE MEDICAMENTO FOI DADO A (nome)? Insista: ALGUM OUTRO MEDICAMENTO? Marque todos os medicamentos recebidos. Escreva o nome da marca de todos os medicamentos mencionados. _________________________________________ (Nomes de todos medicamentos mencionados) Anti-palúdicos: SP/Fansidar (Sulfadoxina + Perimela) . A Artesunate Amodiaquina . C Quinino . D Coartem (Artemether/Lumefantrine) . E Outro antipalúdico (especificar) _______ H Antibióticos: Comprimidos/xaropes . I Injecção . J Outro antibiótico (especificar) _________ K Desparasitantes: Mebendazol . L Albendazol . M Metronidazol . N Zentel . O Outros medicamentos: Paracetamol/Panadol/Acetaminophen . P Aspirina . Q Ibuprofeno . R Outro (especificar) . X NS . Z CA13A. Verifique CA13 : antibiótico mencionado (códigos I a K)?  Sim  Continue com CA13B  Não  Vá para CA13C CA13B. ONDE CONSEGUIU (nome do remédio de CA13)? Insista para identificar o tipo de lugar. Se não for possivel identificar se o lugar pertence ao setor público ou privado, escreva o nome do lugar. (Nome do lugar) Sector público: Hospital central . 11 Centro de saúde . 12 Posto de saúde . 13 Agente de saúde comunitária . 14 Outro público (especificar) . 16 Sector privado: Clínica privada . 21 Médico privado . 22 Farmácia privada . 23 Outro privado (especificar) . 26 Outras fontes: Parente/amigo . 31 Lojas. . 32 Curandeiro . 33 Já tinha em casa . 40 Outro (especificar) . 96 CA13C. Verifique CA13 : antipalúdicos mencionados (códigos A à H)?  Sim  Continue com CA13D  Não  Vá para CA14 Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 385 CA13D. ONDE CONSEGUIU (nome do remédio de CA13)? Insista para identificar o tipo de lugar. Se não for possível identificar se o lugar pertence ao sector público ou privado, escreva o nome do lugar. (Nome do lugar) Sector público: Hospital central . 11 Centro de saúde . 12 Posto de saúde . 13 Agente de saúde comunitária . 14 Outro público (especificar) . 16 Sector privado: Clínica privada . 21 Médico privado . 22 Farmácia privada . 23 Outro privado (especificar) . 26 Outras fontes: Parente/amigo . 31 Lojas. . 32 Curandeiro . 33 Já tinha em casa . 40 Outro (especificar) . 96 CA13E. QUANTO TEMPO DEPOIS DE TER COMEÇADO A FEBRE DE (nome), ELE/A TOMOU PELA PRIMEIRA VEZ (nome do antipalúdico declarado em CA13)? Se mais de um antipalúdico foi mencionado em CA13, nomeie todos os medicamentos antipalúdicos mencionados e anote o tempo em que foi tomado o primeiro medicamento. No mesmo dia . 0 No dia seguinte . 1 2 dias depois do início da febre . 2 3 dias depois do início da febre . 3 4 ou mais dias depois do inicio da febre . 4 NS . 8 CA14. Verifique AG2 : idade da criança?  Criança com idade de 0, 1 ou 2 anos  Continue com CA15  Criança com idade de 3 ou 4 anos  Vá a UF13 CA15. A ÚLTIMA VEZ QUE (nome) DEFECOU, O QUE FOI FEITO PARA SE DESFAZER DOS EXCREMENTOS? Criança utilizou casa de banho/latrinas . 01 Jogado/lavado na casa de banho/latrina . 02 Jogado/lavado no esgoto/vala . 03 Jogado no lixo (resíduos sólidos) . 04 Enterrado . 05 Deixado ao ar livre. 06 Outro (especificar) . 96 NS . 98 UF13. Registe a hora. Hora e minutos . __ __ : __ __ Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 386 UF14. VERIFIQUE COLUNAS HL7B E H15 DA LISTA DOS MEMBROS DO AGREGADO NO QUESTIONÁRIO AGREGADO FAMILIAR: A ENTREVISTADA É A MÃE OU A encarregado/a DE UMA OUTRA CRIANÇA COM IDADE DE 0-4 ANOS QUE VIVE NESTE AGREGADO?  Sim  Diga a entrevistada que irá medir o peso e a altura da criança mais tarde. Vá para o próximo Questionário Crianças menores de 5 anos que deve ser administrado a mesma entrevistada.  Não  Terminar a entrevista agradecendo o/a entrevistado/a pela sua colaboração e lhe diga que vai agora medir o peso e a altura da criança antes de se ir embora do agregado. Verifique se existe uma outra mulher, outro homem ou uma outra criança de menos de 5 anos a quem deve ser administrado um questionário neste agregado. Avisa a inquirida que faremos mais tarde os testes de sangue de todas as crianças menores de 5 anos do agregado familiar para avaliar o nível de anemia e de paludismo na população de São Tomé e Príncipe. Explica também que mais tarde será explicado mais em detalhes e será peddio o seu consentimento para cada teste. Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 387 ANTROPOMETRIA AN Depois que o questionário foi preenchido para todas as crianças do agregado familiar, o técnico responsável pela medição deve medir e pesar todas as crianças do agregado, tomando o cuidado de marcar as medidas antromoétricas no bom questionário para cada criança. Verificar o nome e o número de linha da criança na na lista dos membros do agregado familiar antes de registar as medidas antropométricas. AN1. Nome e código do técnico : Nome ___ ___ AN2. Resultado da medição do tamanho em posição em pé/deitado e do peso. Uma ou as duas medidas . 1 Criança não está presente . 2 Criança ou a mãe/ encarregado/a negou . 3 Outro (especificar) . 6 2AN6 3AN6 6AN6 AN3. Peso da criança: Quilogramas (kg) . __ __ , __ Peso não medido . 99,9 AN3A. A criança foi despida ao mínimo? Sim . 1 Não . 2 AN3B. Verifique a idade da criança em AG2:  A criança tem menos de 2 anos  Medir o comprimento (a criança deve estar deitada).  Criança tem 2 anos e mais  Medir a altura (a criança deve estar em pé). AN4.Comprimento ou altura da criança: Comprimento/altura (cm) . __ __ __ __ Comprimento/altura não medidas.999,9  AN6 AN4A. A criança foi medida deitada ou em pé? Deitada . 1 Em pé . 2 AN6. Existe outra criança no agregado eligível para as medições antropométricas ?  Sim  Registe as medidas para a criança seguinte.  Não  Verifique se existe algum outro questionário individual a ser administrado neste agregado. Fevereiro 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 388 Observações do/a inquiridor/a Observações do/a controlador/a Observações do/a supervisor/a Observações do/a medidor/a Sao Tome and Principe 2014 MICS, Final Report P a g e | 389 Sao Tome and Principe 2014 MICS, Final Report P a g e | 390 Sao Tome and Principe 2014 MICS, Final Report P a g e | 391 Sao Tome and Principe 2014 MICS, Final Report P a g e | 392 Sao Tome and Principe 2014 MICS, Final Report P a g e | 393 Sao Tome and Principe 2014 MICS, Final Report P a g e | 394 Sao Tome and Principe 2014 MICS, Final Report P a g e | 395 Sao Tome and Principe 2014 MICS, Final Report P a g e | 396 Sao Tome and Principe 2014 MICS, Final Report P a g e | 397 Sao Tome and Principe 2014 MICS, Final Report P a g e | 398 Sao Tome and Principe 2014 MICS, Final Report P a g e | 399 Março 2014 Sao Tome and Principe 2014 MICS, Final Report P a g e | 400

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