Sierra Leone - Multiple Indicator Cluster Survey - 2017

Publication date: 2017

Snapshots of Key findings 2 Table of Contents Sample and survey characteristics……………………………. Mass Media Communication and internet……………………… Child Mortality………………………………………………………………. Fertility and Family Planning……………………………………. Adolescents…………………………………………………………………. HIV and Sexual Behaviour………………………………………………………………………………………………………. Child Health and Care of Illness……………………………………. Infant and Young Child Feeding (IYCF)…………………………… Nutritional Status of Children………………………………………… Early childhood Development (ECD)………………………………. Education……………………………………………………………………. Early Grade Learning and Parental Involvement……………. Birth Registration…………………………………………………………. Child Discipline….………………………………. Child Labour……………………………………………………………. Early Marriage ……………………………………………………………… Female Genital Mutilation/Cutting (FGM/C)…………………… Child Functioning…………………………………………………………. Drinking water, Sanitation and Hygiene –WASH……………. Gender Equality …………………………………………………………. 4 8 13 15 18 23 27 30 32 34 36 40 43 45 47 49 51 53 55 61 3 Sierra Leone 2017 Sample and Survey Characteristics Household 15,309 15,364 15,605 Interviewed Sampled 99.6 Survey Implementation Implementing Agency: Statistics Sierra Leone Sampling Frame: 2015 Sierra Leone Population and Housing Census Updated: 2016 Interviewer training: April – May 2017 Fieldwork: May - August 2017 Questionnaires: Household Women age 15-49 Men age 15-49 Children under 5 Children age 5-17 Water Quality Testing Verbal Autopsy Women age 15-49 17,873 18,006 Interviewed Eligible for interview 99. 3 Men age 15-49 7,415 7,534 Interviewed Eligible for interview 98. 4 Children under 5 11,764 11,774Eligible for interview Mothers/Caretakers interviewed 99. 9 Children age 5-17 11,033 11,046 Eligible for interview Mothers/Caretakers interviewed 99. 9 Response Rates 4 Household & Population Characteristics Age & sex distribution of household population Household composition & characteristics of head of household 31 69 23 11 10 56 52 71 83 79 70 0 0 20 40 60 80 100 Female Male Senior Secondary/Higher Junior Secondary Primary Pre-primary or none At least one child <5 years At least one child 5-17 years At least one child <18 years At least one woman 15-49 years At least one man 15-49 years No one 18+ years Percent 10 8 6 4 2 0 2 4 6 8 10 0-4 10-14 20-24 30-34 40-44 50-54 60-64 70-74 80-84 Percent Age Males Females 5 2 34 4 1 3 59 22 19 13 46 2 49 2 0 0 47 37 21 13 30 100 80 60 40 20 0 20 40 60 Has health insurance Never married/not in union Separated Divorced Widowed Currently married/in-union Senior Secondary or higher Junior Secondary Primary Pre-primary or none Percent Female Male Regional and district distribution of population Region /District Households Women Men Children <5 years Children 5-17 Eastern Province 22 22 23 23 23 Kailahun 7 6 6 7 6 Kenema 9 10 10 9 10 Kono 7 6 7 7 7 Northern Province 33 32 30 37 35 Bombali 8 8 9 8 8 Kambia 4 5 4 5 5 Koinadugu 4 5 5 7 5 Port Loko 9 8 8 9 9 Tonkolili 7 6 5 8 7 Southern Province 20 19 18 21 20 Bo 8 8 7 8 9 Bonthe 3 3 3 3 3 Moyamba 5 4 4 5 4 Pujehun 4 4 4 5 4 Western Area 25 27 29 20 21 Western Area Rural 7 8 8 8 7 Western Area Urban 18 19 21 12 14 Women & men’s profile 6 Children’s profile 2 20 19 19 21 22 13 10 11 66 4 16 17 21 22 24 12 14 13 60 100 80 60 40 20 0 20 40 60 80 100 Has health insurance Richest Fourth Middle Second Poorest Senior Secondary or higher Junior Secondary Primary Pre-primary or none Percent Children 5-17 Children under-five M o th e r’ s / c a re g iv e r’ s Children’s living arrangements* 0 6 11 25 46 0 10 20 30 40 50 60 No data Lives with father only Lives with mother only Lives with neither biological parent Lives with both parents Percent *Children 0-17 years 7 Percentage of women age 15-49 years who are exposed to specific mass media (newspaper, radio, television) on a weekly basis and percentage of women age 15-49 who are exposed to all three on a weekly basis Newspaper Exposure to Mass Media Women Sierra Leone 2017 Mass Media, Communications & Internet 11 4 Men 58 32 29 24 7 3 Women Men Women Men Women Men Radio Television All Three Inequalities in Access to Mass Media Men with Access to Radio, Newspapers & Television Weekly Percentage of women age 15-49 years who are exposed to newspaper, radio, and television on a weekly basis Women with Access to Newspaper, Radio & Television Weekly Rural, 0 Pre-primary/none, Poorest, 0 Urban, 5 Senior Secondary or Higher, 11 Richest, 10 0 5 10 15 20 Area Education Wealth Quintile P e rc e n t Natio… Percentage of women age 15-49 years who are exposed to newspaper, radio, and television on a weekly basis Key Messages • Mobile Telephones were owned by 71 percent of households, followed by Radios (55% of households), Television (18% of households), Internet at home (14% of households), Computers (6% of households), and Fixed-Line Telephones (1% of households). Rural, 1 Pre-primary/none, Poorest, 0 Urban, 14 Senior Secondary or higher, 18 Richest, 20 0 5 10 15 20 25 Area Education Wealth Quintile P e rc e n t Natio… 8 Key Messages Household Ownership of a Radio Rural, 45 Poorest, 23 Urban, 67 Richest, 76 0 20 40 60 80 100 Area Wealth Quintile P e rc e n t Nati… Percentage of households with a computer at home Household Ownership of a Mobile Telephone Rural, 53 Poorest, 30 Urban, 94 Richest, 99 0 20 40 60 80 100 Area Wealth Quintile P e rc e n t Natio… Percentage of households with mobile telephone Households with Internet Rural, 4 Poorest, 0 Urban, 26 Richest, 40 0 10 20 30 40 50 60 Area Wealth Quintile P e rc e n t Nati… Percentage of households with access to the internet at home Household Ownership of Information & Communication Technology (ICT) Equipment & Internet at Home Region Radio Television Telephone- Fixed line Telephone- Mobile Computer Internet at Home National 55 18 1 71 6 14 Eastern Province 53 7 1 64 3 11 Kailahun 47 0 1 59 1 7 Kenema 57 14 1 66 4 15 Kono 52 5 0 67 2 9 Northern Province 49 8 0 63 3 10 Bombali 48 17 1 66 5 9 Kambia 51 1 0 71 1 11 Koinadugu 48 1 0 57 1 7 Port Loko 58 11 0 70 5 15 Tonkolili 38 1 0 48 1 3 Southern Province 53 7 0 63 3 7 Bo 55 15 1 65 3 9 Bonthe 55 3 0 69 2 4 Moyamba 57 2 1 60 2 6 Pujehun 44 0 0 59 3 6 Western Area 66 50 2 95 14 27 Western Area Rural 66 14 0 92 8 25 Western Area Urban 65 65 2 97 16 28 Percentage of households which own a radio, television-fixed line, telephone- mobile, computer and that have access to the internet at home Household Ownership of a Computer Rural, 1 Poorest, 0 Urban, 12 Richest, 23 0 5 10 15 20 25 30 Area Wealth Quintile P e rc e n t Natio… Percentage of households with a computer at home Inequalities in Household Ownership of ICT Equipment & Internet at Home 9 Use of Information & Communication Technology Computer Use Women 7 3 Men 47 61 11 8 Women Men Women Men Mobile Phone Use Internet Use: SDG17.8.1 Percentage of women and men age 15-49 years who during the last 3 months used a computer, used a mobile phone and used the internet Disparities in Mobile Phone Use among Women Percentage of men age 15-49 years who during the last 3 months used a mobile phone Rural, 42 Pre- primary/None, 48 Poorest, 32 Urban, 81 Senior Secondary or Higher, 89 Richest, 87 0 20 40 60 80 100 Area Education Wealth Quintile P e rc e n t Natio… Percentage of women age 15-49 years who during the last 3 months used a mobile phone Disparities in Mobile Phone Use among Men Disparities in Internet Use among Women: SDG17.8.1 Rural, 4 Pre- primary/None, 2 Poorest, 1 Urban, 17 Senior Secondary or Higher, 20 Richest, 23 0 5 10 15 20 25 30 Area Education Wealth Quintile P e rc e n t Natio… Percentage of men age 15-49 years who used the internet in the last 3 months Rural, 1 Pre- primary/None, 0 Poorest, 0 Urban, 14 Senior Secondary or Higher, 29 Richest, 23 0 5 10 15 20 25 30 35 40 Area Education Wealth Quintile P e rc e n t Natio… Percentage of women age 15-49 years who used the internet in the last 3 months Disparities in Internet Use among Men: SDG17.8.1 Disparities in Use of Information & Communication Technology Urban, 23 Senior Secondary or Higher, 22 Richest, 14 Rural, 74 Pre- primary/None, 68 Poorest, 89 0 20 40 60 80 100 Area Education Wealth Quintile P e rc e n t Natio… 10 Regional Data on ICT Use & Skills Region Computer Use Mobile Phone Use Internet Use Performed at Least 1 ICT activity National 3 61 8 2 Eastern Province 1 54 5 1 Kailahun 0 43 1 0 Kenema 2 61 9 2 Kono 0 53 5 0 Northern Province 1 49 3 1 Bombali 2 60 4 2 Kambia 0 39 2 0 Koinadugu 1 32 2 1 Port Loko 2 57 6 2 Tonkolili 0 46 1 0 Southern Province 1 61 4 1 Bo 1 62 4 1 Bonthe 0 54 2 0 Moyamba 1 64 4 0 Pujehun 2 58 4 1 Western Area 7 83 17 6 Western Area Rural 3 81 12 2 Western Area Urban 9 84 19 8 Percentage of women aged 15-49 years who during the last 3 months used a computer, used a mobile phone and used the internet and percentage who performed at least 1 computer- related activity Information & Communication Technology (ICT) Skills 6 5 5 3 4 4 2 6 1 7 2 2 2 1 1 1 1 1 0 2 10 8 6 4 2 0 2 4 6 8 10 Copied or moved a file/folder Used copy & paste duplicate or move information in document Sent e-mail with a file (e.g. document, picture or video) Used a basic arithmetic formula in a spreadsheet Connected & installed a new device, such as a modem, camera or printer Found, downloaded, installed & configured software Created an electronic presentation with presentation software, including text,… Transfered a file between a computer and other device Wrote a computer program in any programming language At least one of the 9 activities Percent Men Women Percentage of women and men age 15-49 years who in the last 3 months have carried out specific computer related activities and the percentage who have carried out at least one of these activities Specific Computer Skills 11 Regional Data on ICT Use & Skills Percentage of men aged 15-49 years who during the last 3 months used a computer, used a mobile phone and used the internet and percentage who performed at least 1 computer-related activity Region Computer Use Mobile Phone Use Internet Use Performed at Least 1 ICT activity National 7 47 11 7 Eastern Province 3 57 6 3 Kailahun 1 67 7 1 Kenema 6 49 9 6 Kono 1 60 3 1 Northern Province 4 59 8 3 Bombali 6 55 9 6 Kambia 2 35 5 2 Koinadugu 1 79 6 1 Port Loko 5 53 14 5 Tonkolili 0 74 2 0 Southern Province 6 68 8 5 Bo 9 62 10 9 Bonthe 5 72 7 5 Moyamba 2 70 6 2 Pujehun 3 73 5 3 Western Area 14 15 19 14 Western Area Rural 6 27 7 6 Western Area Urban 17 11 23 17 12 Mortality Rates among Children Under-5 Neonatal mortality (NN): probability of dying within the first month of life Post-neonatal mortality: calculated as 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-5 mortality (5q0): the probability of dying between birth and the fifth birthday Sierra Leone 2017 Child Mortality Years Prior to the Survey Neonatal mortality rate: SDG 3.2.2 Post-neonatal mortality rate Infant mortality rate Child mortality rate Under-5 mortality rate: SDG 3.2.1 0-4 20 36 56 40 94 5-9 25 46 71 47 114 10-14 23 57 80 47 123 123 114 94 80 71 56 23 25 20 10 30 50 70 90 110 130 150 10-14 5-9 0-4 D e a th s p e r 1 0 0 0 l iv e b ir th s Years preceding the survey Under-5 mortality rate Infant mortality rate Neonatal mortality rate 13 Neonatal & Under-5 Mortality Rates by Region Under-5 Mortality Rate by Socio-economic Characteristics & Area Child Mortality Disparities Under-5 Mortality Rate by Demographic Risk Factors Rural, 92 Poorest, 90 Pre-primary or none, 88 Urban, 97 Richest, … Senior Secondary or higher, 102 60 70 80 90 100 110 120 Area Wealth Quintile Mother's Education D e a th s p e r 1 0 0 0 l iv e b ir th s National Female, 86 Less than 20, 111 1, 95 Fisrt birth, 99 Male, 102 35-49, 101 7+, 122 4+Years, 80 60 70 80 90 100 110 120 130 Sex Mother's Age at Birth Birth Order Previous Birth Interval D e a th s p e r 1 0 0 0 l iv e b ir th s Region Neonatal mortality Under-5 mortality National 20 94 Eastern Province 26 102 Kailahun 20 99 Kenema 21 92 Kono 37 118 Northern Province 16 89 Bombali 31 119 Kambia 6 54 Koinadugu 11 63 Port Loko 18 121 Tonkolili 8 63 Southern Province 13 68 Bo 7 38 Bonthe 22 82 Moyamba 13 64 Pujehun 16 116 Western Area 28 117 Western Area Rural 25 128 Western Area Urban 30 112 Under-five mortality rates for the five year period preceding the survey, by socioeconomic characteristics, area and demographic risk factors Neonatal mortality and under-5 mortality rates (deaths per 1000 live births) for the five year period preceding the survey, by region Key Messages • Under 5, infant and neonatal mortality rates have in general decreased over the past 15 years. The values in the past 5 years (U5MR 94, IMR 56 and NMR 20 per 1,000 live births) are lower than in the past 15 years (U5MR 123, IMR 80 and NMR 23 per 1,000 live births. • The mortality vales for the 5 years preceding the survey are lower than expected. There is a need to further investigate the mortality data. 14 Sierra Leone 2017 Fertility & Family Planning Fertility Age Specific Fertility Rates Adolescent Birth Rate: SDG indicator 3.7.2 *Age-specific fertility rate for girls age 15-19 years *Adolescent birth rates and total fertility rates for the three-year period preceding the survey *The total fertility rate (TFR) is calculated by summing the age-specific fertility rates (ASFRs) calculated for each of the five-year age groups of women, from age 15 through to age 49. The 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). Total Fertility Rate Poorest: 5.6 Pre-Primary or none: 4.5 West: 2.9 Richest: 2.5 Secondary or higher: 2.3 North: 4.7 National: 4.1 National: 4.1 National: 4.1 0 Wealth Quintile Woman's Education Region Age-specific fertility rates (ASFR) are the number of live births in the last 3 years, divided by the average number of women in that age group during the same period, expressed per 1,000 women. Adolescent Birth rate SDG 3.7.2 indicator is under target 3.7: By 2030, ensure universal access to sexual and reproductive health- care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes. Reducing adolescent fertility and addressing the multiple factors underlying it are essential for improving sexual and reproductive health and the social and economic well-being of adolescents. Preventing births very early in a woman’s life is an important measure to improve maternal health and reduce infant mortality. 137 241 226 184 132 67 31 0 20 40 60 80 100 120 140 160 180 200 220 240 260 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Rural Urban West, 71 Higher, 45 Richest, 44 South, 123 Pre-Primary or none, 145 Poorest/Second, 143 0 20 40 60 80 100 120 140 160 180 Region Woman's Education Wealth Quintile P e rc e n t o f h o u se h o ld m e m b e rs National 15 Early Child Bearing - by Age 18 Family Planning *Percentage of women age 15-49 years currently married or in union who are using (or whose partner is using) a contraceptive method Modern Methods include female sterilization, male sterilization, IUD, injectables, implants, pills, male condom, Female condom, diaphragm, foam, jelly and contraceptive patch. Traditional methods refer to periodic abstinence and withdrawal. 1 21 78 Type of method* By Residence By Wealth Quintile By Woman’s Education By Age Trends in Early Child Bearing - by Age 18 83 1 16 69 1 30 Urban Rural 85 1 14 70 1 29 Richest Poorest 85 0 14 79 0 20 Age 15-19 Age 20-24 82 1 17 671 32 Higher Primary Percentage of women age 20-24 years who have had a live birth before age 18, by background characteristics. 25 30 30 30 38 30 38 38 38 32 34 3031 34 34 31 36 30 0 10 20 30 40 50 20-24 25-29 30-34 35-39 40-44 45-49 P e rc e n t Urban Rural National Percentage of women age 20-24 years who have had a live birth before age 18. Rural, 11 Poorest, 10 Pre-Primary or none, 11 age 15-19, 14 Urban, 22 Richest, 21 Higher, 27 age 25-29, 21 0 10 20 30 40 Residence Wealth Quintile Woman's Education Age P e rc e n t Total Rural, 6 Poorest, 5 Higher, 6 age 15-19, 1 Urban, 9 Richest, 9 Primary, 8 age 40-44, 15 0 5 10 15 20 Residence Wealth Quintile Woman's Education Age P e rc e n t Total Met Need for Family Planning *Percentage of women age 15-49 years currently married or in union with an met need for family planning for spacing, by background characteristics Met Need for Family Planning - Spacing *Percentage of women age 15-49 years currently married or in union with an met need for family planning for limiting, , by background characteristics . Method of Family Planning by Various Characteristics No Method Any Traditional Method Any Modern Method Met Need for Family Planning – Limiting Urban, 25 Richest, 18 Senior Secondary +, 15 Rural, 38 Poorest, 40 Pre-Primary or none, 44 0 10 20 30 40 50 60 Residence Wealth Quintile Woman's Education P e rc e n t o f h o u se h o ld m e m b e rs National 16 Percentage of Demand for Family Planning Satisfied with Modern Methods - SDG indicator 3.7.1 By AgeBy residence By Wealth Quintile Demand for family planning with modern methods satisfied Demand for family planning with modern methods not satisfied 24 31 28 17 Urban Rural 28 15 23 30 Richest Poorest 28 16 27 21 Age 15-19 Age 20-24 The proportion of demand for family planning satisfied with modern methods (SDG indicator 3.7.1) is useful in assessing overall levels of coverage for family planning programmes and services. Access to and use of an effective means to prevent pregnancy helps enable women and their partners to exercise their rights to decide freely and responsibly the number and spacing of their children and to have the information, education and means to do so. Meeting demand for family planning with modern methods also contributes to maternal and child health by preventing unintended pregnancies and closely spaced pregnancies , which are at higher risk for poor obstetrical outcomes. Key Messages • At current fertility levels, a woman in Sierra Leone will have an average of 4.1 children in her life time • 31% of women age 20-24 have had a live birth before age 18, while 3% have had a live birth before age 15 • Currently Contraceptive Prevalence Rate (CPR) for Sierra Leone is 23 percent Regional and District Data on Fertility & Family Planning Region /Districts Adolescent Birth Rate Total Fertility Rate Child bearing before 15* Child bearing before 18 Contraception Use of modern method among married / in- union women Contraception Use of any method among married / in- union women Demand for family planning satisfied with modern methods among married / in-union women National 101 4.1 3.4 30.6 212 22.5 43.8 Eastern Province 102 4.4 2.4 30.5 22.4 23.4 44.8 Kailahun 138 4.3 2.6 36.7 27.5 28.2 56.6 Kenema 82 4.1 2.6 25.1 24.5 26.2 46.3 Kono 102 4.7 1.7 32.9 13.9 14.1 29.5 Southern Province 123 4.4 3.0 33.7 20.3 21.1 42.4 Western Area 71 2.9 2.9 25.3 28.9 30.2 52.6 Northern Province 117 4.7 4.9 34.0 16.2 18.0 37.0 Bombali 126 4.6 4.7 31.1 22.0 28.8 44.8 Kambia 115 4.7 5.9 31.2 11.5 12.0 27.7 Koinadugu 94 5.1 2.9 32.3 10.5 10.5 23.6 Port Loko 116 4.6 5.1 39.3 19.1 19.5 44.5 Tonkolili 133 4.9 6.3 34.0 13.9 14.5 35.2 Southern Province 123 4.4 3.0 33.7 20.3 21.1 42.4 Bo 113 4.2 3.2 28.6 23.8 24.6 47.9 Bonthe 74 4.0 3.6 33.8 13.4 13.5 31.2 Moyamba 128 4.7 3.3 39.3 14.6 15.0 33.9 Pujehun 179 4.8 1.7 37.7 24.7 26.2 46.3 Western Area 71 2.9 2.9 25.3 28.9 30.2 52.6 Western Area Rural 109 3.7 4.3 32.5 30.7 32.7 51.5 Western Area Urban 54 2.6 2.2 21.8 28.1 29.0 53.2 *Percentage of women age 20-24 years who have had a live birth before age 15 17 Adolescence is by some measures the healthiest period in the life-course, yet it can also mark the first manifestations of issues which can have lifelong effects on health and wellbeing, such as unsafe sexual behavior, early childbearing and substance misuse. Nevertheless, health interventions during this period are shown to have long-lasting effects. Access to appropriate contraceptive methods is critical to prevent adolescent pregnancy and its related consequences, allowing adolescents to transition into adulthood with the ability to plan their pregnancies and live healthy and productive lives. Sierra Leone 2017 Adolescents The Adolescent Population: Age 10-19 Every Adolescent Survives & Thrives Age & Sex Distribution of Household Population Senior Secondary or higher, 45 Urban, 72 Poorest 143 No Education, 145 Rural, 137 Richest, 44 0 40 80 120 160 200 Education Area Wealth Quintile B ir th s p e r 1 0 0 0 g ir ls a g e 1 5 -1 9 National Adolescent Birth Rate: SDG 3.7.2 Age-specific fertility rate for girls age 15-19 years: the number of live births in the last 3 years, divided by the average number of women in that age group during the same period, expressed per 1,000 women This snapshot of adolescent well-being is organized around key priority areas for adolescents: • Every adolescent survives and thrives • Every adolescent learns • Every adolescent is protected from violence and exploitation • Every adolescent lives in a safe and clean environment • Every adolescent has an equitable chance in life Percentage of girls age 15-19 years who are using (or whose partner is using) a contraceptive method, percentage with an unmet need for contraception and percent of demand for modern methods of family planning satisfied, by marital status Modern Contraceptive Use, Unmet Need & Demand Satisfied for Modern Methods: SDG 3.7.1 10 5 0 5 10 0-4 10-14 20-24 30-34 40-44 50-54 60-64 70-74 80-84 Percent Age Males 32 60 29 35 14 54 0 20 40 60 80 Married Unmarried Modern Use Unmet Need 18 Quality education and experiences at school positively affect physical and mental health, safety, civic engagement and social development. Adolescents, however, can also face the risk of school drop-out, early marriage or pregnancy, or being pulled into the workforce prematurely. Data on reading and numeracy skills are collected in MICS through a direct assessment method. The Foundational Learning module captures information on children’s early learning in reading and mathematics at the level of Grade 2 in primary education. Adjusted net attendance ratio, by level of education and by gender Alcohol and tobacco use typically have their onset in adolescence and are major risk factors for adverse health and social outcomes, as well as for non-communicable diseases later in life. Adolescence is a time of heightened risk-taking, independence seeking and experimentation. Adolescents are at increased risk of substance use due to social, genetic, psychological or cultural reasons. Yet adolescence is also an opportune time for education on the negative consequences of substance use, and promote healthy behaviours that will last into adulthood. Every Adolescent Survives & Thrives Percentage of adolescent girls and boys age 15-19 who have ever used tobacco or alcohol Percentage of adolescent girls and boys age 15-19 who have used tobacco or alcohol in the last 1 month *Tobacco use in last month among adolescents is an age disaggregate of SDG 3.a.1 Tobacco* & Alcohol Use Every Adolescent Learns Percentage of children age 7-14 who can 1) read 90% of words in a story correctly, 2) Answer three literal comprehension questions, 3) Answer two inferential comprehension questions 16 12 Foundational Reading Skills SDG 4.1.1.(a) (i: reading) Foundational Numeracy Skills SDG 4.1.1.(a) (ii: numeracy) Percentage of children age 7-14 who can successfully perform 1) a number reading task, 2) a number discrimination task, 3) an addition task and 4) a pattern recognition and completion task School Attendance Ratios 1 Information & Communications Technology (ICT) Skills* Percentage of girls age 15-19 who can perform at least one of the nine listed computer related activities *Age disaggregate of SDG 4.4.1: Proportion of youth and adults with information and communications technology (ICT) skills 84 36 28 79 36 30 0 20 40 60 80 100 Primary Lower Secondary Upper Secondary P e rc e n t Girls Boys 2 0 0 0 4 1 2 2 0.0 2.0 4.0 6.0 Ever-use of tobacco Ever-use of alcohol Used tobacco during last month Used alcohol during last month P e rc e n t Girls Boys 2 Percentage of boys age 15-19 who can perform at least one of the nine listed computer related activities *Age disaggregate of SDG 4.4.1: Proportion of youth and adults with information and communications technology (ICT) skills Girls Boys 19 Every Adolescent is Protected from Violence & Exploitation Adolescence is a period of heightened risk to certain forms of violence and exploitation. The onset of puberty marks an important transition in girls’ and boys’ lives whereby gender, sexuality and sexual identity begin to assume greater importance, increasing vulnerability to particular forms of violence, particularly for adolescent girls. Certain harmful traditional practices, such as female genital mutilation/cutting and child marriage, often take place at the onset of puberty. At the same time, as children enter adolescence, they begin to spend more time outside their homes and interact more intimately with a wider range of people, including peers and romantic partners. This change in social worlds is beneficial in many respects, but also exposes adolescents to new forms of violence. Percentage of women aged 20 to 24 years who were first married or in union before age 15 and before age 18, by residence 13 8 19 30 20 42 0 20 40 60 Total Urban Rural P e rc e n t Married before age 15 Child Marriage: SDG 5.3.1 Female Genital Mutilation/Cutting* 64 75 56 0 20 40 60 80 100 15-19 18-19 15-17 P e rc e n t Age in years Percentage of girls age 15 to 19 years who have undergone FGM/C, by age group *Age disaggregate of SDG 5.3.2: Prevalence of FGM/C among women age 15-49 Percentage of girls age 15-19 who have heard about FGM/C, by their attitudes on if the practice should continue Attitudes towards Female Genital Mutilation/Cutting 62 31 5 2 0% 20% 40% 60% 80% 100% 15- 19 Think FGM/C should continue Think FGM/C should stop Say it depends/not sure Percentage of children age 10 to 14 years who experienced any discipline in the past month, by type Severe 26 Other types 74 Physical punishment 80 Psychological 87 Any violent discipline: SDG 16.2.15 Only non-violent Child Discipline 20 Percentage of adolescents age 5-17 years engaged in child labour, by type of activity and by age Definition of Child Labour Age 5-11 years: At least 1 hour of economic work, 28 hours of unpaid household services per week or hazardous working conditions. Age 12-14 years: At least 14 hours of economic work, 28 hours of unpaid household services per week or hazardous working conditions. Age 15-17 years: At least 43 hours of economic or unpaid household services per week or hazardous working conditions. Economic activities include paid or unpaid work for someone who is not a member of the household, work for a family farm or business. Household chores include activities such as cooking, cleaning or caring for children, as well as collecting firewood or fetching water. The data presented here are at the household level. Evidence suggests that adolescent access to these services are comparable to household-level data. Basic Drinking Water SDG 1.4: Drinking water from an improved source, provided collection time is not more than 30 minutes for a roundtrip including queuing. Improved drinking water sources are those that have the potential to deliver safe water by nature of their design and construction, and include: piped water, boreholes or tubewells, protected dug wells, protected springs, rainwater, and packaged or delivered water Basic Sanitation Services SDG 1.4.1/6.2.1 : Use of improved facilities which are not shared with other households. Improved sanitation facilities are those designed to hygienically separate excreta from human contact, and include: flush/pour flush to piped sewer system, septic tanks or pit latrines; ventilated improved pit latrines, composting toilets or pit latrines with slabs Clean Fuels SDG 7.2.1: Primary reliance on clean fuels and technologies for cooking, space heating and lighting Child Labour: SDG 8.7.1 5 5 12 5 1 29 13 1 44 23 43 44 0 20 40 60 Age 5-17 years Age 5-11 years Age 12-14 years Age 15-17 years Percent Hazardous working conditions Economic activities Household chores Every Adolescent Lives in a Safe & Clean Environment Rural, 47 Rural, 8 Rural, 0 Urban, 75 Urban, 27 Urban, 0 0 20 40 60 80 Basic Water Basic Sanitation Use of Clean Fuels P e rc e n t o f h o u se h o ld m e m b e rs National Every Adolescent is Protected from Violence & Exploitation Water, Sanitation & Clean Fuel Use 21 Functioning Difficulties in Adolescents Achieving sustainable progress and results with regard to equity demands a human rights-based approach. At the core of international human rights legal framework is the principle of non- discrimination, with instruments to combat specific forms of discrimination, including against women, indigenous peoples, migrants, minorities, people with disabilities, and discrimination based on race and religion, or sexual orientation and gender identity. As adolescents begin to form more of an individual identity, discrimination can often become more pronounced, taking form in harassment, bullying, or exclusion from certain activities. At the same time, research has shown that discrimination during adolescence has a particularly strong effect on stress hormones, potentially leading to life-long mental or physical health side effects. Children and adolescents with disabilities are one of the most marginalized groups in society. Facing daily discrimination in the form of negative attitudes, lack of adequate policies and legislation, adolescents with disabilities are effectively barred from realizing their rights to health, education, and even survival. Percentage of adolescents who have a functioning difficulty, by domain, Country, year Key Messages • 101 out of every 1,000 adolescent girl 15-19 years had given birth to a bay in the 3 years preceding the survey. Births among adolescents were higher among the uneducated, the poorest and in rural areas. • Amongst girls aged 15 to 19 years, modern contraceptive use was more prevalent for unmarried girls (54%) than for married girls (14%). • Foundational Reading skills in children 7-14 years were higher (16%) than Foundational Numeracy skills (12.4%). • 12.9%of women aged 20-24 years were married before age 15 years, and 29.9& before age 18 years. • 64% of girls 15-19 years had undergone FGM/C. 31% felt that FGM/C should be stopped. • The most common functioning difficulty in both children aged 10-14 and 15-17 years is anxiety closely followed by depression. Children 10- 14 years were more anxious (13.3%) and depressed (9.6%)than children 15-17 years (anxiety 11.1%, depression 8.0%) Every Adolescent has an Equitable Chance in Life 0.1 0.2 1.8 0.2 0.4 2.0 1.4 0.7 2.6 2.3 0.8 13.3 9.6 0.2 0.0 1.4 0.1 0.1 1.4 0.5 0.3 1.7 1.8 0.9 11.1 8.0 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 Seeing Hearing Walking Self-care Communication Learning Remembering Concentrating Accepting Change Controlling behavior Making friends Anxiety Depression Percent D o m a in Age 15-17 Age 10-14 Percentage of adolescents who have a functioning difficulty, by domain and age 22 Key Messages • 8 in 10 of women and 9 in 10 of men know that the risk of getting HIV can be reduced by using condoms and limiting sex to one faithful, uninfected partner • Discriminatory attitudes are slightly higher in women than in men • Only 1 in 10 women and less than 1 in 10 men were tested and received results within the last 12 months before the survey • 2 in 5 pregnant women with a live birth in the last five years received HIV testing and counseling and received the results during an ANC visit Percent who know of the two 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, and any other local misconception. Knowledge 86 85 Percent of those who report discriminatory attitudes towards people living with HIV, including 1) would not buy fresh vegetables from a shopkeeper or vendor who is HIV-positive and 2) think children living with HIV should not be allowed to attend school with children who do not have HIV. Stigma Percent who have been tested for HIV in the last 12 months and know the result. Testing Percent of women who during their antenatal care for their last pregnancy were offered an HIV test, accepted and received results, and received post-test health information or counselling related to HIV. Testing during Antenatal Care HIV indicators 76 74 11 12 43 43 Age 15-24 Age 15-49 Sierra Leone 2017 HIV & Sexual Behaviours 90 91 69 67 5 6 MenWomen Age 15-24 Age 15-49 Age 15-24 Age 15-49 Age 15-24 Age 15-49 Aged 15-24 Age 15-49 Aged 15-24 Age 15-49 Age 15-24 Age 15-49 23 Men who tested in last 12 months Women who tested in last 12 months Women testing at ANC National 6.3 12.0 36.5 Kailahun 3 7 27 Kenema 14 12 48 Kono 4 13 18 Bombali 8 13 39 Kambia 4 6 29 Koinadugu 1 9 45 Port Loko 10 8 21 Tonkolili 4 5 17 Bo 7 12 59 Bonthe 2 17 46 Moyamba 1 9 21 Pujehun 4 9 27 Western Area Rural 2 16 45 Western Area Urban 7 18 49 HIV Indicators by Key Characteristics Knowledge among Adolescent Girls & Young Women (15-24)* Rural, 17 No education, 18 Urban, 34 Senior Secondary or higher, 43 0 20 40 60 Area Education P e rc e n t Natio… District Data on HIV Testing 16 15 18 12 7 7 7 7 7 7 0 5 10 15 20 15-19 20-24 25-29 30-39 40-49 P e rc e n t Women Men Tested for HIV in last 12 months Tested in last 12 months: percent age 15-49 who have been tested in the last 12 months and know the result HIV testing during ANC: percent of women age 15-49 who during their last antenatal care for their last pregnancy were offered an HIV test, accepted and received results, and received post-test health information or counselling related to HIV Key Messages • Across the districts and among men 15- 49, Kenema district had majority (14%) who within last 12 month of the survey tested and received results while Moyamba had the lowest (1.3%). • Across the districts and among women 15-49, Western Area Urban district had majority (18%) who within last 12 month of the survey tested and received results while Tonkolili had the lowest (5%). • Within the past 12 months, only 7% of men across all age groups (15-49) have been tested and received the results while more than 1 in 10 across all age groups (15-49) have been tested and received the results • Among women who gave birth in the 5 years before the survey, more than half (59%) in Bo district, were counselled and tested for HIV during antenatal care and received the results Percent age 15-49 who have been tested for HIV in the last 12 months and know the result *Percent age 15-24 who know two ways of HIV prevention, who know that a healthy looking person can be HIV-positive, and who reject two most common misconceptions. Knowledge among Adolescent Boys & Young Men (15-24)* Rural, 21 No education, 17 Urban, 41 Senior Secondary or higher, 46 0 20 40 60 Area Education P e rc e n t Natio… 24 Key Messages • 11% of young men and 5% of young women had two or more sexual partners in the past 12 months. • Among young men and young women who had two or more partners in the past year, 15% of young women and 12% of young men reported using a condom at last sexual intercourse. • 1 in 5 women of age 15-49 of sexually active women reported having had sex with a man 10 or more years older in the last 12 months Young People who had Sex Before Age 15 In many settings, sexual behavior can be considered a risk factor for health and social issues. These include reproductive health, HIV and other sexually transmitted infections, and gender equality and empowerment. An understanding of the population’s sexual behavior patterns can inform both disease prevention and health promotion programs. Sexually active: Percent of women and men age 15-49 who had sexual intercourse within the last 12 months Multiple partners: Percent of women and men age 15-49 of those sexually active in the last 12 months who reported more than one sexual partner within the last 12 months Condom use: Percent of women and men age 15-49 of those who had sex with more than one partner in the last 12 months who reported condom use during the last sexual intercourse Sex before age 15: Percent of women and men age 15-49 of population who had sex before age 15 Sex with man 10 years or older: Percent of women age 15-49 of sexually active women who report having had sex with a man 10 or more years older in the last 12 months 5 Adolescent boys and young men 15-24 16 Adolescent girls and young women 15-24 Girls 15-19 who Report Sex with partner 10 years or older 21 Sexual Behaviour by Key Characteristics 77 65 80 55 100 50 0 50 100 15-49 15-24 Percent Men Women Sexually Active Multiple Partners Condom Use 4 5 19 11 30 10 10 30 15-49 15-24 Percent 10 12 12 15 30 10 10 30 15-49 15-24 Percent 25 16 Young men 20-24 Urban, 12 Richest, 8 Senior Secondary or higher, 9 Rural, 22 Poorest, 24 No education, 26 0 20 40 Area of residence Wealth Quintile Education P e rc e n t National District Data on Sexual Behaviour Sexual Behavior by Key Characteristics Sex before Age 15 among Adolescent Girls & Young Women 15-24 Percent of women who had sex before age 15 Condom Use among Young People 9 Adolescent boys 15-19 12 Adolescent girls 15-19 12 Young women 20-24 Rural, 8 No education , 4 Urban, 21 Senior Secondar y or higher, 24 0 10 20 30 Area Education P e rc e n t Percent of those who had sex with more than one partner in the last 12 months who reported condom use during the last sexual intercourse. Men 15-24 Women 15-24 Sex before 15 Condom use Sex before 15 Condom use National 5 16 16 12 Eastern Province 7 18 14 10 Kailahun 20 15 17 11 Kenema 3 22 10 7 Kono 2 16 18 15 Northern Province 5 14 23 9 Bombali 0 22 24 10 Kambia 10 9 27 8 Koinadugu 1 13 8 7 Port Loko 9 16 23 5 Tonkolili 10 3 34 18 Southern Province 2 11 13 19 Bo 3 15 13 13 Bonthe 4 7 17 9 Moyamba 1 3 14 17 Pujehun 3 7 10 46 Western Area 5 18 13 18 Western Area Rural 8 19 20 12 Western Area Urban 4 18 9 21 Adolescent boys and young men age 15-24 Percent of those who had sex with more than one partner in the last 12 months who reported condom use during the last sexual intercourse. Adolescent girls and young women age 15-24 Condom use among Young People Rural, 10 No education , 8 Urban, 16 Senior Secondar y or higher, 18 0 10 20 30 Area Education P e rc e n t 26 Sierra Leone 2017 Child Health & Care of Illness Diarrhoea 64 7 6 7 60 0 10 20 30 40 50 60 70 A health facility or provider Other provider Community Private Public Percent Care-seeking for 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 provider Male, 67 Rural, 71 Poorest, 68 Female, 61 Urban, 49 Richest, 49 20 40 60 80 Sex Area Wealth Quintile P e rc e n t National Disparities in Care-seeking for Diarrhoea Feeding during Diarrhoea 78 43 51 24 35 25 32 19 24 29 5 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Drinking Eating Much less Somewhat less About the same More 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 ORS Treatment for Diarrhoea ORS + Zinc Treatment for Diarrhoea ORT + Continued Feeding for Diarrhoea Percentage of children age 0-59 months with diarrhoea in the last two weeks treated with oral rehydration salt solution (ORS) Percentage of children age 0-59 months with diarrhoea in the last two weeks treated with oral rehydration salt solution (ORS) and zinc Percentage of children age 0-59 months with diarrhoea in the last two weeks who were given oral rehydration therapy (ORT) with continued feeding Percentage of children age 0-59 months with diarrhoea in the last two weeks for whom advice or treatment was sought at a health facility or provider 27 70 5 5 8 61 0 20 40 60 80 A health facility or provider Other provider Community Private Public Percent Malaria Household Availability of Insecticide Treated Nets (ITNs) Children Under-Five who slept under an ITN 71 60 Care-seeking During Fever Percentage of children age 0-59 months with fever in the last two weeks for whom advice or treatment was sought, by source of advice or treatment Disparities in Care-seeking During Fever Malaria Diagnosis Usage ACT Treatment among Children who Received Treatment 50 32 Percentage of children with fever who had blood taken from a finger or heel for testing Among children with fever who received anti-malarial treatment, percent treated with Artemisinin-based Combination Therapy (ACT) Percentage of children age 0-59 months with fever in the last two weeks for whom advice or treatment was sought at a health facility or provider Female, 70 Rural, 73 Poorest, 70 No Education, 70 Male, 71 Urban, 67 Richest, 65 Senior Secondary or more, 68 40 60 80 100 Sex Area Wealth Quintile Mother's Education P e rc e n t National Percentage of households with at least one insecticide-treated net (ITN) Percentage of children age 0-59 months who slept under an ITN last night 28 74 4 9 5 70 0 20 40 60 80 100 A health facility or provider Other provider Community Private Public Percent Regional Data on Care-Seeking for Childhood Illness Symptoms of Acute Respiratory Infection (ARI) Care-seeking for Symptoms of 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 Disparities in Care-seeking for Symptoms of ARI Region Care-Seeking at a health facility or provider for: Diarrhoea Fever Symptoms of ARI National 64 70 74 Kailahun 4 73 86 Kenema 11 70 100 Kono 5 67 79 Bombali 3 71 71 Kambia 7 70 100 Koinadugu 1 72 73 Port Loko 8 68 33 Tonkolili 10 74 71 Bo 2 82 95 Bonthe 0 75 0 Moyamba 0 51 62 Pujehun 17 80 84 Wester Area Rural 2 68 83 Western Area Urban 3 61 73 • ARI (74%) was the predominant ailment for which care was sought at a health facility or provider, followed by Fever (70%), and Diarrhoea (64%), Key Messages Percentage of children age 0-59 months with symptoms of ARI in the last two weeks for whom advice or treatment was sought at a health facility or provider Female, 74 Rural, 71 Poorest, 69 No Education, 72 Male, 74 Urban, 80 Richest, 81 Senior Secondary or more, 33 0 20 40 60 80 100 Sex Area Wealth Quintile Mother's Education P e rc e n t National 29 Early initiation: percentage of newborns put to breast within 1 hour of birth; Exclusive breastfeeding: percentage of infants aged 0-5months receiving only breastmilk; Introduction to solids: percentage of infants aged 6-8 months receiving solid or semi-solid food; Minimum diet diversity: percentage of children aged 6-23 months receiving 5 of the 8 recommended food groups; Minimum meal frequency: percentage of children aged 6-23 months receiving the recommended minimum number of solid/liquid feeds as per the age of child; Minimum acceptable diet: percentage of children aged 6-23 months receiving the minimum diversity of foods and minimum number of feeds; Continued breastfeeding at 1 year: percentage of children aged 12-15 months who continue to receive breastmilk; Continued breastfeeding at 2 years: percentage of children aged 20-23 months who continue to receive breastmilk. Key Messages • Sub-optimal infant and young child feeding practices in the country is prevalent with low breastfeeding and complementary feeding rates • Exclusive breastfeeding rate in the country is low at 52 per cent. In Sierra Leone, three main factors hindering the increase in exclusive breastfeeding practices are: (1) provision of water; (2) early introduction of complementary foods, and; (3) giving no breastmilk at all. • Early initiation of breastfeeding are highly affected by the type of birth delivery, and it is lowest among children born through C-section. • Dietary diversity is lowest in rural areas and poor households. Low maternal education also influences dietary diversity practices. Infant & Young Child Feeding Sierra Leone 2017 Infant & Young Child Feeding (IYCF) 55 52 65 43 24 11 85 38 0 20 40 60 80 100 Early Initiation of breastfeeding Exclusive breastfeeding Introduction of solid, semi-solid or soft foodsMinimum meal frequency Minimum diet diversity Minimum acceptable diet Continued breastfeeding at 1 year Continued breastfeeding at 2 years P e rc e n t 30 Rural, 20 Poorest, 17 No education, 21 6-8 months, 7 Female, 24 Urban, 31 Richest, 40 Senior Secondary or higher, 37 18-23 months, 35 Male, 25 0 20 40 60 Area Wealth quintile Maternal education Age of child Sex of child P e rc e n t National Urban, 53 Richest, 53 Senior Secondary or higher, 51 Home, 52 C-section, 18 Rural, 55 Poorest, 59 No education, 55 Health Facility, 55 Normal, 57 0 20 40 60 80 Area Wealth quintile Maternal education Place of delivery Type of delivery P e rc e n t National 0 10 20 30 40 50 60 70 80 90 100 0-1 2-3 4-5 P e rc e n t Age in months District DataIYCF: What are the Youngest Infants Fed? Early Initiation of Breastfeeding IYCF: Equity Minimum Diet Diversity Notes: 1) may also have been fed plain water; 2) may also have been fed plain water and/or non-milk liquids; 3) may also have been fed plain water, non-milk liquids and/or other milk/formula; 4) may have been fed plain water, non-milk liquids, other milk/infant formula and/or solid, semi-solid and soft foods. Percent of infants aged 0-5 months receiving breastmilk only, breastmilk and plain water, breastmilk and non-milk liquids, breastmilk and other milk/formula, breastmilk and complementary foods and no breastmilk Liquids or foods consumed by infants 0-5 months old District Early Initiation of breastfeeding Minimum Diet Diversity National 55 24 Kailahun 59 33 Kenema 65 32 Kono 36 19 Bombali 28 22 Kambia 66 17 Koinadugu 28 14 Port Loko 46 19 Tonkolili 68 19 Bo 65 23 Bonthe 68 21 Moyamba 77 34 Pujehun 75 9 Wester Area Rural 46 21 Western Area Urban 60 38 Percent of newborns put to the breast within one hour of birth, by background characteristics Percent of children aged 6-23 months that were fed food from at least 5 out of 8 food groups, by background characteristics Percent of newborns put to the breast within one hour of birth, and per cent of children aged 6-23months that were fed food from at least 5 out of 8 food groups by geographic region 31 5 124 26 Key Messages • In Sierra Leone, stunting is moderately high at 26 per cent. Stunting is a result of chronic nutrition deprivation during the first 1,000 days of life affecting a child’s optimal growth and development. It is irreversible and the long term consequences of stunting affect a child’s school performance, an individual’s earning potential, and a nation’s economic productivity. • The rate of stunting in the country starts to increase once a child starts complementary feeding at 6-8 months and it is highest in the Southern region, rural areas, and low income households • The prevalence of wasting in the country is generally low at 5 per cent but children aged 18-23 months are highly vulnerable with a wasting prevalence of 8 per cent. Children suffering from acute malnutrition are more susceptible to sickness, and have increased risk of death. • Stunting and wasting in the country affects young children during the period of complementary feeding. It is therefore important to strengthen programmes that would improve the quantity, quality, frequency and diversity of complementary food given to young children. • Although the prevalence of wasting in the country is low, it is important to ensure that Integrated Management of Acute Malnutrition (IMAM) programme continue to provide accessible and uninterrupted quality treatment services to severely malnourished children in order to maintain the current levels, and prevent the reversal of the situation in the future Stunting refers to a child who is too short for his or her age. Stunting is the failure to grow both physically and cognitively and is the result of chronic or recurrent malnutrition. Stunting Overweight refers to a child who is too heavy for his or her height. This form of malnutrition results from expending too few calories for the amount consumed from food and drinks and increases the risk of noncommunicable diseases later in life. Overweight Percentage children under-5 who are stunted Percentage children under-5 who are overweight Wasting refers to a child who is too thin for his or her height. Wasting, or acute malnutrition, is the result of recent rapid weight loss or the failure to gain weight. A child who is moderately or severely wasted has an increased risk of death, but treatment is possible. Wasting Percentage children under-5 who are wasted Underweight is a composite form of undernutrition that can include elements of stunting and wasting (i.e. an underweight child can have a reduced weight for their age due to being too short for their age and/or being too thin for their height). Underweight Percentage children under-5 who are underweight Sierra Leone 2017 Nutritional Status of Children 0 10 20 30 40 50 60 0 12 24 36 48 60 P e rc e n t Age in months Stunting Overweight Wasting Underweight Percentage children who are underweight, stunted, wasted and overweight, by age in months Anthropometric Malnutrition Indicators Anthropometric Malnutrition Indicators by Age 32 Stunting Rural, 30 Poorest, 32 No education, 29 South, 30 Urban, 20 Richest, 18 Senior Secondary+, 20 West, 18 0 10 20 30 40 50 Area Wealth Quintile Maternal Education Region P e rc e n t Natio… Key Messages • In Sierra Leone, stunting is moderately high at 26 per cent. Stunting is a result of chronic nutrition deprivation during the first 1,000 days of life affecting a child’s optimal growth and development. It is irreversible and the long term consequences of stunting affect a child’s school performance, an individual’s earning potential, and a nation’s economic productivity. • The rate of stunting in the country starts to increase once a child starts complementary feeding at 6-8 months and it is highest in the Southern region, rural areas, and low income households • The prevalence of wasting in the country is generally low at 5 per cent but children aged 18-23 months are highly vulnerable with a wasting prevalence of 8 per cent. Children suffering from acute malnutrition are more susceptible to sickness, and have increased risk of death. • Stunting and wasting in the country affects young children during the period of complementary feeding. It is therefore important to strengthen programmes that would improve the quantity, quality, frequency and diversity of complementary food given to young children. • Although the prevalence of wasting in the country is low, it is important to ensure that Integrated Management of Acute Malnutrition (IMAM) programme continue to provide accessible and uninterrupted quality treatment services to severely malnourished children in order to maintain the current levels, and prevent the reversal of the situation in the future Rural, 5 Poorest, 6 No education, 5 6-11 months, 9 Urban, 5 Richest, 5 Senior Secondary+, 5 18-23 … 0 5 10 15 20 Area Wealth… Maternal Education Age of child P e rc e n t Nati… Wasting Percentage of under 5 children who are stunted, by background characteristics Percentage of under 5 children who are wasted, by background characteristics Rural, 4 Poorest, 5 No education, 4 South, 3Urban, 4 Richest, 4 Senior Secondary+, 5 North, 6 0 5 10 15 Area Wealth Quintile Maternal Education Region P e rc e n t Natio… Overweight Percentage of under 5 children who are overweight, by background characteristics Stunting Overweight Underweight Wasting % stunted (moderat e and severe) % overweight (moderate and severe) % underweight (moderate and severe) % wasted (moderate and severe) % wasted (severe) Nationa l 26 4 12 5 2 Eastern Province 27 4 11 4 1 Kailahun 32 4 13 4 1 Kenema 28 5 11 4 1 Kono 19 2 8 4 0 Northern Province 29 6 12 5 2 Bombali 25 3 8 4 1 Kambia 31 5 13 4 1 Koinadug u 37 9 16 10 4 Port Loko 27 5 12 5 2 Tonkolili 26 5 12 4 1 Bo 32 3 16 5 1 Southern Province 30 3 15 6 2 Bonthe 23 3 12 5 0 Moyamba 31 4 16 6 1 Pujehun 28 2 17 7 0 Western Area 18 3 9 5 2 Wester Area Rural 16 2 8 6 0 Western Area Urban 19 4 9 5 1 Nutritional Status of Children: Disaggregates Regional and District Data on Stunting, Overweight & Wasting 33 Key Messages • Early childhood development programmes are limited with the poorest population with limited access. Poorest have 1.1 while the richest attendance is 41% • Mothers play a critical role in engaging children on activities that promotes learning and readiness for children. (5% Fathers, 12 mothers) Percentage of children age 2-4 years with whom the father, mother or adult household members engaged in activities that promote learning and school readiness during the last three days Early childhood, which spans the period up to 8 years of age, is critical for cognitive, social, emotional and physical development. During these years, a child’s newly developing brain is highly plastic and responsive to change. Optimal early childhood development requires a stimulating and nurturing environment, access to books and learning materials, interactions with responsive and attentive caregivers, adequate nutrients, access to good quality early childhood education, and safety and protection. All these aspects of the environment contribute to developmental outcomes for children. Children facing a broad range of risk factors including poverty; poor health; high levels of family and environmental stress and exposure to violence, abuse, neglect and exploitation; and inadequate care and learning opportunities face inequalities and may fail to reach their developmental potential. Investing in the early years is one of the most critical and cost-effective ways countries can reduce gaps that often place children with low social and economic status at a disadvantage. Note: Activities include: reading books to the child; telling stories to the child; singing songs to the child; taking the child outside the home; playing with the child; and naming, counting or drawing things with the child. 12 12 11 8 15 3 26 6 31 1 41 0 10 20 30 40 50 Total Girls Boys Ages 36-47 months Ages 48-59 months Rural Urban North West Poorest Richest P e rc e n t Percentage of children aged 36-59 months attending an early childhood education programme, by background characteristics 5 12 19 0.0 5.0 10.0 15.0 20.0 25.0 Father Mother Any adult household member P e rc e n t Support for Learning Sierra Leone 2017 Early Childhood Development Attendance at Early Childhood Education Programmes Early Stimulation & Responsive Care 34 Learning Materials & Child Supervision Inadequate supervision of childrenAccess to Play & Learning Materials Percentage of children under age five left alone or under the supervision of another child younger than 10 years of age for more than one hour at least once in the last week, by district Percentage of children under age five according to their access to play and learning materials ECDI: Early Childhood Development Index; the percentage of children age 3-4 years who are developmentally on track in literacy-numeracy, physical, social-emotional, and learning domains ECE = early childhood education 38 65 33 41 2 0 20 40 60 80 Homemade toys Household objects/ objects found outside Toys from a shop/ manufactured toys 2 or more types of playthings 3 or more children's books Percent Rural, 47 Poorest, 43 No education, 48 Male, 48 3 Years, 47 Not attending, 48 Urban, 59 Richest, 72 Senior Secondary or higher, 66 Female, 55 4 Years, 56 Attending, 77 0 20 40 60 80 100 Area of residence Wealth Quintile Maternal education Sex of child Age of child ECE attendance P e rc e n t Natio… 15 60 80 90 51 0 20 40 60 80 100 Literacy-numeracy Social-emotional Learning Physical ECDI Percent ECDI: Total Score & Domains, SDG 4.2.1 ECDI: Disaggregates Early Childhood Development Index (ECDI) District Inadequate supervision National 30 Kailahun 27 Kenema 21 Kono 29 Bombali 28 Kambia 40 Koinadugu 46 Port Loko 26 Tonkolili 39 Bo 21 Bonthe 36 Moyamba 45 Pujehun 32 Western Area Rural 24 Western Area Urban 26 35 Sierra Leone 2017 Education School Net Attendance Rates (adjusted) 29 36 82 13 12 0 20 40 60 80 100 Senior secondary Junior secondary Primary 1 year prior to primary school entry age Early childhood development (36-59 months) Percent Male, 62 Rural, 56 Poorest, 47 Female, 66 Urban, 77 Richest, 85 0 20 40 60 80 100 Sex Area Wealth Quintile P e rc e n t National Male, 11 Rural, 3 Poorest, 1 Female, 12 Urban, 26 Richest, 41 0 5 10 15 20 25 30 35 40 45 50 55 60 Sex Area Wealth Quintile P e rc e n t National Net Attendance Rate for Early Childhood Education Inequalities in Attendance in Early Childhood Education & Participation in Organized Learning Participation Rate in Organized Learning: SDG 4.2.2 Percentage of children age 36-59 months who are attending early childhood education Percentage of children attending an early childhood education programme, or primary education (adjusted net attendance ratio), who are one year younger than the official primary school entry age at the beginning of the school year Attendance Rates & Inequalities 36 Male, 79 Rural, 75 Poorest, 66 Female, 84 Urban, 91 Richest, 93 0 20 40 60 80 100 120 Sex Area Wealth Quintile P e rc e n t National Adjusted primary school net attendance rate Inequalities in Attendance Rates Adjusted junior secondary school net attendance rate Percentage of children of primary school age (as of the beginning of school year) who are attending primary or secondary school Adjusted senior secondary school net attendance rate Percentage of children of junior secondary school age (as of the beginning of the current or most recent school year) who are attending junior secondary school or higher Percentage of children of senior secondary school age (as of the beginning of the current or most recent school year) who are attending senior secondary school or higher Regional Data for Net Attendance Rates (adjusted) Districts Early Childhood Education Participation rate in organized learning Primary Junior Secondary Senior Secondary National 11.5 63.9 81.8 36.2 28.6 Eastern Province 7.8 65.7 81.8 34.4 21.5 Kailahun 6.1 74.8 79.7 29.0 14.3 Kenema 7.0 61.6 80.1 40.6 25.4 Kono 10.5 63.6 85.8 30.7 21.2 Northern Province 6.2 58.8 80.2 28.7 20.8 Bombali 6.9 58.2 86.4 32.5 30.6 Kambia 4.8 57.4 78.7 21.1 16.1 Koinadugu 3.1 53.6 69.5 26.0 19.4 Port Loko 7.4 63.2 82.2 29.1 20.0 Tonkolili 8.0 58.1 79.4 31.0 10.8 Southern Province 6.6 61.1 77.0 27.0 18.3 Bo 14.6 68.4 86.8 34.0 26.3 Bonthe 2.8 44.1 58.0 25.4 15.4 Moyamba 1.5 54.4 69.9 18.0 13.7 Pujehun 1.6 64.1 73.2 21.7 5.9 Western Area 31.1 75.3 89.4 56.9 51.0 Western Area Rural 25.2 77.9 88.5 50.6 39.0 Western Area Urban 35.1 74.2 89.9 60.6 55.8 Key Messages • Early Childhood Education (ECE) is more prevalent in the Western Area of Sierra Leone (31.1%) than in the Eastern Province (7.8%), Southern Province (6.6%) or Northern Province (6.2%). • School net attendance rates (adjusted) are highest for Primary education (82%), but decreases to 36% in Junior Secondary education and 29% in Senior Secondary education. • The disparities in net attendance rate (adjusted) in urban and rural areas, and among the poorest and richest increase as children progress from Primary education to Junior Secondary education and on to Senior Secondary education. Male, 36 Rural, 18 Poorest, 11 Female, 36 Urban, 55 Richest, 61 0 20 40 60 80 100 Sex Area Wealth Quintile P e rc e n t National Male, 30 Rural, 9 Poorest, 4 Female, 28 Urban, 45 Richest, 56 0 20 40 60 80 100 Sex Area Wealth Quintile P e rc e n t National 37 Male, 63 Rural, 45 Poorest, 33 Female, 65 Urban, 83 Richest, 87 0 20 40 60 80 100 Sex Area of Residence Wealth Quintile P e rc e n t National Primary school Completion Rates Junior Secondary Percentage of children who age 3 to 5 years above the intended age for the last grade of primary school who have completed primary education Senior Secondary Percentage of children who age 3 to 5 years above the intended age for the last grade of junior secondary school who have completed junior secondary education Percentage of children or youth who age 3 to 5 years above the intended age for the last grade of senior secondary school who have completed senior secondary education Male, 47 Rural, 20 Poorest, 8 Female, 42 Urban, 65 Richest, 76 0 20 40 60 80 100 Sex Area of Residence Wealth Quintile P e rc e n t National Male, 27 Rural, 5 Poorest, 2 Female, 18 Urban, 33 Richest, 41 0 5 10 15 20 25 30 35 40 45 50 Sex Area of Residence Wealth Quintile P e rc e n t National 22 44 64 0 20 40 60 80 100 Senior secondary Junior secondary Primary Percent Inequalities in Completion Rates Regional an District Data in Completion Rates Districts Primary Junior Secondary Secondary Secondary National 64.2 44.2 21.7 Eastern Province 60.9 34.6 12.8 Kailahun 55.6 23.9 7.6 Kenema 65.8 38.0 18.3 Kono 57.8 38.9 8.8 Northern Province 58.5 35.8 16.9 Bombali 66.2 49.9 21.8 Kambia 49.8 26.7 17.2 Koinadugu 48.0 34.2 11.5 Port Loko 65.1 32.7 21.2 Tonkolili 58.6 23.9 7.8 Southern Province 52.4 30.6 11.9 Bo 62.1 40.1 20.1 Bonthe 41.1 23.4 13.0 Moyamba 40.2 28.5 3.3 Pujehun 52.6 15.0 3.7 Western Area 84.7 69.9 35.4 Western Area Rural 78.9 55.5 27.8 Western Area Urban 87.5 75.9 39.0 38 Dimension 1 : Children not attending an early childhood education programme or primary education Dimension 2: Children of primary school age who are not in primary or secondary school Dimension 3: Children of lower secondary school age who are not in primary or secondary school Dimension 4: Children who are in primary school but at risk of dropping out (overage by 2 or more years) Dimension 5: Children who are in lower secondary school but at risk of dropping out (overage by 2 or more years) 36 11 20 21 38 34 11 19 16 34 0 10 20 30 40 50 DE5 DE4 DE3 DE2 DE1 Percent Female Male Out of School Rates Key Messages • Completion rates are highest for Primary Education (64.2%), and progressively decrease for Junior Secondary Education (44.2%), and Senior Secondary Education (21.7%). • While there are slightly more girls than boys completing primary and Junior Secondary education, the reverse is seen for Senior Secondary education. • The disparities in completion rates increase as children move from primary education to Junior Secondary, and on to Senior Secondary education in urban and rural areas, and among the richest and poorest SDG MICS Indicator Definition & Notes Value 4.1.4 LN.8 a,b,c Completion rate (primary education, junior secondary, secondary secondary education) 64%, 44%, 22% 4.1.5 LN.6 a,b,c Out-of-school rate (primary education, junior and senior secondary education) 18%, 19%, 36% 4.1.6 LN.10 a,b, Percentage of children over-age for grade (primary education, junior secondary education) 11%, 35% 4.2.2 LN.2 Participation rate in organized learning (one year before the official primary entry age), by sex M:62.0%, F:65.9% 4.5.1 LN.5 a Parity indices (orphans/non-orphans, rural/urban, bottom/top wealth quintiles) for primary adjusted net attendance rate 0.88, 0.83, 070 4.5.1 LN.5 b Parity indices (orphans/non-orphans, rural/urban, bottom/top wealth quintiles) for lower secondary adjusted net attendance rate 0.92, 0.93, 0.19 SDG Summary for Education Out of School Dimensions for Levels of Education 39 Key Messages Early Grade Learning Female, 15 Rural, 5 Poorest, 3 Male, 16 Urban, 30 Richest, 39 - 10 20 30 40 50 Sex Area Wealth Quintile P e rc e n t National Region Boys Girls Total National 17 15 16 Kailahun 4 5 5 Kenema 14 18 16 Kono 16 6 11 Bombali 12 15 14 Kambia 13 6 10 Koinadugu 11 5 8 Port Loko 12 7 10 Tonkolili 8 4 5 Bo 14 6 20 Bonthe 9 6 7 Moyamba 7 3 5 Pujehun 3 7 5 Wester Area Rural 41 18 30 Western Area Urban 37 39 38 Disaggregates in Foundational Reading Skills Sierra Leone 2017 Early Grade Learning & Parental Involvement 16 20 21 39 0 20 40 60 80 Has foundational reading skills* Answers inferential comprehension questions correctly Answers literal comprehension questions correctly Reads 90% of words correctly in story Percent District Data on Foundational Reading Skills *Percentage of children age 7-14 who can 1) read 90% of words in a story correctly, 2) Answer three literal comprehension questions, 3) Answer two inferential comprehension questions Foundational Reading Skills: SDG 4.1.1.(a) (i: reading) 40 Early Learning Female, 12 Rural, 5 Male, 13 Urban, 22 0 5 10 15 20 25 Sex Area P e rc e n t National District Data on Foundational Numeracy SkillsDisaggregates in Foundational Numeracy Skills 12 29 23 35 34 0 5 10 15 20 25 30 35 40 45 50 Has foundational numeracy skills* Pattern recognition and completion Addition Number discrimination Number reading Percent *Percentage of children age 7-14 who can successfully perform 1) a number reading task, 2) a number discrimination task, 3) an addition task and 4) a pattern recognition and completion task Reading & Numeracy Skills Data in MICS • The Foundational Learning module adopts a direct assessment method for children’s early learning in reading and mathematics at the level of Grade 2 in primary education. This contributes to SDG4.1.1.(a) Global Indicator. • For the Foundational Learning module, one child age 7 to 14 (inclusively) is randomly selected in each household. • The content of reading assessment is customized in each country, ensuring that the vocabulary used are part of the Grade 2 reading textbook. This ensures national question relevance in terms of vocabulary and cultural appropriateness). The questions on mathematics are based on universal skills needed for that grade level. • As MICS also collects data on school attendance and numerous individual and household characteristics, such as location, household socio-economic status, and ethnicity, the most marginalized sub-populations of children can be identified for support to improve learning outcomes. Region Boys Girls Total National 13 12 12 Kailahun 13 12 12 Kenema 7 10 9 Kono 9 7 8 Bombali 11 11 11 Kambia 15 9 12 Koinadugu 5 2 3 Port Loko 9 7 8 Tonkolili 3 1 2 Bo 15 17 16 Bonthe 6 5 5 Moyamba 1 2 1 Pujehun 5 7 6 Wester Area Rural 28 22 25 Western Area Urban 29 23 26 Foundational Numeracy Skills: SDG 4.1.1.(a) (ii: numeracy) 41 Male, 13 Rural, 5 Poorest, 3 Female, 13 Urban, 24 Richest, 33 -10 10 30 50 Sex Area Wealth Quintile P e rc e n t National Children with 3 or more books to read at home Parental Involvement: Learning Environment at Home Children who read books or are read to at home Children who receive help with homework 82 81 75 71 62 66 0 20 40 60 80 100 Children for whom an adult household member in the last year received a report card for the child School has a governing body open to parents Attended meeting called by governing body A meeting discussed key education/ financial issues Attended school celebration or sport event Met with teachers to discuss child's progress P e rc e n t Male, 58 Rural, 43 Poorest, 33 Female, 60 Urban, 80 Richest, 86 0 20 40 60 80 100 120 Sex Area Wealth Quintile P e rc e n t National Male, 64 Rural, 53 Poorest, 47 Female, 69 Urban, 77 Richest, 81 0 20 40 60 80 100 Sex Area Wealth Quintile P e rc e n t National Parental Involvement: Support for learning at School Involvement by adult in school management in last year Involvement by adult in school activities in last year 42 Percentage of children under age 5 whose births are registered, by whether or not they have a birth certificate and by sex Percentage of children under age 5 whose births are registered, by age in months 53 53 53 28 29 28 0 20 40 60 80 100 Total Male Female P e rc e n t Registered but no birth certificate Has birth certificate 73 83 83 83 83 0 20 40 60 80 100 0-11 months 12-23 months 24-35 months 36-47 months 48-59 months P e rc e n t Birth Registration Levels Sierra Leone 2017 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. Since December 2017, the authority to register births in Sierra Leone rest with the National Civil Registration Authority which is guided by the National Civil Registration Act of 2016. In 2017, 81.1% of children under the age of five are registered, among which 52.9% have birth certificates and 28.2 % do not have birth certificates. It’s observed that the mother’s educational level contributed to ensuring child’s right to being registered and issued a birth certificate . (47.2% with no education or primary and 93% secondary+ education); wealth quintile (poorest 59.2% and richest 89%) and the area they live (rural 46% and urban 87.6%). While 36.1% of unregistered children whose mothers/ caretakers know how to register the child; 63.9% of mothers/caretakers do not know how to register the birth of the child and obtain the certificate. Key Messages Birth registration by Age Birth registration for Children Under-Five: SDG 16.9.1 43 Birth Registration: Inequalities Region Total registered National 81.1 Eastern Province 87.1 Kailahun 87.7 Kenema 83.2 Kono 91.9 Northern Province 74.0 Bombali 82.0 Kambia 65.0 Koinadugu 81.6 Port Loko 78.2 Tonkolili 59.5 Southern Province 87.3 Bo 90.2 Bonthe 87.0 Moyamba 81.4 Pujehun 88.9 Western Area 81.3 West Area Rural 80.7 West Area Urban 81.7 Percentage of children under age 5 whose births are registered, by background characteristics Percentage of children under age 5 whose births are registered, by region and district District Data on Birth Registration Percentage of children under age 5 whose births are not registered, by mother’s (or caregiver’s) knowledge of how to register a child 48 71 40 72 38 70 64 52 29 61 28 62 30 36 0 20 40 60 80 100 Urban Rural Richest quintile Poorest quintile Mother/caregiver has senior secondary education or higher Mother/caregiver has no education Total Unregistered children whose mothers do not know how to register them Unregistered children whose mothers know how to register them Mother’s (or Caregiver’s) Knowledge of How to Register Rural, 79 Poorest, 79 None, 79 Urban, 84 Richest, 86 Senior Secondary or higher, 88 60 80 100 Area Wealth Quintile Maternal Education P e rc e n t National 44 Key Messages • Eighty-seven percent (87%) of children aged 1 to 14 years experienced some form of violent discipline. • Eighty percent (80%) aged 1 to 14 years experienced psychological aggression as a form of discipline. • The use of violent discipline was slightly higher in urban areas, among the richest and with males. • Over fifty percent (50%) of the poorest respondents living in the rural areas, and with no education feel that physical punishment is necessary in bringing up a child. Studies have however shown that exposing a child to violent discipline has harmful consequences and so should be discouraged Percentage of children age 1 to 14 years who experienced any discipline in the past month, by type Percentage of children aged 1 to 14 years who experienced any violent discipline in the past month, by background characteristics Physical punishment: Shaking, hitting or slapping a child on the hand/arm/leg, hitting on the bottom or elsewhere on the body with a hard object, spanking or hitting on the bottom with a bare hand, hitting or slapping on the face, head or ears, and hitting or beating hard and repeatedly. Severe physical punishment: Hitting or slapping a child on the face, head or ears, and hitting or beating a child hard and repeatedly. Psychological aggression: Shouting, yelling or screaming at a child, as well as calling a child offensive names such as ‘dumb’ or ‘lazy’. Violent discipline: Any physical punishment and/or psychological aggression. Sierra Leone 2017 Child Discipline Child Discipline Sever e Other types Physical punishment 80 Psychological 87 Any violent discipline: SDG 16.2.15 Only non-violent Violent Discipline: Inequalities Rural, 85 Poorest, 85 Female, 86 Urban, 89 Richest, 90 Male, 87 80 100 Area Wealth Quintile Sex of child P e rc e n t National Types of Child Discipline 45 Violent Discipline: Age Patterns Percentage of respondents to the child discipline module who think that physical punishment is necessary to raise or educate children, by their background characteristics The Sierra Leone Multiple Indicator Cluster Survey (MICS) was carried out in 2017 by the Ministry of Cabinet and the National Bureau of Statistics as part of the global MICS programme. Technical support was provided by the United Nations Children’s Fund (UNICEF). UNICEF and European UNION, UNFPA. WHO and WFP provided financial support. The objective of this snapshot is to disseminate selected findings from the Sierra Leone MICS 2017 related to child discipline. Data from this snapshot can be found in tables PR2.1 and PR2.2. . Percentage of children age 1 to 14 years who experienced any violent discipline in the past month, by type and by age 0 20 40 60 80 100 1-2 years 3-4 years 5-9 years 10-14 years P e rc e n t Psychological aggression Physical punishment Severe physical punishment Any violent discipline 73 47 Percentage of children age 1-14 years who experienced any physical punishment Percentage of respondents who think that physical punishment is necessary 47 48 46 41 52 43 48 48 49 51 36 55 35 0 20 40 60 80 Total Female Male Urban Rural Below age 25 years Age 25-34 years Age 35-49 years Age 50 years and above Pre- primary or no education Senior Secondary or Higher education Poorest quintile Richest quintile P e rc e n t Physical Punishment: Attitudes & Experiences Attitudes to Physical Punishment 46 Key Messages • Data collection for the MICS was mainly during the school break when the children were at home, and likely to work a lot more than they normally would when school is in session. • Overall, 39% of children age 5-17 in Sierra Leone are involved in child labour • The percentage engaged in labour is almost the same among males (39%) and females (38%). • The proportion of children engaged in labour is substantially higher among rural children (51%) than urban children (23%) • Over half (58%) of children in the poorest wealth quintile are engaged in child labour compared to 15% in the richest wealth quintile Percentage of children aged 5 to 17 years engaged in child labour, by background characteristics *Estimates from MICS of child labour are different from those in the SDG database for indicator 8.7.1, as the database excludes the hazardous work component and applies a threshold of 21 hours for household chores for children aged 5-14 and no threshold for household chores for children aged 15-17 Percentage of children aged 5 to 17 years engaged in child labour, by type of activity and by age Definition of Child Labour Age 5 to 11 years: At least 1 hour of economic work, 28 hours of unpaid household services per week or hazardous working conditions. Age 12 to 14 years: At least 14 hours of economic work, 28 hours of unpaid household services per week or hazardous working conditions. Age 15 to 17 years: At least 43 hours of economic or unpaid household services per week or hazardous working conditions. Economic activities include paid or unpaid work for someone who is not a member of the household, work for a family farm or business. Household chores include activities such as cooking, cleaning or caring for children, as well as collecting firewood or fetching water. Note: These data reflect the proportions of children engaged in the activities at or above the age specific thresholds outlined in the definitions box. 39 38 40 34 49 46 23 51 15 58 0 20 40 60 80 100 Total Girls Boys 5-11 years 12-14 years 15-17 years Urban Rural Richest Poorest P e rc e n t 5 5 12 1 29 13 44 23 43 0 20 40 60 80 100 Age 5-17 years Age 5-11 years Age 12-14 years Percent Hazardous working conditions Economic activities Household chores Sierra Leone 2017 Child Labour Child Labour: Levels & Dissaggregates Child Labour for Age 5-17 years: SDG 8.7.1* Types of Child Labour 47 Inequalities in Child Labour & Hazardous Conditions Percentage of children aged 5 to 17 years engaged in child labour, by region and districts Percentage of children aged 5 to 17 years engaged in child labour, by type of activity and by sex Percentage of children aged 5 to 17 years working under hazardous conditions, by background characteristics 29 32 17 41 10 47 31 0 20 40 60 80 100 Girls Boys Urban Rural Richest Poorest Total Percent Region and District Total Child Labour National 39 Eastern Province 41 Kailahun 57 Kenema 36 Kono 33 Northern Province 47 Bombali 47 Kambia 54 Koinadugu 67 Port Loko 38 Tonkolili 36 Southern Province 45 Bo 39 Bonthe 45 Moyamba 49 Pujehun 52 Western Area 19 Western Area Rural 22 Western Area Urban 18 Regional Data on Child Labour Child Labour Inequalities Hazardous Conditions Inequalities Girls, 29 Girls, 20 Boys, 5 Boys, 32 Boys, 23 Girls, 8 0 10 20 30 40 Hazardous working conditions Economic activities at or above age specific threshold Household chores at or above age specific threshold P e rc e n t National 48 Key Messages • 1 in 5 adolescent girls age 15-19 are currently married, half of which are in a polygynous union • 1 in 10 married adolescents age 15- 19 have a partner who is 10 or more years older • 15% of men aged 20 to 24 years were first married or in union before age 18 8.0 19.0 13.0 20 42 30 0.0 20.0 40.0 60.0 Urban Rural Total Percent Married by 18 Married by 15 Sierra Leone 2017 Early Marriage Early Marriage: Levels & Disaggregates Percentage of women aged 20 to 24 years who were first married or in union before age 15 and before age 18*, by residence SDG 5.3.1 21 35 43 44 43 13 29 43 45 36 0 20 40 60 Richest Fourth Middle Second Poorest Senior Secondary or higher Junior Secondary Primary Pre-primary or no education Total Percent Percentage of women aged 20 to 49 years who were first married or in union before age 18, by wealth quintile and education Marriage before Age 15 & Age 18: SDG 5.3.1 Disaggregates in Marriage before Age 18 49 Regional Data on Early Marriage 0 20 40 60 45-49 40-44 35-39 30-34 25-29 20-24 P e rc e n t Age cohort Married by 15 Married by 18 Region Marriage by age 18 National 36 Eastern Province 40 Kailahun 47 Kenema 31 Kono 47 Northern Province 40 Bombali 40 Kambia 43 Koinadugu 44 Port Loko 36 Tonkolili 41 Southern Province 38 Bo 35 Bonthe 36 Moyamba 37 Pujehun 48 Western Area 27 Western Area Rural 38 Western Area Urban 22 Percentage of women aged 20 to 49 years who were first married or in union before age 18, by region Percentage of women aged 20 to 49 years who were first married or in union before age 15 and before age 18, by age cohort Trends in Early Marriage Marriage before the age of 18 is a reality for many young girls. In many parts of the world parents encourage the marriage of their daughters while they are still children in hopes that the marriage will benefit them both financially and socially, while also relieving financial burdens on the family. In actual fact, child marriage is a violation of human rights, compromising the development of girls and often resulting in early pregnancy and social isolation, with little education and poor vocational training reinforcing the gendered nature of poverty. The right to 'free and full' consent to a marriage is recognized in the Universal Declaration of Human Rights - with the recognition that consent cannot be 'free and full' when one of the parties involved is not sufficiently mature to make an informed decision about a life partner. 50 Key Messages Female genital mutilation/cutting (FGM/C) refers to “all procedures involving partial or total removal of the female external genitalia or other injury to the female genital organs for non-medical reasons.”1 FGM/C is a violation of girls’ and women’s human rights and is condemned by many international treaties and conventions, as well as by national legislation in many countries. Yet, where it is practiced FGM/C is performed in line with tradition and social norms to ensure that girls are socially accepted and marriageable, and to uphold their status and honor and that of the entire family. UNICEF works with government and civil society partners towards the elimination of FGM/C in countries where it is still practiced. 1. World Health Organization, Eliminating Female Genital Mutilation: An interagency statement, WHO, UNFPA, UNICEF, UNIFEM, OHCHR, UNHCR, UNECA, UNESCO, UNDP, UNAIDS, WHO, Geneva, 2008, p. 4. 86 92 80 75 93 0 20 40 60 80 100 120 Total Rural Urban Richest Poorest P e rc e n t 8 9 7 10 9 3 2 6 10 0 5 10 15 Total Rural Urban No education Primary Junior Sec Senior Sec or higher Richest Poorest P e rc e n t Sierra Leone 2017 Female Genital Mutilation/Cutting (FGM/C) Female Genital Mutilation/Cutting Percentage of girls and women age 15 to 49 years who have undergone FGM/C*, by residence and wealth quintile *SDG 5.3.2 Percentage of girls age 0 to 14 years who have undergone FGM/C (as reported by their mothers), by residence, mother's education and wealth quintile Level & Disaggregates of FGM/C Among Women 15-49 Disaggregates of FGM/C Among Daughters 0-14 years 51 Female Genital Mutilation / Cutting 96 98 96 95 91 86 64 0 20 40 60 80 100 120 45-49 years 40-44 years 35-39 years 30-34 years 25-29 years 20-24 years 15-19 years P e rc e n t Trends in FGM/C Percentage of girls and women age 15 to 49 years who have undergone FGM/C, by age cohort Type of FGM/C Percentage distribution of girls and women age 15 to 49 years who have undergone FGM/C, by type Attitudes to FGM/C 2 0 92 6 0 20 40 60 80 100 Form not determined Nicked Flesh removed Sewn closed Percent Percentage distribution of girls and women age 15 to 49 years who have heard about FGM/C, by their attitudes about whether the practice should continue 1 4 27 68 0 20 40 60 80 100 Don't know / missing Say it depends / are not sure Think FGM/C should discontinued Think FGM/C should continue Percent Percentage of girls and women age 15 to 49 years who have heard about FGM/C and think the practice should continue, by wealth quintile, education, residence and age Rural, 80 Poorest, 83 None, 81 15-19, 62 Rural, 56 Richest, 47 Senior Secondary or higher, 45 45-49, 77 20 40 60 80 100 Area Wealth QuintileEducation of head of householdAge P e rc e n t National Key Messages • Prevalence data for girls aged 0 to 14 reflect their current, but not final, FGM/C status since some girls who have not been cut may still be at risk of experiencing the practice once they reach the customary age for cutting. Therefore, the data on prevalence for girls under age 15 is actually an underestimation of the true extent of the practice. Since age at cutting varies among settings, the amount of underestimation also varies and this should be kept in mind when interpreting all FGM/C prevalence data for this age group. • Eighty percent of women aged 15 to 49 years have some form of female mutilation/cutting. • The predominant method for performing FGM/C in Sierra Leone is ‘removal of flesh’ (92%), whilst the next most common method is ‘sewn closed’ (6%). • For women aged 15 to 49 years, 68 percent thought that the practice of FGM/C should be continued, whilst 27 percent thought that the practice of FGM/C should be discontinued. • Amongst women aged 15 to 49 years, FGM/C is more prevalent in the rural areas (92%) than in the urban areas (80%). • Amongst girls aged 0 to 14 years, FGM/C is more prevalent in the rural areas (9%) than in the urban areas (7%). 52 Children with disabilities are among the most marginalized groups in society. Facing daily discrimination in the form of negative attitudes, and lack of adequate policies and legislation, children with disabilities are effectively barred from realizing their rights to health, education, and even survival. Children with disabilities are often likely to be among the poorest members of the population and are less likely to attend school, access medical services, or have their voices heard in society. Discrimination against and exclusion of children with disabilities also puts them at a higher risk of physical and emotional abuse or other forms of neglect, violence and exploitation. The Convention on the Rights of the Child (UNICEF, 1989) and the more recent Convention on the Rights of Persons with Disabilities (UN, 2006) explicitly state the rights of children with disabilities on an equal basis with other children. These Conventions focus on the disparities faced by children with disabilities and call for improvements in their access to services, and in their participation in all aspects of life. In order to achieve these goals, there is a need for cross- nationally comparable, reliable data. 7 23 20 7 24 20 6 23 19 0 10 20 30 2 - 4 years 5 - 17 years 2 - 17 years P e rc e n t Total Male Female Percentage of children aged 2–17 years with functional difficulty in at least one domain, by domain of difficulty N/A- Not Applicable Kazakhstan 2015 Child Functioning Child Functioning: Levels & Domains S e e in g H e a ri n g W a lk in g F in e M o to r C o m m u n ic a ti o n L e a rn in g P la y in g C o n tr o ll in g B e h a v io u r S e lf c a re R e m e m b e ri n g C o n c e n tr a ti n g A c c e p ti n g C h a n g e M a k in g F ri e n d s A n x ie ty D e p re s s io n National 2-4 years 0.1 0.1 0.6 0.5 2.5 3.2 0.9 1.4 N/A N/A N/A N/A N/A N/A N/A 5-17 years 0.2 0.2 3.2 N/A 0.5 1.9 N/A 2.5 1.0 1.5 0.8 3.0 0.8 12.6 9.1 Sierra Leone 2017 Child Functioning Child Functioning Levels by Age-Group Child Functioning Domains 53 Child Functioning: Inequalities Percentage of children aged 2–17 years with functional difficulty in at least one domain, by district Female, 19 Urban, 19 Poorest, 20 Pre-primary or none, 20 Male, 20 Rural, 20 Richest, 16 Senior Secondary or higher, 19 0 10 20 30 Sex of child Area Wealth Quintile Mother's education P e rc e n t District 2-4 years 5-17 years 2-17 years National 7 23 20 Kailahun 6 18 15 Kenema 4 25 20 Kono 4 30 25 Bombali 6 21 18 Kambia 7 28 23 Koinadugu 10 11 11 Port Loko 7 31 26 Tonkolili 7 18 15 Bo 1 26 22 Bonthe 12 43 36 Moyamba 16 38 33 Pujehun 8 19 16 Western Area Rural 7 25 21 Western Area Urban 6 13 12 Percentage of children aged 2-17 years who use assistive devices and have functional difficulty within domain of assistive device District Data on Child Functioning Child Functioning & the Use of Assistive Devices 0 2 8 0 2 4 6 8 10 Wear glasses Use hearing aid Use equipment/assistance for walking P e rc e n t • Almost 1 in 4 children 5-17 years have functioning difficulties. • One out of fourteen children aged 2-4 years have functional difficulties. • 1.2% of children 2-17 years wear glasses of which 0.4% have difficulties seeing when wearing glasses; 1.1 use hearing aid of which2.2% have difficulties hearing when using the hearing aid, 1.8% use equipment or receive assistance for walking of which 8.1% have difficulties walking when using equipment or receiving assistance. Key Messages 54 Definitions Drinking water ladder: At least basic drinking water services (SDG 1.4.1) refer to an improved source, provided collection time is not more than 30 minutes for a roundtrip including queuing. Improved drinking water sources are those that have the potential to deliver safe water by nature of their design and construction, and include: piped water, boreholes or tubewells, protected dug wells, protected springs, rainwater, and packaged or delivered water. Limited refers to an improved source more than 30 minutes roundtrip. Unimproved sources include unprotected dug wells and unprotected springs. No service refers to the direct collection of water from surface waters such as rivers, lakes or irrigation channels. Sanitation ladder: At least basic sanitation services (SDG 1.4.1) refer to the use of improved facilities which are not shared with other households. Improved sanitation facilities are those designed to hygienically separate excreta from human contact, and include: flush/pour flush to piped sewer system, septic tanks or pit latrines; ventilated improved pit latrines, composting toilets or pit latrines with slabs. Limited sanitation service refers to an improved facility shared with other households. Unimproved sanitation facilities include flush/pour flush to an open drain, pit latrines without a slab, hanging latrines and bucket latrines. No service refers to the practice of open defecation. Hygiene ladder: A basic hygiene service (SDG 1.4.1 & SDG 6.2.1) refers to the availability of a handwashing facility on premises with soap and water. Handwashing facilities may be fixed or mobile and include a sink with tap water, buckets with taps, tippy-taps, and jugs or basins designated for handwashing. Soap includes bar soap, liquid soap, powder detergent, and soapy water but does not include ash, soil, sand or other handwashing agents. Limited hygiene service refers to a facility lacking water and/or soap. No facility means there is no handwashing facility on the household’s premises. Basic Drinking Water, Sanitation & Hygiene Services 16 27 8 32 47 20 35 22 45 17 4 28 National Urban Rural Basic sanitation At least basic Limited Unimproved No service 23 33 15 18 17 20 57 50 64 National Urban Rural Basic hygiene Basic Limited No facility Sierra Leone 2017 Drinking Water, Sanitation & Hygiene - WASH 58 72 47 10 15 6 18 11 24 14 2 23 0 20 40 60 80 100 National Urban Rural Basic drinking water At least basic Limited 55 Rural, 47 North, 48 Poorest, 30 No education, 51 Urban, 72 West , 69 Richest, 76 Senior Secondary or more, 73 0 20 40 60 80 100 Area Region Wealth Quintile Education of Household Head P e rc e n t National Regional Data on Basic Services Basic Drinking Water WASH: Inequalities in Basic Services Basic Sanitation Region Basic Drinking Water Basic Sanitation Basic Hygiene National 58 16 23 Districts Kailahun 56 4 6 Kenema 80 18 17 Kono 55 14 29 Bombali 71 8 39 Kambia 37 9 5 Koinadugu 45 12 19 Port Loko 46 15 19 Tonkolili 31 8 20 Bombali 67 21 23 Bonthe 40 10 6 Moyamba 29 20 18 Pujehun 58 7 20 Western Area Rural 60 24 31 Western Area Urban 74 30 36 Percent of population using basic drinking water services by background characteristics Percent of population using basic sanitation services by background characteristics Proportion of population using basic drinking water, sanitation and hygiene services by region The Sudan Multiple Indicator Cluster Survey (MICS) was carried out in 2014 by the Ministry of Cabinet and the National Bureau of Statistics as part of the global MICS programme. Technical support was provided by the United Nations Children’s Fund (UNICEF). UNICEF and Name of other organizations providing financial support provided financial support. The objective of this snapshot is to disseminate selected findings from the Sudan MICS 2014 related to survey and sample characteristics. Data from this snapshot can be found in table SR1.1, SR 5.1W, SR5.1M, SR 5.2, SR 5.3 and SR2.3. Further statistical snapshots and the Summary Findings Report for this and other surveys are available on mics.unicef.org/surveys. Basic Hygiene Key Messages • 58% of households have access to basic drinking water, 16% access to Basic Sanitation and 23% to Basic Hygiene • Area of residence and mother’s educational level contributes immensely to access to water, sanitation and hygiene facilities • Only 2% of the household population in Sierra Leone are using safely managed drinking water services • 9 in 10 (92%) of women are using appropriate menstrual hygiene materials with a private place to wash and change while at home • Almost one quarter (23%) of young women age 15-19 are did not participate in social activities, school or work due to their last menstruation in the last 12 months preceding the survey. Rural, 8 North , 10 Poorest, 1 No education, 11 Urban, 27 West , 28 Richest, 40 Secondary+, 32 0 10 20 30 40 50 Area of residence Region Wealth Quintile Education of Household Head P e rc e n t National Rural, 15 East, 18 Poorest, 8 No education, 18 Urban, 33 West, 35 Richest, 43 Secondary+, 37 0 10 20 30 40 50 Area Region Wealth Quintile Education of Household Head P e rc e n t National Percent of population using basic hygiene services by background characteristics 56 Accessibility of Water & Sanitation Facilities Time Spent Each Day Collecting Water A Statistical Snapshot of the Nutritional Status of Children: Sudan 2014 – 2 The Sudan Multiple Indicator Cluster Survey (MICS) was carried out in 2014 by the Ministry of Cabinet and the National Bureau of Statistics as part of the global MICS programme. Technical support was provided by the United Nations Children’s Fund (UNICEF). UNICEF and Name of other organizations providing financial support provided financial support. The objective of this snapshot is to disseminate selected findings from the Sudan MICS 2014 related to survey and sample characteristics. Data from this snapshot can be found in table SR1.1, SR 5.1W, SR5.1M, SR 5.2, SR 5.3 and SR2.3. Further statistical snapshots and the Summary Findings Report for this and other surveys are available on mics.unicef.org/surveys. • For 18% of the household population, it takes the household up to 30 minutes to get to the improved source and bring water,15% of the household population takes between 31 -60 minutes, 32% of the population takes over 1 hour to 3 hours while 33% takes over 3 hours to get to the improved source and bring water. • For the majority of the households (60%), women usually collects water for the household when the source is not on the premises 18 24 14 15 17 14 32 29 34 33 28 37 0 20 40 60 80 100 National Urban Rural P e rc e n t Over 3 hours Over 1 hour to 3 hours 31 mins to 1 hour Up to 30 minutes Who Primarily Collects Water for the Household Rural, 28 South, 34 Poorest, 46 No education, 22 Urban, 4 West, 5 Richest, 1 Senior Secondary or more, 6 0 20 40 60 Area Region Wealth Quintile Education of household head P e rc e n t National Proportion of the population practising open defecation, by background characteristics 60 15 13 8 0 20 40 60 80 Women Men Girls Boys P e rc e n t Open Defecation Key Messages Key Messages 57 Househol d Safely Managed Drinking Water Services: SDG 6.1.1 Safely managed service represent an ambitious new level of service during the SDGs and is the indicator for target 6.1. Safely managed drinking water services are improved sources: accessible on premises, available when needed, free from contamination In 2017 only 2% of the population used safely managed drinking water services. The majority of water points, both unimproved and improved have been shown to be faecally contaminated and there are a number of other water quality issues such as those relating to salinity , hardness of the water and iron. Efforts are to strengthen national water quality standards and work has started to build capacities of national and sub-national laboratories of the MoWR and for surveillance and monitoring. 15 20 10 58 72 47 10 15 6 18 24 23 National Urban Rural No service Unimproved Limited Basic Safely managed 68 60 24 72 15 1 0 20 40 60 80 100 Improved Basic Improved + Accessible on premises Improved + Available when needed Improved + Free from contamination Safely managed P e rc e n t Drinking Water Quality at Source & Home Proportion of population using drinking water sources free from E. coli (orange) and proportion free from E. coli in glass of drinking water within the home (blue) Proportion of population using drinking water sources with sufficient drinking water in the last month. Proportion of population using improved, basic and safely managed drinking water services See Definitions below Low High Low HighSource Drinking water ladder, urban and rural Availability of Drinking Water Definitions Rural, 74 West, 61 Poorest, 74 No education, 72 Urban, 68 South, 85 Richest, 64 Senior Secondary or more, 71 50 70 90 110 Area Region Wealth Quintile Education of household head P e rc e n t National Rural, 91 Rural, 99 South, 85 West, 94 Poorest, 95 Poorest, 99 Urban, 88 Urban, 94 North, 97 North, 99 Richest, 87Richest, 90 50 70 90 110 Area Area Region Region Wealth Quintile Wealth Quintile P e rc e n t National 58 Safely Managed Sanitation Services: SDG 6.2.1 Types of Sanitation Facility Management of Improved Onsite Sanitation Services A Statistical Snapshot of the Nutritional Status of Children: Sudan 2014 – 2 Proportion of population by type of sanitation facility, grouped by type of disposal The Sudan Multiple Indicator Cluster Survey (MICS) was carried out in 2014 by the Ministry of Cabinet and the National Bureau of Statistics as part of the global MICS programme. Technical support was provided by the United Nations Children’s Fund (UNICEF). UNICEF and Name of other organizations providing financial support provided financial support. The objective of this snapshot is to disseminate selected findings from the Sudan MICS 2014 related to survey and sample characteristics. Data from this snapshot can be found in table SR1.1, SR 5.1W, SR5.1M, SR 5.2, SR 5.3 and SR2.3. Further statistical snapshots and the Summary Findings Report for this and other surveys are available on mics.unicef.org/surveys. Definitions Safely managed sanitation service represent an ambitious new level of service during the SDGs and is an indicator for target 6.2. Safely managed sanitation services refers private are improved facility where faecal wastes are safely disposed on-site or transported and treated off-sit plus a hand washing facility with soap and water. • Out of the population with access to safely managed sanitation facilities, only 41.9% are using onsite sanitation facilities, while 4.6 % and 0.3% are using unsafe disposal and removal of facial matter for treatment respectively. • 17% of the population are still practising open defecation although this denotes an improvement from the initial 24% in 2015 (JMP data) 41.9 0.3 4.6 Safely disposed in situ Unsafe disposal of excreta Removal for treatment Proportion of population using onsite improved sanitation facilities, by final disposal of excreta Types of Sanitation Facility by Region District Sewer connection Onsite sanitation National 1.1 41.9 Kailahun 0.1 42.3 Kenema 0.0 54.1 Kono 0.2 33.4 Bombali 0.0 44.0 Kambia 0.0 21.5 Koinadugu 0.2 37.3 Port Loko 0.9 36.5 Tonkolili 0.0 22.2 Bo 0.0 47.8 Bonthe 0.1 32.4 Moyamba 0.3 42.0 Pujehun 0.0 30.4 Wester Area Rural 1.4 53.1 Western Area Urban 5.2 51.2 Proportion of population using sewer connections and onsite sanitation, by region 17 35 42 1 0 20 40 60 80 100 No sanitation facility Unimproved Onsite sanitation Sewer connection Percent 59 92 Menstrual Hygiene Management Exclusion from Activities during Menstruation A Statistical Snapshot of the Nutritional Status of Children: Sudan 2014 – 2 Percentage of women who did not participate in social activities, school or work due to their last menstruation in the last 12 months, by residence, wealth quintile, education and region, among women reporting menstruating in the last 12 months . • Menstrual hygiene management is critical for reducing barriers to education for girls, fight stigma and contribute to positive health and wellbeing for outcomes for girls and women. Going forward, more efforts needs to be put in ensuring that menstrual hygiene management is entrenched in the school environment with increased focus on related activities in health facilities and communities Percentage of women who did not participate in social activities, school or work due to their last menstruation in the last 12 months, by age, among women reporting menstruating in the last 12 months 23 20 19 19 20 16 20 0 10 20 30 15-19 20-24 25-29 30-34 35-39 40-44 45-49 93 Women with a private place to wash & change at home 68 Women with appropriate materials Percentage of women age 15-49 using appropriate menstrual hygiene materials with a private place to wash and change while at home, among women reporting menstruating in the last 12 months Women with appropriate materials & a private place to wash & change at home Denominator for all 3 indicators: women age 15-49 who reported menstruating in the last 12 months Rural, 90 North, 91 Poorest, 91 No education, 91 Urban, 96 West, 95 Richest, 95 Secondary+, 96 75 95 Area Region Wealth… Education P e rc e n t Natio… Inequities in access to appropriate materials & private place to wash & change at home Exclusion from Activities during Menstruation by Various Characteristics Rural, 20 East, 9 Poorest, 24 No education, 20 Urban, 20 South, 32 Richest, 19 Secondary+, 22 0 10 20 30 40 50 Area Region Wealth… Education P e rc e n t Natio… 60 Country Year Gender Equality Sierra Leone 2017 Gender Equality Every Girl & Boy Survives & Thrives: The First Decade of Life Infant mortality: probability of dying between birth and the first birthday Under-five mortality: the probability of dying between birth and the fifth birthday Mortality rates among children under-5, SDG 3.2.1 Sex Disaggregate Gender equality means that girls and boys, women and men, enjoy the same rights, resources, opportunities and protections. Investments in gender equality contribute to lifelong positive outcomes for children and their communities and have considerable inter-generational payoffs because children’s rights and well- being often depend on women’s rights and well-being. This snapshot shows key dimensions of gender equality during the lifecycle. It is organized around: 1) the first decade of life (0-9 years of age) when gender disparities are often small, particularly in early childhood; 2) the second decade of childhood (10-19 years of age) when gender disparities become more pronounced with the onset of puberty and the consolidation of gender norms; and 3) adulthood, when gender disparities impacts both the wellbeing of women and girls and boys. Nutrition and a supportive environment in early childhood are among the key determinants of the health and survival of children and their physical and cognitive development. Generally, girls tend to have better biological endowments than boys for survival to age five, and thus higher survival chances under natural circumstances. However, gender discrimination against girls can affect survival, resulting in higher than expected female mortality. Similarly, stunting rates are typically lower among girls than boys, potentially due to the higher risk for preterm birth among boys, which is inextricably linked with lower birth weight. However, children with mothers who gave birth at a young age or who have no education may be more likely to be malnourished. Children with restricted cognitive development during early life are at risk for later neuropsychological problems, poor school achievement, early school drop-out, low-skilled employment, and poor care of their own children. Stimulation and interaction with parents and caregivers can jumpstart brain development and promote well- being in early childhood. This is also the period of development when gender socialization, or the process of learning cultural roles according to one’s sex, manifests. Caregivers, particularly fathers, may respond to, and interact with, sons and daughters differently. Stunting refers to a child too short for his or her age Malnutrition: Stunting (moderate & severe) among children under-5, SDG 2.2.1 Boy, 24 Senior Secondary or Higher, 20 20-34 years, 25 Girl, 29 Pre-primary/No education, 29 <20 years, 28 10 15 20 25 30 35 40 Sex Maternal education Age of mother at birth P e rc e n t Nation… Overweight refers to a child who is too heavy for his or her height Malnutrition: Overweight (moderate & severe) among children under-5, SDG 2.2.2 Girl, 3 Primary, 4 35-49 years, 3 Boy, 5 Senior Secondary or Higher, 5 20-34 years, 5 0 1 2 3 4 5 6 7 8 Sex Maternal education Age of mother at birth P e rc e n t Nation… Wasting refers to a child who is too thin for his or her height Malnutrition: Wasting (moderate & severe) among children under-5, SDG 2.2.2 Boy, 5 Junior Secondary+, 4 35-49 years, 4 Girl, 6 Primary, 6 <20 years, 6 2 3 4 5 6 7 8 9 10 Sex Maternal education Age of mother at birth P e rc e n t Nation… 50 86 62 102 0 30 60 90 120 150 Infant mortality rate Under 5 mortality rate D e a th s p e r 1 ,0 0 0 l iv e b ir th s Girls Boys 61 Every Girl & Boy Survives & Thrives: The First Decade of Life Every Girl & Boy Is Protected From Violence & Exploitation: The First Decade of Life Percentage of children age 2-4 years with whom adult household members engaged in activities that promote learning and school readiness during the last three days, by person interacting with child and sex of child. Activities include reading books to the child; telling stories to the child; singing songs to the child; taking the child outside the home; playing with the child; and naming, counting or drawing things with the child. Early Stimulation & Responsive Care by Adults 4 12 19 6 11 19 0 20 40 60 80 100 Father Mother Any Adult P e rc e n t Girls Boys Percentage of children age 3-4 years who are developmentally on track in at least 3 of the following 4 domains: literacy-numeracy, physical, social-emotional, and learning domains, by sex 55 48Girls Boys Early Childhood Development Index, SDG 4.2.1 Birth Registration, SDG 16.9.1 Sex Disaggregate Percentage of children under age 5 whose births are registered, by sex and maternal education level Violent Discipline, SDG 16.2.1 Sex & Age Disaggregate 80 72 86 80 74 87 0 20 40 60 80 100 Psychological aggression Physical punishment Any violent discipline Percent Boys Girls Percentage of children age 1-14 years who experienced violent discipline in the past month, by sex Note: The age group 1-14 spans the first and second decades of life. 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. While vitally important for both girls and boys, the implications of low birth registration rates for girls are significant, rendering them more vulnerable to certain forms of exploitation they are at greater risk of, including child marriage and international trafficking. Although average birth registration rates are similar for girls and boys, children with mothers who have no education may be less likely to have their births registered. While girls and boys face similar risks of experiencing violent discipline -which includes physical punishment and psychological aggression- by caregivers in the home, gender inequality and domestic violence are among the factors associated with an elevated risk of violence against both girls and boys. Girl, 81 No education, 79 Boy, 82 Senior Secondary, 88 70 80 90 100 Sex Maternal education P e rc e n t 62 Key Messages Every Girl & Boy Learns: The First Decade of Life Percent distribution of children age one year younger than the official primary school entry age at the beginning of the school year, by attendance to education, and attendance to an early childhood education programme or primary education (adjusted net attendance ratio), by sex Primary Completion Percentage of children age 3-5 years above the intended age for the last grade who completed the last grade of primary school, by sex Children of Primary School Age Out of School Percentage of children of primary school age not attending either primary or secondary school, having either never attended or dropped out before completion, by wealth quintile and urban/rural residence Participation Rate in Organized Learning, SDG 4.2.2 Investment in good quality early childhood education services prior to entering school improves learning outcomes for children. It also enhances the efficiency of the school system by reducing repetition and drop-out and improving achievement, especially among girls and marginalized groups. Primary education provides the foundation for a lifetime of learning. Considerable progress has been made in achieving universal education and closing the gender gap but gender disparities to the disadvantage of girls still exist in some countries. Further, girls still comprise the majority of the world’s out-of-school population. Note: Because children of primary school age range from 6-14 years, these indicators include some children in their second decade of life. Percentage of children of primary school age attending primary or secondary school (adjusted net attendance ratio), by wealth quintile and urban/rural residence Primary School Attendance Boys, 79 Boys, 62 Girls, 93 Boys, 72 Boys, 90 Girls, 84 Girls, 70 Boys, 93 Girls, 79 Girls, 91 55 60 65 70 75 80 85 90 95 100 Total Poorest Richest Rural Urban P e rc e n t National Girls, 16 Girls, 30 Boys, 7 Girls, 21 Girls, 9 Boys, 21 Boys, 38 Girls, 7 Boys, 28 Boys, 10 0 10 20 30 40 50 60 70 80 90 100 Total Poorest Richest Rural Urban P e rc e n t National Key Messages • Boys have higher infant mortality rate of 62 and higher under five mortality rate of 102 per 1,000 live births compared to the girls at 50 per 1,000 live births and 86 per 1,000 live births respectively. • Stunting is higher in girls (29%) then boys (@$%); in children of parents with pre- primary or no education compared to mothers with senior secondary or higher education; and in children born to teenage mothers compared to children of women above 20 years. • Births of both boys and girls are registered, though parents with higher education attainment have more children registered. [ • Both boys and girls suffer from violent discipline. The abuses are mainly in the form of physical punishment and psychological aggression. • Primary school attendance is lower in boys from poor and rural households compared to girls in the same settings. • There are more boys than girls of primary going school age who are not in school across all quantiles of the population. • Both boys and girls almost equally complete primary education at similar rates. 8 62 0 20 40 60 80 100 Attending early childhood education programme Adjusted net attendance ratio P e rc e n t 65 63 0 20 40 60 80 100 Girls Boys P e rc e n t 63 Every Adolescent Girl & Boy Survives & Thrives: The Second Decade of Life 16 14 32 55 54 60 0 20 40 60 80 100 Current use of any method Current use of any modern method Demand satisfied for family planning by modern methods P e rc e n t Married Unmarried, sexually active Contraceptive use and demand for family planning satisfied by modern methods among adolescent girls age 15-19, by marital status 31 25 38 0 20 40 60 80 100 Total Urban Rural P e rc e n t Percentage of women age 20-24 years who had a live birth by age 18, by urban/rural residence Contraceptive Use & Demand Satisfied Early Childbearing 25 26 0 20 40 60 80 100 Girls Boys P e rc e n t Comprehensive Knowledge of HIV Tobacco & Alcohol Use While adolescence carries new health risks for both girls and boys, girls often face gender-specific vulnerabilities, with lifelong consequences. Complications related to pregnancy and childbirth are among the leading causes of death worldwide for adolescent girls age 15 to 19. Preventing adolescent pregnancy not only improves the health of adolescent girls, but also provides them with opportunities to continue their education, preparing them for jobs and livelihoods, increasing their self-esteem and giving them more say in decisions that affect their lives. Yet, too often, adolescent girls lack access to appropriate sexual and reproductive health services, including modern methods of contraception. Additionally, despite having a higher risk of contracting HIV due to both greater physiological vulnerabilities and gender inequalities, adolescent girls are often less knowledgeable than adolescent boys about how HIV is transmitted. However, gender norms adversely impact adolescent boys as well. For example, norms around masculinity that encourage risk taking may heighten adolescent boys’ use of alcohol and tobacco, increasing their likelihood of developing noncommunicable diseases later in life. Percent of girls and boys age 15-19 who know of the two 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, and any other local misconception. Tobacco and alcohol use among adolescents age 15-19, by sex *Includes an age and sex disaggregate of SDG 3.a.1: use of tobacco 2 0 0 0 4 1 2 2 0.0 2.0 4.0 6.0 Ever-use of tobacco Ever-use of alcohol Used tobacco during last month Used alcohol during last month P e rc e n t Girls Boys 64 Every Adolescent Girl & Boy is Protected from Violence & Exploitation: The Second Decade of Life 20 5 19 8 13 44 15 42 20 30 0 20 40 60 80 100 Poorest Richest Rural Urban Total Percent Married by 18 Married by 15 Percentage of women aged 20-24 years who were first married or in union before age 15 and before age 18*, by residence Child Marriage, SDG 5.3.1 3 1 2 5 2 23 28 15 18 39 32 34 42 30 31 34 29 40 41 23 8 7 2 7 5 0 20 40 60 80 100 Total Poorest Richest Pre-primary/ No education Senior Secondary or Higher Percent Younger 0-4 years 5-9 years 10+ years Age unknown Percent distribution of adolescent girls age 15-19 currently married or in union by age difference with their partner, education level and wealth quintile Spousal Age Difference Percentage of adolescents age 15-19 years who justify wife beating for any of the following reasons: she goes out without telling him; she neglects the children; she argues with him; she refuses sex with him; she burns the food, by sex and age group Attitudes toward Domestic Violence 44 29 0 20 40 60 80 100 Girls Boys P e rc e n t Adolescence presents unique vulnerabilities to violence and exploitation for girls. In many countries, marriage before the age of 18 is a reality for girls due to the interaction of several factors that place a girl at risk, including poverty, social norms, customary or religious laws that condone the practice, an inadequate legislative framework and the state of a country’s civil registration system. Child marriage often compromises a girl’s development by resulting in early pregnancy and social isolation, interrupting her schooling, and limiting her opportunities for career and vocational advancement. It also often involves a substantial age difference between the girl and her partner, thus further disempowering her and putting her at greater risk of partner violence, sexually transmitted diseases and lack of agency. Attitudes about wife beating serve as a marker for the social acceptability of intimate partner violence. Acceptance of wife beating among adolescent girls and boys suggests that it can be difficult for married girls who experience violence to seek assistance and for unmarried girls to identify and negotiate healthy and equitable relationships. Female genital mutilation is a human rights issue that also affects girls and women. Adolescence, in particular, is a vulnerable period for girls who have undergone FGM because they may experience heightened consequences of the procedure as they become sexually active and begin childbearing. Gender-based discrimination may be one of the most ubiquitous forms of discrimination adolescent girls face, and it has long-lasting and far-reaching effects on their personal trajectories as well as on all aspects of social and economic development. While in most regions, girls and boys are equally likely to be involved in child labour, gender is a determinant of the types of activities boys and girls engage in, with girls more likely to be involved in domestic work. 65 Every Adolescent Girl & Boy is Protected from Violence & Exploitation: The Second Decade of Life a Percentage of girls age 10-14 whose mothers report they have undergone FGM/C b Percentage of adolescent girls age 15-19 who report having undergone FGM/C 25 0 20 40 60 80 100 10-14 P e rc e n t 64 15-19 FGM/C among girls 10-14 (mother’s report)a FGM/C among adolescent girls 15-19 (self- report)b Female Genital Mutilation/Cutting (FGM/C), SDG 5.3.2 Age Disaggregate FGM refers to all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons. Percentage of adolescents age 5 to 17 years engaged in child labour, by sex, age group and type of activity 8 5 20 23 29 32 0 20 40 60 80 100 Girls 5-17 Boys 5-17 P e rc e n t Hazardous Working Conditions Economic Activities Household Chores Child Labour, SDG 8.7.1 5.8 5.65.6 5.4 0 2 4 6 8 10 15-17 18-19 P e rc e n t Girls Boys Life Satisfaction To become empowered, adolescent girls and boys need to be engaged as civic participants in the decisions affecting their lives and communities. Life satisfaction measures an individual’s perceived level of well-being or how an individual feels about their life as a whole. Measuring adolescent girls’ and boy’s satisfaction with their lives can provide important insights into their mental health during a stage of life when gender norms consolidate and girls and boys experience different risk factors for mental health disorders. Among adolescents age 15-19, average life satisfaction score on a scale of 0 to 10, by sex and age group * Note: Indicator includes children in the first & second decade of life **Estimates from MICS of child labour are different from those in the SDG database for indicator 8.7.1, as the database excludes the hazardous work component and applies a threshold of 21 hours for household chores for children aged 5-14 and no threshold for household chores for children aged 15-17 Every Adolescent Girl & Boy has an Equitable Chance in Life: The Second Decade of Life 66 Every Adolescent Girl & Boy Learns: The Second Decade of Life Lower Secondary Attendance Percentage of children of lower secondary school age attending lower secondary school or higher (adjusted net attendance ratio), by sex, wealth quintile and area Upper Secondary Attendance Percentage of children of upper secondary school age attending upper secondary school or higher (adjusted net attendance ratio), by sex, wealth quintile and area Lower Secondary Completion Percentage of children age 3-5 years above the intended age for the last grade who completed the last grade of lower secondary school, by sex 42 47 0 20 40 60 80 100 Girls Boys P e rc e n t Upper Secondary Completion Percentage of children age 3-5 years above the intended age for the last grade who completed the last grade of upper secondary school, by sex 18 69 0 20 40 60 80 100 Girls Boys P e rc e n t While participation in secondary education is expanding, progress lags behind primary education. Gender disparities disadvantaging girls are also wider and occur in more countries at the secondary level than at the primary level. Yet, advancing girls’ secondary education is one of the most transformative development strategies countries can invest in. Completion of secondary education brings significant positive benefits to girls and societies – from increased lifetime earnings and national growth rates, to reductions in child marriage, stunting, and child and maternal mortality. Boys, 36 Boys, 10 Girls, 60 Girls, 18 Girls, 54 Girls, 36 Girls, 13 Boys, 61 Boys, 19 Boys, 57 0 10 20 30 40 50 60 70 80 Total Poorest Richest Rural Urban P e rc e n t National Girls, 28 Girls, 4 Girls, 56 Girls, 7 Girls, 44 Boys, 30 Boys, 4 Boys, 56 Boys, 12 Boys, 46 0 10 20 30 40 50 60 70 80 Total Poorest Richest Rural Urban P e rc e n t National 67 20 92 0 20 40 60 80 100 Exclusion from Activities during Menstruation Appropriate Menstural Hygiene Management Percent The ability of adolescent girls to safely manage their monthly menstrual cycle in privacy and with dignity is fundamental to their health, psychosocial well-being and mobility. Girls in low-resource and emergency contexts without access to adequate menstrual hygiene management facilities and supplies experience stigma and social exclusion while also forgoing important educational, social and economic opportunities. Appropriate Menstrual Hygiene Management: Among adolescent girls age 15-19 who reported menstruating in the last 12 months, percentage using appropriate menstrual hygiene materials with a private place to wash and change while at home Exclusion from Activities during Menstruation: Among adolescent girls age 15-19 who reported menstruating in the last 12 months, percentage of women who did not participate in social activities, school or work due to their last menstruation in the last 12 months Key Messages Menstrual Hygiene Management A Statistical Snapshot of the Nutritional Status of Children: Sudan 2014 – 2 • Contraceptive use based on modern methods is higher among unmarried, sexually active adolescent girls, with 60% satisfaction of the modern method. • Adolescents in rural areas are at a higher risk of early child bearing compared to their peers in urban areas. • Very few (less than 26%) adolescents boys and girls have comprehensive knowledge of HIV transmission and prevention. • Adolescent boys are more prone to tobacco and alcohol use than the girls , though both engage in this habit in late adolescent years. • The proportions of girls married below age 18 years is higher among the poorest households living in rural areas compared to their peers from richest and urban areas • Girls with pre-primary or no education and girls from richest quintiles often married spouse 10 +years compared to girls who have attained senior secondary education. • A higher (44%) percentage of adolescent girls believes that domestic violence is justified compared to boys. • FGM/C is more prevalent among 15-19 year old girls compared to 10-14 year old girls which may indicate that few parents are cutting early adolescents. • Higher percentage of boys are engaged in hazardous working conditions and economic activities compared to girls. • On average ,both boys and girls of older adolescents group (15-19) expressed their satisfaction with their life, implying good mental health. • Boys have a higher (69) percentage for completion of upper secondary studies compared to girls at only 18% . • 92% of girls have appropriate menstrual hygiene management compared to 23% who could not participate in social events. Out of School: Lower Secondary School Age Percentage of children of lower secondary school age not attending either primary or secondary school, having either never attended or dropped out before completion, by wealth quintile and area Girls, 18 Girls, 35 Boys, 6 Girls, 27 Boys, 7 Boys, 20 Boys, 43 Girls, 8 Boys, 32 Girls, 9 0 10 20 30 40 50 60 70 Total Poorest Richest Rural Urban P e rc e n t National Every Adolescent Girl & Boy Learns: The Second Decade of Life Every Adolescent Girl & Boy Lives in a Safe & Clean Environment: The Second Decade of Life Key Messages 68 Gender Equality in Adulthood Access to Knowledge, Information & Technology Percentage of adults (age 15-49) who are literate, by sex Percentage of adults (age 15-49) who read a newspaper, listen to the radio, or watch television at least once a week To survive and thrive, all children require care and support from women and men. Care and support can be substantively improved by fostering gender equality, an important goal in its own right, and by reducing the gender-related barriers. Gender-related barriers include women’s and girls’ disproportionate lack of information, knowledge and technology, resources, and safety and mobility, as well as the gender division of labour and gender norms. For example, a mother’s lack of mobility, due to prohibitive norms or lack of transportation, may impede birth registration, nutrition, and other child outcomes. The internalization of gender norms around masculine and feminine expectations and behaviours may influence women’s and men’s attitudes toward intimate partner violence and physical punishment of children as well as self-perceptions of well-being, including life satisfaction and expectations for the future. Percentage of adults (age 15-49) using the internet at least once in the past 3 months, by sexAccess to Resources Percentage of adults age 15-49 who own a mobile phone, by sex, wealth quintile and area Mobile Phone Ownership, SDG 5.b.1 Health Insurance Coverage Women Women Women Women Women Men Men Men Men Men 0 20 40 60 80 100 Total Poorest Richest Rural Urban P e rc e n t National Men Men Men Men Men Women Women Women Women Women 0.1 1.1 2.1 3.1 4.1 5.1 6.1 7.1 8.1 9.1 Total Poorest Richest Rural Urban Percent National Percentage of adults age 15-49 with health insurance,, by sex, wealth quintile and area 42 58 Women Men 3 7 Women Men 8 11 Women Men Percent distribution of household members without drinking water on premises by person usually collecting drinking water used in the household 60 13 15 8 Women 15+ Girls <15 Men 15+ Time on Household Chores: Water Collection Percent distribution of average amount of time spent collecting water per day by sex of person primarily responsible for water collection in households without drinking water on premises 71 75 14 13 11 10 3 2 0 20 40 60 80 100 Women Men P e rc e n t Over 3 hours Over 1 hour to 3 hours 31 mins to 1 hour Up to 30 minutes Who collects water? Time spent on water collection 69 Key Messages Key Messages • Men are more literate (58.3%) than women (41.5%). And have higher access to information through mass and social media compared to women. • Men generally have access to resources compared to women regardless of quintiles. However, more men from richest and urban areas have higher access to resource than women. • Women have higher health insurance coverage than men regardless of quintiles of society, much as women in richest and urban areas have higher access . • Women compared to men undertakes household chores and spends a lot of time on chores such as water collection. • Women believes that domestic violence is justified especially among the poorest household living in rural areas compared to the men in same settings. • Slightly higher proportions of women than men believe that physical punishment is justified for child up brining. • Men generally regardless of quintiles tends to have a higher perception of better life compared to women. • Men have a higher satisfaction of life especially men from richest and ever married categories compared to women in same categories. Gender Equality in Adulthood Attitudes toward physical punishment Percentage of caretakers who believe that physical punishment is needed to bring up, raise, or educate a child properly, by sex of caretaker 38 28 40 26 33 60 46 60 40 53 0 20 40 60 80 Rural Urban Poorest Richest Total Percent Women Men Feminine & masculine attitudes & expectations Attitudes toward domestic violence Percentage of adults age 15-49 who justify wife beating for any of the following reasons: she goes out without telling him; she neglects the children; she argues with him; she refuses sex with him; she burns the food, by sex, wealth quintile and area Perceptions of a better lifeLife satisfaction 7 8 5 8 6 5 6 5 7 5 0 2 4 6 8 10 Never married Ever married Poorest Richest Total Score Women Men 70 69 50 80 60 50 60 48 70 52 0 20 40 60 80 100 Never married Ever married Poorest Richest Total Percent Women Men Among adults age 15-49, average life satisfaction score on a scale of 0 to 10, by sex, wealth quintile and marital status. Higher scores indicate higher satisfaction levels. Percentage of adults age 15-49 who expect that their lives will get better in one year, by sex, wealth quintile and marital status 48 46 Women Men 70

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