Somalia - Multiple Indicator Cluster Survey - 2011

Publication date: 2011

Northeast Zone, Somalia Monitoring the situation of children and women Multiple Indicator Cluster Survey 2011 Northeast Somalia Ministry of Planning and International Cooperation United Nations Children’s Fund Final Report 2014 Ministry of Planning & International Cooperation Wasaaradda Qorsheynta & Iskashiga Calamiga Ministry of Planning & International Cooperation Wasaaradda Qorsheynta & Iskashiga Calamiga Northeast Zone, Somalia Multiple Indicator Cluster Survey 2011 Final Report, March 2014 ii The North East Zone Multiple Indicator Cluster Survey (MICS) was carried out in 2011 by the Puntland Ministry Planning and International Cooperation with technical and financial support from UNICEF. MICS is an international household survey programme developed by UNICEF. MICS was conducted as part of the fourth global round of MICS surveys (MICS4). It provides up-to-date information on the situation of children and women and measures key indicators that allow countries to monitor progress towards the Millennium Development Goals (MDGs) and other internationally agreed upon commitments. Additional information on the global MICS project may be obtained from www.childinfo.org. Suggested citation: UNICEF Somalia and Ministry of Planning and International Cooperation, 2014. Northeast Zone Multiple Indicator Cluster Survey 2011, Final Report. Nairobi, Kenya: UNICEF, Somalia and Ministry of Planning and International Cooperation. Northeast Somalia Multiple Indicator Cluster Survey 2011 Ministry of Planning and International Cooperation UNICEF United Nations Children’s Fund March 2014 iii Summary Table of Findings Multiple Indicator Cluster Surveys (MICS) and Millennium Development Goals (MDG) Indicators, Northeast Zone, Somalia 2011. Topic MICS4 Indicator Number MDG Indicator Number Indicator Value and Units NUTRITION Breastfeeding and infant feeding 2.4 Children ever breastfed 88.8 per cent 2.5 Early initiation of breastfeeding 56.0 per cent 2.6 Exclusive breastfeeding under 6 months 4.8 per cent 2.7 Continued breastfeeding at 1 year 42.5 per cent 2.8 Continued breastfeeding at 2 years 24.0 per cent 2.9 Predominant breastfeeding under 6 months 26.9 per cent 2.10 Duration of breastfeeding 14.5 months 2.11 Bottle feeding 48.3 per cent 2.12 Introduction of solid, semi-solid or soft foods 35.4 per cent 2.13 Minimum meal frequency 57.0 per cent 2.14 Age-appropriate breastfeeding 18.2 per cent 2.15 Milk feeding frequency for non-breastfed children 26.8 per cent Vitamin A 2.17 Vitamin A supplementation (children under age 5) 26.8 per cent Infants weighed at birth 2.19 Infants weighed at birth 3.5 per cent CHILD HEALTH Vaccinations 3.1 Tuberculosis immunization coverage 16.6 per cent 3.2 Polio immunization coverage 8.3 per cent 3.3 Immunization coverage for diphtheria, pertussis and tetanus (DPT) 7.2 per cent 3.4 4.3 Measles immunization coverage 16.6 per cent Tetanus toxoid 3.7 Neonatal tetanus protection 27.3 percent Care of illness 3.8 Oral rehydration therapy with continued feeding 23.9 per cent 3.9 Care seeking for suspected pneumonia 35.1 per cent 3.10 Antibiotic treatment of suspected pneumonia 48.5 per cent Solid fuel use 3.11 Solid fuels 97.6 per cent iv Malaria 3.12 Household availability of insecticide-treated nets (ITNs) 30.1 per cent 3.13 Households protected by a vector control method 30.6 per cent 3.14 Children under age 5 sleeping under any mosquito net 26.1 per cent 3.15 6.7 Children under age 5 sleeping under insecticide- treated nets (ITNs) 25.3 per cent 3.16 Malaria diagnostics usage 19.5 per cent 3.17 Antimalarial treatment of children under 5 the same or next day 8.7 per cent 3.18 6.8 Antimalarial treatment of children under age 5 19.8 per cent 3.19 Pregnant women sleeping under insecticide- treated nets (ITNs) 21.4 per cent 3.20 Intermittent preventive treatment for malaria 1.6 per cent WATER AND SANITATION Water and sanitation 4.1 7.8 Use of improved drinking water sources 51.9 per cent 4.2 Water treatment 6.0 per cent 4.3 7.9 Use of improved sanitation 64.8 per cent 4.4 Safe disposal of child's faeces 72.6 per cent 4.5 Place for handwashing 78.5 per cent 4.6 Availability of soap 58.8 per cent REPRODUCTIVE HEALTH Contraception and unmet need 5.3 5.3 Contraceptive prevalence rate 2.6 per cent 5.4 5.6 Unmet need 11.4 per cent Maternal and new- born health Antenatal care coverage 5.5a At least once by skilled personnel 24.2 per cent 5.5b 5.5 At least four times by any provider 3.3 per cent 5.6 Content of antenatal care 15.7 per cent 5.7 5.2 Skilled attendant at delivery 38.4 per cent 5.8 Institutional deliveries 12.7 per cent 5.9 Caesarean section 2.1 per cent CHILD DEVELOPMENT Child development 6.1 Support for learning 57.5 per cent 6.2 Father’s support for learning 34.6 per cent 6.3 Learning materials: children’s books 0.6 per cent 6.4 Learning materials: playthings 8.4 per cent 6.5 Inadequate care 29.4 per cent 6.6 Early child development index 34.9 per cent 6.7 Attendance to early childhood education 1.7 per cent Topic MICS4 Indicator Number MDG Indicator Number Indicator Value and Units v Topic MICS4 Indicator Number MDG Indicator Number Indicator Value and Units EDUCATION Literacy and education 7.1 2.3 Literacy rate among young women age 15-24 years 36.1 per cent 7.2 School readiness 22.7 per ernt 7.3 Net intake rate in primary education 16.5 per cent 7.4 2.1 Primary school net attendance ratio (adjusted) 43.4 per cent 7.5 Secondary school net attendance ratio(adjusted) 14.9 per cent 7.6 2.2 Children reaching last grade of primary 74.5 per cent 7.7 Primary completion rate 50.3 per cent 7.8 Transition rate to secondary school 47.6 per cent 7.9 Gender parity index (primary school) 0.87 ratio 7.10 Gender parity index (secondary school) 0.61 ratio CHILD PROTECTION Child labour 8.2 Child labour 26.2 per cent 8.3 School attendance among child labourers 41.2 per cent 8.4 Child labour among students 28.7 per cent Child discipline 8.5 Violent discipline 75.2 per cent Early marriage and polygyny 8.6 Marriage before age 15 women age 15-49 years 12.1 per cent 8.7 Marriage before age 18 women age 20-49 years 38.1 per cent 8.8 Young women age 15-19 currently married or in union 11.8 per cent 8.9 Polygyny women age 15-49 years 19.8 per cent 8.10 Spousal age difference 8.10a Women age 15-19 35.0 per cent 8.10b Women age 20-24 29.8 per cent Orphaned children 9.17 Children’s living arrangements 12.1 per cent 9.18 Prevalence of children with one or both parents dead 12.7 per cent 9.19 6.4 School attendance of orphans 31.2 per cent 9.20 6.4 School attendance of non-orphans 56.9 per cent Female genital mutilation/cutting 8.11 Approval for female genital mutilation/cutting (FGM/C) 57.8 per cent 8.12 Prevalence of female genital mutilation/cutting (FGM/C) among women 98.0 per cent Domestic violence 8.14 Attitudes towards domestic violence 30.6 per cent vi Topic MICS4 Indicator Number MDG Indicator Number Indicator Value and Units HIV/AIDS HIV/AIDS knowledge and attitudes 9.1 Comprehensive knowledge about HIV prevention women age 15-49 years 8.9 per cent 9.2 6.3 Comprehensive knowledge about HIV prevention among young people women age 15-24 years 9.7 per cent 9.3 Knowledge of mother-to-child transmission of HIV women age 15-49 years 44.7 per cent 9.4 Accepting attitude towards people living with HIV women age 15-49 years 8.6 per cent 9.5 Women who know where to be tested for HIV 26.9 per cent 9.6 Women who have been tested for HIV and know the results 2.0 per cent 9.8 HIV counselling during antenatal care 3.3 per cent 9.9 HIV testing during antenatal care 2.1 per cent ACCESS TO MASS MEDIA AND USE OF INFORMATION/COMMUNICATION TECHNOLOGY Access to mass Media MT.1 Exposure to mass media women age 15-49 years 4.7 per cent Use of information/ communication technology MT.2 Use of computers women age 15-24 years 7.7 per cent MT.3 Use of internet 9.9 per cent vii Table of Contents Summary Table of Findings .iii Table of Contents .vii List of Tables .ix List of Figures .xii Abbreviations .xiii Acknowledgements .xiv Disclaimer .xiv Executive Summary .xv I. Introduction . 1 Background . 1 Survey Objectives . 2 II. Sample and Survey Methodology . 3 Sample Design . 3 Questionnaires . 3 Training and Fieldwork . 5 Data Processing . 5 III. Sample Coverage and the Characteristics of Households and Respondents . 6 Sample Coverage . 6 Characteristics of Households . 6 Characteristics of Female Respondents 15-49 Years of Age and Children Under-5 . 9 IV. Nutrition . 13 Breastfeeding and Infant and Young Child Feeding . 13 Children’s Vitamin A Supplementation . 22 Weighing children at birth . 24 V. Child Health . 25 Vaccinations . 25 Neonatal Tetanus Protection . 29 Oral Rehydration Treatment . 31 Care Seeking and Antibiotic Treatment of Pneumonia . 36 Solid Fuel Use . 40 Malaria . 42 VI. Water and Sanitation . 49 Use of Improved Water Sources . 49 Use of Improved Sanitation . 55 Handwashimg . 62 viii VII. Reproductive Health . 65 Contraception . 65 Unmet Need . 67 Antenatal Care . 69 Assistance at Delivery . 72 Place of Delivery . 73 VIII. Child Development. 76 Early Childhood Education and Learning . 76 Early Childhood Development . 81 IX. Literacy and Education . 83 Literacy among Young Women . 83 School Readiness . 84 Primary and Secondary School Participation . 85 Non Formal Education . 91 X. Child Protection . 94 Child Labour . 94 Child Discipline . 97 Early Marriage and Polygyny . 99 Female Genital Mutilation/Cutting . 103 Attitudes toward Domestic Violence . 106 Orphans . 108 XI. HIV/AIDS, Sexual Behaviour, and Orphans . 111 Knowledge about HIV Transmission and Misconceptions about HIV/AIDS . 111 Accepting Attitudes toward People Living with HIV/AIDS . 116 Knowledge of a Place for HIV Testing, Counselling and Testing during Antenatal Care . 117 XII. Access to Mass Media and Use of Information/Communication Technology . 120 Access to Mass Media . 120 Use of Information/Communication Technology . 121 Appendix A. Sample Design . 123 Appendix B. List of Personnel Involved in the Survey . 124 Appendix C. Estimates of Sampling Errors . 131 Appendix D. Data Quality Tables . 146 Appendix E. Northeast Zone MICS4 Indicators: Numerators and Denominators . 159 Appendix F. MICS4 Questionnaires. 168 ix List of Tables Table HH.1: Results of household, women’s and under-5 interviews . 6 Table HH.2: Household age distribution by sex . 7 Table HH.3: Household composition . 9 Table HH.4: Women’s background characteristics . 11 Table HH.5: Under-5’s background characteristics . 12 Table NU.1: Initial breastfeeding . 14 Table NU.2: Breastfeeding . 16 Table NU.3: Duration of breastfeeding . 18 Table NU.4: Age-appropriate breastfeeding . 19 Table NU.5: Introduction of solid, semi-solid or soft foods . 20 Table NU.6: Minimum meal frequency . 21 Table NU.7: Bottle feeding . 22 Table NU.8: Children’s vitamin A supplementation . 23 Table NU.9: Infants weighed at birth . 24 Table CH.1: Vaccinations in first year of life . 26 Table CH.2: Vaccinations by background characteristics . 28 Table CH.3: Neonatal tetanus protection . 30 Table CH.4: Oral rehydration solutions . 32 Table CH.5: Feeding practices during diarrhea . 34 Table CH.6: Oral rehydration therapy with continued feeding and other treatments . 35 Table CH.7: Care seeking for suspected pneumonia and antibiotic use during suspected pneumonia . 37 Table CH.8: Knowledge of the two danger signs of pneumonia . 39 Table CH.9: Solid fuel use . 41 Table CH.10: Solid fuel use by place of cooking . 42 Table CH.11: Household availability of insecticide treated nets and protection by a vector control method . 43 Table CH.12: Children sleeping under mosquito nets . 44 Table CH.13: Pregnant women sleeping under mosquito nets . 45 Table CH.14: Anti-malarial treatment of children with anti-malarial drugs . 46 Table CH.15: Malaria diagnostics usage . 47 Table CH.16: Intermittent preventive treatment for malaria . 48 Table WS.1: Use of improved water sources . 50 Table WS.2: Household water treatment . 53 Table WS.3: Time to source of drinking water . 54 Table WS.4: Person collecting water . 55 Table WS.5: Types of sanitation facilities . 56 Table WS.6: Use and sharing of sanitation facilities . 58 Table WS.7: Disposal of child’s faeces . 59 Table WS.8: Drinking water and sanitation ladders . 61 x Table WS.9: Water and soap at place for handwashing . 63 Table WS.10: Availability of soap . 64 Table RH.1: Use of contraception . 66 Table RH.2: Unmet need for contraception . 68 Table RH.3: Antenatal care coverage . 70 Table RH.4: Number of antenatal care visits . 71 Table RH.5: Content of antenatal care . 72 Table RH.6: Assistance during delivery . 74 Table RH.7: Place of delivery . 75 Table CD.1: Early childhood education . 76 Table CD.2: Support for learning . 78 Table CD.3: Learning materials . 79 Table CD.4: Inadequate Care . 80 Table CD.5: Early Child Development Index . 82 Table ED.1: Literacy among young women . 83 Table ED.2: School readiness . 84 Table ED.3: Primary school entry . 86 Table ED.4: Primary school attendance . 87 Table ED.5: Secondary school attendance . 88 Table ED.6: Children reaching last grade of primary school . 89 Table ED.7: Primary school completion and transition to secondary school . 90 Table ED.8: Education gender parity . 91 Table ED.9A: Ever Attendance of Non-Formal Education . 92 Table ED.9B: Current Attendance for Non-Formal Education . 93 Table CP.1: Child labour . 95 Table CP.2: Child labour and school attendance . 96 Table CP.3: Child discipline . 98 Table CP.4: Early marriage and polygyny . 100 Table CP.5: Trends in early marriage . 101 Table CP.6: Spousal age difference . 102 Table CP.7: Female genital mutilation/cutting (FGM/C) among women . 103 Table CP.8: Female genital mutilation/cutting (FGM/C) among daughters . 104 Table CP.9: Approval of female genital mutilation/cutting (FGM/C) . 105 Table CP.10: Attitudes toward domestic violence . 107 Table CP.11: Children’s living arrangements and orphan hood . 109 Table CP.12: School attendance of orphans and non-orphans . 110 Table HA.1: Knowledge about HIV transmission, misconceptions about HIV/AIDS, and comprehensive knowledge about HIV transmission . 112 Table HA.2: Knowledge about HIV transmission, misconceptions about HIV/AIDS, and comprehensive knowledge about HIV transmission among young women . 113 Table HA.3: Knowledge of mother-to-child HIV transmission . 116 Table HA.4: Accepting attitudes toward people living with HIV/AIDS . 117 xi Table HA.5: Knowledge of a place for HIV testing . 118 Table HA.6: HIV counseling and testing during antenatal care . 119 Table MT.1: Exposure to mass media . 121 Table MT.2: Use of computers and internet . 122 Table SD.1: Allocation of Primary Sampling Units to regions . 124 Table SE.1: Indicators selected for sampling error calculations . 132 Table SE.2: Sampling errors: Northeast Zone . 134 Table SE.3: Sampling errors: Urban areas . 136 Table SE.4: Sampling errors: Rural areas . 138 Table SE.5: Sampling errors: Bari region . 140 Table SE.6: Sampling errors: Nugal . 142 Table SE.7: Sampling errors: Mudug . 144 Table DQ.1: Age distribution of household population . 146 Table DQ.2: Age distribution of eligible and interviewed women . 148 Table DQ.3: Age distribution of under-5s in household and under-5 questionnaires . 148 Table DQ.4: Women’s completion rates by socio-economic characteristics of households . 149 Table DQ.5: Completion rates for under-5 questionnaires by socio-economic characteristics of households . 150 Table DQ.6: Completeness of reporting . 151 Table DQ.7: Observation of bed nets and places for hand washing . 151 Table DQ.8: Observation of women’s health cards . 152 Table DQ.9: Observation of vaccination cards . 152 Table DQ.10: Presence of mother in the household and the person interviewed for the under-5 questionnaire . 153 Table DQ.11: Selection of children age 2-14 years for the child discipline module . 153 Table DQ.12: School attendance by single age . 154 Table DQ.13: Sex ratio at birth among children ever born and living . 155 Table DQ.14: Births by calendar years . 156 Table DQ.15: Reporting of age at death in days . 157 Table DQ.16: Reporting of age at death in months . 158 xii List of Figures Figure HH.1. Age and sex distribution of household population, Northeast Zone, 2011 . 8 Figure NU.1. Percentage of mothers who started breastfeeding within one hour and within one day of birth, Northeast Zone, Somalia 2011 . 15 Figure NU.2. Infant feeding patterns by age, Northeast Zone, Somalia 2011 . 17 Figure CH.1. Percentage of children aged 12 – 23 months who received the recommended vaccinations by 12 months, Northeast Zone, Somalia 2011 . 27 Figure CH.2. Percentage of women with a live birth in the last 12 months who are protected against neonatal tetanus, Northeast Zone, Somalia 2011 . 31 Figure CH.3. Percentage of children under age 5 with diarrhoea who received oral rehydration solution, Northeast Zone, Somalia 2011 . 33 Figure CH.4. Percentage of children under age 5 with diarrhoea who received ORT, or increased fluids and continued feeding, Northeast Zone, Somalia 2011 . 36 Figure WS.1: Percent distribution of household members by source of drinking water, Northeast Zone, Somalia 2011 . 51 Figure HA.1: Percentage of women who have comprehensive knowledge of HIV/AIDS transmission by education levels, Northeast Zone, Somalia 2011 . 115 Figure DQ.1: Number of household population by single ages, Northeast Zone, Somalia 2011 . 147 xiii Abbreviations AIDS Acquired Immune Deficiency Syndrome BCG Bacillis-Cereus-Geuerin (Tuberculosis) CSPro Census and Survey Processing System DPT Diphteria Pertussis Tetanus EPI Expanded Programme on Immunization FGM/C Female genital mutilation/cutting GPI Gender Parity Index HIV Human Immunodeficiency Virus IDD Iodine Deficiency Disorders ITN Insecticide Treated Net IUD Intrauterine Device LAM Lactational Amenorrhea Method MDG Millennium Development Goals MICS Multiple Indicator Cluster Survey MICS4 Fourth global round of Multiple Indicator Clusters Surveys programme MoH Ministry of Health NAR Net Attendance Rate ORT Oral rehydration treatment ppm Parts Per Million SPSS Statistical Package for Social Sciences UNAIDS United Nations Programme on HIV/AIDS UNDP United Nations Development Programme UNFPA United Nations Population Fund UNGASS United Nations General Assembly Special Session on HIV/AIDS UNICEF United Nations Children’s Fund WFFC World Fit For Children WHO World Health Organization xiv Acknowledgements The Northeast Zone 2011 Multiple Indicator Cluster Survey was implemented by UNICEF Somalia as part of the global UNICEF MICS programme. The survey was conducted with the support and endorsement of Ministry of Planning and International Cooperation, Puntland State of Somalia. The survey was coordinated by Sicily Matu and Peter Kingori from UNICEF and Mohamed Ali Ismail (MOPIC). The data processing manager was Austin Mueke. Managerial, training and field supervision support was provided by the following UNICEF staff: Debra Bowers, Emily Mwadime, Dimitri Papathanassiou and Awil Bashir. Penina Masibo (UNICEF), contributed in the report writing work. Training for data collection was conducted by the following people; Pierre Martel (UNICEF), Mohammed Dhaqane (UNICEF), Asha Hussein Adam ( UNICEF) Abdulkadir Ali Ghelle (SDRA Galkayo), Ahmed Hassan Yusuf (ANPPCAN), Mohamed Ali Key Ismail (SAREDO), Guled Salah (UNFPA). The following people acted as key resource persons for specific modules during the training; Nancy Balfour, UNICEF USSC Water and Sanitation section, Woki Munyui, UNICEF USSC Education section, Louise Masese, FAO/ FSNAU. Invaluable technical advice and support was provided in the various stages of the survey by the following UNICEF staff and consultants. The staff include: Attila Hancioglu, Bo Pedersen, Debra Bowers, Volker Huls, Edward Addai, Turgay Unalan, Yadigar Coskun, Ivana Bjelic and Mamadou Seyba Thiam. The UNICEF consultants include Pierre Martel, Aleksandar Zoric, David Megill and Oztas Ayhan. Special recognition is due to all the survey team members including team leaders, supervisors, enumerators, editors, sketch mappers, data entry clerks and filed guides for working tirelessly to a successful conclusion of the survey. Finally, the contribution of the survey households and respondents who cooperated and gave their time to respond to the numerous survey questions is sincerely appreciated. Funding for MICS4 in Northeast Zone, Somalia was provided by UNICEF. Disclaimer For the purposes of this survey, the analysis and reporting refers to the Northeast Zone according to the prewar boundaries for Puntland and does not imply any recognition of administrative boundaries by the United Nations. This will allow some comparison with the previous MICS surveys. xv Executive Summary The Northeast Zone Multiple Indicator Survey is a representative sample survey of 4,954 households, out of which 4,785 were successfully interviewed including 5,492 women age 15 – 49 years and 4,714 mothers and caretakers of children less than five years old. The primary purpose of MICS is to provide policy makers and planners with reliable and detailed information needed to monitor the situation of women and children. Information on nutrition, child health, water and sanitation, reproductive health, child development, literacy and education, child protection, HIV/AIDS and orphan hood and access to mass media and use of information/communication technology is included. Nutrition • Fifty six percent of the children are breastfed within one hour of being born. • Exclusive breastfeeding levels are very low, contrary to UNICEF/WHO recommendations, only 5 percent of children age 0 – 6 months are exclusively breastfed. • Among children age 12 -15 months nearly half are still breastfeeding which falls to 24 percent among children age 20 – 23 months. • Complimentary feeding in Northeast Zone is sub optimal. Only a third of the children 6 – 8 months receive appropriate complimentary feeding. Immunization • Immunisation coverage is low and only 3 percent of children age 12 -23 months are fully vaccinated at the time of the survey. • Less than one percent of children received their vaccination by their first birthday. • Twenty three percent of children age 12 – 23 months has received BCG vaccination while 25 percent have been vaccinated against measles. • About 7 percent of children aged 12 – 23 months had received their third dose of DPT by their first birthday. • Nearly two thirds of children aged 12 – 23 months have not received any of the basic vaccines • Twenty seven percent of the women aged 15 – 49 years with a live birth in the last two years are protected against neonatal tetanus. Diarrhoea • One in every ten children under five years of age had diarrhoea at some point in the two weeks before the survey. • Forty one percent of children who had diarrhoea received fluids from ORS packets or pre-packaged ORS fluids. • Twenty four percent of children with diarrhoea received ORT with continued feeding. Pneumonia • Five percent of children under five years had suspect pneumonia in the two weeks before the survey. • Thirty five percent of children under five with suspected pneumonia received treatment from an appropriate provider. • About half of children with suspected pneumonia received antibiotics. xvi Malaria • Thirty one percent of households own at least one mosquito net and close to one third own long lasting Insecticide Treated Net (ITN). • One in every four children under age of five years slept under a bed net during the night prior to the interview; a similar number children sleeping under ITN. • Twenty one percent of pregnant women slept under an ITN during the night prior to the interview. • Eleven percent of children under age five had a fever at one point in the last two weeks before the survey; one in five received any antimalarial drug and only 9 percent received an antimalarial drug on the same or next day. Water and sanitation • Half of the population in Northeast Zone has access to an improved source of drinking water. • Six percent of the population living in households using unimproved drinking water sources use an appropriate water treatment method. • In sixty one percent of households without drinking water on premises, an adult woman bears the responsibility of collecting water. • Seventeen percent of the population is living without any type of toilet facilities. • Nearly two-thirds of the population are using unshared facilities with a sanitary means of excreta disposal; and the latest stool was safely disposed of for nearly three quarters of the children age 0 - 2 years. • Thirty seven percent of the population is using an improved source of drinking water and improved sanitation; the proportion is more than twice as high in urban compared to rural areas. • Water and soap for hand washing is available in 79 percent of households with a place for hand washing; and 59 percent of the households had soap anywhere in the dwelling. Reproductive health • Only three in ten married women are using any method of contraception; the most common non modern method is Lactational Amenorrhea Method (LAM) and the use of any modern method is very low. • The unmet need for contraception is 11 percent. • Nearly one in every four mothers with a live birth in the two years preceding the survey received ante natal care from a skilled provider (Doctor, Nurse or trained midwife). • Among women with a live birth in the two years preceding the survey and who received Ante-Natal Care (ANC), 25 percent had blood pressure taken, 19 percent had urine sample taken and 21 percent had a blood test done. • Only 3 percent of women with a live birth in the two years preceding the survey had four or more ANC visits but 72 percent did not receive ANC. • Thirty eight percent of births in the two years prior to the survey were delivered with the assistance of a skilled attendance. • Thirteen percent of the births were delivered in a health facility. Child development • Only 2 percent of children age 3 – 4 years are attending early childhood education programme. • Fifty eight percent of children 3 – 4 years were engaged by adult household members in four or more playing activities that promote learning and school readiness during the last three days preceding the survey. • Irrespective of the sex of the child, 29 percent of children under five years of age had been left with inadequate care a week before the survey. xvii Literacy and Education • Four in every ten women 15 – 24 years are literate; among this group, literacy is almost twice in urban compared to rural areas and four times higher among the women in the richest quintile compared to those in the poorest quintile. • Nearly one in every four in children first grade attended pre-school the previous year. • Seventeen percent of primary school entry age children enter grade one and this is five times among children in the richest quintile compared to those in poorest quintile. • Forty three percent of primary school age children are in primary school and this declines further to 15 percent of secondary school age children attending secondary school. • For every 10 boys attending primary school there are 9 girls. This declines further in secondary school education with 6 girls attending for every 10 boys. • Seventy three percent of children 5-17 ever attended non formal education; a similar percentage ever attended Koranic school. Child protection • About one in every four children is involved in child labour; and this if more common for girls than boys. • Twenty nine percent of children who are in school are involved in child labour. • Violent method of disciplining children and psychological aggression are very common. • Almost all women aged 15 -49 years have undergone one form of FGM; the most common type is where they are sewn/closed. • One in every four daughters aged 0 – 14 years have undergone FGM. • Fifty-eight percent of women aged 15 – 49 years support continuation of FGM. • About one third of women believe that a husband is justified to beat his wife/partner and mostly if she refuses sex with him. HIV/AIDS • Only 9 percent of women age 15 -49 years have comprehensive knowledge on HIV transmission and about three in every ten reject the two common misconceptions about HIV. • One in ten women age 15-24 years have comprehensive knowledge of HIV transmission. • Forty five percent of women can correctly identify the three means of HIV transmission from mother-to- child. • Thirty percent of women know of a place they can be tested of HIV/AIDS and only 2 percent have been tested and know their result. • Only 9 percent of women who have heard of HIV express accepting attitude towards people living with HIV/AIDS. Access to mass media and information /communication technology • Five percent of women aged 15 - 49 years have access to all three media (Newspaper, radio and television) at least once a week. • Only 8 percent of women aged 15 -24 years have used a computer in the last 12 months; and 10 percent have used internet during the same period. xviii 1 I. Introduction Background This report is based on the Northeast Zone Multiple Indicator Cluster Survey, conducted in 2011 by the Ministry of Planning and International Cooperation with technical and financial support from UNICEF Somalia country office. The survey provides valuable information on the situation of children and women in Northeast Zone, and was based, in large part, on the needs to monitor progress towards goals and targets emanating from recent international agreements: the Millennium Declaration, adopted by all 191 United Nations Member States in September 2000, and the Plan of Action of A World Fit For Children, adopted by 189 Member States at the United Nations Special Session on Children in May 2002. Both of these commitments build upon promises made by the international community at the 1990 World Summit for Children. In signing these international agreements, governments committed themselves to improving conditions for their children and to monitoring progress towards that end. UNICEF was assigned a supporting role in this task (see table below). A Commitment to Action: National and International Reporting Responsibilities The governments that signed the Millennium Declaration and the World Fit for Children Declaration and Plan of Action also committed themselves to monitoring progress towards the goals and objectives they contained: “We will monitor regularly at the national level and, where appropriate, at the regional level and assess progress towards the goals and targets of the present Plan of Action at the national, regional and global levels. Accordingly, we will strengthen our national statistical capacity to collect, analyse and disaggregate data, including by sex, age and other relevant factors that may lead to disparities, and support a wide range of child-focused research. We will enhance international cooperation to support statistical capacity-building efforts and build community capacity for monitoring, assessment and planning.” (A World Fit for Children, paragraph 60) “…We will conduct periodic reviews at the national and subnational levels of progress in order to address obstacles more effectively and accelerate actions.…” (A World Fit for Children, paragraph 61) The Plan of Action (paragraph 61) also calls for the specific involvement of UNICEF in the preparation of periodic progress reports: “… As the world’s lead agency for children, the United Nations Children’s Fund is requested to continue to prepare and disseminate, in close collaboration with Governments, relevant funds, programmes and the specialized agencies of the United Nations system, and all other relevant actors, as appropriate, information on the progress made in the implementation of the Declaration and the Plan of Action.” Similarly, the Millennium Declaration (paragraph 31) calls for periodic reporting on progress: “…We request the General Assembly to review on a regular basis the progress made in implementing the provisions of this Declaration, and ask the Secretary-General to issue periodic reports for consideration by the General Assembly and as a basis for further action.” 2 This final report presents the results of the indicators and topics covered in the survey. Survey Objectives The 2011 Northeast Zone Multiple Indicator Cluster Survey has as its primary objectives: • To provide up-to-date information for assessing the situation of children and women in Northeast Zone; • To furnish data needed for monitoring progress toward goals established in the Millennium Declaration and other internationally agreed upon goals, as a basis for future action; • To contribute to the improvement of data and monitoring systems in Northeast Zone and to strengthen technical expertise in the design, implementation, and analysis of such systems. • To generate data on the situation of children and women, including the identification of vulnerable groups and of disparities, to inform policies and interventions. 3 II. Sample and Survey Methodology Sample Design The sample for the Northeast Zone Multiple Indicator Cluster Survey (MICS) was designed to provide estimates for a large number of indicators on the situation of children and women at the zonal level, for urban and rural areas, and for three regions: Bari, Nugal and Mudug. The urban and rural areas within each region were identified as the main sampling strata and the sample was selected in two stages. Within each stratum, a specified number of census enumeration areas were selected systematically with probability proportional to size. After a household listing was carried out within the selected enumeration areas, a systematic sample of 18 households was drawn in each sample enumeration area. Thirteen (13) of the selected enumeration areas were not visited because they were inaccessible due to population movement during the fieldwork period. The sample is not self-weighting and for reporting national level results, sample weights are used. A more detailed description of the sample design can be found in Appendix A. Questionnaires Four sets of questionnaires were used in the survey:1) a household questionnaire which was used to collect information on all de jure household members (usual residents), the household, and the dwelling;2) a women’s questionnaire administered in each household to all women aged 15-49 years; and 3) an under-5 questionnaire, administered to mothers or caretakers for all children under 5 living in the household. The questionnaires included the following module. The Household Questionnaire included the following modules: • Household Listing Form • Education • Non Formal Education (non-MICS country specific module) • Water and Sanitation • Household Characteristics • Insecticide Treated Nets • Indoor Residual Spraying • Child Labour • Child Discipline • Handwashing The Questionnaire for Individual Women was administered to all women aged 15-49 years living in the households, and included the following modules: • Women’s Background • Access to Mass Media and Use of Information/Communication Technology • Child Mortality with Birth History • Desire for Last Birth • Maternal and Newborn Health • Post-natal Health Checks • Illness Symptoms • Contraception • Unmet Need • Female Genital Mutilation/Cutting 4 • Attitudes Towards Domestic Violence • Marriage/Union • HIV/AIDS The Questionnaire for Children Under Five was administered to mothers or caretakers of children under 5 years of age1 living in the households. Normally, the questionnaire was administered to mothers of under-5 children; in cases when the mother was not listed in the household roster, a primary caretaker for the child was identified and interviewed. The questionnaire included the following modules: • Age • Early Childhood Development • Breastfeeding • Care of Illness • Malaria • Immunization The questionnaires are based on the MICS4 model questionnaire2. From the MICS4 model English version, the questionnaires were translated into Somali and were pre-tested in Gabilely, Hargeisa during February 2011. Based on the results of the pre-test, modifications were made to the wording and translation of the questionnaires. A copy of the Northeast Zone MICS questionnaires is provided in Appendix F. In addition to the administration of questionnaires, fieldwork teams observed the place for hand washing. The following modules were removed from the three sets of questionnaires each for the given reason. In the household questionnaire; • Salt iodisation module was removed because there is more recent data from the Micronutrient Survey of 2009. In the questionnaire for women 15- 49 years; • Sexual behaviour module was not included as it was considered culturally sensitive in Somalia. Furthermore, it was not included in the 2006 MICS In the questionnaire for children under five years; • Birth registration was omitted based on observations in MICS3 that there are very few births registered in Somaliland as most women gave birth at home. • The anthropometry module was excluded as there was more recent data in the micronutrient survey of 2009. The following additions were made to the modules for specific questionnaires; In the questionnaire for children under five years • In the immunisation module treatment of diarrhoea using ORS distributed in the most recent Child Health Days i.e. December 2010 was added • In the same module the type of card in which child immunisation was recorded included additional type of cards from the 2009 and 2010 child health days. In the household questionnaire • The Non Formal Education module was added. It was considered necessary to provide information for the continued intervention and support for Non Formal Education by the government and partners. 1 The terms “children under 5”, “children age 0-4 years”, and “children aged 0-59 months” are used interchangeably in this report. 2 The model MICS4 questionnaires can be found at www.childinfo.org 5 Training and Fieldwork Training for the fieldwork was conducted for 14 days in March 2011. Training included lectures on interviewing techniques and the contents of the questionnaires, and mock interviews between trainees to gain practice in questionnaire administration. Towards the end of the training period, trainees spent two days in practice interviewing in Garowe town in an area not selected for actual data collection. The data were collected by 10 teams; each comprised 6 interviewers, one sketch mapper, two field editors, a supervisor and a team leader. Fieldwork was conducted in three phases, in 2011, due to challenges relating to access. The first and major phase began on 2nd April – to 17th May 2011. Three areas with a total of 70 clusters could not be accessed and data collection was planned to take place later. In the second phase data was collected in the following areas; 41 clusters from South Galkayo and Hobyo (25th July – 16th August), 13 clusters in Haradhere (15th - 29th August) and 16 clusters from Allula/ Bargar/ Ishkushban (15th - 21st December). Before data collection from these areas was done, refresher training for the teams was done. The teams were selected from the same team that collected data in phase one. Data Processing Data were entered using the CSPro software. The data were entered on 12 computers and carried out by 12 data entry operators and one data entry supervisor and one data manager. In order to ensure quality control, all questionnaires were double entered and internal consistency checks were performed. Procedures and standard programs developed under the global MICS4 programme and adapted to the Northeast Zone questionnaire were used throughout. Data entry began in Garowe at Puntland State University (PSU) two weeks into data collection in April 2011 but was stopped in June 2011 due to technical and logistical challenges – the university uses a generator which kept on break down and affecting data entry and some clerks were caught trying to shorten the time taken in entering data by skipping sections of the questionnaire. Following consultations between UNICEF country office, the Ministry of Planning and International Cooperation in the Northeast Zone, it was decided to ship all the questionnaires to Nairobi and have data re-entered by a new set of data entry clerks. This second round of data entry started in September 2011 and was completed in January 2012. Data were analysed using the Statistical Package for Social Sciences (SPSS) software program, Version 18, and the model syntax and tabulation plans developed by UNICEF were used for this purpose. 6 III. Sample Coverage and the Characteristics of Households and Respondents Sample Coverage Of the 4,954 households selected for the sample, excluding the households in the 13 clusters that were not surveyed, 4,904 were found to be occupied. Of these, 4,785 were successfully interviewed for a household response rate of 97.6 percent. In the interviewed households, 5,839 women (age 15-49 years) were identified. Of these, 5,492 were successfully interviewed, yielding a response rate of 94.1 percent within interviewed households. There were 4,827 children under age five listed in the household questionnaire. Questionnaires were completed for 4,714 of these children, which corresponds to a response rate of 97.7 percent within interviewed households. Overall response rates of 91.8 and 95.3 are calculated for the women’s and under-5’s interviews respectively (Table HH.1). Table HH.1: Results of household, women's and under-5 interviews Number of households, women and children under-5 by results of the household, women's and under-5's interviews, and household, women's and under-5's response rates, Northeast Zone, Somalia 2011 Area Region Urban Rural Bari Nugal Mudug Total Households Sampled 3,193 1,761 2,211 989 1,754 4,954 Occupied 3,173 1,731 2,199 967 1,738 4,904 Interviewed 3,104 1,681 2,149 942 1,694 4,785 Household response rate 97.8 97.1 97.7 97.4 97.5 97.6 Women Eligible 3,950 1,889 2,757 1,177 1,905 5,839 Interviewed 3,688 1,804 2,586 1,070 1,836 5,492 Women's response rate 93.4 95.5 93.8 90.9 96.4 94.1 Women's overall response rate 91.3 92.7 91.7 88.6 93.9 91.8 Children under-5 Eligible 3,117 1,710 1,986 1,029 1,812 4,827 Mothers/caretakers interviewed 3,036 1,678 1,949 989 1,776 4,714 Under-5's response rate 97.4 98.1 98.1 96.1 98.0 97.7 Under-5's overall response rate 95.3 95.3 95.9 93.6 95.5 95.3 The response rates were similar between rural and urban areas and for two regions namely Bari and Mudug. However, Nugal region had a response rate below 90 percent for women but all the response rates across regions and areas of residence were above 85 percent. Characteristics of Households The weighted age and sex distribution of survey population is provided in Table HH.2. The distribution was also used to produce the population pyramid in Figure HH.1. In the 4,785 households successfully interviewed in the survey, 28,537 household members were listed. Of these, 13,865 were males, and 14,670 were females. 7 The population pyramid in Figure HH.1, with a wide base, indicates a population that is still very young. Children under 15 years comprise 53 percent of the population is common in societies with high fertility levels. Nearly 60 percent of the population is aged between 0 and 17 years. With regard to dependency 44 percent of the population is between 15 - 64 years and only about 3 percent is 65 years and above. In the absence of birth registration and other services relating to vital statistics, it is extremely difficult to get correct age related data. Many people do not know the year they were born in Northeast Zone. This affects the quality of data as seen in the data quality table (DQ.1) in Appendix D which presents ages in single year categories, the table shows a high level of digit preference for ages ending with zero and five. Table HH.2: Household age distribution by sex Percent and frequency distribution of the household population by five-year age groups, dependency age groups, and by child (age 0-17 years) and adult populations (age 18 or more), by sex, Northeast Zone, Somalia 2011 Males Females Total Number Percent Number Percent Number Percent Age 0-4 2,453 17.7 2,376 16.2 4,829 16.9 5-9 2,993 21.6 2,869 19.6 5,863 20.5 10-14 2,222 16.0 2,217 15.1 4,439 15.6 15-19 1,538 11.1 1,298 8.8 2,836 9.9 20-24 795 5.7 1,113 7.6 1,908 6.7 25-29 572 4.1 1,046 7.1 1,618 5.7 30-34 576 4.2 801 5.5 1,376 4.8 35-39 478 3.4 729 5.0 1,207 4.2 40-44 675 4.9 566 3.9 1,241 4.3 45-49 348 2.5 266 1.8 614 2.2 50-54 419 3.0 486 3.3 905 3.2 55-59 134 1.0 201 1.4 335 1.2 60-64 274 2.0 251 1.7 525 1.8 65-69 58 0.4 75 .5 133 0.5 70-74 164 1.2 179 1.2 344 1.2 75-79 32 0.2 40 0.3 72 0.3 80-84 76 0.5 77 0.5 154 0.5 85+ 53 0.4 77 0.5 130 0.5 Missing/DK 4 0.0 4 0.0 8 0.0 Dependency age groups 0-14 7,668 55.3 7,462 50.9 15,131 53.0 15-64 5,809 41.9 6,756 46.1 12,565 44.0 65+ 383 2.8 448 3.1 833 2.9 Missing/DK 4 0.0 4 0.0 8 0.0 Child and adult populations Children age 0-17 years 8,623 62.2 8,228 56.1 16,853 59.1 Adults age 18+ years 5,237 37.8 6,437 43.9 11,677 40.9 Missing/DK 4 0.0 4 0.0 8 0.0 Total 13,865 100.0 14,670 100.0 28,537 100.0 8 Figure HH.1. Age and sex distribution of household population, Northeast Zone, 2011 Tables HH.3 - HH.5 provide basic information on the households, female respondents age 15-49, male respondents 15-49 and children under-5 by presenting the unweighted, as well as the weighted numbers. Information on the basic characteristics of households, women, men and children under-5 interviewed in the survey is essential for the interpretation of findings presented later in the report and also can provide an indication of the representativeness of the survey. The remaining tables in this report are presented only with weighted numbers. See Appendix A for more details about the weighting. Table HH.3 provides basic background information on the households. Within households, the sex of the household head, region, residence, number of household members, education of household head are shown in the table. These background characteristics are used in subsequent tables in this report; the figures in the table are also intended to show the numbers of observations by major categories of analysis in the report. The weighted and unweighted numbers of households are equal, since sample weights were normalized (See Appendix A). The table also shows the proportions of households with at least one child under 18, at least one child under 5, at least one eligible woman age 15-49. The table also shows the weighted average household size estimated by the survey. About a third of the households are headed by women and the rest by men. The households are typically quite large with an average household size of 6. Household heads are largely illiterate with nearly 3 in 4 household having no education at all. The households are mostly urban with only over one-third coming from rural areas. Ten percent of the households have ten or more members. Nearly two thirds of the households have at least one child under five and the households and about 89 percent of them have at least one woman aged 15 – 49 years. Males Females 5 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Percent 379 1 1 3 5 7 9 1111 9 Characteristics of Female Respondents 15-49 Years of Age and Children Under-5 Tables HH.4 and HH.5 provide information on the background characteristics of female respondents 15- 49 years of age and of children under age 5. In both tables, the total numbers of weighted and unweighted observations are equal, since sample weights have been normalized (standardized). In addition to providing useful information on the background characteristics of women and children, the tables are also intended to show the numbers of observations in each background category. These categories are used in the subsequent tabulations of this report. Table HH.3: Household composition Percent and frequency distribution of households by selected characteristics, Northeast Zone, Somalia 2011 Weighted percent Number of households Weighted Unweighted Sex of household head Male 68.6 3,284 3,284 Female 31.3 1,499 1,499 Region Bari 45.0 2,152 2,149 Nugal 19.8 947 942 Mudug 35.2 1,686 1,694 Area Urban 62.0 2,967 3,104 Rural 38.0 1,818 1,681 Number of household members 1 1.2 57 55 2 6.5 311 308 3 11.2 535 533 4 13.0 621 620 5 15.5 742 742 6 14.7 705 707 7 11.8 564 564 8 9.2 441 442 9 6.6 315 317 10+ 10.3 493 497 Education of household head None 73.9 3,538 3,520 Primary 11.3 539 540 Secondary+ 14.3 684 701 Missing/DK 0.5 24 24 Total 100.0 4,785 4,785 Households with at least One child age 0-4 years 61.1 4,785 4,785 One child age 0-17 years 91.5 4,785 4,785 One woman age 15-49 years 88.7 4,785 4,785 Mean household size 6.0 4,785 4,785 10 Table HH.4 provides background characteristics of female respondents 15-49 years of age. The table includes information on the distribution of women according to region, area of residence, age, marital status, motherhood status, births in last two years, education3, household wealth index quintiles4. Nearly two in three women reside in urban areas compared to one in three who reside in rural areas. The population of women in each 5 year age group decreases with age from 22 percent in the 15 – 19 age category to 10 percent in the 45-49 age category. Over half of the women surveyed are married (58 percent), nearly a third has never been married and about 12 percent reported being widowed or divorced. Of all the women who reported ever being married, 65 percent had given birth. The level of education among the surveyed women is very low. Majority of women have never received any kind of education (70 percent). About one in five have primary level education and only 10 percent have secondary school or higher level of education. The women are nearly equally distributed between five wealth quintiles at around 20 percent in each category. 3 Unless otherwise stated, “education” refers to educational level attended by the respondent throughout this report when it is used as a background variable. 4 Principal components analysis was performed by using information on the ownership of consumer goods, dwelling characteristics, water and sanitation, and other characteristics that are related to the household’s wealth to assign weights (factor scores) to each of the household assets. Each household was then assigned a wealth score based on these weights and the assets owned by that household. The survey household population was then ranked according to the wealth score of the household they are living in, and was finally divided into 5 equal parts (quintiles) from lowest (poorest) to highest (richest). The assets used in these calculations were as follows: main source of drinking water, toilet facility, number of persons per room used for sleeping, main materials for dwelling floor, main material of the roof, main material of the exterior walls, type of cooking fuel , radio, television, non-mobile telephone, refrigerator, charcoal stove/Jiko, wheel barrow, mat, vacuum flask, kerosene lamp, fan , bed , sofa, Somali stool, sitting cushion/pillow, watch, mobile phone, bicycle, motorcycle or scooter, car or truck, having a bank account and if the house has electricity. The wealth index is assumed to capture the underlying long-term wealth through information on the household assets, and is intended to produce a ranking of households by wealth, from poorest to richest. The wealth index does not provide information on absolute poverty, current income or expenditure levels. The wealth scores calculated are applicable for only the particular data set they are based on. Further information on the construction of the wealth index can be found in Filmer, D. and Pritchett, L., 2001. “Estimating wealth effects without expenditure data – or tears: An application to educational enrolments in states of India”. Demography 38(1): 115-132. Gwatkin, D.R., Rutstein, S., Johnson, K. , Pande, R. and Wagstaff. A., 2000. Socio-Economic Differences in Health, Nutrition, and Population. HNP/Poverty Thematic Group, Washington, DC: World Bank. Rutstein, S.O. and Johnson, K., 2004. The DHS Wealth Index. DHS Comparative Reports No. 6. Calverton, Maryland: ORC Macro. 11 Table HH.4: Women's background characteristics Percent and frequency distribution of women age 15-49 years by selected background characteristics, Northeast Zone, Somalia 2011 Weighted percent Number of women Weighted Unweighted Region Bari 47.1 2,586 2,586 Nugal 19.6 1,077 1,070 Mudug 33.3 1,830 1,836 Area Urban 64.9 3,563 3,688 Rural 35.1 1,929 1,804 Age 15-19 21.7 1,191 1,193 20-24 18.6 1,021 1,021 25-29 18.6 1,020 1,021 30-34 14.0 767 765 35-39 12.8 705 707 40-44 10.0 551 547 45-49 Marital/Union status Currently married/in union 57.9 3,179 3,175 Widowed 4.2 233 233 Divorced 7.9 433 432 Separated 0.3 17 17 Never married/in union 29.6 1,626 1,631 Missing /DK 0.1 4 4 Motherhood status Ever gave birth 65.4 3,589 3,585 Never gave birth 34.4 1,887 1,891 Missing /DK 0.3 16 16 Births in last two years Had a birth in last two years 27.9 1,530 1,526 Had no birth in last two years 71.9 3,946 3,950 Missing /DK 0.3 16 16 Education None 70.4 3,865 3,847 Primary 19.8 1,090 1,093 Secondary+ 9.8 537 552 Wealth index quintile Poorest 17.9 985 952 Second 19.8 1,088 1,061 Middle 19.5 1,072 1,068 Fourth 20.6 1,129 1,153 Richest 22.2 1,217 1,258 Total 100.0 5,492 5,492 12 Table HH.5 presents some background characteristics of children under 5. These include distribution of children by several attributes: sex, region and area of residence, age in months, mother’s or caretaker’s education and wealth. The proportion of boys and girls surveyed was similar (51 versus 49 percent). No major differences were observed between the weighted and unweighted categories for the children. Nearly two in three of the children reside in urban areas and the rest in rural areas. The proportion of children in the 0-5 months and 6-11 months age groups were the lowest at 10 and 8 percent. The highest proportions of children were within the age groups of 24-35, 36 – 47 and 48-59 months (22, 23 and 21 percent respectively). Education of mothers/caretakers for children under-five is quite low with about 77 percent having no education. Six percent of the mothers/caretakers had attended secondary education or higher while 17 percent had primary education. Table HH.5: Under-5's background characteristics Percent and frequency distribution of children under five years of age by selected characteristics, Northeast Zone Somalia, 2011 Weighted percent Number of under-5 children Weighted Unweighted Sex Male 50.8 2,395 2,394 Female 49.2 2,319 2,320 Region Bari 41.4 1,952 1,949 Nugal 21.1 993 989 Mudug 37.5 1,768 1,776 Area Urban 61.7 2,908 3,036 Rural 38.3 1,806 1,678 Age 0-5 months 10.2 481 480 6-11 months 8.0 376 377 12-23 months 16.8 792 793 24-35 months 21.8 1,027 1,024 36-47 months 22.6 1,067 1,068 48-59 months 20.6 972 972 Mother’s educationa None 76.9 3,624 3,613 Primary 16.9 797 801 Secondary+ 6.2 293 300 Wealth index quintile Poorest 21.3 1,003 969 Second 20.6 971 947 Middle 19.8 932 931 Fourth 20.2 954 977 Richest 18.1 855 890 Total 100.0 4,714 4,714 a Mother's education refers to educational attainment of mothers and caretakers of children under 5. 13 IV. Nutrition Breastfeeding and Infant and Young Child Feeding Breastfeeding for the first few years of life protects children from infection, provides an ideal source of nutrients, and is economical and safe. However, many mothers stop breastfeeding too soon and there are often pressures to switch to infant formula, which can contribute to growth faltering and micronutrient malnutrition and is unsafe if clean water is not readily available. WHO/UNICEF have the following feeding recommendations: • Exclusive breastfeeding for first six months • Continued breastfeeding for two years or more • Safe and age-appropriate complementary foods beginning at 6 months • Frequency of complementary feeding: 2 times per day for 6-8 month olds; 3 times per day for 9-11 month olds It is also recommended that breastfeeding be initiated within one hour of birth. The indicators related to recommended child feeding practices are as follows: • Early initiation of breastfeeding (within 1 hour of birth) • Exclusive breastfeeding rate (< 6 months) • Predominant breastfeeding (< 6 months) • Continued breastfeeding rate (at 1 year and at 2 years) • Duration of breastfeeding • Age-appropriate breastfeeding (0-23 months) • Introduction of solid, semi-solid and soft foods (6-8 months) • Minimum meal frequency (6-23 months) • Milk feeding frequency for non-breastfeeding children (6-23 months) • Bottle feeding (0-23 months) Table NU.1 shows the proportion of children born in the two years preceding the survey who were ever breastfed, those who were first breastfed within one hour and one day of birth, and those who received a prelacteal feed. Breast feeding within one hour of birth is a very important step in management of lactation and establishment of a physical and emotional relationship between the baby and the mother. In Northeast Zone, slightly above half (56 %) of babies are breastfed for the first time within one hour of birth, while 82 percent of newborns start breastfeeding within one day of birth. On overall, 89 percent of the children were ever breastfed. Initiation of breastfeeding was similar in rural areas and urban areas (Figure NU.1). There were minimal regional differentials in the percent of mothers who started breastfeeding within one hour and within one day of life. 14 Table NU.1: Initial breastfeeding Percentage of last-born children in the 2 years preceding the survey who were ever breastfed, percentage who were breastfed within one hour of birth and within one day of birth, and percentage who received a prelacteal feed, Northeast Zone, Somalia 2011 Percentage who were ever breastfed1 Percentage who were first breastfed: Percentage who received a prelacteal feed Number of last-born children in the two years preceding the survey Within one hour of birth2 Within one day of birth Region Bari 88.0 54.4 79.8 46.0 646 Nugal 88.0 52.0 78.6 49.6 332 Mudug 90.3 60.2 85.8 53.2 553 Area Urban 87.6 54.0 80.1 49.6 955 Rural 90.9 59.2 84.4 49.0 576 Months since last birth 0-11 months 90.0 58.6 83.5 46.8 844 12-23 months 88.3 53.4 80.4 52.7 650 Assistance at deliverya Skilled attendant 91.1 53.3 83.2 47.9 589 Traditional birth attendant 91.4 60.3 84.5 52.7 853 Other (84.4) (52.)5 (77.6) (48.2) 44 Place of delivery Public sector health facility 92.1 59.2 83.9 48.8 140 Private sector health facility 83.7 38.4 72.8 45.3 54 Home 91.0 57.9 84.0 51.0 1,291 Other/Missing (22.2) (13.5) (22.2) (9.3) 46 Mother’s education None 88.4 56.5 81.7 49.6 1,178 Primary 91.5 54.7 82.8 50.4 260 Secondary+ 86.1 53.6 78.8 43.1 93 Wealth index quintile Poorest 89.8 64.4 85.7 47.8 302 Second 89.2 55.6 79.6 50.5 322 Middle 89.4 53.9 80.7 54.3 299 Fourth 86.2 52.4 81.5 47.0 312 Richest 89.5 53.8 81.0 47.2 295 Total 88.8 56.0 81.7 49.4 1,531 1 MICS indicator 2.4 2 MICS indicator 2.5 a Total includes 46 cases of children with missing information on assistance at delivery that are not shown separately ( ) Figures that are based on 25-49 unweighted cases 15 Figure NU.1. Percentage of mothers who started breastfeeding within one hour and within one day of birth, Northeast Zone, Somalia 2011 In Table NU.2, breastfeeding status is based on the reports of mothers/caretakers of children’s consumption of food and fluids during the previous day or night prior to the interview. Exclusively breastfed refers to infants who received only breast milk (and vitamins, mineral supplements, or medicine). The table shows exclusive breastfeeding of infants during the first six months of life, as well as continued breastfeeding of children at 12-15 and 20-23 months of age. 80 70 60 50 40 30 20 10 Within one day P er c en t Within one hour 0 Bari 90 100 7980 54 86 52 60 88 91 56 80 84 82 Nugal Mudug Urban Rural Northeastl Zone 16 Approximately 5 percent of children aged less than six months are exclusively breastfed, a level considerably much lower than recommended. (Table NU.2) About 43 percent of the children are still being breastfed by one year and 24 percent are still breastfed by 2 years of age. Breastfeeding rates are similar between girls and boys except for the 1 year olds whereby breastfeeding rate slightly differs between the boys (48 percent) compared to the girls (37 percent). The percent who are predominantly breastfed between 0-5 months was highest among the poorest households (41 percent), Bari region (33 percent) and in rural areas (33 percent). Figure NU.2 shows the detailed pattern of breastfeeding by the child’s age in months. Even at the earliest ages, the majority of children are receiving liquids or foods other than breast milk. By the end of the sixth month, the percentage of children exclusively breastfed is below 3 percent. Only about 20 percent of children are receiving breast milk up to 2 years. Table NU.2: Breastfeeding Percentage of living children according to breastfeeding status at selected age groups, Northeast Zone, Somalia 2011 Children age 0-5 months Children age 12-15 months Children age 20-23 months Percent exclusively breastfed1 Percent predominantly breastfed2 Number of children Percent breastfed (Continued breastfeeding at 1 year)3 Number of children Percent breastfed (Continued breastfeeding at 2 years)4 Number of children Sex Male 4.1 27.6 247 48.2 187 24.1 93 Female 5.5 26.3 234 37.4 210 23.9 72 Region Bari 6.2 32.5 194 40.7 154 17.3 71 Nugal 6.5 23.8 93 40.4 98 (19.5) 46 Mudug 2.6 22.8 194 45.8 145 (38.5) 48 Area Urban 4.6 23.0 291 41.6 235 18.7 103 Rural 5.1 33.0 189 43.7 162 32.8 62 Mother’s education None 5.2 27.6 370 43.4 301 25.9 137 Primary 2.4 21.7 84 41.9 80 (*) 18 Secondary+ 7.3 (33.6) 26 (*) 17 (*) 10 Wealth index quintile Poorest 4.8 41.0 104 40.7 92 (26.9) 31 Second 4.2 29.1 99 41.2 90 (15.2) 28 Middle 5.9 20.6 103 45.2 79 (36.0) 31 Fourth 6.1 20.4 96 44.3 76 (19.0) 42 Richest 2.4 21.9 79 41.3 60 (23.7) 33 Total 4.8 26.9 481 42.5 397 24.0 165 1 MICS indicator 2.6 2 MICS indicator 2.9 3 MICS indicator 2.7 4 MICS indicator 2.8 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 17 Figure NU.2: Infant feeding patterns by age, Northeast Zone, Somalia 2011 Table NU.3 shows the median duration of breastfeeding by selected background characteristics. Among children under age 3, the median duration is 12 months for any breastfeeding, less than 1 month (12 days) for exclusive breastfeeding, and for predominant breastfeeding. Boys are breastfed for about 2 months longer than girls for any breastfeeding while the median duration of exclusive breastfeeding did not differ based on background characteristics. Breastfed and complimentary foods Weaned (not breastfed) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0-1 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-17 18-19 20-21 22-23 Percent Age Exclusively breastfed Breastfed and plain water only Breastfed and non-milk liquids Breastfed and other milk / formula Breastfed and complimentary foods Weaned (not breastfed) Breastfed and other milk/formula 18 The adequacy of infant feeding in children under 24 months is provided in Table NU.4. Different criteria of feeding are used depending on the age of the child. For infants aged 0-5 months, exclusive breastfeeding is considered as age-appropriate feeding, while infants aged 6-23 months are considered to be appropriately fed if they are receiving breast milk and solid, semi-solid or soft food. Only 24 percent of children aged 6 – 23 months are breastfeeding while receiving solid, semi-solid or soft foods and only 18 percent of children aged 0-23 months are being appropriately fed. Age-appropriate feeding among all infants age 0-5 months is 5 percent. Table NU.3: Duration of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children age 0- 35 months, Northeast Zone, Somalia 2011. Median duration (in months) of Number of children age 0-35 months Any breastfeeding1 Exclusive breastfeeding Predominant breastfeeding Sex Male 12.6 0.4 0.7 1,362 Female 10.9 0.4 0.6 1,314 Region Bari 11.7 0.4 0.7 1,108 Nugal 11.0 0.5 0.6 576 Mudug 11.9 0.4 0.6 991 Area Urban 11.4 0.4 0.6 1,635 Rural 11.9 0.4 1.1 1,041 Mother’s education None 11.9 0.4 0.6 2,054 Primary 10.4 0.4 0.6 462 Secondary+ 10.7 0.4 1.1 159 Wealth index quintile Poorest 10.7 0.4 0.7 549 Second 11.7 0.4 0.6 559 Middle 11.3 0.5 0.8 529 Fourth 12.0 0.4 0.6 555 Richest 12.0 0.4 0.5 483 Median 11.6 0.4 0.6 2,676 Mean for all children (0-35 months) 14.5 0.4 2.6 2,676 1 MICS indicator 2.10 19 Appropriate complementary feeding of children from 6 months to two years of age is particularly important for growth and development and the prevention of under nutrition. Continued breastfeeding beyond six months should be accompanied by consumption of nutritionally adequate, safe and appropriate complementary foods that help meet nutritional requirements when breastmilk is no longer sufficient. This requires that for breastfed children, two or more meals of solid, semi-solid or soft foods are needed if they are six to eight months old, and three or more meals if they are 9-23 months of age. For children 6-23 months and older who are not breastfed, four or more meals of solid, semi-solid or soft foods or milk feeds are needed. Overall, one third of infants age 6-8 received solid, semi-solid, or soft foods (Table NU.5). Among currently breastfeeding infants this percentage is 33 while it is 42 percent among infants currently not breastfeeding. Table NU.4: Age-appropriate breastfeeding Percentage of children age 0-23 months who were appropriately breastfed during the previous day, Northeast Zone, Somalia 2011 Children age 0-5 months Children age 6-23 months Children age 0-23 months Percent exclusively breastfed1 Number of children Percent currently breastfeeding and receiving solid, semi-solid or soft foods Number of children Percent appropriately breastfed2 Number of children Sex Male 4.1 247 23.8 588 18.0 835 Female 5.5 234 23.6 581 18.4 814 Region Bari 6.2 194 20.9 498 16.8 692 Nugal 6.5 93 25.1 272 20.4 365 Mudug 2.6 194 26.2 399 18.5 592 Area Urban 4.6 291 22.5 734 17.4 1,025 Rural 5.1 189 25.7 435 19.5 624 Mother’s education None 5.2 370 24.3 877 18.6 1,247 Primary 2.4 84 24.5 222 18.4 306 Secondary+ 7.3 26 14.0 70 12.1 97 Wealth index quintile Poorest 4.8 104 25.5 222 18.9 326 Second 4.2 99 24.7 247 18.8 345 Middle 5.9 103 21.8 210 16.6 314 Fourth 6.1 96 22.3 257 17.9 353 Richest 2.4 79 24.0 233 18.6 311 Total 4.8 481 23.7 1,169 18.2 1,649 1 MICS indicator 2.6 2 MICS indicator 2.14 20 Table NU.6 presents the proportion of children age 6-23 months who received semi-solid or soft foods the minimum number of times or more during the day or night preceding the interview by breastfeeding status (see the note in Table NU.6 for a definition of minimum number of times for different age groups). Among currently breastfeeding children age 6-23 months, slightly more than one quarter of them (28 percent) were receiving solid, semi-solid and soft foods the minimum frequency and this proportion was highest in Nugal region and among the poorest wealth index quintile (35 percent). Among non-breastfeeding children, majority (83 percent) of the children received solid, semi-solid and soft foods or milk feeds 4 times or more. The proportion of children with the minimum meal frequency increased with age from 39 percent for children 6 to 8 months old to 69 percent for children 18 -23 months of age. Table NU.5: Introduction of solid, semi-solid or soft foods Percentage of infants age 6-8 months who received solid, semi-solid or soft foods during the previous day, Northeast Zone, Somalia 2011 Currently breastfeeding Currently not breastfeeding All Percent receiving solid, semi- solid or soft foods Number of children age 6-8 months Percent receiving solid, semi- solid or soft foods Number of children age 6- 8 months Percent receiving solid, semi- solid or soft foods1 Number of children age 6-8 months Sex Male 28.5 94 (*) 24 31.9 118 Female 38.4 91 (40.2) 30 38.9 121 Area Urban 32.8 117 (45.7) 34 35.7 150 Rural 34.4 69 (*) 20 34.9 89 Total 33.4 186 42.4 54 35.4 240 1 MICS indicator 2.12 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 21 The continued practice of bottle-feeding is a concern because of the possible contamination due to unsafe water and lack of hygiene in preparation. Table NU.7 shows that bottle-feeding is prevalent in Northeast Zone as 48 percent of children 0-23 months are fed using a bottle with a nipple. This is twice as much among younger children less than one year old (62 percent) compared to 33 percent of those between 12 to 23 months of age. Table NU.6: Minimum meal frequency Percentage of children age 6-23 months who received solid, semi-solid, or soft foods (and milk feeds for non-breastfeeding children) the minimum number of times or more during the previous day, according to breastfeeding status, Northeast Zone, Somalia 2011 Currently breastfeeding Currently not breastfeeding All Percent receiving solid, semi- solid and soft foods the minimum number of times Number of children age 6-23 months Percent receiving at least 2 milk feeds1 Percent receiving solid, semi-solid and soft foods or milk feeds 4 times or more Number of children age 6-23 months Percent with minimum meal frequency2 Number of children age 6-23 months Sex Male 26.9 282 89.5 82.9 305 56.0 587 Female 28.7 265 88.7 82.7 316 58.1 581 Age 6-8 months 26.9 186 96.5 81.2 54 39.1 240 9-11 months 21.7 87 94.1 (87.7) 49 45.4 136 12-17 months 29.8 198 87.4 82.7 305 61.8 503 18-23 months 31.7 76 88.6 82.3 214 69.0 290 Region Bari 28.4 236 89.2 83.6 262 57.5 498 Nugal 35.0 118 86.2 78.0 154 59.4 272 Mudug 22.6 194 91.3 85.4 205 54.8 399 Area Urban 27.7 335 90.9 85.3 399 59.0 734 Rural 27.9 212 86.0 78.3 223 53.7 435 Mother’s education None 29.1 422 87.8 81.5 455 56.3 877 Primary 23.4 97 93.5 88.7 124 60.0 222 Secondary+ (24.2) 28 90.9 (79.5) 42 57.2 70 Wealth index quintile Poorest 35.3 96 82.2 77.2 126 59.1 222 Second 24.6 122 85.6 74.0 125 49.6 247 Middle 25.0 96 92.0 84.3 114 57.2 210 Fourth 24.9 122 90.0 87.9 135 57.9 257 Richest 30.4 111 96.1 90.6 122 61.9 233 Total 27.8 547 89.1 82.8 621 57.0 1,169 1 MICS indicator 2.15 2 MICS indicator 2.13 ( ) Figures that are based on 25-49 unweighted cases 22 Children’s Vitamin A Supplementation Vitamin A is essential for eye health and proper functioning of the immune system. It is found in foods such as milk, liver, eggs, red and orange fruits, red palm oil and green leafy vegetables, although the amount of vitamin A readily available to the body from these sources varies widely. In developing areas of the world, where vitamin A is largely consumed in the form of fruits and vegetables, daily per capita intake is often insufficient to meet dietary requirements. Inadequate intakes are further compromised by increased requirements for the vitamin as children grow or during periods of illness, as well as increased losses during common childhood infections. As a result, vitamin A deficiency is quite prevalent in the developing world and particularly in countries with the highest burden of under-five deaths. The 1990 World Summit for Children set the goal of virtual elimination of vitamin A deficiency and its consequences, including blindness, by the year 2000. This goal was also endorsed at the Policy Conference on Ending Hidden Hunger in 1991, the 1992 International Conference on Nutrition, and the UN General Assembly’s Special Session on Children in 2002. The critical role of vitamin A for child health and immune function also makes control of deficiency a primary component of child survival efforts, and therefore critical to the achievement of the fourth Millennium Development Goal: a two-thirds reduction in under-five mortality by the year 2015. For countries with vitamin A deficiency problems, current international recommendations call for high-dose vitamin A supplementation every four to six months, targeted to all children between the ages of six to 59 months living in affected areas. Providing young children with two high-dose vitamin A capsules a year is Table NU.7: Bottle feeding Percentage of children age 0-23 months who were fed with a bottle with a nipple during the previous day, Northeast Zone, Somalia 2011 Percentage of children age 0-23 months fed with a bottle with a nipple1 Number of children age 0-23 months Sex Male 49.7 835 Female 46.9 814 Age 0-5 months 62.3 481 6-11 months 62.4 376 12-23 months 33.2 792 Region Bari 51.9 692 Nugal 48.6 365 Mudug 43.9 592 Area Urban 53.2 1,025 Rural 40.3 624 Mother’s education None 45.6 1,247 Primary 55.0 306 Secondary+ 62.1 97 Wealth index quintile Poorest 35.2 326 Second 49.3 345 Middle 49.2 314 Fourth 53.3 353 Richest 54.4 311 Total 48.3 1,649 1 MICS indicator 2.11 23 Table NU.8: Children's vitamin A supplementation Percentage of children age 6-59 months receiving a high dose vitamin A supplement in the last 6 months, Northeast Zone, Somalia 2011 Percentage who received Vitamin A in the last 6 months according to: Percentage of children who received Vitamin A in the last 6 months1 Number of children age 6- 59 months Child health book/card/vaccination card Mother's report Sex Male 2.4 26.0 26.7 2,148 Female 2.4 26.4 26.9 2,086 Region Bari 3.0 28.4 29.1 1,759 Nugal 2.7 25.0 25.3 900 Mudug 1.6 24.5 25.2 1,575 Area Urban 2.7 30.0 30.6 2,617 Rural 1.9 20.1 20.6 1,616 Age 6-11 months 4.7 17.6 19.2 376 12-23 months 3.4 25.4 26.2 792 24-35 months 2.2 27.2 28.2 1,027 36-47 months 2.2 28.2 28.4 1,067 48-59 months 1.1 27.0 27.1 972 Mother’s education None 2.4 24.2 24.8 3,254 Primary 2.5 33.6 34.0 713 Secondary+ 2.2 31.3 32.4 266 Wealth index quintile Poorest 0.8 21.4 21.5 900 Second 2.8 27.6 28.4 866 Middle 2.4 27.5 28.3 817 Fourth 3.0 24.8 25.7 869 Richest 3.2 30.4 30.9 781 Total 2.4 26.2 26.8 4,233 1 MICS indicator 2.17 a safe, cost-effective, efficient strategy for eliminating vitamin A deficiency and improving child survival. Giving vitamin A to new mothers who are breastfeeding helps protect their children during the first months of life and helps to replenish the mother’s stores of vitamin A, which are depleted during pregnancy and lactation. For countries with vitamin A supplementation programs, the definition of the indicator is the percent of children 6-59 months of age receiving at least one high dose vitamin A supplement in the last six months. In Northeast Zone, vitamin A supplementation of young children is carried out via Child Health Days while for post-partum supplementation for mothers within eight weeks of giving birth is given through the health facilities. Within the six months prior to the MICS, 27 percent of children aged 6-59 months received a high dose Vitamin A supplement (Table NU.8). Vitamin A supplementation coverage is lower in the rural areas, among children 6 – 11 months old, and among children whose mothers have no education. The age pattern of Vitamin A supplementation shows that supplementation in the last six months rises from 19 percent among children aged 6-11 months to 28 percent among children aged 36-47 months. 24 Weighing children at birth Weight at birth is a good indicator not only of a mother’s health and nutritional status but also the newborn’s chances for survival, growth, long-term health and psychosocial development. Low birth weight (less than 2,500 grams) carries a range of grave health risks for children. Babies who were undernourished in the womb face a greatly increased risk of dying during their early months and years. Those who survive have impaired immune function and increased risk of disease; they are likely to remain undernourished, with reduced muscle strength, throughout their lives, and suffer a higher incidence of diabetes and heart disease in later life. Children born underweight also tend to have a lower IQ and cognitive disabilities, affecting their performance in school and their job opportunities as adults. One of the major challenges in measuring the incidence of low birth weight is the fact that more than half of infants in the developing world are not weighed. In the past, most estimates of low birth weight for developing countries were based on data compiled from health facilities. However, these estimates are biased for most developing countries because the majority of newborns are not delivered in facilities, and those who are represent only a selected sample of all births. The percent of live birth below 2,500 grams is not presented here as the method of calculation would introduce significant bias on the estimate due to the low percentage of children actually weighed and the distribution of these across socio-economic and demographic groups. In the Northeast Zone MICS, only 4 percent of infants were weighted at birth (Table NU.9). Table NU.9: Infants weighed at birth Percentage of live births last-born of children in the 2 years preceding the survey that were weighed at birth, North East Zone, Somalia 2011 Percent of live births weighed at birth1 Number of last-born children in the two years preceding the survey Region Bari 5.2 646 Nugal 3.6 332 Mudug 1.4 553 Area Urban 4.4 955 Rural 2.0 576 Mother’s education None 2.6 1,178 Primary 4.2 260 Secondary 12.6 93 Wealth index quintile Poorest 1.4 302 Second 1.3 322 Middle 2.4 299 Fourth 5.1 312 Richest 7.5 295 Total 3.5 1,531 1MICS indicator 2.19 25 V. Child Health Vaccinations The Millennium Development Goal (MDG) 4 is to reduce child mortality by two thirds between 1990 and 2015. Immunization plays a key part in this goal. Immunizations have saved the lives of millions of children in the three decades since the launch of the Expanded Programme on Immunization (EPI) in 1974. Worldwide there are still 27 million children overlooked by routine immunization and as a result, vaccine-preventable diseases cause more than 2 million deaths every year. A World Fit for Children goal is to ensure full immunization of children under one year of age at 90 percent nationally, with at least 80 percent coverage in every district or equivalent administrative unit. According to UNICEF and WHO guidelines, a child should receive a BCG vaccination to protect against tuberculosis, three doses of DPT to protect against diphtheria, pertussis, and tetanus, three doses of polio vaccine, and a measles vaccination by the age of 12 months. Information on vaccination coverage was collected for all children under five years of age. All mothers or caretakers were asked to provide vaccination cards. If the vaccination card for a child was available, interviewers copied vaccination information from the cards onto the MICS questionnaire. If no vaccination card was available for the child, the interviewer proceeded to ask the mother to recall whether or not the child had received each of the vaccinations, and for Polio, DPT and Hepatitis B, how many doses were received. The final vaccination coverage estimates are based on both information obtained from the vaccination card and the mother’s report of vaccinations received by the child. The percentage of children age 12 to 23 months who have received each of the specific vaccinations by source of information (vaccination card and mother’s recall) is shown in Table CH.1. The denominator for the table is comprised of children age 12-23 months so that only children who are old enough to be fully vaccinated are counted. In the first three columns of the table, the numerator includes all children who were vaccinated at any time before the survey according to the vaccination card or the mother’s report. In the last column, only those children who were vaccinated before their first birthday, as recommended, are included. For children without vaccination cards, the proportion of vaccinations given before the first birthday is assumed to be the same as for children with vaccination cards. 26 Approximately 17 percent of children age 12-23 months received a BCG vaccination by the age of 12 months and 19 percent of children had received their first dose of DPT by 12 months of age. The percentage declines for subsequent doses of DPT to 13 percent for the second dose, and 7 percent for the third dose (Figure CH.1). Similarly, 19 percent of children received Polio 1 by the age of 12 months but the proportion declines to 8 percent by the third dose. The coverage for measles vaccine by 12 months is 17 percent although 25 percent of children 12 – 23 months had received measles vaccination any time before the survey. As a result, the percentage of children who had all the recommended vaccinations (excluding polio at birth) by their first birthday is very low; below 1 percent. Table CH.1: Vaccinations in first year of life Percentage of children age 12-23 months immunized against childhood diseases at any time before the survey and before the first birthday, Northeast Zone, Somalia 2011 Vaccinated at any time before the survey according to: Vaccinated by 12 months of age Vaccination card Mother's report Either BCG1 6.4 16.6 23.0 16.6 Polio At birth 4.0 9.6 13.7 12.0 1 7.0 19.5 26.5 19.2 2 4.1 15.3 19.4 17.2 32 2.4 7.2 9.7 8.3 DPT 1 8.5 15.6 24.1 18.8 2 5.7 10.3 16.0 12.7 33 4.1 5.3 9.4 7.2 Measles4 9.3 16.2 25.4 16.6 All vaccinations 1.6 1.7 3.4 0.4 No vaccinations 0.1 65.0 65.1 65.1 Number of children age 12-23 months 792 792 792 792 1 MICS indicator 3.1; 2 MICS indicator 3.2; 3 MICS indicator 3.3 4 MICS indicator 3.4; MDG indicator 4.3 27 Figure CH.1. Percentage of children aged 12 – 23 months who received the recommended vaccinations by 12 months, Northeast Zone, Somalia 2011 Table CH.2 presents vaccination coverage estimates among children 12-23 months by background characteristics. The figures indicate children receiving the vaccinations at any time up to the date of the survey, based on information from both the vaccination cards and mothers’/caretakers’ reports. Vaccination cards have been seen by the interviewer for only 13 percent of children. Vaccination coverage tends to be lower in the rural areas than urban areas with differences sometimes as larger as 10 percentage points. 0 80 40 20 100 60 P er c en t BCG DPT1 DPT2 DPT3 Polio 1 Polio 2 Polio 3 Measles 19 7 19 17 10 30 50 70 90 17 13 17 8 All Vaccines 28 Ta bl e CH .2 : V ac ci na tio ns b y ba ck gr ou nd c ha ra ct er is tic s Pe rc en ta ge o f c hi ld re n ag e 12 -2 3 m on th s c ur re nt ly v ac ci na te d ag ai ns t c hi ld ho od d ise as es , N or th ea st Z on e, S om al ia 2 01 1 Pe rc en ta ge o f c hi ld re n w ho re ce iv ed : Pe rc en ta ge w ith va cc in at io n ca rd se en N um be r of ch ild re n ag e 12 -2 3 m on th s BC G Po lio DP T M ea sle s N on e Al l At b irt h 1 2 3 1 2 3 Se x M al e 20 .9 11 .8 25 .1 17 .3 9. 1 22 .3 13 .2 9. 6 23 .1 66 .7 3. 5 14 .3 39 9 Fe m al e 25 .1 15 .6 27 .8 21 .6 10 .2 25 .8 18 .8 9. 3 27 .8 63 .5 3. 2 11 .7 39 4 Re gi on Ba ri 23 .9 14 .5 27 .8 19 .1 10 .6 26 .1 17 .4 10 .0 27 .7 63 .0 4. 3 15 .8 32 3 N ug al 22 .1 11 .4 27 .1 20 .9 12 .6 22 .8 14 .6 13 .0 26 .3 60 .9 4. 9 17 .6 18 4 M ud ug 22 .5 14 .2 24 .5 18 .9 6. 7 22 .6 15 .2 6. 6 22 .3 70 .2 1. 4 6. 8 28 5 Ar ea U rb an 25 .0 14 .9 30 .1 22 .6 10 .2 27 .0 19 .7 11 .4 27 .9 60 .9 3. 7 14 .8 49 3 Ru ra l 19 .6 11 .6 20 .5 14 .2 8. 7 19 .3 9. 8 6. 2 21 .5 72 .0 2. 9 10 .1 29 9 M ot he r’s e du ca tio n N on e 21 .9 12 .6 25 .2 17 .5 8. 8 22 .4 14 .7 8. 4 23 .6 66 .7 2. 6 12 .8 60 7 Pr im ar y 26 .9 17 .7 31 .9 25 .2 11 .4 31 .7 19 .6 13 .3 31 .2 58 .4 5. 6 14 .6 14 2 Se co nd ar y+ (2 4. 8) (1 5. 5) (2 6. 7) (2 6. 7) (1 5. 3) (2 2. 1) (2 2. 1) (1 0. 9) (3 1. 8) (6 4. 6) (6 .5 ) (1 0. 9) 44 W ea lth in de x qu in til e Po or es t 21 .1 11 .2 23 .1 16 .2 8. 1 19 .9 16 .8 5. 5 21 .8 69 .5 1. 3 6. 7 16 5 Se co nd 27 .4 16 .8 26 .3 20 .0 10 .7 28 .3 16 .1 11 .2 29 .0 61 .6 4. 4 15 .7 16 3 M id dl e 24 .3 12 .1 29 .1 17 .6 11 .4 26 .6 13 .0 12 .5 27 .3 64 .1 3. 5 15 .3 14 5 Fo ur th 19 .0 12 .8 26 .7 18 .2 8. 2 21 .6 13 .3 7. 1 24 .9 65 .9 2. 7 13 .0 17 7 Ri ch es t 23 .8 15 .6 27 .7 25 .8 10 .2 24 .4 21 .1 11 .5 24 .1 64 .0 5. 4 14 .8 14 2 To ta l 23 .0 13 .7 26 .5 19 .4 9. 7 24 .1 16 .0 9. 4 25 .4 65 .1 3. 4 13 .0 79 2 ( ) F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s 29 Neonatal Tetanus Protection One of the MDGs is to reduce by three quarters the maternal mortality ratio, with one strategy to eliminate maternal tetanus. In addition, another goal is to reduce the incidence of neonatal tetanus to less than 1 case of neonatal tetanus per 1000 live births in every district. A World Fit for Children goal is to eliminate maternal and neonatal tetanus by 2005. The strategy for preventing maternal and neonatal tetanus is to ensure all pregnant women receive at least two doses of tetanus toxoid vaccine. If a woman has not received at least two doses of tetanus toxoid during a particular pregnancy, she (and her newborn) is also considered to be protected against tetanus if she: • Received at least two doses of tetanus toxoid vaccine, the last within the previous 3 years; • Received at least 3 doses, the last within the previous 5 years; • Received at least 4 doses, the last within the previous 10 years; • Received 5 or more doses anytime during her life. To assess the status of tetanus vaccination coverage, women who gave birth during the two years before the survey were asked if they had received tetanus toxoid injections during the pregnancy for their most recent birth, and if so, how many. Women who did not receive two or more tetanus toxoid vaccinations during this pregnancy were then asked about tetanus toxoid vaccinations they may have received prior to this pregnancy. Interviewers also asked women to present their vaccination card, on which dates of tetanus toxoid are recorded and referred to information from the cards when available. Table CH.3 shows the protection status from tetanus of women who have had a live birth within the last 2 years. Only 17 percent of women had received at least two doses during the last pregnancy. Another 9 percent had received 2 doses within three years prior to the birth. Overall 27 percent of women are protected against tetanus. 30 Table CH.3: Neonatal tetanus protection Percentage of women age 15-49 years with a live birth in the last 2 years protected against neonatal tetanus, Northeast Zone, 2011 Percentage of women who received at least 2 doses during last pregnancy Percentage of women who did not receive two or more doses during last pregnancy but received: Protected against tetanus1 Number of women with a live birth in the last 2 years 2 doses, the last within prior 3 years 3 doses, the last within prior 5 years 4 doses, the last within prior 10 years 5 or more doses during lifetime Region Bari 17.9 9.9 0.6 0.4 0.3 28.8 646 Nugal 15.0 9.6 1.8 0.4 0.0 26.4 332 Mudug 16.9 7.0 1.1 0.5 0.4 25.3 553 Area Urban 20.4 9.7 1.2 0.0 0.3 31.7 955 Rural 11.1 7.2 0.7 0.5 0.2 19.3 576 Education None 16.0 7.9 0.9 0.5 0.3 25.1 1,178 Primary 18.0 13.0 1.2 0.0 0.0 32.1 260 Secondary+ 26.3 8.3 2.1 0.0 1.0 37.7 93 Wealth index quintile Poorest 12.0 8.5 1.4 0.0 0.0 21.9 302 Second 13.7 8.8 1.5 0.9 0.6 24.7 322 Middle 17.4 9.1 0.0 0.7 0.3 26.8 299 Fourth 21.4 7.8 1.5 0.0 0.0 30.7 312 Richest 20.3 9.8 0.7 0.3 0.3 31.1 295 Total 16.9 8.8 1.0 0.1 0.3 27.2 1,531 1 MICS indicator 3.7 As shown in figure CH.2 Women in urban areas are more likely to vaccinate against tetanus compared to women in rural areas (32 percent versus 19 percent). Vaccination against tetanus is associated to the level of maternal education; 25 percent of women with no education are protected against tetanus compared to 38 percent of women with secondary or higher education. Furthermore, women from the wealthiest households are more likely to be protected from tetanus compared to those from the poorest households (31 percent versus 22 percent). Figure CH.2 shows the protection of women against neonatal tetanus by major background characteristics. 31 Figure CH.2. Percentage of women with a live birth in the last 12 months who are protected against neonatal tetanus, Northeast Zone, Somalia 2011 5 The validity of this indicator is affected by the mother’s perception of diarrhoea as an illness and her capacity to recall the events. Moreover, the prevalence of diarrhea varies seasonally. Thus, this variable should be interpreted with caution. Per cent Northeast Zone Urban 27 0.0 10.0 20.0 30.0 40.0 50.0 Secondary + Primary None Mother’s Education Rural Area Mudug Nugal Bari Regions 38 32 25 29 32 26 26 29 Oral Rehydration Treatment Diarrhoea is the second leading cause of death among children under five worldwide. Most diarrhoea- related deaths in children are due to dehydration from loss of large quantities of water and electrolytes from the body in liquid stools. Management of diarrhoea – either through oral rehydration salts (ORS) or a recommended home fluid (RHF) - can prevent many of these deaths. Preventing dehydration and malnutrition by increasing fluid intake and continuing to feed the child are also important strategies for managing diarrhoea. The goals are to: 1) reduce by one half death due to diarrhoea among children under five by 2010 compared to 2000 (A World Fit for Children); and 2) reduce by two thirds the mortality rate among children under five by 2015 compared to 1990 (Millennium Development Goals). In addition, the World Fit for Children calls for a reduction in the incidence of diarrhoea by 25 percent. In the MICS, prevalence of diarrhoea5 was estimated by asking mothers or caretakers whether their child under age five years had an episode of diarrhoea in the two weeks prior to the survey. In cases where mothers reported that the child had diarrhoea, a series of questions were asked about the treatment of the illness, including what the child had to drink and eat during the episode and whether this was more or less than the child usually drinks and eats. 32 Overall, 10 percent of under five children had diarrhoea in the two weeks preceding the survey (Table CH.4). Table CH.4 also shows the percentage of children receiving oral rehydration solutions during the episode of diarrhoea. About 41 percent received fluids from ORS packets or pre-packaged ORS fluids. More children in urban (47 percent) than rural (33 percent) areas received ORS during diarrhoea episode. Furthermore, children in the richest households were more likely to get treatment with ORS when they got diarrhoea compared to those from the poorest households (29 percent versus 67 percent). Nearly a half (49 percent) of the children who got diarrhoea received oral rehydration solution (Figure CH.3). Oral rehydration solution treatment was highest in Mudug and lowest in Nugal region. Table CH.4: Oral rehydration solutions Percentage of children age 0-59 months with diarrhoea in the last two weeks, and treatment with oral rehydration solutions, Northeast Zone, Somalia 2011 Had diarrhoea in last two weeks Number of children age 0-59 months Children with diarrhoea who received ORS (Fluid from ORS packet or pre-packaged ORS fluid) Number of children age 0-59 months with diarrhoea in last two weeks Sex Male 10.7 2,395 43.0 256 Female 9.9 2,319 38.1 231 Region Bari 11.6 1,952 44.2 226 Nugal 12.2 993 34.5 121 Mudug 7.9 1,768 40.4 139 Area Urban 9.7 2,908 46.8 281 Rural 11.4 1,806 32.5 206 Age 0-11 months 12.7 857 37.4 109 12-23 months 12.4 792 45.4 98 24-35 months 11.3 1,027 41.4 116 36-47 months 7.9 1,067 40.0 84 48-59 months 8.2 972 39.3 79 Mother’s education None 10.4 3,624 40.5 376 Primary 10.1 797 41.2 80 Secondary+ 10.3 293 (42.1) 30 Wealth index quintile Poorest 12.8 1,004 28.7 129 Second 13.0 965 38.9 125 Middle 10.2 920 40.4 94 Fourth 8.8 965 45.4 85 Richest 6.2 860 67.2 53 Total 10.3 4,714 40.7 486 ( ) Figures that are based on 25-49 unweighted cases 33 Figure CH.3. Percentage of children under age 5 with diarrhoea who received oral rehydration solution, Northeast Zone, Somalia 2011 About 16 percent of under five children with diarrhoea drank more than usual while 84 percent drank the same, somewhat less, much less or nothing (Table CH.5). About 53 percent ate somewhat less, same or more (continued feeding), but 37 percent ate much less or ate nothing. The eating and feeding practices during diarrhoea gives a mixed picture across social demographic characteristics with not clear trend in variability between categories of different variables. Table CH.6 provides the proportion of children age 0-59 months with diarrhoea in the last two weeks who received oral rehydration therapy with continued feeding, and percentage of children with diarrhoea who received other treatments. Overall, 49 percent of children with diarrhoea received ORT (ORS or recommended homemade fluids or increased fluids). Combining the information in Table CH.5 with that in Table CH.4 on oral rehydration therapy, it is observed that 24 percent of children either received ORT and, at the same time, feeding was continued, as is the recommendation. Although it is not the recommended treatment for children with diarrhoea, 17 percent of children received antibiotics and a further 17 percent received anti-motility treatments. On the other hand, zinc treatment which is recommended for decreasing the intensity and frequency of diarrhoea was given in 1 per cent of the cases. There are differences in the home management of diarrhoea by background characteristics (Figure CH.4). In Nugal region only 18 percent of children received ORT and continued feeding, while the figure is 37 percent in Mudug region. A child living in the richest households is more than twice as likely to be receiving the recommended treatment during diarrhoea compared to children in the poorest households (17 percent versus 38 percent; Table CH.5). In addition, the age of a child also determines if they will receive ORT treatment with continued feeding with and is lowest among those less than one year (15 percent) compared to those children who are four years old (30 percent). 0 40 20 10 50 30 P er c en t Bari None Primary SecondaryNugal Mudug Northeast Zone 49 60 70 39 59 49 51 (48) 49 ( ) Figures in parenthesis represent less than 50 unweighted cases 34 Ta bl e CH .5 : F ee di ng p ra ct ic es d ur in g di ar rh ea Pe rce nt dis tri bu tio n o f c hil dre n a ge 0- 59 m on ths w ith di arr ho ea in th e l ast tw o w ee ks by am ou nt of liq uid s a nd fo od gi ve n d uri ng ep iso de of di arr ho ea , N ort he ast Zo ne , S om ali a 2 01 1 Ha d dia rrh oe a in las t tw o we ek s Nu mb er of ch ild ren ag e 0-5 9 mo nth s Dr in ki ng p ra ct ic es d ur in g di ar rh oe a: Ea tin g pr ac tic es d ur in g di ar rh oe a: Nu mb er of ch ild ren ag e 0 -59 mo nth s wi th dia rrh oe a in las t tw o we ek s Giv en mu ch les s t o dri nk Giv en so me wh at les s t o dri nk Giv en ab ou t the sam e to dri nk Giv en mo re to dri nk Giv en no thi ng to dri nk Mi ssi ng /D K Giv en mu ch les s t o ea t Giv en so me - wh at les s t o ea t Giv en ab ou t the sam e to ea t Giv en mo re to ea t Sto p- pe d foo d Ha d ne ve r be en giv en foo d Mi ssi ng / DK To tal To tal Se x Ma le 10 .7 23 95 21 .9 32 .7 22 .3 18 .4 3.6 1.2 10 0.0 22 .7 27 .4 14 .6 10 .6 13 .6 9.5 1.6 10 0.0 25 6 Fe ma le 9.9 23 19 26 .4 38 .9 16 .3 12 .3 5.7 0.4 10 0.0 27 .8 31 .4 14 .6 6.7 10 .8 7.8 0.9 10 0.0 23 1 Re gi on Ba ri 11 .6 19 52 31 .5 32 .3 19 .5 11 .1 5.0 0.4 10 0.0 30 .8 24 .2 15 .5 5.0 15 .1 8.0 1.4 10 0.0 22 6 Nu ga l 12 .2 99 3 20 .3 41 .3 20 .5 10 .7 6.4 0.9 10 0.0 18 .2 35 .2 11 .5 8.3 13 .8 12 .2 0.9 10 0.0 12 1 Mu du g 7.9 17 68 15 .0 36 .0 18 .6 26 .8 2.2 1.4 10 0.0 22 .0 32 .5 15 .8 15 .3 6.3 6.7 1.5 10 0.0 13 9 Ar ea Ur ba n 9.7 29 08 20 .5 37 .5 21 .5 15 .4 4.1 1.0 10 0.0 26 .6 26 .6 15 .7 7.2 14 .3 8.9 0.7 10 0.0 28 1 Ru ral 11 .4 18 06 28 .8 33 .0 16 .8 15 .7 5.2 0.5 10 0.0 23 .0 33 .0 13 .1 11 .0 9.4 8.4 2.1 10 0.0 20 6 Ag e 0-1 1 m on ths 12 .7 85 7 27 .9 31 .6 28 .3 8.4 3.8 0.0 10 0.0 27 .7 19 .1 20 .2 5.6 7.0 18 .4 1.9 10 0.0 10 9 12 -23 m on ths 12 .4 79 2 23 .9 31 .6 19 .0 16 .5 6.0 3.0 10 0.0 21 .0 31 .2 11 .2 10 .2 15 .1 11 .2 0.0 10 0.0 98 24 -35 m on ths 11 .3 10 27 21 .9 38 .2 16 .7 19 .7 3.5 0.0 10 0.0 28 .5 25 .3 14 .7 9.9 13 .0 6.8 1.9 10 0.0 11 6 36 -47 m on ths 7.9 10 67 25 .5 36 .7 15 .4 15 .5 5.8 1.1 10 0.0 23 .6 38 .0 13 .1 7.3 14 .4 1.3 2.4 10 0.0 84 48 -59 m on ths 8.2 97 2 20 .2 41 .2 16 .5 18 .0 4.1 0.0 10 0.0 23 .3 37 .6 12 .5 11 .3 12 .5 2.7 0.0 10 0.0 79 M ot he r’s e du ca tio n No ne 10 .4 36 24 23 .8 35 .4 19 .7 15 .0 5.1 1.1 10 0.0 25 .9 28 .4 15 .4 9.5 11 .4 8.0 1.4 10 0.0 37 6 Pri ma ry 10 .1 79 7 25 .4 36 .9 16 .3 19 .0 2.5 0.0 10 0.0 27 .5 36 .0 9.0 4.9 11 .5 10 .0 1.2 10 0.0 80 Se co nd ary + 10 .3 29 3 (23 .0) (34 .9) (25 .4) (13 .1) (3. 6) (0. 0) 10 0.0 (9. 5) (22 .6) (19 .1) (9. 9) (25 .4) (13 .5) (0. 0) 10 0.0 30 W ea lth in de x qu in til e Po ore st 12 .8 10 04 25 .9 34 .7 20 .6 14 .0 4.2 0.7 10 0.0 25 .6 30 .2 16 .7 8.9 8.1 9.7 0.8 10 0.0 12 9 Se co nd 13 .0 96 5 28 .0 33 .0 17 .0 13 .2 7.9 0.9 10 0.0 22 .3 34 .4 9.2 8.3 13 .7 10 .4 1.7 10 0.0 12 5 Mi dd le 10 .2 92 0 17 .4 42 .5 13 .8 22 .0 3.3 1.0 10 0.0 26 .1 21 .1 13 .7 10 .9 18 .8 8.3 1.1 10 0.0 94 Fo urt h 8.8 96 5 23 .7 34 .0 23 .0 17 .0 1.1 1.1 10 0.0 29 .4 28 .6 18 .3 9.0 7.9 5.8 1.1 10 0.0 85 Ric he st 6.2 86 0 22 .2 34 .4 27 .2 10 .9 5.4 0.0 10 0.0 21 .9 30 .8 18 .1 5.4 14 .5 7.5 1.8 10 0.0 53 To tal 10 .3 47 14 24 .0 35 .6 19 .5 15 .5 4.6 0.8 10 0.0 25 .1 29 .3 14 .6 8.8 12 .3 8.7 1.3 10 0.0 48 6 ( ) Fig ure s t ha t a re ba sed on 25 -49 un we igh ted ca ses 35 Ta bl e CH .6 : O ra l r eh yd ra tio n th er ap y w ith co nt in ue d fe ed in g an d ot he r t re at m en ts Pe rc en ta ge o f c hi ld re n ag e 0- 59 m on th s w ith d ia rr ho ea in th e la st tw o w ee ks w ho re ce iv ed o ra l r eh yd ra tio n th er ap y w ith c on tin ue d fe ed in g, a nd p er ce nt ag e of c hi ld re n w ith d ia rr ho ea w ho re ce iv ed ot he r t re at m en ts , N or th ea st Z on e, S om al ia 2 01 1 O th er tr ea tm en ts : N ot g iv en an y tr ea tm en t or d ru g N um be r o f ch ild re n ag e 0- 59 m on th s w ith di ar rh oe a in la st tw o w ee ks O RT (O RS o r in cr ea se d flu id s) O RT w ith co nt in ue d fe ed in g1 Pi ll or sy ru p In je ct io n In tr a- ve no us Ho m e re m ed y, he rb al m ed ic in e O th er An ti- bi ot ic An ti- m ot ili ty Zi nc U nk no w n An ti- bi ot ic N on - an tib io tic Se x M al e 51 .4 25 .9 17 .0 18 .0 1. 2 2. 2 1. 9 0. 4 2. 0 5. 4 1. 6 35 .8 25 6 Fe m al e 47 .0 21 .6 16 .1 15 .7 1. 2 3. 0 2. 5 0. 0 1. 3 3. 6 1. 2 37 .1 23 1 Re gi on Ba ri 48 .7 18 .7 20 .5 14 .7 2. 6 2. 6 3. 5 0. 5 1. 8 5. 8 1. 4 33 .2 22 6 N ug al 39 .4 18 .1 15 .4 11 .6 0. 0 5. 6 1. 6 0. 0 1. 6 3. 4 2. 5 44 .1 12 1 M ud ug 58 .7 37 .4 11 .3 25 .1 0. 0 0. 0 0. 7 0. 0 1. 5 3. 5 0. 7 34 .9 13 9 Ar ea U rb an 53 .9 24 .9 21 .5 20 .5 1. 7 3. 8 3. 1 0. 0 1. 7 4. 4 1. 4 29 .7 28 1 Ru ra l 42 .9 22 .5 9. 9 12 .0 0. 5 1. 0 1. 0 0. 5 1. 6 4. 7 1. 6 45 .5 20 6 Ag e 0- 11 m on th s 43 .1 14 .5 12 .3 13 .6 1. 8 1. 8 3. 5 0. 0 2. 8 3. 6 0. 9 39 .9 10 9 12 -2 3 m on th s 50 .5 27 .6 22 .8 12 .1 1. 0 2. 0 4. 1 0. 0 0. 0 8. 3 2. 1 34 .0 98 24 -3 5 m on th s 55 .1 24 .5 21 .7 22 .5 0. 9 6. 0 0. 0 0. 0 1. 8 4. 3 1. 8 28 .2 11 6 36 -4 7 m on th s 48 .4 24 .9 8. 5 16 .1 1. 1 0. 0 0. 0 0. 0 1. 1 4. 7 1. 3 43 .4 84 48 -5 9 m on th s 48 .6 30 .4 16 .0 20 .1 1. 2 2. 4 3. 6 1. 4 2. 6 1. 4 1. 2 39 .1 79 M ot he r’s e du ca tio n N on e 48 .9 23 .3 14 .6 16 .6 1. 1 2. 6 2. 9 0. 3 1. 9 4. 1 0. 8 38 .6 37 6 Pr im ar y 51 .2 24 .6 22 .8 16 .4 1. 2 2. 4 0. 0 0. 0 0. 0 7. 2 5. 2 26 .3 80 Se co nd ar y+ (4 8. 4) (2 9. 4) (2 5. 8) (2 2. 2) (3 .2 ) (3 .2 ) (0 .0 ) (0 .0 ) (3 .2 ) (3 .6 ) (0 .0 ) (3 5. 7) 30 W ea lth in de x qu in til e Po or es t 38 .7 17 .1 10 .9 10 .3 0. 7 0. 8 1. 6 0. 0 1. 5 5. 7 2. 4 48 .6 12 9 Se co nd 44 .8 20 .6 11 .6 12 .2 0. 0 2. 4 1. 6 0. 9 1. 7 3. 3 0. 0 46 .0 12 5 M id dl e 53 .9 24 .7 20 .8 15 .9 0. 0 3. 0 3. 0 0. 0 2. 2 3. 2 2. 2 26 .3 94 Fo ur th 54 .4 29 .4 17 .0 25 .1 2. 4 4. 5 2. 2 0. 0 1. 1 5. 6 1. 1 27 .4 85 Ri ch es t 69 .0 38 .0 34 .4 32 .6 5. 4 3. 6 3. 6 0. 0 1. 8 5. 4 1. 8 16 .5 53 To ta l 49 .3 23 .9 16 .6 16 .9 1. 2 2. 6 2. 2 0. 2 1. 6 4. 6 1. 5 36 .4 48 6 1 M IC S in di ca to r 3 .8 ( ) F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s 36 Figure CH.4. Percentage of children under age 5 with diarrhoea who received ORT, or increased fluids and continued feeding, Northeast Zone, Somalia 2011 Care Seeking and Antibiotic Treatment of Pneumonia Pneumonia is the leading cause of death in children and the use of antibiotics in children under 5 years of age with suspected pneumonia is a key intervention. A World Fit for Children goal is to reduce by one- third the deaths due to acute respiratory infections. In Northeast Zone, Somalia MICS, the prevalence of suspected pneumonia6 was estimated by asking mothers or caretakers whether their child under age five had an illness with a cough accompanied by rapid or difficult breathing, and whose symptoms were due to a problem in the chest or both a problem in the chest and a blocked nose. 6 These data are based on the mother’s perception of illness and not validated by a medical examination. Moreover, the prevalence of pneumonia varies seasonally. Thus, this variable should be interpreted with caution as it may be subject to considerable bias. Per cent Northeast Zone Urban 24 0.0 10.0 20.0 30.0 40.035.0 Secondary + Primary None Mother’s Education Rural Area Mudug Nugal Bari Regions (29) 25 23 23 25 37 18 19 25.015.05.0 ( ) Figures in parenthesis are based on less than 50 unweighted cases and should be interpreted with caution. 37 Ta bl e CH .7 : C ar e se ek in g fo r s us pe ct ed p ne um on ia a nd a nt ib io tic u se d ur in g su sp ec te d pn eu m on ia Pe rc en ta ge o f c hi ld re n ag e 0- 59 m on th s w ith su sp ec te d pn eu m on ia in th e la st tw o w ee ks w ho w er e ta ke n to a h ea lth p ro vi de r a nd p er ce nt ag e of c hi ld re n w ho w er e gi ve n an tib io tic s, N or th ea st Z on e, 2 01 1 Ha d su sp ec te d pn eu m on ia in th e la st tw o w ee ks N um be r of ch ild re n ag e 0- 59 m on th s Ch ild re n w ith su sp ec te d pn eu m on ia w ho w er e ta ke n to : Pe rc en ta ge o f ch ild re n w ith su sp ec te d pn eu m on ia w ho re ce iv ed an tib io tic s i n th e la st tw o w ee ks 2 N um be r o f ch ild re n ag e 0- 59 m on th s w ith su sp ec te d pn eu m on ia in th e la st tw o w ee ks Pu bl ic so ur ce s Pr iv at e so ur ce s O th er so ur ce An y ap pr op ria te pr ov id er 1 Go vt . ho sp ita l Go vt . he al th ce nt re Go vt . he al th po st Vi lla ge he al th w or ke r O th er pu bl ic Pr iv at e ho sp ita l/ cl in ic Pr iv at e ph ys ic ia n Pr iv at e ph ar m ac y Re la tiv e or fr ie nd Tr ad . Pr ac tit io ne r Se x M al e 4. 7 2, 39 5 12 .3 5. 2 7. 1 1. 9 0. 0 12 .4 8. 7 12 .0 0. 9 0. 0 39 .6 53 .5 11 2 Fe m al e 5. 1 2, 31 9 11 .6 7. 3 1. 6 4. 5 2. 4 2. 4 8. 2 13 .6 0. 0 1. 7 30 .8 43 .8 11 8 Re gi on Ba ri 6. 2 1, 95 2 13 .0 5. 7 4. 1 5. 3 1. 6 9. 1 8. 8 13 .6 0. 0 0. 9 37 .7 53 .1 12 1 N ug al 5. 6 99 3 12 .0 1. 7 3. 4 1. 9 0. 0 10 .3 12 .2 12 .4 0. 0 0. 0 33 .0 43 .9 56 M ud ug 3. 0 1, 76 8 9. 5 12 .7 5. 7 0. 0 1. 8 0. 0 3. 6 11 .5 1. 8 1. 8 31 .5 43 .0 53 Ar ea U rb an 4. 4 2, 90 8 17 .0 10 .4 5. 9 0. 7 2. 2 9. 6 13 .3 11 .1 0. 7 0. 7 48 .1 57 .8 12 9 Ru ra l 5. 5 1, 80 6 5. 4 1. 1 2. 2 6. 5 0. 0 4. 3 2. 2 15 .1 0. 0 1. 1 18 .3 36 .6 10 0 Ag e 0- 11 m on th s 4. 6 85 7 (9 .8 ) (4 .9 ) (0 .0 ) (0 .0 ) (0 .0 ) (4 .9 ) (1 2. 2) (1 1. 0) (0 .0 ) (0 .0 ) (2 9. 3) (4 3. 0) 39 12 -2 3 m on th s 4. 9 79 2 (2 0. 0) (4 .9 ) (7 .4 ) (8 .0 ) (7 .4 ) (9 .9 ) (1 0. 2) (1 2. 3) (0 .0 ) (0 .0 ) (4 5. 5) (5 2. 9) 39 24 -3 5 m on th s 4. 5 1, 02 7 (6 .4 ) (8 .5 ) (4 .1 ) (2 .3 ) (0 .0 ) (4 .4 ) (6 .2 ) (1 9. 8) (2 .1 ) (2 .3 ) (2 7. 5) (4 7. 3) 47 36 -4 7 m on th s 5. 5 1, 06 7 13 .6 8. 2 1. 8 5. 5 0. 0 8. 6 6. 7 10 .6 0. 0 0. 0 37 .5 48 .5 59 48 -5 9 m on th s 4. 7 97 2 (1 0. 4) (4 .2 ) (8 .6 ) (0 .0 ) (0 .0 ) (8 .6 ) (8 .3 ) (1 0. 7) (0 .0 ) (2 .1 ) (3 6. 0) (5 0. 8) 46 M ot he r’s e du ca tio n N on e 5. 1 3, 62 4 11 .2 6. 3 2. 7 3. 5 1. 0 5. 4 6. 8 8. 8 0. 5 1. 1 31 .5 40 .5 18 5 Pr im ar y 4. 7 79 7 (1 2. 7) (2 .5 ) (7 .9 ) (0 .0 ) (0 .0 ) (1 5. 5) (1 3. 0) (3 2. 3) (0 .0 ) (0 .0 ) (4 6. 5) (8 1. 3) 38 Se co nd ar y+ 2. 3 29 3 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 7 W ea lth in de x qu in til e Po or es t 5. 2 1, 00 4 5. 8 3. 7 3. 9 4. 1 0. 0 1. 8 2. 1 7. 8 0. 0 0. 0 15 .7 23 .3 52 Se co nd 5. 5 96 5 11 .0 5. 4 1. 8 4. 0 0. 0 7. 6 1. 8 5. 8 0. 0 2. 0 28 .0 34 .1 53 M id dl e 5. 4 92 0 17 .7 4. 1 3. 8 4. 3 0. 0 6. 0 5. 7 18 .4 0. 0 0. 0 33 .5 54 .8 50 Fo ur th 3. 8 96 5 (1 0. 9) (7 .9 ) (5 .6 ) (0 ) (2 .6 ) (8 .2 ) (7 .9 ) (1 9. 1) (2 .6 ) (0 ) (4 0. 6) (5 9. 4) 36 Ri ch es t 4. 4 86 0 (1 5. 2) (1 2. 7) (7 .6 ) (2 .5 ) (5 .1 ) (1 5. 2) (3 0. 7) (1 6. 1) (0 .0 ) (2 .5 ) (6 8. 7) (8 4. 8) 38 To ta l 4. 9 4, 71 4 12 .0 6. 3 4. 3 3. 2 1. 3 7. 3 8. 5 12 .8 0. 4 0. 9 35 .1 48 .5 22 9 1 M IC S in di ca to r 3 .9 2 M IC S in di ca to r 3 .1 0 ( ) F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s (* ) Fi gu re s t ha t a re b as ed o n le ss th an 2 5 un w ei gh te d ca se s Th er e ar e no c as es o f p ub lic o r p riv at e m ob ile o r o ut re ac h cl in ic s o r s ho ps , s o th ey a re n ot sh ow n in th e ta bl e. 38 Table CH.7 presents the prevalence of suspected pneumonia and, if care was sought outside the home, the site of care. About 5 percent of children age 0-59 months was reported to have had symptoms of pneumonia during the two weeks preceding the survey. Of these children, 35 percent were taken to an appropriate provider. Under the private sources, the private pharmacy is the main source of care for suspected pneumonia (13 percent) and is as important as government hospital (12 percent) under public sources. Children living in urban areas are nearly three times more likely (48 percent) to get an appropriate care if they get pneumonia compared to children in rural areas (18 percent). Table CH.7 also presents the use of antibiotics for the treatment of suspected pneumonia in under- 5s by socio-demographic characteristics. In Northeast Zone, 49 percent of children under-5 years with suspected pneumonia had received an antibiotic during the two weeks prior to the survey. The percentage was considerably higher in urban (58 percent) than rural areas (37 percent). In Mudug region the percent is 43 compared to 53 percent in Bari region. Issues related to knowledge of danger signs of pneumonia are presented in Table CH.8. Obviously, mothers’ knowledge of the danger signs is an important determinant of care-seeking behaviour. Overall, just 7 percent of mothers and caretakers know of the two danger signs of pneumonia – fast and difficult breathing. The most commonly identified symptom for taking a child to a health facility is if the child has fever and become sicker. Twenty two percent of mothers identified fast breathing and 18 percent of mothers identified difficult breathing as symptoms for taking children immediately to a health care provider. More women in urban and those with secondary or higher education compared to rural women or those with no education had knowledge of the two danger signs of pneumonia. 39 dĂďůĞ��,͘ϴ͗�<ŶŽǁůĞĚŐĞ�ŽĨ�ƚŚĞ�ƚǁŽ�ĚĂŶŐĞƌ�ƐŝŐŶƐ�ŽĨ�ƉŶĞƵŵŽŶ ŝĂ� WĞƌĐĞŶƚĂŐĞ�ŽĨ�ŵŽƚŚĞƌƐ�ĂŶĚ�ĐĂƌĞƚĂŬĞƌƐ�ŽĨ�ĐŚŝůĚƌĞŶ�ĂŐĞ�ϬͲϱϵ�ŵ ŽŶƚŚƐ�ďLJ�ƐLJŵƉƚŽŵƐ�ƚŚĂƚ�ǁŽƵůĚ�ĐĂƵƐĞ�ƚŽ�ƚĂŬĞ�ƚŚĞ�ĐŚŝůĚ�ŝŵŵĞĚ ŝĂƚĞůLJ�ƚŽ�Ă�ŚĞĂůƚŚ�ĨĂĐŝůŝƚLJ͕�ĂŶĚ�ƉĞƌĐĞŶƚĂŐĞ�ŽĨ�ŵŽƚŚĞƌƐ�ǁŚŽ�ƌĞĐ ŽŐŶŝnjĞ�ĨĂƐƚ�ĂŶĚ�ĚŝĨĨŝĐƵůƚ�ďƌĞĂƚŚŝŶŐ�ĂƐ� ƐŝŐŶƐ�ĨŽƌ�ƐĞĞŬŝŶŐ�ĐĂƌĞ�ŝŵŵĞĚŝĂƚĞůLJ͕�EŽƌƚŚĞĂƐƚ�ŽŶĞ͕�^ŽŵĂůŝĂ� ϮϬϭϭ� ��WĞƌĐĞŶƚĂŐĞ�ŽĨ�ŵŽƚŚĞƌƐͬĐĂƌĞƚĂŬĞƌƐ �ŽĨ�ĐŚŝůĚƌĞŶ�ĂŐĞ�ϬͲϱϵ�ŵŽŶƚŚƐ�ǁŚŽ�ƚŚŝŶŬ�ƚŚĂƚ�Ă�ĐŚŝůĚ�ƐŚŽƵůĚ�ď Ğ�ƚĂŬĞŶ�ŝŵŵĞĚŝĂƚĞůLJ�ƚŽ�Ă�ŚĞĂůƚŚ�ĨĂĐŝůŝƚLJ�ŝĨ�ƚŚĞ�ĐŚŝůĚ͗� DŽƚŚĞƌƐͬĐĂƌĞƚĂŬĞƌƐ� ǁŚŽ�ƌĞĐŽŐŶŝnjĞ�ƚŚĞ� ƚǁŽ�ĚĂŶŐĞƌ�ƐŝŐŶƐ�ŽĨ� ƉŶĞƵŵŽŶŝĂ�EƵŵďĞƌ�ŽĨ� ŵŽƚŚĞƌƐͬĐĂƌĞƚĂŬ ĞƌƐ�ŽĨ�ĐŚŝůĚƌĞŶ� ĂŐĞ�ϬͲϱϵ�ŵŽŶƚŚƐ� ��/Ɛ�ŶŽƚ�ĂďůĞ�ƚŽ�ĚƌŝŶŬ� Žƌ�ďƌĞĂƐƚĨĞĞĚ��ĞĐŽŵĞƐ�ƐŝĐŬĞƌ ��ĞǀĞůŽƉƐ�Ă�ĨĞǀĞƌ�,ĂƐ�ĨĂƐƚ� ďƌĞĂƚŚŝŶŐ�,ĂƐ�ĚŝĨĨŝĐƵůƚLJ � ďƌĞĂƚŚŝŶŐ�,ĂƐ�ďůŽŽĚ� ŝŶ�ƐƚŽŽů�/Ɛ�ĚƌŝŶŬŝŶŐ� ƉŽŽƌůLJ�,ĂƐ�Žƚ ŚĞƌ� ƐLJŵƉƚŽŵƐ� ZĞŐŝŽŶ����� �� �Ăƌŝ�ϯϮ͘ϵ�ϰϰ͘ϰ� ϱϬ͘ϲϮϯ͘Ϭϭϳ͘ϲϭϰ͘ϯ� Ϯϱ͘ϮϮ͘ϲϲ͘ϳ ϭ͕ϭϯϱ EƵŐĂů�ϯϴ͘Ϭ�ϰϴ͘ϯ� ϰϳ͘ϵϮϮ͘ϵϭϵ͘ϰϭϱ͘ϰ� ϮϮ͘ϲϭ͘ϳϳ͘ϲ ϱϯϯ DƵĚƵŐ�ϰϯ͘Ϭ�ϱϬ͘ϭ� ϰϵ͘ϮϮϭ͘Ϭϭϲ͘ϰϭϮ͘ϱ� ϭϲ͘ϲϭ͘Ϯϳ͘ϳ ϵϱϵ �ƌĞĂ�� � � hƌďĂŶ�ϯϲ͘ϳ�ϰϳ͘ϴ� ϱϮ͘ϭϮϮ͘Ϭϭϴ͘ϭϭϰ͘ϵ� Ϯϭ͘ϭϮ͘ϭϴ͘Ϭ ϭ͕ϲϯϮ ZƵƌĂů�ϯϵ͘ϭ�ϰϲ͘ϰ� ϰϱ͘ϯϮϮ͘ϳϭϲ͘ϲϭϮ͘Ϭ� ϮϮ͘ϭϭ͘ϳϲ͘Ϭ ϵϵϱ DŽƚŚĞƌΖƐ�ĞĚƵĐĂƚŝŽŶ�� � EŽŶĞ�ϯϳ͘ϭ�ϰϳ͘ϱ� ϰϵ͘ϬϮϮ͘ϱϭϳ͘ϳϭϰ͘Ϯ� Ϯϭ͘ϵϭ͘ϴϳ͘ϰ Ϯ͕Ϭϯϭ WƌŝŵĂƌLJ��ϯϳ͘ϵ�ϰϯ͘ϱ� ϱϬ͘ϬϮϭ͘ϰϭϲ͘ϮϭϮ͘Ϯ� Ϯϭ͘ϬϮ͘ϯϱ͘ϴ ϰϯϮ ^ĞĐŽŶĚĂƌLJн�ϰϮ͘ϳ�ϱϰ͘ϴ� ϱϱ͘ϰϮϬ͘ϵϭϴ͘ϳϭϯ͘ϭ� ϭϴ͘ϯϯ͘Ϭϴ͘ϵ ϭϲϰ tĞĂůƚŚ�ŝŶĚĞdž�ƋƵŝŶƚŝůĞ�� � WŽŽƌĞƐƚ�ϯϵ͘Ϯ�ϰϴ͘Ϯ� ϰϲ͘ϱϮϰ͘ϲϭϲ͘ϵϭϯ͘Ϭ� Ϯϯ͘ϬϮ͘ϭϲ͘ϱ ϱϯϴ ^ĞĐŽŶĚ�ϯϲ͘Ϯ�ϰϳ͘ϵ� ϰϵ͘ϬϮϮ͘ϰϭϳ͘Ϭϭϯ͘ϴ� ϮϮ͘ϲϭ͘ϭϳ͘ϭ ϱϯϲ DŝĚĚůĞ�ϯϰ͘ϳ�ϰϱ͘ϯ� ϰϳ͘ϲϮϬ͘Ϯϭϳ͘ϭϭϯ͘ϰ� ϮϬ͘ϯϮ͘Ϭϲ͘ϯ ϱϬϱ &ŽƵƌƚŚ�ϯϳ͘ϲ�ϰϰ͘ϰ� ϱϭ͘ϳϮϭ͘Ϭϭϳ͘ϴϭϰ͘ϯ� ϭϵ͘ϴϮ͘ϭϳ͘ϳ ϱϱϲ ZŝĐŚĞƐƚ�ϰϬ͘ϰ�ϱϬ͘ϳ� ϱϯ͘ϭϮϯ͘Ϭϭϴ͘ϵϭϰ͘ϳ� Ϯϭ͘ϴϮ͘ϰϴ͘ϲ ϰϵϮ �� �� dŽƚĂů�ϯϳ͘ϲ�ϰϳ͘ ϯ�ϰϵ͘ϱϮϮ͘Ϯϭ ϳ͘ϱϭϯ͘ϴ�Ϯϭ͘ϱϭ͘ϵ ϳ͘ϮϮ͕ϲϮϳ 40 Solid Fuel Use More than 3 billion people around the world rely on solid fuels for their basic energy needs, including cooking and heating. Solid fuels include biomass fuels, such as wood, charcoal, crops or other agricultural waste, dung, shrubs and straw, and coal. Cooking and heating with solid fuels leads to high levels of indoor smoke which contains a complex mix of health-damaging pollutants. The main problem with the use of solid fuels is their incomplete combustion, which produces toxic elements such as carbon monoxide, polyaromatic hydrocarbons, and sulphur dioxide (SO2), among others. Use of solid fuels increases the risks of incurring acute respiratory illness, pneumonia, chronic obstructive lung disease, cancer, and possibly tuberculosis, asthma, or cataracts, and may contribute to low birth weight of babies born to pregnant women exposed to smoke. The primary indicator for monitoring use of solid fuels is the proportion of the population using solid fuels as the primary source of domestic energy for cooking, shown in Table CH.9. Overall, nearly all (98 percent) households in the Northeast Zone are using solid fuels for cooking. Differentials with respect to background characteristics were minimal. The table CH.9 also clearly shows that the main form of solid fuel in use was charcoal (48 percent) and coal (49 percent). 41 dĂďůĞ��,͘ϵ͗�^ŽůŝĚ�ĨƵĞů�ƵƐĞ� WĞƌĐĞŶƚ�ĚŝƐƚƌŝďƵƚŝŽŶ�ŽĨ�ŚŽƵƐĞŚŽůĚ�ŵĞŵďĞƌƐ�ĂĐĐŽƌĚŝŶŐ�ƚŽ�ƚLJƉĞ�ŽĨ�ĐŽŽŬŝŶŐ�ĨƵĞ ů�ƵƐĞĚ�ďLJ�ƚŚĞ�ŚŽƵƐĞŚŽůĚ͕�ĂŶĚ�ƉĞƌĐĞŶƚĂŐĞ�ŽĨ�ŚŽƵƐĞŚŽůĚ�ŵĞŵď ĞƌƐ�ůŝǀŝŶŐ�ŝŶ�ŚŽƵƐĞŚŽůĚƐ�ƵƐŝŶŐ�ƐŽůŝĚ�ĨƵĞůƐ�ĨŽƌ�ĐŽŽŬŝŶŐ͕�EŽƌƚŚĞĂ Ɛƚ� ŽŶĞ͕�^ŽŵĂůŝĂ�ϮϬϭϭ� WĞƌĐĞŶƚĂŐĞ�ŽĨ�ŚŽƵƐĞŚŽůĚ�ŵĞŵďĞƌƐ�ŝŶ�ŚŽƵƐĞŚŽůĚƐ�ƵƐŝŶŐ͗� EƵŵďĞƌ�ŽĨ� ŚŽƵƐĞŚŽůĚ� ŵĞŵďĞƌƐ� �ůĞĐƚƌŝĐŝƚLJ�>ŝƋƵĞĨŝĞĚ� WĞƚƌŽůĞƵŵ� 'ĂƐ�;>W'Ϳ�<ĞƌŽƐĞŶĞ� EŽ�ĨŽŽĚ�ĐŽŽŬĞĚ� ŝŶ�ƚŚĞ�ŚŽƵƐĞŚŽůĚ�dŽƚĂů�^ŽůŝĚ�ĨƵĞůƐ� ĨŽƌ�ĐŽŽŬŝŶŐϭ ��ŚĂƌͲ� ĐŽĂů�tŽŽĚ�^ƚƌĂǁ͕�ƐŚƌƵďƐ͕� ŐƌĂƐƐ� DŝƐƐŝŶŐ� ZĞŐŝŽŶ��� �Ăƌŝ�Ϭ͘ϵ�ϭ͘Ϯ Ϭ͘ϮϱϬ͘ϲϰϲ͘ϬϬ͘ϱ� Ϭ͘ϭϬ͘ϲϭϬϬ͘Ϭϵϳ͘ϬϭϮ͕ϴ ϯϰ EƵŐĂů�ϭ͘ϰ�Ϭ͘ϭ Ϭ͘ϴϯϮ͘ϳϲϯ͘ϰϭ͘ϭ� Ϭ͘ϭϬ͘ϭϭϬϬ͘Ϭϵϳ͘ϯϱ͕ϴ ϲϮ DƵĚƵŐ�Ϭ͘Ϯ�Ϭ͘Ϯ Ϭ͘ϬϱϮ͘ϴϰϱ͘ϰϬ͘ϰ� Ϭ͘ϭϬ͘ϴϭϬϬ͘Ϭϵϴ͘ϲϵ͕ϴ ϰϭ �ƌĞĂ� hƌďĂŶ�ϭ͘Ϯ�Ϭ͘ϵ Ϭ͘Ϯϲϲ͘ϭϯϬ͘ϲϬ͘ϯ� Ϭ͘ϭϬ͘ϲϭϬϬ͘Ϭϵϲ͘ϵϭϴ͕Ϯ ϰϮ ZƵƌĂů�Ϭ͘Ϭ�Ϭ͘Ϯ Ϭ͘ϰϭϱ͘ϮϴϮ͘ϱϭ͘ϭ� Ϭ͘ϬϬ͘ϱϭϬϬ͘Ϭϵϴ͘ϴϭϬ͕Ϯ ϵϱ �ĚƵĐĂƚŝŽŶ�ŽĨ�ŚŽƵƐĞŚŽůĚ�ŚĞĂĚ� EŽŶĞ�Ϭ͘ϲ�Ϭ͘ϯ Ϭ͘ϭϰϮ͘Ϯϱϱ͘ϯϬ͘ϳ� Ϭ͘ϭϬ͘ϳϭϬϬ͘Ϭϵϴ͘ϮϮϬ͕ϲ ϴϱ WƌŝŵĂƌLJ�Ϭ͘ϵ�Ϭ͘ϭ Ϭ͘ϴϱϮ͘ϴϰϰ͘ϱϬ͘ϰ� Ϭ͘ϬϬ͘ϯϭϬϬ͘Ϭϵϳ͘ϴϯ͕Ϯ ϲϮ ^ĞĐŽŶĚĂƌLJн�ϭ͘ϳ�Ϯ͘ϳ Ϭ͘ϱϲϵ͘ϮϮϱ͘ϯϬ͘ϭ� Ϭ͘ϮϬ͘ϯϭϬϬ͘Ϭϵϰ͘ϲϰ͕ϰ ϰϮ DŝƐƐŝŶŐͬ�<�Ϭ͘Ϭ�Ϭ͘Ϭ Ϭ͘ϬϲϮ͘Ϭϯϴ͘ϬϬ͘Ϭ� Ϭ͘ϬϬ͘ϬϭϬϬ͘ϬϭϬϬ͘Ϭϭ ϰϴ tĞĂůƚŚ�ŝŶĚĞdž�ƋƵŝŶƚŝůĞƐ� WŽŽƌĞƐƚ�Ϭ͘Ϭ�Ϭ͘Ϭ Ϭ͘Ϯϯ͘ϲϵϰ͘ϴϬ͘ϵ� Ϭ͘ϯϬ͘ϮϭϬϬ͘Ϭϵϵ͘Ϯϱ͕ϳ Ϭϱ ^ĞĐŽŶĚ�Ϭ͘Ϭ�Ϭ͘Ϭ Ϭ͘ϰϭϮ͘ϴϴϱ͘ϴϬ͘ϵ� Ϭ͘ϬϬ͘ϮϭϬϬ͘Ϭϵϵ͘ϰϱ͕ϳ ϭϮ DŝĚĚůĞ�Ϭ͘ϰ�Ϭ͘Ϭ Ϭ͘ϱϰϯ͘ϲϱϮ͘ϲϭ͘ϭ� Ϭ͘ϭϭ͘ϳϭϬϬ͘Ϭϵϳ͘ϯϱ͕ϳ Ϭϱ &ŽƵƌƚŚ�Ϭ͘ϲ�Ϭ͘Ϯ Ϭ͘ϭϴϱ͘ϵϭϮ͘ϰϬ͘Ϭ� Ϭ͘ϬϬ͘ϱϭϬϬ͘Ϭϵϴ͘ϰϱ͕ϳ ϭϬ ZŝĐŚĞƐƚ�Ϯ͘ϵ�Ϯ͘ϵ Ϭ͘ϭϵϮ͘ϲϭ͘ϭϬ͘ϭ� Ϭ͘ϬϬ͘ϯϭϬϬ͘Ϭϵϯ͘ϴϱ͕ϳ Ϭϱ � dŽƚĂů�Ϭ͘ϴ�Ϭ͘ϲ Ϭ͘Ϯϰϳ͘ϳϰϵ͘ϯϬ͘ϲ� Ϭ͘ϭϬ͘ϲϭϬϬ͘Ϭϵϳ͘ϲϮϴ͕ϱ ϯϳ ϭ �D/�^�ŝŶĚŝĐĂƚŽƌ�ϯ͘ϭϭ� � 42 Solid fuel use by place of cooking is depicted in Table CH.10. The presence and extent of indoor pollution are dependent on cooking practices, places used for cooking, as well as types of fuel used. According to the Northeast Zone MICS, among households using solid fuels for cooking, 42 percent cook in a separate room used as a kitchen. The percentage of households that cook within the dwelling unit is higher in urban areas (60 percent) than in rural areas (33 percent). Cooking in a separate room, used as a kitchen, increases with education of the household head and the wealth status of the household. Malaria Malaria is a leading cause of death of children under age five in Africa and is a common cause of school absenteeism. Preventive measures can dramatically reduce malaria mortality rates among children. WHO recommends full coverage of long lasting insecticide treated nets LLINs for all people at risk of malaria in areas targeted for malaria prevention. Neither LLINs nor indoor residual spraying (IRS), the other main method of malaria vector control, may be sufficiently effective alone to achieve and maintain interruption of transmission in holo-endemic areas of Africa. In 2010 WHO recommended universal use of diagnostic testing to confirm malaria infection, followed by appropriate treatment based on the results. According to the new guidelines, treatment solely on the basis of clinical suspicion should only be considered when a parasitological diagnosis is not accessible. Diagnosis is increasingly important, not only to have certainty about malaria cases but also to avoid unnecessary consumption of effective antimalarial drugs, such as artemisinin combination therapies (ACTs), which increases the risk of malaria parasite resistance. dĂďůĞ��,͘ϭϬ͗�^ŽůŝĚ�ĨƵĞů�ƵƐĞ�ďLJ�ƉůĂĐĞ�ŽĨ�ĐŽŽŬŝŶŐ�WĞƌĐĞŶƚ�ĚŝƐƚƌŝďƵƚŝŽŶ�ŽĨ�ŚŽƵƐĞŚŽůĚ�ŵĞŵďĞƌƐ�ŝŶ�ŚŽƵƐĞŚŽůĚƐ�ƵƐŝŶŐ�ƐŽůŝĚ�ĨƵĞůƐ�ďLJ�ƉůĂĐĞ�ŽĨ�ĐŽŽŬŝŶŐ͕�EŽƌƚŚĞĂƐƚ�ŽŶĞ͕�^ŽŵĂůŝĂ�ϮϬϭϭ�WůĂĐĞ�ŽĨ�ĐŽŽŬŝŶŐ͗� EƵŵďĞƌ�ŽĨ�ŚŽƵƐĞŚŽůĚ�ŵĞŵďĞƌƐ�ŝŶ�ŚŽƵƐĞŚŽůĚƐ��ƵƐŝŶŐ�ƐŽůŝĚ�ĨƵĞůƐ�ĨŽƌ�ĐŽŽŬŝŶŐ�/Ŷ�Ă�ƐĞƉĂƌĂƚĞ�ƌŽŽŵ�ƵƐĞĚ�ĂƐ�ŬŝƚĐŚĞŶ� �ůƐĞǁŚĞƌĞ�ŝŶ�ƚŚĞ�ŚŽƵƐĞ� /Ŷ�Ă�ƐĞƉĂƌĂƚĞ�ďƵŝůĚŝŶŐ� KƵƚĚŽŽƌƐ� �ƚ�ĂŶŽƚŚĞƌ�ƉůĂĐĞ� DŝƐƐŝŶŐ� dŽƚĂů�ZĞŐŝŽŶ� � � ��Ăƌŝ� ϰϳ͘Ϭ� ϴ͘ϯ ϰ͘ϲ ϯϴ͘ϯ Ϭ͘Ϯ ϭ͘ϲ ϭϬϬ͘Ϭ� ϭϮ͕ϰϱϯEƵŐĂů� ϯϳ͘ϴ� ϵ͘Ϯ ϰ͘Ϭ ϰϴ͘Ϭ Ϭ͘Ϯ Ϭ͘ϴ ϭϬϬ͘Ϭ� ϱ͕ϳϬϯDƵĚƵŐ� ϯϴ͘ϳ� ϱ͘ϲ ϴ͘ϵ ϰϱ͘ϭ Ϭ͘Ϭ ϭ͘ϳ ϭϬϬ͘Ϭ� ϵ͕ϳϬϯ�ƌĞĂ� � �hƌďĂŶ� ϱϭ͘ϴ� ϳ͘ϴ ϱ͘ϳ ϯϯ͘ϭ Ϭ͘ϭ ϭ͘ϲ ϭϬϬ͘Ϭ� ϭϳ͕ϲϴϰZƵƌĂů� Ϯϱ͘ϳ� ϳ͘ϭ ϲ͘ϱ ϱϵ͘Ϯ Ϭ͘ϭ ϭ͘ϯ ϭϬϬ͘Ϭ� ϭϬ͕ϭϳϱ�ĚƵĐĂƚŝŽŶ�ŽĨ�ŚŽƵƐĞŚŽůĚ�ŚĞĂĚ� � �EŽŶĞ� ϯϲ͘ϵ� ϳ͘ϳ ϲ͘Ϯ ϰϳ͘ϲ Ϭ͘ϭ ϭ͘ϰ ϭϬϬ͘Ϭ� ϮϬ͕ϯϭϴWƌŝŵĂƌLJ� ϰϴ͘Ϯ� ϳ͘Ϯ ϳ͘ϯ ϯϲ͘ϰ Ϭ͘Ϭ Ϭ͘ϵ ϭϬϬ͘Ϭ� ϯ͕ϭϴϵ^ĞĐŽŶĚĂƌLJн� ϲϯ͘Ϯ� ϳ͘ϭ ϰ͘ϭ Ϯϯ͘ϳ Ϭ͘Ϭ Ϯ͘Ϭ ϭϬϬ͘Ϭ� ϰ͕ϮϬϰDŝƐƐŝŶŐͬ�<� ϰϵ͘ϯ� ϱ͘ϴ ϴ͘ϯ ϯϲ͘ϳ Ϭ͘Ϭ Ϭ͘Ϭ ϭϬϬ͘Ϭ� ϭϰϴtĞĂůƚŚ�ŝŶĚĞdž�ƋƵŝŶƚŝůĞƐ� � � �WŽŽƌĞƐƚ� ϳ͘ϯ� ϰ͘ϲ ϯ͘ϵ ϴϮ͘ϰ Ϭ͘ϯ ϭ͘ϲ ϭϬϬ͘Ϭ� ϱ͕ϲϲϮ^ĞĐŽŶĚ� ϮϬ͘ϭ� ϵ͘Ϯ ϵ͘Ϯ ϲϬ͘ϳ Ϭ͘ϭ Ϭ͘ϴ ϭϬϬ͘Ϭ� ϱ͕ϲϴϬDŝĚĚůĞ� ϯϳ͘ϲ� ϭϭ͘ϲ ϴ͘Ϯ ϰϭ͘ϯ Ϭ͘ϭ ϭ͘ϭ ϭϬϬ͘Ϭ� ϱ͕ϱϱϭ&ŽƵƌƚŚ� ϲϱ͘Ϯ� ϲ͘ϴ ϱ͘ϲ ϮϬ͘ϯ Ϭ͘ϭ Ϯ͘Ϭ ϭϬϬ͘Ϭ� ϱ͕ϲϭϳZŝĐŚĞƐƚ� ϴϯ͘ϰ� ϱ͘ϰ Ϯ͘ϵ ϲ͘ϰ Ϭ͘Ϭ ϭ͘ϳ ϭϬϬ͘Ϭ� ϱ͕ϯϰϵ� � �dŽƚĂů� ϰϮ͘ϯ� ϳ͘ϱ ϲ͘Ϭ ϰϮ͘ϳ Ϭ͘ϭ ϭ͘ϰ ϭϬϬ͘Ϭ� Ϯϳ͕ϴϱϵ 43 Insecticide-treated mosquito nets, or ITNs, if used properly, are very effective in offering protection against mosquitos and other insects. The use of ITNs is one of the main health interventions applied to reduce malaria transmission in Northeast Zone of Somalia. The questionnaire incorporates questions on the availability and use of bed nets, both at household level and among children under five years of age and pregnant women. In addition, all households in the Northeast Zone MICS were asked whether the interior dwelling walls were sprayed with an insecticide to kill mosquitoes that spread malaria during the 12 months preceding the survey. In Northeast Zone Somalia, the survey results indicate that 30 percent of households have at least one Insecticide Treated Net (ITN) (Table CH.11). The number of households with at least one ITN is twice as high (41 percent) in Mudug region compared to Bari region (20 percent). More households in urban (34) than rural areas (23 percent) had at least one ITN. Furthermore, household possession of at least one ITN was associated with education status (27 percent for household heads with no education versus 39 percent for household heads with secondary or higher education) and wealth status (15 percent of the poorest households versus 40 percent of the richest households). A common trend that for all the other indicators; households with at least one long lasting mosquito net and the households with at least one ITN or received IRS during the last 12 months, the percentage was highest in Mudug region, in urban areas, in households where the head of household had secondary or higher education and among the richest households. dĂďůĞ��,͘ϭϭ͗�,ŽƵƐĞŚŽůĚ�ĂǀĂŝůĂďŝůŝƚLJ�ŽĨ�ŝŶƐĞĐƚŝĐŝĚĞ�ƚƌĞĂƚĞĚ�ŶĞƚƐ�ĂŶĚ�ƉƌŽƚĞĐƚŝŽŶ�ďLJ�Ă�ǀĞĐƚŽƌ�ĐŽŶƚƌŽů�ŵĞƚŚŽĚ�WĞƌĐĞŶƚĂŐĞ�ŽĨ�ŚŽƵƐĞŚŽůĚƐ�ǁŝƚŚ�Ăƚ�ůĞĂƐƚ�ŽŶĞ�ŵŽƐƋƵŝƚŽ�ŶĞƚ͕�ƉĞƌĐĞŶƚĂŐĞ�ŽĨ�ŚŽƵƐĞŚŽůĚƐ�ǁŝƚŚ�Ăƚ�ůĞĂƐƚ�ŽŶĞ�ůŽŶŐͲůĂƐƚŝŶŐ�ƚƌĞĂƚĞĚ�ŶĞƚ͕�ƉĞƌĐĞŶƚĂŐĞ�ŽĨ�ŚŽƵƐĞŚŽůĚƐ�ǁŝƚŚ�Ăƚ�ůĞĂƐƚ�ŽŶĞ�ŝŶƐĞĐƚŝĐŝĚĞ�ƚƌĞĂƚĞĚ�ŶĞƚ�;/dEͿ�ĂŶĚ�ƉĞƌĐĞŶƚĂŐĞ�ŽĨ�ŚŽƵƐĞŚŽůĚƐ�ǁŚŝĐŚ�ĞŝƚŚĞƌ�ŚĂǀĞ�Ăƚ�ůĞĂƐƚ�ŽŶĞ�/dE�Žƌ�ŚĂǀĞ�ƌĞĐĞŝǀĞĚ�ŝŶĚŽŽƌ�ƌĞƐŝĚƵĂů�ƐƉƌĂLJŝŶŐ�;/Z^Ϳ�ŝŶ�ƚŚĞ�ůĂƐƚ�ϭϮ�ŵŽŶƚŚƐ͕�EŽƌƚŚĞĂƐƚ�ŽŶĞ͕�^ŽŵĂůŝĂ�ϮϬϭϭ��� WĞƌĐĞŶƚĂŐĞ�ŽĨ�ŚŽƵƐĞŚŽůĚƐ�ǁŝƚŚ�Ăƚ�ůĞĂƐƚ�ŽŶĞ�ŵŽƐƋƵŝƚŽ�ŶĞƚ� WĞƌĐĞŶƚĂŐĞ�ŽĨ�ŚŽƵƐĞŚŽůĚƐ�ǁŝƚŚ�Ăƚ�ůĞĂƐƚ�ŽŶĞ�ůŽŶŐͲůĂƐƚŝŶŐ�ƚƌĞĂƚĞĚ�ŶĞƚ� WĞƌĐĞŶƚĂŐĞ�ŽĨ�ŚŽƵƐĞŚŽůĚƐ�ǁŝƚŚ�Ăƚ�ůĞĂƐƚ�ŽŶĞ�/dEϭ� WĞƌĐĞŶƚĂŐĞ�ŽĨ�ŚŽƵƐĞŚŽůĚƐ�ǁŝƚŚ�Ăƚ�ůĞĂƐƚ�ŽŶĞ�/dE�Žƌ�ƌĞĐĞŝǀĞĚ�/Z^�ĚƵƌŝŶŐ�ƚŚĞ�ůĂƐƚ�ϭϮ�ŵŽŶƚŚƐϮ� EƵŵďĞƌ�ŽĨ�ŚŽƵƐĞŚŽůĚƐ�ZĞŐŝŽŶ� �� ���Ăƌŝ� ϮϬ͘ϳ ϭϵ͘ϰ ϭϵ͘ϲ ϭϵ͘ϵ� Ϯ͕ϭϱϮEƵŐĂů� ϯϱ͘ϯ ϯϯ͘ϱ ϯϰ͘ϭ ϯϰ͘ϰ� ϵϰϳDƵĚƵŐ� ϰϮ͘ϴ ϰϭ͘Ϯ ϰϭ͘ϯ ϰϮ͘Ϭ� ϭ͕ϲϴϲ�ƌĞĂ� �hƌďĂŶ� ϯϱ͘ϰ ϯϰ͘Ϭ ϯϰ͘ϯ ϯϰ͘ϵ� Ϯ͕ϵϲϳZƵƌĂů� Ϯϰ͘ϳ Ϯϯ͘ϭ Ϯϯ͘ϯ Ϯϯ͘ϰ� ϭ͕ϴϭϴ�ĚƵĐĂƚŝŽŶ�ŽĨ�ŚŽƵƐĞŚŽůĚ�ŚĞĂĚĂ� ��EŽŶĞ� Ϯϴ͘ϰ Ϯϳ͘ϭ Ϯϳ͘Ϯ Ϯϳ͘ϲ� ϯ͕ϱϯϴWƌŝŵĂƌLJ�� ϯϴ͘ϱ ϯϲ͘ϲ ϯϳ͘Ϯ ϯϴ͘ϭ� ϱϯϵ^ĞĐŽŶĚĂƌLJн� ϰϬ͘Ϯ ϯϴ͘Ϯ ϯϴ͘ϵ ϯϵ͘ϰ� ϲϴϰtĞĂůƚŚ�ŝŶĚĞdž�ƋƵŝŶƚŝůĞƐ� �WŽŽƌĞƐƚ� ϭϲ͘ϭ ϭϰ͘ϴ ϭϰ͘ϴ ϭϰ͘ϴ� ϭ͕Ϭϯϰ^ĞĐŽŶĚ� Ϯϲ͘ϰ Ϯϰ͘ϴ Ϯϱ͘ϭ Ϯϱ͘ϭ� ϵϵϲDŝĚĚůĞ� ϯϰ͘ϵ ϯϯ͘ϭ ϯϯ͘ϯ ϯϯ͘ϳ� ϵϯϰ&ŽƵƌƚŚ� ϰϬ͘Ϯ ϯϵ͘ϰ ϯϵ͘ϱ ϯϵ͘ϵ� ϵϰϭZŝĐŚĞƐƚ� ϰϭ͘ϱ ϯϵ͘ϲ ϰϬ͘ϯ ϰϮ͘Ϭ� ϴϴϭ�� �dŽƚĂů� ϯϭ͘ϰ Ϯϵ͘ϴ ϯϬ͘ϭ ϯϬ͘ϲ� ϰ͕ϳϴϱϭ�D/�^�ŝŶĚŝĐĂƚŽƌ�ϯ͘ϭϮ͕��Ϯ�D/�^�ŝŶĚŝĐĂƚŽƌ�ϯ͘ϭϯ�ĂdŽƚĂů�ŝŶĐůƵĚĞƐ�Ϯϰ�ƵŶǁĞŝŐŚƚĞĚ�ĐĂƐĞƐ�ŽĨ�ŚŽƵƐĞŚŽůĚƐ�ǁŝƚŚ�ŵŝƐƐŝŶŐ�ŝŶĨŽƌŵĂƚŝŽŶ�ŽŶ�ĞĚƵĐĂƚŝŽŶ�ŽĨ�ƚŚĞ�ŚŽƵƐĞŚŽůĚ�ŚĞĂĚ�ƚŚĂƚ�ĂƌĞ�ŶŽƚ�ƐŚŽǁŶ�ƐĞƉĂƌĂƚĞůLJ� 44 Results indicate that 26 percent of children under the age of five slept under any mosquito net the night prior to the survey and 25 percent slept under an Insecticide treated net (Table CH.12). There were no significant gender disparities in ITN use among children under five. The use of ITN among children declines with age. In general children in Mudug region are more likely to sleep under an ITN than their counterparts in Bari or Nugal regions. Table CH.13 presents the proportion of pregnant women who slept under a mosquito net during the previous night. Twenty one percent slept under an insecticide treated net. Women in Mudug region compared to Bari and Nugal regions and women from urban areas compared to rural areas are more likely to sleep under an insecticide treated net. dĂďůĞ��,͘ϭϮ͗��ŚŝůĚƌĞŶ�ƐůĞĞƉŝŶŐ�ƵŶĚĞƌ�ŵŽƐƋƵŝƚŽ�ŶĞƚƐWĞƌĐĞŶƚĂŐĞ�ŽĨ�ĐŚŝůĚƌĞŶ�ĂŐĞ�ϬͲϱϵ�ŵŽŶƚŚƐ�ǁŚŽ�ƐůĞƉƚ�ƵŶĚĞƌ�Ă�ŵŽƐƋƵŝƚŽ�ŶĞƚ�ĚƵƌŝŶŐ�ƚŚĞ�ƉƌĞǀŝŽƵƐ�ŶŝŐŚƚ͕�ďLJ�ƚLJƉĞ�ŽĨ�ŶĞƚ͕�EŽƌƚŚĞĂƐƚ�ŽŶĞ͕�^ŽŵĂůŝĂ�ϮϬϭϭ� WĞƌĐĞŶƚĂŐĞ�ŽĨ�ĐŚŝůĚƌĞŶ�ĂŐĞ�ϬͲϱϵ�ǁŚŽ�ƐƚĂLJĞĚ�ŝŶ�ƚŚĞ�ŚŽƵƐĞŚŽůĚ�ƚŚĞ�ƉƌĞǀŝŽƵƐ�ŶŝŐŚƚ� EƵŵďĞƌ�ŽĨ�ĐŚŝůĚƌĞŶ�ĂŐĞ�ϬͲϱϵ�ŵŽŶƚŚƐ� WĞƌĐĞŶƚĂŐĞ�ŽĨ�ĐŚŝůĚƌĞŶ�ǁŚŽ͗� EƵŵďĞƌ�ŽĨ�ĐŚŝůĚƌĞŶ�ĂŐĞ�ϬͲϱϵ�ŵŽŶƚŚƐ�ǁŚŽ�ƐůĞƉƚ�ŝŶ�ƚŚĞ�ŚŽƵƐĞŚŽůĚ�ƚŚĞ�ƉƌĞǀŝŽƵƐ�ŶŝŐŚƚ� WĞƌĐĞŶƚĂŐĞ�ŽĨ�ĐŚŝůĚƌĞŶ�ǁŚŽ�ƐůĞƉƚ�ƵŶĚĞƌ�ĂŶ�/dE�ůŝǀŝŶŐ�ŝŶ�ŚŽƵƐĞŚŽůĚƐ�ǁŝƚŚ�Ăƚ�ůĞĂƐƚ�ŽŶĞ�/dE� EƵŵďĞƌ�ŽĨ�ĐŚŝůĚƌĞŶ�ĂŐĞ�ϬͲϱϵ�ůŝǀŝŶŐ�ŝŶ�ŚŽƵƐĞŚŽůĚƐ�ǁŝƚŚ�Ăƚ�ůĞĂƐƚ�ŽŶĞ�/dE�^ůĞƉƚ�ƵŶĚĞƌ�ĂŶLJ�ŵŽƐƋƵŝƚŽ�ŶĞƚϭ� ^ůĞƉƚ�ƵŶĚĞƌ�ĂŶ�ŝŶƐĞĐƚŝĐŝĚĞ�ƚƌĞĂƚĞĚ�ŶĞƚϮ�^Ğdž� �� �� ��DĂůĞ�� ϵϵ͘ϰ� Ϯ͕ϯϵϱ Ϯϲ͘ϯ Ϯϱ͘ϱ Ϯ͕ϯϴϬ ϲϵ͘ϵ� ϴϲϳ&ĞŵĂůĞ� ϵϵ͘ϱ� Ϯ͕ϯϭϵ Ϯϲ͘Ϭ Ϯϱ͘Ϯ Ϯ͕ϯϬϵ ϲϴ͘Ϯ� ϴϱϰZĞŐŝŽŶ� � ��Ăƌŝ� ϵϵ͘ϱ� ϭ͕ϵϱϮ ϭϰ͘ϵ ϭϰ͘ϲ ϭ͕ϵϰϯ ϱϱ͘ϰ� ϱϭϭEƵŐĂů� ϵϵ͘ϰ� ϵϵϯ Ϯϴ͘ϲ Ϯϳ͘ϴ ϵϴϳ ϳϮ͘Ϭ� ϯϴϭDƵĚƵŐ� ϵϵ͘ϰ� ϭ͕ϳϲϴ ϯϳ͘ϭ ϯϱ͘ϴ ϭ͕ϳϱϴ ϳϲ͘ϭ� ϴϮϴ�ƌĞĂ� � �hƌďĂŶ� ϵϵ͘ϱ� Ϯ͕ϵϬϴ Ϯϵ͘ϳ Ϯϴ͘ϵ Ϯ͕ϴϵϰ ϳϬ͘Ϭ� ϭ͕ϭϵϱZƵƌĂů� ϵϵ͘ϰ� ϭ͕ϴϬϲ ϮϬ͘ϰ ϭϵ͘ϲ ϭ͕ϳϵϱ ϲϲ͘ϵ� ϱϮϲ�ŐĞ� � �ϬͲϭϭ�ŵŽŶƚŚƐ� ϵϵ͘ϴ� ϴϱϳ Ϯϵ͘ϲ Ϯϴ͘ϴ ϴϱϱ ϳϮ͘ϴ� ϯϯϴϭϮͲϮϯ�ŵŽŶƚŚƐ� ϵϵ͘ϲ� ϳϵϮ Ϯϵ͘ϱ Ϯϴ͘ϲ ϳϵϬ ϳϯ͘ϴ� ϯϬϳϮϰͲϯϱ�ŵŽŶƚŚƐ� ϵϵ͘ϱ� ϭ͕ϬϮϳ Ϯϰ͘ϲ Ϯϯ͘ϳ ϭ͕ϬϮϮ ϳϬ͘ϰ� ϯϰϱϯϲͲϰϳ�ŵŽŶƚŚƐ� ϵϵ͘ϱ� ϭ͕Ϭϲϳ Ϯϱ͘ϱ Ϯϰ͘ϳ ϭ͕Ϭϲϭ ϲϱ͘ϴ� ϯϵϵϰϴͲϱϵ�ŵŽŶƚŚƐ� ϵϵ͘ϭ� ϵϳϮ ϮϮ͘ϳ Ϯϭ͘ϵ ϵϲϮ ϲϯ͘ϰ� ϯϯϯDŽƚŚĞƌΖƐ�ĞĚƵĐĂƚŝŽŶ� � ��EŽŶĞ� ϵϵ͘ϰ� ϯ͕ϲϮϰ Ϯϱ͘Ϯ Ϯϰ͘ϰ ϯ͕ϲϬϭ ϳϬ͘ϴ� ϭϮϯϵWƌŝŵĂƌLJ� ϵϵ͘ϴ� ϳϵϳ ϯϭ͘ϳ ϯϬ͘ϴ ϳϵϱ ϲϱ͘ϲ� ϯϳϯ^ĞĐŽŶĚĂƌLJн� ϭϬϬ͘Ϭ� Ϯϵϯ ϮϮ͘ϱ ϮϮ͘ϱ Ϯϵϯ ϲϬ͘ϲ� ϭϬϵtĞĂůƚŚ�ŝŶĚĞdž�ƋƵŝŶƚŝůĞƐ� � ��WŽŽƌĞƐƚ� ϵϵ͘ϯ� ϭ͕ϬϬϰ ϭϯ͘ϰ ϭϮ͘ϯ ϵϵϳ ϲϴ͘ϳ� ϭϳϴ^ĞĐŽŶĚ� ϵϵ͘Ϯ� ϵϲϱ Ϯϭ͘ϱ Ϯϭ͘Ϭ ϵϱϳ ϲϱ͘ϰ� ϯϬϳDŝĚĚůĞ� ϵϵ͘ϳ� ϵϮϬ Ϯϴ͘ϱ Ϯϳ͘ϳ ϵϭϳ ϲϲ͘ϳ� ϯϴϭ&ŽƵƌƚŚ� ϵϵ͘ϯ� ϵϲϱ ϯϳ͘Ϯ ϯϲ͘ϲ ϵϱϴ ϳϳ͘ϲ� ϰϱϮZŝĐŚĞƐƚ� ϭϬϬ͘Ϭ� ϴϲϬ ϯϭ͘Ϯ ϯϬ͘Ϯ ϴϲϬ ϲϰ͘ϱ� ϰϬϯ�� � �dŽƚĂů� ϵϵ͘ϱ� ϰ͕ϳϭϰ Ϯϲ͘ϭ Ϯϱ͘ϯ ϰ͕ϲϴϵ ϲϵ͘Ϭ� ϭ͕ϳϮϭϭ�D/�^�ŝŶĚŝĐĂƚŽƌ�ϯ͘ϭϰ͕��Ϯ�D/�^�ŝŶĚŝĐĂƚŽƌ�ϯ͘ϭϱ͖�D�'�ŝŶĚŝĐĂƚŽƌ�ϲ͘ϳ� 45 dĂďůĞ��,͘ϭϯ͗�WƌĞŐŶĂŶƚ�ǁŽŵĞŶ�ƐůĞĞƉŝŶŐ�ƵŶĚĞƌ�ŵŽƐƋƵŝƚŽ�ŶĞƚ Ɛ WĞƌĐĞŶƚĂŐĞ�ŽĨ�ƉƌĞŐŶĂŶƚ�ǁŽŵĞŶ�ǁŚŽ�ƐůĞƉƚ�ƵŶĚĞƌ�Ă�ŵŽƐƋƵŝƚŽ� ŶĞƚ�ĚƵƌŝŶŐ�ƚŚĞ�ƉƌĞǀŝŽƵƐ�ŶŝŐŚƚ͕�ďLJ�ƚLJƉĞ�ŽĨ�ŶĞƚ͕�EŽƌƚŚĞĂƐƚ�ŽŶĞ ͕�^ŽŵĂůŝĂ�ϮϬϭϭ� WĞƌĐĞŶƚĂŐĞ�ŽĨ�ƉƌĞŐŶĂŶƚ� ǁŽŵĞŶ�ǁŚŽ�ƐƚĂLJĞĚ�ŝŶ� ƚŚĞ�ŚŽƵƐĞŚŽůĚ�ƚŚĞ� ƉƌĞǀŝŽƵƐ�ŶŝŐŚƚ�EƵŵďĞƌ�ŽĨ� ƉƌĞŐŶĂŶƚ� ǁŽŵĞŶ�WĞƌĐĞŶƚĂŐ Ğ�ŽĨ�ƉƌĞŐŶĂŶƚ�ǁŽŵĞŶ�ǁŚŽ͗� EƵŵďĞƌ�ŽĨ�ƉƌĞŐŶĂŶƚ� ǁŽŵĞŶ�ǁŚŽ�ƐůĞƉƚ�ŝŶ� ƚŚĞ�ŚŽƵƐĞŚŽůĚ�ƚŚĞ� ƉƌĞǀŝŽƵƐ�ŶŝŐŚƚ� WĞƌĐĞŶƚĂŐĞ�ŽĨ�ƉƌĞŐŶĂŶƚ� ǁŽŵĞŶ�ǁŚŽ�ƐůĞƉƚ�ƵŶĚĞƌ�ĂŶ� /dE͕�ůŝǀŝŶŐ�ŝŶ�ŚŽƵƐĞŚŽůĚƐ�ǁŝƚŚ� Ăƚ�ůĞĂƐƚ�ŽŶĞ�/dE�EƵŵďĞƌ�ŽĨ�ƉƌĞŐŶĂŶƚ�ǁŽŵ ĞŶ� ůŝǀŝŶŐ�ŝŶ�ŚŽƵƐĞŚŽůĚƐ�ǁŝƚŚ�Ăƚ� ůĞĂƐƚ�ŽŶĞ�/dE� ^ůĞƉƚ�ƵŶĚĞƌ�ĂŶLJ� ŵŽƐƋƵŝƚŽ�ŶĞƚ�^ůĞƉƚ�ƵŶĚĞƌ�ĂŶ� ŝŶƐĞĐƚŝĐŝĚĞ�ƚƌĞĂƚĞĚ� ŶĞƚϭ � ZĞŐŝŽŶ����� �Ăƌŝ�ϵϱ͘ϱ� ϯϭϲϵ͘ϵϵ͘Ϯ ϯϬϮϯϱ͘ϴ ϳϴ EƵŐĂů�ϵϵ͘ϯ� ϭϰϰϮϬ͘ϲϭϵ͘ϵ ϭϰϯϱϯ͘ϱ ϱϯ DƵĚƵŐ�ϵϵ͘ϯ� Ϯϳϯϯϲ͘ϰϯϱ͘ϳ ϮϳϭϳϮ͘ϰ ϭϯϰ �ƌĞĂ�� hƌďĂŶ�ϵϴ͘ϭ� ϰϲϱϮϰ͘ϰϮϯ͘ϱ ϰϱϲϱϴ͘ϰ ϭϴϰ ZƵƌĂů�ϵϲ͘ϴ� Ϯϲϴϭϴ͘ϭϭϳ͘ϳ ϮϲϬϱϲ͘ϲ ϴϭ �ŐĞ�� ϭϱͲϭϵ�;�ϵϰ͘ϰͿ� ϯϴ;ϭϵ͘ϬͿ;ϭϵ͘ϬͿ ϯϲ;ΎͿ ϭϮ ϮϬͲϮϰ�ϵϲ͘ϰ� ϭϰϰϮϰ͘ϭϮϯ͘ϱ ϭϯϵϱϴ͘ϰ ϱϲ ϮϱͲϮϵ�ϵϴ͘Ϯ� ϮϭϱϮϰ͘ϬϮϯ͘ϲ Ϯϭϭϲϭ͘ϰ ϴϭ ϯϬͲϯϰ�ϵϴ͘ϲ� ϭϰϰϮϰ͘ϳϮϯ͘ϯ ϭϰϮϱϵ͘ϭ ϱϲ ϯϱͲ�ϯϵ�ϵϳ͘ϰ� ϭϭϲϭϴ͘ϳϭϳ͘ϵ ϭϭϯ;ϱϱ͘ϱͿ ϯϲ ϰϬͲϰϱ�ϭϬϬ͘Ϭ� ϲϯϭϭ͘ϭϭϭ͘ϭ ϲϯ;ΎͿ ϭϴ ϰϱͲ�ϰϵ�;ΎͿ� ϭϯ;ΎͿ;ΎͿ ϭϮ;ΎͿ ϲ �ĚƵĐĂƚŝŽŶ�� EŽŶĞ�ϵϳ͘ϱ� ϱϱϱϮϬ͘ϵϮϬ͘Ϯ ϱϰϭϱϴ͘ϭ ϭϴϴ WƌŝŵĂƌLJ�ϵϴ͘ϯ� ϭϮϱϮϳ͘ϬϮϲ͘Ϯ ϭϮϯϱϲ͘ϯ ϱϳ ^ĞĐŽŶĚĂƌLJн�ϵϴ͘Ϯ� ϱϯϮϮ͘ϱϮϮ͘ϱ ϱϮ;ΎͿ ϭϵ tĞĂůƚŚ�ŝŶĚĞdž�ƋƵŝŶƚŝůĞƐ�� WŽŽƌĞƐƚ�ϵϴ͘ϱ� ϭϯϮϭϰ͘ϬϭϮ͘ϱ ϭϯϬ;ϲϭ͘ϱͿ Ϯϲ ^ĞĐŽŶĚ�ϵϲ͘ϳ� ϭϱϭϭϵ͘ϳϭϵ͘Ϭ ϭϰϲ;ϱϳ͘ϮͿ ϰϴ DŝĚĚůĞ�ϵϳ͘ϵ� ϭϱϮϮϯ͘ϭϮϭ͘ϴ ϭϰϵϱϱ͘ϴ ϱϴ &ŽƵƌƚŚ�ϵϳ͘ϰ� ϭϱϮϯϭ͘ϳϯϭ͘ϳ ϭϰϴϲϲ͘ϵ ϳϬ ZŝĐŚĞƐƚ�ϵϳ͘ϵ� ϭϰϲϮϬ͘ϵϮϬ͘ϵ ϭϰϯϰϴ͘ϰ ϲϮ ��� dŽƚĂů�ϵϳ͘ϲ� ϳϯϯϮϮ͘ϭϮϭ͘ϰ ϳϭϲϱϳ͘ϵ Ϯϲϱ ϭ� D/�^�ŝŶĚŝĐĂƚŽƌ�ϯ͘ϭϵ� ;ΎͿ�&ŝŐƵƌĞƐ�ƚŚĂƚ�ĂƌĞ�ďĂƐĞĚ�ŽŶ�ůĞƐƐ�ƚŚĂŶ�Ϯϱ�ƵŶǁĞŝŐŚƚĞĚ�ĐĂƐĞƐ� ;�Ϳ�&ŝŐƵƌĞƐ�ƚŚĂƚ�ĂƌĞ�ďĂƐĞĚ�ŽŶ�ϮϱͲϰϵ�ƵŶǁĞŝŐŚƚĞĚ�ĐĂƐĞƐ� 46 Questions on the prevalence and treatment of fever were asked for all children under age five. Slightly more than one in ten (11 percent) of under five children were ill with fever in the two weeks prior to the survey (Table CH.14). Regional differences in fever prevalence ranged from 7 to 14 percent across the three regions.dĂďůĞ��,͘ϭϰ͗��ŶƚŝͲŵĂůĂƌŝĂů�ƚƌĞĂƚŵĞŶƚ�ŽĨ�ĐŚŝůĚƌĞŶ�ǁŝƚŚ�ĂŶƚŝͲŵĂůĂƌŝĂů�ĚƌƵŐƐWĞƌĐĞŶƚĂŐĞ�ŽĨ�ĐŚŝůĚƌĞŶ�ĂŐĞ�ϬͲϱϵ�ŵŽŶƚŚƐ�ǁŚŽ�ŚĂĚ�Ă�ĨĞǀĞƌ�ŝŶ�ƚŚĞ�ůĂƐƚ�ƚǁŽ�ǁĞĞŬƐ�ǁŚŽ�ƌĞĐĞŝǀĞĚ�ĂŶƚŝͲŵĂůĂƌŝĂů�ĚƌƵŐƐ͕�EŽƌƚŚĞĂƐƚ�ŽŶĞ͕�^ŽŵĂůŝĂ�ϮϬϭϭ�� ,ĂĚ�Ă�ĨĞǀĞƌ�ŝŶ�ůĂƐƚ�ƚǁŽ�ǁĞĞŬƐ� EƵŵďĞƌ�ŽĨ�ĐŚŝůĚƌĞŶ�ĂŐĞ�ϬͲϱϵ�ŵŽŶƚŚƐ� �ŚŝůĚƌĞŶ�ǁŝƚŚ�Ă�ĨĞǀĞƌ�ŝŶ�ƚŚĞ�ůĂƐƚ�ƚǁŽ�ǁĞĞŬƐ�ǁŚŽ�ǁĞƌĞ�ƚƌĞĂƚĞĚ�ǁŝƚŚ͗� EƵŵďĞƌ�ŽĨ�ĐŚŝůĚƌĞŶ�ǁŝƚŚ�ĨĞǀĞƌ�ŝŶ�ůĂƐƚ�ƚǁŽ�ǁĞĞŬƐ��ŶƚŝͲŵĂůĂƌŝĂůƐ͗� WĞƌĐĞŶƚĂŐĞ�ǁŚŽ�ƚŽŽŬ�ĂŶ�ĂŶƚŝͲŵĂůĂƌŝĂů�ĚƌƵŐ�ƐĂŵĞ�Žƌ�ŶĞdžƚ�ĚĂLJϮ�^Wͬ�&ĂŶƐŝĚĂƌ� �ŚůŽƌŽͲƋƵŝŶĞ� �ŵŽĚŝĂͲƋƵŝŶĞ� YƵŝŶŝŶĞ� �ŽŵďŝŶĂƚŝŽŶ�ǁŝƚŚ�ĂƌƚĞŵŝƐŝŶŝŶ� �ŶLJ�ĂŶƚŝͲŵĂůĂƌŝĂů�ĚƌƵŐϭ�^Ğdž� �� �� �� ��DĂůĞ� ϭϭ͘ϯ� Ϯ͕ϯϵϱ� ϵ͘ϱ ϭϮ͘ϲ Ϯ͘Ϯ Ϯ͘Ϯ Ϭ͘ϳ ϮϮ͘Ϯ� ϭϬ͘Ϭ ϮϳϮ&ĞŵĂůĞ� ϵ͘ϲ� Ϯ͕ϯϭϵ� ϱ͘ϯ ϴ͘ϴ Ϭ͘ϵ ϯ͘Ϯ ϭ͘ϴ ϭϲ͘ϴ� ϳ͘Ϭ ϮϮϯZĞŐŝŽŶ� � � ��Ăƌŝ� ϭϮ͘ϭ� ϭ͕ϵϱϮ� ϳ͘ϵ ϴ͘ϯ Ϭ͘ϴ ϰ͘Ϯ ϭ͘ϲ ϭϳ͘Ϯ� ϴ͘ϲ ϮϯϳEƵŐĂů� ϭϯ͘ϲ� ϵϵϯ� ϱ͘ϭ ϭϬ͘ϳ ϭ͘ϰ Ϭ͘ϳ Ϭ͘ϳ ϭϱ͘ϴ� ϵ͘ϯ ϭϯϱDƵĚƵŐ� ϳ͘Ϭ� ϭ͕ϳϲϴ� ϵ͘ϴ ϭϲ͘ϭ ϯ͘Ϯ ϭ͘ϲ Ϭ͘ϵ Ϯϵ͘ϭ� ϴ͘Ϭ ϭϮϯ�ƌĞĂ� � � �hƌďĂŶ� ϭϬ͘ϱ� Ϯ͕ϵϬϴ� ϴ͘ϴ ϭϯ͘ϴ Ϯ͘Ϯ Ϯ͘ϱ ϭ͘ϲ Ϯϯ͘Ϭ� ϭϭ͘ϵ ϯϬϱZƵƌĂů� ϭϬ͘ϱ� ϭ͕ϴϬϲ� ϱ͘ϲ ϲ͘Ϯ Ϭ͘ϲ Ϯ͘ϴ Ϭ͘ϲ ϭϰ͘ϳ� ϯ͘ϰ ϭϵϬ�ŐĞ� � � �ϬͲϭϭ�ŵŽŶƚŚƐ� ϳ͘ϰ� ϴϱϳ� ϰ͘ϳ ϰ͘ϳ Ϭ͘Ϭ Ϭ͘Ϭ Ϭ͘Ϭ ϵ͘ϱ� ϯ͘Ϭ ϲϯϭϮͲϮϯ�ŵŽŶƚŚƐ� ϭϬ͘ϰ� ϳϵϮ� ϭϰ͘ϰ ϭϭ͘ϵ ϰ͘ϲ ϯ͘ϱ ϯ͘ϱ Ϯϳ͘ϰ� ϭϲ͘ϱ ϴϮϮϰͲϯϱ�ŵŽŶƚŚƐ� ϭϮ͘ϯ� ϭ͕ϬϮϳ� ϳ͘ϴ ϭϰ͘Ϭ Ϭ͘Ϭ ϰ͘ϴ Ϭ͘ϴ Ϯϰ͘ϯ� ϵ͘ϯ ϭϮϳϯϲͲϰϳ�ŵŽŶƚŚƐ� ϭϭ͘ϱ� ϭ͕Ϭϲϳ� ϰ͘ϵ ϴ͘ϴ Ϯ͘ϰ Ϭ͘ϴ Ϭ͘ϴ ϭϯ͘ϳ� ϰ͘ϳ ϭϮϯϰϴͲϱϵ�ŵŽŶƚŚƐ� ϭϬ͘ϯ� ϵϳϮ� ϲ͘ϵ ϭϮ͘ϳ ϭ͘Ϭ ϯ͘ϭ ϭ͘ϭ Ϯϭ͘ϳ� ϵ͘ϴ ϭϬϬDŽƚŚĞƌ͛Ɛ�ĞĚƵĐĂƚŝŽŶ� � � �EŽŶĞ� ϵ͘ϵ� ϯ͕ϲϮϰ� ϳ͘ϭ ϭϮ͘ϭ ϭ͘ϭ Ϯ͘ϴ ϭ͘ϰ ϮϬ͘ϰ� ϴ͘ϰ ϯϱϵWƌŝŵĂƌLJ� ϭϯ͘ϯ� ϳϵϳ� ϳ͘ϱ ϰ͘ϱ ϯ͘ϳ Ϯ͘ϵ Ϭ͘ϵ ϭϲ͘ϵ� ϵ͘ϭ ϭϬϲ^ĞĐŽŶĚĂƌLJн� ϭϬ͘ϯ� Ϯϵϯ� ;ϭϯ͘ϭͿ ;ϭϵ͘ϭͿ ;Ϭ͘ϬͿ ;Ϭ͘ϬͿ ;Ϭ͘ϬͿ ;ϮϮ͘ϳͿ� ;ϭϬ͘ϬͿ ϯϬtĞĂůƚŚ�ŝŶĚĞdž�ƋƵŝŶƚŝůĞƐ� � � �WŽŽƌĞƐƚ� ϭϬ͘ϭ� ϭ͕ϬϬϰ� ϯ͘Ϭ ϲ͘ϵ Ϭ͘Ϭ ϭ͘ϭ Ϭ͘Ϭ ϭϬ͘ϵ� ϱ͘ϴ ϭϬϭ^ĞĐŽŶĚ� ϭϭ͘ϵ� ϵϲϱ� ϴ͘ϭ ϳ͘ϭ Ϭ͘ϴ Ϯ͘ϳ Ϭ͘ϵ ϭϴ͘ϴ� ϱ͘ϰ ϭϭϱDŝĚĚůĞ� ϭϬ͘ϲ� ϵϮϬ� ϳ͘Ϯ ϭϯ͘ϯ ϭ͘ϭ ϯ͘Ϯ Ϯ͘Ϭ ϮϬ͘ϲ� ϳ͘Ϭ ϵϴ&ŽƵƌƚŚ� ϴ͘ϲ� ϵϲϱ� ϲ͘ϵ ϭϰ͘Ϭ Ϯ͘ϯ Ϭ͘Ϭ Ϭ͘Ϭ ϮϮ͘ϭ� ϭϭ͘ϲ ϴϯZŝĐŚĞƐƚ� ϭϭ͘ϰ� ϴϲϬ� ϭϮ͘ϳ ϭϰ͘ϲ ϯ͘ϵ ϱ͘ϴ Ϯ͘ϵ Ϯϳ͘ϯ� ϭϰ͘ϲ ϵϴ�� � � �dŽƚĂů� ϭϬ͘ϱ� ϰ͕ϳϭϰ� ϳ͘ϲ ϭϬ͘ϵ ϭ͘ϲ Ϯ͘ϲ ϭ͘Ϯ ϭϵ͘ϴ� ϴ͘ϳ ϰϵϱϭ�D/�^�ŝŶĚŝĐĂƚŽƌ�ϯ͘ϭϴ͖�D�'�ŝŶĚŝĐĂƚŽƌ�ϲ͘ϴ�Ϯ�D/�^�ŝŶĚŝĐĂƚŽƌ�ϯ͘ϭϳ�;�Ϳ�&ŝŐƵƌĞƐ�ƚŚĂƚ�ĂƌĞ�ďĂƐĞĚ�ŽŶ�ϮϱͲϰϵ�ƵŶǁĞŝŐŚƚĞĚ�ĐĂƐĞƐ�dŚĞƌĞ�ǁĂƐ�ŶŽ�ƚƌĞĂƚŵĞŶƚ�ǁŝƚŚ�ŽƚŚĞƌ�ŵĞĚŝĐĂƚŝŽŶƐ�ďĞƐŝĚĞƐ�ĂŶƚŝͲŵĂůĂƌŝĂůƐ�ƚŚƵƐ�ŶŽ�ĚĂƚĂ�ŝƐ�ƐŚŽǁŶ�ŝŶ�ƚŚĞ�ƚĂďůĞ�ĨŽƌ�ŽƚŚĞƌ�ŵĞĚŝĐĂƚŝŽŶƐ͘� Mothers were asked to report all of the medicines given to a child to treat the fever, including both medicines given at home and medicines given or prescribed at a health facility. Overall, 20 percent of children with fever in the last two weeks were treated with an “appropriate” anti-malarial drug and 9 percent received anti-malarial drugs either on the same day or day after the onset of symptoms. There were no cases reported of using other medications like antibiotic pill or syrup, antibiotic injection, paracetamol/ panadol/acetaminophen, aspirin and ibuprofen although they were included in the questionnaire. It is likely that these types of medicines are not readily available in Somalia although further investigation may be necessary. “Appropriate” anti-malarial drugs include chloroquine, SP (sulfadoxine-pyrimethamine), artemisine and combination drugs among other drugs. In Northeast Somalia, the first line of treatment is ACT (Artemisine Combination Therapy) and especially Artemisine + Sulfadoxine-Pyrimethamine (AS+SP). Only 11 percent of children with fever were given chloroquine, and 8 percent were given SP and 1 percent received Artemisine Combination Therapy. 47 Table CH.15 provides the proportion of children age 0-59 months who had a fever in the last two weeks and who had a finger or heel stick for malaria testing. Overall, 20 percent of children with a fever in the last two weeks had a finger or heel stick. Malaria diagnostics among children was more common in urban areas (24 percent) compared to rural areas (12 percent). The percentage of finger pricks for malaria testing was higher in Mudug region (30 percent) compared to the other two regions (14 percent in Bari and 19 percent in Nugal). The percentage of finger pricks for malaria testing increased with increase in household wealth from 10 percent in the poorest households to 27 percent in the richest. Pregnant women living in places where malaria is highly prevalent are four times more likely than other adults to get malaria and twice as likely to die of the disease. Once infected, pregnant women risk anemia, premature delivery and stillbirth. Their babies are likely to be of low birth weight, which makes them unlikely to survive their first year of life. For this reason, steps are taken to protect pregnant women by distributing insecticide-treated mosquito nets and treatment during antenatal check-ups with drugs that prevent malaria infection (Intermittent preventive treatment or IPT). In Northeast Zone MICS, women were asked of the medicines they had received in their last pregnancy during the 2 years preceding the survey. Women are considered to have received intermittent preventive therapy if they have received at least 2 doses of SP/Fansidar during the pregnancy. dĂďůĞ��,͘ϭϱ͗�DĂůĂƌŝĂ�ĚŝĂŐŶŽƐƚŝĐƐ�ƵƐĂŐĞ�WĞƌĐĞŶƚĂŐĞ�ŽĨ�ĐŚŝůĚƌĞŶ�ĂŐĞ�ϬͲϱϵ�ŵŽŶƚŚƐ�ǁŚŽ�ŚĂĚ�Ă�ĨĞǀĞƌ�ŝŶ�ƚŚĞ�ůĂƐƚ�ƚǁŽ�ǁĞĞŬƐ�ĂŶĚ�ǁŚŽ�ŚĂĚ�Ă�ĨŝŶŐĞƌ�Žƌ�ŚĞĞů�ƐƚŝĐŬ�ĨŽƌ�ŵĂůĂƌŝĂ�ƚĞƐƚŝŶŐ͕�EŽƌƚŚĞĂƐƚ�ŽŶĞ͕�^ŽŵĂůŝĂ�ϮϬϭϭ� ,ĂĚ�Ă�ĨŝŶŐĞƌ�Žƌ�ŚĞĞů�ƐƚŝĐŬϭ� EƵŵďĞƌ�ŽĨ�ĐŚŝůĚƌĞŶ�ĂŐĞ�ϬͲϱϵ�ŵŽŶƚŚƐ�ǁŝƚŚ�ĨĞǀĞƌ�ŝŶ�ƚŚĞ�ůĂƐƚ�ƚǁŽ�ǁĞĞŬƐ�^Ğdž� ��DĂůĞ� ϭϵ͘Ϯ ϮϳϮ&ĞŵĂůĞ� ϭϵ͘ϵ ϮϮϯZĞŐŝŽŶ��Ăƌŝ� ϭϰ͘ϭ ϮϯϳEƵŐĂů� ϭϵ͘ϰ ϭϯϱDƵĚƵŐ� ϯϬ͘Ϭ ϭϮϯ�ƌĞĂ�hƌďĂŶ� Ϯϯ͘ϵ ϯϬϱZƵƌĂů� ϭϮ͘ϰ ϭϵϬ�ŐĞ�ϬͲϭϭ�ŵŽŶƚŚƐ� ϭϬ͘ϴ ϲϯϭϮͲϮϯ�ŵŽŶƚŚƐ� Ϯϱ͘Ϭ ϴϮϮϰͲϯϱ�ŵŽŶƚŚƐ� Ϯϭ͘Ϭ ϭϮϳϯϲͲϰϳ�ŵŽŶƚŚƐ� ϭϴ͘ϱ ϭϮϯϰϴͲϱϵ�ŵŽŶƚŚƐ� ϭϵ͘ϳ ϭϬϬDŽƚŚĞƌ͛Ɛ�ĞĚƵĐĂƚŝŽŶ�EŽŶĞ� ϭϵ͘Ϭ ϯϱϵWƌŝŵĂƌLJ� ϭϳ͘ϯ ϭϬϲ^ĞĐŽŶĚĂƌLJн� ;ϯϮ͘ϯͿ ϯϬtĞĂůƚŚ�ŝŶĚĞdž�ƋƵŝŶƚŝůĞƐ�WŽŽƌĞƐƚ� ϭϬ͘Ϭ ϭϬϭ^ĞĐŽŶĚ� ϭϮ͘ϯ ϭϭϱDŝĚĚůĞ� Ϯϰ͘ϳ ϵϴ&ŽƵƌƚŚ� Ϯϱ͘ϲ ϴϯZŝĐŚĞƐƚ� Ϯϳ͘ϰ ϵϴ��dŽƚĂů� ϭϵ͘ϱ ϰϵϱϭ�D/�^�ŝŶĚŝĐĂƚŽƌ�ϯ͘ϭϲ�;�Ϳ�&ŝŐƵƌĞƐ�ƚŚĂƚ�ĂƌĞ�ďĂƐĞĚ�ŽŶ�ϮϱͲϰϵ�ƵŶǁĞŝŐŚƚĞĚ�ĐĂƐĞƐ� 48 Intermittent preventive treatment for malaria in pregnant women who gave birth in the two years preceding the survey is presented in Table CH.16. Overall 15 percent of women who received Antenatal care also received medicine to prevent malaria. About 10 percent received SP/Fansidar at least once and another 2 percent at least two or more times. 7 A review of the quality of data relating to children below 2 years indicates potential data quality limitations hence the need to interpret the results for intermittent preventive treatment (IPT) with caution dĂďůĞ��,͘ϭϲ͗�/ŶƚĞƌŵŝƚƚĞŶƚ�ƉƌĞǀĞŶƚŝǀĞ�ƚƌĞĂƚŵĞŶƚ�ĨŽƌ�ŵĂůĂƌŝĂ�WĞƌĐĞŶƚĂŐĞ�ŽĨ�ǁŽŵĞŶ�ĂŐĞ�ϭϱͲϰϵ�LJĞĂƌƐ�ǁŚŽ�ŚĂĚ�Ă�ůŝǀĞ�ďŝƌƚŚ�ĚƵƌŝŶŐ�ƚŚĞ�ƚǁŽ�LJĞĂƌƐ�ƉƌĞĐĞĚŝŶŐ�ƚŚĞ�ƐƵƌǀĞLJ�ĂŶĚ�ǁŚŽ�ƌĞĐĞŝǀĞĚ�ŝŶƚĞƌŵŝƚƚĞŶƚ�ƉƌĞǀĞŶƚŝǀĞ�ƚƌĞĂƚŵĞŶƚ�;/WdͿ�ĨŽƌ�ŵĂůĂƌŝĂ�ĚƵƌŝŶŐ�ƉƌĞŐŶĂŶĐLJ�Ăƚ�ĂŶLJ�ĂŶƚĞŶĂƚĂů�ĐĂƌĞ�ǀŝƐŝƚ͕�EŽƌƚŚĞĂƐƚ�ŽŶĞ͕�^ŽŵĂůŝĂ�ϮϬϭϭ�WĞƌĐĞŶƚĂŐĞ�ŽĨ�ǁŽŵĞŶ�ǁŚŽ�ƌĞĐĞŝǀĞĚ�ĂŶƚĞŶĂƚĂů�ĐĂƌĞ�;�E�Ϳ� EƵŵďĞƌ�ŽĨ�ǁŽŵĞŶ�ǁŚŽ�ŚĂĚ�Ă�ůŝǀĞ�ďŝƌƚŚ�ŝŶ�ƚŚĞ�ůĂƐƚ�ƚǁŽ�LJĞĂƌƐ� WĞƌĐĞŶƚĂŐĞ�ŽĨ�ƉƌĞŐŶĂŶƚ�ǁŽŵĞŶ�ǁŚŽ�ƚŽŽŬ͗� EƵŵďĞƌ�ŽĨ�ǁŽŵĞŶ�ǁŚŽ�ŚĂĚ�Ă�ůŝǀĞ�ďŝƌƚŚ�ŝŶ�ƚŚĞ�ůĂƐƚ�ƚǁŽ�LJĞĂƌƐ�ĂŶĚ�ǁŚŽ�ƌĞĐĞŝǀĞĚ�ĂŶƚĞŶĂƚĂů�ĐĂƌĞ��ŶLJ�ŵĞĚŝĐŝŶĞ�ƚŽ�ƉƌĞǀĞŶƚ�ŵĂůĂƌŝĂ�Ăƚ�ĂŶLJ��E��ǀŝƐŝƚ�ĚƵƌŝŶŐ�ƉƌĞŐŶĂŶĐLJ� ^Wͬ&ĂŶƐŝĚĂƌ�Ăƚ�ůĞĂƐƚ�ŽŶĐĞ� ϳ^Wͬ&ĂŶƐŝĚĂƌ�ƚǁŽ�Žƌ�ŵŽƌĞ�ƚŝŵĞƐϭ�ZĞŐŝŽŶ� �� ���Ăƌŝ� Ϯϲ͘Ϯ� ϲϰϲ ϭϲ͘ϰ ϴ͘ϲ ϭ͘ϭ� ϭϲϵEƵŐĂů� ϯϭ͘ϴ� ϯϯϮ ϮϮ͘ϭ ϭϰ͘ϴ ϯ͘ϳ� ϭϬϲDƵĚƵŐ� ϭϳ͘ϰ� ϱϱϯ ϲ͘Ϯ ϱ͘Ϯ Ϭ͘Ϭ� ϵϲ�ƌĞĂ� � �hƌďĂŶ� ϯϬ͘ϲ� ϵϱϱ ϭϱ͘ϵ ϭϬ͘ϯ Ϯ͘Ϭ� ϮϵϮZƵƌĂů� ϭϯ͘ϳ� ϱϳϲ ϭϯ͘ϱ ϲ͘ϴ Ϭ͘Ϭ� ϳϵ�ĚƵĐĂƚŝŽŶ� � �EŽŶĞ� ϭϵ͘ϴ� ϭϭϳϴ ϭϲ͘ϱ ϵ͘ϳ ϭ͘ϳ� ϮϯϯWƌŝŵĂƌLJ� ϯϰ͘ϴ� ϮϲϬ ϭϰ͘ϭ ϳ͘ϲ ϭ͘ϭ� ϵϬ^ĞĐŽŶĚĂƌLJн� ϱϬ͘ϳ� ϵϯ ;ϭϮ͘ϯͿ ;ϭϮ͘ϯͿ ;Ϯ͘ϭͿ� ϰϳtĞĂůƚŚ�ŝŶĚĞdž�ƋƵŝŶƚŝůĞƐ� � �WŽŽƌĞƐƚ� ϵ͘ϴ� ϯϬϮ ;Ϯϯ͘ϲͿ ;ϭϯ͘ϭͿ ;ϲ͘ϱͿ� ϯϬ^ĞĐŽŶĚ� ϭϳ͘ϲ� ϯϮϮ ϭϳ͘ϳ ϴ͘ϳ ϭ͘ϳ� ϱϳDŝĚĚůĞ� Ϯϭ͘ϳ� Ϯϵϵ ϵ͘ϯ ϳ͘ϴ ϭ͘ϱ� ϲϱ&ŽƵƌƚŚ� Ϯϵ͘Ϯ� ϯϭϮ ϭϱ͘ϭ ϳ͘ϳ Ϭ͘Ϭ� ϵϭZŝĐŚĞƐƚ� ϰϯ͘ϲ� Ϯϵϱ ϭϱ͘ϴ ϭϭ͘ϯ ϭ͘ϱ� ϭϮϵ�� ��dŽƚĂů� Ϯϰ͘Ϯ� ϭϱϯϭ ϭϱ͘ϰ ϵ͘ϱ ϭ͘ϲ� ϯϳϭϭ�D/�^�ŝŶĚŝĐĂƚŽƌ�ϯ͘ϮϬ�;�Ϳ�&ŝŐƵƌĞƐ�ƚŚĂƚ�ĂƌĞ�ďĂƐĞĚ�ŽŶ�ϮϱͲϰϵ�ƵŶǁĞŝŐŚƚĞĚ�ĐĂƐĞƐ� �������������������������������������������������������$�UHYLHZ�RI�WKH�TXDOLW\�RI�GDWD�UHODWLQJ�WR�FKLOGUHQ�EHORZ���\HDUV�LQGLFDWHV�SRWHQWLDO�GDWD�TXDOLW\�OLPLWDWLRQV�KHQFH�WKH�QHHG�WR�LQWHUSUHW�WKH�UHVXOWV�IRU�LQWHUPLWWHQW�SUHYHQWLYH�WUHDWPHQW��,37��ZLWK�FDXWLRQ 49 VI. Water and Sanitation Safe drinking water is a basic necessity for good health. Unsafe drinking water can be a significant carrier of diseases such as trachoma, cholera, typhoid, and schistosomiasis. Drinking water can also be tainted with chemical, physical and radiological contaminants with harmful effects on human health. In addition to its association with disease, access to drinking water may be particularly important for women and children, especially in rural areas, who bear the primary responsibility for carrying water, often for long distances. The MDG goal (7, C) is to reduce by half, between 1990 and 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation. The World Fit for Children goal calls for a reduction in the proportion of households without access to hygienic sanitation facilities and affordable and safe drinking water by at least one-third. The list of indicators used in MICS is as follows: Water • Use of improved drinking water sources • Use of adequate water treatment method • Time to source of drinking water • Person collecting drinking water Sanitation • Use of improved sanitation facilities • Sanitary disposal of child’s faeces For more details on water and sanitation and to access some reference documents, please visit the UNICEF childinfo website8. MICS also collects additional information on the availability of facilities and conditions for handwashing. The following indicators are collected: • Place for handwashing observed • Availability of soap Use of Improved Water Sources The distribution of the population by main source of drinking water is shown in Table WS.1 and Figure WS.1. The population using improved sources of drinking water are those using any of the following types of supply: piped water (into dwelling, compound, yard or plot, to neighbour, public tap/standpipe), tubewell/borehole, protected well, protected spring. Bottled water is considered as an improved water source only if the household is using an improved water source for handwashing and cooking. Collection of rainwater from rooftops was classified under unimproved sources of drinking because it was considered that the condition of housing and hence rooftops North East Zone is very poor in and does not allow for classification of rainwater from rooftop as improved. 8 http://www.childinfo.org/wes.html 50 dĂďůĞ�t^͘ϭ͗�hƐĞ�ŽĨ�ŝŵƉƌŽǀĞĚ�ǁĂƚĞƌ�ƐŽƵƌĐĞƐ�� WĞƌĐĞŶƚ�ĚŝƐƚƌŝďƵƚŝŽŶ�ŽĨ�ŚŽƵƐĞŚŽůĚ�ƉŽƉƵůĂƚŝŽŶ�ĂĐĐŽƌĚŝŶŐ�ƚŽ�ŵĂŝŶ�ƐŽƵƌĐĞ�ŽĨ�ĚƌŝŶŬŝŶŐ �ǁĂƚĞƌ�ĂŶĚ�ƉĞƌĐĞŶƚĂŐĞ�ŽĨ�ŚŽƵƐĞŚŽůĚ�ƉŽƉƵůĂƚŝŽŶ�ƵƐŝŶŐ�ŝŵƉƌŽǀ ĞĚ�ĚƌŝŶŬŝŶŐ�ǁĂƚĞƌ�ƐŽƵƌĐĞƐ͕�EŽƌƚŚĞĂƐƚ�ŽŶĞ͕�ϮϬϭϭ � DĂŝŶ�ƐŽƵƌĐĞ�ŽĨ�ĚƌŝŶŬŝŶŐ�ǁĂƚĞƌ� DŝƐƐŝŶ Ő�dŽƚĂů�WĞƌĐĞŶƚͲ ĂŐĞ�ƵƐŝŶŐ� ŝŵƉƌŽǀĞĚ� ƐŽƵƌĐĞƐ� ŽĨ� ĚƌŝŶŬŝŶŐ� ǁĂƚĞƌϭ �EƵŵďĞƌ�ŽĨ� ŚŽƵƐĞͲŚŽůĚ� ŵĞŵďĞƌƐ� � /ŵƉƌŽǀĞĚ�ƐŽƵƌĐĞƐ� hŶŝŵƉƌŽǀĞĚ�ƐŽƵƌĐĞƐ� �WŝƉĞĚ�ǁĂƚĞƌ� dƵďĞ Ͳ ǁĞůůͬ� ďŽƌĞͲ ŚŽůĞ�Wƌ ŽͲ ĞĐƚĞĚ� ǁĞůů�WƌŽͲ ƚĞĐƚĞĚ� ƐƉƌŝŶŐ��ŽƚƚůĞĚ� ǁĂƚĞƌ�hŶƉƌŽ Ͳ ƚĞĐƚĞĚ� ƐƉƌŝŶŐ�ZĂŝŶ � ǁĂƚĞƌ� �ŽůůĞĐͲ ƚŝŽŶ͗� ZŽŽĨ� ƚŽƉ�ZĂŝŶ� ǁĂƚĞƌ� �ŽůůĞͲ ĐƚŝŽŶ͗� �ĞƌŬĂĚ�ZĂŝŶ� ǁĂƚĞƌ� �ŽůůĞĐƚŝŽŶ ͗��ĂůůLJ�dĂŶŬĞƌ� ƚƌƵĐŬ��Ăƌƚ� ǁŝƚŚ� ƐŵĂůů� ƚĂŶŬͬ� ĚƌƵ ŵ�^ƵƌĨĂĐ Ğ� ǁĂƚĞƌ��ŽƚƚůĞĚ� ǁĂƚĞƌ�KƚŚĞƌ� /ŶƚŽ� ĚǁĞů ůŝŶŐ�/ŶƚŽ� LJĂƌĚͬ� ƉůŽƚ�dŽ� ŶĞŝŐŚͲ ďŽƵƌ�WƵďůŝĐ� ƚĂƉͬ� ƐƚĂŶĚͲ ƉŝƉĞ� hŶƉƌŽ Ͳ ƚĞĐƚĞĚ� ǁĞůů� ZĞŐŝŽŶ� ������� � �Ăƌŝ� ϭϳ͘ϵ�ϲ͘ϯ�ϭ͘ϯ�ϯ͘ϱ�ϱ͘ϯ� ϲ͘ϲ�ϭ͘Ϯ�Ϭ͘Ϯ�ϰ͘ϭ�ϭ͘ϭ�Ϭ͘ϰ� ϯϱ͘ϲ�ϭ͘ϭ�ϭϮ͘ϯ�ϭ͘ϵ�Ϭ͘ϲ�Ϭ͘Ϭ� Ϭ͘ϯ�Ϭ͘ϰ�ϭϬϬ�ϰϮ͘ϯ�ϭϮ͕ϴϯϰ� EƵŐĂů� ϭϭ͘ϰ�ϯ͘ϰ�ϭ͘Ϭ�ϱ͘ϲ�ϭϯ͘ϵ� ϲ͘ϲ�ϭ͘Ϯ�ϭ͘Ϯ�ϲ͘Ϯ�ϰ͘Ϭ�Ϭ͘Ϯ� Ϯϲ͘Ϯ�Ϭ͘ϴ�ϭϭ͘ϭ�Ϯ͘ϳ�Ϯ͘ϰ�ϭ͘Ϯ� Ϭ͘ϯ�Ϭ͘ϲ�ϭϬϬ�ϰϰ͘ϰ�ϱ͕ϴϲϮ� DƵĚƵŐ� Ϯϳ͘ϭ�ϭϮ͘ϴ�ϰ͘ϰ�ϳ͘ϰ�ϳ͘ϱ� ϵ͘ϰ�Ϭ�Ϭ͘Ϯ�ϭϯ͘ϲ�Ϭ͘ϯ�Ϭ͘Ϯ� ϭϭ͘ϰ�Ϭ͘ϰ�ϭ͘ϳ�ϯ͘ϭ�Ϭ͘Ϭ�Ϭ͘Ϭ� Ϭ͘Ϭ�Ϭ͘ϱ�ϭϬϬ�ϲϴ͘ϴ�ϵ͕ϴϰϭ� �ƌĞĂ� �� hƌďĂŶ�� Ϯϵ�ϭϭ͘ϱ�Ϯ͘ϴ�ϯ͘ϰ�ϱ͘ϰ� ϳ͘ϯ�Ϭ͘ϳ�Ϭ͘ϲ�ϲ͘Ϯ�Ϭ͘ϴ�Ϭ͘ϯ� Ϯϭ͘ϯ�Ϭ͘ϱ�ϲ͘Ϭ�Ϯ͘ϴ�Ϭ͘ϰ�Ϭ͘ϰ� Ϭ͘Ϯ�Ϭ͘ϱ�ϭϬϬ�ϲϬ͘ϳ�ϭϴ͕ϮϰϮ� ZƵƌĂů�ϯ͘ϰ�ϭ͘ϲ�ϭ͘ϰ�ϴ͘ϲ�ϭϮ� ϴ͘Ϭ�ϭ͘Ϭ�Ϭ͘ϭ�ϭϬ͘ϳ�Ϯ͘ϰ�Ϭ͘ϯ� ϯϮ͘ϱ�ϭ͘ϯ�ϭϮ͘ϳ�ϭ͘ϵ�ϭ͘ϰ�Ϭ͘Ϭ� Ϭ͘Ϯ�Ϭ͘ϰ�ϭϬϬ�ϯϲ͘ϭ�ϭϬ͕Ϯϵϱ� �ĚƵĐĂƚŝŽŶ�ŽĨ�ŚŽƵƐĞŚŽůĚ�ŚĞĂĚ� �� EŽŶĞ�ϭϳ͘Ϯ�ϲ͘Ϯ�Ϯ͘ϳ�ϱ͘ϰ�ϴ͘ϱ� ϴ͘ϱ�Ϭ͘ϳ�Ϭ͘ϭ�ϵ͘Ϯ�ϭ͘ϱ�Ϭ͘Ϯ� Ϯϱ͘ϳ�Ϭ͘ϵ�ϴ͘ϵ�Ϯ͘ϱ�Ϭ͘ϵ�Ϭ͘ϭ� Ϭ͘Ϯ�Ϭ͘ϱ�ϭϬϬ�ϰϵ͘ϯ�ϮϬ͕ϲϴϱ� WƌŝŵĂƌLJ�� ϭϵ͘ϯ�ϵ͘Ϭ�ϭ͘ϰ�ϲ͘ϭ�ϳ͘ϯ� ϱ͘ϴ�Ϭ͘ϲ�Ϭ͘Ϯ�ϰ͘Ϭ�ϭ͘ϲ�Ϭ͘ϰ� Ϯϵ͘Ϭ�Ϭ͘ϱ�ϵ͘ϴ�ϯ͘ϰ�Ϭ͘ϰ�Ϭ͘ϰ� Ϭ͘Ϯ�Ϭ͘ϲ�ϭϬϬ�ϰϵ͘ϲ�ϯ͕ϮϲϮ� ^ĞĐŽŶĚĂƌLJн� ϯϮ͘ϭ�ϭϱ͘Ϯ�ϭ͘Ϯ�ϰ͘ϯ�ϰ͘ϵ� ϰ͘ϰ�ϭ͘ϰ�Ϯ͘Ϭ�ϰ͘ϯ�Ϭ͘ϵ�Ϭ͘ϱ� ϮϬ͘ϵ�Ϭ͘Ϯ�ϰ͘ϴ�Ϯ͘Ϭ�Ϭ͘ϭ�Ϭ͘ϯ� Ϭ͘Ϯ�Ϭ͘Ϯ�ϭϬϬ�ϲϱ͘ϱ�ϰ͕ϰϰϮ� DŝƐƐŝŶŐͬ�<�ϭϲ͘ϭ�ϭ͘ϵ�ϯ͘Ϯ�ϱ͘ϴ�ϲ͘ϯ� ϭϮ͘ϭ�Ϭ͘ϬϬ͘ϬϬ͘ϬϬ͘ϬϬ͘Ϭ ϮϮ͘ϴϬ͘Ϭϱ͘Ϯ�Ϭ͘Ϭϭϭ͘Ϭϭϱ͘ϱ Ϭ͘ϬϬ͘Ϭ ϭϬϬ�ϰϱ͘ϲ�ϭϰϴ� tĞĂůƚŚ�ŝŶĚĞdž�ƋƵŝŶƚŝůĞ� �� WŽŽƌĞƐƚ� ϭ͘ϭ�Ϭ͘ϴ�ϯ͘ϱ�ϴ͘ϱ�ϭϯ͘ϰ� ϭϭ͘ϴ�Ϯ͘Ϭ�Ϭ͘Ϭ�ϭϰ͘ϯ�ϰ͘ϯ�Ϭ͘ϭ �ϮϮ͘ϭ�ϭ͘ϰ�ϭϬ͘ϰ�Ϯ͘ϳ�ϯ͘ϭ� Ϭ͘Ϭ�Ϭ͘ϯ�Ϭ͘Ϯ�ϭϬϬ�ϰϭ͘Ϯ� ϱ͕ϳϬϱ� ^ĞĐŽŶĚ�ϰ͘ϭ�ϭ͘ϵ�Ϯ͘ϱ�ϳ͘ϲ�ϭϮ͘ϭ� ϴ͘ϴ�Ϭ͘ϲ�Ϭ͘Ϭ�ϭϬ͘ϯ�ϭ͘ϴ�Ϭ͘ϯ� ϯϮ͘ϭ�Ϭ͘ϴ�ϭϮ͘Ϯ�ϯ͘Ϯ�Ϭ͘ϱ�Ϭ͘ϭ� Ϭ͘Ϯ�Ϭ͘ϳ�ϭϬϬ�ϯϳ͘ϲ�ϱ͕ϳϭϮ� DŝĚĚůĞ� ϭϬ͘ϵ�ϱ͘ϵ�ϯ�ϳ͘ϭ�ϵ͘ϯ� ϴ͘ϰ�Ϭ͘ϴ�Ϭ͘ϭ�ϵ͘ϴ�Ϭ͘ϴ�Ϭ͘ϭ� Ϯϵ͘ϰ�ϭ͘Ϭ�ϴ͘ϱ�ϯ͘ϵ�Ϭ͘ϭ�Ϭ͘ϯ� Ϭ͘ϭ�Ϭ͘ϲ�ϭϬϬ�ϰϱ͘ϱ�ϱ͕ϳϬϱ� &ŽƵƌƚŚ�ϯϬ͘ϲ�ϭϯ͘Ϯ�Ϯ͘ϯ�Ϯ͘ϲ�ϯ͘ϯ� ϳ͘Ϭ�Ϭ͘ϱ�Ϭ͘ϰ�ϯ͘ϳ�Ϭ͘Ϯ�Ϭ͘Ϯ� Ϯϲ͘ϲ�Ϭ͘ϱ�ϲ͘ϯ�ϭ͘ϵ�Ϭ͘Ϭ�Ϭ͘Ϯ� Ϭ͘Ϯ�Ϭ͘ϰ�ϭϬϬ�ϱϵ͘ϴ�ϱ͕ϳϭϬ� ZŝĐŚĞƐƚ� ϱϭ͘ϵ�ϭϳ͘ϴ�Ϭ͘ϰ�Ϭ͘ϲ�Ϭ͘ϵ� ϭ͘ϴ�Ϭ͘Ϯ�ϭ͘ϳ�Ϭ͘ϵ�Ϭ͘Ϭ�Ϭ͘ϳ� ϭϲ͘ϰ�Ϭ͘ϭ�ϰ͘ϱ�Ϭ͘ϳ�Ϭ͘ϭ�Ϭ͘ϳ� Ϭ͘Ϭ�Ϭ͘ϱ�ϭϬϬ�ϳϱ͘ϯ�ϱ͕ϳϬϱ� �� ������ � �� dŽƚĂů� ϭϵ͘ϳ�ϳ͘ϵ�Ϯ͘ϯ�ϱ͘ϯ�ϳ͘ ϴ�ϳ͘ϲ�Ϭ͘ϴ�Ϭ͘ϰ�ϳ͘ϴ�ϭ͘ϰ� Ϭ͘ϯ�Ϯϱ͘ϯ�Ϭ͘ϴ�ϴ͘ϰ�Ϯ͘ϱ�Ϭ͘ϳ� Ϭ͘ϯ�Ϭ͘Ϯ�Ϭ͘ϱ�ϭϬϬ�ϱϭ͘ϵ�Ϯ ϴ͕ϱϯϳ� ϭ� D/�^�ŝŶĚŝĐĂƚŽƌ�ϰ͘ϭ͖�D�'�ŝŶĚŝĐĂƚŽƌ�ϳ͘ϴ� �,ŽƵƐĞŚŽůĚƐ�ƵƐŝŶŐ�ďŽƚƚůĞĚ�ǁĂƚĞƌ�ĂƐ�ƚŚĞ�ŵĂŝŶ�ƐŽƵƌĐĞ�ŽĨ�ĚƌŝŶŬŝ ŶŐ�ǁĂƚĞƌ�ĂƌĞ�ĐůĂƐƐŝĨŝĞĚ�ŝŶƚŽ�ŝŵƉƌŽǀĞĚ�Žƌ�ƵŶŝŵƉƌŽǀĞĚ�ĚƌŝŶŬŝŶŐ �ǁĂƚĞƌ�ƵƐĞƌƐ�ĂĐĐŽƌĚŝŶŐ�ƚŽ�ƚŚĞ�ǁĂƚĞƌ�ƐŽƵƌĐĞ�ƵƐĞĚ�ĨŽƌ�ŽƚŚĞƌ�ƉƵ ƌƉŽƐĞƐ�ƐƵĐŚ�ĂƐ�ĐŽŽŬŝŶŐ�ĂŶĚ�ŚĂŶĚ�ǁĂƐŚŝŶŐ͘� ^ƵƌĨĂĐĞ�ǁĂƚĞƌ�ŝŶĐůƵĚĞƐ�ǁĂƚĞƌ�ĨƌŽŵ�ƚŚĞ�ƌŝǀĞƌ͕�ƐƚƌĞĂŵ͕�ĚĂŵ͕�ůĂŬ Ğ͕�ƉŽŶĚ�ĂŶĚ�ĐĂŶĂů� 51 Overall, 52 percent of the population is using an improved source of drinking water – 61 percent in urban areas and 36 percent in rural areas (Table WS.1). The situation in Mudug region is considerably better than in other regions; more than half (69 percent) of the population in this region gets its drinking water from an improved source. One in every five residents of the Northeast Zone has access to water that is piped into the dwelling place while 8 percent use water that is piped into the yard or plot, from tube-well or from protected wells (Figure WS.1). The source of drinking water for the population varies strongly by region (Table WS.1). In Mudug region, 27 percent of the population uses drinking water that is piped into their dwelling and 13 percent use drinking water that is piped into the yard or plot. In contrast, only 11 percent and 18 percent of the population have access to water piped into their dwelling in Nugal and Bari regions respectively and only 3 percent and 6 percent uses drinking water that is piped into the yard or plot in the two regions respectively. In Nugal and Bari regions, the most important source of drinking water is rainwater (an unimproved source) while in Mudug region more than 14 percent of the population use water from unprotected wells (an unimproved source). Access to improved sources of drinking water increased with household wealth from 41 percent among the poorest to 75 percent for the richest households (Table WS.1). Figure WS.1: Percent distribution of household members by source of drinking water, Northeast Zone, Somalia 2011 3LSHG�LQWR�GZHOOLQJ��\DUG�RU�SORW����� 3LSHG�LQWR�FRPSRXQG��\DUG�RU�SORW����3LSHG�WRQHLJKERXU����3XEOLF�WDS��VWDQGSLSH����7XEHZHOO�ERUHKROH����3URWHFWHG�ZHOO�RU�VSULQJ����8QSURWHFWHG�ZHOO�RU�VSULQJ����%HUNDG�����%DOO\���� 7DQNHU�WUXFN���� &DUW�ZLWK�VPDOO�WDQN���GUXP���� 6XUIDFHZDWHU���� 52 Use of household water treatment is presented in Table WS.2. Households were asked of ways they may be treating water at home to make it safer to drink. Boiling water, adding bleach or chlorine, using a water filter, and using solar disinfection are considered as proper treatment of drinking water. The table shows water treatment by all households and the percentage of household members living in households using unimproved water sources but using appropriate water treatment methods. A high proportion of the households do not use appropriate methods of water treatment in the Northeast Zone. Only 6 percent of household members in households using unimproved drinking water sources are using an appropriate method of water treatment. This percentage is lowest in Mudug. Appropriate methods of water treatment, although generally very low, is higher in the urban (8 percent) compared to rural areas (4 percent) and increases with household wealth from 3 percent among the poorest households to 16 percent in the richest households. 53 dĂďůĞ�t^͘Ϯ͗�,ŽƵƐĞŚŽůĚ�ǁĂƚĞƌ�ƚƌĞĂƚŵĞŶƚ�� WĞƌĐĞŶƚĂŐĞ�ŽĨ�ŚŽƵƐĞŚŽůĚ�ƉŽƉƵůĂƚŝŽŶ�ďLJ�ĚƌŝŶŬŝŶŐ�ǁĂƚĞƌ�ƚƌĞĂƚŵĞŶƚ�ŵĞƚŚŽĚ�ƵƐ ĞĚ�ŝŶ�ƚŚĞ�ŚŽƵƐĞŚŽůĚ͕�ĂŶĚ�ĨŽƌ�ŚŽƵƐĞŚŽůĚ�ŵĞŵďĞƌƐ�ůŝǀŝŶŐ�ŝŶ�ŚŽ ƵƐĞŚŽůĚƐ�ǁŚĞƌĞ�ĂŶ�ƵŶŝŵƉƌŽǀĞĚ�ĚƌŝŶŬŝŶŐ�ǁĂƚĞƌ�ƐŽƵƌĐĞ�ŝƐ�ƵƐĞĚ ͕�ƚŚĞ�ƉĞƌĐĞŶƚĂŐĞ�ǁŚŽ�ĂƌĞƵƐŝŶŐ�ĂŶ� ĂƉƉƌŽƉƌŝĂƚĞ�ƚƌĞĂƚŵĞŶƚ�ŵĞƚŚŽĚ͕�EŽƌƚŚĞĂƐƚ�ŽŶĞ͕�ϮϬϭϭ� tĂƚĞƌ�ƚƌĞĂƚŵĞŶƚ�ŵĞƚŚŽĚ�ƵƐĞĚ�ŝŶ�ƚŚĞ�ŚŽƵƐĞŚŽůĚ� EƵŵďĞƌ�ŽĨ� ŚŽƵƐĞŚŽůĚ� ŵĞŵďĞƌƐ�WĞƌĐĞŶƚĂŐĞ�ŽĨ� ŚŽƵƐĞŚŽůĚ�ŵĞŵďĞƌƐ� ŝŶ�ŚŽƵƐĞŚŽůĚƐ�ƵƐŝŶŐ� ƵŶŝŵƉƌŽǀĞĚ�ĚƌŝŶŬŝŶŐ� ǁĂƚĞƌ�ƐŽƵƌĐĞƐ�ĂŶĚ� ƵƐŝŶŐ�ĂŶ�ĂƉƉƌŽƉƌŝĂƚĞ� ǁĂƚĞƌ�ƚƌĞĂƚŵĞŶƚ� ŵĞƚŚŽĚϭ �EƵŵďĞƌ�ŽĨ� ŚŽƵƐĞŚŽůĚ� ŵĞŵďĞƌƐ�ŝŶ� ŚŽƵƐĞŚŽůĚƐ� ƵƐŝŶŐ� ƵŶŝŵƉƌŽǀĞĚ� ĚƌŝŶŬŝŶŐ�ǁĂƚĞƌ� ƐŽƵƌĐĞƐ� EŽŶĞ��Žŝů��ĚĚ� ďůĞĂĐŚͬ� ĐŚůŽƌŝŶĞ�^ƚƌĂŝŶ� ƚŚƌŽƵŐŚ� Ă�ĐůŽƚŚ�hƐĞ� ǁĂƚĞƌ� ĨŝůƚĞƌ�^ŽůĂƌ� ĚŝƐŝŶĨĞĐƚŝŽŶ �>Ğƚ�ŝƚ� ƐƚĂŶĚ� ĂŶĚ� ƐĞƚƚůĞ�tĂƐŚ� ŚĂŶĚƐ� ďĞĨŽƌĞ� ĐŽůůĞĐƚŝŶŐ� ǁĂƚĞƌ�^ƚŽƌĞ� ĚƌŝŶŬŝŶŐ� ǁĂƚĞƌ�ŝŶ�Ă� ĐůĞĂŶ� ĐŽŶƚĂŝŶĞƌ� ǁŝƚŚ�ĐŽǀĞƌ�hƐĞ�ƐĞƉĂƌĂƚĞ� ĐůĞĂŶ�ĐƵƉ� ǁŝƚŚ�Ă�ůŽŶŐ� ŚĂŶĚůĞ�ĨŽƌ� ƚĂŬŝŶŐ�ǁĂƚĞƌ� ŽƵƚ�ŽĨ� ĐŽŶƚĂŝŶĞƌ� <ĞĞƉ� ĂŶŝŵĂůƐ� ĂǁĂLJ�ĨƌŽŵ� ƚŚĞ� ĐŽŶƚĂŝŶĞƌ�KƚŚĞƌ� ZĞŐŝŽŶ������� �� �Ăƌŝ�ϵϭ͘ϯ�ϰ͘ϲ�ϯ͘Ϯ� Ϭ͘ϴϬ͘ϯϬ͘ϯϬ͘ϱϬ͘ϯ Ϭ͘ϴϬ͘ϮϬ͘ϮϬ͘ϰϭϮ͕ϴϯϰ ϲ͘ϵϳ͕ϰϬϰ� EƵŐĂů�ϵϬ͘Ϭ�ϱ͘ϰ�ϰ͘ϯ� ϭ͘ϮϬ͘ϰϬ͘ϯϬ͘ϴϬ͘ϭ ϭ͘ϵϬ͘ϬϬ͘ϭϬ͘ϯϱ͕ϴϲϮ ϲ͘ϰϯ͕ϮϲϮ� DƵĚƵŐ�ϵϲ͘ϱ�Ϯ͘ϲ�ϭ͘Ϯ� Ϭ͘ϯϬ͘ϬϬ͘ϬϬ͘ϯϬ͘Ϯ Ϭ͘ϯϬ͘ϮϬ͘ϯϬ͘Ϭϵ͕ϴϰϭ ϯ͘ϲϯ͕ϬϳϮ� �ƌĞĂ��� �� hƌďĂŶ��ϵϮ͘Ϭ�ϰ͘ϲ�ϯ͘ϴ� Ϭ͘ϳϬ͘ϮϬ͘ϮϬ͘ϰϬ͘ϯ Ϭ͘ϵϬ͘ϭϬ͘ϮϬ͘ϯϭϴ͕ϮϰϮ ϳ͘ϳϳ͕ϭϲϮ� ZƵƌĂů�ϵϰ͘ϰ�ϯ͘ϭ�Ϭ͘ϵ� Ϭ͘ϴϬ͘ϯϬ͘ϭϬ͘ϲϬ͘Ϭ Ϭ͘ϴϬ͘ϯϬ͘ϯϬ͘ϯϭϬ͕Ϯϵϱ ϰ͘Ϯϲ͕ϱϳϱ� �ĚƵĐĂƚŝŽŶ�ŽĨ�ŚŽƵƐĞŚŽůĚ�ŚĞĂĚ��� �� EŽŶĞ�ϵϰ͘ϰ�ϯ͘ϯ�Ϯ͘Ϭ� Ϭ͘ϲϬ͘ϮϬ͘ϭϬ͘ϱϬ͘Ϯ Ϭ͘ϳϬ͘ϭϬ͘ϮϬ͘ϮϮϬ͕ϲϴϱ ϰ͘ϴϭϬ͕ϰϴϬ� WƌŝŵĂƌLJ��ϴϵ͘ϴ�ϱ͘Ϭ�ϰ͘ϴ� ϭ͘ϮϬ͘ϰϬ͘ϰϬ͘ϳϬ͘Ϭ ϭ͘ϬϬ͘ϲϬ͘ϬϬ͘ϱϯ͕ϮϲϮ ϭϬ͘ϴϭ͕ϲϰϯ� ^ĞĐŽŶĚĂƌLJн�ϴϴ͘Ϯ�ϲ͘ϵ�ϰ͘ϵ� Ϭ͘ϵϬ͘ϯϬ͘ϯϬ͘ϰϬ͘ϱ ϭ͘ϱϬ͘ϮϬ͘ϯϬ͘ϯϰ͕ϰϰϮ ϵ͘ϲϭ͕ϱϯϯ� DŝƐƐŝŶŐͬ�ŽŶ͛ƚ�ŬŶŽǁ�ϴϬ͘ϰ�ϰ͘ϱ�ϱ͘ϴ� Ϭ͘ϬϬ͘ϬϬ͘Ϭϳ͘ϯϬ͘Ϭ Ϭ͘ϬϬ͘ϬϬ͘ϬϬ͘Ϭϭϰϴ Ϭ͘Ϭϴϭ� tĞĂůƚŚ�ŝŶĚĞdž�ƋƵŝŶƚŝůĞ���� �� WŽŽƌĞƐƚ�ϵϰ͘ϳ�Ϯ͘ϱ�ϭ͘ϭ� ϭ͘ϬϬ͘ϬϬ͘ϰϬ͘ϲϬ͘Ϭ Ϭ͘ϲϬ͘ϭϬ͘ϰϬ͘Ϯϱ͕ϳϬϱ Ϯ͘ϲϯ͕ϯϱϱ� ^ĞĐŽŶĚ�ϵϰ͘Ϯ�ϯ͘ϲ�Ϭ͘ϵ� Ϭ͘ϲϬ͘ϯϬ͘ϭϬ͘ϲϬ͘ϯ Ϭ͘ϳϬ͘ϭϬ͘ϬϬ͘Ϯϱ͕ϳϭϮ ϰ͘ϵϯ͕ϱϲϱ� DŝĚĚůĞ�ϵϯ͘Ϯ�ϯ͘ϵ�ϯ͘Ϭ� ϭ͘ϭϬ͘ϯϬ͘ϯϬ͘ϯϬ͘Ϭ Ϭ͘ϲϬ͘ϭϬ͘ϭϬ͘Ϯϱ͕ϳϬϱ ϲ͘ϲϯ͕ϭϭϭ� &ŽƵƌƚŚ�ϵϰ͘ϭ�ϯ͘ϱ�Ϯ͘ϰ� Ϭ͘ϱϬ͘ϮϬ͘ϭϬ͘ϲϬ͘ϯ Ϭ͘ϲϬ͘ϬϬ͘ϮϬ͘ϰϱ͕ϳϭϬ ϲ͘ϭϮ͕Ϯϵϰ� ZŝĐŚĞƐƚ�ϴϴ͘ϭ�ϲ͘ϴ�ϲ͘ϰ� Ϭ͘ϲϬ͘ϱϬ͘ϮϬ͘ϰϬ͘ϲ ϭ͘ϵϬ͘ϲϬ͘ϰϬ͘ϯϱ͕ϳϬϱ ϭϱ͘ϲϭ͕ϰϭϮ� ����� �� dŽƚĂů�ϵϮ͘ϴ�ϰ͘ϭ�Ϯ͘ϴ� Ϭ͘ϳϬ͘ϮϬ͘ϮϬ͘ϱϬ͘Ϯ Ϭ͘ϵϬ͘ϮϬ͘ϮϬ͘ϯϮϴ͕ϱϯϳ ϲ͘Ϭϭϯ͕ϳϯϳ� ϭ �D/�^�ŝŶĚŝĐĂƚŽƌ�ϰ͘Ϯ� �� 54 The amount of time it takes to obtain water is presented in Table WS.3 and the person who usually collected the water in Table WS.4. Note that these results refer to one roundtrip from home to drinking water source. Information on the number of trips made in one day was not collected. Table WS.3 shows that 35 percent of the household population use improved drinking water sources on their premises. About 12 percent of the households take 30 minutes or more to and from the improved source of drinking water. One-quarter of household members use unimproved drinking water sources on their premises while 16 percent require 30 minutes or more to and from the source of drinking water. In rural areas more households members spend longer time collecting water compared to those in urban areas. The amount of time spent collecting water is longer for members of the poorest households compared to the richest.dĂďůĞ�t^͘ϯ͗�dŝŵĞ�ƚŽ�ƐŽƵƌĐĞ�ŽĨ�ĚƌŝŶŬŝŶŐ�ǁĂƚĞƌ��WĞƌĐĞŶƚ�ĚŝƐƚƌŝďƵƚŝŽŶ�ŽĨ�ŚŽƵƐĞŚŽůĚ�ƉŽƉƵůĂƚŝŽŶ�ĂĐĐŽƌĚŝŶŐ�ƚŽ�ƚŝŵĞ�ƚŽ�ŐŽ�ƚŽ�ƐŽƵƌĐĞ�ŽĨ�ĚƌŝŶŬŝŶŐ�ǁĂƚĞƌ͕�ŐĞƚ�ǁĂƚĞƌ�ĂŶĚ�ƌĞƚƵƌŶ͕�ĨŽƌ�ƵƐĞƌƐ�ŽĨ�ŝŵƉƌŽǀĞĚ�ĂŶĚ�ƵŶŝŵƉƌŽǀĞĚ�ĚƌŝŶŬŝŶŐ�ǁĂƚĞƌ�ƐŽƵƌĐĞƐ͕�EŽƌƚŚĞĂƐƚ�ŽŶĞ͕�^ŽŵĂůŝĂ�ϮϬϭϭ� dŝŵĞ�ƚŽ�ƐŽƵƌĐĞ�ŽĨ�ĚƌŝŶŬŝŶŐ�ǁĂƚĞƌ�hƐĞƌƐ�ŽĨ�ŝŵƉƌŽǀĞĚ�ĚƌŝŶŬŝŶŐ�ǁĂƚĞƌ�ƐŽƵƌĐĞƐ� hƐĞƌƐ�ŽĨ�ƵŶŝŵƉƌŽǀĞĚ�ĚƌŝŶŬŝŶŐ�ǁĂƚĞƌ�ƐŽƵƌĐĞƐ� EƵŵďĞƌ�ŽĨ�ŚŽƵƐĞŚŽůĚ�ŵĞŵďĞƌƐ�tĂƚĞƌ�ŽŶ�ƉƌĞŵŝƐĞƐ� >ĞƐƐ�ƚŚĂŶ�ϯϬ�ŵŝŶƵƚĞƐ� ϯϬ�ŵŝŶƵƚĞƐ�Žƌ�ŵŽƌĞ� DŝƐƐŝŶŐͬ�<� tĂƚĞƌ�ŽŶ�ƉƌĞŵŝƐĞƐ� >ĞƐƐ�ƚŚĂŶ�ϯϬ�ŵŝŶƵƚĞƐ� ϯϬ�ŵŝŶƵƚĞƐ�Žƌ�ŵŽƌĞ� DŝƐƐŝŶŐͬ�<� dŽƚĂů�ZĞŐŝŽŶ� �� �� �� ���Ăƌŝ� Ϯϵ͘ϳ� ϯ͘ϯ� ϴ͘ϳ� Ϭ͘ϱ ϯϳ͘Ϭ ϰ͘ϵ ϭϰ͘ϯ ϭ͘ϱ� ϭϬϬ͘Ϭ ϭϮ͕ϴϯϰEƵŐĂů� ϮϮ͘Ϭ� ϱ͘ϴ� ϭϱ͘ϲ� Ϭ͘ϵ ϮϮ͘ϴ ϲ͘Ϯ Ϯϰ͘ϭ Ϯ͘ϲ� ϭϬϬ͘Ϭ ϱ͕ϴϲϮDƵĚƵŐ� ϰϴ͘ϭ� ϲ͘ϴ� ϭϯ͘ϵ� Ϭ͘Ϭ ϭϭ͘ϲ ϰ͘ϳ ϭϰ͘ϭ Ϭ͘ϳ� ϭϬϬ͘Ϭ ϵ͕ϴϰϭ�ƌĞĂ� � � � �hƌďĂŶ�� ϰϵ͘Ϯ� ϯ͘ϯ� ϳ͘ϵ� Ϭ͘ϯ Ϯϲ͘ϭ ϯ͘ϯ ϴ͘ϲ ϭ͘Ϯ� ϭϬϬ͘Ϭ ϭϴ͕ϮϰϮZƵƌĂů� ϴ͘ϯ� ϴ͘ϭ� ϭϵ͘Ϭ� Ϭ͘ϴ Ϯϰ͘Ϭ ϴ͘ϰ Ϯϵ͘ϳ ϭ͘ϴ� ϭϬϬ͘Ϭ ϭϬ͕Ϯϵϱ�ĚƵĐĂƚŝŽŶ�ŽĨ�ŚŽƵƐĞŚŽůĚ�ŚĞĂĚ� � � �EŽŶĞ� ϯϬ͘ϴ� ϱ͘ϱ� ϭϮ͘ϱ� Ϭ͘ϲ Ϯϰ͘ϳ ϱ͘ϯ ϭϵ͘Ϭ ϭ͘ϳ� ϭϬϬ͘Ϭ ϮϬ͕ϲϴϱWƌŝŵĂƌLJ�� ϯϮ͘ϳ� ϯ͘ϴ� ϭϯ͘ϭ� Ϭ͘ϭ ϯϬ͘ϯ ϲ͘ϴ ϭϮ͘Ϭ ϭ͘ϯ� ϭϬϬ͘Ϭ ϯ͕ϮϲϮ^ĞĐŽŶĚĂƌLJн� ϱϯ͘Ϯ� ϯ͘ϯ� ϴ͘ϴ� Ϭ͘Ϯ Ϯϰ͘ϯ ϯ͘Ϭ ϲ͘ϲ Ϭ͘ϳ� ϭϬϬ͘Ϭ ϰ͕ϰϰϮDŝƐƐŝŶŐͬ�ŽŶ͛ƚ��ŬŶŽǁ� Ϯϰ͘ϱ� ϭϰ͘ϳ� ϲ͘ϯ� Ϭ͘Ϭ ϯϮ͘Ϭ ϳ͘ϭ ϭϱ͘ϯ Ϭ͘Ϭ� ϭϬϬ͘Ϭ ϭϰϴtĞĂůƚŚ�ŝŶĚĞdž�ƋƵŝŶƚŝůĞ� � � �WŽŽƌĞƐƚ� ϴ͘ϱ� ϭϭ͘ϭ� ϮϬ͘ϵ� Ϭ͘ϳ ϭϭ͘ϱ ϭϬ͘ϴ ϯϰ͘ϱ ϭ͘ϵ� ϭϬϬ͘Ϭ ϱ͕ϳϬϱ^ĞĐŽŶĚ� ϭϮ͘ϲ� ϱ͘ϵ� ϭϴ͘Ϯ� Ϭ͘ϵ Ϯϳ͘ϯ ϳ͘ϭ Ϯϱ͘ϴ Ϯ͘Ϯ� ϭϬϬ͘Ϭ ϱ͕ϳϭϮDŝĚĚůĞ� Ϯϲ͘ϭ� ϱ͘Ϯ� ϭϯ͘ϳ� Ϭ͘ϱ ϯϰ͘ϱ ϰ͘ϵ ϭϰ͘Ϭ ϭ͘ϭ� ϭϬϬ͘Ϭ ϱ͕ϳϬϱ&ŽƵƌƚŚ� ϱϭ͘ϲ� Ϯ͘ϰ� ϱ͘ϳ� Ϭ͘ϭ ϯϮ͘ϭ ϭ͘ϲ ϱ͘ϰ ϭ͘ϭ� ϭϬϬ͘Ϭ ϱ͕ϳϭϬZŝĐŚĞƐƚ� ϳϯ͘ϳ� Ϭ͘ϱ� ϭ͘ϭ� Ϭ͘Ϭ Ϯϭ͘ϭ ϭ͘Ϭ ϭ͘ϲ ϭ͘Ϭ� ϭϬϬ͘Ϭ ϱ͕ϳϬϱ�� � � � �dŽƚĂů� ϯϰ͘ϱ� ϱ͘Ϭ� ϭϭ͘ϵ� Ϭ͘ϰ Ϯϱ͘ϯ ϱ͘ϭ ϭϲ͘Ϯ ϭ͘ϱ� ϭϬϬ͘Ϭ Ϯϴ͕ϱϯϳ Table WS.4 shows that for the majority of households, an adult female is usually the person collecting the water, when the source of drinking water is not on the premises. Adult men collect water in 22 percent of cases, while for the rest of the households, female or male children under age 15 collect water. 55 Use of Improved Sanitation Inadequate disposal of human excreta and personal hygiene is associated with a range of diseases including diarrhoeal diseases and polio. Improved sanitation can reduce diarrheal disease by more than a third, and can significantly lessen the adverse health impacts of other disorders responsible for death and disease among millions of children in developing countries. An improved sanitation facility is defined as one that hygienically separates human excreta from human contact. Improved sanitation facilities for excreta disposal include flush or pour flush to a piped sewer system, septic tank, or pit latrine; ventilated improved pit latrine, pit latrine with slab, and use of a composting toilet. The data on the use of improved sanitation facilities in Northeast Zone are provided in this report in Table WS.5. Twenty six percent of the population of Northeast Zone is living in households using pit latrines with a slab; a form of improved sanitation facility (Table WS.5). Another 19 percent is using Ventilated improved pit latrines, while 18 percent of the household is using flush or pour flush that goes into Septic tanks. The percentage of those using pit latrines with slab is 29 in urban areas and 20 percent in rural areas. The use of septic tanks (an improved sanitation facility) strongly correlated with wealth and is profoundly different between urban and rural areas. In rural areas, open defecation is a common practice among 36 percent of the population. 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Therefore, ‘use of improved sanitation’ is used both in the context of this report and as an MDG indicator to refer to improved sanitation facilities, which are not shared. Data on the use of improved sanitation are presented in Tables WS.6 and WS.8. As shown in Table WS.6, 65 percent of the household population is using an improved sanitation facility that is not shared. Use of a shared facility by five or less households is more common among households using an improved facility in the urban areas compared to the rural areas. Use of shared sanitation facility is uncommon among the users of unimproved sanitation facilities. Safe disposal of a child’s faeces is disposing of the stool, by the child using a toilet or by rinsing the stool into a toilet or latrine. Disposal of faeces of children 0-2 years of age is presented in Table WS.7. In Northeast Zone, safe disposal of child’s faeces was practiced for more than two thirds (73 percent) of the children age 0 – 2 years. 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This ladder allows a disaggregated analysis of trends in a three rung ladder for drinking-water and a four-rung ladder for sanitation. For sanitation, this gives an understanding of the proportion of population with no sanitation facilities at all, of those reliant on technologies defined by JMP as “unimproved,” of those sharing sanitation facilities of otherwise acceptable technology, and those using “improved” sanitation facilities. Table WS.8 presents the percentages of household population by drinking water and sanitation ladders. The table also shows the percentage of household members using improved sources of drinking water and sanitary means of excreta disposal. On overall, 37 percent of the household members have improved drinking water sources and improved sanitation facilities. 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It is most effective when done using water and soap after visiting a toilet or cleaning a child, before eating or handling food and, before feeding a child. Monitoring correct hand washing behaviour at these critical times is challenging. A reliable alternative to observations or self-reported behaviour is assessing the likelihood that correct hand washing behaviour takes place by observing if a household has a specific place where people most often wash their hands and observing if water and soap (or other local cleansing materials) are present at a specific place for hand washing. In Northeast Zone, a specific place for hand washing was observed in one third of households while 63 percent of households could not indicate a specific place where household members usually wash their hands. Further, 2 percent of the households did not give a permission to see the place used for handwashing (Table WS.9). Of those households where a place for handwashing was observed, more than three quarters (79 percent) had both water and soap present at the specific place. In 8 percent of the households only water was available at the specific place, while in another 8 percent of the households the place only had soap but no water. The remaining 4 percent of households had neither water nor soap available at the designated place for hand washing. Fifty nine percent of the households had soap observed anywhere in the household (Table WS.10). The likelihood of observing soap in the dwelling increased with education and wealth levels. This percentage differed within regions. Mudug region had the lowest availability of soap in households (55 percent) while Bari and Nugal had 61 and 62 percent respectively). 63 dĂďůĞ�t^͘ϵ͗�tĂƚĞƌ�ĂŶĚ�ƐŽĂƉ�Ăƚ�ƉůĂĐĞ�ĨŽƌ�ŚĂŶĚǁĂƐŚŝŶŐ� WĞƌĐĞŶƚĂŐĞ�ŽĨ�ŚŽƵƐĞŚŽůĚƐ�ǁŚĞƌĞ�ƉůĂĐĞ�ĨŽƌ�ŚĂŶĚǁĂƐŚŝŶŐ�ǁĂƐ�ŽďƐĞƌǀĞĚ�ĂŶĚ�Ɖ ĞƌĐĞŶƚ�ĚŝƐƚƌŝďƵƚŝŽŶ�ŽĨ�ŚŽƵƐĞŚŽůĚƐ�ďLJ�ĂǀĂŝůĂďŝůŝƚLJ�ŽĨ�ǁĂƚĞƌ�ĂŶĚ �ƐŽĂƉ�Ăƚ�ƉůĂĐĞ�ĨŽƌ�ŚĂŶĚǁĂƐŚŝŶŐ͕�EŽƌƚŚĞĂƐƚ�ŽŶĞ͕�^ŽŵĂůŝĂ�ϮϬϭ ϭ� WĞƌĐĞŶƚĂŐĞ�ŽĨ� ŚŽƵƐĞŚŽůĚƐ� ǁŚĞƌĞ�ƉůĂĐĞ� ĨŽƌ� ŚĂŶĚǁĂƐŚŝŶŐ� ǁĂƐ�ŽďƐĞƌǀĞĚ�WĞƌĐĞŶƚĂŐĞ�ŽĨ�ŚŽƵƐĞŚŽůĚƐ�ǁŚĞƌĞ�Ɖů ĂĐĞ�ĨŽƌ� ŚĂŶĚǁĂƐŚŝŶŐ�ǁĂƐ�ŶŽƚ�ŽďƐĞƌǀĞĚ� dŽƚĂů�EƵ ŵďĞƌ� ŽĨ�ŚŽƵƐĞ� ŚŽůĚƐ�WĞƌĐĞŶƚ�ĚŝƐƚƌŝďƵƚŝŽŶ�ŽĨ�ŚŽƵƐĞŚŽůĚƐ�ǁŚĞƌĞ�ƉůĂĐ Ğ� ĨŽƌ�ŚĂŶĚǁĂƐŚŝŶŐ�ǁĂƐ�ŽďƐĞƌǀĞĚ͕�ĂŶĚ͗� dŽƚĂů�EƵŵďĞƌ�ŽĨ� ŚŽƵƐĞŚŽůĚƐ� ǁŚĞƌĞ�ƉůĂĐĞ� ĨŽƌ� ŚĂŶĚǁĂƐŚŝŶŐ� ǁĂƐ�ŽďƐĞƌǀĞĚ� EŽƚ�ŝŶ� ĚǁĞůůŝŶŐͬƉůŽƚͬ LJĂƌĚ�EŽ� ƉĞƌŵŝƐƐŝŽŶ� ƚŽ�ƐĞĞ�KƚŚĞƌ� ƌĞĂƐŽŶƐ�DŝƐƐŝŶŐ� tĂƚĞƌ�ĂŶĚ� ƐŽĂƉ�ĂƌĞ� ĂǀĂŝůĂďůĞϭ �tĂƚĞƌ�ŝƐ� ĂǀĂŝůĂďůĞ͕� ƐŽĂƉ�ŝƐ� ŶŽƚ� ĂǀĂŝůĂďůĞ�tĂƚĞƌ�ŝƐ� ŶŽƚ� ĂǀĂŝůĂďůĞ͕� ƐŽĂƉ�ŝƐ� ĂǀĂŝůĂďůĞ�tĂƚĞƌ� ĂŶĚ�ƐŽĂƉ� ĂƌĞ�ŶŽƚ� ĂǀĂŝůĂďůĞ�DŝƐƐ ŝŶŐ� ZĞŐŝŽŶ����� �� �Ăƌŝ�ϯϮ͘ϳ�ϲϭ͘ϰ Ϯ͘ϰϮ͘ϴϬ͘ϳϭϬϬ͘ϬϮ͕ϭϱϮϴ ϯ͘ϵϰ͘ϯϴ͘ϭϮ͘ϴϭ͘Ϭ ϭϬϬ͘ϬϳϬϰ� EƵŐĂů�Ϯϳ͘ϰ�ϲϵ͘Ϭ Ϭ͘ϱϮ͘ϵϬ͘ϮϭϬϬ͘Ϭϵϰϳϴ ϭ͘ϯϲ͘Ϯϴ͘Ϯϭ͘ϵϮ͘ϰ ϭϬϬ͘ϬϮϱϵ� DƵĚƵŐ�ϯϱ͘ϱ�ϲϬ͘ϴ ϭ͘ϱϭ͘ϲϬ͘ϲϭϬϬ͘Ϭϭ͕ϲϴϲϳ Ϭ͘ϵϭϰ͘ϯϳ͘ϰϱ͘ϬϮ͘ϯ ϭϬϬ͘Ϭϱϵϴ� �ƌĞĂ��� � hƌďĂŶ�ϯϵ͘Ϯ�ϱϲ͘ϱ ϭ͘ϲϮ͘ϯϬ͘ϰϭϬϬ͘ϬϮ͕ϵϲϳϴ ϯ͘ϰϱ͘ϴϲ͘ϳϮ͘ϳϭ͘ϯ ϭϬϬ͘Ϭϭ͕ϭϲϮ� ZƵƌĂů�ϮϮ͘Ϭ�ϳϮ͘ϴ ϭ͘ϴϮ͘ϱϬ͘ϵϭϬϬ͘Ϭϭ͕ϴϭϴϲ ϰ͘Ϯϭϲ͘Ϭϭϭ͘ϭϱ͘ϳϯ͘Ϭ ϭϬϬ͘Ϭϯϵϵ� �ĚƵĐĂƚŝŽŶ�ŽĨ�ŚŽƵƐĞŚŽůĚ�ŚĞĂĚ�� � EŽŶĞ�ϯϬ͘ϱ�ϲϱ͘Ϭ Ϯ͘ϬϮ͘ϬϬ͘ϱϭϬϬ͘Ϭϯ͕ϱϯϴϳ ϰ͘ϲϭϬ͘ϱϵ͘Ϭϰ͘ϰϭ͘ϱ ϭϬϬ͘Ϭϭ͕ϬϴϬ� WƌŝŵĂƌLJ��Ϯϳ͘ϲ�ϲϰ͘ϴ ϭ͘ϯϱ͘ϰϬ͘ϵϭϬϬ͘Ϭϱϯϵϴ ϳ͘Ϯϯ͘ϯϱ͘ϯϮ͘ϭϮ͘ϭ ϭϬϬ͘Ϭϭϰϵ� ^ĞĐŽŶĚĂƌLJн�ϰϳ͘ϳ�ϰϵ͘ϯ Ϭ͘ϳϭ͘ϴϬ͘ϱϭϬϬ͘Ϭϲϴϰϴ ϳ͘ϰϰ͘Ϭϱ͘ϰϬ͘ϵϮ͘ϰ ϭϬϬ͘ϬϯϮϲ� DŝƐƐŝŶŐͬ�<�Ϯϴ͘ϲ�ϲϳ͘ϰ ͘Ϭϰ͘ϬϬ͘ϬϭϬϬ͘ϬϮϰϴϲ ͘Ϭ͘Ϭ͘Ϭϭϰ͘Ϭ͘Ϭ ϭϬϬ͘Ϭϳ� tĞĂůƚŚ�ŝŶĚĞdž�ƋƵŝŶƚŝůĞƐ�� � WŽŽƌĞƐƚ�ϭϭ͘ϵ�ϴϯ͘ϰ Ϯ͘ϰϭ͘ϴϬ͘ϱϭϬϬ͘Ϭϭ͕Ϭϯϰϱ Ϭ͘ϯϮϬ͘ϱϭϬ͘ϱϭϱ͘Ϯϯ͘ϰ ϭϬϬ͘ϬϭϮϯ� ^ĞĐŽŶĚ�ϮϬ͘ϭ�ϳϯ͘ϳ Ϯ͘ϭϯ͘Ϭϭ͘ϭϭϬϬ͘Ϭϵϵϲϲ Ϭ͘ϯϭϵ͘ϱϭϯ͘ϲϰ͘ϬϮ͘ϲ ϭϬϬ͘ϬϮϬϬ� DŝĚĚůĞ�ϯϮ͘ϯ�ϲϮ͘ϳ ϭ͘ϰϯ͘ϮϬ͘ϰϭϬϬ͘Ϭϵϯϰϳ ϲ͘Ϭϵ͘ϳϴ͘ϵϰ͘ϲϬ͘ϳ ϭϬϬ͘ϬϯϬϭ� &ŽƵƌƚŚ�ϰϮ͘ϱ�ϱϯ͘ϲ ϭ͘ϱϮ͘ϭϬ͘ϯϭϬϬ͘Ϭϵϰϭϴ Ϭ͘ϭϳ͘ϴϳ͘ϳϮ͘ϰϮ͘Ϭ ϭϬϬ͘ϬϰϬϬ� ZŝĐŚĞƐƚ�ϲϬ͘ϵ�ϯϱ͘ϳ ϭ͘Ϯϭ͘ϳϬ͘ϰϭϬϬ͘Ϭϴϴϭϵ ϭ͘ϵϭ͘Ϯϰ͘ϳϬ͘ϳϭ͘ϰ ϭϬϬ͘Ϭϱϯϳ� ��� �� dŽƚĂů�ϯϮ͘ϲ�ϲϮ͘ϳ ϭ͘ϳϮ͘ϰϬ͘ϲϭϬϬ͘Ϭϰ͕ϳϴϱϳ ϴ͘ϱϴ͘ϰϳ͘ϵϯ͘ϱϭ͘ϳ ϭϬϬ͘Ϭϭ͕ϱϲϭ� ϭ �D/�^�ŝŶĚŝĐĂƚŽƌ�ϰ͘ϱ� 64 dĂďůĞ�t^͘ϭϬ͗��ǀĂŝůĂďŝůŝƚLJ�ŽĨ�ƐŽĂƉ� WĞƌĐĞŶƚ�ĚŝƐƚƌŝďƵƚŝŽŶ�ŽĨ�ŚŽƵƐĞŚŽůĚƐ�ďLJ�ĂǀĂŝůĂďŝůŝƚLJ�ŽĨ�ƐŽĂƉ�ŝŶ�ƚŚĞ�ĚǁĞůůŝŶŐ͕�EŽ ƌƚŚĞĂƐƚ�ŽŶĞ͕�ϮϬϭϭ� ��WůĂĐĞ�ĨŽ ƌ�ŚĂŶĚǁĂƐŚŝŶŐ�ŽďƐĞƌǀĞĚ�WůĂĐĞ�ĨŽƌ �ŚĂŶĚǁĂƐŚŝŶŐ�ŶŽƚ� ŽďƐĞƌǀĞĚ� dŽƚĂů�WĞƌĐĞŶƚĂŐĞ�ŽĨ� ŚŽƵƐĞŚŽůĚƐ� ǁŝƚŚ�ƐŽĂƉ� ĂŶLJǁŚĞƌĞ�ŝŶ� ƚŚĞ�ĚǁĞůůŝŶŐϭ EƵŵďĞƌ�ŽĨ� ŚŽƵƐĞŚŽůĚƐ� �� ^ŽĂƉ� ŽďƐĞƌǀĞĚ� ^ŽĂƉ�ŶŽƚ�ŽďƐĞƌǀĞĚ�Ăƚ�ƉůĂĐĞ�ĨŽƌ� ŚĂŶĚǁĂƐŚŝŶŐ� ^ŽĂƉ� ƐŚŽǁŶE Ž�ƐŽĂƉ�ŝŶ� ŚŽƵƐĞŚŽůĚ�EŽƚ� ĂďůĞͬ�ŽĞƐ� ŶŽƚ�ǁĂŶƚ�ƚŽ� ƐŚŽǁ�ƐŽĂƉ� ��^ ŽĂƉ� ƐŚŽǁŶEŽ�ƐŽĂƉ�ŝŶ� ŚŽƵƐĞŚŽůĚ�EŽƚ� ĂďůĞͬ�ŽĞƐ� ŶŽƚ�ǁĂŶƚ�ƚŽ� ƐŚŽǁ�ƐŽĂƉ�DŝƐƐŝŶŐ� DŝƐƐŝŶŐ� ZĞŐŝŽŶ��� �Ăƌŝ�ϯϬ͘ϭ Ϭ͘ϱϭ͘ϴϬ͘ϬϬ͘ϯϮϵ͘ϵ ϯϳ͘ϮϬ͘ϭϬ͘ϭϭϬϬ͘ϬϲϬ͘ϱ Ϯ͕ϭϱϮ EƵŐĂů�Ϯϰ͘ϱϬ͘ ϱϭ͘ϳϬ͘ϬϬ͘ϲϯϲ͘ϰ ϯϱ͘ϵϬ͘ϭϬ͘ϮϭϬϬ͘Ϭϲϭ͘ϱ ϵϰϳ DƵĚƵŐ�Ϯϳ͘ϴϬ͘ ϱϲ͘ϭϬ͘ϮϬ͘ϴϮϲ͘ϴ ϯϳ͘ϱϬ͘ϭϬ͘ϭϭϬϬ͘Ϭϱϱ͘ϭ ϭ͕ϲϴϲ �ƌĞĂ� hƌďĂŶ�ϯϱ͘ϯ Ϭ͘ϳϮ͘ϲϬ͘ϬϬ͘ϱϮϵ͘Ϭ ϯϭ͘ϲϬ͘ϭϬ͘ϭϭϬϬ͘Ϭϲϰ͘ϵ Ϯ͕ϵϲϳ ZƵƌĂů�ϭϲ͘ϱϬ͘ Ϯϰ͘ϰϬ͘ϭϬ͘ϳϯϭ͘ϵ ϰϱ͘ϵϬ͘ϭϬ͘ϭϭϬϬ͘Ϭϰϴ͘ϳ ϭ͕ϴϭϴ �ĚƵĐĂƚŝŽŶ�ŽĨ�ŚŽƵƐĞŚŽůĚ�ŚĞĂĚ�� � EŽŶĞ�Ϯϱ͘ϱϬ͘ ϰϰ͘ϭϬ͘ϭϬ͘ϱϮϳ͘ϰ ϰϭ͘ϵϬ͘ϭϬ͘ϭϭϬϬ͘Ϭϱϯ͘ϯ ϯ͕ϱϯϴ WƌŝŵĂƌLJ��Ϯϱ͘ϱϬ͘ ϰϭ͘ϭϬ͘ϬϬ͘ϲϰϯ͘ϴ Ϯϴ͘ϰϬ͘ϮϬ͘ϬϭϬϬ͘Ϭϲϵ͘ϳ ϱϯϵ ^ĞĐŽŶĚĂƌLJн�ϰϰ͘Ϯϭ͘ Ϭϭ͘ϯϬ͘Ϭϭ͘ϭϯϮ͘ϴ ϭϵ͘ϰϬ͘ϬϬ͘ϭϭϬϬ͘Ϭϳϴ͘Ϭ ϲϴϰ DŝƐƐŝŶŐͬ�<�Ϯϰ͘ϲϰ͘ ϬϬ͘ϬϬ͘ϬϬ͘Ϭϰϲ͘ϯ Ϯϱ͘ϭϬ͘ϬϬ͘ϬϭϬϬ͘Ϭϳϰ͘ϵ Ϯϰ tĞĂůƚŚ�ŝŶĚĞdž�ƋƵŝŶƚŝůĞ� WŽŽƌĞƐƚ�ϳ͘Ϯ Ϭ͘ϯϯ͘ϵϬ͘ϭϬ͘ϰϮϲ͘Ϯ ϲϭ͘ϲϬ͘ϭϬ͘ϮϭϬϬ͘Ϭϯϯ͘ϳ ϭ͕Ϭϯϰ ^ĞĐŽŶĚ�ϭϰ͘ϵϬ͘ ϰϰ͘ϮϬ͘ϭϬ͘ϱϯϰ͘ϭ ϰϱ͘ϱϬ͘ϯϬ͘ϬϭϬϬ͘Ϭϰϵ͘ϯ ϵϵϲ DŝĚĚůĞ�Ϯϳ͘ϰϬ͘ ϱϰ͘ϭϬ͘ϬϬ͘ϮϯϮ͘ϳ ϯϰ͘ϴϬ͘ϭϬ͘ϭϭϬϬ͘ϬϲϬ͘ϲ ϵϯϰ &ŽƵƌƚŚ�ϯϳ͘ϯϭ͘ Ϭϯ͘ϮϬ͘ϭϬ͘ϴϯϭ͘ϵ Ϯϱ͘ϱϬ͘ϬϬ͘ϭϭϬϬ͘ϬϳϬ͘Ϯ ϵϰϭ ZŝĐŚĞƐƚ�ϱϴ͘ϵϬ͘ ϯϬ͘ϵϬ͘ϬϬ͘ϵϮϱ͘ϱ ϭϯ͘ϰϬ͘ϭϬ͘ϭϭϬϬ͘Ϭϴϰ͘ϳ ϴϴϭ �� dŽƚĂů�Ϯϴ͘Ϯ �Ϭ͘ϱϯ͘ϯ�Ϭ͘ϭ�Ϭ͘ϲ�ϯϬ͘ϭ ��ϯϳ͘Ϭ�Ϭ͘ϭ�Ϭ͘ϭ�ϭϬϬ͘Ϭ�ϱϴ͘ϴ ����ϰ͕ϳϴϱ ϭ �D/�^�ŝŶĚŝĐĂƚŽƌ�ϰ͘ϲ� 65 VII. Reproductive Health Contraception Appropriate family planning is important to the health of women and children by: 1) preventing pregnancies that are too early or too late; 2) extending the period between births; and 3) limiting the number of children. Access by all couples to information and services to prevent pregnancies that are too early, too closely spaced, too late or too many is critical. In Northeast Zone Somalia, current use of contraception is extremely low and was reported by 3 percent of women currently married (Table RH.1). In addition, only 2 percent of currently married women are using Lactational Amenorrhea Method (LAM) as the main traditional method of birth control. Contraceptive prevalence is highest in Nugal region at 5 percent. 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Unmet need is identified in MICS by using a set of questions eliciting current behaviours and preferences pertaining to contraceptive use, fecundity, and fertility preferences. Table RH.2 shows the levels of met need for contraception, unmet need, and the demand for contraception satisfied. Unmet need for spacing is defined as the percentage of women who are not using a method of contraception AND • are not pregnant and not postpartum amenorrheic10 and are fecund11 and say they want to wait two or more years for their next birth OR • are not pregnant and not postpartum amenorrheic and are fecund and unsure whether they want another child OR • are pregnant and say that pregnancy was mistimed: would have wanted to wait OR • are postpartum amenorrheic and say that the birth was mistimed: would have wanted to wait Unmet need for limiting is defined as percentage of women who are not using a method of contraception AND • are not pregnant and not postpartum amenorrheic and are fecund and say they do not want any more children OR • are pregnant and say they do not want to have a child OR • are postpartum amenorrheic and say that they did not want the birth Total unmet need for contraception is the sum of unmet need for spacing and unmet need for limiting. The unmet need is fairly low (11 percent) among married women in the Northeast Zone of Somalia. Most the unmet need is for birth spacing. It is apparent that in Northeast Somali women tend to have many children resulting to low unmet need for contraception. Met need for limiting includes women who are using (or whose part

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