Soudan - Multiple Indicator Cluster Survey - 1999

Publication date: 1999

In the southern part of Sudan, 2000 Multiple Indicator Cluster Survey Results Progress of Regions CONSULTANT STATISTICIANS Professor Anthony G. Turner Sampling Specialist & MICS Adviser Dr. Muhammad Shuaib Questionnaire Design, Survey Staff Training & Data Analysis Mr. Mokhlesur Rahman Data Analysis Mr. Masud Ahmed Preparation of data entry software Mr. Abdullah-Al-Harun Instruction Manual Development, Data & Confidence Interval Analysis Mr. Md. Rezaul Hoque Instruction Manual Development, Data & Confidence Interval Analysis SKILLS FOR SOUTHERN SUDAN Sarah Hayward Director, Skills for Southern Sudan, UK Charles Ogweta Representative, Skills for Southern Sudan, Nairobi Joseph Lam Logistics/Support Officer, Skills for Southern Sudan, Loki SURVEY STAFF Fabio Goi Akec Mayom Riak Alaak Ezekiel Gol Awan Kerubino Akec Ayok Sabrino Garang Barjok Andrew Eliaba Bausumo Abraham Biar Deng Biar William Deng Bol Kong Pal Chang Joseph Chuol Char William Kuol Chol James Gatluak Chuol Peter Kueth Chuol Deng Bulabek Deng Deng Dut Domkooc Rudolf Buola Fedrick Samuel Mut Gai Emmanuel Ayoub Phillip Gaza Ngot Riiny Giir Bichok Gony Guandong Anna Michael Hadjixiros Christine Hayat Jack Riek Jack Martina JohnKani Edward Augustino Kasran Edward Barnaba Kisanga Thomas Krama Arop Deng Kuol Severino Akileo Lado Marina Martin Legge Remijo Amule Lominyo Julius Duku Lonyong Riny Riny Lual Majak Majak Lual Fina Bangu Lujang Lino Lual Machar Majur Mayor Machar Peter Dhieu Mahal Elizabeth Manoa Majok Akec Reec Makur Lwal Diing Malong Malong Nyok Arob Matiok Abel Kau Mayuen Mario Rukokau Mbembe George Benjamin Mogga Malik Doka Morjan Peter Jok Ngor Thomas Tut Nhial Bona Garang Nyol Thomas Serafino Ohure Samuel Lo-KidenOkwera Dina Disan Olweny Martin Justin Onjeriwa Biliu Duap Pei Chol Amol Piok Patric Martin Riak Rose Arop Ring Paul Carlo Sabino Felix Otuduha Siro Joyce Taban Joseph Kang Thuok Peter Hoth Tuach Wal Yang Wel Michael William Acknowledgements Acknowledgements DATA SCREENING & ENTRY STAFF George Cornelius Odera Data Screening & Entry John Chuol Char Data Screening & Entry Louis Avitoson Data Screening & Entry Mark Acire Nyeko Data Screening & Entry Michael Ndemo Bogonko Data Entry / Editing Patrick Manyange Osoro Data Entry / Editing Robert Kojwang Data Entry / Editing Robert Mwenda Mwithia Data Entry / Editing COUNTERPARTS SRRA, RASS & FRRA HQ collaboration and field level practical support. CONSORTIUM NGOs Notably: Oxfam GB, MDM, ZOA, CRS, NCA, IRC For field level support of survey staff accommodation/transport. AIRCRAFT & TRUCK OPERATORS Boskovic, Trackmark & WFP Air support. WFP Fieldwork and Lokichokio truck transport. UNICEF STAFF UNICEF/OLS Management, Logistics, Accommodation & Security Personnel, Lokichokio For briefing, accommodation & logistics support of survey staff. UNICEF/OLS Regional Programme Officers, southern Sudan For initial data collection, questionnaire design/pilot ,training facilitators) and field management/support of survey staff. UNICEF Regional Office Logistics & IT Units, Nairobi For Contracts, supplies procurement & technical support. REPORT PRODUCTION Michelle Mathews Report design, layout & data entry. FILMS & CHROMALINS MarketPower International Limited PRINTING Kenya Litho Contents Notes for the reader 1 Population 5 Table 1: Population Estimates in the southern part of Sudan (where the survey was conducted) 6 Table 2: Population of the southern part of Sudan by Gender & Age 8 Table 3:Mean household size 9 Age Distribution 11 Population age distribution in each region 11 Table 4: Total population age distribution of southern Sudan 12 The Antenatal Period & Delivery 15 Table 5: Antenatal Care not received during last Pregnancy 16 Table 6: Vitamin A not received after Delivery 17 Table 7: Tetanus Toxoid not received during last Pregnancy 18 Table 8: Delivery not Done at a Health Facility 19 Table 9: Delivery conducted by an untrained Birth Attendant 20 Breastfeeding 23 Table 10: Infants who received less than 12 months continuous Breastfeeding 24 Immunization & Vitamin A 29 Table 11: Infants not immunized with the BCG vaccine 30 Table 12: Infants not immunized with the DPT vaccine 32 Table 13: Infants not immunized with the Polio vaccine 34 Table 14: Infants not immunized with the Measles vaccine 36 Table 15: Infants who did not receive Vitamin A in the last 6 months 38 Children under 5 years 41 Diarrhoea 43 Table 16: Children who had a Diarrhoeal episode in the last 15 days 44 Table 17: Children who were not given an ORS/Sugar-Salt Solution during Diarrhoea 46 Table 18: Diarrhoea not treated at a Health Facility 48 Table 19: Children not given more liquid during Diarrhoea 50 Table 20: Children who were given less/no food during Diarrhoea 52 Fever, Cough & Malaria 55 Table 21: Children who had a cough in the last 15 days 58 Table 22: Children with a cough who had difficulty/fast breathing in the last 15 days 60 Table 23: Children with a cough who had difficulty/fast breathing not treated at a health facility 62 Table 24: Children who had fever in the last 15 days 64 Table 25: Children who had fever and were not provided medicine by a health facility 66 Table 26: Children who do not Sleep Under a Bed-net 68 Malnutrition 71 Table 27: Children whose Middle-Upper-Arm-Circumference (MUAC) was less than 125mm 72 Children from 5 to 17 years 75 Education 77 Table 28: Children not Enrolled in School in 1999 80 Table 29: Children Enrolled in School who did not attend classes for more than 3 days in a week 82 Table 30: Children among Unregistered never Registered in School 84 Table 31: Reasons for Children dropping out of school once registered 86 Household Work 89 Table 32: Children who help with Household Domestic Chores 90 Table 33: Children who help with Household Income Generation Work 92 Contents Disability & Impairment in all Children 97 Table 34: Children Under 5 years who have a Disability/Impairment 98 Table 35: Children 5-17 years who have a Disability/Impairment 100 Table 36: Children 5-17 years who had problems with Night Vison 102 Table 37: Types of Disabilities/Impairments in Children Under 5 years 104 Table 38: Types of Disabilities/Impairments in Children 5 - 17 years 105 Water & Sanitation 109 Table 39: Households drinking Unsafe Drinking-Water during the dry Season 110 Table 40: Households drinking Unsafe Drinking-Water during the Cultivation Season 111 Table 41: Source of Water Supply during the two Seasons 112 Table 42: Households not using Sanitary Latrines 114 Table 43: Households who do not own a Sanitary Latrine 115 Household Food Security 117 Table 44: Households who do not have Livestock 118 Table 45: Food since the last harvest not Own or not Purchased 119 Table 46: Wild Food or no Food Consumed Yesterday 120 Table 47: Households consuming Wild or no Food during Drought Periods 121 Salt 123 Table 48: Households who do not use Salt 124 Table 49: Salt user Households who use non-iodized Salt 125 Awareness of Child Rights 127 Table 50: Households Unaware of the Rights of Children 128 Table 51: Households Unaware of the Convention on the Rights of Children 129 The Environment for Survival, Growth & Development 107 Contents The Environment for Survival, Growth & Development Continued Awareness related to HIV/AIDS 131 Table 52: Adults who have never heard of HIV or AIDS 132 Table 53: Adults who do not know about HIV or AIDS related problems 133 Table 54: Adults who do not know about the relationship between unprotected sexual activity and HIV/AIDS 134 Table 55: Adults who are ignorant about the transmission of HIV from Mother to Foetus and Infant 135 Humanitarian Assistance 137 Table 56: Households unaware of Humanitarian Agencies 138 Table 57: Households who do not benefit from Agencies 139 Protection 141 Table 58: The Number of Children Abducted 142 Table 59: The Number of Women Abducted 143 Table 60: The Number of Children Conscripted into the Army 144 Annex 145 Annex 1: Confidence Internal Tables 147 Confidence Intervals of Selected Indicators 148 Annex 2: Methodology 151 Survey Methodology 153 Sample Size Calculations 158 Annex 3: Definitions 161 Annex 4: Questionnaire 169 Annex 5: Convention on the Rights of the Child 179 Preamble 181 Part I of the CRC 183 Part II of the CRC 198 Part III of the CRC 201 Contents Notes for the Reader “Non-achievement” Statistical publications usually report achievements. In this case however, we feel there is so much work to do that focusing on achievement detracts from the gravity of what is still left to accomplish. For instance, every child un-immunized is a child whose right to health is violated. Every girl out of school is a girl whose right to education is violated. This report highlights “non-achievement” in order to show what needs to be done in order to realize the rights of all children, everywhere. Insecurity and Access Insecurity and access denials made it impossible to visit certain locations in southern Sudan. This report reflects data from only those locations that were accessible and only in rebel-held areas. Abduction and Child Soldiers Information on abduction and child soldiers is anecdotal and has been collected for a period of upto 15 years. It has no statistical validity and is included only to give estimates. Population Figures Population figures are estimates and not census figures. The estimated figures, however, correspond closely to information gathered during National Immunization Day's for Polio in 1999. 'Areas with greatest needs’ On each page there is a chart called 'Areas with greatest needs'. This ranks each region, worst to best, based on what percentage of needs are not being covered. The second column of the chart indicates, again worst to best, which areas have the greatest needs according to the number of people surveyed. This chart is important because it allows the reader to get a more accurate idea of which areas are actually experiencing the greatest deficits, despite how the raw percentages may make it appear. While this is useful for prioritizing and strategy development, ultimately all children must be reached. 1 Notes for the Reader ‘Girl/Boy' Ratio The 'Girl/Boy' ratio is derived by dividing the coverage figures for girls by those for boys. A value of one (1) indicates no disparity. A ratio of more than one indicates disparity against boys while a ratio of less than one indicates disparity against girls. These disparities are highlighted in yellow. Missing Gender Data Gender data for about 0.98% children were missing and is therefore not reflected in the separate columns designated boys and girls, but was included in the 'total' column. Therefore, the total is not the sum of the boys and girls but a greater value. Confidence Intervals Surveys such as MICS use a percentage of the population to gain a picture of the whole situation. In order to get an accurate picture it is necessary to allow for a margin of error. This is done through 'confidence interval' calculations. When studying an arbitrary population that is not necessarily normally distributed, one can only calculate an estimate of the mean (average) of the population. Using the mean from a large random sample of measurements, one must allow for a margin of error either side of that figure. This is the 'level of confidence', and in this case the size of the error has been taken at 95%. The range of the estimate for the mean, given by 0.95 + or - the sample mean, is called a confidence interval. Each time a random sample is gathered, a different sample average will be found; thus, there will be a different confidence interval with each sample. Numbers In absence of census figures, the numbers used in the tables are extrapolated from the percentage data using regional population figures. They are presented to indicate the possible quantum of the non-achievement or the problem and have limited statistical validity. 2 Population Population Analysis • The total population of rebel-controlled areas in the southern part of Sudan is estimated at 5.06 million. • 58% of the population is below 17 years of age. Bahr el Ghazal and Lakes account for 56% of the population followed by Equatoria at 32%, then Upper Nile and Jonglei. • There are more women than men. However, there are 20% fewer girls than boys under five years of age. There are also 12% fewer girls than boys in the 6-17 year age category. • There are twice as many women as men in the adult population (above 17 years of age). War, death in conflict and displacement/ emigration (refugees) could be the main reason for this difference. Children under 17 years outnumber adults in Bahr el Ghazal, Upper Nile, Jonglei and Eastern Equatoria. These areas have seen significant conflict and displacement. The average household size in the southern part of Sudan is five (5), with children under 17 accounting for three out of five in every people household. • The population in the southern part of Sudan is increasing rapidly. Some indirect estimates place the crude birth rate at almost 50/1000. There is limited availability of contraceptives. The limited access to health facilities means that many women are repeatedly exposed to the risk of disease, disability and death during pregnancy, labour, birth and in post-natal recovery. Lack of education and employment opportunities for the young will pose serious challenges as this population grows older. 5 Overall Estimated Population of children under 5 Overall Estimated Population of children between 5 and 17 Overall Estimated Population of Adults Overall Estimated Total Population Male Female Total 689,393 574,981 1,264,374 895,757 801,066 1,696,823 682,590 1,413,728 2,096,318 2,267,740 2,789,775 5,057,515 Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Table 1 - Population Estimates in the southern part of Sudan (where the survey was conducted) Table 1 - Population Estimates in the southern part of Sudan (where the survey was conducted) Under 5 Between 5 and 17 Adult Total 528,156 613,579 736,092 1,877,827 241,151 286,328 446,072 973,551 94,856 114,071 113,606 322,533 67,947 99,030 130,008 296,985 133,561 233,949 415,810 783,320 186,039 341,663 277,107 804,809 Bahr el Ghazal 6 Bahr el Ghazal 1,877,827 Upper Nile 322,533 Lakes 973,551 Western Equatoria 783,320 Jonglei 296,985 Eastern Equatoria 804,809 Sudan Population Estimates in the southern part of Sudan (where the survey was conducted) Population Estimates in the southern part of Sudan (where the survey was conducted) 7 Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Table 2 - Population of the southern part of Sudan by Gender & AgeTable 2 - Population of the southern part of Sudan by Gender & Age Under 5 Between 5 and 17 Adult Total M F M F M F M F 294,770 233,386 328,945 284,634 186,256 549,836 809,971 1,067,856 129,735 111,416 154,511 131,817 166,223 279,849 450,469 523,082 51,951 42,905 60,441 53,630 31,372 82,234 143,764 178,769 37,004 30,943 51,043 47,987 43,302 86,706 131,349 165,636 67,529 66,032 125,410 108,539 178,097 237,713 371,036 412,284 100,442 85,597 166,921 174,742 93,938 183,169 361,301 443,508 8 Under 5 Between 5 and 17 Adult Total 1.18 1.72 1.92 4.82 1.45 1.98 2.67 6.10 1.18 1.67 1.55 4.40 1.21 1.68 2.04 4.93 1.06 1.66 2.37 5.09 1.19 1.97 2.15 5.32 1.22 1.79 2.16 5.17 Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Table 3 - Mean Household SizeTable 3 - Mean Household Size Overall 9 Age Distribution 020,00080,000 40,000100,000 60,000 Population Figures 20,000 80,00040,000 100,00060,000 Female Population EstimatesMale Population Estimates The southern part of Sudan 120,000140,000 120,000 140,000 12 Age Distribution in the southern part of Sudan (where the survey was conducted) Age Distribution in the southern part of Sudan (where the survey was conducted) 669,333 (29.7%) (50.2%) 1,385,529 27,849 (1.2%) (1.0%) 28,538 38,196 (1.7%) (1.1%) 29,429 57,668 (2.6%) (1.3%) 37,268 53,051 (2.4%) (1.2%) 34,349 55,976 (2.5%) (1.7%) 48,158 79,170 (3.5%) (2.1%) 56,619 45,661 (2.0%) (1.4%) 38,013 79,107 (3.5%) (2.4%) 66,254 100,680 (4.5%) (3.7%) 103,157 92,715 (4.1%) (2.8%) 77,949 94,521 (4.2%) (4.1%) 111,913 95,582 (4.2%) (3.4%) 94,002 74,211 (3.3%) (2.8%) 76,130 109,703 (4.9%) (3.4%) 95,212 139,385 (6.2%) (4.2%) 116,352 154,496 (4.0%) 110,636 137,552 (6.1%) (4.2%) 118,018 146,138 (6.5%) (4.8%) 133,911 18 years & over 17 years 16 years 15 years 14 years 13 years 12 years 11 years 10 years 9 years 8 years 7 years 6 years 5 years 4 years 3 years (6.9%) 2 years 1 year Up to 1 year 18 years & over 17 years 16 years 15 years 14 years 13 years 12 years 10 years 9 years 8 years 7 years 6 years 5 years 4 years 3 years (6.9%) 2 years 1 year Up to 1 year 11 years Female Population Estimates 020,00080,000 40,00060,000 Population Figures Male Population Estimates 20,000 80,00040,000 60,000 Bahr el Ghazal 020,00080,000 40,00060,000 Population Figures 20,000 80,00040,000 60,000 Lakes 020,00080,000 40,00060,000 Population Figures 20,000 80,00040,000 60,000 Upper Nile Female Population EstimatesMale Population Estimates Female Population EstimatesMale Population Estimates 193,862 (22.2%) (50.4%) 565,809 9,247 (1.1%) (1.2%) 13,827 12,935 (1.5%) (0.8%) 9,387 23,693 (2.7%) (0.9%) 10,508 14,664 (1.7%) (0.8%) 9,374 20,994 (2.4%) (1.3%) 15,111 29,059 (3.3%) (1.8%) 20,174 13,701 (1.6%) (1.4%) 19,996 44,845 (5.1%) (2.4%) 27,423 40,845 (4.7%) (4.2%) 46,659 53,702 (6.1%) (3.1%) 35,166 38,760 (4.4%) (4.0%) 44,524 47,716 (5.5%) (3.6%) 40,639 11,309 (1.3%) (1.6%) 18,077 45,743 (5.3%) (4.0%) 45,648 69,452 (8.0%) (5.1%) 57,512 82,375 (9.5%) (3.3%) 37,759 60,234 (6.9%) (5.0%) 56,496 60,130 (6.9%) (4.8%) 53,645 18 years & over 17 years 16 years 15 years 14 years 13 years 12 years 11 years 10 years 9 years 8 years 7 years 6 years 5 years 4 years 3 years 2 years 1 year Up to 1 year 18 years & over 17 years 16 years 15 years 14 years 13 years 12 years 10 years 9 years 8 years 7 years 6 years 5 years 4 years 3 years 2 years 1 year Up to 1 year 11 years 138,620 (36.4%) (53.0%) 240,804 6,144 (1.6%) (0.7%) 3,258 9,125 (2.4%) (1.5%) 6,774 10,081 (2.6%) (1.1%) 5,216 13,499 (3.5%) (1.8%) 7,956 11,558 (3.0%) (1.2%) 5,523 10,787 (2.8%) (2.3%) 10,233 4,093 (1.1%) (1.3%) 5,785 6,388 (1.7%) (1.7%) 7,767 14,065 (3.7%) (2.7%) 12,168 8,380 (2.2%) (1.9%) 8,810 14,954 (3.9%) (3.5%) 16,060 11,329 (3.0%) (2.9%) 13,243 11,534 (3.0%) (2.8%) 12,842 21,245 (5.5%) (3.6%) 13,85 17,152 (4.5%) (4.5%) 17,3923 24,424 (6.4%) (6.2%) 23,922 24,193 (6.3%) (4.9%) 18,660 23,699 (6.2%) (6.2%) 23,969 18 years & over 17 16 15 14 13 12 years 11 10 9 years 8 years 7 years 6 years 5 years 4 years 3 years 2 years 1 year Up to 1 year 18 years & over 16 15 14 13 12 years 11 10 9 years 8 years 7 years 6 years 5 years 4 years 3 years 2 years 1 year 17 Up to 1 year 44,122 (23.2%) (47.0%) 112,590 3,940 (2.1%) (1.7%) 3,987 2,473 (1.3%) (1.1%) 2,672 5,846 (3.1%) (1.4%) 3,394 5,139 (2.7%) (1.4%) 3,273 5,817 (3.1%) (2.0%) 4,811 5,464 (2.9%) (2.3%) 5,440 4,735 (2.5%) (1.5%) 3,566 4,575 (2.4%) (2.5%) 5,930 6,721 (3.5%) (2.2%) 5,176 6,028 (3.2%) (3.1%) 7,323 10,621 (5.6%) (4.4%) 10,606 7,134 (3.7%) (2.8%) 6,664 10,424 (5.5%) (3.2%) 7,729 12,584 (6.6%) (5.2%) 9,853 15,118 (7.9%) (5.5%) 10,454 13,960 (7.3%) (7.2%) 13,813 13,133 (6.9%) (7.5%) 14,413 12,750 (6.7%) (4.2%) 7,970 18 years & over 17 16 15 14 13 12 11 10 9 8 7 years 6 5 years 4 years 3 years 2 years 1 year Up to 1 18 years & over 17 16 15 14 13 12 11 10 9 8 7 years 6 5 years 4 years 3 years 2 years 1 year Up to 1 020,00080,000 40,00060,000 Population Figures 20,000 80,00040,000 60,000 Jonglei 020,00080,000 40,00060,000 Population Figures 20,000 80,00040,000 60,000 Western Equatoria 020,00080,000 40,00060,000 Population Figures 20,000 80,00040,000 60,000 Eastern Equatoria Female Population EstimatesMale Population EstimatesFemale Population EstimatesMale Population EstimatesFemale Population EstimatesMale Population Estimates 32,073 (33.1%) (53.0%) 64,909 2,816 (2.9%) (1.5%) 1,867 2,435 (2.5%) (1.6%) 1,998 2,486 (2.6%) (2.8%) 3,474 2,401 (2.5%) (2.4%) 2,984 2,702 (2.8%) (2.9%) 3,588 2,644 (2.7%) (2.8%) 3,39 1,956 (2.0%) (1.1%) 1,3740 5,078 (5.2%) (2.9%) 3,493 3,068 (3.2%) (2.4%) 2,940 3,580 (3.7%) (0.9%) 1,114 3,927 (4.1%) (3.4%) 4,155 2,206 (2.3%) (1.3%) 1,571 2,292 (2.4%) (2.5%) 3,000 3,121 (3.3%) (3.0%) 2,887 6,177 (6.5%) (5.4%) 5,160 2,866 (3.0%) (3.1%) 2,975 9,461 (9.9%) (6.2%) 5,968 5,570 (5.8%) (5.8%) 5,527 18 years & over 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 year 0 18 years & over 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 year 0 166,916 (48.0%) (57.6%) 221,431 2,520 (0.7%) (0.7%) 2,712 4,673 (1.3%) (0.5%) 2,103 4,618 (1.3%) (0.4%) 1,724 11,183 (3.2%) (1.6%) 6,045 5,937 (1.7%) (2.5%) 9,538 12,782 (3.7%) (1.1%) 4,166 9,918 (2.9%) (1.0%) 3,79 7,193 (2.1%) (1.5%) 5,8197 19,101 (5.5%) (3.5%) 13,632 5,773 (1.7%) (2.6%) 9,854 8,116 (2.3%) (4.7%) 17,937 7,224 (2.1%) (3.3%) 12,670 18,459 (5.3%) (2.9%) 11,331 5,885 (1.7%) (3.1%) 10,897 11,498 (3.3%) (2.7%) 9,501 16,634 (4.8%) (3.5%) 11,964 13,258 (3.8%) (2.8%) 9,576 16,123 (4.6%) (5.7%) 19,583 18 years & over 17 16 15 14 years 13 12 11 10 9 years 8 7 years 6 years 5 years 4 3 years 2 years 1 year Up to 1 year 18 years & over 17 16 15 14 years 13 12 11 10 9 years 8 7 years 6 years 5 years 4 3 years 2 years 1 year Up to 1 year 93,740 (26.0%) (41.2%) 179,985 3,183 (0.9%) (0.7%) 2,88 6,555 (1.8%) (1.5%) 6,4957 10,944 (3.0%) (3.0%) 12,953 6,164 (1.7%) (1.1%) 4,717 8,967 (2.5%) (2.2%) 9,586 18,434 (5.1%) (3.0%) 13,216 11,258 (3.1%) (1.7%) 7,495 11,028 (3.1%) (3.6%) 15,822 16,903 (4.7%) (5.2%) 22,582 15,251 (4.2%) (3.6%) 15,683 18,143 (5.0%) (4.3%) 18,632 19,973 (5.5%) (4.4%) 19,215 20,193 (5.6%) (5.3%) 23,150 21,126 (5.8%) (3.3%) 12,072 19,989 (5.5%) (4.5%) 16,332 14,237 (3.9%) (5.6%) 20,206 17,273 (4.8%) (3.6%) 12,906 27,866 (7.7%) (6.4%) 23,217 18 years & over 17 16 15 years 14 13 years 12 years 11 10 years 9 years 8 years 7 years 6 years 5 years 4 years 3 years 2 years 1 year Up to 1 year 18 years & over 17 16 15 years 14 13 years 12 years 11 10 years 9 years 8 years 7 years 6 years 5 years 4 years 3 years 2 years 1 year Up to 1 year Population Pyramids for each region of the southern part of Sudan (where the survey was conducted) Population Pyramids for each region of the southern part of Sudan (where the survey was conducted) The Ante-natal Period & Delivery The Antenatal Period & Delivery Analysis • During 1999, most women and their newborns were not protected against Tetanus. Even in the Equatorias, only half of them had received the Tetanus Toxoid (TT) vaccine during their last pregnancy. Most women also did not receive any antenatal care during their last pregnancy. Almost all deliveries are conducted at home. Eastern Equatoria has the highest number of deliveries (18%) conducted in a health facility. Long distances to travel, low awareness levels regarding the benefits of health care and in some cases a lack of trained personnel and essential drugs are some of the reasons that women tend to stay at home. • Most deliveries in the southern part of Sudan are conducted by untrained birth attendants. However, two- thirds of the deliveries in Western Equatoria and 40% in Eastern Equatoria are conducted by trained birth attendants. Relative security and increased availability of trained workers could be the main reasons for this difference. • Almost none of the women surveyed received Vitamin A immediately after delivery. Administration of Vitamin A soon after delivery can reduce the risk of mortality of the mother and the newborn (if it is breastfed) as it is known to be essential for the effective functioning of the immune system. • There is an almost total absence of Obstetricians and Gynaecologists in southern Sudan. In the absence of adequate health services for women, every pregnancy means an increased risk of morbidity, disability or mortality for the mother and child. Disabilities such as ano-rectal fistula, which can make the women's life miserable both physically and socially. While no data is available for maternal mortality rates, the conditions in southern Sudan indicate that theirs would be one of the highest in the world. Action Points 1. Increase access to health services by supporting rehabilitation or construction of simple low cost facilities. 2. Continue to support the training of Traditional Birth Attendants and Community Health Workers in Ante- natal Care 3. Promote the use of Hygienic Delivery Kits in all health facilities and in homes 4. Promote ante-natal contacts between the pregnant women and the nearest health facility 5. Organize special TT immunization campaigns for women (special emphasis women 15-30 years of age) 6. Promote administration of Vitamin A to the mother soon after delivery 15 Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Overall Areas with Greatest Need By: Percent Coverage Absolute Numbers Sudan Bahr el Ghazal 99.5% Upper Nile 99.3% Lakes 83.8% Western Equatoria 36.6% Jonglei 93.6% Eastern Equatoria 52.6% Under 33% 33 - 67% 67 - 100% Bahr el Ghazal Lakes Eastern Equatoria Western Equatoria Jonglei Upper Nile Percent Estimated No. 99.5 116,790 83.8 35,933 99.3 9,040 93.6 9,942 36.6 12,035 52.6 31,792 78.9 215,533 Bahr el Ghazal Upper Nile Jonglei Lakes Eastern Equatoria Western Equatoria 16 Table 5 - Antenatal Care not received during last Pregnancy Table 5 - Antenatal Care not received during last Pregnancy Artic le 6 of the CRC give s ev ery child the righ t to l ife, s urvi val and deve lopm ent. Art icle 24 o f th e CRC giv es ever y m othe r th e r ight to appr opri ate pre- nata l an d p ost-n atal heal th c are. Artic le 6 of the CRC give s ev ery child the righ t to l ife, s urvi val and deve lopm ent. Art icle 24 o f th e CRC giv es ever y m othe r th e r ight to appr opri ate pre- nata l an d p ost-n atal heal th c are. Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Overall Sudan Upper Nile %99.8 Lakes %85.4 Jonglei %95.7 Under 33% 67 - 100% Bahr el Ghazal Eastern Equatoria Lakes Western Equatoria Upper Nile Jonglei Upper Nile Western Equatoria Jonglei Bahr el Ghazal Lakes Eastern Equatoria Percent Estimated No. 95.5 113,470 85.4 33,675 99.8 9,421 95.7 8,841 97.6 31,859 80.8 48,912 91.1 246,181 Table 6 - Vitamin A not received after Delivery Table 6 - Vitamin A not received after Delivery 33 - 67% Western Equatoria %97.6 Eastern Equatoria %80.8 Bahr el Ghazal %95.5 Areas with Greatest Need By: Percent Coverage Absolute Numbers 17 Article 6 of the CRC gives every child the right to life, survival and development. Article 24 of the CRC gives every mother the right to appropriate pre-natal and post-natal health care. Article 6 of the CRC gives every child the right to life, survival and development. Article 24 of the CRC gives every mother the right to appropriate pre-natal and post-natal health care. Table 7 - Tetanus Toxoid not received during last Pregnancy Table 7 - Tetanus Toxoid not received during last Pregnancy Sudan Bahr el Ghazal 98.6% Upper Nile 97.4% Lakes 72.4% Western Equatoria 58.4% Jonglei 96.3% Eastern Equatoria 50.8% Under 33% 33 - 67% 67 - 100% Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Overall Percent Estimated No. 98.6 116,712 72.4 30,901 97.4 8,931 96.3 10,494 58.4 18,931 50.8 31,852 78.9 217,820 Bahr el Ghazal Eastern Equatoria Lakes Western Equatoria Jonglei Upper Nile Bahr el Ghazal Upper Nile Jonglei Lakes Western Equatoria Eastern Equatoria Areas with Greatest Need By: Percent Coverage Absolute Numbers 18 Artic le 6 of the CRC give s ev ery child the righ t to l ife, s urvi val and deve lopm ent. Art icle 24 o f th e CRC giv es ever y m othe r th e r ight to appr opri ate pre- nata l an d p ost-n atal heal th c are. Artic le 6 of the CRC give s ev ery child the righ t to l ife, s urvi val and deve lopm ent. Art icle 24 o f th e CRC giv es ever y m othe r th e r ight to appr opri ate pre- nata l an d p ost-n atal heal th c are. Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Overall Sudan Bahr el Ghazal %99.6 Upper Nile 99.5% Lakes 92.1% Western Equatoria 99.0% Jonglei 97.2% Eastern Equatoria 81.7% Under 33% 67 - 100% Bahr el Ghazal Eastern Equatoria Lakes Western Equatoria Jonglei Upper Nile Bahr el Ghazal Upper Nile Western Equatoria Jonglei Lakes Eastern Equatoria Percent Estimated No. 99.6 118,067 92.1 39,178 99.5 9,724 97.2 11,100 99.0 32,331 81.7 51,267 94.2 261,668 Table 8 - Delivery not done at a Health Facility Table 8 - Delivery not done at a Health Facility 33 - 67% Areas with Greatest Need By: Percent Coverage Absolute Numbers 19 Article 6 of the CRC gives every child the right to life, survival and development. Article 24 of the CRC gives every mother the right to appropriate pre-natal and post-natal health care. Article 6 of the CRC gives every child the right to life, survival and development. Article 24 of the CRC gives every mother the right to appropriate pre-natal and post-natal health care. Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Overall Table 9 - Delivery Conducted by an Untrained Birth Attendant Table 9 - Delivery Conducted by an Birth AttendantUntrained Sudan Bahr el Ghazal 95.1% Upper Nile 94.5% Lakes 84.8% Western Equatoria 35.6% Jonglei 90.9% Eastern Equatoria 59.8% Under 33% 67 - 100% Bahr el Ghazal Lakes Eastern Equatoria Western Equatoria Jonglei Upper Nile Bahr el Ghazal Upper Nile Jonglei Lakes Eastern Equatoria Western Equatoria Percent Estimated No. 95.1 106,120 84.8 36,130 94.5 9,167 90.9 9,447 35.6 12,550 59.8 35,841 77.7 209,257 33 - 67% Areas with Greatest Need By: Percent Coverage Absolute Numbers 20 Artic le 6 of the CRC give s ev ery child the righ t to l ife, s urvi val and deve lopm ent. Art icle 24 o f th e CRC giv es ever y m othe r th e r ight to appr opri ate pre- nata l an d p ost-n atal heal th c are. Artic le 6 of the CRC give s ev ery child the righ t to l ife, s urvi val and deve lopm ent. Art icle 24 o f th e CRC giv es ever y m othe r th e r ight to appr opri ate pre- nata l an d p ost-n atal heal th c are. Breastfeeding Breastfeeding Analysis Almost all children in southern Sudan are breastfed until at least one year of age. Western Equatoria has the largest percentage of infants not receiving any breastmilk at 12 months of age. Very little data is available on the frequency of exclusive breastfeeding. However, it has been documented that traditionally the southern Sudanese breastfeed for up to two years of age. Exclusive breastfeeding for the first six months greatly enhances a child’s prospects of survival, as i Action Points 1. exclusive breastfeeding practices in southern Sudan in order to plan appropriate awareness campaigns. 2. Promote exclusive breastfeeding by including information regarding exclusive breastfeeding in all communications at health facilities and community centers and by including it in the content of Life Skills training materials. 3. Support and train the humanitarian wings of the rebel movements to develop guidelines regarding appropriate breastfeeding practices and marketing/promotion of breast milk substitutes. • mmunity factors in breast milk can help the baby to fight off infections. Breast milk also contains vitamins, minerals, and enzymes which aid the baby’s digestion. Use the growing database systems within OLS to gather and analyze information on 23 Table 10 - Infants who received less than 12 months continuous Breastfeeding Table 10 - Infants who received less than 12 months continuous Breastfeeding Boys Girls Total Percent Number Percent Number Percent Number 17.1 9,819 25.2 12,960 1.47 21.0 22,779 18.5 4,671 9.2 2,047 0.50 14.0 6,717 20.1 2,137 23.4 2,662 1.16 21.8 4,800 27.3 2,796 27.1 2,038 0.99 27.0 4,834 31.3 4,033 38.4 3,670 1.23 34.2 7,702 - - - - - 8.9 2,730 20.3 23,636 22.9 23,377 1.13 19.9 49,563 Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Total Girl Boy / Ratio 24 Sudan Infants who received less than 12 months continuous Breastfeeding Infants who received less than 12 months continuous Breastfeeding Under 33% 67 - 100% Bahr el Ghazal 21.0% Upper Nile 21.8% Lakes 14.0% Western Equatoria 34.2% Jonglei 27.0% Eastern Equatoria 8.9% 33 - 67% Areas with Greatest Need By: Percent Coverage Absolute Numbers Bahr el Ghazal Western Equatoria Lakes Jonglei Upper Nile Eastern Equatoria Western Equatoria Jonglei Upper Nile Bahr el Ghazal Lakes Eastern Equatoria 25 Article 24 of the CRC sets out to ensure that parents, are informed and are supported in the basic knowledge of t h e a d v a n t a g e s o f b r e a s t f e e d i n g . Article 24 of the CRC sets out to ensure that parents, are informed and are supported in the basic knowledge of t h e a d v a n t a g e s o f b r e a s t f e e d i n g . Immunization & Vitamin A Infants: Immunization & Vitamin A Analysis • 72% children were not protected against childhood tuberculosis (TB), the range is from 95% in Bahr el Ghazal to 34% in Western Equatoria. • 75% of children were not protected against Diphtheria, Pertussis and Tetanus. The Equatorias had the highest coverage (58%) while Upper Nile and Bahr el Ghazal had the lowest percentages. • • 66% of children were not protected against measles. Significant gender difference in coverage is seen in Eastern Equatoria where 55% more boys were immunized than girls. Upper Nile, Bahr el Ghazal and Jonglei had the lowest coverage while Western Equatoria had the highest (60%). • 84% of children under-five did not receive Vitamin A in the last 6 months. The coverage was uniformly low in all regions of southern Sudan. Action Points 1. Organize pulse immunization campaigns in southern Sudan and increase the coverage against selected preventable and killer diseases to over 80%. 2. Organize special immunization campaigns for the eradication of Polio. Use house-to-house campaign strategies to reach younger children and to increase immunization coverage in accessible areas. 3. Combine Vitamin A administration with immunization campaigns. Over 70% of children were not protected against polio. Significant gender differences in polio coverage are seen in Upper Nile and Western Equatoria where more girls have received the polio vaccine than boys. Bahr el Ghazal has the lowest coverage while Western Equatoria has the highest. Even though the polio coverage (under five) is reported at 90%, Bahr el Ghazal, Lakes and Upper Nile areas are showing very low coverage amongst infants. Distances from the immunization site and the unwillingness of parents to carry infants over long distances could be the reason for this low coverage. 29 Boys Girls Total Percent Number Percent Number Percent Number 94.8 51,309 95.2 47,760 1.00 95.0 99,069 59.9 13,428 51.9 11,424 0.87 55.5 24,921 92.5 9,655 93.0 10,037 1.01 92.7 19,692 52.5 4,975 49.3 3,409 0.94 51.2 8,384 35.8 4,431 31.9 2,901 0.89 34.1 7,331 35.2 5,910 37.6 4,683 1.07 36.9 10,909 71.4 89,708 72.0 80,214 1.01 71.6 170,305 Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Total Girl Boy / Ratio Table 11 - Infants not immunized with the BCG VaccineTable 11 - Infants not immunized with the BCG Vaccine 30 Sudan Bahr el Ghazal %95.0 Upper Nile %92.7 Lakes %55.5 Western Equatoria %34.1 Jonglei %51.2 Eastern Equatoria %36.9 Infants not immunized with the BCG VaccineInfants not immunized with the BCG Vaccine Under 33% 67 - 100% 33 - 67% Areas with Greatest Need By: Percent Coverage Absolute Numbers Bahr el Ghazal Upper Nile Lakes Jonglei Eastern Equatoria Western Equatoria Bahr el Ghazal Lakes Upper Nile Eastern Equatoria Jonglei Western Equatoria 31 Article 24 of the CRC gives every child the right to the highest attainable standards of health. Article 24 of the CRC gives every child the right to the highest attainable standards of health. Boys Girls Total Percent Number Percent Number Percent Number 91.9 51,589 84.7 42,988 0.92 88.1 94,578 68.8 15,810 75.8 13,055 1.10 71.1 28,934 99.4 9,915 99.8 10,289 1.00 99.6 20,205 59.7 5,661 57.7 3,630 0.97 58.9 9,290 42.4 4,884 35.8 2,531 0.84 39.9 7,415 41.0 6,752 47.2 5,710 1.15 44.2 12,777 75.1 95,093 75.3 78,203 1.00 74.9 173,199 Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Total Girl Boy / Ratio Table 12 - Infants not immunized with the DPT VaccineTable 12 - Infants not immunized with the DPT Vaccine 32 Sudan Bahr el Ghazal %88.1 Upper Nile %99.6 Lakes %71.1 Western Equatoria %39.9 Jonglei %58.9 Eastern Equatoria %44.2 Under 33% 67 - 100% Infants not immunized with the DPT VaccineInfants not immunized with the DPT Vaccine 33 - 67% Areas with Greatest Need By: Percent Coverage Absolute Numbers Upper Nile Bahr el Ghazal Lakes Jonglei Eastern Equatoria Western Equatoria Bahr el Ghazal Lakes Upper Nile Eastern Equatoria Jonglei Western Equatoria 33 Article 24 of the CRC gives every child the right to the highest attainable standards of health. Article 24 of the CRC gives every child the right to the highest attainable standards of health. Boys Girls Total Percent Number Percent Number Percent Number 91.3 51,232 82.4 42,232 0.90 87.0 93,465 69.9 16,355 75.1 15,287 1.07 71.7 31,710 80.9 7,977 65.7 6,599 0.81 73.2 14,576 66.7 6,143 62.5 3,929 0.94 64.9 10,072 32.5 3,779 19.6 1,515 0.60 27.3 5,294 36.0 5,889 38.7 4,707 1.08 37.8 10,911 72.2 91,375 68.9 74,269 0.95 70.6 166,026 Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Total Girl Boy / Ratio Table 13 - Infants not immunized with the Polio VaccineTable 13 - Infants not immunized with the Polio Vaccine 34 Sudan Bahr el Ghazal %87.0 Upper Nile %73.2 Lakes %71.7 Western Equatoria %27.3 Jonglei %64.9 Eastern Equatoria %37.8 Under 33% 67 - 100% Infants not immunized with the Polio VaccineInfants not immunized with the Polio Vaccine 33 - 67% Areas with Greatest Need By: Percent Coverage Absolute Numbers Bahr el Ghazal Upper Nile Lakes Jonglei Eastern Equatoria Western Equatoria Bahr el Ghazal Lakes Upper Nile Eastern Equatoria Jonglei Western Equatoria 35 Article 24 of the CRC gives every child the right to the highest attainable standards of health. Article 24 of the CRC gives every child the right to the highest attainable standards of health. Boys Girls Total Percent Number Percent Number Percent Number 75.3 412,284 68.0 33,495 0.90 71.9 74,779 63.8 13,536 76.1 15,113 1.19 69.1 28,719 76.6 7,343 81.6 8,089 1.07 79.1 15,433 74.8 6,546 66.9 4,666 0.89 71.3 11,212 37.5 4,884 43.0 3,894 1.15 39.7 8,778 35.7 5,809 58.5 7,447 1.64 46.3 13,571 64.2 79,402 67.4 72,704 1.05 65.7 152,492 Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Total Girl Boy / Ratio Table 14 - Infants not immunized with the Measles VaccineTable 14 - Infants not immunized with the Measles Vaccine 36 Sudan Bahr el Ghazal %71.9 Upper Nile %79.1 Lakes %69.1 Western Equatoria %39.7 Jonglei %71.3 Eastern Equatoria %46.3 Under 33% 67 - 100% Infants not immunized with the Measles VaccineInfants not immunized with the Measles Vaccine 33 - 67% Areas with Greatest Need By: Percent Coverage Absolute Numbers Upper Nile Bahr el Ghazal Jonglei Lakes Eastern Equatoria Western Equatoria Bahr el Ghazal Lakes Upper Nile Eastern Equatoria Jonglei Western Equatoria 37 Article 24 of the CRC gives every child the right to the highest attainable standards of health. Article 24 of the CRC gives every child the right to the highest attainable standards of health. Boys Girls Total Percent Number Percent Number Percent Number 82.7 224,359 82.0 172,498 0.99 82.6 400,937 79.9 80,873 78.2 70,992 0.98 79.1 153,813 95.6 43,463 92.4 33,807 0.97 94.2 77,270 83.2 25,363 83.5 22,939 1.00 83.4 48,397 89.6 50,233 90.4 45,090 1.01 90.0 95,322 80.8 64,613 87.8 57,083 1.09 84.1 122,502 83.6 488,904 83.8 402,409 1.00 83.8 896,919 Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Total Girl Boy / Ratio Table 15 - Infants who did not receive Vitamin A in the last 6 months Table 15 - Infants who did not receive Vitamin A in the last 6 months 38 Sudan Bahr el Ghazal %82.6 Upper Nile %94.2 Lakes %79.1 Western Equatoria %90.0 Jonglei %83.4 Eastern Equatoria %84.1 Under 33% 67 - 100% Infants who did not receive Vitamin A in the last 6 months Infants who did not receive Vitamin A in the last 6 months 33 - 67% Areas with Greatest Need By: Percent Coverage Absolute Numbers Upper Nile Western Equatoria Eastern Equatoria Jonglei Bahr el Ghazal Lakes Bahr el Ghazal Lakes Eastern Equatoria Western Equatoria Upper Nile Jonglei 39 Article 24 of the CRC gives every child the right to the highest attainable standards of health. Article 24 of the CRC gives every child the right to the highest attainable standards of health. Children under 5 years Children under 5: Diarrhoea Analysis • 45% of children under-five had diarrhoea in the 15 days prior to the survey. • Almost 63% of the children under-five did not get Oral Rehydration Salts (ORS) during their last episode of diarrhoea. No significant gender differences were found except in Eastern Equatoria where 47% more boys received ORS than girls. Upper Nile and Jonglei had the lowest prescription of ORS. Eastern Equatoria had the most (65%). • There is a direct correlation between the cases of diarrhoea that were treated at a health facility and cases where ORS was prescribed. This indicates that health facilities throughout southern Sudan do prescribe ORS for management of diarrhoea. • Three out of every four children under-five did not get increased fluids during diarrhoea. This indicates that even in health facilities (especially in Eastern Equatoria), families were not being advised or did not choose to increase administration of fluids to children with diarrhoea. Gender differences were insignificant. • Almost 60% of all children under- five were given less or no food during an episode of diarrhoea. Gender differences were significant in Lakes and Eastern Equatoria where 21% and 32% respectively more girls than boys got at least the same amount of food during diarrhoea. Action Points 1. Information on appropriate management of diarrhoea needs to be promoted through all channels of communication to households and through Life Skills materials, teacher-training materials and school- based learning materials. 2. The health worker training materials should be reinforced to communicate the importance of increased fluids and continued feeding during diarrhoea. 43 Boys Girls Total Percent Number Percent Number Percent Number 49.4 151,049 44.4 104,258 0.90 47.2 255,525 43.0 50,404 41.0 44,310 0.95 42.4 96,545 37.1 19,551 33.6 14,617 0.91 37.3 46,356 50.4 17,882 44.1 13,643 0.88 47.6 31,726 50.6 31,774 53.6 32,646 1.06 52.1 64,420 43.3 42,476 40.8 33,580 0.94 42.1 76,214 46.5 313,136 43.4 243,054 0.93 45.2 558,999 Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Total Girl Boy / Ratio Table 16 - Children under 5 years who had a Diarrhoeal episode in the last 15 days Table 16 - Children under 5 years who had a Diarrhoeal episode in the last 15 days 44 Sudan Bahr el Ghazal %47.2 Upper Nile %37.3 Lakes %42.4 Western Equatoria %52.1 Jonglei %47.6 Eastern Equatoria %42.1 Under 33% 67 - 100% 33 - 67% Areas with Greatest Need By: Percent Coverage Absolute Numbers Western Equatoria Jonglei Bahr el Ghazal Lakes Eastern Equatoria Upper Nile Bahr el Ghazal Lakes Eastern Equatoria Western Equatoria Upper Nile Jonglei Children under 5 years who had a Diarrhoeal episode in the last 15 days Children under 5 years who had a Diarrhoeal episode in the last 15 days 45 Article 24 of the CRC sets out to ensure that parents and children, are informed are supported in the basic knowledge of chi ld health and hygeine. Article 24 of the CRC sets out to ensure that parents and children, are informed are supported in the basic knowledge of chi ld health and hygeine. Table 17 - Children under 5 years who were not given an ORS/Sugar-Salt Solution during Diarrhoea Table 17 - Children under 5 years who were not given an ORS/Sugar-Salt Solution during Diarrhoea Boys Girls Total Percent Number Percent Number Percent Number 67.6 101,089 63.4 65,454 0.94 65.9 166,544 62.8 31,146 69.6 30,087 1.11 66.0 61,234 77.5 15,085 76.1 11,057 0.98 76.9 26,142 74.3 13,064 77.6 10,392 1.04 75.7 23,456 63.3 18,121 61.3 19,677 0.97 62.2 37,798 25.1 10,576 48.9 15,747 1.95 35.4 26,323 61.6 189,081 63.8 152,414 1.04 62.6 341,496 Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Total Girl Boy / Ratio 46 Sudan Bahr el Ghazal %65.9 Upper Nile %76.9 Lakes %66.0 Western Equatoria %62.2 Jonglei %75.7 Eastern Equatoria %35.4 Under 33% 67 - 100% Children under 5 years who were not given an ORS/Sugar-Salt Solution during Diarrhoea Children under 5 years who were not given an ORS/Sugar-Salt Solution during Diarrhoea 33 - 67% Areas with Greatest Need By: Percent Coverage Absolute Numbers Upper Nile Jonglei Lakes Bahr el Ghazal Western Equatoria Eastern Equatoria Bahr el Ghazal Lakes Western Equatoria Eastern Equatoria Upper Nile Jonglei 47 Article 24 of the CRC gives every child the right to the highest attainable standards of health and access to facilities for treatment of i llness and rehabilitation of health. Article 24 of the CRC gives every child the right to the highest attainable standards of health and access to facilities for treatment of i llness and rehabilitation of health. Table 18 - Children under 5 years whose Diarrhoea was not treated at a Health Facility Table 18 - Children under 5 years whose Diarrhoea was treated at a Health Facilitynot Boys Girls Total Percent Number Percent Number Percent Number 66.2 98,432 61.9 62,340 0.94 64.5 160,771 55.7 27,913 59.8 25,685 1.07 57.6 53,598 79.7 15,370 69.3 9,902 0.87 75.3 25,272 72.4 12,281 74.4 10,020 1.03 73.2 22,301 44.5 12,749 61.0 17,999 1.37 52.9 30,748 20.1 8,417 44.6 14,416 2.22 30.7 22,833 57.3 175,162 60.2 140,362 1.05 58.5 315,523 Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Total Girl Boy / Ratio 48 Sudan Bahr el Ghazal %64.5 Upper Nile %75.3 Lakes %57.6 Western Equatoria %52.9 Jonglei %73.2 Eastern Equatoria %30.7 Under 33% 67 - 100% Children under 5 years whose Diarrhoea was not Treated at a Health Facility Children under 5 years whose Diarrhoea was Treated at a Health Facilitynot 33 - 67% Areas with Greatest Need By: Percent Coverage Absolute Numbers Upper Nile Jonglei Bahr el Ghazal Lakes Western Equatoria Eastern Equatoria Bahr el Ghazal Lakes Western Equatoria Eastern Equatoria Upper Nile Jonglei 49 Article 24 of the CRC gives every child the right to the highest attainable standards of health and access to facilities for treatment of i llness and rehabilitation of health. Article 24 of the CRC gives every child the right to the highest attainable standards of health and access to facilities for treatment of i llness and rehabilitation of health. Table 19 - Children under 5 years who were not given more Liquid during Diarrhoea Table 19 - Children under 5 years who were not given more Liquid during Diarrhoea Boys Girls Total Percent Number Percent Number Percent Number 72.2 108,733 80.0 81,369 1.11 75.5 191,483 75.3 36,838 81.0 34,741 1.08 78.3 37,411 88.5 17,240 80.6 11,521 0.91 85.1 28,761 71.4 12,334 70.1 8,594 0.98 71.0 21,729 77.1 24,567 82.6 26,439 1.07 79.9 51,572 79.5 34,387 67.8 21,551 0.85 74.6 56,096 75.1 234,091 78.2 184,215 1.04 76.7 423,053 Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Total Girl Boy / Ratio 50 Areas with Greatest Need By: Percent Coverage Absolute Numbers Upper Nile Western Equatoria Lakes Bahr el Ghazal Eastern Equatoria Jonglei Bahr el Ghazal Eastern Equatoria Western Equatoria Lakes Upper Nile Jonglei Sudan Bahr el Ghazal %75.5 Upper Nile %85.1 Lakes %78.3 Western Equatoria %79.9 Jonglei %71.0 Eastern Equatoria %74.6 Under 33% 67 - 100% Children under 5 years who were not given more Liquid during Diarrhoea Children under 5 years who were not given more Liquid during Diarrhoea 33 - 67% 51 Article 24 of the CRC sets out to ensure that parents and children, are informed, have access to education and are supported in the basic knowledge of ch ild health. Article 24 of the CRC sets out to ensure that parents and children, are informed, have access to education and are supported in the basic knowledge of ch ild health. Table 20 - Children under 5 years who were given less/no Food during Diarrhoea Table 20 - Children under 5 years who were given Food during Diarrhoealess/no Boys Girls Total Percent Number Percent Number Percent Number 58.9 88,008 66.1 67,261 1.12 62.1 156,867 48.2 23,459 37.3 15,937 0.77 42.4 39,466 78.1 15,259 79.6 11,388 1.02 78.7 26,647 57.9 10,016 49.5 6,579 0.85 54.2 16,672 53.5 16,940 60.2 19,614 1.13 57.0 36,622 57.8 24,879 44.5 13,840 0.77 52.3 38,876 56.1 178,561 57.1 134,619 1.02 57.4 315,150 Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Total Girl Boy / Ratio 52 Sudan Bahr el Ghazal %62.1 Upper Nile %78.7 Lakes %42.4 Western Equatoria %57.0 Jonglei %54.2 Eastern Equatoria %52.3 Under 33% 67 - 100% Children under 5 years who were given less/no Food during Diarrhoea Children under 5 years who were given Food during Diarrhoealess/no 33 - 67% Areas with Greatest Need By: Percent Coverage Absolute Numbers Upper Nile Bahr el Ghazal Western Equatoria Jonglei Eastern Equatoria Lakes Bahr el Ghazal Lakes Eastern Equatoria Western Equatoria Upper Nile Jonglei 53 Article 24 of the CRC sets out to ensure that parents and children, are informed, have access to education and are supported in the basic knowledge of ch ild health. Article 24 of the CRC sets out to ensure that parents and children, are informed, have access to education and are supported in the basic knowledge of ch ild health. Fever & Cough Analysis • Almost 45% of children had a cough up to 15 days prior to the survey. This reflects high morbidity which is about 2.5 times greater than rural communities in other developing countries. No significant gender differences were noted. Jonglei, Western and Eastern Equatoria had a higher prevalence of coughing than other areas. • Of those who had a cough, three out of four in Bahr el Ghazal and Upper Nile reported difficulty in breathing or fast breathing, indicating a possible lower respiratory infection. Only half in Eastern Equatoria were reported as cases with difficult breathing or fast breathing. Good medical facilities and better quality of health personnel in Eastern Equatoria could account for this difference. • Only 55% of the children who reportedly had difficult or fast breathing were treated at a health facility. There was a direct correlation between the access to health facilities and the number of children treated. • Over 60% of children under-five had a fever in the 15 days prior to the survey. Children in Jonglei and Western Equatoria reported the most cases of fever (72%) while Bahr El Ghazal and Upper Nile reported the lowest number of cases (56%). • 44% of those who reported fever were not given any medicine by the health facility. The percentage was highest in Upper Nile and Jonglei and lowest in Western Equatoria and Lakes. Better availability of drugs in the latter areas could account for this difference. More girls in Western Equatoria, Eastern Equatoria, Upper Nile and Lakes were given drugs than boys. It is possible that girls are more often taken to a health facility when they are seriously ill, while boys may be taken at the first sign of illness. Children under 5: Fever, Cough & MalariaChildren under 5: Fever, Cough & Malaria 55 Malaria Analysis • Almost 64% of children under-five do not sleep under a mosquito net and are therefore exposed to the risk of malaria. The range is from 94% in Eastern Equatoria to 32% in Lakes. Significantly more boys than girls in Lakes did not sleep under a net, increasing their risk of getting malaria. Action Points Access to trained health personnel needs to be significantly increased in Bahr el Ghazal, Upper Nile and Jonglei. Integrated Management of Childhood Illnesses (IMCI) training needs to be accelerated. Medium-term emphasis should be placed on enhancing local capacities, while the immediate or short-term response might be increasing the service provision by International NGOs. Another short-term measure is to organize regular out reach visits by trained health personnel from nearby areas. 1. 2. 3. 5757 Children under 5: Fever, Cough & MalariaChildren under 5: Fever, Cough & Malaria Table 21 - Children under 5 years who had a Cough in the last 15 days Table 21 - Children under 5 years who had a Cough in the last 15 days Boys Girls Total Percent Number Percent Number Percent Number 36.2 101,730 40.5 90,437 1.12 38.1 193,330 43.0 47,954 40.9 42,154 0.95 42.6 92,412 48.3 27,440 46.1 24,207 0.95 45.3 43,080 58.1 19,567 58.8 17,614 1.01 58.5 37,382 56.2 33,246 48.3 27,440 0.86 52.4 60,753 50.9 48,783 57.5 46,904 1.13 53.8 95,889 44.0 278,720 46.3 248,756 1.10 44.4 522,846 Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Total Girl Boy / Ratio 58 Sudan Bahr el Ghazal %38.1 Upper Nile %45.3 Lakes %42.6 Western Equatoria %52.4 Jonglei %58.5 Eastern Equatoria %53.8 Under 33% 67 - 100% Children under 5 years who had a Cough in the last 15 days Children under 5 years who had a Cough in the last 15 days 33 - 67% Areas with Greatest Need By: Percent Coverage Absolute Numbers Jonglei Eastern Equatoria Western Equatoria Upper Nile Lakes Bahr el Ghazal Bahr el Ghazal Eastern Equatoria Lakes Western Equatoria Upper Nile Jonglei 59 Article 24 of the CRC gives every child the right to the highest attainable standards of health and access to facilities for treatment of i llness and rehabilitation of health. Article 24 of the CRC gives every child the right to the highest attainable standards of health and access to facilities for treatment of i llness and rehabilitation of health. Table 22 - Children under 5 years with a Cough who had difficulty /fast Breathing in the last 15 days Table 22 - Children under 5 years with a Cough who had Breathing in the last 15 daysdifficulty /fast Boys Girls Total Percent Number Percent Number Percent Number 70.8 86,385 73.7 76,023 1.04 72.3 163,788 49.1 24,177 54.0 23,361 1.10 52.0 49,300 75.2 18,609 79.3 14,481 1.05 76.9 33,089 63.9 13,149 56.1 9,917 0.88 60.5 23,267 75.8 26,076 61.0 18,893 0.80 68.8 45,036 44.3 21,871 53.2 25,465 1.20 48.8 47,539 65.5 190,256 64.4 168,140 0.98 64.0 362,020 Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Total Girl Boy / Ratio 60 Sudan Bahr el Ghazal %72.3 Upper Nile %76.9 Lakes %52.0 Western Equatoria %68.8 Jonglei %60.5 Eastern Equatoria %48.8 Under 33% 67 - 100% Children under 5 years with a Cough who had difficulty /fast Breathing in the last 15 days Children under 5 years with a Cough who had Breathing in the last 15 daysdifficulty /fast 33 - 67% Areas with Greatest Need By: Percent Coverage Absolute Numbers Upper Nile Bahr el Ghazal Western Equatoria Jonglei Lakes Eastern Equatoria Bahr el Ghazal Lakes Eastern Equatoria Western Equatoria Upper Nile Jonglei 61 Article 24 of the CRC gives every child the right to the highest attainable standards of health and access to facilities for treatment of i llness and rehabilitation of health. Article 24 of the CRC gives every child the right to the highest attainable standards of health and access to facilities for treatment of i llness and rehabilitation of health. Boys Girls Total Percent Number Percent Number Percent Number 56.4 48,354 47.1 35,519 0.84 52.1 83,873 29.7 6,817 32.9 7,582 1.11 31.3 14,400 66.9 9,580 61.6 6,284 0.92 64.7 15,864 64.6 7,894 74.3 6,501 1.15 68.6 14,395 20.8 5,277 28.8 5,287 1.38 24.2 10,564 31.8 6,357 24.3 5,677 0.76 27.8 12,035 46.6 84,279 42.0 66,850 0.90 44.5 151,130 Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Total Girl Boy / Ratio 62 Table 23 - Children under 5 years with a Cough who had difficulty /fast Breathing not Treated at a Health Facility Table 23 - Children under 5 years with a Cough who had Breathing Treated at a Health Facility difficulty /fast not Sudan Bahr el Ghazal %52.1 Upper Nile %64.7 Lakes %31.3 Western Equatoria %24.2 Jonglei %68.6 Eastern Equatoria %27.8 Under 33% 67 - 100% Children under 5 years with a Cough who had difficulty /fast Breathing not Treated at a Health Facility Children under 5 years with a Cough who had Breathing Treated at a Health Facility difficulty /fast not 33 - 67% Areas with Greatest Need By: Percent Coverage Absolute Numbers Jonglei Upper Nile Bahr el Ghazal Lakes Eastern Equatoria Western Equatoria Bahr el Ghazal Upper Nile Lakes Jonglei Eastern Equatoria Western Equatoria 63 Article 24 of the CRC gives every child the right to the highest attainable standards of health and access to facilities for treatment of i llness and rehabilitation of health. Article 24 of the CRC gives every child the right to the highest attainable standards of health and access to facilities for treatment of i llness and rehabilitation of health. Table 24 - Children under 5 years who had a Fever in the last 15 days Table 24 - Children under 5 years who a Fever in the last 15 dayshad Boys Girls Total Percent Number Percent Number Percent Number 59.4 177,793 50.2 114,229 0.85 55.3 292,458 66.5 75,155 59.0 60,831 0.89 62.5 136,643 63.2 33,137 53.3 22,897 0.84 58.8 56,035 73.1 24,844 74.5 22,122 1.02 73.8 47,090 68.9 43,055 73.4 42,404 1.07 71.1 85,458 64.5 62,255 65.2 51,799 1.01 64.7 114,277 74.6 416,239 58.1 314,282 0.78 60.8 731,961 Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Total Girl Boy / Ratio 64 Sudan Bahr el Ghazal %55.3 Upper Nile %58.8 Lakes %62.5 Western Equatoria %71.1 Jonglei %73.8 Eastern Equatoria %64.7 Under 33% 67 - 100% Children under 5 years who had a Fever in the last 15 days Children under 5 years who a Fever in the last 15 dayshad 33 - 67% Areas with Greatest Need By: Percent Coverage Absolute Numbers Jonglei Western Equatoria Eastern Equatoria Lakes Upper Nile Bahr el Ghazal Bahr el Ghazal Lakes Eastern Equatoria Western Equatoria Upper Nile Jonglei 65 Article 24 of the CRC gives every child the right to the highest attainable standards of health and access to facilities for treatment of i llness and rehabilitation of health. Article 24 of the CRC gives every child the right to the highest attainable standards of health and access to facilities for treatment of i llness and rehabilitation of health. Table 25 - Children under 5 years who had a Fever & were not provided Medicine by a Health Facility Table 25 - Children under 5 years who had a Fever & were provided Medicine by a Health Facilitynot Boys Girls Total Percent Number Percent Number Percent Number 42.5 76,273 45.4 51,016 1.07 43.5 127,725 36.4 25,613 30.4 17,952 0.84 33.7 43,820 78.6 25,919 65.4 14,247 0.83 73.4 40,165 64.3 15,595 76.8 116,582 1.19 70.3 32,300 38.6 16,657 29.0 13,251 0.75 33.7 29,908 44.5 26,959 35.7 18,194 0.80 40.6 45,376 45.4 187,016 42.2 131,242 0.93 44.1 319,800 Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Total Girl Boy / Ratio 66 Sudan Bahr el Ghazal %43.5 Upper Nile %73.4 Lakes %33.7 Western Equatoria 3 %3.7 Jonglei %70.3 Eastern Equatoria %40.6 Under 33% 67 - 100% Children under 5 years who had a Fever & were not provided Medicine by a Health Facility Children under 5 years who had a Fever & were provided Medicine by a Health Facilitynot 33 - 67% Areas with Greatest Need By: Percent Coverage Absolute Numbers Upper Nile Jonglei Lakes Bahr el Ghazal Western Equatoria Eastern Equatoria Bahr el Ghazal Lakes Western Equatoria Eastern Equatoria Upper Nile Jonglei 67 Article 24 of the CRC gives every child the right to the highest attainable standards of health and access to facilities for treatment of i llness and rehabilitation of health. Article 24 of the CRC gives every child the right to the highest attainable standards of health and access to facilities for treatment of i llness and rehabilitation of health. Table 26 - Children under 5 years who do not Sleep under a Bed-Net Table 26 - Children under 5 years who Sleep under a Bed-Netdo not Boys Girls Total Percent Number Percent Number Percent Number 57.1 158,605 66.9 147,986 1.17 61.5 308,535 27.8 28,929 36.3 35,779 1.31 31.8 64,823 63.5 31,722 61.4 24,693 0.97 62.6 56,415 48.9 15,048 56.0 15,361 1.15 52.2 30,445 91.6 53,554 93.7 52,213 1.02 92.6 105,767 93.5 80,912 94.4 73,211 1.01 94.0 154,928 60.7 368,770 67.1 349,243 1.11 63.6 720,912 Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Total Girl Boy / Ratio 68 Areas with Greatest Need By: Percent Coverage Absolute Numbers Eastern Equatoria Western Equatoria Upper Nile Bahr el Ghazal Jonglei Lakes Bahr el Ghazal Eastern Equatoria Western Equatoria Lakes Upper Nile Jonglei Sudan Bahr el Ghazal %61.5 Upper Nile %62.6 Lakes %31.8 Western Equatoria %92.6 Jonglei %52.2 Eastern Equatoria %94.0 Under 33% 67 - 100% Children under 5 years who do not Sleep under a Bed-Net Children under 5 years who Sleep under a Bed-Netdo not 33 - 67% 69 Article 24 of the CRC sets out to ensure that parents and children, are informed, have access to education and are supported in the basic knowledge of ch ild health. Article 24 of the CRC sets out to ensure that parents and children, are informed, have access to education and are supported in the basic knowledge of ch ild health. Children under 5: MalnutritionChildren under 5: Malnutrition Analysis • About 7% of children under-five were malnourished at the time of the survey. Jonglei had the highest levels of malnutrition while Western Equatoria had the lowest. • Eastern Equatoria has been experiencing a drought for the last three to four years. Flight denials and high levels of insecurity have seriously limited the access of the local population to humanitarian assistance. Repeated episodes of cattle raiding by the neighbouring Turkana community have had an impact on livestock availability and insecurity. Jonglei has always suffered from food insecurity. Local insecurity caused by cattle raiding as well as poor access due to very harsh terrain has significantly reduced the assess of local communities to food assistance. • Continuous inter-ethnic fighting has led to destruction of crops, looting and displacement of people. Some people are displaced three or four times in a year. • Three times more girls were malnourished than boys in Eastern Equatoria. Significantly higher levels of malnutrition were found in girls in Lakes and Upper Nile, while malnutrition in boys was significantly higher than girls in Jonglei. Action Points 1. Introduction of short maturity crops can increase the household food security, as these crops will significantly reduce the periods for which crops are exposed to looting and burning and also the time needed to harvest. Training households in growing these crops is essential. 2. Continued high-level advocacy to the Government of Sudan is needed to allow for regular access to the populations in need. . Special food convoys are needed to provide food aid to the population in Eastern Equatoria. . Alternative means of transport are needed to ensure perennial access to areas in Jonglei which are very difficult to reach . . Gender sensitivity and awareness workshops need to be organized in Bahr el Ghazal, Lakes and the Equatorias to reduce and possibly eliminate intra-household gender biases in food distribution. 3 4 5 71 Table 27 - Children under 5 years whose MUAC was less than 125mm Table 27 - Children under 5 years whose MUAC was than 125mmless Boys Girls Total Percent Number Percent Number Percent Number 5.7 12,492 4.6 7,103 0.81 5.2 19,593 3.0 2,358 3.7 2,715 1.23 3.3 5,142 10.2 3,450 11.7 3,591 1.15 10.9 7,041 22.3 5,377 15.5 3,407 0.70 18.9 8,784 3.0 1,208 3.2 1,117 1.07 3.1 2,325 5.5 3,533 16.4 9,178 2.98 10.4 12,710 6.2 28,418 7.3 27,111 1.18 6.7 55,595 Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Total Girl Boy / Ratio 72 Sudan Bahr el Ghazal %5.2 Upper Nile %10.9 Lakes %3.3 Western Equatoria %3.1 Jonglei %18.9 Eastern Equatoria %10.4 Children under 5 years whose MUAC was less than 125mm Children under 5 years whose MUAC was than 125mmless Areas with Greatest Need By: Percent Coverage Absolute Numbers Jonglei Upper Nile Eastern Equatoria Bahr el Ghazal Lakes Western Equatoria Bahr el Ghazal Eastern Equatoria Jonglei Upper Nile Lakes Western Equatoria Under 5% 5 -10% 10 - 100% 73 Article 24 of the CRC sets out the child’s rights to adequate nutritious foods. Article 27 assures the child of an adequate nutritional standard of living. Article 24 of the CRC sets out the child’s rights to adequate nutritious foods. Article 27 assures the child of an adequate nutritional standard of living. Children from 5 to 17 years Children from 5 to 17 years: Education Analysis • Only 37% of children between the ages of 6-17 years are enrolled in school. Equatorias have the highest enrollment and Upper Nile has the lowest. This directly correlates with access to schools. In almost all areas (except Upper Nile & Jonglei) there is discrimination against girls enrollment in schools e.g. almost twice the number of boys are in schools compared to girls in Western Equatoria. • Most of those enrolled attended school for more than three days in the week before the survey. Upper Nile had the largest percentage of children who attended school for less than three days in a week. Less girls in Western Equatoria, Bahr el Ghazal and Jonglei were attending school regularly, probably due to household chores. The reverse was true in Upper Nile and Eastern Equatoria. • Of those who were not enrolled, over 86% had never enrolled in school. Lakes had the highest number of those who had never enrolled in school while Eastern Equatoria had the lowest. • • • • Over 30% more girls drop out of school because they have to do household chores than boys. In Upper Nile three times more girls dropout of school than boys for this reason. 25% more boys dropout from school because they help their families in some economic activity besides household chores. Lack of clothes has also emerged as a reason for dropping out of school especially from higher classes. This was found more so for girls in Lakes and Eastern Equatoria than boys. Lack of teaching and learning material was among other key factors leading to drop out from schools. 77 Children from 5 to 17 years: Education Action Points Access to schools is the single most important factor affecting low enrollment rates. Renovation of buildings or construction of low cost schools nearer to households is essential to increase school enrollment rates. Another challenge is to retain those who enroll. This alone could bring the enrollment rates up to around 60%. Teacher training, provision of text books and learning/reading materials as well as relevance of the curriculum are important elements in increasing the retention of those who enroll. Some income generation possibilities or incentive schemes for teachers will be essential to help retain them in the education system. Flexible timing of schools is necessary to allow children to complete their work and still attend the school. The school timings must be set by the local community so as to allow all children to attend school. Timely distribution of teaching and learning materials is necessary to reduce school dropouts. 1. 2. 3. 4. 5. 79 Table 28 - Children 5-17 years not Enrolled in School in 1999 Table 28 - Children 5-17 years not Enrolled in School in 1999 Boys Girls Total Percent Number Percent Number Percent Number 65.6 236,293 86.7 280,407 1.32 75.7 522,822 60.5 84,326 84.7 99,659 1.40 71.6 184,529 80.5 50,117 84.9 47,515 1.05 82.5 98,054 58.8 26,714 69.4 30,531 1.18 64.0 57,282 35.2 41,278 66.2 67,188 1.88 48.9 108,545 26.9 44,180 40.0 66,570 1.49 33.5 110,908 54.3 482,908 73.2 591,870 1.35 63.3 1,082,140 Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Total Girl Boy / Ratio 80 Sudan Bahr el Ghazal %75.7 Upper Nile %82.5 Lakes %71.6 Western Equatoria %48.9 Jonglei %64.0 Eastern Equatoria %33.5 Under 33% 67 - 100% Children 5-17 years not Enrolled in School in 1999 Children 5-17 years not Enrolled in School in 1999 33 - 67% Areas with Greatest Need By: Percent Coverage Absolute Numbers Upper Nile Bahr el Ghazal Lakes Jonglei Western Equatoria Eastern Equatoria Bahr el Ghazal Lakes Eastern Equatoria Western Equatoria Upper Nile Jonglei 81 Article 28 of the CRC establishes the child’s right to an education on the basis of equal opportunity. Wi th emphasis on making primary education free and compulsory. Article 28 of the CRC establishes the child’s right to an education on the basis of equal opportunity. Wi th emphasis on making primary education free and compulsory. Boys Girls Total Percent Number Percent Number Percent Number 5.8 6,943 12.9 5,422 2.22 7.7 12,366 2.5 1,332 0.2 36 0.08 2.0 1,368 25.5 2,863 17.5 1,440 0.69 21.9 4,303 12.7 2,334 16.0 2,078 1.26 14.0 4,412 7.6 5,452 24.2 7,577 3.18 12.2 13,028 14.6 15,797 10.1 9,431 0.69 12.5 25,228 9.1 34,721 12.7 25,984 1.39 10.3 60,705 Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Total Girl Boy / Ratio 82 Table 29- Children 5-17 years Enrolled in School who did not attend Classes for more than 3 days in a week Table 29- Children 5-17 years Enrolled in School who attend Classes for more than 3 days in a week did not Sudan Bahr el Ghazal %7.7 Upper Nile %21.9 Lakes %2.0 Western Equatoria %12.2 Jonglei %14.0 Eastern Equatoria %12.5 Under 5% 5 -10% 10 - 100% Children 5-17 years Enrolled in School who did not attend Classes for more than 3 days in a week Children 5-17 years Enrolled in School who attend Classes for more than 3 days in a week did not Areas with Greatest Need By: Percent Coverage Absolute Numbers Upper Nile Jonglei Eastern Equatoria Western Equatoria Bahr el Ghazal Lakes Eastern Equatoria Western Equatoria Bahr el Ghazal Jonglei Upper Nile Lakes 83 Article 28 of the CRC establishes the child’s right to an education on the basis of equal opportunity. Wi th emphasis on making primary education free and compulsory. Article 28 of the CRC establishes the child’s right to an education on the basis of equal opportunity. Wi th emphasis on making primary education free and compulsory. Table 30 - Children 5-17 years among Unregistered never Registered in School Table 30 - Children 5-17 years among Unregistered Registered in Schoolnever Boys Girls Total Percent Number Percent Number Percent Number 85.2 178,112 89.7 222,233 1.05 87.8 405,900 97.2 74,552 98.4 89,395 1.01 97.9 164,492 90.1 41,643 88.7 38,255 0.98 89.5 80,319 69.9 18,055 82.4 24,462 1.18 76.6 42,516 75.9 22,658 71.3 37,491 0.94 73.0 60,228 77.5 27,489 65.2 32,282 0.84 70.4 59,928 85.7 362,509 86.5 444,118 1.01 86.2 813,383 Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Total Girl Boy / Ratio 84 Sudan Bahr el Ghazal %87.8 Upper Nile %89.5 Lakes %97.9 Western Equatoria %73.0 Jonglei %76.6 Eastern Equatoria %70.4 Under 33% 67 - 100% Children 5-17 years among Unregistered never Registered in School Children 5-17 years among Unregistered Registered in Schoolnever 33 - 67% Areas with Greatest Need By: Percent Coverage Absolute Numbers Lakes Upper Nile Bahr el Ghazal Jonglei Western Equatoria Eastern Equatoria Bahr el Ghazal Lakes Upper Nile Western Equatoria Eastern Equatoria Jonglei 85 Article 28 of the CRC establishes the child’s right to an education on the basis of equal opportunity. Wi th emphasis on making primary education free and compulsory. Article 28 of the CRC establishes the child’s right to an education on the basis of equal opportunity. Wi th emphasis on making primary education free and compulsory. Table 31 - Reasons for Children 5-17 years dropping out of school (multiple responses given by each respondent) Table 31 - Reasons for Children 5-17 years dropping out of school (multiple responses given by each respondent) Domestic Chores Productive Work No Books/Pencils Short of Clothes Bahr el Ghazal Lakes Upper Nile Boys Girls % No. % No. 28.1 14,292 32.9 9,723 24.2 12,310 21.8 6,441 25.6 13,002 25.3 7,498 42.1 21,443 41.5 12,286 15.6 7,916 21.9 6,489 Reasons Others Boys Girls % No. % No. 23.4 1,163 50.8 913 47.7 2,376 53.7 966 5.6 278 7.7 139 10.5 523 30.1 541 44.4 2,209 9.8 177 Boys Girls % No. % No. 4.3 301 13.9 788 16.2 1,143 7.5 425 47.7 3,371 46.4 2,631 31.5 2,228 28.5 1,617 43.1 3,043 44.3 2,512 86 Boys Girls % No. % No. 35.2 3,764 45.8 3,486 32.6 3,487 16.1 1,227 67.3 7,190 65.5 4,994 59.5 6,354 41.8 3,187 32.5 3,475 42.8 3,260 Boys Girls % No. % No. 17.6 1,833 29.5 4,377 10.3 1,069 9.6 1,430 13.0 1,351 10.2 1,517 21.0 2,190 14.2 2,104 83.5 8,707 69.2 10,257 Boys Girls % No. % No. 22.7 1,730 39.9 6,457 32.0 2,440 21.4 3,464 14.0 1,069 20.5 3,315 5.1 387 21.6 3,495 69.8 5,329 63.5 10,283 Boys Girls % No. % No. 25.2 23,083 34.0 25,744 24.9 22,826 18.4 13,953 28.6 26,262 26.5 20,094 36.1 33,124 30.7 23,230 33.5 30,680 43.6 32,978 Eastern EquatoriaWestern Equatoria TotalJonglei 87 Article 28 o f t h e C R C establishes the child’s right to an education on the basis of equal opportunity. With emphasis on making primary education free and compulsory. Article 31 ensures the child the right to rest and leisure, to engage in play and recreational activities. Art icle 27 gives every child the right to material assistance, with particular regard to clothing. Article 28 o f t h e C R C establishes the child’s right to an education on the basis of equal opportunity. With emphasis on making primary education free and compulsory. Article 31 ensures the child the right to rest and leisure, to engage in play and recreational activities. Art icle 27 gives every child the right to material assistance, with particular regard to clothing. Children from 5 to 17 years: Household Work Analysis • Most children in southern Sudan help in household chores. The range is from 84% in Lakes to 56% in Bahr el Ghazal. More girls in Jonglei, Eastern Equatoria and Bahr el Ghazal helped in household chores than boys. Gender differences however were not significant. • 58% of children 5-17 years old helped in generating income for the household. Nearly 80% of children in Western Equatoria and Lakes contributed to household income. Around 50% did so in the other regions. Although more boys were seen to be involved in income generating activities at the household level, gender differences were not statistically significant in all regions. Action Points 1. Due to the impoverished status of southern Sudanese households, every member of the household needs to contribute in the family chores and economic activity. School enrollment should be carefully monitored and school schedules adjusted in such a way that these children are not deprived of education. 2. Awareness should be rased to ensure that children are not engaged in hazardous work. 89 Boys Girls Total Percent Number Percent Number Percent Number 48.1 174,247 64.2 207,550 1.33 55.7 385,501 81.6 114,483 87.3 104,477 1.07 84.3 219,505 55.0 34,220 63.7 35,824 1.16 59.2 70,267 50.7 22,916 75.5 33,336 1.49 62.9 56,289 80.4 94,400 85.1 86,384 1.06 82.8 183,875 58.3 96,308 79.6 135,764 1.37 69.2 232,230 60.8 536,574 74.0 603,335 1.22 66.8 1,147,867 Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Total Girl Boy / Ratio Table 32 - Children 5-17 years who help with Household Domestic Chores Table 32 - Children 5-17 years who help with Household Domestic Chores 90 Sudan Bahr el Ghazal %55.7 Upper Nile %59.2 Lakes %84.3 Western Equatoria %82.8 Jonglei %62.9 Eastern Equatoria %69.2 Children 5-17 years who help with Household Domestic Chores Children 5-17 years who help with Household Domestic Chores Under 33% 67 - 100% 33 - 67% Areas with Greatest Need By: Percent Coverage Absolute Numbers Lakes Western Equatoria Eastern Equatoria Jonglei Upper Nile Bahr el Ghazal Bahr el Ghazal Eastern Equatoria Lakes Western Equatoria Upper Nile Jonglei 91 Article 28 of the CRC establishes the child’s right to an education. Article 31 ensures the child the right to rest and leisure, to engage in play and recreational activities. Article 28 of the CRC establishes the child’s right to an education. Article 31 ensures the child the right to rest and leisure, to engage in play and recreational activities. Boys Girls Total Percent Number Percent Number Percent Number 50.8 184,39 46.2 150,188 0.91 48.8 339,163 83.4 116,456 73.0 87,211 0.88 78.7 204,360 65.5 40,792 54.3 30,224 0.83 60.1 71,261 52.7 24,037 43.5 18,971 0.83 48.2 43,008 81.1 95,165 78.9 80,478 0.97 80.4 178,734 52.6 85,261 42.8 72,358 0.81 47.7 157,776 61.3 546,104 53.3 439,430 0.87 57.9 994,301 Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Total Girl Boy / Ratio Table 33 - Children 5-17 years who help with Household Income Generation Work Table 33 - Children 5-17 years who help with Household Income Generation Work 92 Sudan Bahr el Ghazal %48.8 Upper Nile %60.1 Lakes %78.7 Western Equatoria %80.4 Jonglei %48.2 Eastern Equatoria %47.7 Under 33% 67 - 100% Children 5-17 years who help with Household Income Generation Work Children 5-17 years who help with Household Income Generation Work 33 - 67% Areas with Greatest Need By: Percent Coverage Absolute Numbers Western Equatoria Lakes Upper Nile Bahr el Ghazal Jonglei Eastern Equatoria Bahr el Ghazal Lakes Western Equatoria Eastern Equatoria Upper Nile Jonglei 93 Article 28 of the CRC establishes the child’s right to an education. Article 31 ensures the child the right to rest and leisure, to engage in play and recreational activities. Article 28 of the CRC establishes the child’s right to an education. Article 31 ensures the child the right to rest and leisure, to engage in play and recreational activities. Disability & Impairment Disability & Impairment Analysis • 9% of children under-five had some kind of disability or impairment. Upper Nile and Jonglei had the highest prevalence of childhood disability, followed by Equatoria, Lakes and Bahr el Ghazal. Three times as many boys had some form of disability compared to girls in Bahr el Ghazal and Western Equatoria. The reverse was true for Lakes. 46% more boys had disabilities in Eastern Equatoria than girls. • 10% of children between the ages of 5-17 years had some form of disability or impairment. Jonglei and Upper Nile had the highest prevalence of disability/impairment while Lakes had the lowest prevalence. Gender differences were not statistically significant except in Lakes where more boys had disability/impairment than girls. • s m a i u has a l n f k • Diagnostic and Rehabilitative services in southern Sudan are practically non-existant. Action Points OLS needs to encourage more international NGOs to get involved in preventive, promotive and rehabilitative services for children with disability. The capacity of local NGOs also needs to be strengthened in this area. 2. Blanket distribution of Vitamin A along with Polio NIDs and Immunization campaigns must be done. Promotion of household gardens with green leafy vegetables and promotion of their consumption in regular diet will not only increase the availability of Vitamin A rich foods but will also increase household food security. Young school-going and adolescent children should be trained to organize and maintain household gardens as a part of their school curriculum. Children with disabilities (especially physical) should be identified and brought to the attention of ICRC which has taken a lead role in rehabilitation for people with disabilities. Support should also be provided to indigenous NGOs who deal with rehabilitation for children with disabilities, Children with disabilities have abilities and should be recognized for them. This concept needs to be introduced and inculcated in the society and should be an important part of the Life Skills curriculum. Over 9% of children 5-17 years reported problem with seeing at night, indicating a possible Vita in A deficiency. The prevalence was highest in E stern Equatoria and the lowest in Western Equator a. Eastern Equatoria has been experiencing a dro ght for the last 3 years, while Western Equatoria food surplus and an extensive availability of mangoes and green leafy vegetables. The preva ence has a direct correlation to access to food a d insecurity. Night blindness was reported signi icantly more in boys than girls in La es, Upper Nile and Western Equatoria. 1. 3. 4. 5. 97 Table 34 - Children Under 5 years who have a disability/impairment Table 34 - Children Under 5 years who have a disability/impairment Boys Girls Total Percent Number Percent Number Percent Number 10.0 24,741 3.1 5,759 0.31 7.0 30,500 5.2 4,836 9.0 7,517 1.73 7.1 12,755 15.9 6,991 20.0 7,577 1.26 17.8 14,568 15.2 4,242 14.1 3,423 0.93 14.6 7,665 13.4 6,340 5.0 2,090 0.37 9.5 8,430 11.5 8,317 7.8 4,850 0.68 9.7 13,167 10.4 55,469 7.2 31,216 0.69 9.0 87,085 Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Total Girl Boy / Ratio 98 Sudan Bahr el Ghazal %7.0 Upper Nile %17.8 Lakes %7.1 Western Equatoria %9.5 Jonglei %14.6 Eastern Equatoria %9.7 Children Under 5 years who have a disability/impairment Children Under 5 years who have a disability/impairment Areas with Greatest Need By: Percent Coverage Absolute Numbers Upper Nile Jonglei Eastern Equatoria Western Equatoria Lakes Bahr el Ghazal Bahr el Ghazal Upper Nile Eastern Equatoria Lakes Western Equatoria Jonglei Under 10% 10 - 20% 20 - 100% 99 Article 24 of the CRC gives every child the right to the highest attainable standards of health and access to facilities for treatment of i llness and rehabilitation of health. Article 24 of the CRC gives every child the right to the highest attainable standards of health and access to facilities for treatment of i llness and rehabilitation of health. Boys Girls Total Percent Number Percent Number Percent Number 9.3 43,696 9.1 30,370 0.98 9.2 65,501 5.8 8,346 4.6 5,586 0.79 5.3 13,932 16.7 10,844 16.0 9,109 0.96 16.6 20,342 24.9 11,589 24.0 10,857 0.96 24.5 22,483 9.2 10,908 10.5 10,732 1.14 9.7 21,738 11.5 19,292 11.4 19,695 0.99 11.4 38,987 11.5 104,675 10.4 86,349 0.90 10.4 182,983 Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Total Girl Boy / Ratio Table 35 - Children 5-17 years who have a Disability or Impairment Table 35 - Children 5-17 years who have a Disability or Impairment 100 Sudan Bahr el Ghazal %9.2 Upper Nile %16.6 Lakes %5.3 Western Equatoria %9.7 Jonglei %24.5 Eastern Equatoria %11.4 Children 5-17 years who have a Disability or Impairment Children 5-17 years who have a Disability or Impairment Under 10% 10 - 20% 20 - 100% Areas with Greatest Need By: Percent Coverage Absolute Numbers Jonglei Upper Nile Eastern Equatoria Western Equatoria Bahr el Ghazal Lakes Bahr el Ghazal Eastern Equatoria Jonglei Western Equatoria Upper Nile Lakes 101 Article 24 of the CRC gives every child the right to the highest attainable standards of health and access to facilities for treatment of i llness and rehabilitation of health. Article 24 of the CRC gives every child the right to the highest attainable standards of health and access to facilities for treatment of i llness and rehabilitation of health. Table 36 - Children 5-17 years who had problems with Night Vision Table 36 - Children 5-17 years who had problems with Night Vision Boys Girls Total Percent Number Percent Number Percent Number 10.0 34,799 11.2 35,559 1.12 10.5 70,358 8.2 11,237 6.3 7,417 0.77 7.3 18,654 6.8 3,961 3.8 1,934 0.56 5.4 5,895 12.1 5,297 11.6 4,908 0.96 11.8 10,205 4.1 4,796 2.7 2,573 0.66 3.4 7,369 13.3 21,504 14.0 23,770 1.05 13.6 45,274 9.4 81,594 9.6 76,161 1.02 9.4 157,755 Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Total Girl Boy / Ratio 102 Sudan Bahr el Ghazal %10.5 Upper Nile %5.4 Lakes %7.3 Western Equatoria %3.4 Jonglei %11.8 Eastern Equatoria %13.6 Children 5-17 years who had problems with Night Vision Children 5-17 years who had problems with Night Vision Under 5% 5 -10% 10 - 100% Areas with Greatest Need By: Percent Coverage Absolute Numbers Eastern Equatoria Jonglei Bahr el Ghazal Lakes Upper Nile Western Equatoria Bahr el Ghazal Eastern Equatoria Lakes Jonglei Western Equatoria Upper Nile 103 Article 24 of the CRC gives every child the right to the highest attainable standards of health and access to facilities for treatment of i llness and rehabilitation of health. Article 24 of the CRC gives every child the right to the highest attainable standards of health and access to facilities for treatment of i llness and rehabilitation of health. Table 37 - Types of disabilities/ impairments in Children Under 5 years Table 37 - Types of disabilities/ impairments in Children Under 5 years Boys Girls % No. % No. 26.7 14,833 33.2 10,359 28.7 15,936 40.9 12,757 35.3 19,562 23.0 7,173 15.0 8,347 8.6 2,673 104 Hearing/Vison Hand/Leg Speaking Mental Artic le 2 3 o f th e C RC give s disa bled chil dren the righ t to spec ial care , e duca tion , tr aini ng, hea lth care , reha bilit atio n a nd prep arat ion for emp loym ent. Artic le 2 3 o f th e C RC give s disa bled chil dren the righ t to spec ial care , e duca tion , tr aini ng, hea lth care , reha bilit atio n a nd prep arat ion for emp loym ent. 105 Table 38 - Types of disabilities/ impairments in Children 5-17 years Table 38 - Types of disabilities/ impairments in Children 5-17 years Boys Girls % No. % No. 55.9 53,518 47.1 40,636 19.9 19,029 27.1 23,381 15.6 14,947 20.1 17,373 11.6 11,081 13.7 11,802 Hearing/Vison Hand/Leg Speaking Mental Article 23 of the CRC gives disabled children the right to special care, education, training, health care, rehabilitation and preparation for employment. Article 23 of the CRC gives disabled children the right to special care, education, training, health care, rehabilitation and preparation for employment. The Environment for Survival, Growth & Development Water & Sanitation Analysis • Only 26% of households had access to safe drinking water during the dry season previous to the survey. The access was lowest in Upper Nile. • • • a E o Action Points 1. The focus in the provision of safe water has been predominantly on the use of ground water. Significantly, more work is needed to make surface water safe. To rapidly increase the availability of safe water to the population, the use of intermediate technologies needs to be explored. 2. Promotion of sanitary latrines and hygiene practices has been the most neglected aspect of Water and Sanitation work in southern Sudan. Significant emphasis needs to be placed on these projects in future programme activities. 3. Awareness campaign is needed to increase community awareness regarding the benefits of safe drinking water. The life skills and school curiculum modules must also include this information. 4. Increased access to safe drinking water, closer to the households should be a high priority of the water programme. 5. Protecting open wells and springs can increase the access of households to safe drinking water by about 25%. Because of the long distances that need to be traveled and the time needed to collect safe water, more people switch to drinking unsafe water during the wet season when small water ponds or rivulets are available everywhere. In the dry season, when these seasonal sources of water dry out, more people switch to safe drinking water. This indicates that the awareness regarding the benefits of safe drinking water is still not there in the community. Almost all households in Jonglei, Upper Nile, L kes and Bahr el Ghazal and almost half in Eastern Equatoria do not use sanitary latrines. Western quatoria is the exception, with almost all househ lds using a sanitary latrine. 109 Table 39 - Households drinking Unsafe Drinking-Water during the Dry Season Table 39 - Households drinking Unsafe Drinking-Water during the Dry Season Sudan Bahr el Ghazal 55.8% Upper Nile 98.6% Lakes 84.0% Western Equatoria 76.2% Jonglei 94.5% Eastern Equatoria 75.0% Under 33% 67 - 100% 33 - 67% Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Overall Areas with Greatest Need By: Percent Coverage Absolute Numbers Lakes Eastern Equatoria Bahr el Ghazal Western Equatoria Jonglei Upper Nile Upper Nile Jonglei Lakes Western Equatoria Eastern Equatoria Bahr el Ghazal Percent Estimated No. 55.8 240,083 84.0 261,033 98.6 74,866 94.5 111,232 76.2 237,409 75.0 260,862 74.4 1,185,485 110 Artic le 24 of th e CR C giv es ev ery child the right to c lean drin king -wat er and hygi enic sani tatio n, an d se ts ou t to ensu re that pare nts a nd c hildr en a re e duca ted i n ba sic h ealth . Artic le 24 of th e CR C giv es ev ery child the right to c lean drin king -wat er and hygi enic sani tatio n, an d se ts ou t to ensu re that pare nts a nd c hildr en a re e duca ted i n ba sic h ealth . Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Overall Areas with Greatest Need By: Percent Coverage Absolute Numbers Table 40 - Households Drinking Unsafe Drinking-Water during Cultivation Season Table 40 - Households Drinking Unsafe Drinking-Water during Cultivation Season Sudan Bahr el Ghazal 88.0% Upper Nile 99.0% Lakes 84.8% Western Equatoria 68.1% Jonglei 98.1% Eastern Equatoria 77.3% Under 33% 67 - 100% Bahr el Ghazal Eastern Equatoria Lakes Upper Nile Western Equatoria Jonglei Upper Nile Jonglei Bahr el Ghazal Lakes Eastern Equatoria Western Equatoria Percent Estimated No. 88.0 842,622 84.8 263,375 99.0 161,485 98.1 108,164 68.1 140,723 77.3 275,402 85.2 1,791,771 33 - 67% 111 Article 24 of the CRC gives every child the right to clean drinking-water and hygienic sanitation, and sets out to ensure that parents and children are educated in basic health. Article 24 of the CRC gives every child the right to clean drinking-water and hygienic sanitation, and sets out to ensure that parents and children are educated in basic health. Protect ed Spring Open Well/Spring River/Stream Pond/Canal Bahr el Ghazal Lakes Upper Nile % No. 44.2 190,173 0.0 209 34.4 148,112 15.8 67,919 16.2 69,779 Source of Drinking Water during the Dry Season Pump % No. 31.1 48,671 0.7 1,080 37.2 58,225 31.4 49,182 13.8 21,518 % No. - - 1.4 1,063 31.3 23,474 71.0 53,245 5.0 3,740 Protect ed Spring Open Well/Spring River/Stream Pond/Canal Bahr el Ghazal Lakes Upper Nile % No. 26.1 113,782 0.2 1,043 15.9 69,358 12.1 52,661 57.4 250,631 Source of Drinking Water during Cultivation Pump % No. 25.4 39,558 5.0 7,747 34.1 53,229 9.1 14,134 32.3 50,428 % No. 0.2 177 1.9 1,417 26.4 19,878 63.1 47,436 19.0 14,321 112 Table 41 - Source of Water Supply during the two Seasons (multiple responses given by each respondent) Table 41 - Source of Water Supply during the two Seasons (multiple responses given by each respondent) Article 24 of the CRC in order to combat disease, gives every child the right to clean drinking-water. It also sets out to ensure that all segments of society, in particular parents and children, are informed, have access to education and are supported in the use of basic knowledge of ch ild health, hygiene and environmental sanitation. Article 24 of the CRC in order to combat disease, gives every child the right to clean drinking-water. It also sets out to ensure that all segments of society, in particular parents and children, are informed, have access to education and are supported in the use of basic knowledge of ch ild health, hygiene and environmental sanitation. % No. 3.4 1,998 0.2 103 25.7 15,174 34.3 20,279 47.6 28,135 % No. 7.3 4,279 3.7 2,186 27.7 16,268 36.4 21,402 32.6 19,140 Eastern EquatoriaWestern Equatoria TotalJonglei % No. 45.5 70,393 2.3 3,604 65.9 102,090 22.1 34,240 4.3 6,662 % No. 36.4 63,282 13.5 23,456 27.5 47,772 22.6 39,230 12.4 21,595 % No. 35.9 376,797 3.0 31,599 37.7 395,976 25.3 265,220 13.7 142,436 Eastern EquatoriaWestern Equatoria TotalJonglei % No. 42.4 65,754 2.3 3,604 70.1 108,731 19.9 30,894 7.7 11,904 % No. 32.1 57,045 13.3 23,737 30.2 53,720 37.4 66,540 8.1 14,471 % No. 26.3 278,312 3.5 37,651 30.2 320,093 21.9 231,943 34.9 369,891 113 Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Overall Areas with Greatest Need By: Percent Coverage Absolute Numbers Table 42 - Households not using Sanitary Latrines Table 42 - Households not using Sanitary Latrines Sudan Bahr el Ghazal 88.3% Upper Nile 95.4% Lakes 93.4% Western Equatoria 11.7% Jonglei 96.1% Eastern Equatoria 41.5% Under 33% 67 - 100% Bahr el Ghazal Lakes Eastern Equatoria Upper Nile Jonglei Western Equatoria Jonglei Upper Nile Lakes Bahr el Ghazal Eastern Equatoria Western Equatoria Percent Estimated No. 88.3 382,597 93.4 143,675 95.4 70,228 96.1 56,852 11.7 18,047 41.5 74,041 70.8 745,440 33 - 67% 114 Artic le 24 of t he C RC in orde r to comb at di seas e, se ts ou t to e nsur e tha t pare nts a nd c hildr en a re e duca ted i n the bas ic heal th, hygi ene and envi ronm enta l sa nita tion . Artic le 24 of t he C RC in orde r to comb at di seas e, se ts ou t to e nsur e tha t pare nts a nd c hildr en a re e duca ted i n the bas ic heal th, hygi ene and envi ronm enta l sa nita tion . Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Overall Areas with Greatest Need By: Percent Coverage Absolute Numbers Table 43 - Households which are Latrine Users but do not have one for their Own Household Table 43 - Households which are Latrine Users but do have one for their Own Householdnot Sudan Bahr el Ghazal 83.7% Upper Nile 68.7% Lakes 35.4% Western Equatoria 4.8% Jonglei 70.7% Eastern Equatoria 31.3% Under 33% 67 - 100% Bahr el Ghazal Eastern Equatoria Western Equatoria Lakes Upper Nile Jonglei Bahr el Ghazal Jonglei Upper Nile Lakes Eastern Equatoria Western Equatoria Percent Estimated No. 83.7 43,245 35.4 3,419 68.7 2,627 70.7 1,803 4.8 6,487 31.3 31,530 29.2 89,111 33 - 67% 115 Article 24 of the CRC in order to combat disease, sets out to ensure that parents and children are educated in the basic health, hygiene and environmental sanitation. Article 24 of the CRC in order to combat disease, sets out to ensure that parents and children are educated in the basic health, hygiene and environmental sanitation. Household Food Security Analysis • Most households in southern Sudan keep livestock. The percentage is lower in Western Equatoria where most households depend on agriculture and have poultry. In Bahr el Ghazal, the 1998 famine, continued insecurity, repeated cattle raiding and the presence of large number of IDPs may be the reason that one in three households do not have livestock. • 22% of households either ate wild foods or consumed no food on at least one occasion prior to the survey. These households are the most vulnerable in southern Sudan. The percentage was highest in Bahr el Ghazal and Upper Nile where one in three households had no food (or only wild foods) on at least one occasion prior to the survey and lowest in Western Equatoria which is a food surplus area in southern Sudan. • Almost all households (except in Equatoria) either eat wild foods or have no food during the drought period. Low food reserves due to insecurity and poor agricultural techniques significantly increase the vulnerability of southern Sudanese households. Action Points 1. Promotion of fishing and recipes using wild foods will play a significant role in increasing household food security in Upper Nile, Northern Bahr el Ghazal and Jonglei areas. 2. Introduction of short maturity crops and training in agriculture for predominantly pastoralist population groups will help increase household food security. 3. Timely seed and tools distribution, especially to displaced populations, will increase food security and reduce dependence on food aid. 117 Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Overall Areas with Greatest Need By: Percent Coverage Absolute Numbers Table 44 - Households who do not have Livestock Table 44 - Households who do have Livestocknot Sudan Bahr el Ghazal 33.7% Upper Nile 15.6% Lakes 12.4% Western Equatoria 35.0% Jonglei 19.7% Eastern Equatoria 19.5% Under 33% 67 - 100% Bahr el Ghazal Western Equatoria Eastern Equatoria Lakes Jonglei Upper Nile Western Equatoria Bahr el Ghazal Jonglei Eastern Equatoria Upper Nile Lakes Percent Estimated No. 33.7 148,464 12.4 19,537 15.6 11,896 19.7 11,896 35.0 54,346 19.5 35,426 26.2 281,561 33 - 67% 118 Artic le 24 of t he C RC s ets o ut to ensu re th at a c hild i s pro vide d ad equa te nutr itiou s foo ds. Ar ti cle 2 7 as sure s the chil d supp ort, part icula rly with re gard to nu triti on. Artic le 24 of t he C RC s ets o ut to ensu re th at a c hild i s pro vide d ad equa te nutr itiou s foo ds. Ar ti cle 2 7 as sure s the chil d supp ort, part icula rly with re gard to nu triti on. Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Overall Areas with Greatest Need By: Percent Coverage Absolute Numbers Table 45 - Food consumed since the last harvest not Own or not Purchased (dependence on relief or food loan) Table 45 - Food consumed since the last harvest Own or Purchasednot not (dependence on relief or food loan) Sudan Bahr el Ghazal 77.5% Upper Nile 52.6% Lakes 32.0% Western Equatoria 16.3% Jonglei 48.5% Eastern Equatoria 47.2% Under 33% 67 - 100% Bahr el Ghazal Eastern Equatoria Lakes Upper Nile Jonglei Western Equatoria Bahr el Ghazal Upper Nile Jonglei Eastern Equatoria Lakes Western Equatoria Percent Estimated No. 77.5 334,183 32.0 47,422 52.6 39,109 48.5 27,795 16.3 24,960 47.2 83,316 53.5 556,785 33 - 67% 119 Article 24 of the CRC sets out to ensure that a child is provided adequate nutritious foods. Ar ticle 27 assures the child support, particularly with regard to nutrition. Article 24 of the CRC sets out to ensure that a child is provided adequate nutritious foods. Ar ticle 27 assures the child support, particularly with regard to nutrition. Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Overall Areas with Greatest Need By: Percent Coverage Absolute Numbers Table 46- Wild or No Food Consumed Yesterday Table 46- Wild or No Food Consumed Yesterday Sudan Bahr el Ghazal 35.2% Upper Nile 31.2% Lakes 11.6% Western Equatoria 2.7% Jonglei 10.2% Eastern Equatoria 17.0% Under 10% 10 - 20% 20 - 100% Bahr el Ghazal Eastern Equatoria Upper Nile Lakes Jonglei Western Equatoria Bahr el Ghazal Upper Nile Eastern Equatoria Lakes Jonglei Western Equatoria Percent Estimated No. 35.2 153,007 11.6 17,705 31.2 23,501 10.2 6,047 2.7 4,198 17.0 30,193 22.2 234,649 120 Artic le 24 of t he C RC s ets o ut to ensu re th at a c hild i s pro vide d ad equa te nutr itiou s foo ds. Ar ti cle 2 7 as sure s the chil d supp ort, part icula rly with re gard to nu triti on. Artic le 24 of t he C RC s ets o ut to ensu re th at a c hild i s pro vide d ad equa te nutr itiou s foo ds. Ar ti cle 2 7 as sure s the chil d supp ort, part icula rly with re gard to nu triti on. Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Overall Areas with Greatest Need By: Percent Coverage Absolute Numbers Table 47 - Households consuming Wild or No Food during Drought Periods Table 47 - Households consuming Food during Drought PeriodsWild or No Sudan Bahr el Ghazal 82.9% Upper Nile 83.8% Lakes 88.5% Western Equatoria 10.7% Jonglei 91.4% Eastern Equatoria 56.6% Under 33% 67 - 100% Bahr el Ghazal Lakes Eastern Equatoria Upper Nile Jonglei Western Equatoria Jonglei Lakes Upper Nile Bahr el Ghazal Eastern Equatoria Western Equatoria Percent Number 82.9 348,658 88.5 125,126 83.8 61,669 91.4 50,218 10.7 16,523 56.6 99,229 68.8 701,425 33 - 67% 121 Article 24 of the CRC sets out to ensure that a child is provided adequate nutritious foods. Ar ticle 27 assures the child support, particularly with regard to nutrition. Article 24 of the CRC sets out to ensure that a child is provided adequate nutritious foods. Ar ticle 27 assures the child support, particularly with regard to nutrition. Use of Salt Analysis • 36% of households do not use salt in their diet. Areas which have difficulty accessing salt (northern Bahr el Ghazal and Jonglei) use some kind of ash to meet their salt needs. Almost all households in Equatoria use salt, while two in three households in Lakes and Upper Nile use salt in their diet. • Of those who use salt, almost all in Lakes, Jonglei and Upper Nile use iodated salt. This is because most salt available in these areas is provided by OLS agencies as incentives. Two out of three households in Bahr el Ghazal and Eastern Equatoria use iodated salt, while only one in three do so in Western Equatoria. • Carrying iodated salt into southern Sudan is very expensive. The porous borders and the conflict make any kind o Action Points 1. Advocacy for universal salt iodation in Sudan, Uganda and Kenya. 2. Organization of a three-party meeting of salt manufacturers to promote the manufacture and distribution of iodated salt. 3. Use of iodized oil capsules along with immunization campaigns. f regulation on the import of salt impossible to enforce. Most salt in southern Sudan comes from Port Sudan, Uganda and Kenya. Most of this salt is not iodized. 123 Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Overall Areas with Greatest Need By: Percent Coverage Absolute Numbers Table 48 - Households who do not Use Salt Table 48 - Households who do not Use Salt Sudan Bahr el Ghazal 50.1% Upper Nile 37.8% Lakes 37.0% Western Equatoria 8.0% Jonglei 74.7% Eastern Equatoria 8.7% Under 33% 67 - 100% Bahr el Ghazal Lakes Jonglei Upper Nile Eastern Equatoria Western Equatoria Jonglei Bahr el Ghazal Upper Nile Lakes Eastern Equatoria Western Equatoria Percent Estimated No. 50.1 220,873 37.0 58,601 37.8 28,828 74.7 45,089 8.0 12,422 8.7 15,782 35.6 381,597 33 - 67% 124 Artic le 24 of t he C RC s ets o ut to ensu re th at a child enjo ys th e hig hest attai nabl e sta ndar d of h ealt h. Ar ticle 27 a ssur es the child sup port , par ticul arly with rega rd to nut ritio n. Artic le 24 of t he C RC s ets o ut to ensu re th at a child enjo ys th e hig hest attai nabl e sta ndar d of h ealt h. Ar ticle 27 a ssur es the child sup port , par ticul arly with rega rd to nut ritio n. Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Overall Areas with Greatest Need By: Percent Coverage Absolute Numbers Table 49 - Salt user Households who Use Non-iodized Salt Table 49 - Salt user Households who Use -iodized SaltNon Sudan Bahr el Ghazal 35.5% Upper Nile 19.4% Lakes 4.2% Western Equatoria 68.4% Jonglei 9.4% Eastern Equatoria 34.4% Under 33% 67 - 100% Western Equatoria Bahr el Ghazal Eastern Equatoria Upper Nile Lakes Jonglei Western Equatoria Eastern Equatoria Bahr el Ghazal Upper Nile Jonglei Lakes Percent Estimated No. 35.5 69,003 4.2 3,857 19.4 7,766 9.4 1,129 68.4 95,676 34.4 54,305 36.4 231,736 33 - 67% 125 Article 24 of the CRC sets out to ensure that a child enjoys the highest attainable standard of health. Arti cle 27 assures the child support, particularly with regard to nutrition. Article 24 of the CRC sets out to ensure that a child enjoys the highest attainable standard of health. Arti cle 27 assures the child support, particularly with regard to nutrition. Awareness of Child Rights Analysis • Almost all households (except in Western Equatoria) are aware that children have rights. • Most households are unaware of the Convention on the Rights of the Child (CRC). Action Points An intensive awareness campaign, building on the traditional acceptance of the concept of rights of the child, needs to be launched and its impact monitored carefully. 1. 2. Reasons for low understanding and acceptance of Child Rights in Western Equatoria needs to be studied. 127 Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Overall Areas with Greatest Need By: Percent Coverage Absolute Numbers Table 50 - Households Unaware of the Rights of Children Table 50 - Households Unaware of the Rights of Children Sudan Bahr el Ghazal 4.9% Upper Nile 7.1% Lakes 11.3% Western Equatoria 67.7% Jonglei 10.0% Eastern Equatoria 19.7% Under 10% 10 - 20% 20 - 100% Western Equatoria Eastern Equatoria Bahr el Ghazal Lakes Jonglei Upper Nile Western Equatoria Eastern Equatoria Lakes Jonglei Upper Nile Bahr el Ghazal Percent Estimated No. 4.9 21,384 11.3 17,343 7.1 5,228 10.0 5,804 67.7 104,473 19.7 35,135 18.0 189,366 128 Artic le 3 sets out to en sure that a chi ld is prot ecte d an d car ed fo r, as is nece ssar y for his o r her well -bein g, ta king into acco unt the righ ts a nd d uties of h is or her par ents . Artic le 3 sets out to en sure that a chi ld is prot ecte d an d car ed fo r, as is nece ssar y for his o r her well -bein g, ta king into acco unt the righ ts a nd d uties of h is or her par ents . Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Overall Areas with Greatest Need By: Percent Coverage Absolute Numbers Table 51 - Households Unaware of the Convention on the Rights of Children Table 51 - Households Unaware of the Convention on the Rights of Children Sudan Bahr el Ghazal 91.5% Upper Nile 74.3% Lakes 78.1% Western Equatoria 89.3% Jonglei 84.9% Eastern Equatoria 97.8% Under 33% 67 - 100% Bahr el Ghazal Eastern Equatoria Western Equatoria Lakes Upper Nile Jonglei Eastern Equatoria Bahr el Ghazal Western Equatoria Jonglei Lakes Upper Nile Percent Estimated No. 91.5 375,242 78.1 117,107 74.3 52,165 84.9 46,888 89.3 134,467 97.8 168,542 88.7 894,411 33 - 67% 129 Article 42 sets out to ensure that the principles and provisions of the Convention are widely known, by appropriate and active means, to adults and children alike. Article 42 sets out to ensure that the principles and provisions of the Convention are widely known, by appropriate and active means, to adults and children alike. Awareness related to HIV/AIDS Analysis • Awareness about HIV/AIDS is very low in all regions of southern Sudan except in Eastern Equatoria and toa lesser extent Western Equatoria. • Of those who were aware of HIV/AIDS most were aware of the problems related to HIV/AIDS. The sub- sample from Upper Nile and Jonglei was too small to draw any meaningful conclusions. • Of those who were aware of HIV/AIDS, most of those in the Equatorias knew about the relationship between unprotected sexual activity and HIV/AIDS. However, only two in three people in Lakes and one in four in Bahr el Ghazal knew of this association. • Of those who were aware of HIV/AIDS, most in the Equatorias were aware of the transfoetal transmission of AIDS. Action Points 1. Support is needed for the development of guidelines on dealing with HIV/AIDS in the rebel-controlled areas of southern Sudan. 2. Studies are needed to establish the prevalence of HIV/AIDs in southern Sudan. 3. An intensive HIV/AIDs awareness programme needs to be launched in southern Sudan. 131 Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Overall Areas with Greatest Need By: Percent Coverage Absolute Numbers Table 52 - Adults who have never heard of HIV or AIDS Table 52 - Adults who have never heard of HIV or AIDS Sudan Bahr el Ghazal 75.1% Upper Nile 82.7% Lakes 61.9% Western Equatoria 48.0% Jonglei 74.6% Eastern Equatoria 19.4% Under 33% 67 - 100% Bahr el Ghazal Western Equatoria Lakes Jonglei Eastern Equatoria Upper Nile Upper Nile Bahr el Ghazal Jonglei Lakes Western Equatoria Eastern Equatoria Percent Estimated No. 75.1 176,530 61.9 39,930 82.7 10,426 74.6 27,747 48.0 59,216 19.4 23,271 56.8 337,122 33 - 67% 132 Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Overall Areas with Greatest Need By: Percent Coverage Absolute Numbers Table 53 - Adults who have heard of do not know about problems HIV or AIDS but related to it Table 53 - Adults who have heard of HIV or AIDS but know about problems related to itdo not Sudan Bahr el Ghazal 18.6% Western Equatoria 5.4% Eastern Equatoria 8.5% Under 10% 10 - 20% 20 - 100% Bahr el Ghazal Eastern Equatoria Western Equatoria Lakes - - Lakes Bahr el Ghazal Eastern Equatoria Western Equatoria - - Percent Estimated No. 18.6 10,866 25.2 6,064 - - - - 5.4 3,476 8.5 8,205 12.0 30,473 Lakes 25.2% 133 Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Overall Areas with Greatest Need By: Percent Coverage Absolute Numbers Table 54 - Adults who do not know about the relationship of Unprotected Sexual Activity to HIV or AIDS Table 54 - Adults who do not know about the relationship of Unprotected Sexual Activity to HIV or AIDS Sudan Bahr el Ghazal 74.8% Lakes 39.7% Western Equatoria 10.2% Eastern Equatoria 12.7% Under 33% 67 - 100% Bahr el Ghazal Eastern Equatoria Lakes Western Equatoria - - Bahr el Ghazal Lakes Eastern Equatoria Western Equatoria - - Percent Number 74.8 40,819 39.7 8,782 - - - - 10.2 6,402 12.7 11,846 29.4 71,173 33 - 67% 134 Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Overall Areas with Greatest Need By: Percent Coverage Absolute Numbers Table 55 - Adults who are Ignorant about the Transmission of HIV from Mother to Foetus & Infant Table 55 - Adults who are Ignorant about the Transmission of HIV from Mother to Foetus & Infant Sudan Western Equatoria 11.6% Eastern Equatoria 12.5% Under 33% 67 - 100% Eastern Equatoria Western Equatoria - - - - Eastern Equatoria Western Equatoria - - - - Percent Number - - - - - - - - 11.6 5,618 12.5 10,119 18.1 25,844 33 - 67% 135 Humanitarian Assistance Analysis • Most households in southern Sudan are aware of the presence of humanitarian agencies. The low awareness of humanitarian agencies in Upper Nile could be due to fewer agencies working in that area and limited access due to insecurity and flight denials. While many humanitarian agencies are based in Western Equatoria, the low awareness might be due to the fact that fewer households need their support and therefore are not in contact with them. • Of those who are aware of the presence of humanitarian agencies, most reported that they benefit from them except in Jonglei where one in three households do not. Action Points 1. Development of local capacity and strengthening of coping capacities of the local communities should become the key objective of the work of all humanitarian assistance agencies operating in southern Sudan. 137 Table 56 - Households unaware of Humanitarian AgenciesTable 56 - Households unaware of Humanitarian Agencies Sudan Bahr el Ghazal 35.2% Upper Nile 54.8% Lakes 34.9% Western Equatoria 77.8% Jonglei 39.1% Eastern Equatoria 29.3% Under 33% 33 - 67% 67 - 100% Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Overall Percent 35.2 34.9 54.8 39.1 77.8 29.3 42.1 138 Table 57 - Households who do not benefit from AgenciesTable 57 - Households who do not benefit from Agencies Sudan Bahr el Ghazal 4.3% Upper Nile 16.8% Lakes 11.9% Western Equatoria 16.5% Jonglei 30.8% Eastern Equatoria 15.4% Under 10% 10 - 20% 20 - 100% Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Overall Percent 4.3 11.9 16.8 30.8 16.5 15.4 10.8 139 Protection Analysis • It is estimated that almost 35,000 children of different age groups have been abducted by militia in the last 15 years. The largest numbers are reported in Bahr el Ghazal and Upper Nile - areas which are known for PDF, Muharileen and tribal raids. • An estimated 16,000 women appear to have been abducted by militia in the last 15 years of conflict. Again, the largest numbers are reported from Bahr el Ghazal and Upper Nile. • Over the last 15 years, it is estimated that almost 38,000 children under 18 have been conscripted into the army. Most recruitment seems to have taken place from Equatoria and refugee camps in neighbouring countries. Other studies and recent developments indicate that the trend is changing and that both the SPLA and SPDF are increasingly working towards the demobilization of child soldiers. • Action Points 1. Plans for implementing the commitments of the rebel movements on the demobilization of child soldiers need to be urgently put into place. 2. Coordinated actions with CEWAC on the identification and return of abducted children and women must be accelerated. These figures are based on anecdotal information and are at best indicative of the problem. The figures do not carry any statistical validity. 141 0 Number of Children Abducted 200 400 600 800 25002000 3000 Total in Study Area 3,163 Extrapolated Number between 1985 and 1999 34,909 Table 58 - The Number of Children Abducted Table 58 - The Number of Children Abducted Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Number of Tribes Number Abducted From To 2 1,171 1986 1999 2 41 1990 1999 3 1,327 1985 1999 2 341 1986 1999 3 140 1990 1999 5 143 1990 1999 Lakes Upper Nile Jonglei Overall Bahr el Ghazal Western Equatoria Eastern Equatoria 142 1000 1500 A r t i c l e 35 guar ante es prev entio n of abdu ction , sale or tr affic of c hildr en. A rti cle 37 a ssur es th at no chil d wi ll be sub jecte d to to rture . Art icle 9 ensu res t hat a child shal l not be sepa rate d fr om his or h er p aren ts a gain st t heir will.A r t i c l e 35 guar ante es prev entio n of abdu ction , sale or tr affic of c hildr en. A rti cle 37 a ssur es th at no chil d wi ll be sub jecte d to to rture . Art icle 9 ensu res t hat a child shal l not be sepa rate d fr om his or h er p aren ts a gain st t heir will. 0 Number of Children Abducted 200 400 600 800 Total in Study Area 1,492 Extrapolated Number between 1985 and 1999 16,320 Table 59 - The Number of Women Abducted Table 59 - The Number of Women Abducted Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Number of Tribes Number Abducted From To 2 409 1986 1999 2 20 1990 1992 3 704 1985 1999 2 164 1986 1999 3 61 1990 1997 5 134 1990 1999 Lakes Upper Nile Jonglei Overall Bahr el Ghazal Western Equatoria Eastern Equatoria 143 1000 1200 1400 Article 9 ensures that a child shall not be seperated from his or her parents against their will. Article 9 ensures that a child shall not be seperated from his or her parents against their will. 0 Number of Children Abducted 200 400 600 800 25002000 Total in Study Area 2,638 Extrapolated Number between 1985 and 1999 38,276 Table 60 - The Number of Children Conscripted in the Army Table 60 - The Number of Children Conscripted in the Army Bahr el Ghazal Lakes Upper Nile Jonglei Eastern Equatoria Western Equatoria Number of Tribes Number Abducted From To 2 240 1984 1996 2 127 1997 1999 3 424 1986 1999 2 354 1986 1999 3 711 1987 1999 5 782 1986 1999 Lakes Upper Nile Jonglei Overall Bahr el Ghazal Western Equatoria Eastern Equatoria 144 1000 1500 Artic le 38 of the CR C stat es that ch ildre n unde r 15 will n ot be recr uited as sold iers. Art icle 3 2 giv es al l chil dren the right to p rotec tion from haz ardo us w ork t hat i s likel y to aff ect their ph ysica l, m enta l an d s ocial deve lopm ent. Artic le 39 stat es th at ch ild vi ctim s wil l be s uppo rted in the reco very of ph ysic al and ps ycho logi cal dam age.Artic le 38 of the CR C stat es that ch ildre n unde r 15 will n ot be recr uited as sold iers. Art icle 3 2 giv es al l chil dren the right to p rotec tion from haz ardo us w ork t hat i s likel y to aff ect their ph ysica l, m enta l an d s ocial deve lopm ent. Artic le 39 stat es th at ch ild vi ctim s wil l be s uppo rted in the reco very of ph ysic al and ps ycho logi cal dam age. Annexes Annex 1: Confidence Interval Tables Confidence Interval of Selected Indicators by Group Overall Bahr El Lakes Upper Jonglei Western Eastern Equatoria Antenatal Care not received during last Pregnancy 8.64 0.51 11.16 1.72 5.40 27.87 26.11 Vitamin A not received after Delivery 6.52 4.94 13.72 2.07 6.41 3.07 21.23 Tetanus Toxoid not received during last Pregnancy 7.27 1.89 16.35 3.49 5.140 16.63 27.05 Delivery not done at a Health Facility 6.56 0.52 7.39 0.95 4.61 1.73 26.28 Delivery Conducted by an Untrained Birth Attendant 10.39 6.52 8.95 4.82 5.74 24.20 29.29 Breastfeeding Less than 12 months continuous Breastfeeding 8.78 17.71 4.76 12.89 16.04 31.95 6.23 Immunization & Vitamin A Infants not immunized with the BCG Vaccine 7.06 6.21 15.26 10.94 11.20 22.57 17.17 Ghazal Nile Equatoria Antenatal Period & Delivery Infants not immunized with the DPT Vaccine 8.49 14.52 18.05 9.51 22.38 25.75 18.16 Infants not immunized with the Polio Vaccine 7.87 14.18 11.04 16.76 9.18 19.09 16.14 Infants not immunized with the Measles Vaccine 11.14 22.16 12.47 15.94 13.76 25.64 14.57 Infants who did not receive Vitamin A 6.35 12.70 13.07 2.41 9.79 7.90 9.53 Children under 5 years: Diarrhoea Diarrhoeal episode in the last 15 days 3.48 6.22 9.30 8.67 2.93 13.92 4.70 Not given an ORS/Sugar-Salt solution 5.78 8.77 18.58 11.26 15.54 7.51 14.01 Diarrhoea not treated at a Health Facility 6.25 10.15 13.68 11.33 14.14 16.00 13.75 Not given more liquid during Diarrhoea 6.06 10.43 9.92 9.09 14.67 18.86 19.28 Given less/no food during Diarrhoea 5.83 8.40 20.70 9.71 11.68 16.56 9.67 148 Confidence Interval of Selected Indicators Overall Bahr El Lakes Upper Jonglei Western Eastern EquatoriaChildren under 5 years: Fever, Cough & Malaria Ghazal Nile Equatoria Had a Cough in the last 15 days 6.61 12.23 11.75 9.27 5.98 27.42 6.53 Had difficulty/fast breathing 7.37 13.39 13.20 9.10 15.96 16.77 9.87 Breathing problems not treated at a Health Facility 8.12 13.68 17.12 15.36 18.36 11.14 18.99 Had a Fever in the last 15 days 6.35 11.09 16.58 12.16 8.54 11.37 7.38 Medicine for fever not provided by Health Facility 7.19 11.68 18.36 14.14 12.98 22.10 12.63 Do not Sleep under a Bed-Net 5.96 9.86 16.02 11.85 16.25 10.92 2.67 Children under 5 years: Malnutrition Whose MUAC was less than 125mm 1.75 2.37 1.85 4.21 4.20 3.43 7.73 Children from 5 to 17 years: Education Not Enrolled in School in 1999 4.91 6.92 11.38 8.41 10.21 14.48 10.45 Did not attend classes for more than 3 days in a week 3.05 5.69 1.77 15.64 6.12 4.68 7.27 Among Unregistered never Registered in School 5.27 10.09 1.74 7.29 7.39 10.64 13.53 Children from 5 to 17 years: Household Work Those who help with Household Domestic Chores 7.50 12.27 5.70 16.89 14.64 18.64 9.74 Those who help with Income Generation Work 8.44 13.31 11.27 13.96 9.64 20.51 7.01 Disability & Impairment Children Under 5 who have a Disability/Impairment 3.24 5.17 2.48 14.65 4.92 12.27 7.03 Children 5-17 who have a Disability/Impairment 3.17 5.56 3.43 12.87 12.92 3.72 8.63 Children 5 - 17 who had problems with Night Vision 3.28 5.51 5.02 3.54 6.75 4.24 10.02 Confidence Interval of Selected Indicators Continued 149 The Environment for Survival, Growth & Development Water & Sanitation Ghazal Nile Equatoria Drinking Unsafe Drinking Water in the Dry Season 10.82 17.40 13.34 0.93 5.93 14.86 33.42 Drinking Unsafe Drinking Water during Cultivation 11.74 24.06 16.25 0.46 1.22 11.65 28.29 Households not using Sanitary Latrines 11.87 12.62 5.31 3.65 5.49 13.71 13.36 Latrine Users but do not have one 16.42 - - - - 6.54 11.72 Household Food Security Households who do not have Livestock 5.34 8.96 8.57 12.11 6.57 12.48 9.15 Food since last harvest not own or not purchased 9.78 11.24 13.03 21.79 9.27 13.62 16.67 Wild or No Food Consumed Yesterday 4.81 8.98 4.65 16.78 5.02 3.09 11.07 Households with Wild or No Food during Drought 12.69 17.07 4.66 14.53 4.52 13.31 11.88 Use of Salt Households who do not Use Salt 6.97 10.58 18.48 16.83 9.37 7.46 5.39 Salt user Households who Use Non-iodized Salt 13.27 16.55 2.62 18.27 11.72 32.13 27.66 Awareness of Child Rights Households Unaware of the Rights of Children 13.17 4.30 14.07 7.35 7.55 36.79 10.95 Households Unaware of the CRC 5.04 7.41 17.12 20.95 11.28 17.07 1.32 Awareness related to HIV/AIDS Adults who have never heard of HIV or AIDS 8.14 13.46 24.35 17.58 7.22 19.78 10.43 Do not know about HIV or AIDS related problems 5.35 21.81 19.27 - - 4.99 6.52 Do not know of Relation of Unprotected Sex to HIV 15.90 23.71 13.44 - - 7.37 10.63 Ignorant about Transmission of HIV from Mother to Child 14.56 - - - - 12.73 10.52 Humanitarian Assistance Households Unaware of Humanitarian Agencies 11.31 14.25 20.52 22.85 9.02 19.60 26.52 Households who do not Benefit from Agencies 3.33 3.89 10.49 12.79 11.22 17.40 10.54 Overall Bahr El Lakes Upper Jonglei Western Eastern Equatoria 150 Confidence Interval of Selected Indicators Continued Annex 2: Methodology Purpose The study was conducted to estimate indices related to health, education, child employment and household characteristics for the six individual regions of southern Sudan. A second, equally important goal was to establish statistically significant regional population estimates for southern Sudan for the first time in over seventeen years. Survey Population The study's statistical population was defined as all households in areas of southern Sudan deemed to be accessible in terms of internal security. Government garrison towns and their environs were recognised as 'out of scope' for the survey. It is thought that between 70 and 80 percent of the population residing in southern Sudan is thus covered by the survey. The sample that was designed and executed was done so in accordance with statistical probability selection methods so that the results are a valid representation of the population covered by the survey. Statistical Unit The household was taken as the statistical unit for the survey - defined as those individuals regularly coming together to eat from the same cooking pot. Sampling Unit The sampling unit was a cluster of twenty-five households. The clusters were selected in a 3-stage sampling process that is described in detail in the sub-heading below, 'Choosing Sample Clusters'. Sampling Frame As no recent census information or comparable framework exists for southern Sudan the sampling frame had to be created from scratch. The social hierarchy existent in southern Sudan was therefore used, whereby a listing of 'Executive Chiefs' or their equivalents, together with the number of Sub-Chiefs falling under each, was created. Representatives of town populations, fishing communities and large groups of displaced persons were equated as equivalent to an Executive Chief and therefore included in the sampling frame as such. Sample frame information for five of the twenty-eight counties/states could not be obtained prior to the survey, for reasons of security, access, or data availability, and therefore these areas had to be ruled out of scope for the study. Survey Methodology 153 Data Collection Data were collected through verbal interviews, conducted by southern Sudanese survey staff, working in one or more of the local languages. The information acquired was entered by the interviewer into a pre-prepared questionnaire (in English), designed to record the data of five households. Out of the 5000 households originally targeted by the survey, a total of 4300 were successfully interviewed. Thus the overall survey response rate was 86 percent (100 x number interviewed /number selected into the sample). It should be noted, however, that where households could be reached by survey staff, the response rate was 100% and therefore the interviewed household shortfall with the target was due to the last minute withdrawal of certain sample locations from the survey for reasons of security and/or accessibility. Survey Reference Period The survey reference period for the various indices to be studied varied between the day of questioning, to one day, one week, two weeks, one year, two years, five years or an open ended period in antecedence. Timing th thThe field survey was carried out between October 11 and November 7 , 1999. Sample Size Standard formulas for sample size determination cannot be applied in southern Sudan, as information on the predicted sizes of the key indicators is not available. However, on the basis of MICS surveys carried out in other countries, with sample sizes ranging from 3000 to 10000 households, a plausible sample size of 5000 households was suggested and adopted for southern Sudan. A sample size of 5000 households was judged large enough to provide reliable data for all important indices, even if some of them have low prevalence rates of 10 or 15 percent. Furthermore, a sample of this size would allow reliable estimates to be made for each region (*) and the 3 or 4 largest ethnic groups. Calculation of sample size based on an estimated coverage rate of 15 per cent for key immunisation indicators (e.g. polio), plus a number of other assumptions, yielded a figure of 5509 households, sufficiently close to support the proposed sample size (see appendix). (* Assuming the population sizes of each region are more or less the same and that a given region does not contain less than 10 percent of the total in-scope population). Survey Methodology 154 Choosing Sample Clusters The sample clusters were chosen by means of the following process: - Compilation of a sample frame listing, by county and payam / state and district, of Executive Chiefs, or their equivalents, and the number of Sub-Chiefs falling under each; - Determination of areas (counties/states, payams/districts) out of scope for the survey - for reasons of insecurity, access, or lack of sample frame data and removal of associated Executive Chief and Sub-Chief information from the sampling frame; - Arrangement of Executive Chief and Sub-Chief data according to a serpentine geographic ordering of the counties/states in southern Sudan starting in the northwest corner and finishing in the southeast corner - Extraction of a systematic, stratified sample of 200 Sub-Chiefs from a total of 2238 in the final, adjusted, sampling frame; this by choosing every eleventh Sub-Chief (2238/200 = 11.19) from a random start (6) in the serpentine geographic listing; - Identification of each sample Sub-Chief by number (n) and Executive Chief name and base location; - Field identification of 'nth' Sub-Chief from roster held or generated by the selected Executive Chief or equivalent; - Random selection in the field of sample 'Gol Leader' or headman from roster held or generated by the sample Sub-Chief ; - After locating the sample Gol Leader or headman, he was requested to assist in the generation of a simple sketch map showing the number and relative locations of households under his jurisdiction. The resultant sketch map was then divided into segments, each containing 25 roughly adjoining households. A random selection was then made from one of the resultant segments. Data Collection from the Statistical Units within each Cluster - All 25 households within the selected sample segment or cluster were interviewed in turn this approach was adopted to minimise the time wasted moving between households and to avoid potential respondent data registration problems, when adjoining households are not covered; - A 'household' was defined as those individuals regularly coming together to eat from the same cooking pot; - The questionnaire was divided into six sections: 1) Cover Page: Cluster / Interviewer Details, 2) Household Listing: Demographic Details of up to 5 Households, 3) Section A: Questions for Children Under 5 Years, 4) Section B: Questions for Children Aged 5-17 Years, 5) Section C: Questions on HIV/AIDS, for Men & Women of 18+ Years, 6) Section D: Questions on General Household Data; - In Sections 'A' and 'B' of the questionnaire the reference person for questioning was the mother (or principal 'caretaker') in the household. Where more than one mother/caretaker was present in the same household data was collected from each, starting with the mother of the youngest child, within the particular age group. Information was collected on all the children, in both age groups, of household mothers/caretakers. Survey Methodology 155 156 (2238172 ) ( gi1 ) (mj25) 2238g mi j 4300 g mi j 1.92 - In Section 'C' of the questionnaire, probing knowledge of HIV/AIDS, male interviewers were instructed to direct questions to the youngest man in the household above 18 years of age and female interviewers the youngest women in the household above 18 years of age; - In Section 'D' the key respondent was the senior mother or caretaker - one respondent per household. Formulas and Analysis Completed questionnaire forms were collected by survey supervisors at regional 'hub' locations in southern Sudan, for consolidation, checking and despatch to UNICEF/OLS Headquarters in Nairobi passing via the OLS field base in Lokichokio, north-west Kenya. Upon arrival in Nairobi each questionnaire was again screened prior to entry of the information into the survey database, by means of a specially tailored FoxPro Programme. Data analysis was principally conducted using SPSS version 6, while Excel spreadsheets were used to summarise and present results. Weighting of Indicators The probability of selection is given as follows: P = ij th thP is the probability of selecting the j household or person under the i 'gol' leader / headman,ij 2238 is the total number of locations in the universe - that is, the total number of Sub-Chief jurisdictional areas that are in scope for MICS, 172 is the actual number of sample locations (PSUs) , thgi is the total number of 'gol' leaders / headmen in the i sample PSU, th1 is the number of sample 'gol' leaders / headmen in the i sample PSU, thmj is the total number of households under the j sample 'gol' leader / headman, and th25 is the number of sample households under the j sample 'gol' leader / headman The weight, W , is simply the inverse of P , orij ij W = ij = = Survey Methodology ( 1722238) ( 1gi) (mj25) Sampling Errors To estimate the sampling variances (square of the standard errors, or sampling errors), the Taylor linearization method is the technique to use for MICS Sudan, as it is suitable to estimate variances for simple means or proportions, which is what most of the indicators are. This method of variance estimation organizes the first-stage sampling units the 172 PSUs for MICS Sudan into implicit strata containing at least two such units. To achieve homogeneity of implicit strata this is done by pairing adjacent PSUs in their original order of selection. This means there would be 86 such implicit strata for purposes of estimating the variances. To calculate the variance any percentage or average is treated as a ratio estimate, r = y/x, of two sample totals y and x, where y is the weighted sample total for variable y (example, number of one-year olds vaccinated for polio) and x is the weighted sample total for the population in the sub- group under consideration (that is, one-year-old children). The variance of r is given as var(r) = for which z = y - (r)xhi hi hi and z = y - (r)xh h h h represents the implicit stratum which varies from 1 to H (i.e., 1 to 86), thm is the total number of clusters selected in the h stratum,h th thy is the weighted sum of the values of variable y in the i cluster in the h stratum,hi th thx is the weighted sum of the number of cases in the target group in the i cluster in the h stratum.hi The square root of the variance is the standard error. Source: Anthony G. Turner, Sample Design and Procedures for Multiple Indicators Cluster Survey of South Sudan, August-September 1999 ( 12x ) ( mhmh-1 z 2h mh )H∑h-1 [ mh∑ z - 2 i-1 hi [ Survey Methodology 157 In the MICS Handbook instructions are given for sample size determination, either by application of a mathematical formula that is provided or through using one of two tables in which sample sizes are pre-calculated. The latter may be availed if the country situation fits various pre- determined assumptions. The Handbook suggests that sample size be determined by choosing among several key MICS indicators that are expected to have low coverage rates. These include immunization coverage rates for DPT, measles, polio and tuberculosis, plus the indicator, birth weight below 2.5 kilograms. From among these key indicators, the one which has the lowest expected coverage rate is the one which is used to calculate the sample size, on the grounds that every other important MICS indicator would be measured with an equal or greater sampling reliability. The formula for calculating sample size is given by: n = Taking the components in order, n is the sample size for the KEY (rarest) indicator, 4 is a factor to achieve the 95 percent level of confidence, r is the predicted or anticipated prevalence (coverage rate) for the key indicator, which is further based upon the smallest target group in terms of its proportion of the total population, 1f is the survey design effect , and is assumed to equal 1.75 (if better information is not available from another survey), 1.1 is the factor necessary to raise the sample size by 10 percent to counter non-response, e is the margin of error to be tolerated, either 5 percent or 3 percent (i.e. .05 or .03), p is the proportion of the total population that the smallest target group comprises, and is generally assumed to equal 3 percent (i.e., 03) for a single-year age group such as 12-23 months old, unless more precise information is available, n is the average household size, assumed to be 6.0 again unless better data are available.h 1 The design effect, or deff, is a ratio of the expected sampling variance from the MICS compared to that of a simple random sample of the same size. It is a measure of how much more unreliable the cluster survey is compared to a random sample. 4r(1-r)(f)(1.1) 2e (p)nh Sample Size Calculation 158 In South Sudan, the coverage rates for the key immunization indicators are thought to be about 15 percent value of r of 0.15. When coverage is that low, the Handbook urges the use of a margin of error, e, of .03 (when coverage is considerably higher, e should be taken as .05). Assuming the values of p, f and n are as given above, and ignoring the adjustment factor for non-response since it was expected that the response would be nearly 100 h percent, the calculation for sample size, n, is given by n = = 5509 households. (The actual response rate obtained was 100 percent, in the sample cluster locations successfully reached by survey staff ; the overall survey response rate was 86 percent ). We have settled on a sample size of 5000 households, since that is close to the calculated value and the formula is fraught with assumptions anyway. The interpretation of the sample size is that if the true value of the immunization coverage rate for an indicator, say, polio, is 15 percent, then the survey will measure it within a 3 percentage point margin of error at the 95 percent level of confidence. In other words, the confidence interval of the estimate of polio vaccinations would be 12-18 percent. Coverage may be less than the assumed value of 15 percent for some important indicators. If it is as low as 10 percent, for example, the sample size necessary to measure it with 3 percent margin of error would be about 3900 households. It is better to take the conservative approach, however, and use the larger sample size of 5000. Regional estimates are also wanted. In general the margin of e rror for each of the 6 regions would be about 2.45 (the square root of 6) times higher than the national margin of error, or about 7.3 percentage points rather than 3. For an ethnic, tribal group that comprises about 25 percent of the total population, the margin of error for the estimates would be approximately twice as large (square root of 4), or 6 percentage points. Source: Anthony G. Turner, Sample Design and Procedures for Multiple Indicators Cluster Survey of South Sudan, August-September 1999 4(0.15)(0.85)(1.75) 20.03 (0.03)(6) Sample Size Calculation 159 Annex 3: Definitions Part A: Definitions of terminology used in the Questionnaire For Children Under 5 Years of Age ORS /Home-made fluid not given during Diarrhoea 'ORS' or 'Sugar-Salt Solution' was not administered during last diarrhoeal episode Diarrhoea not Treated in Health Facility Last diarrhoeal episode was treated either by 'Village Practitioner', 'Self /Family' or 'Other' More Liquid Not Given During Diarrhoea 'Same', 'Less' or 'No' liquid was given during the episode Less/No Solid Given During Diarrhoea 'Less' or 'No' solid was given during the episode Difficulty Breathing (ARI) not Treated in Health Facility Short /difficult breathing episode was treated either by 'Village Practitioner', 'Self /Family' or 'Other' Did not go to Health Facility with Fever Did not go to health facility with the complaint of fever Less than 18 Months of Continuous Breastfeeding Children were continuously breastfed for less than or equal to 12 months, among 13-24 month old children Less than 4 Months of Exclusive Breastfeeding (5-18) Children were exclusively breastfed for less than or equal to 4 months, among 5-18 month old children Didn't Receive Vitamin-A in last 6 Months Did not receive Vitamin-A within the last 6 months before the interview, among the 6-59 month old children Didn't Receive BCG Vaccine Did not receive BCG vaccine, among the 12-23 month old children Received None/One DPT Dose Did not receive two or more dose of DPT, among the 12-23 month old children Received None/One Polio Dose Did not receive two or more polio doses, among the 12-23 month old children Didn't Receive Measles Vaccine Did not receive measles vaccine, among the 12-23 month old children Mid-upper-arm-circumfrence (MUAC) less than 125 mm Children with 70-124 mm mid-upper arm circumference (MUAC) Disability / Impairment among Children under 5 Children with 'Hearing /Vision' impairment, 'Hand / Leg' disability, 'Speaking' or 'Mental' retardation, among 12-59 month old children Definitions 163 Part B: Definitions of terminology used in the Questionnaire For Children 5 to 17 Years of Age Not enrolled in School in 1999 Children 5-17 years of age not enrolled in school, irrespective of gender Attended less than 4 Days in Last Week (among enrolled) Among the enrolled children, the number (percent) of children who did not attend school for more than 4 days Never enrolled in Past (among not enrolled) Among the non-enrolled children, the number (percent) of children never enrolled Had Problem with Night Vision Children of 5-17 years with problem in night vision Disability / Impairment among Young Children Children 5-17 years of age with 'Hearing /Vision' impairment, 'Hand / Leg' disability, 'Speaking' or 'Mental' retardation Did Domestic Chores Number of children 5-17 years of age engaged in domestic chores at least half of a day Did Productive Works Number of children 5-17 years of age engaged in productive work for the household at least half of a day Part D: Definitions of terminology used in the Questionnaire For Households Last Delivery Not in Health Facility Last delivery occurred either 'At Home' or 'any other place, other than a Health Facility’ Delivery Assisted by Untrained persons The delivery was assisted by 'Untrained TBA', 'Family members' or 'Others' Did not Receive TT vaccine Did not receive tetanus-toxiod (TT) vaccine during the last pregnancy Advice /Service Not Taken from Doctor /Trained TBA Did not take any advice / service from 'Doctor/ Nurse / Midwife' or 'Trained TBA' other than TT during the last pregnancy Problem with Vision During this Pregnancy Any difficulty in vision during last pregnancy either in 'Day time' , 'Evening' or at 'Night’ Definitions 164 Definitions Part D Continued: Definitions of terminology used in the Questionnaire For Households Did not Receive Vitamin-A After Delivery Did not receive any Vitamin-A dose in the first two months after delivery Not Drinking from Pump /Protected Spring During Dry Season Household drinking water source in dry season is either 'Open well / Spring', 'River /Stream' or 'Pond / Canal' Not Drinking from Pump /Protected Spring During Cultivation Household drinking water source during cultivation is either 'Open well / Spring', 'River /Stream' or 'Pond / Canal' Family Food was not of Own Produce /Purchase Since last harvest, the household was dependent on 'Wild food', 'Loan' or 'Relief / Assistance' ; i.e. they could not afford 'Own produced food' or 'Purchase food' for the family Family did not Take Standard Food Yesterday Household members either took 'Wild food' or 'No food' in the preceding day of interview Family did not Take Standard Food During Worst Days Household members either took 'Wild food' or 'No food' in the worst period since last harvest Household does not Have Livestock The household does not possess any kind of livestock, either 'Owned' or 'Kept' Household does not Use Salt Household does not use salt Non-iodized Salt Used Among the Salt User Use of non-iodized salt in the salt using household Unaware of Humanitarian Agencies Not aware of any humanitarian agencies working in the area Did not Get Any Benefit (Those Aware of Agencies) Did not get any sort of benefit from the agencies. This was asked to those who know about the activities of the NGOs Household Members Defecate in Open Place Household members does not use 'Improved pit latrine' or 'Traditional pit latrine' Latrine Used but Not Owned by the Household The household is using an 'Improved pit latrine' or 'Traditional pit latrine', but it is not in their dwelling unit 165 Definitions and Special Notes of Selected Indicators Diarrhoea within last 15 days The percentage of children under five who had three or more episodes of loose or watery stools per day or blood in stool in the 15 days preceding the date of interview. Diarrhoea treatment practices Percentage of diarrhoea cases managed by the use of ORS, Salt/Sugar solution/ any other fluid prepared at home, modern or traditional medicines or any other practices, used at home, as one of the “types of treatment”. Does not include plain drinking water (multiple responses possible). Source of treatment of diarrhoea Source of treatment of the episode of diarrhoea that took place in the last 15 days. Percentage of cases that received any treatment. This includes the health facility or qualified allopathic practitioner, unqualified village practitioners, self/family etc. (multiple responses possible). ORT use rate The percentage of all cases of diarrhoea episodes in the last 15 days that received increased amounts of fluid and continued feeding. Increased fluid includes all home-made fluids, ORS and water. Continued feeding includes all foods and breastfeeding with increased or same quantity. Water is considered as ORT in cases where feeding is continued. ORS/Sugar-salt use rate Percentage of diarrhoea episodes in under-five age group treated with oral rehydration salts (ORS) and/or sugar-salt solution. Source of Treatment/advice during ARI (care seeking for ARI) The percentage of ARI episode (cough/cold with difficult/fast breathing) in under-five age group children, that received treatment or advice from different sources like heath facility, village practitioner, self/family or others. Medicine provided by Health Facility during fever episode The percentage of fever episodes in last 15 days among children aged less than five years that received some medicine from the health facility. The responses include Paracetamol, chloroquine,. Fansider and others. Some did not know the type of medicine given. Exclusive breastfeeding rate (less than 4 months) The percentage of children aged less than 4 months who were breastfeeding exclusively from birth to the date of interview. Non-exclusive breastfeeding includes feeding the infant honey, water or any other food given as per-lactial food only once after birth. But it does not include water or any other food except breast milk and medicine in case of illness (excluding ORS). Timely Supplementation Rate (6-9 months) The percentage of children aged 6-9 months who are receiving breast milk and complementary food. Definitions 166 Definitions and Special Notes of Selected Indicators Continued Continued breastfeeding rate at two years The percentage of children aged 20-23 months who were breastfeeding continuously from birth to the date of interview with or without supplementation. (Summary Table) Continued breastfeeding rate at fifteen months The percentage of children aged 12-15 months who were breastfeeding continuously from birth to the date of interview with or without supplementation. (Summary Table) Duration of continued breastfeeding The duration of breastfeeding (exclusive or not) in children who are currently in the age group of 13-59 months. BCG vaccination coverage Percentage of children aged 12-23 months immunized against tuberculosis with one dose of BCG. DPT vaccination coverage Percentage of children aged 12-23 months immunized against diptheria, pertusis and tetanus with one, two or three doses (DPT3). OPV (Polio) vaccination coverage Percentage of children aged 12-23 months immunized against poliomyelitis with one, two or three doses (OPV3). Measles vaccination Percentage of children aged 12-23 months given one dose of Measles vaccine within 9 to 12 months of age. Prevalence of severe malnutrition The percentage of children aged 12-59 months who have a mid-upper arm circumference of less than 12.5 cm. This figure represents the prevalence of severe malnutrition. Vitamin A administration The percentage of children aged 6-59 months who received one or more doses of Vitamin A within six months preceding interview. Disability (12-59 months) Percentage of 12-59 months children who had physical or mental disabilities (multiple responses possible). Disability (5-17 years) Percentage of 5-17 years children who had physical or mental disabilities (multiple responses possible). Place of last delivery The percentage of deliveries that occurred in the last year, by the place of occurrence i.e. health center/hospital, home or any other place. Last delivery assisted by The percentage of deliveries in the last year assisted by trained personnel i.e. doctor, trained health worker, midwife or trained traditional birth attendant. Definitions 167 Definitions and Special Notes of Selected Indicators Continued Tetanus Toxoid during last pregnancy Percentage of women in the last year from the date of interview who received one or more doses of TT during this pregnancy. Ante-natal care Percentage of mothers who delivered their last child within one year the date of interview and received ante-natal care in the form of advice or service (excluding TT) from any source during the pregnancy period. Mothers with night blindness The percentage of mothers who delivered their last child within the one year preceding the date of interview who suffered from night blindness during their last pregnancy. Source of drinking water The percentage of households collecting drinking water from various sources. Does not take into consideration the amount of water collected, the time taken for water collection, nor the distance of the water source from the house. Multiple sources were considered for the same house. Iodized salt consumption The percentage of households using iodized salt as assessed by using starch solution. Strong color change of salt after using starch solution indicates “strong iodized”, weak change as “weak” and none as “not iodized”. Type of latrine The percentage of households with sanitary latrines denotes those households where at least one member uses either an improved pit latrine or a traditional pit latrine. Open-air defecation is considered unsanitary (multiple responses possible). Knowledge of mother to child transmission of HIV The percentage of women who correctly identify the means of transmission of HIV from mother to child. Definitions 168 Annex 4: Questionnaire UNICEF OPERATION LIFELINE SUDAN (SOUTHERN SECTOR) DATA COLLECTION FORM MULTIPLE INDICATOR CLUSTER SURVEY 1999 Please do not fill the boxes - official use only. Reg. No: Cluster Number: Stratum: Rural 1 Urban 2 Region: County/State: Payam: Tribe: Chief: Sub-chief: Gol / Community Leader /Headmen: Village: Interviewer, please do fill form number and date boxes. Total Number of Gol/Community Leaders/Headmen under selected Sub-Chief Total Number of Households under selected Gol/Community Leaders/Headmen Form No: 1, 2, 3, 4,5,6 Date (Day/Month/Year): Interviewer (Full Name): Supervisor (Full Name): Last questions to all respondents. Q. Are any of the respondents able to say whether a child or woman from this area has been abducted? If yes, how many and when Children - how many? When? Women - how many? When? Q. Are any of the respondents aware of any children who are working as soldier? If yes, how many children are they aware of Since when? Questionnaire 171 HOUSEHOLD NUMBER: Name of Head of Household (in full): For persons For children under age 15 Line Number Name Male or Age Reading Card Is natural If alive Is natural If alive age 15 or over Female 1 = 0 - 4 1 = Easily mother does mother father does father 2 = 5 - 17 2 = Difficulty alive? live in alive? live in 3 = 18+ 3 = Not at all household? Household? LINE M F AGE E D N Y N DK Y N Y N DK Y N 01 1 2 1 2 3 1 2 3 1 2 9 1 2 1 2 9 1 2 02 1 2 1 2 3 1 2 3 1 2 9 1 2 1 2 9 1 2 03 1 2 1 2 3 1 2 3 1 2 9 1 2 1 2 9 1 2 04 1 2 1 2 3 1 2 3 1 2 9 1 2 1 2 9 1 2 05 1 2 1 2 3 1 2 3 1 2 9 1 2 1 2 9 1 2 06 1 2 1 2 3 1 2 3 1 2 9 1 2 1 2 9 1 2 07 1 2 1 2 3 1 2 3 1 2 9 1 2 1 2 9 1 2 08 1 2 1 2 3 1 2 3 1 2 9 1 2 1 2 9 1 2 09 1 2 1 2 3 1 2 3 1 2 9 1 2 1 2 9 1 2 10 1 2 1 2 3 1 2 3 1 2 9 1 2 1 2 9 1 2 Questionnaire 172 Part A: For Children Under 5 Years of Age Interviewer: in some cases there may be more than one mother/caretaker in the same household. If this is the case, then start with the mother/caretaker of the youngest child and collect information regarding all her children under 5 years before proceeding to the next mother. Serial Number: Household Number: Child’s Name: Mother’s Line Number: Child’s Line Number: Q. 1. Sex of the child A. 1. 1 - Boy 2 - Girl Q. 2. Age of the child A. 2. __ months Q. 3. Was there any loose motion in last 15 days for 3 or more times in a day? A. 3. 1- Yes 2 - No Q. 4. If ‘yes’, what type of treatment was received by the child (if none skip to 6)? A. 4. 1 - None 2 - ORS 3 - Salt/Sugar Solution 4 - Home Fluids 5 - Modern Medicine 6 - Traditional Medicine 7- Other Q. 5. Who treated the child during this loose motion? A. 5. 1 - Health Facility 2 - Village Practice 3 - Self/family 4 - Other Q. 6. How much liquid was given to the child during loose motion, compared to normal? A. 6. 1 - More 2 - Same 3 - Less 4 - None Q. 7. How much solid/usual food was given to the child during loose motion, compared to normal? A. 7. 1 - More 2 - Same 3 - Less 4 - None Q. 8. Has (name) had an illness with a cough at any time in the last two weeks, that is since (day of the week)of the week before last? A. 8. 1- Yes 2 - No 3 - Don’t Know Q. 9. When (name) had an illness with a cough, did he/she breathe faster than usual with short, quick breathes or have difficult breathing? A. 9. 1- Yes 2 - No 3 - Don’t Know Q. 10. Did you seek advice or treatment for the ill ness outside home? If 'yes', from where did you seek care? A. 10. 1 - Health Facility 2 - Village Practice 3 - Self/family 4 - Other Questionnaire 173 Part A Continued: For Children Under 5 Years of Age Q. 11. In the last two weeks, has (name) been ill with a fever? A. 11. 1- Yes 2 - No 3 - Don’t Know Q. 12. Did (name) take a medicine for fever or malaria that was provided at/by the health facility? A. 12. 1- Yes 2 - No 3 - Don’t Know Q. 13. What medicine (name) was provided/ prescribed at the health facility? A. 13. 1- Paracetamol 2 - Chloroquine 3 - Fansidar 4 - Not Known 5 - Others Q. 14. Did (name) sleep under a mosquito net last night? A. 14. 1- Yes 2 - No Q. 15. How long was the child breast feed (in months)? If 'no', code 00. If still breast feeding, code 96. Q. 16. Since this time yesterday, did she/he receive anything other than breast milk? If yes what was that? A. 16. 1 - Cows Milk 2 - Fruit Juice 3 - Porridge 4 - Other Food 5 - None Q. 17. How long was the child exclusively breast fed (in months)? (For 0-23 months child) If 'no', code 00. If still breast feeding code 96. Q. 18. Did the child receive Vitamin-A within the last six months (since April)? (show capsule) (For 6-59 months child) A. 18. 1- Yes 2 - No (If the child is <12 months go to next child) Q. 19. Has the child received BCG vaccine against Tuberculosis? (For 12-23 months child; if child 24 months or older skip to q.24) A. 19. 1- Yes (Scar) 2 - Yes (Card) 3 - No Q. 20. How many doses of DPT has the child received? (For 12-23 months child only) Q. 21. How many doses of Polio vaccine has the child received? (For 12-23 months child) Q. 22. Has the child received measles vaccine? (For 12-23 months child) A. 22. 1- Yes 2 - No Q. 23. (If 'yes' in q22), Was it before one year of age or after? A. 23. 1- Before 2 - After Q. 24. Please measure the mid upper arm circumference of the child and record in mm (For 1-4 year/12-59 months children) Q. 25. Does the child have any difficulty in hearing, vision, walking/moving(leg or hand), speaking, understanding (mentally dull or slow) ? (For 1-4 year/12-59 months children) A. 25. 1- Hearing/Vision 2 - Hand/Leg 3 - Speaking 4 - Mental Questionnaire 174 Part B: For Children 5 to 17 Years of Age Interviewer: in some cases there may be more than one mother/caretaker in the same household. If this is the case, then start with the mother/caretaker of the youngest child (among 5 - 17 years) and collect information regarding all her children 5 - 17 years before proceeding to the next mother. Serial Number: Household Number: Child’s Name: Mother’s Line Number: Child’s Line Number: Q. 1. Sex of the child A. 1. 1 - Boy 2 - Girl Q. 2. Age of the child A. 2. __ years Q. 3. Was s/he admitted/registered in a school in 1999? If no, go to q6 A. 3. 1- Yes 2 - No Q. 4. Class/Grade in which s/he is registered (in 1999)? Q. 5. How many days did s/he attend school in the last five school days? Q. 6. If the child is not registered in school at present, has s/he ever attended school in the past? A. 6. 1- Yes 2 - No Q. 7. If yes, Why did the child leave the school? A. 7. 1 - Domestic Chores 2 - Productive Work 3 - No Books/Pencils 4 - Short of Clothes 5 - Others Q. 8. Does s/he have any problem in seeing/vision during evening or night only? A. 8. 1- Yes 2 - No Q. 9. Compared to other children, does the child have any difficulty in hearing, vision, walking/moving (leg or hand), speaking, understanding? A. 9. 1- Hearing/Vision 2 - Hand/Leg 3 - Speaking 4 - Mental Q. 10. During the past week, whether (name) did domestic chores, if any, for the household, for at least half a day on average? A. 10. 1- Yes 2 - No Q. 11. During the past week, whether (name) did some productive works, if any, for the household, for at least half a day on average? A. 11. 1- Yes 2 - No Note: Domestic chores include fetching water, washing clothes or utensils, cleaning the compound, cooking etc. Productive work include assist the parents in agriculture, livestock or business, cattle rearing, milking, selling goods for the family, gardening etc. which give some direct economic benefit to the family. Questionnaire 175 Part C: For Men/Women over 18 years of Age Interviewer: male interviewers, ask these questions to the youngest male member of the household among those 18 years or more, and female interviewers ask these questions to the youngest female member of the house of the same age. Serial Number: Household Number: Man’s/Woman’s Name: Man’s/Woman’s Line Number: Q. 1. Have you ever heard of the virus HIV or an illness called AIDS? (If no, go to part-D) A. 1. 1- Yes 2 - No 3 - Don’t Know Q. 2. What problems will one suffer after getting infected with AIDS? A. 2. 1- Lose Immunity 2 - Death 3 - Don’t Know Q. 3. Is this disease by any way related to. Sex? (If yes proceed to q4 , otherwise go to part-D) A. 3. 1- Yes 2 - No 3 - Don’t Know Q. 4. How can AIDS be spread among human beings? A. 4. 1 - Sex with person with AIDS 2 - Indiscriminate Sex 3 - Unprotected Sex 4 - Through Blood 5 - Using Syringe/Needle 6 - Don’t Know Q. 5. How can one be protected from this AIDS disease or HIV virus? A. 5. 1 - No sex with person with AIDS/HIV 2 - Avoid more than one sex partner 3 - Not using syringe/needle 4 - Taking refined blood 5 - Using a condom 6 - Don’t Know Q. 6. Can the AIDS virus be transmitted from a mother to a child? If yes, then when or how? A. 6. 1 - During Pregnancy 2 - During Delivery 3 - Through Breast-feeding 4 - No 5 - Don’t Know Questionnaire 176 Part D: For Households Interviewer: in some cases there may be more than one mother/caretaker in the same household. If this is the case, then start with the mother/caretaker of the youngest child and collect information regarding all her children under 5 years before proceeding to the next mother. Serial Number: Household Number: Q. 1. Was there any live birth during the last one year? If 'no' skip to q9. If yes, Mother line number (If the mother is died code 66, if disappeared, code77) A. 1. 1- Yes 2 - No Q. 2. Was it the first delivery for this mother? A. 2. 1- Yes 2 - No Q. 3. Place of the last delivery. A. 3. 1- Health Facility 2 - Home Delivery 3 - Other Q. 4. Who assisted during this delivery? A. 4. 1 - Doctor/Nurse/Midwife 2 - Traditional Birth Attendant 3 - Untraditional Birth Attendant 4 - Family 5 - Other Q. 5. Did you receive doses of Tetanus-Toxiod (TT) during this pregnancy? If yes how many doses? Q. 6. Did you take any advice or service (excluding TT) during this pregnancy? If 'yes', whom did you see? A. 6. 1 - Doctor/Nurse/Midwife 2 - Traditional Birth Attendant 3 - Untraditional Birth Attendant 4 - Other 5 - No advice/service Q. 7. During this pregnancy did you have difficulty with your vision during daylight, evening or night? A. 7. 1- Yes (day) 2- Yes (evening) 3- Yes (night) 4 - No Q. 8. Did you receive any vitamin-A in the first two months after delivery? A. 8. 1- Yes 2 - No Q. 9. What is the source of drinking water during the dry season? A. 9. 1 - Pump 2 -Protected Spring 3 - Open well/spring 4 - River/Stream 5 - Pond/Canal Q. 10. What is the source of drinking water during the cultivation season? A. 10. 1 - Pump 2 -Protected Spring 3 - Open well/spring 4 - River/Stream 5 - Pond/Canal Q. 11. What has been the source of food for your family/household since the last harvest? A. 11. 1- Own Produce 2 - Wild Food 3 - Purchase 4 - Loan 5 - Relief/Assistance Questionnaire 177 Part D Continued: For Households Q. 12. What was the food for the household members yesterday? A. 12. 1- Standard Food 2 - Wild Food 3 - No Food Q. 13. Before the harvest, in a day at the worst time, what was the food for the household members? A. 13. 1- Standard Food 2 - Wild Food 3 - No Food Q. 14. Does the household keep any livestock? If yes, which animals? (If No, go to Q15) Of the animals kept, which, if any, are owned by the household? (If None, go to Q15) A. 14. 1- Cattle Kept 2 - Sheep/Goats Kept 3 - Chickens Kept 4 - Others Kept 5- Cattle Owned 6 - Sheep/Goats Owned 7 - Chickens Owned 8 - Others Owned Q. 15. Where do you get your salt from? (if any) If no salt, go to Q17 A. 15. 1- Northern Sudan 2 - Locally Made 3 - Kenya/Uganda 4 - No Salt Q. 16. We would like to check whether the salt use in your household is iodized? A. 16. 1 - Non-Iodized 2 - Iodized (weak) 3 - Iodized (strong) Q. 17. Are you aware of any humanitarian agencies working in your area? If no, go to 19? A. 17. 1- Yes 2 - No Q. 18. Since last harvest, have you benefitted from the activities of these agencies? If so, which activities? A. 18. 1- Food Relief 2 - Health/Nutrition 3 - Veterinary 4 - Water Sanitation 5- Education 6 - Seed/Tools/Equipment 7 - None Q. 19. In your society, do children have rights? A. 19. 1- Yes 2 - No Q. 20. Are you aware of the Convention of the Rights of the Child? A. 20. 1- Yes 2 - No Q. 21. Can you please list some of the rights that children should have? A. 21. 1- Food 2 - Security/Protection 3 - Education 4 - Health 5- Other Q. 22. Type of latrine used by the household members? A. 22. 1- Improved Pit Latrine 2 - Traditional Pit Latrine 3 - Open Defecation Q. 23. Is this facility located within your dwelling, or yard or compound? A. 23. 1- Yes 2 - No Q. 24. Can you tell me 3 most important things that you like to see happen in your area? A. 24. 1- Water Source 2 - Health Facility 3 - Education 4 - Food Relief 5 - Other Questionnaire 178 Annex 5: Convention on the Rights of the Child The Convention on the Rights of the Child was adopted and opened for signature, ratification and accession by General Assembly resolution 44/25 of 20 November 1989. It entered into force 2 September 1990, in accordance with article 49. The States Parties to the present Convention, Considering that, in accordance with the principles proclaimed in the Charter of the United Nations, recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world, Bearing in mind that the peoples of the United Nations have, in the Charter, reaffirmed their faith in fundamental human rights and in the dignity and worth of the human person and have determined to promote social progress and better standards of life in larger freedom, Recognizing that the United Nations has, in the Universal Declaration of Human Rights and in the International Covenants on Human Rights, proclaimed and agreed that everyone is entitled to all the rights and freedoms set forth therein, without distinction of any kind, such as race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status, Recalling that, in the Universal Declaration of Human Rights, the United Nations has proclaimed that childhood is entitled to special care and assistance, Convinced that the family, as the fundamental group of society and the natural environment for the growth and well-being of all its members and particularly children, should be afforded the necessary protection and assistance so that it can fully assume its responsibilities within the community, Recognizing that the child, for the full and harmonious development of his or her personality, should grow up in a family environment, in an atmosphere of happiness, love and understanding, Considering that the child should be fully prepared to live an individual life in society and brought up in the spirit of the ideals proclaimed in the Charter of the United Nations and in particular in the spirit of peace, dignity, tolerance, freedom, equality and solidarity, Preamble 181 Bearing in mind that the need to extend particular care to the child has been stated in the Geneva Declaration of the Rights of the Child of 1924 and in the Declaration of the Rights of the Child adopted by the General Assembly on 20 November 1959 and recognized in the Universal Declaration of Human Rights, in the International Covenant on Civil and Political Rights (in particular in articles 23 and 24), in the International Covenant on Economic, Social and Cultural Rights (in particular in article 10) and in the statutes and relevant instruments of specialized agencies and international organizations concerned with the welfare of children, Bearing in mind that, as indicated in the Declaration of the Rights of the Child, "the child, by reason of his physical and mental immaturity, needs special safeguards and care, including appropriate legal protection, before as well as after birth", Recalling the provisions of the Declaration on Social and Legal Principles relating to the Protection and Welfare of Children, with Special Reference to Foster Placement and Adoption Nationally and Internationally; the United Nations Standard Minimum Rules for the Administration of Juvenile Justice (The Beijing Rules) ; and the Declaration on the Protection of Women and Children in Emergency and Armed Conflict, Recognizing that, in all countries in the world, there are children living in exceptionally difficult conditions and that such children need special consideration, Taking due account of the importance of the traditions and cultural values of each people for the protection and harmonious development of the child, Recognizing the importance of international co-operation for improving the living conditions of children in every country, in particular in the developing countries, Have agreed as follows: Preamble 182 Article 1 For the purposes of the present Convention, a child means every human being below the age of eighteen years unless under the law applicable to the child, majority is attained earlier. Article 2 1. States Parties shall respect and ensure the rights set forth in the present Convention to each child within their jurisdiction without discrimination of any kind, irrespective of the child's or his or her parent's or legal guardian's race, colour, sex, language, religion, political or other opinion, national, ethnic or social origin, property, disability, birth or other status. 2. States Parties shall take all appropriate measures to ensure that the child is protected against all forms of discrimination or punishment on the basis of the status, activities, expressed opinions, or beliefs of the child's parents, legal guardians, or family members. Article 3 1. In all actions concerning children, whether undertaken by public or private social welfare institutions, courts of law, administrative authorities or legislative bodies, the best interests of the child shall be a primary consideration. 2. States Parties undertake to ensure the child such protection and care as is necessary for his or her well-being, taking into account the rights and duties of his or her parents, legal guardians, or other individuals legally responsible for him or her, and, to this end, shall take all appropriate legislative and administrative measures. 3. States Parties shall ensure that the institutions, services and facilities responsible for the care or protection of children shall conform with the standards established by competent authorities, particularly in the areas of safety, health, in the number and suitability of their staff, as well as competent supervision. Article 4 States Parties shall undertake all appropriate legislative, administrative and other measures for the implementation of the rights recognized in the present Convention. With regard to economic, social and cultural rights, States Parties shall undertake such measures to the maximum extent of their available resources and, where needed, within the framework of international co-operation. Part 1 of the CRC 183 Article 5 States Parties shall respect the responsibilities, rights and duties of parents or, where applicable, the members of the extended family or community as provided for by local custom, legal guardians or other persons legally responsible for the child, to provide, in a manner consistent with the evolving capacities of the child, appropriate direction and guidance in the exercise by the child of the rights recognized in the present Convention. Article 6 1. States Parties recognize that every child has the inherent right to life. 2. States Parties shall ensure to the maximum extent possible the survival and development of the child. Article 7 1. The child shall be registered immediately after birth and shall have the right from birth to a name, the right to acquire a nationality and. as far as possible, the right to know and be cared for by his or her parents. 2. States Parties shall ensure the implementation of these rights in accordance with their national law and their obligations under the relevant international instruments in this field, in particular where the child would otherwise be stateless. Article 8 1. States Parties undertake to respect the right of the child to preserve his or her identity, including nationality, name and family relations as recognized by law without unlawful interference. 2. Where a child is illegally deprived of some or all of the elements of his or her identity, States Parties shall provide appropriate assistance and protection, with a view to re-establishing speedily his or her identity. Article 9 1. States Parties shall ensure that a child shall not be separated from his or her parents against their will, except when competent authorities subject to judicial review determine, in accordance with applicable law and procedures, that such separation is necessary for Part 1 of the CRC 184 the best interests of the child. Such determination may be necessary in a particular case such as one involving abuse or neglect of the child by the parents, or one where the parents are living separately and a decision must be made as to the child's place of residence. 2. In any proceedings pursuant to paragraph 1 of the present article, all interested parties shall be given an opportunity to participate in the proceedings and make their views known. 3. States Parties shall respect the right of the child who is separated from one or both parents to maintain personal relations and direct contact with both parents on a regular basis, except if it is contrary to the child's best interests. 4. Where such separation results from any action initiated by a State Party, such as the detention, imprisonment, exile, deportation or death (including death arising from any cause while the person is in the custody of the State) of one or both parents or of the child, that State Party shall, upon request, provide the parents, the child or, if appropriate, another member of the family with the essential information concerning the whereabouts of the absent member(s) of the family unless the provision of the information would be detrimental to the well-being of the child. States Parties shall further ensure that the submission of such a request shall of itself entail no adverse consequences for the person(s) concerned. Article 10 1. In accordance with the obligation of States Parties under article 9, paragraph 1, applications by a child or his or her parents to enter or leave a State Party for the purpose of family reunification shall be dealt with by States Parties in a positive, humane and expeditious manner. States Parties shall further ensure that the submission of such a request shall entail no adverse consequences for the applicants and for the members of their family. 2. A child whose parents reside in different States shall have the right to maintain on a regular basis, save in exceptional circumstances personal relations and direct contacts with both parents. Towards that end and in accordance with the obligation of States Parties under article 9, paragraph 1, States Parties shall respect the right of the child and his or her parents to leave any country, including their own and to enter their own country. The right to leave any country shall be subject only to such restrictions as are prescribed by law and which are necessary to protect the national security, public order (ordre public), public health or morals or the rights and freedoms of others and are consistent with the other rights recognized in the present Convention. Part 1 of the CRC 185 Article 11 1. States Parties shall take measures to combat the illicit transfer and non-return of children abroad. 2. To this end, States Parties shall promote the conclusion of bilateral or multilateral agreements or accession to existing agreements. Article 12 1. States Parties shall assure to the child who is capable of forming his or her own views the right to express those views freely in all matters affecting the child, the views of the child being given due weight in accordance with the age and maturity of the child. 2. For this purpose, the child shall in particular be provided the opportunity to be heard in any judicial and administrative proceedings affecting the child, either directly, or through a representative or an appropriate body, in a manner consistent with the procedural rules of national law. Article 13 1. The child shall have the right to freedom of expression; this right shall include freedom to seek, receive and impart information and ideas of all kinds, regardless of frontiers, either orally, in writing or in print, in the form of art, or through any other media of the child's choice. 2. The exercise of this right may be subject to certain restrictions, but these shall only be such as are provided by law and are necessary: (a) For respect of the rights or reputations of others; or (b) For the protection of national security or of public order (ordre public), or of public health or morals. Article 14 1. States Parties shall respect the right of the child to freedom of thought, conscience and religion. 2. States Parties shall respect the rights and duties of the parents and, when applicable, legal guardians, to provide direction to the child in the exercise of his or her right in a manner consistent with the evolving capacities of the child. 3. Freedom to manifest one's religion or beliefs may be subject only to such limitations as are prescribed by law and are necessary to protect public safety, order, health or morals, or the fundamental rights and freedoms of others. Part 1 of the CRC 186 Article 15 1. States Parties recognize the rights of the child to freedom of association and to freedom of peaceful assembly. 2. No restrictions may be placed on the exercise of these rights other than those imposed in conformity with the law and which are necessary in a democratic society in the interests of national security or public safety, public order (ordre public), the protection of public health or morals or the protection of the rights and freedoms of others. Article 16 1. No child shall be subjected to arbitrary or unlawful interference with his or her privacy, family, home or correspondence, nor to unlawful attacks on his or her honour and reputation. 2. The child has the right to the protection of the law against such interference or attacks. Article 17 States Parties recognize the important function performed by the mass media and shall ensure that the child has access to information and material from a diversity of national and international sources, especially those aimed at the promotion of his or her social, spiritual and moral well-being and physical and mental health. To this end, States Parties shall: (a) Encourage the mass media to disseminate information and material of social and cultural benefit to the child and in accordance with the spirit of article 29; (b) Encourage international co-operation in the production, exchange and dissemination of such information and material from a diversity of cultural, national and international sources; (c) Encourage the production and dissemination of children's books; (d) Encourage the mass media to have particular regard to the linguistic needs of the child who belongs to a minority group or who is indigenous; (e) Encourage the development of appropriate guidelines for the protection of the child from information and material injurious to his or her well-being, bearing in mind the provisions of articles 13 and 18. Part 1 of the CRC 187 Article 18 1. States Parties shall use their best efforts to ensure recognition of the principle that both parents have common responsibilities for the upbringing and development of the child. Parents or, as the case may be, legal guardians, have the primary responsibility for the upbringing and development of the child. The best interests of the child will be their basic concern. 2. For the purpose of guaranteeing and promoting the rights set forth in the present Convention, States Parties shall render appropriate assistance to parents and legal guardians in the performance of their child-rearing responsibilities and shall ensure the development of institutions, facilities and services for the care of children. 3. States Parties shall take all appropriate measures to ensure that children of working parents have the right to benefit from child-care services and facilities for which they are eligible. Article 19 1. States Parties shall take all appropriate legislative, administrative, social and educational measures to protect the child from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation, including sexual abuse, while in the care of parent(s), legal guardian(s) or any other person who has the care of the child. 2. Such protective measures should, as appropriate, include effective procedures for the establishment of social programmes to provide necessary support for the child and for those who have the care of the child, as well as for other forms of prevention and for identification, reporting, referral, investigation, treatment and follow-up of instances of child maltreatment described heretofore, and, as appropriate, for judicial involvement. Article 20 1. A child temporarily or permanently deprived of his or her family environment, or in whose own best interests cannot be allowed to remain in that environment, shall be entitled to special protection and assistance provided by the State. 2. States Parties shall in accordance with their national laws ensure alternative care for such a child. 3. Such care could include, inter alia, foster placement, kafalah of Islamic law, adoption or if necessary placement in suitable institutions for the care of children. When considering solutions, due regard shall be paid to the desirability of continuity in a child's upbringing and to the child's ethnic, religious, cultural and linguistic background. Part 1 of the CRC 188 Article 21 States Parties that recognize and/or permit the system of adoption shall ensure that the best interests of the child shall be the paramount consideration and they shall: (a) Ensure that the adoption of a child is authorized only by competent authorities who determine, in accordance with applicable law and procedures and on the basis of all pertinent and reliable information, that the adoption is permissible in view of the child's status concerning parents, relatives and legal guardians and that, if required, the persons concerned have given their informed consent to the adoption on the basis of such counselling as may be necessary; (b) Recognize that inter-country adoption may be considered as an alternative means of child's care, if the child cannot be placed in a foster or an adoptive family or cannot in any suitable manner be cared for in the child's country of origin; (c) Ensure that the child concerned by inter-country adoption enjoys safeguards and standards equivalent to those existing in the case of national adoption; (d) Take all appropriate measures to ensure that, in inter-country adoption, the placement does not result in improper financial gain for those involved in it; (e) Promote, where appropriate, the objectives of the present article by concluding bilateral or multilateral arrangements or agreements and endeavour, within this framework, to ensure that the placement of the child in another country is carried out by competent authorities or organs. Article 22 1. States Parties shall take appropriate measures to ensure that a child who is seeking refugee status or who is considered a refugee in accordance with applicable international or domestic law and procedures shall, whether unaccompanied or accompanied by his or her parents or by any other person, receive appropriate protection and humanitarian assistance in the enjoyment of applicable rights set forth in the present Convention and in other international human rights or humanitarian instruments to which the said States are Parties. 2. For this purpose, States Parties shall provide, as they consider appropriate, co-operation in any efforts by the United Nations and other competent intergovernmental organizations or non-governmental organizations co-operating with the United Nations to protect and assist such a child and to trace the parents or other members of the family of any refugee child in order to obtain information necessary for reunification with his or her family. In cases where no parents or other members of the family can be found, the child shall be accorded the same protection as any other child permanently or temporarily deprived of his or her family environment for any reason, as set forth in the present Convention. Part 1 of the CRC 189 Article 23 1. States Parties recognize that a mentally or physically disabled child should enjoy a full and decent life, in conditions which ensure dignity, promote self-reliance and facilitate the child's active participation in the community. 2. States Parties recognize the right of the disabled child to special care and shall encourage and ensure the extension, subject to available resources, to the eligible child and those responsible for his or her care, of assistance for which application is made and which is appropriate to the child's condition and to the circumstances of the parents or others caring for the child. 3. Recognizing the special needs of a disabled child, assistance extended in accordance with paragraph 2 of the present article shall be provided free of charge, whenever possible, taking into account the financial resources of the parents or others caring for the child and shall be designed to ensure that the disabled child has effective access to and receives education, training, health care services, rehabilitation services, preparation for employment and recreation opportunities in a manner conducive to the child's achieving the fullest possible social integration and individual development, including his or her cultural and spiritual development 4. States Parties shall promote, in the spirit of international cooperation, the exchange of appropriate information in the field of preventive health care and of medical, psychological and functional treatment of disabled children, including dissemination of and access to information concerning methods of rehabilitation, education and vocational services, with the aim of enabling States Parties to improve their capabilities and skills and to widen their experience in these areas. In this regard, particular account shall be taken of the needs of developing countries. Article 24 1. States Parties recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. States Parties shall strive to ensure that no child is deprived of his or her right of access to such health care services. 2. States Parties shall pursue full implementation of this right and, in particular, shall take appropriate measures: (a) To diminish infant and child mortality; (b) To ensure the provision of necessary medical assistance and health care to all children with emphasis on the development of primary health care; Part 1 of the CRC 190 (C) To combat disease and malnutrition, including within the framework of primary health care, through, inter alia, the application of readily available technology and through the provision of adequate nutritious foods and clean drinking-water, taking into consideration the dangers and risks of environmental pollution; (d) To ensure appropriate pre-natal and post-natal health care for mothers; (e) To ensure that all segments of society, in particular parents and children, are informed, have access to education and are supported in the use of basic knowledge of child health and nutrition, the advantages of breastfeeding, hygiene and environmental sanitation and the prevention of accidents; (f) To develop preventive health care, guidance for parents and family planning education and services. 3. States Parties shall take all effective and appropriate measures with a view to abolishing traditional practices prejudicial to the health of children. 4. States Parties undertake to promote and encourage international co-operation with a view to achieving progressively the full realization of the right recognized in the present article. In this regard, particular account shall be taken of the needs of developing countries. Article 25 States Parties recognize the right of a child who has been placed by the competent authorities for the purposes of care, protection or treatment of his or her physical or mental health, to a periodic review of the treatment provided to the child and all other circumstances relevant to his or her placement. Article 26 1. States Parties shall recognize for every child the right to benefit from social security, including social insurance and shall take the necessary measures to achieve the full realization of this right in accordance with their national law. 2. The benefits should, where appropriate, be granted, taking into account the resources and the circumstances of the child and persons having responsibility for the maintenance of the child, as well as any other consideration relevant to an application for benefits made by or on behalf of the child. Part 1 of the CRC 191 Article 27 1. States Parties recognize the right of every child to a standard of living adequate for the child's physical, mental, spiritual, moral and social development. 2. The parent(s) or others responsible for the child have the primary responsibility to secure, within their abilities and financial capacities, the conditions of living necessary for the child's development. 3. States Parties, in accordance with national conditions and within their means, shall take appropriate measures to assist parents and others responsible for the child to implement this right and shall in case of need provide material assistance and support programmes, particularly with regard to nutrition, clothing and housing. 4. States Parties shall take all appropriate measures to secure the recovery of maintenance for the child from the parents or other persons having financial responsibility for the child, both within the State Party and from abroad. In particular, where the person having financial responsibility for the child lives in a State different from that of the child, States Parties shall promote the accession to international agreements or the conclusion of such agreements, as well as the making of other appropriate arrangements. Article 28 1. States Parties recognize the right of the child to education and with a view to achieving this right progressively and on the basis of equal opportunity, they shall, in particular: (a) Make primary education compulsory and available free to all; (b) Encourage the development of different forms of secondary educat ion, including general and vocational education, make them available and accessible to every child and take appropriate measures such as the introduction of free education and offering financial assistance in case of need; (c) Make higher education accessible to all on the basis of capacity by every appropriate means; (d) Make educational and vocational information and guidance available and accessible to all children; (e) Take measures to encourage regular attendance at schools and the reduction of drop-out rates. 2. States Parties shall take all appropriate measures to ensure that school discipline is administered in a manner consistent with the child's human dignity and in conformity with the present Convention. Part 1 of the CRC 192 3. States Parties shall promote and encourage international cooperation in matters relating to education, in particular with a view to contributing to the elimination of ignorance and illiteracy throughout the world and facilitating access to scientific and technical knowledge and modern teaching methods. In this regard, particular account shall be taken of the needs of developing countries. Article 29 1. States Parties agree that the education of the child shall be directed to: (a) The development of the child's personality, talents and mental and physical abilities to their fullest potential; (b) The development of respect for human rights and fundamental freedoms, and for the principles enshrined in the Charter of the United Nations; (c) The development of respect for the child's parents, his or her own cultural identity, language and values, for the national values of the country in which the child is living, the country from which he or she may originate, and for civilizations different from his or her own; (d) The preparation of the child for responsible life in a free society, in the spirit of understanding, peace, tolerance, equality of sexes, and friendship among all peoples, ethnic, national and religious groups and persons of indigenous origin; (e) The development of respect for the natural environment. 2. No part of the present article or article 28 shall be construed so as to interfere with the liberty of individuals and bodies to establish and direct educational institutions, subject always to the observance of the principle set forth in paragraph 1 of the present article and to the requirements that the education given in such institutions shall conform to such minimum standards as may be laid down by the State. Article 30 In those States in which ethnic, religious or linguistic minorities or persons of indigenous origin exist, a child belonging to such a minority or who is indigenous shall not be denied the right, in community with other members of his or her group, to enjoy his or her own culture, to profess and practise his or her own religion, or to use his or her own language. Part 1 of the CRC 193 Article 31 1. States Parties recognize the right of the child to rest and leisure, to engage in play and recreational activities appropriate to the age of the child and to participate freely in cultural life and the arts. 2. States Parties shall respect and promote the right of the child to participate fully in cultural and artistic life and shall encourage the provision of appropriate and equal opportunities for cultural, artistic, recreational and leisure activity. Article 32 1. States Parties recognize the right of the child to be protected from economic exploitation and from performing any work that is likely to be hazardous or to interfere with the child's education, or to be harmful to the child's health or physical, mental, spiritual, moral or social development. 2. States Parties shall take legislative, administrative, social and educational measures to ensure the implementation of the present article. To this end and having regard to the relevant provisions of other international instruments, States Parties shall in particular: (a) Provide for a minimum age or minimum ages for admission to employment; (b) Provide for appropriate regulation of the hours and conditions of employment; (c) Provide for appropriate penalties or other sanctions to ensure the effective enforcement of the present article. Article 33 States Parties shall take all appropriate measures, including legislative, administrative, social and educational measures, to protect children from the illicit use of narcotic drugs and psychotropic substances as defined in the relevant international treaties and to prevent the use of children in the illicit production and trafficking of such substances. Article 34 States Parties undertake to protect the child from all forms of sexual exploitation and sexual abuse. For these purposes, States Parties shall in particular take all appropriate national, bilateral and multilateral measures to prevent: (a) The inducement or coercion of a child to engage in any unlawful sexual activity; (b) The exploitative use of children in prostitution or other unlawful sexual practices; (c) The exploitative use of children in pornographic performances and materials. Part 1 of the CRC 194 Article 35 States Parties shall take all appropriate national, bilateral and multilateral measures to prevent the abduction of, the sale of or traffic in children for any purpose or in any form. Article 36 States Parties shall protect the child against all other forms of exploitation prejudicial to any aspects of the child's welfare. Article 37 States Parties shall ensure that: (a) No child shall be subjected to torture or other cruel, inhuman or degrading treatment or punishment. Neither capital punishment nor life imprisonment without possibility of release shall be imposed for offences committed by persons below eighteen years of age; (b) No child shall be deprived of his or her liberty unlawfully or arbitrarily. The arrest, detention or imprisonment of a child shall be in conformity with the law and shall be used only as a measure of last resort and for the shortest appropriate period of time; (c) Every child deprived of liberty shall be treated with humanity and respect for the inherent dignity of the human person and in a manner which takes into account the needs of persons of his or her age. In particular, every child deprived of liberty shall be separated from adults unless it is considered in the child's best interest not to do so and shall have the right to maintain contact with his or her family through correspondence and visits, save in exceptional circumstances; (d) Every child deprived of his or her liberty shall have the right to prompt access to legal and other appropriate assistance, as well as the right to challenge the legality of the deprivation of his or her liberty before a court or other competent, independent and impartial authority and to a prompt decision on any such action. Article 38 1. States Parties undertake to respect and to ensure respect for rules of international humanitarian law applicable to them in armed conflicts which are relevant to the child. 2. States Parties shall take all feasible measures to ensure that persons who have not attained the age of fifteen years do not take a Part 1 of the CRC 195 direct part in hostilities. 3. States Parties shall refrain from recruiting any person who has not attained the age of fifteen years into their armed forces. In recruiting among those persons who have attained the age of fifteen years but who have not attained the age of eighteen years, States Parties shall endeavour to give priority to those who are oldest. 4. In accordance with their obligations under international humanitarian law to protect the civilian population in armed conflicts, States Parties shall take all feasible measures to ensure protection and care of children who are affected by an armed conflict. Article 39 States Parties shall take all appropriate measures to promote physical and psychological recovery and social reintegration of a child victim of: any form of neglect, exploitation, or abuse; torture or any other form of cruel, inhuman or degrading treatment or punishment; or armed conflicts. Such recovery and reintegration shall take place in an environment which fosters the health, self- respect and dignity of the child. Article 40 1. States Parties recognize the right of every child alleged as, accused of, or recognized as having infringed the penal law to be treated in a manner consistent with the promotion of the child's sense of dignity and worth, which reinforces the child's respect for the human rights and fundamental freedoms of others and which takes into account the child's age and the desirability of promoting the child's reintegration and the child's assuming a constructive role in society. 2. To this end and having regard to the relevant provisions of international instruments, States Parties shall, in particular, ensure that: (a) No child shall be alleged as, be accused of, or recognized as having infringed the penal law by reason of acts or omissions that were not prohibited by national or international law at the time they were committed; (b) Every child alleged as or accused of having infringed the penal law has at least the following guarantees: (i) To be presumed innocent until proven guilty according to law; (ii) To be informed promptly and directly of the charges against him or her, and, if appropriate, through his or her parents or legal guardians and to have legal or other appropriate assistance in the preparation and presentation of his or her defence; Part 1 of the CRC 196 Part 1 of the CRC (iii) To have the matter determined without delay by a competent, independent and impartial authority or judicial body in a fair hearing according to law, in the presence of legal or other appropriate assistance and, unless it is considered not to be in the best interest of the child, in particular, taking into account his or her age or situation, his or her parents or legal guardians; (iv) Not to be compelled to give testimony or to confess guilt; to examine or have examined adverse witnesses and to obtain the participation and examination of witnesses on his or her behalf under conditions of equality; (v) If considered to have infringed the penal law, to have this decision and any measures imposed in consequence thereof reviewed by a higher competent, independent and impartial authority or judicial body according to law; (vi) To have the free assistance of an interpreter if the child cannot understand or speak the language used; (vii) To have his or her privacy fully respected at all stages of the proceedings. 3. States Parties shall seek to promote the establishment of laws, procedures, authorities and institutions specifically applicable to children alleged as, accused of, or recognized as having infringed the penal law, and, in particular: (a) The establishment of a minimum age below which children shall be presumed not to have the capacity to infringe the penal law; (b) Whenever appropriate and desirable, measures for dealing with such children without resorting to judicial proceedings, providing that human rights and legal safeguards are fully respected. 4. A variety of dispositions, such as care, guidance and supervision orders; counselling; probation; foster care; education and vocational training programmes and other alternatives to institutional care shall be available to ensure that children are dealt with in a manner appropriate to their well-being and proportionate both to their circumstances and the offence. Article 41 Nothing in the present Convention shall affect any provisions which are more conducive to the realization of the rights of the child and which may be contained in: (a) The law of a State party; or (b) International law in force for that State. 197 Article 42 States Parties undertake to make the principles and provisions of the Convention widely known, by appropriate and active means, to adults and children alike. Article 43 1. For the purpose of examining the progress made by States Parties in achieving the realization of the obligations undertaken in the present Convention, there shall be established a Committee on the Rights of the Child, which shall carry out the functions hereinafter provided. 2. The Committee shall consist of ten experts of high moral standing and recognized competence in the field covered by this Convention. The members of the Committee shall be elected by States Parties from among their nationals and shall serve in their personal capacity, consideration being given to equitable geographical distribution, as well as to the principal legal systems. 3. The members of the Comm

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