Swaziland - Multiple Indicator Cluster Survey - 2014

Publication date: 2014

Page| i Swaziland Multiple Indicator Cluster Survey 2014 Final Report August, 2016 � � � �� � Page| ii The Swaziland Multiple Indicator Cluster Survey (MICS) was carried out in 2014 by the Central Statistical Office in collaboration with the United Nations Children’s Fund (UNICEF). Financial support was provided by the Government of the Kingdom of Swaziland, UNICEF, the United Nations Population fund (UNFPA), United Nations Educational Scientific and Cultural Organisation (UNESCO) and the National Emergency Response Council on HIV/AIDS (NERCHA). MICS is an international household survey programme developed by UNICEF. The Swaziland MICS was conducted as part of the fifth global round of MICS surveys (MICS5). MICS provides up-to-date information on the situation of children and women and measures key indicators that allow countries to monitor progress towards the Millennium Development Goals (MDGs), other national and internationally agreed upon commitments. Additional information on the global MICS project may be obtained from mics.unicef.org. Suggested citation: Central Statistical Office and UNICEF. 2016. Swaziland Multiple Indicator Cluster Survey 2014. Final Report. Mbabane, Swaziland, Central Statistical Office and UNICEF. Page| iiiP a g e | iii Summary Table of Survey Implementation and the Survey Population, Swaziland MICS, 2014 Survey implementation Sample frame Swaziland Population and Housing Census, 2007 Questionnaires Household Women (age 15-49) Men (age 15-49) Children under five Interviewer training June – July 2014 Fieldwork July – October 2014 Survey sample Households Sampled Occupied Interviewed Response rate (Percent) 5,211 4,981 4,865 97.7 Children under-five Eligible Mothers/caretakers interviewed Response rate (Percent) 2,728 2,693 98.7 Women Eligible for interviews Interviewed Response rate (Percent) 5,001 4,762 95.2 Men Eligible for interviews Interviewed Response rate (Percent) 1,629 1,459 89.6 Survey population Average household size 4.0 Percentage of households living in: Urban areas Rural areas Hhohho Manzini Shiselweni Lubombo 37.2 62.8 25.3 39.4 15.1 20.3 Percentage of population under: Age 5 Age 18 12.7 46.6 Percentage of women age 15-49 years with at least one live birth in the last 2 years 20.1 Housing characteristics Household or personal assets Percentage of households with Electricity Finished floor Finished roofing Finished walls 65.0 95.3 94.2 88.8 Percentage of households that own A television A refrigerator Agricultural land Farm animals/livestock 54.9 55.3 65.4 56.8 Mean number of persons per room used for sleeping 2.10 Percentage of households where at least a member has or owns a Mobile phone Car or truck 95.9 22.7 Page| iv P a g e | iv Summary Table of Findings1 Multiple Indicator Cluster Surveys (MICS) and Millennium Development Goals (MDG) Indicators, Swaziland MICS, 2014 CHILD MORTALITY Early childhood mortalitya MICS Indicator Indicator Description Value 1.1 Neonatal mortality rate Probability of dying within the first month of life 20 1.2 MDG 4.2 Infant mortality rate Probability of dying between birth and the first birthday 50 1.3 Post-neonatal mortality rate Difference between infant and neonatal mortality rates 30 1.4 Child mortality rate Probability of dying between the first and the fifth birthdays 18 1.5 MDG 4.1 Under-five mortality rate Probability of dying between birth and the fifth birthday 67 a Rates refer to the 5-year period preceding the survey. NUTRITION Nutritional status MICS Indicator Indicator Description Value 2.1a 2.1b MDG 1.8 Underweight prevalence (a) Moderate and severe (b) Severe Percentage of children under age 5 who fall below (a) minus two standard deviations (moderate and severe) (b) minus three standard deviations (severe) of the median weight for age of the WHO standard 5.8 1.6 2.2a 2.2b Stunting prevalence (a) Moderate and severe (b) Severe Percentage of children under age 5 who fall below (a) minus two standard deviations (moderate and severe) (b) minus three standard deviations (severe) of the median height for age of the WHO standard 25.5 7.2 2.3a 2.3b Wasting prevalence (a) Moderate and severe (b) Severe Percentage of children under age 5 who fall below (a) minus two standard deviations (moderate and severe) (b) minus three standard deviations (severe) of the median weight for height of the WHO standard 2.0 0.4 2.4 Overweight prevalence Percentage of children under age 5 who are above two standard deviations of the median weight for height of the WHO standard 9.0 Breastfeeding and infant feeding 2.5 Children ever breastfed Percentage of women with a live birth in the last 2 years who breastfed their last live-born child at any time 92.1 2.6 Early initiation of breastfeeding Percentage of women with a live birth in the last 2 years who put their last newborn to the breast within one hour of birth 48.3 2.7 Exclusive breastfeeding under 6 months Percentage of infants under 6 months of age who are exclusively breastfed 63.8 2.8 Predominant breastfeeding under 6 months Percentage of infants under 6 months of age who received breast milk as the predominant source of nourishment during the previous day 70.2 2.9 Continued breastfeeding at 1 year Percentage of children age 12-15 months who received breast milk during the previous day 47.8 2.10 Continued breastfeeding at 2 years Percentage of children age 20-23 months who received breast milk during the previous day 7.6 2.11 Median duration of breastfeeding The age in months when 50 percent of children age 0-35 months did not receive breast milk during the previous day 4.2 1 See Appendix G for a detailed description of MICS indicators Page| v P a g e | v 2.12 Age-appropriate breastfeeding Percentage of children age 0-23 months appropriately fed during the previous day 45.3 2.13 Introduction of solid, semi-solid or soft foods Percentage of infants age 6-8 months who received solid, semi-solid or soft foods during the previous day 89.5 2.14 Milk feeding frequency for non-breastfed children Percentage of non-breastfed children age 6-23 months who received at least 2 milk feedings during the previous day 52.8 2.15 Minimum meal frequency Percentage of children age 6-23 months who received solid, semi-solid and soft foods (plus milk feeds for non- breastfed children) the minimum number of times or more during the previous day 81.2 2.16 Minimum dietary diversity Percentage of children age 6–23 months who received foods from 4 or more food groups during the previous day 62.4 2.17a 2.17b Minimum acceptable diet (a) Percentage of breastfed children age 6–23 months who had at least the minimum dietary diversity and the minimum meal frequency during the previous day (b) Percentage of non-breastfed children age 6–23 months who received at least 2 milk feedings and had at least the minimum dietary diversity not including milk feeds and the minimum meal frequency during the previous day 48.6 29.7 2.18 Bottle feeding Percentage of children age 0-23 months who were fed with a bottle during the previous day 31.7 Salt iodization 2.19 Iodized salt consumption Percentage of households with salt testing 15 parts per million or more of iodate 66.1 Low-birthweight 2.20 Low-birthweight infants Percentage of most recent live births in the last 2 years weighing below 2,500 grams at birth 8.0 2.21 Infants weighed at birth Percentage of most recent live births in the last 2 years who were weighed at birth 92.3 CHILD HEALTH Vaccinations MICS Indicator Indicator Description Value 3.1 Tuberculosis immunization coverage Percentage of children age 12-23 months who received BCG vaccine by their first birthday 97.5 3.2 Polio immunization coverage Percentage of children age 12-23 months who received the third dose of OPV vaccine (OPV3) by their first birthday 83.9 3.3 Diphtheria, pertussis and tetanus (DPT) immunization coverage Percentage of children age 12-23 months who received the third dose of DPT vaccine (DPT3) by their first birthday 90.1 3.4 MDG 4.3 Measles immunization coverage Percentage of children age 12-23 months who received measles vaccine by their first birthday 89.3 3.5 Hepatitis B immunization coverage Percentage of children age 12-23 months who received the third dose of Hepatitis B vaccine (HepB3) by their first birthday 90.1 3.6 Haemophilus influenzae type B (Hib) immunization coverage Percentage of children age 12-23 months who received the third dose of Hib vaccine (Hib3) by their first birthday 90.1 3.8 Full immunization coverage Percentage of children age 12-23 months who received all vaccinations recommended in the national immunization schedule by their first birthday 70.7 Tetanus toxoid 3.9 Neonatal tetanus protection Percentage of women age 15-49 years with a live birth in the last 2 years who were given at least two doses of tetanus toxoid vaccine within the appropriate interval prior to the most recent birth 83.0 Page| vi P a g e | vi Diarrhoea - Children with diarrhoea Percentage of children under age 5 with diarrhoea in the last 2 weeks 16.4 3.10 Care-seeking for diarrhoea Percentage of children under age 5 with diarrhoea in the last 2 weeks for whom advice or treatment was sought from a health facility or provider 71.2 3.11 Diarrhoea treatment with oral rehydration salts (ORS) and zinc Percentage of children under age 5 with diarrhoea in the last 2 weeks who received ORS and zinc 42.3 3.12 Diarrhoea treatment with oral rehydration therapy (ORT) and continued feeding Percentage of children under age 5 with diarrhoea in the last 2 weeks who received ORT (ORS packet, pre-packaged ORS fluid, recommended homemade fluid or increased fluids) and continued feeding during the episode of diarrhoea 46.4 Acute Respiratory Infection (ARI) symptoms - Children with ARI symptoms Percentage of children under age 5 with ARI symptoms in the last 2 weeks 9.8 3.13 Care-seeking for children with ARI symptoms Percentage of children under age 5 with ARI symptoms in the last 2 weeks for whom advice or treatment was sought from a health facility or provider 59.6 3.14 Antibiotic treatment for children with ARI symptoms Percentage of children under age 5 with ARI symptoms in the last 2 weeks who received antibiotics 26.6 Solid fuel use 3.15 Use of solid fuels for cooking Percentage of household members in households that use solid fuels as the primary source of domestic energy to cook 62.3 Fever - Children with fever Percentage of children under age 5 with fever in the last 2 weeks 20.6 3.20 Care-seeking for fever Percentage of children under age 5 with fever in the last 2 weeks for whom advice or treatment was sought from a health facility or provider 63.2 WATER AND SANITATION MICS Indicator Indicator Description Value 4.1 MDG 7.8 Use of improved drinking water sources Percentage of household members using improved sources of drinking water 72.0 4.2 Water treatment Percentage of household members in households using unimproved drinking water who use an appropriate treatment method 16.8 4.3 MDG 7.9 Use of improved sanitation Percentage of household members using improved sanitation facilities which are not shared 53.0 4.4 Safe disposal of child’s faeces Percentage of children age 0-2 years whose last stools were disposed of safely 55.3 4.6 Availability of soap or other cleansing agent Percentage of households with soap or other cleansing agent 67.5 Page| vii P a g e | vii REPRODUCTIVE HEALTH Contraception and unmet need MICS Indicator Indicator Description Value - Total fertility rate Total fertility rate for women age 15-49 years 3.3 5.1 MDG 5.4 Adolescent birth rate Age-specific fertility rate for women age 15-19 years 87 5.2 Early childbearing Percentage of women age 20-24 years who had at least one live birth before age 18 16.7 5.3 MDG 5.3 Contraceptive prevalence rate Percentage of women age 15-49 years currently married or in union who are using (or whose partner is using) a (modern or traditional) contraceptive method 66.1 5.4 MDG 5.6 Unmet need Percentage of women age 15-49 years who are currently married or in union who are fecund and want to space their births or limit the number of children they have and who are not currently using contraception 15.2 Maternal and newborn health 5.5a 5.5b MDG 5.5 MDG 5.5 Antenatal care coverage Percentage of women age 15-49 years with a live birth in the last 2 years who were attended during their last pregnancy that led to a live birth (a) at least once by skilled health personnel (b) at least four times by any provider 98.5 76.1 5.6 Content of antenatal care Percentage of women age 15-49 years with a live birth in the last 2 years who had their blood pressure measured and gave urine and blood samples during the last pregnancy that led to a live birth 90.0 5.7 MDG 5.2 Skilled attendant at delivery Percentage of women age 15-49 years with a live birth in the last 2 years who were attended by skilled health personnel during their most recent live birth 88.3 5.8 Institutional deliveries Percentage of women age 15-49 years with a live birth in the last 2 years whose most recent live birth was delivered in a health facility 87.7 5.9 Caesarean section Percentage of women age 15-49 years whose most recent live birth in the last 2 years was delivered by caesarean section 11.6 Post-natal health checks 5.10 Post-partum stay in health facility Percentage of women age 15-49 years who stayed in the health facility for 12 hours or more after the delivery of their most recent live birth in the last 2 years 90.2 5.11 Post-natal health check for the newborn Percentage of last live births in the last 2 years who received a health check while in facility or at home following delivery, or a post-natal care visit within 2 days after delivery 90.4 5.12 Post-natal health check for the mother Percentage of women age 15-49 years who received a health check while in facility or at home following delivery, or a post-natal care visit within 2 days after delivery of their most recent live birth in the last 2 years 87.5 CHILD DEVELOPMENT MICS Indicator Indicator Description Value 6.1 Attendance to early childhood education Percentage of children age 36-59 months who are attending an early childhood education programme 29.5 6.2 Support for learning Percentage of children age 36-59 months with whom an adult has engaged in four or more activities to promote learning and school readiness in the last 3 days 38.6 Page| viii P a g e | viii CHILD DEVELOPMENT MICS Indicator Indicator Description Value 6.3 Father’s support for learning Percentage of children age 36-59 months whose biological father has engaged in four or more activities to promote learning and school readiness in the last 3 days 1.8 6.4 Mother’s support for learning Percentage of children age 36-59 months whose biological mother has engaged in four or more activities to promote learning and school readiness in the last 3 days 16.4 6.5 Availability of children’s books Percentage of children under age 5 who have three or more children’s books 5.9 6.6 Availability of playthings Percentage of children under age 5 who play with two or more types of playthings 67.0 6.7 Inadequate care Percentage of children under age 5 left alone or in the care of another child younger than 10 years of age for more than one hour at least once in the last week 16.5 6.8 Early child development index Percentage of children age 36-59 months who are developmentally on track in at least three of the following four domains: literacy-numeracy, physical, social- emotional, and learning 64.9 LITERACY AND EDUCATION MICS Indicator Indicator Description Value 7.1 MDG 2.3 Literacy rate among young people Percentage of young people age 15-24 years who are able to read a short simple statement about everyday life or who attended secondary or higher education (a) women (b) men 95.3 92.1 7.2 School readiness Percentage of children in first grade of primary school who attended pre-school during the previous school year 60.6 7.3 Net intake rate in primary education Percentage of children of school-entry age who enter the first grade of primary school 89.3 7.4 MDG 2.1 Primary school net attendance ratio (adjusted) Percentage of children of primary school age currently attending primary or secondary school 97.7 7.5 Secondary school net attendance ratio (adjusted) Percentage of children of secondary school age currently attending secondary school or higher 50.4 7.6 MDG 2.2 Children reaching last grade of primary Percentage of children entering the first grade of primary school who eventually reach last grade 92.9 7.7 Primary completion rate Number of children attending the last grade of primary school (excluding repeaters) divided by number of children of primary school completion age (age appropriate to final grade of primary school) 90.9 7.8 Transition rate to secondary school Number of children attending the last grade of primary school during the previous school year who are in the first grade of secondary school during the current school year divided by number of children attending the last grade of primary school during the previous school year 85.5 7.9 MDG 3.1 Gender parity index (primary school) Primary school net attendance ratio (adjusted) for girls divided by primary school net attendance ratio (adjusted) for boys 1.01 7.10 MDG 3.1 Gender parity index (secondary school) Secondary school net attendance ratio (adjusted) for girls divided by secondary school net attendance ratio (adjusted) for boys 1.19 Page| ixP a g e | ix CHILD PROTECTION Birth registration MICS Indicator Indicator Description Value 8.1 Birth registration Percentage of children under age 5 whose births are reported registered 53.5 Child discipline 8.3 Violent discipline Percentage of children age 1-14 years who experienced psychological aggression or physical punishment during the last one month 88.3 Early marriage and polygyny 8.4 Marriage before age 15 Percentage of people age 15-49 years who were first married or in union before age 15 (a) Women (b) Men 1.3 0.2 8.5 Marriage before age 18 Percentage of people age 20-49 years who were first married or in union before age 18 (a) Women (b) Men 8.8 1.7 8.6 Young people age 15-19 years currently married or in union Percentage of young people age 15-19 years who are married or in union (a) Women (b) Men 4.0 0.0 8.7 Polygyny Percentage of people age 15-49 years who are in a polygynous union (a) Women (b) Men 11.7 8.2 8.8a 8.8b Spousal age difference Percentage of young women who are married or in union and whose spouse is 10 or more years older, (a) among women age 15-19 years, (b) among women age 20-24 years (32.5) 22.5 Attitudes towards domestic violence 8.12 Attitudes towards domestic violence Percentage of people age 15-49 years who state that a husband is justified in hitting or beating his wife in at least one of the following circumstances: (1) she goes out without telling him, (2) she neglects the children, (3) she argues with him, (4) she refuses sex with him, (5) she burns the food (a) Women (b) Men 19.9 17.0 CP.S1 Attitudes towards domestic violence Percentage of men age 15-59 years who state that a husband is justified in hitting or beating his wife in at least one of the following circumstances: (1) she goes out without telling him, (2) she neglects the children, (3) she argues with him, (4) she refuses sex with him, (5) she burns the food 16.3 8.13 Children’s living arrangements Percentage of children age 0-17 years living with neither biological parent 33.2 8.14 Prevalence of children with one or both parents dead Percentage of children age 0-17 years with one or both biological parents dead 20.4 8.15 Children with at least one parent living abroad Percentage of children 0-17 years with at least one biological parent living abroad 13.0 ( ) Figures that are based on 25-49 unweighted cases Page| x P a g e | x HIV/AIDS AND SEXUAL BEHAVIOUR HIV/AIDS knowledge and attitudes MICS Indicator Indicator Description Value - Have heard of AIDS Percentage of people age 15-49 years who have heard of AIDS (a) Women (b) Men 99.8 99.8 - Have heard of AIDS Percentage of men age 15-59 years who have heard of AIDS 99.8 9.1 MDG 6.3 Knowledge about HIV prevention among young people Percentage of young people age 15-24 years who correctly identify ways of preventing the sexual transmission of HIV, and who reject major misconceptions about HIV transmission (a) Women (b) Men 49.1 50.9 9.2 Knowledge of mother- to-child transmission of HIV Percentage of people age 15-49 years who correctly identify all three means of mother-to-child transmission of HIV (a) Women (b) Men 66.5 52.9 HA.S2 Knowledge of mother- to-child transmission of HIV Percentage of men age 15-59 years who correctly identify all three means of mother-to-child transmission of HIV 52.2 9.3 Accepting attitudes towards people living with HIV Percentage of people age 15-49 years expressing accepting attitudes on all four questions toward people living with HIV (a) Women (b) Men 37.4 36.2 HA.S3 Accepting attitudes towards people living with HIV Percentage of men age 15-59 years expressing accepting attitudes on all four questions toward people living with HIV 37.0 HIV testing 9.4 People who know where to be tested for HIV Percentage of people age 15-49 years who state knowledge of a place to be tested for HIV (a) Women (b) Men 97.4 96.4 HA.S4 People who know where to be tested for HIV Percentage of men age 15-59 years who state knowledge of a place to be tested for HIV 96.5 9.5 People who have been tested for HIV and know the results Percentage of people age 15-49 years who have been tested for HIV in the last 12 months and who know their results (a) Women (b) Men 66.5 54.5 HA.S5 People who have been tested for HIV and know the results Percentage of men age 15-49 years who have been tested for HIV in the last 12 months and who know their results 55.3 9.6 Sexually active young people who have been tested for HIV and know the results Percentage of young people age 15-24 years who have had sex in the last 12 months, who have been tested for HIV in the last 12 months and who know their results (a) Women (b) Men 80.2 62.3 Page| xi P a g e | xi 9.7 HIV counselling during antenatal care Percentage of women age 15-49 years who had a live birth in the last 2 years and received antenatal care during the pregnancy of their most recent birth, reporting that they received counselling on HIV during antenatal care 89.9 9.8 HIV testing during antenatal care Percentage of women age 15-49 years who had a live birth in the last 2 years and received antenatal care during the pregnancy of their most recent birth, reporting that they were offered and accepted an HIV test during antenatal care and received their results 95.3 Sexual behaviour 9.9 Young people who have never had sex Percentage of never married young people age 15-24 years who have never had sex (a) Women (b) Men 54.5 53.6 9.10 Sex before age 15 among young people Percentage of young people age 15-24 years who had sexual intercourse before age 15 (a) Women (b) Men 3.0 2.8 9.11 Age-mixing among sexual partners Percentage of women age 15-24 years who had sex in the last 12 months with a partner who was 10 or more years older 14.5 9.12 Multiple sexual partnerships Percentage of people age 15-49 years who had sexual intercourse with more than one partner in the last 12 months (a) Women (b) Men 3.3 21.1 HA.S7 Multiple sexual partnerships Percentage of men age 15-59 years who had sexual intercourse with more than one partner in the last 12 months 20.6 9.13 Condom use at last sex among people with multiple sexual partnerships Percentage of people age 15-49 years who report having had more than one sexual partner in the last 12 months who also reported that a condom was used the last time they had sex (a) Women (b) Men 66.0 82.6 HA.S8 Condom use at last sex among people with multiple sexual partnerships Percentage of men age 15-59 years who report having had more than one sexual partner in the last 12 months who also reported that a condom was used the last time they had sex 80.8 9.14 Sex with non-regular partners Percentage of sexually active young people age 15-24 years who had sex with a non-marital, non-cohabitating partner in the last 12 months (a) Women (b) Men 37.3 40.9 9.15 MDG 6.2 Condom use with non- regular partners Percentage of young people age 15-24 years reporting the use of a condom during the last sexual intercourse with a non-marital, non-cohabiting sex partner in the last 12 months (a) Women (b) Men 70.9 93.4 Orphans 9.16 MDG 6.4 Ratio of school attendance of orphans to school attendance of non-orphans Proportion attending school among children age 10-14 years who have lost both parents divided by proportion attending school among children age 10-14 years whose parents are alive and who are living with one or both parents 1.00 Male circumcision 9.17 Male circumcision Percentage of men age 15-49 years who report having been circumcised 25.0 HA.S9 Male circumcision Percentage of men age 15-59 years who report having been circumcised 24.3 Page| xiiP a g e | xii ACCESS TO MASS MEDIA AND ICT Access to mass media MICS Indicator Indicator Description Value 10.1 Exposure to mass media Percentage of people age 15-49 years who, at least once a week, read a newspaper or magazine, listen to the radio, and watch television (a) Women (b) Men 22.6 30.9 MT.S1 Exposure to mass media Percentage of men age 15-59 years who, at least once a week, read a newspaper or magazine, listen to the radio, and watch television 30.1 Use of information/communication technology 10.2 Use of computers Percentage of young people age 15-24 years who used a computer during the last 12 months (a) Women (b) Men 42.7 48.9 10.3 Use of internet Percentage of young people age 15-24 years who used the internet during the last 12 months (a) Women (b) Men 39.8 55.6 SUBJECTIVE WELL-BEING MICS Indicator Indicator Description Value 11.1 Life satisfaction Percentage of young people age 15-24 years who are very or somewhat satisfied with their life, overall (a) Women (b) Men 82.5 84.8 11.2 Happiness Percentage of young people age 15-24 years who are very or somewhat happy (a) Women (b) Men 75.5 75.6 11.3 Perception of a better life Percentage of young people age 15-24 years whose life improved during the last one year, and who expect that their life will be better after one year (a) Women (b) Men 62.2 62.8 TOBACCO AND ALCOHOL USE Tobacco use MICS Indicator Indicator Description Value 12.1 Tobacco use Percentage of people age 15-49 years who smoked cigarettes, or used smoked or smokeless tobacco products at any time during the last one month (a) Women (b) Men 1.3 14.7 12.2 Smoking before age 15 Percentage of people age 15-49 years who smoked a whole cigarette before age 15 (a) Women (b) Men 0.2 2.9 Page| xiii P a g e | xiii TA.S1 Smoking before age 15 Percentage of men age 15-59 years who smoked a whole cigarette before age 15 2.8 Alcohol Use 12.3 Use of alcohol Percentage of people age 15-49 years who had at least one alcoholic drink at any time during the last one month (a) Women (b) Men 5.5 25.5 TA.S3 Use of alcohol Percentage of men age 15-59 years who had at least one alcoholic drink at any time during the last one month 25.9 12.4 Use of alcohol before age 15 Percentage of people age 15-49 years who had at least one alcoholic drink before age 15 (a) Women (b) Men 1.5 5.9 TA.S2 Use of alcohol before age 15 Percentage of men age 15-59 years who had at least one alcoholic drink before age 15 5.8 Page| xiv Table of Contents Summary Table of Survey Implementation and the Survey Population, Swaziland MICS, 2014 . iii Summary Table of Findings . iv Table of Contents . xiv List of Tables . xvii List of Figures. xxii List of Abbreviations . xxiv Preface . xxvi Executive Summary .1 1. Introduction .1 1.1 Background .1 1.2 Survey Objectives .2 2. Sample and Survey Methodology .3 2.1 Sample Design .3 2.2 Questionnaires .3 2.3 Training and Fieldwork .6 2.4 Data Processing .6 3. Sample Coverage and the Characteristics of Households and Respondents .7 3.1 Sample Coverage .7 3.2 Characteristics of Households .9 3.3 Characteristics of Female and Male Respondents 15-49 Years of Age and Children Under-5 .12 3.4 Housing characteristics, asset ownership, and wealth quintiles .15 4. Child Mortality .19 5. Nutrition .24 5.1 Low Birth Weight .24 5.2 Nutritional Status .26 5.3 Breastfeeding and Infant and Young Child Feeding .30 5.4 Salt Iodization .41 6. Child Health .44 6.1 Vaccinations .44 6.2 Neonatal Tetanus Protection .50 6.3 Care of Illness .51 Page| xv Diarrhoea .54 Solid Fuel Use .71 Fever .74 7. Water and Sanitation .76 7.1 Use of Improved Water Sources .76 7.2 Use of Improved Sanitation .85 7.3 Handwashing .93 8. Reproductive Health .95 8.1 Fertility .95 8.2 Contraception .101 8.3 Unmet Need .104 8.4 Antenatal Care .107 8.5 Assistance at Delivery .112 8.6 Place of Delivery .115 8.7 Post-natal Health Checks .117 9. Early Childhood Development .127 9.1 Early Childhood Care and Education .127 9.2 Quality of Care .130 9.3 Developmental Status of Children .135 10. Literacy and Education .138 10.1 Literacy among Young Women and Men .138 10.2 School Readiness .140 10.3 Primary and Secondary School Participation .142 11. Child Protection .155 11.1 Birth Registration .155 11.2 Child Discipline .158 11.3 Early Marriage and Polygyny .163 11.4 Attitudes toward Domestic Violence .171 11.5 Children’s Living Arrangements .175 12. HIV/AIDS and Sexual Behaviour .177 12.1 Knowledge about HIV Transmission and Misconceptions about HIV .177 12.2 Accepting Attitudes toward People Living with HIV .188 12.3 Knowledge of a Place for HIV Testing, Counselling and Testing during Antenatal Care . 193 12.4 Sexual Behaviour Related to HIV Transmission .197 12.5 HIV Indicators for Young Women and Young Men .200 12.6 Male circumcision .210 Page| xvi 13. Access to Mass Media and Use of Information/Communication Technology .216 13.1 Access to Mass Media .216 13.2 Use of Information/Communication Technology .218 14. Subjective well-being .222 15. Tobacco and Alcohol Use .232 15.1 Tobacco Use .232 15.2 Alcohol Use .239 16. Orphans and Vulnerable Children .242 16.1 Orphanhood and Vulnerability among Children .242 16.2 Access to minimum basic needs .243 16.3 HIV and Orphanhood .245 16.4 School Attendance among OVC .246 16.5 Nutrition .250 16.6 Sexual Debut .252 16.7 Children’s Living Arrangements and orphanhood .254 17. Social Participation .256 18. Reported Prevalence of Non Communicable Diseases (NCDs) .260 Appendix A. Documents Reviewed .268 Appendix B. Swaziland MICS5 Indicator Tables .273 Appendix C. Sample Design .289 Appendix D. Estimates of Sampling Errors .294 Appendix E. List of Personnel Involved in the Survey .303 Appendix F. Data Quality Tables .308 Appendix G. Swaziland MICS5 Indicators: Numerators and Denominators .326 Appendix H. Swaziland MICS Questionnaires .338 Page| xvii List of Tables Table HH.1: Results of household, women’s, men’s and under-5 interviews .8 Table HH.2: Household age distribution by sex .9 Table HH.3: Household composition .11 Table HH.4: Women’s background characteristics .13 Table HH.4M: Men’s background characteristics .14 Table HH.5: Under-5’s background characteristics .15 Table HH.6: Housing characteristics .16 Table HH.7: Household and personal assets .17 Table HH.8: Wealth quintiles .18 Table CM.1: Early childhood mortality rates .20 Table CM.2: Early childhood mortality rates by socioeconomic characteristics .21 Table CM.3: Early childhood mortality rates by demographic characteristics .22 Table NU.1: Low birth weight infants .25 Table NU.2: Nutritional status of children .28 Table NU.3: Initial breastfeeding .32 Table NU.4: Breastfeeding .34 Table NU.5: Duration of breastfeeding .36 Table NU.6: Age-appropriate breastfeeding .37 Table NU.7: Introduction of solid, semi-solid, or soft foods .38 Table NU.8: Infant and young child feeding (IYCF) practices .39 Table NU.9: Bottle feeding .41 Table NU.10: Iodized salt consumption .42 Table CH.1: Vaccinations in the first years of life .47 Table CH.2: Vaccinations by background characteristics .49 Table CH.3: Neonatal tetanus protection .51 Table CH.4: Reported disease episodes .53 Table CH.5: Care-seeking during diarrhoea .55 Table CH.6: Feeding practices during diarrhoea .57 Table CH.7: Oral rehydration solutions, recommended homemade fluids, and zinc .59 Table CH.8: Oral rehydration therapy with continued feeding and other treatments .62 Table CH.9: Source of ORS and zinc .65 Table CH.10: Care-seeking for and antibiotic treatment of symptoms of acute respiratory infection (ARI) .68 Table CH.11: Knowledge of the two danger signs of pneumonia .70 Table CH.12: Solid fuel use .72 Table CH.13: Solid fuel use by place of cooking .73 Table CH.14: Care-seeking during fever .74 Table WS.1: Use of improved water sources .78 Table WS.2: Household water treatment .81 Table WS.3: Time to source of drinking water .84 Table WS.4: Person collecting water .87 Table WS.5: Types of sanitation facilities .85 Table WS.6: Use and sharing of sanitation facilities .87 Table WS.7: Drinking water and sanitation ladders .90 Page| xviii Table WS.8: Disposal of child’s faeces .92 Table WS.9: Availability of soap or other cleansing agent .94 Table RH.1: Fertility rates .96 Table RH.2: Adolescent birth rate and total fertility rate .98 Table RH.3: Early childbearing .99 Table RH.4: Trends in early childbearing .100 Table RH.5: Use of contraception .102 Table RH.6: Unmet need for contraception .106 Table RH.7: Antenatal care coverage .108 Table RH.8: Number of antenatal care visits and timing of first visit .109 Table RH.9: Content of antenatal care .111 Table RH.10: Assistance during delivery and caesarean section .113 Table RH.11: Place of delivery .116 Table RH.12: Post-partum stay in health facility .118 Table RH.13: Post-natal health checks for newborns .120 Table RH.14: Post-natal care visits for newborns within one week of birth .122 Table RH.15: Post-natal health checks for mothers .123 Table RH.16: Post-natal care visits for mothers within one week of birth .125 Table RH.17: Post-natal health checks for mothers and newborns .126 Table CD.1: Early childhood education .129 Table CD.2: Support for learning .131 Table CD.3: Learning materials .134 Table CD.4: Inadequate care .135 Table CD.5: Early child development index .137 Table ED.1: Literacy (young women) .139 Table ED.1M: Literacy (young men) .140 Table ED.2: School readiness .141 Table ED.3: Primary school entry .143 Table ED.4: Primary school attendance and out of school children.144 Table ED.5: Secondary school attendance and out of school children .147 Table ED.6: Children reaching last grade of primary school .149 Table ED.7: Primary school completion and transition to secondary school .151 Table ED.8: Education gender parity .152 Table ED.9: Out of school gender parity .153 Table CP.1: Birth registration .157 Table CP.2: Child discipline .160 Table CP.3: Attitudes toward physical punishment .162 Table CP.4: Early marriage and polygyny (women) .164 Table CP.4M: Early marriage and polygyny (men) .166 Table CP.5: Trends in early marriage (women) .168 Table CP.5M: Trends in early marriage (men) .169 Table CP.6: Spousal age difference .171 Table CP.7: Attitudes toward domestic violence (women) .172 Table CP.7M: Attitudes toward domestic violence (men) .174 Table CP.8: Children with parents living abroad .175 Page| xix Table HA.1: Knowledge about HIV transmission, misconceptions about HIV, and comprehensive knowledge about HIV transmission (women) .179 Table HA.1M: Knowledge about HIV transmission, misconceptions about HIV, and comprehensive knowledge about HIV transmission (men) .181 Table HA.2: Knowledge of mother-to-child HIV transmission (women) .184 Table HA.2M: Knowledge of mother-to-child HIV transmission (men).186 Table HA.3: Accepting attitudes toward people living with HIV (women) .189 Table HA.3M: Accepting attitudes toward people living with HIV (men) .191 Table HA.4: Knowledge of a place for HIV testing (women) .194 Table HA.4M: Knowledge of a place for HIV testing (men) .195 Table HA.5: HIV counselling and testing during antenatal care.196 Table HA.6: Sex with multiple partners (women).198 Table HA.6M: Sex with multiple partners (men) .199 Table HA.7: Key HIV and AIDS indicators (young women) .201 Table HA.7M: Key HIV and AIDS indicators (young men).203 Table HA.8: Key sexual behaviour indicators (young women) .206 Table HA.8M: Key sexual behaviour indicators (young men) .208 Table HA.9: Male circumcision .212 Table HA.10: Provider and location of circumcision .214 Table MT.1: Exposure to mass media (women) .217 Table MT.1M: Exposure to mass media (men) .218 Table MT.2: Use of computers and internet (women) .220 Table MT.2M: Use of computers and internet (men) .221 Table SW.1: Domains of life satisfaction (women).223 Table SW.1M: Domains of life satisfaction (men) .225 Table SW.2: Overall life satisfaction and happiness (women) .228 Table SW.2M: Overall life satisfaction and happiness (men) .229 Table SW.3: Perception of a better life (women) .230 Table SW.3M: Perception of a better life (men) .231 Table TA.1: Current and ever use of tobacco (women) .233 Table TA.1M: Current and ever use of tobacco (men) .235 Table TA.2: Age at first use of cigarettes and frequency of use (women) .238 Table TA.2M: Age at first use of cigarettes and frequency of use (men) .239 Table TA.3: Use of alcohol (women) .240 Table TA.3M: Use of alcohol (men) .241 Table OV.1: Prevalence of orphanhood and vulnerability among children .243 Table OV.2: Access to minimum basic needs by orphans and vulnerable children .244 Table OV.3: School attendance of orphans and non-orphans .246 Table OV.4: School attendance of orphans and vulnerable children (10-14 years) .247 Table OV.4A: School attendance of orphans and vulnerable children (6-17 years) .249 Table OV.5: Nutritional status of OVC and non-OVC .251 Table OV.6: Sexual intercourse before age 15 by OVC status .253 Table OV.7: Children’s living arrangements and orphanhood .255 Table SP.1: Attended social activities or events (women) .258 Table SP.1M: Attended social activities or events (men) .259 Table ND.1: Suffering non-communicable diseases (women) .262 Page| xx Table ND.1M: Suffering non-communicable diseases (men) .263 Appendices: Table CP.5M: Trends in early marriage (men) .273 Table CP.7M: Attitudes toward domestic violence (men) .274 Table HA.1M: Knowledge about HIV transmission, misconceptions about HIV, and comprehensive knowledge about HIV transmission (men) .275 Table HA.2M: Knowledge of mother-to-child HIV transmission (men).277 Table HA.3M: Accepting attitudes toward people living with HIV (men) .279 Table HA.4M: Knowledge of a place for HIV testing .281 Table HA.6M: Sex with multiple partners (men) .282 Table HA.10: Male circumcision .283 Table MT.1M: Exposure to mass media (men) .284 Table TA.2M: Age at first use of cigarettes and frequency of use (men) .285 Table TA.3M: Use of alcohol (men) .286 Table SP.1M: Attended social activities or events (men) .287 Table ND.1M: Suffering from non-communicable disease (men) .288 Table SD.1: Allocation of Sample Clusters (Primary Sampling Units) to Sampling Strata .290 Table SE.1: Indicators selected for sampling error calculations .295 Table SE.2: Sampling errors: Total sample .296 Table SE.3: Sampling errors: Urban .297 Table SE.4: Sampling errors: Rural .298 Table SE.5: Sampling errors: Hhohho region .299 Table SE.6: Sampling errors: Manzini region .300 Table SE.7: Sampling errors: Shiselweni region .301 Table SE.8: Sampling errors: Lubombo region .302 Table DQ.1: Age distribution of household population .308 Table DQ.2: Age distribution of eligible and interviewed women .310 Table DQ.3: Age distribution of eligible and interviewed men .310 Table DQ.4: Age distribution of children in household and under-5 questionnaires .311 Table DQ.5: Birth date reporting: Household population .311 Table DQ.6: Birth date and age reporting: Women .312 Table DQ.7: Birth date and age reporting: Men .312 Table DQ.8: Birth date and age reporting: Under-5s .313 Table DQ.9: Birth date reporting: Children, adolescents and young people .313 Table DQ.10: Birth date reporting: First and last births .314 Table DQ.11: Completeness of reporting .315 Table DQ.12: Completeness of information for anthropometric indicators: Underweight .316 Table DQ.13: Completeness of information for anthropometric indicators: Stunting .316 Table DQ.14: Completeness of information for anthropometric indicators: Wasting .317 Table DQ.15: Heaping in anthropometric measurements .317 Table DQ.16: Observation of birth certificates .318 Table DQ.17: Observation of vaccination cards .319 Page| xxi Table DQ.18: Observation of women’s health cards .319 Table DQ.19: Observation of places for handwashing .320 Table DQ.20: Presence of mother in the household and the person interviewed for the under-5 questionnaire .320 Table DQ.21: Selection of children age 1-17 years for the child labour and child discipline modules .321 Table DQ.22: School attendance by single age .322 Table DQ.23: Sex ratio at birth among children ever born and living .323 Table DQ.24: Births in years preceding the survey .323 Table DQ.25: Reporting of age at death in days .324 Table DQ.26: Reporting of age at death in months .325 Page| xxii List of Figures Figure HH.1: Age and sex distribution of household population .10 Figure CM.1: Early child mortality rates .20 Figure CM.2: Trend in under-5 mortality rates .23 Figure NU.1: Underweight, stunted, wasted and overweight children under age 5 (moderate and severe) .30 Figure NU.2: Initiation of breastfeeding .33 Figure NU.3: Infant feeding patterns by age .35 Figure NU.4: Consumption of iodized salt .43 Figure CH.1: Vaccinations by age 12 months .48 Figure CH.2: Children under-5 with diarrhoea who received ORS or recommended homemade liquids .60 Figure CH.3: Children under-5 with diarrhoea receiving oral rehydration therapy (ORT) and continued feeding .64 Figure WS.1: Percent distribution of household members by source of drinking water .79 Figure WS.2: Percent distribution of household members using improved water sources by wealth .80 Figure WS.3: Percent distribution of household members by use and sharing of sanitation facilities .88 Figure WS.4: Percent distribution of household members using improved sanitation facilities by wealth .91 Figure RH.1: Age-specific fertility rates by area .97 Figure RH.2: Differentials in contraceptive use .104 Figure RH.3: Person assisting at delivery .115 Figure ED.1: Education indicators by sex .154 Figure CP.1: Children under-5 whose births are registered .158 Figure CP.2: Child disciplining methods, children age 1-14 years .161 Figure CP.3: Early marriage among women .170 Figure HA.1: Women and men with comprehensive knowledge of HIV transmission .183 Figure HA.2: Sexual behaviour that increases the risk of HIV infection, young people age 15-24 .210 Figure TA.1: Ever and current smokers .237 Figure OV.1: Access to minimum basic needs among children age 5-17 years .245 Figure OV.2: Percent of children under-five stunted by OVC status .252 Figure OV.3: Percent of children under-five underweight by OVC status .253 Page| xxiii Appendix: Figure DQ.1: Number of household population by single ages .309 Figure DQ.2: Weight and height/length measurements by digits reported for the decimal points .318 Page| xxivP a g e | xxiv List of Abbreviations AIDS Acquired Immune Deficiency Syndrome ANC Antenatal Care ASFRs Age-specific fertility rates ASRH Adolescent Sexual Reproductive Health BCG Bacillus Calmette-Guérin (tuberculosis vaccine) BMD The Births, Marriages and Deaths Registration Act CBR Crude birth rate CDIS Culture for Development Indicators CPR Contraceptive Prevalence Rate CRC Convention of the Rights of the Child CSO Central Statistical Office CSPro Census and Survey Processing System CVD Cardiovascular Diseases DBP Diastolic Blood Pressure DM Diabetes Mellitus DPT Diphtheria, Pertussis, Tetanus EA Enumeration Area ECCE Early Childhood Care and Education ECCI Early Childhood Care Index ECDI Early Child Development Index EFA Education for All EPI Expanded Programme on Immunization FPE Free Primary Education GARPR Global AIDS Response Progress Reporting GDP Gross Domestic Product GVAP Global Vaccine Action Plan GPI Gender Parity Index HIV Human Immunodeficiency Virus HMIS Health Management Information System ID National Identity card IDD Iodine Deficiency Disorders ICPD International Conference on Population and Development ICT Information and Communication Technology ISCED International Standard for the Classification of Education IUD Intrauterine device LAM Lactational amenorrhea method MDG Millennium Development Goal MICS Multiple Indicator Cluster Survey MICS5 Fifth global round of Multiple Indicator Clusters Surveys programme MNCH Maternal Neonatal and Child Health MoEPD Ministry of Economic Planning and Development MoET Ministry of Education and Training MoH Ministry of Health MTCT Mother-to-Child Transmission (of HIV) NAR Net Attendance Ratio NCP Neighbourhood Care Point NCD Non Communicable Diseases NDS National Development Strategy Vision 2022 Page| xxv P a g e | xxv NERCHA National Emergency Response Council on HIV/AIDS NETIP National Education and Training Improvement Programme NHP National Health policy NHSSPII National Health Sector Strategic Plan II. NN Neonatal mortality NPA National Plan of Action for Children NPSRH National Policy on Sexual and Reproductive Health NSRHRSP National Sexual and Reproductive Health and Rights Strategic Plan NSF National Multi-Sectoral Strategic Framework for HIV/AIDS NSRHS National Sexual Reproductive Health Strategy ORS Oral Rehydration Salts ORT Oral rehydration treatment OVC Orphaned and Vulnerable Children PMTCT Prevention of Mother-to-Child Transmission Ppm Parts per million PNC Post-natal care PNHC Post-natal Health Checks PNN Post-neonatal mortality PRSAP Poverty Reduction Strategy and Action Plan PSU Primary Sampling Unit SBP Systolic Blood Pressure SDG Sustainable Developmental Goals SDP Sector Development Plan SNCAC Swaziland National Council of Arts and Culture SNNC Swaziland National Nutrition Council SNTC Swaziland National Trust Commission SPSS Statistical Package for Social Sciences STEPS The WHO STEPWISE Approach to Surveillance TFR Total Fertility Rate UN United Nations UNAIDS United Nations Programme on HIV/AIDS UNDAF United Nations Development Assistance Framework UNDP United Nations Development Programme UNESCO United Nations, Educational, Scientific and Cultural Organization UNFPA United Nations Population Fund UNGASS United Nations General Assembly 26th Special Session UNICEF United Nations Children’s Fund UPE Universal Primary Education UNGASS United Nations General Assembly Special Session on HIV/AIDS VMMC Voluntary Male Medical Circumcision WFFC World Fit for Children WFP World Food Programme WHO World Health Organization Page| xxvi Preface In 2014, the Central Statistical Office (CSO) conducted the fifth round of the Multiple Indicator Cluster Survey (MICS), an international household survey developed by UNICEF to monitor progress towards the goals and targets of the Plan of Action for the World Fit For Children (WFFC) Declaration and the Millennium Declaration. The 2014 Swaziland MICS was implemented in collaboration with various ministries and agencies, including the Deputy Prime Minister’s Office, the Ministry of Health, the Ministry of Education and Training, the Ministry of Natural Resources and Energy, the National Emergency Response Council on HIV/AIDS (NERCHA), and United Nations agencies. This report presents results of the 2014 Swaziland MICS. CSO wishes to acknowledge the expert contributions of the MICS Technical and Steering Committees and the UNICEF Country Office for their invaluable guidance in all the phases of this work. We greatly appreciate the contribution and commitment made by CSO staff throughout the survey process. Special recognition is due to all field teams for working tirelessly to bring the survey to a successful conclusion. Lastly, sincere appreciation goes to all interviewed households for their time and cooperation, without which the survey could have not taken place. We are indebted to the UNICEF Global and Regional Offices for the technical backstopping for the survey. We are also grateful for the full financial support from the Government of the Kingdom of Swaziland, as well as technical assistance and financial assistance from other partners like UNICEF, UNFPA, UNESCO and NERCHA. It is hoped that the findings will contribute to informed policies and programmes that help improve the lives of the Swazi population. Amos M. Zwane Director, Central Statistical Office Page| 1P a g e | 1 Executive Summary This report presents results of the fourth round of the Multiple Indicator Cluster Survey (MICS) carried out by Central Statistical Office (CSO) in 2014. MICS is an international household survey initiative developed by UNICEF to monitor progress towards the goals and targets of the Plan of Action for the World Fit For Children (WFFC) Declaration and the Millennium Declaration. The 2014 Swaziland MICS was designed to provide estimates for indicators on the situation of the country at the national level, for urban and rural areas, and for the four administrative regions of Swaziland: Hhohho, Manzini, Shiselweni and Lubombo. The 2014 Swaziland MICS consists of four main questionnaires including a household questionnaire, women’s and men’s questionnaires and a questionnaire for children under age five. The following topics were included in each of the questionnaires: Household questionnaire: household information panel, list of household members, household composition, children orphaned and made vulnerable, education and basic needs, child discipline, household characteristics, water and sanitation, hand washing and salt iodization. Questionnaire for children under-five: child information panel, birth registration, early childhood development, breastfeeding and dietary intake, immunization, care of illness (including diarrhoea and fever and pneumonia) and anthropometry. Women’s questionnaire: women’s information panel, woman’s background, access to media and use of information/communication technology, fertility /birth history, desire for last birth, maternal and newborn health, post-natal health checks, illness symptoms, contraception, unmet need, attitudes towards domestic violence, marriage/union, sexual behaviour, HIV/AIDS, non-communicable diseases, tobacco and alcohol use, life satisfaction, and social participation. Men’s questionnaire: man’s information panel, man’s background, , access to media and use of information/communication technology, fertility, attitudes towards domestic violence, marriage/union, contraception, sexual behaviour, HIV/AIDS, non-communicable diseases, male circumcision, tobacco and alcohol use, life satisfaction, and social participation. Sample Coverage The 2014 Swaziland MICS is based on a nationally representative sample of 5,211 households selected from 365 enumeration areas distributed in the four regions of the country. The target populations were men age 15–59 years, women age 15–49 years and children under- five years of age. A total of 4,981 households were successfully interviewed, which included 4,762 women age 15–49 years, 1,459 men age 15–59 years and 2,693 mothers/caretakers of children under-five years. Response rates were generally high for all target population sub-groups: 95 percent for women, 90 for men and 99 for children under-five years. The overall household response rate was 98 percent. Child Mortality In the 2014 Swaziland MICS, a direct method based on birth histories of women was used to estimate child mortality rates. The results indicate that neonatal mortality in the five years preceding the survey is 20 deaths per 1,000 live births, post neonatal mortality is 30 deaths per 1,000 live births, and infant mortality is 50 per 1,000 live births while under-five mortality is 67 per 1,000 live births. The results suggest a decreasing trend in under-five mortality at the national level, during the last 15 years. Page| 2 P a g e | 2 Nutrition Status Children’s nutritional status is a reflection of their overall health. When children are not exposed to repeated illnesses, are well cared for and have access to an adequate food supply – varied enough and rich in micronutrients, such as vitamin A – they have better chances to reach their growth potential. In the 2014 Swaziland MICS, weights and heights of all children under-five years of age were measured using anthropometric equipment recommended by UNICEF. The reference population used in this report is based on WHO growth standards. Nationally, about six percent of children under-five are underweight, i.e., they are thin for their age and about two percent are classified as severely underweight. Overall, 26 percent of under-five children are stunted, i.e., they are short for their age. Stunting is more prevalent in rural areas (27 percent) compared with urban areas (19 percent). Children whose mothers have no education or with primary education and those from the poorest households have the highest rates of stunting (33 percent, 32 percent and 30 percent, respectively). Two percent of under-five children are wasted nationally, meaning that they are thin for their height. Weight at birth is a good indicator not only of a mother's health and nutritional status but also the newborn’s chances for survival, growth, long-term health and psychosocial development. Low birth weight (defined as less than 2,500 grams) carries a range of grave health risks for children. Overall, 92 percent of births were weighed at birth and eight percent of infants weighed less than 2,500 grams at birth. Proper feeding of infants and young children can increase their chances of survival; it can also promote optimal growth and development, especially in the critical window from birth to two years of age. Breastfeeding for the first few years of life protects children from infection, provides an ideal source of nutrients, and is economical and safe. Although a very important step in management of lactation and establishment of a physical and emotional relationship between the baby and the mother, the Swaziland MICS 2014 show that only 48 percent of babies are breastfed for the first time within one hour of birth, while 81 percent of newborns start breastfeeding within one day of birth. Approximately, 64 percent of children less than six months are exclusively breastfed and 70 percent are predominantly breastfed. The results also show that most of the children are not fed appropriately in Swaziland. As a result of feeding patterns, only 40 percent of children age 6-23 months are being appropriately breastfed and age-appropriate breastfeeding among all children age 0-23 months is 45 percent. About 32 percent of children under-six months are fed using a bottle with a nipple. Iodine Deficiency Disorders (IDD) is the world’s leading cause of preventable mental retardation and impaired psychomotor development in young children. In 94 percent of households, salt used for cooking was tested for iodine content by using salt test kits and testing for the presence of potassium iodate. The results show that in 66 percent of households, salt was found to contain 15 parts per million (ppm) or more of iodine meaning these households were using adequately iodized salt. Child Health The Millennium Development Goal (MDG) 4 is to reduce child mortality by two thirds between 1990 and 2015. Immunization plays a key part in this goal. WHO Recommended Routine Immunization for all children, so that all children can be vaccinated against all vaccine preventable diseases which vary amongst countries such as tuberculosis, diphtheria, pertussis, tetanus, polio, measles, rubella, Page| 3 P a g e | 3 hepatitis B, Haemophilus Influenzae type b, Pneumonia, Meningitis and Rotavirus. In the Swaziland MICS 2014, information on vaccination coverage was collected from all children under three years of age. Approximately 97 percent of children age 12-23 months received BCG vaccination by the age of 12 months and the first dose of DPT-HepB-Hib vaccine was given to 96 percent. The percentage declines to 95 percent for the second dose of DPT-HepB-Hib, and 90 percent for the third dose. Similarly, 97 percent of children received Polio 1 by age 12 months and this declines to 84 percent by the third dose. The coverage for the first dose of measles vaccine by 12/24 months is lower than the other vaccines at 86 percent. A key strategy for accelerating progress towards the attainment of MDG 4 is to focus on the diseases which are leading killers of children under-five years old. Diarrhoea and Pneumonia are two of such diseases. Overall, 16 percent of children under-five years were reported to have had diarrhoea in the two weeks preceding the survey, 10 percent symptoms of ARI, and 21 percent an episode of fever. The overall period-prevalence of diarrhoea in children under-five years of age is 16 percent and ranges from 13 percent in Hhohho region to 20 percent in Shiselweni region. Overall, children seen in a health facility or by a provider accounts for 71 percent of cases, predominantly in the public sector (56 percent). About 84 percent received fluids from ORS packets or pre-packaged ORS fluids and 39 percent received recommended homemade fluids (Sugar-Salt-Solution). Additionally, 45 percent received zinc in one form or another. Symptoms of Acute Respiratory Infections (ARI) were collected during the Swaziland MICS5 to capture pneumonia disease, the leading cause of death in children under-five years. The results depict that 60 percent children age 0-59 months with symptoms of ARI were taken to a qualified health provider. Water and Sanitation A safe and sustainable water supply, basic sanitation and good hygiene are fundamental for a healthy, productive and dignified life. Safe drinking water is a basic necessity for good health. Unsafe drinking water can be a significant determinant of diseases such as cholera, typhoid, and schistosomiasis. Drinking water can also be contaminated with chemical and physical contaminants with harmful effects on human health. In addition to preventing disease, improved access to drinking water may be particularly important for women and children, especially in rural areas, who bear the primary responsibility for carrying water, often for long distances. Inadequate disposal of human excreta and personal hygiene is associated with a range of diseases including diarrhoeal diseases and polio and is an important determinant for stunting. Improved sanitation can reduce diarrhoeal disease by more than a third, and can significantly lessen the adverse health impacts of other disorders responsible for death and disease among millions of children in developing countries. The Swaziland MICS 2014 depicts that overall, 72 percent of the population uses an improved source of drinking water: 96 percent in urban areas and 63 percent in rural areas. The survey results show that 17 percent of household members are using unimproved drinking water sources and are using an appropriate water treatment method. Twenty percent of the households in the Lubombo region that are using unimproved drinking water sources are using appropriate water treatment methods while the rate is eight percent in Hhohho region. The survey results also show that for 46 percent of the household population, the drinking water source is on premises and for about eight percent of the Page| 4 P a g e | 4 household population, it takes more than 30 minutes to get to the water source and bring water. Seventeen percent of household members in Lubombo region live in households spending 30 minutes or more to fetch drinking water as compared to the other regions. It could also be noted that the results show that for the majority of households (62 percent), an adult female usually collects drinking water when the source is not on the premises. Adult men collect water in only 21 percent of cases. Fifty-three percent of the household population is using an improved and not shared sanitation facility. Twenty-nine percent of households use an improved toilet facility that is public or shared with other households. Reproductive Health The TFR for the three-year period preceding the Swaziland MICS is 3.3 births per woman. Fertility is higher in rural areas (3.6 births per woman) than in urban areas (2.8 births per woman). The adolescent birth rate is 87 per 1,000. Fourteen percent of women age 15-19 years have already had a live birth. About three percent are pregnant with their first child, and about one percent have had a live birth before age 15. The results also show that 17 percent of women age 20-24 years have had a live birth before age 18. Current use of contraception was reported by 66 percent of women currently married or in union. The most popular methods used are the male condom and injectables which are used by nearly half of married women in Swaziland (24 percent and 22 percent, respectively). Contraceptive prevalence ranges from 62 percent in the Lubombo region to 68 percent in Manzini region. About 73 percent of married women in urban and 63 percent in rural areas use a method of contraception. There is no conclusive decision that can be made on use of contraception by adolescents that are married or in union due to the sample size. The percentage of married women using any method of contraception rises from 58 percent among those with no education to 75 percent with higher education and 69 percent amongst those with tertiary education. The total unmet need is 15 percent whilst the total met need is 66 percent. The antenatal care (ANC) coverage is 99 percent. The majority of ANC is provided by a nurse/midwife (87 percent) while 12 percent of women receive care from a medical doctor. Almost all women (99 percent) residing in urban areas and 98 percent of rural women were attended by a skilled health provider. Over nine in ten mothers (96 percent) received ANC more than once and about three- quarters of mothers received ANC at least four times (76 percent). Overall, 37 percent of women with a live birth in the last two years preceding the survey had their first ANC visit during the first trimester of their last pregnancy, with a median of 4.0 months of pregnancy at the first visit among those who received ANC. About 88 percent of births occurring in the two years preceding the survey were delivered by skilled personnel. Nearly three-quarters of the births (70 percent) in the two years preceding the survey were assisted at delivery by a nurse or midwife. Doctors assisted with the delivery of 18 percent of births. Overall, 12 percent of women who delivered in the last two years preceding the survey had a C- section; for five percent of women, the decision was taken before the onset of labour pains and for seven percent, it was after. In Swaziland, 88 percent of births are delivered in a health facility and 59 percent of deliveries occur in public health facilities whilst 28 percent in private health facilities. One in ten births (10 percent) take place at home. Overall, 90 percent of women who gave birth in a health facility stay 12 hours or more in the facility after delivery. Page| 5 P a g e | 5 Overall, 86 percent of newborns receive a health check following birth while in a health facility or at home. PNC visits predominantly occur after the first week (57 percent), five percent after six days and three percent on the first and second day. As a result, a total of 90 percent of all newborns receive a post-natal health check. Ninety-five percent of health checks following birth occur in health facility deliveries (97 percent in public health facilities and 92 percent in private health facilities). Eighty-eight percent of mothers receive post-natal health checks. The main provider of first PNC visit for mothers are doctors and nurse or midwife (92 percent), eight percent are by community health workers and one percent are by traditional birth attendants. Early Childhood Development Readiness of children for primary school can be improved through attendance to early childhood education programmes or through pre-school attendance. Early childhood education programmes include programmes for children that have organised learning components as opposed to baby-sitting and day-care which do not typically have organised education and learning. The Swaziland MICS 2014 results show that 30 percent of children age 36-59 months are attending an organised early childhood education programme. The findings from the survey indicate that during the three days preceding the survey, 39 percent of children age 36-59 months were engaged with an adult household member in four or more activities that promote learning and school readiness (33 percent for boys and 44 percent for girls). Fathers’ engagement in activities for both male and female children is two percent. Exposure to books in the early childhood years not only provides the child with greater understanding of the nature of print, but also gives the child opportunities to see others reading, such as older siblings doing school work. The survey reveals that in Swaziland, six percent of children age 0-59 months live in households where at least three children’s books are available for the child (12 percent in urban areas and 4 percent in rural areas). There is a positive correlation between the proportion of children with three or more children’s books with an increase in mother’s education and an improvement in household wealth. Sixty-seven percent of children age 0-59 months play with two or more playthings (74 percent in urban areas and 65 percent in rural areas). The survey also shows that 17 percent of the children age 0-59 months were left with inadequate care in the week preceding the survey, 11 percent were left in the care of other children, while eight percent were left alone. Literacy and Education The National Constitution of the Kingdom of Swaziland (2005) declared primary education a right for all Swazis. It further stated that primary education shall be “free and compulsory”. To operationalize this, the Ministry of Education and Training in 2010, through Parliament enacted the “Free Primary Education Act of 2010”, which was to ensure that every Swazi citizen accesses the first seven full years of primary education. The Swaziland MICS 2014 results indicate that 95 percent of young women in Swaziland are literate and that literacy status does not vary that much by area and region. Literacy rate by place of residence shows 96 percent for rural areas and 94 percent for urban communities. The results also show that 92 percent of the young men in Swaziland are literate, three percent lower than their female counterparts. Pre-school education is important for the readiness of children to attend school. Pre-school in Swaziland is defined as the education that is a year before entry into Grade 1. Overall, 61 percent of children who are currently attending the first grade of primary school were attending pre-school the previous year. The proportion is 81 percent for children residing in urban areas compared to 57 percent for their counterparts in rural areas. Page| 6 P a g e | 6 Universal access to basic education and the achievement of primary education by the world’s children is one of the Millennium Development Goals. In Swaziland basic education consists of seven years of primary education plus three years of lower secondary. The majority of children starting grade 1 (93 percent) reach grade 6. The survey results also show that 86 percent of the children who were attending the last grade of primary school in the previous school year were found to be attending the first grade of secondary school in the school year of the survey. Gender parity for primary school is 1.01, indicating no difference in the attendance of girls and boys to primary school. The indicator increases from 1.01 at primary to 1.19 for secondary education indicating that girls were attending at a higher rate than the boys. At secondary level, disadvantage of girls is particularly pronounced in urban areas (0.86), as well as among children living in the wealthiest households (0.95). Child Protection Registering children at birth is the first step in securing their recognition before the law, safeguarding their rights, and ensuring that any violation of these rights does not go unnoticed. Universal birth registration is also part of a system of vital statistics, which is essential for sound economic and social planning. Birth registration is therefore not only a fundamental human right, but also a key to ensuring the fulfilment of other rights. The Swaziland MICS 2014 results show births of 54 percent of children under-five years have been registered. About 21 percent possessed birth certificates seen by the interviewer, 16 percent were said to be in possession but were not seen by the interviewer whilst 17 percent did not have birth certificates but were said to be registered with the Registrar General’s Office. Teaching children self-control and acceptable behaviour is an integral part of child discipline in all cultures. Positive parenting practices involve providing guidance on how to handle emotions or conflicts in manners that encourage judgment and responsibility and preserve children's self-esteem, physical and psychological integrity and dignity. The survey results show that 88 percent of children age 1-14 years were subjected to at least one form of psychological or physical punishment by household members during the past month. About 66 percent of respondents to the household questionnaire believe that physical punishment is a necessary part of child-rearing. Among currently married/in union women age 20-24 years, almost one in four are married/in union with a man who is older by ten years or more (23 percent). Marriage before the age of 18 is a reality for many young girls. Among women age 15-49 years, about one percent were married before age 15 and, among women age 20-49 years, about nine percent of the women were married before age 18. Among all women age 15-49 years who are in union, 12 percent are in polygamous unions. The report presents information on the living arrangements and orphan hood status of children under the age 18 years. Overall, 33 percent of children age 0-17 years live with neither biological parent. About 20 percent of children age 0-17 years have one or both parents deceased. Thirteen percent of children age 0-17 years have at least one parent living abroad. HIV/AIDS and Sexual Behaviour One of the most important prerequisites for reducing HIV infections is accurate knowledge of how HIV is transmitted and strategies for preventing transmission. Correct information is the first step towards raising awareness and giving adolescents and young people the tools to protect themselves from HIV Page| 7 P a g e | 7 infections. According to the Swaziland MICS 2014 results, almost all women age 15-49 years and men age 15-59 years have heard of AIDS. The percentage of those who know of both main ways of preventing HIV transmission, that is – having only one faithful uninfected partner and using a condom every time – is slightly lower (85 percent women and 86 percent men). About 83 percent of women and 85 percent of men know that a healthy looking person can be HIV-positive. Knowledge of mother-to-child transmission of HIV is also an important first step for women to seek HIV testing when they are pregnant to avoid HIV transmission from the mother to the baby. The survey results show that 95 percent of women and 93 percent of men know that HIV can be transmitted from the mother to the child. The percentage of women and men who know all three ways of mother-to- child transmission is 67 percent and 52 percent, respectively. In the Swaziland MICS 2014, stigma and discrimination are considered low if respondents report an accepting attitude on the following four situations: 1) would care for a family member with AIDS in own home; 2) would buy fresh vegetables from a vendor who is HIV-positive; 3) thinks that a female teacher who is HIV-positive should be allowed to teach in school; and 4) would not want to keep it a secret if a family member is HIV-positive. The survey results show almost all respondents, both women and men, who have heard of AIDS agree with at least one accepting statement. In order to protect themselves and to prevent infecting others, it is important for individuals to know their HIV status. The results show that 97 percent women and 96 percent men know where to get tested for HIV, while 87 percent and 76 percent of women and men, respectively, have ever been tested. Further the results show that 67 percent women and 55 percent, men have been tested in the last 12 months preceding the survey and know the result. Promoting safer sexual behaviour is critical for reducing HIV prevalence. The use of condoms during sex, especially when non-regular or multiple partners are involved, is particularly important for reducing the spread of HIV. The survey results depict that about three percent of women age 15-49 years and 21 percent of men age 15-59 years reported having sex with more than one partner in the last 12 months and of those, only 66 percent of women and 83 percent of men report using a condom the last time they had sex. Nationally, almost all women age 15-49 years and men age 15-59 years have heard of HIV. However, only 53 percent of women and 54 percent of men have comprehensive knowledge about HIV transmission. Knowledge of a place to get tested is 97 percent for women and 96 percent for men. More women have ever been tested (87 percent) compared with men (76 percent). The proportion of women and men ever been tested for HIV in the last 12 months before the survey and received results is relatively low, at 67 percent for women and 55 percent for men. Ninety percent of women who attended ANC tested for HIV during pregnancy. In the 2014 Swaziland MICS, a sexual behaviour module was administered to women age 15-49 years and men age 15-59 years to assess risk of HIV infection. The results are also tabulated separately for young women and men (age 15-24 years). The survey found that nationally, 55 percent of women age 15-24 years and 54 percent of men age 15-24 years have never had sex. Only three percent on both young men and women age 15-24 years have had sex before age 15. Sex with multiple partners is more common among men than among women; 21 percent of men age 15-59 years had sex with more than one partner in the last 12 months, whereas only three percent of women age 15-49 years engaged in such an activity in the last 12 months. Of those that had sex with more than one partner, 81 percent of men and 66 percent of women reported using a condom during last sex. Page| 8 P a g e | 8 In many countries, over half of new adult HIV infections are among young people age 15-24 years thus a change in behaviour among members of this age group is especially important to reduce new infections. The survey results show 49 percent of young women and 51 percent of young men have comprehensive knowledge of HIV/AIDS. Accepting attitudes towards people living with HIV are also less prevalent in this age group (35 percent of young women and 32 percent of young men). Overall, 80 percent of young women and 62 percent of young men in this age group, who are sexually active, have been tested for HIV in the last 12 months and know the result. Certain behaviour may create, increase, or perpetuate risk of exposure to HIV. For this young age group (15-24 years), such behaviour includes sex at an early age and women having sex with older men. The survey results show that overall, three percent of both young women and young men reported having sex before age 15. Further, about four percent of young women and 13 percent of young men had sex with more than one partner in the last 12 months preceding the survey; of those only 71 percent of women and 93 percent of men reported using a condom during their last sexual encounter. Evidence has shown that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60 percent and is safe when performed by well-trained health professionals in properly equipped settings. Results from the Swaziland MICS 2014 show that a total of 25 percent of men age 15-49, and 24 percent of men age 15-59 years are circumcised. The results also show that 89 of all men that reported that they were circumcised had their circumcisions performed by a health care worker/professional. Access to Media and Information and Communication Technology In Swaziland, 23 percent of women are exposed to all three media, 13 percent are not exposed to any of the three media, while 87 percent are exposed to at least one form of media at least once a week. Sixty-five percent of women listen to the radio, 58 percent watch television and 43 percent read a newspaper or magazine at least once a week. Men in the age group 15-59 years report a slightly higher level of exposure to all types of media (30 percent) than women. At least once a week, 71 percent of men listen to the radio, 60 percent watch television and 55 percent read a newspaper or magazine. Internet use during the last 12 months preceding the survey is 40 percent among women age 15-24 years, while the use of computers during the same period is 43 percent. Use of the internet and of computers for men age 15-24 years is 56 percent and 49 percent, respectively. Subjective well-being Overall, 83 percent of women and 85 percent of men age 15-24 years are satisfied with their life. About 76 percent of both women and men age 15-24 years are very or somewhat happy. The results further show that there is no difference in the overall life satisfaction levels of women in all four regions and in both rural and urban areas, as they all show an average score of 1.7, with men scoring 1.6. The proportion of women age 15-24 years who think that their lives improved during the last one year and who expect that their lives will get better after one year, is 62 percent. The corresponding indicator for men age 15-24 years is 63 percent. Page| 9 P a g e | 9 Tobacco and Alcohol use The Swaziland MICS collected information on ever and current use of tobacco and alcohol and intensity of use among women age 15-49 years and men age 15-59 years. Overall, about one percent of women age 15-49 years and 15 percent of men age 15-49 years used any tobacco products at any time in the last month preceding the survey. About three percent of men age 15-59 years smoked a cigarette for the first time before age 15 and less than one percent for women. About six percent of women age 15-49 years had at least one drink of alcohol on one or more days during the last one month preceding the survey. Approximately, two percent of women of the same age group first drank alcohol before the age of 15 years. Twenty-six percent of men age 15-59 years had at least one drink of alcohol on one or more days during the last one month preceding the survey and six percent have had at least one alcohol drink before the age of 15 years. Orphans and Vulnerable Children (OVC) Over the years, there has been a continuous increase in the number of orphans and vulnerable children in Swaziland. In 2012, the number of OVC was estimated at 181,000. These are children who have lost either or both parents, either parent is chronically ill, or an adult in the age range 18-59 in the household either died after being chronically ill or was chronically ill in the year prior to the survey. Overall, 23 percent of children are living with both parents and 33 percent are living with neither biological parent. A considerable proportion (20 percent) of children are single or double orphans. A total of 60 percent of all children in Swaziland are classified as vulnerable and 71 percent are orphans or vulnerable children (OVC). The findings reveal that a total of 54 percent of the parents are chronically ill, 12 percent of the households have a chronically ill adult and four percent of the children had experienced an adult death in the household. The survey results also show that about four percent of all children have lost both parents. The ratio of school attendance of orphans to non-orphans is 1:1 for the age group 10-14 whilst it is 0.97 in the age group 6-17 years. Although School attendance is high, the urban/rural comparison reveals that school attendance in urban areas is slightly lower 87 percent compared to 96 percent in rural areas in the age group 6-17 years. In general the results demonstrate a minimal variations in malnutrition among OVC and non-OVC. The prevalence of underweight among orphans is eight percent while that for all children under five is six percent. Stunting prevalence among OVC is 26 percent and 24 percent among non-OVC. Orphans are most at risk of malnutrition as negative nutrition indicators were observed for this category of children. The results also show that a total of 33 percent of orphans are stunted compared to 26 percent observed for all children under-five years. Overall, 87 percent of orphans and vulnerable children have their basic needs met. The results further reveal that girls experience sexual debut earlier than boys as the proportion of girls who had sexual intercourse before exact age 15 is three percent whilst the figures indicate that none of the boys engage in sex before this age. There are no variations on early sexual debut between OVC and non- OVC. A comparison of the two groups shows that four percent of orphan girls and three percent of non-orphans experience early sexual debut. Page| 10 P a g e | 10 Social Participation The role of culture in development is today recognized not only by the culture community but also increasingly acknowledged by the development community. The Social Participation Dimension examines the multi-dimensional ways culture influences the preservation and enhancement of an enabling environment for social progress and development by analysing the levels of cultural participation, interconnectedness within a given society, sense of solidarity and cooperation, and individuals’ sense of empowerment. The most highly attended activities by both women age 15-49 years and men age 15-59 years are cultural based events such as community rites, events or ceremonies, community celebrations, local or national festivals and visiting museums, art galleries or craft expositions. The highly attended social activities or events by both women and men are the community rites, events or ceremonies at 87 and 90 percent, respectively. Attendance to local or national festivals is 15 percent for women age 15-49 years and 20 percent for men age 15-59 years. Museums, art galleries or craft exposition are also visited at a rate of 14 percent for women and 17 percent for men. The least attended social activities or events are visiting the theatre at six percent for both women and men. Non-communicable Diseases Non-communicable diseases comprise many conditions which are classified as those attributed to lifestyle such as diabetes mellitus, hypertension, cardiovascular diseases, malignancies, Chronic Obstructive Pulmonary diseases all of which share common risk factors namely dietary intake, physical activity, harmful use of alcohol, tobacco intake these being the core mandate of the Swaziland NCD disease unit. Other NCDs include epilepsy, injuries, mental health, eye and ear health amongst others. The approach to NCD interventions is the use of the ‘whole of Government approach’ and using the life cycle approach. The MICS 2014 introduces the NCD module, focusing on self-reported findings for NCD disease burden and risk factors contributing to the increase of NCDs in Swaziland. Individuals age 15-49 years were asked whether they knew to be suffering from the different types of NCDs, if they have had injuries, if they had a green card and on exposure to the different types of NCD risk factors. The reported results show no differences on diabetes mellitus among women and their male counterparts (1 percent for both women age 15-49 years and men age 15-59 years). The results demonstrate that the prevalence of high blood pressure is reported to be the highest when compared with other NCDs (9 percent among women age 15-49 years and 6 percent among men age 15-59 years). Four percent of women and two percent of men reported to suffer from heart diseases. All regions reported a prevalence of heart disease in both sexes. In both sexes, a total of one percent reported suffering from epilepsy. The reported prevalence of cataract is six percent in women age 15-49 years and four percent in men age 15-59 years. Page| 11 P a g e | 11 Less than one percent of both men (15-59 years) and women (15-49 years) reported suffering from breast cancer. The prevalence of cervical cancer was one percent. Three percent of men age 15-59 years reported suffering from impotence. One percent of both women age 15-49 years and men age 15-59 years reported having a green card which is an indicator od using psychiatric services. Page| 12 Page| 1P a g e | 1 1. Introduction This chapter covers the background to and the objectives of the Swaziland Multiple Indicator Cluster Survey (MICS5) 2014. It also gives a brief background on the socio-economic status of the country and the strategies and plans put in place by the Government of Swaziland to improve the well-being of the population, especially women, children and men. 1.1 Background This report is based on the Swaziland MICS5, conducted in 2014 by the Central Statistical Office with technical and financial support from UNICEF. The survey provides statistically sound and internationally comparable data essential for developing evidence-based policies and programmes, and for monitoring progress toward national goals and global commitments. Among these global commitments are those emanating from the World Fit for Children Declaration and Plan of Action, the goals of the United Nations General Assembly Special Session on HIV/AIDS, the Education for All Declaration and the Millennium Development Goals (MDGs). A Commitment to Action: National and International Reporting Responsibilities The governments that signed the Millennium Declaration and the World Fit for Children Declaration and Plan of Action also committed themselves to monitoring progress towards the goals and objectives they contained: “We will monitor regularly at the national level and, where appropriate, at the regional level and assess progress towards the goals and targets of the present Plan of Action at the national, regional and global levels. Accordingly, we will strengthen our national statistical capacity to collect, analyse and disaggregate data, including by sex, age and other relevant factors that may lead to disparities, and support a wide range of child- focused research. We will enhance international cooperation to support statistical capacity-building efforts and build community capacity for monitoring, assessment and planning.” (A World Fit for Children, paragraph 60) “…We will conduct periodic reviews at the national and subnational levels of progress in order to address obstacles more effectively and accelerate actions.…” (A World Fit for Children, paragraph 61) The Plan of Action of the World Fit for Children (paragraph 61) also calls for the specific involvement of UNICEF in the preparation of periodic progress reports: “… As the world’s lead agency for children, the United Nations Children’s Fund is requested to continue to prepare and disseminate, in close collaboration with Governments, relevant funds, programmes and the specialized agencies of the United Nations system, and all other relevant actors, as appropriate, information on the progress made in the implementation of the Declaration and the Plan of Action.” Similarly, the Millennium Declaration (paragraph 31) calls for periodic reporting on progress: “…We request the General Assembly to review on a regular basis the progress made in implementing the provisions of this Declaration, and ask the Secretary-General to issue periodic reports for consideration by the General Assembly and as a basis for further action.” Page| 2 P a g e | 2 The Swaziland MICS5 results are expected to form part of the baseline data for the post-2015 era. Swaziland launched the Poverty Reduction Strategy Action Plan (PRSAP) in 2008, the National Strategic Framework for HIV and AIDS (NSF) 2009 - 2014 and the Health sector strategic plan. Most of the indicators for monitoring progress are generated through the MICS5 round. The Government of Swaziland is a signatory to the 1990 Convention of the Rights of the Child (CRC). The Government of Swaziland has national action plans for children namely: the National plan of action for orphans and vulnerable children 2006 – 2010, the National plan of action for children 2011-2015, Children's policy, June 2009 and the Child protection and Welfare Act, 2012. Swaziland MICS5 is expected to contribute to the evidence base of several other important initiatives, including Committing to Child Survival: A Promise Renewed, a global movement to end child deaths from preventable causes, and the accountability framework proposed by the Commission on Information and Accountability for the Global Strategy for Women's and Children's Health. This final report presents the results of the indicators and topics covered in the survey. 1.2 Survey Objectives The 2014 Swaziland MICS5 has as its primary objectives to:  Provide up-to-date information on the situation of women, children, men and other vulnerable populations in Swaziland;  Generate data for the critical assessment of the progress made in various areas, and to put additional efforts in those areas that require more attention;  Furnish data needed for monitoring progress toward goals established in the Millennium Declaration and other internationally agreed upon goals, as a basis for future action;  Collect disaggregated data for the identification of disparities, to allow for evidence based policy-making aimed at social inclusion of the most vulnerable;  Contribute to the generation of baseline data for the post-2015 agenda;  Validate data from other sources and the results of focused interventions.  Track progress made in the implementation of national commitments, strategies and frameworks, National Development Strategy (NDS) Vision 2022, PRSAP 2008, extended National Strategic Framework 2014-2018, National Health Sector Strategic Plan (NHSSPII), and National Plan of Action for Children 2011-2015.  Identify new areas of concern for government and partners. Page| 3P a g e | 3 2. Sample and Survey Methodology Chapter two presents the sample design and survey methodology, content for the four questionnaires, the interviewer training, fieldwork and data processing. 2.1 Sample Design The sample for the 2014 Swaziland MICS5 was designed to provide estimates for a large number of indicators on the situation of children and women at the national level, for urban and rural areas, and for four regions: Hhohho, Manzini, Shiselweni and Lubombo. A total of 347 sample clusters (enumeration areas) and 5,211 households were selected for the survey. These sample clusters had previously been selected for the Integrated Labour Force Survey (ILFS) 2013/14, and the listing of households from that survey for each sample EA was used for selecting the MICS households at the second sampling stage. The urban and rural areas within each region were identified as the main sampling strata and the sample was selected in two stages. Within each stratum, a specified number of census enumeration areas (EAs/Clusters) were selected systematically using probability proportional to size. Using the ILFS listing of households for each sample EA, a systematic sample of 15 households was drawn in each sample enumeration area. The sample was stratified by region, urban and rural areas, and is not self-weighting. For reporting all survey results, sample weights are used. A more detailed description of the sample design can be found in Appendix C, Sample Design. 2.2 Questionnaires Four sets of questionnaires were used in the survey: 1) a household questionnaire which was used to collect basic demographic information on all de jure household members (usual residents), the household, and the dwelling; 2) a questionnaire for individual women administered in each household to all women age 15-49 years; 3) a questionnaire for individual men administered in every three households to all men age 15-59 years; and 4) an under-five questionnaire, administered to mothers (or caretakers) of all children under-five years of age living in the household. The questionnaires included the following modules: Household Questionnaire:  List of Household Members  Children Orphaned or made Vulnerable  Education and Basic Needs  Child Discipline  Household Characteristics  Water and Sanitation  Handwashing  Salt Iodization Questionnaire for Individual Women:  Woman’s Background Page| 4 P a g e | 4  Access to Mass Media and Use of Information/Communication Technology  Fertility/Birth History  Desire for Last Birth  Maternal and Newborn Health  Post-natal Health Checks  Illness Symptoms  Contraception  Unmet Need  Attitudes Toward Domestic Violence  Marriage/Union  Sexual Behaviour  HIV/AIDS  Non Communicable diseases  Tobacco and Alcohol Use  Life Satisfaction  Social Participation Questionnaire for Individual Men (only in the selected sub-sample):  Man’s Background  Access to Mass Media and Use of Information/Communication Technology  Fertility  Attitudes Toward Domestic Violence  Marriage/Union  Contraception  Sexual Behaviour  HIV/AIDS  Non Communicable Diseases  Circumcision  Tobacco and Alcohol Use  Life Satisfaction  Social Participation Questionnaire for Children Under-five2:  Age  Birth Registration  Early Childhood Development  Breastfeeding and Dietary Intake  Immunization  Care of Illness  Anthropometry 2The terms “children under-5”, “children age 0-4 years”, and “children age 0-59 months” are used interchangeably in this report. Normally, the questionnaire was administered to mothers of under-five children listed in the household listing; in cases where the mother was not listed in the household roster, a primary caretaker for the child was identified and interviewed Page| 5 P a g e | 5 The questionnaires are based on the MICS5 model questionnaires3. From the MICS5 model English, version, the questionnaires were customised and translated into siSwati and were pre-tested in Moti, Sphocosini and the Police College in July 2014. Based on the results of the pre-test, modifications were made to the wording and translation of the questionnaires. A copy of the Swaziland MICS5 questionnaires is provided in Appendix H. In addition to the administration of questionnaires, fieldwork teams tested the salt used for cooking in the households for iodine content, observed the place for handwashing, and measured the weights and heights of children age under-five years. Details and findings of these observations and measurements are provided in the respective sections of the report. A number of country specific modifications were also made to better serve the data needs of the country. The modifications include the following: Modules that are not part of the generic MICS5 that have been included in the Swaziland 2014 MICS5: Household Questionnaire  Children Orphaned or made Vulnerable (children 0-17 years)  Basic Needs (children age 5-17 years) Questionnaire for Individual Women  Non Communicable Diseases  Social Participation Questionnaire for Individual Men  Non Communicable Diseases  Social Participation Modules that are part of the generic MICS5 that have been omitted: Household Questionnaire  Child Labour  Insecticide Treated Nets  Indoor Residual Spraying Women Questionnaire  Female Genital Cutting Under-Five Questionnaire  Malaria 3The model MICS5 questionnaires can be found at http://mics.unicef.org Page| 6 P a g e | 6 2.3 Training and Fieldwork Training for the fieldwork was conducted for 19 days in July 2014. Training included lectures on interviewing techniques and the contents of the questionnaires, and mock interviews between trainees to gain practice in asking questions. Towards the end of the training period, trainees spent five days in practice interviewing in Khoza, Ludzeludze and Maliyaduma. The data was collected by eight teams; each comprised five interviewers, one driver, one editor, one measurer and a supervisor. Fieldwork began in July 2014 and concluded in October 2014. 2.4 Data Processing Data was entered using the CSPro software, Version 5.0. The data was entered on seven desktop computers and carried out by seven data entry operators and one data entry supervisor. For quality assurance purposes, all questionnaires were double-entered and internal consistency checks were performed. Procedures and standard programs developed under the global MICS programme and adapted to the Swaziland MICS5 questionnaire were used throughout. Data processing began simultaneously with data collection in August 2014 and was completed in November 2014. Data were analysed using the Statistical Package for Social Sciences (SPSS) software, Version 21. Model syntax and tabulation plans developed by UNICEF were customized and used for this purpose. Page| 7 P a g e | 7 3. Sample Coverage and the Characteristics of Households and Respondents This section presents information on the sample coverage and respondents, and socio-economic and demographic characteristics of the household population, focusing on age, sex, region, place of residence, and socio-economic conditions of households. 3.1 Sample Coverage Of the 5,205 households selected for the sample, 4,981 were found to be occupied. Of these, 4,865 were successfully interviewed for a household response rate of 98 percent. In the interviewed households, 5,001 women (age 15-49 years) were identified. Of these, 4,762 were successfully interviewed, yielding a response rate of 95 percent within the interviewed households. The survey also sampled men (age 15-59 years), but required only a subsample. All men (age 15-59 years) were identified in every third household. A total of 1,629 men (age 15-59 years) were listed in the household questionnaires. Questionnaires were completed for 1,459 eligible men, which corresponds to a response rate of 90 percent within eligible interviewed households. There were 2,728 children under-five years listed in the household questionnaires. Questionnaires were completed for 2,693 of these children, which corresponds to a response rate of 99 percent within interviewed households. Overall response rates of 93, 88, and 96 percent are calculated for the individual interviews of women, men, and under-5s, respectively (Table HH.1). Page| 8P a g e | 8 Table HH.1: Results of household, women's, men's and under-5 interviews Number of households, women, men, and children under-5 by interview results, and household, women's, men's and under- 5's response rates, Swaziland MICS, 2014 Total Area Region Urban Rural Hhohho Manzini Shiselweni Lubombo Households Sampled 5,211 1,351 3,860 1,457 1,469 1,200 1,085 Occupied 4,981 1,310 3,671 1,390 1,384 1,153 1,054 Interviewed 4,865 1,286 3,579 1,344 1,347 1,142 1,032 Household response rate 97.7 98.2 97.5 96.7 97.3 99.0 97.9 Women Eligible 5,001 1,128 3,873 1,331 1,407 1,262 1,001 Interviewed 4,762 1,076 3,686 1,261 1,308 1,223 970 Women's response rate 95.2 95.4 95.2 94.7 93.0 96.9 96.9 Women's overall response rate 93.0 93.6 92.8 91.6 90.5 96.0 94.9 Men Eligible 1,629 395 1,234 463 476 377 313 Interviewed 1,459 361 1,098 410 421 331 297 Men's response rate 89.6 91.4 89.0 88.6 88.4 87.8 94.9 Men's overall response rate 87.5 89.7 86.7 85.6 86.1 87.0 92.9 Children under-5 Eligible 2,728 432 2,296 659 710 749 610 Mothers/caretakers interviewed 2,693 426 2,267 652 698 741 602 Under-5's response rate 98.7 98.6 98.7 98.9 98.3 98.9 98.7 Under-5's overall response rate 96.4 96.8 96.3 95.7 95.7 98.0 96.6 Response rates were similar across surveyed areas and regions, except in the Manzini region, which recorded a slightly lower response rate of 93 percent for women. This was because some women often work long hours in industrial firms and return very late to their homes, hence their absence during the Swaziland MICS 2014 fieldwork. Page| 9 P a g e | 9 3.2 Characteristics of Households The weighted age and sex distribution of the survey population is provided in Table HH.2. The distribution is also used to produce the population pyramid in Figure HH.1. In the 4,865 households successfully interviewed in the survey, 19,636 household members were listed. Of these, 9,401 are males, and 10,234 are females. Table HH.2: Age distribution of household population by sex Percent and frequency distribution of the household population by five-year age groups, dependency age groups, and by child (age 0-17 years) and adult populations (age 18 or more), by sex, Swaziland MICS, 2014 Total Males Females Number Percent Number Percent Number Percent Total 19,636 100.0 9,402 100.0 10,234 100.0 Age 0-4 2,488 12.7 1,268 13.5 1,220 11.9 5-9 2,747 14.0 1,405 14.9 1,342 13.1 10-14 2,558 13.0 1,242 13.2 1,317 12.9 15-19 2,190 11.2 1,134 12.1 1,056 10.3 20-24 1,781 9.1 872 9.3 909 8.9 25-29 1,535 7.8 738 7.8 798 7.8 30-34 1,319 6.7 599 6.4 719 7.0 35-39 1,025 5.2 514 5.5 511 5.0 40-44 823 4.2 352 3.7 470 4.6 45-49 698 3.6 312 3.3 386 3.8 50-54 607 3.1 233 2.5 375 3.7 55-59 463 2.4 200 2.1 264 2.6 60-64 428 2.2 169 1.8 259 2.5 65-69 346 1.8 133 1.4 213 2.1 70-74 278 1.4 118 1.3 160 1.6 75-79 164 0.8 55 0.6 109 1.1 80-84 112 0.6 42 0.4 71 0.7 85+ 74 0.4 18 0.2 56 0.5 Missing/DK1 1 0.0 Dependency age groups 0-14 7,793 39.7 3,914 41.6 3,878 37.9 15-64 10,869 55.4 5,122 54.5 5,747 56.2 65+ 973 5.0 365 3.9 608 5.9 Missing/DK 1 0.0 Child and adult populations Children age 0-17 years 9,141 46.6 4,601 48.9 4,540 44.4 Adults age 18+ years 10,494 53.4 4,800 51.1 5,694 55.6 Missing/DK 1 0.0 1One household member with missing ‘age’ and ‘sex’ categorisation has been excluded from disaggregated analysis in subsequent tables and figures Children age 0-14 years make up two-fifths of the population, while those age 15-64 years represent 55 percent and those age 65+ years contribute five percent to the total population. The population age 0-17 years is approximately 47 percent. Table HH.2 and Figure HH.1 suggest that children under- five years may be under-represented in the sample. Page| 10 P a g e | 10 Figure HH.1: Age and sex d istr ibut ion of household populat ion , Swazi land MICS, 2014 Tables HH.3, HH.4 and HH.5 provide basic information on the households, female respondents age 15- 49 years, male respondents age 15-59 years, and children under-five years. Both unweighted and weighted numbers are presented. Such information is essential for the interpretation of findings presented later in the report and provide background information on the representativeness of the survey sample. The remaining tables in this report are presented only with weighted numbers.4 Table HH.3 provides basic background information on the households, including the sex of the household head, region, place of residence, number of household members, and education of household head. The weighted and unweighted total number of households are equal, since sample weights were normalized. Fifty-four percent of the heads of household are male and 46 percent are female. An assessment of the population distribution by place of residence indicates that 63 percent are in rural areas while 37 percent are in urban areas. The table also shows the weighted mean household size of four persons estimated by the survey. 4 See Appendix C: Sample Design, for more details on sample weights. 8 6 4 2 0 2 4 6 8 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Percent Age Males Females Note: one household member with missing sex is excluded Page| 11P a g e | 11 Table HH.3: Household composition Percent and frequency distribution of households by selected characteristics, Swaziland MICS, 2014 Weighted percent Number of households Weighted Unweighted Total 100.0 4,865 4,865 Sex of household head Male 54.4 2,647 2,561 Female 45.6 2,218 2,304 Region Hhohho 25.3 1,230 1,344 Manzini 39.4 1,916 1,347 Shiselweni 15.1 734 1,142 Lubombo 20.3 985 1,032 Area Urban 37.2 1,811 1,286 Rural 62.8 3,054 3,579 Number of household members 1 21.7 1,057 939 2 14.4 699 624 3 14.9 727 689 4 13.5 655 666 5 10.7 523 564 6 7.5 366 410 7 5.7 275 304 8 3.9 188 220 9 2.3 114 144 10+ 5.4 263 305 Education of household head None 15.9 774 911 Primary 26.8 1,305 1,409 Secondary 20.8 1,012 1,004 Higher 20.5 995 828 Tertiary 15.7 762 695 Missing/DK 0.3 16 18 Mean household size 4.0 4,865 4,865 Page| 12P a g e | 12 3.3 Characteristics of Female and Male Respondents 15-49 Years of Age and Children Under-5 Tables HH.4, HH.4M and HH.5 provide information on the background characteristics of female age 15-49 years and male respondents age 15-59 years and of children under age five. In all three tables, the total numbers of weighted and unweighted observations are equal, since sample weights have been normalized (standardized). In addition to providing useful information on the background characteristics of women, men, and children under age five, the tables are also intended to show the numbers of observations in each background category. These categories are used in the subsequent tabulations of this report. Table HH.4 provides background characteristics of female respondents, age 15-49 years. The table includes information on the distribution of women according to region, area, age, marital/union status, motherhood status, births in last two years, education5, and wealth index quintiles.6, 7 Half of the women are never married/in union, 40 percent currently married/in union, and the remainder are either divorced, widowed or separated. 5 Throughout this report, unless otherwise stated, “education” refers to highest educational level ever attended by the respondent when it is used as a background variable. 6 The wealth index is a composite indicator of wealth. To construct the wealth index, principal components analysis is performed by using information on the ownership of consumer goods, dwelling characteristics, water and sanitation, and other characteristics that are related to the household’s wealth, to generate weights (factor scores) for each of the items used. First, initial factor scores are calculated for the total sample. Then, separate factor scores are calculated for households in urban and rural areas. Finally, the urban and rural factor scores are regressed on the initial factor scores to obtain the combined, final factor scores for the total sample. This is carried out to minimize the urban bias in the wealth index values. Each household in the total sample is then assigned a wealth score based on the assets owned by that household and on the final factor scores obtained as described above. The survey household population is then ranked according to the wealth score of the household they are living in, and is finally divided into 5 equal parts (quintiles) from lowest (poorest) to highest (richest). In Swaziland MICS, the following assets were used in these calculations; radio, television, non-mobile telephone, watch, refrigerator, table and chair, tractor, animal-drawn cart, car or truck, boat with motor, mobile telephone, bicycle, motorcycle or scooter, ownership of dwelling, bank account, agricultural land, and animals/livestock. The wealth index is assumed to capture the underlying long-term wealth through information on the household assets, and is intended to produce a ranking of households by wealth, from poorest to richest. The wealth index does not provide information on absolute poverty, current income or expenditure levels. The wealth scores calculated are applicable for only the particular data set they are based on. Further information on the construction of the wealth index can be found in Filmer, D and Pritchett, L. 2001. Estimating wealth effects without expenditure data – or tears: An application to educational enrolments in states of India. Demography 38(1): 115-132; Rutstein, SO and Johnson, K. 2004. The DHS Wealth Index. DHS Comparative Reports No. 6; and Rutstein, SO. 2008. The DHS Wealth Index: Approaches for Rural and Urban Areas. DHS Working Papers No. 60. 7 When describing survey results by wealth quintiles, appropriate terminology is used when referring to individual household members, such as for instance “women in the richest population quintile”, which is used interchangeably with “women in the wealthiest survey population”, “women living in households in the richest population wealth quintile”, and similar. Page| 13P a g e | 13 Table HH.4: Women's background characteristics Percent and frequency distribution of women age 15-49 years by selected background characteristics, Swaziland MICS, Swaziland MICS, 2014 Weighted percent Number of women Weighted Unweighted Total 100.0 4,762 4,762 Region Hhohho 24.6 1,169 1,261 Manzini 40.4 1,923 1,308 Shiselweni 16.8 799 1,223 Lubombo 18.3 871 970 Area Urban 32.3 1,540 1,076 Rural 67.7 3,222 3,686 Age 15-19 21.8 1,037 1,112 20-24 18.7 888 870 25-29 16.7 795 769 30-34 14.9 707 653 35-39 10.5 501 512 40-44 9.7 462 464 45-49 7.8 370 382 Marital/Union status Currently married/in union 40.1 1,909 1,919 Widowed 4.6 218 210 Divorced 0.6 31 26 Separated 4.7 225 196 Never married/in union 50.0 2,380 2,411 Motherhood and recent births Never gave birth 30.0 1,429 1,469 Ever gave birth 70.0 3,333 3,293 Gave birth in last two years 20.1 959 987 No birth in last two years 49.8 2,373 2,306 Education None 3.9 188 210 Primary 23.0 1,095 1,163 Secondary 35.6 1,697 1,721 Higher 26.8 1,275 1,209 Tertiary 10.7 507 459 Wealth index quintile Poorest 15.8 752 953 Second 17.6 838 950 Middle 19.8 941 1,042 Fourth 22.5 1,073 892 Richest 24.3 1,158 925 Similarly, Table HH.4M provides background characteristics of male respondents 15-59 years of age. The table shows information on the distribution of men according to region, area, age, marital status, fatherhood status, education and wealth index quintiles. Thirty-nine percent of the men are from Manzini region, 26 percent in Hhohho region, and 16 percent are in Shiselweni. Fifty-eight percent of the men are never married/in union while 34 percent are currently married/in union. Page| 14P a g e | 14 Table HH.4M: Men's background characteristics Percent and frequency distribution of men age 15-59 years by selected background characteristics, Swaziland MICS, 2014 Weighted percent Number of men Weighted Unweighted Total 100.0 1,459 1,459 Region Hhohho 25.9 377 410 Manzini 39.3 573 421 Shiselweni 15.6 228 331 Lubombo 19.3 281 297 Area Urban 33.6 491 361 Rural 66.4 968 1,098 Age 15-19 21.1 308 335 20-24 19.9 291 283 25-29 15.2 222 211 30-34 10.6 155 149 35-39 9.6 140 129 40-44 8.1 118 120 45-49 6.1 90 95 50-54 5.4 79 80 55-59 3.8 56 57 Marital/Union status Currently married/in union 33.6 490 488 Widowed 1.4 20 18 Divorced 0.9 13 14 Separated 6.3 92 77 Never married/in union 57.8 843 862 Fatherhood status Has at least one living child 49.5 722 715 Has no living children 49.4 721 727 Missing/DK 1.0 15 17 Education None 4.6 66 73 Primary 25.7 375 404 Secondary 28.5 416 434 Higher 29.0 424 394 Tertiary 12.2 178 154 Wealth index quintile Poorest 13.5 197 255 Second 16.1 235 268 Middle 22.3 325 342 Fourth 25.7 375 312 Richest 22.4 326 282 Background characteristics of children under-five years are presented in Table HH.5. These include the distribution of children by several attributes: sex, region, place of residence, age in months, respondent type, mother’s (or caretaker’s) education, and household wealth. Seventy-seven percent of the children reside in rural areas and 23 percent in urban areas. Seventy-six percent of the children Page| 15 P a g e | 15 are under the care of their mothers while 24 percent are under the care of a primary caretaker other than their natural mother. Table HH.5: Under-5's background characteristics Percent and frequency distribution of children under five years of age by selected characteristics, Swaziland MICS, 2014 Weighted percent Number of under-5 children Weighted Unweighted Total 100.0 2,693 2,693 Sex Male 50.9 1,370 1,377 Female 49.1 1,323 1,316 Region Hhohho 22.4 604 652 Manzini 36.8 992 698 Shiselweni 19.7 530 741 Lubombo 21.1 567 602 Area Urban 22.7 612 426 Rural 77.3 2,081 2,267 Age 0-5 months 9.3 250 235 6-11 months 9.7 260 249 12-23 months 19.8 533 540 24-35 months 22.1 594 578 36-47 months 19.6 529 559 48-59 months 19.5 526 532 Respondent to the under-5 questionnaire Mother 76.3 2,056 1,989 Other primary caretaker 23.7 637 704 Mother’s educationa None 8.7 235 272 Primary 30.6 825 849 Secondary 31.6 852 874 Higher 21.4 575 530 Tertiary 7.4 200 163 Missing/DK 0.2 6 5 Wealth index quintile Poorest 23.4 631 748 Second 23.6 636 662 Middle 19.8 534 582 Fourth 17.0 458 383 Richest 16.1 434 318 a In this table and throughout the report, mother's education refers to educational attainment of mothers as well as caretakers of children under 5, who are the respondents to the under-5 questionnaire if the mother is deceased or is living elsewhere. P a g e | 16 3.4 Housing characteristics, asset ownership, and wealth quintiles Tables HH.6, HH.7 and HH.8 provide further details on household level characteristics. Table HH.6 presents characteristics of housing, disaggregated by area and region, distributed by whether the dwelling has electricity, the main materials of the flooring, roof, and exterior walls, as well as the number of rooms used for sleeping. Nationally, 65 percent of the households have electricity (84 percent in urban areas and 54 percent in rural areas). The results show that 70 percent of households in Manzini, 67 percent in Hhohho region, 66 percent in Lubombo, and 48 percent in Shiselweni have electricity. Materials used for dwelling roofing, flooring and exterior walls are classified into three categories: natural, rudimentary and finished. The majority of households had finished floors (95 percent), finished roofing (94 percent) and finished walls (89 percent). Overall, a quarter of households had three or more rooms used for sleeping, reflecting better living conditions. Rural areas have higher percentages of households with three or more rooms for sleeping (32 percent) than urban areas (12 percent). The mean number of persons per sleeping room is 2.1. Table HH.6: Housing characteristics Percent distribution of households by selected housing characteristics, according to area of residence and regions, Swaziland MICS, 2014 Total Area Region Urban Rural Hhohho Manzini Shiselweni Lubombo Electricity Yes 65.0 83.8 53.8 67.3 69.7 47.7 65.6 No 35.0 16.2 46.2 32.7 30.3 52.3 34.4 Flooring Natural floor 4.6 0.2 7.2 4.2 2.2 9.0 6.3 Rudimentary floor 0.1 0.0 0.1 0.0 0.2 0.0 0.0 Finished floor 95.3 99.6 92.7 95.7 97.5 91.0 93.6 Other 0.1 0.1 0.0 0.0 0.1 0.0 0.1 Missing/DK 0.0 0.1 0.0 0.1 0.0 0.0 0.0 Roof Natural roofing 5.6 0.0 8.9 3.2 1.7 11.2 12.1 Rudimentary roofing 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Finished roofing 94.2 99.7 91.0 96.7 98.1 88.6 87.9 Other 0.1 0.1 0.1 0.1 0.0 0.2 0.0 Missing/DK 0.1 0.2 0.0 0.0 0.2 0.0 0.0 Exterior walls Natural walls 0.8 0.0 1.3 0.2 1.5 0.0 0.8 Rudimentary walls 9.9 3.5 13.7 11.9 3.0 20.3 12.9 Finished walls 88.8 95.7 84.7 87.7 94.5 79.7 86.0 Other 0.4 0.4 0.4 0.2 0.6 0.0 0.3 Missing/DK 0.2 0.4 0.0 0.0 0.4 0.0 0.0 Rooms used for sleeping 1 44.4 59.6 35.5 43.2 50.7 35.2 40.7 2 30.0 27.2 31.7 31.1 26.4 31.5 34.5 3 or more 25.1 12.9 32.4 25.6 22.3 32.9 24.4 Missing/DK 0.4 0.3 0.5 0.1 0.6 0.5 0.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Page| 16 P a g e | 16 3.4 Housing characteristics, asset ownership, and wealth quintiles Tables HH.6, HH.7 and HH.8 provide further details on household level characteristics. Table HH.6 presents characteristics of housing, disaggregated by area and region, distributed by whether the dwelling has electricity, the main materials of the flooring, roof, and exterior walls, as well as the number of rooms used for sleeping. Nationally, 65 percent of the households have electricity (84 percent in urban areas and 54 percent in rural areas). The results show that 70 percent of households in Manzini, 67 percent in Hhohho region, 66 percent in Lubombo, and 48 percent in Shiselweni have electricity. Materials used for dwelling roofing, flooring and exterior walls are classified into three categories: natural, rudimentary and finished. The majority of households had finished floors (95 percent), finished roofing (94 percent) and finished walls (89 percent). Overall, a quarter of households had three or more rooms used for sleeping, reflecting better living conditions. Rural areas have higher percentages of households with three or more rooms for sleeping (32 percent) than urban areas (12 percent). The mean number of persons per sleeping room is 2.1. Table HH.6: Housing characteristics Percent distribution of households by selected housing characteristics, according to area of residence and regions, Swaziland MICS, 2014 Total Area Region Urban Rural Hhohho Manzini Shiselweni Lubombo Electricity Yes 65.0 83.8 53.8 67.3 69.7 47.7 65.6 No 35.0 16.2 46.2 32.7 30.3 52.3 34.4 Flooring Natural floor 4.6 0.2 7.2 4.2 2.2 9.0 6.3 Rudimentary floor 0.1 0.0 0.1 0.0 0.2 0.0 0.0 Finished floor 95.3 99.6 92.7 95.7 97.5 91.0 93.6 Other 0.1 0.1 0.0 0.0 0.1 0.0 0.1 Missing/DK 0.0 0.1 0.0 0.1 0.0 0.0 0.0 Roof Natural roofing 5.6 0.0 8.9 3.2 1.7 11.2 12.1 Rudimentary roofing 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Finished roofing 94.2 99.7 91.0 96.7 98.1 88.6 87.9 Other 0.1 0.1 0.1 0.1 0.0 0.2 0.0 Missing/DK 0.1 0.2 0.0 0.0 0.2 0.0 0.0 Exterior walls Natural walls 0.8 0.0 1.3 0.2 1.5 0.0 0.8 Rudimentary walls 9.9 3.5 13.7 11.9 3.0 20.3 12.9 Finished walls 88.8 95.7 84.7 87.7 94.5 79.7 86.0 Other 0.4 0.4 0.4 0.2 0.6 0.0 0.3 Missing/DK 0.2 0.4 0.0 0.0 0.4 0.0 0.0 Rooms used for sleeping 1 44.4 59.6 35.5 43.2 50.7 35.2 40.7 2 30.0 27.2 31.7 31.1 26.4 31.5 34.5 3 or more 25.1 12.9 32.4 25.6 22.3 32.9 24.4 Missing/DK 0.4 0.3 0.5 0.1 0.6 0.5 0.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 P a g e | 17 Number of households 4,865 1,811 3,054 1,230 1,916 734 985 Mean number of persons per room used for sleeping 2.1 1.8 2.3 2.1 2.1 2.3 2.0 In Table HH.7, households are distributed according to ownership of assets by household and by individual household members. Household assets include those used in daily life, such as radio(s), refrigerator(s), television(s), bed(s) and non-mobile phone(s) and those of higher value such as a dwelling, agricultural land and farm animals/livestock. Sixty-five percent of households nationally have agricultural land, with the percentage highest in the Shiselweni region (81 percent), followed by Lubombo region (72 percent) with the lowest in Hhohho and Manzini regions (60 percent). Household ownership of farm animals/livestock ranges from 52 percent in Hhohho region to 74 percent in Shiselweni region. Of the interviewed households, 61 percent have their dwelling unit owned by a household member (26 percent in urban areas and 82 percent in rural areas). Ownership of dwelling unit by a household member is 81 percent in Shiselweni region and 52 percent in Manzini region. Table HH.7: Household and personal assets Percentage of households by ownership of selected household and personal assets, and percent distribution by ownership of dwelling, according to area of residence and regions, Swaziland MICS, 2014 Total Area Region Urban Rural Hhohho Manzini Shiselweni Lubombo Percentage of households that own a Radio 67.7 71.4 65.5 72.9 69.6 65.0 59.5 Television 54.9 69.4 46.3 58.2 59.1 44.1 50.7 Non-mobile telephone 7.4 12.3 4.5 10.8 6.9 5.9 5.1 Refrigerator 55.3 69.0 47.2 60.1 59.8 44.2 49.0 Bed 94.2 93.7 94.5 97.1 97.3 94.9 84.1 Stove 68.3 88.6 56.3 67.7 77.2 61.6 57.0 Table 79.5 81.4 78.3 86.5 84.7 74.9 64.0 Chair 77.5 74.9 79.0 86.5 77.9 76.1 66.4 Cupboard 60.3 62.6 58.9 69.4 60.9 59.6 48.2 Percentage of households that own Agricultural land 65.4 43.4 78.4 59.9 59.5 80.5 72.3 Farm animals/Livestock 56.8 28.9 73.3 51.8 53.0 73.8 57.6 Percentage of households where at least one member owns or has a Watch 34.6 42.0 30.1 39.9 39.1 28.3 23.7 Mobile telephone 95.9 98.4 94.4 96.5 96.8 92.9 95.6 Bicycle 8.7 10.1 7.9 7.9 8.2 5.9 12.7 Motorcycle or scooter 0.9 1.1 0.8 1.1 1.1 0.4 0.5 Animal-drawn cart 3.3 2.6 3.8 4.0 4.2 2.4 1.5 Car or truck 22.7 29.5 18.7 29.2 24.3 16.5 16.2 Boat with a motor 0.2 0.3 0.1 0.4 0.2 0.0 0.1 Pot 99.6 99.6 99.7 99.5 99.8 99.8 99.5 Hoe 63.9 39.3 78.5 65.5 51.9 78.9 74.1 Sleeping mat 79.7 65.7 88.0 75.0 77.8 88.6 82.5 P a g e | 16 3.4 Housing characteristics, asset ownership, and wealth quintiles Tables HH.6, HH.7 and HH.8 provide further details on household level characteristics. Table HH.6 presents characteristics of housing, disaggregated by area and region, distributed by whether the dwelling has electricity, the main materials of the flooring, roof, and exterior walls, as well as the number of rooms used for sleeping. Nationally, 65 percent of the households have electricity (84 percent in urban areas and 54 percent in rural areas). The results show that 70 percent of households in Manzini, 67 percent in Hhohho region, 66 percent in Lubombo, and 48 percent in Shiselweni have electricity. Materials used for dwelling roofing, flooring and exterior walls are classified into three categories: natural, rudimentary and finished. The majority of households had finished floors (95 percent), finished roofing (94 percent) and finished walls (89 percent). Overall, a quarter of households had three or more rooms used for sleeping, reflecting better living conditions. Rural areas have higher percentages of households with three or more rooms for sleeping (32 percent) than urban areas (12 percent). The mean number of persons per sleeping room is 2.1. Table HH.6: Housing characteristics Percent distribution of households by selected housing characteristics, according to area of residence and regions, Swaziland MICS, 2014 Total Area Region Urban Rural Hhohho Manzini Shiselweni Lubombo Electricity Yes 65.0 83.8 53.8 67.3 69.7 47.7 65.6 No 35.0 16.2 46.2 32.7 30.3 52.3 34.4 Flooring Natural floor 4.6 0.2 7.2 4.2 2.2 9.0 6.3 Rudimentary floor 0.1 0.0 0.1 0.0 0.2 0.0 0.0 Finished floor 95.3 99.6 92.7 95.7 97.5 91.0 93.6 Other 0.1 0.1 0.0 0.0 0.1 0.0 0.1 Missing/DK 0.0 0.1 0.0 0.1 0.0 0.0 0.0 Roof Natural roofing 5.6 0.0 8.9 3.2 1.7 11.2 12.1 Rudimentary roofing 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Finished roofing 94.2 99.7 91.0 96.7 98.1 88.6 87.9 Other 0.1 0.1 0.1 0.1 0.0 0.2 0.0 Missing/DK 0.1 0.2 0.0 0.0 0.2 0.0 0.0 Exterior walls Natural walls 0.8 0.0 1.3 0.2 1.5 0.0 0.8 Rudimentary walls 9.9 3.5 13.7 11.9 3.0 20.3 12.9 Finished walls 88.8 95.7 84.7 87.7 94.5 79.7 86.0 Other 0.4 0.4 0.4 0.2 0.6 0.0 0.3 Missing/DK 0.2 0.4 0.0 0.0 0.4 0.0 0.0 Rooms used for sleeping 1 44.4 59.6 35.5 43.2 50.7 35.2 40.7 2 30.0 27.2 31.7 31.1 26.4 31.5 34.5 3 or more 25.1 12.9 32.4 25.6 22.3 32.9 24.4 Missing/DK 0.4 0.3 0.5 0.1 0.6 0.5 0.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Page| 17 P a g e | 17 Number of households 4,865 1,811 3,054 1,230 1,916 734 985 Mean number of persons per room used for sleeping 2.1 1.8 2.3 2.1 2.1 2.3 2.0 In Table HH.7, households are distributed according to ownership of assets by household and by individual household members. Household assets include those used in daily life, such as radio(s), refrigerator(s), television(s), bed(s) and non-mobile phone(s) and those of higher value such as a dwelling, agricultural land and farm animals/livestock. Sixty-five percent of households nationally have agricultural land, with the percentage highest in the Shiselweni region (81 percent), followed by Lubombo region (72 percent) with the lowest in Hhohho and Manzini regions (60 percent). Household ownership of farm animals/livestock ranges from 52 percent in Hhohho region to 74 percent in Shiselweni region. Of the interviewed households, 61 percent have their dwelling unit owned by a household member (26 percent in urban areas and 82 percent in rural areas). Ownership of dwelling unit by a household member is 81 percent in Shiselweni region and 52 percent in Manzini region. Table HH.7: Household and personal assets Percentage of households by ownership of selected household and personal assets, and percent distribution by ownership of dwelling, according to area of residence and regions, Swaziland MICS, 2014 Total Area Region Urban Rural Hhohho Manzini Shiselweni Lubombo Percentage of households that own a Radio 67.7 71.4 65.5 72.9 69.6 65.0 59.5 Television 54.9 69.4 46.3 58.2 59.1 44.1 50.7 Non-mobile telephone 7.4 12.3 4.5 10.8 6.9 5.9 5.1 Refrigerator 55.3 69.0 47.2 60.1 59.8 44.2 49.0 Bed 94.2 93.7 94.5 97.1 97.3 94.9 84.1 Stove 68.3 88.6 56.3 67.7 77.2 61.6 57.0 Table 79.5 81.4 78.3 86.5 84.7 74.9 64.0 Chair 77.5 74.9 79.0 86.5 77.9 76.1 66.4 Cupboard 60.3 62.6 58.9 69.4 60.9 59.6 48.2 Percentage of households that own Agricultural land 65.4 43.4 78.4 59.9 59.5 80.5 72.3 Farm animals/Livestock 56.8 28.9 73.3 51.8 53.0 73.8 57.6 Percentage of households where at least one member owns or has a Watch 34.6 42.0 30.1 39.9 39.1 28.3 23.7 Mobile telephone 95.9 98.4 94.4 96.5 96.8 92.9 95.6 Bicycle 8.7 10.1 7.9 7.9 8.2 5.9 12.7 Motorcycle or scooter 0.9 1.1 0.8 1.1 1.1 0.4 0.5 Animal-drawn cart 3.3 2.6 3.8 4.0 4.2 2.4 1.5 Car or truck 22.7 29.5 18.7 29.2 24.3 16.5 16.2 Boat with a motor 0.2 0.3 0.1 0.4 0.2 0.0 0.1 Pot 99.6 99.6 99.7 99.5 99.8 99.8 99.5 Hoe 63.9 39.3 78.5 65.5 51.9 78.9 74.1 Sleeping mat 79.7 65.7 88.0 75.0 77.8 88.6 82.5 P a g e | 17 Number of households 4,865 1,811 3,054 1,230 1,916 734 985 Mean number of persons per room used for sleeping 2.1 1.8 2.3 2.1 2.1 2.3 2.0 In Table HH.7, households are distributed according to ownership of assets by household and by individual household members. Household assets include those used in daily life, such as radio(s), refrigerator(s), television(s), bed(s) and non-mobile phone(s) and those of higher value such as a dwelling, agricultural land and farm animals/livestock. Sixty-five percent of households nationally have agricultural land, with the percentage highest in the Shiselweni region (81 percent), followed by Lubombo region (72 percent) with the lowest in Hhohho and Manzini regions (60 percent). Household ownership of farm animals/livestock ranges from 52 percent in Hhohho region to 74 percent in Shiselweni region. Of the interviewed households, 61 percent have their dwelling unit owned by a household member (26 percent in urban areas and 82 percent in rural areas). Ownership of dwelling unit by a household member is 81 percent in Shiselweni region and 52 percent in Manzini region. Table HH.7: Household and personal assets Percentage of households by ownership of selected household and personal assets, and percent distribution by ownership of dwelling, according to area of residence and regions, Swaziland MICS, 2014 Total Area Region Urban Rural Hhohho Manzini Shiselweni Lubombo Percentage of households that own a Radio 67.7 71.4 65.5 72.9 69.6 65.0 59.5 Television 54.9 69.4 46.3 58.2 59.1 44.1 50.7 Non-mobile telephone 7.4 12.3 4.5 10.8 6.9 5.9 5.1 Refrigerator 55.3 69.0 47.2 60.1 59.8 44.2 49.0 Bed 94.2 93.7 94.5 97.1 97.3 94.9 84.1 Stove 68.3 88.6 56.3 67.7 77.2 61.6 57.0 Table 79.5 81.4 78.3 86.5 84.7 74.9 64.0 Chair 77.5 74.9 79.0 86.5 77.9 76.1 66.4 Cupboard 60.3 62.6 58.9 69.4 60.9 59.6 48.2 Percentage of households that own Agricultural land 65.4 43.4 78.4 59.9 59.5 80.5 72.3 Farm animals/Livestock 56.8 28.9 73.3 51.8 53.0 73.8 57.6 Percentage of households where at least one member owns or has a Watch 34.6 42.0 30.1 39.9 39.1 28.3 23.7 Mobile telephone 95.9 98.4 94.4 96.5 96.8 92.9 95.6 Bicycle 8.7 10.1 7.9 7.9 8.2 5.9 12.7 Motorcycle or scooter 0.9 1.1 0.8 1.1 1.1 0.4 0.5 Animal-drawn cart 3.3 2.6 3.8 4.0 4.2 2.4 1.5 Car or truck 22.7 29.5 18.7 29.2 24.3 16.5 16.2 Boat with a motor 0.2 0.3 0.1 0.4 0.2 0.0 0.1 Pot 99.6 99.6 99.7 99.5 99.8 99.8 99.5 Hoe 63.9 39.3 78.5 65.5 51.9 78.9 74.1 Sleeping mat 79.7 65.7 88.0 75.0 77.8 88.6 82.5 P a g e | 18 Tractor 3.0 1.7 3.7 2.0 3.0 5.4 2.3 Bank account 67.7 83.4 58.4 72.3 70.1 53.3 67.9 Ownership of dwelling Owned by a household member 61.3 25.7 82.4 65.7 51.9 80.8 59.5 Not owned 38.7 74.3 17.6 34.3 48.1 19.2 40.5 Rented 37.2 72.6 16.2 32.1 46.8 17.5 39.7 Other 1.5 1.7 1.3 2.2 1.3 1.7 0.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 4,865 1,811 3,054 1,230 1,916 734 985 Table HH.8 shows the distribution of household population, by rural/urban residence as well as by region, according to wealth index quintiles. Fifty-three percent of the urban population is in the richest wealth index quintile, in contrast with only eight percent of the rural population. Moreover, more than a quarter of the rural population is in the poorest wealth index quintile, higher than the poorest urban population of one percent. Table HH.8: Wealth quintiles Percent distribution of the household population by wealth index quintile, according to area of residence and regions, Swaziland MICS, 2014 Wealth index quintile Total Number of household members Poorest Second Middle Fourth Richest Total 20.0 20.0 20.0 20.0 20.0 100.0 19,636 Area Urban 1.1 5.4 10.9 29.6 53.0 100.0 5,238 Rural 26.9 25.3 23.3 16.5 8.0 100.0 14,398 Region Hhohho 15.0 22.2 19.6 19.1 24.1 100.0 4,909 Manzini 10.5 17.0 20.5 27.5 24.5 100.0 7,287 Shiselweni 33.1 23.4 23.7 12.4 7.4 100.0 3,513 Lubombo 32.3 19.8 16.2 14.0 17.7 100.0 3,927 Page| 18 P a g e | 18 Tractor 3.0 1.7 3.7 2.0 3.0 5.4 2.3 Bank account 67.7 83.4 58.4 72.3 70.1 53.3 67.9 Ownership of dwelling Owned by a household member 61.3 25.7 82.4 65.7 51.9 80.8 59.5 Not owned 38.7 74.3 17.6 34.3 48.1 19.2 40.5 Rented 37.2 72.6 16.2 32.1 46.8 17.5 39.7 Other 1.5 1.7 1.3 2.2 1.3 1.7 0.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 4,865 1,811 3,054 1,230 1,916 734 985 Table HH.8 shows the distribution of household population, by rural/urban residence as well as by region, according to wealth index quintiles. Fifty-three percent of the urban population is in the richest wealth index quintile, in contrast with only eight percent of the rural population. Moreover, more than a quarter of the rural population is in the poorest wealth index quintile, higher than the poorest urban population of one percent. Table HH.8: Wealth quintiles Percent distribution of the household population by wealth index quintile, according to area of residence and regions, Swaziland MICS, 2014 Wealth index quintile Total Number of household members Poorest Second Middle Fourth Richest Total 20.0 20.0 20.0 20.0 20.0 100.0 19,636 Area Urban 1.1 5.4 10.9 29.6 53.0 100.0 5,238 Rural 26.9 25.3 23.3 16.5 8.0 100.0 14,398 Region Hhohho 15.0 22.2 19.6 19.1 24.1 100.0 4,909 Manzini 10.5 17.0 20.5 27.5 24.5 100.0 7,287 Shiselweni 33.1 23.4 23.7 12.4 7.4 100.0 3,513 Lubombo 32.3 19.8 16.2 14.0 17.7 100.0 3,927 Page| 19 P a g e | 19 4. Child Mortality One of the overarching goals of the Millennium Development Goals (MDGs) is to reduce infant and under- five mortality. Specifically, the MDGs called for the reduction of under-five mortality by two-thirds between 1990 and 2015. Monitoring progress towards this goal is an important but difficult objective. Mortality rates presented in this chapter are calculated from information collected in the birth histories of the Women’s Questionnaires. All interviewed women were asked whether they had ever given birth, and if yes, they were asked to report the number of sons and daughters who live with them, the number who live elsewhere, and the number who have died. In addition, they were asked to provide a detailed birth history of live births of children in chronological order starting with the firstborn. Women were asked whether births were single or multiple, the sex of the children, the date of birth (month and year), and survival status. Further, for children still alive, they were asked the current age of the child and, if not alive, the age at death. Childhood mortality rates are expressed by conventional age categories and are defined as follows: • Neonatal mortality (NN): probability of dying within 28 days of life • Post-neonatal mortality (PNN): difference between infant and neonatal mortality rates • Infant mortality (1q0): probability of dying between birth and the first birthday • Child mortality (4q1): probability of dying between the first and the fifth birthdays • Under-five mortality (5q0): the probability of dying between birth and the fifth birthday Rates are expressed as deaths per 1,000 live births, except in the case of child mortality, which is expressed as deaths per 1,000 children surviving to age one. Table CM.1 shows trends in neonatal, post-neonatal, infant, child and under-five mortality rates for the three consecutive five-year periods preceding the survey. In the most recent five-year period preceding the survey, infant mortality is 50 deaths per 1,000 live births, and under-five mortality is 67 deaths per 1,000 live births. This means that about seven in 100 children born in Swaziland die before reaching their fifth birthday. Neonatal mortality in the most recent five-year period is estimated at 20 deaths per 1,000 live births, while the post-neonatal mortality rate is estimated at 30 deaths per 1,000 live births. The age pattern of mortality during the first five-year period before the survey shows that three-quarters of the deaths take place during the first year of the child’s life and that nearly one in three of the of deaths among under-five happen within the first month of life. Page| 20 P a g e | 20 Table CM.1: Early childhood mortality rates Neonatal, post-neonatal, Infant, child and under-five mortality rates for five year periods preceding the survey, Swaziland MICS, 2014 Neonatal mortality rate1 Post-neonatal mortality rate2, a Infant mortality rate3 Child mortality rate4 Under-five mortality rate5 Years preceding the survey 0-4 20 30 50 18 67 5-9 17 57 74 20 92 10-14 23 45 67 27 92 1 MICS indicator 1.1 - Neonatal mortality rate 2 MICS indicator 1.3 - Post-neonatal mortality rate 3 MICS indicator 1.2; MDG indicator 4.2 - Infant mortality rate 4 MICS indicator 1.4 - Child mortality rate 5 MICS indicator 1.5; MDG indicator 4.1 - Under-five mortality rate a Post-neonatal mortality rates are computed as the difference between the infant and neonatal mortality rates Figure CM.1: Early childhood mortality rates, Swaziland MICS, 2014 Childhood mortality by demographic and socio-economic characteristics Tables CM.2 and CM.3 provide estimates of child mortality by socioeconomic and demographic characteristics. Infant mortality rates range between 37 deaths per 1,000 live births in Hhohho region and 23 45 67 27 92 17 57 74 20 92 20 30 50 18 67 Neonatal mortality rate Post-neonatal mortality rate Infant mortality rate Child mortality rate Under-five mortality rate Years preceding the survey Note: Indicator values are per 1,000 live births 10-14 5-9 0-4 P a g e | 21 78 deaths per 1,000 live births in Shiselweni region. Under-five mortality rates range from 45 deaths per 1,000 live births in Hhohho region to 92 deaths per 1,000 live births in Shiselweni region. Table CM.2: Early childhood mortality rates by socioeconomic characteristics Neonatal, post-neonatal, Infant, child and under-five mortality rates for the five year period preceding the survey, by socioeconomic characteristics, Swaziland MICS, 2014 Neonatal mortality rate1 Post-neonatal mortality rate2, a Infant mortality rate3 Child mortality rate4 Under-five mortality rate5 Total 20 30 50 18 67 Region Hhohho 11 27 37 8 45 Manzini 24 24 48 20 68 Shiselweni 27 51 78 14 92 Lubombo 17 (26) (42) (30) (71) Area Urban 24 26 50 (17) (67) Rural 18 31 50 19 67 Mother's education None (*) (*) (*) (*) (*) Primary 34 37 71 27 97 Secondary 21 41 62 20 81 Higher 8 8 17 (10) (27) Tertiary (*) (*) (*) (*) (*) Wealth index quintile Poorest 28 43 71 (24) (94) Second 17 23 40 (23) (62) Middle 22 25 48 (5) (52) Fourth (18) (33) (51) (27) (77) Richest (15) (25) (40) (12) (52) 1 MICS indicator 1.1 - Neonatal mortality rate 2 MICS indicator 1.3 - Post-neonatal mortality rate 3 MICS indicator 1.2; MDG indicator 4.2 - Infant mortality rate 4 MICS indicator 1.4 - Child mortality rate 5 MICS indicator 1.5; MDG indicator 4.1 - Under-five mortality rate a Post-neonatal mortality rates are computed as the difference between the infant and neonatal mortality rates (*) Rates based on fewer than 250 unweighted exposed person years ( ) Rates based on 250 to 499 unweighted exposed person years Page| 21 P a g e | 21 78 deaths per 1,000 live births in Shiselweni region. Under-five mortality rates range from 45 deaths per 1,000 live births in Hhohho region to 92 deaths per 1,000 live births in Shiselweni region. Table CM.2: Early childhood mortality rates by socioeconomic characteristics Neonatal, post-neonatal, Infant, child and under-five mortality rates for the five year period preceding the survey, by socioeconomic characteristics, Swaziland MICS, 2014 Neonatal mortality rate1 Post-neonatal mortality rate2, a Infant mortality rate3 Child mortality rate4 Under-five mortality rate5 Total 20 30 50 18 67 Region Hhohho 11 27 37 8 45 Manzini 24 24 48 20 68 Shiselweni 27 51 78 14 92 Lubombo 17 (26) (42) (30) (71) Area Urban 24 26 50 (17) (67) Rural 18 31 50 19 67 Mother's education None (*) (*) (*) (*) (*) Primary 34 37 71 27 97 Secondary 21 41 62 20 81 Higher 8 8 17 (10) (27) Tertiary (*) (*) (*) (*) (*) Wealth index quintile Poorest 28 43 71 (24) (94) Second 17 23 40 (23) (62) Middle 22 25 48 (5) (52) Fourth (18) (33) (51) (27) (77) Richest (15) (25) (40) (12) (52) 1 MICS indicator 1.1 - Neonatal mortality rate 2 MICS indicator 1.3 - Post-neonatal mortality rate 3 MICS indicator 1.2; MDG indicator 4.2 - Infant mortality rate 4 MICS indicator 1.4 - Child mortality rate 5 MICS indicator 1.5; MDG indicator 4.1 - Under-five mortality rate a Post-neonatal mortality rates are computed as the difference between the infant and neonatal mortality rates (*) Rates based on fewer than 250 unweighted exposed person years ( ) Rates based on 250 to 499 unweighted exposed person years Page| 22 P a g e | 22 Table CM.3: Early childhood mortality rates by demographic characteristics Neonatal, post-neonatal, Infant, child and under-five mortality rates for the five year period preceding the survey, by demographic characteristics, Swaziland MICS, 2014 Neonatal mortality rate1 Post-neonatal mortality rate2, a Infant mortality rate3 Child mortality rate4 Under-five mortality rate5 Total 20 30 50 18 67 Sex of child Male 21 35 56 20 74 Female 19 25 44 16 60 Mother's age at birth Less than 20 (27) (29) (57) (21) (76) 20-34 (17) (31) (48) (18) (65) 35-49 (29) (22) (51) (17) (67) Birth order 1 17 24 40 26 65 2-3 19 30 50 14 63 4-6 26 35 61 15 75 7+ (*) (*) (*) (*) (*) Previous birth intervalb < 2 years 15 28 42 22 63 2 years 32 42 74 19 92 3 years 25 34 59 17 75 4+ years 19 25 43 13 55 1 MICS indicator 1.1 - Neonatal mortality rate 2 MICS indicator 1.3 - Post-neonatal mortality rate 3 MICS indicator 1.2; MDG indicator 4.2 - Infant mortality rate 4 MICS indicator 1.4 - Child mortality rate 5 MICS indicator 1.5; MDG indicator 4.1 - Under-five mortality rate a Post-neonatal mortality rates are computed as the difference between the infant and neonatal mortality rates b Excludes first order births (*) Rates based on fewer than 250 unweighted exposed person years ( ) Rates based on 250 to 499 unweighted exposed person years Figure CM.2 compares the findings of Swaziland MICS5 on under-five mortality rates with those from Swaziland MICS4. The Swaziland MICS5 child mortality findings are obtained from Table CM.1 above. MICS5 estimates are compatible with an overall decline in under-five mortality during the last fifteen years preceding the survey. Similarly, under-five mortality is 104 deaths per 1,000 live births in MICS4 2010 and 67 deaths per 1,000 live births in MICS5 2014. P a g e | 22 Table CM.3: Early childhood mortality rates by demographic characteristics Neonatal, post-neonatal, Infant, child and under-five mortality rates for the five year period preceding the survey, by demographic characteristics, Swaziland MICS, 2014 Neonatal mortality rate1 Post-neonatal mortality rate2, a Infant mortality rate3 Child mortality rate4 Under-five mortality rate5 Total 20 30 50 18 67 Sex of child Male 21 35 56 20 74 Female 19 25 44 16 60 Mother's age at birth Less than 20 (27) (29) (57) (21) (76) 20-34 (17) (31) (48) (18) (65) 35-49 (29) (22) (51) (17) (67) Birth order 1 17 24 40 26 65 2-3 19 30 50 14 63 4-6 26 35 61 15 75 7+ (*) (*) (*) (*) (*) Previous birth intervalb < 2 years 15 28 42 22 63 2 years 32 42 74 19 92 3 years 25 34 59 17 75 4+ years 19 25 43 13 55 1 MICS indicator 1.1 - Neonatal mortality rate 2 MICS indicator 1.3 - Post-neonatal mortality rate 3 MICS indicator 1.2; MDG indicator 4.2 - Infant mortality rate 4 MICS indicator 1.4 - Child mortality rate 5 MICS indicator 1.5; MDG indicator 4.1 - Under-five mortality rate a Post-neonatal mortality rates are computed as the difference between the infant and neonatal mortality rates b Excludes first order births (*) Rates based on fewer than 250 unweighted exposed person years ( ) Rates based on 250 to 499 unweighted exposed person years Figure CM.2 compares the findings of Swaziland MICS5 on under-five mortality rates with those from Swaziland MICS4. The Swaziland MICS5 child mortality findings are obtained from Table CM.1 above. MICS5 estimates are compatible with an overall decline in under-five mortality during the last fifteen years preceding the survey. Similarly, under-five mortality is 104 deaths per 1,000 live births in MICS4 2010 and 67 deaths per 1,000 live births in MICS5 2014. Page| 23 P a g e | 23 F i g u r e C M . 2 : T r e n d i n u n d e r - 5 m o r t a l i t y r a t e s , S w a z i l a n d M I C S , 2 0 1 4 10494 76 120 90 60 67 9292 0 20 40 60 80 100 120 140 1990 1994 1998 2002 2006 2010 2014 Per 1,000 live births Year MICS 2010 DHS 2007 MICS 2014 Page| 24 P a g e | 24 5. Nutrition In Swaziland, the Ministry of Health (MOH) has several statutory bodies under its jurisdiction and one of those is the Swaziland National Nutrition Council (SNNC). The Swaziland National Nutrition Council was established by the SNNC Act of 1945 and is mandated to promote food and nutrition activities and to advise the government accordingly. The Council is faced with an obligation to ensure that strategies which are developed to improve the nutritional status of the Swazi nation are put in place. This is done to enable comprehensive service provision regarding adequate food and nutrition service delivery, coordination and collaboration of food and nutrition activities, resource mobilization for the sustainability of food and nutrition services. There are nutrition specific interventions being implemented in the country to address malnutrition issues, namely; Integrated Management of Acute Malnutrition, Integrated Community Based Growth Monitoring and Promotion, Infant and Young Child Feeding Practices, Nutrition and HIV, Promotion and Prevention of Micronutrients Deficiencies. This chapter discusses results on low birth weight, nutritional status, Infant and Young Child Feeding practises and salt iodisation. 5.1 Low Birth Weight Weight at birth is a good indicator not only of a mother's health and nutritional status but also the newborn’s chances for survival, growth, long-term health and psychosocial development. Low birth weight (defined as less than 2,500 grams) carries a range of grave health risks for children. Babies who were undernourished in the womb face a greatly increased risk of dying during their early days, months and years. Those who survive may have impaired immune function and increased risk of disease; they are likely to remain undernourished, with reduced muscle strength, throughout their lives, and suffer a higher incidence of diabetes and heart disease in later life. Children born with low birth weight also risk a lower IQ and cognitive disabilities, affecting their performance in school and their job opportunities as adults. In the developing world, low birth weight stems primarily from the mother's poor health and nutrition. Three factors have most impact: the mother's poor nutritional status before conception, short stature (due mostly to under nutrition and infections during her childhood), and poor nutrition during pregnancy. Inadequate weight gain during pregnancy is particularly important since it accounts for a large proportion of foetal growth retardation. Moreover, diseases such as diarrhoea and malaria, which are common in many developing countries, can significantly impair foetal growth if the mother becomes infected while pregnant. In the industrialized world, cigarette smoking during pregnancy is the leading cause of low birth weight. In developed and developing countries alike, teenagers who give birth when their own bodies have yet to finish growing run a higher risk of bearing low birth weight babies. One of the major challenges in measuring the incidence of low birth weight is that more than half of infants in the developing world are not weighed at birth. In the past, most estimates of low birth weight for developing countries were based on data compiled from health facilities. However, these Page| 25 P a g e | 25 estimates are biased for most developing countries because the majority of newborns are not delivered in facilities, and those who are represent only a selected sample of all births. Because many infants are not weighed at birth and those who are weighed may be a biased sample of all births, the reported birth weights usually cannot be used to estimate the prevalence of low birth weight among all children. Therefore, the percentage of births weighing below 2,500 grams is estimated from two items in the questionnaire: the mother’s assessment of the child’s size at birth (i.e., very small, smaller than average, average, larger than average, very large) and the mother’s recall of the child’s weight or the weight as recorded on a health card if the child was weighed at birth.8 Overall, 92 percent of births were weighed at birth and eight percent of infants weighed less than 2,500 grams at birth (Table NU.1). The proportion of children with low birth weight is seven percent in urban areas and eight percent in rural areas. Table NU.1: Low birth weight infants Percentage of last live-born children in the last two years that are estimated to have weighed below 2,500 grams at birth and percentage of live births weighed at birth, Swaziland MICS, 2014 Percent distribution of births by mother's assessment of size at birth Total Percentage of live births: Number of last live- born children in the last two years Very small Smaller than average Average Larger than average or very large DK Below 2,500 grams1 Weighed at birth2 Total 4.6 10.1 52.7 32.1 0.6 100.0 8.0 92.3 959 Mother's age at birth Less than 20 years 3.8 11.1 50.9 33.4 0.7 100.0 7.8 90.2 179 20-34 years 4.7 10.1 53.3 31.4 0.6 100.0 8.1 93.2 683 35-49 years 5.5 7.9 51.5 35.1 0.0 100.0 7.8 90.4 98 Birth order 1 3.7 11.8 54.7 28.8 1.1 100.0 8.0 93.5 322 2-3 4.9 9.2 50.9 34.6 0.4 100.0 7.9 93.4 419 4-5 7.5 6.7 57.1 28.7 0.0 100.0 8.8 89.9 149 6+ 0.8 14.4 44.5 40.4 0.0 100.0 6.9 86.3 70 Region Hhohho 5.6 11.8 57.4 24.1 1.1 100.0 9.1 93.9 230 Manzini 2.5 9.0 54.5 33.2 0.8 100.0 6.8 96.0 376 Shiselweni 5.5 13.2 40.3 41.0 0.0 100.0 8.7 89.0 171 Lubombo 6.7 7.0 54.6 31.7 0.0 100.0 8.4 85.9 182 Area Urban 3.5 8.1 57.3 31.1 0.0 100.0 7.1 98.9 257 Rural 5.0 10.8 51.0 32.5 0.8 100.0 8.3 90.0 702 Mother’s education None (10.4) (13.1) (44.5) (32.1) (0.0) 100.0 (11.4) (72.8) 32 Primary 6.1 8.7 49.8 34.6 0.8 100.0 8.3 85.2 239 Secondary 4.6 11.5 49.3 34.1 0.5 100.0 8.2 94.1 353 Higher 3.7 9.3 55.6 30.7 0.7 100.0 7.4 97.2 268 Tertiary 0.0 9.0 72.5 18.5 0.0 100.0 6.2 98.4 68 8 For a detailed description of the methodology, see Boerma, JT et al. 1996. Data on Birth Weight in Developing Countries: Can Surveys Help? Bulletin of the World Health Organization 74(2): 209-16. Page| 26 P a g e | 26 Wealth index quintile Poorest 7.1 9.2 50.1 33.6 0.0 100.0 8.9 80.9 205 Second 4.1 10.1 52.9 32.0 0.9 100.0 7.7 92.8 213 Middle 5.5 11.4 51.5 30.5 1.1 100.0 8.8 94.8 200 Fourth 3.9 12.0 47.4 35.9 0.8 100.0 7.9 98.0 175 Richest 1.8 7.3 62.3 28.6 0.0 100.0 6.3 96.9 167 1 MICS indicator 2.20 - Low-birthweight infants 2 MICS indicator 2.21 - Infants weighed at birth ( ) Figures that are based on 25-49 unweighted cases 5.2 Nutritional Status Children’s nutritional status is a reflection of their overall health. When children have access to an adequate food supply, are not exposed to repeated illness, and are well cared for, they reach their growth potential and are considered well nourished. Undernutrition is associated with more than half of all child deaths worldwide. Undernourished children are more likely to die from common childhood ailments, and for those who survive, have recurring sicknesses and faltering growth. Three-quarters of children who die from causes related to malnutrition were only mildly or moderately malnourished – showing no outward sign of their vulnerability. The Millennium Development Goal target was to reduce by half the proportion of people who suffer from hunger between 1990 and 2015. A reduction in the prevalence of malnutrition will also assist in the goal to reduce child mortality. In a well-nourished population, there is a reference distribution of height and weight for children under-five years. Under-nourishment in a population can be gauged by comparing children to a reference population. The reference population used in this report is based on the WHO growth standards.9 Each of the three nutritional status indicators – weight-for-age, height-for-age, and weight-for-height - can be expressed in standard deviation units (z-scores) from the median of the reference population. Weight-for-age is a measure of both acute and chronic malnutrition. Children whose weight-for-age is more than two standard deviations below the median of the reference population are considered moderately or severely underweight while those whose weight-for-age is more than three standard deviations below the median are classified as severely underweight. Height-for-age is a measure of linear growth. Children whose height-for-age is more than two standard deviations below the median of the reference population are considered short for their age and are classified as moderately or severely stunted. Those whose height-for-age is more than three standard deviations below the median are classified as severely stunted. Stunting is a reflection of chronic malnutrition as a result of failure to receive adequate nutrition over a long period and recurrent or chronic illness. Weight-for-height can be used to assess wasting and overweight status. Children whose weight-for- height is more than two standard deviations below the median of the reference population are 9 http://www.who.int/childgrowth/standards/technical_report P a g e | 26 Wealth index quintile Poorest 7.1 9.2 50.1 33.6 0.0 100.0 8.9 80.9 205 Second 4.1 10.1 52.9 32.0 0.9 100.0 7.7 92.8 213 Middle 5.5 11.4 51.5 30.5 1.1 100.0 8.8 94.8 200 Fourth 3.9 12.0 47.4 35.9 0.8 100.0 7.9 98.0 175 Richest 1.8 7.3 62.3 28.6 0.0 100.0 6.3 96.9 167 1 MICS indicator 2.20 - Low-birthweight infants 2 MICS indicator 2.21 - Infants weighed at birth ( ) Figures that are based on 25-49 unweighted cases 5.2 Nutritional Status Children’s nutritional status is a reflection of their overall health. When children have access to an adequate food supply, are not exposed to repeated illness, and are well cared for, they reach their growth potential and are considered well nourished. Undernutrition is associated with more than half of all child deaths worldwide. Undernourished children are more likely to die from common childhood ailments, and for those who survive, have recurring sicknesses and faltering growth. Three-quarters of children who die from causes related to malnutrition were only mildly or moderately malnourished – showing no outward sign of their vulnerability. The Millennium Development Goal target was to reduce by half the proportion of people who suffer from hunger between 1990 and 2015. A reduction in the prevalence of malnutrition will also assist in the goal to reduce child mortality. In a well-nourished population, there is a reference distribution of height and weight for children under-five years. Under-nourishment in a population can be gauged by comparing children to a reference population. The reference population used in this report is based on the WHO growth standards.9 Each of the three nutritional status indicators – weight-for-age, height-for-age, and weight-for-height - can be expressed in standard deviation units (z-scores) from the median of the reference population. Weight-for-age is a measure of both acute and chronic malnutrition. Children whose weight-for-age is more than two standard deviations below the median of the reference population are considered moderately or severely underweight while those whose weight-for-age is more than three standard deviations below the median are classified as severely underweight. Height-for-age is a measure of linear growth. Children whose height-for-age is more than two standard deviations below the median of the reference population are considered short for their age and are classified as moderately or severely stunted. Those whose height-for-age is more than three standard deviations below the median are classified as severely stunted. Stunting is a reflection of chronic malnutrition as a result of failure to receive adequate nutrition over a long period and recurrent or chronic illness. Weight-for-height can be used to assess wasting and overweight status. Children whose weight-for- height is more than two standard deviations below the median of the reference population are 9 http://www.who.int/childgrowth/standards/technical_report Page| 27 P a g e | 27 classified as moderately or severely wasted, while those who fall more than three standard deviations below the median are classified as severely wasted. Wasting is usually the result of a recent nutritional deficiency. The indicator of wasting may exhibit significant seasonal shifts associated with changes in the availability of food or disease prevalence. Children whose weight-for-height is more than two standard deviations above the median reference population are classified as moderately or severely overweight. In MICS, weights and heights of all children under-five years of age are measured using the anthropometric equipment recommended10 by UNICEF. Findings in this section are based on the results of these measurements. Table NU.2 shows percentages of children classified into each of the above described categories, based on the anthropometric measurements that were taken during fieldwork. Additionally, the table includes mean z-scores for all three anthropometric indicators. Children whose full birth date (month and year) were not obtained and children whose measurements are outside a plausible range are excluded from Table NU.2. Children are excluded from one or more of the anthropometric indicators when their weights and heights have not been measured, whichever applicable. For example, if a child has been weighed but his/her height has not been measured, the child is included in underweight calculations, but not in the calculations for stunting and wasting. Percentages of children by age and reasons for exclusion are shown in the data quality Tables DQ.12, DQ.13, and DQ.14 in Appendix D. The tables show that due to incomplete dates of birth, implausible measurements, and/or missing weight and/or height, two percent of children were excluded from the calculation of the weight-for-age indicator, and three percent each from the height-for-age and the weight-for-height indicators. Table DQ.4 indicates that 99 percent of children 0 to 4 eligible for the survey had completed interviews. Table DQ.15 shows that 20 percent of the weight measurements and 18 percent of the height/length measurements report ‘0’ or ‘5’ in their final digits. These percentages are within the acceptable level and are not indicative of heaping or preference for one or more digits in the reporting of anthropometric measurements. Table DQ.8 shows that completeness of reporting of date of birth and age was 100 percent. In Swaziland, six percent of children under-five years are moderately or severely underweight and about two percent are classified as severely underweight (Table NU.2). Overall, 26 percent of children are stunted or too short for their age and two percent are wasted or too thin for their height. Nine percent of children are overweight or too heavy for their height. Stunting is 27 percent in rural areas and 19 percent in urban areas. For children whose mothers have no education, stunting is 33 percent, while it is only five percent for those with mothers who have tertiary education. The age pattern depicted in Figure NU.1 shows that stunting becomes more prevalent after age one. Differences in stunting were also noted by household wealth (30 percent in the poorest households and 9 percent in the richest), with an inverse relationship observed for overweight (18 percent in richest households and 6 percent in the poorest). Overweight is more prevalent among children under 12 months, compared to older children aged between 1 and 5 years. 10 See MICS Supply Procurement Instructions: http://mics.unicef.orgl Page| 28 P a g e | 28 Ta bl e N U .2 : N ut rit io na l s ta tu s of c hi ld re n Pe rc en ta ge o f c hi ld re n un de r a ge 5 b y nu tri tio na l s ta tu s ac co rd in g to th re e an th ro po m et ric in di ce s: w ei gh t f or a ge , h ei gh t f or a ge , a nd w ei gh t f or h ei gh t, Sw az ila nd M IC S, 2 01 4 W ei gh t f or a ge N um be r o f ch ild re n un de r a ge 5 He ig ht fo r a ge N um be r o f ch ild re n un de r a ge 5 W ei gh t f or h ei gh t N um be r o f ch ild re n un de r a ge 5 Un de rw ei gh t M ea n Z- Sc or e (S D ) St un te d M ea n Z- Sc or e (S D ) W as te d O ve rw ei gh t M ea n Z- Sc or e (S D ) Pe rc en t b el ow Pe rc en t b el ow Pe rc en t b el ow Pe rc en t ab ov e - 2 SD 1 - 3 SD 2 - 2 SD 3 - 3 SD 4 - 2 SD 5 - 3 SD 6 + 2 SD 7 To ta l 5. 8 1. 6 -0 .3 2, 63 5 25 .5 7. 2 -1 .2 2, 61 5 2. 0 0. 4 9. 0 0. 6 2, 62 3 Se x M al e 7. 3 1. 9 -0 .4 1, 33 2 29 .2 8. 9 -1 .3 1, 32 1 2. 3 0. 5 9. 0 0. 5 1, 32 9 Fe m al e 4. 3 1. 4 -0 .2 1, 30 3 21 .7 5. 5 -1 .1 1, 29 5 1. 7 0. 2 8. 9 0. 6 1, 29 3 Re gi on H ho hh o 5. 5 1. 5 -0 .2 59 2 23 .5 6. 0 -1 .2 58 4 1. 5 0. 5 10 .2 0. 6 58 5 M an zi ni 5. 4 1. 5 -0 .2 96 0 24 .5 6. 3 -1 .1 95 7 1. 6 0. 1 9. 4 0. 6 95 7 Sh is el w en i 6. 5 1. 8 -0 .4 52 7 28 .0 9. 0 -1 .3 52 5 2. 2 0. 2 6. 1 0. 5 52 5 Lu bo m bo 6. 1 1. 8 -0 .4 55 5 26 .9 8. 4 -1 .3 54 9 3. 0 0. 8 9. 7 0. 6 55 7 Ar ea U rb an 4. 3 0. 4 0. 0 58 3 19 .0 4. 2 -0 .9 57 7 1. 8 0. 1 11 .6 0. 7 58 6 R ur al 6. 2 2. 0 -0 .3 2, 05 2 27 .3 8. 1 -1 .3 2, 03 8 2. 1 0. 4 8. 2 0. 5 2, 03 7 Ag e 0- 5 m on th s 5. 9 2. 1 0. 0 23 4 16 .4 2. 4 -0 .8 22 9 4. 4 2. 1 19 .3 0. 8 22 8 6- 11 m on th s 8. 6 2. 5 0. 0 25 7 15 .4 6. 0 -0 .7 25 6 4. 3 0. 3 15 .8 0. 5 25 7 12 -1 7 m on th s 6. 4 3. 4 -0 .2 28 6 27 .0 7. 6 -1 .2 28 2 2. 7 0. 4 8. 6 0. 4 28 5 18 -2 3 m on th s 8. 2 2. 1 -0 .3 24 1 35 .3 14 .1 -1 .5 24 0 2. 8 0. 2 9. 0 0. 6 24 0 24 -3 5 m on th s 5. 2 1. 3 -0 .4 58 3 33 .8 8. 4 -1 .5 58 1 2. 0 0. 0 7. 3 0. 6 58 3 36 -4 7 m on th s 4. 5 1. 3 -0 .4 51 7 27 .4 7. 8 -1 .3 51 1 1. 0 0. 4 7. 7 0. 6 51 4 48 -5 9 m on th s 4. 9 0. 5 -0 .4 51 7 17 .9 4. 8 -1 .1 51 6 0. 0 0. 0 4. 5 0. 4 51 6 Page| 29 P a g e | 29 M ot he r’s e du ca tio n N on e 7. 1 1. 6 -0 .6 23 3 32 .6 8. 2 -1 .5 23 2 1. 3 0. 0 5. 8 0. 4 23 3 Pr im ar y 7. 7 2. 2 -0 .5 81 2 32 .2 11 .0 -1 .5 80 5 2. 4 0. 4 7. 6 0. 5 81 1 Se co nd ar y 6. 2 1. 7 -0 .3 82 3 26 .5 5. 7 -1 .2 81 4 2. 4 0. 7 8. 7 0. 5 81 6 H ig he r 3. 2 1. 2 -0 .1 56 7 18 .1 5. 3 -1 .0 56 5 1. 5 0. 2 10 .7 0. 7 56 4 Te rti ar y 2. 4 0. 4 0. 3 19 4 5. 0 1. 5 -0 .4 19 3 1. 0 0. 0 12 .8 0. 7 19 3 W ea lth in de x qu in til e Po or es t 8. 1 2. 0 -0 .5 61 8 30 .2 12 .0 -1 .5 61 5 2. 1 0. 4 5. 8 0. 4 61 7 Se co nd 7. 9 2. 7 -0 .5 62 6 31 .2 9. 4 -1 .5 62 4 3. 0 0. 6 7. 0 0. 5 62 3 M id dl e 4. 3 1. 3 -0 .3 53 0 27 .8 5. 6 -1 .3 52 5 1. 4 0. 4 7. 6 0. 6 52 8 Fo ur th 4. 9 1. 5 -0 .2 43 8 23 .3 3. 9 -1 .1 43 8 1. 8 0. 2 9. 9 0. 5 43 7 R ic he st 2. 1 0. 2 0. 4 42 2 9. 2 2. 3 -0 .5 41 2 1. 5 0. 0 17 .5 0. 9 41 8 1 M IC S in di ca to r 2 .1 a an d M DG in di ca to r 1 .8 - Un de rw ei gh t p re va le nc e (m od er at e an d se ve re ) 2 M IC S in di ca to r 2 .1 b - U nd er w ei gh t p re va le nc e (s ev er e) 3 M IC S in di ca to r 2 .2 a - S tu nt in g pr ev al en ce (m od er at e an d se ve re ) 4 M IC S in di ca to r 2 .2 b - S tu nt in g pr ev al en ce (s ev er e) 5 M IC S in di ca to r 2 .3 a - W as tin g pr ev al en ce (m od er at e an d se ve re ) 6 M IC S in di ca to r 2 .3 b - W as tin g pr ev al en ce (s ev er e) 7 M IC S in di ca to r 2 .4 - O ve rw ei gh t p re va le nc e Page| 30 P a g e | 30 Figure NU.1: Under weight , s tunted, wast ed and over weight ch i ldren under age 5 (moderat e and sever e) , Swazi land MICS, 2014 5.3 Breastfeeding and Infant and Young Child Feeding Proper feeding of infants and young children can increase their chances of survival; it can also promote optimal growth and development, especially in the critical window from birth to two years of age. Breastfeeding for the first few years of life protects children from infection, provides an ideal source of nutrients, and is economical and safe. However, many mothers don’t start to breastfeed early enough, do not breastfeed exclusively for the recommended six months or stop breastfeeding too soon. There are often pressures to switch to infant formula, which can contribute to growth faltering and micronutrient malnutrition and can be unsafe if hygienic conditions, including safe drinking water are not readily available. Studies have shown that, in addition to continued breastfeeding, consumption of appropriate, adequate and safe solid, semi-solid and soft foods from the age of six months onwards leads to better health and growth outcomes, with potential to reduce stunting during the first two years of life.11 11 Bhuta, Z. et al. 2013. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? The Lancet June 6, 2013. 0 5 10 15 20 25 30 35 40 0 12 24 36 48 60 Pe rc en t Age in months Underweight Stunted Wasted Overweight Page| 31 P a g e | 31 UNICEF and WHO recommend that infants be breastfed within one hour of birth, breastfed exclusively for the first six months of life and continue to be breastfed up to two years of age and beyond.12 Starting at six months, breastfeeding should be combined with safe, age-appropriate feeding of solid, semi-solid and soft foods.13 A summary of key guiding principles14, 15 for feeding 6-23 month olds is provided in the table below along with proximate measures for these guidelines collected in this survey. The guiding principles for which proximate measures and indicators exist are: (i) continued breastfeeding; (ii) appropriate frequency of meals (but not energy density); and (iii) appropriate nutrient content of food. Feeding frequency is used as proxy for energy intake, requiring children to receive a minimum number of meals/snacks (and milk feeds for non-breastfed children) for their age. Dietary diversity is used to ascertain the adequacy of the nutrient content of the food (not including iron) consumed. For dietary diversity, seven food groups were created for which a child consuming at least four of these is considered to have a better quality diet. In most populations, consumption of at least four food groups means that the child has a high likelihood of consuming at least one animal-source food and at least one fruit or vegetable, in addition to a staple food (grain, root or tuber).16 These three dimensions of child feeding are combined into an assessment of the children who received appropriate feeding, using the indicator of “minimum acceptable diet”. To have a minimum acceptable diet in the previous day, a child must have received: (i) the appropriate number of meals/snacks/milk feeds; (ii) food items from at least 4 food groups; and (iii) breastmilk or at least 2 milk feeds (for non-breastfed children). Guiding Principle (age 6-23 months) Proximate measures Table Continue frequent, on-demand breastfeeding for two years and beyond Breastfed in the last 24 hours NU.4 Appropriate frequency and energy density of meals Breastfed children Depending on age, two or three meals/snacks provided in the last 24 hours Non-breastfed children Four meals/snacks and/or milk feeds provided in the last 24 hours NU.6 Appropriate nutrient content of food Four food groups17 eaten in the last 24 hours NU.6 Appropriate amount of food No standard indicator exists Na Appropriate consistency of food No standard indicator exists na 12 WHO. 2003. Implementing the Global Strategy for Infant and Young Child Feeding. Meeting Report Geneva, 3-5 February, 2003. 13 WHO. 2003. Global Strategy for Infant and Young Child Feeding. 14 PAHO. 2003. Guiding principles for complementary feeding of the breastfed child. 15 WHO. 2005. Guiding principles for feeding non-breastfed children 6-24 months of age. 16 WHO. 2008. Indicators for assessing infant and young child feeding practices. Part 1: Definitions. 17 Food groups used for assessment of this indicator are 1) Grains, roots and tubers, 2) legumes and nuts, 3) dairy products (milk, yogurt, cheese), 4) flesh foods (meat, fish, poultry and liver/organ meats), 5) eggs, 6) vitamin-A rich fruits and vegetables, and 7) other fruits and vegetables. Page| 32 P a g e | 32 Use of vitamin-mineral supplements or fortified products for infant and mother No standard indicator exists Na Practice good hygiene and proper food handling While it was not possible to develop indicators to fully capture programme guidance, one standard indicator does cover part of the principle: Not feeding with a bottle with a nipple NU.9 Practice responsive feeding, applying the principles of psycho-social care No standard indicator exists na Table NU.3 is based on mothers’ reports of what their last-born child, born in the last two years, was fed in the first few days of life. It indicates the proportion who were ever breastfed, those who were first breastfed within one hour and one day of birth, and those who received a prelacteal feed.18 Although a very important step in management of lactation and establishment of a physical and emotional relationship between the baby and the mother, only 48 percent of babies are breastfed for the first time within one hour of birth, while 81 percent of newborns in Swaziland start breastfeeding within one day of birth. The figures range between 40 percent in Shiselweni region and 57 percent in Lubombo. The findings are presented in Figure NU.2 by region and area of residence. Table NU.3: Initial breastfeeding Percentage of last live-born children in the last two years who were ever breastfed, breastfed within one hour of birth, and within one day of birth, and percentage who received a prelacteal feed, Swaziland MICS, 2014 Percentage who were ever breastfed1 Percentage who were first breastfed: Percentage who received a prelacteal feed Number of last live-born children in the last two years Within one hour of birth2 Within one day of birth Total 92.1 48.3 81.0 12.8 959 Region Hhohho 89.9 52.7 83.7 6.2 230 Manzini 91.7 45.4 81.1 15.0 376 Shiselweni 93.0 39.8 73.2 15.3 171 Lubombo 95.0 56.8 84.6 14.1 182 Area Urban 90.2 48.0 79.5 12.8 257 Rural 92.8 48.5 81.5 12.8 702 Months since last birth 0-11 months 93.6 51.5 84.2 11.2 473 12-23 months 90.6 45.3 77.9 14.3 487 Assistance at delivery Skilled attendant 92.6 49.8 82.6 10.8 847 Traditional birth attendant (*) (*) (*) (*) 5 Other 91.3 39.3 72.2 29.2 84 No one/Missing (76.7) (31.3) (64.8) (14.2) 23 Place of delivery Home 91.2 38.2 69.7 25.8 96 Health facility 92.6 49.6 82.7 10.7 842 Public 91.6 50.3 81.5 10.0 570 Private 94.7 48.0 85.3 12.2 272 On the way (*) (*) (*) (*) 12 Other/DK/Missing (*) (*) (*) (*) 10 18 Prelacteal feed refers to the provision any liquid or food, other than breastmilk, to a newborn during the period when breastmilk flow is generally being established (estimated here as the first 3 days of life). P a g e | 32 Use of vitamin-mineral supplements or fortified products for infant and mother No standard indicator exists Na Practice good hygiene and proper food handling While it was not possible to develop indicators to fully capture programme guidance, one standard indicator does cover part of the principle: Not feeding with a bottle with a nipple NU.9 Practice responsive feeding, applying the principles of psycho-social care No standard indicator exists na Table NU.3 is based on mothers’ reports of what their last-born child, born in the last two years, was fed in the first few days of life. It indicates the proportion who were ever breastfed, those who were first breastfed within one hour and one day of birth, and those who received a prelacteal feed.18 Although a very important step in management of lactation and establishment of a physical and emotional relationship between the baby and the mother, only 48 percent of babies are breastfed for the first time within one hour of birth, while 81 percent of newborns in Swaziland start breastfeeding within one day of birth. The figures range between 40 percent in Shiselweni region and 57 percent in Lubombo. The findings are presented in Figure NU.2 by region and area of residence. Table NU.3: Initial breastfeeding Percentage of last live-born children in the last two years who were ever breastfed, breastfed within one hour of birth, and within one day of birth, and percentage who received a prelacteal feed, Swaziland MICS, 2014 Percentage who were ever breastfed1 Percentage who were first breastfed: Percentage who received a prelacteal feed Number of last live-born children in the last two years Within one hour of birth2 Within one day of birth Total 92.1 48.3 81.0 12.8 959 Region Hhohho 89.9 52.7 83.7 6.2 230 Manzini 91.7 45.4 81.1 15.0 376 Shiselweni 93.0 39.8 73.2 15.3 171 Lubombo 95.0 56.8 84.6 14.1 182 Area Urban 90.2 48.0 79.5 12.8 257 Rural 92.8 48.5 81.5 12.8 702 Months since last birth 0-11 months 93.6 51.5 84.2 11.2 473 12-23 months 90.6 45.3 77.9 14.3 487 Assistance at delivery Skilled attendant 92.6 49.8 82.6 10.8 847 Traditional birth attendant (*) (*) (*) (*) 5 Other 91.3 39.3 72.2 29.2 84 No one/Missing (76.7) (31.3) (64.8) (14.2) 23 Place of delivery Home 91.2 38.2 69.7 25.8 96 Health facility 92.6 49.6 82.7 10.7 842 Public 91.6 50.3 81.5 10.0 570 Private 94.7 48.0 85.3 12.2 272 On the way (*) (*) (*) (*) 12 Other/DK/Missing (*) (*) (*) (*) 10 18 Prelacteal feed refers to the provision any liquid or food, other than breastmilk, to a newborn during the period when breastmilk flow is generally being established (estimated here as the first 3 days of life). P a g e | 32 Use of vitamin-mineral supplements or fortified products for infant and mother No standard indicator exists Na Practice good hygiene and proper food handling While it was not possible to develop indicators to fully capture programme guidance, one standard indicator does cover part of the principle: Not feeding with a bottle with a nipple NU.9 Practice responsive feeding, applying the principles of psycho-social care No standard indicator exists na Table NU.3 is based on mothers’ reports of what their last-born child, born in the last two years, was fed in the first few days of life. It indicates the proportion who were ever breastfed, those who were first breastfed within one hour and one day of birth, and those who received a prelacteal feed.18 Although a very important step in management of lactation and establishment of a physical and emotional relationship between the baby and the mother, only 48 percent of babies are breastfed for the first time within one hour of birth, while 81 percent of newborns in Swaziland start breastfeeding within one day of birth. The figures range between 40 percent in Shiselweni region and 57 percent in Lubombo. The findings are presented in Figure NU.2 by region and area of residence. Table NU.3: Initial breastfeeding Percentage of last live-born children in the last two years who were ever breastfed, breastfed within one hour of birth, and within one day of birth, and percentage who received a prelacteal feed, Swaziland MICS, 2014 Percentage who were ever breastfed1 Percentage who were first breastfed: Percentage who received a prelacteal feed Number of last live-born children in the last two years Within one hour of birth2 Within one day of birth Total 92.1 48.3 81.0 12.8 959 Region Hhohho 89.9 52.7 83.7 6.2 230 Manzini 91.7 45.4 81.1 15.0 376 Shiselweni 93.0 39.8 73.2 15.3 171 Lubombo 95.0 56.8 84.6 14.1 182 Area Urban 90.2 48.0 79.5 12.8 257 Rural 92.8 48.5 81.5 12.8 702 Months since last birth 0-11 months 93.6 51.5 84.2 11.2 473 12-23 months 90.6 45.3 77.9 14.3 487 Assistance at delivery Skilled attendant 92.6 49.8 82.6 10.8 847 Traditional birth attendant (*) (*) (*) (*) 5 Other 91.3 39.3 72.2 29.2 84 No one/Missing (76.7) (31.3) (64.8) (14.2) 23 Place of delivery Home 91.2 38.2 69.7 25.8 96 Health facility 92.6 49.6 82.7 10.7 842 Public 91.6 50.3 81.5 10.0 570 Private 94.7 48.0 85.3 12.2 272 On the way (*) (*) (*) (*) 12 Other/DK/Missing (*) (*) (*) (*) 10 18 Prelacteal feed refers to the provision any liquid or food, other than breastmilk, to a newborn during the period when breastmilk flow is generally being established (estimated here as the first 3 days of life). Page| 33 P a g e | 33 Mother’s education None (98.1) (44.3) (80.4) (8.8) 32 Primary 92.8 49.2 82.3 15.4 239 Secondary 93.1 53.7 83.0 10.2 353 Higher 93.3 44.2 79.7 15.6 268 Tertiary 77.2 35.2 71.2 7.7 68 Wealth index quintile Poorest 96.2 45.1 81.0 15.8 205 Second 92.1 48.4 83.2 14.5 213 Middle 91.5 45.7 82.8 9.8 200 Fourth 92.6 55.4 78.8 11.8 175 Richest 87.3 48.0 78.2 11.6 167 1 MICS indicator 2.5 - Children ever breastfed 2 MICS indicator 2.6 - Early initiation of breastfeeding ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Figure NU.2: In i t iat ion of breastfeeding, Swazi land MICS, 2014 The set of Infant and Young Child Feeding indicators reported in tables NU.4 through NU.8 are based on the mother’s report of consumption of food and fluids during the day or night prior to being interviewed. Data are subject to a number of limitations, some related to the respondent’s ability to provide a full report on the child’s liquid and food intake due to recall errors as well as lack of knowledge in cases where the child was fed by other individuals. 84 81 73 85 80 82 81 53 45 40 57 48 49 48 0 20 40 60 80 100 Pe rc en t Within one day Within one hour P a g e | 33 Mother’s education None (98.1) (44.3) (80.4) (8.8) 32 Primary 92.8 49.2 82.3 15.4 239 Secondary 93.1 53.7 83.0 10.2 353 Higher 93.3 44.2 79.7 15.6 268 Tertiary 77.2 35.2 71.2 7.7 68 Wealth index quintile Poorest 96.2 45.1 81.0 15.8 205 Second 92.1 48.4 83.2 14.5 213 Middle 91.5 45.7 82.8 9.8 200 Fourth 92.6 55.4 78.8 11.8 175 Richest 87.3 48.0 78.2 11.6 167 1 MICS indicator 2.5 - Children ever breastfed 2 MICS indicator 2.6 - Early initiation of breastfeeding ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Figure NU.2: In i t iat ion of breastfeeding, Swazi land MICS, 2014 The set of Infant and Young Child Feeding indicators reported in tables NU.4 through NU.8 are based on the mother’s report of consumption of food and fluids during the day or night prior to being interviewed. Data are subject to a number of limitations, some related to the respondent’s ability to provide a full report on the child’s liquid and food intake due to recall errors as well as lack of knowledge in cases where the child was fed by other individuals. 84 81 73 85 80 82 81 53 45 40 57 48 49 48 0 20 40 60 80 100 Pe rc en t Within one day Within one hour Page| 34 P a g e | 34 Table NU.4 and Figure NU.2 present breastfeeding status for both Exclusively breastfed and Predominantly breastfed; referring to infants age less than six months who are breastfed, distinguished by the former only allowing vitamins, mineral supplements, and medicine, and the latter allowing also plain water and non-milk liquids. Table NU.4 also shows continued breastfeeding of children at 12-15 and 20-23 months of age. Approximately 64 percent of children age less than six months are exclusively breastfed while 70 percent are predominantly breastfed. By age 12-15 months, 48 percent of children are breastfed and by age 20-23 months, eight percent are breastfed. The exclusive breastfeeding rate does not vary much by sex of the child and place of residence. Table NU.4: Breastfeeding Percentage of living children according to breastfeeding status at selected age groups, Swaziland MICS, 2014 Children age 0-5 months Children age 12-15 months Children age 20-23 months Percent exclusively breastfed1 Percent predominantly breastfed2 Number of children Percent breastfed (Continued breastfeeding at 1 year)3 Number of children Percent breastfed (Continued breastfeeding at 2 years)4 Number of children Total 63.8 70.2 250 47.8 196 7.6 170 Sex Male 64.0 72.1 140 47.1 97 7.3 85 Female 63.7 67.8 110 48.5 98 7.8 85 Region Hhohho 68.0 74.3 57 52.0 46 (9.6) 31 Manzini 58.2 64.5 94 (39.4) 70 7.6 71 Shiselweni 62.3 68.1 45 47.6 40 (2.8) 34 Lubombo 70.5 77.4 54 (57.7) 41 (10.4) 33 Area Urban 60.3 (65.2) 58 (35.3) 50 (6.2) 33 Rural 64.9 71.7 192 52.2 145 7.9 137 Mother’s education None (*) (*) 9 (*) 6 (*) 13 Primary 68.3 76.5 56 43.8 58 9.0 51 Secondary 68.0 72.7 110 54.1 68 9.0 56 Higher 52.5 56.5 61 52.2 52 (6.1) 33 Tertiary (*) (*) 14 (*) 13 (*) 17 Wealth index quintile Poorest 67.0 75.2 63 58.6 45 (0.9) 42 Second 71.9 76.6 56 (59.0) 38 (14.4) 39 Middle 56.0 63.9 50 (51.6) 39 (4.4) 38 Fourth (67.0) (71.5) 51 (41.1) 34 (*) 24 Richest (50.2) (56.3) 31 (27.4) 40 (*) 27 1 MICS indicator 2.7 - Exclusive breastfeeding under 6 months 2 MICS indicator 2.8 - Predominant breastfeeding under 6 months 3 MICS indicator 2.9 - Continued breastfeeding at 1 year 4 MICS indicator 2.10 - Continued breastfeeding at 2 years ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases P a g e | 34 Table NU.4 and Figure NU.2 present breastfeeding status for both Exclusively breastfed and Predominantly breastfed; referring to infants age less than six months who are breastfed, distinguished by the former only allowing vitamins, mineral supplements, and medicine, and the latter allowing also plain water and non-milk liquids. Table NU.4 also shows continued breastfeeding of children at 12-15 and 20-23 months of age. Approximately 64 percent of children age less than six months are exclusively breastfed while 70 percent are predominantly breastfed. By age 12-15 months, 48 percent of children are breastfed and by age 20-23 months, eight percent are breastfed. The exclusive breastfeeding rate does not vary much by sex of the child and place of residence. Table NU.4: Breastfeeding Percentage of living children according to breastfeeding status at selected age groups, Swaziland MICS, 2014 Children age 0-5 months Children age 12-15 months Children age 20-23 months Percent exclusively breastfed1 Percent predominantly breastfed2 Number of children Percent breastfed (Continued breastfeeding at 1 year)3 Number of children Percent breastfed (Continued breastfeeding at 2 years)4 Number of children Total 63.8 70.2 250 47.8 196 7.6 170 Sex Male 64.0 72.1 140 47.1 97 7.3 85 Female 63.7 67.8 110 48.5 98 7.8 85 Region Hhohho 68.0 74.3 57 52.0 46 (9.6) 31 Manzini 58.2 64.5 94 (39.4) 70 7.6 71 Shiselweni 62.3 68.1 45 47.6 40 (2.8) 34 Lubombo 70.5 77.4 54 (57.7) 41 (10.4) 33 Area Urban 60.3 (65.2) 58 (35.3) 50 (6.2) 33 Rural 64.9 71.7 192 52.2 145 7.9 137 Mother’s education None (*) (*) 9 (*) 6 (*) 13 Primary 68.3 76.5 56 43.8 58 9.0 51 Secondary 68.0 72.7 110 54.1 68 9.0 56 Higher 52.5 56.5 61 52.2 52 (6.1) 33 Tertiary (*) (*) 14 (*) 13 (*) 17 Wealth index quintile Poorest 67.0 75.2 63 58.6 45 (0.9) 42 Second 71.9 76.6 56 (59.0) 38 (14.4) 39 Middle 56.0 63.9 50 (51.6) 39 (4.4) 38 Fourth (67.0) (71.5) 51 (41.1) 34 (*) 24 Richest (50.2) (56.3) 31 (27.4) 40 (*) 27 1 MICS indicator 2.7 - Exclusive breastfeeding under 6 months 2 MICS indicator 2.8 - Predominant breastfeeding under 6 months 3 MICS indicator 2.9 - Continued breastfeeding at 1 year 4 MICS indicator 2.10 - Continued breastfeeding at 2 years ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Page| 35 P a g e | 35 Figure NU.3: Infant feeding patterns by age , Swazi land MICS, 2014 Exclusively breastfed Breastfed and complementary foods Weaned (not breastfed) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0-1 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-17 18-19 20-21 22-23 Age in months Exclusively breastfed Breastfed and plain water only Breastfed and other milk / formula Breastfed and complementary foods Weaned (not breastfed) Page| 36 P a g e | 36 Table NU.5 shows the median duration of breastfeeding by selected background characteristics. Among children under-three months, the median duration is 13 months for any breastfeeding, about four months for both exclusive breastfeeding and predominant breastfeeding. Table NU.5: Duration of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children age 0-35 months, Swaziland MICS, 2014 Median duration (in months) of: Number of children age 0-35 months Any breastfeeding1 Exclusive breastfeeding Predominant breastfeeding Median 13.0 3.7 4.2 1,638 Sex Male 12.8 3.6 4.4 842 Female 13.1 3.8 4.0 796 Region Hhohho 14.5 4.1 4.9 355 Manzini 11.3 3.3 3.9 631 Shiselweni 13.2 3.4 3.7 320 Lubombo 13.0 4.2 4.6 332 Area Urban 11.5 3.1 3.5 400 Rural 13.6 3.9 4.5 1,238 Mother’s education None 12.7 2.1 3.7 116 Primary 13.0 3.7 4.2 471 Secondary 15.4 4.1 4.6 549 Higher 13.1 2.9 3.4 387 Wealth index quintile Poorest 14.3 4.2 4.8 364 Second 14.4 4.2 4.5 391 Middle 13.5 3.0 3.6 332 Fourth 13.0 3.9 4.3 287 Richest 9.4 2.5 3.0 263 Mean 12.7 3.8 4.2 1,638 1 MICS indicator 2.11 - Duration of breastfeeding The age-appropriateness of breastfeeding of children under-24 months is provided in Table NU.6. Different criteria of feeding are used depending on the age of the child. For infants age 0-5 months, exclusive breastfeeding is considered as age-appropriate feeding, while children age 6-23 months are considered to be appropriately fed if they are receiving breastmilk and solid, semi-solid or soft food. The results show that most of the children are not fed appropriately in Swaziland. As a result of feeding patterns, only 40 percent of children age 6-23 months are appropriately breastfed and age- appropriate breastfeeding among all children age 0-23 months is 45 percent. Page| 37 P a g e | 37 Table NU.6: Age-appropriate breastfeeding Percentage of children age 0-23 months who were appropriately breastfed during the previous day, Swaziland MICS, 2014 Children age 0-5 months Children age 6-23 months Children age 0-23 months Percent exclusively breastfed1 Number of children Percent currently breastfeeding and receiving solid, semi- solid or soft foods Number of children Percent appropriately breastfed2 Number of children Total 63.8 250 39.5 793 45.3 1,043 Sex Male 64.0 140 38.6 397 45.2 537 Female 63.7 110 40.4 396 45.4 506 Region Hhohho 68.0 57 46.5 174 51.8 231 Manzini 58.2 94 35.3 299 40.8 394 Shiselweni 62.3 45 40.1 156 45.0 201 Lubombo 70.5 54 39.0 164 46.8 218 Area Urban (60.3) 58 38.7 194 43.6 252 Rural 64.9 192 39.7 599 45.8 791 Mother’s education None (*) 9 26.7 48 29.2 57 Primary 68.3 56 39.0 238 44.6 294 Secondary 68.0 110 46.0 258 52.6 368 Higher 52.5 61 40.1 193 43.1 254 Tertiary (*) 14 (19.6) 56 31.3 70 Wealth index quintile Poorest 67.0 63 41.5 181 48.0 244 Second 71.9 56 44.4 190 50.7 245 Middle 56.0 50 35.9 162 40.6 212 Fourth (67.0) 51 43.4 124 50.3 174 Richest (50.2) 31 30.5 137 34.1 168 1 MICS indicator 2.7 - Exclusive breastfeeding under 6 months 2 MICS indicator 2.12 - Age-appropriate breastfeeding ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Page| 38 P a g e | 38 Overall, 90 percent of infants age 6-8 months received solid, semi-solid, or soft foods at least once during the previous day (Table NU.7). Among currently breastfeeding infants this percentage is 92. Table NU.7: Introduction of solid, semi-solid, or soft foods Percentage of infants age 6-8 months who received solid, semi-solid, or soft foods during the previous day, Swaziland MICS, 2014 Currently breastfeeding Currently not breastfeeding All Percent receiving solid, semi- solid or soft foods Number of children age 6-8 months Percent receiving solid, semi- solid or soft foods Number of children age 6-8 months Percent receiving solid, semi- solid or soft foods1 Number of children age 6-8 months Total 91.6 85 (85.3) 40 89.5 125 Sex Male (92.7) 37 (*) 19 88.6 56 Female 90.7 48 (*) 21 90.3 69 Area Urban (*) 22 (*) 10 (*) 32 Rural 90.1 63 (80.2) 30 86.9 93 1 MICS indicator 2.13 - Introduction of solid, semi-solid or soft foods ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Overall, more than four-fifths of the children age 6-23 months (81 percent) are receiving solid, semi- solid and soft foods the minimum number of times (Table NU.8). The proportion of children receiving the minimum dietary diversity, or foods from at least four food groups, is much lower than that for minimum meal frequency, indicating the need to focus on improving diet quality and nutrient intake among this vulnerable group. The overall assessment using the indicator of minimum acceptable diet reveals that only 38 percent are benefitting from a diet sufficient in both diversity and frequency. Page| 39 P a g e | 39 T ab le N U .8 : I nf an t a nd y ou ng c hi ld fe ed in g (IY C F) p ra ct ic es Pe rc en ta ge o f c hi ld re n ag e 6- 23 m on th s w ho re ce iv ed a pp ro pr ia te li qu id s an d so lid , s em i-s ol id , o r s of t f oo ds th e m in im um n um be r o f t im es o r m or e du rin g th e pr ev io us d ay , b y br ea st fe ed in g st at us , S w az ila nd M IC S, 2 01 4 Cu rr en tly b re as tfe ed in g Cu rr en tly n ot b re as tfe ed in g Al l Pe rc en t o f c hi ld re n w ho re ce iv ed : N um be r of ch ild re n ag e 6- 23 m on th s Pe rc en t o f c hi ld re n w ho re ce iv ed : N um be r of ch ild re n ag e 6- 23 m on th s Pe rc en t o f c hi ld re n w ho re ce iv ed : N um be r of ch ild re n ag e 6- 23 m on th s M in im um di et ar y di ve rs ity a M in im um m ea l fre qu en cy b M in im um ac ce pt ab le di et 1, c M in im um di et ar y di ve rs ity a M in im um m ea l fre qu en cy b M in im um ac ce pt ab le di et 2, c At le as t 2 m ilk fe ed s3 M in im um di et ar y di ve rs ity 4, a M in im um m ea l fre qu en cy 5, b M in im um ac ce pt ab le di et c To ta l 52 .1 82 .8 48 .6 32 0 68 .4 79 .9 29 .7 52 .8 39 9 62 .4 81 .2 38 .1 79 3 Se x M al e 55 .0 84 .1 50 .5 15 6 70 .3 80 .9 29 .6 51 .5 20 7 64 .0 82 .3 38 .6 39 7 Fe m al e 49 .4 81 .7 46 .8 16 4 66 .3 78 .7 29 .8 54 .1 19 2 60 .8 80 .1 37 .6 39 6 Ag e 6- 8 m on th s 30 .4 81 .0 30 .4 85 (3 1. 5) (7 6. 7) (1 6. 3) (7 1. 1) 28 33 .0 80 .0 26 .9 12 5 9- 11 m on th s 61 .8 86 .5 57 .1 84 (7 9. 1) (9 8. 4) (5 7. 3) (8 6. 3) 37 68 .1 90 .2 57 .2 13 5 12 -1 7 m on th s 58 .4 81 .5 52 .7 12 5 74 .4 81 .3 33 .8 60 .8 12 5 68 .9 81 .4 43 .3 28 7 18 -2 3 m on th s (6 0. 5) (8 3. 4) (6 0. 5) 27 67 .9 76 .2 24 .1 39 .4 20 8 66 .8 77 .0 28 .3 24 6 Re gi on H ho hh o 42 .6 75 .4 42 .6 86 62 .5 72 .7 20 .9 41 .2 72 53 .1 74 .2 32 .7 17 4 M an zi ni 65 .6 84 .2 59 .0 10 7 79 .9 90 .6 39 .9 67 .9 15 8 74 .3 88 .0 47 .6 29 9 Sh is el w en i 52 .9 85 .9 49 .1 63 60 .4 75 .2 20 .7 43 .1 78 58 .9 80 .0 33 .4 15 6 Lu bo m bo 41 .5 87 .5 39 .0 65 59 .7 70 .7 26 .7 43 .7 90 54 .2 77 .7 31 .8 16 4 Ar ea U rb an 57 .3 84 .4 55 .7 76 81 .3 94 .2 45 .8 78 .8 94 72 .0 89 .8 50 .2 19 4 R ur al 50 .5 82 .4 46 .4 24 4 64 .4 75 .5 24 .8 44 .8 30 5 59 .3 78 .5 34 .4 59 9 M ot he r’s e du ca tio n N on e (* ) (* ) (* ) 13 (5 2. 6) (6 6. 5) (1 9. 1) (3 2. 5) 30 (5 4. 4) (7 2. 9) (2 6. 8) 48 Pr im ar y 39 .5 83 .9 37 .1 95 54 .0 68 .2 17 .2 37 .9 12 0 50 .1 75 .1 26 .0 23 8 Se co nd ar y 57 .3 80 .9 56 .0 12 2 73 .8 85 .1 27 .9 52 .2 11 7 66 .1 83 .0 42 .3 25 8 H ig he r 56 .8 83 .2 50 .1 79 81 .0 87 .8 39 .9 65 .7 98 71 .9 85 .8 44 .5 19 3 Te rti ar y (* ) (* ) (* ) 11 (7 8. 3) (9 2. 1) (5 9. 8) (8 7. 8) 34 72 .2 90 .9 59 .6 56 Page| 40 P a g e | 40 W ea lth in de x qu in til e Po or es t 35 .9 79 .3 33 .8 77 55 .8 74 .2 20 .5 34 .5 94 46 .9 76 .5 26 .5 18 1 Se co nd 51 .9 86 .1 50 .0 87 58 .4 68 .2 23 .0 41 .3 85 57 .4 77 .3 36 .7 19 0 M id dl e 55 .2 82 .6 50 .5 59 65 .6 77 .1 24 .8 49 .8 89 63 .4 79 .3 35 .1 16 2 Fo ur th (7 2. 8) (8 7. 7) (6 8. 2) 55 85 .1 87 .2 32 .1 62 .7 54 79 .4 87 .4 50 .2 12 4 R ic he st (5 0. 8) (7 7. 0) (4 4. 9) 43 86 .3 97 .9 52 .3 84 .2 76 73 .7 90 .4 49 .7 13 7 1 M IC S in di ca to r 2 .1 7a - M in im um a cc ep ta bl e di et (b re as tfe d) 2 M IC S in di ca to r 2 .1 7b - M in im um a cc ep ta bl e di et (n on -b re as tfe d) 3 M IC S in di ca to r 2 .1 4 - M ilk fe ed in g fr eq ue nc y fo r n on -b re as tfe d ch ild re n 4 M IC S in di ca to r 2 .1 6 - M in im um d ie ta ry d iv er si ty 5 M IC S in di ca to r 2 .1 5 - M in im um m ea l f re qu en cy a M in im um d ie ta ry d iv er si ty is d ef in ed a s re ce iv in g fo od s fro m a t l ea st 4 o f 7 fo od g ro up s: 1 ) G ra in s, ro ot s an d tu be rs , 2 ) l eg um es a nd n ut s, 3 ) d ai ry p ro du ct s (m ilk , y og ur t, ch ee se ), 4) fl es h fo od s (m ea t, fis h, p ou ltr y an d liv er /o rg an m ea ts ), 5) e gg s, 6 ) v ita m in -A ri ch fr ui ts a nd v eg et ab le s, a nd 7 ) o th er fr ui ts a nd v eg et ab le s. b M in im um m ea l f re qu en cy a m on g cu rre nt ly b re as tfe ed in g ch ild re n is d ef in ed a s ch ild re n w ho a ls o re ce iv ed s ol id , s em i-s ol id , o r s of t f oo ds 2 ti m es o r m or e da ily fo r c hi ld re n ag e 6- 8 m on th s an d 3 tim es o r m or e da ily fo r c hi ld re n ag e 9- 23 m on th s. F or n on -b re as tfe ed in g ch ild re n ag e 6- 23 m on th s it is d ef in ed a s re ce iv in g so lid , s em i-s ol id o r s of t f oo ds , o r m ilk fe ed s, a t l ea st 4 ti m es . c Th e m in im um a cc ep ta bl e di et fo r b re as tfe d ch ild re n ag e 6- 23 m on th s is d ef in ed a s re ce iv in g th e m in im um d ie ta ry d iv er si ty a nd th e m in im um m ea l f re qu en cy , w hi le it fo r n on -b re as tfe d ch ild re n fu rth er re qu ire s at le as t 2 m ilk fe ed in gs a nd th at th e m in im um d ie ta ry d iv er si ty is a ch ie ve d w ith ou t c ou nt in g m ilk fe ed s. ( ) F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s (* ) F ig ur es th at a re b as ed o n fe w er th an 2 5 un w ei gh te d ca se s Page| 41 P a g e | 41 The continued practice of bottle-feeding is a concern because of the possible contamination due to unsafe water and lack of hygiene in preparation. About 32 percent of children under-six months are fed using a bottle with a nipple (table NU.9). The percentages are higher for children whose mothers have higher/tertiary education and those in richest households compared to the other education and wealth index quintile categories. Table NU.9: Bottle feeding Percentage of children age 0-23 months who were fed with a bottle with a nipple during the previous day, Swaziland MICS, 2014 Percentage of children age 0-23 months fed with a bottle with a nipple1 Number of children age 0-23 months Total 31.7 1,043 Sex Male 31.1 537 Female 32.4 506 Age 0-5 months 18.4 250 6-11 months 43.2 260 12-23 months 32.3 533 Region Hhohho 25.9 231 Manzini 38.1 394 Shiselweni 34.8 201 Lubombo 23.3 218 Area Urban 40.6 252 Rural 28.9 791 Mother’s education None 30.9 57 Primary 26.4 294 Secondary 24.9 368 Higher 43.6 254 Tertiary 47.4 70 Wealth index quintile Poorest 24.8 244 Second 23.1 245 Middle 32.4 212 Fourth 33.6 174 Richest 51.5 168 1 MICS indicator 2.18 - Bottle feeding 5.4 Salt Iodization Iodine Deficiency Disorders (IDD) is the world’s leading cause of preventable mental retardation and impaired psychomotor development in young children. In its most extreme form, iodine deficiency causes cretinism. It also increases the risks of stillbirth and miscarriage in pregnant women. Iodine deficiency is most commonly and visibly associated with goitre. IDD takes its greatest toll in impaired Page| 42 P a g e | 42 mental growth and development, contributing in turn to poor school performance, reduced intellectual ability, and impaired work performance. The indicator is the percentage of households consuming adequately iodized salt (>15 parts per million). In Swaziland, there is an intervention for preventing of micronutrients deficiencies. The promotion of consumption of iodized salt by households falls under this programme. There are National Standards for salt iodization (1985) and Salt Iodization Regulations, 1997 (under section 26). According to the regulations, the content of potassium iodate in salt should be >15ppm at household level. Table NU. 10 shows the results of households consuming iodized salt. In 94 percent of households, salt used for cooking was tested for iodine content by using salt test kits and testing for the presence of potassium iodate. The table shows that there was no salt in five percent of households. These households are included in the denominator of the indicator. In 66 percent of households, salt was found to contain at least 15 parts per million (ppm) or more of iodine. Table NU.10: Iodized salt consumption Percent distribution of households by consumption of iodized salt, Swaziland MICS, 2014 Percentage of households in which salt was tested Number of households Percent of households with: Total Number of households in which salt was tested or with no salt No salt Salt test result Not iodized 0 PPM >0 and <15 PPM 15+ PPM1 Total 94.4 4,865 5.1 4.5 24.2 66.1 100 4,840 Region Hhohho 96.1 1,230 3.5 4.7 27.2 64.6 100.0 1,225 Manzini 94.4 1,916 5.0 5.9 21.4 67.7 100.0 1,904 Shiselweni 93.2 734 6.6 3.8 19.9 69.6 100.0 732 Lubombo 92.9 985 6.4 2.0 29.2 62.4 100.0 979 Area Urban 95.4 1,811 3.8 3.5 19.9 72.8 100.0 1,796 Rural 93.8 3,054 5.9 5.1 26.7 62.2 100.0 3,044 Wealth index quintile Poorest 89.7 759 10.0 5.3 31.9 52.9 100.0 757 Second 94.2 801 5.4 5.9 29.6 59.1 100.0 798 Middle 92.7 898 6.7 5.6 23.6 64.1 100.0 892 Fourth 96.0 1,138 3.9 4.5 22.4 69.3 100.0 1,136 Richest 97.0 1,269 2.1 2.4 18.3 77.2 100.0 1,256 1 MICS indicator 2.19 - Iodized salt consumption The consumption of adequately iodized salt is graphically presented in Figure NU.4 together with the percentage of salt containing less the 15 ppm. Use of iodized salt by region ranges between 62 percent in Lubombo and 70 percent in Shiselweni. About 73 percent of urban households were found to be using adequately iodized salt as compared to 62 percent in rural areas. Page| 43 P a g e | 43 Figure NU.4: Consumption of iodized sa lt , Swazi land MICS, 2014 92 89 90 92 93 89 85 89 88 92 96 90 65 68 70 62 73 62 53 59 64 69 77 66 0 20 40 60 80 100 Pe rc en t Any iodine 15+ PPM of iodine Page| 44 P a g e | 44 6. Child Health Child health is a state of physical, mental, intellectual, social and emotional well-being and not merely the absence of disease or infirmity. It also refers to the care and treatment of children. Child health is the purview of paediatrics, which became a medical specialty in the mid-nineteenth century. Before that time the care and treatment of childhood diseases were included within such areas as general medicine, obstetrics, and midwifery. Ministry of Health has prioritized child health survival programmes and has designated public health programmes to look into child health issues. This chapter will only focus on child health care services provided by two public health programmes which are: the Swaziland Expanded Programme on Immunization (SEPI) and the Integrated Management of Childhood illnesses (IMCI) Programme. The SEPI oversees all immunizations to all eligible populations according to an official national immunization schedule while the IMCI Programme coordinates all integrated childhood illness and health care services in the country. Sections to be covered in this chapter include: acute respiratory illnesses which are pneumonia and diarrhoea management and control as well as immunization coverage for all antigens administered to the eligible population according to the national immunization schedule. 6.1 Vaccinations The Millennium Development Goal (MDG) 4 is to reduce child mortality by two thirds between 1990 and 2015. Immunization plays a key part in this goal. In addition, the Global Vaccine Action Plan (GVAP) was endorsed by the 194 Member States of the World Health Assembly in May 2012 to achieve the Decade of Vaccines vision by delivering universal access to immunization. Immunization has saved the lives of millions of children in the four decades since the launch of the Expanded Programme on Immunization (EPI) in 1974. Worldwide there are still millions of children not reached by routine immunization and as a result, vaccine-preventable diseases cause more than 2 million deaths every year. WHO Recommended Routine Immunization for all children, so that all children can be vaccinated against all vaccine preventable diseases which vary amongst countries such as tuberculosis, diphtheria, pertussis, tetanus, polio, measles, rubella, hepatitis B, haemophilus influenzae type b, pneumonia, meningitis and rotavirus. All doses in the primary series are recommended to be completed before the child’s first birthday

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