Syrian Arab Republic - Multiple Indicator Cluster Survey - 2006

Publication date: 2006

Syrian Arabic Republic - Multi Cluster Indicator Survey ISPN no. 978 - 92 - 806 - 4286 - 5 UNICEF /Syria Syrian Arab Republic Multiple Indicator Cluster Survey 2006 Central Bureau of Statistics Pan-Arab Project for Family Health / League of Arab States UNICEF United Nations Children’s Fund February 2008 Contributors to the report: Central Bureau of Statistics Ministry of Health State Planning Commission United Nations Children’s Fund, UNICEF Pan Arab Project for Family Health, PAPFAM/League of Arab States The Syrian Arab Republic Multiple Indicator Cluster Survey (MICS) was carried by the Central Bureau of Statistics in collaboration with Ministry of Health, State Planning Commission, Pan Arab Project for Family Health/League of Arab States, and UNICEF. Financial and technical support was provided by the United Nations Children’s Fund (UNICEF). The survey has been conducted as part of the third round of MICS surveys (MICS3), carried out around the world in more than 50 countries, in 2005-2006, following the first two rounds of MICS surveys that were conducted in 1995 and the year 2000. Survey tools are based on the models and standards developed by the global MICS project, designed to collect information on the situation of children and women in countries around the world. Additional information on the global MICS project may be obtained from www.childinfo.org 5Multiple Indicator Cluster Survey 2006 Summary Table of Findings Multiple Indicator Cluster Survey and Millennium Development Goals (MDG) Indicators in the Syrian Arab Republic, 2006. Topic MICS3 Indicator Number MDG Indicator Number Indicator Value Unit CHILD MORTALITY Child Mortality 1 13 Under-five mortality rate (MDG) 22 Per thousand2 14 Infant mortality rate 18 Per thousand NUTRITION Nutrition 6 4 Underweight prevalence 9.7 Percent 7 Stunting prevalence 22.4 Percent 8 Wasting prevalence 8.6 Percent Breast feeding 45 Timely initiation of breastfeeding 32.4 Percent 16 Continued breastfeeding rate 12-15 Months 20-23 Months 63.9 Percent 16.3 Percent 17 Timely complementary feeding rate 6-9 months 36.5 Percent 18 Frequency of complementary feeding 20.8 Percent 19 Adequately fed infants 25.3 Percent Vitamin (A) 42 Vitamin (A) supplementation (under fives) 2.9 Percent 43 Vitamin (A) supplementation(postpartum mothers) 17.8 Percent Low Birth Weight 9 Low birth weight infants 9.4 Percent 10 Infants weighed at birth 47.9 Percent CHILD HEALTH Immunization 25 Tuberculosis immunization coverage 99.9 Percent 26 Polio immunization coverage 96.9 Percent 28 15 Measles immunization coverage 92.4 Percent 31 Fully immunized children 87.8 Percent Tetanus toxoid 32 Neonatal tetanus protection 37.8 Percent Care of illness 33 Use of oral rehydration therapy (ORT) 67.7 Percent 34 Home management of diarrhoea 15.6 Percent 35 Received ORT or increased fluids, and continued feeding 34.2 Percent 23 Care seeking for suspected pneumonia 76.8 Percent 22 Antibiotic treatment of suspected pneumonia 71.0 Percent Solid fuel use 24 29 Solid fuels 0.3 Percent ENVIRONMENT Water and Sanitation 11 30 Use of improved drinking water sources 87.3 Percent 13 Water treatment 4.5 Percent 12 31 Use of improved sanitation facilities 97.1 Percent REPRODUCTIVE HEALTH Contraception and unmet need 21 19c Contraceptive prevalence 58.3 Percent 99 84.1 Percent Maternal and newborn health 44 Content of antenatal care Blood test taken 54.2 Percent Blood pressure measured 76.8 Percent Urine sampling 52.6 Percent Measuring weight 66.9 Percent 4 17 Skilled attendant at delivery 93.0 Percent 5 Institutional deliveries 70.4 percent CHILD DEVELOPMENT Child development 46 Support for learning 55.0 Percent 47 Father’s support for learning 56.2 Percent 48 Support for learning: children’s books 30.1 Percent 49 Support for learning: non-children’s books 62.6 Percent 50 Support for learning: materials for play 19.3 Percent 51 Non-adult care 16.6 Percent EDUCATION Education 53 Pre-school attendance 33.6 Percent 54 Net intake rate in primary education 92 Percent 6 Multiple Indicator Cluster Survey 2006 TOPIC MICS3 INDICATOR NUMBER MDG INDICATOR NUMBER INDICATOR VALUE UNIT 55 6 Net primary school attendance rate 96.1 Percent 56 Net secondary school attendance rate 54.2 Percent 57 7 Children reaching grade five 99.4 Percent 58 Transition rate to secondary school 94.0 Percent 59 7b Primary completion rate 75.3 Percent 61 9 Gender parity index Percent Primary school 1.00 Rate Secondary school 1.00 Rate CHILD PROTECTION Birth registration 62 Birth registration 95.2 Percent Child labour 71 Child labour 4.0 Percent 72 Labourer students 61.0 Percent 73 Student Labourers 3.1 Percent Child discipline 74 Child discipline Any psychological/physical punishment 24.3 Percent Early marriage 67 Marriage before age 15 3.4 Percent Marriage before age 18 17.7 Percent 68 Young women aged 15-19 currently married 9.7 Percent HIV/AIDS HIV/AIDS Knowledge and attitudes 82 19b Comprehensive knowledge about HIV prevention among young people 7.9 Percent 89 Knowledge of mother-to-child transmission of HIV 19.7 Percent 86 Women refusing to care for family member with HIV 11.7 Percent 7Multiple Indicator Cluster Survey 2006 Table of Contents Summary Table of Findings . 5 Table of Contents . 7 List of Tables . 9 List of Figures . 11 List of Abbreviations . 12 Acknowledgements . 13 I. Background . 15 Introduction . 15 Survey Objectives . 16 II. Sample and Survey Methodology. 17 Sample Design . 17 Questionnaires . 17 Fieldwork and Data Processing . 18 III. Sample Coverage and the Characteristics of Households and Respondents. 19 Sample Coverage . 19 Characteristics of Households . 19 Characteristics of Respondents . 21 IV. Child Mortality . 22 V. Nutrition . 25 Nutritional Status . 25 Breastfeeding . 26 Vitamin A Supplements . 30 Low Birth Weight . 31 VI. Child Health . 33 Immunization . 33 Tetanus Toxoid . 34 Oral Rehydration Treatment . 36 Care Seeking and Antibiotic Treatment of Pneumonia . 38 Solid Fuel Use . 39 VII. Environment . 40 Water and Sanitation . 40 VIII. Reproductive Health. 42 Contraception . 42 Unmet Need . 42 Antenatal Care . 43 Assistance at Delivery . 44 IX. Child Development . 45 X. Education . 47 Pre-School Attendance and School Readiness . 47 Primary and Secondary School Participation . 47 8 Multiple Indicator Cluster Survey 2006 XI. Child Protection . 50 Birth Registration . 50 Child Labour . 50 Child Discipline . 51 Early Marriage . 51 XII. HIV/AIDS. 53 Knowledge of HIV Transmission and Condom Use . 53 XIII. Summary & Recommendations . 56 List of References……………………………………………………………. 58 Appendix A. Sample Design . 120 Appendix B. List of Personnel Involved in the Survey . 127 Appendix C. Estimates of Sampling Errors . 132 Appendix D. Data Quality Tables . 153 Appendix E. MICS Indicators: Numerators and Denominators . 161 Appendix F. Questionnaires . 164 9Multiple Indicator Cluster Survey 2006 List of Tables Table HH.1: Results of household and individual interviews . 59 Table HH.2: Household age distribution by sex . 60 Table HH.3: Household composition . 61 Table HH.4: Women’s background characteristics . 62 Table HH.5: Children’s background characteristics . 63 Table CM.1: Child mortality . 64 Table CM.2: Children ever born and proportion dead . 65 Table NU.1: Child malnourishment . 66 Table NU.2: Initial breastfeeding . 67 Table NU.3: Breastfeeding . 68 Table NU.4: Adequately fed infants . 69 Table NU.6: Children’s vitamin A supplementation . 70 Table NU.7: Post-partum mothers’ vitamin A supplementation . 71 Table NU.8: Low birth weight infants . 72 Table CH.1: Vaccinations in first year of life . 73 Table CH.1A: Vaccinations in first year of life (cont.) . 73 Table CH.1Ac: Vaccinations in first year of life (cont.) . 74 Table CH.2: Vaccinations by background characteristics . 75 Table CH.2c: Vaccinations by background characteristics (continued) . 76 Table CH.2A: Vaccinations by background characteristics (continued) . 77 Table CH.2Ac: Vaccinations by background characteristics (continued) . 78 Table CH.3: Neonatal tetanus protection . 79 Table CH.4: Oral rehydration treatment . 80 Table CH.5: Home management of diarrhoea . 81 Table CH.6: Care seeking for suspected pneumonia . 82 Table CH.7: Antibiotic treatment of pneumonia . 83 Table CH.7A: Knowledge of the two danger signs of pneumonia . 85 Table CH.8: Solid fuel use . 86 Table EN.1: Use of improved water sources . 87 Table EN.2: Household water treatment . 88 Table EN.3: Time to source of water . 89 Table EN.4: Person collecting water . 90 Table EN.5: Use of sanitary means of excreta disposal . 91 Table EN.7: Use of improved water sources and improved sanitation . 92 Table RH.1: Use of contraception . 93 Table RH.2: Unmet need for contraception . 94 Table RH.3: Antenatal care provider . 95 Table RH.4: Antenatal care . 96 Table RH.5: Assistance during delivery . 97 Table CD.1: Family support for learning . 98 Table CD.2: Learning materials . 99 Table CD.3: Children left alone or with other children . 100 Table ED.1: Early childhood education . 101 Table ED.2: Primary school entry . 102 Table ED.3: Primary school net attendance ratio . 103 Table ED.4: Secondary school net attendance ratio . 104 Table ED.4w: Secondary school age children attending primary school . 105 Table ED.5: Children reaching grade 5 . 106 Table ED.6: Primary school completion and transition to secondary education . 107 Table ED.7: Education gender parity . 108 able ED.8 : Education gender parity . 109 10 Multiple Indicator Cluster Survey 2006 Table CP.1: Birth registration . 110 Table CP.2: Child labour . 111 Table CP.3: Labourer students and student labourers . 112 Table CP.4: Child discipline . 113 Table CP.5: Early marriage . 114 Table HA.1: Knowledge of preventing HIV transmission . . 115 Table HA.2: Identifying misconceptions about HIV/AIDS . 116 Table HA.3: Comprehensive knowledge of HIV/AIDS transmission . 117 Table HA.4: Knowledge of mother-to-child HIV transmission . 118 Table HA.5: Attitudes toward people living with HIV/AIDS . 119 List of Tables 11Multiple Indicator Cluster Survey 2006 List of Figures Below is the list of figures provided with this sample report Figure HH.1: Age and sex distribution of household population . 20 Figure CM.1: Under-5 mortality rates by background characteristics . 23 Figure CM.2: Trend in under-5 mortality rates . 24 Figure NU.1: Percentage of children under-5 who are undernourished . 26 Figure NU.2: Percentage of mothers who started breastfeeding within one hour and within one day of birth . 28 Figure NU.3: Infant feeding patterns by age: Percent distribution of children aged under 3 years by feeding pattern by age group . 29 Figure NU.5: Percentage of infants weighing less than 2500 grams at birth . 32 Figure CH.1: Percentage of children aged 12-23 months who received the recommended vaccination by 12 months . 34 Figure CH.2: Percentage of women with a live birth in the last 12 months who are protected against neonatal tentanus . 35 Figure CH.3: Percentage of children aged 0-59 months with diarrhoea who received oral rehydration treatment . 37 Figure CH.4: Percentage of children aged 0-59 months with diarrhoea who received ORT or increased fluids, AND continued feeding . 38 Figure EN.1: Percentage distribution of household members by source of drinking water . 40 Figure HA.1: Percent of women who have comprehensive knowledge of HIV/AIDS transmission . 54 12 Multiple Indicator Cluster Survey 2006 13Multiple Indicator Cluster Survey 2006 Acknowledgements Within the framework of cooperation between the Central Bureau of Statistics (C.B.S) and the United Nations Children’s Fund (UNICEF), and the management of the pan-Arab Project for Family Health of the League of Arab States, the Central Bureau of Statistics, in cooperation and coordination with the State Planning Commission and the Ministry of Health, conducted a multiple indicator survey on health, social and educational aspects in 2006. The survey aimed to provide a data base with updated indicators which reflect children’s health, social and educational status, and assess the progress made towards the achievement of the Millennium Development Goals and the environment of national work on the survival, protection and development of children during the new millennium. The survey also aimed to measure the changes that had occurred in the situation of children since the performance of the multiple indicator survey on child health in the mid-1990’s. This would make it possible to diagnose the situation of children, to conduct comparative analytical studies, and to prepare appropriate programmes for upholding their status in various fields. The Central Bureau of Statistics wishes to seize the opportunity of the issuance of the final report of the survey to extend sincere thanks and appreciation to the UNICEF, the management of the Pan-Arab Project for Family Health of the League of Arab States, and to all local parties for their support and contributions. Besides, we hope the results thereof will meet the needs of all the bodies concerned, so that such parties can depend on these findings and use them in drawing up the policies and programmes pertinent to children. Dr. Chafic Arbash Director Central Bureau of Statistics 14 Multiple Indicator Cluster Survey 2006 15Multiple Indicator Cluster Survey 2006 I. Background Introduction: This final report contains the findings of the Multiple Indicator Cluster Survey conducted in the Syrian Arab Republic in 2006, in cooperation between the Central Bureau of Statistics and the United Nations Children’s Fund (UNICEF), in coordination with the State Planning Commission and the Ministry of Health. The survey was based, in large part, on monitoring progress towards the goals and targets emanating from recent international agreements: the Millennium Declaration, adopted by all 191 United Nations Member States in September 2000, and the Plan of Action of A World Fit for Children, adopted by 189 Member States at the United Nations Special Session on Children in May 2002. Both of these commitments build upon promises made by the international community at the 1990 World Summit for Children, and on resolutions issued by the League of Arab States and competent establishments and organizations; which resolutions relate to the Pan – Arab framework of the rights of Arab children and the Cairo Declaration. “Towards an Arab World Fit for Children” and the Second Pan-Arab Plan for Children (2004-2015) adopted by Arab summits. By approving these international agreements, governments committed themselves to improving conditions for their children and to monitoring progress towards that end. UNICEF was assigned a supporting role in this task (see Table below). A Commitment to Action: National and International Reporting Responsibilities The governments that signed the Millennium Declaration and the World Fit for Children Declaration and Plan of Action also committed themselves to monitoring progress towards the goals and objectives they contained: “We will monitor regularly at the national level and, where appropriate, at the regional level and assess progress towards the goals and targets of the present Plan of Action at the national, regional and global levels. Accordingly, we will enhance international cooperation to support 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 sub-national levels of progress in order to address obstacles more effectively and accelerate actions…” (A World Fit for Children, paragraph 61) The Plan of Action (paragraph 61) also calls for the specific involvement of UNICEF in the preparation of periodic progress reports: “…As the world’s lead agency for children, the United Nations Children’s Fund is requested to continue to prepare and disseminate, in close collaboration with Governments, relevant funds, programmes and the specialized agencies of the United Nations system and all other relevant actors, as appropriate, information on the progress made in the implementation of the Declaration and the Plan of Action. Similarly the Millennium Declaration (paragraph 31) calls for periodic reporting on progress: “…We request the General Assembly to review on a regular basis the progress made in implementing the provisions of this Declaration, and ask the Secretary-General to issue periodic reports for consideration by the General Assembly and as a basis for further action.” 16 Multiple Indicator Cluster Survey 2006 Besides, UNICEF Country Office in Syria has contributed to the establishment of a special unit for children’s studies within the framework of the Central Bank of Statistics. The outcome of the unit’s work will involve consolidating national capacities in the field of collecting, providing and analyzing data and indicators related to children. The eight main goals which the Millennium Declaration focused on have always constituted key priorities in the economic and social development plans in Syria. The successive, five-year plans have aimed to enhance the citizens’ prosperity and increase their income, and to insure the best means to expand education in both urban and rural areas, for males and females alike. Such plans also paid special attention to the sectors of health, the environment, the empowerment of women, and others. The multiple indicator survey will form an important source of the data necessary for monitoring progress towards the goals of the millennium. This final report presents the findings of the indicators and the topics covered by the survey. Survey Objectives The primary objectives of the 2006 Multiple Indicator Cluster Survey of the Syrian Arab Republic are as follows: • To provide up-to-date information for assessing the situation of children and women in the Syrian Arab Republic; • To furnish data needed for monitoring progress achieved towards the goals established by the Millennium Development Goals and the goals of A World Fit for Children (WFFC) as a basis for future action; • To contribute to the improvement of data and monitoring systems in the Syrian Arab Republic, and to strengthen technical expertise in the design, implementation, and analysis of such systems. 17Multiple Indicator Cluster Survey 2006 II. Sample Design and Survey Methodology Sample Design The sample for the Multiple Indicator Cluster Survey of the Syrian Arab Republic was designed to estimate a number of indicators on the situation of women and children at the national, and governorate levels, for urban and rural areas. The framework of the 2004 Overall Census of Inhabitants and Dwellings was used as the sampling frame. The sample was selected in two stages in each area. In the first stage, the clusters were drawn as census areas in proportion to size with a total of (1000) clusters. In the second stage, the counting units were drawn (households) in a regular arbitrary manner. The sample was stratified as per areas, and the sample was a self-weighted sampling design Table: List of the Number of Sample Clusters of the MICS 2006. Governorate Proportion of households in each Governorate March 2006 No. of Clusters. No. of Sample Households Damascus 10.6 105 2100 Aleppo 22.8 228 4560 Rural Dam. 13.7 139 2780 Homs 8.6 86 1720 Hama 7.4 73 1460 Lattakia 5.7 57 1140 Idleb 6.4 64 1280 Hassaka 5.7 57 1140 Deir Ezzor 4.3 43 860 Tartous 4.5 44 880 Raqqa 3.9 39 780 Daraa 4.2 42 840 Sweida 2.0 20 400 * Qunaitra 0.3 2+3 100 Total 100 1002 20,040 * the size of the Qunaitra sample has been increased to five clusters to enhance representation. Questionnaires Three questionnaires were used in the survey in addition to a household questionnaire which was used to collect information on all household members, the household, and the dwelling. Questionnaires were administered in each household to women aged 15-49ــــ mothers or caretakers of under -5 children were identified in each household. The questionnaires included the following modules: Household Questionnaire o Household Listing o Education o Water and Sanitation o Household characteristics o Child Labour Questionnaire for Individual Women o Child Mortality o Tetanus Toxoid o Maternal and Newborn Health o Marriage o Contraception o HIV/AIDS Questionnaire for Children Under Five o Birth Registration and Early Learning o Vitamin A o Breastfeeding o Care of Illness o Immunization o Anthropometry The questionnaires are based on the MICS3 model questionnaire and were pre-tested during February, 2006. Based on the results of the pre-test, modifications were made to the wording of the questionnaires. Fieldwork and Processing Members of the fieldwork staff were trained for ten days in early April, 2006. (35) Teams collected the data, each comprising (4) interviewers, a team head, and a supervisor for each governorate. Fieldwork began on April 19th, 2006 and lasted until the end of May, 2006. The data were entered on microcomputers using the CSPro software. In order to ensure quality control, all questionnaires were double entered and internal consistency checks were performed. Procedures and standard programs developed under the global MICS3 project and adapted to the questionnaires were used in the Syrian Arab Republic. Data entry and checking procedures were concluded on July, 1st, 2006. Data processing began simultaneously with data collection in May 2006 and finished in July 2006. Data were analysed using the SPSS software program and the model syntax and tabulation plans developed for this purpose. 18 Multiple Indicator Cluster Survey 2006 III. Sample Coverage and the Characteristics of Households and Respondents Sample Coverage Out of (20022) households selected for sampling, (19870) were actually found, while the dwellings of the remaining households were either not occupied, or else the households themselves were out. (19019) households were successfully interviewed yielding a household response rate of (95.7) percent. In the interviewed households (25563) women aged 15-49 were identified. Out of these (25026) women were interviewed, yielding a response rate of (97.9) percent. The number of children under five listed in the household questionnaire totaled (11104). Out of these, (11017) children were interviewed, which corresponds to a response rate of 99.2%. The overall response rate for the women’s questionnaires was (93.7) percent, while the one for the children under five was (95) percent. The response rate was similar in urban and rural areas, as Table (HH1) shows. Characteristics of Households The age and sex distribution of the survey population is provided in Table HH2. In the (19870) households successfully interviewed in the survey (107365) household members were listed. Of these,52 percent were males (55644), and 48 percent were females (51721). These figures indicate that the average households size is (5.4) members. The proportion of the below -15- year age group was (37.6) percent, while those between 15 and 64 years old were (58.7) percent, and those above 65 years old were (3.7) percent. If we compare the survey age pyramid data with those from the 2004 census, we note a slight decrease in the below – 15 population age group from (39.5) percent in 2004 to (37.6) percent in 2006, as well as a slight increase in the above 65 age group; from (3.4) percent in 2004 to (3.7) percent in 2006. 19Multiple Indicator Cluster Survey 2006 Figure HH.1: Age and Sex Population Distribution in the Syrian Arab Republic, 2006 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+ Percent Males Females Table HH.3 provides basic background information on the households. Within households, the sex of the household head, governorate, urban/rural status, number of household members. These background characteristics are also used in subsequent tables in this report, the figures in the table are also intended to show the numbers of observations by major categories of analysis in the report. The weighted and unweighted numbers of households are equal, since sample weights were normalized. The table also shows the proportions of households where at least one child under 18, at least one child under 5, and at least one eligible woman age 15-49 were found. The households headed by males were (91.7) percent while those headed by females were (8.3) percent. The (4-5) member households were (32) percent, followed by the (6-7) member households at (27) percent. 20 Multiple Indicator Cluster Survey 2006 Characteristics of Respondents Table HH.4 and HH.5 provide information on the background characteristics of female respondents 15-49 years of age and of children under age 5. In both tables, the total numbers of weighted and unweighted observations are equal, since sample weights have been normalized (standardized). In addition to providing useful information on the background characteristics of women and children, the tables are also intended to show the numbers of observations in each background category. Theses categories are used in the subsequent tabulations of this report. Table HH.4 and HH.5 provide information on the background characteristics of female respondents 15-49 years of age. The table includes information on the distribution of women according to governorate, urban-rural areas, age, marital status, motherhood status, education, wealth index quintiles. The proportion of urban women was (53.9) percent while that of rural women was (46.1) percent and about 85% of the women were educated. The proportion of currently married women was (54.4) percent, while (43.8) percent had never got married and (1.7) percent had been previously married. As for the motherhood status, the proportion of women who had given birth was (91.8) percent, while (8.2) percent had not given birth to children. Some background characteristics of children under 5 are presented in Table HH.5. These include distribution of children by several attributes: sex, governorate and area of residence, age in months, mother’s or caretaker’s education, and wealth. The proportion of under -5 male children was (52.7) percent while that of females was (47.3) percent. As for area of residence, the proportion of under – 5 males was (49.8) percent in urban areas and (50.2) percent in rural areas. 82,3 percent of all mothers/caretakers were educated. In terms of age structure the highest proportion went to the (36-47 month) group; (23.7) percent, followed by those between (24-35) months; (21.9) percent. The lowest proportion was scored by (6-11 month) children; (7.9) percent. 21Multiple Indicator Cluster Survey 2006 22 Multiple Indicator Cluster Survey 2006 IV. Child Mortality One of the overarching goals of the Millennium Development Goals (MDGs) and the World Fit for Children (WFEC) is to reduce infant and under-five mortality. Specifically, the MDGs call for the reduction in under-five mortality by two-thirds between 1990 and 2015. Monitoring progress towards this goal is an important but difficult objective. Measuring childhood mortality may seem easy, but attempts using direct questions, such as “Has anyone in this household died in the last year?” give inaccurate results. Using direct measures of child mortality from birth histories is time consuming, more expensive, and requires greater attention to training and supervision. Alternatively, indirect methods developed to measure child mortality produce robust estimates that are comparable with the ones obtained from other sources. Indirect methods minimize the pitfalls of memory lapses, inexact or misinterpreted definitions, and poor interviewing technique. The infant mortality rate is the probability of dying before the first birthday. The under-five mortality rate is the probability of dying before the fifth birthday. In MICS surveys, infant and under five mortality rates are calculated based on an indirect estimation technique known as the Brass method (United Nations, 1983; 1990a; 1990b). The data used in the estimation are: the mean number of children ever born for five year age groups of women from age 15 to 49, and the proportion of these children who are dead, also for five-year age groups of women. The technique converts these data into probabilities of dying by taking into account both the mortality risks to which children are exposed and their length of exposure to the risk of dying, assuming a particular model age pattern of mortality. Based on previous information on mortality in the Syrian Arab Republic, the West model life table was selected as most appropriate. Table CM.1 provides estimates of child mortality by various background characteristics, while Table CM.2 provides the basic data used in the calculation of the mortality rates for the national total. The infant mortality rate is estimated at (18) per thousand, while the probability of dying under-5 mortality rate (U5MR) is around (22) per thousand. These estimates have been calculated by averaging mortality estimates obtained from women age 25-29 and 30-34, and refer to 2003. Probability of dying is higher among males. Infant mortality rate is lowest in the Eastern Region (15) per thousand while the figures for the Southern Region rise to (22) per thousand. There are also significant differences in mortality in terms of educational levels, and wealth.1 In particular, the probabilities of dying among infants and children under 5 years living in the richest (40) percent of households are considerably lower than the national average. Differentials in under-5 mortality rates by background characteristics are also shown in figure CM.1. It should be noted that using the indirect method in calculating the child mortality rates provides estimates which relate to the three years prior to the survey. They conform with the mortality estimates shown in the family health survey of 2002, and with the data of the 2004 census. 1-Northern region includes the following governorates: Aleppo and Idleb; the Eastern region: Raqqa, Deir Ezzor and Hassake, Middle Region: Homs and Hama, The Southern Region:Daraa, Sweida, Quneitra and Damascus and the Coastal Region: Lattakia and Tartous. 23Multiple Indicator Cluster Survey 2006 Figure CM.1 Under-five Mortality Rates by Background Characteristics in the Syrian Arab Republic, 2006. 19 27 18 20 21 19 24 20 25 19 8 8 22 23 23 20 20 22 0 5 10 15 20 25 30 Regions Nor t hern Sout hern East ern Cent ral Coast al A rea Urban Rural M o t her ' s Educ at ion No educ at ion P r imary Sec ondary Inst it ut e Universit y + Wealt h Quint i les P oo rest Sec ond M iddle Four t h Ric hest Syr ia Per 1000 Figure CM.2 shows the series of U5MR estimates of the survey, based on responses of women in different age groups, and referring to various points in time, thus showing the estimated trend in U5MR based on the survey. The MICS estimates indicate a decline in mortality during the last 15 years. The U5MR estimates dropped from (30) per thousand in 1993 to (22) per thousand in 2003. 24 Multiple Indicator Cluster Survey 2006 Figure CM.2: Trend in Under-5 Mortality Rates, Syrian Arab Republic, 2006 0 20 40 60 80 100 120 140 160 180 1960 1964 1968 1972 1976 1980 1984 1988 1992 1996 2000 2004 2008 Year Pe rc en t WFS 1978 Census 1981 PAPFAM 1993 MICS 2000 PAPFAM 2001 MICS 2006 25Multiple Indicator Cluster Survey 2006 V. Nutrition 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. In a well-nourished population, there is a reference distribution of height and weight for children under age five. Under-nourishment in a population can be gauged by comparing children to a reference population. The reference population used in this report is the WHO/CDC NCHS reference, which was recommended for use by UNICEF and the World Health Organization at the time the survey was implemented. Each of the three nutritional status indicators 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 over a long period and recurrent or chronic illness. Children whose weight-for-height is more than two standard deviations below the median of the reference population are classified as moderately or severely wasted, while those who fall more than three standard deviations below the median are severely wasted. Wasting is usually the result of a recent nutritional deficiency. The indicator may exhibit significant seasonal shifts associated with changes in the availability of food or disease prevalence. Table NU.1 shows percentages of children classified into each of these categories, based on the anthropometric measurements that were taken during fieldwork. Additionally, the table includes the percentage of children who are overweight, which takes into account those children whose weight for height is above 2 standard deviations from the median of the reference population. Almost one in ten children under five in the Syrian Arab Republic is underweight (9.7 percent), and (1.8) percent are classified as severely underweight (Table NU.1) for their age, (2.3) percent are wasted or too thin for their height, while (10) percent of the children are severely stunted for their age. Also worth mentioning is that 22 percent are classified as moderately stunted for their age. 26 Multiple Indicator Cluster Survey 2006 Underweight and wasting are more prevalent in the governorate of Raqqa while stunting is more common in Aleppo. Those children whose mothers have secondary or higher education are the least likely to be underweight and stunted compared to children of mothers with no education. Boys appear to be more likely to be underweight, stunted and wasted than girls. The age pattern shows that a higher percentage of children aged (12-23) months are stunted. A higher proportion of children in the (24-35) month age group are underweight compared to other children while wasting is prevalent among children of (6-11) months of age; (Figure NU.1). Figure NU.1: Percentage of children under-5 who are undernourished, Syrian Arab Republic, 2006 0 2 4 6 8 10 12 14 16 0 6 12 18 24 30 36 42 48 54 60 Age in Months P er se nt Underw eight Stunted Wasted Breastfeeding Breastfeeding for the first two years of life protects children from infection, provides an ideal source of nutrients, and is economical and safe. However, many mothers stop breastfeeding too soon and there are often pressures to switch to infant formula, which can contribute to growth faltering and micronutrient malnutrition and is unsafe if clean water is not readily available. The World Fit for Children goal states that children should be exclusively breastfed for 6 months and continue to be breastfed with safe, appropriate and adequate complementary feeding for up to 2 years of age and beyond. Pe rce nt 27Multiple Indicator Cluster Survey 2006 WHO/UNICEF have the following feeding recommendations: • Exclusive breastfeeding for first six months • Continued breastfeeding for two years or more • Safe, appropriate and adequate complementary foods beginning at 6 months • Frequency of complementary feeding 2 times per day for 6-8 months olds, 3 times per day for 9-11 month olds. It is also recommended that breastfeeding be initiated within one hour of birth. The indicators of recommended child feeding practices are as follows: • Exclusive breastfeeding rate (<6 months &<4 months) • Timely complementary feeding rate (6-9 months) • Continued breastfeeding rate (12-15 & 20-23 months) • Timely initiation of breastfeeding (within 1 hour of birth) • Frequency of complementary feeding (6-11 months) • Adequately fed infants (0-11 months) Table NU.2 provides the proportion of women who started breastfeeding their infants within one hour of birth, and women who started breastfeeding within on day of birth and those who started within on hour. The survey findings showed that the proportion of women who breastfed their infants within one hour of birth was (32.4) percent. The rate also differs from one governorate to another; the highest was in Sweida (50.7) percent and the lowest in Raqqa (16) percent. The rate tends to decline as the woman’s education level rises. It is also higher among poor households compared to rich ones. The proportion of women who started breastfeeding their infants within one day of birth was (80.5) percent. The rate again differs between urban and rural areas; (81.9) percent and (79.2) percent respectively. The rate rises as the woman’s education level rises. It is also higher among rich households than poor ones. 28 Multiple Indicator Cluster Survey 2006 Figure NU.2 Percentage of mothers who started breastfeeding within one hour and within one day of birth, Syrian Arab Republic, 2006 87.9 87.6 77.2 84.4 79.1 84.6 82.8 67.1 76.3 79.1 68 78.5 94.7 51.6 81.9 79.2 80.5 22.1 41 29.9 27.6 40.2 37.6 38.6 24.3 34.2 31.3 16 26.6 50.7 16.1 31.8 33.1 32.4 0 10 20 30 40 50 60 70 80 90 100 D am as cu s Al ep po R ur al -D am H om s H am a La tta ki a Id le b H as sa ke D ei r E zz or Ta rto us R aq qa D ar aa Sw ei da Q un ei tra U rb an R ur al Sy ria P er se nt Within one day Within one hour In Table NU.3, breastfeeding status is based on the reports of mothers/caretakers of children’s consumption of food and fluids in the 24 hours prior to the interview. Exclusively breastfed refers to infants who received only breast milk (and vitamins, mineral supplements, or medicine). The table shows exclusive breastfeeding of infants during the first six months of life (separately for 0-3 months and 0-5 months), as well as complementary feeding of children 6-9 months and continued breastfeeding of children at 12-15 and 20-23 months of age. We may note that approximately (29) percent of infants aged less than six months are exclusively breastfed. At age 6-9 months, (36.5) percent of children are receiving breast milk and solid or semi-solid foods. By age 12-15 months, (63.9) percent of them are still being breastfed, and by age 20-23 months, (16.3) percent are still breastfed. These rates differ between urban and rural area. They are higher in rural areas, 41 percent than in urban ones, 31 percent. They also show differences among governorates. The rate declines as the mother’s / caretaker’s education level rises. It is also higher among poor households compared to richer ones. Pe rce nt 29Multiple Indicator Cluster Survey 2006 Figure NU.3 shows the detailed pattern of breastfeeding, by the child’s age in months. (This figure is obtained by using data from Table NU.3 w). Figure NU.3 Infant feeding patterns by age: Percent distribution of children aged under 3 years by feeding pattern by age group, Syrian Arab Republic, 2006 0 10 20 30 40 50 60 70 80 90 100 0- 1 2- 3 4- 5 6- 7 8- 9 10 -1 1 12 -1 3 14 -1 5 16 -1 7 18 -1 9 20 -2 1 22 -2 3 24 -2 5 26 -2 7 28 -2 9 30 -3 1 32 -3 3 34 -3 5 Age group in months P er se nt Weaned (not breastfed) Breastfed and complementary foods Breastfed and other milk/ formula Breastfed and non-milk liquids Breastfed and plain w ater only Exclusively breastfed The adequacy of infant feeding in children under 12 months is provided in Table NU.4. Different criteria of adequate feeding are used depending on the age of the child. For infants aged (0-5) months, exclusive breastfeeding is considered as adequate feeding. Infants aged (6-8) months are considered to be adequately fed if they are receiving breast milk and complementary food at least two times per day, while infants aged (9-11) months are considered to be adequately fed if they are receiving breast milk and eating complementary food at least three times a day. The survey findings showed the percentage of children aged (0-5) months who were predominantly breastfed was (28.7) percent. The rate in rural areas was higher than it was in urban ones. It is also higher among uneducated mothers than educated ones; and among poor households compared to rich ones. The percentage of children aged (6-8) months who were breastfed and received at least two complementary meals within 24 hours prior to the survey was (25.7) percent; a rate which is almost the same in urban and rural areas. This rate goes up as the mother’s education level rises until the level of university when the rate is decreasing. It is lower among poor households than rich ones. The percentage of children aged (9-11) months who were breastfed and received at least three complementary meals within 24 hours prior to the survey was (15.8) percent; which is almost the Pe rce nt 30 Multiple Indicator Cluster Survey 2006 same in urban and rural areas. This rate goes up as the mother’s education level rises. It is higher among rich households than poor ones. The maximum was recorded in Tartous; (46.7) percent. The percentage of children aged (6-11) months who were breastfed and received the minimum recommended number of complementary meals a day was (20.8) percent, a rate which was almost the same in both urban and rural areas. Besides, it tends to rise as the mother’s education level goes up until the level of university when the rate is decreasing, and it is higher among rich households than the case among poor ones. The percentage of children aged (0-11) months who are adequately fed was (25.3) percent. In urban areas the rate was (24.9) percent, and (25.7) in rural ones. There is also a difference between the governorates with Lattakia showing the highest rate of 37 percent and Hassake the lowest, 16 percent. Vitamin A Supplements Vitamin A is essential for eye health and proper functioning of the immune system. It is found in foods such as milk, liver, eggs, red and orange fruits, red palm oil and green leafy vegetables, although the amount of vitamin A readily available to the body from these sources varies widely. In developing areas of the world, where vitamin A is largely consumed in the form of fruits and vegetables, daily per capita intake is often insufficient to meet dietary requirements. Inadequate intakes are further compromised by increased requirements for the vitamin as children grow or during periods of illness, as well as increased losses during common childhood infections. As a result, vitamin A deficiency is quite prevalent in the developing world and particularly in countries with the highest burden of under-five deaths. The 1990 World Summit for Children set the goal of virtual elimination of vitamin A deficiency and its consequences, including blindness, by the year 2000. This goal was also endorsed at the Policy Conference on Ending Hidden Hunger in 1991, the 1992 International Conference on Nutrition, and the UN General Assembly’s Special Session on Children in 2002. The critical role of vitamin A for child health and immune function also makes control of deficiency a primary component of child survival efforts, and therefore critical to the achievement of the fourth Millennium Development Goal: a two-thirds reduction in under-five mortality by the year 2015. For countries with vitamin A deficiency problems, current international recommendations call for high-dose vitamin A supplementation every four to six months, targeted to all children between the ages of six to 59 months living in affected areas. Providing young children with two high- dose vitamin A capsules a year is a safe, cost-effective, efficient strategy for eliminating vitamin A deficiency and improving child survival. Giving vitamin A to new mothers who are breastfeeding helps protect their children during the first months of life and helps to replenish the mother’s stores of vitamin A, which are depleted during pregnancy and lactation. For countries with vitamin A supplementation programs, the definition of the indicator is the percent of children 6-59 months of age receiving at least one high dose vitamin A supplement in the last six months. Within the six months prior to the MICS, (2.9) percent of children aged (6-59) months received a high dose Vitamin A supplement (Table NU.6). Approximately (6.3) percent did not receive the supplement in the last 6 months. However, they did receive one in the past, but their 31Multiple Indicator Cluster Survey 2006 mother / caretaker could not specify when. It was found that Vitamin A supplementation coverage is slightly lower in rural areas than in urban ones. It is also higher among rich households than it is among poor ones. The age pattern of Vitamin A supplementation shows that supplementation in the last six months rises from (4.5) percent among children aged 6-11 months to (6.2) percent among children aged 12-23 months and then declines steadily with age to (0.8) percent among the oldest children. The mother’s level of education is also related to the likelihood of Vitamin A supplementation. The percentage receiving a supplement in the last six months increases from (1.1) percent among children whose mothers have no education to (2.7) percent of thoses whose mothers have primary education and (5.5) percent among children of mothers with secondary or higher education. Only (17.8) percent of mothers with a birth in the two years prior to the MICS received a Vitamin A supplement within eight weeks of the birth (Table NU.7). This percentage is highest in Sweida; (53.3) percent, and lowest in Raqqa; (6.3) percent and Hassake (6.6) percent. . Coverage increases with the education of the mother, and it is higher among rich households than among poor ones. 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 (less than 2500 grams) carries a range of grave health risks for children. Babies who were undernourished in the womb face a greatly increased risk of dying during their early months and years. Those who survive have impaired immune function and increased risk of disease; they are likely to remain undernourished, with reduced muscle strength, throughout their lives, and suffer a higher incidence of diabetes and heart disease in later life. Children born underweight also tend to have a lower 1Q and cognitive disabilities, affecting their performance in school and their job opportunities as adults. In the developing world, low birth weight stems primarily form 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 the 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 the risk of bearing underweight babies. One of the major challenges in measuring the incidence of low birth weight is the fact that more than half of infants in the developing world are not weighed. In the past, most estimates of low birth weight for developing countries were based on data compiled from the health facilities. However, these estimates are biased for most developing countries because the majority of 32 Multiple Indicator Cluster Survey 2006 newborns are not delivered in facilities, and those who are represent only a selected sample of all births. Because many infants are not weighed at birth and those who are weighed may be a biased sample of all births, the reported birth weights usually cannot be used to estimate the prevalence of low birth weight among all children. Therefore, the percentage of births weighing below 2500 grams is estimated from two items in the questionnaire: the mother’s assessment of the child’s size at birth (i. e. very small, smaller than average, average, larger than average, very large) and the mother’s recall of the child’s weight or the weight as recorded on a health card if the child was weighed at birth. Overall, (47.9) percent of children were weighed at birth. Approximately (9.4) percent of infants weighed less than 2500 grams at birth (Table NU.8); there was some variation by governorate, the highest being in Damascus; (11.9) percent, and the lowest in Swieda; (7.0) percent. The percentage of low birth weight does not vary much by urban and rural areas or by wealth of the household. (Figure NU.5). Figure NU.5 Percentage of Infants Weighing Less Than 2500 Grams at Birth, Syrian Arab Republic, 2006 12 8 10 8 9 11 8 11 10 9 11 10 7 10 9 0 2 4 6 8 10 12 14 D am as cu s Al ep po R ur al -D am H om s H am a La tta ki a Id le b H as sa ke D ei r E zz or Ta rto us R aq qa D ar aa Sw ei da Q un ei tra Sy ria P er se nt Governorates Pe rce nt 33Multiple Indicator Cluster Survey 2006 VI. Child Health Immunization The Millennium Development Goal (MDG) 4 is to reduce child mortality by two thirds between 1990 and 2015. Immunization plays a key part in this goal. Immunizations have saved the lives of millions of children in the three decades since the launch of the Expanded Programme on Immunization (EPI) in 1974. Worldwide there are still 27 million children overlooked by routine immunization and as a result, vaccine-preventable diseases cause more than 2 million deaths every year. A World Fit for Children goal is to ensure full immunization of children under one year of age at 90 percent nationally, with at least 80 percent coverage in every district or equivalent administrative unit. According to UNICEF and WHO guidelines, a child should receive a BCG vaccination to protect against tuberculosis, three doses of DPT to protect against diphtheria, pertussis, and tetanus, three doses of polio vaccine, and a measles vaccination by the age of 12 months. Mothers were asked to provide vaccination cards for children under the age of five and around 55 percent of the mothers/caretakers had the vaccination card. Interviewers copied vaccination information from the cards onto the MICS questionnaire. Around (99.9) percent of children aged (12-23) months received a (BCG) vaccination by the age of 12 months. The first dose of (DPT) was given to (99.4) percent of the children. The percentage declines to (96.8) percent for the subsequent dose of (DPT), and to (91.6) percent for the third dose. Similarly, (99.4) percent of children received (Polio -1) by age 12 months, and this declines to (91.7) percent for the third dose. The coverage for measles vaccine by 12 months is lower than for other vaccines at (92.4) percent. The percentage of children who had all the vaccines is (87.8) percent between the age 12 – 23 months. Figure CH1 shows the vaccinations given to children before the age of 12 months. 34 Multiple Indicator Cluster Survey 2006 Figure CH.1 Percentage of children aged 12-23 months who received the recommended vaccinations by 12 months, Syrian Arab Republic, 2006 99.7 98.6 95.6 89 98.6 95.8 88.9 85.2 79 0 10 20 30 40 50 60 70 80 90 100 BCG * DPT 1 DPT 2 DPT 3 ** Polio 1 Polio 2 Polio 3 **** Measles **** All ***** P er ce nt Tables CH.2 and CH2.c. show vaccination coverage rates among children (12-23) months by background characteristics. The figures indicate children receiving the vaccination at any time up to the date of the survey, and are based on information from mothers with vaccination cards. (Tables CH2 and CH3 describe the background characteristics associated with higher or lower immunization coverage). Please refer to tables CH1A and CH2A for vaccination rates including both mothers having vaccination cards and mothers report (i.e mothers without a card) Tetanus Toxoid One of the MDGs is to reduce by three quarters the maternal mortality ratio, with one strategy to eliminate maternal tetanus. In addition, another goal is to reduce the incidence of neonatal tetanus to less than 1 case of neonatal tetanus per 1000 live births in every district. A World Fit for Children goal is to eliminate maternal and neonatal tetanus by 2005. Prevention of maternal and neonatal tetanus is to assure all pregnant women receive at least two doses of tetanus toxoid vaccine. However, if women have not received two doses of the vaccine during the pregnancy, they (and their newborn) are also considered to be protected if the following conditions are met: • Received at least two doses of tetanus toxoid vaccine, the last within the prior 3 years; • Received at least 3 doses, the last within the prior 5 years; • Received at least 4 doses, the last within 10 years; • Received at least 5 doses during lifetime. 35Multiple Indicator Cluster Survey 2006 Table CH.3 shows the protection status from tetanus of women who have had a live birth within the last 12 months. Figure CH.2 shows the protection of women against neonatal tetanus by major background characteristics. Fig. CH.2: Percentage of Mothers with a Birth in the Last 12 Months Protected Against Neonatal Tetanus in the Syrian Arab Republic, 2006. Figure CH.2 Percentage of women with a live birth in the last 12 months who are protected against neonatal tetanus Syrian Arab Republic, 2006 33.8 36.4 30.2 34 48 36.2 26.7 39.9 37.4 47.2 49.1 50.2 60 29 38.6 37 37.8 29.1 34 43.9 42.4 47.4 37.8 0 10 20 30 40 50 60 Governorates Damascus Aleppo Rural -Dam Homs Hama Lattakia Idleb Hassake Deir Ezzor Tartous Raqqa Daraa Sw eida Quneitra Urban Rural Total Mother's Education None Primary Secondary Higher Institutions University+ Syria Percent Table CH.3 shows the protection status of women with a birth in the last twelve months. Figure CH2 shows women’s neonatal tetanus protection by major background characteristics. The percentage of women with tetanus protection was (37.8) percent. The highest rate was in Sweida (60.0) percent, the lowest in Idleb (26.7) percent. There is a slight variation between urban and rural areas; (38.6) percent and (37.0) percent respectively. The percentage rises with women’s higher education levels, and it is higher among rich households than among poor ones. 36 Multiple Indicator Cluster Survey 2006 Oral Rehydration Treatment Diarrhoea is the second leading cause of death among children under five worldwide. Most diarrhoea-related deaths in children are due to dehydration from loss of large quantities of water and electrolytes from the body in liquid stools. Management of diarrhoea-either through oral rehydration salts (ORS) or a recommended home fluid (RHF) – can prevent many of these deaths. Preventing dehydration and malnutrition by increasing fluid intake and continuing to feed the child are also important strategies for managing diarrhoea. The goals are to: 1) reduce by one half death due to diarrhoea among children under five by 2010 compared to 2000 (A World Fit for Children); and 2) reduce by two thirds the mortality rate among children under five by 2015 compared to 1990 (Millennium Development Goals). In addition, the World Fit for Children calls for a reduction in the incidence of diarrhoea by 25 percent. The indicators are: • Prevalence of diarrhoea • Oral rehydration therapy (ORT) • Home management of diarrhoea • (ORT or increase fluids) AND continued feeding. In the MICS questionnaire, mothers (or caretakers) were asked to report whether their child had had diarrhoea in the two weeks prior to the survey. If so, the mother was asked a series of questions about what the child had to drink and eat during the episode and whether this was more or less than the child usually ate and drank. Overall, (8.1) percent of under five children had diarrhoea in the two weeks preceding the survey (Table CH.4). Diarrhoea prevalence showed some variation between one governorate and another. The highest rate occurs in Sweida; (13.9) percent, the lowest in Tartous; (2.7) percent. A small variation also occurs between urban and rural areas, with (8.3) percent for the former and (7.9) percent for the latter. The peak of diarrhoea prevalence occurs at the age of (6-11) months. The rate declines as the mother's education level rises. Furthermore, the percentage is higher among poor households than it is among rich ones (Figure CH.3). Table CH.4 also shows the percentage of children receiving various types of recommended liquids during the episode or diarrhoea. Since mothers were able to name more than one type of liquid, the percentages do not necessarily add to 100. About (34) percent received fluids from ORS packets; (24.2) percent received per-packaged ORS fluids and (30.9) percent received recommended homemade fluids. Children of mothers with secondary education are less likely to receive oral rehydration treatment than other children. Approximately (68) percent of children with diarrhoea received one or more of the recommended home treatments (i.e., were treated with ORS or RHF), while (32.3) percent received no treatment. 37Multiple Indicator Cluster Survey 2006 Figure CH.3 Percentage of children aged 0-59 months with diarrhoea who received oral rehydration treatment, Syrian Arab Republic, 2006 10 6 11 7 7 5 10 12 11 3 10 7 14 7 8 9 8 6 4 8 0 2 4 6 8 10 12 14 16 D am as cu s A le pp o R ur al -D am H om s H am a La tta ki a Id le b H as sa ke D ei r E zz or Ta rto us R aq qa D ar aa S w ei da Q un ei tra M ot he r's E du ca tio n N on e P rim ar y S ec on da ry H ig he r I ns tit ut io ns U ni ve rs ity + S yr ia P es rc en t The findings show that (34.7) percent of under five children with diarrhoea drank more than usual while (62.9) percent drank the same or less (Table CH.5). (47.4) percent ate somewhat less, same or more (continued feeding), but (50.3) percent ate much less or ate almost none. Given these figures, only (15.6) percent of children received increased fluids and at the same time continued feeding. Combining the information in Table CH.5 with those in Table CH.4 on oral rehydration therapy, it is observed that (34.2) percent of children either received ORT or fluid intake was increased, and at the same time, feeding was continued, as is the recommendation. This is in addition to the significant differences in the home management of diarrhoea by background characteristics. Pe rce nt 38 Multiple Indicator Cluster Survey 2006 Figure CH.4 Percentage of children aged 0-59 with diarrhoea who received ORT or increased fluids, AND continued feeding Syrian Arab Republic, 2006 23 38 34 48 40 30 13 34 51 33 24 44 32 0 33 35 28 33 37 43 36 34 0 10 20 30 40 50 60 Governorates Damascus Aleppo Rural -Dam Homs Hama Lattakia Idleb Hassake Deir Ezzor Tartous Raqqa Daraa Sw eida Quneitra Urban Rural Mother's Education None Primary Secondary Higher Institutions University+ Syria Percentage Care Seeking and Antibiotic Treatment of Pneumonia Pneumonia is the leading cause of death in children and the use of antibiotics in under-5s with suspected pneumonia is a key intervention. A World Fit for Children goal is to reduce to one-third the deaths due to acute respiratory infections. Children with suspected pneumonia are those who had an illness with a cough accompanied by rapid or difficult breathing and whose symptoms were NOT due to a problem in the chest and a blocked nose. The indicators are: • Prevalence of suspected pneumonia • Care seeking for suspected pneumonia • Antibiotic treatment for suspected pneumonia • Knowledge of the danger signs of pneumonia 39Multiple Indicator Cluster Survey 2006 Table CH.6 presents the prevalence of suspected pneumonia and, if care was sought outside the home, the site of care. (5.4) percent of children aged (0-59) months were reported to have had symptoms of pneumonia during the two weeks preceding the survey. Of these children, (76.8) percent were taken to an appropriate provider. (49.8) percent were treated by a private physician, (15.6) percent at a government health center, and (11.7) percent consulted a pharmacy. The rate of treatment of children with pneumonia varies between urban and rural areas, with (80.5) percent in urban communities and (72.1) percent in rural ones. The percentage of such children receiving treatment rises with a higher education of the mother. It is lowest among poor households as compared to rich ones. It is higher among male children than females, (79.9) percent and (72.8) percent respectively Table CH.7 presents the use of antibiotics for the treatment of suspected pneumonia in under- 5s by sex, age, region, and socioeconomic factors. In Syria (71) percent of under-5 children with suspected pneumonia had received an antibiotic during the two weeks prior to the survey. The table also shows that antibiotic treatment of suspected pneumonia is very low among the middle- income and below households, and among children whose mothers / caretakers have at most primary education. The use of antibiotics rises with the age of the child Issues related to knowledge of danger signs of pneumonia are presented in Table CH.7A. Obviously, mothers' knowledge of the danger signs is an important determinant of care-seeking behavior. Overall, (30) percent of women know of the two danger signs of Pneumonia fast and difficult breathing. The most commonly identified symptom for taking a child to a health facility is high temperature. (35.2) percent of mothers identified difficult breathing as symptoms for taking children immediately to a health care provider. The percentage of women who know the two signs of pneumonia is higher in urban area than in rural ones; (32.4) percent and (27.5) percent respectively. It is also higher among mothers with at least secondary education, and among rich households than poor ones. Solid Fuel Use Use of solid fuel for cooking (coal and biomass) leads to indoor pollution, and is a major cause of poor health at a global level, particularly among under-5 children. Such poor health is mainly witnessed in acute respiratory illnesses. The survey findings show that (98.1) percent of households use gas for cooking, a percentage which is almost the same in urban and rural households, while (1.4) percent use electricity. This percentage, varies slightly between urban areas (1.7) percent and rural areas (1.1) percent). The use of gas and electricity does not show much variation between rich and poor households (Table CH.8). 40 Multiple Indicator Cluster Survey 2006 VII. Environment Water and Sanitation Safe drinking water is a basic necessity for good health. Unsafe drinking water can be a significant carrier of diseases such as trachoma, cholera, typhoid, and shistosomiasis. Drinking water can also be tainted with chemical, physical and radiological contaminants with harmful effects on human health. The distribution of the population by source of drinking water is shown in Table EN.1 and Figure EN.1. The population using improved sources of drinking water are those using any of the following types of supply: piped water (into dwelling, yard or plot), public tap/standpipe, tubewell, protected well, protected spring and rainwater collection. Overall, (88.3) percent of the population have access to improved drinking water sources, (93.7) percent of those are in urban areas, while (81.2) percent are in rural ones. Table (EN.1) shows that the improved drinking water sources differ by governorates. The main source of drinking water is the public network, with the highest percentage in Damascus, Dara’a, Sweida and Qunaitra, while the lowest is in the Governorate of Rural Damascus. Although (94.1) percent (source: Census 2004) of the homes there are linked with a public water network, (45) percent of the household members resort to a mobile water tanker because the public network water contains lime components. There is also a considerable difference between rich and poor households; (99.3) percent with the former and (70.9) percent with the latter. Figure EN.1 Percentage distribution of household members by source of drinking water, Syrian Arab republic, 2006 Other unimproved, 0.4 Unprotected well or spring, 0.6 Tanker-truck, 11.7 Bottled Water, 0.3 Public tap/standpipe 0.3 Tubewell/ borehole, 2.4 Piped into dwelling, yard or plot, 79.6 Protected well or spring, 4.7 41Multiple Indicator Cluster Survey 2006 Use of in-house water treatment is presented in Table EN.2. Households were asked of ways they may be treating water at home to make it safer to drink – boiling, adding bleach or chlorine, using a water filter, and using solar disinfection were considered as proper treatment of drinking water. The table shows the percentages of household members using appropriate water treatment methods, separately for all households, for households using improved and unimproved drinking water sources. The table shows that (93.7) percent of the households do not use water treatment methods. The percentage varies between urban and rural areas, with (93) percent in the former and (94.5) percent in the latter. It also varies by governorate; the highest being in Raqqa and Qunaitra (100) percent and the lowest in Deir Ezzor (60.7) percent. The amount of time it takes to obtain water is presented in Table EN.3 and the person who usually collected the water in Table EN.4. Note that these results refer to one roundtrip form home to drinking water source. Information on the number of trips made in one day was not collected. Table EN.3 shows that for (86.6) percent of households, the drinking water source is on the premises. For (9.7) percent of all households, it takes less than 30 minutes to get to the water source and bring water, while (1.4) percent of households spend more than 1 hour for this purpose. Excluding those households with water on the premises, the average time to the source of drinking water is (19.6) minutes. The time spent in rural areas in collecting water is significantly higher than in urban areas. One striking finding is the high average time spent in Raqqa (112.6) minutes, and in Deir Ezzor (116.8) minutes. Table EN.4 shows that for the majority of households, an adult male is usually the person collecting the water, when the source of drinking water is not on the premises. Adult women collect water in only (22.4) percent of cases, while for the rest of the households, female or male children under age 15 collect water; (1.5) percent. Inadequate disposal of human excreta and personal hygiene is closely associated with a range of diseases, particularly intestinal diseases and polio. Improved sanitation facilities for excreta disposal include flush or pour flush to a piped sewer system, septic tank, ventilated improved pit latrine, with slab and composting toilet. Table EN.5 shows that (97.1) percent of the population in the Syrian Arab Republic are living in premises equipped with improved sanitation facilities. The percentage is (99.7) percent in urban areas and (94.2) percent in rural areas. We find that residents in governorates generally enjoy improved sanitation. The table shows that improved sanitation facilities are strongly correlated with wealth. Table EN.7 presents the percentage of households with improved sources of drinking water and sanitary means of excreta disposal. (87.3) percent use improved sources of drinking water, while (97.1) percent use sanitary means of excreta disposal. 42 Multiple Indicator Cluster Survey 2006 VIII. Reproductive Health Contraception Appropriate family planning is important to the health of women and children by: 1) preventing pregnancies that are too early or too late; 2) extending the period between births; and 3) limiting the number of children. A World Fit for Children goal is access by all couples to information and services to prevent pregnancies that are too early, too closely spaced, too late or too many. Current use of contraception was reported by (58.3) percent of women currently married (Table RH.1). The most popular method is the IUD which is used by (25.7) percent of married women in Syria. The next most popular method is the pill which accounts for (12.9) percent of married women. Contraception prevalence is highest in Sweida (74.9 percent) and lowest in Raqqa (33.7 percent). The percentage rises as women get older. Women’s education level is strongly associated with contraceptive prevalence. The percentage of women using any method of contraception rises from (45.2) percent among those with no education to (57.5) percent among women with primary education, and to (65.3) percent among women with secondary education and to (71) percent among women with higher education. Unmet Need Unmet need1 for contraception refers to fecund women who are not using any method of contraception, but who wish to postpone the next birth or who wish to stop childbearing altogether. Unmet need is denitrified in MICS by using a set of questions eliciting current behaviors and preferences pertaining to contraceptive use, fecundity, and fertility preferences. Women in unmet need for spacing includes women who are currently married fecund (are currently pregnant or think that they are physically able to become pregnant), currently not using contraception, and want to space their births. Pregnant women are considered to want to space their births when they did not want the child at the time they got pregnant. Women who are not pregnant are classified in this category if they want to have a (another) child, but want to have the child at least two years later, or after marriage. Women in unmet need for limiting are those women who are currently married, fecund ((are currently pregnant or think that they are physically able to become pregnant), currently not using contraception, and want to limit their births. The latter group includes women who are currently pregnant but had not wanted the pregnancy at all, and women who are not currently pregnant but do not want to have a (another) child. Total unmet need for contraception is simply the sum of unmet need for spacing and unmet need for limiting. 1- Unmet need measurement in MICS is somewhat different than that used in other household surveys, such as the Demographic and Health Surveys (DHS). In DHS, more detailed information is collected on additional variables, such as postpartum amenorrhoea, and sexual activity. Results from the two types of surveys are strictly not comparable. 43Multiple Indicator Cluster Survey 2006 Using information on contraception and unmet need, the percentage of demand for contraception satisfied is also estimated from the MICS data. Percentage of demand for contraception satisfied is defined as the proportion of women currently married who are currently using contraception, of the total demand for contraception. The total demand for contraception includes women who currently have an unmet need (for spacing or limiting), plus those who are currently using contraception. Table RH.2 shows the results of the survey on contraception, unmet need, and the demand for contraception satisfied. The findings show that (4.8) percent of women use contraception for spacing births, while (6.2) percent use it to limit their pregnancy opportunity. The total unmet need for contraception is (11) percent, Antenatal Care The antenatal period presents important opportunities for reaching pregnant women with a number of interventions that may be vital to their health and well-being and that of their infants. Better understanding of foetal growth and development and its relationship to the mother’s health has resulted in increased attention to the potential of antenatal care as an intervention to improve both maternal and newborn health. For example, if the antenatal period is used to inform women and families about the danger signs and symptoms and about the risks of labour and delivery, it may provide the route for ensuring that pregnant women do, in practice, deliver with the assistance of a skilled health care provider. The antenatal period also provides an opportunity to supply information on birth spacing, which is recognized as an important factor in improving infant survival. Tetanus immunization during pregnancy can be life-saving for both the mother and infant. The prevention and treatment of malaria among pregnant women, management of anemia during pregnancy and treatment of STIs can significantly improve foetal outcomes and improve maternal health. Adverse outcomes such as low birth weight can be reduced through a combination of interventions to improve women’s nutritional status and prevent infections (e. g. malaria and STIs) during pregnancy. More recently, the potential of the antenatal period as an entry point for HIV prevention and care, in particular for the prevention of HIV transmission from mother to child, has led to renewed interest in access to and use of antenatal services. WHO recommends a minimum of four antenatal visits based on a review of the effectiveness of different models of antenatal care. WHO guidelines are specific on the content on antenatal care visits, which include: Blood pressure measurement Urine testing for bateriuria and proteinuria Blood testing to detect syphilis and severe anemia Weight/height measurement (optional) Table RH.3 presents the type of personnel providing antenatal care to women aged 15-49 years who gave birth in the two years preceding the survey. The findings show that (84) percent of women aged 15-49 years who gave birth in the preceding two years consulted skilled personnel for antenatal care, (75.3) percent received antenatal care from a doctor while (8) percent received care from a nurse/midwife. The types of services pregnant women received are shown in Table RH.4. (54.2) percent had a 44 Multiple Indicator Cluster Survey 2006 blood test taken, (76.8) percent had their blood pressure measured, (52.6) had a urine specimen taken and (66.9) had their weight measured. Assistance at Delivery Three quarters of all maternal deaths occur during delivery and the immediate post-partum period. The single most critical intervention for safe motherhood is to ensure a competent health worker with midwifery skills is present at every birth, and transport is available to a referral facility for obstetric care in case of emergency. A World Fit for Children goal is to ensure that women have ready and affordable access to skilled attendance at delivery. The indicators are the proportion of births with a skilled attendant and proportion of institutional deliveries. The skilled attendant at delivery indicator is also used to track progress toward the Millennium Development target of reducing the maternal mortality ratio by three quarters between 1990 and 2015. The MICS included a number of questions to assess the proportion of births attended by a skilled attendant. A skilled attendant includes a doctor, nurse, midwife or auxiliary midwife. Delivery with the assistance of a skilled attendant has good results for both the mother and the newborn, because the attendant uses the right technical measures and takes speedy and correct decisions to diagnose and manage the complications that may occur. Specialized assistance at delivery is defined as the assistance given by a doctor, nurse or auxiliary midwife. About (93) percent of births occurring in the two years prior to the MICS survey were delivered by skilled personnel (Table RH.5). This percentage is highest in Tartous, (100) percent, and lowest in Hassaka, (80.3) percent. The more educated a woman is, the more likely she is to have delivered with the assistance of a skilled attendant. Besides, the percentage of deliveries with the assistance of skilled attendants is higher among rich households (98.9) percent than poor ones (77.6) percent. 45Multiple Indicator Cluster Survey 2006 IX. Child Development It is well recognized that a period of rapid brain development occurs in the first 3-4 years of life, and the quality of home care is the major determinant of the child’s development during this period. In this context, adult activities with children, presence of books in the home, for the child, and the conditions of care are important indicators of quality of home care. A World Fit for Children goal is that “children should be physically healthy, mentally alert, emotionally secure, socially competent and ready to learn.” Information on a number of activities that support early learning was collected in the survey. These included the involvement of adults with children in the following activities: reading books or looking at picture books, telling stories, singing songs, taking children outside the home, compound or yard, playing with children, and spending time with children naming, counting, or drawing things. For almost (55) percent of under-five children, an adult engaged in more than four activities that promote learning and school readiness during the 3 days preceding the survey (Table CD.1). The average number of activities that adults engaged with children was (4). The table also indicates that the father’s involvement in such activities was somewhat limited. Father’s involvement with one or more activities was (56.2) percent. (1.8) percent of children were living in a household without their fathers. There are no gender differentials in terms of adult activities with children; Larger proportions of fathers engaged in learning and school readiness activities with children in urban areas (61.2 percent) than in rural areas (51.2 percent). Strong differentials by region and socio-economic status are also observed: father’s engagement in activities with children was great in Qunaitra; (85.1) percent and lowest in Homs; (43.8) percent, while the proportion was (66.6) percent for children living in the richest households, as opposed to those living in the poorest households (47.4 percent). Adults’ involvement showed a similar pattern in terms of father’s engagement in such activities. It is interesting to note that more educated mothers and fathers engaged more in such activities with children than those with less education. Exposure to books in early years not only provides the child with greater understanding of the nature of printing, but may also give the child opportunities to see others reading, such as older siblings doing school work. Presence of books is important for later school performance and IQ scores. In the Syrian Arab Republic, (62.6) percent of children are living in households where at least 3 non-children’s books are present (Table CD.2). However, (30.1) percent of children aged (0-59) months live in households that have 3 or more children’s books; both the median number of non-children’s books and children’s books are low 8 and 0 books respectively. While no gender differentials are observed, urban children appear to have more access to both types of books than those living in rural households. (65.9) percent of under-5 children living in urban areas live in households with more than 3 non-children’s books, while the figure is (59.4) percent in rural households. The proportion of under-5 children who have 3 or more children’s books is (36.5) percent in urban areas compared to (23.7) percent in rural areas. The presence of both non-children’s and children’s books is positively correlated with the child’s age; in the homes of (66.2) percent of children aged (24-59) months, There are three or more non children’s books, 46 Multiple Indicator Cluster Survey 2006 while the percentage drops to (56.6) percent for the homes of children aged (0-23) months. Similar differentials exist in terms of children’s books. Table CD.2 also shows that (19.3) percent of children aged (0-59) months had 3 or more playthings to play with in their homes, while (14.1) percent had none. The playthings in MICS included household objects, homemade toys, toys that came from a store, and objects and materials found outside the home. It is interesting to note that (68.4) percent of children play with toys that come from a store; however, the percentages for other types of toys are (37.2) percent for home- made toys, (29.2) percent for playthings they find outside their homes and (29.4) percent for household things. The proportion of children who have 3 or more playthings to play with is (19.7) percent among male children and only (18.8) percent among female children. Some urban – rural differentials are observed in this respect, but differences are also observed in terms of mother’s education; (20) percent of children whose mothers have no education have 3 or more playthings, while the proportion drops to (15.1) percent among the children whose mothers have university education. Remarkable differences are noted by governorate, with the highest percentage of children who have three or more playthings in Tartous (43.6) percent and the lowest in Qunaitra (1.1) percent. Leaving children alone or in the presence of other young children is known to increase the risk of accidents. In MICS, two questions were asked to find out whether children aged 0-59 months were left alone during the week preceding the interview, and whether children were left in the care of other children under 10 years of age. Table CD.3 shows that (16.3) percent of children aged (0-59) months were left in the care of other children, while (1.4) percent were left alone during the week preceding the interview. Combining the two care indicators, it is calculated that (16.6) percent of children were left with inadequate care during the week preceding the survey. No differences were observed by the sex of the child but some differentials were noted between urban areas (14.8) percent and rural areas (18.4) percent. On the other hand, inadequate care was less prevalent among children whose mothers had university education (10.1) percent, as opposed to children whose mothers had no education; (28.7) percent. Children aged (24-59) moths were left with inadequate care more than those who were aged (0-23) months. (10.4) percent. No fundamental differences are observed in regard to socioeconomic status of the household. The highest percentage was among poor households as compared to rich ones. 47Multiple Indicator Cluster Survey 2006 X. Education Pre-School Attendance and School Readiness Attendance to pre-school education in an organized learning or child education program is important for the readiness of children to school. One of the World Fit for Children goals is the promotion of early childhood education. Only (7.5) percent of children aged (36-59) months are attending pre-school (Table ED.1). Urban- rural and regional differentials are significant-the figure is as high as (9.7) percent in urban areas, compared to (5.4) percent in rural areas. Among children aged (36-59) months, attendance to pre- school is more prevalent in Sweida (19.7) percent and lowest in Raqqa (1 percent). Slight gender differential exists; (7.9) percent among male children and (7.2) percent among female children. However, differentials by socioeconomic status are significant; (18.1) percent of children living in rich households attend per-school, while the figure drops to (3.6) percent among poor households. Some difference was also recorded in the proportions of children attending pre-school by the two age groups; (10.9) percent at age (48-59) months dropping to (5.1) percent at age (36-47) months. The table also shows the proportion of children in the first grade of primary school who attended pre-school the previous year (Table ED.1), an important indicator of school readiness. Overall (33.6) percent of children who are currently at age 6 and attending the first grade of primary school were attending pre- school the previous year. The proportion among males is slightly higher (34.8) percent than females (32.1) percent. (40) percent of children in urban areas had attended pre-school the previous year compared to (25.8) percent among children living in rural area. Regional differentials by governorate are also very significant; while (52.4) percent of first graders have attended pre-school in Damascus, only 22.8 percent of their counterparts in Aleppo have. Socioeconomic status appears to have a positive correlation with school readiness- while the indicator is only (18.8) percent among the poorest households, it increases to (49.5) percent among those children living in the richest households. Besides, a significant differential was evident by the mother’s education level; with (21.2) percent among children whose mothers have no education rising to (57.2) percent among children whose mothers have university education. Primary and Secondary School Participation Universal access to basic education and the achievement of primary education by the world’s children is one of the most important goals of the Millennium Development Goals and A World Fit for Children. Education is a vital prerequisite for combating poverty, empowering women, protecting children from hazardous and exploitative labor and sexual exploitation, promoting human rights and democracy, protecting the environment and influencing population growth. The indicators for primary and secondary school attendance include: • Net intake rate in primary education • Net primary school attendance rate • Net secondary school attendance rate • Net primary school attendance rate of children of secondary school age • Female to male education ratio (GPI) The indicators of school progression include: 48 Multiple Indicator Cluster Survey 2006 • Survival rate to grade five • Transition rate to secondary school • Net primary completion rate Of children who are of primary school entry age (6 years), (92) percent are attending the first grade of primary school (Table ED.2). Slight sex differentials exist; (91.3) percent for males compared to (96.2) percent for females. However, significant differentials are present by governorate and urban- rural areas. The highest rates are in Lattakia and Daraa , while the lowest are in Deir Ezzor and Raqqa. Children’s timely participation to primary school is (97.7) percent in urban areas decreasing to (89.4) percent in rural areas. A slight differential was observed by the mother’s education level and the socioeconomic status; for children age six whose mothers have no education (83.7) percent were attending the first grade, while (94.2) percent of their counterparts whose mothers have university education were attending it. The proportion is (82.4) percent among children of poor households increasing to (96.9) percent among children of rich households. Table ED.3 provides the percentage of children of primary school age attending primary or secondary school. The majority of children of primary school age in the Syrian Arab Republic are attending school (96.1) percent. However, (3.8) percent of the children are out of school when they are expected to be participating in school. This is because a portion of them are not enrolled at school due to dropout, illness or disability. The findings of the table show a slight differential in net attendance ratio between urban and rural areas, (96.8) percent and (95.5) percent respectively. Some differences are also observed by governorate; the highest in Sweida (99) percent and the lowest in Deir Ezzor (90.7) percent. In terms of the socioeconomic status, it is (92.1) percent among children of poor households rising to (98.4) percent among children living in rich households. The secondary school net attendance ratio is presented in Table ED.4. We observe that the percentage of secondary school participation is (54.2) percent. The percentage differs between urban areas (57.4) percent and rural areas (50.8) percent. There is also a differential by governorate; with the highest in Sweida (83.6) percent and the lowest in Aleppo (39.9) percent. The percentage of children entering first grade who eventually reach grade 5 is presented in Table ED.5. Of all children starting grade one, the majority of them (99.4) percent will eventually reach grade five. Notice that this number includes children that repeat grades and that eventually move up to reach grade five. No worthwhile difference was observed by sex, residence, education or socioeconomic status. The net primary school completion rate and transition rate to secondary education is presented in Table ED.6. At the time of the survey, only (75.3) percent of the children of primary completion age (11 years) completed the last grade of primary education. This value should be distinguished from the gross primary completion ratio which includes children of any age attending the last grade of primary school. A differential by sex exists in the percentage of those completing primary schooling, rising to (77.5) percent among females and declining to (73.3) percent among males. By governorate, the highest was in Sweida (89.3) percent and the lowest in Al Raqqa (55.3) percent. The rate also rises with a woman’s higher education. In terms of the socioeconomic status of the household, it was only (65.3) percent among children 49Multiple Indicator Cluster Survey 2006 living in poor households compared to (87.2) percent among children living in rich households. Around (94) percent of children who completed successfully the last grade of primary education attend the secondary education schools. It is observed that no noticeable male-female differential exists in this percentage. However, it varies from one governorate to another; the highest (100) percent, in Sweida, the lowest in Aleppo (91.3) percent. As for the socioeconomic status, it was (89.1) percent among children of poor households rising to (97.2) among those living in rich households. The ratio of girls to boys attending primary and secondary education is provided in Table ED.7. These ratios are known as the Gender Parity Index (GPI). Notice that the ratios included here are obtained from net attendance ratios rather than gross attendance ratios. The last ratios provide an erroneous description of the GPI mainly because in most of the cases the majority of over-aged children attending primary education tend to be boys. The table shows that gender parity for primary and secondary school is close to 1.00, indicating no difference in the attendance of girls and boys. 50 Multiple Indicator Cluster Survey 2006 XI. Child Protection Birth Registration The Convention on the Rights of the Child states that every child has the right to a name and a nationality and the right to protection from being deprived of his or her identity. Birth registration is a fundamental means of securing these rights for children. The World Fit for Children states the goal to develop systems to ensure the registration of every child at or shortly after birth, and fulfill his or her right to acquire a name and a nationality, in accordance with national laws and relevant international instruments. The indicator is the percentage of children under 5 years of age whose birth is registered. (95.2) percent of children under 5 born in the Syrian Arab Republic in the five years preceding the survey have been registered (Table CP.1). There are no significant variations in birth registration across sex; (95.4) percent among males and (95.1) percent among females. But we observe such variation by age; (87.2) percent for the (0-11) month age group rising to (98.1) percent for the (48- 59) month age group. The percentage rises with the mother’s higher education, and it is higher among rich households; (98.6) percent than poor ones; (91.6) percent. Among those births that are not registered (4.8) percent, cost, travel distance and lack of knowledge appear to be the main reasons. Child Labour Article 32 of the Convention on the Rights of the Child states: “States Parties recognize the right of the child to be protected from economic exploitation and from performing any work that is likely to be hazardous or to interfere with the child’s education, or to be harmful to the child’s health or physical, mental, spiritual, moral or social development…” The World Fit for Children mentions nine strategies to combat child labour and the MDGs call for the protection of children against exploitation. In the MICS questionnaire, a number of questions addressed the issue of child Labour, that is, children (5-14) years of age involved in labour activities. A child is considered to be involved in child labour activities at the moment of the survey if during the week preceding the survey: • ages 5-11: at least one hour of economic work or 28 hours of domestic work per week. • Ages 12-14: at least 14 hours of economic work or 28 hours of domestic work per week. This definition allows to differentiate child labour from child work to identify the type of work that should be eliminated. As such, the estimate provided here is a minimum of the prevalence of child labour since some children may be involved in hazardous labour activities for a number of hours that could be less than the numbers specified in the criteria explained before. Table CP.2 presents the results of child labour by the type of work. The total percentage does not however equal total child labourers because a child can be involved in more than one type of work. The findings indicate that (4) percent of children aged (5-14) years work. The rate rises to (5) percent among male children and declines to (3) percent among female children. Child labour ratios are high among children not attending school. The percentage among the children who do not attend school is (7.8) percent, but it drops to (3.1) percent among the children who attend school regularly. It is high in rural areas (5.5) percent declining to only (2.6) percent in urban areas. 51Multiple Indicator Cluster Survey 2006 Variations also exist by governorate and the socioeconomic status. Child labour is as high as (12.5) percent in Hama declining to only (1.2) percent in Sweida. The ratio is high among children living in poor households; (6.7) percent but low among those living in rich households; (1.6) percent. Table CP.3 presents the percentage of children classified as student labourers or as labourer students. Student labourers are the children attending school that were involved in child labour activities at the moment of the surveys. More specifically, of the (79.7) percent of the children 5- 14 yeas of age attending school, (3.1) percent are also involved in child labour activities. On the other hand, out of the (20) percent of the children classified as child labourers aged 5-14 years the majority of them are also attending school (61) percent. Child Discipline As stated in A World Fit for Children, “children must be protected against any acts of violence…” and the Millennium Declaration calls for the protection of children against abuse, exploitation and violence. In the Syrian Arab Republic MICS survey, mothers/caretakers of children age 2-14 years were asked a series of questions on the ways parents tend to use to discipline their children when they misbehave. Note that for the child discipline module, one child aged 2-14 per household was selected randomly during fieldwork. Out of these questions, three indicators used to describe aspects of child discipline are: 1) the number of children 2-14 years that experience psychological aggression as punishment or minor physical punishment or severe physical punishment; and 2) the number of parents/caretakers of children 2-14 years of age that believe that in order to raise their children properly, they need to physically punish them. In the Syrian Arab Republic, (87.1) percent of children aged 2-14 years were subjected to at least one form to psychological or physical punishment by their mothers/caretakers or other household members. More importantly, (21.3 percent of children were subjected to severe physical punishment. On the other hand, (12.8) percent of mothers/caretakers believed that children should be physically punished. Male children were subjected more to both minor and severe physical discipline (76 and 23 percent) than female children (71.7 and 19.5 percent). It is interesting that for children experiencing any psychological or physical punishment the differentials with respect to governorates were significant; the highest in Sweida (93.5 percent) and the lowest in Quneitra (62.9) percent. The percentage of children subjected to any psychological or physical punishment declines as the mother’s/caretaker’s education rises. It is also lower among rich households than poor ones. Early Marriage Marriage before the age of 18 is a reality for many young girls. According to UNICEF’s worldwide estimates, over 60 million women aged 20-24 were married before the age of 18. Factors that influence child marriage rates include: the state of the country’s civil registration system, which provides proof of age for children; the existence of an adequate legislative framework with an accompanying enforcement mechanism to address cases of child marriage; and the existence of customary or religious laws that condone the practice. In many parts of the world parents encourage the marriage of their daughters while they are 52 Multiple Indicator Cluster Survey 2006 still children in hopes that the marriage will benefit them both financially and socially, while also relieving financial burdens on the family. In actual fact, child marriage is a violation of human rights, compromising the development of girls and often resulting in early pregnancy and social isolation, with little education and poor vocational training reinforcing the gendered nature of poverty. The right to ‘free and full’ consent to a marriage is recognized in the Universal Declaration of Human Rights- with the recognition that consent cannot be ‘free and full’ when one of the parties involved is not sufficiently mature to make an informed decision about a life partner. The Convention on the Elimination of all Forms of Discrimination against Women mentions the right to protection from child marriage in article 16, which states: “The betrothal and the marriage of a child shall have no legal effect, and all necessary action, including legislation, shall be taken to specify a minimum age for marriage…” While marriage is not considered directly in the Convention on the Rights of the Child, child marriage is linked to other rights-such as the right to express their views freely, the right to protection from all forms of abuse, and the right to be protected from harmful traditional practices-and is frequently addressed by the Committee on the Rights of the Child. Other international agreements related to child marriage are the Convention on Consent to Marriage, Minimum Age for Marriage and Registration of Marriages and Registration of Marriages and the African Charter on the Rights and Welfare of the Child and the Protocol to the African Charter on Human and People’s Rights on the Rights of Women in Africa. Child marriage was also identified by the Pan-African Forum against the commercial sexual exploitation of children. Research suggests that many factors interact to place a child at risk of marriage. Poverty, protection of girls, family honour and the provision of stability during unstable social periods are considered as significant factors in determining a girl’s risk of becoming married while still a child. Women who married at younger ages were more likely to believe that it is sometimes acceptable for a husband to beat his wife and were more likely to experience domestic violence themselves. The age gap between partners is thought to contribute to these abusive power dynamics and to increase the risk of untimely widowhood. Closely related to the issue of child marriage is the age at which girls become sexually active. Women who are married before the age of 18 tend to have more children than those who marry later in life. Pregnancy related deaths are known to be a leading cause of mortality for both married and unmarried girls between the ages of 15 and 19, particularly among the youngest of this cohort. There is evidence to suggest that girls who marry at young ages are more likely to marry older men, which puts them at increased risk of HIV infection. Parents seek to marry off their girls to protect their honour, and men often seek younger women as wives as a means to avoid choosing a wife who might already be infected. The demand for this young wife to reproduce and the power imbalance resulting from the age differential lead to very low condom use among such couples. Table CP.5 presents the percentage of women getting married at different ages. The findings indicate that (3.4) percent of women marry early; before (15) years of age. The percentage varies by governorate, the highest in Dara’a (5.2) percent and the lowest in Tartous (1.1) percent. It declines as the woman’s education rises, but it goes up with a higher socioeconomic status of the household. There is also a differential by area of residence; (4) percent in urban areas compared to (2.7) percent in rural ones. Around 18 percent of married women married before the age of 18 whereas the proportion of women between 15-19 who are currently married is around 10 percent. 53Multiple Indicator Cluster Survey 2006 XII. HIV/AIDS Knowledge of HIV Transmission and Condom Use One of the most important prerequisites for reducing the rate of HIV infection is accurate knowledge of how HIV is transmitted and strategies for preventing transmission. Correct information is the first step toward raising awareness and giving young people the tools to protect themselves from infection. Misconceptions about HIV are common and can confuse young people and hinder prevention efforts. Different regions are likely to have variations in misconceptions although some appear to be universal (for example that sharing food can transmit HIV or mosquito bites can transmit HIV). The UN General Assembly Special Session on HIV/AIDS (UNIGASS) called on governments to improve the knowledge and skills of young people to protect themselves from HIV. The indicators to measure this goal as well as the MDG of reducing HIV infections by half include improving the level of knowledge of HIV and its prevention, and changing behaviours to prevent further spread of the disease. The HIV module was administered to women 15-49 years of age. One indicator which is both an MDG and UNGASS indicator is the percent of young women who have comprehensive and correct knowledge of HIV prevention and transmission. Women were asked whether they knew of the three main ways of HIV transmission – having only one faithful uninfected partner, using a condom every time, and abstaining from sex. The results are presented in Table HA.1. The findings of the survey showed that (78.5) percent of the women interviewed have heard of AIDS. However, only (18.6) percent of women knew all three main ways of preventing HIV transmission. (58.6) percent of women know of having one faithful uninfected sex partner, (34.7) percent know of using a condom every time, and (33.5) percent know of abstaining from sex as main ways of preventing HIV transmission. While (64.8) percent of women know at least one way, a high proportion of women (35.2) percent do not know any of the three ways. Table HA.2 presents the percentage of women who can correctly identify misconceptions concerning HIV transmission. The indicator is based on the most common misconceptions, including mosquito bites. (35.4) percent agreed that HIV is transmitted that way. (38.7) percent answered that they knew that a healthy – looking person can be infected. The results also showed that (56.6) percent of women know that HIV can not be transmitted by sharing food with the HIV/AIDS infected person, while (70.5) percent know it can be transmitted by sharing needles. Table HA.3 summarizes information from Tables HA.1 and HA.2 and presents the percentage of women who know 2 ways of preventing HIV transmission and reject three common misconceptions. Comprehensive knowledge of HIV prevention methods and transmission is still fairly low. Overall, 7.9 percent of women were found to have comprehensive knowledge, with slightly higher rates in urban areas 8.3 percent compared to 7.5 in rural areas. There are also differences by Governorates, in Tartous the rate is 20 percent and in Idleb it is around 3 percent. As expected, the percent of women with comprehensive knowledge increases with the woman’s education level (see Figure HA.1). 54 Multiple Indicator Cluster Survey 2006 Figure HA.1 Percent of women who have comprehensive knowledge of HIV/AIDS transmission according to their level of education, Syrian Arab Republic, 2006 12 26 38 49 53 9 22 33 35 1 10 18 19 3 4 0 10 20 30 40 50 60 None Primary Secondary + Higher Institutions University+ P er ce nt Know s 2 w ays to prevent HIV Identify 3 misconceptions Comprehensive know ledge Knowledge of mother – to – child transmission of HIV is also an important first step for women to seek HIV testing when they are pregnant to avoid infection in the baby. Women should know that HIV can be transmitted during pregnancy, delivery, and through breastfeeding. The level of knowledge among women age (15-49) years concerning mother-to-child transmission is presented in Table HA.4. Overall, (71.3) percent of women know that HIV can be transmitted from mother to child. The percentage of women who know all three ways of mother-to-child transmission is (19.7) percent, while (7.2) percent of women did not of any way. Women’s knowledge of HIV transmission from mother to child varies between urban and rural areas as well as by governorate; (75.9) percent in urban areas as compared to (65.8) percent in rural ones; as high as (90.8) percent in Lattakia in contrast to as low as (30.9) percent in Raqqa. The percentage also rises with the mother’s / caretaker’s education and it is higher among rich households than among poor ones. The indicators on attitudes toward people living with HIV measure stigma and discrimination in the community. Stigma and discrimination are low if respondents report an accepting attitude on the following four questions: 1) would care for family member sick with AIDS; 2) would buy fresh vegetables form a vendor who was HIV positive; 3) thinks that a female teacher who is HIV positive should be allowed to teach in school; 4) would not want to keep HIV status of a family member a secret. 55Multiple Indicator Cluster Survey 2006 Table HA.5 presents the attitudes of women towards people infected with HIV/AIDS. The data show that (11.7) percent of women would refuse to care for a family member sick with AIDS, (41.4) percent of women would want to keep HIV status of a family member a secret, (54.5) percent of women believe that a teacher who is HIV positive should not be allowed to teach in school, and (72.5) percent would refuse to buy food from a vendor who is HIV positive. The table also indicates that (9.7) percent of women refuse all the discrimination phrases indicated above. Among women who had given birth within the two years preceding the survey, the percent who received counseling and HIV testing during antenatal care is presented in Table HA.7. The table indicates that (84) percent of women received health care from a health care professional during their latest pregnancy, with (9.3) percent of them having been provided with information about HIV prevention during an ANC visit. In Raqqa the figure was as low as 0.6 percent whereas the highest figure is for Tartous at 28 percent. 56 Multiple Indicator Cluster Survey 2006 XIII. Summary & Recommendations The Multiple Indicator Cluster Survey was conducted in the Syrian Arab Republic to monitor and to evaluate the situation of children and women. Survey data were collected in the period from 19 April 2006 till the end of May 2006 using three questionnaires. The questionnaires are the Household Questionnaires, The Questionnaire for Individual Women aged 15 – 49 years, and The Questionnaire for Children under Five. A random self -weighted sample of 20,000 households was selected. 19019 households were successfully interviewed yielding a response rate of 95.7%. The women interviewed were 25026 yielding a response rate of 97.9%. Children under 5 whose questionnaires were successfully completed were 11017 children, thus yielding a response rate of 99.2%. Response rates were similar in urban and rural areas. Following is a display of the most important survey results: • Survey results revealed a decline in mortality rates during the last 15 years. Under 5 mortality rate dropped from 41.7 per thousand in 1993 to 22 per thousand in 2006. • Approximately one tenth of children under 5 in the Syrian Arab Republic is underweight, 8.6% are wasted, and 22.4% are stunted. • It was revealed that 29% of infant under 6 month are exclusively breastfed, that 36.5% of infant are receiving liquids or foods other than breast milk, and that only 20% of children continue to receive breastfeeding after completing 2 years of age. • 87.8% of children in the age group 12 – 23 months completed their immunizations anytime prior to the survey and 79% completed all recommendation before their first birthday (among mothers with vaccination cards). • There is strong correlation between contraception and the women’s level of education. The percentage of women using contraception went up from 45.2% among uneducated women to 71.0% among women with higher education. • The results revealed that 84% of the women in the age group 15 – 49 that gave birth in the two years preceding the survey consulted qualified medical staff for antenatal care and that 93% of the deliveries were skilled-attended. • We observe that 92% of children in primary school age are attending the first grade of the primary school. Secondary school attendance rate was 54.2% with slight gender differences. • Survey results indicate that 4% of children aged 5 – 14 years are labourers. 2.3% of children were severely physically punished. 12.8% of mothers/ caretakers stated that they believed that physical punishment is necessary for raising a child. • Only 7.9 percent of women between 15 – 49 have comprehensive knowledge. After reviewing the above results, the following general recommendations can be made: • Healthcare services should be expanded to include new services, information on their provision sites, available care modalities, and the prevention and the elimination of all unhealthy practices of child and mother nutrition. • More attention should be given to contraception. Informative and educational programs targeting rural areas for illiterate and less educated women should be implemented since this will contribute to enhancing the health of mothers and children. It will also protect elderly women from health hazards. 57Multiple Indicator Cluster Survey 2006 • It is necessary to continue the ongoing trend of the Syrian government in integrating health services, improving the quality of the services provided, and improving the skills of service providers. • Media should be utilized to the maximum for improving the awareness and health education among all household members. The goals are to encourage breastfeeding and healthy nutrition, to complete different immunization shots, and to minimize the incidence of harmful practices and sexually transmitted infections (STIs) especially in rural areas. • It is necessary to conduct some analytical studies to inform policy makers and to assist health programs especially those regarding fertility trends, unmet health needs, and the nutritional status of children. 58 Multiple Indicator Cluster Survey 2006 List of References Boerma, J. T., Weinstein, K. I., Rutstein, S.O., and Sommerfelt, A. E. , 1996. Data on Birth Weight in Developing Countries: Can Surveys Help? Bulletin of the World Health Organization, 74(2), 209-16. Blanc, A. and Wardlaw, T. 2005. «Monitoring Low Birth Weight: An Evaluation of International Estimates and an Updated Estimation Procedure». WHO Bulletin, 83 (3), 178-185. 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, S.O. and Johnson, K., 2004. The DHS Wealth Index. DHS Comparative Reports No. 6. Calverton, Maryland: ORC Macro. UNICEF, 2006. Monitoring the Situation of Children and Women. Multiple Indicator Cluster Survey Manual, New York. United Nations, 1983. Manual X: Indirect Techniques for Demographic Estimation (United Nations publication, Sales No. E.83. XIII.2). United Nations, 1990a. QFIVE, United Nations Program for Child Mortality Estimation. New York, UN Pop Division United Nations, 1990b. Step-by-step Guide to the Estimation of Child Mortality. New York, UN WHO and UNICEF, 1997. The Sisterhood Method for Estimating Maternal Mortality. Guidance notes for potential users, Geneva. www.Childinfo.org. 59Multiple Indicator Cluster Survey 2006 Table HH.1: Results of household and individual interviews Numbers of households, women and children under 5 by results of the household, women’s and under-five’s interviews, and household, women’s and under-five’s response rates, Syrian Arab Republic, 2006 Governorates Ur ba n Ru ral Da ma sc us Ale pp o Ru ral -D am Ho ms Ha ma La tta kia Idl eb Ha ss ak e De ir E zz or Ta rto us Ra qq a Da raa Sw eid a Qu ne itra To tal Sampled households 11,317 8,705 2,100 4,560 2,780 1,720 1,445 1,139 1,280 1,140 860 878 780 840 400 100 20,022 Occupied households 11,202 8,668 2,078 4,552 2,714 1,710 1,426 1,132 1,272 1,139 857 878 778 835 399 100 19,870 Interviewed households 10,717 8,302 1,970 4,522 2,571 1,630 1,395 1,064 1,174 1,002 826 871 737 782 378 97 19,019 Household response rate 95.7 95.8 94.8 99.3 94.7 95.3 97.8 94.0 92.3 88.0 96.4 99.2 94.7 93.7 94.7 97.0 95.7 Eligible women 13,764 11,799 2,259 5,531 3,644 2,199 1,946 1,368 1,551 1,635 1,232 1,220 1,075 1,261 495 147 25,563 Interviewed women 13,467 11,559 2,211 5,492 3,370 2,171 1,921 1,366 1,509 1,594 1,219 1,219 1,069 1,246 492 147 25,026 Women response rate 97.8 98.0 97.9 99.3 92.5 98.7 98.7 99.9 97.3 97.5 98.9 99.9 99.4 98.8 99.4 100.0 97.9 Women’s overall response rate 93.6 93.8 92.8 98.6 87.6 94.1 96.6 93.9 89.8 85.8 95.4 99.1 94.2 92.5 94.2 97.0 93.7 Eligible children under 5 5,526 5,578 596 2,293 1,638 1,036 842 440 930 678 630 448 494 812 180 87 11,104 Mother/Caretaker Interviewed 5,483 5,534 591 2,284 1,598 1,032 838 440 927 668 626 447 491 808 180 87 11,017 Child response rate 99.2 99.2 99.2 99.6 97.6 99.6 99.5 100.0 99.7 98.5 99.4 99.8 99.4 99.5 100.0 100.0 99.2 Children’s overall response rate 94.9 95.0 94.0 99.0 92.4 95.0 97.4 94.0 92.0 86.7 95.8 99.0 94.2 93.2 94.7 97.0 95.0 60 Multiple Indicator Cluster Survey 2006 Table HH.2: Household age distribution by sex Percent distribution of the household population by five-year age groups and dependency age groups, and number of children aged 0-17 years, by sex, Syrian Arab Republic, 2006 Sex TotalMale Female Number Percent Number Percent Number Percent Age 0-4 5,852 10.5 5,252 10.2 11,103 10.3 5-9 7,542 13.6 7,037 13.6 14,579 13.6 10-14 7,444 13.4 7,287 14.1 14,730 13.7 15-19 6,956 12.5 5,854 11.3 12,809 11.9 20-24 5,977 10.7 5,051 9.8 11,028 10.3 25-29 4,140 7.4 4,163 8.0 8,303 7.7 30-34 3,038 5.5 3,302 6.4 6,340 5.9 35-39 2,924 5.3 3,097 6.0 6,021 5.6 40-44 2,572 4.6 2,468 4.8 5,040 4.7 45-49 2,173 3.9 1,628 3.1 3,801 3.5 50-54 1,826 3.3 2,606 5.0 4,432 4.1 55-59 1,586 2.9 1,379 2.7 2,965 2.8 60-64 1,256 2.3 1,008 1.9 2,264 2.1 65-69 869 1.6 677 1.3 1,546 1.4 70+ 1,482 2.7 909 1.8 2,391 2.2 Missing/DK 8 0.0 5 0.0 13 0.0 Dependency age groups <15 20,838 37.4 19,575 37.8 40,412 37.6 15-64 32,448 58.3 30,555 59.1 63,003 58.7 65+ 2,351 4.2 1,586 3.1 3,937 3.7 Missing/DK 8 0.0 5 0.0 13 0.0 Age Children aged 0-17 24,988 44.9 23,150 44.8 48,139 44.8 Adults 18+/Missing/ DK 30,656 55.1 28,570 55.2 59,226 55.2 Total 55,644 100.0 51,721 100.0 107,365 100.0 61Multiple Indicator Cluster Survey 2006 Table HH.3: Household composition Percent distribution of households by selected characteristics, Syrian Arab Republic, 2006 Number of households Weighted percent weighted unweighted Sex of household head Male 91.7 17,436 17,436 Female 8.3 1,583 1,583 Governorates Damascus 10.4 1,971 1,970 Aleppo 23.8 4,523 4,522 Rural-Dam 13.5 2,571 2,571 Homs 8.6 1,630 1,630 Hama 7.3 1,395 1,395 Lattakia 5.6 1,064 1,064 Idleb 6.2 1,174 1,174 Hassake 5.3 1,002 1,002 Deir Ezzor 4.3 826 826 Tartous 4.6 871 871 Raqqa 3.9 737 737 Daraa 4.1 782 782 Sweida 2.0 378 378 Quneitra 0.5 97 97 Urban_Rural Urban 56.4 10,722 10,717 Rural 43.6 8,297 8,302 Number of household members 1 2.4 453 453 2-3 17.7 3,367 3,367 4-5 32.0 6,079 6,079 6-7 27.0 5,127 5,127 8-9 13.2 2,509 2,509 10+ 7.8 1,484 1,484 Total 100.0 19,019 19,019 Table HH.3c: Household composition Percent distribution of households by selected characteristics, Syrian Arab Republic, 2006 Weighted percent Number of households weighted Number of households unweighted At least one child aged < 18 years 77,1 19019 19019 At least one child aged < 5 years 39,4 19019 19019 At least one woman aged 15-49 years 87,6 19019 19019 62 Multiple Indicator Cluster Survey 2006 Table HH.4: Women’s background characteristics Percent distribution of women aged 15-49 years by background characteristics, Syrian Arab Republic, 2006 Number of women Weighted percent weighted unweighted Governorates Damascus 8.8 2,213 2,211 Aleppo 22.0 5,494 5,492 Rural-Dam 13.5 3,370 3,370 Homs 8.7 2,171 2,171 Hama 7.7 1,920 1,921 Lattakia 5.5 1,366 1,366 Idleb 6.0 1,508 1,509 Hassake 6.4 1,593 1,594 Deir Ezzor 4.9 1,219 1,219 Tartous 4.9 1,218 1,219 Raqqa 4.3 1,069 1,069 Daraa 5.0 1,246 1,246 Sweida 2.0 492 492 Quneitra 0.6 147 147 Urban_Rural Urban 53.9 13,482 13,467 Rural 46.1 11,544 11,559 Age 15-19 22.5 5,637 5,637 20-24 19.8 4,944 4,944 25-29 16.3 4,088 4,088 30-34 13.0 3,250 3,250 35-39 12.3 3,070 3,070 40-44 9.7 2,430 2,430 45-49 6.4 1,607 1,607 Marital/Union status Currently married/in union 54.4 13,618 13,617 NOT married NOW/in union 1.7 436 436 Never married/in union 43.8 10,972 10,973 Motherhood status Ever gave birth 91.8 12,900 12,899 Never gave birth 8.2 1,154 1,154 Education None 14.2 3,555 3,557 Primary 32.4 8,102 8,103 Secondary 40.7 10,177 10,175 Higher institutions 6.7 1,674 1,673 University + 6.1 1,519 1,518 Wealth index quintiles Poorest 18.5 4,617 4,622 Second 19.6 4,909 4,912 Middle 20.7 5,186 5,186 Fourth 18.1 4,521 4,519 Richest 23.1 5,791 5,787 Total 100.0 25,026 25,026 63Multiple Indicator Cluster Survey 2006 Table HH.5: Children’s background characteristics Percent distribution of children under five years of age by background characteristics, Syrian Arab Republic, 2006 Number of under-5 children Weighted percent weighted unweighted Sex Male 52.7 5,804 5,804 Female 47.3 5,213 5,213 Governorates Damascus 5.4 591 591 Aleppo 20.7 2,284 2,284 Rural-Dam 14.5 1,598 1,598 Homs 9.4 1,032 1,032 Hama 7.6 838 838 Lattakia 4.0 440 440 Idleb 8.4 927 927 Hassake 6.1 668 668 Deir Ezzor 5.7 626 626 Tartous 4.1 447 447 Raqqa 4.5 491 491 Daraa 7.3 808 808 Sweida 1.6 180 180 Quneitra 0.8 87 87 Urban_Rural Urban 49.8 5,486 5,483 Rural 50.2 5,531 5,534 Age < 6 months 10.6 1,163 1,163 6-11 months 7.9 867 867 12-23 months 18.9 2,083 2,083 24-35 months 21.9 2,410 2,410 36-47 months 23.7 2,609 2,609 48-59 months 17.1 1,885 1,885 Mother’s education None 17.7 1,947 1,947 Primary 37.8 4,164 4,164 Secondary 36.0 3,961 3,961 Higher institutions 5.5 608 608 University + 3.1 337 337 Wealth index quintiles Poorest 21.3 2,342 2,343 Second 23.0 2,536 2,536 Middle 21.8 2,396 2,396 Fourth 17.5 1,927 1,927 Richest 16.5 1,816 1,815 Total 100.0 11,017 11,017 64 Multiple Indicator Cluster Survey 2006 Table CM.1: Child mortality Infant and under-five mortality rates by background and demographic characteristics [BASED ON NORTH], Syrian Arab Republic, 2006 Infant Mortality Rate* Under-five Mortality Rate** Sex Male 21 26 Female 14 17 HH7new South 16 19 North 22 27 East 15 18 Middle 17 20 Coast 17 21 Area Urban 16 19 Rural 20 24 Mother’s education None 17 20 Primary 20 25 Secondary 16 19 Higher institutions 7 8 University + 7 8 Wealth index quintiles Poorest 18 22 Second 19 23 Middle 19 23 Fourth 17 20 Richest 16 20 Total 18 22 * MICS indicator 2; MDG indicator 14 ** MICS indicator 1; MDG indicator 13 65Multiple Indicator Cluster Survey 2006 Table CM.2: Children ever born, children surviving, proportion dead Mean number of children ever born, children surviving and proportion dead by age of women, Syrian Arab Republic, 2006 Mean number of children ever born Mean number children surviving Proportion dead Number of women Age 15-19 0.067 0.066 0.018 5,637 20-24 0.602 0.595 0.010 4,944 25-29 1.687 1.655 0.019 4,088 30-34 3.013 2.947 0.022 3,250 35-39 4.255 4.128 0.030 3,070 40-44 5.080 4.906 0.034 2,430 45-49 5.947 5.725 0.037 1,607 Total 2.198 2.136 0.028 25,026 66 Multiple Indicator Cluster Survey 2006 Table NU.1: Child malnourishment Percentage of under-five children who are severely or moderately undernourished, Syrian Arab Republic, 2006 Weight for age Height for age Weight for height Number of children %below -2 SD %below -3 SD* %below -2 SD %below -3 SD** %below -2 SD %below -3 SD*** %above +2 SD Sex Male 10.7 2.1 23.6 11.0 9.5 2.8 11.8 5,042 Female 8.6 1.6 21.1 9.1 7.6 1.7 13.1 4,536 Governorates Damascus 12.0 3.2 23.7 11.6 12.0 4.4 19.3 476 Aleppo 10.2 1.3 36.0 19.7 8.0 2.5 16.0 1,909 Rural-Dam 12.4 2.4 20.6 7.9 11.3 2.6 11.5 1,430 Homs 10.2 1.7 24.0 9.3 7.5 1.4 15.9 875 Hama 10.1 2.5 17.5 7.2 13.5 3.7 10.5 753 Lattakia 4.9 0.5 9.7 2.3 10.0 0.8 10.7 391 Idleb 3.8 0.5 16.5 5.0 1.4 0.3 5.4 878 Hassake 11.0 2.8 17.1 7.1 10.8 3.5 15.8 538 Deir Ezzor 17.9 5.2 29.4 15.1 16.1 5.4 13.3 496 Tartous 3.7 0.9 9.5 2.5 5.8 0.7 12.0 432 Raqqa 22.7 3.7 35.4 19.5 12.2 3.7 9.5 401 Daraa 3.8 0.3 11.5 3.3 3.3 0.3 8.4 738 Sweida 0.6 0.0 4.0 1.1 0.0 0.0 4.5 177 Quneitra 1.2 0.0 15.5 6.0 2.4 1.2 8.3 84 Urban_Rural Urban 9.4 1.6 21.9 10.0 8.5 2.4 12.9 4,728 Rural 10.0 2.1 22.9 10.2 8.8 2.2 11.9 4,850 Age < 6 months 4.1 0.5 16.4 5.7 7.6 2.1 20.5 959 6-11 months 10.4 2.9 20.2 6.8 10.4 2.6 15.5 734 12-23 months 11.2 2.5 28.3 13.7 9.1 2.4 15.3 1,731 24-35 months 13.4 2.0 22.3 11.0 9.1 2.0 7.8 2,154 36-47 months 8.4 1.6 24.4 11.1 8.6 2.5 11.3 2,314 48-59 months 8.3 1.4 18.1 7.8 7.6 2.3 10.8 1,686 Mother’s education None 13.8 3.6 29.1 15.1 11.8 3.6 12.9 1,613 Primary 10.2 1.9 25.2 11.3 8.1 2.3 13.0 3,630 Secondary 8.1 1.1 18.1 7.1 7.7 1.7 11.3 3,499 Higher institutions 6.8 2.0 17.4 8.5 9.4 2.4 13.3 541 University+ 6.1 0.3 11.5 6.4 7.8 1.7 13.2 295 Wealth index quintiles Poorest 12.7 3.3 29.5 14.6 10.4 3.0 13.4 1,961 Second 10.2 1.7 21.1 8.8 8.1 2.2 11.4 2,244 Middle 9.9 1.7 20.9 8.9 8.6 2.4 11.6 2,092 Fourth 7.2 1.1 20.2 7.8 7.2 1.5 13.5 1,704 Richest 7.9 1.2 19.9 10.3 8.8 2.0 12.4 1,577 Total 9.7 1.8 22.4 10.1 8.6 2.3 12.4 9,578 67Multiple Indicator Cluster Survey 2006 Table NU.2: Initial breastfeeding Percentage of women aged 15-49 years with a birth in the 2 years preceding the survey who breastfed their baby within one hour of birth and within one day of birth, Syrian Arab Republic, 2006 Percentage who started breastfeeding within one hour of birth* Percentage who started breastfeeding within one day of birth Number of women with live birth in the two years preceding the survey Governorates Damascus 22.1 87.9 240 Aleppo 41.0 87.6 734 Rural-Dam 29.9 77.2 613 Homs 27.6 84.4 373 Hama 40.2 79.1 296 Lattakia 37.3 84.0 150 Idleb 38.6 82.8 319 Hassake 24.3 67.1 243 Deir Ezzor 34.2 76.3 257 Tartous 31.3 79.1 163 Raqqa 16.0 68.0 175 Daraa 26.6 78.5 289 Sweida 50.7 94.7 75 Quneitra (16.1) (51.6) 31 Urban_Rural Urban 31.8 81.9 1,988 Rural 33.1 79.2 1,969 Months since last birth < 6 months 32.1 79.0 1,183 6-11 months 34.7 79.8 872 12-23 months 31.6 81.8 1,903 Education None 35.5 77.0 609 Primary 32.9 81.0 1,535 Secondary 31.5 80.9 1,452 Higher institutions 29.3 83.0 229 University+ 28.6 83.5 133 Wealth index quintiles Poorest 33.6 77.6 815 Second 29.3 78.3 972 Middle 36.1 80.8 877 Fourth 32.6 82.4 666 Richest 30.5 85.3 626 Total 32.4 80.5 3,958 * MICS indicator 45 68 Multiple Indicator Cluster Survey 2006 Table NU.3: Breastfeeding Percent of living children according to breastfeeding status at each age group, Syrian Arab Republic, 2006 Children 0-3 months Children 0-5 months Children 6-9 months Children 12-15 months Children 20-23 months Pe rce nt ex clu siv ely br ea stf ed Nu mb er of ch ild re n Pe rce nt ex clu siv ely br ea stf ed * Nu mb er of ch ild re n Pe rce nt re ce ivi ng br ea stm ilk an d s oli d/m us hy fo od ** Nu mb er of ch ild re n Pe rce nt br ea stf ed *** Nu mb er of ch ild re n Pe rce nt br ea stf ed ** * Nu mb er of ch ild re n Sex Male 33.0 348 27.2 621 35.2 327 64.1 457 18.3 263 Female 37.6 327 30.4 542 38.1 265 63.7 410 14.0 222 Governorates Damascus (21.4) 42 (21.4) 70 (31.6) 38 69.2 52 (18.8) 32 Aleppo 36.5 148 36.3 251 17.8 90 75.0 204 (22.5) 40 Rural-Dam 34.3 99 22.9 170 52.8 89 48.5 101 9.1 99 Homs 40.8 76 33.3 120 45.0 60 59.0 83 25.5 55 Hama (33.3) 36 21.9 64 44.1 59 72.6 62 (13.3) 45 Lattakia (46.4) 28 (45.7) 46 (25.0) 24 (41.4) 29 (10.7) 28 Idleb (39.6) 48 22.9 109 (33.3) 42 66.2 71 (14.8) 27 Hassake (27.5) 40 23.2 69 (17.1) 35 (65.3) 49 (20.0) 30 Deir Ezzor (35.6) 45 30.3 76 (38.5) 39 64.5 62 (42.4) 33 Tartous (*) 19 (26.7) 30 (45.0) 20 (38.5) 39 (3.2) 31 Raqqa (26.7) 30 (26.5) 49 (16.7) 24 69.1 55 (*) 7 Daraa 40.4 52 29.4 85 43.1 51 (65.9) 44 (10.3) 39 Sweida * 9 * 16 * 17 * 10 * 14 Quneitra * 3 * 8 * 4 * 6 * 5 Urban_Rural Urban 31.3 371 27.6 609 36.1 277 62.4 436 15.4 247 Rural 40.1 304 30.0 554 36.8 315 65.4 431 17.2 238 Mother’s education None 38.0 100 31.4 188 22.5 89 76.4 161 37.7 53 Primary 34.4 273 29.3 478 36.6 216 65.0 340 18.3 164 Secondary 36.3 245 27.9 408 40.5 227 55.9 295 9.3 205 Higher institutions (32.5) 40 25.0 60 (37.1) 35 (69.8) 43 (19.4) 36 University+ * 17 (20.7) 29 (48.0) 25 (53.6) 28 (11.1) 27 Wealth index quintiles Poorest 41.7 139 35.5 248 28.6 119 73.2 194 27.8 79 Second 38.3 128 28.6 248 39.1 151 63.3 207 13.2 121 Middle 36.7 169 29.6 280 41.7 139 57.9 178 11.1 117 Fourth 30.6 124 23.8 202 35.0 100 62.7 150 12.6 87 Richest 27.0 115 23.8 185 36.1 83 60.9 138 21.0 81 Total 35.3 675 28.7 1,163 36.5 592 63.9 867 16.3 485 69Multiple Indicator Cluster Survey 2006 Table NU.4: Adequately fed infants Percentage of infants under 6 months of age exclusively breastfed, percentage of infants 6-11 months who are breastfed and who ate solid/semi-solid food at least the minimum recommended number of times yesterday and percentage of infants adequately fed, Syrian Arab Republic, 2006 0- 5 m on ths ex clu siv ely b re as tfe d 6- 8 m on ths w ho re ce ive d b re as tm ilk an d co mp lem en tar y f oo d a t le as t 2 tim es in pr ior 24 ho ur s 9- 11 m on ths w ho re ce ive d b re as tm ilk an d co mp lem en tar y f oo d a t le as t 3 tim es in pr ior 24 ho ur s 6- 11 m on ths w ho re ce ive d b re as tm ilk an d co mp lem en tar y f oo d a t le as t th e m ini mu m re co mm en de d n um be r o f ti me s p er da y* 0- 11 m on ths w ho w er e a pp ro pr iat ely fe d* * Nu mb er of in fan ts ag ed 0- 11 m on ths Sex Male 27.2 25.8 16.7 21.5 24.7 1,087 Female 30.4 25.5 14.8 20.0 26.0 943 Governorates Damascus 21.4 28.6 11.5 20.4 21.0 124 Aleppo 36.3 8.8 8.3 8.6 27.5 367 Rural-Dam 22.9 37.9 14.5 25.4 24.0 312 Homs 33.3 39.1 24.3 32.5 33.0 203 Hama 21.9 36.0 16.2 27.6 25.2 151 Lattakia 45.7 18.7 31.6 25.7 37.0 81 Idleb 22.9 24.1 14.3 18.8 21.4 173 Hassake 23.2 17.4 2.6 8.1 16.0 131 Deir Ezzor 30.3 20.8 13.8 17.0 24.8 129 Tartous 26.7 26.7 46.7 36.7 31.7 60 Raqqa 26.5 11.8 0.0 6.5 18.8 80 Daraa 29.4 20.0 20.6 20.3 25.2 159 Sweida (6.2) (36.4) (27.8) (31.0) (22.2) 45 Quneitra * * * * * 15 Urban_Rural Urban 27.6 26.0 15.8 20.9 24.9 1,016 Rural 30.0 25.4 15.7 20.6 25.7 1,014 Mother’s education None 31.4 12.7 3.3 8.1 22.2 311 Primary 29.3 23.9 12.7 18.1 24.8 799 Secondary 27.9 31.6 21.3 26.8 27.4 740 Higher institutions 25.0 32.0 31.0 31.5 28.1 114 University+ 20.7 18.7 14.3 16.2 18.2 66 Wealth index quintiles Poorest 35.5 17.4 4.9 11.6 25.7 421 Second 28.6 29.9 13.9 21.6 25.3 470 Middle 29.6 27.5 21.4 24.4 27.4 485 Fourth 23.8 25.3 15.5 20.5 22.4 348 Richest 23.8 28.3 24.6 26.4 24.8 306 Total 28.7 25.7 15.8 20.8 25.3 2,030 70 Multiple Indicator Cluster Survey 2006 Table NU.6: Children’s vitamin A supplementation Percent distribution of children aged 6-59 months by whether they received a high dose Vitamin A supplement in the last 6 months, Syrian Arab Republic, 2006 Percent of children who received Vitamin A: Number of children aged 6-59 months Within last 6 months* Prior to last 6 months Not sure when Not sure if received Never received Vitamin A Total Sex Male 3.2 6.6 12.6 14.0 63.6 100.0 5,183 Female 2.5 6.1 12.5 13.5 65.3 100.0 4,671 Governorates Damascus 5.2 7.5 22.8 20.0 44.5 100.0 521 Aleppo 4.3 3.7 18.3 19.6 54.1 100.0 2,033 Rural-Dam 1.8 4.2 3.2 2.9 88.0 100.0 1,428 Homs 2.7 1.8 3.1 6.7 85.7 100.0 912 Hama 3.7 11.8 19.5 20.9 44.1 100.0 774 Lattakia 2.3 12.4 22.1 16.5 46.7 100.0 394 Idleb 2.3 6.2 12.8 13.0 65.6 100.0 818 Hassake 2.2 4.7 14.9 28.4 49.9 100.0 599 Deir Ezzor 0.0 0.5 0.2 19.8 79.5 100.0 550 Tartous 4.3 15.6 23.7 5.8 50.6 100.0 417 Raqqa 0.0 0.7 0.9 16.7 81.7 100.0 442 Daraa 3.0 8.4 16.5 5.1 66.9 100.0 723 Sweida 4.9 44.5 6.1 2.4 42.1 100.0 164 Quneitra 1.3 12.7 12.7 2.5 70.9 100.0 79 Urban_Rural Urban 3.5 6.3 14.9 13.3 62.1 100.0 4,876 Rural 2.3 6.4 10.3 14.2 66.8 100.0 4,977 Age 6-11 months 4.5 1.3 4.5 10.5 79.2 100.0 867 12-23 months 6.2 5.6 6.8 11.2 70.1 100.0 2,083 24-35 months 2.7 8.6 12.1 13.0 63.6 100.0 2,410 36-47 months 1.3 6.9 16.9 15.3 59.6 100.0 2,609 48-59 months 0.8 5.8 17.3 17.0 59.1 100.0 1,885 Mother’s education None 1.1 1.9 8.7 20.5 67.8 100.0 1,759 Primary 2.7 4.7 11.7 14.5 66.4 100.0 3,686 Secondary 3.6 9.0 14.5 10.6 62.4 100.0 3,553 Higher institutions 3.3 12.2 17.2 10.4 56.9 100.0 548 University+ 5.5 10.1 15.3 9.4 59.7 100.0 308 Wealth index quintiles Poorest 2.1 3.1 8.4 21.0 65.5 100.0 2,094 Second 2.6 7.0 11.8 10.8 67.8 100.0 2,288 Middle 2.4 6.0 13.2 10.8 67.6 100.0 2,116 Fourth 3.0 7.7 14.7 12.5 62.2 100.0 1,725 Richest 5.0 8.6 16.0 13.8 56.6 100.0 1,631 Total 2.9 6.3 12.6 13.8 64.4 100.0 9,854 * MICS indicator 42 71Multiple Indicator Cluster Survey 2006 Table NU.7: Post-partum mother’s Vitamin A supplementation Percentage of women aged 15-49 years with a birth in the 2 last years preceding the survey whether they received a high dose Vitamin A supplement before the infant was 8 weeks old, Syrian Arab Republic, 2006 Received Vitamin A supplement* Not sure if received Vitamin A Number of women aged 15-49 years Governorates Damascus 13.3 5.8 240 Aleppo 11.6 16.3 734 Rural-Dam 16.2 3.4 613 Homs 18.2 7.2 373 Hama 35.1 7.4 296 Lattakia 46.7 5.3 150 Idleb 11.6 4.4 319 Hassake 6.6 17.7 243 Deir Ezzor 10.1 10.5 257 Tartous 25.8 7.4 163 Raqqa 6.3 15.4 175 Daraa 23.9 3.8 289 Sweida 53.3 0.0 75 Quneitra (19.4) (9.7) 31 Urban_Rural Urban 17.3 8.9 1,988 Rural 18.3 8.7 1,969 Education None 9.9 14.9 609 Primary 15.4 9.7 1,535 Secondary 21.7 5.9 1,452 Higher institutions 24.4 7.0 229 University+ 28.6 6.0 133 Wealth index quintiles Poorest 12.1 14.3 815 Second 18.0 6.5 972 Middle 19.6 7.0 877 Fourth 18.0 7.8 666 Richest 22.2 8.9 626 Total 17.8 8.8 3,958 * MICS indicator 43 72 Multiple Indicator Cluster Survey 2006 Table NU.8 : Low birth weight infants Percentage of live births in the 2 years preceding the survey that weighed below 2500 grams at birth, Syrian Arab Republic, 2006 Percent of live births: below 2500 grams * weighed at birth ** Number of live births Governorates Damascus 11.9 53.3 240 Aleppo 8.2 33.1 734 Rural-Dam 10.0 83.4 613 Homs 8.0 63.8 373 Hama 9.2 51.7 296 Lattakia 10.8 78.0 150 Idleb 8.4 21.0 319 Hassake 10.9 17.7 243 Deir Ezzor 9.7 24.1 257 Tartous 8.5 82.2 163 Raqqa 10.8 18.9 175 Daraa 10.3 37.0 289 Sweida 7.0 68.0 75 Quneitra (9.6) (22.6) 31 Urban_Rural Urban 9.5 55.9 1,988 Rural 9.3 39.7 1,969 Education None 8.8 16.9 609 Primary 9.2 39.6 1,535 Secondary 10.0 62.3 1,452 Higher institutions 9.5 73.4 229 University+ 7.7 83.5 133 Wealth index quintiles Poorest 9.5 19.9 815 Second 9.6 45.1 972 Middle 9.4 56.4 877 Fourth 8.5 57.5 666 Richest 9.9 66.3 626 Total 9.4 47.9 3,958 * MICS Indicator 9 ** MICS Indicator 10 73Multiple Indicator Cluster Survey 2006 Table CH.1: Vaccinations in first year of life Percentage of children aged 12-23 months immunized against childhood diseases at any time before the survey and before the first birthday, Syrian Arab Republic, 2006 (mother with cards only) BCG * DPT 1 DPT 2 DPT 3 ** Polio 0 Polio 1 Polio 2 Polio 3 **** Measles **** All ***** None Number of children aged 12-23 months Vaccination card 99.9 99.4 96.6 91.2 99.9 99.3 96.7 91.3 92.4 87.8 0.0 1,152 Mother’s report 0.0 0.0 0.2 0.3 0.0 0.1 0.2 0.3 0.1 0.0 0.0 1,152 Either 99.9 99.4 96.8 91.6 99.9 99.4 96.9 91.7 92.4 87.8 0.0 1,152 Vaccinated by 12 months of age 99.7 98.6 95.6 89.0 99.7 98.6 95.8 88.9 85.2 79.0 0.1 1,152 * MICS Indicator 25 ** MICS Indicator 27 *** MICS Indicator 26 **** MICS Indicator 28 ; MDG Indicator 15 ***** MICS Indicator 31 Table CH.1A: Vaccinations in first year of life (continued) Percentage of children aged 12-23 months immunized against childhood diseases at any time before the survey and before the first birthday, Syria, 2006 BCG * DPT 1 DPT 2 DPT 3 ** Polio 0 Polio 1 Polio 2 Polio 3 *** Measles **** All ***** None Number of children aged 12-23 months Vaccination card 56.6 57.0 55.6 52.5 56.4 56.2 54.7 51.7 52.0 49.4 0.0 2,083 Mother’s report 33.2 31.4 28.5 24.1 17.9 33.1 30.4 24.1 28.7 17.5 9.4 2,083 Either 89.8 88.5 84.0 76.6 74.3 89.2 85.2 75.8 80.7 66.9 9.4 2,083 Vaccinated by 12 months of age 89.6 87.8 83.0 74.5 74.2 88.5 84.2 73.5 74.4 60.2 9.5 2,083 * MICS Indicator 25 ** MICS Indicator 27 *** MICS Indicator 26 **** MICS Indicator 28 ; MDG Indicator 15 ***** MICS Indicator 31 74 Multiple Indicator Cluster Survey 2006 Table CH.1Ac Vaccinations in first year of life (continued) Percentage of children aged 12-23 months immunized against childhood diseases at any time before the survey and before the first birthday, Syria, 2006 HepB1 HepB2 HepB3* Number of children aged 12-23 months Vaccination card 57.3 57.2 53.1 2,083 Mother’s report 31.4 28.4 24.0 2,083 Either 88.8 85.6 77.1 2,083 Vaccinated by 12 months of age 88.6 84.9 71.4 2,083 * MICS Indicator 29 75Multiple Indicator Cluster Survey 2006 Table CH.2: Vaccinations by background characteristics Percentage of children aged 12-23 months currently vaccinated against childhood diseases, Syrian Arab Republic, 2006 (mothers with cards only) BCG* DPT1 DPT2** DPT3*** Polio 0 Polio 1 Polio 2 Polio 3*** MMR*** All**** None Number of children aged 12-23 months Sex Male 100.0 99.2 96.9 91.6 100.0 99.2 97.0 91.8 92.9 87.5 0.0 609 Female 99.8 99.6 96.7 91.5 99.8 99.6 96.7 91.5 91.9 88.0 0.0 543 Governorates Damascus 100.0 100.0 98.4 95.2 100.0 100.0 98.4 95.2 96.8 91.9 0.0 62 Aleppo 100.0 100.0 96.7 82.7 100.0 100.0 96.7 82.7 90.0 78.0 0.0 150 Rural-Dam 100.0 99.5 98.6 96.8 100.0 99.5 98.6 96.8 95.0 94.1 0.0 220 Homa 100.0 99.3 98.5 96.3 100.0 99.3 98.5 96.3 94.8 91.8 0.0 134 Hama 100.0 98.1 94.4 91.6 100.0 98.1 95.3 92.5 90.7 85.0 0.0 107 Lattakia 100.0 100.0 100.0 98.3 100.0 100.0 100.0 98.3 96.6 96.6 0.0 58 Idleb 98.8 100.0 93.7 87.5 98.8 100.0 93.7 87.5 91.2 85.0 0.0 80 Hassake 100.0 98.3 90.0 81.7 100.0 98.3 90.0 81.7 81.7 78.3 0.0 60 Deir Ezzor 100.0 100.0 88.9 75.9 100.0 100.0 88.9 75.9 81.5 64.8 0.0 54 Tartous 100.0 100.0 98.7 97.3 100.0 100.0 98.7 97.3 94.7 94.7 0.0 75 Raqqa 100.0 100.0 100.0 89.7 100.0 100.0 100.0 89.7 86.2 86.2 0.0 29 Daraa 100.0 98.8 98.8 93.1 100.0 98.8 98.8 93.1 96.6 90.8 0.0 87 Sweida 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 0.0 26 Quneitra 100.0 90.0 90.0 90.0 100.0 90.0 90.0 90.0 90.0 90.0 0.0 10 Urban_Rural Urban 100.0 99.6 96.7 92.5 100.0 99.6 96.8 92.6 93.9 89.0 0.0 571 Rural 99.8 99.1 96.9 90.7 99.8 99.1 96.9 90.7 91.0 86.6 0.0 581 Mother’s education None 100.0 99.1 90.6 76.9 100.0 99.1 90.6 76.9 79.5 68.4 0.0 117 Primary 99.8 99.3 97.4 91.2 99.8 99.3 97.4 91.2 90.7 86.3 0.0 431 Secondary 100.0 99.4 97.3 94.5 100.0 99.4 97.5 94.7 95.5 92.0 0.0 489 Higher institutions 100.0 100.0 98.6 95.8 100.0 100.0 98.6 95.8 98.6 94.4 0.0 71 University+ 100.0 100.0 97.7 95.5 100.0 100.0 97.7 95.5 100.0 95.5 0.0 44 Wealth index quintiles Poorest 100.0 98.4 94.0 83.7 100.0 98.4 94.0 83.7 88.6 81.0 0.0 184 Second 99.7 99.1 96.9 91.7 99.7 99.1 96.9 91.7 89.8 86.7 0.0 324 Middle 100.0 100.0 97.5 95.0 100.0 100.0 97.5 95.0 95.5 91.3 0.0 242 Fourth 100.0 100.0 97.4 92.7 100.0 100.0 97.4 92.7 91.7 87.0 0.0 193 Richest 100.0 99.5 97.6 93.3 100.0 99.5 98.1 93.8 97.1 91.9 0.0 209 Total 99.9 99.4 96.8 91.6 99.9 99.4 96.9 91.7 92.4 87.8 0.0 1,152 * MICS Indicator 25 ** MICS Indicator 27 *** MICS Indicator 26 76 Multiple Indicator Cluster Survey 2006 Table CH.2c: Vaccinations by background characteristics (continued) Percentage of children aged 12-23 months currently vaccinated against childhood diseases, Syrian Arab Republic, 2006 HepB1 HepB2 HepB3 Percent with health card Number of children aged 12-23 months Sex Male 100.0 99.2 92.9 100.0 609 Female 99.8 99.8 91.9 100.0 543 Governorates Damascus 100.0 100.0 96.8 100.0 62 Aleppo 100.0 100.0 90.0 100.0 150 Rural-Dam 100.0 99.5 95.0 100.0 220 Homa 100.0 99.3 94.8 100.0 134 Hama 100.0 99.1 90.7 100.0 107 Lattakia 100.0 100.0 96.6 100.0 58 Idleb 98.8 100.0 91.2 100.0 80 Hassake 100.0 98.3 81.7 100.0 60 Deir Ezzor 100.0 100.0 81.5 100.0 54 Tartous 100.0 100.0 94.7 100.0 75 Raqqa 100.0 100.0 86.2 100.0 29 Daraa 100.0 98.8 96.6 100.0 87 Sweida 100.0 100.0 100.0 100.0 26 Quneitra 100.0 90.0 90.0 100.0 10 Urban_Rural Urban 100.0 99.6 93.9 100.0 571 Rural 99.8 99.3 91.0 100.0 581 Mother’s education None 100.0 99.1 79.5 100.0 117 Primary 99.8 99.5 90.7 100.0 431 Secondary 100.0 99.4 95.5 100.0 489 Higher institutions 100.0 100.0 98.6 100.0 71 University+ 100.0 100.0 100.0 100.0 44 Total 99.9 99.5 92.4 100.0 1,152 77Multiple Indicator Cluster Survey 2006 Table CH.2A: Vaccinations by background characteristics (Continued) Percentage of children aged 12-23 months currently vaccinated against childhood diseases, Syria, 2006 (Mother’s report and vaccination cards) BCG DPT1 DPT2 DPT3 Polio 0 Polio 1 Polio 2 Polio 3 MMR All None Percent with health card Number of children aged 12- 23 months Sex Male 89.7 88.3 84.3 76.2 74.7 89.1 85.5 75.9 80.1 66.0 9.6 54.6 1,115 Female 90.0 88.7 83.7 77.1 73.8 89.5 84.7 75.7 81.4 68.0 9.1 56.1 968 Governorates Damascus 98.3 95.5 86.4 69.1 91.4 100.0 83.6 69.8 95.7 57.5 0.0 52.1 119 Aleppo 84.6 81.9 77.6 66.9 51.3 83.8 80.6 69.7 73.3 58.6 14.6 39.1 384 Rural-Dam 91.8 91.5 88.3 85.8 86.5 90.9 88.6 84.9 86.3 80.8 8.2 68.7 320 Homs 95.5 94.4 91.3 88.2 84.9 94.9 93.9 82.3 87.5 75.8 4.5 67.0 200 Hama 95.6 94.9 89.1 83.3 84.7 94.9 90.4 82.7 85.8 70.4 3.2 65.6 163 Lattakia 98.7 100.0 89.7 80.8 92.3 96.2 91.0 83.3 97.4 76.9 0.0 74.4 78 Idleb 82.9 83.8 79.9 75.3 65.4 83.5 80.4 74.1 76.7 68.5 15.8 48.8 164 Hassake 93.1 91.6 86.3 75.6 68.9 90.2 84.1 72.0 72.1 58.9 6.8 45.5 132 Deir Ezzor 70.5 68.9 62.3 50.8 54.8 72.2 65.1 42.9 50.4 31.4 27.0 39.4 137 Tartous 89.6 87.6 84.8 83.8 86.9 90.7 86.0 84.1 87.8 78.3 7.5 69.4 108 Raqqa 88.8 87.6 86.5 68.5 70.0 87.8 84.4 74.4 75.9 60.5 11.1 32.2 90 Daraa 94.8 92.4 88.4 82.2 80.0 94.1 92.5 80.6 87.7 71.9 5.2 62.1 140 Sweida 96.7 96.7 96.7 96.7 96.7 96.7 96.7 96.7 96.7 96.7 3.3 86.7 30 Quneitra 82.4 76.5 76.5 76.5 64.7 76.5 76.5 76.5 72.2 72.2 17.6 55.6 18 Urban_Rural Urban 90.8 89.7 85.3 77.6 75.7 90.6 85.7 76.7 84.6 68.5 8.4 54.4 1,050 Rural 88.8 87.3 82.8 75.5 72.9 87.9 84.6 74.9 76.8 65.3 10.4 56.2 1,033 Mother’s education None 79.7 78.3 70.5 56.2 54.0 79.6 72.3 58.6 60.6 43.4 19.0 35.9 326 Primary 88.0 87.0 83.8 77.4 70.5 87.5 84.7 75.0 77.4 65.8 11.0 54.3 793 Secondary 95.2 93.6 89.4 83.4 84.6 93.8 90.2 82.6 89.9 75.7 4.7 64.5 758 Higher institutions 93.0 91.3 87.3 80.9 83.7 93.8 89.1 79.8 89.9 77.5 6.2 55.0 129 University+ 92.0 90.4 83.6 78.1 80.0 93.3 86.7 81.3 90.9 72.4 5.3 57.1 77 Wealth index quintiles Poorest 83.9 81.2 74.3 63.7 60.1 81.9 76.7 62.9 66.3 51.4 15.2 42.5 433 Second 89.0 88.8 85.7 77.7 74.8 88.7 86.0 77.2 80.0 68.2 9.9 60.4 536 Middle 91.8 91.2 86.9 81.8 79.5 91.7 87.6 79.9 85.0 70.6 7.2 56.8 426 Fourth 91.6 89.3 86.4 79.1 77.7 91.6 86.4 78.3 84.9 69.9 8.1 55.5 348 Richest 94.3 93.0 87.5 81.7 81.5 93.7 90.1 82.1 89.7 76.5 5.4 61.5 340 Total 89.8 88.5 84.0 76.6 74.3 89.2 85.2 75.8 80.7 66.9 9.4 55.3 2,083 78 Multiple Indicator Cluster Survey 2006 Table CH.2Ac: Vaccinations by background characteristics (continued) Percentage of children aged 12-23 months currently vaccinated against childhood diseases, Syria, 2006 (mothers report and vaccination cards) HepB1 HepB2 HepB3 Percent with health card Number of children aged 12-23 months Sex Male 88.8 85.6 76.9 54.6 1,115 Female 88.8 85.5 77.3 56.1 968 Governorates Damascus 95.5 87.3 70.0 52.1 119 Aleppo 81.9 79.0 69.8 39.1 384 Rural-Dam 91.8 88.9 84.5 68.7 320 Homs 94.9 91.8 87.2 67.0 200 Hama 96.2 92.3 82.7 65.6 163 Lattakia 100.0 89.7 79.5 74.4 78 Idleb 83.1 83.1 77.3 48.8 164 Hassake 92.4 90.1 75.6 45.5 132 Deir Ezzor 68.9 67.2 53.3 39.4 137 Tartous 87.6 85.7 81.9 69.4 108 Raqqa 87.6 86.5 67.4 32.2 90 Daraa 93.2 88.4 84.5 62.1 140 Sweida 96.7 96.7 96.7 86.7 30 Quneitra 82.4 76.5 76.5 55.6 18 Urban_Rural Urban 89.9 86.9 78.4 54.4 1,050 Rural 87.7 84.2 75.7 56.2 1,033 Mother’s education None 78.6 73.7 57.1 35.9 326 Primary 87.3 85.0 77.1 54.3 793 Secondary 94.0 90.7 84.1 64.5 758 Higher institutions 91.3 88.1 82.5 55.0 129 University+ 90.4 84.9 80.8 57.1 77 Total 88.8 85.6 77.1 55.3 2,083 79Multiple Indicator Cluster Survey 2006 Table CH.3: Neonatal tetanus protection Percentage of mothers with a birth in the last 12 months protected against neonatal tetanus, Syrian Arab Republic, 2006 Percentage of mothers with a birth in the last 12 months who: Received at least 2 doses during last pregnancy Received at least 2 doses, the last within prior 3 years Received at least 3 doses, the last within 5 years Received at least 4 doses, the last within 10 years Received at least 5 doses during lifetime Protected against tetanus * Number of mothers Governorates Damascus 10.0 21.2 1.7 0.8 0.0 33.7 240 Aleppo 16.8 16.9 1.5 0.8 0.4 36.4 734 Rural-Dam 9.0 16.0 2.4 1.8 1.0 30.2 613 Homs 8.3 18.2 4.0 2.7 0.8 34.0 373 Hama 10.1 28.4 5.1 2.0 2.4 48.0 296 Lattakia 14.0 19.3 2.0 0.7 0.0 36.0 150 Idleb 6.0 15.4 2.2 1.9 1.3 26.7 319 Hassake 12.3 18.5 6.2 1.6 1.2 39.9 243 Deir Ezzor 19.8 12.1 4.7 0.8 0.0 37.4 257 Tartous 14.1 29.4 1.2 1.8 0.6 47.2 163 Raqqa 29.1 15.4 4.6 0.0 0.0 49.1 175 Daraa 9.0 25.3 5.9 5.9 4.2 50.2 289 Sweida 4.0 22.7 6.7 18.7 8.0 60.0 75 Quneitra (3.2) (25.8) (0.0) (0.0) (0.0) (29.0) 31 Urban_Rural Urban 13.4 19.0 3.0 1.8 1.3 38.6 1,988 Rural 11.3 19.0 3.5 2.3 1.0 37.0 1,969 Age 15-19 18.2 15.0 1.2 0.0 0.4 34.8 247 20-24 14.1 20.4 2.7 0.8 0.6 38.5 1,002 25-29 11.8 20.1 3.6 2.2 0.7 38.3 1,114 30-34 11.0 20.3 4.1 2.6 0.7 38.8 801 35-39 11.1 17.1 3.1 4.2 2.4 37.8 551 40-44 9.8 12.7 3.4 1.5 4.9 32.2 205 45-49 (5.3) (10.5) (5.3) (7.9) (2.6) (31.6) 38 Education None 12.2 12.0 3.1 1.1 0.7 29.1 609 Primary 12.5 16.8 2.6 1.3 0.8 34.0 1,535 Secondary 11.8 23.5 4.2 3.1 1.3 43.9 1,452 Higher institutions 14.0 21.8 3.5 2.2 0.9 42.4 229 University+ 14.3 22.6 0.8 3.8 6.0 47.4 133 Wealth index quintiles Poorest 11.2 15.1 3.1 2.0 0.6 31.9 815 Second 11.4 20.3 3.9 1.8 1.1 38.6 972 Middle 12.7 20.0 3.5 1.7 1.1 39.0 877 Fourth 12.8 19.1 3.3 2.6 1.7 39.3 666 Richest 14.4 20.6 2.1 2.6 1.3 40.9 626 Total 12.3 19.0 3.3 2.1 1.1 37.8 3,958 * MICS Indicator 32 80 Multiple Indicator Cluster Survey 2006 Table CH.4: Oral rehydration treatment Percentage of children aged 0-59 months with diarrhoea in the last two weeks and treatment with oral rehydration solution (ORS) or other oral rehydration treatment (ORT), Syrian Arab Republic, 2006 Number of children aged 0-59 months children with diarrhoea who received: Number of children aged 0-59 months with diarrhoea Had diarrhoea in last two weeks Fluid from ORS packet Recommended homemade fluid Pre- packaged ORS fluid No treatment ORT use rate * Sex Male 8.5 5,804 35.0 29.9 25.8 30.9 69.1 492 Female 7.7 5,213 32.4 32.2 22.3 33.9 66.1 404 Governorates Damascus 9.5 591 66.1 44.6 17.9 5.4 94.6 56 Aleppo 6.3 2,284 37.8 35.0 35.0 16.8 83.2 143 Rural-Dam 10.5 1,598 22.2 36.5 14.4 44.3 55.7 167 Homs 6.5 1,032 28.4 34.3 25.4 23.9 76.1 67 Hama 7.2 838 56.7 26.7 28.3 21.7 78.3 60 Lattakia 4.5 440 50.0 35.0 15.0 20.0 80.0 20 Idleb 9.7 927 15.6 13.3 31.1 50.0 50.0 90 Hassake 11.5 668 28.6 28.6 24.7 42.9 57.1 77 Deir Ezzor 10.7 626 53.7 43.3 13.4 23.9 76.1 67 Tartous 2.7 447 33.3 25.0 25.0 33.3 66.7 12 Raqqa 10.0 491 42.9 12.2 57.1 24.5 75.5 49 Daraa 7.1 808 21.1 29.8 15.8 40.3 59.7 57 Sweida 13.9 180 12.0 24.0 0.0 64.0 36.0 25 Quneitra 6.9 87 * * * * * 6 Urban_Rural Urban 8.3 5,486 37.6 28.9 25.4 28.9 71.1 457 Rural 7.9 5,531 29.8 33.0 23.0 35.8 64.2 439 Age < 6 months 9.0 1,163 26.7 17.1 19.0 49.5 50.5 105 6-11 months 18.0 867 31.4 30.1 18.0 39.1 60.9 156 12-23 months 11.2 2,083 38.6 26.2 24.5 33.5 66.5 233 24-35 months 6.8 2,410 32.3 35.4 25.0 28.0 72.0 164 36-47 months 5.8 2,609 38.8 40.1 26.3 21.7 78.3 152 48-59 months 4.6 1,885 27.9 37.2 36.1 22.1 77.9 86 Mother’s education None 8.0 1,947 34.2 29.7 31.6 31.6 68.4 155 Primary 8.8 4,164 34.1 26.7 24.5 33.2 66.8 367 Secondary 8.2 3,961 33.2 34.5 21.5 31.7 68.3 325 Higher institutions 5.8 608 34.3 48.6 17.1 22.9 77.1 35 University+ 4.2 337 35.7 28.6 14.3 50.0 50.0 14 Wealth index quintiles Poorest 8.9 2,342 31.1 33.0 24.9 36.4 63.6 209 Second 8.8 2,536 32.3 33.6 23.8 33.6 66.4 223 Middle 8.3 2,396 34.0 23.5 19.5 36.0 64.0 200 Fourth 8.1 1,927 36.9 33.1 26.1 24.8 75.2 157 Richest 5.9 1,816 37.4 31.8 29.9 25.2 74.8 107 Total 8.1 11,017 33.8 30.9 24.2 32.3 67.7 896 * MICS Indicator 33 81Multiple Indicator Cluster Survey 2006 Table CH.5: Home management of diarrhoea Percentage of children aged 0-59 months with diarrhoea in the last two weeks who took increased fluids and continued to feed during the episode, Syrian Arab Republic, 2006 Ha d d iar rh oe a i n l as t tw o w ee ks Nu mb er of ch ild re n a ge d 0 -5 9 m on ths Ch ild re n w ith di ar rh oe a w ho dr an k m or e Ch ild re n w ith di ar rh oe a w ho dr an k t he sa me or le ss Ch ild re n w ith di ar rh oe a w ho at e s om ew ha t les s, sa me or m or e Ch ild re n w ith di ar rh oe a w ho at e m uc h l es s or no ne Ho me m an ag em en t o f d iar rh oe a * Re ce ive d O RT o r i nc re as ed fl ui ds A ND co nti nu ed fe ed ing ** Nu mb er of ch ild re n a ge d 0 -5 9 m on ths w ith dia rrh oe a Sex Male 8.5 5,804 34.6 63.8 49.8 48.2 15.9 36.2 492 Female 7.7 5,213 34.9 61.9 44.6 53.0 15.3 31.7 404 Governorates Damascus 9.5 591 12.5 85.7 25.0 75.0 3.6 23.2 56 Aleppo 6.3 2,284 58.7 39.9 44.8 53.9 25.9 37.8 143 Rural-Dam 10.5 1,598 45.5 54.5 47.3 52.1 19.8 33.5 167 Homs 6.5 1,032 31.3 65.7 56.7 43.3 17.9 47.8 67 Hama 7.2 838 23.3 76.7 55.0 41.7 6.7 40.0 60 Lattakia 4.5 440 * * * * * * 20 Idleb 9.7 927 28.9 62.2 35.6 56.7 7.8 13.3 90 Hassake 11.5 668 22.1 75.3 54.5 42.9 14.3 33.8 77 Deir Ezzor 10.7 626 26.9 71.6 61.2 31.3 17.9 50.7 67 Tartous 2.7 447 * * * * * * 12 Raqqa 10.0 491 24.5 75.5 30.6 67.3 10.2 24.5 49 Daraa 7.1 808 31.6 64.9 57.9 42.1 15.8 43.9 57 Sweida 13.9 180 (28.0) (72.0) (56.0) (44.0) (16.0) (32.0) 25 Quneitra 6.9 87 * * * * * * 6 Urban_Rural Urban 8.3 5,486 37.6 61.3 44.0 54.9 16.2 33.0 457 Rural 7.9 5,531 31.7 64.7 51.0 45.6 15.0 35.3 439 Age 0-11 months 12.9 2,030 24.1 71.6 56.3 39.1 12.3 33.3 261 12-23 months 11.2 2,083 39.9 58.4 42.5 56.7 17.6 35.2 233 24-35 months 6.8 2,410 37.8 61.0 40.9 56.7 14.6 31.7 164 36-47 months 5.8 2,609 34.9 65.1 39.5 59.9 11.2 27.6 152 48-59 months 4.6 1,885 46.5 48.8 60.5 38.4 30.2 50.0 86 Mother’s education None 8.0 1,947 30.3 69.0 42.6 53.6 10.3 28.4 155 Primary 8.8 4,164 35.7 60.8 43.9 53.4 17.2 33.0 367 Secondary 8.2 3,961 34.8 63.1 52.6 46.2 15.4 37.2 325 Higher institutions 5.8 608 (45.7) (54.3) (57.1) (42.9) (28.6) (42.9) 35 University+ * * * * * * * * 14 Wealth index quintiles Poorest 8.9 2,342 30.6 67.5 49.8 46.4 15.3 36.8 209 Second 8.8 2,536 35.9 61.4 48.0 50.2 14.3 32.7 223 Middle 8.3 2,396 34.5 64.0 46.5 51.5 17.5 33.0 200 Fourth 8.1 1,927 37.6 58.6 44.6 54.1 14.6 31.2 157 Richest 5.9 1,816 36.4 61.7 47.7 50.5 16.8 38.3 107 Total 8.1 11,017 34.7 62.9 47.4 50.3 15.6 34.2 896 * MICS indicator 34 ** MICS indicator 35 82 Multiple Indicator Cluster Survey 2006 Table CH.6: Care seeking for suspected pneumonia Percentage of children aged 0-59 months in the last two weeks taken to a health provider, Syrian Arab Republic, 2006 Ha d a cu te re sp ito ry inf ec tio n Nu mb er of ch ild re n a ge d 0 -5 9 m on ths Go vt. ho sp ita l Go vt. he alt h c en tre Go vt. he alt h p os t Vi lla ge he alt h w or ke r Mo bil e/o utr ea ch cl ini c Ot he r p ub lic Pr iva te ho sp ita l c lin ic Pr iva te ph ys ici an Ph ar ma cy Mo bil e c lin ic Ot he r p riv ate m ed ica l Re lat ive or fr ien d Tr ad itio na l p ra cti tio ne r Ot he r An y a pp ro pr iat e p ro vid er * Nu mb er of ch ild re n a ge d 0 -5 9 m on ths wi th su sp ec ted pn eu mo nia Sex Male 5.7 5,804 8.2 17.0 0.9 0.6 0.3 0.0 7.9 53.2 10.3 0.3 0.0 0.9 0.6 1.8 79.9 329 Female 5.0 5,213 10.0 13.8 1.5 0.4 0.8 0.0 7.7 45.6 13.4 0.4 0.4 0.4 0.0 0.8 72.8 261 Governorates Damascus 6.1 591 (11.1) (33.3) (5.6) (0.0) (0.0) (0.0) (16.7) (38.9) (19.4) (0.0) (0.0) (0.0) (0.0) (0.0( (83.3) 36 Aleppo 4.3 2,284 3.0 20.2 0.0 0.0 0.0 0.0 3.0 54.6 11.1 0.0 0.0 2.0 1.0 0.0 79.8 99 Rural-Dam 7.9 1,598 4.7 8.7 0.8 0.0 0.0 0.0 11.8 44.1 9.4 0.0 0.0 0.0 0.0 2.4 67.7 127 Homs 6.1 1,032 14.3 20.6 1.6 0.0 0.0 0.0 4.8 36.5 4.8 0.0 1.6 0.0 0.0 3.2 79.4 63 Hama 5.0 838 (9.5) (26.2) (4.8) (7.1) (0.0) (0.0) (11.9) (38.1) (7.1) (2.4) (0.0) (0.0) (0.0) (0.0) (85.7) 42 Lattakia 7.5 440 (27.3) (6.1) (0.0) (0.0) (3.0) (0.0) (3.0) (75.8) (9.1) (0.0) (0.0) (0.0) (0.0) (0.0) (90.9) 33 Idleb 4.2 927 (2.6) (7.7) (0.0) (0.0) (2.6) (0.0) (5.1) (53.9) (12.8) (0.0) (0.0) (2.6) (0.0) (5.1) (66.7) 39 Hassake 6.9 668 (8.7) (6.5) (0.0) (0.0) (0.0) (0.0) (0.0) (58.7) (23.9) (0.0) (0.0) (0.0) (0.0) (0.0) (73.9) 46 Deir Ezzor 3.5 626 * * * * * * * * * * * * * * * 22 Tartous 4.5 447 * * * * * * * * * * * * * * * 20 Raqqa 3.7 491 * * * * * * * * * * * * * * * 18 Daraa 4.1 808 (0.0) 912.1) (0.0) (0.0) (3.0) (0.0) (12.1) (60.6) (6.1) (0.0) (0.0) (3.0) (0.0) (0.0) (72.70) 33 Sweida 6.1 180 * * * * * * * * * * * * * * * 11 Quneitra 1.1 87 * * * * * * * * * * * * * * * 1 Urban_Rural Urban 6.0 5,486 10.1 15.2 1.2 0.6 0.9 0.0 9.5 53.7 10.1 0.3 0.3 0.6 0.6 2.1 80.5 328 Rural 4.7 5,531 7.6 16.0 1.1 0.4 0.0 0.0 5.7 45.0 13.7 0.4 0.0 0.8 0.0 0.4 72.1 262 Age 0-11 months 6.2 2,030 9.6 14.4 2.4 0.0 0.0 0.0 14.4 48.8 7.2 0.8 0.8 0.0 0.0 1.6 82.4 125 12-23 months 6.6 2,083 8.7 14.5 0.7 0.0 0.7 0.0 8.0 49.3 10.9 0.0 0.0 0.7 0.7 1.4 75.4 138 24-35 months 5.2 2,410 7.1 14.3 0.8 2.4 0.0 0.0 7.1 47.6 17.5 0.0 0.0 1.6 0.0 0.8 72.2 126 36-47 months 4.9 2,609 9.4 18.0 1.6 0.0 0.8 0.0 2.3 54.7 10.9 0.8 0.0 0.8 0.8 0.8 78.9 128 48-59 months 3.9 1,885 11.0 17.8 0.0 0.0 1.4 0.0 6.8 48.0 12.3 0.0 0.0 0.0 0.0 2.7 74.0 73 Mother’s education None 4.4 1,947 9.3 19.8 0.0 0.0 0.0 0.0 3.5 44.2 18.6 0.0 0.0 1.2 1.2 2.3 68.6 86 Primary 5.2 4,164 9.7 15.7 0.9 0.9 0.5 0.0 7.8 42.4 12.0 0.0 0.5 0.5 0.0 0.9 72.8 217 Secondary 5.8 3,961 8.3 13.5 1.7 0.4 0.9 0.0 9.6 52.6 10.4 0.9 0.0 0.9 0.0 1.7 79.6 230 Higher institutions 5.9 608 (5.6) (22.2) (0.0) (0.0) (0.0) (0.0) (11.1) (69.4) (2.8) (0.0) (0.0) (0.0) (0.0) (0.0) (91.7) 36 University+ 6.2 337 * * * * * * * * * * * * * * * 21 Wealth index quintiles Poorest 4.1 2,342 8.4 18.9 0.0 0.0 0.0 0.0 2.1 45.3 17.9 0.0 0.0 0.0 0.0 1.1 71.6 95 Second 5.6 2,536 9.2 13.5 1.4 1.4 0.0 0.0 7.1 38.3 14.2 0.7 0.0 1.4 0.0 0.7 66.7 141 Middle 6.0 2,396 7.7 12.6 2.1 0.0 0.7 0.0 12.6 52.4 9.8 0.7 0.0 1.4 0.7 2.8 81.1 143 Fourth 5.3 1,927 7.8 18.6 1.0 1.0 1.0 0.0 8.8 51.0 7.8 0.0 1.0 0.0 0.0 0.0 79.4 102 Richest 6.0 1,816 11.9 16.5 0.9 0.0 0.9 0.0 6.4 64.2 9.2 0.0 0.0 0.0 0.9 1.8 86.2 109 Total 5.4 11,017 9.0 15.6 1.2 0.5 0.5 0.0 7.8 49.8 11.7 0.3 0.2 0.7 0.3 1.4 76.8 590 * MICS indicator 23 83Multiple Indicator Cluster Survey 2006 Table CH.7: Antibiotic treatment of pneumonia Percentage of children aged 0-59 months with suspected pneumonia who received antibiotic treatment, Syrian Arab Republic, 2006 Percentage of children aged 0-59 months with suspected pneumonia who received antibiotics in the last two weeks * Number of children aged 0-59 months with suspected pneumonia in the two weeks prior to the survey Sex Male 70.2 329 Female 72.0 261 Governorates Damascus 72.2 36 Aleppo 79.8 99 Rural-Dam 52.0 127 Homs 66.7 63 Hama (71.4) 42 Lattakia (78.8) 33 Idleb (71.8) 39 Hassake (91.3) 46 Deir Ezzor * 22 Tartous * 20 Raqqa * 18 Daraa * 33 Sweida * 11 Quneitra 100.0 1 Urban_Rural Urban 75.3 328 Rural 65.6 262 Age 0-11 months 68.8 125 12-23 months 67.4 138 24-35 months 72.2 126 36-47 months 75.8 128 48-59 months 71.2 73 Mother’s education None 70.9 86 Primary 66.8 217 Secondary 72.2 230 Higher institutions (86.1) 36 University+ * 21 84 Multiple Indicator Cluster Survey 2006 Wealth index quintiles Poorest 71.6 95 Second 64.5 141 Middle 63.6 143 Fourth 79.4 102 Richest 80.7 109 Total 71.0 590 * MICS indicator 22 85Multiple Indicator Cluster Survey 2006 Table CH.7A: Knowledge of the two danger signs of pneumonia Percentage of mothers/caretakers of children aged 0-59 months by knowledge of types of symptoms for taking a child immediately to a health facility, and percentage of mothers/caretakers who recognize fast and difficult breathing as signs for seeking care immediately, Syrian Arab Republic, 2006 Percentage of mother/caretakers of children aged 0-59 months who think that a child should be taken immediately to a health facility if the child: Mo the rs/ ca re tak er s w ho re co gn ize th e t wo da ng er si gn s o f pn eu mo nia Nu mb er of m oth er s/c ar eta ke rs of ch ild re n a ge d 0 -5 9 m on ths Is no t a ble to dr ink or br ea stf ee d Be co me s s ick er De ve lop s a fe ve r Ha s f as t b re ath ing Ha s di ffi cu lty b re at hi ng Ha s b loo d i n s too l Is dr ink ing po or ly Ha s o the r s ym pto ms Governorates Damascus 20.3 52.3 77.5 49.7 58.7 59.2 27.7 16.6 37.7 591 Aleppo 20.6 68.0 83.3 46.2 51.4 43.4 13.3 14.8 40.7 2,284 Rural-Dam 11.1 48.1 82.4 23.8 43.7 27.4 9.3 23.3 20.6 1,598 Homs 24.4 58.6 72.6 29.8 54.1 38.1 15.4 26.5 26.0 1,032 Hama 24.6 75.8 89.6 47.6 52.4 50.0 23.5 10.1 43.1 838 Lattakia 29.5 66.1 90.7 45.0 53.9 51.8 20.0 21.4 35.5 440 Idleb 16.8 72.1 75.5 26.9 44.3 28.2 10.4 21.9 20.1 927 Hassake 10.0 44.9 90.9 24.6 42.1 23.7 12.0 48.8 18.0 668 Deir Ezzor 24.9 68.2 86.6 20.5 34.5 35.8 16.3 11.5 18.1 626 Tartous 41.6 87.7 98.9 48.1 70.0 64.4 30.0 23.5 46.5 447 Raqqa 31.0 73.1 77.4 30.3 67.2 28.3 15.1 60.3 24.0 491 Daraa 26.6 67.1 81.7 39.5 51.4 49.1 10.3 4.7 34.2 808 Sweida 10.0 26.1 82.2 7.2 13.9 17.2 4.4 53.9 7.2 180 Quneitra 1.1 83.9 98.9 1.1 25.3 12.6 0.0 27.6 0.0 87 Urban_Rural Urban 21.8 60.9 84.3 38.4 52.3 40.5 16.0 20.7 32.4 5,486 Rural 20.1 65.6 81.7 31.9 46.9 38.1 13.7 23.3 27.5 5,531 Mother’s education None 17.3 64.9 80.6 29.9 44.0 33.8 11.5 24.3 23.9 1,947 Primary 20.6 64.6 82.2 34.4 49.5 39.0 13.6 21.0 29.6 4,164 Secondary 22.1 61.9 84.0 37.1 51.6 41.7 16.7 21.8 31.8 3,961 Higher institutions 25.3 62.2 86.7 41.9 54.4 43.7 19.9 22.4 35.9 608 University+ 24.0 55.8 87.2 40.7 51.6 39.5 19.0 22.6 37.4 337 Wealth index quintiles Poorest 18.1 63.0 82.1 30.9 45.2 34.6 11.7 26.1 25.4 2,342 Second 20.5 64.8 82.1 33.2 49.4 39.5 14.0 20.5 28.6 2,536 Middle 21.8 61.7 82.8 33.3 48.2 38.8 13.9 22.1 28.3 2,396 Fourth 21.7 63.7 82.6 36.1 50.5 41.2 16.8 19.6 30.6 1,927 Richest 23.1 63.1 85.9 44.8 56.4 43.7 19.4 21.1 39.4 1,816 Total 20.9 63.3 83.0 35.2 49.6 39.3 14.9 22.0 30.0 11,017 86 Multiple Indicator Cluster Survey 2006 Table CH.8: Solid fuel use Percent distribution of households according to type of cooking fuel, and percentage of households used solid fuels for cooking, Syrian Arab Republic, 2006 Type of fuel using for cooking Total Solid fuels for cooking * Number of householdsElectricity Liquid propane gas (LPG) Other Governorates Damascus 1.4 98.6 0.0 100.0 0.0 1,971 Aleppo 0.6 99.2 0.3 100.0 0.3 4,523 Rural-Dam 2.4 97.6 0.0 100.0 0.0 2,571 Homs 1.9 97.7 0.4 100.0 0.4 1,630 Hama 0.9 98.8 0.3 100.0 0.3 1,395 Lattakia 1.1 98.8 0.1 100.0 0.0 1,064 Idleb 0.7 99.3 0.0 100.0 0.0 1,174 Hassake 1.2 97.9 0.9 100.0 0.1 1,002 Deir Ezzor 5.6 89.6 4.9 100.0 2.1 826 Tartous 0.7 98.9 0.4 100.0 0.3 871 Raqqa 1.1 98.4 0.5 100.0 0.4 737 Daraa 1.9 97.8 0.3 100.0 0.3 782 Sweida 0.3 99.2 0.5 100.0 0.5 378 Quneitra 2.1 97.9 0.0 100.0 0.0 97 Urban_Rural Urban 1.7 98.2 0.1 100.0 0.0 10,722 Rural 1.1 98.0 0.3 100.0 0.6 8,297 Education of household head None 1.1 97.6 1.2 100.0 0.8 4,116 Primary 1.0 98.6 0.4 100.0 0.2 6,186 Secondary 1.7 98.2 0.2 100.0 0.1 6,072 Higher institutions 1.4 98.6 0.0 100.0 0.0 1,156 University+ 2.9 97.1 0.1 100.0 0.0 1,462 Missing/DK 3.8 96.2 0.0 100.0 0.0 26 Wealth index quintiles Poorest 1.4 96.4 2.2 100.0 1.4 3,520 Second 1.6 98.2 0.2 100.0 0.0 3,622 Middle 1.6 98.4 0.0 100.0 0.0 3,889 Fourth 1.5 98.5 0.0 100.0 0.0 3,541 Richest 1.1 98.9 0.0 100.0 0.0 4,447 Total 1.4 98.1 0.4 100.0 0.3 19,019 * MICS indicator 24; MDG indicator 29 87Multiple Indicator Cluster Survey 2006 Table EN.1: Use of improved water sources Percent distribution of household population according to main source of drinking water and percentage of household members using improved drinking water sources, Syrian Arab Republic, 2006 Main source of drinking water To tal Im pr ov ed so ur ce of dr ink ing w ate r Nu mb er of ho us eh old m em be rsImproved sources Unimproved sources Pi pe d i nto dw ell ing Pi pe d i nto ya rd or pl ot Pu bli c t ap /st an dp ipe Tu be we ll/b or eh ole Pr ote cte d w ell Pr ote cte d s pr ing Ra inw ate r c oll ec tio n Bo ttle d w ate r Un pr ote cte d w ell Un pr ote cte d s pr ing Ta nk er -tr uc k Ca rt wi th sm all ta nk /dr um Su rfa ce w ate r Ot he r Governorates Damascus 99.2 0.4 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.3 0.1 0.0 0.0 100.0 99.6 9,359 Aleppo 74.1 0.8 0.1 4.4 10.6 0.3 0.0 0.1 0.3 0.0 9.1 0.1 0.0 0.1 100.0 90.4 24,682 Rural-Dam 49.0 0.2 0.5 1.1 1.5 0.1 0.0 1.8 0.3 0.0 45.0 0.2 0.0 0.3 100.0 54.2 14,399 Homs 85.9 1.3 0.0 6.2 2.8 0.0 0.0 0.5 0.1 0.0 1.8 0.0 0.0 1.4 100.0 96.6 9,178 Hama 86.8 3.0 0.0 2.3 4.2 0.3 0.0 0.0 1.0 0.3 1.7 0.0 0.0 0.2 100.0 96.8 8,237 Lattakia 86.2 0.7 0.0 6.8 3.7 0.1 0.0 0.0 0.0 1.7 0.6 0.0 0.0 0.2 100.0 97.5 5,020 Idleb 82.1 2.7 1.9 0.6 5.7 0.5 0.1 0.2 0.9 0.1 5.1 0.0 0.0 0.0 100.0 93.8 7,079 Hassake 50.2 3.7 0.1 3.0 8.8 0.4 0.0 0.2 2.6 0.6 29.4 0.9 0.0 0.0 100.0 66.4 6,724 Deir Ezzor 78.0 8.8 0.1 0.1 0.0 0.0 0.0 0.0 0.0 0.0 12.4 0.4 0.4 0.0 100.0 86.9 5,689 Tartous 95.2 0.2 0.0 0.1 2.4 2.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 100.0 99.9 4,499 Raqqa 79.5 11.7 0.1 0.1 0.6 0.4 0.0 0.0 0.0 0.0 7.3 0.2 0.0 0.1 100.0 92.4 4,765 Daraa 97.7 0.3 0.6 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.5 0.0 0.0 0.0 100.0 98.5 5,371 Sweida 98.1 1.8 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 100.0 99.9 1,765 Quneitra 97.3 1.7 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 100.0 99.0 599 Urban_Rural Urban 91.3 0.9 0.1 0.3 0.7 0.0 0.0 0.3 0.0 0.0 6.2 0.1 0.0 0.2 100.0 93.5 56,930 Rural 61.9 3.5 0.5 4.8 8.6 0.6 0.0 0.4 0.8 0.3 17.9 0.2 0.0 0.3 100.0 80.4 50,435 Education of household head None 68.3 3.6 0.4 3.3 6.8 0.4 0.1 0.4 0.7 0.1 15.4 0.2 0.1 0.3 100.0 83.3 23,002 Primary 74.1 2.3 0.2 2.6 5.4 0.2 0.0 0.2 0.4 0.2 13.9 0.2 0.0 0.1 100.0 85.1 36,043 Secondary 83.1 1.2 0.2 1.9 2.8 0.3 0.0 0.4 0.3 0.2 9.3 0.1 0.0 0.3 100.0 89.9 34,399 Higher Institutions 85.6 1.2 0.2 2.5 2.6 0.4 0.0 0.2 0.9 0.1 6.4 0.0 0.0 0.0 100.0 92.7 6,451 University+ 89.8 1.3 0.3 1.1 1.0 0.1 0.0 0.6 0.1 0.1 5.4 0.1 0.0 0.2 100.0 94.2 7,346 Missing/DK 86.3 0.0 0.0 8.1 0.0 0.0 0.0 0.0 0.0 5.6 0.0 0.0 0.0 0.0 100.0 94.4 124 Wealth index quintiles Poorest 34.9 7.7 0.8 7.1 17.6 1.0 0.1 0.3 1.8 0.4 27.2 0.5 0.1 0.5 100.0 69.5 21,473 Second 76.3 1.5 0.2 3.6 3.6 0.3 0.0 0.3 0.2 0.3 13.2 0.1 0.0 0.4 100.0 85.9 21,444 Middle 83.3 0.7 0.1 1.2 0.9 0.1 0.0 0.6 0.0 0.0 12.8 0.1 0.0 0.2 100.0 86.8 21,988 Fourth 93.8 0.5 0.2 0.1 0.1 0.0 0.0 0.3 0.1 0.0 4.9 0.0 0.0 0.1 100.0 94.9 19,309 Richest 99.0 0.0 0.0 0.1 0.0 0.0 0.0 0.2 0.0 0.0 0.7 0.0 0.0 0.0 100.0 99.3 23,151 Total 77.5 2.1 0.3 2.4 4.4 0.3 0.0 0.3 0.4 0.2 11.7 0.1 0.0 0.3 100.0 87.3 107,365 * MICS indicator 11; MDG indicator 30 88 Multiple Indicator Cluster Survey 2006 Table EN.2: Household water treatment Percentage distribution of household population according to drinking water treatment method used in the household and percentage of household members that applied an appropriate water treatment method, Syrian Arab Republic, 2006 Water treatment method used in the household Al l d rin kin g w ate r s ou rce s Ap pr op ria te wa ter tr ea tm en t m eth od * Nu mb er of ho us eh old m em be rs Im pr ov ed dr ink ing w ate r Ap pr op ria te wa ter tr ea tm en t m eth od Nu mb er of ho us eh old m em be rs Un im pr ov ed dr ink ing w ate r s ou rce s Ap pr op ria te wa ter tr ea tm en t m eth od Nu mb er of ho us eh old m em be rs No ne Bo il Ad d b lea ch /ch lor ine St ra in thr ou gh a clo th Us e wa te r fi lte r So lar di sin fec tio n Le t it st an d a nd se ttle Ot he r Do n’t kn ow Governorates Damascus 97.7 0.8 0.1 0.3 1.0 0.1 0.3 0.0 0.1 1.9 9,359 2.0 9,321 (0.0) 38 Aleppo 99.0 0.1 0.0 0.0 0.6 0.0 0.3 0.0 0.1 0.7 24,682 0.7 22,295 0.3 2,388 Rural-Dam 89.5 3.1 4.4 0.2 2.7 0.1 0.5 0.1 0.1 9.8 14,399 14.8 7,537 4.3 6,861 Homs 88.7 1.2 2.6 3.9 3.4 0.0 3.6 0.0 0.0 7.1 9,178 7.2 8,823 5.6 355 Hama 93.2 0.2 5.6 0.0 0.6 0.0 0.4 0.0 0.0 6.3 8,237 6.6 7,971 0.0 266 Lattakia 91.1 1.0 1.0 1.8 4.5 0.0 4.6 0.1 0.0 6.0 5,020 6.2 4,891 0.0 129 Idleb 98.1 0.1 0.7 0.1 0.0 0.0 1.0 0.1 0.1 0.8 7,079 0.8 6,622 0.0 457 Hassake 96.7 0.5 0.6 0.1 1.2 0.0 0.9 0.0 0.0 2.4 6,724 3.6 4,452 0.0 2,273 Deir Ezzor 60.7 10.2 0.8 0.5 15.9 0.5 20.7 0.3 0.4 21.9 5,689 24.1 4,943 7.2 746 Tartous 99.8 0.2 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.2 4,499 0.2 4,494 * 5 Raqqa 100.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 4,765 0.0 4,403 0.0 362 Daraa 99.4 0.2 0.3 0.0 0.1 0.0 0.0 0.1 0.0 0.5 5,371 0.5 5,292 0.0 79 Sweida 92.6 0.0 0.5 0.6 6.2 0.2 0.0 0.0 0.0 6.9 1,765 6.9 1,764 * 1 Quneitra 100.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 599 0.0 593 * 6 Urban_Rural Urban 93.0 1.4 1.2 0.7 3.2 0.0 1.7 0.1 0.1 5.3 56,930 5.3 53,040 5.7 3,890 Rural 94.5 1.1 1.7 0.4 0.9 0.1 2.2 0.0 0.0 3.6 50,435 4.1 40,361 1.5 10,075 Education of household head None 95.5 0.6 1.0 0.4 0.9 0.1 2.2 0.0 0.0 2.4 23,002 2.8 19,076 0.9 3,926 Primary 94.3 1.2 1.4 0.6 1.4 0.0 1.9 0.0 0.1 3.8 36,043 3.9 30,599 3.2 5,443 Secondary 93.0 1.5 1.7 0.5 2.5 0.1 1.9 0.0 0.1 5.3 34,399 5.5 30,771 3.6 3,628 Higher institutions 92.6 2.0 1.3 0.4 3.3 0.0 1.8 0.0 0.0 5.9 6,451 6.1 5,965 3.7 486 University+ 89.2 1.6 1.8 0.3 7.3 0.1 1.7 0.3 0.0 9.7 7,346 10.0 6,872 4.4 474 Missing/DK 87.1 0.0 0.0 2.4 10.5 0.0 0.0 0.0 0.0 10.5 124 11.1 117 0.0 7 Wealth index quintiles Poorest 96.0 0.8 0.7 0.2 0.2 0.0 2.6 0.0 0.0 1.8 21,473 2.2 14,850 0.7 6,623 Second 93.7 1.5 1.8 0.6 1.1 0.1 2.3 0.0 0.0 4.2 21,444 4.4 18,368 3.4 3,076 Middle 94.0 1.5 1.3 0.8 1.8 0.1 1.7 0.0 0.1 4.1 21,988 4.1 18,971 4.0 3,017 Fourth 93.4 1.5 1.8 0.6 2.4 0.0 1.5 0.0 0.2 5.1 19,309 4.8 18,261 9.5 1,048 Richest 91.5 1.1 1.7 0.5 5.1 0.1 1.5 0.1 0.0 7.3 23,151 7.4 22,951 0.0 200 Total 93.7 1.3 1.5 0.5 2.2 0.1 1.9 0.0 0.1 4.5 107,365 4.8 93,400 2.7 13,965 * MICS indicator 13 89Multiple Indicator Cluster Survey 2006 Table EN.3: Time to source of water Percent distribution of households according to time to go to source of drinking water, get water and return, and mean time to source of drinking water, Syrian Arab Republic, 2006 Time to source of drinking water Me an tim e t o s ou rce of dr ink ing wa ter (e xc lud ing th os e o n pr em ise s) Nu mb er of ho us eh old s W ate r o n p re mi se s Le ss th an 15 m inu tes 15 m inu tes to le ss th an 30 mi nu tes 30 m inu tes to le ss th an 1 h ou r 1 h ou r o r m or e DK To tal Governorates Damascus 99.6 0.0 0.0 0.1 0.0 0.3 100.0 30.0 1,971 Aleppo 86.1 5.3 1.0 2.3 2.5 2.9 100.0 29.6 4,523 Rural-Dam 54.0 41.7 2.4 0.6 0.8 0.5 100.0 8.5 2,571 Homs 94.7 2.4 0.9 0.6 0.7 0.7 100.0 29.1 1,630 Hama 93.9 4.4 0.8 0.1 0.4 0.4 100.0 12.5 1,395 Lattakia 94.8 3.7 0.9 0.0 0.0 0.6 100.0 7.5 1,064 Idleb 89.6 6.2 1.6 0.9 0.9 0.8 100.0 17.1 1,174 Hassake 82.8 11.0 1.7 1.1 0.9 2.5 100.0 13.7 1,002 Deir Ezzor 87.8 0.0 0.0 0.2 6.4 5.6 100.0 116.8 826 Tartous 95.9 2.3 0.6 0.6 0.7 0.0 100.0 20.3 871 Raqqa 92.4 0.7 0.0 0.4 4.7 1.8 100.0 112.6 737 Daraa 98.2 0.4 0.1 0.5 0.6 0.1 100.0 35.7 782 Sweida 99.7 0.0 0.3 0.0 0.0 0.0 100.0 15.0 378 Quneitra 97.9 0.0 0.0 0.0 0.0 2.1 100.0 . 97 Urban_Rural Urban 93.3 5.2 0.6 0.1 0.2 0.6 100.0 9.9 10,722 Rural 78.0 13.2 1.5 1.8 3.0 2.5 100.0 23.5 8,297 Education of household head None 83.7 8.3 1.3 1.4 2.5 2.8 100.0 28.7 4,116 Primary 83.8 10.5 1.0 1.2 1.8 1.6 100.0 19.6 6,186 Secondary 89.0 8.3 0.9 0.4 0.6 0.7 100.0 13.3 6,072 Higher Institutions 91.3 5.9 1.0 0.3 1.0 0.6 100.0 17.1 1,156 University+ 93.3 5.7 0.2 0.3 0.3 0.2 100.0 11.7 1,462 Missing/DK 96.2 3.8 0.0 0.0 0.0 0.0 100.0 10.0 26 Wealth index quintiles Poorest 65.3 15.3 2.6 4.1 6.6 6.2 100.0 31.9 3,520 Second 83.3 13.0 1.5 0.4 0.7 1.1 100.0 11.9 3,622 Middle 87.3 11.4 0.8 0.2 0.2 0.2 100.0 8.2 3,889 Fourth 95.0 4.5 0.3 0.1 0.1 0.1 100.0 7.6 3,541 Richest 99.2 0.8 0.0 0.0 0.1 0.0 100.0 11.1 4,447 Total 86.6 8.7 1.0 0.9 1.4 1.4 100.0 19.6 19,019 90 Multiple Indicator Cluster Survey 2006 Table EN.4: Person collecting water Percent distribution of households according to the person collecting water used in the household, Syrian Arab Republic, 2006 Person collecting drinking water Number of householdsAdult woman Adult man Female child (under 15) Male child (under 15) DK Missing Total Governorates Damascus * * * * * * * 7 Aleppo 30.6 66.9 0.3 1.1 1.1 0.0 100.0 631 Rural-Dam 8.9 89.6 0.4 0.4 0.6 0.0 100.0 1,166 Homs 12.6 83.9 0.0 0.0 3.4 0.0 100.0 87 Hama 28.2 49.4 3.5 4.7 12.9 1.2 100.0 85 Lattakia 47.3 41.8 0.0 3.6 7.3 0.0 100.0 55 Idleb 48.4 44.3 2.5 0.8 4.1 0.0 100.0 122 Hassake 69.2 25.6 0.6 0.0 4.7 0.0 100.0 172 Deir Ezzor 5.9 83.2 2.0 1.0 7.9 0.0 100.0 101 Tartous (44.4) (55.6) (0.0) (0.0) (0.0) (0.0) (100.0) 36 Raqqa 5.4 91.1 0.0 1.8 1.8 0.0 100.0 56 Daraa 35.7 57.2 7.1 0.0 0.0 0.0 100.0 14 Sweida * * * * * * * 1 Quneitra * * * * * * * 2 Urban_Rural Urban 8.8 88.6 0.6 0.4 1.4 0.1 100.0 713 Rural 27.7 68.1 0.7 1.0 2.5 0.0 100.0 1,821 Education of household head None 31.8 63.1 1.0 1.3 2.7 0.0 100.0 670 Primary 21.2 75.5 0.7 0.9 1.7 0.0 100.0 1,001 Secondary 17.6 79.6 0.3 0.2 2.3 0.2 100.0 665 Higher Institutions 19.0 76.0 1.0 1.0 3.0 0.0 100.0 100 University+ 6.1 90.8 0.0 1.0 2.0 0.0 100.0 98 Missing/DK 100.0 0.0 0.0 0.0 0.0 0.0 100.0 1 Wealth index quintiles Poorest 33.2 62.0 0.7 1.1 2.9 0.0 100.0 1,221 Second 17.7 79.7 1.0 0.2 1.3 0.2 100.0 606 Middle 9.8 86.6 0.4 1.2 2.0 0.0 100.0 492 Fourth 3.9 95.5 0.0 0.0 0.6 0.0 100.0 178 Richest (0.0) (97.3) (0.0) (0.0) (2.7) (0.0) (100.0) 37 Total 22.4 73.9 0.7 0.8 2.2 0.0 100.0 2,534 91Multiple Indicator Cluster Survey 2006 Table EN.5: Use of sanitary means of excreta disposal Percent distribution of household population according to type of toilet used by the household and the percentage of household members using sanitary means of excreta disposal, Syrian Arab Republic, 2006 Type of toilet facility used by household To tal Pe rce nta ge of po pu lat ion us ing sa nit ar y me an s o f e xc re ta dis po sa l * Nu mb er of ho us eh old s m em be rs Improved sanitation facility Unimproved sanitation facility Flu sh to pi pe d s ew er sy ste m Flu sh to se pti c t an k Ve nti lat ed Im pr ov ed P it lat rin e ( VI P) Pi t la trin e w ith ou t s lab /op en pit No fa cil itie s or b us h or fi el d Ot he r Governorates Damascus 99.1 0.7 0.0 0.0 0.2 0.0 100.0 99.8 1,970 Aleppo 75.1 3.7 18.1 1.8 1.0 0.2 100.0 97.0 4,522 Rural-Dam 96.5 0.9 2.1 0.3 0.1 0.0 100.0 99.5 2,571 Homs 88.4 2.7 8.0 0.4 0.5 0.0 100.0 99.1 1,630 Hama 61.9 9.6 26.7 1.6 0.1 0.1 100.0 98.1 1,395 Lattakia 83.1 5.4 11.2 0.2 0.1 0.1 100.0 99.6 1,064 Idleb 62.5 20.5 14.7 1.6 0.6 0.0 100.0 97.8 1,174 Hassake 48.4 6.5 34.2 4.3 6.5 0.1 100.0 89.1 1,002 Deir Ezzor 55.4 10.2 32.0 0.5 1.9 0.0 100.0 97.6 826 Tartous 68.7 8.2 22.2 0.9 0.1 0.0 100.0 99.0 871 Raqqa 36.5 1.8 46.3 12.1 3.3 0.1 100.0 84.5 737 Daraa 51.9 17.6 27.9 1.4 0.9 0.3 100.0 97.4 782 Sweida 46.8 29.1 20.1 2.6 1.1 0.3 100.0 96.0 378 Quneitra 43.3 3.1 52.6 1.0 0.0 0.0 100.0 99.0 97 Urban_Rural Urban 96.6 1.1 2.0 0.1 0.1 0.0 100.0 99.7 10,717 Rural 46.2 12.7 35.4 3.5 2.1 0.2 100.0 94.2 8,302 Education of household head None 60.3 9.3 24.8 3.2 2.2 0.2 100.0 94.3 4,117 Primary 73.3 5.8 18.2 1.6 1.0 0.0 100.0 97.4 6,186 Secondary 80.1 5.3 12.9 1.1 0.5 0.0 100.0 98.4 6,072 Higher Institutions 81.1 5.1 12.6 0.7 0.3 0.1 100.0 98.9 1,156 University+ 91.9 2.7 5.0 0.3 0.1 0.1 100.0 99.6 1,462 Missing/DK 92.3 3.8 3.8 0.0 0.0 0.0 100.0 100.0 26 Wealth index quintiles Poorest 17.3 13.8 56.5 7.1 5.0 0.3 100.0 87.6 3,522 Second 58.9 13.6 25.7 1.3 0.3 0.2 100.0 98.2 3,623 Middle 90.4 4.1 5.3 0.2 0.0 0.0 100.0 99.8 3,889 Fourth 98.5 0.7 0.7 0.0 0.0 0.1 100.0 99.9 3,540 Richest 99.9 0.1 0.0 0.0 0.0 0.0 100.0 100.0 4,445 Total 74.6 6.1 16.6 1.6 1.0 0.1 100.0 97.3 19,019 * MICS Indicator 12; MDG Indicator 31 92 Multiple Indicator Cluster Survey 2006 Table EN.7: Use of improved water sources and improved sanitation Percentage of household population using both improved drinking water sources and sanitary means of excreta disposal, Syrian Arab Republic, 2006 Percentage of household population: using improved sources of drinking water * using sanitary means of excreta disposal ** using improved sources of drinking water and using sanitary means of excreta disposal Number of household members Governorates Damascus 99.6 99.9 99.5 9,359 Aleppo 90.4 97.0 88.8 24,682 Rural-Dam 54.2 99.5 54.0 14,399 Homs 96.6 98.8 96.0 9,178 Hama 96.8 98.0 94.9 8,237 Lattakia 97.5 99.6 97.3 5,020 Idleb 93.8 98.0 92.3 7,079 Hassake 66.4 89.3 63.6 6,724 Deir Ezzor 86.9 97.1 85.7 5,689 Tartous 99.9 98.8 98.8 4,499 Raqqa 92.4 85.0 80.2 4,765 Daraa 98.5 97.3 96.8 5,371 Sweida 99.9 96.0 96.0 1,765 Quneitra 99.0 98.5 97.5 599 Urban_Rural Urban 93.5 99.7 93.2 56,930 Rural 80.4 94.2 77.1 50,435 Education of household head None 83.3 93.8 80.1 23,002 Primary 85.1 97.1 83.5 36,043 Secondary 89.9 98.4 88.8 34,399 Higher Institutions 92.7 98.6 91.5 6,451 University+ 94.2 99.6 93.8 7,346 Missing/DK 94.4 100.0 94.4 124 Wealth index quintiles Poorest 69.5 87.7 63.2 21,473 Second 85.9 98.1 84.1 21,444 Middle 86.8 99.8 86.6 21,988 Fourth 94.9 99.9 94.9 19,309 Richest 99.3 100.0 99.3 23,151 Total 87.3 97.1 85.6 107,365 * MICS indicator 11; MDG indicator 30 ** MICS indicator 12; MDG indicator 31 93Multiple Indicator Cluster Survey 2006 Table RH.1: Use of contraception Percentage of women aged 15-49 years married or in union who are using (or whose partner is using) a contraceptive method, Syrian Arab Republic, 2006 Percent of women (currently married or in union) who are using: To tal An y m od er n m eth od An y t ra dit ion al me tho d An y m eth od * Nu mb er of w om en cu rre ntl y m ar rie d o r in un ion No t u sin g a ny m eth od Fe ma le ste rili za tio n Pi ll IU D Inj ec tio ns Co nd om Di ap hr ag m/ foa m/ jel ly LA M Pe rio dic ab sti ne nc e W ith dr aw al Ot he r Governorates Damascus 29.2 0.1 14.1 40.3 0.7 2.6 0.0 2.8 8.1 1.4 0.5 100.0 58.0 12.9 70.8 1,181 Aleppo 40.2 1.3 17.1 27.1 2.4 1.5 0.1 3.7 5.1 1.2 0.2 100.0 49.6 10.2 59.8 3,148 Rural-Dam 35.6 1.5 13.3 26.1 0.2 2.1 0.2 3.5 12.2 4.2 1.0 100.0 43.5 20.9 64.4 2,071 Homs 40.5 0.8 8.9 29.3 0.6 0.9 0.5 5.8 10.3 1.7 0.7 100.0 41.0 18.4 59.5 1,209 Hama 43.8 1.5 9.1 27.5 0.3 0.5 0.1 2.7 12.9 0.7 0.9 100.0 39.0 17.2 56.2 964 Lattakia 29.5 0.7 10.7 29.9 0.1 1.5 0.0 5.3 20.1 0.1 2.0 100.0 42.9 27.6 70.5 685 Idleb 42.8 1.5 16.0 19.5 1.1 0.6 0.4 6.0 8.9 1.5 1.7 100.0 39.1 18.1 57.2 811 Hassake 55.9 1.8 5.7 18.0 0.4 0.4 0.4 6.0 8.9 2.2 0.3 100.0 26.7 17.3 44.1 733 Deir Ezzor 62.2 0.3 15.3 13.4 0.7 0.5 0.0 5.4 1.6 0.0 0.5 100.0 30.3 7.5 37.8 614 Tartous 34.1 2.6 7.3 26.0 0.2 5.1 0.0 2.8 20.1 0.0 1.8 100.0 41.2 24.7 65.9 607 Raqqa 66.3 0.6 13.8 10.3 0.2 0.2 0.4 2.9 4.0 1.1 0.2 100.0 25.4 8.2 33.7 523 Daraa 56.9 1.0 13.0 18.5 0.7 2.0 0.0 2.4 3.6 0.4 1.0 100.0 35.6 7.4 43.1 713 Sweida 25.1 1.1 8.6 28.7 1.4 3.9 0.7 6.8 13.3 9.0 1.4 100.0 44.4 30.5 74.9 279 Quneitra 63.0 0.0 6.2 18.5 1.2 6.2 0.0 1.2 3.7 0.0 0.0 100.0 32.1 4.9 37.0 81 Urban_Rural Urban 36.5 1.2 14.3 29.8 0.9 1.8 0.2 3.3 9.4 1.8 0.7 100.0 48.2 15.2 63.5 7,598 Rural 48.2 1.2 11.0 20.6 1.0 1.3 0.2 5.0 9.0 1.5 0.8 100.0 35.4 16.4 51.8 6,019 Age 15-19 78.4 0.0 6.0 3.8 0.5 0.4 0.4 7.3 2.9 0.2 0.0 100.0 11.2 10.4 21.6 546 20-24 59.6 0.0 11.3 13.8 0.3 0.7 0.3 6.7 5.9 1.3 0.2 100.0 26.3 14.1 40.4 1,811 25-29 43.9 0.1 14.7 23.4 0.6 1.5 0.1 6.3 7.3 1.9 0.2 100.0 40.3 15.8 56.1 2,536 30-34 35.6 0.5 15.3 30.4 0.9 2.1 0.2 4.5 9.3 0.9 0.4 100.0 49.4 15.0 64.4 2,533 35-39 30.3 1.2 15.1 34.1 1.1 1.6 0.1 3.1 10.6 2.0 0.8 100.0 53.2 16.5 69.7 2,643 40-44 31.1 2.8 11.7 32.3 1.9 1.7 0.3 1.4 12.9 2.5 1.4 100.0 50.7 18.1 68.9 2,139 45-49 48.9 3.7 7.7 19.9 1.0 2.7 0.1 0.2 11.0 2.1 2.6 100.0 35.2 15.9 51.1 1,409 Number of living children 0 98.6 0.0 0.2 0.6 0.0 0.1 0.0 0.1 0.4 0.0 0.1 100.0 0.8 0.6 1.4 1,089 1 66.5 0.0 9.4 4.9 0.2 1.1 0.2 6.8 9.2 1.5 0.2 100.0 15.8 17.6 33.5 1,315 2 38.6 0.1 13.7 25.6 0.5 1.9 0.1 5.3 11.9 1.9 0.4 100.0 42.0 19.4 61.4 2,188 3 31.1 0.9 13.6 34.1 0.7 2.0 0.1 4.6 10.8 1.7 0.4 100.0 51.4 17.5 68.9 2,313 4+ 32.3 2.0 15.1 31.1 1.5 1.7 0.3 3.5 9.2 2.0 1.3 100.0 51.8 16.0 67.7 6,712 Mother’s education None 54.8 2.1 12.5 17.1 1.7 0.7 0.2 3.0 5.7 1.2 0.9 100.0 34.3 10.9 45.2 2,649 Primary 42.5 1.3 14.1 24.6 1.2 1.4 0.1 4.9 7.2 1.8 0.8 100.0 42.6 14.8 57.5 4,734 Secondary 36.5 0.7 13.0 29.3 0.5 2.1 0.3 4.0 11.0 1.9 0.7 100.0 46.0 17.5 63.5 4,850 Higher institutions 33.7 0.9 9.2 32.4 0.2 1.7 0.0 3.7 16.0 1.7 0.5 100.0 44.4 21.9 66.3 887 University+ 29.0 0.6 9.5 35.2 0.2 3.6 0.4 2.2 16.9 1.8 0.4 100.0 49.7 21.3 71.0 497 Wealth index quintiles Poorest 58.2 0.9 11.0 14.8 1.2 1.1 0.3 5.5 5.2 1.3 0.5 100.0 29.4 12.4 41.8 2,372 Second 47.2 1.2 12.4 20.1 1.0 1.6 0.2 5.0 8.6 1.7 0.9 100.0 36.6 16.3 52.8 2,674 Middle 38.8 1.0 14.3 25.6 0.8 1.6 0.1 4.5 9.7 2.3 0.9 100.0 43.6 17.6 61.2 2,858 Fourth 36.3 1.3 13.8 30.2 1.0 1.3 0.1 3.3 10.0 1.9 0.8 100.0 47.7 16.0 63.7 2,577 Richest 31.7 1.4 12.6 35.2 0.8 2.2 0.2 2.3 11.6 1.3 0.7 100.0 52.5 15.9 68.3 3,136 Total 41.7 1.2 12.9 25.7 0.9 1.6 0.2 4.0 9.2 1.7 0.8 100.0 42.6 15.7 58.3 13,618 * MICS indicator 21; MDG indicator 19C 94 Multiple Indicator Cluster Survey 2006 Table RH.2: Unmet need for contraception Percentage of women aged 15-49 years currently married or in union with an unmet need for family planning and percentage of demand for contraception satisfied, Syrian Arab Republic, 2006 Cu rre nt us e o f c on tra ce pti on * Un me t n ee d f or co ntr ac ep tio n - F or sp ac ing ** Un me t n ee d f or co ntr ac ep tio n - F or lim itin g* ** Un me t n ee d f or co ntr ac ep tio n - To tal ** ** Nu mb er of w om en cu rre ntl y m ar rie d o r in un ion Pe rce nta ge of de ma nd fo r c on tra ce pti on sa tis fie d ** ** * Nu mb er of w om en cu rre ntl y m ar rie d o r in un ion w ith ne ed fo r c on tra ce pti on Governorates Damascus 70.8 3.1 3.9 6.9 1,181 91.1 919 Aleppo 59.8 3.3 3.1 6.4 3,148 90.3 2,087 Rural-Dam 64.4 4.2 7.5 11.8 2,071 84.5 1,577 Homs 59.5 5.2 5.0 10.3 1,209 85.3 843 Hama 56.2 6.8 9.4 16.3 964 77.5 699 Lattakia 70.5 1.6 1.5 3.1 685 95.8 504 Idleb 57.2 6.2 7.6 13.8 811 80.6 576 Hassake 44.1 4.5 10.8 15.3 733 74.3 435 Deir Ezzor 37.8 6.5 8.5 15.0 614 71.6 324 Tartous 65.9 3.8 8.9 12.7 607 83.9 477 Raqqa 33.7 7.1 12.2 19.3 523 63.5 277 Daraa 43.1 12.8 8.0 20.8 713 67.5 455 Sweida 74.9 2.5 3.9 6.4 279 92.1 227 Quneitra (37.0) (8.6) (6.2) (14.8) (81) (71.4) 42 Urban_Rural Urban 63.5 4.3 4.9 9.2 7,598 87.4 5,518 Rural 51.8 5.5 7.9 13.4 6,019 79.5 3,923 Age 15-19 21.6 11.5 0.9 12.5 546 63.4 186 20-24 40.4 12.6 1.7 14.2 1,811 73.9 989 25-29 56.1 7.4 3.1 10.5 2,536 84.2 1,688 30-34 64.4 3.8 5.8 9.6 2,533 87.0 1,875 35-39 69.7 2.6 7.8 10.4 2,643 87.0 2,116 40-44 68.9 0.5 10.2 10.7 2,139 86.5 1,702 45-49 51.1 0.2 11.4 11.6 1,409 81.5 884 Education None 45.2 3.5 10.4 13.9 2,649 76.5 1,565 Primary 57.5 5.3 5.3 10.6 4,734 84.4 3,222 Secondary 63.5 5.3 5.2 10.5 4,850 85.8 3,587 Higher Institutions 66.3 5.1 5.2 10.3 887 86.6 679 University+ 71.0 2.8 4.0 6.8 497 91.2 387 Wealth index quintiles Poorest 41.8 6.4 7.6 14.0 2,372 74.9 1,324 Second 52.8 6.0 7.6 13.5 2,674 79.6 1,774 Middle 61.2 5.0 6.1 11.1 2,858 84.6 2,067 Fourth 63.7 4.1 4.9 9.0 2,577 87.7 1,872 Richest 68.3 3.0 5.3 8.3 3,136 89.2 2,404 Total 58.3 4.8 6.2 11.0 13,618 84.1 9,441 * MICS indicator 21; MDG indicator 19C **** MICS indicator 98 ***** MICS indicator 99 95Multiple Indicator Cluster Survey 2006 Table RH.3: Antenatal care provider Percent distribution of women aged 15-49 who gave birth in the two years preceding the survey by type of personnel providing antenatal care, Syrian Arab Republic, 2006 Person providing antenatal care Total Any skilled personnel * Number of women who gave birth in the preceding two years Medical doctor Nurse/ midwife Auxiliary midwife Traditional birth attendant Other/ missing No antenatal care received Governorates Damascus 86.7 6.7 1.2 0.4 0.0 5.0 100.0 94.6 240 Aleppo 49.3 25.5 0.8 2.7 0.3 21.4 100.0 75.6 734 Rural- Dam 91.2 2.4 0.0 0.5 0.0 5.9 100.0 93.6 613 Homs 81.5 3.5 0.0 0.8 0.0 14.2 100.0 85.0 373 Hama 71.6 7.1 1.7 0.0 0.3 19.3 100.0 80.4 296 Lattakia 94.0 2.7 0.0 0.0 0.7 2.7 100.0 96.7 150 Idleb 59.9 6.6 0.6 0.3 0.3 32.3 100.0 67.1 319 Hassake 79.4 1.2 1.2 0.8 0.0 17.3 100.0 81.9 243 Deir Ezzor 68.1 5.8 3.1 4.7 0.0 18.3 100.0 77.1 257 Tartous 99.4 0.0 0.0 0.0 0.0 0.6 100.0 99.4 163 Raqqa 73.1 5.7 0.0 1.7 0.0 19.4 100.0 78.9 175 Daraa 85.8 3.8 0.0 1.0 0.0 9.3 100.0 89.6 289 Sweida 96.0 1.3 0.0 0.0 0.0 2.7 100.0 97.3 75 Quneitra (77.4) (3.2) (0.0) (0.0) (0.0) (19.4) 100.0 (80.6) 31 Urban_Rural Urban 79.5 9.9 0.7 0.3 0.1 9.6 100.0 90.0 1,988 Rural 71.0 6.2 0.7 2.1 0.2 19.8 100.0 77.9 1,969 Age 15-19 80.6 9.7 0.8 0.4 0.0 8.5 100.0 91.1 247 20-24 76.8 8.2 0.6 1.0 0.1 13.3 100.0 85.6 1,002 25-29 76.2 8.0 0.7 1.2 0.2 13.7 100.0 84.9 1,114 30-34 74.5 7.2 0.5 1.0 0.1 16.6 100.0 82.3 801 35-39 72.4 8.5 0.9 1.3 0.2 16.7 100.0 81.9 551 40-44 68.3 6.8 1.0 2.9 0.0 21.0 100.0 76.1 205 45-49 (65.8) (10.5) (0.0) (7.9) (0.0) (15.8) 100.0 (76.3) 38 Education None 52.7 9.0 2.0 5.1 0.3 30.9 100.0 63.7 609 Primary 69.1 11.4 0.5 0.8 0.1 18.0 100.0 81.0 1,535 Secondary 86.2 5.4 0.5 0.3 0.1 7.4 100.0 92.2 1,452 Higher Institutions 94.8 3.1 0.0 0.0 0.0 2.2 100.0 97.8 229 University+ 96.2 1.5 0.0 0.0 0.0 2.3 100.0 97.7 133 Wealth index quintiles Poorest 58.5 8.3 1.2 4.2 0.4 27.4 100.0 68.0 815 Second 75.0 6.8 0.6 0.7 0.0 16.9 100.0 82.4 972 Middle 79.5 8.7 0.8 0.3 0.0 10.7 100.0 88.9 877 Fourth 80.6 8.7 0.3 0.4 0.2 9.8 100.0 89.6 666 Richest 85.9 8.0 0.3 0.2 0.2 5.4 100.0 94.2 626 Total 75.3 8.0 0.7 1.2 0.1 14.7 100.0 84.0 3,958 * MICS indicator 20 96 Multiple Indicator Cluster Survey 2006 Table RH.4: Antenatal care content Percentage of pregnant women receiving antenal care among women aged 15-49 years who gave birth in two years preceding the survey and percentage of pregnant women receiving specific care as part of the antenatal care received, Syrian Arab Republic, 2006 Percent of pregnant women receiving ANC one or more times during pregnancy* Percent of pregnant women who had: Number of women who gave birth in two years preceding survey Blood sample taken Blood pressure measured Urine specimen taken Weight measured Governorates Damascus 95.0 85.4 92.5 82.9 92.9 240 Aleppo 78.6 45.0 68.5 37.5 59.1 734 Rural-Dam 94.1 67.4 87.3 67.2 80.4 613 Homs 85.8 50.4 80.7 51.2 79.1 373 Hama 80.7 57.8 69.6 57.8 63.5 296 Lattakia 97.3 91.3 94.0 91.3 95.3 150 Idleb 67.7 37.3 59.6 38.9 46.7 319 Hassake 82.7 49.0 76.1 42.8 37.5 243 Deir Ezzor 81.7 21.0 68.1 21.8 44.8 257 Tartous 99.4 96.9 98.8 96.3 99.4 163 Raqqa 80.6 30.3 69.2 33.2 46.3 175 Daraa 90.7 46.4 74.4 45.0 65.7 289 Sweida 97.3 80.0 97.3 80.0 97.3 75 Quneitra (80.6) (16.1) (41.9) (19.4) (29.0) 31 Urban_Rural Urban 90.4 63.8 84.2 61.1 75.9 1,988 Rural 80.2 44.6 69.4 43.9 57.7 1,969 Age 15-19 91.5 62.0 83.0 54.3 72.5 247 20-24 86.7 56.1 78.0 54.3 68.7 1,002 25-29 86.3 55.6 79.1 54.3 68.3 1,114 30-34 83.4 54.7 75.3 54.2 65.7 801 35-39 83.3 49.9 74.2 48.7 63.5 551 40-44 79.0 44.4 66.8 42.9 60.0 205 45-49 (84.2) (21.1) (65.8) (18.4) (50.0) 38 Education None 69.1 27.6 53.4 24.5 38.1 609 Primary 82.0 45.5 72.2 43.7 60.7 1,535 Secondary 92.6 67.8 87.0 67.0 79.8 1,452 Higher Institutions 97.8 77.3 93.9 76.4 87.3 229 University+ 97.7 88.7 97.7 84.2 94.0 133 Wealth index quintiles Poorest 72.6 30.4 58.1 29.4 40.6 815 Second 83.1 48.7 73.1 47.6 62.3 972 Middle 89.3 60.4 82.2 58.2 74.1 877 Fourth 90.2 63.7 85.1 61.1 79.3 666 Richest 94.6 75.1 90.7 73.5 84.8 626 Total 85.3 54.2 76.8 52.6 66.9 3,958 * MICS indicator 44 97Multiple Indicator Cluster Survey 2006 Table RH.5: Assistance during delivery Percent distribution of women aged 15-49 with a birth in two years preceding the survey by type of personnel assisting at delivery, Syrian Arab Republic, 2006 Person assisting at delivery To tal An y s kil led pe rso nn el * De liv er ed in he alt h f ac ilit y * * Nu mb er of w om en w ho ga ve bir th in pr ec ed ing tw o y ea rs Me dic al do cto r Nu rse /m idw ife Au xil iar y m idw ife Tr ad itio na l b irth att en da nt Ot he r No at ten da nt Governorates Damascus 88.3 9.2 0.4 2.1 0.0 0.0 100.0 97.9 92.5 240 Aleppo 41.8 47.5 1.8 7.9 0.8 0.1 100.0 91.2 53.6 734 Rural-Dam 78.3 19.9 0.2 0.8 0.3 0.5 100.0 98.4 86.3 613 Homs 67.0 27.9 1.1 2.9 0.8 0.3 100.0 96.0 69.7 373 Hama 62.8 29.7 1.7 4.1 1.4 0.3 100.0 94.3 70.3 296 Lattakia 84.6 13.4 0.0 0.0 0.0 2.0 100.0 98.0 87.2 149 Idleb 46.7 41.4 1.9 5.0 0.6 4.4 100.0 90.0 61.1 319 Hassake 49.4 26.8 4.1 16.9 1.6 1.2 100.0 80.3 58.9 243 Deir Ezzor 42.4 36.2 6.6 14.0 0.8 0.0 100.0 85.2 56.4 257 Tartous 92.6 6.7 0.6 0.0 0.0 0.0 100.0 100.0 93.9 163 Raqqa 57.1 26.9 1.1 12.6 0.0 2.3 100.0 85.2 62.9 175 Daraa 43.3 50.9 0.7 3.1 0.7 1.4 100.0 94.8 69.2 289 Sweida 74.7 24.0 0.0 1.3 0.0 0.0 100.0 98.7 93.3 75 Quneitra (80.6) (12.9) (0.0) 96.5) (0.0) (0.0) 100.0 (93.5) (90.3) 31 Urban_Rural Urban 66.8 29.6 1.3 1.5 0.2 0.7 100.0 97.6 75.3 1,987 Rural 54.3 32.2 1.9 9.5 1.1 1.0 100.0 88.4 65.5 1,969 Age 15-19 67.2 28.7 1.2 1.2 0.8 0.8 100.0 97.2 78.5 247 20-24 61.4 31.2 1.8 4.4 0.4 0.8 100.0 94.4 72.0 1,001 25-29 59.0 33.6 1.6 5.0 0.3 0.5 100.0 94.2 68.5 1,114 30-34 58.7 31.7 1.0 6.6 0.7 1.2 100.0 91.4 70.0 801 35-39 63.5 26.5 1.8 6.2 1.3 0.7 100.0 91.8 71.3 551 40-44 57.1 28.8 2.4 8.8 1.5 1.5 100.0 88.3 63.9 205 45-49 (55.3) (15.8) (0.0) (26.3) (0.0) (2.6) 100.0 (71.1) (60.5) 38 Mother’s education None 42.4 31.7 3.3 19.4 2.1 1.1 100.0 77.3 51.9 609 Primary 54.5 37.1 1.7 5.1 0.5 1.2 100.0 93.3 66.3 1,535 Secondary 68.9 27.8 1.0 1.4 0.2 0.6 100.0 97.8 78.1 1,451 Higher institutions 79.0 19.2 0.4 0.9 0.0 0.4 100.0 98.7 85.2 229 University+ 90.2 9.0 0.0 0.0 0.8 0.0 100.0 99.2 94.0 133 Wealth index quintiles Poorest 42.4 32.5 2.7 18.7 1.9 1.7 100.0 77.6 55.3 815 Second 57.9 35.1 2.1 3.6 0.6 0.7 100.0 95.1 71.2 972 Middle 62.4 34.2 1.4 1.0 0.2 0.7 100.0 98.1 71.2 876 Fourth 68.6 27.2 0.9 2.6 0.2 0.6 100.0 96.7 75.2 666 Richest 77.2 21.4 0.3 0.6 0.0 0.5 100.0 98.9 82.6 626 Total 60.6 30.9 1.6 5.5 0.6 0.9 100.0 93.0 70.4 3,957 * MICS indicator 4; MDG indicator 17 ** MICS indicator 5 98 Multiple Indicator Cluster Survey 2006 Table CD.1: Family support for learning Percentage of children aged 0-59 months for whom household members are engaged in activities that promote learning and school readiness, Syrian Arab Republic, 2006 Percentage of children aged 0-59 months Nu mb er of ch ild re n a ge d 0 -5 9 m on ths Fo r w ho m ho us eh old m em be rs en ga ge d i n f ou r o r m or e a cti vit ies tha t p ro mo te lea rn ing an d s ch oo l re ad ine ss * Me an nu mb er of ac tiv itie s ho us eh old m em be rs en ga ge in w ith the ch ild Fo r w ho m the fa the r e ng ag ed in on e o r m or e a cti vit ies th at pr om ote lea rn ing an d s ch oo l re ad ine ss ** Me an nu mb er of ac tiv itie s t he fa the r en ga ge in w ith th e c hil d Liv ing in a ho us eh old w ith ou t th eir na tur al fat he r Sex Male 55.0 3.8 57.4 1.1 1.8 5,804 Female 55.1 3.8 54.7 1.1 1.7 5,213 Governorates Damascus 78.0 4.9 76.6 1.5 1.2 591 Aleppo 40.9 3.3 58.1 0.9 0.9 2,284 Rural-Dam 68.1 4.3 63.1 1.0 1.0 1,598 Homs 40.6 3.3 43.8 0.8 2.7 1,032 Hama 60.3 3.9 60.1 1.2 0.8 838 Lattakia 58.0 3.9 58.4 1.3 1.4 440 Idleb 48.9 3.5 50.9 1.2 1.7 927 Hassake 48.2 3.5 50.8 0.9 1.0 668 Deir Ezzor 69.8 4.3 51.0 1.2 5.8 626 Tartous 69.6 4.4 63.1 1.8 0.9 447 Raqqa 45.6 3.3 46.0 1.0 0.8 491 Daraa 58.2 3.8 45.8 1.1 2.5 808 Sweida 66.1 4.2 58.9 1.5 13.3 180 Quneitra 73.6 4.4 85.1 1.5 0.0 87 Urban_Rural Urban 60.1 4.0 61.2 1.2 1.3 5,486 Rural 50.0 3.6 51.2 1.0 2.2 5,531 Age 0-23 months 34.8 3.0 47.7 0.9 1.8 4,113 24-59 months 67.1 4.3 61.2 1.3 1.8 6,904 Mother’s education None 42.9 3.3 46.1 0.8 2.3 1,947 Primary 49.2 3.5 53.7 1.0 1.6 4,164 Secondary 62.9 4.1 60.4 1.3 1.9 3,961 Higher Institutions 71.9 4.5 68.7 1.6 0.8 608 University+ 75.1 4.8 72.7 1.8 1.2 337 Father’s education None 42.1 3.2 45.5 0.7 0.0 837 Primary 48.7 3.5 53.7 1.0 0.0 3,819 Secondary 58.4 3.9 58.5 1.2 0.0 4,575 Higher Institutions 65.8 4.2 66.0 1.5 0.0 830 University+ 66.4 4.3 55.8 1.3 20.6 953 Missing/DK 100.0 6.0 0.0 0.0 0.0 3 Wealth index quintiles Poorest 40.7 3.2 47.4 0.9 2.0 2,342 Second 54.3 3.7 52.5 1.1 2.2 2,536 Middle 55.0 3.8 57.9 1.1 2.2 2,396 Fourth 61.3 4.1 59.7 1.2 1.2 1,927 Richest 68.0 4.4 66.6 1.4 0.8 1,816 Total 55.0 3.8 56.2 1.1 1.8 11,017 * MICS indicator 46 ** MICS indicator 47 99Multiple Indicator Cluster Survey 2006 Table CD.2: Learning materials Percentage of children aged 0-59 months living in households containing learning materials, Syrian Arab Republic, 2006 children living in households with: child has: Child plays with: 3 o r m or e t yp es of pl ay thi ng s * ** Nu mb er of ch ild re n a ge d 0 -5 9 m on ths 3 o r m or e n on -ch ild re n’s bo ok s * Me dia n n um be r o f n on -ch ild re n’s bo ok s 3 o r m or e c hil dr en ’s bo ok s * * Me dia n n um be r o f c hil dr en ’s bo ok s Ho us eh old ob jec ts Ob jec ts an d m ate ria ls fou nd ou tsi de th e h om e Ho me ma de to ys To ys th at ca me fr om a sto re No pl ay thi ng s m en tio ne d Sex Male 62.3 8.0 30.0 0.0 28.5 30.5 37.7 68.9 13.9 19.7 5,804 Female 63.0 9.0 30.2 0.0 30.4 27.7 36.7 67.9 14.4 18.8 5,213 Governorates Damascus 76.5 10.0 57.4 3.0 40.3 18.3 39.3 86.6 7.1 24.4 591 Aleppo 67.3 6.0 28.6 0.0 29.2 25.0 33.5 62.8 12.7 13.5 2,284 Rural-Dam 68.1 10.0 35.7 0.0 14.9 16.1 21.0 80.8 11.3 8.0 1,598 Homs 70.8 10.0 34.7 0.0 31.6 30.9 29.0 63.8 18.2 15.5 1,032 Hama 66.2 10.0 24.9 0.0 30.6 30.2 40.5 72.3 14.3 21.1 838 Lattakia 47.7 0.0 40.7 0.0 30.0 21.4 40.2 78.2 12.7 20.0 440 Idleb 53.3 5.0 35.3 0.0 21.1 32.3 53.0 66.7 14.6 21.9 927 Hassake 59.0 6.0 12.4 0.0 37.9 41.3 34.9 44.9 21.0 21.4 668 Deir Ezzor 52.4 3.0 27.6 0.0 41.7 43.4 50.2 62.9 16.0 33.5 626 Tartous 36.5 0.0 21.5 0.0 52.4 43.2 52.8 85.7 10.7 43.6 447 Raqqa 49.7 1.0 8.1 0.0 16.5 38.1 43.0 46.4 18.9 12.6 491 Daraa 60.9 10.0 20.4 0.0 32.2 35.5 50.0 66.6 17.5 30.2 808 Sweida 72.2 10.0 52.2 3.0 46.7 41.7 30.0 92.2 6.1 35.0 180 Quneitra 94.3 10.0 29.9 0.0 12.6 27.6 10.3 69.0 11.5 1.1 87 Urban_Rural Urban 65.9 9.0 36.5 0.0 29.4 19.3 38.8 75.9 12.1 18.6 5,486 Rural 59.4 7.0 23.7 0.0 29.3 39.0 35.7 61.0 16.1 20.0 5,531 Age 0-23 months 56.6 5.0 23.7 0.0 21.4 12.7 25.0 54.4 32.7 9.8 4,113 24-59 months 66.2 10.0 33.9 0.0 34.1 39.0 44.5 76.7 3.1 25.0 6,904 Mother’s education None 58.8 9.0 14.4 0.0 35.3 45.2 36.5 46.7 16.8 20.0 1,947 Primary 59.0 5.0 23.5 0.0 27.8 30.3 36.6 64.9 15.7 18.3 4,164 Secondary 64.0 9.0 37.8 0.0 28.9 23.1 37.8 78.5 12.4 20.6 3,961 Higher Institutions 79.8 10.0 54.6 3.0 25.3 18.7 42.1 84.5 8.7 18.1 608 University+ 83.7 10.0 66.2 6.0 27.9 12.2 33.8 88.4 8.6 15.1 337 Wealth index quintiles Poorest 53.0 4.0 12.0 0.0 33.2 48.0 34.1 44.6 18.7 19.2 2,342 Second 56.5 5.0 22.5 0.0 29.0 34.3 37.7 67.7 15.5 21.0 2,536 Middle 63.9 9.0 32.5 0.0 26.7 22.0 34.2 74.5 14.4 17.7 2,396 Fourth 69.3 10.0 37.9 0.0 30.4 20.0 40.6 78.9 10.6 20.4 1,927 Richest 74.9 10.0 52.5 3.0 27.4 17.0 40.9 80.7 9.6 17.9 1,816 Total 62.6 8.0 30.1 0.0 29.4 29.2 37.2 68.4 14.1 19.3 11,017 * MICS indicator 49 ** MICS indicator 48 *** MICS indicator 50 100 Multiple Indicator Cluster Survey 2006 Table CD.3: Children left alone or with other children Percentage of children age 0-59 months left in the care of other children under the age of 10 years or left alone in the past week, Syrian Arab Republic, 2006 Left in the care children under the age of 10 years in past week Left alone in the past week Left with inadequate care in past week * Number of children aged 0-59 months Sex Male 16.2 1.3 16.5 5,804 Female 16.4 1.5 16.7 5,213 Governorates Damascus 17.1 1.0 18.1 591 Aleppo 22.2 1.3 22.5 2,284 Rural-Dam 7.4 1.0 7.8 1,598 Homs 11.1 1.5 11.2 1,032 Hama 23.3 2.3 24.0 838 Lattakia 7.7 0.7 8.0 440 Idleb 20.1 3.1 20.4 927 Hassake 16.9 0.9 17.1 668 Deir Ezzor 38.3 1.8 38.5 626 Tartous 9.8 1.8 10.1 447 Raqqa 12.8 1.6 13.2 491 Daraa 7.2 0.7 7.4 808 Sweida 9.4 0.0 9.4 180 Quneitra 0.0 0.0 0.0 87 Urban_Rural Urban 14.5 1.2 14.8 5,486 Rural 18.0 1.7 18.4 5,531 Age 0-23 10.2 0.6 10.4 4,113 24-59 19.9 1.9 20.3 6,904 Mother’s education None 28.5 2.0 28.7 1,947 Primary 15.4 1.5 15.7 4,164 Secondary 12.2 1.2 12.6 3,961 Higher Institutions 13.2 0.7 13.5 608 University+ 10.1 0.3 10.1 337 Wealth index quintiles Poorest 21.2 1.7 21.6 2,342 Second 17.0 1.3 17.3 2,536 Middle 14.0 1.1 14.2 2,396 Fourth 13.8 1.7 14.2 1,927 Richest 14.5 1.4 14.9 1,816 Total 16.3 1.4 16.6 11,017 * MICS indicator 51 101Multiple Indicator Cluster Survey 2006 Table ED.1: Early childhood education Percentage of children aged 36-59 months who are attending some form of organized early childhood education programme and percentage of first graders who attended pre-school, Syrian Arab Republic, 2006 Percentage of children aged 36-59 months currently attending early childhood education* Number of children aged 36-59 months Percentage of children attending first grade who attended preschool program in previous year** Number of children attending first grade Sex Male 7.9 2,310 34.8 985 Female 7.2 2,184 32.1 872 Governorates Damascus 10.1 238 52.4 166 Aleppo 10.0 1,046 22.8 382 Rural-Dam 9.7 610 37.5 272 Homs 5.2 401 34.4 183 Hama 4.2 330 40.9 176 Lattakia 14.6 185 41.4 111 Idleb 3.5 369 17.7 102 Hassake 1.5 261 27.5 102 Deir Ezzor 7.2 236 26.2 65 Tartous 15.6 180 44.0 91 Raqqa 1.0 192 19.1 63 Daraa 2.4 340 34.0 100 Sweida 19.7 76 65.4 26 Quneitra 6.7 30 0.0 18 Urban_Rural Urban 9.7 2,234 40.0 1,016 Rural 5.4 2,260 25.8 840 Age of child 36-47 months 5.1 2,609 . 0 48-59 months 10.9 1,885 . 0 6 years . 0 33.6 1,857 Mother’s education None 4.5 895 21.2 326 Primary 3.5 1,644 25.5 612 Secondary 8.6 1,584 41.2 714 Higher Institutions 25.1 239 47.4 135 University+ 34.1 132 57.2 70 Wealth index quintiles Poorest 3.6 989 18.8 282 Second 4.1 963 27.0 381 Middle 5.6 940 28.4 415 Fourth 8.4 817 39.3 361 Richest 18.1 785 49.5 418 Total 7.5 4,494 33.6 1,857 * MICS Indicator 52 ** MICS Indicator 53 102 Multiple Indicator Cluster Survey 2006 Table ED.2: Primary school entry Percentage of children of primary school entry age attending grade 1, Syria, 2006 Percentage of children of primary school entry age currently attending grade 1 * Number of children of primary school entry age Sex Male 91.3 1,329 Female 92.6 1,281 Governorates Damascus 93.8 176 Aleppo 92.3 637 Rural-Dam 96.9 357 Homs 96.2 236 Hama 94.0 166 Lattakia 98.1 107 Idleb 92.6 189 Hassake 84.7 157 Deir Ezzor 76.4 174 Tartous 94.4 90 Raqqa 76.4 127 Daraa 99.3 142 Sweida (90.3) 31 Quneitra * 21 Urban_Rural Urban 94.7 1,276 Rural 89.4 1,334 Age at beginning of school year 6 92.0 2,610 Mother’s education None 83.7 712 Primary 93.2 932 Secondary 96.7 785 Higher institutions 99.1 111 University+ 94.2 69 Missing/DK 100.0 1 Wealth index quintiles Poorest 82.4 621 Second 93.4 547 Middle 95.4 520 Fourth 94.3 472 Richest 96.9 450 Total 92.0 2,610 * MICS Indicator 54 103Multiple Indicator Cluster Survey 2006 Table ED.3: Primary school net attendance ratio Percentage of children of primary school age attending primary school or secondary school (NAR), Syrian Arab Republic, 2006 Male Female Total Net attendance ratio Number of children Net attendance ratio Number of children Net attendance ratio* Number of children Governorates Damascus 97.9 661 98.8 587 98.3 1,249 Aleppo 95.6 2,275 94.6 1,975 95.1 4,250 Rural-Dam 97.7 1,127 98.0 1,127 97.9 2,254 Homs 98.6 711 98.2 707 98.4 1,418 Hama 96.4 641 97.0 664 96.7 1,305 Lattakia 98.0 345 99.7 308 98.8 653 Idleb 97.0 637 97.0 572 97.0 1,209 Hassake 94.5 614 93.9 523 94.2 1,137 Deir Ezzor 91.3 589 90.0 509 90.7 1,098 Tartous 96.9 258 98.3 294 97.6 552 Raqqa 91.1 438 88.5 410 89.9 848 Daraa 99.6 446 98.5 462 99.0 908 Sweida 99.1 116 99.2 119 99.1 235 Quneitra (97.6) 41 98.2 56 97.9 97 Urban_Rural Urban 96.5 4,469 97.1 4,157 96.8 8,626 Rural 96.0 4,429 95.0 4,155 95.5 8,585 Age 6 93.5 1,329 94.2 1,281 93.8 2,610 7 97.1 1,541 97.3 1,405 97.2 2,946 8 98.1 1,447 97.2 1,339 97.7 2,786 9 97.4 1,653 96.5 1,565 97.0 3,218 10 96.2 1,391 96.1 1,317 96.1 2,708 11 94.7 1,538 94.7 1,406 94.7 2,944 Mother’s education None 92.6 2,891 91.3 2,528 92.0 5,419 Primary 96.9 2,904 97.0 2,791 96.9 5,695 Secondary 98.9 2,491 99.2 2,366 99.1 4,857 Higher institutions 98.7 388 99.5 416 99.1 804 University+ 99.5 220 98.6 210 99.1 430 Missing/DK 100.0 4 100.0 1 100.0 5 Wealth index quintiles Poorest 93.2 2,077 90.9 1,788 92.1 3,865 Second 96.3 1,789 96.3 1,762 96.3 3,550 Middle 96.6 1,777 97.4 1,704 97.0 3,481 Fourth 97.5 1,557 97.8 1,438 97.7 2,996 Richest 98.4 1,699 98.4 1,621 98.4 3,319 Total 96.2 8,898 96.0 8,312 96.1 17,211 * MICS indicator 55; MDG indicator 6 104 Multiple Indicator Cluster Survey 2006 Table ED.4: Secondary school net attendance ratio Percentage of children of secondary school age attending secondary or higher school (NAR), Syrian Arab Republic, 2006 Male Female Total Net attendance ratio Number of children Net attendance ratio Number of children Net attendance ratio* Number of children Governorates Damascus 61.0 666 71.0 590 65.7 1,257 Aleppo 42.2 2,197 37.2 1,854 39.9 4,051 Rural-Dam 48.3 1,045 64.3 1,025 56.2 2,070 Homs 56.5 688 64.6 642 60.5 1,330 Hama 60.0 710 62.8 645 61.3 1,355 Lattakia 72.5 335 82.4 302 77.2 637 Idleb 51.3 583 45.3 539 48.4 1,122 Hassake 58.9 569 50.9 531 55.0 1,100 Deir Ezzor 57.1 485 47.8 477 52.5 962 Tartous 67.9 277 77.1 292 72.6 569 Raqqa 50.7 434 37.7 403 44.4 837 Daraa 58.8 452 59.9 424 59.4 876 Sweida 78.3 115 88.7 106 83.3 221 Quneitra (79.4) 34 (43.9) 41 60.0 75 Urban_Rural Urban 53.7 4,430 61.6 4,010 57.4 8,440 Rural 53.3 4,159 48.0 3,861 50.8 8,020 Age 12 65.4 1,499 67.9 1,427 66.6 2,926 13 67.1 1,363 65.1 1,572 66.0 2,935 14 60.7 1,424 61.6 1,163 61.1 2,587 15 48.2 1,430 50.4 1,249 49.2 2,679 16 41.6 1,297 42.6 1,164 42.1 2,461 17 38.7 1,577 37.6 1,296 38.2 2,873 Mother’s education None 45.5 3,002 41.1 2,704 43.4 5,707 Primary 53.0 2,015 61.5 1,772 57.0 3,787 Secondary 74.2 1,502 83.4 1,451 78.7 2,953 Higher Institutions 95.8 285 97.8 268 96.7 553 University+ 79.8 203 41.9 375 55.2 578 Missing/DK 100.0 5 100.0 4 100.0 9 Wealth index quintiles Poorest 42.9 1,772 31.3 1,617 37.4 3,389 Second 52.7 1,672 50.8 1,592 51.8 3,263 Middle 49.1 1,748 57.8 1,650 53.3 3,398 Fourth 53.6 1,552 59.0 1,370 56.2 2,923 Richest 68.6 1,846 75.7 1,642 71.9 3,487 Total 53.5 8,590 54.9 7,871 54.2 16,460 * MICS indicator 56 105Multiple Indicator Cluster Survey 2006 Table ED.4w: Secondary school age children attending primary school Percentage of children of secondary school age attending primary school, Syria, 2006 Male Female Total Percent attending primary school Number of children Percent attending primary school Number of children Percent attending primary school Number of children Governorates Damascus 1.8 666 2.4 590 2.1 1,257 Aleppo 3.9 2,197 3.0 1,854 3.5 4,051 Rural-Dam 3.6 1,045 2.3 1,025 3.0 2,070 Homs 3.8 688 1.9 642 2.9 1,330 Hama 3.7 710 3.9 645 3.8 1,355 Lattakia 2.1 335 0.7 302 1.4 637 Idleb 5.1 583 3.5 539 4.4 1,122 Hassake 6.7 569 6.0 531 6.4 1,100 Deir Ezzor 5.6 485 4.6 477 5.1 962 Tartous 5.8 277 2.1 292 3.9 569 Raqqa 6.5 434 5.7 403 6.1 837 Daraa 4.0 452 4.0 424 4.0 876 Sweida 0.9 115 0.0 106 0.5 221 Quneitra (2.9) 34 (4.9) 41 4.0 75 Urban_Rural Urban 3.1 4,430 2.5 4,010 2.8 8,440 Rural 5.2 4,159 3.9 3,861 4.6 8,020 Age at beginning of school year 12 17.7 1,499 13.2 1,427 15.5 2,926 13 4.3 1,363 3.4 1,572 3.8 2,935 14 1.2 1,424 0.8 1,163 1.0 2,587 15 0.6 1,430 0.2 1,249 0.4 2,679 16 0.2 1,297 0.0 1,164 0.1 2,461 17 0.0 1,577 0.0 1,296 0.0 2,873 Mother’s education None 7.2 3,002 5.4 2,704 6.4 5,707 Primary 4.5 2,015 3.9 1,772 4.3 3,787 Secondary 2.9 1,502 2.2 1,451 2.5 2,953 Higher institutions 0.4 285 0.4 268 0.4 553 University+ 1.0 203 0.8 375 0.9 578 Missing/DK 0.0 5 0.0 4 0.0 9 Wealth index quintiles Poorest 6.8 1,772 5.4 1,617 6.1 3,389 Second 4.4 1,672 4.4 1,592 4.4 3,263 Middle 4.1 1,748 2.7 1,650 3.4 3,398 Fourth 3.5 1,552 1.5 1,370 2.6 2,923 Richest 1.7 1,846 1.8 1,642 1.8 3,487 Total 4.1 8,590 3.2 7,871 3.7 16,460 Table based on estimated age as of the beginning of the school year 106 Multiple Indicator Cluster Survey 2006 Table ED.5: Children reaching grade 5 Percentage of

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