Syrian Arab Republic (Palestinians) - Multiple Indicator Cluster Survey - 2006

Publication date: 2006

Monitoring the Situation of Children and Women Multiple Indicator Cluster SurveyIII in Palestinian Refugee Camps and Gatherings in Syria 2006 General Administration for Palestine Arab Refugees (GAPAR) Palestinian Central Bureau of Statistics (PCBS) Pan-Arab Project for Family Health (PAPFAM) UNICEF United Nations Children’s Fund May 2007 2 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 UNICEF-SYRIA ISBN: 978-92-806-4481-4 3 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Contributors to the report: General Administration for Palestine Arab Refugees (GAPAR) Palestinian Central Bureau of Statistics (PCBS) UNICEF Pan-Arab Project for Family Health (PAPFAM) The Multiple Indicator Cluster Survey (MICS) in Palestinian Refugee Camps and Gatherings in Syria was carried out by the General Administration for Palestine Arab Refugees (GAPAR) in collaboration with the Palestinian Central Bureau of Statistics (PCBS). Financial and technical support was provided by the United Nations Children’s Fund (UNICEF) and the Pan-Arab Project for Family Health (PAPFAM). The survey was conducted as part of the third round of MICS surveys (MICS3), carried out in 2005- 2006 in more than 50 countries around the world— building on 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. Suggested citation: GAPAR and PCBS. 2006. Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006, Final Report. Damascus, Syria: GAPAR and PCBS. 4 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Summary Table of Findings Multiple Indicator Cluster Surveys (MICS) and Millennium Development Goals (MDG) Indicators, Palestinian Refugee Camps and Gatherings in Syria, 2006 Topic MICS Indicator Number MDG Indicator Number Indicator Value CHILD MORTALITY Child mortality 1 13 Under-five mortality rate 30 per 1000 2 14 Infant mortality rate 25 per 1000 NUTRITION Nutritional status 6 4 Underweight prevalence 10.0 % 7 Stunting prevalence 26.9 % 8 Wasting prevalence 8 % Breastfeeding 45 Timely initiation of breastfeeding 55.4 % 15 Exclusive breastfeeding rate 16.2 % 16 Continued breastfeeding rate of infants 12- 15 months 49.7 % 17 Timely complementary rate 64.1 % 18 Frequency of complementary feeding 43.5 % 19 Adequately fed infants 30.4 % Salt iodization 41 Iodised salt consumption 61 % Vitamin A 42 Vitamin A supplementation (under-fives) 2.2 % 43 Vitamin A supplementation (post-partum mothers) 15.5 % Low birth weight 9 Low birth weight infants 11.1 % 10 Infants weighed at birth 94.7 % CHILD HEALTH Immunisation 25 Tuberculosis immunisation coverage 99.0 % 26 Polio immunisation coverage First dose 96.8 % Second dose 95.2 % Third dose 93.5 % 27 DPT immunisation coverage First dose 96.8 % Second dose 95.4 % Third dose 93.5 % 28 15 Measles immunisation coverage 99.4 % 31 Fully immunised children 90.6 % Tetanus toxoid 32 Neonatal tetanus protection 24.7 % 5 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Topic MICS Indicator Number MDG Indicator Number Indicator Value Care of illness 33 Use of oral rehydration therapy (ORT) 71.9 % 34 Home management of diarrhoea 16.4 % 35 Received ORT or increased fluids, and continued feeding 32.9 % 23 Care seeking for suspected pneumonia 66.8 % 22 Antibiotic treatment of suspected pneumonia 71.4 % Solid fuel use 24 29 Solid fuels 0.0 % ENVIRONMENT Water and Sanitation 11 30 Use of improved drinking water sources 73.2 % 13 Water treatment 5.7 % 12 31 Use of improved sanitation facilities 97.4 % REPRODUCTIVE HEALTH Contraception 21 19c Contraceptive prevalence 60.1 % Maternal and Newborn health 20 Antenatal care 95.1 % 44 Content of antenatal care Blood test taken 95.8 % Blood pressure measurement 97.9 % Urine specimen taken 97.1 % Weight measured 98.0 % 4 17 Skilled attendant at delivery 97.6 % 5 Institutional deliveries 92.6 % Maternal mortality 3 16 Maternal mortality ratio 46 per 100,000 CHILD DEVELOPMENT Child development 46 Support for learning 65.2 % 47 Father’s support for learning 65.0 % 48 Support for learning: children’s books 42.1 % 49 Support for learning: non-children’s books 59.4 % 50 Support for learning: materials for play 20.7 % 51 Non-adult care 13.9 % EDUCATION 6 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Topic MICS Indicator Number MDG Indicator Number Indicator Value Education 52 Pre-school attendance 6.4 % 53 School readiness 43.7 % 54 Net intake rate in primary education 60.9 % 55 6 Net primary school attendance rate 91.5 % 56 Net secondary school attendance rate 42.7 % 57 7 Children reaching grade five 98.3 % 58 Transition rate to secondary school 88.9 % 59 7b Primary completion rate 82.5 % 61 9 Gender parity index primary school 1.01 % Literacy 60 8 Adult literacy rate 77.5 % CHILD PROTECTION Birth registration 62 Birth registration 99.0 % Child labour 71 Child labour 1.5 % 72 Labourer students 59.6 % 73 Student labourers 1.0 % Early marriage and polygyny 67 Marriage before age 18 14.6 % 68 Young women aged 1519- currently married/in union 4.7 % 70 Polygyny 8.3 % HIV/AIDS HIV/AIDS knowledge and attitudes 89 Knowledge of mother- to-child transmission of HIV 37.5 % 86 Attitude towards people with HIV/AIDS 9.9 % 87 Women who know where to be tested for HIV 25.6 % 7 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Table of Contents Summary Table of Findings Table of Contents List of Tables List of Figures List of Abbreviations Acknowledgements Executive Summary I Introduction Background Survey Objectives II Sample and Survey Methodology…… Sample Design Questionnaires Fieldwork and Data Processing III Sample Coverage and the Characteristics of Households and Respondents Sample Coverage Characteristics of Households Characteristics of Respondents IV Child Mortality V Nutrition Nutritional Status Breastfeeding Salt Iodisation Vitamin A Supplements Low Birth Weight VI Child Health Immunisation Tetanus Toxoid Oral Rehydration Treatment Care Seeking and Antibiotic Treatment of Pneumonia Solid Fuel Use VII Environment Water and Sanitation VIII Reproductive Health Contraception 8 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Antenatal Care Assistance at Delivery Maternal Mortality IX Child Development X Education Pre-School Attendance and School Readiness Primary and Secondary School Participation Adult Literacy XI Child Protection Birth Registration Child Labour Early Marriage and Polygyny XII HIV/AIDS Knowledge of HIV Transmission XIII Orphans and Vulnerable Children List of References Tables Appendix A. Sample Design Appendix B. Estimates of Sampling Errors Appendix C. Data Quality Tables Appendix D. MICS Indicators: Numerators and Denominators Appendix E. Questionnaires 9 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 List of Tables Table HH.1: Results of household and individual interviews Table HH.2: Household age distribution by sex Table HH.3: Household composition Table HH.4: Women>s background characteristics Table HH.5: Children>s background characteristics Table CM.1: Child mortality Table CM.2: Children ever born and proportion dead Table NU.1: Child malnourishment Table NU.1W: Child malnourishment (working table) Table NU.2: Initial breastfeeding Table NU.3: Breastfeeding Table NU.3W: Infant feeding patterns by age (working table) Table NU.4: Adequately fed infants Table NU.5: Iodised salt consumption Table NU.6: Children>s vitamin A supplementation Table NU.7: Post-partum mothers> vitamin A supplementation Table NU.8: Low birth weight infants Table CH.1: Vaccinations in first year of life Table CH.2: Vaccinations by background characteristics Table CH.3: Neonatal tetanus protection Table CH.4: Oral rehydration treatment Table CH.5: Home management of diarrhoea Table CH.6: Care seeking for suspected pneumonia Table CH.7: Antibiotic treatment of pneumonia Table CH.7A: Knowledge of the two danger signs of pneumonia Table CH.8: Solid fuel use Table EN.1: Use of improved water sources Table EN.2: Household water treatment Table EN.3: Time to source of water Table EN.4: Person collecting water Table EN.5: Use of sanitary means of excreta disposal Table EN.5W: Shared use of improved sanitation facilities (working table) Table EN.6: Use of improved water sources and improved sanitation Table RH.1: Use of contraception Table RH.2: Antenatal care provider Table RH.3: Antenatal care Table RH.4: Assistance during delivery Table RH.5: Maternal mortality ratio Table CD.1: Family support for learning Table CD.2: Learning materials Table CD.3: Children left alone or with other children Table ED.1: Early childhood education Table ED.2: Primary school entry Table ED.3: Primary school net attendance ratio 10 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Table ED.4: Secondary school net attendance ratio Table ED.4W: Secondary school age children attending primary school (working table) Table ED.5: Children reaching grade 5 Table ED.6: Primary school completion and transition to secondary education Table ED.7: Education gender parity Table ED.8: Adult literacy Table CP.1: Birth registration Table CP.2: Child labour Table CP.2W: Child labour (working table) Table CP.3: Labourer students and student labourers Table HA.1: Knowledge of preventing HIV transmission Table HA.2: Identifying misconceptions about HIV/AIDS Table HA.3: Knowledge of mother-to-child HIV transmission Table HA.4: Attitudes toward people living with HIV/AIDS Table HA.5: Knowledge of a facility for HIV testing Table HA.6: Children>s living arrangements and orphanhood 11 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 List of Figures Figure HH.1: Age and sex distribution of household population Figure CM.1: Infant and under-5 mortality rates by background characteristics Figure CM.2: Trend in under-5 mortality rates Figure NU.1: Percentage of children under-5 who are underweight or stunted Figure NU.2: Percentage of mothers who started breastfeeding within one hour and within one day of birth Figure NU.3: Infant feeding patterns by age: Percent distribution of children aged under 3 years by feeding pattern by age group Figure NU.4: Percentage of households consuming adequately iodised salt Figure NU.5: Percentage of infants weighing less than 2500 grams at birth Figure CH.1: Percentage of Children aged 1213- months who received the recommended vaccinations by 12 months Figure CH.2: Percentage of women with a live birth in the last 12 months who are protected against neonatal tetanus Figure CH.3: Percentage of children aged 059- months with diarrhoea who received oral rehydration treatment Figure CH.4: Percentage of U5 children with diarrhoea within two weeks prior to survey who received ORT or increased fluids, and continued feeding Figure EN.1: Percentage distribution of household members by source of drinking water List of Abbreviations AIDS Acquired Immune Deficiency Syndrome BCG Bacillis-Cereus-Geuerin (Tuberculosis) CSPro Census and Survey Processing System DPT Diphteria Pertussis Tetanus EPI Expanded Programme on Immunisation GPI Gender Parity Index HIV Human Immunodeficiency Virus IDD Iodine Deficiency Disorders ITN Insecticide Treated Net IUD Intrauterine Device LAM Lactational Amenorrhea Method MDG Millennium Development Goals MICS Multiple Indicator Cluster Survey MoH Ministry of Health NAR Net Attendance Rate ORT Oral Rehydration Treatment PAPFAM The Pan-Arab Project for Family Health ppm Parts Per Million SPSS Statistical Package for Social Sciences UNAIDS United Nations Programme on HIV/AIDS UNDP United Nations Development Programme UNFPA United Nations Population Fund UNGASS United Nations General Assembly Special Session on HIV/AIDS UNICEF United Nations Children’s Fund UNRWA United Nations Relief and Works Agency for Palestine Refugees in the Near East WFFC World Fit For Children WHO World Health Organization 12 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Acknowledgements The General Administration for Palestine Arab Refugees (GAPAR) would like to thank UNICEF and the Pan-Arab Project for Family Health (PAPFAM) of the League of Arab States as well as the Palestinian Central Bureau of Statistics and Natural Resources for conducting this important survey. Gratitude is extended to UNRWA, to the Arab Cultural Centre of Yarmouk, to all individual interviewers, supervisors, and administrative personnel, to the local offices of GAPAR and the Development Committees in the camps as well as to the Palestinian families for their invaluable contribution to making this survey successful. The results of the survey are expected to have a positive bearing on future projects for Palestinian children and women who receive the attention and continuous support of the Syrian Government, led by its President Dr. Bashar al-Asad. The Syrian Government and its leader have embraced their guest sisters and brothers and treated them like their citizens in all aspects of life and will do so until they are able to return to their homes, the homes they were driven away from by threat and force in 1948 and after. Ali Moustafa General Director General Administration for Palestine Arab Refugees (GAPAR) 13 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Executive Summary Man is the ultimate goal of any development process. Therefore, and incontrovertibly, the Multiple Indicator Cluster Survey, which was accomplished thanks to a memorandum of understanding signed between GAPAR and UNICEF and conducted under the kind auspices of the State Planning Commission in cooperation with the Palestinian Central Bureau of Statistics and Natural Resources and UNRWA, represents a step in the right direction. This report is the fruit of a constructive collaboration between the implementing and participating parties of the survey and between the supporting institutions represented by UNICEF and PAPFAM of the League of Arab States. The survey provides detailed data at the levels of environment, health, education and demography in the hope that the results will help policy and decision makers in the design and implementation of development plans and projects for women and children. It is also anticipated that scholars and researchers will benefit from these results in conducting in-depth studies on matters of public health, reproductive health, childhood and child protection. 14 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 I. Introduction 1-1 Background This final report includes the results of the Multiple Indicator Cluster Survey III of Palestinian Refugee Camps and Gatherings in Syria conducted in 2006 by the General Administration for Palestine Arab Refugees (GAPAR) and the Palestinian Central Bureau of Statistics and Natural Resources (PCBS) in collaboration with the UNICEF Syria Country Office and the Pan-Arab Project for Family Health (PAPFAM). The survey mainly focused on monitoring progress towards attaining the targets and goals set by international agreements such as 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. The League of Arab States, together with interested organizations and institutions, also passed additional resolutions including the Arab Framework on Arab Child Rights, the Cairo Declaration towards “An Arab World Fit for Children” and the Second Arab Plan of Action on the Child (2004 - 2015) that were adopted by Arab Summits (all of the resolutions?). By signing these international agreements, governments committed themselves to improving conditions for their children and to monitoring progress towards these targets. UNICEF was assigned a supporting role in this task (see table 1). 15 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Table 1 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 committed themselves to monitoring progress towards the following goals and objectives: “We will monitor regularly at the national level and, where appropriate, at the regional level and assess progress towards the goals and targets of the present Plan of Action at the national, regional and global levels. Accordingly, we will strengthen our national statistical capacity to collect, analyse and disaggregate data, including by sex, age and other relevant factors that may lead to disparities, and support a wide range of child-focused research. We will enhance international cooperation to support statistical capacity-building efforts and build community capacity for monitoring, assessment and planning.” (A World Fit for Children, paragraph 60) “…We will conduct periodic reviews at national and subnational levels of progress in order to more effectively address obstacles 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.” It is worthwhile to mention that the Syrian government and the United Nations Relief and Works Agency (UNRWA) are the main providers of health services offered to Palestinian refugee mothers and children in Syria. Both the Syrian Ministry of Health and UNRWA have continued to monitor health indicators emanating from the 2001 MICS II Survey of Palestinian refugee camps in Syria in order to increase, according to those indicators, their support to the health, education and environment of Palestinians. This final report introduces the results of topics covered by the survey and a subset of indicators.1 1 For more information on definitions, numerators, denominators, logarithms of MICS3, and MDGs indicators covered by the Survey, refer to chapter 1, annex 1 and annex 7 of MICS guide – MICS 2005: Monitoring The Situation of Women and Children, also available at www.childinfo.org 16 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 1-2 Survey Objectives The 2006 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria’s primary objectives are: To provide up-to-date information for assessing the situation of children and women in Palestinian Refugee Camps and Gatherings in Syria; To provide data needed to monitor progress towards achieving the goals established in the Millennium Declaration and A World Fit For Children as well as other internationally agreed upon objectives, as a basis for future action; To contribute to the improvement of data and monitoring systems in Palestinian Refugee Camps and Gatherings in Syria, and to strengthen technical expertise in the design, implementation, and analysis of such systems. 17 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 II. Sample and Survey Methodology 2-1 Sample Design The sample for the Multiple Indicator Cluster Survey (MICS) in Palestinian Refugee Camps and Gatherings in Syria was designed to provide estimates on a large number of indicators on the situation of children and women at the governorate and camp/gathering level, in urban and rural areas, for 13 camps and 3 gatherings in 6 governorates in the Syrian Arab Republic. The sample population (based on the Palestinian Refugee Camps and Gatherings in Syria Census of 2000) was divided into equal clusters each containing 20 households (totalling 8700 clusters). Sample clusters (400 clusters, i.e. 8000 households) were drawn in proportion to the Palestinian population weight of each governorate (the sample was thus normalized). A more detailed description of the sample design can be found in Appendix A. The distribution of sample households by governorate was as follows: Table 2 Distribution of Sample Households by Governorate Governorate Sample size (households) Damascus 5679 Aleppo 882 Homs 541 Hama 321 Latakia 238 Dera’a 339 Total 8000 2-2 Questionnaires Three sets of questionnaires were used in the survey: 1) a household questionnaire was used to collect information on all household members, the household, and the dwelling; 2) a women’s questionnaire was administered in each household to all women aged 1549- years; and 3) an under-5 questionnaire was administered to mothers or caretakers of all children under 5 living in the household. The questionnaires included the following modules: Household Questionnaire:• Household Listing• Education• Water and Sanitation Facilities• Household Background Characteristics• Child Labour• Salt Iodisation• 18 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Questionnaire for Individual Women:• Child Mortality• Tetanus Toxoid• Maternal and Newborn Health • Family planning• HIV/AIDS• Questionnaire for Children Under Five:• Birth Registration and Early Learning• Vitamin A• Breastfeeding• Care of Illness• Immunisation• Anthropometry• The questionnaires are based on the MICS3 model questionnaires. Changes in format were made to the UNICEF MICS3 model Arabic version questionnaires that were pre-tested during March 2006. 2-3 Fieldwork and Data Processing Training for the fieldwork team members (totalling 80 interviewers, measurers and supervisors) was conducted centrally (in Damascus) for 10 days from the 20th through the 30th of March 2006. The data were collected by 13 teams; each comprised of 4 interviewers, one measurer and a supervisor. Fieldwork began on April 4th 2006 and was concluded on May 31st 2006. Data were entered using the CSPro software. In order to ensure quality control, all questionnaire data were entered simultaneously with ongoing fieldwork and internal consistency checks were performed for 10 percent of the questionnaires. Procedures and standard programmes developed under the global MICS3 project and adapted to the Palestinian Refugee Camps and Gatherings in Syria questionnaire were used throughout. Data entry and checking were completed on July 1st 2006. Data were analysed using the Statistical Package for Social Sciences (SPSS) software programme and the model tables designed for that purpose. Data processing began simultaneously with data collection in April 2006 and was completed in the beginning of July 2006. 19 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 III. Sample Coverage and the Characteristics of Households and Respondents 3-1 Sample Coverage The response rate of households, mothers and children was remarkably high. Of the 8000 households selected for the sample, only 52 households could not be interviewed thus making the household response rate 99.4 percent. In the interviewed households, 5620 ever married women (aged 15 -49) were identified. Of these, 5610 were successfully interviewed, yielding a response rate of 99.8 percent. In addition, 3804 children under age five were listed in the household questionnaire. Separate questionnaires were completed for 3801 of these children, which corresponds to a response rate of 99.9 percent (Table HH.1). 3-2 Household Characteristics Table HH.3 provides basic background information on the households. Within households the sex of the household head, the governorate, the urban/rural status, and the number of household members are shown in the table. These background characteristics are used in subsequent tables in this report; the figures in the table are also intended to show the number of observations by major categories of analysis in the report. The number of weighted and unweighted households are equal, since sample weights were normalized (see Appendix A). The table also shows the proportions of households where at least one child under 18 years, at least one child under 5 years, and at least one eligible woman aged 15 -49 were found. Table HH.3 also shows that the total number of households in the sample was 7948; where males made up 87.7 percent of the household heads with the remaining 12.3 percent consisting of females. From the table it can be observed that 71.1 percent of the sample households were located in Damascus and that 66.5 percent lived in urban areas. The table also shows that 71.2 percent of the households had at least one child under 18 years old and that 35.6 percent of the households had at least one child under 5. Seventy percent of households had at least one woman aged 15 -49. 20 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 8 6 4 2 0 2 4 6 8 Males Females Percent Figure HH.1 shows that the population is shrinking as a result of a decrease in the fertility rate. 21 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 3-3 Respondent Characteristics Tables HH.4 and HH.5 provide information on the background characteristics of female respondents 1549- years of age and of children under age 5. In both tables, the total number of weighted and unweighted observations are equal, since sample weights were normalized. In addition to providing useful information on the background characteristics of women and children, the tables are also intended to show the number of observations in each background category. These categories are used in the subsequent tabulations of this report. Table HH.4 provides background characteristics of female respondents 15 -49 years of age. The table includes information on the distribution of women according to governorate, urban-rural areas, age, motherhood status, education2, and wealth index quintiles3. The table shows that two thirds of women in the sample were urban women and the remaining third was composed of rural women. It also shows that one tenth of all married women had never given birth. Some background characteristics of children under 5 are presented in Table HH.5. These include the distribution of children by several attributes: sex, governorate and area of residence, age in months, mother’s or caretaker’s education, and wealth. Figures in the table show that the gender parity index for children under five was 1.01 and that two thirds of children belonged to a medium wealth quintile household or below. 2 Unless otherwise stated, “education” refers to educational level attended by the respondent throughout this report when it is used as a background variable. 3 Principal components analysis was performed by using information on the ownership of household goods and amenities (assets) to assign weights to each household asset, and obtain wealth scores for each household in the sample (The assets used in these calculations include: connection of the home to the public electricity grid, family possession of radio, television, telephone, refrigerator, the number of rooms, type of ground material of floor, roof and walls, type of cooking fuel, source of drinking water, time required to bring drinking water, type of toilet facility. For more, see Appendix E. Questionnaires). Each household was then weighted by the number of household members, and the household population was divided into five groups of equal size, from the poorest quintile to the richest quintile, based on the wealth scores of the households they were living in. The wealth index is assumed to capture the underlying long-term wealth through information on household assets, and is intended to produce a ranking of households by wealth, from poorest to richest. The wealth index does not provide information on absolute poverty, current income or expenditure levels, and the wealth scores calculated are applicable only to the particular data set they are based on. Further information on the construction of the wealth index can be found in Rutstein and Johnson, 2004, and Filmer and Pritchett, 2001. 22 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 IV. Child Mortality One of the overarching objectives of the Millennium Development Goals (MDGs) and the World Fit for Children (WFFC) is to reduce (the) infant and under-five mortality rate. 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 training in research and supervision. On the other hand, indirect methods of measuring child mortality produce robust estimates that are comparable with the ones obtained from other sources. Indirect methods minimise the pitfalls of memory lapses, inexact or misinterpreted definitions, and the drawbacks of 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 to women aged 15 to 49, and the proportion of these children who are dead for the same 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 Palestinian Refugee Camps and Gatherings in Syria, the West model life table was selected as the most appropriate option. Table CM.1 provides estimates of child mortality according to various background characteristics. Table CM.1 shows that the infant mortality rate is 25 per thousand–meaning that among each 1000 live births that took place during the year, 25 infants died. Meanwhile, the under-5 mortality rate (U5MR), the probability of dying under age 5, is 30 per thousand. These estimates have been calculated by averaging child mortality estimates obtained from women aged 25 -29 and 30 -34, and refer to 2003. There is some difference between the probabilities of dying among males and females with an infant mortality rate of 28 per thousand in males and 23 per thousand in females. The infant mortality rate drops from 28 per thousand in southern camps (Damascus and Dera’a) to 16 per thousand in central region camps (Homs, Hama, and Latakia). U5MR drops from 34 per thousand in southern camps to 18 per thousand in central region camps. Mortality rates also differ according to the mother’s level of education and the household wealth index quintile. The household standard of living had an impact on the infant mortality rate and U5MR. Accordingly, the infant mortality rate drops from 33 per thousand for poorer households to 17 per thousand for the richest households. Similarly, U5MR drops from 40 per thousand for poorer households to 19 per thousand for the richest households. Differentials in infant and under-5 mortality rates by background characteristics are shown in Figure CM.1 and are summarised in figure CM.2. 23 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 0 20 10 30 40 50 Rich Middle Poor Mother's education below secodary Mother's education secodary+ Urban Rural Males Females Total Figure CM.1: Infant and under-5 mortality rates by background characteristics Figure CM.2 shows a series of U5MR survey estimates based on the responses of women in different age groups at different points in time, and reveals an overall decline in U5MR. 1990 1994 1998 2002 2006 0 5 10 15 20 25 30 35 40 45 Year Per 1.000 Figure CM.2: Trend in under-5 mortality rates 24 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 V. Nutrition 5-1 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. Malnutrition is the reason behind more than half of all child deaths worldwide. Undernourished children are more likely to die from childhood illnesses, and for those who survive, have recurring sicknesses and slow growth. Three-quarters of the children who died from causes related to malnutrition were mildly or moderately malnourished – showing no outward sign of their vulnerability. The Millennium Development target is, therefore, to reduce by half the proportion of people who suffer from hunger between 1990 and 2015. The World Fit for Children goal is to reduce the prevalence of malnutrition among children under five years of age by at least one-third (between 2000 and 2010), focusing special attention on children under 2 years of age. A reduction in the prevalence of malnutrition will assist to decrease child mortality. In a well-nourished population, there is a standard 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 reference of the World Health Organization (WHO), the Centre of Disease Control (CDC), and the National Centre for Health Surveys (NCHS). It is the same reference 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 and 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 resulting from a failure to receive adequate nutrition over a long period and recurrent or chronic illnesses. Finally, 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. In MICS, weights and heights of all children under 5 years of age were measured using anthropometric 25 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 equipment recommended by UNICEF (UNICEF, 2006). Table NU.1 shows percentages of children classified into each of these categories, based on the anthropometric measurements that were taken during fieldwork. The table also includes the percentage of children who are overweight, i.e. those children whose weight for height is over 2 standard deviations above the median of the reference population. In Table NU.1, children who were not weighed and measured (approximately 13 percent of children) and those whose measurements are outside a plausible range are excluded. In addition, a small number of children whose birth dates are not known are excluded. Almost one in ten children under age five in Palestinian Refugee Camps and Gatherings in Syria are moderately or severely underweight (10 percent) and 2.3 percent are classified as severely underweight (Table NU.1). More than a quarter of children (26.9 percent) are moderately stunted or too short for their age and 8 percent are moderately or severely wasted or too thin for their height. 12.7 percent of children were overweight. 0 5 10 15 20 25 30 35 40 Age (in months) Percent % 0 6 12 18 24 30 36 42 48 54 60 Underweight Stunted Wasted Overweight Figure NU.1: Percentage of children under-5 who are underweight or stunted 26 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Children in Hama camps are more likely to be underweight and stunted than other children, followed by Dera’a camps. On the other hand the percentage of wasted children is the highest in Hama camps. 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 undernourished according to all three indices in comparison to children who are younger and older (Figure NU.1). This observation is related to the age at which many children cease to be breastfed and are exposed to contamination in water, food, and the environment. 5-2 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 are obliged to stop breastfeeding too soon and switch to infant formula, which can contribute to growth delays and 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. 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- month olds; 3 times per day for 911- 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)• Figure NU.2 shows the proportion of women who started breastfeeding their infants within one hour of birth, and women who started breastfeeding within one day of birth (which also includes those who started within one hour). We observe that more than half of the mothers breastfed their infants within one hour of birth while 83 percent of mothers breastfed their infants during their first day of life. Ratios in urban areas are higher than in rural areas. They are also higher in central region camps (Homs, Hama, and Latakia) as compared to other regions. 27 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 0 10 20 30 40 50 60 70 80 90 100 81.9 83.5 82.2 94 92.2 81.3 85.6 78.4 82.9 50.1 55.7 76.7 88.1 83.3 61.3 64.4 40.2 55.4 Damascus Aleppo Homs Hama Latakia Daraa Urban Rural Country Within on day Within one hour Percent Figure NU.2: Percentage of mothers who started breastfeeding within one hour and within one day of birth In Table NU.3, breastfeeding status is based on mothers’/caretakers’ reports of children’s food and fluid intake in the 24 hours prior to the interview. The Exclusively breastfed indicator 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 aged 69- months and continued breastfeeding of children at 12 -15 and 20 -23 months of age. Approximately 16.2 percent of children aged less than six months are exclusively breastfed, a level that is considerably lower than recommended. At age 6 -9 months, 64.1 percent of children are receiving breast milk and solid or semi-solid foods. By age 12 -15 months half of the children are still being breastfed and by age 20 -23 months 7.3 percent are still breastfed. Breastfeeding ratios were higher in mothers with secondary or higher education compared to mothers with primary or lower education. Moreover, breastfeeding ratios were higher for mothers in poorer households compared to mothers in the richest households. 28 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Figure NU.3 shows the detailed patterns of breastfeeding by the child’s age in months. Even at the earliest ages, the majority of children are receiving liquids or foods other than breast milk by the end of the sixth month. Weaned Exclusively breastfed Mainly breastfed Breastfed and non-milk liquids Breastfed and other milk/formula Breastfed and complementary food 0 10 0-1 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-17 18-19 20-21 22-23 24-25 26-27 28 29 30 31 32-33 34-35 20 30 40 50 60 70 80 90 100 Percent % Age (in months) Figure NU.2: Infant feeding patterns by age: Percent distribution of children aged under 3 years by feeding pattern by age group The adequacy of infant feeding in children under 12 months is provided in Table NU.4. where 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 twice 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 table shows that 53 percent of children aged 6 -8 months are adequately fed compared to 35.6 percent for children aged 9 -11 months. As a result of these feeding patterns, 43.5 percent of children aged 6 -11 months are being adequately fed. The ratio goes up to 46.3 percent for girls and drops to 40.8 percent in boys. Ratios are higher in rural camps than in urban camps. In Dera’a camps ratios are higher than other camps. Adequate feeding among all infants (aged 0 -11) drops to 30.4 percent. 29 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 5-3 Salt Iodisation Iodine Deficiency Disorder (IDD) is the world’s leading cause of preventable mental retardation and impaired psychomotor development in children. In its most extreme form, iodine deficiency causes cretinism which is a form of stunting, body figure distortion and mental retardation caused by a malfunctioning thyroid gland. Iodine deficiency also increases the risks of stillbirth and miscarriage in pregnant women. Iodine deficiency is most commonly and visibly associated with goitre. IDD takes its greatest toll by impairing mental growth and development, contributing to poor school performance, reduced intellectual ability, and impaired work performance. The international goal is to achieve sustainable elimination of iodine deficiency by 2007. The indicator is the percentage of households consuming adequately iodised salt (>15 parts per million). 58.1 61 69.1 73.2 100 56 6164.2 54.6 0 20 40 60 80 100 120 Dama scus Alepp o Homs Ham a Latak ia Dara a Urba n Rura l Coun try Regions Percent % Figure NU.4: Percentage of households consuming adequately iodised salt In about 98.1 percent of households, salt used for cooking was tested for iodine content by using salt test kits and testing for the presence of potassium iodide or potassium iodate content or both. Table NU.5 shows that in a very small proportion of households (0.4 percent), there was no salt available. In 61 percent of households, salt was found to contain 15 parts per million (ppm) or more of iodine. Use of iodised salt was lowest in the South (Damascus and Dera’a), where it was around 58.1 percent in Damascus camps and 56 in Dera’a, and highest in Latakia (100 percent). Two thirds (64.2 percent) of households in urban camps were found to be using adequately iodised salt as compared to 54.6 percent in rural camps. 30 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 5-4 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. Vitamin A requirements increase as children grow and during periods of illness, as well as 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 eliminating 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 controlling and preventing 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 6 to 59 months living in affected areas. Providing young children with two high-dose vitamin A capsules a year is a safe, cost-effective, and 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 prior to the survey. UNICEF/WHO guidelines recommend that children aged 6 -11 months be given one high dose vitamin A capsule and children aged 12- 59 months be given a vitamin A capsule every 6 months. The guidelines also recommend that vitamin A capsules be linked to immunisation services and given when the child gets his shots after six months of age. It is also recommended that mothers take a vitamin A supplement within eight weeks of giving birth due to increased vitamin A requirements during pregnancy and lactation. Within the six months prior to the MICS, 2.2 percent of children aged 659- months received a high dose vitamin A supplement (Table NU.6). Approximately 2.3 percent did not receive the supplement in the last 6 months but did receive a vitamin A supplement prior to that time. Almost 4 percent of children received a vitamin A supplement at some point in the past although their mother/caretaker was unable to specify when. Vitamin A supplementation coverage is lower in the Homs and Hama camps than in other camps. 31 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 The age pattern of vitamin A supplementation shows that supplementation in the last six months dropped from 3.5 percent among children aged 6 -11 months to 2.7 percent among children aged 12 -23 months and then declines steadily with age to 1.8 percent among the oldest age group. The mother’s education level is related to the likelihood of vitamin A supplementation. The percentage receiving a supplement in the last six months increases from 1.6 percent among children whose mothers have primary education to 3.5 percent of those whose mothers have secondary or higher education. Only about 15.5 percent of mothers with a birth in the two years prior to MICS received a vitamin A supplement within eight weeks of the birth (Table NU.7). This percentage is highest in the Damascus camps at 17.1 percent and lowest in Hama camps at 3 percent. 5-6 Low Birth Weight Weight at birth is a good indicator of a mother´s health and nutritional status and of the newborn>s chances of survival, growth, long-term health and psychosocial development. Low birth weight (less than 2,500 grams) carries grave health risks for children. Babies who were undernourished in the uterus face a greatly increased risk of dying during their early months and years. Those who survive have impaired immune function and increased risk of disease; they are likely to remain undernourished, with reduced muscle strength, throughout their lives, and suffer a higher incidence of diabetes and heart disease in later life. Children born underweight also tend to have a lower IQ and cognitive disabilities, affecting their performance in school and their job opportunities as adults. In the developing world, low birth weight stems primarily from the mothe´s poor health and nutrition. Three factors have the 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 leads to underdevelopment of the placenta through which the foetus gets its nutrients. Moreover, diseases such as diarrhoea and malaria, which are common in many developing countries, can significantly impair placental and foetal growth if the mother becomes infected while pregnant. In the industrialised 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 challenges in measuring the incidence of low birth weight is the fact that more than half of infants in the developing world are not weighed. In the past, most estimates of low birth weight for developing countries were based on data compiled from health facilities. However, these estimates are biased for most developing countries because the majority of newborns are not delivered in facilities, and those who are represent only a selected sample of all births. 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 32 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 from two items in the MICS 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 birth4. Overall, 94.7 percent of infants were weighed at birth and 11.1 percent of infants are estimated to weigh less than 2500 grams at birth (Table NU.8). There was significant variation by region (Figure NU.5). The percentage of low birth weight varies very much between camps in governorates rising up to 15.4 percent in Dera’a and decreasing to 9 percent in Hama. 0 2 4 6 8 10 12 14 16 Damascus Aleppo Homs Hama Latakia Daraa Total Governorate 11 12 10 9 13 15 11 Percent % Figure NU.5: Percentage of infants weighing less than 2500 grams at birth 4. For a detailed description of the methodology, see Boerma, Weinstein, Rutstein and Sommerfelt, 1996. 33 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 VI. Child Health 6-1 Immunisation Millennium Development Goal (MDG) 4 is to reduce child mortality by two thirds between 1990 and 2015. Immunisation plays a key part in this goal. Immunisations have saved the lives of millions of children in the three decades since the launch of the Expanded Programme on Immunisation (EPI) in 1974. Worldwide there are still 27 million children overlooked by routine immunisation 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 immunisation of children under one year of age at 90 percent nationally, with at least 80 percent coverage in every 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. Interviewers copied vaccination information from the cards onto the MICS questionnaire. Overall, 100 percent of children had health cards. If the child did not have a card, the mother was asked to recall whether or not the child had received vaccinations and how many times he/she received vaccination for DPT and Polio,. The percentage of children aged 12 to 23 months who received each of the vaccinations is shown in Table CH.1. The denominator for the table is comprised of children aged 1223- months so that only children who are old enough to be fully vaccinated are counted. In the top panel, the numerator includes all children who were vaccinated at any time before the survey according to the vaccination card or the mother’s report. In the bottom panel, only those who were vaccinated before their first birthday, as recommended, are included. For children without vaccination cards, the proportion of vaccinations given before the first birthday is assumed to be the same as for children with vaccination cards. 99 percent of children aged 12 -23 months received a BCG vaccination by the age of 12 months and the first dose of DPT was given to 96.8 percent of them. The percentage declines for subsequent doses of DPT to 95.4 percent for the second dose, and 93.5 percent for the third dose (Figure CH.1). Similarly, 96.8 percent of children received Polio 1 by age 12 months and this declines to 93.5 percent by the third dose. The coverage for measles vaccine by 12 months is 99.4 percent. In total, the percentage of children who had all the recommended vaccinations by their first birthday is 90.6 percent. This proportion is particularly high because Palestinian children benefit from free health services offered by the Syrian government as well as from the services offered by UNRWA to Palestinians. UNRWA provides dose 0 of polio vaccine within the first month of life in addition to the three basic booster doses of DPT and polio vaccines. 34 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 86 88 90 92 94 96 98 100 102 11 12 13 15 11 Percent % BCG DPT1 DPT2 DPT3 Measles AllPolio1 Polio2 Polio3 99 96.8 95.4 93.5 96.8 95.2 93.5 99.4 90.6 Figure CH.1: Percentage of Children aged 12- 13 months who received the recommended vaccinations by 12 months Table CH.2 shows vaccination coverage rates among children 12 -23 months by background characteristics. The figures indicate children receiving the vaccinations at any time up to the date the survey was administered, and are based on information from the vaccination cards. No significant disparities are observed among camp and/or by mother’s level of education. 6-2 Tetanus Toxoid One of the MDGs is to reduce the maternal mortality ratio by three quarters with one strategy; eliminating 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 that all pregnant women receive at least two doses of tetanus toxoid vaccine. However, if women have not received two doses of the vaccine during their 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 within the previous 3 years;• Received at least 3 doses within the previous 5 years;• Received at least 4 doses within the previous 10 years;• Received at least 5 doses during lifetime.• Table CH.3 shows the protection from tetanus status of women who have had a live birth within the 12 months prior to the survey. Figure CH.2 shows the level protection of women against neonatal tetanus 35 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 by major background characteristics. One forth of the women who have had a live birth within the last two years had a tetanus toxoid vaccination. The percentage varies among camps with the highest rate (34.7 percent) in Dera’a and the lowest in Latakia (7.1 per cent). 0 10 20 30 40 50 11 12 13 15 11 25.3 27.2 15.6 20.9 7.1 34.7 23.1 27.5 25.8 23.6 24.8 24.7 Damascus Aleppo Homs Hama Latakia Deraa Urban Rural No Education Primary Preparatory + All mothers Percent Figure CH.2: Percentage of women with a live birth in the last 12 months who are protected against neonatal tetanus 6-3 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 deaths due to diarrhoea by half among children under five by 2010 compared to 2000 (A World Fit for Children); 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)• 36 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Home management of diarrhoea• (ORT or increased fluids) and continued feeding• In the MICS questionnaire, mothers (or caretakers) were asked to report whether their child 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. 100 120 60 80 20 0 40 Percent % 69 78 96 80 80 69 76 72 71 72 Figure CH.3: Percentage of children aged 059- months with diarrhoea who received oral rehydration treatment Overall, 11.5 percent of children under five had diarrhoea in the two weeks preceding the survey (Table CH.4). Diarrhoea prevalence was different among camps. 18.5 percent of Aleppo camp children had had diarrhoea during the previous two weeks— representing the highest prevalence. The percentage goes down to 3.3 per cent in Hama. The peak of diarrhoea prevalence occurs in the teething period, among children aged 611- months. Table CH.4 also shows the percentage of children receiving various types of recommended liquids during the episode of diarrhoea. Since mothers were able to name two types of liquid, the percentages do not necessarily add to 100. Approximately 35.6 percent received fluids from ORS packets; 22.1 percent received pre-packaged ORS fluids, and 42.7 percent received recommended homemade fluids. Children of mothers with secondary education are less likely to receive oral rehydration treatment than other children. Approximately 72 percent of children with diarrhoea received one or more of the recommended home treatments (i.e., were treated with ORS or RHF), while 28.1 percent received no treatment (see Figure CH.3). 37 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 0 10 20 30 40 50 34.5 23.4 27.3 60 40 43.8 37.2 26.2 29.3 36.7 32.6 33 Damascus Aleppo Homs Hama Latakia Deraa Urban Rural No Education Primary Preparatory + All mothers Percent 40.9 percent of under five children with diarrhoea drank more than usual while 57.1 percent drank the same or less (Table CH.5). 42.9 percent ate somewhat less, same or more (continued feeding), but 55.9 percent ate much less or ate almost nothing. Given these figures, 32.9 percent children were treated for diarrhoea at home and the percentage using ORT reached around 71.9 percent. This figure increases in urban areas to around 66.9 percent compared to around 79.7 percent in rural areas (table CH.4). 32.9 percent of children received ORT or increased fluids and at the same time continued feeding (Table CH.5). 38 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 6-4 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 deaths due to acute respiratory infections by one-third. 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• Table CH.6 presents the prevalence of suspected pneumonia and, if care was sought outside the home, the site of care. 7.8 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, 57.6 percent were taken to an appropriate provider. Medical advice was sought in private clinics for 29.0 percent of children and in UNRWA paediatric consultation clinics for 21.2 percent of children. Table CH.7 shows the use of antibiotics for the treatment of suspected pneumonia in under-5s by sex, governorate, residence, and socioeconomic factors. In Palestinian Refugee Camps and Gatherings 71.4 percent of under-5 children with suspected pneumonia had received an antibiotic during the two weeks prior to the survey. The percentage was higher in the 12 -23 months age group. Issues related to knowledge of the danger signs of pneumonia are presented in Table CH.7A. Obviously, mothers’ knowledge of the danger signs is an important determinant of care-seeking behaviour. Overall, 14.4 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 child fever (87.3 percent). 25.5 percent of mothers identified fast breathing and 28.8 percent of mothers identified difficult breathing as symptoms for taking children immediately to a health care facility. Results show that mothers’ caretakers’ knowledge of the signs of pneumonia increases by their level of education and wealth index quintiles. 39 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 6-5 Solid Fuel Use More than 3 billion people around the world rely on solid fuels (biomass and coal) for their basic energy needs, including cooking and heating. Cooking and heating with solid fuels leads to high levels of indoor smoke a complex mix of health damaging pollutants. The main problem with the use of solid fuels is products of incomplete combustion, including CO, polyaromatic hydrocarbons, SO2, and other toxic elements. Use of solid fuels increases the risks of acute respiratory illness, pneumonia, chronic obstructive lung disease, cancer, and possibly tuberculosis, low birth weight, cataracts, and asthma. The primary indicator is the proportion of the population using solid fuels as the primary source of domestic energy for cooking. Overall, use of solid fuels in cooking is an almost nonexistent practice in Palestinian Refugee Camps and Gatherings in Syria. Most households use natural gas for cooking purposes (table CH. 8). 40 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 VII. Environment 7-1 Water and Sanitation Safe drinking water is a basic necessity for good health. Unsafe drinking water can be a significant carrier of diseases such as trachoma, cholera, typhoid, and schistosomiasis. Drinking water can also contain chemical, physical and radiological contaminants that have harmful effects on human health. In addition to its impact on health, access to drinking water may be particularly important for women and children, especially in rural areas, who bear the primary responsibility for carrying water, often for long distances. The MDG goal is to reduce by half, between 1990 and 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation. The World Fit for Children goal calls for a reduction in the proportion of households without access to hygienic sanitation facilities and affordable and safe drinking water by at least one-third. The indicators used in MICS are as follows: Water Use of improved drinking water sources• Use of an adequate water treatment method• Time to source of drinking water• Person collecting drinking water• Sanitation Use of improved sanitation facilities• Sanitary disposal of child’s faeces• 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/borehole, protected well, protected spring, and rainwater collection. Bottled water is considered as an improved water source only if the household is also using an improved water source for other purposes, such as hand washing and cooking. Sold in water trucks 6% Other sources 1% Sold in water tanks 21%Protected well 3% Piped into dwelling, yard or plot 69% 41 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Overall, 73.2 percent of the population is using an improved source of drinking water – 88.2 percent in urban areas and 45.2 percent in rural areas (Table EN.1). The situation in Damascus camps is worse than in other camps; 69 percent of the population in these camps get improved water from a public source while others buy water from water tanks. Although public water pipelines are accessible for all camp residents, the existence of some calcium salts in public water in some camps makes water unpalatable. The source of drinking water for the population varies strongly by governorate. In all governorates (except Damascus), most of the population uses drinking water that is piped into their dwelling or into their yard or plot. While in Damascus only 57.2 percent use piped water. The second most important source of drinking water in Damascus camps is the water sold in tanks or trucks. In-house water treatment use is presented in Table EN.2. Households were asked about ways they are treating water at home to make it safer to drink – boiling, adding bleach or chlorine, using a 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, individually for all households, in households using improved and unimproved drinking water sources. 5.7 percent of households use one of the home water treatment methods with boiling heading the list followed by the use of filters. The amount of time it takes to obtain water is presented in Table EN.3. The table shows that for 74.1 percent of households, the drinking water source is on the premises. For 17 percent of all households, it takes less than 15 minutes to get to the water source and bring water, while the remaining households spend more than 15 minutes for this activity. Excluding those households with water on the premises, the average time to the source of drinking water is 15.8 minutes. Inadequate disposal of human excreta and poor personal hygiene is associated with a range of diseases including diarrhoeal 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, pit latrine with slab, and composting toilet. 97.4 percent of the population of Palestinian Refugee Camps and Gatherings in Syria is living in households using improved sanitation facilities (Table EN.5). This percentage is 99.7 in urban areas and 93.2 percent in rural areas. An overview of the percentage of household members using improved sources of drinking water and sanitary means of excreta disposal is presented in Table EN.7 The rate in Palestinian Refugee Camps and Gatherings in Syria is 71.5 percent. 42 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 VIII. Reproductive Health 8-1 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 60.1 percent of currently married women (Table RH.1). The most popular method is the intrauterine device (IUD), which is used by one in four married women in Palestinian Refugee Camps and Gatherings in Syria. The next most popular method is the pill, which accounts for 14.5 percent of married women. 5.5 percent of women reported that their husbands use the condom. 9 percent use abstinence around ovulation time. Contraceptive prevalence is highest in Hama at 77.6 percent followed by Homs and Aleppo at 67 and 66 percent respectively. 44.8 percent of married women in Dera’a and 58.8 percent in Damascus camps use a method of contraception. Adolescents are far less likely to use contraception than older women. Only about 25 percent of married women aged 15 -19 currently use a method of contraception compared to 43.4 percent of 20- 24 year old and 70.2 percent of 35 -39 year old women. The positive impact of educating mothers to use contraception is evident. 45.7 percent of illiterate mothers use contraception compared to 59.7 percent of mothers with secondary and higher education. 8-2 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 immunisation during pregnancy can be life-saving for both the mother and infant. The prevention and treatment of malaria among pregnant women, management of anaemia 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 43 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 models of antenatal care. WHO guidelines are specific on the content on antenatal care visits, which include: Blood pressure measurement• Urine testing for bacteriuria and proteinuria• Blood testing to detect syphilis and severe anaemia• Weight/height measurement (optional)• Coverage of antenatal care (by a doctor, nurse, or midwife) is relatively high in Palestinian Refugee Camps and Gatherings in Syria with 95.1 percent of women receiving antenatal care at least once during the pregnancy (Table RH.3). The type of personnel providing antenatal care to women aged 1549- years who gave birth in the two years preceding the survey is presented in Table RH.3. 82.2 percent of women’s antenatal care was attended by a doctor while 12.3 percent had their care provided by nurses or midwives. The types of services pregnant women received are shown in table RH.4. Most pregnant women were provided with all basic types of care including weight and blood pressure measurement, urine testing, and blood testing. 8-3 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. About 99.1 percent of births occurring in the two years prior to the MICS survey were delivered by skilled personnel (Table RH.5). 83.2 percent of births were delivered with the assistance of a doctor. Midwives/nurses assisted with 14.4 percent of deliveries. 92.6 percent of births took place in an obstetric facility. 44 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 8-4 Maternal Mortality The complications of pregnancy and childbirth are a leading cause of death and disability among women of reproductive age in developing countries. It is estimated worldwide that around 529,000 women die each year from maternal causes. For every woman who dies, approximately 20 more suffer injuries, infection and disabilities in pregnancy or childbirth. The most common fatal complication is post-partum haemorrhage. Sepsis, complications of unsafe abortion, prolonged or obstructed labour and the hypertensive disorders of pregnancy, especially eclampsia, claim further lives. These complications, which can occur at any time during pregnancy and childbirth, require prompt access to quality obstetric services equipped to provide lifesaving drugs, antibiotics and transfusions and to perform caesarean sections and other surgical interventions that prevent deaths caused by obstructed labour, eclampsia and intractable haemorrhage. One MDG target is to reduce by three quarters, between 1990 and 2015, the maternal mortality ratio. Maternal mortality is defined as the death of a woman from pregnancy-related causes, when pregnant or within 42 days after childbirth. The maternal mortality ratio is the number of maternal deaths per 100,000 live births. In MICS, the maternal mortality ratio is estimated by using the indirect sisterhood method. To collect the information needed for this estimation method, adult household members are asked a range of questions regarding the survival of their sisters and the timing of death relative to pregnancy, childbirth and the postpartum period for deceased sisters. The information collected is then converted to lifetime risks of maternal death and maternal mortality ratios5. Palestinian Refugee Camps and Gatherings in Syria MICS results on maternal mortality are shown in Table RH.6. The results are also presented only for the national total, since maternal mortality ratios generally have very large sampling errors. The maternal mortality ratio in Palestinian Refugee Camps and Gatherings in Syria was 46 per 100,000. 5 For more information on the indirect sisterhood method, see WHO and UNICEF, 1997. 45 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 IX. Child Development It is well recognized that a period of rapid brain development occurs in the first 34 years of life, and the quality of home care is the major determinant of the child’s development during this period. Adult activities with children, presence of books in the home, and the conditions of child care are important indicators of the 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, taking children outside the home, compound or yard, playing with children, and spending time with children naming, counting, or drawing things. For almost two-thirds (65.2 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 high with 65 percent of father’s involvement with one or more activities. Only 1.4 percent of children were living in a household without their fathers. There are slight gender differentials in terms of adult activities with children as the percentage reaches 66.7 percent for girls and 63.9 percent for boys. There was no gender difference in fathers’ involvement with their children. 65.8 of adults engaged in learning and school readiness activities with children in urban areas compared to 64.2 percent in rural areas. Differentials by governorate and socio-economic status are also observed: Adult engagement in activities with children was greatest in Hama (83.6 percent) and lowest in the Dera’a (51.8 percent), while the proportion was 72.2 percent for children living in the richest households, as opposed to 58.8 percent for those living in the poorest households. Father’s involvement showed a similar pattern in terms of adults’ engagement in such activities. It is interesting to note that more educated mothers and fathers engaged in such activities with children at a higher rate than those with less education. Exposure to books in early years not only provides the child with a greater understanding of the nature of print, 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 Palestinian Refugee Camps and Gatherings in Syria, 59.4 percent of children are living in households where at least 3 non-children’s books are present (Table CD.2). 42.1 percent of children aged 059- months have three or more children’s books. Both the median number of non-children’s books and children’s books are high (5 and 3 books respectively). No significant gender or urban-rural differentials are observed. The presence of both non-children’s and children’s books is positively correlated with the child’s age; in the homes of 62.6 percent of children aged 2459- months, there are 3 or more non- children’s books, while the figure is 54.7 percent for children aged 023- months. Similar differentials exist in terms of children’s books. Table CD.2 shows that the more educated the mother is the more books exist in the home. 46 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Table CD.2 also shows that 20.7 percent of children aged 059- months had 3 or more toys to play with in their homes, while 9 percent had no playthings. Playthings, as defined by MICS, include household objects, homemade toys, toys that came from a store, and objects and materials found outside the home. It is interesting to note that 77.8 percent of children play with toys that come from a store; however, the percentages for other homemade toys drops to 33.8 percent. The proportion of children who have 3 or more playthings to play with is 22.3 percent among male children decreasing to 19 percent among female children. Large differentials are observed between camps with regard to the proportion of children having 3 or more toys; it is as high as 39.7 percent in Aleppo camps and drops as low as 3 percent in Homs and Latakia camps. 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 059- 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 13.5 percent of children aged 0 -59 months were left in the care of other children, while 1.9 percent were left alone during the week preceding the interview. Combining the two indicators, it was calculated that 14 percent of children were left with inadequate supervision during the week preceding the survey. No differences were observed by sex of the child but there are differences between urban and rural areas. The percentage was higher in rural areas reaching 19.5 percent and dropping down to 10.7 percent in urban areas. Moreover, differences between individual camps were also observed. Inadequate care among children in Aleppo camps was 29.3 percent compared to 7.2 percent in Hama. The percentage of children left without adequate care was higher in the 24 -59 months age group reaching 16.6 percent while it decreased to 10.1 percent for children aged 0 -23 months. No differences were observed with regard to the mothers’ education level. 47 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 X. Education 10-1 Pre-School Attendance and School Readiness Attending pre-school education in an organized learning or child education programme is important to preparing children for school. One of the World Fit for Children goals is the promotion of early childhood education. Only 6.4 percent of children aged 3659- months are attending pre-school (Table ED.1). Attendance was lowest in Hama (3.6 percent). No gender differences were observed. Socio-economic status had an impact with 8.4 percent of children living in rich households attending pre-school, while the figure drops to 6.6 percent in poor households. The proportions of children attending pre-school at ages 36- 47 months and 48 -59 months are different (3.4 percent and 9.8 percent respectively). The table also shows the proportion of children in the first grade of primary school who attended pre- school the previous year; an important indicator of school readiness. Overall, 43.7 percent of children who are currently age 6 and attending the first grade of primary school were attending pre-school the previous year. The proportion among males is slightly higher (45.7 percent) than females (41.9 percent). 54.4 percent of children in urban areas who are currently attending the first grade of primary school had attended pre-school the previous year compared to 24.5 percent among children living in rural areas. Regional differentials are also significant; 63 percent of first graders in Homs have attended pre- school. This is more than twice their counterparts in the Aleppo region (27.3 percent). Socioeconomic status has a positive correlation with school readiness – while the indicator is only 34.3 percent among the poor households, it increases to 62.5 percent among children living in rich households. 10-2 Primary and Secondary School Participation6 Universal access to basic education and the accomplishment of primary education by the world’s children is one of the most important goals for both 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 labour 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 (or gender parity index - GPI)• 6 Secondary means both preparatory and secondary education as one stage 48 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 The indicators of school progression include: Survival rate to grade five• Transition rate to secondary school• Net primary completion rate• Of the children who are of primary school entry age (age 6), 92 percent are attending the first grade of primary school (Table ED.2). Sex differentials do not exist; however, significant differentials are present by region. In Dera’a, for instance, the value of the indicator reaches 86.5 percent, while it is 93.9 percent in Damascus. Table ED.3 provides the percentage of children of primary school age attending primary or secondary (i.e. preparatory and secondary) school. The majority (98.1 percent) of primary school age children are attending school. Whereas, 1.9 percent of children are not in primary school. Some may be attending the first grade of preparatory school while others who are not attending school might be dropouts, sick, and/or handicapped. The table indicates that there are neither major gender nor rural/urban differentials in net attendance rates. The secondary school net attendance ratio is presented in Table ED.4. Worse than primary school attendance rates, is the fact that only 70.5 percent of secondary school aged (12 -17 years) children are attending secondary school. The remaining percentage is either out of school or attending primary school (see below). This net attendance ratio rises as the mother’s education level increases and at higher levels of the wealth indicator. The percentage of children entering first grade who eventually reach grade 5 is presented in Table ED.5. Of all children starting grade one, 98.7 percent will eventually reach grade five. It is important to note that this number includes children that repeat grades and who eventually move up to reach grade five. There are no significant gender differences. The net primary school completion rate and transition rate to secondary education are presented in Table ED.6. At the time of the survey, only 83.4 percent of the children of primary school completion age (11 years) were attending 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. 94.4 percent of the children that successfully completed the last grade of primary school at the time of the survey were found to be attending the first grade of secondary school. No significant gender differences were noticed. The ratio of girls to boys attending primary and secondary education is provided in Table ED.7. These ratios are better known as the Gender Parity Index (GPI). It must be underscored 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 school is close to 1.01 for primary school going up to 1.12 in secondary school. The advantage of girls is particularly pronounced in Homs and in rural areas. 49 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 10-3 Adult Literacy One of the World Fit for Children goals is to assure adult literacy. Adult literacy is also an MDG indicator, relating to both men and women. In MICS, since only a women’s questionnaire was administered, the results are based only on females aged 15 -49. Literacy was assessed on the women’s ability to read a short simple statement or on school attendance. The literacy percentages are presented in Table ED.8. The percentage of women (aged 15- 24) that are able to read is 87 percent; reaching 89.2 percent in urban areas and decreasing to 83.4 percent in rural camps. 50 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 XI. Child Protection 11-1 Birth Registration The Convention on the Rights of the Child states that every child has the right to a name and a nationality, as well as 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 introduces the goal to develop systems that 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. The births of 99 percent of children under five years in Palestinian Refugee Camps and Gatherings in Syria have been registered (Table CP.1). There are no variations in birth registration across any variable including sex, age, or mother’s level of education. 11-2 Child Labour Article 32 of the Convention on the Rights of the Child asserts: «States Party 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 514- years of age involved in labour activities. A child is considered to be involved in child labour activities at the time of the survey if during the week preceding the survey they participated in: 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 differentiation between child labour and child work in order 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 above. Table CP.2 presents the results of child labour by type of work. Percentages do not add up to the total child labour number as children may be involved in more than one type of work. Survey results indicate that 1.5 percent of children aged 5 -14 were involved in labour activities during the reference week. The indicator goes up to 1.7 percent for boys and down to 1.2 for girls. Child labour is particularly high among school dropouts reaching 5 percent in children not attending school as opposed to 1 percent among children attending school regularly. In rural areas, the indicator is 2 percent and drops down to 1.2 for children living in urban areas. In Aleppo camps it is as high as 3.4 percent while it is nonexistent in Homs and Hama camps. Table CP.3 presents the percentage of children classified as student labourers or as labourer students. 51 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Student labourers are children attending school that were involved in child labour activities at the time of the survey. More specifically, of the 87.9 percent of children 5 -14 years of age attending school, 1 percent are also involved in child labour activities. Student labourers represent 59.6 percent of all child labourers. 11-3 Child Discipline According to WFFC «Children should be protected from any form of violence…» The Millennium Declaration calls for the protection of children from abuse, exploitation and violence. Through the MICS of Palestinian refugee camps in Syria a number of questions were addressed to mothers/caretakers who care for children aged 2 -14 about the methods used by adult family members to discipline their children when they misbehave. It should be noted that when the child discipline module was administered, one child aged 2 -14 was selected randomly from each household during fieldwork. The necessary information that describe the type of discipline applied on children are as follows: The number of children aged 2- 14 who are subjected to psychological punishment as a form of 1- discipline, or children who are subjected to light or medium physical punishment. The number of mothers/caretakers who care for children aged 22- 14- who believe that physical punishment is necessary for healthy child raising. Survey results show that 90 percent of children in camps aged 2 -14 had been subjected to a form of psychological or physical punishment at least once by their fathers, mothers or other household members. Most importantly, 9.6 percent of mothers believe that physical punishment is for a necessary component of child rearing. Male children were more subjected to light physical punishment at 74.7 percent and harsh physical punishment at 13.7 percent compared to 67.3 percent and 12.9 percent in the case of female children. It is interesting to note that significant differences are observed by camp in the proportion of psychological and physical punishment applied. The highest rate was in Damascus camps with 91.9 percent while the lowest were found in the Latakia camp at 73.9 percent. The rate of subjecting children to any form of physical or psychological punishment decreases as the mother´s level of education increases and in rich households compared to poor ones. 52 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 11-4 Early Marriage Child marriage is a violation of human rights, compromising the development of girls and often resulting in early pregnancy and social isolation, low levels of education and poor vocational training. The right to (free and full) consent to a marriage is recognised in the Universal Declaration of Human Rights - with the acknowledgement 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. 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 married girls between the ages of 15 and 19. 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 often seek to marry off their girls to protect their honour. The percentage of women aged 20- 49 that were married at an early age (before the age of 18) was around 22 percent. 53 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 XII. HIV/AIDS 12-1 Knowledge of HIV Transmission 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 (UNGASS) called on governments to improve the knowledge and skills of young people in order to protect themselves from HIV. The indicators used 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 measure, 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 had ever heard of AIDS. The results are presented in Table HA.1. In Palestinian Refugee Camps and Gatherings in Syria, the majority of the interviewed women (96 percent) have heard of AIDS. This percentage differs according to the mother>s level of education; 85.8 percent for mothers who have no education at all compared to 99.7 percent for mothers with higher educational levels. Table HA.2 presents the percentage of women who can correctly identify misconceptions concerning the transmission of HIV. The indicator is based on the two most common and relevant misconceptions in Palestinian Refugee Camps and Gatherings in Syria: that HIV can be transmitted by supernatural means and by mosquito bites. The table also provided information on whether women know that HIV cannot be transmitted by sharing food (80.2 percent) and that HIV can be transmitted by sharing needles (92.2 percent). Of the interviewed women, 49.4 percent reject the two most common misconceptions and know that a healthy-looking person can be infected. 84.4 percent of women know that HIV cannot be transmitted by supernatural means, and 58.8 percent of women know that HIV cannot be transmitted by mosquito bites, while 62.9 percent of women know that a healthy-looking person can be infected. 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 1549- years old concerning mother-to-child transmission is presented in Table HA.3. Overall, 93 percent of women knew of the possibility of mother-to-child transmission. Mothers who knew all three ways of mother-to-child transmission were around 38 percent, while only 3 percent of women did not know of any specific way of HIV mother-to-child transmission. 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 54 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 following four questions: would care for family member sick with AIDS; 1- would buy fresh vegetables from a vendor who was HIV positive; 2- thinks that a female teacher who is HIV positive should be allowed to teach in school; 3- would not want to keep HIV status of a family member a secret. 4- Table HA.5 presents the attitudes of women towards people living with HIV/AIDS. The table indicates that 8 percent of women would refuse caring for a family member sick with AIDS. 57 percent of women would want to keep the HIV status of a family member a secret. 62 percent of women think that a female teacher who is HIV positive should not be allowed to teach in school and two thirds of women would refuse to buy food from an HIV positive person. The table indicates that one in ten women refuse all of the above mentioned discriminatory statements. Another important indicator is the knowledge of where to be tested for HIV and use of such services. Questions related to knowledge among women of a facility for HIV testing and whether they have ever been tested is presented in Table HA.6. Only one fourth of women knew where to be tested. The percentage was 29.1 percent in Damascus camps down to 3.3 percent in the Homs camp. This percentage is 11.9 percent among illiterate mothers compared to 84.8 among mothers with a higher education. 55 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 XIII. ORPHANHOOD The percentage of children aged (0- 17) who are living with their parents reached around 94 percent. This figure is relatively higher in urban areas compared to rural ones and the highest is in the Hama Governorate with 97.2 percent. It is interesting to note that this percentage decreases as children grow older (Table HA.10.) On the other hand the table shows that around 4 percent of children in the said age category have one or both parents who died prior to the survey; but this percentage is slightly lower in urban areas compared to rural ones. It is also noted that the orphanhood rate is higher in poorer households compared to the richest ones. 56 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 XIV. SUMMARY AND RECOMMENDATIONS The Multiple Indicator Cluster Survey of Palestinian Refugee Camps and Gatherings in Syria was conducted to monitor and assess the situation of women and children. The survey data were collected between April 4th 2006 and May 31st 2006 using three questionnaires: the household questionnaire, the women aged (15 - 49) questionnaire and the children under five years of age questionnaire. Out of the weighted random sample of around 8000 households, 7048 households were interviewed with a success rate of 99.4 percent. The number of women interviewed reached 5610 with a response rate of 99.8 percent. The number of children whose questionnaires were successfully completed reached 3801 at a rate of 99.9 percent. The key survey results are as follows: The survey results show a drop in mortality rates during the past fifteen years. Mortality figures for • children under five years of age also dropped from 40 deaths per 1000 in 1992 to 30 deaths per 1000 in 2006. One in every ten children under five years of age in Palestinian camps in Syria is moderately or • severely underweight. More than one quarter of children are stunted. 8 percent are underweight, while 13 percent are overweight. The percentage of children under six months of age who receive exclusive breastfeeding reached • 16.2 percent, which is a low percentage, while 46.1 percent of children aged 6- 9 months receive solid or semi sold food in addition to breast milk. 7.3 percent of children aged 20 -23 months still receive breastfeeding. The percentage of children aged 12 -23 months who received the recommended vaccinations is • 90.6 percent. The percentage of camp residents who live in dwellings with improved sanitation facilities reached • 97.4 percent. 60.1 percent of married women said that they are currently using a means of contraception. IUD is • the most popular method followed by the pill. 95.1 percent of women receive antenatal care from trained health personnel at least once during • their pregnancy. 99.1 percent of births during the two years preceding the survey were delivered in the presence of qualified doctors and 92.6 percent of births were delivered at health facilities. Results show that only 6.4 percent of children aged 36 -59 months attend kindergartens, while 92 • percent of children of primary-school age (6 years) attend the first grade of secondary school. The reason behind the low intake rate is that the survey was conducted in April 2006 while school began in September 2005. The percentage of women aged (20- 49) whom married at an early age (under 18 years of age) • reached approximately 22 percent. Most women interviewed (around 96 percent) said that they have heard of AIDS and around 93 • percent have knowledge of mother-to-child transmission of HIV. 57 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Recommendations Health care should be expanded to include modern services and information about health facility • locations that provide these services should be available. In addition, all practices that are harmful to health with respect to mother and child nutrition should be eradicated and the culture of breastfeeding should be promoted. Intensify efforts to increase visits to hospitals and specialised facilities, reduce the cost of services • provided, move toward the integration of health services, enhance the quality of services provided and improve the skills of service providers. Maximise use of the media to raise public health awareness and knowledge to promote breastfeeding • and healthy nutrition, complete the various vaccinations and reduce harmful practices and sexually transmitted diseases. Conduct a number of analytical studies to help policy makers and health programmes, in particular • programmes that address fertility trends, unfulfilled health needs and children’s nutritional status. 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), 20916-. Blanc, A. and Wardlaw, T. 2005. «Monitoring Low Birth Weight: An Evaluation of International Estimates and an Updated Estimation Procedure». WHO Bulletin, 83 (3), 178185-. 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): 115132-. 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. 58 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Table HH.1: Household and individual interview Results Number 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, Palestinian Refugee Camps and Gatherings in Syria, 2006 Urban / Rural Governorate Total Urban Rural Damascus Aleppo Homs Hama Latakia Dera’a Sampled households 5325 2675 5680 880 540 320 240 340 8000 Occupied households 5325 2675 5680 880 540 320 240 340 8000 Interviewed households 5285 2663 5655 876 530 320 240 327 7948 Household response rate 99.2 99.6 99.6 99.5 98.1 100.0 100.0 96.2 99.4 Eligible women 3709 1911 4004 629 368 236 157 226 5620 Interviewed women 3702 1908 3997 627 368 235 157 226 5610 Women’s response rate 99.8 99.8 99.8 99.7 100.0 99.6 100.0 100.0 99.8 Women’s overall response rate 99.1 99.4 99.4 99.2 98.1 99.6 100.0 96.2 99.2 Eligible children under 5 2413 1391 2717 413 231 151 100 192 3804 Mother/Caretaker Interviewed 2411 1390 2716 412 231 151 100 191 3801 Child response rate 99.9 99.9 100.0 99.8 100.0 100.0 100.0 99.5 99.9 Children’s overall response rate 99.2 99.5 99.5 99.3 98.1 100.0 100.0 95.7 99.3 59 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Ta bl e H H .1 (c on tin ue d) : H ou se ho ld a nd In di vi du al In te rv ie w R es ul ts N um be rs o f h ou se ho ld s, w om en a nd c hi ld re n un de r 5 b y re su lts o f t he h ou se ho ld , w om en ’s a nd u nd er -fi ve ’s in te rv ie w s, a nd h ou se ho ld , w om en ’s a nd u nd er -fi ve ’s re sp on se ra te s, P al es tin ia n R ef ug ee C am ps a nd G at he rin gs in S yr ia , 2 00 6 C am p / G at he rin g To ta l Ya rm ou k Ja ra m an a S be in eh K ha n E sh ie h K ha n D un ou n S itt Ze in ab R am ad an H us sa yn ie h N ei ra b H an da ra t H om s H am a R am el D er a’ a M za ire eb Je lly n S am pl ed ho us eh ol ds 31 43 73 8 49 9 49 9 35 9 38 0 42 20 72 0 16 0 54 0 32 0 24 0 18 1 13 8 21 80 00 O cc up ie d ho us eh ol ds 31 43 73 8 49 9 49 9 35 9 38 0 42 20 72 0 16 0 54 0 32 0 24 0 18 1 13 8 21 80 00 In te rv ie w ed ho us eh ol ds 31 27 73 6 49 9 49 4 35 7 38 0 42 20 71 6 16 0 53 0 32 0 24 0 17 3 13 3 21 79 48 H ou se ho ld re sp on se ra te 99 .5 99 .7 10 0. 0 99 .0 99 .4 10 0. 0 10 0. 0 10 0. 0 99 .4 10 0. 0 98 .1 10 0. 0 10 0. 0 95 .6 96 .4 10 0. 0 99 .4 E lig ib le w om en 21 71 54 3 37 3 34 8 26 0 26 5 33 11 51 6 11 3 36 8 23 6 15 7 11 7 92 17 56 20 In te rv ie w ed w om en 21 66 54 2 37 3 34 7 26 0 26 5 33 11 51 4 11 3 36 8 23 5 15 7 11 7 92 17 56 10 W om en re sp on se ra te 99 .8 99 .8 10 0. 0 99 .7 10 0. 0 10 0. 0 10 0. 0 10 0. 0 99 .6 10 0. 0 10 0. 0 99 .6 10 0. 0 10 0. 0 10 0. 0 10 0. 0 99 .8 W om en ’s o ve ra ll re sp on se ra te 99 .3 99 .5 10 0. 0 98 .7 99 .4 10 0. 0 10 0. 0 10 0. 0 99 .1 10 0. 0 98 .1 99 .6 10 0. 0 95 .6 96 .4 10 0. 0 99 .2 E lig ib le c hi ld re n un de r 5 13 18 41 5 28 3 28 8 16 7 20 1 34 11 33 5 78 23 1 15 1 10 0 85 89 18 38 04 M ot he r/C ar et ak er In te rv ie w ed 13 17 41 5 28 3 28 8 16 7 20 1 34 11 33 4 78 23 1 15 1 10 0 84 89 18 38 01 C hi ld re sp on se ra te 99 .9 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 99 .7 10 0. 0 10 0. 0 10 0. 0 10 0. 0 98 .8 10 0. 0 10 0. 0 99 .9 C hi ld re n’ s ov er al l re sp on se ra te 99 .4 99 .7 10 0. 0 99 .0 99 .4 10 0. 0 10 0. 0 10 0. 0 99 .1 10 0. 0 98 .1 10 0. 0 10 0. 0 94 .5 96 .4 10 0. 0 99 .3 60 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 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, Palestinian Refugee Camps and Gatherings in Syria, 2006 Sex Total Male Female Number Percent Number Percent Number Percent Age 0 - 4 1949 10.0 1855 9.5 3804 9.7 5-9 2314 11.8 2236 11.5 4550 11.7 10-14 2316 11.8 2250 11.6 4566 11.7 15 -19 2322 11.9 2295 11.8 4617 11.8 20 - 24 2179 11.1 1994 10.2 4173 10.7 25 - 29 1525 7.8 1578 8.1 3103 8.0 30 - 34 1236 6.3 1386 7.1 2622 6.7 35 - 39 1139 5.8 1342 6.9 2481 6.4 40 - 44 1122 5.7 1177 6.0 2299 5.9 45 - 49 900 4.6 813 4.2 1713 4.4 50 - 54 690 3.5 773 4.0 1463 3.7 55 - 59 495 2.5 468 2.4 963 2.5 60 - 64 521 2.7 465 2.4 986 2.5 65 - 69 344 1.8 315 1.6 659 1.7 70+ 496 2.5 524 2.7 1020 2.6 Missing/DK 2 .0 0 .0 2 .0 Dependency Age Groups <15 6579 33.7 6341 32.6 12920 33.1 15 - 64 12129 62.0 12291 63.1 24420 62.6 65+ 840 4.3 839 4.3 1679 4.3 Missing/DK 2 .0 0 .0 2 .0 Age Children aged 0-17 7975 40.8 7711 39.6 15686 40.2 Adults 18+/Missing/DK 11575 59.2 11760 60.4 23335 59.8 Total 19550 100.0 19471 100.0 39021 100.0 61 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Table HH.3: Household Composition Percent distribution of households by selected characteristics, Palestinian Refugee Camps and Gatherings in Syria, 2006 Weighted percent Number of households weighted Number of households unweighted Sex of household head Male 87.7 6973 6973 Female 12.3 975 975 Governorates Damascus 71.1 5655 5655 Aleppo 11.0 876 876 Homs 6.7 530 530 Hama 4.0 320 320 Latakia 3.0 240 240 Dera’a 4.1 327 327 Camps / Gatherings Yarmouk 39.3 3127 3127 Jaramana 9.3 736 736 Sbeineh 6.3 499 499 Khan Eshieh 6.2 494 494 Khan Dunoun 4.5 357 357 Sitt Zeinab 4.8 380 380 Ramadan .5 42 42 Hussaynieh .3 20 20 Neirab 9.0 716 716 Handarat 2.0 160 160 Homs 6.7 530 530 Hama 4.0 320 320 Ramel 3.0 240 240 Dera’a 2.2 173 173 Mzaireeb 1.7 133 133 Jellyn .3 21 21 Urban / Rural Urban 66.5 5285 5285 Rural 33.5 2663 2663 Number of household members 1 4.4 346 346 2-3 22.5 1791 1791 4-5 35.3 2808 2808 6-7 26.1 2077 2077 8-9 9.4 751 751 10+ 2.2 175 175 Total 100.0 7948 7948 At least one child aged < 18 years 71.2 7948 7948 At least one child aged < 5 years 35.6 7948 7948 At least one woman aged 15-49 years 69.8 7948 7948 62 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Table HH.4: Women’s Background Characteristics Percent distribution of women aged 15-49 years by background characteristics, Palestinian Refugee Camps and Gatherings in Syria, 2006 Weighted percent Number of Women weighted Number of Women unweighted Governorates Damascus 71.2 3995 3995 Aleppo 11.2 629 629 Homs 6.6 369 369 Hama 4.2 236 236 Latakia 2.8 155 155 Dera’a 4.0 226 226 Camps / Gatherings Yarmouk 38.6 2166 2166 Jaramana 9.7 543 543 Sbeineh 6.6 372 372 Khan Eshieh 6.2 346 346 Khan Dunoun 4.6 260 260 Sitt Zeinab 4.7 264 264 Ramadan .6 33 33 Hussaynieh .2 11 11 Neirab 9.2 516 516 Handarat 2.0 113 113 Homs 6.6 369 369 Hama 4.2 236 236 Ramel 2.8 155 155 Dera’a 2.1 117 117 Mzaireeb 1.6 92 92 Jellyn .3 17 17 Urban / Rural Urban 66.0 3702 3702 Rural 34.0 1908 1908 Age 15-19 3.0 166 166 20-24 12.0 675 675 25-29 17.7 991 991 30-34 17.9 1004 1004 35-39 19.3 1081 1081 40-44 17.7 991 991 45-49 12.5 702 702 Motherhood status Ever gave birth 90.6 5082 5082 Never gave birth 9.4 528 528 63 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Table HH.4 (continued): Women’s Background Characteristics Percent distribution of women aged 1549- years by background characteristics, Palestinian Refugee Camps and Gatherings in Syria, 2006 Weighted percent Number of Women weighted Number of Women unweighted Education None 3.9 218 218 Primary 20.1 1130 1130 Preparatory 34.9 1960 1960 Secondary 23.3 1309 1309 Vocational 11.1 622 622 Higher education 6.5 363 363 Informal education * * 8 Wealth index quintiles Poorest 20.4 1143 1143 Second 19.0 1068 1068 Middle 21.0 1176 1176 Fourth 20.4 1143 1143 Richest 19.3 1080 1080 Total 100.0 5610 5610 * number < 25 64 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Table HH.5: Children’s Background Characteristics Percent distribution of children under five years of age by background characteristics, Palestinian Refugee Camps and Gatherings in Syria, 2006 Weighted percent Number of under-5 children weighted Number of under-5 children unweighted Sex Male 51.3 1949 1949 Female 48.7 1852 1852 Governorates Damascus 71.3 2712 2712 Aleppo 10.9 416 416 Homs 6.1 231 231 Hama 4.0 152 152 Latakia 2.6 99 99 Dera’a 5.0 191 191 Camps / Gath- erings Yarmouk 34.6 1317 1317 Jaramana 10.9 416 416 Sbeineh 7.4 281 281 Khan Eshieh 7.6 287 287 Khan Dunoun 4.4 167 167 Sitt Zeinab 5.3 200 200 Ramadan .9 34 34 Hussaynieh .3 10 10 Neirab 8.9 338 338 Handarat 2.1 78 78 Homs 6.1 231 231 Hama 4.0 152 152 Ramel 2.6 99 99 Dera’a 2.2 84 84 Mzaireeb 2.3 89 89 Jellyn .5 18 18 Urban / Rural Urban 63.4 2411 2411 Rural 36.6 1390 1390 Age < 6 months 9.7 369 369 6-11 months 10.6 402 402 12-23 months 20.6 784 784 24-35 months 20.6 782 782 36-47 months 20.8 791 791 48-59 months 17.7 671 671 Mother’s education None 1.7 65 65 Primary 20.1 765 765 Preparatory 36.9 1403 1403 Secondary 22.9 872 872 Vocational 12.4 470 470 Higher education 5.9 225 225 Informal education * 1 1 Wealth index quintiles Poorest 25.1 954 954 Second 20.7 785 785 Middle 22.0 837 837 Fourth 18.9 718 718 Richest 13.3 507 507 Total 100.0 3801 * number < 25 65 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Table CM.1: Child Mortality Infant and under-five mortality rates, Palestinian Refugee Camps and Gatherings in Syria, 2006 Infant Mortality Rate* Under-five Mortality Rate** Sex Male 28 33 Female 23 27 Area South1 28 34 North2 16 19 Middle3 16 18 Urban / Rural Urban 19 22 Rural 37 45 Mother’s education None 66 93 Primary 34 42 Preparatory 29 35 Secondary 18 21 Vocational 10 12 Wealth index quintiles Poorest 33 40 Second 42 53 Middle 20 24 Fourth 11 12 Richest 17 19 Total 25 30 * MICS indicator 2; MDG indicator 14 ** MICS indicator 1; MDG indicator 13 66 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Table NU.1: Child Malnourishment Percentage of under-five children who are severely or moderately undernourished, Palestinian Refugee Camps and Gatherings in Syria, 2006 Weight for age Height for age Weight for height %below -2 SD** %below -3 SD** %below -2 SD*** %below -3 SD*** %below -2 SD**** %below -3 SD**** %above +2 SD Number of children Sex Male 10.2 1.9 28.2 14.1 8.8 2.6 12.2 1701 Female 9.8 2.7 25.6 12.1 7.2 1.9 13.2 1618 Governorates Damascus 9.4 2.1 27.1 12.6 8.1 2.3 14.0 2406 Aleppo 8.0 1.8 18.1 6.5 6.5 1.5 4.8 398 Homs 5.6 .0 46.4 31.2 4.8 .8 26.4 125 Hama 26.0 12.2 40.5 26.7 16.0 6.1 12.2 131 Latakia 6.5 .0 8.6 .0 6.5 3.2 3.2 93 Dera’a 16.3 1.2 30.7 18.1 7.8 .6 9.0 166 Camps / Gatherings Yarmouk 11.3 2.6 21.2 9.4 8.6 2.5 11.9 1182 Jaramana 2.3 .6 46.3 23.6 .9 .3 32.8 348 Sbeineh 3.1 .8 19.5 6.9 6.9 1.9 11.1 262 Khan Eshieh 13.7 4.0 25.0 10.9 9.3 3.2 6.5 248 Khan Dunoun 10.3 .0 43.2 24.7 13.7 3.4 12.3 146 Sitt Zeinab 11.8 2.8 31.5 15.2 12.9 3.9 9.0 178 Ramadan 15.6 3.1 12.5 6.3 15.6 3.1 6.3 32 Hussaynieh * * * * * * * 10 Neirab 7.8 1.9 18.0 6.5 6.5 1.6 4.7 322 Handarat 9.2 1.3 18.4 6.6 6.6 1.3 5.3 76 Homs 5.6 .0 46.4 31.2 4.8 .8 26.4 125 Hama 26.0 12.2 40.5 26.7 16.0 6.1 12.2 131 Ramel 6.5 .0 8.6 .0 6.5 3.2 3.2 93 Dera’a 19.1 1.5 22.1 8.8 13.2 .0 7.4 68 Mzaireeb 12.2 1.2 35.4 22.0 4.9 1.2 9.8 82 Jellyn * * * * * * * 16 Urban / Rural Urban 10.5 2.5 28.5 14.5 7.6 2.1 15.7 2049 Rural 9.1 1.9 24.5 10.7 8.7 2.4 7.9 1270 Age < 6 months 3.8 .7 18.5 4.1 7.5 1.0 21.6 292 6-11 months 6.3 .6 23.4 8.9 6.6 1.6 19.9 316 12-23 months 11.1 2.8 33.9 18.8 8.2 2.2 14.9 637 24-35 months 10.1 2.4 30.0 17.4 5.9 1.3 7.6 713 36-47 months 12.0 3.4 26.4 12.1 10.5 3.0 9.7 734 48-59 months 11.0 1.9 22.6 9.7 8.3 3.5 12.1 627 67 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Table NU.1 (continued): Child Malnourishment Percentage of under-five children who are severely or moderately undernourished, Palestinian Refugee Camps and Gatherings in Syria, 2006 Weight for age Height for age Weight for height %below -2 SD** %below -3 SD** %below -2 SD*** %below -3 SD*** %below -2 SD**** %below -3 SD**** %above +2 SD Number of children Mother’s education None 9.1 .0 21.8 10.9 12.7 1.8 18.2 55 Primary 10.6 2.5 31.3 14.8 8.4 3.0 13.6 667 Preparatory 10.7 1.8 28.2 14.6 8.0 2.4 13.8 1210 Secondary 9.5 2.1 25.7 12.0 6.3 1.4 11.1 767 Vocational 7.4 3.3 21.1 9.6 9.6 2.4 11.2 418 Higher edu- cation 10.4 3.5 22.9 10.0 9.0 2.0 10.4 201 Informal education * * * * * * * 1 Wealth index quintiles Poorest 10.0 2.6 29.9 15.3 7.2 2.4 12.5 847 Second 7.5 1.0 30.3 14.2 7.5 1.6 15.2 690 Middle 10.5 2.0 27.2 13.1 7.7 2.2 13.5 712 Fourth 10.9 2.9 23.5 11.0 9.3 2.4 9.6 616 Richest 11.5 3.3 20.5 9.9 9.0 2.9 12.3 454 Total 10.0 2.3 26.9 13.1 8.0 2.3 12.7 3319 * number < 25 ** MICS indicator 6; MDG indicator 4 *** MICS indicator 7 **** MICS indicator 8 68 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Table NU.2: Initial Breastfeeding Percentage of women aged 1549- 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, Palestinian Refugee Camps and Gatherings in Syria, 2006 Percentage who started breastfeeding after birth immediately Percentage who started breastfeeding within one hour of birth** Percentage who started breastfeeding within one day of birth Number of women with live birth inthe two years preceding the survey Governorates Damascus 49.4 50.1 81.9 1089 Aleppo 55.7 55.7 83.5 158 Homs 75.6 76.7 82.2 90 Hama 86.6 88.1 94.0 67 Latakia (83.3) (83.3) (92.9) 42 Dera’a 61.3 61.3 81.3 75 Camps / Gatherings Yarmouk 58.8 59.8 85.8 520 Jaramana 58.8 60.0 83.6 165 Sbeineh 53.4 54.2 80.5 118 Khan Eshieh 19.1 19.1 72.2 115 Khan Dunoun 28.2 28.2 73.2 71 Sitt Zeinab 27.8 27.8 74.7 79 Ramadan * * * 17 Hussaynieh * * * 4 Neirab 55.2 55.2 82.1 134 Handarat * * * 24 Homs 75.6 76.7 82.2 90 Hama 86.6 88.1 94.0 67 Ramel (83.3) (83.3) (92.9) 42 Dera’a (65.7) (65.7) (82.9) 35 Mzaireeb (62.5) (62.5) (81.3) 32 Jellyn * * * 8 Urban / Rural Urban 63.4 64.4 85.6 957 Rural 40.1 40.2 78.4 564 Months since last birth < 6 months 51.6 52.4 82.6 380 6-11 months 54.0 54.3 80.2 409 12-23 months 56.7 57.5 84.5 730 69 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Table NU.2 (continued): Initial Breastfeeding Percentage of women aged 1549- 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, Palestinian Refugee Camps and Gatherings in Syria, 2006 Percentage who started breastfeeding after birth immediately 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 Mother’s education None (40.0) (44.0) (68.0) 25 Primary 46.6 47.5 77.0 305 Preparatory 55.2 55.9 84.3 547 Secondary 60.9 60.9 84.2 361 Vocational 52.1 53.2 87.4 190 Higher education 64.8 64.8 84.6 91 Informal education * * * 2 Wealth index quintiles Poorest 45.8 46.3 77.3 400 Second 48.7 48.7 81.4 318 Middle 58.5 59.8 87.3 323 Fourth 64.6 65.6 85.2 291 Richest 62.4 63.0 86.2 189 Total 54.8 55.4 82.9 1521 * number < 25, () number < 50 ** MICS indicator 45 70 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Ta bl e N U .3 : B re as tfe ed in g P er ce nt o f l iv in g ch ild re n ac co rd in g to b re as tfe ed in g st at us a t e ac h ag e gr ou p, P al es tin ia n R ef ug ee C am ps a nd G at he rin gs in S yr ia , 2 00 6 C hi ld re n 0- 3 m on th s C hi ld re n 0- 5 m on th s C hi ld re n 6- 9 m on th s C hi ld re n 12 -1 5 m on th s C hi ld re n 20 -2 3 m on th s P er ce nt m ai nl y br ea st fe d N um be r of c hi l- dr en P er ce nt ex cl us iv el y br ea st fe d* * N um be r o f ch ild re n P er ce nt re ce iv in g br ea st m ilk an d so lid /m us hy fo od * ** N um be r o f ch ild re n P er ce nt br ea st fe d* ** * N um be r o f ch ild re n P er ce nt br ea st fe d* ** * N um be r of c hi l- dr en S ex M al e 18 .5 13 0 13 .9 20 9 62 .0 12 9 50 .7 15 2 T7 .0 14 2 Fe m al e 25 .5 11 0 19 .1 16 2 66 .4 12 2 48 .5 13 4 7. 6 11 9 G ov er no r- at es D am as cu s 24 .1 17 0 17 .6 26 7 66 .7 17 7 43 .5 19 3 7. 8 20 5 A le pp o 8. 8 34 6. 3 48 * 24 59 .3 27 * 17 H om s * 13 * 20 * 20 * 14 * 18 H am a * 7 * 13 * 12 * 22 * 6 La ta ki a * 9 * 12 * 8 * 11 * 6 D er a’ a * 7 * 11 * 10 * 19 * 9 C am ps / G at he rin gs Ya rm ou k 16 .5 91 11 .7 13 7 70 .1 87 49 .4 77 8. 2 98 Ja ra m an a 33 .3 21 27 .0 37 70 .0 20 38 .2 34 10 .7 28 S be in eh * 18 ( 1 2. 0) 25 (6 7. 9 ) 28 * 14 * 18 K ha n E sh ie h * 20 (5 1. 9) 27 * 18 (3 6. 0) 25 (.0 ) 26 K ha n D un ou n * 6 * 10 * 13 * 18 * 13 S itt Z ei na b 27 .3 11 12 .0 25 37 .5 8 25 .0 16 19 .0 21 R am ad an * 1 * 4 * 3 * 6 * 1 H us sa yn ie h * 2 * 2 . 0 * 3 . 0 N ei ra b (1 0. 0) 30 (7 .1 ) 42 * 18 * 21 * 14 H an da ra t * 4 * 6 * 6 * 6 * 3 H om s * 13 * 20 * 20 * 14 * 18 H am a * 7 * 13 * 12 * 22 * 6 R am el * 9 * 12 * 8 * 11 * 6 D er a’ a * 3 * 4 * 3 * 5 * 5 M za ire eb * 4 * 6 * 6 * 9 * 3 Je lly n . 0 * 1 * 1 * 5 * 1 U rb an / R ur al U rb an 19 .7 15 2 15 .4 23 4 67 .1 15 5 51 .4 17 5 7. 9 16 5 R ur al 25 .0 88 17 .5 13 7 59 .4 96 46 .8 11 1 6. 3 96 71 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Ta bl e N U .3 (c on tin ue d) : B re as tfe ed in g P er ce nt o f l iv in g ch ild re n ac co rd in g to b re as tfe ed in g st at us a t e ac h ag e gr ou p, P al es tin ia n R ef ug ee C am ps a nd G at he rin gs in S yr ia , 2 00 6 C hi ld re n 0 -3 m on th s C hi ld re n 0 -5 m on th s C hi ld re n 6 -9 m on th s C hi ld re n 12 -1 5 m on th s C hi ld re n 20 -2 3 m on th s P er ce nt m ai nl y br ea st fe d N um be r of ch ild re n P er ce nt ex cl us iv el y br ea st fe d* * N um be r of ch ild re n P er ce nt re ce iv - in g br ea st m ilk a nd s ol id / m us hy fo od * ** N um be r of ch ild re n P er ce nt br ea st fe d* ** * N um be r of ch ild re n P er ce nt br ea st fe d* ** * N um be r of ch ild re n M ot he r’s ed uc at io n N on e * 2 * 4 * 6 * 3 * 3 P rim ar y 16 .7 36 9. 7 62 47 .2 53 57 .6 66 8. 3 60 P re pa ra to ry 20 .5 88 16 .1 13 7 67 .5 80 42 .0 10 0 8. 4 95 S ec on da ry 28 .0 50 21 .7 83 70 .3 64 56 .9 65 4. 9 61 Vo ca tio na l (2 0. 0) 45 15 .0 60 (7 3. 3) 30 (4 1. 2) 34 (3 .8 ) 26 H ig he r e du ca tio n * 19 (1 6. 0) 25 * 17 * 18 * 16 In fo rm al e du ca tio n * * * * * 1 * * * 0 W ea lth in de x qu in til es P oo re st 32 .1 53 22 .7 88 63 .0 54 46 .2 91 8. 2 73 S ec on d (2 3. 4) 47 16 .7 84 65 .0 60 (4 8. 9) 47 10 .3 58 M id dl e 18 .0 61 14 .1 85 60 .0 55 53 .8 65 5. 7 53 Fo ur th (6 .8 ) 44 5. 9 68 56 .8 44 50 .0 50 4. 0 50 R ic he st (2 8. 6) 35 (2 1. 7) 46 (7 8. 9) 38 (5 1. 5) 33 (7 .4 ) 27 To ta l 21 .7 24 0 16 .2 37 1 64 .1 25 1 49 .7 28 6 7. 3 26 1 * nu m be r < 2 5, () n um be r < 5 0 ** M IC S in di ca to r 1 5 ** * M IC S in di ca to r 1 7 ** ** M IC S in di ca to r 1 6 72 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 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, Palestinian Refugee Camps and Gatherings in Syria, 2006 05- months who received breast milk mainly 6 -8 months who received breast milk and complementary food at least 2 times in prior 24 hours 9 -11 months who received breast milk and complementary food at least 3 times in prior 24 hours 6 -11 months who received breast milk and complementary food at least the minimum recommended number of times per day** 0 -11 months who were appropriately fed*** Number of infants aged 0- 11 months Sex Male 13.9 49.5 32.4 40.8 27.1 410 Female 19.1 57.1 38.5 46.3 34.2 363 Governorates Damascus 17.6 53.4 36.8 44.4 31.5 553 Aleppo 6.3 50.0 39.3 43.5 24.5 94 Homs (30.0) (50.0) (35.3) (41.4) (36.7) 49 Hama (7.7) (50.0) (9.1) (26.3) (18.8) 32 Latakia * * * * * 20 Dera’a (18.2) (85.7) (28.6) (57.1) (40.0) 25 Camps / Gatherings Yarmouk 11.7 59.0 34.7 45.6 28.6 273 Jaramana 27.0 35.3 30.0 32.4 29.7 74 Sbeineh 12.0 60.0 41.7 50.0 36.2 69 Khan Eshieh 51.9 54.5 56.3 55.6 53.7 54 Khan Dunoun (10.0) (46.2) (22.2) (36.4) (28.1) 32 Sitt Zeinab (12.0) (42.9) (44.4) (43.8) (24.4) 41 Ramadan * * * * * 8 Hussaynieh * * * * * 2 Neirab 7.1 50.0 43.5 45.9 25.3 79 Handarat * * * * * 15 Homs (30.0) (50.0) (35.3) (41.4) (36.7) 49 Hama (7.7) (50.0 ) (9.1) (26.3) (18.8) 32 Ramel * * * * * 20 Dera’a * * * * * 10 Mzaireeb * * * * * 12 Jellyn * * * * * 3 Urban / Rural Urban 15.4 53.2 31.5 41.5 28.6 475 Rural 17.5 52.8 41.6 46.6 33.2 298 73 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Table NU.4 (continued): 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, Palestinian Refugee Camps and Gatherings in Syria, 2006 0- 5 months who received breast milk mainly 6 -8 months who received breast milk and complementary food at least 2 times in prior 24 hours 9 -11 months who received breast milk and complementary food at least 3 times in prior 24 hours 6 -11 months who received breast milk and complementary food at least the minimum recommended number of times per day** 0 -11 months who were appropriately fed*** Number of infants aged 0- 11 months Mother’s education None * * * * * 13 Primary 9.7 41.5 42.5 42.0 28.0 143 Preparatory 16.1 59.0 30.1 43.3 29.5 271 Secondary 21.7 56.8 37.3 45.6 34.9 186 Vocational 15.0 61.1 35.5 44.9 28.4 109 Higher education 16.0 50.0 45.5 48.0 32.0 50 Informal education * * * * * 1 Wealth index quintiles Poorest 22.7 48.7 48.1 48.4 35.9 181 Second 16.7 54.5 31.8 43.2 30.2 172 Middle 14.1 53.5 22.2 37.5 26.0 173 Fourth 5.9 45.5 44.0 44.6 27.2 151 Richest 21.7 66.7 23.1 44.0 33.3 96 Total 16.2 53.0 35.6 43.5 30.4 773 * number < 25, () number < 50 ** MICS indicator 18 *** MICS indicator 19 74 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Table NU.5: Iiodised Salt Consumption Percentage of households which consume iodised Salt, Palestinian Refugee Camps and Gatherings in Syria, 2006 Percentage who Subjected to salt test Interviewed households Percentage who Total Percen- tage who Subjec- ted to salt test or Didn’t have salt Didn’t have salt Have Salt test result <15ppm >=15ppm* Governorates Damascus 98.5 5655 .4 41.5 58.1 100.0 5592 Aleppo 94.7 876 1.1 37.7 61.3 100.0 839 Homs 99.8 530 .0 31.0 69.0 100.0 529 Hama 96.6 320 1.0 26.0 73.1 100.0 312 Latakia 100.0 240 .0 .0 100.0 100.0 240 Dera’a 96.6 327 .0 44.0 56.0 100.0 316 Camps / Gatherings Yarmouk 97.7 3128 .4 36.5 63.2 100.0 3068 Jaramana 99.6 736 .3 47.2 52.5 100.0 735 Sbeineh 98.8 500 1.0 44.9 54.1 100.0 499 Khan Es- hieh 100.0 494 .0 43.3 56.7 100.0 494 Khan Du- noun 100.0 357 .0 67.5 32.5 100.0 357 Sitt Zeinab 99.2 380 .5 33.8 65.7 100.0 379 Ramadan ( 100.0) 42 (.0 ) (95.2) (4.8) (100.0) 42 Hus- saynieh 98.3 60 1.7 45.0 53.3 100.0 60 Neirab 94.8 676 .3 35.0 64.7 100.0 643 Handarat 93.1 160 4.5 46.2 49.4 100.0 156 Homs 99.8 530 .0 31.1 69.0 100.0 530 Hama 96.6 320 1.0 26.0 73.1 100.0 312 Ramel 100.0 240 .0 .0 100.0 100.0 240 Dera’a 98.8 173 .0 42.7 57.3 100.0 171 Mzaireeb 93.2 133 .0 44.4 55.6 100.0 124 Jellyn * 21 * * * * 21 Urban / Rural Urban 98.1 5285 .3 35.5 64.2 100.0 5203 Rural 97.9 2663 .6 44.7 54.6 100.0 2625 Wealth index quintiles Poorest 98.7 1569 .4 45.9 53.7 100.0 1554 Second 98.4 1523 .6 49.2 50.2 100.0 1507 Middle 97.6 1657 .5 40.4 59.1 100.0 1625 Fourth 98.2 1584 .2 31.2 68.6 100.0 1558 Richest 97.6 1615 .4 26.7 72.9 100.0 1584 Total 98.1 7948 .4 38.6 61.0 100.0 7828 * MICS indicator 41 75 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 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, Palestinian Refugee Camps and Gatherings in Syria, 2006 Percent of children who received Vitamin A: Within last 6 months** Prior to last 6 months Not sure when Not sure if received Never received Vitamin A Total Number of children aged 6-59 months Sex Male 1.7 2.3 4.1 2.6 89.2 100.0 1740 Female 2.7 2.2 3.3 3.1 88.7 100.0 1690 Governo- rates Damascus 2.6 2.8 4.2 2.9 87.5 100.0 2445 Aleppo 1.4 1.4 .5 2.7 94.0 100.0 368 Homs .5 .5 4.3 6.6 88.2 100.0 211 Hama .0 .0 .7 .7 98.6 100.0 139 Latakia 1.1 .0 .0 .0 98.9 100.0 87 Dera’a 2.2 1.7 7.2 1.7 87.2 100.0 180 Camps / Gatherings Yarmouk 2.8 4.5 4.0 2.6 86.0 100.0 1180 Jaramana 4.5 2.9 3.7 3.2 85.8 100.0 379 Sbeineh 2.7 1.6 .8 4.3 90.6 100.0 256 Khan Eshieh 2.3 .4 13.1 3.8 80.4 100.0 260 Khan Du- noun .0 .0 1.3 1.9 96.8 100.0 157 Sitt Zeinab .0 .0 1.7 1.7 96.6 100.0 175 Ramadan (.0) (.0) (.0) (.0) (100.0) (100.0) 30 Hussaynieh * * * * * * 8 Neirab 1.7 .7 .7 3.4 93.6 100.0 296 Handarat .0 4.2 .0 .0 95.8 100.0 72 Homs .5 .5 4.3 6.6 88.2 100.0 211 Hama .0 .0 .7 .7 98.6 100.0 139 Ramel 1.1 .0 .0 .0 98.9 100.0 87 Dera’a 5.0 2.5 10.0 3.8 78.8 100.0 80 Mzaireeb .0 1.2 6.0 .0 92.8 100.0 83 Jellyn * * * * * * 17 Urban / Rural Urban 2.6 3.1 3.9 2.8 87.6 100.0 2177 Rural 1.5 .8 3.4 3.0 91.3 100.0 1253 Age 6-11 months 3.5 .7 2.2 2.5 91.0 100.0 402 12-23 months 2.7 1.7 2.6 1.9 91.2 100.0 784 24-35 months 1.8 2.9 3.8 3.1 88.4 100.0 782 36-47 months 1.8 3.2 3.7 3.5 87.9 100.0 791 48-59 months 1.8 2.1 5.8 3.3 87.0 100.0 671 76 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Table NU.6 (continued): 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, Palestinian Refugee Camps and Gatherings in Syria, 2006 Percent of children who received Vitamin A: Total 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 Mother’s education None 1.6 1.6 4.9 3.3 88.5 100.0 61 Primary 1.6 2.8 3.4 3.3 88.9 100.0 703 Preparatory 2.5 2.3 4.0 3.0 88.2 100.0 1266 Secondary 1.9 2.5 3.4 2.4 89.7 100.0 789 Vocational 2.2 1.7 4.9 3.7 87.6 100.0 410 Higher education 3.5 .5 1.0 1.0 94.0 100.0 200 Informal education * * * * * * 1 Wealth index quintiles Poorest 2.5 1.3 5.3 3.1 87.8 100.0 866 Second 2.0 1.4 2.9 2.9 90.9 100.0 701 Middle 1.9 3.7 3.5 3.1 87.9 100.0 752 Fourth 1.2 2.6 3.1 2.5 90.6 100.0 650 Richest 3.7 2.6 3.3 2.8 87.6 100.0 461 Total 2.2 2.3 3.7 2.9 89.0 100.0 3430 * number < 25 ** MICS indicator 42 77 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 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, Palestinian Refugee Camps and Gatherings in Syria, 2006 Number of women aged 15 - 49 years Not sure if received Vitamin A Received Vitamin A supplement** 10892.217.1DamascusGovernorates 1583.213.9Aleppo 901.113.3Homs 67.03.0Hama 42(.0)(9.5)Latakia 752.713.3Dera’a 5202.515.6YarmoukCamps / Gatherings 1651.815.8Jaramana 1181.715.3Sbeineh 115.923.5Khan Eshieh 711.419.7Khan Dunoun 795.116.5Sitt Zeinab 17.035.3Ramadan 4**Hussaynieh 1343.712.7Neirab 24**Handarat 901.113.3Homs 67.03.0Hama 42.09.5Ramel 35(2.9)(11.4)Dera’a 32(3.1)(15.6)Mzaireeb 8**Jellyn 9572.014.1UrbanUrban / Rural 5642.317.9Rural 25(.0)(8.0)NoneMother’s education 3052.018.7Primary 5471.614.8Preparatory 3613.915.8Secondary 1901.113.7Vocational 911.114.3Higher education 2**Informal educa- tion 4001.519.0PoorestWealth index quintiles 3181.915.1Second 3232.514.2Middle 2911.711.3Fourth 1893.717.5Richest 15212.115.5Total * number < 25 ** MICS indicator 43 78 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 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, Palestinian Refugee Camps and Gatherings in Syria, 2006 Percent of live births: Number of live birthsweighed at birth ***below 2500 grams ** 108997.110.8DamascusGovernorates 15896.812.0Aleppo 9087.810.1Homs 6767.29.0Hama 42(92.9)(12.5)Latakia 7590.715.4Dera’a 52097.79.3YarmoukCamps / Gatherings 16594.511.2Jaramana 11897.56.7Sbeineh 11599.110.0Khan Eshieh 7195.819.0Khan Dunoun 7996.220.7Sitt Zeinab 17**Ramadan 4**Hussaynieh 13496.312.4Neirab 24**Handarat 9087.810.1Homs 6767.29.0Hama 42(92.9)(12.5)Ramel 35(85.7)(11.5)Dera’a 32(96.9)(14.2)Mzaireeb 8**Jellyn 95793.410.3UrbanUrban / Rural 56497.012.4Damascus 25(84.0)(12.9)NoneMother’s education 30592.813.0Primary 54795.611.3Preparatory 36194.210.1Secondary 19095.810.4Vocational 9198.98.0Higher education 2**Informal education 40095.012.1PoorestWealth index quintiles 31895.911.4Second 32395.011.7Middle 29191.810.0Fourth 18996.39.1Richest 152194.711.1Total * number < 25, () number < 50 ** MICS indicator 9 *** MICS indicator 10 79 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Table CH.1: Vaccinations in First Year of Life Percentage of children aged 12-23 months immunised against childhood diseases at any time before the survey and before the first birthday, Palestinian Refugee Camps and Gatherings in Syria, 2006 (mother with cards only) Number Of children Aged 12-23 months None All ***** Mea- sles **** Polio 3 **** Polio 2 Polio 1 Polio 0 DPT 3 ** DPT 2 DPT 1 BCG * 630 .0 90.6 99.4 93.5 95.2 96.8 94.8 93.5 95.4 96.8 99.0 Vaccination card * MICS indicator 25 ** MICS indicator 27 *** MICS indicator 26 **** MICS indicator 28, MDG indicator 15 ***** MICS indicator 31 80 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Ta bl e C H .2 : V ac ci na tio ns b y B ac kg ro un d C ha ra ct er is tic s P er ce nt ag e of c hi ld re n ag ed 1 2 -2 3 m on th s cu rr en tly v ac ci na te d ag ai ns t c hi ld ho od d is ea se s, P al es tin ia n R ef ug ee C am ps a nd G at he rin gs in S yr ia , 2 00 6 (m ot he rs w ith c ar ds o nl y) N um be r O f c hi ld re n A ge d 12 - 2 3 m on th s N on e A ll M ea sl es P ol io 3 P ol io 2 P ol io 1 P ol io 0 D P T 3 D P T 2 D P T 1 B C G * 32 9 .0 90 .0 99 .7 93 .3 95 .4 96 .7 94 .5 93 .3 95 .7 96 .7 98 .8 M al e S ex 30 1 .0 91 .4 99 .0 93 .7 95 .0 97 .0 95 .0 93 .7 95 .0 97 .0 99 .3 Fe m al e 43 8 .0 88 .1 99 .5 91 .5 94 .1 95 .9 92 .4 91 .6 94 .3 95 .9 98 .6 D am as cu s G ov er no ra te s 55 .0 98 .2 10 0. 0 98 .2 10 0. 0 10 0. 0 10 0. 0 98 .2 10 0. 0 10 0. 0 10 0. 0 A le pp o 46 (.0 ) (9 3. 5) (1 00 .0 ) (9 5. 7) (9 5. 7) (9 7. 8) (1 00 .0 ) (9 5. 7) (9 5. 7) (9 7. 8) (1 00 .0 ) H om s 32 (.0 ) (9 6. 9) (9 6. 9) (9 6. 9) (9 6. 9) (1 00 .0 ) (1 00 .0 ) (9 6. 9) (9 6. 9) (1 00 .0 ) (1 00 .0 ) H am a 24 * * * * * * * * * * * La ta ki a 35 (.0 ) (9 7. 1) (1 00 .0 ) (1 00 .0 ) (9 7. 1) (9 7. 1) (1 00 .0 ) (1 00 .0 ) (9 7. 1) (9 7. 1) (1 00 .0 ) D er a’ a 40 6 .0 88 .4 99 .0 92 .4 93 .3 95 .6 93 .6 92 .4 93 .6 95 .6 98 .8 U rb an U rb an / R ur al 22 4 .0 94 .6 10 0. 0 95 .5 98 .7 99 .1 96 .9 95 .5 98 .7 99 .1 99 .6 R ur al 9 * * * * * * * * * * * N on e M ot he r’s e du ca tio n 13 6 .0 89 .0 10 0. 0 92 .6 95 .6 95 .6 94 .1 92 .6 95 .6 95 .6 99 .3 P rim ar y 23 9 .0 89 .5 99 .2 93 .3 95 .0 96 .7 93 .7 93 .3 95 .0 96 .7 98 .3 P re pa ra - to ry 15 1 .0 93 .4 99 .3 94 .7 95 .4 97 .4 97 .4 94 .7 95 .4 97 .4 99 .3 S ec on da ry 65 .0 95 .4 10 0. 0 95 .4 96 .9 98 .5 10 0. 0 95 .4 98 .5 98 .5 10 0. 0 Vo ca tio na l 30 (.0 ) (8 6. 7) (9 6. 7) (9 0. 0) (9 3. 3) (1 00 .0 ) (8 3. 3) (9 0. 0) (9 3. 3) (1 00 .0 ) (1 00 .0 ) H ig he r ed uc at io n 17 9 .0 92 .2 99 .4 95 .0 96 .1 98 .3 95 .0 95 .0 96 .1 98 .3 10 0. 0 P oo re st 12 0 .0 92 .5 10 0. 0 94 .2 97 .5 98 .3 95 .8 94 .2 97 .5 98 .3 99 .2 S ec on d 14 1 .0 88 .7 10 0. 0 93 .6 94 .3 94 .3 95 .0 93 .6 94 .3 94 .3 98 .6 M id dl e 11 5 .0 88 .7 99 .1 90 .4 93 .9 95 .7 93 .9 90 .4 93 .9 95 .7 98 .3 Fo ur th 75 .0 90 .7 97 .3 93 .3 93 .3 97 .3 93 .3 93 .3 94 .7 97 .3 98 .7 R ic he st 63 0 .0 90 .6 99 .4 93 .5 95 .2 96 .8 94 .8 93 .5 95 .4 96 .8 99 .0 To ta l * nu m be r < 2 5, ( ) n um be r < 5 0 81 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Table CH.3: Neonatal Tetanus Protection Percentage of mothers with a birth in the last 12 months protected against neonatal tetanus, Palestinian Refugee Camps and Gatherings in Syria, 2006 Number of mothers Protected Against tetanus ** Received at least 5 doses during lifetime Received at least 4 doses, the last within 10 years Received at least 3 doses, the last within 5 years Received at least 2 doses, the last within prior 3 years Received at least 2 doses during last pregnancy 108925.3.1.1.318.86.1DamascusGovernor- ates 15827.2.0.0.613.912.7Aleppo 9015.6.0.0.08.96.7Homs 6720.9.0.0.019.41.5Hama 42(7.1)(.0)(2.4)(.0)(4.8)(.0)Latakia 7534.71.3.01.314.717.3Dera’a 52022.9.2.2.218.73.7YarmoukCamps / Gatherings 16529.7.0.0.028.51.2Jaramana 11820.3.0.0.814.45.1Sbeineh 11526.1.0.0.98.716.5Khan Es- hieh 7138.0.0.0.023.914.1Khan Du- noun 7920.3.0.0.016.53.8Sitt Zeinab 1758.8.0.0.017.641.2Ramadan 4******Hussaynieh 13429.9.0.0.714.914.2Neirab 24******Handarat 9015.6.0.0.08.96.7Homs 6720.9.0.0.019.41.5Hama 42(7.1)(.0)(2.4)(.0)(4.8)(.0)Ramel 35(31.4)(.0)(.0)(.0)(17.1)(14.3)Dera’a 32(34.4)(3.1)(.0)(3.1)(12.5)(15.6)Mzaireeb 8******Jellyn 95723.1.2.2.218.54.0UrbanUrban / Rural 56427.5.0.0.514.912.1Rural 7012.9.0.0.07.15.715-19Mother’s Age 36615.8.0.0.011.24.620-24 46624.5.0.0.018.26.225-29 31934.5.3.01.325.17.830-34 22528.4.4.4.416.410.735-39 7028.6.01.4.018.68.640-44 5******45-49 82 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Table CH.3 (continued): Neonatal Tetanus Protection Percentage of mothers with a birth in the last 12 months protected against neonatal tetanus, Palestinian Refugee Camps and Gatherings in Syria, 2006 Number of moth- ers Protected Against tetanus ** Received at least 5 doses during lifetime Received at least 4 doses, the last within 10 years Received at least 3 doses, the last within 5 years Received at least 2 doses, the last within prior 3 years Received at least 2 doses during last pregnancy 25(40.0)(8.0)(.0)(.0)(16.0)(16.0)NoneMother’s education 30523.6.0.0.017.06.6Primary 54723.6.0.0.416.56.8Preparatory 36126.6.0.3.818.66.9Secondary 19029.5.0.0.021.18.4Vocational 9114.3.01.1.08.84.4Higher education 2******Informal education 40027.3.0.0.017.310.0PoorestWealth index quintiles 31828.3.0.0.920.17.2Second 32319.5.6.0.313.35.3Middle 29125.1.0.3.019.94.8Fourth 18921.7.0.5.514.36.3Richest 152124.7.1.1.317.27.0Total * number < 25, () number < 50 ** MICS indicator 32 83 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 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), Palestinian Refugee Camps and Gatherings in Syria, 2006 Children with diarrhoea who received: Number of children aged 0-59 months with diarrhoea ORT use rate ** No treat- ment Pre-pack- aged ORS fluid Recom- mended home- made fluid Fluid from ORS packet Number Of chil- dren Aged 0-59 months Had diarrhoea in last two weeks 22874.125.921.945.236.0194911.7MaleSex 21069.530.522.440.035.2185211.3Female 31368.731.318.845.035.5271211.5DamascusGovernor- ates 7777.922.129.944.229.941618.5Aleppo 2295.54.527.313.668.22319.5Homs 580.020.060.020.020.01523.3Hama 580.020.040.020.040.0995.1Latakia 1668.831.325.043.825.01918.4Dera’a 26666.933.117.338.035.7241111.0UrbanUrban / Rural 17279.720.329.750.035.5139012.4Rural 48(47.9)(52.1)(22.9)(25.0)(18.8)36913.0< 6 monthsChild’s Age 10166.333.713.939.631.740225.16-11 months 12469.430.621.840.334.778415.812-23 months 6882.417.626.548.542.67828.724-35 months 6487.512.529.748.450.07918.136-47 months 32(81.3)(18.8)(25.0)(62.5)(31.3)6714.848-59 months 9*****6513.8NoneMother’s education 9872.427.622.442.935.776512.8Primary 16768.331.719.841.340.1140311.9Preparatory 9174.725.319.848.430.887210.4Secondary 5477.822.231.540.727.847011.5Vocational 1968.431.621.126.336.82258.4Higher edu- cation 0*******Informal education 11173.027.024.351.434.295411.6PoorestWealth index quintiles 10070.030.020.042.035.078512.7Second 8873.926.123.938.638.683710.5Middle 9668.831.319.835.438.571813.4Fourth 43(76.7)(23.3)(23.3)(46.5)(27.9)5078.5Richest 43871.928.122.142.735.6380111.5Total * number < 25, () number < 50 ** MICS indicator 33 84 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Ta bl e C H .5 : H om e M an ag em en t o f D ia rr ho ea P er ce nt ag e of c hi ld re n ag ed 0 -5 9 m on th s w ith d ia rr ho ea in th e la st tw o w ee ks w ho to ok in cr ea se d flu id s an d co nt in ue d to fe ed d ur in g th e ep is od e, P al es tin ia n R ef ug ee C am ps a nd G at he rin gs in S yr ia , 2 00 6 N um be r of c hi ld re n ag ed 0 -5 9 m on th s w ith d ia r- rh oe a R ec ei ve d O R T or in cr ea se d flu id s A N D co nt in ue d fe ed in g ** * H om e m an ag e- m en t o f di ar rh oe a ** C hi ld re n w ith di ar rh oe a w ho a te m uc h le ss o r n on e C hi ld re n w ith di ar rh oe a w ho at e so m ew ha t le ss , s am e or m or e C hi ld re n w ith di ar rh oe a w ho d ra nk th e sa m e or le ss C hi ld re n w ith di ar rh oe a w ho d ra nk m or e N um be r o f ch ild re n ag ed 0 -5 9 m on th s H ad di ar rh oe a in la st tw o w ee ks 22 8 31 .6 17 .1 57 .5 40 .8 56 .1 42 .1 19 49 11 .7 M al e S ex 21 0 34 .3 15 .7 54 .3 45 .2 58 .1 39 .5 18 52 11 .3 Fe m al e 26 6 37 .2 18 .4 50 .0 49 .2 54 .5 44 .0 24 11 11 .0 U rb an U rb an / R ur al 17 2 26 .2 13 .4 65 .1 33 .1 61 .0 36 .0 13 90 12 .4 R ur al 14 9 29 .5 11 .4 51 .0 47 .0 67 .8 28 .2 77 1 19 .3 0- 11 m on th s C hi ld ’s A ge 12 4 33 .1 18 .5 58 .1 41 .9 49 .2 50 .0 78 4 15 .8 12 -2 3 m on th s 68 35 .3 20 .6 58 .8 41 .2 54 .4 44 .1 78 2 8. 7 24 -3 5 m on th s 64 37 .5 15 .6 59 .4 39 .1 50 .0 48 .4 79 1 8. 1 36 -4 7 m on th s 32 (3 4. 4) (2 5. 0) (5 6. 3) (4 0. 6) (5 6. 3) (4 3. 8) 67 1 4. 8 48 -5 9 m on th s 9 * * * * * * 65 13 .8 N on e M ot he r’s ed uc a- tio n 98 36 .7 15 .3 50 .0 49 .0 62 .2 34 .7 76 5 12 .8 P rim ar y 16 7 31 .1 17 .4 59 .3 40 .1 56 .3 42 .5 14 03 11 .9 P re pa ra to ry 91 35 .2 19 .8 52 .7 47 .3 49 .5 48 .4 87 2 10 .4 S ec on da ry 54 31 .5 14 .8 59 .3 35 .2 59 .3 37 .0 47 0 11 .5 Vo ca tio na l 19 31 .6 10 .5 57 .9 42 .1 52 .6 47 .4 22 5 8. 4 H ig he r e du ca tio n 0 . . . . . . 1 * In fo rm al e du ca tio n 11 1 30 .6 13 .5 63 .1 36 .0 60 .4 37 .8 95 4 11 .6 P oo re st W ea lth in de x qu in til es 10 0 32 .0 18 .0 50 .0 49 .0 59 .0 38 .0 78 5 12 .7 S ec on d 88 31 .8 17 .0 58 .0 42 .0 58 .0 42 .0 83 7 10 .5 M id dl e 96 33 .3 16 .7 53 .1 43 .8 50 .0 45 .8 71 8 13 .4 Fo ur th 43 (4 1. 9) (1 8. 6) (5 3. 5) (4 6. 5) (5 8. 1) (4 1. 9) 50 7 8. 5 R ic he st 43 8 32 .9 16 .4 55 .9 42 .9 57 .1 40 .9 38 01 11 .5 To ta l * nu m be r < 2 5, () n um be r < 5 0 ** M IC S in di ca to r 3 4 ** * M IC S in di ca to r 3 5 85 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Ta bl e C H .6 : C ar e S ee ki ng fo r S us pe ct ed P ne um on ia P er ce nt ag e of c hi ld re n ag ed 0 -5 9 m on th s w ho h ad a cu te re sp ira to ry in fe ct io 1 n in th e la st tw o w ee ks a nd w as ta ke n to a h ea lth p ro vi de r, P al es tin ia n R ef ug ee C am ps a nd G at he rin gs in S yr ia , 2 00 6 H ad a cu te re sp ira to ry in fe ct io n N um be r o f ch ild re n ag ed 0- 59 m on th s G ov t. ho sp ita l/ he al th ce nt re R ed C re sc en t ce nt re M ob ile cl in ic U N R W A cl in ic P riv at e cl in ic P ha rm ac y O th er A ny ap pr op ria te pr ov id er * * N um be r o f c hi ld re n ag ed 0 -5 9 m on th s w ith s us pe ct ed pn eu m on ia S ex M al e 8. 6 19 49 7. 7 1. 2 1. 8 23 .8 29 .2 4. 8 2. 4 60 .7 16 8 Fe m al e 7. 0 18 52 3. 9 .8 2. 3 17 .8 28 .7 14 .0 .8 53 .5 12 9 G ov er - no ra te s D am as cu s 6. 3 27 12 7. 6 1. 8 2. 9 24 .1 32 .9 4. 7 1. 8 67 .6 17 0 A le pp o 17 .1 41 6 7. 0 .0 .0 18 .3 18 .3 18 .3 1. 4 43 .7 71 H om s 14 .7 23 1 (.0 ) (.0 ) (2 .9 ) (5 .9 ) (2 0. 6) (1 1. 8) (2 .9 ) (2 6. 5) 34 H am a 5. 9 15 2 * * * * * * * * 9 La ta ki a 4. 0 99 * * * * * * * * 4 D er a’ a 4. 7 19 1 * * * * * * * * 9 U rb an / R ur al U rb an 7. 1 24 11 4. 1 1. 2 3. 5 22 .9 30 .6 4. 7 1. 8 60 .0 17 0 R ur al 9. 1 13 90 8. 7 .8 .0 18 .9 26 .8 14 .2 1. 6 54 .3 12 7 C hi ld ’s A ge 0- 11 m on th s 7. 4 77 1 7. 0 1. 8 .0 26 .3 31 .6 7. 0 .0 63 .2 57 12 -2 3 m on th s 9. 7 78 4 6. 6 .0 3. 9 21 .1 30 .3 5. 3 2. 6 60 .5 76 24 -3 5 m on th s 8. 3 78 2 6. 2 .0 1. 5 24 .6 23 .1 9. 2 .0 52 .3 65 36 -4 7 m on th s 7. 3 79 1 5. 2 3. 4 1. 7 17 .2 32 .8 10 .3 3. 4 60 .3 58 48 -5 9 m on th s 6. 1 67 1 (4 .9 ) (.0 ) (2 .4 ) (1 4. 6) (2 6. 8) (1 4. 6) (2 .4 ) (4 8. 8) 41 M ot he r’s ed uc a- tio n N on e 9. 2 65 * * * * * * * * 6 P rim ar y 9. 3 76 5 11 .3 4. 2 4. 2 11 .3 29 .6 5. 6 1. 4 54 .9 71 P re pa ra to ry 7. 6 14 03 4. 7 .0 .0 18 .9 26 .4 12 .3 2. 8 50 .0 10 6 S ec on da ry 6. 9 87 2 5. 0 .0 1. 7 36 .7 25 .0 3. 3 1. 7 70 .0 60 Vo ca tio na l 8. 7 47 0 (2 .4 ) (.0 ) (2 .4 ) (1 7. 1) (3 1. 7) (1 7. 1) (.0 ) (5 3. 7) 41 H ig he r e du ca tio n 5. 8 22 5 * * * * * * * * 13 In fo rm al e du ca tio n * 1 . . . . . . . . 0 W ea lth in de x qu in til es P oo re st 6. 4 95 4 8. 2 .0 .0 14 .8 34 .4 6. 6 1. 6 57 .4 61 S ec on d 8. 2 78 5 9. 4 4. 7 1. 6 18 .8 23 .4 9. 4 3. 1 53 .1 64 M id dl e 9. 6 83 7 8. 8 .0 2. 5 17 .5 26 .3 16 .3 .0 52 .5 80 Fo ur th 7. 5 71 8 .0 .0 .0 31 .5 25 .9 5. 6 3. 7 57 .4 54 R ic he st 7. 5 50 7 (.0 ) (.0 ) (7 .9 ) (2 8. 9) (3 9. 5) (.0 ) (.0 ) (7 6. 3) 38 To ta l 7. 8 38 01 6. 1 1. 0 2. 0 21 .2 29 .0 8. 8 1. 7 57 .6 29 7 * nu m be r < 2 5, () n um be r < 5 0 ** M IC S in di ca to r 2 3 86 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Table CH.7: Antibiotic Treatment of Pneumonia Percentage of children aged 0-59 months with suspected pneumonia who received antibiotic treatment, Pal- estinian Refugee Camps and Gatherings in Syria, 2006 Number of children aged 0-59 months with suspected pneumonia in the two weeks prior to the survey Percentage of children aged 0-59 months with suspected pneumonia who received antibiotics in the last two weeks ** 16871.4MaleSex 12971.3Female 17070.6DamascusGovernorates 7181.7Aleppo 34(44.1)Homs 9*Hama 4*Latakia 9*Dera’a 17064.1UrbanUrban / Rural 12781.1Rural 5763.20-11 monthsChild’s Age 7677.612-23 months 6567.724-35 months 5874.136-47 months 4173.248-59 months 6*NoneMother’s edu- cation 7170.4Primary 10665.1Preparatory 6068.3Secondary 41(82.9)Vocational 13*Higher education 6170.5PoorestWealth index quintiles 6478.1Second 8063.8Middle 5472.2Fourth 38(76.3)Richest 29771.4Total * number < 25, () number < 50 ** MICS indicator 22 87 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Table CH.7A: Knowle dge 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 recognise fast and difficult breathing as signs for seeking care immediately, Palestinian Refugee Camps and Gatherings in Syria, 2006 Number of mothers/ caretakers of children aged 0-59 months Mothers/ caretakers who recog- nize the two danger signs of pneumo- nia 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: Has other symp- toms Is drink- ing poorly Has blood in stool Has difficulty breath- ing Has fast breath- ing Devel- ops a fever Be- comes sicker Is not able to drink or breast- feed 271214.724.65.713.128.626.187.136.813.9DamascusGovernor- ates 41620.716.88.214.941.328.887.729.624.5Aleppo 2313.99.51.32.616.010.487.421.615.6Homs 1522.6.715.8.711.222.482.252.668.4Hama 995.03.02.0.020.013.097.010.029.0Latakia 19122.519.97.920.437.236.688.532.517.3Dera’a 131716.719.78.617.234.524.387.542.017.6YarmoukCamps / Gatherings 41622.445.27.912.730.325.073.143.012.7Jaramana 2817.412.01.15.323.037.893.349.84.9Sbeineh 28716.326.41.414.926.741.098.610.85.9Khan Eshieh 1671.832.3.6.69.07.888.021.612.0Khan Dunoun 2006.520.0.07.016.519.086.523.519.5Sitt Zeinab 34(2.9)(32.4)(.0)(8.8)(20.6)(17.6)(100.0)(29.4)(5.9)Ramadan 10*********Hussaynieh 33817.716.16.112.543.125.790.425.120.9Neirab 7839.77.719.229.547.447.489.744.947.4Handarat 2313.99.51.32.616.010.487.421.615.6Homs 1522.6.715.9.711.322.582.852.368.9Hama 995.13.02.0.019.213.198.09.129.3Ramel 8441.212.914.137.648.256.582.442.420.0Dera’a 899.027.02.25.627.023.693.327.015.7Mzaireeb 18*********Jellyn 241115.621.27.813.430.023.585.138.820.3UrbanUrban / Rural 139012.220.93.110.126.528.891.227.813.7Rural 6515.421.56.210.829.223.189.229.213.8NoneMother’s education 76513.323.83.812.025.824.783.837.614.0Primary 140315.019.76.812.530.926.987.535.118.8Preparatory 87212.820.46.011.227.822.987.433.619.6Secondary 47015.522.37.713.829.826.089.433.218.1Vocational 22517.320.47.112.027.128.093.332.919.6Higher education 1*********Informal education 95412.126.13.111.724.526.686.030.611.3PoorestWealth index quintiles 78512.424.85.69.723.226.487.139.716.2Second 83718.516.78.213.037.227.287.235.623.3Middle 71814.217.06.813.028.122.188.434.320.9Fourth 50715.218.77.914.632.323.789.034.519.9Richest 380114.421.16.112.228.825.587.334.817.9Total * number < 25 88 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Table CH.8: Solid Fuel Use Percent distribution of households according to type of cooking fuel, and percentage of households that used solid fuels for cooking, Palestinian Refugee Camps and Gatherings in Syria, 2006 Number of households Solid fuels for cooking ** TotalType of fuel used for cooking keroseneLiquid propane gas (LPG) Electricity 5655.0100.0.099.8.2DamascusGovernorates 876.0100.0.199.8.1Aleppo 530.0100.0.099.8.2Homs 320.0100.0.0100.0.0Hama 240.0100.0.099.2.8Latakia 327.0100.0.099.7.3Dera’a 3127.0100.0.099.7.3YarmoukCamps / Gather- ings 736.0100.0.099.9.1Jaramana 499.0100.0.0100.0.0Sbeineh 494.0100.0.299.8.0Khan Eshieh 357.0100.0.0100.0.0Khan Dunoun 380.0100.0.0100.0.0Sitt Zeinab 42(.0)(100.0)(.0)(100.0)(.0)Ramadan 20*****Hussaynieh 716.0100.0.199.7.1Neirab 160.0100.0.0100.0.0Handarat 530.0100.0.099.8.2Homs 320.0100.0.0100.0.0Hama 240.0100.0.099.2.8Ramel 173.0100.0.099.4.6Dera’a 133.0100.0.0100.0.0Mzaireeb 21*****Jellyn 5285.0100.0.099.7.2UrbanUrban / Rural 2663.0100.0.199.8.1Rural 89 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Table CH.8 (continued): Solid Fuel Use Percent distribution of households according to type of cooking fuel, and percentage of households that used solid fuels for cooking, Palestinian Refugee Camps and Gatherings in Syria, 2006 Number of households Solid fuels for cooking ** TotalType of fuel used for cooking keroseneLiquid propane gas (LPG) Electricity .199.7.2NoneEducation of household head 1802.0100.0.099.9.1Primary 2435.0100.0.099.8.2Preparatory 1271.0100.0.0100.0.0Secondary 798.0100.0.099.7.3Vocational 745.0100.0.399.2.5Higher education 14*****Informal education 2*****Poorest 1569.0100.0.199.7.2SecondWealth index quintiles 1523.0100.0.099.7.3Middle 1657.0100.0.099.7.3Fourth 1584.0100.0.199.8.1Richest 1615.0100.0.099.9.1None 7948.0100.0.099.8.2Total * number < 25, () number < 50 ** MICS indicator 24; MDG indicator 29 90 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Ta bl e E N .1 : U se o f I m pr ov ed W at er S ou rc es P er ce nt d is tri bu tio n of h ou se ho ld p op ul at io n ac co rd in g to m ai n so ur ce o f d rin ki ng w at er a nd p er ce nt ag e of h ou se ho ld m em be rs u si ng im pr ov ed d rin ki ng w at er s ou rc es , P al es tin ia n R ef ug ee C am ps a nd G at he rin gs in S yr ia , 2 00 6 N um be r o f ho us eh ol d m em be rs Im pr ov ed so ur ce o f dr in ki ng w at er ** To ta l M ai n so ur ce o f d rin ki ng w at er U ni m pr ov ed s ou rc es Im pr ov ed s ou rc es O th er B ot tle d w at er C ar t w ith sm al l ta nk / dr um Ta nk er - tru ck U np ro te ct ed w el l R ai nw at er co lle ct io n P ro te ct ed sp rin g P ro te ct ed w el l Tu be w el l/ bo re ho le P ub lic ta p/ st an dp ip e P ip ed in to ya rd o r pl ot P ip ed in to dw el lin g 27 61 9 62 .9 10 0. 0 .3 .0 8. 1 28 .3 .4 .1 .0 4. 1 .0 .1 1. 4 57 .2 D am as cu s G ov er no ra te s 42 51 95 .0 10 0. 0 .0 .0 .0 5. 0 .0 .0 .0 .0 .1 .0 .0 94 .9 A le pp o 27 22 10 0. 0 10 0. 0 .0 .0 .0 .0 .0 .0 .0 .0 t .0 .0 .0 10 0. 0 H om s 16 59 10 0. 0 10 0. 0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 10 0. 0 H am a 10 39 10 0. 0 10 0. 0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 10 0. 0 La ta ki a 17 33 10 0. 0 10 0. 0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 10 0. 0 D er a’ a 14 57 3 99 .8 10 0. 0 .0 .0 .0 .1 .0 .0 .0 .0 .0 .0 .1 99 .7 Ya rm ou k C am ps / G at he rin gs 36 09 20 .8 10 0. 0 .0 .0 36 .3 42 .7 .2 .0 .0 .0 .0 .0 .0 20 .8 Ja ra m an a 25 30 .6 10 0. 0 .0 .0 11 .3 88 .1 .0 .3 .0 .0 .0 .0 .0 .3 S be in eh 26 62 44 .0 10 0. 0 2. 7 .3 .3 48 .9 3. 8 .0 .5 41 .7 .4 .5 .6 .3 K ha n E sh ie h 18 98 33 .2 10 0. 0 .0 .0 16 .2 50 .5 .0 .4 .0 1. 2 .0 .0 18 .4 13 .3 K ha n D un ou n 20 37 2. 1 10 0. 0 .4 .0 15 .0 82 .5 .0 .0 .0 .0 .0 .0 .0 2. 1 S itt Z ei na b 21 6 98 .1 10 0. 0 .0 .0 .0 1. 9 .0 .0 .0 1. 9 .0 .9 .0 95 .4 R am ad an 94 .0 10 0. 0 .0 .0 3. 9 96 .1 .0 .0 .0 .0 .0 .0 .0 .0 H us sa yn ie h 34 97 10 0. 0 10 0. 0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 10 0. 0 N ei ra b 75 4 10 0. 0 10 0. 0 .0 .0 .0 .0 .0 .0 .0 .0 .5 .0 .0 99 .5 H an da ra t 27 22 10 0. 0 10 0. 0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 10 0. 0 H om s 16 59 10 0. 0 10 0. 0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 10 0. 0 H am a 10 39 10 0. 0 10 0. 0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 10 0. 0 R am el 91 3 99 .6 10 0. 0 .0 .0 .0 .4 .0 .0 .0 .0 .0 .0 .0 99 .6 D er a’ a 69 7 10 0. 0 10 0. 0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 10 0. 0 M za ire eb 12 3 10 0. 0 10 0. 0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 10 0. 0 Je lly n 25 37 1 88 .2 10 0. 0 .0 .0 5. 3 6. 5 .0 .0 .0 .0 .0 .0 .0 88 .2 U rb an U rb an / R ur al 13 65 2 45 .2 10 0. 0 .6 .1 6. 5 46 .9 .7 .1 .1 8. 4 .1 .1 2. 7 33 .8 R ur al 91 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Ta bl e E N .1 (c on tin ue d) : U se o f I m pr ov ed W at er S ou rc es P er ce nt d is tri bu tio n of h ou se ho ld p op ul at io n ac co rd in g to m ai n so ur ce o f d rin ki ng w at er a nd p er ce nt ag e of h ou se ho ld m em be rs u si ng im pr ov ed d rin ki ng w at er s ou rc es , P al es tin ia n R ef ug ee C am ps a nd G at he rin gs in S yr ia , 2 00 6 N um be r of ho us e- ho ld m em be rs Im pr ov ed so ur ce of dr in ki ng w at er ** To ta l M ai n so ur ce o f d rin ki ng w at er U ni m pr ov ed s ou rc es Im pr ov ed s ou rc es O th er B ot tle d w at er C ar t w ith sm al l ta nk / dr um Ta nk er - tru ck U np ro - te ct ed w el l R ai nw at er co lle ct io n P ro - te ct ed sp rin g P ro - te ct ed w el l Tu be w el l/ bo re ho le P ub lic ta p/ st an dp ip e P ip ed in to ya rd or pl ot P ip ed in to dw el lin g .6 .2 9. 2 32 .6 .1 .1 .0 3. 2 .0 .1 1. 6 52 .4 N on e E du ca tio n of ho us eh ol d he ad .1 .0 6. 6 26 .5 .2 .0 .1 1. 4 .0 .0 1. 2 63 .7 P rim ar y 12 85 4 71 .8 10 0. 0 .2 .0 7. 0 21 .0 .1 .1 .0 2. 1 .1 .0 1. 1 68 .4 P re pa ra - to ry 65 05 77 .5 10 0. 0 .2 .0 3. 8 18 .0 .5 .0 .0 3. 5 .0 .0 .6 73 .4 S ec on d- ar y 39 17 83 .6 10 0. 0 .2 .0 3. 5 11 .7 1. 0 .0 .0 6. 9 .0 .0 .2 76 .5 Vo ca tio na l 37 57 88 .0 10 0. 0 .2 .0 2. 2 9. 6 .1 .0 .0 4. 0 .0 .2 .7 83 .1 H ig he r ed uc at io n 65 80 .0 10 0. 0 .0 .0 6. 2 13 .8 .0 .0 .0 .0 .0 .0 .0 80 .0 In fo rm al ed uc at io n 15 * 10 0. 0 * * * * * * * * * * * * M is si ng / D K 78 07 42 .8 10 0. 0 .5 .1 8. 3 47 .6 .7 .1 .2 10 .4 .1 .2 .4 31 .5 P oo re st W ea lth in de x qu in til es 78 05 33 .7 10 0. 0 .4 .0 16 .1 49 .1 .6 .1 .0 3. 9 .1 .0 3. 6 26 .0 S ec on d 77 58 90 .1 10 0. 0 .0 .0 4. 0 5. 8 .0 .0 .0 .4 .0 .0 .8 88 .9 M id dl e 78 44 99 .2 10 0. 0 .1 .0 .2 .5 .0 .0 .0 .0 .0 .0 .0 99 .2 Fo ur th 78 09 10 0. 0 10 0. 0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 10 0. 0 R ic he st 39 02 3 73 .2 10 0. 0 .2 .0 5. 7 20 .6 .3 .0 .0 2. 9 .0 .0 1. 0 69 .1 To ta l * nu m be r < 2 5, () n um be r < 5 0 ** M IC S in di ca to r 1 1; M D G in di ca to r 3 0 92 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Ta bl e E N .2 : H ou se ho ld W at er T re at m en t P er ce nt ag e di st rib ut io n of h ou se ho ld p op ul at io n ac co rd in g to d rin ki ng w at er tr ea tm en t m et ho d us ed in th e ho us eh ol d an d pe rc en ta ge o f h ou se ho ld m em be rs th at a pp lie d an ap pr op ria te w at er tr ea tm en t m et ho d, P al es tin ia n R ef ug ee C am ps a nd G at he rin gs in S yr ia , 2 00 6 N um be r o f ho us eh ol d m em be rs U ni m pr ov ed dr in ki ng w at er so ur ce s A pp ro pr ia te w at er tre at m en t m et ho d N um be r o f ho us eh ol d m em be rs Im pr ov ed dr in ki ng w at er A pp ro pr ia te w at er tre at m en t m et ho d N um be r o f ho us eh ol d m em be rs A ll dr in ki ng w at er s ou rc es A pp ro pr ia te w at er tr ea tm en t m et ho d ** W at er tr ea tm en t m et ho d us ed in th e ho us eh ol d Le t i t st an d an d se ttl e U se w at er fil te r S tra in th ro ug h a cl ot h A dd bl ea ch /c hl o- rin e B oi l N on e 10 25 6 5. 2 17 36 3 7. 4 27 61 9 6. 6 1. 7 2. 9 .2 .2 3. 7 92 .4 D am as cu s G ov er no ra te s 21 4 .0 40 37 .0 42 51 .0 .0 .0 .0 .0 .0 10 0. 0 A le pp o 0 . 27 22 6. 2 27 22 6. 2 1. 8 6. 0 3. 6 .0 .2 88 .5 H om s 0 . 16 59 5. 6 16 59 5. 6 16 .2 .0 .0 .0 5. 6 80 .2 H am a 0 . 10 39 11 .3 10 39 11 .3 .5 11 .3 15 .5 .0 .0 72 .8 La ta ki a 0 . 17 33 .1 17 33 .1 .0 .0 .0 .0 .1 99 .9 D er a’ a 23 .0 14 55 0 7. 7 14 57 3 7. 7 1. 5 3. 7 .2 .2 4. 0 91 .0 Ya rm ou k C am ps / G at he rin gs 28 60 4. 0 74 9 12 .2 36 09 5. 7 1. 7 .7 .0 .1 4. 8 93 .7 Ja ra m an a 25 22 1. 4 8 .0 25 30 1. 4 .0 .0 .0 .0 1. 4 98 .6 S be in eh 14 91 3. 9 11 71 4. 1 26 62 4. 0 .0 1. 2 .8 .8 2. 0 95 .2 K ha n E sh ie h 12 67 10 .7 63 1 .8 18 98 7. 4 3. 0 3. 6 .0 .3 5. 3 92 .2 K ha n D un ou n 19 95 9. 7 42 45 .2 20 37 10 .4 6. 1 6. 9 .0 .0 3. 9 87 .2 S itt Z ei na b 4 .0 21 2 .0 21 6 .0 .0 .0 .0 .0 .0 10 0. 0 R am ad an 94 1. 3 0 . 94 1. 3 .0 1. 3 .0 .0 .0 98 .7 H us sa yn ie h 21 4 . 32 83 .0 34 97 .0 .0 .0 .0 .0 .0 10 0. 0 N ei ra b 0 . 75 4 .0 75 4 .0 .0 .0 .0 .0 .0 10 0. 0 H an da ra t 0 . 27 22 6. 2 27 22 6. 2 1. 8 6. 0 3. 6 .0 .2 88 .4 H om s 0 . 16 59 5. 6 16 59 5. 6 16 .2 .0 .0 .0 5. 6 80 .2 H am a 0 . 10 39 11 .0 10 39 11 .0 .5 11 .0 15 .5 .0 .0 73 .0 R am el 0 .0 91 3 .2 91 3 .2 .0 .0 .0 .0 .2 99 .8 D er a’ a 0 . 69 7 .0 69 7 .0 .0 .0 .0 .0 .0 10 0. 0 M za ire eb 0 . 12 3 .0 12 3 .0 .0 .0 .0 .0 .0 10 0. 0 Je lly n 29 95 4. 0 22 37 6 7. 2 25 37 1 6. 8 2. 5 3. 3 1. 2 .2 3. 4 90 .2 U rb an U rb an / R ur al 74 75 5. 6 61 77 1. 0 13 65 2 3. 5 1. 3 1. 7 .2 .2 1. 9 95 .9 R ur al 93 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Ta bl e E N .2 (c on tin ue d) : H ou se ho ld W at er T re at m en t P er ce nt ag e di st rib ut io n of h ou se ho ld p op ul at io n ac co rd in g to d rin ki ng w at er tr ea tm en t m et ho d us ed in th e ho us eh ol d an d pe rc en ta ge o f h ou se ho ld m em be rs th at a pp lie d an ap pr op ria te w at er tr ea tm en t m et ho d, P al es tin ia n R ef ug ee C am ps a nd G at he rin gs in S yr ia , 2 00 6 N um be r of h ou se - ho ld m em be rs U ni m pr ov ed dr in ki ng w at er so ur ce s A pp ro pr ia te w at er tr ea t- m en t m et ho d N um be r of h ou se - ho ld m em be rs Im pr ov ed dr in ki ng w at er A pp ro pr ia te w at er tr ea t- m en t m et ho d N um be r of h ou se - ho ld m em be rs A ll dr in ki ng w at er s ou rc es A pp ro pr ia te w at er tr ea t- m en t m et ho d ** W at er tr ea tm en t m et ho d us ed in th e ho us eh ol d Le t i t st an d an d se ttl e U se w at er fil te r S tra in th ro ug h a cl ot h A dd bl ea ch / ch lo rin e B oi l N on e .1 .9 .7 .0 3. 8 93 .8 N on e E du ca tio n of ho us eh ol d he ad 29 47 5. 7 58 61 5. 3 88 08 5. 4 .0 2. 2 1. 0 .1 3. 4 92 .0 P rim ar y 36 25 3. 9 92 29 5. 6 12 85 4 5. 2 .0 2. 5 .8 .2 2. 5 92 .9 P re pa ra to ry 14 61 6. 2 50 44 5. 2 65 05 5. 4 .0 2. 9 .8 .1 2. 7 92 .4 S ec on da ry 64 2 5. 5 32 75 6. 8 39 17 6. 6 .0 4. 2 .8 .5 2. 0 90 .6 Vo ca tio na l 45 0 7. 1 33 07 8. 3 37 57 8. 1 .0 5. 0 .4 .2 3. 1 90 .5 H ig he r e du ca tio n 13 * * * 65 .0 .0 .0 .0 .0 .0 10 0. 0 In fo rm al e du ca tio n 10 * * * 15 * * * * * * * M is si ng /D K 44 66 7. 3 33 41 3. 5 78 07 5. 6 2. 5 2. 2 .2 .1 3. 8 93 .1 P oo re st W ea lth in de x qu in til es 51 71 2. 7 26 34 8. 9 78 05 4. 8 .5 1. 1 .1 .3 3. 5 94 .7 S ec on d 76 9 9. 1 69 89 4. 4 77 58 4. 9 2. 2 1. 8 .6 .2 3. 0 93 .0 M id dl e 64 7. 8 77 80 6. 2 78 44 6. 2 2. 4 3. 2 1. 8 .2 2. 9 90 .2 Fo ur th 0 . 78 09 6. 7 78 09 6. 7 2. 6 5. 6 1. 3 .0 1. 2 90 .1 R ic he st 10 47 0 5. 1 28 55 3 5. 8 39 02 3 5. 7 2. 0 2. 8 .8 .2 2. 9 92 .2 To ta l * nu m be r < 2 5 ** M IC S in di ca to r 1 3 94 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 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, Palestinian Refugee Camps and Gatherings in Syria, 2006 Num- ber of house- holds Mean time to source of drinking water (excluding those on premises) TotalTime to source of drinking water DK1 hour or more 30 minutes to less than 1 hour 15 minutes to less than 30 minutes Less than 15 minutes Water on premises 565516.0100.07.41.51.52.123.164.3DamascusGovernorates 87610.0100.0.0.0.0.04.695.4Aleppo 530.100.0.0.0.0.0.0100.0Homs 320.100.0.3.0.0.0.0100.0Hama 240.100.0.0.0.0.0.0100.0Latakia 327.100.0.0.0.0.0.0100.0Dera’a 312720.0100.0.0.0.02.1.199.9YarmoukCamps / Gatherings 73615.5100.01.54.5.82.171.420.6Jaramana 4999.9100.0.0.0.02.199.8.2Sbeineh 49429.7100.0.48.316.22.112.640.7Khan Eshieh 35713.6100.022.42.2.02.142.032.5Khan Dunoun 38010.0100.086.5.0.02.111.91.6Sitt Zeinab 42(10.0)(100.0)(.0)(.0)(.0)(2.1)(2.4)(97.6)Ramadan 20********Hussaynieh 716.100.0.0.0.02.1.0100.0Neirab 160.100.0.0.0.02.1.0100.0Handarat 530.100.0.0.0.02.1.0100.0Homs 320.100.0.0.0.02.1.0100.0Hama 240.100.0.0.0.02.1.0100.0Ramel 173.100.0.6.0.02.1.099.4Dera’a 133.100.0.0.0.02.1.0100.0Mzaireeb 21********Jellyn 528515.5100.0.5.6.1.210.088.5UrbanUrban / Rural 266316.0100.014.81.93.04.230.645.6Rural 95 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Table EN.3 (continued): 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, Palestinian Refugee Camps and Gatherings in Syria, 2006 Number of house- holds Mean time to source of drinking water (excluding those on premises) TotalTime to source of drinking water DK1 hour or more 30 min- utes to less than 1 hour 15 minutes to less than 30 minutes Less than 15 min- utes Water on premises 9.91.72.21.222.562.5NoneEducation of household head 180214.6100.06.21.1.71.421.768.9Primary 243515.7100.05.71.21.11.718.771.6Prepara- tory 127116.1100.04.1.8.91.613.279.4Secondary 79816.2100.02.6.51.32.18.984.6Vocational 74516.4100.01.6.7.8.77.988.3Higher education 14********Informal education 2********Missing/DK 156919.4100.09.93.94.36.234.441.2PoorestWealth index quintiles 152312.8100.015.51.21.21.445.035.6Second 165712.5100.01.7.2.1.06.791.3Middle 158410.0100.0.1.0.0.0.599.4Fourth 1615.100.0.0.0.0.0.0100.0Richest 794815.8100.05.31.01.11.516.974.1Total 96 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 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 per- centage of household members using sanitary means of excreta disposal, Palestinian Refugee Camps and Gatherings in Syria, 2006 Number of house- holds members Percent- age of popula- tion using sanitary means of excreta disposal ** TotalType of toilet facility used by household Unimproved sanitation facility Improved sanitation facility Other Pit latrine without slab/ open pit Pit la- trine with slab Venti- lated Improved Pit latrine (VIP) Flush to piped sewer sys- tem 2761997.5100.0.12.4.17.090.4DamascusGovernor- ates 425193.1100.0.06.9.0.093.1Aleppo 2722100.0100.0.0.0.0.499.6Homs 1659100.0100.0.0.0.0.0100.0Hama 1039100.0100.0.0.0.0.0100.0Latakia 173398.7100.01.3.0.0.098.7Dera’a 14573100.0100.0.0.0.0.0100.0YarmoukCamps / Gatherings 360998.4100.0.01.6.0.098.4Jaramana 2530100.0100.0.0.0.0.499.6Sbeineh 266276.1100.0.923.0.772.33.2Khan Eshieh 1898100.0100.0.0.0.0.299.8Khan Dunoun 2037100.0100.0.0.0.0.0100.0Sitt Zeinab 216100.0100.0.0.0.01.998.1Ramadan 94100.0100.0.0.0.0.0100.0Hussaynieh 3497100.0100.0.0.0.0.0100.0Neirab 75461.3100.0.038.7.0.061.3Handarat 2722100.0100.0.0.0.0.499.6Homs 1659100.0100.0.0.0.0.0100.0Hama 1039100.0100.0.0.0.0.0100.0Ramel 913100.0100.0.0.0.0.0100.0Dera’a 69798.3100.01.7.0.0.098.3Mzaireeb 12391.9100.08.1.0.0.091.9Jellyn 2537199.7100.0.0.3.0.099.7UrbanUrban / Rural 1365293.2100.0.26.6.114.278.8Rural 97 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Table EN.5 (continued): Use of Sanitary Means of Excreta Disposal Percent distribution of household population according to type of toilet used by the household and the per- centage of household members using sanitary means of excreta disposal, Palestinian Refugee Camps and Gatherings in Syria, 2006 Number of house- holds members Percent- age of popula- tion using sanitary means of excreta disposal ** TotalType of toilet facility used by household Unimproved sanitation facility Improved sanitation facility Other Pit latrine without slab/ open pit Pit latrine with slab Venti- lated Im- proved Pit latrine (VIP) Flush to piped sewer system .02.0.06.591.4NoneEducation of household head 880897.7100.0.22.1.02.994.7Primary 1285497.6100.0.12.3.04.693.0Preparatory 650597.0100.0.03.0.26.190.8Secondary 391795.8100.0.24.0.08.687.2Vocational 375798.0100.0.02.0.14.693.4Higher educa- tion 65100.0100.0.0.0.0.0100.0Informal education 15*******Missing/DK 780793.7100.0.36.0.220.772.7PoorestWealth index quintiles 780594.6100.0.15.3.04.290.5Second 775898.8100.0.21.1.0.198.6Middle 7844100.0100.0.0.0.0.0100.0Fourth 7809100.0100.0.0.0.0.0100.0Richest 3902397.4100.0.12.5.05.092.4Total * number < 25 ** MICS indicator 12; MDG indicator 31 98 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Table EN.5w: Sharing in Use of Improved Sanitation Facility Percentage of household population using improved sanitation facility according to the number of households sharing in use of that facility, Palestinian Refugee Camps and Gatherings in Syria, 2006 Popula- tion using improved sanitation facilities TotalNumber of households sharing in use of an improved sanita- tion facility Missing/ DK 987654321 36045100.0.1.1.0.1.1.0.61.33.594.2Flush to piped sewer system Sanitation Facility Type 1953100.0.0.0.0.0.0.0.02.32.395.4Ventilated Improved Pit latrine 18***********Pit latrine with slab 26926100.0.0.0.0.1.0.0.71.54.093.7DamascusGovernor- ates 3959100.0.0.3.1.0.1.0.11.83.694.1Aleppo 2722100.0.0.0.0.0.0.0.2.31.298.2Homs 1659100.0.51.1.3.01.7.3.4.72.392.8Hama 1039100.0.0.0.0.0.0.0.0.0.0100.0Latakia 1711100.0.0.0.5.0.0.0.7.72.096.1Dera’a 14573100.0.1.0.0.0.0.0.0.11.098.6YarmoukCamps / Gatherings 3551100.0.0.0.0.5.0.14.05.813.875.8Jaramana 2530100.0.0.0.0.0.0.01.5.76.391.5Sbeineh 2027100.0.0.0.0.0.0.0.02.22.295.6Khan Eshieh 1898100.0.0.0.0.4.0.0.02.05.991.7Khan Dunoun 2037100.0.0.0.0.0.0.0.01.94.393.8Sitt Zeinab 216100.0.0.0.0.0.0.04.218.118.559.3Ramadan 94100.0.0.0.0.0.0.0.0.09.690.4Hus- saynieh 3497100.0.0.3.1.0.1.0.11.93.294.3Neirab 462100.0.0.0.0.0.0.0.0.94.594.6Handarat 2722100.0.0.0.0.0.0.0.2.31.298.2Homs 1659100.0.51.1.3.01.7.3.4.72.392.8Hama 1039100.0.0.0.0.0.0.0.0.0.0100.0Ramel 913100.0.0.0.0.0.0.01.31.31.495.9Dera’a 685100.0.0.01.2.0.0.0.0.02.296.6Mzaireeb 113100.0.0.0.0.0.0.0.0.05.394.7Jellyn 25294100.0.1.1.1.1.1.0.71.02.995.0UrbanUrban / Rural 12722100.0.0.1.0.1.0.0.42.04.792.8Rural 99 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Table EN.5w (continued): Sharing in Use of Improved Sanitation Facility Percentage of household population using improved sanitation facility according to the number of households sharing in use of that facility, Palestinian Refugee Camps and Gatherings in Syria, 2006 Popula- tion using improved sanitation facilities TotalNumber of households sharing in use of an improved sanitation facility Missing/ DK 987654321 .0.0.0.0.0.01.03.67.487.8NoneEducation of household head 8603100.0.0.0.1.0.1.0.61.65.392.1Primary 12548100.0.1.2.0.0.0.1.71.53.194.1Preparatory 6310100.0.0.1.1.2.1.0.3.82.196.2Secondary 3754100.0.2.0.0.2.0.0.6.32.096.8Vocational 3683100.0.0.0.0.0.2.0.1.3.598.9Higher edu- cation 65100.0.0.0.0.0.0.0.0.0.0100.0Informal education 15***********Missing/DK 7313100.0.0.0.0.2.1.11.33.86.787.8PoorestWealth index quintiles 7387100.0.0.1.0.1.1.01.21.75.491.4Second 7663100.0.0.1.1.0.1.1.2.52.596.4Middle 7844100.0.2.1.0.0.0.0.2.52.097.0Fourth 7809100.0.1.1.1.0.2.0.1.41.098.2Richest 38016100.0.1.1.0.1.1.0.61.33.594.3Total * number < 25 100 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 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, Palestinian Refugee Camps and Gatherings in Syria, 2006 Number of household members Using improved sources of drinking water and using sanitary means of excreta disposal Using improved sources of drinking water *** Using improved sources of drinking water ** 2761961.697.562.9DamascusGovernorates 425188.193.195.0Aleppo 2722100.0100.0100.0Homs 1659100.0100.0100.0Hama 1039100.0100.0100.0Latakia 173398.798.7100.0Dera’a 1457399.8100.099.8YarmoukCamps / Gath- erings 360920.698.420.8Jaramana 2530.6100.0.6Sbeineh 266231.176.144.0Khan Eshieh 189833.2100.033.2Khan Dunoun 20372.1100.02.1Sitt Zeinab 21698.1100.098.1Ramadan 94.0100.0.0Hussaynieh 3497100.0100.0100.0Neirab 75461.361.3100.0Handarat 2722100.0100.0100.0Homs 1659100.0100.0100.0Hama 1039100.0100.0100.0Ramel 91399.6100.099.6Dera’a 69798.398.3100.0Mzaireeb 12391.991.9100.0Jellyn 2537188.199.788.2UrbanUrban / Rural 1365240.693.245.2Rural 310256.597.957.4NoneEducation of household head 880864.997.766.5Primary 1285470.597.671.8Preparatory 650575.297.077.5Secondary 391780.395.883.6Vocational 375786.998.088.0Higher education 6580.0100.080.0Informal education 15***Missing/DK 780739.793.742.8PoorestWealth index quintiles 780529.694.633.7Second 775888.998.890.1Middle 784499.2100.099.2Fourth 7809100.0100.0100.0Richest 3902371.597.473.2Total * number < 25 ** MICS indicator 11; MDG indicator 30 ** MICS indicator 12; MDG indicator 31 101 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Ta bl e R H .1 : U se o f C on tra ce pt io n P er ce nt ag e of w om en a ge d 15 49 - y ea rs m ar rie d w ho a re u si ng (o r w ho se p ar tn er is u si ng ) a c on tra ce pt iv e m et ho d, P al es tin ia n R ef ug ee C am ps a nd G at he rin gs in S yr ia , 2 00 6 N um be r of w om en cu rr en tly m ar rie d A ny m et ho d ** A ny tra di tio na l m et ho d A ny m od er n m et ho d To ta l P er ce nt o f w om en (c ur re nt ly m ar rie d) w ho a re u si ng : N ot us in g an y m et ho d P er io di c ab st in en ce LA M D ia ph ra gm / fo am / j el ly Fe m al e C on do m C on do m im pl an ts in je ct io ns IU D P ill Fe m al e st er ili za tio n 37 51 58 .8 9. 3 49 .5 10 0. 0 8. 2 1. 1 .2 .5 5. 5 .0 .7 26 .4 15 .0 1. 1 41 .2 D am as cu s G ov er no ra te s 58 5 66 .0 14 .5 51 .5 10 0. 0 12 .3 2. 2 .0 .3 7. 0 .2 .5 24 .3 16 .3 2. 9 34 .0 A le pp o 35 0 67 .1 16 .9 50 .3 10 0. 0 13 .1 3. 7 .0 1. 7 5. 7 .0 .3 29 .4 8. 3 4. 9 32 .9 H om s 22 3 77 .6 16 .6 61 .0 10 0. 0 12 .1 4. 5 .4 .0 4. 0 .0 .4 37 .2 14 .8 4. 0 22 .4 H am a 13 9 50 .4 6. 5 43 .9 10 0. 0 5. 8 .7 .0 .0 4. 3 .0 .0 25 .2 12 .2 2. 2 49 .6 La ta ki a 21 2 44 .8 8. 0 36 .8 10 0. 0 6. 1 1. 9 .0 .0 2. 4 .0 .0 21 .2 13 .2 .0 55 .2 D er a’ a 20 35 62 .8 10 .7 52 .0 10 0. 0 9. 8 .9 .2 .3 4. 1 .0 .4 30 .3 15 .2 1. 4 37 .2 Ya rm ou k C am ps / G at he rin gs 51 8 54 .1 8. 9 45 .2 10 0. 0 8. 1 .8 .0 .2 6. 9 .0 1. 2 21 .8 14 .9 .2 45 .9 Ja ra m an a 34 7 50 .3 9. 2 41 .1 10 0. 0 7. 2 2. 0 .0 2. 6 4. 9 .0 1. 1 17 .0 15 .2 .3 49 .7 S be in eh 32 0 56 .7 9. 3 47 .4 10 0. 0 7. 8 1. 6 .0 .0 7. 8 .0 1. 6 26 .5 10 .9 .6 43 .3 K ha n E sh ie h 24 2 58 .7 4. 5 54 .1 10 0. 0 2. 9 1. 7 .8 .4 7. 9 .0 .4 23 .1 18 .2 3. 3 41 .3 K ha n D un ou n 24 5 51 .8 3. 7 48 .2 10 0. 0 3. 3 .4 .0 .0 11 .0 .4 .0 23 .7 12 .7 .4 48 .2 S itt Z ei na b 33 (6 0. 6 (9 .1 ) (5 1. 5 10 0. 0 (3 .0 ) (6 .1 ) (3 .0 ) (.0 ) (.0 ) (.0 ) (.0 ) (1 2. 1 (3 6. 4 (.0 ) (9 .4 ) R am ad an 11 * * * * * * * * * * * * * * * H us - sa yn ie h 47 8 65 .5 15 .2 50 .2 10 0. 0 12 .6 2. 7 .0 .2 7. 4 .2 .7 23 .1 15 .7 2. 7 34 .5 N ei ra b 10 7 73 .8 14 .0 59 .8 10 0. 0 13 .1 .9 .0 .9 6. 5 .0 .0 28 .0 19 .6 4. 7 26 .2 H an da ra t 35 0 67 .1 16 .9 50 .3 10 0. 0 13 .1 3. 7 .0 1. 7 5. 7 .0 .3 29 .4 8. 3 4. 9 32 .9 H om s 22 3 77 .5 16 .7 60 .8 10 0. 0 12 .2 4. 5 .5 .0 3. 6 .0 .5 37 .4 14 .9 4. 1 22 .4 H am a 13 9 50 .4 6. 5 43 .9 10 0. 0 5. 8 .7 .0 .0 4. 3 .0 .0 25 .2 12 .2 2. 2 49 .6 R am el 10 8 47 .7 8. 3 39 .4 10 0. 0 6. 4 1. 8 .0 .0 1. 8 .0 .0 22 .9 14 .7 .0 52 .3 D er a’ a 88 40 .9 9. 1 31 .8 10 0. 0 6. 8 2. 3 .0 .0 3. 4 .0 .0 17 .0 11 .4 .0 59 .1 M za ire eb 16 * * * * * * * * * * * * * * * Je lly n 34 82 61 .2 11 .1 50 .1 10 0. 0 9. 6 1. 4 .2 .4 4. 6 .0 .5 28 .6 14 .2 1. 7 38 .8 U rb an U rb an / R ur al 17 78 58 .0 9. 6 48 .4 10 0. 0 7. 8 1. 8 .2 .7 7. 2 .1 .7 22 .7 15 .3 1. 6 42 .0 R ur al 102 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Ta bl e R H .1 (c on tin ue d) : U se o f C on tra ce pt io n P er ce nt ag e of w om en a ge d 15 -4 9 ye ar s m ar rie d w ho a re u si ng (o r w ho se p ar tn er is u si ng ) a c on tra ce pt iv e m et ho d, P al es tin ia n R ef ug ee C am ps a nd G at he rin gs in S yr ia , 2 00 6 N um be r of w om en cu rr en tly m ar rie d A ny m et ho d ** A ny tr a- di tio na l m et ho d A ny m od er n m et ho d To ta l P er ce nt o f w om en (c ur re nt ly m ar rie d) w ho a re u si ng : N ot u s- in g an y m et ho d P er io di c ab st i- ne nc e LA M D ia - ph ra gm / fo am / j el ly Fe m al e C on do m C on - do m im - pl an ts in je c- tio ns IU D P ill Fe m al e st er ili za - tio n 16 0 25 .0 5. 0 20 .0 10 0. 0 3. 1 1. 9 .0 .6 5. 0 .0 .0 8. 1 6. 3 .0 75 .0 15 -1 9 W om an ’s A ge 65 7 43 .4 7. 6 35 .8 10 0. 0 5. 3 2. 3 .0 .3 7. 5 .2 .9 13 .9 13 .1 .0 56 .6 20 -2 4 95 1 55 .1 8. 0 47 .1 10 0. 0 4. 7 3. 3 .1 .3 6. 4 .0 .5 25 .1 14 .3 .3 44 .9 25 -2 9 96 0 66 .6 12 .6 54 .0 10 0. 0 10 .8 1. 8 .2 .8 6. 9 .0 .9 27 .9 16 .6 .6 33 .4 30 -3 4 10 09 70 .2 11 .4 58 .8 10 0. 0 10 .3 1. 1 .1 .6 5. 5 .0 .5 34 .1 16 .1 2. 0 29 .8 35 -3 9 91 2 68 .0 11 .5 56 .5 10 0. 0 11 .1 .4 .4 .5 3. 4 .1 .4 32 .1 15 .9 3. 5 32 .0 40 -4 4 61 1 56 .8 13 .3 43 .5 10 0. 0 13 .1 .2 .2 .0 2. 8 .0 .2 24 .9 11 .3 4. 3 43 .2 45 -4 9 46 6 4. 9 1. 3 3. 6 10 0. 0 1. 1 .2 .0 .0 .4 .2 .0 2. 4 .4 .2 95 .1 0 N um be r of li vi ng ch ild re n 55 3 34 .5 9. 6 25 .0 10 0. 0 6. 3 3. 3 .0 .4 8. 0 .0 .7 5. 1 10 .7 .2 65 .5 1 89 4 59 .4 9. 3 50 .1 10 0. 0 7. 0 2. 2 .0 .4 8. 2 .0 1. 1 25 .7 14 .2 .4 40 .6 2 11 02 72 .7 13 .0 59 .7 10 0. 0 11 .3 1. 7 .2 .6 6. 1 .0 .4 33 .1 18 .7 .6 27 .3 3 22 45 72 .0 12 .1 60 .0 10 0. 0 11 .0 1. 1 .3 .5 4. 5 .0 .5 34 .1 16 .6 3. 3 28 .0 4+ 18 6 45 .7 9. 1 36 .6 10 0. 0 8. 1 1. 1 .5 .0 2. 7 .5 .5 19 .4 12 .4 .5 54 .3 N on e M ot he r’s ed uc at io n 10 40 56 .7 6. 9 49 .8 10 0. 0 5. 3 1. 6 .2 .9 5. 5 .1 .6 25 .1 16 .1 1. 4 43 .3 P rim ar y 18 46 61 .1 9. 3 51 .8 10 0. 0 8. 0 1. 2 .3 .3 5. 0 .0 .7 29 .0 15 .1 1. 5 38 .9 P re pa ra to ry 12 36 62 .6 12 .9 49 .8 10 0. 0 10 .8 2. 0 .0 .5 5. 8 .0 .6 27 .1 13 .8 1. 9 37 .4 S ec on da ry 59 4 62 .6 13 .5 49 .2 10 0. 0 11 .4 2. 0 .2 .5 6. 7 .0 .5 24 .6 14 .5 2. 2 37 .4 Vo ca tio na l 35 0 59 .7 16 .3 43 .4 10 0. 0 15 .4 .9 .0 .3 5. 7 .0 .3 24 .0 11 .4 1. 7 40 .3 H ig he r e du - ca tio n 8 * * * * * * * * * * * * * * * In fo rm al ed uc at io n 10 60 55 .7 7. 6 48 .0 10 0. 0 5. 9 1. 7 .1 .3 8. 1 .0 .8 23 .1 15 .2 .5 44 .3 P oo re st W ea lth in de x qu in - til es 10 10 54 .1 8. 2 45 .8 10 0. 0 6. 7 1. 5 .2 1. 0 6. 5 .1 .6 22 .3 14 .1 1. 1 45 .9 S ec on d 10 94 62 .1 12 .6 49 .5 10 0. 0 10 .8 1. 8 .2 .5 5. 3 .1 .7 26 .2 15 .0 1. 4 37 .9 M id dl e 10 75 64 .0 11 .9 52 .1 10 0. 0 10 .4 1. 5 .2 .6 3. 7 .0 .5 29 .9 14 .5 2. 8 36 .0 Fo ur th 10 21 64 .6 12 .3 52 .3 10 0. 0 11 .1 1. 3 .2 .0 3. 6 .0 .3 31 .5 14 .1 2. 5 35 .4 R ic he st 52 60 60 .1 10 .6 49 .6 10 0. 0 9. 0 1. 6 .2 .5 5. 5 .0 .6 26 .6 14 .5 1. 7 39 .9 To ta l * nu m be r < 2 5 ** M IC S in di ca to r 2 1; M D G in di ca to r 1 9 103 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Ta bl e R H .3 : A nt en at al C ar e P ro vi de r P er ce nt d is tri bu tio n of w om en a ge d 15 49 - w ho g av e bi rth in th e tw o ye ar s pr ec ed in g th e su rv ey b y ty pe o f p er so nn el p ro vi di ng a nt en at al c ar e, P al es tin ia n R ef ug ee C am ps a nd G at he rin gs in S yr ia , 2 00 6 N um be r o f w om en w ho g av e bi rth in th e pr ec ed in g tw o ye ar s A ny s ki lle d pe rs on ne l * * To ta l P er so n pr ov id in g an te na ta l c ar e N o an te na ta l ca re re ce iv ed ot he r R el at iv es / f rie nd s A ux ili ar y m id w ife N ur se / m id w ife M ed ic al do ct or 10 89 94 .7 10 0. 0 1. 1 4. 1 .1 .4 11 .0 83 .3 D am as cu s G ov er no ra te s 15 8 93 .0 10 0. 0 .0 7. 0 .0 .0 18 .4 74 .7 A le pp o 90 96 .7 10 0. 0 .0 3. 3 .0 .0 5. 6 91 .1 H om s 67 98 .5 10 0. 0 .0 1. 5 .0 1. 5 1. 5 95 .5 H am a 42 (1 00 .0 ) (1 00 .0 ) (.0 ) (.0 ) (.0 ) (.0 ) (2 .4 ) (9 7. 6) La ta ki a 75 98 .7 10 0. 0 1. 3 .0 .0 5. 3 41 .3 52 .0 D er a’ a 52 0 97 .1 10 0. 0 1. 5 1. 2 .2 .4 6. 9 89 .8 Ya rm ou k C am ps / G at he rin gs 16 5 96 .4 10 0. 0 .6 3. 0 .0 .0 10 .3 86 .1 Ja ra m an a 11 8 10 0. 0 10 0. 0 .0 .0 .0 .8 16 .8 82 .4 S be in eh 11 5 98 .3 10 0. 0 1. 7 .0 .0 .9 20 .9 76 .5 K ha n E sh ie h 71 74 .6 10 0. 0 1. 4 23 .9 .0 .0 12 .7 62 .0 K ha n D un ou n 79 78 .8 10 0. 0 .0 21 .3 .0 .0 5. 0 73 .8 S itt Z ei na b 17 * * * * * * * * R am ad an 4 * * * * * * * * H us sa yn ie h 13 4 91 .3 10 0. 0 .0 8. 7 .0 .0 13 .5 77 .8 N ei ra b 24 ( * ) ( * ) ( * ) ( * ) ( * ) ( * ) ( * ) ( * ) H an da ra t 90 96 .7 10 0. 0 .0 3. 3 .0 .0 5. 6 91 .1 H om s 67 98 .5 10 0. 0 .0 1. 5 .0 1. 5 1. 5 95 .5 H am a 42 (1 00 .0 ) (1 00 .0 ) (.0 ) (.0 ) (.0 ) (.0 ) (2 .4 ) (9 7. 6) R am el 35 (9 7. 1) (1 00 .0 ) (2 .9 ) (.0 ) (.0 ) (5 .7 ) (3 1. 4) (6 0. 0) D er a’ a 32 (1 00 .0 ) (1 00 .0 ) (.0 ) (.0 ) (.0 ) (6 .3 ) (4 6. 9) (4 6. 9) M za ire eb 8 ( * ) ( * ) ( * ) ( * ) ( * ) ( * ) ( * ) ( * ) Je lly n 95 7 96 .9 10 0. 0 1. 0 2. 0 .1 .7 9. 1 87 .0 U rb an U rb an / R ur al 56 4 92 .2 10 0. 0 .5 7. 3 .0 .4 17 .7 74 .1 R ur al 104 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Ta bl e R H .3 (c on tin ue d) : A nt en at al C ar e P ro vi de r P er ce nt d is tri bu tio n of w om en a ge d 15 49 - w ho g av e bi rth in th e tw o ye ar s pr ec ed in g th e su rv ey b y ty pe o f p er so nn el p ro vi di ng a nt en at al c ar e, P al es tin ia n R ef ug ee C am ps a nd G at he rin gs in S yr ia , 2 00 6 N um be r o f w om en w ho g av e bi rth in th e pr ec ed in g tw o ye ar s A ny s ki lle d pe rs on ne l * * To ta l P er so n pr ov id in g an te na ta l c ar e N o an te na ta l ca re re ce iv ed O th er R el at iv es / f rie nd s A ux ili ar y m id w ife N ur se / m id w ife M ed ic al do ct or 70 98 .6 10 0. 0 1. 4 .0 .0 .0 8. 6 90 .0 15 -1 9 W om an ’s A ge 36 6 95 .4 10 0. 0 .3 4. 4 .0 .8 9. 6 85 .0 20 -2 4 46 6 95 .1 10 0. 0 1. 1 3. 6 .2 .2 13 .7 81 .1 25 -2 9 31 9 94 .7 10 0. 0 .6 4. 7 .0 .6 13 .2 80 .9 30 -3 4 22 5 96 .4 10 0. 0 .9 2. 7 .0 .9 12 .0 83 .6 35 -3 9 70 90 .0 10 0. 0 2. 9 7. 1 .0 1. 4 17 .1 71 .4 40 -4 4 5 80 .0 10 0. 0 * * * * * * 45 -4 9 25 (9 2. 0) 10 0. 0 (4 .0 ) (4 .0 ) (.0 ) (.0 ) (1 6. 0) (7 6. 0) N on e M ot he r’s e du - ca tio n 30 5 93 .8 10 0. 0 1. 0 4. 9 .3 1. 0 16 .1 76 .7 P rim ar y 54 7 94 .3 10 0. 0 .7 4. 9 .0 .7 13 .5 80 .1 P re pa ra to ry 36 1 96 .7 10 0. 0 .8 2. 5 .0 .6 11 .9 84 .2 S ec on da ry 19 0 96 .3 10 0. 0 .0 3. 7 .0 .0 6. 8 89 .5 Vo ca tio na l 91 96 .7 10 0. 0 2. 2 1. 1 .0 .0 4. 4 92 .3 H ig he r e du ca tio n 2 * * * * * * * * In fo rm al e du ca tio n 40 0 96 .0 10 0. 0 .8 3. 3 .0 .8 20 .3 75 .0 P oo re st W ea lth in de x qu in til es T 31 8 91 .5 10 0. 0 .6 7. 9 .0 .6 13 .8 77 .0 S ec on d 32 3 94 .4 10 0. 0 1. 2 4. 3 .0 .6 8. 4 85 .4 M id dl e 29 1 95 .9 10 0. 0 1. 4 2. 4 .3 .3 6. 9 88 .7 Fo ur th 18 9 99 .5 10 0. 0 .0 .5 .0 .5 7. 9 91 .0 R ic he st 15 21 95 .1 10 0. 0 .9 3. 9 .1 .6 12 .3 82 .2 To ta l * nu m be r < 2 5, () n um be r < 5 0 ** M IC S in di ca to r 2 0 105 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Table RH.4: Antenatal Care Content Percentage of pregnant women receiving antenatal care among women aged 15-49 years who gave birth in the two years preceding the survey and percentage of pregnant women receiving specific care as part of the antenatal care received, Palestinian Refugee Camps and Gatherings in Syria, 2006 Number of women who gave birth in two years preceding survey Percent of pregnant women who had:Percent of pregnant women receiving ANC one or more times during pregnancy Weight Mea- sured** Urine speci- men taken** Blood pressure mea- sured** Blood sample taken** 108997.896.997.795.498.9DamascusGovernor- ates 15898.198.198.197.5100.0Aleppo 90100.0100.0100.0100.0100.0Homs 67100.095.598.595.5100.0Hama 42(100.0)(100.0)(100.0)(100.0)(100.0)Latakia 7594.794.796.090.798.7Dera’a 52097.596.097.594.698.5YarmoukCamps / Gatherings 16599.498.299.497.699.4Jaramana 11896.696.697.595.0100.0Sbeineh 11596.596.594.893.098.3Khan Es- hieh 7198.698.698.698.698.6Khan Du- noun 79100.097.598.895.0100.0Sitt Zeinab 17****100.0Ramadan 4****100.0Hus- saynieh 13497.697.697.697.6100.0Neirab 24( * )( * )( * )( * )100.0Handarat 90100.0100.0100.0100.0100.0Homs 67100.097.098.597.0100.0Hama 42(100.0)(100.0)(100.0)(100.0)(100.0)Ramel 35(91.4)(91.4)(91.4)(82.9)(97.1)Dera’a 32(100.0)(100.0)(100.0)(100.0)(100.0)Mzaireeb 8*****Jellyn 95798.297.098.195.799.0UrbanUrban / Rural 56497.597.397.595.999.5Rural 106 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Table RH.4 (continued): Antenatal Care Content Percentage of pregnant women receiving antenatal care among women aged 1549- years who gave birth in the two years preceding the survey and percentage of pregnant women receiving specific care as part of the antenatal care received, Palestinian Refugee Camps and Gatherings in Syria, 2006 Number of women who gave birth in two years preceding survey Percent of pregnant women who had:Percent of pregnant women receiving ANC one or more times during pregnancy Weight Mea- sured** Urine specimen taken** Blood pressure measured** Blood sample taken** 7095.792.997.191.498.615-19Woman’s Age 36698.697.898.196.499.720-24 46697.996.897.695.198.925-29 31997.897.297.595.999.430-34 22598.297.899.196.999.135-39 7097.197.197.197.197.140-44 5*****45-49 25(96.0)(96.0)(96.0)(92.0)(96.0)NoneMother’s education 30597.495.498.493.899.0Primary 54798.497.898.096.099.3Prepara- tory 36197.597.297.596.799.2Secondary 19099.598.998.997.9100.0Vocational 9196.794.595.694.597.8Higher education 2*****Informal education 40098.097.597.595.899.3PoorestWealth index quintiles 31897.896.998.195.699.4Second 32397.597.298.594.798.8Middle 29197.396.296.295.998.6Fourth 189100.097.9100.097.9100.0Richest 152198.097.197.995.899.1Total * number < 25, () number < 50 ** MICS indicator 44 107 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Table RH.5: Assistance During Delivery Percent distribution of women aged 1549- with a birth in the two years preceding the survey by type of personnel assisting at delivery, Palestinian Refugee Camps and Gatherings in Syria, 2006 Number of women who gave birth in preceding two years Delivered in health facility *** Any skilled person- nel ** TotalPerson assisting at delivery No attendant OtherRela- tives / friends Auxiliary midwife Nurse/ midwife Medical doctor 108992.999.5100.0.2.2.11.19.688.9DamascusGovernorates 15897.596.8100.0.22.5.01.330.465.2Aleppo 9092.2100.0100.0.0.0.0.024.475.6Homs 6789.698.5100.0.01.5.0.014.983.6Hama 42(83.3)(100.0)(100.0)(.0)(.0)(.0)(.0)(16.7)(83.3)Latakia 7585.397.3100.01.31.3.012.037.348.0Dera’a 52095.499.0100.0.2.0.0.86.992.1YarmoukCamps / Gatherings 16592.197.6100.0.0.6.61.213.983.6Jaramana 11891.598.3100.0.0.0.01.76.891.5Sbeineh 11597.498.3100.0.0.0.01.74.393.9Khan Eshieh 7187.398.6100.01.4.0.0.022.576.1Khan Dunoun 7979.796.2100.0.01.3.02.517.778.5Sitt Zeinab 17*********Ramadan 4*********Hus- saynieh 13497.094.8100.0.73.0.01.526.967.9Neirab 24*******50.050.0Handarat 9092.2100.0100.0.0.0.0.024.475.6Homs 6789.698.5100.0.01.5.0.014.983.6Hama 42(83.3)(100.0)(100.0)(.0)(.0)(.0)(.0)(16.7)(83.3)Ramel 35(91.4)(88.6)(100.0)(2.9)(2.9)(.0)(5.7)(54.3)(34.3)Dera’a 32(87.5)(87.5)(100.0)(.0)(.0)(.0)(12.5)(25.0)(62.5)Mzaireeb 8*********Jellyn 95793.299.4100.0.2.3.11.313.185.1UrbanUrban / Rural 56491.598.8100.0.4.9.02.016.780.1Rural 108 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Table RH.5 (continued): Assistance During Delivery Percent distribution of women aged 1549- with a birth in the two years preceding the survey by type of personnel assisting at delivery, Palestinian Refugee Camps and Gatherings in Syria, 2006 Number of women who gave birth in preceding two years Delivered in health facility *** Any skilled person- nel ** TotalPerson assisting at delivery No attendant otherRelatives / friends Auxiliary midwife Nurse/ midwife Medical doctor 7090.0100.0100.0.0.0.0.015.784.315-19Woman’s Age 36692.999.5100.0.3.3.01.415.882.220-24 46694.898.5100.0.41.1.01.312.085.225-29 31991.899.1100.0.0.6.32.515.081.530-34 22590.2100.0100.0.0.0.0.916.982.235-39 7088.698.6100.01.4.0.02.910.085.740-44 5*********45-49 25(92.0)(96.0)100.0(4.0)).0().0((4.0)(16.0)(76.0)NoneMother’s educa- tion 30590.299.3100.0.3.3.01.616.781.0Primary 54790.999.5100.0.2.2.22.216.580.8Prepara- tory 36193.999.2100.0.3.6.01.112.585.6Secondary 19097.997.9100.0.02.1.0.510.586.8Vocational 9195.6100.0100.0.0.0.0.08.891.2Higher education 2*********Informal education 40092.899.5100.0.0.3.32.015.082.5PoorestWealth index quintiles 31889.099.7100.0.3.0.02.215.482.1Second 32393.598.5100.0.6.9.01.217.679.6Middle 29194.298.6100.0.31.0.01.011.386.3Fourth 18994.299.5100.0.0.5.0.510.688.4Richest 152192.699.1100.0.3.5.11.514.483.2Total * number < 25, () number < 50 ** MICS indicator 4; MDG indicator 17 *** MICS indicator 5 109 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Ta bl e R H .6 : M at er na l M or ta lit y R at io R is ks o f m at er na l d ea th a nd p er ce nt ag e of w om en w ho d ie d fro m m at er na l-r el at ed c au se s, P al es tin ia n R ef ug ee C am ps a nd G at he rin gs in S yr ia , 2 00 6 M a- te rn al m or ta lit y ra tio * To ta l fe rti lit y ra te b ef or e ag e 10 -1 4 ye ar s P er ce nt ag e of w om en w ho d ie d fro m m at er na l- re la te d ca us es R is ks o f m at er na l de at h W om en su bj ec te d to ri sk s of m at er na l de at h C on tro l fa ct or M at er na l m or ta lit y W om en w ho re ac he d 15 y ea rs an d di ed W om en w ho re ac he d 15 y ea rs (a ve ra ge ) W om en w ho re ac he d 15 y ea rs N um be r of a du lt ho us eh ol d re sp on de nt s . . .0 .0 00 29 53 .1 07 0 41 27 59 8 83 46 46 15 15 -1 9 Fe m al e re sp on de nt ’s A ge . . 10 .1 .0 01 73 43 .2 06 7 69 35 64 7 10 78 0 41 73 20 -2 4 . . 4. 3 .0 00 11 23 2 .3 43 4 94 32 74 7 99 03 31 03 25 -2 9 . . 7. 5 .0 02 47 77 .5 03 8 10 7 94 97 94 97 26 22 30 -3 4 . . 13 .1 .0 04 63 01 .6 64 25 19 1 94 90 94 90 24 80 35 -3 9 . . 9. 5 .0 03 69 37 .8 02 19 20 0 86 50 86 50 22 99 40 -4 4 . . 6. 9 .0 02 56 78 .9 00 12 17 4 63 09 63 09 17 11 45 -4 9 . . 4. 1 .0 02 49 17 .9 58 9 21 8 51 33 51 33 14 63 50 -5 4 . . .9 .0 01 31 14 .9 86 2 22 2 31 58 31 58 96 3 55 -5 9 . . 2. 7 .0 04 70 66 1. 00 0 29 10 57 70 66 70 66 26 65 60 + 46 6. 00 4. 8 .0 03 41 74 4 . 11 5 23 73 76 90 1 78 33 2 26 09 4 To ta l * M IC S in di ca to r 3 ; M D G in di ca to r 1 6 110 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Ta bl e C D .1 : F am ily S up po rt fo r L ea rn in g P er ce nt ag e of c hi ld re n ag ed 0 -5 9 m on th s fo r w ho m h ou se ho ld m em be rs a re e ng ag ed in a ct iv iti es th at p ro m ot e le ar ni ng a nd s ch oo l r ea di ne ss , P al es tin ia n R ef ug ee C am ps an d G at he rin gs in S yr ia , 2 00 6 N um be r o f ch ild re n ag ed 0- 59 m on th s P er ce nt ag e of c hi ld re n ag ed 0 -5 9 m on th s Li vi ng in a ho us eh ol d w ith ou t t he ir na tu ra l f at he r M ea n nu m be r o f ac tiv iti es th e fa th er en ga ge in w ith th e ch ild Fo r w ho m th e fa th er e n- ga ge d in o ne o r m or e ac tiv i- tie s th at p ro m ot e le ar ni ng an d sc ho ol re ad in es s ** * M ea n nu m be r o f ac tiv iti es h ou se ho ld m em be rs e ng ag e in w ith th e ch ild Fo r w ho m h ou se ho ld m em - be rs e ng ag ed in fo ur o r m or e ac tiv iti es th at p ro m ot e le ar n- in g an d sc ho ol re ad in es s ** 19 49 1. 4 1. 5 64 .8 4. 1 63 .9 M al e S ex 18 52 1. 5 1. 5 65 .3 4. 2 66 .7 Fe m al e 27 11 1. 5 1. 4 63 .1 4. 1 65 .0 D am as cu s G ov er no r- at es 41 6 2. 2 1. 7 62 .7 4. 3 64 .2 A le pp o 23 1 .0 2. 2 90 .5 4. 1 68 .4 H om s 15 2 1. 3 2. 6 84 .9 4. 3 83 .6 H am a 10 0 1. 0 3. 2 96 .0 4. 4 68 .0 La ta ki a 19 1 1. 0 .6 34 .6 3. 6 51 .8 D er a’ a 13 17 1. 5 1. 5 61 .4 4. 2 67 .9 Ya rm ou k C am ps / G at he rin gs 41 6 .5 1. 3 73 .8 3. 8 55 .3 Ja ra m an a 28 1 1. 4 1. 1 66 .5 3. 9 62 .3 S be in eh 28 7 2. 4 1. 1 56 .1 4. 1 62 .0 K ha n E sh ie h 16 7 1. 8 1. 3 60 .5 4. 3 71 .9 K ha n D un ou n 20 0 2. 5 1. 6 65 .0 4. 3 75 .5 S itt Z ei na b 34 (.0 ) (.7 ) (2 9. 4) (3 .2 ) (3 5. 3) R am ad an 10 * * * * * H us sa yn ie h 33 8 2. 7 1. 7 63 .6 4. 3 63 .3 N ei ra b 78 .0 1. 4 59 .0 4. 3 67 .9 H an da ra t 23 1 .0 2. 2 90 .5 4. 1 68 .4 H om s 15 2 1. 3 2. 6 84 .9 4. 3 83 .6 H am a 99 1. 0 3. 2 96 .0 4. 4 68 .7 R am el 84 .0 .9 39 .3 4. 5 66 .7 D er a’ a 89 .0 .3 31 .5 3. 0 41 .6 M za ire eb 18 * * * * * Je lly n 24 11 1. 1 1. 6 67 .4 4. 1 65 .8 U rb an U rb an / R ur al 13 90 2. 0 1. 3 60 .9 4. 1 64 .2 R ur al 15 57 .9 1. 3 62 .2 3. 3 42 .6 0- 23 m on th s A ge 22 44 1. 8 1. 6 67 .0 4. 7 80 .9 24 -5 9 m on th s 111 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Syria 2006 Ta bl e C D .1 (c on tin ue d) : F am ily S up po rt fo r L ea rn in g P er ce nt ag e o

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