Thailand - Multiple Indicator Cluster Survey - 2013

Publication date: 2013

Thailand Monitoring the situation of children and women Multiple Indicator Cluster Survey 2012 NSO National Statistical Office UNICEF United Nations Children’s Fund MOPH Ministry of Public Health NHSO National Health Security Office THPF Thai Health Promotion Foundation IHPP International Health Policy Program 20140502_MICS_book_Eng_1/2.indd 1 5/2/14 6:13 PM Thailand Multiple Indicator Cluster Survey 2012 20140502_MICS_book_Eng_1/2.indd 126 5/2/14 6:13 PM T h ailan d : M o n ito rin g th e situ atio n o f ch ild ren an d w o m en M u ltip le In d icato r C lu ster S u rvey 2012 MICS_Eng_cover_AW.pdf 1 5/2/14 7:12 PM Monitoring the situation of children and women Multiple Indicator Cluster Survey National Statistical Office United Nations Children’s Fund Ministry of Public Health National Health Security Office Thai Health Promotion Foundation International Health Policy Program 20140502_MICS_book_Eng_1/2.indd 15/2/14 6:13 PM Multiple Indicator Cluster Survey T h ailan d : M o n ito rin g th e situ atio n o f ch ild ren an d w o m en M u ltip le In d icato r C lu ster S u rvey 2012 MICS_Eng_cover_AW.pdf 1 5/2/14 7:12 PM Thailand Monitoring the situation of children and women Multiple Indicator Cluster Survey 2012 NSO National Statistical Office UNICEF United Nations Children’s Fund MOPH Ministry of Public Health NHSO National Health Security Office THPF Thai Health Promotion Foundation IHPP International Health Policy Program Thailand Multiple Indicator Cluster Survey 2012 20140502_MICS_book_Eng_1/2.indd 126 5/2/14 6:13 PM T h ailan d : M o n ito rin g th e situ atio n o f ch ild ren an d w o m en M u ltip le In d icato r C lu ster S u rvey 2012 MICS_Eng_cover_AW.pdf 1 5/2/14 7:12 PM Thailand Monitoring the situation of children and women Multiple Indicator Cluster Survey 2012 NSO National Statistical Office UNICEF United Nations Children’s Fund MOPH Ministry of Public Health NHSO National Health Security Office THPF Thai Health Promotion Foundation IHPP International Health Policy Program 20140502_MICS_book_Eng_1/2.indd 1 5/2/14 6:13 PM Thailand Multiple Indicator Cluster Survey 2012 T h ailan d : M o n ito rin g th e situ atio n o f ch ild ren an d w o m en M u ltip le In d icato r C lu ster S u rvey 2012 MICS_Eng_cover_AW.pdf 1 5/2/14 7:12 PM 210x297 210x297sun 14 mm 57-05-011_COVER Mics Repovt_Eng_A-kim57-05-011_COVER Mics Repovt_Eng_A-kim.indd 1 5/6/14 4:47 PM Thailand Monitoring the situation of children and women Multiple Indicator Cluster Survey 2012 NSO National Statistical Office UNICEF United Nations Children’s Fund MOPH Ministry of Public Health NHSO National Health Security Office THPF Thai Health Promotion Foundation IHPP International Health Policy Program 20140501_UNICEF_book_Eng.indd 1 5/2/14 11:18 AM Thailand Multiple Indicator Cluster Survey 2012 NSO National Statistical Office UNICEF United Nations Children’s Fund MOPH Ministry of Public Health NHSO National Health Security Office THPF Thai Health Promotion Foundation IHPP International Health Policy Program November 2013 Cover photopraph: UNICEF Thailand/2009/M. Thomas 20140501_UNICEF_book_Eng.indd 2 5/2/14 11:18 AM iii Preface The National Statistical Office (NSO) conducted the Thailand 2012 Multiple Indicator Cluster Survey (MICS), which was part of MICS4 programme, between September and November 2012. This was the second such survey, following the earlier survey being part of MICS3 programme, which was carried out between December 2005 and February 2006 in collaboration with the Ministry of Public Health, the Ministry of Education, the Ministry of Social Development and Human Security and the United Nations Children’s Fund (UNICEF). For Thailand 2012 MICS, the National Statistical Office’s aims were to obtain updated information on the situation of children and women, including various key indicators that allow countries to monitor progress towards the Millennium Development Goals (MDGs), A World Fit for Children (WFFC) and other internationally agreed upon commitments. The data/information obtained from Thailand 2012 MICS can be used by government organizations in their evidence-based plans and policies regarding children and women. Additional information on the global MICS project may be obtained from www.childinfo.org. The National Statistical Office would like to take this opportunity to express its gratitude to the United Nations Children’s Fund (UNICEF), the Ministry of Public Health, the Ministry of Education, the Ministry of Social Development and Human Security, the Thai Health Promotion Foundation, the National Health Security Office, the International Health Policy Program, Thailand (IHPP) and Academic Institutes (Institute for Population and Social Research: Mahidol University, College of Population Studies: Chulalongkorn University) for their financial and technical support. National Statistical Office 20140501_UNICEF_book_Eng.indd 3 5/2/14 11:18 AM 20140501_UNICEF_book_Eng.indd 4 5/2/14 11:18 AM Contents List of Tables vii List of Figures x List of Abbreviations xi Summary Table of Findings xii Executive Summary 1 I. Introduction 7 Background 7 Survey Objectives 8 II. Sample and Survey Methodology 9 Sample Design 9 Questionnaires 9 Pre-test 11 Training 11 Fieldwork and Data Processing 12 III. Sample Coverage and the Characteristics of Households and Respondents 13 Sample Coverage 13 Characteristics of Households 14 Characteristics of Female Respondents 15-49 Years of Age and Children Under-5 17 IV. Nutrition 21 Nutritional Status 21 Breastfeeding and Infant and Young Child Feeding 24 Salt Iodization 35 Low Birth Weight 37 V. Child Health 39 Vaccinations 39 Neonatal Tetanus Protection 42 Oral Rehydration Treatment 44 Care Seeking and Antibiotic Treatment of Pneumonia 50 Solid Fuel Use 51 VI. Water and Sanitation 55 Use of Improved Water Sources 55 Use of Improved Sanitation 61 20140501_UNICEF_book_Eng.indd 5 5/2/14 11:18 AM VII. Reproductive Health 67 Fertility 67 Contraception 71 Unmet Need 73 Antenatal Care 75 Assistance at Delivery 80 Place of Delivery 80 VIII. Child Development 83 Early Childhood Education and Learning 83 Early Childhood Development 89 IX. Literacy and Education 91 Literacy among Young Women 91 School Readiness 92 Primary and Secondary School Participation 93 X. Child Protection 103 Birth Registration 103 Early Marriage 105 Attitudes toward Domestic Violence 109 XI. HIV/AIDS and Orphans 111 Knowledge about HIV Transmission and Misconceptions about HIV/AIDS 111 Accepting Attitudes Towards People Living with HIV/AIDS 117 Knowledge of a Place for HIV Testing, Counselling and Testing During Antenatal Care 118 Orphans 121 Appendix A. Sample Design 125 Appendix B. List of Personnel Involved in the Survey 129 Appendix C. Estimates of Sampling Errors 131 Appendix D. Data Quality Tables 151 Appendix E. Thailand 2012 MICS Indicators: Numerators and Denominators 165 Appendix F. Definitions 173 Appendix G. Questionnaires 177 20140502_MICS_book_Eng_1/2.indd 6 5/6/14 5:38 PM viiMultiple Indicator Cluster Survey 2012 List of Tables Table HH.1: Results of household, women’s and under-5 interviews 13 Table HH.2: Household age distribution by sex 14 Table HH.3: Household composition 16 Table HH.4: Women’s background characteristics 18 Table HH.5: Under-5’s background characteristics 19 Table NU.1: Nutritional status of children 23 Table NU.2: Initial breastfeeding 25 Table NU.3: Breastfeeding 27 Table NU.4: Duration of breastfeeding 29 Table NU.5: Age-appropriate breastfeeding 30 Table NU.6: Introduction of solid, semi-solid or soft foods 31 Table NU.7: Minimum meal frequency 33 Table NU.8: Bottle feeding 34 Table NU.9: Iodized salt consumption 35 Table NU.10: Low birth weight infants 38 Table CH.1: Vaccinations in first year of life 40 Table CH.2: Vaccinations by background characteristics 42 Table CH.3: Neonatal tetanus protection 43 Table CH.4: Oral rehydration solutions and recommended homemade fluids 45 Table CH.5: Feeding practices during diarrhoea 47 Table CH.6: Oral rehydration therapy with continued feeding and other treatments 49 Table CH.7: Care seeking for suspected pneumonia and antibiotic use during suspected pneumonia 50 Table CH.8: Solid fuel use 52 Table CH.9: Solid fuel use by place of cooking 53 Table WS.1: Use of improved water sources 56 Table WS.2: Household water treatment 58 Table WS.3: Time to source of drinking water 59 Table WS.4: Person collecting water 60 Table WS.5: Types of sanitation facilities 61 Table WS.6: Use and sharing of sanitation facilities 62 Table WS.7: Disposal of child’s faeces 63 Table WS.8: Drinking water and sanitation ladders 65 Table RH.1A: Fertility rates 67 Table RH.1B: Adolescent birth rate and total fertility rate 68 Table RH.2: Early childbearing 69 Table RH.3: Trends in early childbearing 70 Table RH.4: Use of contraception 72 Table RH.5: Unmet need for contraception 74 20140502_MICS_book_Eng_1/2.indd 7 5/6/14 5:38 PM Thailand: Monitoring the situation of children and womenviii Table RH.6: Antenatal care coverage 77 Table RH.7: Number of antenatal care visits 78 Table RH.8: Content of antenatal care 79 Table RH.9: Assistance during delivery 81 Table RH.10: Place of delivery 82 Table CD.1: Early childhood education 84 Table CD.2: Support for learning 85 Table CD.3: Learning materials 87 Table CD.4: Inadequate care 88 Table CD.5: Early child development index 90 Table ED.1: Literacy among young women 91 Table ED.2: School readiness 92 Table ED.3: Primary school entry 94 Table ED.4: Primary school attendance 95 Table ED.5: Secondary school attendance 96 Table ED.6: Children reaching last grade of primary school 97 Table ED.7: Primary school completion and transition to secondary school 99 Table ED.8: Education gender parity 100 Table ED.9: School attendance 101 Table CP.1: Birth registration 103 Table CP.2: Early marriage 106 Table CP.3: Trends in early marriage 108 Table CP.4: Spousal age difference 108 Table CP.5: Attitudes toward domestic violence 110 Table HA.1: Knowledge about HIV transmission, misconceptions about HIV/AIDS, and comprehensive knowledge about HIV transmission 112 Table HA.2: Knowledge about HIV transmission, misconceptions about HIV/AIDS, and comprehensive knowledge about HIV transmission among young women 115 Table HA.3: Knowledge of mother-to-child HIV transmission 116 Table HA.4: Accepting attitudes toward people living with HIV/AIDS 117 Table HA.5: Knowledge of a place for HIV testing 119 Table HA.6: HIV counselling and testing during antenatal care 120 Table HA.7: Children’s living arrangements and orphanhood 122 Table HA.8: School attendance of orphans and non-orphans 123 Table SD.1: Allocation of sample clusters (Primary sampling units) to sampling strata 126 Table SE.1: Indicators selected for sampling error calculations 132 Table SE.2: Sampling errors: Thailand 134 Table SE.3: Sampling errors: Municipal areas 136 Table SE.4: Sampling errors: Non-municipal areas 138 20140501_UNICEF_book_Eng.indd 8 5/2/14 11:18 AM ixMultiple Indicator Cluster Survey 2012 Table SE.5: Sampling errors: Bangkok 140 Table SE.6: Sampling errors: Central 142 Table SE.7: Sampling errors: North 144 Table SE.8: Sampling errors: Northeast 146 Table SE.9: Sampling errors: South 148 Table DQ.1: Age distribution of household population 151 Table DQ.2: Age distribution of eligible and interviewed women 152 Table DQ.3: Age distribution of under-5s in household and under-5 questionnaires 153 Table DQ.4: Women’s completion rates by socio-economic characteristics of households 154 Table DQ.5: Completion rates for under-5 questionnaires by socio-economic characteristics of households 155 Table DQ.6: Completeness of reporting 156 Table DQ.7: Completeness of information for anthropometric indicators 157 Table DQ.8: Heaping in anthropometric measurements 159 Table DQ.9: Observation of women’s health cards 159 Table DQ.10: Observation of under-5s birth certificates 160 Table DQ.11: Observation of vaccination cards 161 Table DQ.12: Presence of mother in the household and the person interviewed for the under-5 questionnaire 162 Table DQ.13: School attendance by single age 163 Table DQ.14: Sex ratio at birth among children ever born and living 164 20140501_UNICEF_book_Eng.indd 9 5/2/14 11:18 AM Thailand: Monitoring the situation of children and womenx List of Figures Figure HH.1: Age and sex distribution of household population 15 Figure NU.1: Percentage of children under age 5 who are underweight, stunted and wasted 24 Figure NU.2: Percentage of mothers who started breastfeeding within one hour and within one day of birth 27 Figure NU.3: Infant feeding patterns by age 28 Figure NU.4: Percentage of households consuming adequately iodized salt 36 Figure NU.5: Percentage of households consuming iodized salt by wealth index quintile, Thailand, 2012 36 Figure NU.6: Percentage of households consuming iodized salt by region and area, Thailand, 2012 37 Figure NU.7: Percentage of infants weighing less than 2,500 grams at birth 38 Figure CH.1: Percentage of children aged 12-23 months who received the recommended vaccinations by 12 months 40 Figure CH.2: Percentage of women with a live birth in the last 2 years who are protected against neonatal tetanus 44 Figure CH.3: Percentage of children under age 5 with diarrhoea who received ORS or recommended home fluids 46 Figure CH.4: Percentage of children under age 5 with diarrhoea who received ORT or increased fluids, AND continued feeding 48 Figure WS.1: Per cent distribution of household members by source of drinking water 57 Figure CP.1: Percentage of women age 20-49 years who were married before age 18 and percentage of women age 15-49 years who were married before age 15 by wealth index quintiles, Thailand, 2012 107 Figure HA.1: Percentage of women who have comprehensive knowledge of HIV/AIDS transmission 114 20140501_UNICEF_book_Eng.indd 10 5/2/14 11:18 AM xiMultiple Indicator Cluster Survey 2012 List of Abbreviations AIDS Acquired Immune Deficiency Syndrome ASFR Age-specific fertility rate BCG Bacillis-Cereus-Geuerin (Tuberculosis) CBR Crude birth rate CSPro Census and Survey Processing System DPT Diphtheria Pertussis Tetanus EPI Expanded Programme on Immunization GFR General fertility rate GPI Gender Parity Index HepB Hepatitis B HIV Human Immunodeficiency Virus IDD Iodine Deficiency Disorders IHPP International Health Policy Program IUD Intrauterine Device JMP Joint Monitoring Programme LAM Lactational Amenorrhea Method MDG Millennium Development Goals MICS Multiple Indicator Cluster Survey MICS4 Fourth global round of Multiple Indicator Clusters Surveys programme MoPH Ministry of Public Health NAR Net Attendance Rate NHSO National Health Security Office NSO National Statistical Office ORT Oral rehydration treatment ppm Parts Per Million SPSS Statistical Package for Social Sciences STIs Sexually transmitted infections TFR Total fertility rate UNAIDS United Nations Programme on HIV/AIDS UNDP United Nations Development Programme UNFPA United Nations Population Fund UNGASS United Nations General Assembly Special Session on HIV/AIDS UNICEF United Nations Children’s Fund WFFC World Fit for Children WHO World Health Organization 20140501_UNICEF_book_Eng.indd 11 5/2/14 11:18 AM Thailand: Monitoring the situation of children and womenxii Summary Table of Findings Multiple Indicator Cluster Survey and Millennium Development Goal Indicators, Thailand, 2012 Multiple Indicator Cluster Survey and Millennium Development Goal Indicators, Thailand, 2012 Topic Indicator Number Indicator Whole Kingdom Bangkok Central North North- east South Value MICS4 MDG NUTRITION Nutritional status 2.1a 2.1b 1.8 Underweight prevalence Moderate and Severe (- 2 SD) Severe (- 3 SD) 9.2 2.1 7.9 2.4 7.3 1.7 7.8 1.4 10.7 2.5 10.0 2.3 % % 2.2a 2.2b Stunting prevalence Moderate and Severe (- 2 SD) Severe (- 3 SD) 16.3 5.9 16.2 6.4 13.6 5.3 13.8 3.5 18.9 7.1 16.7 6.1 % % 2.3a 2.3b Wasting prevalence Moderate and Severe (- 2 SD) Severe (- 3 SD) 6.7 2.2 6.7 1.9 6.5 2.3 6.1 1.8 6.5 2.3 8.2 2.6 % % Breastfeeding and infant feeding 2.4 Children ever breastfed 96.8 93.7 95.8 97.6 97.7 97.6 % 2.5 Early initiation of breastfeeding 46.3 29.2 40.9 49.6 47.0 60.9 % 2.6 Exclusive breastfeeding under 6 months 12.3 8.2 7.9 19.6 13.8 12.2 % 2.7 Continued breastfeeding at 1 year 32.4 23.0 27.6 21.6 38.1 40.5 % 2.8 Continued breastfeeding at 2 years 17.8 12.5 17.3 13.4 18.0 24.2 % 2.9 Predominant breastfeeding under 6 months 40.8 38.8 31.3 53.8 39.0 48.8 % 2.10 Duration of breastfeeding 6.5 4.6 5.5 7.7 7.6 9.4 months 2.11 Bottle feeding 72.7 83.2 79.3 67.5 73.0 61.0 % 2.12 Introduction of solid, semi-solid or soft foods 74.8 (*) 87.4 71.7 75.4 72.5 % 2.13 Minimum meal frequency 77.5 86.7 84.6 76.8 74.8 70.8 % 2.14 Age-appropriate breastfeeding 20.9 10.9 17.9 21.3 23.2 24.6 % 2.15 Milk feeding frequency for non-breastfed children 98.4 97.9 99.2 95.2 99.2 98.9 % Salt iodization 2.16 Iodized salt consumption 70.9 82.1 79.9 77.3 54.0 80.1 % Low birth weight 2.18 Low-birthweight infants 7.6 6.3 6.0 8.9 9.3 6.7 % 2.19 Infants weighed at birth 99.0 98.8 98.7 99.3 99.3 98.7 % CHILD HEALTH Vaccinations 3.1 Tuberculosis immunization coverage 97.5 - - - - - % 3.2 Polio immunization coverage 89.0 - - - - - % 3.3 Immunization coverage for diphtheria, pertussis and tetanus (DPT) 87.9 - - - - - % 3.4 4.3 Measles immunization coverage 91.9 - - - - - % 3.5 Hepatitis B immunization coverage 80.7 - - - - - % Tetanus toxoid 3.7 Neonatal tetanus protection 75.9 84.9 76.9 75.0 71.9 77.4 % Care of illness 3.8 Oral rehydration therapy with continued feeding 52.7 60.3 56.7 42.5 55.8 50.4 % 20140501_UNICEF_book_Eng.indd 12 5/2/14 11:18 AM xiiiMultiple Indicator Cluster Survey 2012 Multiple Indicator Cluster Survey and Millennium Development Goal Indicators, Thailand, 2012 Topic Indicator Number Indicator Whole Kingdom Bangkok Central North North- east South Value MICS4 MDG 3.9 Care seeking for suspected pneumonia 83.3 (*) (62.0) (76.0) 95.5 (*) % 3.10 Antibiotic treatment of suspected pneumonia 45.4 (*) (57.3) (48.5) 41.8 (*) % Solid fuel use 3.11 Solid fuels 26.1 0.5 5.2 35.7 53.7 2.2 % WATER AND SANITATION Water and sanitation 4.1 7.8 Use of improved drinking water sources 97.0 100.0 98.6 94.6 98.8 89.6 % 4.2 Water treatment 13.5 -* 3.3 11.8 7.4 19.1 % 4.3 7.9 Use of improved sanitation 97.2 94.9 98.5 97.5 96.9 97.0 % 4.4 Safe disposal of child’s faeces 56.9 44.7 53.1 67.1 63.0 44.5 % REPRODUCTIVE HEALTH Contraception and unmet need 5.1 5.4 Adolescent birth rate 60 45 60 47 73 53 per 1,000 5.2 Early childbearing 13.0 12.2 14.3 15.0 14.6 7.9 % 5.3 5.3 Contraceptive prevalence rate 79.3 75.7 81.3 81.4 81.7 69.7 % 5.4 5.6 Unmet need 6.9 8.2 5.7 5.7 5.5 12.7 % Maternal and newborn health 5.5a 5.5b 5.5 Antenatal care coverage At least once by skilled personnel At least four times by any provider 98.1 93.4 97.8 93.2 97.3 94.9 97.7 91.6 98.9 92.7 98.5 94.0 % % 5.6 Content of antenatal care 98.0 96.6 97.1 98.5 98.6 98.9 % 5.7 5.2 Skilled attendant at delivery 99.6 99.7 99.9 99.0 99.8 99.2 % 5.8 Institutional deliveries 99.6 99.8 99.9 99.7 99.6 98.6 % 5.9 Caesarean section 32.0 42.6 38.6 32.8 23.9 29.8 % *100 per cent of the household population are using improved drinking water sources. CHILD DEVELOPMENT Child development 6.1 Support for learning 92.7 93.5 92.7 90.7 93.4 92.9 % 6.2 Father’s support for learning 35.3 48.1 41.9 35.8 24.8 43.2 % 6.3 Learning materials: children’s books 42.7 62.4 47.7 43.4 33.8 45.2 % 6.4 Learning materials: playthings 70.8 66.3 69.5 68.8 70.3 78.4 % 6.5 Inadequate care 4.6 5.5 2.6 3.6 5.8 5.3 % 6.6 Early child development index 91.5 91.8 96.1 87.9 90.4 91.0 % 6.7 Attendance to early childhood education 84.4 66.3 77.8 90.9 91.0 81.4 % EDUCATION Literacy and education 7.1 2.3 Literacy rate among young women age 15-24 years 98.0 97.0 97.5 97.7 99.1 97.5 % 7.2 School readiness 100.0 100.0 100.0 99.9 100.0 100.0 % 7.3 Net intake rate in primary education 75.3 83.2 77.9 76.6 69.5 79.7 % 7.4 2.1 Primary school net attendance ratio (adjusted) 95.7 96.4 95.9 95.5 95.3 96.1 % 7.5 Secondary school net attendance ratio (adjusted) 78.8 82.0 77.4 80.7 80.8 71.3 % 7.6 2.2 Children reaching last grade of primary 99.5 99.4 98.4 99.8 100.0 99.4 % 7.7 Primary completion rate 106.8 108.6 122.4 122.6 94.3 100.4 % 7.8 Transition rate to secondary school 98.5 98.9 98.3 98.8 98.5 97.7 % 20140501_UNICEF_book_Eng.indd 13 5/2/14 11:18 AM Thailand: Monitoring the situation of children and womenxiv Multiple Indicator Cluster Survey and Millennium Development Goal Indicators, Thailand, 2012 Topic Indicator Number Indicator Whole Kingdom Bangkok Central North North- east South Value MICS4 MDG 7.9 3.1 Gender parity index (primary school) 1.0 1.0 1.0 1.0 1.0 1.0 ratio 7.10 3.1 Gender parity index (secondary school) 1.2 1.0 1.2 1.2 1.1 1.2 ratio CHILD PROTECTION Birth registration 8.1 Birth registration 99.4 99.9 99.3 99.0 99.9 99.0 % Early marriage 8.6 Marriage before age 15 among women age 15-49 years 2.7 2.5 2.8 2.8 2.7 2.4 % 8.7 Marriage before age 18 among women age 20-49 years 14.7 11.6 12.1 14.6 19.1 12.8 % 8.8 Young women age 15-19 years currently married or in union 16.3 12.3 16.4 15.1 18.4 15.4 % 8.10a 8.10b Spousal age difference women age 15-19 years women age 20-24 years 11.3 13.1 17.1 12.5 7.7 15.0 4.5 16.9 13.7 11.8 14.0 9.2 % % Domestic violence 8.14 Attitudes toward domestic violence: women age 15-49 years 13.1 7.0 6.6 14.8 19.8 13.9 % HIV/AIDS AND ORPHANED CHILDREN HIV/AIDS knowledge and attitudes 9.1 Comprehensive knowledge about HIV prevention among women age 15-49 years 52.4 51.9 60.0 55.6 48.3 43.9 % 9.2 6.3 Comprehensive knowledge about HIV prevention among women age 15-24 years 55.7 51.1 61.5 59.8 56.0 45.1 % 9.3 Knowledge of mother-to-child transmission of HIV among women age 15-49 years 74.0 63.8 80.7 72.9 74.9 69.9 % 9.4 Accepting attitudes towards people living with HIV among women age 15-49 years 30.5 16.0 23.8 48.1 36.9 24.0 % 9.5 Women who know where to be tested for HIV 81.4 85.1 86.4 83.3 75.3 80.4 % 9.6 Women who have been tested for HIV and know the results 8.5 8.3 8.9 10.0 8.1 7.3 % 9.8 HIV counselling during antenatal care 77.1 79.1 75.9 87.8 79.8 64.2 % 9.9 HIV testing during antenatal care 72.8 82.9 78.7 83.6 69.1 55.1 % Orphaned children 9.17 Children’s living arrangements 22.8 13.0 18.5 23.2 31.2 12.5 % 9.18 Prevalence of children with one or both parents dead 4.1 2.8 4.4 5.2 3.6 4.4 % 9.19 6.4 School attendance of orphans 91.7 (*) (*) (*) (*) (*) % 9.20 6.4 School attendance of non-orphans 97.7 99.1 97.6 98.6 97.5 96.5 % Notes 1) Figures denoted by an asterisk (*) are based on denominators of 24 un-weighted cases and less. 2) Figures shown in parenthesis (.) are based on denominators of 25-49 un-weighted cases. 20140501_UNICEF_book_Eng.indd 14 5/2/14 11:18 AM 1Multiple Indicator Cluster Survey 2012 Executive Summary Nutrition Nutritional Status • About 16 per cent of children under 5 in Thailand suffer from stunting or are too short for their age, while almost 1 out of 10 (9 per cent) is moderately underweight. About 7 per cent of children are moderately wasted or too thin for their height. • Children living in the Northeastern and Southern regions of Thailand are more likely to be underweight and stunted than other children. The prevalence of underweight (14 per cent) and stunting (34 per cent) are significant among children of mothers with no education. The age pattern shows that a higher percentage of children aged 0-5 months are undernourished according to three indices (18 per cent with underweight, 19 per cent with stunting and 16 per cent with wasting) in comparison to children who are older. • Children from the poorest households have higher rates of stunting and underweight than those from the richest households. • One in ten children (11 per cent) under 5 years of age is overweight. Children in the richest households and those who have mothers with higher education are more likely to be overweight. The largest populations of overweight children are concentrated in the Central region and Bangkok, with the smallest in the Northeastern region. Breastfeeding • Fewer than half of newborns (46 per cent) in Thailand are put to the breast within one hour of birth. Regional averages range from a high of 61 per cent in the South to a low of 29 per cent in Bangkok. Children born in the poorest households (51 per cent) are more likely to be breastfed within one hour of birth than those in the richest households (34 per cent). • Only 12 per cent of infants under the age of 6 months receive the benefits of exclusive breastfeeding. • The prevalence of exclusive breastfeeding for six months is particularly low in the Central region and Bangkok, at 8 per cent. The practice of exclusive breastfeeding is higher in Northern (20 per cent), Northeastern (14 per cent), and Southern (12 per cent) regions. • Children born in the richest households are less likely to be exclusively breastfed (9 per cent) than those born in the poorest households (16 per cent). • Girls (16 per cent) are more likely to be breastfed than boys (10 per cent). • Only 24 per cent of children aged 6-23 months are being appropriately fed. Salt Iodization • Some 71 per cent of households consume adequately iodized salt. Around 87 per cent of the richest households consume adequately iodized salt compared to 54 per cent of the poorest households. Use of iodized salt was lowest in the Northeastern region at 54 per cent and highest in Bangkok at 82 per cent. More than two thirds (73 per cent) of municipal households were found to be using adequately iodized salt compared to only 69 per cent in non-municipal areas. Low Birth Weight • Some 8 per cent of all births are low birth weight. Children living in the Northern and Northeastern regions (9 per cent) are more likely to be born with low birth weight compared to the national average. There was no significant variation of low birth weight in municipal and non-municipal areas or by mother’s education. 20140501_UNICEF_book_Eng.indd 1 5/2/14 11:18 AM Thailand: Monitoring the situation of children and women2 Executive Summary Child Health Immunization Coverage • Nearly all children (98 per cent) aged 12-23 months in Thailand received a BCG vaccination in the first year of life. • All three doses of OPV (oral polio) and DPT were given to 89 per cent and 88 per cent of children, respectively. Some 92 per cent of children aged 12-23 months received a measles vaccine in the form of the measles-mumps-rubella (MMR) vaccine. • Around 75 per cent of children had all eight recommended vaccinations on schedule. • There are significant regional differences in immunization coverage. The lowest percentage of fully immunized children is in Bangkok at 63 per cent, and the highest is in the Northern region at 88 per cent. Children living in non-municipal areas (85 per cent) are more likely to be fully immunized than those in non-municipal areas (75 per cent). • The findings also show that the percentage of fully immunized children in the poorest households (89 per cent) is much higher than for those living in the richest households (70 per cent). Tetanus Immunization • Overall, 76 per cent of women in Thailand received vaccines against tetanus during pregnancy, with 71 per cent receiving at least two doses during their last pregnancy. • The highest proportion of women who are protected against tetanus is in Bangkok (85 per cent) and the lowest is in the Northeastern region (72 per cent). • Significant differences are also observed by education level of mother and economic status of household. Oral Rehydration Treatment • Overall, 5 per cent of children under the age of 5 had diarrhoea in the two weeks preceding the survey, which is a relatively low rate. The prevalence of diarrhoea is higher among children living in non-municipal areas than in municipal areas, at 6 per cent versus 4 per cent. • The use of oral rehydration salts or other recommended homemade fluids is low at 64 per cent, with significantly lower coverage in the Northern and Southern regions at 49 per cent. • Only half of children (53 per cent) who had diarrhoea in the two weeks prior to the survey received ORT (or increased fluids) and continued feeding, with far fewer among those aged 0-11 months (37 per cent). Care Seeking and Antibiotic Treatment of Pneumonia • Only 2 per cent of children aged 0-59 months had suspected pneumonia during the two weeks preceding the survey and 83 per cent of those children were taken to an appropriate health care provider. Solid Fuel Use • Approximately one quarter of households (26 per cent) are using solid fuels for cooking with the proportion much higher among the poorest households (82 per cent). Use of solid fuels is quite common in the Northeastern region (54 per cent). The findings show that use of solid fuels in non-municipal areas is higher than in municipal areas. Overall, 11 per cent of households use wood and around 71 per cent use liquid petroleum gas (LPG) for cooking. • Three quarters of households (75 per cent) cook either in a separate room used as a kitchen, outdoors, or in a separate building. One quarter of households (25 per cent) cook inside the dwelling. 20140501_UNICEF_book_Eng.indd 2 5/2/14 11:18 AM 3Multiple Indicator Cluster Survey 2012 Executive Summary Environment Drinking Water • Overall 97 per cent of households have access to improved drinking water and 99 per cent to improved sanitation facilities. There was no significant variation for either by region or residential areas. • The main sources of drinking water are bottled and rain water. Municipal people prefer to use bottled water whereas non-municipal people use rain water. Disposal of Children’s Faeces • Over half (57 per cent) of children’s faeces are disposed of safely. The percentages are lowest in Bangkok and the Southern region (45 per cent). The richest households are more likely to throw their children’s faeces into the garbage (50 per cent) compared to the poorest households (14 per cent). Reproductive Health Contraception • The total fertility rate for the one year preceding the survey is 1.8 births per woman. Fertility is slightly higher in non-municipal areas (2.1 births per woman) than in municipal areas (1.5 births per woman). The findings show that the fertility rate among women with only primary education is significantly higher at 2.9 births per woman compared to the national average. • The adolescent birth rate of women aged 15-19 is 60 births per 1,000 women. A very high rate of 224 births per 1,000 women is presented in women with primary education only and among the poorest households at 85 births per 1,000 women. • Overall, 9 per cent of women aged 15-19 have already had a birth, 2 per cent are pregnant with their first child and 11 per cent have begun childbearing. Less than 1 per cent have had a live birth before age 15. • Some 79 per cent of women aged 15-49 years currently married or in union are using (or their partner is using) a contraceptive method. Contraceptive usage is lowest among women in the Southern region at 70 per cent. Modern methods are more popular (77 per cent) than traditional ones (2 per cent). Women who have not given birth are less likely to use contraception than those who have already had a birth. Unmet Need for Contraception • About 80 per cent of women aged 15-49 who are currently married or in union have their need for contraception met; 17 per cent have their need met for spacing and 63 per cent for limiting births. • Only 7 per cent of women married or in union have an unmet need for contraception in Thailand, with the highest percentages in the Southern region (13 per cent) and among adolescents aged 15-19 (12 per cent). The need for contraception is less satisfied among women in the Southern region (85 per cent) compared to other regions (above 90 per cent). Antenatal Care • Some 98 per cent of women aged 15-49 who gave birth in the two years preceding the survey received antenatal care, almost all of which was provided by skilled personnel. • Coverage of antenatal care – at least four visits during pregnancy – is quite high at 93 per cent. Lower coverage is found among women with no education (87 per cent) and women living in the poorest households (86 per cent). 20140501_UNICEF_book_Eng.indd 3 5/2/14 11:18 AM Thailand: Monitoring the situation of children and women4 Executive Summary Assistant at Birth • Nearly 100 per cent of births in the two years preceding the survey were delivered by professional health personnel. This includes 78 per cent assisted by a nurse or a mid-wife, 14 per cent by a medical doctor and 7 per cent by a health care centre staff. Only 0.1 per cent of women were assisted by a traditional birth attendant. Child Development • Some 93 per cent of children under 5 with an adult household member over 15 years of age engaged in at least four activities that promote learning and school readiness in the three days prior to the survey. The average number of activities was 5.4. The father’s involvement in such activities was very low, at 1.1 activities. Children from the poorest households and mothers and fathers who are less educated are less likely to be involved in activities that promote learning. • Around 43 per cent of children are living in households that have at least three children’s books, with the lowest percentage in the Northeastern region at 34 per cent. Children living in the poorest households (24 per cent) are less likely to have children’s books compared to those living in the richest households (71 per cent). • More than two thirds (71 per cent) of children aged 0-59 months had two or more playthings at home. • About 5 per cent of children were left with inadequate care during the week preceding the survey. This practice is particularly common among the poorest households (7 per cent). • Some 92 per cent of children aged 36-59 months are developmentally on track in literacy- numeracy, physical, social-emotional, and learning domains. The percentage of children on track in literacy and numeracy is the lowest at 63 per cent, compared to children on track in the physical (97 per cent), social-emotional (87 per cent) and learning (97 per cent) domains. The findings show that children attending an early childhood development programme have higher rankings in the Early Childhood Development Index compared to those who are not attending, at 94 per cent versus 77 per cent. Education Pre-school Attendance and School Readiness • Some 84 per cent of children aged 36-59 months are attending some form of organized early childhood education programme. Differentials by education of mother are noticeable. The percentage of children enrolled in early childhood education increases from 75 per cent to 87 per cent as the mother’s education rises from no education to higher. Mothers in non-municipal areas (87 per cent) are more likely to enroll their children in early childhood education programmes compared to mothers in municipal areas (80 per cent). Fewer children aged 36-47 months attend early childhood education programmes than those aged 48-59 months (75 per cent versus 93 per cent). Primary and Secondary School Participation • Three quarters (75 per cent) of children who are of primary school entry age are attending Grade 1. Children in the Northeastern region (70 per cent), children with mothers who have no education (59 per cent) and those in the poorest households (65 per cent) are less likely to attend primary school at the age-appropriate time. • Almost all (96 per cent) children of primary school age attend primary school. 20140501_UNICEF_book_Eng.indd 4 5/2/14 11:18 AM 5Multiple Indicator Cluster Survey 2012 Executive Summary • Some 79 per cent of children of secondary school age are attending secondary school or higher. Differentials by economic status are significant, with 74 per cent of those in the poorest households attending secondary school versus 91 per cent in the richest households. Children living in the Southern (71 per cent) and Central regions (77 per cent) are less likely to attend secondary school. • Almost 100 per cent of children who enter the first grade of primary school eventually reached Grade 6. • Some 99 per cent of children who complete primary school continue on to secondary education. • Gender parity at the primary level is 1.0, indicating no difference in attendance between girls and boys. At the secondary level, gender parity is 1.2, indicating that more girls are attending secondary schools than boys. Adult Literacy • Nationally, 98 per cent of women aged 15-24 are literate. Only 48 per cent of women living in households with non-Thai speakers are literate. There are no significant differences by region, age and socioeconomic status of women. Child Protection Birth Registration • Almost 100 per cent of the births of children under 5 years of age have been registered. There are no significant variations in birth registration across sex, age or education. Children living in households with non-Thai speakers are somewhat less likely to have their births registered (79 per cent). This appears to be mainly because a relatively large proportion (72 per cent) of mothers/caretakers do not know that they need to obtain a birth certificate from District or Provincial Offices after receiving a birth document from a hospital. Early Marriage • Some 3 per cent of women aged 15-49 were married before the age of 15. Nationally 16 per cent of women aged 15-19 are currently married or in union, with the percentage highest in the poorest households (23 per cent), in non-municipal areas (19 per cent), in the Northeastern region (18 per cent), and in particular among women with only primary education (59 per cent). • Around 11 per cent of young married women aged 15-19 are married to a partner 10 or more years older. The percentage is higher (23 per cent) among married women with only primary school education. Domestic Violence • Some 13 per cent of women feel that their husband/partner has a right to hit or beat them for at least one of a variety of reasons, with 11 per cent of women agreeing with and justifying violence in instances where they neglect their children. • Domestic violence is more accepted by women in the Northeastern region (20 per cent) than in other regions. Acceptance is more common among women in poor and the poorest households (20 per cent and 18 per cent, respectively). It is also strongly correlated to the education levels of women (18 per cent among women who have no and only primary education) and among older women aged 40-49 years (17 per cent). 20140501_UNICEF_book_Eng.indd 5 5/2/14 11:18 AM Thailand: Monitoring the situation of children and women6 Executive Summary HIV/AIDS Infection and Orphaned Children Knowledge of HIV Transmission • Almost all (97 per cent) of the women interviewed had heard of AIDS. However, just 82 per cent knew of the two key ways to prevent HIV transmission: having one faithful uninfected sex partner (89 per cent), and using a condom (87 per cent). Knowledge of HIV transmission is lowest among women with no education (52 per cent). Women in the Northeastern region (79 per cent) are less likely to know of both key ways of preventing HIV transmission). • More than half (59 per cent) of women can correctly identify the two most common misconceptions about HIV transmission (that HIV cannot be transmitted by sharing food and through mosquito bites) and know that a healthy looking person can be infected. The percentage is higher among women living in households speaking Thai and among more educated women. • Overall, 93 per cent of women know that HIV can be transmitted from mother to child. Three quarters (74 per cent) know all three modes of mother-to-child transmission (during pregnancy, during delivery and through breastfeeding), while 4 per cent did not know any. Women in Bangkok (63 per cent) and those with no education (47 per cent) are less likely to know all three ways. • Fewer women know about mother-to-child transmission during delivery (80 per cent) than during pregnancy (89 per cent) and breastfeeding (85 per cent). • Almost all (97 per cent) women who have heard of AIDS agree with at least one accepting statement. The most common accepting attitude is willing to care for a family member with the AIDS virus in own home (92 per cent), while the least common accepting attitude is would not want to keep secret that a family member got infected with the AIDS virus (54 per cent). More educated women, women living in municipal areas and those in the richest households have less accepting attitudes on all four indicators than women with lower education, living in non-municipal areas and with a poorer wealth status. Only 16 per cent of women living in Bangkok have accepting attitudes towards people living with HIV/AIDS. Testing for HIV • Around 81 per cent of women knew where to be tested, while 50 per cent have actually been tested. Of these, a small proportion (9 per cent) had been tested within the last 12 months and told the result. • Some 78 per cent of young women aged 15-24 knew where to test, while 29 per cent have been tested. Of these, 10 per cent had been tested within the last 12 months and told the result. Orphan Children • More than half (58 per cent) of children aged 0-17 years in Thailand live with both parents. Some 15 per cent live with their mothers only, with 14 per cent of their biological fathers alive. About 3 per cent live with fathers only. Almost one quarter (23 per cent) of children live with neither of their biological parents, 21 per cent of whom are both alive. • In the Northern and Northeastern regions, the proportion of children living with both parents is lower than other regions, at 56 per cent and 50 per cent, respectively. Two thirds of children living in poor and the poorest households live with neither parent. Orphan Children School Attendance • Less than 1 per cent (0.5) of children aged 10-14 have lost both parents and 92 per cent of those children are currently attending school. Among children whose parents are both alive and who are living with at least one parent, 98 per cent are attending school 20140501_UNICEF_book_Eng.indd 6 5/2/14 11:18 AM 7Multiple Indicator Cluster Survey 2012 I. Introduction © U N IC E F T h ai la n d /2 01 0/ M . T h o m as Background The National Statistical Office (NSO) conducted its first Multiple Indicator Cluster Survey (2005- 06 MICS), which was part of MICS3 programme, between December 2005 and February 2006. The data were compiled and presented at national and provincial level (26 provinces). UNICEF Thailand provided key support in the collaboration between the various agencies involved in child development, namely the Ministry of Public Health, the Ministry of Education, the Ministry of Social Development and Human Security, and other agencies responsible for policy and planning. The previous MICS provided the data to create indicators for use in evaluating the well-being of children in Thailand in order to inform policy-making. The survey also provides valuable information on the situation of children and women in Thailand, and was based, in large part, on the need to monitor progress towards goals and targets emanating from recent international agreements: The Millennium Declaration, adopted by all 191 United Nations Member States in September 2000, and the Plan of Action of A World Fit For Children, adopted by 189 Member States at the United Nations Special Session on Children in May 2002. Both of these commitments build upon promises made by the international community at the 1990 World Summit for Children. The second round of the Multiple Indicator Cluster Survey (Thailand 2012 MICS), which was part of MICS4 programme, was conducted in 2012 by NSO, collecting data from 27,000 households. The field work was carried out from September to November. The main purpose is to present the situation of women and children in Thailand and to continually monitor its change. UNICEF is the main agency providing technical and financial support, as in the previous MICS. It is also important to note that this project is the first time that NSO integrated budgets and work with various agencies, namely, Ministry of Public Health, Ministry of Education and Ministry of Social Development and Human Security, National Health Security Office, Thai Health Promotion Foundation, International Health Policy Program, Thailand and Educational Institutes (Institute for Population and Social Research: Mahidol University, College of Population Studies: Chulalongkorn University). This round of the MICS is distinctive since the NSO introduced an electronic survey (E-Survey methodology). Instead of using paper-based questionnaires, enumerators used Tablet PCs as a tool for data collection. Data entry software with built-in basic consistency checks was installed on each Tablet PC. Hence, the quality control can be initiated early during the field work. 20140502_MICS_book_Eng_1/2.indd 7 5/6/14 5:38 PM Thailand: Monitoring the situation of children and women8 I. Introduction In signing these international agreements, governments committed themselves to improving conditions for children and to monitoring progress towards that end. UNICEF was assigned a supporting role in this task (see below). A Commitment to Action: National and International Reporting Responsibilities The governments that signed the Millennium Declaration, the World Fit for Children Declaration and the Plan of Action also committed themselves to monitoring progress towards the goals and objectives they contained: “We will monitor regularly at the national level and, where appropriate, at the regional level and assess progress towards the goals and targets of the present Plan of Action at the national, regional and global levels. Accordingly, we will strengthen our national statistical capacity to collect, analyse and disaggregate data, including by sex, age and other relevant factors that may lead to disparities, and support a wide range of child- focused research. We will enhance international cooperation to support statistical capacity-building efforts and build community capacity for monitoring, assessment and planning.” (A World Fit for Children, paragraph 60) “…We will conduct periodic reviews at the national and subnational levels of progress in order to address obstacles more effectively and accelerate actions.…” (A World Fit for Children, paragraph 61) The Plan of Action (paragraph 61) also calls for the specific involvement of UNICEF in the preparation of periodic progress reports: “… As the world’s lead agency for children, the United Nations Children’s Fund is requested to continue to prepare and disseminate, in close collaboration with Governments, relevant funds, programmes and the specialized agencies of the United Nations system, and all other relevant actors, as appropriate, information on the progress made in the implementation of the Declaration and the Plan of Action.” Similarly, the Millennium Declaration (paragraph 31) calls for periodic reporting on progress: “…We request the General Assembly to review on a regular basis the progress made in implementing the provisions of this Declaration, and ask the Secretary-General to issue periodic reports for consideration by the General Assembly and as a basis for further action.” This final report presents the results of the indicators and topics covered in the survey. Survey Objectives The 2012 Thailand Multiple Indicator Cluster Survey has as its primary objectives: • To provide up-to-date information for assessing the situation of children and women in Thailand; • To furnish data needed for monitoring progress toward goals established in the Millennium Declaration and other internationally agreed upon goals, as a basis for future action; • To contribute to the improvement of data and monitoring systems in Thailand and to strengthen technical expertise in the design, implementation and analysis of such systems. • To generate data on the situation of children and women, including the identification of vulnerable groups and disparities, to inform policies and interventions. 20140501_UNICEF_book_Eng.indd 8 5/2/14 11:18 AM 9Multiple Indicator Cluster Survey 2012 II. Sample and Survey Methodology © U N IC E F T h ai la n d /2 01 2/ M . T h o m as Sample Design The sample for the Thailand Multiple Indicator Cluster Survey (MICS) was designed to provide estimates for a large number of indicators on the situation of children and women at the national level, for municipal (urban) and non-municipal (rural) areas, and for Bangkok and four regions: Central, North, Northeast and South. The urban and rural areas within each region were identified as the main sampling strata and the sample was selected in two stages. Within each stratum, a specified number of census enumeration areas were selected systematically with probability proportional to size. After a household listing was carried out within the selected enumeration areas, a systematic sample of 20 households was drawn in each sample enumeration area. An equal sample was allocated to each stratum (region, municipal and non-municipal areas), and the sample is not self-weighting. For reporting national level results, sample weights are used. A more detailed description of the sample design can be found in Appendix A. Questionnaires Three sets of questionnaires were used in the survey: 1) a household questionnaire which was used to collect information on all de jure household members (usual residents), the household, and the dwelling; 2) a women’s questionnaire administered in each household to all women aged 15-49 years; and 3) an under-5 questionnaire, administered to mothers or caretakers for all children under 5 living in the household. The Household Questionnaire included the following modules: • Household Listing Form • Education • Water and Sanitation • Household Characteristics • Child Labour • Salt Iodization 20140501_UNICEF_book_Eng.indd 9 5/2/14 11:18 AM Thailand: Monitoring the situation of children and women10 II. Sample and Survey Methodology The Questionnaire for Individual Women was administered to all women aged 15-49 years living in the households, and included the following modules: • Women’s Background • Child Mortality1 • Desire for Last Birth • Maternal and Newborn Health • Contraception • Unmet Need • Marriage/Union • HIV/AIDS • Attitudes Towards Domestic Violence The Questionnaire for Children Under Five was administered to mothers or caretakers of children under 5 years of age2 living in the households. Normally, the questionnaire was administered to mothers of under-5 children; in cases where the mother was not listed in the household roster, a primary caretaker for the child was identified and interviewed. The questionnaire included the following modules: • Age • Birth Registration • Early Childhood Development • Breastfeeding • Care of Illness • Immunization • Anthropometry The questionnaires are based on the MICS4 model questionnaire3. From the MICS4 model English version, the questionnaires were translated into Thai4. In addition to the administration of questionnaires, fieldwork teams tested the salt used in household cooking for iodine content and measured the weights and heights of children under 5. Details and findings of these measurements are provided in the respective sections of the report. 1 The results of this module are not included in this report because the summary birth history (indirect method) used to collect data on child deaths does not perform so well in countries with low child mortality. 2 The terms ‘children under 5’, ‘children aged 0-4 years’, and ‘children aged 0-59 months’ are used interchangeably in this report. 3 The model MICS4 questionnaires can be found at www.childinfo.org/mics4_questionnaire.html 4 In addition to the standard questions, a set of country specific questions is also included as follows: items HL8A, HL8B, HL12A, HL14A, HC15A in household questionnaire; items CM13A, CM13B, MN4D, MN27A, MN27B, MN27C, MN27D, CP3A, CP3B, UN2A, UN2B, MA2A, MA2B, MA2C, MA2D, MA2E, MA2F in questionnaire for women and BR2A, BR2B, BF2A, BF7A, BF7B, BF11A, CA6A, IM16A, IM16B in questionnaire for children under five. These additions are supposed to be analyzed by responsible agencies. 20140501_UNICEF_book_Eng.indd 10 5/2/14 11:18 AM 11Multiple Indicator Cluster Survey 2012 II. Sample and Survey Methodology Pre-test The first pre-test was carried out in Samut Songkhram province during 15-17 September 2011. The interviews were carried out by provincial field staff under the observation of NSO MICS co-ordinators, representatives from UNICEF Thailand, and specialists from Mahidol University. Before starting the test survey, field staff were provided with training on definitions and the survey’s objectives. The test revealed that it took about an hour per household to finish all three questionnaires (excluding iodization and anthropometry modules). Based on the results of the pre-test, modifications were made to the wording and translation of the questionnaires. A big turning point occurred after the first pre-test when the NSO decided to implement a data collection system with CAPI (Computer Assisted Personal Interviewing) for MICS. A company was outsourced to develop data entry software for the Tablet PCs using the Android operating system. Several months later, a MICS headquarters team visited the NSO during 12-16 March 2012. The main purpose of the team’s visit was to discuss and make recommendations for improvements to the CAPI. The mission also sought to provide feedback on the proposed fieldwork team structure, review and make recommendations on further development of survey instruments, and discuss a revised survey timetable. The second pre-test was held in Kanchanaburi province during 15-17 July 2012. The main focus was on the data entry system. The interviews were jointly conducted by the NSO MICS co-ordinators, the outsourced company, representatives from UNICEF Thailand, and specialists from Mahidol University. Results from the second pre-test were discussed among the related parties, and the data entry software was revised accordingly. The questionnaires were also slightly changed. A copy of the final MICS questionnaires is provided in Appendix G. Training The anthropometry training of trainers for NSO MICS co-ordinators was held on 31 July 2012. An expert from UNICEF headquarters provided information on anthropometry issues. As well as learning theory, NSO staff had a chance to practice using scales and measuring boards. Two 10-day fieldwork trainings were conducted in August 2012. The first round took place in Chiang Mai province from 6-15 August for staff from Northern and Northeastern regions. The second round was for staff from Bangkok, Central and Southern regions, and was held in Phetchaburi province from August 22-31. Training focused on interviewing techniques, the contents of the questionnaires, and mock interviews between trainees to gain practice in asking questions. The NSO MICS co-ordinators, NSO officials and representatives from UNICEF Thailand participated in both training sessions. Representatives from UNICEF headquarters participated as observers in the second round. Moreover, in both rounds instructors from the Ministry of Public Health were invited to provide information on antenatal care, attendance at birth, child vaccination, maternal tetanus vaccination and oral rehydration treatment for children with diarrhoea. The knowledge and information acquired through the training were useful for the interview process and the accuracy of the survey results. 20140501_UNICEF_book_Eng.indd 11 5/2/14 11:18 AM Thailand: Monitoring the situation of children and women12 II. Sample and Survey Methodology Fieldwork and Data Processing Administratively, Thailand is divided into 77 provinces, including Bangkok (Metropolis). In Bangkok, the fieldwork was carried out under the responsibility of the Field Administration Bureau, while Provincial Statistical Officers were responsible for the fieldwork undertaken in the other 76 provinces. The MICS fieldwork began in September 2012 and concluded in November 2012. Data were collected by about 80 teams; each was comprised of two to four interviewers, one measurer and a supervisor. In some areas in which non-Thai households were prevalent, the team also had a translator. The data were entered during fieldwork on 225 Tablet PCs using data entry software and the data from each Tablet PC were sent directly to the server computer in the central office via Internet. The supervisor provided advice, helped solve problems arising during the course of the fieldwork, and checked the completeness of the data through a web-based application. The NSO MICS co-ordinators provided overall supervision, with continuous visits to the field. Data in CSPro format were exported by NSO MICS co-ordinators also through a web-based application. Procedures and standard programs developed under the global MICS4 programme and adapted to the Thailand questionnaires were used throughout. Data were analysed using the Statistical Package for Social Sciences (SPSS) software programme, Version 18, and the model syntax and tabulation plans developed by UNICEF were used for this purpose. 20140501_UNICEF_book_Eng.indd 12 5/2/14 11:18 AM 13Multiple Indicator Cluster Survey 2012 Sample Coverage Of the 26,850 households selected for the sample, 24,482 were found to be occupied. Of these, 24,119 were successfully interviewed for a household response rate of 98.5 per cent. In the interviewed households, 22,256 women (aged 15-49 years) were identified. Of these, 21,981 were successfully interviewed, yielding a response rate of 98.8 per cent within interviewed households. There were 9,757 children under age 5 listed in the household questionnaire. Questionnaires were completed for 9,716 of these children, which corresponds to a response rate of 99.6 per cent within interviewed households. Overall response rates of 97.3 and 98.1 are calculated for the women’s and under-5’s interviews respectively (Table HH.1). Table HH.1 Results of household, women’s, and under-5’s interviews Number of households, women, and children under 5 by results of the household, women’s, and under-5’s interviews, and household, women’s, and under-5’s response rates, Thailand, 2012 Area Region Total Municipal Non- municipal Bangkok Central North North- east South Households Sampled 14,851 11,999 2,959 5,970 5,945 5,999 5,977 26,850* Occupied 13,262 11,220 2,589 5,262 5,562 5,656 5,413 24,482 Interviewed 12,987 11,132 2,480 5,190 5,532 5,631 5,286 24,119 Response rate 97.9 99.2 95.8 98.6 99.5 99.6 97.7 98.5 Women Eligible 12,349 9,907 2,707 5,107 4,432 4,924 5,086 22,256 Interviewed 12,168 9,813 2,649 5,066 4,399 4,848 5,019 21,981 Response rate 98.5 99.1 97.9 99.2 99.3 98.5 98.7 98.8 Overall response rate 96.5 98.3 93.7 97.8 98.7 98.0 96.4 97.3 Children under 5 Eligible 5,032 4,725 848 2,043 2,157 2,494 2,215 9,757 Mothers/caretakers interviewed 5,004 4,712 841 2,036 2,150 2,490 2,199 9,716 Response rate 99.4 99.7 99.2 99.7 99.7 99.8 99.3 99.6 Overall response rate 97.4 98.9 95.0 98.3 99.1 99.4 96.9 98.1 *The actual number of households in Group 1 (households with children under 5) for some enumeration areas is less than 10. As a result, the actual number of sample households is slightly less than that of the design. III. Sample Coverage and the Characteristics of Households and Respondents © U N IC E F T h ai la n d /2 00 8/ P er aw o n g m et h a 20140501_UNICEF_book_Eng.indd 13 5/2/14 11:18 AM Thailand: Monitoring the situation of children and women14 III. Sample Coverage and the Characteristics of Households and Respondents Response rates of municipal areas are somewhat lower than those of non-municipal areas. The rates across regions are almost similar, with the remark that all rates in Bangkok are lower than other regions. It is also interesting to note that all rates are above 90 per cent. Characteristics of Households The weighted age and sex distribution of the survey population is provided in Table HH.2. The distribution is also used to produce the population pyramid in Figure HH.1. In the 24,119 households successfully interviewed in the survey, 79,033 household members were listed. Of these, 37,596 were males and 41,437 were females. The child population (aged 0-14 years) was 17,065 children, accounting for 21.6 per cent of the total. The labour age population (aged 15- 64 years) was 53,766 members, or 68 per cent of the total. The elderly population (65 years and older) was 8,202 members, or 10.4 per cent of the total. The corresponding proportions in the 2010 Population Census are 19.3 per cent, 72.1 per cent and 8.6 per cent, respectively. In addition, of the surveyed population, 26.3 per cent were children aged 0-17 years, and 73.7 per cent adults aged 18 and over. Table HH.2 Household age distribution by sex Per cent and frequency distribution of the household population by five-year age groups, dependency age groups, and by child (aged 0-17 years) and adult populations (aged 18 or more) by sex, Thailand, 2012 Males Females Total Number Per cent Number Per cent Number Per cent Age 0-4 2,620 7.0 2,652 6.4 5,272 6.7 5-9 2,847 7.6 2,923 7.1 5,769 7.3 10-14 3,050 8.1 2,974 7.2 6,024 7.6 15-19 2,782 7.4 2,788 6.7 5,570 7.0 20-24 1,991 5.3 2,014 4.9 4,005 5.1 25-29 2,150 5.7 2,263 5.5 4,413 5.6 30-34 2,515 6.7 2,804 6.8 5,319 6.7 35-39 2,854 7.6 3,104 7.5 5,958 7.5 40-44 3,033 8.1 3,427 8.3 6,460 8.2 45-49 3,197 8.5 3,464 8.4 6,661 8.4 50-54 2,854 7.6 3,319 8.0 6,173 7.8 55-59 2,474 6.6 2,671 6.4 5,144 6.5 60-64 1,786 4.7 2,276 5.5 4,062 5.1 65-69 1,254 3.3 1,610 3.9 2,864 3.6 70-74 986 2.6 1,289 3.1 2,275 2.9 75-79 645 1.7 920 2.2 1,565 2.0 80-84 335 0.9 546 1.3 880 1.1 85+ 226 0.6 391 0.9 617 0.8 Dependency age groups 0-14 8,516 22.7 8,549 20.6 17,065 21.6 15-64 25,635 68.2 28,131 67.9 53,766 68.0 65+ 3,445 9.2 4,757 11.5 8,202 10.4 Child and adult populations Children aged 0-17 years 10,331 27.5 10,420 25.1 20,751 26.3 Adults aged 18+ years 27,265 72.5 31,017 74.9 58,282 73.7 Total 37,596 100.0 41,437 100.0 79,033 100.0 20140501_UNICEF_book_Eng.indd 14 5/2/14 11:18 AM 15Multiple Indicator Cluster Survey 2012 III. Sample Coverage and the Characteristics of Households and Respondents The age cohorts 20-24 and 25-29 for both male and female are smaller than would be expected. This may be due to the impact of migration and will require further analysis. Census data indicate that the number of the male population in the five-year age groups from 0–4 to 20–24 years is higher than that of the female population, but a reverse pattern is observed in the age group 25–29 years and above, where the number of the male population is lower. MICS 2012 data indicate a somewhat different age-sex pattern, with males accounting for a higher number of the population only in the age group 10-14. Tables HH.3 – HH.5 provide basic information on the households, female respondents aged 15-49 and children under the age of 5 by presenting the unweighted, as well as the weighted numbers. Information on the basic characteristics of households, women and children under-5 interviewed in the survey is essential for the interpretation of findings presented later in the report and can also provide an indication of the representativeness of the survey. The remaining tables in this report are presented only with weighted numbers. See Appendix A for more details about the weighting. Table HH.3 provides basic background information on the households. Within households, the sex of the household head, region, area, number of household members, education of household head and ethnicity1 of the household head are shown in the table. These background characteristics are used in subsequent tables in this report; the figures in the table are also intended to show the numbers of observations by major categories of analysis in the report. 1 This was determined by asking “To what ethnic group does the head of this household belong?” Households were divided into two groups: 1) Thai; and 2) Non-Thai. Please refer to the questionnaire in Appendix F for detailed questions. 50 – 54 0 – 4 5 10 – 14 20 – 24 30 – 34 80 – 84 70 – 74 60 – 64 40 – 44 Figure HH.1 Age and sex distribution of household population, Thailand, 2012 A g e ra n g e 55 – 59 5 – 9 15 – 19 25 – 29 35 – 39 85 + 75 – 79 65 – 69 45 – 49 Males Females 4 23 0 211 3 4 5 Per cent 20140501_UNICEF_book_Eng.indd 15 5/2/14 11:18 AM Thailand: Monitoring the situation of children and women16 III. Sample Coverage and the Characteristics of Households and Respondents Table HH.3 Household composition Per cent and frequency distribution of households by selected characteristics, Thailand, 2012 Weighted Number of households Per cent Weighted Unweighted Sex of household head Male 64.5 15,568 15,794 Female 35.5 8,550 8,324 Region Bangkok 11.1 2,683 2,480 Central 25.0 6,034 5,190 North 17.5 4,217 5,532 Northeast 33.9 8,184 5,631 South 12.4 3,000 5,286 Area Municipal 43.7 10,542 12,987 Non-municipal 56.3 13,577 11,132 Number of household members 1 12.9 3,103 2,260 2 23.5 5,670 4,239 3 23.6 5,700 5,427 4 19.8 4,784 5,347 5 10.7 2,583 3,363 6 5.5 1,328 1,918 7 2.2 536 858 8 1.0 230 378 9 0.4 93 173 10+ 0.4 92 156 Education of household head None 5.6 1,360 1,439 Primary 60.8 14,663 14,143 Secondary 19.9 4,809 5,164 Higher 13.5 3,251 3,327 Missing/DK 0.1 36 46 Ethnicity of household head Thai 98.5 23,750 23,662 Non-Thai 1.4 341 434 Missing/DK 0.1 29 23 Total 100.0 24,119 24,119 Households with at least One child aged 0-4 years 19.0 24,119 24,119 One child aged 0-17 years 53.9 24,119 24,119 One woman aged 15-49 years 64.3 24,119 24,119 Mean household size 3.3 24,119 24,119 20140501_UNICEF_book_Eng.indd 16 5/2/14 11:18 AM 17Multiple Indicator Cluster Survey 2012 III. Sample Coverage and the Characteristics of Households and Respondents The weighted and unweighted numbers of households are equal, since sample weights were normalized (See Appendix A). The table also shows the proportions of households with at least one child under 18 years of age, at least one child under 5 and at least one eligible woman aged 15-49. The table also shows the weighted average household size estimated by the survey. According to Table HH.3, most households are headed by a male (64.5 per cent), more than 55 per cent of the population is living in non-municipal areas, and about 1.4 per cent of the population belongs to ethnic groups other than Thai. The weighted number of households in the Northern and Southern regions are lower than the unweighted number due to over-sampling. In contrast, the weighted number of households in other regions are higher than the unweighted number because of under-sampling. Some 12.9 per cent of the household population is living in single households and about 77.6 per cent is living in households containing two to five persons. Three in five household heads (60.8 per cent) completed primary level. The average household size is 3.3 members, which is close to the results of the 2010 Population Census (3.1 persons). The table further shows that half of interviewed households (53.9 per cent) have at least one child aged 0-17 years and three in five (64.3 per cent) households have women of productive age. Characteristics of Female Respondents 15-49 Years of Age and Children Under-5 Tables HH.4 and HH.5 provide information on the background characteristics of female respondents 15-49 years of age and of children under age 5. In both tables, the total numbers of weighted and unweighted observations are equal, since sample weights have been normalized (standardized). In addition to providing useful information on the background characteristics of women and children, the tables are also intended to show the numbers of observations in each background category. These categories are used in the subsequent tabulations of this report. Table HH.4 provides background characteristics of female respondents 15-49 years of age. The table includes information on the distribution of women according to region, area, age, marital status, motherhood status, births in last two years, education2, wealth index quintiles3, and ethnicity of the household head. The regions with the largest share of women in the sample were the Northeast (31.9 per cent) and the Central region (26.6 per cent). Bangkok accounted for only 13.1 per cent of all females in the survey. In the sample, 45.8 per cent of women were residing in municipal areas and 54.2 per cent in non-municipal areas. With regard to marital status, 68.1 per cent of the women were married/in union and 66.2 per cent had given birth(s). The education level of more than half of the women (62.3 per cent) was secondary and beyond, with only 2.9 per cent never attending school. 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 consumer goods, dwelling characteristics, water and sanitation, and other characteristics that are related to the household’s wealth to assign weights (factor scores) to each of the household assets. Each household was then assigned a wealth score based on these weights and the assets owned by that household. The survey household population was then ranked according to the wealth score of the household they are living in, and was finally divided into five equal parts (quintiles) from lowest (poorest) to highest (richest). The assets used in these calculations were as follows: water sources, toilet facility, housing, fuel types for cooking, electricity, durable goods (such as radio, TV, refrigerator, washing machine, microwave oven, watch, mobile phone, motorcycle, boat with motor, car), bank account, credit card account. The wealth index is assumed to capture the underlying long-term wealth through information on the household assets, and is intended to produce a ranking of households by wealth, from poorest to richest. The wealth index does not provide information on absolute poverty, current income or expenditure levels. The wealth scores calculated are applicable for only the particular data set they are based on. Further information on the construction of the wealth index can be found in Filmer, D., and Pritchett, L., 2001. ‘Estimating wealth effects without expenditure data – or tears: An application to educational enrolments in states of India’. Demography 38(1): 115-132. Gwatkin, D.R., Rutstein, S., Johnson, K., Pande, R. and Wagstaff. A., 2000. Socio-Economic Differences in Health, Nutrition, and Population. HNP/Poverty Thematic Group, Washington, DC: World Bank. Rutstein, S.O. and Johnson, K., 2004. The DHS Wealth Index. DHS Comparative Reports No. 6. Calverton, Maryland: ORC Macro. 20140501_UNICEF_book_Eng.indd 17 5/2/14 11:18 AM Thailand: Monitoring the situation of children and women18 III. Sample Coverage and the Characteristics of Households and Respondents Table HH.4 Women’s background characteristics Per cent and frequency distribution of women aged 15-49 years by selected background characteristics, Thailand, 2012 Weighted Number of women Per cent Weighted Unweighted Region Bangkok 13.1 2,881 2,649 Central 26.6 5,851 5,066 North 14.8 3,258 4,399 Northeast 31.9 7,022 4,848 South 13.5 2,968 5,019 Area Municipal 45.8 10,072 12,168 Non-municipal 54.2 11,909 9,813 Age 15-19 14.0 3,080 2,662 20-24 10.2 2,234 2,452 25-29 11.3 2,490 3,031 30-34 14.2 3,113 3,594 35-39 15.6 3,437 3,568 40-44 17.3 3,814 3,391 45-49 17.3 3,813 3,283 Marital/Union status Currently married/in union 68.1 14,977 15,841 Widowed 1.7 375 388 Divorced 2.3 516 478 Separated 2.9 633 742 Never married/in union 24.9 5,480 4,532 Motherhood status Ever gave birth 66.2 14,554 16,006 Never gave birth 33.8 7,427 5,975 Births in last two years Had a birth in last two years 8.7 1,914 2,762 Had no birth in last two years 91.3 20,067 19,217 Missing 0.0 0 2 Education None 2.8 610 647 Primary 34.9 7,675 7,044 Secondary 38.9 8,544 8,993 Higher 23.4 5,152 5,297 Wealth index quintile Poorest 15.2 3,340 2,502 Second 18.2 4,007 3,533 Middle 20.4 4,476 4,746 Fourth 22.9 5,033 5,660 Richest 23.3 5,125 5,540 Ethnicity of household head Thai 98.3 21,609 21,525 Non-Thai 1.6 341 434 Missing/DK 0.1 31 22 Total 100.0 21,981 21,981 20140501_UNICEF_book_Eng.indd 18 5/2/14 11:18 AM 19Multiple Indicator Cluster Survey 2012 III. Sample Coverage and the Characteristics of Households and Respondents Some background characteristics of children under 5 are presented in Table HH.5. These include the distribution of children by several attributes: sex, region, area, age, mother’s or caretaker’s education, wealth, and ethnicity. Table HH.5 shows some background characteristics of children under the age of five, 49.8 per cent of whom were male and 50.2 per cent female. The Northeast comprised up to 37.8 per cent of the children under 5 years of age. Of the children under 5, one in five (19.6 per cent) was less than 12 months old. Most of the children under 5 in the survey had mothers or caretakers with secondary or higher education (57.3 per cent), with only 3.9 per cent having mothers or caregivers with no education. In addition, 98 per cent of the children were born to Thai-headed households, and only 1.9 per cent to non-Thai households. Table HH.5 Under-5’s background characteristics Per cent and frequency distribution of children under five years of age by selected characteristics, Thailand, 2012 Weighted Number of under-5 children Per cent Weighted Unweighted Sex Male 49.8 4,836 4,953 Female 50.2 4,880 4,763 Region Bangkok 8.6 833 841 Central 23.3 2,268 2,036 North 15.4 1,493 2,150 Northeast 37.8 3,672 2,490 South 14.9 1,450 2,199 Area Municipal 38.3 3,723 5,004 Non-municipal 61.7 5,993 4,712 Age 0-5 months 9.3 906 591 6-11 months 10.3 1,005 655 12-23 months 18.8 1,827 1,963 24-35 months 20.5 1,995 2,148 36-47 months 19.4 1,887 2,134 48-59 months 21.6 2,095 2,225 Mother’s education* None 3.9 375 348 Primary 38.9 3,775 3,409 Secondary 39.2 3,812 3,874 Higher 18.1 1,754 2,085 Wealth index quintile Poorest 19.1 1,858 1,418 Second 21.9 2,127 1,812 Middle 22.5 2,183 2,166 Fourth 19.5 1,897 2,288 Richest 17.0 1,651 2,032 20140501_UNICEF_book_Eng.indd 19 5/2/14 11:18 AM Thailand: Monitoring the situation of children and women20 III. Sample Coverage and the Characteristics of Households and Respondents Table HH.5 Under-5’s background characteristics (continued) Per cent and frequency distribution of children under five years of age by selected characteristics, Thailand, 2012 Weighted Number of under-5 children Per cent Weighted Unweighted Ethnicity of household head Thai 98.0 9,522 9,522 Non-Thai 1.9 184 181 Missing/DK 0.1 10 13 Total 100.0 9,716 9,716 *Mother’s education refers to educational attainment of mothers or caretakers of children under 5. 20140501_UNICEF_book_Eng.indd 20 5/2/14 11:18 AM 21Multiple Indicator Cluster Survey 2012 IV. Nutrition © U N IC E F T h ai la n d /2 00 9/ M . T h o m as 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 associated with more than half of all child deaths worldwide. Undernourished children are more likely to die from common childhood ailments, and for those who survive, have recurring sicknesses and faltering growth. Three-quarters of the children who die from causes related to malnutrition were only mildly or moderately malnourished – showing no outward sign of their vulnerability. The Millennium Development target is to reduce by half the proportion of people who suffer from hunger between 1990 and 2015. A reduction in the prevalence of malnutrition will also assist in the goal to reduce child mortality. In a well-nourished population, there is a reference distribution of height and weight for children under age 5. Under-nourishment in a population can be gauged by comparing children to a reference population. The reference population used in this report is based on the WHO growth standards1. 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 but less than three standard deviations below the median of the reference population are considered moderately underweight while those whose weight-for-age is more than three standard deviations below the median are classified as severely underweight. Height-for-age is a measure of linear growth. Children whose height-for-age is more than two but less than three standard deviations below the median of the reference population are considered short for their age and are classified as moderately stunted. Those whose height-for-age is more than three standard deviations below the median are classified as severely stunted. Stunting is a reflection of chronic malnutrition as a result of failure to receive adequate nutrition over a long period and recurrent or chronic illness. 1 http://www.who.int/childgrowth/standards/second_set/technical_report_2.pdf 20140501_UNICEF_book_Eng.indd 21 5/2/14 11:18 AM Thailand: Monitoring the situation of children and women22 IV. Nutrition Finally, children whose weight-for-height is more than two but less than three standard deviations below the median of the reference population are classified as moderately wasted, while those who fall more than three standard deviations below the median are classified as severely wasted. Wasting is usually the result of a recent nutritional deficiency. The indicator may exhibit significant seasonal shifts associated with changes in the availability of food or disease prevalence. In the Multiple Indicator Cluster Survey, the weights and heights of all children under 5 years of age were measured using anthropometric equipment recommended by UNICEF (www.childinfo.org). Findings in this section are based on the results of these measurements. Children whose full birth date (month and year) were not obtained, and children whose measurements are outside a possible range are excluded from Table NU.1. Children are excluded from one or more of the anthropometric indicators when their weights and heights have not been measured, whichever applicable. For example if a child has been weighed but his/her height has not been measured, the child is included in underweight calculations, but not in the calculations for stunting and wasting. Percentages of children by age and reasons for exclusion are shown in the data quality table DQ.7. Overall 91.4 per cent of children had both their weights and heights measured. Table DQ.7 also shows that due to incomplete dates of birth, implausible measurements, and missing weight and/or height, 5.2 per cent of children were excluded from calculations of the weight-for-age indicator, while the percentages are 7.2 for the height-for-age indicator, and 8.6 for the weight-for- height indicator. Table NU.1 shows percentages of children classified into each of the above described categories, based on the anthropometric measurements that were taken during fieldwork. Additionally, the table includes the percentage of children who are overweight, which takes into account those children whose weight for height is above two standard deviations from the median of the reference population, and mean z-scores for all three anthropometric indicators. Almost 1 in 10 children under age 5 (Table NU.1) in Thailand (9.2 per cent) are underweight (7.1 per cent are classified as moderately and 2.1 per cent as severely underweight). About 16.3 per cent of children are stunted or too short for their age (10.4 per cent are moderately and 5.9 per cent are severely stunted), 6.7 per cent are wasted or too thin for their height (4.5 per cent are moderately and 2.2 per cent are severely wasted). Children in the Northeastern and the Southern regions are more likely to be underweight and stunted than other children. In contrast, the percentage wasted is highest in the Southern region (8.2 per cent). Children of mothers with no education are the most likely to be underweight, stunted, and wasted compared to children of educated mothers. There is no large difference in underweight, stunting and wasting rates between boys and girls. In addition, children of the poorest households are more undernourished according to all three indices in comparison to their counterparts in the richest households. The age pattern shows that a higher percentage of children aged less than 6 months are undernourished according to underweight and wasted in comparison to children who are older (Figure NU.1). To understand the relationship between underweight, stunting and wasting found in this survey will require further in-depth analysis of the data. 20140501_UNICEF_book_Eng.indd 22 5/2/14 11:18 AM 23Multiple Indicator Cluster Survey 2012 IV. Nutrition Table NU.1 Nutritional status of children Percentage of children under age 5 by nutritional status according to three anthropometric indices: weight for age, height for age, and weight for height, Thailand, 2012 Weight for age N um be r o f c hi ld re n un de r a ge 5 Height for age N um be r o f c hi ld re n un de r a ge 5 Weight for height N um be r o f c hi ld re n un de r a ge 5 Underweight Per cent below Mean Z-Score (SD) Stunted Per cent below Mean Z-Score (SD) Wasted Per cent below Over- weight Per cent above + 2 SD Mean Z-Score (SD) - 2 SD1 - 3 SD2 - 2 SD3 - 3 SD4 - 2 SD5 - 3 SD6 Sex Male 9.9 2.6 -0.4 4,564 16.4 5.5 -0.7 4,463 7.4 2.8 10.1 0.0 4,397 Female 8.4 1.6 -0.3 4,639 16.3 6.3 -0.6 4,548 6.1 1.7 11.6 0.1 4,477 Region Bangkok 7.9 2.4 -0.1 676 16.2 6.4 -0.4 659 6.7 1.9 13.6 0.2 639 Central 7.3 1.7 -0.1 2,137 13.6 5.3 -0.5 2,119 6.5 2.3 15.4 0.3 2,077 North 7.8 1.4 -0.3 1,457 13.8 3.5 -0.6 1,434 6.1 1.8 9.2 0.1 1,418 Northeast 10.7 2.5 -0.5 3,543 18.9 7.1 -0.8 3,433 6.5 2.3 8.4 -0.1 3,407 South 10.0 2.3 -0.4 1,391 16.7 6.1 -0.7 1,364 8.2 2.6 10.7 0.0 1,334 Area Municipal 7.1 1.9 -0.2 3,423 13.3 4.7 -0.5 3,358 6.4 1.8 11.3 0.1 3,294 Non-municipal 10.4 2.2 -0.4 5,780 18.1 6.6 -0.7 5,653 6.9 2.5 10.6 0.0 5,580 Age 0-5 months 17.9 6.5 -0.7 834 19.0 8.8 -0.4 782 15.7 6.6 7.7 -0.3 770 6-11 months 9.2 2.5 -0.4 981 19.7 10.6 -0.7 947 6.3 1.8 10.4 0.1 952 12-23 months 6.7 2.1 -0.2 1,764 17.2 6.6 -0.7 1,713 4.8 1.4 12.0 0.3 1,699 24-35 months 6.4 1.1 -0.1 1,892 16.3 5.3 -0.6 1,864 4.9 1.8 13.3 0.2 1,831 36-47 months 9.7 1.6 -0.3 1,771 14.7 4.6 -0.6 1,753 6.3 2.1 10.8 0.0 1,715 48-59 months 9.8 1.4 -0.5 1,961 14.2 3.6 -0.7 1,952 7.1 2.1 9.2 -0.1 1,908 Mother’s education None 14.0 5.0 -0.8 371 34.1 10.7 -1.2 364 9.2 3.2 11.1 0.0 363 Primary 9.9 1.8 -0.4 3,606 16.5 6.0 -0.7 3,528 6.3 1.9 9.7 0.0 3,491 Secondary 9.0 2.2 -0.3 3,627 15.9 5.8 -0.6 3,542 6.9 2.5 10.9 0.0 3,490 Higher 6.7 1.9 -0.1 1,600 12.6 4.8 -0.4 1,576 6.8 2.1 13.7 0.2 1,530 Wealth index quintile Poorest 13.5 2.6 -0.7 1,814 23.1 8.1 -1.0 1,752 7.7 3.1 8.5 -0.1 1,744 Second 10.0 2.5 -0.5 2,045 19.9 7.6 -0.9 2,008 6.8 2.2 7.7 -0.1 1,979 Middle 10.2 2.4 -0.3 2,111 15.5 5.9 -0.7 2,070 6.5 1.7 11.3 0.1 2,038 Fourth 7.0 1.5 -0.1 1,768 10.9 3.4 -0.4 1,737 5.9 1.6 13.2 0.2 1,718 Richest 3.7 1.3 0.1 1,465 10.6 4.0 -0.3 1,442 6.7 2.9 14.9 0.4 1,396 Ethnicity of household head* Thai 9.1 2.1 -0.3 9,019 16.2 5.8 -0.6 8,830 6.7 2.2 10.9 0.1 8,699 Non-Thai 14.1 4.1 -0.6 174 24.0 8.6 -0.9 171 9.0 2.6 8.2 0.0 169 Missing/DK (*) (*) (*) 10 (*) (*) (*) 10 (*) (*) (*) (*) 7 Total 9.2 2.1 -0.3 9,203 16.3 5.9 -0.6 9,010 6.7 2.2 10.9 0.1 8,874 1 MICS indicator 2.1a and MDG indicator 1.8 2 MICS indicator 2.1b 3 MICS indicator 2.2a 4 MICS indicator 2.2b 5 MICS indicator 2.3a 6 MICS indicator 2.3b (*) Figures that are based on less than 25 unweighted cases 20140501_UNICEF_book_Eng.indd 23 5/2/14 11:18 AM Thailand: Monitoring the situation of children and women24 IV. Nutrition Overweight is one of the concerns of Thailand’s Strategy against Malnutrition. The overweight prevalence is 10.9 per cent. The largest population of overweight children is found in the Central region (15.4 per cent), followed by Bangkok (13.6 per cent), with the least in the Northeast (8.4 per cent). Overweight children are found more in municipal (11.3 per cent) than in non-municipal households (10.6 per cent), and more among children 24–35 months (13.3 per cent) than other age groups. The overweight prevalence is highest among children whose mothers have higher education (13.7 per cent) in comparison with other educational levels. Similarly, the prevalence rate in very rich households (14.9 per cent) is greater than in the other groups. Breastfeeding and Infant and Young Child Feeding Breastfeeding for the first few years of life protects children from infection, provides an ideal source of nutrients, and is economical and safe. However, many mothers stop breastfeeding too soon and there are often pressures to switch to infant formula, which can contribute to growth faltering and micronutrient malnutrition and is unsafe if clean water is not readily available. WHO/UNICEF have the following feeding recommendations: • Exclusive breastfeeding for first six months • Continued breastfeeding for two years or more • Safe and age-appropriate complementary foods beginning at 6 months • Frequency of complementary feeding: two times per day for 6-8 month olds; three times per day for 9-11 month olds (4 times for non-breastfed children) It is also recommended that breastfeeding be initiated within one hour of birth. The indicators related to recommended child feeding practices are as follows: • Early initiation of breastfeeding (within one hour of birth) • Exclusive breastfeeding rate (< 6 months) • Predominant breastfeeding (< 6 months) 25 15 5 20 0 10 0 12 186 24 30 36 48 5442 Stunted Underweight Wasted Figure NU.1 Percentage of children under age 5 who are underweight, stunted and wasted, Thailand, 2012 P er c en t Age (in months) 60 20140501_UNICEF_book_Eng.indd 24 5/2/14 11:18 AM 25Multiple Indicator Cluster Survey 2012 IV. Nutrition • Continued breastfeeding rate (at 1 year and at 2 years) • Duration of breastfeeding • Age-appropriate breastfeeding (0-23 months) • Introduction of solid, semi-solid and soft foods (6-8 months) • Minimum meal frequency (6-23 months) • Milk feeding frequency for non-breastfeeding children (6-23 months) • Bottle feeding (0-23 months) Table NU.2 shows the proportion of children born in the two years preceding the survey who were ever breastfed, those who were first breastfed within one hour and one day of birth, and those who received a prelacteal feed. Although a very important step in management of lactation and establishment of a physical and emotional relationship between the baby and the mother, only 46.3 per cent of babies are breastfed for the first time within one hour of birth, while 85.2 per cent of newborns in Thailand start breastfeeding within one day of birth. The highest proportion is found among newborns in the Southern region and the lowest proportion is found among newborns in Bangkok. Differentials are clearly seen with respect to mother’s residential area, mother’s education, household socioeconomic status and the ethnicity of household head. The percentage breakdowns for starting breastfeeding within one hour of birth were: newborns in the South at 60.9 per cent compared to newborns in Bangkok at 29.2 per cent; non-municipal newborns at 52.2 per cent compared to municipal newborns at 38 per cent; and children with uneducated mothers at 66.9 per cent compared to children whose mothers have beyond secondary education at 34 per cent. Children living in very poor households are more likely to be breastfed compared to those living in very rich households (50.7 per cent versus 33.7 per cent) as are children living in non-Thai-headed households compared to those living in Thai headed households (73.1 per cent versus 45.6 per cent). Table NU.2 Initial breastfeeding Percentage of last-born children in the two years preceding the survey who were ever breastfed, percentage who were first breastfed within one hour of birth and within one day of birth, and percentage who received a prelacteal feed, Thailand, 2012 Percentage who were ever breastfed1 Percentage who were first breastfed: Percentage who received a prelacteal feed Number of last-born children in the two years preceding the survey Within one hour of birth2 Within one day of birth Region Bangkok 93.7 29.2 65.8 20.5 194 Central 95.8 40.9 85.7 29.2 520 North 97.6 49.6 86.5 31.5 266 Northeast 97.7 47.0 87.6 20.4 611 South 97.6 60.9 90.7 33.3 323 Area Municipal 96.0 38.0 80.4 24.3 803 Non-municipal 97.3 52.2 88.8 28.1 1,110 20140501_UNICEF_book_Eng.indd 25 5/2/14 11:18 AM Thailand: Monitoring the situation of children and women26 IV. Nutrition Table NU.2 Initial breastfeeding (continued) Percentage of last-born children in the two years preceding the survey who were ever breastfed, percentage who were first breastfed within one hour of birth and within one day of birth, and percentage who received a prelacteal feed, Thailand, 2012 Percentage who were ever breastfed1 Percentage who were first breastfed: Percentage who received a prelacteal feed Number of last-born children in the two years preceding the survey Within one hour of birth2 Within one day of birth Months since last birth 0-11 months 97.4 45.8 86.9 25.6 978 12-23 months 96.5 47.4 83.7 28.6 806 Assistance at delivery Skilled attendant 96.8 46.3 85.3 26.4 1,906 Other (*) (*) (*) (*) 7 No one/Missing (*) (*) (*) (*) 1 Place of delivery Public sector health facility 96.8 48.6 87.0 25.6 1,740 Private sector health facility 96.3 21.2 66.8 36.0 165 Home (*) (*) (*) (*) 4 Other/Missing (*) (*) (*) (*) 5 Mother’s education None 98.8 66.9 96.2 23.9 51 Primary 96.9 48.2 86.7 32.4 412 Secondary 97.1 50.0 86.7 24.0 997 Higher 95.8 34.0 79.5 26.9 454 Wealth index quintile Poorest 98.1 50.7 88.5 26.3 277 Second 97.9 48.2 89.4 31.2 397 Middle 98.2 52.6 86.7 27.3 454 Fourth 96.8 45.2 84.8 23.4 428 Richest 92.6 33.7 76.8 24.2 358 Ethnicity of household head* Thai 96.7 45.6 85.0 26.5 1,869 Non-Thai 99.7 73.1 96.4 25.8 43 Total 96.8 46.3 85.2 26.5 1,914 1 MICS indicator 2.4 2 MICS indicator 2.5 (*) Figures that are based on less than 25 unweighted cases *1 case with missing ethnicity of household head not shown 20140501_UNICEF_book_Eng.indd 26 5/2/14 11:18 AM 27Multiple Indicator Cluster Survey 2012 IV. Nutrition In Table NU.3, breastfeeding status is based on the reports of mothers/caretakers of children’s consumption of food and fluids during the previous day or night prior to the interview. Exclusively breastfed refers to infants who received only breast milk (and vitamins, mineral supplements or medicine). The table shows exclusive breastfeeding of infants during the first six months of life, as well as continued breastfeeding of children at 12-15 and 20-23 months of age. Approximately 12.3 per cent of children aged less than 6 months are exclusively breastfed. By age 12-15 months, 32.4 per cent of children are still being breastfed and by age 20-23 months, 17.8 per cent are still breastfed. Exclusive breastfeeding of infants during the first six month of life is associated with background characteristics. For example, infants aged 0-5 months living in the Northern region are twice as likely to be exclusively breastfed (19.6 per cent) than infants living in the Central region (7.9 per cent). Similarly, 15.8 per cent of infants in the poorest households are exclusively breastfed, compared to 8.6 per cent in the richest households. Among the five regions, children in the South are breastfed most until the age of 1 and 2 years (40.5 per cent versus 24.2 per cent). Table NU.3 Breastfeeding Percentage of living children according to breastfeeding status at selected age groups, Thailand, 2012 Children age 0-5 months Children age 12-15 months Children age 20-23 months Per cent exclusively breastfed1 Per cent predominantly breastfed2 Number of children Per cent breastfed (Continued breastfeeding at 1 year)3 Number of children Per cent breastfed (Continued breastfeeding at 2 years)4 Number of children Sex Male 9.6 38.6 533 30.0 310 14.3 295 Female 16.1 44.0 374 34.5 355 21.7 254 Region Bangkok 8.2 38.8 121 23.0 36 12.5 47 Central 7.9 31.3 215 27.6 189 17.3 114 North 19.6 53.8 138 21.6 93 13.4 90 Northeast 13.8 39.0 299 38.1 240 18.0 196 South 12.2 48.8 133 40.5 107 24.2 101 100 80 40 20 60 0 Bangkok Central Within one day Within one hour Figure NU.2 Percentage of mothers who started breastfeeding within one hour and within one day of birth, Thailand, 2012 P er c en t North Northeast South Municipal Non- municipal Thailand Region Area 29.2 40.9 49.6 47.0 60.9 38.0 52.2 46.3 65.8 85.7 86.5 87.6 90.7 80.4 88.8 85.2 20140501_UNICEF_book_Eng.indd 27 5/2/14 11:18 AM Thailand: Monitoring the situation of children and women28 IV. Nutrition Table NU.3 Breastfeeding (continued) Percentage of living children according to breastfeeding status at selected age groups, Thailand, 2012 Children age 0-5 months Children age 12-15 months Children age 20-23 months Per cent exclusively breastfed1 Per cent predominantly breastfed2 Number of children Per cent breastfed (Continued breastfeeding at 1 year)3 Number of children Per cent breastfed (Continued breastfeeding at 2 years)4 Number of children Area Municipal 12.2 41.1 375 27.0 261 15.2 188 Non-municipal 12.3 40.7 531 35.9 404 19.1 360 Mother’s education None (*) (*) 23 (*) 23 (*) 20 Primary 9.4 29.6 248 29.6 226 20.3 215 Secondary 15.6 46.2 466 36.3 286 19.6 212 Higher 5.4 37.4 169 22.2 129 9.7 102 Wealth index quintile Poorest 15.8 43.3 149 37.3 94 21.1 117 Second 13.5 48.8 191 42.2 143 14.7 112 Middle 12.2 46.0 238 30.8 167 22.3 117 Fourth 11.3 32.1 180 29.0 142 12.6 122 Richest 8.6 30.3 148 23.0 117 18.2 80 Ethnicity of household head* Thai 12.1 40.0 881 30.7 646 18.0 534 Non-Thai (*) (*) 25 (*) 17 (*) 14 Total 12.3 40.8 906 32.4 665 17.8 549 1 MICS indicator 2.6 2 MICS indicator 2.9 3 MICS indicator 2.7 4 MICS indicator 2.8 (*) Figures that are based on less than 25 unweighted cases *1 case with missing ethnicity of household head not shown Figure NU.3 shows the detailed pattern of breastfeeding by the child’s age in months. Even at the earliest ages, the majority of children are receiving liquids or foods other than breast milk. By 100 80 40 2-3 60 0 0-1 4-5 6-7 8-9 12-13 P er c en t 14-15 16-17 18-19 20-21 22-23 Weaned (not breastfed) Breastfed and complimentary foods 20 10-11 Figure NU.3 Infant feeding patterns by age, Thailand, 2012 Breastfed and other milk/formula Breastfed and non-milk liquids Breastfed and plain water only Exclusively breastfed Age (in months) 20140501_UNICEF_book_Eng.indd 28 5/2/14 11:18 AM 29Multiple Indicator Cluster Survey 2012 IV. Nutrition the end of the sixth month, the percentage of children exclusively breastfed is below 1 per cent. In addition, less than 20 per cent of children receive breast milk through the end of the second year of life. Table NU.4 shows the median duration of breastfeeding by selected background characteristics. Among children under age 3, the median duration is 6.5 months for any breastfeeding, 0.5 months for exclusive breastfeeding, and 1.8 months for predominant breastfeeding. The highest median duration of any breastfeeding is found in the Southern region (9.4 months), and the lowest is in Bangkok (4.6 months). The longest period is found in non-municipal areas (7.8 months) compared to municipal areas (5.1 months). In addition, children with non-educated mothers are more likely to continue breastfeeding than other groups. Non-Thai mothers have longer median duration of any breastfeeding than Thai mothers. Table NU.4 Duration of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children aged 0-35 months, Thailand, 2012 Median duration (in months) of Number of children age 0-35 months Any breastfeeding1 Exclusive breastfeeding Predominant breastfeeding Sex Male 5.8 0.5 1.7 2,895 Female 9.3 0.6 1.8 2,839 Region Bangkok 4.6 0.4 1.8 490 Central 5.5 0.5 0.8 1,361 North 7.7 0.6 2.9 850 Northeast 7.6 0.5 1.8 2,186 South 9.4 0.5 1.3 848 Area Municipal 5.1 0.5 1.9 2,207 Non-municipal 7.8 0.5 1.6 3,527 Mother’s education None 11.2 0.4 4.0 192 Primary 4.4 0.5 1.2 2,120 Secondary 7.3 0.5 2.2 2,359 Higher 7.3 0.4 0.7 1,064 Wealth index quintile Poorest 7.5 0.6 2.1 1,095 Second 6.9 0.5 2.4 1,284 Middle 9.5 0.4 2.2 1,292 Fourth 5.3 0.6 1.7 1,133 Richest 5.6 0.4 0.6 931 Ethnicity of household head Thai 6.4 0.5 1.7 5,620 Non-Thai 16.9 0.7 4.9 109 Median 6.5 0.5 1.8 5,734 Mean for all children (0-35 months) 10.8 0.8 2.8 5,734 1 MICS indicator 2.10 20140501_UNICEF_book_Eng.indd 29 5/2/14 11:18 AM Thailand: Monitoring the situation of children and women30 IV. Nutrition The adequacy of infant feeding in children under 24 months is provided in Table NU.5. Different criteria of feeding are used depending on the age of the child. For infants aged 0-5 months, exclusive breastfeeding is considered as age-appropriate feeding, while infants aged 6-23 months are considered to be appropriately fed if they are receiving breast milk and solid, semi-solid or soft food. Table NU.5 Age-appropriate breastfeeding Percentage of children age 0-23 months who were appropriately breastfed during the previous day, Thailand, 2012 Children age 0-5 months Children age 6-23 months Children age 0-23 months Per cent exclusively breastfed1 Number of children Per cent currently breastfeeding and receiving solid, semi-solid or soft foods Number of children Per cent appropriately breastfed2 Number of children Sex Male 9.6 533 18.7 1,351 16.1 1,883 Female 16.1 374 28.1 1,482 25.7 1,856 Region Bangkok 8.2 121 12.5 200 10.9 321 Central 7.9 215 21.3 643 17.9 858 North 19.6 138 21.9 409 21.3 548 Northeast 13.8 299 25.7 1,140 23.2 1,439 South 12.2 133 28.3 441 24.6 574 Area Municipal 12.2 375 19.5 1,060 17.6 1,435 Non-municipal 12.3 531 26.1 1,773 22.9 2,304 Mother’s education None (*) 23 32.3 98 31.2 120 Primary 9.4 248 23.7 1,015 20.9 1,263 Secondary 15.6 466 24.2 1,193 21.8 1,659 Higher 5.4 169 20.6 528 16.9 697 Wealth index quintile Poorest 15.8 149 29.8 501 26.6 650 Second 13.5 191 26.1 714 23.4 906 Middle 12.2 238 24.1 611 20.8 849 Fourth 11.3 180 19.8 559 17.7 739 Richest 8.6 148 17.0 448 14.9 596 Ethnicity of household head* Thai 12.1 881 23.4 2,783 20.6 3,664 Non-Thai (*) 25 40.5 47 33.3 72 Total 12.3 906 23.6 2,833 20.9 3,739 1 MICS indicator 2.6 2 MICS indicator 2.14 (*) Figures that are based on less than 25 unweighted cases *3 cases with missing ethnicity of household head not shown 20140501_UNICEF_book_Eng.indd 30 5/2/14 11:18 AM 31Multiple Indicator Cluster Survey 2012 IV. Nutrition The survey results show disparities by region in age-appropriate feeding for children aged 0–5 months and 6–23 months, with the Central region indicating a comparatively low percentage of adequate feeding for 0–5 month olds and Bangkok for 6–23 month olds, at 7.9 per cent and 12.5 per cent, respectively. There is no difference in the rate of exclusive breastfeeding in infants aged 0-5 months living in municipal and non-municipal areas. Whereas the proportion of children aged 6-23 months who are appropriately fed is higher in non-municipal areas than in municipal areas (26.1 per cent versus 19.5 per cent). As a result of these feeding patterns, overall only 23.6 per cent of children aged 6–23 months are being adequately fed. Age-appropriate feeding among all infants aged 0-5 months is 12.3 per cent. Taking the two age groups together, age-appropriate feeding of children below 24 months is 20.9 per cent in Thailand. The differences in adequate feeding for children aged 0-23 months are also associated with children’s background characteristics. Children in the South are adequately fed the most (24.6 per cent), while children in Bangkok are adequately fed the least (10.9 per cent). A lower proportion of municipal children (17.6 per cent) are adequately fed than non-municipal children (22.9 per cent). It is also noted that adequate feeding is negatively related to mother’s education and household wealth. Babies with non-educated mothers (31.2 per cent) are adequately fed more than those with educated mothers. Similarly, children of poor households are more adequately fed than those of very rich households (26.6 per cent versus 14.9 per cent). Table NU.6 Introduction of solid, semi-solid or soft foods Percentage of infants aged 6-8 months who received solid, semi-solid or soft foods during the previous day, Thailand, 2012 Currently breastfeeding Currently not breastfeeding All Per cent receiving solid, semi-solid or softfoods Number of children age 6-8 months Per cent receiving solid, semi-solid or soft foods Number of children age 6-8 months Per cent receiving solid, semi-solid or soft foods1 Number of children age 6-8 months Sex Male 76.9 69 76.6 122 76.7 191 Female 64.7 163 86.8 108 73.5 271 Region Bangkok (*) 2 (*) 23 (*) 25 Central (92.0) 34 (*) 42 87.4 76 North (82.1) 34 (*) 29 71.7 62 Northeast (58.2) 127 (95.1) 111 75.4 238 South (66.5) 35 (80.7) 26 72.5 61 Area Municipal 73.7 56 77.8 93 76.2 149 Non-municipal 66.6 175 83.8 137 74.1 313 Total 68.3 232 81.4 230 74.8 462 1 MICS indicator 2.12 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 20140501_UNICEF_book_Eng.indd 31 5/2/14 11:18 AM Thailand: Monitoring the situation of children and women32 IV. Nutrition Appropriate complementary feeding of children from 6 months to 2 years of age is particularly important for growth and development and the prevention of under-nutrition. Continued breastfeeding beyond six months should be accompanied by consumption of nutritionally adequate, safe and appropriate complementary foods that help meet nutritional requirements when breast milk is no longer sufficient. This requires that for breastfed children, two or more meals of solid, semi-solid or soft foods are needed if they are 6-8 months old, and three or more meals if they are 9-23 months of age. For children 6-23 months and older who are not breastfed, four or more meals of solid, semi-solid or soft foods or milk feeds are needed. Overall, 74.8 per cent of infants aged 6-8 months received solid, semi-solid, or soft foods (Table NU.6). Among currently breastfeeding infants this percentage is 68.3 while it is 81.4 for infants currently not breastfeeding. Regional differences are observed, with the Central region indicating the highest percentage of infants aged 6-8 months who received solid, semi-solid or soft foods (87.4 per cent), and the Northern region indicating the lowest (71.7 per cent). Table NU.7 presents the proportion of children aged 6-23 months who received semi-solid or soft foods the minimum number of times or more during the day or night preceding the interview by breastfeeding status (see the note in Table NU.7 for a definition of minimum number of times for different age groups). Overall, more than three quarters of the children aged 6-23 months (77.5 per cent) were receiving solid, semi-solid and soft foods the minimum number of times. A higher proportion of males (81.2 per cent) were achieving the minimum meal frequency compared to females (74.2 per cent). Among currently breastfeeding children aged 6-23 months, two in five (42.5 per cent) were receiving solid, semi-solid and soft foods the minimum number of times. Among non-breastfeeding children, 94.3 per cent were receiving solid, semi-solid and soft foods or milk feeds four times or more and 98.4 per cent were receiving at least two milk feeds. The continued practice of bottle-feeding is a concern because of possible contamination due to unsafe water and lack of hygiene in preparation. Table NU.8 shows that bottle-feeding is still prevalent in Thailand. Some 64.4 per cent of children under 6 months are fed using a bottle with a nipple. The highest percentage of bottle-feeding is found in Bangkok, at 83.2 per cent, followed by the Central region (79.3 per cent) while the lowest is in the South (61 per cent). Bottle-feeding is more common among children living in municipal areas (77.8 per cent) and among children whose mothers have higher education (79.7 per cent). It is also higher among children in very rich households compared to very poor households (79.6 per cent versus 70.5 per cent). 20140501_UNICEF_book_Eng.indd 32 5/2/14 11:18 AM 33Multiple Indicator Cluster Survey 2012 IV. Nutrition Table NU.7 Minimum meal frequency Percentage of children aged 6-23 months who received solid, semi-solid, or soft foods (and milk feeds for non- breastfeeding children) the minimum number of times or more during the previous day, according to breastfeeding status, Thailand, 2012 Currently breastfeeding Currently not breastfeeding All Per cent receiving solid, semi-solid and soft foods the minimum number of times Number of children age 6-23 months Per cent receiving at least 2 milk feeds1 Per cent solid, semi-solid and soft foods or milk feeds 4 times or more Number of children age 6-23 months Per cent with minimum meal frequency2 Number of children age 6-23 months Sex Male 40.9 348 98.2 95.2 1,003 81.2 1,351 Female 43.6 571 98.6 93.4 911 74.2 1,482 Age 6-8 months 48.0 232 99.6 96.2 230 72.0 462 9-11 months 35.4 214 100.0 92.6 330 70.1 543 12-17 months 42.5 305 98.6 94.6 696 78.7 1,002 18-23 months 44.3 168 96.9 94.2 658 84.1 826 Region Bangkok (54.6) 35 97.9 93.6 165 86.7 200 Central 54.4 173 99.2 95.7 470 84.6 643 North 44.5 121 95.2 90.4 288 76.8 409 Northeast 39.1 419 99.2 95.6 721 74.8 1,140 South 35.1 171 98.4 93.4 270 70.8 441 Area Municipal 42.5 291 97.9 95.8 768 81.2 1,060 Non-municipal 42.5 628 98.7 93.4 1,145 75.4 1,773 Mother’s education None (54.6) 48 (96.3) (89.0) 49 72.0 98 Primary 42.2 299 97.6 92.6 716 77.8 1,015 Secondary 40.6 436 98.9 95.1 757 75.2 1,193 Higher 45.4 136 99.1 96.8 392 83.5 528 Wealth index quintile Poorest 44.6 192 95.8 93.8 309 74.9 501 Second 38.0 253 99.4 95.7 461 75.3 714 Middle 40.2 226 98.8 93.2 384 73.5 611 Fourth 42.2 153 99.3 92.3 406 78.6 559 Richest 56.6 94 97.7 96.7 354 88.2 448 Ethnicity of household head* Thai 42.6 892 98.5 94.6 1,891 77.9 2,783 Non-Thai (40.9) 27 (88.9) (72.5) 20 (54.6) 47 Total 42.5 919 98.4 94.3 1,914 77.5 2,833 1 MICS indicator 2.15 2 MICS indicator 2.13 ( ) Figures that are based on 25-49 unweighted cases *3 cases with missing ethnicity of household head not shown Note: Among currently breastfeeding children aged 6-8 months, minimum meal frequency is defined as children who also received solid, semi-solid or soft foods 2 times or more. Among currently breastfeeding children aged 9-23 months, receipt of solid, semi-solid or soft foods at least 3 times constitutes minimum meal frequency. For non-breastfeeding children aged 6-23 months, minimum meal frequency is defined as children receiving solid, semi-solid or soft foods, and milk feeds, at least 4 times during the previous day. 20140501_UNICEF_book_Eng.indd 33 5/2/14 11:18 AM Thailand: Monitoring the situation of children and women34 IV. Nutrition Table NU.8 Bottle feeding Percentage of children aged 0-23 months who were fed with a bottle with a nipple during the previous day, Thailand, 2012 Percentage of children aged 0-23 months fed with a bottle with a nipple1 Number of children aged 0-23 months Sex Male 73.1 1,883 Female 72.3 1,856 Age 0-5 months 64.4 906 6-11 months 78.9 1,005 12-23 months 73.4 1,827 Region Bangkok 83.2 321 Central 79.3 858 North 67.5 548 Northeast 73.0 1,439 South 61.0 574 Area Municipal 77.8 1,435 Non-municipal 69.5 2,304 Mother’s education None 49.6 120 Primary 75.3 1,263 Secondary 69.4 1,659 Higher 79.7 697 Wealth index quintile Poorest 70.5 650 Second 71.6 906 Middle 67.1 849 Fourth 76.9 739 Richest 79.6 596 Ethnicity of household head* Thai 73.2 3,664 Non-Thai 44.0 72 Total 72.7 3,739 1 MICS indicator 2.11 *3 cases with missing ethnicity of household head not shown 20140501_UNICEF_book_Eng.indd 34 5/2/14 11:18 AM 35Multiple Indicator Cluster Survey 2012 IV. Nutrition Salt Iodization Iodine deficiency disorder (IDD) is the world’s leading cause of preventable mental retardation and impaired psychomotor development in young children. In its most extreme form, iodine deficiency causes cretinism. It also increases the risks of stillbirth and miscarriage in pregnant women. Iodine deficiency is most commonly and visibly associated with goitre. The greatest impact of IDD is impaired mental growth and development, which contributes in turn to poor school performance, reduced intellectual ability, and impaired work performance. The indicator is the percentage of households consuming adequately iodized salt (>15 parts per million). In Thailand, there are food and nutrition programmes for the reduction and control of micronutrient deficiencies, including iodine deficiency. The IDD national programme includes the universal iodized salt triferdine (Fe, folate and iodine), supplementation in pregnancy, vitamin supplementation in children under 3, triple fortification of instant noodles, enrichment of iodine egg, and fish sauce fortification. Table NU.9 Iodized salt consumption Per cent distribution of households by consumption of iodized salt, Thailand, 2012 Percentage of households in which salt was tested Number of households Per cent of households with: Total Number of households in which salt was tested or with no salt No salt Salt test result Not iodized 0 PPM >0 and <15 PPM 15+ PPM1 Region Bangkok 88.5 2,683 8.6 2.5 6.9 82.1 100.0 2,598 Central 92.6 6,034 6.8 3.9 9.4 79.9 100.0 5,993 North 95.2 4,217 4.4 8.9 9.4 77.3 100.0 4,196 Northeast 97.2 8,184 2.4 22.5 21.1 54.0 100.0 8,144 South 95.8 3,000 3.4 5.7 10.8 80.1 100.0 2,976 Area Municipal 91.6 10,542 7.1 8.2 11.3 73.3 100.0 10,395 Non-municipal 96.8 13,577 2.7 13.5 14.8 69.0 100.0 13,513 Wealth index quintile Poorest 96.1 5,195 3.4 23.8 19.0 53.7 100.0 5,172 Second 95.1 4,861 4.5 14.8 17.6 63.0 100.0 4,838 Middle 92.1 4,831 7.1 7.6 12.2 73.2 100.0 4,789 Fourth 94.5 4,730 4.6 5.8 9.5 80.0 100.0 4,686 Richest 94.7 4,501 3.6 2.0 7.1 87.3 100.0 4,422 Total 94.5 24,119 4.6 11.2 13.3 70.9 100.0 23,908 1 MICS indicator 2.16 In about 94.5 per cent of households, salt used for cooking was tested for iodine content by using salt test kits (both potassium iodide and potassium iodate content). Table NU.9 shows that in a very small proportion of households (4.6 per cent), there was no salt available. These households may use iodized fish sauce for cooking, which is commonly used in Thailand. In 70.9 per cent of households, salt was found to contain 15 parts per million (ppm) or more of iodine. Use of iodized salt was lowest in the Northeast (only 54 per cent) and highest in Bangkok (82.1 per cent). Interestingly, the difference between the richest and poorest households in terms of iodized salt consumption is much more than expected, at 87.3 per cent and 53.7 per cent, respectively (Figure NU.4). 20140501_UNICEF_book_Eng.indd 35 5/2/14 11:18 AM Thailand: Monitoring the situation of children and women36 IV. Nutrition Figure NU.5 and NU.6 depict a comparison between households consuming iodized salt (> 0 ppm iodine) and quality iodized salt (> 15 ppm iodine). Figure NU.5 shows that use of iodized salt was lowest among poorest (72.7 per cent) and highest among richest (94.4 per cent). The findings also reveal that relative declines between coverage and quality coverage are largest among poorest (19 percentage point) and lowest among richest (7.1 percentage point). Figure NU.6 indicates that 84.2 percent of households in Thailand consume iodized salt; while 70.9 percent of households consume quality iodized salt. The findings also show that both areas (municipal and non-municipal) have the same coverage but the decline from coverage to quality coverage is greater for non-municipal. It is also interesting to note that relative declines between coverage and quality coverage are largest among households in the Northeast (21.1 percentage point) and lowest among households in Bangkok (6.9 percentage point). 100 80 40 20 60 0 Ba ng ko k Ce nt ra l Figure NU.4 Percentage of households consuming adequately iodized salt, Thailand, 2012 P er c en t No rth No rth ea st So ut h Region Po or es t Se co nd M id dl e Fo ur th Ri ch es t M un ici pa l No n- m un ici pa l Th ail an d Wealth Area 82.1 79.9 77.8 54.0 80.1 53.7 63.0 73.2 80.0 87.8 73.3 69.0 70.9 100 80 40 20 60 0 Poorest Coverage (>0 ppm iodine) Quality coverage (>15 ppm iodine) Figure NU.5 Percentage of households consuming iodized salt by wealth index quintile, Thailand, 2012 P er c en t Second Middle Fourth Richest 72.7 53.7 80.6 63.0 85.4 73.2 89.5 80.0 94.4 87.3 20140501_UNICEF_book_Eng.indd 36 5/2/14 11:18 AM 37Multiple Indicator Cluster Survey 2012 IV. Nutrition Low Birth Weight Weight at birth is a good indicator not only of a mother’s health and nutritional status but also of the newborn’s chances for survival, growth, long-term health and psychosocial development. Low birth weight (less than 2,500 grams) carries a range of grave health risks for children. Babies who were undernourished in the womb face a greatly increased risk of dying during early childhood. Those who survive are at increased risk of impaired immune function and 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 mother’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 is particularly important since it accounts for a large proportion of foetal growth retardation. Moreover, diseases such as diarrhoea and malaria, which are common in many developing countries, can significantly impair foetal growth if the mother becomes infected while pregnant. In the industrialized world, cigarette smoking during pregnancy is the leading cause of low birth weight. In developed and developing countries alike, teenagers who give birth when their own bodies have yet to finish growing run the risk of bearing underweight babies. Overall, 99 per cent of births were weighed at birth and approximately 7.6 per cent of infants are estimated to weigh less than 2,500 grams at birth (Table NU.10). There was obvious variation by region (Figure NU.5). The percentage of low birth weight does not vary much by municipal and non- municipal areas or by mother’s education. A small disparity can be observed by living standards (8.5 and 6.1 per cent for the poorest and the richest, respectively). 100 80 40 20 60 0 Bangkok Central Coverage (>0 ppm iodine) Quality coverage (>15 ppm iodine) Figure NU.6 Percentage of households consuming iodized salt by region and area, Thailand, 2012 P er c en t North Northeast South Municipal Non- municipal Thailand Region Area 82.1 79.9 77.3 54.0 80.1 73.3 69.0 70.9 89.0 89.3 86.7 75.1 90.9 84.6 83.8 84.2 20140501_UNICEF_book_Eng.indd 37 5/2/14 11:18 AM Thailand: Monitoring the situation of children and women38 IV. Nutrition Table NU.10 Low birth weight infants Percentage of last-born children in the two years preceding the survey that are estimated to have weighed below 2,500 grams at birth and percentage of live births weighed at birth, Thailand, 2012 Per cent of live births: Number of last-born children two years preceding the survey Below 2,500 grams1 Weighed at birth2 Region Bangkok 6.3 98.8 194 Central 6.0 98.7 520 North 8.9 99.3 266 Northeast 9.3 99.3 611 South 6.7 98.7 323 Area Municipal 6.9 98.5 803 Non-municipal 8.1 99.3 1,110 Mother’s education None 7.7 97.0 51 Primary 7.3 99.6 412 Secondary 7.6 98.8 997 Higher 7.7 99.1 454 Wealth index quintile Poorest 8.5 99.0 277 Second 8.1 99.0 397 Middle 8.1 99.9 454 Fourth 7.3 99.0 428 Richest 6.1 97.9 358 Ethnicity of household head* Thai 7.5 99.1 1,869 Non-Thai 10.0 96.8 43 Total 7.6 99.0 1,914 1 MICS indicator 2.18 2 MICS indicator 2.19 *1 case with missing ethnicity of household head not shown 10 8 4 2 6 0 Ba ng ko k Ce nt ra l Figure NU.7 Percentage of infants weighing less than 2,500 grams at birth, Thailand, 2012 P er c en t No rth No rth ea st So ut h Region Po or es t Se co nd M id dl e Fo ur th Ri ch es t Th ail an d Wealth 6.3 6.0 8.9 9.3 6.7 8.5 8.1 8.1 7.3 6.1 7.6 20140501_UNICEF_book_Eng.indd 38 5/2/14 11:18 AM 39Multiple Indicator Cluster Survey 2012 V. Child Health © C h ir aw at P o o n sa b N at io n al S ta ti st ic al O ffi ce , T h ai la n d Vaccinations The Millennium Development Goal (MDG) 4 aims to reduce child mortality by two thirds between 1990 and 2015. Immunization plays a key part in achieving this goal. Immunizations have saved the lives of millions of children in the three decades since the launch of the Expanded Programme on Immunization (EPI) in 1974. One of the World Fit for Children goals is to ensure 90 per cent full immunization coverage of children under age 1 nationally, with at least 80 per cent coverage in every district or equivalent administrative unit. According to UNICEF and WHO guidelines, a child should receive a BCG vaccination to protect against tuberculosis, three doses of DPT to protect against diphtheria, pertussis, and tetanus, three doses of polio vaccine, and a measles vaccination by 12 months of age. The vaccination schedule followed by the Thailand National Immunization Programme provides all the above-mentioned vaccinations as well as three doses of vaccine against Hepatitis B. All vaccinations should be received during the first year of life. Taking into consideration this vaccination schedule, the estimates for full immunization coverage from the Thailand MICS are based on children aged 12-23 months. Information on vaccination coverage was collected for all children under five years of age. All mothers or caretakers were asked to provide vaccination cards. If the vaccination card for a child was available, interviewers copied vaccination information from the cards onto the MICS questionnaire in the Tablet PC. If no vaccination card was available for the child, the interviewer proceeded to ask the mother to recall whether or not the child had received each of the vaccinations, and for Polio, DPT and Hepatitis B, how many doses were received. The final vaccination coverage estimates are based on both information obtained from the vaccination card and the mother’s report of vaccinations received by the child. 20140501_UNICEF_book_Eng.indd 39 5/2/14 11:18 AM Thailand: Monitoring the situation of children and women40 V. Child Health Table CH.1 Vaccinations in first year of life Percentage of children aged 12-23 months immunized against childhood diseases at any time before the survey and percentage vaccinated before the first birthday, Thailand, 2012 Vaccinated at any time before the survey according to: Vaccinated by 12 months of age Vaccination card Mother’s/ Caretaker’s report Either BCG1 82.0 15.5 97.5 97.5 Polio 1 80.8 15.6 96.4 96.3 2 79.7 14.6 94.3 94.0 32 79.7 11.2 90.9 89.0 DPT 1 81.7 15.0 96.7 96.3 2 80.5 13.3 93.8 93.5 33 80.5 9.5 89.9 87.9 MMR4 80.8 14.5 95.3 91.9 HepB At birth 82.8 12.6 95.5 95.5 1 81.8 11.0 92.8 92.7 2 80.7 6.1 86.8 86.5 35 80.8 2.8 83.6 80.7 All vaccinations 79.4 1.8 81.2 75.1 No vaccinations 0.0 1.9 1.9 1.9 Number of children age 12-23 months 1,827 1,827 1,827 1,827 1 MICS indicator 3.1 2 MICS indicator 3.2 3 MICS indicator 3.3 4 MICS indicator 3.4 MDG indicator 4.3 5 MICS indicator 3.5 100 80 40 20 60 0 BC G Figure CH.1 Percentage of children aged 12-23 months who received the recommended vaccinations by 12 months of age, Thailand, 2012 P er ce n ta g e Po lio Po lio Po lio DP T1 DP T2 DP T3 He pB He pB 97.5 96.3 94.0 89.0 96.3 93.5 87.9 86.5 80.7 Al l 75.1 M M R 91.9 He pB 92.7 He pB 95.5 20140501_UNICEF_book_Eng.indd 40 5/2/14 11:18 AM 41Multiple Indicator Cluster Survey 2012 V. Child Health The percentage of children aged 12 to 23 months who have received each of the specific vaccinations by source of information (vaccination card and mother’s recall) is shown in Table CH.1. The denominator for the table is comprised of children aged 12-23 months so that only children who are old enough to be fully vaccinated are counted. In the first three columns of the table, the numerator includes all children who were vaccinated at any time before the survey according to the vaccination card or the mother’s report. In the last column, only those children who were vaccinated before their first birthday, as recommended, are included. For children without vaccination cards, the proportion of vaccinations given before the first birthday is assumed to be the same as for children with vaccination cards. A total of 97.5 per cent 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 96.3 per cent. The percentage declines for subsequent doses of DPT to 93.5 per cent for the second dose, and 87.9 per cent for the third dose (Table CH.1 & Figure CH.1). Similarly, 96.3 per cent of children received Polio 1 by age 12 months and this declines to 89 per cent by the third dose. The coverage for the measles/mumps/rubella vaccine (MMR) by 12 months of age is 91.9 per cent. There is also a slight decline in the Hepatitis B vaccination doses received from 92.7 per cent for the first dose to 86.5 per cent for the second dose, and 80.7 per cent for the third dose. The percentage of children who had all the recommended vaccinations by their first birthday is low at only 75.1 per cent. For vaccination of children any time before the survey, 81.2 per cent of children aged 12-23 months had received all recommended and only 1.9 per cent had received none. For individual vaccines, 97.5 per cent of children aged 12-23 months had received BCG, 89.9 per cent received three doses of DPT, 90.9 per cent received three doses of Polio, 83.6 per cent received three doses of Hepatitis B, and 95.3 per cent received measles vaccines. Table CH.2 presents vaccination coverage estimates among children 12-23 months by background characteristics. The figures indicate children receiving the vaccinations at any time up to the date of the survey, and are based on information from both the vaccination cards and mothers’/caretakers’ reports. Vaccination cards were seen by the interviewer for only 81.9 per cent of children. With respect to the background characteristics of vaccinated children, children in the North have the highest coverage of all the recommended vaccinations at 87.5 per cent; the lowest proportion (63.3 per cent) is found among children in Bangkok. It is interesting to note that children whose mothers have tertiary education are less likely to be vaccinated than those whose mothers have lower or no education (71.9 per cent compared to above 80 per cent). Household living standards also seem to be a factor. Some 70.1 per cent of children living in the richest households received all recommended vaccinations, compared to 88.6 per cent among their peers in the poorest households. There is not much variation by sex. 20140501_UNICEF_book_Eng.indd 41 5/2/14 11:18 AM Thailand: Monitoring the situation of children and women42 V. Child Health Table CH.2 Vaccinations by background characteristics Percentage of children aged 12-23 months currently vaccinated against childhood diseases, Thailand, 2012 Percentage of children who received: Pe rc en ta ge w ith v ac ci na tio n ca rd s ee n N um be r o f c hi ld re n ag e 12 -2 3 m on th s BCG Polio DPT M ea sl es HepB None All Po lio 1 Po lio 2 Po lio 3 D PT 1 D PT 2 D PT 3 A t b irt h H ep B 1 H ep B 2 H ep B 3 Sex Male 98.1 96.9 94.8 92.2 96.9 94.4 91.0 95.2 95.5 93.3 86.9 83.5 1.6 81.7 82.9 885 Female 97.0 95.8 93.7 89.7 96.6 93.2 88.9 95.4 95.5 92.4 86.7 83.6 2.1 80.7 81.0 943 Region Bangkok 97.7 93.5 88.4 78.8 94.6 88.9 79.2 91.3 92.7 90.1 69.4 66.4 2.3 63.3 66.8 145 Central 97.7 97.2 93.9 90.1 97.3 92.4 87.8 95.6 95.2 92.9 83.6 80.3 1.6 77.9 79.9 444 North 99.1 98.6 98.5 96.8 99.0 98.5 96.5 97.9 95.0 96.2 93.6 90.9 0.6 87.5 87.3 282 Northeast 96.6 95.7 94.1 91.8 96.4 94.2 91.1 95.8 96.3 92.6 90.2 86.6 2.7 85.0 83.4 661 South 97.6 95.9 94.1 90.5 95.4 92.6 89.4 93.2 95.6 91.3 85.9 83.1 1.5 80.2 83.9 295 Area Municipal 97.0 95.9 93.1 87.9 96.3 92.8 87.5 95.1 93.8 91.1 81.1 77.9 2.3 74.8 76.3 687 Non- municipal 97.8 96.6 95.0 92.7 96.9 94.4 91.4 95.4 96.5 93.9 90.2 87.0 1.6 85.0 85.3 1,140 Mother’s education None 96.5 92.5 91.3 88.2 93.4 91.2 88.2 88.9 94.6 90.6 87.2 85.9 3.5 83.5 90.3 69 Primary 97.1 97.4 96.4 94.1 97.3 96.2 93.8 96.2 96.1 95.3 90.0 88.5 1.7 85.3 86.8 674 Secondary 98.5 97.3 95.1 91.1 97.9 94.7 89.6 96.8 96.1 93.2 87.4 83.2 1.3 81.7 81.4 716 Higher 96.6 93.3 89.3 85.2 94.0 87.8 83.7 92.1 93.2 88.0 79.5 75.0 3.0 71.9 72.4 368 Wealth index quintile Poorest 98.9 97.8 96.0 93.9 98.4 96.3 93.1 95.8 98.9 95.4 91.1 89.9 0.7 88.6 90.7 308 Second 98.5 98.6 95.2 92.7 98.6 95.0 92.3 97.5 96.7 94.7 89.9 86.6 0.8 84.8 88.7 416 Middle 96.1 94.6 93.2 90.5 95.4 92.2 88.5 95.4 94.1 92.2 86.3 82.4 2.6 79.6 78.0 414 Fourth 97.6 96.3 96.4 92.2 96.3 95.0 90.5 94.9 94.5 93.6 88.8 84.9 2.3 81.9 80.1 377 Richest 96.5 94.3 90.1 84.6 94.7 89.9 84.8 92.2 93.2 87.5 76.5 73.3 3.0 70.1 71.7 312 Ethnicity of household head* Thai 97.6 96.4 94.3 90.9 96.8 93.8 89.9 95.4 95.6 92.9 86.7 83.4 1.8 81.1 81.9 1,786 Non-Thai (94.1) (92.3) (92.8) (91.6) (92.9) (92.9) (91.8) (91.7) (89.0) (92.9) (91.8) (91.8) (5.9) (85.0) (86.0) 39 Total 97.5 96.4 94.3 90.9 96.7 93.8 89.9 95.3 95.5 92.8 86.8 83.6 1.9 81.2 81.9 1,827 ( ) Figures that are based on 25-49 unweighted cases *3 cases with missing ethnicity of household head not shown Neonatal Tetanus Protection Eliminating maternal tetanus is a key strategy to achieve MDG 5: reducing the maternal mortality ratio by three quarters between 1990 and 2015. Another global health objective is to reduce the incidence of neonatal tetanus to less than 1 case per every 1,000 live births in every district. The strategy for preventing maternal and neonatal tetanus is to ensure that all pregnant women receive at least two doses of tetanus toxoid vaccine. If a woman has not received at least two 20140501_UNICEF_book_Eng.indd 42 5/2/14 11:18 AM 43Multiple Indicator Cluster Survey 2012 V. Child Health doses of tetanus toxoid during a particular pregnancy, she (and her newborn) is considered to be protected against tetanus if she has: • Received at least two doses of tetanus toxoid vaccine, the last within the previous three years; • Received at least three doses, the last within the previous five years; • Received at least four doses, the last within the previous 10 years; • Received five or more doses anytime during her life. To assess the status of tetanus vaccination coverage, women who gave birth in the two years prior to the survey were asked if they had received tetanus toxoid injections during the pregnancy for their most recent birth, and if so, how many. Women who did not receive two or more tetanus toxoid vaccinations during this pregnancy were then asked about any tetanus toxoid vaccinations they may have received prior to this pregnancy. Interviewers also asked women to present their vaccination card, on which dates of tetanus toxoid injections are recorded and referred to information from the cards when available. Table CH.3 Neonatal tetanus protection Percentage of women aged 15-49 years with a live birth in the last 2 years protected against neonatal tetanus, Thailand, 2012 Percentage of women who received at least 2 doses during last pregnancy Percentage of women who did not receive two or more doses during last pregnancy but received: Protected against tetanus1 Number of women with a live birth in the last 2 years 2 doses, the last within prior 3 years 3 doses, the last within prior 5 years 4 doses, the last within prior 10 years Region Bangkok 83.8 0.6 0.5 0.0 84.9 194 Central 72.7 3.5 0.6 0.0 76.9 520 North 66.8 4.7 3.1 0.3 75.0 266 Northeast 65.7 4.8 1.4 0.0 71.9 611 South 73.2 2.0 2.2 0.1 77.4 323 Area Municipal 77.1 3.4 1.2 0.0 81.7 803 Non-municipal 66.3 3.6 1.7 0.1 71.7 1,110 Education None 73.9 1.8 0.2 0.0 75.9 51 Primary 71.2 2.7 1.8 0.0 75.8 412 Secondary 66.6 3.8 1.2 0.1 71.8 997 Higher 79.5 3.8 2.0 0.0 85.2 454 Wealth index quintile Poorest 62.2 5.6 1.8 0.0 69.6 277 Second 68.6 3.1 2.0 0.0 73.7 397 Middle 67.1 3.7 0.9 0.2 71.8 454 Fourth 71.9 3.1 1.0 0.0 76.0 428 Richest 83.6 2.8 2.0 0.0 88.4 358 Ethnicity of household head* Thai 71.0 3.5 1.5 0.0 76.0 1,869 Non-Thai 64.5 6.5 0.0 1.0 72.1 43 Total 70.8 3.5 1.5 0.0 75.9 1,914 1 MICS indicator 3.7 *1 case with missing ethnicity of household head not shown 20140501_UNICEF_book_Eng.indd 43 5/2/14 11:18 AM Thailand: Monitoring the situation of children and women44 V. Child Health Table CH.3 shows the protection from tetanus of women who have had a live birth within the last two years. In Thailand, 75.9 per cent of women aged 15-49 with a live birth in the last two years are protected against tetanus, and 70.8 per cent received at least two doses during the last pregnancy. The proportion of women receiving two doses of tetanus toxoid vaccine (the last within the prior three years) and three doses of tetanus toxoid vaccine (the last within the prior five years) were 3.5 per cent and 1.5 per cent, respectively. Figure CH.2 shows the protection of women against neonatal tetanus by major background characteristics. There is a considerable differential in tetanus protection by region, area, mother’s education and household wealth. About 84.9 per cent of women living in Bangkok are protected against tetanus, compared to only 71.9 per cent of women living in the Northeast. The percentage was higher in municipal areas than in non-municipal areas (81.7 per cent and 71.7 per cent). Women who have secondary education are less likely to protect against tetanus than those with other educational levels. Living standards also influence the prevalence of tetanus protection. About 88.4 per cent of women from the richest households are protected against tetanus, compared to 69.6 per cent of very poor women. Oral Rehydration Treatment Diarrhoea is a leading cause of death globally among children under five. 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 homemade fluid (RHF) – can prevent many of these deaths. Preventing dehydration and malnutrition by increasing fluid intake and continuing to feed the child are also important strategies for managing diarrhoea. The goals are to: 1) reduce by one half deaths due to diarrhoea among children under 5 between 2000 and 2010 (A World Fit for Children); and 2) reduce by two thirds the mortality rate among children under 5 between 1990 and 2015 (Millennium Development Goals). In addition, A World Fit for Children calls for a reduction in the incidence of diarrhoea by 25 per cent. 100 80 40 20 60 0 Ba ng ko k Figure CH.2 Percentage of women with a live birth in the last 2 years who are protected against neonatal tetanus, Thailand, 2012 P er c en t No rth No rth ea st So ut h M un ici pa l No n- m un ici pa l No ed uc at io n Hi gh er Po or es t 84.9 75.0 71.9 77.4 81.7 71.7 75.9 85.2 69.6 Fo ur th 76.0 Se co nd 73.7 Se co nd ar y 71.8 Pr im ar y 75.8 Ce nt ra l 76.9 M id dl e 71.8 Th ail an d 75.9 Region Mother’s educationArea Ri ch es t 88.4 Wealth index quintile 20140501_UNICEF_book_Eng.indd 44 5/2/14 11:18 AM 45Multiple Indicator Cluster Survey 2012 V. Child Health In the MICS, the prevalence of diarrhoea was estimated by asking mothers or caretakers whether their child under 5 years of age had had an episode of diarrhoea in the two weeks prior to the survey. In cases where mothers reported that the child had diarrhoea, a series of questions were asked about the treatment of the illness, including what was given to the child to drink and eat during the episode and whether this was more or less than what was usually given to the child. Overall, 5.1 per cent of children under 5 had diarrhoea in the two weeks preceding the survey (Table CH.4). Diarrhoea prevalence was highest in the North (6.4 per cent). The peak of diarrhoea prevalence occurs in the weaning period, among children aged 12-23 months (9.2 per cent compared to less than 7 per cent). Table CH.4 also shows the percentage of children who were given various types of recommended liquids during the episode of diarrhoea. Since children may have been given more than one type of liquid, the percentages do not necessarily add to 100. Overall, 57.8 per cent were given fluids from ORS packets and 33.9 per cent were given recommended homemade fluids. Children of mothers with higher education were least likely to be given oral rehydration solution. Some 63.9 per cent of children with diarrhoea were given one or more of the recommended home treatments (i.e., were treated with ORS or any recommended homemade fluid). Table CH.4 Oral rehydration solutions and recommended homemade fluids Percentage of children aged 0-59 months with diarrhoea in the last two weeks, and treatment with oral rehydration solutions and recommended homemade fluids, Thailand, 2012 Had diarrhoea in last two weeks Number of children age 0-59 months Children with diarrhoea who were given: Number of children age 0-59 months with diarrhoea in last two weeks Fluid from ORS packet Any recommended homemade fluid ORS or any recommended homemade fluid Sex Male 5.4 4,836 57.2 28.2 58.8 263 Female 4.7 4,880 58.5 40.4 69.8 230 Region Bangkok (3.5) (833) (70.2) (23.6) (73.1) 29 Central 4.4 2,268 52.1 34.9 71.8 100 North 6.4 1,493 48.6 30.7 48.9 96 Northeast 4.9 3,672 69.3 43.2 73.4 179 South 6.1 1,450 46.9 20.7 49.0 89 Area Municipal 4.4 3,723 58.8 35.1 69.2 165 Non-municipal 5.5 5,993 57.3 33.2 61.3 329 Age 0-11 months 6.2 1,912 45.1 37.4 53.9 119 12-23 months 9.2 1,827 63.9 36.5 69.3 168 24-35 months 4.9 1,995 54.6 40.9 65.8 97 36-47 months 3.5 1,887 57.1 17.2 57.1 66 48-59 months (2.1) (2,095) (77.3) (23.7) (77.3) 43 Mother’s education None (9.7) (375) (59.2) (62.0) (72.7) 36 Primary 4.2 3,775 50.1 38.2 60.2 160 Secondary 5.6 3,812 63.8 30.8 68.1 213 Higher 4.8 1,754 56.7 21.4 56.8 84 20140501_UNICEF_book_Eng.indd 45 5/2/14 11:18 AM Thailand: Monitoring the situation of children and women46 V. Child Health Table CH.4 Oral rehydration solutions and recommended homemade fluids (continued) Percentage of children aged 0-59 months with diarrhoea in the last two weeks, and treatment with oral rehydration solutions and recommended homemade fluids, Thailand, 2012 Had diarrhoea in last two weeks Number of children age 0-59 months Children with diarrhoea who were given: Number of children age 0-59 months with diarrhoea in last two weeks Fluid from ORS packet Any recommended homemade fluid ORS or any recommended homemade fluid Wealth index quintile Poorest 4.5 1,858 70.9 49.3 74.3 83 Second 5.8 2,127 52.3 25.2 60.5 124 Middle 4.4 2,183 63.3 38.1 66.8 97 Fourth 6.7 1,897 52.9 36.3 63.1 127 Richest 3.8 1,651 52.7 18.8 54.1 62 Ethnicity of household head* Thai 5.0 9,522 58.3 33.5 64.1 474 Non-Thai (*) (*) (*) (*) (*) 19 Total 5.1 9,716 57.8 33.9 63.9 494 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases *1 case with missing ethnicity of household head not shown The use of ORS or other fluids is associated with children’s gender and the socioeconomic status of households. The percentage for boys with diarrhoea that were given this solution was slightly lower than that of girls (58.8 per cent versus 69.8 per cent). Only 54.1 per cent of children from richest households received ORS or other fluids compared with 74.3 per cent of children from the poorest households. The use rate of ORS or other fluids is also associated with region and mother’s education (Figure CH.3). The percentage in the North and the South (49 per cent) are considerably less than for other regions (between 71 and 73 per cent). ( ) Figures that are based on 25-49 unweighted cases 100 80 40 20 60 0 Ba ng ko k Ce nt ra l Figure CH.3 Percentage of children under age 5 with diarrhoea who received ORS or recommended home fluids, Thailand, 2012 P er c en t No rth No rth ea st So ut h Region No ed uc at io n Pr im ar y Se co nd ar y Hi gh er Th ail an d Mother’s education (73.1) 71.8 48.9 73.4 49.0 (72.7) 60.2 68.1 56.8 63.9 20140501_UNICEF_book_Eng.indd 46 5/2/14 11:18 AM 47Multiple Indicator Cluster Survey 2012 V. Child Health Less than 9 per cent of under-5 children with diarrhoea were given more than usual to drink while 86.7 per cent were given the same or less (Table CH.5). Giving the child more to drink during diarrhoea is most prevalent among children aged 48-59 months (32.2 per cent) and children in the second quintile (20 per cent) as well as children in the Northeast (17.4 per cent). Table CH.5 Feeding practices during diarrhoea Per cent distribution of children aged 0-59 months with diarrhoea in the last two weeks by amount of liquids and food given during episode of diarrhoea, Thailand, 2012 H ad d ia rr ho ea in la st tw o w ee ks N um be r o f c hi ld re n ag e 0- 59 m on th s Drinking practices during diarrhoea: Total Eating practices during diarrhoea: Total N um be r o f c hi ld re n ag e 0- 59 m on th s w ith d ia rr ho ea In la st tw o w ee ks G iv en m uc h le ss G iv en s om e w ha t l es s G iv en a bo ut th e sa m e G iv en m or e G iv en n ot hi ng M is si ng /D K G iv en m uc h le ss G iv en s om e w ha t l es s G iv en a bo ut th e sa m e G iv en m or e St op pe d fo od H ad n ev er be en g iv en Sex Male 5.4 4,836 7.9 28.5 47.4 10.0 6.0 0.2 100.0 8.8 35.3 44.3 6.6 2.7 2.4 100.0 263 Female 4.7 4,880 8.3 27.1 54.7 7.0 3.0 0.0 100.0 9.8 30.5 48.4 0.9 6.0 4.4 100.0 230 Region Bangkok 3.5 833 (28.4) (25.4) (41.4) (0.0) (4.8) (0.0) 100.0 (25.5) (48.9) (25.7) (0.0) (0.0) (0.0) 100.0 29 Central 4.4 2,268 13.7 32.3 49.0 1.3 3.7 0.0 100.0 16.8 26.6 55.9 0.0 0.0 0.7 100.0 100 North 6.4 1,493 4.6 16.2 70.3 5.3 3.1 0.5 100.0 5.8 21.6 65.6 2.8 0.8 3.3 100.0 96 Northeast 4.9 3,672 5.5 25.6 46.4 17.4 5.0 0.0 100.0 7.3 35.0 32.7 8.8 11.2 5.0 100.0 179 South 6.1 1,450 3.8 40.5 43.6 5.8 6.3 0.0 100.0 2.9 43.6 48.3 1.2 (0.0) 3.9 100.0 89 Area Municipal 4.4 3,723 16.2 21.8 52.9 5.0 4.1 0.0 100.0 16.5 26.7 53.0 1.7 1.0 1.1 100.0 165 Non-municipal 5.5 5,993 4.0 30.8 49.7 10.5 4.8 0.1 100.0 5.6 36.2 42.8 5.1 5.9 4.5 100.0 329 Age 0-11 months 6.2 1,912 11.2 12.0 73.2 3.6 0.0 0.0 100.0 11.0 9.4 61.6 2.4 10.5 5.0 100.0 119 12-23 months 9.2 1,827 6.8 36.5 41.7 11.1 3.9 0.0 100.0 10.3 40.0 41.5 0.4 2.4 5.4 100.0 168 24-35 months 4.9 1,995 9.2 34.8 49.9 2.5 3.4 0.0 100.0 9.6 53.0 36.4 0.0 0.3 0.7 100.0 97 36-47 months 3.5 1,887 5.6 25.2 58.0 4.9 5.6 0.7 100.0 5.5 24.7 61.0 1.5 6.2 1.1 100.0 66 48-59 months 2.1 2,095 (5.3) (25.5) (15.8) (32.2) (21.1) (0.0) 100.0 (5.5) (39.0) (21.4) (34.2) (0.0) (0.0) 100.0 43 Mother’s education None 9.7 375 (20.7) (36.1) (36.8) (3.3) (1.7) (1.3) 100.0 (26.8) (26.0) (34.3) (4.2) (8.7) (0.0) 100.0 36 Primary 4.2 3,775 11.6 24.8 56.2 2.7 4.7 0.0 100.0 12.3 39.0 42.1 0.4 3.4 2.7 100.0 160 Secondary 5.6 3,812 5.5 26.2 47.4 15.1 5.8 0.0 100.0 5.2 31.9 43.8 7.7 5.7 5.7 100.0 213 Higher 4.8 1,754 2.5 34.0 55.1 5.7 2.6 0.0 100.0 6.0 27.8 65.2 1.0 0.0 0.0 100.0 84 Wealth index quintile Poorest 4.5 1,858 8.2 31.7 50.9 3.0 5.7 0.6 100.0 9.2 44.0 39.5 0.0 5.0 2.3 100.0 83 Second 5.8 2,127 3.1 28.8 45.3 20.0 2.7 0.0 100.0 7.1 29.1 48.2 12.8 1.8 1.1 100.0 124 Middle 4.4 2,183 3.4 27.3 53.6 8.8 6.9 0.0 100.0 4.1 34.2 44.5 2.4 3.2 11.7 100.0 97 Fourth 6.7 1,897 15.5 22.0 54.3 3.8 4.4 0.0 100.0 15.1 23.2 51.0 0.3 9.0 1.5 100.0 127 Richest 3.8 1,651 9.8 33.3 50.1 3.2 3.6 0.0 100.0 9.5 45.0 44.1 1.3 0.0 0.0 100.0 62 Ethnicity of household head* Thai 5.0 9,522 8.0 27.7 50.5 9.0 4.7 0.1 100.0 8.6 33.6 46.1 3.8 4.4 3.5 100.0 474 Non-Thai 10.4 184 (*) (*) (*) (*) (*) (*) 100.0 (*) (*) (*) (*) (*) (*) 100.0 19 Total 5.1 9,716 8.1 27.8 50.8 8.6 4.6 0.1 100.0 9.2 33.1 46.2 3.9 4.2 3.3 100.0 494 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases *1 case with missing ethnicity of household head not shown 20140501_UNICEF_book_Eng.indd 47 5/2/14 11:18 AM Thailand: Monitoring the situation of children and women48 V. Child Health Around four in five children (83.2 per cent) were given somewhat less to eat, the same or more (continued feeding), but 9.2 per cent were given much less to eat. There are considerable differences in continued eating practices by region, with 93.1 per cent of children aged 0–59 months in the South who continued feeding, compared with only 74.6 per cent of children in Bangkok. Age differentials indicate that 94.6 per cent of children aged 48-59 months continued feeding compared with 73.4 per cent of children aged 0-11 months. Indeed, the practice of continued feeding increases substantially as the mother’s education increases, from 64.5 per cent among children with uneducated mothers to 94 per cent for children whose mothers have higher education. Table CH.6 shows the percentage of children aged 0-59 months with diarrhoea in the last two weeks who were given ORS or increased fluid with continued feeding, and the percentage of children with diarrhoea who were given other treatments. Overall, 59.3 per cent of children with diarrhoea received ORS or increased fluids, 65.4 per cent received ORT (ORS or recommended homemade fluids or increased fluids). Combining the information in Table CH.5 with that in Table CH.4 on oral rehydration therapy, it is observed that 52.7 per cent of children received ORT and continued feeding, as is the recommendation. There are differences in the home management of diarrhoea by background characteristics (Figure CH.4). In the North, only 42.5 per cent of children were given ORT and continued feeding, while the figure is 50 per cent and above in other regions. Children with educated mothers are more likely to receive ORT and continued feeding than children whose mothers have no education. About one child in five (18.4 per cent) with diarrhoea in the last two weeks prior to the survey was given antimotility medicine, which is the highest percentage for all other treatments given. Even so, 23.6 per cent of children with diarrhoea did not receive any treatment or medicine. Gender disparities are observed in the use of antibiotics for diarrhoea treatment, with 0.5 per cent of girls aged 0-59 months with diarrhoea receiving antibiotics, compared to 2 per cent of boys. ( ) Figures that are based on 25-49 unweighted cases 100 80 40 20 60 0 Ba ng ko k Ce nt ra l Figure CH.4 Percentage of children under age 5 with diarrhoea who received ORT or increased fluids, AND continued feeding, Thailand, 2012 P er c en t No rth No rth ea st So ut h Region M un ici pa l No n- m un ici pa l No ed uc at io n Pr im ar y Se co nd ar y Hi gh er Th ail an d Mother’s educationArea (60.3) 56.7 42.5 55.8 50.4 55.2 51.4 (45.8) 51.4 54.4 53.7 52.7 20140501_UNICEF_book_Eng.indd 48 5/2/14 11:18 AM 49Multiple Indicator Cluster Survey 2012 V. Child Health Table CH.6 Oral rehydration therapy with continued feeding and other treatments Percentage of children aged 0-59 months with diarrhoea in the last two weeks who received oral rehydration therapy with continued feeding, and percentage of children with diarrhoea who received other treatments, Thailand, 2012 Children with diarrhoea who received: Other treatments: Not given any treatment or drug Number of children age 0-59 months with diarrhoea in last two weeks ORS or increased fluids ORT (ORS or recommended homemade fluids or increased fluids) ORT with continued feeding1 Pill or syrup Other*Anti- biotic Anti- motility Other Un- known Sex Male 58.7 60.4 53.0 2.0 16.9 2.3 25.3 0.0 28.9 263 Female 60.0 71.2 52.3 0.5 20.0 0.3 32.9 0.0 17.5 230 Region Bangkok (70.2) (73.1) (60.3) (0.0) (5.2) (10.7) (26.2) (0.0) (22.0) 29 Central 53.0 72.7 56.7 5.1 26.3 2.7 24.7 0.0 23.4 100 North 50.2 50.5 42.5 0.0 0.0 0.0 30.7 0.0 37.8 96 Northeast 70.7 74.8 55.8 0.0 29.3 0.0 26.1 0.0 16.3 179 South 49.8 51.9 50.4 1.5 11.4 1.2 38.1 0.0 23.8 89 Area Municipal 60.2 70.6 55.2 1.2 20.8 2.2 30.1 0.0 22.3 165 Non-municipal 58.9 62.9 51.4 1.4 17.2 1.0 28.2 0.0 24.2 329 Age 0-11 months 46.7 55.5 37.1 2.9 20.4 2.6 20.9 0.0 38.1 119 12-23 months 65.9 71.3 55.5 1.2 12.3 0.1 39.9 0.0 16.3 168 24-35 months 56.9 68.0 59.1 0.3 20.5 0.0 24.8 0.0 19.9 97 36-47 months 57.1 57.1 50.0 0.7 10.5 5.6 32.7 0.0 26.8 66 48-59 months (77.3) (77.3) (74.2) (0.7) (43.6) (0.0) (11.5) (0.0) (15.4) 43 Mother’s education None (59.2) (72.7) (45.8) (0.0) (27.9) (0.0) (30.6) (0.0) (25.4) 36 Primary 52.0 62.0 51.4 1.7 19.8 1.9 21.5 0.0 25.1 160 Secondary 64.9 69.3 54.4 1.2 19.4 1.9 28.6 0.0 20.3 213 Higher 59.0 59.2 53.7 1.3 9.0 0.0 42.9 0.0 28.3 84 Wealth index quintile Poorest 70.9 74.3 62.4 0.0 16.8 0.0 14.7 0.0 20.8 83 Second 55.6 63.8 55.5 2.2 24.8 2.2 23.2 0.0 25.2 124 Middle 63.6 67.2 55.6 1.6 7.7 0.9 52.5 0.0 13.3 97 Fourth 54.9 65.1 42.0 1.1 28.4 2.7 23.4 0.0 28.2 127 Richest 53.6 55.0 51.4 1.2 3.9 0.0 33.2 0.0 30.8 62 Ethnicity of household head** Thai 59.9 65.7 53.4 1.4 18.3 1.5 29.2 0.0 23.0 474 Non-Thai (*) (*) (*) (*) (*) (*) (*) (*) (*) 19 Total 59.3 65.4 52.7 1.3 18.4 1.4 28.9 0.0 23.6 494 1 MICS indicator 3.8 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases *such as zinc, injection, intravenous, home remedy, herbal medicine **1 case with missing ethnicity of household head not shown 20140501_UNICEF_book_Eng.indd 49 5/2/14 11:18 AM Thailand: Monitoring the situation of children and women50 V. Child Health Care Seeking and Antibiotic Treatment of Pneumonia Pneumonia is one of the leading causes of death of children under 5 and the use of antibiotics by children with suspected pneumonia is a key life-saving intervention. One of the World Fit for Children goals is to reduce by one-third the deaths due to acute respiratory infections. In the Thailand MICS, the prevalence of suspected pneumonia was estimated by asking mothers or caretakers whether their child under age 5 had had an illness with a cough accompanied by rapid or difficult breathing, and whose symptoms were due either to a problem in the chest or a problem in the chest and a blocked nose. Table CH.7 presents the prevalence of suspected pneumonia and, if care was sought outside the home, the site of care. Only 1.9 per cent of children aged 0-59 months were reported to have had symptoms of pneumonia during the two weeks preceding the survey. Just over one third of children with suspected pneumonia were taken to a government hospital (37.5 per cent) and one third to a private hospital (33.9 per cent). Some 83.3 per cent of children with suspected pneumonia were taken to an appropriate health-care provider, with the highest percentage in the Northeast (95.5 per cent) and the lowest in the Central region (62 per cent). The proportion of non-municipal children taken to an appropriate health-care provider is higher than that of municipal children (85.7 per cent versus 78.5 per cent). As many as 90.2 per cent of children with suspected pneumonia whose mothers have higher education went to an appropriate health care providers. Table CH.7 also presents the use of antibiotics for the treatment of suspected pneumonia in children under 5 by sex, age, region, area, and socioeconomic factors. Some 45.4 per cent of children under 5 with suspected pneumonia had received antibiotics during the two weeks prior to the survey. The percentage was higher in municipal areas compared to non-municipal areas (53.1 per cent versus 41.6). A cautious interpretation is required since the number of observations is small and makes it difficult to reach conclusions about the differences by background characteristics. Table CH.7 Care seeking for suspected pneumonia and antibiotic use during suspected pneumonia Percentage of children aged 0-59 months with suspected pneumonia in the last two weeks who were taken to a health provider and percentage of children who were given antibiotics, Thailand, 2012 Had suspected pneumonia in the last two weeks Number of children aged 0-59 months Children with suspected pneumonia who were taken to: Any appropriate provider1 Percentage of children with suspected pneumonia who received antibiotics in the last two weeks2 Number of children aged 0-59 months with suspected pneumonia in the last two weeks Public sources Private sources Other source G ov t. ho sp ita l G ov t. he al th p os t Pr iv at e ho sp ita l/ cl in ic Pr iv at e ph ys ic ia n Pr iv at e ph ar m ac y Sh op O th er * Sex Male 1.8 4,836 30.6 8.6 37.0 2.0 2.2 0.0 0.0 78.2 55.3 86 Female 2.1 4,880 43.3 7.2 31.3 5.8 0.0 0.9 0.0 87.6 37.1 102 Region Bangkok 0.7 833 (*) (*) (*) (*) (*) (*) (*) (*) (*) 6 Central 2.2 2,268 (32.6) (4.4) (25.0) (0.0) (0.9) (1.3) (0.0) (62.0) (57.3) 49 North 1.5 1,493 (10.6) (4.8) (27.1) (33.5) (0.0) (1.3) (0.0) (76.0) (48.5) 23 Northeast 2.6 3,672 48.3 12.3 34.8 0.0 1.5 0.0 0.0 95.5 41.8 94 South 1.2 1,450 (*) (*) (*) (*) (*) (*) (*) (*) (*) 17 Area Municipal 1.7 3,723 39.2 5.2 32.3 1.7 0.7 0.5 0.0 78.5 53.1 63 Non-municipal 2.1 5,993 36.6 9.2 34.7 5.2 1.2 0.5 0.0 85.7 41.6 125 20140501_UNICEF_book_Eng.indd 50 5/2/14 11:18 AM 51Multiple Indicator Cluster Survey 2012 V. Child Health Table CH.7 Care seeking for suspected pneumonia and antibiotic use during suspected pneumonia (continued) Percentage of children aged 0-59 months with suspected pneumonia in the last two weeks who were taken to a health provider and percentage of children who were given antibiotics, Thailand, 2012 Had suspected pneumonia in the last two weeks Number of children aged 0-59 months Children with suspected pneumonia who were taken to: Any appropriate provider1 Percentage of children with suspected pneumonia who received antibiotics in the last two weeks2 Number of children aged 0-59 months with suspected pneumonia in the last two weeks Public sources Private sources Other source G ov t. ho sp ita l G ov t. he al th po st Pr iv at e ho sp ita l/ cl in ic Pr iv at e ph ys ic ia n Pr iv at e ph ar m ac y Sh op O th er * Age 0-11 months 2.3 1,912 (*) (*) (*) (*) (*) (*) (*) (*) (*) 44 12-23 months 3.1 1,827 (30.9) (10.1) (33.9) (3.0) (0.0) (0.0) 0.0 (78.0) (30.5) 57 24-35 months 2.3 1,995 (31.5) (10.8) (33.6) (1.1) (3.2) (0.0) 0.0 (77.0) (56.4) 46 36-47 months 1.3 1,887 (32.5) (1.8) (46.6) (5.5) (1.8) (1.2) 0.0 (86.4) (56.0) 25 48-59 months 0.8 2,095 (*) (*) (*) (*) (*) (*) (*) (*) (*) 17 Mother’s education None 1.6 375 (*) (*) (*) (*) (*) (*) (*) (*) (*) 6 Primary 2.1 3,775 45.8 6.5 27.6 6.6 0.5 0.0 0.0 86.6 40.9 81 Secondary 1.9 3,812 30.6 7.2 37.4 1.7 2.0 0.4 0.0 76.9 50.1 72 Higher 1.7 1,754 (38.4) (1.1) (47.4) (3.3) (0.0) (0.0) (0.0) (90.2) (51.0) 30 Wealth index quintile Poorest 3.5 1,858 (54.3) (9.9) (23.0) (7.6) (2.9) (0.0) (0.0) (94.9) (43.7) 66 Second 1.8 2,127 (15.1) (16.1) (54.4) (2.9) (0.0) (1.7) (0.0) (88.5) (32.7) 39 Middle 2.1 2,183 (36.2) (2.2) (30.5) (0.0) (0.0) (0.0) (0.0) (68.9) (58.2) 46 Fourth 0.8 1,897 (30.5) (3.2) (34.1) (9.4) (0.0) (0.0) (0.0) (77.2) (58.2) 16 Richest 1.4 1,651 (34.7) (2.4) (36.9) (0.0) (0.0) (1.3) (0.0) (74.0) (37.0) 22 Ethnicity of household head** Thai 1.9 9,522 38.8 8.1 34.4 4.2 0.8 0.5 0.0 85.5 43.5 182 Non-Thai 3.4 184 (*) (*) (*) (*) (*) (*) (*) (*) (*) 6 Total 1.9 9,716 37.5 7.8 33.9 4.0 1.0 0.5 0.0 83.3 45.4 189 1 MICS indicator 3.9 2 MICS indicator 3.10 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases *such as relative, friend, traditional practitioner **10 cases with missing ethnicity of household head not shown Solid Fuel Use More than three billion people around the world rely on solid fuels for their basic energy needs, including cooking and heating. Solid fuels include biomass fuels such as wood, charcoal, crops or other agricultural waste, dung, shrubs, straw and coal. Cooking and heating with solid fuels leads to high levels of indoor smoke which contains a complex mix of health-damaging pollutants. The main problem with the use of solid fuels is their incomplete combustion, which produces toxic elements such as carbon monoxide, polyaromatic hydrocarbons, and sulphur dioxide (SO2), among others. Use of solid fuels increases the risks of incurring acute respiratory illness, pneumonia, chronic obstructive lung disease, cancer, and possibly tuberculosis, asthma, or cataracts, and may contribute to low birth weight of babies born to pregnant women exposed to smoke. The primary indicator for monitoring use of solid fuels is the proportion of the population using solid fuels as the primary source of domestic energy for cooking, shown in Table CH.8. 20140501_UNICEF_book_Eng.indd 51 5/2/14 11:18 AM Thailand: Monitoring the situation of children and women52 V. Child Health Overall, one quarter (26.1 per cent) of the population in Thailand are using solid fuels for cooking. The use of solid fuels is very low in municipal areas (14.7 per cent), but quite high in non-municipal areas (34.5 per cent). Differentials with respect to household wealth and the educational level of the household head are also substantial. The poorest 20 per cent of the population uses solid fuel for cooking the most (82.3 per cent), especially compared to richest 20 per cent of the population (0.1 per cent). The reverse is found in relation to the use of liquefied petroleum gas (LPG), used by 98 per cent of the richest, but only 15.4 per cent of the poorest population. Similarly, the use of solid fuels is negatively associated with the educational level of the household head. About 40.4 per cent of the population in households with uneducated household heads rely on solid fuels compared to only 1.7 per cent of the population in households whose heads have tertiary education. The findings further indicate that the use of solid fuels is very common in the Northeast (53.7 per cent) and the North (35.7 per cent) but very rare in Bangkok (0.5 per cent). The table also shows that the overall percentage is high due to high levels of charcoal and wood used for cooking purposes. Table CH.8 Solid fuel use Per cent distribution of household members according to type of cooking fuel used by the household, and percentage of household members living in households using solid fuels for cooking, Thailand, 2012 Percentage of household members in households using: Number of household members El ec tr ic ity Liquefied Petroleum Gas (LPG) Natural Gas/ Biogas Solid fuels Other fuel No food cooked in the household Total Solid fuels for cooking1 Coal/ lignite Charcoal Wood Agricultural crop residue Region Bangkok 3.8 92.9 0.1 0.0 0.5 0.0 0.0 0.0 2.6 100.0 0.5 8,862 Central 1.8 91.3 0.0 0.0 4.3 0.9 0.0 0.0 1.6 100.0 5.2 19,568 North 1.2 61.1 0.0 0.0 18.0 17.7 0.0 0.0 1.4 100.0 35.7 12,700 Northeast 0.5 44.6 0.0 0.0 32.2 21.5 0.0 0.0 0.9 100.0 53.7 27,671 South 2.0 94.5 0.1 0.0 1.2 1.0 0.0 0.0 1.2 100.0 2.2 10,232 Area Municipal 2.5 80.2 0.0 0.0 8.2 6.5 0.0 0.0 2.3 100.0 14.7 33,424 Non-municipal 0.8 63.7 0.0 0.0 20.7 13.8 0.0 0.0 0.8 100.0 34.5 45,609 Education of household head None 1.6 56.5 0.0 0.0 17.3 23.1 0.0 0.0 1.2 100.0 40.4 4,508 Primary 0.8 64.3 0.0 0.0 20.3 13.7 0.0 0.0 0.7 100.0 34.0 49,886 Secondary 2.4 83.6 0.1 0.0 7.7 3.7 0.0 0.0 2.3 100.0 11.4 15,045 Higher 3.7 90.7 0.1 0.0 1.4 0.3 0.0 0.0 3.6 100.0 1.7 9,468 Missing/DK 3.0 75.9 0.0 0.0 0.3 19.2 0.0 0.0 1.6 100.0 19.5 119 Wealth index quintiles Poorest 0.6 15.4 0.0 0.0 47.7 34.6 0.0 0.0 1.5 100.0 82.3 15,807 Second 1.3 61.8 0.0 0.0 21.7 13.3 0.0 0.0 1.6 100.0 35.0 15,807 Middle 3.0 84.0 0.0 0.0 6.2 4.5 0.0 0.0 2.1 100.0 10.7 15,806 Fourth 1.5 94.3 0.1 0.0 1.6 1.1 0.0 0.0 1.2 100.0 2.7 15,806 Richest 1.1 98.0 0.0 0.0 0.0 0.1 0.0 0.0 0.6 100.0 0.1 15,808 Ethnicity of household head* Thai 1.4 70.7 0.0 0.0 15.5 10.7 0.0 0.0 1.4 100.0 26.2 77,902 Non-Thai 8.5 69.3 0.0 0.0 8.4 10.3 0.0 0.0 3.5 100.0 18.7 1,029 Total 1.5 70.7 0.0 0.0 15.4 10.7 0.0 0.0 1.4 100.0 26.1 79,033 1 MICS indicator 3.11 *102 cases with missing ethnicity of household head not shown 20140501_UNICEF_book_Eng.indd 52 5/2/14 11:18 AM 53Multiple Indicator Cluster Survey 2012 V. Child Health Solid fuel use by place of cooking is shown in Table CH.9. The presence and extent of indoor pollution are dependent on cooking practices, places used for cooking, as well as types of fuel used. According to the Thailand MICS, 39.8 per cent of the population cook in a separate room used as a kitchen. The percentage of households members that cook within the dwelling unit is less in municipal areas than in non-municipal areas (59.5 per cent versus 66.4 per cent). A higher prevalence of outdoor cooking is observed among households in the Central region (16.9 per cent), compared to 5.1 per cent overall. Table CH.9 Solid fuel use by place of cooking Per cent distribution of household members in households using solid fuels by place of cooking, Thailand, 2012 Place of cooking Number of household members In a separate room used as kitchen Elsewhere in the house In a separate building Outdoors At another place Total Region Bangkok (18.8) (46.8) (12.5) (21.9) (0.0) 100.0 51 Central 46.5 18.8 17.8 16.9 0.0 100.0 1,020 North 47.9 21.5 27.2 3.0 0.4 100.0 4,537 Northeast 36.8 26.4 32.0 4.8 0.0 100.0 14,848 South 53.7 21.3 17.5 7.6 0.0 100.0 222 Area Municipal 34.9 24.6 32.6 7.8 0.1 100.0 4,909 Non-municipal 41.3 25.1 29.2 4.3 0.1 100.0 15,770 Education of household head None 39.8 27.9 30.1 2.2 0.0 100.0 1,824 Primary 39.9 24.6 30.1 5.4 0.1 100.0 16,949 Secondary 38.2 26.7 29.6 5.6 0.0 100.0 1,722 Higher 56.9 16.4 19.2 7.5 0.0 100.0 160 Missing/DK (*) (*) (*) (*) (*) 100.0 23 Wealth index quintiles Poorest 40.0 27.7 28.3 3.9 0.2 100.0 13,002 Second 39.4 23.5 30.0 7.1 0.0 100.0 5,531 Middle 42.4 11.2 39.1 7.3 0.0 100.0 1,687 Fourth 30.7 14.9 45.5 8.8 0.0 100.0 438 Richest (16.9) (14.4) (68.8) (0.0) (0.0) 100.0 21 Ethnicity of household head* Thai 40.0 24.8 30.0 5.1 0.1 100.0 20,456 Non-Thai 25.2 40.6 30.5 3.7 0.0 100.0 192 Total 39.8 24.9 30.0 5.1 0.1 100.0 20,679 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases *30 cases with missing ethnicity of household head not shown 20140501_UNICEF_book_Eng.indd 53 5/2/14 11:18 AM 20140501_UNICEF_book_Eng.indd 54 5/2/14 11:18 AM 55Multiple Indicator Cluster Survey 2012 Safe drinking water is a basic necessity for good health. Unsafe drinking water can be a significant carrier of diseases such as trachoma, cholera, typhoid, and schistosomiasis. Drinking water can also be tainted with chemical, physical and radiological contaminants with harmful effects on human health. In addition to its association with disease, access to drinking water may be particularly important for women and children, especially in rural areas, who bear the primary responsibility for carrying water, often for long distances. Millennium Development Goal 7 target c is to reduce by half between 1990 and 2015 the proportion of people without sustainable access to safe drinking water and basic sanitation. The World Fit for Children goal calls for at least a one-third reduction in the proportion of households without access to hygienic sanitation facilities and affordable and safe drinking water. The list of indicators1 used in the Thailand MICS is as follows: Water • Use of improved drinking water sources • Use of adequate water treatment method • Time to source of drinking water • Person collecting drinking water Sanitation • Use of improved sanitation • Sanitary disposal of child’s faeces Use of Improved Water Sources The distribution of the population by main source of drinking water is shown in Table WS.1 and Figure WS.1. The populations using improved sources of drinking water are those using any of the following types of supply: piped water (into dwelling, compound, yard or plot, to neighbour, public tap/standpipe), tube well/borehole, protected well, protected spring and rainwater collection. Bottled water is considered an improved water source only if the household is using an improved water source for handwashing and cooking. 1 For more details on water and sanitation and to access some reference documents, please visit the UNICEF childinfo website http://www. childinfo.org/wes.html VI. Water and Sanitation © U N IC E F T h ai la n d /2 00 9/ M . T h o m as 20140501_UNICEF_book_Eng.indd 55 5/2/14 11:18 AM Thailand: Monitoring the situation of children and women56 VI. Water and Sanitation Table WS.1 Use of improved water sources Per cent distribution of household population according to main source of drinking water and percentage of household population using improved drinking water sources, Thailand, 2012 Main source of drinking water Total Percentage using improved sources of drinking water1 Number of hous hold members Improved sources Unimproved sources Piped water Tu be -w el l/ bo re -h ol e Pr o- te ct ed w el l Pr ot ec te d sp rin g Ra in -w at er co lle ct io n B ot tle d w at er * U np ro -t ec te d w el l Ta nk er tr uc k Su rf ac e w at er B ot tle d w at er * O th er In to dw el lin g In to y ar d/ pl ot To ne ig hb ou r Pu bl ic ta p/ st an d- pi pe Region Bangkok 62.0 10.7 0.1 0.0 0.1 0.0 0.0 0.4 26.7 0.0 0.0 0.0 0.0 0.0 100.0 100.0 8,862 Central 24.8 2.3 0.0 0.1 1.0 1.0 0.0 21.2 48.2 0.2 0.1 0.1 0.9 0.0 100.0 98.6 19,568 North 25.9 1.9 0.1 0.4 1.7 4.9 0.1 18.6 41.0 0.2 0.1 3.3 1.8 0.1 100.0 94.6 12,700 Northeast 8.0 1.3 0.0 0.2 3.2 1.5 0.0 56.8 27.8 0.3 0.1 0.4 0.4 0.0 100.0 98.8 27,671 South 8.3 1.0 0.1 0.2 7.3 10.0 0.0 15.5 47.2 4.8 0.0 0.5 4.9 0.2 100.0 89.6 10,232 Area Municipal 30.9 4.4 0.0 0.1 1.1 1.8 0.0 14.3 45.6 0.3 0.1 0.6 0.6 0.1 100.0 98.3 33,424 Non- municipal 14.0 1.4 0.1 0.2 3.7 3.6 0.0 41.8 31.3 1.2 0.1 0.9 1.8 0.0 100.0 96.0 45,609 Education of household head None 16.1 2.3 0.0 0.3 3.5 4.8 0.1 27.6 30.7 3.4 0.1 6.0 5.0 0.2 100.0 85.4 4,508 Primary 17.4 2.2 0.1 0.2 2.9 3.3 0.0 39.4 32.2 0.8 0.1 0.5 1.1 0.1 100.0 97.5 49,886 Secondary 26.6 2.6 0.0 0.2 2.4 2.0 0.0 16.7 46.9 0.6 0.1 0.4 1.3 0.0 100.0 97.6 15,052 Higher 34.5 5.3 0.0 0.0 1.0 1.2 0.0 4.7 52.3 0.1 0.2 0.3 0.5 0.0 100.0 98.9 9,468 Missing/DK 14.9 0.0 0.0 0.0 0.3 1.3 0.0 8.7 54.9 0.0 0.0 1.0 18.9 0.0 100.0 80.2 119 Wealth index quintile Poorest 7.5 1.3 0.1 0.3 3.8 3.0 0.0 69.2 10.7 0.7 0.2 2.5 0.5 0.1 100.0 96.0 15,807 Second 15.3 1.8 0.1 0.2 3.4 3.3 0.0 44.5 27.7 1.5 0.1 0.8 1.2 0.1 100.0 96.4 15,807 Middle 16.0 2.3 0.1 0.2 2.9 3.9 0.0 25.5 45.3 1.3 0.1 0.3 2.2 0.0 100.0 96.1 15,806 Fourth 23.5 2.4 0.0 0.1 2.0 3.2 0.0 10.1 55.9 0.5 0.0 0.2 2.1 0.1 100.0 97.1 15,806 Richest 43.4 5.3 0.0 0.1 0.9 0.8 0.0 1.7 47.2 0.0 0.1 0.0 0.5 0.0 100.0 99.4 15,808 Ethnicity of household head** Thai 21.2 2.6 0.0 0.2 2.6 2.9 0.0 30.5 37.0 0.8 0.1 0.7 1.3 0.0 100.0 97.1 77,902 Non-Thai 15.8 2.9 0.0 1.4 1.8 2.2 0.0 5.9 59.6 1.0 0.0 7.5 1.1 0.7 100.0 89.7 1,029 Total 21.1 2.6 0.0 0.2 2.6 2.9 0.0 30.2 37.3 0.8 0.1 0.8 1.3 0.1 100.0 97.0 79,033 1 MICS indicator 4.1; MDG indicator 7.8 *Households using bottled water as the main source of drinking water are classified into improved or unimproved drinking water users according to the water source used for other purposes such as cooking and handwashing. **102 cases with missing ethnicity of household head not shown Overall, 97 per cent of the population is using an improved source of drinking water. The proportion in municipal areas is not much different than in non-municipal areas (98.3 per cent versus 96 per cent). The situation in the Southern region is considerably worse than in other regions: Only 89.6 per cent of the population in this region gets its drinking water from an improved source. In contrast, 100 per cent of Bangkok’s population gets its drinking water from an improved source. The source of drinking water varies strongly by region (Table WS.1). In Bangkok, 72.7 per cent of the population uses drinking water that is piped into dwellings, yards or plots. In contrast, fewer than 10 per cent of those residing in Northeastern and Southern regions have piped water. Bottled water use is the main source of drinking water in the Central (48.2 per cent), Southern (47.2 per cent) and Northern regions (41 per cent). Notably in the Northeast, the most important source of drinking water is rainwater collection (56.8 per cent). 20140501_UNICEF_book_Eng.indd 56 5/2/14 11:18 AM 57Multiple Indicator Cluster Survey 2012 VI. Water and Sanitation As expected, living standards show the highest differential for piped water into dwellings, with 7.5 per cent of the poorest households using piped water sources compared with 43.4 per cent of the richest households. A similar differential is observed between municipal (30.9 per cent) and non-municipal areas (14 per cent). It is interesting to note that approximately 3 per cent of the population uses an unimproved source of drinking water. People living in households with a non- educated head (14.7 per cent), people living in the South (10.4 per cent) and in households headed by a non-Thai (10.3 per cent) represent the highest proportion of the population using unimproved drinking water sources. Use of household water treatment is presented in Table WS.2. Households were asked about the ways they were treating water at home to make it safer to drink. Boiling water, adding bleach or chlorine, using a water filter, and using solar disinfection are considered proper treatments of drinking water. The table shows water treatment by all households and the percentage of household members living in households using unimproved water sources but using appropriate water treatment methods. Overall, more than half the population (64.5 per cent) accessing drinking water from either an improved or an unimproved source does not use any water treatment methods. The proportion in the Northeast (76.8 per cent) is higher than in other regions. In addition, no water treatment method used is more prevalent among people living in non-municipal areas (70 per cent), in the poorest households (73.1 per cent) and in non-Thai-headed households (70 per cent). Water filter (21 per cent) is the most popular method used for water treatment, followed by boiling (6.1 per cent) and letting the water stand and settle (4.4 per cent). The use of a water filter is higher among people living in Bangkok, in municipal areas, people using improved drinking water sources and the better off. Boiling is a more common method in the Southern region, among people using unimproved drinking water sources and households whose heads have no education. Letting the water stand and settle is more prevalent among people living in the North and people using unimproved drinking water sources. Figure WS.1 Per cent distribution of household members by source of drinking water, Thailand, 2012 Piped water 23.9% Tubewell/borehole 2.6% Rain water 30.2% Bottled water 37.3% Protected well 2.9% Unimproved drinking water 3.0% 20140501_UNICEF_book_Eng.indd 57 5/2/14 11:18 AM Thailand: Monitoring the situation of children and women58 VI. Water and Sanitation Table WS.2 Household water treatment Percentage of household population by drinking water treatment method used in the household, and for household members living in households where an unimproved drinking water source is used, the percentage who are using an appropriate treatment method, Thailand, 2012 Water treatment method used in the household Number of household members Percentage of household members in households using unimproved drinking water sources and using an appropriate water treatment method1 Number of household members in households using unimproved drinking water sources N on e B oi l A dd b le ac h/ ch lo rin e St ra in th ro ug h a cl ot h U se w at er fil te r So la r d is - in fe ct io n Le t i t s ta nd an d se ttl e O th er Region Bangkok 25.7 5.2 0.0 0.2 68.0 0.4 0.3 0.2 8,862 - - Central 60.0 4.5 0.0 2.4 26.8 0.3 6.0 0.0 19,568 3.3 277 North 64.6 4.9 0.0 2.4 16.3 1.0 10.8 0.1 12,700 11.8 687 Northeast 76.8 6.9 0.2 6.0 7.8 0.4 2.0 0.0 27,671 7.4 336 South 72.9 9.0 0.0 3.2 10.9 0.0 3.7 0.3 10,232 19.1 1,069 Area Municipal 56.9 5.6 0.0 2.1 32.7 0.2 2.3 0.1 33,424 19.2 566 Non-municipal 70.0 6.4 0.1 4.5 12.5 0.6 6.0 0.0 45,609 11.7 1,803 Main source of drinking water Improved 64.3 5.9 0.1 3.5 21.6 0.4 4.2 0.1 76,665 NA* NA* Unimproved 70.6 10.2 0.1 4.0 3.2 0.0 12.0 0.0 2,369 13.5 2,369 Education of household head None 66.6 9.7 0.0 3.5 11.4 0.2 8.5 0.0 4,508 15.2 657 Primary 67.5 6.2 0.1 4.5 15.9 0.5 5.2 0.1 49,886 13.2 1,222 Secondary 61.0 5.3 0.0 2.0 28.7 0.1 2.8 0.1 15,052 10.2 365 Higher 52.7 5.2 0.1 0.8 40.2 0.2 0.9 0.0 9,468 21.4 100 Missing/DK 78.1 1.8 0.0 1.0 18.2 0.0 1.0 0.0 119 (*) 24 Wealth index quintile Poorest 73.1 7.7 0.1 8.7 2.8 0.6 7.0 0.0 15,807 13.3 639 Second 70.3 7.0 0.1 4.2 11.9 1.0 5.5 0.1 15,807 17.8 569 Middle 67.5 6.6 0.0 3.0 16.3 0.2 6.4 0.1 15,806 13.2 615 Fourth 65.4 5.1 0.1 1.1 25.2 0.2 2.8 0.1 15,806 10.9 451 Richest 46.0 3.9 0.0 0.6 48.9 0.1 0.5 0.1 15,808 3.2 95 Ethnicity of household head** Thai 64.4 6.0 0.1 3.5 21.1 0.4 4.4 0.1 77,902 13.0 2,259 Non-Thai 70.0 9.0 0.0 3.7 11.1 0.9 5.3 0.0 1,029 22.9 106 Total 64.5 6.1 0.1 3.5 21.0 0.4 4.4 0.1 79,033 13.5 2,369 MICS indicator 4.2 (*) Figures that are based on less than 25 unweighted cases *NA = Not applicable **3 cases with missing ethnicity of household head not shown Before drinking water from unimproved water sources, one tenth (13.5 per cent) use an appropriate water treatment method. The percentage is highest in the South (19.1 per cent) and quite low in the Central region (3.3 per cent). The proportion of the municipal population appropriately treating water is more than that of non-municipal areas (19.2 per cent versus 11.7 per cent). The amount of time it takes to obtain water is presented in Table WS.3 and the person who usually collects the water in Table WS.4. Note that these results refer to one roundtrip from home to drinking water source. Information on the number of trips made in one day was not collected. 20140501_UNICEF_book_Eng.indd 58 5/2/14 11:18 AM 59Multiple Indicator Cluster Survey 2012 VI. Water and Sanitation Table WS.3 shows that for 99 per cent of households, the drinking water source is on the premises. Of these, 96.4 per cent have an improved and 2.6 per cent an unimproved water source on their premises. The differences in water source on premises by background characteristics are negligible. Among the 1 per cent of the population without a water source on their premises, 0.8 per cent needed less than 30 minutes to get to the water source and bring back water, while 0.2 per cent of households spend 30 minutes or more for this purpose. In non-municipal areas more households spend time collecting water compared with those in municipal areas. One striking finding is the high percentage of households in the North spending 30 minutes or more to fetch drinking water (0.5 per cent). Table WS.3 Time to source of drinking water Per cent distribution of household population according to time to go to source of drinking water, get water and return, for users of improved and unimproved drinking water sources, Thailand, 2012 Time to source of drinking water Total Number of household members Users of improved drinking water sources Users of unimproved drinking water sources Water on premises Less than 30 minutes 30 minutes or more Missing/ DK Water on premises Less than 30 minutes 30 minutes or more Missing/ DK Region Bangkok 100.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 8,862 Central 98.5 0.1 0.0 0.0 1.2 0.1 0.1 0.0 100.0 19,568 North 92.9 1.2 0.4 0.1 3.9 1.4 0.1 0.0 100.0 12,700 Northeast 98.1 0.6 0.1 0.0 1.0 0.1 0.1 0.0 100.0 27,671 South 89.1 0.4 0.0 0.0 10.1 0.2 0.1 0.0 100.0 10,232 Area Municipal 97.8 0.4 0.1 0.0 1.3 0.3 0.0 0.0 100.0 33,424 Non-municipal 95.4 0.5 0.1 0.0 3.5 0.3 0.1 0.0 100.0 45,609 Education of household head None 83.8 1.0 0.6 0.0 11.8 2.6 0.2 0.0 100.0 4,508 Primary 96.9 0.5 0.1 0.0 2.2 0.2 0.1 0.0 100.0 49,886 Secondary 97.2 0.3 0.0 0.0 2.3 0.1 0.0 0.0 100.0 15,052 Higher 98.8 0.2 0.0 0.0 0.8 0.3 0.0 0.0 100.0 9,468 Missing/DK 79.8 0.3 0.0 0.0 18.9 1.0 0.0 0.0 100.0 119 Wealth index quintile Poorest 95.0 0.8 0.2 0.0 3.1 0.8 0.1 0.0 100.0 15,807 Second 95.3 0.9 0.2 0.0 3.2 0.2 0.2 0.0 100.0 15,807 Middle 95.6 0.4 0.1 0.0 3.4 0.3 0.2 0.0 100.0 15,806 Fourth 97.0 0.1 0.0 0.0 2.7 0.1 0.1 0.0 100.0 15,806 Richest 99.3 0.1 0.0 0.0 0.5 0.1 0.0 0.0 100.0 15,808 Ethnicity of household head* Thai 96.5 0.4 0.1 0.0 2.6 0.2 0.1 0.0 100.0 77,902 Non-Thai 87.6 0.8 1.2 0.0 4.1 5.4 0.8 0.0 100.0 1,029 Total 96.4 0.5 0.1 0.0 2.6 0.3 0.1 0.0 100.0 79,033 *102 cases with missing ethnicity of household head not shown 20140501_UNICEF_book_Eng.indd 59 5/2/14 11:18 AM Thailand: Monitoring the situation of children and women60 VI. Water and Sanitation Table WS.4 shows that for half of households (50.5 per cent) an adult female is usually the person collecting the water, when the source of drinking water is not on the premises. Adult men collect water in 43.6 per cent of cases, while for the rest of the households, female or male children under age 15 collect water (3.6 per cent). Table WS.4 Person collecting water Percentage of households without drinking water on premises, and per cent distribution of households without drinking water on premises according to the person usually collecting drinking water used in the household, Thailand, 2012 Percentage of households without drinking water on premises Number of households Person usually collecting drinking water Number of households without drinking water on premises Adult woman Adult man Female child under age 15 Male child under age 15 Missing/ DK Total Region Bangkok - 2,683 - - - - - - - Central 0.3 6,034 (*) (*) (*) (*) (*) 100.0 18 North 2.6 4,217 59.7 34.3 1.6 1.2 3.3 100.0 110 Northeast 1.0 8,184 42.3 51.3 5.0 1.3 0.0 100.0 79 South 0.8 3,000 (41.4) (50.7) (0.0) (0.0) (7.9) 100.0 25 Area Municipal 0.8 10,542 38.2 52.5 5.9 1.5 1.9 100.0 86 Non-municipal 1.1 13,577 57.7 38.3 0.6 0.7 2.7 100.0 146 Education of household head None 3.7 1,360 72.2 17.3 9.3 0.0 1.2 100.0 50 Primary 1.0 14,663 46.0 49.6 0.7 0.8 2.9 100.0 142 Secondary 0.5 4,809 (24.1) (70.4) (1.1) (4.4) (0.0) 100.0 26 Higher 0.4 3,251 (*) (*) (*) (*) (*) 100.0 13 Missing/DK (3.4) 36 (*) (*) (*) (*) (*) 100.0 1 Wealth index quintile Poorest 1.9 5,195 56.9 34.7 5.0 2.2 1.1 100.0 98 Second 1.4 4,861 48.4 48.8 0.0 0.0 2.8 100.0 69 Middle 0.8 4,831 (46.5) (46.9) (2.6) (0.0) (4.0) 100.0 41 Fourth 0.3 4,730 (52.3) (40.3) (0.0) (1.2) (6.3) 100.0 15 Richest 0.2 4,501 (*) (*) (*) (*) (*) 100.0 9 Ethnicity of household head* Thai 0.9 23,750 48.5 46.3 2.0 0.6 2.6 100.0 210 Non-Thai 6.0 341 (66.6) (18.7) (8.5) (5.6) (0.7) 100.0 20 Total 1.0 24,119 50.5 43.6 2.6 1.0 2.4 100.0 232 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases *2 cases with missing ethnicity of household head not shown 20140501_UNICEF_book_Eng.indd 60 5/2/14 11:18 AM 61Multiple Indicator Cluster Survey 2012 VI. Water and Sanitation Use of Improved Sanitation Inadequate disposal of human excreta and personal hygiene is associated with a range of diseases, including diarrhoeal diseases and polio. Improved sanitation can reduce diarrhoeal diseases by more than a third, and can significantly lessen the adverse health impacts of other disorders responsible for death and disease among millions of children in developing countries. An improved sanitation facility is defined as one that hygienically separates human excreta from human contact. Improved sanitation facilities for excreta disposal include flush or pour flush to a piped sewer system, septic tank, or pit latrine; ventilated improved pit latrine, pit latrine with slab, and use of a composting toilet. Data on the type of improved sanitation facilities used in Thailand are provided in Table WS.5. Table WS.5 Types of sanitation facilities Per cent distribution of household population according to type of toilet facility used by the household, Thailand, 2012 Type of toilet facility used by household Open defecation (no facility, bush, field) Total Number of household members Improved sanitation facility Unimproved sanitation facility Flush/pour flush to somewhere else, pit latrine without slab/ open pit, bucket, hanging toilet/ latrine, other Flush/pour flush to: Flush/pour flush to unknown place, pit latrinePiped sewer system Septic tank Pit Region Bangkok 17.0 82.8 0.2 0.0 0.0 0.0 100.0 8,862 Central 8.7 90.7 0.4 0.0 0.1 0.0 100.0 19,568 North 4.2 92.6 2.8 0.0 0.2 0.2 100.0 12,700 Northeast 0.3 98.1 0.8 0.0 0.7 0.1 100.0 27,671 South 4.0 90.6 3.7 0.7 0.4 0.6 100.0 10,232 Area Municipal 8.7 90.2 0.7 0.2 0.2 0.0 100.0 33,424 Non-municipal 2.8 94.6 1.8 0.0 0.5 0.3 100.0 45,609 Education of household head None 3.4 89.5 6.2 0.1 0.5 0.4 100.0 4,508 Primary 3.6 94.5 1.2 0.1 0.4 0.2 100.0 49,886 Secondary 8.6 90.0 1.0 0.1 0.3 0.1 100.0 15,052 Higher 10.5 89.0 0.3 0.1 0.1 0.0 100.0 9,468 Missing/DK 9.2 89.0 1.0 0.4 0.0 0.3 100.0 119 Wealth index quintile Poorest 1.0 94.1 3.1 0.0 1.1 0.7 100.0 15,807 Second 2.1 96.2 0.8 0.1 0.6 0.1 100.0 15,807 Middle 4.2 94.3 1.3 0.1 0.1 0.0 100.0 15,806 Fourth 6.3 92.4 1.1 0.1 0.0 0.0 100.0 15,806 Richest 13.1 86.5 0.3 0.1 0.0 0.0 100.0 15,808 Ethnicity of household head* Thai 5.2 92.8 1.3 0.1 0.4 0.2 100.0 77,902 Non-Thai 13.2 80.7 6.0 0.1 0.0 0.0 100.0 1,029 Total 5.3 92.7 1.3 0.1 0.4 0.2 100.0 79,033 *102 cases with missing ethnicity of household head not shown 20140501_UNICEF_book_Eng.indd 61 5/2/14 11:18 AM Thailand: Monitoring the situation of children and women62 VI. Water and Sanitation As Table WS.5 shows, 99.4 per cent of the population in Thailand lives in households using improved sanitation facilities. Differentials by background characteristics are generally small or practically non-existent. Among those having improved sanitation facilities, the most common facility in Thailand is a flush toilet connected to a septic tank (92.7 per cent). Notably, the percentage using unimproved sanitation facilities is highest in the South (1 per cent). The MDGs and the WHO/UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation classify households as using an unimproved sanitation facility if they are using otherwise acceptable sanitation facilities but sharing a facility between two or more households or using a public toilet. Therefore, ‘use of improved sanitation’ is used both in the context of this report and as an MDG indicator to refer to improved sanitation facilities which are not shared. Table WS.6 Use and sharing of sanitation facilities Per cent distribution of household population by use of private and public sanitation facilities and use of shared facilities, by users of improved and unimproved sanitation facilities, Thailand, 2012 Users of improved sanitation facilities Users of unimproved sanitation facilities Open defecation (no facility, bush, field) Total Number of household membersNot shared1 Public facility Shared by Missing/ DK Not shared Public facility Shared by 5 households or less 5 households or less More than 5 households Region Bangkok 94.9 0.2 4.1 0.7 0.0 0.0 0.0 0.0 0.0 100.0 8,862 Central 98.5 0.1 1.1 0.1 0.0 0.1 0.0 0.0 0.0 100.0 19,568 North 97.5 0.0 1.9 0.1 0.0 0.1 0.0 0.1 0.2 100.0 12,700 Northeast 96.9 0.4 1.8 0.0 0.1 0.7 0.0 0.0 0.1 100.0 27,671 South 97.0 0.1 1.8 0.0 0.0 0.2 0.1 0.2 0.6 100.0 10,232 Area Municipal 97.2 0.3 2.1 0.2 0.0 0.1 0.0 0.0 0.0 100.0 33,424 Non-municipal 97.2 0.1 1.8 0.1 0.0 0.5 0.0 0.1 0.3 100.0 45,609 Education of household head None 95.5 0.1 3.4 0.2 0.0 0.3 0.1 0.0 0.4 100.0 4,508 Primary 97.1 0.1 1.9 0.1 0.0 0.4 0.0 0.0 0.2 100.0 49,886 Secondary 97.4 0.2 1.8 0.2 0.0 0.2 0.0 0.1 0.1 100.0 15,052 Higher 98.2 0.6 1.1 0.0 0.0 0.0 0.0 0.0 0.0 100.0 9,468 Missing/DK 93.7 0.0 6.0 0.0 0.0 0.0 0.0 0.0 0.3 100.0 119 Wealth index quintile Poorest 94.8 0.1 3.0 0.2 0.1 1.0 0.0 0.1 0.7 100.0 15,807 Second 96.5 0.1 2.5 0.2 0.0 0.5 0.0 0.1 0.1 100.0 15,807 Middle 97.1 0.3 2.3 0.2 0.0 0.0 0.0 0.0 0.0 100.0 15,806 Fourth 98.7 0.2 0.9 0.1 0.0 0.0 0.0 0.0 0.0 100.0 15,806 Richest 99.0 0.3 0.7 0.0 0.0 0.0 0.0 0.0 0.0 100.0 15,808 Ethnicity of household head* Thai 97.3 0.2 1.8 0.1 0.0 0.3 0.0 0.0 0.2 100.0 77,902 Non-Thai 91.6 0.3 6.2 1.9 0.0 0.0 0.0 0.0 0.0 100.0 1,029 Total 97.2 0.2 1.9 0.1 0.0 0.3 0.0 0.0 0.2 100.0 79,033 1 MICS indicator 4.3; MDG indicator 7.9 *102 cases with missing ethnicity of household head not shown 20140501_UNICEF_book_Eng.indd 62 5/2/14 11:18 AM 63Multiple Indicator Cluster Survey 2012 VI. Water and Sanitation As Table WS.6 shows, 97.2 per cent of the household population is using an improved sanitation facility that is not shared. Only 2 per cent of households use an improved toilet facility that is shared with other households, while 0.2 per cent of households use an improved public facility. Municipal households are slightly more likely than non-municipal households to use a shared improved toilet facility (2.3 per cent versus 1.9 per cent). The information on the household population using improved sanitation facilities that are not shared shows small disparities by most background variables. Table WS.7 Disposal of child’s faeces Per cent distribution of children aged 0-2 years according to place of disposal of child’s faeces, and the percentage of children aged 0-2 years whose stools were disposed of safely the last time the child passed stools, Thailand, 2012 Place of disposal of child’s faeces Percentage of children whose last stools were disposed of safely1 Number of children age 0-2 years Child used toilet/ latrine Put/rinsed into toilet or latrine Put/rinsed into drain or ditch Thrown into garbage Buried Left in the open Other Missing/ DK Total Type of sanitation facility in dwelling Improved 23.3 34.0 1.3 32.2 5.7 2.7 0.8 0.1 100.0 57.3 5,753 Unimproved (*) (*) (*) (*) (*) (*) (*) (*) 100.0 (*) 30 Open defecation (*) (*) (*) (*) (*) (*) (*) (*) 100.0 (*) 18 Region Bangkok 17.8 27.0 0.1 54.9 0.0 0.1 0.1 0.0 100.0 44.7 504 Central 20.0 33.1 2.6 39.8 1.7 2.5 0.2 0.0 100.0 53.1 1,375 North 24.6 42.5 2.0 21.0 3.6 4.4 1.8 0.1 100.0 67.1 861 Northeast 26.9 36.1 0.5 23.2 10.6 2.0 0.4 0.2 100.0 63.0 2,198 South 20.6 23.9 1.1 40.3 6.3 5.4 2.3 0.0 100.0 44.5 862 Area Municipal 21.6 29.9 1.4 42.2 2.3 2.2 0.3 0.1 100.0 51.5 2,238 Non-municipal 24.1 36.2 1.2 25.8 8.2 3.2 1.2 0.1 100.0 60.4 3,562 Mother’s education None 24.9 35.0 2.0 14.3 9.3 9.0 4.6 1.0 100.0 59.9 192 Primary 27.1 35.5 1.3 23.2 8.5 3.8 0.5 0.2 100.0 62.5 2,142 Secondary 20.9 32.8 1.8 36.2 5.1 2.0 1.2 0.0 100.0 53.7 2,390 Higher 20.1 32.3 0.1 43.9 1.8 1.6 0.2 0.0 100.0 52.4 1,077 Wealth index quintile Poorest 25.0 39.9 0.7 14.4 13.6 5.5 0.6 0.2 100.0 64.9 1,104 Second 22.1 34.1 1.7 28.6 8.9 3.5 0.8 0.2 100.0 56.2 1,294 Middle 23.8 33.0 2.3 32.6 4.3 2.3 1.7 0.0 100.0 56.7 1,303 Fourth 24.7 32.4 0.7 37.9 1.4 2.1 0.7 0.1 100.0 57.1 1,148 Richest 19.8 28.9 0.5 49.7 0.6 0.5 0.1 0.0 100.0 48.7 952 Ethnicity of household head* Thai 23.3 33.9 1.1 32.2 5.9 2.7 0.8 0.1 100.0 57.2 5,681 Non-Thai 15.4 29.3 12.8 30.6 3.6 6.8 1.5 0.0 100.0 44.6 113 Total 23.2 33.8 1.3 32.1 5.9 2.8 0.8 0.1 100.0 56.9 5,801 1 MICS indicator 4.4 (*) Figures that are based on less than 25 unweighted cases *6 cases with missing ethnicity of household head not shown 20140501_UNICEF_book_Eng.indd 63 5/2/14 11:18 AM Thailand: Monitoring the situation of children and women64 VI. Water and Sanitation Safe disposal of a child’s faeces is disposing of the stool by the child using a toilet or by rinsing the stool into a toilet or latrine. Disposal of faeces of children 0-2 years of age is presented in Table WS.7. In Thailand, a noteworthy point is the popularity of disposable diapers, which are normally thrown into the garbage after use. This classifies them as an unsafe method of faeces disposal. As shown in Table WS.7, the faeces of one third of children aged 0-2 years (32.1 per cent) are thrown into the garbage. Nationally, the stools of 56.9 per cent of children 0-2 years of age were disposed of safely the last time the child defecated, with the percentage highest in the North (67.1 per cent) and lowest in the South (44.5 per cent). It is interesting to note that in Bangkok the percentage is only 44.7 per cent. The largest differential for safe disposal of children’s faeces is socioeconomic status of households. Almost two thirds (64.9 per cent) of the poorest households safely dispose of faeces compared with 48.7 per cent of the wealthiest households. It is important to note that in Bangkok as well as in the wealthiest households where disposable diapers are common, this indicator produces a lower value than one might expect. In its 2008 report, the JMP developed a new way of presenting the access figures, by disaggregating and refining the data on drinking water and sanitation and reflecting them in ‘ladder’ format. This ladder allows a disaggregated analysis of trends in a three-rung ladder for drinking water and a four-rung ladder for sanitation. For sanitation, this gives an understanding of the proportion of the population with no sanitation facilities at all, of those reliant on technologies defined by JMP as “unimproved,” of those sharing sanitation facilities of otherwise acceptable technology, and those using “improved” sanitation facilities. Table WS.8 presents the percentages of household population by drinking water and sanitation ladders. The table also shows the percentage of household members using improved sources of drinking water and sanitary means of excreta disposal. The table shows that 97 per cent of the population has improved drinking water and 97.2 per cent improved sanitation. At the national level, 94.3 per cent of the population is using both improved sources of drinking water and improved sanitation. The most important differences are in education of household head and ethnicity of household head. People living in households in which the head has higher education are more likely to use both improved drinking water sources and improved sanitation facilities (97.1 per cent) compared with people living in households with uneducated household heads (81.6 per cent). Likewise, 94.5 per cent of people living in Thai- headed households are using such facilities compared with only 81.9 per cent of people living in households headed by a non-Thai. 20140501_UNICEF_book_Eng.indd 64 5/2/14 11:18 AM 65Multiple Indicator Cluster Survey 2012 VI. Water and Sanitation Table WS.8 Drinking water and sanitation ladders Percentage of household population by drinking water and sanitation ladders, Thailand, 2012 Percentage of household population using Number of household members Improved drinking water 1 Unimproved drinking water Total Im pr ov ed sa ni ta tio n2 Unimproved sanitation Total Improved drinking water sources and improved sanitation Piped into dwelling, plot or yard Other improved Shared improved facilities Unimproved facilities Open defecation Region Bangkok 99.5 0.5 0.0 100.0 94.9 5.1 0.0 0.0 100.0 94.9 8,862 Central 68.4 30.2 1.4 100.0 98.5 1.3 0.1 0.0 100.0 97.1 19,568 North 61.5 33.1 5.4 100.0 97.5 2.0 0.2 0.2 100.0 92.3 12,700 Northeast 32.6 66.2 1.2 100.0 96.9 2.2 0.7 0.1 100.0 95.8 27,671 South 43.5 46.1 10.4 100.0 97.0 1.9 0.4 0.6 100.0 87.1 10,232 Area Municipal 76.0 22.3 1.7 100.0 97.2 2.6 0.2 0.0 100.0 95.6 33,424 Non-municipal 39.6 56.4 4.0 100.0 97.2 2.0 0.5 0.3 100.0 93.4 45,609 Education of household head None 44.7 40.7 14.6 100.0 95.5 3.6 0.5 0.4 100.0 81.6 4,508 Primary 45.6 51.9 2.5 100.0 97.1 2.2 0.4 0.2 100.0 94.8 49,886 Secondary 69.5 28.1 2.4 100.0 97.4 2.3 0.3 0.1 100.0 95.0 15,052 Higher 86.3 12.6 1.1 100.0 98.2 1.7 0.1 0.0 100.0 97.1 9,468 Missing/DK 62.5 17.7 19.8 100.0 93.7 6.0 0.0 0.3 100.0 73.8 119 Wealth index quintile Poorest 17.7 78.3 4.0 100.0 94.8 3.4 1.1 0.7 100.0 91.0 15,807 Second 39.5 56.9 3.6 100.0 96.5 2.8 0.6 0.1 100.0 93.1 15,807 Middle 55.7 40.4 3.9 100.0 97.1 2.8 0.1 0.0 100.0 93.2 15,806 Fourth 72.0 25.2 2.9 100.0 98.7 1.3 0.0 0.0 100.0 95.9 15,806 Richest 90.2 9.2 0.6 100.0 99.0 1.0 0.0 0.0 100.0 98.4 15,808 Ethnicity of household head* Thai 54.8 42.3 2.9 100.0 97.3 2.2 0.4 0.2 100.0 94.5 77,902 Non-Thai 70.0 19.6 10.3 100.0 91.6 8.4 0.0 0.0 100.0 81.9 1,029 Total 55.0 42.0 3.0 100.0 97.2 2.3 0.4 0.2 100.0 94.3 79,033 1 MICS indicator 4.1; MDG indicator 7.8 2 MICS indicator 4.3; MDG indicator 7.9 *102 cases with missing ethnicity of household head not shown 20140501_UNICEF_book_Eng.indd 65 5/2/14 11:18 AM 20140501_UNICEF_book_Eng.indd 66 5/2/14 11:18 AM 67Multiple Indicator Cluster Survey 2012 Fertility Measures of current fertility are presented in Table RH.1A for the one-year period preceding the survey. In MICS4, age-specific and total fertility rates are calculated by using information on the date of last birth of each woman and are based on the one-year period (1-12 months) preceding the survey. Rates are underestimated by a very small margin due to an absence of information on multiple births (twins, triplets etc.) and on women who may have had multiple deliveries during the one-year period preceding the survey. The total fertility rate (TFR) is calculated by summing the age- specific fertility rates (ASFRs) calculated for each of the five-year age groups of women, from age 15 to 49. The TFR denotes the average number of children a woman will have given birth to by the end of her reproductive years if current fertility rates prevail. The general fertility rate (GFR) is the number of live births occurring during the specified period per 1,000 women aged 15-49. The crude birth rate (CBR) is the number of live births per 1,000 people during the specified period. Table RH.1A Fertility rates Adolescent birth rate, age-specific and total fertility rates, the general fertility rate, and the crude birth rate for the one year preceding the survey, by area, Thailand, 2012 Municipal Non-municipal Total Age 15-19 55 63 60 20-24 69 142 106 25-29 87 95 91 30-34 61 74 68 35-39 30 40 35 40-44 8 4 6 45-49 0 0 0 Total Fertility Rate (TFR) 1.5 2.1 1.8 General Fertility Rate (GFR) 49 60 55 Crude Birth Rate (CBR) 10 13 12 1 MICS indicator 5.1; MDG indicator 5.4 VII. Reproductive Health © U N IC E F T h ai la n d /2 01 0/ P er aw o n g m et h a 20140501_UNICEF_book_Eng.indd 67 5/2/14 11:18 AM Thailand: Monitoring the situation of children and women68 VII. Reproductive Health Table RH.1A shows current fertility in Thailand at the national level and by residential area. The TFR for the one year preceding the Thailand MICS is 1.8 births per woman. Fertility is considerably higher in non-municipal areas than in municipal areas (2.1 births versus 1.5 births per woman). As the age-specific fertility rates show, the pattern of higher non-municipal fertility is prevalent in the groups of women aged 15-39. The difference between areas in fertility is most pronounced for women in the 20-24 age group (69 births per 1,000 women in municipal areas versus 142 births per 1,000 women in non-municipal areas). Fertility is low among adolescents (60 births per 1,000 women aged 15-19), increases to a peak of 106 births per 1,000 women aged 20-24, and declines thereafter. Table RH.1B Adolescent birth rate and total fertility rate Adolescent birth rates and total fertility rates for the one year preceding the survey, Thailand, 2012 Adolescent birth rate1 (Age-specific fertility rate for women age 15-19) Total fertility rate Region Bangkok 45 1.2 Central 60 1.8 North 47 1.7 Northeast 73 2.2 South 53 2.0 Area Municipal 55 1.5 Non-municipal 63 2.1 Women’s education None (*) 1.1 Primary 224 2.9 Secondary 59 2.1 Higher 7 1.2 Wealth index quintile Poorest 85 2.2 Second 59 2.2 Middle 74 2.1 Fourth 67 1.7 Richest 16 1.3 Ethnicity of household head Thai 60 1.8 Non-Thai 28 1.9 Total 60 1.8 1 MICS indicator 5.1; MDG indicator 5.4 (*) Figures that are based on less than 25 unweighted cases Table RH.1B shows adolescent birth rates and total fertility rates. The adolescent birth rate (age- specific fertility rate for women aged 15-19) is defined as the number of births to women aged 15-19 during the one-year period preceding the survey, divided by the average number of women aged 15- 19 (number of women-years lived between the ages of 15 and 19, inclusive) during the same period, expressed per 1,000 women. The table reveals that the adolescent birth rate is 60 in Thailand. The Northeast has the highest adolescent birth rate, whereas Bangkok has the lowest (73 and 45 per 1,000 20140501_UNICEF_book_Eng.indd 68 5/2/14 11:18 AM 69Multiple Indicator Cluster Survey 2012 VII. Reproductive Health women, respectively). Women in non-municipal areas have a higher rate compared to municipal areas (63 and 55 per 1,000 women, respectively). The findings show a higher adolescent birth rate among the poorest women. Table RH.1B also shows total fertility rates according to different background characteristics. The TFR is found to be highest in the Northeast and lowest in Bangkok (2.2 versus 1.2). The rate is relatively higher in poorer quintiles. The adolescent birth rate and the TFR are lower in municipal than in non- municipal areas. In general, sexual activity and childbearing early in life carry significant risks for young girls. Table RH.2 presents some early childbearing indicators for women aged 15-19 and 20-24 while Table RH.3 presents trends in early childbearing. As shown in Table RH.2, 9.1 per cent of women aged 15-19 have given birth, 1.7 per cent are pregnant with their first child, 10.8 per cent have begun childbearing and 0.3 per cent have had a live birth before age 15. Regional patterns indicate that among women aged 15–19 in the Central region, 0.7 per cent have had a live birth before age 15, while in other regions 0.3 per cent or less have had a live birth before this age. It is also important to note that all indicators are found to be higher in non-municipal than in municipal areas. Some 13 per cent of women aged 20-24 have had a live birth before age 18. Only 7.9 per cent of women in the Southern region have had a live birth before age 18 while the proportion in other regions is greater than 12 per cent. There is a negative correlation between the percentage of women aged 20-24 who had a birth before age 18 and wealth quintile. The percentage is 22.1 for women aged 20-24 in the poorest quintile compared with 7.1 per cent for women in the richest quintile. Table RH.2 Early childbearing Percentage of women aged 15-19 years who have had a live birth, are pregnant with their first child, and have begun childbearing, and those who have had a live birth before age 15, and percentage of women aged 20-24 who have had a live birth before age 18, Thailand, 2012 Percentage of women aged 15-19 who: Number of women aged 15-19 Percentage of women aged 20-24 who have had a live birth before age 181 Number of women aged 20-24 Have had a live birth Are pregnant with first child Have begun child-bearing Have had a live birth before age 15 Region Bangkok 8.0 2.0 10.0 0.2 384 12.2 356 Central 8.2 1.2 9.4 0.7 748 14.3 627 North 9.1 2.1 11.2 0.1 454 15.0 296 Northeast 9.7 1.8 11.5 0.2 1,094 14.6 576 South 10.0 1.5 11.5 0.3 401 7.9 379 Area Municipal 8.2 1.3 9.5 0.2 1,325 12.7 1,092 Non-municipal 9.7 1.9 11.6 0.4 1,755 13.4 1,142 Education None (*) (*) (*) (*) 12 10.6 43 Primary 34.3 3.0 37.3 2.5 150 35.0 181 Secondary 8.4 1.8 10.2 0.2 2,632 18.6 1,150 Higher 1.8 0.0 1.8 0.0 286 1.2 860 20140501_UNICEF_book_Eng.indd 69 5/2/14 11:18 AM Thailand: Monitoring the situation of children and women70 VII. Reproductive Health Table RH.2 Early childbearing (continued) Percentage of women aged 15-19 years who have had a live birth, are pregnant with their first child, and have begun childbearing, and those who have had a live birth before age 15, and percentage of women aged 20-24 who have had a live birth before age 18, Thailand, 2012 Percentage of women aged 15-19 who: Number of women aged 15-19 Percentage of women aged 20-24 who have had a live birth before age 181 Number of women aged 20-24 Have had a live birth Are pregnant with first child Have begun child-bearing Have had a live birth before age 15 Wealth index quintile Poorest 11.8 2.4 14.2 0.1 536 22.1 279 Second 10.1 1.4 11.5 0.9 641 15.1 410 Middle 11.7 2.6 14.3 0.3 569 13.6 555 Fourth 9.7 1.4 11.1 0.2 705 11.3 524 Richest 2.6 0.8 3.4 0.0 629 7.1 467 Ethnicity of household head* Thai 9.1 1.7 10.8 0.3 3,035 13.2 2,166 Non-Thai 5.1 0.0 5.1 0.0 41 9.9 63 Total 9.1 1.7 10.8 0.3 3,080 13.0 2,234 1 MICS indicator 5.2 (*) Figures that are based on less than 25 unweighted cases *5 cases with missing ethnicity of household head not shown Early childbearing before age 18 is more prevalent in women in the 20-24, 40-44 and 45-49 age groups, all of which indicate above 10 per cent, as shown in Table RH.3. As expected, the percentages in all age groups are slightly higher in non-municipal areas. Table RH.3 Trends in early childbearing Percentage of women who have had a live birth, by age 15 and 18, by area and age group, Thailand, 2012 Municipal Non-municipal All Percentage of women aged 15-49 years with a live birth before age 15 Numbe of women aged 15- 49 years Percentage of women aged 20-49 years with a live birth before age 18 Number of women aged 20-49 years Percentage of women aged 15-49 years with a live birth before age 15 Number of women aged 15-49 years Percentage of women aged 20-49 years with a live birth before age 18 Number of women aged 20-49 years Percentage of women aged 15-49 years with a live birth before age 15 Number of women aged 15-49 years Percentage of women aged 20-49 years with a live birth before age 18 Number of women aged 20-49 years Age 15-19 0.2 1,325 - - 0.4 1,755 - - 0.3 3,080 - - 20-24 0.6 1,092 12.7 1,092 0.6 1,142 13.4 1,142 0.6 2,234 13.0 2,234 25-29 0.3 1,276 5.5 1,276 0.7 1,214 8.5 1,214 0.5 2,490 7.0 2,490 30-34 0.5 1,544 6.6 1,544 0.7 1,568 9.2 1,568 0.6 3,113 7.9 3,113 35-39

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