Thailand - Multiple Indicator Cluster Survey - 2016

Publication date: 2016

Thailand MICS Monitoring the situation of children and women Multiple Indicator Cluster Survey 2015-2016 UNICEF United Nations Children’s Fund NSO National Statistical Office NHSO National Health Security Office Thailand M IC S 2015-2016 M ultiple Indicator C luster S urvey Thailand MICS Multiple Indicator Cluster Survey 2016 Thailand MICS Multiple Indicator Cluster Survey 2015-2016 Final Report December, 2016 The Thailand Multiple Indicator Cluster Survey (MICS) was carried out in 2015-2016 by the National Statistical Office (NSO) in collaboration with the United Nations Children’s Fund (UNICEF) as part of the global MICS programme. Technical and financial support was provided by the UNICEF. The global MICS programme was developed by UNICEF in the 1990s as an international household survey programme to support countries in the collection of internationally comparable data on a wide range of indicators on the situation of children and women. MICS surveys measure key indicators that allow countries to generate data for use in policies and programmes, and to monitor progress towards the Millennium Development Goals (MDGs) and other internationally agreed upon commitments. Suggested citation: National Statistical Office and United Nations Children’s Fund, Thailand Multiple Indicator Cluster Survey 2015- 2016, Final Report, NSO and UNICEF, Bangkok, 2016. The Thailand Multiple Indicator Cluster Survey (MICS) was carried out in 2015-2016 by the National Statistical Office (NSO) in collaboration with the United Nations Children’s Fund (UNICEF) as part of the global MICS programme. Technical and financial support was provided by the UNICEF. The global MICS programme was developed by UNICEF in the 1990s as an international household survey programme to support countries in the collection of internationally comparable data on a wide range of indicators on the situation of children and women. MICS surveys measure key indicators that allow countries to generate data for use in policies and programmes, and to monitor progress towards the Millennium Development Goals (MDGs) and other internationally agreed upon commitments. Suggested citation: National Statistical Office and United Nations Children’s Fund, Thailand Multiple Indicator Cluster Survey 2015- 2016, Final Report, NSO and UNICEF, Bangkok, 2016. P a g e | iii PREFACE Since the very start of the adoption of the Millennium Development Goals (MDGs), the Royal Thai Government, along with its national and international partners in social development sector, has continuously demonstrated its commitment for their achievement. The national commitment was further reconfirmed with the support for the implementation of the Sustainable Development Goals (SDGs) and the national response to it. Sustaining such a commitment requires a systematic approach to allocate resources, identification of emerging needs and monitoring of the progress based on solid data. Multiple Indicators Cluster Survey (MICS) offers a reliable methodology and sources of data to support effective and evidence- based decision making. The MICS, as developed by UNICEF and implemented by national partners, collects internationally comparable data on a wide range of indicators on the situation of children and women. MICS surveys measure key indicators that allow countries to generate data for use in policies and programmes, and to monitor progress towards the international commitments. The Thailand National Statistical Office (NSO) carried out the fifth round of MICS between November 2015 and March 2016 with technical and financial support from UNICEF. The survey was also supported by the National Health Security Office. A joint Royal Thai Government Steering Group guided the initial planning of the MICS5. A technical group, composed of key line ministries’ representatives, assisted in customising and adopting the global MICS5 tools to the local context. The main objective of the survey is to track progress on various programs, post-MDGs situation and to help establish a baseline on indicators under the SDGs. The objective of publishing and releasing this Final Report is to disseminate the detailed information on all survey findings by various demographic, socio-economic and cultural characteristics. NSO would like to express our sincere gratitude to our partners for their continuous support to complete Thailand MICS5 within stipulated time. Special thanks to UNICEF Thailand country office and National Health Security Office for their financial and technical support. We would also like to appreciate contributions from line ministries and organizations namely, Ministry of Public Health, Ministry of Education, Ministry of Social Development and Human Security, Ministry of Labour, Office of the National Economic and Social Development Board, International Health Policy Program, Thai Health Promotion Foundation, Institute for Population and Social Research: Mahidol University, College of Population Studies: Chulalongkorn University). National Statistical Office hopes that the information from this report will be useful to ministries, agencies, both public and private institutions and the general public. Director General National Statistical Office Representative UNICEF, Thailand Country Office P a g e | iv Summary Table of Survey Implementation and the Survey Population, Thailand MICS, 2015-2016 Survey implementation Sample frame Oct-Dec, 2014 Questionnaires Household Women (age 15-49) Men (age 15-49) Children under five Interviewer training 1st batch: September, 2015 2nd batch: October, 2015 Fieldwork November 2015 to March 2016 Survey sample Households - Sampled - Occupied - Interviewed - Response rate (Per cent) 31,010 29,375 28,652 97.5 Children under five - Eligible - Mothers/caretakers interviewed - Response rate (Per cent) 12,313 12,250 99.5 Women - Eligible for interviews - Interviewed - Response rate (Per cent) 26,033 25,414 98.4 Men - Eligible for interviews - Interviewed - Response rate (Per cent) 23,642 23,183 98.1 Survey population Average household size 3.2 Percentage of population living in - Urban areas - Rural areas - Bangkok - Central - North - North East - South 48.4 51.6 13.5 30.1 16.6 26.3 13.3 Percentage of population under: - Age 5 - Age 18 5.9 23.6 Percentage of women age 15-49 years with at least one live birth in the last 2 years 0 8.2 Housing characteristics Household or personal assets Percentage of households with - Electricity - Finished floor - Finished roofing - Finished walls - Rooms used for sleeping (3 or more) 99.6 80.2 99.4 97.1 18.3 Percentage of households that own - A television (Plain Monitor) - A television (LCD/LED/Plasma) - A refrigerator - Agricultural land - Farm animals/livestock - Computer - Tablet - Air Conditioner 77.0 38.0 91.9 42.3 26.0 32.0 24.6 28.1 Mean number of persons per room used for sleeping 1.91 Percentage of households where at least a member has or owns a - Mobile phone (traditional) - Mobile phone (Smart) - Car or truck - Motorcycle or scooter - Bank account - Credit card 68.6 68.2 46.4 78.9 89.9 23.7 P a g e | iv Summary Table of Survey Implementation and the Survey Population, Thailand MICS, 2015-2016 Survey implementation Sample frame Oct-Dec, 2014 Questionnaires Household Women (age 15-49) Men (age 15-49) Children under five Interviewer training 1st batch: September, 2015 2nd batch: October, 2015 Fieldwork November 2015 to March 2016 Survey sample Households - Sampled - Occupied - Interviewed - Response rate (Per cent) 31,010 29,375 28,652 97.5 Children under five - Eligible - Mothers/caretakers interviewed - Response rate (Per cent) 12,313 12,250 99.5 Women - Eligible for interviews - Interviewed - Response rate (Per cent) 26,033 25,414 98.4 Men - Eligible for interviews - Interviewed - Response rate (Per cent) 23,642 23,183 98.1 Survey population Average household size 3.2 Percentage of population living in - Urban areas - Rural areas - Bangkok - Central - North - North East - South 48.4 51.6 13.5 30.1 16.6 26.3 13.3 Percentage of population under: - Age 5 - Age 18 5.9 23.6 Percentage of women age 15-49 years with at least one live birth in the last 2 years 0 8.2 Housing characteristics Household or personal assets Percentage of households with - Electricity - Finished floor - Finished roofing - Finished walls - Rooms used for sleeping (3 or more) 99.6 80.2 99.4 97.1 18.3 Percentage of households that own - A television (Plain Monitor) - A television (LCD/LED/Plasma) - A refrigerator - Agricultural land - Farm animals/livestock - Computer - Tablet - Air Conditioner 77.0 38.0 91.9 42.3 26.0 32.0 24.6 28.1 Mean number of persons per room used for sleeping 1.91 Percentage of households where at least a member has or owns a - Mobile phone (traditional) - Mobile phone (Smart) - Car or truck - Motorcycle or scooter - Bank account - Credit card 68.6 68.2 46.4 78.9 89.9 23.7 P a g e | v Summary Table of Findings1 Multiple Indicator Cluster Surveys (MICS) and Millennium Development Goals (MDG) Indicators, Thailand MICS, 2015-2016 NUTRITION Nutritional status MICS Indicator Indicator Description Value 2.1a 2.1b MDG 1.8 Underweight prevalence (a) Moderate and severe (b) Severe Percentage of children under age 5 who fall below (a) minus two standard deviations (moderate and severe) (b) minus three standard deviations (severe) of the median weight for age of the WHO standard 6.7 1.5 2.2a 2.2b Stunting prevalence (a) Moderate and severe (b) Severe Percentage of children under age 5 who fall below (a) minus two standard deviations (moderate and severe) (b) minus three standard deviations (severe) of the median height for age of the WHO standard 10.5 2.6 2.3a 2.3b Wasting prevalence (a) Moderate and severe (b) Severe Percentage of children under age 5 who fall below (a) minus two standard deviations (moderate and severe) (b) minus three standard deviations (severe) of the median weight for height of the WHO standard 5.4 1.4 2.4 Overweight prevalence Percentage of children under age 5 who are above two standard deviations of the median weight for height of the WHO standard 8.2 Breastfeeding and infant feeding 2.5 Children ever breastfed Percentage of women with a live birth in the last 2 years who breastfed their last live-born child at any time 97.4 2.6 Early initiation of breastfeeding Percentage of women with a live birth in the last 2 years who put their last newborn to the breast within one hour of birth 39.9 2.7 Exclusive breastfeeding under 6 months Percentage of infants under 6 months of age who are exclusively breastfed 23.1 2.8 Predominant breastfeeding under 6 months Percentage of infants under 6 months of age who received breast milk as the predominant source of nourishment during the previous day 42.1 2.9 Continued breastfeeding at 1 year Percentage of children age 12-15 months who received breast milk during the previous day 33.3 2.10 Continued breastfeeding at 2 years Percentage of children age 20-23 months who received breast milk during the previous day 15.6 2.11 Median duration of breastfeeding The age in months when 50 per cent of children age 0-35 months did not receive breast milk during the previous day 7.9 2.12 Age-appropriate breastfeeding Percentage of children age 0-23 months appropriately fed during the previous day 28.0 2.13 Introduction of solid, semi- solid or soft foods Percentage of infants age 6-8 months who received solid, semi- solid or soft foods during the previous day 84.6 2.14 Milk feeding frequency for non-breastfed children Percentage of non-breastfed children age 6-23 months who received at least 2 milk feedings during the previous day 92.0 2.15 Minimum meal frequency Percentage of children age 6-23 months who received solid, semi-solid and soft foods (plus milk feeds for non-breastfed children) the minimum number of times or more during the previous day 84.6 2.16 Minimum dietary diversity Percentage of children age 6-23 months who received foods from 4 or more food groups during the previous day 75.0 1 See Appendix C for a detailed description of MICS indicators P a g e | vi MICS Indicator Indicator Description Value 2.17a 2.17b Minimum acceptable diet (a) Percentage of breastfed children age 6-23 months who had at least the minimum dietary diversity and the minimum meal frequency during the previous day (b) Percentage of non-breastfed children age 6-23 months who received at least 2 milk feedings and had at least the minimum dietary diversity not including milk feeds and the minimum meal frequency during the previous day 49.6 58.5 2.18 Bottle feeding Percentage of children age 0-23 months who were fed with a bottle during the previous day 79.3 Salt iodization 2.19 Iodized salt consumption Percentage of households with salt testing 15 parts per million or more of iodide/iodate 73.3 Low birth weight 2.20 Low birth weight infants Percentage of most recent live births in the last 2 years weighing below 2,500 grams at birth 9.4 2.S20 Low birth weight infants (born during last five years) Percentage of live births in the last 5 years weighing below 2,500 grams at birth 8.6 2.21 Infants weighed at birth Percentage of most recent live births in the last 2 years who were weighed at birth 98.9 CHILD HEALTH Vaccinations 3.1 Tuberculosis immunization coverage Percentage of children age 12-23 months who received BCG vaccine by their first birthday 96.2 3.2 Polio immunization coverage Percentage of children age 12-23 months who received the third dose of OPV vaccine (OPV3) by their first birthday 85.8 3.3 Diphtheria, pertussis and tetanus (DPT) immunization coverage Percentage of children age 12-23 months who received the third dose of DPT vaccine (DPT3) by their first birthday 87.6 3.4 MDG 4.3 Measles immunization coverage Percentage of children age 12-23 months who received measles vaccine by their first birthday 89.0 3.5 Hepatitis B immunization coverage Percentage of children age 12-23 months who received the third dose of Hepatitis B vaccine (HepB3) by their first birthday 84.3 3.8 Full immunization coverage Percentage of children age 12-23 months who received all vaccinations recommended in the national immunization schedule by their first birthday 71.6 Tetanus toxoid 3.9 Neonatal tetanus protection Percentage of women age 15-49 years with a live birth in the last 2 years who were given at least two doses of tetanus toxoid vaccine within the appropriate interval prior to the most recent birth 73.9 Diarrhoea - Children with diarrhoea Percentage of children under age 5 with diarrhoea in the last 2 weeks 4.9 3.10 Care-seeking for diarrhoea Percentage of children under age 5 with diarrhoea in the last 2 weeks for whom advice or treatment was sought from a health facility or provider 70.7 3.S11 Diarrhoea treatment with oral rehydration salts (ORS) Percentage of children under age 5 with diarrhoea in the last 2 weeks who received ORS 74.1 3.12 Diarrhoea treatment with oral rehydration therapy (ORT) and continued feeding Percentage of children under age 5 with diarrhoea in the last 2 weeks who received ORT (ORS packet, pre-packaged ORS fluid, recommended homemade fluid or increased fluids) and continued feeding during the episode of diarrhoea 70.5 P a g e | vi MICS Indicator Indicator Description Value 2.17a 2.17b Minimum acceptable diet (a) Percentage of breastfed children age 6-23 months who had at least the minimum dietary diversity and the minimum meal frequency during the previous day (b) Percentage of non-breastfed children age 6-23 months who received at least 2 milk feedings and had at least the minimum dietary diversity not including milk feeds and the minimum meal frequency during the previous day 49.6 58.5 2.18 Bottle feeding Percentage of children age 0-23 months who were fed with a bottle during the previous day 79.3 Salt iodization 2.19 Iodized salt consumption Percentage of households with salt testing 15 parts per million or more of iodide/iodate 73.3 Low birth weight 2.20 Low birth weight infants Percentage of most recent live births in the last 2 years weighing below 2,500 grams at birth 9.4 2.S20 Low birth weight infants (born during last five years) Percentage of live births in the last 5 years weighing below 2,500 grams at birth 8.6 2.21 Infants weighed at birth Percentage of most recent live births in the last 2 years who were weighed at birth 98.9 CHILD HEALTH Vaccinations 3.1 Tuberculosis immunization coverage Percentage of children age 12-23 months who received BCG vaccine by their first birthday 96.2 3.2 Polio immunization coverage Percentage of children age 12-23 months who received the third dose of OPV vaccine (OPV3) by their first birthday 85.8 3.3 Diphtheria, pertussis and tetanus (DPT) immunization coverage Percentage of children age 12-23 months who received the third dose of DPT vaccine (DPT3) by their first birthday 87.6 3.4 MDG 4.3 Measles immunization coverage Percentage of children age 12-23 months who received measles vaccine by their first birthday 89.0 3.5 Hepatitis B immunization coverage Percentage of children age 12-23 months who received the third dose of Hepatitis B vaccine (HepB3) by their first birthday 84.3 3.8 Full immunization coverage Percentage of children age 12-23 months who received all vaccinations recommended in the national immunization schedule by their first birthday 71.6 Tetanus toxoid 3.9 Neonatal tetanus protection Percentage of women age 15-49 years with a live birth in the last 2 years who were given at least two doses of tetanus toxoid vaccine within the appropriate interval prior to the most recent birth 73.9 Diarrhoea - Children with diarrhoea Percentage of children under age 5 with diarrhoea in the last 2 weeks 4.9 3.10 Care-seeking for diarrhoea Percentage of children under age 5 with diarrhoea in the last 2 weeks for whom advice or treatment was sought from a health facility or provider 70.7 3.S11 Diarrhoea treatment with oral rehydration salts (ORS) Percentage of children under age 5 with diarrhoea in the last 2 weeks who received ORS 74.1 3.12 Diarrhoea treatment with oral rehydration therapy (ORT) and continued feeding Percentage of children under age 5 with diarrhoea in the last 2 weeks who received ORT (ORS packet, pre-packaged ORS fluid, recommended homemade fluid or increased fluids) and continued feeding during the episode of diarrhoea 70.5 P a g e | vii Acute Respiratory Infection (ARI) symptoms MICS Indicator Indicator Description Value - Children with ARI symptoms Percentage of children under age 5 with ARI symptoms in the last 2 weeks 1.4 3.13 Care-seeking for children with ARI symptoms Percentage of children under age 5 with ARI symptoms in the last 2 weeks for whom advice or treatment was sought from a health facility or provider 79.5 3.14 Antibiotic treatment for children with ARI symptoms Percentage of children under age 5 with ARI symptoms in the last 2 weeks who received antibiotics 70.0 Solid fuel use 3.15 Use of solid fuels for cooking Percentage of household members in households that use solid fuels as the primary source of domestic energy to cook 21.1 Fever 3.20 Care-seeking for fever Percentage of children under age 5 with fever in the last 2 weeks for whom advice or treatment was sought from a health facility or provider 75.6 WATER AND SANITATION 4.1 MDG 7.8 Use of improved drinking water sources Percentage of household members using improved sources of drinking water 98.0 4.2 Water treatment Percentage of household members in households using unimproved drinking water who use an appropriate treatment method 21.6 4.3 MDG 7.9 Use of improved sanitation Percentage of household members using improved sanitation facilities which are not shared 97.2 4.4 Safe disposal of child’s faeces Percentage of children age 0-2 years whose last stools were disposed of safely 42.0 4.5 Place for handwashing Percentage of households with a specific place for hand washing where water and soap or other cleansing agent are present 81.2 4.6 Availability of soap or other cleansing agent Percentage of households with soap or other cleansing agent 85.5 REPRODUCTIVE HEALTH Contraception and unmet need - Total fertility rate Total fertility rate for women age 15-49 years 1.5 5.1 MDG 5.4 Adolescent birth rate Age-specific fertility rate for women age 15-19 years 51.0 5.2 Early childbearing Percentage of women age 20-24 years who had at least one live birth before age 18 9.4 5.3 MDG 5.3 Contraceptive prevalence rate Percentage of women age 15-49 years currently married or in union who are using (or whose partner is using) a (modern or traditional) contraceptive method 78.4 5.4 MDG 5.6 Unmet need Percentage of women age 15-49 years who are currently married or in union who are fecund and want to space their births or limit the number of children they have and who are not currently using contraception 6.2 P a g e | viii Maternal and newborn health MICS Indicator Indicator Description Value 5.5a 5.5b MDG 5.5 MDG 5.5 Antenatal care coverage Percentage of women age 15-49 years with a live birth in the last 2 years who were attended during their last pregnancy that led to a live birth (a) at least once by skilled health personnel (b) at least four times by any provider 98.1 90.8 5.6 Content of antenatal care Percentage of women age 15-49 years with a live birth in the last 2 years who had their blood pressure measured and gave urine and blood samples during the last pregnancy that led to a live birth 97.0 5.S6 STI (VDRL 1st) screening during antenatal care Percentage of women age 15-49 years with a live birth in the last 2 years who had blood screening for STIs (VDRL 1st) 93.2 5.S7 STI (VDRL 2nd) screening during antenatal care Percentage of women age 15-49 years with a live birth in the last 2 years who had blood screening for STIs (VDRL 2nd) 48.6 5.S8 Thalassemia screening for women during antenatal care Percentage of women age 15-49 years with a live birth in the last 2 years who had blood screening for thalassemia 87.6 5.S9 Thalassemia screening for husband Percentage of women age 15-49 years with a live birth in the last 2 years whose husband had blood screening for thalassemia 37.1 5.7 MDG 5.2 Skilled attendant at delivery Percentage of women age 15-49 years with a live birth in the last 2 years who were attended by skilled health personnel during their most recent live birth 99.1 5.8 Institutional deliveries Percentage of women age 15-49 years with a live birth in the last 2 years whose most recent live birth was delivered in a health facility 98.6 5.9 Caesarean section Percentage of women age 15-49 years whose most recent live birth in the last 2 years was delivered by caesarean section 32.7 5.S10 Post-natal health check Percentage of women age 15-49 years with a live birth in the last 2 years who had at least one post-natal health check within 42 days of delivery. 78.1 CHILD DEVELOPMENT 6.1 Attendance in early childhood education Percentage of children age 36-59 months who are attending an early childhood education programme 84.7 6.2 Support for learning Percentage of children age 36-59 months with whom an adult has engaged in four or more activities to promote learning and school readiness in the last 3 days 92.7 6.3 Father’s support for learning Percentage of children age 36-59 months whose biological father has engaged in four or more activities to promote learning and school readiness in the last 3 days 34.0 6.4 Mother’s support for learning Percentage of children age 36-59 months whose biological mother has engaged in four or more activities to promote learning and school readiness in the last 3 days 62.8 6.5 Availability of children’s books Percentage of children under age 5 who have three or more children’s books 41.2 6.6 Availability of playthings Percentage of children under age 5 who play with two or more types of playthings 75.6 6.S6 Availability of playthings (Electronic devices) Percentage of children under age 5 who play with electronic devices, i.e., mobile phones, tablets and game players 50.9 6.7 Inadequate care Percentage of children under age 5 left alone or in the care of another child younger than 10 years of age for more than one hour at least once in the last week 6.1 6.8 Early child development index Percentage of children age 36-59 months who are developmentally on track in at least three of the following four domains: literacy-numeracy, physical, social-emotional, and learning 91.1 P a g e | viii Maternal and newborn health MICS Indicator Indicator Description Value 5.5a 5.5b MDG 5.5 MDG 5.5 Antenatal care coverage Percentage of women age 15-49 years with a live birth in the last 2 years who were attended during their last pregnancy that led to a live birth (a) at least once by skilled health personnel (b) at least four times by any provider 98.1 90.8 5.6 Content of antenatal care Percentage of women age 15-49 years with a live birth in the last 2 years who had their blood pressure measured and gave urine and blood samples during the last pregnancy that led to a live birth 97.0 5.S6 STI (VDRL 1st) screening during antenatal care Percentage of women age 15-49 years with a live birth in the last 2 years who had blood screening for STIs (VDRL 1st) 93.2 5.S7 STI (VDRL 2nd) screening during antenatal care Percentage of women age 15-49 years with a live birth in the last 2 years who had blood screening for STIs (VDRL 2nd) 48.6 5.S8 Thalassemia screening for women during antenatal care Percentage of women age 15-49 years with a live birth in the last 2 years who had blood screening for thalassemia 87.6 5.S9 Thalassemia screening for husband Percentage of women age 15-49 years with a live birth in the last 2 years whose husband had blood screening for thalassemia 37.1 5.7 MDG 5.2 Skilled attendant at delivery Percentage of women age 15-49 years with a live birth in the last 2 years who were attended by skilled health personnel during their most recent live birth 99.1 5.8 Institutional deliveries Percentage of women age 15-49 years with a live birth in the last 2 years whose most recent live birth was delivered in a health facility 98.6 5.9 Caesarean section Percentage of women age 15-49 years whose most recent live birth in the last 2 years was delivered by caesarean section 32.7 5.S10 Post-natal health check Percentage of women age 15-49 years with a live birth in the last 2 years who had at least one post-natal health check within 42 days of delivery. 78.1 CHILD DEVELOPMENT 6.1 Attendance in early childhood education Percentage of children age 36-59 months who are attending an early childhood education programme 84.7 6.2 Support for learning Percentage of children age 36-59 months with whom an adult has engaged in four or more activities to promote learning and school readiness in the last 3 days 92.7 6.3 Father’s support for learning Percentage of children age 36-59 months whose biological father has engaged in four or more activities to promote learning and school readiness in the last 3 days 34.0 6.4 Mother’s support for learning Percentage of children age 36-59 months whose biological mother has engaged in four or more activities to promote learning and school readiness in the last 3 days 62.8 6.5 Availability of children’s books Percentage of children under age 5 who have three or more children’s books 41.2 6.6 Availability of playthings Percentage of children under age 5 who play with two or more types of playthings 75.6 6.S6 Availability of playthings (Electronic devices) Percentage of children under age 5 who play with electronic devices, i.e., mobile phones, tablets and game players 50.9 6.7 Inadequate care Percentage of children under age 5 left alone or in the care of another child younger than 10 years of age for more than one hour at least once in the last week 6.1 6.8 Early child development index Percentage of children age 36-59 months who are developmentally on track in at least three of the following four domains: literacy-numeracy, physical, social-emotional, and learning 91.1 P a g e | ix LITERACY AND EDUCATION MICS Indicator Indicator Description Value 7.1 MDG 2.3 Literacy rate among young people Percentage of young people age 15-24 years who are able to read a short simple statement about everyday life or who attended secondary or higher education (a) women (b) men 95.4 94.7 7.2 School readiness Percentage of children in first grade of primary school who attended preschool during the previous school year 98.7 7.3 Net intake rate in primary education Percentage of children of school-entry age who enter the first grade of primary school 75.7 7.4 MDG 2.1 Primary school net attendance ratio (adjusted) Percentage of children of primary school age currently attending primary or secondary school 94.8 7.5 Secondary school net attendance ratio (adjusted) Percentage of children of secondary school age currently attending secondary school or higher 81.0 7.6 MDG 2.2 Children reaching last grade of primary Percentage of children entering the first grade of primary school who eventually reach last grade 99.5 7.7 Primary completion rate Number of children attending the last grade of primary school (excluding repeaters) divided by number of children of primary school completion age (age appropriate to final grade of primary school) 99.5 7.8 Transition rate to secondary school Number of children attending the last grade of primary school during the previous school year who are in the first grade of secondary school during the current school year divided by number of children attending the last grade of primary school during the previous school year 98.2 7.9 MDG 3.1 Gender parity index (primary school) Primary school net attendance ratio (adjusted) for girls divided by primary school net attendance ratio (adjusted) for boys 1.00 7.10 MDG 3.1 Gender parity index (secondary school) Secondary school net attendance ratio (adjusted) for girls divided by secondary school net attendance ratio (adjusted) for boys 1.11 CHILD PROTECTION Birth registration 8.1 Birth registration Percentage of children under age 5 whose births are reported registered 99.5 Child discipline 8.3 Violent discipline Percentage of children age 1-14 years who experienced psychological aggression or physical punishment during the last one month 75.2 Early marriage and polygyny 8.4 Marriage before age 15 Percentage of people age 15-49 years who were first married or in union before age 15 (a) Women (b) Men 4.3 1.7 8.5 Marriage before age 18 Percentage of people age 20-49 years who were first married or in union before age 18 (a) Women (b) Men 21.3 8.0 8.6 Young people age 15-19 years currently married or in union Percentage of young people age 15-19 years who are married or in union (a) Women (b) Men 14.1 6.8 P a g e | x MICS Indicator Indicator Description Value 8.7 Polygyny Percentage of people age 15-49 years who are in a polygynous union (a) Women (b) Men 3.4 2.9 8.8a 8.8b Spousal age difference Percentage of young women who are married or in union and whose spouse is 10 or more years older (a) among women age 15-19 years (b) among women age 20-24 years 7.5 15.1 Attitudes towards domestic violence 8.12 Attitudes towards domestic violence Percentage of people age 15-49 years who state that a husband is justified in hitting or beating his wife in at least one of the following circumstances: (1) she goes out without telling him, (2) she neglects the children, (3) she argues with him, (4) she refuses sex with him, (5) she burns the food (a) Women (b) Men 8.6 8.7 Children’s living arrangements 8.13 Children’s living arrangements Percentage of children age 0-17 years living with neither biological parent 22.7 8.14 Prevalence of children with one or both parents dead Percentage of children age 0-17 years with one or both biological parents dead 3.5 8.15 Children with at least one parent living abroad Percentage of children 0-17 years with at least one biological parent living abroad 1.6 HIV/AIDS HIV/AIDS knowledge and attitudes - Have heard of AIDS Percentage of people age 15-49 years who have heard of AIDS (a) Women (b) Men 96.2 95.2 9.1 MDG 6.3 Knowledge about HIV prevention among young people Percentage of young people age 15-24 years who correctly identify ways of preventing the sexual transmission of HIV, and who reject major misconceptions about HIV transmission (a) Women (b) Men 46.0 45.1 9.2 Knowledge of mother-to- child transmission of HIV Percentage of people age 15-49 years who correctly identify all three means of mother-to-child transmission of HIV (a) Women (b) Men 66.4 57.4 9.3 Accepting attitudes towards people living with HIV Percentage of people age 15-49 years expressing accepting attitudes on all four questions towards people living with HIV (a) Women (b) Men 31.6 33.0 HIV testing 9.4 People who know where to be tested for HIV Percentage of people age 15-49 years who state knowledge of a place to be tested for HIV (a) Women (b) Men 84.7 80.3 9.5 People who have been tested for HIV and know the results Percentage of people age 15-49 years who have been tested for HIV in the last 12 months and who know their results (a) Women (b) Men 9.3 8.5 P a g e | x MICS Indicator Indicator Description Value 8.7 Polygyny Percentage of people age 15-49 years who are in a polygynous union (a) Women (b) Men 3.4 2.9 8.8a 8.8b Spousal age difference Percentage of young women who are married or in union and whose spouse is 10 or more years older (a) among women age 15-19 years (b) among women age 20-24 years 7.5 15.1 Attitudes towards domestic violence 8.12 Attitudes towards domestic violence Percentage of people age 15-49 years who state that a husband is justified in hitting or beating his wife in at least one of the following circumstances: (1) she goes out without telling him, (2) she neglects the children, (3) she argues with him, (4) she refuses sex with him, (5) she burns the food (a) Women (b) Men 8.6 8.7 Children’s living arrangements 8.13 Children’s living arrangements Percentage of children age 0-17 years living with neither biological parent 22.7 8.14 Prevalence of children with one or both parents dead Percentage of children age 0-17 years with one or both biological parents dead 3.5 8.15 Children with at least one parent living abroad Percentage of children 0-17 years with at least one biological parent living abroad 1.6 HIV/AIDS HIV/AIDS knowledge and attitudes - Have heard of AIDS Percentage of people age 15-49 years who have heard of AIDS (a) Women (b) Men 96.2 95.2 9.1 MDG 6.3 Knowledge about HIV prevention among young people Percentage of young people age 15-24 years who correctly identify ways of preventing the sexual transmission of HIV, and who reject major misconceptions about HIV transmission (a) Women (b) Men 46.0 45.1 9.2 Knowledge of mother-to- child transmission of HIV Percentage of people age 15-49 years who correctly identify all three means of mother-to-child transmission of HIV (a) Women (b) Men 66.4 57.4 9.3 Accepting attitudes towards people living with HIV Percentage of people age 15-49 years expressing accepting attitudes on all four questions towards people living with HIV (a) Women (b) Men 31.6 33.0 HIV testing 9.4 People who know where to be tested for HIV Percentage of people age 15-49 years who state knowledge of a place to be tested for HIV (a) Women (b) Men 84.7 80.3 9.5 People who have been tested for HIV and know the results Percentage of people age 15-49 years who have been tested for HIV in the last 12 months and who know their results (a) Women (b) Men 9.3 8.5 P a g e | xi MICS Indicator Indicator Description Value 9.7 HIV counselling during antenatal care Percentage of women age 15-49 years who had a live birth in the last 2 years and received antenatal care during the pregnancy of their most recent birth, reporting that they received counselling on HIV during antenatal care 69.4 9.8 HIV testing during antenatal care Percentage of women age 15-49 years who had a live birth in the last 2 years and received antenatal care during the pregnancy of their most recent birth, reporting that they were offered and accepted an HIV test during antenatal care and received their results 75.5 P a g e | xii Table of Contents Preface . iii Summary Table of Survey Implementation and the Survey Population, Thailand MICS, 2015-2016 . iv Summary Table of Findings . v Table of Contents . xii List of Tables . xiv List of Figures . xvii List of Abbreviations . xviii Executive Summary . xix I. Introduction . 1 Background . 1 Survey Objectives . 2 II. Sample and Survey Methodology . 3 Sample Design . 3 Questionnaires . 3 Training and Fieldwork . 4 Data Processing . 5 III. Sample Coverage and the Characteristics of Households and Respondents . 6 Sample Coverage . 6 Characteristics of Households . 7 Characteristics of Female and Male Respondents 15-49 Years of Age and Children Under 5 . 10 Housing Characteristics, Asset Ownership and Wealth Quintiles . 15 IV. Nutrition . 19 Low Birth Weight . 19 Nutritional Status . 22 Breastfeeding and Infant and Young Child Feeding . 27 Salt Iodization . 40 V. Child Health . 43 Vaccinations. 43 Neonatal Tetanus Protection . 47 Care of Illness . 48 Diarrhoea . 50 Acute Respiratory Infections . 61 Solid Fuel Use . 64 VI. Water and Sanitation . 68 Use of Improved Water Sources . 68 Use of Improved Sanitation . 75 Handwashing . 83 P a g e | xii Table of Contents Preface . iii Summary Table of Survey Implementation and the Survey Population, Thailand MICS, 2015-2016 . iv Summary Table of Findings . v Table of Contents . xii List of Tables . xiv List of Figures . xvii List of Abbreviations . xviii Executive Summary . xix I. Introduction . 1 Background . 1 Survey Objectives . 2 II. Sample and Survey Methodology . 3 Sample Design . 3 Questionnaires . 3 Training and Fieldwork . 4 Data Processing . 5 III. Sample Coverage and the Characteristics of Households and Respondents . 6 Sample Coverage . 6 Characteristics of Households . 7 Characteristics of Female and Male Respondents 15-49 Years of Age and Children Under 5 . 10 Housing Characteristics, Asset Ownership and Wealth Quintiles . 15 IV. Nutrition . 19 Low Birth Weight . 19 Nutritional Status . 22 Breastfeeding and Infant and Young Child Feeding . 27 Salt Iodization . 40 V. Child Health . 43 Vaccinations. 43 Neonatal Tetanus Protection . 47 Care of Illness . 48 Diarrhoea . 50 Acute Respiratory Infections . 61 Solid Fuel Use . 64 VI. Water and Sanitation . 68 Use of Improved Water Sources . 68 Use of Improved Sanitation . 75 Handwashing . 83 P a g e | xiii VII. Reproductive Health . 87 Fertility. 87 Contraception . 92 Unmet Need . 98 Antenatal Care . 102 Assistance at Delivery . 109 Place of Delivery . 113 Post-natal Health Checks . 114 VIII. Early Childhood Development . 117 Early Childhood Care and Education . 117 Quality of Care . 118 Developmental Status of Children . 127 IX. Literacy and Education . 129 Literacy among Young Women and Men . 129 School Readiness . 130 Primary and Secondary School Participation . 131 X. Child Protection . 145 Birth Registration . 145 Child Discipline . 147 Early Marriage and Polygyny . 151 Attitudes towards Domestic Violence . 162 Children’s Living Arrangements . 165 XI. HIV/AIDS . 169 Knowledge about HIV Transmission and Misconceptions about HIV . 169 Accepting Attitudes towards People Living with HIV . 177 Knowledge of a Place for HIV Testing, Counselling and Testing during Antenatal Care . 182 HIV Indicators for Young Women and Young Men . 187 Appendices . 192 Appendix A. Sample Design . 193 Appendix B. Estimates of Sampling Errors . 198 Appendix C. Thailand MICS, 2015-2016 Indicators: Numerators and Denominators . 217 Appendix D. Data Quality Tables . 227 Appendix E. Thailand MICS Questionnaires . 240 Appendix F. List of Definitions . 309 P a g e | xiv List of Tables Table HH.1: Results of household, women's, men's and under-5 interviews . 6 Table HH.2: Household age distribution by sex . 7 Table HH.3: Household composition . 9 Table HH.4: Women's background characteristics .11 Table HH.4M: Men's background characteristics .13 Table HH.5: Under-5's background characteristics .14 Table HH.6: Housing characteristics .16 Table HH.7: Household and personal assets .17 Table HH.8: Wealth quintiles .18 Table NU.1: Low birth weight infants .20 Table NU.S1: Low birth weight children (country specific) .21 Table NU.2: Nutritional status of children .24 Table NU.3: Initial breastfeeding .29 Table NU.4: Breastfeeding .32 Table NU.5: Duration of breastfeeding .34 Table NU.6: Age-appropriate breastfeeding .35 Table NU.7: Introduction of solid, semi-solid or soft foods .36 Table NU.8: Infant and young child feeding (IYCF) practices .37 Table NU.9: Bottle feeding .39 Table NU.10: Iodized salt consumption .40 Table NU.S2: Iodized salt consumption (country specific) .42 Table CH.1: Vaccinations in the first years of life .44 Table CH.2: Vaccinations by background characteristics .46 Table CH.3: Neonatal tetanus protection .48 Table CH.4: Reported disease episodes .49 Table CH.5: Care-seeking during diarrhoea .51 Table CH.6: Feeding practices during diarrhoea .53 Table CH.7: Oral rehydration solutions, recommended homemade fluids .55 Table CH.8: Oral rehydration therapy with continued feeding and other treatments .57 Table CH.9: Source of ORS .60 Table CH.10: Care-seeking for and antibiotic treatment of symptoms of acute respiratory infection (ARI) .62 Table CH.11: Solid fuel use .64 Table CH.12: Solid fuel use by place of cooking .65 Table CH.13: Care-seeking during fever.66 Table CH.14: Treatment of children with fever .67 Table WS.1: Use of improved water sources .69 Table WS.2: Household water treatment .71 Table WS.3: Time to source of drinking water .73 Table WS.4: Person collecting water .74 Table WS.5: Types of sanitation facilities .76 Table WS.6: Use and sharing of sanitation facilities .78 Table WS.7: Drinking water and sanitation ladders .80 Table WS.8: Disposal of child's faeces .82 Table WS.9: Water and soap at place for handwashing .84 Table WS.10: Availability of soap or other cleansing agent .86 Table RH.1: Fertility rates.87 P a g e | xiv List of Tables Table HH.1: Results of household, women's, men's and under-5 interviews . 6 Table HH.2: Household age distribution by sex . 7 Table HH.3: Household composition . 9 Table HH.4: Women's background characteristics .11 Table HH.4M: Men's background characteristics .13 Table HH.5: Under-5's background characteristics .14 Table HH.6: Housing characteristics .16 Table HH.7: Household and personal assets .17 Table HH.8: Wealth quintiles .18 Table NU.1: Low birth weight infants .20 Table NU.S1: Low birth weight children (country specific) .21 Table NU.2: Nutritional status of children .24 Table NU.3: Initial breastfeeding .29 Table NU.4: Breastfeeding .32 Table NU.5: Duration of breastfeeding .34 Table NU.6: Age-appropriate breastfeeding .35 Table NU.7: Introduction of solid, semi-solid or soft foods .36 Table NU.8: Infant and young child feeding (IYCF) practices .37 Table NU.9: Bottle feeding .39 Table NU.10: Iodized salt consumption .40 Table NU.S2: Iodized salt consumption (country specific) .42 Table CH.1: Vaccinations in the first years of life .44 Table CH.2: Vaccinations by background characteristics .46 Table CH.3: Neonatal tetanus protection .48 Table CH.4: Reported disease episodes .49 Table CH.5: Care-seeking during diarrhoea .51 Table CH.6: Feeding practices during diarrhoea .53 Table CH.7: Oral rehydration solutions, recommended homemade fluids .55 Table CH.8: Oral rehydration therapy with continued feeding and other treatments .57 Table CH.9: Source of ORS .60 Table CH.10: Care-seeking for and antibiotic treatment of symptoms of acute respiratory infection (ARI) .62 Table CH.11: Solid fuel use .64 Table CH.12: Solid fuel use by place of cooking .65 Table CH.13: Care-seeking during fever.66 Table CH.14: Treatment of children with fever .67 Table WS.1: Use of improved water sources .69 Table WS.2: Household water treatment .71 Table WS.3: Time to source of drinking water .73 Table WS.4: Person collecting water .74 Table WS.5: Types of sanitation facilities .76 Table WS.6: Use and sharing of sanitation facilities .78 Table WS.7: Drinking water and sanitation ladders .80 Table WS.8: Disposal of child's faeces .82 Table WS.9: Water and soap at place for handwashing .84 Table WS.10: Availability of soap or other cleansing agent .86 Table RH.1: Fertility rates.87 P a g e | xv Table RH.2: Adolescent birth rate and total fertility rate .89 Table RH.3: Early childbearing .90 Table RH.4: Trends in early childbearing .91 Table RH.5: Use of contraception .94 Table RH.S1: Reasons for not using contraceptive methods .96 Table RH.6: Unmet need for contraception.100 Table RH.7: Antenatal care coverage .103 Table RH.8: Number of antenatal care visits and timing of first visit .105 Table RH.9: Content of antenatal care .107 Table RH.S2: Content of antenatal care (STIs and Thalassemia) .108 Table RH.10: Assistance during delivery and caesarian section .110 Table RH.11: Place of delivery .113 Table RH.S3: Post-natal health checks for mothers .115 Table CD.1: Early childhood education .117 Table CD.2: Support for learning .120 Table CD.3: Learning materials .124 Table CD.4: Inadequate care .125 Table CD.5: Early child development index .128 Table ED.1: Literacy (young women) .129 Table ED.1M: Literacy (young men) .129 Table ED.2: School readiness .130 Table ED.3: Primary school entry .132 Table ED.4: Primary school attendance and out of school children .133 Table ED.5: Secondary school attendance and out of school children .136 Table ED.6: Children reaching last grade of primary school .139 Table ED.7: Primary school completion and transition to secondary school .141 Table ED.8: Education gender parity .142 Table ED.9: Out of school gender parity .143 Table CP.1: Birth registration .146 Table CP.2: Child discipline .149 Table CP.3: Attitudes toward physical punishment .150 Table CP.4: Early marriage and polygyny (women) .153 Table CP.4M: Early marriage and polygyny (men) .156 Table CP.5: Trends in early marriage (women) .159 Table CP.5M: Trends in early marriage (men) .159 Table CP.6: Spousal age difference .161 Table CP.7: Attitudes towards domestic violence (women) .163 Table CP.7M: Attitudes towards domestic violence (men) .164 Table CP.8: Children's living arrangements and orphanhood .166 Table CP.9: Children with parents living abroad .168 Table HA.1: Knowledge about HIV transmission, misconceptions about HIV, and comprehensive knowledge about HIV transmission (women) .170 Table HA.1M: Knowledge about HIV transmission, misconceptions about HIV, and comprehensive knowledge about HIV transmission (men) .172 Table HA.2: Knowledge of mother-to-child transmission of HIV (women) .175 Table HA.2M: Knowledge of mother-to-child transmission of HIV (men) .176 Table HA.3: Accepting attitudes towards people living with HIV (women) .178 Table HA.3M: Accepting attitudes towards people living with HIV (men) .180 Table HA.4: Knowledge of a place for HIV testing (women) .183 P a g e | xvi Table HA.4M: Knowledge of a place for HIV testing (men) .184 Table HA.5: HIV counselling and testing during antenatal care.186 Table HA.6: Key HIV and AIDS indicators (young women) .188 Table HA.6M: Key HIV and AIDS indicators (young men) .190 Appendices: Table SD.1: Allocation of Sample Clusters (Primary Sampling Units) to Sampling Strata .194 Table SE.1: Indicators selected for sampling error calculations .199 Table SE.2: Sampling errors: Total sample .201 Table SE.3: Sampling errors: Urban .203 Table SE.4: Sampling errors: Rural .205 Table SE.5: Sampling errors: Bangkok .207 Table SE.6: Sampling errors: Central .209 Table SE.7: Sampling errors: North .211 Table SE.8: Sampling errors: Northeast .213 Table SE.9: Sampling errors: South .215 Table DQ.1: Age distribution of household population .227 Table DQ.2: Age distribution of eligible and interviewed women .228 Table DQ.3: Age distribution of eligible and interviewed men .229 Table DQ.4: Age distribution of children in household and under-5 questionnaires .229 Table DQ.5: Birth date reporting: Household population .230 Table DQ.6: Birth date and age reporting: Women .230 Table DQ.7: Birth date and age reporting: Men .231 Table DQ.8: Birth date and age reporting: Under-5s .231 Table DQ.9: Birth date reporting: Children, adolescents and young people .231 Table DQ.10: Birth date reporting: First and last births .232 Table DQ.11: Completeness of reporting .232 Table DQ.12: Completeness of information for anthropometric indicators: Underweight .233 Table DQ.13: Completeness of information for anthropometric indicators: Stunting .233 Table DQ.14: Completeness of information for anthropometric indicators: Wasting.234 Table DQ.15: Heaping in anthropometric measurements .234 Table DQ.16: Observation of birth certificates .235 Table DQ.17: Observation of vaccination cards .236 Table DQ.18: Observation of women's health cards .236 Table DQ.19: Observation of places for handwashing .237 Table DQ.20: Presence of mother in the household and the person interviewed for the under-5 questionnaire.237 Table DQ.21: School attendance by single age .238 Table DQ.22: Sex ratio at birth among children ever born and living .239 P a g e | xvi Table HA.4M: Knowledge of a place for HIV testing (men) .184 Table HA.5: HIV counselling and testing during antenatal care.186 Table HA.6: Key HIV and AIDS indicators (young women) .188 Table HA.6M: Key HIV and AIDS indicators (young men) .190 Appendices: Table SD.1: Allocation of Sample Clusters (Primary Sampling Units) to Sampling Strata .194 Table SE.1: Indicators selected for sampling error calculations .199 Table SE.2: Sampling errors: Total sample .201 Table SE.3: Sampling errors: Urban .203 Table SE.4: Sampling errors: Rural .205 Table SE.5: Sampling errors: Bangkok .207 Table SE.6: Sampling errors: Central .209 Table SE.7: Sampling errors: North .211 Table SE.8: Sampling errors: Northeast .213 Table SE.9: Sampling errors: South .215 Table DQ.1: Age distribution of household population .227 Table DQ.2: Age distribution of eligible and interviewed women .228 Table DQ.3: Age distribution of eligible and interviewed men .229 Table DQ.4: Age distribution of children in household and under-5 questionnaires .229 Table DQ.5: Birth date reporting: Household population .230 Table DQ.6: Birth date and age reporting: Women .230 Table DQ.7: Birth date and age reporting: Men .231 Table DQ.8: Birth date and age reporting: Under-5s .231 Table DQ.9: Birth date reporting: Children, adolescents and young people .231 Table DQ.10: Birth date reporting: First and last births .232 Table DQ.11: Completeness of reporting .232 Table DQ.12: Completeness of information for anthropometric indicators: Underweight .233 Table DQ.13: Completeness of information for anthropometric indicators: Stunting .233 Table DQ.14: Completeness of information for anthropometric indicators: Wasting.234 Table DQ.15: Heaping in anthropometric measurements .234 Table DQ.16: Observation of birth certificates .235 Table DQ.17: Observation of vaccination cards .236 Table DQ.18: Observation of women's health cards .236 Table DQ.19: Observation of places for handwashing .237 Table DQ.20: Presence of mother in the household and the person interviewed for the under-5 questionnaire.237 Table DQ.21: School attendance by single age .238 Table DQ.22: Sex ratio at birth among children ever born and living .239 P a g e | xvii List of Figures Figure HH.1: Age and sex distribution of household population, Thailand MICS, 2015-2016 . 8 Figure NU.1: Underweight, stunted, wasted and overweight children under age 5 (moderate and severe), Thailand MICS, 2015-2016 .26 Figure NU.2: Initiation of breastfeeding, Thailand MICS, 2015-2016 .30 Figure NU.3: Infant feeding patterns by age, Thailand MICS, 2015-2016 .33 Figure NU.4: Consumption of iodized salt, Thailand MICS, 2015-2016 .41 Figure CH.1: Vaccinations by age 12 months, Thailand MICS, 2015-2016 .45 Figure CH.2: Children under 5 with diarrhoea who received ORS or recommended homemade liquids, Thailand MICS, 2015-2016 .56 Figure CH.3: Children under 5 with diarrhoea receiving oral rehydration therapy (ORT) and continued feeding, Thailand MICS, 2015-2016 .59 Figure WS.1: Per cent distribution of household members by source of drinking water, Thailand MICS, 2015-2016 .70 Figure WS.2: Use of improved drinking water sources and improved sanitation facilities by household members, Thailand MICS, 2015-2016 .81 Figure RH.1: Age-specific fertility rates by area, Thailand MICS, 2015-2016 .88 Figure RH.2: Differentials in contraceptive use, Thailand MICS, 2015-2016 .92 Figure RH.3: Delivery assisted by medical doctor, Thailand MICS, 2015-2016 .112 Figure ED.1: Education indicators by sex, Thailand, 2015-2016 .144 Figure CP.1: Children under 5 whose birth certificates were shown, Thailand MICS, 2015-2016.147 Figure CP.2: Child disciplining methods, children age 1-14 years, Thailand MICS, 2015-2016 .148 Figure CP.3: Early marriage among women, Thailand MICS, 2015-2016 .160 Figure HA.1: Women and men with comprehensive knowledge of HIV transmission, Thailand MICS, 2015-2016 .174 Figure HA.2: Accepting attitudes toward people living with HIV/AIDS, Thailand MICS, 2015-2016 .182 Appendices Figure DQ.1: Household population by single ages, Thailand MICS, 2015-2016 .228 Figure DQ.2: Weight and height/length measurements by digits reported for the decimal points, Thailand MICS, 2015-2016 .235 P a g e | xviii List of Abbreviations AIDS Acquired Immune Deficiency Syndrome ARI Acute Respiratory Infection ASFR Age Specific Fertility Rate BCG Bacillis-Cereus-Geuerin (Tuberculosis) CBR Crude Birth Rate CSPro Census and Survey Processing System DPT Diptheria Pertussis Tetanus ECD Early Childhood Development ECDI Early Childhood Development Index EPI Expanded Programme on Immunization GFR General Fertility Rate GPI Gender Parity Index HepB Hepatitis B HIV Human Immunodeficiency Virus IDD Iodine Deficiency Disorders IUD Intrauterine Device IYCF Infant and young child feeding JE Japanese encephalitis JMP Joint Monitoring Programme MDG Millennium Development Goal MICS Multiple Indicator Cluster Survey MICS5 Fifth global round of Multiple Indicator Cluster Surveys programme MMR Measles, Mumps and Rubella NAR Net Attendance Rate NSO National Statistical Office ORS Oral rehydration salts ORT Oral rehydration treatment ppm Parts Per Million PSU Primary Sampling Unit RHF Recommended home fluid SPSS Statistical Package for Social Sciences SSU Secondary Sampling Unit STIs Sexually transmitted infections TSFB Time Since First Birth TFR Total Fertility Rate UNAIDS The Joint 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 VDRL Venereal disease research laboratory WFFC World Fit for Children WHO World Health Organization P a g e | xviii List of Abbreviations AIDS Acquired Immune Deficiency Syndrome ARI Acute Respiratory Infection ASFR Age Specific Fertility Rate BCG Bacillis-Cereus-Geuerin (Tuberculosis) CBR Crude Birth Rate CSPro Census and Survey Processing System DPT Diptheria Pertussis Tetanus ECD Early Childhood Development ECDI Early Childhood Development Index EPI Expanded Programme on Immunization GFR General Fertility Rate GPI Gender Parity Index HepB Hepatitis B HIV Human Immunodeficiency Virus IDD Iodine Deficiency Disorders IUD Intrauterine Device IYCF Infant and young child feeding JE Japanese encephalitis JMP Joint Monitoring Programme MDG Millennium Development Goal MICS Multiple Indicator Cluster Survey MICS5 Fifth global round of Multiple Indicator Cluster Surveys programme MMR Measles, Mumps and Rubella NAR Net Attendance Rate NSO National Statistical Office ORS Oral rehydration salts ORT Oral rehydration treatment ppm Parts Per Million PSU Primary Sampling Unit RHF Recommended home fluid SPSS Statistical Package for Social Sciences SSU Secondary Sampling Unit STIs Sexually transmitted infections TSFB Time Since First Birth TFR Total Fertility Rate UNAIDS The Joint 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 VDRL Venereal disease research laboratory WFFC World Fit for Children WHO World Health Organization P a g e | xix Executive Summary The Thailand Multiple Indicator Cluster Survey (MICS 2015-2016) was conducted from November 2015 to March 2016 by the National Statistical Office (NSO). Technical and financial support for the survey was mainly provided by the United Nations Children’s Fund (UNICEF) in Thailand. The Thailand MICS, 2015-2016 provides valuable information and the latest evidence on the situation of children and women in Thailand, updating information from the previous MICS and other relevant household surveys. The survey presents data from an equity perspective by indicating disparities by sex, area, region, education, household wealth and other characteristics. The Thailand MICS, 2015-2016 is based on a sample of 28,652 households that were interviewed and provides a comprehensive picture of children, women and men in the five regions of Thailand. Nutritional Status and Breastfeeding Almost all children born during the two years prior to the survey were weighed at birth. Overall, 9.4 per cent were reported to weigh less than 2,500 grams at birth. The prevalence of moderate or severe underweight among children under 5 in Thailand is reported at 6.7 per cent. Among children aged 0-5 months, 11.6 per cent are moderately or severely underweight. Children under 5 in the poorest households in Thailand are also more likely to be moderately or severely underweight than children from other wealth index quintiles. However, 1 in 12 children under 5 in Thailand is overweight. One in 10 children in Thailand is moderately or severely stunted. The highest percentage of stunting is reported for children under 5 living in households headed by a non-Thai speaker (16.3 per cent). Moderate or severe wasting among children under 5 in Thailand stands at 5.4 per cent. Children aged 0- 5 months record the highest percentage of moderate or severe wasting (12.4 per cent). Almost all (97.4 per cent) newborns in Thailand were breastfed at some point after birth. However, only 39.9 per cent started breastfeeding at the correct time (i.e., within one hour of birth). A total of 23.1 per cent of infants aged 0-5 months are exclusively breastfed. Children under 6 months of age in the North region are more likely to be exclusively breastfed compared to children in other regions. Some 15.6 per cent of children in Thailand continue to receive breastfeeding at 2 years old. Household wealth status shows an inverse relation with the percentage of children breastfed at age 2. Children aged 0-35 months are exclusively breastfed for a median duration of 0.6 months. Among children 6-23 months of age, 55.6 per cent receive a minimum acceptable diet in terms of meal frequency and dietary diversity. Adequately iodized salt, defined as salt containing 15 or more parts per million (15+ ppm), is used in three out of four households (73.3 per cent), with the percentage considerably higher in the richest households (86.3 per cent). In the Northeast, 39.1 per cent of households use either no iodized salt or inadequately iodized salt for household consumption. Child Health In Thailand, 71.6 per cent of children aged 12-23 months received all the recommended vaccinations before their first birthday. However, 79.1 per cent of children in this age group were fully vaccinated at any time before the survey. Among children aged 12-23 months, 96.2 per cent were protected against tuberculosis before their first birthday and almost 9 out of 10 children were given the measles vaccine before the age of 12 months. Three out of four women aged 15-49 who had a live birth during the P a g e | xx previous two years were given at least two doses for tetanus protection. Women in the poorest households are least likely (63.8 per cent) to be protected against tetanus compared to other women. For 70.7 per cent of children who had an episode of diarrhoea, medical care or advice was sought. Children in the South were least likely to receive any medical attention or advice for diarrhoea. Three out of four children with diarrhoea received ORS or health personnel recommended homemade fluid. Care-seeking behaviour is also common for episodes of fever in children. For three out of four children with fever, medical treatment or advice was sought from a health facility or provider. Interestingly, children in rural areas were more likely to receive medical treatment or advice for fever from a health facility or provider compared to children in urban areas. Water and Sanitation The Thailand MICS, 2015-2016 shows that 98.0 per cent of the population has access to improved sources of drinking water. Similarly, almost the entire population (99.6 per cent) lives in households with access to improved sanitation facilities. Use of an improved source of drinking water is lowest in the South region, at 94.4 per cent, compared to other regions. Open defecation in Thailand is almost non- existent (0.2 per cent). However, only 42.0 per cent of children under 2 years of age had their last stool disposed of safely. Four out of five households in Thailand with a specific place for handwashing had water and soap or other cleansing agents present at the handwashing place. For the poorest households, this indicator was lower, at 69.6 per cent. Reproductive Health The total fertility rate (TFR) as a measure of current fertility is estimated at 1.5 children per woman. Fertility is slightly higher in rural areas compared to urban areas. A total of 9.4 per cent of women aged 20-24 had a live birth before the age of 18. The percentage is highest (20.9 per cent) for primary educated women followed by women in the poorest households (17.8 per cent). Current use of a contraceptive method is reported by 78.4 per cent of currently married women. The most popular method is the pill (32.8 per cent) followed by female sterilization (24.3 per cent). Total unmet need for contraception is 6.2 per cent, but for women aged 15-19 years it is 13.0 per cent. Among women with who had a live birth in the last two years, almost all (98.1 per cent) received antenatal care from a skilled personnel at least once during their pregnancy. In four out of five cases, antenatal care was provided by a medical doctor. The percentage of women who sought antenatal care from a healthcare center staff or nurse’s aide was highest (14.3 per cent) in the Northeast region. A total of 90.8 per cent of women who had a live birth during the last two years, had four or more antenatal care visits during their last pregnancy and 79.8 per cent women had there their first antenatal care visit during the first trimester. However, only around 40.3 per cent of uneducated women had their first antenatal care visit during the first trimester. Nine out of 10 women who had a live birth during the two years preceding the survey had a test for STIs (VDRL 1st), while 87.6 per cent were tested for thalassemia and 37.1 per cent had their husbands tested for thalassemia. Almost all deliveries (99.1 per cent) were attended by skilled personnel and 32.7 per cent of deliveries were by C-section. Moreover, large variations were observed across regions and background characteristics. Almost half of the deliveries in the Bangkok region (46.5 per cent) and deliveries to women aged 35-49 (48.8 per cent), higher educated women (54.2 per cent) and women in the richest P a g e | xx previous two years were given at least two doses for tetanus protection. Women in the poorest households are least likely (63.8 per cent) to be protected against tetanus compared to other women. For 70.7 per cent of children who had an episode of diarrhoea, medical care or advice was sought. Children in the South were least likely to receive any medical attention or advice for diarrhoea. Three out of four children with diarrhoea received ORS or health personnel recommended homemade fluid. Care-seeking behaviour is also common for episodes of fever in children. For three out of four children with fever, medical treatment or advice was sought from a health facility or provider. Interestingly, children in rural areas were more likely to receive medical treatment or advice for fever from a health facility or provider compared to children in urban areas. Water and Sanitation The Thailand MICS, 2015-2016 shows that 98.0 per cent of the population has access to improved sources of drinking water. Similarly, almost the entire population (99.6 per cent) lives in households with access to improved sanitation facilities. Use of an improved source of drinking water is lowest in the South region, at 94.4 per cent, compared to other regions. Open defecation in Thailand is almost non- existent (0.2 per cent). However, only 42.0 per cent of children under 2 years of age had their last stool disposed of safely. Four out of five households in Thailand with a specific place for handwashing had water and soap or other cleansing agents present at the handwashing place. For the poorest households, this indicator was lower, at 69.6 per cent. Reproductive Health The total fertility rate (TFR) as a measure of current fertility is estimated at 1.5 children per woman. Fertility is slightly higher in rural areas compared to urban areas. A total of 9.4 per cent of women aged 20-24 had a live birth before the age of 18. The percentage is highest (20.9 per cent) for primary educated women followed by women in the poorest households (17.8 per cent). Current use of a contraceptive method is reported by 78.4 per cent of currently married women. The most popular method is the pill (32.8 per cent) followed by female sterilization (24.3 per cent). Total unmet need for contraception is 6.2 per cent, but for women aged 15-19 years it is 13.0 per cent. Among women with who had a live birth in the last two years, almost all (98.1 per cent) received antenatal care from a skilled personnel at least once during their pregnancy. In four out of five cases, antenatal care was provided by a medical doctor. The percentage of women who sought antenatal care from a healthcare center staff or nurse’s aide was highest (14.3 per cent) in the Northeast region. A total of 90.8 per cent of women who had a live birth during the last two years, had four or more antenatal care visits during their last pregnancy and 79.8 per cent women had there their first antenatal care visit during the first trimester. However, only around 40.3 per cent of uneducated women had their first antenatal care visit during the first trimester. Nine out of 10 women who had a live birth during the two years preceding the survey had a test for STIs (VDRL 1st), while 87.6 per cent were tested for thalassemia and 37.1 per cent had their husbands tested for thalassemia. Almost all deliveries (99.1 per cent) were attended by skilled personnel and 32.7 per cent of deliveries were by C-section. Moreover, large variations were observed across regions and background characteristics. Almost half of the deliveries in the Bangkok region (46.5 per cent) and deliveries to women aged 35-49 (48.8 per cent), higher educated women (54.2 per cent) and women in the richest P a g e | xxi households (50.5 per cent) were delivered through C-section. More than 6 out of 10 deliveries (64.1 per cent) in private health facilities were delivered by C-section. Delivery in a health facility is almost universal (98.6 per cent) in Thailand and in a majority of cases (88.7 per cent) mothers delivered at a public health facility. The percentage of deliveries in a private health facility was positively related to household wealth status. A total of 78.1 per cent of women who had a live birth during the preceding two years had at least one post-natal health check within 42 days of delivery. Early Childhood Development In Thailand, 84.7 per cent of children aged 3-4 years are attending an organized early childhood education programme. Interestingly, this percentage is quite low in Bangkok (63.4 per cent) compared to other regions. Moreover, for 92.7 per cent of children, an adult household member engages in four or more activities that promote learning or school readiness. Three out of four children have access to two or more playthings and half the children (50.9 per cent) play with electronic devices. Some 6.1 per cent of children aged under 5 were left with inadequate care during the week preceding the survey. Among children age 36-59 months, 91.1 per cent are developmentally on track. Children in the richest households (96.0 per cent), children born to higher educated mothers (95.4 per cent), older children (95.6 per cent) and children attending early childhood education (93.4 per cent) are more likely to be developmentally on track. Literacy and Education In Thailand, 95.4 per cent of young women aged 15-24 years and 94.7 per cent of young men aged 15-24 years are literate. In terms of school readiness, the percentage of children attending Grade 1 who were attending preschool the previous year is 98.7 per cent. Overall, 75.7 per cent of primary school entry- age children enter primary school Grade 1. However, this percentage is reported as quite low for children born to uneducated mothers (66.0 per cent) and children living in the poorest households (66.9 per cent). The net attendance ratio at primary level (adjusted) is 94.8 per cent, with 4.1 per cent of children of primary school age attending preschool and 1.0 per cent not attending school or preschool. The percentage of children not attending school or preschool is highest (6.2 per cent) among children born to uneducated mothers. Similarly, the net attendance ratio (adjusted) at secondary level is 81.0 per cent. A total of 56.8 per cent of secondary school age children living in households headed by a non- Thai speaker attend secondary school or higher. Almost all children entering Grade 1 eventually reach Grade 6. Completion of primary school and transition into secondary school is quite high across all background characteristics. At national level, 98.2 per cent complete primary school and transit into secondary school. The primary to secondary transition rate is lowest among children in the poorest households (94.7 per cent). In Thailand, there is no gender parity at primary level. However, at secondary level, there are 1.11 secondary school age girls attending secondary school for every secondary school age boy attending secondary school. Child Protection Birth registration for children under 5 years of age is universal in Thailand (99.5 per cent). Children born to uneducated mothers are somewhat less likely to be registered (92.3 per cent). The use of violent discipline methods is quite high in Thailand, with 75.2 per cent of children aged 1-14 years having faced any violent discipline method during the one month preceding the survey. Household wealth status is P a g e | xxii inversely associated with use of any violent discipline method. Similarly, almost one out of two respondents feels that physical punishment should be used to discipline children. This indicator also shows a negative relation with the respondent’s education level and household wealth status. Among women aged 15-19 years, 14.1 per cent are currently married compared to 6.8 per cent of men in the same age group. A total of 3.4 per cent of women aged 15-49 are in polygynous marriages/union compared to 2.9 per cent of men in the 15-49 age group. Moreover, 18.6 per cent of women aged 20-24 are married to or in union with a younger partner. Similarly, 15.1 per cent of women in the same age group are married to or in union with a person older by 10 or more years. Overall, 8.6 per cent of women in Thailand feel that a husband/partner is justified in hitting or beating his wife if she neglects the children, goes out without her husband’s permission, refuses sex with her husband, burns food or argues with her husband. A similar percentage (8.7 per cent) of men also feel that a husband is justified in hitting or beating his wife in at least one of the five situations mentioned above. Almost one out of four (22.7 per cent) children aged 0-17 lives with neither biological parent. The percentage is higher among children living in the Northeast (33.2 per cent) and in the poorest households (34.0 per cent). In total, 3.5 per cent of children in Thailand have one or both parents dead and 1.6 per cent have at least one parent abroad. HIV/AIDS Almost all women (96.2 per cent) and men (95.2 per cent) aged 15-49 in Thailand have ever heard of AIDS. Two thirds (66.9 per cent) of uneducated women in Thailand have ever heard of AIDS compared to slightly more than half (55.0 per cent) of uneducated men. Moreover, 48.8 per cent of women and a similar percentage of men have comprehensive knowledge about HIV prevention. Two thirds of women who have heard of AIDS know that HIV can be transmitted from mother to child during pregnancy, during delivery and by breastfeeding. Among uneducated women the percentage is lower, at 37.3per cent. In Thailand, 31.6 per cent of women and 33.0 per cent of men aged 15-49 express an accepting attitude towards people living with HIV. Age for both women and men shows a positive relation with accepting attitudes towards people living with HIV. Moreover, household wealth for both women and men is negatively related with accepting attitudes towards people living with HIV. However, 9 out of 10 women and men in Thailand are willing to take care of a family member with AIDS in their own home. A higher percentage (84.7 per cent) of women aged 15-49 years have knowledge of a place for HIV testing compared to men (80.3 per cent) in the same age group. Similarly, 9.3 per cent of women were tested for HIV during the previous 12 months and know the result compared to 8.5 per cent of men in the same period. Among women who received antenatal care for their last pregnancy during the previous two years, 69.4 per cent received HIV counselling during antenatal care and 62.3 per cent received HIV counselling, were offered an HIV test, accepted the offer and received the results of the HIV test. I. INTRODUCTION P a g e | 1 I. Introduction Background This report is based on the Thailand Multiple Indicator Cluster Survey (MICS), conducted in 2015-2016 by the National Statistical Office (NSO). The survey provides statistically sound and internationally comparable data essential for developing evidence-based policies and programmes, and for monitoring progress toward national goals and global commitments. Among these global commitments are those emanating from the World Fit for Children Declaration and Plan of Action, the goals of the United Nations General Assembly Special Session on HIV/AIDS, the Education for All Declaration and the Millennium Development Goals (MDGs). A Commitment to Action: National and International Reporting Responsibilities The governments that signed the Millennium Declaration and the World Fit for Children Declaration and Plan of Action also committed themselves to monitoring progress towards the goals and objectives they contained: “We will monitor regularly at the national level and, where appropriate, at the regional level and assess progress towards the goals and targets of the present Plan of Action at the national, regional and global levels. Accordingly, we will strengthen our national statistical capacity to collect, analyse and disaggregate data, including by sex, age and other relevant factors that may lead to disparities, and support a wide range of child-focused research. We will enhance international cooperation to support statistical capacity-building efforts and build community capacity for monitoring, assessment and planning.” (A World Fit for Children, paragraph 60) “…We will conduct periodic reviews at the national and subnational levels of progress in order to address obstacles more effectively and accelerate actions.” (A World Fit for Children, paragraph 61) The Plan of Action of the World Fit for Children (paragraph 61) also calls for the specific involvement of UNICEF in the preparation of periodic progress reports: “… As the world’s lead agency for children, the United Nations Children’s Fund is requested to continue to prepare and disseminate, in close collaboration with Governments, relevant funds, programmes and the specialized agencies of the United Nations system, and all other relevant actors, as appropriate, information on the progress made in the implementation of the Declaration and the Plan of Action.” Similarly, the Millennium Declaration (paragraph 31) calls for periodic reporting on progress: “…We request the General Assembly to review on a regular basis the progress made in implementing the provisions of this Declaration, and ask the Secretary-General to issue periodic reports for consideration by the General Assembly and as a basis for further action.” For Thailand, guidance on how to improve the well-being of children and women is articulated in the Policy Statement of the Cabinet and explained in ministerial strategies. The Cabinet’s Policy Statement is aimed at reducing social inequality, creating opportunities to access public services and improving the quality of public health services. The Ministry of Education reform strategy aims to improve the quality of learning and education, as well as increase and diversify educational opportunities for all people. The Ministry of Social Development and Human Security runs projects that work for the protection of children and women and the development of their capacities. The guidelines and operations of various ministries and agencies impact on the lives of children and women. The data from the MICS survey is a reflection of their situation. P a g e | 2 The Thailand MICS results will be critically important for the post MDG reporting, and are expected to form part of the baseline data for the 2030 agenda. The Thailand MICS is expected to contribute to the evidence base of several other important initiatives, including Committing to Child Survival: A Promise Renewed, a global movement to end all child and maternal deaths from preventable causes, and the accountability framework proposed by the Commission on Information and Accountability for the Global Strategy for Women's and Children's Health. This final report presents the results of the indicators and topics covered in the survey. Survey Objectives The 2015-2016 Thailand MICS has as its primary objectives:  To provide up-to-date information for assessing the situation of children and women in Thailand;  To generate data for the critical assessment of the progress made in various areas, and to commit additional efforts to those areas that require more attention;  To furnish data needed for monitoring progress towards goals established in the Millennium Declaration and other internationally agreed upon goals, as a basis for future action;  To collect disaggregated data for the identification of disparities to allow for evidence-based policy- making aimed at social inclusion of the most vulnerable;  To contribute to the generation of baseline data for the 2030 agenda;  To validate data from other sources and the results of focused interventions. This report covers the result of the indicators at national and regional level. National level results were published earlier this year as part of key report findings. The report consists of 11 chapters with the narratives in each chapter based on the tables presented in the respective sections. The first three chapters are dedicated to an introduction of the survey, the methodology and sample and household characteristics. The remaining chapters are related to nutrition, child health, water and sanitation, reproductive health, early childhood development, literacy and education, child protection and knowledge of HIV/AIDS. P a g e | 1 I. Introduction Background This report is based on the Thailand Multiple Indicator Cluster Survey (MICS), conducted in 2015-2016 by the National Statistical Office (NSO). The survey provides statistically sound and internationally comparable data essential for developing evidence-based policies and programmes, and for monitoring progress toward national goals and global commitments. Among these global commitments are those emanating from the World Fit for Children Declaration and Plan of Action, the goals of the United Nations General Assembly Special Session on HIV/AIDS, the Education for All Declaration and the Millennium Development Goals (MDGs). A Commitment to Action: National and International Reporting Responsibilities The governments that signed the Millennium Declaration and the World Fit for Children Declaration and Plan of Action also committed themselves to monitoring progress towards the goals and objectives they contained: “We will monitor regularly at the national level and, where appropriate, at the regional level and assess progress towards the goals and targets of the present Plan of Action at the national, regional and global levels. Accordingly, we will strengthen our national statistical capacity to collect, analyse and disaggregate data, including by sex, age and other relevant factors that may lead to disparities, and support a wide range of child-focused research. We will enhance international cooperation to support statistical capacity-building efforts and build community capacity for monitoring, assessment and planning.” (A World Fit for Children, paragraph 60) “…We will conduct periodic reviews at the national and subnational levels of progress in order to address obstacles more effectively and accelerate actions.” (A World Fit for Children, paragraph 61) The Plan of Action of the World Fit for Children (paragraph 61) also calls for the specific involvement of UNICEF in the preparation of periodic progress reports: “… As the world’s lead agency for children, the United Nations Children’s Fund is requested to continue to prepare and disseminate, in close collaboration with Governments, relevant funds, programmes and the specialized agencies of the United Nations system, and all other relevant actors, as appropriate, information on the progress made in the implementation of the Declaration and the Plan of Action.” Similarly, the Millennium Declaration (paragraph 31) calls for periodic reporting on progress: “…We request the General Assembly to review on a regular basis the progress made in implementing the provisions of this Declaration, and ask the Secretary-General to issue periodic reports for consideration by the General Assembly and as a basis for further action.” For Thailand, guidance on how to improve the well-being of children and women is articulated in the Policy Statement of the Cabinet and explained in ministerial strategies. The Cabinet’s Policy Statement is aimed at reducing social inequality, creating opportunities to access public services and improving the quality of public health services. The Ministry of Education reform strategy aims to improve the quality of learning and education, as well as increase and diversify educational opportunities for all people. The Ministry of Social Development and Human Security runs projects that work for the protection of children and women and the development of their capacities. The guidelines and operations of various ministries and agencies impact on the lives of children and women. The data from the MICS survey is a reflection of their situation. P a g e | 2 The Thailand MICS results will be critically important for the post MDG reporting, and are expected to form part of the baseline data for the 2030 agenda. The Thailand MICS is expected to contribute to the evidence base of several other important initiatives, including Committing to Child Survival: A Promise Renewed, a global movement to end all child and maternal deaths from preventable causes, and the accountability framework proposed by the Commission on Information and Accountability for the Global Strategy for Women's and Children's Health. This final report presents the results of the indicators and topics covered in the survey. Survey Objectives The 2015-2016 Thailand MICS has as its primary objectives:  To provide up-to-date information for assessing the situation of children and women in Thailand;  To generate data for the critical assessment of the progress made in various areas, and to commit additional efforts to those areas that require more attention;  To furnish data needed for monitoring progress towards goals established in the Millennium Declaration and other internationally agreed upon goals, as a basis for future action;  To collect disaggregated data for the identification of disparities to allow for evidence-based policy- making aimed at social inclusion of the most vulnerable;  To contribute to the generation of baseline data for the 2030 agenda;  To validate data from other sources and the results of focused interventions. This report covers the result of the indicators at national and regional level. National level results were published earlier this year as part of key report findings. The report consists of 11 chapters with the narratives in each chapter based on the tables presented in the respective sections. The first three chapters are dedicated to an introduction of the survey, the methodology and sample and household characteristics. The remaining chapters are related to nutrition, child health, water and sanitation, reproductive health, early childhood development, literacy and education, child protection and knowledge of HIV/AIDS. II. SAMPLE AND SURVEY METHODOLOGY P a g e | 3 II. Sample and Survey Methodology Sample Design The sample for the Thailand Multiple Indicator Cluster Survey was designed to provide estimates for a large number of indicators on the situation of children and women at the national level, for urban and rural areas, and for five regions: Bangkok, Central, North, Northeast and South. In addition, the results are produced for 14 individual provinces. The urban and rural areas by province 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: 10 households with under-five children and 10 without under-five children. The sample was stratified by province, urban and rural areas, and is not self-weighting. For reporting all survey results, sample weights are used. A more detailed description of the sample design can be found in Appendix A, Sample Design. Questionnaires Four sets of questionnaires were used in the survey: 1. a household questionnaire which was used to collect basic demographic information on all de jure household members (usual residents), the household and the dwelling; 2. a questionnaire for individual women administered in each household to all women aged 15-49 years; 3. a questionnaire for individual men administered in each household to all men aged 15-49 years; and 4. a questionnaire for children under the age of five, administered to mothers (or caretakers) for all children under 5 living in the household. The questionnaires included the following modules: The Household Questionnaire included the following modules: 1. List of Household Members 2. Education 3. Child Discipline 4. Household Characteristics 5. Water and Sanitation 6. Handwashing 7. Salt Iodization The Questionnaire for Individual Women was administered to all women aged 15-49 years living in the households, and included the following modules: 1. Woman’s Background 2. Fertility2 3. Desire for Last Birth 4. Maternal and Newborn Health 5. Contraception 6. Unmet Need 7. Attitudes Toward Domestic Violence 2 Due to very low number of child deaths, the results of child mortality are not included in this report. P a g e | 4 8. Marriage/Union 9. HIV/AIDS The Questionnaire for Individual Men was administered to all men aged 15-49 years living in the each households, and included the following modules: 1. Man’s Background 2. Fertility 3. Attitudes Toward Domestic Violence 4. Marriage/Union 5. HIV/AIDS The Questionnaire for Children aged under five was administered to mothers (or caretakers) of children under 5 years of age3 living in the households. Normally, the questionnaire was administered to mothers of under-5 children; in cases when 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: 1. Age 2. Birth Registration 3. Early Childhood Development 4. Breastfeeding and Dietary Intake 5. Immunization 6. Care of Illness 7. Anthropometry The questionnaires are based on the MICS5 model questionnaire4. From the MICS5 model English version, the questionnaires were customised and translated into Thai5 and were tested through three rounds of pre-test in Sing Buri and Phra Nakhon Si Ayutthaya (during July 13-17, 2015), Bangkok (July 27, 2015) and Satun (during August 9-18, 2015). Based on the results of the pre-test, modifications were made to the wording and translation of the questionnaires. A copy of the Thailand MICS questionnaires is provided in Appendix E. In addition to the administration of questionnaires, fieldwork teams tested the salt used for cooking in the households for iodine content, observed the place for handwashing, and measured the weights and heights of children under 5 years. Details and findings of these observations and measurements are provided in the respective sections of the report. Training and Fieldwork Training for the fieldwork was conducted for 10 days during September 15-29, 2015 for the first batch and during 18-29 October for the second batch in a central location (Bangkok). Due to large number of participants, each batch was split into two groups. Sixteen provinces with large number of clusters were 3 The terms “children under 5”, “children aged 0-4 years”, and “children age 0-59 months” are used interchangeably in this report. 4 The model MICS5 questionnaires can be found at http://mics.unicef.org/tools 5 In addition to the standard questions, a set of country specific questions is also included as follows: items MN5A, MN28, MN29, CP2A1, HA29 and HA30 in questionnaire for women, items MHA29 and MHA30 in questionnaire for men and EC2D, IM16A and IM16B in questionnaire for children under five. These additions are supposed to be analyzed by responsible agencies. P a g e | 4 8. Marriage/Union 9. HIV/AIDS The Questionnaire for Individual Men was administered to all men aged 15-49 years living in the each households, and included the following modules: 1. Man’s Background 2. Fertility 3. Attitudes Toward Domestic Violence 4. Marriage/Union 5. HIV/AIDS The Questionnaire for Children aged under five was administered to mothers (or caretakers) of children under 5 years of age3 living in the households. Normally, the questionnaire was administered to mothers of under-5 children; in cases when 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: 1. Age 2. Birth Registration 3. Early Childhood Development 4. Breastfeeding and Dietary Intake 5. Immunization 6. Care of Illness 7. Anthropometry The questionnaires are based on the MICS5 model questionnaire4. From the MICS5 model English version, the questionnaires were customised and translated into Thai5 and were tested through three rounds of pre-test in Sing Buri and Phra Nakhon Si Ayutthaya (during July 13-17, 2015), Bangkok (July 27, 2015) and Satun (during August 9-18, 2015). Based on the results of the pre-test, modifications were made to the wording and translation of the questionnaires. A copy of the Thailand MICS questionnaires is provided in Appendix E. In addition to the administration of questionnaires, fieldwork teams tested the salt used for cooking in the households for iodine content, observed the place for handwashing, and measured the weights and heights of children under 5 years. Details and findings of these observations and measurements are provided in the respective sections of the report. Training and Fieldwork Training for the fieldwork was conducted for 10 days during September 15-29, 2015 for the first batch and during 18-29 October for the second batch in a central location (Bangkok). Due to large number of participants, each batch was split into two groups. Sixteen provinces with large number of clusters were 3 The terms “children under 5”, “children aged 0-4 years”, and “children age 0-59 months” are used interchangeably in this report. 4 The model MICS5 questionnaires can be found at http://mics.unicef.org/tools 5 In addition to the standard questions, a set of country specific questions is also included as follows: items MN5A, MN28, MN29, CP2A1, HA29 and HA30 in questionnaire for women, items MHA29 and MHA30 in questionnaire for men and EC2D, IM16A and IM16B in questionnaire for children under five. These additions are supposed to be analyzed by responsible agencies. P a g e | 5 included in the first batch, while staffs from remaining 61 provinces attended the second. In some provinces, there was a gap between the end of training and the start of fieldwork. In those provinces, two-day special refresher trainings were arranged before starting the actual data collection on 1 November 2015. The main training included lectures on interviewing techniques and the contents of the questionnaires as well as mock interviews between trainees to gain practice in asking questions. Towards the end of the training period, trainees spent one day on interviewing practice in Bangkok. Moreover, for both batches, experts from the Ministry of Public Health were invited to speak about maternal and newborn health issues such as contraception, antenatal care and vaccination. The knowledge and information acquired through the training were useful for the interview process and the accuracy of the survey results. 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 data were collected by 98 teams from the respective provinces; each team on average was comprised of 3 interviewers and a supervisor. All the field team members were NSO staff and have been working with NSO on various regular and ongoing surveys for many years. Most of them had experience using android-based tablet surveys, including from the previous round of the Thailand MICS. In order to facilitate data collection in areas in which non-Thai households were prevalent, a specific translator was also a part of team. Fieldwork concluded in March, 2016. Data Processing The Thailand MICS, 2015-2016 used window-based tablets to collect the data. CSPro software, version 5.0.3 was used for data collection and entry. Robust data transfer mechanism were developed to immediately transfer collected data to the central office. Data processing began simultaneously with data collection in November 2015 and was completed in early May 2016. Data were analysed using the Statistical Package for Social Sciences (SPSS) software, Version 21. Model syntax and tabulation plans developed by UNICEF were customized and used for this purpose. III. SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS P a g e | 6 III. Sample Coverage and the Characteristics of Households and Respondents Sample Coverage Of the 31,010 households selected for the sample, 29,375 were found to be occupied. Of these, 28,652 were successfully interviewed, for a household response rate of 97.5 per cent. In the interviewed households, 26,033 women (aged 15-49 years) were identified. Of these, 25,614 were successfully interviewed, yielding a household response rate of 98.4 per cent. In the interviewed households, 23,642 men (aged 15-49) were identified. Questionnaires were completed for 23,183 eligible men, which corresponds to a response rate of 98.1 per cent within eligible interviewed households. There were 12,313 children under 5 years of age listed in the household questionnaires. Questionnaires were completed for 12,250 of these children, which corresponds to a response rate of 99.5 per cent within interviewed households. Overall response rates of 96.0 per cent, 95.6 per cent, and 97.0 per cent are calculated for the individual interviews of women, men and children under 5, respectively (Table HH.1). Table HH.1: Results of household, women's, men's and under-5 interviews Number of households, women, men, and children under 5 by interview results, and household, women's, men's and under-5's response rates, Thailand MICS, 2015-2016 Total Area Region Urban Rural Bangkok Central North Northeast South Households Sampled 6 31,010 15,006 16,004 2,802 5,360 5,395 8,844 8,609 Occupied 29,375 14,086 15,289 2,611 5,067 5,080 8,424 8,193 Interviewed 28,652 13,504 15,148 2,261 4,906 5,059 8,364 8,062 Household response rate 97.5 95.9 99.1 86.6 96.8 99.6 99.3 98.4 Women Eligible 26,033 12,531 13,502 2,438 4,600 4,144 6,880 7,971 Interviewed 25,614 12,251 13,363 2,283 4,524 4,109 6,829 7,869 Women's response rate 98.4 97.8 99.0 93.6 98.3 99.2 99.3 98.7 Women's overall response rate 96.0 93.7 98.1 81.1 95.2 98.7 98.6 97.1 Men Eligible 23,642 11,198 12,444 2,172 4,308 3,646 6,228 7,288 Interviewed 23,183 10,912 12,271 2,044 4,216 3,600 6,147 7,176 Men's response rate 98.1 97.4 98.6 94.1 97.9 98.7 98.7 98.5 Men's overall response rate 95.6 93.4 97.7 81.5 94.8 98.3 98.0 96.9 Children under 5 Eligible 12,313 5,520 6,793 766 1,973 2,201 3,750 3,623 Mothers/caretakers interviewed 12,250 5,472 6,778 737 1,964 2,201 3,738 3,610 Under-5's response rate 99.5 99.1 99.8 96.2 99.5 100.0 99.7 99.6 Under-5's overall response rate 97.0 95.0 98.9 83.3 96.4 99.6 99.0 98.0 6 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. P a g e | 7 Across regions, response rates remained very high. Bangkok, which is highly urban, had the lowest response rate. The response rate for households in Bangkok was 86.6 per cent, for eligible women 93.6 per cent, for eligible men 94.1 per cent and for children under 5 years of age 96.2 per cent. Despite many follow-ups and at least three revisits, access to some of the households and respondents was limited due to the absence of knowledgeable or eligible household members or the refusal of the respondent to participate in the survey during the time of visits and subsequent revisits. 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 28,652 households successfully interviewed in the survey, 92,073 household members were listed. Of these, 44,033 were males and 48,040 were females. Table HH.2: Age distribution of household population by sex Per cent and frequency distribution of the household population by five-year age groups, dependency age groups, and by child (age 0-17 years) and adult populations (age 18 or more), by sex, Thailand MICS, 2015-2016 Total Males Females Number Per cent Number Per cent Number Per cent Total 92,073 100.0 44,033 100.0 48,040 100.0 Age 0-4 5,462 5.9 2,846 6.5 2,616 5.4 5-9 6,072 6.6 3,023 6.9 3,049 6.3 10-14 6,422 7.0 3,248 7.4 3,175 6.6 15-19 6,156 6.7 3,172 7.2 2,984 6.2 20-24 5,162 5.6 2,600 5.9 2,562 5.3 25-29 5,117 5.6 2,370 5.4 2,747 5.7 30-34 6,098 6.6 3,021 6.9 3,077 6.4 35-39 7,075 7.7 3,439 7.8 3,636 7.6 40-44 7,084 7.7 3,401 7.7 3,684 7.7 45-49 7,676 8.3 3,585 8.1 4,091 8.5 50-54 7,193 7.8 3,316 7.5 3,877 8.1 55-59 6,729 7.3 3,095 7.0 3,634 7.6 60-64 5,128 5.6 2,430 5.5 2,698 5.6 65-69 3,903 4.2 1,765 4.0 2,137 4.4 70-74 2,811 3.1 1,192 2.7 1,619 3.4 75-79 1,860 2.0 821 1.9 1,039 2.2 80-84 1,130 1.2 376 0.9 754 1.6 85+ 967 1.1 330 0.8 637 1.3 Missing/DK 29 0.0 5 0.0 24 0.0 Dependency age groups 0-14 17,957 19.5 9,117 20.7 8,840 18.4 15-64 63,417 68.9 30,427 69.1 32,990 68.7 65+ 10,671 11.6 4,484 10.2 6,186 12.9 Missing/DK 29 0.0 5 0.0 24 0.0 Child and adult populations Children age 0-17 years 21,705 23.6 11,055 25.1 10,649 22.2 Adults age 18+ years 70,340 76.4 32,973 74.9 37,367 77.8 Missing/DK 29 0.0 5 0.0 24 0.0 P a g e | 7 Across regions, response rates remained very high. Bangkok, which is highly urban, had the lowest response rate. The response rate for households in Bangkok was 86.6 per cent, for eligible women 93.6 per cent, for eligible men 94.1 per cent and for children under 5 years of age 96.2 per cent. Despite many follow-ups and at least three revisits, access to some of the households and respondents was limited due to the absence of knowledgeable or eligible household members or the refusal of the respondent to participate in the survey during the time of visits and subsequent revisits. 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 28,652 households successfully interviewed in the survey, 92,073 household members were listed. Of these, 44,033 were males and 48,040 were females. Table HH.2: Age distribution of household population by sex Per cent and frequency distribution of the household population by five-year age groups, dependency age groups, and by child (age 0-17 years) and adult populations (age 18 or more), by sex, Thailand MICS, 2015-2016 Total Males Females Number Per cent Number Per cent Number Per cent Total 92,073 100.0 44,033 100.0 48,040 100.0 Age 0-4 5,462 5.9 2,846 6.5 2,616 5.4 5-9 6,072 6.6 3,023 6.9 3,049 6.3 10-14 6,422 7.0 3,248 7.4 3,175 6.6 15-19 6,156 6.7 3,172 7.2 2,984 6.2 20-24 5,162 5.6 2,600 5.9 2,562 5.3 25-29 5,117 5.6 2,370 5.4 2,747 5.7 30-34 6,098 6.6 3,021 6.9 3,077 6.4 35-39 7,075 7.7 3,439 7.8 3,636 7.6 40-44 7,084 7.7 3,401 7.7 3,684 7.7 45-49 7,676 8.3 3,585 8.1 4,091 8.5 50-54 7,193 7.8 3,316 7.5 3,877 8.1 55-59 6,729 7.3 3,095 7.0 3,634 7.6 60-64 5,128 5.6 2,430 5.5 2,698 5.6 65-69 3,903 4.2 1,765 4.0 2,137 4.4 70-74 2,811 3.1 1,192 2.7 1,619 3.4 75-79 1,860 2.0 821 1.9 1,039 2.2 80-84 1,130 1.2 376 0.9 754 1.6 85+ 967 1.1 330 0.8 637 1.3 Missing/DK 29 0.0 5 0.0 24 0.0 Dependency age groups 0-14 17,957 19.5 9,117 20.7 8,840 18.4 15-64 63,417 68.9 30,427 69.1 32,990 68.7 65+ 10,671 11.6 4,484 10.2 6,186 12.9 Missing/DK 29 0.0 5 0.0 24 0.0 Child and adult populations Children age 0-17 years 21,705 23.6 11,055 25.1 10,649 22.2 Adults age 18+ years 70,340 76.4 32,973 74.9 37,367 77.8 Missing/DK 29 0.0 5 0.0 24 0.0 P a g e | 8 Table HH.2 shows that 19.5 per cent of the population is under 15 years of age and 11.6 per cent is 65 years or above. Almost one third (31.1 per cent) of the population is dependent on the working age population. Two thirds of the population (68.9 per cent) is of working age (15 to 64 years of age). A large proportion (76.4 per cent) of the population is 18 years or older. It is interesting to note that the proportion of males outnumbers females in the 0-24 and 30-39 age groups. However, this difference narrows, with the proportion of males identical to that of females in the 40-44 age group. In each older age group, the proportion of females surpasses that of males. The gap is most prominent when we compare women and men in the 80-84 and 85+ age groups. The percentage of women in these age groups is almost twice as high as that of men, showing a high survival rate for women in Thailand. The 2010 Population Census indicates that the male population aged 0-24 years is larger than the female population, while the number of women in the 25-29 age group outnumbers that of males. The current MICS reveals a similar pattern, as shown in Figure HH.1. A large percentage of the population is above 30 years of age, showing the trend of an ageing society in the near future. Moreover, the proportion of children up to 14 years of age is relatively low, indicating a reduction in the fertility rate. Figure HH.1: Age and sex distribution of household population, Thailand MICS, 2015-2016 Tables HH.3, HH.4 and HH.5 provide basic information on the households, female respondents aged 15- 49, male respondents aged 15-49, and children aged under 5. Both unweighted and weighted numbers are presented. Such information is essential for the interpretation of findings presented later in the report and provides background information on the representativeness of the survey sample. The remaining tables in this report are presented only with weighted numbers.7 Table HH.3 provides basic background information on the households, including the sex of the household head, region, area, number of household members, education of household head, language8 of the household head and the weighted mean household size. These background characteristics are 7 See Appendix A: Sample Design, for more details on sample weights. 8 This was determined by asking “What is the mother tongue/native language of the head of this household?”. 5 4 3 2 1 0 1 2 3 4 5 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Per cent Age Males Females Note: 29 household members with missing age and/or sex are excluded P a g e | 9 used in subsequent tables in this report; the figures in the table are also intended to show the numbers of observations by major categories of analysis in the report. The weighted and unweighted total number of households is equal, since sample weights were normalized (See Appendix A). Table HH.3: Household composition Per cent and frequency distribution of households by selected characteristics, Thailand MICS, 2015-2016 Weighted per cent Number of households Weighted Unweighted Total 100.0 28,652 28,652 Sex of household head Male 62.7 17,965 17,816 Female 37.3 10,687 10,836 Region Bangkok 13.7 3,932 2,261 Central 30.5 8,747 4,906 North 17.8 5,103 5,059 Northeast 25.0 7,161 8,364 South 12.9 3,708 8,062 Area Urban 47.6 13,638 13,504 Rural 52.4 15,014 15,148 Number of household members 1 13.6 3,885 2,741 2 24.9 7,145 4,924 3 24.2 6,945 6,116 4 18.5 5,287 6,037 5 9.4 2,704 4,169 6 5.2 1,492 2,469 7 2.2 637 1,113 8 1.0 278 551 9 0.5 154 269 10+ 0.4 124 263 Education of household head None 6.1 1,759 2,418 Primary 57.9 16,584 16,365 Secondary 21.9 6,282 6,102 Higher 14.0 4,008 3,695 Missing/DK 0.1 18 72 Language of household head Thai 93.8 26,879 24,523 Non-Thai 6.2 1,773 4,129 Mean household size 3.2 28,652 28,652 Table HH.3 shows that almost 4 in 10 (37.3 per cent) households are female-headed and 6 in 10 (62.7 per cent) have less than four household members. Overall mean household size is 3.2 members (the corresponding figure from the 2010 Population Census is 3.1). It is also interesting to note that nearly 94 per cent of the household heads have attained primary education or above. A total of 6.2 per cent of the household heads speak a language other than Thai as a mother/native tongue. P a g e | 9 used in subsequent tables in this report; the figures in the table are also intended to show the numbers of observations by major categories of analysis in the report. The weighted and unweighted total number of households is equal, since sample weights were normalized (See Appendix A). Table HH.3: Household composition Per cent and frequency distribution of households by selected characteristics, Thailand MICS, 2015-2016 Weighted per cent Number of households Weighted Unweighted Total 100.0 28,652 28,652 Sex of household head Male 62.7 17,965 17,816 Female 37.3 10,687 10,836 Region Bangkok 13.7 3,932 2,261 Central 30.5 8,747 4,906 North 17.8 5,103 5,059 Northeast 25.0 7,161 8,364 South 12.9 3,708 8,062 Area Urban 47.6 13,638 13,504 Rural 52.4 15,014 15,148 Number of household members 1 13.6 3,885 2,741 2 24.9 7,145 4,924 3 24.2 6,945 6,116 4 18.5 5,287 6,037 5 9.4 2,704 4,169 6 5.2 1,492 2,469 7 2.2 637 1,113 8 1.0 278 551 9 0.5 154 269 10+ 0.4 124 263 Education of household head None 6.1 1,759 2,418 Primary 57.9 16,584 16,365 Secondary 21.9 6,282 6,102 Higher 14.0 4,008 3,695 Missing/DK 0.1 18 72 Language of household head Thai 93.8 26,879 24,523 Non-Thai 6.2 1,773 4,129 Mean household size 3.2 28,652 28,652 Table HH.3 shows that almost 4 in 10 (37.3 per cent) households are female-headed and 6 in 10 (62.7 per cent) have less than four household members. Overall mean household size is 3.2 members (the corresponding figure from the 2010 Population Census is 3.1). It is also interesting to note that nearly 94 per cent of the household heads have attained primary education or above. A total of 6.2 per cent of the household heads speak a language other than Thai as a mother/native tongue. P a g e | 10 Characteristics of Female and Male Respondents 15-49 Years of Age and Children Under 5 Tables HH.4, HH.4M and HH.5 provide information on the background characteristics of female and male respondents 15-49 years of age and children under age 5. In all three tables, the total numbers of weighted and unweighted observations are equal, since sample weights have been normalized (standardized).7 In addition to providing useful information on the background characteristics of women, men and children under age 5, the tables are also intended to show the number of observations in each background category. These categories are used in the subsequent tabulations of this report. Table HH.4 provides the background characteristics of female respondents aged 15-49 years. The table includes information on the distribution of women according to region, area, age, marital/union status, motherhood status, births in last two years, education,9 wealth index quintiles,10, 11 and language of the household head. 9 Throughout this report, unless otherwise stated, “education” refers to highest educational level ever attended by the respondent when it is used as a background variable. 10 The wealth index is a composite indicator of wealth. To construct the wealth index, principal components analysis is performed by using information on the ownership of consumer goods, dwelling characteristics, water and sanitation and other characteristics that are related to the household’s wealth, to generate weights (factor scores) for each of the items used. First, initial factor scores are calculated for the total sample. Then, separate factor scores are calculated for households in urban and rural areas. Finally, the urban and rural factor scores are regressed on the initial factor scores to obtain the combined, final factor scores for the total sample. This is carried out to minimize the urban bias in the wealth index values. Each household in the total sample is then assigned a wealth score based on the assets owned by that household and on the final factor scores obtained as described above. The survey household population is then ranked according to the wealth score of the household they are living in, and is finally divided into five equal parts (quintiles) from lowest (poorest) to highest (richest). In the Thailand MICS, the following assets were used in these calculations: household characteristics (main material of the dwelling floor, roof and exterior walls), main type of fuel used for cooking, durable goods (such as refrigerator, electric fan, washing machine, microwave oven, television, watch, mobile phone, motorcycle, car, etc.), ownership of agricultural land, ownership of livestock, bank account, credit card account, main source of drinking water, toilet facility, hand washing, number of servants and number of parents living abroad. 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 L. Pritchett, ‘Estimating wealth effects without expenditure data – or tears: An application to educational enrolments in states of India’, in Demography, vol. 38, no. 1, February 2001, pp. 115–132; Rutstein, Shea O., and Kiersten Johnson, The DHS Wealth Index, DHS Comparative Reports No. 6, August 2004; and Rutstein, Shea O., The DHS Wealth Index: Approaches for Rural and Urban Areas, DHS Working Papers No. 60, 2008. 11 When describing survey results by wealth quintiles, appropriate terminology is used when referring to individual household members, such as for instance “women in the richest population quintile”, which is used interchangeably with “women in the wealthiest survey population”, “women living in households in the richest population wealth quintile”, and similar. P a g e | 11 Table HH.4: Women's background characteristics Per cent and frequency distribution of women age 15-49 years by selected background characteristics, Thailand MICS, 2015-2016 Weighted per cent Number of women Weighted Unweighted Total 100.0 25,614 25,614 Region Bangkok 15.6 3,998 2,283 Central 32.9 8,415 4,524 North 14.9 3,815 4,109 Northeast 23.2 5,937 6,829 South 13.5 3,450 7,869 Area Urban 49.2 12,599 12,251 Rural 50.8 13,015 13,363 Age 15-19 13.1 3,359 3,277 20-24 11.2 2,878 3,016 25-29 12.1 3,089 3,555 30-34 13.4 3,437 4,117 35-39 15.9 4,084 4,008 40-44 16.2 4,141 3,820 45-49 18.1 4,626 3,821 Marital/Union status Currently married/in union 65.4 16,756 18,147 Widowed 1.4 359 371 Divorced 2.4 614 639 Separated 3.6 910 799 Never married/in union 27.2 6,975 5,658 Motherhood and recent births Never gave birth 36.5 9,342 7,021 Ever gave birth 63.5 16,272 18,593 Gave birth in last two years 8.2 2,092 3,382 No birth in last two years 55.4 14,179 15,211 Education None 3.2 829 1,012 Primary 28.4 7,281 7,090 Secondary 43.1 11,043 11,126 Higher 25.2 6,453 6,319 Missing/DK 0.0 8 67 Wealth index quintile Poorest 14.3 3,655 4,933 Second 18.5 4,747 5,198 Middle 21.6 5,522 5,717 Fourth 22.7 5,820 5,618 Richest 22.9 5,870 4,148 Language of household head Thai 92.7 23,755 21,188 Non-Thai 7.3 1,859 4,426 Table HH.4 shows that the highest percentage (32.9 per cent) of women interviewed are from the Central region and the lowest (13.5 per cent) are from the South region. Age distribution of the women shows that a large percentage (50.2 per cent) of women interviewed are from the older age group (35- 49 years). Two thirds are currently married or in union (65.4 per cent) while 7.4 per cent were formerly P a g e | 11 Table HH.4: Women's background characteristics Per cent and frequency distribution of women age 15-49 years by selected background characteristics, Thailand MICS, 2015-2016 Weighted per cent Number of women Weighted Unweighted Total 100.0 25,614 25,614 Region Bangkok 15.6 3,998 2,283 Central 32.9 8,415 4,524 North 14.9 3,815 4,109 Northeast 23.2 5,937 6,829 South 13.5 3,450 7,869 Area Urban 49.2 12,599 12,251 Rural 50.8 13,015 13,363 Age 15-19 13.1 3,359 3,277 20-24 11.2 2,878 3,016 25-29 12.1 3,089 3,555 30-34 13.4 3,437 4,117 35-39 15.9 4,084 4,008 40-44 16.2 4,141 3,820 45-49 18.1 4,626 3,821 Marital/Union status Currently married/in union 65.4 16,756 18,147 Widowed 1.4 359 371 Divorced 2.4 614 639 Separated 3.6 910 799 Never married/in union 27.2 6,975 5,658 Motherhood and recent births Never gave birth 36.5 9,342 7,021 Ever gave birth 63.5 16,272 18,593 Gave birth in last two years 8.2 2,092 3,382 No birth in last two years 55.4 14,179 15,211 Education None 3.2 829 1,012 Primary 28.4 7,281 7,090 Secondary 43.1 11,043 11,126 Higher 25.2 6,453 6,319 Missing/DK 0.0 8 67 Wealth index quintile Poorest 14.3 3,655 4,933 Second 18.5 4,747 5,198 Middle 21.6 5,522 5,717 Fourth 22.7 5,820 5,618 Richest 22.9 5,870 4,148 Language of household head Thai 92.7 23,755 21,188 Non-Thai 7.3 1,859 4,426 Table HH.4 shows that the highest percentage (32.9 per cent) of women interviewed are from the Central region and the lowest (13.5 per cent) are from the South region. Age distribution of the women shows that a large percentage (50.2 per cent) of women interviewed are from the older age group (35- 49 years). Two thirds are currently married or in union (65.4 per cent) while 7.4 per cent were formerly P a g e | 12 married or in union. More than one third (36.5 per cent) of the women aged 15-49 interviewed have never given birth while 8.2 per cent had given a live birth during the last two years. A small percentage (3.2 per cent) of the women interviewed had no education; however, 43.1 per cent of the women interviewed had secondary education. The distribution of the women interviewed by wealth quintiles shows that 14.3 per cent are from the poorest households and 22.9 per cent from the richest quintile. Similarly, Table HH.4M provides background characteristics of the male respondents 15-49 years of age. The table shows information on the distribution of men according to region, area, age, marital status, fatherhood status, education, wealth index quintiles and language of the household head. Table HH.4M shows that one third (33.1 per cent) of the men interviewed are from the Central region followed by almost one quarter (23.9 per cent) from the Northeast region and 13.6 per cent from the South, which had the lowest percentage of men interviewed. In terms of the age distribution of the men interviewed, the highest percentage of male respondents (16.6 per cent) fall into the 45-49 age group compared to the lowest (10.9 per cent) from the 25-29 age group. Almost 6 out of 10 (57.6 per cent) of the men interviewed are currently married or in union, while 6.4 per cent were formerly married or in union. More than half (52.3 per cent) of the men interviewed had at least one living child. Overall, 3.1 per cent had no education compared to 46.2 per cent with secondary education. The proportion of men interviewed who are from the poorest quintile (17.9 per cent) is lower than those from other quintiles (19-21 per cent) and 92.0 per cent of the men are from households headed by a Thai speaker. P a g e | 13 Table HH.4M: Men's background characteristics Per cent and frequency distribution of men age 15-49 years by selected background characteristics, Thailand MICS, 2015-2016 Weighted per cent Number of men Weighted Unweighted Total 100.0 23,183 23,183 Region Bangkok 14.9 3,460 2,044 Central 33.1 7,663 4,216 North 14.5 3,358 3,600 Northeast 23.9 5,547 6,147 South 13.6 3,155 7,176 Area Urban 48.4 11,216 10,912 Rural 51.6 11,967 12,271 Age 15-19 14.7 3,400 3,180 20-24 12.1 2,797 2,622 25-29 10.9 2,524 3,014 30-34 14.1 3,267 3,704 35-39 15.8 3,666 3,703 40-44 15.9 3,678 3,558 45-49 16.6 3,850 3,402 Marital/Union status Currently married/in union 57.6 13,346 14,685 Widowed 0.4 83 54 Divorced 1.8 427 386 Separated 4.2 979 675 Never married/in union 36.0 8,342 7,379 Missing/DK 0.0 6 4 Fatherhood status Has at least one living child 52.3 12,123 14,095 Has no living children 47.4 10,993 9,029 Missing/DK 0.3 67 59 Education None 3.1 728 681 Primary 29.6 6,870 7,106 Secondary 46.2 10,713 10,797 Higher 21.0 4,865 4,540 Missing/DK 0.0 7 59 Wealth index quintile Poorest 17.9 4,155 5,036 Second 20.5 4,757 4,808 Middle 21.0 4,875 5,065 Fourth 21.3 4,937 4,861 Richest 19.2 4,460 3,413 Language of household head Thai 92.0 21,325 19,084 Non-Thai 8.0 1,858 4,099 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 in months, respondent type, mother’s (or caretaker’s) education, wealth, and language of the household head. P a g e | 13 Table HH.4M: Men's background characteristics Per cent and frequency distribution of men age 15-49 years by selected background characteristics, Thailand MICS, 2015-2016 Weighted per cent Number of men Weighted Unweighted Total 100.0 23,183 23,183 Region Bangkok 14.9 3,460 2,044 Central 33.1 7,663 4,216 North 14.5 3,358 3,600 Northeast 23.9 5,547 6,147 South 13.6 3,155 7,176 Area Urban 48.4 11,216 10,912 Rural 51.6 11,967 12,271 Age 15-19 14.7 3,400 3,180 20-24 12.1 2,797 2,622 25-29 10.9 2,524 3,014 30-34 14.1 3,267 3,704 35-39 15.8 3,666 3,703 40-44 15.9 3,678 3,558 45-49 16.6 3,850 3,402 Marital/Union status Currently married/in union 57.6 13,346 14,685 Widowed 0.4 83 54 Divorced 1.8 427 386 Separated 4.2 979 675 Never married/in union 36.0 8,342 7,379 Missing/DK 0.0 6 4 Fatherhood status Has at least one living child 52.3 12,123 14,095 Has no living children 47.4 10,993 9,029 Missing/DK 0.3 67 59 Education None 3.1 728 681 Primary 29.6 6,870 7,106 Secondary 46.2 10,713 10,797 Higher 21.0 4,865 4,540 Missing/DK 0.0 7 59 Wealth index quintile Poorest 17.9 4,155 5,036 Second 20.5 4,757 4,808 Middle 21.0 4,875 5,065 Fourth 21.3 4,937 4,861 Richest 19.2 4,460 3,413 Language of household head Thai 92.0 21,325 19,084 Non-Thai 8.0 1,858 4,099 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 in months, respondent type, mother’s (or caretaker’s) education, wealth, and language of the household head. P a g e | 14 Table HH.5: Under-5's background characteristics Per cent and frequency distribution of children under 5 years of age by selected characteristics, Thailand MICS, 2015-2016 Weighted per cent Number of under-5 children Weighted Unweighted Total 100.0 12,250 12,250 Sex Male 52.2 6,392 6,283 Female 47.8 5,858 5,967 Region Bangkok 9.4 1,146 737 Central 28.9 3,546 1,964 North 17.0 2,084 2,201 Northeast 28.9 3,545 3,738 South 15.7 1,929 3,610 Area Urban 40.7 4,988 5,472 Rural 59.3 7,262 6,778 Age 0-5 months 9.3 1,138 661 6-11 months 7.9 973 722 12-23 months 20.5 2,510 2,500 24-35 months 20.8 2,550 2,764 36-47 months 20.9 2,560 2,838 48-59 months 20.6 2,519 2,765 Respondent to the under-5 questionnaire Mother 78.5 9,620 9,716 Other primary caretaker 21.5 2,630 2,534 Mother’s educationa None 4.8 587 524 Primary 29.0 3,557 3,670 Secondary 45.4 5,562 5,063 Higher 20.7 2,537 2,959 Missing/DK 0.1 6 34 Wealth index quintile Poorest 20.9 2,565 2,844 Second 21.8 2,675 2,614 Middle 19.3 2,366 2,536 Fourth 22.3 2,727 2,535 Richest 15.6 1,917 1,721 Language of household head Thai 90.7 11,112 10,276 Non-Thai 9.3 1,138 1,974 a In this table and throughout the report, mother's education refers to educational attainment of mothers as well as caretakers of children under 5, who are the respondents to the under-5 questionnaire if the mother is deceased or is living elsewhere. Table HH.5 shows that approximately 1 out of 10 (9.4 per cent) children under 5 surveyed are from Bangkok compared to 28.9 per cent from both the Northeast and the Central region. Similarly, 59.3 per cent are from rural areas. In almost four out of five (78.5 per cent) cases, the respondent to the under-5 questionnaire was the natural mother and less than 5 per cent of respondents had no education. A total P a g e | 15 of 15.6 per cent of the children were from the richest quintile compared to 19 per cent to 22 per cent from other quintiles. One out of 10 (9.3 per cent) children surveyed were from a household headed by a non-Thai speaker. Housing Characteristics, Asset Ownership and Wealth Quintiles Tables HH.6, HH.7 and HH.8 provide further details on household level characteristics. Table HH.6 presents characteristics of housing, disaggregated by area and region, distributed by whether the dwelling has electricity, the main materials of the flooring, roof, and exterior walls, as well as the number of rooms used for sleeping. Table HH.6 shows that almost all the households have access to electricity. Well above 99 per cent of the households have electricity across urban, rural and the five regions. However, some differences were found in the main material of the household flooring. Almost 4 out of 10 (37.3 per cent) households in the North region had rudimentary flooring compared to less than 1 in 10 (9.8 per cent) in the South region. Rural households are more likely (22.8 per cent) to have a rudimentary floor compared to urban households (15.0 per cent). Almost one in five (19.1 per cent) households have rudimentary floors at national level. The percentage of households with finished roofs and finished exterior walls is also very high across all the regions and urban-rural areas. In terms of the number of rooms for sleeping, both urban and rural areas have the same characteristics in the sense that most of the households have two or fewer rooms (80.5 per cent and 82.8 per cent respectively). Bangkok has the lowest percentage of households with two or fewer rooms for sleeping but almost double the proportion of households with at least three rooms compared to those in the Central and South regions. Furthermore, the mean number of persons sleeping per room is highest in the South and rural areas (1.99 persons per room) followed by the Northeast (1.97 persons per room). P a g e | 15 of 15.6 per cent of the children were from the richest quintile compared to 19 per cent to 22 per cent from other quintiles. One out of 10 (9.3 per cent) children surveyed were from a household headed by a non-Thai speaker. Housing Characteristics, Asset Ownership and Wealth Quintiles Tables HH.6, HH.7 and HH.8 provide further details on household level characteristics. Table HH.6 presents characteristics of housing, disaggregated by area and region, distributed by whether the dwelling has electricity, the main materials of the flooring, roof, and exterior walls, as well as the number of rooms used for sleeping. Table HH.6 shows that almost all the households have access to electricity. Well above 99 per cent of the households have electricity across urban, rural and the five regions. However, some differences were found in the main material of the household flooring. Almost 4 out of 10 (37.3 per cent) households in the North region had rudimentary flooring compared to less than 1 in 10 (9.8 per cent) in the South region. Rural households are more likely (22.8 per cent) to have a rudimentary floor compared to urban households (15.0 per cent). Almost one in five (19.1 per cent) households have rudimentary floors at national level. The percentage of households with finished roofs and finished exterior walls is also very high across all the regions and urban-rural areas. In terms of the number of rooms for sleeping, both urban and rural areas have the same characteristics in the sense that most of the households have two or fewer rooms (80.5 per cent and 82.8 per cent respectively). Bangkok has the lowest percentage of households with two or fewer rooms for sleeping but almost double the proportion of households with at least three rooms compared to those in the Central and South regions. Furthermore, the mean number of persons sleeping per room is highest in the South and rural areas (1.99 persons per room) followed by the Northeast (1.97 persons per room). P a g e | 16 Table HH.6: Housing characteristics Per cent distribution of households by selected housing characteristics, according to area of residence and regions, Thailand MICS, 2015-2016 Total Area Region Urban Rural Bangkok Central North Northeas t South Electricity Yes 99.6 99.7 99.5 99.6 99.5 99.5 99.7 99.7 No 0.4 0.3 0.5 0.4 0.5 0.5 0.3 0.3 Flooring Natural floor 0.6 0.2 0.9 0.1 0.8 0.2 0.9 0.2 Rudimentary floor 19.1 15.0 22.8 11.3 16.8 37.3 18.1 9.8 Finished floor 80.2 84.6 76.3 87.9 82.4 62.5 81.0 89.8 Other 0.1 0.2 0.0 0.6 0.0 0.0 0.0 0.1 Roof Natural roofing 0.2 0.0 0.3 0.0 0.0 0.5 0.1 0.2 Rudimentary roofing 0.4 0.4 0.4 0.4 0.2 0.5 0.4 0.6 Finished roofing 99.4 99.6 99.3 99.3 99.8 99.0 99.4 99.2 Other 0.1 0.1 0.0 0.2 0.0 0.0 0.1 0.0 Exterior walls Natural walls 0.3 0.2 0.3 0.2 0.2 0.3 0.4 0.3 Rudimentary walls 2.4 2.1 2.7 2.1 2.7 2.7 2.1 2.1 Finished walls 97.1 97.5 96.8 97.1 96.9 97.0 97.4 97.3 Other 0.2 0.2 0.2 0.7 0.2 0.1 0.1 0.2 Rooms used for sleeping 1 42.2 41.8 42.5 38.0 47.1 42.5 38.5 41.8 2 39.6 38.7 40.3 34.6 37.6 40.5 42.7 42.1 3 or more 18.3 19.5 17.2 27.5 15.3 17.0 18.8 16.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 28,652 13,638 15,014 3,932 8,747 5,103 7,161 3,708 Mean number of persons per room used for sleeping 1.91 1.82 1.99 1.71 1.96 1.81 1.97 1.99 In Table HH.7 households are distributed according to ownership of assets by households and by individual household members. This also includes ownership of the dwelling. Overall, 13.5 per cent of households at national level own a non-mobile telephone. Households in urban areas are almost four times (22.1 per cent) more likely to own a non-mobile phone compared to their rural (5.8 per cent) counterparts and 3.6 per cent of households in the Northeast region possess a non- mobile phone. More than half of the households in Bangkok have an oven or microwave oven (51.4 per cent), air conditioner (55.5 per cent), computer (53.7 per cent) and LED/LCD/Plasma TV (56.3 per cent), while less than 40 per cent of households in other regions have these items. P a g e | 17 Table HH.7: Household and personal assets Percentage of households by ownership of selected household and personal assets, and per cent distribution by ownership of dwelling, according to area of residence and regions, Thailand MICS, 2015-2016 Total Area Region Urban Rural Bangkok Central North Northeast South Percentage of households that own a Electricity 99.6 99.7 99.5 99.6 99.5 99.5 99.7 99.7 Radio 56.8 57.3 56.3 61.0 50.2 66.3 64.0 40.6 Non-mobile phone 13.5 22.1 5.8 42.1 15.0 6.7 3.6 8.2 Refrigerator 91.9 91.2 92.6 89.0 92.5 92.0 92.7 92.2 Electric fan 98.6 99.3 98.0 99.4 99.2 96.8 98.9 98.4 Washing machine 70.1 71.2 69.0 68.1 67.7 76.6 67.2 74.2 Oven/Microwave oven 28.4 37.3 20.3 51.4 30.1 22.6 20.1 23.9 Computer 32.0 41.0 23.9 53.7 32.9 28.2 24.3 27.2 Tablet 24.6 29.5 20.1 38.9 26.9 19.0 18.8 22.8 VCD/DVD player 54.2 60.6 48.4 69.9 59.2 48.6 45.6 49.9 Blu-ray player 2.6 3.7 1.6 6.2 3.0 1.6 1.2 1.9 Air Conditioner 28.2 39.5 17.9 55.5 35.7 20.2 13.8 20.0 Television (Plain monitor) 77.0 72.9 80.7 65.1 74.4 83.3 83.4 74.5 Television 38.0 45.4 31.2 56.3 45.0 27.9 28.0 35.0 (LCD/LED/Plasma monitor) Percentage of households that own Agricultural land 42.3 27.9 55.4 13.0 27.1 49.9 67.0 51.0 Farm animals/Livestock 26.0 12.9 38.0 1.1 10.7 36.9 49.9 27.7 Percentage of households where at least one member owns or has a Watch 69.1 76.2 62.8 87.8 76.3 58.3 56.9 70.8 Bicycle 60.8 56.7 64.4 46.1 57.8 67.1 74.5 48.0 Car or truck 46.4 50.4 42.8 52.1 49.7 44.3 40.6 46.6 Boat with motor 1.3 1.0 1.5 1.1 1.3 0.5 1.1 2.6 Two-wheeled tractor 16.2 8.1 23.6 1.0 7.4 23.3 37.2 3.0 Four-wheeled tractor 4.2 2.7 5.6 1.7 2.8 6.4 7.1 1.7 Traditional mobile telephone 68.6 62.0 74.6 52.5 62.8 76.7 78.5 68.9 Smart phone 68.2 75.1 62.0 84.5 72.6 58.3 60.0 69.9 Motorcycle or scooter 78.8 72.2 84.9 47.6 75.9 86.9 88.4 89.3 Sport motorcycle (Big bike) 1.4 1.8 1.1 1.9 1.4 1.2 1.2 1.6 Bank account 89.9 91.6 88.5 94.7 89.7 86.6 90.5 89.0 Credit card 23.7 30.1 17.8 46.3 24.1 15.4 19.0 18.9 Ownership of dwelling Owned by a household member 79.6 69.5 88.7 57.1 72.4 87.6 93.8 81.9 Not owned 20.4 30.5 11.3 42.9 27.6 12.4 6.2 18.1 Rented 14.5 23.7 6.1 33.6 22.0 5.2 2.6 11.9 Other 6.0 6.8 5.2 9.3 5.6 7.2 3.6 6.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 28,652 13,638 15,014 3,932 8,747 5,103 7,161 3,708 Households in rural areas are twice as likely (55.4 per cent) to own agricultural land compared to their urban counterparts (27.9 per cent). Similarly, rural households are three times more likely (38.0 per cent) to own farm animals and livestock compared to urban households (12.9 per cent). Farm animal and livestock ownership is lowest in Bangkok (1.1 per cent) while in the Northeast every second household (49.9 per cent) owns farm animals and livestock. P a g e | 17 Table HH.7: Household and personal assets Percentage of households by ownership of selected household and personal assets, and per cent distribution by ownership of dwelling, according to area of residence and regions, Thailand MICS, 2015-2016 Total Area Region Urban Rural Bangkok Central North Northeast South Percentage of households that own a Electricity 99.6 99.7 99.5 99.6 99.5 99.5 99.7 99.7 Radio 56.8 57.3 56.3 61.0 50.2 66.3 64.0 40.6 Non-mobile phone 13.5 22.1 5.8 42.1 15.0 6.7 3.6 8.2 Refrigerator 91.9 91.2 92.6 89.0 92.5 92.0 92.7 92.2 Electric fan 98.6 99.3 98.0 99.4 99.2 96.8 98.9 98.4 Washing machine 70.1 71.2 69.0 68.1 67.7 76.6 67.2 74.2 Oven/Microwave oven 28.4 37.3 20.3 51.4 30.1 22.6 20.1 23.9 Computer 32.0 41.0 23.9 53.7 32.9 28.2 24.3 27.2 Tablet 24.6 29.5 20.1 38.9 26.9 19.0 18.8 22.8 VCD/DVD player 54.2 60.6 48.4 69.9 59.2 48.6 45.6 49.9 Blu-ray player 2.6 3.7 1.6 6.2 3.0 1.6 1.2 1.9 Air Conditioner 28.2 39.5 17.9 55.5 35.7 20.2 13.8 20.0 Television (Plain monitor) 77.0 72.9 80.7 65.1 74.4 83.3 83.4 74.5 Television 38.0 45.4 31.2 56.3 45.0 27.9 28.0 35.0 (LCD/LED/Plasma monitor) Percentage of households that own Agricultural land 42.3 27.9 55.4 13.0 27.1 49.9 67.0 51.0 Farm animals/Livestock 26.0 12.9 38.0 1.1 10.7 36.9 49.9 27.7 Percentage of households where at least one member owns or has a Watch 69.1 76.2 62.8 87.8 76.3 58.3 56.9 70.8 Bicycle 60.8 56.7 64.4 46.1 57.8 67.1 74.5 48.0 Car or truck 46.4 50.4 42.8 52.1 49.7 44.3 40.6 46.6 Boat with motor 1.3 1.0 1.5 1.1 1.3 0.5 1.1 2.6 Two-wheeled tractor 16.2 8.1 23.6 1.0 7.4 23.3 37.2 3.0 Four-wheeled tractor 4.2 2.7 5.6 1.7 2.8 6.4 7.1 1.7 Traditional mobile telephone 68.6 62.0 74.6 52.5 62.8 76.7 78.5 68.9 Smart phone 68.2 75.1 62.0 84.5 72.6 58.3 60.0 69.9 Motorcycle or scooter 78.8 72.2 84.9 47.6 75.9 86.9 88.4 89.3 Sport motorcycle (Big bike) 1.4 1.8 1.1 1.9 1.4 1.2 1.2 1.6 Bank account 89.9 91.6 88.5 94.7 89.7 86.6 90.5 89.0 Credit card 23.7 30.1 17.8 46.3 24.1 15.4 19.0 18.9 Ownership of dwelling Owned by a household member 79.6 69.5 88.7 57.1 72.4 87.6 93.8 81.9 Not owned 20.4 30.5 11.3 42.9 27.6 12.4 6.2 18.1 Rented 14.5 23.7 6.1 33.6 22.0 5.2 2.6 11.9 Other 6.0 6.8 5.2 9.3 5.6 7.2 3.6 6.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 28,652 13,638 15,014 3,932 8,747 5,103 7,161 3,708 Households in rural areas are twice as likely (55.4 per cent) to own agricultural land compared to their urban counterparts (27.9 per cent). Similarly, rural households are three times more likely (38.0 per cent) to own farm animals and livestock compared to urban households (12.9 per cent). Farm animal and livestock ownership is lowest in Bangkok (1.1 per cent) while in the Northeast every second household (49.9 per cent) owns farm animals and livestock. P a g e | 18 At least 4 out of 10 households in the North (44.3 per cent), Northeast (40.6 per cent) and South (46.6 per cent) have a household member who owns a car or truck while 5 out of 10 households (52.1 per cent) in Bangkok and the Central region (49.7 per cent) have a household member who owns a car or truck. Interestingly, ownership of a motorcycle or scooter tells a different story. The percentage of households where a member of the household owns a motorcycle or scooter is lowest in Bangkok (47.6 per cent) while almost 9 out of 10 households in the North (86.9 per cent), Northeast (88.4 per cent) and South (89.3 per cent) regions have a member who owns a motorcycle or scooter. There are noticeable differences in smartphone ownership. In Bangkok, 84.5 per cent of households have a household member who owns a smartphone. This percentage drops to 58.3 per cent in the North region. However, ownership of a mobile phone (conventional) by a member of the household is highest in the Northeast (78.5 per cent) followed by the North (76.7 per cent) and lowest in Bangkok (52.5 per cent). Ownership of the dwelling by a household member is lowest in Bangkok (57.1 per cent) and highest in the Northeast region (93.8 per cent). Ownership of the dwelling is more common in rural areas (88.7 per cent) than urban areas (69.5 per cent). Table HH.8 shows how the household population in areas and regions is distributed according to household wealth quintiles. Table HH.8 shows that 31.8 per cent of the household population in urban areas falls into the richest category compared to 9.8 per cent in rural areas. This difference is widest in Bangkok where more than half (51.6 per cent) of the household population falls into the richest quintile and less than two per cent into the poorest quintile. However, in the North and Northeast regions, 30.0 per cent and 39.8 per cent respectively fall into the poorest quintile. Interestingly, in the South region, most of the population falls into the middle three quintiles. Almost three quarters (74.6 per cent) of the household population falls into the second (21.3 per cent), middle (27.5 per cent) and fourth (25.8 per cent) wealth quintiles. Table HH.8: Wealth quintiles Per cent distribution of the household population by wealth index quintile, according to area of residence and regions, Thailand MICS, 2015-2016 Wealth index quintile Total Number of Poorest Second Middle Fourth Richest household members Total 20.0 20.0 20.0 20.0 20.0 100.0 92,073 Area Urban 11.4 13.7 18.9 24.1 31.8 100.0 42,713 Rural 27.4 25.4 20.9 16.4 9.8 100.0 49,360 Region Bangkok 1.7 9.0 14.0 23.7 51.6 100.0 12,517 Central 8.9 17.6 23.2 24.5 25.9 100.0 27,739 North 30.0 25.2 17.6 16.3 10.9 100.0 15,301 Northeast 39.8 24.6 17.2 12.3 6.2 100.0 24,242 South 12.2 21.3 27.5 25.8 13.2 100.0 12,273 IV. NUTRITION P a g e | 19 IV. Nutrition Low Birth Weight Weight at birth is a good indicator not only of a mother's health and nutritional status but also the newborn's chances for survival, growth, long-term health and psychosocial development. Low birth weight (defined as less than 2,500 grams) carries a range of grave health risks for children. Babies who were undernourished in the womb face a greatly increased risk of dying during their early days, months and years. Those who survive may have impaired immune function and increased risk of disease; they are likely to remain undernourished, with reduced muscle strength, throughout their lives, and suffer a higher incidence of diabetes and heart disease in later life. Children born with low birth weight also risk a lower IQ and cognitive disabilities, affecting their performance in school and their job opportunities as adults. In the developing world, low birth weight stems primarily from the mother's poor health and nutrition. Three factors have the most impact: the mother's poor nutritional status before conception, short stature (due mostly to undernutrition and infections during her childhood) and poor nutrition during pregnancy. Inadequate weight gain during pregnancy is particularly important since it accounts for a large proportion of foetal growth retardation. Moreover, diseases such as diarrhoea and malaria, which are common in many developing countries, can significantly impair foetal growth if the mother becomes infected while pregnant. In the industrialized world, cigarette smoking during pregnancy is the leading cause of low birth weight. In developed and developing countries alike, teenagers who give birth when their own bodies have yet to finish growing run a higher risk of bearing low birth weight babies. One of the major challenges in measuring the incidence of low birth weight is that more than half of infants in the developing world are not weighed at birth. In the past, most estimates of low birth weight for developing countries were based on data compiled from health facilities. However, these estimates are biased for most developing countries because the majority of newborns are not delivered in facilities, and those who are represent only a selected sample of all births. Because many infants are not weighed at birth and those who are weighed may be a biased sample of all births, the reported birth weights usually cannot be used to estimate the prevalence of low birth weight among all children. Therefore, the percentage of births weighing below 2,500 grams is estimated from two items in the questionnaire: the mother’s assessment of the child’s size at birth (i.e., very small, smaller than average, average, larger than average, very large) and the mother’s recall of the child’s weight or the weight as recorded on a health card if the child was weighed at birth.12 12 For a detailed description of the methodology, see Boerma, J.T., et al., Data on Birth Weight in Developing Countries: Can Surveys Help? Bulletin of the World Health Organization, vol. 74, no. 2, 1996, pp. 209–216. P a g e | 20 Table NU.1: Low birth weight infants Percentage of last live-born children in the last two years that are estimated to have weighed below 2,500 grams at birth and percentage of live births weighed at birth, Thailand MICS, 2015-2016 Per cent distribution of births by mother's Total Percentage of Number of assessment of size at birth live births: last live-born Very Smaller Average Larger DK Below Weighed children in small than than 2,500 at birth2 the last average average grams1 two years or very large Total 0.6 10.4 72.8 15.9 0.4 100.0 9.4 98.9 2,092 Mother's age at birth Less than 20 years 0.1 12.8 75.5 11.5 0.2 100.0 10.4 99.5 319 20-34 years 0.6 8.8 73.2 16.9 0.5 100.0 8.7 98.5 1,464 35-49 years 0.7 15.1 68.0 16.1 0.1 100.0 11.9 99.6 309 Birth order 1 0.3 10.1 73.8 15.6 0.3 100.0 8.9 98.3 1,000 2-3 0.5 11.0 72.3 15.8 0.3 100.0 9.9 99.5 1,013 4-5 4.6 6.5 64.8 22.7 1.4 100.0 10.3 98.5 71 6+ (0.5) (6.4) (80.4) (12.7) (0.0) (100.0) (7.2) (88.1) 8 Region Bangkok 0.1 6.1 79.5 13.0 1.3 100.0 6.8 95.8 231 Central 0.3 9.5 74.3 15.8 0.1 100.0 8.6 99.7 713 North 0.3 12.8 68.5 18.2 0.2 100.0 10.3 97.7 354 Northeast 0.1 11.7 73.1 14.8 0.4 100.0 9.9 99.6 437 South 2.3 10.8 69.4 17.1 0.4 100.0 11.3 99.4 359 Area Urban 0.5 8.7 75.5 14.7 0.6 100.0 8.5 97.9 932 Rural 0.6 11.7 70.6 16.9 0.1 100.0 10.1 99.6 1,160 Mother’s education None 0.0 13.0 78.8 7.9 0.3 100.0 10.3 91.6 103 Primary 0.5 10.6 70.5 18.2 0.2 100.0 9.5 99.9 300 Secondary 0.8 10.1 73.4 15.3 0.4 100.0 9.4 99.0 1,173 Higher 0.2 10.3 71.6 17.7 0.3 100.0 9.2 99.4 514 Missing/DK (*) (*) (*) (*) (*) (*) (*) (*) 1 Wealth index quintile Poorest 0.3 11.1 73.5 14.4 0.7 100.0 10.1 98.4 305 Second 0.1 13.5 67.3 19.1 0.0 100.0 10.4 98.5 491 Middle 1.1 9.4 76.1 13.4 0.0 100.0 9.3 98.7 425 Fourth 0.8 6.4 74.6 17.4 0.8 100.0 7.6 99.1 540 Richest 0.4 12.8 73.1 13.4 0.2 100.0 10.5 99.5 331 Language of household head Thai 0.6 10.4 72.6 16.1 0.4 100.0 9.4 99.2 1,881 Non-Thai 0.6 10.3 74.6 14.3 0.2 100.0 9.3 95.8 211 1 MICS indicator 2.20 - Low-birthweight infants 2 MICS indicator 2.21 - Infants weighed at birth ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Overall, 98.9 per cent of infants were weighed at birth and approximately 9.4 per cent of infants are estimated to weigh less than 2,500 grams at birth (Table NU.1). There was some variation by region, with the highest percentage of infants weighing under 2,500 grams in the South (11.3 per cent) and the lowest in Bangkok (6.8 per cent). The prevalence of low birth weight is slightly higher in rural areas (10.1 per cent) compared to urban areas (8.5 per cent). Interestingly, children born in the second richest P a g e | 20 Table NU.1: Low birth weight infants Percentage of last live-born children in the last two years that are estimated to have weighed below 2,500 grams at birth and percentage of live births weighed at birth, Thailand MICS, 2015-2016 Per cent distribution of births by mother's Total Percentage of Number of assessment of size at birth live births: last live-born Very Smaller Average Larger DK Below Weighed children in small than than 2,500 at birth2 the last average average grams1 two years or very large Total 0.6 10.4 72.8 15.9 0.4 100.0 9.4 98.9 2,092 Mother's age at birth Less than 20 years 0.1 12.8 75.5 11.5 0.2 100.0 10.4 99.5 319 20-34 years 0.6 8.8 73.2 16.9 0.5 100.0 8.7 98.5 1,464 35-49 years 0.7 15.1 68.0 16.1 0.1 100.0 11.9 99.6 309 Birth order 1 0.3 10.1 73.8 15.6 0.3 100.0 8.9 98.3 1,000 2-3 0.5 11.0 72.3 15.8 0.3 100.0 9.9 99.5 1,013 4-5 4.6 6.5 64.8 22.7 1.4 100.0 10.3 98.5 71 6+ (0.5) (6.4) (80.4) (12.7) (0.0) (100.0) (7.2) (88.1) 8 Region Bangkok 0.1 6.1 79.5 13.0 1.3 100.0 6.8 95.8 231 Central 0.3 9.5 74.3 15.8 0.1 100.0 8.6 99.7 713 North 0.3 12.8 68.5 18.2 0.2 100.0 10.3 97.7 354 Northeast 0.1 11.7 73.1 14.8 0.4 100.0 9.9 99.6 437 South 2.3 10.8 69.4 17.1 0.4 100.0 11.3 99.4 359 Area Urban 0.5 8.7 75.5 14.7 0.6 100.0 8.5 97.9 932 Rural 0.6 11.7 70.6 16.9 0.1 100.0 10.1 99.6 1,160 Mother’s education None 0.0 13.0 78.8 7.9 0.3 100.0 10.3 91.6 103 Primary 0.5 10.6 70.5 18.2 0.2 100.0 9.5 99.9 300 Secondary 0.8 10.1 73.4 15.3 0.4 100.0 9.4 99.0 1,173 Higher 0.2 10.3 71.6 17.7 0.3 100.0 9.2 99.4 514 Missing/DK (*) (*) (*) (*) (*) (*) (*) (*) 1 Wealth index quintile Poorest 0.3 11.1 73.5 14.4 0.7 100.0 10.1 98.4 305 Second 0.1 13.5 67.3 19.1 0.0 100.0 10.4 98.5 491 Middle 1.1 9.4 76.1 13.4 0.0 100.0 9.3 98.7 425 Fourth 0.8 6.4 74.6 17.4 0.8 100.0 7.6 99.1 540 Richest 0.4 12.8 73.1 13.4 0.2 100.0 10.5 99.5 331 Language of household head Thai 0.6 10.4 72.6 16.1 0.4 100.0 9.4 99.2 1,881 Non-Thai 0.6 10.3 74.6 14.3 0.2 100.0 9.3 95.8 211 1 MICS indicator 2.20 - Low-birthweight infants 2 MICS indicator 2.21 - Infants weighed at birth ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Overall, 98.9 per cent of infants were weighed at birth and approximately 9.4 per cent of infants are estimated to weigh less than 2,500 grams at birth (Table NU.1). There was some variation by region, with the highest percentage of infants weighing under 2,500 grams in the South (11.3 per cent) and the lowest in Bangkok (6.8 per cent). The prevalence of low birth weight is slightly higher in rural areas (10.1 per cent) compared to urban areas (8.5 per cent). Interestingly, children born in the second richest P a g e | 21 households are less likely to be low weight at birth (7.6 per cent) compared to children born in other wealth quintiles. Table NU.S1: Low birth weight children Percentage of under-five children who weighed below 2,500 grams at birth, Thailand, 2015-2016 Percentage of weight at birth: Number of under- Below 2,500 grams Not weighed/ Total five children 2,500 grams 1 and above DK/Missing Total 8.6 88.2 3.2 100.0 12,250 Region Bangkok 5.9 87.2 6.8 100.0 1,146 Central 8.7 88.1 3.2 100.0 3,546 North 10.1 86.6 3.2 100.0 2,084 Northeast 8.2 89.8 2.0 100.0 3,545 South 9.4 87.6 3.0 100.0 1,929 Area Urban 7.9 88.4 3.7 100.0 4,988 Rural 9.1 88.0 2.8 100.0 7,262 Mother's education None 11.2 81.3 7.5 100.0 587 Primary 9.9 86.1 4.0 100.0 3,557 Secondary 7.0 90.4 2.5 100.0 5,562 Higher 9.8 87.7 2.5 100.0 2,537 Missing/DK (7.0) (89.9) (3.1) (100.0) 6 Wealth index quintile Poorest 8.5 88.2 3.3 100.0 2,565 Second 9.1 87.6 3.3 100.0 2,675 Middle 8.5 88.4 3.1 100.0 2,366 Fourth 7.6 89.2 3.2 100.0 2,727 Richest 9.8 87.2 3.0 100.0 1,917 Language of household head Thai 8.6 88.3 3.0 100.0 11,112 Non-Thai 8.7 86.4 4.9 100.0 1,138 1 Country specific indicator 2.S20 - Low-birthweight infants (born in last five years) ( ) Figures that are based on 25-49 unweighted cases Apart from the birth weight for children born during the last two years, the birth weight records for under-five children were collected. In cases where the birth weight was recorded on the child’s health card, information was copied onto the questionnaire, otherwise mothers were asked to recall the child’s birth weight. Table NU.S1 shows that in Thailand, 8.6 per cent of children at birth weighed below 2,500 grams. Children in the North were almost twice as likely (10.1 per cent) to weigh below 2,500 grams at birth compared with children in Bangkok (5.9 per cent). Children born in rural areas (9.1 per cent) and children born to mothers with no education (11.2 per cent) were more likely to weigh below 2,500 grams at birth. P a g e | 22 Nutritional Status Children’s nutritional status is a reflection of their overall health. When children have access to an adequate food supply, are not exposed to repeated illness and are well cared for, they reach their growth potential and are considered well nourished. Undernutrition is associated with more than half of all child deaths worldwide. Undernourished children are more likely to die from common childhood ailments, and for those who survive, have recurring sicknesses and faltering growth. Three quarters of children who die from causes related to malnutrition were only mildly or moderately malnourished – showing no outward sign of their vulnerability. The Millennium Development Goal target 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 five. Under-nourishment in a population can be gauged by comparing children to a reference population. The reference population used in this report is based on the WHO growth standards.13 Each of the three nutritional status indicators – weight-for-age, height-for-age, and weight-for-height – can be expressed in standard deviation units (z-scores) from the median of the reference population. Weight-for-age is a measure of both acute and chronic malnutrition. Children whose weight-for-age is more than two but equal or 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 equal or 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. Weight-for-height can be used to assess wasting and overweight status. Children whose weight-for- height is more than two but equal or 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 of wasting may exhibit significant seasonal shifts associated with changes in the availability of food or disease prevalence. Children whose weight-for-height is more than two standard deviations above the median reference population are classified as moderately or severely overweight. In the Thailand MICS, the weights and heights of all children under 5 years of age were measured using the anthropometric equipment recommended14 by UNICEF. Findings in this section are based on the results of these measurements. 13 http://www.who.int/childgrowth/standards/technical_report 14 See MICS Supply Procurement Instructions: http://www.childinfo.org/mics5_planning.html P a g e | 22 Nutritional Status Children’s nutritional status is a reflection of their overall health. When children have access to an adequate food supply, are not exposed to repeated illness and are well cared for, they reach their growth potential and are considered well nourished. Undernutrition is associated with more than half of all child deaths worldwide. Undernourished children are more likely to die from common childhood ailments, and for those who survive, have recurring sicknesses and faltering growth. Three quarters of children who die from causes related to malnutrition were only mildly or moderately malnourished – showing no outward sign of their vulnerability. The Millennium Development Goal target 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 five. Under-nourishment in a population can be gauged by comparing children to a reference population. The reference population used in this report is based on the WHO growth standards.13 Each of the three nutritional status indicators – weight-for-age, height-for-age, and weight-for-height – can be expressed in standard deviation units (z-scores) from the median of the reference population. Weight-for-age is a measure of both acute and chronic malnutrition. Children whose weight-for-age is more than two but equal or 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 equal or 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. Weight-for-height can be used to assess wasting and overweight status. Children whose weight-for- height is more than two but equal or 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 of wasting may exhibit significant seasonal shifts associated with changes in the availability of food or disease prevalence. Children whose weight-for-height is more than two standard deviations above the median reference population are classified as moderately or severely overweight. In the Thailand MICS, the weights and heights of all children under 5 years of age were measured using the anthropometric equipment recommended14 by UNICEF. Findings in this section are based on the results of these measurements. 13 http://www.who.int/childgrowth/standards/technical_report 14 See MICS Supply Procurement Instructions: http://www.childinfo.org/mics5_planning.html P a g e | 23 Table NU.2 shows the percentages of children classified into each of the above-described categories based on the anthropometric measurements that were taken during fieldwork. Additionally, the table includes mean z-scores for all three anthropometric indicators. P a g e | 24 Ta bl e N U .2 : N ut ri tio na l s ta tu s of c hi ld re n P er ce nt ag e of c hi ld re n un de r ag e 5 by n ut rit io na l s ta tu s ac co rd in g to th re e an th ro po m et ric in di ce s: w ei gh t f or a ge , h ei gh t f or a ge , a nd w ei gh t f or h ei gh t, T ha ila nd M IC S , 2 01 5- 20 16 W ei gh t f or a ge N um be r of H ei gh t f or a ge N um be r of W ei gh t f or h ei gh t N um be r of U nd er w ei gh t M ea n ch ild re n S tu nt ed M ea n C hi ld re n W as te d O ve rw ei gh t M ea n ch ild re n P er c en t b el ow Z -S co re un de r ag e 5 P er c en t b el ow Z -S co re un de r ag e 5 P er c en t b el ow P er c en t Z -S co re un de r ag e 5 - 2 - 3 (S D ) - 2 - 3 (S D ) - 2 - 3 ab ov e (S D ) S D 1 S D 2 S D 3 S D 4 S D 5 S D 6 + 2 S D 7 To ta l 6. 7 1. 5 -0 .2 11 ,1 89 10 .5 2. 6 -0 .5 11 ,0 08 5. 4 1. 4 8. 2 0. 1 10 ,9 42 S ex M al e 7. 6 1. 3 -0 .2 5, 87 0 11 .5 3. 1 -0 .5 5, 76 4 5. 5 1. 3 8. 8 0. 1 5, 71 4 F em al e 5. 6 1. 7 -0 .2 5, 31 9 9. 4 2. 1 -0 .4 5, 24 3 5. 2 1. 6 7. 5 0. 0 5, 22 8 R eg io n B an gk ok 4. 4 0. 9 -0 .1 80 6 7. 9 1. 8 -0 .2 75 6 3. 6 0. 7 9. 1 0. 2 74 6 C en tr al 6. 8 2. 3 -0 .1 3, 21 9 11 .8 3. 2 -0 .5 3, 16 5 5. 2 1. 8 8. 8 0. 1 3, 16 2 N or th 6. 9 1. 4 -0 .2 2, 00 1 9. 8 2. 2 -0 .5 1, 97 5 5. 2 1. 1 8. 2 0. 1 1, 97 1 N or th ea st 5. 6 0. 7 -0 .2 3, 36 9 8. 7 1. 6 -0 .4 3, 35 2 4. 8 1. 0 7. 9 0. 0 3, 31 2 S ou th 9. 1 1. 9 -0 .4 1, 79 5 13 .6 4. 0 -0 .7 1, 76 0 7. 8 2. 2 7. 3 -0 .1 1, 75 1 A re a U rb an 4. 9 1. 2 -0 .1 4, 40 3 9. 8 1. 9 -0 .3 4, 29 2 4. 4 1. 4 8. 5 0. 1 4, 27 8 R ur al 7. 8 1. 7 -0 .3 6, 78 6 11 .0 3. 0 -0 .6 6, 71 6 6. 0 1. 5 8. 0 0. 0 6, 66 4 A ge 0- 5 m on th s 11 .6 5. 4 -0 .5 98 0 11 .4 5. 6 -0 .3 91 9 12 .4 2. 5 3. 7 -0 .3 91 6 6- 11 m on th s 4. 5 1. 3 -0 .4 92 0 8. 7 1. 9 -0 .2 89 4 3. 9 1. 3 2. 8 -0 .2 89 4 12 -1 7 m on th s 6. 2 0. 9 -0 .3 1, 23 6 11 .5 1. 7 -0 .5 1, 19 9 4. 4 1. 2 3. 8 0. 0 1, 19 8 18 -2 3 m on th s 5. 4 1. 1 -0 .1 1, 07 2 12 .2 3. 1 -0 .6 1, 04 1 5. 1 2. 0 9. 3 0. 3 1, 04 0 24 -3 5 m on th s 7. 1 1. 0 -0 .1 2, 34 2 12 .7 4. 2 -0 .5 2, 32 2 5. 4 1. 4 10 .9 0. 2 2, 28 6 36 -4 7 m on th s 5. 6 1. 5 -0 .1 2, 34 9 9. 5 1. 5 -0 .5 2, 33 8 4. 0 1. 4 9. 3 0. 2 2, 32 3 48 -5 9 m on th s 6. 8 0. 9 -0 .3 2, 29 1 8. 4 1. 3 -0 .5 2, 29 4 5. 2 1. 0 10 .2 0. 0 2, 28 5 M ot he r’ s ed uc at io n N on e 5. 5 0. 7 -0 .3 50 3 16 .6 2. 0 -0 .6 48 3 8. 6 1. 8 10 .2 0. 0 48 7 P rim ar y 6. 9 1. 6 -0 .3 3, 31 8 9. 9 2. 2 -0 .5 3, 27 3 5. 2 1. 4 7. 2 0. 0 3, 26 9 S ec on da ry 7. 2 1. 9 -0 .3 5, 11 3 10 .9 2. 4 -0 .5 5, 03 2 5. 3 1. 6 8. 5 0. 0 4, 98 9 H ig he r 5. 2 0. 7 0. 0 2, 24 9 9. 2 3. 6 -0 .4 2, 21 5 5. 0 1. 0 8. 6 0. 2 2, 19 1 M is si ng /D K (1 2. 2) (5 .1 ) (- 0. 7) 6 (2 3. 8) (2 0. 1) (- 1. 2) 6 (7 .4 ) (2 .6 ) (1 6. 8) (0 .3 ) 6 P a g e | 24 Ta bl e N U .2 : N ut ri tio na l s ta tu s of c hi ld re n P er ce nt ag e of c hi ld re n un de r ag e 5 by n ut rit io na l s ta tu s ac co rd in g to th re e an th ro po m et ric in di ce s: w ei gh t f or a ge , h ei gh t f or a ge , a nd w ei gh t f or h ei gh t, T ha ila nd M IC S , 2 01 5- 20 16 W ei gh t f or a ge N um be r of H ei gh t f or a ge N um be r of W ei gh t f or h ei gh t N um be r of U nd er w ei gh t M ea n ch ild re n S tu nt ed M ea n C hi ld re n W as te d O ve rw ei gh t M ea n ch ild re n P er c en t b el ow Z -S co re un de r ag e 5 P er c en t b el ow Z -S co re un de r ag e 5 P er c en t b el ow P er c en t Z -S co re un de r ag e 5 - 2 - 3 (S D ) - 2 - 3 (S D ) - 2 - 3 ab ov e (S D ) S D 1 S D 2 S D 3 S D 4 S D 5 S D 6 + 2 S D 7 To ta l 6. 7 1. 5 -0 .2 11 ,1 89 10 .5 2. 6 -0 .5 11 ,0 08 5. 4 1. 4 8. 2 0. 1 10 ,9 42 S ex M al e 7. 6 1. 3 -0 .2 5, 87 0 11 .5 3. 1 -0 .5 5, 76 4 5. 5 1. 3 8. 8 0. 1 5, 71 4 F em al e 5. 6 1. 7 -0 .2 5, 31 9 9. 4 2. 1 -0 .4 5, 24 3 5. 2 1. 6 7. 5 0. 0 5, 22 8 R eg io n B an gk ok 4. 4 0. 9 -0 .1 80 6 7. 9 1. 8 -0 .2 75 6 3. 6 0. 7 9. 1 0. 2 74 6 C en tr al 6. 8 2. 3 -0 .1 3, 21 9 11 .8 3. 2 -0 .5 3, 16 5 5. 2 1. 8 8. 8 0. 1 3, 16 2 N or th 6. 9 1. 4 -0 .2 2, 00 1 9. 8 2. 2 -0 .5 1, 97 5 5. 2 1. 1 8. 2 0. 1 1, 97 1 N or th ea st 5. 6 0. 7 -0 .2 3, 36 9 8. 7 1. 6 -0 .4 3, 35 2 4. 8 1. 0 7. 9 0. 0 3, 31 2 S ou th 9. 1 1. 9 -0 .4 1, 79 5 13 .6 4. 0 -0 .7 1, 76 0 7. 8 2. 2 7. 3 -0 .1 1, 75 1 A re a U rb an 4. 9 1. 2 -0 .1 4, 40 3 9. 8 1. 9 -0 .3 4, 29 2 4. 4 1. 4 8. 5 0. 1 4, 27 8 R ur al 7. 8 1. 7 -0 .3 6, 78 6 11 .0 3. 0 -0 .6 6, 71 6 6. 0 1. 5 8. 0 0. 0 6, 66 4 A ge 0- 5 m on th s 11 .6 5. 4 -0 .5 98 0 11 .4 5. 6 -0 .3 91 9 12 .4 2. 5 3. 7 -0 .3 91 6 6- 11 m on th s 4. 5 1. 3 -0 .4 92 0 8. 7 1. 9 -0 .2 89 4 3. 9 1. 3 2. 8 -0 .2 89 4 12 -1 7 m on th s 6. 2 0. 9 -0 .3 1, 23 6 11 .5 1. 7 -0 .5 1, 19 9 4. 4 1. 2 3. 8 0. 0 1, 19 8 18 -2 3 m on th s 5. 4 1. 1 -0 .1 1, 07 2 12 .2 3. 1 -0 .6 1, 04 1 5. 1 2. 0 9. 3 0. 3 1, 04 0 24 -3 5 m on th s 7. 1 1. 0 -0 .1 2, 34 2 12 .7 4. 2 -0 .5 2, 32 2 5. 4 1. 4 10 .9 0. 2 2, 28 6 36 -4 7 m on th s 5. 6 1. 5 -0 .1 2, 34 9 9. 5 1. 5 -0 .5 2, 33 8 4. 0 1. 4 9. 3 0. 2 2, 32 3 48 -5 9 m on th s 6. 8 0. 9 -0 .3 2, 29 1 8. 4 1. 3 -0 .5 2, 29 4 5. 2 1. 0 10 .2 0. 0 2, 28 5 M ot he r’ s ed uc at io n N on e 5. 5 0. 7 -0 .3 50 3 16 .6 2. 0 -0 .6 48 3 8. 6 1. 8 10 .2 0. 0 48 7 P rim ar y 6. 9 1. 6 -0 .3 3, 31 8 9. 9 2. 2 -0 .5 3, 27 3 5. 2 1. 4 7. 2 0. 0 3, 26 9 S ec on da ry 7. 2 1. 9 -0 .3 5, 11 3 10 .9 2. 4 -0 .5 5, 03 2 5. 3 1. 6 8. 5 0. 0 4, 98 9 H ig he r 5. 2 0. 7 0. 0 2, 24 9 9. 2 3. 6 -0 .4 2, 21 5 5. 0 1. 0 8. 6 0. 2 2, 19 1 M is si ng /D K (1 2. 2) (5 .1 ) (- 0. 7) 6 (2 3. 8) (2 0. 1) (- 1. 2) 6 (7 .4 ) (2 .6 ) (1 6. 8) (0 .3 ) 6 P a g e | 25 Ta bl e N U .2 : N ut ri tio na l s ta tu s of c hi ld re n (c on tin ue d) P er ce nt ag e of c hi ld re n un de r ag e 5 by n ut rit io na l s ta tu s ac co rd in g to th re e an th ro po m et ric in di ce s: w ei gh t f or a ge , h ei gh t f or a ge , a nd w ei gh t f or h ei gh t, T ha ila nd M IC S , 2 01 5- 20 16 W ei gh t f or a ge N um be r of H ei gh t f or a ge N um be r of W ei gh t f or h ei gh t N um be r of U nd er w ei gh t M ea n ch ild re n S tu nt ed M ea n C hi ld re n W as te d O ve rw ei gh t M ea n ch ild re n P er c en t b el ow Z -S co re un de r ag e 5 P er c en t b el ow Z -S co re un de r ag e 5 P er c en t b el ow P er c en t Z -S co re un de r ag e 5 - 2 - 3 (S D ) - 2 - 3 (S D ) - 2 - 3 ab ov e (S D ) S D 1 S D 2 S D 3 S D 4 S D 5 S D 6 + 2 S D 7 W ea lth in de x qu in til e P oo re st 9. 9 2. 3 -0 .5 2, 46 4 13 .1 2. 1 -0 .7 2, 43 3 6. 1 2. 2 7. 5 -0 .1 2, 43 1 S ec on d 6. 6 1. 2 -0 .3 2, 51 1 10 .6 2. 8 -0 .6 2, 47 1 5. 9 2. 5 7. 5 0. 0 2, 45 9 M id dl e 5. 8 1. 3 -0 .1 2, 15 6 9. 3 1. 6 -0 .4 2, 12 6 6. 6 0. 8 8. 2 0. 1 2, 09 8 F ou rt h 5. 1 1. 6 0. 0 2, 41 0 8. 0 2. 7 -0 .4 2, 35 2 3. 8 0. 7 9. 8 0. 2 2, 33 7 R ic he st 5. 3 0. 8 -0 .1 1, 64 8 11 .8 4. 2 -0 .4 1, 62 6 4. 1 0. 5 8. 0 0. 2 1, 61 7 La ng ua ge o f h ou se ho ld h ea d T ha i 6. 6 1. 5 -0 .2 10 ,1 41 9. 9 2. 5 -0 .5 10 ,0 04 5. 2 1. 4 8. 2 0. 1 9, 92 3 N on -T ha i 7. 6 1. 6 -0 .5 1, 04 8 16 .3 3. 8 -0 .7 1, 00 4 7. 3 1. 8 8. 6 -0 .2 1, 01 9 1 M IC S in di ca to r 2. 1a a nd M D G in di ca to r 1. 8 - U nd er w ei gh t p re va le nc e (m od er at e an d se ve re ) 2 M IC S in di ca to r 2. 1b - U nd er w ei gh t p re va le nc e (s ev er e) 3 M IC S in di ca to r 2. 2a - S tu nt in g pr ev al en ce (m od er at e an d se ve re ) 4 M IC S in di ca to r 2. 2b - S tu nt in g pr ev al en ce (s ev er e) 5 M IC S in di ca to r 2. 3a - W as tin g pr ev al en ce (m od er at e an d se ve re ) 6 M IC S in di ca to r 2. 3b - W as tin g pr ev al en ce (s ev er e) 7 M IC S in di ca to r 2. 4 - O ve rw ei gh t p re va le nc e ( ) F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s P a g e | 26 Children whose full birth date (month and year) were not obtained, and children whose measurements are outside a plausible range are excluded from Table NU.2. Children are excluded from one or more of the anthropometric indicators when their weights and heights have not been measured, whichever applicable. For example, if a child has been weighed but his/her height has not been measured, the child is included in underweight calculations, but not in the calculations for stunting and wasting. Percentages of children by age and reasons for exclusion are shown in the data quality Tables DQ.12, DQ.13 and DQ.14 in Appendix D. The tables show that due to incomplete dates of birth, implausible measurements, and/or missing weight and/or height, 8.7 per cent of children were excluded from calculations of the weight-for-age indicator, 10.1 per cent from the height-for-age indicator, and 10.7 per cent from the weight-for-height indicator. As shown in Table DQ.8, complete date of birth (month and year) reporting for under-5 children was very high (99.8 per cent). Decimal digits for weight measurements were normally distributed (DQ.15). Somewhat decimal digit preference (21.2 per cent) for height measurements was recorded for zero. As shown in Table NU.2, 6.7 per cent of children under age 5 in Thailand are moderately or severely underweight and 1.5 per cent are classified as severely underweight. More than 1 in 10 children (10.5 per cent) are moderately or severely stunted or too short for their age and 5.4 per cent are moderately or severely wasted or too thin for their height. Almost 1 in 10 children (8.2 per cent) are overweight or too heavy for their height. Male children, children in the South and children living in the poorest households are more likely to be underweight, stunted and wasted than other children. Children in rural areas are also likely to be more underweight, stunted and wasted. Children whose mothers have no education are most likely to be stunted (16.6 per cent) and wasted (8.6 per cent) compared to children of mothers with some education. The age pattern shows that a higher percentage of children age 0-5 months are more likely to be underweight and wasted in comparison to children in other age groups. However, children in the 24-35 months age group are more likely to be stunted compared to children in other age groups. Stunting is highest (16.3 per cent) among children born in households headed by non-Thai speakers. Figure NU.1: Underweight, stunted, wasted and overweight children under age 5 (moderate and severe), Thailand MICS, 2015-2016 Underweight Stunted Wasted Overweight 0 2 4 6 8 10 12 14 0 12 24 36 48 60 Pe r ce nt Age in months P a g e | 26 Children whose full birth date (month and year) were not obtained, and children whose measurements are outside a plausible range are excluded from Table NU.2. Children are excluded from one or more of the anthropometric indicators when their weights and heights have not been measured, whichever applicable. For example, if a child has been weighed but his/her height has not been measured, the child is included in underweight calculations, but not in the calculations for stunting and wasting. Percentages of children by age and reasons for exclusion are shown in the data quality Tables DQ.12, DQ.13 and DQ.14 in Appendix D. The tables show that due to incomplete dates of birth, implausible measurements, and/or missing weight and/or height, 8.7 per cent of children were excluded from calculations of the weight-for-age indicator, 10.1 per cent from the height-for-age indicator, and 10.7 per cent from the weight-for-height indicator. As shown in Table DQ.8, complete date of birth (month and year) reporting for under-5 children was very high (99.8 per cent). Decimal digits for weight measurements were normally distributed (DQ.15). Somewhat decimal digit preference (21.2 per cent) for height measurements was recorded for zero. As shown in Table NU.2, 6.7 per cent of children under age 5 in Thailand are moderately or severely underweight and 1.5 per cent are classified as severely underweight. More than 1 in 10 children (10.5 per cent) are moderately or severely stunted or too short for their age and 5.4 per cent are moderately or severely wasted or too thin for their height. Almost 1 in 10 children (8.2 per cent) are overweight or too heavy for their height. Male children, children in the South and children living in the poorest households are more likely to be underweight, stunted and wasted than other children. Children in rural areas are also likely to be more underweight, stunted and wasted. Children whose mothers have no education are most likely to be stunted (16.6 per cent) and wasted (8.6 per cent) compared to children of mothers with some education. The age pattern shows that a higher percentage of children age 0-5 months are more likely to be underweight and wasted in comparison to children in other age groups. However, children in the 24-35 months age group are more likely to be stunted compared to children in other age groups. Stunting is highest (16.3 per cent) among children born in households headed by non-Thai speakers. Figure NU.1: Underweight, stunted, wasted and overweight children under age 5 (moderate and severe), Thailand MICS, 2015-2016 Underweight Stunted Wasted Overweight 0 2 4 6 8 10 12 14 0 12 24 36 48 60 Pe r ce nt Age in months P a g e | 27 Breastfeeding and Infant and Young Child Feeding Proper feeding of infants and young children can increase their chances of survival; it can also promote optimal growth and development, especially in the critical window from birth to 2 years of age. Breastfeeding for the first few years of life protects children from infection, provides an ideal source of nutrients and is economical and safe. However, many mothers do not start to breastfeed early enough, do not breastfeed exclusively for the recommended six months or stop breastfeeding too soon. There are often pressures to switch to infant formula, which can contribute to growth faltering and micronutrient malnutrition and can be unsafe if hygienic conditions, including safe drinking water, are not readily available. Studies have shown that, in addition to continued breastfeeding, consumption of appropriate, adequate and safe solid, semi-solid and soft foods from the age of 6 months onwards leads to better health and growth outcomes, with the potential to reduce stunting during the first two years of life.15 UNICEF and WHO recommend that infants be breastfed within one hour of birth, breastfed exclusively for the first six months of life and continue to be breastfed up to 2 years of age and beyond.16 Starting at 6 months, breastfeeding should be combined with safe, age-appropriate feeding of solid, semi-solid and soft foods.17 A summary of key guiding principles18, 19 for feeding 6-23 month olds is provided in the table below along with proximate measures for these guidelines collected in this survey. The guiding principles for which proximate measures and indicators exist are: (i) continued breastfeeding; (ii) appropriate frequency of meals (but not energy density); and (iii) appropriate nutrient content of food. Feeding frequency is used as a proxy for energy intake, requiring children to receive a minimum number of meals/snacks (and milk feeds for non-breastfed children) for their age. Dietary diversity is used to ascertain the adequacy of the nutrient content of the food (not including iron) consumed. For dietary diversity, seven food groups were created for which a child consuming at least four of these is considered to have a better quality diet. In most populations, consumption of at least four food groups means that the child has a high likelihood of consuming at least one animal-source food and at least one fruit or vegetable, in addition to a staple food (grain, root or tuber).20 These three dimensions of child feeding are combined into an assessment of the children who received appropriate feeding, using the indicator of “minimum acceptable diet”. To have a minimum acceptable diet on the previous day, a child must have received: (i) the appropriate number of meals/snacks/milk feeds; (ii) food items from at least four food groups; and (iii) breastmilk or at least two milk feeds (for non-breastfed children). 15 Bhuta, Z., et al., ‘Evidence-based interventions for improvement of maternal and child nutrition: What can be done and at what cost?’, in The Lancet, 6 June 2013. 16 WHO, Implementing the Global Strategy for Infant and Young Child Feeding, Meeting Report, Geneva, 3-5 February 2003. 17 WHO, Global Strategy for Infant and Young Child Feeding, 2003. 18 PAHO, Guiding principles for complementary feeding of the breastfed child, 2003. 19 WHO, Guiding principles for feeding non-breastfed children 6-24 months of age, 2005. 20 WHO, Indicators for assessing infant and young child feeding practices, Part 1: Definitions, 2008. P a g e | 28 Guiding Principle (age 6-23 months) Proximate measures Table Continue frequent, on-demand breastfeeding for two years and beyond Breastfed in the last 24 hours NU.4 Appropriate frequency and energy density of meals Breastfed children Depending on age, two or three meals/snacks provided in the last 24 hours Non-breastfed children Four meals/snacks and/or milk feeds provided in the last 24 hours NU.6 Appropriate nutrient content of food Four food groups21 eaten in the last 24 hours NU.6 Appropriate amount of food No standard indicator exists na Appropriate consistency of food No standard indicator exists na Use of vitamin-mineral supplements or fortified products for infant and mother No standard indicator exists na Practice good hygiene and proper food handling While it was not possible to develop indicators to fully capture programme guidance, one standard indicator does cover part of the principle: Not feeding with a bottle with a nipple NU.9 Practice responsive feeding, applying the principles of psychosocial care No standard indicator exists na 21 Food groups used for assessment of this indicator are 1) grains, roots and tubers, 2) legumes and nuts, 3) dairy products (milk, yogurt, cheese), 4) flesh foods (meat, fish, poultry and liver/organ meats), 5) eggs, 6) vitamin-A rich fruits and vegetables, and 7) other fruits and vegetables. P a g e | 28 Guiding Principle (age 6-23 months) Proximate measures Table Continue frequent, on-demand breastfeeding for two years and beyond Breastfed in the last 24 hours NU.4 Appropriate frequency and energy density of meals Breastfed children Depending on age, two or three meals/snacks provided in the last 24 hours Non-breastfed children Four meals/snacks and/or milk feeds provided in the last 24 hours NU.6 Appropriate nutrient content of food Four food groups21 eaten in the last 24 hours NU.6 Appropriate amount of food No standard indicator exists na Appropriate consistency of food No standard indicator exists na Use of vitamin-mineral supplements or fortified products for infant and mother No standard indicator exists na Practice good hygiene and proper food handling While it was not possible to develop indicators to fully capture programme guidance, one standard indicator does cover part of the principle: Not feeding with a bottle with a nipple NU.9 Practice responsive feeding, applying the principles of psychosocial care No standard indicator exists na 21 Food groups used for assessment of this indicator are 1) grains, roots and tubers, 2) legumes and nuts, 3) dairy products (milk, yogurt, cheese), 4) flesh foods (meat, fish, poultry and liver/organ meats), 5) eggs, 6) vitamin-A rich fruits and vegetables, and 7) other fruits and vegetables. P a g e | 29 Table NU.3: Initial breastfeeding Percentage of last live-born children in the last two years who were ever breastfed, breastfed within one hour of birth, and within one day of birth, and percentage who received a prelacteal feed, Thailand MICS, 2015-2016 Percentage Percentage who were first breastfed: Percentage Number of last who were Within one hour Within one day who received live-born children ever of birth2 of birth a prelacteal in the last two years breastfed1 feed Total 97.4 39.9 77.9 24.0 2,092 Region Bangkok 93.0 27.9 57.8 31.0 231 Central 98.6 33.3 75.6 27.9 713 North 97.7 58.6 85.2 19.9 354 Northeast 98.7 44.1 84.4 17.2 437 South 96.0 37.3 80.5 24.0 359 Area Urban 96.3 37.0 71.4 28.0 932 Rural 98.3 42.3 83.2 20.8 1,160 Months since last birth 0-11 months 97.6 38.2 76.0 27.1 974 12-23 months 97.2 41.5 79.7 21.3 1,118 Assistance at delivery Skilled attendant 97.6 40.2 78.4 23.8 2,074 Other (100.0) (14.8) (34.5) (73.4) 12 No one/Missing (*) (*) (*) (*) 7 Place of delivery Home (85.5) (15.8) (42.7) (47.9) 18 Health facility 97.6 40.3 78.3 23.6 2,063 Public 97.6 42.0 80.9 21.9 1,856 Private 97.7 24.8 54.7 38.5 207 Other/DK/Missing (*) (*) (*) (*) 11 Mother’s education None 99.2 37.1 87.3 30.4 103 Primary 95.3 43.6 81.4 30.9 300 Secondary 97.9 44.2 79.7 22.1 1,173 Higher 97.2 28.7 70.0 23.0 514 Missing/DK (*) (*) (*) (*) 1 Wealth index quintile Poorest 98.2 53.0 87.9 12.9 305 Second 98.7 43.1 80.7 19.6 491 Middle 95.1 41.7 80.2 26.5 425 Fourth 97.7 36.0 74.0 33.9 540 Richest 97.2 27.2 68.2 21.4 331 Language of household head Thai 97.3 37.8 77.3 23.1 1,881 Non-Thai 98.6 59.4 84.0 31.5 211 1 MICS indicator 2.5 - Children ever breastfed 2 MICS indicator 2.6 - Early initiation of breastfeeding ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases P a g e | 30 Table NU.3 is based on mothers’ reports of what their last-born child, born in the last two years, was fed in the first few days of life. It indicates the proportion who were ever breastfed, those who were first breastfed within one hour and one day of birth, and those who received a prelacteal feed.22 Although it is a very important step in management of lactation and establishment of a physical and emotional relationship between the baby and the mother, 39.9 per cent of babies are breastfed for the first time within one hour of birth, while 77.9 per cent of newborns in Thailand start breastfeeding within one day of birth. Children born in the North region are more likely to be breastfed within one hour of birth compared to children in other regions. Almost 6 out of 10 (58.6 per cent) children born in the North are breastfed within one hour compared to 3 in 10 (27.9 per cent) in Bangkok. Children delivered with the assistance of a skilled attendant are more likely (40.2 per cent) to be breastfed within one hour of birth compared to children delivered with the assistance of other birth attendant (14.8 per cent). However, only 12 weighted cases were reported to be delivered by other birth attendant. Breastfeeding within one hour of birth has an inverse relation to household wealth quintile. More than half (53.0 per cent) of children born in the poorest households were breastfed within one hour of birth compared to 27.2 per cent in the richest households. Children in households headed by a non-Thai speaker are more likely (59.4 per cent) to be breastfed within one hour compared to other children (37.8 per cent). The findings are presented in Figure NU.2 by region and area. Figure NU.2: Initiation of breastfeeding, Thailand MICS, 2015-2016 The set of Infant and Young Child Feeding indicators reported in tables NU.4 through NU.8 are based on the mother’s report of consumption of food and fluids during the day or night prior to being interviewed. Data are subject to a number of limitations, some related to the respondent’s ability to provide a full report on the child’s liquid and food intake due to recall errors as well as a lack of knowledge in cases where the child was fed by other individuals. 22 Prelacteal feed refers to the provision of any liquid or food, other than breastmilk, to a newborn during the period when breastmilk flow is generally being established (estimated here as the first three days of life). 58 76 85 84 80 71 83 78 28 33 59 44 37 37 42 40 0 20 40 60 80 100 Pe r ce nt Within one day Within one hour P a g e | 30 Table NU.3 is based on mothers’ reports of what their last-born child, born in the last two years, was fed in the first few days of life. It indicates the proportion who were ever breastfed, those who were first breastfed within one hour and one day of birth, and those who received a prelacteal feed.22 Although it is a very important step in management of lactation and establishment of a physical and emotional relationship between the baby and the mother, 39.9 per cent of babies are breastfed for the first time within one hour of birth, while 77.9 per cent of newborns in Thailand start breastfeeding within one day of birth. Children born in the North region are more likely to be breastfed within one hour of birth compared to children in other regions. Almost 6 out of 10 (58.6 per cent) children born in the North are breastfed within one hour compared to 3 in 10 (27.9 per cent) in Bangkok. Children delivered with the assistance of a skilled attendant are more likely (40.2 per cent) to be breastfed within one hour of birth compared to children delivered with the assistance of other birth attendant (14.8 per cent). However, only 12 weighted cases were reported to be delivered by other birth attendant. Breastfeeding within one hour of birth has an inverse relation to household wealth quintile. More than half (53.0 per cent) of children born in the poorest households were breastfed within one hour of birth compared to 27.2 per cent in the richest households. Children in households headed by a non-Thai speaker are more likely (59.4 per cent) to be breastfed within one hour compared to other children (37.8 per cent). The findings are presented in Figure NU.2 by region and area. Figure NU.2: Initiation of breastfeeding, Thailand MICS, 2015-2016 The set of Infant and Young Child Feeding indicators reported in tables NU.4 through NU.8 are based on the mother’s report of consumption of food and fluids during the day or night prior to being interviewed. Data are subject to a number of limitations, some related to the respondent’s ability to provide a full report on the child’s liquid and food intake due to recall errors as well as a lack of knowledge in cases where the child was fed by other individuals. 22 Prelacteal feed refers to the provision of any liquid or food, other than breastmilk, to a newborn during the period when breastmilk flow is generally being established (estimated here as the first three days of life). 58 76 85 84 80 71 83 78 28 33 59 44 37 37 42 40 0 20 40 60 80 100 Pe r ce nt Within one day Within one hour P a g e | 31 In Table NU.4, breastfeeding status is presented for both exclusively breastfed and predominantly breastfed, referring to infants less than 6 months old who are breastfed; the former only allows vitamins, mineral supplements and medicine and the latter allows also plain water and non-milk liquids. The table also shows continued breastfeeding of children at 12-15 and 20-23 months of age. Approximately 23.1 per cent of children less than 6 months old are exclusively breastfed and 42.1 per cent are predominantly breastfed. By age 12-15 months, 33.3 per cent of children are breastfed and by age 20-23 months, 15.6 per cent are breastfed. Female children are more likely (25.9 per cent) to be exclusively breastfed compared to their male counterparts (20.7 per cent). The percentage of children exclusively breastfed varies widely across regions, with 36.7 per cent of children under 6 months exclusively breastfed in the North compared to only 6.4* per cent in Bangkok. Table NU.4 further shows that almost none (0.2* per cent) of the children under 6 months of age born to mothers with no education are exclusively breastfed compared to 28.6 per cent of children born to mothers with secondary education. However, continued breastfeeding at one year is highest among children born to mothers with no education (79.5* per cent) and children born in households headed by non-Thai speakers (54.0 per cent). Children under 6 months of age in the richest households are more likely (36.4 per cent) to be breastfed. The percentage of children continuing to be breastfed at 2 years is high among female children (20.0 per cent), children living in the South (30.4 per cent), children in rural areas (19.7 per cent) and children in households headed by non-Thai speakers (33.9 per cent). * Figures that are based on 25-49 unweighted cases P a g e | 32 Table NU.4: Breastfeeding Percentage of living children according to breastfeeding status at selected age groups, Thailand MICS, 2015-2016 Children age Children age Children age 0-5 months 12-15 months 20-23 months Per cent Per cent Number of Per cent Number of Per cent Number of exclusively predominantly children breastfed Children breastfed children breastfed1 breastfed2 (Continued (Continued breastfeeding breastfeeding at 1 year)3 at 2 years)4 Total 23.1 42.1 1,138 33.3 914 15.6 760 Sex Male 20.7 43.3 605 32.3 461 12.0 423 Female 25.9 40.8 533 34.2 453 20.0 337 Region Bangkok (6.4) (17.2) 133 19.5 62 (14.5) 47 Central 27.4 51.4 321 38.1 226 12.2 207 North 36.7 52.6 205 32.0 181 10.8 140 Northeast 17.5 35.6 300 31.9 313 11.5 212 South 21.6 43.0 179 36.6 131 30.4 153 Area Urban 18.8 37.4 476 36.1 287 10.6 348 Rural 26.3 45.6 662 32.0 627 19.7 412 Mother’s education None (0.2) (82.4) 54 (79.5) 35 (26.9) 11 Primary 16.9 28.9 229 28.1 297 18.2 210 Secondary 28.6 45.3 585 36.9 430 14.5 386 Higher 21.0 38.6 269 22.0 152 13.8 152 Missing/DK (*) (*) 1 (*) 0 (*) 0 Wealth index quintile Poorest 24.0 32.4 170 46.6 243 18.9 138 Second 18.2 45.7 270 35.3 225 19.5 192 Middle 24.7 50.0 240 34.1 173 17.4 153 Fourth 18.5 29.6 293 22.1 166 10.7 182 Richest 36.4 57.3 165 14.9 108 8.9 95 Language of household head Thai 23.0 40.2 1,022 31.0 824 14.1 703 Non-Thai 24.7 58.9 115 54.0 90 33.9 57 1 MICS indicator 2.7 - Exclusive breastfeeding under 6 months 2 MICS indicator 2.8 - Predominant breastfeeding under 6 months 3 MICS indicator 2.9 - Continued breastfeeding at 1 year 4 MICS indicator 2.10 - Continued breastfeeding at 2 years ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Figure NU.3 shows the detailed pattern of breastfeeding by the child’s age in months. Even at 0-1 month of age, barely 33.5 per cent of children are exclusively breastfed and 13.1 per cent of children are already weaned at this stage. Almost one fifth of children 2-3 months old are breastfed and given plain water. However, 8.9 per cent of children aged 4-5 months are exclusively breastfed. Only about 13 per cent of children are receiving breast milk at 2 years of age. P a g e | 32 Table NU.4: Breastfeeding Percentage of living children according to breastfeeding status at selected age groups, Thailand MICS, 2015-2016 Children age Children age Children age 0-5 months 12-15 months 20-23 months Per cent Per cent Number of Per cent Number of Per cent Number of exclusively predominantly children breastfed Children breastfed children breastfed1 breastfed2 (Continued (Continued breastfeeding breastfeeding at 1 year)3 at 2 years)4 Total 23.1 42.1 1,138 33.3 914 15.6 760 Sex Male 20.7 43.3 605 32.3 461 12.0 423 Female 25.9 40.8 533 34.2 453 20.0 337 Region Bangkok (6.4) (17.2) 133 19.5 62 (14.5) 47 Central 27.4 51.4 321 38.1 226 12.2 207 North 36.7 52.6 205 32.0 181 10.8 140 Northeast 17.5 35.6 300 31.9 313 11.5 212 South 21.6 43.0 179 36.6 131 30.4 153 Area Urban 18.8 37.4 476 36.1 287 10.6 348 Rural 26.3 45.6 662 32.0 627 19.7 412 Mother’s education None (0.2) (82.4) 54 (79.5) 35 (26.9) 11 Primary 16.9 28.9 229 28.1 297 18.2 210 Secondary 28.6 45.3 585 36.9 430 14.5 386 Higher 21.0 38.6 269 22.0 152 13.8 152 Missing/DK (*) (*) 1 (*) 0 (*) 0 Wealth index quintile Poorest 24.0 32.4 170 46.6 243 18.9 138 Second 18.2 45.7 270 35.3 225 19.5 192 Middle 24.7 50.0 240 34.1 173 17.4 153 Fourth 18.5 29.6 293 22.1 166 10.7 182 Richest 36.4 57.3 165 14.9 108 8.9 95 Language of household head Thai 23.0 40.2 1,022 31.0 824 14.1 703 Non-Thai 24.7 58.9 115 54.0 90 33.9 57 1 MICS indicator 2.7 - Exclusive breastfeeding under 6 months 2 MICS indicator 2.8 - Predominant breastfeeding under 6 months 3 MICS indicator 2.9 - Continued breastfeeding at 1 year 4 MICS indicator 2.10 - Continued breastfeeding at 2 years ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Figure NU.3 shows the detailed pattern of breastfeeding by the child’s age in months. Even at 0-1 month of age, barely 33.5 per cent of children are exclusively breastfed and 13.1 per cent of children are already weaned at this stage. Almost one fifth of children 2-3 months old are breastfed and given plain water. However, 8.9 per cent of children aged 4-5 months are exclusively breastfed. Only about 13 per cent of children are receiving breast milk at 2 years of age. P a g e | 33 Figure NU.3: Infant feeding patterns by age, Thailand MICS, 2015-2016 Table NU.5 shows the median duration of breastfeeding by selected background characteristics. Among children under age 3, the median duration is 7.9 months for any breastfeeding, 0.6 months for exclusive breastfeeding and 1.8 months for predominant breastfeeding. Some variations are observed in median duration of breastfeeding across regions. Children under 3 years of age are breastfed for 11.1 median months in the Central region compared to 6.1 median months in Bangkok. Interestingly, mothers with no education breastfeed children for the longest duration (16.2 median months) but barely provide 0.4 months of exclusive breastfeeding. The longest duration of exclusive breastfeeding is observed among children in the richest households (1.2 median months) and children in the North region (1.0 median months). However, the mean duration of breastfeeding in Thailand is 10.8 months; it is 1.4 months for exclusive breastfeeding and 2.6 months for predominant breastfeeding. Higher mean values indicate that some children in Thailand are breastfed for a longer duration than most children. Exclusively breastfed Breastfed and complimentary foods Weaned (not breastfed) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0-1 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-17 18-19 20-21 22-23 Age in months Exclusively breastfed Breastfed and plain water only Breastfed and non-milk liquids Breastfed and other milk / formula Breastfed and complimentary foods Weaned (not breastfed) P a g e | 34 Table NU.5: Duration of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children age 0-35 months, Thailand MICS, 2015-2016 Median duration (in months) of: Number of children Any breastfeeding1 Exclusive Predominant age 0-35 months breastfeeding breastfeeding Median 7.9 0.6 1.8 7,171 Sex Male 6.5 0.6 2.1 3,813 Female 9.7 0.5 0.7 3,358 Region Bangkok 6.1 0.4 0.5 646 Central 11.1 0.4 2.7 2,107 North 7.6 1.0 2.8 1,291 Northeast 7.1 0.6 0.8 1,980 South 10.1 0.7 2.1 1,147 Area Urban 7.3 0.6 1.1 2,895 Rural 8.5 0.6 2.1 4,276 Mother’s education None 16.2 0.4 4.1 372 Primary 3.3 0.5 0.7 1,867 Secondary 9.4 0.7 2.2 3,441 Higher 8.2 0.6 0.7 1,487 Wealth index quintile Poorest 10.1 0.7 1.2 1,369 Second 9.0 0.7 2.2 1,644 Middle 9.2 0.5 2.5 1,447 Fourth 4.4 0.5 0.6 1,642 Richest 9.4 1.2 4.5 1,069 Language of household head Thai 7.4 0.6 1.4 6,487 Non-Thai 18.6 0.5 3.2 684 Mean 10.8 1.4 2.6 7,171 1 MICS indicator 2.11 - Duration of breastfeeding The age-appropriateness of breastfeeding of children under 24 months of age is provided in Table NU.6. Different criteria of feeding are used depending on the age of the child. For infants aged 0-5 months, exclusive breastfeeding is considered age-appropriate feeding, while children aged 6-23 months are considered to be appropriately fed if they are receiving breast milk and solid, semi-solid or soft food. As a result of feeding patterns, only 29.6 per cent of children aged 6-23 months are being appropriately breastfed and receiving solid, semi-solid or soft foods. A total of 28.0 per cent of children aged 0-23 months are being appropriately breastfed. Girls aged 6-23 months are more likely (31.7 per cent) to be appropriately breastfed and given solids, semi-solid or soft foods compared to boys (28.0 per cent). Similarly, children (6-23 months) born in the South, (36.1 per cent), from rural areas (30.6 per cent), born to mothers with no education (54.5 per cent), living in the poorest households (37.2 per cent) and born to households headed by a non-Thai speaker (50.1 per cent) are more likely to be appropriately breastfed and given solid, semi-solid or soft foods. Similar trends are also observed for appropriate breastfeeding at age 0-23 months. P a g e | 34 Table NU.5: Duration of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children age 0-35 months, Thailand MICS, 2015-2016 Median duration (in months) of: Number of children Any breastfeeding1 Exclusive Predominant age 0-35 months breastfeeding breastfeeding Median 7.9 0.6 1.8 7,171 Sex Male 6.5 0.6 2.1 3,813 Female 9.7 0.5 0.7 3,358 Region Bangkok 6.1 0.4 0.5 646 Central 11.1 0.4 2.7 2,107 North 7.6 1.0 2.8 1,291 Northeast 7.1 0.6 0.8 1,980 South 10.1 0.7 2.1 1,147 Area Urban 7.3 0.6 1.1 2,895 Rural 8.5 0.6 2.1 4,276 Mother’s education None 16.2 0.4 4.1 372 Primary 3.3 0.5 0.7 1,867 Secondary 9.4 0.7 2.2 3,441 Higher 8.2 0.6 0.7 1,487 Wealth index quintile Poorest 10.1 0.7 1.2 1,369 Second 9.0 0.7 2.2 1,644 Middle 9.2 0.5 2.5 1,447 Fourth 4.4 0.5 0.6 1,642 Richest 9.4 1.2 4.5 1,069 Language of household head Thai 7.4 0.6 1.4 6,487 Non-Thai 18.6 0.5 3.2 684 Mean 10.8 1.4 2.6 7,171 1 MICS indicator 2.11 - Duration of breastfeeding The age-appropriateness of breastfeeding of children under 24 months of age is provided in Table NU.6. Different criteria of feeding are used depending on the age of the child. For infants aged 0-5 months, exclusive breastfeeding is considered age-appropriate feeding, while children aged 6-23 months are considered to be appropriately fed if they are receiving breast milk and solid, semi-solid or soft food. As a result of feeding patterns, only 29.6 per cent of children aged 6-23 months are being appropriately breastfed and receiving solid, semi-solid or soft foods. A total of 28.0 per cent of children aged 0-23 months are being appropriately breastfed. Girls aged 6-23 months are more likely (31.7 per cent) to be appropriately breastfed and given solids, semi-solid or soft foods compared to boys (28.0 per cent). Similarly, children (6-23 months) born in the South, (36.1 per cent), from rural areas (30.6 per cent), born to mothers with no education (54.5 per cent), living in the poorest households (37.2 per cent) and born to households headed by a non-Thai speaker (50.1 per cent) are more likely to be appropriately breastfed and given solid, semi-solid or soft foods. Similar trends are also observed for appropriate breastfeeding at age 0-23 months. P a g e | 35 Table NU.6: Age-appropriate breastfeeding Percentage of children age 0-23 months who were appropriately breastfed during the previous day, Thailand MICS, 2015-2016 Children age Children age Children age 0-5 months 6-23 months 0-23 months Per cent Number Per cent currently Number Per cent Number exclusively of breastfeeding and of appropriately of breastfed1 children receiving solid, semi-solid children breastfed2 children or soft foods Total 23.1 1,138 29.6 3,484 28.0 4,622 Sex Male 20.7 605 28.0 1,944 26.2 2,548 Female 25.9 533 31.7 1,540 30.2 2,073 Region Bangkok (6.4) 133 27.2 292 20.6 425 Central 27.4 321 32.3 1,062 31.2 1,382 North 36.7 205 24.7 650 27.6 855 Northeast 17.5 300 26.8 917 24.5 1,217 South 21.6 179 36.1 563 32.6 742 Area Urban 18.8 476 28.2 1,413 25.8 1,889 Rural 26.3 662 30.6 2,070 29.5 2,732 Mother’s education None (0.2) 54 54.5 194 42.7 248 Primary 16.9 229 23.3 942 22.1 1,172 Secondary 28.6 585 30.6 1,657 30.0 2,242 Higher 21.0 269 29.0 688 26.7 957 Missing/DK (*) 1 (*) 2 (*) 3 Wealth index quintile Poorest 24.0 170 37.2 656 34.5 826 Second 18.2 270 31.7 852 28.4 1,122 Middle 24.7 240 30.2 687 28.8 926 Fourth 18.5 293 24.2 824 22.7 1,117 Richest 36.4 165 24.0 465 27.3 631 Language of household head Thai 23.0 1,022 27.4 3,147 26.3 4,170 Non-Thai 24.7 115 50.1 336 43.6 452 1 MICS indicator 2.7 - Exclusive breastfeeding under 6 months 2 MICS indicator 2.12 - Age-appropriate breastfeeding ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Overall, 84.6 per cent of infants 6-8 months old received solid, semi-solid or soft foods at least once during the previous day (Table NU.7). Among currently breastfeeding infants the percentage is 87.0 per cent while it is 82.1 per cent among infants currently not breastfeeding. The percentage of girls aged 6-8 months receiving solid, semi-solid or soft foods is slightly higher (85.7 per cent) than for boys (83.8 per cent). However, more boys (93.5 per cent) currently breastfeeding are likely to receive solid, semi-solid or soft foods compared to girls (79.7 per cent) in the same age group. Among children 6-8 months old who are currently not breastfed, 93.8 per cent of girls received solid, semi-solid or soft foods compared to 75.5 per cent of boys. P a g e | 36 Table NU.7: Introduction of solid, semi-solid or soft foods Percentage of infants age 6-8 months who received solid, semi-solid or soft foods during the previous day, Thailand MICS, 2015-2016 Currently breastfeeding Currently not breastfeeding All Per cent Number of Per cent Number of Per cent Number of receiving solid, children age receiving solid, children age receiving solid, children age semi-solid or 6-8 months semi-solid or 6-8 months semi-solid or 6-8 months soft foods soft foods soft foods1 Total 87.0 300 82.1 288 84.6 588 Sex Male 93.5 158 75.5 185 83.8 343 Female 79.7 142 93.8 104 85.7 245 Area Urban 86.6 138 80.2 137 83.4 274 Rural 87.3 162 83.8 152 85.6 314 1 MICS indicator 2.13 - Introduction of solid, semi-solid or soft foods Table NU.8 shows that overall, more than 8 out of 10 children aged 6-23 months (84.6 per cent) were receiving solid, semi-solid or soft foods the minimum number of times. The proportion of children receiving the minimum dietary diversity, or foods from at least four food groups, was lower (75.0 per cent) than that for minimum meal frequency (84.6 per cent), indicating the need to focus on improving diet quality and nutrient intake among this vulnerable group. A slightly higher proportion of older (18- 23-month-old) children (86.0 per cent) were achieving the minimum dietary diversity compared to younger (6-8-month-old) children (33.4 per cent). The overall assessment using the indicator of minimum acceptable diet revealed that only 55.6 per cent were benefitting from a diet sufficient in both diversity and frequency. Children in the 6-8 months age group are three times (22.7 per cent) less likely to receive a minimum acceptable diet compared to children in the 18-23 months age group (67.8 per cent). Similarly, one in four children born to mothers wit

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