The Selected Districts of Papua Province Multiple Indicator Cluster Survey 2011, Final Report.

Publication date: 2013

Indonesia SELECTED DISTRICTS OF PAPUA PROVINCE Multiple Indicator Cluster Survey 2011 Monitoring the situation of children and women 2 MULTIPLE INDICATOR CLUSTER SURVEY 2011 The Selected Districts of Papua Province Multiple Indicator Cluster Survey (MICS) was carried out in 2011 by Badan Pusat Statistik (BPS) under the leadership of the National Development Planning Agency (BAPPENAS) and the Ministry of Home Affairs. Financial and technical support was provided by the United Nations Children’s Fund (UNICEF). MICS is an international household survey programme developed by UNICEF. The Selected Districts of Papua Province MICS was conducted as part of the fourth global round of MICS surveys (MICS4). MICS provides up-to-date information on the situation of children and women, and measures key indicators that allow countries to monitor progress towards the Millennium Development Goals (MDGs) and other internationally agreed upon commitments. Additional information on the global MICS project may be obtained from www.childinfo.org. Suggested citation: BPS. [2013]. The Selected Districts of Papua Province Multiple Indicator Cluster Survey 2011, Final Report. Jakarta, Indonesia: BPS. MULTIPLE INDICATOR CLUSTER SURVEY 2011 March, 2013 Indonesia SELECTED DISTRICTS OF PAPUA PROVINCE Multiple Indicator Cluster Survey 2011 Monitoring the situation of children and women ii MULTIPLE INDICATOR CLUSTER SURVEY 2011 MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 iii Multiple Indicator Cluster Surveys (MICS) and Millennium Development Goals (MDGs) Indicators, Selected Districts of Papua Province, Indonesia, 2011 1.1 1.2 2.4 2.5 2.6 2.7 2.8 2.9 2.10 2.11 2.13 2.14 2.15 2.17 2.18 2.19 3.1 3.2 3.3 3.4 3.5 3.7 3.11 3.12 3.14 3.15 3.16 3.17 3.18 4.1 4.2 4.3 6.7 6.8 Indicator Under-five mortality rate Infant mortality rate Children ever breastfed Early initiation of breastfeeding Exclusive breastfeeding under 6 months Continued breastfeeding at 1 year Continued breastfeeding at 2 years Predominant breastfeeding under 6 months Duration of breastfeeding Bottle feeding Minimum meal frequency Age-appropriate breastfeeding Milk feeding frequency for non-breastfed children Vitamin A supplementation (children under age 5) Low-birth weight infants Infants weighed at birth Tuberculosis immunization coverage Polio immunization coverage Immunization coverage for diphtheria, pertussis and tetanus (DPT) Measles immunization coverage Hepatitis B immunization coverage Neonatal tetanus protection Solid fuels Household availability of insecticide-treated nets (ITNs) Children under age 5 sleeping under any mosquito net Children under age 5 sleeping under insecticide-treated nets (ITNs) Malaria diagnostics usage Antimalarial treatment of children under 5 the same or next day Antimalarial treatment of children under age 5 Merauke 48 39 92.3 44.1 23.3 87.0 33.6 35.6 20.0 45.8 52.0 41.6 76.5 71.4 12.5 83.2 96.3 81.4 70.1 92.2 69.2 71.5 54.2 60.5 60.3 41.7 24.2 6.7 13.0 Jayawijaya 122 86 94.2 38.5 55.0 89.9 79.0 59.5 - 17.4 59.6 68.8 93.2 33.1 7.9 28.3 62.7 35.5 30.9 43.8 32.2 46.9 83.3 10.5 18.3 8.9 12.1 0.2 0.8 Biak Numfor 62 48 93.4 19.0 38.3 61.8 44.3 42.9 18.7 49.9 50.8 39.7 79.5 80.7 16.5 71.4 90.8 58.8 57.3 86.0 48.7 73.6 50.1 46.2 47.2 41.9 44.5 35.9 45.7 per 1,000 per 1,000 per cent per cent per cent per cent per cent per cent months per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent Value Topic Child mortality NUTRITION Breastfeeding and infant feeding Vitamin A Low birth weight CHILD HEALTH Vaccinations Tetanus toxoid Solid fuel use Malaria CHILD MORTALITY SUMMARY TABLE OF FINDINGS MICS4 Indicator Number MDGs Indicator Number iv MULTIPLE INDICATOR CLUSTER SURVEY 2011 1 Results for child labour for age group 5-17 can be found in the report in Table CP.2 4.1 4.2 4.3 5.1 5.2 5.3 5.5a 5.5b 5.6 5.7 5.8 7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8 7.9 7.10 8.1 8.2 8.3 8.4 8.5 8.6 8.7 7.8 7.9 5.4 5.3 5.5 5.2 2.3 2.1 2.2 Indicator Use of improved drinking water sources Water treatment Use of improved sanitation Adolescent birth rate Early childbearing Contraceptive prevalence rate Unmet need Antenatal care coverage: • At least once by skilled personnel • At least four times by any provider Content of antenatal care Skilled attendant at delivery Institutional deliveries Literacy rate among young people • women age 15-24 years • men age 15-24 years School readiness Net intake rate in primary education Primary school net attendance ratio (adjusted) Secondary school net attendance ratio (adjusted) Children reaching last grade of primary Primary completion rate Transition rate to secondary school Gender parity index (primary school) Gender parity index (secondary school) Birth registration Child labour School attendance among child labourers Child labour among students Violent discipline Marriage before age 15: • women age 15-49 years • men age 15-49 years Marriage before age 18 • women age 20-49 years • men age 20-49 years Merauke 54.3 76.7 64.0 77 11.1 51.8 12.1 96.4 89.6 40.3 85.7 61.1 90.2 92.4 48.3 73.0 96.5 70.5 98.6 88.1 96.5 0.98 1.17 65.9 20.4 91.2 27.6 86.5 9.9 1.1 34.1 3.4 Jayawijaya 34.9 26.1 23.6 145 36.9 33.7 11.5 57.1 36.0 12.0 35.6 27.6 60.2 71.8 12.5 69.6 81.7 54.1 94.2 90.9 94.7 1.04 0.92 19.7 36.2 72.0 49.6 92.1 15.6 1.5 46.8 11.0 Biak Numfor 87.0 71.0 74.5 59 10.2 42.5 11.1 90.1 65.7 18.6 77.3 42.6 90.3 92.2 29.2 70.7 96.4 75.4 97.3 115.7 96.1 1.03 1.01 32.7 22.0 90.6 29.6 91.5 3.8 0.5 20.2 3.9 per cent per cent per cent per 1,000 per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent ratio ratio per cent per cent per cent per cent per cent per cent per cent per cent per cent Value Topic Water and sanitation Contraception Maternal and newborn health Literacy and education Birth registration Child labour (age 15-14)1 Child discipline Early marriage MICS4 Indicator Number MDGs Indicator Number WATER AND SANITATION REPRODUCTIVE HEALTH EDUCATION CHILD PROTECTION MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 v 8.8 8.10b 8.14 9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.10 9.11 9.12 6.3 Indicator Young women age 15-19 years currently married or in union Young men age 15-19 years currently married or in union Spousal age difference women age 20-24 years Attitudes towards domestic violence • women age 15-49 years • men age 15-49 years Comprehensive knowledge about HIV prevention • women age 15-49 years • men age 15-49 years Comprehensive knowledge about HIV prevention among young people • women age 15-24 years • men age 15-24 years Knowledge of mother-to-child transmission of HIV • women age 15-49 years • men age 15-49 years Accepting attitudes towards people living with HIV • women age 15-49 years • men age 15-49 years Know a place to get tested for HIV • women age 15-49 years • men age 15-49 years Have been tested and have been told result • women age 15-49 years • men age 15-49 years Sexually active young women who have been tested for HIV and know the result • women age 15-49 years • men age 15-49 years Young women who have never had sex Young men who have never had sex Sex before age 15 among young people • women age 15-24 years • men age 15-24 years Age-mixing among sexual partners • women age 15-24 years • men age 15-24 years Merauke 21.0 2.7 14.7 31.1 32.5 25.4 17.8 30.2 14.6 59.7 53.7 21.5 22.1 41.2 43.9 3.7 3.0 9.6 3.9 89.4 77.8 2.0 2.5 21.2 2.1 Jayawijaya 41.4 9.2 25.1 59.4 66.6 12.7 14.1 14.1 13.8 41.0 58.4 8.2 10.8 23.9 33.6 2.0 3.7 2.8 0.0 86.2 79.9 16.3 7.5 22.0 0.0 Biak Numfor 7.9 1.1 9.0 50.6 37.2 24.0 28.1 24.7 26.2 69.4 65.1 13.9 11.4 33.2 39.2 1.3 5.6 0.9 5.1 86.9 74.7 2.7 0.7 14.1 1.1 per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent percent percent Value Topic Domestic violence HIV/AIDS knowledge and attitudes Sexual behaviour MICS4 Indicator Number MDGs Indicator Number HIV/AIDS, SEXUAL BEHAVIOUR, AND ORPHANED MULTIPLE INDICATOR CLUSTER SURVEY 2011vi MULTIPLE INDICATOR CLUSTER SURVEY 2011 9.13 9.14 9.15 9.17 9.18 9.21 TA.3 TA.4 Indicator Sex with multiple partners • women age 15-49 years • men age 15-49 years Condom use during sex with multiple partners • men age 15-49 years Sex with non-regular partners • women age 15-24 years • men age 15-24 years Children’s living arrangements Prevalence of children with one or both parents dead Male circumcision Alcohol use • women age 15-49 years • men age 15-49 years Use of alcohol before age 15 • women age 15-49 years • men age 15-49 years Merauke 0.6 3.5 (25.5) 8.9 49.8 10.4 7.0 63.0 1.2 20.9 0.3 6.3 Jayawijaya 1.2 13.9 8.4 8.3 38.6 7.4 9.2 11.8 2.5 12.9 3.7 5.4 Biak Numfor 0.7 5.7 21.8 20.7 58.2 12.3 7.5 24.6 2.9 24.8 2.1 7.8 per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent Value Topic Orphaned Children Male circumcision Alcohol use MICS4 Indicator Number MDGs Indicator Number ALCOHOL USE MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 viiMULTIPLE INDICATOR CLUSTER SURVEY 2011 TABLE OF CONTENTS Summary table of findings Table of contents List of tables List of figures List of abbreviations Acknowledgements Six selected MICS districts in Papua and West Papua provinces Executive summary 1. INTRODUCTION 1.1. Background 1.2. Survey objectives 1.3. Limitations of the survey 2. SAMPLE AND SURVEY METHODOLOGY 2.1. Sample design 2.2. Questionnaires 2.3. Training and fieldwork 2.4. Data processing 3. SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS 3.1. Sample coverage 3.2. Characteristics of households 3.3. Characteristics of female and male respondents 15-49 years of age and children under-5 4. CHILD MORTALITY 5. NUTRITION 5.1. Breastfeeding 5.2. Vitamin A supplements 5.3. Low birth weight 6. CHILD HEALTH 6.1. Immunization 6.2. Neonatal tetanus protection 6.3. Solid fuel use 6.4. Malaria 7. WATER AND SANITATION 7.1. Use of improved water sources 7.2. Use of improved sanitation facilities 7.3. Distance between water source and closest excreta disposal iii vii ix xii xiii xv xvi xvii 1 1 2 2 5 5 5 6 7 9 9 10 12 17 21 21 30 32 35 35 39 41 44 51 51 59 65 MULTIPLE INDICATOR CLUSTER SURVEY 2011viii MULTIPLE INDICATOR CLUSTER SURVEY 2011 67 67 71 74 76 81 84 84 87 87 89 90 97 97 99 105 105 115 117 121 121 129 132 137 145 147 151 155 157 159 163 167 179 185 195 8. REPRODUCTIVE HEALTH 8.1. Fertility 8.2. Contraception 8.3. Unmet need 8.4. Antenatal care 8.5. Malaria testing and protection during antenatal care visit 8.6. Assistance at delivery 8.7. Place of delivery 9. LITERACY AND EDUCATION 9.1. Literacy among young women and men 9.2. School readiness 9.3. Primary and secondary school participation 10. CHILD PROTECTION 10.1. Birth registration 10.2. Child labour 10.3. Child discipline 10.4. Early marriage 10.5. Type of marriage registration 10.6. Attitudes toward domestic violence 11. HIV/AIDS, SEXUAL BEHAVIOUR, AND ORPHANS 11.1. Knowledge about HIV transmission and misconceptions About HIV/AIDS 11.2. Accepting attitudes toward people living with HIV/AIDS 11.3. Knowledge of a place for HIV testing and counselling 11.4. Sexual behaviour related to HIV transmission 11.5. Orphans 11.6. Male circumcision 12. ALCOHOL USE 13. MIGRATION 14. FLOOR AREA PER PERSON Appendix A. Sample design Appendix B. List of personnel involved in the survey Appendix C. Data quality tables Appendix D. Estimates of sampling errors Appendix E. MICS indicators: numerators and denominator Appendix F. Questionnaires MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 ixMULTIPLE INDICATOR CLUSTER SURVEY 2011 LIST OF TABLES Table HH.1: Results of household, women’s, men’s and under-5 interviews Table HH.2: Household age distribution by sex Table HH.3: Household composition Table HH.4: Women’s background characteristics Table HH.4M: Men’s background characteristics Table HH.5: Under-5’s background characteristics Table CM.1: Children ever born, children surviving and proportion dead Table CM.2: Child mortality Table NU.1: Initial breastfeeding Table NU.2: Breastfeeding Table NU.3: Duration of breastfeeding Table NU.4: Age-appropriate breastfeeding Table NU.5: Introduction of solid, semi-solid or soft foods Table NU.6: Minimum meal frequency Table NU.7: Bottle feeding Table NU.8: Children’s vitamin A supplementation Table NU.9: Low birth weight infants Table CH.1: Vaccinations in first year of life Table CH.2: Vaccinations by background characteristics Table CH.3: Neonatal tetanus protection Table CH.4: Solid fuel use Table CH.5: Solid fuel use by place of cooking Table CH.6: Household availability of insecticide-treated nets and protection by a vector control method Table CH.7: Children sleeping under mosquito nets Table CH.8: Anti-malarial treatment of children with anti-malarial drugs Table CH.9: Malaria diagnostics usage Table WS.1: Use of improved water sources Table WS.2: Household water treatment Table WS.3: Time to source of drinking water Table WS.4: Person collecting water Table WS.5: Types of sanitation facilities Table WS.6: Use and sharing of sanitation facilities Table WS.7: Drinking water and sanitation ladders Table WS.8: Distance between water source and closest excreta disposal Table RH.1: Adolescent birth rate and total fertility rate Table RH.2: Early childbearing Table RH.3: Trends in early childbearing Table RH.4: Use of contraception Table RH.4A: Unmet need for contraception Table RH.5: Antenatal care coverage Table RH.6: Number of antenatal care visits 9 10 11 13 15 16 18 18 23 24 25 26 27 28 29 31 33 36 38 40 42 43 45 46 47 50 53 56 57 58 60 61 64 65 68 69 70 72 75 78 79 x MULTIPLE INDICATOR CLUSTER SURVEY 2011 Table RH.7: Content of antenatal care Table RH.8: Malaria testing and protection during antenatal care visit Table RH.9: Treatment for malaria Table RH.10: Assistance during delivery Table RH.11: Place of delivery Table ED.1: Literacy among young women Table ED.1M: Literacy among young men Table ED.2: School readiness Table ED.3: Primary school entry Table ED.4: Primary school attendance Table ED.5: Secondary school attendance Table ED.6: Children reaching last grade of primary school Table ED.7: Primary school completion and transition to secondary school Table ED.8: Education gender parity Table CP.1: Birth registration Table CP.2: Child labour Table CP.3: Child labour and school attendance Table CP.4: Child discipline Table CP.5: Early marriage among women Table CP.5M: Early marriage among men Table CP.6: Trends in early marriage among women Table CP.6M: Trends in early marriage among men Table CP.7: Spousal age difference Table CP.8: Type of marriage registration Table CP.9: Attitudes toward domestic violence among women Table CP.9M: Attitudes toward domestic violence among men Table HA.1: Knowledge about HIV transmission, misconceptions about HIV/AIDS, and comprehensive knowledge about HIV transmission among women Table HA.1M: Knowledge about HIV transmission, misconceptions about HIV/AIDS, and comprehensive knowledge about HIV transmission among men Table HA.2: Knowledge about HIV transmission, misconceptions about HIV/AIDS, and comprehensive knowledge about HIV transmission among young women Table HA.2M: Knowledge about HIV transmission, misconceptions about HIV/AIDS, and comprehensive knowledge about HIV transmission among young men Table HA.3: Knowledge of mother-to-child HIV transmission among women Table HA.3M: Knowledge of mother-to-child HIV transmission among men Table HA.4: Accepting attitudes toward people living with HIV/AIDS among women Table HA.4M: Accepting attitudes toward people living with HIV/AIDS among men 80 81 83 85 86 87 88 89 91 92 93 94 95 96 98 101 104 106 109 110 112 113 114 116 118 119 123 124 125 126 128 129 130 131 MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 xi Table HA.5: Knowledge of a place for HIV testing among women Table HA.5M: Knowledge of a place for HIV testing among men Table HA.6: Knowledge of a place for HIV testing among sexually active young women Table HA.6M: Knowledge of a place for HIV testing among sexually active young men Table HA.7: Sexual behaviour that increases the risk of HIV infection among young women Table HA.7M: Sexual behaviour that increases the risk of HIV infection among young men Table HA.8: Sex with multiple partners among women Table HA.8M: Sex with multiple partners among men Table HA.9: Sex with multiple partners among young women Table HA.9M: Sex with multiple partners among young men Table HA.10: Sex with non-regular partners among young women Table HA.10M: Sex with non-regular partners among young men Table HA.11: Children’s living arrangements and orphanhood Table HA.12: Male circumcision Table HA.13: Provider and location of circumcision Table TA.1: Use of alcohol among women Table TA.1M: Use of alcohol among men Table MI.1: Migration Table FA.1: Floor area per person Table DQ.1: Age distribution of household population Table DQ.2: Age distribution of eligible and interviewed women Table DQ.2M: Age distribution of eligible and interviewed men Table DQ.3: Age distribution of under-5s in household and under-5 questionnaires Table DQ.4: Women’s completion rates by socio-economic characteristics of households Table DQ.4M: Men’s completion rates by socio-economic characteristics of households Table DQ.5: Completion rates for under-5 questionnaires by socio-economic characteristics of households Table DQ.6: Completeness of reporting Table DQ.7: Observation of bednets Table DQ.8: Observation of women’s health cards Table DQ.9: Observation of under-5s birth certificates Table DQ.10: Observation of vaccination cards Table DQ.11: Presence of mother in the household and the person interviewed for the under-5 questionnaire Table DQ.12: Selection of children age 2-14 years for the child discipline module Table DQ.13: School attendance by single age Table DQ.14: Sex ratio at birth among children ever born and living Table SE.1: Indicators selected for sampling error calculations Table SE.2: Sampling errors: Merauke District Table SE.3: Sampling errors: Jayawijaya District Table SE.4: Sampling errors: Biak Numfor District 133 134 135 136 138 139 140 141 142 143 144 145 146 148 149 152 153 156 157 167 168 168 169 169 170 171 172 173 173 174 174 175 175 176 177 180 181 182 183 xii MULTIPLE INDICATOR CLUSTER SURVEY 2011 19 22 27 37 39 49 52 62 63 67 71 77 97 99 115 122 LIST OF FIGURES Figure CM.1: Under-5 mortality rates by background characteristics Figure NU.1: Percentage of mothers who started breastfeeding within one hour and within one day of birth Figure NU.2: Percentage of children age 6-23 months who were appropriately breastfed during the previous day by mother’s education and wealth index Figure CH.1: Percentage of children aged 12-23 months who received the recommended vaccinations by 12 months Figure CH.2: Percentage of women with a live birth in the last 12 months who are protected against neonatal tetanus Figure CH.3: Percentage of children age 0-59 months who had a fever in the last two weeks and who had a finger or heel stick for malaria testing Figure WS.1: Per cent distribution of household members by source of drinking water Figure WS.2: Percentage of household population using improved (not shared) sanitation facilities Figure WS.3: Percentage of household population using improved drinking water sources and improved sanitation Figure RH.1: Percentage of women age 15-19 who have had a live birth or who are pregnant with the first child, or who have begun childbearing before age 15 by district Figure RH.2: Percentage of currently married women aged 15-49 years using contraceptive methods Figure RH.3: Percentage of women age 15-49 who gave birth in the two years preceding the survey who received antenatal care at least once by skilled personnel Figure CP.1: Percentage of children under age 5 whose birth is registered Figure CP.2: Percentage of children under 5-17 involved in child labour Figure CP.3: Percentage of women and men aged 20-49 years married before their 18th birthday Figure HA.1: Percentage of women who have comprehensive knowledge of HIV/AIDS transmission MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 xiii AIDS Acquired Immune Deficiency Syndrome BCG Bacillis-Cereus-Geuerin (Tuberculosis) CDC Center for Disease Control CEDAW Convention on the Elimination of All Forms of Discrimination against Women COSIT Central Organization for Statistics and Information Technology CRC Convention on the Rights of the Child DPT Diptheria, Pertussis, and Tetanus GPI Gender Parity Index Hep B Hepatitis B HIV Human Immunodeficiency Virus IUD Intrauterine Device LAM Lactational Amenorrhea Method LAS League of Arab States MDGs Millennium Development Goals MICS Multiple Indicator Cluster Survey MICS4 The fourth round of the Multiple Indicator Cluster Survey MMR Measles, Mumps, and Rubella MOH Ministry of Health MOI Ministry of Interior NAR Net Attendance Rate NCHS National Center for Health Statistics (USA) PPS Probability Proportional to Size PSU Primary Sampling Unit SD Standard Deviation SPSS Statistical Package for Social Sciences SSD Suleimaniya Statistical Directorate TFR Total Fertility Rate UNFPA United Nations Population Fund UNICEF United Nations Children’s Fund WFFC World Fit For Children WHO World Health Organization LIST OF ABBREVIATIONS MULTIPLE INDICATOR CLUSTER SURVEY 2011xiv MULTIPLE INDICATOR CLUSTER SURVEY 2011 MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 xvMULTIPLE INDICATOR CLUSTER SURVEY 2011 The Selected Districts of Papua Multiple Indicator Cluster Survey 2011 was conducted by the Statistics Indonesia – Badan Pusat Statistik (BPS) – with technical and financial support from UNICEF. Similar Survey was also conducted at the same time in West Papua Province. The Selected Districts of Papua Multiple Indicator Cluster Survey was designed to collect information across a broad number of social indicators covering education, environment, health and child protection sectors in the three districts of Biak Numfor, Jayawijaya and Merauke. This report comprises a full analysis of the data for all the indicators covered by the survey. A Steering Committee, consisting of BAPPENAS, BPS, and UNICEF, led the planning, conduct and dissemination of the survey. A team of sectoral experts from relevant ministries reviewed the global survey tools and customized them. Data collection and data entry was led by the provincial BPS office under the close supervision and guidance of central BPS. The tabulation, data processing and report writing work were supported by an independent consultant. The report was finalized by a team consisting of BPS’s Directorate of Social Welfare Statistics and UNICEF Indonesia Monitoring and Evaluation Officers. We would like to acknowledge the guidance and quality assurance provided by MICS Specialists in UNICEF Headquarters in New York and Regional Office in Bangkok. Special thanks are due to all the master trainers, interviewers, supervisors and editors for their hard work and commitment during the survey implementation. Finally, we would like to thank the communities and households who participated in the survey for their willingness to give their time to provide valuable information about their lives. Without their collaboration this survey would not have been possible. We hope the findings of this report will be of valuable service to policy makers and the planners and researchers of different institutions for further developing appropriate measures to improve the lives of children and women in the three survey districts. Any suggestion and comments for further improvement of the report are most welcome. ACKNOWLEDGEMENTS Dra. Nina Sardjunani, MA Deputy Minister for Human Resources and Culture, Ministry of National Development Planning/ BAPPENAS Drs. Wynandin Imawan, M.Sc Deputy Director General for Social Statistics, BPS Angela Kearney Representative, UNICEF xvi MULTIPLE INDICATOR CLUSTER SURVEY 2011 SIX SELECTED MICS DISTRICTS IN PAPUA AND WEST PAPUA PROVINCES West Papua Province Papua Province MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 xvii The Selected Districts of Papua Province Multiple Indicator Cluster Survey (MICS) is a sample survey of households, women, men and children covering the Districts of Merauke, Jayawijaya and Biak Numfor. The survey of 3,000 selected households was conducted in 2011 and was part of the fourth round of the Multiple Indicator Cluster Surveys Programme of UNICEF. CHILD MORTALITY The infant mortality rates are estimated at 39, 86 and 48 per thousand in the districts of Merauke, Jayawijaya and Biak Numfor respectively. The probabilities of dying under age 5 (U5MR) are 48, 122 and 62 per thousand in the districts of Merauke, Jayawijaya and Biak Numfor respectively. NUTRITION Breastfeeding. Women in Biak Numfor District were the least likely to start breastfeeding within one hour (19 per cent) compared with women in Merauke (44 per cent) and Jayawijaya (39 per cent). Breastfeeding within one day of birth was higher in Jayawijaya District (86 per cent) than in Biak Numfor (70 per cent) and Merauke (64 per cent). Exclusive and predominant breastfeeding among children age less than six months are higher in Jayawijaya District (55 and 60 per cent respectively) than the other two districts (Merauke: 23 and 36 respectively; Biak Numfor: 38 and 43 respectively). Appropriate feeding among children aged 6-23 months is highest in Jayawijaya District (74 per cent) compared with Merauke (47 per cent) and Biak Numfor (40 per cent) districts. More children age 6-23 months (60 per cent) were receiving solid, semi-solid and soft foods the minimum number of times in Jayawijaya compared with those in Merauke (52 per cent) and Biak Numfor (51 per cent). Bottle feeding among children age 6-23 months was considerably lower in Jayawijaya District (17 per cent) compared with Merauke (46 per cent) and Biak Numfor (50 per cent). Vitamin A supplements. Vitamin A supplementation coverage within the six months prior to the survey was considerably lower in Jayawijaya District (33 per cent) compared with Merauke (71 per cent) and Biak Numfor (81 per cent) districts. Low birth weight. The estimated percentage of infants weighing less than 2,500 grams at birth was considerably lower in Jayawijaya (8 per cent) than Merauke (13 per cent) and Biak Numfor (17 per cent) districts. These percentages of births weighing below 2,500 grams are based only on the mother’s recollection of the child’s weight, or the weight as recorded on a health card if the child was weighed at birth. EXECUTIVE SUMMARY xviii MULTIPLE INDICATOR CLUSTER SURVEY 2011 CHILD HEALTH Immunization. In general, percentages of currently vaccinated children aged 12-23 months by different vaccines fluctuated across districts, but it is worth noting that Polio 1, DPT 3 and HepB at birth are considerably lagging behind in Jayawijaya. HepB at birth has low coverage across the districts, particularly Jayawijaya District (Merauke, 58 per cent; Jayawijaya, 12 per cent; Biak Numfor, 30 per cent). Tetanus toxoid. Tetanus toxoid coverage among women age 15-49 years with a live birth in the last 2 years is considerably lower in Jayawijaya District compared with the other districts (Jayawijaya, 47 per cent; Merauke, 72 per cent; Biak Numfor, 74 per cent). Solid fuel use. Solid fuel use is very common among households in Jayawijaya District, where 83 per cent of households use solid fuel, mostly wood. About half the households in Merauke (54 per cent) and Biak Numfor (50 per cent) are using solid fuel, also mostly wood. Malaria. Differentials exist in the availability of ITNs among districts where the availability is least in Jayawijaya District (11 per cent) and most in Merauke District (61 per cent). The percentage of this indicator is 46 per cent in Biak Numfor District. Compared with other districts, the percentages of children under the age of five who slept under any mosquito net or an insecticide-treated net are considerably lower in Jayawijaya District (18 and 9 per cent respectively). These percentages are 60 per cent and 42 per cent for Merauke and 47 per cent and 42 per cent for Biak Numfor District. Compared with the other districts, which also showed a low percentage in these indicators, Jayawijaya District was strikingly lacking in anti-malarial treatment. The percentage of children receiving any anti-malarial drug in Jayawijaya was less than one per cent compared with 13 per cent in Merauke and 46 per cent in Biak Numfor. Similarly, none of the children in Jayawijaya took an anti-malarial drug same or next day compared with 7 per cent in Merauke and 36 per cent in Biak Numfor District. The proportion of children age 0-59 months who had a fever in the last two weeks and who had a finger or heel stick for malaria testing was highest in Biak Numfor District (45 per cent) compared with 24 per cent in Merauke and only 12 per cent in Jayawijaya District. WATER AND SANITATION Water. The situation in Jayawijaya District is considerably worse than in other districts; only 35 per cent of the population in this district gets its drinking water from an improved source. The percentages in Merauke and Biak Numfor districts are 54 and 87 per cent respectively. In Biak Numfor, only 14 per cent of the population uses drinking water that is piped into their dwelling or into their yard or plot. More drastically, only five and one per cent of the population use piped water in Merauke and Jayawijaya respectively. In Jayawijaya District, the most important source of drinking water is surface water (river, stream, dam, lake, pond, canal, irrigation channel) (39 per cent) (an unimproved source). In Merauke, bottled water is the most important source (17 per cent) (an improved source) while in Biak Numfor it is rainwater collection (24 per cent) (an improved source). In-house water treatment. In spite of poor indicators of drinking water from an improved source in Jayawijaya, only about a quarter of household members using unimproved drinking water sources in this district (26 per cent) use appropriate water treatment MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 xix methods. 64 per cent of them do not use any treatment. About 77 and 71 per cent of household members in Merauke and Biak Numfor respectively using unimproved drinking water sources are using an appropriate water treatment method. Time and person to obtain water. Most of the households in Biak Numfor have an improved drinking water source on the premises (80 per cent). This is contrary to households in Jayawijaya (24 per cent) and Merauke (41 per cent). For household users from unimproved drinking water sources, it takes less than 30 minutes to get to the water source and bring water for 46 and 8 per cent of households in Jayawijaya and Biak Numfor districts. More adult women in Jayawijaya (69 per cent) and Biak Numfor (61 per cent) districts collect water than adult men and children. In Merauke District slightly more adult men (49 per cent) than adult women (45 per cent) collect water. Sanitation. Almost two-thirds of the population in Jayawijaya District has no facility or use bushes or fields (59 per cent). No facility or use of bushes or fields is much less common in Merauke (5 per cent) and Biak Numfor (8 per cent). About 49 per cent of the population in Merauke and 86 per cent in Biak Numfor use facilities that flush to a septic tank or pit (latrines). About 75 per cent of the household population in Biak Numfor District is using an improved sanitation facility which is not shared; higher than in Merauke District (64 per cent) and considerably higher than in Jayawijaya (24 per cent). REPRODUCTIVE HEALTH Fertility. The total fertility rate (TFR) is highest in Jayawijaya District (4.5 children per woman) and lowest in Merauke District (3 children per woman). TFR in Biak Numfor District is 3.5 children per woman. Similarly, the adolescent birth rate is considerably higher in Jayawijaya District (145 births per 1,000 women) compared with the rates in Merauke (77 births per 1,000 women) and Biak Numfor (59 births per 1,000 women). Early childbearing. Compared with the other two districts, a considerably higher percentage of giving birth before age 18 was seen in Jayawijaya (37 per cent). The rate was 11 per cent in Merauke and 10 per cent in Biak Numfor. Contraception. The lowest current use of contraception among currently married women age 15-49 was seen in Jayawijaya District (34 per cent), mostly traditional methods. This compares with 43 per cent in Biak Numfor District and 52 per cent in Merauke District, where women mostly use modern methods. The most popular methods in Jayawijaya are Withdrawal (9 per cent), injectables (9 per cent) and Diaphragm/foam/jelly (7 per cent). The most popular methods in Biak Numfor are IUD (18 per cent) and injectables (9 per cent). The most popular methods in Merauke are IUD (29 per cent) and the implants (13 per cent). Antenatal care. Antenatal care (by a doctor, nurse or midwife) is high in Merauke District (96 per cent) and Biak Numfor District (90 per cent) and low in Jayawijaya District (57 per cent). Within each of the three districts, antenatal care is provided mostly by midwives, followed by doctors. xx MULTIPLE INDICATOR CLUSTER SURVEY 2011 The percentage of mothers who received antenatal care at least four times was 90, 36 and 66 per cent in Merauke, Jayawijaya and Biak Numfor districts respectively. Women living in Jayawijaya were less likely to have all three tests made. These tests are: taking blood sample, checking blood pressure and taking urine specimen. Assistance at delivery. The percentage of babies delivered by skilled personnel was 86, 36 and 77 per cent in Merauke, Jayawijaya and Biak Numfor districts respectively. These deliveries were mostly assisted by midwives. Delivery in a health facility. The percentage of babies delivered in a health facility was 61, 28 and 43 per cent in Merauke, Jayawijaya and Biak Numfor districts respectively. LITERACY AND EDUCATION Literacy among young women and men. The lowest literacy rate in young women is in Jayawijaya District (60 per cent) compared with 90 per cent each in Merauke and Biak Numfor districts. For men, literacy rates among the three districts are similar to those among women except that in Jayawijaya District (72 per cent) more men are literate than women (60 per cent). Male literacy rates in Merauke and Biak Numfor districts are 92 per cent each. School readiness. About 48 per cent of children in Merauke who are currently attending the first grade of primary school were attending pre-school the previous year. This is compared with 13 per cent in Jayawijaya and 29 per cent in Biak Numfor District. Net intake rate in primary education. Of children who are of primary school entry age (age 7) in Biak Numfor, 70.7 per cent are attending the first grade of primary school. This indicator is 69 per cent in Jayawijaya and 73 per cent in Merauke District. Net primary school attendance rate. The majority of children of primary school age in Merauke (97 per cent) and Biak Numfor (96 per cent) are attending primary school or secondary school. A lower net primary school attendance rate was seen in Jayawijaya (82 per cent). Net secondary school attendance rate. Compared with primary education, fewer children of secondary school age in Merauke (71 per cent) and Biak Numfor (75 per cent) are attending secondary school or higher. Again, a lower net secondary school attendance rate was seen in Jayawijaya (54 per cent). Survival rate to grade five. Of all children starting grade one, the majority of them in each of the three districts will eventually reach grade five. Primary completion rate. Primary completion rate was lowest rate in Merauke (88 per cent) and the highest rates in Biak Numfor (116 per cent). The primary completion rate in Jayawijaya is 91 per cent. Transition rate to secondary school. Most children who successfully completed the last grade of primary school were found at the moment of the survey to be attending the first grade of secondary school (Merauke, 97 per cent; Jayawijaya, 95 per cent; Biak Numfor, 96 per cent). MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 xxi Gender parity index. The gender parity for primary school is 0.98 in Merauke, 1.04 in Jayawijaya and 1.03 in Biak Numfor. In Jayawijaya and Biak Numfor, more girls attend primary school than boys. The gender parity for secondary school is 1.17 in Merauke, 0.92 in Jayawijaya and 1.01 in Biak Numfor. This means that more girls in Merauke attend secondary school while in Jayawijaya girls are disadvantaged in attending secondary school. CHILD PROTECTION Birth registration. Birth registration is strikingly low in Jayawijaya (20 per cent) and in Biak Numfor Districts (33 per cent) compared with Merauke District (66 per cent). Child labour. Child labour is more profound in Jayawijaya Districts where almost one third of children 5-17 are involved in child labour (36 per cent). This compares with 20 and 22 per cent in Merauke and Biak Numfor districts respectively. The percentage of child labourers who are attending school in Jayawijaya is lower than in the two other districts. On the other hand, the percentage of children attending school who are involved in child labour in Jayawijaya is higher than in the two other districts. Child discipline. High percentages of children age 2-14 years were subjected to at least one form of psychological or physical punishment by their mothers/caretakers or other household members in each of the three districts (Merauke, 87 per cent; Jayawijaya, 92 per cent; Biak Numfor, 92 per cent). More importantly, considerable percentages of children were subjected to severe physical punishment (Merauke, 24 per cent; Jayawijaya, 31 per cent; Biak Numfor, 26 per cent). Early marriage. The percentage of women age 15-19 years who are currently married or in union is significantly higher in Jayawijaya (41 per cent) and significantly lower in Biak Numfor District (8 per cent) when compared with Merauke District (21 per cent). The percentage of women married before age 15 and age 18 was considerably higher in Jayawijaya District (16 and 47 per cent respectively) compared with Merauke District (10 and 34 per cent respectively) and Biak Numfor (4 and 20 per cent respectively). The percentage of young men age 15-19 years who are currently married or in union is higher in Jayawijaya District (9 per cent) compared with Merauke (3 per cent) and Biak Numfor (1 per cent). Among men, marriage/ union before age 15 and 18 is not common, except for Jayawijaya District which shows that 11 per cent of men are married/ in union before age 18 compared with three and four per cent in Merauke and Biak Numfor districts respectively. About 25 per cent women age 20-24 in Jayawijaya District are currently married to a man who is older by ten years or more. This is compared with Merauke (15 per cent) and Biak Numfor districts (9 per cent). Domestic Violence. Differences in the percentage of women who believe that a husband is justified in beating his wife were clear among districts. 59 per cent of women in Jayawijaya District accept this type of violence. This percentage is reduced in Biak Numfor and Merauke districts to 51 and 31 per cent respectively. Patterns of domestic violence indicators for men are similar to those of women but with smaller percentages. xxii MULTIPLE INDICATOR CLUSTER SURVEY 2011 HIV/AIDS, SEXUAL BEHAVIOUR AND ORPHANS Knowledge of HIV transmission. Lower percentages of the interviewed women have heard of AIDS in Jayawijaya District than in the other two districts (Merauke, 85 per cent; Jayawijaya, 63 per cent; Biak Numfor, 96 per cent). Comprehensive knowledge (knowing 2 ways of preventing HIV transmission and rejecting three common misconceptions) of HIV prevention methods and transmission among women age 15-49 is drastically lower in Jayawijaya District (13 per cent) than Merauke (25 per cent) and Biak Numfor (24 per cent) districts. Results were higher for women age 15-24. Comprehensive knowledge among men age 15-49 is lower in Jayawijaya District (14 per cent) and Merauke (18 per cent) than in Biak Numfor (28 per cent) district. Unlike for women, comprehensive knowledge was lower among men in the younger age group 15-24 than knowledge of men age 15-49. Knowledge of mother-to-child transmission of HIV. Knowledge of mother-to-child HIV transmission among women was highest in the district of Biak Numfor (69 per cent) and lowest in Jayawijaya (41 per cent). Knowledge of mother-to-child HIV transmission from mother to child was generally higher among men than women, particularly in Jayawijaya. Attitudes toward people living with HIV. The percentage of women agreeing to all accepting attitudes toward people living with HIV is highest in Merauke District (22 per cent) compared with Biak Numfor District (14 per cent) and Jayawijaya District (8 per cent). Knowledge of where to be tested for HIV. A small but higher percentage of women age 15-49 have been tested and received a result in Merauke (4 per cent) compared with Jayawijaya (2 per cent) and Biak Numfor (1 per cent). Higher percentages were reported among men 15-49 in Jayawijaya (4 per cent) and Biak Numfor (6 per cent). The percentage of men who have been tested and received a result in Merauke is three per cent. Knowledge of where to be tested for HIV among sexually active young women was higher in Merauke District (10 per cent) and considerably lower in Jayawijaya (3 per cent) and Biak Numfor (1 per cent). Among sexually active young men, five per cent have been tested in the last 12 months and received a result in Biak Numfor District compared with four per cent in Merauke District. None of the young men in Jayawijaya District have been tested in the last 12 months and received a result. Sexual Behaviour Related to HIV Transmission. About one in six women age 15-24 years in Jayawijaya District (16 per cent) had sex before age 15. This compares with much lower percentages in Merauke (2 per cent) and Biak Numfor districts (3 per cent). Fewer men than women had sex before age 15, particularly in Jayawijaya District where only eight per cent of men had sex before age 15. This compares with lower percentages in Merauke (3 per cent) and Biak Numfor districts (1 per cent). Sex with multiple partners. Sex with multiple partners is higher among men age 15-49 years than among women in the same age category. Fewer than one per cent of women in each of the three districts reported having sex with more than one partner in last 12 months. This compares with a high 14 per cent of men in Jayawijaya reporting having sex with more than one partner in the last 12 months, six per cent in Biak Numfor and four per cent in Merauke District. Similar results were observed among women age 15-24 years. Results among men age 15-24 years were lower than those among men 15-49 years. MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 xxiii 2 Orphanhood in this report refers to children orphaned by any cause, not only HIV/AIDS. Sex with non-regular partners. Sex with non-marital, non-cohabiting partners in the last 12 months among women 15-24 is considerably higher in Biak Numfor District (21 per cent) than in Merauke (9 per cent) and Jayawijaya (8 per cent) districts. This indicator is considerably higher among men than among women where 58 per cent of young men age 15-24 years in Biak Numfor had sex with a non-marital, non-cohabiting partner in the last 12 months compared with 50 per cent in Merauke and 39 per cent in Jayawijaya District. Orphaned Children.2 Nine per cent of children aged 0-17 years in Jayawijaya are orphans who have lost one or both parent. The percentage of orphans is slightly lower in Biak Numfor (8 per cent) and in Merauke (7 per cent) districts. Male circumcision. Circumcision is more prevalent in Merauke District (63 per cent) than in Biak Numfor (25 per cent) and Jayawijaya districts (12 per cent). In each district, most circumcision was performed at home by health workers/professionals. Alcohol use. About three per cent each of the women age 15-49 years in districts of Jayawijaya and Biak Numfor had at least one drink of alcohol on one or more days during the last month. Alcohol use is considerably higher among men in the same age group with about one quarter of men age 15-49 years in Biak Numfor reporting having at least one drink of alcohol on one or more days during the last one month. This compares with percentages of 21 and 13 in Merauke and Jayawijaya districts respectively. MULTIPLE INDICATOR CLUSTER SURVEY 2011xxiv MULTIPLE INDICATOR CLUSTER SURVEY 2011 MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 1MULTIPLE INDICATOR CLUSTER SURVEY 2011 1 INTRODUCTION 1.1. BACKGROUND This report is based on the Selected Districts of Papua Province Multiple Indicator Cluster Survey, conducted in 2011 by the BPS. The survey provides valuable information on the situation of children and women in three selected districts of Papua Province: Merauke, Jayawijaya and Biak Numfor, and was based, in large part, on the need to furnish up-to- date information on the situation of children and women in the selected districts of Papua Province to inform planning. Indonesia as a whole shows good performance on most social indicators, however, there are disparities within provinces. This survey forms part of the fourth round of the global MICS surveys initiated in 1995 to monitor progress towards goals and targets emanating from recent international agreements: the Millennium Declaration, adopted by all 191 United Nations Member States in September 2000, and the Plan of Action of A World Fit For Children, adopted by 189 Member States at the United Nations Special Session on Children in May 2002. Both of these commitments build upon promises made by the international community at the 1990 World Summit for Children. In signing these international agreements, governments committed themselves to improving conditions for their children and to monitoring progress towards that end. UNICEF was assigned a supporting role in this task (see table below). A Commitment to Action: National and International Reporting Responsibilities The governments that signed the Millennium Declaration and the World Fit for Children Declaration and Plan of Action also committed themselves to monitoring progress towards the goals and objectives they contained: “We will monitor regularly at the national level and, where appropriate, at the regional level and assess progress towards the goals and targets of the present Plan of Action at the national, regional and global levels. Accordingly, we will 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) 2 MULTIPLE INDICATOR CLUSTER SURVEY 2011 The Plan of Action (paragraph 61) also calls for the specific involvement of UNICEF in the preparation of periodic progress reports: “… As the world’s lead agency for children, the United Nations Children’s Fund is requested to continue to prepare and disseminate, in close collaboration with Governments, relevant funds, programmes and the specialized agencies of the United Nations system, and all other relevant actors, as appropriate, information on the progress made in the implementation of the Declaration and the Plan of Action.” Similarly, the Millennium Declaration (paragraph 31) calls for periodic reporting on progress: “…We request the General Assembly to review on a regular basis the progress made in implementing the provisions of this Declaration, and ask the Secretary- General to issue periodic reports for consideration by the General Assembly and as a basis for further action.” This final report presents the results of the indicators and topics covered in the survey. 1.2. SURVEY OBJECTIVES The 2011 Selected Districts of Papua Province Multiple Indicator Cluster Survey has as its primary objectives: • To provide up-to-date information for assessing the situation of children and women in three selected districts of Papua Province; • To furnish data needed for monitoring progress toward district and provincial development plan targets, as a basis for future action; • To contribute to the improvement of data and monitoring systems in Indonesia and to strengthen technical expertise in the design, implementation, and analysis of such systems. • To generate data on the situation of children and women, including the identification of vulnerable groups and of disparities, to inform policies and interventions. 1.3 LIMITATIONS OF THE SURVEY Papua and West Papua are Indonesia’s two eastern most provinces. Together the two pronvinces have an estimated population of about 3.6 million (Census 2010). Much of the provinces’ land is covered by forest. As such, travel to and around Papua and West Papua is a provinces’s challenge. The main cities are not connected by road. Expensive boat or plane charter is the only option in many instances. As a result all survey costs are extremely high and data collection requires special effort. For this reason, the MICS in selected districts of Papua and West Papua was not representative of the two provinces as that would have required much higher budget availability. The coastal areas of these provinces have been influenced by outside culture, but the tribal groups in the interior have by and large preserved traditional cultures and have MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 3 limited contact with the outside world. Therefore, accurate concepts regarding age and other such information can be challenging to collect. During supervision visits by UNICEF and Statistics Indonesia (BPS), it was observed that elders and mothers could not provide accurate information about their ages and their children’s ages despite probing by the interviewers and use of local calendars. MULTIPLE INDICATOR CLUSTER SURVEY 20114 MULTIPLE INDICATOR CLUSTER SURVEY 2011 MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 5MULTIPLE INDICATOR CLUSTER SURVEY 2011 2 SAMPLE AND SURVEY METHODOLOGY 2.1. SAMPLE DESIGN The sample for the 2011 Selected Districts of Papua Province Multiple Indicator Cluster Survey (MICS) was designed to provide estimates for a large number of indicators on the situation of children and women at the district level. The three districts of Merauke, Jayawijaya and Biak Numfor were included in this survey. The sample was selected in two stages. Within each district, 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 25 households was drawn in each sample enumeration area. The total sample size was 3,000 households (1,000 for each district). The sample is not self-weighting and sample weights are used. A more detailed description of the sample design can be found in Appendix A. 2.2. QUESTIONNAIRES Four sets of questionnaires were used in the survey: 1) a household questionnaire which was used to collect information on all de jure household members (usual residents), the household, and the dwelling; 2) a women’s questionnaire administered in each household to all women aged 15-49 years; 3) a men’s questionnaire administered in each household to all men aged 15-49 years; and 4) an under-5 questionnaire, 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: • Household Listing Form • Education • Water and Sanitation • Household Characteristics • Insecticide-treated Nets • Child Labour • Child Discipline The Questionnaire for Individual Women was administered to all women aged 15-49 years living in the households, and included the following modules: • Women’s Background • Child Mortality • Desire for Last Birth • Maternal and Newborn Health • Contraception 6 MULTIPLE INDICATOR CLUSTER SURVEY 2011 • Unmet Need • Attitudes Towards Domestic Violence • Marriage/Union • Sexual Behaviour • HIV/AIDS • Alcohol Use The Questionnaire for Individual Men was administered to all men aged 15-49 years living in the households, and included the following modules: • Men’s Background • Attitudes Towards Domestic Violence • Marriage/Union • Sexual Behaviour • HIV/AIDS • Circumcision • Alcohol Use The Questionnaire for Children 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: • Age • Birth Registration • Breastfeeding • Malaria • Immunization The questionnaires are based on the MICS4 model questionnaire.4 From the MICS4 model English version, the questionnaires were translated into Bahasa Indonesia and were pre- tested in Kemtuk Village in Jayapura district and Bagai Village in Keerom district in Papua Province during 18 – 22 July 2011. Based on the results of the pre-test, modifications were made to the wording and translation of the questionnaires. A copy of the Selected Districts of Papua Province MICS questionnaires is provided in Appendix F. 2.3. TRAINING AND FIELDWORK Training of trainers for the field was conducted for 12 days during 4-15 July 2011 in Bogor. Enumerator training was conducted in Manokwari for 15 days during 19 September- 3 October 2011. Training included lectures on interviewing techniques and the contents of the questionnaires, and mock interviews between trainees to gain practice in asking questions. Towards the end of the training period, trainees spent one and half days in practice interviewing in Jayapura district. The data was collected by four teams; each was comprised of four interviewers, one editor, and a supervisor. Fieldwork began in 5 October 2011 and concluded in 5 December 2011. 3 The terms “children under 5”, “children age 0-4 years”, and “children aged 0-59 months” are used interchangeably in this report. 4 The model MICS4 questionnaires can be found at www.childinfo.org MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 7 2.4. DATA PROCESSING Data was entered using the CSPro software. The data was entered on 12 microcomputers, carried out by 12 data entry operators under the supervision of one secondary editor and one data entry supervisor. In order to ensure quality control, all questionnaires were double-entered and internal consistency checks were performed. Procedures and standard programmes developed under the global MICS4 programme and adapted to the Selected Districts of Papua MICS questionnaire were used throughout. Data processing began simultaneously with data collection in 8 October 2011 and was completed in 31 December 2011. Data was analysed using the Statistical Package for Social Sciences (SPSS) software programme, Version 18, and the model syntax and tabulation plans developed by UNICEF were used for this purpose. MULTIPLE INDICATOR CLUSTER SURVEY 20118 MULTIPLE INDICATOR CLUSTER SURVEY 2011 MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 9MULTIPLE INDICATOR CLUSTER SURVEY 2011 3.1. SAMPLE COVERAGE Of the 3,000 households selected for the three districts sample, 2,900 were found to be occupied. Of these, 2,866 were successfully interviewed for a household response rate of 98.8 per cent. In the interviewed households, 3,017 women (age 15-49 years) were identified. Of these, 2,784 were successfully interviewed, yielding a response rate of 92.3 per cent within interviewed households. In addition, 2,996 men (age 15-49 years) were listed in the household questionnaire. Questionnaires were completed for 2,568 of eligible men, a response rate of 85.7 per cent within interviewed households. There were 1,561 children under age five listed in the household questionnaire. Questionnaires were completed for 1,511 of these children, which corresponds to a response rate of 96.8 per cent within interviewed households. Overall response rates of 91.2, 84.7 and 95.7 are calculated for the women’s, men’s and under-5’s interviews respectively (Table HH.1). The household response rate was similar among the three districts of Merauke, Jayawijaya and Biak Numfor; whereas the women, men and children response rates were Households Sampled Occupied Interviewed Household response rate Women Eligible Interviewed Women’s response rate Women’s overall response rate Men Eligible Interviewed Men’s response rate Men’s overall response rate Children under 5 Eligible Mothers/caretakers interviewed Under-5’s response rate Under-5’s overall response rate Urban 1,075 1,041 1,027 98.7 1,215 1,085 89.3 88.1 1,301 1,063 81.7 80.6 545 517 94.9 93.6 Rural 1,925 1,859 1,839 98.9 1,802 1,699 94.3 93.3 1,695 1,505 88.8 87.8 1,016 994 97.8 96.8 Merauke 1,000 936 914 97.6 958 841 87.8 85.7 1,012 763 75.4 73.6 443 420 94.8 92.6 Jayawijaya 1,000 976 966 99.0 956 886 92.7 91.7 869 745 85.7 84.9 507 492 97.0 96.0 Biak Numfor 1,000 988 986 99.8 1,103 1,057 95.8 95.6 1,115 1,060 95.1 94.9 611 599 98.0 97.8 Total 3,000 2,900 2,866 98.8 3,017 2,784 92.3 91.2 2,996 2,568 85.7 84.7 1,561 1,511 96.8 95.7 Table HH.1: Results of household, women’s, men’s and under-5 interviews Number of households, women, men and children under 5 by results of the household, women’s and under-5’s interviews, and household, women’s and under-5’s response rates, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 Area District 3 SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS 10 MULTIPLE INDICATOR CLUSTER SURVEY 2011 generally lower in the districts of Merauke and Jayawijaya. It is worth noting that male response rates in Merauke District were around 75 per cent and results for this district should be interpreted with some caution, as the response rates are low. 3.2. CHARACTERISTICS OF HOUSEHOLDS The age and sex distribution of the three districts survey population is provided in Table HH.2. In the 2,866 households successfully interviewed in the survey, 12,070 household members were listed. Of these, 6,182 were males, and 5,888 were females. The age structure of the selected three districts of Papua is experiencing rapid growth with a larger proportion of its population in the younger age groups than in the older age groups. About 37 per cent of the population is under the age of 15 years. About 42 per cent of the population in the three districts comprise children 0-17 years. Tables HH.3 - HH.5 provide basic information on the households, female respondents age 15-49, male respondents 15-49 and children under-5 by presenting the unweighted, as well as the weighted numbers. Information on the basic characteristics of households, women, men and children under-5 interviewed in the survey is essential for the interpretation of findings presented later in the report and can also provide an indication Age 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+ Dependency age groups 0-14 15-64 65+ Child and adult populations Children age 0-17 years Adults age 18+ years Total for 3 districts Number 698 765 669 522 456 540 453 457 304 316 302 184 108 54 24 24 5 7 2,132 3,641 115 2,451 3,437 5,888 Number 817 810 728 522 407 485 430 444 410 353 276 211 128 86 33 22 13 7 2,354 3,666 162 2,682 3,501 6,182 Per cent 11.9 13.0 11.4 8.9 7.8 9.2 7.7 7.8 5.2 5.4 5.1 3.1 1.8 0.9 0.4 0.4 0.1 0.1 36.2 61.8 2.0 41.6 58.4 100.0 Per cent 13.2 13.1 11.8 8.4 6.6 7.8 7.0 7.2 6.6 5.7 4.5 3.4 2.1 1.4 0.5 0.4 0.2 0.1 38.1 59.3 2.6 43.4 56.6 100.0 Number 1,515 1,574 1,397 1,044 864 1,025 883 900 715 669 577 395 235 141 57 47 18 15 4,486 7,308 277 5,133 6,938 12,070 Per cent 12.5 13.0 11.6 8.6 7.2 8.5 7.3 7.5 5.9 5.5 4.8 3.3 1.9 1.2 0.5 0.4 0.2 0.1 37.2 60.5 2.3 42.5 57.5 100.0 Table HH.2: Household age distribution by sex Per cent and frequency distribution of the household population by five-year age groups, dependency age groups, and by child (age 0-17 years) and adult populations (age 18 or more), by sex, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 FemalesMales Total MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 11 District Merauke Jayawijaya Biak Numfor Sex of household head Male Female Area Urban Rural Number of household members 1 2 3 4 5 6 7 8 9 10+ Education of household head None Primary SMP/SM Higher Missing/DK Ethnicity of household head* Papua Jawa Sulawesi Maluku Others Missing/DK Total for 3 districts Households with at least One child age 0-4 years One child age 0-17 years One woman age 15-49 years One man age 15-49 years Mean household size Unweighted 914 966 986 2,546 320 1,027 1,839 181 425 536 613 458 274 155 115 53 56 440 878 1147 399 2 1,829 541 250 114 131 1 2,866 2,866 2,866 2,866 2,866 2,866 43.6 27.9 28.6 89.1 10.9 39.5 60.5 6.0 14.9 19.4 21.7 15.7 9.3 5.3 3.8 1.9 2.0 12.6 32.8 40.4 14.0 0.1 54.5 25.9 9.4 4.5 5.8 0.0 100.0 40.8 76.1 81.7 78.8 4.2 Weighted 1,248 799 819 2,555 311 1,132 1,734 172 427 556 622 451 267 151 109 55 56 362 940 1159 402 2 1,561 741 269 129 165 1 2,866 2,866 2,866 2,866 2,866 2,866 Table HH.3: Household composition Per cent and frequency distribution of households by selected characteristics, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 Number of households Weighted per cent of the representativeness of the survey. The remaining tables in this report are presented only with weighted numbers. See Appendix A for more details about the weighting. Table HH.3 provides basic background information on the households. Within households, the sex of the household head, area, number of household members, education of household head and ethnicity of the household head are shown in the table. In addition to districts, these background characteristics are used in subsequent tables in this report; the figures in the table are also intended to show the numbers of observations by major categories of analysis in the report. 12 MULTIPLE INDICATOR CLUSTER SURVEY 2011 The weighted and unweighted numbers of households are equal, since sample weights were normalized (See Appendix A). The table also shows the proportions of households with at least one child under 18, at least one child under 5, at least one eligible woman age 15-49 and at least one man age 15-49. The table also shows the weighted average household size estimated by the survey. About 44 per cent of the three districts Papua Province sample resides in Merauke, 28 per cent reside in Jayawijaya and 29 per cent reside in Biak Numfor. Most of the households consisted of 4 members (22 per cent) and the mean household size is 4 members. About half of the survey sample consisted of households with Papuan heads (55 per cent), followed with Javanese heads of households which accounted for about a quarter of the survey sample (25 per cent). The remaining quarter of the survey sample was headed by other ethnic groups from: Sulawesi, Maluku and others. Forty-one per cent of the households contained at least one child under-five years of age, 82 per cent contained at least one woman aged 15-49 years and 79 per cent contained at least one man aged 15-49 years. Weighted and unweighted number of cases were generally similar except for districts and some of the ethnicity of household head categories. There seems to be oversampling in Merauke District and some undersampling in Jayawijaya and Biak Numfor districts. Similarly there seems to be oversampling for Papua ethnic group and under sampling for Java. 3.3. CHARACTERISTICS OF FEMALE AND MALE RESPONDENTS 15-49 YEARS OF AGE AND CHILDREN UNDER-5 Tables HH.4, HH.4M and HH.5 provide information on the background characteristics of female and male respondents 15-49 years of age and of 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). In addition to providing useful information on the background characteristics of women and children, the tables are also intended to show the numbers of observations in each background category. These categories are used in the subsequent tabulations of this report. Table HH.4 provides background characteristics of female respondents 15-49 years of age. The table includes information on the distribution of women according to district, area, age, marital status, motherhood status, births in last two years, education5, wealth index quintiles6 and ethnicity of the household head. 5 Unless otherwise stated, “education” refers to educational level attended by the respondent throughout this report when it is used as a background variable. 6 Principal components analysis was performed by using information on the ownership of consumer goods, dwelling characteristics, water and sanitation, and other characteristics that are related to the household’s wealth to assign weights (factor scores) to each of the household assets. Each household was then assigned a wealth score based on these weights and the assets owned by that household. The survey household population was then ranked according to the wealth score of the household they are living in, and was finally divided into 5 equal parts (quintiles) from lowest (poorest) to highest (richest). The assets used in these calculations were as follows: source of drinking water, type of sanitation facility, persons per sleeping room, type of floor, type of roof, type of wall, type of cooking fuel, household assets, household members assets, ownership of dwelling, ownership of agricultural land, ownership of livestock, and ownership of bank account. The wealth index is assumed to capture the underlying long-term wealth through information on the household assets, and is intended to produce a ranking of households by wealth, from poorest to richest. The wealth index does not provide information on absolute poverty, current income or expenditure levels. The wealth scores calculated are applicable for only the particular data set they are based on. Further information on the construction of the wealth index can be found in Filmer, D. and Pritchett, L., 2001. “Estimating wealth effects without expenditure data – or tears: An application to educational enrolments in states of India”. Demography 38(1): 115-132. Gwatkin, D.R., Rutstein, S., Johnson, K. , Pande, R. and Wagstaff. A., 2000. Socio-Economic Differences in Health, Nutrition, and Population. HNP/Poverty Thematic Group, Washington, DC: World Bank. Rutstein, S.O. and Johnson, K., 2004. The DHS Wealth Index. DHS Comparative Reports No. 6. Calverton, Maryland: ORC Macro. MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 13 District Merauke Jayawijaya Biak Numfor Area Urban Rural Age of woman 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Marital/Union status Currently married/in union Widowed Divorced Separated Never married/in union Motherhood status Ever gave birth Never gave birth Births in last two years Had a birth in last two years Had no birth in last two years Education None Primary SMP/SM Higher Wealth index quintile Poorest Second Middle Fourth Richest Ethnicity of household head Papua Jawa Sulawesi Maluku Others Total for 3 districts Unweighted 841 886 1,057 1,085 1,699 465 399 504 432 421 289 274 2,086 74 25 53 546 2,002 782 571 2,213 474 727 1,237 346 696 471 484 560 573 1,759 488 285 128 124 2,784 42.7 26.9 30.4 42.2 57.8 16.6 14.5 18.2 14.9 15.1 10.3 10.5 75.3 2.4 0.9 1.6 19.8 72.1 27.9 19.5 80.5 13.0 28.4 45.7 13.0 19.2 18.2 18.9 21.3 22.3 53.9 24.5 10.8 5.2 5.6 100.0 Weighted 1,189 748 848 1,174 1,610 462 403 506 414 420 288 291 2,096 68 24 45 551 2,006 778 544 2,240 362 789 1,272 361 536 506 528 594 621 1,501 682 302 144 156 2,784 Table HH.4: Women’s background characteristics Per cent and frequency distribution of women age 15-49 years by selected background characteristics, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 Number of women Weighted per cent 14 MULTIPLE INDICATOR CLUSTER SURVEY 2011 Table HH.4 provides background characteristics of female respondents 15-49 years of age. The table includes information on the distribution of women according to district, residence, age, marital status, motherhood status, births in last two years, education, wealth index quintiles and ethnicity of the household head. About 43 per cent of female respondents 15-49 years of age live in Merauke, 27 per cent in Jayawijaya and 30 per cent in Biak Numfor. About 58 per cent of these women live in urban areas while the remaining 42 per cent live in rural areas. Of the 2,784 successfully interviewed women, 2,086 women (75 per cent) were currently married or in union, 546 women (20 per cent) were never married or in union and fewer women (5 per cent) were widowed, divorced or separated. Seventy-two per cent of women gave birth while 28 per cent never did. To assess their education, women were asked about highest level of school they reached. About 13 per cent of all women never attended any form of education. The majority (46 per cent) of all women have junior or senior secondary (SMP/ SM) education, 28 per cent have primary education and only 13 per cent have higher than secondary education. Weighted and unweighted number of cases were generally similar except for districts and ethnicity of head of household. Similarly, Table HH.4M provides background characteristics of male respondents 15-49 years of age. The table shows information on the distribution of men according to district, area, age, marital status, education, wealth index quintiles, and ethnicity. Men’s characteristics are generally similar to those of women, except that more men than women are not married or in union (32 per cent) whereas most of the remaining survey sample were currently married or in union (66 per cent). Some background characteristics of children under-five are presented in Table HH.5. These include distribution of children by several attributes: sex, district, area of residence, age, mother’s or caretaker’s education, wealth and ethnicity. The percentage of male children under-five is slightly higher compared with female (54 per cent vs 46 per cent respectively). Slightly less than one-fifth of children were under one year of age (19 per cent), 18 per cent were 12-23 months, 20 per cent were 24-35 months, 21 per cent were 36-47 months and 21 per cent were 48-59 months. The majority (61 per cent) of these children reside in rural areas whereas 39 per cent reside in urban areas. Thirteen per cent of children’s mothers or care takers were uneducated, 30 per cent had primary education, 46 per cent had secondary education (SMP/SM) while 11 per cent had higher education. Weighted and unweighted number of cases were generally similar, except for districts. MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 15 District Merauke Jayawijaya Biak Numfor Area Urban Rural Age of Man 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Marital/Union status Currently married/in union Widowed Divorced Separated Never married/in union Education None Primary SMP/SM Higher Wealth index quintile Poorest Second Middle Fourth Richest Ethnicity of household head Papua Jawa Sulawesi Maluku Others Missing/DK Total for 3 districts Unweighted 763 745 1,060 1,063 1,505 443 332 391 365 385 350 302 1,665 24 15 31 833 187 586 1393 402 617 415 478 531 527 1,619 480 244 109 115 1 2,568 45.2 24.4 30.4 44.9 55.1 16.4 12.9 15.9 14.3 14.9 13.5 12.2 65.5 0.9 0.5 1.1 32.1 5.6 24.8 54.1 15.4 18.9 17.3 19.3 22.5 21.9 52.7 26.7 9.8 4.8 5.9 0.0 100.0 Weighted 1,161 627 780 1,153 1,415 420 330 407 368 383 347 313 1,681 23 12 27 825 145 636 1,390 396 486 445 496 577 563 1,354 686 252 123 152 1 2,568 Table HH.4M: Men’s background characteristics Per cent and frequency distribution of men age 15-49 years by selected background characteristics, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 Number of men Weighted per cent MULTIPLE INDICATOR CLUSTER SURVEY 201116 MULTIPLE INDICATOR CLUSTER SURVEY 2011 District Merauke Jayawijaya Biak Numfor Sex Male Female Area Urban Rural Age 0-5 months 6-11 months 12-23 months 24-35 months 36-47 months 48-59 months Mother’s education* None Primary SMP/SM Higher Wealth index quintile Poorest Second Middle Fourth Richest Ethnicity of household head Papua Jawa Sulawesi Maluku Others Total for 3 districts Unweighted 420 492 599 799 712 517 994 139 155 280 304 332 301 265 428 661 157 425 284 290 273 239 1,065 194 134 51 118 1,511 38.1 28.0 33.9 54.2 45.8 38.6 61.4 9.1 10.1 18.4 20.3 21.4 20.7 13.3 29.5 45.9 11.2 22.2 20.0 20.3 19.6 17.9 61.8 18.3 9.6 4.0 10.3 100.0 Weighted 576 424 512 819 692 583 928 138 153 279 306 323 313 201 446 694 170 335 302 307 297 270 934 276 146 60 155 1,511 Table HH.5: Under-5’s background characteristics Per cent and frequency distribution of children under five years of age by selected characteristics, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 Number of under-5 children Weighted per cent * Mother’s education refers to educational attainment of mothers and caretakers of children under 5. MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 17MULTIPLE INDICATOR CLUSTER SURVEY 2011 4 CHILD MORTALITY One of the overarching goals of the Millennium Development Goals (MDGs) is the reduction of infant and under-five mortality. Specifically, the MDGs call for the reduction in under-five mortality by two-thirds between 1990 and 2015. Monitoring progress towards this goal is an important but difficult objective. Measuring childhood mortality may seem easy, but attempts using direct questions, such as “Has anyone in this household died in the last year?” give inaccurate results. Using direct measures of child mortality from birth histories is time-consuming, more expensive, and requires greater attention to training and supervision. Alternatively, indirect methods developed to measure child mortality produce robust estimates that are comparable with the ones obtained from other sources. Indirect methods minimize the pitfalls of memory lapses, inexact or misinterpreted definitions, and poor interviewing technique. The infant mortality rate is the probability of dying before the first birthday. The under- five mortality rate is the probability of dying before the fifth birthday. In MICS surveys, infant and under five mortality rates are calculated based on an indirect estimation technique known as the Brass method.7 The data used in the estimation are: the mean number of children ever born for five year age groups of women from age 15 to 49, and the proportion of these children who are dead, also for five-year age groups of women (Table CM.1). The technique converts the proportions dead among children of women in each age group into probabilities of dying by taking into account the approximate length of exposure of children to the risk of dying, assuming a particular model age pattern of mortality. Based on previous information on mortality in Indonesia, the West model life table was selected as most appropriate. It should be noted that the infant and child mortality estimates presented in the report are based on relatively small numbers of cases which can lead to unstable estimates. Therefore, interpretation of these estimated should be treated with caution. Table CM.2 provides estimates of child mortality. The infant mortality rates are estimated at 39, 86 and 48 per thousand in the districts of Merauke, Jayawijaya and Biak Numfor respectively. The probabilities of dying under age 5 (U5MR) are 48, 122 and 62 per thousand in the districts of Merauke, Jayawijaya and Biak Numfor respectively. These estimates have been calculated by averaging mortality estimates obtained from women age 25-29 and 30-34, and refer roughly to 2006. These mortality estimates show a clear disadvantage in Jayawijaya District compared with Merauke and Biak Numfor. The overall combined three districts infant and under-five mortality rates were 58 and 78 per thousand respectively. The Indonesian Demographic and Health survey conducted in 2007 gave a figure of 41 and 64 per thousand for infant and under-five mortality rates for the 10-year period preceding the survey using the direct method of mortality estimation. 7 United Nations, 1983. Manual X: Indirect Techniques for Demographic Estimation (United Nations publication, Sales No. E.83.XIII.2). United Nations, 1990a. QFIVE, United Nations Programme for Child Mortality Estimation. New York, UN Pop Division. United Nations, 1990b. Step-by-step Guide to the Estimation of Child Mortality. New York, UN. 18 MULTIPLE INDICATOR CLUSTER SURVEY 2011 Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total for 3 districts Mean 0.089 0.533 0.997 1.331 1.704 1.838 2.085 1.136 Mean 0.077 0.484 0.932 1.208 1.509 1.633 1.812 1.018 Total 41 215 505 551 716 529 607 3,163 Total 35 195 472 500 635 470 527 2,834 0.141 0.092 0.065 0.093 0.114 0.111 0.131 0.104 Number of women 462 403 506 414 420 288 291 2,784 Table CM.1: Children ever born, children surviving and proportion dead Mean and total numbers of children ever born, children surviving and proportion dead by age of women, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 Children ever born Children surviving Proportion dead District Merauke Jayawijaya Biak Numfor Sex Male Female Area Urban Rural Mother’s education None Primary SMP/SM Higher Wealth index quintile Poorest Second Middle Fourth Richest Ethnicity of household head Papuan Others Total for 3 districts 39 86 48 61 55 36 70 106 68 39 27 112 66 36 33 15 79 21 58 48 122 62 79 77 45 96 153 94 48 32 162 90 45 41 17 110 25 78 Table CM.2: Child mortality Infant and under-five mortality rates, West Model, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 1 MICS indicator 1.2; MDG indicator 4.2 2 MICS indicator 1.1; MDG indicator 4.1 Rates refer to 2006, West Model was assumed to approximate the age pattern of mortality in Indonesia Infant mortality rate1 Under-five mortality rate2 MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 19 For the combined three districts, there is some difference between the probabilities of dying among males and females. There are also significant differences in mortality in terms of area of residence, educational levels, wealth and ethnicity. Mortality rates are approximately double in rural areas compared with urban. As expected, sharp negative association between mortality and education is observed; for example the under-five mortality rate decreased from 153 per thousand for children with uneducated mothers to 32 per thousand for children with mothers with higher education. Similarly, under- five mortality rate decreased sharply from 162 per thousand among children living in the poorest household to 17 per thousand among those living in the richest households. Mortality was considerably greater among children whose household heads are Papuan compared with others. Differentials in under-5 mortality rates by selected background characteristics are shown in Figure CM.1. Figure CM. 1: Under-5 mortality rates by background characteristics, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 District Merauke Jayawijaya Biak Numfor Area Urban Rural Mother’s Education No education Primary Secondary Higher Wealth quintiles Poorest Second Middle Fourth Richest Ethznicity Papuan Other 0 50 100 150 Per 1,000 live births 48 122 62 45 96 153 94 48 32 162 90 45 41 17 110 25 MULTIPLE INDICATOR CLUSTER SURVEY 201120 MULTIPLE INDICATOR CLUSTER SURVEY 2011 MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 21MULTIPLE INDICATOR CLUSTER SURVEY 2011 5 NUTRITION 5.1. BREASTFEEDING Breastfeeding for the first few years of life protects children from infection, provides an ideal source of nutrients, and is economical and safe. However, many mothers stop breastfeeding too soon and there are often pressures to switch to infant formula, which can contribute to growth faltering and micronutrient malnutrition and is unsafe if clean water is not readily available. WHO/UNICEF provide the following feeding recommendations: • Exclusive breastfeeding for first six months • Continued breastfeeding for two years or more • Safe and age-appropriate complementary foods beginning at 6 months • Frequency of complementary feeding: 2 times per day for 6-8 month olds; 3 times per day for 9-11 month olds It is also recommended that breastfeeding be initiated within one hour of birth. The indicators related to recommended child feeding practices are as follows: • Early initiation of breastfeeding (within 1 hour of birth) • Exclusive breastfeeding rate (< 6 months) • Predominant breastfeeding (< 6 months) • Continued breastfeeding rate (at 1 year and at 2 years) • Duration of breastfeeding • Age-appropriate breastfeeding (0-23 months) • Introduction of solid, semi-solid and soft foods (6-8 months) • Minimum meal frequency (6-23 months) • Milk feeding frequency for non-breastfeeding children (6-23 months) • Bottle feeding (0-23 months) Table NU.1 charts the proportion of children born in the last two years who were ever breastfed and those who were first breastfed within one hour and one day of birth. Although a very important step in management of lactation and establishment of a physical and emotional relationship between the baby and the mother, only 35 per cent of babies in the three selected districts of Papua Province were breastfed for the first time within one hour of birth, while 73 per cent of newborns start breastfeeding within one day of birth. Women differed in the timing of initial breastfeeding according to districts, particularly when considering initiation of breastfeeding within one hour. Women in Biak Numfor District were the least likely to start breastfeeding within one hour (19 per cent) compared with women in Merauke (44 per cent) and Jayawijaya (39 per cent) (Figure NU.1). 22 MULTIPLE INDICATOR CLUSTER SURVEY 2011 Breastfeeding within one day of birth was higher in Jayawijaya District (86 per cent) than in Biak Numfor (70 per cent) and Merauke (64 per cent). It was also noticed that initial breastfeeding was highest among children born in the poorest households compared with the others. Children born in private hospitals (61 per cent) were more likely to be initially breastfed appropriately within one hour compared with those born in public sector hospitals (27 per cent) and those born at home (35 per cent). Children born by mothers whose head of household was Javanese were more likely to be initially breastfed with an hour (53 per cent) compared with households whose heads belong to other ethnic groups. In Table NU.2, breastfeeding status is based on the reports of mothers/caretakers of children’s consumption of food and fluids in the 24 hours prior to the interview. Exclusively breastfed refers to infants who received only breast milk (and vitamins, mineral supplements, or medicine). The table shows exclusive breastfeeding of infants during the first six months of life, as well as continued breastfeeding of children at 12-15 and 20-23 months of age. For the three districts of Papua Province, only 39 per cent of children aged less than six months are exclusively breastfed and 46 per cent are predominantly breastfed. Exclusive and predominant breast feeding are higher in Jayawijaya District (55 and 60 per cent respectively) compared with the other two districts (Merauke: 23 and 36 respectively; Biak Numfor: 38 and 43 respectively). At age 12-15 months, 80 per cent of the children are breastfed, while this percentage is 48 per cent for children aged 20-23 months. Continued breastfeeding indicators by background characteristics are not reported due to small number of cases. Table NU.3 shows the median duration of breastfeeding by selected background characteristics. Among children under age 3, the median duration is 22 months for any -breastfeeding, two months for exclusive breastfeeding, and four months for predominant breastfeeding. Results show that the median duration of breastfeeding was least at Biak Numfor (19 months) district compared with Merauke (20 months) districts. The median duration of breastfeeding shows a positive correlation with mother’s education and wealth. Figure NU.1: Percentage of mothers who started breastfeeding within one hour and within one day of birth, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 100 90 80 70 60 50 40 30 20 10 0 Merauke P er c en t UrbanJayawijaya Within one day Within one hour RuralBiak Numfor Three districts 44 64 86 38 19 70 63 33 36 80 87 64 MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 23 District Merauke Jayawijaya Biak Numfor Area Urban Rural Months since birth 0-11 months 12-23 months Assistance at delivery Skilled attendant Traditional birth attendant Other Missing Place of delivery* Public sector health facility Private sector health facility Home Mother’s education None Primary SMP/SM Higher Wealth index quintile Poorest Second Middle Fourth Richest Ethnicity of household head Papua Jawa Sulawesi Maluku Others Total for 3 districts 92.3 94.2 93.4 91.7 94.4 92.6 94.1 92.4 (90.9) 95.7 96.3 89.2 (100.0) 94.5 97.1 92.3 93.0 91.1 96.5 93.4 90.9 90.5 94.3 93.8 96.1 95.7 (*) (79.1) 93.2 44.1 38.5 19.0 32.8 36.1 35.1 33.8 36.4 (19.4) 33.6 36.2 26.6 (61.3) 35.0 44.7 39.3 33.8 17.4 40.3 29.4 35.4 30.8 36.4 30.2 53.4 31.4 (*) (35.1) 34.7 63.9 86.4 69.7 63.4 80.2 72.3 73.2 66.0 (68.3) 92.2 84.7 54.2 (77.8) 84.0 91.8 75.3 71.4 51.8 93.3 69.3 73.2 62.0 63.5 79.8 70.4 55.5 (*) (58.4) 72.9 204 174 167 237 307 296 242 365 34 129 16 190 53 297 79 122 279 64 125 101 102 112 105 322 105 58 21 37 544 Table NU.1: Initial breastfeeding Percentage of last-born children in the 2 years preceding the survey who were ever breastfed, percentage who were breastfed within one hour of birth and within one day of birth, and percentage who received a prelacteal feed, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 *3 cases with missing place of delivery not shown ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases 1 MICS indicator 2.4 2 MICS indicator 2.5 Percentage who were ever breastfed1 Percentage who were first breastfed: Number of last-born children in the two years preceding the surveyWithin one hour of birth2 Within one day of birth 24 MULTIPLE INDICATOR CLUSTER SURVEY 2011 The adequacy of infant feeding in children under 24 months is provided in Table NU.4. Different criteria of adequate feeding are used depending on the age of the child. For infants aged 0-5 months, exclusive breastfeeding is considered as adequate feeding, while infants aged 6-23 months are considered to be adequately fed if they are receiving breastmilk and solid, semi-solid or soft food. As a result of these feeding patterns, half of the children aged 6-23 months are being appropriately fed (52 per cent). The level of age-appropriate feeding is highest in Jayawijaya District (74 per cent) compared with Merauke (47 per cent) and Biak Numfor (40 per cent) districts. Appropriate feeding was higher among children residing in rural areas (57 per cent) compared with urban areas (46 per cent). Appropriate feeding showed negative correlation with mother’s education and wealth i.e. the percentage of appropriate feeding increases as the level of mother education decreases and it also increases as the wealth decreases (Figure NU.2). Similar patterns were observed for children age 0-23 months. Appropriate complementary feeding of children from 6 months to two years of age is particularly important for growth and development and the prevention of undernutrition. Continued breastfeeding beyond six months should be accompanied by consumption of nutritionally adequate, safe and appropriate complementary foods that help meet nutritional requirements when breast milk is no longer sufficient. This requires that for breastfed children, two or more meals of solid, semi-solid or soft foods are needed if they are six to eight months old, and three or more meals if they are 9-23 months of age. For children 6-23 months and older who are not breastfed, four or more meals of solid, semi- solid or soft foods or milk feeds are needed. District Merauke Jayawijaya Biak Numfor Sex Male Female Area Urban Rural Total for 3 districts (23.3) 55.0 38.3 37.3 41.4 (36.8) 40.6 39.1 (35.6) 59.5 42.9 46.0 46.5 (47.9) 45.1 46.2 (*) (89.9) (61.8) (81.0) 79.3 (78.9) 81.0 80.0 (33.6) (*) (44.3) (44.3) (53.8) (45.3) 50.7 48.3 46 48 44 77 61 55 83 138 33 33 31 41 56 44 54 97 35 21 31 51 36 39 48 87 Table NU.2: Breastfeeding Percentage of living children according to breastfeeding status at selected age groups, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 Children age 0-5 months Children age 12-15 months Children age 20-23 months Per cent exclusively breastfed1 Per cent predominantly breastfed2 Per cent breastfed (Continued breastfeeding at 1 year)3 Per cent breastfed (Continued breastfeeding at 2 years)4 Number of children Number of children Number of children ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 1 MICS indicator 2.6 2 MICS indicator 2.9 3 MICS indicator 2.7 4 MICS indicator 2.8 MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 25 Overall, 32 per cent of infants age 6-8 received solid, semi-solid, or soft foods (Table NU.5). Among currently breastfeeding infants this percentage is 31 while it is 34 among infants currently not breastfeeding. Table NU.6 presents the proportion of children age 6-23 months who received semi-solid or soft foods the minimum number of times or more during the previous day according to breastfeeding status (see the note in Table NU.6 for a definition of minimum number of times for different age groups). Overall, slightly more than half of the children age 6-23 months (54 per cent) were receiving solid, semi-solid and soft foods the minimum number of times (Merauke, 52 per cent; Jayawijaya, 60 per cent; Biak Numfor, 51 per cent). District Merauke Jayawijaya Biak Numfor Sex Male Female Area Urban Rural Mother’s education None Primary SMP/SM Higher Wealth index quintile Poorest Second Middle Fourth Richest Ethnicity of household head Papua Jawa Sulawesi Maluku Others Median Mean for all children (0-35 months) 20.0 18.7 20.4 22.1 20.3 22.7 23.8 20.1 10.1 20.3 19.6 19.7 19.8 24.2 20.3 19.8 (14.2) (*) 21.8 22.2 0.6 2.9 1.4 0.9 2.1 1.5 1.6 3.2 2.2 0.7 0.5 2.9 2.0 0.7 0.7 0.7 2.5 0.4 1.9 (4.8) (*) 1.6 2.4 0.6 3.5 1.8 1.6 2.3 2.3 1.9 4.4 2.4 0.7 0.6 3.6 2.4 0.7 1.4 0.7 3.1 0.4 2.1 (4.8) (*) 2.1 3.6 324 259 293 492 384 347 528 115 231 429 101 187 167 194 172 155 535 165 86 35 89 876 876 Table NU.3: Duration of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children age 0-35 months, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 Median duration (in months) of Any breastfeeding1 Exclusive breastfeeding Predominant breastfeeding Number of children age 0-35 months ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases 1 MICS indicator 2.10 26 MULTIPLE INDICATOR CLUSTER SURVEY 2011 District Merauke Jayawijaya Biak Numfor Sex Male Female Area Urban Rural Mother’s education None Primary SMP/SM Higher Wealth index quintile Poorest Second Middle Fourth Richest Ethnicity of household head Papua Jawa Sulawesi Maluku Others Total for 3 districts (23.3) 55.0 38.3 37.3 41.4 (36.8) 40.6 (56.6) (43.3) 33.2 (*) (54.1) (34.0) (*) (28.8) (*) 50.6 (*) (*) (*) (*) 39.1 41.6 68.8 39.7 48.4 49.8 43.9 52.9 73.2 57.2 43.4 28.0 78.3 44.1 46.2 37.7 37.2 56.9 45.7 41.1 (*) 19.0 49.0 46.8 74.3 40.1 52.1 52.4 45.9 57.2 81.0 61.1 46.7 28.2 87.4 48.0 46.4 40.6 38.6 59.0 55.5 (*) (*) 16.8 52.2 46 48 44 77 61 55 83 26 30 68 14 33 29 23 30 24 84 27 12 4 15 138 160 121 150 234 198 192 240 55 106 214 56 87 76 94 89 85 260 76 46 20 49 431 206 169 194 310 259 247 323 80 136 283 70 119 105 117 119 108 344 103 59 24 64 569 Table NU.4: Age-appropriate breastfeeding Percentage of children age 0-23 months who were appropriately breastfed during the previous day, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 Children age 0-5 months Children age 6-23 months Children age 0-23 months Per cent exclusively breastfed1 Per cent appropriately breastfed2 Per cent currently breastfeeding and receiving solid, semi-solid or soft foods Number of children Number of children Number of children ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases 1 MICS indicator 2.6 2 MICS indicator 2.14 The continued practice of bottle-feeding is a concern because of the possible contamination due to unsafe water and lack of hygiene in preparation. Table NU.7 shows that thirty-nine per cent of children under 6 months are fed using a bottle with a nipple. Bottle feeding is considerably lower in Jayawijaya District (17 per cent) compared with Merauke (46 per cent) and Biak Numfor (50 per cent). Bottle feeding is higher in urban areas, among children of the more educated richer women. MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 27 Sex Male Female Area Urban Rural Total for 3 districts (24.8) (39.6) (*) (39.8) 31.4 (27.6) (36.4) (22.2) (42.0) 31.9 (39.6) (29.8) (25.7) 57.0 (33.5) 34 28 26 35 62 8 13 16 5 21 42 41 42 41 83 Table NU.5: 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, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 Currently breastfeeding Currently not breastfeeding All Per cent receiving solid, semi-solid or soft foods Per cent receiving solid, semi-solid or soft foods1 Per cent receiving solid, semi-solid or soft foods Number of children age 6-8 months Number of children age 6-8 months Number of children age 6-8 months ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases 1 MICS indicator 2.12 Figure NU.2: Percentage of children age 6-23 months who were appropriately breastfed during the previous day by mother’s education and wealth index, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 100 90 80 70 60 50 40 30 20 10 0 None P er c en t Poorest Mother’s education Wealth index Primary Second Middle Fourth RichestSMP/SM Higher 81 87 48 46 41 39 61 47 28 28 MULTIPLE INDICATOR CLUSTER SURVEY 2011 District Merauke Jayawijaya Biak Numfor Sex Male Female Age 6-8 months 9-11 months 12-17 months 18-23 months Area Urban Rural Mother’s education None Primary SMP/SM Higher Wealth index quintile Poorest Second Middle Fourth Richest Ethnicity of household head Papua Jawa Sulawesi Maluku Others Total for 3 districts 41.9 56.9 35.2 48.0 42.0 28.1 43.8 54.3 46.8 47.9 43.3 53.4 45.4 42.3 45.6 (*) 39.2 27.5 44.9 48.1 46.4 51.5 37.3 26.8 (*) 45.2 51 13 60 70 55 21 9 34 60 65 59 5 22 64 33 2 21 33 35 34 61 22 15 10 26 124 (76.5) (*) 79.5 74.3 86.6 (*) (*) (86.2) 68.4 89.1 69.5 (53.9) (71.5) 77.7 (93.4) (*) (*) (65.6) (86.6) (100.0) 68.6 (*) (*) (*) (*) 79.7 109 108 90 164 143 62 61 113 71 127 180 50 84 150 24 84 55 62 55 50 198 54 32 10 22 307 73.4 81.6 74.3 70.0 80.6 79.3 100.0 81.4 65.5 82.0 66.7 53.9 63.2 68.5 97.9 0.0 62.6 59.9 80.2 95.5 66.3 72.4 94.6 86.5 (*) 74.7 52.0 59.6 50.8 54.5 52.7 41.1 50.8 60.6 55.4 59.5 49.1 53.5 49.1 50.2 76.0 58.9 45.5 38.7 58.6 67.3 51.1 57.5 (55.5) (*) (59.8) 53.7 160 121 150 234 198 83 70 148 131 192 240 55 106 214 56 87 76 94 89 85 260 76 46 20 49 431 Table NU.6: Minimum meal frequency Percentage of children age 6-23 months who received solid, semi-solid, or soft foods (and milk feeds for non-breastfeeding children) the minimum number of times or more during the previous day, according to breastfeeding status, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 Currently breastfeeding Currently not breastfeeding All Per cent receiving solid, semi-solid and soft foods the minimum number of times Number of children age 6-23 months Number of children age 6-23 months Per cent receiving solid, semi-solid and soft foods or milk feeds 4 times or more Per cent with minimum meal frequency2 Per cent receiving at least 2 milk feeds1 Number of children age 6-23 months ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases 1 MICS indicator 2.15 2 MICS indicator 2.13 MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 29 District Merauke Jayawijaya Biak Numfor Sex Male Female Age 0-5 months 6-11 months 12-23 months Area Urban Rural Mother’s education None Primary SMP/SM Higher Wealth index quintile Poorest Second Middle Fourth Richest Ethnicity of household head Papua Jawa Sulawesi Maluku Others Total for 3 districts 45.8 17.4 49.9 39.4 38.1 34.5 39.7 40.3 46.1 33.1 7.7 38.5 40.3 68.6 9.2 38.7 39.8 49.8 58.1 30.2 48.1 51.8 (*) (57.8) 38.8 206 169 194 310 259 138 153 279 247 323 80 136 283 70 119 105 117 119 108 344 103 59 24 64 569 Table NU.7: Bottle feeding Percentage of children age 0-23 months who were fed with a bottle with a nipple during the previous day, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 Number of children age 0-23 months Percentage of children age 0-23 months fed with a bottle with a nipple1 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases 1 MICS indicator 2.11 30 MULTIPLE INDICATOR CLUSTER SURVEY 2011 5.2. VITAMIN A SUPPLEMENTS Vitamin A is essential for eye health and proper functioning of the immune system. It is found in foods such as milk, liver, eggs, red and orange fruits, red palm oil and green leafy vegetables, although the amount of vitamin A readily available to the body from these sources varies widely. In developing areas of the world, where vitamin A is largely consumed in the form of fruits and vegetables, daily per capita intake is often insufficient to meet dietary requirements. Inadequate intakes are further compromised by increased requirements for the vitamin as children grow or during periods of illness, as well as increased losses during common childhood infections. As a result, vitamin A deficiency is quite prevalent in the developing world and particularly in countries with the highest burden of under-five deaths. The 1990 World Summit for Children set the goal of virtual elimination of vitamin A deficiency and its consequences, including blindness, by the year 2000. This goal was also endorsed at the Policy Conference on Ending Hidden Hunger in 1991, the 1992 International Conference on Nutrition, and the UN General Assembly’s Special Session on Children in 2002. The critical role of vitamin A for child health and immune function also makes control of deficiency a primary component of child survival efforts, and therefore critical to the achievement of the fourth Millennium Development Goal: a two-thirds reduction in under-five mortality by the year 2015. For countries with vitamin A deficiency problems, current international recommendations call for high-dose vitamin A supplementation every four to six months, targeted to all children between the ages of six to 59 months living in affected areas. Providing young children with two high-dose vitamin A capsules a year is a safe, cost-effective, efficient strategy for eliminating vitamin A deficiency and improving child survival. Giving vitamin A to new mothers who are breastfeeding helps protect their children during the first months of life and helps to replenish the mother’s stores of vitamin A, which are depleted during pregnancy and lactation. For countries with vitamin A supplementation programmes, the definition of the indicator is the percentage of children 6-59 months of age receiving at least one high dose vitamin A supplement in the last six months. As per the 2011 WHO recommendations, the Indonesian Ministry of Health recommends that children aged 6-59 months be given two high dose Vitamin A capsules every 6 months. In Indonesia, Vitamin A capsules are generally distributed through two National Campaigns held in February and August. Indonesian post-partum women also receive a Vitamin A capsule within eight weeks after delivery, though 2011 WHO Guidelines do not recommend this anymore. Within the six months prior to the Selected Districts of Papua Province MICS, 64 per cent of children aged 6-59 months received a high dose Vitamin A supplement (Table NU.8). About 62 per cent of children received a high dose of vitamin A supplement according to mothers report. Vitamin A supplementation coverage is considerable lower in Jayawijaya District (33 per cent) compared with Merauke (71 per cent) and Biak Numfor (81 per cent) districts. The age pattern of Vitamin A supplementation shows that supplementation in the last six months rises from 52 per cent among children aged 6-11 months to 67 per cent among children aged 12-23 months and 24-35 months each, then declines to 62 per cent among children 36-47 months and increases to 66 per cent among 48-59 months. MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 31 The mother’s level of education is also related to the likelihood of Vitamin A supplementation. The percentage receiving a supplement in the last six months increases from 25 per cent among children whose mothers have no education, to 64 per cent of those whose mothers have primary education, to 73 per cent of those whose mothers have secondary education and to 74 per cent among children of mothers with higher education. District Merauke Jayawijaya Biak Numfor Sex Male Female Area Urban Rural Age 6-11 months 12-23 months 24-35 months 36-47 months 48-59 months Mother’s education None Primary SMP/SM Higher Wealth index quintile Poorest Second Middle Fourth Richest Ethnicity of household head Papua Jawa Sulawesi Maluku Others Total for 3 districts 18.0 1.7 4.3 10.0 7.6 11.5 7.3 14.7 15.0 8.7 5.8 4.0 0.8 6.3 12.3 11.5 0.6 8.2 8.5 12.6 16.3 2.8 24.9 13.6 (20.7) 13.1 8.9 66.8 33.0 80.7 63.5 61.0 62.1 62.4 47.2 65.5 64.7 61.1 65.8 24.9 62.6 69.9 73.0 37.3 63.0 73.7 66.7 74.3 59.9 73.9 67.4 (55.6) 51.2 62.3 71.4 33.1 80.7 64.8 63.3 62.6 65.1 51.6 67.0 67.2 62.4 66.3 24.9 64.4 72.5 73.9 38.0 66.9 76.3 67.9 75.0 60.0 81.1 68.6 (64.6) 54.8 64.1 530 376 468 742 632 528 845 153 279 306 323 313 176 416 625 156 303 272 285 267 246 850 249 133 56 140 1,373 Table NU.8: Children’s vitamin A supplementation Per cent distribution of children age 6-59 months by receipt of a high dose vitamin A supplement in the last 6 months, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 Percentage of children who received Vitamin A during the last 6 months1 Child health book/ vaccination card Percentage who received Vitamin A according to: Mother’s report Number of children age 6-59 months ( ) Figures that are based on 25-49 unweighted cases 1 MICS indicator 2.17 32 MULTIPLE INDICATOR CLUSTER SURVEY 2011 5.3. LOW BIRTH WEIGHT Weight at birth is a good indicator not only of a mother’s health and nutritional status but also the newborn’s chances for survival, growth, long-term health and psychosocial development. Low birth weight (less than 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 months and years. Those who survive have impaired immune function and increased risk of disease; they are likely to remain undernourished, with reduced muscle strength, throughout their lives, and suffer a higher incidence of diabetes and heart disease in later life. Children born underweight also tend to have a lower IQ and cognitive disabilities, affecting their performance in school and their job opportunities as adults. In the developing world, low birth weight stems primarily from the mother’s poor health and nutrition. Three factors have most impact: the mother’s poor nutritional status before conception, short stature (due mostly to under nutrition and infections during her childhood), and poor nutrition during the pregnancy. Inadequate weight gain during pregnancy is particularly important since it accounts for a large proportion of foetal growth retardation. Moreover, diseases such as diarrhoea and malaria, which are common in many developing countries, can significantly impair foetal growth if the mother becomes infected while pregnant. In the industrialized world, cigarette smoking during pregnancy is the leading cause of low birth weight. In developed and developing countries alike, teenagers who give birth when their own bodies have yet to finish growing run the risk of bearing underweight babies. One of the major challenges in measuring the incidence of low birth weight is the fact that more than half of infants in the developing world are not weighed. In the past, most estimates of low birth weight for developing countries were based on data compiled from 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, in standard MICS methodology, the percentage of births weighing below 2,500 grams is estimated from two items in the questionnaire: the mother’s assessment of the child’s size at birth (i.e., very small, smaller than average, average, larger than average, very large) and the mother’s recall of the child’s weight or the weight as recorded on a health card if the child was weighed at birth.8 For the Selected Districts of Papua Province 2011 MICS, information on mother’s assessment of the child’s size at birth was not collected. Therefore reporting of percentage of births weighing below 2,500 grams is only based on the mother’s recall of the child’s weight or the weight as recorded on a health card if the child was weighed at birth. 8 For a detailed description of the methodology, see Boerma, J. T., Weinstein, K. I., Rutstein, S.O., and Sommerfelt, A. E. , 1996. Data on Birth Weight in Developing Countries: Can Surveys Help? Bulletin of the World Health Organization, 74(2), 209-16. MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 33 District Merauke Jayawijaya Biak Numfor Area Urban Rural Mother’s education None Primary SMP/SM Higher Wealth index quintile Poorest Second Middle Fourth Richest Ethnicity of household head Papua Jawa Sulawesi Maluku Others Total for 3 districts 12.5 7.9 16.5 13.1 13.3 0.0 12.5 14.3 12.0 9.4 18.2 14.1 12.0 11.2 18.2 10.3 10.5 (13.1) (6.9) 13.2 83.2 28.3 71.4 79.4 48.7 9.6 56.2 73.1 89.6 10.5 60.8 66.2 87.9 93.0 41.1 91.8 93.3 (90.0) (94.9) 62.1 204 174 167 237 307 79 122 279 64 125 101 102 112 105 322 105 58 21 37 544 Table NU.9: Low birth weight infants Percentage of last-born children in the 2 years preceding the survey that are estimated to have weighed below 2,500 grams at birth and percentage of live births weighed at birth, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 Number of last- born children in the two years preceding the survey Below 2,500 grams1 Per cent of live births: Weighed at birth2 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases 1 MICS indicator 2.18 (only based on 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) 2 MICS indicator 2.19 Overall, 62 per cent of births were weighed at birth with approximately 13 per cent of infants estimated to weigh less than 2,500 grams at birth (Table NU.9). There are variations by districts. The lowest estimated percentage of infants weighing less than 2,500 grams at birth was in Jayawijaya (8 per cent) compared with 13 per cent in Merauke and 17 per cent in Biak Numfor District. MULTIPLE INDICATOR CLUSTER SURVEY 201134 MULTIPLE INDICATOR CLUSTER SURVEY 2011 MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 35MULTIPLE INDICATOR CLUSTER SURVEY 2011 6 CHILD HEALTH 6.1. IMMUNIZATION The Millennium Development Goal (MDG) 4 is to reduce child mortality by two thirds between 1990 and 2015. Immunization plays a key part in this goal. Immunizations have saved the lives of millions of children in the three decades since the launch of the Expanded Programme on Immunization (EPI) in 1974. Worldwide there are still 27 million children overlooked by routine immunization and as a result, vaccine-preventable diseases cause more than 2 million deaths every year. A World Fit for Children goal is to ensure full immunization of children under one year of age at 90 per cent nationally, with at least 80 per cent coverage in every district or equivalent administrative unit. According to UNICEF and WHO guidelines, a child should receive a BCG vaccination to protect against tuberculosis, three doses of DPT to protect against diphtheria, pertussis, and tetanus, three doses of polio vaccine, and a measles vaccination by the age of 12 months. According to the national immunization schedule, by a first birthday each child in Indonesia should receive through routine immunization - a BCG vaccination to protect against tuberculosis, three doses of DPT to protect against Diphtheria, Pertussis, and Tetanus, four doses of polio vaccine, four doses of Hepatitis B vaccine and a measles or MMR vaccination at the age of 9 months or older. Taking into consideration this vaccination schedule, the estimates for full immunization coverage from the Selected Districts of Papua Province MICS are based on children age 12-23 months. Information on vaccination coverage was collected for all children under five years of age. All mothers or caretakers were asked to provide vaccination cards. If the vaccination card for a child was available, interviewers copied vaccination information from the cards onto the MICS questionnaire. If no vaccination card was available for the child, the interviewer proceeded to ask the mother to recall whether or not the child had received each of the vaccinations, and for Polio, DPT and Hepatitis B, how many doses were received. The final vaccination coverage estimates are based on both information obtained from the vaccination card and the mother’s report of vaccinations received by the child. The percentage of children age 12 to 23 months who have received each of the specific vaccinations by source of information (vaccination card and mother’s recall) is shown in Table CH.1. The denominator for the table is comprised of children age 12-23 months so that only children who are old enough to be fully vaccinated are counted. In the first three columns of the table, the numerator includes all children who were vaccinated at 36 MULTIPLE INDICATOR CLUSTER SURVEY 2011 any time before the survey according to the vaccination card or the mother’s report. In the last column, only those children who were vaccinated before their first birthday, as recommended, are included. For children without vaccination cards, the proportion of vaccinations given before the first birthday is assumed to be the same as for children with vaccination cards. Considering the three selected districts of Papua Province, approximately 85 per cent of children age 12-23 months received a BCG vaccination by the age of 12 months and the first dose of DPT was given to 85 per cent. The percentage declines for subsequent doses of DPT to 76 per cent for the second dose and 56 per cent for the third dose (Figure CH.1). Similarly, 59 per cent of children received Polio 1 by age 12 months and this increases to 78 per cent for the second dose and then declines to 60 per cent by the fourth dose. The coverage for measles/ MMR vaccine by 12 months is 75 per cent. There is also a decline in the Hepatitis B vaccination from 84 per cent for the first dose to 76 per cent for the second dose and 52 per cent for the third dose. As a result, the percentage of children who had all the recommended vaccinations by their first birthday is low at only 35 per cent. BCG1 Polio 1 2 3 42 DPT 1 2 33 Measles4 HepB At birth 1 2 35 DPT/ HepB 1 2 3 All vaccinations No vaccinations Number of children age 12-23 months 39.5 38.6 38.2 37.5 35.4 40.5 40.6 40.2 37.2 27.5 40.0 40.7 39.9 32.8 32.8 31.5 35.1 0.0 279 45.8 20.1 39.3 27.3 25.5 44.1 35.7 15.4 39.8 8.7 44.1 35.2 12.4 34.4 26.3 13.7 3.9 12.9 279 85.3 58.7 77.5 64.8 60.9 84.6 76.3 55.6 77.1 36.2 84.1 75.9 52.3 67.3 59.1 45.1 39.0 12.9 279 85.3 58.7 77.5 64.8 60.4 84.6 76.3 55.6 74.8 36.2 84.1 75.9 52.3 67.3 59.1 45.1 34.8 12.9 279 Table CH.1: Vaccinations in first year of life Percentage of children age 12-23 months immunized against childhood diseases at any time before the survey and before the first birthday, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 Vaccinated by 12 months of age Child health book/ vaccination card Vaccinated at any time before the survey according to Mother’s report Either 1 MICS indicator 3.1 2 MICS indicator 3.2 3 MICS indicator 3.3 4 MICS indicator 3.4; MDG indicator 4.3 5 MICS indicator 3.5 MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 37 Figure CH.1: Percentage of children age12-23 months who received the recommended vaccinations by 12 months, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011. 100 90 80 70 60 50 40 30 20 10 0 B C G D P T 1 D P T 2 D P T 3 P o lio 1 H ep B 0 P o lio 2 H ep B 1 P o lio 3 H ep B 2 P o lio 4 M ea sl es A ll H ep B 3 P er c en t 85 85 76 56 59 78 75 84 76 52 3536 65 60 Table CH.2 presents vaccination coverage estimates among children 12-23 months by background characteristics. The figures indicate children receiving the vaccinations at any time up to the date of the survey and are based on information from both the vaccination cards and mothers’/caretakers’ reports. Vaccination cards have been seen by the interviewer for only 40 per cent of children (Jayawijaya, 55 per cent; Merauke 27 per cent; Biak Numfor, 34 per cent). Compared with all elected districts, the survey results show that Jayawijaya District has the lowest coverage for all vaccinations as well as the lowest full vaccination coverage of only 16 per cent. The full vaccination coverage in Merauke and Biak Numfor districts was 58 and 37 per cent respectively. Often given to infants at the time of birth, BCG vaccine and DPT 1 (85 per cent each) have the highest coverage. In general, percentages of currently vaccinated children aged 12-23 months by the different vaccines fluctuated across districts, but it is worth noting that Polio 1, DPT 3 and HepB at birth are considerably lagging behind in Jayawijaya. HepB at birth has low coverage overall and among districts particularly among Jayawijaya District (Merauke, 54 per cent; Jayawijaya, 9 per cent; Biak Numfor, 31 per cent) Mother’s education is highly positively associated with vaccination coverage – Children of mothers with secondary or higher level of education are more than twice as likely to be vaccinated as those born to mothers with no education. 38 MULTIPLE INDICATOR CLUSTER SURVEY 2011 D is tr ic t M er au ke Ja ya w ija ya B ia k N u m fo r S ex M al e Fe m al e A re a U rb an R u ra l M o th er ’s e d u ca ti o n N o n e P ri m ar y S M P /S M H ig h er W ea lt h in d ex q u in ti le P o o re st S ec o n d M id d le Fo u rt h R ic h es t E th n ic it y o f h o u se h o ld h ea d P ap u a Ja w a S u la w es i M al u ku O th er s To ta l f o r 3 d is tr ic ts 75 .5 32 .9 60 .7 62 .3 54 .7 73 .2 47 .5 (1 6. 9) 43 .4 71 .5 (7 2. 7) 12 .2 (5 7) 58 .3 74 .3 (8 8. 7) 43 .7 (8 8. 8) (7 9. 3) (* ) (7 3. 1) 58 .7 96 .3 62 .7 90 .8 86 .4 84 90 .2 81 .4 (4 5. 4) 86 91 (9 7) 54 .3 (9 4. 7) 91 .4 89 .5 (9 5. 7) 78 .9 (9 8. 6) (8 8. 3) (* ) (9 6. 0) 85 .3 91 .5 50 83 .5 77 .5 77 .5 82 .6 73 .6 (3 5. 8) 77 .5 85 (8 5. 5) 40 .8 (8 4. 7) 86 .2 87 .8 (8 6. 5) 70 .5 (9 5. 9) (6 7. 3) (* ) (8 6. 0) 77 .5 81 .4 43 .2 63 .9 65 .6 63 .9 72 .2 59 .2 (2 4. 9) 64 .6 73 (6 9. 5) 24 .3 (7 2. 2) 69 .6 76 .5 (8 0) 53 .2 (9 1. 6) (6 4. 4) (* ) (8 5. 8) 64 .8 81 .4 35 .5 58 .8 62 .2 59 .5 69 .6 54 .2 (2 0. 3) 61 .2 67 .9 (6 9. 5) 18 .9 (6 8. 8) 65 .7 71 .1 (7 8. 4) 48 .2 (8 9. 8) (6 4. 4) (* ) (8 0. 8) 60 .9 97 .1 59 .8 90 .1 85 84 .1 90 .7 79 .7 (3 8. 8) 87 .4 90 .5 (9 7) 47 .5 (9 1. 5) 94 91 ( 97 ) 77 (1 00 ) (8 8. 3) (* ) (9 5. 9) 84 .6 91 .4 52 .2 77 .6 75 .8 76 .9 84 .2 69 .8 (3 1. 7) 78 .8 81 (9 1. 8) 35 (8 1. 4) 80 .3 87 .5 (9 2. 8) 65 .5 (9 8. 6) (7 9. 6) (* ) (9 3) 76 .3 70 .1 30 .9 57 .3 52 .4 59 .5 61 .2 51 (1 4. 6) 62 .2 60 .2 (6 1. 7) 12 .4 (6 0. 5) 58 .5 63 .8 (7 6. 9) 42 .7 (8 0. 2) (5 7. 4) (* ) (8 0. 9) 55 .6 92 .2 43 .8 86 7 6. 3 78 84 .1 71 .6 (3 5. 3) 73 82 .9 (9 7) 32 .4 (8 5. 4) 88 .3 85 .1 (9 0. 8) 67 .4 (9 4. 8) (8 2. 6) (* ) (9 6. 0) 77 .1 58 .2 11 .8 30 .3 40 .1 31 .5 44 .6 29 .5 (7 .8 ) 34 .6 43 .3 (3 6. 9) 7. 4 (4 0) 30 .9 40 .4 (5 8. 9) 19 .9 (6 9. 7) (4 9. 5) (* ) (5 5. 6) 36 .2 97 .2 59 .2 88 .7 84 .6 83 .5 90 .8 78 .9 (3 8. 2) 86 .1 90 ( 97 ) 47 .4 (8 8. 4) 94 .3 91 ( 97 ) 76 .3 (1 00 ) (8 8. 3) (* ) (9 6) 84 .1 91 .7 51 .3 76 .6 75 .9 75 .9 82 .2 70 .7 (3 2. 6) 78 .2 81 (8 8. 1) 36 .4 (7 8) 82 8 7. 5 (9 0. 2) 64 .2 (9 8. 6) (8 2. 8) (* ) (9 3) 75 .9 69 .2 32 .2 48 .7 49 .4 55 .8 59 .5 46 .5 (1 7. 8) 51 .9 58 .5 (5 8. 7) 13 (5 4. 9) 52 61 .8 (7 4. 5) 39 .6 (7 6. 4) (5 1. 2) (* ) (8 0. 9) 52 .3 2. 7 36 .4 5. 9 11 .8 14 .2 9. 2 15 .8 (5 4. 6) 10 7 .3 (3 ) 45 .7 (5 .2 ) 4. 2 7. 6 (3 ) 18 .5 0. 0 (1 1. 7) (* ) (4 .0 ) 12 .9 58 .4 15 .6 36 .5 40 .5 37 .4 48 .9 31 .5 (9 .4 ) 28 .4 46 .8 (5 2. 9) 3. 7 (3 6. 6) 41 .3 48 .5 (6 3) 25 .7 (7 3. 2) (3 5. 2) (* ) (6 1. 5) 39 54 .7 27 .4 33 .5 40 .5 39 48 .6 33 (1 4. 1) 31 48 .1 (9 7) 7 .8 30 .3 40 .1 58 .4 59 .1 25 .4 69 .9 49 .4 (* ) (6 1. 7) 39 .8 10 4 74 10 0 14 9 12 9 12 1 15 7 33 65 14 1 40 54 51 59 57 57 17 0 50 29 13 31 27 9 Ta b le C H .2 : V ac ci n at io n s b y b ac kg ro u n d c h ar ac te ri st ic s P er ce n ta g e o f ch ild re n a g e 12 -2 3 m o n th s cu rr en tl y va cc in at ed a g ai n st c h ild h o o d d is ea se s, D is tr ic ts o f M er au ke , J ay aw ija ya a n d B ia k N u m fo r, P ap u a P ro vi n ce , I n d o n es ia , 2 01 1 ( ) Fi g u re s th at a re b as ed o n 2 5- 49 u n w ei g h te d c as es (* ) Fi g u re s th at a re b as ed o n f ew er t h an 2 5 u n w ei g h te d c as es P o lio D P T H ep B A t b ir th A t b ir th 1 1 2 2 3 3 N o n e A ll 3 1 2 B C G M ea sl es P er ce n ta g e w it h va cc in at io n c ar d se en N u m b er o f ch ild re n a g e 12 -2 3 m o n th s P er ce n ta g e o f ch ild re n w h o r ec ei ve d : MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 39 6.2. NEONATAL TETANUS PROTECTION One of the MDGs is to reduce by three quarters the maternal mortality ratio, with one strategy to eliminate maternal tetanus. In addition, another goal is to reduce the incidence of neonatal tetanus to less than 1 case of neonatal tetanus per 1,000 live births in every district. A World Fit for Children goal is to eliminate maternal and neonatal tetanus by 2005. The strategy for preventing maternal and neonatal tetanus is to assure all pregnant women receive at least two doses of tetanus toxoid vaccine. If a woman has not received two doses of tetanus toxoid during a particular pregnancy, she (and her newborn) are also considered to be protected against tetanus if the woman: • Received at least two doses of tetanus toxoid vaccine, the last within the previous 3 years; • Received at least 3 doses, the last within the previous 5 years; • Received at least 4 doses, the last within the previous 10 years; • Received at least 5 doses anytime during life. To assess the status of tetanus vaccination coverage, women who gave birth during the two years before the survey were asked if they had received tetanus toxoid injections during the pregnancy for their most recent birth, and if so, how many. Women who did not receive two or more tetanus toxoid vaccinations during this pregnancy were then asked about tetanus toxoid vaccinations they may have received prior to this pregnancy. Interviewers also asked women to present their vaccination card, on which dates of tetanus toxoid are recorded and referred to information from the cards when available. District Merauke Jayawijaya Biak Numfor Area Urban Rural Mother’s Education None Primary SMP/SM Higher Wealth index quintile Poorest Second Middle Fourth Richest 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0 Per cent Figure CH.2: Percentage of women with a live birth in the last 12 months who are protected against neonatal tetanus, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011. 71 47 74 71 59 33 62 74 65 38 63 71 70 83 40 MULTIPLE INDICATOR CLUSTER SURVEY 2011 Table CH.3 shows the protection status from tetanus of women who have had a live birth within the last 2 years. Figure CH.2 shows the protection of women against neonatal tetanus by major background characteristics. The results of the survey indicate that tetanus toxoid coverage in the three selected districts of Papua Province is at 64 per cent and least in Jayawijaya District (Jayawijaya, 47 per cent; Merauke, 72 per cent; Biak Numfor, 74 per cent). It is worth noting that tetanus toxoid protection is much lower among the poorest households (38 per cent) compared with the richest households (83 per cent). Similarly, tetanus toxoid protection increases from 33 per cent among women with no education to 65 per cent among women with higher education. District Merauke Jayawijaya Biak Numfor Area Urban Rural Education None Primary SMP/SM Higher Wealth index quintile Poorest Second Middle Fourth Richest Ethnicity of household head Papua Jawa Sulawesi Maluku Others Total for 3 districts 42.1 35.2 58.0 43.6 45.6 29.9 43.2 49.6 45.1 29.1 45.7 45.4 53.5 52.6 43.5 39.6 55.7 (*) (*) 44.8 25.8 11.6 14.2 23.5 13.3 2.9 18.4 22.0 16.1 9.0 16.4 25.3 14.2 25.7 12.6 31.0 17.0 (*) (*) 17.7 0.7 0.0 1.4 1.6 0.0 0.0 0.0 1.1 1.2 0.0 0.0 0.0 1.3 2.1 0.5 0.8 2.4 (*) (*) 0.7 2.9 0.0 0.0 1.9 0.5 0.0 0.0 1.6 2.4 0.0 1.4 0.0 1.4 2.8 0.0 2.8 2.7 (*) (*) 1.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 (*) (*) 0.0 71.5 46.9 73.6 70.6 59.4 32.7 61.6 74.2 64.7 38.1 63.5 70.7 70.5 83.2 56.5 74.2 77.7 (*) (*) 64.3 204 174 167 237 307 79 122 279 64 125 101 102 112 105 322 105 58 21 37 544 Table CH.3: Neonatal tetanus protection Percentage of women age 15-49 years with a live birth in the last 2 years protected against neonatal tetanus, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases 1 MICS indicator 3.7 Percentage of women who received at least 2 doses during last pregnancy Number of women with a live birth in the last 2 years Percentage of women who did not receive two or more doses during last pregnancy but received: 2 doses, the last within prior 3 years 3 doses, the last within prior 5 years 4 doses, the last within prior 10 years 5 or more doses during lifetime Protected against tetanus1 MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 41 6.3. SOLID FUEL USE More than 3 billion people around the world rely on solid fuels for their basic energy needs, including cooking and heating. Solid fuels include biomass fuels, such as wood, charcoal, crops or other agricultural waste, dung, shrubs and straw, and coal. Cooking and heating with solid fuels leads to high levels of indoor smoke, which contains a complex mix of health-damaging pollutants. The main problem with the use of solid fuels is their incomplete combustion, which produces toxic elements such as carbon dioxide, polyaromatic hydrocarbons, and sulphur dioxide, among others. Use of solid fuels increases the risks of incurring acute respiratory illness, pneumonia, chronic obstructive lung disease, cancer, and possibly tuberculosis, asthma or cataracts, and may contribute to low birth weight. The primary indicator for monitoring use of solid fuels is the proportion of the population using solid fuels as the primary source of domestic energy for cooking. Table CH.4 shows that solid fuel use is common in the three selected districts of Papua Province where 61 per cent of all households are using solid fuel for cooking. The findings show that use of solid fuels is very common among households in Jayawijaya District where 83 per cent of households use solid fuel, mostly wood. About half the households in Merauke (54 per cent) and Biak Numfor (50 per cent) are using solid fuel, also mostly wood. Use of solid fuels is low in urban areas (25 per cent), but very high in rural areas, where most of the households (85 per cent) are using solid fuels. Differentials with respect to household wealth and the educational level of the household head are also significant. The findings show that use of solid fuels is more uncommon among households whose household heads are Papuan compared with households from other ethnic groups. Solid fuel by place of cooking is shown in Table CH.5. The presence and extent of indoor pollution are dependent on cooking practices, places used for cooking, as well as types of fuel used. About half the sample cooks in a separate room used as a kitchen (48 per cent), 11 per cent cook elsewhere in the house, 38 per cent cook in a separate building and about four per cent cook outdoors. Most of the household members in Merauke (79 per cent) and 46 per cent in Biak Numfor cook in a separate room while most of the household members in Jayawijaya cook in a separate building (60 per cent). 42 MULTIPLE INDICATOR CLUSTER SURVEY 2011 D is tr ic t M er au ke Ja ya w ija ya B ia k N u m fo r A re a U rb an R u ra l E d u ca ti o n o f h o u se h o ld h ea d N o n e P ri m ar y S M P /S M H ig h er M is si n g /D K W ea lt h in d ex q u in ti le s P o o re st S ec o n d M id d le Fo u rt h R ic h es t E th n ic it y o f h o u se h o ld h ea d * P ap u a Ja w a S u la w es i M al u ku O th er s To ta l f o r 3 d is tr ic ts 0. 0 0. 2 0. 1 0. 0 0. 2 0. 0 0. 0 0. 1 0. 5 0. 0 0. 0 0. 0 0. 0 0. 2 0. 4 0. 1 0. 1 0. 0 0. 0 1. 1 0. 1 0. 3 0. 0 0. 5 0. 7 0. 0 0. 0 0. 2 0. 2 1. 1 0. 0 0. 0 0. 0 0. 0 0. 1 1. 3 0. 1 0. 2 0. 7 0. 6 1. 1 0. 3 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 0. 3 0. 0 44 .9 16 .5 49 .0 73 .5 14 .5 6. 0 25 .6 47 .0 67 .2 69 .4 0. 0 1. 0 22 .7 72 .7 97 .2 21 .1 50 .2 88 .5 85 .0 52 .8 38 .7 0. 3 0. 1 0. 4 0. 1 0. 4 0. 0 0. 5 0. 2 0. 3 0. 0 0. 1 0. 8 0. 5 0. 0 0. 0 0. 5 0. 0 0. 0 0. 0 0. 0 0. 3 0. 0 0. 2 0. 0 0. 0 0. 1 0. 4 0. 0 .0 0. 0 0. 0 0. 3 0. 0 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 0. 1 53 .8 83 .1 49 .6 25 .0 84 .6 93 .3 73 .4 52 .3 29 .8 30 .6 99 .4 98 .1 76 .4 26 .2 0. 9 77 .9 48 .6 10 .8 14 .0 44 .7 60 .2 0. 1 0. 0 0. 0 0. 0 0. 1 0. 0 0. 1 0. 0 0. 0 0. 0 0. 2 0. 0 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 0. 0 0. 5 0. 0 0. 3 0. 6 0. 1 0. 3 0. 2 0. 2 0. 9 0. 0 0. 1 0. 1 0. 4 0. 9 0. 1 0. 1 1. 0 0. 1 0. 4 0. 0 0. 3 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 54 .2 83 .3 50 .1 25 .1 85 .2 93 .7 74 .0 52 .6 30 .2 30 .6 99 .9 98 .9 77 .0 26 .2 0. 9 78 .6 48 .6 10 .8 14 .0 44 .7 60 .6 5, 05 0 3, 19 2 3, 82 8 4, 94 3 7, 12 8 1, 21 4 4, 04 9 5, 02 4 1, 77 1 13 2, 41 2 2, 41 7 2, 41 6 2, 41 3 2, 41 3 6, 99 1 2, 67 8 1, 13 5 54 1 72 4 12 ,0 70 Ta b le C H .4 : S o lid f u el u se P er c en t d is tr ib u ti o n o f h o u se h o ld m em b er s ac co rd in g t o t yp e o f co o ki n g f u el u se d b y th e h o u se h o ld , a n d p er ce n ta g e o f h o u se h o ld m em b er s liv in g in h o u se h o ld s u si n g so lid f u el s fo r co o ki n g , D is tr ic ts o f M er au ke , J ay aw ija ya a n d B ia k N u m fo r, P ap u a P ro vi n ce , I n d o n es ia , 2 01 1 *1 c as e w it h m is si n g “ E th n ic it y o f h o u se h o ld h ea d ” n o t sh o w n ( ) Fi g u re s th at a re b as ed o n 2 5- 49 u n w ei g h te d c as es (* ) Fi g u re s th at a re b as ed o n f ew er t h an 2 5 u n w ei g h te d c as es 1 M IC S in d ic at o r 3. 11 E le ct ri ci ty Li q u efi ed P et ro le u m G as ( LP G ) N o f o o d co o ke d in t h e h o u se h o ld To ta l S o lid f u el s fo r co o ki n g 1 N at u ra l G as K er o se n e C o al , lig n it e W o o d C h ar - co al S tr aw , sh ru b s, g ra ss S o lid f u el s N u m b er o f h o u se h o ld m em b er s P er ce n ta g e o f h o u se h o ld m em b er s in h o u se h o ld s u si n g : MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 43 District Merauke Jayawijaya Biak Numfor Area Urban Rural Education of household head* None Primary SMP/SM Higher Wealth index quintiles Poorest Second Middle Fourth Richest Ethnicity of household head* Papua Jawa Sulawesi Maluku Others Total for 3 districts 78.7 17.6 46.3 51.0 47.4 23.0 56.6 48.1 52.4 22.6 60.0 60.3 61.8 (*) 36.5 81.0 83.1 67.8 93.7 48.0 3.0 21.4 6.2 14.8 9.7 19.2 8.5 9.2 10.7 19.2 8.0 5.6 2.0 (*) 13.7 1.3 3.5 0.0 0.0 10.5 14.9 60.0 38.5 24.5 40.2 57.5 31.7 36.3 33.7 57.5 26.5 27.4 33.8 (*) 44.8 17.0 13.4 28.7 6.3 37.5 3.3 0.7 8.9 9.7 2.7 0.0 3.3 6.3 3.0 0.6 5.4 6.6 2.4 (*) 4.9 0.7 0.0 3.5 0.0 3.8 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.1 0.0 0.0 (*) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.1 0.3 0.0 0.0 0.1 0.1 0.0 0.0 0.0 (*) 0.1 0.0 0.0 0.0 0.0 0.1 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 (*) 100.0 100.0 100.0 100.0 100.0 100.0 2,739 2,659 1,917 1,243 6,072 1,138 2,997 2,642 534 2,411 2,390 1,859 633 22 5,492 1,300 122 76 324 7,315 Table CH.5: Solid fuel use by place of cooking Per cent distribution of household members in households using solid fuels by place of cooking, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 *4 cases with missing “Education of household head” and 1 case with missing “Ethnicity of household head” not shown (*) Figures that are based on fewer than 25 unweighted cases In a separate room used as kitchen Elsewhere in the house In a separate building Outdoors At another place Missing Number of household members in households using solid fuels for cooking Total Place of cooking: 44 MULTIPLE INDICATOR CLUSTER SURVEY 2011 6.4. MALARIA Malaria is a leading cause of death of children under age five in Papua Province. It also contributes to anaemia in children and is a common cause of school absenteeism. Preventive measures can dramatically reduce malaria mortality rates among children. In areas where malaria is common, the WHO recommends Indoor Residual Spraying (IRS), use of insecticide-treated bednets (ITNs) and prompt treatment of confirmed cases with recommended anti-malarial drugs. International recommendations also suggest treating any fever in children as if it were malaria and immediately giving the child a full course of recommended anti-malarial tablets. Children with severe malaria symptoms, such as fever or convulsions, should be taken to a health facility. Also, children recovering from malaria should be given extra liquids and food and, for younger children, should continue breastfeeding. Insecticide-treated mosquito nets, or ITNs, if used properly, are very effective in offering protection against mosquitos and other insects. The use of ITNs is one of the main health interventions applied to reduce malaria transmission in Papua. The questionnaire incorporates questions on the availability and use of bed nets, both at household level and among children under five years of age and pregnant women. In the 2011 Selected Districts of Papua Province MICS results indicate that 43 per cent of households have at least one insecticide-treated net (Table CH.6). The percentage of households with at least one mosquito net was 54 per cent and the percentage of households with at least one long-lasting treated net is 43 per cent. Differentials exist in the availability of ITNs among districts where the availability is least in Jayawijaya District (11 per cent) and most in Merauke District (61 per cent). The percentage of this indicator is 46 per cent in Biak Numfor. Availability of at least one ITN does not show any clear increasing trend by education and wealth. This percentage is higher among households with Javanese heads (56 per cent) compared with those households with Papuan heads (37 per cent). Results indicate that 44 per cent of children under the age of five slept under any mosquito net the night prior to the survey and 33 per cent slept under an insecticide- treated net (Table CH.7). Compared with other districts, the percentages of children under the age of five who slept under any mosquito net or an insecticide-treated net are considerably lower in Jayawijaya District (18 and 9 per cent respectively). These percentages are 60 per cent and 42 per cent for Merauke and 47 per cent and 42 per cent for Biak Numfor. There were no significant gender disparities in ITN use among children under five. Results on the proportion of pregnant women who slept under a mosquito net during the previous night have been suppressed due to inadequate sample sizes. MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 45 District Merauke Jayawijaya Biak Numfor Area Urban Rural Education of household head* None Primary SMP/SM Higher Wealth index quintiles Poorest Second Middle Fourth Richest Ethnicity of household head* Papua Jawa Sulawesi Maluku Others Total for 3 districts 73.4 24.3 54.3 45.8 59.8 27.0 70.3 54.3 41.2 24.0 79.3 79.7 58.9 35.5 47.8 69.9 51.4 43.8 58.3 54.3 60.5 10.4 46.2 33.6 48.2 20.2 56.8 42.7 28.6 18.0 61.6 65.3 45.7 26.7 37.0 56.2 35.6 38.8 46.9 42.5 60.5 10.5 46.2 33.6 48.3 20.2 56.8 42.7 28.6 18.0 61.7 65.3 45.7 26.7 37.0 56.2 35.6 38.8 46.9 42.5 1,248 799 819 1,132 1,734 362 940 1,159 402 639 557 533 565 572 1,561 741 269 129 165 2,866 Table CH.6: Household availability of insecticide treated nets and protection by a vector control method Percentage of households with at least one mosquito net, percentage of households with at least one long- lasting treated net, percentage of households with at least one insecticide-treated net (ITN) and percentage of households which either have at least one ITN or have received indoor residual spraying (IRS) in the last 12 months, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 *2 cases with missing “Education of household head” and 1 case with missing “Ethnicity of household head” not shown 1 MICS indicator 3.12 Percentage of households with at least one mosquito net Percentage of households with at least one long- lasting treated net Percentage of households with at least one ITN1 Number of households 46 MULTIPLE INDICATOR CLUSTER SURVEY 2011 District Merauke Jayawijaya Biak Numfor Sex Male Female Area Urban Rural Age 0-11 months 12-23 months 24-35 months 36-47 months 48-59 months Mother’s education None Primary SMP/SM Higher Wealth index quintiles Poorest Second Middle Fourth Richest Ethnicity of household head Papua Jawa Sulawesi Maluku Others Total for 3 districts 97.7 98.4 98.5 98.4 97.9 97.5 98.6 97.8 98.4 98.3 98.4 97.9 98.5 99.2 98.6 93.3 98.9 99.2 97.9 96.4 98.4 98.1 98.5 100.0 96.0 96.4 98.2 576 424 512 819 692 583 928 290 279 306 323 313 201 446 694 170 335 302 307 297 270 934 276 146 60 155 1,511 60.3 18.3 47.2 44.5 43.5 31.1 52.1 41.1 43.0 48.3 45.2 42.2 14.4 56.9 46.5 34.4 26.0 66.5 66.0 44.2 16.2 43.0 53.1 30.7 29.3 46.9 44.0 41.7 8.9 41.9 32.7 32.4 21.6 39.4 30.3 34.0 34.5 34.1 29.8 11.2 39.4 37.4 19.3 19.1 50.5 49.4 30.9 11.9 33.3 31.2 24.5 29.3 38.1 32.6 562 417 504 806 678 568 915 284 274 301 317 306 198 443 684 158 331 299 301 286 266 916 272 146 58 149 1,483 59.2 52.2 63.0 60.3 60.0 46.0 67.2 57.1 63.5 63.0 60.2 57.0 (67.6) 60.6 62.5 41.9 71.1 68.1 67.4 54.3 29.1 65.1 48.9 55.2 (*) 59.9 60.2 396 71 335 436 366 266 536 151 147 165 180 160 33 288 409 73 89 222 220 163 109 469 174 65 27 95 803 Table CH.7: Children sleeping under mosquito nets Percentage of children age 0-59 months who slept under a mosquito net during the previous night, by type of net, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 (*) Figures that are based on fewer than 25 unweighted cases 1 MICS indicator 3.14, 2 MICS indicator 3.15; MDG indicator 6.7 Percentage of children age 0-59 who stayed in the household the previous night Number of children age 0-59 months who slept in the household the previous night Percentage of children who slept under an ITN living in households with at least one ITN Number of children age 0-59 living in households with at least one ITN Percentage of children who: Number of children age 0-59 months Slept under any mosquito net1 Slept under an insecticide- treated net2 MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 47 District Merauke Jayawijaya Biak Numfor Sex Male Female Area Urban Rural Age 0-11 months 12-23 months 24-35 months 36-47 months 48-59 months Mother’s education None Primary SMP/SM Higher Wealth index quintiles Poorest Second Middle Fourth Richest Ethnicity of household head Papua Jawa Sulawesi Others Total for 3 districts 27.4 31.5 31.1 32.5 26.7 34.6 26.8 31.3 31.2 33.2 27.2 26.5 25.0 28.9 32.0 28.8 29.8 21.3 34.7 34.6 28.4 30.5 27.0 32.9 27.5 29.8 576 424 512 819 692 583 928 290 279 306 323 313 201 446 694 170 335 302 307 297 270 934 276 146 155 1,511 0.0 0.0 0.4 0.0 0.4 0.0 0.3 0.0 0.0 0.7 0.0 0.0 0.0 0.0 0.3 0.0 0.0 0.0 0.0 0.6 0.0 0.2 0.0 0.0 (0.0) 0.1 0.0 0.0 10.7 3.6 4.0 2.9 4.4 1.0 1.0 7.4 4.2 4.8 0.0 4.1 4.9 2.0 0.0 5.3 8.6 2.2 2.8 6.0 0.0 0.0 (0.0) 3.8 0.0 0.0 1.7 0.3 1.1 0.7 0.5 0.0 0.0 0.8 0.8 1.6 0.0 0.5 0.9 0.0 0.0 2.0 0.0 1.4 0.0 1.0 0.0 0.0 (0.0) 0.6 1.0 0.0 1.6 0.9 0.9 1.3 0.6 0.0 0.0 2.3 2.0 0.0 0.0 0.0 1.8 0.0 0.0 0.0 2.2 0.9 1.0 0.9 0.0 0.0 (3.6) 0.9 1.0 0.2 4.5 2.6 1.1 1.8 2.1 0.6 0.0 5.8 0.0 3.0 0.4 2.7 2.4 0.0 0.2 2.1 5.6 0.6 1.1 2.6 2.1 0.0 0.0 2.0 0.9 0.0 1.4 0.3 1.6 0.7 0.9 2.3 0.0 1.5 0.0 0.0 0.0 1.2 0.9 0.0 0.0 0.0 1.4 2.1 0.0 0.8 1.8 0.0 0.0 0.8 10.2 0.7 26.7 11.2 16.1 14.6 12.1 8.7 20.5 13.8 13.8 9.2 0.0 10.0 16.7 19.4 2.3 11.0 14.1 14.5 26.4 11.7 14.1 17.3 (17.1) 13.2 13.0 0.8 45.7 18.0 25.2 22.0 20.1 12.6 21.5 31.3 20.8 16.8 0.4 18.5 26.9 21.4 2.5 18.1 31.9 22.3 30.2 22.3 18.1 17.3 (20.6) 20.9 Table CH.8: Anti-malarial treatment of children with anti-malarial drugs Percentage of children age 0-59 months who had fever in the last two weeks who received anti-malarial drugs, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 ( ) Figures that are based on 25-49 unweighted cases 1 MICS indicator 3.18; MDG indicator 6.8 Had a fever in last two weeks Number of children age 0-59 months Anti- malari- als: SP/ Fansidar Anti-ma- larials: Chloro- quine Anti- malarials: Quinine/ Kina Anti-ma- larials: Artesdi- aquine Anti- malar- ials: Arsua- mon Anti- malari- als: Ar- terakin/ Artekin Anti- malarials: Other Anti- malarial Anti- malarials: Any anti- malarial drug1 Children with a fever in the last two weeks who were treated with: Anti-malarials: 48 MULTIPLE INDICATOR CLUSTER SURVEY 2011 District Merauke Jayawijaya Biak Numfor Sex Male Female Area Urban Rural Age 0-11 months 12-23 months 24-35 months 36-47 months 48-59 months Mother’s education None Primary SMP/SM Higher Wealth index quintiles Poorest Second Middle Fourth Richest Ethnicity of household head Papua Jawa Sulawesi Others Total for 3 districts 7.1 2.4 24.4 10.2 14.1 15.1 9.2 17.7 9.4 18.2 10.0 2.1 0.4 7.5 14.2 24.3 1.4 12.6 14.4 15.4 16.5 12.8 7.5 10.3 (14.5) 11.8 1.3 0.7 0.5 0.7 1.0 1.4 0.4 2.3 0.0 0.9 0.8 0.0 0.0 0.9 0.8 1.5 0.0 1.5 0.9 1.1 0.9 0.7 1.0 0.0 (2.6) 0.8 51.5 38.6 61.3 51.1 51.2 56.7 46.6 47.6 53.0 46.3 57.8 52.0 23.7 49.3 57.0 57.5 20.9 47.3 61.8 62.3 64.0 44.8 54.3 66.3 (71.3) 51.1 1.3 0.0 0.0 0.0 1.1 1.0 0.0 0.0 0.0 0.0 0.0 2.5 0.0 0.0 0.9 0.0 0.0 0.0 0.0 0.0 2.7 0.0 2.8 0.0 (0.0) 0.5 0.0 1.2 1.0 1.1 0.0 0.0 1.2 0.3 0.0 2.8 0.0 0.0 0.0 1.2 0.7 0.0 0.0 0.4 0.6 1.3 1.1 0.6 0.0 2.7 (0.0) 0.7 33.4 9.8 24.5 24.0 22.2 27.8 19.6 27.3 21.2 19.6 23.6 25.1 3.0 22.5 27.1 28.7 8.9 25.8 22.9 23.7 39.7 16.3 44.5 37.0 (17.0) 23.2 2.3 1.6 0.0 1.8 0.5 0.5 2.0 3.4 0.0 0.0 2.3 0.8 1.7 1.4 1.4 0.0 3.3 2.5 0.9 0.0 0.0 2.0 0.0 0.0 (0.0) 1.3 6.7 0.2 35.9 12.3 19.1 16.0 14.3 8.2 15.2 22.4 12.9 15.9 0.4 13.7 19.4 14.1 1.6 13.1 24.6 15.0 21.2 17.1 13.8 9.3 (10.3) 15.1 158 133 159 266 185 202 249 91 87 102 88 83 50 129 222 49 100 64 107 103 77 285 74 48 43 450 Table CH.8: Anti-malarial treatment of children with anti-malarial drugs (continued) Percentage of children age 0-59 months who had fever in the last two weeks who received anti-malarial drugs, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 ( ) Figures that are based on 25-49 unweighted cases 1 MICS indicator 3.17 Other medica- tions: Antibiotic injection Other medications: Paracetamol/ Panadol/ Ace taminophan Other medica- tions: Aspirin Other medica- tions: Ibuprofen Other medica- tions: Other Other DK Percentage who took an anti- malarial drug same or next day 1 Num- ber of children with fever in last two weeks Other medications: MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 49 Questions on the prevalence and treatment of fever were asked for all children under age five. Slightly fewer than one in three (30 per cent) of under five children were ill with fever in the two weeks prior to the survey (Merauke, 27 per cent; Jayawijaya, 32 per cent; Biak Numfor, 31 per cent (Table CH.8) ). Fever prevalence slightly declined with age. There was no clear trend in this indicator with mother’s education or wealth. Mothers were asked to report all of the medicines given to a child to treat the fever, including both medicines given at home and medicines given or prescribed at a health facility. Overall, only 17 per cent of children with fever in the last two weeks were treated with an “appropriate” anti-malarial drug and 12 per cent received anti-malarial drugs either on the same day or day after the onset of symptoms. “Appropriate” anti-malarial drugs include chloroquine, SP (sulfadoxine-pyrimethamine), artimisine combination drugs, etc. Compared with the other districts that also showed a low percentage in these indicators, Jayawijaya District was strikingly lacking in anti-malarial treatment. The percentage of children receiving any anti-malarial drug in Jayawijaya was less than one per cent compared with 10 per cent in Merauke and 37 per cent in Biak Numfor. Similarly, none of the children in Jayawijaya took an anti-malarial drug same or next day compared with 5 per cent in Merauke and 29 per cent in Biak Numfor. Overall in the three districts, four per cent of children with fever were given chloroquine and a very negligible per cent were given SP/ Fansidar. None received artemisinin combination therapy and most of the children were given anti-malarial drug (13 per cent). About half the children (51 per cent) were given other types of medicines that are not anti-malarial, including paracetamol, panadol and acetaminophan. Urban children (18 per cent) are similarly treated appropriately as rural children (17 per cent). Children 0-11 months and children from the poorest households were disadvantaged in receiving appropriate ant-malarial drug. Girls (21 per cent) were more likely to receive appropriate anti-malarial drugs than boys (15 per cent). Figure CH.3: Percentage of children age 0-59 months who had a fever in the last two weeks and who had a finger or heel stick for malaria testing, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 60 55 50 45 40 35 30 25 20 15 10 5 0 P er c en t None PoorestSecondary MiddlePrimary SecondHigher Fourth Richest 5 34 47 8 16 36 34 45 19 Mother’s education Wealth index MULTIPLE INDICATOR CLUSTER SURVEY 201150 MULTIPLE INDICATOR CLUSTER SURVEY 2011 District Merauke Jayawijaya Biak Numfor Sex Male Female Area Urban Rural Age 0-11 months 12-23 months 24-35 months 36-47 months 48-59 months Mother’s education None Primary SMP/SM Higher Wealth index quintiles Poorest Second Middle Fourth Richest Ethnicity of household head Papua Jawa Sulawesi Maluku Others Total for 3 districts 24.2 12.1 44.5 27.0 28.8 37.8 19.6 28.2 25.0 29.6 35.6 19.6 4.7 18.9 33.9 47.2 7.9 15.7 35.5 33.9 44.7 29.2 23.0 20.1 38.6 (35.3) 27.8 158 133 159 266 185 202 249 91 87 102 88 83 50 129 222 49 100 64 107 103 77 285 74 48 14 43 450 Table CH.9: Malaria diagnostics usage Percentage of children age 0-59 months who had a fever in the last two weeks and who had a finger or heel stick for malaria testing, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases 1 MICS indicator 3.16 Number of children age 0-59 months with fever in the last two weeks Had a finger or heel stick1 Table CH.9 provides the proportion of children age 0-59 months who had a fever in the last two weeks and who had a finger or heel stick for malaria testing. Overall, 28 per cent of children with a fever in the last two weeks had a finger or heel stick. Biak Numfor District showed the highest value for this indicator (45 per cent) compared with 24 per cent in Merauke and only 12 per cent in Jayawijaya. Having a finger or heel stick for malaria testing is more common in urban areas (38 per cent) than in rural areas (20 per cent). This indicator increases dramatically by mother’s education; from only 5 per cent among children of uneducated women to 47 per cent among children with higher education. A similar pattern is seen by wealth where the percentage of children age 0-59 months who had a fever in the last two weeks and who had a finger or heel stick for malaria testing increased from 8 per cent for children living in the poorest households to 45 per cent for those living in the richest (Figure CH.3). MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 51MULTIPLE INDICATOR CLUSTER SURVEY 2011 7 WATER AND SANITATION Safe drinking water is a basic necessity for good health. Unsafe drinking water can be a significant carrier of diseases such as trachoma, cholera, typhoid, and schistosomiasis. Drinking water can also be tainted with chemical, physical and radiological contaminants with harmful effects on human health. In addition to its association with disease, access to drinking water may be particularly important for women and children, especially in rural areas, who bear the primary responsibility for carrying water, often for long distances. The MDG goal (7, C) is to reduce by half, between 1990 and 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation. The World Fit for Children goal calls for a reduction in the proportion of households without access to hygienic sanitation facilities and affordable and safe drinking water by at least one- third. The list of indicators used in MICS is as follows: Water • Use of improved drinking water sources • Use of adequate water treatment method • Time to source of drinking water • Person collecting drinking water Sanitation • Use of improved sanitation facilities • Sanitary disposal of child’s faeces For more details on water and sanitation and to access some reference documents, please visit the UNICEF childinfo website.9 7.1. USE OF IMPROVED WATER SOURCES The distribution of the population by main source of drinking water is shown in Table WS.1 and Figure WS.1. The population using improved sources of drinking water are those using any of the following types of supply: piped water (into dwelling, compound, yard or plot, to neighbour, public tap/standpipe), tube well/borehole, protected well, protected spring and rainwater collection. Bottled water is considered as an improved water source only if the household is using an improved water source for handwashing and cooking. 9 http://www.childinfo.org/wes.html 52 MULTIPLE INDICATOR CLUSTER SURVEY 2011 Overall, 60 per cent of the population in the three districts is using an improved source of drinking water – 78 per cent in urban areas and 47 per cent in rural areas. The situation in Jayawijaya District is considerably worse than in other districts; only 35 per cent of the population in this district gets its drinking water from an improved source. The percentage of population in Merauke and Biak Numfor Districts are 54 and 87 per cent respectively. The source of drinking water for the population varies strongly by district (Table WS.1). In Biak Numfor, only 14 per cent of the population uses drinking water that is piped into their dwelling or into their yard or plot. More drastically, only five and one per cent of the population use piped water in Merauke and Jayawijaya respectively. In Jayawijaya District, the most important source of drinking water is surface water (river, stream, dam, lake, pond, canal, irrigation channel) (39 per cent) (an unimproved source). In Merauke, bottled water is the first most important source (17 per cent) (an improved source) while in Biak Numfor it is rainwater collection (24 per cent) (an improved source). Figure WS.1: Per cent distribution of household members by source of drinking water, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 Piped into dwelling, yard, plot or neighbour 12% Public tap/standpipe 4% Tubewell/borehole 2% Bottled water 22% Surface water 16% Other unimproved 3% Unprotected well or spring 16% Rain-water collection 14% Protected well or spring 11% MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 53 District Merauke Jayawijaya Biak Numfor Area Urban Rural Education of household head* None Primary SMP/SM Higher Wealth index quintile Poorest Second Middle Fourth Richest Ethnicity of household head* Papua Jawa Sulawesi Maluku Others Total for 3 districts 5.4 0.7 13.5 13.1 2.3 1.5 3.5 7.7 14.9 0.0 0.3 4.7 10.4 18.2 6.6 3.2 11.9 12.4 8.9 6.7 0.3 1.2 5.7 4.0 1.1 0.0 0.9 3.1 4.7 0.0 0.3 1.6 6.1 3.3 2.9 0.9 1.2 3.3 2.6 2.3 11.4 3.1 6.1 5.7 8.8 4.9 9.7 7.0 5.9 1.2 7.3 13.1 13.0 3.2 6.4 11.6 7.0 6.3 5.6 7.5 4.1 2.7 2.7 0.3 5.3 3.6 3.2 4.0 1.0 3.9 5.2 4.6 2.5 0.1 3.2 2.8 4.0 5.3 3.0 3.3 8.7 10.7 23.7 6.6 19.0 8.9 15.6 15.2 10.4 9.0 23.1 22.1 13.0 2.6 18.1 10.1 4.8 6.7 7.6 14.0 17.2 8.8 22.4 36.0 3.2 1.4 8.4 21.3 32.9 0.0 0.0 3.1 22.5 57.7 5.8 26.2 40.3 47.2 26.0 16.6 1.2 0.7 9.8 3.9 3.7 1.1 3.6 4.0 5.6 0.2 3.5 8.4 3.7 3.2 6.1 0.1 0.6 1.4 1.7 3.8 2.3 0.0 2.1 3.3 0.4 0.8 1.8 2.1 0.6 0.4 3.1 2.6 1.9 0.2 2.2 0.6 1.8 1.3 0.0 1.6 3.6 7.1 1.0 5.0 2.9 5.9 4.1 2.7 4.3 6.9 5.8 2.6 2.7 0.6 5.3 1.4 1.2 1.3 2.3 3.7 Table WS.1: Use of improved water sources Per cent distribution of household population according to main source of drinking water and percentage of household population using improved drinking water sources, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 Piped water Improved sources Main source of drinking water Into dwelling Tube- well/ bore- hole Pro- tected well Pro- tected spring Rain- water collection Bottled water** Into yard/ plot To neigh- bour Public tap/ stand-pipe * 13 cases with missing “Education of household head” and 1 case with missing “Ethnicity of household head” not shown ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases ** Households using bottled water as the main source of drinking water are classified into improved or unimproved drinking water users according to the water source used for other purposes such as cooking and handwashing. 1 MICS indicator 4.1; MDG indicator 7.8 54 MULTIPLE INDICATOR CLUSTER SURVEY 2011 District Merauke Jayawijaya Biak Numfor Area Urban Rural Education of household head* None Primary SMP/SM Higher Wealth index quintile Poorest Second Middle Fourth Richest Ethnicity of household head* Papua Jawa Sulawesi Maluku Others Total for 3 districts 11.1 8.8 3.2 3.9 10.8 5.3 11.5 7.3 3.9 8.8 16.3 10.2 4.5 0.2 8.6 10.5 4.6 1.3 3.1 8.0 10.7 39.1 3.6 1.2 26.3 45.7 18.6 9.7 7.3 51.6 15.7 10.5 2.2 0.0 20.7 8.1 3.8 0.2 30.3 16.0 10.2 4.2 0.9 10.6 2.3 2.5 5.4 7.2 4.0 0.5 0.3 6.6 11.8 9.1 1.5 13.5 13.1 6.5 4.8 5.7 0.0 0.6 0.0 0.1 0.2 0.2 0.1 0.2 0.3 0.4 0.2 0.2 0.1 0.0 0.3 0.0 0.0 0.0 0.0 0.2 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 54.3 34.9 87.0 78.0 46.8 28.1 50.9 67.0 80.2 21.5 48.6 62.8 75.8 89.1 56.6 56.9 72.9 85.2 57.6 59.6 5,050 3,192 3,828 4,943 7,128 12,14 4,049 5,024 1,771 2,412 2,417 2,416 2,413 2,413 6,991 2,678 1,135 541 724 12,070 8.0 11.8 5.0 1.5 12.6 17.8 9.8 6.0 3.2 16.7 15.7 5.1 2.8 0.0 9.9 7.4 3.5 4.1 2.6 8.1 4.1 0.0 0.3 3.3 0.8 0.1 3.2 1.6 0.5 0.0 3.0 2.9 1.9 1.2 1.8 2.5 1.7 0.0 0.7 1.8 1.5 0.5 0.0 1.5 0.3 0.4 0.6 1.1 0.6 0.6 0.3 1.6 1.0 0.4 0.6 1.1 0.4 2.7 0.8 0.8 Table WS.1: Use of improved water sources (continued) Per cent distribution of household population according to main source of drinking water and percentage of household population using improved drinking water sources, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 Unimproved sources Main source of drinking water Unpro- tected well Surface water Bottled water* Other Total Percentage using improved sources of drinking water1 Number of household members Unpro- tected spring Tanker truck Cart with tank/ drum * 13 cases with missing “Education of household head” and 1 case with missing “Ethnicity of household head” not shown ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases ** Households using bottled water as the main source of drinking water are classified into improved or unimproved drinking water users according to the water source used for other purposes such as cooking and handwashing. 1 MICS indicator 4.1; MDG indicator 7.8 MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 55 Use of household water treatment is presented in Table WS.2. Households were asked of ways they may be treating water at home to make it safer to drink. Boiling water, adding bleach or chlorine, using a water filter, and using solar disinfection are considered as proper treatment of drinking water. The table shows water treatment by all households and the percentage of household members living in households using unimproved water sources but using appropriate water treatment methods. About 55 per cent of households in the selected districts of Papua Province use appropriate water treatment for unimproved drinking water sources and 34 per cent do not use any method for water treatment. The most common methods of water treatment are boiling (65 per cent), letting water stand and settle (34 per cent) and straining through a cloth (24 per cent). There exist large differentials in use of appropriate water treatment among districts. Household members in Jayawijaya District show only 26 per cent use of appropriate water treatment methods and 64 per cent of them do not use any treatment. It was also observed that appropriate water treatment use is greater in urban areas and among educated women. Appropriate water treatment use is 71 per cent in Biak Numfor and 77 per cent in Merauke District. The amount of time it takes to obtain water is presented in Table WS.3 and the person who usually collected the water in Table WS.4. Note that these results refer to one roundtrip from home to drinking water source. Information on the number of trips made in one day was not collected. Table WS.3 shows that for about half of household members who use an improved source of drinking water, the source is on the premises. For eight per cent, it takes less than 30 minutes to get to the water source and bring water, while three per cent of household members spend 30 minutes or more for this purpose. For users of unimproved drinking water sources, water is on premises for 12 per cent of household members. One fifth of household members take less than 30 minutes to get to the water source and bring water (21 per cent) and for seven per cent it takes more than 30 minutes. In rural areas considerably more household members spend time in collecting water compared with those in urban areas. 56 MULTIPLE INDICATOR CLUSTER SURVEY 2011 D is tr ic t M er au ke Ja ya w ija ya B ia k N u m fo r A re a U rb an R u ra l M ai n s o u rc e o f d ri n ki n g w at er Im p ro ve d U n im p ro ve d E d u ca ti o n o f h o u se h o ld h ea d * N o n e P ri m ar y S M P /S M H ig h er W ea lt h in d ex q u in ti le P o o re st S ec o n d M id d le Fo u rt h R ic h es t E th n ic it y o f h o u se h o ld h ea d * P ap u a Ja w a S u la w es i M al u ku O th er s To ta l f o r 3 d is tr ic ts 25 .6 64 .1 20 .4 43 .3 27 .7 26 .7 45 .0 65 .6 25 .5 33 .5 34 .2 69 .8 6. 4 10 .7 27 .8 55 .8 32 .4 34 .2 45 .1 45 .3 24 .8 34 .1 0. 3 1. 2 2. 2 1. 9 0. 6 1. 7 0. 4 0. 0 0. 4 1. 0 4. 2 0. 0 0. 3 0. 7 1. 9 2. 8 1. 1 0. 9 1. 5 0. 0 2. 7 1. 1 0. 0 0. 4 0. 0 0. 3 0. 0 0. 2 0. 0 0. 5 0. 0 0. 0 0. 4 0. 0 0. 0 0. 2 0. 3 0. 0 0. 1 0. 0 0. 5 0. 0 0. 0 0. 1 49 .3 1. 9 39 .8 26 .9 38 .5 34 .8 32 .2 11 .6 43 .4 32 .6 29 .6 7. 6 51 .9 46 .3 39 .0 23 .9 27 .1 44 .4 32 .8 34 .8 59 .0 33 .7 0. 0 0. 0 0. 4 0. 2 0. 1 0. 2 0. 0 0. 0 0. 2 0. 2 0. 0 0. 0 0. 1 0. 0 0. 2 0. 4 0. 1 0. 2 0. 4 0. 0 0. 0 0. 1 5, 05 0 3, 19 2 3, 82 8 4, 94 3 7, 12 8 7, 18 8 4, 88 2 1, 21 4 4, 04 9 5, 02 4 1, 77 1 2, 41 2 2, 41 7 2, 41 6 2, 41 3 2, 41 3 6, 99 1 2, 67 8 1, 13 5 54 1 72 4 12 ,0 70 76 .7 26 .1 71 .0 47 .2 56 .7 n a 54 .6 23 .3 66 .2 55 .3 61 .6 22 .7 90 .3 79 .4 56 .5 26 .3 44 .2 72 .8 51 .8 54 .4 91 .2 54 .6 2, 30 8 2, 07 8 49 7 1, 08 8 3, 79 5 n a 4, 88 2 87 3 1, 99 0 1, 65 7 35 1 1, 89 4 1, 24 2 89 8 58 4 26 3 3, 03 4 1, 15 4 30 7 80 30 7 4, 88 2 73 .5 35 .9 78 .3 55 .4 71 .8 72 .2 54 .6 34 .4 73 .9 65 .8 63 .6 30 .0 92 .6 88 .5 71 .8 42 .4 66 .9 64 .8 54 .1 53 .2 74 .6 65 .1 0 .1 0. 1 0. 4 0. 2 0. 2 0. 2 0. 2 0. 2 0. 1 0. 2 0. 3 0. 1 0. 2 0. 3 0. 1 0. 4 0. 1 0. 2 0. 0 0. 0 1. 2 0. 2 3 1. 4 3. 9 31 .3 23 .3 24 .6 26 .5 20 .6 10 .0 27 .7 23 .7 26 .6 3. 6 34 .6 32 .4 29 .3 20 .7 20 .7 25 .9 22 .0 29 .3 49 .4 24 .1 Ta b le W S .2 : H o u se h o ld w at er t re at m en t P er ce n ta g e o f h o u se h o ld p o p u la ti o n b y d ri n ki n g w at er t re at m en t m et h o d u se d in t h e h o u se h o ld , a n d f o r h o u se h o ld m em b er s liv in g in h o u se h o ld s w h er e an u n im p ro ve d d ri n ki n g w at er s o u rc e is u se d , t h e p er ce n ta g e w h o a re u si n g a n a p p ro p ri at e tr ea tm en t m et h o d , D is tr ic ts o f M er au ke , J ay aw ija ya a n d B ia k N u m fo r, P ap u a P ro vi n ce , I n d o n es ia , 20 11 W at er t re at m en t m et h o d u se d in t h e h o u se h o ld N o n e U se w at er fi lt er S o la r d is - in fe ct io n Le t it st an d a n d se tt le O th er N u m b er o f h o u se h o ld m em b er s P er ce n ta g e o f h o u se h o ld m em b er s in h o u se h o ld s u si n g u n im p ro ve d d ri n ki n g w at er s o u rc es a n d u si n g a n a p p ro p ri at e w at er t re at m en t m et h o d 1 N u m b er o f h o u se h o ld m em b er s in h o u se h o ld s u si n g u n im p ro ve d d ri n ki n g w at er s o u rc es B o il A d d b le ac h / ch lo ri n e S tr ai n th ro u g h a cl o th *1 3 ca se s w it h m is si n g “ E d u ca ti o n o f h o u se h o ld h ea d ” a n d 1 c as e w it h m is si n g “ E th n ic it y o f h o u se h o ld h ea d ” n o t sh o w n 1 M IC S in d ic at o r 4. 2 MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 57 District Merauke Jayawijaya Biak Numfor Area Urban Rural Education of household head* None Primary SMP/SM Higher Wealth index quintile Poorest Second Middle Fourth Richest Ethnicity of household head* Papua Jawa Sulawesi Maluku Others Total for 3 districts 40.9 23.6 80.0 69.6 34.3 15.5 36.8 57.3 74.7 7.0 32.5 49.3 67.1 87.8 44.3 48.3 64.5 76.2 47.5 48.7 21.1 8.7 1.9 13.1 10.8 7.9 14.4 12.1 7.2 2.9 16.7 13.9 16.1 9.1 6.3 25.2 17.5 9.6 7.3 11.7 16.0 45.9 8.0 5.6 32.4 52.6 23.7 16.2 9.2 60.3 24.5 16.3 4.7 1.2 29.8 12.7 4.2 3.1 13.2 21.4 8.1 8.7 2.8 1.8 9.9 11.1 10.1 3.9 2.4 14.4 10.1 6.4 1.8 0.0 7.0 4.6 3.5 1.5 18.5 6.6 0.4 1.9 0.3 1.5 0.2 0.3 0.9 0.7 1.0 0.9 0.1 0.6 1.7 0.6 0.4 0.6 1.9 0.7 3.5 0.8 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 5,050 3,192 3,828 4,943 7,128 1,214 4,049 5,024 1,771 2,412 2,417 2,416 2,413 2,413 6,991 2,678 1,135 541 724 12,070 9.5 8.9 5.6 6.9 9.0 10.7 9.6 7.7 4.2 10.0 12.4 9.9 7.0 1.3 8.9 6.9 6.8 8.5 6.7 8.1 3.8 2.4 1.2 1.5 3.3 1.9 4.2 1.9 1.3 4.4 3.4 3.7 1.5 0.0 3.3 1.5 1.6 0.5 3.5 2.6 0.1 0.0 0.2 0.0 0.2 0.0 0.3 0.0 0.0 0.1 0.3 0.0 0.2 0.0 0.1 0.2 0.0 0.0 0.0 0.1 Table WS.3: Time to source of drinking water Per cent distribution of household population according to time to go to source of drinking water, get water and return, for users of improved and unimproved drinking water sources, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 Users of improved drinking water sources Users of unimproved drinking water sources Time to source of drinking water Water on premises Water on premises Less than 30 minutes 30 minutes or more Missing/ DK Total Number of house- hold membersLess than 30 minutes 30 minutes or more Missing/ DK * 13 cases with missing “Education of household head” and 1 case with missing “Ethnicity of household head” not shown 58 MULTIPLE INDICATOR CLUSTER SURVEY 2011 Table WS.4 shows that for 59 per cent of households, an adult female is usually the person collecting the water, when the source of drinking water is not on the premises. Adult men collect water in 29 per cent of cases, while for the rest of the households, female (7 per cent) or male children (4 per cent) under age 15 collect water. District Merauke Jayawijaya Biak Numfor Area Urban Rural Education of household head* None Primary SMP/SM Higher Wealth index quintile Poorest Second Middle Fourth Richest Ethnicity of household head* Papua Jawa Sulawesi Maluku Others Total for 3 districts 34.7 70.7 18.3 15.8 55.9 76.7 47.7 29.8 18.2 89.5 49.6 35.3 16.5 3.0 53.3 25.0 17.3 14.6 39.0 40.0 2.2 11.4 1.6 4.4 7.1 7.9 6.6 5.3 9.1 9.8 6.0 2.0 0.0 (*) 8.6 0.9 (0.0) (*) (4.4) 6.7 2.0 5.8 1.9 0.8 4.4 6.2 2.6 3.8 3.3 5.2 3.3 1.7 2.2 (*) 4.7 0.3 (0.0) (*) (6.8) 3.8 1.8 1.1 1.0 8.6 0.0 0.0 1.2 2.1 4.0 0.0 0.0 2.0 9.3 (*) 0.0 3.1 (5.8) (*) (6.5) 1.3 0.4 0.1 0.6 0.0 0.3 0.2 0.2 0.5 0.0 0.1 0.3 0.0 1.8 (*) 0.2 0.9 (0.0) (*) (0.0) 0.3 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 (*) 100.0 100.0 100.0 100.0 100.0 100.0 433 565 150 178 969 278 449 345 73 572 276 188 93 17 832 185 46 19 64 1,147 1,248 799 819 1,132 1,734 362 940 1,159 402 639 557 533 565 572 1,561 741 269 129 165 2,866 44.7 69.0 60.7 47.8 60.8 69.5 54.9 57.0 51.1 70.7 57.5 41.9 30.5 (*) 67.3 35.5 (25.4) 36.7 (46.6) 58.8 49.0 12.5 34.2 38.3 27.4 16.2 34.6 31.4 32.5 14.2 32.9 52.4 56.2 (*) 19.2 59.4 (68.8) (*) (35.6) 29.1 Table WS.4: Person collecting water Percentage of households without drinking water on premises, and per cent distribution of households without drinking water on premises according to the person usually collecting drinking water used in the household, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 Person usually collecting drinking waterPercentage of households without drinking water on premises Female child under age 15 Male child under age 15 Missing DK Total Number of households without drinking water on premises Number of house- holds Adult woman Adult man * 2 cases with missing “Education of household head” and 1 case with missing “Ethnicity of household head” not shown ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 59 7.2. USE OF IMPROVED SANITATION FACILITIES Inadequate disposal of human excreta and personal hygiene is associated with a range of diseases including diarrhoeal diseases and polio. An improved sanitation facility is defined as one that hygienically separates human excreta from human contact. Improved sanitation can reduce diarrhoeal disease by more than a third, and can significantly lessen the adverse health impacts of other disorders responsible for death and disease among millions of children in developing countries. Improved sanitation facilities for excreta disposal include flush or pour flush to a piped sewer system, septic tank, or pit latrine; ventilated improved pit latrine, pit latrine with slab, and use of a composting toilet. Forty-threeper cent of the population of three selected districts of Papua Province is living in households that use improved sanitation facilities that flush to septic tank or flush into tanks (13 per cent) or use pit latrine with slab (13 per cent) (Table WS.5). About one fifth of the population have no facility or use bush or field (20 per cent). 60 MULTIPLE INDICATOR CLUSTER SURVEY 2011 D is tr ic t M er au ke Ja ya w ija ya B ia k N u m fo r A re a U rb an R u ra l E d u ca ti o n o f h o u se h o ld h ea d * N o n e P ri m ar y S M P /S M H ig h er W ea lt h in d ex q u in ti le P o o re st S ec o n d M id d le Fo u rt h R ic h es t E th n ic it y o f h o u se h o ld h ea d * P ap u a Ja w a S u la w es i M al u ku O th er s To ta l f o r 3 d is tr ic ts 35 .0 24 .2 69 .7 67 .0 26 .7 9. 8 28 .4 52 .4 73 .6 1. 1 14 .8 44 .5 69 .3 86 .1 36 .5 42 .9 66 .4 69 .9 52 .3 43 .2 3 1. 1 0. 4 0. 8 4. 2 19 .7 7. 3 23 .1 10 .8 2. 5 3. 6 33 .0 21 .8 8. 1 0. 2 5. 6 36 .2 9. 0 9. 1 14 .0 13 .3 0. 2 0. 3 0. 7 0. 6 0. 2 0. 2 0. 3 0. 6 0. 3 0. 1 0. 3 0. 3 0. 6 0. 7 0. 4 0. 0 1. 7 0. 5 0. 0 0. 4 12 .2 6. 7 1. 2 2. 6 10 .4 10 .3 10 .9 4. 8 3. 1 7. 2 15 .4 9. 7 3. 6 0. 3 5. 6 9. 3 3. 2 4. 2 23 .9 7. 2 1. 0 0. 0 0. 3 1. 1 0. 1 0. 0 1. 3 0. 2 0. 0 0. 0 0. 7 0. 9 0. 9 0. 0 0. 1 1. 9 0. 0 0. 0 0. 0 0. 5 1. 0 0. 1 2. 4 2. 8 0. 1 0. 7 1. 7 0. 9 1. 3 0. 2 1. 5 1. 8 2. 5 0. 0 1. 4 0. 0 3. 9 0. 0 0. 0 1. 2 0. 6 0. 6 0. 1 0. 3 0. 6 0. 0 0. 7 0. 4 0. 1 0. 4 1. 0 0. 8 0. 0 0. 0 0. 5 0. 8 0. 0 0. 0 0. 0 0. 4 4 .9 59 .3 7. 7 4. 0 31 .4 67 .6 19 .4 13 .9 7. 4 84 .9 13 .4 2. 6 0. 0 0. 0 34 .4 0. 2 0. 9 0. 2 1. 4 20 .2 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 5, 05 0 3, 19 2 3, 82 8 4, 94 3 7, 12 8 1, 21 4 4, 04 9 5, 02 4 1, 77 1 2, 41 2 2, 41 7 2, 41 6 2, 41 3 2, 41 3 6, 99 1 2, 67 8 1, 13 5 54 1 72 4 12 ,0 70 13 .9 8. 2 16 .5 17 .1 10 .6 4. 0 14 .2 15 .4 11 .4 2. 5 19 .7 17 .0 14 .5 12 .5 15 .1 8. 5 14 .7 16 .2 8. 4 13 .2 0. 0 0. 0 0. 3 0. 3 0. 0 0. 0 0. 0 0. 2 0. 3 0. 0 0. 0 0. 0 0. 3 0. 2 0. 1 0. 1 0. 2 0. 0 0. 0 0. 1 0. 0 0. 1 0. 4 0. 0 0. 3 0. 0 0. 1 0. 3 0. 0 0. 0 0. 1 0. 5 0. 1 0. 0 0. 3 0. 0 0. 0 0. 0 0. 0 0. 1 Ta b le W S .5 : T yp es o f sa n it at io n f ac ili ti es P er c en t d is tr ib u ti o n o f h o u se h o ld p o p u la ti o n a cc o rd in g t o t yp e o f to ile t fa ci lit y u se d b y th e h o u se h o ld , D is tr ic ts o f M er au ke , J ay aw ija ya a n d B ia k N u m fo r, P ap u a P ro vi n ce , I n d o n es ia , 2 01 1 Fl u sh t o se p ti c ta n k Fl u sh / p o u r fl u sh t o so m ew h er e el se P it la tr in e w it h o u t sl ab / o p en p it B u ck et Fl u sh /p o u r fl u sh t o : Im p ro ve d s an it at io n f ac ili ty U n im p ro ve d s an it at io n f ac ili ty Ty p e o f to ile t fa ci lit y u se d b y h o u se h o ld H an g in g to ile t/ h an g in g la tr in e O th er O p en d ef ec at io n (n o fa ci lit y, b u sh , fi el d ) To ta l To ta l N u m b er o f h o u se h o ld m em b er s Fl u sh to p it (l at ri n e) Fl u sh t o u n kn o w n p la ce / N o t su re / D K w h er e V en ti la te d im p ro ve d p it la tr in e *1 3 c as es w it h m is si n g “ E d u ca ti o n o f h o u se h o ld h ea d ” a n d 1 c as e w it h m is si n g “ E th n ic it y o f h o u se h o ld h ea d ” n o t sh o w n ( ) F ig u re s th at a re b as ed o n 2 5- 49 u n w ei g h te d c as es (* ) Fi g u re s th at a re b as ed o n f ew er t h an 2 5 u n w ei g h te d c as es MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 61 D is tr ic t M er au ke Ja ya w ija ya B ia k N u m fo r A re a U rb an R u ra l E d u ca ti o n o f h o u se h o ld h ea d * N o n e P ri m ar y S M P /S M H ig h er W ea lt h in d ex q u in ti le P o o re st S ec o n d M id d le Fo u rt h R ic h es t E th n ic it y o f h o u se h o ld h ea d * P ap u a Ja w a S u la w es i M al u ku O th er s To ta l f o r 3 d is tr ic ts 64 .0 23 .6 74 .5 72 .4 45 .7 16 .6 50 .0 64 .3 77 .6 3. 2 44 .6 64 .8 78 .8 91 .7 42 .3 77 .7 73 .9 81 .5 71 .0 56 .6 0. 0 1. 2 0. 2 0. 5 0. 3 0. 8 0. 1 0. 6 0. 0 0. 0 0. 7 0. 5 0. 7 0. 0 0. 5 0. 1 0. 9 0. 0 0. 0 0. 4 12 .3 4. 8 2. 5 4. 2 9. 3 8. 3 11 .5 4. 8 3. 3 5. 5 15 .3 9. 6 4. 7 0. 8 5. 4 10 .0 4. 8 3. 3 20 .9 7. 2 0 .3 0. 1 1. 4 1. 2 0. 1 0. 1 1. 0 0. 5 0. 0 0. 1 0. 2 0. 9 1. 6 0. 0 0. 3 0. 1 3. 6 0. 0 0. 0 0. 6 2 .5 2. 5 0. 7 1. 9 2. 0 2. 8 2. 0 1. 6 1. 6 2. 0 3. 4 2. 9 1. 1 0. 2 2. 2 1. 8 0. 4 1. 4 3. 0 1. 9 0 .1 0. 4 0. 0 0. 1 0. 2 0. 0 0. 3 0. 1 0. 0 0. 4 0. 0 0. 1 0. 2 0. 0 0. 2 0. 1 0. 0 0. 0 0. 0 0. 1 4. 9 59 .3 7. 7 4. 0 31 .4 67 .6 19 .4 13 .9 7. 4 84 .9 13 .4 2. 6 0. 0 0. 0 34 .4 0. 2 0. 9 0. 2 1. 4 20 .2 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 5, 05 0 3, 19 2 3, 82 8 4, 94 3 7, 12 8 1, 21 4 4, 04 9 5, 02 4 1, 77 1 2, 41 2 2, 41 7 2, 41 6 2, 41 3 2, 41 3 6, 99 1 2, 67 8 1, 13 5 54 1 72 4 12 ,0 70 4. 2 2. 3 1. 6 5. 2 1. 2 1. 0 4. 0 3. 1 0. 8 1. 0 5. 1 4. 4 2. 6 1. 2 3. 4 1. 8 4. 0 2. 0 0. 0 2. 9 1 1. 3 4. 7 10 .6 9. 6 9. 1 2. 3 10 .5 10 .2 9. 0 2. 4 16 .1 13 .0 9. 3 5. 8 10 .4 7. 6 9. 9 10 .4 3. 6 9. 3 0. 6 1. 2 0. 8 0. 9 0. 8 0. 5 1. 1 0. 8 0. 3 0. 6 1. 2 1. 1 0. 9 0. 3 0. 8 0. 5 1. 6 1. 1 0. 0 0. 8 Ta b le W S .6 : U se a n d s h ar in g o f sa n it at io n f ac ili ti es P er c en t d is tr ib u ti o n o f h o u se h o ld p o p u la ti o n b y u se o f p ri va te a n d p u b lic s an it at io n f ac ili ti es a n d u se o f sh ar ed f ac ili ti es , b y u se rs o f im p ro ve d a n d u n im p ro ve d s an it at io n fa ci lit ie s, D is tr ic ts o f M er au ke , J ay aw ija ya a n d B ia k N u m fo r, P ap u a P ro vi n ce , I n d o n es ia , 2 01 1 N o t sh ar ed 1 M is si n g / D K N o t sh ar ed P u b lic fa ci lit y S h ar ed b y U se rs o f im p ro ve d s an it at io n f ac ili ti es U se rs o f u n im p ro ve d s an it at io n f ac ili ti es S h ar ed b y 5 h o u se h o ld s o r le ss M o re t h an 5 h o u se h o ld s O p en d ef ec at io n (n o fa ci lit y, b u sh , fi el d ) To ta l N u m b er o f h o u se h o ld m em b er s P u b lic fa ci lit y 5 h o u se h o ld s o r le ss M o re t h an 5 h o u se h o ld s *1 3 ca se s w it h m is si n g “ E d u ca ti o n o f h o u se h o ld h ea d ” a n d 1 c as e w it h m is si n g “ E th n ic it y o f h o u se h o ld h ea d ” n o t sh o w n 1 M IC S in d ic at o r 4. 3; M D G in d ic at o r 7. 9 62 MULTIPLE INDICATOR CLUSTER SURVEY 2011 Almost two-thirds of the population of Jayawijaya District has no facility or use bush or field (59 per cent). No facility or use of bush or field is much less common in Merauke (5 per cent) and Biak Numfor (8 per cent). About 49 per cent of the population in Merauke and 70 per cent in Biak Numfor use facilities that flush to septic tank or pit (latrines). The percentage of the population who have no facility or use bush or field is higher in rural areas (31 per cent) than urban areas (4 per cent). The table indicates that no facility or use of bush or field is strongly correlated with education of household head and wealth. The MDGs and the WHO / UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation classify households as using an unimproved sanitation facility if they are using otherwise acceptable sanitation facilities but sharing a facility between two or more households or using a public toilet facility. As shown in Table WS.6, 57 per cent of the household population is using an improved sanitation facility with Biak Numfor District (75 per cent) showing the highest percentage in this indicator and Jayawijaya the lowest (24 per cent). About 13 per cent of the household population are using an improved sanitation facility but this facility is shared with others. As expected, improved sanitation facility correlates strongly with area, education of head of household and wealth (Figure WS.2). For example, the percentage of households using an improved sanitation facility increases dramatically from threeper cent among the poorest household population to 92 per cent for the richest. In its 2008 report, the JMP developed a new way of presenting the access figures, by disaggregating and refining the data on drinking water and sanitation and reflecting them in “ladder” format. This ladder allows a disaggregated analysis of trends in a three rung ladder for drinking water and a four-rung ladder for sanitation. For sanitation, this gives an understanding of the proportion of population with no sanitation facilities at all, of those reliant on technologies defined by JMP as “unimproved,” of those sharing Figure WS.2: Percentage of household population using improved (not shared) sanitation facilities, Districts of Merauke, Jayawijya and Biak Numfor, Papua Province, Indonesia, 2011. District Merauke Jayawijaya Biak Numfor Area Urban Rural Mother’s Education No education Primary Secondary Higher Wealth quintiles Poorest Second Middle Fourth Richest 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0 Per cent 64 24 74 72 46 17 50 64 78 3 45 65 79 92 MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 63 sanitation facilities of otherwise acceptable technology, and those using “improved” sanitation facilities. Table WS.7 presents the percentages of household population by drinking water and sanitation ladders. The table also shows the percentage of household members using improved sources of drinking water and sanitary means of excreta disposal. About 41 per cent of household population use both improved drinking sources and sanitation with clear correlation with background characteristics (Figure WS.3). Wide disparities exist among districts: The highest percentage of household population that use both improved drinking sources and sanitation was seen in Biak Numfor (65 per cent), followed by Merauke (39 per cent) and the lowest percentage was seen in Jayawijaya (only 16 per cent). Urban areas have a higher use of both improved drinking sources and sanitation (59 per cent) than rural (29 per cent). Strong positive associations exist for this indicator by education of head of household and wealth. Figure WS.3: Percentage of household population using improved drinking water sources and improved sanitation, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 District Merauke Jayawijaya Biak Numfor Area Urban Rural Mother’s Education No education Primary Secondary Higher Wealth quintiles Poorest Second Middle Fourth Richest 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0 Per cent 39 16 65 59 29 11 31 48 65 2 22 40 60 82 64 MULTIPLE INDICATOR CLUSTER SURVEY 2011 D is tr ic t M er au ke Ja ya w ija ya B ia k N u m fo r A re a U rb an R u ra l E d u ca ti o n o f h o u se h o ld h ea d * N o n e P ri m ar y S M P /S M H ig h er W ea lt h in d ex q u in ti le P o o re st S ec o n d M id d le Fo u rt h R ic h es t E th n ic it y o f h o u se h o ld h ea d * P ap u a Ja w a S u la w es i M al u ku O th er s To ta l f o r 3 d is tr ic ts 13 .8 3. 0 37 .3 34 .6 7. 1 2. 7 10 .4 22 .0 37 .2 0. 2 3. 8 13 .5 22 .2 52 .4 15 .2 14 .5 34 .9 39 .4 22 .2 18 .4 6 4. 0 23 .6 74 .5 72 .4 45 .7 16 .6 50 .0 64 .3 77 .6 3. 2 44 .6 64 .8 78 .8 91 .7 42 .3 77 .7 73 .9 81 .5 71 .0 56 .6 16 .0 9. 4 13 .3 16 .2 11 .5 4. 5 15 .7 14 .8 10 .1 4. 0 23 .1 19 .0 13 .5 7. 3 15 .1 10 .0 16 .4 13 .6 3. 6 13 .4 1 5. 1 7. 7 4. 6 7. 4 11 .5 11 .2 14 .8 7. 0 4. 8 7. 9 18 .9 13 .6 7. 6 1. 0 8. 1 12 .0 8. 8 4. 7 23 .9 9. 8 4. 9 59 .3 7. 7 4. 0 31 .4 67 .6 19 .4 13 .9 7. 4 84 .9 13 .4 2. 6 0. 0 0. 0 34 .4 0. 2 0. 9 0. 2 1. 4 20 .2 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 3 9. 1 15 .6 65 .2 59 .4 28 .5 10 .8 31 .3 48 .2 64 .9 1. 8 22 .4 39 .8 60 .4 81 .6 33 .5 47 .2 54 .1 67 .6 52 .9 41 .2 5, 05 0 3, 19 2 3, 82 8 4, 94 3 7, 12 8 1, 21 4 4, 04 9 5, 02 4 1, 77 1 2, 41 2 2, 41 7 2, 41 6 2, 41 3 2, 41 3 6, 99 1 2, 67 8 1, 13 5 54 1 72 4 12 ,0 70 40 .5 31 .9 49 .7 43 .3 39 .6 25 .4 40 .5 45 .0 43 .0 21 .3 44 .8 49 .4 53 .6 36 .7 41 .4 42 .5 38 .0 45 .7 35 .4 41 .2 45 .7 65 .1 13 .0 22 .0 53 .2 71 .9 49 .1 33 .0 19 .8 78 .5 51 .4 37 .2 24 .2 10 .9 43 .4 43 .1 27 .1 14 .8 42 .4 40 .4 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 Ta b le W S .7 : D ri n ki n g w at er a n d s an it at io n la d d er s P er ce n ta g e o f h o u se h o ld p o p u la ti o n b y d ri n ki n g w at er a n d s an it at io n la d d er s, D is tr ic ts o f M er au ke , J ay aw ija ya a n d B ia k N u m fo r, P ap u a P ro vi n ce , I n d o n es ia , 2 01 1 P ip ed in to d w el lin g , p lo t o r ya rd Im p ro ve d sa n it at io n 2 S h ar ed im p ro ve d fa ci lit ie s U n im p ro ve d fa ci lit ie s Im p ro ve d d ri n ki n g w at er 1 P er ce n ta g e o f h o u se h o ld p o p u la ti o n u si n g : U n im p ro ve d s an it at io n O p en d ef ec at io n To ta l Im p ro ve d d ri n ki n g w at er so u rc es an d im p ro ve d sa n it at io n N u m b er o f h o u se h o ld m em b er s O th er im p ro ve d U n im p ro ve d d ri n ki n g w at er To ta l *1 3 ca se s w it h m is si n g “ E d u ca ti o n o f h o u se h o ld h ea d ” a n d 1 c as e w it h m is si n g “ E th n ic it y o f h o u se h o ld h ea d ” n o t sh o w n 1 M IC S in d ic at o r 4. 1; M D G in d ic at o r 7. 8 2 M IC S in d ic at o r 4. 3; M D G in d ic at o r 7. 9 MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 65 7.3. DISTANCE BETWEEN WATER SOURCE AND CLOSEST EXCRETA DISPOSAL In cities, toilets are connected to septic tanks with absorption fields. In order to avoid the contamination of drinking water by sewage, the Indonesian Ministry of Public Works recommends that the distance between the septic tank absorption field and the water source be at least 10 metres. About 52 per cent of households in all three districts reported that their water source is 10 or more metres away from the closest excreta place while about 39 per cent did not know how much the distance was. By district the proportion of households reporting water sources 10 or more metres away from the closest excreta place was 64, 53 and 29 per cent in Merauke, Biak Numfor and Jayawijaya respectively. In Jayawijaya District two thirds of households (66 per cent) did not know the distance between their water source and the closest excreta disposal place (Table WS.8) compared with 24 and 35 per cent in Merauke and Biak Numfor. District Merauke Jayawijaya Biak Numfor Area Urban Rural Education of household head* None Primary SMP/SM Higher Wealth index quintile Poorest Second Middle Fourth Richest Ethnicity of household head* Papua Jawa Sulawesi Maluku Others Total for 3 districts 23.8 65.7 35.0 40.8 36.7 61.4 35.7 33.9 42.0 67.9 27.0 23.5 30.7 43.1 43.4 22.8 40.2 37.1 46.0 38.4 0.9 1.8 1.2 0.9 1.4 2.3 1.2 1.2 0.6 3.2 1.1 0.9 0.6 0.3 1.7 0.4 0.5 1.4 0.0 1.2 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 5,050 3,192 3,828 4,943 7,128 1,214 4,049 5,024 1,771 2,412 2,417 2,416 2,413 2,413 6,991 2,678 1,135 541 724 12,070 11.1 3.2 10.4 13.5 5.6 3.7 7.6 9.8 12.5 1.4 9.6 9.2 11.5 12.4 8.0 9.0 14.6 8.4 7.1 8.8 64.1 29.3 53.4 44.8 56.2 32.6 55.6 55.1 44.9 27.5 62.3 66.4 57.2 44.2 46.8 67.7 44.7 53.1 46.9 51.5 Table WS.8: Distance between water source and closest excreta disposal Percentage of household population by distance between water source and closest excreta disposal, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 Percentage of household population by distance between water source and closest excreta disposal DK Missing Total Number of household members Less than 10 meters 10 meters or more * 13 cases with missing “Education of household head” and 1 case with missing “Ethnicity of household head” not shown MULTIPLE INDICATOR CLUSTER SURVEY 201166 MULTIPLE INDICATOR CLUSTER SURVEY 2011 MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 67MULTIPLE INDICATOR CLUSTER SURVEY 2011 8 REPRODUCTIVE HEALTH 8.1. FERTILITY In MICS4, adolescent birth rates and total fertility rates are calculated by using information on the date of last birth of each woman and are based on the one-year period (1-12 months) preceding the survey. Rates are underestimated by a very small margin due to absence of information on multiple births (twins, triplets etc) and on women having multiple deliveries during the one year period preceding the survey. Table RH.1 shows adolescent birth rates and total fertility rate. The adolescent birth rate (age-specific fertility rate for women age 15-19) is defined as the number of births to women age 15-19 years during the one year period preceding the survey, divided by the average number of women age 15-19 (number of women-years lived between ages 15 through 19, inclusive) during the same period, expressed per 1,000 women. The total fertility rate (TFR) is calculated by summing the age-specific fertility rates calculated for each of the 5-year age groups of women, from age 15 through to age 49. The TFR denotes the average number of children to which a woman will have given birth by the end of her reproductive years if current fertility rates prevailed. Figure RH.1: Percentage of women age 15-19 who have had a live birth or who are pregnant with the first child, or who have begun childbearing before age 15 by district, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 35 30 25 20 15 10 5 0 P er c en t Have had a live birth Are pregnant with first child Have begun childbearing Have had a live birth before age 15 23 14 1 1 7 7 31 15 9 4 02 Merauke Biak NumforJayawijaya 68 MULTIPLE INDICATOR CLUSTER SURVEY 2011 The TFR in the three selected districts of Papua Province for the one-year period preceding the survey is 3.5 children per woman. TFR is highest in Jayawijaya District (4.5 children per woman) and lowest in Merauke District (3 children per woman). TFR in Biak Numfor District is 3.5 children per woman. Table RH.1 also show differentials in fertility by area residence, education, wealth quintile and ethnicity. TFR deceases as mother’s education increases and also with increasing wealth. TFR is higher among households headed by Papuan compared with others. The adolescent birth rate (Age-specific fertility rate for women age 15-19) is 90 births per 1,000 women. The adolescent birth rate is considerably higher in Jayawijaya District (145 births per 1,000 women) compared with the rates in Merauke (77 births per 1,000 women) and Biak Numfor (59 births per 1,000 women). The birth rate is highest among rural adolescents, poorest adolescents and those with no education, and those whose heads of household are Papuan. Sexual activity and childbearing early in life carry significant risks for young people all around the world. Table RH.2 presents some early childbearing indicators for women age 15-19 and 20-24 while Table RH.3 presents the trends for early childbearing. As shown in Table RH.2, 14 per cent of women age 15-19 have already given birth, three per cent are pregnant with their first child, 17 per cent have begun childbearing and one per cent given birth to a live baby before age 15. All these indicators are considerably higher in Jayawijaya District than in Merauke and Biak Numfor districts (Figure RH.1). District Merauke Jayawijaya Biak Numfor Area Urban Rural Women’s education None Primary SMP/SM Higher Wealth index quintile Poorest Second Middle Fourth Richest Ethnicity of household head Papua Others Total for 3 districts 77 145 59 68 106 248 66 77 92 192 97 42 77 38 100 72 90 3.0 4.5 3.5 3.4 3.6 5.5 3.3 3.7 2.4 4.6 4.0 3.5 3.4 2.4 4.0 3.0 3.5 Table RH.1: Adolescent birth rate and total fertility rate Adolescent birth rates and total fertility rates, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 Adolescent birth rate1 (Age-specific fertility rate for women age 15-19) Total fertility rate 1 MICS indicator 5.1; MDG indicator 5.4 MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 69 Seventeen per cent of women aged 20-24 years gave birth before reaching 18 years of age. Across the three districts, a considerably higher birthrate before age 18 for this age group was seen in Jayawijaya (37 per cent). This percentage was 11 per cent in Merauke and 10 per cent in Biak Numfor. District Merauke Jayawijaya Biak Numfor Area Urban Rural Education None Primary SMP/SM Higher Wealth index quintile Poorest Second Middle Fourth Richest Ethnicity of household head Papua Jawa Sulawesi Maluku Others Total for 3 districts 14.2 23.3 7.2 12.4 15.2 (32.9) 12.4 13.0 8.5 30.5 10.0 10.0 16.5 4.3 4.1 15.6 (12.1) (*) (*) 14.0 0.8 7.3 1.7 1.5 3.8 (11.0) 8.0 1.1 0.0 7.8 1.3 3.4 1.6 0.8 3.5 1.6 (3.8) (*) (*) 2.8 15.0 30.6 9.0 14.0 19.1 (43.9) 20.3 14.1 8.5 38.3 11.4 13.3 18.1 5.1 17.6 17.2 (15.9) (*) (*) 16.8 0.6 4.0 0.0 0.2 2.1 (7.1) 2.3 0.6 0.0 5.8 0.0 0.0 1.0 0.0 1.7 0.0 (0.0) (*) (*) 1.3 172 120 171 203 259 31 73 336 22 84 93 83 106 97 285 86 45 27 15 462 11.1 36.9 10.2 7.8 25.4 (36.2) 30.1 16.6 (*)7 40.1 (12.5) 19.4 12.1 4.6 22.4 11.1 (12.2) (*) (*) 17.1 193 97 113 190 213 36 68 210 89 75 51 81 102 94 216 109 38 18 21 403 Table RH.2: Early childbearing Percentage of women age 15-19 years who have had a live birth or who are pregnant with the first child and percentage of women age 15-19 years who have begun childbearing, percentage of women who have had a live birth before age 15, and percentage of women age 20-24 who have had a live birth before age 18, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 Have had a live birth Are pregnant with first child Have begun childbearing Have had a live birth before age 15 Number of women age 15-19 Percentage of women age 20-24 who have had a live birth before age 181 Number of women age 20-24 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases 1 MICS indicator 5.2 Percentage of women age 15-19 who: 70 MULTIPLE INDICATOR CLUSTER SURVEY 2011 A g e 15 -1 9 20 -2 4 25 -2 9 30 -3 4 35 -3 9 40 -4 4 45 -4 9 To ta l f o r 3 d is tr ic ts 0. 2 0. 9 2. 0 1. 1 3. 5 6. 4 1. 1 1. 9 20 3 19 0 24 0 16 3 17 3 11 3 92 1, 17 4 n a 7. 8 14 .1 11 .7 10 .9 14 .1 8. 9 11 .4 n a 19 0 24 0 16 3 17 3 11 3 92 97 0 2. 1 2. 6 4. 5 2. 9 4. 2 5. 8 4. 6 3. 7 25 9 21 3 26 6 25 1 24 7 17 5 19 9 1, 61 0 n a 25 .4 21 .0 23 .0 19 .2 25 .5 22 .5 22 .5 46 2 40 3 50 6 41 4 42 0 28 8 29 1 2, 78 4 n a 21 3 26 6 25 1 24 7 17 5 19 9 1, 35 2 n a 17 .1 17 .7 18 .5 15 .8 21 .0 18 .2 17 .9 1. 3 1. 8 3. 3 2. 2 3. 9 6. 0 3. 5 3. 0 n a 40 3 50 6 41 4 42 0 28 8 29 1 2, 32 2 Ta b le R H .3 : T re n d s in e ar ly c h ild b ea ri n g P er ce n ta g e o f w o m en w h o h av e h ad a li ve b ir th , b y ag e 15 a n d 1 8, b y ar ea a n d a g e g ro u p , D is tr ic ts o f M er au ke , J ay aw ija ya a n d B ia k N u m fo r, P ap u a P ro vi n ce , I n d o n es ia , 2 01 1 P er ce n ta g e o f w o m en w it h a liv e b ir th b ef o re a g e 15 N u m b er o f w o m en ag e 15 -4 9 U rb an R u ra l A ll N u m b er o f w o m en ag e 20 -4 9 P er ce n ta g e o f w o m en w it h a li ve b ir th b ef o re ag e 18 P er ce n ta g e o f w o m en w it h a li ve b ir th b ef o re ag e 15 N u m b er o f w o m en ag e 20 -4 9 N u m b er o f w o m en ag e 15 -4 9 N u m b er o f w o m en ag e 20 -4 9 P er ce n ta g e o f w o m en w it h a li ve b ir th b ef o re ag e 18 N u m b er o f w o m en ag e 15 -4 9 P er ce n ta g e o f w o m en w it h a li ve b ir th b ef o re ag e 15 P er ce n ta g e o f w o m en w it h a li ve b ir th b ef o re ag e 18 MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 71 8.2. CONTRACEPTION Appropriate family planning is important to the health of women and children by: 1) preventing pregnancies that are too early or too late; 2) extending the period between births; and 3) limiting the number of children. Access by all couples to information and services to prevent pregnancies that are too early, too closely spaced, too late or too many is critical. Current use of contraception in the three selected districts of Papua Province was reported by 44 per cent of women currently married or in union (Table RH.4). The lowest current use was seen in Jayawijaya District (34 per cent), mostly traditional methods, compared with 43 per cent in Biak Numfor District and 52 per cent in Merauke District where women mostly use modern method (Figure RH.2). The most popular methods in Jayawijaya are others (9 per cent), injectables (9 per cent) and Lactational Amenorrhoea Method (LAM) (7 per cent). The most popular methods in Biak Numfor are injectables (18 per cent) and implants (9 per cent). The most popular methods in Merauke are injectables (29 per cent) and the pill (13 per cent). Only about 31 per cent of women aged 15-19 currently use a method of contraception compared with 41 per cent of 20-24 years old and 50 per cent of 35-39 years old women. Women’s education levels are associated with contraceptive prevalence. The percentage of women using any method of contraception rises from 26 per cent among those with no education to 43 per cent among women with primary education, to 51 per cent among women with secondary education, and drops to 44 per cent among women with higher education. In addition to differences in prevalence, the method mix varies by education. Most contraceptive users with no or primary education use ‘others’ (11 per cent). In contrast most contraceptive users with higher education use injectables (17 per cent). Use of any contraceptive method did not show clearly the expected positive association between contraceptive use and number of living children a woman. Figure RH.2: Percentage of currently married women aged 15-49 years using contraceptive methods, Districts of Merauke, Jayawijaya and Biak Numfor, Papua Province, Indonesia, 2011 100 90 80 70 60 50 40 30 20 10 0 P er c en t Merauke Jayawijaya Biak Numfor Traditional Method No MethodModern Method 50 2 17 5 48 66 16 38 57 72 MULTIPLE INDICATOR CLUSTER SURVEY 2011 Ta b le R H .4 : U se o f co n tr ac ep ti o n P er ce n ta g e o f w o m en a g e 15 -4 9 ye ar s cu rr en tl y m ar ri ed o r in u n io n w h o a re u si n g ( o r w h o se p ar tn er is u si n g ) a co n tr ac ep ti ve m et h o d , D is tr ic ts o f M er au ke , J ay aw ija ya a n d B ia k N u m fo r, P ap u a P ro vi n ce , I n d o n es ia , 2 01 1 D is tr ic t M er au ke Ja ya w ija ya B ia k N u m fo r A re a U rb an R u ra l A g e 15 -1 9 20 -2 4 25 -2 9 30 -3 4 35 -3 9 40 -4 4 45 -4 9 N u m b er o f liv in g c h ild re n 0 1 2 3 4+ N u m b er o f w o m en cu rr en tl y m ar ri ed o r in u n io n w it h n ee d fo r co n tr a- ce p ti o n 93 6 61 5 54 6 81 2 1, 28 4 99 28 3 43 1 38 2 38 6 25 6 25 8 25 7 44 1 49 3 40 1 50 4 1 M IC S in d ic at o r 5. 3; M D G in d ic at o r 5. 3 48 .2 66 .3 57 .5 52 .2 58 .3 69 .4 59 .2 52 .8 55 .2 50 .4 53 .7 64 .0 98 .5 59 .7 42 .4 46 .8 51 .4 2. 4 1. 4 3. 8 4. 6 1. 1 0. 0 0. 0 1. 1 1. 5 2. 8 5. 0 6. 8 0. 0 0. 0 1. 6 4. 8 4. 9 1 2. 8 3. 0 5. 8 8. 3 7. 9 4. 4 8. 5 7. 3 10 .0 10 .1 7. 8 4. 8 1. 5 8. 9 11 .1 9. 1 7. 0 1. 2 0. 5 1. 0 1. 8 0. 4 0. 0 1. 1 0. 7 1. 0 0. 6 0. 7 2. 4 0. 0 0. 7 1. 8 1. 1 0. 8 2 8. 9 9. 3 18 .1 22 .8 18 .7 15 .3 20 .9 26 .4 20 .1 20 .9 18 .6 12 .6 0. 0 22 .3 28 .5 21 .2 20 .3 4 .1 2. 3 8. 8 2. 6 6. 1 0. 7 3. 4 4. 5 5. 1 6. 9 6. 5 2. 8 0. 0 1. 5 5. 8 8. 3 6. 3 0. 0 0. 0 0. 5 0. 2 0. 1 0. 0 0. 0 0. 2 0. 0 0. 0 0. 3 0. 4 0. 0 0. 0 0. 2 0. 4 0. 0 IU D Fe m al e st er ili za - ti on In je ct - ab le s M al e st er ili za - ti on Im pl an ts Pi ll N ot us in g an y m et ho d P er c en t o f w o m en ( cu rr en tl y m ar ri ed o r in u n io n ) w h o a re u si n g : M al e co nd om D ia - ph ra gm / fo am / je lly Fe m al e co nd om La ct a- tio na l am en or - rh oe a m et ho d (L A M ) Pe ri od ic ab st i- ne nc e/ R hy th m W it h- dr aw al A ny m od er n m et ho d A ny m et ho d1 A ny t ra - di ti on al m et ho d 0. 2 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 6 0. 0 0. 0 0. 0 0. 4 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 2 6. 8 0. 1 1. 4 2. 6 6. 6 2. 6 3. 2 2. 3 1. 2 1. 3 0. 0 0. 0 2. 3 2. 7 2. 8 2. 0 49 .6 16 .4 38 .0 40 .4 34 .5 20 .3 33 .8 40 .3 37 .7 41 .3 38 .9 30 .4 1. 5 33 .3 49 .0 45 .3 39 .2 1. 0 1. 1 2. 5 3. 2 0. 3 0. 0 0. 0 0. 5 1. 3 3. 5 2. 5 1. 1 0. 0 1. 0 2. 6 2. 0 0. 9 0. 3 0. 0 0. 3 0. 2 0. 2 0. 0 0. 0 0. 2 0. 0 0. 6 0. 0 0. 6 0. 0 0. 2 0. 3 0. 0 0. 4 0. 7 9. 4 1. 7 2. 6 4. 1 3. 6 4. 4 3. 1 3. 5 2. 9 3. 6 3. 9 0. 0 3. 6 3. 0 3. 1 6. 0 2. 2 17 .3 4. 6 7. 4 7. 2 10 .2 7. 0 6. 9 7. 1 8. 2 7. 4 5. 6 0. 0 7. 0 8. 6 7. 9 9. 3 5 1. 8 33 .7 42 .5 47 .8 41 .7 30 .6 40 .8 47 .2 44 .8 49 .6 46 .3 36 .0 1. 5 40 .3 57 .6 53 .2 48 .6 MULTIPLE INDICATOR CLUSTER SURVEY 2011MULTIPLE INDICATOR CLUSTER SURVEY 2011 73 Ta b le R H .4 : U se o f co n tr ac ep ti o n ( co n ti n u ed ) P er ce n ta g e o f w o m en a g e 15 -4 9 ye ar s cu rr en tl y m ar ri ed o r in u n io n w h o a re u si n g ( o r w h o se p ar tn er is u si n g ) a co n tr ac ep ti ve m et h o d , D is tr ic ts o f M er au ke , J ay aw ija ya a n d B ia k N u m fo r, P ap u a P ro vi n ce , I n d o n es ia , 2 01 1 E d u ca ti o n N o n e P ri m ar y S M P /S M H ig h er W ea lt h in d ex q u in ti le P o o re st S ec o n d M id d le Fo u rt h R ic h es t E th n ic it y o f h o u se h o ld h ea d P ap u a Ja w a S u la w es i M al u ku O th er s To ta l f o r 3 d is tr ic ts N u m b er o f w o m en cu rr en tl y m ar ri ed o r in u n io n w it h n ee d fo r co n tr a- ce p ti o n 73 .7 56 .3 49 .0 55 .8 75 .4 55 .8 50 .0 48 .4 48 .3 67 .6 37 .1 48 .3 50 .7 57 .9 55 .9 0. 0 3. 0 2. 2 5. 4 0. 1 2. 1 1. 9 2. 3 6. 0 2. 2 2. 5 2. 6 3. 6 3. 4 2. 5 0. 6 7. 9 11 .9 4. 5 0. 6 7. 8 9. 1 13 .5 10 .1 2. 6 17 .0 13 .1 8. 6 5. 3 8. 1 0. 0 0. 6 1. 1 2. 9 0. 0 0. 0 0. 8 0. 6 3. 3 0 .4 1. 3 1. 2 2. 3 3. 1 1. 0 6. 3 22 .4 24 .7 17 .3 5. 0 21 .8 28 .5 24 .3 23 .7 11 .3 33 .6 28 .8 22 .4 21 .9 20 .3 0. 7 5. 1 6. 0 4. 8 2. 1 7. 0 5. 8 6. 1 3. 3 4. 4 5. 4 4. 3 5. 1 6. 0 4. 8 0. 0 0. 2 0. 2 0. 0 0. 0 0. 0 0. 0 0. 2 0. 4 0. 0 0. 2 0. 8 0. 0 0. 0 0. 1 IU D Fe m al e st er ili za - ti on In je ct - ab le s M al e st er ili za - ti on Im pl an ts Pi ll N ot us in g an y m et ho d P er c en t o f w o m en ( cu rr en tl y m ar ri ed o r in u n io n ) w h o a re u si n g : M al e co nd om D ia - ph ra gm / fo am / je lly Fe m al e co nd om La ct a- tio na l am en or - rh oe a m et ho d (L A M ) Pe ri od ic ab st i- ne nc e/ R hy th m W it h- dr aw al A ny m od er n m et ho d A ny m et ho d1 A ny t ra - di ti on al m et ho d 0. 0 0. 0 0. 0 0. 7 0. 0 0. 0 0. 0 0. 4 0. 0 0. 0 0. 3 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 7. 6 1. 3 1. 3 0. 0 7. 5 1. 9 0. 0 0. 6 0. 0 4. 0 0. 0 0. 5 0. 0 0. 0 2. 1 7. 6 39 .1 46 .1 35 .6 7. 8 38 .7 46 .1 47 .5 46 .9 20 .9 60 .3 50 .8 42 .1 39 .7 36 .8 0. 0 0. 3 1. 5 6. 7 0. 0 0. 6 1. 1 1. 6 3. 9 1. 2 1. 3 0. 4 6. 5 2. 4 1. 4 0. 0 0. 4 0. 2 0. 0 0. 0 0. 4 0. 4 0. 2 0. 2 0. 1 0. 5 0. 0 0. 7 0. 0 0. 2 11 .0 2. 5 1. 9 1. 9 9. 3 2. 7 2. 5 1. 6 0. 8 6. 3 0. 8 0. 0 0. 0 0. 0 3. 5 18 .7 4. 5 4. 8 8. 6 16 .8 5. 6 3. 9 4. 1 4. 8 11 .6 2. 6 0. 9 7. 2 2. 4 7. 3 26 .3 43 .7 51 .0 44 .2 24 .6 44 .2 50 .0 51 .6 51 .7 32 .4 62 .9 51 .7 49 .3 42 .1 44 .1 32 3 67 7 87 3 22 3 45 9 37 6 41 3 42 5 42 3 1, 08

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