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

Publication date: 2013

Indonesia SELECTED DISTRICTS OF WEST PAPUA PROVINCE Multiple Indicator Cluster Survey 2011 Monitoring the situation of children and women The Selected Districts of West 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 West 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 West Papua Province Multiple Indicator Cluster Survey 2011, Final Report. Jakarta, Indonesia: BPS. March, 2013 Indonesia SELECTED DISTRICTS OF WEST PAPUA PROVINCE Multiple Indicator Cluster Survey 2011 Monitoring the situation of children and women MULTIPLE INDICATOR CLUSTER SURVEY 2011 iii Multiple Indicator Cluster Surveys (MICS) and Millennium Development Goals (MDGs) Indicators, Selected Districts of West 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 4.1 4.2 4.1 4.2 4.3 6.7 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) 65 50 91.3 22.7 (41.3) (75.0) (65.5) (46.1) 25.2 43.9 45.9 41.3 71.2 51.1 12.0 47.3 79.2 38.4 33.1 53.6 31.9 62.4 53.0 37.2 46.6 36.1 81 60 90.9 23.2 (18.6) (*) (54.7) (30.6) 21.6 43.6 59.3 38.9 (86.2) 47.1 15.3 70.0 68.1 50.8 38.8 61.0 29.2 56.5 45.9 31.8 40.9 25.2 54 42 92.8 27.2 (43.9) (74.2) (*) (51.2) 22.5 41.9 62.7 46.4 (93.5) 70.4 14.4 63.3 95.9 87.0 69.9 88.9 67.6 76.4 52.0 44.0 64.3 45.6 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 Child mortality Breastfeeding and infant feeding Vitamin A Low birth weight Vaccinations Tetanus toxoid Solid fuel use Malaria Topic Indicator Kaimana Manokwari Sorong Value CHILD MORTALITY NUTRITION CHILD HEALTH SUMMARY TABLE OF FINDINGS MICS4 Indicator Number MDGs Indicator Number MULTIPLE INDICATOR CLUSTER SURVEY 2011iv 1 Results for child labour for age group 5-17 can be found in the report in Table CP.2 3.16 3.17 3.18 4.1 4.2 4.3 8.2 8.3 7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8 7.9 7.10 5.1 5.2 5.3 5.5a 5.5b 5.6 5.7 5.8 6.8 7.8 7.9 2.3 2.1 2.2 5.4 5.3 5.5 5.2 Malaria diagnostics usage Antimalarial treatment of children under 5 the same or next day Antimalarial treatment of children under age 5 Use of improved drinking water sources Water treatment Use of improved sanitation Birth registration Child labour School attendance among child labourers 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) 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 40.3 20.0 33.5 66.4 75.6 43.6 46.2 26.9 89.5 73.7 73.1 27.8 77.0 93.6 48.0 96.3 88.8 (80.7) 1.02 1.32 66 15.5 30.1 14.7 83.7 53.7 29.6 57.7 33.4 48.4 47.2 55.7 69.0 88.0 56.3 50.1 20.1 88.0 87.5 89.2 42.2 76.6 94.0 77.9 98.8 114.4 95.3 1.01 0.98 44 15.2 53.9 9.7 85.8 66.5 19.4 75.5 54.4 15.0 12.9 14.1 79.9 92.3 48.7 51.2 22.0 92.4 95.2 89.7 40.1 69.6 95.8 77.1 96.3 112.6 100.0 1.01 1.07 53 16.8 53.7 10.9 91.2 72.5 16.6 75.3 21.8 per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent ratio ratio per 1,000 per cent per cent per cent per cent per cent per cent per cent per cent Water and sanitation Birth registration Child labour (age 5-14)1 Literacy and education Contraception Maternal and newborn health Kaimana Manokwari Sorong Value WATER AND SANITATION CHILD PROTECTION EDUCATION REPRODUCTIVE HEALTH Topic IndicatorMICS4 Indicator Number MDGs Indicator Number MULTIPLE INDICATOR CLUSTER SURVEY 2011 v 8.4 8.5 8.6 8.7 8.8 8.10b 8.14 9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.10 6.3 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 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 29.0 86.4 5.0 1.5 21.5 4.5 13.0 0.6 5.4 36.0 48.1 17.9 12.1 16.3 8.7 50.5 65.8 6.2 6.8 22.6 21.2 0.6 2.0 0.0 1.1 91.3 73.2 23.1 83.7 9.6 2.8 30.1 8.0 21.7 6.6 9.9 40.7 28.2 24.9 26.1 27.1 29.7 61.7 57.8 13.4 14.6 31.1 36.4 0.8 2.8 0.0 5.6 94.3 79.7 23.8 89.9 8.1 0.9 34.7 5.1 15.4 1.2 19.2 32.6 20.1 22.7 25.1 36.8 27.7 59.5 67.2 21.1 17.0 19.5 20.1 0.8 0.8 1.2 (2.2) 96.2 92.3 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 per cent per cent per cent per cent Child discipline Early marriage Domestic violence HIV/AIDS knowledge and attitudes Sexual behaviour Kaimana Manokwari Sorong Value HIV/AIDS, SEXUAL BEHAVIOUR, AND ORPHANED Topic IndicatorMICS4 Indicator Number MDGs Indicator Number MULTIPLE INDICATOR CLUSTER SURVEY 2011vi 9.11 9.12 9.13 9.14 9.15 9.17 9.18 9.21 TA. 3 TA. 4 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 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 3.6 3.7 6.3 5.5 0.4 6.4 20.1 3.6 58.9 5.8 7.7 41.4 0.5 21.5 0.5 5.9 6.6 4.6 15.0 1.5 0.2 4.5 27.9 4.0 38.3 9.6 7.3 47.3 2.4 19.4 1.9 9.4 2.8 1.1 26.4 (0.0) 0.1 1.9 (*) 4.2 (48.9) 6.6 5.5 68.4 0.2 10.1 0.0 3.8 per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent per cent Orphaned children Male circumcision Alcohol use Kaimana Manokwari Sorong Value ACOHOL USE Topic IndicatorMICS4 Indicator Number MDGs Indicator Number (*) Figures that are based on fewer than 25 unweighted cases MULTIPLE INDICATOR CLUSTER SURVEY 2011 vii 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 xiv xv 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 viii 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 2011 ix 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 MULTIPLE INDICATOR CLUSTER SURVEY 2011x 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 and among women Table CP.5M: Early marriage and 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 Table HA.5: Knowledge of a place for HIV testing among women Table HA.5M: Knowledge of a place for HIV testing among men 80 81 83 85 86 87 88 89 91 92 93 94 95 96 98 101 104 106 109 110 112 113 114 116 118 119 123 124 125 126 128 129 130 131 133 134 MULTIPLE INDICATOR CLUSTER SURVEY 2011 xi 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: Kaimana District Table SE.3: Sampling errors: Manokwari District Table SE.4: Sampling errors: Sorong District 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: Per centage 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 aged 15-49 years married before their 15th birthday, percentage of women 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 2011 xiii AIDS BAPPENAS BCG BPS CDC CEDAW CRC DPT GPI Hep B HIV IUD LAM MDG MICS MICS4 MMR MoH NAR NCHS PPS PSU SD SPSS TFR UNFPA UNICEF WFFC WHO Acquired Immune Deficiency Syndrome Badan Perencanaan Pembangunan Nasional Bacillis-Cereus-Geuerin (Tuberculosis) Badan Pusat Statistik Center for Disease Control Convention on the Elimination of All Forms of Discrimination against Women Convention on the Rights of the Child Diptheria, Pertussis, and Tetanus Gender Parity Index Hepatitis B Human Immunodeficiency Virus Intrauterine Device Lactational Amenorrhea Method Millennium Development Goals Multiple Indicator Cluster Survey The fourth round of the Multiple Indicator Cluster Survey Measles, Mumps, and Rubella Ministry of Health Net Attendance Rate National Center for Health Statistics (USA) Probability Proportional to Size Primary Sampling Unit Standard Deviation Statistical Package for Social Sciences Total Fertility Rate United Nations Population Fund United Nations Children’s Fund World Fit For Children World Health Organization LIST OF ABBREVIATIONS MULTIPLE INDICATOR CLUSTER SURVEY 2011xiv MULTIPLE INDICATOR CLUSTER SURVEY 2011 xv The Selected Districts of West Papua Province Multiple Indicator Cluster Survey 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 Papua Province. The Selected Districts of West Papua Province Multiple Indicator Cluster Survey 2011 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 Kaimana, Manokwari and Sorong. 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, conducting 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 was 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 committment 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 West Papua Province Papua Province SIX SELECTED MICS DISTRICTS IN PAPUA AND WEST PAPUA PROVINCES MULTIPLE INDICATOR CLUSTER SURVEY 2011 xvii The Selected Districts of West Papua Province Multiple Indicator Cluster Survey (MICS) is a sample survey of households, women, men and children covering the districts of Kaimana, Manokwari and Sorong. 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 50, 60 and 42 per thousand in the districts of Kaimana, Manokwari and Sorong respectively. The probabilities of dying under age 5 (U5MR) are 65, 81 and 54 per thousand in the districts of Kaimana, Manokwari and Sorong respectively. NUTRITION Breastfeeding. Women in Kaimana were the least likely to start breastfeeding within one day (45 per cent) compared with women in Manokwari (69 per cent) and Sorong (51 per cent) (Figure NU.1). Breastfeeding within one hour was higher in Sorong District (27 per cent) than in Kaimana and Manokwari (23 per cent for each). Exclusive and predominant breast feeding is higher in Sorong District (44 and 51 per cent respectively) compared with the other two districts (Kaimana: 41 and 46 respectively; Manokwari: 19 and 31 respectively). Appropriate feeding among children aged 6-23 months is highest in Sorong District (47 per cent) compared with Manokwari (39 per cent) and Kaimana (41 per cent) districts. There are more children age 6-23 months in Sorong (52 per cent) and Manokwari (45 per cent) districts were receiving solid, semi-solid and soft foods the minimum number of times compared with those in Kaimana (46 per cent). About 44 per cent of children under 6 months are fed using a bottle with a nipple each in Kaimana and Manokwari districts compared with 42 per cent in Sorong District. Vitamin A supplements. Vitamin A supplementation coverage, within the six months prior to the survey, was considerable lower in Manokwari District (47 per cent) and Kaimana District (51 per cent) compared with Sorong District (71 per cent). Low birth weight. The lowest estimated percentage of infants weighing less than 2,500 grams at birth was in Kaimana (12 per cent) compared with 14 per cent in Sorong and 15 per cent in Manokwari districts. EXECUTIVE SUMMARY MULTIPLE INDICATOR CLUSTER SURVEY 2011xviii CHILD HEALTH Immunization. Manokwari District tended to have low coverage for most of the vaccinations with full vaccination coverage at any time up to the date of the survey being 20 per cent. Levels of full vaccination coverage in Kaimana and Sorong districts were 22 and 46 per cent respectively. Tetanus toxoid. Tetanus toxoid coverage among women age 15-49 years with a live birth in the last 2 years is lowest in Manokwari District (Kaimana, 62 per cent; Manokwari, 57 per cent; Sorong, 76 per cent). Solid fuel use. Use of solid fuels generally does not vary much among districts (Kaimana, 53 per cent; Manokwari, 46 per cent; Sorong, 52 per cent). Almost all solid fuel use in each district is from wood. Malaria. Differentials exist in the households availability of ITNs among districts where the availability is lowest in Manokwari District (32 per cent) and highest in Sorong District (44 per cent). The percentage of this indicator is 37 per cent in Kaimana 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 lower in Manokwari District (41 and 25 per cent respectively). These percentages are 47 per cent and 36 per cent for Kaimana and 64 per cent and 46 per cent for Sorong District. Compared with Manokwari District, Kaimana and Sorong districts were lacking anti- malarial treatment. The percentages of children receiving any anti-malarial drug on the same or next day in Kaimana and Sorong (20 and 13 per cent respectively) were about half that observed in Manokwari District (47 per cent). 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 lowest in Sorong District (15 per cent) compared with 40 per cent in Kaimana and 48 per cent in Manokwari District. WATER AND SANITATION Water. The situation in Sorong District is better than in other districts; 80 per cent of the population in this district gets its drinking water from an improved source, mostly from rainwater collection (48 per cent) and bottled water (18 per cent). The percentage of population getting its drinking water from improved sources in Manokwari and Kaimana districts are 69 and 66 per cent respectively. Although Kaimana District shows the lowest percentage of people using an improved source of drinking water, the district has the highest percentage of households where people drink water that is piped into their dwelling or into their yard or plot (20 per cent). These percentages are nine and two per cent for Manokwari and Sorong respectively. In Manokwari District, the most common improved sources of drinking water are bottled water (19 per cent), tube well or borehole (14 per cent) and protected well (13 per cent). Household members in Kaimana District show 76 per cent use of appropriate water treatment methods while this percentage is 88 and 92 per cent in Manokwari and Sorong districts respectively. MULTIPLE INDICATOR CLUSTER SURVEY 2011 xix Time and person to obtain water. Most of the households in Sorong have an improved drinking water source on the premises (75 per cent). This is higher than households in Kaimana and Manokwari (57 per cent each). For household users of unimproved drinking water sources it takes more than 30 minutes to get to the water source and bring water for six per cent of households in Kaimana District. Lower percentages in this indicator were observed in Manokwari (1 per cent) and Sorong (3 per cent) districts. More adult women in Manokwari (60 per cent) and Sorong (56 per cent) districts collect water than adult men and children. In Kaimana District slightly more men (52 per cent) than adult women (44 per cent) collect water. Collection of water by children is not common. Sanitation. About one-fourth of the population Kaimana District has no facility or uses bushes or fields (25 per cent). No facility or use of bushes or fields is much less common in Manokwari (13 per cent) and Sorong (5 per cent). About 68, 73 and 69 per cent of the population in Kaimana, Manokwari and Sorong districts respectively use facilities that flush to a septic tank or pit (latrines). About 56 per cent of the household population in Manokwari District is using an improved sanitation facility which is not shared; higher than in Sorong District (49 per cent) and higher than in Kaimana (44 per cent). REPRODUCTIVE HEALTH Fertility. TFR is highest in Kaimana District (3.2 children per woman) and lowest in Sorong District (2.8 children per woman). TFR in Manokwari District is 3.1 children per woman. The adolescent birth rate is higher in Kaimana District (66 births per 1,000 women) than in Sorong (53 births per 1,000 women) and Manokwari (44 births per 1,000 women). Early childbearing. The percentage of women aged 20-24 years who gave birth before age 18 did not vary much among districts (Kaimana, 16 per cent; Manokwari, 15 per cent; Sorong, 17 per cent). Contraception. The lowest current usage was seen in Kaimana District (30 per cent), (mostly modern methods) compared with 54 per cent each in Manokwari and Sorong districts, where women are also mostly using modern methods. The most popular methods in Kaimana District are IUD (18 per cent) and implants (9 per cent). The most popular methods in Manokwari are IUD (29 per cent) and implants (11 per cent). The most popular methods in Sorong are IUD (31 per cent) and implants (14 per cent). Antenatal care. Coverage of antenatal care (by a doctor, nurse or midwife) is higher in Sorong District (91 per cent) than Manokwari District (86 per cent) and Kaimana District (84 per cent). Within Kaimana and Sorong districts, antenatal care is provided mostly by midwives, while in Manokwari antenatal care is provided mostly by doctors. The percentage of mothers who received antenatal care at least four times was 54, 67 and 73 per cent in Kaimana, Manokwari and Sorong districts respectively. MULTIPLE INDICATOR CLUSTER SURVEY 2011xx Women living in Manokwari (19 per cent) and Sorong (17 per cent) districts were less likely to have all three tests made than those living in Kaimana District (30 per cent). These tests are: taking blood sample, checking blood pressure and taking urine specimen. Assistance at delivery. The percentages of babies who were delivered by skilled personnel were 58, 76 and 75 per cent in Kaimana, Manokwari and Sorong districts respectively. These deliveries were mostly assisted by midwives. Delivery in a health facility. The percentages of babies delivered in a health facility were 33, 54 and 22 per cent in Kaimana, Manokwari and Sorong districts respectively. LITERACY AND EDUCATION Literacy among young women and men. The lowest literacy rate among women was found in Kaimana District (74 per cent), compared with 88 per cent in Manokwari and 95 per cent in Sorong districts. For men, literacy rates among the three were similar to those among women, except that in Sorong District (89 per cent) slightly fewer men are literate than women (95 per cent). School readiness. About 42 per cent of children in Manokwari who are currently attending the first grade of primary school were attending pre-school the previous year. This compares with 40 per cent in Sorong and 28 per cent in Kaimana. Net intake rate in primary education. Of children who are of primary school entry age (age 7), 77 per cent are attending the first grade of primary school in Kaimana and Manokwari districts. This indicator is 70 per cent in Sorong District. Net primary school attendance rate. The majority of children of primary school age in Kaimana (94 per cent), Manokwari (94 per cent) and Sorong (96 per cent) are attending primary school or secondary school. Net secondary school attendance rate. The survey ranks the secondary school net attendance ratio in Kaimana as the lowest and shows a striking 48 per cent of children of secondary school age who are out of school. 24 per cent are still in primary school, while 28 per cent are out of school. Net secondary school attendance rates are 77 and 78 per cent in Sorong and Manokwari districts respectively. 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 in Kaimana (88 per cent) with the highest rates in Manokwari (114 per cent). The primary completion rate in Sorong is 113 per cent. Transition rate to secondary school. High percentages of children that completed successfully the last grade of primary school were found at the moment the survey to be attending the first grade of secondary school (Kaimana, 81 per cent; Manokwari, 95 per cent; Sorong, 100 per cent). MULTIPLE INDICATOR CLUSTER SURVEY 2011 xxi Gender parity index. The gender parity for primary school is 1.02, 1.01 and 1.01 in Kaimana, Manokwari and Sorong districts respectively, i.e. girls and boys similarly attend primary school. The gender parity for secondary school is 1.34, 0.99 and 1.05 in Kaimana, Manokwari and Sorong districts respectively. This shows that far more girls in Kaimana attend secondary school. CHILD PROTECTION Birth registration. Birth registration is generally slightly lower in Kaimana District (46 per cent) compared with Manokwari (51 per cent) and Sorong (50 per cent) districts. Child labour. Child labour is 24, 22 and 22 per cent in Kaimana, Manokwari and Sorong districts respectively. 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 (Kaimana, 86 per cent; Manokwari, 84 per cent; Sorong, 90 per cent). More importantly, 23 per cent of children were subjected to severe physical punishment (Kaimana, 31 per cent; Manokwari, 23 per cent; Sorong, 18 per cent). Early marriage. The percentage of women age 15-19 years who are currently married or in union is higher in Manokwari (22 per cent) and lower in Kaimana District (13 per cent). In Sorong District, 15 per cent of women 15-19 are currently married or in union. The percentage of women aged 20-49 years married before age 18 was higher in Sorong District (35 per cent) than Kaimana District (22 per cent) and Manokwari District (30 per cent). Among men, marriage/union before age 18 is not common, but it is higher in Manokwari District (8 per cent) than in Kaimana and Sorong districts (5 per cent each). About 19 per cent of women age 20-24 in Sorong District are currently married to a man who is older by ten years or more. This compares with much lower percentages in Manokwari (10 per cent) and Kaimana districts (5 per cent). Domestic Violence. Differences in the percentage of women who believe that a husband is justified to beat his wife were clear among districts. 41 per cent of women in Manokwari District accept this type of violence. This percentage is reduced in Sorong and Kaimana districts to 33 and 36 per cent respectively. Domestic violence is lower among men in Manokwari (28 per cent) than among women (41 per cent) and higher among men in Kaimana (48 per cent) than among women (36 per cent). In Sorong, more women justify domestic violence (33 per cent) than men (20 per cent). MULTIPLE INDICATOR CLUSTER SURVEY 2011xxii HIV/AIDS, SEXUAL BEHAVIOUR AND ORPHANS Knowledge of HIV transmission. Lower percentages of the interviewed women have heard of AIDS in Kaimana District than in the other two districts (Kaimana, 64 per cent; Manokwari, 84 per cent; Sorong, 72 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 much lower in Kaimana District (18 per cent) than in Manokwari (25 per cent) and Sorong (23 per cent). Comprehensive knowledge among men age 15-49 is lower in Kaimana District (12 per cent) compared than in Manokwari (26 per cent) and Sorong (25 per cent) districts. Knowledge of mother-to-child transmission of HIV. Knowledge of mother-to-child HIV transmission among women was highest in Manokwari (62 per cent) and lowest in Kaimana (51 per cent). This indicator was 60 per cent in Sorong District. Knowledge of mother-to-child HIV transmission from mother to child was generally higher among men than women. Attitudes toward people living with HIV. The percentage of women agreeing to all accepting attitudes is highest in Sorong District (21 per cent) compared with Manokwari District (13 per cent) and Kaimana District (6 per cent). Accepting attitudes toward people living with HIV/AIDS were generally similar among men. Knowledge of where to be tested for HIV. Very small numbers of women age 15-49 have been tested and told their result in Kaimana (0.6 per cent), Manokwari and Sorong (0.8 per cent each). The percentages of men who have been tested and told their result were slightly higher (Kaimana, 2 per cent; Manokwari, 3 per cent; Sorong, 1 per cent). Very small numbers of young women, were tested in the last 12 months and have been told their result. Among young men, a higher percentage of men have been tested in the last 12 months and told their result in Manokwari District (6 per cent) than in the other two districts. Sexual Behaviour Related to HIV Transmission. About seven per cent of never-married women age 15-24 years in Manokwari District had sex before age 15. This compares with to lower percentages in Kaimana (4 per cent) and Sorong districts (3 per cent). About five per cent of men in Manokwari District had sex before age 15. This compares to with lower percentages in Kaimana (4 per cent) and Sorong districts (1 per cent). Sex with multiple partners. Sex with multiple partners is higher among men than among women in the same age category. A Negligible number of women 15-49 in each of the three districts reported having sex with more than one partner in last 12 months. Six, five and two per cent of men 15-49 in Kaimana, Manokwari and Sorong respectively reported having sex with more than one partner in last 12 months. Results among men age 15-24 years men were higher than those among men 15-49 years. MULTIPLE 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 a non-marital, non-cohabiting partner in the last 12 months among women 15-24 is similar among the three districts (4 per cent each). This indicator is considerably higher among men than among women where 59 per cent of young men age 15-24 years in Kaimana had sex with a non-marital, non-cohabiting partner in the last 12 months, compared with 38 per cent in Manokwari District and 49 per cent in Sorong District. Orphaned Children.2 Higher percentages of orphans were found in Kaimana (8 per cent) and Manokwari (7 per cent) districts than in Sorong District (6 per cent). Male circumcision. Circumcision is more prevalent in Sorong District (68 per cent) than in Manokwari (47 per cent) and Kaimana districts (41 per cent). In each district, most circumcision was performed at home by a health worker/professional. Alcohol use. About two per cent of women age 15-49 years in the district of Manokwari had at least one drink of alcohol on one or more days during the last one month. This is compared with less than one per cent each in the districts of Kaimana (0.5 per cent) and Sorong (0.2 per cent). Alcohol use is considerably higher among men in the same age group with about one fifth of men age 15-49 years in Kaimana District (22 per cent) reporting having at least one drink of alcohol on one or more days during the last one month. This compares with percentages of 19 and 10 in Manokwari and Sorong districts respectively. MULTIPLE INDICATOR CLUSTER SURVEY 2011xxiv MULTIPLE INDICATOR CLUSTER SURVEY 2011 1 1 INTRODUCTION 1.1. BACKGROUND This report is based on the Selected Districts of West 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 West Papua Province: Kaimana, Manokwari and Sorong, 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 West 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 the 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) MULTIPLE INDICATOR CLUSTER SURVEY 20112 “…We will conduct periodic reviews at the national and subnational levels of progress in order to address obstacles more effectively and accelerate actions.…” (A World Fit for Children, paragraph 61) The Plan of Action (paragraph 61) also calls for the specific involvement of UNICEF in the preparation of periodic progress reports: “… As the world’s lead agency for children, the United Nations Children’s Fund is requested to continue to prepare and disseminate, in close collaboration with Governments, relevant funds, programmes and the specialized agencies of the United Nations system, and all other relevant actors, as appropriate, information on the progress made in the implementation of the Declaration and the Plan of Action.” Similarly, the Millennium Declaration (paragraph 31) calls for periodic reporting on progress: “…We request the General Assembly to review on a regular basis the progress made in implementing the provisions of this Declaration, and ask the Secretary- General to issue periodic reports for consideration by the General Assembly and as a basis for further action.” This final report presents the results of the indicators and topics covered in the survey. 1.2. SURVEY OBJECTIVES The 2011 Selected Districts of West 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 West 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 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 MULTIPLE INDICATOR CLUSTER SURVEY 2011 3 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 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 5 2 SAMPLE AND SURVEY METHODOLOGY 2.1. SAMPLE DESIGN The sample for the 2011 Selected Districts of West 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 Kaimana, Manokwari and Sorong 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 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 MULTIPLE INDICATOR CLUSTER SURVEY 20116 • 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 West Papua Province MICS questionnaires is provided in Appendix F. 2.3. TRAINING AND FIELDWORK Training of trainers for the field was conduct for 12 days during 4-15 July 2011 in Bogor. Enumerators training was conducted in Jayapura 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 a half days in practice interviewing in Manokwari District. The data were 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 2011 7 2.4. DATA PROCESSING Data was entered using the CSPro software. The data was entered on 12 microcomputers and 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 programs developed under the global MICS4 programme and adapted to the Selected Districts of West Papua Province 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 9 3 SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS 3.1. SAMPLE COVERAGE Of the 2,913 households selected for the three districts sample, 2,843 were found to be occupied. Of these, 2,816 were successfully interviewed for a household response rate of 99.1 per cent. In the interviewed households, 2,853 women (age 15-49 years) were identified. Of these, 2,715 were successfully interviewed, yielding a response rate of 95.2 per cent within interviewed households. In addition, 2,917 men (age 15-49 years) were listed in the household questionnaire. Questionnaires were completed for 2,736 of eligible men, a response rate of 93.8 per cent within interviewed households. There were 1,394 children under age five listed in the household questionnaire. Questionnaires were completed for 1,354 of these children, a response rate of 97.1 per cent within interviewed households. Overall response rates of 94.3, 92.9 and 96.2 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 Kaimana, Manokwari and Sorong, whereas the women, men and children response rates were generally lower in the district of Manokwari. Households Sampled Occupied Interviewed Household response rate Women Eligible Interviewed Women’s response rate Women’s overall response rate Men Men Eligible Men 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 873 851 840 98.7 936 891 95.2 94.0 952 877 92.1 90.9 394 383 97.2 96.0 2,040 1,992 1,976 99.2 1,917 1,824 95.1 94.4 1,965 1,859 94.6 93.8 1,000 971 97.1 96.3 990 961 943 98.1 959 922 96.1 94.3 999 955 95.6 93.8 533 527 98.9 97.0 923 896 889 99.2 946 868 91.8 91.0 961 876 91.2 90.4 418 391 93.5 92.8 1,000 986 984 99.8 948 925 97.6 97.4 957 905 94.6 94.4 443 436 98.4 98.2 2,913 2,843 2,816 99.1 2,853 2,715 95.2 94.3 2,917 2,736 93.8 92.9 1,394 1,354 97.1 96.2 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 Kaimana, Manokwari and Sorong, West Papua Province, Indonesia, 2011 Area Urban Rural Kaimana Sorong TotalManokwari District MULTIPLE INDICATOR CLUSTER SURVEY 201110 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 3.2. CHARACTERISTICS OF HOUSEHOLDS The age and sex distribution of the three districts survey population is provided in Table HH.2. In the 2,816 households successfully interviewed in the survey, 11,667 household members were listed. Of these, 5,990 were males and 5,659 were females. The age structure of the selected three districts of West Papua is experiencing substantial 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 43 per cent of the population in the three districts is comprised of children 0-17 years. 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 1,342 1,542 1,456 1,007 769 926 982 875 747 595 521 346 233 138 93 52 33 10 4,340 7,001 326 4,962 6,706 11,667 8 5 3 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 17 0 2 17 2 19 658 758 676 491 418 490 473 427 334 279 245 156 110 63 46 23 7 4 2,092 3,424 142 2,386 3,273 5,659 676 779 777 516 352 436 508 448 413 316 275 190 124 75 48 29 24 6 2,231 3,577 182 2,559 3,431 5,990 11.5 13.2 12.5 8.6 6.6 7.9 8.4 7.5 6.4 5.1 4.5 3.0 2.0 1.2 0.8 0.4 0.3 0.1 37.2 60.0 2.8 42.5 57.5 100.0 44.6 27.0 17.5 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 10.9 0.0 89.1 0.0 10.9 89.1 10.9 100.0 11.6 13.4 11.9 8.7 7.4 8.7 8.4 7.5 5.9 4.9 4.3 2.8 1.9 1.1 0.8 0.4 0.1 0.1 37.0 60.5 2.5 42.2 57.8 100.0 11.3 13.0 13.0 8.6 5.9 7.3 8.5 7.5 6.9 5.3 4.6 3.2 2.1 1.3 0.8 0.5 0.4 0.1 37.3 59.7 3.0 42.7 57.3 100.0 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 Kaimana, Manokwari and Sorong, West Papua Province, Indonesia, 2011 TotalMissingFemaleMale Per centPer centPer centPer cent NumberNumberNumberNumber MULTIPLE INDICATOR CLUSTER SURVEY 2011 11 District Kaimana Manokwari Sorong 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 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 943 889 984 2,478 338 840 1,976 240 377 556 622 427 281 158 57 45 53 220 982 1,253 359 2 1,265 828 352 253 111 7 2,816 2,816 2,816 2,816 2,816 2,816 15.9 58.2 25.9 88.2 11.8 24.7 75.3 8.5 13.7 19.2 21.2 15.9 9.6 5.8 2.2 1.7 2.2 7.4 33.7 44.2 14.6 0.0 43.7 33.3 12.1 6.2 4.4 0.3 100.0 36.8 74.3 81.1 79.0 4.1 448 1,638 730 2,485 331 697 2,119 238 387 540 597 449 271 163 63 47 61 208 950 1,245 412 1 1,231 937 342 174 124 9 2,816 2,816 2,816 2,816 2,816 2,816 Table HH.3: Household composition Per cent and frequency distribution of households by selected characteristics, Districts of Kaimana, Manokwari and Sorong, West Papua Province, Indonesia, 2011 Number of households Weighted per cent Weighted Unweighted of the representativeness of the survey. The remaining tables in this report are presented only with weighted numbers. See Appendix A for more details about the weighting. Table HH.3 provides basic background information on the households. Within households, the sex of the household head, region, area, number of household members, education of household head and 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. MULTIPLE INDICATOR CLUSTER SURVEY 201112 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. 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 16 per cent of the three districts West Papua sample resides in Kaimana, 58 per cent reside in Manokwari and 26 per cent reside in Sorong. Most of the households consisted of 4 members (21 per cent) and the mean household size is four members. About 44 per cent of the survey sample consisted of households with Papuan heads, followed by Javanese heads of households, who accounted for about one third of the survey sample (33 per cent). The remaining 23 per cent of the survey sample was headed by other ethnic groups from: Sulawesi, Maluku and others. Thirty-seven per cent of the households contained at least one child under-five years of age, 81 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. There seems to be oversampling in Kaimana and Sorong districts and some undersampling in Manokwari District. 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 un-weighted 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 of residence, age, marital status, motherhood status, births in last two years, education,5 wealth index quintiles6 and ethnicity of the household head. MULTIPLE INDICATOR CLUSTER SURVEY 2011 13 Table HH.4: Women’s background characteristics Per cent and frequency distribution of women age 15-49 years by selected background characteristics, Districts of Kaimana, Manokwari and Sorong, West Papua Province, Indonesia, 2011 District Kaimana Manokwari Sorong 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 Missing Total for 3 districts 922 868 925 891 1,824 437 377 495 435 392 326 253 1,998 61 43 41 572 1,988 727 519 2,196 150 836 1,364 365 580 540 484 559 552 1,216 760 340 289 106 4 2,715 15.6 60.3 24.1 28.1 71.9 17.1 14.6 17.0 16.3 14.2 11.2 9.5 73.2 1.8 1.3 1.8 21.9 72.2 27.8 18.0 82.0 4.9 28.1 51.6 15.3 17.2 18.5 18.2 23.6 22.6 44.6 31.7 12.3 7.2 4.0 0.2 100.0 423 1,638 654 763 1,952 465 395 462 443 387 305 259 1,987 50 35 49 594 1,959 756 489 2,226 134 764 1,402 415 467 502 493 640 614 1,212 860 333 197 107 7 2,715 Number of women Weighted per cent Weighted Unweighted MULTIPLE INDICATOR CLUSTER SURVEY 201114 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 of residence, age, marital status, motherhood status, births in last two years, education, wealth index quintiles and ethnicity of the household head. About 15 per cent of female respondents 15-49 years of age live in Kaimana, 60 per cent in Manokwari and 24 per cent in Sorong. About 28 per cent of these women live in urban areas while the remaining 72 per cent live in rural areas. Of the 2,715 successfully interviewed women, 1,987 women (73 per cent) were currently married or in union, 594 women (22 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 had give birth while 28 per cent never had. To assess their education, women were asked about the highest level of school they had reached. About five per cent of all women had never attended any form of education. The majority (42 per cent) of all women have junior or senior secondary (SMP/SM) education, 28 per cent have primary education and only 15 per cent have higher than secondary education. Weighted and un-weighted number of cases were generally similar except for districts. 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 of residence, 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 (33 per cent) whereas almost all of the remaining survey sample were currently married or in union (65 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 similar to that of female children (50 per cent and 49 per cent respectively). About one per cent of responses did not list the child’s sex. About one-fifth of children were under one year of age (20 per cent), 19 per cent were 12-23 months, 22 per cent were 24-35 months, 21 per cent were 36-47 months and 19 per cent were 48-59 months. The majority (76 per cent) of these children reside in rural areas whereas 24 per cent reside in urban areas. Six per cent of children’s mothers or care takers were uneducated, 30 per cent had primary education, 53 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 2011 15 Table HH.4M: Men’s background characteristics Per cent and frequency distribution of men age 15-49 years by selected background characteristics, Districts of Kaimana, Manokwari and Sorong, West Papua Province, Indonesia, 2011 District Kaimana Manokwari Sorong 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 955 876 905 877 1,859 453 322 409 467 404 383 298 1,776 26 22 29 883 85 702 1,560 389 623 528 533 530 522 1,207 787 365 263 109 5 2,736 16.0 60.2 23.8 26.7 73.3 17.4 11.6 14.2 17.5 15.0 13.7 10.6 64.6 0.6 0.7 1.1 33.0 2.7 22.9 57.6 16.8 18.2 18.3 21.6 21.1 20.9 43.4 33.1 12.2 6.2 4.7 0.3 100.0 437 1,647 652 732 2,004 477 317 388 479 410 374 291 1,767 17 20 31 902 74 625 1,576 460 498 499 591 576 571 1,189 906 333 171 129 9 2,736 Number of men Weighted per cent Weighted Unweighted MULTIPLE INDICATOR CLUSTER SURVEY 201116 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 Kaimana, Manokwari and Sorong, West Papua Province, Indonesia, 2011 District Kaimana Manokwari Sorong 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 Missing/DK Total for 3 districts 527 391 436 693 653 383 971 115 135 273 290 291 250 94 438 683 139 406 288 247 209 204 741 280 137 145 49 2 1,354 19.4 56.1 24.5 50.2 49.2 24.3 75.7 8.9 10.6 19.0 21.5 20.6 19.3 6.3 30.0 52.6 11.0 23.5 20.1 20.4 17.2 18.7 53.7 24.6 10.5 7.2 3.7 0.3 100.0 262 760 332 679 666 329 1,025 121 143 257 292 280 261 85 407 713 150 319 272 277 234 253 727 333 142 98 50 4 1,354 Number of under-5 children Weighted per cent Weighted Unweighted * Mother’s education refers to educational attainment of mothers and caretakers of children under 5. MULTIPLE INDICATOR CLUSTER SURVEY 2011 17 4 CHILD MORTALITY 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. 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 of 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 estimateds should be undertaken with caution. Table CM.2 provides estimates of child mortality. The infant mortality rates are estimated at 50, 60 and 42 per thousand in the districts of Kaimana, Manokwari and Sorong respectively. The probabilities of dying under age 5 (U5MR) are 65, 81 and 45 per thousand in the districts of Kaimana, Manokwari and Sorong 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 clear a disadvantage in Manokwari District compared with Kaimana and Sorong. The overall combined three districts infant and under- five mortality rates were 54 and 72 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 Papua Province for the 10-year period preceding the survey using the direct method of mortality estimation. MULTIPLE INDICATOR CLUSTER SURVEY 201118 Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total for 3 districts 0.136 0.868 1.863 2.602 3.231 3.830 3.988 2.161 0.133 0.786 1.754 2.394 2.980 3.524 3.588 1.988 63 343 860 1,152 1,249 1,168 1,032 5,867 62 311 810 1,060 1,152 1,075 929 5,398 0.023 0.094 0.058 0.080 0.077 0.080 0.100 0.080 465 395 462 443 387 305 259 2,715 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 Kaimana, Manokwari and Sorong, Papua, Indonesia, 2011 Children ever born Total TotalMean Mean Children surviving Proportion dead Number of women District Kaimana Manokwari Sorong 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 50 60 42 65 43 46 57 55 70 47 29 74 57 22 61 44 70 35 54 65 81 54 86 57 59 76 73 96 61 36 103 76 28 82 57 96 43 72 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 Table CM.2: Child mortality Infant and under-five mortality rates, West Model, Districts of Kaimana, Manokwari and Sorong, West Papua Province, Indonesia, 2011 MULTIPLE 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 higher in rural areas compared with urban. As expected, a sharp negative association between mortality and education is observed; for example the under-five mortality rate decreased from 73 per thousand for children with uneducated mothers to 36 per thousand for children with mothers with higher education. Similarly under-five mortality rate decreased sharply from 103 per thousand among children living in the poorest households to 57 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 Kaimana, Manokwari and Sorong, West Papua Province, Indonesia, 2011 District Kaimana Manokwari Sorong Area Urban Rural Mother’s Education No education Primary Secondary Higher Wealth quintiles Poorest Second Middle Fourth Richest Ethnicity Papuan Other 0 40 8020 60 100 120 Per 1,000 live births 65 54 59 76 76 82 73 96 61 36 28 96 57 43 103 81 MULTIPLE INDICATOR CLUSTER SURVEY 201120 MULTIPLE INDICATOR CLUSTER SURVEY 2011 21 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 folowing 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 23 per cent of babies in the three selected districts of West Papua were breastfed for the first time within one hour of birth, while 61 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 day of birth. Women in Kaimana were the least likely to start breastfeeding within one day (45 per cent), compared with women in Manokwari (69 per cent) and Sorong (51 per cent) (Figure NU.1). MULTIPLE INDICATOR CLUSTER SURVEY 201122 Breastfeeding within one hour was highest in Sorong District (27 per cent) than in Kaimana and Manokwari (23 per cent for each). Children born in private hospitals (29 per cent) were more likely to be initially breastfed appropriately within one hour compared with those born in public sector hospitals (20 per cent) and those born at home (26 per cent). Children born to mothers with no education were more likely to be initially breastfed within one hour compared with children born to mothers with higher education. Figure NU.1: Percentage of mothers who started breastfeeding within one hour and within one day of birth, Districts of Kaimana, Manokwari and Sorong, West Papua Province, Indonesia, 2011 100 90 80 70 60 50 40 30 20 10 0 Within one hourWithin one day P er c en t Three districts SorongManokwariKaimana RuralUrban In Table NU.2, breastfeeding status is based on the reports of mothers/caretakers of children’s consumption of food and fluids during the previous day or night prior to the interview. Exclusively breastfed refers to infants who received only breast milk (and vitamins, mineral supplements, or medicine). The table shows exclusive breastfeeding of infants during the first six months of life, as well as continued breastfeeding of children at 12-15 and 20-23 months of age. For the three districts of West Papua, only 28 per cent of children aged less than six months are exclusively breastfed and 37 per cent are predominantly breastfed. Exclusive and predominant breast feeding are higher in Sorong District (44 and 51 per cent respectively) compared with the other two districts (Kaimana: 41 and 46 respectively; Manokwari: 19 and 31 respectively). At age 12-15 months, 62 per cent of the children are breastfed, while this percentage is 55 per cent for children aged 20-23 months. It should be noted that these figures should be treated with caution due to the small number of cases observed. Continued breastfeeding indicators by background characteristics are not reported due to the 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, about half a month for exclusive breastfeeding and about half a month for predominant breastfeeding. Results show that the median duration of breastfeeding was lowest in Kaimana District (25 months) compared with Manokwari (22 months) and Sorong (23 months) districts. The median duration of breastfeeding showed a negative correlation with mothers’ education, being considerably lower among mothers with higher education (10 months), 45 69 59 61 60 23 24 2727 2323 51 MULTIPLE INDICATOR CLUSTER SURVEY 2011 23 District Kaimana Manokwari Sorong 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 Other/Missing 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 91.3 90.9 92.8 83.5 94.1 94.5 87.5 93.0 96.0 98.4 (*) 92.1 (100.0) 94.8 (*) 96.4 88.7 91.8 93.4 95.3 90.1 91.8 92.5 86.3 94.3 90.5 85.1 83.8 (*) 91.4 22.7 23.2 27.2 27.0 22.9 21.3 25.0 24.2 15.1 31.5 (*) 19.8 (29.4) 25.9 (*) 46.5 24.4 22.7 20.5 24.1 24.3 26.0 22.0 22.9 24.0 25.8 19.3 17.7 (*) 23.9 44.5 69.4 51.0 59.2 60.9 60.1 59.9 60.3 54.3 75.3 (*) 61.9 (55.7) 62.6 (*) 78.2 49.3 64.8 58.4 58.6 63.5 54.9 64.2 62.2 67.6 55.0 51.5 44.5 (*) 60.5 99 287 102 124 365 255 223 351 49 68 21 173 38 254 23 23 128 272 67 109 96 103 93 87 251 128 59 34 15 489 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 Kaimana, Manokwari and Sorong, West Papua Province, Indonesia, 2011 * 2 cases 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 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 MULTIPLE INDICATOR CLUSTER SURVEY 201124 while that median was 25 months among women with no education. A similar negative correlation was also observed between duration of breastfeeding and wealth. The adequacy of infant feeding in children under 24 months is provided in Table NU.4. Different criteria of feeding are used depending on the age of the child. For infants aged 0-5 months, exclusive breastfeeding is considered as age-appropriate feeding, while infants aged 6-23 months are considered to be appropriately fed if they are receiving breastmilk and solid, semi-solid or soft food. As a result of these feeding patterns, fewer than half of the children aged 6-23 months are being appropriately fed (45 per cent). The level of age-appropriate feeding is highest in Sorong District (47 per cent), compared with Manokwari (46 per cent) and Kaimana (41 per cent) districts. Appropriate feeding was higher among children residing in rural areas (46 per cent) compared with urban areas (42 per cent). Appropriate feeding varied unsystematically according to mother education and wealth (Figure NU.2). Similar patterns were observed for children age 0-23 months. District Kaimana Manokwari Sorong Sex Male Female Area Urban Rural Total for 3 districts (41.3) (18.6) (43.9) 35.9 18.4 (21.1) 28.9 27.5 (46.1) (30.6) (51.2) 48.0 25.9 (21.1) 40.7 37.2 (75.0) (*) (74.2) (59.2) (68.7) (53.3) 66.2 62.2 (65.5) (54.7) (*) (65.4) (45.8) (20.1) 66.9 54.9 25 76 21 60 60 21 100 121 19 36 18 47 26 23 50 73 16 56 18 42 48 23 67 90 Table NU.2: Breastfeeding Percentage of living children according to breastfeeding status at selected age groups, Districts of Kaimana, Manokwari and Sorong, West 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 * 2 cases 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 1 MICS indicator 2.6 2 MICS indicator 2.9 3 MICS indicator 2.7 4 MICS indicator 2.8 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 breastmilk 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 MULTIPLE INDICATOR CLUSTER SURVEY 2011 25 District Kaimana Manokwari Sorong 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) 25.2 21.6 22.5 23.3 20.7 9.9 23.5 23.7 23.4 22.6 9.7 25.3 27.8 22.1 16.2 15.1 23.5 19.9 7.9 23.8 (*) 22.4 19.7 0.7 0.5 0.7 0.7 0.5 0.5 0.6 2.2 0.5 0.6 0.5 2.5 0.6 0.5 0.4 0.5 0.6 0.4 1.6 0.7 (*) 0.6 1.8 2.1 0.5 1.7 0.7 0.5 0.5 0.6 2.2 0.5 0.6 0.5 3.2 0.6 0.5 0.4 0.5 0.6 0.4 2.0 0.7 (*) 0.6 3.2 162 466 185 392 415 208 606 51 240 427 95 188 158 170 143 155 447 198 86 58 22 813 813 Table NU.3: Duration of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children age 0-35 months, Districts of Kaimana, Manokwari and Sorong, West 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 fewer than 25 unweighted cases 1 MICS indicator 2.10 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. Overall, 51 per cent of infants age 6-8 received solid, semi-solid, or soft foods (Table NU.5). Among currently breastfeeding infants this percentage is 41, while it is 87 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, more than half of the children age 6-23 months (57 per cent) were receiving solid, semi-solid and soft foods the minimum number of times (Kaimana, 44 per cent; Manokwari, 44 per cent; Sorong, 42 per cent). MULTIPLE INDICATOR CLUSTER SURVEY 201126 Table NU.4: Age-appropriate breastfeeding Percentage of children age 0-23 months who were appropriately breastfed during the previous day, Districts of Kaimana, Manokwari and Sorong, West Papua Province, Indonesia, 2011 * 2 cases 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 1 MICS indicator 2.6 2 MICS indicator 2.14 District Kaimana Manokwari Sorong 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 (41.3) (18.6) (43.9) 35.9 18.4 (21.1) 28.9 (*) (39.2) 20.2 (*) (50.5) (*) (*) (*) (*) 28.0 (*) (*) (*) 27.5 25 76 21 60 60 21 100 11 27 68 16 28 22 22 23 25 77 20 18 6 121 41.3 38.9 46.4 46.1 36.3 38.0 41.9 (54.1) 39.9 43.1 25.2 48.7 36.6 46.6 34.7 34.1 43.2 40.8 28.4 49.6 (*) 40.9 41.3 45.6 47.0 49.4 41.5 41.5 46.2 (*) 40.0 50.3 (24.5) 48.2 39.1 52.3 42.7 40.2 48.7 43.2 (33.2) (50.2) (*) 45.0 83 230 87 191 206 105 296 26 114 215 45 103 85 85 63 65 213 111 37 27 10 401 108 306 107 252 266 126 395 37 141 283 61 131 107 107 86 91 290 131 55 34 10 522 Children age 0-5 months Children age 6-23 months Children age 0-23 months Per cent exclusively breastfed1 Per cent currently breastfeeding and receiving solid, semi-solid or soft foods Per cent appropriately breastfed2 Number of children Number of children Number of children The continued practice of bottle-feeding is a concern due to possible contamination due to by unsafe water and lack of hygiene in preparation. Table NU.7 shows that 43 per cent of children under 6 months are fed using a bottle with a nipple (Kaimana, 44 per cent; Manokwari, 44 per cent; Sorong, 42 per cent). Bottle feeding is higher among female children, in urban areas, among children of the more educated, and of the richest women. MULTIPLE INDICATOR CLUSTER SURVEY 2011 27 Sex Male Female Area Urban Rural Total for 3 districts (46.2) (35.9) (*) 34.6 40.5 (56.6) (45.9) (75.2) 42.3 50.9 (*) (*) (*) (*) (*) 33 42 15 61 75 13 9 11 11 22 46 51 26 72 97 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 Kaimana, Manokwari and Sorong, West 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 Kaimana, Manokwari and Sorong, West Papua Province, Indonesia, 2011 100 90 80 70 60 50 40 30 20 10 0 P er c en t Mother’s education Wealth index None PoorestSMP/SM MiddlePrimary SecondHigher Fourth Richest 58 50 24 48 39 52 43 4040 MULTIPLE INDICATOR CLUSTER SURVEY 201128 District Kaimana Manokwari Sorong 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 37.4 44.7 51.8 53.9 37.0 36.4 (27.8) 51.0 54.0 54.1 42.3 (*) 39.0 44.9 (*) 38.9 34.4 49.2 (55.1) (57.8) 39.5 50.1 (*) (42.9) (*) 44.7 24 81 25 64 65 22 10 45 52 49 81 8 33 63 25 21 26 25 25 33 48 41 23 8 7 130 71.2 (86.2) (93.5) 83.5 85.9 (*) (*) 83.3 76.6 89.9 81.6 (*) (73.0) 91.1 (*) (*) (76.2) (82.9) (*) (93.2) (80.1) (94.3) (*) (*) (*) 84.8 59 149 62 127 141 75 35 87 73 56 215 18 81 152 20 82 59 60 37 33 164 70 14 19 3 271 66.7 (86.1) (90.4) 82.6 84.0 (*) (*) 80.7 80.3 91.2 78.6 (*) (71.4) 91.2 (*) (*) (84.7) (84.6) (*) (90.8) (77.8) (94.3) (*) (*) (*) 83.3 45.9 59.3 62.7 63.5 51.9 50.7 (38.6) 61.2 65.0 71.5 52.2 (*) 48.4 58.6 (68.6) 41.9 49.6 59.7 71.7 74.3 48.2 66.5 (80.2) (56.2) (*) 57.2 83 230 87 191 206 97 46 132 125 105 296 26 114 215 45 103 85 85 63 65 213 111 37 27 10 401 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 Kaimana, Manokwari and Sorong, West Papua Province, Indonesia, 2011 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 * 2 cases with missing “Ethnicity of household head” and 3 cases with missing “Sex” not shown ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases 1 MICS indicator 2.15 2 MICS indicator 2.13 MULTIPLE INDICATOR CLUSTER SURVEY 2011 29 District Kaimana Manokwari Sorong Sex* Male Female Age 0-5 months 6-11 months 12-13 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 43.9 43.6 41.9 39.1 46.8 38.6 44.3 45.0 63.4 36.9 18.7 31.2 46.5 71.5 25.4 32.1 37.1 72.4 62.2 36.2 53.7 56.0 37.7 (*) 43.3 108 306 107 252 266 121 143 257 126 395 37 141 283 61 131 107 107 86 91 290 131 55 34 10 522 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 Kaimana, Manokwari and Sorong, West 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 * 2 cases with missing “Ethnicity of household head” and 4 cases with missing “Sex”not shown ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases 1 MICS indicator 2.11 MULTIPLE INDICATOR CLUSTER SURVEY 201130 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 programs, the definition of the indicator is the per cent 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 throughout two National Campaigns held in February and August. Indonesian post-partum women also receive one Vitamin A capsule within eight weeks of delivery, though 2011 WHO Guidelines no longer recommend this. Within the six months prior to the Selected Districts of West Papua Province MICS, 54 per cent of children aged 6-59 months received a high-dose Vitamin A supplement (Table NU.8). About 53 per cent of children received a high dose vitamin A supplement according to mothers’ reports. Vitamin A supplementation coverage is considerable lower in Manokwari District (47 per cent) and Kaimana District (51 per cent) than in Sorong (71 per cent). The age pattern of Vitamin A supplementation shows that supplementation in the last six months rises from 35 per cent among children aged 6-11 months to 61 per cent among children aged 12-23 months, then declines to 60, 54 and 49 per cent among children 24-35, 36-47 and 48-59 months respectively. MULTIPLE 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 31 per cent among children whose mothers have no education, to 48 per cent of those whose mothers have primary education, to 58 per cent of those whose mothers have secondary education and to 59 per cent among children of mothers with higher education. 9.0 8.0 17.4 12.6 8.5 14.3 9.3 17.4 17.6 9.3 7.9 4.1 4.9 6.9 13.0 12.1 2.7 11.2 15.1 11.8 13.6 4.6 23.9 11.5 9.2 9.0 10.6 50.5 46.0 69.3 53.5 51.5 47.4 54.6 33.5 58.5 59.9 53.7 48.7 30.6 48.4 57.2 56.6 44.1 59.4 58.1 59.0 44.9 49.2 61.2 46.4 61.8 57.4 52.8 51.1 47.1 70.4 54.1 52.7 48.7 55.4 35.1 61.4 60.2 54.0 48.7 30.6 48.4 58.4 59.0 44.4 59.9 58.7 60.1 47.4 49.3 64.6 46.7 61.8 57.4 53.7 237 685 311 619 606 307 926 143 257 292 280 261 75 379 645 134 291 250 254 210 227 650 313 124 92 50 1,233 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 Kaimana, Manokwari and Sorong, West 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 * 4 cases with missing “Ethnicity of household head” and 8 cases with missing “Sex” not shown 1 MICS indicator 2.17 District Kaimana Manokwari Sorong 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 MULTIPLE INDICATOR CLUSTER SURVEY 201132 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 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 babies weighing below 2,500 grams at birth 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 West 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 based only on the mother’s recall of the child’s weight, or on the weight as recorded on a health card if the child was weighed at birth.8 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 2011 33 District Kaimana Manokwari Sorong 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 12.0 15.3 14.4 9.3 16.8 (0.0) 31.6 12.9 2.7 41.2 13.6 14.3 11.9 5.5 20.5 13.5 8.2 12.3 (*) 14.6 47.3 70.0 63.6 73.7 60.8 (17.1) 45.9 73.7 75.3 34.5 53.9 66.8 81.1 90.8 45.4 89.5 79.5 72.7 58.8 64.0 99 287 102 124 365 23 128 272 67 109 96 103 93 87 251 128 59 34 15 489 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 Kaimana, Manokwari and Sorong, West 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 * 2 cases 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 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, 64 per cent of babies were weighed at birth, with approximately 15 per cent of infants estimated to weigh less than 2,500 grams at birth (Table NU.9). There are great variations by districts. The lowest estimated percentage of infants weighing less than 2500 grams at birth was found in Kaimana (12 per cent), compared with 14 per cent in Sorong and 15 per cent in Manokwari District. MULTIPLE INDICATOR CLUSTER SURVEY 201134 MULTIPLE INDICATOR CLUSTER SURVEY 2011 35 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 West 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 MULTIPLE INDICATOR CLUSTER SURVEY 201136 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 44.0 15.8 38.8 30.6 27.5 41.8 36.0 12.9 35.4 13.4 41.2 33.5 8.6 34.5 29.2 12.5 1.3 17.0 257 32.8 32.9 32.5 31.4 28.1 34.3 32.4 31.5 29.9 6.1 33.1 31.3 29.7 20.3 19.1 17.7 25.1 0.0 257 76.8 48.7 71.3 62.0 55.7 76.1 68.4 44.4 65.4 19.5 74.3 64.8 38.3 54.8 48.3 30.2 26.4 17.0 257 76.0 48.3 70.5 61.4 54.5 76.1 68.4 44.4 61.2 19.5 74.3 64.8 38.1 53.9 47.0 30.2 20.7 17.0 257 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 Kaimana, Manokwari and Sorong, West Papua Province, Indonesia, 2011 Vaccinated by 12 months of ageChild health book/ vaccination card Mother’s report Either Vaccinated at any time before the survey according to 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 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 West Papua, approximately 76 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 76 per cent. The percentage declines for subsequent doses of DPT, to 68 per cent for the second dose and 44 per cent for the third dose (Figure CH.1). Similarly, 48 per cent of children received Polio 1 by age 12 months. And this increased to 71 per cent for the second dose and then declineds to 55 per cent by the fourth dose. The coverage for measles/ MMR vaccine by 12 months is 61 per cent. There is also a decline in the Hepatitis B vaccination, from 74 per cent for the first dose to 65 per cent for the second dose and 38 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, only 21 per cent. MULTIPLE INDICATOR CLUSTER SURVEY 2011 37 Figure CH.1: Percentage of children aged 12-23 months who received the recommended vaccinations by 12 months, Districts of Kaimana, Manokwari and Sorong, West Papua Province, Indonesia, 2011 100 90 80 70 60 50 40 30 20 10 0 P er c en t B C G D P T 1 P o lio 1 H ep B 0 D P T 2 P o lio 2 H ep B 1 D P T 3 P o lio 3 H ep B 2 P o lio 4 H ep B 3 A ll M ea sl es 76 76 71 74 61 61 21 65 54 68 44 48 38 19 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 36 per cent of children (Kaimana, 28 per cent; Manokwari, 32 per cent; Sorong, 54 per cent). Out of all selected districts, the survey results show that Kaimana District tended to have low coverage for most of the vaccinations with full vaccination coverage of only 22 per cent of children. The full vaccination coverage in Manokwari and Sorong districts was 20 and 46 per cent respectively. Often given to infants at the time of birth, BCG vaccine and DPT 1 (77 and 76 per cent respectively) 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 3 and DPT 3 are considerably lagging behind in Kaimana. HepB at birth has low coverage both overall and among the districts (Kaimana, 15 per cent; Manokwari, 22 per cent; Sorong, 20 per cent). MULTIPLE INDICATOR CLUSTER SURVEY 201138 * 2 ca se s 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 ” an d 1 c as e w it h m is si n g “ S ex ” 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 79 .2 68 .1 95 .9 73 .4 79 .9 86 .6 73 .4 ( *) 77 .0 78 .2 ( *) 62 .4 78 .9 80 .3 ( 90 .9 ) ( 79 .6 ) 64 .3 91 .9 79 .1 92 .3 ( *) 76 .8 40 .9 48 .3 58 .5 50 .7 46 .9 68 .7 41 .8 ( *) 47 .9 51 .6 ( *) 29 .9 46 .4 53 .0 ( 63 .3 ) ( 63 .9 ) 30 .6 72 .8 71 .6 52 .7 ( *) 48 .7 43 .6 58 .9 90 .3 59 .3 64 .8 73 .7 58 .0 ( *) 61 .1 64 .7 ( *) 47 .6 57 .4 69 .6 ( 72 .6 ) ( 72 .1 ) 45 .7 80 .4 80 .0 64 .1 ( *) 62 .0 38 .4 50 .8 87 .0 54 .2 57 .1 70 .1 50 .7 ( *) 57 .7 56 .7 ( *) 39 .9 53 .5 60 .1 ( 69 .4 ) ( 66 .0 ) 38 .9 74 .1 71 .7 61 .1 ( *) 55 .7 75 .7 68 .4 95 .9 68 .8 82 .9 83 .1 73 .7 ( *) 71 .8 79 .6 ( *) 60 .4 72 .0 81 .2 ( 92 .7 ) ( 85 .0 ) 62 .3 91 .9 87 .3 83 .2 ( *) 76 .1 61 .5 61 .0 94 .5 62 .2 74 .1 75 .7 65 .9 ( *) 65 .3 73 .9 ( *) 45 .3 67 .4 78 .7 ( 84 .1 ) ( 80 .0 ) 49 .7 89 .3 87 .3 74 .5 ( *) 68 .4 61 .7 66 .8 93 .1 67 .7 74 .5 79 .5 68 .4 ( *) 73 .4 72 .3 ( *) 58 .7 70 .3 75 .9 ( 80 .9 ) ( 78 .0 ) 61 .1 83 .7 82 .2 68 .9 ( *) 71 .3 D is tr ic t K ai m an a M an o kw ar i S o ro n g 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 T o ta l f o r 3 d is tr ic ts 33 .1 38 .8 69 .9 39 .9 48 .8 65 .8 37 .1 ( *) 42 .1 48 .7 ( *) 20 .8 41 .1 51 .4 ( 59 .4 ) ( 65 .6 ) 21 .4 74 .6 66 .5 57 .7 ( *) 44 .4 P er ce n ta g e o f ch ild re n w h o r ec ei ve d : P o lio D P T B C G A t b ir th A t b ir th 1 1 1 2 2 2 3 3 3 T ab 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 K ai m an a, M an o kw ar i a n d S o ro n g , W es t P ap u a P ro vi n ce , I n d o n es ia , 2 01 1 M ea sl es N o n e A ll Pe rc en ta ge w it h va cc in at io n ca rd s ee n N um be r of ch ild re n ag e 12 -2 3 m on th s 53 .6 61 .0 88 .9 57 .8 72 .1 70 .3 63 .6 ( *) 63 .8 68 .9 ( *) 47 .1 66 .8 80 .3 ( 74 .2 ) ( 66 .1 ) 48 .4 85 .3 75 .5 77 .5 ( *) 65 .4 14 .6 21 .6 19 .5 16 .2 22 .4 25 .6 17 .3 ( *) 16 .6 23 .7 ( *) 4. 5 23 .0 22 .4 ( 21 .8 ) ( 33 .8 ) 12 .9 26 .9 34 .6 8. 9 ( *) 19 .5 73 .8 66 .5 94 .5 68 .0 80 .0 87 .3 69 .8 ( *) 70 .6 77 .9 ( *) 54 .1 72 .7 79 .8 ( 92 .8 ) ( 85 .0 ) 62 .6 85 .5 87 .3 83 .2 ( *) 74 .3 59 .6 55 .8 93 .1 57 .9 71 .2 75 .9 61 .0 ( *) 58 .3 71 .8 ( *) 39 .5 68 .0 68 .0 ( 84 .3 ) ( 80 .0 ) 46 .5 82 .9 87 .3 72 .5 ( *) 64 .8 31 .9 29 .2 67 .6 33 .2 43 .2 60 .1 30 .6 ( *) 40 .9 38 .9 ( *) 14 .4 31 .2 54 .2 ( 45 .1 ) ( 60 .0 ) 17 .5 67 .2 55 .0 46 .7 ( *) 38 .3 17 .4 22 .5 2. 7 19 .9 14 .4 9. 6 19 .6 ( *) 14 .7 15 .9 ( *) 29 .6 19 .4 7. 4 (7 .2 ) ( 15 .0 ) 27 .1 4. 6 12 .7 7. 7 ( *) 17 .0 21 .8 20 .4 46 .3 25 .9 26 .7 45 .5 19 .9 ( *) 25 .8 28 .2 ( *) 7. 3 27 .5 33 .1 ( 25 .5 ) ( 49 .6 ) 9. 9 52 .0 32 .6 35 .3 ( *) 26 .4 28 .2 31 .6 54 .1 38 .4 32 .8 59 .8 27 .3 ( *) 32 .6 37 .7 ( *) 16 .0 28 .6 48 .0 ( 38 .3 ) ( 58 .9 ) 15 .1 64 .2 51 .4 48 .6 ( *) 35 .5 61 14 2 55 12 3 13 3 65 19 2 15 83 13 8 22 68 56 56 40 39 13 1 74 26 18 6 25 7 H ep B MULTIPLE 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. 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 women: • 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 her 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. Figure CH.2: Percentage of women with a live birth in the last 12 months who are protected against neonatal tetanus, Districts of Kaimana, Manokwari and Sorong, West Papua Province, Indonesia, 2011 District Kaimana Manokwari Sorong Area Urban Rural Mother’s Education No education Primary Secondary Higher Wealth quintiles Poorest Second Middle Fourth Richest 0 40 8020 60 100 Per cent 62 76 56 64 52 62 34 55 67 65 65 80 52 57 MULTIPLE INDICATOR CLUSTER SURVEY 201140 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 West Papua is at 62 per cent and lowest in Manokwari District (Kaimana, 62 per cent; Manokwari, 57 per cent; Sorong, 76 per cent). It is worth noting that tetanus toxoid protection is much lower among the poorest households (52 per cent) than the richest households (80 per cent). Similarly, tetanus toxoid protection increases from 34 per cent among women with no education to 62 per cent among women with higher education. District Kaimana Manokwari Sorong 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 4.5 5.7 7.3 8.2 5.0 (2.3) 7.1 4.8 8.4 2.6 4.7 4.2 8.2 10.3 5.6 6.9 4.3 6.6 (*) 5.8 0.0 0.0 0.6 0.5 0.0 (0.0) 0.0 0.0 0.8 0.0 0.0 0.0 0.0 0.6 0.0 0.4 0.0 0.0 (*) 0.1 0.0 0.6 0.0 0.0 0.5 (0.0) 0.0 0.0 2.7 0.0 0.0 0.0 0.0 2.1 0.0 0.0 3.1 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 (*) 0.0 99 287 102 124 365 23 128 272 67 109 96 103 93 87 251 128 59 34 15 489 57.9 50.2 68.6 47.7 58.3 (31.4) 48.0 62.6 50.1 49.6 47.6 60.8 54.3 67.4 52.1 60.7 57.8 50.3 (*) 55.6 62.4 56.5 76.4 56.3 63.8 (33.7) 55.0 67.4 62.0 52.2 52.3 65.0 62.4 80.4 57.7 68.1 65.2 56.9 (*) 61.9 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 Kaimana, Manokwari and Sorong, West Papua Province, Indonesia, 2011 Number of women with a live birth in the last 2 years Percentage of women who received at least 2 doses during last pregnancy Protected against tetanus1 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 Percentage of women who did not receive two or more doses during last pregnancy but received: ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases 1 MICS indicator 3.7 MULTIPLE 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 monoxide, 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 of babies born to pregnant women exposed to smoke. The primary indicator for monitoring use of solid fuels is the proportion of the population using solid fuels as the primary source of domestic energy for cooking. Table CH.4 shows that solid fuel use is common in the three selected districts of West Papua Province, where about half of households are using solid fuel for cooking (49 per cent). Almost all of the remaining half is using kerosene (49 per cent). The findings show that use of solid fuels generally does not vary much between districts (Kaimana, 53 per cent; Manokwari, 46 per cent; Sorong, 52 per cent). Almost all solid fuel use in each district is from wood. Use of solid fuels is considerably lower in urban areas (13 per cent) than in rural areas (61 per cent). Differentials with respect to household wealth and the educational level of the household head are also greatly significant. The findings show that use of solid fuels is more common among households whose household heads are Papuan than in 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, and types of fuel used. Most people sampled cooks in a separate room used as a kitchen (77 per cent), eight per cent cook elsewhere in the house, 12 per cent cook in a separate building and about two per cent cook outdoors. The percentages of households that cook in a separate building are generally similar between districts (Kaimana, 77 per cent; Manokwari, 76 per cent; Sorong, 80 per cent). MULTIPLE INDICATOR CLUSTER SURVEY 201142 T ab 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 s o lid f u el s fo r co o ki n g , D is tr ic ts o f K ai m an a, M an o kw ar i a n d S o ro n g , W es t 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 1 M IC S in d ic at o r 3. 11 0. 1 0. 6 0. 1 0. 7 0. 3 0. 0 0. 6 0. 5 0. 0 ( *) 0. 0 0. 0 1. 0 0. 8 0. 3 0. 4 0. 2 1. 7 0. 1 0. 0 (0 .0 ) 0. 4 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 : E le ct ri ci ty Li qu efi ed Pe tr ol eu m G as (L PG ) K er o se n e N at u ra l G as B io g as D is tr ic t K ai m an a M an o kw ar i S o ro n g 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 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 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 M is si n g /D K T o ta l f o r 3 d is tr ic ts 0. 5 0. 4 0. 0 0. 7 0. 1 0. 0 0. 1 0. 3 0. 8 ( *) 0. 0 0. 1 0. 6 0. 5 0. 3 0. 0 0. 6 1. 0 0. 2 0. 0 (0 .0 ) 0. 3 0. 1 0. 0 0. 0 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 (* ) 0. 1 0. 1 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 (0 .0 ) 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 10 0. 0 10 0. 0 53 .0 45 .9 52 .0 12 .5 61 .2 86 .9 67 .6 37 .8 18 .1 ( *) 98 .7 86 .3 44 .0 12 .6 1. 1 66 .3 38 .2 14 .1 28 .1 26 .9 ( 65 .8 ) 48 .5 1, 85 8 6, 91 2 2, 89 8 3, 03 6 8, 63 1 76 5 3, 96 8 5, 36 9 1, 56 1 4 2, 33 3 2, 33 7 2, 32 6 2, 33 7 2, 33 4 5, 79 0 3, 37 8 1, 28 0 72 0 46 2 37 11 ,6 67 S o lid f u el s S tr aw , s hr ub s, gr as s N o fo od co ok ed in th e ho us e- ho ld W o o d M is si n g C h ar co al C oa l, lig ni te T o ta l S ol id fu el s fo r co ok in g1 N um be r of h ou se - ho ld m em be rs 0. 1 0. 0 0. 1 0. 1 0. 0 0. 0 0. 0 0. 0 0. 1 ( *) 0. 0 0. 0 0. 0 0. 0 0. 2 0. 0 0. 1 0. 2 0. 0 0. 0 (0 .0 ) 0. 0 0. 0 0. 1 0. 1 0. 1 0. 1 0. 0 0. 2 0. 0 0. 2 ( *) 0. 0 0. 0 0. 0 0. 4 0. 1 0. 0 0. 4 0. 0 0. 0 0. 0 (0 .0 ) 0. 1 0. 6 1. 2 1. 5 2. 2 0. 8 0. 0 0. 2 1. 1 4. 5 ( *) 0. 0 0. 0 0. 0 0. 5 5. 4 0. 2 2. 4 1. 7 0. 0 4. 1 (0 .0 ) 1. 2 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 1 ( *) 0. 1 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 (0 .0 ) 0. 0 45 .7 51 .8 46 .2 83 .5 37 .4 13 .1 31 .1 60 .3 76 .2 ( *) 1. 2 13 .6 54 .5 85 .1 92 .6 33 .0 58 .2 81 .2 71 .7 69 .0 ( 34 .2 ) 49 .4 0. 1 0. 0 0. 0 0. 0 0. 0 0. 0 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 52 .9 45 .7 52 .0 12 .5 61 .1 86 .9 67 .6 37 .7 18 .0 ( *) 98 .6 85 .9 44 .0 12 .6 1. 1 66 .3 37 .9 14 .1 28 .1 26 .9 ( 65 .8 ) 48 .4 0. 0 0. 1 0. 0 0. 0 0. 1 0. 0 0. 0 0. 2 0. 0 ( *) 0. 0 0. 4 0. 0 0. 0 0. 0 0. 0 0. 2 0. 0 0. 0 0. 0 (0 .0 ) 0. 1 MULTIPLE INDICATOR CLUSTER SURVEY 2011 43 District Kaimana Manokwari Sorong 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 Missing/DK Total for 3 districts 76.9 75.8 79.8 55.7 78.6 74.5 78.9 76.6 69.3 71.8 79.5 82.0 83.0 (*) 72.0 93.2 78.8 70.2 68.8 (*) 77.1 6.5 11.6 0.7 8.2 7.8 11.2 5.1 9.6 13.2 11.2 5.3 4.9 9.0 (*) 9.9 1.5 8.0 5.7 13.5 (*) 7.8 0.0 0.2 0.0 1.6 0.0 0.0 0.2 0.0 0.0 0.0 0.0 0.6 0.0 (*) 0.0 0.0 0.0 3.0 0.0 (*) 0.1 12.4 10.1 15.4 27.7 10.8 11.6 13.3 10.7 8.1 13.0 12.0 10.7 8.0 (*) 14.4 4.9 8.3 13.2 14.1 (*) 11.9 2.5 0.9 0.6 0.0 1.2 2.3 1.3 0.6 0.0 1.8 0.7 0.7 0.0 (*) 1.4 0.0 2.3 3.1 0.0 (*) 1.1 1.7 1.4 3.5 6.8 1.6 0.4 1.2 2.6 9.4 2.3 2.4 1.1 0.0 (*) 2.3 0.5 2.5 4.8 2.6 (*) 2.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 984 3,171 1,507 381 5,281 665 2,684 2,030 283 2,303 2,017 1,023 295 25 3,840 1,290 181 202 125 24 5,662 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 Kaimana, Manokwari and Sorong, West Papua Province, Indonesia, 2011 Number of household members in households using solid fuels for cooking In a separate room used as kitchen Elsewhere in the house At another place In a separate building MissingOutdoors Total for 3 districts Place of cooking: (*) Figures that are based on fewer than 25 unweighted cases MULTIPLE INDICATOR CLUSTER SURVEY 201144 6.4. MALARIA Malaria is a leading cause of death of children under age five in West Papua. 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 mosquitoes and other insects. The use of ITNs is one of the main health interventions applied to reduce malaria transmission in West 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 West Papua Province MICS results indicate that 36 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 58 per cent and the percentage of households with at least one long-lasting treated net is 36 per cent. Differentials exist in the availability of ITNs among districts where the availability is the lowest in Manokwari District (32 per cent) and highest in Sorong District (44 per cent). The percentage of this indicator is 37 per cent in Kaimana. Availability of at least one ITN was positively associated with education and wealth. This percentage is higher among households with Papuan heads (43 per cent) than among households with Javanese heads (28 per cent). Results indicate that 48 per cent of children under the age of five slept under any mosquito net the night prior to the survey and 32 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 lower in Manokwari District (41 and 25 per cent respectively). These percentages are 47 per cent and 36 per cent for Kaimana and 64 per cent and 46 per cent for Sorong District. Slightly more male children slept under any net or an insecticide-treated net (50 and 34 respectively) than females (45 and 30 per cent respectively). 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. Questions on the prevalence and treatment of fever were asked for all children under age five. Slightly fewer than one in three (29 per cent) of children under five were ill with fever in the two weeks prior to the survey (Table CH.8) (Kaimana, 22 per cent; Manokwari, 35 per cent; Sorong, 18 per cent). Fever prevalence slightly declined with age. There was no clear trend linking this indicator with mother’s education or wealth. MULTIPLE INDICATOR CLUSTER SURVEY 2011 45 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 Kaimana, Manokwari and Sorong, West Papua Province, Indonesia, 2011 * 9 cases with missing “Ethnicity of household head” and 1 case with missing “Education of household head” not shown 1 MICS indicator 3.12 37.1 31.6 44.0 29.5 37.8 39.9 39.3 33.9 30.7 47.2 46.8 35.5 26.5 22.7 43.2 28.3 31.2 35.7 31.2 35.7 37.2 31.8 44.0 29.6 37.9 39.9 39.5 33.9 30.7 47.5 46.9 35.5 26.5 22.7 43.4 28.4 31.2 35.7 31.2 35.8 50.2 55.5 69.8 43.7 63.2 59.7 67.4 55.6 45.1 63.0 75.8 64.6 51.5 36.4 59.9 61.1 52.6 47.4 58.5 58.4 District Kaimana Manokwari Sorong 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 448 1,638 730 697 2,119 208 950 1,245 412 568 550 565 602 532 1,231 937 342 174 124 2,816 Percentage of households with at least one mosquito net Percentage of households with at least one ITN1 Percentage of households with at least one long- lasting treated net Number of households MULTIPLE INDICATOR CLUSTER SURVEY 201146 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 Kaimana, Manokwari and Sorong, West Papua Province, Indonesia, 2011 * 4 cases with missing “Ethnicity of household head” and 7 cases with missing “Sex” not shown ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted case 1 MICS indicator 3.14, 2 MICS indicator 3.15; MDG indicator 6.7 98.7 98.7 98.1 98.2 98.9 98.6 98.6 99.8 99.5 99.0 97.5 97.0 97.5 99.2 98.9 96.1 98.9 99.1 98.7 97.5 98.4 99.4 97.5 99.6 96.0 (100.0) 98.6 46.6 40.9 64.3 50.0 44.7 29.6 53.5 48.6 50.6 45.9 49.2 44.3 44.5 53.7 47.3 34.9 54.2 71.1 49.7 39.5 19.4 47.2 57.1 32.8 40.9 (50.4) 47.7 36.1 25.2 45.6 34.1 30.3 21.5 35.8 34.3 37.1 32.0 31.4 26.8 35.2 37.5 29.6 29.2 44.7 44.0 30.4 21.7 15.7 37.1 29.1 20.2 25.9 25.4 32.3 259 751 325 667 659 324 1,011 264 256 289 273 254 83 403 704 144 315 270 273 228 249 722 324 142 94 48 1,335 70.0 54.0 79.8 64.3 64.4 51.1 67.8 70.7 67.9 61.0 64.4 57.6 78.9 65.8 62.9 59.2 80.8 75.0 59.1 49.0 40.8 71.0 61.1 42.3 51.7 (*) 64.4 262 760 332 679 666 329 1,025 264 257 292 280 261 85 407 713 150 319 272 277 234 253 727 333 142 98 50 1,354 District Kaimana Manokwari Sorong 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 quintile Poorest Second Middle Fourth Richest Ethnicity of household head* Papua Jawa Sulawesi Maluku Others Total for 3 districts 133 351 186 354 310 136 534 128 140 151 133 118 37 230 332 71 175 158 141 101 96 377 154 68 47 20 670 Percentage of children who:Percentage of children age 0-59 who stayed in the household the previous night Number of children age 0-59 months Number of children age 0-59 months who slept in the household the previous night Slept under any mosquito net1 Percentage of children who slept under an ITN living in households with at least one ITN Slept under an insecticide- treated net2 Number of children age 0-59 living in households with at least one ITN MULTIPLE INDICATOR CLUSTER SURVEY 2011 47 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 Kaimana, Manokwari and Sorong, West Papua Province, Indonesia, 2011 * 4 cases with missing “Ethnicity of household head” and 9 cases with missing “Sex” not shown ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted case 1 MICS indicator 3.18; MDG indicator 6.8 22.4 35.3 18.1 26.9 29.7 29.2 28.4 30.9 31.9 30.1 25.7 24.4 29.4 27.4 29.3 27.9 20.9 30.1 33.0 29.9 30.5 26.9 32.2 30.4 23.6 31.8 28.6 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 0.0 0.0 0.0 0.0 0.0 (0.0) (0.0) (*) 0.0 5.1 7.3 2.6 6.0 5.7 14.2 3.6 2.8 0.0 6.0 12.4 11.8 0.0 6.1 8.0 (1.5) 6.5 3.6 11.1 0.9 7.7 10.7 2.9 (0.0) (0.0) (*) 6.2 10.4 14.2 0.0 9.7 11.3 8.8 12.3 10.7 12.8 12.5 16.3 3.5 9.5 10.7 11.3 (14.7) 7.9 12.1 16.8 10.5 8.1 15.1 9.0 (6.3) (1.8) (*) 11.4 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 0.0 0.0 0.0 0.0 0.0 (0.0) (0.0) (*) 0.0 262 760 332 679 666 329 1025 264 257 292 280 261 85 407 713 150 319 272 277 234 253 727 333 142 98 50 1354 District Kaimana Manokwari Sorong 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 quintile Poorest Second Middle Fourth Richest Ethnicity of household head* Papua Jawa Sulawesi Maluku Others Total for 3 districts 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 0.0 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 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 19.7 35.0 14.1 30.4 28.3 33.8 28.0 42.4 30.8 21.4 24.5 27.5 12.0 34.2 30.2 (23.2) 11.8 24.5 36.2 34.8 37.0 26.7 34.1 (36.1) (23.8) (*) 29.4 33.5 55.7 16.7 45.8 45.0 55.0 43.4 55.4 42.9 39.9 53.2 40.1 21.5 50.5 48.4 (39.4) 24.7 40.3 62.2 46.2 52.7 51.3 45.9 (41.1) (25.5) (*) 46.3 Children with a fever in the last two weeks who were treated with: Anti-malarials: Had a fever in last two weeks Num- ber of children age 0-59 months Anti malari- als/SP/ Fansidar Anti ma- larials/ Artesdia- quine Anti ma- larials/ Chloro- quine Anti ma- larials/ Arsua- mon Anti ma- larials/ Other Anti- malarial Anti ma- larials/ Quinine/ Kina Anti malari- als/ Ar- terakin/ Artekin Anti ma- larials/ Any anti- malarial drug1 MULTIPLE INDICATOR CLUSTER SURVEY 201148 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 Kaimana, Manokwari and Sorong, West Papua Province, Indonesia, 2011 * 4 cases with missing “Ethnicity of household head” and 9 cases with missing “Sex” not shown ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted case 2 MICS indicator 3.18; MDG indicator 3.17 District Kaimana Manokwari Sorong 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 quintile Poorest Second Middle Fourth Richest Ethnicity of household head* Papua Jawa Sulawesi Maluku Others Total for 3 districts 30.9 15.9 19.1 21.6 15.4 23.5 17.1 18.0 21.2 17.0 25.9 10.4 2.2 13.2 24.2 (15.6) 11.6 25.6 16.5 12.6 25.4 21.6 8.1 (17.6) (30.3) (*) 18.7 0.8 1.5 0.0 2.1 0.2 1.9 0.9 0.0 0.0 4.5 0.6 0.0 0.0 2.3 0.9 (0.0) 0.0 0.0 2.8 2.6 0.0 2.0 0.0 (0.0) (2.0) (*) 1.1 47.5 53.5 72.4 54.4 55.0 78.4 48.0 61.5 57.6 54.8 48.9 53.4 38.6 52.9 56.9 (65.5) 30.2 59.7 57.6 58.6 67.4 48.2 69.6 (57.7) (61.4) (*) 55.5 1.0 2.1 0.0 2.2 1.1 1.7 1.6 0.0 0.0 6.5 0.0 0.9 0.0 3.4 1.2 (0.0) 0.0 0.7 4.1 0.0 2.5 1.1 0.0 (4.4) (7.2) (*) 1.6 0.0 2.8 1.4 3.0 1.4 3.5 1.7 1.0 5.0 0.0 2.4 2.6 0.0 2.2 2.8 (0.0) 2.5 1.0 2.1 0.0 5.1 2.2 2.0 (0.0) (0.0) (*) 2.2 14.1 43.6 46.0 38.9 39.3 38.7 39.8 36.5 39.5 45.9 32.4 42.3 30.7 36.8 39.9 (49.8) 24.9 39.9 37.9 61.1 33.9 34.4 50.2 (43.7) (30.5) (*) 39.5 0.0 4.6 0.9 2.5 4.2 1.9 3.8 3.2 5.4 4.5 0.0 3.0 8.4 3.9 3.1 (0.0) 9.7 5.6 0.0 0.0 2.4 5.3 2.4 (0.0) (0.0) (*) 3.3 20.0 47.2 12.9 34.7 38.6 40.7 36.8 49.2 38.0 32.5 36.3 31.7 21.5 36.2 41.6 (32.8) 17.2 27.9 50.6 42.0 47.1 37.5 42.3 (39.8) (23.1) (*) 37.8 59 268 60 183 198 96 291 82 82 88 72 64 25 112 208 42 67 82 91 70 77 196 107 43 23 16 387 Other medications: Other medica- tions: Antibiotic injection Other medica- tions: Other Other medications: Paracetamol/ Panadol/ Acetamino- phan OtherOther medica- tions: Ibupro- fen Other medica- tions: Aspirin DK Percent- age who took an anti- malarial drug same or next day2 Num- ber of children with fever in last two weeks Children with a fever in the last two weeks who were treated with: MULTIPLE INDICATOR CLUSTER SURVEY 2011 49 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 36 per cent of children with fever in the last two weeks were treated with an “appropriate” anti-malarial drug and 28 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 Manokwari District, Kaimana and Sorong districts were lacking anti- malarial treatment. The percentage of children receiving any anti-malarial drug on the same or next day in Kaimana and Sorong (15 and 13 per cent respectively) was about half that observed in Manokwari District (34 per cent). Overall across the three districts, six per cent of children with fever were given chloroquine, and none were given SP/ Fansidar. None received quinine/ kina, artesdiaquine or arsuamon and most of the children who were given an anti-malarial drug were given another anti-malarial drug (29 per cent). A large number of children were given other types of medicines that are not anti-malarial, including paracetamol, panadol, acetaminophen (56 per cent) and antibiotic pills or syrups (19 per cent). Urban children (64 per cent) are more often treated appropriately than rural children (36 per cent). Children 24-35 and 36-47 months and children from the poorest households were disadvantaged in receiving appropriate ant-malarial drugs. Girls (29 per cent) were more likely to receive appropriate anti-malarial drugs than boys (26 per cent). 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, 42 per cent of children with a fever in the last two weeks had a finger or heel stick. Sorong District revealed the lowest value for this indicator (15 per cent), compared with 40 per cent in Kaimana and 48 per cent in Manokwari District. Having a finger or heel stick for malaria testing is more common in urban areas (60 per cent) than in rural areas (36 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 Kaimana, Manokwari and Sorong, West Papua Province, Indonesia, 2011 100 90 80 70 60 50 40 30 20 10 0 P er c en t None PoorestSecondary MiddlePrimary SecondHigher Fourth Richest 22 45 56 21 37 54 45 50 35 Mother’s education Wealth index MULTIPLE INDICATOR CLUSTER SURVEY 201150 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 Kaimana, Manokwari and Sorong, West Papua Province, Indonesia, 2011 * 2 cases with missing “Ethnicity of household head” and 6 cases with missing “Sex” not shown ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases 1 MICS indicator 3.16 40.3 48.4 15.0 39.8 42.1 60.8 35.8 55.8 38.6 43.3 43.6 25.0 (*) 34.9 45.5 (55.9) 20.6 37.0 53.6 44.8 49.5 43.8 41.0 (34.3) (54.1) (*) 42.0 District Kaimana Manokwari Sorong Sex* Male Female Area Urban Rural Age 0-11 12-23 24-35 36-47 48-59 Mother’sEducation 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 59 268 60 183 198 96 291 82 82 88 72 64 25 112 208 42 67 82 91 70 77 196 107 43 23 16 387 Had a finger or heel stick1 Number of children age 0-59 months with fever in the last two weeks This indicator increases according to mother’s education; from 22 per cent among children of uneducated women to 56 per cent among children with higher education. A similar pattern is seen according to 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 21 per cent for children living in the poorest households to 50 per cent for those living in the richest (Figure CH.3). MULTIPLE INDICATOR CLUSTER SURVEY 2011 51 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 MULTIPLE INDICATOR CLUSTER SURVEY 201152 Overall, 71 per cent of the population in the three districts is using an improved source of drinking water–86 per cent in urban areas and 66 per cent in rural areas. The situation in Sorong District is better than in other districts; 80 per cent of the population in this district gets its drinking water from an improved source, mostly from rainwater collection (48 per cent) and bottled water (18 per cent). The percentage of the population getting their drinking water from an improved source in Manokwari and Kaimana districts is 69 and 66 per cent respectively. The source of drinking water for the population varies strongly by district (Table WS.1). Although Kaimana District had the lowest percentage of people using an improved source of drinking water, the district had the highest percentage of households that drink water that is piped into their dwelling or into their yard or plot (20 per cent). These percentages are nine and two per cent for Manokwari and Sorong respectively. In Manokwari District, the most common improved sources of drinking water are bottled water (19 per cent), tube well or borehole (14 per cent) and protected well (13 per cent). Figure WS.1: Per cent distribution of household members by source of drinking water, Districts of Kaimana, Manokwari and Sorong, West Papua Province, Indonesia, 2011 Piped into dwelling, yard, plot or neighbour 10% Public tap/standpipe 5% Tubewell/borehole 10% Unprotected well or spring 22% Bottled water 21% Surface water 3% Other unimproved 0% Rain-water collection 16% Protected well or spring 13% MULTIPLE INDICATOR CLUSTER SURVEY 2011 53 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 Kaimana, Manokwari and Sorong, West Papua Province, Indonesia, 2011 11.8 7.7 1.8 14.7 4.2 0.6 2.8 8.6 14.2 0.3 1.9 6.0 10.9 15.6 7.1 5.8 7.5 10.0 2.1 (0.0) 6.9 2.6 0.7 0.1 2.0 0.4 0.6 1.6 0.6 0.1 1.0 0.4 1.9 1.0 0.0 1.2 0.3 0.4 1.8 0.0 (0.0) 0.9 1.2 7.6 0.7 4.2 5.1 14.5 5.6 3.3 3.6 6.3 8.8 4.7 2.8 1.7 8.9 0.5 1.4 1.9 0.0 (3.4) 4.9 0.7 14.3 6.7 15.5 8.3 3.3 9.2 11.4 12.3 0.4 3.4 11.3 17.3 18.7 7.8 12.7 14.0 10.0 9.8 31.5 10.2 9.1 12.8 3.9 8.6 10.5 14.5 11.6 9.4 6.0 8.3 14.1 14.9 8.9 3.8 11.7 9.9 5.2 7.3 7.7 (0.0) 10.0 5.0 3.5 0.5 2.1 3.3 4.2 3.2 2.9 2.3 3.5 4.0 3.3 2.7 1.4 4.3 1.5 1.7 1.3 3.8 (0.0) 3.0 15.6 1.4 48.4 6.6 18.4 17.9 18.6 15.0 7.2 16.6 25.0 17.8 12.3 5.1 11.1 22.8 10.8 20.5 20.4 (0.0) 15.4 8.9 1.7 0.0 2.0 2.6 5.2 3.1 1.8 1.4 6.3 1.2 2.4 1.2 1.0 4.3 0.1 1.1 2.2 0.0 (0.0) 2.4 District Kaimana Manokwari Sorong 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 Missing/DK Total for 3 districts 11.6 19.3 17.7 29.6 13.5 2.2 9.7 20.9 34.4 0.1 2.1 11.0 29.5 45.7 6.3 25.3 42.5 22.5 29.4 (15.2) 17.7 Main source of drinking water Improved sources Piped water Into dwelling Into yard/ plot Protected well Rain- water collection Bottled water* To neigh- bour Public tap/ stand- pipe Tube- well/ bore- hole Protected spring * 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. ** 4 cases with missing “Education of household head” not shown ( ) Figures that are based on 25-49 unweighted cases 1 MICS indicator 4.1; MDG indicator 7.8 MULTIPLE INDICATOR CLUSTER SURVEY 201154 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 Kaimana, Manokwari and Sorong, West Papua Province, Indonesia, 2011 District Kaimana Manokwari Sorong 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 Missing/DK Total for 3 districts 9.0 17.9 13.6 6.2 18.6 14.8 18.5 15.4 7.8 24.0 28.7 18.6 5.1 0.6 20.0 12.9 3.5 12.5 14.0 (2.8) 15.4 0.8 0.2 0.0 0.9 0.0 0.0 0.1 0.1 1.1 0.0 0.1 0.3 0.1 0.5 0.3 0.0 0.0 0.8 0.7 (0.0) 0.2 0.2 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0 (0.0) 0.0 6.0 2.8 2.7 0.1 4.4 10.8 4.1 2.6 0.0 14.0 1.8 0.1 0.5 0.0 6.5 0.1 0.1 0.5 0.0 (0.0) 3.3 7.0 3.0 1.8 5.5 2.5 0.4 2.2 3.9 5.8 0.2 1.4 3.6 5.7 5.6 1.1 4.2 9.0 4.6 7.4 (0.0) 3.3 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 0.0 (0.0) 0.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 66.4 69.0 79.9 85.5 66.3 62.9 65.3 73.9 81.5 42.8 60.8 73.2 86.7 92.9 62.7 79.0 84.6 77.5 77.4 (50.1) 71.3 10.6 7.2 2.1 1.9 8.1 11.0 9.8 4.1 4.0 18.8 7.2 4.1 2.0 0.3 9.4 3.9 2.8 4.0 0.5 (47.1) 6.5 1,858 6,912 2,898 3,036 8,631 765 3,968 5,369 1,561 2,333 2,337 2,326 2,337 2,334 5,790 3,378 1,280 720 462 37 11,667 Main source of drinking water Unimproved sources Unpro- tected well Unpro- tected spring Bottled water* Percent- age using im- proved sources of drinking water1 Total for 3 districts Num- ber of house- hold mem- bers Tank- er truck Cart with tank/ drum Surface water Other * 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. ** 4 cases with missing “Education of household head” not shown ( ) Figures that are based on 25-49 unweighted cases 1 MICS indicator 4.1; MDG indicator 7.8 MULTIPLE 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 87 per cent of households in the selected districts of West Papua use appropriate water treatment for unimproved drinking water sources and 17 per cent do not use any method for water treatment. The most common method of water treatment is boiling (82 per cent). There exist some differentials in the use of appropriate water treatment between districts. Household members in Kaimana District show 17 per cent use of appropriate water treatment methods, while this percentage is 88 and 92 per cent in Manokwari and Sorong districts respectively. It was also observed that appropriate water treatment use is greater in rural areas and among less educated women. The amount of time it takes to obtain water is presented in Table WS.3 and the person who usually collects the water in Table WS.4. Note that these results refer to one roundtrip from home to drinking water source. Information on the number of trips made in one day was not collected. Table WS.3 shows that for about one third of household members who use an improved source of drinking water, the source is on the premises (61 per cent). For eight per cent, it takes less than 30 minutes to get to the water source and bring water, while two per cent of household members spend 30 minutes or more for this purpose. For users of unimproved drinking water sources, water is on the premises for 16 per cent of household members. One tenth of household members take less than 30 minutes to get to the water source and bring water (10 per cent), and for two 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. MULTIPLE INDICATOR CLUSTER SURVEY 201156 D is tr ic t K ai m an a M an o kw ar i S o ro n g 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 M is si n g /D K T o ta l f o r 3 d is tr ic ts * 4 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 ” 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 4. 2 T ab 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 K ai m an a, M an o kw ar i a n d S o ro n g , W es t P ap u a P ro vi n ce , I n d o n es ia , 2 01 1 17 .1 17 .8 16 .1 27 .2 13 .8 19 .5 11 .9 11 .9 11 .5 18 .8 29 .5 7. 7 3. 0 11 .6 27 .6 36 .5 8. 1 21 .4 39 .4 22 .6 32 .8 (3 .4 ) 17 .3 0. 5 2. 1 0. 1 1. 8 1. 2 0. 9 2. 4 0. 9 1. 3 1. 4 1. 4 2. 3 1. 0 1. 7 1. 2 0. 4 2. 2 0. 3 0. 7 0. 8 0. 8 (0 .0 ) 1. 3 22 .6 46 .4 6. 9 38 .6 30 .8 30 .2 39 .3 30 .1 30 .5 34 .0 36 .1 28 .0 36 .7 37 .7 34 .2 27 .6 44 .6 19 .3 20 .8 24 .3 27 .6 ( 78 .6 ) 32 .8 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. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 1 0. 0 (0 .0 ) 0. 0 32 .4 25 .0 4. 2 24 .2 19 .8 17 .6 29 .5 23 .3 19 .9 22 .0 19 .4 25 .7 25 .0 20 .8 14 .8 18 .6 29 .2 11 .9 18 .6 10 .4 8. 6 (0 .0 ) 21 .0 0. 2 0. 0 0. 1 0. 1 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 0. 2 0. 0 0. 0 0. 0 0. 0 0. 2 0. 0 0. 2 0. 0 0. 0 0. 0 (0 .0 ) 0. 0 75 .6 88 .0 92 .3 67 .2 89 .4 n a 86 .5 82 .8 89 .8 85 .7 77 .5 89 .3 94 .9 86 .3 68 .6 50 .5 91 .6 85 .4 46 .2 80 .6 70 .5 (* ) 86 .5 0. 1 0. 3 0. 7 0. 6 0. 3 0. 4 0. 3 0. 0 0. 1 0. 7 0. 1 0. 7 0. 2 0. 1 0. 3 0. 5 0. 4 0. 2 1. 1 0. 0 0. 0 (0 .0 ) 0. 4 80 .9 81 .0 83 .5 70 .7 85 .4 79 .7 86 .3 87 .8 88 .0 79 .4 69 .9 90 .7 96 .6 86 .7 71 .9 62 .1 90 .4 77 .7 59 .7 77 .4 65 .9 ( 96 .6 ) 81 .6 1, 85 8 6, 91 2 2, 89 8 3, 03 6 8, 63 1 8, 31 6 3, 35 1 76 5 3, 96 8 5, 36 9 1, 56 1 2, 33 3 2, 33 7 2, 32 6 2, 33 7 2, 33 4 5, 79 0 3, 37 8 1, 28 0 72 0 46 2 37 11 ,6 67 62 4 2, 14 3 58 4 44 0 2, 91 1 n a 3, 35 1 28 4 1, 37 8 1, 40 0 28 9 1, 33 5 91 6 62 3 31 2 16 5 2, 15 8 71 1 19 7 16 2 10 4 19 3, 35 1 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 B o il S o la r d is in fe c- ti o n Le t it st an d a n d se tt le N u m b er o f h o u se h o ld m em b er s Pe rc en ta ge o f h ou se ho ld m em be rs in h ou se ho ld s us in g un im pr ov ed d ri nk in g w at er so ur ce s an d us in g an a pp ro pr i- at e w at er t re at m en t m et ho d1 N um be r of h ou se - ho ld m em be rs in ho us eh ol d us in g un im pr ov ed d ri nk - in g w at er s ou rc es A d d b le ac h / ch lo ri n e S tr ai n th ro ug h a cl ot h U se w at er fi lt er O th er MULTIPLE INDICATOR CLUSTER SURVEY 2011 57 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 Kaimana, Manokwari and Sorong, West Papua Province, Indonesia, 2011 56.8 56.8 74.5 72.0 57.4 43.4 53.7 64.8 76.2 32.8 (47.0) 57.8 78.9 89.5 48.6 72.6 79.2 70.5 71.6 (50.1) 61.2 2.1 2.4 0.7 4.5 1.1 5.8 2.5 1.5 0.4 2.1 2.0 2.8 2.3 0.5 3.3 0.6 1.3 0.4 0.0 (0.0) 2.0 0.4 0.3 0.3 0.5 0.2 1.0 0.6 0.0 0.0 0.4 0.5 0.6 0.0 0.0 0.2 0.1 0.5 1.2 0.0 (0.0) 0.3 12.9 19.7 10.3 7.6 19.4 11.1 17.7 16.9 13.3 22.0 22.0 21.5 10.3 5.6 17.8 16.5 12.1 12.8 14.0 (2.8) 16.3 14.0 9.7 6.9 5.8 11.1 20.6 14.4 6.4 3.9 26.7 15.0 4.1 2.5 0.4 15.4 3.3 1.9 7.8 6.9 (47.1) 9.7 6.1 1.2 3.0 1.0 2.9 4.5 2.5 2.7 0.3 8.2 2.1 1.0 0.5 0.3 3.9 0.8 1.0 1.0 1.6 (0.0) 2.4 0.6 0.4 0.0 0.2 0.3 0.9 0.1 0.1 1.0 0.3 0.2 0.2 0.0 0.8 0.1 0.5 0.4 0.9 0.0 (0.0) 0.3 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 1,858 6,912 2,898 3,036 8,631 765 3,968 5,369 1,561 2,333 2,337 2,326 2,337 2,334 5,790 3,378 1,280 720 462 37 11,667 7.1 9.5 4.3 8.5 7.6 12.8 8.5 7.5 4.9 7.4 11.3 12.1 5.5 2.9 10.6 5.6 3.6 5.4 5.9 (0.0) 7.8 District Kaimana Manokwari Sorong 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 Missing/DK Total for 3 districts Time to source of drinking water Users of improved drinking water sources Users of unimproved drinking water sources Water on premises Water on premises 30 min- utes or more 30 min- utes or more Less than 30 minutes Less than 30 minutes Missing/ DK Missing/ DK Number of house- hold members Total * 4 cases with missing “Education of household head” not shown ( ) Figures that are based on 25-49 unweighted cases MULTIPLE INDICATOR CLUSTER SURVEY 201158 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 Kaimana, Manokwari and Sorong, West Papua Province, Indonesia, 2011 30.0 22.8 14.1 18.2 22.9 44.8 26.7 17.3 12.0 44.5 29.0 20.0 10.7 4.2 35.5 10.4 9.2 14.2 15.2 21.7 43.6 59.7 55.9 50.4 56.9 57.0 56.9 53.0 (57.1) 63.6 54.6 44.6 48.5 (*) 60.5 42.7 (30.3) (37.0) (*) 55.5 52.1 36.5 38.4 44.6 39.1 35.6 38.5 43.8 (42.3) 32.6 40.9 50.4 49.0 (*) 35.4 55.5 (62.7) (46.3) (*) 40.2 1.2 1.9 2.3 0.0 2.3 0.6 2.6 1.7 (0.0) 2.3 2.7 0.0 1.3 (*) 2.3 0.0 (0.0) (3.3) (*) 1.8 1.1 1.6 1.5 2.1 1.3 6.2 0.4 1.1 (0.0) 1.3 0.2 3.2 0.0 (*) 1.3 0.0 (5.4) (6.1) (*) 1.5 0.4 0.0 0.0 0.5 0.0 0.0 0.0 0.1 (0.6) 0.0 0.0 0.0 0.4 (*) 0.1 0.0 (0.0) (1.2) (*) 0.1 1.5 0.4 1.8 2.4 0.5 0.6 1.7 0.2 (0.0) 0.2 1.5 1.8 0.8 (*) 0.3 1.9 (1.6) (6.2) (*) 0.9 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 134 374 103 127 485 93 254 215 50 253 160 113 64 22 437 98 32 25 19 611 448 1638 730 697 2119 208 950 1245 412 568 550 565 602 532 1231 937 342 174 124 2816 District Kaimana Manokwari Sorong 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 Person usually collecting drinking water Percent- age of house- holds without drinking water on premises Female child under age 15 Adult woman Missing Num- ber of house- holds Male child under age 15 Adult man DK Number of house- holds without drinking water on premises Total * 2 cases with missing “Ethnicity of household head” and 1 case with missing “Education of household head” not shown ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Table WS.4 shows that for 56 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 40 per cent of cases, while for the rest of the households, female (2 per cent) or male children (2 per cent) under age 15 collect water. MULTIPLE 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. Seventy-one per cent of the population of the three selected districts of West Papua Province is living in households that use improved sanitation facilities that flush to septic tank (59 per cent) or use pit latrine with slab (13 per cent) (Table WS.5). About 13 per cent of the population have no facility or use bushes or fields. MULTIPLE INDICATOR CLUSTER SURVEY 201160 T ab 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 K ai m an a, M an o kw ar i a n d S o ro n g , W es t P ap u a P ro vi n ce , In d o n es ia , 2 01 1 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 (0 .0 ) 0. 0 0. 4 0. 2 0. 0 0. 3 0. 2 0. 0 0. 0 0. 4 0. 2 0. 0 0. 0 0. 7 0. 2 0. 1 0. 1 (0 .1 ) 0. 0 0. 2 2. 7 (0 .0 ) 0. 2 0. 1 0. 3 1. 7 0. 0 0. 8 1. 6 0. 5 0. 5 0. 8 0. 7 1. 2 0. 7 0. 3 0. 0 0. 5 1. 0 0. 5 0. 0 0. 0 (0 .0 ) 0. 6 0. 1 0. 0 0. 5 0. 0 0. 2 0. 4 0. 2 0. 1 0. 0 0. 0 0. 1 0. 1 0. 3 0. 2 0. 0 0. 4 0. 1 0. 0 0. 0 (0 .0 ) 0. 1 31 .9 9. 9 6. 4 21 .9 9. 2 8. 9 13 .7 13 .4 8. 3 11 .2 17 .9 14 .7 12 .1 6. 6 13 .3 8. 3 16 .0 19 .1 13 .5 (0 .0 ) 12 .5 36 .0 62 .7 62 .8 65 .1 56 .1 33 .1 45 .5 65 .0 81 .2 16 .2 36 .0 66 .9 81 .5 91 .6 48 .0 68 .0 74 .5 64 .2 67 .3 ( 49 .5 ) 58 .5 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 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 D is tr ic t K ai m an a M an o kw ar i S o ro n g 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 * 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 M is si n g /D K T o ta l f o r 3 d is tr ic ts T yp e o f to ile t fa ci lit y u se d b y h o u se h o ld Fl u sh to p it (l at ri n e) Fl u sh t o se p ti c ta n k 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 Fl u sh t o p ip ed se w er sy st em Fl us h to un kn ow n pl ac e/ N ot su re /D K w he re C o m - p o st in g to ile t P it la tr in e w it h sl ab V en ti - la te d Im - p ro ve d P it la tr in e (V IP ) P it la tr in e w it h o u t sl ab / o p en p it U n m p ro ve d s an it at io n f ac ili ty Fl u sh / p o u r fl u sh t o so m e- w h er e el se B u ck et H an g in g to ile t/ h an g in g la tr in e M is si n g O th er N u m - b er o f h o u se - h o ld m em - b er s T o ta l O p en d ef ec a- ti o n ( n o fa ci lit y, b u sh , fi el d ) * 4 ca se 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 ” 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 0. 4 1. 0 0. 7 2. 4 0. 2 0. 0 1. 2 0. 8 0. 3 0. 0 0. 6 0. 6 1. 8 1. 1 1. 0 0. 6 0. 7 0. 9 0. 0 (0 .0 ) 0. 8 2. 1 5. 6 3. 0 5. 8 3. 9 6. 5 6. 6 3. 3 1. 4 6. 6 11 .1 2. 9 1. 2 0. 0 7. 1 0. 9 1. 7 5. 3 1. 9 (0 .0 ) 4. 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 10 0. 0 25 .2 12 .5 4. 6 1. 3 16 .5 23 .7 18 .3 9. 1 4. 6 43 .7 12 .8 5. 4 1. 0 0. 0 21 .3 3. 8 1. 6 6. 6 4. 5 ( 47 .1 ) 12 .6 0. 5 0. 8 0. 1 0. 3 0. 7 1. 7 0. 9 0. 3 0. 0 1. 5 1. 0 0. 4 0. 0 0. 0 1. 0 0. 3 0. 1 0. 1 0. 0 (0 .0 ) 0. 6 0. 3 0. 1 0. 3 0. 2 0. 2 0. 0 0. 1 0. 3 0. 3 0. 2 0. 2 0. 4 0. 1 0. 2 0. 3 0. 2 0. 0 0. 0 0. 0 (0 .0 ) 0. 2 0. 0 0. 1 0. 1 0. 0 0. 1 0. 6 0. 0 0. 1 0. 1 0. 5 0. 0 0. 0 0. 0 0. 0 0. 2 0. 1 0. 0 0. 0 0. 0 (0 .0 ) 0. 1 3. 1 6. 9 19 .6 2. 6 11 .8 23 .6 13 .0 6. 7 3. 0 19 .0 19 .1 7. 2 1. 7 0. 2 7. 2 16 .3 4. 7 3. 6 10 .1 (3 .4 ) 9. 4 1, 85 8 6, 91 2 2, 89 8 3, 03 6 8, 63 1 76 5 3, 96 8 5, 36 9 1, 56 1 2, 33 3 2, 33 7 2, 32 6 2, 33 7 2, 33 4 5, 79 0 3, 37 8 1, 28 0 72 0 46 2 37 11 ,6 67 MULTIPLE INDICATOR CLUSTER SURVEY 2011 61 T ab 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 f ac ili ti es , D is tr ic ts o f K ai m an a, M an o kw ar i a n d S o ro n g , W es t P ap u a P ro vi n ce , I n d o n es ia , 2 01 1 D is tr ic t K ai m an a M an o kw ar i S o ro n g 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 M is si n g /D K T o ta l f o r 3 d is tr ic ts U se rs o f i m pr ov ed s an ita tio n fa ci lit ie s S ha re d by N ot sh ar ed 1 5 ho us e- ho ld s or le ss Pu bl ic fa ci lit y M or e th an 5 ho us e- ho ld s M is si ng / D K U se rs o f u ni m pr ov ed s an ita tio n fa ci lit ie s S ha re d by N ot sh ar ed 1 5 ho us e- ho ld s or le ss Pu bl ic fa ci lit y M or e th an 5 ho us e- ho ld s M is si ng / D K O pe n de f- ec at io n (n o fa ci l- ity , b us h, fie ld ) To ta l N um be r of h ou se - ho ld m em be rs * 4 ca se 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 ” 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 1 M IC S in d ic at o r 4. 3; M D G in d ic at o r 7. 9 43 .6 56 .3 48 .7 63 .0 48 .7 25 .8 40 .8 58 .5 74 .0 11 .3 31 .6 57 .7 72 .3 89 .2 40 .9 62 .4 68 .3 63 .2 65 .0 ( 30 .5 ) 52 .4 10 .7 10 .8 12 .0 16 .6 9. 2 5. 9 8. 8 13 .7 10 .9 5. 2 12 .2 16 .1 15 .6 6. 4 10 .0 11 .9 14 .1 13 .1 9. 0 (0 .0 ) 11 .1 3. 5 2. 5 0. 6 3. 8 1. 6 0. 6 2. 1 2. 4 2. 4 0. 6 1. 5 3. 8 3. 2 1. 9 1. 4 2. 3 4. 3 3. 4 2. 7 ( 19 .0 ) 2. 2 0. 5 1. 0 0. 4 1. 4 0. 6 0. 0 1. 0 0. 6 1. 1 0. 3 0. 2 0. 4 1. 8 1. 0 0. 3 0. 7 1. 2 0. 8 5. 1 (0 .0 ) 0. 8 10 .3 2. 4 9. 8 2. 5 6. 5 11 .7 7. 2 4. 2 2. 1 11 .0 9. 8 5. 2 1. 4 0. 0 9. 4 0. 6 3. 3 3. 0 1. 8 (0 .0 ) 5. 5 2. 8 8. 8 17 .8 5. 8 11 .6 18 .8 15 .1 7. 0 3. 7 16 .4 22 .0 8. 0 3. 6 0. 5 9. 2 15 .1 4. 6 3. 5 10 .6 (3 .4 ) 10 .1 1. 4 2. 1 4. 3 2. 8 2. 4 7. 7 2. 3 2. 5 0. 7 4. 1 4. 5 2. 8 0. 3 1. 0 2. 8 2. 8 0. 6 3. 4 1. 1 (0 .0 ) 2. 5 25 .2 12 .5 4. 6 1. 3 16 .5 23 .7 18 .3 9. 1 4. 6 43 .7 12 .8 5. 4 1. 0 0. 0 21 .3 3. 8 1. 6 6. 6 4. 5 ( 47 .1 ) 12 .6 0. 7 0. 1 0. 0 0. 4 0. 1 0. 9 0. 1 0. 1 0. 1 0. 4 0. 4 0. 1 0. 0 0. 0 0. 2 0. 0 0. 2 1. 0 0. 0 (0 .0 ) 0. 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 10 0. 0 0. 0 0. 2 0. 2 0. 3 0. 1 0. 2 0. 2 0. 1 0. 0 0. 2 0. 0 0. 3 0. 1 0. 0 0. 3 0. 0 0. 0 0. 0 0. 0 (0 .0 ) 0. 1 1, 85 8 6, 91 2 2, 89 8 3, 03 6 8, 63 1 76 5 3, 96 8 5, 36 9 1, 56 1 2, 33 3 2, 33 7 2, 32 6 2, 33 7 2, 33 4 5, 79 0 3, 37 8 1, 28 0 72 0 46 2 37 11 ,6 67 1. 5 3. 2 1. 7 2. 1 2. 7 4. 7 4. 1 1. 7 0. 5 6. 8 5. 1 0. 3 0. 7 0. 0 4. 3 0. 4 1. 8 2. 0 0. 3 (0 .0 ) 2. 6 MULTIPLE INDICATOR CLUSTER SURVEY 201162 About one-fourth of the population Kaimana District has no facility or use bushes or fields (25 per cent). No facility or use of bushes or fields is much less common in Manokwari (13 per cent) and Sorong (5 per cent). About 69, 73 and 69 per cent of the population in Kaimana, Manokwari and Sorong districts respectively use facilities that flush to a septic tank or pit (latrines). As expected, the percentage of population that have no facility or use bushes or fields is higher in rural areas (17 per cent) than urban areas (1 per cent). The table indicates that no facility or use of bushes or fields is strongly correlated with both education level 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, 52 per cent of the household population is using an improved sanitation facility (Kaimana, 44 per cent; Manokwari, 56 per cent; Sorong, 49 per cent). About 19 per cent of the household population are using an improved sanitation facility shared with others. As expected, use of improved sanitation facilitiesy 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 11 per cent among the poorest household population to 89 per cent for the richest. Figure WS.2: Percentage of household population using improved (not shared) sanitation facilities, Districts of Kaimana, Manokwari and Sorong, West Papua Province, Indonesia, 2011 District Kaimana Manokwari Sorong Area Urban Rural Mother’s Education No education Primary Secondary Higher Wealth quintiles Poorest Second Middle Fourth Richest 0 40 8020 60 100 Per cent 44 49 49 63 32 72 26 41 59 74 58 89 11 56 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 MULTIPLE INDICATOR CLUSTER SURVEY 2011 63 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 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 43 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: Higher percentages of household populations using both improved drinking sources and sanitation were seen in Manokwari and Sorong (45 per cent each) than in Kaimana (32 per cent). Urban areas exhibit a higher use of both improved drinking sources and sanitation (56 per cent) than rural (38 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 Kaimana, Manokwari and Sorong, West Papua Province, Indonesia, 2011 District Kaimana Manokwari Sorong Area Urban Rural Mother’s Education No education Primary Secondary Higher Wealth quintiles Poorest Second Middle Fourth Richest 0 40 8020 60 100 Per cent 32 45 45 38 56 24 62 20 32 49 61 39 84 4 MULTIPLE INDICATOR CLUSTER SURVEY 201164 T ab 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 K ai m an a, M an o kw ar i a n d S o ro n g , W es t P ap u a P ro vi n ce , I n d o n es ia , 2 01 1 25 .4 15 .2 3. 1 25 .9 9. 6 5. 8 6. 8 16 .7 25 .4 6. 6 3. 1 10 .2 18 .7 30 .4 13 .0 12 .0 20 .0 18 .8 13 .4 (0 .0 ) 13 .8 33 .6 31 .0 20 .1 14 .5 33 .7 37 .1 34 .7 26 .1 18 .5 57 .2 39 .2 26 .8 13 .3 7. 1 37 .3 21 .0 15 .4 22 .5 22 .6 ( 49 .9 ) 28 .7 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 43 .6 56 .3 48 .7 63 .0 48 .7 25 .8 40 .8 58 .5 74 .0 11 .3 31 .6 57 .7 72 .3 89 .2 40 .9 62 .4 68 .3 63 .2 65 .0 ( 30 .5 ) 52 .4 24 .9 16 .7 22 .9 24 .3 17 .8 18 .2 19 .1 20 .9 16 .5 17 .1 23 .7 25 .5 22 .0 9. 3 21 .1 15 .5 22 .9 20 .3 18 .6 ( 19 .0 ) 19 .5 6. 4 14 .5 23 .9 11 .3 17 .0 32 .3 21 .8 11 .5 5. 0 27 .9 32 .0 11 .4 4. 7 1. 5 16 .8 18 .3 7. 2 9. 9 12 .0 (3 .4 ) 15 .5 25 .2 12 .5 4. 6 1. 3 16 .5 23 .7 18 .3 9. 1 4. 6 43 .7 12 .8 5. 4 1. 0 0. 0 21 .3 3. 8 1. 6 6. 6 4. 5 ( 47 .1 ) 12 .6 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 31 .7 44 .6 44 .9 56 .5 37 .7 19 .5 31 .6 48 .8 60 .8 4. 5 23 .6 39 .5 61 .8 83 .6 31 .2 52 .0 60 .7 52 .4 53 .4 ( 27 .7 ) 42 .6 1, 85 8 6, 91 2 2, 89 8 3, 03 6 8, 63 1 76 5 3, 96 8 5, 36 9 1, 56 1 2, 33 3 2, 33 7 2, 32 6 2, 33 7 2, 33 4 5, 79 0 3, 37 8 1, 28 0 72 0 46 2 37 11 ,6 67 41 .1 53 .8 76 .7 59 .6 56 .7 57 .1 58 .5 57 .2 56 .1 36 .1 57 .7 63 .0 67 .9 62 .5 49 .7 67 .0 64 .6 58 .7 64 .0 ( 50 .1 ) 57 .5 D is tr ic t K ai m an a M an o kw ar i S o ro n g 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 M is si n g /D K T o ta l f o r 3 d is tr ic ts 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 d ri n ki n g w at er Im pr ov ed d rin ki ng w at er 1 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 O p en d ef ec at io n P ip ed in to d w el lin g , p lo t o r ya rd U n im - p ro ve d d ri n ki n g w at er T o ta l Im p ro ve d s an i- ta ti o n 2 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 T o ta l Im p ro ve d d ri n ki n g w at er so u rc es a n d im p ro ve d sa n it at io n * 4 ca se 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 ” 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 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 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 46 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 28 per cent did not know how great the distance was. By district the proportion of households reporting water sources 10 or more metres away from the closest excreta place was 52, 40 and 35 per cent in Manokwari, Kaimana and Sorong respectively. In Sorong District 58 per cent of households did not know the distance between their water source and the closest excreta disposal place (Table WS.8) compared with 20 and 17 per cent in Kaimana and Manokwari. District Kaimana Manokwari Sorong 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 Missing/DK Total for 3 districts 28.4 20.1 6.0 26.2 15.0 9.2 16.0 19.6 21.3 6.5 15.8 21.5 28.4 17.4 14.6 19.0 25.1 25.2 33.2 15.3 17.9 39.9 52.1 35.0 40.4 47.9 48.6 51.3 42.4 43.0 53.1 51.6 44.0 39.3 41.6 51.1 40.6 42.7 36.3 89.2 53.8 45.9 20.2 16.8 57.7 25.1 28.4 27.8 25.7 29.4 25.5 25.6 27.6 28.1 25.5 30.8 23.0 35.5 23.5 31.6 58.4 27.6 27.5 11.6 10.9 1.3 8.3 8.8 14.4 7.1 8.5 10.2 14.7 5.0 6.4 6.8 10.3 11.4 4.9 8.8 6.9 9.1 3.4 8.6 1,858 6,912 2,898 3,036 8,631 765 3,968 5,369 1,561 2,333 2,337 2,326 2,337 2,334 5,790 3,378 1,280 720 462 37 11,667 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 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 Kaimana, Manokwari and Sorong, West Papua Province, Indonesia, 2011 Number of household members Total less than 10 meters 10 meters or more DK Missing * 4 case with missing “Education of household head” not shown MULTIPLE INDICATOR CLUSTER SURVEY 201166 MULTIPLE INDICATOR CLUSTER SURVEY 2011 67 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 Kaimana, Manokwari and Sorong, West Papua Province, Indonesia, 2011 16 14 12 10 8 6 4 2 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 10 12 0 0 11 5 15 13 13 2 1 2 Kaimana SorongManokwari MULTIPLE INDICATOR CLUSTER SURVEY 201168 The TFR in the three selected districts of West Papua for the one-year period preceding the survey is 3 children per woman. TFR is highest in Kaimana District (3.2 children per woman) and lowest in Sorong District (2.8 children per woman). TFR in Manokwari District is 3.1 children per woman. Table RH.1 also shows differentials in fertility by area of 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 Papuans compared with others. The adolescent birth rate (Age-specific fertility rate for women age 15-19) is 49 births per 1,000 women. The adolescent birth rate is higher in Kaimana District (66 births per 1,000 women) than in Sorong (53 births per 1,000 women) and Manokwari (44 births per 1,000 women). The birth rate is highest among rural adolescents, the poorest adolescents, 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, 11 per cent of women age 15-19 have already given birth, four per cent are District Kaimana Manokwari Sorong 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 66 44 53 18 63 0 164 32 25 101 45 55 36 19 53 45 45 3.2 3.1 2.8 2.7 3.2 4.2 3.1 3.2 3.2 3.6 3.1 3.5 2.6 2.5 3.7 2.5 3.0 Table RH.1: Adolescent birth rate and total fertility rate Adolescent birth rates and total fertility rates, Districts of Kaimana, Manokwari and Sorong, West Papua Province, Indonesia, 2011 Total fertility rate Adolescent birth rate1 (Age-specific fertility rate for women age 15-19) 1 MICS indicator 5.1; MDG indicator 5.4 MULTIPLE INDICATOR CLUSTER SURVEY 2011 69 pregnant with their first child, 15 per cent have begun childbearing and one per cent has gave birth before age 15. More women have begun childbearing in Manokwari District than in other districts (Figure RH.1). Sixteen per cent of women aged 20-24 years gave birth before reaching 18 years of age. The percentage of women giving birth before age 18 in this age group did not vary much among districts (Kaimana, 16 per cent; Manokwari, 15 per cent; Sorong, 17 per cent). 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 Kaimana, Manokwari and Sorong, West Papua Province, Indonesia, 2011 12.2 10.3 10.8 10.0 10.9 (*) 28.7 7.3 11.1 20.1 9.2 8.2 9.4 6.8 14.8 5.9 (8.8) (4.8) (*) 10.7 0.4 5.1 2.1 4.4 3.6 (*) 8.0 3.8 0.0 2.5 6.7 6.5 1.7 3.1 3.2 3.9 (9.3) (0.9) (*) 3.8 12.6 15.4 13.0 14.4 14.5 (*) 36.8 11.1 11.1 22.5 15.9 14.6 11.1 9.9 18.0 9.9 (18.1) (5.7) (*) 14.5 0.0 1.6 1.1 1.5 1.2 (*) 1.8 1.4 0.0 2.3 0.0 0.0 1.6 2.0 1.6 0.0 (4.4) (0.0) (*) 1.3 63 301 101 138 327 6 62 342 56 86 96 70 124 88 248 130 41 33 13 465 15.5 15.2 16.8 5.2 19.8 (*) 30.3 15.8 1.3 38.7 21.4 13.8 9.0 0.0 19.0 18.1 2.1 (5.3) (*) 15.5 58 265 72 116 279 7 79 201 108 74 68 74 89 90 193 117 51 27 7 395 District Kaimana Manokwari Sorong 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 Have had a live birth Are preg- nant with first child Have begun childbear- ing 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 Percentage of women age 15-19 who: * 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 1 MICS indicator 5.2 MULTIPLE INDICATOR CLUSTER SURVEY 201170 T ab 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 K ai m an a, M an o kw ar i a n d S o ro n g , W es t P ap u a P ro vi n ce , I n d o n es ia , 2 01 1 1. 5 0. 0 1. 5 0. 4 0. 0 2. 3 2. 1 1. 0 13 8 11 6 15 3 11 4 97 76 69 76 3 n a 5. 2 13 .8 14 .3 9. 3 19 .3 20 .2 13 .0 n a 27 9 30 8 32 9 29 0 22 9 19 0 1, 62 4 n a 11 6 15 3 11 4 97 76 69 62 6 1. 3 3. 5 2. 9 2. 3 2. 4 6. 4 3. 4 3. 0 1. 2 4. 9 3. 6 2. 9 3. 2 7. 8 3. 8 3. 7 46 5 39 5 46 2 44 3 38 7 30 5 25 9 2, 71 5 32 7 27 9 30 8 32 9 29 0 22 9 19 0 1, 95 2 n a 15 .5 17 .1 16 .1 16 .4 20 .4 25 .2 17 .9 n a 19 .8 18 .7 16 .7 18 .8 20 .8 27 .0 19 .8 n a 39 5 46 2 44 3 38 7 30 5 25 9 2, 25 0 A g e 15 -1 9 20 -2 4 25 -2 9 30 -3 4 35 -3 9 40 -4 4 45 -4 9 T o ta l f o r 3 d is tr ic ts 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 a g 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 18 N u m b er o f w o m en a g e 20 -4 9 U rb an 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 a g 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 18 N u m b er o f w o m en a g e 20 -4 9 R u ra l 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 a g 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 18 N u m b er o f w o m en a g e 20 -4 9 A ll MULTIPLE 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 West Papua was reported by half of women currently married (50 per cent) (Table RH.4). The lowest current use was seen in Kaimana District (30 per cent), mostly modern methods, compared with 54 per cent each in Manokwari and Sorong districts with women also mostly using modern methods (Figure RH.2). Figure RH.2: Percentage of currently married women aged 15-49 years using contraceptive methods, Districts of Kaimana, Manokwari and Sorong, West Papua Province, Indonesia, 2011 100 90 80 70 60 50 40 30 20 10 0 P er c en t Kaimana Manokwari Sorong Traditional Method No MethodModern Method 28 2 2 1 70 46 52 53 46 The most popular methods in Kaimana District are injectables (18 per cent) and the pill (9 per cent). The most popular methods in Manokwari are injectables (29 per cent) and the pill (11 per cent). The most popular methods in Sorong are injectables (31 per cent) and the pill (14 per cent). Only about 21 per cent of women aged 15-19 currently use a method of contraception compared 58 per cent for women aged 35-39. Women’s education levels are associated with contraceptive prevalence. The percentage of women using any method of contraception rises from 23 per cent among those with no education to 47 per cent among women with primary education, to 57 per cent among women with secondary education and drops to 44 per cent among women with higher education. The method mix did not vary by education. Contraceptive users among the different education categories were mostly using injectables and the pill. Use of any contraceptive method did not show clearly the expected positive association between contraceptive use and number of living children a woman had. MULTIPLE INDICATOR CLUSTER SURVEY 201172 T ab 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 K ai m an a, M an o kw ar i a n d S o ro n g , W es t P ap u a P ro vi n ce , I n d o n es ia , 2 01 1 D is tr ic t K ai m an a M an o kw ar i S o ro n g 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 30 4 1, 17 6 50 7 49 2 1, 49 5 89 24 0 38 2 40 9 36 4 26 6 23 7 18 0 40 9 53 9 36 2 49 7 1 M IC S in d ic at o r 5. 3; M D G in d ic at o r 5. 3 69 .9 46 .1 46 .3 49 .2 50 .0 78 .8 49 .6 45 .2 48 .2 41 .7 48 .1 63 .4 96 .2 51 .4 42 .8 37 .1 48 .4 0. 0 0. 0 0. 2 0. 0 0. 1 0. 0 0. 0 0. 0 0. 2 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 2 9. 2 10 .6 14 .1 10 .2 11 .6 3. 8 10 .8 8. 2 12 .0 17 .3 13 .9 6. 1 1. 0 9. 9 14 .7 15 .0 9. 7 0. 3 1. 0 1. 0 1. 3 0. 8 1. 9 1. 2 0. 0 1. 5 0. 4 0. 4 1. 9 0. 0 1. 0 1. 0 1. 7 0. 5 17 .7 28 .8 30 .6 24 .9 28 .5 15 .5 33 .2 39 .1 31 .6 26 .9 20 .4 10 .2 2. 8 31 .5 33 .0 31 .4 24 .6 0. 3 4. 2 4. 2 2. 2 4. 1 0. 0 3. 8 3. 7 3. 9 5. 8 1. 2 3. 2 0. 0 3. 4 4. 0 4. 9 3. 7 0. 3 2. 3 0. 3 3. 5 0. 8 0. 0 1. 5 1. 7 0. 4 1. 6 3. 6 0. 8 0. 0 1. 8 1. 0 2. 6 1. 3 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. 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 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. 1 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 1 0. 0 28 .5 51 .9 52 .5 47 .9 48 .7 21 .2 50 .4 53 .4 50 .9 55 .2 47 .5 35 .4 3. 8 47 .7 55 .4 60 .9 48 .8 0. 6 1. 1 0. 5 1. 1 0. 8 0. 0 0. 0 0. 4 0. 3 1. 2 4. 0 0. 0 0. 0 0. 9 1. 2 0. 6 1. 1 0. 2 0. 6 0. 1 1. 0 0. 2 0. 0 0. 0 0. 9 0. 0 0. 6 0. 0 1. 0 0. 0 0. 0 0. 6 0. 0 0. 9 0. 8 0. 3 0. 5 0. 8 0. 3 0. 0 0. 0 0. 1 0. 6 1. 3 0. 4 0. 2 0. 0 0. 1 0. 0 1. 3 0. 8 1. 7 2. 0 1. 2 2. 9 1. 4 0. 0 0. 0 1. 4 0. 9 3. 1 4. 4 1. 2 0. 0 1. 0 1. 8 2. 0 2. 8 30 .1 53 .9 53 .7 50 .8 50 .0 21 .2 50 .4 54 .8 51 .8 58 .3 51 .9 36 .6 3. 8 48 .6 57 .2 62 .9 51 .6 MULTIPLE INDICATOR CLUSTER SURVEY 2011 73 T ab 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 K ai m an a, M an o kw ar i a n d S o ro n g , W es t 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 T o 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 76 .7 53 .1 43 .1 56 .2 67 .4 50 .0 48 .6 40 .3 45 .9 63 .8 35 .0 43 .2 56 .8 36 .8 49 .8 1. 2 4. 4 3. 6 2. 3 1. 8 4. 4 0. 2 5. 3 5. 9 3. 7 3. 1 5. 7 2. 3 3. 3 3. 6 3. 9 11 .1 12 .8 8. 7 5. 7 9. 3 12 .6 13 .7 14 .0 3. 9 17 .3 12 .5 11 .4 30 .4 11 .3 1. 0 0. 7 0. 8 2. 0 0. 3 0. 6 1. 8 0. 1 1. 6 0. 7 1. 2 1. 3 0. 4 0. 0 0. 9 15 .8 24 .5 31 .9 23 .5 22 .1 31 .2 28 .4 30 .4 25 .3 23 .5 34 .0 29 .1 22 .6 21 .0 27 .6 1. 4 4. 3 3. 4 3. 6 1. 7 3. 2 5. 8 4. 0 3. 1 2. 1 6. 2 2. 6 2. 0 2. 9 3. 6 0. 0 0. 4 2. 1 2. 6 0. 0 0. 2 0. 4 4. 7 1. 4 0. 9 1. 6 3. 2 2. 1 0. 0 1. 5 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. 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 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. 1 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 23 .3 45 .6 54 .6 42 .6 31 .6 48 .9 49 .4 58 .2 51 .2 34 .9 63 .4 54 .7 40 .9 57 .6 48 .5 0. 0 0. 1 1. 5 1. 2 0. 2 0. 1 1. 4 0. 7 1. 9 0. 2 1. 2 1. 2 1. 4 3. 0 0. 9 0. 0 0. 7 0. 3 0. 0 0. 2 0. 6 0. 4 0. 8 0. 0 0. 5 0. 3 0. 0 0. 0 2. 0 0. 4 0. 0 0. 6 0. 5 0. 0 0. 6 0. 4 0. 3 0. 1 0. 9 0. 5 0. 1 0. 9 0. 9 0. 5 0. 4 0. 0 1. 3 2. 3 1. 2 1. 0 1. 1 2. 0 1. 6 2. 9 1. 3 1. 6 2. 1 2. 3 5. 5 1. 7 23 .3 46 .9 56 .9 43 .8 32 .6 50 .0 51 .4 59 .7 54 .1 36 .2 65 .0 56 .8 43 .2 63 .2 50 .2 11 1 66 1 99 5 22 0 35 0 37 8 38 9 43 7 43 4 82 6 68 5 24 7 13 4 89 1, 98 7 *6 c as es 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 5. 3; M D G in d ic at o r 5. 3 MULTIPLE INDICATOR CLUSTER SURVEY 201174 8.3. UNMET NEED Unmet need for contraception refers to fecund women who are not using any method of contraception, but who wish to postpone the next birth (spacing) or who wish to stop childbearing altogether (limiting). Unmet need is identified in MICS by using a set of questions eliciting current behaviours and preferences pertaining to contraceptive use, fecundity, and fertility preferences. Table RH.5 shows the levels of met need for contraception, unmet need, and the demand for contraception satisfied. Unmet need for spacing is defined as the percentage of women who are not using a method of contraception AND • are not pregnant and not postpartum amenorrheic10 and are fecund11 and say they want to wait two or more years for their next birth OR • are not pregnant and not postpartum amenorrheic and are fecund and unsure whether they want another child OR • are pregnant and say that pregnancy was mistimed: would have wanted to wait OR • are postpartum amenorrheic and say that the birth was mistimed: would have wanted to wait Unmet need for limiting is defined as percentage of women who are not using a method of contraception AND • are not pregnant and not postpartum amenorrheic and are fecund and say they do not want any more children OR • are pregnant and say they do not want to have a child OR • are postpartum amenorrheic and say that they did not want the birth Total unmet need for contraception is the sum of unmet need for spacing and unmet need for limiting. In this survey data was not completely collected to allow for the proper calculation of the unmet need indicators. More specifically, data was not collected on return of the menstrual period of a woman. Nonetheless results for these indicators are presented so as to give some indication of the levels of unmet need for contraception. Total unmet need for contraception in the three districts of Papua is about 11 per cent, i.e. one in 10 women are not using contraceptives but wish to stop having children (limit) or postpone the next pregnancy for at least two years (space) (Table RH.4A). Slightly less women are in unmet need for limiting for contraception (5 per cent) than in unmet need in for spacing for contraception (6 per cent). 10 A women is postpartum amenorrheic if she had a birth in last two years and is not currently pregnant, and her menstrual period has not returned since the birth of the last child 11 A women is considered infecund if she is neither pregnant nor postpartum amenorrheic, and (1a) has not had menstruation for at least six months, or (1b) never menstruated, or (1c) her last menstruation occurred before her last birth, or (1d) in menopause/has had hysterectomy OR (2) She declares that she has had a hysterectomy, or that she has never menstruated or that she is menopausal, or that she has been trying to get pregnant for 2 or more years without result in response to questions on why she thinks she is not physically able to get pregnant at the time of survey OR (3) She declares she cannot get pregnant when asked about desire for future birth OR (4) She has not had a birth in the preceding 5 years, is currently not using contraception and is currently married and was continuously married during the last 5 years preceding the survey MULTIPLE INDICATOR CLUSTER SURVEY 2011 75 Table RH.4A: Unmet need for contraception Percentage of women age 15-49 years currently married or in union with an unmet need for family planning and percentage of demand for contraception satisfied, Districts of Kaimana, Manokwari and Sorong, West Papua Province, Indonesia, 2011 22.4 23.0 26.9 23.5 24.1 17.5 44.9 36.0 30.0 14.7 10.1 4.8 7.2 19.4 27.5 29.8 14.0 25.1 28.3 25.6 25.3 17.0 32.4 25.3 22.6 22.1 23.9 8.5 31.0 26.8 27.3 26.2 3.9 5.7 18.9 22.0 43.7 41.8 32.2 16.1 28.0 29.4 14.0 19.3 25.0 23.1 34.1 28.8 19.5 32.6 31.4 20.6 41.1 26.5 30.9 54.0 53.7 50.8 50.2 21.5 50.7 54.9 51.9 58.3 51.9 37.0 23.3 47.4 56.9 43.8 33.3 50.1 51.4 59.7 54.1 36.5 65.0 56.8 43.2 63.2 50.4 9.5 5.4 5.7 5.8 6.2 23.1 7.2 8.5 8.0 2.6 2.7 0.7 9.2 5.7 5.6 8.2 9.9 6.5 5.2 4.4 5.3 9.0 3.2 6.2 4.6 4.4 6.1 5.2 4.3 5.2 4.5 4.7 0.0 0.5 4.0 4.7 5.4 7.6 7.0 7.7 6.5 3.7 2.2 6.0 5.1 5.3 2.6 4.6 5.4 3.5 3.8 10.7 0.0 4.7 14.7 9.7 10.9 10.3 10.9 23.1 7.8 12.5 12.7 8.0 10.4 7.8 16.9 12.1 9.3 10.4 16.0 11.6 10.5 7.0 9.9 14

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