Ukraine - Multiple Indicator Cluster Survey - 2012

Publication date: 2012

State Statistics Service of Ukraine Ukrainian Institute for Social Reforms Statinformconsulting UNICEF United Nations Children’s Fund USAID United States Agency for International Development SDC Swiss Cooperation Office Ministry of Health of Ukraine Ukraine MULTIPLE INDICATOR CLUSTER SURVEY 2012 December, 2013 The Ukraine Multiple Indicator Cluster Survey (MICS) was carried out in 2012 by the State Statistics Service in collaboration with the Ukrainian Institute for Social Reforms and StatInformConsulting. Financial and technical support was provided by the United Nations Children’s Fund (UNICEF), Swiss Cooperation Office in Ukraine (SDC) and the United States Agency for International Development (USAID). MICS is an international household survey programme developed by UNICEF. The Ukraine 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 HYPERLINK «http://www.childinfo.org» www.childinfo.org. Suggested citation: State Statistics Service and Ukrainian Center for Social Reforms, 2013. Ukraine Multiple Indicator Cluster Survey 2012, Final Report. Kyiv, Ukraine: State Statistics Committee and the Ukrainian Center for Social Reforms. ISBN 978-617-684-071-8 Published in December, 2013 / Revised and edited in April, 2014 3Foreword Foreword The formation and development of a sovereign Ukrainian state has opened a new chapter in the social development and demographic history of Ukraine. At the same time, it requires enhanced responsibility for the present and future of the Ukrainian people. Reproduction of sound generation and improving the quality of life requires increased attention to the problems of social development and the elaboration of an effective national population policy. Developing a balanced state social policy and monitoring its implementation requires special population surveys, the results of which will provide information on socio-demographic and health status of the population in the country. The State Statistics Service of Ukraine and the UN Children’s Fund (UNICEF)  in Ukraine reached an agreement on the implementation of the Multiple Indicator Cluster Survey (MICS)  in  2012, and a respective Memorandum of Understanding was signed. The Multiple Indicator Cluster Survey (MICS) is an international program that collects data regarding the situation of children and women in the world. UNICEF developed the program in the mid-1990s, and implements it in cooperation with governments globally. Ukraine  2012  MICS  was conducted by the State Statistics Service of Ukraine in collaboration with UNICEF  with financial support of the U.S. Agency for International Development (USAID) and the Swiss Agency for Development and Cooperation (SDC). MICS  2012  provided an opportunity to obtain reliable data using indicators of nutrition levels, children’s health, access to drinking water and sanitation, child mortality, reproductive health, child development, education, child protection, HIV/AIDS, sexual behaviour, and others. These factors are then used by the Government of Ukraine to monitor the situation of children, women and households as a whole, including in the preparation of national reports on the implementation of commitments and assessment of progress towards the «Millennium Development Goals», Declaration «A World Fit for Children», and other international obligations. 4Contents Contents FOREWORD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 SUMMARY TABLE OF FINDINGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 LIST OF TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 LIST OF FIGURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 ABBREVIATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 EXECUTIVE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 MAP OF UKRAINE MICS 2012 REGIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 1 . INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 1.1.  Background and Survey Objectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 1.2.  Demographic Features of Ukraine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 1.3.  Healthcare in Ukraine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 2 . SAMPLE AND SURVEY METHODOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 2.1.  Sample Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 2.2.  Questionnaires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 2.3.  Training and Fieldwork . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 2.4.  Data Processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 3 . SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS . . . 39 3.1.  Sample Coverage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 3.2.  Characteristics of Households . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 3.3.  Characteristics of Respondents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 4 . CHILD MORTALITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 4.1.  Definition and methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 4.2.  Levels and trends in infant and under 5 mortality rates. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 5 . CHILD NUTRITION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 5.1.  Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 5.2.  Infant and Young Child Feeding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 5.3.  Salt Iodization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 5.4.  Low Birth Weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 6 . CHILD HEALTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 6.1.  Immunization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 6.2.  Oral Rehydration Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 5Contents 6.3.  Care Seeking and Antibiotic Treatment of Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 6.4. Solid Fuel Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 7 . WATER AND SANITATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 7.1.  Use of Improved Water Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 7.2.  Use of Improved Sanitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 8 . REPRODUCTIVE HEALTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 8.1. Fertility Rates and Age Trends. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 8.2. Age at First Birth and Early Childbearing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 8.3. Birth Intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 8.4. Abortion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 8.5. Antenatal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 8.6.  Assistance at Delivery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 8.7.  Place of Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 8.8. Postnatal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 8.9. Menopause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 9 . FAMILY PLANNING AND UNMET NEED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 9.1. Desire for More Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 9.2. Circumstances under Which a Woman Should Not Become Pregnant . . . . . . . . . . . . . . . . . . . . . 124 9.3.  Knowledge of Contraception Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 9.4. Ever and Current Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 9.5.  Sources of Contraception and Informed Choice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 9.6. Future Use of Contraception and Preferred Method. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142 9.7.  Desire to Limit Childbearing and Unmet Need . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 9.8.  Exposure to Family Planning Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146 9.9.  Husband / Partner’s Knowledge of Woman’s Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . 148 10 . CHILD DEVELOPMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 10.1. Early Childhood Education and Learning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 10.2. Early Childhood Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 11 . EDUCATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 11.1. Literacy among Young People . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 11.2. School Readiness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164 11.3. Primary and Secondary School Participation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 12 . CHILD PROTECTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 12.1. Birth Registration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 12.2. Child Labour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174 12.3. Child Discipline. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177 12.4. Early Marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 12.5. Attitudes toward Domestic Violence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184 12.6. Children’s Living Arrangements and Orphanhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186 6Contents 13 . HIV/AIDS AND SEXUAL BEHAVIOUR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .189 13.1. Knowledge of HIV Transmission and Misconceptions about HIV/AIDS . . . . . . . . . . . . . . . . . . . . . 189 13.2. Accepting Attitudes toward People Living with HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198 13.3. Knowledge of a Place for HIV Testing, Counselling, and Testing during Antenatal Care. . . . . 201 13.4. Sexual Behaviour Related to HIV Transmission. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207 14 . ACCESS TO MASS MEDIA AND USE OF INFORMATION/COMMUNICATION TECHNOLOGY . .223 14.1. Access to Mass Media. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223 14.2. Use of Information/Communication Technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225 14.3. Sources of information on health related issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227 15 . TOBACCO AND ALCOHOL USE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .235 15.1. Use of Tobacco . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235 15.2. Use of Alcohol. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238 16 . SUBJECTIVE WELL-BEING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .243 APPENDIX A . SAMPLE DESIGN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .250 APPENDIX B . PERSONNEL INVOLVED IN MICS 2012 IN UKRAINE . . . . . . . . . . . . . . . . . . . . . . . . . . . .255 APPENDIX C . ESTIMATES OF SAMPLING ERRORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .258 APPENDIX D . DATA QUALITY TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .286 APPENDIX E . UKRAINE MICS 2012 INDICATORS: NUMERATORS AND DENOMINATORS . . . . . . .298 APPENDIX F . UKRAINE MICS 2012 QUESTIONNAIRES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .305 APPENDIX G . CORRESPONDENCE BETWEEN MICS 2012 AND DHS 2007 TABLES . . . . . . . . . . . . . .427 7Summary Table of Findings Summary Table of Findings Multiple Indicator Cluster Survey (MICS) and Millennium Development Goals (MDG) Indicators for Ukraine 20121 2 Topic MICS Indicator Number MDG Indicator Number Indicator Value Child Mortality2 Child Mortality 1.1 4.1 Under-five mortality rate 7 per 1,000 1.2 4.2 Infant mortality rate 7 per 1,000 1.3 Neonatal mortality rate 4 per 1,000 1.4 Post-neonatal mortality rate 3 per 1,000 1.5 Child mortality rate 0 per 1,000 Nutrition Breastfeeding and Infant Feeding 2.4 Children ever breastfed 95.4 per cent 2.5 Early initiation of breastfeeding 65.7 per cent 2.6 Exclusive breastfeeding under 6 months 19.7 per cent 2.7 Continued breastfeeding at 1 year 37.9 per cent 2.8 Continued breastfeeding at 2 years 22.0 per cent 2.9 Predominant breastfeeding under 6 months 51.6 per cent 2.10 Duration of breastfeeding 9.8 months 2.11 Bottle feeding 66.6 per cent 2.12 Introduction of solid, semi-solid or soft foods 43.2 per cent 2.13 Minimum meal frequency 63.7 per cent 2.14 Age-appropriate breastfeeding 24.3 per cent 2.15 Milk feeding frequency for non- breastfed children 95.2 per cent Salt Iodisation 2.16 Iodized salt consumption 20.7 per cent Low Birth Weight 2.18 Low-birth weight infants 3.1 per cent 2.19 Infants weighed at birth 97.2 per cent Child Health Vaccinations 3.1 Tuberculosis immunization coverage 94.5 per cent 3.2 Polio immunization coverage 47.8 per cent 3.3 Immunization coverage for diphtheria, pertussis and tetanus (DPT) 41.8 per cent 3.4 4.3 Measles immunization coverage 62.7 per cent 3.5 Hepatitis B immunization coverage 26.1 per cent Care of Illness 3.8 Oral rehydration therapy with continued feeding 69.3 per cent 3.9 Care-seeking for suspected pneumonia 92.3 per cent 3.10 Antibiotic treatment of suspected pneumonia 88.2 per cent Solid Fuel use 3.11 Solid fuels 5.1 per cent Water and Sanitation Water and Sanitation 4.1 7.8 Use of improved drinking water sources 98.2 per cent 4.2 Water treatment 21.9 per cent 4.3 7.9 Use of improved sanitation 97.7 per cent Reproductive Health Contraception and Unmet Need 5.1 5.4 Adolescent birth rate 34 per 1,000 5.2 Early childbearing 4.4 per cent 5.3 5.3 Contraceptive prevalence rate 65.5 per cent 5.4 5.6 Unmet need 4.9 per cent 1 See Annex E for details on indicator definitions 2 For the 5-year period preceding the survey which coincides with 2007-2012. 8Summary Table of Findings Topic MICS Indicator Number MDG Indicator Number Indicator Value Maternal and NewbornHealth 5.5a 5.5b 5.5 Antenatal care coverage At least once by skilled personnel At least four times by any provider 98.6 87.2 per cent per cent 5.6 Content of antenatal care 98.6 per cent 5.7 5.2 Skilled attendant at delivery 99.0 per cent 5.8 Institutional deliveries 98.9 per cent 5.9 Caesarean section 12.1 per cent Post-Natal Health Checks 5.10 Post-partum stay in health facility 99.9 per cent 5.11 Post-natal health check for the new born 98.9 per cent 5.12 Post-natal health check for the mother 95.6 per cent Child Development Child Development 6.1 Support for learning 97.5 per cent 6.2 Father’s support for learning 71.1 per cent 6.3 Learning materials: children’s books 91.2 per cent 6.4 Learning materials: playthings 51.6 per cent 6.5 Inadequate care 6.5 per cent 6.6 Early Child Development Index 89.0 per cent 6.7 Attendance to early childhood education 51.9 per cent Literacy and Education Literacy and Education 7.1 2.3 Literacy rate among young people aged 15– 24 years women aged 15–24 years men aged 15–24 years 100.0 100.0 per cent per cent 7.2 School readiness 78.5 per cent 7.3 Net intake rate in primary education 94.0 per cent 7.4 2.1 Primary school net attendance ratio (adjusted) 99.8 per cent 7.5 Secondary school net attendance ratio (adjusted) 93.1 per cent 7.6 2.2 Children reaching last grade of primary school 100.0 per cent 7.7 Primary completion rate 95.1 per cent 7.8 Transition rate to secondary school 91.1 per cent 7.9 3.1 Gender Parity Index (primary school) 1.00 ratio 7.10 3.1 Gender Parity Index (secondary school) 1.00 ratio Child Protection Birth Registration 8.1 Birth registration 99.8 per cent Child Labour 8.2 Child labour 2.4 per cent 8.3 School attendance among child labourers 95.2 per cent 8.4 Child labour among students 5.2 per cent Child Discipline 8.5 Violent discipline 61.2 per cent Early Marriage 8.6 Marriage before age 15 Women age 15–49 years Men age 15–49 years 0.4 0.0 per cent per cent 8.7 Marriage before age 18 Women age 20–49 years who were first married or in union by the exact age of 18 Men age 20–49 years who were first married or in union by the exact age of 18 11.0 2.9 per cent per cent 8.8 Young women age 15–19 years currently married or in union 6.5 per cent Young men age 15–19 currently married or in union 0.3 per cent 9Summary Table of Findings Topic MICS Indicator Number MDG Indicator Number Indicator Value Spousal age difference 8.10a Women age 15-19 years 8.8 per cent 8.10b Women age 20-24 years 5.1 per cent Domestic Violence 8.14 Attitudes towards domestic violence women aged 15–49 years 2.9 per cent men aged 15–49 years 9.4 per cent HIV/AIDS and Sexual Behaviour HIV/ AIDS Knowledge and Attitudes 9.1 Comprehensive knowledge about HIV prevention women aged 15–49 years 53.8 per cent men aged 15–49 years 46.7 per cent 9.2 6.3 Comprehensive knowledge about HIV prevention among young people women aged 15–24 years 49.9 per cent men aged 15–24 years 45.8 per cent 9.3 Knowledge of mother-to-child transmission of HIV women aged 15–49 years 50.6 per cent men aged 15–49 years 35.9 per cent 9.4 Accepting attitudes towards people living with HIV women aged 15–49 years 0.7 per cent men aged 15–49 years 0.8 per cent 9.5 Women who know where to be tested for HIV Men who know where to be tested for HIV 90.6 87.3 per cent per cent 9.6 Women who have been tested for HIV and know the results Men who have been tested for HIV and know the results 8.7 8.1 per cent per cent 9.7 Sexually active young women who have been tested for HIV and know the results Sexually active young men who have been tested for HIV and know the results 17.5 13.0 per cent per cent 9.8 HIV counselling during antenatal care 74.9 per cent 9.9 HIV testing during antenatal care 84.5 per cent Sexual Behaviour 9.10 Young men who have never had sex Young women who have never had sex 35.6 61.5 per cent per cent 9.11 Sex before age 15 among young people women aged 15–24 years men aged 15–24 years 0.4 1.8 per cent per cent 9.12 Age-mixing among sexual partners women aged 15–24 years men aged 15–24 years 4.8 0.3 per cent per cent 9.13 Sex with multiple partners women aged 15–49 years men aged 15–49 years 3.1 12.6 per cent per cent 9.14 Condom use during sex with multiple partners women aged 15–49 years men aged 15–49 years 53.3 69.0 per cent per cent 9.15 Sex with non-regular partners women aged 15–24 years men aged 15–24 years 45.9 84.0 per cent per cent 9.16 6.2 Condom use with non-regular partners women aged 15–24 years men aged 15–24 years 74.3 82.5 per cent per cent 10Summary Table of Findings Topic MICS Indicator Number MDG Indicator Number Indicator Value Orphaned children 9.17 Children’s living arrangements 2.7 per cent 9.18 Prevalence of children with one or both parents dead 4.7 per cent Access to Mass Media and Use of Information/Communication Technology Access to Mass Media MT.1 Exposure to mass media women aged 15–49 years men aged 15–49 years 35.8 34.6 per cent per cent Use of Information/ Communication Technology MT.2 Use of computers women aged 15–24 years men aged 15–24 years 91.1 94.9 per cent per cent MT.3 Use of internet women aged 15–24 years men aged 15–24 years 88.8 92.1 per cent per cent Subjective Well-Being Subjective Well- being SW.1 Life satisfaction women aged 15–24 years men aged 15–24 years 56.0 56.0 per cent per cent SW.2 Happiness women aged 15–24 years men aged 15–24 years 90.2 88.1 per cent per cent SW.3 Perception of a better life women aged 15–24 years men aged 15–24 years 22.6 17.1 per cent per cent Tobacco and Alcohol Use Among Women Tobacco Use TA.1 Tobacco use 17.1 per cent TA.2 Smoking before age 15 2.9 per cent Alcohol Use TA.3 Alcohol use 48.4 per cent TA.4 Use of alcohol before age 15 5.2 per cent 11List of Tables List of Tables Table HH.1. Results of household, women’s, men’s and under-5’s 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. Early childhood mortality rates Table CM.2. Early childhood mortality rates by socio-economic characteristics 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 food Table NU.6. Minimum meal frequency Table NU.7. Bottle feeding Table NU.8. Iodized salt consumption 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. Oral rehydration solutions Table CH.4. Feeding practices during diarrhoea Table CH.5. Oral rehydration therapy with continued feeding and other treatments Table CH.6. Care seeking for suspected pneumonia and antibiotic use during suspected pneumonia Table CH.7. Knowledge of two danger signs of pneumonia Table CH.8. Solid fuel use Table CH.9. Solid fuel use by place of cooking 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 RH.1.  Fertility rates Table RH.2.  Adolescent birth rate and total fertility rate Table RH.3.  Trends in age-specific fertility rates Table RH.4.  Children ever born and living, according to age Table RH.5.  Age at first birth Table RH.6.  Median age at first birth Table RH.7. Early childbearing Table RH.8. Trends in early childbearing (by age 15) Table RH.9. Trends in early childbearing (by age 18) Table RH.10.  Birth intervals Table RH.11.  Pregnancy outcome by background characteristics Table RH.12. Lifetime experience with induced abortion Table RH.13. Induced abortion rates Table RH.14. Induced abortion rates by background characteristics Table RH.15. Antenatal care provider Table RH.16. Number of antenatal care visits Table RH.17. Content of antenatal care Table RH.18. Assistance during delivery Table RH.19. Place of delivery Table RH.20. Post-partum stay in health facility 12List of Tables Table RH.21. Postnatal health checks for newborns Table RH.22. Postnatal health checks for mothers Table RH.23.  Menopause Table FP.1.  Fertility preferences – Women Table FP.1M. Fertility preferences – Men Table FP.2. Ideal number of children – Women Table FP.2M. Ideal number of children – Men Table FP.3.  Perceived circumstances under which a woman should not become pregnant -Women Table FP.3М. Perceived circumstances under which a woman should not become pregnant – Men Table FP.4.  Circumstances under which a woman should not become pregnant Table FP.5.  Attitudes about what a woman should do if she becomes pregnant under circumstances when she should not be pregnant Table FP.6.  Attitudes about what a woman should do when a child is born as a result of a pregnancy that should not have occurred Table FP.7.  Knowledge of contraceptive methods – Women Table FP.7M. Knowledge of contraceptive methods – Men Table FP.8.  Knowledge of fertile period Table FP.9.  Ever use of contraception Table FP.10.  Current use of contraception by age Table FP.11.  Current use of contraception by background characteristics Table FP.12.  Source of modern contraception method Table FP.13.  Informed choice Table FP.14.  Future use of contraception Table FP.15.  Reason for not intending to use contraception in the future Table FP.16.  Preferred method of contraception for future use Table FP.17. Unmet need for contraception Table FP.18.  Desire to limit childbearing – Women Table FP.18M. Desire to limit childbearing – Men Table FP.19.  Exposure to family planning messages – Women Table FP.19M. Exposure to family planning messages – Men Table FP.20.  Husband / partner’s knowledge of women’s use of contraception Table CD.1. Early childhood education Table CD.2. Support for learning Table CD.3. Learning materials Table CD.4. Inadequate care Table CD.5. Early child development index 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. Primary school completion and transition to secondary school Table ED.7. 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 – Women Table CP5M. Early Marriage- Men Table CP.6. Trends in early marriage – Women Table CP.6M. Trends in early marriage – Men Table CP.7. Spousal age difference Table CP.8. Attitudes toward domestic violence – Women Table CP.8M.  Attitudes toward domestic violence – Men Table CP.9. Children’s living arrangements and orphanhood 13List of Tables Table HA.1. Knowledge about HIV transmission, misconceptions about HIV/AIDS, and comprehensive knowledge about HIV transmission – Women Table HA.1M. Knowledge about HIV transmission, misconceptions about HIV/AIDS, and comprehensive knowledge about HIV transmission – Men Table HA.2. Knowledge about HIV transmission, misconceptions about HIV, and comprehensive knowledge about HIV transmission among young women Table HA.2M. Knowledge about HIV transmission, misconceptions about HIV, and comprehensive knowledge about HIV transmission among young men Table HA.3. Knowledge of mother-to-child HIV transmission – Women Table HA.3M. Knowledge of mother-to-child HIV transmission – Men Table HA.4. Accepting attitudes toward people living with HIV/AIDS – Women Table HA.4M. Accepting attitudes toward people living with HIV/AIDS – Men Table HA.5. Knowledge of a place for HIV testing – Women Table HA.5M. Knowledge of a place for HIV testing – Men Table HA.6. Knowledge of a place for HIV testing among sexually active young women Table HA.6M. Knowledge of a place for HIV testing among sexually active young men Table HA.7. HIV counselling and testing during antenatal care Table HA.8. Age at first sexual intercourse – Women Table HA.8M. Age at first sexual intercourse – Men Table HA.9. Median age at first intercourse – Women Table HA.9M. Median age at first intercourse – Men Table HA.10. Recent sexual activity – Women Table HA.10M. Recent sexual activity – Men Table HA.11. Sexual behaviour that increases the risk of HIV infection – Women Table HA.11M. Sexual behaviour that increases the risk of HIV infection – Men Table HA.12. Sex with multiple partners – Women Table HA.12M. Sex with multiple partners – Men Table HA.13. Sex with multiple partners among young women Table HA.13M. Sex with multiple partners among young men Table HA.14. Sex with non-regular partners – Women Table HA.14M. Sex with non-regular partners – Men Table MT.1. Exposure to mass media – Women Table MT.1М. Exposure to mass media – Men Table MT.2. Use of computers and Internet – Women Table MT.2М. Use of computers and Internet – Men Table MT.3. Sources of information on issues related to health – Women Table MT.3М. Sources of information on issues related to health – Men Table MT.4. Trusted sources of information on issues related to health- Women Table MT.4M. Trusted sources of information in issues related to health – Men Table TA.1. Current and ever use of tobacco Table TA.2. Age at first use of cigarettes and frequency of use Table TA.3. Use of alcohol Table SW.1. Domains of life satisfaction – Women Table SW.1М.  Domains of life satisfaction – Men Table SW.2. Life satisfaction and happiness – Women Table SW.2М. Life satisfaction and happiness – Men Table SW.3. Perception of a better life – Women Table SW.3М.  Perception of a better life – Men Table SD.1. Regional Structure Table SD.2. PSU distribution in MICS 2012 by settlement types and regions Table SD.3. Actual household sample allocation by settlement types and regions Table SE.1. Indicators selected for sampling error calculations Table SE.2. Sampling errors: Total sample Table SE.3. Sampling errors: Urban areas Table SE.4. Sampling errors: Big city Table SE.5. Sampling errors: Small town Table SE.6. Sampling errors: Rural areas 14List of Tables Table SE.7. Sampling errors: North Table SE.8. Sampling errors: West Table SE.9. Sampling errors: Center Table SE.10. Sampling errors: East Table SE.11. Sampling errors: South 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 under-5s birth certificates Table DQ.8. Observation of vaccination cards Table DQ.9. Presence of mother in the household and the person interviewed for the under-5 questionnaire Table DQ.10. Selection of children age 2–14 years for the child discipline module Table DQ.11. School attendance by single age Table DQ.12. Sex ratio at birth among children ever born and living Table DQ.13. Births by calendar years Table DQ.14. Reporting of age at death in days Table DQ.15. Reporting of age at death in months 15List of Figures List of Figures Figure НН.1. Age and sex distribution of household population Figure СМ.1. Infant mortality rate dynamics in Ukraine according to the State Statistics data (1995–2011), DHS 2007 and MICS 2012 (direct and indirect estimates), Ukraine, 2012 Figure NU.1. Proportion of children who were breastfed within one hour and one day of birth, Ukraine, 2012 Figure NU.2. Infant feeding patterns by age, Ukraine, 2012 Figure NU.3. Per cent of households that consume adequately iodized salt, Ukraine, 2012 Figure СН.1. The proportion of children aged 18–29 months who received the recommended vaccinations by their first birthday (by 18 months of age for MMR) , Ukraine, 2012 Figure WS.1. Per cent distribution of household members by the main source of drinking water, Ukraine, 2012 Figure WS.2. Use of improved sanitation, Ukraine, 2012 Figure RH.1. Age specific fertility rates among women in urban and rural areas of Ukraine according to the MICS 2012 and state statistics as of 2011, per 1,000 women of respective age, Ukraine, 2012 Figure RH.2. Age-specific fertility rates by periods preceding the survey, by mother’s age at the time of birth, Ukraine, 2012 Figure RH.3. Mean number of children ever born to all women and currently married women, by age groups, Ukraine, 2012 Figure RH.4.  Median birth intervals according to background characteristics, Ukraine, 2012 Figure RH.5. Per cent distribution of pregnancies that ended in an induced abortion, by background characteristics, Ukraine, 2012 Figure RH.6. Percentage of women who have ever had an abortion, by number of abortions, Ukraine, 2012 Figure RH.7. Percentage of women who have ever had an abortion, by marital status Figure RH.8. Abortion rates by age groups, Ukraine, 2012 Figure�RH.9. Distribution of first post-natal health checks of newborns and mothers, by place of visit, Ukraine, 2012 Figure RH.10. Coverage of mothers and newborns with post-natal care services (during the first 2 days after delivery), Ukraine, 2012 Figure FP.1. Percentage of women and men aged 15–49 years who think there can be circumstances under which a woman should not become pregnant, by specific circumstances, Ukraine, 2012 Figure FP.2.  Attitudes of women and men aged 15–49 about what a woman should do when a child is born as a result of a pregnancy that should not have occurred, Ukraine, 2012 Figure FP.3. Knowledge of modern methods of contraception among all men and women aged 15–49, Ukraine, 2012 Figure FP.4. Knowledge of traditional methods of contraception among married and sexually active unmarried men and women aged 15–49, Ukraine, 2012 Figure FP.5. Ever use of contraception methods among women aged 15–49, Ukraine, 2012 Figure FP.6. Current use of contraception among women aged 15–49 by age group, Ukraine, 2012 Figure FP.7. Current use of contraception among married and sexually active unmarried women aged 15–49, Ukraine, 2012 Figure FP.8. Met and unmet need for contraception among women aged 15–49 in marriage/union, Ukraine, 2012 Figure CD.1. Proportion of children aged 36–59 months who are developmentally on track in indicated domains, Ukraine, 2012 Figure СР.1. Percentage of children aged 2–14 years subjected to any violent discipline method, Ukraine, 2012 Figure НА.1. Percentage of women aged 15–49 who have comprehensive knowledge of HIV/AIDS transmission, Ukraine, 2012 Figure НА.1M.  Percentage of men aged 15–49 who have comprehensive knowledge of HIV/AIDS transmission, Ukraine, 2012 Figure HA.2. Sexual behaviour that increases the risk of HIV infection, Ukraine, 2012 Figure SD.1. Arranging of the village councils by the ‘geographic serpentine’ 16Abbreviations Abbreviations AIDS Acquired Immunodeficiency Syndrome ANC Antenatal Care ASARs Age-specific abortion rates ASFRs Age-specific fertility rates BCG Bacilli Calmet-Geren (anti-tuberculosis vaccine) C-section Caesarean section CBR Crude birth rate CSPro Census and Survey Processing System CIS Community of Independent States CSPro Census and Survey Processing System DPT Diphtheria Pertussis Tetanus DHS Demographic and Health Survey DK Don’t know ECDI Early Child Development Index EBF Exclusive Breastfeeding EPI Extended Immunisation Programme GDP Gross Domestic Product GAC General abortion coefficient GPI Gender parity index GFR General Fertility Rate HepB Hepatitis B Hib Haemophilus influenza HIV/AIDS Human immunodeficiency virus / Acquired immunodeficiency syndrome HLCS Household Living Conditions Survey IUD Intrauterine device IGE Index of gender equality IDD Iodine deficiency disorders ICT Information/Communication Technology JMP Joint Monitoring Programme LAM Lactational Amenorrhea Method MDG Millennium Development Goals MICS Multiple Indicator Cluster Survey MoH Ministry of Health NAR Net Attendance Rate NN Neonatal mortality ОRS Oral Rehydration Salts ORT Oral Rehydration Treatment PNN Post-neonatal mortality PNC postnatal care PPS Probability proportional to size PPM Parts per million PSU Primary Sampling Unit RHF Recommended Home Fluid SE/r Variation coefficient SPSS Statistical package for social sciences STD Sexually transmitted diseases SDC Swiss Agency for Development and Cooperation TAR Total abortion rate TFR Total fertility rate U5MR Under-Five Mortality Rate UNDP United Nations Development Programme UNICEF United Nations Children’s Fund UNFPA  United Nations Population Fund UNAIDS United Nations AIDS programme UNGASS United Nations General Assembly Special Session on HIV/AIDS WFFC World Fit for Children WHO World Health Organisation 17Acknowledgements Acknowledgements The State Statistics Service of Ukraine has committed itself to monitoring the situation of children and women in Ukraine, and to assess the progress in achieving the Millennium Development Goals, objectives of the Declaration «A World Fit for Children» as well as goals of the «World Summit for Children» and other international obligations. In  addition, problems with social development and overcoming implications of the demographic crisis place a number of issues on the state agenda, related to the development of effective and prudent state social policy. The development of this policy and monitoring its implementation requires special surveys of certain categories of the population and households in general. The uniqueness of the Multiple Indicator Cluster Survey (MICS)  is that due to significant differences of social and economic development of certain regions of the country, it was conducted at five separate macro regions that emerged in Ukraine as a result of geographical location, economic development, and demographic conditions. We hope that the data collected during the survey will be widely used by the government of the country, think tanks and civil society organizations to plan and develop social programs that meet the reality of the present situation in the country, and would match needs of specific groups at all levels. The State Statistics Service of Ukraine would like to acknowledge all participants of the MICS 2012 process in Ukraine. This survey was made possible thanks to the financial and technical support from the UN Children’s Fund (UNICEF), the United States Agency for International Development (USAID)  and the Swiss Agency for Development and Cooperation (SDC). We express our special thanks to the staff and consultants of the UNICEF Country Office in Ukraine, UNICEF Headquarters and Regional Office who provided maximum assistance in the preparation of the MICS 2012 in Ukraine. Their assistance included defining the sample for the survey, supervising the training of interviewers, supervising the fieldwork, data processing and preparation of the final report. The importance and significance of the «Statinformconsulting» in training the personnel, conducting the survey, and supervising data entry and data processing specialists cannot be overestimated. We appreciate the valuable comments of the Intergovernmental Council on MICS, as well as advice from the Ministry of Health of Ukraine experts in approving the survey tools, its implementation, and preparation of the final report. We express our gratitude to the staff of the Ukrainian Center for Social Reforms and the Institute of Demography and Social Studies of the National Academy of Sciences of Ukraine, who participated in the preparation of preliminary and final reports, as well as its presentation to a wider audience. The national staff of the survey must be congratulated for their unmatched commitment to the success of the survey. Special recognition goes to the Department of Statistics of Services of the State Statistics Committee of Ukraine, regional departments of the state statistics, powerful team of interviewers, editors, coordinators, listing experts and data entry operators. The names of these experts are listed in the Appendix B to this report. We are also grateful to you, dear reader, that you have shown interest in the results of the survey and issues covered in this report, as they are crucial in the development of each country. Natalia Vlasenko Deputy Head State Statistics Service of Ukraine 18Executive Summary Executive Summary MICS 2012 was implemented in Ukraine in cooperation between the State Statistics Service of Ukraine and the United Nations Children’s Fund (UNICEF) to provide important data on the status of children and women in the country. A key feature of MICS 2012 in Ukraine was the introduction of separate questions and modules from the Demographic and Household Survey (DHS) program into standard MICS questionnaires for, women and men . The sample size of  12,459  households and overall response rates of over  90% for households, women, men and children under five years of age (mothers/caretakers were interviewed) ensured representative data for the national level, and the strata of urban (including subdivision in large cities/small towns) and rural areas, as well as five regions (North, West, Centre, East and South). Child Mortality It is estimated that between the years 2007 and 2012 in Ukraine, the neonatal mortality rate was 4 per 1,000 live births, post-neonatal mortality was 3 per 1,000 live births, and the under 5 mortality rate was 7 per 1,000 live births. Child mortality rates vary in regards to rural and urban areas. Child Nutrition Breastfeeding and Infant and Young Child Feeding Only 65.7% of newborns in Ukraine start breastfeeding within one hour of birth. 87.1% of mothers initiated breastfeeding within 24 hours after the delivery. Only  19.7% of children under six months of age are exclusively breastfed (which is significantly lower than the recommended level), whereas  51.6% of children aged  0–5  months are predominantly breastfed. By  age  12– 15 months 37.9% of children are still breastfed, and by age 20–23 months, 22.0% of children are still breastfed. Overall, 43.2% of infants aged 6–8 months received solid, semi-solid or soft food. Salt iodisation Within the framework of MICS 2012, almost all households (96.6%) provided salt used for cooking to be tested for iodine content. Obtained samples were immediately tested for the presence of potassium iodate by using salt test kits. As a result, only 0.7% of households did not have salt available. The overall proportion of households where iodized salt was consumed was only 20.7%, with the iodine contents of 15 ppm (particles per million) or more. Low birth weight In  Ukraine virtually all children (97.2%) are weighed at birth and approximately  3.1% of infants weigh less than 2,500 grams at birth. Child Health Immunisation Almost all children (94.5%) aged 18–29 months received a BCG vaccination by the age of 12 months, and the first dose of DPT was given to 79.4% of children. This percentage declines to 41.8% for the third dose. 79% of children received Polio1 by 12 months of age, which decreases to 47.8% for the third dose of Polio vaccine. The coverage for MMR (measles, mumps, rubella) vaccination of children aged 18–29 months during the first 18 months of their lives is only 62.7%. 19Executive Summary According to MICS 2012 results, only 65.1% of children received the first dose against Hepatitis B by their first birthday. The coverage with subsequent HepB vaccinations declines to 26.1% for the third dose. The coverage for Haemophilus influenza (Hib) during the first year of life is 74.9% for the first dose (at one month of age), and 60.7% – for the second dose (at 4 months of age). Solid Fuel Use Overall, only 5.1% of the household population in Ukraine uses solid fuels for cooking. The use of solid fuels is very low in urban areas (2.4%), but substantially higher in rural areas, where  11.9% of the household population uses solid fuels for cooking. The largest proportion of the household population living in households using solid fuels for cooking (81.7%), cooks in a separate room used as a kitchen (91.8% in urban areas, and 76.3% in rural areas). Water and Sanitation Improved Use of Water Sources Overall, 98.2% of the population in Ukraine use an improved source of drinking water. The source of drinking water for the population varies by the area type and by the household wealth. In urban settlements 78.8% of the population uses drinking water piped into dwelling, whereas in rural areas this type of water supply is only available to 25% of the population; at the same time, depending on the wealth index, this indicator ranges from 9.2% in the first quintile (the poorest) to 89.9% in the fourth and 88.6% in the fifth quintile (the richest), which can be explained by stronger disposition of rural population towards lower wealth levels. Use of Improved Sanitation Almost the entire population of Ukraine (97.7%) lives in households that have improved sanitation facilities. Use of improved sanitation is closely linked to households’ wealth and living conditions; the rural population tends to use pit latrines with slab (almost 60%), while the most widespread sanitation facility in urban settlements is the toilet with flush to a piped sewer system or septic tank. Reproductive Health Fertility Rates According to MICS 2012 data the total fertility rate (TFR) is 1.5 children per woman of reproductive age (1.9 in rural areas and 1.3 in urban areas). Fertility rates of women belonging to neighbouring age groups of  20–24  and  25–29  years are the highest  – about 92 live births per 1,000 women in the specified age groups. The proportion of women who never had children among respondents of the oldest age group (45–49 years) was at 6.7%. The proportion of young women with the experience of pregnancy among those who already turned 18 increases drastically – almost 11% as compared to 1.6% among those aged 17 years. Abortion In Ukraine, induced termination of pregnancy used to be one of the most widespread means of birth control. In the last years, the abortion and birth rates in health care facilities of Ukraine show positive dynamics with steady reduction of abortion rates per 1,000 fecund women (aged 15–49), and correlation between the number of abortions and live births. According to the survey data, the majority of pregnancies within the three-year period preceding the survey (over 80%) ended in a live birth and 13.9% of pregnancies ended in abortion (5.3% – in miscarriages). According to MICS 2012, the percentage of women with a lifetime experience of induced abortion is 23.1%. Among women who have ever had an abortion 58.2% had one induced abortion; a significant percentage of women (37.2%) reported having 2–3 abortions; and less than 5% of Ukrainian women artificially terminated their pregnancies four or more times. 20Executive Summary Antenatal Care and Assistance at Delivery According to MICS 2012, the coverage of women with antenatal care is very high: 98.6% of pregnant women were provided with antenatal care at least once by skilled personnel. Antenatal care in Ukraine is typically provided by doctors (in 97.4% of cases); in rare cases (1.2%) pregnant women are observed by nurses or midwives. Virtually all births in Ukraine in the two years preceding MICS were delivered by a skilled health professional. Most of these deliveries (almost 92%) were attended by a doctor, with nurses/midwives attending only 7% of births, and in very rare cases (about 1%) – by another person. The majority of deliveries (98.9%) in Ukraine take place in health facilities. In Ukraine all women who gave birth in a health facility stay there for 12 or more hours following delivery. Family Planning and Unmet Need Information on fertility preferences is useful for understanding future fertility patterns, its characteristics and the demand for contraception. 15.2% of married women want to have a child/another child soon (within two years); 9.4% want a child/another child two or more years in the future;  15.6% of women are undecided as to when to have a child/another child; and  7.1% declared themselves to be infecund.  50.7% of all married women do not want a child/more children. The majority of women and men (among those who provided a numeric response) prefer an ideal family size of two children. Generally, women have good knowledge of contraceptive methods, both modern and traditional. The most widely-known modern methods of family planning among women are: male condoms (99.8%), contraceptive pills (98%), IUD (95.8%), and female sterilization (82.9%). Women are much less aware of such methods as injectables and implants, diaphragms and rings, foam/jelly, patch and emergency contraception.  53.6% of all women have ever used one or more contraception method and 52.1% of women are currently using a method of contraception. Unmet need for contraception in Ukraine constitutes 4.9%, including 3.1% of women with unmet need for spacing, and 1.8% with unmet need for limiting. The percentage of unmet need for contraception is  5.7% in rural areas and 3.7% in big cities. Child Development In Ukraine, 51.9% of children aged 36–59 months are attending organized early childhood education programmes. No gender differentials exist in the coverage of children with early childhood education programmes, but differentials by socio-economic status of households are evident. 65.1% and 68.4% of children living in households in the fourth and the richest wealth quintiles respectively attend such programmes, while the figure drops to 29.9% in poorest households. Additionally, the Early Child Development Index in Ukraine is 89.0%. It should also be added that 98.1% of children aged 36–59 months are on track in terms of physical development. Education In Ukraine, up to 78.5% of children attending first grade of primary school had attended pre-school in the previous year. 99.8% of children aged 7–10 attended elementary school. The percentage of children aged 11–17 attending secondary school was somewhat lower – 93.1%. Child Protection Birth Registration The births of 99.8% of children under 5 have been registered with civil authorities in Ukraine. There are no significant variations in birth registration across regions, areas of residence, types of household, sex, age, mother’s education or wealth. 21Executive Summary Child Labour According to Ukraine MICS 2012, 3.4% of children aged 5–11 years, and 0.3% of children aged 12–14 years are involved in different forms of child labour. Overall, the percentage of children of 5–14 years of age involved in different forms of child labour in Ukraine is 2.4%. The biggest involvement of children in child labour activities was found in households in the poorest and second wealth quintiles. Child discipline In  Ukraine,  61.2% of children aged  2–14  years were subjected to at least one form of psychological or physical punishment by an adult in the household during the past month preceding the survey. More importantly,  1.0% of children were subjected to severe physical punishment. 11.2% of respondents believed that children should be physically punished. In practice, however, as many as 29.9% of children aged 2 to 14 years were subjected to some kind of physical punishment, which indicates an obvious contrast between declared views and real actions of a share of parents and other members of households with children. Male children are more likely to be subjected to any physical discipline (36.5%) than female children (23.4%). HIV/AIDS and Sexual Behaviour In Ukraine, knowledge of HIV/AIDS is almost universal, as 99.7% of women have heard of AIDS. 95.6% of women know that having only one faithful uninfected partner reduces their chance of contracting HIV, and 93.0% know that using a condom every time they have sex reduces their chance of contracting HIV. 90.8% of women are aware of these two key prevention methods. Almost all men (99.5%) have heard of AIDS. 95.2% of men know that having only one faithful uninfected partner reduces their chances of contracting HIV, and 92.8% know that using a condom every time they have sex reduces their chances of contracting HIV.  The percentage of men who know both of these two main ways of preventing HIV transmission is 90.4%. In general, comprehensive knowledge about HIV prevention remains fairly low. According to MICS 2012 results, 53.8% of women and 46.7% of men were found to have comprehensive knowledge about HIV/AIDS. Awareness of mother- to-child transmission of HIV  encourages women to seek HIV  testing when they are pregnant, in order to avoid transmitting the infection to their offspring. Overall, 90.5% of women know that HIV can be transmitted from mother to child, but the percentage of women who have knowledge of all three ways of mother-to-child transmission is only 50.6%. Men are less aware of information regarding mother-to-child transmission of HIV, as only 73.5% of men know that HIV can be transmitted from mother to child. Another important indicator in terms of HIV awareness is the knowledge of a place for HIV testing and the use of such services. Although 90.6% of women know where to get tested for HIV, only 62.9% have actually done so. Despite the fact that 87.3% of men know where to get tested for HIV, only 52.2% of men have actually been tested. Access to Mass Media In Ukraine, 59.3% of women and 52.8% of men aged 15–49 read newspapers at least once a week; about 50% of both men and women of this age listen to the radio, and almost all men and women (over 95%) watch television at least once a week. 35.8% of women and 34.6% of men are exposed to all three types of media at least on a weekly basis, while 1.8% of women and 2.9% of men do not have regular exposure to any of the three media. Main sources of information on health-related issues for both women (87.1%) and men (77.2%) aged 15–49 years are health workers.  44.3% of women and  43.4% of men mentioned friends and relatives as sources of such information; 42.7% of women and 30.4% of men receive health-related information from television. Over one-third of women (34.7%) and slightly fewer men (29.5%) aged 15–49 years search for information on health- related issues on the Internet, which is a particularly popular source of information on issues related to health among youth and among urban residents in general. 22Executive Summary Tobacco and Alcohol Use Tobacco Use Overall, 16.2% of women aged 15–49 are current cigarette smokers. Smoking is most common among women living in big cities, where almost each fourth woman (22.4%) of childbearing age is a smoker. Smoking is significantly less prevalent among rural women, however, where the percentage of female smokers of the same age is only  8.1%. In Ukraine, smoking mainly starts during adolescence, and the percentage of those who smoked their first cigarette before the age of 15 does not differ significantly between urban and rural residents (3.0–2.4%). Alcohol Use According to MICS 2012, only 9.3% of women reported that they had never had an alcoholic drink. This indicator differs significantly by type of settlement: 13.7% in rural areas compared to 7.8% in urban areas. 5.2% of women had their first drink of alcohol before the age of 15. Subjective Well-being MICS 2012 results revealed that, in Ukraine, the majority of youth (both women and men aged 15–24) are satisfied with their lives with regards to health, friendship, looks and appearance, and treatment by others. More specifically, the proportion of women who are generally satisfied with their family life and current job is somewhat higher than that among men, while young men hold the slight edge over women in other domains with the exception of income, where the satisfaction level is even between men and women. It is noteworthy that young women aged 15–24 are the least satisfied with their current jobs (69.4% of respondents who have a job), and their current incomes (44.4% of those who have income), which is almost the same for men: 68.2% and 44.4% respectively. In addition to life satisfaction questions, Ukraine MICS 2012 also asked questions regarding the sense of happiness and the perception of a better life. The survey reveals certain differences in the respondents’ subjective perceptions of life satisfaction and happiness. The majority of young people aged 15–24 years in Ukraine are very or somewhat happy, particularly 90.2% of female, and 88.1% of male respondents. The proportion of women aged 15–24 years who think that their lives improved during the last one year, and who expect that their lives will get better in one year, is 22.6% in Ukraine. The corresponding indicator for men is 17.1%. 23Map of Ukraine MICS 2012 Regions Map of Ukraine MICS 2012 Regions North region West region Centre region South region East region Kyiv Chapter I Introduction U N IC E F/ U K R A IN E /2 0 0 5 /G .P ir o zz i 271. Introduction 1 . Introduction 1 .1 . Background and Survey Objectives This report is based on the Ukraine Multiple Indicator Cluster Survey (MICS 2012), conducted in 2012 by the State Statistics Service of Ukraine with the support of the United Nations Children’s Fund (UNICEF) Country Office in Ukraine, in collaboration with the Ministry of Health, the Ministry of Social Policy and the Ministry of Education and Science, with support from the United States Agency for International Development (USAID) and the Swiss Cooperation Office (SDC). The survey provides valuable information on the situation of children and women in Ukraine including the data required to meet the needs to monitor Ukraine’s progress towards goals and targets emanating from international commitments under the Millennium Declaration adopted by all the United Nations Member States in September 2000, and the Plan of Action of A World Fit for Children, adopted by Member States at the United Nations Special Session on Children in May 2002. Both of these commitments build upon promises made by the international community at the 1990 World Summit for Children. In signing these international agreements, governments committed themselves to improving conditions for their children and to monitoring progress towards that end. UNICEF was assigned a supporting role in this task (see table below). A Commitment to Action: National and International Reporting Responsibilities The governments that signed the Millennium Declaration and the World Fit for Children Declaration and Plan of Action also committed themselves to monitoring progress towards the goals and objectives they contained: «We will monitor regularly at the national level and, where appropriate, at the regional level and assess progress towards the goals and targets of the present Plan of Action at the national, regional and global levels. Accordingly, we will strengthen our national statistical capacity to collect, analyse and disaggregate data, including by sex, age and other relevant factors that may lead to disparities, and support a wide range of child-focused research. We will enhance international cooperation to support statistical capacity-building efforts and build community capacity for monitoring, assessment and planning.» (A World Fit for Children, paragraph 60) «…We will conduct periodic reviews at the national and subnational levels of progress in order to address obstacles more effectively and accelerate actions…» (A World Fit for Children, paragraph 61) 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. The Ukraine Multiple Indicator Cluster Survey 2012 has as its primary objectives: – To provide up-to-date information for assessing the situation of children and women in Ukraine; – To furnish data needed for monitoring progress towards goals established in the World Fit for Children Plan of Action, Millennium Declaration and other internationally agreed upon goals, as a basis for future action; – To  contribute to the improvement of data collection and monitoring systems in Ukraine, and to strengthen technical expertise in the design, implementation and analysis of such systems; – To generate data on the situation of children and women, including the identification of vulnerable groups and disparities, to inform policies and interventions. 281. Introduction 1 .2 . Demographic Features of Ukraine Ukraine is located in Eastern Europe and occupies the territory of 603.5 thousand square kilometres. Ukraine borders on the Russian Federation in the east and northeast; Belarus in the north; Poland, Slovakia, Hungary and Romania in the west, and Moldova in the southwest. Administratively Ukraine is divided into  24  oblasts,  2  cities with special status (Kyiv and Sevastopol), and the Autonomous Republic of Crimea. Kyiv is the capital of Ukraine. As of 1 January 2013, the population of Ukraine was 45.6 million3. Ukraine’s population currently ranks among the ten biggest in Europe. The population of Ukraine reached its peak in 1993 (52.2 million); since then it has been decreasing steadily, with a decline by almost 6.7 million in the last 20 years. 68.9% of Ukraine’s population live in urban areas, and close to 60% of urban residents populate country’s 45 big cities (cities with a population of 100,000 and more). The average population density is over 75 people per square kilometre. The population density depends on the level of urbanization, concentration of big cities, and density of rural population. Therefore the population density in Ukraine is heterogeneous: it is the highest in the East (especially in Donetsk oblast – 166 persons per sq. km) and in the West (in Lviv oblast – over 116 persons per sq. km) and lowest in the North and in the South (the lowest population density is in Chernihiv oblast – 34 persons per sq. km).4 As many other European countries, Ukraine faces depopulation. But unlike other countries of the continent, Ukraine’s population decline is notable for its scale and rapid pace. At the beginning of 2000’s the country was losing an average of 350,000 persons annually. During the last three years the population decline has somewhat slowed down to 180– 80 thousand annually.5 The gender and age composition of Ukraine’s population was significantly affected by important historic events of the 20th century. Ukraine is one of the «oldest» countries of Europe as the percentage of people over 60 years in recent decades has been growing steadily in both urban and rural populations.6 Overall, this cohort exceeds 21% of the total population of Ukraine. Younger population groups prevail in the West, while the proportion of older generations is generally higher in the North (especially in Chernihiv and Sumy oblasts), in the East and the Centre of Ukraine. Population decline and ageing are closely associated with falling birth rates and resulting reduction of share of child population under  18  and under  5  in the overall structure of the country’s population. In  absolute numbers the age group of  0–17  years has decreased from  13.3  million in  1990  to  8  million in  2012.7 The increase in birth rates since 2007 did not have any impact on the reduction of population under 18 due to sharp decline of fertility rates in the period prior to 2007 and persons born before 1990 leaving this age group. The under-five population has also declined between 1990 and 2012 from 3.7 million to 2.5 million, but it has been growing steadily in recent years, having already reached the rates of the end of 1990’s. Government’s demographic policy aims at increasing birth and fertility rates among women. The share of population of reproductive age (15–49 years) – both male and female – virtually did not change in the overall structure of Ukrainian population in recent decades remaining at approximately 25 per cent. At the same time, deteriorating health conditions, low life expectancy, and high rates of mortality, especially among able-bodied men are seen as factors contributing to negative demographic trends in Ukraine. Average life expectancy in 2011 was 76 years for women and 66 years for men. The health status of the population is an integral indicator of country’s demographic and social wellbeing. Ukraine’s social transformation processes in  1990’s were accompanied by acute social and economic crisis that negatively affected the health status of the population. Adverse effect of the Chernobyl nuclear accident, as well as pollution from other man-made sources may have consequences on the health of the population. 1 .3 . Healthcare in Ukraine The Constitution guarantees the right to health to every citizen of Ukraine. Almost  11  000  hospitals,  224  000  medical doctors of all profiles (49.3  doctors per  10,000  population), and  460  000  nursing staff (101  nursing staff per 10,000 population) provide this right. 3 State Statistics Service of Ukraine. 2013 Yearbook ‘The Number of the Population in Ukraine as of 1 January 2013’. Kyiv, 2013.- http://ukrstat.gov. ua/druk/publicat/kat_u/2013/sb/06_13/sb_nnas_2012.zip. 4 Ibid. 5 State Statistics Service of Ukraine. Population of Ukraine.2011 Yearbook. Kyiv, 2012.- http://ukrstat.gov.ua/druk/publicat/kat_u/2012/12_2012/ zb_nasel_2011.zip. 6 Ibid. 7 Ibid. 291. Introduction 20% of the state budget of Ukraine is allocated annually to the health care, which constitutes approximately 5% of GDP. Health care facilities are primarily state financed, with the exception of private and specific targeted institutions. Due to the lack of financial support of the sector in recent years, the introduction of compulsory state health insurance is currently debated. All hospitals of the country are divided into three levels of state, municipal and private medical care provision. The hierarchy of these components of the system is based on political and administrative levels: the district, the regional, and the national levels. The state fully controls the health care system. The management and coordination of the system is provided by the Ministry of Health through Departments of Health within regional state administrations, Kyiv and Sevastopol city state administrations and through the Ministry of Health of the Autonomous Republic of Crimea. Polyclinics, dispensaries, rural medical points, and antenatal clinics provide the first level of care (non-specialized medical care). There is no clear division between services of primary and secondary (specialized) care in Ukraine. Patients can refer to a medical facility either with or without a referral. Specialized medical care is important in the health care provision system of Ukraine. It is divided into the second and the third levels of medical care. Specialized units in polyclinics and inpatient hospitals as well as dispensaries represent the second level. Highly specialized hospitals, research institutes under the Ministry of Health and under the Academy of Medical Sciences of Ukraine represent the third level. These medical facilities are equipped with expensive modern equipment. They apply the most advanced medical technology and elaborate new treatment methods for patients. The Ministry of Health, the President and the Cabinet of Ministers of Ukraine jointly develop and implement reforms and selected health care programs. A number of government programs are under implementation in the health sector, with the most important being the State Program «Reproductive Health of the Nation» until 2015, the National Programme for Immunization and Protection against Infectious Diseases for 2009–2015, the National Program for HIV Prevention, Treatment, Care and Support for HIV and AIDS for 2009–2013, the State Social Program to Reduce the Impact of Tobacco on Public Health until 2012. As a prerequisite for improving public health in Ukraine, the country is facing the task of reforming the health care system. In addition to improving the quality and the accessibility of basic health care, reform must change the budget healthcare system to gradually transfer Ukraine’s health system to the social health insurance model. Priorities for health care reform include: reform of health care financing, review of the structure of health services towards a model based on primary health care, as well as improvement of emergency medical services. Chapter II Sample and Survey Methodology U N IC E F/ U K R A IN E /2 01 2 /D .X a n th o p o u lo s 332. Sample and Survey Methodology 2 . Sample and Survey Methodology 2 .1 . Sample Design The sample for the Ukraine Multiple Indicator Cluster Survey 2012 was designed to provide reliable estimates for core survey indicators at the national level, for urban and rural areas, and for five geographical regions: North (the city of Kyiv, Kyiv oblast, Zhytomyr oblast, Sumy oblast, Chernihiv oblast); Centre (Cherkasy oblast, Poltava oblast, Kirovohrad oblast, Vinnytsia oblast); East (Dnipropetrovsk oblast, Donetsk oblast, Zaporizhia oblast, Luhansk oblast, Kharkiv oblast); South (Autonomous Republic of Crimea, the city of Sevastopol, Odesa oblast, Mykolayiv oblast, Kherson oblast); and West (Ivano-Frankivsk oblast, Khmelnytsky oblast, Chernivtsi oblast, Lviv oblast, Rivne oblast, Ternopil oblast, Volyn oblast, Zakarpatia oblast). The base population of MICS  2012  included all non-institutional households in Ukraine and their inhabitants excluding the households and persons residing in the first and second zone of radioactive contamination caused by the Chornobyl accident. The survey was based on probability stratified two-stage sample design. The primary stratification was based on geographical regions, and within regional domains  – on three types of settlements: cities (with a population of 100,000 and more), towns (with a population of less than 100,000) and rural areas. This has led to the formation of 15 strata. The sample PSUs (primary sampling units) were selected systematically with probability proportional to size (PPS) within each stratum at the first sampling stage – 480 sample PSUs overall. The database of election units for the presidential election 2010 served as the sampling frame for the urban areas. Therefore PSUs were arranged by the ordinal numbers of election units within larger election districts. The PSU size was determined by the number of voters in the election unit. The most recent (January  01,  2012) village council registration of households served as the sampling frame for the rural areas. A geographic serpentine ordering of rural rayons and PSUs within their limits (village councils) was applied to ensure better geographic coverage of the sample. The PSU size in rural areas was based on the number of households in village councils. Full listing of households was conducted in all selected PSUs  (household sampling frame); the households were stratified by those with children under 5 years, and those without children as of October 1, 2012. 27 enumerators were involved in household listing process (August 1–3, 2012). A systematic random sampling was applied in each secondary stratum within PSU  leading to the selection of 16 households without children under 5 and 10 households with children of this age. To improve the reliability of estimatesfor indicators of children under 5, the latter were oversampled. During the fieldwork, men aged 15–49 in every second sample household were selected for completion of the men’s questionnaires. Therefore the planned sample size of the MICS 2012 was 12,480 households; the actual sample size was 12,459 house- holds (the difference results from the fact that in 8 out of the 480 sample PSUs fewer than 10 households with children under 5 were listed due to the smaller number of households with children under 5 in these rural PSUs). The sample design results in different probabilities of selection for the two types of households by PSU. Therefore the estimation of survey indicators required the application of weighting procedures. A detailed description of the sample design and weighting procedures is provided in Appendix А. 2 .2 . Questionnaires The survey used four questionnaires and the form for vaccinations at health facility:  1) household questionnaire which was used to collect information on all de jure household members (usual residents), the household, and the dwelling;  2)  women’s questionnaire administered in each household to all women aged  15– 49 years; 3) men’s questionnaire, administered in every second household in the cluster to men aged 15–49 years;8 and  4)  under-5  questionnaire, administered to mothers or primary caretakers of all children under  5  living in the household. 8 The men’s questionnaire was introduced in MICS in Ukraine for the first time. 342. Sample and Survey Methodology Questionnaires included the following modules: Household Questionnaire: – Household Listing Form – Education – Water and Sanitation – Household Characteristics – Child Labour – Child Discipline – Salt Iodization Questionnaire for Individual Women – Woman’s Background – Access to Mass Media and Use of Information/Communication Technology – Child Mortality9 – Pregnancy History10 – Desire for Last Birth – Maternal and Newborn Health – Post-Natal Health Checks – Illness Symptoms – Contraception11 – Marriage / Union – Unmet Need for Contraception12 – Attitudes toward Domestic Violence – Sexual Behaviour – HIV/AIDS – Tobacco and Alcohol Use – Life Satisfaction Questionnaire for Individual Men – Man’s Background – Access to Mass Media and Use of Information/Communication Technology – Child Mortality – Contraception13 – Attitudes toward Domestic Violence – Marriage / Union – Fertility Preferences14 – Sexual Behaviour15 – HIV/AIDS – Life Satisfaction Questionnaire for Children Under Five – Age – Birth Registration – Early Childhood Development – Breastfeeding – Care of Illness – Immunization 9 With additional questions adapted from the DHS. 10 Module adapted from the DHS. 11 With additional questions adapted from the DHS. 12 With additional questions adapted from the DHS. 13 Module adapted from the DHS. 14 Module adapted from the DHS. 15 With additional questions adapted from the DHS. 352. Sample and Survey Methodology These questionnaires are based on the MICS4  model questionnaire. From the MICS4  model English version, the questionnaires were translated into Ukrainian and Russian languages. Similarly, instructions for interviewers and guidelines for completing and editing questionnaires were translated into Ukrainian. Upon recommendations of the United States Agency for International Development and taking into account the need to collect additional information on household living conditions and on the situation of children, women and men in Ukraine, standard questionnaires were supplemented with modules and individual questions from the Demographic and Health Survey (DHS) mostly related to reproductive health and sexual behaviour. A 13-day pre-test training for supervisors on August 1–13, 2012 was combined with the pre-test exercise. The questionnaires were pre- tested in August 2012 in the city of Kyiv and in several rural communities of Kyiv oblast. Based on the results of pre- test, modifications were made to the wording of some questions, and to questionnaire format. In addition to administration of questionnaires, field teams tested the salt used for cooking in the households for iodine content; and visited child health facilities to obtain information about immunization of children under five, if the immunization card was not available in the household. 2 .3 . Training and Fieldwork Training for the fieldwork was conducted throughout September 10–21, 2012. Training included lectures on interviewing techniques and the contents of questionnaires, as well as mock interviews among trainees to gain practice in interviewing. Towards the end of the training, trainees spent 2 days practicing interviewing in the city of Kyiv, in the town of Bucha, and in Kyiv-Sviatoshyn rayon of Kyiv oblast. The data was collected by  26  teams; each team comprised of  2  to  4  interviewers (depending on the number of clusters in the oblast), one supervisor, one editor, and one driver. Overall, 26 supervisors, 26 editors, 78  interview ers and  25  drivers were involved in the fieldwork. The fieldwork began on September  28,  2012, and concluded on December  31,  2012. The duration of the survey in the regions with  9  to  15  clusters was  2  months; with  16– 25 clusters – 2.5 months; and with 26–32 clusters – 3 months. 2 .4 . Data Processing The data was entered using CSPro software. The data was entered on  14  computers by  24  data entry operators and 3 supervisors working in two shifts. 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 adapted to the Ukraine questionnaire were used throughout. Data processing began almost simultaneously with data collection at the beginning of October 2012. Data entry was completed on January 14, 2013, while editing of the primary database was completed in February  2013. In  parallel with the data entry process, MICS  team proceeded with adaptation and finalisation of MICS  syntax for DHS  modules, included in survey questionnaires. Data was analysed using the Statistical Package for Social Sciences (SPSS) software, and the model syntax and tabulation plans, adapted to Ukraine questionnaires were used for this purpose. MICS tabulations were finalised in March 2013. In April 2013, preliminary findings of the survey analysis were submitted to the experts of academic, non-governmental and international organisations for their critical review. Chapter III Sample Coverage U N IC E F/ U K R A IN E /2 01 2 /M .K o ry sh o v 393. Sample Coverage and the Characteristics of Households and Respondents 3 . Sample Coverage and the Characteristics of Households and Respondents 3 .1 . Sample Coverage Results of household, women’s, men’s and children under-five’s interviews by area16 and regions are provided in Table НН.1. Of the 12,459 sampled households, 11,871 households were occupied. Of these, 11,321 were successfully interviewed yielding a household response rate of 95.4 per cent. In  the interviewed households,  8,239  women (aged  15–49  years) were identified as eligible. Of  these,  8,006  were successfully interviewed yielding a response rate of 97.2% within interviewed households. 3,829 men (aged 15–49 years) were identified in the households selected for the men’s questionnaire. Questionnaires were completed for 3,620 of eligible men, which corresponds to a response rate of 94.5% within interviewed households. There were 4,402 children under the age of 5 identified in the interviewed households. Questionnaires were completed for 4,379 of these children, which corresponds to a response rate of 99.5% within interviewed households. Overall response rates17 of  92.7% and  90.2% are calculated for the interviews of women and men aged  15–49, respectively. The overall response rate calculated for children under the age of 5 is slightly higher than women’s and men’s overall response rates, reaching 94.9%. One should note the differentials in household response rates by the area. The response rate in rural areas is 98.6%, which is slightly higher than that in urban settlements (95.4% in towns and 92.6% – in cities). Household response rates are comparatively high in the West, the Centre and the East regions, ranging from 96.4% to 97.7%. At the same time, the response rates in the North and in the South are slightly lower – 93.2% and 91.7%, respectively. Table HH .1 . Results of household, women’s, men’s and under-5’s interviews Number of households, women, men, and children under 5 by results of the household, women’s, men’s and under- 5’s interviews, and household, women’s, men’s and under-5’s response rates, Ukraine, 2012 Households Area Region Total Urban including Rural North West Center East South Big city Small town Sampled 8232 5010 3222 4227 2488 2497 2495 2487 2492 12459 Occupied 7837 4767 3070 4034 2355 2392 2342 2420 2362 11871 Interviewed 7344 4415 2929 3977 2195 2338 2257 2366 2165 11321 Household response rate 93.7 92.6 95.4 98.6 93.2 97.7 96.4 97.8 91.7 95.4 Women Eligible 5362 3250 2112 2877 1541 1953 1578 1724 1443 8239 Interviewed 5199 3140 2059 2807 1453 1915 1539 1705 1394 8006 Women's response rate 97.0 96.6 97.5 97.6 94.3 98.1 97.5 98.9 96.6 97.2 Women's overall response rate 90.9 89.5 93.0 96.2 87.9 95.8 94.0 96.7 88.5 92.7 Men Eligible 2518 1552 966 1311 692 884 716 840 697 3829 Interviewed 2378 1446 932 1242 609 854 680 820 657 3620 Men's response rate 94.4 93.2 96.5 94.7 88.0 96.6 95.0 97.6 94.3 94.5 Men's overall response rate 88.5 86.3 92.0 93.4 82.0 94.4 91.5 95.4 86.4 90.2 Children under 5 Eligible 2788 1618 1170 1614 761 996 868 909 868 4402 Mother/Caretaker Interviewed 2769 1605 1164 1610 749 991 866 906 867 4379 Under-5's response rate 99.3 99.2 99.5 99.8 98.4 99.5 99.8 99.7 99.9 99.5 Under-5's overall response rate 93.1 91.9 94.9 98.3 91.7 97.3 96.1 97.4 91.6 94.9 16 Ukraine MICS4 provides estimates for urban and rural areas, with urban areas further subdivided into big cities (with a population of 100,000 and more) and small towns (with a population less than 100,000). 17 Overall response rates are calculated for women, men and under-5’s by multiplying the household response rate with the women’s, men’s and under-5’s response rates, respectively. 403. Sample Coverage and the Characteristics of Households and Respondents 3 .2 . Characteristics of Households The weighted age and sex distribution of the survey population is provided in Table НН.2. The distribution is also used to produce the population pyramid in Figure НН.1. When estimating indicators a system of statistical weights was used to take into account the probabilities of selecting households and their members as well as their response rates. Final statistical weights were normalised to equal the total number of households and their members with the unweighted data. Detailed information on the weighting procedures is provided in Annex A. 28,658  people were listed in  11,321  households that were successfully interviewed. The mean household size is  2.53  members, which is almost identical to the national household living conditions survey (HLCS), which shows 2.58 members18. Table HH .2 . Household age distribution by sex Per cent and frequency distribution of the household population by five-year age groups, dependency age groups, and by child (aged 0–17) and adult populations (aged 18 and more), by sex, Ukraine, 2012 Males Females Total Number Percent Number Percent Number Percent Age 0–4 782 5.9 767 5.0 1549 5.4 5–9 695 5.3 632 4.1 1327 4.6 10–14 636 4.8 648 4.2 1283 4.5 15–19 710 5.4 619 4.0 1330 4.6 20–24 827 6.3 886 5.7 1713 6.0 25–29 1114 8.5 1155 7.5 2270 7.9 30–34 1126 8.5 990 6.4 2116 7.4 35–39 924 7.0 986 6.4 1911 6.7 40–44 917 7.0 988 6.4 1905 6.6 45–49 953 7.2 982 6.3 1934 6.8 50–54 937 7.1 1223 7.9 2160 7.5 55–59 1074 8.2 1525 9.9 2599 9.1 60–64 872 6.6 1142 7.4 2014 7.0 65–69 495 3.8 758 4.9 1253 4.4 70–74 578 4.4 934 6.0 1512 5.3 75–79 297 2.3 562 3.6 858 3.0 80–84 180 1.4 452 2.9 632 2.2 85+ 58 0.4 227 1.5 285 1.0 Missing/DK 4 0.0 3 0.0 8 0.0 Dependency age groups 0–14 2112 16.0 2046 13.2 4159 14.5 15–64 9455 71.7 10497 67.8 19952 69.6 65+ 1607 12.2 2932 18.9 4540 15.8 Missing/DK 4 0.0 3 0.0 8 0.0 Children and adult populations Children age 0–17 years 2553 19.4 2449 15.8 5002 17.5 Adults age 18+ years 10622 80.6 13026 84.2 23648 82.5 Missing/DK 4 0.0 3 0.0 8 0.0 Total 13179 100 .0 15479 100 .0 28658 100 .0 Table HH.2 shows that the population group aged 0–14 constitutes 14.5%, boys aged 0–14 years constitute 16.0% of the total male population, and the girls of this age group constitutes 13.2% of the total female population. The age group of 15 to 64 years that defines economically active population is 69.9% of the population. This age group 18 «The Socio-Demographic Characteristics of Households in Ukraine in  2012»: statistical publication, I.  Osypov; the State Statistics Service of Ukraine – Kyiv, state enterprise «Information-Analytical Agency», 2012–80p. This multipurpose sample survey of household living conditions has been carried out by the State Statistics Committee since 1999. Close to 10.5 thousand non-institutional households are surveyed quarterly on condition of full annual sample rotation. HLCS is based on internationally accepted standards. 413. Sample Coverage and the Characteristics of Households and Respondents comprises 71.7% of the total male population, and 67.8% of the total female population. The share of elderly people above  65  years is  15.8%, including  12.2% of the total male population and  18.9% of the total female population. Finally, 17.5% of all household members are children age 0–17 years (boys form 19.4% of the total male population and girls form 15.8% of the total female population). According to estimates of the State Statistics Service of Ukraine as of January  1,  2012,19 the proportion of those aged 0–14 years made up 14.4% of the country’s population; of persons aged 15–64 years – 70.4%; and of persons aged 65 years and older – 15.2%. Figure НН .1 . Age and sex distribution of household population, Ukraine, 2012 Figure НН.1  provides the per cent distribution of survey population by age and sex within five-year age groups. Women and Men represent 54.0% and 46.0% of household residents correspondingly. It should be noted that gender disparity is mostly concentrated among the population aged 50 and older, which can be explained by differences in life expectancies of men and women in Ukraine. According to the State Statistics Service data, the proportion of male and female population in Ukraine as of January 1, 201220 was 46.2% and 53.8% respectively. Therefore, there are no significant variations between the MICS 2012 data and official demographic statistics, while distributions of the population by age and sex are very similar. Tables HH.3-HH.5 provide basic information on the households, female respondents age 15–49, male respondents age 15–49, and children under-5 by presenting the unweighted, as well as the weighted numbers. Information on the basic characteristics of women, men and children under-5 interviewed in the survey is essential for the interpretation of findings presented later in the report, and also can provide an indication of the representativeness of the survey. 19 Hereinafter all the references for the national statistical data stand for the official website of the State Statistics Service of Ukraine – www.ukrstat. gov.ua. 20 Distribution of Permanent Population of Ukraine by Gender and Age as of January 01, 2012: Statistical Publication, H. Tymoshenko; the State Statistics Service of Ukraine – Kyiv, state enterprise «Information-Analytical Agency», 2012–413p. 8 6 4 2 0 2 4 6 8 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Per cent Рис . НН .1. Статево – вікова піраміда населення , Україна , 2012 Females Males 423. Sample Coverage and the Characteristics of Households and Respondents Table HH .3 . Household composition Per cent and frequency distribution of households by selected characteristics, Ukraine, 2012 Weighted per cent Number of households Weighted Unweighted Sex of household head Male 52.1 5895 6087 Female 47.9 5426 5234 Region North 18.1 2045 2195 West 20.7 2346 2338 Center 12.2 1380 2257 East 33.0 3731 2366 South 16.1 1819 2165 Area Urban 73.5 8323 7344 Big city 44.2 5000 4415 Small town 29.4 3323 2929 Rural 26.5 2998 3977 Number of household members 1 25.0 2825 2100 2 31.8 3597 2759 3 21.4 2418 2625 4 13.7 1550 2097 5 5.3 602 1035 6 1.9 213 441 7 0.6 67 156 8 0.2 28 56 9 0.1 11 24 10+ 0.1 10 28 Education of household head None 0.3 32 44 Primary 3.7 416 366 Secondary 46.5 5259 5331 Higher 49.6 5611 5575 Missing/DK 0.0 3 5 Total 100.0 11321 11321 Households with at least: one child age 0–4 years 12.3 11321 11321 one child age 0–17 years 31.3 11321 11321 one woman age 15–49 years 48.8 11321 11321 one man age 15–49 years 52.6 5603 5632 Mean household size 2.5 11321 11321 Table НН.3 provides basic information on households. Within households, the sex of the household head, region, area, number of household members, education of household head21 are shown in the table. These background characteristics are used in subsequent tables of the present report. The figures in the table show the numbers of observations by major categories of analysis. Furthermore, the table shows proportions of households with at least 21 To determine respondents’ education, the MICS questionnaires used the following levels (number of study years provided in brackets): none, primary (1–4), secondary (5–12), PTU (1–3), technical / vocational school (1–4), higher education (1+). At the stage of data analysis all information concerning educational levels of respondents was grouped into the following categories: none; primary; secondary (includes secondary schools and PTU, that is, secondary and secondary special education); and higher (includes higher education facilities and technicums of levels 1–4). Therefore, two basic educational levels were established for adult respondents – secondary and higher. This made it possible to determine key differentials for the majority of indicators more effectively. The levels of education used for data disaggregation in the present report indicate the highest level which the person attended or is attending. 433. Sample Coverage and the Characteristics of Households and Respondents one child under 5, at least one child under 18, at least one eligible woman aged 15–49 years, and at least one eligible man in the same age group. Therefore, the proportion of households with at least one child under five is 12.3%. 31.3% of households have at least one child under 18 years of age. Of all surveyed households, there are 48.8% and 52.6% of them house at least one woman aged 15–49, and at least one man aged 15–49, respectively. The majority of households (73.5%) are located in urban areas (44.2% in cities and 29.4% in towns); the remaining 26.5% are rural households. Distribution of households by the sex of household head shows that representation of men and women in this role is fairly even (52.1% and 47.9% respectively). The heads of about half of all households have higher education, and persons with secondary education head  46.5% of households. Heads of the remaining households mainly have primary education. 25.0% of households consist of one member (according to the HLCS 2012 data, the proportion of single-member households is 23.4%); 31.8% of households have two members (HLCS – 29.0%); 21.4% of households consist of three persons (HLCS – 24.8%); 13.7% of households have four members (HLCS – 14.4%); and 8.2% of households include five and more members (HLCS – 8.4%). 3 .3 . Characteristics of Respondents Tables HH.4, HH.4M and HH.5 provide information on the background characteristics of female and male respondents of 15–49 years of age and of children under age 5. Since sample weights have been normalised, the total numbers of weighted and unweighted observations are equal in all three tables. In addition to providing information on the background characteristics of women and children, the tables show the numbers of observations in each background category. These categories are used in the subsequent tabulations of the report. Table HH.4  provides background characteristics of female respondents of  15–49  years of age. The table includes information on the distribution of women according to the region and the area of residence, age, marital status, motherhood status, birth in last two years, education and wealth index quintiles.22 Three quarters of women aged 15–49 years live in urban areas (45.7% – in big cities, and 29.1% – in small towns); the remaining women aged 15–49 (25.2%) live in rural communities. 32.4% of women aged 15–49 live in the East; 25.3% – in the West; 17.4% – in the North; 13.9% – in the South, and 11.0% – in the Centre of the country. In  MICS  2012, female population aged  15–49  is almost evenly distributed according to age. Even though the proportion of women aged 25–29 is somewhat higher than that of other age groups (which can be explained by the fact that women in this group were born in 1980’s when there was a peak in birth rate), this distribution is very similar to the State Statistics Service of Ukraine data as of January 1, 2012.23 When MICS 2012 was conducted, the majority of women aged 15–49 years (63.1%) were married or in union; 13.6% of women were divorced or separated; 2.5% of surveyed women were widows, 20.8% of female respondents had never been married / in union. 22 Principal components analysis was performed by using information on the ownership of consumer goods and dwelling and water and sanitation facilities characteristics (use of improved water sources, improved sanitation, number of rooms used in household for sleeping, material of the floor, material of the roof, material of the walls, type of fuel used for cooking, availability of electricity, radio tuner, CRT  TV,  flat screen TV, fixed-line telephone, refrigerator, DVD player, air conditioner, satellite dish, desktop computer, laptop, tablet computer, washing machine, microwave oven; watch, cell phone, car/truck, motorboat owned by one of household members; bank account), as well as other dwelling and other characteristics (the number of rooms used for sleeping, sources of energy to cook meals) that are related to the household’s wealth to assign weights 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 the lowest to highest: 1) the lowest group (poorest); 2) below average (second); 3) average (middle); 4) above average (fourth); and 5) the highest (richest). 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. This approach to calculating wealth index is widely used in international household survey programmes. Further information on the construction of the wealth index can be found in 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. 23 Distribution of Permanent Population of Ukraine by Gender and Age as of January 01, 2012: Statistical Publication, H. Tymoshenko; the State Statistics Service of Ukraine – Kyiv, state enterprise «Information-Analytical Agency», 2012–413p. 443. Sample Coverage and the Characteristics of Households and Respondents Table HH .4 . Women’s background characteristics Per cent and frequency distribution of women aged 15–49 years by selected background characteristics, Ukraine, 2012 Weighted per cent Number of women Weighted Unweighted Region North 17.4 1396 1453 West 25.3 2022 1915 Centre 11.0 883 1539 East 32.4 2594 1705 South 13.9 1112 1394 Area Urban 74.8 5988 5199 Big city 45.7 3660 3140 Small town 29.1 2329 2059 Rural 25.2 2018 2807 Age 15–19 9.2 733 593 20–24 13.4 1075 1203 25–29 17.5 1402 1942 30–34 15.0 1200 1421 35–39 15.0 1200 1086 40–44 15.0 1204 888 45–49 14.9 1191 873 Marital / Union status Currently married / in union 63.1 5051 5547 Widowed 2.5 204 176 Divorced 10.4 830 738 Separated 3.2 253 274 Never married / in union 20.8 1668 1271 Motherhood status Ever gave birth 70.7 5662 6478 Never gave birth 29.3 2344 1528 Births in the last two years Had a birth in the last two tears 8.8 707 1564 Had no birth in the last two years 91.2 7299 6442 Education Secondary 32.0 2559 2811 Higher 68.0 5441 5187 Wealth Index quintiles Poorest 14.5 1157 1566 Second 19.1 1527 1780 Middle 19.1 1532 1424 Fourth 21.8 1744 1547 Richest 25.6 2046 1689 Total 100.0 8006 8006 8 unweighted cases of women with no education not shown According to their motherhood status, 70.7% of women aged 15–49 years had given birth before, but only 8.8% of all women of this age category had a birth in the last two years. As a rule, women aged 15–49 years have high levels of education, with 68% of them having attended higher education, and 32% – secondary education.24 In terms of household wealth index, about one-third of all women aged 15–49 years live in households in two lowest quintiles – the poorest and the second (14.5% and 19.1% respectively). 19.1% of women represent households in the 24 See footnote further. 453. Sample Coverage and the Characteristics of Households and Respondents middle wealth quintile, and 21.8% – in the fourth wealth quintile. At the same time, slightly more than one quarter of women aged 15–49 years (25.6%) live in prosperous households that belong to the highest (richest) wealth quintile. Similarly, Table HH.4M provides background characteristics of male respondents  15–49  years of age. The table provides information on the distribution of men according to the region, the area, age, marital status, education, and wealth index quintiles. Table HH .4M . Men’s background characteristics Per cent and frequency distribution of men aged 15–49 years by selected background characteristics, Ukraine, 2012 Weighted per cent Number of men Weighted Unweighted Region North 16.6 600 609 West 23.8 863 854 Centre 10.5 381 680 East 34.3 1243 820 South 14.8 534 657 Area Urban 74.8 2709 2378 Big city 45.9 1662 1446 Small town 28.9 1047 932 Rural 25.2 911 1242 Age 15–19 9.9 357 302 20–24 12.4 448 422 25–29 17.3 626 725 30–34 17.5 635 763 35–39 13.6 491 561 40–44 13.3 481 409 45–49 16.1 582 438 Marital / Union status Currently married / in union 56.5 2045 2448 Widowed 0.8 28 23 Divorced 7.8 283 198 Separated 3.9 141 91 Never married / in union 31.0 1123 860 Education Secondary 42.2 1526 1603 Higher 57.8 2093 2014 Wealth Index quintiles Poorest 15.3 555 719 Second 18.3 664 750 Middle 20.2 730 671 Fourth 20.8 754 704 Richest 25.3 917 776 Total 100.0 3620 3620 3 unweighted cases of men with no education not shown Table HH.4М shows that the majority of male respondents aged  15–49  live in urban areas (45.9%  – in big cities, and 28.9% – in small towns); 25.2% of men live in rural areas. 34.3% of surveyed men live in the East; 23.8% – in the West; 16.6% – in the North; 14.8% – in the South; and 10.5% – in the Centre of Ukraine. Age distribution of male population of 15–49 years of age is as follows: 9.9% in the group of 15–19 years; 12.4% – 20– 24 years; 17.3% – 25–29 years; 17.5% –30–34 years; 13.6% – 35–39 years; 13.5% – 40–44 years; and 16.1% – in the group of 45–49 years. Slightly more than half of men aged 15–49 (56.5%) are either married or live in union; 11.7% of men are divorced or separated; 0.8% are widowers; and 31.0% of men have never been married or in union. 463. Sample Coverage and the Characteristics of Households and Respondents Similar to women, Ukrainian men aged 15–49 have high level of education, including 57.8% – with higher education, and 42.2% – with secondary education. 15.3% and 18.3% of men aged 15–49 can be found in two lowest wealth index quintiles – in the poorest and in the second respectively. 20.2% of men live in households in the middle wealth index quintile, and 20.8% – in the fourth wealth quintile. 25.3% of men aged 15–49 years belong to the highest (richest) wealth index quintile. Some background characteristics of children under 5 are presented in Table HH.5. These include the distribution of children by sex, region, area, age, mother’s (caretaker’s) education, and household’s wealth. According to MICS 2012, 50.2% of children under 5 are boys, and 49.8% are girls. Almost 70% of under-5s live in urban settlements (38.5% – in cities, and 31.2% – in towns); the remaining children live in rural areas. The age distribution of surveyed children is as follows: under  6  months  –  8.2%;  6–11  months  –  9.7%;  12– 23 months – 19.0%; 24–35 months – 19.0%; 36–47 months – 21.7%, and 48–59 months – 22.3%. 66.7% of mothers with children under five have higher education; the remaining 33.2% of mothers have secondary education. Special attention should be given to the prosperity level of households with children under  5, as it is somewhat different from the general wealth indexes of surveyed households.  40.3% of households with children under five belong to two lowest wealth quintiles, including  17.7% of such households in the poorest quintile.  18.1% of households with children under 5 belong to the middle wealth quintile, and 19.6% – to the fourth wealth quintile. The remaining 22.0% of children under 5 live in households in the highest (richest) wealth quintile. Table HH .5 . Under-5’s background characteristics Per cent and frequency distribution of children under five years of age by selected characteristics, Ukraine, 2012 Sex Weighted per cent Number of children Weighted Unweighted Male 50.2 2198 2229 Female 49.8 2181 2150 Region North 17.2 751 749 West 29.2 1278 991 Centre 11.3 497 866 East 27.4 1199 906 South 14.9 654 867 Area Urban 69.7 3052 2769 Big city 38.5 1684 1605 Small town 31.2 1367 1164 Rural 30.3 1327 1610 Age 0–5 months 8.2 358 307 6–11 months 9.7 427 401 12–23 months 19.0 834 855 24–35 months 19.0 832 887 36–47 months 21.7 952 976 48–59 months 22.3 976 953 Mother’s education* Secondary 33.2 1453 1564 Higher 66.7 2921 2810 Wealth Index quintiles Poorest 17.7 775 959 Second 22.6 990 980 Middle 18.1 794 739 Fourth 19.6 858 827 Richest 22.0 963 874 Total 100.0 4379 4379 * Mother’s education refers to educational attainment of mothers and caretakers of children under 5. 5 unweighted cases of mothers with no education not shown Chapter IV Child Mortality U N IC E F/ U K R A IN E /2 0 0 5 /G .P ir o zz i 494. Child Mortality 4 . Child Mortality 4 .1 .  Definition and methodology Child mortality rates are universally recognised indicators of the nation’s health as they mirror the quality of people’s life and their prosperity, distribution of social and material benefits in the society, environmental status, the level of education and culture, effectiveness of prevention, accessibility and quality of health care. One of the overarching goals of the Millennium Development Goals (MDGs) is the reduction of infant and under-five mortality. Specifically, MDG 4 calls for the reduction in child mortality by two-thirds between 1990 and 2015. Monitoring progress towards this goal is an important social objective. MDG goal to reduce child mortality in Ukraine was duly included in already completed National programme «Reproductive Health  2001–2005» and in currently implemented programme «Reproductive Health of the Nation for the Period until  2015»25. The national project «New Life  – New Quality of Maternity and Childhood» was launched in 2011 to develop a network of specialised perinatal centres in all oblasts of the country26. Since the primary causes of childhood mortality, from biological to environmental factors, change as children age, childhood mortality rates analysed in the present report are defined as follows: – Neonatal mortality (NN): the probability of dying within the first month of life (at the age of 0–30 days); – Post-neonatal mortality (PNN): the probability of dying after the first month of life but before the first birthday (at the age of 1–11 months); – Infant mortality (1q0): the probability of dying before the first birthday (at the age of 0–11 months); – Child mortality (4q1): the probability of dying between the first and fifth birthday (at the age of 1–4 years or 12– 59 months); – Under-five mortality (5q0): the probability of dying between birth and the fifth birthday (at the age of 0–4 years or 0–59 months). The rates of child mortality are expressed as deaths per 1,000 live births, except in the case of child mortality (4q1), which is expressed as deaths per 1,000 children surviving to age one. Women of reproductive age (15–49  years) were asked whether they had ever given birth, and if yes, they were asked to report the number of sons and daughters who live with them, the number who live elsewhere, and the number who died. Using the standard international definition, a live birth was any birth, irrespective of the duration of pregnancy that, after separation from the mother, showed any sign of life (e.g. breathing, beating of the heart, or movement of muscles) (WHO, 1992)27. In addition, they were asked to provide their detailed pregnancy history in reversed chronological order starting with the last pregnancy outcome. Women were asked to provide outcomes of each pregnancy (a live birth, an induced abortion, a miscarriage, or a stillbirth), the date of pregnancy termination, sex of the children, survival status, and if child is not alive, the age at death (in days, months or years). In 2007 Ukraine adopted an international registration and statistics system in the definition of criteria of perinatal period, live births and stillbirths, and relevant procedure of live births and stillbirths registration28. This has led to an increase in child mortality rate, which, however, was lower than expected. According to the official data of the State Statistics Committee of Ukraine, infant and under-five mortality rates in Ukraine are gradually declining since 2007. Nonetheless, the child mortality level in Ukraine is still higher than in most of the European countries. Infant mortality in Ukraine is a fundamental determinant of under-five mortality. The probability of dying reduces drastically after a child reaches his or her first birthday. Therefore, it is expedient to perform comparative analysis of child mortality estimates and the state registration statistics on the basis of infant mortality rates. Figure CM.1 shows infant mortality rate estimates from different sources, based on responses of women in different age groups, and referring to various points in time, thus showing the estimated trend in infant mortality rates on the basis of the DHS 2007 and MICS 2012 surveys and the State Statistics data. 25 Approved by the Cabinet of Ministers of Ukraine Resolution No. 1849 as of December 27, 2006. 26 http://www.ukrproject.gov.ua/project/nove-zhittya. 27 International classification of diseases and related health problems.10th revision. – Geneva: World Health Organization; 1992. 28 Order of the Ministry of Health of Ukraine No. 179 as of March 29, 2006 «On Approval of Guidelines for Definition of Perinatal Period, Live Births and Stillbirths Criteria, and for Procedure of Registration of Live Births and Stillbirts». 504. Child Mortality Figure СМ .1 Infant mortality rate dynamics in Ukraine according to the State Statistics data (WHO vital registration, 1995–2011), DHS 2007 and MICS 2012 (direct and indirect estimates), Ukraine, 2012 . 29 Differences between the data from different sources prior to mid-2007 may be preconditioned by varying approaches to the definition of live birth, and by different methods for estimating child mortality before and after 2007. Further qualification of these apparent declines and differences as well as their determinants should be taken up in a more detailed and separate analysis. Calculations of early childhood mortality rates presented below are based on direct estimation (based on the information of pregnancy histories provided by female respondents in responses to the respective module of the women’s questionnaire). 4 .2 .  Levels and trends in infant and under 5 mortality rates It  is estimated that the neonatal mortality (data for five-year period preceding the survey which approximately coincides with years 2007–2012) in Ukraine was 4 per 1,000 live births; post-neonatal mortality was 3 per 1,000 live births; under 5 mortality was 7 per 1,000 live births (Table CM.1). According to the survey findings, child mortality was approaching zero. In other words, the under-five mortality during the five-year period preceding the survey was almost identical with infant mortality rate (7 per 1,000 live births). Table CM.1 also presents early childhood mortality rates for other five-year periods preceding Ukraine MICS 2012 survey. It is logical that with time, estimated rates tend to reduce, however changes in neonatal and post-neonatal mortality rates were less homogeneous. Table CM .1 . Early childhood mortality rates Neonatal, post-neonatal, infant, child and under-five mortality rates for five year periods preceding the survey, Ukraine, 2012 Years preceding the survey Neonatal mortality rate [1] Post-neonatal mortality rate [2] Infant mortality rate [3] Child mortality rate [4] Under-five mortality rate [5] 0–4 4 3 7 0 7 5–9 4 3 8 0 8 10–14 9 5 13 3 16 [1] MICS Indicator 1.3 [2] MICS Indicator 1.4 [3] MICS Indicator 1.2; MDG Indicator 4.2 [4] MICS Indicator 1.5 [5] MICS Indicator 1.1; MDG Indicator 4.1 29 The graph shows that the data on infant mortality from different sources generally fits within the confidence intervals (CI) of the MICS direct estimates and shows similar trends. 0 5 10 15 20 25 30 35 1980 1985 1990 1995 2000 2005 2010 2015 DHS 2007 MICS 2012 -direct MICS 2012 - indirect Lower CI Upper CI WHO VR MICS - TSFB 514. Child Mortality Estimates of child mortality by socio-economic characteristics are presented in Table CM.2. It should be noted that neonatal, post-neonatal, infant and under-five mortality rates in rural areas are on average by 1.5–2 times higher than in urban areas. The data confirms substantially higher estimates of child mortality among mothers with secondary education compared to those with higher education. Furthermore, neonatal mortality rates were highest in the East and in the Centre of the country. Table CM .2: Early childhood mortality rates by socioeconomic characteristics Neonatal, post-neonatal, Infant, child and under-five mortality rates for five year period preceding the survey, by socioeconomic characteristics, Ukraine, 2012 Neonatal mortality[1] Post neonatal mortality[2] Infant mortality[3] Child mortality[4] Under five mortality[5] Region North 5 1 6 (0) (6) West 3 2 6 0 6 Center 7 2 9 (0) (9) East 7 1 7 (1) (8) South 0 8 8 (1) (9) Area Urban 4 2 6 0 6 Big city 5 1 6 0 6 Small town 2 3 6 1 6 Rural 6 4 10 1 11 Mother's education Secondary 9 6 15 1 15 Higher 2 1 3 0 4 Sex of child Male 6 3 9 0 9 Female 2 3 5 1 6 Wealth index quintile Poorest 60% 2 3 5 0 5 Richest 40% 7 3 10 0 10 Total 4 3 7 0 7 [1] MICS indicator 1.3 [2] MICS indicator 1.4 [3] MICS indicator 1.2; MDG indicator 4.2 [4] MICS indicator 1.5 [5] MICS indicator 1.1; MDG indicator 4.1 Note: Post-neonatal mortality rates are computed as the difference between the infant and neonatal mortality rates ( ) Figures based on 250–499 unweighted exposed person-years for that group In  estimating early childhood mortality rates for the five-year period preceding the survey by demographic characteristics, one could observe sex differentials in neonatal, infant and under-five mortality rates, that is, higher mortality of boys (Table CM.2). The difference was found in neonatal mortality rates – the probability of dying within the first month of life (at age 0–30 days) for infant boys higher than that for infant girls. Chapter V Child Nutrition U N IC E F/ U K R A IN E /2 0 0 5 /G .P ir o zz i 555. Child Nutrition 5 . Child Nutrition 5 .1 .  Breastfeeding Breastfeeding for the first few years of life protects children from infection, provides an ideal source of nutrients, and can have economical benefits both at individual and national levels. However, many mothers don’t practice it exclusively for long enough, stop breastfeeding all together too soon, or accede to pressures to switch to infant formula, which can contribute to growth faltering and micronutrient malnutrition. Breastfeeding also has positive influence on mothers’ health as it decreases the risk of breast cancer and cancer of ovaries during the lifespan of the woman. Apart from that, exclusive breastfeeding for the first 6 months of life decreases the risk of child obesity. WHO/UNICEF have the following feeding recommendations: – Exclusive breastfeeding for the first six months; – Continued breastfeeding for two years or more; – Safe and age-appropriate complementary food 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 one 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 food (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 shows the proportion of children born in the two years preceding the survey who were ever breastfed, those who were first breastfed within one hour and one day of birth, and those who received a pre-lacteal feed. Although a very important step in management of lactation and establishment of a physical and emotional relationship between the baby and the mother, only 65.7% of new-borns in Ukraine start breastfeeding within one hour of birth. Children born to mothers in households in the poorest quintile are less likely (62.1%) to start breastfeeding for the first time within one hour after birth, compared to children born to mothers representing households in the richest quintile (73.5%). The proportion of children who were first breastfed within one hour of birth is the highest in the Centre (76.5%). By contrast, this indicator in the East and in the South is below country average (Fig. NU.1). 87.1% of children born in the two years preceding the survey were first breastfed within one day of birth. There are no clear differences between children born to women living in urban and rural areas. 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. 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. 565. Child Nutrition Table NU .1 . Initial breastfeeding Percentage of last-born children in the 2 years preceding the survey ever breastfed, percentage breastfed within one hour of birth and within one day of birth, and percentage who received a pre-lacteal feed, Ukraine, 2012 Percentage ever breastfed[1] Percentage who were first breastfed: Percentage who received a pre- lacteal feed Number of last- born children in the two years preceding the survey Within one hour of birth[2] Within one day of birth Region North 92.1 67.1 82.9 21.3 110 West 94.2 67.4 91.1 8.8 207 Centre 96.4 76.5 89.2 14.3 74 East 96.7 61.5 83.2 18.5 212 South 97.6 61.7 89.9 10.2 104 Area Urban 96.1 66.3 86.0 16.6 499 Big city 97.3 71.6 89.1 19.3 270 Small town 94.8 60.0 82.3 13.3 228 Rural 93.6 64.3 89.7 9.2 208 Months since last birth 0–11 months 96.1 67.5 89.2 13.6 329 12–23 months 94.8 64.1 85.2 15.1 378 Assistance at delivery Doctor 96.7 66.5 88.5 15.2 649 Nurse / midwife 91.4 63.4 80.7 6.0 51 Missing * * * * 7 Place of delivery Public sector health facility 96.3 66.2 87.8 14.5 694 Private sector health facility * * * * 5 Home * * * * 1 Other/Missing * * * * 7 Mother’s education Secondary 95.3 66.8 89.7 12.4 233 Higher 95.4 65.0 85.7 15.5 471 Wealth Index quintiles Poorest 93.1 62.1 90.3 8.4 114 Second 92.4 59.9 85.4 11.0 170 Middle 95.9 67.8 85.6 15.4 119 Fourth 98.8 64.8 82.2 16.8 142 Richest 96.7 73.5 91.9 19.4 162 Total 95 .4 65 .7 87 .1 14 .4 707 [1] MICS Indicator 2.4 [2] MICS Indicator 2.5 * Figures based on fewer than 25 unweighted cases 2 cases of mothers with no education not shown 575. Child Nutrition Table NU .2 . Breastfeeding Percentage of living children according to breastfeeding status at selected age groups, Ukraine, 2012 Children aged 0–5 months Children aged  12–15 months Children aged  20–23 months Pe r c en t ex cl us iv el y br ea st fe d[ 1] Pe r c en t pr ed om in an tl y br ea st fe d[ 2] N um be r o f ch ild re n Pe r c en t br ea st fe d (c on ti nu ed br ea st fe ed in g at  1  y ea r) [3 ] N um be r o f ch ild re n Pe r c en t br ea st fe d (c on ti nu ed br ea st fe ed in g at  2  y ea rs )[ 4] N um be r o f ch ild re n Sex Male 19.4 48.9 183 39.6 153 20.3 151 Female 20.0 54.4 176 36.2 152 24.4 107 Region North (3.3) (42.5) 50 26.5 67 (18.5) 39 West 24.6 54.6 97 47.8 85 18.7 65 Centre 36.3 59.8 36 47.2 29 18.3 26 East 21.3 47.5 121 33.4 77 31.1 94 South 11.6 58.2 54 37.7 47 (10.8) 35 Area Urban 16.0 51.5 256 36.0 220 22.3 194 Big city 11.6 47.9 114 27.5 145 17.9 100 Small town 19.6 54.5 141 52.4 75 27.0 94 Rural 29.0 51.7 102 42.8 85 21.2 64 Mother’s education Secondary 20.7 40.5 106 34.6 103 19.4 93 Higher 19.3 56.3 252 39.5 202 23.6 165 Wealth Index quintiles Poorest 20.4 47.9 44 39.2 43 16.9 45 Second 29.0 45.2 87 41.6 67 16.4 48 Middle (10.7) (62.0) 60 (39.2) 53 (13.9) 39 Fourth 18.3 46.7 66 37.8 69 29.5 71 Richest 17.7 55.8 100 32.8 73 27.4 55 Total 19 .7 51 .6 358 37 .9 305 22 .0 258 [1] MICS Indicator 2.6 [2] MICS Indicator 2.9 [3] MICS Indicator 2.7 [4] MICS Indicator 2.8 ( ) Figures based on 25–49 unweighted cases Only 19.7% of children below six months-old are exclusively breastfed, whereas 51.6% of children of this age are predominantly breastfed. By 12–15 months-old 37.9% of children are still breastfed, and by 20–23 months-old, 22.0% of children are still breastfed. New-borns in rural areas are more likely to receive exclusive breastfeeding during the first 6 months of their lives than children in urban communities (29.0% and 16.0% respectively). The difference between continued breastfeeding indicators for rural and urban children at 12–15 months of age is less pronounced; being non-existent at 20–23 months. It is also interesting to note, that infants and young children in large urban centres are at a significantly larger disadvantage in terms of optimal breastfeeding practices than their rural counterparts. Figure NU.2 shows the detailed pattern of breastfeeding disaggregated by the child’s age in months. Even at the earliest ages, the majority of children are receiving liquids or foods other than breast milk. By the end of the fifth month, the percentage of children exclusively breastfed is below 10 per cent. Data for the age group 0–1 months is based on 25–49 unweighted cases and should be treated with caution. 585. Child Nutrition Figure NU .1 . Proportion of children who were breastfed within one hour and one day of birth, Ukraine, 2012 Figure NU .2 . Infant feeding patterns by age . Per cent distribution of children age 0-23 months by feeding pattern, Ukraine, 2012 Table NU.3  depicts the average duration of breastfeeding in regards to by selected background characteristics. Among children aged 0–35 months, the median duration is 9.8 months for any breastfeeding; and only 0.6 months for exclusive breastfeeding. Girls are typically breastfed longer than boys, regardless of the type of breastfeeding. Moreover, the data highlights that the median duration of exclusive breastfeeding in rural areas is higher than in the cities (1.8 months vs. 0.4 months). The average duration of exclusive breastfeeding is the highest in the Centre of the country (1.9 months), which is high in comparison to other regions, especially in the North and in the East of Ukraine, where the median duration does not exceed 0.4 months. 67.1 67.4 76.5 61.5 61.7 65.7 82.9 91.1 89.2 83.2 89.9 87.1 0 20 40 60 80 100 120 140 160 180 North West Centre East South Ukraine Рис . NU.1. Частка матерів , які почали грудне вигодовування не пізніше ніж через оду годину та не пізніше ніж черед одну добу після пологів , Україна , 2012 within one day within one hour pe rc en ta ge Exclusively breastfed Breastfed and complementary foods Weaned (not breastfed) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0-1 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-17 18-19 20-21 22-23 pe rc en ta ge Age (by months) Рис. NU.2. Харчування дітей за віком . Відсотковий розподіл дітей віком 0-23 місяці за типом харчування , Україна , 2012 Weaned (not breastfed) Breastfed and complementary foods Breastfed and other milk / formula Breastfed and non-milk liquids Breastfed and plain water only Exclusively breastfed 595. Child Nutrition Table NU .3 . Duration of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children aged 0–35 months, Ukraine, 2012 Median duration (in months) of Number of children aged 0–35 monthsAny breastfeeding[1] Exclusive breastfeeding Predominant breastfeeding Sex Male 8.1 0.5 2.4 1241 Female 11.6 0.6 3.0 1210 Region North 10.5 0.4 2.1 399 West 7.9 0.7 3.0 709 Centre 13.2 1.9 3.9 252 East 9.1 0.4 2.4 713 South 11.5 0.6 4.8 378 Area Urban 11.3 0.4 2.8 853 Big city 9.4 0.4 2.4 931 Small town 13.3 0.5 3.1 774 Rural 10.3 1.8 2.7 745 Mother’s education Secondary 9.9 0.7 1.8 819 Higher 9.7 0.5 3.4 1627 Wealth Index quintiles Poorest 11.8 1.6 2.4 416 Second 8.9 1.6 2.3 591 Middle 7.4 0.6 3.9 399 Fourth 11.3 0.9 2.4 480 Richest 9.9 0 3.6 565 Median 9.8 0.6 2.7 2450 Mean for all children (0–35 months) 12 .5 1 .2 3 .8 2450 [1] MICS Indicator 2.10 5 cases of mothers with no education not shown The data on age-appropriate feeding among infants 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 correctly fed if they are receiving breast milk and solid, semi-solid or soft food. The data on age-appropriate feeding (Table NU.4) highlights the fact that only 19.7% of infants aged 0–5 months are adequately fed (that is, exclusively breastfed). As for children aged 6–23 months, the prevalence of age-appropriate feeding is 25.6%. The percentage of children aged 0–23 months who are appropriately breastfed is 24.3%. 605. Child Nutrition Table NU .4 . Age-appropriate breastfeeding Percentage of children aged 0–23 months who were appropriately breastfed during the previous day, Ukraine, 2012 Children aged 0–5 months Children aged 6–23 months Children aged 0–23 months Per cent exclusively breastfed[1] Number of children Per cent currently breastfeeding and receiving solid, semi-solid, or soft food Number of children Per cent appropriately breastfed[2] Number of children Sex Male 19.4 183 25.3 651 24.0 834 Female 20.0 176 25.9 609 24.6 785 Region North (3.3) 50 20.4 196 16.9 247 West 24.6 97 30.7 377 29.4 474 Centre 36.3 36 26.8 139 28.8 176 East 21.3 121 22.6 372 22.3 492 South 11.6 54 25.6 176 22.3 230 Area Urban 16.0 256 24.1 877 22.2 1133 Big city 11.6 114 21.5 492 19.6 606 Small town 19.6 141 27.3 386 25.2 527 Rural 29.0 102 29.0 383 29.0 485 Mother’s education Secondary 20.7 106 29.8 437 28.0 544 Higher 19.3 252 23.4 819 22.5 1070 Wealth Index quintiles Poorest 20.4 44 30.5 218 28.8 262 Second 29.0 87 21.9 303 23.5 391 Middle (10.7) 60 24.7 212 21.6 272 Fourth 18.3 66 27.1 261 25.3 327 Richest 17.7 100 24.9 266 22.9 366 Total 19 .7 358 25 .6 1260 24 .3 1618 [1] MICS Indicator 2.6 [2] MICS Indicator 2.14 () Figures based on 25–49 unweighted cases 4 cases of mothers with no education not shown 5 .2 .  Infant and Young Child Feeding 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 6 months of age should be accompanied by the consumption of nutritionally adequate, safe and appropriate complementary foods to ensure nutritional requirements are met when breast milk is no longer sufficient. This requires that for breastfed children, two or more meals of solid, semi-solid or soft food are needed if they are 6–8 months old, and three or more meals if they are 9–23 months of age. For children aged 6–23 months and older who are not breastfed, four or more meals of solid, semi-solid or soft food or milk feeds are needed. Overall, as the table below demonstrates, 43.2% of infants aged 6–8 months received solid, semi-solid, or soft food (Table NU.5). 615. Child Nutrition Table NU .5 . Introduction of solid, semi-solid or soft food Percentage of infants age 6–8 months who received solid, semi-solid or soft food during the previous day, Ukraine, 2012 Currently breastfed Currently not breastfed All Per cent receiving solid, semi-solid or soft food Number of children aged 6–8 months Per cent receiving solid, semi-solid or soft food Number of children aged 6–8 months Per cent receiving solid, semi-solid or soft food[1] Number of children aged 6–8 months Sex Male 32.5 48 (74.6) 41 51.9 89 Female 33.6 83 (44.0) 41 37.1 125 Area Urban 32.7 81 64.1 59 45.9 141 Big city (32.9) 37 * 17 38.4 55 Small town (32.5) 44 * 42 50.7 86 Rural 34.0 49 * 23 37.9 72 Total 33 .2 131 59 .2 82 43 .2 213 [1] MICS Indicator 2.12 * Figures based on fewer than 25 unweighted cases ( ) Figures based on 25–49 unweighted cases Table NU.6 presents the proportion of children aged 6–23 months who received solid, semi-solid or soft food the minimum number of times or more, during the day or night preceding the interview by breastfeeding status. Among the children aged 6–8 months currently breastfed, the minimum meal frequency with solid, semi-solid or soft food is two times or more per day. Among children aged 9–23 months who are breastfed, receiving solid, semi-solid or soft food at least three times per day constitutes the minimum meal frequency. For non-breastfed children aged 6–23 months, the minimum meal frequency is defined as solid, semi-solid or soft food, and milk feeds, at least four times per day. Overall, almost two-thirds of the infants aged  6–23  months (63.7%) receive solid, semi-solid and soft food the minimum number of times. Among currently breastfed children aged  6–23  months, slightly more than a quarter (26.3%) receive solid, semi- solid, or soft food the minimum number of times daily. Regionally, the highest percentage of currently breastfed children receiving solid, semi-solid, or soft food the minimum number of times is observed in the West (35.6%), and the lowest – in the East (13.6%) of the country. Among those who are not breastfed, the majority (88.2%) of children were receiving solid, semi-solid and soft food or milk feeds at least four times a day. 625. Child Nutrition Table NU .6 . Minimum meal frequency Percentage of children aged  6–23  months who received solid, semi-solid, or soft food (and milk feeds for non- breastfed children) the minimum number of times or more during the previous day, according to breastfeeding status, Ukraine, 2012 Currently breastfeeding Currently not breastfeeding All Pe r c en t r ec ei vi ng so lid , s em i-s ol id an d so ft fo od th e m in im um n um be r of ti m es N um be r o f c hi ld re n ag ed  6 –2 3  m on th s Pe r c en t r ec ei vi ng at le as t 2  m ilk fe ed s[ 1] Pe r c en t r ec ei vi ng so lid , s em i-s ol id an d so ft fo od o r m ilk fe ed  4  ti m es o r m or e N um be r o f c hi ld re n ag ed  6 –2 3  m on th s Pe r c en t w it h m in im um m ea l fr eq ue nc y[ 2] N um be r o f c hi ld re n ag ed  6 –2 3  m on th s Sex Male 23.0 226 94.6 89.3 425 66.3 651 Female 29.1 273 96.0 86.8 336 61.0 609 Age 6–8 months 18.9 131 99.2 81.3 82 43.0 213 9–11 months 10.3 110 98.1 96.7 103 52.0 214 12–17 months 41.8 166 96.0 87.9 294 71.2 460 18–23 months 28.2 91 92.2 87.4 283 73.0 374 Region North 14.2 72 94.2 90.7 124 62.5 196 West 35.6 157 96.2 88.7 220 66.6 377 Centre 16.9 58 94.1 89.9 81 59.3 139 East 32.1 144 97.1 89.3 228 67.2 372 South 13.6 67 91.5 80.7 109 55.1 176 Area Urban 27.2 336 94.7 86.8 541 64.0 877 Big city 25.1 169 95.0 87.4 322 65.9 492 Small town 29.3 167 94.1 86.0 219 61.5 386 Rural 24.5 162 96.6 91.5 221 63.2 383 Mother’s education Secondary 31.8 183 95.3 89.8 255 65.6 437 Higher 23.2 315 95.1 87.3 503 62.6 819 Wealth Index quintiles Poorest 38.4 91 95.2 91.3 127 69.2 218 Second 17.9 110 95.0 87.7 193 62.4 303 Middle 25.7 75 96.9 90.5 137 67.6 212 Fourth 31.1 115 95.5 88.8 145 63.3 261 Richest 19.9 107 93.7 83.8 159 58.1 266 Total 26 .3 498 95 .2 88 .2 762 63 .7 1260 [1] MICS Indicator 2.15 [2] MICS Indicator 2.13 4 cases of mothers with no education not shown Table NU.7  shows that  66.6% of children aged  0–23  months are fed using a bottle with a nipple, whereas the percentage of children under six months who are bottle-fed is 59.2%. Bottle-feeding is the most prevalent in the West of Ukraine (82.9%), while proportions of children fed with a bottle with a nipple in other regions are notably lower (the Centre has the lowest prevalence of bottle-feeding: 51.1%). 635. Child Nutrition Table NU .7 . Bottle feeding Percentage of children aged 0–23 months fed with a bottle with a nipple with a during the previous day, Ukraine, 2012 Percentage of children aged 0–23 months fed with a bottle with a nipple[1] Number of children aged 0–23 months Sex Male 68.8 834 Female 64.2 785 Age 0–5 months 59.2 358 6–11 months 81.3 427 12–23 months 62.2 834 Region North 68.0 247 West 82.9 474 Centre 60.6 176 East 51.1 492 South 69.0 230 Area Urban 64.6 1133 Big city 65.9 606 Small town 63.1 527 Rural 71.1 485 Mother’s education Secondary 66.0 544 Higher 67.1 1070 Wealth Index quintiles Poorest 65.0 262 Second 68.3 391 Middle 72.1 272 Fourth 65.3 327 Richest 62.8 366 Total 66 .6 1618 [1] MICS Indicator 2.11 4 cases of mothers with no education not shown 5 .3 .  Salt Iodization Iodine Deficiency Disorders (IDD)  are the world’s leading cause of preventable mental retardation and impaired psychomotor development in young children. In its most extreme form, iodine deficiency causes cretinism. It also increases the risks of stillbirth and miscarriage in pregnant women. Iodine deficiency is most commonly and visibly associated with goitre. IDD takes its greatest toll in impaired mental growth and development, contributing in turn to poor school performance, reduced intellectual ability, and impaired work performance. The indicator enabling an estimation of IDD-related issues in a given country is the percentage of households consuming adequately iodized salt (>15 parts per million) Within the framework of MICS 2012, almost all households (96.6%) provided salt used for cooking to be tested for iodine content. Obtained samples were immediately tested for the presence of potassium iodate by using salt test kits. Table NU.8  reveals that the majority of households (63.4%) use cooking salt that is not iodized, yet the overall iodized salt consumption throughout the country was only 20.7%. Use of iodized salt was the lowest in the Southern and Northern regions of Ukraine (14.7% and  14.9%, respectively); and the highest  – in the West (39.3%) (see Fig. NU.2). The difference between the richest and poorest households in terms of consumption of adequately iodized salt constitutes 10.6 percentage points (26.5% and 15.9% respectively). It is here one can observe a certain positive correlation – the richer the household, the greater the likelihood of iodized salt consumption. 645. Child Nutrition Table NU .8 . Iodized salt consumption Per cent distribution of households by consumption of iodized salt, Ukraine, 2012 Per cent of households in which salt was tested Number of households Per cent of households with Number of households in which salt was tested, or with no salt no salt Salt test results TotalNot iodized, 0 PPM >0 and <15 PPM 15+ PPM[1] Region North 94.0 2045 1.3 70.9 12.9 14.9 100.0 1949 West 99.0 2346 0.2 43.6 16.8 39.3 100.0 2328 Centre 97.8 1380 0.2 66.5 16.1 17.2 100.0 1352 East 97.0 3731 0.8 67.3 15.8 16.1 100.0 3647 South 94.6 1819 0.7 70.7 13.8 14.7 100.0 1732 Area Urban 96.2 8323 0.8 61.8 16.6 20.9 100.0 8075 Big city 96.0 5000 0.8 61.4 17.0 20.8 100.0 4839 Small town 96.6 3323 0.8 62.4 15.9 21.0 100.0 3236 Rural 97.5 2997 0.3 67.9 11.6 20.3 100.0 2933 Wealth Index quintiles Poorest 96.0 2649 0.7 74.5 8.9 15.9 100.0 2562 Second 98.1 2126 0.4 68.2 14.1 17.4 100.0 2093 Middle 96.1 2334 0.7 64.5 13.9 21.0 100.0 2258 Fourth 97.0 2260 0.7 56.3 18.6 24.3 100.0 2208 Richest 95.9 1953 0.8 50.0 22.7 26.5 100.0 1887 Total 96 .6 11321 0 .7 63 .4 15 .2 20 .7 100 .0 11008 [1] MICS Indicator 2.16 Of  particular concern is the share of the population that consumes iodized salt of poor quality (iodine content < 15 PPM). Explanation of this situation and its impact on overall consumption of adequately iodized salt requires additional research, and is beyond the scope of the present report. Figure NU .3 . Per cent of households that consume adequately iodized salt, Ukraine, 2012-2013 14.9 39.3 17.2 16.1 14.7 20.9 20.3 20.7 0 5 10 15 20 25 30 35 40 45 North West Centre East South Urban Rural Ukraine Рис. NU.2. Частка домогосподарств, які споживають належним чином йодовану сіль , Україна , 2012-2013 Pe r c en t 655. Child Nutrition 5 .4 .  Low Birth Weight Weight at birth is a useful indicator not only of a mother’s health and nutritional status, but also of the newborn’s chances for survival, growth, long-term health and psychosocial development. Low birth weight (less than 2,500 grams) carries a range of grave health risks for children. Babies who were undernourished in the womb face increased mortality risks in the first few months and years after birth. Those who survive may have impaired immune functions and increased risk of diseases; they risk remaining undernourished, have reduced muscle strength, and suffer a higher incidence of diabetes and heart disease later on in life. Children born underweight also tend to have a lower IQ and cognitive disabilities, affecting their academic performance in school and hindering their job opportunities as adults. 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. Within Ukraine MICS 2012, the percentage of births weighing below 2,500 grams is estimated from two items in the questionnaire: the mother’s assessment of the child’s size at birth (i.e. very small, smaller than average, average, larger than average, very large), and the mother’s recall of the child’s weight or the weight as recorded on a child’s health card. Table NU .9 . Low birth weight infants Percentage of last-born children in the  2  years preceding the survey that are estimated to have weighted below 2,500 grams at birth, and percentage of live births weighted at birth, Ukraine, 2012 Per cent of live births: Number of last-born children in the two years preceding the surveyBelow 2500 grams [1] Weighed at birth [2] Region North 2.2 98.7 110 West 2.2 96.5 207 Center 2.1 99.0 74 East 4.9 97.1 212 South 2.6 96.0 104 Area Urban 3.2 97.1 499 Big city 3.3 97.3 270 Small town 2.9 96.8 228 Rural 2.8 97.6 208 Education Secondary 3.7 96.9 233 Higher 2.8 97.4 471 Wealth index quintiles Poorest 2.5 97.9 114 Second 2.8 95.9 170 Middle 2.6 97.0 119 Fourth 4.1 99.0 142 Richest 3.1 96.8 162 Total 3 .1 97 .2 707 [1] MICS Indicator 2.18 [2] MICS Indicator 2.19 2 cases of mothers with no education not shown In  Ukraine, virtually all children (97.2%) are weighed at birth, with only  3.1% of newborns weighing less than 2,500 grams (Table NU.9). Chapter VI Child Health U N IC E F/ U K R A IN E /2 01 0 /G .P ir o zz i 696. Child Health 6 . Child Health 6 .1 .  Immunization Millennium Development Goal (MDG) 4 aims to reduce child mortality rates by two thirds between 1990 and 2015. Immunization plays a key part in this goal, saving the lives of millions of children for almost four 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 strives to ensure complete the 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 WHO  guidelines, and in line with the national vaccination schedule, 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 vaccine against Hepatitis B;  three doses of polio vaccine, and two vaccinations against Haemophilus influenza (Hib). MMR vaccine against measles, mumps and rubella is received at the age of 12 months. National calendar of vaccinations The national calendar of vaccinations has been changed by the Order No. 595 of the Ministry of Health of Ukraine as of 16.09.2011. Age Tuberculosis Hep B DPT Polio Hib MMR 1 day х 3–5 days х 1 month х 3 months х х х 4 months х х х 5 months х х 6 months х 12 months х 18 months х x x Traditionally, Ukraine has benefited from high immunization coverage among both child and adult populations. However, in recent years, cautious and even negative attitudes towards vaccination originating from apprehension as for the quality of vaccines have spread in society. According to national legislation, the decision on whether to vaccinate a child remains with his/her parents. ‘Persons who have not reached the age of fifteen or have been legally acknowledged as being a person with disability are vaccinated upon the agreement of their parents or other legitimate representatives’ states the Law of Ukraine ‘On the Protection of Population from Infectious Diseases’. Apart from that, parents are to provide written acceptance for it before vaccination. Information on vaccination coverage was collected from all children under five years of age. All mothers or caretakers were asked to provide health cards. If  the health card for a child was available, interviewers copied vaccination information from it. If  no card was available for the child, the interviewer proceeded to ask the mother to recall whether the child received various vaccinations, and relevant information was recorded according to the mother’s (caretaker’s) report. In cases where the child’s health record cards were not presented in households, interviewers visited health facilities at the place of child’s residence and completed separate immunization forms for each child under five. 706. Child Health Table CH .1 . Vaccinations in first year of life Percentage of children aged 18–29 months immunized against childhood diseases at any time before the survey and before the first birthday (during the first 18 months of age for MMR), Ukraine, 2012 Vaccinated at any time before the survey according to: Vaccinated by 12 months of age (by 18 months of age for MMR) Vaccination card, located at home Data from medical facility Mother’s report Any BCG[1] 14.6 74.9 5.9 95.4 94.5 Polio 1 13.9 67.5 4.1 85.4 79.0 2 14.0 63.8 3.2 80.9 65.5 3[2] 12.4 58.4 2.4 73.3 47.8 DPT  1 14.3 67.5 4.2 86.0 79.4 2 13.9 63.7 3.5 81.1 65.0 3[3] 13.7 57.8 2.8 74.3 41.8 HepB At birth 10.8 54.1 3.5 68.4 65.1 1 10.7 48.0 10.0 68.7 53.6 2[5] 8.0 34.6 7.7 50.3 26.1 Hib 1 12.2 64.2 4.0 80.4 74.9 2 11.4 57.1 2.7 71.3 60.7 MMR[4] 11.7 54.1 7.3 73.1 62.7 All vaccinations 5.0 29.2 0. 0 34.2 6.1 No vaccinations 0.0 0.6 2.7 3.2 3.2 Number of children age 18–29 months 829 829 829 829 829 [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 The total percentage of children aged 18–29 months who, according to the given source of vaccination (vaccination card located at home, data from the medical facility and mother’s (caretaker’s) recall) were vaccinated during the first 12 months of age (by 18 month of age for MMR) is calculated for each type of vaccination. In order to calculate the proportion of children for whom no vaccination card was available and who received vaccinations during the first year of life, the proportion of vaccination is assumed to be the same as for children with vaccination cards. The percentage of children who received specific vaccinations (disaggregated by sources of information: vaccination card and mother’s recall) is shown in Table CH.1. The denominator for the table is comprised of children aged 18– 29 months, so that only children old enough to be fully vaccinated are counted. In the first three columns of the table, the numerator includes all children vaccinated at any time prior to the survey according to the vaccination records in the health card (located at home or at the health facility), or the mother’s report. In the last column, only children vaccinated by their first birthday, as recommended, are included (with the exception of MMR vaccination, which takes into account vaccinations administered by 18 months of age). For children without vaccination cards, the proportion of vaccinations given prior to their first birthday is assumed to be the same as for children with vaccination cards. According to all sources of information, 94.5% of children aged 18–29 months received a BCG vaccination within the first year of their life. The first dose of DPT was given to 79.4% of children. The percentage declines for subsequent doses of DPT to 65% for the second dose, and 41.8% for the third dose (Fig. CH.1). 79% of children received Polio1 by 12 months of age. This percentage declines to 65.5% for the second, and to 47.8% – for the third dose of Polio vaccine. 716. Child Health The coverage for MMR (measles, mumps, rubella) vaccination of children aged 18–29 months during the first 18 months of age is only 62.7%. In Ukraine, coverage of the Hepatitis B vaccination is generally lower than for the Polio and DPT vaccines . According to the immunization schedule, the first dose of the HepB vaccine is administered at birth, the second – at 1, and the third – by 6 months of age. According to MICS 2012 results, only 65.1% of children received the first dose against Hepatitis B by their first birthday. The coverage with subsequent HepB vaccinations declines to 53.6% for the second dose, and to 26.1% for the third dose (Table CH.1). The coverage for Haemophilus influenza (Hib) during the first year of life is 74.9% for the first dose, and 60.7% – for the second dose. Figure СН .1 . The proportion of children aged 18–29 months who received the recommended vaccinations by their first birthday (by 18 months of age for MMR) Table CH.2 presents vaccination coverage estimates among children age 18–29 months by background characteristics. Figures indicate those who received the vaccinations at any time up to the date of the survey, and are based on information from both the vaccination records in health cards (located at home or in health facilities) and mothers’/ caretakers’ reports. Documented evidence of vaccination, either from home-based vaccination records or facility-based records, was available for 91.5% of children aged 18–29 months There are no significant variations in BCG  coverage by sex, area of residence, mother’s education and household wealth index. 86.0% of children received the first dose of DPT, 81.1% – the second dose, and 74.3% – the third dose at any time before the survey; the level of DPT vaccination coverage of boys and girls, as well as urban and rural children is similar. It should be noted that the percentage of children receiving the first dose of Polio vaccine is 85.4%. This proportion declines to 73.3% by the third dose. Polio vaccination coverage of boys and girls is the same. MMR vaccination coverage of children age 18–29 months at any time before the survey is 73.1%. 50.3% of children aged 18–29 months received all three doses of vaccination against Hepatitis В, and 71.3% of children were immunized against Hib. 94.5 65.1 53.6 26.1 79.4 65.0 41.8 79.0 65.5 47.8 74.9 60.7 62.7 0 10 20 30 40 50 60 70 80 90 100 BC G He pB 1 He pB 2 He pB 3 DP T1 DP T2 DP T3 Po lio 1 Po lio 2 Po lio 3 Ні в1 Ні в2 MM R Pe rc en ta ge 726. Child Health Table CH .2 . Vaccinations by background characteristics Percentage of children age 18–29 months currently vaccinated against childhood diseases, Ukraine, 2012 Percentage of children who received: N on e A ll Pe rc en ta ge w it h va cc in at io n ca rd se en N um be r o f c hi ld re n ag e  18 –2 9  m on th s BCG Polio DPT HepB Haemophilia (Hib) MMR 1 2 3 1 2 3 At birth 1 2 1 2 Sex Male 94.4 85.0 80.1 73.0 85.7 81.1 75.4 65.0 64.4 47.7 79.6 70.5 73.5 3.5 34.3 93.2 447 Female 96.6 85.9 81.9 73.7 86.4 81.0 73.0 72.5 73.8 53.4 81.3 72.1 72.6 2.9 34.1 89.5 382 Region North 97.0 83.4 77.3 66.4 82.9 74.9 65.1 62.8 65.4 40.1 81.5 63.0 68.8 3.0 23.6 84.2 132 West 92.5 81.5 77.1 66.6 81.2 76.9 70.4 67.7 63.3 46.5 73.7 66.8 70.4 5.9 35.1 91.9 221 Centre 92.9 79.5 76.8 66.7 81.8 78.4 67.9 62.7 65.0 54.2 74.9 67.9 66.3 6.8 29.5 89.8 83 East 98.2 88.1 83.4 79.2 90.0 83.5 80.9 75.7 72.3 51.7 83.9 74.3 76.3 0.8 38.0 94.1 256 South 94.8 92.3 88.8 84.0 92.2 90.8 81.7 64.9 76.5 61.4 86.6 82.8 79.4 1.4 39.1 94.0 136 Area Urban 95.7 85.6 81.2 73.0 86.2 80.8 73.7 66.4 67.3 48.8 81.8 72.1 74.8 2.7 33.3 90.8 598 Big city 96.6 81.8 78.9 72.7 82.6 78.3 73.4 63.0 62.9 44.0 79.7 73.4 72.2 2.2 33.1 92.1 328 Small town 94.5 90.5 84.1 73.3 90.8 83.9 74.1 70.4 72.6 54.7 84.6 70.5 78.3 3.2 33.6 89.2 270 Rural 94.6 84.8 80.2 74.0 85.5 81.7 75.8 73.8 72.5 54.0 76.5 69.0 68.7 4.6 36.6 93.3 232 Mother’s education Secondary 95.5 81.3 77.0 64.6 83.0 76.4 69.7 69.9 70.7 50.8 74.4 65.7 71.0 3.8 33.5 91.0 278 Higher 95.3 87.4 82.8 77.5 87.5 83.3 76.5 67.7 67.8 50.0 83.3 73.9 74.2 2.9 34.6 91.8 551 Wealth Index quintiles Poorest 93.2 78.3 74.4 63.4 79.2 75.1 67.7 73.9 73.0 51.9 72.8 66.1 65.7 6.1 36.9 93.7 145 Second 96.0 92.2 86.1 81.3 92.3 86.9 81.2 71.2 74.0 55.1 82.7 68.8 71.4 4.0 37.0 87.9 185 Middle 94.0 88.3 85.8 78.4 90.2 84.4 79.6 67.9 72.3 54.7 85.7 80.7 83.4 2.6 34.6 98.4 154 Fourth 96.0 86.4 81.2 71.9 87.0 81.6 72.8 64.2 62.0 48.4 79.5 69.5 75.9 2.4 30.2 92.7 169 Richest 97.1 81.0 76.6 70.3 80.9 76.7 69.9 65.6 63.3 42.1 80.2 71.1 69.6 1.3 32.4 86.4 177 Total 95 .4 85 .4 80 .9 73 .3 86 .0 81 .1 74 .3 68 .4 68 .7 50 .3 80 .4 71 .3 73 .1 3 .2 34 .2 91 .5 829 6 .2 .  Oral Rehydration Treatment Diarrhoea is an important issue for the health and survival of children under five worldwide. Management of diarrhoea through oral dehydration salts (ORS)  can prevent many dehydration-related deaths. Preventing dehydration and malnutrition by increasing fluid intake and continued breastfeeding are important strategies for managing diarrhoea. In the MICS 2012, diarrhoea prevalence was estimated by asking mothers or caretakers whether their child under age five years had an episode of diarrhoea in the two weeks prior to the survey30. In cases where mothers reported that the child had diarrhoea, a series of questions were asked regarding the treatment of the illness, including what the child had to drink and eat during the episode, and whether this was more or less what the child usually consumes. There were no differences in diarrhoea prevalence by sex, as well as by area of residence. 59.2 % of children with diarrhoea received oral rehydration solutions (ORS). 30 The validity of this indicator is affected by the mother’s perception of diarrhoea as an illness and her capacity to recall the events. Moreover, the prevalence of diarrhoea varies seasonally. Thus, this variable should be interpreted with caution. 736. Child Health Table CH .3 . Oral rehydration solutions Percentage of children aged 0–59 months with diarrhoea in the last two weeks, and treatment with oral rehydration solutions (ORS), Ukraine, 2012 Had diarrhoea in the last two weeks Number of children aged 0–59 months ORS (fluid from ORS packet or pre-packed ORS fluid) Number of children aged 0–59 months with diarrhoea in the last two weeks Sex Male 3.0 2198 64.6 67 Female 3.0 2181 53.8 66 Area Urban 3.3 3052 57.2 101 Big city 3.4 1684 (47.8) 57 Small town 3.2 1367 (69.1) 44 Rural 2.4 1327 (65.8) 32 Mother’s education Secondary 3.3 1453 (44.5) 48 Higher 2.9 2921 67.7 84 Total 3 .0 4379 59 .2 133 ( ) Figures based on 25–49 unweighted cases 6 cases of mothers with no education not shown About half of the children who were under the age of five with diarrhoea drink more than usual, while 34.8% were given about the same to drink, and a lower percentage were given somewhat less to drink (7.4%) and much less to drink (7.4%) (Table CH.4). The proportion of children who ate somewhat less, same or more are 37.6 %, 42.5% and 1.1% respectively. At the same time, for 1.2% of children food was stopped, while 17.5% had much less to eat (Table CH.4). Table CH .4 . Feeding practices during diarrhoea Per cent distribution of children aged 0–59 months with diarrhoea in the last two weeks by amount of liquids and food given during episode of diarrhoea, Ukraine, 2012 H ad d ia rr ho ea in th e la st tw o w ee ks N um be r o f c hi ld re n ag ed  0 –5 9  m on th s Drinking practices during diarrhoea: To ta l Eating practices during diarrhoea: To ta l N um be r o f c hi ld re n ag ed  0 –5 9  m on th s w it h di ar rh oe a in th e la st tw o w ee ks G iv en m uc h le ss to d ri nk G iv en s om ew ha t le ss to d ri nk G iv en a bo ut th e sa m e to d ri nk G iv en m or e to dr in k G iv en m uc h le ss to e at G iv en s om ew ha t le ss to e at G iv en a bo ut th e sa m e to e at G iv en m or e to e at St op pe d fo od Sex Male 3.0 2198 13.1 7.3 35.1 44.4 100.0 19.6 48.2 29.8 0.0 2.4 100.0 67 Female 3.0 2181 1.6 7.4 34.6 56.4 100.0 15.4 27.0 55.3 2.3 0.0 100.0 66 Area Urban 3.3 3052 4.0 4.8 38.4 52.8 100.0 14.8 36.9 46.7 1.5 0.0 100.0 101 Big city 3.4 1684 (3.8) (4.5) (21.2) (70.4) 100.0 (19.7) (37.7) (39.9) (2.7) (0.0) 100.0 57 Small town 3.2 1367 (4.3) (5.2) (60.5) (30.1) 100.0 (8.6) (36.0) (55.4) (0.0) (0.0) 100.0 44 Rural 2.4 1327 (18.1) (15.6) (23.5) (42.8) 100.0 (26.2) (39.8) (29.0) (0.0) (5.1) 100.0 32 Mother’s education Secondary 3.3 1453 (4.2) (7.5) (45.0) (43.3) 100.0 (11.5) (51.3) (31.8) (3.1) (2.3) 100.0 48 Higher 2.9 2921 9.2 7.3 29.1 54.4 100.0 21.0 29.8 48.6 0.0 0.6 100.0 84 Total 3 .0 4379 7 .4 7 .4 34 .8 50 .4 100 .0 17 .5 37 .6 42 .5 1 .1 1 .2 100 .0 133 ( ) Figures based on 25–49 unweighted cases 6 cases of mothers with no education not shown 746. Child Health Table CH.5 shows the proportion of children aged 0–59 months with diarrhoea in the last two weeks who received oral rehydration therapy (ORT) with continued feeding and drinking, and the percentage of children with diarrhoea who received other treatments. Overall, 85.9% of children with diarrhoea received ORS or increased fluids. Combining the information in Table CH.4 with the one in Table CH.3 on oral rehydration therapy, 69.3% of children either received ORT and, at the same time, feeding was continued, as is recommended. In some cases, children with diarrhoea received other treatments. Specifically, 18.2% of children received antibiotics as a (pill or syrup), while 0.8% received antibiotic injections. More than one-third of children with diarrhoea (35.4%) were receiving home remedies or herbal medicine. Table CH .5 . Oral rehydration therapy with continued feeding and other treatments Percentage of children aged 0–59 months with diarrhoea in the last two weeks who received oral rehydration therapy with continued feeding, and percentage of children with diarrhoea who received other treatments, Ukraine, 2012 Children with diarrhoea who received: Other treatment: N ot g iv en a ny tr ea tm en t o r dr ug N um be r o f c hi ld re n ag ed  0 –5 9  m on th s w it h di ar rh oe a in th e la st tw o w ee ks O RS  o r i nc re as ed fl ui ds O RT  w it h co nt in ue d fe ed in g[ 1] Pills or syrup: Injection: In tr av en ou s H om e re m ed y / h er ba l m ed ic in e O th er A nt ib io ti c A nt i-m ot ili ty d ru g O th er U nk no w n A nt ib io ti c N on -a nt ib io ti c Sex Male 85.5 64.6 29.1 19.6 22.2 2.8 1.7 0.5 0.7 23.7 6.0 8.0 67 Female 86.3 74.0 7.3 15.6 21.0 1.4 0.0 0.0 0.0 47.2 3.4 3.9 66 Area Urban 85.8 73.8 16.6 21.3 21.3 2.3 0.0 0.3 0.0 32.0 5.5 7.6 101 Big city (88.3) (69.2) (7.9) (19.1) (13.9) (4.0) (0.0) (0.6) (0.0) (41.5) (5.9) (7.7) 57 Small town (82.7) (79.7) (27.7) (24.1) (30.6) (0.0) (0.0) (0.0) (0.0) (19.9) (5.0) (7.4) 44 Rural (86.0) (54.7) (23.5) (5.9) (22.8) (1.6) (3.5) (0.0) (1.5) (46.2) (1.9) (0.8) 32 Mother’s education Secondary (81.5) (67.7) (19.7) (18.7) (28.5) (4.2) (2.3) (0.0) (0.0) (46.2) (5.2) (6.9) 48 Higher 88.4 70.1 17.4 17.0 17.7 0.9 0.0 0.4 0.6 29.2 4.4 5.4 84 Total 85 .9 69 .3 18 .2 17 .6 21 .6 2 .1 0 .8 0 .3 0 .4 35 .4 4 .7 6 .0 133 [1] MICS Indicator 3.8 ( ) Figures based on 25–49 unweighted cases 6 .3 .  Care Seeking and Antibiotic Treatment of Pneumonia Pneumonia is the leading cause of death in children, and the use of antibiotics in under-5s with suspected pneumonia is a key intervention. A key goal of the organisation, AWorld Fit for Children, is to reduce pneumonia mortality rate due to acute respiratory infections by one-third. The prevalence of suspected pneumonia was estimated by asking mothers or caretakers whether their child under age five had an illness with a cough accompanied by rapid or difficult breathing, and whose symptoms were due to a problem in the chest, or both a problem in the chest and a blocked nose. The following indicators characterise pneumonia management in the country:31 – The prevalence of suspected pneumonia ; – Care seeking for suspected pneumonia; – Antibiotic treatment of patients with suspected pneumonia; – Knowledge of danger signs of pneumonia. 31 These data are based on the mother’s perception of illness and not validated by a medical examination. Moreover, the prevalence of pneumonia varies seasonally. Thus, this variable should be interpreted with caution as it may be subject to considerable bias. 756. Child Health Table CH.6 also presents the use of antibiotics for the treatment of suspected pneumonia in under-5s by sex, age, region, area, age, and socioeconomic factors. In Ukraine, the majority of under-5 children (88.2%) with suspected pneumonia had received an antibiotic during the two weeks prior to the survey. Table CH .6 . Care seeking for suspected pneumonia and antibiotic use during suspected pneumonia Percentage of children aged 0–59 months with suspected pneumonia in the last two weeks who were taken to a health provider, and percentage of children who were given antibiotics, Ukraine, 2012 H ad s us pe ct ed p ne um on ia in th e la st tw o w ee ks N um be r o f c hi ld re n ag ed  0 –5 9  m on th s Children with suspected pneumonia who were taken to: A ny a pp ro pr ia te p ro vi de r[ 1] Pe rc en ta ge o f c hi ld re n w it h su sp ec te d pn eu m on ia w ho re ce iv ed an ti bi ot ic s in th e la st tw o w ee ks N um be r o f c hi ld re n ag e  0– 59  m on th s w it h su sp ec te d pn eu m on ia in th e la st tw o w ee ks Public sector  Private sector G ov er nm en t h os pi ta l G ov er nm en t h ea lt h ce nt re G ov er nm en t h ea lt h po st (p ol yc lin ic ) Vi lla ge h ea lt h w or ke r O th er p ub lic h ea lt h fa ci lit y Pr iv at e ph ar m ac y Sex Male 3.9 2198 45.2 0.0 37.0 10.6 1.7  2.4 93.2 86.8 87 Female 2.5 2181 40.7 1.7 43.7 11.4 0.0 6.2 91.0 90.2 55 Area Urban 3.6 3052 46.5 0.0 47.3 0.6 0.0 5.0 93.5 91.9 110 Big city 3.7 1684 32.6 0.0 62.0 0.0 0.0 5.4 92.9 91.4 63 Small town 3.4 1367 (65.4) (0.0) (27.4) (1.5) (0.0) (4.6) (94.3) (92.7) 47 Rural 2.4 1327 (32.9) (3.0) (13.4) (46.2) (4.6) (0.0) (88.3) (75.2) 32 Mother’s education Secondary 2.9 1453 34.1 2.2 30.8 28.3 3.5 8.2 88.5 79.8 42 Higher 3.4 2921 47.4 0.0 43.4 3.5 0.0  2.1 93.9 91.7 100 Total 3 .2 4379 43 .4 0 .7 39 .6 10 .9 1 .0 3 .9 92 .3 88 .2 142 [1] MICS Indicator 3.9 [2] MICS Indicator 3.10 ( ) Figures based on 25–49 unweighted cases 6 cases of mothers with no education not shown Issues related to knowledge of danger signs of pneumonia are presented in Table CH.7.Mothers’ knowledge of the danger signs is an important determinant of care-seeking behaviour. Overall, almost one-third (30.3%) of women know two danger signs of pneumonia – fast and difficult breathing. The most commonly identified symptom for taking a child to a health facility is fever (increased temperature) (88.2%). 58.6% of mothers identified difficult breathing, and 47.2% of mothers identified blood in the stool as symptoms for taking children immediately to a health facility. More than half of surveyed mothers would seek medical assistance if a child was getting sicker. 39.7% of mothers knew that fast breathing was a sign for taking a child to the doctors, and 24.9% if the child was unable to drink or breastfeed. Only 16.6% of mothers believe that it is necessary to take a child to a health facility if he or she drinks poorly. 766. Child Health Table CH .7 . Knowledge of two danger signs of pneumonia Percentage of mothers and caretakers of children aged 0–59 months by symptoms that would cause to take the child immediately to a health facility, and percentage of mothers who recognize fast and difficult breathing as signs for seeking care immediately, Ukraine, 2012 Percentage of mothers/caretakers who think that a child should be taken immediately to a health facility if a child: M ot he rs /c ar et ak er s w ho re co gn iz e th e tw o da ng er si gn s of p ne um on ia N um be r o f m ot he rs / ca re ta ke rs o f c hi ld re n ag e  0– 59  m on th s Is  n ot a bl e to d ri nk o r br ea st fe ed Be co m es s ic ke r D ev el op s a fe ve r H as fa st b re at hi ng H as d iffi cu lt y br ea th in g H as b lo od in s to ol Is  d ri nk in g po or ly H as o th er s ym pt om s Region North 16.7 50.7 89.6 27.9 49.9 38.6 11.6 29.4 18.5 297 West 22.3 58.6 91.3 40.5 57.2 47.9 14.8 9.0 29.8 477 Centre 19.4 40.3 91.6 26.8 52.5 37.2 11.0 22.5 17.9 190 East 29.1 50.1 81.1 42.9 60.1 50.5 16.8 16.1 32.9 485 South 35.4 59.0 91.9 56.1 73.0 57.6 29.8 9.6 49.8 250 Area Urban 25.5 52.6 88.6 41.7 57.8 45.4 16.0 18.1 31.5 1215 Big city 22.1 52.9 88.4 36.7 55.0 39.9 15.0 21.0 27.4 679 Small town 29.7 52.1 88.8 47.9 61.3 52.3 17.2 14.5 36.6 536 Rural 23.5 53.5 87.3 34.8 60.6 51.9 18.1 11.3 27.4 483 Mother’s education Secondary 22.7 51.9 89.3 36.1 57.9 44.8 15.4 14.0 27.2 541 Higher 25.8 53.2 87.7 41.4 58.8 48.3 17.0 17.2 31.7 1155 Wealth Index quintiles Poorest 17.9 52.6 90.5 36.2 56.6 47.6 14.3 9.9 26.4 273 Second 27.5 52.4 86.8 42.5 61.2 52.4 16.8 13.8 33.9 373 Middle 26.6 54.7 89.0 41.1 60.1 48.2 17.2 15.1 31.9 308 Fourth 27.5 53.3 88.1 40.1 57.1 46.8 20.7 17.7 32.5 352 Richest 23.6 51.5 87.4 38.1 57.5 41.6 13.8 22.2 26.5 393 Total 24 .9 52 .8 88 .2 39 .7 58 .6 47 .2 16 .6 16 .2 30 .3 1698 2 cases of mothers with no education not shown 6 .4 . 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 (SO2), among others. Use of solid fuels increases the risks of incurring acute respiratory illness, pneumonia, chronic obstructive lung disease, cancer, and possibly tuberculosis, asthma, or cataracts, and may contribute to low birth weight of babies born to pregnant women exposed to smoke. The primary indicator for monitoring the use of solid fuels is the proportion of the population using solid fuels as the primary source of domestic energy for cooking, shown in Table CH.8. 776. Child Health Table CH .8 . Solid fuel use Per cent distribution of household members according to type of cooking fuel used by the household, and percentage of household members living in households using solid fuels for cooking, Ukraine, 2012 Percentage of household members in households using: N um be r o f ho us eh ol d m em be rs El ec tr ic it y Li qu efi ed pe tr ol eu m g as (L PG ) N at ur al g as Bi og as Solid fuels M is si ng To ta l So lid fu el s fo r co ok in g[ 1] Co al / lig ni te W oo d Region North 11.6 6.0 77.6 0.0 0.0 4.7 0.2 100.0 4.7 5037 West 3.5 4.7 77.2 0.1 0.0 14.5 0.0 100.0 14.5 7040 Centre 2.5 15.4 81.0 0.0 0.0 1.1 0.0 100.0 1.1 3266 East 7.2 12.3 79.0 0.0 1.4 0.1 0.0 100.0 1.5 8943 South 6.7 21.9 70.9 0.0 0.2 0.3 0.0 100.0 0.5 4372 Area Urban 7.0 5.7 84.8 0.0 0.3 2.1 0.0 100.0 2.4 20681 Big city 8.3 5.4 85.9 0.0 0.3 0.0 0.1 100.0 0.3 12353 Small town 5.0 6.1 83.2 0.0 0.4 5.2 0.0 100.0 5.7 8328 Rural 5.0 25.2 57.8 0.1 0.9 11.0 0.0 100.0 11.9 7976 Education of household head None 0.6 7.2 87.5 0.0 0.0 4.8 0.0 100.0 4.8 91 Primary 4.6 15.2 63.0 0.0 0.8 16.5 0.0 100.0 17.2 837 Secondary 5.6 13.8 73.0 0.0 0.8 6.8 0.0 100.0 7.5 13236 Higher 7.4 8.5 82.0 0.0 0.2 1.9 0.0  100.0 2.1 14482 Missing/DK * * * * * * * 100.0 * 12 Wealth Index quintiles Poorest 7.3 30.2 42.0 0.1 1.4 18.9 0.0 100.0 20.3 5730 Second 4.7 15.0 76.7 0.0 0.8 2.9 0.0 100.0 3.7 5732 Middle 5.4 6.8 86.8 0.0 0.2 0.9 0.0 100.0 1.1 5734 Fourth 6.7 2.3 90.6 0.0 0.0 0.2 0.1 100.0 0.2 5731 Richest 8.1 1.5 90.4 0.0 0.0 0.0 0.1 100.0 0.0 5731 Total 6 .4 11 .2 77 .3 0 .0 0 .5 4 .6 0 .0 100 .0 5 .1 28658 [1] MICS Indicator 3.11 * Figures based on fewer than 25 unweighted cases Overall, only 5.1% of the household population in Ukraine use solid fuels for cooking (Table CH.8). The use of solid fuels is very low in urban areas (2.4%), but substantially higher in rural areas, where 11.9% of the household population uses solid fuels for cooking. Differentials with respect to household wealth and the educational level of the household head are also significant. The findings show that the use of solid fuels is very uncommon among the household population whose heads have higher education – 2.1%, against 17.2% of the population whose heads having only primary education. In the regional context, the proportion of the use of solid fuels for cooking is highest in the West (14.5%), and the lowest  – in the South (only 0.5%). The household population in the richest wealth quintile does not use solid fuels at all, while the proportion in the poorest wealth quintile using such types of fuel reaches 20.3%. The table also shows that the largest proportion of the household population (77.3%) uses natural gas for cooking, whereby this percentage is higher among the household population in urban areas (84.8%), compared to rural areas (57.8%). Solid fuel use by place of cooking is depicted in Table CH.9. The largest proportion of the household population in households using solid fuels for cooking (81.7%) cooks in a separate room used as a kitchen. The percentage in urban areas is 91.8%, while in rural areas it is 76.3%. 10.8% of the household population in households using solid fuels for cooking (4.6% in urban and 14% in rural areas) cooks elsewhere in the house. Moreover, 6.7% cooks in a separate building. 786. Child Health Table CH .9 . Solid fuel use by place of cooking Per cent distribution of household members in households using solid fuels by place of cooking, Ukraine, 2012 Place of cooking: Number of household members in households using solid fuels for cooking In a separate room used as kitchen Elsewhere in the house In a separate building Other Missing Total Region North 75.9 19.0 4.6 0.0 0.4 100.0 236 West 87.2 9.0 3.4 0.1 0.3 100.0 1022 Centre 66.6 2.4 11.0 0.0 20.0 100.0 37 East 58.2 13.7 28.1 0.0 0.0 100.0 134 South (56.8) (0.6) (42.6) (0.0) (0.0) 100.0 22 Area Urban 91.8 4.6 3.6 0.0 0.0 100.0 503 Big city * * * * * 100.0 31 Small town 94.1 3.6 2.3 0.0 0.0 100.0 472 Rural 76.3 14.0 8.3 0.1 1.2 100.0 947 Education of household head None * * * * * * 4 Primary 90.8 4.1 4.2 0.9 0.0 100.0 144 Secondary 78.9 13.3 7.0 0.0 0.8 100.0 999 Higher 86.3 5.9 6.9 0.0 0.9 100.0 302 Wealth Index quintiles Poorest  81.6 11.4 6.1 0.1 0.8 100.0 1373 Richest  83.6 0.0 16.4 0.0 0.0 100.0 77 Total 81 .7 10 .8 6 .7 0 .1 0 .8 100 .0 1450 * Figures based on fewer than 25 unweighted cases. ( ) Figures based on 25–49 unweighted cases. Chapter VII Water and Sanitation U N IC E F/ U K R A IN E /2 0 0 5 /G .P ir o zz i Water piped into dwelling 63.8 % Water piped into yard / plot 4.3 % Water piped to neighbour 0.1 % Public tap / standpipe 1.2 % Tube well / borehole 5.6 % Protected well 17.6 % Protected spring 1 % Bottled water 4.6 % Unimproved sources 1.8 % 817. Water and Sanitation 7 . Water and Sanitation Safe drinking water is a prerequisite for good health. Unsafe drinking water can carry various diseases, and can even be tainted with chemical and radiological contaminants with harmful effects on human health. Clean drinking water, however, prevents the spread of diseases. MDG  goal  7C is to reduce the proportion of people without sustainable access to safe drinking water and basic sanitation by half between 1990 and 2015, The World Fit for Children goal calls for a reduction in the proportion of households lacking access to hygienic sanitation facilities, and affordable and safe drinking water by at least one- third. The list of indicators used in the Ukraine MICS 2012 is as follows: Water – Use of improved drinking water sources – Use of adequate water treatment methods – Time to source of drinking water – Person collecting drinking water Sanitation – Use of improved sanitation For more detail on water and sanitation, please visit the UNICEF ChildInfo website http://www.childinfo.org/wes.html 7 .1 .  Use of Improved Water Sources The distribution of the population in terms of their main source of drinking water is outlined in Table WS.1 and Figure WS.1. Those using improved sources of drinking water include any of the following types of water supplies: piped water into dwelling (house/apartment), yard or plot, to neighbour, public tap/standpipe, tube well/borehole, protected well and protected spring. Bottled water is considered to be an improved water source only if the household uses an improved water source for hand washing and cooking. Overall,  98.2% of the population in Ukraine uses an improved source of drinking water  –  98.6% in urban areas, and 97.1% in rural areas. The source of drinking water for the population varies by the area type and by household wealth (Table WS.1). Figure WS .1: Per cent distribution of household members by the main source of drinking water, Ukraine, 2012 Water piped into dwelling 63.8 % Water piped into yard / plot 4.3 % Water piped to neighbour 0.1 % Public tap / standpipe 1.2 % Tube well / borehole 5.6 % Protected well 17.6 % Protected spring 1 % Bottled water 4.6 % Unimproved sources 1.8 % 827. Water and Sanitation Ta bl e W S . 1 . U se o f i m pr ov ed w at er s ou rc es Pe r ce nt d is tr ib ut io n of h ou se ho ld p op ul at io n ac co rd in g to t he m ai n so ur ce o f dr in ki ng w at er a nd p er ce nt ag e of h ou se ho ld p op ul at io n us in g im pr ov ed d rin ki ng w at er so ur ce s, U kr ai ne , 2 01 2 M ai n so ur ce o f d ri nk in g w at er Total Percentage using improved sources of drinking water [1] Number of household members Im pr ov ed s ou rc es U ni m pr ov ed s ou rc es Pi pe d w at er Tube well, Borehole Protected well Protected spring Bottled water[2] Unprotected well Unprotected spring Tanker-truck Cart with small tank / drum Surface water (river, stream, dam, lake, pond, canal, irrigation channel) Bottled water [2] Piped into dwelling Piped into compound, yard or plot Piped to neighbour Public tap / standpipe Re gi on N or th 63 .6 1. 6 0. 0 1. 2 8. 3 19 .7 0. 5 4. 4 0. 5 0. 1 0. 0 0. 0 0. 0 0. 0 10 0. 0 99 .4 50 37 W es t 51 .2 2. 6 0. 1 0. 5 7. 4 33 .0 1. 5 2. 6 0. 6 0. 2 0. 0 0. 0 0. 0 0. 2 10 0. 0 98 .9 70 40 Ce nt er 51 .8 3. 2 0. 2 1. 9 5. 9 31 .1 1. 6 2. 6 0. 8 0. 1 0. 6 0. 0 0. 0 0. 0 10 0. 0 98 .3 32 66 Ea st 73 .7 6. 2 0. 1 1. 8 4. 4 4. 3 0. 7 6. 2 0. 1 0. 2 1. 9 0. 1 0. 0 0. 1 10 0. 0 97 .6 89 43 So ut h 73 .2 7. 1 0. 1 0. 4 2. 0 7. 4 0. 3 6. 1 0. 0 0. 0 2. 4 0. 1 0. 0 0. 7 10 0. 0 96 .8 43 72 A re a U rb an 78 .8 2. 8 0. 1 1. 1 3. 1 5. 7 0. 8 6. 2 0. 1 0. 1 0. 9 0. 0 0. 0 0. 2 10 0. 0 98 .6 20 68 1 Bi g ci ty 83 .9 1. 3 0. 0 0. 2 1. 8 1. 6 0. 8 8. 7 0. 0 0. 1 1. 2 0. 0 0. 0 0. 4 10 0. 0 98 .2 12 35 3 Sm al l t ow n 71 .3 5. 0 0. 2 2. 5 5. 0 11 .9 0. 7 2. 5 0. 2 0. 1 0. 6 0. 0 0. 0 0. 0 10 0. 0 99 .1 83 28 Ru ra l 25 .0 8. 3 0. 3 1. 4 12 .2 48 .3 1. 4 0. 4 1. 1 0. 2 1. 3 0. 1 0. 0 0. 0 10 0. 0 97 .1 79 76 Ed uc at io n of h ou se ho ld h ea d N on e 71 .9 3. 7 0. 0 0. 0 5. 6 18 .8 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 10 0. 0 10 0. 0 91 Pr im ar y 35 .6 6. 9 0. 4 3. 5 6. 1 44 .4 0. 5 0. 0 2. 1 0. 3 0. 3 0. 0 0. 0 0. 0 10 0. 0 97 .4 83 7 Se co nd ar y 54 .4 5. 5 0. 2 1. 4 7. 4 24 .9 1. 1 3. 2 0. 5 0. 2 1. 1 0. 1 0. 0 0. 1 10 0. 0 98 .0 13 23 6 H ig he r 74 .1 3. 1 0. 1 0. 9 4. 0 9. 3 0. 8 6. 2 0. 2 0. 1 1. 0 0. 0 0. 0 0. 3 10 0. 0 98 .4 14 48 2 M is si ng /D K * * * * * * * * * * * * * * 10 0. 0 * 12 W ea lt h in de x qu in ti le s Po or es t 9. 2 13 .5 0. 7 2. 2 12 .2 56 .8 1. 5 0. 3 1. 2 0. 4 1. 7 0. 2 0. 1 0. 1 10 0. 0 96 .3 57 30 Se co nd 49 .4 6. 5 0. 0 1. 8 11 .6 27 .4 1. 4 0. 8 0. 6 0. 0 0. 6 0. 0 0. 0 0. 0 10 0. 0 98 .8 57 32 M id dl e 82 .1 1. 6 0. 0 1. 6 3. 1 3. 3 0. 7 5. 4 0. 0 0. 4 1. 3 0. 0 0. 0 0. 5 10 0. 0 97 .9 57 34 Fo ur th 89 .8 0. 0 0. 0 0. 1 0. 8 0. 3 0. 4 7. 1 0. 0 0. 0 1. 2 0. 0 0. 0 0. 2 10 0. 0 98 .6 57 31 Ri ch es t 88 .6 0. 0 0. 0 0. 1 0. 4 0. 1 0. 6 9. 5 0. 0 0. 0 0. 4 0. 0 0. 0 0. 2 10 0. 0 99 .3 57 31 To ta l 63 .8 4 . 3 0 . 1 1 . 2 5 . 6 17 .6 0 . 9 4 . 6 0 . 4 0 . 2 1 . 0 0 . 0 0 . 0 0 . 2 10 0 . 0 98 .2 28 65 8 [1 ] M IC S  in di ca to r 4 .1 ; M D G  in di ca to r 7 .8 * Fi gu re s ba se d on fe w er th an  2 5  un w ei gh te d ca se s [2 ]  H ou se ho ld s us in g bo tt le d w at er a s th e m ai n so ur ce o f d rin ki ng w at er a re c la ss ifi ed in to im pr ov ed o r u ni m pr ov ed d rin ki ng w at er u se rs a cc or di ng to th e w at er s ou rc e us ed fo r o th er pu rp os es s uc h as c oo ki ng a nd h an dw as hi ng 837. Water and Sanitation Table WS .2 . Household water treatment Percentage of household population by drinking water treatment method used in the household, and for household members living in households where an unimproved drinking water source is used, the percentage who are using an appropriate treatment method, Ukraine, 2012 Water treatment method used in the household N um be r o f h ou se ho ld m em be rs Pe rc en ta ge o f ho us eh ol d 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 s ou rc es a nd us in g an a pp ro pr ia te w at er tr ea tm en t m et ho d [1 ] N um be r 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 dr in ki ng w at er s ou rc es N on e Bo il A dd b le ac h / ch lo ri ne St ra in th ro ug h a cl ot h U se w at er fi lt er Le t i t s ta nd a nd se tt le O th er D on 't kn ow Region North 46.8 31.9 0.8 0.9 26.2 12.2 0.8 0.0 5037 (18.3) 32 West 49.6 33.2 6.6 1.0 18.0 11.0 0.8 0.0 7040 41.7 76 Center 53.7 28.6 2.0 0.1 19.3 8.6 0.3 0.0 3266 17.2 55 East 29.6 49.9 0.0 1.4 34.2 17.6 0.1 0.0 8943 24.4 218 South 32.0 42.0 0.0 0.2 34.9 16.0 0.4 0.0 4372 10.0 142 Urban Urban 32.2 43.9 0.5 1.0 33.3 15.3 0.5 0.0 20681 20.7 295 Big city 23.0 50.3 0.3 1.3 38.9 18.0 0.6 0.0 12353 25.8 219 Small town 45.9 34.6 0.8 0.6 25.1 11.3 0.3 0.0 8328 5.9 76 Rural 62.5 26.1 5.8 0.5 11.4 9.7 0.5 0.0 7976 23.5 228 Main source of drinking water Improved sources 40.0 39.4 1.9 0.9 27.7 13.9 0.5 0.0 28134 na na Unimproved sources 76.0 17.6 4.0 1.4 4.0 6.2 0.9 0.0 523 21.9 523 Education of household head None 79.7 19.5 0.8 0.0 2.5 3.4 0.0 0.0 91 * 0 Primary 59.9 32.5 3.5 0.3 5.9 18.4 0.2 0.0 837 * 22 Secondary 48.6 36.1 3.0 0.8 18.1 13.6 0.5 0.0 13236 25.5 263 Higher 32.0 42.1 1.0 1.0 37.0 13.7 0.5 0.0 14482 20.0 238 Missing/DK * * * * * * * * 12 * 1 Wealth index quintiles Poorest 67.8 24.2 4.6 0.6 5.2 8.7 0.6 0.0 5730 19.0 212 Second 53.1 33.9 4.2 0.6 14.6 11.5 0.3 0.0 5732 25.5 69 Middle 38.7 41.5 0.9 1.1 24.9 14.9 0.3 0.0 5734 20.1 121 Fourth 26.7 46.1 0.1 0.9 38.5 16.4 0.8 0.0 5731 25.8 83 Richest 16.9 49.2 0.1 1.3 52.8 17.3 0.3 0.0 5731 28.4 39 Total 40 .6 39 .0 2 .0 0 .9 27 .2 13 .8 0 .5 0 .0 28658 21 .9 523 [1] MICS Indicator 4.2 Drinking water is considered properly treated if one of the following methods of treatment are used: boiling, adding bleach/ chlorine, or using a water filter. As households can use more than one method of water treatment the sum of responses can exceed 100%. * Figures based on fewer than 25 unweighted cases ( ) Figures based on 25–49 unweighted cases In urban settlements, 78.8% of the population uses drinking water piped into a dwelling, whereas in rural areas this type of water supply is only available to 25% of the population. At the same time, depending on the wealth index, this indicator ranges from 9.2% in the first quintile (the poorest) to 89.8% in the fourth, and 88.6% in the fifth quintile (the richest), which can be explained by a stronger disposition of rural population towards lower wealth levels. Almost half of the rural population (48.3%) use a protected well as the main source of drinking water, while this percentage is smaller among the urban population (5.7%). The proportion of the population using a protected well as the main source of drinking water ranges from 56.8% in the poorest quintile to 0.1% in the richest. 847. Water and Sanitation Use of household water treatment is presented in Table WS.2. Households were asked the ways they may be treating water at home to make it safer to drink. Boiling water, adding bleach or chlorine, and using a water filter are methods of proper drinking water treatment. The table also shows water treatment by all households, and the percentage of household members living in households using unimproved water sources but using appropriate methods of water treatment. 40.6% of household members do not use any water treatment methods, (32.2% in urban areas, and  62.5% in rural areas). Boiling water is used by  39% of household members, (43.9% in cities and towns, and  26.1% in rural communities). Almost one-third of household members – predominantly urban – tend to use water filters to treat water. Quite a popular method, letting water stand and settle is used by 13.8% of household members. Only 2% of household members add bleach or chlorine, and 0.9% strain water through a cloth. The time it takes to go to a water source, obtain water, and return home is presented in Table WS.3, and the person who usually collects the water – in Table WS.4. These results refer to one round-trip from home to drinking water source. Information on the number of trips made in one day was not collected. 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, Ukraine, 2012 Time to source of drinking water Total Number of household members Users of improved drinking water sources Users of unimproved drinking water sources W at er o n pr em is es Le ss th an  3 0  m in ut es 30  m in ut es a nd m or e M is si ng /D K W at er o n pr em is es Le ss th an  3 0  m in ut es 30  m in ut es a nd m or e M is si ng /D K Region North 94.4 3.9 0.9 0.3 0.3 0.2 0.1 0.0 100.0 5037 West 94.9 3.0 1.1 0.0 0.6 0.2 0.2 0.0 100.0 7040 Centre 92.1 5.6 0.6 0.0 0.8 0.8 0.0 0.0 100.0 3266 East 94.6 1.8 1.1 0.1 0.3 1.9 0.2 0.0 100.0 8943 South 96.0 0.7 0.0 0.0 0.1 1.7 1.4 0.1 100.0 4372 Area Urban 96.2 1.5 0.9 0.1 0.2 1.1 0.1 0.0 100.0 20681 Big city 96.2 0.9 1.0 0.1 0.2 1.4 0.1 0.0 100.0 12353 Small town 96.1 2.3 0.7 0.0 0.2 0.7 0.0 0.0 100.0 8328 Rural 90.4 6.0 0.7 0.0 1.0 0.8 1.0 0.1 100.0 7976 Education of household head None 93.6 6.4 0.0 0.0 0.0 0.0 0.0 0.0 100.0 91 Primary 91.1 5.4 0.9 0.0 1.4 0.7 0.5 0.0 100.0 837 Secondary 93.2 3.9 0.8 0.1 0.6 0.9 0.6 0.0 100.0 13236 Higher 96.0 1.4 0.8 0.1 0.2 1.3 0.1 0.0 100.0 14482 Missing/DK * * * * * * * * 100.0 12 Wealth Index quintiles Poorest 86.1 8.9 1.2 0.0 1.1 1.3 1.2 0.1 100.0 5730 Second 95.1 3.0 0.7 0.0 0.5 0.5 0.1 0.0 100.0 5732 Middle 96.2 0.9 0.6 0.2 0.1 1.8 0.2 0.1 100.0 5734 Fourth 97.3 0.5 0.6 0.0 0.2 1.2 0.1 0.0 100.0 5731 Richest 98.1 0.3 1.0 0.0 0.1 0.5 0.0 0.0 100.0 5731 Total 94 .6 2 .7 0 .8 0 .1 0 .4 1 .1 0 .3 0 .0 100 .0 28658 * Figures based on fewer than 25 unweighted cases 857. Water and Sanitation Table WS.3 shows that for 94.6% of households (96.2% for urban and 90.4% for rural households) the drinking water is on the premises. For 2.7% of households, it takes less than 30 minutes to get to the water source and bring water, while 0.8% of households spend 30 minutes or more for this purpose. Table WS.4 indicates that for 5.7% of households, the drinking water source is not on the premises, and in 34.7% of them an adult female usually collects the water. Adult men collect water in 62.2% of cases; cases of female or male children under the age of 15 collecting water were not recorded. 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, Ukraine, 2012 Pe rc en ta ge o f ho us eh ol ds w it ho ut d ri nk in g w at er o n pr em is es N um be r o f ho us eh ol ds Person usually collecting drinking water (%) N um be r o f ho us eh ol ds w it ho ut d ri nk in g w at er o n pr em is es A du lt w om an (a ge  1 5+ y ea rs ) A du lt m an (a ge  1 5+ y ea rs ) Fe m al e ch ild (u nd er  1 5  ye ar s) M al e ch ild (u nd er  1 5  ye ar s) D K M is si ng To ta l Region North 6.8 2045 45.2 53.3 0.0 0.0 0.0 1.5 100.0 139 West 5.3 2346 30.6 67.7 0.0 0.0 1.3 0.3 100.0 124 Centre 7.5 1380 42.6 51.0 0.0 0.1 1.0 5.3 100.0 104 East 5.4 3731 24.5 72.7 0.0 0.0 0.0 2.8 100.0 203 South 3.9 1819 39.4 56.4 0.0 0.0 3.9 0.3 100.0 71 Area Urban 3.8 8323 28.8 68.2 0.0 0.0 0.0 2.9 100.0 318 Big city 3.5 5000 19.8 76.5 0.0 0.1 0.0 3.7 100.0 177 Small town 4.2 3323 40.3 57.8 0.0 0.0 0.0 1.9 100.0 140 Rural 10.7 2998 40.6 56.3 0.0 0.0 1.7 1.4 100.0 322 Education of household head None 9.5 32 * * * * * * 100.0 3 Primary 11.1 416 (66.8) (33.2) (0.0) (0.0) (0.0) (0.0) 100.0 46 Secondary 7.1 5259 37.3 59.8 0.0 0.0 0.8 2.1 100.0 375 Higher 3.8 5611 23.6 72.5 0.0 0.0 1.2 2.7 100.0 214 Missing/DK * 3 * * * * * * 100.0 1 Wealth Index quintiles Poorest 14.3 2649 43.6 53.9 0.0 0.0 1.0 1.5 100.0 379 Second 4.0 2126 30.7 65.6 0.0 0.0 1.9 1.8 100.0 85 Middle 3.7 2334 19.1 77.0 0.0 0.1 0.0 3.8 87 Fourth 2.7 2260 16.6 78.9 0.0 0.0 0.0 4.5 100.0 60 Richest 1.5 1953 (15.6) (82.3) (0.0) (0.0) (0.0) (2.0) 100.0 30 Total 5 .7 11321 34 .7 62 .2 0 .0 0 .0 0 .9 2 .2 100 .0 640 * Figures based on fewer than 25 unweighted cases ( ) Figures based on 25–49 unweighted cases 867. Water and Sanitation 7 .2 .  Use of Improved Sanitation An  improved sanitation facility is defined as one that hygienically separates human excreta from human contact. Improved sanitation facilities for excreta disposal include flush or pour flush to a piped sewer system, septic tank, or pit latrine, ventilated improved pit latrine, pit latrine with slab, and the use of a composting toilet. The data on the use of improved sanitation facilities in Ukraine are provided in Table WS.5 of this report. The MDG sanitation indicator excludes users of improved sanitation facilities which are shared between two or more households from having access to sanitation. Therefore, «improved sanitation» is used both in the context of this report, and as an MDG indicator to refer to improved sanitation facilities, which are not shared. Data on improved sanitation are presented in Tables WS.6 and WS.7. Almost the entire population of Ukraine (98.9%) lives in households that have improved sanitation facilities (Table WS.5). Table WS .5 . Types of sanitation facilities Per cent distribution of household population according to the type of toilet facilities used by the household, Ukraine, 2012 Type of toilet facility used by the household M is si ng To ta l N um be r o f h ou se ho ld m em be rs Improved sanitation facility Unimproved sanitation facility Flush / pour flush to Ve nt ila te d im pr ov ed p it la tr in e Pi t l at ri ne w it h sl ab Co m po st in g to ile t Fl us he d to so m ew he re e ls e Pi t l at ri ne w it ho ut sl ab / op en p it Bu ck et O th er Pi pe d se w er sy st em Se pt ic ta nk Pi t ( la tr in e) Region North 58.1 0.3 9.1 8.5 23.2 0.0 0.0 0.5 0.0 0.0 0.1 100.0 5037 West 44.3 4.3 5.5 6.5 38.0 0.3 0.0 0.3 0.8 0.0 0.0 100.0 7040 Centre 42.7 0.4 16.0 3.5 31.6 2.0 0.0 1.5 2.3 0.0 0.0 100.0 3266 East 67.3 0.5 14.9 6.3 10.7 0.2 0.0 0.1 0.0 0.1 0.0 100.0 8943 South 60.7 1.0 16.3 2.6 18.9 0.2 0.0 0.2 0.0 0.0 0.0 100.0 4372 Area Urban 74.9 0.7 10.8 3.2 9.9 0.2 0.0 0.1 0.0 0.0 0.0 100.0 20681 Big city 86.5 0.2 8.2 2.7 2.4 0.1 0.0 0.0 0.0 0.0 0.0 100.0 12353 Small town 57.8 1.6 14.7 3.9 21.1 0.4 0.0 0.3 0.1 0.1 0.0 100.0 8328 Rural 7.8 3.2 14.6 12.7 57.9 0.9 0.0 1.1 1.7 0.0 0.1 100.0 7976 Education of household head None 13.3 10.2 21.6 0.0 45.8 0.0 0.0 5.6 0.0 0.0 3.5 100.0 91 Primary 26.0 0.8 7.1 7.0 55.5 0.0 0.0 2.1 1.2 0.0 0.2 100.0 837 Secondary 43.5 1.5 12.4 8.2 32.5 0.6 0.0 0.4 0.8 0.1 0.0 100.0 13236 Higher 69.9 1.3 11.7 3.6 12.8 0.2 0.0 0.2 0.2 0.0 0.0 100.0 14482 Missing/DK * * * * * * * * * * * 100.0 12 Wealth Index quintiles Poorest 0.4 0.8 7.5 12.7 74.0 1.3 0.0 1.6 1.6 0.0 0.1 100.0 5730 Second 15.7 2.0 28.8 13.3 38.4 0.6 0.0 0.3 0.7 0.0 0.1 100.0 5732 Middle 69.4 3.8 19.9 2.9 3.7 0.1 0.0 0.1 0.1 0.0 0.0 100.0 5734 Fourth 96.0 0.6 3.0 0.2 0.1 0.0 0.0 0.0 0.0 0.2 0.0 100.0 5731 Richest 99.7 0.0 0.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 5731 Total 56 .2 1 .4 11 .9 5 .8 23 .2 0 .4 0 .0 0 .4 0 .5 0 .0 0 .0 100 .0 28658 * Figures based on fewer than 25 unweighted cases 877. Water and Sanitation The above table depicts that the use of improved sanitation is closely linked to households’ wealth and living conditions. The rural population tends to use pit latrines with slab (almost 60%), while the most widespread sanitation facility in urban settlements is a flush toilet with connection to a sewage system or septic tank. Specifically, urban household population typically use flush toilets (74.9% of households), while a smaller percentage use pour flush systems piped to a pit latrine (10.8%), and pit latrine with slab (9.9%). Flush toilets are predominantly used by the richest households (99.7%) and those of the fourth quintile (96.0%), while pit latrines with a slab are the most common type of sanitation facility used by the poorest (74.0%) and second quintile (38.4%). Figure WS .2 . Use of improved sanitation facilities, Ukraine, 2012 The MDGs  and the WHO/UNICEF  Joint Monitoring Programme (JMP)  for Water Supply and Sanitation classify households 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. In Ukraine, the use of improved sanitation facilities that are not shared with other households is almost universal (97.7%, Table WS.6). 0.9% of the population shared a sanitation facility with 5 households or less, while 0.3% shared a sanitation facility with more than 5 other households. In its 2008 report32, the JMP developed a new way of presenting the access figures, by disaggregating and refining the data on drinking-water and sanitation and reflecting them in «ladder» format. This ladder allows a disaggregated analysis of trends in a three rung ladder for drinking water and a four-rung ladder for sanitation. For sanitation, this gives an understanding of the proportion of the population: – with no sanitation facilities at all; – reliant on technologies defined by JMP as «unimproved»; – sharing sanitation facilities of otherwise acceptable («improved») technology; – using «improved» sanitation facilities. Table WS.7 shows the distribution of household population by the drinking water and sanitation ladders. The table also shows the percentage of household members using both improved drinking water sources and improved sanitation facilities. Overall, 95.9% of the household population of Ukraine uses improved sources of drinking water and improved sanitation facilities. Accessibility of improved water sources and sanitation for rural residents (93.5%) is lower by 3.4 percentage points than that for the urban population (96.9%). Members of households representing the poorest and the second wealth quintiles have more limited access to improved sources of drinking water and sanitation facilities. The regional availability of these comfortable living conditions ranges from 92.7% in the Centre to 97.9% in the North. 32 WHO/UNICEF JMP (2008), MDG assessment report – http://www.wssinfo.org/fileadmin/user_upload/resources/1251794333-JMP_08_en.pdf Flush/Pour �ush piped to sewer system 56.2 % Flush/Pour lush piped to septic tank 1.4 % Flush/Pour �ush piped to pit latrine 11.9 % Pit latrine with slab 23.2 % Ventilated improved pit latrine 5.8 % Unimproved sanitation facilities 1.3 % Рис. Використання покращених санітарно-гігієнічних умов, Україна, 2012 887. Water and Sanitation Table WS .6 . Use and sharing of sanitation facilities Per cent distribution of household population by use of private or public sanitation facilities, and use of shared facilities, by users of improved and unimproved sanitation facilities, Ukraine, 2012 Users of improved sanitation facilities Users of unimproved sanitation facilities O pe n de fe ca ti on (n o fa ci lit y, b us h, fi el d) To ta l N um be r o f h ou se ho ld m em be rs N ot s ha re d¹ Pu bl ic fa ci lit y Shared by: M is si ng /D K N ot s ha re d[ 1] Pu bl ic fa ci lit y Shared by: M is si ng /D K 5  ho us eh ol ds o r le ss M or e th an  5  h ou se ho ld s 5  ho us eh ol ds o r le ss M or e th an  5  h ou se ho ld s Region North 98.3 0.1 0.2 0.7 0.0 0.7 0.0 0.0 0.0 0.0 0.0 100.0 5037 West 97.9 0.0 0.8 0.1 0.0 1.1 0.0 0.1 0.0 0.0 0.0 100.0 7040 Centre 94.1 0.4 1.1 0.6 0.0 3.8 0.0 0.0 0.0 0.0 0.0 100.0 3266 East 98.9 0.1 0.5 0.3 0.0 0.2 0.0 0.0 0.0 0.0 0.0 100.0 8943 South 96.7 0.0 2.8 0.1 0.0 0.3 0.0 0.0 0.0 0.0 0.0 100.0 4372 Area Urban 98.3 0.1 1.0 0.4 0.0 0.2 0.0 0.0 0.0 0.0 0.0 100.0 20681 Big city 98.4 0.0 1.1 0.4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 12353 Small town 98.1 0.2 0.9 0.3 0.0 0.4 0.0 0.1 0.0 0.0 0.0 100.0 8328 Rural 96.1 0.1 0.7 0.3 0.0 2.7 0.0 0.0 0.0 0.0 0.1 100.0 7976 Education of household head None 90.8 0.0 0.0 0.0 0.0 5.6 0.0 0.0 0.0 0.0 3.5 100.0 91 Primary 96.2 0.0 0.1 0.0 0.1 3.3 0.0 0.0 0.0 0.0 0.2 100.0 837 Secondary 97.0 0.1 1.2 0.4 0.0 1.2 0.0 0.0 0.0 0.0 0.0 100.0 13236 Higher 98.4 0.1 0.8 0.3 0.0 0.4 0.0 0.0 0.0 0.0 0.0 100.0 14482 Missing/DK * * * * * * * * * * * 100.0 12 Wealth Index quintiles Poorest 95.2 0.2 1.1 0.2 0.0 3.1 0.0 0.1 0.0 0.0 0.1 100.0 5730 Second 97.5 0.2 0.6 0.6 0.0 1.0 0.0 0.0 0.0 0.0 0.1 100.0 5732 Middle 97.9 0.0 1.5 0.5 0.0 0.2 0.0 0.0 0.0 0.0 0.0 100.0 5734 Fourth 98.6 0.0 0.8 0.4 0.0 0.2 0.0 0.0 0.0 0.0 0.0 100.0 5731 Richest 99.2 0.0 0.7 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 5731 Total 97 .7 0 .1 0 .9 0 .3 0 .0 0 .9 0 .0 0 .0 0 .0 0 .0 0 .0 100 .0 28658 [1] MICS Indicator 4.3; MDG Indicator 7.9 * Figures based on fewer than 25 unweighted cases 897. Water and Sanitation Table WS .7: Drinking water and sanitation ladders Percentage of household population by drinking water and sanitation ladders, Ukraine, 2012 Percentage of household population using: N um be r o f h ou se ho ld m em be rs Improved drinking water [1] U ni m pr ov ed d ri nk in g w at er To ta l Im pr ov ed s an it at io n [2 ] Unimproved sanitation To ta l Im pr ov ed d ri nk in g w at er s ou rc es a nd im pr ov ed s an it at io n Pi pe d in to dw el lin g, p lo t or y ar d O th er im pr ov ed Sh ar ed im pr ov ed fa ci lit ie s U ni m pr ov ed fa ci lit ie s O pe n de fe ca ti on Region North 69.6 29.8 0.6 100.0 98.3 1.0 0.7 0.0 100.0 97.9 5037 West 56.3 42.7 1.1 100.0 97.9 0.9 1.1 0.0 100.0 97.0 7040 Center 57.3 41.0 1.7 100.0 94.1 2.1 3.8 0.0 100.0 92.7 3266 East 86.1 11.5 2.4 100.0 98.9 0.9 0.2 0.0 100.0 96.4 8943 South 86.4 10.3 3.2 100.0 96.7 3.0 0.3 0.0 100.0 93.5 4372 Area Urban 87.7 10.9 1.4 100.0 98.3 1.5 0.2 0.0 100.0 96.9 20681 Big city 93.8 4.4 1.8 100.0 98.4 1.5 0.0 0.0 100.0 96.7 12353 Small town 78.7 20.4 0.9 100.0 98.1 1.3 0.5 0.0 100.0 97.2 8328 Rural 33.5 63.6 2.9 100.0 96.1 1.1 2.7 0.1 100.0 93.5 7976 Education of household head None 75.6 24.4 0.0 100.0 90.8 0.0 5.6 3.5 100.0 90.8 91 Primary 42.5 54.9 2.6 100.0 96.2 0.3 3.3 0.2 100.0 94.4 837 Secondary 62.9 35.1 2.0 100.0 97.0 1.7 1.3 0.0 100.0 95.1 13236 Higher 83.2 15.1 1.6 100.0 98.4 1.2 0.4 0.0 100.0 96.8 14482 Missing/DK * * * 100.0 100.0 * * * 100.0 * 12 Wealth index quintiles Poorest 22.9 73.4 3.7 100.0 95.2 1.5 3.2 0.1 100.0 91.8 5730 Second 56.6 42.2 1.2 100.0 97.5 1.4 1.0 0.1 100.0 96.4 5732 Middle 88.8 9.0 2.1 97.9 1.9 0.2 0.0 95.8 5734 F

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