Vanuatu - Multiple Indicator Cluster Survey - 2008

Publication date: 2008

Monitoring the Situation of Children and Women Vanuatu Multiple Indicator Cluster Survey 2007 FINAL REPORT Ministry of Health Government of Vanuatu UNITED NATIONS CHILDREN’S FUND Multiple Indicator Cluster Survey, Vanuatu, 2007 ii Multiple Indicator Cluster Survey, Vanuatu, 2007 iii Vanuatu Multiple Indicator Cluster Survey 2007 Ministry of Health Government of Vanuatu UNICEF United Nations Children’s Fund December 2008 Multiple Indicator Cluster Survey, Vanuatu, 2007 iv Contributors to the report: Muhammad Shuaib Md. Mokhlesur Rahman The Vanuatu Multiple Indicator Cluster Survey (MICS) was carried by Ministry of Health. Financial and technical support was provided by the United Nations Children’s Fund (UNICEF) and The Global Fund. The survey has been conducted as part of the third round of MICS surveys (MICS3), carried out around the world in more than 50 countries, mostly in 2005-2006, following the first two rounds of MICS surveys that were conducted in 1995 and the year 2000. Survey tools are based on the models and standards developed by the global MICS project, designed to collect information on the situation of children and women in countries around the world. Additional information on the global MICS project may be obtained from www.childinfo.org. Ministry of Health, Government of Vanuatu, 2008. Vanuatu Multiple Indicator Cluster Survey 2007, Final Report, Port Vila, Vanuatu Multiple Indicator Cluster Survey, Vanuatu, 2007 v SSSSUMMARY TABLE OF FINDINGSUMMARY TABLE OF FINDINGSUMMARY TABLE OF FINDINGSUMMARY TABLE OF FINDINGS The Multiple Indicator Cluster Survey (MICS) and Millennium Development Goals indicators, Vanuatu, 2007 Topics MICS Indicator Number MDG Indicator Number Indicator Value CHILD MORTALITY Child mortality 1 13 Under-five mortality rate 30 per thousand 2 14 Infant mortality rate 25 per thousand NUTRITION Nutritional status 6 4 Underweight prevalence 15.9 percent 7 Stunting prevalence 20.1 percent 8 Wasting prevalence 6.5 percent Breastfeeding 45 Timely initiation of breastfeeding 71.9 percent 15 Exclusive breastfeeding rate for 0-5 months 40.1 percent 16 Continued breastfeeding rate at 12-15 months at 20-23 months 79.1 percent 31.7 percent 17 Timely complementary feeding rate 61.9 percent 18 Frequency of complementary feeding 49.6 percent 19 Adequately fed infants (0-11 months) 45.2 percent Salt iodization 41 Iodized salt consumption 22.9 percent Low birth weight 9 10 Low birth weight infants Infants weighted at birth 10.2 percent 79.3 percent CHILD HEALTH Immunization 25 Tuberculosis immunization coverage 79.2 percent 26 Polio immunization coverage 55.2 percent 27 DPT immunization coverage 58.2 percent 28 15 Measles immunization coverage 37.1 percent 31 Fully immunized children 24.3 percent 29 Hepatitis-B immunization coverage 55.1 percent Tetanus toxoid 32 Neonatal tetanus protection 49.2 percent Care of illness 33 Use of oral rehydration therapy (ORT) 53.7 percent 34 Home management of diarrhoea 16.4 percent 35 Received ORT or increased fluid and continued feeding 43.1 percent 23 Care seeking for suspected pneumonia 63.0 percent 22 Antibiotic treatment of suspected pneumonia 48.0 percent Solid fuel use 24 29 Solid fuel use 85.1 percent Malaria 36 Household availability of long-lasting nets (LLNs) 67.6 percent 37 22 Under-fives sleeping under LLNs 55.7 percent 38 Under-fives sleeping under mosquito net 66.1 percent 39 22 Anti malarial treatments given to under-fives 35.8 percent ENVIRONMENT Water and sanitation 11 30 Improved drinking water sources 85.1 percent 13 Water treatment 14.5 percent 12 31 Improved sanitation facilities 63.5 percent 14 Disposal of childs’ faeces 29.9 percent Multiple Indicator Cluster Survey, Vanuatu, 2007 vi REPRODUCTIVE HEALTH Uses of contraceptive method 21 19c Women aged 15-49 years married or in union using any contraceptive method 38.4 percent Maternal and newborn health 20 Antenatal care provided by skilled personnel 84.3 percent 44 Content of antenatal care Blood sample taken Blood pressure measured Urine specimen taken Weight measured 98.1 percent 68.9 percent 80.2 percent 69.3 percent 84.5 percent 4 17 Skilled attendant at delivery 74.0 percent 5 Institutional deliveries 79.8 percent CHILD DEVELOPMENT Child development 46 Family support for learning 90.6 percent 47 Fathers’ support for learning 64.6 percent 48 Have 3 or more children’s books 40.7 percent 49 Have 3 or more non-children’s books 52.9 percent 50 Have 3 or more types of play things 18.6 percent 51 Non-adult care 39.1 percent EDUCATION Education 52 Pre-school attendance 23.4 percent 53 School readiness 96.2 percent 54 Primary school entry age grade-I 37.1 percent 55 6 Net primary school attendance ratio 72.7 percent 56 Secondary school attendance ratio Junior secondary school Senior secondary school 37.2 percent 11.5 percent 57 7 Child reaching Grade-5 Child reaching Grade-6 91.7 percent 88.5 percent 61 9 Gender parity index Primary school Junior secondary school Senior secondary school 1.02 ratio 1.14 ratio 0.91 ratio Literacy 60 8 Adult literacy rate for females aged 15-24 years 76.6 percent CHILD PROTECTION Birth registration 62 Birth registration 25.6 percent Early marriage and polygyny 67 Marriage before age 15 Marriage before age 18 7.0 percent 23.6 percent 68 Young women aged 15-19 currently married/in-union 12.8 percent 69 Spousal age difference, 10 years and above Women aged 15-19 Women aged 20-24 31.6 percent 10.2 percent HIV/AIDS AND ORPHANED AND VULNERABLE CHILDREN HIV/AIDS knowledge and attitudes 82 19b Comprehensive knowledge about HIV prevention among young people 16.3 percent 89 Knowledge of mother-to-child transmission of HIV 62.9 percent 86 Attitudes towards people with HIV/AIDS (no discrimination) 17.5 percent 87 Women who know where to be tested for HIV 50.4 percent 88 Women who have been tested for HIV 8.5 percent 90 Counseling coverage for the prevention of transmission of HIV during ANC visit 27.8 percent 91 Testing coverage of HIV during ANC visit 6.8 percent Support to orphaned and vulnerable children 75 78 77 20 Prevalence of orphans Children not living with a biological parent School attendance of double-orphans versus non-orphans 2.9 percent 9.4 percent 0.92 ratio Multiple Indicator Cluster Survey, Vanuatu, 2007 vii TTTTABLE OF CON T E N T SABLE OF CON T E N T SABLE OF CON T E N T SABLE OF CON T E N T S Summary table of findings C O N T E N T S List of Tables List of figures ACRONYMS Foreword/Preface Acknowledgements MAP 1: MAP OF VANUATU Executive summary 1. Introduction Background Survey Objectives 2. Sample and survey methodology Sample Design Questionnaires Training and Fieldwork Data Processing Facts from the Field 3. Sample coverage and the characteristics of households and respondents Sample Coverage Characteristics of Households Characteristics of Respondents 4. Infant and under-five mortality 5. Nutrition Nutritional Status Breastfeeding Exclusive and Continued Breastfeeding Complementary Feeding Adequacy of Feeding Salt Iodization Low Birth Weight 6. Child health Immunization Tetanus Toxoid Diarrhoea Oral Rehydration Treatment Care Seeking and Antibiotic Treatment of Pneumonia Solid Fuel Use Malaria 7. Environment Water and Sanitation Indicators Related to Water Indicators Related to Sanitation Multiple Indicator Cluster Survey, Vanuatu, 2007 viii Security of Tenure 8. Reproductive health Contraception Antenatal Care Assistance during Delivery 9. Child development Family Support for Learning Learning Materials Children Left Alone or with Other Children 10. Education Pre-school Participation Primary and Secondary School Participation Gender Parity in Primary and Secondary Education Adult Literacy 11. Child protection Birth Registration Early Marriage Spousal Age Difference 12. HIV/AIDS, Sexual Behaviour, and Orphaned and Vulnerable Children Knowledge of HIV Transmission and Utilization of HIV Testing Services Knowledge of HIV Prevention and Transmission Identifying Misconception about HIV/AIDS Comprehensive Knowledge of HIV/AIDS Transmission Knowledge of Mother-to-Child HIV Transmission Attitudes Toward People Living with HIV/AIDS Utilization of HIV Testing Services Counseling and HIV Testing During Antenatal Care Orphans and vulnerable children School Attendance of Orphaned and Vulnerable children List of references APPENDIX A: SAMPLE DESIGN APPENDIX B: LIST OF PERSONS INVOLVED IN THE SURVEY APPENDIX C: ESTIMATES OF SAMPLING ERRORS APPENDIX D: DATA QUALITY TABLES APPENDIX E: MICS INDICATORS: NUMERATORS AND DENOMINATORS APPENDIX F: SURVEY QUESTIONNAIRES APPENDIX G: TASK FORCE MEMBERS OF THE MICS 2007 Multiple Indicator Cluster Survey, Vanuatu, 2007 ix LIST OF TABLES Table HH.1 Results of household and individual interviews. 8 Table HH.2 Household age distribution by sex. 10 Table HH.2a Population age distribution of MICS-3 survey and 1999 census…… 11 Table HH.3 Household composition. 12 Table HH.4 Women's background characteristics. 14 Table HH.5 Children's background characteristics. 16 Table CM.1 Child Mortality. 17 Table CM.2 Children ever born and proportion dead. 18 Table NU.1 Child malnourishment. 22 Table NU.2 Initial breastfeeding. 25 Table NU.3. Breastfeeding. 27 Table NU.4 Adequately fed infants. 30 Table NU.5 Iodized salt consumption. 32 Table NU.8 Low birth weight infants. 35 Table CH.1 Vaccinations in first year of life. 37 Table CH.1c Vaccinations in first year of life (continued). 37 Table CH.2 Vaccinations by background characteristics. 39 Table CH.3 Neonatal tetanus protection. 42 Table CH.4 Oral rehydration treatment. 44 Table CH.5 Home management of diarrhoea. 46 Table CH.7A Knowledge of the two danger signs of pneumonia. 48 Table CH.8 Solid fuel use. 50 Table CH.9 Solid fuel use by type of stove or fire. 51 Table CH.10 Availability of insecticide treated long-lasting nets. 53 Table CH.10A Causes of malaria. 54 Table CH.10B Knowledge on prevention of malaria. 55 Table CH.10C Source of knowledge on prevention of malaria ……………. 56 Table CH.11 Children sleeping under bednets. 58 Table CH.12 Treatment of children with anti-malarial drugs. 59 Table EN.1 Use of improved water sources. 61 Table EN.1A Percentage of households by source of drinking water use in 1999 census and MICS-2007 . 62 Table EN.2 Household water treatment. 64 Table EN.3 Time to source of water. 66 Table EN.4 Person collecting water. 67 Table EN.5 Use of sanitary means of excreta disposal. 69 Table EN.6 Disposal of child's faeces. 70 Table EN.7 Use of improved water sources and improved sanitation. 71 Table OT.1: Women aged 15-49 years fearing of eviction. 72 Table RH.1 Use of contraception. 75 Table RH.3 Antenatal care provider. 79 Table RH.4 Antenatal care. . 80 Table RH.5 Assistance during delivery. 83 Table CD.1 Family support for learning. 85 Multiple Indicator Cluster Survey, Vanuatu, 2007 x Table CD.2 Learning materials. 87 Table CD.3 Children left alone or with other children. 88 Table ED.1 Early childhood education. 91 Table ED.2 Primary school entry. 92 Table ED.3 Primary school net attendance ratio. 93 Table ED.4a Junior secondary school net attendance ratio. 94 Table ED.4aw Junior secondary school aged children attending primary school. 95 Table ED.4b Senior secondary school net attendance ratio. 96 Table ED.4bw Senior secondary school aged children attending junior secondary school 97 Table ED.5 Children reaching Grade 6. 98 Table ED.7 Education gender parity. 100 Table ED.8 Adult literacy. 102 Table CP.1 Birth registration. 104 Table CP.5 Early marriage. 106 Table CP.6 Spousal age difference. 109 Table HA.1 Knowledge of preventing HIV transmission. 111 Table HA.2 Identifying misconceptions about HIV/AIDS. 112 Table HA.3 Comprehensive knowledge of HIV/AIDS transmission. 113 Table HA.4 Knowledge of mother-to-child HIV transmission. 115 Table HA.5 Attitudes towards people living with HIV/AIDS. 117 Table HA.6 Knowledge of a facility for HIV testing. 118 Table HA.7 HIV testing and counseling coverage during antenatal care. 120 Table HA.10 Children's living arrangements and orphanhood. 123 Table HA.12 School attendance of orphaned and vulnerable children. 124 Multiple Indicator Cluster Survey, Vanuatu, 2007 xi LIST OF FIGURES Map 1: Map of Vanuatu Figure HH.1: Age and sex distribution of household population 11 Figure CM.1: Trend in under -5 mortality rates 18 Figure NU.1: Percentage of children under-5 who are undernourished 21 Figure NU.2: Percentage of mothers who started breastfeeding within one hour and within one day of birth 24 Figure NU.3: Percent distribution of children aged under 3 years by feeding pattern by age group 29 Figure NU.4 Percentage of households consuming adequately iodized salt 31 Figure NU.5: Percentage of live births in the 2 years preceding the survey weighed less than 2500 grams at birth 33 Figure CH.1: Percentage of children aged 12-23 months who received the recommended vaccination by 12 months 37 Figure CH.2: Percentage of women with a live birth in the last 12 months who are protected against neonatal tetanus 41 Figure CH.5: Children sleeping under bed nets (under-5 children slept under an insecticide treated net during the previous night) 57 Figure EN.1: Percentage distribution of household members by source of drinking water 63 Figure RH.1: Percentage of women aged 15-49 who are married or in union and using (or whose partner is using) a contraceptive method 74 Figure RH.2: Type of personnel assisting with delivery among women aged 15-49 who gave birth in the two years preceding the survey 77 Figure RH.3: Health facility deliveries among women aged 15-49 years who gave birth in the two years preceding the survey 81 Figure ED.1: Percentage of women aged 15-24 who are literate 101 Figure HA.1: Percentage of women aged 15-49 who correctly identify means of HIV transmission from mother to child 114 Multiple Indicator Cluster Survey, Vanuatu, 2007 xii AAAACRONYMSCRONYMSCRONYMSCRONYMS ANC Ante-Natal Care ARI Acute Respiratory Infection BCG Bacillus Calment Guerin CBO Community Based Organizations CDC Center for Disease Control CEB Children Ever Born CEDAW Convention on the Elimination of All Forms of Discrimination against Women CGS Child Growth Standard CPR Contraceptive Prevalence Rate CRC Convention on the Rights of the Children DESP Department of Statistics and Planning DOWA Department of Women Affairs DPT Diphtheria, Pertusis and Tetanus EA Enumeration Area ECD Early Child Development GAM Global Acute Malnutrition (Z score up to <-2 SD) GCM Global Chronic Malnutrition (Z score up to <-2 SD) GoV Government of Vanuatu GPI Gender Parity Index GRS Growth Reference Standard HAZ Height-for-age Z score HH Household HIV/AIDS Human Immune Virus/ Acquired Immune Deficiency Syndrome IDD Iodine Deficiency Disorder IUD Intrauterine Device LBW Low Birth Weight LLN Long Lasting Net LPG Liquid Propane Gas MTCT Mother to Child Transmission MDG Millennium Development Goal MICS Multiple Indicator Cluster Survey MoH Ministry of Health NAR Net Attendance Ratio NCHS National Center for Health Statistics NID National Immunization Day OPV Oral Polio Vaccine ORS Oral Rehydration Saline ORT Oral Rehydration Therapy OVC Orphans and Vulnerable Children PLHA Persons Living with HIV/AIDS PPM Parts Per Million PPS Probability Proportionate to Size PSU Primary Sampling Unit RHF Recommended Home Fluid SD Standard Deviation Multiple Indicator Cluster Survey, Vanuatu, 2007 xiii STD Sexually Transmitted Diseases STI Sexually Transmitted Infections TT Tetanus Toxoid U5MR Under-five Mortality Rate UN United Nations UNAIDS Joint United Nations Programme on HIV/AIDS UNDAF United Nations Development Assistance Framework UNGASS United Nations General Assembly Special Session on HIV/AIDS UNICEF United Nations Children’s Fund VNPHC Vanuatu National Population and Housing Census (1999) WAZ Weight-for-age Z score WFFC World Fit for Children WHO World Health Organization WHZ Weight-for-height Z score Multiple Indicator Cluster Survey, Vanuatu, 2007 xiv FFFFOREWORDOREWORDOREWORDOREWORD//// PPPPRRRREFACEEFACEEFACEEFACE Multiple Indicator Cluster Survey, Vanuatu, 2007 xv AAAACKNOWLECKNOWLECKNOWLECKNOWLEDGEMENT DGEMENT DGEMENT DGEMENT Ministry of Health, Government of Vanuatu UNICEF- Pacific The Global Fund Statistics Office, Government of Vanuatu Ministry of Education, Government of Vanuatu Department of Women Affairs, Government of Vanuatu World Health Organization Save the children (Australia) Vanuatu Institute of Technology Ministry of Health, Government of Vanuatu Len Tarivonda, Project Director Jean Jacques Rory, Project Coordinator Yoan Bororoa, Assistant Project Coordinator Edgell Tari National Statistics office Simil Johnson Bannuel Lengue Consultant Statisticians Anthony G. Turner (Sampling specialist & MICS advisor, USA) Muhammad Shuaib (Survey Manager, Bangladesh) Md. Mokhlesur Rahman (Data Manager, Bangladesh) UNICEF Will Parks Asenaca Vakacegu Laura Warner May Pauscal Elham Monsef We acknowledge all persons participated in the Vanuatu MICS-2007 (List attached in the Appendix-B) Multiple Indicator Cluster Survey, Vanuatu, 2007 xvi MMMMAP OF AP OF AP OF AP OF VVVVANUATUANUATUANUATUANUATU Multiple Indicator Cluster Survey, Vanuatu, 2007 xvii EEEEXECUTIVE SUMMARYXECUTIVE SUMMARYXECUTIVE SUMMARYXECUTIVE SUMMARY This report is based on the Vanuatu Multiple Indicator Cluster Survey (MICS) conducted in 2007 by the Ministry of Health, Government of the Republic of Vanuatu (GoV) with financial and technical support from United Nations Children’s Fund (UNICEF) – Pacific. The major objectives of the survey are to provide up-to-date information for assessing the situation of children and women in Vanuatu and furnish data needed for monitoring progress towards goals established by the Millennium Development Goals (MDGs) and the goals of A World Fit for Children (WFFC) as a basis for future action and development of a monitoring and evaluation system for Vanuatu’s Poverty Reduction Strategy and United Nations Development Assistance Framework (UNDAF). The survey covered a nationally representative sample of 2,632 households; 2,692 women respondents aged 15-49 years and 1634 under-five children. Data were collected through three questionnaires: 1) the Household Questionnaire, 2) the Individual Questionnaire for Women aged 15-49, and 3) the Questionnaire for Children under-five years of age. Independent samples for each domain (6 provinces and 2 cities) made it equivalent to 8 separate surveys to produce valid estimates for each domain simultaneously. National, and urban and rural estimates are obtained by combining these provincial data. The fieldwork began in 01 November, 2007 and concluded in 20 December, 2007. Characteristics of the Household Population A larger proportion of the population is in the younger age groups than in the older age groups indicating a young age structure of the population. About 41 percent of the population is below 15 years of age and only 3 percent is aged 65 and above. The average household size is 5 persons per household. The dependency ratio is 0.83 or 83 dependent population per 100 working population. Children aged 0-17 years composed of 47 percent of the total population and 53 percent is adult population aged 18 and above. Overwhelming majority (91.9%) of the households are male-headed households, while 8 percent are female-headed households. Most of the households (84.4%) comprised of at least one child below 18 years of age, while 50 percent households have at least one child below five years. More than 85 percent households comprised of at least one woman of reproductive age of 15-49 years. Characteristics of the Respondents The respondents were mostly young women within their thirties, with an average age of 39 years. Around 16 percent of the women were aged 40 and above, while 18 percent were adolescent girl of age 15-19 years. About 39 percent of the women were aged 20-29 years, and 74 percent of the women have given birth to at least one child. Only 6 percent respondents were illiterate; while 63 percent completed primary and 30 percent secondary level of education. Child mortality The infant mortality rate is the probability of dying before the first birthday. The under-five mortality rate is the probability of dying before the fifth birthday. The infant mortality rate is estimated at 25 per thousand, while the under-5 mortality rate (U5MR) is around 30 per thousand. These estimates have been calculated by averaging mortality estimates obtained from women age 25-29 and 30-34, and refer to mid 2001. Infant and under-5 mortality rates are lower in urban areas. There are also visible differences in mortality in terms of educational levels and wealth status. Multiple Indicator Cluster Survey, Vanuatu, 2007 xviii Child Malnutrition Nationally 16 percent children are moderately or severely underweight, 20 percent are moderately or severely stunted and 7 percent are moderately or severely wasted. The prevalence of malnutrition is higher among boys than girls. Mother’s education and household wealth status show a negative effect on child malnutrition. Breastfeeding About 72 percent women initiated breastfeeding to their babies within one hour of birth, while 82 percent within one day of birth. About 40 percent of children aged less than 6 months are exclusively breastfed. At age 6-9 months, 62 percent of children are receiving breast milk and semisolid or solid food and the rate is higher in the rural area (65%) than the national average. By age of 12-15 months, 79 percent children are still being breastfed, and by age of 20-23 months about 32 percent of them are still being breastfed. Female children are more likely to receive continued breastfeeding till 12-15 months and 20-23 months of age than their male counterparts. Salt Iodization In the interviewed households, salt used for cooking was tested for iodine content using an iodine testing solution. About 11 percent households were reported to have no salt available at the time of survey. Nearly a quarter (22.9%) of the households consumes salt containing 15 Parts per Million (PPM) or more iodine in salt. It is higher in the urban area (43.8%) compared with the rural area (16.4%). The data also show that, households in the richest quintiles is more likely to consume iodized salt compared to the households in the poorest quintiles (49.4% vs. 7.5%). Low Birth Weight Among the weighed children, one in ten (10.2%) appeared as low birth weight (<2500 grams) children. No major difference visible between residential areas (urban: 9.2% and rural: 10.3%). Mother’s education and household wealth status show some overall negative effect on low birth weight. Child immunization Over 79 percent of children aged 12-23 months received a BCG vaccine by the age of 12 months. 74 percent of them received the first dose of DTP. The proportion declines for subsequent doses of DPT, to 65 percent for the second dose and 58 percent for the third dose. Similarly, 75 percent of children received the first dose of polio vaccination by age 12 months but this declined to 55 percent by the third dose. The coverage for measles vaccination by 12 months was lower than for the other immunizations, at 37 percent. Overall, 42 percent children 12-23 months of age (urban 48.7% and rural 39.9%) are fully immunized, far below the target of universal immunization. The proportion is slightly higher for girls (43.7%) than boys (39.5%). Provincial variations are visible, ranging from 31 to 57 percent across the provinces; highest in Shefa and the lowest in Sanma. Tetanus Toxoid Nearly half (49.2%) of the mothers with a birth in the 24 months preceding the survey are protected against neonatal tetanus. There is a little urban-rural variation in neonatal tetanus coverage (50.7% vs. 49.0%). Among the mothers being protected, 39 percent received at least two doses of tetanus toxoid (TT) during last pregnancy. Mother’s education shows a strong positive effect on receiving at least two Multiple Indicator Cluster Survey, Vanuatu, 2007 xix doses of TT during last pregnancy. Wealth status shows no consistent pattern on receiving at least two doses of TT during last pregnancy. Diarrhoea One in every 7 (13.8%) under-five children had diarrhoea in two weeks before the survey, with little urban-rural differentials (12.8% vs. 14.1%). Male children had slightly higher prevalence of diarrhoea than female children (14.4% vs. 13.3%). The prevalence of diarrhoea is the lowest among the children aged less than 6 months (6.2%), reaches at its peak of 23 percent at the age of 6-11 months and then starts declining. Mother’s education and wealth quintiles show no consistent pattern of relationship with diarrhoea prevalence. More than half (53.7%) of the children with diarrhoea received Oral Rehydration Therapy (ORT), while 46 percent of the children with diarrhoea received no treatment. Overall, 16 percent of the diarrhoeal cases are managed at home during the episode and 43 percent children received increased fluids and continued food. Acute Respiratory Infection (ARI) Nearly 3 percent children reportedly had some symptoms of ARI in two weeks preceding the survey. Most of them sought treatment from government health facilities. About 48 percent of children under- five with suspected pneumonia got antibiotic treatment; 63 percent received the treatment from an appropriate provider. Only 8 percent mothers could correctly identify the two danger signs of pneumonia. Malaria More than 90 percent (93.0%) of the respondents correctly identified mosquito bite as the main cause of malaria, and 83 percent of them were able to correctly mention three preventive measures. Among the three measures, the most prominent are ‘using mosquito net’ (68.2%), ‘destroying mosquito breeding sites’ (39.3%) and ‘taking medicine’ (16.1%). Health workers (85.0%) appeared as the most prominent source of knowledge about prevention of malaria. Overwhelming majority of the households (overall: 86.5%, urban: 89.0%, rural: 85.7%) were reportedly taking some measure to prevent malaria, among them 68 percent household have at least one long-lasting net. About 66 percent of under-five year children slept under a bed-net during the previous night while 56 percent slept under an insecticide treated long lasting bed-net, and the proportion is quite high in rural areas. Water and Sanitation Overall, 85 percent of the population had access to improved drinking water sources - 98 percent in urban and 81 percent in rural areas. Still, 15 percent of the population uses drinking water from unimproved sources namely unprotected well (3.5%), unprotected spring (4.4%), and surface water (7.0%). Use of unsafe surface water is higher in Tafea (22.1%). Only 15 percent household treats water for drinking. About half of the households (48.7%) have drinking water on their premises (urban 70.5%, rural 42.1%). It takes less than 15 minutes to get to the water source and bring water in 36 percent households; while only 4 percent and 2 percent of the households spend 30 minutes to less than one hour, and one hour or more time for this purpose respectively. More than 60 percent (63.5%) of the surveyed population lives in the households that use improved sanitation facilities (urban 91.2% and rural 55.1%). Unimproved sanitation facilities include pit latrine without slab (32.8%) and open field (3.2%). Multiple Indicator Cluster Survey, Vanuatu, 2007 xx Use of Contraception Overall, 38 percent of the women aged 15-49 years, married or in-union, are currently using any contraceptive method, of which 37 percent are using modern methods and nearly 2 percent are using traditional methods. Pill is by far the most popular modern contraceptive method used by 16 percent eligible women followed by injectables used by 11 percent and female sterilization by 6 percent women. Urban women are more likely to use family planning methods than that of rural women and the rate varies widely across the provinces. Contraceptive prevalence rate increased to a peak of 48 percent for the women aged 30-34 years and then decreased to a rate of 24 percent for the women aged 45-49 years. Women's educational level and household wealth status are strongly associated with contraceptive prevalence. Antenatal Care (ANC) One or more ANC visit during pregnancy is almost universal in Vanuatu, as, 98 percent of the pregnant women had one or more ANC visits during pregnancy, and 84 percent pregnant women received ANC from a skilled provider (i.e., doctor, nurse, or midwife) at least once during their last pregnancies. An additional 14 percent received ANC from an unskilled provider. Only 2 percent of them did not receive any ANC. Assistance during Delivery About 80 percent women aged 15-49 years had their child birth in health facilities and 74 percent child births were attended by skilled personnel; low in Sanma rural. The proportion of deliveries attended by skilled personnel is lower than the deliveries in the health facilities, because people bring the pregnant to the nearest health facility for delivery though there might not be any trained personnel there. Delivery attended by skilled personnel is positively associated with education of pregnant and wealth status. Child Development For most of the under-five children (90.6%), an adult household member engaged in four or more activities that promote children’s learning and school readiness. Adult engagement in activities with children varies little with gender of the children (91.9% for male and 89.2% for female). Mothers’ and fathers’ education show a positive relationship with the engagement of the activities promoting child development. Adults engaged with children on an average in 5.2 activities, while the mean number of activities that father engaged in with the child is 2.6. About 16 percent children are living in the households without their natural fathers. The proportion is higher in the rural area than in urban area (16.1% vs. 13.7%). Pre-school Participation, Primary and Secondary School Participation Nearly one-fourth (23.4%) of the children aged 36-59 months are attending pre-school. There is no gender and urban-rural differentials in pre-school attendance. Overall, 96 percent of the children who attended pre-school in the previous year are currently attending the first grade of primary school. Girls are almost universally (98.5%) attending in the first grade of primary school, while the rate is 94 percent for their boy counterparts. More than one-third (37.1%) of the children of primary school- entry age were attending Grade-I at the time of the survey. Overall, 73 percent of the primary school Multiple Indicator Cluster Survey, Vanuatu, 2007 xxi age children attend primary or secondary school. The rate is higher in the urban area than in the rural (78.6% vs. 71.2%) and among the richest than poorer. Adult Literacy About 77 percent women aged 15-24 are literate. The literacy rate is the highest in Port Vila (83.7%) and the lowest in Tafea (67.8%). It is higher in the urban area (85.6%) than the rural area (73.3%). Similar to other educational indicators, adult literacy rate is positively associated with the wealth status of the households. Birth Registration Birth registration still remain very low with only one-fourth (25.6%) of under-five births have been registered. Children from the richest households were more likely to be registered than the children from the poorest family. Mother’s education also shows a strong positive effect on birth registration. The most common reasons for non-registration include "did not think it an urgent matter" (40.1%), “did not know that child should be registered" (28.3%), "did not know where to register" (9.7%), “must travel too far” (7.6%) and “costs too much” (4.3%). Early Marriage About 7 percent of the married women aged 15-49 were married before the age of 15; while 24 percent before reaching 18 years of age. Literacy and wealth status does not show any consistent trend on early marriage. Knowledge of HIV/AIDS Overall, 83 percent of the women aged 15-49 have heard of AIDS; 75 percent of them know at least one way of preventing human immune virus (HIV) transmission, while 42 percent know all three ways of prevention. Overall, 47 and 61 percent of the women aged 15-49 years know that, HIV cannot be transmitted by mosquito bites and by sharing food respectively. Only 16 percent respondents have comprehensive correct knowledge of HIV. About 81 percent of women know that AIDS can be transmitted from mother to child. Half of them know where they can get the HIV testing facilities; while only 8.5 percent reported that they actually were tested. Orphans and Vulnerable Children Around 9 percent of the children are not living with a biological parent, while 3 percent of the children aged 0-17 years have one or both parents as dead. 1.1.1.1. INTRODUCTIONINTRODUCTIONINTRODUCTIONINTRODUCTION Background This report is based on the Vanuatu Multiple Indicator Cluster Survey conducted in 2007 by the Ministry of Health, Government of the Republic of Vanuatu with financial and technical support from United Nations Children’s Fund (UNICEF) – Pacific. The survey provides valuable information on the situation of children and women in Vanuatu, and was based on the need to monitor progress towards goals and targets emanating from recent international agreements: the Millennium Declaration that was adopted by all 191 United Nations Member States (including Vanuatu) in September 2008 and the Plan of Action of A World Fit for Children (WFFC) that was adopted by 189 Member States (including Vanuatu) at the United Nations Special Session on Children in May 2002. Both of these commitments are built upon the promises made by the international community of the 1990 World Summit for Children. By signing these international agreements, governments (including the Government of Vanuatu) committed themselves to realize the rights of children enshrined in them, improve conditions for children and to monitor progress towards these ends. UNICEF was assigned a supporting role in this task (see box 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 sub-national 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". Multiple Indicator Cluster Survey, Vanuatu, 2007 2 The Government of Vanuatu in collaboration with its development partners is implementing several policies and programs aimed at achieving national and international goals which are in line with the Millennium Development Goals (MDGs) and the Plan of Action of A World Fit for Children (WFFC). The government has been keen to create a more comprehensive monitoring system to capture the results for children and women, and get an idea about the quality of investment. A strong database is needed for this. Monitoring progress will ensure greater realization of the rights of children and women. More systematic data collection on selected indicators and impact results will be institutionalized. Surveys like the MICS-3 has been identified as a major effort to generate valid and reliable data and information that will be used to monitor key indicators that are being tracked by the Government of Vanuatu (GoV) to ensure the realization of major international commitments that include MDGs, WFFC goals, United Nations General Assembly Special Session (UNGASS) on HIV/AIDS and the Convention on the Rights of the Children (CRC). The MICS-3 effort will also contribute to the development of a monitoring and evaluation system for Vanuatu’s Poverty Reduction Strategy and United Nations Development Assistance Framework (UNDAF). This final report presents indicator, estimates for different aspects covered in the survey. Survey Objectives The Vanuatu Multiple Indicator Cluster Survey - 2007 has the following primary objectives: 1. To provide up-to-date information for assessing the situation of children and women both at national and sub-national (provincial and urban/rural) levels. 2. To furnish data needed for monitoring progress towards goals established by the Millennium Development Goals (MDGs) and the goals of A World Fit for Children (WFFC) as a basis for future action. 3. To contribute to the improvement of data and monitoring systems, and to strengthen technical expertise in the design, implementation and analysis of such systems. Multiple Indicator Cluster Survey, Vanuatu, 2007 3 2.2.2.2. SAMPLE AND SURVEY METHODOLOGYSAMPLE AND SURVEY METHODOLOGYSAMPLE AND SURVEY METHODOLOGYSAMPLE AND SURVEY METHODOLOGY Sample Design The sample for MICS Vanuatu - 2007 is a probability-based, stratified cluster sample of 3000 households. They were selected in 120 clusters, each of size 25 households. The sample was designed with the intention of providing reliable estimates for the key MICS indicators at the national level and also for urban and rural areas separately, as well as for the 6 Provinces of Malampa, Penama, Sanma, Shefa, Tafea and Torba. Port Vila under Shefa Province and Luganville under Sanma province are the two major cities considered as two domains under the urban stratum. The Shefa and Sanma provinces mentioned here exclude these two cities of corresponding provinces and bear rural character. The entire areas of all other provinces are considered as rural. The sample was allocated to the provinces/cities and by urban-rural in an optimum fashion to secure enough sample cases in each domain for reliable estimates to be obtained. That is, independent samples for each domain (6 provinces and 2 cities) made it equivalent to 8 separate surveys to produce valid estimates for each domain simultaneously. National, and urban and rural estimates are obtained by combining these provincial data. The sample frame was the enumeration areas (EA) that made up the 1999 Population Census of Vanuatu, which had been updated in the 2006 Agricultural Census. Primary sampling units, or PSUs, were defined as either single EA or combinations of EAs. Combining EA was necessary whenever an EA contained fewer than 25 households, because the cluster size to be interviewed was set at 25 households as mentioned above. The sample was selected in two stages. The first stage consisted of first stratifying the PSUs by province and within-province by urban/rural in two provinces namely Shefa and Sanma and then selecting 120 PSUs with probability proportionate to size or pps. At the second-stage, a fixed sample size of exactly 25 households was selected from each PSU, using systematic, equal-probability sampling or epsem. Thus a total of 3000 households were selected (120 clusters times 25 households). A household was defined as “a group of people those are eating from the same pot”. Sample sizes for six rural provinces are 300 households each, while 500 and 700 households for Luganville and Port Vila cities respectively. It is to be noted here that the cities of Port Vila and Luganville are the urban part of the Shefa and Sanma provinces respectively. Total areas of other provinces are considered as rural. The resulting sample was not theoretically self-weighing; and sample weights have been used to adjust for major variations among the provinces and urban/rural EA with regard to different estimates. Detail sampling plan and sample allocation is shown in Appendix–A. It can be also mentioned here that, every fourth households in each cluster were selected for a nutrition component of the survey, which was additional to MICS nutrition modules. Thus the sample size for the additional nutrition component was exactly one-fourth of the MICS sample size in each domain and at national level. Multiple Indicator Cluster Survey, Vanuatu, 2007 4 Questionnaires Three questionnaires were used in the survey: These were: 1) the Household Questionnaire, 2) the Questionnaire for Individual Women aged 15-49, and 3) the Questionnaire for Children under-five. • Household Questionnaire: The Household Questionnaire was used to collect information about all de-jure household members, the household and the dwelling of each interviewed household. The respondent for this questionnaire was the head of household or other adult member who lives in the household and was capable of providing information as required in the questionnaire. The household questionnaire included modules for the household information panel, household listing form, education, water and sanitation, household characteristics, malaria prevention, salt iodization and nutrition information for household. • Questionnaire for Individual Women: The Questionnaire for Individual Women was administered to all women aged 15-49 living in each surveyed household. This questionnaire included the modules for the women's information panel, child mortality, tetanus toxoid, maternal and newborn health, marriage/union, security of tenure, contraceptive, HIV/AIDS and nutrition information for women. • Questionnaire for Children Under-five: The Questionnaire for Children Under-five was administered to mothers or caretakers of children under-5 years of age1 living in each surveyed household. Normally, the questionnaire was administered to mothers of under-5 children; in case, when the mother was not listed in the household roster, a primary caretaker for the child was identified and interviewed. This questionnaire included the modules for under-five child information panel, child development, birth registration and early learning, breastfeeding, care of illness, malaria and it’s prevention, immunization, anthropometry and nutrition information for children. The last modules of all three MICS questionnaires were related to the additional nutrition component of the survey. The questionnaires were developed on the basis of the MICS-3 model questionnaires in English language and were translated into Vanuatu national language, Bislama, and back translation was done to ensure the accuracy of the translation. The questionnaires were pre-tested. Based on the results of the pre-test, modifications were made to the wording of the questions, the response categories, and the key words. The Vanuatu questionnaires thus adapted as per Vanuatu situations are given in Appendix–F. In addition to administration of questionnaires, the survey teams tested the salt used for cooking in the households for iodine content by UNICEF recommended salt testing kit (manufacturer’s name) and measured the weights (by Uniscale with 100 grams graduation, SECA) and heights (by SHORR board, Maryland, USA) of children of age under 5 years. Details and findings of these measurements are provided in the respective sections of the report. Training and Fieldwork Ten master trainers were identified by the MoH those had some previous experience of fieldwork in health related programmes. These trainers were trained by the external consultant for three weeks including field-testing and field practice of the questionnaires for five successive times each followed 1 The term "Children under 5", "Children age 0-4 years", and "children aged 0-59 months" are used interchangeably in this report. Multiple Indicator Cluster Survey, Vanuatu, 2007 5 by extensive discussion. A total of 55 enumerators were trained by the trainers in local language, Bislama, for another 3 weeks with field practice for 4 times in September, 2007. Training included lectures on interviewing techniques, contents of the questionnaires and mock interviews between trainees Bislama, to gain practice in asking questions. During the training period, trainees spent 8–10 days conducting practice interviews in and around Port Vila in both urban and rural settings. The data were collected by 6 teams comprising of one male/female supervisor, 5 female enumerators and a laboratory technician who is assigned to collect nutritional (biochemical) sample. The fieldwork began in November 01, 2007 and concluded in December 20, 2007. Revisits were carried out during 01-10 April, 2008 for the missing cases mainly in urban areas. Data Processing Completed questionnaires were checked in the field by supervisors and were sent to Port Vila for processing. In Port Vila, data entry personnel checked each questionnaire again to make sure that it had been correctly completed and all parts are consistently filled-in. Data were entered on 6 microcomputers by 6 data entry operators and 2 data entry supervisors using CSPro software under direct supervision of data manager. In order to ensure quality, all the questionnaires were double entered and internal consistency checks were performed. Procedures and standard programs developed using CSPro software under the global MICS-3 project that was adapted to Vanuatu questionnaires and was reviewed by the NYHQ before data entry. Data entry and processing began in November 10, 2007 and was completed in January 31, 2008, while revisit data were processed during 08-15 April, 2008. Data was analyzed using the Statistical Package for Social Science (SPSS) software, version 14 and the model syntax and tabulation plan developed by UNICEF for this purpose. Non-response rate for the women age group 15-19 was quite high and, hence, a post survey adjustment was carried out for non-response by weighting through post-stratification. Data that were available for the additional nutrition component of the survey during the processing of MICS data were processed with the MICS data. But after getting the laboratory results, all data are processed and analysed separately. The results will be produced in a separate report as per the decision of the MICS Task Force. Facts from the Field Six teams were formed to cover the field works in six provinces and two cities. A total of 2,632 households from 120 clusters were covered in systematic random sampling to represent the whole country. In covering the areas, the team members faced some difficulties which they have successfully overcome either by themselves or with the help of local health officials or by discussing with the MICS coordination team in Port Vila. It was found that, some teams faced resistance from the local communities as the locals were not aware of the survey. Awareness before the actual survey by the local health officials, sticking posters in this regard in the important places, instruction through local church authority and convincing local chiefs were found to be effective to conduct the field work smoothly. Company of local MoH filed staffs/ nurses were also found to be fruitful in this regard. Publication through media (Radio/TV/news papers) was also found effective in the urban areas. Multiple Indicator Cluster Survey, Vanuatu, 2007 6 In a few places, the community people were not satisfied with the local health office and refused to be interviewed; that was mitigated by the local health coordinator/manager and the team has finally completed the survey. Sometimes, the respondents thought the team members as health professionals and asked for medication. They also enquired about the result of bio-chemic samples and asked if the blood samples were taken for HIV test. Some people were thankful to have hemoglobin test result and enquired about the natural foods that contain high level of iron. One of the teams was comprised of all female and the locals did not cooperate with the team initially. But after explaining their objective to the local elders, the community people extended their full support to complete the job smoothly. Sometimes the team members needed to explain the objective of the survey, its implication at the policy level of the country to convince the people. So the team members needed to be conceptually clear about the survey objective. The teams were trained in this regard before sending to the field. Some of the households did not cooperate due to the death of family member or festivals. Moreover, mothers were reluctant to give stool samples fearing of magic activities as per the local belief of the community. The community was expecting that the team would visit all households in the community. But covering of only 25 households was a question to them. Most of the Ni-Vanuatu community and the English-spoken people extended cooperation to the team. Women of Chinese-spoken households do not know either Bislama/English or French and it was very difficult to handle them until working people of the households came back to the household, while the French spoken community were unwilling to respond to the survey. The people were reluctant to cooperate in the re-visits, especially, the households wherefrom the biochemical samples has already been collected. The people are not well convinced about the health benefits of using iodized salt. Some people were also interested in having the result of the survey and enquired about the way of utilization of the result in the national level planning. They also wanted the report or its excerpt in the television or radio. It can be recommended from the experiences that, such nation-wide survey should be carried out in the middle of the year to avoid major festivals (Christmas/New year) as most of the people visit other islands or their home during the festivals. The team members needed to be well dressed and follow the codes and behaviors of the community to get their cooperation. It was also found that the communication/awareness drive beforehand was an effective measure to cover the survey with less hindrance. Multiple Indicator Cluster Survey, Vanuatu, 2007 7 3.3.3.3. SAMPLE COVERAGE AND THE CHARACTERISTICS OF SAMPLE COVERAGE AND THE CHARACTERISTICS OF SAMPLE COVERAGE AND THE CHARACTERISTICS OF SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTSHOUSEHOLDS AND RESPONDENTSHOUSEHOLDS AND RESPONDENTSHOUSEHOLDS AND RESPONDENTS Sample Coverage Of the 2,963 households selected for the sample, 2,959 were found to be occupied. Among the occupied households, 2,632 were successfully interviewed with a household response rate of 89 percent. In the interviewed households, 3,261 eligible women (aged 15-49) were identified for interview and 2,692 were successfully interviewed, giving women response rate of 83 percent. Among the interviewed households, 1,741 under-five children were identified. Of them, mothers/caretakers of 1,634 children were successfully interviewed, yielding children response rate of 94 percent. The overall response rates of women and children were found to be 73 percent and 84 percent respectively (Table HH.1). The sample response rates vary to some extent by urban-rural areas and by provinces. Urban area shows higher response rate for household and children than those of rural area. However, there is little variation in women response rate between rural and urban area. The response rate varied widely among the provinces/urban domains. The household response rate ranges from 71 percent in Sanma to as high as 99 percent in Port Vila. Women's response rate varies from 76 percent in Malampa to 89 percent in Penama and Sanma. Children’s response rate vary in a narrow range among the provinces/domains, with 90 percent in Luganville to 97 percent in Sanma and Torba (Table HH.1) M u lt ip le I n d ic a to r C lu st e r S u rv ey , V a n u a tu , 20 0 7 8 T a b le H H .1 : R e su lt s o f h o u se h o ld a n d i n d iv id u a l in te rv ie w s N u m b er s o f h o u se h o ld s, w o m en a n d c h il d re n u n d er 5 b y re su lt s o f th e h o u se h o ld , w o m en 's a n d u n d er -f iv e' s in te rv ie w s, a n d h o u se h o ld , w o m e n 's a n d u n d er -f iv e' s re sp o n se r a te s, V a n u a tu , 2 00 7 In di ca to rs A re a P ro vi nc e T ot al U rb an R ur al T af ea S he fa M al am pa P en am a S an m a T or ba P or t V ila Lu ga nv ill e S am pl ed h ou se ho ld s 11 92 17 71 30 0 30 0 30 0 29 6 27 5 30 0 69 2 50 0 29 63 O cc up ie d ho us eh ol ds 11 91 17 68 30 0 30 0 29 8 29 6 27 5 29 9 69 1 50 0 29 59 In te rv ie w ed h o us eh ol ds 11 43 14 89 27 2 26 3 22 8 25 0 19 5 28 1 68 3 46 0 26 32 H ou se ho ld r es po ns e ra te ( % ) 96 .0 84 .2 90 .7 87 .7 76 .5 84 .5 70 .9 94 .0 98 .8 92 .0 88 .9 E lig ib le w o m en 15 36 17 25 33 0 32 7 27 5 21 6 21 7 36 0 92 8 60 8 32 61 In te rv ie w ed w om en 12 71 14 21 26 8 27 9 20 9 19 2 19 4 27 9 76 4 50 7 26 92 W om en r es po n se r at e (% ) 82 .7 82 .4 81 .2 85 .3 76 .0 88 .9 89 .4 77 .5 82 .3 83 .4 82 .6 W om en 's o ve ra ll re sp on se r at e (% ) 79 .4 69 .4 73 .6 74 .8 58 .1 75 .1 63 .4 72 .8 81 .4 76 .7 73 .4 E lig ib le c hi ld re n un de r 5 64 8 10 93 25 3 19 1 15 8 15 6 12 5 21 0 36 6 28 2 17 41 M ot he r/ C ar et ak er In te rv ie w ed 59 6 10 38 24 0 17 9 14 6 14 9 12 1 20 3 34 2 25 4 16 34 C hi ld r es po ns e ra te ( % ) 92 .0 95 .0 94 .9 93 .7 92 .4 95 .5 96 .8 96 .7 93 .4 90 .1 93 .9 C hi ld re n 's o ve ra ll re sp on se r at e (% ) 88 .3 80 .0 86 .0 82 .2 70 .7 80 .7 68 .6 90 .8 92 .4 82 .9 83 .5 Vanuatu Multiple Indicator Cluster Survey-2007 9 Characteristics of Household Population Table HH.2 shows the distribution of the de-jure (usual residence) household population by five-year age groups according to sex. Overall, age of the household members could not be established for nearly five percent cases (4.7 percent) and, therefore, shown as missing or don’t know. Age did not know or missing was found to be higher for male than female (6.5% Vs 2.9%). They are mostly illiterate and could not recollect their own age or that their spouse after repeated request and trial. Special attention will be needed in any future surveys to overcome such problem of non-response of age. The total enumerated population in the 2,632 interviewed households were 13,370 persons, of whom, 6,890 (51.5%) were male and 6,480 (48.5%) female. The overall sex ratio, the number of males per female, is 1.06, which indicates that there are more males than females in the country (i.e. there are 106 male per 100 female). The survey experienced a high non-response rate especially due to the local festivals and death occasions, while during second half of December people traveled to their home or other island on the eve of Christmas. Inaccessibility was reason for one cluster in Pentecost of Sanma province. A higher proportion of the young women aged 15-19 were found to be living away due to work or study and absent from the households. The survey provides an estimate of the average household size of 5 persons per household, which is in a complete agreement with the average household size observed in the 1999 census. There is a larger proportion of population in the younger age groups than in the older age groups indicating a young age structure. About 41 percent of the population is below 15 years of age and only 3 percent is aged 65 and above. This is a typical situation of a community in an early stage of demographic development with high birth rates and death rates. The population of the age groups below age 15 and above age 64 are considered as the “dependent” population and the population of age group 15-64 as the working population. Thus the dependency ratio, defined as the ratio of dependent population to population of working ages 15-64, is 0.83 or 83 dependent population per 100 working population. The corresponding estimate in the 1999 census was 0.85. The age-sex structure of the population is shown by a population pyramid in Figure HH.1. The pyramid is broad based and slightly narrower at the lowest base, a pattern that typically describes a high fertility regime that has recently declined slightly. The proportions of males and females are more or less same in the age groups below age 20 (Table HH.2, Figure HH.1). However, the male-female ratio markedly changed in the prime reproductive age group 20-34, with more females than males in these ages. This may be due in part to international migration of young men for work or study and/or high mortality among men in those ages. However, some combination of over reporting of ages of men and/or underreporting of ages of women may account for the excess of men over women at ages 40 and above. The ratio returns to balance for the older age groups. Vanuatu Multiple Indicator Cluster Survey-2007 10 Table HH.2: Household age distribution by sex Percent distribution of the household population by five-year age groups and dependency age groups, and number of children aged 0-17 years, by sex, Vanuatu, 2007 Background Characteristics Sex Total Male Female Number Percent Number Percent Number Percent Age 0-4 925 13.4 868 13.4 1793 13.4 5-9 1081 15.7 875 13.5 1956 14.6 10-14 852 12.4 833 12.9 1685 12.6 15-19 684 9.9 626 9.7 1310 9.8 20-24 531 7.7 633 9.8 1163 8.7 25-29 446 6.5 517 8.0 964 7.2 30-34 363 5.3 434 6.7 797 6.0 35-39 418 6.1 419 6.5 837 6.3 40-44 281 4.1 260 4.0 541 4.0 45-49 267 3.9 241 3.7 508 3.8 50-54 190 2.8 240 3.7 430 3.2 55-59 130 1.9 116 1.8 246 1.8 60-64 85 1.2 76 1.2 161 1.2 65-69 64 0.9 70 1.1 134 1.0 70 or above 129 1.9 85 1.3 214 1.6 Missing/DK 446 6.5 185 2.9 631 4.7 Dependency age groups <15 2857 41.5 2577 39.8 5434 40.6 15-64 3394 49.3 3563 55.0 6958 52.0 65+ 193 2.8 155 2.4 348 2.6 Missing/DK 446 6.5 185 2.9 631 4.7 Age Children aged 0-17 3281 47.6 2950 45.5 6231 46.6 Adults 18+/Missing/DK 3609 52.4 3531 54.5 7139 53.4 Total 6890 100.0 6480 100.0 13370 100.0 Children aged 0-17 years composed of 47 percent of the total population and 53 percent is adult population aged 18 and above. Child women ratio, defined as the ratio of children under age five and the women of reproductive age 15-49, a measure of fertility performance during the five years preceding the survey, indicates that there are 573 births or children per 1,000 women in Vanuatu, which is an indication of high fertility in the country. It may be concluded that the prevailing age-sex composition in Vanuatu undoubtedly favors high fertility in the absence of a high level of fertility regulation programme. Vanuatu Multiple Indicator Cluster Survey-2007 11 Figure HH.1: Age and Sex Distribution of Household Population, Vanuatu, 2007 10 8 6 4 2 0 2 4 6 8 10 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+ A g e g ro u p Percent Males Females Table HH.2a compares the age and gender distribution of the MICS-3 survey population with that of 1999 Vanuatu National Population and Housing Census (National Statistics, 2000). Similarities in the population age distribution between the two sources suggest that the MICS-3 survey presents a valid sample of the country population. Table HH.2a: Population age distribution of MICS-3 survey and 1999 Census Age group MICS-3 (Percent) 1999 Census (Percent) Male Female Total Male Female Total 0-14 41.5 39.8 40.6 41.9 41.0 41.5 15-64 49.3 55.0 52.1 51.5 53.2 52.3 65+ 2.8 2.4 2.6 3.7 3.0 3.3 Missing/don't know 6.5 2.9 4.7 3.0 2.8 2.9 Total 100.0 100.1 100.0 100.0 100.0 100.0 Table HH.3 provides basic background information of the households having at least one child aged <18 years, at least one child <5 years, at least one woman aged 15-49 years, sex of household head, province, urban-rural status, number of household members, and mother tongue of household head. These background characteristics are also used in subsequent analysis. The data in the table are also intended to show the number of observations by major categories of analysis in the report. Vanuatu Multiple Indicator Cluster Survey-2007 12 Table HH.3: Household composition Percent distribution of households by selected characteristics, Vanuatu, 2007 Background Characteristics Weighted percent Number of HH weighted Number of HH unweighted Sex of household head Male 91.9 2418 2429 Female 8.1 214 203 Region Tafea 12.9 339 272 Shefa 13.9 367 263 Malampa 18.0 475 228 Penama 13.3 350 250 Sanma 14.6 385 195 Torba 3.8 100 281 Port Vila 17.6 464 683 Luganville 5.8 153 460 Area Urban 23.4 617 1143 Rural 76.6 2015 1489 Number of household members 1 3.0 79 95 2-3 23.0 604 589 4-5 36.1 951 924 6-7 24.1 635 645 8-9 9.5 249 254 10+ 4.3 113 125 Mother tongue of head Bislama 13.8 364 550 Other Language 85.9 2261 2073 Missing (*) 7 9 National 100.0 2632 2632 At least one child aged < 18 years 84.4 2632 2632 At least one child aged < 5 years 50.1 2632 2632 At least one woman aged 15-49 years 85.2 2632 2632 (*) Percent count has been suppressed as the figure is based on less than 25 unweighted cases The weighted and unweighted numbers of households are equal since sample weights were normalized (See Appendix – A). Most of the households (84.4%) comprised of at least one child below 18 years of age, while 50 percent households have at least one child below five years. Around 85 percent households comprised of at least one woman of reproductive age 15-49 years. Overwhelming majority (91.9%) of the households are headed by males; while the rest 8 percent are female headed households. According to the MICS-2007 survey, 23 percent households are located in urban and 77 percent in rural areas. The households are located in all the provinces of Vanuatu. Comparatively lower proportions of households are there in the province of Torba (3.8%) and Luganville city (5.8%). The proportion of households from other provinces varies from 13 percent to 18 percent. Majority sample households are of medium to large size and are comprised of 4-5 members (36.1%) and 6-7 members (24.1%). Overall there are 3 percent households with only one member. The country has over 100 languages with Bislama as the official language. It was found that Bislama is the mother tongue of only 14 percent heads of household; the remaining 86 percent household heads speak in their own local languages. Vanuatu Multiple Indicator Cluster Survey-2007 13 Characteristics of Respondents This section provides information on the background characteristics of female respondents of reproductive age. In addition to providing useful information on the background characteristics of women, the data in the tables are also intended to show the number of observations in each background category. These categories are used in the subsequent analysis. Table HH.4 presents background characteristics of female respondents aged 15-49 years. The table shows the percent distribution of women aged 15-49 according to province, urban-rural areas, age groups, marital status, motherhood status, education2, wealth index quintiles3 and mother tongue of household heads. 2 Unless otherwise stated, "education" refers to educational level attended by the respondent throughout this report when it is used as a background variable. 3 Principal components analysis was performed by using information on the ownership of household goods and amenities (assets) to assign weights to each household asset, and obtain wealth scores for each household in the sample (the assets or variables used in these calculations were as follows: [number of persons per sleeping room; type of floor; type of roof; type of wall; type of cooking fuel; presence of household assets including electricity supply, radio, TV, mobile phone, static phone, refrigerator, watch, bicycle, motorcycle, cart, car, motorized boat and canoe; source of drinking water; and, type of sanitary facility]). Each household was then weighted by the number of household members, and the household population was divided into five groups of equal size, from the poorest quintile to the richest quintile, based on the wealth scores of households they were living in. 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, and the wealth scores calculated are applicable for only the particular data set they are based on. Vanuatu Multiple Indicator Cluster Survey-2007 14 Table HH.4: Women's background characteristics Percent distribution of women aged 15-49 years by background characteristics, Vanuatu, 2007 Background Characteristics Weighted percent Number of women weighted unweighted Region Tafea 13.1 353 268 Shefa 14.6 392 279 Malampa 18.3 492 209 Penama 9.7 260 192 Sanma 13.7 368 194 Torba 4.1 110 279 Port Vila 20.1 542 764 Luganville 6.5 174 507 Area Urban 26.6 716 1271 Rural 73.4 1976 1421 Age 15-19 17.9 481 457 20-24 22.4 602 522 25-29 16.2 437 470 30-34 14.4 387 405 35-39 13.3 358 393 40-44 8.4 227 241 45-49 7.5 201 204 Marital/Union status Currently married/in union 72.4 1949 1921 Formerly married/in union 3.5 94 91 Never married/in union 24.1 649 680 Motherhood status Ever gave birth 73.8 1986 1969 Never gave birth 26.2 706 723 Education None 6.3 171 171 Primary 62.8 1689 1552 Secondary + 30.1 810 955 Non-standard curriculum (*) 22 14 Wealth index quintiles Poorest 17.7 476 358 Second 20.9 564 411 Middle 19.4 522 426 Fourth 19.1 515 549 Richest 22.8 615 948 Mother tongue of head Bislama 14.6 393 592 Other Language 85.1 2291 2090 Missing (*) 8 10 National 100.0 2692 2692 (*) Percent count has been suppressed as the figure is based on less than 25 unweighted cases Vanuatu Multiple Indicator Cluster Survey-2007 15 The women respondents include both married and never-married women. Among the women aged 15- 49, about one-fourth (24.1%) were never married, while nearly three-fourth (72.4%) were currently married and 4 percent were either widowed, divorced or separated. The respondents were mostly young women within their thirties, with an average age of 39 years. About 16 percent of the women were aged 40 and above, while 18 percent were adolescent girl of age 15-19 years, and 39 percent of the women were aged 20-29 years. About 74 percent of the women have given birth to at least one child. Only 6 percent respondents were uneducated; while 63 percent completed primary and 30 percent secondary level of education. The proportion of respondents belonging to different wealth index quintiles varies slightly within the range of 18 percent in the poorest quintile to 23 percent in the richest quintile. Table HH.5 presents some selected background characteristics of under-5 children identified from collected information. The background characteristics of children include: sex, province, area of residence, age in months, mother's or caretaker's education, wealth and mother tongue of household heads. The household listing identified 1634 under-5 children, of which more than half (51.9%) were male and the remaining 48 percent were female. The percentage of children in different age groups varies to some extent between the ranges of 10 percent in the age group of less than 6 months to 22 percent in the age group of 12-23 months. About 9 percent mothers or caretakers of the children under-5 are non-educated; while 63 percent and 28 percent have completed primary and secondary level education respectively. The proportion of children belonging to the households of different wealth index quintiles varies slightly between the ranges of 16 percent in the richest quintile to 24 percent in the second quintiles. Vanuatu Multiple Indicator Cluster Survey-2007 16 Table HH.5: Children's background characteristics Percent distribution of children under five years of age by background characteristics, Vanuatu, 2007 Background Characteristics Weighted percent Number of under-5 children weighted unweighted Sex Male 51.9 849 844 Female 48.1 785 790 Region Tafea 17.6 287 240 Shefa 14.9 243 179 Malampa 18.3 300 146 Penama 12.2 199 149 Sanma 13.7 225 121 Torba 4.2 68 203 Port Vila 13.9 227 342 Luganville 5.2 86 254 Area Urban 19.1 312 596 Rural 80.9 1322 1038 Age < 6 months 9.9 161 155 6-11 months 11.1 182 192 12-23 months 22.0 359 342 24-35 months 21.0 342 337 36-47 months 19.8 324 339 48-59 months 16.2 265 269 Mother's education None 8.5 140 139 Primary 63.1 1031 960 Secondary 28.1 459 532 Non-standard (*) 3 2 Missing/DK (*) 1 1 Wealth index quintiles Poorest 22.4 367 311 Second 23.5 383 295 Middle 20.1 328 278 Fourth 18.5 302 332 Richest 15.5 254 418 Mother tongue of head Bislama 10.9 179 280 Other Language 88.9 1452 1350 Missing (*) 3 4 National 100.0 1634 1634 (*) Percent count has been suppressed as the figure is based on less than 25 unweighted cases. Vanuatu Multiple Indicator Cluster Survey-2007 17 4444. . . . INFANT AND UNDERINFANT AND UNDERINFANT AND UNDERINFANT AND UNDER----FIVE MORTALITYFIVE MORTALITYFIVE MORTALITYFIVE MORTALITY Infant and Under-Five Mortality One of the overarching goals of the Millennium Development Goals (MDGs) and the World Fit for Children (WFFC) is to reduce infant and under-five mortality. Specifically, the MDGs call for the reduction in under-five mortality by two-thirds between 1990 and 2015. Monitoring progress towards this goal is an important but difficult objective. Measuring childhood mortality may seem easy, but attempts using direct questions, such as “Has anyone in this household died in the last year?” give inaccurate results. Using direct measures of child mortality from birth histories is time consuming, more expensive, and requires greater attention to training and supervision. Alternatively, indirect methods developed to measure child mortality produce robust estimates that are comparable with the ones obtained from other sources. Indirect methods minimize the pitfalls of memory lapses, inexact or misinterpreted definitions, and poor interviewing technique. The infant mortality rate is the probability of dying before the first birthday. The under-five mortality rate is the probability of dying before the fifth birthday. In MICS surveys, infant and under-five mortality rates are calculated based on an indirect estimation technique known as the Brass method (United Nations, 1983; 1990a; 1990b). The data used in the estimation are: the mean number of children ever born for five year age groups of women from age 15 to 49, and the proportion of these children who are dead, also for five-year age groups of women. The technique converts these data into probabilities of dying by taking into account both the mortality risks to which children are exposed and their length of exposure to the risk of dying, assuming a particular model age pattern of mortality. Based on previous information on mortality in Vanuatu, the West model life table was selected as most appropriate. Table CM.1: Child mortality Infant and under-five mortality rates, Vanuatu, 2007 Background Characteristics Infant Mortality Rate* Under-five Mortality Rate** Sex Male 25 29 Female 25 31 Area Urban 23 27 Rural 26 32 Mother's education None/Primary 28 34 Secondary+ 12 14 Wealth index quintiles Poorest 60% 27 33 Richest 40% 22 26 National 25 30 * MICS indicator 2; MDG indicator 14 ** MICS indicator 1; MDG indicator 13 Table CM.1 provides estimates of child mortality by various background characteristics, while Table CM.2 provides the basic data used in the calculation of the mortality rates for the national total. The infant mortality rate is estimated at 25 per thousand, while the under-5 mortality rate (U5MR) is around Vanuatu Multiple Indicator Cluster Survey-2007 18 30 per thousand. These estimates have been calculated by averaging mortality estimates obtained from women aged 25-29 and 30-34, and refer to mid 2001. The estimate from the 1999 census for the under-5 mortality was 33 per 1000 live births which is very close to this estimate. There is slight difference between the probabilities of dying among males and females. Infant and under-5 mortality rates are lower in urban areas. There are also significant differences in mortality in terms of educational levels and wealth. In particular, the probabilities of dying among children of secondary or above education of mothers are significantly lower than the national average. However, the estimates for secondary or higher education, and wealth quintiles of richest 40 percent are based on small sample and require caution to interpret. Table CM.2. Children ever born and proportion dead Mean number of children ever born (CEB) and proportion dead by age of mother, Vanuatu, 2007 Age (in years) Mean number of children ever born Mean number of children surviving Proportion died Number of women 15-19 20-24 25-29 30-34 35-39 40-44 45-49 0.163 1.240 2.178 3.158 3.979 4.322 4.709 0.155 1.197 2.101 3.077 3.864 4.202 4.505 0.048 0.034 0.035 0.026 0.029 0.028 0.043 481 602 437 387 358 227 201 Total 2.358 2.283 0.032 2692 Figure CM.1 shows the series of U5MR estimates of the survey, based on responses of women in different age groups, and referring to various points in time, thus showing the estimated trend in U5MR based on the survey. The MICS estimates indicate a decline in mortality during the last 15 years. The U5MR estimate of 30 per thousand live births for 2001 from MICS3 is about 10 percent lower than the estimate from Population Census (33 per thousand live births) for the year 1999. There is no other survey to see the trend and the mortality trend depicted by the Census 1999 is also a declining one; however, MICS results are considerably lower than those indicated by Census 1999. Figure CM.1: Trend in Under-5 Mortality Rates, Vanuatu, 2007 42 35 33 39 27 29 31 32 36 2526 23 0 5 10 15 20 25 30 35 40 45 1980 1985 1990 1995 2000 2005 2010 Year U 5 M R P e r 1 0 0 0 1999 Census MICS 2007 Vanuatu Multiple Indicator Cluster Survey-2007 19 5.5.5.5. NUTRITIONNUTRITIONNUTRITIONNUTRITION Nutritional status Nutritional status of children is a reflection of the overall health and welfare status of a community. It is an outcome of complex interactions between food consumption and the overall status of health and care practices. If children have access to a regular and adequate food supply, they are not exposed to repeated illness, and hence are well cared for and attain their growth potential. Thus they reach their growth potential and are considered well nourished. Growth patterns of such healthy and well-fed children reflect the positive changes in their height and weight outcome. Different study findings reveal that, undernourishment or malnutrition is linked with more than half of all child deaths across the world. Undernourished children are more likely to die from common childhood ailments. Again, undernourished children who survive these illnesses often suffer from chronic diseases and faltering growth. Furthermore, three-quarters of the children worldwide who die from causes related to malnutrition are only mildly or moderately malnourished. Thus, this indicates a complex situation that being these children malnourished it does not show outward signs of their vulnerability. A key Millennium Development Goal (MDG), adopted by GoV, is to reduce the percentage of people suffering from hunger by half between 1990 and 2015. On the other hand, the WFFC goal, also adopted by GoV, is to reduce the prevalence of malnutrition among children below five years of age by at least one-third between 2000 and 2010, giving special attention to children below two years of age. The prevalence of malnutrition among children is associated with the child mortality. Hence a reduction in the prevalence of malnutrition contributes to the attainment of the MDG of reducing child mortality. Policies and plans have been articulated by successive Vanuatu governments of the past decades for the development of her children and women in this regard. The extent of undernourishment in a given population of children can be estimated by comparing their nutritional status to that of a well-nourished reference population. Conveniently, there is a reference distribution of height and weight for children under five years in a well-nourished population. The reference population used in this MICS-3 analysis is the WHO/CDC/NCHS reference, which is a UNICEF and the WHO, recommended reference. Internationally accepted indicators for measuring the prevalence of undernourishment or malnutrition of children are the following three anthropometric indices: (i) Underweight measured by Weight-for-Age Z score (WAZ), (ii) Stunting measured by Height-for-Age Z score (HAZ), and (iii) Wasting measured by Weight-for-Height Z scores (WHZ). Each of these three nutritional status indices is expressed in standard deviation (SD) units (i.e. Z- scores) from the median of this reference population. In the reference population, only 2.3 percent of children fall below minus two standard deviations for each of these three indices. Weight-for-age is a composite index of height-for-age and weight-for-height and thus takes into account both acute malnutrition (wasting) and chronic malnutrition (stunting). A child can be Vanuatu Multiple Indicator Cluster Survey-2007 20 underweight for his/her age because he/she is stunted, wasted, or both. Weight-for-age is a useful tool in clinical settings for continuous assessment of nutritional progress and growth. Children whose weight-for-age is below minus two standard deviations from the median of the reference population are classified as underweight. Height-for-age is a measure of linear growth. Children who are below minus two standard deviations (-2SD) from the median of the NCHS reference population in terms of height-for-age are considered short for their age, or stunted, a condition reflecting the cumulative effect of chronic malnutrition. Children below minus three standard deviations (-3SD) from the reference median are considered as severely stunted. A child between -2SD and -3SD is considered as moderately stunted. Stunting reflects failure to receive adequate nutrition over a long period and may also be caused by recurrent and chronic illness. Height-for-age, therefore, represents a measure of the long-term effects of malnutrition in a population and does not vary appreciably according to the season of data collection. Stunted children are not immediately obvious in a population; a stunted three-year-old child could look like a well-fed two-year-old. Weight-for-height indicates wasting as reflecting recent acute nutritional deficit in a child. A child whose weight-for-height Z score is below -2SD from the median value of the reference population is considered to be too thin for his/her height or moderately or severely wasted. The children whose weight-for-height is more than three SD below the median are classified as severely wasted. Severe wasting is closely linked to an elevated risk of mortality. The indicator may show evidence of significant seasonal variations associated with changes in the accessibility of food or disease prevalence. In the MICS-3 in Vanuatu, weights and heights of all children below five years of age were measured using anthropometric equipments recommended by UNICEF. The findings in this section are based on the results of these measurements. The MICS-3 in Vanuatu identified 1,741 under-five children eligible to be weighed and measured. The survey, however, was not able to measure the height and weight of all eligible children for various reasons including the child was not at home at the time of the health investigator’s visit or because the mother/caretaker refused to allow the child to be weighed and measured. The analysis also excluded the children whose month or year of birth was not known and those with grossly improbable height or weight measurements. In addition, two of the three indices (weight for-age and height-for-age) are sensitive to misreporting of children’s age, including heaping on preferred digits. Of the 1,741 children eligible for measurement (aged 0-59 months at the time of the survey), 73 percent or 1,281 were weighed and measured. The survey, thus, failed to measure the height or weight of 27 percent of children under-five. The following analysis focuses on the 1,281 children age 0-59 months for whom complete and plausible anthropometric data were collected. Table NU.1 shows the percentage of children those are classified as malnourished according to height- for-age, weight-for-height, and weight-for-age indices, by the child’s age and selected demographic background characteristics. Nearly 1 out of 6 (15.9%) children are considered underweight (low weight-for-age), and only few (2.2%) are classified as severely underweight. Boys are more likely to be underweight (<-2SD) than the girls (18.3% vs. 13.4%). But, the prevalence of severely underweight (<-3SD) is higher among girls than boys (2.5% vs. 1.9%). The prevalence of underweight is almost equal among urban and rural children (15.2% and 16.1% respectively). Children under six months are least likely to be underweight, Vanuatu Multiple Indicator Cluster Survey-2007 21 probably due to the positive effects of breastfeeding and birth weight. After six months of age, the proportion of underweight children rises substantially to 26 percent among the children aged 12-23 months and then drops steadily to 17 percent among 48-59 months age. There is some regional variation in the underweight of children. Children in Luganville (23.4%), Penama (21.8%), Sanma (19.6%) and Torba (19.0%) are more likely to be underweight (<-2SD) than the children from other provinces. Severe malnourishment (<-3 SD) is slightly higher in Sanma, Torba and Port Vila (3.2-4.0%) than those in other provinces. As expected, underweight decreases with the mother’s education and wealth quintiles. Figure NU.1: Percentage of children under-5 who are undernourished, Vanuatu, 2007 0 5 10 15 20 25 30 0 6 12 18 24 30 36 42 48 54 60 Age (in Months) P e rc e n t Underweight Stunted Wasted About one-fifth (20.1%) of the under-five children are stunted (Global Chronic Malnutrition; <-2SD), of whom 7 percent are severely stunted or too short for their age. Boys are more likely to be stunted than girls (23.4% vs. 16.6%), while similar pattern is observed in case of severely stunted children (boys: 7.0%, girls: 6.6%). Children under six months are least likely to be stunted (3.0%). After six months of age, the proportion of children those are stunted rises substantially to 26 percent among those of 12-23 months and then drops steadily to 21 percent among children aged 36-47 months and then increased to 29 percent among the children aged 48-59 months. Proportion of stunted children (<-2 SD) varies within the range of 15 percent to 23 percent across the provinces. The highest proportion is found in Malampa, Penama, Sanma, and Port Vila (21.0-23.1%), compared with other provinces (15.1-17.7%). Also, severely stunted children is more prevalent in Port Vila (10.4%), Sanma (8.9%), Tafea (6.9%), Malampa (6.5%) and Luganville city (7.3%) compared with those in the remaining provinces (3.2-5.1%). Stunting decreases with the mother’s education. The prevalence of stunting is highest (23.2%) among the children of the poorest group. Around 7 percent children are wasted (Global Acute Malnutrition, <-2SD) or too thin for their height. Only nominal (1.3%) are severely wasted. Boys are more likely to be wasted than girls (7.0% vs. 5.9%). Urban children are more likely to be wasted than the rural children (7.9% and 6.1% respectively). Children under six months are least likely to be wasted. After six months of age, the proportion of wasted children rises substantially to 14 percent among those 12-23 months and then drops steadily to 4 percent among children aged 48-59 months. Children with acute malnutrition are the highest in Vanuatu Multiple Indicator Cluster Survey-2007 22 Sanma (11.6%), followed by Luganville (9.7%), Torba (8.7%), Port Vila (7.6%) and Penama (7.6%), and is the lowest in Tafea (1.1%). Province wise the severe wasted children are quite marginal; slightly high is in Port Vila (3.2%), while it is nil in Shefa and Torba. Acute malnutrition decreases with mother’s education. However, wealth quintile does not show any consistent pattern. Table NU.1: Child malnourishment Percentage of children aged 0-59 months who are severely or moderately undernourished, Vanuatu, 2007 Background Characteristics Weight for age: % below -2 SD* Weight for age: % below -3 SD Height for age: % below - 2 SD** Height for age: % below -3 SD* Weight for height: % below -2 SD*** Weight for height: % below -3 SD Weight for height: % above +2 SD Number of children Sex Male 18.3 1.9 23.4 7.0 7.0 1.1 2.4 665 Female 13.4 2.5 16.6 6.6 5.9 1.6 2.3 615 Region Tafea 11.4 1.7 17.7 6.9 1.1 0.6 2.9 209 Shefa 12.7 0.6 16.5 5.1 5.7 0.0 1.9 214 Malampa 15.7 2.8 23.1 6.5 4.6 0.9 1.9 222 Penama 21.8 0.8 21.0 3.4 7.6 2.5 3.4 159 Sanma 19.6 3.6 22.3 8.9 11.6 1.8 0.9 208 Torba (19.0) (4.0) (15.1) (3.2) (8.7) (0.0) (0.8) 42 Port Vila 13.3 3.2 22.3 10.4 7.6 3.2 3.6 184 Luganville (23.4) (1.6) (16.9) (7.3) (9.7) (0.8) (3.2) 42 Area Urban 15.2 2.9 21.3 9.8 7.9 2.8 3.5 226 Rural 16.1 2.0 19.9 6.1 6.1 1.0 2.1 1055 Age < 6 months 2.2 0.0 3.0 0.0 0.4 0.0 3.0 89 6-11 months 6.4 0.9 4.1 1.8 6.3 1.8 4.5 147 12-23 months 26.0 3.4 25.9 7.3 14.3 2.4 1.9 308 24-35 months 17.9 2.4 20.5 7.9 4.1 0.5 2.2 265 36-47 months 11.3 1.4 20.9 7.4 3.9 1.3 0.0 258 48-59 months 16.8 2.9 28.7 10.2 3.7 1.2 4.2 213 Mother's education None 21.0 3.1 26.9 12.1 7.9 1.9 5.8 100 Primary 17.3 2.5 20.1 7.0 6.5 1.5 1.9 817 Secondary 11.6 1.3 18.1 4.9 5.9 0.9 2.2 360 Non-standard (*) (*) (*) (*) (*) (*) (*) 3 Wealth index quintiles Poorest 18.1 4.6 23.2 9.9 6.1 1.0 2.3 278 Second 20.5 2.0 18.4 5.0 9.0 0.8 0.9 316 Middle 13.5 0.3 20.9 5.0 5.0 1.5 4.2 267 Fourth 12.3 0.8 18.9 5.3 4.7 1.1 1.5 228 Richest 13.0 3.4 19.2 9.5 6.9 2.9 3.1 193 Mother tongue of head Bislama 16.3 1.9 23.1 14.1 6.5 1.8 4.6 136 Other Language 15.9 2.2 19.8 5.9 6.5 1.3 2.0 1142 Missing (*) (*) (*) (*) (*) (*) (*) 3 National 15.9 2.2 20.1 6.8 6.5 1.3 2.3 1281 * MICS indicator 6; MDG indicator 4 ** MICS indicator 7 *** MICS indicator 8 (*) Percent count has been suppressed as the figure is based on less than 25 unweighted cases ( ) Figure is based on 25-49 unweighted cases The age pattern of the children shows a noticeable similar trend in nutritional status i.e. a higher proportion of them aged 12-23 months are undernourished according to all the three indices in comparison to those who are younger and older than this age range (Figure NU.1). This pattern might Vanuatu Multiple Indicator Cluster Survey-2007 23 16% underweight (<-2 SD), 20% stunted and 7% wasted nationally be because this is related to the child age at which many children cease to be breastfed and are exposed to contamination in water, food and the environment or inadequate complementary feeding. In brief, nationally 16 percent children are moderately or severely underweight, 20 percent are moderately or severely stunted and 7 percent are moderately or severely wasted. This situation is more or less similar to that of the East Asia and the Pacific region with 15 percent underweight and 19 percent stunted there (UNICEF, 2007). However, the situation is better than the world average, as 25 percent children are underweight and 30 percent stunted worldwide (G. Haberkorn and A. Jopari, 2007). The MICS-3 data shows slightly higher prevalence than that was found in National Nutrition Survey, 1996 (15.9% vs. 12.1% for underweight and 6.5% vs. 5.5% for wasted; while stunting remained unchanged at 20.1%) (DoH and AusAid 1996). However, child nutrition status of Vanuatu seems to be slightly improved in recent years compared to UN estimates for 2005, as the prevalence of underweight decreased from 20 percent to 16 percent and prevalence of stunting slightly increased from 19 percent to 20 percent (GoV and UNICEF, 2005). In fact, Vanuatu has enough food grown out of subsistence agriculture and gardening, and fishing, and raring poultry and livestock to feed her people; although many families do not get protein regularly. Thus some children suffer from malnutrition not due to want of food but due to lack of awareness of people to have balanced diet with sufficient quantities of vitamins, proteins and micro-nutrients. Therefore, efforts should be there to make people aware and conscious about child and mother's health and nutrition. Breastfeeding Inadequate or inappropriate child feeding practices is the foremost reason that leads to malnutrition of children. It plays an important role for optimal growth of children. Contrary to this, inadequate and inappropriate breastfeeding and complementary feeding practices lead to poor health and malnutrition of children, which again hinders their proper physical growth and mental development. Early initiation of breastfeeding creates bondage between the mother and the newborn and it helps maintaining baby's body temperature and increases body resistance for protection against diseases. UNICEF and WHO recommended for feeding colostrums (the first breast milk) to the newborn immediately after birth and continuous exclusive breastfeeding for the first five months of life. They also recommended that breastfeeding be initiated within one hour of birth, continue breastfeeding for two years or more; safe, appropriate and adequate complementary foods be started at six months onward, and this food be given at least twice per day for 6-8 month-olds; at least three times for 9-11 months children. The indicators for recommended child feeding practices are: • Exclusive breastfeeding rate (<6 months and <4 months), • Timely complementary feeding rate (6-9 months), • Continuous breastfeeding rate (12-15 months and 20-23 months), • Timely initiation of breastfeeding (within one hour of birth), Vanuatu Multiple Indicator Cluster Survey-2007 24 • Frequency of complementary feeding (6-11 months), • Adequately fed infants (10-11 months). Figure NU.2: Percentage of mothers who started breastfeeding (within one hour and within one day of birth), Vanuatu, 2007 8 8 .3 6 7 .4 6 7 .2 6 3 .9 6 5 .9 4 1 .6 8 5 .9 7 4 .7 8 2 .4 7 0 7 1 .9 9 2 .4 8 2 .6 8 7 .7 7 7 .2 6 8 4 8 .8 9 1 .2 7 6 .5 8 6 .6 8 1 .5 8 2 .3 0 10 20 30 40 50 60 70 80 90 100 Tafea Shefa Malampa Penama Sanma Torba* Port Vila Luganville* Urban Rural National P e rc e n t Within one hour Within one day * Figure is based on 25-49 unweighted cases Initial breastfeeding Table NU.2 presents the proportion of sample women in Vanuatu who initiated breastfeeding to infants within one hour of birth and women who initiated within one day of birth. About 72 percent women, who gave birth in two years preceding the survey, breastfed their babies within one hour of birth, while 82 percent within one day of birth. Urban women are more likely to initiate breastfeeding within one hour or within one day of birth than the rural women. Comparatively higher proportion of women in Tafea (88.3%), Port Vila (85.9%), Luganville (74.7%), Shefa, Malampa and Sanma (65.9-67.4%) than those in Torba (41.6%) breastfed their babies within one hour of birth. Women in Tafea (92.4%), Port Vila (91.2%) and Malampa (87.7%) are more likely to have initiated breastfeeding within one day of birth than those in Shefa, Penama, Luganville and Sanma (68.0% to 82.6%) and Torba (48.8%). Mother’s education and wealth status show positive association with the early initiation of breastfeeding. Mothers with primary or secondary level of education and those from the higher wealth quintiles (except middle class) reported higher practice of both types of behavior than those who have no education or from lower wealth quintiles. 72% initiated within 1 hour (higher in urban), 82% within 1 day; urban: 86%, rural: 81% Vanuatu Multiple Indicator Cluster Survey-2007 25 Table NU.2: Initial breastfeeding Percentage of women aged 15-49 years with a birth in the 2 years preceding the survey who breastfed their baby within one hour of birth and within one day of birth, Vanuatu, 2007 Background Characteristics Percentage who started breastfeeding within one hour of birth* Percentage who started breastfeeding within one day of birth Number of women with live birth in the two years preceding the survey Region Tafea 88.3 92.4 149 Shefa 67.4 82.6 116 Malampa 67.2 87.7 162 Penama 63.9 77.2 90 Sanma 65.9 68.0 84 Torba (41.6) (48.8) 37 Port Vila 85.9 91.2 80 Luganville (74.7) (76.5) 36 Area Urban 82.4 86.6 116 Rural 70.0 81.5 639 Months since last birth < 6 months 69.5 78.8 199 6-11 months 66.8 80.4 193 12-23 months 76.0 85.2 363 Education None 61.3 73.3 59 Primary 70.5 81.2 488 Secondary + 78.5 87.6 207 Non-standard curriculum (*) (*) 0 Wealth index quintiles Poorest 68.4 80.4 191 Second 69.2 83.8 202 Middle 71.6 78.8 148 Fourth 75.1 84.3 135 Richest 82.6 86.5 78 Mother tongue of head Bislama 75.6 75.6 68 Other Language 71.5 83.0 686 Missing (*) (*) 0 National 71.9 82.3 755 * MICS indicator 45 (*) Percent count has been suppressed as the figure is based on less than 25 unweighted cases ( ) Figure is based on 25-49 unweighted cases Exclusive and continued breastfeeding Table NU.3 provides the assessment of breastfeeding status based on the mothers’ or caregivers’ reports regarding children’s consumptions of food and fluid within 24-hours prior to the interview. Here exclusively breastfed refers to infants who received only breastmilk (with or without vitamins, mineral supplements and/or medicine) during this time. The Table shows the rates of exclusive breastfeeding of infants during the first six months of life (separately for 0-3 months and for 0-5 months), complementary feeding to the children aged 6-9 months and continued breastfeeding to the children at 12-15 months and 20-23 months of age. Vanuatu Multiple Indicator Cluster Survey-2007 26 Slightly less than half (47.6%) of children aged less than 4 months and 40 percent children aged less than 6 months are exclusively breastfed. The results indicate that majority of the children were given substitute food along with breast milk before 4 months or 6 months of age. Female babies are more likely to receive exclusive breastfeeding than males. Provincial and urban-rural variation can not be depicted due to smaller number of samples in most of the provinces. However, the rates of exclusive breastfeeding among 0-6 months children are 65 percent in Tafea and 24 percent in Malampa. Continued breastfeeding for the first two years of age is an ideal source of nutrients to children and it protects them from infection; it is also safe and economical. But many mothers unknowingly stop breastfeeding too early and begin giving formula food to their children, which often, instead of providing balanced nutrition, may contribute to micronutrient deficiencies and imbalanced growth. Following is the description of complementary feeding status of the children below two years of age. Complementary feeding At age 6-9 months, 62 percent of children are receiving breast milk along with semisolid or solid food (Table NU.3). Higher proportion of children aged 6-9 months from rural areas (65.1%) and with primary level of education (64.8%) is receiving complementary food than that of national average. By age 12-15 months, 79 percent children are still being breastfed and by age 20-23 months about 32 percent of them are still being breastfed. Female children are more likely to receive continued breastfeeding till 12-23 months of age than their male counterparts. The differentials by mothers’ education, wealth categories and by province cannot be produced due to smaller number of observation. 40% children (<6 month) exclusively breastfed; No variations in areas 62% children (6-9 months) given complementary food; higher in rural area V a n u a tu M u lt ip le I n d ic a to r C lu st er S u rv ey -2 00 7 27 T a b le N U .3 : B re a st fe e d in g P e rc en ta g e o f li vi n g c h il d re n a cc o rd in g t o b re a st fe ed in g s ta tu s a t e a ch a g e g ro u p , V a n u a tu , 20 07 C h ild re n 0 -3 m o n th s C h ild re n 0 -5 m o n th s C h ild re n 6 -9 m o n th s C h ild re n 1 2 -1 5 m o n th s C h ild re n 2 0 -2 3 m o n th s B ac kg ro un d C ha ra ct e ris tic s P er ce nt ex cl us iv el y br ea st fe d N um be r of ch ild re n P er ce nt ex cl us iv el y br ea st fe d * N um be r of ch ild re n P er ce nt r ec e iv in g br ea st m ilk a nd so lid /m u sh y fo od * * N um be r of ch ild re n P er ce nt br ea st fe d* ** N um be r of ch ild re n P er ce nt br ea st fe d ** * N um be r of ch ild re n S e x M a le 4 2 .8 5 3 3 6 .9 7 3 5 8 .9 5 4 7 7 .4 7 4 2 8 .8 4 9 F e m a le 5 2 .5 5 2 4 2 .8 8 6 6 4 .3 6 8 8 1 .3 5 7 3 4 .6 4 9 R e g io n T a fe a (* ) 1 9 (6 5 .4 ) 3 1 (3 3 .3 ) 2 5 (8 3 .3 ) 2 9 (* ) 1 3 S h e fa (* ) 1 5 (* ) 2 3 (* ) 2 4 (* ) 1 9 (* ) 1 4 M a la m p a (2 5 .0 ) 2 5 (2 3 .5 ) 3 5 (* ) 1 6 (8 7 .5 ) 3 3 (* ) 1 6 P e n a m a (* ) 1 1 (* ) 1 6 (* ) 1 3 (* ) 1 3 (* ) 1 9 S a n m a (* ) 1 7 (* ) 2 4 (* ) 1 3 (* ) 1 3 (* ) 1 5 T o rb a (* ) 4 (* ) 7 (* ) 7 (* ) 2 (* ) 4 P o rt V ila (* ) 1 0 (* ) 1 5 (* ) 1 6 (* ) 1 7 (* ) 1 2 L u g a n v ill e (* ) 4 (* ) 8 (* ) 6 (* ) 4 (* ) 6 A re a U rb a n (* ) 1 4 (* ) 2 3 (* ) 2 2 (* ) 2 2 (* ) 1 8 R u ra l 4 6 .3 9 0 4 0 .0 1 3 7 6 5 .1 9 9 8 1 .4 1 0 9 3 0 .8 8 0 M o th e r' s e d u c a ti o n N o n e (* ) 9 (* ) 1 6 (* ) 4 (* ) 1 6 (* ) 6 P ri m a ry 4 8 .2 6 4 4 3 .7 9 5 6 4 .8 8 4 7 5 .3 7 0 3 2 .3 7 0 S e c o n d a ry (4 6 .6 ) 3 2 (3 5 .4 ) 4 8 (5 7 .8 ) 3 3 (8 3 .5 ) 4 5 (* ) 2 2 W e a lt h in d e x q u in ti le s P o o re s t (4 1 .1 ) 3 2 (3 9 .9 ) 4 4 (7 3 .3 ) 2 6 7 5 .9 3 4 (* ) 2 3 S e c o n d (6 4 .8 ) 2 9 (5 3 .8 ) 4 0 (6 1 .1 ) 2 8 8 2 .0 3 8 (* ) 1 7 M id d le (* ) 1 6 (4 1 .1 ) 2 8 (* ) 1 7 (8 9 .6 ) 2 6 (1 9 .9 ) 2 5 F o u rt h (* ) 1 5 (2 0 .2 ) 3 0 (7 4 .2 ) 3 5 (* ) 2 1 (* ) 2 4 R ic h e s t (* ) 1 2 (* ) 1 7 (* ) 1 6 (* ) 1 2 (* ) 1 1 M o th e r to n g u e o f h e a d B is la m a (* ) 6 (* ) 1 4 (* ) 1 5 (* ) 9 (* ) 1 2 O th e r L a n g u a g e 4 7 .5 9 8 4 1 .3 1 4 5 6 1 .8 1 0 7 8 0 .3 1 2 2 3 2 .8 8 6 N a ti o n a l 4 7 .6 1 0 4 4 0 .1 1 6 0 6 1 .9 1 2 2 7 9 .1 1 3 1 3 1 .7 9 8 * M IC S i n d ic a to r 1 5 ** M IC S i n d ic a to r 1 7 ** * M IC S i n d ic a to r 1 6 (* ) P e rc e n t c o u n t h a s b e e n s u p p re s s e d a s t h e f ig u re i s b a s e d o n l e s s t h a n 2 5 u n w e ig h te d c a s e s ( ) F ig u re i s b a s e d o n 2 5 -4 9 u n w e ig h te d c a s e s Vanuatu Multiple Indicator Cluster Survey-2007 28 Adequacy of feeding Table NU.4 and Figure NU.3 shows the adequacy of infant feeding to children below 12 months. Different criteria of adequate feeding are used depending on the age of the child. For infants age 0-5 months, exclusively breastfeeding represents adequate feeding. On the other hand, infants aged 6-8 months are considered to be adequately fed if they receive breastmilk and complementary food at least two times per day, while infants aged 9-11 months are considered to be adequately fed if they receive breastmilk and complementary food at least three times a day. The data indicate that 40 percent of the children aged 0-5 months are receiving adequate feeding of exclusive breastfeeding. However, over half (52.4%) of the children aged 6-8 months are receiving breastmilk and complementary foods at least for the minimum recommended number of times (i.e. 2 times) in 24 hours prior to the survey (Table NU.4). It is the highest in Shefa (76.9%) and the lowest in Tafea (33.3%). Girls (57.2%) are more likely to receive such foods for 2 times in past 24 hours than their boy counterparts (46.9%). Children from rural areas are more likely to receive adequate feeding than the children from urban areas (54.5% vs. 42.8%). Mother’s education shows positive effect on adequate feeding, while household wealth status does not show any consistent effect on adequate feeding. For the children aged 9-11 months, 47 percent received breastmilk and complementary foods at least three times in 24 hours leading up to the interview. It is higher in rural area (50.1%) compared with urban area (32.0%); highest in Malampa (71.4%) and lowest in Sanma (20.0%). Again, the children aged 6-11 months received breastmilk and complementary foods for the minimum recommended number of times in past 24 hours are 50 percent (urban: 37.3% and rural: 52.3%). As an outcome of these feeding patterns, 45 percent children aged 0-11 months are adequately and appropriately fed. Children from rural areas are more likely to receive adequate feeding than that of urban area (46.2% vs. 38.4%). The proportion is found comparatively high in Penama, Tafea and Shefa (50.0%-55.0%) than in other provinces/cities (29.2%-44.6%). Higher education of mother have no explicit impact, while the wealth quintiles show negative trend on such feeding practices, as indicated by background characteristics. Vanuatu Multiple Indicator Cluster Survey-2007 29 Figure NU.3: Infant feeding pattern by Age Percent distribution of children aged under 3 years by feeding pattern by age, Vanuatu, 2007 Vanuatu Multiple Indicator Cluster Survey-2007 30 Table NU.4: Adequately fed infants Percentage of infants under 6 months of age exclusively breastfed, percentage of infants 6-11 months who are breastfed and who ate solid/semi-solid food at least the minimum recommended number of times yesterday and percentage of infants adequately fed, Vanuatu, 2007 Background Characteristics 0-5 months exclusively breastfed 6-8 months who received breastmilk and complementary food at least 2 times in prior 24 hours 9-11 months who received breastmilk and complementary food at least 3 times in prior 24 hours 6-11 months who received breastmilk and complementary food at least the minimum recommended number of times per day* 0-11 months who were appropriately fed** Number of infants aged 0- 11 months Sex Male 36.7 46.9 57.1 52.0 45.0 159 Female 42.1 57.2 37.3 47.5 45.3 185 Region Tafea 65.4 33.3 57.9 47.1 55.0 72 Shefa 41.2 76.9 30.0 56.5 50.0 54 Malampa 23.5 50.0 71.4 61.5 40.0 62 Penama (46.2) (62.5) (57.1) (60.0) (53.6) 37 Sanma (23.1) (50.0) (20.0) (36.4) (29.2) 45 Torba (*) (*) (*) (*) (*) 17 Port Vila (47.8) (50.0) (33.3) (42.4) (44.6) 37 Luganville (*) (*) (*) (*) (*) 19 Area Urban 39.9 42.8 32.0 37.3 38.4 56 Rural 39.6 54.5 50.1 52.3 46.2 287 Mother's education None (32.4) (21.9) (70.1) (64.4) (46.5) 29 Primary 43.0 51.4 46.0 48.9 46.3 222 Secondary 35.4 57.0 34.7 47.4 41.1 92 Wealth index quintiles Poorest 38.7 62.8 86.6 71.7 53.6 83 Second 53.8 47.0 73.1 59.2 56.6 84 Middle 40.7 30.0 20.8 22.9 30.7 66 Fourth 20.2 63.7 35.3 52.8 39.1 71 Richest (41.1) (34.0) (32.3) (33.2) (36.5) 40 Mother tongue of head Bislama (27.7) (60.9) (25.1) (47.8) (38.9) 33 Other language 40.8 51.2 48.5 49.8 45.6 311 National 39.7 52.4 46.7 49.6 44.9 343 * MICS indicator 18 ** MICS indicator 19 (*) Percent count has been suppressed as the figure is based on less than 25 unweighted cases ( ) Figure is based on 25-49 unweighted cases Vanuatu Multiple Indicator Cluster Survey-2007 31 Salt iodization Iodine Deficiency Disorder (IDD) is the world’s foremost cause of preventable mental retardation and impaired psychomotor development in young children. When it is in its extreme form, iodine deficiency causes cretinism. Iodine deficiency also increases the risks of stillbirth and miscarriage in pregnant women. It is most commonly associated and visible with goiter. IDD takes its maximum toll in impaired mental growth and development, contributing in turn to poor school performance, reduced intellectual ability and impaired work performance. The indicator in this regard is the proportion of households consuming adequately iodized salt (≥15 Parts per Million: PPM). The findings of the survey related to the household consumption of iodized salt are given in table NU.5 and Figure NU.4. In 82 percent of the sample households, salt used for cooking was tested for iodine contents by using salt test kits, testing for the presence of potassium iodate and the test result was recorded accordingly. The findings show that, no salt is available in a very small proportion of the households (10.9% nationally, urban: 4.8% rural: 12.8%). Nearly a quarter (22.9%) of the households consumes salt containing 15 PPM or more iodine and is higher in urban area (43.8%) than rural area (16.4%). Provincial differentials are also there in this regard, as it varies from 5 percent in Penama to 28 percent in Shefa province among rural areas; the highest is in Luganville city, where nearly three-fourth of the households (72.5%) have adequately iodized salt. The data also show that, households in the richest quintiles consume more iodized salt compared to households in the poorest quintiles (49.4% vs. 7.5%). Figure NU.4 Percentage of households consuming adequately iodized salt, Vanuatu, 2007 14.1 28.3 12.0 5.4 21.2 18.1 35.2 72.5 88.5 79.8 81.9 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0 Tafea Shefa Malampa Penama Sanma Torba Port Vila Lugenville Urban Rural National P e rc e n t Vanuatu Multiple Indicator Cluster Survey-2007 32 Table NU.5: Iodized salt consumption Percentage of households consuming adequately iodized salt, Vanuatu, 2007 Percent of households in which salt was tested Number of households interviewed Percent of households with salt test result Total Number of households in which salt was tested or with no salt Households with no salt < 15 PPM 15+ PPM* Region Tafea 77.6 339 15.3 70.7 14.1 100.0 310 Shefa 87.5 367 6.9 64.8 28.3 100.0 345 Malampa 81.1 475 11.1 76.9 12.0 100.0 433 Penama 75.6 350 15.2 79.4 5.4 100.0 312 Sanma 86.2 385 6.1 72.6 21.2 100.0 353 Torba 43.4 100 52.0 29.9 18.1 100.0 91 Port Vila 90.2 464 5.4 59.4 35.2 100.0 442 Luganville 83.5 153 3.0 24.5 72.5 100.0 132 Area Urban 88.5 617 4.8 51.4 43.8 100.0 574 Rural 79.8 2015 12.8 70.9 16.4 100.0 1843 Wealth index quintiles Poorest 72.1 525 21.0 71.5 7.5 100.0 479 Second 80.4 547 11.3 78.6 10.1 100.0 496 Middle 81.5 512 10.7 69.4 19.9 100.0 468 Fourth 84.2 533 8.0 64.7 27.3 100.0 488 Richest 91.3 514 3.6 47.0 49.4 100.0 486 National 81.9 2632 10.9 66.3 22.9 100.0 2417 *MICS indicator 41 Vanuatu Multiple Indicator Cluster Survey-2007 33 Low birth weight Weight at birth is a good indicator not only for mother’s health and nutritional status but also for newborn’s chances of survival, growth, long-term health and psychosocial development. Because, weight at birth interprets the health and nutritional condition of the newborn and it indicates the future trend. Low birth weight (i.e. birth weight less than 2,500 grams) holds a range of grave health risks for children. Babies who are undernourished in the mothers’ womb usually face a greatly increased risk of dying during the early months and years of their lives. Those who survive are not also out of risk. They often have impaired immune function and increased risk of diseases. LBW infants are more likely to remain undernourished, with reduced muscle strength throughout their lives, and suffer a higher incidence of diabetes and heart disease in later life. Children born underweight also tend to have a lower IQ and cognitive disabilities. It affects their performance in school or learning and in their job opportunities as adults. Figure NU.5: Live births in the 2 years preceding the survey that weighed below 2500 grams at birth, Vanuatu, 2007 67.5 96.4 88.2 83.1 57.2 36.2 96.5 80.4 91.5 77 79.3 10.8 10.5 11.1 8.8 7.5 14.7 9.9 7.9 9.2 10.3 10.2 0 10 20 30 40 50 60 70 80 90 100 Tafea Shefa Malampa Penama Sanma Torba* Port Vila Lugenville* Urban Rural National P er ce nt Births below 2500 grams Births weighed at birth * Figure is based on 25-49 unweighted cases In the developing world, LBW stems primarily from the mother's poor health and nutrition. Three factors have been found to influence a newborn to be born with LBW: 1) the mother's poor nutritional status before conception, 2) her short stature (due mostly to poor nutrition and infections during her childhood), and 3) poor nutrition during the pregnancy. Inadequate weight gain during pregnancy is particularly important since it accounts for a large percentage of foetal growth retardation. Moreover, diseases such as diarrhoea and malaria, which are common in many developing countries, can significantly impair foetal growth if the mother becomes infected while pregnant. In the industrialized world, smoking during pregnancy is the major cause of LBW. In developed and developing countries alike, teenagers who give birth when their own bodies have yet to finish growing run a higher risk of bearing LBW babies than do fully-developed individuals. One of the major challenges in measuring the incidence of LBW is the fact that more than half of infants in the developing world are not weighed at birth. In the past, most estimates of LBW for developing countries were based on data compiled from health facilities. However, these estimates are Vanuatu Multiple Indicator Cluster Survey-2007 34 biased in most developing countries because the majority of newborns are not delivered in facilities; those who are born in facilities represent a selected sample of all births that is not representative of the overall population. Upon this backdrop, the GoV has introduced birth registration system and all children are to be weighed at birth there. Note that 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 as recorded on a health card if the child was weighed at birth. Table NU.8 presents the percentage of live births in 2 years preceding the survey that has been weighted as low birth (<2500 mg) according to some selected background characteristics. Nearly 79 percent of the children born in two years preceding the survey were weighed at birth; the proportion is more in urban area (91.5%) than in rural area (77.0%). Substantial provincial variations are noticed in this regard. Slightly over 67 percent to 97 percent children in Tafea, Shefa, Malampa, Penama, Luganville and Port Vila were weighed; while it was 36 to 57 percent in the remaining 2 provinces. Mother’s education and household’s wealth status show strong positive effect on weighting children at birth. For example, 90 percent of the children having mother with secondary or above level of education were weighted at birth compared to 53 percent with mother having no education. Among the weighed children, one in ten (10.2%) appeared as low birth weight (<2500 grams) children. No major difference is visible between residential areas (urban: 9.2% and rural: 10.3%). However, slight provincial differences are observed in this regard: 11-15 percent is in Tafea, Shefa, Malampa and below 10 percent is in Penama, Sanma, Port Vila city and Luganville city. Mother’s education shows negative effect on low birth weight. Household wealth status (except poorest group) also shows an overall negative effect on low birth weight. Vanuatu Multiple Indicator Cluster Survey-2007 35 Table NU.8: Low birth weight infants Percentage of live births in the 2 years preceding the survey that weighed below 2500 grams at birth, Vanuatu, 2007 Background Characteristics Percent of live births below 2500 grams * Percent of live births weighed at birth ** Number of live births Region Tafea 10.8 67.5 149 Shefa 10.5 96.4 116 Malampa 11.1 88.2 162 Penama 8.8 83.1 90 Sanma 7.5 57.2 84 Torba (14.7) (36.2) 37 Port Vila 9.9 96.5 80 Luganville (7.9) (80.4) 36 Area Urban 9.2 91.5 116 Rural 10.3 77.0 639 Education None 11.3 53.2 59 Primary 10.3 78.0 488 Secondary + 9.5 89.8 207 Non-standard curriculum (*) (*) 0 Wealth index quintiles Poorest 9.4 66.1 191 Second 10.4 80.3 202 Middle 12.9 77.6 148 Fourth 8.8 91.2 135 Richest 8.6 91.2 78 Mother tongue of head Bislama 9.9 82.9 68 Other Language 10.2 78.9 686 Missing (*) (*) 0 National 10.2 79.3 755 * MICS Indicator 9 ** MICS Indicator 10 (*) Percent count has been suppressed as the figure is based on less than 25 unweighted cases ( ) Figure is based on 25-49 unweighted cases Vanuatu Multiple Indicator Cluster Survey-2007 36 6.6.6.6. CHILD HEALTHCHILD HEALTHCHILD HEALTHCHILD HEALTH Immunization MDG number 4 seeks to reduce child mortality by two thirds from 1990 till 2015. Immunization plays a pivotal role and is a key part of this goal. Immunization has saved lives of millions of children in the past three decades since the launch of the Extended Programme on Immunization (NID) in 1979. Nonetheless, 27 million children worldwide are currently overlooked by routine immunization and consequently vaccine preventable diseases cause more than two million child-deaths every year4. The WFFC on immunization expects countries to reach 90 percent coverage nationally in full immunization of children below one year of age against childhood diseases like diphtheria, pertusis, tetanus, polio and measles. Vaccination coverage by age one year is generally assessed by examining children aged 12-23 months. According to the UNICEF and WHO guidelines, children should receive a BCG vaccination to protect them against tuberculosis, three doses of DPT to protect them against diphtheria, pertusis and tetanus, three doses of polio vaccine, and a measles vaccination by the age of 12 months. Mothers were asked to provide vaccination cards for their under-2 children. Interviewers recorded vaccination information from the cards on to the MICS questionnaire. Where cards were not available, vaccination status was assessed through a structured oral history taken from the mother or caretaker of the child. The data indicates that only 68 percent of the surveyed under-2 children had vaccination cards. If the child did not have a card, the mother was asked to recall whether or not the child had received each of the vaccinations and, for DPT and polio number of times the child received the vaccine. Table CH.1 shows the proportion of children aged 12-23 months who received each of the vaccinations. Only children within that age group - old enough to be fully vaccinated - were counted. In the top panel, the numerator includes all children who were vaccinated at any time before the survey, according to the vaccination card or the mother's recall. In the bottom panel, only those who were vaccinated before their first birthday are included. BCG vaccination coverage is one key MICS indicator (25). Over 79 percent of children aged 12-23 months received BCG vaccine by the age of 12 months and 74 percent of them received the first dose of DTP (Table CH.1). The proportion declines for subsequent doses of DPT, to 65 percent for the second dose and 58 percent for the third dose. Similarly, 76 percent of children received the first dose of polio vaccination by age 12 months but this declined to 55 percent by the third dose. The coverage for measles vaccination at 12 months was lower than for the other immunizations, at 37 percent. 4 The Gambia Multiple Indicator Cluster Survey 2005-2006 Report Vanuatu Multiple Indicator Cluster Survey-2007 37 Figure CH.1: Percentage of Children aged 12-23 months who received the recommended vaccinations by 12 months, Vanuatu, 2007 79.2 74.0 65.1 58.2 75.2 66.0 55.2 37.1 24.3 0 10 20 30 40 50 60 70 80 90 100 BCG DPT 1 DPT 2 DPT 3 Polio 1 Polio 2 Polio 3 Measles All P e rc e n t Table CH.1: Vaccinations in first year of life Percentage of children aged 12-23 months immunized against childhood diseases at any time before the survey and before the first birthday, Vanuatu, 2007 Background Characteristics BCG * DPT 1 DPT 2 DPT 3 ** Polio 1 Polio 2 Polio 3 *** Measles **** All ***** None Number of children aged 12-23 months Vaccination card 68.0 67.1 60.8 58.1 65.9 62.3 56.7 43.6 38.0 0.0 359 Mother's report 12.6 11.4 9.4 5.3 12.4 9.1 4.4 8.9 3.6 18.0 359 Either 80.6 78.5 70.3 63.4 78.3 71.4 61.1 52.5 41.6 18.0 359 Vaccinated by 12 months of age 79.1 74.3 65.4 58.3 75.5 66.2 55.4 37.2 24.2 18.0 359 * MICS Indicator 25 ** MICS Indicator 26 *** MICS Indicator 27 **** MICS Indicator 28 ; MDG Indicator 15 ***** MICS Indicator 31 Table CH.1c Vaccinations in first year of life (continued) Percentage of children aged 12-23 months immunized against childhood diseases at any time before the survey and before the first birthday, Vanuatu, 2007 Background Characteristics HepB1 HepB2 HepB3* Number of children aged 12-23 months Vaccination card 65.8 63.7 59.2 359 Mother's report 0.0 0.0 0.0 359 Either 65.8 63.7 59.2 359 Vaccinated by 12 months of age 65.3 61.0 55.3 359 * MICS Indicator 29 The coverage of DPT3, another MICS indicator, is 58 percent by the age of 12 months. Other two MICS indicators i.e. coverage of polio3 and vaccine for measles to the children by 12 months of age is 55 percent and 37 percent respectively. On the other hand, hepatitis-B3 vaccination coverage is 55 percent (Table CH.1c). Vanuatu Multiple Indicator Cluster Survey-2007 38 Table CH.2 presents the vaccination coverage rates among children 12-23 months by background characteristics. Overall, 42 percent children 12-23 months of age (urban 48.7% and rural 40.1%) are fully immunized, far below the target of universal immunization. The proportion is slightly higher for girls (44.1%) than boys (39.5%). Provincial variations are visible, ranging from 31 to 57 percent across the provinces; highest in Shefa and the lowest in Sanma. 42 percent children fully immunized; urban 48%, rural 40% V a n u a tu M u lt ip le I n d ic a to r C lu st er S u rv ey -2 00 7 39 T a b le C H .2 : V ac ci n a ti o n s b y b a c k g ro u n d c h a ra c te ri st ic s P e rc en ta g e o f ch il d re n a g ed 1 2 -2 3 m o n th s cu rr en tl y v a cc in a te d a g a in st c h il d h o o d d is e a se s, V a n u a tu , 2 00 7 B C G D P T 1 D P T 2 D P T 3 P ol io 1 P ol io 2 P ol io 3 M M R H ep B 1 H ep B 2 H ep B 3 A ll N on e P er ce nt w ith h ea lth ca rd N um be r of ch ild re n ag ed 12 -2 3 m on th s S ex M al e 79 .4 77 .5 69 .3 63 .9 75 .5 67 .2 56 .4 53 .1 64 .5 61 .2 57 .2 39 .5 19 .1 66 .9 19 4 F em al e 82 .0 79 .6 71 .5 62 .8 81 .6 76 .3 66 .6 51 .9 67 .3 66 .6 61 .5 44 .1 16 .6 71 .1 16 5 R eg io n T af ea 74 .0 74 .0 72 .0 54 .0 74 .0 72 .0 56 .0 48 .0 64 .0 60 .0 52 .0 40 .0 24 .0 66 .0 60 S he fa 83 .3 83 .3 83 .3 83 .3 83 .3 81 .0 81 .0 59 .5 83 .3 83 .3 78 .6 57 .1 16 .7 83 .3 57 M al a m pa 97 .1 91 .2 79 .4 73 .5 91 .2 82 .4 70 .6 64 .7 70 .6 67 .6 70 .6 41 .2 2. 9 79 .4 70 P en am a 81 .1 75 .7 62 .2 51 .4 75 .7 64 .9 48 .6 48 .6 40 .5 37 .8 29 .7 35 .1 18 .9 43 .2 49 S an m a (7 6. 9) (7 3. 1 ) (5 3. 8 ) (5 0. 0 ) (7 3. 1 ) (5 7. 7 ) (4 2. 3 ) (4 2. 3 ) (6 9. 2 ) (6 5. 4) (5 7. 7 ) (3 0. 8) (1 9. 2 ) (6 9. 2 ) 48 T or ba (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 12 P or t V ila (7 3. 2) (7 3. 2 ) (7 1. 8 ) (7 0. 4 ) (7 1. 8 ) (7 0. 4 ) (6 7. 6 ) (5 0. 7 ) (6 4. 8 ) (6 4. 8) (6 2. 0 ) (4 9. 3) (2 6. 8 ) (6 4. 8 ) 47 Lu ga nv ill e (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 16 A re a U rb an 73 .0 73 .0 71 .4 69 .3 70 .9 69 .3 66 .7 50 .3 65 .6 66 .2 63 .5 48 .7 27 .0 66 .2 63 R ur al 82 .2 79 .6 70 .1 62 .1 79 .9 71 .8 59 .9 53 .0 65 .8 63 .1 58 .2 40 .1 16 .1 69 .4 29 6 M ot he r's ed uc at io n N on e (6 7. 5) (5 6. 4 ) (4 1. 4 ) (3 6. 6 ) (6 7. 5 ) (5 2. 6 ) (4 0. 8 ) (2 7. 9 ) (4 9. 4 ) (4 2. 5) (3 2. 8 ) (2 6. 8) (3 2. 5 ) (5 7. 4 ) 32 P rim a ry 81 .1 79 .8 70 .1 63 .6 77 .0 68 .6 58 .5 57 .9 64 .1 62 .2 58 .5 43 .1 17 .2 68 .0 22 3 S ec on da ry 83 .5 82 .4 79 .8 71 .2 84 .3 83 .0 72 .8 48 .6 74 .2 73 .1 68 .6 42 .9 15 .4 74 .2 10 5 W ea lth in de x qu in til es P oo re st 82 .8 78 .8 59 .4 46 .0 80 .5 69 .1 49 .2 40 .9 55 .8 53 .9 45 .0 25 .6 15 .9 65 .3 80 S ec on d 84 .4 81 .4 76 .7 70 .6 83 .3 76 .7 67 .4 63 .5 70 .3 66 .3 66 .3 50 .5 12 .7 71 .4 97 M id dl e 76 .5 77 .7 66 .3 63 .6 72 .6 65 .9 55 .6 52 .3 62 .8 61 .0 56 .7 41 .2 21 .9 65 .7 73 F ou rt h 83 .8 80 .2 79 .7 71 .3 81 .0 75 .3 69 .1 51 .9 75 .3 73 .5 65 .5 43 .0 16 .2 75 .3 66 R ic he st (7 0. 0) (7 0. 0 ) (6 8. 5 ) (6 6. 9 ) (6 8. 4 ) (6 6. 9 ) (6 6. 1 ) (5 0. 7 ) (6 4. 6 ) (6 5. 4) (6 3. 9 ) (4 9. 9) (3 0. 0 ) (6 5. 4 ) 43 M ot he r to ng ue of h ea d B is la m a (7 1. 1) (7 1. 1 ) (7 0. 1 ) (7 0. 1 ) (6 9. 1 ) (6 9. 1 ) (6 6. 0 ) (4 6. 9 ) (6 8. 1 ) (6 8. 1) (6 8. 1 ) (4 4. 9) (2 8. 9 ) (6 8. 1 ) 33 O th er L an gu ag e 81 .6 79 .2 70 .3 62 .7 79 .2 71 .6 60 .6 53 .1 65 .6 63 .2 58 .3 41 .3 16 .9 68 .9 32 6 N at io n al 80 .6 78 .5 70 .3 63 .4 78 .3 71 .4 61 .1 52 .5 65 .8 63 .7 59 .2 41 .6 18 .0 68 .9 35 9 (* ) P e rc e n t c o u n t h a s b e e n s u p p re s s e d a s t h e f ig u re i s b a s e d o n l e s s t h a n 2 5 u n w e ig h te d c a s e s ( ) F ig u re i s b a s e d o n 2 5 -4 9 u n w e ig h te d c a s e s Vanuatu Multiple Indicator Cluster Survey-2007 40 Tetanus Toxoid The MDG expects countries to reduce their maternal mortality ratio by three quarters between 1990 and 2015. One of the strategies to achieve this goal is to eliminate the incidence of maternal tetanus. The WFFC also set to eliminate both maternal and neonatal tetanus by 2005. Prevention of maternal and neonatal tetanus requires that all pregnant women receive at least two doses of tetanus toxoid vaccines. However, if women have not received two doses of the vaccine during their pregnancy, they (and their newborn) are still considered protected under the following conditions: • Received at least two doses of tetanus toxoid vaccine, the last within three years prior to the interview; • Received at least three doses, the last within the prior five years; • Received at least four doses, the last within ten years; • Received at least five doses up to the present. Table CH.3 shows the proportion of mothers those are protected against neonatal tetanus. It is observed that nearly half (49.2%) of the mothers with a birth in 24 months preceding the survey are protected against neonatal tetanus. There is little urban-rural variation in neonatal tetanus coverage (50.7% vs. 49.0%). Mothers in Malampa, Port Vila, Shefa and Penama are more likely to be protected than mothers in other provinces. The rate of being protected is more among the mothers with primary to secondary education than those with no education. However, no specific trend exists among wealth quintiles. Mother’s age also do not show any consistent pattern of variation. Among the mothers being protected, about 39 percent received at least two doses of tetanus toxoid during last pregnancy. The rate is higher for urban mothers than that of rural (41.7% vs. 38.5%). The rate also varies across the provinces: lowest in Torba (18.7%) and the highest in Malampa (56.2%). Only 10 percent mothers (urban: 8.9%, rural: 10.0%) received two doses within three years prior to the survey. This is over 18 percent in Penama, the highest and only 3 percent in Shefa, the lowest, across the provinces. Mothers’ education shows strong positive effect on receiving at least two doses of TT during last pregnancy. Richest women are more likely to receive at least two does of TT during last pregnancy than the poorest women (42.6% vs. 35.1%). 49% protected; urban: 51%, rural: 49% Vanuatu Multiple Indicator Cluster Survey-2007 41 Figure CH.2: Percentage of women with a live birth in the last 24 months who are protected against neonatal tetanus, Vanuatu, 2007 49.2 28.0 47.9 58.5 0.0 50.7 49.0 34.1 47.0 72.8 47.5 42.8 56.7 0 10 20 30 40 50 60 70 80 90 100 National None Primary Secondary + Non-standard * Urban Rural Tafea Shefa Malampa Penama Sanma Torba (*) Port Vila Luganville (*) Percent (*) Percent count has been suppressed as the figure is based on less than 25 unweighted cases * Figure is based on 25-49 unweighted cases Vanuatu Multiple Indicator Cluster Survey-2007 42 Table CH.3: Neonatal tetanus protection Percentage of mothers with a birth in the last 24 months protected against neonatal tetanus, Vanuatu, 2007 Background Characteristics Received at least 2 doses during last pregnancy Received at least 2 doses, the last within prior 3 years Received at least 3 doses, the last within 5 years Received at least 4 doses, the last within 10 years Received at least 5 doses during lifetime Protected against tetanus * Number of mothers Region Tafea 28.4 5.7 0.0 0.0 0.0 34.1 149 Shefa 43.6 3.4 0.0 0.0 0.0 47.0 116 Malampa 56.2 14.9 1.8 0.0 0.0 72.8 162 Penama 29.5 18.1 0.0 0.0 0.0 47.5 90 Sanma 33.7 9.1 0.0 0.0 0.0 42.8 84 Torba (18.7) (8.6) (0.0) (0.0) (1.2) (28.6) 37 Port Vila 46.1 10.6 0.0 0.0 0.0 56.7 80 Luganville (32.0) (5.1) (0.0) (0.0) (0.0) (37.2) 36 Area Urban 41.7 8.9 0.0 0.0 0.0 50.7 116 Rural 38.5 10.0 0.5 0.0 0.1 49.0 639 Age 15-19 30.2 8.5 0.0 0.0 0.8 39.5 58 20-24 42.6 8.6 1.0 0.0 0.0 52.1 291 25-29 44.6 6.8 0.0 0.0 0.0 51.4 166 30-34 34.1 14.1 0.0 0.0 0.0 48.1 119 35-39 34.4 13.4 0.0 0.0 0.0 47.8 85 40-44 (*) (*) (*) (*) (*) (*) 24 45-49 (*) (*) (*) (*) (*) (*) 11 Education None 22.5 4.7 0.0 0.0 0.8 28.0 59 Primary 37.7 10.2 0.0 0.0 0.0 47.9 488 Secondary + 46.8 10.4 1.4 0.0 0.0 58.5 207 Non-standard (*) (*) (*) (*) (*) (*) 0 Wealth index quintiles Poorest 35.1 7.4 0.0 0.0 0.0 42.5 191 Second 44.3 12.0 1.4 0.0 0.2 58.0 202 Middle 35.5 11.8 0.0 0.0 0.0 47.3 148 Fourth 38.2 7.7 0.0 0.0 0.0 45.9 135 Richest 42.6 10.0 0.0 0.0 0.0 52.5 78 Mother tongue of head Bislama 30.9 6.5 4.2 0.0 0.0 41.7 68 Other Language 39.8 10.1 0.0 0.0 0.1 50.0 686 Missing (*) (*) (*) (*) (*) (*) 0 National 39.0 9.8 0.4 0.0 0.1 49.2 755 * MICS Indicator 32 (*) Percent count has been suppressed as the figure is based on less than 25 unweighted cases ( ) Figure is based on 25-49 unweighted cases Diarrhoea Worldwide, diarrhoea is one of the leading causes of death among under-five children. The MICS-3 in Vanuatu collected information on diarrhoea among under-five children from the mothers or caretakers of the children. Mothers or caretakers were asked to report whether their children had had diarrhoea in two weeks prior to the survey. If affected, the mothers or caretakers were asked some more questions about the treatment that was given to the attacked children, drinks and food taken during the episode and it’s volume in comparison to that the children has taken usually. Vanuatu Multiple Indicator Cluster Survey-2007 43 Table CH.4 shows the prevalence of diarrhoea among children below five years of age and use rate of oral rehydration therapy (ORT). The data indicate quite high prevalence of diarrhoea among the under-five children, as one in every 7 (13.8%) under-five children had diarrhoea in the two weeks before the survey, with little urban-rural differentials (12.8% vs. 14.1%). Male children have slightly higher prevalence of diarrhoea than female children (14.4% vs. 13.3%). The prevalence of childhood diarrhoea varies widely across the provinces. The rate is comparatively high in Shefa (20.1%) and Sanma (18.2%) compared to other provinces (7.1%-14.2%). The prevalence of diarrhoea is the lowest among the children aged less than 6 months (6.1%), reaches at its peak of 23 percent at the age of 6-11 months – a period of initiation of complementary feeding and the weaning – and then start declining. The higher prevalence of diarrhoea among the children aged 6-11 months and 12-35 months is mainly due to the fact that at these ages children receive breastmilk along with complementary foods with the risks of contamination in it. Education of mother and wealth quintiles shows no consistent pattern of relationship with diarrhoea prevalence. Oral Rehydration Treatment Diarrhoea causes death mainly because it leads to dehydration from loss of large quantities of fluids and electrolytes from the body in watery stool. Home management of diarrhoea, through oral rehydration salt (ORS) or recommended home fluid (RHF) can prevent such deaths to a great extent. Also, prevention of dehydration and malnutrition by increasing fluid intake and continuing to feed the attacked child are important strategies for managing diarrhoea. One of the WFFC goals is to reduce by half the deaths due to diarrhoea among under-five children by 2010 compared to 2000. Similarly, one MDG is to reduce by two-thirds the mortality rate among same aged children by 2015 compared to 1990. Besides, WFFC seeks to reduce the incidence of diarrhoea by 25 percent. In this regard, the indicators are: • Prevalence of diarrhoea, • Oral rehydration therapy, • Home management of diarrhoea, • ORT or increased fluids and continued feeding. The Table CH.4 provides the ORT use rate among under-five children who had diarrhoea in two weeks preceding the survey. Over half (53.7%) of the children with diarrhoea received ORT, while 46 percent of the children with diarrhoea received no treatment. Male children are more likely to receive ORT than female children (55.2% vs. 52.0%). No major variations are visible between urban and rural areas (54.9% vs. 53.4%). However, differentials regarding ORT rate are observed across the provinces; lowest in Shefa (44.4%) and the highest in Malampa (75.0%), though proportion cannot be calculated due to small sample in some of the provinces and cities. However, wealth quintiles show no consistent patterns of variation of ORT use rate. Received ORT: 54%, ORS: 23%, Homemade fluid: 38%; No treatment: 46% Diarrhoea 13.8%; urban: 13%, rural: 14%, for 6-11 month children: 22.7% Vanuatu Multiple Indicator Cluster Survey-2007 44 Table CH.4: Oral rehydration treatment Percentage of aged 0-59 months with diarrhoea in the last two weeks and treatment with oral rehydration solution (ORS) or other oral rehydration treatment (ORT), Vanuatu, 2007 Background Characteristics Had diarrhoea in last two weeks Number of children aged 0-59 months Fluid from ORS packet Recommended homemade fluid No treatment ORT use rate * Number of children aged 0- 59 months with diarrhoea Sex Male 14.4 849 25.9 38.1 44.8 55.2 122 Female 13.3 785 20.1 37.1 48.0 52.0 104 Region Tafea 7.1 287 (*) (*) (*) (*) 20 Shefa 20.1 243 (13.9) (38.9) (55.6) (44.4) 49 Malampa 13.7 300 (25.0) (60.0) (25.0) (75.0) 41 Penama 13.4 199 (25.0) (40.0) (40.0) (60.0) 27 Sanma 18.2 225 (36.4) (13.6) (54.5) (45.5) 41 Torba 12.3 68 (*) (*) (*) (*) 8 Port Vila 12.3 227 (19.0) (50.0) (40.5) (59.5) 28 Luganville 14.2 86 (*) (*) (*) (*) 12 Area Urban 12.8 312 (22.5) (41.6) (45.1) (54.9) 40 Rural 14.1 1322 23.4 36.8 46.6 53.4 186 Age < 6 months 6.1 161 (*) (*) (*) (*) 10 6-11 months 22.7 182 (30.8) (30.4) (51.6) (48.4) 41 12-23 months 18.5 359 27.2 39.3 41.9 58.1 66 24-35 months 12.5 342 (15.0) (43.4) (47.1) (52.9) 43 36-47 months 12.1 324 (20.6) (40.6) (41.3) (58.7) 39 48-59 months 10.2 265 (11.3) (33.0) (58.1) (41.9) 27 Mother's education None 6.9 140 (*) (*) (*) (*) 10 Primary 14.9 1031 24.1 41.2 42.7 57.3 153 Secondary 13.8 459 21.8 32.2 52.3 47.7 63 Non-standard curriculum (*) 3 . . . . 0 Missing/DK (*) 1 . . . . 0 Wealth index quintiles Poorest 11.4 367 (22.0) (35.8) (50.3) (49.7) 42 Second 15.9 383 23.1 36.3 45.0 55.0 61 Middle 10.7 328 (18.9) (41.6) (51.6) (48.4) 35 Fourth 18.8 302 28.7 32.5 44.4 55.6 57 Richest 12.5 254 (20.0) (47.4) (41.0) (59.0) 32 Mother tongue of head Bislama 13.7 179 (15.0) (39.7) (48.1) (51.9) 25 Other Language 13.8 1452 23.5 37.8 46.5 53.5 200 Missing (*) 3 (*) (*) (*) (*) 2 National 13.8 1634 23.2 37.7 46.3 53.7 226 * MICS Indicator 33 (*) Percent count has been suppressed as the figure is based on less than 25 unweighted cases ( ) Figure is based on 25-49 unweighted cases Vanuatu Multiple Indicator Cluster Survey-2007 45 Table CH.5 presents the information about home management of diarrhoea by selected background characteristics. Overall, 16 percent of the diarrhoeal cases are managed at home during the episode (urban: 19.2%, rural: 15.8%). On the other hand, 43 percent children received ORT or increased fluids and continued food (urban 44.9% and rural 42.7%). Province wise, 60 percent of them received such treatment and continued normal food in Malampa and Penama, followed by Shefa (38.9%) and Sanma (27.3%). Higher ORT or increased fluid use rate was found by mothers with secondary or higher level of education. But wealth quintiles show no specific patterns in this regard. More fluid should be given to children during diarrhoeal episode. But only a quarter (26.1%) children were given more fluids than usual (urban 29.2% and rural 25.4%) during diarrhoeal episode (Table CH.5). Over two-thirds (70.8%) children took the same or less amount of fluid (urban 65.8% and rural 71.9%). In over two-third (69.1%) cases, no change during this time is reported regarding children's dietary and fluid intake, while in 31 percent cases (urban: 32.5%, rural: 30.4%) they did eat much less or nothing during this episode. Children given ORT or increased fluid; urban 44.9%, rural 42.7% V a n u a tu M u lt ip le I n d ic a to r C lu st er S u rv ey -2 00 7 46 T a b le C H .5 : H o m e m a n a g em e n t o f d ia rr h o e a P er ce n ta g e o f c h il d re n a g ed 0 -5 9 m o n th s w it h d ia rr h o e a i n t h e la st t w o w ee k s w h o t o o k i n c re a se d f lu id s a n d c o n ti n u ed t o f ee d d u ri n g t h e e p is o d e, V a n u a tu , 20 07 B ac kg ro un d C ha ra ct er is tic s H ad di ar rh oe a in la st tw o w ee ks N um be r of ch ild re n ag ed 0- 59 m on th s C hi ld re n w ith di ar rh oe a w ho dr an k m or e C hi ld re n w ith di ar rh oe a w ho dr an k th e sa m e or le ss C hi ld re n w ith di ar rh oe a w ho a te so m ew ha t l es s, sa m e or m or e C hi ld re n w ith di ar rh oe a w ho at e m uc h le ss or n on e H om e m an ag em en t of d ia rr ho ea * R ec ei ve d O R T o r in cr ea se d flu id s an d co nt in ue d fe ed in g ** N um be r of ch ild re n ag ed 0- 59 m on th s w ith d ia rr ho ea S ex M al e 14 .4 84 9 27 .7 67 .6 71 .1 28 .7 18 .5 49 .9 12 2 F e m al e 13 .3 78 5 24 .1 74 .6 66 .8 33 .2 14 .1 35 .1 10 4 R eg io n T af ea 7. 1 28 7 (* ) (* ) (* ) (* ) (* ) (* ) 20 S he fa 20 .1 24 3 (8 .3 ) (9 1. 7) (9 1. 7) (8 .3 ) (8 .3 ) (3 8. 9 ) 49 M al a m pa 13 .7 30 0 (3 5. 0 ) (6 5. 0) (8 0. 0) (2 0. 0 ) (2 5. 0) (6 0. 0 ) 41 P en am a 13 .4 19 9 (2 5. 0 ) (7 0. 0) (8 0. 0) (2 0. 0 ) (2 0. 0) (6 0. 0 ) 27 S an m a 18 .2 22 5 (4 5. 5 ) (5 0. 0) (3 1. 8) (6 8. 2 ) (1 8. 2) (2 7. 3 ) 41 T o rb a 12 .3 68 (* ) (* ) (* ) (* ) (* ) (* ) 8 P or t V ila 12 .3 22 7 (2 8. 6 ) (6 6. 7) (6 6. 7) (3 3. 3 ) (1 6. 7) (5 0. 0 ) 28 Lu ga nv ill e 14 .2 86 (* ) (* ) (* ) (* ) (* ) (* ) 12 A re a U rb an 12 .8 31 2 (2 9. 2 ) (6 5. 8) (6 6. 7) (3 2. 5 ) (1 9. 2) (4 4. 9 ) 40 R ur al 14 .1 13 22 25 .4 71 .9 69 .6 30 .4 15 .8 42 .7 18 6 A ge 0- 11 m on th s 14 .9 34 3 16 .9 79 .4 62 .0 38 .0 9. 6 36 .4 51 12 -2 3 m on th s 18 .5 35 9 24 .0 72 .7 64 .8 35 .2 12 .8 40 .8 66 24 -3 5 m on th s 12 .5 34 2 (2 8. 8 ) (6 5. 7) (8 7. 3) (1 1. 9 ) (2 7. 3) (6 7. 1 ) 43 36 -4 7 m on th s 12 .1 32 4 (2 9. 7 ) (7 0. 3) (6 8. 1) (3 1. 9 ) (1 7. 2) (3 8. 4 ) 39 48 -5 9 m on th s 10 .2 26 5 (3 7. 9 ) (5 9. 6) (6 5. 3) (3 4. 7 ) (1 9. 0) (2 9. 2 ) 27 M ot he r's ed uc at io n N on e 6. 9 14 0 (* ) (* ) (* ) (* ) (* ) (* ) 10 P rim ar y 14 .9 10 31 24 .1 71 .6 66 .4 33 .4 17 41 .5 15 3 S ec on da ry 13 .8 45 9 31 .9 68 .1 77 .9 22 .1 17 .6 50 .9 63 N on -s ta nd a rd c ur ric ul um (* ) 3 . . . . . . 0 M is si ng /D K (* ) 1 . . . . . . 0 W ea lth in de x qu in til es P oo re st 11 .4 36 7 (2 6. 9 ) (6 7. 0) (6 5. 0) (3 5. 0 ) (1 7. 5) (3 8. 2 ) 42 S ec on d 15 .9 38 3 25 .3 74 .7 67 .5 32 .5 11 .2 50 .5 61 M id dl e 10 .7 32 8 (3 0. 9 ) (6 7. 2) (6 4. 1) (3 5. 9 ) (1 9. 8) (3 1. 3 ) 35 F ou rt h 18 .8 30 2 23 .7 73 .0 74 .9 25 .1 19 .6 40 .6 57 R ic he st 12 .5 25 4 (2 5. 2 ) (6 8. 5) (7 2. 7) (2 6. 2 ) (1 5. 7) (5 2. 7 ) 32 M ot he r to ng ue o f he ad B is la m a 13 .7 17 9 (3 2. 8 ) (6 1. 7) (7 0. 7) (2 8. 0 ) (1 5. 8) (4 2. 4 ) 25 O th er L an gu ag e 13 .8 14 52 24 .5 72 .6 68 .6 31 .4 15 .7 42 .6 20 0 M is si ng (* ) 3 (* ) (* ) (* ) (* ) (* ) (* ) 2 N at io n al 13 .8 16 34 26 .1 70 .8 69 .1 30 .7 16 .4 43 .1 22 6 * M IC S in di ca to r 34 * * M IC S in di ca to r 35 (* ) P er ce nt c ou nt h as b ee n su pp re ss ed a s th e fig ur e is b as ed o n le ss th an 2 5 un w ei gh te d ca se s ( ) F ig ur e is b as ed o n 25 -4 9 un w ei gh te d ca se s Vanuatu Multiple Indicator Cluster Survey-2007 47 Care Seeking and Antibiotic Treatment of Pneumonia Pneumonia is another leading cause of death of children below 5 years of age. Use of antibiotic for children with suspected pneumonia is a key intervention against such child death. Children with suspected pneumonia are those who have an illness with a cough, accompanied by rapid or difficult breathing and whose symptoms are not due to a problem in the chest or a blocked nose. One of the WFFC goals is to reduce the deaths due to acute respiratory infection (ARI) by one third. In this regard, the indicators are: • Prevalence of suspected pneumonia, • Care seeking for suspected pneumonia, • Antibiotic treatment for suspected pneumonia, • Knowledge of the danger signs of the pneumonia. About 3 percent children reportedly had some symptoms of ARI in two weeks preceding the survey (Table CH.6). The data indicate that only 48 percent children with suspected pneumonia got antibiotic treatment (table not shown); of them 63 percent received the treatment from an appropriate provider (Govt. hospital, Govt. health center or health post), which is little lower among children of mothers with primary school education (52.8%). However, the figures to be considered cautiously because of small number of cases of suspected pneumonia (only 47 cases). Mother’s knowledge of the danger signs of pneumonia is an important factor to decide when to take the child to appropriate health care facility or to a health provider. The data reveal that, only 8 percent of them correctly identified and mentioned two danger signs in this regard e.g. fast and difficult breathing (higher for urban mothers: 10.2%, compared with rural mothers: 7.0%). Also, there was a wide variation among the provinces ranging from zero percent in Malampa to 21 percent in Shefa (Table CH.7A). Mother’s education and wealth status have strong positive correlation with knowledge of the danger signs of pneumonia. Majority mothers (nationally 72.3%, urban: 66.6% and rural: 73.6%) reported that, fever is a symptom of pneumonia and is a sign of seeking treatment in an appropriate health care facility. However, 23 percent mothers (urban: 26.7%, rural: 22.2%) identified fast breathing and 16 percent (urban: 18.1%, rural: 15.1%) identified difficult breathing as the symptoms of pneumonia (Table CH.7A). Only 8% mothers know 2 signs; urban 10%, rural 7% Vanuatu Multiple Indicator Cluster Survey-2007 48 Table CH.6: Care seeking for suspected pneumonia Percentage of children aged 0-59 months in the last two weeks taken to a health provider, Vanuatu, 2007 Background Characteristics Had acute respiratory infection Number of children aged 0-59 months Sex Male 2.7 849 Female 3.1 785 Region Tafea 0.8 287 Shefa 3.4 243 Malampa 4.1 300 Penama 2.0 199 Sanma 5.0 225 Torba 3.0 68 Port Vila 2.3 227 Luganville 2.0 86 Area Urban 2.2 312 Rural 3.0 1322 Age 0-11 months 2.4 343 12-23 months 3.1 359 24-35 months 2.7 342 36-47 months 4.2 324 48-59 months 1.8 265 Mother's education None 0.0 140 Primary 3.0 1031 Secondary 3.4 459 Non-standard curriculum (*) 3 Missing/DK (*) 1 Wealth index quintiles Poorest 2.9 367 Second 2.8 383 Middle 2.4 328 Fourth 4.2 302 Richest 1.9 254 Mother tongue of head Bislama 2.0 179 Other Language 3.0 1452 Missing (*) 3 National 2.9 1634 (*) Percent count has been suppressed as the figure is based on less than 25 unweighted cases V a n u a tu M u lt ip le I n d ic a to r C lu st er S u rv ey -2 00 7 49 T a b le C H .7 A : K n o w le d g e o f th e tw o d a n g e r si g n s o f p n e u m o n ia P e rc en ta g e o f m o th er s/ c a re ta k e rs o f ch il d re n a g ed 0 -5 9 m o n th s b y k n o w le d g e o f ty p es o f sy m p to m s fo r ta k in g a c h il d i m m ed ia te ly t o a h ea lt h fa c il it y, a n d p e rc en ta g e o f m o th e rs / ca re ta k er s w h o r ec o g n iz e fa st a n d d if fi cu lt b re a th in g a s si g n s fo r se ek in g c a re i m m ed ia te ly , V a n u a tu , 2 00 7 B ac kg ro un d C ha ra ct er is tic s P er ce nt ag e of m ot he r/ ca re ta ke rs o f c hi ld re n ag ed 0 -5 9 m on th s w ho th in k th at a c hi ld s ho ul d be ta ke n im m ed ia te ly to a he al th fa ci lit y if th e ch ild : M ot he rs /c ar et ak er s w ho r ec og ni ze th e tw o da ng er s ig ns of p ne um on ia N um be r of m ot he rs /c ar et ak er s of c hi ld re n ag ed 0 - 59 m on th s Is n ot a bl e to d rin k or br ea st fe ed B ec om es si ck er D ev el op s a fe ve r H as fa st br ea th in g H as di ffi cu lty br ea th in g H as bl oo d in st oo l Is d rin ki ng po or ly H as o th er sy m pt om s R eg io n T af ea 13 .3 53 .8 70 .4 11 .7 11 .7 2. 1 15 .0 10 .4 2. 9 28 7 S he fa 6. 1 14 .5 54 .7 71 .5 32 .4 2. 2 5. 0 9. 5 21 .2 24 3 M al am pa 2. 1 25 .3 69 .2 0. 7 2. 1 0. 7 0. 7 43 .2 0. 0 30 0 P en am a 19 .5 53 .7 85 .2 13 .4 16 .1 1. 3 12 .8 42 .3 4. 7 19 9 S an m a 13 .2 19 .8 89 .3 16 .5 13 .2 1. 7 17 .4 19 .8 5. 0 22 5 T or ba 13 .3 37 .4 88 .2 30 .5 28 .1 10 .3 6. 9 27 .1 17 .7 68 P or t V ila 8. 2 48 .0 62 .3 30 .4 19 .9 3. 5 9. 4 19 .9 11 .7 22 7 Lu ga nv ill e 20 .1 28 .7 78 .0 16 .9 13 .4 5. 1 13 .4 28 .0 6. 3 86 A re a U rb an 11 .4 42 .7 66 .6 26 .7 18 .1 4. 0 10 .5 22 .1 10 .2 31 2 R ur al 10 .4 33 .5 73 .6 22 .2 15 .1 2. 0 9. 6 24 .9 7. 0 13 22 M ot he r's ed uc at io n N on e 13 .5 45 .9 78 18 .9 10 .9 3. 4 12 .6 12 .2 3. 6 14 0 P rim ar y 9. 6 31 .5 72 .2 23 .1 16 .6 1. 6 10 .9 24 .5 7. 7 10 31 S ec on da ry 12 .0 40 .0 70 .3 24 .2 14 .7 4. 0 6. 3 28 .0 8. 5 45 9 N on -s ta nd ar d (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 3 M is si ng /D K (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 1 W ea lth in de x qu in til es P oo re st 9. 6 35 .1 72 .5 14 .1 12 .3 2. 1 8. 8 18 .9 3. 5 36 7 S ec on d 12 .1 38 .4 75 .7 18 .2 12 .8 2. 2 11 .8 29 .4 6. 0 38 3 M id dl e 9. 2 31 .0 76 .6 26 .0 16 .4 1. 9 9. 9 25 .2 8. 0 32 8 F ou rt h 11 .1 31 .0 65 .4 32 .3 18 .1 2. 6 6. 1 25 .4 11 .0 30 2 R ic he st 10 .8 41 .3 69 .3 28 .8 21 .0 3. 4 12 .1 22 .5 11 .5 25 4 M ot he r to ng ue o f he ad B is la m a 9. 9 40 .0 73 .4 22 .5 14 .7 5. 3 11 .8 24 .1 6. 0 17 9 O th er La ng ua ge 10 .7 34 .7 72 .1 23 .2 15 .8 2. 1 9. 5 24 .3 7. 8 14 52 M is si ng (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 3 N at io n al 10 .6 35 .2 72 .3 23 .1 15 .7 2. 4 9. 7 24 .4 7. 6 16 34 (* ) P er ce n t co u n t h as b ee n s u p p re ss ed a s th e fi gu re is b as ed o n l es s th an 2 5 u n w ei gh te d c as es Vanuatu Multiple Indicator Cluster Survey-2007 50 Solid Fuel Use Over three billion people around the world rely on solid fuel i.e. biomass and coal to address their basic energy need including cooking and heating. But cooking or heating with solid fuel creates high level of indoor smoke, a complex mix of health hazardous pollutants. The major problem with the use of solid fuel is products of incomplete combustion; carbon mono- oxide (CO), poly-aromatic hydrocarbons, sulfur dioxide (SO2) and other toxic elements. Use of such fuel increases the risks of acute respiratory illness, pneumonia, chronic obstructive lung diseases, cancer and tuberculosis, low birth weight, cataracts and asthma. Here the indicator is the proportion of the population using solid fuel as the primary source of domestic energy for cooking. The data in Table CH.8 shows an overwhelming reliance on solid fuel by the people in Vanuatu, as the majority (85.1%) of the sample households use solid fuel for cooking, mostly wood (64.5%) followed by straw/shrub/grass (20.0%). The rate of solid fuel use is much higher in the rural area (95.2%) compared to the urban area (52.2%). The rate is also very high across the provinces (88.6-99.3%); though comparatively low in Port Vila city (47.4%) and Luganville city (66.7%). By background characteristics the rate is higher in the households with less educated household heads and in the poorer section of the population. Overall, 12 percent of the households use LPG as fuel. About 44 percent of the urban households compared to only 3 percent of the rural households are using LPG as fuel. This proportion is higher in Port Vila (48.2%), followed by Luganville (30.7%) and very low (less than one percent) in Torba, Tafea and Penama. As expected, the richest households are more likely to use LPG than the poorer households (Table CH.8). Solid fuel use caused indoor air pollution. However, the concentration of the pollutants depends on where it is burned - in a fire or in different types of stoves. A closed stove with a chimney minimizes the indoor pollution, while an open stove or fire with no chimney or hood means that there is no protection from the harmful effects of solid fuels. Table CH.9 shows a very high proportion of households (93.8%) were using an open stove or fire with no chimney or hood for their cooking purposes. Only 6 percent of the surveyed households used a open stove with a chimney. Use of closed stove with a chimney was found almost nil in Vanuatu. Vanuatu Multiple Indicator Cluster Survey-2007 51 Table CH.8: Solid fuel use Percent distribution of households according to type of cooking fuel, and percentage of households using solid fuels for cooking, Vanuatu, 2007 Background Characteristics Type of fuel using for cooking Total Solid fuels for cookin g * Number of household s Electricit y LPG Kerosen e Char coal Wood Straw / shrubs /grass Missin g Region Tafea 1.8 0.7 8.8 0.0 67.3 21.3 0.0 100.0 88.6 339 Shefa 0.4 7.6 0.0 0.0 92.0 0.0 0.0 100.0 92.0 367 Malampa 0.0 1.3 0.0 0.0 39.5 58.3 0.9 100.0 97.8 475 Penama 0.0 0.8 0.0 0.4 93.2 5.6 0.0 100.0 99.2 350 Sanma 0.5 3.1 0.0 0.5 74.9 20.5 0.5 100.0 95.9 385 Torba 0.0 0.4 0.4 0.7 80.8 17.8 0.0 100.0 99.3 100 Port Vila 2.3 48.2 1.5 1.9 37.9 7.6 0.6 100.0 47.4 464 Luganville 1.3 30.7 0.0 0.9 48.9 17.0 1.3 100.0 66.7 153 Area Urban 2.1 43.8 1.1 1.6 40.7 9.9 0.8 100.0 52.2 617 Rural 0.5 2.6 1.5 0.2 71.9 23.1 0.3 100.0 95.2 2015 Education of househol d head None 0.4 2.0 2.8 0.5 67.8 25.7 0.7 100.0 94.0 332 Primary 0.4 5.6 1.5 0.5 70.3 21.3 0.3 100.0 92.1 1470 Secondary + 2.1 30.6 0.8 0.7 50.6 14.7 0.5 100.0 66.1 723 Non-standard (0.0) (12.8) (0.0) (0.0) (58.7) (28.5) (0.0) (100.0) (87.2) 35 Missing/DK 0.0 9.8 0.0 0.0 74.5 15.7 0.0 100.0 90.2 73 Wealth index quintiles Poorest 0.0 0.0 1.7 0.0 74.3 24.0 0.0 100.0 98.3 525 Second 0.0 0.0 2.3 0.4 70.6 26.7 0.0 100.0 97.7 547 Middle 0.2 0.5 2.0 0.4 72.3 23.8 0.8 100.0 96.5 512 Fourth 0.8 4.5 0.7 0.3 75.0 17.9 0.7 100.0 93.3 533 Richest 3.3 57.5 0.4 1.6 29.4 7.2 0.6 100.0 38.2 514 Mother tongue of head Bislama 3.6 31.2 1.8 1.5 48.4 13.5 0.1 100.0 63.4 364 Other Language 0.4 9.2 1.4 0.4 67.3 21.1 0.2 100.0 88.8 2261 Missing (*) (*) (*) (*) (*) (*) (*) 100.0 (*) 7 National 0.9 12.2 1.4 0.5 64.5 20.0 0.4 100.0 85.1 2632 * MICS indicator 24; MDG indicator 29 (*) Percent count has been suppressed as the figure is based on less than 25 unweighted cases ( ) Figure is based on 25-49 unweighted cases Vanuatu Multiple Indicator Cluster Survey-2007 52 Table CH.9: Solid fuel use by type of stove or fire Percentage of households using solid fuels for cooking by type of stove or fire, Vanuatu, 2007 Background Characteristics Percentage of households using solid fuels for cooking: Total Number of households using solid fuels for cooking Closed stove with chimney Open stove or fire with chimney or hood Open stove or fire with no chimney or hood DK stove type/ missing Region Tafea 0.0 0.4 99.6 0.0 100.0 300 Shefa 0.0 2.9 97.1 0.0 100.0 338 Malampa 0.0 16.1 83.9 0.0 100.0 464 Penama 0.0 2.0 97.6 0.4 100.0 347 Sanma 0.0 2.1 97.9 0.0 100.0 369 Torba 0.4 14.3 85.3 0.0 100.0 99 Port Vila 0.0 6.2 93.5 0.3 100.0 220 Luganville 0.3 6.8 92.2 0.7 100.0 102 Area Urban 0.1 6.4 93.1 0.4 100.0 322 Rural 0.0 6.0 93.9 0.1 100.0 1917 Education of household head None 0.0 3.0 97.0 0.0 100.0 312 Primary 0.0 5.6 94.2 0.1 100.0 1354 Secondary + 0.1 8.8 90.9 0.2 100.0 478 Non-standard (0.0) (6.9) (93.1) (0.0) (100.0) 30 Missing/DK 0.0 9.5 90.5 0.0 100.0 65 Wealth index quintiles Poorest 0.0 6.2 93.5 0.3 100.0 517 Second 0.0 7.3 92.7 0.0 100.0 535 Middle 0.1 3.9 96.0 0.0 100.0 494 Fourth 0.0 6.5 93.4 0.1 100.0 497 Richest 0.2 6.6 92.9 0.3 100.0 196 Mother tongue of head Bislama 0.1 4.3 95.2 0.3 100.0 230 Other Language 0.0 6.3 93.6 0.1 100.0 2009 Missing (*) (*) (*) (*) (100.0) 0 National 0.0 6.1 93.8 0.1 100.0 2240 (*) Percent count has been suppressed as the figure is based on less than 25 unweighted cases ( ) Figure is based on 25-49 unweighted cases Vanuatu Multiple Indicator Cluster Survey-2007 53 93% correctly identified main cause of malaria (i.e. mosquito bite); (urban: 98% and rural: 91.5%) Malaria Malaria is a health hazard and one of the main causes of death of under-five children in Vanuatu. Malaria causes anaemia in children and it is a common cause of school absenteeism. Preventive measures like use of mosquito net treated with insecticide can reduce malaria mortality rate to great extent among young children. International recommendations suggest that in an area where malaria is common, any fever in children should be treated as if it were malaria and a full course of recommended anti-malarial tablets should be given to the affected child without delay. Children with symptoms of severe malaria like fever or convulsion etc. should be taken to a health facility. Such children should be provided with additional liquids and foods and continuous breastfeeding for younger children. The survey provides information on the respondents’ knowledge and source of knowledge about malaria, questions on availability and use of bed-net, both at household level and among children (<5 years). Besides, it includes questions related to anti-malarial treatment of the affected. Overwhelming majority of the households (overall: 86.5%, urban: 89.0%, rural: 85.7%) were reportedly using mosquito net for safety from mosquito bites. There are little variations in the proportions in different provinces in this regard (Table CH.10). Richest households are more likely to use mosquito net than the poorest households. Overall 81 percent households (urban: 55.8% and rural: 88.8%) have at least one mosquito net, while 68 percent of them have at least one long lasting mosquito net (LLN). This is also higher for the rural households (74.3%) compared with the urban households (45.6%) as WHO distributed LLN in the malaria prone rural communities only to reduce the morbidity caused by malaria (Table CH.10). Vanuatu Multiple Indicator Cluster Survey-2007 54 Table CH.10: Availability of insecticide-treated long-lasting nets Percent of households with at least one long-lasting net (LLN), Vanuatu, 2007 Percentage of households with at least one mosquito net Percentage of households with at least one long-lasting net (LLN)* Number of long-lasting nets in the household Any measure taken to prevent malaria Number of households 1 2 3 4 5 6 7+ Region Tafea 73.2 47.4 2.2 2.3 1.2 1.1 1.1 0.6 0.5 75.0 339 Shefa 85.6 75.7 2.0 4.0 2.8 2.9 1.8 1.1 0.9 79.8 367 Malampa 93.4 76.8 3.3 6.3 4.2 3.7 1.5 0.7 0.7 87.7 475 Penama 94.0 86.0 3.5 4.1 3.2 2.6 1.7 1.0 0.8 91.6 350 Sanma 93.3 79.5 3.5 5.2 3.4 1.9 1.0 1.4 0.7 90.8 385 Torba 96.1 87.2 0.4 1.1 0.9 1.1 0.6 0.4 0.4 92.9 100 Port Vila 53.3 43.0 3.1 3.7 2.4 0.8 0.5 0.4 0.3 88.9 464 Luganville 63.5 53.5 1.0 1.3 1.0 0.5 0.4 0.3 0.1 89.6 153 Area Urban 55.8 45.6 4.1 5.0 3.4 1.3 0.9 0.7 0.4 89.0 617 Rural 88.8 74.3 15.0 23.0 15.8 13.3 7.8 5.3 4.0 85.7 2015 Educatio n of househol d head None 79.8 64.7 3.4 3.4 2.2 1.3 0.7 0.4 0.6 73.2 332 Primary 86.5 73.0 10.8 16.0 11.8 9.4 5.2 4.3 2.8 88.7 1470 Secondary + 70.3 58.2 4.3 6.8 4.5 3.4 2.3 1.4 0.9 87.9 723 Non-standard curriculum (80.5) (52.8) (0.2) (0.4) (0.4) (0.0) (0.1) (0.0) (0.0) (78.3) 35 Missing/DK 85.3 69.9 0.4 1.4 0.3 0.4 0.4 0.0 0.0 91.4 73 Wealth index quintiles Poorest 85.2 71.1 5.2 5.9 3.3 3.0 1.7 1.2 0.7 78.5 525 Second 93.6 82.2 4.8 7.3 4.3 4.4 1.7 1.5 1.3 89.3 547 Middle 92.2 76.7 2.8 6.6 5.1 2.9 2.1 1.4 1.2 87.8 512 Fourth 80.6 66.3 3.8 4.7 3.8 3.3 2.0 1.5 0.8 87.9 533 Richest 52.8 40.6 2.4 3.5 2.7 1.1 1.1 0.5 0.4 88.7 514 Mother tongue of head Bislama 68.1 54.5 2.1 2.8 2.3 1.6 0.8 0.9 0.6 89.9 364 Other Language 83.2 69.8 17.0 25.2 16.9 12.9 7.8 5.1 3.8 86.0 2261 Missing (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 7 National 81.1 67.6 19.1 28.0 19.3 14.6 8.7 6.0 4.4 86.5 2632 * MICS Indicator 36 (*) Percent count has been suppressed as the figure is based on less than 25 unweighted cases ( ) Figure is based on 25-49 unweighted cases Vanuatu Multiple Indicator Cluster Survey-2007 55 Table CH.10A shows the knowledge of respondent about the causes of malaria. More than ninety percent (93.0%) of the respondents correctly identified mosquito bite as the main cause of malaria. The knowledge is rather universal. This proportion of knowledge is higher among the urban respondents than that of rural (97.9% vs.91.5%). Variations in knowledge with respect to provinces are found to be marginal (82.7% to 98.9%). As expected, respondent’s education and wealth status are positively associated with the knowledge of causes of malaria. Table CH.10A: Causes of malaria Percentage of respondents by causes of malaria, Vanuatu, 2007 Background Characteristics Mosquito Mosquito and others Others Don't know At least one correct response Total Region Tafea 82.7 0.7 1.1 16.2 82.7 339 Shefa 98.9 0.0 0.0 1.1 98.9 367 Malampa 92.1 5.7 3.5 7.0 93.0 475 Penama 86.8 2.0 1.2 12.4 86.8 350 Sanma 94.9 5.6 4.6 3.6 94.9 385 Torba 94.0 0.4 0.0 5.3 94.0 100 Port Vila 98.2 6.9 0.1 0.9 98.2 464 Luganville 97.0 9.6 4.3 2.4 97.0 153 Area Urban 97.9 7.5 1.2 1.3 97.9 617 Rural 91.5 2.9 2.1 7.7 91.7 2015 Education of household head None 80.8 0.7 1.3 18.6 80.8 332 Primary 94.1 3.5 2.6 5.3 94.1 1470 Secondary + 96.9 5.9 1.0 2.2 96.9 723 Non-standard (76.0) (16.0) (0.0) (12.0) (88.0) 35 Missing/DK 95.2 4.7 0.0 4.8 95.2 73 Wealth index quintiles Poorest 82.5 1.8 2.2 16.8 82.9 525 Second 92.6 3.4 1.8 7.2 92.6 547 Middle 95.8 3.7 1.7 3.4 96.3 512 Fourth 95.3 3.3 2.9 2.6 95.3 533 Richest 98.8 7.9 0.9 0.7 98.8 514 Mother tongue of head Bislama 97.5 7.3 1.5 1.6 97.5 364 Other Language 92.3 3.4 1.9 6.9 92.5 2261 Missing (*) (*) (*) (*) (*) 7 National 93.0 4.0 1.9 6.2 93.1 2632 (*) Percent count has been suppressed as the figure is based on less than 25 unweighted cases ( ) Figure is based on 25-49 unweighted cases Vanuatu Multiple Indicator Cluster Survey-2007 56 Table CH.10B presents the knowledge of prevention of malaria by selected background characteristics. The results indicate that, a very high proportion of respondents had adequate knowledge about the preventive measures to be taken against malaria. Overall, 83 percent of them could correctly mention three preventive measures. Among the three measures, the most prominent are using mosquito net (68.2%), destroying mosquito breeding sites (39.3%) and take medicine (16.1%). There is no urban- rural difference regarding the knowledge of prevention of malaria. By provinces/cities the proportion ranges from 74 percent (Tafea) to 92 percent (Torba). Knowledge of prevention of malaria increases with the education of household head. However, respondent’s wealth status does not show any consistent pattern of variation in the knowledge of prevention of malaria. Table CH.10B: Knowledge of prevention of malaria Percentage of respondents by prevention of malaria, Vanuatu, 2007 Using mosquito net Destroy mosquito breeding sites Take medicine Spray insecticide at home Using mosquito coil Using traditional repelents Take other measures Could mention 3 preventive measures correctly Total Region Tafea 62.1 49.6 14.7 0.0 0.0 0.0 1.5 74.3 339 Shefa 66.5 16.0 2.3 5.3 18.3 0.4 4.9 78.3 367 Malampa 70.2 40.8 15.4 3.1 12.7 0.9 3.9 82.5 475 Penama 84.4 48.4 24.0 4.8 5.6 5.2 1.6 88.8 350 Sanma 84.1 36.9 22.1 14.4 13.3 0.5 4.6 88.2 385 Torba 90.7 65.8 23.5 1.8 3.6 0.4 4.3 91.5 100 Port Vila 43.2 39.2 16.1 28.7 22.7 0.0 7.5 82.9 464 Luganville 64.3 36.5 16.3 21.3 22.8 0.0 16.5 83.5 153 Area Urban 48.4 38.6 16.2 26.9 22.7 0.0 9.7 83.0 617 Rural 74.3 39.6 16.0 5.4 10.0 1.3 3.4 83.0 2015 Education of household head None 64.1 32.7 14.6 3.8 3.6 1.0 1.3 72.3 332 Primary 73.4 40.9 16.5 7.1 12.1 1.1 4.1 85.3 1470 Secondary + 60.2 41.3 16.1 20.7 18.3 1.0 8.0 83.1 723 Non- standard (56.5) (31.6) (23.6) (2.9) (9.9) (0.0) (17.9) (66.4) 35 Missing/DK 69.2 22.0 9.5 9.0 21.8 0.0 0.5 91.4 73 Wealth index quintiles Poorest 69.0 34.1 13.7 1.0 2.9 2.0 2.0 76.0 525 Second 79.8 42.6 18.9 3.4 7.7 0.8 4.2 86.4 547 Middle 78.8 41.6 17.8 6.3 11.1 1.0 1.8 86.1 512 Fourth 68.4 41.9 13.5 11.1 17.8 0.8 6.2 84.8 533 Richest 44.5 36.4 16.4 30.9 25.8 0.4 10.4 81.5 514 Mother tongue of head Bislama 64.9 43.6 19.1 23.8 13.6 0.0 8.4 85.9 364 Other Language 68.8 38.7 15.6 8.3 12.9 1.2 4.4 82.6 2261 Missing (*) (*) (*) (*) (*) (*) (*) (*) 7 National 68.2 39.3 16.1 10.4 13.0 1.0 4.9 83.0 2632 (*) Percent count has been suppressed as the figure is based on less than 25 unweighted cases ( ) Figure is based on 25-49 unweighted cases Vanuatu Multiple Indicator Cluster Survey-2007 57 Regarding source of knowledge of malaria prevention, the most prominent one was the health workers (85.0%) followed by school (23.5%), radio (18.7%), book/poster (11.1%) and family members or friends or neighbour (10.7%). On the other hand, about 44 percent respondents (urban: 57.7%, rural: 39.3%) heard about the preventive measures from at least two different sources simultaneously (highest in Luganville and the lowest in Malampa) (Table CH.10C). Education level of household head and wealth quintile show positive relationship with the source of knowledge of prevention of malaria. Table CH.10C: Source of knowledge on prevention of malaria Percentage of respondents by source of preventive knowledge on malaria, Vanuatu, 2007 Heard from at least 2 different sources Source of preventive knowledge on malaria: Total Radio Television Booklet / poster Health worker Chief of church Family/ friend/ neighbor School Other sources Region Tafea 46.6 10.8 0.5 9.8 83.8 25.5 16.7 18.1 2.0 339 Shefa 42.9 18.1 6.2 13.8 86.7 1.4 11.0 17.1 6.2 367 Malampa 18.5 1.0 1.0 6.0 93.0 2.5 6.5 9.0 4.5 475 Penama 44.5 25.3 0.0 6.6 92.1 5.7 11.8 9.6 1.7 350 Sanma 49.7 22.6 5.1 9.6 86.4 3.4 8.5 37.3 5.1 385 Torba 44.8 6.9 1.5 31.8 96.2 4.2 2.3 12.3 4.6 100 Port Vila 57.7 30.8 21.4 14.8 69.9 8.4 15.0 43.3 8.4 464 Luganville 57.8 34.7 11.7 12.6 76.7 1.5 7.5 36.9 18.4 153 Area Urban 57.7 31.8 19.0 14.3 71.6 6.7 13.1 41.7 10.9 617 Rural 39.3 14.5 2.5 10.1 89.3 6.6 9.9 17.7 4.0 2015 Educatio n of househol d head None 29.8 11.6 1.9 10.3 87.6 8.1 9.5 9.2 1.8 332 Primary 41.6 17.5 4.2 9.7 87.7 6.7 11.1 17.5 4.6 1470 Secondary + 55.8 25.5 12.8 14.8 77.7 6.6 10.9 42.9 9.1 723 Non-standard (11.4) (2.5) (2.5) (3.8) (88.0) (0.0) (3.7) (6.4) (22.9) 35 Missing/DK 36.0 10.3 8.3 9.4 89.7 1.0 6.8 16.1 0.5 73 Wealth index quintiles Poorest 29.2 7.6 0.0 10.6 90.5 6.1 9.0 9.9 2.5 525 Second 35.0 10.7 0.5 9.8 92.6 7.7 10.0 11.4 4.7 547 Middle 41.9 16.4 1.9 10.2 90.5 5.7 10.9 19.8 2.0 512 Fourth 51.4 24.4 7.9 9.6 83.7 7.1 11.3 28.3 7.1 533 Richest 60.3 33.8 21.7 15.4 67.8 6.2 12.0 47.5 11.8 514 Mother tongue of head Bislama 58.5 35.0 13.0 13.4 72.5 8.0 9.5 45.4 9.3 364 Other Language 41.3 15.9 5.4 10.8 87.1 6.4 10.8 19.9 5.1 2261 Missing (*) (*) (*) (*) (*) (*) (*) (*) (*) 7 National 43.8 18.7 6.5 11.1 85.0 6.6 10.7 23.5 5.7 2632 (*) Percent count has been suppressed as the figure is based on less than 25 unweighted cases ( ) Figure is based on 25-49 unweighted cases Source: health worker (85%) and school, radio, booklet and friends, family and neighbor Vanuatu Multiple Indicator Cluster Survey-2007 58 66% children slept under bed- net; urban: 39.4% and rural: 72.4% Table CH.11 shows the percentage of children sleep under a bed net. As a regular safety practice, majority of under-5 year children (66.1%) slept under bed net during the previous night of the survey day. The proportion is higher in rural area (72.4%) than the urban area (39.4%). More than half (55.7%) of them slept under long-lasting bed nets at the same night (higher in the rural area: 61.0%, lower in urban area: 33.2%). Preserving and using mosquito net in the urban area is less prevalent compared to the rural area, because the urban area is less malaria prone compared to rural areas and the people of urban areas prefer other preventive measures as mosquito coils, net in the windows, spraying insecticides, etc. (Table CH.11). Figure CH.5: Children sleeping under bed nets (Under-5 children slept under an insecticide treated net during the previous night), Vanuatu, 2007 66.1 74.3 69.7 64.0 59.9 61.3 39.4 72.4 56.3 87.0 78.5 84.2 39.2 40.2 54.7 84.6 62.2 55.7 56.2 53.5 50.3 56.0 33.2 61.0 42.1 49.7 76 77.9 56.2 80.8 30.7 34.2 0 10 20 30 40 50 60 70 80 90 100 National 0-11 months 24-35 months 48-59 months Urban Shefa Penama Torba Lugenville Percent Slept under a bednet Slept under long-lasting net Vanuatu Multiple Indicator Cluster Survey-2007 59 Over one-third treated with anti- malarial drugs within 24 hours of onset of symptoms; rural: 37.7%, urban: 22.4% Table CH.11: Children sleeping under bednets Percentage of children aged 0-59 months who slept under an insecticide treated net during the previous night, Vanuatu, 2007 Background Characteristics Slept under a bednet * Sleep under long- lasting net ** Slept under an untreated net Don't know if slept under a net Did not sleep under a bednet Number of children aged 0-59 months Sex Male 65.9 55.6 10.3 0.4 33.7 849 Female 66.4 55.8 10.6 0.3 33.3 785 Region Tafea 56.3 42.1 14.2 0.0 43.8 287 Shefa 54.7 49.7 5.0 0.6 44.7 243 Malampa 87.0 76.0 11.0 0.0 13.0 300 Penama 84.6 77.9 6.7 0.7 14.8 199 Sanma 78.5 56.2 22.3 0.0 21.5 225 Torba 84.2 80.8 3.4 1.0 14.8 68 Port Vila 39.2 34.2 5.0 0.6 60.2 227 Luganville 40.2 30.7 9.4 1.2 58.7 86 Area Urban 39.4 33.2 6.2 0.7 59.8 312 Rural 72.4 61.0 11.5 0.3 27.3 1322 Age 0-11 months 74.4 62.2 12.1 0.1 25.5 343 12-23 months 69.6 56.0 13.6 0.5 30.0 359 24-35 months 64.0 53.5 10.4 0.1 35.9 342 36-47 months 59.5 50.0 9.4 0.6 39.9 324 48-59 months 61.8 56.4 5.3 0.5 37.7 265 Wealth index quintiles Poorest 72.8 59.3 13.5 0.5 26.7 367 Second 84.0 72.9 11.1 0.0 16.0 383 Middle 70.4 62.6 7.8 0.1 29.5 328 Fourth 59.8 47.3 12.4 0.3 39.9 302 Richest 31.5 25.3 6.2 1.1 67.4 254 Mother tongue of head Bislama 50.3 42.2 8.1 0.6 49.2 179 Other Language 68.1 57.3 10.8 0.3 31.6 1452 Missing (*) (*) (*) (*) (*) 3 National 66.1 55.7 10.5 0.3 33.5 1634 * MICS indicator 38 ** MICS indicator 37; MDG indicator 22 (*) Percent count has been suppressed as the figure is based on less than 25 unweighted cases Only 9 percent (urban: 6.2% and rural: 10.1%) under 5-year children were ill with fever in two weeks preceding the survey. Of them, 36 percent got treatment with appropriate anti- malarial drugs within twenty-four hours of onset of malarial symptoms. Provincial variation cannot be assessed due to smaller sample. But, over half of them (53.1%) are treated with such appropriate anti-malarial drugs at any time after having fallen sick and the proportion is slightly higher in the rural area (56.1%) than that of the national average. It may be due to the fact that malaria prevalence is higher in the rural areas and the health service providers promote to use anti-malarial drugs whenever a person got fever as recommended by WHO. No consistent trend was observed in the treatment of fever by wealth quintiles and the age of children (Table CH.12). V a n u a tu M u lt ip le I n d ic a to r C lu st er S u rv ey -2 00 7 60 T a b le C H .1 2 : T re a tm e n t o f ch il d re n w it h a n ti -m a la ri a l d ru g s P e rc en ta g e o f ch il d re n a g e 0 -5 9 m o n th s w h o w er e i ll w it h f e ve r in t h e l a st t w o w ee k s w h o r e ce iv e d a n ti -m a la ri a l d ru g s, V a n u a tu , 2 00 7 B ac kg ro un d C ha ra ct e ris tic s Had a fever in last two weeks Number of children aged 0-59 months C hi ld re n w ith a fe ve r in t he la st tw o w ee ks w ho w e re t re at ed w ith : N um be r of ch ild re n w ith fe ve r in la st tw o w ee ks Anti- malarials: SP/Fansida r Anti- malarials: Chloroquine Anti- malarials: Quinine Anti- malarials: Other Anti- malarial Any appropriate anti-malarial drug Other medications Paracetamo l/ Panadol/ Acetaminop han Other medications : Aspirin Other medications : Other A n y ap p ro p ria te a nt i- m al ar ia l d ru g w ith in 2 4 ho ur s of o ns et o f sy m pt om s * S ex M al e 9. 6 84 9 36 .1 41 .8 2. 3 0. 0 53 .8 45 .6 2. 9 22 .4 39 .7 81 F e m al e 9. 1 78 5 28 .3 36 .2 5. 5 5. 9 52 .3 47 .9 0. 0 21 .2 31 .3 72 R eg io n T af ea 3. 3 28 7 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 10 S he fa 11 .7 24 3 (2 3. 8 ) (2 3. 8 ) (0 .0 ) (0 .0 ) (3 3. 3) (5 2. 4 ) (0 .0 ) (4 .8 ) (1 4. 3) 28 M al a m pa 15 .1 30 0 (5 9. 1 ) (5 4. 5 ) (4 .5 ) (4 .5 ) (7 2. 7) (3 1. 8 ) (4 .5 ) (2 2. 7 ) (6 8. 2) 45 P en am a 10 .7 19 9 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 21 S an m a 10 .7 22 5 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 24 T o rb a 6. 9 68 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 5 P or t V ila 5. 3 22 7 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 12 Lu ga nv ill e 8. 7 86 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 7 A re a U rb an 6. 2 31 2 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 19 R ur al 10 .1 13 22 35 .2 41 .1 4. 3 2. 9 56 .1 44 .7 1. 8 21 .5 37 .7 13 3 A ge 0- 11 m on th s 8. 0 34 3 (1 4. 8 ) (3 4. 4 ) (7 .5 ) (1 .2 ) (4 5. 6) (6 3. 8 ) (0 .0 ) (1 8. 2 ) (2 4. 0) 28 12 -2 3 m on th s 11 .7 35 9 (3 1. 1 ) (4 0. 3 ) (0 .0 ) (4 .4 ) (5 5. 5) (4 6. 1 ) (0 .8 ) (1 7. 5 ) (3 7. 5) 42 24 -3 5 m on th s 8. 8 34 2 (3 3. 1 ) (1 8. 0 ) (6 .1 ) (0 .0 ) (3 9. 9) (4 7. 1 ) (0 .0 ) (3 3. 8 ) (2 7. 0) 30 36 -4 7 m on th s 11 .6 32 4 (4 6. 1 ) (5 9. 0 ) (4 .9 ) (5 .5 ) (6 7. 6) (4 4. 2 ) (5 .5 ) (2 2. 5 ) (4 5. 2) 38 48 -5 9 m on th s 5. 8 26 5 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 15 M ot he r's e du ca tio n N on e 1. 9 14 0 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 3 P rim a ry 10 .6 10 31 32 .8 44 .4 1. 9 3. 6 53 .6 43 .6 0. 0 19 .7 36 .5 10 9 S ec on da ry 8. 7 45 9 (3 1. 5 ) (2 4. 6 ) (9 .3 ) (0 .8 ) (5 3. 1) (5 8. 9 ) (5 .2 ) (2 9. 1 ) (3 4. 0) 40 N on -s ta nd a rd (* ) 3 - - - - - - - - - - M is si ng /D K (* ) 1 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 1 W ea lth in de x qu in til es P oo re st 11 .2 36 7 (4 1. 1 ) (5 4. 4 ) (0 .0 ) (9 .5 ) (6 2. 2) (3 1. 9 ) (5 .0 ) (1 7. 3 ) (4 7. 0) 41 S ec on d 9. 4 38 3 (5 4. 1 ) (4 8. 8 ) (1 0. 3) (0 .0 ) (8 6. 0) (5 2. 6 ) (0 .9 ) (1 4. 4 ) (5 1. 3) 36 M id dl e 11 .9 32 8 (2 3. 5 ) (2 8. 7 ) (5 .3 ) (0 .0 ) (3 7. 4) (5 2. 6 ) (0 .0 ) (2 9. 7 ) (2 8. 8) 39 F ou rt h 7. 0 30 2 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 21 R ic he st 6. 2 25 4 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 16 M ot he r to ng ue o f he ad B is la m a 4. 3 17 9 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 8 O th er L an gu ag e 10 .0 14 52 33 .5 39 .6 4. 0 2. 9 54 .1 45 .9 1. 6 21 .9 36 .8 14 5 N at io n al 9. 4 16 34 32 .4 39 .1 3. 8 2. 8 53 .1 46 .7 1. 6 21 .9 35 .8 15 3 * M IC S in di ca to r 39 ; M D G in di ca to r 22 (* ) P er ce nt c ou nt h as b ee n su pp re ss ed a s th e fig u re is b as ed o n le ss th an 2 5 un w ei gh te d ca se s ( ) F ig u re is b as ed o n 25 -4 9 un w e ig ht ed c as es Vanuatu Multiple Indicator Cluster Survey-2007 61 7.7.7.7. ENVIRONMENTENVIRONMENTENVIRONMENTENVIRONMENT Water and Sanitation Safe drinking water is a basic need for good health. Unsafe drinking water can be a significant carrier of diseases, such as trachoma, cholera, typhoid, and schistosomiasis. Drinking water can also be tainted with chemical, physical and radiological contaminants that harmfully affect human health. In addition to its association with diseases, access to safe drinking water may be particularly important for woman and children especially in rural areas, where they often bear primary responsibility for carrying water from long distances. The 7th MDG with regard to water and sanitation is to reduce the percentage of people not having sustainable access to safe drinking water and basic sanitation by half between 1990 and 2015. The WFFC goal calls for a reduction in the percentage of households that do not have access to hygienic sanitation facilities, and affordable and safe drinking water by at least one-third. The MICS-3 indicators that are related to water and sanitation are as follows: Indicators Related to Water: • Use of improved drinking water sources, • Use of adequate water treatment method, • Time to source of drinking water, • Persons collecting drinking water. Indicators Related to Sanitation: • Use of improved sanitation facilities, • Sanitary disposal of child's faeces. Indicators Related to Water In the MICS-3, water obtained from any of the following sources is considered as improved water: piped water (into dwelling, yard or plot), public tap/standpipe, tube well/bore whole, protected well, protected spring, or rainwater collection. Table EN.1 presents the distribution of the surveyed population by source of improved drinking water according to some selected background characteristics. It is evident from Table EN.1, 85 percent of the population have access to improved drinking water sources - 98 percent in urban and 81 percent in rural areas. Only in two provinces the situation is worse than the overall situation; in Sanma and Tafea the proportion of population having access to improved sources are 67 percent and 74 percent respectively. In all other provinces/cities this proportion varies between the range of 84 percent in Panama and 98 percent in Luganville city. V a n u a tu M u lt ip le I n d ic a to r C lu st er S u rv ey -2 00 7 62 T a b le E N .1 : U se o f im p ro ve d w a te r so u rc es P e rc en t d is tr ib u ti o n o f h o u se h o ld m em b er s a c co rd in g t o m a in s o u rc e o f d ri n k in g w a te r a n d p er ce n ta g e o f h o u se h o ld m em b e rs u si n g i m p ro ve d d ri n k in g w a te r so u rc e s, V a n u a tu , 20 0 7 B ac kg ro un d C ha ra ct er is tic s M ai n so ur ce o f d rin ki ng w at e r T ot al Im p ro ve d so ur ce o f dr in ki ng w at er * N um be r of ho us eh ol d m em be rs Im p ro ve d so ur ce s U ni m pr ov ed s ou rc es Piped into dwelling Piped into yard or plot Public tap /standpipe Tubewell/ borehole Protected well Protected spring Rainwater collection Bottled water Unprotect ed well Unprotect ed spring Surface water Bottled water 1 Other Missing R eg io n T af ea 3. 2 21 .3 30 .5 1. 9 1. 7 0. 0 15 .7 0. 0 0. 2 3. 4 22 .1 0. 0 0. 0 0. 0 10 0. 0 74 .3 18 81 S he fa 1. 5 13 .8 2. 5 0. 8 16 .1 1. 4 55 .7 0. 0 1. 6 2. 1 4. 5 0. 0 0. 0 0. 0 10 0. 0 91 .8 19 83 M al a m pa 0. 5 10 .4 10 .4 6. 6 22 .4 1. 8 32 .4 0. 0 7. 2 4. 3 3. 9 0. 0 0. 0 0. 0 10 0. 0 84 .6 23 77 P en am a 0. 4 27 .4 15 .8 0. 0 19 .4 0. 0 20 .6 0. 0 10 .0 1. 6 4. 8 0. 0 0. 0 0. 0 10 0. 0 83 .6 15 33 S an m a 0. 4 4. 5 8. 0 3. 5 11 .2 8. 1 31 .2 0. 0 3. 3 17 .4 11 .5 0. 0 0. 0 0. 7 10 0. 0 67 .0 19 15 T o rb a 0. 9 5. 5 7. 0 0. 0 1. 9 0. 6 78 .9 0. 0 0. 0 0. 5 4. 9 0. 0 0. 0 0. 0 10 0. 0 94 .7 57 3 P or t V ila 33 .9 19 .5 17 .7 0. 2 2. 7 0. 0 22 .2 1. 3 1. 5 0. 4 0. 4 0. 1 0. 0 0. 0 10 0. 0 97 .6 23 41 Lu ga nv ill e 14 .3 19 .5 5. 3 0. 0 0. 7 0. 2 58 .4 0. 0 0. 7 0. 6 0. 0 0. 0 0. 3 0. 0 10 0. 0 98 .4 76 9 A re a U rb an 29 .1 19 .5 14 .7 0. 2 2. 2 0. 0 31 .1 1. 0 1. 3 0. 5 0. 3 0. 1 0. 1 0. 0 10 0. 0 97 .8 31 10 R ur al 1. 2 14 .2 12 .7 2. 7 13 .7 2. 2 34 .4 0. 0 4. 1 5. 5 9. 0 0. 0 0. 0 0. 1 10 0. 0 81 .2 10 26 0 E du ca tio n of ho us eh ol d he ad N on e 2. 8 10 .1 22 .5 3. 4 9. 5 1. 8 25 .3 0. 0 1. 0 9. 2 13 .6 0. 0 0. 0 0. 9 10 0. 0 75 .3 15 25 P rim a ry 4. 0 16 .1 12 .8 2. 3 12 .5 1. 4 34 .1 0. 0 3. 8 5. 0 7. 9 0. 0 0. 0 0. 0 10 0. 0 83 .3 76 45 S ec on da ry + 17 .8 16 .8 11 .4 1. 0 8. 2 2. 0 35 .1 0. 8 3. 3 1. 6 1. 8 0. 0 0. 1 0. 0 10 0. 0 93 .2 36 33 N on -s ta nd a rd 3. 0 10 .6 0. 0 4. 1 30 .1 0. 0 34 .9 0. 0 5. 5 0. 0 11 .8 0. 0 0. 0 0. 0 10 0. 0 82 .7 20 3 M is si ng /D K 7. 0 12 .7 7. 0 2. 3 4. 6 6. 1 44 .9 0. 0 7. 5 0. 0 8. 0 0. 0 0. 0 0. 0 10 0. 0 84 .6 36 4 W ea lth in de x qu in til es P oo re st 0. 1 11 .9 17 .1 4. 7 9. 3 1. 6 24 .6 0. 0 3. 2 8. 1 19 .5 0. 0 0. 0 0. 0 10 0. 0 69 .2 26 76 S ec on d 0. 5 12 .7 15 .9 3. 9 14 .1 3. 3 28 .2 0. 0 4. 4 8. 3 8. 8 0. 0 0. 0 0. 0 10 0. 0 78 .5 26 71 M id dl e 1. 2 13 .7 12 .0 1. 1 17 .8 2. 5 37 .2 0. 0 6. 1 3. 0 5. 3 0. 0 0. 0 0. 0 10 0. 0 85 .5 26 74 F ou rt h 2. 2 23 .6 11 .0 0. 5 11 .4 1. 1 42 .5 0. 0 3. 6 2. 4 1. 0 0. 1 0. 1 0. 5 10 0. 0 92 .3 26 68 R ic he st 34 .3 15 .4 10 .0 0. 2 2. 6 0. 3 35 .8 1. 1 0. 0 0. 0 0. 2 0. 1 0. 0 0. 0 10 0. 0 99 .8 26 80 M ot he r to ng ue o f he ad B is la m a 18 .8 12 .7 14 .3 1. 1 7. 1 2. 7 40 .2 1. 1 0. 5 0. 6 0. 8 0. 0 0. 1 0. 0 10 0. 0 97 .9 17 94 O th er La ng ua ge 6. 0 15 .9 13 .1 2. 3 11 .7 1. 6 32 .6 0. 1 4. 0 4. 9 7. 9 0. 0 0. 0 0. 0 10 0. 0 83 .1 11 53 9 M is si ng (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (6 2. 7 ) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (3 7. 3) (1 00 .0 ) (6 2. 7) 37 N at io n al 7. 7 15 .5 13 .2 2. 1 11 .0 1. 7 33 .7 0. 2 3. 5 4. 4 7. 0 0. 0 0. 0 0. 1 10 0. 0 85 .1 13 37 0 * M IC S in di ca to r 11 ; M D G in d ic at or 3 0 1 H ou se ho ld s us in g bo ttl ed w at e r on ly fo r d rin ki ng , f o r ot he r pu rp os es a s co ok in g an d ha nd w as hi ng ; t he s ou rc es a re u ni m pr ov ed ( ) F ig ur e is b as ed o n 25 -4 9 un w ei gh te d ca se s Vanuatu Multiple Indicator Cluster Survey-2007 63 The proportion of population having access to improved drinking water source varies to some extent according to wealth status of households, between the ranges of 69 percent in the poorest to almost 100 percent in the richest households. Educational level of household head also shows positive association with the use of improved drinking water. Still, 15 percent population uses drinking water from unimproved sources namely unprotected well (3.5%), unprotected spring (4.4%) and surface water (7%). Use of unsafe surface water is higher in Tafea and Sanma, as 26 percent and 33 percent of the population of these two provinces are using water from unimproved sources mainly unprotected spring and surface water for drinking respectively. Nearly, one-fifth (19.5%) of the population of the poorest households are using unsafe surface water for drinking. Table EN.1A shows a comparative situation of the use of drinking water in 1999 Vanuatu census and this study. The data indicate that the proportion of population using tapped water has slightly increased in MICS-2007 over 1999 Census (44.0% vs. 47.0%). This is due to the fact that, the proportion of population using Village standpipe has become doubled (from 6.0% to 13.0%) over this period of time. Besides, tube well or borehole, protected well, protected spring and rainwater collection have been segregated as improved source of water in MICS-2007, resulting the overall percentage of population using improved water source to 85 percent. Table EN.1A. Percentage of households by source of drinking water use in 1999 census and MICS-2007 1999 Vanuatu Census % MICS-2007 % 1. Piped water, private 17 1. Piped into dwelling 18 2. Piped water, shared 21 Piped into yard/plot 16 3. Village standpipe 6 3. Public tap/standpipe 13 Subtotal 47 4. Tube well/borehole 2 5. Protected well 11 6. Protected spring 2 7.Rainwater collection 34 Sub total improved 44 Sub total: improved 85 4. Household tank 14 8. Unprotected well 4 5. Community tank 15 9. Unprotected spring 4 6. Well 8 10. Surface water 7 7. Spring 6 8. River 8 9. Other 4 10. Not stated 1 Sub total unimproved 56 Sub total: Unimproved 15 Total 100 Total 100 Note: All wells and springs were considered as unprotected and hence unimproved in Census 1999. Vanuatu Multiple Indicator Cluster Survey-2007 64 Table EN.2 presents the distribution of the household population by the practice of in-house water treatment. The respondents were asked if they treat water at home to make it safer to drink and the methods they usually apply to do so. The data show that, overall only about 15 percent household treats water for drinking (improved 14.9% and unimproved 12.2%). The practice of water treatment is more prevalent in urban area (19.2%) than rural area (13.0%). The practice level varies considerably across the provinces. It is the lowest in Sanma (3.9%) and the highest in Shefa (25.0%). Some variation is also observed in the practice of water treatment by households of different wealth status ranging from 10 percent in the poorest quintile to 23 percent in the richest quintile. Level of education of the household head also shows positive association with the practice of water treatment. Figure EN.1: Percentage distribution of household members by source of drinking water, Vanuatu, 2007 14.5 19.2 13.0 6.2 25.0 16.4 15.3 3.9 4.7 21.6 12.0 0 10 20 30 40 50 60 70 80 90 100 National Urban Rural Tafea Shefa Malampa Penama Sanma Torba Port Vila Lugenville Percent V a n u a tu M u lt ip le I n d ic a to r C lu st er S u rv ey -2 00 7 65 T a b le E N .2 : H o u se h o ld w a te r tr e a tm e n t P e rc en t d is tr ib u ti o n o f h o u se h o ld p o p u la ti o n a cc o rd in g t o d ri n k in g w a te r tr ea tm e n t m e th o d u se d i n t h e h o u se h o ld a n d p e rc e n ta g e o f h o u se h o ld p o p u la ti o n th a t ap p li e d a n a p p ro p ri a te w at e r tr e at m en t m e th o d , V a n u a tu , 2 00 7 B ac kg ro un d C ha ra ct e ris tic s W at er t re at m en t m et ho d us ed in t he h ou se ho ld A ll dr in ki ng w at er so ur ce s: A pp ro pr ia te w at er tr ea tm en t m et ho d * N um be r of ho us eh ol d m e m be rs Im p ro ve d dr in ki ng w at er so ur ce s: A pp ro pr ia te w at er t re at m en t m et ho d N um be r of ho us eh ol d m e m be rs U ni m pr ov ed dr in ki ng w at er so ur ce s: A pp ro pr ia te w at er tr ea tm en t m et ho d N um be r of ho us eh ol d m e m be rs None Boil Add bleach/chlorine Strain through a cloth Use water filter Solar disinfection Let it stand and settle Other Don't know R eg io n T af ea 90 .8 5. 3 0. 0 0. 3 0. 0 1. 1 3. 6 0. 0 0. 0 6. 2 18 81 6. 1 13 97 6. 2 48 3 S he fa 66 .9 25 .0 0. 0 4. 9 0. 0 0. 2 13 .1 0. 0 0. 4 25 .0 19 83 24 .9 18 19 25 .6 16 3 M al a m pa 74 .1 15 .8 0. 0 3. 7 0. 5 0. 0 5. 3 4. 2 0. 0 16 .4 23 77 14 .3 20 11 27 .8 36 6 P en am a 80 .9 13 .3 0. 5 0. 5 2. 0 0. 5 6. 9 1. 9 0. 0 15 .3 15 33 16 .9 12 81 7. 2 25 2 S an m a 92 .8 3. 9 0. 0 2. 3 0. 0 0. 0 0. 0 1. 4 0. 0 3. 9 19 15 3. 7 12 84 4. 4 63 1 T o rb a 86 .8 4. 0 0. 6 1. 6 0. 0 0. 0 8. 0 0. 9 0. 0 4. 7 57 3 4. 7 54 2 (4 .7 ) 31 P or t V ila 70 .2 20 .9 0. 0 3. 8 0. 2 0. 4 7. 0 5. 2 0. 0 21 .6 23 41 21 .4 22 87 28 .8 54 Lu ga nv ill e 82 .3 12 .0 0. 4 8. 9 0. 0 0. 0 2. 3 0. 3 0. 0 12 .0 76 9 11 .3 75 6 (* ) 12 A re a U rb an 73 .2 18 .7 0. 1 5. 1 0. 2 0. 3 5. 9 4. 0 0. 0 19 .2 31 10 18 .9 30 43 33 .4 67 R ur al 81 .0 12 .4 0. 1 2. 4 0. 4 0. 3 5. 9 1. 6 0. 1 13 .0 10 26 0 13 .4 83 34 11 .5 19 26 E du ca tio n of ho us eh ol d he ad N on e 87 .4 8. 3 0. 0 2. 0 0. 2 0. 0 4. 3 0. 7 0. 0 8. 5 15 25 10 .2 11 49 3. 3 37 6 P rim ar y 80 .4 13 .2 0. 2 2. 3 0. 2 0. 3 6. 4 1. 4 0. 1 13 .5 76 45 14 .2 63 67 10 .2 12 78 S ec on da ry + 74 .9 16 .6 0. 1 3. 8 0. 5 0. 7 5. 6 4. 4 0. 0 17 .6 36 33 16 .6 33 85 31 .1 24 7 N on -s ta nd a rd cu rr ic ul u m 68 .9 12 .6 0. 0 14 .5 6. 1 0. 0 5. 1 0. 0 0. 0 18 .7 20 3 22 .6 16 8 (0 .0 ) 35 M is si ng /D K 66 .6 26 .3 0. 0 8. 9 0. 0 0. 0 4. 6 1. 3 0. 0 26 .3 36 4 23 .7 30 8 40 .8 56 W ea lth in de x qu in til es P oo re st 86 .4 9. 8 0. 0 2. 0 0. 6 0. 0 5. 1 1. 8 0. 0 10 .4 26 76 9. 8 18 53 11 .6 82 4 S ec on d 83 .4 10 .4 0. 3 2. 5 0. 2 0. 5 6. 5 0. 1 0. 0 10 .6 26 71 12 .3 20 96 4. 4 57 6 M id dl e 79 .1 12 .6 0. 1 3. 1 0. 0 0. 0 6. 5 2. 5 0. 0 12 .8 26 74 12 .0 22 88 17 .6 38 7 F ou rt h 77 .1 14 .2 0. 0 2. 9 0. 9 0. 8 5. 3 1. 5 0. 3 15 .7 26 68 14 .8 24 65 26 .7 20 3 R ic he st 69 .8 22 .4 0. 1 4. 8 0. 2 0. 4 6. 1 4. 8 0. 0 22 .9 26 80 23 .0 26 76 (* ) 4 M ot he r to ng ue o f he ad B is la m a 78 .6 12 .8 0. 0 3. 7 0. 7 0. 4 5. 8 1. 8 0. 0 13 .9 17 94 13 .8 17 57 (1 7. 4) 37 O th er L an gu ag e 79 .2 14 .0 0. 1 2. 9 0. 3 0. 3 5. 9 2. 2 0. 1 14 .6 11 53 9 15 .0 95 97 12 .2 19 42 M is si ng (8 2. 2 ) (1 7. 8 ) (0 .0 ) (0 .9 ) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (1 7. 8 ) 37 (* ) 23 (* ) 14 N at io n al 79 .2 13 .9 0. 1 3. 0 0. 4 0. 3 5. 9 2. 1 0. 1 14 .5 13 37 0 14 .9 11 37 7 12 .2 19 93 * M IC S in di ca to r 13 (* ) P er ce nt c ou nt h as b ee n su pp re ss ed a s th e fig ur e is b as ed o n le ss th an 2 5 un w ei gh te d ca se s ( ) F ig ur e is b as ed o n 25 -4 9 un w ei gh te d ca se s Vanuatu Multiple Indicator Cluster Survey-2007 66 Boiling, adding bleach or chlorine, using a water filter, solar disinfection, strain through a cloth, let it stand and settle, and others are the methods usually applied to treat water in the households; boiling is predominant among them. Information on amount of time required to collect water from the source is placed in Table EN.3. The data refer to the time needed to go to the water source and comeback home in one trip of water collection. Results in Table EN.3 show that, about half of the households (48.7%) have drinking water on their premises (urban 70.5%, rural 42.1%) and 51 percent households collect water from outside of their premises (urban 29.5%, rural 57.9%). Having drinking water in the premises varies from 30 percent among the poorest households to 75 percent among the richest households. Drinking water in the premises varies widely across the provinces, ranging from as low as 11 percent in Sanma to as high as 67 percent in Penama and 76 percent in Port Vila city. It takes less than 30 minutes to get to the water source and bring water in 45 percent households; while only 4 and 2 percent of the households spend 30 minutes to less than one hour, and one hour or more time respectively for this purpose. For the households having outside drinking water source the average time taken to collect drinking water in one round is 14 minutes (Table EN.3). On the overage more time is spent in collecting water in rural area (14 minutes) than urban area (9 minutes). The average time spent is less than 10 minutes in Luganville city (6 minutes), Torba (6 minutes), Penama (9 minutes); and in all other provinces except Tafea it varies from 11 to 14 minutes, while in Tafea it takes 28 minutes to collect water. Vanuatu Multiple Indicator Cluster Survey-2007 67 Table EN.3: Time to source of water Percent distribution of households according to time to go to source of drinking water, get water and return, and mean time to source of drinking water, Vanuatu, 2007 Background Characteristics Time to source of drinking water Total Mean time to source of drinking water (excluding those on premises) Number of househ olds Water on premises Less than 15 minutes 15 minutes to less than 30 minutes 30 minutes to less than 1 hour 1 hour or more DK Missing Region Tafea 32.7 23.5 24.3 10.7 7.4 0.0 1.5 100.0 27.7 339 Shefa 54.0 28.9 8.7 3.4 1.5 2.3 1.1 100.0 14.3 367 Malampa 50.9 36.8 7.5 1.8 2.6 0.0 0.4 100.0 10.8 475 Penama 66.8 28.0 2.8 1.6 0.4 0.4 0.0 100.0 9.3 350 Sanma 10.8 72.8 6.7 6.2 2.1 0.0 1.5 100.0 11.1 385 Torba 22.1 73.3 3.2 0.7 0.7 0.0 0.0 100.0 6.2 100 Port Vila 76.1 15.7 7.0 0.4 0.0 0.1 0.6 100.0 11.1 464 Luganville 53.9 40.0 1.7 1.3 0.4 2.6 0.0 100.0 6.2 153 Area Urban 70.5 21.8 5.7 0.7 0.1 0.8 0.4 100.0 9.2 617 Rural 42.1 40.3 9.3 4.3 2.6 0.5 0.9 100.0 14.2 2015 Education of househol d head None 36.1 39.8 10.1 6.8 5.5 0.1 1.6 100.0 20.0 332 Primary 45.7 38.4 9.6 3.9 1.4 0.5 0.4 100.0 12.4 1470 Secondary + 59.3 30.5 5.8 1.5 0.9 0.9 1.2 100.0 11.5 723 Non- standard (48.4) (39.9) (5.7) (0.0) (6.0) (0.0) (0.0) 100.0 (12.5) 35 Missing/DK 62.5 22.7 7.2 0.0 7.7 0.0 0.0 100.0 19.4 73 Wealth index quintiles Poorest 30.0 43.6 13.2 6.3 6.0 0.0 0.9 100.0 18.1 525 Second 36.6 44.5 9.7 5.4 2.6 0.8 0.4 100.0 14.6 547 Middle 44.4 41.4 9.5 2.7 0.7 0.8 0.4 100.0 10.7 512 Fourth 58.3 31.7 5.9 1.6 0.6 0.7 1.3 100.0 9.8 533 Richest 75.4 17.9 4.1 1.1 0.1 0.5 0.9 100.0 10.2 514 Mother tongue of head Bislama 54.7 36.2 6.6 1.2 0.3 0.8 0.2 100.0 9.1 364 Other Language 47.7 36.0 8.8 3.8 2.3 0.5 0.8 100.0 14.2 2261 Missing (*) (*) (*) (*) (*) (*) (*) 100.0 (*) 7 National 48.7 36.0 8.5 3.5 2.0 0.6 0.8 100.0 13.6 2632 (*) Percent count has been suppressed as the figure is based on less than 25 unweighted cases ( ) Figure is based on 25-49 unweighted cases Vanuatu Multiple Indicator Cluster Survey-2007 68 Table EN.4 shows the distribution of the households according to the person collecting water used in the households where the source is not in the premises. The data reveals that, adult women collect water in 59 percent households (urban 65.6%, rural 58.4%); while in 30 percent household adult men collect water (urban 21.8%, rural 31.2%). Female and male child under 15 years, of course, collect water in 5 and 3 percent households respectively. The proportions are greater in the rural area than the urban area. Adult women and men play a greater role in collecting water in all the provinces. Table EN.4: Person collecting water Percent distribution of households according to the person collecting water used in the household, Vanuatu, 2007 Background Characteristics Person collecting drinking water Total Number of households Adult woman Adult man Female child (under 15) Male child (under 15) DK Missing Region Tafea 43.2 44.3 5.5 3.8 0.0 3.3 100.0 228 Shefa 52.9 39.7 1.7 4.1 0.0 1.7 100.0 169 Malampa 49.1 42.0 4.5 2.7 0.0 1.8 100.0 233 Penama 61.4 26.5 7.2 1.2 0.0 3.6 100.0 116 Sanma 73.6 14.4 8.0 2.3 0.0 1.7 100.0 343 Torba 70.8 23.7 2.7 2.3 0.0 0.5 100.0 78 Port Vila 57.8 29.2 3.1 2.5 0.0 7.5 100.0 109 Luganville 77.8 10.4 4.7 0.0 1.4 5.7 100.0 71 Area Urban 65.6 21.8 3.7 1.5 0.6 6.7 100.0 180 Rural 58.4 31.2 5.5 2.8 0.0 2.1 100.0 1167 Education of household head None 58.4 30.0 3.5 2.9 0.2 5.0 100.0 212 Primary 58.5 31.0 5.5 3.0 0.0 2.0 100.0 798 Secondary + 63.7 27.0 5.3 0.9 0.1 3.0 100.0 292 Non-standard (*) (*) (*) (*) (*) (*) (100.0) 18 Missing/DK (64.9) (17.8) (5.1) (9.7) (0.0) (2.5) (100.0) 27 Wealth index quintiles Poorest 58.4 32.3 4.3 2.4 0.0 2.6 100.0 368 Second 55.7 34.3 6.2 2.0 0.0 1.9 100.0 347 Middle 58.8 28.3 6.9 4.4 0.1 1.4 100.0 285 Fourth 61.1 29.1 3.6 2.1 0.0 4.1 100.0 223 Richest 70.3 16.2 4.5 2.2 0.5 6.2 100.0 125 Mother tongue of head Bislama 64.6 27.3 2.8 1.2 0.2 3.9 100.0 164 Other Language 58.7 30.4 5.6 2.9 0.1 2.4 100.0 1179 Missing (*) (*) (*) (*) (*) (*) (100.0) 4 National 59.3 30.0 5.2 2.7 0.1 2.7 100.0 1347 (*) Percent count has been suppressed as the figure is based on less than 25 unweighted cases ( ) Figure is based on 25-49 unweighted cases Vanuatu Multiple Indicator Cluster Survey-2007 69 Indicators Related to Sanitation Inadequate disposal of human excreta and poor personal hygiene is associated with different diseases such as diarrhoea, polio, worm infestation, etc. Improved sanitation facilities for excreta disposal provide improved personal hygiene. Improved sanitation facilities include: flush to piped sewerage system, septic tank or pit latrine, ventilated improved pit latrine, pit latrine with slab. However, flush to piped sewerage system does not exist in Vanuatu. The survey data indicate that, more than 60 percent (63.5%) of the surveyed population live in the households that use improved sanitation facilities. The proportion is 91 percent in the urban area and 55 percent in the rural area (Table EN.5). Across the provinces this proportion ranges from 38 percent in Malampa to 72 percent in Shefa province and to 94 percent in Port Vila city. Improved sanitation facilities have strong positive correlation with household wealth status and education level. Use of improved sanitation facility varies from 38 percent among the poorest households to 97 percent among the richest households. It is evident from the survey that, still 36 percent of the population uses unimproved sanitation facilities including pit latrine without slab (32.8%) and open field (3.2%). Pit latrine without slab is used in majority households of Malampa (61.6%) and Penama (60.4%). In the MICS-3, a child's faeces are considered to be safely disposed off if child's last stool/most recent stool (at the time of interview) was rinsed into a toilet or latrine or if the child used a toilet to defecate. Data that describe the disposal of faeces of children 0-2 years of age are presented in Table EN.6. The data reveal that, the stools of 30 percent of the surveyed children are disposed off safely. The rate varies from 26 percent in the urban area to 31 percent in the rural area. The practice of safe disposal was the lowest in Port Vila and Shefa (20.4% and 20.8% respectively) and the highest in Luganville (39.4%). Education of the mothers shows positive association with the practice of safe disposal of child faeces, ranging from 19 percent with no education to 31 percent with secondary or above level of education. However, household wealth status shows no consistent pattern of variation with the practice of safe disposal of child faeces. Vanuatu Multiple Indicator Cluster Survey-2007 70 Table EN.5: Use of sanitary means of excreta disposal Percent distribution of household members according to type of toilet used by the household and the percentage of household members using sanitary means of excreta disposal, Vanuatu, 2007 Background Characteristics Type of toilet facility used by household Total P er ce nt ag e of po pu la tio n us in g sa ni ta ry m ea ns o f ex cr et a di sp os al * N um be r of ho us eh ol ds m e m be rs Improved sanitation facility Unimproved sanitation facility F lu sh to se pt ic ta nk F lu sh to p it (la tr in e ) V en til at ed Im p ro ve d P it la tr in e (V IP ) P it la tr in e w ith sl ab P it la tr in e w ith ou t sl ab /o pe n pi t N o fa ci lit ie s o r bu sh o r fie ld O th er M is si ng Region Tafea 0.0 14.7 15.9 23.4 37.5 8.2 0.0 0.3 100.0 54.0 1881 Shefa 10.2 5.2 23.2 33.0 28.0 0.4 0.0 0.0 100.0 71.6 1983 Malampa 3.6 8.9 20.2 5.4 61.6 0.2 0.0 0.0 100.0 38.2 2377 Penama 0.1 1.6 4.7 32.6 60.4 0.0 0.0 0.6 100.0 39.0 1533 Sanma 2.6 2.9 29.5 33.8 18.6 11.3 0.6 0.7 100.0 68.7 1915 Torba 1.3 1.2 48.9 18.0 24.1 4.7 1.0 0.7 100.0 69.4 573 Port Vila 73.4 3.2 10.2 7.5 5.1 0.3 0.2 0.2 100.0 94.3 2341 Luganville 61.3 4.9 9.8 5.9 14.9 2.2 0.9 0.3 100.0 81.8 769 Area Urban 70.4 3.6 10.1 7.1 7.5 0.8 0.3 0.2 100.0 91.2 3110 Rural 3.4 6.6 21.0 24.1 40.4 4.0 0.2 0.3 100.0 55.1 10260 Education of household head None 6.1 4.4 16.7 17.8 43.2 10.2 0.7 0.9 100.0 45.0 1525 Primary 10.8 6.5 20.2 23.6 35.7 2.7 0.2 0.3 100.0 61.1 7645 Secondary + 42.0 6.2 13.3 14.2 22.4 1.7 0.2 0.1 100.0 75.7 3633 Non- standard 17.8 0.0 43.0 5.2 34.0 0.0 0.0 0.0 100.0 66.0 203 Missing/DK 13.7 1.2 28.4 24.5 29.3 3.0 0.0 0.0 100.0 67.7 364 Wealth index quintiles Poorest 0.0 2.8 11.9 22.8 57.9 4.4 0.1 0.0 100.0 37.6 2676 Second 0.0 5.0 23.0 23.8 43.8 3.7 0.4 0.4 100.0 51.7 2671 Middle 0.7 7.9 22.5 25.7 39.4 3.3 0.2 0.3 100.0 56.8 2674 Fourth 13.9 10.6 25.7 23.9 20.4 4.5 0.3 0.6 100.0 74.2 2668 Richest 80.0 3.2 9.3 4.6 2.4 0.3 0.0 0.2 100.0 97.1 2680 Mother tongue of head Bislama 47.8 3.9 18.5 9.2 10.8 9.0 0.5 0.2 100.0 79.5 1794 Other Language 14.4 6.2 18.5 21.9 36.3 2.3 0.2 0.2 100.0 61.0 11539 Missing (41.0) (0.0) (16.9) (4.8) (0.0) (0.0) (0.0) (37.3) 100.0 (62.7) 37 National 19.0 5.9 18.5 20.1 32.8 3.2 0.2 0.3 100.0 63.5 13370 * MICS Indicator 12; MDG Indicator 31 ( ) Figure is based on 25-49 unweighted cases Vanuatu Multiple Indicator Cluster Survey-2007 71 Table EN.6: Disposal of child's faeces Percent distribution of children aged 0-2 years according to place of disposal of child's faeces, and the percentage of children aged 0-2 years whose stools are disposed of safely, Vanuatu, 2007 Background Characteristics What was done to dispose of the stools Total ch ild re n w ho se st oo ls a re di sp os ed o ff sa fe ly * N um be r of ch ild re n ag ed 0 -2 ye ar s C hi ld u se d to ile t/ la tr in e P ut /r in se d in to to ile t o r la tr in e P ut /r in se d in to dr ai n or d itc h T h ro w n in to ga rb ag e (s ol id w as te ) B ur ie d Le ft in th e op en O th er D K M is si ng Region Tafea 4.3 27.8 17.9 2.5 26.5 10.5 3.1 1.2 6.2 100.0 32.1 194 Shefa 0.8 20.0 49.6 8.8 17.6 0.0 1.6 0.0 1.6 100.0 20.8 170 Malampa 2.1 36.5 15.6 4.2 24.0 2.1 13.5 0.0 2.1 100.0 38.5 197 Penama 0.0 35.4 12.5 0.0 26.0 0.0 20.8 0.0 5.2 100.0 35.4 128 Sanma 5.4 18.9 5.4 6.8 36.5 1.4 20.3 2.7 2.7 100.0 24.3 137 Torba (10.2) (24.4) (20.5) (2.4) (17.3) (3.1) (5.5) (2.4) (14.2) (100.0) (34.6) 43 Port Vila 5.5 14.9 19.9 42.8 7.0 0.0 2.0 1.0 7.0 100.0 20.4 133 Luganville 12.5 26.9 7.5 21.9 8.7 0.6 13.7 1.2 6.9 100.0 39.4 54 Area Urban 7.5 18.4 16.3 36.8 7.5 0.2 5.4 1.1 6.9 100.0 25.9 187 Rural 3.0 27.8 20.9 4.4 25.3 3.2 10.6 0.8 4.1 100.0 30.7 869 Mother's education None 4.7 14.2 9.6 3.3 28.2 17.8 10.4 0.0 11.8 100.0 18.8 87 Primary 3.4 27.2 22.2 8.0 22.7 1.7 10.1 1.3 3.5 100.0 30.6 665 Secondary 4.3 26.7 18.8 16.9 19.1 0.4 8.7 0.1 4.8 100.0 31.1 302 Non-standard (*) (*) (*) (*) (*) (*) (*) (*) (*) (100.0) (*) 2 Wealth index quintiles Poorest 1.9 22.0 19.3 2.1 29.1 9.3 9.6 0.0 6.6 100.0 23.9 229 Second 3.9 30.0 18.1 4.3 26.5 1.2 13.2 0.9 2.0 100.0 33.8 282 Middle 2.9 31.3 21.3 1.8 24.4 1.7 10.7 0.9 4.9 100.0 34.2 199 Fourth 2.3 28.2 25.3 13.7 16.0 0.0 8.2 2.3 4.0 100.0 30.5 195 Richest 9.3 15.8 16.8 39.3 8.0 0.0 4.0 0.2 6.6 100.0 25.1 151 Mother tongue of head Bislama 7.5 20.4 20.3 18.3 20.7 0.3 5.2 0.3 7.0 100.0 27.9 107 Other Language 3.3 26.6 20.1 9.2 22.3 2.9 10.2 0.9 4.3 100.0 30.0 946 Missing (*) (*) (*) (*) (*) (*) (*) (*) (*) (100.0) (*) 2 National 3.8 26.1 20.1 10.1 22.1 2.7 9.7 0.9 4.6 100.0 29.9 1056 * MICS indicator 14 (*) Percent count has been suppressed as the figure is based on less than 25 unweighted cases ( ) Figure is based on 25-49 unweighted cases An overview of the percentage of households with improved sources of drinking water and improved sanitary facilities of excreta disposal is given in table EN.7. A combined indicator has been formed that measures the percentage of household population that are using both of ‘improved source of drinking water’ and ‘improved sanitary facilities of excreta disposal’. About 57 percent of the surveyed household population meet this standard (urban 90.1%, rural 46.5%), ranging from 34 percent in Malampa to 93 percent in Port Vila. The data show that, the higher values of this indicator are associated with urban residence, increasing wealth status of the households and increasing level of education of the household heads. Access of the people to safe drinking water is found to be 85 percent in the MICS-3. Comparison with last census is not possible because the census data did not consider the protected well and spring, and rainwater as safe source. Proportion of households having improved sanitation facilities has also increased during this period from 42 percent to 62 percent. Now 57 percent of the household population are using both improved source of drinking water and improved sanitation facilities of Vanuatu Multiple Indicator Cluster Survey-2007 72 excreta disposal. The government should enhance its water and sanitation policies and programs to provide the people those have no access to safe drinking water and improved sanitation facilities. Table EN.7: Use of improved water sources and improved sanitation Percentage of household population using both improved drinking water sources and sanitary means of excreta disposal, Vanuatu, 2007 Background Characteristics Percentage of household population using improved sources of drinking water * Percentage of household population using sanitary means of excreta disposal ** Percentage of household population using improved sources of drinking water and using sanitary means of excreta disposal Number of household members Region Tafea 74.3 54.0 41.2 1881 Shefa 91.8 71.6 67.5 1983 Malampa 84.6 38.2 34.0 2377 Penama 83.6 39.0 36.3 1533 Sanma 67.0 68.7 47.4 1915 Torba 94.7 69.4 68.2 573 Port Vila 97.6 94.3 93.0 2341 Luganville 98.4 81.8 81.4 769 Area Urban 97.8 91.2 90.1 3110 Rural 81.2 55.1 46.5 10260 Education of household head None 75.3 45.0 34.4 1525 Primary 83.3 61.1 52.9 7645 Secondary + 93.2 75.7 73.4 3633 Non-standard 82.7 66.0 63.9 203 Missing/DK 84.6 67.7 58.3 364 Wealth index quintiles Poorest 69.2 37.6 26.8 2676 Second 78.5 51.7 39.7 2671 Middle 85.5 56.8 49.2 2674 Fourth 92.3 74.2 70.6 2668 Richest 99.8 97.1 96.9 2680 Mother tongue of head Bislama 97.9 79.5 78.1 1794 Other Language 83.1 61.0 53.3 11539 Missing (62.7) (62.7) (62.7) 37 National 85.1 63.5 56.7 13370 * MICS indicator 11; MDG indicator 30 ** MICS indicator 12; MDG indicator 31 ( ) Figure is based on 25-49 unweighted cases Vanuatu Multiple Indicator Cluster Survey-2007 73 Security of Tenure One of the targets of the MDGs is the achievement of significant improvements in the lives of the dwellers. A household is considered to be at risk of eviction when the household members do not have formal documentation for residence (such as deeds or tenants contracts), or if household members feel at risk of eviction from the dwelling. The Millennium declaration targets for the slum dwellers in urban area and accordingly MICS-3 in other countries assess the status of them. But in Vanuatu, slums are not defined and the MICS-3 attempted to assess the situation for the households in both urban and rural areas. The study revealed that, 18 percent women aged 15-49 years fear eviction from their households, the proportion is slightly higher in the urban area (19.7%) than the rural area (16.8%) and the provincial differentials are observed in this re

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