Viet Nam - Multiple Indicator Cluster Survey - 2010

Publication date: 2010

Viet N am 2011 VIET NAM Multiple Indicator Cluster Survey 2011 Monitoring the situation of children and women MICS M ultiple Indicator C luster S urvey 2011 M IC S General Statistics Cluster Survey 2011 Viet Nam Multiple Indicator Website: mics.gso.gov.vn United Nations Children’s Fund United Nations Population Fund Viet Nam Multiple Indicator Cluster Survey 2011 Final Report December, 2011 The Viet Nam Multiple Indicator Cluster Survey (MICS) was carried out in 2010-2011 by the General Statistics Office of Viet Nam. Financial and technical support was provided by the United Nations Children’s Fund (UNICEF) and financial support was provided by the United Nations Population Fund (UNFPA). MICS is an international household survey programme developed by UNICEF. The Viet Nam MICS was conducted as part of the fourth global round of MICS surveys (MICS 4). MICS provides up-to-date information on the situation of children and women and measures key indicators that allow countries to monitor progress towards the Millennium Development Goals (MDGs) and other internationally agreed upon commitments. Additional information on the global MICS project may be obtained from www.childinfo.org. Suggested citation: General Statistical Office (GSO), Viet Nam Multiple Indicator Cluster Survey 2011, Final Report, 2011, Ha Noi, Viet Nam. 11 Viet Nam Multiple Indicator Cluster Survey 2011 GSO General Statistics Office UNICEF United Nations Children’s Fund UNFPA United Nations Population Fund December, 2011 2 3VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN SUMMARy TAblE OF FINDINGS Multiple Indicator Cluster Surveys (MICS) and Millennium Development Goals (MDG) Indicators, Viet Nam, 2011 Topic MICS 2011 Indicator Number MDG Indicator Number Indicator Value CHILD MORTALITY Child mortality 1.1 4.1 Under-five mortality rate 16 per thousand 1.2 4.2 Infant mortality rate 14 per thousand NUTRITION Nutritional status 2.1a 2.1b 1.8 Underweight prevalence Moderate and Severe (- 2 SD) Severe (- 3 SD) 11.7 1.8 per cent per cent 2.2a 2.2b Stunting prevalence Moderate and Severe (- 2 SD) Severe (- 3 SD) 22.7 6 per cent per cent 2.3a 2.3b Wasting prevalence Moderate and Severe (- 2 SD) Severe (- 3 SD) 4.1 1.2 per cent per cent breastfeeding and infant feeding 2.4 Children ever breastfed 98 per cent 2.5 Early initiation of breastfeeding 39.7 per cent 2.6 Exclusive breastfeeding under 6 months 17 per cent 2.7 Continued breastfeeding at 1 year 73.9 per cent 2.8 Continued breastfeeding at 2 years 19.4 per cent 2.9 Predominant breastfeeding under 6 months 43.3 per cent 2.10 Duration of breastfeeding 16.7 median months 2.11 bottle feeding 38.7 per cent 2.12 Introduction of solid, semi-solid or soft foods 50.4 per cent 2.13 Minimum meal frequency 58.5 per cent 2.14 Age-appropriate breastfeeding 33.5 per cent 2.15 Milk feeding frequency for non-breastfed children 82.2 per cent Salt iodisation 2.16 Iodised salt consumption 45.1 per cent Vitamin A 2.17 Vitamin A supplementation (children under age 5) 83.4 per cent low birth weight 2.18 low-birthweight infants 5.1 per cent 2.19 Infants weighed at birth 93.2 per cent CHILD HEALTH Vaccinations 3.1 bCG immunization coverage 95 per cent 3.2 Polio immunization coverage 68.1 per cent 3.3 Diphtheria, Pertussis, Tetanus (DPT) immunization coverage 73 per cent 3.4 4.3 Measles immunization coverage 84.2 per cent 3.5 Hepatitis b immunization coverage 53.3 per cent Tetanus toxoid 3.7 Neonatal tetanus protection 77.5 per cent Care of illness 3.8 Oral rehydration therapy with continued feeding 56.7 per cent 3.9 Care seeking for suspected pneumonia 73 per cent 3.10 Antibiotic treatment of suspected pneumonia 68.3 per cent Solid fuel use 3.11 Solid fuels 46.4 per cent 4 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Topic MICS 2011 Indicator Number MDG Indicator Number Indicator Value Malaria 3.12 Household availability of insecticide-treated nets (ITNs) 9.5 per cent 3.13 Households protected by a vector control method 25 per cent 3.14 Children under age 5 sleeping under any mosquito net 94.4 per cent 3.15 6.7 Children under age 5 sleeping under insecticide-treated nets (ITNs) 9.4 per cent 3.16 Malaria diagnostics usage 10.7 per cent 3.17 Antimalarial treatment of children under age 5 the same or next day 0.9 per cent 3.18 6.8 Antimalarial treatment of children under age 5 1.2 per cent 3.19 Pregnant women sleeping under insecticide-treated nets (ITNs) 11.3 per cent WATER, SANITATION AND HYGIENE Water and sanitation 4.1 7.8 Use of improved drinking water sources 92 per cent 4.2 Water treatment 89.6 per cent 4.3 7.9 Use of improved sanitation facilities 73.8 per cent 4.4 Safe disposal of child's faeces 61.1 per cent Hygiene 4.5 Place for handwashing with water and soap 86.6 per cent 4.6 Availability of soap 95.1 per cent REPRODUCTIVE HEALTH Contraception and unmet need 5.1 5.4 Adolescent birth rate 46 per thousand 5.2 Early childbearing 3.0 per cent 5.3 5.3 Contraceptive prevalence rate 77.8 per cent 5.4 5.6 Unmet need for contraception 4.3 per cent Maternal and newborn health 5.5a 5.5b 5.5 Antenatal care coverage At least once by skilled personnel At least four times by any provider 93.7 59.6 per cent per cent 5.6 Pregnant women received blood pressure check, urine test and blood test before delivery 42.5 per cent 5.7 5.2 Skilled attendant at delivery 92.9 per cent 5.8 Institutional deliveries 92.4 per cent 5.9 Caesarean section 20 per cent CHILD DEVELOPMENT Child development 6.1 Support for learning 76.8 per cent 6.2 Father's support for learning 61.3 per cent 6.3 learning materials: children’s books 19.6 per cent 6.4 learning materials: playthings 49.3 per cent 6.5 Inadequate care 9.4 per cent 6.6 Early child development index 82.8 per cent 6.7 Attendance in early childhood education 71.9 per cent EDUCATION literacy and education 7.1 2.3 literacy rate among young women 96.4 per cent 7.2 School readiness 92.6 per cent 7.3 Net intake rate in primary education 94.9 per cent 7.4 Primary school net attendance ratio (adjusted) 97.9 per cent 7.5 Secondary school net attendance ratio (adjusted) 81.0 per cent 7.6 2.2 Children reaching last grade of primary 99.4 per cent 7.7 Primary completion rate 99.6 per cent 7.8 Transition rate to secondary school 98.8 per cent 7.9 3.1 Gender parity index (primary school) 1.00 ratio 7.10 3.1 Gender parity index (secondary school) 1.07 ratio CHILD PROTECTION birth registration 8.1 birth registration 95 per cent Child labour 8.2 Child labour 9.5 per cent 8.3 School attendance among child labourers 83.4 per cent 8.4 Child labour among students 8.3 per cent Child discipline 8.5 Violent discipline 73.9 per cent 5VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Topic MICS 2011 Indicator Number MDG Indicator Number Indicator Value Early marriage and polygyny 8.6 Marriage before age 15 0.7 per cent 8.7 Marriage before age 18 12.3 per cent 8.8 Young women age 15-19 currently married or in union 8.4 per cent 8.9 Polygyny 2.5 per cent 8.10a 8.10b Spousal age difference (10 or more years) Women age 15-19 Women age 20-24 7.4 4.8 per cent per cent Domestic violence 8.14 Attitudes towards domestic violence 35.8 per cent Orphaned children 8.15 Children’s living arrangements 5.3 per cent 8.16 Prevalence of children with at least one parent dead 3.9 per cent HIV/AIDS AND SEXUAL BEHAVIOUR HIV/AIDS knowledge and attitudes 9.1 Comprehensive knowledge about HIV prevention 45.1 per cent 9.2 6.3 Comprehensive knowledge about HIV prevention among young people 51.1 per cent 9.3 Knowledge of mother-to-child transmission of HIV 49.6 per cent 9.4 Accepting attitude towards people living with HIV 28.9 per cent 9.5 Women who know where to be tested for HIV 61.1 per cent 9.6 Women who have been tested for HIV and know the results 6.6 per cent 9.7 Sexually active young women who have been tested for HIV and know the results 7.9 per cent 9.8 HIV counselling during antenatal care 20.9 per cent 9.9 HIV testing during antenatal care 28.6 per cent Sexual behaviour 9.10 young women who have never had sex 98.5 per cent 9.11 Sex before age 15 among young women 0.5 per cent 9.12 Age-mixing among sexual partners 6.3 per cent 9.13 Sex with multiple partners 0.1 per cent 9.15 Sex with non-regular partners 0.8 per cent 6 7VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN TAblE OF CONTENTS SUMMARy TAblE OF FINDINGS . 3 TAblE OF CONTENTS . 7 lIST OF TAblES. .10 lIST OF FIGURES . 14 lIST OF AbbREVIATIONS . 15 ACKNOWlEDGEMENTS . 17 MAP OF DISTRICTS WITH MICS 2011 DATA COllECTION SITES . 19 ExECUTIVE SUMMARy . 20 I. INTROdUCTION . 25 background . 26 MICS 2011 Objectives . 27 II. SAMPlE AND SURVEy METHODOlOGy . 29 Sample Design . 30 Questionnaires . 30 Training and Fieldwork . 32 Data Processing . 32 III. SAMPlE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOlDS AND RESPONDENTS . 33 Sample Coverage . 34 Household Characteristics . 34 Characteristics of Female Respondents 15–49 Years of Age and Children Under 5 years of Age . 38 IV. CHIld MORTAlITY . 43 V. NUTRITION . 49 Nutritional Status . 50 breastfeeding and Infant and young Child Feeding . 54 Salt Iodisation . 65 Children’s Vitamin A Supplementation. 67 low birth Weight . 70 8 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN VI. CHIld HEAlTH . 73 Immunization . 74 Neonatal Tetanus Protection . 78 Oral Rehydration Treatment . 80 Care Seeking and Antibiotic Treatment of Pneumonia . 90 Solid Fuel Use . 95 Malaria . 98 VII. WATER, SANITATION ANd HYGIENE . 107 Use of Improved Water Sources . 108 Use of Improved Sanitation Facilities .114 Handwashing . 121 VIII. REPROdUCTIVE HEAlTH . 123 Fertility . 124 Contraception . 128 Unmet Need . 131 Antenatal Care . 133 Assistance at Delivery . 137 Place of Delivery . 140 IX. CHIld dEVElOPMENT . 143 Early Childhood Education and learning . 144 Early Childhood Development . 150 X. lITERACY ANd EdUCATION . 155 literacy among young Women . 156 School Readiness . 156 Primary and Secondary School Participation . 158 XI. CHIld PROTECTION . 169 birth Registration . 170 Child labour . 172 Child Discipline . 176 Early Marriage and Polygyny . 178 Domestic Violence . 185 Orphanhood . 187 9VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN XII. HIV/AIdS ANd SEXUAl BEHAVIOUR . 189 Knowledge about HIV Transmission and Misconceptions about HIV/AIDS . 190 Accepting Attitudes toward People living with HIV/AIDS . 200 Knowledge of a Place for HIV Testing, Counselling and Testing during Antenatal Care . 203 Sexual behaviour Related to HIV Transmission . 208 APPENDIx A. Sample Design . 215 APPENdIX B. list of Personnel Involved in the Survey . 219 APPENdIX C. Estimates of Sampling Errors . 223 APPENdIX d. Data Quality Tables . 253 APPENdIX E. MICS 2011 Indicators: Numerators and Denominators . 269 APPENdIX F. Questionnaires .A1 10 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN lIST OF TAblES Table HH.1: Interview results for households, women and children under 5 years of age 34 Table HH.2: Sample age distribution by sex 35 Table HH.3: Household characteristics 37 Table HH.4: Women’s background characteristics 39 Table HH.5: Background characteristics of children under age 5 41 Table CM.1: Children ever born, children surviving and proportion dead 44 Table CM.2: Child mortality 45 Table NU.1: Nutritional status of children 51 Table NU.2: Initial breastfeeding 55 Table NU.3: Breastfeeding 57 Table NU.3a: Feeding patterns by age 58 Table NU.4: duration of breastfeeding 60 Table NU.5: Age-appropriate breastfeeding 61 Table NU.6: Introduction of solid, semi-solid or soft foods 62 Table NU.7: Minimum meal frequency 63 Table NU.8: Bottle feeding 64 Table NU.9: Iodised salt consumption 66 Table NU.10: Children’s vitamin A supplementation 69 Table NU.11: low birth weight infants 71 Table CH.1: Vaccinations in the first year of life 75 Table CH.2: Vaccinations by background characteristics 77 Table CH.3: Neonatal tetanus protection 79 Table CH.4: Oral rehydration solutions and recommended homemade fluids 82 Table CH.5: Feeding practices during diarrhoea 85 Table CH.6: Oral rehydration therapy with continued feeding and other treatments 88 Table CH.7: Care seeking for suspected pneumonia and antibiotic use during suspected pneumonia 91 11VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Table CH.8: Knowledge of the two danger signs of pneumonia 94 Table CH.9: Solid fuel use 96 Table CH.10: Solid fuel use by place of cooking 98 Table CH.11: Household availability of insecticide treated nets and protection by a vector control method 99 Table CH.12: Children sleeping under mosquito nets 100 Table CH.13: Pregnant women sleeping under mosquito nets 101 Table CH.14: Anti-malarial treatment of children with anti-malarial drugs 103 Table CH.15: Malaria diagnostics usage 105 Table WS.1: Use of improved water sources 109 Table WS.2: Household water treatment 112 Table WS.3: Time to source of drinking water 113 Table WS.4: Person collecting water 114 Table WS.5: Use of improved sanitation facilities 116 Table WS.6: Shared use of sanitation facilities 118 Table WS.7: disposal of child’s faeces 119 Table WS.8: Use of improved water sources and improved sanitation facilities 120 Table WS.9: Water and soap at place for handwashing 121 Table WS.10: Availability of soap 122 Table RH.1: Adolescent birth rate and total fertility rate 125 Table RH.2: Early childbearing 126 Table RH.3: Trends in early childbearing 127 Table RH.4: Use of contraception 129 Table RH.5: Unmet need for contraception 132 Table RH.6: Antenatal care coverage 134 Table RH.7: Number of antenatal care visits 135 Table RH.8: Content of antenatal care 136 Table RH.9: Assistance during delivery 138 Table RH.10: Place of delivery 141 12 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Table Cd.1: Early childhood education 144 Table Cd.2: Support for learning 146 Table Cd.3: learning materials 148 Table Cd.4: Inadequate care 150 Table Cd.5: Early child development index 152 Table Ed.1: literacy among young women 156 Table Ed.2: School readiness 157 Table Ed.3: Primary school entry 159 Table Ed.4: Primary school attendance 160 Table Ed.5: Secondary school attendance 162 Table Ed.6: Children reaching the last grade of primary school 164 Table Ed.7: Primary school completion and transition to secondary school 166 Table Ed.8: Education gender parity 167 Table CP.1: Birth registration 171 Table CP.2a: Child labour among children aged 5-11 years 173 Table CP.2b: Child labour among children aged 12-14 years 174 Table CP.3: Child labour and school attendance 176 Table CP.4: Child discipline 177 Table CP.5: Early marriage and polygyny 180 Table CP.6: Trends in early marriage 182 Table CP.7: Spousal age difference 184 Table CP.8: Attitudes toward domestic violence 186 Table CP.9: Children’s living arrangements and orphanhood 188 Table HA.1: Knowledge about HIV transmission, misconceptions about HIV/AIdS, and comprehensive knowledge about HIV transmission 192 Table HA.2: Knowledge about HIV transmission, misconceptions about HIV/AIDS, and comprehensive knowledge about HIV transmission among young people 195 Table HA.3: Knowledge of mother-to-child HIV transmission 199 Table HA.4: Accepting attitudes toward people living with HIV/AIdS 201 13VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Table HA.5: Knowledge of a place for HIV testing 204 Table HA.6: Knowledge of a place for HIV testing among sexually active young women 205 Table HA.7: HIV counselling and testing during antenatal care 207 Table HA.8: Sexual behaviour that increases the risk of HIV infection 209 Table HA.9: Sex with multiple partners 212 Table HA.10: Sex with multiple partners (young women) 213 Table HA.11: Sex with non-regular partners 214 14 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN lIST OF FIGURES Figure HH.1: Age and sex distribution of household population 36 Figure HH.2: Household composition 38 Figure CM.1: Under five mortality rate by background characteristics 46 Figure CM.2: Trend in under five mortality rates 47 Figure NU.1: Percentage of children under 5 years of age who are undernourished by age in months 53 Figure NU.2: Percentage distribution of children under age 2 across feeding patterns by age group 59 Figure NU.3: Percentage of households consuming adequately iodised salt by region 67 Figure NU.4: Percentage of infants weighing less than 2500 grams at birth by region 72 Figure CH.1: Percentage of children aged 12-23 months who received basic vaccinations by 12 months 76 Figure CH.2: Percentage of women with a live birth in the last 2 years protected against neonatal tetanus 80 Figure WS.1: Percentage distribution of population by source of drinking water 111 Figure HA.1: Percentage of women aged 15–24 years with comprehensive knowledge about HIV/AIdS by background characteristics 197 Figure HA.2: Percentage of women aged 15–24 years who had sex in the last 12 months with a man 10 or more years older by background characteristics 211 15VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN lIST OF AbbREVIATIONS AIdS Acquired Immune deficiency Syndrome bCG bacillus-Calmette-Guerin (Tuberculosis) CSPro Census and Survey Processing System DPT Diphtheria Pertussis Tetanus EA Enumeration Area ECDI Early Child Development Index EPI Expanded Programme on Immunization GPI Gender Parity Index GSO General Statistics Office HIV Human Immunodeficiency Virus Idd Iodine deficiency disorders IlO International labour Organization IRS Indoor Residual Spraying ITN Insecticide Treated Net IUD Intrauterine Device lAM lactational Amenorrhea Method MDG Millennium Development Goals MICS Multiple Indicator Cluster Survey MOH Ministry of Health NAR Net Attendance Rate ORT Oral Rehydration Treatment ppm Parts Per Million SESD Social and Environmental Statistics Department SPSS Statistical Package for Social Sciences UNAIDS United Nations Programme on HIV/AIDS UNDP United Nations Development Programme UNFPA United Nations Population Fund UNGASS United Nations General Assembly Special Session on HIV/AIDS UNICEF United Nations Children’s Fund WFFC World Fit For Children WHO World Health Organization 16 17VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN ACKNOWlEDGEMENTS The Viet Nam Multiple Indicator Cluster Survey 2011 was conducted by the General Statistics Office (GSO) in collaboration with the Ministry of Health (MOH) and the Ministry of labour, Invalids and Social Affairs (MOlISA), with financial and technical support from UNICEF and financial support from UNFPA. The Viet Nam Multiple Indicator Cluster Survey 2011 is the fourth round of Multiple Indicator Cluster Surveys in Viet Nam. The three previous MICS surveys were conducted in 1996 (MICS1), 2000 (MICS2), and 2006 (MICS3). The current survey was designed to collect information on a large number of indicators that cover a broad range of issues affecting the health, development and living conditions of Vietnamese women and children. This information is essential to monitor the goals and targets of the Millennium Declaration, the World Fit for Children Declaration and Action Plan, as well as the National Programme of Action for Children 2011–2020. The survey will serve as an up-to-date source of information on the situation of children and women and will be of substantial use for reporting on Viet Nam’s international commitments on children, such as the World Fit for Children End-decade Assessment and the 5th National Report on the implementation of the Convention on the Rights of the Child. Under the leadership of the MICS 2011 Steering Committee, including GSO, UNICEF and UNFPA, the organisation of the survey, data collection, processing and report writing was carried out by GSO staff, in close collaboration with professionals and staff from relevant government ministries/agencies and UNICEF. We would like to acknowledge the technical and financial support provided by UNICEF Viet Nam, Headquarters and the Asia Pacific Shared Service Centre, in particular the provision of training, guidance and template for data collection and analysis tools. We would like to express our sincere gratitude to specialists and experts from relevant government ministries and agencies, including GSO, Ministry of Education and Training, Ministry of Health, Ministry of labour, Invalids and Social Affairs; UNICEF, UNFPA, UNDP, UNESCO, IlO and WHO; and some non-governmental organisations (NGOs) for their valuable advice and comments during the organisation of the survey, questionnaire development and report writing. We would also like to thank all the local authorities involved, particularly the People’s Committees of the selected communes. A special note of thanks goes to all the interviewers, supervisors and other participants in the survey for their hard work and long working hours committed to completing all the steps of the survey from its initial design to the dissemination of its findings. This includes the 30 fieldwork teams traveling nation-wide for almost two months to complete the data collection in a timely and professional manner. We would like to express our genuine thankfulness to all households who participated in the survey and their willingness to give their time to provide valuable information about their private lives. Without their collaboration this survey would not have been possible. We are grateful for the continuous active cooperation from all national as well as international agencies, organisations and individuals for the benefit of Viet Nam’s children. LottaSylwander Representative, UNICEF Viet Nam Do Thuc Director General, General Statistics Office 18 19VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN MAP OF DISTRICTS WITH MICS 2011 DATA COllECTION SITES Red River Delta Northern Midlands and Mountain areas North Central area and Central Coastal area Central Highlands South East Mekong River Delta Districts with MICS 2011 Enumeration Areas, by region Districts with no Enumeration Areas Note: The boundaries and the names shown the designations used on these maps do not imply official endorsement or acceptance by the United Nations. 20 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN ExECUTIVE SUMMARy The Viet Nam Multiple Indicator Cluster Survey (MICS 2011) was conducted from december 2010 to January 2011 by the General Statistics Office of Viet Nam, in collaboration with the Ministry of Health (MOH) and the Ministry of labour, Invalids and Social Affairs (MOlISA). Financial and technical support for the survey was provided by the United Nations Children’s Fund (UNICEF) and financial support was provided by the United Nations Population Fund (UNFPA) in Viet Nam. MICS 2011 provides valuable information and the latest evidence on the situation of children and women in Viet Nam, updating information from the previous 2006 Viet Nam MICS survey as well as earlier data collected in the first two MICS rounds carried out in 1996 and 2000. The survey presents data from an equity perspective by indicating disparities by sex, region, area, ethnicity, living standards and other characteristics. MICS 2011 is based on a sample of 11,614 households interviewed and provides a comprehensive picture of children and women in Viet Nam’s six regions. Child Mortality In the Viet Nam MICS 2011 survey, child mortality rates are calculated based on an indirect estimation technique known as the Brass method. According to the survey results, the under-five mortality rate in Viet Nam is 16 per 1,000 live births and the infant mortality rate is 14 per 1,000 live births. Substantial disparities exist along the dimensions of ethnicity and living standards: ethnic minority children are three times as likely as Kinh/Hoa1 children to die before their first and fifth birthdays; and children in the poorest households are twice as likely to die before reaching 1 and 5 years of age compared to children living in better off families. Nutritional Status and breastfeeding during MICS 2011 data collection, the weights and heights of all children under 5 years of age in the sample households were measured using anthropometric equipment recommended by UNICEF (see www.childinfo.org). These measurements show that 11.7 per cent of Vietnamese children are underweight (weight-for-age malnourished), 22.7 per cent are stunted (height-for-age malnourished), and 4.1 per cent are wasted (weight-for- height malnourished). There are large disparities between urban and rural areas, between Kinh/Hoa and ethnic minority children, between different wealth quintiles and by mother’s education level. At the same time, 4.4 per cent of children in Viet Nam are overweight. Only two in five children in Viet Nam (39.7 per cent) start breastfeeding at the correct time (i.e. within one hour of birth) and less than one in five children (17 per cent) are exclusively breastfed until 6 months of age. Exclusive breastfeeding is highest in the Northern Midlands and Mountain areas at 37.6 per cent. More than four in five children (83.4 per cent) aged 6 to 59 months received a high dose of vitamin A supplementation within the six months prior to the MICS 2011 survey. Roughly 93 per cent of children below two years of age were weighed at birth and only 5.1 per cent were born with low weight. 1 In MICS 2011, the Chinese (Hoa) ethnic minority is grouped together with the Kinh majority under the label Kinh/Hoa, mainly because Kinh and Hoa have similar living standards. All other ethnicities are grouped together under the label Ethnic Minorities. 21VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Adequately iodised salt, defined as containing 15 or more particles per million (15+ ppm), is used in less than half of all households (45.1 per cent) with the consumption pattern showing considerable regional differences. This is far below global standards: The World Health Organization (WHO) and UNICEF recommend Universal Salt Iodisation as a safe, cost-effective and sustainable strategy to ensure sufficient intake of iodine, meaning that at least 90 per cent of households must consume adequately iodised salt. Immunization Two out of five children (40.1 per cent) between 1 and 2 years of age have received all recommended vaccinations – notably BCG, three doses of polio, measles, three doses of DPT (or Pentavalent), and three doses of hepatitis b (or Pentavalent). However, an immunization card could be presented for only half of sampled children. The immunization coverage for dPT and polio drops considerably between the first and the third doses: by 20 percentage points for dPT, and by 23 percentage points for polio. The lowest coverage was observed for the hepatitis B birth dose (it is not included in the full immunization indicator). In particular, only 18.2 per cent of ethnic minority children have received the hepatitis B birth dose, and only 18.5 per cent of children of mothers with no education have received it. Almost four of five mothers who gave birth within two years prior to the survey were adequately protected against neonatal tetanus (77.5 per cent). Yet among ethnic minority women, only three in five mothers had received this protection (59.2 per cent). Care of Illness Reported prevalence of diarrhoea among children under 5 during the two weeks preceding the survey stood at 7.4 per cent. Among these children, 46.5 per cent had received oral rehydration salt (ORS) solution, 42.8 per cent had reported home management of diarrhoea with recommended fluids, and 65.6 per cent had received either ORS or another recommended homemade fluid. Approximately 3.3 per cent of children under 5 years of age showed symptoms of pneumonia in the two weeks preceding the survey. Of these, 73 per cent were taken to an appropriate provider and 68.3 per cent were treated with antibiotics. Only one in twenty mothers and caregivers (5 per cent) are aware of the danger signs of pneumonia. The use of solid fuels as a main source of energy for domestic cooking stands at 46.4 per cent. Ethnic minority households are twice as likely as Kinh/Hoa households to use these health-damaging fuels for cooking purposes (89.5 versus 40.5 per cent). Malaria Prevention Viet Nam is considered a low malaria prevalence country. Almost all households in Viet Nam (95.5 per cent) have at least one mosquito net, yet almost none have long-lasting insecticide-treated nets (0.4 per cent). The percentage of children under age 5 and the percentage of pregnant women who slept under a mosquito net during the night prior to the survey was 94.4 and 94.1 per cent, respectively. Water and Sanitation According to the survey, 92 per cent of the population in Viet Nam use improved drinking water sources, though only 68.4 per cent of the ethnic minority population use such sources. Some 12.4 per cent of the population that do not use improved drinking water sources do not use any form of water treatment. Among those who use water treatment, boiling the water is the most common treatment method, used in 84 per cent of the population with unimproved drinking water sources. Some 89.5 per cent of the population using improved drinking water sources and 5.1 per cent of the population using unimproved drinking water sources have a water source directly on their premises. 22 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Overall, less than three in four Vietnamese use improved sanitation facilities (73.8 per cent), though among ethnic minorities only half use such facilities (44.2 per cent). Open defecation is not widespread in Viet Nam: only 6.4 per cent of the population practice it. However, this percentage increases to 27.7 per cent among ethnic minorities, meaning that one in every four Vietnamese living in ethnic minority households defecate in the open. In addition, the faeces of two in five children under the age of 2 are disposed of in an unsafe manner (39.9 per cent); among ethnic minorities this is common practice for four in five children (78.5 per cent). The survey results indicate that 86.6 per cent of Vietnamese households have a place for hand washing that includes water and soap. This percentage is higher in urban (93.4 per cent) than in rural areas (83.7 per cent), and higher among house hold with heads as Kinh/ Hoa households (88.7per cent) than ethnic minority households (67.1 per cent). Reproductive Health The Total Fertility Rate (TFR) in Viet Nam is 2, meaning that a Vietnamese woman, by the end of her reproductive years, will have given birth to an average of two children. Early childbearing is relatively rare, with 7.5 per cent of women aged 15-19 having begun childbearing. About three in four women aged 15-49 who are currently married or in a union use any form of contraception (77.8 per cent). Of these, 59.8 per cent use modern methods and 17.9 per cent use traditional methods. The use of contraceptives – modern or traditional – among young women aged 15–19 who are married or in union is low, at 21 per cent. The unmet need for contraception is low among women aged 15-49 (4.3 per cent), but increases to 15.6 per cent among young women aged 15-19. The survey results show that 93.7 per cent of women aged 15–49 who gave birth in the two years preceding the survey received antenatal care from skilled personnel at least once, and 59.6 per cent had the recommended four antenatal care visits. A total of 92.4 per cent of all deliveries took place in health facilities. Considerable disparities emerge by ethnicity: virtually all women in Kinh/Hoa households delivered in a health facility (98.3 per cent) compared to three in five women (61.7 per cent) from ethnic minority households. Early Childhood Development Almost three in four children aged 3-5 years receive early childhood education (71.9 per cent), and an even higher proportion (76.8 per cent) of children aged 3-5 years had adults engage with them in four or more activities that promote learning and school readiness during the three days prior to the survey. However, only one in five children under 5 have three or more children’s books at home (19.6 per cent). One in ten children under 5 were left under inadequate care sometime during the week preceding the survey (9.4 per cent), meaning that they were either left alone or in the care of another child under the age of 10. The child development index score is 82.8 in Viet Nam. The score is calculated based on the percentage of children aged 3-5 years who are developmentally on track in at least three of the following four domains: literacy/numeracy, physical, social/emotional and learning. 23VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Education Overall literacy among Vietnamese women aged 15–24 years is high, at 96.4 per cent. However, the literacy rate drops to 82.3 per cent among ethnic minority women, meaning that almost one in every five women living in an ethnic minority household is not identified as literate. Primary school attendance is high, and there is virtually no difference between boys and girls or between Kinh/Hoa and ethnic minority children. Secondary school attendance, meanwhile, reveals both gender and ethnic disparities: the attendance rate is 78.3 per cent for boys and 83.9 per cent for girls, and 66.3 per cent for ethnic minority boys and 65 per cent for ethnic minority girls. Overall, one in every three ethnic minority children do not receive secondary education, compared with one in every five Kinh/Hoa children (34.4 versus 16.3 per cent). Child Protection Birth registration in Viet Nam is almost universal, with 95 per cent of children under the age of 5 reported to have had their births registered. Yet only 66.1 per cent of birth certificates were seen by survey workers. The survey indicates that 9.5 per cent of children aged 5-14 years are engaged in child labour2 activities. The majority of child labourers also attend school (83.4 per cent). More than half of all children aged 2-14 years in Viet Nam have experienced some form of physical discipline (55 per cent). This contrasts with the relatively limited belief, held by 17.2 per cent of mothers and caregivers, that children need to be physically punished. Approximately 5.3 per cent of children aged 0-17 years are not living with either biological parent, and for 3.9 per cent of children one or both parents have died. Approximately one in three Vietnamese women (35.8 per cent) agree that it is acceptable for husbands to physically punish their wife for various reasons. large disparities emerge by living standards and ethnicity: women living in the poorest households are twice as likely as those in the richest households to accept wife beating (48.8 versus 20.1 per cent), and almost every second ethnic minority woman shows an accepting attitude, compared to one in three Kinh/Hoa women (47.2 versus 34.3 per cent). More than one in every ten women (12.3 per cent) aged 20–49 got married before the age of 18. HIV and AIDS Nearly all young women aged 15-24 have heard of HIV (96.5 per cent), yet only one in two women of the same age group (51.1 per cent) have a comprehensive knowledge of HIV, meaning they can correctly identify two ways of preventing HIV infection; know that a healthy looking person can have HIV; and reject the two most common misconceptions about HIV transmission. Almost all women aged 15-49 know that HIV can be transmitted from mother to child (92.4 per cent). More than three in five young women aged 15-24 know a place where they can be tested for HIV (60.7 per cent), and around one in three women have been tested (32.1 per cent). 2 Please refer to the Child Protection Chapter (Chapter XI.) for the definition of child labour used in this report. 24 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN The percentage of young women aged 15-24 who have been tested for HIV in the last 12 months is 16.2 per cent and the percentage of women who have been told the result is 7.9 per cent. About one third of women aged 15-49 who received antenatal care during their last pregnancy were tested for HIV (36.1 per cent). Important disparities emerge by area of residence: women living in urban areas are twice as likely to have been tested compared to women living in rural areas (56.4 versus 27.7 per cent). Sexual behaviour that increases risk of HIV transmission (such as sex with multiple partners, sex with non-regular partners, sex before marriage, and sex before age 15) is very limited among women in Viet Nam. 25VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN I. INTRODUCTION 26 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN background This report is based on the Viet Nam Multiple Indicator Cluster Survey, conducted from december 2010 to January 2011 by the General Statistics Office of Viet Nam in collaboration with the Ministry of Health (MOH) and the Ministry of labour, Invalids and Social Affairs (MOlISA). Financial and technical support was provided by the United Nations Children’s Fund (UNICEF) and financial support was provided by the United Nations Population Fund (UNFPA). The survey provides valuable information on the situation of children and women in Viet Nam, and was based, in large part, on the needs to monitor progress towards goals and targets emanating from international agreements: the Millennium Declaration, adopted by all 191 United Nations Member States in September 2000, and the Declaration and Plan of Action of A World Fit For Children, adopted by 189 Member States at the United Nations Special Session on Children in May 2002. These commitments build upon promises made by the international community at the 1990 World Summit for Children. In signing these international agreements, governments committed themselves to improving conditions for their children and to monitoring progress towards that end. UNICEF was assigned a supporting role in this task (see table below). A Commitment to Action: National and International Reporting Responsibilities The governments that signed the Millennium Declaration and the World Fit for Children Declaration and Plan of Action also committed themselves to monitoring progress towards the goals and objectives they contained: “We will monitor regularly at the national level and, where appropriate, at the regional level and assess progress towards the goals and targets of the present Plan of Action at the national, regional and global levels. Accordingly, we will strengthen our national statistical capacity to collect, analyse and disaggregate data, including by sex, age and other relevant factors that may lead to disparities, and support a wide range of child-focused research. We will enhance international cooperation to support statistical capacity-building efforts and build community capacity for monitoring, assessment and planning.” (A World Fit for Children, paragraph 60) “…We will conduct periodic reviews at the national and subnational levels of progress in order to address obstacles more effectively and accelerate actions.…” (A World Fit for Children, paragraph 61) The Plan of Action (paragraph 61) also calls for the specific involvement of UNICEF in the preparation of periodic progress reports: “… As the world’s lead agency for children, the United Nations Children’s Fund is requested to continue to prepare and disseminate, in close collaboration with Governments, relevant funds, programmes and the specialized agencies of the United Nations system, and all other relevant actors, as appropriate, information on the progress made in the implementation of the declaration and the Plan of Action.” Similarly, the Millennium Declaration (paragraph 31) calls for periodic reporting on progress: “…We request the General Assembly to review on a regular basis the progress made in implementing the provisions of this Declaration, and ask the Secretary-General to issue periodic reports for consideration by the General Assembly and as a basis for further action.” 27VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN MICS 2011 updates the Viet Nam MICS 2006 data and comes at an important time for evaluating the National Programme of Action for Children 2001–2010 and for preparing and monitoring the next Programme for 2011–2020. Based on an actual sample of 11,614 households, the survey provides a comprehensive picture of children and women in Viet Nam across the six regions, and from an equity approach. It indicates disparities by sex, area, ethnicity, education, living standards and other characteristics. The results of the Viet Nam MICS 2011 are presented in this final report. MICS 2011 Objectives The primary objectives of the Viet Nam Multiple Indicator Cluster Survey 2011 are: ● To provide up-to-date information for assessing the situation of children and women in Viet Nam; ● To furnish data needed for monitoring progress towards goals established in the Viet Nam National Programme of Action (NPA) for Children for the period 2001–2010, the Millennium declaration (Md), the Convention on the Rights of the Child (CRC), and other national and international commitments as well as to provide information for developing the National Programme of Action for Children for the period 2011–2020; ● To generate data for the identification of vulnerable groups, inequities and disparities, as a basis for informing policies and interventions; ● To contribute to the improvement of data and monitoring systems in Viet Nam and to strengthen technical expertise in survey design, implementation and analysis. 28 29VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN II. SAMPlE ANd SURVEY METHODOlOGy 30 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Sample Design The sample for the Viet Nam Multiple Indicator Cluster Survey (MICS) was designed to provide estimates for a large number of indicators on the situation of children and women at the national level, for urban and rural areas, and for Viet Nam’s six regions: Red River Delta, Northern Midland and Mountain areas, North Central area and Central Coastal area, Central Highlands, South East and Mekong River delta. The urban and rural areas within each region were identified as the main sampling strata and the sample was selected in two stages. Within each stratum, a specified number of census enumeration areas were selected with probability proportional to size. After the updating of household lists was carried out within the selected enumeration areas, a systematic sample of 20 households was drawn in each sample enumeration area. Two of the selected enumeration areas were not included in the survey as they no longer existed at the time of the survey fieldwork. The sample was stratified by region, urban and rural areas, and is not self-weighting. For reporting national level results, sample weights are used. A more detailed description of the sample design can be found in Appendix A. Questionnaires Three sets of questionnaires were used in the survey: 1) a household questionnaire which was used to collect information on all de jure household members (usual residents), the household, and the dwelling; 2) a woman questionnaire administered in each household to all women aged 15–49 years; and 3) a children questionnaire, administered to mothers or caregivers of all children under 5 years of age living in the household. The questionnaires included the following contents: The household questionnaire, administered to a knowledgeable adult living in the household, included the following modules: ● Household listing Form ● Education ● Water and Sanitation ● Household Characteristics ● Insecticide Treated bednets ● Indoor Residual Spraying ● Child labour ● Child Discipline ● Handwashing ● Salt Iodisation The questionnaire for women was administered to all women aged 15–49 years living in the households, and included the following modules: ● Woman’s background ● Child Mortality ● Desire for last birth 31VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN ● Maternal and Newborn Health ● Illness Symptoms ● Contraception ● Unmet Need ● Attitudes Towards Domestic Violence ● Marriage/Union ● Sexual behaviour ● HIV/AIDS The questionnaire for children under 5 years of age was administered to mothers or caregivers of all children under 5 years of age3 living in the households. Normally, the questionnaire was administered to mothers of these children. In cases when the mother was not listed in the household roster, a primary caregiver for the child was identified and interviewed. The questionnaire included the following modules: ● Age ● birth Registration ● Early Childhood Development ● breastfeeding ● Care of Illness ● Malaria ● Immunization ● Anthropometry The questionnaires are based on the global MICS 4 model questionnaire.4 From the English version of the MICS 4 model, the questionnaires were translated into Vietnamese and were pre-tested in Hoa binh province (in the Northern Midland and Mountain areas) and binh Dinh province (in the North Central area and Central Coastal area) from 26 September to 6 October 2010. Based on the results of the pre-test, modifications were made to the wording and translation of the questionnaires. The questionnaires were revised and printed after the first training for the southern provinces in Can Tho city. A copy of the Viet Nam MICS 2011 questionnaires is provided in Appendix F. In addition to the administration of questionnaires, the fieldwork teams tested the iodine content of salt used for cooking in the households, observed the place for hand washing and measured the weights and heights of children under 5 years of age. details and findings of these measurements are provided in the respective sections of the report. 3 The terms “children under age 5”, “children aged 0–4 years”, and “children aged 0–59 months” are used interchangeably in this report. 4 The model MICS 4 questionnaires can be found at www.childinfo.org 32 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Training and Fieldwork GSO conducted two training courses for interviewers, measurers, field data editors, team leaders and supervisors. About 250 field workers participated. One training was conducted in Can Tho city for the participants from the Southern provinces, and another in Ha Noi for those from the Northern provinces. Each training course lasted 14 days: the Can Tho training was conducted from 25 October to 7 November 2010 and the Ha Noi training from 8 November to 21 November 2010. The training included sessions on interviewing techniques and the contents of the questionnaires, and mock interviews between trainees to gain practice in asking questions. Towards the end of the training period, trainees spent two days in practice, interviewing, taking anthropometric measurements, editing and supervising. Before the field practice (pilot-test) the trainees spent one day practicing anthropometric measurements in a kindergarten. Some 180 persons were selected for the fieldwork. They were grouped into 30 survey teams, each comprised of three interviewers, one measurer, one field data editor and one team leader acting as a supervisor. Fieldwork began on 29 November 2010 and was concluded on 26 January 2011. Fieldwork monitoring was conducted at three levels to ensure quality and allow timely corrective action as necessary, notably: supervision by GSO, UNICEF and UNFPA, technical supervision from the National Steering Committee, and supervision by the team leaders. Supervisors are experts with technical knowledge who are able to take corrective action and resolve emerging issues that arise during the fieldwork. Data Processing data were entered using CSPro software on eight small computers. Ten operators working in shifts performed data entry under supervision of two data entry supervisors. In order to ensure quality control, all questionnaires were double entered and internal consistency checks were performed. Procedures and standard programs developed under the global MICS 4 programme and adapted to the Viet Nam questionnaire were used throughout. data processing began on 27 december 2010 and was completed on 21 March 2011. data were analysed using the Statistical Package for Social Sciences (SPSS) software program, Version 19. The model syntax and tabulation plans developed by UNICEF were used for this purpose. 33VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN III. SAMPlE COVERAGE ANd THE CHARACTERISTICS OF HOUSEHOlDS AND RESPONDENTS 34 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Sample Coverage Of the 12,000 households selected for the sample, 11,642 were present at the time of the survey. Of these, 11,614 successfully completed the interview, resulting in a household response rate of 99.8 per cent. In the interviewed households, 12,115 women (aged 15–49 years) were identified. Of these, 11,663 completed the interview, yielding a response rate of 96.3 per cent compared to eligible respondents in interviewed households. In addition, 3,729 children under 5 years were listed in the household questionnaire. Questionnaires were completed for 3,678 of these children, which corresponds to a response rate of 98.6 per cent within interviewed households. The overall response rates (household response rate times the woman and child response rates within households) were 96 and 98.4 per cent for the survey of women and of children under 5 years of age, respectively (Table HH.1). Table HH.1: Interview results for households, women and children under 5 years of age Interview outcomes and response rates for households, women, and children under 5 years of age by area and region, Viet Nam, 2011 Area Region Urban Rural Red River Delta Northern Midlands and Mountain areas North Central area and Central Coastal area Central Highlands South East Mekong River Delta Total Households Sampled 5200 6800 2000 2000 2000 2000 2000 2000 12000 Present 5016 6626 1912 1961 1947 1960 1930 1932 11642 Interviewed 5001 6613 1907 1955 1943 1956 1928 1925 11614 Response rate 99.7 99.8 99.7 99.7 99.8 99.8 99.9 99.6 99.8 Women Eligible 5364 6751 1739 2053 1942 2176 2168 2037 12115 Interviewed 5183 6480 1682 1970 1868 2078 2116 1949 11663 Response rate 96.6 96 96.7 96 96.2 95.5 97.6 95.7 96.3 Overall response rate 96.3 95.8 96.5 95.7 96 95.3 97.5 95.3 96 Children under five Eligible 1438 2291 555 722 552 734 585 581 3729 Mothers/caregivers interviewed 1409 2269 543 712 548 727 581 567 3678 Response rate 98 99 97.8 98.6 99.3 99 99.3 97.6 98.6 Overall response rate 97.7 98.8 97.6 98.3 99.1 98.8 99.2 97.2 98.4 Table HH.1 shows that there were no large differences in response rates across regions and urban/rural areas. This is the result of the collective effort of all survey teams, who overcame difficulties in the field and used every opportunity to visit household members at all times, whether day or night. Household Characteristics The weighted age and sex distribution of the survey sample is provided in Table HH.2. The distribution is also used to produce the population pyramid in Figure HH.1. The 11,614 households that completed interviews in the survey yielded a list of 43,998 household members. Of these, 21,559 were male (49 per cent) and 22,439 were female (51 per cent). According to the 2009 Viet Nam Population and Housing Census the sex distribution of the overall population was 49.5 per cent male and 50.5 per cent female. 35VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Table HH.2: Sample age distribution by sex Frequency and percentage of the population by sex and five-year age group, dependent age groups, and by child (aged 0–17 years) and adult populations (aged 18 or older), Viet Nam, 2011 Males Females Total Number Percentage Number Percentage Number Percentage Age (years) 0-4 1867 8.7 1802 8 3668 8.3 5-9 1928 8.9 1778 7.9 3706 8.4 10-14 1984 9.2 1821 8.1 3805 8.6 15-19 1881 8.7 1776 7.9 3657 8.3 20-24 1582 7.3 1663 7.4 3245 7.4 25-29 1746 8.1 1814 8.1 3560 8.1 30-34 1648 7.6 1786 8 3435 7.8 35-39 1753 8.1 1646 7.3 3398 7.7 40-44 1545 7.2 1603 7.1 3148 7.2 45-49 1518 7 1447 6.4 2965 6.7 50-54 1244 5.8 1522 6.8 2767 6.3 55-59 877 4.1 1030 4.6 1907 4.3 60-64 663 3.1 794 3.5 1457 3.3 65-69 406 1.9 488 2.2 893 2 70-74 376 1.7 530 2.4 906 2.1 75-79 222 1 362 1.6 584 1.3 80-84 184 0.9 317 1.4 501 1.1 85+ 136 0.6 259 1.2 395 0.9 Dependency age groups 0-14 5778 26.8 5401 24.1 11180 25.4 15-64 14457 67.1 15081 67.2 29539 67.1 65+ 1324 6.1 1956 8.7 3280 7.5 Child and adult population Children aged 0-17 years 7002 32.5 6593 29.4 13594 30.9 Adults aged 18+ years 14558 67.5 15846 70.6 30404 69.1 Total 21559 100 22439 100 43998 100 Table HH.2 shows the age-sex structure of the household population. The proportions in child, working and old-age age groups (0–14, 15–64 and 65 years and over) in the household population of the sample are 25.4, 67.1 and 7.5 per cent, respectively. The corresponding proportions in the Census are 25.0, 68.4 and 6.6 per cent, respectively.5 Census data indicate that the proportion of the male population in the five-year age groups from 0–4 to 15–19 years is higher than of the female population, but a reverse pattern is observed in the age group 50–54 years and above, where the share of the male population is lower. MICS 2011 data indicate a similar age-sex pattern, with males accounting for a higher proportion of the population in the younger age groups (0–17 years) and a smaller share among adults (18 years old and above). The proportion of women in the 50-54 year age group is slightly higher than expected. This might be explained by some interviewers’ tendency of transferring women from one age group (reproductive age) to the next age group (non-reproductive), in order to make women ineligible for the interview. This possibility is confirmed by the data quality 5 Central Population and Housing Census Steering Committee, The 2009 Viet Nam Population and Housing Census, Major Findings, Hanoi, June 2010. 36 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Table 1 (see Appendix D), which more precisely indicates the transfer of women from age 49-50. A similar drop is observed in age group 20–24, both for men and for women. Figure HH.1: Age and sex distribution of household population, Viet Nam, 2011 Tables HH.3 to HH.5 provide basic information on households, female respondents aged 15–49, and children under 5 years of age by presenting the unweighted, as well as the weighted results. Information on the basic characteristics of households, women and children under 5 years of age interviewed in the survey is essential for the interpretation of findings presented later in the report and also provides an indication of the representativeness of the survey. Besides these three tables, all other tables in this report are presented only with weighted numbers. See Appendix A for more details about weighting. Table HH.3 provides basic background information on interviewed households, including sex of the household head, region, urban/rural area of residence, number of household members, educational attainment and ethnicity6 of the household head. In MICS 2011, the Chinese (Hoa) ethnic minority is grouped together with the Kinh majority under the label Kinh/Hoa, because Kinh and Hoa have similar living standards. All other ethnicities are grouped together under the label Ethnic Minorities. These background characteristics are used in subsequent tables in this report. The figures in the table also include the numbers of observations by major categories of analysis in the report. 6 This was determined by asking the question: “To what ethnic group does the head of this household belong?” Households were divided into two groups: 1) Kinh/Hoa (including the Kinh [Vietnamese] majority and the Hoa [ethnic Chinese] minority); and 2) Ethnic Minorities (including all ethnicities other than Kinh and Hoa). Please refer to the questionnaire in Appendix F for detailed questions. 37VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Table HH.3: Household characteristics Percentage and frequency distribution of households by selected characteristics, Viet Nam, 2011 Weighted percentage Number of households Weighted Unweighted Sex of household head Male 73.8 8569 8421 Female 26.2 3045 3193 Region Red River Delta 22.4 2601 1907 Northern Midland and Mountain areas 15.8 1836 1955 North Central area and Central Coastal area 21.7 2522 1943 Central Highlands 5.2 604 1956 South East 16.1 1873 1928 Mekong River Delta 18.8 2178 1925 Area Urban 29.7 3454 5001 Rural 70.3 8160 6613 Number of household members 1 6.3 733 680 2 15.9 1850 1732 3 20.7 2407 2436 4 29.2 3396 3381 5 15 1739 1793 6 7.4 864 882 7 3.2 368 397 8 1.2 138 161 9 0.5 59 74 10+ 0.5 60 78 Education of household head None 5.9 691 775 Primary 25.1 2919 2839 lower Secondary 39.3 4568 4322 Upper Secondary 16.4 1904 1980 Tertiary 12.9 1504 1670 Missing/DK (0.3) 30 28 Ethnicity of household head Kinh/Hoa 89.9 10436 10068 Ethnic Minorities 10.1 1178 1546 Households with at least One child aged 0-4 years 27.1 11614 11614 One child aged 0-17 years 67.1 11614 11614 One woman aged 15-49 years 77.1 11614 11614 Mean household size 3.8 11614 11614 Note: Figures shown in parenthesis are based on denominators of 25-49 un-weighted cases The weighted and unweighted numbers for total households are equal, since sample weights were normalized (See Appendix A). The table also shows the proportions of households with at least one child under the age of 18, at least one child under the age of 5, and at least one eligible woman aged 15–49 years. The weighted average household size estimated by the survey is also presented. 38 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN According to Table HH.3, most households are headed by a male (73.8 per cent), more than 70 per cent of the population is living in rural areas, and about 10.1 per cent of the population belongs to ethnic groups other than Kinh (Vietnamese) and ethnic Chinese (Hoa). The weighted number of households in some regions such as the Central Highlands is considerably lower than the unweighted number due to over-sampling in this region. Some 6.3 per cent of the household population is living in single households and about 80.8 per cent were living in households containing 2–5 persons. The average household size is 3.8 members, which corresponds to the results of the 2009 Population Census. Figure HH.2 shows that for every 100 households interviewed, there are 27 households with at least one child aged 0–4 years, 67 households with at least one child aged 0–17 years and 77 households with at least one woman aged 15–49 years. Figure HH.2 Household composition, Viet Nam, 2011 Characteristics of Female Respondents 15–49 Years of Age and Children Under 5 years of Age Information on the background characteristics of female respondents 15–49 years of age and of children under 5 years of age is provided in Tables HH.4 and HH.5. In both tables, the totals of weighted and unweighted observations are equal, since sample weights have been normalized (See Appendix A). In addition to providing useful information on the background characteristics of women and children, the tables also show the number of observations in each background category. These categories are used in the subsequent tabulations of the report. 39VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Table HH.4: Women's background characteristics Percentage and frequency distribution of women aged 15–49 years by selected background characteristics, Viet Nam, 2011 Weighted percent Number of women Weighted Unweighted Region Red River Delta 20.3 2368 1682 Northern Midland and Mountain areas 16.3 1896 1970 North Central area and Central Coastal area 20.8 2429 1868 Central Highlands 5.8 671 2078 South East 17.8 2080 2116 Mekong River Delta 19 2220 1949 Area Urban 31.5 3676 5183 Rural 68.5 7987 6480 Age (years) 15-19 14.6 1707 1769 20-24 13.8 1608 1629 25-29 15.5 1806 1789 30-34 15.6 1817 1741 35-39 14.2 1657 1638 40-44 13.9 1621 1654 45-49 12.4 1448 1443 Marital/Union status Currently married/in union 71.5 8341 8194 Widowed 1.9 223 231 Divorced 1.3 148 174 Separated 0.9 101 105 Never married/in union 24.4 2849 2959 Motherhood status Ever gave birth 71.2 8304 8179 Never gave birth 28.8 3359 3484 Births in last two years Had a birth in last two years 11.9 1383 1363 Had no birth in last two years 88.1 10280 10300 Education None 4.1 479 612 Primary 16.3 1900 1883 lower Secondary 38.7 4517 4244 Upper Secondary 24.3 2836 2830 Tertiary 16.6 1931 2094 Wealth index quintile Poorest 17.7 2062 2152 Second 18.9 2200 1924 Middle 20.8 2429 2222 Fourth 21.3 2479 2529 Richest 21.4 2493 2836 Ethnicity of household head Kinh/Hoa 87.9 10247 9836 Ethnic Minorities 12.1 1416 1827 Total 100 11663 11663 Table HH.4 provides the background characteristics of the female respondents aged 15– 49 years. More specifically, the table includes information on the distribution of women 40 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN according to region, area of residence, age, marital status, motherhood status, births given in last two years, highest educational attendance7, wealth index quintiles8, and ethnicity of household head. The regions with the largest share of women in the sample were the Red River delta (20.3 per cent) and the North Central area and Central Coast area (20.8 per cent). The Central Highlands accounted for only 5.8 per cent of all females in survey the population. In the sample, 68.5 per cent of women live in rural areas and 87.9 per cent of women live in Kinh/Hoa headed households. At the time of the interviews, 71.5 per cent of women were married or in union, 4 per cent were divorced, widowed or separated, and 24.4 per cent had never previously been married or lived in a union. Out of every five women interviewed, four had attained secondary education level or higher and only one had primary school education (16.3 per cent) or had never been to school (4.1 per cent). The background characteristics of children under 5 years of age covered in the survey are presented in Table HH.5. This table covers the distribution of children across several attributes, notably sex, region and area of residence, age, mother’s or caregiver’s highest education level, wealth index quintiles, and ethnicity. Table HH.5 shows that the proportion of boys exceeded the proportion of girls by 1.6 per cent. This is consistent with the Census 2009 results and other surveys implemented by GSO, and reflects the increasing trend towards an unbalanced sex ratio at birth in Viet Nam. The Northern Midland and Mountain areas comprise only 15.8 per cent of the population, but up to 19.2 per cent of the children under 5 years of age. The same pattern is observed for the Central Highlands, accounting for 5.2 per cent of the population but 6.3 per cent of all children under 5 years of age. Most of the children under 5 years in the survey had mothers or caregivers with secondary or higher education (76.5 per cent), with just 17.9 per cent having mothers or caregivers with primary education, and 5.6 per cent with no education. Some 14.5 per cent of children under 5 years of age live in ethnic minority households, exceeding both the proportion of women aged 15–49 living in ethnic minority households (12.1 per cent) and the proportion of households with an ethnic minority head (10.1 per cent). 7 Throughout this report, unless otherwise stated, “education” refers to the highest educational level attended by the respondent when it is used as a background variable. 8 Principal components analysis was performed by using information on the ownership of consumer goods, dwelling characteristics, water and sanitation, and other characteristics that are related to the household’s wealth to assign weights (factor scores) to each of the household assets. Each household was then assigned a wealth score based on these weights and the assets owned by that household. The survey household population was then ranked according to the wealth score of the household, and was finally divided into 5 equal parts (quintiles) from lowest (poorest) to highest (richest). The assets and other characteristics related to wealth used in these calculations were as follows: water sources, toilet facility, housing, fuel types for cooking, electricity, bank account, durable goods (such as radio, TV, refrigerator, fixed telephone, watch, mobile phone, bicycle, motorcycle, boat with motor, car), animals (such as buffalo, cattle, horse, donkey, goat, sheep, chicken, pig). The wealth index is assumed to capture the underlying long-term wealth through information on the household assets, and is intended to produce a ranking of households by wealth, from poorest to richest. The wealth index does not provide information on absolute poverty, current income or expenditure levels. The wealth scores calculated are applicable for only the particular data set they are based on. Further information on the construction of the wealth index can be found in Rutstein and Johnson, 2004, Filmer and Pritchett, 2001, and Gwatkinet. al., 2000. 41VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Table HH.5: Background characteristics of children under 5 years of age Percentage and frequency distribution of children under 5 years of age by selected characteristics, Viet Nam, 2011 Weighted percentage Number of children under 5 years Weighted Unweighted Sex Male 50.8 1869 1871 Female 49.2 1809 1807 Region Red River Delta 21.7 798 543 Northern Midland and Mountain areas 19.2 707 712 North Central area and Central Coastal area 19.5 719 548 Central Highlands 6.3 233 727 South East 15.5 572 581 Mekong River Delta 17.7 650 567 Area Urban 27.5 1013 1409 Rural 72.5 2665 2269 Age (months) 0-5 8.9 327 319 6-11 9.3 341 350 12-23 20.6 759 760 24-35 21.5 792 786 36-47 20.8 764 770 48-59 18.9 695 693 Mother’s education None 5.6 207 291 Primary 17.9 658 672 lower Secondary 40.2 1479 1380 Upper Secondary 18.2 670 661 Tertiary 18.1 664 674 Wealth index quintile Poorest 22.6 831 922 Second 18.3 673 595 Middle 19 700 649 Fourth 20.4 749 737 Richest 19.7 725 775 Ethnicity of household head Kinh/Hoa 85.5 3143 2964 Ethnic Minorities 14.5 535 714 Total 100 3678 3678 42 43VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN IV. CHIld MORTAlITY 44 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN One of the overarching goals of the Millennium Development Goals (MDGs) is the reduction of infant and under-five mortality. Specifically, MdG 4 calls for the reduction in 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 minimise the pitfalls of memory lapses, inexact or misinterpreted definitions, and poor interviewing techniques. The Infant Mortality Rate (IMR) is the probability of dying before the first birthday. The Under-five Mortality Rate (U5MR) is the probability of dying before the fifth birthday. In the Viet Nam MICS 2011 survey, infant and under five mortality rates are calculated based on an indirect estimation technique known as the brass method9. The data used in the estimation are: the mean number of children ever born for the five-year age groups of women aged 15-49 years, and the proportion of these children who are dead also for the five-year age groups of women (Table CM.1). The technique converts the proportions dead among children of women in each age group into probabilities of dying by taking into account the approximate length of exposure of children to the risk of dying, assuming a particular model age pattern of mortality. Based on previous information on mortality in Viet Nam, the North model life table was selected as most appropriate10. The North model has been used in this and in all the previous Viet Nam MICS rounds, based on a comparison of the population structure with the model life tables. Table CM.1: Children ever born, children surviving and proportion dead Mean and total numbers of children ever born, children surviving and proportion dead by mother’s age, Viet Nam, 2011 Children ever born Children surviving Proportion dead Number of women Mean Total Mean Total Mother’s age 15-19 0.048 82 0.047 81 0.018 1707 20-24 0.511 823 0.504 810 0.015 1608 25-29 1.229 2220 1.208 2182 0.017 1806 30-34 1.833 3330 1.805 3280 0.015 1817 35-39 2.195 3636 2.118 3509 0.035 1657 40-44 2.44 3954 2.329 3774 0.046 1621 45-49 2.783 4029 2.619 3792 0.059 1448 Total 1.55 18075 1.494 17427 0.036 11663 Table CM.2 provides the estimates of child mortality. The IMR is estimated at 14 per thousand live births, while the probability of dying under age 5 (U5MR) is around 16 per thousand live births. These estimates have been calculated by averaging mortality estimates obtained from women aged 25–29 and 30–34, and refer to mid-2009. Child mortality does not indicate large differences by gender. Regional estimates cannot be shown due to the low number of observations of deceased children. 9 United Nations (1983). Indirect Techniques for demographic Estimation. Population Studies No. 81; United Nations (1990) Step-by-step guide to the estimation of Child Mortality; United Nations (1990) United Nations programme for child mortality estimation: a microcomputer programme to accompany the step-by-step guide to the estimation of child mortality. Population Studies No. 107. 10 Ministry of Planning and Investment and General Statistics Office, Population projection for Viet Nam 2009-2049, February 2011. 45VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN The largest differentials in mortality exist in relation to the mother’s education level, household living standards (based on a wealth index), and ethnicity of the household head. As expected, the higher the mother’s education level, the lower the child mortality. It is interesting to observe that the U5MR for the mothers with no education was 29 per thousand live births, which declined to 21 per thousand live births for mothers with primary school, and further decreased to 14 per thousand live births for mothers with secondary or higher education levels. Similar differences by mother’s education level are observed for IMR. The U5MR of the 20 per cent poorest households was 28 per thousand live births, more than twice the U5MR of the rest of the population. Child mortality in ethnic minority households was quite high (39 per thousand live births for U5MR and 30 per thousand live births for IMR). This is equivalent to the mortality rates of the country ten years ago and more than three times higher than the mortality rate of children in Kinh/Hoa households (12 per thousand live births for U5MR and 10 per thousand live births for IMR). differentials in under-five mortality rates by selected background characteristics are shown in Figure CM.1. Table CM.2: Child mortality Infant and Under-five Mortality rates (per thousand live births), North Model, Viet Nam, 2011 Infant mortality rate1 Under-five mortality rate2 Sex Male 14 17 Female 14 16 Area Urban 13 15 Rural 14 17 Mother's education None 23 29 Primary 17 21 Secondary and higher 12 14 Wealth index quintile 20% Poorest 23 28 80% Better off 11 12 Ethnicity of household head Kinh/Hoa 10 12 Ethnic Minorities 30 39 Total 14 16 1 MICS indicator 1.2; MDG indicator 4.2 2 MICS indicator 1.1; MDG indicator 4.1 46 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Per thousand live births Figure CM1. Under five mortality rate by background characteristics, Viet Nam, 2011 Figure CM.2 shows various series of U5MR estimates from different surveys, based on responses of women in different age groups, and referring to various points in time, thus showing the estimated trend in U5MR. The MICS estimates indicate a decline in mortality over the last 10 years. The most recent U5MR estimate from the Population Census 200911 is 24.4 per thousand live births, which is higher than the 16 per thousand live births estimate from MICS 2011 for the year 2009. While the trend indicated by the MICS 2011 results are in broad agreement with the results of MICS 2006, the Population Change Survey 2010, and the Population Census 2009, Figure CM.2 does show that the MICS 2011 estimates of mortality levels are higher than the MICS 2006 estimates, and lower than the estimates from the Population Change Survey and Census. It should be mentioned here that the Census and the Population Change Survey had larger sample sizes than the MICS 2011 survey12. Further explanation of these apparent declines and differences, as well as analysis of determinants, should be taken up in more detail in a separate analysis. 11 The Population Census contains a sub-sample survey with a sampling rate of 15 per cent of all Enumeration Areas (EAs) selected from the total EAs of the Census 2009. Two questionnaires were used for simultaneous interviews in the Census, one was the short form covering all households in Viet Nam and the other (long form) covering 15 per cent of selected EAs. 12 The Population Change Survey is conducted annually. The sample rate for this survey is 1.5 per cent of all households in the country. The sample contained about 400,000 households in the 2010 round of the Population Change Survey, which is 33 times greater than the survey. 47VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Figure CM.2: Trend in under five mortality rates, Viet Nam, 2011 48 49VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN V. NUTRITION 50 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Nutritional Status Children’s nutritional status is a reflection of their overall health. When children have access to an adequate food supply, are not exposed to repeated illness, and are well cared for, they reach their growth potential and are considered well nourished. Malnutrition is associated with more than half of all child deaths worldwide. Undernourished children are more likely to die from common childhood ailments, and for those who survive, to have recurring sicknesses and faltering growth. Three-quarters of the children who die from causes related to malnutrition were only mildly or moderately malnourished – showing no outward sign of their vulnerability. The Millennium development Goal is to reduce by half the proportion of people who suffer from hunger between 1990 and 2015. A reduction in the prevalence of malnutrition will also assist in the goal to reduce child mortality. There is a reference distribution of height and weight for children under age 5 based on a well-nourished population. Undernourishment in a population can be gauged by comparing children to this reference population. The reference population used in this report is based on new WHO growth standards.13 Each of the three nutritional status indicators can be expressed in standard deviation units (z-scores) from the median of the reference population. Weight-for-age is a measure of both acute and chronic malnutrition. Children whose weight-for-age is more than two standard deviations below the median of the reference population are considered moderately or severely underweight while those whose weight- for-age is more than three standard deviations below the median are classified as severely underweight. Height-for-age is a measure of linear growth. Children whose height-for-age is more than two standard deviations below the median of the reference population are considered short for their age and are classified as moderately or severely stunted. Those whose height-for- age is more than three standard deviations below the median are classified as severely stunted. Stunting is a reflection of chronic malnutrition as a result of failure to receive adequate nutrition over a long period and recurrent or chronic illness. Finally, children whose weight-for-height is more than two standard deviations below the median of the reference population are classified as moderately or severely wasted, while those who fall more than three standard deviations below the median are classified as severely wasted. Wasting is usually the result of a recent nutritional deficiency. The indicator may exhibit significant seasonal shifts associated with changes in the availability of food or disease prevalence. In the MICS 2011, weights and heights of all children under 5 years of age were measured using anthropometric equipment recommended by UNICEF (www.childinfo.org). Findings in this section are based on the results of these measurements. Table NU.1 shows percentages of children classified into each of these categories, based on the anthropometric measurements that were taken during fieldwork. Additionally, the table includes the percentage of children who are overweight, which takes into account those children whose weight for height is above 2 standard deviations from the median of the reference population, and mean z-scores for all three anthropometric indicators. 13 WHO, 2007. WHO Child Growth Standards – Methods and development, Geneva: WHO accessed at http://www.who. int/childgrowth/standards/second_set/technical_report_2.pdf 51VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Ta bl e N U .1 : N ut rit io na l s ta tu s of c hi ld re n1 4 P er ce nt ag e of c hi ld re n un de r a ge 5 b y nu tri tio na l s ta tu s ac co rd in g to th re e an th ro po m et ric in di ce s: w ei gh t-f or -a ge , h ei gh t-f or -a ge , a nd w ei gh t-f or -h ei gh t, V ie t N am , 2 01 1 W ei gh t-f or -a ge N um be r of ch ild re n un de r ag e 5 H ei gh t-f or -a ge N um be r of c hi ld re n un de r ag e 5 W ei gh t-f or -h ei gh t N um be r o f ch ild re n un de r ag e 5 U nd er w ei gh t M ea n Z- S co re (S D ) St un te d M ea n Z- S co re (S D ) W as te d O ve rw ei gh t M ea n Z- S co re (S D ) P er ce nt ag e be lo w P er ce nt ag e be lo w P er ce nt ag e be lo w P er ce nt ag e ab ov e - 2 S D 1 - 3 S D 2 - 2 S D 3 - 3 S D 4 - 2 S D 5 - 3 S D 6 + 2 S d Se x M al e 12 .1 1. 8 -0 .7 18 37 23 .7 6. 7 -1 .1 18 21 4. 3 1. 2 5. 5 -0 .1 18 21 Fe m al e 11 .4 1. 9 -0 .7 17 69 21 .6 5. 3 -1 17 51 3. 9 1. 2 3. 4 -0 .1 17 47 R eg io n R ed R iv er D el ta 7. 4 1. 7 -0 .6 76 6 18 .3 3. 3 -1 .0 75 8 3. 6 1. 4 2. 5 -0 .1 75 5 N or th er n M id la nd a nd M ou nt ai n ar ea s 15 .4 1. 8 -0 .9 69 2 31 .4 9. 3 -1 .4 68 0 4. 3 0. 9 3. 4 -0 .2 68 3 N or th C en tra l a re a an d C en tra l C oa st al a re a 14 .3 1. 8 -0 .8 71 2 28 .4 8. 3 -1 .2 70 9 4. 3 1. 5 4. 3 -0 .1 71 0 C en tra l H ig hl an ds 17 .6 2. 5 -0 .9 22 9 30 .6 9. 9 -1 .4 22 7 4. 1 1. 2 4. 2 -0 .2 22 7 S ou th E as t 4. 5 1. 1 -0 .1 56 3 9. 7 2. 2 -0 .5 55 8 3. 7 1. 3 10 .6 0. 2 55 5 M ek on g R iv er D el ta 14 .3 2. 3 -0 .8 64 5 20 .7 5. 0 -1 .1 64 1 4. 8 0. 9 2. 9 -0 .3 63 9 A re a U rb an 6. 0 0. 7 -0 .2 99 0 11 .8 2. 7 -0 .6 98 3 3. 9 1 8 0. 2 97 8 R ur al 13 .9 2. 3 -0 .9 26 17 26 .8 7. 3 -1 .3 25 89 4. 2 1. 3 3. 1 -0 .2 25 90 A ge (m on th s) 0- 5 6. 7 1. 3 -0 .4 31 6 9. 9 2. 9 -0 .2 30 6 9. 2 2. 6 4. 4 -0 .2 30 4 6- 11 6. 5 0. 8 -0 .4 33 4 6. 9 1. 7 -0 .4 32 7 4. 3 1. 5 2. 3 -0 .2 33 1 12 -2 3 9. 2 1. 2 -0 .5 74 7 22 .5 5. 9 -1 .1 74 2 3. 8 0. 9 6. 3 0 73 9 24 -3 5 12 .3 1. 5 -0 .7 78 1 28 .5 7. 2 -1 .3 77 4 2. 2 0. 6 4. 7 0 77 3 36 -4 7 15 .5 2. 5 -0 .9 75 2 26 .8 7. 6 -1 .3 74 9 3. 5 1 3. 4 -0 .1 74 7 48 -5 9 14 .6 3 -0 .9 67 7 25 6. 4 -1 .3 67 5 5 1. 7 4. 3 -0 .2 67 5 M ot he r’s e du ca tio n N on e 22 .4 5. 5 -1 .3 20 2 40 .8 20 .4 -1 .7 19 6 7. 7 1. 9 0. 7 -0 .4 20 0 P rim ar y 13 .9 2. 2 -0 .9 65 0 28 .7 8 -1 .3 64 4 5. 7 0. 9 2. 7 -0 .3 64 1 lo w er S ec on da ry 12 .7 2 -0 .8 14 62 24 .9 5. 9 -1 .2 14 53 4 1. 4 3. 7 -0 .2 14 51 U pp er S ec on da ry 10 .3 1. 4 -0 .5 64 9 19 .5 4. 2 -0 .9 64 6 3. 7 1. 8 6. 8 0 64 2 Te rti ar y 5. 5 0. 3 -0 .1 64 4 9. 1 1. 5 -0 .5 63 3 2. 1 0. 2 6. 7 0. 3 63 4 W ea lth in de x qu in til e 52 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Ta bl e N U .1 : N ut rit io na l s ta tu s of c hi ld re n1 4 P er ce nt ag e of c hi ld re n un de r a ge 5 b y nu tri tio na l s ta tu s ac co rd in g to th re e an th ro po m et ric in di ce s: w ei gh t-f or -a ge , h ei gh t-f or -a ge , a nd w ei gh t-f or -h ei gh t, V ie t N am , 2 01 1 W ei gh t-f or -a ge N um be r of ch ild re n un de r ag e 5 H ei gh t-f or -a ge N um be r of c hi ld re n un de r ag e 5 W ei gh t-f or -h ei gh t N um be r o f ch ild re n un de r ag e 5 U nd er w ei gh t M ea n Z- S co re (S D ) St un te d M ea n Z- S co re (S D ) W as te d O ve rw ei gh t M ea n Z- S co re (S D ) P er ce nt ag e be lo w P er ce nt ag e be lo w P er ce nt ag e be lo w P er ce nt ag e ab ov e - 2 S D 1 - 3 S D 2 - 2 S D 3 - 3 S D 4 - 2 S D 5 - 3 S D 6 + 2 S d P oo re st 20 .6 3. 7 -1 .2 81 8 40 .9 14 .3 -1 .7 80 3 5. 4 1. 2 1. 6 -0 .3 80 6 S ec on d 11 .3 1. 5 -0 .9 67 0 24 .2 4. 3 -1 .2 66 6 4. 1 1 2. 8 -0 .3 66 6 M id dl e 13 .9 2 -0 .8 68 3 24 .2 4. 8 -1 .2 68 1 4. 5 1. 5 2. 9 -0 .2 67 9 Fo ur th 8. 5 1. 1 -0 .5 72 6 15 .6 3. 6 -0 .8 72 1 4. 4 2 6. 3 0 71 9 R ic he st 3. 1 0. 6 0. 1 71 0 6. 1 1. 7 -0 .4 70 2 2. 1 0. 2 8. 9 0. 4 69 8 Et hn ic ity o f h ou se ho ld h ea d K in h/ H oa 10 1. 6 -0 .6 30 81 19 .6 4. 7 -1 30 54 3. 8 1. 1 4. 9 30 47 E th ni c M in or iti es 22 3. 5 -1 .2 52 6 40 .9 13 .8 -1 .6 51 8 5. 7 1. 6 1. 7 -0 .4 52 1 To ta l 11 .7 1. 8 -0 .7 36 07 22 .7 6 -1 .1 35 72 4. 1 1. 2 4. 4 -0 .1 35 68 1 M IC S in di ca to r 2 .1 a an d M D G in di ca to r 1 .8 2 M IC S in di ca to r 2 .1 b 3 M IC S in di ca to r 2 .2 a, 4 M IC S in di ca to r 2 .2 b 5 M IC S in di ca to r 2 .3 a, 6 M IC S in di ca to r 2 .3 b .14 14 A cc or di ng to th e N at io na l I ns tit ut e of N ut rit io n, th e pe rc en ta ge o f c hi ld re n un de r 5 w ho a re u nd er w ei gh t i s 17 .5 p er c en t, th e pe rc en ta ge o f c hi ld re n un de r 5 w ho a re s tu nt ed is 2 9. 3 pe r c en t an d th e pe r c en ta ge o f c hi ld re n un de r 5 w ho a re w as te d is 7 .1 p er c en t. N at io na l I ns tit ut e of N ut rit io n (2 01 1) . A R ev ie w o f t he N ut rit io n S itu at io n in V ie t N am 2 00 9– 20 10 . H an oi : S ta tis tic al P ub - lis hi ng H ou se . 53VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Children whose full birth date (month and year) were not obtained, and children whose measurements are outside a plausible range are excluded from Table NU.1. Children are excluded from one or more of the anthropometric indicators when their weights or heights have not been measured, whichever applicable. For example if a child has been weighed but his/her height has not been measured, the child is included in the underweight calculations, but not in the calculations for stunting and wasting. Percentages of children by age and reasons for exclusion are shown in the data quality tables dQ.5(a,b,c) and dQ.6. Overall 98.2 per cent of children had both their weights and heights measured (Table dQ.5), 1.9 per cent of children are missing information on weight and 2.5 per cent are missing information on height. Table dQ.6 shows that due to incomplete dates of birth, implausible measurements, and missing weight and/or height, 2.1 per cent of children have been excluded from calculations of the weight-for-age indicator, while the figures are 3.1 for the height-for-age indicator, and 2.4 per cent for the weight-for-height indicator. Almost one in nine children under age 5 in Viet Nam are considered moderately or serevely underweight (11.7 per cent) and 1.8 per cent are classified as severely underweight (Table NU.1). What is striking is that twice as many children living in ethnic minority households are underweight compared to their peers in Kinh/Hoa households. Almost a quarter of children (22.7 per cent) are stunted or short for their age. Again, twice as many children from ethnic minority households are suffering from stunting compared to children in Kinh/ Hoa households. Some 4.1 per cent of children are wasted or thin for their height and 1.2 per cent are severely wasted. Figure NU.1: Percentage of children under 5 years of age who are undernourished by age in months, Viet Nam, 2011 Children in the Northern Midland and Mountain areas and the Central Highlands are more likely to be underweight and stunted than other children. The prevalence rate for wasting among children does not differ much among regions, ranging from around 3.6 to 4.8 per cent. Children whose mothers have secondary or higher education are the least likely to be underweight and stunted compared to children of mothers with no education. Boys appear to be slightly more likely to be underweight, stunted, and wasted than girls. The age pattern shows that a lower percentage of children aged 0–11 months are undernourished according to all three indices in comparison to older children (Figure NU.1). This pattern is 54 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN expected and is related to the age at which many children are weaned from breastfeeding and are exposed to contamination in water, food, and environment. Overweight is one of the concerns of Viet Nam’s Strategy against Malnutrition. Overweight is rapidly increasing in developing countries due to inappropriate diet for children. In MICS 2011, the overweight prevalence is 4.4 per cent. The overweight prevalence is highest among children living in the South East (10.6 per cent) and lowest among children living in the Red River delta (2.5 per cent). The prevalence rate in urban areas is almost three times greater than in rural areas (8 per cent versus 3.1 per cent); and progressively increases with household living standards, with 1.6 per cent of children in the poorest households being overweight, compared to 8.9 per cent in the richest households. The overweight prevalence is highest among children aged 12–23 months (6.3 per cent) in comparison with other age groups. breastfeeding and Infant and young Child Feeding Breastfeeding for the first few years of life protects children from infection, provides an ideal source of nutrients, and is economical and safe. However, many mothers stop breastfeeding too soon and there are often pressures to switch to infant formula, which can contribute to growth faltering and micronutrient malnutrition and is unsafe if clean water is not readily available. WHO and UNICEF have the following feeding recommendations: ● Exclusive breastfeeding for the first six months; ● Continued breastfeeding for two years or more; ● Safe, appropriate and adequate complementary foods beginning at 6 months; ● Frequency of complementary feeding: two times per day for 6–8 month olds; three times per day for 9–11 month olds. It is also recommended that breastfeeding be initiated within one hour of birth. Indicators related to recommended child feeding practices are as follows: ● Early initiation of breastfeeding (within one hour of birth); ● Exclusive breastfeeding rate (< 6 months); ● Predominant breastfeeding rate (< 6 months); ● Continued breastfeeding rate (at 1 year and at 2 years); ● Duration of breastfeeding; ● Age-appropriate breastfeeding (0–23 months); ● Introduction of solid, semi-solid and soft foods (6–8 months); ● Minimum meal frequency (6–23 months); ● Milk feeding frequency for non-breastfeeding children (6–23 months); ● Bottle feeding (0–23 months). 55VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Table NU.2: Initial breastfeeding Percentage of last-born children in the two years preceding the survey who were ever breastfed, percentage who were breastfed within one hour of birth and within one day of birth, and percentage who received a prelacteal feed, Viet Nam, 2011 Percentage ever breastfed1 Percentage who were first breastfed: Percentage who received a prelacteal feed Number of last-born children in the two years preceding the survey Within one hour of birth2 Within one day of birth Region Red River Delta 97.3 33.1 80.6 76 294 Northern Midland and Mountain areas 99.4 57 88.7 44 285 North Central area and Central Coastal area 99 42.7 81.6 49.8 287 Central Highlands 98.5 37 81.2 51.5 92 South East 95.9 28.9 67.5 72 214 Mekong River Delta 97.7 33.3 77.3 74.5 210 Area Urban 97.9 30.3 72.2 73.7 402 Rural 98.1 43.5 83.2 56.4 980 Months since birth 0-11 98.2 35.4 78.0 64.0 636 12-23 97.9 43.3 81.7 59.3 747 Assistance at delivery§ Skilled attendant 98.2 37.9 79.6 64.4 1284 Traditional birth attendant (100) (67.7) (92.5) (25.7) 28 Others (100) (70.6) (92.5) (23.0) 42 Place of delivery§§ Public sector health facility 98.4 37.8 79.7 65 1220 Private sector health facility 92.7 37.8 75.7 56.5 57 Home 100 64.2 88.6 23.8 102 Mother’s education None 97.7 55.9 89.8 33.9 64 Primary 98 38.5 77.8 58 203 lower Secondary 98.8 41.4 82.7 56.1 523 Upper Secondary 97.1 36.6 79.7 63.2 296 Tertiary 97.7 36.8 74.7 77.7 295 Wealth index quintile Poorest 98.8 51.9 86.5 39.8 300 Second 99 46 86.3 49.8 263 Middle 98.8 35.8 79.5 63.7 251 Fourth 97.4 31.4 76.6 75.4 270 Richest 96.3 32.5 71.3 79.1 299 Ethnicity of household head Kinh/Hoa 97.8 36.7 78.7 65.7 1158 Ethnic Minorities 99.2 54.7 86.9 39.6 225 Total 98 39.7 80 61.5 1383 1 MICS indicator 2.4 2 MICS indicator 2.5 § This excludes 28 missing cases of assistance at delivery §§ This excludes 4 missing cases of place of delivery Note: Figures shown in parenthesis are based on denominators of 25-49 un-weighted cases Table NU.2 presents the proportion of children born in the last two years who were ever breastfed, those who were first breastfed within one hour and one day of birth, and those 56 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN who received a prelacteal feed. Breastfeeding is a very important step in the management of lactation and the establishment of a physical and emotional relationship between the baby and the mother. However, only 39.7 per cent of babies are breastfed for the first time within one hour of birth, although 80 per cent of newborns in Viet Nam start breastfeeding within one day of birth. The percentage of children ever breastfed is quite high, at 98 per cent. Some 61.5 per cent of children received a prelacteal feed in the first three days of life. With an overall high percentage of children ever breastfed, virtually no disparities are noticed across any background variable. Meanwhile, place of delivery, attendance at delivery, mother’s education and wealth quintile are the strongest determinants for whether a child receives prelacteal feeding or not. It is interesting to observe that approximately 24 per cent of children born at home received a prelacteal feeding compared to 65 per cent of children born in a government health facility. Surprising results by background characteristics are observed for early initiation of breastfeeding (within one hour of birth). Children born at home are almost twice as likely to be breastfed within one hour of birth compared to those delivered in a public or private health facility (64.2 versus 37.8 per cent). Also, the higher the mother’s education and the wealthier the household the less likely the child will be breastfed within one hour of birth. Regional differences are also observed, with the Northern Midland and Mountain area indicating the highest percentage of breastfeeding within one hour of birth (57 per cent) and the South East indicating the lowest (28.9 per cent). The percentage is also higher in rural areas compared to urban areas, at 43.5 and 30.3 per cent, respectively. In Table NU.3, the breastfeeding status is based on the mother’s/caregiver’s report of children’s consumption of food and fluids in the 24 hours prior to the interview. Exclusively breastfed refers to infants who received only breast milk (and possibly vitamins, mineral supplements, or medicine). The table shows exclusive breastfeeding of infants during the first six months of life, as well as continued breastfeeding of children at 12–15 and 20–23 months of age. 57VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Table NU.3: Breastfeeding Percentage of living children according to breastfeeding status at selected age groups, Viet Nam, 2011 Children aged 0-5 months Children aged 12-15 months Children aged 20-23 months Percentage exclusively breastfed1 Percentage predominantly breastfed2 Number of children Percentage breastfed (Continued breastfeeding at 1 year)3 Number of children Percentage breastfed (Continued breastfeeding at 2 years)4 Number of children Sex Male 15.1 43.3 160 74.5 145 20.9 117 Female 18.8 43.3 167 73.3 128 18 122 Region Red River Delta 15.3 35.8 83 72.2 51 (10.5) 48 Northern Midland and Mountain areas 37.6 54.9 74 84.5 66 (34.6) 43 North Central area and Central Coastal area 14 49.5 66 78.9 59 (21.5) 47 Central Highlands * * 18 * 18 * 18 South East (7.3) (33.3) 41 (59.8) 40 (7.4) 47 Mekong River Delta (1.7) (35.5) 45 (57.1) 39 (19.9) 35 Area Urban 12.8 33.1 83 62.6 95 16.8 81 Rural 18.4 46.8 244 79.9 178 20.8 158 Mother’s education None * * 14 * 12 * 13 Primary 15.3 48 57 (76.1) 38 (15.5) 28 lower Secondary 16.2 42.2 101 71 101 22 96 Upper Secondary 18.1 49.2 81 77.8 62 (26.4) 40 Tertiary 14.3 31.5 75 72.4 60 10.9 61 Wealth index quintile Poorest 28 59.8 79 72 60 (38.6) 44 Second 17.3 54.6 61 82.7 46 (21.7) 39 Middle 18.4 37.4 65 82.8 56 (16.9) 40 Fourth 6.8 40.4 60 (72.4) 48 21.7 52 Richest 11.2 20.5 63 62.4 62 4.3 63 Ethnicity of household head Kinh/Hoa 14 39.1 273 71.5 233 13.4 203 Ethnic Minorities 31.9 64.6 54 (87.8) 40 (54) 35 Total 17 43.3 327 73.9 273 19.4 238 1 MICS indicator 2.6; 2 MICS indicator 2.9 3 MICS indicator 2.7; 4 MICS indicator 2.8 Note: Figures denoted by an asterisk are based on denominators of 24 un-weighted cases and less Figures shown in parenthesis are based on denominators of 25-49 un-weighted cases Only 17 per cent of children in Viet Nam aged less than six months are exclusively breastfed. This represents a low percentage. By the age of 12–15 months, 73.9 per cent of children are breastfed and by the age of 20–23 months, 19.4 per cent. Almost one in every two children aged 0–5 months (43.3 per cent) is predominantly breastfed.15 Differences in exclusive breastfeeding between girls and boys are minimal, however, considerable variations are observed by living standards, ethnicity of the household 15 Received breast milk and certain fluids (water and water-based drinks like sugar water, fruit juice, gripe water, oral rehydration solution, tea or herbal infusions), but did not receive anything else (in particular, non-human milk and food- based fluids) 58 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN head and region. For example, children aged 0-5 months in ethnic minority households are twice as likely to be exclusively breastfed compared to their peers in Kinh/Hoa households (31.9 per cent versus 14 per cent). A child living in the Northern Midland and Mountain areas is twice as likely to be exclusively breastfed (37.6 per cent) than a child living in the North Central area and Central Coastal area (14 per cent) or the Red River Delta (15.3 per cent). Similarly, 28 per cent of children in the poorest households are exclusively breastfed, compared to 11.2 per cent in the richest households. Table NU.3a. Feeding patterns by age Percent distribution of children aged 0-23 months by feeding pattern, Viet Nam, 2011 Feeding pattern Total Number of children Predominant breastfeeding breastfed and other milk / formula breastfed and other foods Not breastfed Exclusively breastfed breastfed and plain water only breastfed and non-milk liquids Age (months) 0-1 27.2 23.8 3.3 44.3 0 1.4 100 95 2-3 21.6 25.7 6.6 39.1 3.5 3.5 100 119 4-5 3.7 17.7 16.8 39.9 19.0 2.9 100 113 6-7 1.9 7.0 17.1 27.3 38.3 8.3 100 85 8-9 0.3 0.5 17.6 17.5 48.9 15.3 100 140 10-11 0 3.0 13.2 21.0 50.6 12.2 100 116 12-13 0 0.7 5.3 14.6 59.0 20.3 100 125 14-15 0 0.7 6.1 16.8 45.4 31.0 100 147 16-17 0 0 1.7 7.0 42.4 49.0 100 142 18-19 0 0.9 2.3 3.9 20.3 72.5 100 106 20-21 0 0 1.9 0.4 18.0 79.8 100 108 22-23 0 2.4 0 0 16.4 81.2 100 130 Figure NU.2 shows the detailed pattern of breastfeeding by the child’s age in months, up to the age of 2. Even at the earliest ages, the majority of children receive liquids or foods other than breast milk. Only about 20 per cent of children receive breast milk through the end of the second year of life. By the end of the first six months, the percentage of children exclusively breastfed is already below 3 per cent. 59VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Figure NU. 2. Percentage distribution of children under age 2 across feeding patterns by age group, Viet Nam, 2011 Table NU.4 shows the median duration of breastfeeding by selected background characteristics. Among children under age 3, the median duration is 16.7 months for any breastfeeding, 0.5 months for exclusive breastfeeding, and 1.4 months for predominant breastfeeding. The differences in median duration of any breastfeeding and exclusive breastfeeding are not large across gender or area. More notable differences are observed according to the ethnicity of the household heads, especially for the median duration of exclusive breastfeeding. The children in ethnic minority households are likely to be breastfed three times longer, on average about 1.8 months, compared to 0.5 months median duration of exclusive breastfeeding of children who live in households headed by a Kinh/Hoa. The median duration of predominantly breastfed children indicates some, yet no substantial, differences by all background variables. 60 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Table NU.4: Duration of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children aged 0-35 months, Viet Nam, 2011 Median duration (in months) of Number of children aged 0-35 months Any breastfeeding1 Exclusive breastfeeding Predominant breastfeeding Sex Male 16.6 0.5 1.8 1143 Female 16.8 0.5 0.7 1076 Region Red River Delta 17.1 0.5 0.7 496 Northern Midland and Mountain areas 17 1.3 3 440 North Central area and Central Coastal area 17.8 0.4 2.3 423 Central Highlands 19.5 0.5 2.4 144 South East 14.8 0.4 1.1 339 Mekong River Delta 14.4 0 0.4 376 Area Urban 16.3 0.5 0.6 626 Rural 16.8 0.5 2.1 1594 Mother’s education None 18.2 0.5 4.5 110 Primary 16.3 0.5 1 367 lower Secondary 16.6 0.6 0.7 873 Upper Secondary 17.4 0.5 2.4 428 Tertiary 15.8 0.5 0.7 442 Wealth index quintile Poorest 16.9 1.6 4 495 Second 17 0.4 3.3 402 Middle 16.6 0.4 0.7 427 Fourth 17.3 0.5 1.8 434 Richest 15.6 0.5 0.5 462 Ethnicity of household head Kinh/Hoa 16.5 0.5 0.7 1869 Ethnic Minorities 20.7 1.8 4.3 351 Median 16.7 0.5 1.4 2219 Mean for all children (0-35 months) 16.7 1 2.9 2219 1 MICS indicator 2.10 Information about the adequacy of infant feeding of children under 24 months is provided in Table NU.5. different criteria for adequate feeding are used depending on the age of the child. For infants aged 0–5 months, exclusive breastfeeding is considered as adequate feeding, while infants aged 6–23 months are considered to be adequately fed if they are receiving breast milk and solid, semi-solid or soft food. Age appropriate feeding shows disparities by area, living standards and ethnicity of the household head for both 0–5 and 6–23 month old children. Taking the ethnicity of the household head as an example, 31.9 per cent of 0–5 month old children in ethnic minority households are appropriately fed for their age compared to 14.0 per cent of children in Kinh/Hoa households. Regional differences are also observed, with the South East indicating a comparatively low percentage of adequate feeding for both 0–5 month old and 6–23 month old children, at 7.3 and 24.2 per cent respectively. As a result of these feeding patterns, overall only 38.5 per cent of children aged 6–23 months are being adequately fed.Taking the two age groups together, age appropriate feeding of children below 24 months is 33.5 per cent in Viet Nam. The widest range is observed across regions, with the Northern Midland and Mountain areas indicating the highest percentage of under 24 month children appropriately fed (42.5 per cent) and the South East the lowest (21 per cent). 61VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Table NU.5: Age-appropriate breastfeeding Percentage of children age 0-23 months who were appropriately breastfed during the previous day, Viet Nam, 2011 Children age 0-5 months Children age 6-23 months Children age 0-23 months Percentage exclusively breastfed1 0Number of children Percentage currently breastfeeding and receiving solid, semi- solid or soft foods Number of children Percentage appropriately breastfed2 Number of children Sex Male 15.1 160 38 539 32.8 699 Female 18.8 167 38.9 561 34.3 728 Region Red River Delta 15.3 83 42.3 221 34.9 304 Northern Midland and Mountain areas 37.6 74 44.1 219 42.5 293 North Central area and Central Coastal area 14 66 38.4 224 32.9 290 Central Highlands * 18 37 76 32.2 93 South East (7.3) 41 24.2 176 21 218 Mekong River Delta (1.7) 45 41.5 184 33.6 229 Area Urban 12.8 83 32.5 325 28.5 408 Rural 18.4 244 41 775 35.6 1019 Mother’s education None * 14 37.3 53 37.3 67 Primary 15.3 57 36.7 167 31.3 224 lower Secondary 16.2 101 37.5 445 33.6 545 Upper Secondary 18.1 81 45 218 37.7 299 Tertiary 14.3 75 35.6 217 30.1 291 Wealth index quintile Poorest 28 79 43.5 234 39.6 313 Second 17.3 61 40.9 210 35.6 271 Middle 18.4 65 36.5 199 32.1 264 Fourth 6.8 60 40.4 212 33 272 Richest 11.2 63 31.5 244 27.3 307 Ethnicity of household head Kinh/Hoa 14 273 37 929 31.8 1202 Ethnic Minorities 31.9 54 46.4 171 42.9 225 Total 17 327 38.5 1100 33.5 1427 1 MICS indicator 2.6 2 MICS indicator 2.14 Note: Figures denoted by an asterisk are based on denominators of 24 un-weighted cases and less Figures shown in parenthesis are based on denominators of 25-49 un-weighted cases Adequate complementary feeding of children from six months to two years of age is particularly important for growth and development and the prevention of under-nutrition. Continued breastfeeding beyond six months should be accompanied by consumption of nutritionally adequate, safe and appropriate complementary foods that help meet nutritional requirements when breast milk is no longer sufficient. This requires that for breastfed children, two or more meals of solid, semi-solid or soft foods are needed if they are 6–8 months old, and three or more meals if they are 9–23 months of age. For children 6–23 months and older who are not breastfed, four or more meals of solid, semi-solid or soft foods or milk feeds are needed. 62 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Overall, 50.4 per cent of infants aged 6–8 months received solid, semi-solid, or soft foods (Table NU.6). Among currently breastfeeding infants the percentage is 46. There are no noteworthy disparities by sex. Table NU.6: Introduction of solid, semi-solid or soft foods Percentage of infants age 6-8 months who received solid, semi-solid or soft foods during the previous day, Viet Nam, 2011 All Currently breastfeeding Percent receiving solid, semi-solid or soft foods1 Number of children age 6-8 months Percent receiving solid, semi-solid or soft foods Number of children age 6-8 months Sex Male 52 72 47 63 Female 49 79 45 68 Area Urban (52.3) 37 (39.1) 25 Rural 49.8 114 47.6 106 Total 50.4 151 46 131 1 MICS indicator 2.12 Note: Figures shown in parenthesis are based on denominators of 25-49 un-weighted cases Table NU.7 presents the proportion of children aged 6–23 months who received semi-solid or soft foods the minimum number of times or more during the previous day according to breastfeeding status. The note at the bottom of Table NU.7 provides the definition of minimum number of times for different age groups. 63VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Table NU.7: Minimum meal frequency Percentage of children aged 6-23 months who received solid, semi-solid, or soft foods (and milk feeds for non-breastfeeding children) the minimum number of times or more during the previous day, according to breastfeeding status, Viet Nam, 2011 Currently breastfeeding Currently not breastfeeding All Percentage receiving solid, semi-solid and soft foods the minimum number of times§ Number of children aged 6-23 months Percentage receiving at least 2 milk feeds1 Percentage receiving solid, semi- solid and soft foods or milk feeds 4 times or more Number of children aged 6-23 months Percentage with minimum meal frequency2 Number of children aged 6-23 months Sex Male 46 316 82.9 82.8 223 61.2 539 Female 35.5 332 81.6 85.5 229 55.9 561 Age (months) 6-8 41.1 131 * * 20 47.9 151 9-11 33.1 167 * * 23 39.7 190 12-17 39.3 274 85.7 85.8 141 55.1 415 18-23 61.1 75 77.9 82.4 269 77.7 344 Region Red River Delta 54.5 123 93.4 88.4 98 69.5 221 Northern Midland and Mountain areas 37.3 150 62.3 80.6 68 50.8 219 North Central area and Central Coastal area 37.9 147 69.1 77.9 77 51.7 224 Central Highlands 24.3 54 * * 22 36.7 76 South East 37.5 75 98.6 94.3 101 70.1 176 Mekong River Delta 43.7 98 79 80.1 85 60.6 184 Area Urban 33.3 169 95.1 90.9 156 61 325 Rural 43.2 479 75.4 80.6 296 57.5 775 Mother’s education None (39.5) 36 * * 17 42.1 53 Primary 43.1 95 64.9 73.4 72 56.2 167 lower Secondary 36.2 272 83.3 83.7 172 54.6 445 Upper Secondary 49.8 138 89.6 88.1 81 63.9 218 Tertiary 38.3 107 95.7 94.7 110 66.9 217 Wealth index quintile Poorest 42.5 155 51.9 70.6 79 52 234 Second 44.8 137 72.1 74.8 73 55.2 210 Middle 33.5 118 84.5 81.9 81 53.2 199 Fourth 42.3 126 92.7 89.1 86 61.2 212 Richest 38.5 111 97.7 95.6 133 69.6 244 Ethnicity of household head Kinh/Hoa 40.9 523 85 85.5 407 60.4 929 Ethnic Minorities 39.3 125 (57.6) (72.3) 45 48.1 171 Total 40.6 648 82.2 84.2 452 58.5 1100 1 MICS indicator 2.15 2 MICS indicator 2.13 §Among currently breastfeeding children aged 6-8 months, minimum meal frequency is defined as children who also received solid, semi-solid or soft foods 2 times or more. Among currently breastfeeding children aged 9-23 months, receipt of solid, semi-solid or soft foods at least 3 times constitutes minimum meal frequency. For non-breastfeeding children aged 6-23 months, minimum meal frequency is defined as children receiving solid, semi-solid or soft foods, and milk feeds, at least 4 times during the previous day. Note: Figures denoted by an asterisk are based on denominators of 24 un-weighted cases and less Figures shown in parenthesis are based on denominators of 25-49 un-weighted cases 64 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Among currently breastfeeding children aged 6–23 months, 40.6 per cent were receiving solid, semi-solid and soft foods the minimum number of times. This proportion was 10 per cent higher among males compared to females. In the age group 6–23 months the older children (18–23 months) who are currently breastfeeding are more likely to receive solid, semi-solid and soft foods the minimum number of times, compared to their younger peers. Among non-breastfeeding children, 84 per cent of the children were receiving solid, semi- solid and soft foods or milk feeds 4 times or more, and 82 per cent were receiving at least two milk feeds. Both indicators for non-breastfeeding children reveal disparities by mother’s education and household living standards. For example, only one in two non-breastfeeding children are likely to receive at least two milk feeds if living in the poorest households, compared with virtually all children in the richest households. Among all children 6–23 months of age, 58.5 per cent received the minimum meal frequency. differences are observed by all background characteristics, with the widest variations across regions. At 36.7 per cent, children from the Central Highlands are less likely to receive the minimum meal frequency compared to other regions, with the South East ranking highest, at 70.1 per cent. The continued practice of bottle-feeding is a concern because of the possible contamination due to unsafe water and lack of hygiene in preparation. Table NU.8 shows that bottle-feeding is still prevalent in Viet Nam. Some 38.7 per cent of children aged 0–23 months are fed using a bottle with a nipple. Bottle feeding is more common among children living in urban areas, in richer households, and among children whose mother has higher education. Regional disparities are striking, with the percentage of children below 24 months fed with a bottle with a nipple being highest in the South East (68.2 per cent) and lowest in the Northern Midland and Mountain areas (18.6 per cent). It is also higher among children living in Kinh/Hoa households as opposed to ethnic minority households (43.4 and 13.4 per cent, respectively). Table NU.8: Bottle feeding Percentage of children aged 0-23 months who were fed with a bottle with a nipple during the previous day, Viet Nam, 2011 Percentage of children aged 0-23 months fed with a bottle with a nipple1 Number of children aged 0-23 months Sex Male 36.1 699 Female 41.2 728 Age (months) 0-5 41.5 327 6-11 44.5 341 12-23 34.8 759 Region Red River Delta 33.8 304 Northern Midland and Mountain areas 18.6 293 North Central area and Central Coastal area 30.8 290 Central Highlands 30 93 South East 68.2 218 Mekong River Delta 56.2 229 Area Urban 53.3 408 Rural 32.8 1019 Mother’s education None 15.8 67 Primary 32.9 224 65VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Table NU.8: Bottle feeding Percentage of children aged 0-23 months who were fed with a bottle with a nipple during the previous day, Viet Nam, 2011 Percentage of children aged 0-23 months fed with a bottle with a nipple1 Number of children aged 0-23 months lower Secondary 35.4 545 Upper Secondary 42.4 299 Tertiary 50.8 291 Wealth index quintile Poorest 18 313 Second 28.4 271 Middle 42.5 264 Fourth 48.3 272 Richest 57.2 307 Ethnicity of household head Kinh/Hoa 43.4 1202 Ethnic Minorities 13.4 225 Total 38.7 1427 1 MICS indicator 2.11 Salt Iodisation Iodine deficiency disorders (Idd) are the world’s leading cause of preventable mental retardation and impaired psychomotor development in young children. In its most extreme form, iodine deficiency causes cretinism. It also increases the risks of stillbirth and miscarriage in pregnant women. Iodine deficiency is most commonly and visibly associated with goitre. IDD takes its greatest toll in impaired mental growth and development, contributing in turn to poor school performance, reduced intellectual ability, and impaired work performance. The international goal is to achieve sustainable elimination of iodine deficiency by 2005. The monitoring indicator is the percentage of households consuming adequately iodised salt (>15 parts per million). In Viet Nam, the Endocrinology Hospital (MOH) was established to carry out goitre control activities. Since the 1970s, Viet Nam has implemented programmes to provide iodised salt to mountainous residents. Results from the 1993 Census on Goitre Status conducted by the Endocrinology Hospital in cooperation with UNICEF and CEMUbAC (belgium) revealed that 94 per cent of the Vietnamese population was at risk of iodine deficiency. Goitre prevalence among children was 22.4 per cent and the median urinary iodine level was 32 mcg/l. Because of these findings, at the end of 1994, the government of Viet Nam decided to provide iodised salt instead of normal salt throughout the country in order to fight against Idd. Based on criteria to assess IDD elimination (including the three indicators: prevalence of goitre among children under age 5; coverage of adequately iodised salt and median urinary iodine level), MoH announced that Viet Nam achieved the goal of eliminating Idd in 2005. 66 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Table NU.9: Iodised salt consumption Percentage distribution of households by consumption of iodised salt, Viet Nam, 2011 Percentage of households in which salt was tested Number of households Percentage of households with Number of households in which salt was tested or with no saltNo salt Salt test result Not iodised 0 ppm >0 and <15 ppm 15+ ppm1 Total Region Red River Delta 97.8 2601 1.7 57 13.4 27.8 100 2587 Northern Midland and Mountain areas 98.9 1836 0.9 38 21.1 40 100 1832 North Central area and Central Coastal area 97.5 2522 2.2 30.6 17 50.2 100 2515 Central Highlands 98.8 604 0.9 3.3 7.8 88.1 100 602 South East 95 1873 4.1 15.9 23.4 56.5 100 1855 Mekong River Delta 95.2 2178 3.7 45.6 8.3 42.4 100 2154 Area Urban 96.2 3454 3.2 34.8 17.6 44.4 100 3431 Rural 97.4 8160 2.1 37.5 15 45.4 100 8114 Wealth index quintile Poorest 97.5 2329 2 33.6 16.8 47.6 100 2316 Second 97.6 2368 1.7 41.6 16.3 40.5 100 2350 Middle 96.7 2406 3 38.7 14.4 44 100 2398 Fourth 96 2326 3.4 34.6 14.7 47.4 100 2310 Richest 97.4 2186 2 34.9 16.8 46.3 100 2171 Total 97 11614 2.4 36.7 15.8 45.1 100 11545 1 MICS indicator 2.16 In about 97 per cent of households, salt used for cooking was tested for iodine content by using salt test kits and testing for the presence of potassium iodide content. Table NU.9 shows that in a very small proportion of households (2.4 per cent), there was no salt available. In 45.1 per cent of households, salt was found to contain 15 or more parts per million (ppm) of iodine; and in 15.8 per cent of households salt was found to have iodine content below 15 ppm. Some 36.7 per cent of households were found to use salt with no iodine. Use of iodised salt is lowest in the Red River delta (41.2 per cent any iodine, 27.8 per cent with 15 or more ppm) and highest in the Central Highlands (95.9 per cent any iodine, 88.1 per cent with 15 or more ppm). Use of iodised salt and use of adequately iodised salt do not differ substantially between urban and rural areas, standing at 44.4 per cent (15 or more ppm) and 17.6 per cent (positive amounts but <15ppm) for urban areas and 45.4 per cent (15 or more ppm) and 15 per cent (positive amounts but <15ppm) for rural areas, respectively (Figure NU.3). 67VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Figure NU.3 Percentage of households consuming adequately iodised salt by region, Viet Nam, 2011 Children’s Vitamin A Supplementation Vitamin A is essential for eye health and proper functioning of the immune system. It is found in foods such as milk, liver, eggs, red and orange fruits, red palm oil and green leafy vegetables, although the amount of vitamin A readily available to the body from these sources varies widely. In developing areas of the world, where vitamin A is largely consumed in the form of fruits and vegetables, daily per capita intake is often insufficient to meet dietary requirements. Inadequate intakes are further compromised by increased requirements for the vitamin as children grow or during periods of illness, as well as increased losses during common childhood infections. As a result, vitamin A deficiency is prevalent in the developing world and particularly in countries with the highest burden of under-five deaths. The 1990 World Summit for Children set the goal of virtual elimination of vitamin A deficiency and its consequences, including blindness, by the year 2000. This goal was also endorsed at the Policy Conference on Ending Hidden Hunger in 1991, the 1992 International Conference on Nutrition, and the UN General Assembly’s Special Session on Children in 2002. The critical role of vitamin A for child health and immune function also makes control of deficiency a primary component of child survival efforts, and therefore critical to the achievement of the fourth Millennium Development Goal: a two-thirds reduction in under- five mortality by the year 2015. For countries with vitamin A deficiency problems, current international recommendations call for high-dose vitamin A supplementation every four to six months, targeted to all children between the ages of 6–59 months living in affected areas. Providing young children with two high-dose vitamin A capsules a year is a safe, cost-effective, efficient strategy for eliminating vitamin A deficiency and improving child survival. Giving vitamin A to new mothers who are breastfeeding helps protect their children during the first months 68 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN of life and helps to replenish the mother’s stores of vitamin A, which are depleted during pregnancy and lactation. For countries with vitamin A supplementation programmes, the definition of the indicator is the percentage of children 6–59 months of age receiving at least one high dose vitamin A supplement in the last six months. In 1987, the Government of Viet Nam approved the National Programme for Prevention and Control of Vitamin A deficiency. This programme was piloted in some districts and was then expanded to the entire country in 1993. Based on UNICEF/WHO guidelines, the Viet Nam Ministry of Health recommends that children aged 6–11 months be given one high dose Vitamin A capsule per year and children aged 12–59 months be given a vitamin A capsule every 6 months. Vitamin A is integrated with immunization services and is given when the child has contact with these services after six months of age. The Vitamin A supplementation campaigns in Viet Nam are organised twice per year in June and december. It is also recommended that mothers take a vitamin A supplement within eight weeks of giving birth due to increased Vitamin A requirements during pregnancy and lactation It is noted that the Vietnamese Vitamin A Supplementation Programme targets children aged 6–36 (and not 6–59) months nation-wide, and that children up to 59 months are only targeted in selected provinces. Within the six months prior to MICS 2011 data collection, 83.4 per cent of children aged 6–59 months received a high dose Vitamin A supplement (Table NU.10). Vitamin A supplementation coverage is lower in the South East (77.6 per cent) than in other regions (for example 88.2 per cent in the Red River delta).This percentage is quite low when the mother has no education, at only 60.9 per cent. There are no large differences by sex, area and ethnicity. 69VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Table NU.10: Children's vitamin A supplementation Percentage distribution of children aged 6-59 months by receipt of a high dose vitamin A supplement in the last 6 months, Viet Nam, 2011 Percentage who received Vitamin A according to: Percentage of children who received Vitamin A during the last 6 months1 Number of children aged 6-59 months Child health book/card/ vaccination card Mother's report Sex Male 3.3 82.9 82.9 1709 Female 5.1 83.8 83.9 1642 Region Red River Delta 6.5 88.2 88.2 715 Northern Midland and Mountain areas 2.4 84.9 84.9 633 North Central area and Central Coastal area 1.2 84 84 653 Central Highlands 5.7 85.8 85.8 216 South East 4.4 77.6 77.6 530 Mekong River Delta 5.5 79.5 79.6 605 Area Urban 7.2 84.4 84.4 930 Rural 3 83 83 2421 Age (months) 6-11 5.9 72.5 72.5 341 12-23 7.4 90.9 91 759 24-35 5.5 88.9 88.9 792 36-47 1.6 83.4 83.4 764 48-59 1 74.2 74.2 695 Mother’s education None 2 60.9 60.9 193 Primary 1.7 76.9 76.9 601 lower Secondary 2.5 85.6 85.7 1378 Upper Secondary 6.1 85.8 85.8 589 Tertiary 9.4 89.7 89.7 589 Wealth index quintile Poorest 2 76 76 752 Second 3.1 81.6 81.6 613 Middle 3.1 86.3 86.4 636 Fourth 3.9 88.3 88.3 689 Richest 8.8 85.4 85.4 662 Ethnicity of household head Kinh/Hoa 4.6 84.5 84.5 2870 Ethnic Minorities 1.5 76.4 76.4 481 Total 4.1 83.4 83.4 3351 1 MICS indicator 2.17 The age pattern of Vitamin A supplementation shows that the highest proportion of children are missing the first high dose of supplementation at the age 6–11 months, and the last dose at the age of 48–59 months, with the doses in between showing a higher percentage. Only 72.5 per cent of children receive the first dose and 74.2 per cent the last dose, with percentages in between ranging from 83.4 per cent for children aged 36–47 months to 91 per cent for those aged 12–23 months. The mother’s level of education is also positively correlated with the likelihood of a child receiving Vitamin A supplementation, increasing from 60.9 per cent among children whose mothers have no education to 76.9 per cent of children whose mothers have primary 70 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN education and 85.7 per cent of children whose mothers have lower secondary education. disparities are also observed by household living standards, with 76 per cent of children in the poorest households receiving Vitamin A during the 6 months preceding the survey, compared with 85.4 per cent in the richest households. low birth Weight Weight at birth is a good indicator reflecting a mother’s health and nutritional status but also a good indicator of the newborn’s chances for survival, growth, long-term health and psychosocial development. low birth weight (less than 2500 grams) carries with it a range of grave health risks for children. Babies who were undernourished in the womb face a greatly increased risk of dying during their early months and years. Those who survive have impaired immune function and increased risk of disease; they are likely to remain undernourished, with reduced muscle strength, throughout their lives, and suffer a higher incidence of diabetes and heart disease in later life. Children born underweight also tend to have a lower IQ and cognitive disabilities, affecting their performance in school and their job opportunities as adults. In the developing world, low birth weight stems primarily from the mother’s poor health and nutrition. Three factors have the most impact: the mother’s poor nutritional status before conception, short stature (due mostly to under nutrition and infections during her childhood), and poor nutrition during the pregnancy. Inadequate weight gain during pregnancy is particularly important since it accounts for a large proportion of foetal growth retardation. Moreover, diseases such as diarrhoea and malaria, which are common in many developing countries, can substantially impair foetal growth if the mother becomes infected while pregnant. In the industrialized world, cigarette smoking during pregnancy is the leading cause of low birth weight. In developed and developing countries alike, teenagers who give birth when their own bodies have yet to finish growing run the risk of bearing underweight babies. One of the major challenges in measuring the incidence of low birth weight is the fact that more than half of infants in the developing world are not weighed. In the past, most estimates of low birth weight for developing countries were based on data compiled from health facilities. However, these estimates are biased for most developing countries because the majority of newborns are not delivered in facilities, and those who are represent only a selected sample of all births. because many infants are not weighed at birth and those who are weighed may be a biased sample of all births, the reported birth weights usually cannot be used to estimate the prevalence of low birth weight among all children. Therefore, the percentage of births weighing below 2500 grams is estimated from two items in the questionnaire: the mother’s assessment of the child’s size at birth (i.e., very small, smaller than average, average, larger than average, very large) and the mother’s recall of the child’s weight or the weight as recorded on a health card if the child was weighed at birth16. 16 For a detailed description of the methodology, see JT Boerma, KI Weinstein, SO Rutstein and AE Sommerfelt, 1996. “data on birth weight in developing countries: can surveys help?” in Bulletin of the World Health Organization. 74(2): 209–216. 71VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Table NU.11: Low birth weight infants Percentage of last-born children in the two years preceding the survey that are estimated to have weighed below 2500 grams at birth and percentage of live births weighed at birth, Viet Nam, 2011 Percent of live births: Number of live births in the last 2 yearsBelow 2500 grams1 Weighed at birth2 Region Red River Delta 4.4 99.2 294 Northern Midland and Mountain areas 5.9 78.1 285 North Central area and Central Coastal area 4.3 96.6 287 Central Highlands 6.5 79.6 92 South East 5.5 100 214 Mekong River Delta 5.3 100 210 Area Urban 5.2 98.4 402 Rural 5.1 91.1 980 Mother’s education None 8.4 46.5 64 Primary 6.5 87.5 203 lower Secondary 4.9 95.9 523 Upper Secondary 5.4 97.1 296 Tertiary 3.6 98.9 295 Wealth index quintile Poorest 5.4 75.1 300 Second 5.5 97 263 Middle 5.1 97.9 251 Fourth 5.3 98.8 270 Richest 4.4 99.2 299 Ethnicity of household head Kinh/Hoa 5 98.6 1158 Ethnic Minorities 6 65.8 225 Total 5.1 93.2 1383 1 MICS indicator 2.18 2 MICS indicator 2.19 Overall, 93.2 per cent of children are weighed at birth and approximately 5.1 per cent are estimated to weigh less than 2500 grams at birth (Table NU.11). There was some variation by region and mother’s education (Figure NU.4). The percentage of low birth weight does not vary much by urban and rural areas. 72 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Figure NU.4 Percentage of infants weighing less than 2500 grams at birth by region, Viet Nam, 2011 73VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN VI. CHIld HEAlTH 74 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Immunization The Millennium Development Goal (MDG) 4 is to reduce child mortality by two thirds between 1990 and 2015. Immunization plays a key part in this goal. It has saved the lives of millions of children in the three decades since the launch of the Expanded Programme on Immunization (EPI) in 1974. Worldwide there are still 27 million children overlooked by routine immunization and as a result, vaccine-preventable diseases cause more than two million deaths every year. One of the World Fit for Children goals is to ensure full immunization of children under 1 year of age at 90 per cent nationally, with at least 80 per cent coverage in every district or equivalent administrative unit. According to the Viet Nam Ministry of Health (MoH) guidelines, a child should receive a bCG vaccination to protect against tuberculosis; a birth dose of hepatitis b vaccine, three doses of DPT to protect against diphtheria, pertussis, and tetanus; three doses of Hepatitis B vaccine; three doses of polio vaccine, and a measles vaccination by the age of 12 months. In June 2010 the new Pentavalent vaccine was introduced in Viet Nam, which combines dPT, Hepatitis B and Hib (Haemophilusinfluenza type B) antigens. Administered in three doses, the Pentavalent vaccine replaced the previously separate DPT and Hepatitis b vaccines. To accommodate the registration of the Pentavalent vaccine a new immunization handbook was issued. In Viet Nam, a child is considered to be fully immunized if he/she received seven antigens, notably BCG, dPT (1–3), Polio (1–3), measles and Hepatitis B (1–3). Hepatitis B at birth is not included in the full immunization indicator. In the Viet Nam MICS 2011, mothers were asked to provide vaccination cards for children under the age of 5 years, from which interviewers copied vaccination information onto the MICS questionnaire. The questionnaire was customised to allow the registration of immunizations for children who received single as well as those who received combined vaccines. 75VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Table CH.1: Vaccinations in the 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, Viet Nam, 2011 Vaccinated at any time before the survey according to Vaccinated by 12 months of ageImmunization card Mother's report Either bCG1 50.5 45 95.5 95.0 Polio 1 47.3 44.3 91.7 91.2 Polio 2 45.9 38.2 84.1 83.7 Polio 32 44.9 23.8 68.7 68.1 DPT 1 49.6 44.4 94.1 93.5 DPT 2 48.6 38.2 86.7 86.2 DPT 33 47 27.3 74.3 73.0 Measles4 46.9 45.3 92.2 84.2 Hep b at birth 20.3 27.9 48.2 48.2 Hep b 1 49.5 41.1 90.6 89.6 Hep b 2 48.8 30.1 78.9 77.9 Hep b 35 39.8 16 55.8 53.3 All vaccinations§ 30.9 9.2 40.1 31.3 No vaccinations 0.3 1.9 2.2 2.2 Number of children aged 12-23 months 759 759 759 759 1 MICS indicator 3.1 2 MICS indicator 3.2 3 MICS indicator 3.3 4 MICS indicator 3.4; MDG indicator 4.3 5 MICS indicator 3.5 §This excludes Hepatitis b at birth Overall, 51.6 per cent of children had immunization cards (Table CH.2). 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, Hepatitis B and Polio, how many times. The percentage of children aged 12–23 months who received each of the vaccinations is shown in Table CH.1. The denominator for the table is comprised of children aged 12–23 months so that only children who are old enough to be fully vaccinated are counted. In the top panel, the numerator includes all children who were vaccinated at any time before the survey according to the immunization card, the mother’s report and either source. In the last column, only those who were vaccinated before their first birthday, are included. For children without immunization cards, the proportion of vaccinations given before the first birthday is assumed to be the same as for children with immunization cards. Some 95 per cent of children aged 12–23 months received a BCG vaccination by the age of 12 months and the first dose of dPT was given to 93.5 per cent. The percentage declines for subsequent doses of dPT to 86.2 per cent for the second dose, and 73 per cent for the third dose (Figure CH.1). Similarly, 91.2 per cent of children received the first dose of the Polio vaccine by the age of 12 months and this declines to 68.1 per cent for the third dose. The decline from the first dose to the third is steeper for the Hepatitis b vaccine, from almost 90 per cent to about 53 per cent. The measles vaccine coverage by 12 months is lower than for bCG, DPT1, DPT2, Hepatitis b1 and Polio1, at 84.2 per cent. 76 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Figure CH.1: Percentage of children aged 12-23 months who received basic vaccinations by 12 months, Viet Nam, 2011 Table CH.2 shows the vaccination coverage rates among children aged 12–23 months by background characteristics. The figures indicate children receiving the vaccinations at any time up to the date of the survey, and are based on information from both the immunization cards and mothers’/caregivers’ reports. differentials are observed by all background characteristics, but the widest ranges are noticed by mother’s education and ethnicity of the household head. For example, the vaccine with the highest national coverage, BCG, shows an almost 15 percentage point difference between children living in Kinh/ Hoa households and children living in ethnic minority households. Children whose mother has a higher education level are more likely to be vaccinated than those whose mother has lower or no education. In fact, the majority of children who received no vaccination (23.5 per cent) have uneducated mothers. Only 18.5 per cent of children whose mothers are uneducated received a Hepatitis B vaccination at birth compared to 62.5 per cent of children whose mothers have tertiary education. Household living standards also seem to be a factor. Some 30.4 per cent of children living in the poorest households received all recommended vaccinations, which is 20 percentage points lower than among their peers in the richest households. The North Central area and Central Coastal area is the region with the lowest percentage of children who received all vaccinations, only 28.2 per cent. This region indicates comparatively lower levels of immunization for the third dose of Hepatitis b, DPT and especially Polio, and compares to 53.6 per cent in the South East. As expected, higher immunization rates are observed in urban areas. The percentage of children whose immunization cards were seen by the interviewers declines as mothers’ education level and wealth quintile decline, and is higher in urban areas than in rural areas. The details in the data quality table dQ.10 (see Appendix d) show a notably lower percentage of immunization cards seen for older children. This may indicate poor vaccination record keeping in households. 77VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Ta bl e C H .2 : V ac ci na tio ns b y ba ck gr ou nd c ha ra ct er is tic s P er ce nt ag e of c hi ld re n ag ed 1 2- 23 m on th s cu rr en tly v ac ci na te d ag ai ns t c hi ld ho od d is ea se s, V ie t N am , 2 01 1 Pe rc en ta ge o f c hi ld re n w ho re ce iv ed : P er ce nt ag e w ith va cc in at io n ca rd s ee n N um be r of c hi ld re n ag e 12 -2 3 m on th s b C G M ea sl es N on e A ll§ P ol io 1 P ol io 2 P ol io 3 D P T 1 D P T 2 D P T 3 H ep b at b irt h H ep b 1 H ep b 2 H ep b 3 Se x M al e 95 .1 91 .1 82 .7 65 .7 94 .5 86 .2 72 .5 92 .8 46 .7 91 .3 77 .9 54 .7 2. 2 38 .4 51 39 1 Fe m al e 95 .9 92 .2 85 .6 72 93 .5 87 .2 76 .2 91 .6 49 .7 89 .9 80 57 2. 2 41 .9 52 .3 36 8 R eg io n R ed R iv er D el ta 98 .4 95 .5 89 .3 72 .6 10 0 95 .9 82 .3 95 .8 64 .9 98 .3 84 60 .7 0 50 .3 43 .3 15 6 N or th er n M id la nd a nd M ou nt ai n ar ea s 92 88 .2 77 .7 63 .5 91 80 67 .9 90 .6 26 .7 91 .4 78 .4 53 .1 3. 8 37 .9 47 .1 15 4 N or th C en tra l a re a an d C en tra l C oa st al a re a 96 .1 93 .2 83 61 .9 91 .9 79 .4 65 .1 94 .1 51 .3 82 .1 66 .9 46 .1 1. 2 28 .2 50 .4 16 0 C en tra l H ig hl an ds 91 .3 90 .8 82 63 .2 89 .3 81 .8 63 .4 87 .9 39 .6 84 .1 77 .1 44 .1 5. 4 36 .2 42 .4 54 S ou th E as t 98 .8 88 .3 84 .4 78 .7 99 .5 97 89 96 .2 49 .1 96 .7 93 .6 67 .9 0. 5 53 .6 71 12 1 M ek on g R iv er D el ta 93 .7 92 .7 87 .8 72 .1 89 .2 84 .6 73 .8 84 .6 52 .4 87 .9 74 .9 59 .2 4. 8 33 .3 54 .6 11 4 A re a U rb an 97 .5 93 .6 87 .1 77 97 .8 93 .1 82 .3 95 .2 58 .3 93 .9 88 .4 65 0. 6 52 63 .3 23 2 R ur al 94 .6 90 .8 82 .8 65 .1 92 .4 83 .9 70 .7 90 .9 43 .7 89 .2 74 .7 51 .7 2. 9 34 .8 46 .5 52 7 M ot he r’s e du ca tio n N on e (7 0. 9) (6 1. 9) (5 0. 9) (2 7. 9) (6 2. 8) (5 0. 3) (3 5. 3) (6 4. 8) (1 8. 5) (5 9. 6) (4 8. ) (3 1. 6) (2 3. 5) (1 4. 2) (1 7. 3) 33 P rim ar y 92 .2 89 76 .8 60 89 .4 78 .5 66 .2 85 .4 35 .6 87 .3 76 .4 53 .5 5. 2 37 .2 47 .8 11 3 lo w er S ec on da ry 96 .5 93 .8 87 .2 70 .4 95 .1 87 .7 75 .5 95 .2 46 .2 90 .3 78 .9 54 .6 0. 9 37 .9 50 .3 30 0 U pp er S ec on da ry 98 .5 91 .7 86 .3 73 97 .5 91 79 .2 96 .8 51 .7 92 .1 81 .4 56 .6 0. 4 44 .5 56 .1 14 4 Te rti ar y 97 .9 95 .1 87 .8 75 .5 98 .3 93 .7 80 .5 92 .6 62 .5 97 .7 84 63 .3 0 47 59 .6 16 8 W ea lth in de x qu in til e P oo re st 88 .4 86 .3 69 .2 55 .6 86 .7 71 .5 60 .4 85 .4 28 .1 85 .4 62 .9 44 .7 6 30 .4 37 .9 16 5 S ec on d 97 .4 98 .3 94 .3 72 92 .8 85 .2 72 .4 94 .4 47 .8 85 .9 79 .7 53 .8 1. 7 37 .8 57 .6 13 1 M id dl e 97 .3 92 .9 88 66 .1 95 .6 88 .7 74 .1 95 .2 50 .4 91 .3 81 55 .2 0. 4 37 .4 42 .5 14 4 Fo ur th 96 .9 87 .8 84 .1 71 95 .1 91 .9 78 .1 91 .1 55 .8 90 .7 80 .4 61 .2 2. 7 43 .6 52 .4 14 5 R ic he st 98 93 .9 87 .3 78 .9 99 .7 96 85 .5 95 .4 59 98 .5 90 .2 63 .6 0 50 .3 67 .2 17 4 Et hn ic ity o f h ou se ho ld h ea d K in h/ H oa 97 .7 93 .6 87 .6 71 .6 96 .5 90 .6 78 .2 93 .9 53 .3 92 81 .1 57 .6 1. 1 40 .9 53 .2 64 6 E th ni c M in or iti es 82 .5 80 .1 64 .3 52 .8 79 .8 63 .7 51 .2 82 .4 18 .2 82 .8 63 .6 45 .5 8. 5 35 .1 42 .6 11 3 To ta l 95 .5 91 .7 84 .1 68 .7 94 .1 86 .7 74 .3 92 .2 48 .2 90 .6 78 .9 55 .8 2. 2 40 .1 51 .6 75 9 § Th is in di ca to r e xc lu de s H ep at iti s B a t b irt h. In V ie t N am , t he n ew P en ta va le nt v ac ci ne (c om bi ni ng th e fo llo w in g 5 an tig en s: d P T, H ep at iti s B a nd H ib ) w as in tro du ce d in J un e 20 10 . T he re fo re , a ch ild is c on si de re d to h av e re ce iv ed a ll va cc in at io n if he /s he (1 ) r ec ei ve d b C G , P ol io 1 -3 , D P T 1- 3, H ep at iti s b 1 -3 a nd M ea sl es o r ( 2) re ce iv ed P en ta va le nt 1 -3 , P ol io 1 -3 , b C G a nd M ea sl es N ot e: Fi gu re s sh ow n in p ar en th es is a re b as ed o n de no m in at or s of 2 5- 49 u n- w ei gh te d ca se s 78 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Neonatal Tetanus Protection MdG 5 is to reduce by three quarters the maternal mortality ratio, with one strategy being to eliminate maternal tetanus. Another goal is to reduce the incidence of neonatal tetanus to less than 1 case per 1,000 live births. One of the A World Fit for Children goals is to eliminate maternal and neonatal tetanus by 2005. Prevention of maternal and neonatal tetanus requires assuring that all pregnant women receive at least two doses of tetanus toxoid vaccine. However, if women have not received two doses of the vaccine during the pregnancy, they (and their newborn) are also considered to be protected, if the following conditions are met: ● Received at least two doses of tetanus toxoid vaccine, the last within the past three years; ● Received at least three doses, the last within the past five years; ● Received at least four doses, the last within the past ten years; ● Received at least five doses during lifetime. Table CH.3 shows the tetanus protection status of women who have had a live birth within the last two years. Figure CH.2 shows the protection of women against neonatal tetanus by major background characteristics. 79VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Table CH.3: Neonatal tetanus protection Percentage of women aged 15-49 years with a live birth in the last two years protected against neonatal tetanus, Viet Nam, 2011 Percentage of women who received at least two doses during last pregnancy Percentage of women who did not receive two or more doses during their last pregnancy but received: Protected against tetanus1 Number of women with a live birth in the last two years two doses, the last within the past three years three doses, the last within the past five years four doses, the last within the past ten years Region Red River Delta 64.6 20.5 0 0 85.1 294 Northern Midland and Mountain areas 60.6 14 0 0.4 74.9 285 North Central area and Central Coastal area 63.6 15 0 0 78.6 287 Central Highlands 55 16.7 0.7 0.2 72.6 92 South East 60.7 17.1 0.3 0.5 78.7 214 Mekong River Delta 56.6 13.2 0 0 69.8 210 Area Urban 61.9 17.9 0.1 0 80 402 Rural 60.8 15.4 0.1 0.2 76.5 980 Women’s education None 22.5 8.2 0 0 30.6 64 Primary 49.9 18.1 0.3 0 68.3 203 lower Secondary 61.5 16.5 0.1 0 78.1 523 Upper Secondary 68.1 17.3 0 0 85.4 296 Tertiary 69.6 14.6 0.1 0.8 85.1 295 Wealth index quintile Poorest 49.7 10.8 0 0 60.5 300 Second 65.5 15.8 0.3 0.4 81.9 263 Middle 64.8 19 0 0 83.8 251 Fourth 64.6 15 0.3 0.4 80.3 270 Richest 62.5 20.2 0 0.1 82.8 299 Ethnicity of household head Kinh/Hoa 63.6 17.2 0.1 0.1 81 1158 Ethnic Minorities 48.3 10.4 0 0.5 59.2 225 Total 61.1 16.1 0.1 0.2 77.5 1383 1 MICS indicator 3.7 Table CH.3 shows that 77.5 per cent of women aged 15–49 years with a live birth in the last two years are protected against tetanus.There is a considerable differential in tetanus protection by ethnicity groups. About 81 per cent of women living in Kinh/Hoa households are protected against tetanus while only 59.2 per cent among women living in ethnic minority households are protected. The widest gap, however, is observed across women’s education levels. There is a 54 percentage point difference between women with tertiary and those with no education. The likelihood of being protected against tetanus doubles between women with no education and those with at least primary education. Regional differentials show that in the Red River delta 85.1 per cent of women of reproductive age who had a live birth in the last two years are protected against tetanus, while the percentage is about 69.8 among women living in the Mekong River delta. living standards also influence the prevalence of tetanus protection. About 80 per cent of women in the second, third, fourth, and fifth wealth index quintiles are protected against tetanus. A large disparity is observed for women in the poorest households, with only 60.5 per cent of women protected against neonatal tetanus. 80 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Figure CH.2: Percentage of women with a live birth in the last two years protected against neonatal tetanus, Viet Nam, 2011 Oral Rehydration Treatment diarrhoea is the second leading cause of death among children under age 5 worldwide. Most diarrhoea-related deaths in children are due to dehydration from loss of large quantities of water and electrolytes from the body in liquid stools. Management of diarrhoea – either through oral rehydration salts (ORS) or a recommended home fluid (RHF) – can prevent many of these deaths. Preventing dehydration and malnutrition by increasing fluid intake and continuing to feed the child are also important strategies for managing diarrhoea. The goals are to: 1) reduce by one half the deaths due to diarrhoea among children under age 5 by 2010 compared to 2000 (A World Fit for Children); and 2) reduce by two thirds the mortality rate among children under age 5 by 2015 compared to 1990 (MdG). In addition, A World Fit for Children calls for a reduction in the incidence of diarrhoea by 25 per cent. 81VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN The indicators are: ● Prevalence of diarrhoea ● Oral rehydration therapy (ORT) ● Home management of diarrhoea ● ORT with continued feeding In the Viet Nam MICS 2011 questionnaire, mothers (or caregivers) were asked to report whether their child had diarrhoea in the two weeks prior to the survey. If so, the mother was asked a series of questions about what and how much the child was given to drink and eat during the episode and whether this was more or less than usual. Overall, 7.4 per cent of children under age 5 had diarrhoea in the two weeks preceding the survey (Table CH.4). The peak of diarrhoea prevalence occurs in the infancy period, among children aged 0–11 months. diarrhoea prevalence varies across regions. More than 10 per cent of children under age 5 had diarrhoea in the Northern Midland and Mountain areas, compared to the lowest level at 5 per cent in the South East. This indicates that a child in the Northern Midland and Mountain areas is twice as likely to have diarrhoea than a child in the South East. Ethnic differentials indicate that 11.6 per cent of children living in ethnic minority households had diarrhoea in the last two weeks compared with 6.6 per cent of children in Kinh/Hoa households. It can also be observed that the younger the child, the more likely it is to suffer from diarrhoea. Indeed, the incidence of diarrhoea decreases substantially as age increases, from 13 per cent among children aged 0–11 months to 2.8 per cent for children aged 48–59 months. 82 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Ta bl e C H .4 : O ra l r eh yd ra tio n so lu tio ns a nd r ec om m en de d ho m em ad e flu id s P er ce nt ag e of c hi ld re n ag ed 0 -5 9 m on th s w ith d ia rr ho ea in th e la st tw o w ee ks , a nd tr ea tm en t w ith o ra l r eh yd ra tio n so lu tio ns a nd re co m m en de d ho m em ad e flu id s, V ie t N am , 2 01 1 H ad di ar rh oe a in la st tw o w ee ks N um be r of c hi ld re n ag e 0- 59 m on th s C hi ld re n w ith d ia rr ho ea w ho re ce iv ed : N um be r o f c hi ld re n ag ed 0 -5 9 m on th s w ith d ia rr ho ea in la st tw o w ee ks O R S (F lu id fr om O R S pa ck et o r p re - pa ck ag ed O R S fl ui d) R ec om m en de d ho m em ad e flu id s O R S o r a ny re co m m en de d ho m em ad e flu id R ic e po rr id ge / r ic e so up le m on /o ra ng e/ co co nu t d rin k S ou p w at er fro m b oi le d ve ge ta bl es A ny re co m m en de d ho m em ad e flu id Se x M al e 7. 4 18 69 55 10 .6 8. 8 33 .5 42 .1 70 .3 13 8 Fe m al e 7. 3 18 09 37 .7 7. 7 14 .4 34 .2 43 .6 60 .7 13 2 R eg io n R ed R iv er D el ta 8 79 8 49 .3 0. 9 15 .7 42 .9 45 .2 69 .5 64 N or th er n M id la nd a nd M ou nt ai n ar ea s 10 .4 70 7 34 .8 11 .4 7. 5 35 .4 44 .3 63 .8 74 N or th C en tra l a re a an d C en tra l C oa st al a re a 6. 9 71 9 60 .8 23 .2 3. 8 27 41 .6 66 .8 49 C en tra l H ig hl an ds 6. 3 23 3 * * * * * * 15 S ou th E as t 5 57 2 (6 0. 8) (7 .7 ) (1 9. 4) (2 8. 7) (3 6. 6) (6 9. 4) 28 M ek on g R iv er D el ta 6. 2 65 0 (3 3. 3) (2 .7 ) (1 7. 7) (3 3. ) (4 5. 9) (5 6. 6) 40 A re a U rb an 5. 3 10 13 47 .3 8. 4 17 33 .4 43 .6 64 .6 54 R ur al 8. 1 26 65 46 .3 9. 4 10 .1 33 .9 42 .6 65 .9 21 6 A ge (m on th s) 0- 11 13 66 8 51 .2 8. 2 2. 3 15 .5 24 61 .4 87 12 -2 3 10 .4 75 9 48 .6 16 .4 17 .8 41 .3 52 .2 65 .4 79 24 -3 5 6. 9 79 2 45 .1 4. 8 15 .6 41 .9 48 71 .8 55 36 -4 7 4 76 4 (3 2. 4) (6 .7 ) (1 3. 7) (4 0. 6) (5 1. 8) (5 9. 5) 30 48 -5 9 2. 8 69 5 * * * * * * 19 83VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Ta bl e C H .4 : O ra l r eh yd ra tio n so lu tio ns a nd r ec om m en de d ho m em ad e flu id s P er ce nt ag e of c hi ld re n ag e 0- 59 m on th s w ith d ia rr ho ea in th e la st tw o w ee ks , a nd tr ea tm en t w ith o ra l r eh yd ra tio n so lu tio ns a nd re co m m en de d ho m em ad e flu id s, V ie t N am , 2 01 1 H ad di ar rh oe a in la st tw o w ee ks N um be r of c hi ld re n ag e 0- 59 m on th s C hi ld re n w ith d ia rr ho ea w ho re ce iv ed : N um be r o f c hi ld re n ag e 0- 59 m on th s w ith d ia rr ho ea in la st tw o w ee ks O R S (F lu id fr om O R S pa ck et o r p re - pa ck ag ed O R S fl ui d) R ec om m en de d ho m em ad e flu id s O R S o r a ny re co m m en de d ho m em ad e flu id R ic e po rr id ge / r ic e so up le m on /o ra ng e/ co co nu t d rin k S ou p w at er fro m b oi le d ve ge ta bl es A ny re co m m en de d ho m em ad e flu id M ot he r’s e du ca tio n N on e 10 20 7 * * * * * * 21 P rim ar y 7. 5 65 8 (2 2. 5) (4 .9 ) (4 .1 ) (2 3. 6) (3 0. 6) (4 7. 5) 49 lo w er S ec on da ry 7. 4 14 79 47 .4 13 .3 13 .6 35 .9 48 .6 70 .2 11 0 U pp er S ec on da ry 6. 7 67 0 (5 8. 7) (1 0. 3) (1 5. 8) (4 2. 6) (4 6. 6) (7 5. ) 45 Te rti ar y 6. 9 66 4 (5 7. 2) (3 .8 ) (1 4. 3) (3 5. 6) (4 2. 6) (6 4. 7) 46 W ea lth in de x qu in til e P oo re st 9. 4 83 1 34 .9 10 .4 8 33 .7 42 .1 63 .5 78 S ec on d 7. 3 67 3 (4 3. 4) (9 .8 ) (2 .9 ) (2 7. 2) (3 6. 2) (6 1. 5) 49 M id dl e 7. 4 70 0 61 .4 6. 8 18 .8 44 .2 53 .6 81 .4 52 Fo ur th 6. 3 74 9 (4 6. 8) (1 2. 8) (1 1. 1) (2 5. 7) (3 5. ) (4 7. 9) 47 R ic he st 6. 1 72 5 (5 2. 7) (5 .1 ) (1 9. 1) (3 8. ) (4 7. 2) (7 4. 5) 44 Et hn ic ity o f h ou se ho ld h ea d K in h/ H oa 6. 6 31 43 49 9. 6 14 .4 34 .4 44 .8 66 .2 20 8 E th ni c M in or iti es 11 .6 53 5 38 .1 7. 8 2 32 .1 43 .8 67 .4 62 To ta l 7. 4 36 78 46 .5 9. 2 11 .5 33 .8 42 .8 65 .6 27 0 N ot e: Fi gu re s de no te d by a n as te ris k a re b as ed o n de no m in at or s of 2 4 un -w ei gh te d ca se s an d le ss Fi gu re s sh ow n in p ar en th es is a re b as ed o n de no m in at or s of 2 5- 49 u n- w ei gh te d ca se s 84 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Table CH.4 also shows the percentage of children receiving various types of recommended liquids during the episode of diarrhoea. Since mothers were allowed to name more than one type of liquid, the percentages do not necessarily add to 100. About 46.5 per cent received fluids from ORS packets or pre-packaged ORS fluids. ORS is the rehydration treatment of choice for children with diarrhoea in the North Central area and Central Coast area and the South East. Recommended homemade fluids were given to 42.8 per cent of children who experienced diarrhoea in the last two weeks preceding the survey. Among the fluids, soup water from boiled vegetables was the most prevalent, given in 33.8 per cent of cases. It is interesting to note that ORS packets are the rehydration treatment of choice given to boys (55 per cent for boys versus 37.7 per cent for girls), whereas homemade fluids are the treatment of choice for girls (43.6 per cent versus 42.1 per cent). Some 65.6 per cent of children with diarrhoea received ORS or any recommended homemade fluid. About 70.3 per cent of boys with diarrhoea received ORS or any recommended homemade fluid compared to 60.7 per cent of girls. No notable disparities for ORS or any recommended homemade fluid preference are observed between urban and rural areas, and between Kinh/Hoa and ethnic minority households. less than one third (28.6 per cent) of children under age 5 with diarrhoea were given more than the usual amount to drink while 45.4 per cent were given the same amount (Table CH.5). Giving the child more to drink during diarrhoea is similar in the Red River delta and Northern Midland and Mountain areas, with 36.6 and 35.6 per cent, respectively, while it is less practised in the other regions. About one in three children (36.4 per cent) with diarrhoea were given somewhat less to eat than normal. 42.8 per cent of children were given the same amount to eat or more (continued feeding) and 16.9 per cent were given much less to eat during the episode of diarrhoea. There are considerable differences in continued eating practices by ethnicity, with as many as 20 per cent of children aged 0–59 months in Kinh/Hoa households being given much less to eat, compared with only 6.5 per cent of children in ethnic minority households. 85VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Ta bl e C H .5 : F ee di ng p ra ct ic es d ur in g di ar rh oe a P er ce nt ag e di st rib ut io n of c hi ld re n ag ed 0 –5 9 m on th s w ith d ia rr ho ea in th e la st tw o w ee ks b y am ou nt o f l iq ui ds a nd fo od g iv en d ur in g ep is od e of d ia rr ho ea , V ie t N am , 2 01 1 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 D rin ki ng p ra ct ic es d ur in g di ar rh oe a: Ea tin g pr ac tic es d ur in g di ar rh oe a: N um be r o f ch ild re n ag ed 0– 59 m on th s w ith d ia rr ho ea in la st tw o w ee ks G iv en m uc h le ss to dr in k G iv en so m ew ha t le ss to dr in k G iv en ab ou t th e sa m e to dr in k G iv en m or e to dr in k G iv en no th in g to d rin k G iv en m uc h le ss to ea t G iv en so m ew ha t le ss to e at G iv en ab ou t th e sa m e to e at G iv en m or e to e at S to pp ed fo od N ev er be en gi ve n fo od be fo re To ta l To ta l Se x M al e 7. 4 18 69 5. 3 19 42 .7 33 0 10 0 13 .5 39 .4 40 3. 5 1. 7 1. 9 10 0 13 8 Fe m al e 7. 3 18 09 5. 6 20 .6 48 .3 24 .1 1 10 0 20 .4 33 .4 38 .6 3. 5 0 4. 2 10 0 13 2 R eg io n R ed R iv er D el ta 8 79 8 0 8. 3 55 .1 36 .6 0 10 0 11 .1 29 52 .6 3. 7 0 3. 6 10 0 64 N or th er n M id la nd a nd M ou nt ai n ar ea s 10 .4 70 7 3. 6 16 44 .7 35 .6 0. 1 10 0 9. 6 46 .3 35 .9 7. 4 0. 5 0. 3 10 0 74 N or th C en tra l a re a an d C en tra l C oa st al a re a 6. 9 71 9 (6 .3 ) (3 2. 1) (3 6. 7) (2 3. 6) (0 ) 10 0 (2 2. 9) (4 0. 8) (3 1. 3) (0 ) (0 ) (5 ) 10 0 49 C en tra l H ig hl an ds 6. 3 23 3 * * * * * 10 0 * * * * * * 10 0 15 S ou th E as t 5 57 2 (1 1. 1) (2 6. 1) (4 6. 4) (1 6. 4) (0 ) 10 0 (1 8. 3) (3 4. 9) (3 4. 3) (1 .9 ) (2 .1 ) (8 .5 ) 10 0 28 M ek on g R iv er D el ta 6. 2 65 0 (9 .7 ) (2 2. 5) (4 1) (2 4. 9) (1 .9 ) 10 0 (2 7. 1) (2 7. 8) (3 9. 5) (2 .7 ) (2 .9 ) (0 ) 10 0 40 A re a U rb an 5. 3 10 13 7. 1 27 .2 32 .6 31 .6 1. 5 10 0 19 .2 30 .4 44 .8 2. 6 0 2. 9 10 0 54 R ur al 8. 1 26 65 5 18 48 .6 27 .9 0. 2 10 0 16 .3 37 .9 37 .9 3. 7 1. 1 3. 1 10 0 21 6 A ge (m on th s) 0– 11 13 66 8 4. 2 15 .1 60 .2 20 0. 5 10 0 14 26 .8 44 5. 7 1. 8 7. 8 10 0 87 12 –2 3 10 .4 75 9 4. 9 25 .2 39 .4 30 .4 0 10 0 21 38 .2 35 .9 2. 8 0. 2 1. 9 10 0 79 24 –3 5 6. 9 79 2 6. 6 18 .6 47 .4 27 .2 0. 2 10 0 7 42 .4 49 .1 0. 5 1. 1 0 10 0 55 36 –4 7 4 76 4 (3 .1 ) (2 2. 2) (3 5. 8) (3 6. 4) (2 .5 ) 10 0 (2 5. 2) (4 0. 1) (3 1. 1) (3 .6 ) (0 ) (0 ) 10 0 30 48 –5 9 2. 8 69 5 (1 3. 7) (1 8. 5) (1 2. 4) (5 2) (0 ) 10 0 (2 8. 3) (4 9. 8) (1 6. 9) (5 ) (0 ) (0 ) 10 0 19 M ot he r’s e du ca tio n N on e 10 20 7 * * * * * 10 0 * * * * * * 10 0 21 P rim ar y 7. 5 65 8 (1 0. 3) (1 9. 9) (4 7. 9) (1 9. 2) (1 .5 ) 10 0 (2 3. 1) (4 3. 1) (3 2. 2) (0 ) (.3 ) (1 .3 ) 10 0 49 lo w er S ec on da ry 7. 4 14 79 5 17 .4 47 .6 29 .9 0. 1 10 0 15 39 .5 41 .8 2 1. 6 0 10 0 11 0 U pp er S ec on da ry 6. 7 67 0 (0 ) (1 9. 8) (4 9. 3) (2 9. 9) (1 ) 10 0 (1 3. 2) (3 3. 1) (4 5. 7) (4 .7 ) (.9 ) (2 .5 ) 10 0 45 Te rti ar y 6. 9 66 4 (9 ) (2 2. 8) (3 4. 6) (3 3. 6) (0 ) 10 0 (1 4. 7) (2 6. 6) (3 5. 7) (8 .9 ) (0 ) (1 4. 1) 10 0 46 86 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Ta bl e C H .5 : F ee di ng p ra ct ic es d ur in g di ar rh oe a P er ce nt ag e di st rib ut io n of c hi ld re n ag ed 0 –5 9 m on th s w ith d ia rr ho ea in th e la st tw o w ee ks b y am ou nt o f l iq ui ds a nd fo od g iv en d ur in g ep is od e of d ia rr ho ea , V ie t N am , 2 01 1 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 D rin ki ng p ra ct ic es d ur in g di ar rh oe a: Ea tin g pr ac tic es d ur in g di ar rh oe a: N um be r o f ch ild re n ag ed 0– 59 m on th s w ith d ia rr ho ea in la st tw o w ee ks G iv en m uc h le ss to dr in k G iv en so m ew ha t le ss to dr in k G iv en ab ou t th e sa m e to dr in k G iv en m or e to dr in k G iv en no th in g to d rin k G iv en m uc h le ss to ea t G iv en so m ew ha t le ss to e at G iv en ab ou t th e sa m e to e at G iv en m or e to e at S to pp ed fo od N ev er be en gi ve n fo od be fo re To ta l To ta l W ea lth in de x qu in til e P oo re st 9. 4 83 1 4. 5 20 .8 42 .1 31 .6 0. 1 10 0 11 .6 50 .1 34 .4 2. 3 1. 5 0 10 0 78 S ec on d 7. 3 67 3 (3 .7 ) (1 5. 2) (5 8. 3) (2 2. 8) (0 ) 10 0 (1 3. 3) (2 9. 2) (4 9. 9) (5 .7 ) (1 .1 ) (0 .9 ) 10 0 49 M id dl e 7. 4 70 0 9. 1 23 40 .6 26 .4 0. 9 10 0 28 .7 26 .3 29 .9 5. 7 1. 2 8. 1 10 0 52 Fo ur th 6. 3 74 9 (6 .3 ) (1 5. 6) (4 9. 1) (2 7. 4) (1 .6 ) 10 0 21 (2 8. 5) (4 1. 6) (1 .1 ) (0 ) (7 .7 ) 10 0 47 R ic he st 6. 1 72 5 (3 .8 ) (2 3. 8) (3 8. 7) (3 3. 7) (0 ) 10 0 11 .8 (4 0. 4) (4 4. 6) (3 .2 ) (0 ) (0 ) 10 0 44 Et hn ic ity o f h ou se ho ld h ea d K in h/ H oa 6. 6 31 43 6 20 .7 43 .8 29 .1 0. 4 10 0 20 33 .3 38 .3 3. 8 1. 1 3. 6 10 0 20 8 E th ni c M in or iti es 11 .6 53 5 3. 4 16 .8 50 .8 27 .1 0. 9 10 0 6. 5 47 42 .6 2. 7 0 1. 2 10 0 62 To ta l 7. 4 36 78 5. 4 19 .8 45 .4 28 .6 0. 5 10 0 16 .9 36 .4 39 .3 3. 5 0. 9 3. 1 10 0 27 0 N ot e: Fi gu re s de no te d by a n as te ris k a re b as ed o n de no m in at or s of 2 4 un -w ei gh te d ca se s an d le ss Fi gu re s sh ow n in p ar en th es is a re b as ed o n de no m in at or s of 2 5- 49 u n- w ei gh te d ca se s 87VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Table CH.6 presents the proportion of children aged 0–59 months with diarrhoea in the last two weeks who received oral rehydration therapy with continued feeding, and the percentage of children with diarrhoea who received other treatments. Overall, more than half of all the children (58.2 per cent) with diarrhoea received ORS or increased fluids and 70.5 per cent received oral rehydration therapy (ORS or recommended homemade fluids or increased fluids). Most background characteristics indicate unclear patterns. However, it is clear that ORT use is higher among older children, boys and those living in ethnic minority households. For example, about 75.9 per cent of boys receive ORT compared with 64.8 per cent of girls. Combining the indicators in Table CH.5 and Table CH.4 on oral rehydration therapy, it is observed that 56.7 per cent of children received both oral rehydration therapy (ORT) and continued feeding, as is recommended. The same background characteristics, child age, sex and ethnicity of the household head, show differentials for the indicator ORT with continued feeding. The Northern Midland and Mountain areas show the highest percentage of children receiving ORT with continued feeding at 64.1 per cent. About a quarter of children with diarrhoea in the last two weeks were given antibiotics (pill, syrup or injection), which is the highest percentage among all treatments given. Still, 5.6 per cent of children with diarrhoea did not receive any treatment or drug. Gender disparities are observed in the use of antibiotics for diarrhoea treatment, with as many as 30.1 per cent of girls aged 0-59 months with diarrhoea receiving antibiotics, compared to 18 per cent of boys. 88 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Ta bl e C H .6 : O ra l r eh yd ra tio n th er ap y w ith c on tin ue d fe ed in g an d ot he r t re at m en ts P er ce nt ag e of c hi ld re n ag ed 0 –5 9 m on th s w ith d ia rr ho ea in th e la st tw o w ee ks w ho re ce iv ed o ra l r eh yd ra tio n th er ap y w ith c on tin ue d fe ed in g, a nd p er ce nt ag e of c hi ld re n w ith d ia rr ho ea w ho re ce iv ed o th er tr ea tm en ts , V ie t N am , 2 01 1 C hi ld re n w ith d ia rr ho ea w ho re ce iv ed : O th er tr ea tm en ts : N ot g iv en an y tre at m en t or d ru g N um be r of c hi ld re n ag ed 0 –5 9 m on th s w ith di ar rh oe a in la st tw o w ee ks O R S o r in cr ea se d flu id s O R T (O R S or re co m - m en de d ho m em ad e flu id s or in cr ea se d flu id s) O R T w ith co nt in ue d fe ed in g1 Pi ll or s yr up In je ct io n In tra - ve no us th er ap y H om e re m ed y, he rb al m ed ic in e O th er A nt i- bi ot ic A nt i- m ot ili ty dr ug Zi nc O th er U n- kn ow n A nt i- bi ot ic U n- kn ow n Se x M al e 66 .4 75 .9 64 .4 18 5. 3 0. 9 10 .9 20 .1 1. 7 2 3. 3 6. 7 28 .1 5. 9 13 8 Fe m al e 49 .7 64 .8 48 .8 30 .1 7. 4 1 6. 2 18 .9 1. 3 6. 3 1. 3 9. 9 28 .1 5. 3 13 2 R eg io n R ed R iv er D el ta 54 .4 69 .5 57 23 .7 6. 2 3. 6 11 .2 19 .1 6. 3 5. 4 5 0 46 .1 4. 7 64 N or th er n M id la nd a nd M ou nt ai n ar ea s 58 .9 74 .2 64 .1 26 3. 3 0 9. 5 11 0 5. 3 0 22 .5 19 .4 8 74 N or th C en tra l a re a an d C en tra l C oa st al a re a (6 5. 4) (7 0. 1) (5 2. 9) (3 2. 4) (1 2. 6) (0 ) (8 .2 ) (1 9. 7) (0 ) (0 ) (6 .3 ) (5 ) (1 9. 5) (9 .6 ) 49 C en tra l H ig hl an ds * * * * * * * * * * * * * * 15 S ou th E as t (6 3. 3) (7 1. 9) (5 9. 7) (7 .9 ) (9 .5 ) (0 ) (4 ) (3 2. 1) (0 ) (3 .6 ) (0 ) (0 ) (2 9. 8) (0 ) 28 M ek on g R iv er D el ta (5 0. 8) (6 3. 1) (4 4. 7) (2 4. 4) (2 .5 ) (0 ) (4 .7 ) (2 7. 5) (0 ) (5 .8 ) (0 ) (7 ) (3 1. 6) (0 ) 40 A re a U rb an 58 .5 71 56 .8 25 .6 7. 7 3. 1 10 .7 18 .5 0 2. 8 0 1. 5 30 .9 1. 5 54 R ur al 58 .2 70 .3 56 .7 23 .5 6 0. 4 8. 1 19 .8 1. 9 4. 4 2. 9 9. 9 27 .4 6. 6 21 6 A ge (m on th s) 0– 11 54 .8 62 .8 49 .1 20 3. 3 1. 6 4. 8 11 0 2. 7 0 10 .3 32 9. 5 87 12 –2 3 61 .2 69 .8 53 .8 35 .4 9. 3 0. 4 15 .5 29 .1 2. 2 4. 9 6. 1 5. 4 33 .4 1. 7 79 24 –3 5 55 .4 76 .2 68 .8 19 12 .5 0 7. 2 18 .4 4. 2 7. 1 2. 6 9. 4 13 .8 5. 4 55 36 –4 7 (5 3. 9) (7 1) (5 6. 9) (8 .8 ) (0 ) (3 .1 ) (9 ) (1 7. 5) (0 ) (3 .3 ) (0 ) (7 .7 ) (3 2. 1) (6 ) 30 48 –5 9 * * * * * * * * * * * * * * 19 89VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Ta bl e C H .6 : O ra l r eh yd ra tio n th er ap y w ith c on tin ue d fe ed in g an d ot he r t re at m en ts P er ce nt ag e of c hi ld re n ag ed 0 –5 9 m on th s w ith d ia rr ho ea in th e la st tw o w ee ks w ho re ce iv ed o ra l r eh yd ra tio n th er ap y w ith c on tin ue d fe ed in g, a nd p er ce nt ag e of c hi ld re n w ith d ia rr ho ea w ho re ce iv ed o th er tr ea tm en ts , V ie t N am , 2 01 1 C hi ld re n w ith d ia rr ho ea w ho re ce iv ed : O th er tr ea tm en ts : N ot g iv en an y tre at m en t or d ru g N um be r of c hi ld re n ag ed 0 –5 9 m on th s w ith di ar rh oe a in la st tw o w ee ks O R S o r in cr ea se d flu id s O R T (O R S or re co m - m en de d ho m em ad e flu id s or in cr ea se d flu id s) O R T w ith co nt in ue d fe ed in g1 Pi ll or s yr up In je ct io n In tra - ve no us th er ap y H om e re m ed y, he rb al m ed ic in e O th er A nt i- bi ot ic A nt i- m ot ili ty dr ug Zi nc O th er U n- kn ow n A nt i- bi ot ic U n- kn ow n M ot he r’s e du ca tio n N on e * * * * * * * * * * * * * * 21 P rim ar y 37 .3 56 .1 46 9. 9 3. 6 0 8. 1 15 0 3 0 21 7. 5 17 .6 49 lo w er S ec on da ry 61 .5 74 61 .6 26 .7 6. 2 0 6. 8 27 1. 6 4. 3 2. 8 5. 4 35 .3 2. 1 11 0 U pp er S ec on da ry (7 0. 4) (7 9. 8) (6 7. 3) (2 5. 3) (3 ) (5 .8 ) (6 .2 ) (2 1. 5) (5 .1 ) (8 .2 ) (3 .9 ) (1 .8 ) (1 9. 5) (5 .5 ) 45 Te rti ar y (6 0. 7) (6 8. 2) (4 8) (3 2. 9) (1 5. 5) (0 ) (1 9. 8) (6 .2 ) (0 ) (0 ) (3 .1 ) (5 .3 ) (4 6. 5) (2 ) 46 W ea lth in de x qu in til e P oo re st 51 .9 70 .2 57 .8 23 2. 3 0 6. 6 12 .3 0 7. 3 3. 9 17 .9 15 .7 10 .3 78 S ec on d 59 .4 67 .2 62 .1 18 .4 6. 3 0 2. 5 10 .5 4. 7 4. 4 3. 6 11 .5 32 .8 6. 1 49 M id dl e 68 .8 81 .4 56 .4 18 .7 0 0 11 .7 43 .4 3. 4 3. 3 0 0. 4 36 .7 3. 8 52 Fo ur th (5 3. 8) (5 5) (4 0. 7) (2 9. 4) (1 5) (2 ) (7 .5 ) (2 1) (0 ) (1 .1 ) (0 ) (5 .2 ) (3 1. 3) (4 .2 ) 47 R ic he st (6 0. 5) (7 8. 1) (6 6. 3) (3 1. 7) (1 1. 7) (3 .8 ) (1 6. 5) (1 2. 9) (0 ) (2 .3 ) (3 .2 ) (0 ) (3 1. 2) (0 ) 44 Et hn ic ity o f h ou se ho ld he ad K in h/ H oa 58 .5 68 .5 53 .4 25 .5 8 1. 2 9. 4 22 .4 1. 9 3. 3 3 4. 1 33 .9 3. 8 20 8 E th ni c M in or iti es 57 .4 77 .1 70 .1 18 .5 0. 7 0 6. 1 10 .1 0 6. 9 0 22 .1 8. 6 11 .5 62 To ta l 58 .2 70 .5 56 .7 23 .9 6. 3 1 8. 6 19 .5 1. 5 4. 1 2. 3 8. 2 28 .1 5. 6 27 0 N ot e: Fi gu re s de no te d by a n as te ris k a re b as ed o n de no m in at or s of 2 4 un -w ei gh te d ca se s an d le ss Fi gu re s sh ow n in p ar en th es is a re b as ed o n de no m in at or s of 2 5- 49 u n- w ei gh te d ca se s 90 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Care Seeking and Antibiotic Treatment of Pneumonia Pneumonia is the leading cause of death of children globally and the use of antibiotics for children under age 5 with presumed pneumonia is a key intervention. One of the A World Fit for Children goals is to reduce by one third the deaths due to acute respiratory infections. Children with suspected pneumonia are those who had an illness with a cough accompanied by rapid or difficult breathing and whose symptoms were not due to a blocked nose. The indicators are: ● Prevalence of suspected pneumonia ● Care seeking for suspected pneumonia ● Antibiotic treatment for suspected pneumonia ● Knowledge of the danger signs of pneumonia 91VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Ta bl e C H .7 : C ar e se ek in g fo r s us pe ct ed p ne um on ia a nd a nt ib io tic u se d ur in g su sp ec te d pn eu m on ia P er ce nt ag e of c hi ld re n ag ed 0 -5 9 m on th s w ith s us pe ct ed p ne um on ia in th e la st tw o w ee ks w ho w er e ta ke n to a h ea lth c ar e pr ov id er a nd p er ce nt ag e of c hi ld re n w ho w er e gi ve n an tib io tic s, V ie t N am , 2 01 1 H ad su sp ec te d pn eu m on ia in th e 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 s us pe ct ed p ne um on ia w ho w er e ta ke n to : A ny ap pr op ria te pr ov id er 1§ P er ce nt ag e of ch ild re n w ith su sp ec te d pn eu m on ia w ho re ce iv ed an tib io tic s in th e la st tw o w ee ks 2 N um be r o f ch ild re n ag ed 0- 59 m on th s w ith s us pe ct ed pn eu m on ia in th e la st tw o w ee ks Pu bl ic s ou rc es Pr iv at e so ur ce s Gov. hospital Commune health centre Village health worker Private hospital/ clinic Private physician Private pharmacy Other private facility Relative/ Friend Traditional practitioner Se x M al e 3. 4 18 69 22 .5 28 1. 8 16 .2 13 .3 17 .7 0. 8 0. 6 0 69 .6 69 .7 64 Fe m al e 3. 1 18 09 17 .4 31 .8 2. 4 10 .1 18 .6 12 .5 0 1. 7 0. 6 76 .9 66 .8 56 R eg io n R ed R iv er D el ta 3. 9 79 8 (9 .7 ) (2 5. 3) (3 .8 ) (1 5. ) (8 .6 ) (1 1. 2) (0 ) (0 ) (0 ) (5 8. 6) (8 1. 4) 31 N or th er n M id la nd a nd M ou nt ai n ar ea s 1. 2 70 7 * * * * * * * * * * * 9 N or th C en tra l a re a an d C en tra l C oa st al a re a 5. 4 71 9 (1 8. 9) (3 0. 9) (0 ) (1 0. 4) (4 .9 ) (2 2. 2) (0 ) (2 .5 ) (0 ) (5 8. 5) (5 5. 2) 39 C en tra l H ig hl an ds 3. 8 23 3 * * * * * * * * * * * 9 S ou th E as t 3. 5 57 2 * * * * * * * * * * * 20 M ek on g R iv er D el ta 1. 9 65 0 * * * * * * * * * * * 13 A re a U rb an 2. 3 10 13 * * * * * * * * * * * 23 R ur al 3. 6 26 65 19 .4 33 .5 2. 6 9. 6 16 .8 14 .3 0 1. 4 0. 4 73 .1 66 .7 97 A ge (m on th s) 0- 11 2. 4 66 8 * * * * * * * * * * * 16 12 -2 3 3 75 9 * * * * * * * * * * * 23 24 -3 5 3. 8 79 2 (1 3. 4) (2 0. 8) (3 .9 ) (1 3. 4) (1 5. 3) (1 8. 9) (0 ) (3 .2 ) (0 ) (6 2. 8) (7 6. 2) 30 36 -4 7 3. 4 76 4 (2 7. 3) (2 4. 2) (0 ) (5 .) (1 5. ) (5 .4 ) (0 ) (1 .6 ) (0 ) (6 4. 4) (5 5. 4) 26 48 -5 9 3. 7 69 5 (1 2. 2) (3 4. 8) (0 ) (9 .9 ) (2 0. 1) (2 0. 5) (0 ) (0 ) (0 ) (6 8. 5) (7 2. 1) 26 92 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Ta bl e C H .7 : C ar e se ek in g fo r s us pe ct ed p ne um on ia a nd a nt ib io tic u se d ur in g su sp ec te d pn eu m on ia ** P er ce nt ag e of c hi ld re n ag ed 0 -5 9 m on th s w ith s us pe ct ed s us pe ct ed in th e la st tw o w ee ks w ho w er e ta ke n to a h ea lth p ro vi de r a nd p er ce nt ag e of c hi ld re n w ho w er e gi ve n an tib io tic s, V ie t N am , 20 11 H ad su sp ec te d pn eu m on ia in th e 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 s us pe ct ed p ne um on ia w ho w er e ta ke n to : A ny ap pr op ria te pr ov id er 1§ P er ce nt ag e of ch ild re n w ith su sp ec te d pn eu m on ia w ho re ce iv ed an tib io tic s in th e la st tw o w ee ks 2 N um be r o f ch ild re n ag ed 0- 59 m on th s w ith s us pe ct ed pn eu m on ia in th e la st tw o w ee ks Pu bl ic s ou rc es Pr iv at e so ur ce s Gov. hospital Commune health centre Village health worker Private hospital/ clinic Private physician Private pharmacy Other private facility Relative/ Friend Traditional practitioner M ot he r’s e du ca tio n N on e 2. 6 20 7 * * * * * * * * * * * 5 P rim ar y 3. 4 65 8 * * * * * * * * * * * 23 lo w er S ec on da ry 3. 9 14 79 18 .2 34 .1 0 14 13 .7 10 0 0 0. 6 72 .6 63 .1 57 U pp er S ec on da ry 2. 9 67 0 * * * * * * * * * * * 19 Te rti ar y 2. 4 66 4 * * * * * * * * * * * 16 W ea lth in de x qu in til e P oo re st 4 83 1 (2 .3 ) (5 2. 7) (0 ) (5 .3 ) (7 .7 ) (1 6. 5) (0 ) (0 ) (0 ) (6 7. 9) (4 3. 7) 33 S ec on d 3. 7 67 3 (2 4. 9) (3 2. 7) (0 ) (3 .6 ) (2 1. 4) (2 1. 7) (2 .) (5 .6 ) (0 ) (6 7. 4) (5 3. 7) 25 M id dl e 3 70 0 * * * * * * * * * * * 21 Fo ur th 3. 9 74 9 (1 7. 6) (1 0. 9) (0 ) (2 2. 7) (2 4. 6) (1 4. 8) (0 ) (0 ) (1 .2 ) (6 8. 4) (9 0. 2) 29 R ic he st 1. 7 72 5 * * * * * * * * * * * 12 Et hn ic ity o f h ou se ho ld h ea d K in h/ H oa 3. 4 31 43 18 .3 26 .5 2. 4 14 .5 17 .2 14 .4 0. 5 0. 9 0. 3 72 .1 67 10 8 E th ni c M in or iti es 2. 3 53 5 * * * * * * * * * * * 12 To ta l 3. 3 36 78 20 .1 29 .8 2. 1 13 .3 15 .8 15 .2 0. 4 1. 1 0. 3 73 68 .3 12 0 1 M IC S in di ca to r 3 .9 ; 2 M IC S in di ca to r 3 .1 0 § T hi s in di ca to r i nc lu de s th e fo llo w in g: G ov er nm en t h os pi ta l, C om m un e he al th c en tre , V ill ag e he al th w or ke r, pr iv at e ho sp ita l/c lin ic , p riv at e ph ar m ac y, a nd o th er p riv at e fa ci lit ie s N ot e: Fi gu re s de no te d by a n as te ris k a re b as ed o n de no m in at or s of 2 4 un -w ei gh te d ca se s an d le ss Fi gu re s sh ow n in p ar en th es is a re b as ed o n de no m in at or s of 2 5- 49 u n- w ei gh te d ca se s 93VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Table CH.7 presents results on prevalence of presumed pneumonia, whether care was sought outside the home, and the site of care. Some 3.3 per cent of children aged 0–59 months were reported to have had symptoms of pneumonia during the two weeks preceding the survey. Of these children, 73 per cent were taken to an appropriate health care provider, and 68.3 per cent received antibiotics for presumed pneumonia. The number of observations is small and makes it difficult to further conclude about the differences by background characteristics. Details about the mother’s/caregiver’s knowledge of the danger signs of pneumonia are presented in Table CH.8. The mother’s/caregiver’s knowledge is an important determinant for care-seeking behaviour. Overall, only 5 per cent of mothers/caregivers recognised the two danger signs of pneumonia – fast and difficult breathing. The most commonly identified symptom for taking a child to a health facility is when the child develops a fever (87.1 per cent). Only 10.6 per cent of mothers/caregivers identified fast breathing and 29.1 per cent of mothers/caregivers identified difficult breathing as symptoms for taking children immediately to a health care provider. Although knowledge about the two danger signs of pneumonia is generally low in Viet Nam, there is some indication that the mother’s/ caregiver’s education is a factor. In addition, more mothers/caregivers in the Red River delta know about the two danger signs (8.9 per cent), compared to 0.1 per cent in the Mekong River delta and 2.8 per cent in the Central Highlands. 94 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Ta bl e C H .8 : K no w le dg e of th e tw o da ng er s ig ns o f p ne um on ia P er ce nt ag e of m ot he rs a nd c ar eg iv er s of c hi ld re n ag ed 0 -5 9 m on th s by s ym pt om s th at w ou ld c au se th em to ta ke th e ch ild im m ed ia te ly to a h ea lth fa ci lit y, a nd p er ce nt ag e of m ot he rs w ho re co gn is e fa st a nd d iffi cu lt br ea th in g as s ig ns fo r s ee ki ng c ar e im m ed ia te ly , V ie t N am , 2 01 1 Pe rc en ta ge o f m ot he rs /c ar eg iv er s of 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 sh ou ld b e ta ke n im m ed ia te ly to a h ea lth fa ci lit y if th e ch ild : M ot he rs / c ar eg iv er s w ho re co gn is e th e tw o da ng er s ig ns o f pn eu m on ia N um be r o f m ot he rs / ca re gi ve rs o f ch ild re n ag ed 0 -5 9 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 dr in ki ng po or ly H as o th er sy m pt om s R eg io n R ed R iv er D el ta 14 .8 38 .3 90 .4 13 .8 38 .8 14 8. 4 41 .7 8. 9 65 4 N or th er n M id la nd a nd M ou nt ai n ar ea s 10 .7 43 .1 84 .2 11 .1 25 .3 10 .4 5. 4 25 .4 4. 7 58 9 N or th C en tra l a re a an d C en tra l C oa st al a re a 14 .9 38 .5 90 .4 12 .1 36 .1 8. 7 5. 3 22 .2 7. 4 61 4 C en tra l H ig hl an ds 10 .1 36 .6 79 .5 10 .1 22 .2 6. 7 9. 7 23 .4 2. 8 19 5 S ou th E as t 10 .1 23 .5 86 .1 9 22 .1 5. 4 7. 2 41 3. 7 51 3 M ek on g R iv er D el ta 6. 4 21 .9 86 .2 6. 6 22 .6 1. 5 2. 4 30 .8 0. 1 55 2 A re a U rb an 12 .1 29 .8 88 .7 11 30 .7 9. 2 7. 6 35 .1 5. 9 88 6 R ur al 11 .3 35 .4 86 .4 10 .5 28 .4 7. 8 5. 4 30 .2 4. 6 22 32 M ot he r's e du ca tio n N on e 12 .2 38 .6 75 .1 5. 4 27 .4 8. 2 4. 8 16 .2 1 14 6 P rim ar y 7. 3 31 .5 83 .2 9. 1 24 4. 1 4. 4 28 .1 2. 1 52 4 lo w er S ec on da ry 10 .4 35 .4 87 .1 8. 9 27 .8 7. 3 5 31 .1 4 12 52 U pp er S ec on da ry 16 .8 35 .1 90 .5 16 32 .7 10 .1 8. 1 35 .4 9. 9 60 1 Te rti ar y 12 29 .9 90 .1 11 .6 33 11 .7 7. 8 35 .5 5. 7 59 4 W ea lth in de x qu in til e P oo re st 12 .3 38 .8 83 .4 9. 8 28 7. 5 3. 4 20 .7 2. 9 64 5 S ec on d 9. 8 31 .4 86 .6 9. 3 28 .5 4. 2 4. 5 32 .3 5. 2 57 9 M id dl e 9. 4 33 .7 88 .8 11 .4 28 .1 7. 1 7. 7 32 .1 5. 2 61 0 Fo ur th 12 .9 36 .8 88 .1 12 .3 28 .9 10 .8 7. 2 36 .5 6. 6 64 9 R ic he st 12 .9 27 .9 88 .6 10 .4 31 .9 10 .8 7. 3 36 .4 5. 2 63 3 Et hn ic ity o f h ou se ho ld h ea d K in h/ H oa 11 .2 32 .4 88 .1 10 .3 29 .9 8. 1 6. 6 32 .8 5. 3 27 43 E th ni c M in or iti es 13 .3 42 .2 80 .7 12 .5 24 .2 8. 7 2. 7 24 .2 3. 4 37 5 To ta l 11 .5 33 .8 87 .1 10 .6 29 .1 8. 2 6 31 .6 5 31 18 95VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Solid Fuel Use More than 3 billion people around the world rely on solid fuels (biomass and coal) for their basic energy needs, including cooking and heating. Cooking and heating with solid fuels leads to high levels of indoor smoke, a complex mix of health-damaging pollutants. The main problem with the use of solid fuels is products of incomplete combustion, including carbon monoxide (CO), polyaromatic hydrocarbons, sulphur dioxide (SO2) and other toxic elements. Use of solid fuels increases the risks of acute respiratory illness, pneumonia, chronic obstructive pulmonary disease, cancer, and possibly tuberculosis, low birth weight, cataracts and asthma. The primary monitoring indicator is the proportion of the household population using solid fuels as the primary source of domestic energy for cooking. Results presented here are calculated for the population living in households, and therefore represent the percentage of the population exposed to various types of fuels, not percentage of households. 96 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Ta bl e C H .9 : S ol id fu el u se P er ce nt ag e di st rib ut io n of h ou se ho ld p op ul at io n ac co rd in g to ty pe o f c oo ki ng fu el u se d by th e ho us eh ol d, a nd p er ce nt ag e of h ou se ho ld p op ul at io n liv in g in h ou se ho ld s us in g so lid fu el s fo r co ok in g, V ie t N am , 2 01 1 Pe rc en ta ge o f h ou se ho ld p op ul at io n in h ou se ho ld s us in g: N um be r o f ho us eh ol d m em be rs E le ct ric ity li qu efi ed P et ro le um G as (l P G ) N at ur al G as b io ga s K er os en e So lid fu el s O th er fu el N o fo od co ok ed in th e ho us eh ol d To ta l S ol id fu el s fo r co ok in g1 C oa l, lig ni te C ha r- co al W oo d S tra w , sh ru bs , gr as s A gr ic ul tu ra l cr op re si du e R eg io n R ed R iv er D el ta 0. 7 59 .9 0. 3 1. 3 0 9. 3 1. 4 9. 6 16 .7 0. 6 0. 1 0. 1 10 0 37 .6 92 61 N or th er n M id la nd a nd M ou nt ai n ar ea s 0. 7 27 .5 0. 1 1. 6 0 1 0. 4 66 .8 1. 5 0 0. 1 0. 1 10 0 69 .8 72 42 N or th C en tra l a re a an d C en tra l C oa st al ar ea 0. 3 45 .2 0. 1 1. 1 0. 4 0. 7 4. 1 44 .4 3. 2 0. 1 0 0 10 0 52 .5 94 43 C en tra l H ig hl an ds 1 49 .1 0. 2 0. 4 0 0. 1 1. 4 47 .6 0 0 0. 1 0. 1 10 0 49 .1 25 51 S ou th E as t 0. 4 81 .2 0. 2 0. 4 1. 6 0. 1 0. 7 13 .9 0 0 1. 2 1. 2 10 0 14 .6 70 66 M ek on g R iv er D el ta 0. 5 42 0. 1 0. 5 0. 7 0. 1 2. 5 51 .7 0. 2 0. 7 0. 4 0. 4 10 0 55 .2 84 34 A re a U rb an 0. 6 80 .7 0 0. 2 0. 9 3. 7 1. 1 11 .5 0. 6 0 0. 6 0. 6 10 0 16 .9 13 00 3 R ur al 0. 5 38 .2 0. 2 1. 3 0. 3 1. 7 2. 2 48 .4 6. 1 0. 4 0. 2 0. 2 10 0 58 .9 30 99 5 Ed uc at io n of h ou se ho ld h ea d N on e 0. 5 21 .9 0. 1 0 0. 8 1. 3 4. 4 67 .6 2. 9 0 0. 5 0. 5 10 0 76 .3 26 51 P rim ar y 0. 5 35 .2 0. 1 0. 5 0. 7 0. 8 2. 9 53 .4 4. 7 0. 4 0. 3 0. 3 10 0 62 .3 11 33 1 lo w er S ec on da ry 0. 5 49 0. 3 1. 4 0. 3 3 1. 6 37 .1 6 0. 3 0. 3 0. 3 10 0 47 .8 17 45 2 U pp er S ec on da ry 0. 6 65 .5 0 1. 6 0. 5 3. 6 1. 4 22 .1 3. 8 0. 3 0. 3 0. 3 10 0 31 .1 72 22 Te rti ar y 0. 7 85 0. 1 0. 3 0. 2 2. 1 0. 1 10 0. 7 0. 3 0. 5 0. 5 10 0 13 .2 51 90 W ea lth in de x qu in til es P oo re st 0. 1 1. 5 0 0. 3 0. 2 0. 1 2. 2 89 .5 5. 4 0. 2 0. 2 0. 2 10 0 97 .4 88 03 S ec on d 0. 9 16 .4 0. 1 1. 1 0. 4 1. 5 3. 7 64 .2 10 .5 0. 5 0. 3 0. 3 10 0 80 .3 87 96 M id dl e 0. 8 52 .7 0. 5 2. 1 1. 1 3. 8 2. 2 29 .2 5. 8 0. 8 0. 5 0. 5 10 0 41 .7 87 98 Fo ur th 0. 8 85 .9 0. 1 1. 4 0. 4 4. 5 1. 1 4. 4 0. 8 0 0. 6 0. 6 10 0 10 .8 87 97 R ic he st 0. 2 97 .4 0 0 0. 3 1. 7 0. 3 0 0 0 0. 1 0. 1 10 0 2 88 03 Et hn ic ity o f h ou se ho ld h ea d K in h/ H oa 0. 6 56 .5 0. 2 1 0. 5 2. 6 2. 1 30 .5 5. 1 0. 3 0. 4 0. 3 10 0 40 .5 38 67 5 E th ni c M in or iti es 0. 4 9. 2 0 0. 6 0. 1 0. 3 0. 7 88 .3 0. 3 0 0 0. 1 10 0 89 .5 53 23 To ta l 0. 6 50 .8 0. 2 1 0. 5 2. 3 1. 9 37 .5 4. 5 0. 3 0. 3 0. 3 10 0 46 .4 43 99 8 1 M IC S in di ca to r 3 .1 1 97VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Overall, close to half (46.4 per cent) of all households in Viet Nam use solid fuels for cooking. Use of solid fuels is lower in urban areas (16.9 per cent) than in rural areas where 58.9 per cent of the household population uses solid fuels. The most important differentials are with respect to household living standards and the educational level of the household head. About 76.3 per cent of the population in households with uneducated household heads rely on solid fuels compared to only 13.2 per cent among the population in which household heads have tertiary education. The findings show that the use of solid fuels is rare among the richest households (2 per cent) and very common among the poorest (97.4 per cent). The reverse is found in relation to the use of liquefied petroleum gas, used by 97.4 per cent of the richest, but only 1.5 per cent of the poorest households .Table CH.9 clearly shows that the overall percentage of the population relying on solid fuels is high due to the high use of wood for cooking purposes. Clear disparities are also revealed by ethnicity, with ethnic minority households being twice as likely to use solid fuels for cooking than Kinh/Hoa households. Solid fuel use alone is a poor proxy indicator for indoor air pollution, since the concentration of the pollutants varies when the same fuel is burnt in different stoves or ovens. Use of closed stoves with chimneys minimises indoor pollution, while open stoves or fires with no chimney or hood mean that there is no protection from the harmful effects of solid fuels. Solid fuel use by place of cooking is depicted in Table CH.10. Among the population in households using solid fuels about 63 per cent use a separate building as place for cooking, and 15.9 per cent use a separate room as kitchen. Some 18.9 per cent cook elsewhere in the house and only 1.9 per cent cook outdoors. Cooking elsewhere in the house among households using solid fuels is negatively correlated with the education level of the household head and household living standards. For example, 33.6 per cent of the population in households where the head is uneducated cook elsewhere in the house compared to 8.4 per cent in households where the head has tertiary education. A higher prevalence of outdoor cooking is observed among richest households (23.8 per cent) and in the South East (10.3 per cent), compared to 1.9 per cent overall. 98 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Table CH.10: Solid fuel use by place of cooking Percentage distribution of household members in households using solid fuels by place of cooking, Viet Nam, 2011 Place of cooking: Number of household members in households using solid fuels for cooking In a separate room used as kitchen Elsewhere in the house In a separate building Outdoors At another place Total Region Red River Delta 6.8 1.7 87.7 3.4 0.4 100 3480 Northern Midland and Mountain areas 12.9 21.8 64.8 0.3 0.1 100 5056 North Central area and Central Coastal area 21 11.8 65.5 1.6 0 100 4953 Central Highlands 20.2 29.5 48.5 1.5 0 100 1253 South East 20.6 14.4 53.7 10.3 0 100 1035 Mekong River Delta 18.6 34.3 45.8 1.2 0.1 100 4659 Area Urban 19.2 18.3 54.9 7.3 0.3 100 2192 Rural 15.5 19 63.9 1.3 0.1 100 18244 Education of household head None 20.8 33.6 42.7 2.5 0 100 2023 Primary 18.2 24.5 54.9 2.2 0.1 100 7059 lower Secondary 13.6 14.2 70.6 1.3 0.2 100 8342 Upper Secondary 14.4 9 73.7 2.3 0 100 2250 Tertiary 9.3 8.4 78.6 3.4 0.3 100 684 Wealth index quintiles Poorest 15.4 27.8 55 1.5 0.2 100 8571 Second 15 14.4 69 1.5 0 100 7067 Middle 18.1 10 69.5 2.1 0 100 3671 Fourth 17.3 9.6 67.1 5.2 0.8 100 954 Richest 23 1.8 51.4 23.8 0 100 173 Ethnicity of household head Kinh/Hoa 15.6 14.6 67.2 2.4 0.1 100 15671 Ethnic Minorities 17.2 33.2 49.1 0.4 0.1 100 4764 Total 15.9 18.9 63 1.9 0.1 100 20435 Malaria Malaria contributes to anaemia in children and is a common cause of school absenteeism. Preventive measures, especially the use of insecticide treated mosquito nets (ITNs), can dramatically reduce malaria mortality rates among children. In areas where malaria is common, international recommendations suggest treating any fever in children as if it were malaria and immediately giving the child a full course of recommended anti-malarial tablets. Children with severe malaria symptoms, such as fever or convulsions, should be taken to a health facility. Also, children recovering from malaria should be given extra liquids and food and, for younger children, should continue to be breastfed. Viet Nam is considered a low malaria prevalence country with considerable achievements in malaria prevention. The National Malaria Control Programme aims to reduce mortality and morbidity caused by malaria. 99VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Table CH.11: Household availability of insecticide treated nets and protection by a vector control method Percentage of households with at least one mosquito net, percentage of households with at least one long-lasting treated net, percentage of households with at least one insecticide treated net (ITN) and percentage of households which either have at least one ITN or have received spraying through an indoor residual spraying (IRS) campaign in the last 12 months, Viet Nam, 2011 Percentage of households with at least one mosquito net Percentage of households with at least one long- lasting treated net Percentage of households with at least one ITN1 Percentage of households with at least one ITN or received IRS during the last 12 months2 Number of households Region Red River Delta 98.5 0.1 6.1 24 2601 Northern Midland and Mountain areas 98.9 0.9 16.7 28.5 1836 North Central area and Central Coastal area 98.5 0.2 10.5 25.4 2522 Central Highlands 97.9 1.1 22.8 28.8 604 South East 79.8 0.7 5 22 1873 Mekong River Delta 98.6 0.1 6.4 24.4 2178 Area Urban 88 0.1 4.4 27.4 3454 Rural 98.7 0.5 11.6 24 8160 Education of household head None 94.3 1.2 13.5 28 691 Primary 97 0.7 10.5 24.6 2919 lower Secondary 96.4 0.3 9.6 23.6 4568 Upper Secondary 94 0.2 7.7 25.5 1904 Tertiary 92.4 0.3 7.4 28.3 1504 Wealth index quintiles Poorest 98.5 1.3 16.8 26.2 2329 Second 99.7 0.2 9.2 20.7 2368 Middle 97.9 0.1 8.7 22.6 2406 Fourth 94.3 0.4 7.1 23.6 2326 Richest 86.6 0.1 5.3 32.7 2186 Ethnicity of household head Kinh/Hoa 95.3 0.2 7.4 23.7 10436 Ethnic Minorities 97.4 1.9 27.7 36.7 1178 Total 95.5 0.4 9.5 25 11614 1 MICS indicator 3.12, 2 MICS indicator 3.13 The Viet Nam MICS 2011 questionnaire incorporates questions on the availability and use of bed nets, both at the household level, among children under 5 years of age, and among pregnant women. It also includes anti-malarial treatment, intermittent preventive therapy for malaria, and indoor residual spraying of households. The survey results indicate that almost all households in Viet Nam have at least one mosquito net (Table CH.11). On the other hand, long-lasting treated nets are almost non-existent (0.4 per cent). Insecticide treated nets (ITN) include long-lasting treated nets, pre-treated nets obtained within the past 12 months and other nets treated in the previous 12 months. Other types of mosquito nets are considered untreated. Some 9.5 per cent of households have at least one ITN. The percentage is higher in malaria prone regions, such as the Northern Midland and Mountain areas (16.7 per cent) and the Central Highlands (22.8 per cent). Prevalence of households with at least one ITN is higher among those headed by ethnic minorities (27.7 per cent), which is evidence of the Government’s policy to distribute ITNs among ethnic minority people. Mosquito net and ITN use is higher in rural compared to urban areas, and 100 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN in poorer compared to richer households. This is attributable to the fact that households in urban areas and better off households have other methods to prevent mosquito-borne malaria transmission, such as good sanitation facilities and use of air-conditioners. About 25 per cent of all households are protected by a vector control method, with at least one ITN or indoor residual spraying in the 12 months preceding the survey. Table CH.12: Children sleeping under mosquito nets Percentage of children aged 0-59 months who slept under a mosquito net during the previous night, by type of net, Viet Nam, 2011 Percentage of children aged 0-59 who stayed in the household the previous night Number of children aged 0-59 months Percentage of children who: Number of children aged 0-59 months who slept in the household the previous night Percentage of children who slept under an ITN living in households with at least one ITN Number of children aged 0-59 living in households with at least one ITN Slept under any mosquito net1 Slept under ITN2 Sex Male 97.5 1869 94.2 10.2 1821 86.9 214 Female 96.5 1809 94.6 8.6 1747 88.4 170 Region Red River Delta 96.2 798 97.9 5.5 768 (100) 42 Northen Midland and Mountain areas 96.8 707 96.5 16.8 684 79 146 North Central area and Central Coastal area 98.1 719 97.6 9 705 91.6 69 Central Highlands 98 233 95.6 21 228 85.8 56 South East 97.7 572 78.6 5.2 559 (94.5) 30 Mekong River Delta 96 650 97.8 6.3 624 (95.9) 41 Area Urban 97.6 1013 86.6 4.1 988 (91.9) 44 Rural 96.8 2665 97.4 11.5 2580 87 340 Age (months) 0-11 97.5 668 94.9 10 651 87 75 12-23 96.4 759 94.9 9.5 732 82.5 85 24-35 97.4 792 94.9 9.9 771 92.5 82 36-47 97.1 764 94.1 10.1 742 89.2 84 48-59 96.7 695 93 7.6 672 86.4 59 Mother's education None 95.8 207 87.6 16.4 198 (70.2) 46 Primary 97.3 658 95.4 10.3 640 88.2 75 lower Secondary 97.3 1479 96.2 9.4 1438 88.9 152 Upper Secondary 97.7 670 94.1 9.1 654 95.5 63 Tertiary 95.9 664 91.7 6.8 637 (88.7) 49 Wealth index quintiles Poorest 96.9 831 95.6 15.9 805 79.3 162 Second 97.5 673 99.2 8.1 656 89.5 59 Middle 96.5 700 97.7 10.4 676 97.2 73 Fourth 96.9 749 96 6.6 726 (97.7) 49 Richest 97.2 725 83.8 5.1 705 (88.2) 41 Ethnicity of household head Kinh/Hoa 97 3143 94.6 6.9 3048 93.7 226 Ethnic Minorities 97.3 535 93.5 24 520 78.8 158 Total 97 3678 94.4 9.4 3568 87.6 384 1 MICS indicator 3.14 2 MICS indicator 3.15; MDG indicator 6.7 Note: Figures shown in parenthesis are based on denominators of 25-49 un-weighted cases 101VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN The survey results indicate that 94.4 per cent of children under the age of 5 slept under some type of mosquito net the night prior to the survey and only 9.4 per cent slept under an insecticide treated net (Table CH.12). A higher percentage of children sleep under ITNs in poorer households and in rural areas. Having a mother with low or no education or living in an ethnic minority household is associated with a higher likelihood of sleeping under ITNs. Here too the living standards pattern mentioned above explains why children in disadvantaged households have higher ITN use rates. Overall, some 87.6 per cent of children slept under an ITN in the households that have such nets. This means that 12.4 per cent of children under age 5 did not sleep under an ITN even though the household had at least one of these nets. Table CH.13: Pregnant women sleeping under mosquito nets Percentage of pregnant women who slept under a mosquito net during the previous night, by type of net, Viet Nam, 2011 Percentage of pregnant women who stayed in the household the previous night Number of pregnant women Percentage of pregnant women who: Number of pregnant women who slept in the household the previous night Percentage of pregnant women who slept under an ITN, living in households with at least one ITN Number of pregnant women living in households with at least one ITN Slept under any mosquito net Slept under ITN1 Region Red River Delta 98 68 100 4.9 67 * 5 Northen Midland and Mountain areas 97.8 76 98 10.6 74 * 14 North Central area and Central Coastal area 94.3 91 98.4 23.2 86 * 22 Central Highlands * 24 * * 24 * 7 South East 94.8 70 73.6 3 66 * 3 Mekong River Delta 95.9 60 97.7 4.2 58 * 2 Area Urban 97.3 119 87.5 4 116 * 5 Rural 95.7 271 97 14.6 259 (78.3) 48 Age group 15-19 94.5 54 98.1 20.2 51 * 15 20-24 96.2 147 94.1 8.6 142 * 17 25-29 95.2 106 93.1 9.9 101 * 10 30-34 98.3 64 94.7 10.9 63 * 7 35-39 * 16 * * 16 * 1 40-44 * 2 * * 2 * 2 45-49 * 1 * * 1 * 0 Women’s education None * 7 * * 7 * 2 Primary 98.3 50 (95.4) (16.8) 49 * 13 lower Secondary 97.2 145 92.8 9.6 141 * 19 Upper Secondary 95.3 102 97.5 12.5 98 * 12 Tertiary 94.2 85 90.9 7.8 80 * 6 Wealth index quintiles Poorest 97.3 83 97.5 16 81 * 18 Second 96 69 100 16.4 66 * 14 Middle 95.9 61 97.8 11.2 58 * 9 Fourth 94.9 92 90.9 9.1 87 * 9 Richest 97 85 86.7 5 82 * 4 Ethnicity of household head ` Kinh/Hoa 95.8 334 93.8 9 320 (82.7) 35 Ethnic Minorities 98.5 56 95.5 24.9 55 * 18 Total 96.2 390 94.1 11.3 375 80.2 53 1 MICS indicator 3.19 Note: Figures denoted by an asterisk are based on denominators of 24 un-weighted cases and less Figures shown in parenthesis are based on denominators of 25-49 un-weighted cases 102 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Table CH.13 presents the proportion of pregnant women who slept under a mosquito net or ITN during the previous night. Some 94.1 per cent of pregnant women slept under any mosquito net the night prior to the survey but only 11.3 per cent slept under an ITN. Questions on the prevalence and treatment of fever were asked for all children under age 5. About 16.4 per cent of children under 5 years of age were ill with fever in the two weeks prior to the survey (Table CH.14). Fever prevalence peaked at the age group 12–23 months (20.1 per cent) and declined with age. Fever is less commonly reported among children from the Central Highlands (8.6 per cent) compared to those from the North Central area and Central Coastal area (21.7 per cent). 103VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Ta bl e C H .1 4: A nt i-m al ar ia l t re at m en t o f c hi ld re n w ith a nt i-m al ar ia l d ru gs P er ce nt ag e of c hi ld re n ag ed 0 -5 9 m on th s w ho h ad fe ve r i n th e la st tw o w ee ks w ho re ce iv ed a nt i-m al ar ia l d ru gs , V ie t N am , 2 01 1 H ad a fe ve r in th e la st tw o w ee ks N um be r of ch ild re n ag ed 0- 59 m on th s A nt i-m al ar ia ls : O th er m ed ic at io ns : P er ce nt ag e w ho to ok a n an ti- m al ar ia l dr ug th e sa m e or ne xt d ay 2 N um be r of ch ild re n w ith fe ve r i n la st tw o w ee ks C hl or o- qu in e Q ui ni ne s ul ph at e ,A C T, Q ui ni ne di hy dr oc hl or at eD ih yd ro - ar te m is in in -P ip er aq ui ne , P rim aq ui ne O th er an ti- m al ar ia l A ny an ti- m al ar ia l dr ug 1 A nt i -b io tic pi ll or sy ru p A nt i -b io tic in je ct io n P ar ac et - am ol / P an ad ol / A ce ta m in - op he n A sp iri n Ib up ro fe n O th er M is si ng / D K Se x M al e 17 .4 1, 86 9 0. 4 0. 4 0. 5 1. 2 23 .7 7. 4 47 .4 1. 9 0. 7 22 .7 10 .1 1. 1 32 5 Fe m al e 15 .3 1, 80 9 0. 7 0. 6 0. 2 1. 2 23 .7 5. 2 38 .6 2. 3 0. 7 27 .2 8. 7 0. 7 27 7 R eg io n R ed R iv er D el ta 14 .8 79 8 0 0 0 0 15 .8 8. 5 28 3. 4 0 24 .8 3. 2 0 11 8 N or th er n M id la nd a nd M ou nt ai n ar ea s 16 .8 70 7 0 0 0 0 36 .5 8. 5 28 .3 3. 4 0 34 .2 1. 5 0 11 9 N or th C en tra l a re a an d C en tra l C oa st al a re a 21 .7 71 9 0. 9 0 0. 5 1. 3 21 .1 6. 9 57 .8 1 1. 1 13 .3 6. 4 0. 5 15 6 C en tra l H ig hl an ds 8. 6 23 3 * * * * * * * * * * * * 20 S ou th E as t 19 .3 57 2 1. 2 2. 7 0. 8 3. 6 23 .5 3. 4 47 .9 1. 7 2. 3 29 .1 17 .8 3. 2 11 0 M ek on g R iv er D el ta 12 .3 65 0 0. 8 0 0 0. 8 20 3. 5 51 .9 0. 8 0 28 .3 26 .8 0. 8 80 A re a U rb an 15 .5 1, 01 3 1. 3 1. 3 0. 5 2. 5 26 .2 4. 3 46 .1 1. 1 1 27 .9 8. 3 1. 4 15 7 R ur al 16 .7 2, 66 5 0. 3 0. 2 0. 3 0. 7 22 .8 7. 1 42 .4 2. 4 0. 6 23 .7 9. 9 0. 7 44 5 A ge (m on th s) 0- 11 14 .6 66 8 0 0 1. 5 1. 5 16 .5 1. 3 38 .7 0 1. 8 26 .2 4. 1 1. 5 98 12 -2 3 20 .1 75 9 0 0. 6 0 0. 3 26 .2 11 .3 40 .4 3 0. 6 28 .4 7. 8 0. 3 15 3 24 -3 5 18 .4 79 2 0 0. 3 0 0. 3 21 .7 6 42 .3 1. 1 0. 4 26 .8 13 0 14 6 36 -4 7 14 .2 76 4 1. 8 1. 4 0 2. 5 29 .3 3. 9 45 .9 3. 6 1 17 .4 10 .9 1. 3 10 8 48 -5 9 14 .1 69 5 1. 3 0 0. 7 2. 1 23 .6 7. 1 51 .4 2. 4 0 22 .8 10 .5 2. 1 98 M ot he r’s e du ca tio n N on e 19 .5 20 7 (0 ) (0 ) (0 ) (0 ) (2 1. 1) (1 0. 4) (5 3. 7) (0 ) (0 ) (1 6. 9) (8 .3 ) (0 ) 40 P rim ar y 16 .6 65 8 1. 2 0 0. 5 1. 7 25 .3 2. 3 40 .6 1. 4 0 25 .2 12 .3 0. 5 10 9 lo w er S ec on da ry 17 .7 1, 47 9 0. 8 1 0. 6 1. 9 22 .6 7. 9 41 .4 2. 6 1 24 .3 12 .3 1. 9 26 1 U pp er S ec on da ry 13 .9 67 0 0 0 0 0 25 .7 6. 4 47 .3 0. 2 0 15 .8 7. 5 0 93 Te rti ar y 14 .9 66 4 0 0. 5 0 0. 5 24 5. 2 43 .7 4 1. 8 37 .1 1. 2 0 99 104 VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Ta bl e C H .1 4: A nt i-m al ar ia l t re at m en t o f c hi ld re n w ith a nt i-m al ar ia l d ru gs P er ce nt ag e of c hi ld re n ag ed 0 -5 9 m on th s w ho h ad fe ve r i n th e la st tw o w ee ks w ho re ce iv ed a nt i-m al ar ia l d ru gs , V ie t N am , 2 01 1 H ad a fe ve r in th e la st tw o w ee ks N um be r of ch ild re n ag ed 0- 59 m on th s N um be r of ch ild re n w ith fe ve r i n la st tw o w ee ks A nt i-m al ar ia ls : O th er m ed ic at io ns : P er ce nt ag e w ho to ok a n an ti- m al ar ia l dr ug th e sa m e or ne xt d ay 2 C hl or o- qu in e Q ui ni ne s ul ph at e ,A C T, Q ui ni ne di hy dr oc hl or at eD ih yd ro - ar te m is in in -P ip er aq ui ne , P rim aq ui ne O th er an ti- m al ar ia l A ny an ti- m al ar ia l dr ug 1 A nt i -b io tic pi ll or sy ru p A nt i -b io tic in je ct io n P ar ac et - am ol / P an ad ol / A ce ta m in - op he n A sp iri n Ib up ro fe n O th er M is si ng / D K W ea lth in de x qu in til es P oo re st 18 .8 83 1 0 0. 6 0 0. 3 25 .9 10 .9 37 1 0 21 .6 8. 9 0. 3 15 6 S ec on d 15 .3 67 3 1. 3 0 0. 5 1. 8 23 .6 3. 3 55 .3 1. 6 0 27 .3 9. 1 0. 5 10 3 M id dl e 16 .6 70 0 0 0 0. 6 0. 6 22 .3 8. 1 37 .3 0. 7 0 21 .1 14 0. 6 11 6 Fo ur th 16 74 9 1. 1 1. 3 0 1. 8 21 .8 5. 2 42 .7 2. 4 1. 5 30 10 .8 1. 8 12 0 R ic he st 14 .9 72 5 0. 6 0. 4 0. 8 1. 9 24 .1 2. 3 48 .5 5. 3 2. 4 25 .2 4. 3 1. 4 10 8 Et hn ic ity o f h ou se ho ld h ea d K in h/ H oa 16 .4 3, 14 3 0. 6 0. 4 0. 4 1. 3 21 .7 5. 8 44 .4 2. 4 0. 8 25 .1 10 .4 1 51 7 E th ni c M in or iti es 16 53 5 0 1. 2 0 0. 6 35 .7 9. 9 37 .3 0 0 23 .2 3. 8 0. 6 86 To ta l 16 .4 3, 67 8 0. 5 0. 5 0. 4 1. 2 23 .7 6. 4 43 .4 2. 1 0. 7 24 .8 9. 5 0. 9 60 2 1 M IC S in di ca to r 3 .1 8; M D G in di ca to r 6 .8 ; 2 M IC S in di ca to r 3 .1 7 N ot e: Fi gu re s de no te d by a n as te ris k a re b as ed o n de no m in at or s of 2 4 un -w ei gh te d ca se s an d le ss Fi gu re s sh ow n in p ar en th es is a re b as ed o n de no m in at or s of 2 5- 49 u n- w ei gh te d ca se s 105VIET NAM MULTIPLE INDICATOR CLUSTER SURVEY 2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Overall, the use of “appropriate”17 anti-malarial drugs for children with fever is very low in Viet Nam, at 1.2 per cent. The majority of children are given other medications, including anti-pyretics such as paracetamol, panadol, acetaminophen, or antibiotic drugs. Because of the overall low rate of anti-malarial drug use, the percentage of children with fever who received anti-malarial drugs the same or next day is also low, barely 1 per cent. Since Viet Nam is a low prevalence country for malaria, it is normal that anti-malarials are not given for any fever, except in areas where the disease remains endemic. Table CH.15: Malaria diagnostics usage Percentage of children aged 0–59 months who had a fever in the last two weeks and who had a finger or heel stick for malaria testing, Viet Nam, 2011 Had a finger or heel stick1 Number of children aged 0-59 months with

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