Viet Nam - Multiple Indicator Cluster Survey - 2013

Publication date: 2013

MICS VIET NAM VIET NAM Cluster Survey 2014 Viet Nam Multiple Indicator Viet Nam Multiple Indicator Cluster Survey 2014 Website: www.mics.gso.gov.vn United Nations Children’s Fund M IC S General Statistics O�ce of Viet Nam Monitoring the situation of children and women VIET NAM M ULTIPLE INDICATOR CLUSTER SURVEY 2014 General Statistics office Viet Nam The Viet Nam Multiple Indicator Cluster Survey (MICS) was carried out during 2013-2014 by the Viet Nam General Statistics Office (GSO) in collaboration with the United Nations Children’s Fund (UNICEF), as part of the global MICS programme. Technical and financial support was provided by UNICEF. The global MICS programme was developed by UNICEF in the 1990s as an international household survey programme to collect internationally comparable data on a wide range of indicators on the situation of children and women. MICS surveys measure key indicators that allow countries to generate data for use in policies and programmes, and to monitor progress towards the Millennium Development Goals (MDGs) and other internationally agreed upon commitments. Additional information on indicators and the analysis conducted in the final report can be found at www.gso.gov.vn, and mics.unicef.org. . Suggested citation: General Statistics Office and UNICEF, 2015. Viet Nam Multiple Indicator Cluster Survey 2014, Final Report. Ha Noi, Viet Nam VIET NAM Cluster survey 2014 MulTIplE INdIcATor 2 viet nam mics 2014 report summary table of survey Implementation and the survey Population, viet Nam MICs 2014 sample frame 15% Sample, 2009 Population and Housing Census Questionnaires Household Women (aged 15-49) Children aged under 5 - Updated Dec. 2013 Interviewer training Dec. 2013 Fieldwork In late Dec. 2013 to Apr. 2014 survey sample Households: Children aged under 5: - Sampled 10200 - Eligible 3346 - Occupied 10018 - Mothers/caretakers interviewed 3316 - Interviewed 9979 - Response rate (%) 99.1 - Response rate (%) 99.6 Women: - Eligible for interviews 10,190 - Interviewed 9,827 - Response rate (%) 96.4 survey population Average household size 3.9 Percentage of population living in: Percentage of population under: - Urban areas 31.8 - Age 5 8.3 - Rural areas 68.2 - Age 18 29.3 Percentage of women aged 15-49 years with at least one live birth in the last two years 14.9 - Red River Delta 23.6 - Northern Midlands-Mountainous area 13.6 - North Central and Central Coastal 21.3 - Central Highlands 6.3 - South East 16.6 - Mekong River Delta 18.6 Percentage of households with: Percentage of households that own: - Electricity 99.2 - A television 94.0 - Finished floor 92.9 - A refrigerator 60.9 - Finished roofing 97.2 - Agricultural land 56.0 - Finished walls 89.3 - Water surface 10.4 Mean number of persons per room used for sleeping per household 2.22 - Forestry land 8.8 - Farm animals/livestock 50.1 - Car or tractor 7.7 Percentage of households where at least a member has or owns a: - Mobile phone 92.5 - Motorcycle or scooter 82.1 3viet nam mics 2014 report summary table of Findings1 Multiple Indicator Cluster Survey (MICS) and Millennium Development Goals (MDGs) Indicators, Viet Nam MICS 2014 CHIlD MOrtAlIty early childhood mortality MICs Indicator Indicator Description value 1.1 Neonatal mortality rate Probability of dying within the first 28 days of life 11.95 1.2 MDG 4.2 Infant mortality rate Probability of dying between birth and first birthday 16.21 1.3 Post-neonatal mortality rate Difference between infant and neonatal mortality rates 4.26 1.4 Child mortality rate Probability of dying between the first and fifth birthdays 3.59 1.5 MDG 4.1 Under-5mortality rate Probability of dying between birth and fifth birthday 19.74 A Indicator values are per 1,000 live births and refer to the five-year period before this survey. NutrItION Breastfeeding and infant feeding MICs Indicator Indicator Description value 2.5 Children ever breastfed Percentage of women with a live birth in the last two years who breastfed their last live-born child at any time 96.9 2.6 Early initiation of breastfeeding Percentage of women with a live birth in the last two years who put their last newborn to the breast within one hour of birth 26.5 2.7 Exclusive breastfeeding under 6 months Percentage of infants under 6 months of age who are exclusively breastfedi 24.3 2.8 Predominant breastfeeding under 6 months Percentage of infants under 6 months of age who received breast milk as the predominant source of nourishmentii during the previous day 49.0 2.9 Continued breastfeeding at 1 year Percentage of children aged 12-15 months who received breast milk during the previous day 65.6 2.10 Continued breastfeeding at 2 years Percentage of children aged 20-23 months who received breast milk during the previous day 21.8 2.11 Median duration of breastfeeding The age in months when 50 per cent of children aged 0-35 months did not receive breast milk during the previous day 15.8 2.12 Age-appropriate breastfeeding Percentage of children aged 0-23 months appropriately fediii during the previous day 46.9 2.13 Introduction of solid, semi-solid or soft foods Percentage of infants aged 6-8 months who received solid, semi-solid or soft foods during the previous day 90.7 2.14 Milk feeding frequency for non-breastfed children Percentage of non-breastfed children aged 6-23 months who received at least two milk feedings during the previous day 89.5 2.15 Minimum meal frequency Percentage of children aged 6-23 months who received solid, semi-solid and soft foods (plus milk feeds for non-breastfed children) the minimum number of timesiv or more during the previous day 90.5 1 See Appendix E for a detailed description of MICS indicators. 4 viet nam mics 2014 report 2.16 Minimum dietary diversity Percentage of children aged 6-23 months who received foods from four or more food groupsv during the previous day. 76.9 2.17a Minimum acceptable diet (a) Percentage of breastfed children aged 6-23 months who had at least the minimum dietary diversity and the minimum meal frequency during the previous day 62.4 2.17b (b) Percentage of non-breastfed children aged 6-23 months who received at least two milk feedings and had at least the minimum dietary diversity not including milk feeds and the minimum meal frequency during the previous day. 54.5 2.18 Bottle feeding Percentage of children aged 0-23 months who were fed with a bottle during the previous day. 44.1 2.20 Low birthweight infants Percentage of live births in the last two years with children weighing less than 2,500 grams at birth 5.7 2.21 Infants weighed at birth Percentage of live births in the last two years with children weighed at birth. 94.3 CHIlD HeAltH vaccinations MICs Indicator Indicator Description value 3.1 Tuberculosis immunization coverage Percentage of children aged 12-23 months who received BCG vaccine by their first birthday 98.0 3.2 Polio immunization coverage Percentage of children aged 12-23 months who received the third dose oforal polio vaccine (OPV) vaccine (OPV3) by their first birthday 91.9 3.3 Diphtheria, pertussis and tetanus (DPT) immunization coverage Percentage of children aged 12-23 months who received the third dose of DPT vaccine (DPT3) by their first birthday 88.6 3.4 MDG 4.3 Measles immunization coverage Percentage of children aged 12-23 months who received measles vaccine by their first birthday 86.2 3.5 Hepatitis B immunization coverage Percentage of children aged 12-23 months who received the third dose of Hepatitis B vaccine (HepB3) by their first birthday 87.4 3.6 Haemophilus influenzae type B (Hib) immunization coverage Percentage of children aged 12-23 months who received the third dose of Hib vaccine (Hib3) by their first birthday 87.5 3.8 Full immunization coverage Percentage of children aged 12-23 months who received allvi vaccinations recommended in the national immunization schedule by their first birthday. 75.6 tetanus toxoid 3.9 Neonatal tetanus protection Percentage of women aged 15-49 years with a live birth in the last two years who were given at least two doses of tetanus toxoid vaccine within the appropriate interval prior to the most recent birth. 82.2 Diarrhoea - Children with diarrhoea Percentage of children aged under 5 with diarrhoea in the last two weeks 8.6 3.10 Care-seeking for diarrhoea Percentage of children aged under 5 with diarrhoea in the last two weeks for whom advice or treatment was sought from a health facility or provider 55.1 5viet nam mics 2014 report 3.11 Diarrhoea treatment with oral rehydration salts (ORS) and zinc Percentage of children aged under 5 with diarrhoea in the last two weeks who received ORS and zinc 12.6 3.12 Diarrhoea treatment with oral rehydration therapy (ORT) and continued feeding Percentage of children aged under 5 with diarrhoea in the last two weeks who received ORT (ORS packet, pre-packaged ORS fluid, recommended homemade fluid or increased fluids) and continued feeding during the episode of diarrhoea. 57.8 Acute respiratory Infection symptoms - Children with ARI symptoms Percentage of children aged under 5 with ARI symptoms in the last two weeks 3.0 3.13 Care-seeking for children with ARI symptoms Percentage of children aged under 5 with ARI symptoms in the last two weeks for whom advice or treatment was sought from a health facility or provider 81.1 3.14 Antibiotic treatment for children with ARI symptoms Percentage of children aged under 5 with ARI symptoms in the last two weeks who received antibiotics. 88.2 solid fuel use 3.15 Use of solid fuels for cooking Percentage of household members who use solid fuels as primary source of domestic energy to cook. 41.6 WAter AND sANItAtION MICs Indicator Indicator Description value 4.1 MDG 7.8 Use of improved drinking water sources Percentage of household members who use improved sources of drinking water 92.0 4.2 Water treatment Percentage of household members who use unimproved drinking water, but appropriate treatment methods 79.0 4.3 MDG 7.9 Use of improved sanitation Percentage of household members who use improved sanitation facilities not shared 79.2 4.4 Safe disposal of child faeces Percentage of children aged 0-2 years whose last stools were disposed of safely 57.7 4.5 Place for handwashing Percentage of households with a specific place for handwashing, where water and soap or other cleansing agents are present 86.3 4.6 Availability of soap or other cleansing agents Percentage of households with soap or other cleansing agents. 92.4 rePrODuCtIve HeAltH Contraception and unmet need MICs Indicator Indicator Description value 5.1 MDG 5.4 Adolescent birth rate Age-specific fertility rate for women aged 15-19 years. 45 5.2 Early childbearing Percentage of women aged 20-24 years who had at least one live birth before the age of 18 4.7 5.3 MDG 5.3 Contraceptive prevalence rate Percentage of women aged 15-49 years currently married or in union who are using (or whose partner is using) a (modern or traditional) contraceptive method 75.7 5.4 MDG 5.6 Unmet need Percentage of women aged 15-49 years currently married or in union who are fecund and want to space their births or limit the number of children they have and who are not currently using contraception. 6.1 6 viet nam mics 2014 report Maternal and newborn health Antenatal care coverage Percentage of women aged 15-49 years with a live birth in the last two years who were attended during their last pregnancy by: 5.5a MDG 5.5 (a) At least once by skilled health personnel 95.8 5.5b MDG 5.5 (b) At least four times by any provider 73.7 5.6 Content of antenatal care Percentage of women aged 15-49 years with a live birth in the last two years who had their blood pressure measured and gave urine and blood samples during the last pregnancy 56.2 5.7 MDG 5.2 Skilled attendant at delivery Percentage of women aged 15-49 years with a live birth in the last two years who were attended by skilled health personnel during their most recent live birth 93.8 5.8 Institutional deliveries Percentage of women aged 15-49 years with a live birth in the last two years whose most recent live birth was delivered in a health facility 93.6 5.9 Caesarean section Percentage of women aged 15-49 years whose most recent live birth in the last two years was delivered by caesarean section. 27.5 Post-natal health checks 5.10 Post-partum stay in health facility Percentage of women aged 15-49 years who stayed in a health facility for 12 hours or more after the delivery of their most recent live birth in the last two years 98.2 5.11 Post-natal health check for the newborn Percentage of last live births in the last two years when the newbornreceived a health check while at a healthfacility or at home following delivery, or a post-natal care visit within two days after delivery 89.1 5.12 Post-natal health check for the mother Percentage of women aged 15-49 years who received a health check while at a health facility or at home following delivery, or a post-natal care visit within two days after delivery of their most recent live birth in the last two years. 89.8 CHIlD DevelOPMeNt MICs Indicator Indicator Description value 6.1 Attendance for early childhood education Percentage of children aged 36-59 months attending an early childhood education programme 71.3 6.2 Support for learning Percentage of children aged 36-59 months with whom an adult has engaged in four or more activities to promote learning and school readiness in the last three days 75.9 6.3 Father’s support for learning Percentage of children aged 36-59 months whose biological father has engaged in four or more activities to promote learning and school readiness in the last three days. 14.9 6.4 Mother’s support for learning Percentage of children aged 36-59 months whose biological mother has engaged in four or more activities to promote learning and school readiness in the last three days 45.0 6.5 Availability of children’s books Percentage of children aged under 5 who have three or more children’s books 26.2 6.6 Availability of playthings Percentage of children aged under 5 who play with two or more types of playthings 51.5 6.7 Inadequate care Percentage of children aged under 5 left alone or in the care of another child younger than 10 years for more than one hour at least once in the last week 7.0 6.8 Early child development index Percentage of children aged 36-59 months who are developmentally on track in at least three of the following four domains: literacy-numeracy, physical, social-emotional and learning. 88.7 7viet nam mics 2014 report lIterACy AND eDuCAtIONvii MICs Indicator Indicator Description value 7.1 MDG 2.3 Literacy rate among young people Percentage of woman aged 15-24 years able to read a short, simple statement about everyday life or who attended secondary or higher education 96.5 7.2 School readiness Percentage of children in first grade of primary school who attended pre-school during the previous school year 96.8 7.3 Net intake rate in primary education Percentage of children of school-entry age who entered the first grade of primary school 96.1 7.4 MDG 2.1 Primary school net attendance ratio (adjusted) Percentage of children of primary school age currently attending primary or secondary school 97.7 7.5 Secondary school net attendance ratio (adjusted) Percentage of children of secondary school age currently attending secondary school or higher 83.9 7.S1 Lower secondary school net attendance ratio (adjusted) Percentage of children of lower secondary school age currently attending lower secondary school or higher 90.4 7.S2 Upper secondary school net attendance ratio (adjusted) Percentage of children of upper secondary school age currently attending upper secondary school or higher 70.7 7.6 MDG 2.2 Children reaching last grade of primary school Percentage of children entering first grade of primary school who reached last grade 98.6 7.7 Primary school completion rate Number of children attending last grade of primary school (excluding repeaters) divided by number of children of primary school completion age (age appropriate to final grade of primary school) 95.9 7.8 Transition rate to secondary school Number of children who attended the last grade of primary school during the previous school year who are in the first grade of secondary school during the current school year divided by the number of children who attended the last grade of primary school during the previous school year. 98.0 7.S3 Transition rate to upper secondary school Number of children who attended the last grade of lower secondary school during the previous school year who are in the first grade of upper secondary school during the current school year divided by the number of children who attended the last grade of lower secondary school during the previous school year 89.5 7.9 MDG 3.1 Gender parity index (primary school) Primary school net attendance ratio (adjusted) for girls divided by primary school net attendance ratio (adjusted) for boys 1.00 7.10 MDG 3.1 Gender parity index (secondary school) Secondary school net attendance ratio (adjusted) for girls divided by secondary school net attendance ratio (adjusted) for boys 1.04 7.S4 Gender Parity Index (lower secondary school) Lower secondary school net attendance ratio (adjusted) for girls divided by lower secondary school net attendance ratio (adjusted) for boys 1.03 7.S5 Gender parity index (upper secondary school) Upper secondary school net attendance ratio (adjusted) for girls divided by upper secondary school net attendance ratio (adjusted) for boys. 1.11 8 viet nam mics 2014 report CHIlD PrOteCtION Birth registration MICs INDICAtOr Indicator Description value 8.1 Birth registration Percentage of children aged under 5 whose births were reported registered 96.1 Child labour 8.2 Child labour Percentage of children aged 5-17 years who are involved in child labourviii 16.4 Child discipline 8.3 Violent discipline Percentage of children aged 1-14 years who experienced psychological aggression or physical punishment during the last month. 68.4 early marriage and polygyny 8.4 Marriage before age of 15 Percentage of women aged 15-49 years who were first married or in union before the age of 15 0.9 8.5 Marriage before age of 18 Percentage of women aged 20-49 years who were first married or in union before the age of 18 11.2 8.6 Young people aged 15-19 years currently married or in union Percentage of young women aged 15-19 years married or in union 10.3 8.7 Polygyny Percentage of women aged 15-49 years in a polygynous union 0.7 Spousal age difference Percentage of young women who are married or in union and whose spouse is 10 or more years older: 8.8a (a) Among women aged 15-19 years 5.8 8.8b (b) Among women aged 20-24 years 4.7 Attitudes towards domestic violence 8.12 Attitudes towards domestic violence Percentage of women aged 15-49 years who state that a husband is justified in hitting or beating his wife in at least one of the following circumstances: (1) she goes out without telling him, (2) she neglects the children, (3) she argues with him, (4) she refuses sex with him, (5) she burns the food. 28.2 8.S1 Attitudes towards domestic violenceix Percentage of women aged 15-49 years who state that a husband is justified in hitting or beating his wife in at least one of the following circumstances: (1) she goes out without telling him, (2) she neglects the children, (3) she argues with him, (4) she refuses sex with him, (5) she burns the food, (5) she does not complete housework, (6) she is doubted to be faithful, (7) she is disclosed as faithful. 50.0 Children’s living arrangements 8.13 Children’s living arrangements Percentage of children aged 0-17 years living with neither biological parent 5.2 8.14 Prevalence of children with one or both parents dead Percentage of children aged 0-17 years with one or both biological parents dead 3.5 8.15 Children with at least one parent living abroad Percentage of children aged 0-17 years with at least one biological parent living abroad. 1.3 HIv/AIDs HIv/AIDs knowledge and attitudes MICs Indicator Indicator Description value - Have heard of AIDS Percentage of women aged 15-49 years who have heard of AIDS 94.5 9.1 MDG 6.3 Knowledge of HIV prevention among young women Percentage of young women aged 15-24 years who correctly identified ways to prevent sexual transmission of HIVx and who rejected major misconceptions about HIV transmission 49.3 9viet nam mics 2014 report 9.2 Knowledge of mother-to-child transmission of HIV Percentage of women aged 15-49 years who correctly identified all three meansxi of mother-to-child transmission of HIV 46.8 9.3 Accepting attitudes towards people living with HIV Percentage of women aged 15-49 years who expressed accepting attitudes in all four questionsxii on attitudes towards people living with HIV. 30.0 HIv testing 9.4 People who know where to be tested for HIV Percentage of women 15-49 years who stated knowledge of a place to be tested for HIV 69.9 9.5 People who have been tested for HIV and know the results Percentage of women aged 15-49 years who have been tested for HIV in the last 12 months and who know their results 11.3 9.7 HIV counselling during antenatal care Percentage of women aged 15-49 years who had a live birth in the last two years and received antenatal care during the pregnancy of their most recent birth, with counselling on HIV during antenatal care 29.3 9.8 HIV testing during antenatal care Percentage of women aged 15-49 years who had a live birth in the last two years and received antenatal care during the pregnancy of their most recent birth, reporting they offered and accepted an HIV test during antenatal care and received their results. 30.0 ACCess tO MAss MeDIA AND INFOrMAtION/COMMuNICAtION teCHNOlOGy Access to mass media MICs Indicator Indicator Description value 10.1 Exposure to mass media Percentage of women aged 15-49 years who, at least once a week, read a newspaper or magazine, listen to the radio, and watch television. 13.2 use of information/communication technology 10.2 Use of computers Percentage of young women aged 15-24 years who used a computer during the last 12 months 63.3 10.3 Use of internet Percentage of young women aged 15-24 years who used the internet during the last 12 months 66.7 10.S1 Use of mobile phones Percentage of women aged 15-49 years who own a mobile phone or use one as if was theirs. 81.9 i Infants receiving breast milk, and not receiving any other fluids or foods, with the exception of oral rehydration solution, vitamins, mineral supplements and medicines ii Infants receiving breast milk and certain fluids (water and water-based drinks, fruit juice, ritual fluids, oral rehydration solution, drops, vitamins, minerals, and medicines), but do not receive anything else (in particular, non-human milk and food-based fluids) iii Infants age 0-5 months who are exclusively breastfed, and children age 6-23 months who are breastfed and ate solid, semi-solid or soft foods iv Breastfeeding children: Solid, semi-solid, or soft foods, two times for infants age 6-8 months, and three times for children 9-23 months; Non-breastfeeding children: Solid, semi-solid, or soft foods, or milk feeds, four times for children age 6-23 months v The indicator is based on consumption of any amount of food from at least four out of the seven following food groups: 1) grains, roots and tubers, 2) legumes and nuts, 3) dairy products (milk, yogurt, cheese), 4) flesh foods (meat, fish, poultry and liver/organ meats), 5) eggs, 6) vitamin-A rich fruits and vegetables, and 7) other fruits and vegetables vi Full vaccination includes the following: a BCG vaccination to protect against tuberculosis, three doses of Polio, three doses of DPT to protect against diphtheria, pertussis, tetanus; three doses of Hepatitis B vaccine; three doses of Hib, one dose of measles vii Education indicators were based on schooling information (throughout the school year, as proxy for calculation of enrolment rates) viii Children involved in child labour are defined as children involved in economic activities above the age-specific thresholds, children involved in household chores above the age-specific thresholds, and children involved in hazardous work ix Viet Nam has supplemented three more questions on domestic violence. x Using condoms and limiting sex to one faithful, uninfected partner xi Transmission during pregnancy, during delivery, and by breastfeeding xii People (1) who think that a female teacher with the AIDS virus should be allowed to teach in school, (2) who would buy fresh vegetables from a shopkeeper or vendor who has the AIDS virus, (3) who would not want to keep it as a secret if a family member became infected with the AIDS virus, and (4) who would be willing to care for a family member who became sick with the AIDS virus 10 viet nam mics 2014 report tABle OF CONteNts Acknowledgements .18 I. Introduction .25 Background .25 Survey Objectives .27 II. sample and survey Methodology .29 Sample Design .29 Questionnaires .30 Training and Fieldwork .31 Data Processing .32 Dissemination of Survey Results .32 III. sample Coverage and the Characteristics of Households and respondents .35 Sample Coverage .35 Characteristics of Households .37 Characteristics of Female Respondents 15-49 Years of Age and Children Under-5 .40 Housing Characteristics, Asset Ownership and Wealth Quintiles .44 Iv. Child Mortality .51 v. Nutrition .59 Low Birth Weight .59 Breastfeeding, Infant and Young Child Feeding .61 vI. Child Health .77 Vaccinations .77 Neonatal Tetanus Protection.84 Care of Illness .86 Diarrhoea .87 Acute Respiratory Infections . 101 Solid Fuel Use . 106 vII. Water and sanitation . 111 Use of Improved Water Sources . 111 Use of Improved Sanitation . 121 Handwashing . 129 vIII. reproductive Health . 135 Fertility . 135 Contraception . 141 Unmet Need . 145 11viet nam mics 2014 report Antenatal Care . 149 Assistance at Delivery . 155 Place of Delivery . 159 Post-natal Health Checks . 161 IX. early Childhood Development . 177 Early Childhood Care and Education . 177 Quality of Care . 179 X. literacy and education . 189 Literacy among Young Women . 189 Primary and Secondary School Participation . 191 XI. Child Protection . 213 Birth Registration . 213 Child Labour . 216 Child Discipline . 223 Early Marriage and Polygyny . 227 Attitudes toward Domestic Violence . 234 Children’s Living Arrangements . 237 XII. HIv/AIDs . 243 Knowledge about HIV Transmission and Misconceptions about HIV . 243 Accepting Attitudes towards People Living with HIV . 250 Knowledge of a Place for HIV Testing, Counselling and Testing during Antenatal Care . 253 HIV Indicators for Young Women . 258 Orphans . 261 XIII. Access to Mass Media and use of Information/Communication technology . 265 Access to Mass Media . 265 Mobile Telephone Use . 268 Use of Information/Communication Technology. 268 Appendix A. sample Design . 271 Appendix B. list of Personnel Involved in the survey . 276 Appendix C. estimates of sampling errors . 279 Appendix D. Data Quality tables . 338 Appendix e. viet Nam MICs 2014 Indicators: Numerators and Denominators . 357 Appendix F. viet Nam MICs 2014 Questionnaires . 367 12 viet nam mics 2014 report lIst OF tABles Summary Table of Survey Implementation and the Survey Population, Viet Nam MICS 2014 . 2 Summary Table of Findings Multiple Indicator Cluster Survey (MICS) and Millennium Development Goals (MDGs) Indicators, Viet Nam MICS 2014 . 3 Table HH.1: Results of household, women’s and under-5 interviews .36 Table HH.2: Household age distribution by sex .37 Table HH.3: Household composition .39 Table HH.4: Women’s background characteristics .40 Table HH.5: Under-5’s background characteristics .43 Table HH.6: Housing characteristics .45 Table HH.7: Household and personal assets .46 Table HH.8: Wealth quintile .48 Table CM.1: Early childhood mortality rates (per thousand live births) .52 Table NU.1: Low birth weight infants .60 Table NU.3: Initial breastfeeding .64 Table NU.4: Breastfeeding .67 Table NU.5: Duration of breastfeeding .69 Table NU.7: Introduction of solid, semi-solid or soft foods .71 Table NU.8: Infant and young child feeding practices .72 Table NU.9: Bottle-feeding .74 Table CH.2: Vaccinations by background characteristics .82 Table CH.3: Neonatal tetanus protection .85 Table CH.4: Reported disease episodes .86 Table CH.5: Care-seeking during diarrhoea .88 Table CH.6: Feeding practices during diarrhea .90 Table CH.7: Oral rehydration solutions, recommended homemade fluids and zinc .93 Table CH.8: Oral rehydration therapy with continued feeding and other treatments.96 Table CH.9: Source of ORS and zinc .99 Table CH.10: Care-seeking for and antibiotic treatment of symptoms of acute respiratory infection (ARI) . 102 Table CH.11: Knowledge of the two danger signs of pneumonia . 105 Table CH.12: Solid fuel use . 107 13viet nam mics 2014 report Table CH.13: Solid fuel use by place of cooking . 109 Table WS.1: Use of improved water sources . 112 Table WS.2: Household water treatment . 116 Table WS.3: Time to source of drinking water . 119 Table WS.4: Person collecting water . 120 Table WS.5: Types of sanitation facilities . 122 Table WS.6: Use and sharing of sanitation facilities . 124 Table WS.7: Drinking water and sanitation ladders . 126 Table WS.8: Disposal of children’s faeces . 128 Table WS.9: Water and soap at place for handwashing . 130 Table WS.10 : Availability of soap or other cleansing agent . 132 Table RH.1: Fertility rates . 136 Table RH.2: Adolescent birth rate . 138 Table RH.3: Early childbearing . 139 Table RH.4: Trends in early childbearing . 140 Table RH.5: Use of contraception . 142 Table RH.6: Unmet need for contraception . 146 Table RH.7: Antenatal care coverage . 150 Table RH.9: Content of antenatal care . 154 Table RH.10: Assistance during delivery and caesarian section . 156 Table RH.11: Place of delivery . 160 Table RH.12: Post-partum stay in health facility . 162 Table RH.14: Post-natal care visits for newborns within one week of birth . 166 Table RH.15: Post-natal health checks for mothers . 168 Table RH.16: Post-natal care visits for mothers within one week of birth . 171 Table RH.17: Post-natal health checks for mothers and newborns . 173 Table CD.1: Early childhood education . 178 Table CD.2: Support for learning . 180 Table CD.3: Learning materials . 183 Table CD.4: Inadequate care . 184 Table CD.5: Early child development index . 186 Table ED.1: Literacy (young women) . 190 14 viet nam mics 2014 report Table ED.2: School readiness . 191 Table ED.3: Primary school entry . 192 Table ED.4: Primary school attendance and out of school children . 194 Table ED.5: Lower secondary school attendance and out of school children . 197 Table ED.5A: Upper secondary school attendance and out of school children . 198 Table ED.5B: Secondary school attendance and out of school children . 200 Table ED.6: Children reaching last grade of primary school . 202 Table ED.7: Primary school completion and transition to lower secondary school . 204 Table ED.7A: Lower secondary school completion and transition to upper secondary school . 205 Table ED.8: Education gender parity . 207 Table ED.9: Out of school gender parity . 209 Table CP.1: Birth registration . 214 Table CP.2: Children’s involvement in economic activities . 218 Table CP.3: Children’s involvement in household chores . 221 Table CP.4: Child labour . 222 Table CP.5: Child discipline . 224 Table CP.6: Attitudes toward physical punishment . 226 Table CP.7: Early marriage and polygyny (women) . 228 Table CP.8: Trends in early marriage (women) . 231 Table CP.9: Spousal age difference . 233 Table CP.13: Attitudes toward domestic violence . 235 Table CP.14: Children’s living arrangements and orphan hood . 238 Table HA.1: Knowledge about HIV transmission, misconceptions about HIV/AIDS and comprehensive knowledge about HIV transmission . 244 Table HA.2: Knowledge of mother-to-child HIV transmission . 248 Table HA.3: Accepting attitudes toward people living with HIV . 251 Table HA.4: Knowledge of a place for HIV testing . 253 Table HA.5: HIV counseling and testing during antenatal care . 256 Table HA.7: Key HIV and AIDS indicators (young women) . 259 Table HA.9: Orphanhood status of children aged 10-14 years . 262 Table MT.1: Exposure to mass media . 266 Table MT.2: Use of computers and internet . 269 Table SD.1: Allocation of Sample Clusters (Primary Sampling Units) to Sampling Strata . 272 15viet nam mics 2014 report Table SE.1: Indicators selected for sampling error calculations . 280 Table SE.2: Sampling errors: Total sample . 283 Table SE.3: Sampling errors: Urban . 288 Table SE.4: Sampling errors: Rural . 294 Table SE.5: Sampling errors: Red River Delta . 300 Table SE.6: Sampling errors: Northern Midlands and Mountain areas . 306 Table SE.7: Sampling errors: North Central and Central coastal area . 312 Table SE.8: Sampling errors: Central Highlands . 318 Table SE.9: Sampling errors: South East . 325 Table SE.10: Sampling errors: Mekong River Delta . 331 DQ.1: Age distribution of household population . 336 DQ.2: Age distribution of eligible and interviewed women . 338 DQ.4: Age distribution of children in household and under-5 questionnaires . 339 DQ.5: Birth date reporting: Household population . 340 DQ.6: Birth date and age reporting: Women . 341 DQ.8: Birth date and age reporting: Under-5s . 342 DQ.9: Birth date reporting: Children, adolescents and young people . 343 DQ.11: Completeness of reporting . 344 DQ:16: Observation of birth certificates . 345 DQ.17: Observation of vaccination cards . 346 DQ.18: Observation of women’s health cards . 347 DQ.20: Presence of mother in the household and the person interviewed f or the under-5 questionnaire . 348 DQ.21: Selection of children aged 1-17 years for the child labour and child discipline modules . 349 DQ.22: School attendance by single age . 350 DQ.23: Sex ratio at birth among children ever born and living. 351 DQ.24: Births by periods preceding the survey. 352 DQ.25: Reporting of age at death in days . 353 DQ.26: Reporting of age at death in months . 354 16 viet nam mics 2014 report lIst OF FIGures Figure HH.1: Age and sex distribution of household population, Viet Nam MICS 2014 .38 Figure CM.1: Early childhood mortality rates, Viet Nam MICS 2014 .53 Figure CM.2: Under-5 mortality rates by area Viet Nam MICS 2014 .56 Figure CM.3: Under-5 mortality rate trends in Viet Nam MICS 2014 and other surveys .57 Figure NU.2: Initiation of breastfeeding, Viet Nam MICS 2014 .66 Figure NU.3: Infant and young child feeding patterns by age, Viet Nam MICS 2014 .68 Figure CH.1: Vaccinations by age of 12 months, Viet Nam MICS 2014 .81 Figure CH.2: Children under-5 with diarrhoea who received ORS or recommended homemade liquids, Viet Nam MICS 2014 .95 Figure CH.3: Children under-5 with diarrhoea receiving oral rehydration therapy and continued feeding, Viet Nam MICS 2014 .98 Figure WS.1: Percentage distribution of household members by source of drinking water, Viet Nam MICS 2014 . 114 Figure WS.2: Percentage distribution of household members by use and sharing of sanitation facilities, Viet Nam MICS 2014 . 125 Figure WS.3: Use of improved drinking water sources and improved sanitation facilities by household members, Viet Nam MICS 2014 . 127 Figure RH.1: Age-specific fertility rates by area,Viet Nam MICS 2014 . 137 Figure RH.2: Differentials in contraceptive use, Viet Nam MICS 2014 . 144 Figure RH.3: Person assisting at delivery, Viet Nam MICS 2014 . 158 Figure ED.1: Education indicators by sex, Viet Nam MICS 2014 . 210 Figure CP.1: Children under-5 whose births were registered, Viet Nam MICS 2014 . 216 Figure CP.2: Child disciplining methods, children aged 1-14 years, Viet Nam MICS 2014 . 225 Figure CP.3: Early marriage among women, Viet Nam MICS 2014 . 232 Figure DQ.1: Household population by single ages, Viet Nam MICS 2014 .337a 17viet nam mics 2014 report lIst OF ABBrevIAtIONs AIDS Acquired Immune Deficiency Syndrome ANC Antenatal care ARI Acute respiratory infection ASFRs Age-specific fertility rates BCG Bacillis-Cereus-Geuerin (Tuberculosis) CBR Crude birth rate CRC Convention on the Rights of the Child CSPro Census and Survey Processing System DPT Diphteria, Pertussis, Tetanus ECDI Early Child Development Index EPI Expanded Programme on Immunization GAPPD Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea GFR General fertility rate GPI Gender Parity Index GSO General Statistical Office GVAP Global Vaccine Action Plan HIV Human Immunodeficiency Virus IQ Intelligence Quotient IPS2014 Intercensal Population Survey 2014 IUD Intrauterine Device IYCF Infant and Young Child Feeding JMP Joint Monitoring Programme MICS Multiple Indicator Cluster Survey MICS5 Fifth global round of Multiple Indicator Clusters Surveys programme MoET Ministry of Education and Training MoH Ministry of Health MoLISA Ministry of Labour, Invalids and Social Affairs MPI Ministry of Planning and Investment NAR Net Attendance Ratio NCC North Central and Central coastal region NN Neonatal mortality NSIS National Statistical Indicator System OPV Oral polio vaccine ORS Oral rehydration salts ORT Oral rehydration treatment PHC2009 Population and Housing Census 2009 PNC Post-natal care PNN Post-neonatal mortality PSO Province Statistical Office PSU Primary Sampling Unit RHF Recommended home fluid SPSS Statistical Package for Social Sciences STIs Sexually transmitted infections TOT Training of Trainers 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 WHO World Health Organization 18 viet nam mics 2014 report ACkNOWleDGeMeNts During the past 20 years, the General Statistics Office (GSO) has successfully conducted five rounds of the Multiple Indicator Cluster Survey (MICS) in Viet Nam. This is a household survey programme with multiple subjects, initiated by UNICEF and implemented globally. The fifth round of MICS in Viet Nam (Viet Nam MICS 2014) collected information covering a wide range of issues related to the well-being and development of children and women in Viet Nam. The MICS findings are essential to inform the formulation, monitoring and evaluation of policies and programmes on children and women’s rights in Viet Nam, to monitor progress towards national goals and global commitments as part of the National Programme of Action for Children 2012-2020, targets and plans of action for “A World Fit for Children”, final reporting of the Millennium Development Goals by 2015 as well as provide baseline data for implementation of Sustainable Development Goals post 2015. We would like to extend our sincere thanks to all relevant line ministries, local and international organizations and experts who actively participated in the preparation, field work and analysis of the survey results. In particular, we would like to acknowledge the efforts of the GSO, Ministry of Planning and Investment, Ministry of Labour, Invalids and Social Affairs, Ministry of Health, Ministry of Education and Training, Committee for Ethnic Minority, UNFPA, UNDP and especially UNICEF for valuable inputs, technical support, expertise and financial support for the implementation of Viet Nam MICS 2014 as well as previous rounds of MICS. Also of note are the important contributions from surveyors, team leaders and supervisors who performed their tasks with the utmost integrity and technical ability as well as the valuable cooperation from participating households and active support from local authorities at all levels during the survey process. Their participation and support were important factors that contributed to ensuring the survey’s quality. The GSO and UNICEF are pleased to disseminate this publication to all local and international users. We welcome all comments from readers as well as expect stakeholders to extensively utilize the survey’s results to improve the well-being of children and women in Viet Nam. youssouf Abdel-Jelil Nguyen Bich lam Representative UNICEF Viet Nam Director General General Statistics Office 19viet nam mics 2014 report MAP OF surveyeD DIstrICts, vIet NAM MICs 2014 Red River Delta Northern Midlands & Mountainous area North Central and Central coastal area Central highlands South East Mekong River Delta 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 mics 2014 report eXeCutIve suMMAry MICS was carried out in Viet Nam during 2013-2014 by Viet Nam General Statistics Office in collaboration with UNICEF, as part of the global MICS programme. Technical and financial support for the survey was provided by UNICEF. The global MICS programme was developed by UNICEF in the 1990s as an international household survey to collect internationally comparable data on a wide range of indicators to evaluate the situation of children and women. The survey provides statistically sound and internationally comparable data essential for developing evidence-based policies and programmes as well as monitoring progress towards national goals and global commitments including MDGs. The sample for Viet Nam MICS 2014 was designed to provide estimates for a large number of indicators on the national level situation of children and women in urban and rural areas as well as six geographic regions. Viet Nam MICS 2014 is based on a sample of 10,018 interviewed households, with 9,827 women and 3,316 children interviewed. CHIlD MOrtAlIty Neonatal mortality during the most recent five-years preceding Viet Nam MICS 2014 is estimated at 12 per 1,000 live births, while the post-neonatal mortality rate is four per 1,000 live births. The infant mortality rate in the five years preceding Viet Nam MICS 2014 was more than 16 per 1,000 live births and under-5 mortality amounted to nearly 20 deaths per 1,000 live births for the same period. This indicates that 82 per cent of under-5 deaths were infants. NutrItION AND BreAstFeeDING Overall, 94.3 per cent of newborns were found to have been weighed at birth and 5.7 per cent of infants had low birth weights (less than 2,500 grams at birth). Breastfeeding in the first few years of life protects children from infection, provides an ideal source of nutrients, is economical and safe. While 96.6 per cent of children were discovered by Viet Nam MICS 2014 to be ever breastfed, only 26.5 per cent of babies were breastfed within one hour of birth and 67.8 per cent of newborns started breastfeeding within one day of birth. Approximately 24.3 per cent of children aged less than six months were exclusively breastfed and by 12-15 months, 65.6 per cent continued to be breastfed. Use of the minimum acceptable diet indicator revealed that only 59.0 per cent of children aged 6-23 months benefitted from a diet sufficient in diversity and frequency. This indicator was slightly higher among children currently breastfeeding (62.4 per cent) than those not breastfeeding (54.5 per cent). IMMuNIzAtION Viet Nam MICS 2014 results show that the fully vaccinated rate of children aged 12-23 months was 78.5 per cent and 80.0 per cent for children aged 24-35 months. The proportion of children not immunized was 1.5 and 1.9 per cent for those aged 12-23 and 24-35 months, respectively 21viet nam mics 2014 report The lowest proportion of vaccinated children at birth was for Hepatitis B, at 78.5 among children aged 12-23 months. The second lowest vaccination rate was for measles, at 86.2 per cent. CAre OF IllNess Overall, 8.6 per cent of under-5 children in Viet Nam were reported to have had diarrhoea in the two weeks preceding the survey, and 3.0 per cent had symptoms of Acute Respiratory Infection. Importantly, diarrhoea is a leading cause of death among children under-5 worldwide and most such deaths are due to dehydration from loss of large quantities of water and electrolytes. In Viet Nam, advice or treatment from a health facility or provider was sought for 55.1 per cent of all children with diarrhoea. However, no such assistance was requested for 15.4 per cent. Overall, 28.4 per cent of mothers or caretakers of children knew at least one of the two danger signs of pneumonia (fast breathing and difficult breathing). The most commonly identified symptom for taking a child to a health facility was “the child develops a fever” (90.8 per cent). Only 4.8 per cent of mothers identified “fast breathing” and 25.5 per cent “difficult breathing” as symptoms for immediately taking children to a health facility. WAter AND sANItAtION Viet Nam MICS 2014 results reveal that 92 per cent of the household population uses an improved source of drinking water – 98.2 per cent in urban areas and 89.1 per cent in rural areas. About 79.2 per cent of the population of Viet Nam lives in households with improved sanitation facilities. This percentage was 90.9 per cent in urban areas and 73.8 per cent in rural areas, while 97.3 per cent of households were observed with a specific place for hand washing. rePrODuCtIve HeAltH The adolescent birth rate for the three years preceding Viet Nam MICS 2014 was 45 births per 1,000 women aged 15-19 years. Strikingly, the rate in rural areas (56 births per 1,000 women) was more than double that of urban areas (24 births per 1,000 women). Sexual activity and childbearing early in life carry significant risks for young people, yet 6.3 per cent of women aged 15-19 were found to have already given birth. Appropriate family planning is important to the health of women and children, as it prevents pregnancies too early or late, extends the period between births and limits the total number of children. Current use of contraception was reported by 75.7 per cent of women currently married or in union. The most popular method was IUDs used by three-in-10 married women (28.2 per cent) in Viet Nam. An “unmet need” for contraception refers to fecund women married or in union not using any method of contraception, but who wish to postpone the next birth (spacing) or who wish to stop childbearing altogether (limiting). Overall, the unmet need for spacing and limiting amounted to 2.5 and 3.6 per cent, respectively of women aged 15-49 years married or in union. The total unmet need for contraception was 6.1 per cent. The percentage of women aged 15-49 with a live birth in the last two years who received antenatal care, an important period to reach pregnant women with interventions potentially vital to their health and that of their infants, from skilled providers was 95.8 per cent nationwide. 22 viet nam mics 2014 report Three-quarters of all maternal deaths occur during delivery or the immediate post-partum period. The single most critical intervention for safe motherhood is to ensure that a competent health worker with midwifery skills is present at every birth. Some 93.8 per cent of births in the two years preceding Viet Nam MICS 2014 were delivered by skilled personnel. eArly CHIlDHOOD DevelOPMeNt Viet Nam MICS 2014 found that 71.3 per cent of children aged 36-59 months attended organized early childhood education programmes, while 75.9 per cent had an adult household member engaged in four or more activities that promoted learning and school readiness during the three days preceding the survey. However, only 26.2 per cent of children aged 0-59 months lived in households where at least three children’s books were present. Leaving children alone or in the care of other young children under 10 years is known to increase risk of injury. Viet Nam MICS 2014 reveals that 6.0 per cent of children aged 0-59 months were left in the care of other children, while 1.5 per cent was left alone within the week preceding the survey. eDuCAtION Overall, Viet Nam MICS 2014 indicates that a high proportion (96.5 per cent) of women aged 15-24 in Viet Nam were literate. However, relatively large differences emerged between Kinh/ Hoa (99.1 per cent) and ethnic minority (83.2 per cent) women. The majority of primary school aged children attended school (97.9 per cent). However, 2.1 per cent of children aged 6-10 years do not currently attend school. Of all children who started Grade 1, the vast majority (98.6 per cent) reached Grade 5 and 98 per cent from the last grade of primary school in the previous school year were found to be attending first grade of secondary school in the survey school year. Meanwhile, 89.5 per cent of children who completed the last grade of lower secondary school in the previous school year were found to be attending first grade of upper secondary school. Overall, the net attendance ratios at lower and upper secondary schools were less than primary school rates. Some 90.4 per cent of children aged 11-14 years attended lower secondary school, while 3.5 per cent of them were still in primary school and 6 per cent out of school. Some 70.7 per cent of children aged 15-17 years attended upper secondary school, 4.9 per cent attended primary or lower secondary school and 24.1 per cent of children were out of school. CHIlD PrOteCtION Viet Nam’s birth registration rate has risen in recent years, as reflected by the births of 96.1 per cent of children aged under-5 found by Viet Nam MICS 2014 to have been registered. However, 36.1 per cent of mothers of unregistered children reported not knowing how to register a child’s birth. Child labour is defined by MICS as having performed economic activities during the last week preceding the survey for more than the age-specific number of hours. Viet Nam MICS 2014 discovered that 14.9 per cent of children aged 5-11 years were involved in economic activities for at least one hour, 10.2 per cent of children aged 12-14 years were involved in economic activities for more than 14 hours and 6.8 per cent of children aged 15-17 were engaged in economic activities for more than 43 hours. About 16.4 per cent of children aged 5-17 years 23viet nam mics 2014 report were involved in household chores and economic activities for more than the age-specific threshold of hours, which are considered as child labour. Especially, 7.8 per cent of children aged 5-17 years were found to work in hazardous conditions. Some 68.4 per cent of children aged 1-14 years in Viet Nam were subjected to at least one form of psychological or physical punishment by household members during the month preceding the survey, yet 14.6 per cent of respondents believed that children should be physically punished. Marriage before the age of 18 is a reality for many young girls in Viet Nam and 11.1 per cent of women aged 20-49 were discovered to be married before their 18th birthday. HIv/AIDs In Viet Nam, the vast majority of women (94.5 per cent) aged 15-49 years had heard of HIV/AIDS. However, the percentage of women with comprehensive knowledge was not high (43.4 per cent) and this proportion was 49.3 per cent among women aged 15-24 years. Meanwhile, 46.8 per cent of women aged 15-49 years knew all three ways of mother-to-child transmission (during pregnancy, delivery and through breastfeeding). While 69.9 per cent of women aged 15-49 knew where to get tested HIV, only 29 per cent had actually been tested HIV. Only 20.1 per cent of women knew the result of their most recent test. ACCess tO MAss MeDIA AND use OF INFOrMAtION/ COMMuNICAtION teCHNOlOGy Viet Nam MICS 2014 found that 81.9 per cent of women aged 15-49 years owned or used a mobile telephone, with 63.3 per cent using them to read or write SMS messages and 51.3 per cent doing so at least once a week. Meanwhile, 36.6 per cent of women read newspapers or magazines, 27.6 per cent listen to the radio and 95.3 per cent watch television at least once a week. 24 viet nam mics 2014 report INTroducTIoN chAPTER I 25viet nam mics 2014 report I. INtrODuCtION Background This report is based on the Viet Nam Multiple Indicator Cluster Survey 2014 (Viet Nam MICS 2014), conducted from the end of December 2013 to April 2014 by the GSO in collaboration with UNICEF, with support from line ministries, including the Ministry of Planning and Investment and Ministry of Labour, Invalids and Social Affairs. The survey provides statistically sound and internationally comparable data essential for developing evidence-based policies and programmes, and for monitoring progress toward national goals and global commitments. Among these global commitments are those emanating from the World Fit for Children Declaration and Plan of Action, the goals of the United Nations General Assembly Special Session on HIV/AIDS, the Education for All Declaration and the Millennium Development Goals (MDGs). 26 viet nam mics 2014 report A Commitment to Action: National and International reporting responsibilities The governments that signed the Millennium Declaration and the World Fit for Children Declaration and Plan of Action also committed themselves to monitoring progress towards the goals and objectives they contained: “We will monitor regularly at the national level and, where appropriate, at the regional level and assess progress towards the goals and targets of the present Plan of Action at the national, regional and global levels. Accordingly, we will strengthen our national statistical capacity to collect, analyse and disaggregate data, including by sex, age and other relevant factors that may lead to disparities, and support a wide range of child-focused research. We will enhance international cooperation to support statistical capacity-building efforts and build community capacity for monitoring, assessment and planning.” (A World Fit for Children, paragraph 60) “…We will conduct periodic reviews at the national and sub national levels of progress in order to address obstacles more effectively and accelerate actions.…” (A World Fit for Children, paragraph 61) The Plan of Action of the World Fit for Children (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.” Viet Nam MICS 2014 provides up-to-date information on the situation of children and women in the country, as a basis to accurately assess progress towards achievement of the international commitments (final MDG reporting, World Fit for Children reporting and 5th Country Report on the implementation of the Convention of the Rights of the Child), as well as the national plans, policies and programmes for the realization of children’s rights (2012-2020 National Programme of Action for Children and 2015 National Situation Analysis of Women and Children). The Government of Viet Nam is strongly committed to improving children’s living conditions by not only signing the international agreements, but also implementing a range of socio-economic development and poverty reduction policies and programmes. These include compulsory pre-school, primary and lower secondary education, free health insurance for children aged under 6 years of age as well as child-focused national programmes, such as the 2012-2020 National Programme of Action for Children, 2011-2015 National Programme for Child Protection and 2014-2020 National Programme of Action for Children affected by HIV/AIDS. In addition, Viet Nam MICS 2014 will generate data for identification of vulnerable groups, inequities and disparities to inform policies and interventions, contribute to national data and monitoring system improvements as well as strengthen technical expertise in the design, implementation and analysis of other nationwide surveys. Viet Nam MICS 2014 results will be critically important for final MDG reporting in 2015, and are expected to form part of the baseline data for the Sustainable Development Goals post-2015. 27viet nam mics 2014 report Viet Nam MICS 2014 is expected to contribute to the evidence base of several other important initiatives, including Committing to Child Survival: A Promise Renewed, a global movement to end child deaths from preventable causes, and the accountability framework proposed by the Commission on Information and Accountability for the Global Strategy for Women’s and Children’s Health (CoIA). This final report presents the results of the indicators and topics covered in the survey. survey Objectives Viet Nam MICS 2014 has the following primary objectives: • To provide up-to-date information for assessing the situation of children and women in Viet Nam. • To generate data for the critical assessment of progress made in various areas, and to put additional efforts in areas that require more attention. • To furnish data needed for monitoring progress toward goals established in the Millennium Declaration and other internationally agreed upon goals and those in the Viet Nam National Programme of Action for Children 2012-2020 and other national commitments such as reporting for the MDGs, World Fit for Children and 5th Country Report on the implementation of the Convention of the Rights of the Child, as a basis for future action. • To collect disaggregated data for the identification of disparities, to allow for evidence-based policy-making aimed at social inclusion of the most vulnerable children’s groups. • To contribute to the generation of baseline data for the post-2015 agenda. • To validate data from other sources and the results of focused interventions. 28 viet nam mics 2014 report SAMplE ANd SurVEy METhodology chAPTER II 29viet nam mics 2014 report II. sAMPle AND survey MetHODOlOGy sample Design The sample for Viet Nam MICS 2014 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 of Viet Nam as well as six geographic regions in the country, the Red River Delta, Northern Midlands and Mountainous area, North Central and Central Coastal area, Central Highlands, South East and Mekong River Delta. 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 systematically with probability proportional to size. After a household listing was carried out within the selected enumeration areas, a systematic sample of 20 households was drawn in each sample enumeration area. A total of 510 enumeration areas belonging to 510 communes were selected and visited during the fieldwork period. The sample was stratified by region, urban and rural areas, and is not self-weighted. For reporting national level results and producing all the tables, sample weights are used. A more detailed description of the sample design can be found in Appendix A. 30 viet nam mics 2014 report Questionnaires Three sets of questionnaires of the global programme were used in the survey: 1) a household questionnaire to collect basic demographic information on all de jure household members (usual residents), the household and dwelling, 2) a questionnaire for individual women administered in each household to all women aged 15-49 years and 3) an under-5 questionnaire administered to mothers (or caretakers) for all children aged under-5 living in the household. In addition, there was one country specific questionnaire form with supplementary questions on Multi-Dimensional Child Poverty, administered during the Household Questionnaire (after the Household Characteristic Module), which was not part of the global programme. The questionnaires included the following modules: The Household Questionnaire included the following modules: o List of Household Members o Education o Child Labour o Child Discipline o Household Characteristics o Water and Sanitation o Handwashing. The Questionnaire for Individual Women was administered to all women aged 15-49 years living in the households and included the following modules: o Woman’s Background o Access to Mass Media and Use of Information/Communication Technology o Fertility/Birth History o Desire for Last Birth o Maternal and Newborn Health o Post-natal Health Checks o Illness Symptoms o Contraception o Unmet Need o Attitudes Toward Domestic Violence o Marriage/Union o HIV/AIDS. 31viet nam mics 2014 report The Questionnaire for Children Under-5 was administered to mothers (or caretakers) of children under 5 years of age1 living in the households. Normally, the questionnaire was administered to mothers of under-5 children. But, if the mother was not listed in the household roster, a primary caretaker for the child was identified and interviewed. The questionnaire included the following modules: o Age o Birth Registration o Early Childhood Development o Breastfeeding and Dietary Intake o Immunization2 o Care of Illness. The questionnaire form for vaccination records at commune health centres included the immunization module. The questionnaires are based on the MICS5 model questionnaire3. From the MICS5 model English version, the questionnaires were customized and translated into Vietnamese and cross-checked by translating back into English and compared with the original version. After a five-day Training of Trainers (TOT), the questionnaires were pre-tested in a commune and ward of Hoa Binh province during October 2013. Hoa Binh belongs to the Northern Midlands and Mountainous area and it is also home to the majority Kinh/Hoa people as well as the Muong ethnic minority people. Specifically, the rural commune of Dan Chu is home to concentrations of the Muong ethnic minority people, while Phuong Lam ward of Hoa Binh City is typically-sized urban ward. Based on the pre-test results, modifications were made to the wording and translations of the questionnaires. A copy of the Viet Nam MICS 2014 questionnaires is provided in Appendix F. In addition to the administration of questionnaires, fieldwork teams observed the place for handwashing. Details and findings of these observations are provided in the respective sections of the report. training and Fieldwork Training for the fieldwork was conducted for 13 days in December 2013 with 180 trainees, the majority of whom were female, mobilized from the GSO, Province Statistical Offices (PSOs), District Statistics Offices (DSOs) and relevant stakeholders. Training included lectures on interviewing techniques and the contents of the questionnaires, and mock interviews between trainees to gain practice in asking questions. Towards the end of the training period, the 180 trainees spent two days practice interviewing in a rural commune and an urban ward of Da Nang city, in central Viet Nam. All participants were examined at the end of the training and their results were used to select interviewers, data editors and team leaders for field work. Data were collected by 32 teams from 16 December, 2013 to 25 January, 2014 (before the Lunar New Year “Tet holidays”). The number of teams was reduced to 16 from 28 February to 5 April, 1 The terms “children under 5”, “children aged 0-4 years” and “children aged 0-59 months” are used interchangeably in this report. 2 Immunization data were collected both from households and commune health centres, accordingly there was a separate data collection form for commune health centres. 3 The model MICS5 questionnaires can be found at http://mics.unicef.org/tools#survey-design. 32 viet nam mics 2014 report 2014. The reduction in the number of post-Tet survey teams was due to the smaller number of households left to be surveyed. Each survey team comprised of three interviewers, one field editor and one supervisor. Interpreters accompanied survey interviewers in areas with concentrations of ethnic minority households to assist in translating questions and responses to respondents and interviewers, respectively. Data Processing Data were entered, using CSPro software Version 5.0, on 13 desktop computers by 12 data entry operators and two data entry supervisors. For quality assurance purposes, all questionnaires were double-entered and internal consistency checks performed. Procedures and standard programmes developed under the global MICS programme and adapted to the Viet Nam MICS 2014 questionnaires were used throughout. Data processing began simultaneously with data collection on 25 December 2013 and was completed on 18 April 2014. Data were analysed using the Statistical Package for Social Sciences (SPSS) software, Version 21.0. Model syntax and tabulation plans developed by UNICEF were customized and used for this purpose. Dissemination of survey results After processing and reviewing the quality of data, the Viet Nam MICS 2014 Steering Committee conducted a dissemination of key findings on 4 September 2014 in Ha Noi, to provide updated information for users. Its content included all key indicators and MDG indicators. The official MICS results, which include a full report, summary report, database (micro data, MICS information, metadata) as well as communication products, will be disseminated widely in electronic and hard copy form. 33viet nam mics 2014 report 34 viet nam mics 2014 report SAMplE coVErAgE ANd ThE chArAcTErISTIcS of houSEholdS ANd rESpoNdENTS chAPTER III 35viet nam mics 2014 report III. sAMPle COverAGe AND tHe CHArACterIstICs OF HOuseHOlDs AND resPONDeNts sample Coverage Of the 10,200 households selected for the sample, 10,018 were found to be occupied. Of these, 9,979 were successfully interviewed for a household response rate of 99.6 per cent. In the interviewed households, 10,190 women (aged 15-49 years) were identified. Of these, 9,827 were successfully interviewed, yielding a response rate of 96.4 per cent within interviewed households. There were 3,346 children under-5 listed in the household questionnaires. Questionnaires were completed for 3,316 of these children, which corresponds to a response rate of 99.1 per cent within interviewed households. Overall response rates of 96.1 and 98.7 per cent were calculated for the individual interviews of women and children under-5, respectively (Table HH.1). 36 viet nam mics 2014 report ta bl e H H .1 : r es ul ts o f h ou se ho ld , w om en ’s an d un de r- 5 in te rv ie w s N um be r o f h ou se ho ld s, w om en a nd c hi ld re n ag ed u nd er -5 fr om re su lts o f h ou se ho ld , w om en ’s an d un de r- 5’ s in te rv ie w s as w el l a s ho us eh ol d, w om en ’s an d un de r- 5’ s re sp on se ra te s, M IC S Vi et N am , 2 01 4 To ta l A re a re gi on U rb an Ru ra l Re d Ri ve r D el ta N or th er n M id la nd s an d M ou nt ai no us ar ea N or th C en tr al an d Ce nt ra l co as ta l a re a Ce nt ra l H ig hl an ds So ut h Ea st M ek on g Ri ve r D el ta H ou se ho ld s Sa m pl ed 10 20 0 42 00 60 00 17 00 17 00 17 00 17 00 17 00 17 00 O cc up ie d 10 01 8 41 32 58 86 16 81 16 77 16 66 16 73 16 67 16 54 In te rv ie w ed 99 79 41 07 58 72 16 74 16 74 16 61 16 68 16 52 16 50 H ou se ho ld re sp on se ra te 99 .6 99 .4 99 .8 99 .6 99 .8 99 .7 99 .7 99 .1 99 .8 W om en El ig ib le 10 19 0 43 23 58 67 15 35 17 11 15 80 18 66 18 69 16 29 In te rv ie w ed 98 27 42 00 56 27 14 95 15 99 15 35 18 11 18 21 15 66 W om en 's re sp on se ra te 96 .4 97 .2 95 .9 97 .4 93 .5 97 .2 97 .1 97 .4 96 .1 W om en 's ov er al l r es po ns e ra te 96 .1 96 .6 95 .7 97 .0 93 .3 96 .9 96 .8 96 .6 95 .9 Ch ild re n un de r- 5 El ig ib le 33 46 12 74 20 72 52 0 64 4 49 5 67 3 52 1 49 3 M ot he rs /c ar et ak er s in te rv ie w ed 33 16 12 65 20 51 51 6 63 8 49 2 66 8 51 6 48 6 U nd er -5 's re sp on se ra te 99 .1 99 .3 99 .0 99 .2 99 .1 99 .4 99 .3 99 .0 98 .6 U nd er -5 's ov er al l r es po ns e ra te 98 .7 98 .7 98 .8 98 .8 98 .9 99 .1 99 .0 98 .1 98 .3 37viet nam mics 2014 report Response rates were similar across surveyed areas and regions, except in the Northern Midlands and Mountainous area, which recorded a slightly lower response rate (93.3 per cent) for women. This was because some women often go to farms far from their homes and stay for several days, hence their absence during the Viet Nam MICS 2014 fieldwork. Characteristics of Households The weighted age and sex distribution of the survey population is provided in Table HH.2. This distribution was also used to produce the population pyramid in Figure HH.1. In the 9,979 households successfully interviewed in the survey, 38,506 household members were listed. Of these, 18,927 were males and 19,579 were females. table HH.2: Household age distribution by sex Percentage and frequency distribution of household population by five-year age groups, dependency age groups, and by child (age 0-17 years) and adult populations (aged 18 or more), by sex, Viet Nam, 2014 total Males Females Number Per cent Number Per cent Number Per cent total 38506 100 18927 100 19579 100 Age 0-4 3206 8.3 1668 8.8 1537 7.9 5-9 3242 8.4 1694 9.0 1548 7.9 10-14 3010 7.8 1550 8.2 1460 7.5 15-19 2911 7.6 1474 7.8 1437 7.3 20-24 2867 7.4 1502 7.9 1365 7.0 25-29 2867 7.4 1489 7.9 1378 7.0 30-34 2919 7.6 1383 7.3 1536 7.8 35-39 2768 7.2 1387 7.3 1381 7.1 40-44 2813 7.3 1386 7.3 1427 7.3 45-49 2728 7.1 1335 7.1 1393 7.1 50-54 2629 6.8 1253 6.6 1376 7.0 55-59 2015 5.2 951 5.0 1064 5.4 60-64 1401 3.6 633 3.3 768 3.9 65-69 871 2.3 380 2.0 491 2.5 70-74 743 1.9 316 1.7 427 2.2 75-79 582 1.5 209 1.1 373 1.9 80-84 553 1.4 208 1.1 344 1.8 85+ 383 1.0 108 0.6 275 1.4 Dependency age groups 0-14 9458 24.6 4913 26.0 4545 23.2 15-64 25917 67.3 12793 67.6 13124 67.0 65+ 3131 8.1 1221 6.5 1910 9.8 Child and adult populations Children aged 0-17 years 11283 29.3 5820 30.7 5463 27.9 Adults aged 18+ years 27223 70.7 13107 69.3 14116 72.1 38 viet nam mics 2014 report Children aged 0-14 make up one-fourth of the population (24.6 per cent), while those aged 15-64 represent 67.3 per cent and those aged 65 and above years make up 8.1 per cent. These figures were similar to the corresponding proportions in the 1 April 2013 time-point Population Change and Family Planning Survey (PCS 2013), which also recorded 24.3, 65.2 and 10.5 per cent for these age groups, respectively. Both PCS 2013 and Viet Nam MICS 2014 showed the proportion of population aged 15-64 years was double that of the population aged 0-14 years and aged 65 and above. According to Viet Nam MICS 2014, the sex ratio of each five-year age group, from 0-4 years to 45-49 years (excluding the group 30-34 years) was equal or larger than one and the sex ratios of the remaining groups from 50-54 were smaller than one. Figure HH.1: Age and sex distribution of household population, viet Nam MICs 2014 85+ 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 5 0 Per cent 1 2 3 4 5123 Males Females 4 Tables HH.3, HH.4 and HH.5 provide basic information on the households, female respondents aged 15-49 years and children aged under-5 years. Both unweighted and weighted numbers are presented. Such information is essential for interpretation of the findings presented later in this report and provides background information on the representativeness of the survey sample. The remaining tables in this report are only presented with weighted numbers4. Table HH.3 provides basic background information on households, including the sex of the household heads, regions, areas and numbers of household members as well as sex, education 4 See Appendix A: Sample Design, for more details on sample weights. 39viet nam mics 2014 report and ethnicity5 details of household heads. These background characteristics are used in subsequent tables in this report and are intended to show the numbers of observations in major categories of analysis in this report. table HH.3: Household composition Percentage and frequency distribution of households by selected characteristics, Viet Nam, 2014 Weighted per cent Number of households Weighted unweighted total 100 9979 9979 sex of household head Male 73.1 7297 7279 Female 26.9 2682 2700 region Red River Delta 24.7 2468 1674 Northern Midlands and Mountainous area 13.0 1292 1674 North Central and Central coastal area 22.5 2245 1661 Central Highlands 5.6 558 1668 South East 15.6 1557 1652 Mekong River Delta 18.6 1859 1650 Area Urban 31.1 3102 4107 Rural 68.9 6877 5872 Number of household members 1 6.8 683 613 2 15.2 1512 1436 3 20.0 1994 1964 4 28.0 2794 2824 5 15.4 1535 1572 6 8.6 858 870 7 3.2 318 355 8 1.4 135 161 9 0.7 66 85 10+ 0.8 83 99 education of household head None 6.8 680 753 Primary 25.4 2534 2464 Lower Secondary 38.6 3853 3710 Upper Secondary 15.8 1578 1643 Tertiary 13.4 1333 1409 ethnicity of household head Kinh/Hoa 87.9 8772 8392 Ethnic Minorities 12.1 1207 1587 Mean household size 3.9 9979 9979 5 This was determined by asking respondents about their ethnic backgrounds. The majority of Kinh people and those of Hoa ethnicity are classified in the same group as they have similar living standards. 40 viet nam mics 2014 report The weighted and unweighted total numbers of households were equal, since sample weights were normalized. The table also shows the weighted mean household size estimated by the survey. Under observation in some classifications, for example the Central Highlands, Northern Midlands and Mountainous area and South East, the weighted number of observations was smaller than the unweighted number. However, a reverse pattern emerged in other classifications such as the Mekong River Delta, North Central and Central coastal area and Red River Delta. This reflects the unequal portion sampling strategy in the sample design of the survey to ensure that the indicators were representative and efficient. The Central Highlands, Northern Midlands and Mountainous area and South East were over-sampled in the sample selection to ensure a sufficient level of precision for survey estimates for these regions. For further rationale for the over-sampling in these regions, please consult Appendix A on the sample design. In the Viet Nam MICS 2014, the percentage of households with sizes of one, two-to-four, five-to-six and seven or more members were 6.8, 63.2, 24 and 6.1 per cent, respectively. These percentages were similar to the 2013 PCS, which recorded 7.8, 66.5, 21.1 and 4.5 per cent for one, two-to-four, five-to-six and seven or more household members, respectively. The average household size was 3.9 (Table HH.3), which was similar to the figure recorded in the 2013 PCS. Characteristics of Female respondents 15-49 years of Age and Children under-5 Tables HH.4 and HH.5 provide important information on the background characteristics of female respondents 15-49 years of age and children aged under-5. The total numbers of weighted and unweighted observations in the tables were equal, as sample weights have been standardized. In addition to providing useful information on the background characteristics of women and children, the tables illustrate the numbers of observations in each background category. These categories are used in subsequent tabulations of this report. table HH.4: Women’s background characteristics Percentage and frequency distribution of women age 15-49 years by selected background characteristics, Viet Nam, 2014. Weighted per cent Number of women Weighted unweighted total 100 9827 9827 region Red River Delta 22,6 2221 1495 Northern Midlands and Mountainous area 13,5 1325 1599 North Central and Central coastal area 21,2 2082 1535 Central Highlands 6,3 619 1811 South East 18,0 1768 1821 Mekong River Delta 18,4 1811 1566 41viet nam mics 2014 report Weighted per cent Number of women Weighted unweighted Area Urban 33,2 3259 4200 Rural 66,8 6568 5627 Age 15-19 14,0 1374 1398 20-24 13,6 1333 1338 25-29 13,8 1359 1369 30-34 15,7 1539 1546 35-39 14,2 1391 1402 40-44 14,7 1442 1414 45-49 14,1 1390 1360 Marital/union status Currently married/in union 71,6 7038 6972 Widowed 2,1 206 207 Divorced 1,9 185 193 Separated 0,9 90 107 Never married/in union 23,5 2308 2348 Motherhood and recent births Never gave birth 27,4 2692 2726 Ever gave birth 72,6 7135 7101 Gave birth in last two years 14,9 1464 1484 No birth in last two years 57,7 5671 5617 education None 4,8 475 581 Primary 15,1 1483 1459 Lower Secondary 35,8 3516 3370 Upper Secondary 24,2 2382 2412 Tertiary 20,1 1971 2005 Wealth Index quintiles Poorest 18,0 1773 1980 Second 18,5 1814 1638 Middle 20,4 2003 1860 Fourth 22,1 2171 2204 Richest 21,0 2067 2145 ethnicity of household head Kinh/Hoa 86,0 8456 8016 Ethnic Minorities 14,0 1371 1811 42 viet nam mics 2014 report Table HH.4 provides background characteristics of female respondents aged 15-49 years. It includes information on the distribution of women according to region, area, age, marital/in union and motherhood status, births in last two years, education6, wealth index quintiles7,8 and ethnicity of household head. The weighted number is higher than the unweighted number for Kinh/Hoa, while ethnic minorities were over sampled with a larger unweighted number. Table HH.5 highlights background characteristics of children aged under-5 years. It includes information on the distribution of children under-5 according to sex, region, area, age in months, the respondent to the under-5 questionnaire, mother’s education, wealth index quintiles and ethnicity of the household head. The over-sampling strategy is again in evidence, as the unweighted number of ethnic minority women and children was larger than the weighted numbers. 6 Throughout this report, unless otherwise stated, “education” refers to highest educational level ever attended by the respondent when used as a background variable. 7 The Wealth Index is a composite indicator of wealth. To construct the Wealth Index, a principal components analysis is performed using information on the ownership of consumer goods, dwelling characteristics, water and sanitation, and other characteristics related to the household’s wealth, to generate weights (factor scores) for each of the items used. First, initial factor scores are calculated for the total sample. Then, separate factor scores are calculated for households in urban and rural areas. Finally, the urban and rural factor scores are regressed on the initial factor scores to obtain the combined, final factor scores for the total sample. This is carried out to minimize the urban bias in the Wealth Index values. Each household in the total sample is then assigned a wealth score based on the assets owned by that household and on the final factor scores obtained as described above. The survey household population is then ranked according to the wealth score of the household they live in and is finally divided into five equal parts (quintiles), from lowest (poorest) to highest (richest). In Viet Nam MICS 2014, the following assets were used in these calculations: radio, television, telephone, refrigerator, table and chair set, fan, computer, air conditioner, gas cooker, electric cooker, washing machine, car or tractor, ship or boat, mobile telephone, bicycle, motorbike, ownership of dwelling, bank account, agricultural land, water surface, forestry land and animals/livestock. 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 only applicable for the particular dataset they are based on. Further information on the construction of the Wealth Index can be found in Filmer, D. and Pritchett, L., 2001. “Estimating wealth effects without expenditure data – or tears: An application to educational enrolments in states of India”. Demography 38(1): 115-132. Rutstein, S.O. and Johnson, K., 2004. The DHS Wealth Index. DHS Comparative Reports No.6. Calverton, Maryland: ORC Macro and Rutstein, S.O., 2008. The DHS Wealth Index: Approaches for Rural and Urban Areas. DHS Working Papers No.60. Calverton, Maryland: Macro International Inc. 8 When describing survey results by Wealth Index quintiles, appropriate terminology is used when referring to individual household members, such as “women in the richest household population”, used interchangeably with “women in the wealthiest survey population” and similar. 43viet nam mics 2014 report table HH.5: under-5’s background characteristics Percentage and frequency distribution of children aged under-5 by selected characteristics, Viet Nam, 2014 Weighted per cent Number of under-5 children Weighted unweighted total 100 3316 3316 sex Male 51.8 1719 1713 Female 48.2 1597 1603 region Red River Delta 23.6 784 516 Northern Midlands and Mountainous area 15.5 513 638 North Central and Central coastal area 20.8 690 492 Central Highlands 7.3 241 668 South East 15.5 515 516 Mekong River Delta 17.3 573 486 Area Urban 29.7 985 1265 Rural 70.3 2331 2051 Age 0-5 months 10.6 350 358 6-11 months 10.2 338 333 12-23 months 23.8 790 785 24-35 months 19.3 641 633 36-47 months 16.3 539 548 48-59 months 19.8 658 659 respondent to the under-5 questionnaire Mother 95.2 3156 3176 Other primary caretaker 4.8 160 140 Mother’s educationa None 5.9 197 250 Primary 15.3 506 518 Lower Secondary 36.8 1219 1171 Upper Secondary 20.6 683 692 Tertiary 21.4 710 685 Wealth Index quintiles Poorest 20.9 694 828 Second 20.0 662 589 Middle 20.3 672 617 Fourth 19.9 659 655 Richest 18.9 628 627 ethnicity of household head Kinh/Hoa 82.8 2746 2530 Ethnic Minorities 17.2 570 786 a In this table and throughout the report, “mother’s education” refers to educational attainment of mothers as well as caretakers of children under-5, who are the respondents to the under-5 questionnaire if the mother is deceased or living elsewhere. 44 viet nam mics 2014 report Housing Characteristics, Asset Ownership and Wealth Quintiles Tables HH.6, HH.7 and HH.8 provide further details on household level characteristics. Table HH.6 presents characteristics of housing, disaggregated by area and region, distributed by whether the dwelling has electricity, the main materials of flooring, roofing and exterior walls as well as the number of rooms used for sleeping. Nationally, the availability of electricity was almost universal in households (99.2 per cent). However, 1.1 per cent of households in rural areas had no electricity. Regions with higher percentages of dwellings without electricity are the Northern Midlands and Mountainous area (2.8 per cent) and Mekong River Delta (1.0 per cent). Materials used for dwelling roofing, flooring and exterior walls are classified into three categories: natural, rudimentary and finished. The majority of households had finished floors (92.9 per cent), finished roofing (97.2 per cent) and finished walls (89.3 per cent). The natural category is considered bad for inhabitants’ health, especially children. The proportion of households with natural category materials for roofing, flooring and exterior walls were much higher in rural than urban areas: 5.7 and 0.9 per cent for flooring, 3.1 and 0.4 per cent for roofing and 5.6 and 1.0 per cent for walls, respectively. The proportions in natural categories were higher in the Mekong River Delta and Northern Midlands and Mountainous area. Sixteen per cent of households in the Mekong River Delta had natural walls, 7.2 per cent had natural roofing and 13.3 per cent had natural flooring. Overall, 24 per cent of households had three or more rooms used for sleeping, reflecting better living conditions. Urban areas have higher percentages of households with three or more rooms for sleeping (31 per cent), than rural areas (21 per cent). The Mekong River Delta had the lowest percentage (16.9 per cent) of households with three or more rooms for sleeping. The national mean number of persons per room used for sleeping was 2.22. However, the Red River Delta had a mean number of persons per room used for sleeping below the national figure (1.88), while the Northern Midlands and Mountainous area had a figure of 2.67 for this indicator. 45viet nam mics 2014 report table HH.6: Housing characteristics Percentage distribution of households by selected housing characteristics, according to area of residence and region, Viet Nam, 2014 Total Area region Urban Rural Red River Delta Northern Midlands and Mountainous area North Central and Central coastal area Central Highlands South East Mekong River Delta electricity Yes 99.2 99.9 98.9 100 97.2 99.7 99.3 99.3 99.0 No 0.8 0.1 1.1 0.0 2.8 0.3 0.7 0.7 1.0 Flooring Natural flooring 4.2 0.9 5.7 0.7 7.3 1.3 2.2 1.5 13.3 Rudimentary flooring 2.9 0.6 3.9 0.0 10.8 1.9 4.8 0.1 4.2 Finished flooring 92.9 98.5 90.4 99.3 81.9 96.8 93.0 98.4 82.5 roofing Natural roofing 2.3 0.4 3.1 0.1 5.1 0.6 0.1 0.5 7.2 Rudimentary roofing 0.6 0.2 0.8 0.0 2.9 0.5 0.2 0.1 0.3 Finished roofing 97.2 99.4 96.1 99.9 92.0 98.8 99.6 99.4 92.4 exterior walls Natural walls 4.2 1.0 5.6 0.0 6.0 0.5 0.3 1.8 16.0 Rudimentary walls 3.4 1.4 4.3 0.3 7.5 4.2 2.8 1.8 5.4 Finished walls 89.3 95.5 86.5 99.5 86.6 95.1 94.7 95.7 63.6 Other 3.1 2.0 3.6 0.1 0.0 0.2 2.2 0.6 15.0 rooms used for sleeping 1 32.6 27.3 35.0 24.9 42.2 32.5 30.5 31.8 37.7 2 43.4 41.7 44.2 44.7 35.3 45.0 40.4 44.4 45.4 3 or more 24.0 31.0 20.8 30.3 22.5 22.5 29.1 23.8 16.9 total 100 100 100 100 100 100 100 100 100 Number of households 9979 3102 6877 2468 1292 2245 558 1557 1859 Mean number of persons per room used for sleeping 2.22 2.09 2.28 1.88 2.67 2.10 2.52 2.27 2.36 In Table HH.7, households are distributed according to ownership of assets by household and by individual household members. Household assets include those used in daily life, such as air conditioner(s), refrigerator(s), television(s) and washing machine(s) and those of higher value such as a dwelling, agricultural land, water surface and forestry land. Fifty-six per cent of households nationally have agricultural land, with the percentage highest in the Northern Midlands and Mountainous area and Central Highlands. These data also reflect the regional characteristics of Viet Nam. The predominantly forested Northern Midlands and Mountainous area had the highest percentage of forestry land use (36.9 per cent), while the Mekong River Delta’s large number of rivers was reflected in its inhabitants’ high use of water surfaces (19.8 per cent). Of the interviewed households, 93.4 per cent owned their dwelling. But, this was lowest in the South East (83.6 per cent), which could be explained by the region’s large number of migrants who live in rented households or households not owned. 46 viet nam mics 2014 report ta bl e H H .7 : H ou se ho ld a nd p er so na l a ss et s Pe rc en ta ge o f h ou se ho ld s by o w ne rs hi p of s el ec te d ho us eh ol d an d pe rs on al a ss et s, an d pe rc en ta ge d is tr ib ut io n by o w ne rs hi p of d w el lin g, a cc or di ng to a re as o f r es id en ce a nd re gi on s, Vi et N am , 2 01 4 To ta l A re a re gi on U rb an Ru ra l Re d Ri ve r D el ta N or th er n M id la nd s an d M ou nt ai no us ar ea N or th C en tr al an d Ce nt ra l co as ta l a re a Ce nt ra l H ig hl an ds So ut h Ea st M ek on g Ri ve r D el ta Pe rc en ta ge o f h ou se ho ld s th at o w n a: Ra di o 18 .7 22 .3 17 .0 24 .6 10 .4 14 .7 10 .6 21 .7 21 .1 Te le vi si on 94 .0 96 .6 92 .8 95 .7 89 .2 93 .6 93 .4 95 .5 94 .5 Fi xe d ph on e 23 .0 38 .0 16 .3 26 .8 13 .3 17 .2 15 .3 34 .1 24 .8 Re fr ig er at or 60 .9 80 .9 51 .8 74 .2 55 .3 51 .0 46 .3 79 .1 48 .0 Be d 90 .2 85 .1 92 .5 98 .2 86 .3 94 .8 95 .2 73 .5 89 .5 Ta bl e an d ch ai r s et 71 .4 71 .9 71 .2 73 .4 63 .0 75 .1 60 .2 70 .8 73 .9 So fa 26 .8 35 .8 22 .7 31 .7 25 .3 27 .0 29 .0 29 .2 18 .2 Fa n 93 .2 97 .0 91 .5 99 .3 86 .2 95 .0 67 .7 97 .6 91 .9 Co m pu te r 27 .1 49 .4 17 .1 32 .9 17 .0 21 .2 21 .9 46 .3 19 .1 A ir co nd iti on er 15 .0 33 .9 6. 4 26 .2 6. 2 8. 4 1. 6 27 .1 8. 1 G as c oo ke r 76 .3 88 .6 70 .7 85 .0 54 .4 73 .9 63 .3 90 .1 75 .1 El ec tr ic c oo ke r 22 .6 33 .2 17 .9 36 .2 17 .5 11 .3 19 .0 25 .6 20 .5 W as hi ng m ac hi ne 32 .2 58 .2 20 .5 45 .1 20 .9 20 .8 29 .2 55 .9 17 .8 Tr ac to r 3. 6 1. 3 4. 6 2. 7 7. 9 2. 2 16 .2 .9 1. 8 Ca r 4. 2 8. 4 2. 3 5. 5 4. 3 3. 0 3. 9 6. 7 1. 8 Ca r o r t ra ct or 7. 7 9. 6 6. 8 8. 1 12 .1 5. 2 19 .5 7. 5 3. 6 Sh ip o r b oa t w ith a m ot or 4. 8 1. 9 6. 1 0. 7 0. 7 3. 0 0. 1 0. 7 20 .1 47viet nam mics 2014 report To ta l A re a re gi on U rb an Ru ra l Re d Ri ve r D el ta N or th er n M id la nd s an d M ou nt ai no us ar ea N or th C en tr al an d Ce nt ra l co as ta l a re a Ce nt ra l H ig hl an ds So ut h Ea st M ek on g Ri ve r D el ta Pe rc en ta ge o f h ou se ho ld s th at o w n: Ag ric ul tu ra l l an d 56 .0 20 .6 71 .9 64 .5 77 .0 61 .9 73 .1 21 .5 46 .6 W at er s ur fa ce 10 .4 2. 4 14 .1 8. 7 17 .4 8. 3 4. 3 1. 5 19 .8 Fo re st ry la nd 8. 8 2. 0 11 .9 1. 5 36 .9 13 .3 2. 6 0. 7 2. 4 Fa rm a ni m al s/ Li ve st oc k 50 .1 21 .3 63 .2 44 .2 81 .0 63 .1 53 .7 22 .3 43 .1 Pe rc en ta ge o f h ou se ho ld s w he re a t l ea st o ne m em be r o w ns o r h as a : M ob ile te le ph on e 92 .5 95 .6 91 .1 92 .1 93 .9 91 .0 88 .8 95 .7 92 .4 Bi cy cl e 64 .6 60 .0 66 .6 80 .3 58 .8 69 .6 41 .8 48 .7 61 .8 M ot or cy cl e or s co ot er 82 .1 89 .0 79 .1 79 .5 84 .9 79 .0 89 .6 92 .4 76 .7 Ba nk a cc ou nt 33 .1 53 .5 23 .9 38 .6 23 .0 28 .8 25 .5 53 .5 23 .3 O w ne rs hi p of d w el lin g O w ne d by a h ou se ho ld m em be r 93 .4 89 .5 95 .1 95 .4 96 .6 96 .5 96 .0 83 .6 92 .0 N ot o w ne d 6. 6 10 .5 4. 9 4. 6 3. 4 3. 5 4. 0 16 .4 8. 0 Re nt ed 3. 4 7. 6 1. 5 2. 2 0. 7 0. 8 1. 7 13 .6 2. 0 O th er 3. 2 2. 9 3. 4 2. 4 2. 7 2. 7 2. 3 2. 8 6. 0 To ta l 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 N um be r o f h ou se ho ld s 99 79 31 02 68 77 24 68 12 92 22 45 55 8 15 57 18 59 48 viet nam mics 2014 report Table HH.8 shows how household populations in areas and regions are distributed according to household wealth index quintiles. This table shows each of five wealth index quintiles occupied 20 per cent of the household population. Table HH.8 shows that 47.2 per cent of the urban population is in the richest wealth index quintile, in stark contrast to just 7.3 per cent of the rural population. Moreover, more than a quarter of the rural population is in the poorest wealth index quintile (26.8 per cent), five times higher than the poorest urban population (5.4 per cent). Of the six regions, the Red River Delta (31.7 per cent) and South East (36.9 per cent) occupied one-third of the richest wealth quintiles, while the Northern Midlands and Mountainous area and Central Highlands had two-fifths of their populations in the poorest wealth index quintile. table HH.8: Wealth quintile Percentage distribution of household population by Wealth Index quintiles, according to area of residence and regions, Viet Nam, 2014 Wealth Index quintile Total Number of household membersPoorest Second Middle Fourth Richest total 20.0 20.0 20.0 20.0 20.0 100 38506 Area Urban 5.4 7.1 14.8 25.5 47.2 100 12236 Rural 26.8 26.0 22.4 17.4 7.3 100 26270 region Red River Delta 3.5 15.8 23.7 25.3 31.7 100 9091 Northern Midlands and Mountainous area 44.6 21.8 15.0 9.9 8.8 100 5240 North Central and Central coastal area 19.6 27.1 22.0 17.7 13.5 100 8214 Central Highlands 40.2 17.5 17.2 17.7 7.3 100 2432 South East 6.9 9.7 17.6 28.8 36.9 100 6373 Mekong River Delta 28.3 25.8 19.8 16.2 10.0 100 7156 49viet nam mics 2014 report 50 viet nam mics 2014 report chIld MorTAlITy chapter IV 51viet nam mics 2014 report Iv. CHIlD MOrtAlIty One of the overarching goals of the MDGs is to reduce infant and under-5 mortality. Specifically, the MDGs call for the reduction of under-5 mortality by two-thirds between 1990 and 2015. Monitoring progress towards this goal is an important, yet challenging objective. Mortality rates presented in this chapter are calculated from information collected in the birth histories of women’s questionnaires. All interviewed women in Viet Nam MICS 2014 were asked whether they had ever given birth. If the answer was yes, they were asked to report the number of sons and daughters who live with them, the number who live elsewhere and the number who have died. In addition, they were asked to provide a detailed birth history of live births in chronological order starting with the firstborn. Women were also asked whether births were single or multiple, the child’s sex, the date of birth (month and year), and survival status. Furthermore, for children still alive, they were asked the current age of the child and, if not alive, the age at death. Childhood mortality rates are expressed by conventional age categories and are defined as follows: 52 viet nam mics 2014 report • Neonatal mortality (NN): probability of dying within the first month of life • Post-neonatal mortality (PNN): difference between infant and neonatal mortality rates • Infant mortality (1q0): probability of dying between birth and the first birthday • Child mortality (4q1): probability of dying between the first and the fifth birthdays • Under-5 mortality (5q0): probability of dying between birth and the fifth birthday. table CM.1: early childhood mortality rates (per thousand live births) Neonatal, post-neonatal, infant, child and under-5 mortality rates for five-year periods preceding the survey, Viet Nam, 2014 Neonatal mortality rate1 Post-neonatal mortality rate2, a Infant mortality rate3 Child mortality rate4 under-5 mortality rate5 years preceding the survey 0-4 11.95 4.26 16.21 3.59 19.74 5-9 7.20 6.13 13.33 5.18 18.44 10-14 9.72 6.15 15.87 8.46 24.19 15-19 18.23 4.79 23.03 9.56 32.37 20-24 25.71 14.03 39.73 12.39 51.63 1 MICs Indicator 1.1 - Neonatal mortality rate 2 MICs Indicator 1.3 - Post-neonatal mortality rate 3 MICs Indicator 1.2, MDG Indicator 4.2 - Infant mortality rate 4 MICs Indicator 1.4 - Child mortality rate 5 MICs Indicator 1.5; MDG Indicator 4.1 - under-5 mortality rate a Post-neonatal mortality rates are computed as the difference between the infant and neonatal mortality rates Table CM.1 and Figure CM.1 present neonatal, post-neonatal, infant, child and under-5 mortality rates for the three most recent five-year periods before the survey. Neonatal mortality in the most recent five-year period is estimated at 12 per 1,000 live births, while the post-neonatal mortality rate is estimated at four per 1,000 live births. 53viet nam mics 2014 report Figure CM.1: early childhood mortality rates, viet Nam MICs 2014 Post-neonatal mortality rate Infant mortality rate Child mortality rate Under-�ve mortality rate Neonatal mortality rate 11.95 4.26 16.21 3.59 19.74 0 5 10 15 20 25 30 Note: Indicator values are per 1,000 live births The infant mortality rate in the five years preceding the survey was more than 16 per 1,000 live births (95% confidence interval from 12.78%0 to 19.64%0) and under-5 mortality amounted to nearly 20 deaths per 1,000 live births (95% confidence interval from 15.99%0 to 23.49%0) for the same period, indicating that around 82 per cent of under-5 deaths were infant deaths. denotes confidence interval 54 viet nam mics 2014 report table CM.2: early childhood mortality rates by socio-economic characteristics (per thousand live births) Neonatal, post-neonatal, infant, child and under-5 mortality rates for the five-year period preceding the survey, by socio-economic characteristics, Viet Nam, 2014 Neonatal mortality rate1 Post-neonatal mortality rate2, a Infant mortality rate3 Child mortality rate4 under-5 mortality rate5 total 11.95 4.26 16.21 3.59 19.74 Area Urban 8.69 3.93 12.62 3.13 15.71 Rural 13.37 4.41 17.78 3.79 21.51 Mother's education None 46.27 20.74 67.02 19.47 85.19 Primary 5.95 2.00 7.95 0.00 7.95 Lower Secondary 11.43 4.05 15.48 3.59 19.01 Upper Secondary 10.14 3.99 14.14 0.00 14.14 Tertiary 8.88 1.63 10.51 4.23 14.70 Wealth Index quintiles 40% Poorest 18.73 6.86 25.59 6.10 31.53 60% Richest 7.35 2.51 9.86 1.91 11.76 ethnicity of household head Kinh/Hoa 8.21 1.99 10.20 2.25 12.42 Ethnic Minorities 28.97 14.59 43.56 9.89 53.02 1 MICs Indicator 1.1 - Neonatal mortality rate 2 MICs Indicator 1.3 - Post-neonatal mortality rate 3 MICs Indicator 1.2, MDG indicator 4.2 - Infant mortality rate 4 MICs Indicator 1.4 - Child mortality rate 5 MICs Indicator 1.5, MDG indicator 4.1 - under-5 mortality rate a Post-neonatal mortality rates are computed as the difference between the infant and neonatal mortality rates 55viet nam mics 2014 report table CM.3: early childhood mortality rates by demographic characteristics (per thousand live births) Neonatal, post-neonatal, infant, child and under-5 mortality rates for the five-year period preceding the survey, by demographic characteristics, Viet Nam, 2014 Neonatal mortality rate 1 Post-neonatal mortality rate2, a Infant mortality rate3 Child mortality rate4 under-5 mortality rate5 total 11.95 4.26 16.21 3.59 19.74 sex of child Male 14.69 3.26 17.95 4.92 22.79 Female 8.99 5.35 14.33 2.10 16.40 Mother's age at birth Less than 20 24.13 10.51 34.64 8.23 42.59 20-34 8.99 3.46 12.45 3.18 15.58 35-49 27.44 5.90 33.35 3.88 37.09 Birth order 1 7.50 5.99 13.48 5.02 18.44 2-3 11.47 3.15 14.62 1.40 15.99 4-6 53.73 0.73 54.46 3.05 57.34 7+ 51.86 0.00 51.86 65.15 113.63 Previous birth intervalb < 2 years 28.11 13.16 41.27 9.03 49.92 2 years 16.82 0.00 16.82 0.77 17.57 3 years 14.70 0.50 15.20 6.16 21.26 4+ years 11.35 1.00 12.35 0.52 12.86 1 MICs Indicator 1.1 - Neonatal mortality rate 2 MICs Indicator 1.3 - Post-neonatal mortality rate 3 MICs Indicator 1.2, MDG indicator 4.2 - Infant mortality rate 4 MICs Indicator 1.4 - Child mortality rate 5 MICs Indicator 1.5, MDG indicator 4.1 - under-5 mortality rate a Post-neonatal mortality rates are computed as the difference between the infant and neonatal mortality rates b Excludes first order births Tables CM.2 and CM.3 provide estimates of child mortality by socio-economic and demographic characteristics. The probabilities of dying were higher for males than for females, but lower for those in urban and Kinh/Hoa groups than for those from rural and ethnic minority groups. The probability of dying was also lowest for children of mothers aged 20-34 years. Neonatal, infant and under-5 mortality rates were highest for the 40 per cent poorest wealth index group and triple the 60 per cent richest wealth index group. Figure CM.2 shows the disparities of under-5 mortality rates by urban-rural areas. The under-5 mortality rate in rural areas was 22 per 1,000, 1.38 times higher than in urban areas. 56 viet nam mics 2014 report Figure CM.2: under-5 mortality rates by area viet Nam MICs 2014 19.74 31.53 11.76 15.71 21.51 0 5 10 15 20 25 30 35 Per 1.000 live births General Wealth index quintiles 40% Poorest 60% Richest Area Urban Rural Figure CM.3 compares the findings of Viet Nam MICS 2014 on under-5 mortality rates with those from other data sources: Viet Nam MICS 2011, Viet Nam Population and Housing Census 2009 (PHC2009), Population Change and Family Planning Survey (PCFPS 2010, 2011, 2012 and 2013) and Inter-censal Population Survey 2014 (IPS 2014). The Viet Nam MICS 2014 findings were obtained from Table CM.21. The MICS estimates indicate a decline in mortality during the last 20 years. The most recent under-5 mortality estimate (20 per 1,000 live births) from Viet Nam MICS 2014 was lower than estimated by PCFPS (87 per cent) and IPS 2014 (91 per cent). The mortality trend depicted by the UN IGME9 is also a declining one. However, Viet Nam MICS 2014 results were also lower than those indicated by the UN IGME estimate. Further qualification of these apparent declines and differences as well as their determinants should be taken up in a more detailed and separate analysis. 9 The UN Inter-agency Group for Child Mortality Estimation (IGME). The IGME, led by the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO), also includes the World Bank and the United Nations Population Division of the Department of Economic and Social Affairs as full members. 57viet nam mics 2014 report Figure CM.3: under-5 mortality rate trends in viet Nam MICs 2014 and other surveys 1990 MICS 2011 Census 2009 Pop change 2010-13 IPS 2014 MICS 2014 UN IGME Estimation 70 60 50 40 30 20 10 0 1994 1998 2002 2006 2010 2014 58 viet nam mics 2014 report NuTrITIoN chAPTER V 59viet nam mics 2014 report v. NutrItION low Birth Weight Weight at birth is a good indicator not only of a mother’s health and nutritional status but also the newborn’s chances for survival, growth, long-term health and psychosocial development. Low birth weight (defined as less than 2,500 grams) carries a range of grave health risks for children. Babies who were undernourished in the womb face a greatly increased risk of dying during their early days, months and years. Those who survive may 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 with low birth weight also risk 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 - mother’s poor nutritional status before conception, short stature (due mostly to under nutrition and infections during her childhood) and poor nutrition during pregnancy. Inadequate weight gain during pregnancy is particularly important, as it accounts for a large proportion of foetal growth retardation. Moreover diseases such as diarrhoea and malaria, which are common in many developing countries, can significantly impair foetal growth if the mother becomes infected while pregnant. 60 viet nam mics 2014 report 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 a higher risk of bearing low birth weight babies. One of the major challenges in measuring incidences of low birth weight is that more than half of infants in the developing world are not weighed at birth. 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 2,500 grams is estimated from two items in the Viet Nam MICS 2014 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 birth10. table Nu.1: low birth weight infants Percentage of last live-born children in the last two years estimated to have weighed below 2500 grams at birth and percentage of live births weighed at birth, Viet Nam, 2014 Percentage distribution of births by mother's assessment of size at birth: Total Percentage of live births: Number of last live-born children in the last two years Very small Smaller than average Average Larger than average or very large DK Below 2500 grams1 Weighed at birth2 total 1.4 8.3 77.7 11.8 0.8 100 5.7 94.3 1464 Mother's age at birth Less than 20 years 0.9 10.9 79.7 6.8 1.6 100 6.4 86.8 124 20-34 years 1.6 7.7 77.6 12.3 0.8 100 5.6 95.2 1212 35-49 years 0 10.8 76.9 12.3 0 100 5.5 92.9 128 Birth order 1 1.0 9.0 80.4 8.8 0.8 100 5.7 97.1 603 2-3 1.3 7.3 76.4 14.1 0.9 100 5.2 93.7 807 4-5 9.9 15.5 61.6 13.0 0 100 13.9 77.7 46 6+ * * * * * * * * 9 region Red River Delta 1.1 8.0 80.4 9.4 1.0 100 5.4 98.3 343 Northern Midlands and Mountainousarea 2.4 7.4 78.1 8.6 3.6 100 6.2 79.2 230 North Central and Central coastal area 2.7 8.6 75.7 13.0 0 100 6.6 97.7 300 Central Highlands 0.9 13.9 74.4 10.8 0 100 7.2 85.6 109 South East 1.0 9.2 73.8 16.0 0 100 5.5 97.3 242 MekongRiver Delta 0 5.5 81.4 13.1 0 100 3.7 99.6 239 10 For a detailed description of the methodology, see Boerma, J. T., Weinstein, K. I., Rutstein, S.O., and Sommerfelt, A. E. , 1996.Data on Birth Weight in Developing Countries: Can Surveys Help? Bulletin of the World Health Organization, 74(2), 209-16. 61viet nam mics 2014 report Percentage distribution of births by mother's assessment of size at birth: Total Percentage of live births: Number of last live-born children in the last two years Very small Smaller than average Average Larger than average or very large DK Below 2500 grams1 Weighed at birth2 Area Urban 1.2 7.3 75.7 15.5 0.3 100 5.1 98.5 428 Rural 1.5 8.7 78.5 10.3 1.0 100 5.9 92.5 1037 Mother’s education None 5.3 12.5 61.4 16.0 4.7 100 10.1 41.8 67 Primary 2.7 8.2 75.5 13.6 0 100 6.5 87.2 182 Lower Secondary 0.7 9.6 78.3 10.5 1.0 100 5.6 96.7 529 Upper Secondary 0.4 8.2 77.8 13.3 0.3 100 4.8 99.6 340 Tertiary 2.2 5.6 80.9 10.8 0.6 100 5.3 99.2 347 Wealth Index quintiles Poorest 1.7 10.4 75.7 10.1 2.1 100 6.7 75.3 294 Second 2.8 6.6 79.0 10.1 1.6 100 6.1 97.0 288 Middle 0.2 10.3 75.2 14.0 0.3 100 5.4 99.7 292 Fourth 1.1 7.3 80.2 11.4 0 100 5.1 99.7 314 Richest 1.5 6.7 78.1 13.7 0 100 5.1 99.7 275 ethnicity of household head Kinh/Hoa 1.1 7.6 78.4 12.5 0.4 100 5.2 99.1 1215 Ethnic Minorities 3.0 11.6 74.1 8.4 2.8 100 8.1 70.9 250 1 MICs Indicator 2.20 –low birth weight infants 2 MICs Indicator 2.21 - Infants weighed at birth Note: Figures denoted by an asterisk are based on denominators of less than 25 unweighted cases Overall, 94.3 per cent of births were weighed and 5.7 per cent of infants had low birth weights - less than 2,500 grams at birth (Table NU.1). There were significant regional variations with the lowest percentage of 3.7 per cent in the Mekong River Delta in contrast to the highest of 7.2 per cent in the Central Highlands. Generally, the prevalence of low birth weights did not vary much by mother’s age or wealth index quintile. However, children born to mothers with primary education or no education had a higher prevalence of low weight at birth than lower secondary education and above. Viet Nam MICS 2014 did not include anthropometric measurements for children under 5, which had been included in Viet Nam MICS 2011, due to time and resource constraints as well as the availability of national nutrition survey data. Breastfeeding, Infant and young Child Feeding Proper feeding of infants and young children can increase their chances of survival and promote optimal growth and development, especially in the critical window from birth to two years of age. 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 do not start to breastfeed early enough, do not breastfeed exclusively for the recommended six months or stop breastfeeding too soon. There are often pressures to switch to infant formula, 62 viet nam mics 2014 report which can contribute to growth faltering and micronutrient malnutrition and can be unsafe if hygienic conditions, including safe drinking water, are not readily available. Studies have shown that in addition to continued breastfeeding, consumption of appropriate, adequate and safe solid, semi-solid and soft foods from the age of six months onwards leads to better health and growth outcomes, with potential to reduce stunting during the first two years of life11. UNICEF and WHO recommend that infants be breastfed within one hour of birth, breastfed exclusively for the first six months of life and continue to be breastfed up to two years of age and beyond12. Starting at six months, breastfeeding should be combined with safe, age-appropriate feeding of solid, semi-solid and soft foods13. A summary of key guiding principles14, 15, for feeding 6 to 23-month-old children is provided in the table below along with proximate measures for these guidelines collected in this survey. The guiding principles for which proximate measures and indicators exist are: (i) Continued breastfeeding (ii) Appropriate frequency of meals (but not energy density) (iii) Appropriate nutrient content of food. Feeding frequency is used as a proxy for energy intake, requiring children to receive a minimum number of meals/snacks (and milk feeds for non-breastfed children) for their age. Dietary diversity is used to ascertain the adequacy of the nutrient content of the food (not including iron) consumed. For dietary diversity seven food groups were created, for which a child consuming at least four of these is considered to have a better quality diet. In most populations, consumption of at least four food groups means that the child has a high likelihood of consuming at least one animal-source food and at least one fruit or vegetable, in addition to a staple food (grain, root or tuber)16. These three dimensions of child feeding are combined into an assessment of children who received appropriate feeding, using the indicator of “minimum acceptable diet”. To have a minimum acceptable diet in the previous day, a child must have received: (i) The appropriate number of meals/snacks/milk feeds (ii) Food items from at least four food groups (iii) Breastmilk or at least two milk feeds (for non-breastfed children). 11 Bhuta Z. et al. (2013). Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? The Lancet June 6, 2013. 12 WHO (2003). Implementing the Global Strategy for Infant and Young Child Feeding. Meeting Report Geneva, 3-5 February 2003. 13 WHO (2003). Global Strategy for Infant and Young Child Feeding. 14 PAHO (2003). Guiding principles for complementary feeding of the breastfed child. 15 WHO (2005). Guiding principles for feeding non-breastfed children 6-24 months of age. 16 WHO (2008).Indicators for assessing infant and young child feeding practices. Part 1: Definitions. 63viet nam mics 2014 report Guiding Principle (age 6-23 months) Proximate measures table Continue frequent, on-demand breastfeeding for two years and beyond Breastfed in the last 24 hours NU.4 Appropriate frequency and energy density of meals Breastfed children Depending on age, two or three meals/ snacks provided in the last 24 hours Non-breastfed children Four meals/snacks and/or milk feeds provided in the last 24 hours NU.6 Appropriate nutrient content of food Four food groups17 eaten in the last 24 hours NU.6 Appropriate amount of food No standard indicator exists na Appropriate consistency of food No standard indicator exists na Use of vitamin-mineral supplements or fortified products for infant and mother No standard indicator exists na Practice good hygiene and proper food handling While it was not possible to develop indicators to fully capture programme guidance, one standard indicator does cover part of the principle: Not feeding with a bottle with a nipple NU.9 Practice responsive feeding, applying the principles of psycho-social care No standard indicator exists na 17 Food groups used for assessment of this indicator are 1) Grains, roots and tubers, 2) legumes and nuts, 3) dairy products (milk, yogurt, cheese), 4) flesh foods (meat, fish, poultry and liver/organ meats), 5) eggs, 6) vitamin-A rich fruits and vegetables and 7) other fruits and vegetables. 64 viet nam mics 2014 report table Nu.3: Initial breastfeeding Percentage of last live-born children in the last two years who were ever breastfed, breastfed within one hour of birth, within one day of birth, and percentage who received a prelacteal feed, Viet Nam, 2014 Percentage of children who were first breastfed: Percentage who received a prelacteal feed Number of last live-born children in the last two years Percentage who were ever breastfed1 Within one hour of birth2 Within one day of birth total 96.9 26.5 67.8 72.2 1464 region Red River Delta 97.4 20.9 70.8 81.8 343 Northern Midlands and Mountainous area 96.0 31.1 69.4 58.7 230 North Central and Central coastal area 98.6 28.5 69.1 71.2 300 Central Highlands 98.1 35.1 69.7 59.5 109 South East 93.4 22.1 57.1 79.3 242 Mekong River Delta 98.0 27.8 70.1 71.0 239 Area Urban 95.7 23.8 57.9 83.2 428 Rural 97.5 27.6 71.9 67.6 1037 Months since last birth 0-11 months 97.3 26.0 64.4 73.4 680 12-23 months 97.0 26.7 71.4 71.4 744 Assistance at delivery Skilled attendant 97.5 25.8 68.1 74.7 1373 Traditional birth attendant (100) (42.3) (75.9) (29.1) 12 Other 99.6 43.2 69.6 37.8 64 No one/Missing * * * * 16 Place of delivery Home 99.7 45.1 73.5 32.9 82 Health facility 97.5 25.5 68.0 75.1 1371 Public 97.5 25.4 68.4 74.6 1313 Private 97.0 28.4 58.3 85.2 58 Other/DK/Missing * * * * 11 Mother’s education None 93.1 39.8 68.9 36.9 67 Primary 97.6 27.5 65.8 66.1 182 Lower Secondary 97.2 27.7 73.1 69.3 529 Upper Secondary 98.0 27.0 66.7 74.7 340 Tertiary 95.9 20.8 61.5 83.9 347 65viet nam mics 2014 report Percentage of children who were first breastfed: Percentage who received a prelacteal feed Number of last live-born children in the last two years Percentage who were ever breastfed1 Within one hour of birth2 Within one day of birth Wealth Index quintiles Poorest 95.2 31.2 68.9 50.0 294 Second 96.8 25.5 70.5 68.7 288 Middle 98.6 28.2 70.3 77.5 292 Fourth 97.8 24.6 67.7 80.0 314 Richest 96.1 22.7 61.1 84.8 275 ethnicity of household head Kinh/Hoa 97.0 24.4 67.6 76.5 1215 Ethnic Minorities 96.4 36.3 68.4 50.8 250 1 MICs Indicator 2.5 - Children ever breastfed 2 MICs Indicator 2.6 - early initiation of breastfeeding Note: Figures denoted by an asterisk are based on denominators of less than 25 unweighted cases Figures shown in parenthesis are based on denominators of 25-49 unweighted cases Table NU.3 is based on mothers’ reports of what their last-born child, born within the last two years, was fed in the first few days of life. It indicates the proportion who were ever breastfed, those who were first breastfed within one hour and one day of birth as well as those who received a prelacteal feed18. Although a very important step in management of lactation and establishment of a physical and emotional relationship between baby and mother, only 26.5 per cent of babies were breastfed for the first time within one hour of birth, while 67.8 per cent of newborns in Viet Nam started breastfeeding within one day of birth. The highest proportion of children breastfed within one hour of birth was recorded in the Central Highlands (35.1 per cent), while the lowest proportion was recorded in the Red River Delta (20.9 per cent). Women in rural areas, those in the poorest wealth index quintile and ethnic minority women are more likely to breastfeed their children within one hour of birth than those from urban areas, the richest wealth index quintile and Kinh/Hoa group, respectively. Tertiary-educated women are less likely to breastfeed their children within one hour than those with other educational levels. 18 Prelacteal feed refers to the provision any liquid or food, other than breastmilk, to a newborn during the period when breast milk flow is generally being established (estimated here as the first three days of life). 66 viet nam mics 2014 report Figure Nu.2: Initiation of breastfeeding, viet Nam MICs 2014 100 80 60 40 20 0 Re d Ri ve r D el ta Pe r c en t N or th er n M ou nt ai no us a nd M ou nt ai n ar ea N or th C en tr al a nd C en tr al Co as ta l a re a M ek on g Ri ve r D el ta Ce nt ra l H ig hl an ds So ut h Ea st U rb an Ru ra l To ta l 20.9 31.1 28.5 35.1 22.1 27.8 23.8 27.6 26.5 70.8 69.4 69.1 69.7 Within one day Within one hour 57.1 70.1 57.9 71.9 67.8 The set of Infant and Young Child Feeding (IYCF) indicators reported in Tables NU.4 through NU.8 are based on mothers’ reports of consumption of food and fluids during the day or night prior to being interviewed. Data are subject to a number of limitations, some related to the respondent’s ability to provide a full report on the child’s liquid and food intake due to recall errors as well as lack of knowledge in cases where the child was fed by other individuals. In Table NU.4, breastfeeding status is presented for both exclusively breastfed and predominantly breastfed referring to infants aged less than six months who are breastfed, distinguished by the former only allowing vitamins, mineral supplements and medicine and the latter allowing also plain water and non-milk liquids. The table also shows continued breastfeeding of children at 12-15 and 20-23 months of age. 67viet nam mics 2014 report table Nu.4: Breastfeeding Percentage of living children according to breastfeeding status at selected age groups, Viet Nam, 2014 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 one year)3 Number of children Percentage breastfed (Continued breastfeeding at two years)4 Number of children total 24.3 49.0 350 65.6 260 21.8 233 sex Male 23.8 51.2 191 65.5 131 21.2 136 Female 25.0 46.3 159 65.7 130 22.7 98 region Red River Delta 28.9 48.0 78 (64.5) 49 (34.6) 51 Northern Midlands and Mountainous area 41.0 55.3 61 87.2 50 (11.5) 28 North Central and Central coastal area 26.7 54.2 77 (82.8) 45 (20.6) 50 Central Highlands 28.7 57.4 25 (81.3) 17 42.3 23 South East 7.4 29.2 56 (31.0) 41 (13.4) 38 Mekong River Delta (11.1) (52.4) 54 54.7 58 (11.7) 44 Area Urban 20.8 42.7 99 57.7 84 18.0 84 Rural 25.8 51.4 251 69.4 177 23.9 149 Mother’s education None * * 14 * 12 * 15 Primary (24.2) (53.1) 44 (76.7) 31 (16.9) 38 Lower Secondary 25.0 52.4 144 68.8 85 28.1 76 Upper Secondary 28.1 48.4 72 62.1 73 18.3 48 Tertiary 16.5 38.3 76 55.1 60 14.0 57 Wealth Index quintiles Poorest 41.6 74.0 72 81.2 53 24.7 50 Second 20.6 45.0 76 (78.9) 52 (31.0) 47 Middle 24.1 44.7 79 (69.5) 48 (22.3) 34 Fourth 12.0 39.7 66 58.2 60 18.7 54 Richest 22.2 39.4 57 38.9 47 13.3 49 ethnicity of household head Kinh/Hoa 19.7 45.5 283 58.6 209 18.8 195 Ethnic Minorities 44.0 63.4 67 94.2 52 37.0 39 1 MICs Indicator 2.7 - exclusive breastfeeding under six months 2 MICs Indicator 2.8 - Predominant breastfeeding under six months 3 MICs Indicator 2.9 - Continued breastfeeding at one year 4 MICs Indicator 2.10 - Continued breastfeeding at two years Note: Figures denoted by an asterisk are based on denominators of less than 25 unweighted cases Figures shown in parenthesis are based on denominators of 25-49 unweighted cases 68 viet nam mics 2014 report Approximately 24.3 per cent of children aged less than six months were exclusively breastfed. With 49 per cent predominantly breastfed, it was evident that water-based liquids were displacing feeding of breastmilk to a greater degree. By the age of 12-15 months, 65.6 per cent of children were breastfed and by 20-23 months, 21.8 per cent were breastfed. However, male children were predominantly breastfed more than female children. Exclusive or continued breastfeeding was more common in rural areas, among ethnic minority households. Figure NU.3 shows the detailed pattern of breastfeeding by child’s age in months. Within in the first 4-5 months of life, the majority of children received breastfeeding, liquids or foods other than breast milk, with other milk/formula liquid(s), even at an early age of 0-1 months. At 4-5 months old, the percentage of children exclusively breastfed was below 15 per cent. At 6-13 months, about 80 per cent of children were breastfed and/or received other foods. Only 20 per cent of children received breast milk aged 22-23 months. Figure Nu.3: Infant and young child feeding patterns by age, viet Nam MICs 2014 Exclusively breastfed Breastfed and other milks/formula Weaned (not breastfed) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0-1 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-17 18-19 20-21 22-23 Age in months Exclusively breastfed Breastfed and other milks/formula Breastfed and other foods Weaned (not breastfed) Breastfed and non-milk liquids Table NU.5 shows the median duration of breastfeeding by selected background characteristics. Among children age under 3 years, the median duration was 15.8 months for any breastfeeding, 0.6 months for exclusive breastfeeding and 2.4 months for predominant breastfeeding. The duration of breastfeeding is longer among mothers with lower educational levels, those in rural areas or in ethnic minority households (19.1 months). In terms of regional disparities, mothers in the Central Highlands tend to breastfeed for a longer period, while those in the South East had the lowest duration of breastfeeding (9.9 months). 69viet nam mics 2014 report table Nu.5: Duration of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding and predominant breastfeeding among children aged 0-35 months, Viet Nam, 2014 Median duration (in months) of: Number of children aged 0-35 months Any breastfeeding1 Exclusive breastfeeding Predominant breastfeeding Median 15.8 0.6 2.4 2119 sex Male 15.6 0.7 2.6 1128 Female 15.9 0.5 1.7 991 region Red River Delta 15.9 0.7 2.4 502 Northern Midlands and Mountainous area 17.2 0.7 2.1 325 North Central and Central coastal area 17.0 0.4 3.4 433 Central Highlands 18.1 1.2 3.1 148 South East 9.9 0.5 0.7 343 Mekong River Delta 14.0 0.5 2.8 368 Area Urban 14.8 0.5 0.9 635 Rural 16.2 0.6 2.7 1484 Mother’s education None 20.2 2.2 3.6 116 Primary 15.8 0.5 3.1 286 Lower Secondary 16.1 0.6 2.9 754 Upper Secondary 15.7 0.6 2.4 476 Tertiary 14.8 0.4 0.7 487 Wealth Index quintiles Poorest 17.9 0.7 4.9 425 Second 16.3 0.7 2.3 427 Middle 15.9 0.5 2.1 420 Fourth 15.3 0.5 0.6 439 Richest 12.0 0.4 0.6 408 ethnicity of household head Kinh/Hoa 15.0 0.5 2.0 1764 Ethnic Minorities 19.1 1.9 4.1 355 Mean 16.5 1.5 3.1 2119 1 MICs Indicator 2.11 - Duration of breastfeeding The age-appropriateness of breastfeeding of children under age 24 months is provided in Table NU.6. Different criteria of feeding are used depending on the age of the child. For infants aged 0-5 months, exclusive breastfeeding is considered as age-appropriate feeding, while children aged 6-23 months were considered to be appropriately fed if they are receiving breast milk and solids, semi-solids or soft food. As a result of feeding patterns, only 53.9 per cent of children aged 6-23 months were appropriately breastfed and age-appropriate breastfeeding among all 70 viet nam mics 2014 report children aged 0-23 months drops to 46.9 per cent. There was no considerable sex differential in breastfeeding or appropriate breastfeeding. Among the regions, age appropriate breastfeeding among children aged 0-23 months was highest in Northern Midlands and Mountainous area (57.3 per cent) and lowest in South East (27.4 per cent). It was high (64.3 per cent) among children living in households whose heads were ethnic minority. table Nu.6: Age-appropriate breastfeeding Percentage of children aged 0-23 months who were appropriately breastfed during the previous day, Viet Nam, 2014 Children aged 0-5 months Children aged 6-23 months Children aged 0-23 months Percentage exclusively breastfed1 Number of children Percentage currently breastfeeding and receiving solid, semi-solid or soft foods Number of children Percentage appropriately breastfed2 Number of children total 24.3 350 53.9 1128 46.9 1478 sex Male 23.8 191 52.8 600 45.8 791 Female 25.0 159 55.1 528 48.2 687 region Red River Delta 28.9 78 58.0 270 51.5 348 Northern Midlands and Mountainous area 41.0 61 63.2 167 57.3 228 North Central and Central coastal area 26.7 77 60.5 233 52.1 309 Central Highlands 28.7 25 65.6 82 57.0 107 South East 7.4 56 33.5 183 27.4 239 Mekong River Delta (11.1) 54 46.3 193 38.6 246 Area Urban 20.8 99 45.8 337 40.1 436 Rural 25.8 251 57.3 790 49.7 1042 Mother’s education None * 14 59.4 51 55.5 65 Primary (24.2) 44 50.7 140 44.4 184 Lower Secondary 25.0 144 58.6 392 49.6 536 Upper Secondary 28.1 72 53.1 272 47.9 344 Tertiary 16.5 76 48.4 272 41.5 349 Wealth Index quintiles Poorest 41.6 72 64.0 218 58.4 290 Second 20.6 76 59.7 220 49.7 296 Middle 24.1 79 56.8 218 48.1 296 Fourth 12.0 66 47.9 247 40.3 314 Richest 22.2 57 42.2 225 38.1 282 ethnicity of household head Kinh/Hoa 19.7 283 50.5 949 43.4 1232 Ethnic Minorities 44.0 67 71.9 179 64.3 246 1 MICs Indicator 2.7 - exclusive breastfeeding under six months 2 MICs Indicator 2.12 - Age-appropriate breastfeeding Note: Figures denoted by an asterisk are based on denominators of less than 25 unweighted cases Figures shown in parenthesis are based on denominators of 25-49 unweighted cases 71viet nam mics 2014 report Overall, 90.7 per cent of infants aged 6-8 months received solid, semi-solid or soft foods at least once during the previous day (Table NU.7). Among currently breastfeeding infants this percentage was 90.5. table Nu.7: Introduction of solid, semi-solid or soft foods Percentage of infants aged 6-8 months who received solid, semi-solid, or soft foods during the previous day, Viet Nam, 2014 Currently breastfeeding Currently not breastfeeding All Percentage receiving solid, semi-solid or soft foods Number of children aged 6-8 months Percentage receiving solid, semi-solid or soft foods Number of children aged 6-8 months Percentage receiving solid, semi-solid or soft foods1 Number of children aged 6-8 months total 90.5 143 * 12 90.7 155 sex Male 92.7 75 * 5 92.1 81 Female 88.1 67 * 7 89.2 74 Area Urban (98.1) 32 * 4 (95.7) 36 Rural 88.3 111 * 9 89.2 119 1 MICs Indicator 2.13 - Introduction of solid, semi-solid or soft foods Note: Figures denoted by an asterisk are based on denominators of less than 25 unweighted cases Figures shown in parenthesis are based on denominators of 25-49 unweighted cases Overall, nine-in-10 children age 6-23 months were receiving solid, semi-solid and soft foods the minimum number of times, as shown in Table NU.8. There was no sex differential. The proportion of children receiving the minimum dietary diversity or foods from at least four food groups, was much lower than that for minimum meal frequency. This indicates a need to focus on improving quality, dietary diversity and nutrient intake among this vulnerable group. A higher proportion of older (18-23 months old) children (88.9 per cent) achieved the minimum dietary diversity compared to younger (6-8 months old) children (45 per cent). The overall assessment using the indicator of minimum acceptable diet revealed that only 59.0 per cent were benefiting from a diet sufficient in both diversity and frequency. While there was little difference between urban and rural areas, the percentage of children receiving a minimum acceptable diet was highest in the North Central and Central coastal area (71.2 per cent) and lowest in the Mekong River Delta (44.6 per cent), as well as highest for children whose mother had a tertiary education (74.5 per cent) in contrast to 21.7 per cent for women with no education. There were also noticeable differences between the richest household (73.3 per cent) and the poorest households (32.0 per cent) as well as between Kinh/Hoa (63.0 per cent) and ethnic minorities (38.0 per cent). 72 viet nam mics 2014 report ta bl e N u .8 : I nf an t a nd y ou ng c hi ld fe ed in g pr ac ti ce s Pe rc en ta ge o f c hi ld re n ag ed 6 -2 3 m on th s w ho re ce iv ed a pp ro pr ia te li qu id s an d so lid , s em i-s ol id or s of t f oo ds th e m in im um n um be r o f t im es o r m or e du rin g th e pr ev io us d ay , b y br ea st fe ed in g st at us , V ie t N am , 2 01 4 Cu rr en tl y br ea st fe ed in g Cu rr en tl y no t b re as tf ee di ng A ll Pe rc en ta ge o f c hi ld re n w ho re ce iv ed : Pe rc en ta ge o f c hi ld re n w ho re ce iv ed : Pe rc en ta ge o f c hi ld re n w ho re ce iv ed : M in im um di et ar y di ve rs ity a M in im um m ea l fr eq ue nc yb M in im um ac ce pt ab le di et 1, c N um be r of ch ild re n ag ed 6- 23 m on th s M in im um di et ar y di ve rs ity a M in im um m ea l fr eq ue nc yb M in im um ac ce pt ab le di et 2, c A t l ea st tw o m ilk fe ed s3 N um be r of ch ild re n ag ed 6 -2 3 m on th s M in im um di et ar y di ve rs ity 4, a M in im um m ea l fr eq ue nc y5 ,b M in im um ac ce pt ab le di et c N um be r of ch ild re n ag e 6- 23 m on th s to ta l 66 .4 87 .1 62 .4 63 3 90 .2 95 .1 54 .5 89 .5 46 8 76 .9 90 .5 59 .0 11 28 se x M al e 66 .4 87 .0 62 .1 32 8 90 .1 95 .7 52 .6 89 .2 25 4 77 .0 90 .8 57 .9 60 0 Fe m al e 66 .4 87 .1 62 .7 30 5 90 .4 94 .4 56 .7 89 .9 21 4 76 .7 90 .1 60 .3 52 8 A ge 6- 8 m on th s 41 .7 84 .8 41 .2 14 3 * * * * 11 45 .0 85 .9 41 .9 15 5 9- 11 m on th s 64 .6 81 .7 57 .2 15 0 (9 0. 1) (9 5. 1) (6 4. 0) (9 1. 4) 29 69 .3 83 .9 58 .3 18 3 12 -1 7 m on th s 74 .2 89 .0 70 .2 23 6 90 .8 97 .4 52 .8 92 .2 14 7 80 .8 92 .2 63 .5 39 5 18 -2 3 m on th s 85 .4 93 .6 81 .7 10 3 90 .3 93 .8 54 .5 87 .5 28 1 88 .9 93 .7 61 .8 39 5 re gi on Re d Ri ve r D el ta 73 .6 90 .0 71 .3 16 4 96 .3 98 .2 66 .7 96 .2 10 2 82 .6 93 .2 69 .5 27 0 N or th er n M id la nd s an d M ou nt ai no us a re a 52 .4 83 .7 50 .6 11 4 79 .3 92 .5 44 .3 67 .5 51 60 .9 86 .4 48 .7 16 7 N or th C en tr al a nd Ce nt ra l c oa st al a re a 79 .7 90 .6 73 .7 14 2 94 .3 92 .2 67 .2 92 .8 87 84 .7 91 .2 71 .2 23 3 Ce nt ra l H ig hl an ds 51 .3 84 .8 48 .0 56 87 .7 93 .3 55 .4 77 .5 25 63 .3 87 .4 50 .3 82 So ut h Ea st 74 .7 82 .6 67 .4 65 95 .0 98 .0 49 .6 96 .0 10 7 87 .4 92 .1 56 .3 18 3 M ek on g Ri ve r D el ta 53 .5 84 .9 48 .7 91 81 .3 93 .2 40 .6 87 .2 96 68 .9 89 .2 44 .6 19 3 A re a U rb an 78 .3 90 .4 73 .4 15 7 94 .0 97 .1 57 .4 95 .3 16 9 86 .5 93 .9 65 .1 33 7 Ru ra l 62 .5 85 .9 58 .8 47 6 88 .1 94 .0 52 .8 86 .3 29 9 72 .7 89 .1 56 .5 79 0 73viet nam mics 2014 report Cu rr en tl y br ea st fe ed in g Cu rr en tl y no t b re as tf ee di ng A ll Pe rc en ta ge o f c hi ld re n w ho re ce iv ed : Pe rc en ta ge o f c hi ld re n w ho re ce iv ed : Pe rc en ta ge o f c hi ld re n w ho re ce iv ed : M in im um di et ar y di ve rs ity a M in im um m ea l fr eq ue nc yb M in im um ac ce pt ab le di et 1, c N um be r of ch ild re n ag ed 6- 23 m on th s M in im um di et ar y di ve rs ity a M in im um m ea l fr eq ue nc yb M in im um ac ce pt ab le di et 2, c A t l ea st tw o m ilk fe ed s3 N um be r of ch ild re n ag ed 6 -2 3 m on th s M in im um di et ar y di ve rs ity 4, a M in im um m ea l fr eq ue nc y5 ,b M in im um ac ce pt ab le di et c N um be r of ch ild re n ag e 6- 23 m on th s M ot he r’s e du ca ti on N on e (2 4. 1) (7 3. 8) (2 4. 1) 37 * * * * 12 40 .0 74 .2 21 .7 51 Pr im ar y 44 .5 78 .7 41 .5 76 81 .7 91 .1 36 .9 81 .4 58 61 .1 84 .1 39 .5 14 0 Lo w er S ec on da ry 67 .0 90 .6 64 .7 23 4 87 .5 93 .9 42 .8 82 .8 15 0 75 .5 91 .9 56 .2 39 2 U pp er S ec on da ry 76 .2 89 .0 68 .4 14 8 92 .8 96 .7 59 .5 96 .1 12 2 83 .9 92 .5 64 .4 27 2 Te rt ia ry 78 .2 87 .0 73 .8 13 8 96 .1 98 .8 75 .4 97 .5 12 6 86 .7 92 .6 74 .5 27 2 W ea lt h In de x qu in ti le s Po or es t 38 .4 79 .8 37 .1 14 8 71 .2 78 .8 19 .9 60 .3 63 49 .7 79 .5 32 .0 21 8 Se co nd 63 .9 85 .6 58 .2 13 8 89 .6 95 .7 50 .4 85 .4 74 73 .8 89 .2 55 .5 22 0 M id dl e 68 .6 87 .7 62 .0 12 8 88 .9 95 .4 56 .2 91 .3 88 77 .1 90 .8 59 .6 21 8 Fo ur th 86 .1 92 .7 83 .1 12 4 92 .9 98 .1 60 .8 96 .2 11 7 89 .1 95 .3 72 .3 24 7 Ri ch es t 85 .2 92 .3 81 .5 95 98 .6 10 0 67 .1 99 .2 12 6 92 .5 96 .7 73 .3 22 5 et hn ic it y of h ou se ho ld h ea d Ki nh /H oa 73 .2 89 .3 68 .9 49 6 91 .4 96 .1 56 .3 92 .5 42 9 81 .8 92 .4 63 .0 94 9 Et hn ic M in or iti es 41 .8 78 .9 38 .9 13 7 77 .4 84 .8 34 .7 56 .9 39 50 .4 80 .2 38 .0 17 9 1 M IC s In di ca to r 2 .1 7a - M in im um a cc ep ta bl e di et (b re as tf ed ) 2 M IC s In di ca to r 2 .1 7b - M in im um a cc ep ta bl e di et (n on -b re as tf ed ) 3 M IC s i= In di ca to r 2 .1 4 - M ilk fe ed in g fr eq ue nc y fo r n on -b re as tf ed c hi ld re n 4 M IC s In di ca to r 2 .1 6 - M in im um d ie ta ry d iv er si ty 5 M IC s In di ca to r 2 .1 5 - M in im um m ea l f re qu en cy a M in im um d ie ta ry d iv er si ty is d efi ne d as re ce iv in g fo od s fr om a t l ea st fo ur o f s ev en fo od g ro up s: 1 ) G ra in s, ro ot s an d tu be rs , 2 ) l eg um es a nd n ut s, 3) d ai ry p ro du ct s (m ilk , y og ur t, ch ee se ), 4) fl es h fo od s (m ea t, fis h, po ul tr y an d liv er /o rg an m ea ts ), 5) e gg s, 6) v ita m in -A ri ch fr ui ts a nd v eg et ab le s an d 7) o th er fr ui ts a nd v eg et ab le s. b M in im um m ea l f re qu en cy a m on g cu rr en tly b re as tf ee di ng c hi ld re n is d efi ne d as c hi ld re n w ho a ls o re ce iv ed s ol id , s em i-s ol id , o r s of t f oo ds tw ic e or m or e da ily fo r c hi ld re n ag ed 6 -8 m on th s an d th re e tim es o r m or e da ily fo r c hi ld re n ag ed 9 -2 3 m on th s. Fo r n on -b re as tf ee di ng c hi ld re n ag ed 6 -2 3 m on th s it is d efi ne d as re ce iv in g so lid , s em i-s ol id o r s of t f oo ds , o r m ilk fe ed s, at le as t f ou r t im es . c Th e m in im um a cc ep ta bl e di et fo r b re as tf ed c hi ld re n ag ed 6 -2 3 m on th s is d efi ne d as re ce iv in g th e m in im um d ie ta ry d iv er si ty a nd th e m in im um m ea l f re qu en cy , w hi le it fo r n on -b re as tf ed c hi ld re n fu rt he r r eq ui re s at le as t t w o m ilk fe ed in gs a nd th at th e m in im um d ie ta ry d iv er si ty is a ch ie ve d w ith ou t c ou nt in g m ilk fe ed s. N ot e: F ig ur es d en ot ed b y an a st er is k ar e ba se d on d en om in at or s of le ss th an 2 5 un w ei gh te d ca se s 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 nw ei gh te d ca se s 74 viet nam mics 2014 report The continued practice of bottle-feeding is a concern because of possible contamination due to unsafe water and lack of hygiene in preparation. Table NU.9 shows that bottle-feeding is prevalent in Viet Nam, with 37.6 per cent of children aged under 6 months fed using a bottle with a nipple. Among children aged 0-23 months, 44.1 per cent were fed using a bottle with a nipple. This practice was observed much more among mothers with tertiary educational levels and those in households in the higher wealth index quintiles. It was also observed among Kinh/ Hoa households, where about half of all children aged 0-23 months were fed using a bottle with a nipple in contrast to ethnic minority households (15.7 per cent). table Nu.9: Bottle-feeding Percentage of children aged 0-23 months fed with a bottle with a nipple during the previous day, Viet Nam, 2014 Percentage of children aged 0-23 months fed with a bottle with a nipple1 Number of children aged 0-23 months total 44.1 1478 sex Male 44.4 791 Female 43.7 687 Age 0-5 months 37.6 350 6-11 months 47.2 338 12-23 months 45.6 790 region Red River Delta 35.7 348 Northern Midlands and Mountainous area 20.6 228 North Central and Central coastal area 40.8 309 Central Highlands 35.6 107 South East 68.2 239 Mekong River Delta 62.0 246 Area Urban 55.5 436 Rural 39.3 1042 Mother’s education None 21.1 65 Primary 47.7 184 Lower Secondary 38.3 536 Upper Secondary 46.5 344 Tertiary 52.9 349 75viet nam mics 2014 report Percentage of children aged 0-23 months fed with a bottle with a nipple1 Number of children aged 0-23 months Wealth Index quintiles Poorest 24.9 290 Second 33.9 296 Middle 46.7 296 Fourth 56.0 314 Richest 58.5 282 ethnicity of household head Kinh/Hoa 49.7 1232 Ethnic Minorities 15.7 246 1 MICs Indicator 2.18 - Bottle feeding 76 viet nam mics 2014 report chIld hEAlTh chAPTER VI 77viet nam mics 2014 report vI. CHIlD HeAltH vaccinations 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. In addition, the Global Vaccine Action Plan (GVAP) was endorsed by the 194 Member States of the World Health Assembly in May 2012 to achieve the Decade of Vaccines vision by delivering universal access to immunization. Immunization has saved the lives of millions of children in the four decades since the launch of the Expanded Programme on Immunization (EPI) in 1974. Worldwide there are still millions of children not reached by routine immunization and as a result, vaccine-preventable diseases cause more than two million deaths each year. According to UNICEF and WHO guidelines, a child should receive a BCG vaccination to protect against tuberculosis, three doses of DPT containing vaccine to protect against diphtheria, pertussis, and tetanus, three doses of Polio vaccine and a first dose of measles vaccination 78 viet nam mics 2014 report before a child’s first birthday. The recommended number and timing of most other doses also vary slightly with local epidemiology and may include booster doses later in childhood. The vaccination schedule followed by the Viet Nam National Immunization Programme provides all the above-mentioned vaccinations as well as three doses of vaccine against Hepatitis B, three doses of Haemophilus influenzae type b (Hib) vaccine. All vaccinations should be received during the first year of life. Taking into consideration this vaccination schedule, the estimates for full immunization coverage from Viet Nam MICS 2014 are based on children aged 12-23. Information on vaccination coverage was collected for all children under three years of age. All mothers or caretakers were asked to provide vaccination cards. If the vaccination card for a child was available, interviewers copied vaccination information from the cards onto the Viet Nam MICS 2014 questionnaire. If no vaccination card was available for the child, the interviewer proceeded to ask the mother to recall whether or not the child had received each of the vaccinations and for Polio, DPT and Hepatitis B, how many doses were received. After this home-based interview, information on vaccinations was also obtained from vaccination records at health facilities for all children. The final vaccination coverage estimates are based on information obtained from vaccination cards and mothers’ recall, then supplemented by information from the log books of commune health centres. Referring to Table DQ.17 in Appendix D, it is seen that 94.4 per cent of children aged 0-35 months had a vaccination card seen by the interviewer in a household or health facility. The percentage of children with vaccination cards seen by the interviewer in a household or health facility was slightly higher in rural areas (95.4 per cent) than in urban areas (92.7 per cent) and lowest in the South East (90.0 per cent) and Mekong River Delta (89.9 per cent). 79viet nam mics 2014 report table CH.1: vaccinations in the first years of life Percentage of children aged 12-23 months and 24-35 months vaccinated against vaccine-preventable childhood diseases at any time before the survey and by their first birthday, Viet Nam, 2014 Children aged 12-23 months: Children aged 24-35 months: vaccinated at any time before the survey according to: Vaccinated by 12 months of age a vaccinated at any time before the survey according to: Vaccinated by 12 months of age Thẻ tiêm chủng hoặc trạm y tế Mẹ khai báo Thẻ tiêm chủng hoặc mẹ khai báo Vaccination card Mother’s report Either BCG1 92.8 5.2 98.0 98.0 87.2 10.5 97.7 96.9 Polio 1 92.2 5.0 97.2 96.9 87.1 9.6 96.8 95.9 2 90.7 4.9 95.6 95.1 86.6 9.0 95.6 94.0 32 88.8 4.3 93.0 91.9 85.6 7.9 93.6 91.7 DPt 1 89.2 7.1 96.3 96.3 84.3 11.9 96.2 96.2 2 87.6 5.9 93.5 93.5 84.3 10.4 94.7 94.7 33 83.4 5.3 88.6 88.6 84.6 8.6 93.2 93.2 HepB At birth 70.9 7.6 78.5 78.5 61.8 9.0 70.8 70.8 1 88.3 6.9 95.2 95.2 81.1 13.6 94.7 94.7 2 86.7 5.6 92.3 92.3 82.7 10.6 93.3 93.3 34 82.5 4.9 87.4 87.4 82.1 9.8 92.0 92.0 Hib 1 88.8 6.2 95.0 95.0 83.2 12.1 95.3 95.3 2 87.1 5.3 92.3 92.3 83.9 9.4 93.4 93.1 35 82.4 5.0 87.5 87.5 84.1 8.0 92.1 92.1 Measles (MCV1)7 85.7 5.2 90.9 86.2 86.5 7.7 94.3 88.8 Fully vaccinated8, b 80.3 2.2 82.4 75.6 82.7 4.6 87.3 80.0 No vaccinations 0.0 1.5 1.5 1.5 0.3 1.6 1.9 1.9 Number of children 790 790 790 790 641 641 641 641 1 MICs Indicator 3.1 - tuberculosis immunization coverage 2 MICs Indicator 3.2 - Polio immunization coverage 3 MICs indicator 3.3 - Diphtheria, pertussis and tetanus (DPt) immunization coverage 4 MICs Indicator 3.5 - Hepatitis B immunization coverage 5 MICs indicator 3.6 – Haemophilus influenzae type B (Hib) immunization coverage 7 MICs Indicator 3.4, MDG indicator 4.3 - Measles immunization coverage 8 MICs Indicator 3.8 - Full immunization coverage a All MICS indicators refer to results in this column b Includes: BCG, Polio3, DPT3, HepB3, Hib3, and Measles (MCV1) as per the vaccination schedule in Viet Nam. 80 viet nam mics 2014 report The percentage of children aged 12-23 months and 24-35 months who received each of the specific vaccinations by source of information (vaccination card or vaccination records at health facilities and mother’s recall) is shown in Table CH.1. The denominators for the table are comprised of children aged 12-23 months and 24-35 months. In the first three columns in each panel of the table, the numerator includes all children who were vaccinated at any time before the survey according to the vaccination card or vaccination records at health facilities or the mother’s report. In the last column in each panel, only children who were vaccinated before their first birthday, as recommended, are included. For children without vaccination cards/records, the proportion of vaccinations given before the first birthday is assumed to be the same as for children with vaccination cards/records. According to Table CH.1, the fully vaccinated rate of children aged 12-23 months was 75.6 per cent and children aged 24-35 months was 80.0 per cent. Information from vaccination cards or health facilities seen as more reliable than mothers’ reports, was 80.3 compared to 2.2 per cent, respectively for children aged 12-23 months and 82.7 against 4.6 per cent for children aged 24-35 months. Regarding vaccinations by 12 months of age against different childhood diseases, the proportion of children vaccinated against Hepatitis B at birth was lowest, 78.5 per cent and 70.8 per cent, respectively for the children aged 12-23 months and 24-35 months. The second lowest vaccinated proportion was for measles, at 86.2 and 88.8 per cent, respectively for the two above-mentioned age groups. Figure CH.1 shows the proportion of children vaccinated. Approximately 98.0 per cent of children age 12-23 months received a BCG vaccination by the age of 12 months and the first dose of DPT-HepB-Hib vaccine was given to 96.3, 95.2 and 95.0 per cent. The percentage declines to 93.5, 92.3 and 92.3 per cent for the second dose of DPT-HepB-Hib and declines to 88.6, 87.4 and 87.5 per cent, respectively for the third dose. Similarly, 96.9 per cent of children received Polio 1 by age 12 months and this declines to 91.9 per cent by the third dose. The coverage for the first dose of measles vaccine by 12 months is lower than for the other vaccines at 86.2 per cent. The primary reason is that although 90.9 per cent of children 12-23 months received the vaccine, only 86.2 per cent had received it by their first birthday. As a result, the percentage of children who had all the recommended vaccinations by their first birthday is low at only 75.6 per cent. 81viet nam mics 2014 report Figure CH.1: vaccinations by age of 12 months, viet Nam MICs 2014 BCG Polio 1 Polio 2 Polio 3 DPT1 DPT2 DPT3 HepB at birth HepB 1 HepB 2 HepB 3 Hib 1 Hib 2 Hib 3 Measles Full vaccinated No vaccination BCG Polio 1 Polio 2 Polio 3 DPT1 DPT2 DPT3 HepB at birth HepB 1 HepB 2 HepB 3 Hib 1 Hib 2 Hib 3 Measles Full vaccinated No vaccination Children Age 24-35 monthsChildren Age 12-23 months Per cent 98.0 96.9 95.1 91.9 96.3 93.5 88.6 78.5 95.2 92.3 87.4 95.0 92.3 87.5 86.2 75.6 1.5 96.9 95.9 94.0 91.7 96.2 94.7 93.2 70.8 94.7 93.3 92.0 95.3 93.1 92.1 88.8 80.0 1.9 82 viet nam mics 2014 report ta bl e CH .2 : v ac ci na ti on s by b ac kg ro un d ch ar ac te ri st ic s Pe rc en ta ge o f 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 v ac ci ne -p re ve nt ab le c hi ld ho od d is ea se s, Vi et N am , 2 01 4 Pe rc en ta ge o f c hi ld re n w ho re ce iv ed : Pe rc en ta ge w ith va cc in at io n ca rd s ee n N um be r of ch ild re n ag ed 12 -2 3 m on th s BC G Po lio D Pt H ep B H ib M ea sl es (M CV 1) Fu lla N on e 1 2 3 1 2 3 A t b irt h 1 2 3 1 2 3 to ta l 98 .0 97 .2 95 .6 93 .0 96 .3 93 .5 88 .6 78 .5 95 .2 92 .3 87 .4 95 .0 92 .3 87 .5 90 .9 82 .4 1. 5 94 .1 79 0 se x M al e 97 .5 96 .1 94 .8 91 .8 95 .0 92 .3 87 .5 76 .9 93 .6 90 .6 85 .9 93 .1 90 .5 85 .8 89 .3 80 .9 2. 0 94 .0 41 4 Fe m al e 98 .5 98 .4 96 .5 94 .5 97 .7 94 .9 89 .9 80 .2 97 .0 94 .2 89 .1 97 .1 94 .3 89 .3 92 .7 84 .1 1. 0 94 .2 37 6 re gi on Re d Ri ve r D el ta 10 0 10 0 98 .9 98 .3 99 .4 98 .2 96 .0 84 .6 99 .4 98 .9 96 .7 99 .4 98 .2 95 .9 97 .2 93 .7 0. 0 96 .3 19 2 N or th er n M id la nd s an d M ou nt ai no us ar ea 94 .9 95 .3 94 .4 90 .1 94 .8 92 .8 83 .0 46 .5 89 .6 87 .7 77 .1 90 .3 88 .3 78 .4 90 .4 71 .9 3. 0 94 .2 11 3 N or th C en tr al a nd Ce nt ra l c oa st al ar ea 10 0 98 .9 97 .2 96 .6 97 .6 93 .1 90 .2 87 .2 97 .1 91 .8 88 .9 96 .0 91 .9 88 .9 94 .0 85 .4 0. 0 98 .4 15 7 Ce nt ra l H ig hl an ds 93 .8 92 .5 89 .9 87 .4 89 .9 84 .2 75 .8 61 .0 90 .0 84 .3 76 .1 90 .5 85 .4 77 .0 83 .6 70 .5 5. 7 86 .5 58 So ut h Ea st 97 .2 95 .4 92 .5 85 .7 96 .1 92 .8 84 .7 88 .3 97 .0 92 .8 84 .0 96 .1 92 .8 84 .0 82 .1 74 .7 2. 2 90 .6 13 3 M ek on g Ri ve r D el ta 98 .1 96 .5 95 .5 93 .5 94 .5 92 .5 90 .0 82 .4 92 .1 90 .1 88 .6 92 .1 90 .1 88 .6 90 .5 83 .9 1. 9 92 .7 13 7 A re a U rb an 99 .7 99 .1 97 .6 93 .6 98 .6 95 .6 88 .5 84 .4 98 .0 95 .8 88 .4 98 .0 95 .3 87 .9 88 .8 81 .1 0. 1 93 .8 25 3 Ru ra l 97 .2 96 .3 94 .6 92 .8 95 .2 92 .5 88 .7 75 .6 93 .9 90 .7 86 .9 93 .6 90 .9 87 .3 91 .9 83 .1 2. 2 94 .3 53 7 83viet nam mics 2014 report Pe rc en ta ge o f c hi ld re n w ho re ce iv ed : Pe rc en ta ge w ith va cc in at io n ca rd s ee n N um be r of ch ild re n ag ed 12 -2 3 m on th s BC G Po lio D Pt H ep B H ib M ea sl es (M CV 1) Fu lla N on e 1 2 3 1 2 3 A t b irt h 1 2 3 1 2 3 M ot he r’s e du ca ti on N on e (7 7. 7) (7 3. 9) (7 0. 4) (6 7. 6) (6 7. 0) (6 2. 4) (5 8. 2) (3 1. 1) (6 4. 5) (6 0. 0) (5 5. 9) (6 7. 0) (6 2. 4) (5 8. 2) (6 8. 3) (4 9. 7) (1 9. 3) (6 8. 5) 38 Pr im ar y 94 .9 94 .6 90 .9 86 .5 95 .6 89 .7 87 .8 75 .8 95 .5 89 .6 87 .7 95 .6 90 .0 88 .1 87 .7 79 .8 3. 9 86 .5 98 Lo w er S ec on da ry 99 .4 97 .9 96 .3 93 .7 96 .6 93 .9 88 .4 78 .9 94 .7 91 .0 85 .4 93 .8 91 .0 85 .6 93 .3 82 .1 0. 3 97 .1 27 9 U pp er S ec on da ry 10 0 99 .4 99 .0 96 .0 99 .4 98 .7 92 .5 79 .4 98 .5 97 .9 91 .6 98 .6 97 .9 91 .7 92 .6 87 .6 0. 0 96 .8 19 2 Te rt ia ry 99 .6 99 .9 98 .6 97 .7 98 .1 95 .0 90 .8 86 .6 97 .7 95 .7 91 .4 97 .7 94 .9 90 .6 91 .8 84 .4 0. 1 96 .1 18 4 W ea lt h In de x qu in ti le s Po or es t 89 .6 88 .8 87 .1 83 .4 87 .3 83 .9 81 .5 55 .5 85 .9 82 .6 80 .2 86 .6 83 .5 81 .1 81 .8 72 .2 8. 2 86 .5 14 6 Se co nd 99 .5 98 .6 94 .6 93 .6 97 .3 92 .6 86 .4 78 .8 96 .2 90 .9 84 .7 95 .8 91 .1 84 .6 93 .7 82 .5 0. 1 93 .1 14 9 M id dl e 10 0 98 .9 97 .9 95 .2 97 .9 96 .2 90 .6 80 .2 97 .5 94 .6 89 .8 96 .4 94 .5 89 .8 95 .5 87 .7 0. 0 97 .6 14 9 Fo ur th 10 0 98 .9 98 .9 96 .4 98 .3 95 .7 91 .3 88 .1 96 .3 93 .7 88 .9 96 .2 93 .6 89 .2 93 .7 85 .1 0. 0 96 .6 18 9 Ri ch es t 10 0 10 0 98 .3 95 .3 99 .3 97 .5 91 .8 84 .6 98 .8 98 .3 92 .0 98 .8 97 .5 91 .3 88 .8 83 .2 0. 0 95 .6 15 8 et hn ic it y of h ou se ho ld h ea d Ki nh /H oa 99 .4 98 .5 96 .9 94 .8 97 .6 95 .2 90 .6 84 .0 96 .4 93 .8 89 .1 96 .1 93 .7 89 .2 92 .5 84 .6 0. 5 95 .2 67 2 Et hn ic M in or iti es 89 .8 90 .1 87 .9 83 .3 88 .3 83 .4 76 .7 44 .4 88 .3 83 .5 76 .8 88 .3 83 .8 77 .1 81 .5 69 .4 7. 4 87 .8 11 8 a In cl ud es : B CG , P ol io 3, D PT 3, H ep B3 , H ib 3, a nd M ea sl es (M CV 1) a s pe r t he v ac ci na tio n sc he du le in V ie t N am 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 nw ei gh te d ca se s 84 viet nam mics 2014 report Table CH.2 presents vaccination coverage estimates among children 12-23 by background characteristics. The figures indicate children receiving vaccinations at any time up to the date of the survey and are based on information from vaccination cards or health facility records and mothers’/caretakers’ reports. Vaccination cards have been seen by the interviewer for 94.1 per cent of children aged 12-23 months, with the highest in North Central and Central coastal area (98.4 per cent) and lowest in the Central Highlands region (86.5 per cent). Overall, this percentage tends to increase in relation to mothers’ education, from 68.5 per cent among children of non-educated mothers to 96.1 per cent among children of tertiary-educated mothers. The proportion of children aged 12-23 months fully vaccinated is 82.4 per cent. Full vaccination coverage was higher among Kinh/Hoa children (84.6 per cent) than ethnic minority children (69.4 per cent). The coverage of full vaccination does not differ significantly between boys (80.9 per cent) and girls (84.1 per cent) and between rural (83.1 per cent) and urban (81.1 per cent) children. The proportions of children vaccinated in general and by order of doses from first to third dose of Polio, DPT, HepB and Hib are highest in Red River Delta (except for Hepatitis B at birth). The vaccination coverage in the Central Highlands is the lowest of all regions. By household’s wealth index quintile status, full vaccination coverage is lowest among the poorest households (72.2 per cent), while it ranges from 82.5 to 87.7 per cent between households of other wealth categories. Neonatal tetanus Protection One of the MDGs is to reduce by three-quarters the maternal mortality ratio, with one strategy to eliminate maternal tetanus. Following on from the 42nd and 44th World Health Assembly calls for elimination of neonatal tetanus, the global community continues to work to reduce the incidence of neonatal tetanus to less than one case of neonatal tetanus per 1,000 live births in every district by 2015. The strategy for preventing maternal and neonatal tetanus is to ensure that all pregnant women receive at least two doses of tetanus toxoid vaccine. If a woman has not received at least two doses of tetanus toxoid during a particular pregnancy, she (and her newborn) are also considered to be protected against tetanus if the woman: • Received at least two doses of tetanus toxoid vaccine, the last within the previous three years • Received at least three doses, the last within the previous five years • Received at least four doses, the last within the previous 10 years • Received five or more doses anytime during her life. To assess the status of tetanus vaccination coverage, women with a live birth during the two years before the survey were asked if they had received tetanus toxoid injections during the pregnancy for their most recent birth and if so, how many. Women who did not receive two or more tetanus toxoid vaccinations during this recent pregnancy were then asked about tetanus toxoid vaccinations they may have previously received. Interviewers also asked women to present their vaccination cards on which dates of tetanus toxoid were recorded and referred to information from the cards when available. 85viet nam mics 2014 report 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, 2014 Percentage of women who received at least two doses during last pregnancy Percentage of women who did not receive two or more doses during last pregnancy, but received: Protected against tetanus1 Number of women with a live birth in the last two years Two doses, the last within prior three years Three doses, the last within prior five years Four doses, the last within prior 10 years Five or more doses during lifetime total 59.6 22.4 0.1 0.1 0.0 82.2 1464 region Red River Delta 52.3 31.8 0.0 0.0 0.0 84.1 343 Northern Midlands and Mountainous area 55.1 15.5 0.0 0.4 0.0 71.0 230 North Central and Central coastal area 67.6 19.6 0.4 0.0 0.0 87.6 300 Central Highlands 51.7 12.0 0.0 0.0 0.0 63.7 109 South East 63.7 24.1 0.0 0.0 0.0 87.8 242 Mekong River Delta 63.8 22.1 0.0 0.0 0.0 86.0 239 Area Urban 62.7 23.2 0.3 0.0 0.0 86.2 428 Rural 58.3 22.1 0.0 0.1 0.0 80.5 1037 education None 33.1 16.8 0.0 0.0 0.0 49.9 67 Primary 46.5 25.0 0.0 0.0 0.0 71.5 182 Lower Secondary 60.7 21.9 0.0 0.0 0.0 82.6 529 Upper Secondary 65.2 22.3 0.3 0.0 0.0 87.8 340 Tertiary 64.4 23.1 0.0 0.3 0.0 87.7 347 Wealth Index quintiles Poorest 51.9 13.2 0.0 0.3 0.0 65.4 294 Second 59.1 20.4 0.0 0.0 0.0 79.5 288 Middle 59.4 24.9 0.0 0.0 0.0 84.3 292 Fourth 66.8 24.1 0.0 0.0 0.0 91.0 314 Richest 60.2 29.9 0.4 0.0 0.0 90.5 275 ethnicity of household head Kinh/Hoa 61.2 24.6 0.1 0.1 0.0 86.0 1215 Ethnic Minorities 51.7 11.7 0.0 0.0 0.0 63.4 250 1MICS Indicator 3.9 - Neonatal tetanus protection Table CH.3 shows the tetanus protection status of women who have had a live birth within the last two years. Overall, 82.2 per cent of women were protected against tetanus, with 59.6 per cent having received at least two doses during the last pregnancy and 22.4 per cent having received two doses within the past three years. 86 viet nam mics 2014 report Women living in urban areas (86.2 per cent) were more likely to be better protected against tetanus than those in rural areas (80.5 per cent), while Kinh/Hoa women (86.0 per cent) were more likely to be protected from tetanus than ethnic minority ones (63.4 per cent). Of the six regions, women in the Central Highlands had the lowest levels of protection from tetanus (63.7 per cent). By wealth index quintiles, only 65.4 per cent of women in the poorest quintile were protected from tetanus, compared to 90.5 per cent from the richest quintile. Care of Illness A key strategy to accelerate progress towards MDG 4 is to tackle diseases that are the leading killers of children aged under-5. Diarrhoea and pneumonia are two such diseases. The Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) aims to end preventable pneumonia and diarrhoea death by reducing mortality from pneumonia to three deaths per 1,000 live births and mortality from diarrhoea to one death per 1,000 live births by 2025. Table CH.4 presents the percentage of children under-5 years of age reported to have had an episode of diarrhoea and symptoms of acute respiratory infection (ARI) during the two weeks preceding the survey. These results are not measures of true prevalence and should not be used as such, but rather the period-prevalence of those illnesses over a two-week time window. The definition of a case of diarrhoea, in this survey, was the mother’s or caretaker’s report that the child had such symptoms over the specified period. No other evidence were sought besides the opinion of the mother. A child was considered to have had an episode of ARI if the mother or caretaker reported that the child had, over the specified period, an illness with a cough with rapid or difficult breathing, and whose symptoms were perceived to be due to a problem in the chest or both a problem in the chest and a blocked nose. While this approach is reasonable in the context of the MICS survey, these basically simple case definitions must be kept in mind when interpreting the results, as well as the potential for reporting and recall biases. Further, diarrhoea and ARI are not only seasonal but are also characterized by the often rapid spread of localized outbreaks from one area to another at different points in time. The timing of the survey and the location of the teams might thus considerably affect the results, which must consequently be interpreted with caution. For these reasons, although the period-prevalence over a two-week time window was reported, these data should not be used to assess the epidemiological characteristics of these diseases but rather to obtain denominators for indicators related to use of health services and treatment. table CH.4: reported disease episodes Percentage of children aged 0-59 months for whom the mother/caretaker reported an episode of diarrhoea, symptoms of acute respiratory infection (ARI), in the last two weeks, Viet Nam, 2014 Percentage of children who in the last two weeks had: Number of children aged 0-59 months An episode of diarrhoea Symptoms of ARI total 8.6 3.0 3316 sex Male 9.8 3.2 1719 Female 7.2 2.7 1597 87viet nam mics 2014 report Percentage of children who in the last two weeks had: Number of children aged 0-59 months An episode of diarrhoea Symptoms of ARI region Red River Delta 6.6 1.8 784 Northern Midlands and Mountainous Area 14.1 2.1 513 North Central and Central coastal area 7.7 3.0 690 Central Highlands 12.7 4.6 241 South East 6.8 2.6 515 Mekong River Delta 7.4 4.9 573 Area Urban 6.0 2.5 985 Rural 9.7 3.2 2331 Age 0-11 months 12.7 2.3 688 12-23 months 11.6 2.1 790 24-35 months 8.0 3.0 641 36-47 months 4.6 4.7 539 48-59 months 4.5 3.2 658 Mother’s education None 17.8 3.6 197 Primary 10.4 4.2 506 Lower Secondary 8.3 3.4 1219 Upper Secondary 7.3 1.7 683 Tertiary 6.6 2.4 710 Wealth Index quintiles Poorest 15.4 5.1 694 Second 7.6 2.5 662 Middle 7.7 2.7 672 Fourth 6.5 2.5 659 Richest 5.2 1.9 628 ethnicity of household head Kinh/Hoa 6.5 2.8 2746 Ethnic Minorities 18.5 4.0 570 Overall, 8.6 per cent of under-5 children were reported to have had diarrhoea in the two weeks preceding the survey, and 3.0 per cent had symptoms of ARI (Table CH.4). Period-prevalence ranges from 4.5 to 18.5 per cent in the case of diarrhoea and 1.8 to 5.1 per cent for ARI. Major differences, as examined in the next section, were observed between urban and rural areas, regions, ages, educational level of mothers, wealth index quintiles and ethnicity, particularly in the case of diarrhoea. Diarrhoea Diarrhoea is a leading cause of death among children under-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 88 viet nam mics 2014 report oral rehydration salts (ORS) or a recommended home fluid (RHF) can prevent many of these deaths. In addition, provision of zinc supplements has been shown to reduce the duration and severity of the illness as well as the risk of future episodes within the next two or three months. Preventing dehydration and malnutrition by increasing fluid intake and continuing to feed the child are also important strategies for managing diarrhoea. In Viet Nam MICS 2014, mothers or caretakers were asked whether their child aged under-5 had an episode of diarrhoea in the two weeks prior to the survey. In cases where mothers reported that the child had diarrhoea, a series of questions were asked about the treatment of the illness, including what the child had been given to drink and eat during the episode and whether this was more or less than what was usually given to the child. The overall period-prevalence of diarrhoea in children under-5 years of age was 8.6 per cent (Table CH.4) and ranges from a low of 6.6 per cent in the Red River Delta region to a high of 14.1 per cent in the Northern Midlands and Mountainous area. A higher prevalence is observed among younger children (12.7 per cent), among those whose mothers have little or no education (17.8 per cent), children living in the poorest wealth index quintile households (15.4 per cent) as well as children living in ethnic minority households (18.5 per cent). table CH.5: Care-seeking during diarrhoea Percentage of children aged 0-59 months with diarrhoea in the last two weeks for whom advice or treatment was sought, by source of advice or treatment, Viet Nam, 2014 Percentage of children with diarrhoea for whom: Number of children aged 0-59 months with diarrhoea in the last two weeks Advice or treatment was sought from: No advice or treatment sought Health facilities or providers Other source (excluded pharmacy) A health facility or provider1, PharmacyPublic Private Community health providera total 35.5 43.8 0.0 15.5 55.1 24.5 15.4 285 sex Male 41.5 39.7 0.0 16.3 59.4 21.4 14.0 169 Female 26.8 49.7 0.0 14.3 48.8 29.1 17.3 116 region Red River Delta (21.6) (54.2) (0.0) (12.5) (46.4) (33.0) (12.9) 52 Northern Midlands and Mountainous area 39.1 23.8 0.0 21.6 46.9 15.5 26.2 72 North Central and Central coastal area (40.4) (42.2) (0.0) (27.1) (60.6) (23.9) (11.4) 53 Central Highlands 41.8 43.9 0.0 11.6 60.3 24.5 13.2 30 South East (22.6) (66.4) (0.0) (5.6) (56.6) (28.5) (13.2) 35 Mekong River Delta (46.5) (48.3) (0.0) (5.3) (68.0) (27.0) (8.3) 42 Area Urban 22.6 62.9 0.0 15.1 50.8 36.4 9.7 59 Rural 38.9 38.8 0.0 15.6 56.2 21.4 16.9 226 Age 0-11 months 33.2 40.9 0.0 13.8 54.6 20.0 18.8 87 12-23 months 35.9 46.2 0.0 16.2 55.9 25.1 13.9 92 89viet nam mics 2014 report Percentage of children with diarrhoea for whom: Number of children aged 0-59 months with diarrhoea in the last two weeks Advice or treatment was sought from: No advice or treatment sought Health facilities or providers Other source (excluded pharmacy) A health facility or provider1, PharmacyPublic Private Community health providera 24-35 months 36.7 41.5 0.0 16.5 54.4 28.3 16.5 51 36-47 months (36.5) (56.3) (0.0) (16.0) (55.7) (37.1) (4.9) 25 48-59 months (38.5) (38.0) (0.0) (16.3) (54.8) (18.6) (16.7) 29 Mother’s education None (24.0) (35.4) (0.0) (19.0) (31.6) (24.2) (29.5) 35 Primary 45.8 36.1 0.0 19.1 60.0 23.2 14.6 52 Lower Secondary 33.2 52.1 0.0 9.9 56.7 30.3 14.8 101 Upper Secondary 45.3 47.4 0.0 16.8 69.0 23.2 0.0 50 Tertiary (27.3) (36.8) (0.0) (19.4) (48.9) (15.2) (23.3) 47 Wealth Index quintiles Poorest 44.4 29.7 0.0 14.3 53.1 18.9 21.6 107 Second (22.8) (62.0) (0.0) (17.4) (51.3) (41.3) (6.9) 50 Middle (39.8) (41.3) (0.0) (25.3) (60.8) (19.3) (10.7) 52 Fourth (29.7) (56.7) (0.0) (6.7) (58.5) (27.3) (8.4) 43 Richest (27.0) (48.7) (0.0) (12.6) (54.0) (21.7) (24.6) 33 ethnicity of household head Kinh/Hoa 31.2 53.9 0.0 13.0 57.7 28.4 10.8 179 Ethnic Minorities 42.8 26.6 0.0 19.7 50.7 17.9 23.2 106 1 MICs Indicator 3.10 - Care-seeking for diarrhea a Community health providers, include both public (Community health worker and Mobile/outreach clinic) and private (Mobile clinic) health facilities b Includes all public and private health facilities and providers, but excludes pharmacies Note:Figures shown in parenthesis are based on denominators of 25-49 unweighted cases Table CH.5 shows the percentage of children with diarrhoea in the two weeks preceding the survey, for whom advice or treatment was sought and where. Overall, 55.1 per cent of all children with diarrhoea sought advice or treatment from a health facility or provider, predominantly in the private sector (43.8 per cent) and public health sector (35.5 per cent)”. Surprisingly, the percentage of all children with diarrhoea seeking advice or treatment from a health facility or provider in urban areas (50.8 per cent) was lower than in rural areas (56.2 per cent). This percentage was higher for Kinh/Hoa children (57.7 per cent) than for ethnic minority ones (50.7 per cent). Mothers and caretakers’ preference for private health facilities or providers (53.9 per cent) when children had diarrhoea was almost double that for public sector assistance (31.2 per cent), while the trend for ethnic minority children was the reverse (26.6 per cent compared to 42.8 per cent). It is worth noting that children aged under-6 years in Viet Nam can access free health insurance, which could have influenced these results. No advice or treatment was sought for 15.4 per cent of children with diarrhoea and the proportions were higher among children in rural areas (16.9 per cent), children in the Northern Midlands and Mountainous area (26.2 per cent) and ethnic minority children (23.2 per cent). 90 viet nam mics 2014 report ta bl e CH .6 : F ee di ng p ra ct ic es d ur in g di ar rh ea Pe rc en ta ge d is tr ib 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 di ar rh oe a, V ie t N am , 2 01 4 D ri nk in g pr ac ti ce s du ri ng d ia rr ho ea ea ti ng p ra ct ic es d ur in g di ar rh oe a 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 th e la st tw o w ee ks Ch ild w as g iv en to d rin k: To ta l Ch ild w as g iv en to e at : To ta l M uc h le ss So m e w ha t le ss A bo ut th e sa m e M or e N ot hi ng M uc h le ss So m ew ha t le ss A bo ut th e sa m e M or e N ot hi ng M is si ng / D K to ta l 6. 8 16 .0 45 .8 30 .8 0. 6 10 0 12 .6 35 .4 43 .2 2. 3 6. 2 0. 4 10 0 28 5 se x M al e 8. 1 18 .6 40 .8 31 .5 1. 1 10 0 16 .7 38 .2 37 .8 3. 5 3. 8 0. 0 10 0 16 9 Fe m al e 4. 9 12 .2 53 .1 29 .8 0. 0 10 0 6. 6 31 .4 51 .0 0. 5 9. 6 0. 9 10 0 11 6 re gi on Re d Ri ve r D el ta (1 3. 0) (1 4. 6) (4 7. 5) (2 4. 8) (0 .0 ) (1 00 ) (9 .4 ) (2 9. 2) (5 2. 3) (5 .1 ) (4 .0 ) (0 .0 ) 10 0 52 N or th er n M id la nd s an d M ou nt ai no us a re a 6. 7 16 .7 46 .0 30 .5 0. 0 10 0 13 .6 26 .5 57 .7 0. 6 1. 5 0. 0 10 0 72 N or th C en tr al a nd C en tr al co as ta l a re a (7 .4 ) (9 .2 ) (3 9. 1) (4 0. 9) (3 .4 ) (1 00 ) (2 3. 5) (3 0. 3) (3 0. 4) (3 .2 ) (1 2. 7) (0 .0 ) 10 0 53 Ce nt ra l H ig hl an ds 3. 2 26 .7 44 .6 25 .6 0. 0 10 0 5. 8 49 .3 38 .4 1. 7 4. 8 0. 0 10 0 30 So ut h Ea st (0 .0 ) (2 3. 0) (6 0. 2) (1 6. 8) (0 .0 ) (1 00 ) (8 .4 ) (3 6. 9) (4 1. 3) (0 .0 ) (1 3. 5) (0 .0 ) 10 0 35 M ek on g Ri ve r D el ta (6 .6 ) (1 1. 3) (4 0. 9) (4 1. 2) (0 .0 ) (1 00 ) (9 .6 ) (5 3. 6) (2 8. 1) (2 .8 ) (3 .4 ) (2 .5 ) 10 0 42 A re a U rb an 5. 1 14 .1 49 .8 31 .0 0. 0 10 0 7. 2 30 .4 49 .6 1. 7 9. 3 1. 8 10 0 59 Ru ra l 7. 2 16 .5 44 .8 30 .8 0. 8 10 0 14 .0 36 .7 41 .5 2. 4 5. 4 0. 0 10 0 22 6 A ge 0- 11 m on th s 4. 8 11 .7 57 .3 26 .2 0. 0 10 0 9. 1 30 .2 42 .7 1. 9 16 .1 0. 0 0. 0 87 12 -2 3 m on th s 13 .4 20 .9 39 .1 26 .5 0. 0 10 0 14 .4 35 .1 43 .8 2. 8 3. 9 0. 0 0. 0 92 91viet nam mics 2014 report D ri nk in g pr ac ti ce s du ri ng d ia rr ho ea ea ti ng p ra ct ic es d ur in g di ar rh oe a 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 th e la st tw o w ee ks Ch ild w as g iv en to d rin k: To ta l Ch ild w as g iv en to e at : To ta l M uc h le ss So m e w ha t le ss A bo ut th e sa m e M or e N ot hi ng M uc h le ss So m ew ha t le ss A bo ut th e sa m e M or e N ot hi ng M is si ng / D K 24 -3 5 m on th s 3. 8 7. 7 52 .9 35 .7 0. 0 10 0 15 .3 32 .2 46 .1 4. 3 0. 0 2. 1 2. 1 51 36 -4 7 m on th s (0 .0 ) (2 0. 5) (3 3. 6) (4 5. 9) (0 .0 ) (1 00 ) (8 .8 ) (6 1. 4) (2 9. 8 (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) 25 48 -5 9 m on th s (2 .7 ) (2 3. 8) (3 1. 0) (3 6. 4) (6 .1 ) (1 00 ) (1 5. 8) (3 5. 6) (4 8. 7) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) 29 M ot he r’s e du ca ti on (0 .0 ) (3 1. 5) (6 1. 8) (6 .7 ) (0 .0 ) (1 00 ) (3 .8 ) (3 2. 9) (5 1. 3) (0 .0 ) (1 2. 0) (0 .0 ) 10 0 35 N on e 9. 1 12 .6 46 .1 28 .8 3. 4 10 0 11 .4 49 .6 29 .8 0. 8 6. 4 2. 0 10 0 52 Pr im ar y 6. 1 13 .6 48 .0 32 .3 0. 0 10 0 14 .4 33 .7 47 .2 1. 5 3. 1 0. 0 10 0 10 1 Lo w er S ec on da ry 9. 1 14 .8 22 .1 54 .0 0. 0 10 0 21 .9 31 .3 30 .4 9. 0 7. 4 0. 0 10 0 50 U pp er S ec on da ry (8 .3 ) (1 4. 4) (5 4. 1) (2 3. 2) (0 .0 ) 10 0 (6 .7 ) (2 9. 7) (5 6. 8) (0 .0 ) (6 .8 ) (0 .0 ) 10 0 47 Te rt ia ry (0 .0 ) (3 1. 5) (6 1. 8) (6 .7 ) (0 .0 ) (1 00 ) (3 .8 ) (3 2. 9) (5 1. 3) (0 .0 ) (1 2. 0) (0 .0 ) 10 0 35 W ea lt h In de x qu in ti le s Po or es t 3. 0 19 .1 49 .8 26 .5 1. 7 10 0 13 .7 37 .8 42 .4 0. 9 4. 2 1. 0 10 0 10 7 Se co nd (4 .8 ) (2 4. 2) (3 2. 0) (3 9. 0) (0 .0 ) (1 00 ) (1 0. 6) (4 6. 5) (2 9. 1) (4 .4 ) (9 .3 ) (0 .0 ) 10 0 50 M id dl e (1 2. 1) (7 .4 ) (4 3. 8) (3 6. 7) (0 .0 ) (1 00 ) (1 7. 8) (3 3. 1) (4 0. 2) (0 .0 ) (8 .9 ) (0 .0 ) 10 0 52 Fo ur th (1 5. 6) (1 1. 9) (5 5. 4) (1 7. 1) (0 .0 ) (1 00 ) (1 0. 4) (2 7. 1) (5 4. 7) (3 .9 ) (3 .8 ) (0 .0 ) 10 0 43 Ri ch es t (2 .4 ) (1 2. 0) (4 4. 7) (4 1. 0) (0 .0 ) (1 00 ) (6 .7 ) (2 5. 2) (5 6. 6) (4 .9 ) (6 .5 ) (0 .0 ) 10 0 33 et hn ic it y of h ou se ho ld h ea d Ki nh /H oa 8. 2 13 .9 44 .0 32 .9 1. 0 10 0 12 .2 34 .4 44 .0 3. 1 5. 7 0. 6 10 0 17 9 Et hn ic M in or iti es 4. 3 19 .5 49 .0 27 .2 0. 0 10 0 13 .3 37 .1 41 .7 0. 9 7. 0 0. 0 10 0 10 6 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 nw ei gh te d ca se s 92 viet nam mics 2014 report Table CH.6 provides statistics on drinking and feeding practices during diarrhoea. Less than one-third (30.8 per cent) of under-5 children with diarrhoea in the last two weeks were given more to drink than usual, 45.8 per cent were given the normal amount and the remaining, 23.4 per cent were given some what less, much less or almost nothing. Regarding food intake, 45.5 per cent were given to eat the same or more (continued feeding), but 54.2 per cent were given some what less, much less or almost nothing. The percentage of under-5 ethnic minority children with diarrhoea in the last two weeks given less, much less or almost nothing to drink was higher than Kinh/Hoa children (72.8 per cent against 67.1 per cent). However, there is no significant differential of continued feeding (somewhat less, same or more) between Kinh/Hoa (81.5 per cent) children and ethnic minorities (79.7 per cent). 93viet nam mics 2014 report ta bl e CH .7 : O ra l r eh yd ra ti on s ol ut io ns , r ec om m en de d ho m em ad e flu id s an d zi nc Pe rc en ta ge o f 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 sa lts (O RS ), re co m m en de d ho m em ad e flu id s an d zi nc , V ie t N am , 2 01 4 Pe rc en ta ge o f c hi ld re n w it h di ar rh oe a w ho re ce iv ed : N um be r o f ch ild re n ag ed 0 -5 9 m on th s w it h di ar rh oe a in th e la st tw o w ee ks O ra l r eh yd ra ti on s al ts re co m m en de d ho m em ad e flu id s O RS o r a ny re co m m en de d ho m em ad e flu id zi nc O RS an d zi nc 1 Fl ui d fr om pa ck et Pr e- pa ck ag ed flu id A ny O RS Ri ce so up Le m on / or an ge ju ic e W at er fr om bo ile d ve ge ta bl es / m ea t W at er fr om bo ile d/ fr ie d ric e A ny re co m m en de d ho m em ad e flu id Ta bl et Sy ru p A ny zi nc to ta l 48 .6 6. 2 50 .9 12 .7 16 .1 19 .9 10 .4 41 .1 66 .3 7. 3 11 .0 16 .9 12 .6 28 5 se x M al e 52 .1 8. 4 54 .3 15 .0 17 .3 20 .1 8. 8 43 .7 70 .8 8. 2 12 .1 19 .5 13 .8 16 9 Fe m al e 43 .5 2. 9 46 .0 9. 4 14 .3 19 .7 12 .9 37 .3 59 .8 6. 1 9. 5 13 .2 10 .8 11 6 re gi on Re d Ri ve r D el ta (4 8. 3) (1 0. 4) (5 1. 9) (1 0. 2) (1 6. 5) (1 6. 4) (1 0. 6) (3 8. 8) (6 4. 2) (3 .7 ) (5 .6 ) (9 .4 ) (9 .4 ) 52 N or th er n M id la nd s an d M ou nt ai no us a re a 37 .2 3. 9 38 .6 18 .4 11 .2 42 .9 6. 6 53 .5 62 .0 2. 2 3. 8 5. 2 3. 4 72 N or th C en tr al a nd C en tr al co as ta l a re a (5 2. 7) (0 .0 ) (5 2. 7) (1 8. 2) (2 0. 2) (9 .8 ) (1 3. 6) (4 1. 6) (6 9. 3) (7 .6 ) (1 6. 6) (2 2. 8) (1 5. 0) 53 Ce nt ra l H ig hl an ds 62 .7 11 .8 65 .1 16 .3 20 .9 17 .2 13 .5 46 .3 77 .8 7. 3 13 .5 16 .3 14 .0 30 So ut h Ea st (5 0. 6) (6 .0 ) (5 0. 6) (8 .3 ) (2 4. 0) (5 .9 ) (1 4. 1) (3 7. 9) (6 5. 3) (9 .3 ) (1 6. 9) (2 6. 2) (1 7. 1) 35 M ek on g Ri ve r D el ta (5 1. 7) (8 .7 ) (5 8. 6) (0 .0 ) (8 .6 ) (1 1. 2) (7 .8 ) (2 0. 7) (6 5. 4) (1 8. 6) (1 6. 4) (3 1. 6) (2 4. 6) 42 A re a U rb an 56 .1 3. 9 58 .4 10 .5 20 .7 19 .3 9. 8 41 .3 69 .4 10 .4 13 .7 22 .0 17 .7 59 Ru ra l 46 .6 6. 8 49 .0 13 .3 14 .9 20 .1 10 .6 41 .0 65 .6 6. 5 10 .3 15 .6 11 .3 22 6 A ge 0- 11 m on th s 36 .1 7. 0 40 .9 9. 3 7. 5 5. 2 5. 5 20 .6 48 .5 7. 6 13 .3 18 .9 12 .0 87 12 -2 3 m on th s 56 .0 1. 6 57 .6 13 .1 9. 4 19 .9 6. 5 35 .8 72 .1 6. 5 9. 9 15 .8 15 .3 92 24 -3 5 m on th s 46 .4 11 .1 47 .3 15 .4 15 .3 31 .2 20 .6 56 .6 65 .6 9. 4 14 .0 22 .3 14 .9 51 36 -4 7 m on th s (5 9. 8) (1 .8 ) (6 1. 6) (1 6. 1) (5 2. 0) (4 0. 9) (1 2. 5) (7 7. 4) (9 1. 9) (3 .1 ) (8 .6 ) (8 .6 ) (8 .6 ) 25 48 -5 9 m on th s (5 7. 0) (1 3. 2) (5 7. 0) (1 3. 8) (3 3. 3) (2 6. 5) (1 7. 7) (6 0. 6) (8 1. 1) (9 .1 ) (4 .5 ) (1 1. 8) (5 .4 ) 29 94 viet nam mics 2014 report Pe rc en ta ge o f c hi ld re n w it h di ar rh oe a w ho re ce iv ed : N um be r o f ch ild re n ag ed 0 -5 9 m on th s w it h di ar rh oe a in th e la st tw o w ee ks O ra l r eh yd ra ti on s al ts re co m m en de d ho m em ad e flu id s O RS o r a ny re co m m en de d ho m em ad e flu id zi nc O RS an d zi nc 1 Fl ui d fr om pa ck et Pr e- pa ck ag ed flu id A ny O RS Ri ce so up Le m on / or an ge ju ic e W at er fr om bo ile d ve ge ta bl es / m ea t W at er fr om bo ile d/ fr ie d ric e A ny re co m m en de d ho m em ad e flu id Ta bl et Sy ru p A ny zi nc M ot he r’s e du ca ti on N on e (3 0. 1) (4 .0 ) (3 0. 1) (1 4. 0) (2 .6 ) (1 4. 9) (6 .8 ) (3 8. 3) (5 3. 5) (3 .4 ) (3 .0 ) (6 .4 ) (3 .4 ) 35 Pr im ar y 42 .3 6. 8 42 .3 10 .1 18 .8 20 .8 9. 8 38 .7 60 .9 7. 4 3. 0 9. 3 8. 6 52 Lo w er S ec on da ry 52 .5 9. 1 57 .7 12 .2 16 .7 20 .3 12 .0 39 .9 68 .1 6. 8 14 .1 20 .1 16 .4 10 1 U pp er S ec on da ry 63 .2 1. 5 63 .8 17 .6 13 .9 21 .9 8. 9 47 .1 77 .7 14 .9 11 .9 21 .2 14 .7 50 Te rt ia ry (4 5. 6) (5 .7 ) (4 7. 8) (1 0. 3) (2 4. 0) (1 9. 8) (1 2. 1) (4 1. 9) (6 6. 3) (3 .5 ) (1 8. 4) (2 1. 9) (1 3. 7) 47 W ea lt h In de x qu in ti le s Po or es t 39 .1 3. 3 39 .5 16 .5 9. 0 19 .4 7. 5 37 .9 58 .0 1. 8 6. 7 8. 0 6. 9 10 7 Se co nd (5 1. 1) (8 .6 ) (5 4. 8) (1 2. 9) (1 3. 6) (2 6. 9) (1 1. 8) (4 1. 8) (6 6. 9) (1 1. 5) (9 .9 ) (2 0. 4 (1 5. 2) 50 M id dl e (6 1. 8) (8 .9 ) (6 5. 1) (9 .3 ) (2 3. 1) (2 3. 8) (1 1. 3) (4 5. 1) (7 4. 1) (1 3. 8) (8 .6 ) (1 8. 1 (1 7. 5) 52 Fo ur th (5 5. 1) (7 .0 ) (5 9. 8) (1 2. 9) (2 2. 1) (1 7. 2) (1 5. 2) (4 1. 6) (7 6. 3) (1 0. 4) (1 9. 3) (2 8. 5) (1 5. 0) 43 Ri ch es t (4 6. 6) (6 .4 ) (4 8. 1) (4 .9 ) (2 3. 7) (8 .4 ) (1 0. 2) (4 3. 3) (6 7. 4) (4 .9 ) (1 9. 6) (2 3. 5) (1 6. 2) 33 et hn ic it y of h ou se ho ld h ea d Ki nh /H oa 53 .3 7. 3 57 .0 10 .1 18 .1 18 .2 12 .0 41 .0 70 .1 9. 5 12 .3 20 .9 15 .5 17 9 Et hn ic M in or iti es 40 .6 4. 3 40 .6 17 .2 12 .6 22 .8 7. 7 41 .1 60 .0 3. 7 8. 9 10 .2 7. 6 10 6 1 M IC s In di ca to r 3 .1 1 - D ia rr ho ea tr ea tm en t w it h or al re hy dr at io n sa lt s an d zi nc 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 nw ei gh te d ca se s 95viet nam mics 2014 report Table CH.7 shows the percentage of children receiving ORS, various types of recommended homemade fluids and zinc during episodes of diarrhoea. Since children may have been given more than one type of liquid, the percentages do not necessarily add to 100. About 50.9 per cent of children received fluids from ORS packets or pre-packaged ORS fluids and 41.1 per cent of children received recommended homemade fluids (rice soup, lemon/ orange juice, water from boiled vegetables/meat, water from boiled/fried rice). Additionally, 16.9 per cent received zinc in one form or another. Girls as well as children in rural areas, of mothers with lower education and those who are ethnic minority were less likely to receive ORS or recommended fluids than others. Children in urban areas were more likely to receive zinc (tablet or syrup) than those in rural areas (22.0 compared to 15.6 per cent). In addition, 12.6 per cent of urban and rural children received ORS and zinc. This percentage was lower for girls as well as children in rural areas, children who were ethnic minority. Figure CH.2 summarizes the percentages of children under-5 with diarrhoea who received ORS or recommended home-made liquids among area and ethnic groups. Figure CH.2: Children under-5 with diarrhoea who received Ors or recommended homemade liquids, viet Nam MICs 2014 70.1 Kinh/Hoa 60.0 Ethnic minority Urban Rural Total 69.4 65.6 66.3 Pe r c en t 96 viet nam mics 2014 report ta bl e CH .8 : O ra l r eh yd ra ti on th er ap y w it h co nt in ue d fe ed in g an d ot he r t re at m en ts Pe rc en ta ge o f 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 w er e gi ve n or al re hy dr at io n th er ap y w ith c on tin ue d fe ed in g an d pe rc en ta ge w ho w er e gi ve n ot he r t re at m en ts , V ie t N am , 2 01 4 Ch ild re n w it h di ar rh oe a w ho w er e gi ve n: 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 th e la st tw o w ee ks Zi nc O RS o r in cr ea se d flu id s O RT (O RS o r 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 RT w ith co nt in ue d fe ed in g1 O th er tr ea tm en ts N ot gi ve n an y tr ea tm en t or d ru g Pi ll or s yr up In je ct io n In tr a- ve no us h 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 O th er U nk no w n A nt i- bi ot ic N on - an tib io tic U nk no w n to ta l 16 .9 59 .5 70 .8 57 .8 17 .7 1. 1 5. 7 9. 0 0. 3 0. 0 0. 8 1. 7 9. 1 21 .8 9. 9 28 5 se x M al e 19 .5 62 .1 74 .5 58 .3 15 .0 1. 8 4. 7 10 .5 0. 5 0. 0 1. 3 2. 8 11 .0 17 .7 8. 2 16 9 Fe m al e 13 .2 55 .8 65 .3 57 .0 21 .8 0. 0 7. 2 6. 9 0. 0 0. 0 0. 0 0. 0 6. 3 27 .7 12 .4 11 6 re gi on Re d Ri ve r D el ta (9 .4 ) (5 7. 3) (6 9. 7) (6 0. 3) (3 0. 1) (4 .2 ) (0 .0 ) (0 .0 ) (1 .6 ) (0 .0 ) (3 .6 ) (3 .1 ) (3 .6 ) (3 1. 9) (8 .0 ) 52 N or th er n M id la nd s an d M ou nt ai no us ar ea 5. 2 48 .4 64 .7 57 .3 11 .5 0. 0 8. 0 13 .3 0. 0 0. 0 0. 0 0. 0 19 .1 19 .7 14 .6 72 N or th C en tr al a nd Ce nt ra l c oa st al a re a (2 2. 8) (6 2. 2) (6 9. 3) (4 2. 3) (2 2. 8) (0 .0 ) (1 2. 3) (1 2. 3) (0 .0 ) (0 .0 ) (0 .0 ) (5 .9 ) (8 .6 ) (3 0. 1) (9 .9 ) 53 Ce nt ra l H ig hl an ds 16 .3 71 .0 80 .9 73 .9 4. 6 0. 9 2. 0 7. 1 0. 0 0. 0 1. 3 0. 0 8. 1 8. 8 3. 9 30 So ut h Ea st (2 6. 2) (5 8. 7) (7 0. 5) (5 6. 8) (1 9. 3) (1 .8 ) (3 .6 ) (3 .1 ) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (3 .0 ) (1 6. 0) (1 3. 3) 35 M ek on g Ri ve r D el ta (3 1. 6) (7 0. 5) (7 7. 3) (6 4. 3) (1 5. 2) (0 .0 ) (5 .1 ) (1 4. 7) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (4 .9 ) (1 6. 4) (5 .9 ) 42 A re a U rb an 22 .0 67 .8 74 .9 64 .2 19 .1 1. 5 10 .9 2. 1 1. 4 0. 0 0. 0 0. 0 13 .9 11 .0 10 .7 59 Ru ra l 15 .6 57 .4 69 .7 56 .1 17 .4 1. 0 4. 4 10 .8 0. 0 0. 0 1. 0 2. 1 7. 8 24 .6 9. 7 22 6 A ge 0- 11 m on th s 18 .9 49 .4 54 .6 43 .4 10 .3 1. 0 4. 3 6. 0 0. 0 0. 0 2. 1 0. 0 7. 0 25 .8 17 .9 87 12 -2 3 m on th s 15 .8 61 .8 75 .7 62 .0 21 .8 2. 4 9. 3 9. 3 0. 9 0. 0 0. 4 5. 2 10 .2 21 .1 5. 7 92 97viet nam mics 2014 report Ch ild re n w it h di ar rh oe a w ho w er e gi ve n: 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 th e la st tw o w ee ks Zi nc O RS o r in cr ea se d flu id s O RT (O RS o r 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 RT w ith co nt in ue d fe ed in g1 O th er tr ea tm en ts N ot gi ve n an y tr ea tm en t or d ru g Pi ll or s yr up In je ct io n In tr a- ve no us h 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 O th er U nk no w n A nt i- bi ot ic N on - an tib io tic U nk no w n 24 -3 5 m on th s 22 .3 62 .2 72 .6 57 .4 24 .0 0. 0 3. 5 8. 6 0. 0 0. 0 0. 0 0. 0 9. 8 14 .7 9. 2 51 36 -4 7 m on th s (8 .6 ) (7 1. 5) (9 1. 9) (8 3. 1) (1 3. 6) (0 .0 ) (4 .1 ) (1 2. 6) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (1 1. 2) (1 9. 9) (1 .1 ) 25 48 -5 9 m on th s (1 1. 8) (6 8. 0) (8 2. 4) (6 6. 6) (1 9. 5) (0 .0 ) (4 .1 ) (1 4. 4) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (8 .4 ) (2 5. 6) (8 .3 ) 29 M ot he r’s e du ca ti on N on e (6 .4 ) (3 3. 1) (5 6. 4) (4 3. 7) (1 5. 2) (0 .0 ) (0 .8 ) (8 .8 ) (0 .0 ) (0 .0 ) (1 .1 ) (0 .0 ) (1 5. 7) (7 .2 ) (1 4. 1) 35 Pr im ar y 9. 3 60 .7 74 .0 61 .9 17 .1 1. 2 5. 2 16 .9 0. 0 0. 0 0. 0 60 60 21 .4 13 .0 52 Lo w er S ec on da ry 20 .1 58 .3 68 .1 54 .3 13 .9 0. 3 9. 2 8. 8 0. 8 0. 0 0. 0 0. 0 6. 4 22 .7 9. 4 10 1 U pp er S ec on da ry 21 .2 85 .5 87 .1 67 .0 21 .4 0 6. 1 9. 8 0. 0 0. 0 3. 7 3. 2 9. 8 22 .1 0. 9 50 Te rt ia ry (2 1. 9) (5 3. 1) (6 6. 3) (6 1. 5) (2 4. 8) (4 .7 ) (2 .2 ) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (1 2. 6) (3 0. 6) (1 4. 2) 47 W ea lt h In de x qu in ti le s Po or es t 8. 0 49 .8 62 .9 50 .5 13 .0 0. 0 5. 5 11 .9 0. 0 0. 0 0. 4 0. 0 10 .6 20 .0 12 .9 10 7 Se co nd (2 0. 4) (6 6. 7) (7 4. 7) (6 1. 2) (2 0. 2) (0 .5 ) (7 .7 ) (7 .5 ) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (8 .5 ) (1 8. 4) (4 .9 ) 50 M id dl e (1 8. 1) (6 8. 1) (7 6. 0) (5 7. 5) (1 8. 4) (0 .0 ) (6 .7 ) (1 4. 9) (1 .6 ) (0 .0 ) (0 .0 ) (6 .1 ) (9 .7 ) (2 7. 7) (1 1. 3) 52 Fo ur th (2 8. 5) (6 5. 8) (7 8. 4) (6 6. 5) (1 8. 8) (1 .4 ) (5 .3 ) (3 .5 ) (0 .0 ) (0 .0 ) (4 .3 ) (0 .0 ) (4 .4 ) (1 4. 0) (3 .6 ) 43 Ri ch es t (2 3. 5) (5 8. 8) (7 2. 3) (6 5. 6) (2 6. 9) (6 .6 ) (2 .4 ) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (4 .9 ) (9 .9 ) (3 3. 3) (1 4. 2) 33 et hn ic it y of h ou se ho ld h ea d Ki nh /H oa 20 .9 65 .3 75 .0 60 .9 22 .5 1. 7 6. 0 6. 6 0. 5 0. 0 1. 0 2. 7 6. 6 25 .8 7. 9 17 9 Et hn ic M in or iti es 10 .2 49 .7 63 .6 52 .5 9 .6 0. 0 5. 3 13 .1 0 .0 0. 0 0. 4 0. 0 13 .3 14 .9 13 .4 10 6 1 M IC s In di ca to r 3 .1 2 - D ia rr ho ea tr ea tm en t w it h or al re hy dr at io n th er ap y an d co nt in ue d fe ed in g 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 nw ei gh te d ca se s 98 viet nam mics 2014 report Table CH.8 provides 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, 59.5 per cent of children with diarrhoea received ORS or increased fluids, 70.8 per cent received ORT (ORS or recommended homemade or increased fluids). Combining the information in Table CH.6 with that of Table CH.7 on oral rehydration therapy, it was observed that 57.8 per cent of children received ORT and at the same time, feeding was continued, as is recommended. There were notable differences in the home management of diarrhoea by background characteristics. Girls as well as children in rural areas and ethnic minority children were less likely to receive ORT (ORS or recommended homemade or increased fluids) or ORT with continued feeding. Table CH.8 also shows the percentage of children having had diarrhoea in the two weeks preceding the survey who were given various forms of treatment, leaving 9.9 per cent of them without any treatment or drug. Overall, 17.7 per cent of children were given antibiotics (pill or syrup) and 0.3 per cent (injection) during episodes of diarrhoea. Kinh/Hoa children (22.5 per cent) were more likely to use antibiotics against diarrhoea than ethnic minority children (9.6 per cent). The figures also indicate a relatively high proportion of treatment by home remedies and herbal medicines (9.1 per cent), especially in urban areas (13.9 per cent) and among ethnic minorities (13.3 per cent). Figure CH.3 summarizes the percentages of children under-5 with diarrhea who received oral rehydration therapy and continued feeding. Figure CH.3: Children under-5 with diarrhoea receiving oral rehydration therapy and continued feeding, viet Nam MICs 2014 64.2 56.1 60.9 52.5 57.8 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 Kinh/Hoa Per cent Area Urban Rural Ethnicity of household head Ethnic minority Total 99viet nam mics 2014 report ta bl e CH .9 : s ou rc e of O rs a nd z in c Pe rc en ta ge o f 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 w er e gi ve n O RS a nd p er ce nt ag e gi ve n zi nc , b y th e so ur ce o f O RS an d zi nc , V ie t N am , 2 01 4 Pe rc en ta ge o f ch ild re n w ho w er e gi ve n as tr ea tm en t fo r d ia rr ho ea : N um be r of c hi ld re n ag ed 0- 59 m on th s w ith di ar rh oe a in th e la st tw o w ee ks Pe rc en ta ge o f c hi ld re n fo r w ho m th e so ur ce o f O RS w as : N um be r o f ch ild re n ag ed 0- 59 m on th s w ho w er e gi ve n O RS a s tr ea tm en t f or di ar rh oe a in th e la st tw o w ee ks Pe rc en ta ge o f c hi ld re n fo r w ho m th e so ur ce o f z in c w as : N um be r o f ch ild re n ag ed 0- 59 m on th s w ho w er e gi ve n zi nc a s tr ea tm en t f or di ar rh oe a in th e la st tw o w ee ks O RS Zi nc H ea lth fa ci lit ie s or pr ov id er s A h ea lth fa ci lit y or pr ov id er b H ea lth fa ci lit ie s or pr ov id er s A h ea lth fa ci lit y or pr ov id er b Pu bl ic Pr iv at e Pu bl ic Pr iv at e to ta l 50 .9 16 .9 28 5 41 .7 58 .3 10 0 14 5 (4 4. 3) (5 5. 7) (1 00 ) 48 se x M al e 54 .3 19 .5 16 9 48 .9 51 .1 10 0 92 (6 0. 6) (3 9. 4) (1 00 ) 33 Fe m al e 46 .0 13 .2 11 6 29 .2 70 .8 10 0 53 * * * 15 re gi on Re d Ri ve r D el ta (5 1. 9) (9 .4 ) 52 * * * 27 * * * 5 N or th er n M id la nd s an d M ou nt ai no us a re a 38 .6 5. 2 72 (4 9. 3) (5 0. 7) (1 00 ) 28 * * * 4 N or th C en tr al a nd C en tr al co as ta l a re a (5 2. 7) (2 2. 8) 53 * * * 28 * * * 12 Ce nt ra l H ig hl an ds 65 .1 16 .3 30 51 .8 48 .2 10 0 20 * * * 5 So ut h Ea st (5 0. 6) (2 6. 2) 35 * * * 18 * * * 9 M ek on g Ri ve r D el ta (5 8. 6) (3 1. 6) 42 * * * 25 * * * 13 A re a * * * U rb an 58 .4 22 .0 59 19 .4 80 .6 10 0 34 * * * 13 Ru ra l 49 .0 15 .6 22 6 48 .6 51 .4 10 0 11 1 55 .4 44 .6 10 0 35 A ge 0- 11 m on th s 40 .9 18 .9 87 (4 4. 6) (5 5. 4) (1 00 ) 36 * * * 17 12 -2 3 m on th s 57 .6 15 .8 92 38 .2 61 .8 10 0 53 * * * 15 100 viet nam mics 2014 report Pe rc en ta ge o f ch ild re n w ho w er e gi ve n as tr ea tm en t fo r d ia rr ho ea : N um be r of c hi ld re n ag ed 0- 59 m on th s w ith di ar rh oe a in th e la st tw o w ee ks Pe rc en ta ge o f c hi ld re n fo r w ho m th e so ur ce o f O RS w as : N um be r o f ch ild re n ag ed 0- 59 m on th s w ho w er e gi ve n O RS a s tr ea tm en t f or di ar rh oe a in th e la st tw o w ee ks Pe rc en ta ge o f c hi ld re n fo r w ho m th e so ur ce o f z in c w as : N um be r o f ch ild re n ag ed 0- 59 m on th s w ho w er e gi ve n zi nc a s tr ea tm en t f or di ar rh oe a in th e la st tw o w ee ks O RS Zi nc H ea lth fa ci lit ie s or pr ov id er s A h ea lth fa ci lit y or pr ov id er b H ea lth fa ci lit ie s or pr ov id er s A h ea lth fa ci lit y or pr ov id er b Pu bl ic Pr iv at e Pu bl ic Pr iv at e 24 -3 5 m on th s 47 .3 22 .3 51 (4 5. 3) (5 4. 7) (1 00 ) 24 * * * 11 36 -4 7 m on th s (6 1. 6) (8 .6 ) 25 * * * 15 * * * 2 48 -5 9 m on th s (5 7. 0) (1 1. 8) 29 * * * 17 * * * 3 M ot he r’s e du ca ti on N on e (3 0. 1) (6 .4 ) 35 * * * 11 * * * 2 Pr im ar y 42 .3 9. 3 52 * * * 22 * * * 5 Lo w er S ec on da ry 57 .7 20 .1 10 1 36 .7 63 .3 10 0 58 * * * 20 U pp er S ec on da ry 63 .8 21 .2 50 (4 5. 8) (5 4. 2) (1 00 ) 32 * * * 11 Te rt ia ry (4 7. 8) (2 1. 9) 47 * * * 22 * * * 10 W ea lt h In de x qu in ti le s Po or es t 39 .5 8. 0 10 7 68 .8 31 .2 10 0 42 * * * 9 Se co nd (5 4. 8) (2 0. 4) 50 (1 7. 5) (8 2. 5) (1 00 ) 27 * * * 10 M id dl e (6 5. 1) (1 8. 1) 52 (4 7. 4) (5 2. 6) (1 00 ) 34 * * * 9 Fo ur th (5 9. 8) (2 8. 5) 43 * * * 26 * * * 12 Ri ch es t (4 8. 1) (2 3. 5) 33 * * * 16 * * * 8 et hn ic it y of h ou se ho ld h ea d Ki nh /H oa 57 .0 20 .9 17 9 33 .5 66 .5 10 0 10 2 (4 6. 7) (5 3. 3) (1 00 ) 37 Et hn ic M in or iti es 40 .6 10 .2 10 6 61 .3 38 .7 10 0 43 * * * 11 b Ba o gồ m tấ t c ả cơ s ở y tế c ủa n hà n ướ c và tư n hâ n G hi c hú : S ố liệ u có k ý hi ệu (* ) đ ượ c tín h dự a tr ên m ẫu s ố củ a 24 tr ườ ng h ợp k hô ng g ia q uy ền Số li ệu tr on g ng oặ c đơ n đư ợc tí nh d ựa tr ên m ẫu s ố củ a 25 -4 9 tr ườ ng h ợp k hô ng g ia q uy ền 101viet nam mics 2014 report Table CH.9 provides information on the source of ORS and zinc for children who benefitted from these treatments. The main source of ORS came from the private sector (58.3 per cent) in contrast to the public sector (41.7 per cent) and the same applies for zinc (55.7 per cent from private sources and 44.3 per cent from public). Acute respiratory Infections Reports of symptoms of ARI were collected during the Viet Nam MICS 2014 to examine the incidences of pneumonia, the leading cause of death in children under-5. Once diagnosed, pneumonia is treated effectively with antibiotics. Studies have shown a limitation in the survey approach of measuring pneumonia because many of the suspected cases identified through surveys are in fact, not true pneumonia19. While this limitation does not affect the level and patterns of care-seeking for suspected pneumonia, it limits the validity of the level of treatment of pneumonia with antibiotics, as reported through household surveys. The treatment indicator described in this report must, therefore, be taken with caution, keeping in mind that an accurate level is likely higher. 19 Campbell H, el Arifeen S, Hazir T, O’Kelly J, Bryce J, et al. (2013) Measuring Coverage in MNCH: Challenges in Monitoring the Proportion of Young Children with Pneumonia Who Receive Antibiotic Treatment. PLoS Med 10(5): e1001421. doi:10.1371/journal. pmed.1001421. 102 viet nam mics 2014 report ta bl e CH .1 0: C ar e- se ek in g fo r a nd a nt ib io ti c tr ea tm en t o f s ym pt om s of a cu te re sp ir at or y in fe ct io n (A rI ) Pe rc en ta ge o f c hi ld re n ag ed 0 -5 9 m on th s w ith s ym pt om s of A RI in th e la st tw o w ee ks fo r w ho m a dv ic e or tr ea tm en t w as s ou gh t, by s ou rc e of a dv ic e or tr ea tm en t, an d pe rc en ta ge o f c hi ld re n w ith s ym pt om s w ho w er e gi ve n an tib io tic s, Vi et N am , 2 01 4 Pe rc en ta ge o f c hi ld re n w it h sy m pt om s of A rI fo r w ho m : Pe rc en ta ge o f ch ild re n w ith sy m pt om s of A RI in th e la st tw o w ee ks w ho w er e gi ve n an tib io tic s2 N um be r of c hi ld re n ag ed 0 -5 9 m on th s w ith sy m pt om s of A RI in th e la st tw o w ee ks Pe rc en ta ge o f c hi ld re n w it h sy m pt om s of A rI fo r w ho m th e so ur ce o f a nt ib io ti cs w as : N um be r o f ch ild re n w ith sy m pt om s of A RI in th e la st tw o w ee ks w ho w er e gi ve n an tib io tic s A dv ic e or tr ea tm en t w as s ou gh t f ro m : N o ad vi ce o r tr ea tm en t so ug ht H ea lt h fa ci lit ie s or p ro vi de rs O th er so ur ce A h ea lth fa ci lit y or pr ov id er 1, b H ea lt h fa ci lit ie s or p ro vi de rs O th er so ur ce A h ea lth fa ci lit y or pr ov id er c Pu bl ic Pr iv at e Co m m un ity he al th pr ov id er a Pu bl ic Pr iv at e Co m m un ity he al th pr ov id er a to ta l 46 .2 50 .0 0. 0 3. 2 81 .1 10 .0 88 .2 98 42 .6 56 .4 0. 0 0. 9 99 .1 87 se x M al e 48 .0 50 .5 0. 0 3. 0 85 .2 7. 3 92 .5 56 41 .0 57 .4 0. 0 1. 6 98 .4 51 Fe m al e 43 .8 49 .3 0. 0 3. 5 75 .8 13 .5 82 .6 43 (4 5. 0) (5 5. 0) (0 .0 ) (0 .0 ) (1 00 ) 35 Re gi on Re d Ri ve r D el ta * * * * * * * 14 * * * * * 14 N or th er n M id la nd s an d M ou nt ai no us a re a * * * * * * * 11 * * * * * 5 N or th C en tr al a nd C en tr al co as ta l a re a * * * * * * * 21 * * * * * 21 Ce nt ra l H ig hl an ds (5 6. 7) (4 4. 5) (0 .0 ) (4 .8 ) (7 6. 3) (7 .1 ) (8 8. 5) 11 45 .0 55 .0 0. 0 0. 0 10 0 10 So ut h Ea st * * * * * * * 13 * * * * * 13 M ek on g Ri ve r D el ta * * * * * * * 28 * * * * * 23 A re a U rb an (3 1. 6) (7 6. 9) (0 .0 ) (0 .8 ) (8 1. 2) (4 .9 ) (9 6. 5) 24 (3 3. 3) (6 6. 7) (0 .0 ) (0 .0 ) (1 00 ) 23 Ru ra l 51 .0 41 .2 0. 0 4. 0 81 .1 11 .7 85 .5 74 46 .1 52 .6 0. 0 1. 3 98 .7 63 Ag e 0- 11 m on th s * * * * * * * 16 * * * * * 15 12 -2 3 m on th s * * * * * * * 17 * * * * * 15 24 -3 5 m on th s * * * * * * * 19 * * * * * 19 36 -4 7 m on th s (3 6. 3) (5 5. 2) (0 .0 ) (5 .2 ) (7 2. 6) (1 0. 9) (7 9. 6) 25 * * * * * 20 48 -5 9 m on th s * * * * * * * 21 * * * * * 17 103viet nam mics 2014 report Pe rc en ta ge o f c hi ld re n w it h sy m pt om s of A rI fo r w ho m : Pe rc en ta ge o f ch ild re n w ith sy m pt om s of A RI in th e la st tw o w ee ks w ho w er e gi ve n an tib io tic s2 N um be r of c hi ld re n ag ed 0 -5 9 m on th s w ith sy m pt om s of A RI in th e la st tw o w ee ks Pe rc en ta ge o f c hi ld re n w it h sy m pt om s of A rI fo r w ho m th e so ur ce o f a nt ib io ti cs w as : N um be r o f ch ild re n w ith sy m pt om s of A RI in th e la st tw o w ee ks w ho w er e gi ve n an tib io tic s A dv ic e or tr ea tm en t w as s ou gh t f ro m : N o ad vi ce o r tr ea tm en t so ug ht H ea lt h fa ci lit ie s or p ro vi de rs O th er so ur ce A h ea lth fa ci lit y or pr ov id er 1, b H ea lt h fa ci lit ie s or p ro vi de rs O th er so ur ce A h ea lth fa ci lit y or pr ov id er c Pu bl ic Pr iv at e Co m m un ity he al th pr ov id er a Pu bl ic Pr iv at e Co m m un ity he al th pr ov id er a M ot he r’s e du ca ti on N on e * * * * * * * 7 * * * * * 3 Pr im ar y * * * * * * * 21 * * * * * 17 Lo w er S ec on da ry (4 9. 0) (5 0. 2) (0 .0 ) (0 .0 ) (8 3. 2) (8 .4 ) (9 2. 5) 41 (4 8. 1) (4 9. 8) (0 .0 ) (0 .0 ) (2 .1 ) 38 U pp er S ec on da ry * * * * * * * 12 * * * * * 12 Te rt ia ry * * * * * * * 17 * * * * * 17 W ea lt h In de x qu in ti le s Po or es t (4 9. 4) (3 8. 2) (0 .0 ) (3 .7 ) (6 8. 0) (2 0. 3) (7 0. 9) 35 (5 1. 7) (4 5. 1) (0 .0 ) (3 .2 ) (9 6. 8) 25 Se co nd * * * * * * * 16 * * * * * 15 M id dl e * * * * * * * 18 * * * * * 18 Fo ur th * * * * * * * 16 * * * * * 16 Ri ch es t * * * * * * * 12 * * * * * 12 et hn ic it y of h ou se ho ld he ad Ki nh /H oa 45 .7 55 .7 0. 0 2. 5 90 .1 3. 5 95 .1 76 40 .8 59 .2 0. 0 0. 0 10 0 72 Et hn ic M in or iti es (4 7. 9) (3 0. 8) (0 .0 ) (5 .8 ) (5 0. 9) (3 1. 7) (6 5. 3) 23 * * * * * 15 1 M IC s In di ca to r 3 .1 3 - C ar e- se ek in g fo r c hi ld re n w it h ac ut e re sp ir at or y in fe ct io n sy m pt om s 2 M IC s In di ca to r 3 .1 4 - A nt ib io ti c tr ea tm en t f or c hi ld re n w it h A rI s ym pt om s a Co m m un ity h ea lth p ro vi de rs in cl ud es p ub lic (C om m un ity h ea lth w or ke r a nd M ob ile /o ut re ac h cl in ic ) a nd p riv at e (M ob ile c lin ic ) h ea lth fa ci lit ie s b In cl ud es a ll pu bl ic a nd p riv at e he al th fa ci lit ie s an d pr ov id er s, bu t e xc lu de s pr iv at e ph ar m ac ie s c In cl ud es a ll pu bl ic a nd p riv at e he al th fa ci lit ie s an d pr ov id er s N ot e: Fi gu re s de no te d by a n as te ris k ar e ba se d on d en om in at or s of le ss th an 2 5 un w ei gh te d ca se s 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 nw ei gh te d ca se s 104 viet nam mics 2014 report Table CH.10 presents the percentage of children with symptoms of ARI in the two weeks preceding the survey for whom care was sought, by source of care and percentage who received antibiotics. Overall, 81.1 per cent of children aged 0-59 months with symptoms of ARI were taken to a qualified health provider with the figure slightly higher for private providers. However, treatment or advice was not sought for one-in-10 children with symptoms of ARI. In Viet Nam, 88.2 per cent of under-5 children with symptoms of ARI received antibiotics during the two weeks prior to the survey. Table CH.10 also shows the point of treatment among children with symptoms of ARI who were treated with antibiotics. The treatment was received more from private health facilities (56.4 per cent) than public ones (42.6 per cent). 105viet nam mics 2014 report ta bl e CH .1 1: k no w le dg e of th e tw o da ng er s ig ns o f p ne um on ia Pe rc en ta ge o f w om en a ge d 15 -4 9 ye ar s w ho a re m ot he rs o r c ar et ak er s of c hi ld re n ag ed u nd er -5 b y sy m pt om s th at w ou ld c au se th em to ta ke a ch ild a ge d un de r- 5 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 iz e fa st o r 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 4 Pe rc en ta ge o f m ot he rs /c ar et ak 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 s ho ul d be ta ke n im m ed ia te ly to a h ea lt h fa ci lit y if th e ch ild : M ot he rs /c ar et ak er s w ho re co gn iz e at le as t o ne o f t he tw o da ng er s ig ns of p ne um on ia (f as t an d/ or d iffi cu lt br ea th in g) N um be r o f w om en a ge d 15 -4 9 ye ar s w ho ar e m ot he rs / ca re ta ke rs o f ch ild re n ag ed un de r 5 Is n ot a bl e to d rin k or be b re as tf ed Be co m 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 lt br ea th in g H as bl oo d in st oo l Is dr in ki ng po or ly H as vo m iti ng H as ch ok in g H as o th er sy m pt om s to ta l 7. 0 27 .7 90 .8 4. 8 25 .5 2. 7 4. 2 16 .9 1. 2 55 .2 28 .4 27 15 re gi on Re d Ri ve r D el ta 5. 6 36 .3 90 .8 8. 8 33 .7 3. 5 5. 5 14 .1 0. 4 49 .3 38 .8 63 8 N or th er n M id la nd s an d M ou nt ai no us a re a 7. 7 25 .3 90 .3 3. 5 25 .5 4. 5 1. 9 19 .6 2. 1 62 .8 27 .2 41 9 N or th C en tr al a nd C en tr al co as ta l a re a 8. 8 21 .5 92 .1 2. 2 23 .5 2. 0 2. 8 16 .0 0. 7 56 .1 24 .6 56 6 Ce nt ra l H ig hl an ds 9. 8 31 .8 89 .0 5. 9 26 .0 2. 9 5. 2 24 .1 1. 4 55 .8 27 .8 19 6 So ut h Ea st 7. 5 23 .7 91 .5 5. 3 21 .8 1. 6 7. 1 19 .6 1. 9 55 .9 25 .9 43 5 M ek on g Ri ve r D el ta 4. 5 27 .5 89 .7 2. 5 19 .9 1. 7 2. 8 13 .9 1. 5 54 .3 22 .2 46 2 A re a U rb an 8. 1 22 .7 92 .1 4. 4 25 .4 3. 3 4. 4 20 .7 2. 0 57 .3 27 .2 83 2 Ru ra l 6. 6 29 .8 90 .2 4. 9 25 .5 2. 4 4. 1 15 .2 0. 9 54 .2 28 .8 18 84 ed uc at io n N on e 5. 9 32 .7 84 .2 4. 6 13 .8 1. 2 3. 5 13 .4 0. 0 47 .0 18 .4 14 2 Pr im ar y 3. 8 30 .6 87 .4 3. 3 20 .7 1. 5 4. 0 13 .2 0. 2 52 .7 23 .1 38 4 Lo w er S ec on da ry 5. 8 28 .2 92 .2 4. 2 24 .6 2. 4 4. 5 15 .2 1. 5 56 .0 27 .3 10 11 U pp er S ec on da ry 7. 5 24 .5 91 .4 6. 2 28 .0 3. 1 3. 7 17 .6 1. 4 57 .6 31 .9 56 7 Te rt ia ry 10 .9 26 .7 91 .5 5. 2 30 .3 3. 7 4. 3 22 .3 1. 4 54 .9 32 .5 61 1 W ea lt h In de x qu in ti le s Po or es t 5. 6 30 .6 87 .8 3. 6 22 .6 2. 2 4. 3 16 .4 1. 1 51 .2 24 .9 55 2 Se co nd 7. 1 24 .6 92 .4 3. 1 24 .2 2. 5 4. 3 15 .0 0. 8 55 .2 26 .4 52 1 M id dl e 5. 9 27 .9 91 .2 5. 4 24 .6 1. 6 3. 1 16 .0 0. 2 56 .0 28 .7 54 3 Fo ur th 6. 8 29 .6 91 .9 6. 7 24 .7 2. 8 4. 3 16 .1 1. 2 59 .0 28 .2 56 5 Ri ch es t 9. 8 25 .2 90 .7 4. 9 31 .6 4. 3 4. 7 21 .1 2. 7 54 .3 33 .7 53 4 et hn ic it y of h ou se ho ld h ea d Ki nh /H oa 7. 0 27 .8 91 .2 5. 1 26 .2 2. 6 4. 2 16 .8 1. 2 55 .0 29 .3 22 59 Et hn ic M in or iti es 7. 4 27 .2 88 .9 3. 0 22 .0 3. 2 3. 8 17 .4 1. 2 55 .8 23 .7 45 7 106 viet nam mics 2014 report Mothers’ knowledge of danger signs is an important determinant of care-seeking behaviour. In Viet Nam MICS 2014, mothers

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