Zimbabwe Multiple Indicator Cluster Survey 2014

Publication date: 2015

����� ���� ����� � ��� ������������ ������ � ���� �������� ������� ��� The Zimbabwe Multiple Indicator Cluster Survey (MICS) was carried out in 2014 by the Zimbabwe National Statistics Agency (ZIMSTAT) as part of the global MICS programme. Technical and financial support was coordinated by the United Nations Children’s Fund (UNICEF). The global MICS programme was developed by UNICEF in the 1990s as an international household survey programme to support countries in the collection of 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. Suggested citation: Zimbabwe National Statistics Agency (ZIMSTAT), 2015. Zimbabwe Multiple Indicator Cluster Survey 2014, Final Report. Harare, Zimbabwe. P a g e | iii Summary Table of Survey Implementation and the Survey Population, Zimbabwe MICS, 2014 Survey implementation Sample frame Updated 2012 Zimbabwe Master Sample (ZMS12) January 2014 Questionnaires Household Women (age 15-49) Men (age 15-54) Children under five Interviewer training February 2014 Fieldwork February – April 2014 Survey sample Households Sampled Occupied Interviewed Response rate (Percent) 17 047 16 041 15 686 97.8 Children under five Eligible Mothers/caregivers interviewed Response rate (Percent) 10 223 9 884 96.7 Women Eligible for interviews Interviewed Response rate (Percent) 15 376 14 408 93.7 Men Eligible for interviews Interviewed Response rate (Percent) 9 008 7 914 87.9 Survey population Average household size 4.2 Percentage of survey households Urban areas Rural areas Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo 30.6 69.4 12.7 5.0 11.7 12.8 8.8 8.2 12.3 11.1 9.7 7.6 Percentage of population under: Age 5 Age 18 15.6 50.3 Percentage of women age 15-49 years with at least one live birth in the last 2 years 27.1 Housing characteristics Household or personal assets Percentage of households with Electricity Finished floor Finished roofing Finished walls 32.3 70.1 70.2 84.6 Percentage of households that own A television A refrigerator Agricultural land Farm animals/livestock 37.4 18.7 68.7 62.4 Mean number of persons per room used for sleeping 2.34 Percentage of households where at least a member has or owns a Mobile phone Car or truck 84.4 8.8 P a g e | iv Summary Table of Findings1 Multiple Indicator Cluster Surveys (MICS) and Millennium Development Goals (MDG) Indicators, Zimbabwe MICS, 2014 CHILD MORTALITY Early childhood mortality* MICS Indicator Indicator Description Value 1.1 Neonatal mortality rate Probability of dying within the first month of life 29 1.2 MDG 4.2 Infant mortality rate Probability of dying between birth and the first birthday 55 1.3 Post-neonatal mortality rate Difference between infant and neonatal mortality rates 25 1.4 Child mortality rate Probability of dying between the first and the fifth birthdays 21 1.5 MDG 4.1 Under-five mortality rate Probability of dying between birth and the fifth birthday 75 * Rates refer to the 5-year period preceding the survey. NUTRITION Nutritional status MICS Indicator Indicator Description Value 2.1a 2.1b MDG 1.8 Underweight prevalence (a) Moderate and severe (b) Severe Percentage of children under age 5 who fall below (a) minus two standard deviations (moderate and severe) (b) minus three standard deviations (severe) of the median weight for age of the WHO standard 11.2 2.2 2.2a 2.2b Stunting prevalence (a) Moderate and severe (b) Severe Percentage of children under age 5 who fall below (a) minus two standard deviations (moderate and severe) (b) minus three standard deviations (severe) of the median height for age of the WHO standard 27.6 7.8 2.3a 2.3b Wasting prevalence (a) Moderate and severe (b) Severe Percentage of children under age 5 who fall below (a) minus two standard deviations (moderate and severe) (b) minus three standard deviations (severe) of the median weight for height of the WHO standard 3.3 0.7 2.4 Overweight prevalence Percentage of children under age 5 who are above two standard deviations of the median weight for height of the WHO standard 3.6 Nutritional Oedema 2.S1 Nutritional oedema prevalence Percentage of children 6-59 months with bilateral oedema 0.2 Breastfeeding and infant feeding 2.5 Children ever breastfed Percentage of women with a live birth in the last 2 years who breastfed their last live-born child at any time 98.1 2.6 Early initiation of breastfeeding Percentage of women with a live birth in the last 2 years who put their last newborn to the breast within one hour of birth 58.9 2.7 Exclusive breastfeeding under 6 months Percentage of infants under 6 months of age who are exclusively breastfed 41.0 1 See Appendix G for a detailed description of MICS indicators P a g e | v 2.8 Predominant breastfeeding under 6 months Percentage of infants under 6 months of age who received breast milk as the predominant source of nourishment during the previous day 64.4 2.9 Continued breastfeeding at 1 year Percentage of children age 12-15 months who received breast milk during the previous day 84.4 2.10 Continued breastfeeding at 2 years Percentage of children age 20-23 months who received breast milk during the previous day 17.1 2.11 Median duration of breastfeeding The age in months when 50 percent of children age 0-35 months did not receive breast milk during the previous day 17.7 2.12 Age-appropriate breastfeeding Percentage of children age 0-23 months appropriately fed during the previous day 57.1 2.13 Introduction of solid, semi-solid or soft foods Percentage of infants age 6-8 months who received solid, semi-solid or soft foods during the previous day 87.3 2.14 Milk feeding frequency for non-breastfed children Percentage of non-breastfed children age 6-23 months who received at least 2 milk feedings during the previous day 11.3 2.15 Minimum meal frequency Percentage of children age 6-23 months who received solid, semi-solid and soft foods (plus milk feeds for non- breastfed children) the minimum number of times or more during the previous day 59.1 2.16 Minimum dietary diversity Percentage of children age 6–23 months who received foods from 4 or more food groups during the previous day 28.0 2.17a 2.17b Minimum acceptable diet (a) Percentage of breastfed children age 6–23 months who had at least the minimum dietary diversity and the minimum meal frequency during the previous day (b) Percentage of non-breastfed children age 6–23 months who received at least 2 milk feedings and had at least the minimum dietary diversity not including milk feeds and the minimum meal frequency during the previous day 17.3 4.6 2.18 Bottle feeding Percentage of children age 0-23 months who were fed with a bottle during the previous day 10.3 Salt iodisation 2.19 Iodised salt consumption Percentage of households with salt testing 15 parts per million or more of iodide/iodate 54.5 Low-birth weight 2.20 Low-birth weight infants Percentage of most recent live births in the last 2 years weighing below 2 500 grams at birth 10.1 2.21 Infants weighed at birth Percentage of most recent live births in the last 2 years who were weighed at birth 83.0 Vitamin A supplementation 2.S2 Vitamin A Supplementation Percentage of children age 6-59 months who received at least one high dose Vitamin A supplement in the last 6 months 32.3 CHILD HEALTH Vaccinations MICS Indicator Indicator Description Value 3.1 Tuberculosis immunisation coverage Percentage of children age 12-23 months who received BCG vaccine by their first birthday 92.4 3.2 Polio immunisation coverage Percentage of children age 12-23 months who received the third dose of OPV vaccine (OPV3) by their first birthday 84.9 3.S1 Diphtheria, pertussis and tetanus (DPT) immunisation coverage Percentage of children age 12-23 months who received the third dose of DPT vaccine (DPT3) by their first birthday 85.4 P a g e | vi 3.4 MDG 4.3 Measles immunisation coverage Percentage of children age 12-23 months who received measles vaccine by their first birthday 82.6 3.5 Hepatitis B immunisation coverage Percentage of children age 12-23 months who received the third dose of Hepatitis B vaccine (HepB3) by their first birthday 85.4 3.6 Haemophilus influenzae type B (Hib) immunisation coverage Percentage of children age 12-23 months who received the third dose of Hib vaccine (Hib3) by their first birthday 85.4 3.8 Full immunisation coverage Percentage of children age 12-23 months who received all vaccinations recommended in the national immunisation schedule by their first birthday. 69.2 Tetanus toxoid 3.9 Neonatal tetanus protection Percentage of women age 15-49 years with a live birth in the last 2 years who were given at least two doses of tetanus toxoid vaccine within the appropriate interval prior to the most recent birth 63.5 Diarrhoea - Children with diarrhoea Percentage of children under age 5 with diarrhoea in the last 2 weeks 15.5 3.10 Care-seeking for diarrhoea Percentage of children under age 5 with diarrhoea in the last 2 weeks for whom advice or treatment was sought from a health facility or provider 44.3 3.11 Diarrhoea treatment with oral rehydration salts (ORS) and zinc Percentage of children under age 5 with diarrhoea in the last 2 weeks who received ORS and zinc 13.8 3.12 Diarrhoea treatment with oral rehydration therapy (ORT) and continued feeding Percentage of children under age 5 with diarrhoea in the last 2 weeks who received ORT (ORS packet, pre-packaged ORS fluid, recommended homemade fluid or increased fluids) and continued feeding during the episode of diarrhoea 56.4 Acute Respiratory Infection (ARI) symptoms - Children with ARI symptoms Percentage of children under age 5 with ARI symptoms in the last 2 weeks 5.3 3.13 Care-seeking for children with ARI symptoms Percentage of children under age 5 with ARI symptoms in the last 2 weeks for whom advice or treatment was sought from a health facility or provider 58.6 3.14 Antibiotic treatment for children with ARI symptoms Percentage of children under age 5 with ARI symptoms in the last 2 weeks who received antibiotics 34.3 Solid fuel use 3.15 Use of solid fuels for cooking Percentage of household members in households that use solid fuels as the primary source of domestic energy to cook 73.9 Malaria / Fever MICS Indicator Indicator Description Value - Children with fever Percentage of children under age 5 with fever in the last 2 weeks 27.1 3.16a 3.16b Household availability of insecticide-treated nets (ITNs) Percentage of households with (a) at least one ITN (b) at least one ITN for every two people 42.2 20.9 3.17a 3.17b Household vector control Percentage of households (a) with at least one ITN or that have been sprayed by IRS in the last 12 months (b) with at least one ITN for every two people or that have been sprayed by IRS in the last 12 months 47.6 34.0 3.18 MDG 6.7 Children under age 5 who slept under an ITN Percentage of children under age 5 who slept under an ITN the previous night 26.8 P a g e | vii 3.19 Population that slept under an ITN Percentage of household members who slept under an ITN the previous night 23.2 3.20 Care-seeking for fever Percentage of children under age 5 with fever in the last 2 weeks for whom advice or treatment was sought from a health facility or provider 47.1 3.21 Malaria diagnostics usage Percentage of children under age 5 with fever in the last 2 weeks who had a finger or heel stick for malaria testing 14.1 3.22 MDG 6.8 Anti-malarial treatment of children under age 5 Percentage of children under age 5 with fever in the last 2 weeks who received any antimalarial treatment 3.0 3.23 Treatment with Artemisinin-based Combination Therapy (ACT) among children who received anti- malarial treatment Percentage of children under age 5 with fever in the last 2 weeks who received ACT (or other first-line treatment according to national policy) 78.8 3.24 Pregnant women who slept under an ITN Percentage of pregnant women who slept under an ITN the previous night 26.3 3.25 Intermittent preventive treatment for malaria during pregnancy Percentage of women age 15-49 years who received three or more doses of SP/Fansidar, at least one of which was received during an ANC visit, to prevent malaria during their last pregnancy that led to a live birth in the last 2 years 6.4 WATER AND SANITATION MICS Indicator Indicator Description Value 4.1 MDG 7.8 Use of improved drinking water sources Percentage of household members using improved sources of drinking water 76.1 4.2 Water treatment Percentage of household members in households using unimproved drinking water who use an appropriate treatment method 16.4 4.3 MDG 7.9 Use of improved sanitation Percentage of household members using improved sanitation facilities which are not shared 35.0 4.4 Safe disposal of child’s faeces Percentage of children age 0-2 years whose last stools were disposed of safely 57.8 4.5 Place for handwashing Percentage of households with a specific place for hand washing where water and soap or other cleansing agent are present 10.3 4.6 Availability of soap or other cleansing agent Percentage of households with soap or other cleansing agent 55.8 REPRODUCTIVE HEALTH Contraception and unmet need MICS Indicator Indicator Description Value - Total fertility rate Total fertility rate for women age 15-49 years 4.3 5.1 MDG 5.4 Adolescent birth rate Age-specific fertility rate for women age 15-19 years 120 5.2 Early childbearing Percentage of women age 20-24 years who had at least one live birth before age 18 22.4 5.3 MDG 5.3 Contraceptive prevalence rate Percentage of women age 15-49 years currently married or in union who are using (or whose partner is using) a (modern or traditional) contraceptive method 67.0 5.4 MDG 5.6 Unmet need Percentage of women age 15-49 years who are 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 10.4 P a g e | viii Maternal and newborn health 5.5a 5.5b MDG 5.5 MDG 5.5 Antenatal care coverage Percentage of women age 15-49 years with a live birth in the last 2 years who were attended during their last pregnancy that led to a live birth (a) at least once by skilled health personnel (b) at least four times by any provider 93.7 70.1 5.6 Content of antenatal care Percentage of women age 15-49 years with a live birth in the last 2 years who had their blood pressure measured and gave urine and blood samples during the last pregnancy that led to a live birth 51.8 5.S1 Iron supplementation Percentage of women age 15-49 years with a live birth in the last 2 years who received iron supplements 83.5 5.S2 Folate supplementation Percentage of women age 15-49 years with a live birth in the last 2 years who received folate supplement 66.9 5.7 MDG 5.2 Skilled attendant at delivery Percentage of women age 15-49 years with a live birth in the last 2 years who were attended by skilled health personnel during their most recent live birth 80.0 5.8 Institutional deliveries Percentage of women age 15-49 years with a live birth in the last 2 years whose most recent live birth was delivered in a health facility 79.6 5.9 Caesarean section Percentage of women age 15-49 years whose most recent live birth in the last 2 years was delivered by caesarean section 6.0 Post-natal health checks 5.10 Post-partum stay in health facility Percentage of women age 15-49 years who stayed in the health facility for 12 hours or more after the delivery of their most recent live birth in the last 2 years 83.5 5.11 Post-natal health check for the newborn Percentage of last live births in the last 2 years who received a health check while in facility or at home following delivery, or a post-natal care visit within 2 days after delivery 85.0 5.12 Post-natal health check for the mother Percentage of women age 15-49 years who received a health check while in facility or at home following delivery, or a post-natal care visit within 2 days after delivery of their most recent live birth in the last 2 years 77.3 Maternal mortality 5.13 MDG 5.1 Maternal mortality ratio Deaths during pregnancy, childbirth, or within two months after delivery or termination of pregnancy, per 100 000 live births within the 7-year period preceding the survey 614 CHILD DEVELOPMENT MICS Indicator Indicator Description Value 6.1 Attendance to early childhood education Percentage of children age 36-59 months who are attending an early childhood education programme 21.6 6.2 Support for learning Percentage of children age 36-59 months with whom an adult has engaged in four or more activities to promote learning and school readiness in the last 3 days 43.1 6.3 Father’s support for learning Percentage of children age 36-59 months whose biological father has engaged in four or more activities to promote learning and school readiness in the last 3 days 2.6 6.4 Mother’s support for learning Percentage of children age 36-59 months whose biological mother has engaged in four or more activities to promote learning and school readiness in the last 3 days 17.3 6.5 Availability of children’s books Percentage of children under age 5 who have three or more children’s books 3.4 6.6 Availability of playthings Percentage of children under age 5 who play with two or more types of playthings 62.3 P a g e | ix CHILD DEVELOPMENT MICS Indicator Indicator Description Value 6.7 Inadequate care Percentage of children under age 5 left alone or in the care of another child younger than 10 years of age for more than one hour at least once in the last week 18.5 6.8 Early child development index Percentage of children age 36-59 months who are developmentally on track in at least three of the following four domains: literacy-numeracy, physical, social- emotional, and learning 61.8 LITERACY AND EDUCATION MICS Indicator Indicator Description Value 7.1 MDG 2.3 Literacy rate among young people Percentage of young people age 15-24 years who are able to read a short simple statement about everyday life or who attended secondary or higher education (a) women (b) men 92.0 86.1 7.2 School readiness Percentage of children in first grade of primary school who attended pre-school during the previous school year 86.2 7.3 Net intake rate in primary education Percentage of children of school-entry age who enter the first grade of primary school 73.3 7.4 MDG 2.1 Primary school net attendance ratio (adjusted) Percentage of children of primary school age currently attending primary or secondary school 93.3 7.5 Secondary school net attendance ratio (adjusted) Percentage of children of secondary school age currently attending secondary school or higher 47.7 7.6 MDG 2.2 Children reaching last grade of primary Percentage of children entering the first grade of primary school who eventually reach last grade 90.7 7.7 Primary completion rate Number of children attending the 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) 98.9 7.8 Transition rate to secondary school Number of children attending 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 number of children attending the last grade of primary school during the previous school year 78.9 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 1.01 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 1.17 CHILD PROTECTION Birth registration MICS Indicator Indicator Description Value 8.1 Birth registration Percentage of children under age 5 whose births are reported registered 32.3 P a g e | x Child discipline 8.3 Violent discipline Percentage of children age 1-14 years who experienced psychological aggression or physical punishment during the last one month 62.6 Early marriage and polygyny 8.4 Marriage before age 15 Percentage of people age 15-49 years who were first married or in union before age 15 (a) Women (b) Men 4.9 0.3 8.5 Marriage before age 18 Percentage of people age 20-49 years who were first married or in union before age 18 (a) Women (b) Men 32.8 3.7 8.6 Young people age 15-19 years currently married or in union Percentage of young people age 15-19 years who are married or in union (a) Women (b) Men 24.5 1.7 8.7 Polygyny Percentage of people age 15-49 years who are in a polygynous union (a) Women (b) Men 10.1 3.8 8.8a 8.8b Spousal age difference Percentage of young women who are married or in union and whose spouse is 10 or more years older, (a) among women age 15-19 years, (b) among women age 20-24 years 19.9 17.5 Attitudes Towards Domestic Violence 8.12 Attitudes towards domestic violence Percentage of people age 15-49 years who state that a husband/partner 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 (a) Women (b) Men 37.4 23.7 Children’s living arrangements 8.13 Children’s living arrangements Percentage of children age 0-17 years living with neither biological parent 26.6 8.14 Prevalence of children with one or both parents dead Percentage of children age 0-17 years with one or both biological parents dead 17.9 8.15 Children with at least one parent living abroad Percentage of children 0-17 years with at least one biological parent living abroad 10.6 HIV/AIDS AND SEXUAL BEHAVIOUR HIV/AIDS knowledge and attitudes MICS Indicator Indicator Description Value - Have heard of AIDS Percentage of people age 15-49 years who have heard of AIDS (a) Women (b) Men 99.4 98.8 P a g e | xi 9.1 MDG 6.3 Knowledge about HIV prevention among young people Percentage of young people age 15-24 years who correctly identify ways of preventing the sexual transmission of HIV, and who reject major misconceptions about HIV transmission (a) Women (b) Men 56.4 51.7 9.2 Knowledge of mother-to- child transmission of HIV Percentage of people age 15-49 years who correctly identify all three means of mother-to-child transmission of HIV (a) Women (b) Men 63.4 51.6 9.3 Accepting attitudes towards people living with HIV Percentage of people age 15-49 years expressing accepting attitudes on all four questions toward people living with HIV (a) Women (b) Men 43.2 43.8 HIV testing 9.4 People who know where to be tested for HIV Percentage of people age 15-49 years who state knowledge of a place to be tested for HIV (a) Women (b) Men 95.2 93.5 9.5 People who have been tested for HIV and know the results Percentage of people age 15-49 years who have been tested for HIV in the last 12 months and who know their results (a) Women (b) Men 50.6 40.3 9.6 Sexually active young people who have been tested for HIV and know the results Percentage of young people age 15-24 years who have had sex in the last 12 months, who have been tested for HIV in the last 12 months and who know their results (a) Women (b) Men 84.5 58.9 9.7 HIV counselling during antenatal care Percentage of women age 15-49 years who had a live birth in the last 2 years and received antenatal care during the pregnancy of their most recent birth, reporting that they received counselling on HIV during antenatal care 77.7 9.8 HIV testing during antenatal care Percentage of women age 15-49 years who had a live birth in the last 2 years and received antenatal care during the pregnancy of their most recent birth, reporting that they were offered and accepted an HIV test during antenatal care and received their results 89.3 Sexual behaviour 9.9 Young people who have never had sex Percentage of never married young people age 15-24 years who have never had sex (a) Women (b) Men 78.0 61.9 9.10 Sex before age 15 among young people Percentage of young people age 15-24 years who had sexual intercourse before age 15 (a) Women (b) Men 4.1 3.9 9.11 Age-mixing among sexual partners Percentage of women age 15-24 years who had sex in the last 12 months with a partner who was 10 or more years older 17.9 9.12 Multiple sexual partnerships Percentage of people age 15-49 years who had sexual intercourse with more than one partner in the last 12 months (a) Women (b) Men 1.2 10.6 P a g e | xii 9.13 Condom use at last sex among people with multiple sexual partnerships Percentage of people age 15-49 years who report having had more than one sexual partner in the last 12 months who also reported that a condom was used the last time they had sex (a) Women (b) Men 49.1 43.1 9.14 Sex with non-regular partners Percentage of sexually active young people age 15-24 years who had sex with a non-marital, non-cohabitating partner in the last 12 months (a) Women (b) Men 11.8 28.8 9.15 MDG 6.2 Condom use with non- regular partners Percentage of young people age 15-24 years reporting the use of a condom during the last sexual intercourse with a non-marital, non-cohabiting sex partner in the last 12 months (a) Women (b) Men 57.6 74.9 Orphans 9.16 MDG 6.4 Ratio of school attendance of orphans to school attendance of non-orphans Proportion attending school among children age 10-14 years who have lost both parents divided by proportion attending school among children age 10-14 years whose parents are alive and who are living with one or both parents 0.94 Male circumcision 9.17 Male circumcision Percentage of men age 15-49 years who report having been circumcised 11.2 ACCESS TO MASS MEDIA AND ICT Access to mass media MICS Indicator Indicator Description Value 10.1 Exposure to mass media Percentage of people age 15-49 years who, at least once a week, read a newspaper or magazine, listen to the radio, and watch television (a) Women (b) Men 8.0 15.0 Use of information and communication technology 10.2 Use of computers Percentage of young people age 15-24 years who used a computer during the last 12 months (a) Women (b) Men 18.0 24.0 10.S1 Use of computers Percentage of adults who used a computer during the last 12 months (a) Women age 15-49 years (b) Men age 15-54 years 13.9 22.2 10.S2 Use of mobile or non- mobile phones Percentage of young people age 15-24 years who used a mobile or non-mobile phone during the last 12 months (a) Young women (b) Young men 85.2 85.6 10.S3 Use of mobile or non- mobile phones Percentage of adults who used a mobile or non-mobile phone during the last 12 months (a) Women age 15-49 years (b) Men age 15-54 years 88.6 90.3 10.3 Use of internet Percentage of young people age 15-24 years who used the internet during the last 12 months (a) Women (b) Men 21.6 30.8 P a g e | xiii 10.S4 Use of internet Percentage of adults who used the internet during the last 12 months (a) Women age 15-49 years (b) Men age 15-54 years 19.1 30.3 TOBACCO AND ALCOHOL USE Tobacco use MICS Indicator Indicator Description Value 12.1 Tobacco use Percentage of people age 15-49 years who smoked cigarettes, or used smoked or smokeless tobacco products at any time during the last one month (a) Women (b) Men 0.7 19.4 12.2 Smoking before age 15 Percentage of people age 15-49 years who smoked a whole cigarette before age 15 (a) Women (b) Men 0.1 1.9 Alcohol use 12.3 Use of alcohol Percentage of people age 15-49 years who had at least one alcoholic drink at any time during the last one month (a) Women (b) Men 2.0 29.6 12.4 Use of alcohol before age 15 Percentage of people age 15-49 years who had at least one alcoholic drink before age 15 (a) Women (b) Men 0.5 2.8 P a g e | xiv Table of Contents   Summary  Table  of  Survey  Implementation  and  the  Survey  Population,  Zimbabwe  MICS,  2014  .  iii   Summary  Table  of  Findings  .  iv   Table  of  Contents  .  xiv   List  of  Tables  .  xvii   List  of  Figures  .  xxi   List  of  Abbreviations  and  Acronyms  .  xxii   Acknowledgements/Preface  .  xxiv   Executive  Summary  .  xxvi   1     Introduction  .  1   1.1  Background  .  1   1.2  Survey  Objectives  .  2   2   Sample  and  Survey  Methodology  .  3   2.1  Sample  Design  .  3   2.2  Questionnaires  .  3   2.3  Pre-­‐test  .  4   2.4  Training  and  Fieldwork  .  4   2.5  Data  Processing  .  5   2.6  Quality  Control  .  5   2.7  Quality  Assurance  .  5   3   Sample  Coverage  and  the  Characteristics  of  Households  and  Respondents  .  7   3.1  Sample  Coverage  .  7   3.2  Characteristics  of  Households  .  9   3.3  Characteristics  of  Female  Respondents  (15-­‐49)  and  Male  Respondents  (15-­‐54)  Years  of  Age  and     Children  Under-­‐5  .  12   3.4  Housing  Characteristics,  Asset  Ownership  and  Wealth  Quintiles  .  17   4   Child  Mortality  .  24   4.1  Early  Childhood  mortality  rates  .  24   4.2  Early  childhood  mortality  rates  by  background  characteristics  .  26   4.3  Early  childhood  mortality  rates  by  demographic  characteristics  .  29   5   Nutrition  .  31   5.1  Low  Birth  Weight  .  31   P  a  g  e  |  xv 5.2  Nutritional  Status  .  33   5.3  Breastfeeding  and  Infant  and  Young  Child  Feeding  .  38   5.4  Salt  Iodisation  .  53   5.5  Children’s  Vitamin  A  Supplementation  .  54   5.6  Oedema  Prevalence  .  57   6   Child  Health  .  59   6.1  Vaccinations  .  59   6.2  Neonatal  Tetanus  Protection  .  64   6.3  Care  of  Illness  .  66   6.3.1  Diarrhoea  .  68   6.3.2  Acute  Respiratory  Infections  (ARI)  .  81 6.3.3  Solid  Fuel  Use  .  85   6.3.4  Malaria/Fever  .  89   7     Water  and  Sanitation  .  111   7.1  Use  of  Improved  Water  Sources  .  111   7.2  Use  of  Improved  Sanitation  .  121   7.3  Handwashing  .  133   8   Reproductive  Health  .  139   8.1  Fertility  .  139   8.2  Contraception  .  145   8.3  Unmet  Need  .  148   8.4  Antenatal  Care  (ANC)  .  152   8.5  Assistance  at  Delivery  .  160   8.6  Place  of  Delivery  .  163   8.7  Post-­‐natal  Health  Checks  .  165   8.8  Adult  Mortality  Rates  .  178   8.9  Maternal  Mortality  .  179   9   Early  Childhood  Development  .  182   9.1  Early  Childhood  Care  and  Education  .  182   9.2  Quality  of  Care  .  184   9.3  Developmental  Status  of  Children  .  191   10   Literacy  and  Education  .  193   10.1  Literacy  among  Young  Women  and  Men  .  193   10.2  School  Readiness  .  196   10.3  Primary  and  Secondary  School  Participation  .  197   P  a  g  e  |  xvi 11   Child  Protection  .  214   11.1  Birth  Registration  .  214   11.2  Child  Discipline  .  218   11.3  Early  Marriage  and  Polygyny  .  223   11.4  Attitudes  towards  Domestic  Violence  .  236   11.5  Children’s  Living  Arrangements  and  Orphanhood  Status  .  240   12   HIV  and  AIDS  and  Sexual  Behaviour  .  244   12.1  Knowledge  about  HIV  Transmission  and  Misconceptions  about  HIV  .  245   12.2  Knowledge  of  mother-­‐to-­‐child  HIV  transmission  (MTCT)  .  251   12.3  Accepting  Attitudes  toward  People  Living  with  HIV  .  255   12.4  Knowledge  of  a  Place  for  HIV  Testing,  Counselling  and  Testing  during  Antenatal  Care  (ANC)  .  258   12.5  Sexual  Behaviour  Related  to  HIV  Transmission  .  264   12.6  HIV  Indicators  for  Young  Women  and  Young  Men  .  268   12.7  Orphans  .  278   12.8  Male  circumcision  .  279   13     Access  to  Mass  Media  and  Use  of  Information  and  Communication  Technology  .  286   13.1  Access  to  Mass  Media  .  286   13.2  Use  of  Information  and  Communication  Technology  .  290   14   Tobacco  and  Alcohol  Use  .  299   14.1  Tobacco  Use  .  299   14.2  Alcohol  Use  .  306   Appendix  A.            Documents  Reviewed  .  310   Appendix  B.              Tables  with  MICS  Indicators  .  .315   Appendix  C.   Sample  Design  .  333   Appendix  D.   List  of  Personnel  Involved  in  the  Survey  .  338   Appendix  E.   Estimates  of  Sampling  Errors  .  348   Appendix  F.   Data  Quality  Tables  .  364   Appendix  G.   Zimbabwe  MICS5  Indicators:  Numerators  and  Denominators  .  392   Appendix  H.              Birth  Registration  .  404   Appendix  I.                  The  Wealth  Index  .  407   Appendix  J.    Zimbabwe  MICS  Questionnaires  .  408             P  a  g  e  |  xvii List  of  Tables     Table  HH.1:   Results  of  household,  women's,  men's  and  under-­‐5  interviews  .  8   Table  HH.2:   Household  age  distribution  by  sex  .  9   Table  HH.3:   Household  composition  .  11   Table  HH.4:   Women's  background  characteristics  .  13   Table  HH.4M:   Men's  background  characteristics  .  15   Table  HH.5:   Under-­‐5's  background  characteristics  .  16   Table  HH.6:   Housing  characteristics  .  18   Table  HH.7:   Household  and  personal  assets  .  21   Table  HH.8:   Wealth  quintiles  .  23     Table  CM.1:   Early  childhood  mortality  rates  .  25   Table  CM.2:   Early  childhood  mortality  rates  by  socioeconomic  characteristics  .  27   Table  CM.3:   Early  childhood  mortality  rates  by  demographic  characteristics  .  29     Table  NU.1:   Low  birth  weight  infants  .  32   Table  NU.2:   Nutritional  status  of  children  .  35   Table  NU.3:   Initial  breastfeeding  .  40   Table  NU.4:   Breastfeeding  .  44   Table  NU.5:   Duration  of  breastfeeding  .  46   Table  NU.6:   Age-­‐appropriate  breastfeeding  .  47   Table  NU.7:   Introduction  of  solid,  semi-­‐solid,  or  soft  foods  .  48   Table  NU.8:   Infant  and  young  child  feeding  (IYCF)  practices  .  49   Table  NU.9:   Bottle  feeding  .  52   Table  NU.10:   Iodised  salt  consumption  .  53   Table  NU.11:   Children’s  Vitamin  A  supplementation  .  56   Table  NU.12:   Oedema  prevalence  .  58     Table  CH.1:   Vaccinations  in  the  first  years  of  life  .  61   Table  CH.2:   Vaccinations  by  background  characteristics  .  63   Table  CH.3:   Neonatal  tetanus  protection  .  65   Table  CH.4:   Reported  disease  episodes  .  67   Table  CH.5:   Care-­‐seeking  during  diarrhoea  .  69   Table  CH.6:   Feeding  practices  during  diarrhoea  .  71   Table  CH.7:   Oral  rehydration  solutions,  recommended  homemade  fluids,  and  zinc  .  74   Table  CH.8:   Oral  rehydration  therapy  with  continued  feeding  and  other  treatments  .  76   Table  CH.9:   Source  of  ORS  and  zinc  .  79   Table  CH.10:   Care-­‐seeking  for  and  antibiotic  treatment  of  symptoms  of  acute  respiratory  infection  (ARI)  ………………82   Table  CH.11:   Knowledge  of  the  two  danger  signs  of  pneumonia  .  84   Table  CH.12:   Solid  fuel  use  .  86   Table  CH.13:   Solid  fuel  use  by  place  of  cooking  .  88   Table  CH.14:   Household  availability  of  insecticide  treated  nets  and  protection  by  a  vector  control  method  .  90   Table  CH.15:   Access  to  an  insecticide  treated  net  (ITN)  -­‐  number  of  household  members  .  91   Table  CH.16:   Access  to  an  insecticide  treated  net  (ITN)  -­‐  background  characteristics  .  92   Table  CH.17:   Use  of  ITNs  .  94   Table  CH.18:   Children  sleeping  under  mosquito  nets  .  95   Table  CH.19:   Use  of  mosquito  nets  by  the  household  population  .  97   Table  CH.20:   Care-­‐seeking  during  fever  .  99   Table  CH.21:   Treatment  of  children  with  fever  .  101   Table  CH.22:   Diagnostics  and  anti-­‐malarial  treatment  of  children  .  103   Table  CH.22A:   Diagnostics  and  anti-­‐malarial  treatment  of  children  .  105   Table  CH.23:   Source  of  anti-­‐malarial  .  107   Table  CH.24:   Pregnant  women  sleeping  under  mosquito  nets  .  109   Table  CH.25:     Intermittent  preventive  treatment  for  malaria  .  110   P  a  g  e  |  xviii   Table  WS.1:   Use  of  improved  water  sources  .  113   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  .  125   Table  WS.7:   Drinking  water  and  sanitation  ladders  .  129   Table  WS.8:   Disposal  of  child's  faeces  .  131   Table  WS.9:   Water  and  soap  at  place  for  handwashing  .  134   Table  WS.10:   Availability  of  soap  or  other  cleansing  agent  .  137     Table  RH.1:   Fertility  rates  .  140   Table  RH.2:   Adolescent  birth  rate  and  total  fertility  rate  .  142   Table  RH.3:   Early  childbearing  .  143   Table  RH.4:   Trends  in  early  childbearing  .  144   Table  RH.5:   Use  of  contraception  .  146   Table  RH.6:   Unmet  need  for  contraception  .  151   Table  RH.7:   Antenatal  care  coverage  .  153   Table  RH.8:   Number  of  antenatal  care  visits  and  timing  of  first  visit  .  155   Table  RH.9:   Content  of  antenatal  care  .  158   Table  RH.9A:   Iron  and  folic  acid  supplementation  .  159   Table  RH.10:   Assistance  during  delivery  and  caesarean  section  .  161   Table  RH.11:   Place  of  delivery  .  164   Table  RH.12:   Post-­‐partum  stay  in  health  facility  .  166   Table  RH.13:   Post-­‐natal  health  checks  for  newborns  .  168   Table  RH.14:   Post-­‐natal  care  visits  for  newborns  within  one  week  of  birth  .  170   Table  RH.15:   Post-­‐natal  health  checks  for  mothers  .  172   Table  RH.16:   Post-­‐natal  care  visits  for  mothers  within  one  week  of  birth  .  174   Table  RH.17:   Post-­‐natal  health  checks  for  mothers  and  newborns  .  177   Table  RH.18:   Adult  mortality  rates  .  178   Table  RH.19:   Adult  mortality  probabilities  .  179   Table  RH.20A:   Maternal  mortality  .  180   Table  RH.20B:   Maternal  mortality  .  181     Table  CD.1:   Early  childhood  education  .  183   Table  CD.2:   Support  for  learning  .  185   Table  CD.3:   Learning  materials  .  188   Table  CD.4:   Inadequate  care  .  190   Table  CD.5:   Early  child  development  index  .  192     Table  ED.1:   Literacy  (young  women)  .  194   Table  ED.1M:   Literacy  (young  men)  .  195   Table  ED.2:   School  readiness  .  197   Table  ED.3:   Primary  school  entry  .  199   Table  ED.4:   Primary  school  attendance  and  out  of  school  children  .  201   Table  ED.5:   Secondary  school  attendance  and  out  of  school  children  .  204   Table  ED.6:   Children  reaching  last  grade  of  primary  school  .  207   Table  ED.7:   Primary  school  completion  and  transition  to  secondary  school  .  209   Table  ED.8:   Education  gender  parity  .  211   Table  ED.9:   Out  of  school  gender  parity  .  212     Table  CP.1:   Birth  registration  .  216   Table  CP.5:   Child  discipline  .  220   Table  CP.6:   Attitudes  toward  physical  punishment  .  222   Table  CP.7:   Early  marriage  and  polygyny  (women)  .  225   Table  CP.7M:   Early  marriage  and  polygyny  (men)  .  228   P  a  g  e  |  xix Table  CP.8:   Trends  in  early  marriage  (women)  .  231   Table  CP.8M:   Trends  in  early  marriage  (men)  .  232   Table  CP.9:   Spousal  age  difference  .  234   Table  CP.13:   Attitudes  toward  domestic  violence  (women)  .  237   Table  CP.13M:   Attitudes  toward  domestic  violence  (men)  .  239   Table  CP.14:   Children's  living  arrangements  and  orphanhood  .  241   Table  CP.15:   Children  with  parents  living  abroad  .  243     Table  HA.1:   Knowledge  about  HIV  transmission,  misconceptions  about  HIV,  and  comprehensive   knowledge  about  HIV  transmission  (women)  .  246   Table  HA.1M:   Knowledge  about  HIV  transmission,  misconceptions  about  HIV,  and  comprehensive   knowledge  about  HIV  transmission  (men)  .  249   Table  HA.2:   Knowledge  of  mother-­‐to-­‐child  HIV  transmission  (women)  .  253   Table  HA.2M:   Knowledge  of  mother-­‐to-­‐child  HIV  transmission  (men)  .  254   Table  HA.3:   Accepting  attitudes  toward  people  living  with  HIV  (women)  .  256   Table  HA.3M:   Accepting  attitudes  toward  people  living  with  HIV  (men)  .  257   Table  HA.4:   Knowledge  of  a  place  for  HIV  testing  (women)  .  259   Table  HA.4M:   Knowledge  of  a  place  for  HIV  testing  (men)  .  261   Table  HA.5:   HIV  counselling  and  testing  during  antenatal  care  .  263   Table  HA.6:   Sex  with  multiple  partners  (women)  .  265   Table  HA.6M:   Sex  with  multiple  partners  (men)  .  267   Table  HA.7:   Key  HIV  and  AIDS  indicators  (young  women)  .  269   Table  HA.7M:   Key  HIV  and  AIDS  indicators  (young  men)  .  271   Table  HA.8:   Key  sexual  behaviour  indicators  (young  women)  .  274   Table  HA.8M:   Key  sexual  behaviour  indicators  (young  men)  .  276   Table  HA.9:   School  attendance  of  orphans  and  non-­‐orphans  .  279   Table  HA.10:   Male  circumcision  .  281   Table  HA.11:   Provider  and  location  of  circumcision  .  284     Table  MT.1:   Exposure  to  mass  media  (women)  .  287   Table  MT.1M:   Exposure  to  mass  media  (men)  .  289   Table  MT.2:   Use  of  computer,  internet  and  mobile  or  non-­‐mobile  phone  (young  women)  .  291   Table  MT.2A:   Use  of  computer,  internet  and  mobile  or  non-­‐mobile  phone  (women)  .  293   Table  MT.2M:   Use  of  computer,  internet  and  mobile  or  non-­‐mobile  phone  (young  men)  .  295   Table  MT.2MA:  Use  of  computer,  internet  and  mobile  or  non-­‐mobile  phone  (men)  .  297     Table  TA.1:   Current  and  ever  use  of  tobacco  (women)  .  300   Table  TA.1M:   Current  and  ever  use  of  tobacco  (men)  .  302   Table  TA.2:   Age  at  first  use  of  cigarettes  and  frequency  of  use  (women)  .  304   Table  TA.2M:   Age  at  first  use  of  cigarettes  and  frequency  of  use  (men)  .  305   Table  TA.3:   Use  of  alcohol  (women)  .  307   Table  TA.3M:   Use  of  alcohol  (men)  .  309     Appendices:     Table  ED.5:     Secondary  school  attendance  and  out  of  school  children  .  315   Table  ED.8:     Education  gender  parity  .  317   Table  ED.9:     Out  of  school  gender  parity  .  318     Table  CP.7M:     Early  marriage  and  polygyny  (men)  .  319     Table  HA.1M:   Knowledge  about  HIV  transmission,  misconceptions  about  HIV,  and  comprehensive   knowledge  about  HIV  transmission  (men)  .  320   Table  HA.2M:   Knowledge  of  mother-­‐to-­‐child  HIV  transmission  (men)  .  322   Table  HA.3M:     Accepting  attitudes  toward  people  living  with  HIV  (men)  .  323   Table  HA.4M:     Knowledge  of  a  place  for  HIV  testing  (men)  .  324   P  a  g  e  |  xx Table  HA.6M:     Sex  with  multiple  partners  (men)  .  326   Table  HA.10:     Male  circumcision  .  327     Table  MT.1M:     Exposure  to  mass  media  (men)  .  329     Table  TA.1M:     Current  and  ever  use  of  tobacco  (men)  .  330   Table  TA.2M:     Age  at  first  use  of  cigarettes  and  frequency  of  use  (men)  .  331   Table  TA.3M:     Use  of  alcohol  (men)  .  332     Table  SD.1:     Allocation  of  Sample  Clusters  (Primary  Sampling  Units)  to  Sampling  Strata  .  334     Table  SE.1:   Indicators  selected  for  sampling  error  calculations  .  350   Table  SE.2:     Sampling  errors:  Total  sample  .  351   Table  SE.3:     Sampling  errors:  Urban  .  352   Table  SE.4:     Sampling  errors:  Rural  .  353   Table  SE.5:     Sampling  errors:  Manicaland  .  354   Table  SE.6:     Sampling  errors:  Mashonaland  Central  .  355   Table  SE.7:     Sampling  errors:  Mashonaland  East  .  356   Table  SE.8:     Sampling  errors:  Mashonaland  West  .  357   Table  SE.9:     Sampling  errors:  Matabeleland  North  .  358   Table  SE.10:     Sampling  errors:  Matabeleland  South  .  359   Table  SE.11:     Sampling  errors:  Midlands  .  360   Table  SE.12:     Sampling  errors:  Masvingo  .  361   Table  SE.13:     Sampling  errors:  Harare  .  362   Table  SE.14:     Sampling  errors:  Bulawayo  .  363     Table  DQ.1:   Age  distribution  of  household  population  .  364   Table  DQ.2:   Age  distribution  of  eligible  and  interviewed  women  .  366   Table  DQ.3:   Age  distribution  of  eligible  and  interviewed  men  .  367   Table  DQ.4:   Age  distribution  of  children  in  household  and  under-­‐5  questionnaires  .  368   Table  DQ.5:   Birth  date  reporting:  Household  population  .  369   Table  DQ.6:   Birth  date  and  age  reporting:  Women  .  370   Table  DQ.7:   Birth  date  and  age  reporting:  Men  .  371   Table  DQ.8:   Birth  date  and  age  reporting:  Under-­‐5s  .  372   Table  DQ.9:   Birth  date  reporting:  Children,  adolescents  and  young  people  .  373   Table  DQ.10:   Birth  date  reporting:  First  and  last  births  .  374   Table  DQ.11:   Completeness  of  reporting  .  375   Table  DQ.12:   Completeness  of  information  for  anthropometric  indicators:  Underweight  .  376   Table  DQ.13:   Completeness  of  information  for  anthropometric  indicators:  Stunting  .  376   Table  DQ.14:   Completeness  of  information  for  anthropometric  indicators:  Wasting  .  377   Table  DQ.15:   Heaping  in  anthropometric  measurements  .  377   Table  DQ  16:   Observation  of  birth  certificates  .  379   Table  DQ.17:   Observation  of  vaccination  cards  .  380   Table  DQ.18:   Observation  of  women's  health  cards  .  381   Table  DQ.19:   Observation  of  bednets  and  places  for  handwashing  .  382   Table  DQ.20:   Presence  of  mother  in  the  household  and  the  person  interviewed  for  the  under-­‐5   questionnaire  .  383   Table  DQ.21:   Selection  of  children  age  1-­‐17  years  for  the  child  labour  and  child  discipline  modules  .  384   Table  DQ.22:   School  attendance  by  single  age  .  385   Table  DQ.23:   Sex  ratio  at  birth  among  children  ever  born  and  living  .  386   Table  DQ.24:   Births  in  years  preceding  the  survey  .  387   Table  DQ.25:   Reporting  of  age  at  death  in  days  .  388   Table  DQ.26:   Reporting  of  age  at  death  in  months  .  389   Table  DQ.27:   Completeness  of  information  on  siblings  .  390   Table  DQ.28:   Sibship  size  and  sex  ratio  of  siblings  .  391 P  a  g  e  |  xxi List  of  Figures     Figure  HH.1:   Age  and  sex  distribution  of  household  population  .  10     Figure  CM.1:   Early  childhood  mortality  rates  .  26   Figure  CM.2:   Under-­‐5  mortality  rates  by  area  and  province  .  28   Figure  CM.3:   Trend  in  under-­‐5  mortality  rates    .  30     Figure  NU.1:     Underweight,  stunted,  wasted  and  overweight  children  under  age  5  (moderate  and     severe)……………………………………………………………………………………………………………………….……….38   Figure  NU.2:     Initiation  of  breastfeeding    .  42   Figure  NU.3:     Infant  feeding  patterns  by  age  .  45   Figure  NU.4:     Consumption  of  iodised  salt  .  54     Figure  CH.1:     Vaccinations  by  age  12  months  (measles  by  24  months)  .  62   Figure  CH.2:     Children  under-­‐5  with  diarrhoea  who  received  ORS  or  recommended  homemade  liquids  .  75   Figure  CH.3:     Children  under-­‐5  with  diarrhoea  receiving  oral  rehydration  therapy  (ORT)  and  continued  feeding  .  78   Figure  CH.4:     Percentage  of  household  population  with  access  to  an  ITN  in  the  household  .  93     Figure  WS.1:     Percent  distribution  of  household  members  by  source  of  drinking  water  .  115   Figure  WS.2:     Percent  distribution  of  household  members  by  use  and  sharing  of  sanitation  facilities  .  127   Figure  WS.3:     Use  of  improved  drinking  water  sources  and  improved  sanitation  facilities  by  household  members    .  130     Figure  RH.1:     Age-­‐specific  fertility  rates  by  area  .  141   Figure  RH.2:     Differentials  in  contraceptive  use  .  148   Figure  RH.3:     Person  assisting  at  delivery  .  163     Figure  ED.1:     Education  indicators  by  sex  .  213     Figure  CP.1:     Children  under-­‐5  whose  births  are  registered  .  217   Figure  CP.2:     Child  disciplining  methods,  children  age  1-­‐14  years  .  221   Figure  CP.3:     Early  marriage  among  women  .  233     Figure  HA.1:     Women  and  men  with  comprehensive  knowledge  of  HIV  transmission  .  251   Figure  HA.2:     Accepting  attitudes  toward  people  living  with  HIV/AIDS  .  258   Figure  HA.3:     Sexual  behaviour  that  increases  the  risk  of  HIV  infection,  young  people  age  15-­‐24  .  278     Figure  TA.1:     Ever  and  current  smokers  .  304     Appendix:     Figure  DQ.1:   Number  of  household  population  by  single  ages  .  365   Figure  DQ.2:     Weight  and  height/length  measurements  by  digits  reported  for  the  decimal  points  .  378     P a g e | xxii List of Abbreviations and Acronyms ACT Artemisinin-based Combination Therapy AIDS Acquired Immune Deficiency Syndrome ANC Antenatal Care ARI Acute Respiratory Infection ART Antiretroviral treatment ASFR Age Specific Fertility Rate BCG Bacillus Calmette–Guérin CBR Crude Birth Rate CDC Centers for Disease Control and Prevention CEDAW Convention on the Elimination of all forms of Discrimination against Women CMR Child Mortality Rate CPF Child Protection Fund CRC Convention on the Rights of the Child CSPro Census and Survey Processing System DFID Department for International Development DK Don’t know DPT Diphtheria, Pertussis Tetanus DQ Data Quality EA Enumeration Area EC European Council ECD Early Childhood Development ECDI Early Child Development Index ETF Education Transition Fund EPI Expanded Programme on Immunisation EU European Union FCTC Framework Convention on Tobacco Control GAPPD The Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea GARPR Global AIDS Response Progress Reporting GFR General Fertility Rate GMAP The Global Malaria Action Plan GoZ Government of Zimbabwe GPI Gender Parity Index GVAP Global Vaccine Action Plan HH Household HIV Human Immunodeficiency Virus HTF Health Transition Fund ICT Information and Communication Technology ICPD International Conference on Population and Development IMR Infant Mortality Rate IRS Indoor Residual Spraying ITNs Insecticide Treated Nets IUCD Intrauterine Contraceptive Device IYCF Infant and Young Child Feeding practices JMP Joint Monitoring Programme LAM Lactational Amenorrhea Method LLIN Long Lasting Insecticidal Treated Nets Mash Central Mashonaland Central Mash East Mashonaland East Mash West Mashonaland West Mat North Matabeleland North Mat South Matabeleland South MC Male Circumcision P a g e | xxiii MDGs Millennium Development Goals MICS Multiple Indicator Cluster Survey MICS5 Fifth global round of Multiple Indicator Cluster Surveys programme MIMS Multiple Indicator Monitoring Survey MMR Maternal Mortality Ratio MMRate Maternal Mortality Rate MoHCC Ministry of Health and Child Care MTCT Mother to Child Transmission MTP Medium Term Plan NA Not applicable NAR Net Attendance Rate OPV Oral Polio Vaccine ORS Oral Rehydration Solution ORT Oral Rehydration Treatment PLHIV People Living with HIV PMTCT Prevention of Mother to Child Transmission POA Programme of Action PNC Postnatal Care PNHC Postnatal Health Checks PPM Parts Per Million PPS Probability Proportional to Size PSUs Primary Sampling Units RHF Recommended Home Fluid SD Standard Deviation SMT Survey Management Team SP Sulfadoxine-Pyrimethamine SPSS Statistical Package for Social Sciences SRHR Sexual Reproductive Health and Rights SSS Sugar and Salt Solution STERP II Short Term Emergency Recovery Programme II STI Sexually Transmitted Infection TFR Total Fertility Rate UNICEF United Nations Children’s Fund UNDP United Nations Development Programme UNGASS United Nations General Assembly Special Session on HIV and AIDS UNFPA United Nations Population Fund UNAIDS the Joint United Nations Programme on HIV/AIDS USAID United States Agency for International Development VMMC Voluntary Medical Male Circumcision WASH Water, Sanitation and Hygiene WB World Bank WHO World Health Organisation ZimASSET Zimbabwe Agenda for Sustainable Socio-Economic Transformation ZDHS Zimbabwe Demographic and Health Survey ZEPI Zimbabwe Expanded Programme on Immunisation ZIMSTAT Zimbabwe National Statistics Agency ZMS12 Zimbabwe Master Sample 2012 ZNASP II Zimbabwe National HIV/AIDS Strategic Plan II ZNFPC Zimbabwe National Family Planning Council ZRP Zimbabwe Republic Police ZUNDAF Zimbabwe United Nations Development Assistance Framework P a g e | xxiv Acknowledgements/Preface The first Zimbabwe Multiple Indicator Cluster Survey (MICS), following the Multiple Indicator Monitoring Survey (MIMS) which was a customised version, was conducted in 2014. The MICS was designed to collect information on a variety of socioeconomic and health indicators required to inform the planning, implementation and monitoring of national policies and programmes for the enhancement of the welfare of women and children. The MICS plays a critical role in informing national policies such as the Zimbabwe Agenda for Sustainable Socio-Economic Transformation (ZimASSET) October 2013 to December 2018. The Zimbabwe National Statistics Agency (ZIMSTAT) wishes to express sincere gratitude to the various institutions and individuals who worked tirelessly to make the survey a success. Their commitment and dedication to duty was above the norm and worth ZIMSTAT’s profound gratitude. The survey was made possible through financial and technical support from the United Nations Children’s Fund (UNICEF), the European Union (EU), the United Nations Population Fund (UNFPA), the United Nations Development Fund (UNDP), the United States Agency for International Development (USAID) and Maternal and Child Health Integrated Programme (MCHIP). In addition, the expertise contributed by various consultants (global, regional and national) in the areas of sampling, training, fieldwork, data processing and report writing, timely coverage from the media, and input from various stakeholders who participated in MICS workshops cannot be overemphasized. This survey would not have been possible without the unwavering commitment of the Survey Management Team (SMT), field and data entry personnel, and patience and cooperation of respondents. ZIMSTAT would like to acknowledge the following institutions who were members of the MICS Steering and Technical Committees for their invaluable contributions towards the accomplishment of the survey:  Ministry of Finance and Economic Development;  Ministry of Health and Child Care;  Ministry of Primary and Secondary Education;  Ministry of Public Service, Labour and Social Welfare;  Ministry of Environment, Water and Climate;  Ministry of Information, Media and Broadcasting Services;  Ministry of Women’s Affairs, Gender and Community Development;  Ministry of Local Government, Public Works and National Housing;  Ministry of Justice, Legal and Parliamentary Affairs;  Ministry of Information Communication Technology, Postal and Courier Services;  Office of the President and Cabinet;  National AIDS Council (NAC);  Registrar General’s Department;  Zimbabwe Republic Police (ZRP) Victim Friendly Unit;  the Harare City Health Department; P a g e | xxv  United Nations Development Fund (UNDP);  World Health Organisation (WHO);  the Joint United Nations Programme on HIV and AIDS (UNAIDS);  the United Nations Population Fund (UNFPA);  European Commission (EC);  United States Aid for International Development (USAID);  Centres for Disease Control and Prevention (CDC);  the World Bank (WB); and  the Department for International Development (DFID). M. Dzinotizei Director-General, ZIMSTAT P a g e | xxvi Executive Summary This Final Report is based on the findings of the Zimbabwe Multiple Indicator Cluster Survey (MICS), conducted between February and April in 2014 by the Zimbabwe National Statistics Agency (ZIMSTAT). Technical and financial support for the survey was coordinated by the United Nations Children’s Fund (UNICEF). The Zimbabwe MICS is a nationally representative survey of 17 047 households, comprising 14 408 women in the 15-49 years age group, 7 914 men age 15-54 years and 10 223 children under 5 years of age. The sample allows for the estimation of some key indicators at the national, provincial and urban/rural levels. The MICS is designed to provide statistically sound and internationally comparable data essential for developing evidence-based policies and programmes and for monitoring progress towards 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 (UNGASS), the Education for All Declaration (EFA) and the Millennium Development Goals (MDGs). The Zimbabwe MICS 2014 results are critical for final MDG reporting in 2015, and are expected to form part of the baseline data for the post-2015 era. This Final Report covers the following areas: sample and survey methodology, sample coverage and the characteristics of households and respondents, child mortality, child nutrition, child health, water and sanitation, reproductive health, early childhood development, literacy and education, child protection, HIV and sexual behaviour, mass media and information and communication technology, and tobacco and alcohol use. CHILD MORTALITY In the five years preceding the survey (2010-2014), Zimbabwe had neonatal, infant and under 5 mortality rates of 29, 55 and 75 per 1 000 live births, respectively, with males having higher rates than females. Variations in neonatal, infant and under 5 mortality were notable by province and by mother’s level of education, and decreased with increasing levels of education of the mother. For under-5 mortality, rural areas recorded more deaths per 1 000 live births compared to urban areas and was highest in poorest households compared to those from the richest households. Comparing the MICS findings on under 5 mortality rates with those from the MIMS 2009, ZDHS 2010/11 and the MICS 2014, the results showed stagnation in under 5 mortality rates over the years. CHILD NUTRITION The World Health Organisation (WHO) standards were used in estimating child nutrition. In Zimbabwe, 11.2 percent of children under 5 years of age were moderately underweight and 2.2 percent were severely underweight while more than a quarter of children (27.6 percent) were moderately stunted or too short for their age and 3.3 percent were moderately wasted or too thin for their height. About 3.6 percent of the children were moderately overweight or too heavy for their height. Children in Matabeleland South Province were more likely to be underweight (13.9 percent) and wasted (3.9 percent) than children in other provinces while stunting (34.0 percent) was highest in Manicaland P a g e | xxvii Province. The results show that the percentage of stunted and underweight children was higher in rural compared to urban areas. Those children whose mothers had secondary or higher education were the least likely to be underweight and stunted compared to children born of mothers with no education. The prevalence of overweight among children tended to increase as the mother’s level of education increased. Boys appeared to be slightly more likely to be underweight, stunted, and wasted than girls. Breastfeeding is near universal in Zimbabwe with 98.1 percent of children ever breastfed. Although a very important step in management of lactation and establishment of a physical and emotional relationship between the baby and the mother, only 58.9 percent of babies were breastfed for the first time within one hour of birth, while 92.2 percent of newborn babies in Zimbabwe started breastfeeding within one day of birth. Only 6.8 percent of children received prelacteal feed. The Government of Zimbabwe promotes exclusive breastfeeding for all infants less than 6 months old. The MICS results showed that 41.0 percent of infants less than 6 months were exclusively breastfed, with infants in urban areas more likely to be exclusively breastfed than those in rural areas. Although none of the provinces is yet to reach the national target (90 percent), Matabeleland North and Matabeleland South provinces had the highest percentages of exclusively breastfed infants, 58.6 and 57.3, respectively, whilst Mashonaland West Province had the lowest (29.6 percent). Eighty-four percent of children age 12-15 months were still breastfeeding while 17.1 percent of children age 20- 23 months were still breastfeeding. Overall, 64.4 percent of infants age 0-5 months were predominantly breastfed. CHILD HEALTH Zimbabwe has been implementing an immunisation programme under the Zimbabwe Expanded Programme of Immunisation (ZEPI) since 1982. The MICS results indicated that, overall, 80.3 percent of children age 12-23 months were fully vaccinated against vaccine preventable childhood diseases, while 87.6 percent were vaccinated for measles. Full vaccination was higher for urban areas than for rural areas, for children of mothers with secondary or higher education than for those with no education or primary education and for children from households in the richest wealth quintiles than those from the poorest. The proportion of children age 12-23 with full immunisation varied by province, with the lowest in Masvingo Province (65.2 percent) and the highest recorded for Matabeleland North Province (86.9 percent). For individual vaccinations, immunisation was high with 92.4 percent of children age 12-23 months having received a BCG vaccination and 93.7 percent having received the first dose of Pentavalent (DTP- HepB-Hib) vaccine by the age of 12 months. The percentage declined to 91 percent for the second dose of Pentavalent vaccine and 85.4 percent for the third dose. Similarly, 94.2 percent of children received Polio 1 vaccine by age 12 months and this declined to 84.9 percent by the third dose. The coverage for measles vaccine by 12 months was 82.6 percent. The percentage of children age 12-23 months who had been fully vaccinated by their first birthday was 69.2 percent while that of age 24-35 months was 54.4 percent. At national level, 15.5 percent of children under 5 years of age were reported to have had diarrhoea in the two weeks preceding the survey of whom 44.3 percent visited a health facility or a health P a g e | xxviii provider for treatment. The proportion that was seen in a health facility or provider was lowest in Matabeleland South Province (31.5 percent), the highest was recorded in Mashonaland Central Province (60.6 percent) and 45.5 percent were in rural areas while 40.4 percent were in urban areas. About 43 percent of the children with diarrhoea in the two weeks preceding the survey received fluids from Oral Rehydration Salts (ORS) packets or pre-packaged ORS fluids and 56.7 percent received Sugar and Salt Solution (SSS). The percentage of children age 0-59 months for whom the mother/primary caregiver reported symptoms of Acute Respiratory Infection (ARI) in the last two weeks preceding the survey was 5.3 percent. Fifty-nine percent of children age 0-59 months with symptoms of ARI were taken to a health facility or provider and 34.3 percent received antibiotics. The percentage was 48.5 percent in urban areas and 31.0 percent in rural areas. The use of antibiotics was highest for children age 12-23 months (42.6 percent) compared to other age groups. Overall, 73.9 percent of the household population in Zimbabwe used solid fuels for cooking, mainly wood (73.4 percent). Use of solid fuels was high in rural areas (95.7 percent) but low in urban areas (17.1 percent). It declined with education of head of household from 95.8 percent for those with no education to 25.1 percent for those with higher education. The survey sought information on the availability and use of bed nets, indoor residual spraying in the last 12 months at household level, care seeking behaviour for children under 5 and Intermittent Preventive Treatment (IPTp) for pregnant women. The results indicated that 53.7 percent of households had at least one mosquito net (any type), 42.2 percent had at least one Insecticide-Treated Mosquito Net (ITN) and 40.4 percent had at least one Long-Lasting Insecticidal Treated Net (LLIN). Further, 23.2 percent of households received indoor residual spraying during the last 12 months, and 34.0 percent had at least one ITN for every two household members and/or received IRS during the last 12 months. WATER AND SANITATION The Zimbabwe MICS 2014 indicated that 76.1 percent of the population was using an improved source of drinking water (98.4 percent in urban areas and 67.5 percent in rural areas). Harare and Bulawayo Provinces (the major cities) were at 97.2 percent and 98.9 percent, respectively. Of the predominantly rural provinces, Masvingo Province had the least percentage (64.3) of the household population using improved drinking water sources. The source of drinking water for the population varied by province. Use of Piped water2 as a source of drinking water in Harare Province was 29.0 percent as compared to 98.1 percent in Bulawayo. In Harare, 68.7 percent of the population used water from a tubewell/borehole, protected well, protected spring, rainwater collection or bottled water while the corresponding proportion is only 1.3 percent in Bulawayo. In the predominantly rural provinces, Mashonaland West and Midlands Provinces, 27.3 percent and 27.7 percent, respectively, use piped water. At the other end of the scale, 13.5 percent of those residing in Masvingo Province and 12.1 percent of those in Mashonaland East Province used piped water. 2 Piped water refers to various sources, including piped water into dwelling, backyard, neighbours house or public stand pipe. P a g e | xxix Households were asked of the methods they were using for treating water at home to make it safer to drink. The main methods of water treatment were boiling (6 percent), bleaching/chlorination (4.8 percent) and use of water treatment tablets (4.6 percent). Overall, 31.7 percent of the population had access/lived in households that had access to improved drinking water sources on the premises. In urban areas, 76.4 percent of the population had access to improved drinking water sources that were on premises compared to 14.6 percent in rural areas. A quarter of the population (24.9 percent) lived in households that took less than 30 minutes to fetch water from an improved water source while 19 percent spent 30 minutes or more per roundtrip. The percentage of households/population living in households that spent 30 minutes or more when fetching drinking water was highest in Matabeleland North Province (32.1 percent), Masvingo Province (27.5 percent) and Matabeleland South Province (25.9 percent). In 80 percent of the households, an adult woman was the person who usually fetched drinking water, when the source was not on the premises. About 62 percent of the population of Zimbabwe was living in households using improved sanitation facilities. Use of improved sanitation facilities was almost universal in urban areas (98.9 percent) compared to 56.5 percent in rural areas. Overall, 29.7 percent of households used improved water sources and improved sanitation. A higher proportion of the population in urban areas had access to both improved water sources and improved sanitation (46.9 percent) compared to 23.1 percent in rural areas. In Zimbabwe, a specific place for handwashing was observed for 19.9 percent of the households. The majority of households (78.4 percent) practice ‘run to waste’, hence, a specific place of handwashing was not observed. The percentage of households with a specific place for handwashing where water and soap or other cleansing agents were present was 10.3 percent. Of these, the highest proportions of households with a designated place for handwashing where water and soap or other cleansing agents were present were observed in Bulawayo Province (41.0 percent), Midlands (19.5 percent) and Harare Province (17.2 percent). It was higher in urban areas (27.9 percent) compared to rural areas (2.6 percent) and increased with an increase in socio-economic status of the household and the level of education of the head of the household. REPRODUCTIVE HEALTH The Total Fertility Rate (TFR) for Zimbabwe for the three years preceding the MICS was 4.3 births per woman. Fertility was considerably higher in rural areas (4.8 births per woman) than in urban areas (3.4 births per woman). Adolescent birth rate was 120 births per 1 000 women. About 24 percent of women age 15-19 years had begun child bearing and 0.6 percent had had a live birth before age 15. More women age 15-19 years in rural areas (28.7 percent) had begun child bearing than their peers in urban areas (14.2 percent). Of the predominantly rural provinces, Mashonaland Central had the highest proportion of women 15-19 years who had begun child bearing (29.2 percent) and this was lowest in Masvingo Province (22.3 percent). Current use of contraception was reported by 67 percent of women currently married or in union of whom 66.5 percent used any modern methods. The most commonly used method was the pill (43.9 P a g e | xxx percent), followed by injectables, which accounted for 9 percent. About 8 percent of married women reported using implants and 3.3 percent were using the male condom. Thirty-three percent of married women were not using any form of contraception. The unmet need for contraception in Zimbabwe was 10.4 percent. The unmet need for contraception ranged from 8.6 percent in Mashonaland East Province to 17.9 percent in Matabeleland South Province. Unmet need declined with level of education of the woman from 21.4 percent for those with no education to 6.5 percent for those with higher levels of education. It also declined with higher socio-economic status as it was 13.9 percent for women in poorest households compared to 9.2 percent for those in the richest households. The proportion of women who had had a birth in the two years preceding the survey and received ANC from any skilled provider was 93.7 percent. Among these, a majority of women (80.1 percent) received ANC from a nurse/midwife. Seventy percent of the mothers received ANC at least four times as recommended and 31.2 percent of the women had their first ANC visit during the first trimester of their last pregnancy. Among the women who had had a live birth during the two years preceding the survey, 92.3 percent reported that a blood sample was taken during ANC visits, 89.4 percent had their blood pressure measured and 52.9 percent reported that a urine specimen was taken at least once during the ANC visits. About 80 percent of women who delivered in the two years preceding the survey were assisted by a skilled attendant. Delivery by a skilled attendant varied by urban (92.9 percent) and rural (74.6 percent) areas. Overall, 83.5 percent of women who gave birth in a health facility stayed 12 hours or more in the facility after delivery and 77 percent spent at least a day. Across the country, the percentage of women who stayed 12 hours or more varied from 67.5 percent in Mashonaland Central Province to 95 percent in Matabeleland North Province. A much higher proportion (92.6 percent) of women who had delivered in a private facility stayed 12 hours or more compared to those who delivered in a public facility (81.6 percent). Overall mortality rates for adults aged 15-49 years were estimated at 9.8 per 1 000 population for either sex. There were 149 maternal deaths in the seven years preceding the survey. During the last seven years, roughly between 2007 and 2014, the maternal mortality rate, which is the annual number of maternal deaths per 1 000 women age 15-49, was 0.86. Maternal deaths accounted for 9.2 percent of all deaths among women age 15-49 years. For any given age group, maternal deaths are a relatively rare occurrence, and as such the age-specific pattern should be interpreted with caution. EARLY CHILDHOOD DEVELOPMENT About 22 percent of children age 36-59 months were attending an organised early childhood education programme. The proportion of children age 36-59 months attending an organised early childhood education programme was 26.2 percent in urban areas compared to 20.1 percent in rural areas. Among children age 36-59 months, attendance in early childhood education programmes was highest in Manicaland Province at 26.5 percent and lowest in Midlands Province (14 percent). Sex differentials were minimal (male 20.1 percent and female 23.1 percent). P a g e | xxxi The proportion of children age 36-59 months with whom an adult household member engaged in four or more activities that promote learning and school readiness during the 3 days preceding the survey was 43.1. The mean number of activities that adults engaged with children was 3. In Zimbabwe, 3.4 percent of children under 5 years of age lived in households where at least 3 children’s books were present for the child. And 62.3 percent of children under 5 years of age played with two or more types of playthings. In Zimbabwe, 61.8 percent of children age 36-59 months were developmentally on track. Early Child Development Index (ECDI) was higher among girls (64.3 percent) than boys (59.2 percent). The index was higher in the 48-59 months age group (67.2 percent) compared to the 36-47 months age group (57.1 percent). Higher ECDI was observed in children attending an early childhood education programme at 71.1 percent compared to 59.3 percent among those who were not attending. LITERACY AND EDUCATION Ninety-two percent of young women and 86 percent of young men and 15-24 were literate. Of women who stated that primary school was their highest level of education 62.8 percent were able to read in full the statement shown to them, compared to only 49.1 percent of men. Pre-school education is important for the readiness of children to school. Overall, 86.2 percent of children who were currently attending the first grade of primary school were attending pre-school the previous year. The proportion of children who attended pre-school the previous year currently attending first grade of primary school increased with the education status of the mother. The proportion was 80.6 percent for children with mothers with no education, while it was 90.8 percent for mothers with higher education. The highest percentage of children attending first grade who had attended pre-school the previous year were in the Manicaland and Midlands provinces (about 89 percent) while the least was in Bulawayo Province (76.1 percent). Socio-economic status suggests a positive relationship with school readiness. While the indicator was 86.7 percent among the poorest households, it increased to 90 percent among those children living in the richest households. Of the children who were of the official primary school entry age, 73.3 percent were in the first grade of primary school. The percentage of children of primary school entry age entering grade 1 increased with an increase in mother’s education and socioeconomic status; for the proportion of children age 6 years whose mothers had at least secondary school education was 82.2 percent. In richest households, the proportion was 86.8 percent while it was 65.8 percent among children living in the poorest households. The majority of children of primary school age were attending school (93.7 percent). Attendance ratio was above 90 percent for both boys and girls by different background characteristics. About seven percent of primary age children were out of school, including both children who were not attending any type of school AND those who were attending pre-school. Only 3.2 percent of primary age children were out of school (not attending any type of school). Almost 55 percent of children of lower secondary school age were attending lower secondary school or higher education and 24.3 percent were attending primary school. One out of five children of lower secondary school age were out of school. The net attendance ratio for girls of 59.6 percent was higher P a g e | xxxii than that for boys 50.5 percent while the proportion out of school was higher for boys (21.0 percent) than for girls (20.1 percent). Of all children starting grade one, 90.7 percent will reach grade 7. Girls were more likely to reach grade 7 than boys. The proportion of girls entering grade 1 who eventually reach grade 7 was 91.8 percent, compared to 89.6 percent for boys. The primary school completion rate was 98.9 percent (99.5 percent for boys and 98.4 percent for girls) with a transition rate of 78.9 percent from primary to secondary school. The GPI (Gender Parity Index) for primary school was 1.01, indicating no differences in the attendance of girls and boys. The GPI for secondary school was 1.18, suggesting girls were attending secondary school at a higher rate than boys. CHILD PROTECTION The MICS indicated that the births of 32.3 percent of children under 5 years of age in Zimbabwe have been registered. Of these, 18.9 percent possessed birth certificates as seen by the interviewer, 10.1 percent were said to be in possession but were not seen by the interviewer whilst 3.4 percent did not have birth certificates but were said to be registered with the Registrar’s Office. Birth registration increased from 21.9 percent at 0-11 months to 38.8 percent at 48-59 months. Urban areas had a higher percentage (57.2 percent) of under-5s who had registered births than rural areas (23.4 percent). Children in Mashonaland West Province (22.4 percent) recorded the lowest percentage in birth registration. Harare (54.9 percent) and Bulawayo (56.5 percent) provinces had the highest proportion of children under 5 years of age whose births were registered. Birth registration increased with household wealth with the poorest household showing the lowest registration (17.3 percent) compared to the richest at 68.0 percent. In the MICS, respondents to the household questionnaire were asked a series of questions on the methods adults in the household used to discipline a selected child in the month preceding the survey. The three disciplinary methods assessed were non-violent discipline, psychological aggression, and physical punishment. About 63 percent of children age 1-14 years were subjected to a violent discipline method, 53.3 percent were subjected to psychological aggression and 4.7 percent experienced severe physical punishment. Children between 3 and 9 years were more likely to be subjected to one form or other of violent discipline, psychological aggression, severe physical punishment or any physical punishment than the other age groups. Among women age 15-49 years, about one in twenty (5 percent) were married before age 15 and among women age 20-49 years, about one in three (32.8 percent) were married before age 18. About one in four women age 15-19 years were currently married. For men age 15-54 years, 0.3 percent were married before age 15 and 3.9 percent of men 20-54 years were married before age 18 while 1.7 percent of men age 15-19 years were currently married or in union. Polygyny (the practice of having more than one wife) has implications for the frequency of exposure to sexual activity, therefore, fertility. The percentage of women age 15-49 years who were in a polygynous marriage/union was 10.1 percent while the percentage was 4.1 percent for men age 15-54 years. The proportion of men and women in polygynous marriages or unions decreased with education and household wealth. P a g e | xxxiii The survey assessed the attitudes of women age 15-49 years and men age 15-54 years towards wife beating by asking the respondents whether husbands were justified to hit or beat their wives in each of the following situations: If she goes out without telling him; neglects the children; argues with him; refuses to have sex with him; burns the food; and commits infidelity. In Zimbabwe, 37.4 percent of women and 23.7 percent of men felt that a husband/partner was justified in hitting or beating his wife in at least one of the five situations (excluding infidelity). Of all six reasons provided, the highest proportion of women (43.2 percent) and men (24.6 percent) believed that a partner was justified in beating his wife if she committed infidelity. Convergence of views towards domestic violence was observed between men and women according to some background characteristics. The proportions of respondents who felt that it was justifiable to hit or beat a wife in any of the five reasons (excluding infidelity) and those respondents who felt likewise if a woman committed infidelity were highest for men and women who were residing in rural areas, who were younger, had attained primary education and those who had never been married nor in union. The MICS results showed that 26.6 percent of children under age 18 lived with neither biological parent. The older the child the more likely they were to live with neither biological parent. Twenty- nine percent of children in rural areas lived with neither biological parent compared to 19.3 percent in urban areas. Eighteen percent of the children had one or both parents deceased. About 3 percent of children age 0-17 years had both parents living abroad whilst 10.6 percent had at least one parent living abroad. HIV AND AIDS AND SEXUAL BEHAVIOUR Nearly all the women age 15-49 years and men age 15-54 years had heard about human immuno- deficiency virus and the acquired immuno-deficiency syndrome (HIV and AIDS) at 99.4 percent and 98.8 percent, respectively. Overall, 62.5 percent of women and 59.5 percent of men had comprehensive knowledge of HIV. Among young women and men age 15-24 years, this proportion was 56.4 percent and 51.7 percent, respectively. Knowledge of HIV prevention and transmission was higher amongst women age 15-49 years in urban areas compared to their rural counterparts. Comprehensive knowledge was least in Matabeleland South Province (55.6 percent) and highest in Bulawayo Province 67.9 percent. Results suggest that there is a correlation between age and HIV knowledge as older women were more likely to know about HIV than younger women. Knowledge increased with woman’s education and household wealth quintile. Knowledge of HIV prevention and transmission was higher amongst men in urban areas (68.9 percent) compared to their rural counterparts (55.0 percent), increased with increasing age, education and household wealth quintiles. This pattern is similar to that of women. Comprehensive knowledge was least in Matabeleland South Province (45.1 percent) and highest in Bulawayo Province at 67.6 percent. The MICS assessed knowledge of Mother-To-Child-Transmission (MTCT) of HIV where respondents were asked whether HIV can be transmitted from a mother to child during pregnancy, during delivery and through breastfeeding. Nationally, 96.8 percent of women knew that HIV can be transmitted from mother to child. However, the percentage of women who knew all three means of HIV transmission from mother to child was 63.4 percent and 52.0 percent for men. MTCT knowledge for both men and women generally increased with age and levels of education. P a g e | xxxiv The indicators on attitudes towards people living with HIV measure stigma and discrimination in the community. Stigma and discrimination are considered low if respondents report an accepting attitude on the following four situations: 1) would care for a family member with AIDS in own home; 2) would buy fresh vegetables from a vendor who is HIV-positive; 3) thinks that a female teacher who is HIV- positive should be allowed to teach in school; and 4) would not want to keep it a secret if a family member is HIV-positive. In Zimbabwe, 99.6 percent of women and 99.7 percent of men who have heard of AIDS agreed with at least one accepting statement. The most common accepting attitude for both women and men was willingness to care for a family member with AIDS in respondent’s house (97.1 percent and 96.4 percent, respectively). On willingness to care for a family member with AIDS in respondent’s house, the highest proportion for women (98.5 percent) was in Masvingo Province while that for men (98.8 percent) was in Mashonaland Central Province. About 95 percent of women age 15-49 years and 94.0 percent of men age 15-54 years knew of a place to get tested. Knowledge of a place to get tested for both men and women was universal across all provinces, by age groups, sexual activity, level of education and household wealth. The proportion of the women age 15-49 years who were tested in the last twelve months preceding the survey and knew the results was 50.6 percent while the proportion for men age 15-54 years was 40.5 percent. For both women and men, Midlands Province had the least proportions tested in the last twelve months preceding the survey and knew their HIV result. The percentage of pregnant women age 15-49 years who had given birth two years preceding the survey and had received HIV counselling and testing during ANC was 77.7 percent. More women in urban areas (83.4 percent) compared to those in rural areas (75.4 percent) were counselled. Matabeleland North Province had the highest proportion of women who had received HIV counselling during ANC (87.8 percent) and Mashonaland West Province had the least (67.2 percent). The proportion also increased with education level of the pregnant women (66.2 percent for those with no education and 85.2 percent for those with higher education) and with wealth quintile. About 89 percent of all women who attended ANC were offered an HIV test, got tested and received their results. Results on sexual behaviour of young women age 15 to 24 years indicated that 4.1 percent of young women had sex before the age of 15 years, 58.7 percent had ever had sex and 1.3 percent had had sex with more than one sexual partner in the last 12 months preceding the survey. Amongst young women who had had sex, 17.9 percent had sex with a man 10 or more years older and 11.8 percent had it with a non-marital/non-cohabiting partner. For young men, 3.9 percent had sex before the age of 15 years, 46 percent had ever had sex and 8.3 percent had had sex with more than one sexual partner in the last 12 months preceding the survey. Eleven percent of men age 15-54 were circumcised. Men were most likely to be circumcised between ages 15 and 19 years (34.2 percent), 18.3 percent were circumcised between ages 10 and 14 years whilst 16.4 percent were circumcised when they were 25 years or older. P a g e | xxxv MEDIA AND INFORMATION AND COMMUNICATION TECHNOLOGY The proportion of women age 15-49 years who read a newspaper or magazine, listened to the radio or watched television at least once a week was eight percent and 15 percent for men age 15-54 years. For both women and men, exposure to the three types of media increased with an increase in education and household wealth quintile. Urban provinces (Harare and Bulawayo) recorded high exposure compared to predominantly rural provinces. Radio was the most common medium that the majority of both women and men were exposed to with about 44.5 percent of women and 57.5 percent of men listening to a radio at least once a week. Twenty-six percent of women age 15-24 years had ever used a computer, 18 percent had used a computer during the last year and 10 percent had used one at least once a week during the last month. Overall, 23.3 percent of women age 15-24 years had ever used the internet, while 21.6 percent had used it during the last year. The proportion of young women who had used the internet more frequently, at least once a week during the last month, was smaller, at 15.8 percent. Both computer and internet use during the last 12 months was more prevalent among women age 15-19 years. Use of a computer and the internet was strongly associated with area, education and wealth. The proportion of women who had ever used a mobile or non-mobile phone was 88.5 percent while use in the last twelve months was 85.2 percent and those who had used a mobile or non-mobile phone at least once a week during the last one month was 71.2 percent. Urban areas had higher use than rural areas, while a greater proportion of young women with higher education had used the mobile or non- mobile phones more than those with lower or no education. Twenty-four percent of young men age 15-24 years had used a computer during the last 12 months preceding the survey. Young men in urban areas were more likely to have used a computer than their counterparts in the rural areas (68.7 percent and 16.6 percent, respectively). Three-quarters of young men in the richest quintile had ever used a computer compared with one in twenty in the lowest wealth quintile. The proportion of young men who had used the internet during the reference period was 30.8 percent. Sixty-nine percent and 16.6 percent of young men in urban and rural areas, respectively, had used the internet during the last 12 months preceding the survey and the percentage increased with an increase in household wealth. TOBACCO AND ALCOHOL USE The proportion of women age 15-49 years who used any tobacco product in the month preceding the survey was 0.7 percent while it was 20.3 percent for men age 15-54 years. Tobacco use decreased with an increase in men’s education and generally with household wealth. Sixty-two percent of men had never smoked cigarettes or used other tobacco products. Among the 15-19 years age group, 89.4 percent had never smoked cigarettes or used other tobacco products. A majority of women (88.8 percent) had never had an alcoholic drink in their life, less than one percent had at least one before age 15 and two percent had at least one anytime during the last month prior to the survey. Women residing in urban areas, with higher levels of education and from the richest wealth quintile were more likely to have had at least one alcoholic drink at any time during the one month prior to the survey. Forty-four percent of men age 15-54 years had never had an alcoholic drink P a g e | xxxvi in their life and 29.6 percent had at least one alcoholic drink at any time during one month prior to the survey and 2.8 percent had at least one alcoholic drink before age 15. 1 1 Introduction This chapter covers the background to and the objectives of the Zimbabwe Multiple Indicator Cluster Survey (MICS) 2014. It also gives a brief background on the socio-economic status of the country and the strategies and plans put in place by the Government of Zimbabwe (GoZ) to improve the well-being of the population, especially women and children. 1.1 Background This report is based on the Zimbabwe Multiple Indicator Cluster Survey (MICS), conducted in 2014 by the Zimbabwe National Statistics Agency (ZIMSTAT). The survey is designed to provide statistically sound and internationally comparable data essential for developing evidence-based policies and programmes and for monitoring progress towards 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). There is evidence of growing confidence and improvement in the economy over the last few years. The Gross Domestic Product3 grew at 11 percent and five percent in 2012 and 2013, respectively. Despite promising developments in the country’s economic sphere, there are challenges that still remain to achieve sufficient recovery to enable effective rehabilitation of social and health services that had been undermined by years of economic decline and stagnation. One of the major concerns that the country is facing is the issue of low levels of formal employment (11 percent4) which adversely affect the capacity of most households and individuals to afford basic commodities including health care services. This does not only directly impact on individuals but it also shrinks the tax base for Government. According to the Poverty and Poverty Datum Line Analysis in Zimbabwe 2011/12, 62.6 percent of households were deemed poor whilst 16.2 percent were in extreme poverty (ZIMSTAT, 2013). In 2010, the GoZ launched the Three Year Rolling Macroeconomic and Budget Framework, 2010-12 also referred to as the Short Term Economic Recovery Programme II (STERP II), and began implementation of a five-year strategic development plan, the Zimbabwe 2011-2015 Medium Term Plan (MTP) aimed at stimulating sustainable economic recovery and growth. To guide national development for the period 2013 to 2018, the GoZ developed a new economic blue print, the Zimbabwe Agenda for Sustainable Socio-Economic Transformation (ZimASSET). The economic blueprint “was crafted to achieve sustainable development and social equity anchored on indigenization, empowerment and employment creation which will be largely propelled by the judicious exploitation of the country’s abundant human and natural resources. The four strategic clusters identified under ZimASSET are: Food Security and Nutrition; Social Services and Poverty Eradication; Infrastructure and Utilities; and Value Addition and Beneficiation” (GoZ, 2013). 3 ZIMSTAT. 2014. Quarterly Digest of Statistics 3rd Quarter 2014 4 2011 Labour Force Survey Report, ZIMSTAT 2012. 2 In such a transitional environment of socio-economic recovery towards sustained growth and development, it is critical that policy, planning and programming be informed by recent and comprehensive studies such as the MICS. The Zimbabwe MICS 2014 results are critical for final MDG reporting in 2015 and are expected to form part of the baseline data for the post-2015 era. The survey results are expected to contribute to the evidence base of several other important initiatives, including Committing to Child Survival: A Promise Renewed 20125. This Final Report, produced following the publication of the Key Findings Report in August 2014, consists of 14 chapters as follows: Chapter 1 which is an introductory note to the report; Chapter 2 on sample and survey methodology; Chapter 3 on sample coverage and the characteristics of households and respondents; Chapter 4 covers child mortality; Chapter 5 dwells on child nutrition; Chapter 6 discusses child health; Chapter 7 focuses on water and sanitation; Chapter 8 deals with reproductive health; Chapter 9 presents early childhood development; Chapter 10 deliberates on literacy and education; Chapter 11 on child protection; Chapter 12 covers HIV and sexual behaviour; Chapter 13 dwells on mass media and information and communication technology; and finally Chapter 14 on tobacco and alcohol use. 1.2 Survey Objectives The Zimbabwe MICS 2014 primary objectives were:  To collect information critical to the monitoring and reporting on selected indicators for all the 8 MDGs,  To assist in monitoring of Government of Zimbabwe (GoZ) ZimASSET national priorities focusing on basic social services,  To assist monitoring the Zimbabwe United Nations Development Assistance Framework (ZUNDAF) 2012 to 2015 and individual GoZ/United Nations programme social outcome indicators including transition funds, namely, the Health Transition Fund (HTF), Education Transition Fund (ETF), Child Protection Fund (CPF), and Water, Sanitation and Hygiene (WASH) programme  To provide decision makers with evidence on the situation of children’s and women’s welfare and rights and other vulnerable groups in Zimbabwe. 5 The Child Survival Call to Action was launched in 2012. The Call is now known as 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 2010). 3 2 Sample and Survey Methodology Chapter two presents the sample design and survey methodology, content for the four questionnaires, the interviewer training process, fieldwork, data management and processing and the appraisal workshop. In October 2013, the Zimbabwe National Statistics Agency (ZIMSTAT) and the United Nations Children’s Fund (UNICEF) organised a one-day consultative workshop for stakeholders and the members of the Steering and Technical Committees. Participants agreed on the most critical indicators to be collected in the survey, established and agreed on the composition and Terms of Reference for the two Committees. 2.1 Sample Design The sample for the Zimbabwe Multiple Indicator Cluster Survey was designed to provide estimates for a large number of indicators on the situation of children and women at the national, provincial and urban/rural levels. The ten provinces of the country are Manicaland, Mashonaland Central, Mashonaland East, Mashonaland West, Matabeleland North, Matabeleland South, Midlands, Masvingo, Harare and Bulawayo. With the exception of Bulawayo, the other nine provinces were stratified into urban and rural areas. The sample was selected in two stages with the selection of census enumeration areas/clusters in the first stage and selection of households in the second stage. Within each stratum, a specified number of clusters were selected systematically with probability proportional to size. At the second sampling stage, 25 households were selected from each cluster using systematic random sampling. After a household listing was carried out within the selected enumeration areas, a representative sample of 17 075 households was drawn from 683 clusters. One cluster in Masvingo Province (Tokwe- Mukosi) was not enumerated due to flooding as affected households were re-located. The sample was stratified by province, urban and rural areas and is not self-weighting. For reporting national level results, sample weights are used. A more detailed description of the sample design can be found in Appendix C, Sample Design. 2.2 Questionnaires A set of four questionnaires was used in the survey. These questionnaires were adapted and customized from standard MICS5 questionnaires6. All questionnaires were translated from English to two main vernacular languages in Zimbabwe, i.e. Shona and Ndebele. The questionnaires are described below: A household questionnaire was used to collect basic demographic information on all de jure household members (usual residents), the household, and the dwelling. This questionnaire was responded to by the head of household or a chief respondent covered the household information panel, listing of household members, education, child discipline for children 1-14 years of age, household characteristics, water and sanitation, handwashing, indoor residual spraying, use of Insect Treated Nets (ITNs), and salt iodisation. 6 The model MICS5 questionnaires can be found at http://www.childinfo.org/mics5_questionnaire.html 4 A Woman’s questionnaire was administered to all women in the 15 to 49 year age group from each selected household, encompassed the woman’s information panel, her background characteristics, fertility, birth history, desire for last birth, maternal and newborn health, maternal mortality, post- natal care, marriage/union, illness symptoms, attitudes towards domestic violence, access to mass media and use of information communication technology, tobacco and alcohol use, contraception, unmet need, sexual behaviour, and knowledge on HIV and AIDS. A Man’s questionnaire for the 15 to 54 year age group was administered in every third household selected. The man’s information panel, his background characteristics, fertility, marriage/union, attitudes towards domestic violence, access to mass media and use of information communication technology, tobacco and alcohol use, sexual behaviour, circumcision and knowledge on HIV and AIDS. The under-five questionnaire was administered to mothers (or primary caregivers) of children under 5 years of age7 living in the households. Normally, the questionnaire was administered to mothers of under-5 children; in cases when the mother was not listed in the household listing panel, a primary caregiver for the child was identified and interviewed. The questionnaire covered children’s characteristics, birth registration, early childhood development, breastfeeding and dietary intake, care of illness, immunisation and anthropometry. 2.3 Pre-test A pre-test workshop was conducted from 24 November to 7 December, 2013. During pre-test, fieldwork was conducted in selected urban and rural localities. The clusters used for pre-testing were not part of the final sample selection. Based on the results of the pre-test, modifications were made to the wording and translation of the questionnaires. A copy of the Zimbabwe MICS questionnaires is provided in Appendix J. 2.4 Training and Fieldwork Training for the fieldwork was conducted for 20 days in February 2014. Training included presentations on interviewing techniques and the contents of the questionnaires. Mock interviews were conducted among trainees to gain practice in asking questions. In addition, trainees received instructions and practiced weighing and measuring the height of children under five years of age. Salt testing, for the presence of iodine, was practiced as part of the training. Towards the end of the training period, trainees spent three days practicing interviewing in areas outside the MICS sample. The data were collected by 29 mobile teams; each team comprised a team leader, a measurer, four to five interviewers and a driver. Teams were supported by a provincial and national supervisors. The survey did not use Field Editors, even though it is one of the recommendations of MICS and part of the field protocols of the survey programme. However, their duties were assumed by the Field Supervisors. Fieldwork began in February and ended in April 2014. As part of the administration of questionnaires, fieldwork teams tested the salt used for cooking in the households for iodine content, observed the place for handwashing, types of exterior walls, roofing materials, flooring materials and mosquito nets. Children under five years of age had their 7The terms “children under 5”, “children age 0-4 years”, and “children age 0-59 months” are used interchangeably in this report. 5 weight and height measured and were assessed for oedema. Details and findings of these observations and measurements are provided in the respective sections of the report. 2.5 Data Processing Data were entered into the computers using the Census and Surveys Processing System (CSPro) software package, Version 5.0. The data were entered on 32 desktop computers by 42 data entry operators and nine data entry supervisors. For quality assurance purposes, all questionnaires were double-entered and internal consistency checks were performed. Procedures and standard programmes developed under the global MICS programme and adapted to the Zimbabwe questionnaire were used throughout. Data entry started two weeks into data collection in March 2014 and was completed in May 2014. Data were analysed using the Statistical Package for Social Sciences (SPSS) software, Version 21. Model syntax and tabulation plans developed by the Global MICS team were customized and used for this purpose. 2.6 Quality Control ZIMSTAT used a variety of and complementary quality control measures and checks to ensure that the MICS data and findings were of high quality. Some of the controls utilized include the following: Training: All persons involved in the MICS received at least one form of training to strengthen their capacity in their designated area of focus. All interviewers and supervisors were trained on the data collection tools at one central location, which ensured the sharing of the same information and understanding of the survey objectives, instruments and expected survey output. Field Teams Supervision: Supervision was done by Team Leaders, Provincial Supervisors and National Supervisors. The supervision involved observing the interviews and visiting completed clusters for spot checks. Field Editing: Questionnaires were edited in the field. This was done to ensure that quality data was collected and high response rates for households and all eligible individuals was achieved. Data entry feedback to the field team: Data entry commenced two weeks after the survey started. This enhanced data quality as field check tables containing identified errors were sent back to the field without delay. Data verification: All questionnaires were double entered to ensure accurate data capturing. Secondly, a verification exercise of households in selected clusters was undertaken. Global and Regional Technical Support: MICS received technical support from both the global and regional MICS Teams at all stages of the survey and this included experts coming into the country at pre-test, fieldwork, data entry and data processing stages. 2.7 Quality Assurance Steering and Technical Committees: Two committees were established to oversee the MICS process. The Steering Committee for the MICS was responsible for providing overall guidance to the survey’s Technical Committee with regards to the organization, implementation, financing of the survey, the dissemination and utilization of the survey results. The Committee was chaired by ZIMSTAT and 6 comprised designated representatives from relevant Government institutions, UN agencies and donor agencies involved in the MICS. The overall objective of the Technical Committee was to provide technical input at all stages until the final reports are published. The Technical Committee reported to the Steering Committee. An appraisal workshop was held in May 2014 to reflect and evaluate the whole survey process. All survey staff categories were represented at the workshop. 7 3 Sample Coverage and the Characteristics of Households and Respondents This chapter presents the MICS sample coverage and the characteristics of the households and their population including women age 15-49 years, men age 15-54 years and children under 5 years of age. The sample coverage includes response rates by households, women, men and children by urban/rural areas and by provinces. The second section of the chapter focuses on characteristics of households, population and household composition and their distribution. This is followed by a description of characteristics of respondents (women, men and children under 5 years of age). The chapter concludes with a review of respondents’ housing characteristics, asset ownership as well as household wealth quintiles. 3.1 Sample Coverage The Zimbabwe MICS 2014 was based on a representative sample8 of 17 047 households9. Of the sampled households, 33.6 percent (5 723 households) were in urban areas and 66.4 percent (11 324 households) were in rural areas with response rates of 96 percent and 98.7 percent, respectively. Out of the 17 047 households selected for the sample, 16 041 were found to be occupied. Of these, 15 686 were successfully interviewed yielding a household response rate of 97.8 percent. In the interviewed households, 15 376 women (age 15-49 years) were identified. Of these, 14 408 women were successfully interviewed, yielding a response rate of 93.7 percent. The survey also sampled men (age 15-54 years), but required only a subsample. A man’s questionnaire, for age 15-54 years, was administered in every third household selected. Nine thousand and eight (9 008) men age 15-54 years were listed in the household questionnaires. Questionnaires were completed for 7 914 eligible men, a response rate of 87.9 percent. The response rates for men in urban areas was lower than for those in rural areas with Harare Province having an even lower response rate compared to Bulawayo Province. The possible reasons for non-response are that respondents were either not reached by data collectors or due to lack of accessibility, refused to provide data, or were unable to provide data. Non-response tends to bias estimates. Therefore, users are to be cautious in interpreting the results with a low response rate, particularly results on men from Harare. There were 10 223 children under 5 years of age listed for the household questionnaires. Questionnaires were completed for 9 884 of these children, a response rate of 96.7 percent. Overall response rates of 91.6 percent, 85.9 percent and 94.5 percent were calculated for the individual interviews of women, men and under-5s, respectively. The household response rates by province were generally high across all provinces ranging from 95 percent for Harare Province to 99.3 percent for Midlands Province. The individual response rates for all categories were lowest in Harare and highest in Masvingo provinces, see Table HH.1. 8 The sample is representative at national, provincial and urban/rural levels 9 A representative sample of 17 075 households was drawn from 683 clusters. One cluster in Masvingo Province (Tokwe- Mukosi) was not enumerated due to flooding as affected households were re-located. From the remaining 17 050 households, three could not be located hence the 17 047 households remaining. 8 10 The denominator for the household response rate is the number of households found to be occupied during fieldwork (HH9 = 01, 02, 04, 07); the numerator is the number of households with complete household questionnaires (HH9 = 01). The denominator for the women’s response rate is the number of eligible women enumerated in the household listing form (HH12); the numerator is the number of women with a complete interview (HH13). The denominator for the men's response rate is the number of eligible men enumerated in the household listing form (HH13A); the numerator is the number of men with a complete interview (HH13B). The denominator for the response rate for the questionnaire for children under 5 is the number of under-5 children identified in the household listing form (HH14); the numerator is the number of complete questionnaires for children under 5 (HH15). Overall response rates are calculated for women, men and under-5's by multiplying the household response rate by the women's, men's and under-5's response rates, respectively. Table HH.1: Results of household, women's, men's and under-5 interviews Number of households, women, men, and children under 5 by results of the household, women's, men's and under-5's interviews, and household, women's, men's and under-5's response rates, Zimbabwe MICS, 2014 Total Area Province Urban Rural Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Households Sampled 17 047 5 723 11 324 2 025 1 625 1 800 1 850 1 251 1 250 1 875 1 798 2 300 1 273 Occupied 16 041 5 347 10 694 1 892 1 544 1 676 1 741 1 199 1 184 1 779 1 680 2 182 1 164 Interviewed 15 686 5 134 10 552 1 870 1 531 1 658 1 696 1 168 1 147 1 766 1 661 2 072 1 117 Household response rate10 97.8 96.0 98.7 98.8 99.2 98.9 97.4 97.4 96.9 99.3 98.9 95.0 96.0 Women Eligible 15 376 5 743 9 633 1 733 1 430 1 468 1 668 1 121 1 076 1 729 1 564 2 396 1 191 Interviewed 14 408 5 335 9 073 1 597 1 377 1 392 1 555 1 052 989 1 652 1 513 2 158 1 123 Women's response rate 93.7 92.9 94.2 92.2 96.3 94.8 93.2 93.8 91.9 95.5 96.7 90.1 94.3 Women's overall response rate 91.6 89.2 92.9 91.1 95.5 93.8 90.8 91.4 89.0 94.8 95.6 85.5 90.5 Men Eligible 9 008 3 190 5 818 977 944 881 1 065 655 586 1 048 797 1 394 661 Interviewed 7 914 2 600 5 314 859 869 807 966 587 523 977 750 1 023 553 Men's response rate 87.9 81.5 91.3 87.9 92.1 91.6 90.7 89.6 89.2 93.2 94.1 73.4 83.7 Men's overall response rate 85.9 78.3 90.1 86.9 91.3 90.6 88.4 87.3 86.5 92.5 93.0 69.7 80.3 Children under 5 Eligible 10 223 2 923 7 300 1 298 1 095 1 004 1 110 826 747 1 152 1 108 1 275 608 Mothers/caretakers interviewed 9 884 2 808 7 076 1 238 1 061 982 1 075 808 716 1 112 1 092 1 209 591 Under-5's response rate 96.7 96.1 96.9 95.4 96.9 97.8 96.8 97.8 95.9 96.5 98.6 94.8 97.2 Under-5's overall response rate 94.5 92.2 95.6 94.3 96.1 96.8 94.3 95.3 92.9 95.8 97.4 90.0 93.3 9 3.2 Characteristics of Households The weighted age and sex distribution of the survey population is provided in Table HH.2. The distribution was also used to produce the population pyramid in Figure HH.1. In the 15 686 households successfully interviewed in the survey, 65 259 household members were listed. Of these, 30 986 (47.5 percent) were males, and 34 273 (52.5 percent) were females. The estimated average household size from MICS was 4.2 persons, as was for the Zimbabwe Population Census 2012. Table HH.2: Household age distribution by sex Percent and frequency distribution of the household population by five-year age groups, dependency age groups, and by child (age 0-17 years) and adult populations (age 18 or more), by sex, Zimbabwe MICS, 2014 Total Males Females Number Percent Number Percent Number Percent Total 65 259 100.0 30 986 100.0 34 273 100.0 Age 0-4 10 180 15.6 5 058 16.3 5 122 14.9 5-9 9 416 14.4 4 712 15.2 4 705 13.7 10-14 9 030 13.8 4 573 14.8 4 457 13.0 15-19 6 999 10.7 3 659 11.8 3 340 9.7 20-24 4 969 7.6 2 244 7.2 2 725 8.0 25-29 4 462 6.8 1 986 6.4 2 476 7.2 30-34 4 416 6.8 1 958 6.3 2 458 7.2 35-39 3 475 5.3 1 610 5.2 1 865 5.4 40-44 2 820 4.3 1 370 4.4 1 450 4.2 45-49 1 709 2.6 782 2.5 927 2.7 50-54 1 828 2.8 624 2.0 1 205 3.5 55-59 1 636 2.5 684 2.2 952 2.8 60-64 1 299 2.0 523 1.7 777 2.3 65-69 962 1.5 393 1.3 569 1.7 70-74 691 1.1 309 1.0 382 1.1 75-79 539 0.8 218 0.7 321 0.9 80-84 414 0.6 164 0.5 250 0.7 85+ 408 0.6 119 0.4 289 0.8 Missing/DK 5 0.0 3 0.0 2 0.0 Dependency age groups 0-14 28 627 43.9 14 342 46.3 14 284 41.7 15-64 33 614 51.5 15 438 49.8 18 176 53.0 65+ 3 013 4.6 1 202 3.9 1 810 5.3 Missing/DK 5 0.0 3 0.0 2 0.0 Child and adult populations Children age 0-17 years 32 855 50.3 16 548 53.4 16 307 47.6 Adults age 18+ years 32 398 49.6 14 435 46.6 17 964 52.4 Missing/DK 5 0.0 3 0.0 2 0.0 10 The population pyramid (Figure HH.1) is broad based indicating a high proportion of population (43.9 percent) was of age below 15 years. About fifty-two percent (51.5 percent) of the population was in the 15 to 64 age category, with 4.6 percent age 65 years and above. The MICS age composition was comparable to the results of MIMS 2009, (42.0 percent, 54.0 percent and 4.0 percent) and the 2012 Population Census indicating 41.0 percent, 55 percent and four percent, respectively. Half of the population (50.3 percent) was under the age of 18 years. The percentage of males under 18 years of age was 53.4 percent while for females it was 47.6 percent. The drop between age groups 10-14 to 15-19 and having more men age 55-59 years compared to women in the same age group may be due to data quality issues, age heaping and digit preference. Appendix F contains Data Quality Tables and provides details on population by single years in Table DQ.1 and Figure DQ.1. F igure HH.1: Age a nd sex d istr ibut ion of household populat ion, Z imbabwe MICS, 2014 Tables HH.3, HH.4 and HH.5 provide information on household composition and background characteristics of female respondents age 15-49 years, male respondents age 15-54 years, and children under 5 years of age. Both unweighted and weighted numbers are presented. This information is essential for the interpretation of findings presented later in the report and provides background information on the representativeness of the survey sample. The remaining tables in this report are presented only with weighted numbers.11 The total number of weighted and unweighted households are equal, since sample weights were normalised. The table also shows the weighted mean household size estimated by the survey. About 62 percent of the households were male headed compared to 65 percent from the Zimbabwe 2012 Population Census. The highest proportions of households were in Mashonaland West Province at 12.8 percent and Manicaland Province at 12.7 while Mashonaland Central Province had the lowest (five percent). Sixty-nine percent of the households were in rural areas. 11See Appendix C: Sample Design, for more details on sample weights. 10 8 6 4 2 0 2 4 6 8 10 0-4 10-14 20-24 30-34 40-44 50-54 60-64 70-74 80-84 Percent Age Males Females Note: Five household members with missing age are 11 About a third of the households (34.4 percent) had household sizes of 4-5 persons, 30.9 percent had 2-3 persons, 16.4 percent had 6-7 persons, 11 percent had 1 person, 5.2 percent had 8-9 persons and 2.2 percent had 10 or more persons. The average household size was 4.2 persons. In relation to education, 45.3 percent of household heads had attained secondary education, 36.5 percent had primary education 10.3 percent had higher education whereas 7.8 percent of household heads had no education, see Table HH.3. Table HH.3: Household composition Percent and frequency distribution of households by selected characteristics, Zimbabwe MICS, 2014 Weighted percent Number of households Weighted Unweighted Total 100.0 15 686 15 686 Sex of household head Male 61.8 9 689 9 835 Female 38.2 5 997 5 851 Province Manicaland 12.7 1 991 1 870 Mashonaland Central 5.0 792 1 531 Mashonaland East 11.7 1 828 1 658 Mashonaland West 12.8 2 015 1 696 Matabeleland North 8.8 1 382 1 168 Matabeleland South 8.2 1 285 1 147 Midlands 12.3 1 932 1 766 Masvingo 11.1 1 748 1 661 Harare 9.7 1 518 2 072 Bulawayo 7.6 1 194 1 117 Area Urban 30.6 4 798 5 134 Rural 69.4 10 888 10 552 Number of household members 1 11.0 1 731 1 706 2 12.4 1 940 1 923 3 18.5 2 895 2 904 4 19.3 3 024 3 034 5 15.1 2 368 2 398 6 10.6 1 659 1 658 7 5.8 904 914 8 3.2 506 500 9 2.0 309 304 10+ 2.2 351 345 Education of household head None 7.8 1 226 1 201 Primary 36.5 5 723 5 566 Secondary 45.3 7 108 7 171 Higher 10.3 1 610 1 728 Missing/DK 0.1 19 20 Mean household size 4.2 15 686 15 686 12 3.3 Characteristics of Female Respondents (15-49) and Male Respondents (15-54) Years of Age and Children Under-5 Tables HH.4, HH.4M and HH.5 provide information on the background characteristics of female respondents 15-49 years of age, male respondents 15-54 years of age and of children under age 5. As discussed above, in all three tables, the total numbers of weighted and unweighted observations are equal, since sample weights have been normalised. In addition to providing information on the background characteristics of women, men and children under 5 years of age, the tables are also intended to show the number of observations in each background category. These categories are used in the subsequent tabulations of this report. Table HH.4 includes information on the distribution of women according to province, urban/rural areas, age, marital/union status, motherhood status, births in last two years, education12 and wealth index quintiles13, 14. The highest proportion of women with completed interviews was in Mashonaland West Province (13 percent), while the lowest of 5.1 percent was in Mashonaland Central Province. About 65 percent of the women resided in rural areas. The results show that 21.5 percent of women were of age 15-19 years, 17.9 percent were 20-24 years and 16.5 percent were 25-29 years. Sixty-three percent of the women were currently married while 23.6 percent had never married. In the 2012 population census, 58 percent of women were currently married and 29 percent had never married. The majority of the women interviewed (65.3 percent) had attended secondary education, 27.1 percent had primary education while 6.3 percent had higher level of education and only 1.4 percent had no education. Seventy-five percent of women age 15-49 years had ever given birth. Twenty-seven percent of the women age 15-49 years had given birth in the last two years preceding the survey while 48.2 percent had given birth but not in the last two years. In terms of the wealth index, 17 percent of women were in the poorest quintile, 16.9 percent were in the second quintile while 25.1 percent were in the richest quintile. 12Throughout this report, unless otherwise stated, “education” refers to highest educational level ever attended by the respondent when it is used as a background variable. 13The wealth index is a composite indicator of wealth. See Appendix I for more information 14When describing survey results by wealth quintiles, appropriate terminology is used when referring to individual household members, such as for instance “women in the richest household population”, which is used interchangeably with “women in the wealthiest survey population” and similar. 13 Table HH.4: Women's background characteristics Percent and frequency distribution of women age 15-49 years by selected background characteristics, Zimbabwe MICS, 2014 Weighted percent Number of women Weighted Unweighted Total 100.0 14 409 14 409 Province Manicaland 12.2 1 755 1 597 Mashonaland Central 5.1 739 1 377 Mashonaland East 10.8 1 550 1 392 Mashonaland West 13.0 1 874 1 555 Matabeleland North 8.6 1 238 1 052 Matabeleland South 7.8 1 120 989 Midlands 12.5 1 800 1 652 Masvingo 10.5 1 509 1 513 Harare 11.3 1 624 2 159 Bulawayo 8.3 1 200 1 123 Area Urban 34.7 5 004 5 336 Rural 65.3 9 405 9 073 Age 15-19 21.5 3 105 3 079 20-24 17.9 2 572 2 550 25-29 16.5 2 372 2 392 30-34 16.1 2 327 2 359 35-39 12.4 1 783 1 791 40-44 9.5 1 371 1 367 45-49 6.1 879 871 Marital/Union status Currently married/in union 63.2 9 112 9 129 Widowed 5.4 781 771 Divorced 4.3 619 644 Separated 3.5 498 494 Never married/in union 23.6 3 393 3 366 Missing 0.0 6 5 Motherhood and recent births Never gave birth 24.8 3 574 3 566 Ever gave birth 75.2 10 835 10 843 Gave birth in last two years 27.1 3 902 3 913 No birth in last two years 48.2 6 941 6 938 Education None 1.4 197 210 Primary 27.1 3 904 3 849 Secondary 65.3 9 402 9 363 Higher 6.3 907 987 Wealth index quintile Poorest 17.0 2 445 2 279 Second 16.9 2 441 2 422 Middle 17.7 2 553 2 528 Fourth 23.3 3 356 3 333 Richest 25.1 3 614 3 847 14 Similarly, Table HH.4M provides background characteristics of men 15-54 years of age. The table shows information on the distribution of men according to province, urban/rural areas, age, marital status, fatherhood status, education, and wealth index quintiles. Mashonaland West Province had the highest proportion (14.4 percent) of male respondents’ age 15-54 years while the lowest (6.2 percent) were in Mashonaland Central Province. Most of the men (67.7 percent) resided in rural areas and 32.3 percent in urban areas. Fifty-three percent of the men were currently married while 42 percent had never married. About fifty-four percent had at least one living child and 44.9 percent had no living children. As was for women, the majority of men had attended secondary education (64.3 percent) while those with primary education were 25.7 percent. Nine percent had attended a higher level of education while less than one percent had never been to school. From Table HH.4M, 15.9 percent of men were in the poorest quintile while 22.6 percent were in the richest households. 15 Table HH.4M: Men's background characteristics Percent and frequency distribution of men age 15-54 years by selected background characteristics, Zimbabwe MICS, 2014 Weighted percent Number of men Weighted Unweighted Total 100.0 7 914 7 914 Province Manicaland 11.8 937 859 Mashonaland Central 6.2 492 869 Mashonaland East 11.0 869 807 Mashonaland West 14.4 1 136 966 Matabeleland North 8.5 670 587 Matabeleland South 7.5 591 523 Midlands 13.0 1 026 977 Masvingo 9.2 728 750 Harare 10.6 838 1 023 Bulawayo 7.9 627 553 Area Urban 32.3 2 558 2 600 Rural 67.7 5 356 5 314 Age 15-19 26.1 2 068 2 025 20-24 15.5 1 227 1 237 25-29 13.9 1 096 1 114 30-34 13.8 1 088 1 096 35-39 11.5 910 922 40-44 9.4 746 745 45-49 5.4 427 427 50-54 4.4 351 348 Marital/Union status Currently married/in union 53.0 4 193 4 246 Widowed 0.7 59 55 Divorced 2.0 161 162 Separated 2.1 169 165 Never married/in union 42.1 3 330 3 285 Missing 0.0 1 1 Fatherhood status Has at least one living child 54.4 4 305 4 340 Has no living children 44.9 3 556 3 525 Missing/DK 0.7 52 49 Education None 0.9 70 70 Primary 25.7 2 033 2 015 Secondary 64.3 5 090 5 076 Higher 9.1 721 753 Wealth index quintile Poorest 15.9 1 258 1 212 Second 16.8 1 330 1 357 Middle 19.1 1 511 1 542 Fourth 25.6 2 025 1 968 Richest 22.6 1 790 1 835 16 In households where there were children under 5 years of age, mothers/primary caregivers of the children were interviewed. Nine thousand eight hundred and eighty-four children had completed interviews. Background characteristics of children under 5 years of age are presented in Table HH.5. The highest number of children under 5 years of age, 13.4 percent, were in Manicaland Province and 13 percent were in Mashonaland West Province while the lowest (5.6 percent) were in Mashonaland Central Province. Seventy-three percent of the children resided in rural areas while 26.6 percent were in urban areas. Table HH.5: Under-5's background characteristics Percent and frequency distribution of children under five years of age by selected characteristics, Zimbabwe MICS, 2014 Weighted percent Number of under-5 children Weighted Unweighted Total 100.0 9 884 9 884 Sex Male 49.7 4 913 4 935 Female 50.3 4 971 4 949 Province Manicaland 13.4 1 326 1 238 Mashonaland Central 5.6 552 1 061 Mashonaland East 11.1 1 093 982 Mashonaland West 13.0 1 281 1 075 Matabeleland North 9.3 918 808 Matabeleland South 8.1 800 716 Midlands 12.4 1 227 1 112 Masvingo 11.6 1 143 1 092 Harare 9.3 917 1 209 Bulawayo 6.3 626 591 Area Urban 26.6 2 625 2 808 Rural 73.4 7 259 7 076 Age 0-5 months 8.9 879 867 6-11 months 9.5 937 974 12-23 months 20.1 1 990 1 991 24-35 months 20.8 2 054 2 043 36-47 months 21.7 2 145 2 146 48-59 months 19.0 1 879 1 863 Respondent to the under-5 questionnaire Mother 84.2 8 319 8 374 Other primary caregiver 15.8 1 565 1 510 Mother’s educationa None 3.3 323 325 Primary 36.2 3 576 3 520 Secondary 55.9 5 522 5 517 Higher 4.7 463 521 Missing/DK 0.0 1 1 17 Wealth index quintile Poorest 22.1 2 187 2 063 Second 21.2 2 100 2 098 Middle 18.3 1 808 1 809 Fourth 21.8 2 155 2 161 Richest 16.5 1 634 1 753 a In this table and throughout the report, mother's education refers to educational attainment of mothers as well as caregivers of children under 5, who are the respondents to the under-5 questionnaire if the mother is deceased or is living elsewhere. Most of the children under 5 years of age (81.6 percent) included in the survey were between 12 and 59 months of age. The proportion in the age group 0 to 11 months was 18.4 percent. The respondents to the under-5 questionnaire were mainly mothers of the children (84.2 percent) while other primary caregivers constituted 15.8 percent. Of these mothers, 55.9 percent had attended secondary education, 36.2 percent had primary education. About five percent had attended a higher level of education while 3.3 percent had no education. Twenty-two percent of the children were in the poorest quintile followed by 21.2 percent who were in the second quintile. 3.4 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 information on household access to connected electricity and dwelling unit characteristics. Thirty-two percent of households had connected electricity (83.4 percent urban and 9.8 percent rural areas). This was lower than the proportion that had electricity in the 2010/11 Zimbabwe Demographic and Health Survey which was 37 percent and 44 percent in the 2012 population census. Apart from the urban provinces (Harare 73.6 percent; Bulawayo 92.4 percent), use of electricity was minimal in the other provinces. The lowest proportion of households with electricity was in Masvingo Province (7.4 percent) and the highest was in Mashonaland West Province (32.2 percent). Seventy percent of households had dwelling units with finished floors while 29.8 percent had natural floors. The results are comparable to ZDHS 2010/11 (71.4 and 28.1 percent, respectively). Data were collected on the number of sleeping rooms per household. The mean number of persons per room used for sleeping was 2.2 in urban areas and 2.4 in rural areas. 18 Table HH.6: Housing characteristics Percent distribution of households by selected housing characteristics, according to area of residence and provinces, Zimbabwe MICS, 2014 Total Area Province Urban Rural Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Electricity Yes 32.3 83.4 9.8 24.5 16.1 23.4 32.2 15.2 18.6 29.9 7.4 73.6 92.4 No 67.7 16.6 90.2 75.5 83.9 76.6 67.8 84.8 81.4 70.1 92.6 26.4 7.6 Flooring Natural floor 29.8 1.1 42.3 24.1 48.9 17.4 38.2 67.6 27.2 36.5 39.7 1.0 1.3 Rudimentary floor 0.1 0.2 0.1 0.3 0.0 0.1 0.1 0.0 0.0 0.1 0.1 0.3 0.3 Finished floor 70.1 98.7 57.5 75.5 51.1 82.6 61.7 32.4 72.8 63.3 60.2 98.7 98.5 Other 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Missing/DK 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 Roof Natural roofing 29.7 0.1 42.7 19.9 45.0 22.6 33.3 68.1 34.1 38.6 39.4 0.0 0.4 Rudimentary roofing 0.0 0.0 0.1 0.0 0.1 0.0 0.1 0.0 0.0 0.0 0.2 0.0 0.0 Finished roofing 70.2 99.7 57.2 79.9 54.9 77.3 66.6 31.9 65.8 61.4 60.3 99.8 99.6 Other 0.1 0.1 0.1 0.1 0.1 0.1 0.0 0.0 0.2 0.0 0.1 0.1 0.0 Missing/DK 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 Exterior walls Natural walls 14.4 0.2 20.6 8.8 12.0 1.3 14.7 65.7 14.1 20.5 9.6 0.2 0.6 Rudimentary walls 0.5 0.6 0.5 1.7 0.1 0.0 0.2 1.1 0.6 0.1 0.4 0.4 0.2 Finished walls 84.6 98.0 78.7 89.3 87.4 98.6 84.8 32.6 84.8 79.2 89.8 97.1 98.6 Other 0.4 1.0 0.2 0.2 0.4 0.1 0.3 0.5 0.5 0.1 0.3 1.9 0.6 Missing/DK 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.1 0.0 0.3 0.0 Rooms used for sleeping 1 39.7 43.6 37.9 39.0 36.3 39.4 39.3 39.2 45.7 35.6 36.8 45.1 42.0 2 36.3 34.4 37.2 37.7 37.9 35.8 38.3 35.0 31.2 38.3 37.4 33.4 36.6 3 or more 22.8 20.6 23.8 22.4 25.2 23.3 21.7 25.1 22.5 24.9 24.4 18.6 20.4 Missing/DK 1.2 1.3 1.1 0.9 0.6 1.5 0.7 0.7 0.5 1.2 1.5 2.9 1.1 19 Type of dwelling unit Traditional 22.3 0.1 32.1 13.7 34.6 7.4 24.4 65.6 24.4 25.6 35.0 0.1 0.4 Mixed 33.4 0.5 47.9 43.6 47.4 51.2 37.2 15.8 44.4 39.0 43.5 0.0 0.5 Detached 35.8 78.9 16.8 34.8 16.1 36.4 31.5 13.5 26.0 31.1 15.0 82.1 72.4 Semi-detached 6.2 15.3 2.2 6.5 1.0 3.0 6.1 5.0 3.0 1.2 6.1 14.0 17.4 Flat/Town home 1.8 4.5 0.6 0.2 0.4 1.7 0.7 0.0 1.4 3.0 0.3 2.3 9.0 Shack 0.3 0.5 0.2 1.1 0.0 0.1 0.0 0.0 0.1 0.1 0.1 1.0 0.1 Other/specify 0.1 0.1 0.1 0.1 0.5 0.1 0.0 0.1 0.6 0.0 0.0 0.2 0.1 Missing 0.1 0.1 0.0 0.1 0.0 0.0 0.0 0.0 0.1 0.0 0.1 0.3 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 15 686 4 798 10 888 1 991 792 1 828 2 015 1 382 1 285 1 932 1 748 1 518 1 194 Mean number of persons per room used for sleeping 2.34 2.22 2.40 2.33 2.43 2.24 2.46 2.47 2.41 2.30 2.32 2.35 2.15 20 Table HH.7 shows distribution of households by ownership of assets. Forty-three percent of households owned a radio, 37.4 percent owned a television set and 84 percent owned a mobile phone. Proportions of households with a radio or a mobile phone in MICS were higher than those for ZDHS 2010/11, 36 percent and 62 percent, respectively. About 66 percent of households resided in dwelling units, which they owned. Ownership of dwelling unit was higher in rural areas (79.1 percent) compared to urban areas (35.4 percent). 21 Table HH.7: Household and personal assets Percentage of households by ownership of selected household and personal assets, and percent distribution by ownership of dwelling, according to area of residence and provinces, Zimbabwe MICS, 2014 Total Area Province Urban Rural Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Percentage of households that own a Radio 43.0 47.4 41.0 42.6 46.8 46.0 45.0 38.2 33.2 45.6 38.0 46.0 48.3 Television 37.4 77.0 19.9 29.9 29.4 32.2 36.8 23.0 24.4 36.9 17.2 71.6 81.6 Non-mobile telephone 2.9 8.8 0.3 1.7 0.6 0.8 1.4 1.7 1.1 5.1 0.4 4.4 13.9 Refrigerator 18.7 52.3 3.9 12.0 7.1 11.3 11.3 7.7 12.9 20.0 5.3 48.0 60.9 Satellite Dish 20.1 51.4 6.4 15.4 13.2 13.3 19.8 11.0 11.4 22.8 6.4 40.8 53.3 Computer/laptop 7.9 21.4 2.0 3.9 5.2 5.6 6.3 3.7 3.7 8.8 3.2 20.3 21.9 Deep freezer 8.0 20.8 2.4 6.0 5.7 4.8 7.6 4.7 4.8 9.8 4.1 18.6 15.4 DVD/VCD 35.8 69.8 20.8 30.6 26.3 30.2 35.0 25.6 26.9 35.3 19.6 64.6 70.2 Battery/Generator 28.9 12.8 35.9 27.3 38.4 33.3 26.0 35.5 31.2 33.3 37.4 18.3 6.4 Solar Panel 35.2 8.3 47.1 37.1 44.6 43.2 34.1 38.2 40.5 40.1 50.4 12.7 4.7 Percentage of households that own Agricultural land 68.7 31.4 85.2 73.8 78.9 77.5 64.8 84.7 75.0 76.8 90.6 31.1 24.3 Farm animals/Livestock 62.4 29.5 77.0 70.5 65.7 66.6 54.4 78.4 71.2 70.3 84.2 27.0 26.7 Percentage of households where at least one member owns or has a Watch 12.7 22.6 8.3 9.1 8.9 11.6 9.9 9.8 10.4 12.3 7.4 26.0 24.2 Mobile telephone 84.4 96.8 79.0 83.9 78.8 84.7 82.1 75.5 82.4 82.8 81.9 97.1 95.4 Bicycle 27.4 23.7 29.1 19.1 27.2 29.1 34.0 27.5 33.0 26.9 29.0 24.4 24.1 Motorcycle or scooter 1.1 1.7 0.9 1.1 1.9 1.5 1.8 0.4 0.5 0.8 1.0 1.3 0.8 Animal-drawn cart 19.2 7.8 24.2 13.8 23.3 20.0 18.2 27.9 25.3 26.1 21.8 8.0 8.2 Car or truck 8.8 20.8 3.6 4.6 6.2 6.4 7.7 5.4 6.7 9.8 4.1 22.2 18.0 Boat with a motor 0.1 0.3 0.1 0.1 0.1 0.1 0.1 0.2 0.1 0.3 0.0 0.6 0.0 Wheel barrow 31.6 24.9 34.5 30.3 23.4 36.4 24.5 31.5 46.8 32.9 40.0 26.0 19.8 Bank account 27.5 54.6 15.5 22.9 22.0 23.2 25.9 18.2 18.6 26.8 17.9 54.2 49.1 22 Ownership of dwelling Owned by a household member 65.8 35.4 79.1 72.9 75.7 68.8 60.8 79.9 72.5 72.9 77.7 38.8 32.9 Not owned 34.2 64.5 20.8 27.1 24.3 31.2 39.2 20.1 27.5 27.1 22.3 61.2 67.1 Rented 15.9 46.3 2.5 12.1 5.9 11.8 12.3 4.8 9.4 14.4 2.6 46.5 43.6 Tied accommodation 12.6 9.1 14.2 10.5 11.8 15.6 19.3 13.3 12.1 9.3 16.7 8.7 5.1 Relative's house 5.3 8.7 3.9 4.3 5.2 3.4 7.4 2.0 5.9 2.7 2.8 5.8 17.4 Other 0.4 0.5 0.3 0.2 1.5 0.3 0.2 0.0 0.1 0.7 0.1 0.1 1.0 Missing/DK 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.1 0.0 0.0 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 15 686 4 798 10 888 1 991 792 1 828 2 015 1 382 1 285 1 932 1 748 1 518 1 194 23 Table HH.8 shows how the household populations in urban/rural areas and provinces were distributed according to household population wealth quintiles. All urban population were in the fourth and richest quintiles, with 67.3 percent in the richest quintile. Rural areas had only 2 percent of the household population in the richest quintile. Most rural population were within the poorest and middle wealth quintiles (83.1 percent). The predominantly urban provinces Harare and Bulawayo had the highest percentage of population in the richest quintile, 55.8 percent and 75.3 percent, respectively. Matabeleland North Province had the highest proportion of population in the poorest quintile (58.0 percent) while Mashonaland East Province had the lowest proportion of 8.5 percent. Table HH.8: Wealth quintiles Percent distribution of the household population by wealth index quintiles, according to area of residence and provinces, Zimbabwe MICS, 2014 Wealth index quintiles Total Number of household members Poorest Second Middle Fourth Richest Total 20.0 20.0 20.0 20.0 20.0 100.0 65 259 Area Urban 0.0 0.0 0.0 32.7 67.3 100.0 18 082 Rural 27.7 27.7 27.7 15.1 1.9 100.0 47 177 Province Manicaland 9.9 24.5 30.9 21.5 13.2 100.0 8 164 Mashonaland Central 19.8 30.5 25.9 14.4 9.4 100.0 3 455 Mashonaland East 8.5 21.8 34.2 25.7 9.7 100.0 7 232 Mashonaland West 16.6 21.8 20.6 26.0 15.0 100.0 8 684 Matabeleland North 58.0 16.4 10.9 7.9 6.7 100.0 6 226 Matabeleland South 22.7 29.8 25.3 14.3 7.9 100.0 5 464 Midlands 29.9 19.8 18.0 10.9 21.4 100.0 8 264 Masvingo 29.3 30.3 24.0 11.4 5.1 100.0 7 400 Harare 0.0 0.1 0.8 43.4 55.8 100.0 5 901 Bulawayo 0.0 0.0 0.0 24.7 75.3 100.0 4 469 24 4 Child Mortality The Millennium Development Goal number 4 specifically calls for the reduction of under-five mortality by two-thirds between 1990 and 2015. One of the MICS objectives is to contribute to monitoring progress towards this goal. In 2008, the leading causes of under 5 mortality in Zimbabwe were causes during the neonatal period (comprising premature birth complications, birth asphyxia and neonatal sepsis) (which contributed 29 percent of the deaths), and HIV and AIDS (which contributed 22 percent of the deaths). The other major causes of under-five mortality were pneumonia, diarrhoea and measles although HIV and AIDS may also underlie deaths recorded under pneumonia and diarrhoea. Malaria contributed three percent of under 5 mortality. Malnutrition is an underlying factor in most of these deaths (GoZ, 2010). Most of these deaths can be prevented through simple, cost-effective interventions. The GoZ developed a National Child Survival Strategy for Zimbabwe 2010-2015 to deliver its commitment to reduce early child mortality as promoted in the MDGs. The Child Survival Strategy was developed in the context of the existing National Health Strategy (2009-2013) and complements other strategies including the Maternal and Neonatal Health Roadmap 2007-2015. Child health indicators are of interest to policy makers and planners as they are important indicators of the success of Government policies and programmes. Mortality rates presented in this chapter were calculated from birth histories in the Woman’s Questionnaire. The direct method of estimation is based on the assumption that mortality among mothers is very low and the reported birth history is complete. All interviewed women were asked whether they had ever given birth, and if yes, they were asked to report the number of sons and daughters who lived with them, the number who lived elsewhere and the number who had died. In addition, they were asked to provide a detailed birth history of live births of children in chronological order starting with the firstborn. Women were asked whether the births were single or multiple, the sex of the children, the date of birth (month and year) and survival status. Further, for children still alive, women 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: • 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-five mortality (5q0): the probability of dying between birth and the fifth birthday 4.1 Early Childhood mortality rates Rates are expressed as deaths per 1 000 live births except in the case of child mortality, which is expressed as deaths per 1 000 children surviving to age one, and post-neonatal mortality, which is the difference between infant and neonatal mortality rates. Digit preference shown in Table DQ.26 indicates heaping on deaths at 12 months. The implication of this is an underestimation of infant mortality rate and an overestimation of child mortality rate. 25 Table CM.1: Early childhood mortality rates Neonatal, post-neonatal, infant, child and under-five mortality rates for five year periods preceding the survey, West Model, Zimbabwe MICS, 2014 Neonatal mortality rate1 Post-neonatal mortality rate2, a Infant mortality rate3 Child mortality rate4 Under-five mortality rate5 Years preceding the survey 0-4 29 25 55 21 75 5-9 25 33 58 27 84 10-14 20 31 50 26 75 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-five 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-five mortality rates for the three most recent five-year periods before the survey. Neonatal mortality in the most recent 5-year period (2010-2014) was estimated at 29 deaths per 1 000 live births, 25 deaths per 1 000 live births in the 5-9 years preceding the survey (2005-2009) and 20 deaths per 1 000 live births in the 10-14 years preceding the survey (2000-2004). The trend indicated an increase in neonatal mortality over the fifteen year period. Post-neonatal mortality rate was estimated at 25 deaths per 1 000 live births in the five years preceding the survey (2010-2014). The rate was 33 deaths per 1 000 live births and 31 deaths per 1 000 live births for the 5-9 years and 10-14 years preceding the survey, respectively. This shows a stable trend from 31 deaths between 2000 and 2004 to 33 deaths per 1 000 live births between 2005 and 2009 and a decline to 25 deaths per 1 000 live births between 2010 and 2014. 26 F igure CM.1: Ear ly ch i ldhood morta l i ty rates , Z imbabwe MICS, 2014 The mortality rates across the three successive five-year periods suggests that infant mortality rate rose from 50 deaths per 1 000 live births between 2000 and 2004 to 58 deaths per 1 000 live births between 2005 to 2009 and declined to 55 deaths per 1 000 live births between 2010 and 2014. Similarly, the under-five mortality rate rose from 75 deaths per 1 000 live births between 2000 and 2004 to 84 deaths per 1 000 live births between 2005 and 2009 and declined to 75 deaths per 1 000 live births between 2010 and 2014, see Table CM.1 and Figure CM.1. 4.2 Early childhood mortality rates by background characteristics Table CM.2 provides estimates of child mortality by background characteristics for the five year period preceding the survey (2010-2014). The national neonatal mortality rate was 29 deaths per 1 000 live births. At provincial level, neonatal mortality were highest in Mashonaland Central and Midlands Provinces, each at 39 deaths per 1 000 live births. The lowest neonatal mortality was reported in Matabeleland North Province (14 percent). The rates for the other provinces ranged between 20 and 35 deaths per 1 000 live births. The rates are the same by urban/rural areas at 29 deaths per 1 000 live births. 20 31 50 26 75 25 33 58 27 84 29 25 55 21 75 0.00 10.00 20.00 30.00 40.00 50.00 60.00 70.00 80.00 90.00 Neonatal mortality rate Post-neonatal mortality rate Infant mortality rate Child mortality rate Under-five mortality rate Years preceding the survey Note: Indicator values are per 1 000 live births 10-14 5-9 0-4 27 The post-neonatal mortality was 25 deaths per 1 000 live births. Post-neonatal mortality was highest in Mashonaland Central Province at 34 deaths per 1 000 live births and lowest in Bulawayo Province at 15 deaths per 1 000 live births. The results show that rural areas had a post-neonatal mortality rate of 27 deaths and 22 deaths per 1 000 live births for urban areas. Post-neonatal mortality rate was 30 deaths per 1 000 live births for children of mothers with primary education, 23 deaths per 1 000 live births for those with secondary education and 19 deaths per 1 000 live births for those with higher education, see Table CM.2. Table CM.2: Early childhood mortality rates by socioeconomic characteristics Neonatal, post-neonatal, Infant, child and under-five mortality rates for the five year period preceding the survey, by socioeconomic characteristics, West Model, Zimbabwe MICS, 2014 Neonatal mortality rate1 Post-neonatal mortality rate2, a Infant mortality rate3 Child mortality rate4 Under-five mortality rate5 Total 29 25 55 21 75 Province Manicaland 26 23 50 26 75 Mashonaland Central 39 34 73 19 91 Mashonaland East 20 19 39 27 64 Mashonaland West 33 24 58 17 74 Matabeleland North 14 23 36 18 53 Matabeleland South 35 32 67 19 85 Midlands 39 24 63 22 84 Masvingo 34 29 63 28 89 Harare 28 33 61 17 77 Bulawayo 22 15 37 (11) (48) Area Urban 29 22 51 16 66 Rural 29 27 56 23 78 Mother's education None (*) (*) (*) (*) (*) Primary 33 30 64 31 92 Secondary 27 23 50 17 67 Higher 21 19 40 (6) (46) Wealth index quintile Poorest 28 26 53 25 78 Second 29 27 56 33 87 Middle 30 25 55 16 70 Fourth 32 25 58 19 75 Richest 26 24 49 10 59 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-five mortality rate a Post-neonatal mortality rates are computed as the difference between the infant and neonatal mortality rates (*) Rates based on fewer than 250 unweighted exposed persons ( ) Rates based on 250 to 499 unweighted exposed persons 28 The national infant mortality rate was 55 deaths per 1 000 live births. Infant mortality rate was highest in Mashonaland Central Province at 73 deaths per 1 000 live births and lowest in Bulawayo Province (37 deaths per 1 000 live births). There appeared to be no major differences between urban and rural areas. As was the case for neonatal mortality, infant mortality rates differed by the education status of the mother. The prevalence of child mortality at national level was 21 deaths per 1 000 children surviving to the first birthday. The results showed child mortality of 10 deaths per 1 000 children surviving to their first birthday for the richest wealth quintile and 25 deaths for the poorest. The under 5 mortality at national level was 75 deaths per 1 000 live births. Rural areas recorded 78 deaths per 1 000 live births with urban areas at 66 deaths per 1 000 live births. Under-five mortality rate by wealth quintiles indicated 78 deaths per 1 000 live births for the poorest households and 59 deaths per 1 000 live births for those in the richest households, see Table CM.2 and Figure CM.2. F igure CM.2: Under -5 morta l i ty rates by area and province, West Model , Z imbabwe MICS, 2014 75 75 91 64 74 53 85 84 89 77 (48) 66 78 0 20 40 60 80 100 Zimbabwe Province Manicaland Mash Central Mash East Mash West Mat North Mat South Midlands Masvingo Harare Bulawayo Area Urban Rural Under-5 Mortality Rates per 1,000 Births 29 4.3 Early childhood mortality rates by demographic characteristics Neonatal, post-neonatal, infant, child and under five mortality rates are analysed by demographic characteristics that include sex of child, mother’s age at birth, birth order, and previous birth interval. Neonatal mortality rate was higher for male children (32 deaths per 1 000 live births) than for female children (26 deaths per 1 000 live births). Babies born to teenage mothers and those born to mothers age 35 years and above were more likely to die during the neonatal period (30 deaths per 1 000 live births and 45 deaths per 1 000 live births, respectively) compared to babies born to mothers between ages 20-34 years (26 deaths per 1 000 live births). Neonatal mortality generally increased with birth order ranging from 28 deaths per 1 000 live births for the first birth order to 50 deaths per 1 000 live births for the 7th child or higher. Babies born within birth intervals of less than two years or four years and above are more likely to die compared to those born within a birth interval of two to three years. Table CM.3: Early childhood mortality rates by demographic characteristics Neonatal, post-neonatal, Infant, child and under-five mortality rates for the five year period preceding the survey, by demographic characteristics, West Model, Zimbabwe MICS, 2014 Neonatal mortality rate1 Post-neonatal mortality rate2, a Infant mortality rate3 Child mortality rate4 Under-five mortality rate5 Total 29 25 55 21 75 Sex of child Male 32 27 59 21 79 Female 26 24 50 21 70 Mother's age at birth Less than 20 30 28 58 21 78 20-34 26 24 50 20 68 35-49 45 33 78 33 108 Birth order 1 28 25 53 16 67 2-3 29 23 53 19 70 4-6 26 30 56 29 83 7+ (50) (30) (80) (42) (119) Previous birth intervalb < 2 years 32 28 60 22 81 2 years 21 31 52 31 82 3 years 23 23 45 14 59 4+ years 33 21 54 18 72 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-five mortality rate a Post-neonatal mortality rates are computed as the difference between the infant and neonatal mortality rates b Excludes first order births ( ) Rates based on 250 to 499 unweighted exposed persons 30 Infant mortality rates showed similar pattern as neonatal mortality, higher for male children (59 deaths per 1 000 live births) than females (50 deaths per 1 000 live births); high for mother less than 20 years at birth and for those age 35 to 49 years; and increased with birth order. Under-five mortality rate was 79 deaths per 1 000 live births for males and 70 deaths per 1 000 live births for females. It was highest for babies born to mothers age 35-49 years (108 deaths per 1 000 live births) and for birth order 7 and above (119 deaths per 1 000 live births), see Tables CM.2 and CM.3. Figure CM.3 compares the findings of the Zimbabwe MICS on under 5 mortality rates with those from other data sources. The three surveys, the MIMS 2009, ZDHS 2010/11 and the MICS 2014, showed stagnation in under 5 mortality rates over the years. F igure CM.3: Trend in under -5 morta l i ty rates , Z imbabwe MICS, 2014 0 10 20 30 40 50 60 70 80 90 100 1994 1998 2002 2006 2010 2014 Per 1 000 live births Year MIMS 2009 ZDHS 2010-11 MICS 2014 31 5  Nutrition    In  Zimbabwe,  the nutrition  situation  is of  concern  to  the Government  as one out of  every  three  children  is chronically malnourished.15 The GoZ noted  in the National Child Survival Strategy 2010 ‐  2015  that 25 percent of  all deaths of  children under  the  age of  five  are  attributed  to nutritional  deficiencies. Improved nutrition contributes to sustainable and equitable growth, which in turn leads  to  poverty  reduction.  Optimal  nutrition  also  significantly  decreases  maternal  and  child  deaths,  enhances gender equality and  improves  the efficacy of  treatment  for  conditions  such as HIV  and  AIDS.16  The  National  Food  and  Nutrition  Security  Policy,  launched  in  2013,  aims  to  ensure   adequate food and nutrition security in Zimbabwe for all people at all times.     This chapter  focuses on nutritional status of children under 5 years of age,  infant and young child  feeding practices and use of iodised salt at household level. It also looks at Vitamin A supplementation  and prevalence of oedema.    5.1 Low Birth Weight    Weight at birth  is a good  indicator of 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.    Low birth weight stems primarily  from  the mother's poor health and nutrition. Three  factors have  most  impact: the mother's poor nutritional status before conception, short stature  (due mostly to  under nutrition and infections during her childhood) and poor nutrition during pregnancy. Inadequate  weight gain during pregnancy is particularly adverse since it accounts for a large proportion of foetal  growth retardation. Moreover, diseases such as diarrhoea and malaria, which are common in many  developing  countries, can  significantly  impair  foetal growth  if  the mother becomes  infected while  pregnant.    Cigarette smoking during pregnancy also causes low birth weight. Teenagers who give birth when their  own bodies have not yet fully developed run a higher risk of bearing low birth weight babies.    The  percentage  of  births  weighing  below  2  500  grams  is  estimated  from  two  items  in  the  questionnaire:  the mother’s  assessment  of  the  child’s  size  at  birth  (i.e.  very  small,  smaller  than       15 Food and Nutrition Council, 2013. The Food and Nutrition Security Policy for Zimbabwe in the Context of Economic  Growth and Development.  16 The Lancet, 2010. Child Health Epidemiologic Reference Group cited National Child Survival Strategy 2010‐2015  32 average, average, larger than average, very large) and the mother’s recall of the child’s weight or the weight as recorded on a health card if the child was weighed at birth.17 Overall, 83 percent of last live births in the two years preceding the survey were weighed at birth. Of all the last live births in the two years preceding the survey, 10.1 percent were estimated to have weighed less than 2 500 grams at birth (see Table NU.1). There was variation by province, ranging from 8.6 percent in Midlands Province to 12.4 percent in Matabeleland South Province. 17 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 Table NU.1: Low birth weight infants Percentage of last live births in the last two years that are estimated to have weighed below 2 500 grams at birth and percentage of live births weighed at birth, Zimbabwe MICS, 2014 Percent 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 Missing/ DK Below 2 500 grams1 Weighed at birth2 Total 3.8 10.1 52.5 33.5 0.2 100.0 10.1 83.0 3 902 Mother's age at birth Less than 20 years 3.9 12.8 52.9 30.4 0.0 100.0 11.1 83.8 707 20-34 years 3.4 9.8 52.9 33.7 0.2 100.0 9.7 83.0 2 737 35-49 years 5.5 7.7 50.0 36.7 0.2 100.0 10.4 82.2 459 Birth order 1 4.4 12.1 52.9 30.5 0.1 100.0 11.2 90.0 1 060 2-3 3.1 8.9 53.8 34.0 0.2 100.0 9.2 83.6 1 737 4-5 4.0 10.7 50.4 34.7 0.1 100.0 10.4 81.0 802 6+ 5.0 8.5 49.4 37.2 0.0 100.0 10.3 60.5 303 Province Manicaland 6.4 6.4 57.8 29.2 0.2 100.0 11.0 73.3 503 Mash Central 2.3 10.4 52.1 35.2 0.0 100.0 9.0 73.2 228 Mash East 2.1 11.7 55.6 30.4 0.3 100.0 9.5 81.0 446 Mash West 3.9 12.3 41.6 42.0 0.2 100.0 10.4 81.2 516 Mat North 3.3 15.1 42.5 38.9 0.2 100.0 11.0 88.8 336 Mat South 5.1 14.6 49.4 30.8 0.0 100.0 12.4 90.4 298 Midlands 2.5 8.4 55.2 33.9 0.0 100.0 8.6 78.2 464 Masvingo 4.0 7.5 56.8 31.6 0.2 100.0 9.4 80.1 423 Harare 3.5 7.0 54.7 34.8 0.0 100.0 8.9 92.8 411 Bulawayo 4.2 10.4 59.9 25.1 0.4 100.0 10.8 98.8 276 Area Urban 3.5 7.9 55.1 33.2 0.2 100.0 9.2 95.2 1 145 Rural 3.9 11.0 51.4 33.6 0.1 100.0 10.4 78.0 2 758 Mother’s education None (17.1) (16.1) (36.1) (30.6) (0.0) 100.0 (21.2) (65.3) 44 Primary 3.5 12.4 49.5 34.3 0.3 100.0 10.6 72.0 1 194 Secondary 3.7 9.2 54.4 32.7 0.1 100.0 9.8 87.5 2 473 Higher 2.8 6.5 50.9 39.3 0.4 100.0 8.0 98.7 192 33 5.2 Nutritional Status Children’s nutritional status is a reflection of their overall health. When children have access to an adequate food supply, are not exposed to repeated illness and are well cared for, they reach their growth potential and are considered well nourished. The Millennium Development Goal target is to reduce by half the proportion of people who suffer from hunger between 1990 and 2015. A reduction in the prevalence of malnutrition will also assist in the goal to reduce child mortality. In a well-nourished population, there is a reference distribution of height18 and weight for children under age five. Under-nourishment in a population can be gauged by comparing children to a reference population. The reference population used in this report is based on the WHO growth standards19. Each of the three nutritional status indicators – weight-for-age, height-for-age and weight-for-height - can be expressed in standard deviation units (z-scores) from the median of the reference population. Weight-for-age is a measure of both acute and chronic malnutrition. Children whose weight-for-age is more than two standard deviations below the median of the reference population are considered moderately or severely underweight while those whose weight-for-age is more than three standard deviations below the median are classified as severely underweight. Height-for-age is a measure of linear growth. Children whose height-for-age is more than two standard deviations below the median of the reference population are considered short for their age and are classified as moderately or severely stunted. Those whose height-for-age is more than three standard deviations below the median are classified as severely stunted. Stunting is a reflection of chronic malnutrition as a result of failure to receive adequate nutrition over a long period and recurrent or chronic illness. Weight-for-height can be used to assess wasting and overweight status. Children whose weight-for- height is more than two standard deviations below the median of the reference population are classified as moderately or severely wasted while those who fall more than three standard deviations below the median are classified as severely wasted. Wasting is usually the result of a recent nutritional deficiency. The indicator of wasting may exhibit significant seasonal shifts associated with changes in the availability of food or disease prevalence. Children whose weight-for-height is more than two 18 Length was measured for children under two years. Height includes length. 19 http://www.who.int/childgrowth/standards/technical_report Wealth index quintile Poorest 4.6 10.9 49.0 35.4 0.1 100.0 10.8 73.0 810 Second 4.0 11.3 51.3 33.2 0.1 100.0 10.6 76.2 781 Middle 3.1 12.0 52.2 32.5 0.2 100.0 10.2 81.0 664 Fourth 3.9 8.7 55.7 31.8 0.0 100.0 9.8 88.2 959 Richest 3.1 7.9 54.0 34.6 0.4 100.0 8.9 97.3 688 1 MICS indicator 2.20 - Low-birth weight infants 2 MICS indicator 2.21 - Infants weighed at birth ( ) Figures that are based on 25-49 unweighted cases 34 standard deviations above the median reference population are classified as moderately or severely overweight. In MICS, weights and heights of all children under 5 years of age were measured using the anthropometric equipment recommended20 by UNICEF. Findings in this section are based on the results of these measurements. Table NU.2 shows percentages of children classified into each of the above described categories, based on the anthropometric measurements that were taken during fieldwork. Additionally, the table includes mean z-scores for all three anthropometric indicators. Children whose full birth date (month and year) were not obtained and children whose measurements were outside a plausible range are excluded from Table NU.2. Children were excluded from one or more of the anthropometric indicators when either their weights or heights had not been measured, whichever was applicable. For example, if a child had been weighed but his/her height had not been measured, the child was included in underweight calculations, but not in the calculations for stunting and wasting. Percentages of children by age and reasons for exclusion are shown in the data quality Tables DQ.12, DQ.13, and DQ.14 in Appendix F. The tables show that due to incomplete dates of birth, implausible measurements, and/or missing weight and/or height, three percent of children have been excluded from calculations of the weight-for-age indicator and 3.4 percent each from the height-for- age and the weight-for-height indicators. Table DQ.4 indicates that 97 percent of children 0 to 4 were eligible for the survey and shows an out-transference of children from age 4 to age 5. Age heaping (Table DQ.15) on ‘0’ or ‘5’, due to digit preference, indicates 20.8 percent for weight and 22.2 percent for height which are within acceptable level of 20 percent. Table DQ.8 shows that completeness of reporting of date of birth and age was 99.9 percent. 20 See MICS Supply Procurement Instructions here: http://www.childinfo.org/mics5_planning.html 35 Table NU.2: Nutritional status of children Percentage of children under age 5 by nutritional status according to three anthropometric indices: weight for age, height for age, and weight for height, Zimbabwe MICS, 2014 Weight for age Number of children under age 5 Height for age Number of children under age 5 Weight for height Number of children under age 5 Underweight Mean Z- Score (SD) Stunted Mean Z- Score (SD) Wasted Overweight Mean Z- Score (SD) Percent below Percent below Percent below Percent above - 2 SD1 - 3 SD2 - 2 SD3 - 3 SD4 - 2 SD5 - 3 SD6 + 2 SD7 Total 11.2 2.2 -0.8 9 591 27.6 7.8 -1.3 9 558 3.3 0.7 3.6 0.0 9 550 Sex Male 12.5 2.4 -0.8 4 771 31.1 9.7 -1.4 4 753 3.7 0.9 3.6 0.0 4 748 Female 9.8 2.0 -0.7 4 820 24.1 5.8 -1.2 4 805 2.9 0.6 3.5 0.0 4 802 Province Manicaland 10.8 1.5 -0.8 1 277 34.0 10.0 -1.6 1 275 2.6 0.3 4.2 0.1 1 272 Mashonaland Central 13.0 2.5 -0.9 539 31.8 8.8 -1.5 537 2.8 0.5 2.4 -0.1 538 Mashonaland East 12.5 2.7 -0.9 1 049 25.7 7.0 -1.3 1 046 3.6 1.2 2.1 -0.2 1 045 Mashonaland West 11.7 2.1 -0.8 1 243 28.0 7.6 -1.4 1 239 3.6 0.7 3.4 -0.1 1 240 Matabeleland North 11.4 2.1 -0.7 896 25.8 7.9 -1.3 887 3.8 1.0 4.9 -0.1 883 Matabeleland South 13.9 2.8 -1.0 780 30.1 7.3 -1.4 779 3.9 0.4 1.8 -0.3 780 Midlands 11.1 2.9 -0.8 1 198 26.9 8.2 -1.3 1 196 3.7 0.8 3.3 -0.1 1 195 Masvingo 10.9 2.5 -0.7 1 124 29.4 8.8 -1.4 1 121 2.8 0.9 4.9 0.1 1 119 Harare 7.0 0.7 -0.5 883 21.0 4.1 -1.1 879 2.1 0.3 3.3 0.1 878 Bulawayo 9.6 2.1 -0.6 601 20.0 6.5 -1.1 598 3.8 1.1 5.2 0.0 600 Area Urban 6.8 1.2 -0.5 2 545 20.0 5.2 -1.1 2 537 2.5 0.6 4.0 0.1 2 535 Rural 12.7 2.5 -0.9 7 047 30.4 8.7 -1.4 7 021 3.5 0.8 3.4 -0.1 7 015 Age 0-5 months 7.8 3.0 -0.4 853 14.1 5.8 -0.7 846 4.9 2.0 9.4 0.2 828 6-11 months 9.9 2.3 -0.5 926 15.8 4.4 -0.8 922 5.3 .9 4.5 -0.1 923 12-17 months 13.4 2.8 -0.7 935 25.2 5.7 -1.2 930 6.4 1.2 3.6 -0.2 932 18-23 months 14.7 3.7 -0.9 1 006 39.0 13.1 -1.7 1 006 4.3 .9 3.6 -0.1 1 004 24-35 months 10.9 2.0 -0.8 1 989 38.6 11.0 -1.7 1 983 1.8 0.5 3.6 0.1 1 987 36 36-47 months 11.0 1.5 -0.9 2 072 28.4 7.9 -1.5 2 064 1.8 0.3 2.3 0.0 2 068 48-59 months 10.8 1.4 -0.9 1 810 22.0 4.7 -1.2 1 806 2.6 0.4 1.7 -0.2 1 807 Mother’s education None 15.2 5.3 -1.0 308 30.9 13.8 -1.6 308 4.5 1.6 1.1 -0.2 313 Primary 14.0 2.6 -0.9 3 477 33.5 10.3 -1.5 3 461 3.4 0.7 3.4 -0.1 3 462 Secondary 9.5 1.9 -0.7 5 371 24.7 6.3 -1.3 5 355 3.2 0.7 3.6 0.0 5 344 Higher 5.4 .3 -0.3 434 13.9 1.8 -0.8 432 1.8 0.3 5.6 0.2 431 Missing/DK (*) (*) (*) 1 (*) (*) (*) 1 (*) (*) (*) (*) 1 Wealth index quintile Poorest 15.2 3.2 -0.9 2 133 33.4 11.3 -1.5 2 123 4.5 1.3 3.7 -0.2 2 113 Second 12.7 2.3 -0.9 2 036 31.3 8.6 -1.5 2 027 3.2 0.5 2.7 -0.1 2 028 Middle 10.5 2.1 -0.8 1 755 28.3 7.5 -1.4 1 750 2.6 0.5 3.4 0.0 1 751 Fourth 11.2 2.2 -0.7 2 100 27.0 7.1 -1.3 2 095 3.6 0.5 3.5 0.0 2 095 Richest 4.4 0.7 -0.4 1 568 15.0 3.1 -0.9 1 563 2.0 0.7 4.8 0.1 1 563 1 MICS indicator 2.1a and MDG indicator 1.8 - Underweight prevalence (moderate and severe) 2 MICS indicator 2.1b - Underweight prevalence (severe) 3 MICS indicator 2.2a - Stunting prevalence (moderate and severe) 4 MICS indicator 2.2b - Stunting prevalence (severe) 5 MICS indicator 2.3a - Wasting prevalence (moderate and severe) 6 MICS indicator 2.3b - Wasting prevalence (severe) 7 MICS indicator 2.4 - Overweight prevalence (*) Figures that are based on less than 25 unweighted cases 37 Eleven percent of children under 5 years of age in Zimbabwe were moderately underweight and 2.2 percent were severely underweight, see Table NU.2. More than a quarter of children (27.6 percent) were moderately stunted or too short for their age and 3.3 percent were moderately wasted or too thin for their height. About 3.6 percent of the children were moderately overweight or too heavy for their height. Children in Matabeleland South Province were more likely to be underweight (13.9 percent) and wasted (3.9 percent) than children in other provinces while stunting (34.0 percent) was highest in Manicaland Province. The results show that the percentage of stunted children was higher in rural (30.4 percent) compared to 20 percent in urban areas. Similarly, children in rural areas were more likely to be underweight than children in urban areas. Those children whose mothers had secondary or higher education were the least likely to be underweight and stunted compared to children born of mothers with no education. Boys appeared to be slightly more likely to be underweight, stunted and wasted than girls. The age pattern showed that a higher percentage of children age 12-23 months were undernourished according to underweight and wasting indicators, in comparison to children who were younger and older (see Figure NU.1). Stunting rates significantly increased after 11 months reaching its highest levels between 18 and 36 months. Children in Bulawayo, Matabeleland North, Masvingo and Manicaland provinces were more likely to be overweight as the proportions overweight were 5.2 percent, 4.9 percent (Matabeleland North and Masvingo provinces) and 4.2 percent, respectively. The prevalence of being overweight among children tended to increase as the mother’s level of education increased (see Table NU.2). 38 F igure NU.1: Underweight , s tunted, wasted and overweight ch i ldren under age 5 (moderate and severe) , Z imbabwe MICS, 2014 5.3 Breastfeeding and Infant and Young Child Feeding Proper feeding of infants and young children can increase their chances of survival; it can also promote optimal growth and development, especially in the critical window from birth to 2 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 6 months or stop breastfeeding too soon. There are often pressures to switch to infant formula, 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 6 months onwards leads to better health and growth outcomes, with a potential to reduce stunting during the first two years of life.21 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 2 years of age and beyond.22 Starting at 6 months, breastfeeding should be combined with safe, age-appropriate feeding of solid, semi-solid 21 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. 22 WHO (2003). Implementing the Global Strategy for Infant and Young Child Feeding. Meeting Report Geneva, 3-5 February 2003. 0 5 10 15 20 25 30 35 40 45 0 12 24 36 48 60 P e rc e n t Age in months Underweight Stunted Wasted Overweight 39 and soft foods.23 A summary of key guiding principles24, 25 for feeding 6-23 month olds 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:  continued breastfeeding;  appropriate frequency of meals (but not energy density); and  appropriate nutrient content of food. Feeding frequency is used as proxy for energy intake, requiring children to receive a minimum number of meals/snacks (and milk feeds for non-breastfed children) for their age. Diet diversity is used to ascertain the adequacy of the nutrient content of the food (not including iron) consumed. For diet 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).26 These three dimensions of child feeding are combined into an assessment of the 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:  the appropriate number of meals/snacks/milk feeds;  food items from at least 4 food groups; and  breast milk or at least 2 milk feeds (for non-breastfed children). 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 groups27 eaten in the last 24 hours NU.6 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 23 WHO (2003). Global Strategy for Infant and Young Child Feeding. 24 PAHO (2003). Guiding principles for complementary feeding of the breastfed child. 25 WHO (2005). Guiding principles for feeding non-breastfed children 6-24 months of age 26 WHO (2008). Indicators for assessing infant and young child feeding practices. Part 1: Definitions. 27 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. 40 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, and within one day of birth, and percentage who received a prelacteal feed, Zimbabwe MICS, 2014 Percentage who were ever breastfed1 Percentage who were first breastfed: Percentage who received a prelacteal feed Number of last live-born children in the last two years Within one hour of birth2 Within one day of birth Total 98.1 58.9 92.2 6.8 3 902 Province Manicaland 98.7 52.5 95.1 6.7 503 Mashonaland Central 99.2 63.8 93.2 7.9 228 Mashonaland East 99.0 59.3 91.9 11.0 446 Mashonaland West 98.2 59.3 91.9 7.0 516 Matabeleland North 98.9 70.0 96.0 3.7 336 Matabeleland South 95.6 53.2 85.8 3.2 298 Midlands 99.0 60.3 91.8 6.8 464 Masvingo 97.6 59.6 93.4 7.0 423 Harare 97.4 54.1 89.9 8.5 411 Bulawayo 96.8 60.8 91.9 3.9 276 Area Urban 97.4 58.2 92.0 6.4 1 145 Rural 98.4 59.1 92.3 7.0 2 758 Months since last birth 0-11 months 97.8 58.5 92.8 7.2 1 871 12-23 months 98.4 59.2 91.7 6.5 2 031 Assistance at delivery Skilled attendant 98.2 63.1 93.0 4.2 3 122 Traditional birth attendant 98.7 33.4 82.7 33.7 225 Other 97.6 45.6 92.3 11.5 450 No one/Missing 95.7 43.7 88.7 6.0 106 Place of delivery On way to clinic (98.3) (33.2) (94.4) (3.6) 32 Home 98.3 43.6 89.7 17.6 688 Health Facility 98.2 63.2 93.0 4.3 3 108 Public 98.2 63.7 93.2 3.9 2 575 Private 97.8 52.0 87.9 11.2 183 Mission 98.9 65.4 94.3 3.1 349 Other/DK/Missing 92.2 30.5 81.1 15.0 74 Mother’s education None (97.6) (53.7) (88.2) (9.2) 44 Primary 97.9 57.5 92.2 8.2 1 194 Secondary 98.2 59.8 92.3 6.0 2 473 Higher 98.8 56.1 92.7 8.4 192 Wealth index quintile Poorest 98.6 59.7 92.1 7.7 810 Second 98.0 58.4 91.5 8.4 781 Middle 98.4 57.7 91.9 5.6 664 Fourth 98.7 59.6 94.3 5.8 959 Richest 96.7 58.5 90.6 6.5 688 1 MICS indicator 2.5 - Children ever breastfed 2 MICS indicator 2.6 - Early initiation of breastfeeding ( ) Figures that are based on 25-49 unweighted cases 41 Table NU.3 is based on mothers’ reports of what their last-born child, born in the last two years preceding the survey, were 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 and those who received a prelacteal feed.28 Breastfeeding is near universal in Zimbabwe with 98.1 percent of children ever breastfed. Although a very important step in management of lactation and establishment of a physical and emotional relationship between the baby and the mother, only 58.9 percent of babies were breastfed for the first time within one hour of birth while 92.2 percent of newborn babies in Zimbabwe started breastfeeding within one day of birth. Newborn babies in Matabeleland North Province were most likely to be breastfed within one hour of birth (70.0 percent) or within a day (96.0 percent). They were least likely to be breastfed within one hour of birth in Manicaland Province (52.5 percent). About eighty-six percent of newborn babies in Matabeleland South Province were breastfed within one day of birth, which was the lowest among all the provinces. The onset of breastfeeding also varied with place of delivery and by the person who assisted the delivery. Children delivered in mission or public health facilities were more likely to be breastfed within the hour or in one day than those delivered in a private sector health facility. Babies delivered by a skilled birth attendant were more likely to be breastfed within one hour (63.1 percent) compared to those delivered by a traditional birth attendant (33.4 percent). The percentage of children who received prelacteal feed was 6.8 percent. Most of the children who received prelacteal feeds were delivered by a traditional birth attendant (33.7 percent), delivered at home (17.6 percent) or delivered in a private sector health facility (11.2 percent). 28 Prelacteal feed refers to the provision any liquid or food, other than breastmilk, to a newborn during the period when breastmilk flow is generally being established (estimated here as the first 3 days of life). 42 F igure NU.2: In i t iat ion of breast feeding, Z imbabwe MICS, 2014 The set of infant and young child feeding indicators reported in tables NU.4 through NU.8 are based on the mother’s/primary caregiver’s report of the baby’s consumption of food and fluids during the day or night prior to being interviewed. Data are subject to a number of limitations, including 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 infants. Exclusive breastfeeding is when infants age less than 6 months are fed on breast milk only, allowing for vitamins, mineral supplements and medicine to be administered as prescribed. Predominant breastfeeding is when infants age less than 6 months are given plain water and non-milk liquids in addition to breast milk. The table also shows continued breastfeeding of children at 12-15 and 20-23 months of age. 95 93 92 92 96 86 92 93 90 92 92 92 92 53 64 59 59 70 53 60 60 54 61 58 59 59 0 20 40 60 80 100 P er ce n t Within one day Within one hour 43 Overall, 64.4 percent of infants age 0-5 months were predominantly breastfed. Female infants were more likely to be predominantly breastfed (67.5 percent) compared to male infants (61.1 percent) and there were no urban/rural differentials. In Zimbabwe, exclusive breastfeeding is being promoted. According to WHO/UNICEF, the widely accepted ‘’universal coverage’’ target for exclusive breastfeeding is 90 percent29. Forty-one percent of infants less than 6 months were exclusively breastfed. There were no sex differentials, however, infants in urban areas (44.9 percent) were more likely to be exclusively breastfed than those in rural areas (39.5 percent). Although none of the provinces is yet to reach the national target, Matabeleland North and Matabeleland South provinces had the highest percentages of exclusively breastfed infants, 58.6 and 57.3, respectively, whilst Mashonaland West Province had the lowest (29.6 percent). Eighty- four percent of children age 12-15 months were still breastfeeding while 17.1 percent of children age 20-23 months were still breastfeeding, see Table NU.4. 29 Caix, Brown D.W, Wardlaw T. 2012. Global Trends in Exclusive Breastfeeding. International Breastfeeding Journal Vol 7, No. 12. 44 Table NU.4: Breastfeeding Percentage of living children according to breastfeeding status at selected age groups, Zimbabwe MICS, 2014 Children age 0-5 months Children age 12-15 months Children age 20-23 months Percent exclusively breastfed1 Percent predominantly breastfed2 Number of children Percent breastfed (Continued breastfeeding at 1 year)3 Number of children Percent breastfed (Continued breastfeeding at 2 years)4 Number of children Total 41.0 64.4 879 84.4 638 17.1 686 Sex Male 41.1 61.1 434 86.8 308 15.7 335 Female 41.0 67.5 444 82.2 331 18.4 350 Province Manicaland 34.8 75.4 108 90.9 84 14.5 95 Mashonaland Central (32.4) (63.0) 45 (92.8) 33 (23.6) 44 Mashonaland East 30.6 55.9 117 92.8 81 14.7 60 Mashonaland West 29.6 59.6 109 82.8 80 14.5 87 Matabeleland North 58.6 72.2 77 (86.2) 49 (34.1) 49 Matabeleland South 57.3 75.9 69 (78.1) 49 (12.5) 50 Midlands 48.6 68.6 117 80.9 69 24.7 90 Masvingo 41.8 53.2 98 81.2 81 17.1 87 Harare 41.6 66.1 84 75.5 64 6.9 72 Bulawayo 41.9 53.5 53 (82.7) 49 (12.0) 51 Area Urban 44.9 64.1 249 78.7 175 9.3 189 Rural 39.5 64.5 630 86.5 464 20.0 497 Mother’s education None (*) (*) 5 (*) 13 (*) 22 Primary 34.8 61.8 287 83.0 204 20.5 234 Secondary 44.7 65.9 544 86.7 384 15.6 395 Higher (36.4) (58.3) 43 (76.5) 38 (9.0) 35 Wealth index quintile Poorest 43.4 68.0 178 84.4 132 26.9 165 Second 39.9 62.7 183 89.4 140 25.9 143 Middle 35.9 66.6 148 85.8 119 11.3 110 Fourth 41.0 61.5 216 83.2 146 7.2 145 Richest 44.5 64.0 155 77.7 102 10.5 122 1 MICS indicator 2.7 - Exclusive breastfeeding under 6 months 2 MICS indicator 2.8 - Predominant breastfeeding under 6 months 3 MICS indicator 2.9 - Continued breastfeeding at 1 year 4 MICS indicator 2.10 - Continued breastfeeding at 2 years ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 45 Figure NU.3 shows the detailed pattern of breastfeeding by the child’s age in months. Some children were receiving liquids or foods other than breast milk, with plain water being of highest prevalence at the early age of 0-1 month. At age 4-5 months, the percentage of children exclusively breastfed was below 20 percent. F igure NU.3: Infant feeding patterns by age, Z imb abwe MICS, 2014 Table NU.5 shows the median duration of breastfeeding by selected background characteristics. Among children under age 3 years, the median duration was 17.7 months for any breastfeeding, 2 months for exclusive breastfeeding and 3.8 months for predominant breastfeeding. The median duration of exclusive breastfeeding varied from less than a month in Mashonaland Central Province to more than 3 months in Matabeleland South and Matabeleland North provinces. Exclusively breastfed Breastfed and complimentary foods Weaned (not breastfed) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0-1 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-17 18-19 20-21 22-23 Age in months Exclusively breastfed Breastfed and plain water only Breastfed and non-milk liquids Breastfed and other milk / formula Breastfed and complimentary foods Weaned (not breastfed) 46 Table NU.5: Duration of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children age 0-35 months, Zimbabwe MICS, 2014 Median duration (in months) of: Number of children age 0-35 months Any breastfeeding1 Exclusive breastfeeding Predominant breastfeeding Median 17.7 2.0 3.8 5 859 Sex 17.8 2.0 3.5 2 936 Male 17.7 2.0 4.0 2 924 Female Province Manicaland 17.7 1.7 4.5 779 Mashonaland Central 19.3 0.7 3.9 330 Mashonaland East 18.9 1.3 3.1 655 Mashonaland West 17.6 1.7 3.3 773 Matabeleland North 19.3 3.2 4.3 535 Matabeleland South 16.2 3.1 4.4 452 Midlands 16.9 2.4 4.4 700 Masvingo 18.1 2.1 2.8 663 Harare 17.0 2.1 3.8 561 Bulawayo 16.7 2.1 2.8 410 Area Urban 16.9 2.2 3.6 1 627 Rural 18.1 1.9 3.8 4 232 Mother’s education None 17.1 0.5 4.7 139 Primary 18.4 1.6 3.9 1 995 Secondary 17.5 2.2 3.8 3 426 Higher 16.6 1.6 3.1 298 Wealth index quintile Poorest 18.9 2.2 4.2 1 256 Second 18.0 1.7 3.7 1 205 Middle 17.2 1.5 4.0 1 040 Fourth 17.4 2.1 3.6 1 353 Richest 17.2 2.2 3.5 1 006 Mean 17.7 2.6 4.4 5 859 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 were used depending on the age of the child. For infants age 0-5 months, exclusive breastfeeding was considered as age-appropriate feeding while children age 6-23 months were considered to be appropriately fed if they were receiving breast milk and solid, semi-solid or soft food. Age appropriate breastfeeding was 57.1 percent for children age 0-23 months. Variations were noted for mother’s education ranging from 48.9 percent for mothers with no education to 58.7 percent for those with secondary education. 47 Table NU.6: Age-appropriate breastfeeding Percentage of children age 0-23 months who were appropriately breastfed during the previous day, Zimbabwe MICS, 2014 Children age 0-5 months Children age 6-23 months Children age 0-23 months Percent exclusively breastfed1 Number of children Percent currently breastfeeding and receiving solid, semi-solid or soft foods Number of children Percent appropriately breastfed2 Number of children Total 41.0 879 61.9 2 927 57.1 3 806 Sex Male 41.1 434 62.3 1 433 57.4 1 867 Female 41.0 444 61.6 1 494 56.8 1 939 Province Manicaland 34.8 108 60.3 387 54.7 496 Mashonaland Central (32.4) 45 67.7 171 60.3 216 Mashonaland East 30.6 117 70.3 311 59.4 428 Mashonaland West 29.6 109 62.4 384 55.1 493 Matabeleland North 58.6 77 70.2 242 67.4 319 Matabeleland South 57.3 69 53.9 219 54.7 288 Midlands 48.6 117 60.6 353 57.6 469 Masvingo 41.8 98 61.0 343 56.7 441 Harare 41.6 84 57.7 306 54.2 390 Bulawayo 41.9 53 56.1 213 53.2 266 Area Urban 44.9 249 57.3 832 54.5 1 081 Rural 39.5 630 63.8 2 095 58.2 2 724 Mother’s education None (*) 5 49.6 60 48.9 65 Primary 34.8 287 61.5 930 55.2 1 218 Secondary 44.7 544 63.0 1 783 58.7 2 327 Higher (36.4) 43 56.4 154 52.1 196 Wealth index quintile Poorest 43.4 178 64.4 645 59.9 823 Second 39.9 183 65.9 604 59.8 787 Middle 35.9 148 60.1 501 54.6 649 Fourth 41.0 216 60.0 671 55.4 887 Richest 44.5 155 58.5 506 55.2 661 1 MICS indicator 2.7 - Exclusive breastfeeding under 6 months 2 MICS indicator 2.12 - Age-appropriate breastfeeding ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases Overall, 87.3 percent of infants age 6-8 months received solid, semi-solid, or soft foods at least once during the previous day (see Table NU.7). The proportion for all infants who received solid, semi-solid, or soft foods at least once during the previous day was comparable for both boys and girls and by urban/rural areas. Due to a low case count for infants 6-8 months currently not breastfeeding, it was not possible to compare between breastfeeding and non-breastfeeding infants. 48 Table NU.7: Introduction of solid, semi-solid, or soft foods Percentage of infants age 6-8 months who received solid, semi-solid, or soft foods during the previous day, Zimbabwe MICS, 2014 Currently breastfeeding Currently not breastfeeding All Percent receiving solid, semi- solid or soft foods Number of children age 6-8 months Percent receiving solid, semi- solid or soft foods Number of children age 6- 8 months Percent receiving solid, semi- solid or soft foods1 Number of children age 6-8 months Total 87.1 461 (*) 23 87.3 484 Sex Male 86.6 226 (*) 9 86.2 236 Female 87.7 235 (*) 13 88.3 248 Area Urban 88.7 130 (*) 11 89.1 141 Rural 86.5 332 (*) 11 86.5 343 Wealth Index quintile Poorest 79.8 85 (*) 4 79.5 89 Second 92.2 91 (*) 2 91.9 93 Middle 87.1 87 (*) 3 87.5 90 Fourth 84.3 115 (*) 2 84.5 117 Richest 93.0 83 (*) 11 93.0 94 1 MICS indicator 2.13 - Introduction of solid, semi-solid or soft foods (*) Figures that are based on less than 25 unweighted cases The critical “window of opportunity” that exists between conception and the child’s second year of life paves way for a strong, healthy and productive future. Optimal nutrition (exclusive breastfeeding and minimum acceptable diet) from 0-23 months has a lasting impact on a child’s growth, development and future productivity. Absence of proper nutrition during this critical period exposes the child to frequent and severe childhood illnesses, stunted growth, developmental delays and death.30 Overall, more than half of the children age 6-23 months (59.1 percent) were fed the minimum number of times. A slightly higher proportion of females (60.4 percent) were achieving the minimum meal frequency compared to males (57.8 percent) (see Table NU.8). The proportion of children receiving the minimum dietary diversity, that is, foods from at least 4 food groups (28.0 percent), was much lower than that for minimum meal frequency. The overall assessment using the indicator of minimum acceptable diet revealed that only 12.9 percent of children age 6-23 months were benefitting from a diet sufficient in both diversity and frequency. By province, diet sufficiency in both diversity and frequency was highest in Bulawayo Province (27.3 percent) and lowest in Matabeleland South, Mashonaland Central and Mashonaland West provinces (7 percent each). The proportion was higher in urban than rural areas and increased with mother’s education and household socio-economic status. 30 2013 Lancet Series (on nutrition) launch and roundtable meeting, 29 August 2013. http://scalingupnutrition.org/wp- content/uploads/2013/09/06-Nigeria-Lancet-Full-Summary.pdf 49 Table NU.8: Infant and young child feeding (IYCF) practices Percentage of children age 6-23 months who received appropriate liquids and solid, semi-solid, or soft foods the minimum number of times or more during the previous day, by breastfeeding status, Zimbabwe MICS, 2014 Currently breastfeeding Currently not breastfeeding All Percent of children who received: Number of children age 6-23 months Percent of children who received: Number of children age 6- 23 months Percent of children who received: Number of children age 6- 23 months Minimum dietary diversitya Minimum meal frequencyb Minimum acceptable diet1, c Minimum dietary diversitya Minimum meal frequencyb Minimum acceptable diet2, c At least 2 milk feeds3 Minimum dietary diversity4, a Minimum meal frequency5, b Minimum acceptable dietc Total 21.2 60.8 17.3 1 911 40.7 55.8 4.6 11.3 985 28.0 59.1 12.9 2 927 Sex Male 21.1 60.4 17.2 945 39.5 52.6 4.9 11.1 477 27.3 57.8 13.1 1 433 Female 21.3 61.3 17.3 965 41.8 58.9 4.2 11.6 508 28.6 60.4 12.8 1 494 Age 6-8 months 5.4 63.5 5.1 461 44.4 (*) (*) (*) 19 6.9 63.4 5.3 484 9-11 months 17.6 49.2 15.0 437 24.5 (*) (*) (*) 16 17.8 50.0 14.8 453 12-17 months 29.1 64.3 22.7 743 50.3 62.6 10.3 22.1 192 33.6 64.0 20.2 949 18-23 months 32.3 65.4 26.6 269 38.5 53.6 2.9 7.5 758 37.0 56.7 9.1 1 041 Province Manicaland 21.5 52.0 17.1 248 36.9 46.5 0.8 4.3 137 26.8 50.1 11.3 387 Mash Central 12.6 50.2 9.6 124 (27.3) (40.9) (1.3) (2.3) 46 16.5 47.6 7.4 171 Mash East 30.9 67.7 25.5 228 57.6 55.9 2.9 9.9 81 38.4 64.6 19.6 311 Mash West 9.9 62.5 8.7 254 37.2 54.4 4.6 10.9 129 19.3 59.8 7.3 384 Mat North 13.6 66.0 13.2 178 12.4 56.7 0.0 14.5 59 13.5 63.6 9.9 242 Mat South 15.5 63.6 11.7 121 35.8 70.1 1.3 13.9 92 23.7 66.4 7.2 219 Midlands 17.7 61.4 13.3 224 37.4 58.1 2.3 7.0 124 25.6 60.2 9.4 353 Masvingo 21.3 46.7 16.6 227 31.1 33.9 3.8 8.0 114 24.5 42.4 12.4 343 Harare 33.5 66.5 24.4 183 65.8 69.5 13.0 19.5 119 46.1 67.7 19.9 306 Bulawayo 39.0 79.5 36.6 123 51.4 72.1 13.4 24.3 83 43.7 76.5 27.3 213 Area Urban 33.9 69.4 28.2 500 59.6 70.7 9.4 18.1 318 43.9 69.9 20.9 832 Rural 16.7 57.8 13.4 1 410 31.7 48.7 2.3 8.1 667 21.6 54.9 9.8 2 095 50 Mother’s education None (3.8) (46.7) (0.0) 30 (23.5) (37.5) (3.7) (7.4) 26 14.1 42.4 1.7 60 Primary 16.2 54.3 12.6 602 28.7 44.8 3.7 9.7 318 20.7 51.0 9.5 930 Secondary 22.3 63.3 18.4 1 191 43.7 59.4 3.4 10.4 575 29.4 62.0 13.5 1 783 Higher 45.8 77.1 40.3 88 79.6 85.6 20.0 29.2 65 60.4 80.7 31.7 154 Wealth index quintile Poorest 13.7 54.0 11.7 441 25.2 38.3 0.5 4.5 195 17.3 49.2 8.3 645 Second 16.5 57.8 12.9 413 23.8 43.0 0.0 9.5 186 19.0 53.2 8.9 604 Middle 17.4 57.9 13.2 324 38.1 57.1 5.5 10.5 174 24.7 57.6 10.5 501 Fourth 24.1 62.1 18.8 430 47.2 60.3 3.0 8.8 238 32.2 61.5 13.2 671 Richest 38.4 76.3 33.5 303 67.1 79.3 14.2 24.0 192 49.8 77.4 26.0 506 1 MICS indicator 2.17a - Minimum acceptable diet (breastfed) 2 MICS indicator 2.17b - Minimum acceptable diet (non-breastfed) 3 MICS indicator 2.14 - Milk feeding frequency for non-breastfed children 4 MICS indicator 2.16 - Minimum dietary diversity 5 MICS indicator 2.15 - Minimum meal frequency a Minimum dietary diversity is defined as receiving foods from at least 4 of 7 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. b Minimum meal frequency among currently breastfeeding children is defined as children who also received solid, semi-solid, or soft foods 2 times or more daily for children age 6-8 months and 3 times or more daily for children age 9-23 months. For non-breastfeeding children age 6-23 months it is defined as receiving solid, semi-solid or soft foods, or milk feeds, at least 4 times. c The minimum acceptable diet for breastfed children age 6-23 months is defined as receiving the minimum dietary diversity and the minimum meal frequency, while it for non-breastfed children further requires at least 2 milk feedings and that the minimum dietary diversity is achieved without counting milk feeds. ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 51 Bottle feeding is the practice of feeding infants from a bottle. Bottles with teats are discouraged from use as they are difficult to clean and can be easily contaminated increasing the risk of introducing illness to infants. Use of low quality bottles can further aggravate this risk. The adverse effects of bottle use are profound in areas with limited economic resources, lack of clean water and unhygienic surroundings. Bottle feeding then increases infants’ susceptibility to diarrhoea and other gastro- intestinal infections. Table NU.9 shows that 10.3 percent of children under 2 years were fed using a bottle with a nipple. The proportion was higher in urban areas (21.6 percent), for children of mothers with secondary or higher education, by age of the child especially for those 6-11 months and for households in higher wealth quintiles. Urban provinces, Bulawayo (25.9 percent) and Harare (22.6 percent) had the highest prevalence of bottle feeding. In the predominantly rural provinces the prevalence of bottle feeding ranged from 3.7 percent in Mashonaland Central Province to 10.8 percent in Matabeleland South Province. 52 Table NU.9: Bottle feeding Percentage of children age 0-23 months who were fed with a bottle with a nipple during the previous day, Zimbabwe MICS, 2014 Percentage of children age 0-23 months fed with a bottle with a nipple1 Number of children age 0-23 months Total 10.3 3 806 Sex Male 10.0 1 867 Female 10.6 1 939 Age 0-5 months 7.8 879 6-11 months 15.3 937 12-23 months 9.1 1 990 Province Manicaland 9.1 496 Mashonaland Central 3.7 216 Mashonaland East 9.8 428 Mashonaland West 6.9 493 Matabeleland North 4.6 319 Matabeleland South 10.8 288 Midlands 6.6 469 Masvingo 6.8 441 Harare 22.6 390 Bulawayo 25.9 266 Area Urban 21.6 1 081 Rural 5.8 2 724 Mother’s education None 4.7 65 Primary 4.4 1 218 Secondary 11.4 2 327 Higher 36.3 196 Wealth index quintile Poorest 2.2 823 Second 4.9 787 Middle 8.9 649 Fourth 10.2 887 Richest 28.3 661 1 MICS indicator 2.18 - Bottle feeding 53 5.4 Salt Iodisation Iodine is an essential micronutrient and iodised salt prevents goitre among children and adults. Iodine deficiency is the world’s leading cause of preventable mental retardation and impaired psychomotor development in young children. This in turn contributes to poor school performance, reduced intellectual ability and impaired work performance. In its most extreme form, iodine deficiency causes cretinism. It also increases the risks of stillbirth and miscarriage in pregnant women. The Zimbabwe Food and Food Standards Regulations of 1995 require that household salt be fortified with iodine to at least 25 parts per million (ppm) at production level. Salt is adequately iodised when it contains at least 15 ppm for household use. The indicator is the percentage of households consuming adequately iodized salt (>15 ppm). The MBI rapid salt test kit was used to test for iodine in salt used by households for cooking. Ninety-six percent of households had salt tested for iodine as shown in Table NU.10. There was no salt in 3.1 percent of households and these households were included in the denominator of the indicator. In 54.5 percent of households, salt was found to contain 15 ppm or more of iodine. There were no variations in households using adequately iodised salt in urban and rural areas. The difference between the richest and poorest households, in terms of iodised salt consumption, was ranging from 51.5 percent in the poorest households to 58.2 in the richest. Table NU.10: Iodised salt consumption Percent distribution of households by consumption of iodized salt, Zimbabwe MICS, 2014 Percentage of households in which salt was tested Number of households Percent of households with: Total Number of households in which salt was tested or with no salt No salt Salt test result Not iodised 0 PPM >0 and <15 PPM 15+ PPM1 Total 96.0 15 686 3.1 8.5 34.0 54.5 100.0 15 528 Province Manicaland 97.1 1 991 2.6 7.5 35.6 54.3 100.0 1 985 Mash Central 97.6 792 1.9 8.8 34.0 55.3 100.0 787 Mash East 97.9 1 828 1.1 10.1 37.4 51.5 100.0 1 809 Mash West 96.0 2 015 3.5 13.9 38.1 44.5 1

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