Kyrgyzstan Multiple Indicator Cluster Survey 1995

Publication date: 1996

MICS Alultiple Indicator Cluster Survey KYRGYZ REPUBLIC 1995 Ill TABLE OF CONTENTS Pages Executive summary . . . . I. Introduction . . 5 1.1. Background of the study . 5 1.2. Organization of the survey . . . 5 1.3. The target population . . . . 6 1.4. The questionnaire and data collection method . . . 6 1.5. Sample size and sample design . 6 1.6. Implementation of field survey . . 7 1.7. Data entry, processing and statistical analysis. . . . . 7 2. Description of the sample population. 8 2.1. Characteristics of sample population . . 8 Households and number of persons in the hqusehold . 8 Number of rooms . 8 Number of children and sex distribution . . 8 2.2 Water and sanitation. 9 Water sources and distance. . . 9 Sanitation facilities . . I 0 Availability of soap . . 11 2.3. Education . . . . . . . II 2.4. Care of Acute Respiratory Infections . 13 2.5. Diarrhoea. . . . 14 2.6. Breast-feeding . 17 2.7. Immunization. . 18 BCG scar. . . . 21 3. Conclusions . . 22 4. Recommendations . . . . . . . . . . . . . . . . . 24 MICS communication planning . . . . 24 Immunization . ,. . 25 Use ofORT and the knowledge of mothers on danger signs of ARI 26 Basic education . ;. 26 Water and sanitation. . . 26 Breast-feeding. 26 Acute Respiratory Infections . . 26 Annexes. . . . . . . 27 Annex I. Map of Kyrgyzstan . 28 Annex II. Location of clusters by oblast . 29 Osh . . . . . . . : . . . ;. . . . 29 Jalal-abad . 30 Chui . :. 31 Jssyk-kul . . :. 32 Naryn . . . . . . . 33 Talas. . . . . . 34 Bishkek city . . . . 35 Annex III. List of interviewers and supervisors . . 40 Annex IV. List of participants, MICS results review meeting . 44 Annex V. Questionnaires . . . :. 45 Questionnaire I. Household module . 45 Questionnaire 2. Water and sanitation module . 46 Questionnaire 3. Education module. . . 47 Questionnaire 4. Care of Acute Respiratory Illness . . 48 Questionnaire 5. Diarrhoea. . 49 Questionnaire 6. Breast-feeding module . 50 Questionnaire 7. Immunization . ;. 51 v LIST OF TABLES and FIGURES TABLES Page Table 1. Distribution of households visited by oblast . . . .' . . . 8 Table 2. Sex distribution of children under 11 years of age by oblast . . 9 Table 3. Age distribution of children by oblast . : . . . . 9 Table 4. Safe toilet facilities by type and oblast . . . . . . . . . . 10 Tabre 5. Indicator status 12.1 by oblast and by gender: Percentage of children entering 1st grade of primary school who eventually reach grade 5 . . . 12 Table 6. School attendance: distribution of school age children by age and gender . . . . . 12 Table 7. Indicator status 12.2 by oblast and gender: Proportion of children of primary school age enrolled in primary school this year . . . . : . . . . . . . 13 Table 8. Indicator status 12.3 by oblast and gender: Proportion of children entering school at entry age . . . . . . . . . 13 Table 9. ARI indicator status by oblast . . . . . 14 Table 10. Signs and symptoms mentioned by mothers for ARI . . . 14 Table 11. Diarrhoea incidence rates in children under 5 years of age in the two weeks prior to the survey . . . : . . . . . . . . . . 15 Table 12. Percentage of diarrhoea cases that are given ORT . . . . . . . 15 Table 13. Type of fluids and food the children received during the last episode of diarrhoea . . 16 Table 14. Changes in amount of fluids given to children with diarrhoea . . . . . . . . . . 17 Table 15. Changes in the amount offood given to children with diarrhoea . . 17 Table !6. Ever and still breast-feeding rates in children under two years of age . . . . 17 Table 17. Exclusive breast-feeding for children under 4 months of age . . . 18 Table 18. Type of fluid and food given to children under II months of age during the previous 24 hours (percentage) . . . . 18 Table 19. Immunization coverage for children aged 12-23 months receiving vaccination before the first birthday (valid immunization coverage) . . . . 19 Table 20. Immunization coverage for children aged 12-23 month receiving vaccination at the time of the survey . . . . . . . . . . . . . . . . . 19 Table 21. The interval in days between DPT2-DPTI and DPT3-DPT2 doses . . . 20 Table 22. Average and modal children's age (in months) at the date of immunization . . . 20 Table 23. BCG scar by oblast, percent found (checked at home by interviewers) . . . . 21 FIGURES Figure I. Access to water sources by oblast . . . . 10 Figure 2. Access to sanitary facilities by oblast . . . ,. II Figure 3. Signs and symptoms mentioned by mothers for ARI . . . . 14 Figure 4. Indicator status, ORT use (old and new definition) by oblast . 15 Figure 5. Type of fluid and food the children received during the last episode of diarrhoea. . . 16 Figure 6. Immunization coverage for children aged 12-23 months receiving vaccination before the first birthday (valid immunization coverage) . . . . . . . . . . . . . 19 EXECUTIVE SUMMARY F ollowing two training workshops in Ashgabat, Turkmenistan, in July 1995 and in Bishkek in October 1995 to introdu.ce the methodolog~, a national Multiple Indicator Cluster Survey (MICS) was conducted m November 1995 m the Kyrgyz Republic. The major objective was to ~valuate the situatio~ at ~id-decade and draw recommendations for programme implementation, taking mto account the dechne m standards due to the economic depression and social deterioration. Detailed objectives can be summarized as follows: I. To evaluate the national situation in child immunization; diarrhoeal diseases, acute respiratory infections, water and sanitation, and basic education in the year 1995 2. To define areas for improved service 3. To define practical implications for improving country programmes 4. To define areas where stronger communication work is needed to better empower families and lower level health workers. 5. To introduce an appropriate, easy-to-use methodology to health and education officials, technicians, and local researchers (mainly universities) for monitoring purposes. The UNICEF Area Office for the Central Asian Republics and Kazakhstan (CARK AO), in collaboration with the Ministry of Health and Ministry of Education, supported the survey as part of the Country Programme of Cooperation. The Kyrgyz Republic gained its independence in 1991. Independence brought a variety of unprecedented economic problems that have had tremendous impact on the living condition of the population, especially in the remote areas of the country, such as Naryn and Talas. Unprepared for the consequences of political and economic independence, the new independent Republic and its people have become recipients of emergency and development assistance provided by multilateral and bilateral donors and international NGOs. Severe economic crisis resulting from the disintegration of the former Soviet Union (FSU) has led to the erosion or discontinuation of most services previously provided by the state. Due to the lack of social benefits that formerly existed, many individuals and families are finding themselves without a functioning social safety net. Economic transition difficulties have trickled down to all levels of society. However, the most vulnerable groups, including children living in remote areas, suffered the most from lack of medicine, malnutrition, iodine and iron deficiency, acute respiratory infections, diarrhoeal diseases, anemia, etc. The financial status of families in the Republic has also sharply declined. Family incomes are usually 8-1 0 times less than the amount needed to support one person, and this minima! income must often feed 5-7 family members. UNICEF intervened in the Kyrgyz Republic in 1993, with the aim of reducing the falls from previous accomplishments and to help compensate for the losses that did occur. UNICEF cooperation combines direct assistance with essential supplies, training and consultations on alternative means for basic services, activities aimed at empowering .families and parents, and advocacy to the government for children and women. Upon starting work in the CARK area, UNICEF has, as a priority, related programme activities to mai~taining indicators regarding the mid-decade goals and addressing the countries with the most urgent needs for children. The MICS s4rvey in the Kyrgyz Republic was conducted in the context of this cooperation. Summary of Findings . Compulsory Education The Kyrgyz Republic Compulsory Education System continues to serve all children, both boys and girls, throughout the country. Enrolment and retention should be monitored carefully in some provinces. MICS Kyrgyz Republic, 1995 2 O~er ~5% of children of school age are attending compulsory schools nationwide. Over 99% of the chtldren who begin school remain in school, and 99% of the children who attend first grade reach fifth grade. Drinking Water Safe drinking water is not available to 29% of the population. In Naryn Province, especially, there is a great problem with access to safe drinking water, with almost half of the population Jacking it. 71% of the national population has access to safe water sources that include piped water supply in the dwelling, tube well or borehole, and protected dugwells or springs. Access in all provinces is over 72%, except for Naryn (55%), Jalal-Abad (61 %) and Osh (64%). The public tab is the most common water source (38.4%), followed by piped-in dwellings (37.8%). Use of pond, river, or stream water, which is considered unsafe, has increased to 22% in Naryn. Sanitation 95% of the population have access to safe sanitation facilities. 111 all areas except Bishkek, the most common type of latrines is the "non-flush private" latrine (this type of latrine can also be called "covered dry pit" latrine). "Non-flush private" latrine is considered "safe" in the sanitation category; however, our observation in the course of more than two years shows that most of them cannot be considered as "safe" due to uncleanliness. The survey measures only the "quantitative" part of the facilities, and not the "qualitative" part. Almost 90% of the homes have soap for washing. Safe sanitary facilities in use include flush-to-sewage latrines and non-flush private latrines. In Chui Province, 12.7% of the population have access to non-flush public latrines, while 10.2% in Osh Province do. Acute Respiratory Infections 75% of the mothers do not know the most important signs of acute respiratory infections in children. Without the parental understanding of these signs, the severity of the illness and the need to seek proper medical care may not come to attention. Fever is found to be a sign most mothers know (82.3%), whereas fast breathing is known by only 12.6% of the mothers. Diarrhoeal Diseases Due to seasonal reasons, only 336 diarrhoeal cases were found in the two weeks prior to the survey. Almost all children with diarrhoea are given some form ofORT (98%). ORS is used in 30.7% of diarrhoeal cases. However, the children who do receive a form ofORT do not receive continued feeding at the same. Using the up-to-date definition of ORT that includes feeding, only 19% of the children who have diarrhoea are treated with ORT. The national incidence rate of children who have had diarrhoea in the first I 0 months of 1995 is 6.8 per 100. Osh Province has the highest incidence rate (9.4 per 100). The survey was conducted in November MICS Kyrgyz Republic, 1995 and lo~er inci~enc~ rate had been expected due to the cold season. Survey findings show that most of the chtldren With diarrhoea were not taken to the health facilities, but treated at home by their mothers. Breast-feeding M.ot.hers usually breast-feed ~eir babies in the Kyrgy~ Republic, and they do so for longer than the mmimum recommended penod. However, only 38% of the mothers do not supplement breast milk with other sub~tances. The practice of exclusive breast-feeding varies greatly among provinces (24% in Chui and 59% m Talas). 93% of all children under one year of age have been breast-fed one time or another. 72% of them are still on breast-feeding. 38% of the infants under 4 months of age are exclusively breast-fed. Immunization Immunization coverage of children 0-11 months of age is above 65% nationally for all antigens. Measles has the lowest coverage with 65%. Coverage rates for BCG, DPT3 and OPV3 are 83%, 74% and 67%, respectively. Over 65% of the children are vaccinated at intervals longer than recommended. Valid immunization coverage rates Research Communication Planning BCG DPT3 OPV3 83% 74% 67% Measles 65% Based on the objectives noted above, a set of"audiences" or users ofMICS data was projected and defined prior to the survey. An effort was made to identify all those who could benefit from the information as well as from its analysis and interpretation. On the basis of the identified audiences and their presumed use ofMICS information, an initial research communloation plan was developed. This "plan" was then revised after a data analysis and an initial interpretation, and prior to a Survey Results Presentation workshop in the Kyrgyz Republic in April 1996. I MICS Communication Plan Initial implementation of the MICS Communication Plan was carried out in Bishkek with the leaders and supervisors of the MICS. The group worked on setting priorities for work with the various audiences/users and finalized the modes of communication and time-frame for effective presentation, . discussion and uses of the national survey. A draft of the "audience segmentation" table is given in the recommendations' part. Summary of Method and Samples The target population was considered all households of the Kyrgyz Republic, which numbered 756,166 according to the last population census of 1995 (to 4.5 million population). The questionnaire and data collection method used were proposed by the Planning Office and the Evaluation and Research Office of UNICEF (monitoring progress towards the goals of the World Summit for Children and A Practical Handbook for Multiple Indicator Surveys). A total of six modules were used to design the questionnaire (Household Module, Water and Sanitation Module, Education Module, ARI Module, Diarrhoea Module, Breast-feeding Module, and Immunization Module). The · questionnaire was adapted, translated into Russian, and pre-tested, before being used in Turkmenistan MICS survey. The same questionnaire was translated into Kyrgyz and widely discussed with supervisors during the Bishkek workshop. Several modules were adjusted to fit the local circumstances. MICS Kyrgyz Republic, 1995 3 4 . , . ·· --, A separate sampling frame was used for each oblast (province) and the capital city, in order to reflect situations in all territories and to allow valid comparison among them. I,020 households in 34 clusters were selected from each oblast and Bishkek as study samples. They added up to a total of 7,140 households .in 238 clusters nationally. No stratification for rural and urban differences was used in the sample design. The field survey was conducted from 6 to 30 November I 995, by a specially trained team of 56 interviewers and 22 supervisors (8 interviewers and 3 supervisors per oblast) under the supervision of Dr. Sabircan Abdykerimov, Head of the Sanitary and Epidemiological Department at the Ministry of Health, and Dr. Kubanichbek Monalbaev, Deputy Director of the Republican Centre for Immunoprophylaxis. Team supervisors oversaw the survey in all the oblasts. Central headquarters w~ established in the UNICEF CARK Kyrgyz Republic country office, and daily telephone contacts were made with the field supervisors. The UNICEF CARK Kyrgyz Republic country office staff also supported the supervisors and carried out field trips to oblasts during the data collection period. When the 34 clusters in all the oblasts were completed, the questionnaires were taken back to the supervisors in Bishkek. Local headquarters were established in each oblast centre. They served as the operational centres for oblast activities and storage for questionnaires. Supervisors traveled to their respective oblasts immediately after the training and worked on the actual location of clusters and compiling the lists of households for each cluster. Interviewers traveled to oblasts two days prior to data collection period and were met by oblast supervisors. Data collection was completed in one week starting on 13 November 1995. One nurse for each identified cluster area polyclinic was appointed by local authorities to accompany the interviewer during the study in order to eliminate suspicion from the households. A total of 7, I 70 households were visited. A "data entry room" was arranged in the Republican Centre for Immunoprophylaxis in Bishkek. Five data clerks were trained on data entry using EPIJNF0-6. Data entry was supervised by Dr. Kubanichbek Monoibaev, the Deputy Head of the Centre. Statistical analysis was done by Dr. Nicolae Beldescu, a UNICEF consultant for Turkmenistan and Kyrgyzstan MICS surveys. The overall survey was supervised, and the initial interpretation was made by UNICEF CARK Area Health Officer Dr. Omit Kartoglu. Country operations were coordinated by Mr. Rudy Rodrigues, CARK AO RPO in the Kyrgyz Republic. MICS Kyrgyz Republic, 1995 . \ --- -------- I. INTRODUCTION F oil owing two training workshops in Ashgabat, Turkmenistan, in July 1995 and in Bishkek in October _I 995 to introduce t~e methodology, a nat_ional Mult!ple I~dic~tor Cluster Survey (MlCS) was conducted . m November 1995 m the Kyrgyz Repubhc. The maJor obJeCtive was to evaluate the situation at mid- decade and draw recommendations for programme implementation, taking into account the decline in standards due to the economic depression and social deterioration. · UNICEF Central Asian Republics and .{<.azakhstan (CARK) Area Office, in collaboration with the Ministry of Health and the Ministry of Education agreed to sponsor the survey. 1.1. Background of the study The Kyrgyz Republic gained its independence in 1991. Independence brought a variety of unprecedented economic problems that have had tremendous impact on the living condition of the population, especially in the remote areas of the country, such as Naryn and Talas. Unprepared for the consequences of political and economic independence, the new independent Republic and its people have become recipients of emergency and development assistance provided by multilateral and bilateral donors and international NGOs. Severe economic crisis resulting from the disintegration of the former Soviet Union (FSU) has led to the erosion or discontinuation of most services previously provided by the state. Due to the lack of social benefits that formerly existed, many individuals and families are finding themselves without a functioning social safety net. Economic transition difficulties have trickled down to all levels of society. However, the most vulnerable groups, including children living in the remote areas, suffered the most from lack of medicine, malnutrition, iodine and iron deficiency, acute respiratory infections, diarrhoeal diseases, anemia, et~;. The financial status of families in the Republic has also sharply declined. Family incomes are usually 8-10 times less than the amount needed to support one person, and this minimal income must often feed 5-7 family members. UNICEF intervened in the Kyrgyz Republic in 1993, with the aim of reducing the falls from previous accomplishments and to help compensate for the losses that did occur. UNICEF cooperation combines direct assistance with essential supplies, training and consultations on alternative means for basic services, activities aimed at empowering families and parents, and advocacy to the government for children and women. Upon starting work in the CARK area, UNICEF has, as a priority, related programme activities to maintaining indicators regarding the mid-decade goals and addressing the countries with the most urgent needs for children. The MICS survey in the Kyrgyz Republic was conducted in the context of this cooperation. The national MICS was planned in order to evaluate the situation at mid-decade and draw recommendations for programmes. 1.2. Organization of the survey Organizational activities for the national MICS were carried out by the UNICEF CARK Area Office. A training activity was held in Ashgabat from I 2 to I 9 July 1995 on MICS, epidemiology and vaccinology with assistance of International Children's Centre in Paris. This workshop was held for the entire area, and participants from Kyrgyzstan, Tajikistan, and Turkmenistan were in attendance. The training activity included theoretical and practical sessions on survey methodology, epidemiology and vaccinology. A two-day field exercise was organized in Ashgabat city in order to test the questionnaires to be used in the national survey: All the Kyrgyz attendees at the Ashgabat workshop pa11icipated as supervisors for the Kyrgyzstan National survey. A second workshop was held in Bishl(ek I 7-24 October I 995 to train supervisors and finalize the questionnaires for the survey. Ms. Patricia H. David and Mr. Mark Hereward from UNICEF NYHQ Planning Office facilitated the workshop. Finalization of survey plans and sampling were also done at the workshop. Interviewers were selected through the Ministry of Health and Ministry of Education from vocational schools in MICS Kyrgyz Republic, 1995 5 6 Bishkek. All interviewers were c~pable of comm~nicating in Kyrgyz in order to prevent non-communicatio~~~~,,., househ_old level (the_ Kyrgyz versiOn of the questiOnnaires were used at household level). Interviewers and supervisors were tramed for two days prior to the data collection as described in the Guide by Dr 0 ·t Kartoglu, the UNICEF CARK Area Office Health Officer. · mJ 1.3. The target population The tru:get population was c~nsidered all households of the Kyrgyz Republic which numbered 756, I 66 accordmg to the last population census of I 995 (with 4.5 million population). The _elementary sampling unit was the "household", i.e. the group of people living in the same dwelling and sharmg_ a common hou~ehol~ ~conom~ (residin~ tog~ther, connected by on.e budget). In the case of the Kyrgyz Re_pubhc, a household I.s a d1stmct ~ocweconon_uc umt where several couples (families) may reside (e.g. married children and even mamed grandchildren may hve together with the parents). The country is divided into seven administrative regions (six oblast and Bishkek city). Separate sampling was carried out for each region to represent each oblast and to compare results. /.4. The questionnaire and data collection method The questionnaire and data collection followed the method proposed by the Planning Office, Evaluation and Research Office, and the Programme Division of UNICEF (monitoring progress toward the goals of the World Summit for Children and A Practical Handbook for Multiple Indicator Surveys). A total of six modules were used in questionnaire (Household Module, Water and Sanitation Module, Education Module, ARI Module, Diarrhoea Module, Breast-feeding Module, Immunization Module). At the same time, as the Guide permitted adaptation to the local conditions for each country, some questions were added, revised and/or excluded (see Annex I). The questionnaire was translated into Kyrgyz from Russian (tested during July 1995 MICS workshop in Ashgabat and used in Turkmenistan MICS) and revised during the Bishkek October workshop. Interviewers were given a list of houses with family names and addresses by the supervisors on a daily basis at the field. In each household, interviewers carried out the interview with all mothers or principal caretakers of children under 11 years. Household module and water and sanitation module were completed for all household disregarding the number of children they had. Education module was given to mothers with children between the age of 6-11 (age composition for the education module is revised based on the education system in the Kyrgyz Republic). Care of Acute Respiratory Infections Module was given to all mothers with children under five years of age. Breast-feeding Module was used for mothers with children under two years of age. Immunization Module was used for children between 12 and 24 months of age, because of the measles schedule in Kyrgyzstan. All modules were completed at household level except for the Immunization Module. Main task of the interviewers with the Immunization Module at the household level was to identify the name of the child, identify the polyclinic where immunization takes place and check whether the child had any BCG scar. Immunization dates were filled in from polyclinic records by the interviewer on the same day. 1.5. Sample size and design A separate sampling frame was used for each oblast (including the capital city) in order to represent all territories and allow comparison among them. Ten percent margin error was used for sub-national sampling. The other basic assumptions used in the calculation of required number of households for each oblast were as follows: (a) design effect 2, (b) persons per household 6, (c) percentage of population under 5 years of age 0.15, and (d) prevalence of diarrhoea 15 days 0.2. As for the indicators, 70% was used as an estimated prevalence for DPT3, OPV3 and Measles coverage, 80% for BCG coverage, 70% for ORT use, 90% for school enrollment, 44% for safe water and 16% for·sanitation facilities. Based on these assumptions and estimated prevalence, 933 households were needed in each oblast. Finally, a sample of 1,020 households in 34 clusters were selected as study sample from each oblast and Bishkek city, which added up to a total of7,140 households in 238 clusters nationally. No stratification for rural and urban difference was used in sampling design. MICS Kyrgyz Republic, 1995 A detailed list of the smallest administrative units (selsoviet) with population for each oblast was obtained from the Goskomstat, the State Statistical Committee. From each oblast frame, 34 clusters were selected with PPS (Probability Proportional to Size). The actual location pfclusters in relatively big administrative units (i.e. city centres) was defined at the oblast level by supervisors with random selection among the zones in the city. The final stage of household selection was completed by the supervisors assigned to each oblast. Supervisors complied the most recent census lists provided by village and/or city polyclinics (each dwelling unit re- enumerated and a list of occupants updated every year). This list of occupied dwellings was numbered and 30 households were selected randomly from each, allowing for a reserve list of households in case of the need for replacement. 1.6. Implementation of field survey The field survey was conducted from 6 to 30 November 1995, by a specially trained team of 56 interviewers and 22 supervisors (8 interviewers and 3 supervisors per oblast) under the supervision of Dr. Sabircan Abdykerimov, the Head of the Sanitary and Epidemiological Department at the Ministry of Health, and Dr. Kubanichbek Monolbaev, the Deputy Director of the Republican Centre for lmmunoprophyhixis. Team supervisors controlled the survey in all the oblasts. Central headquarters, was established in UNICEF Kyrgyz Republic office, and daily telephone contacts were made with the field supervisors. UNICEF Kyrgyz Republic office staff also supported the supervisors and made field trips to oblasts during the data collection period. Local headquarters were established in each oblast centre. These offices served as the operational centre for oblast activities and storage for questionnaires. An explanatory letter was circulated by the Ministry of Health to all local authorities for their coordination. Supervisors made travels to their respective oblasts immediately after the training and worked in the actual locations of clusters to compile the lists of households for each cluster. Interviewers traveled to the oblasts two days prior to data collection and were met by oblast supervisors. Data <:ollootion was <:olllploted in <mo week starting on 13 November 1995. One nurse for each identifiedcluster area polyclinic was appointed by local authorities to accompany the interviewer during the study in order to eliminate suspicion from the households. I. 7. Data entry, processing and statistical analysis Data entry room was set up in the Republican Centre for Immunoprophylaxis in Bishkek. Five data clerks were trained on EPI.INF06, and carried out the data entry under the supervision of Dr. Kubanichbek Monolbaev, the Deputy Head of the Centre. Data entry started with completed clusters from Bishkek and Chui in November and continued with other oblasts. Statistical analysis was carried out by Dr. Nicolae Beldescu, a UNICEF consultant for Turkmenistan and Kyrgyzstan MICS surveys. 7 MICS Kyrgyz Republic, 1995 8 2. DESCRIPTION OF THE SAMPLE POPULATION 2.1. Characteristics of sample population Households and number of persons per household ~ tota.l of 7, l7.0.households were visited (actual number of samples were 7, 140, but in Naryn oblast mterv1ewers VISited a total of 1,050--including the tteserve samples--instead of the original 1020) Distrib t. fh h ld · · d · . u Ion o ouse o s VISite m each oblast is shown in Table I. Table I. Distribution of households visited, by oblast, MICS 1995, The Kyrgyz Republic Bishkek 1,020 100.0 Chui 1,020 100.0 Tal as 1,020 100.0 lssyk-kul 1,020 100.0 Naryn 1,050 103.0 Jalal-Ahad 1,020 100.0 Osh 1,020 100.0 TOTAL 7,170 100.0 According to the survey, the mean size of a household was 5.0 persons (95% confidence limits 5.9-6.2), in comparison with the assumptions made prior to the sample design, which was 6.0 persons. The smallest households were found in Bishkek (3.3) and Chui (4.0). Osh had the highest number of persons per household with 5.9. Modal household size varied between 4 to 6 among oblasts. Number of rooms The national average number of rooms per household was three. The average was the lowest in Bishkek (2.6 rooms) and highest in Talas and Osh (3.5 rooms). About 30% ofthe families were living in houses with fewer than three rooms. Number of children and sex distribution There were I6,424 children under II years of age in 7,170 houses visited. 65% were girls, and 35%, boys. Sex distribution of children under 11 years of age was similar in all oblasts. Sex distribution of all children up to 11 years of age by oblast is shown in Table 2. MICS Kyrgyz Republic, 1995 Table 2, Sex distribution of children under 11 years of age, by oblast, MICS 1995, The Kyrgyz Republic ••• Talas Y ···· -~;k~~~· ••••• Naf}'k ••. .·.· . ·-::;··.:·-·.·· · ·•·I >osh >··· NationJlde Sex Bishkek Chui Jaia1-atiad Male 336 589 1,058 766 1,015 948 1,020 5,732 Female .726 1,184 1,883 1,508 1,783 1,699 1,909 10,692 Total 1,062 1,773 2,941 2,274 2,798 2,647 2,929 16,424 Age distribution of children by oblast is shown in Table 3. Table 3. Age distribution of children, by oblast, MICS 1995, The Kyrgyz Republic Age Bishkek Chui ·. T!llas · . . •.• . ~I 1 . :,r;r I ti:.~~~;.~~.{ I p,s~ Y .•• Nationwide ·. • . · : ~""'~-;;[ 1•·····77."'L77"')••••· group . . ; 2 . > unknown 450 646 924 765 902 858 927 5,472 0 50 115 205 161 181 211 215 1,138 I 35 107 206 . 123 139 172 200 982 2 36 100 181 130 198 174 198 1,017 3 56 106 198 138 195 164 191 1,048 4 56 103 176 147 173 172 181 1,008 5 57 96 186 141 146 138 189 953 6 55 103 178 153 189 162 176 1,016 7 57 109 180 143 184 153 178 1,004 8 59 88 175 147 190 168 170 997 9 62 93 173 121 170 155 171 945 10 89 107 159 105 131 120 133 844 Total 1,062 1,773 2,941 2,274 2,798 2,647 2,929 16,424 2.2. Water and Sanitation The questions in this survey focused on identifying the following with regard to water and sanitation: * * *· the main sources of drinking water, and as applicable, their relative distances to the dwellings the various toilet facilities used, also in relation to distance to the dwellings the availability of soap as a yardstick for personal hygiene practices. Water Sources and Distance Nationally, 71% of all respondents (weighted by household size) indicated the availability of safe water sources, i.e piped water supply in the dwelling, tube well, borehole, protected dugwells, or protected springs. Unprotected dugwells or springs, ponds, rivers or streains, and any other sources is considered unsafe in this regard. MICS Kyrgyz Republic, 1995 9 10 Figures from the various regions show that almostthe total population of the capital Bishkek has access to.piped water supply (99%). Naryn is the oblast with the lowest percentage of the population with access to safe water sources. 100 80 60 = u (.) . u Q. 40 20 0 Bishkek Chui Talas lssyk·kul Nal)'n Jalal-abad Osh Nationwid • Unsafe D Safe Figure 1. Access to safe water sources, by oblast, the Kyrgyz Republic The majority of the respondents, or 80.5 %, indicated that an average distance between the source and their • dwellings was less than 100 meters (including on premises 37.8%). Naryn oblast had the lowest number of people with access to water sources within 100 meters(64.l%), including on the premises through house connections, standpipes in the yard or street standpipes. This figure was close to the national average of 80.5% in other oblasts. Sanitation facilities Various types of latrines are seen in the country such as flush-to~sewerage systems, flush~ to-septic tanks, pour flush latrines, and covered dry pit latrines, which are all regarded as safe sanitary facilities, uncovered latrines, which are characterized as unsafe. The outcome of the survey is presented in the figure 2. 91.3% ofthe respondents nationwide have access to either flush or non-flush private latrines (covered dry pit latrines). The figures in the following table show that .except in Bishkek, most people in the other areas use non· flush private latrines. Table 4. Safe toilet facilities by type and oblast, MICS1995, The KyrgyzRepublic (in percent) Latrine type Flush 62.6 26.6 2.4 11.1 8.8 14.6 10.7 19.5 Non-t1ush private 36.1 60.3 95.3 88.0 83.6 80.8 79.1 74.8 (covered dry pit latrine) MICS Kyrgyz Republic, 1995 -----------T --------:-'-- -c-~~~~- II 100 80 = 60 ., 0 . ., c:>. 40 20 0 Bishkek Chui Talas Issyk'kul Naryn Jalal-abad Osh Nationwid • Unsafe 0 Safe · Figure 2. Access to safe sanitary facilities, by oblasts, the Kyrgyz Republic Many ofthe facilities were located within 50 meters from the dwelling except in Osh, where 8.3% of the toilet facilities are located at further distances. Nationally, 19.5% ofthe toilets were located within the dwellings, with figures for other areas varying from 62.6% for Bishkek, 2.5% in Talas, and 10.7% in Osh. Availability of Soap Soap is widely available in the country, with an average use of 89%. Whether soap is used for purposes such as washing hands after defecation, etc. is not clear. Questions have been raised in the past concerning the affordability of soap. The outcome of this exercise shows that only II% of the population have difficulties obtaining soap. 2.3. Education Education Module was used for all children in the household aged 6-11 years. The questions focused on identifying the following: * * * Whether the children have ever attended school Current attendance Attendance in the past year Out of4,715 respondents, 4,072(86.3%) were found to have attendedschool.at one time or another. 99.7%of them were currently attending school at the time ofthe survey. There were only 10 children who had attended school• in the past but were currently not in school. The indicator 12.1 (percentage of children entering I st grade of primary school who eventually reach grade 5) was 99% nationally. The lowest percentage was found in the females in Bishkek (93%). All the other areas had high percentages {over 98%). Indicator status by oblast is shown in Table 5. MICS Kyrgyz Republic, 1995 12 Table 5. · Indicator status 12. 1 by oblast and by gender: Percentage ofchi/dren entering 1st grade of primary school who eventually reach grade 5 (n=4, 728), MICS 1995, the Kyrgyz Rf!public . :· . ··- · :.:·--·-:-. Oblast Male Female TOTAL Bishkek 100 93 96 Chui 100 100 100 Tal as 100 100 100 Issyk-kul 98 100 99 Naryn 99 98 98 Jalal-Abad 100 100 100 Osh 100 100 100 TOTAL 100 99 99 The indicator 12.2 (proportion of children of primary-school age actually enrolled in primary school) was 86.2% nationally. The lowest proportion was found in Issyk-kul (81.3%). However, it should be noted that a · great majority of children who are not attending schooL was at 6 years of age. Although school entry age is 6 in the Kyrgyz Republic, most parents prefer to enter their children in school when they reach 7. Nationally, out of 4,715 school age children, 652 were not enrolled in school, and 80% of these children were at the age of6. Table 6 shows the age distribution of school attendance in the national scale by gender. · Table 6. School attendance: distribution of school age children by age and gender, MICS, the Kyrgyz Republic, .J, 715 children Age in years Male Female , . _ . _ . ·. ) l'pt~tf 1\ J>.:: _ . . . . . ·. I '!~';~ No Yes ·•·-··· No •••••••···.·• v~s · I ; "NIJ i> x~s I . ·••··•·-· . . . . . -. 6 303 187 261 195 564 382 946 7 21 463 30 484 51 947 998 8 5 481 2 509 7 990 997 9 7 473 7 453 14 926 940 10 1 384 1 376 2 760 762 11 3 44 2 23 5 67 72 TOTAL 340 2,032 303 643 643 4,072 4,715 Indicator status 12.2 by oblast and by gender is shown in Table 7. MICS Kytgy% Republic, 1995 Table 7. lndici.Jtor status 12.2 by oblast and gender: Proportion of children of primary school age enrolled in primary school this year (n=4, 715), MICS 1995, the Kyrgyz Republic Oblast Male Fema.le ••. TOTAL > • •• Bishkck 89 87 88 Chui 89 89 89 Talas 81 86 83 lssyk-kul 81 83 79 Naryn 87 91 89 Jalal-Abad 81 84 83 Osh 92 92 92 TOTAL 86 87 86 13 The indicator 12.3 (proportion of children entering school at entry age) was 40.4% nationally. This is also due to the aforementioned reasons. Oblast figures range from 292% in Talas to 64.6% in OSh. The indicator status by oblast and gender is shown in Table 8. · Table 8. Indicator status 12 . 3 by oblast and gender: Proportion of children entering school at entry age, MICS 1995, the Kyrgyz Republic Male < . •·.··· < •••••••••••••••••• < ••>··· < ~~M~~:~~ <···· ····· >··········· ··· ·•· < TOT, Oblast . •·•·. Total Attending Total Total Attending children school <· . cllildren ;j ;;: ii ili!~f',l!'':! i , c~~~r" •• school aged ·.·.··· ·.·· it:t~ ·· ~:- ·.·. ·.· 6 years · .·.:·.·< .• · n<····•·•·••>u ··· ·•>\6years ~ Bishkek 29 13 (44.8%) 23 5 (21.7%) 52 18 (34.6%) Chui 40 17 (42.5%) 53 29 (54.7%) 93 46 (49.5%) Tal as 100 25 (25%) 71 25 (35.2%) 171 50 (29.2%) lssyk-kul 75 25.(33.3%) 71 13 (18 .3%) 146 38 (26%) Naryn 95 31 (32 .6%) 89 32 (36%) 184 63 (34.2%) Jalal-Abad 83 33 (39.8%) 70 39 (55 .7%) 153 72 (47.1%) Osh 68 43 (63 .2%) 79 52 (65 .8%) 147 95 (64.6%) TOTAL 490 187 (38.2%) 456 195 (42.8%) 946 382 (40.4%) If the school entry age .is regarded as 7, 94.7% of this age group was found in s.chool (60.6% attending Grade I and 34.2% attending Grade 2). 2.4. Care of acute respiratory infections(CARI) CARl Module was directed to all mothers of children aged under five in the households. The questionnaire focused on learning what symptoms and signs would lead the mother to take the child to a health worker/doctor. Mothers were asked, when their children were ill with a cough and/or cold what signs or symptoms would lead them to takethetn to a clinic. MICS Kyrgyz Republic, 1995 14 The indicator shows the proportion of mothers of children under five years of age who know the signs ofARI at 25%. Table 9. ARI Indicator status byoblast (percent of mothers who know the signs of ARI), MICS 1995, the Kyrgyz Republic JJishkek , clllli ••' T~bis ,', ~s~yk""@r Ni~ i. J~J~)2~lj~d i p~ij · · ~~tlt~Wia~ · ·- --- ' ' -- --- --- - _ -- . · . ·. ·. . ·.-. -.·.··.··.·-:::-: :::::::::~::-:-:>> " · 16 41 20 38 18 30 11 25 In general, fever was the most mentioned sign of ARI (82.3% of the mothers nationally). Blocked nose was the second (39.7%). 321 out of 3,715 mothers (8.6%) did not know any signs or symptoms ofARI. Table /0. Signs and symptoms mentioned by mothers for A RI, MICS 1995, the Kyrgyz Republic Fever 78. 75.3 83.5 90.6 83.2 91.5 71.1 I • Blocked nose 43 .1 53.8 29.7 51.9 29.5 58.5 22.8 Trouble sleeping/eating 13.2 22.3 7.7 24.2 12.2 27.2 14.4 Difficult breathing 12.3 28.6 16.7 30.1 16.8 22.3 7.1 Being ill for along time 11.8 28.6 6.8 19.6 22.5 25.8 4.7 Fast breathing 4.9 15.3 5.3 25.5 7;0 24.4 5.0 Don' t know 6.9 6.3 10.5 2.6 5.4 3.7 21.0 Fever Blocked nose Difficult breathing Trouble sleeping/eating Fast bre_athing Don't know 0 20 40 60 80 100 percent Figure 3. Signs and symptoms mentioned by mothers for ARI, national percentage, the Kyrgyz Republic The major indicator for pneumonia (fast breathing) was known by only 12.6% of the mothers. The lowest percentage was observed in Bishkek (4.9%) while the highest was in lssyk"kul (25.5%). MICS Kyrgyz Republic, 1995 82.3 39.7 17.1 18.8 16.7 12.6 8.6 2.5. Diarrhoea Diarrhoea Module was directed to mothers of all children under five years of age in the household. The questions focused on three major points: * * * Whether the children had diarrhoea during the previous two weeks Food and fluids children received during the last episode Changes in the amount of fluids and food given to children Due to the season at the time of data collection, fewer diarrhoeal cases were found than estimated. The incidence rate for diarrhoea in the two weeks .preceding the survey was found the highest in Osh (9.4%) and Bishkek(7.8%) and the lowest in Talas (5.3%). Table 11. Diarrhoea incidence rates in children under five years of age in the two weeks preceding the survey, MICS 1995, the Kyrgyz Republic Incidence rate (percentage) 7.8 5.4 5.3 5.7 6.7 7.3 9.4 6.8 15 The indicator of use of ORT (old and new definition) .is shown in Table 12. When the old definition is used the Kyrgyz Republic has very high percentage of use of ORT (percentage of diarrhoea cases among children under five in the two weeks preceding the survey who received ORT and/or recommended home fluid). However, when the new definition is used--it covers continued eating--all figures decrease dramatically. The lowest figure is foundin Osh (14%), while the highest is in Naryn (28%). Table 12. Percentage of diarrhoea cases that are given ORT, MICS 1995 the Kyrgyz Republic OLD NEW 100 22 Nationwide Osh Jalal-abad Naryn lssyk-kul Tal as Chui Bishkek 100 21 1----l f-----l I I 0 20 • Old definition 96 97 96 98 100 16 23 28 15 14 40 60 80 100 percent 0 New Definition Figure 3. Indicator status, ORT use (old and new definition) by oblasts, the Kyrgyz Republic 98 19 MICS Kyrgyz Republic, 1995 16 Table 13. type of fluids and food the children received during the last episode ofdiimhoea {in percentage) , M1CS 1995, the Kyrgyz Republic D ·-··-·· . -- ~ - escr1pt1oQ Breast-milk Gruels Local home fluids ORS Milk/infant formula Water w/feeding Water alone Unacceptable fluids Water w/feeding Milk/infant formula Unacceptable fluids Breast-milk: Gruels Local home fluids ORS Water alone 50.0 34.4 38.0 20.5 35.0 66.6 51.7 36.7 38.4 32.2 50.0 41.3 24.4 33.3 30.5 33.3 34.4 28.5 28.2 22.0 72.2 48.2 48.9 30.7 67.7 44.4 75.8 59.1 43.5 67.7 61.1 75.8 38.7 30.7 35.0 _l I I I .I I - I - I - -- - - I - - 0 10 20 30 40 so 60 70 percent 47.5 47.0 39.8 45.0 32.9 39.5 55.0 41.1 38.9 44.0 28.2 30.7 58.3 48 . .2 52.8 65.0 63.5 . 62.1 41.6. 34.1 40.1 Figure 4. Type of fluid and food the children received during the last episode of diarrhoea {in percentage), the Kyrgyz Republic Carbonated soft drinks and sweetened juices were considered unacceptable fluids. ORS was given to 30.7% of children with diarrhoea. The highest rates were observed in Jalal-abad (44.0%)and in Chui (34.4%). Naryn had the lowest figure (22%). ')'lationally, breast-feeding was continued for about 40% Of the children with diarrhoea. However, unacceptable fluids were given to children with diarrhoea in about40% ofthe cases. In terms of changes in the amount of fluids given to the children with diarrhoea, most ofthe children received about the same or more amounts of fluids (75%together), However, only about41% of the children were given about the same or more food during the last diarrhoea episode. MICS Kyrgyz Republic, 1995 Table 14. Changes in the amount of fluids given to children with diarrhoea (percentage), MICS 1995, the Kyrgyz Republic Drinking status Bishkek Chui Tal as lssyk-kul ~laGn Jalal~abad Osb Nationwide Much less or none 22.3 25.0 20.4 18.0 21.0 20.0 18.8 20.2 About the same 33.3 42.9 51.0 48.7 31.6 31.6 29.4 36.9 More 33.3 28.6 24.5 28.2 47.4 41.7 48.3 38.7 Don't know 11.1 3.5 4.1 5.1 - 6.7 3.5 4.2 Table 15. Changes in the amount of food given to children with diarrhoea (percentage), MICS 1995, the Kyrgyz Republic None 5.6 7.1 4.1 2.6 8.8 6.7 14.1 8.0 Much less 44.4 14.3 24.5 20.5 36.8 40.0. 23.5 28.9 Somewhat less 27.7 14.3 26.5 12.8 12.3 15.0 5.9 14.3 About the same 16.7 64.3 34.7 53.9 38.6 33.3 30.6 37.8 More 5.6 4.1 5.1 3.5 1.7 4.7 3.6 Don't know 6.1 5.1 3.3 21.2 7.4 2.6. Breast-feeding Breast-feeding Module was directed to the mothers of all children under two years of age. The questions focused mainly on two points: * * Ever and still breast-feeding rates 24-hour recall on what babies received 17 93.2% of all children under two years ofage was breast-fed at one time or another, and 72.4% of them were still on breast-feeding. Table 16. Ever and still breast-feeding rates in children under two years of age, MICS 1995, the Kyrgyz Republic Ever breast-fed Currently on breast-feeding 78.5 69.4 9.1.7 93.5 72.6 68.6 96.0· 93.9 96.7 90:9 93.2 66.2 68.9 76.7 80.5 72.4 Although the breast-feeding rates were high, exclusive breast-feeding rates for children under four months of age were relatively low. Chui had the lowest exclusive breast-feeding rate by 24%, while the rate was the highest in Talas (59%). MICS Kyrgyz Republic, 1995 18 Table 17. Exclusive breast-feeding in children under four months of age, M1CS 1995, the Kyrgyz Republic Bishkek (12) 25 24 59 49 35 28 27 38 Table 18. Type of fluid and food given to children under _// months of age during the previous 24 hours (perc_entage), M1CS 1995 the Kyrgyz Republic .· "(--.ved······· Y····················· ···\·············• 1•• a,i$~~~~ :• 1 •• ••• thlli [ ····· . T~la~ - ~~s.syR-kJ~I <.f~J~l]ll~~;; •••••. l !9~b. i···-· l ••• • •t~if'- ->--~ ·~ -•·•. Vitamin, mineral 25.6 32.5 12.8 6.3 8.4 16.1 12.8 14.5 supplements or medicine Plain water 72.1 73.3 39.1 60.9 56.4 52.0 59.8 55.6 Sweetened, flavored 69.8 78.6 59.7 46.0 47.0 71.8 58.7 60.6 water ot fruit juice or tea or infusion ORS 2.3 11.0 4.7 2.9 5.4 11.0 5.0 6.5 Tinned, powdered or 58.1 53.2 44.6 31.6 53.5 41.8 37.4 43.7 fresh milk or infant formula Other liquids 27.9 50.6 5.4 8.0 16.3 21.6 20.3 19.3 Solid, semi-solid food 55.8 57,1 46.1 26.4 46.0 45.8 46.2 45.3 Only breast-milk 11.6 5.8 25.6 27.0 15.8 11.4 12.8 16.4 Plain water and sweetened/flavored water/fruit juice and tea were given to more than 60% of the children. Bottle· feeding rates for children under 12 months of age were: Bishkek (55%), Chui (43%), Osh (41 %), Jalal- abad (34%), Naryn (31 %), Talas (29%) and lssyk-kul(18%). · 2. 7. Immunization Immunization Module was used for children aged 12-24 months. (24th month was included due to measles schedule in the Kyrgyz Republic). There were mainly three focuses in the questionnaire: . * * Immunization coverage Intervals between doses, and BCG scar. BCG scar was checked by interviewers at home, and all other information was collected at the polyclinic level where the children received their vaccination. In all oblasts except Chui, the percentage of positive BCG scar (checked at home) was higher than the BCG coverage rates, and this may be due to the fact that some children who received BCG vaccine had no records at the polyclinic level. For example, in Bishkek, positive BCG scar was found in lOOo/o of the children aged 12-23 months while the immunization coverage at the time of the survey for BCG was 94%. Similar discrepancies were observed in all other oblasts except Chui. MICS Kyrgyz Republic, 1995 Table /9. BCG DPT3 OPV3 Measles Figure 5. --------------···--·- Immunization coverage for children aged 12-23 months receiving vaccination before their first birthday (valid immunization coverage) n=98/, MlCS 1995, the Kyrgyz Republic (12-24 months for measles) 86 76 85 87 85 85 80 66 68 76 74 81 77 70 60 61 73 57 74 72 63 51 50 70 73 62 65 68 100 ---~-----~------------- 80 - - 60 ,- 1 -- ~ ~ - ~ - -- -- - - - - !----'- ·- 20- 1-- ~ 1- I-- I-- - --- -- o- Bishkek Chui Talas lssyk-ku!NarynJalal-abad OshNationwid • BCG [] OPV3 IZJ DPT3 • Measles 8.3 74 67 65 Immunization coverage for children aged 12-23 months receiving vaccination before their first birthday, MICS /995, the Kyrgyz Republic (/2-24 months for measles) When the coverage rates were analyzed for the same children, higher rates were found. This coverage over a period of two years can be used to interpret the extension of backlog coverage. For example, valid BCG coverage rate was 83% nationally, with the remaining 17% backlog, and the coverage at the time of the survey was 90%, with the remaining 10% backlog for the third year cycle. This means only one third of the backlog was cleared in the second 12-month cycle. Similarly, backlog clearance was 31% in DPT3, and 42% in OPV3. Table 20. Antigen BCG DPT3 OPV3 Immunization coverage for children aged 12-23 months receiving vaccination at the time of the survey n=981, MICS 1995, the Kyrgyz Republic Bishkek C!tui Nationwide (35) (1Q7) (981) 94 91 92 93 89 91 87 90 74 77 83 86 86 85 79 82 71 76 82 84 86 86 74 81 19 MICS Kyrgyz Republic, 1995 20 The analysis of intervals between doses showed that more than 45%.of children received their 2nd and 3rd dose of DPT at an interval of over 60 days. Table 21. The interval in days between DPT2-DPT1 (n=1226) and DPT3-DPT2 doses(n=1124), MICS 1995, the Kyrgyz Republic under 30 days 21 2.3 15 1.7 30-39 19 2.1 15 1.7 40-49 227 25.2 239 27.1 50-59 208 23.1 204 23.2 60 days and over 427 47.3 408 26.3 Total 902 100.0 881 100.0 Longer intervals between doses indicate false contra• indications and missed opportunities. Although the Ministry of Health revised the immunization schedule and contra-indications in 1994, old practices still exist at the filed level. \ Children's age at the date of immunization is shown in Table 22. Table 22. Average and modal children's age (in months) a,t the date of immunization, MICS 1995, the Kyrgyz Republic BCG 5 4 4 4 5 4 5 4 5 3 5 4 6 5 5 4 DPTI 3 3 3 2 3 2 3 2 3 2 4 2 3 2 3 2 DPT2 7 5 6 4 6 4 6 4 5 4 6 4 6 4 6 4 DPT3 9 6 8 6 8 6 8 6 7 6 8 6 8 6 9 6 OPVl 4 3 4 2 3 2 4 2 4 2 4 2 4 2 4 2 OPV2 7 5 7 4 6 4 7 4 6 4 6 4 6 4 6 4 OPV3 9 7 9 6 8 6 9 6 8 6 8 6 8 6 9 6 Measles 13 12 13 12 13 12 14 12 13 12 13 12 13 12 13 12 (A =Average, M =Mode, Age for BCG is in days) MICS Kyrgyz Republic, 1995 BCG scar Table 23. Scar Positive Negative BCG scar by oblast, percent found (checked at home by interviewers), MICS 1995, the Kyrgyz Republic 100.0 86.4 96.2 94.0 .96.9 97.1 90.9 93.9 12.1 3.8 3.0 1.6 1.7 8.7 5.0 Not examined 1.5 3.0 1.5 1.2 0.6 1.1 BCG scar rate was found much higher compared to reported BCG vaccination coverage. 21 MICS Kyrgyz Republic, 1995 22 3. CONCLUSIONS I. This was the first nationwide survey conducted with the MICS methodology in the Kyrgyz Republic. The survey design was new to the epidemiologists, and international expertise was needed at all stages ofthe survey. The survey methodology was introduced first in an eight-day training in Ashgabatwhich included two days of field work and introduction of EPI INFO computer software for data entry and analysis (two persons from Kyrgyzstan participated in the training workshop). The second training workshop took place in Bishkek and involved all supervisors. The participants of this workshop tookthe role ofsupervision . during the survey and were trained for two additional days on how to use and control the questionnaires. · Students and teachers from vocational schools and medieal fa_culties were trained as interviewers. Workers from the State Statistics Committee and the Republican Centre for Immunoprophylaxis were trained and used. Data clearance and analysis were done by the UNICEF consultant. 2. A total of 56· interviewers and 22 supervisors actively participated in data collection. Data collection lasted one full week. Serious logistic planning had to be carried out, due to the large number of interviewers, in order to complete the field work in a relatively short period of time. All participants of the survey were enthusiastic about the work and were very cooperative. However, in tenns of capacity oforganizing and conducting such surveys, more technical support is needed in the country. 3. Mid-Decade Goals: 3.1. Immunization National immunization coverage rates were lower than expected: BCG 83%, DPT3 74%, OPV3 67% and measles 65%. In BCG, all oblasts had coverage rates of over 80% except for Chui (76%). For DPT3, the highest coverage was found in Naryn (81%), while the lowest was in Bishkek(66%). As for OPV3, the highest coverage was again found in Naryn (74%) arid the lowest in Issyk-kuJ (57%). Measles had the lowest coverage figures among all aritigens. The lowest among oblasts was Chui (50%) and the highest, Issyk-kul {73%). Backlog clearance, which was interpretedfrom the immunization coverage rates at the time ofthe survey was noted as an area for attention. By the time of the survey, coverage rates for BCG, DPTJ and OPVJ had increased to at least 80%. The interval between DPT2-DPT1 and DPT3-DPT2 showed that over 45% of the children are vaccinated at a 60-day or longer intervals. It was also found that 25% of the children did not receive their DPTJ, although they had reached 9 months of age. Similarly for 0PV3, 25% ofthe children did not receive the third dose, although they had reached I 0 months of age. BCG scar examination had a higher positive percentage in comparison to the records at the health facilities. Positive scars were found in 93.9% of the children nationwide, while only 90% coverage was recorded at health facilities. The MOH reported over 90% coverage rates for all antigens in 1994. Although the coverage rates from the MICS survey did not cover the full calendar year of 1994, the discrepancies were found to great. It was also reported that no vaccine shortages were observed during 1994 and 1995 in the Kyrgyz Republic. Therefore, in terms of vaccination coverages for BCG, DPT arid OPV, Mid-Decade Goal status can be concluded as achieved. 3.2. Use ofORT ORS was widely used. Around two thirds of the mothers continued to give about the same or more amounts of fluids to their children during diarrhoea. However, the use ofthenew definition ofORT was very low in all the oblasts. This is mainly due to continued feeding. Unacceptable home fluids were also found to be highly in use (40%). . · in the Kyrgyz Republic, there is no study that shows the use ofORTand continued feeding as part of the programme to control diarrhoeal diseases in the country. In practice, ORS is available. in. all health centres in the country, and mothers with children under 5years of age receive several packages ofORS in the beginning of the diarrhoeal season (100% accessibility). On the other hand, continued feeding is a problem and needsmore attention. MICS Kyrgyz Republic, 1995 23 3.3. Education The .rate of children who have attended school at one time or another in their lifetime was 86.3% nationally. However, the majority of children not attending school was 6-year-olds. Proportion of children ofprimary school age enrolled in primary school was 40.4% due to the same reason. It was found out that mostchildren do not enter school until they reach 7 years ofage. No difference was observed between boys and girls in terms of enrollment and retention rates. Official data indicates that more than 95% of all primary school age population are enrolled in primary school, and 95% of all school children entering first grade of primary school reach grade 5. Lower figures were found in MICS for primary school enrollment (which means the cut-off point for school entry age is taken differently by the government), but higher figures were found (99%) in all primary school children entering first grade who eventually reach grade 5. 3.4. Water and Sanitation In general, access to safe water sources and safe sanitary facilities was high. However, considerably low figures were observed in Naryn for safe water sources. Soap was found available in 89% of households nationwide. However, based on this figure, no further interpretation could be done in ter!l.ls of the use of soap. Access to safe water sources and safe sanitation facilities were reported officially at 53% and 31%, respectively, in the Kyrgyz Republic (1993). The figures found in the MICS were higher than official reports (71% for safe water sources and 91% for safe sanitation facilities). Safe sanitation facilities include flush and non-flush private latrines (covered dry pit latrines). MICS results showed that except in Bishkek, most people in other areas were using non-flush private latrines. However, field visits in various regions in the Kyrgyz Republic since 1994 showed that most of the dry pit latrines were not kept clean and could not be considered as "safe". In that case, such high figures are not a surprise since the water and sanitation module is only focused the availability of sanitation facilities by types and not their "quality". 3.5. Breast-feeding Very high breast-feeding rates were observed among the oblasts. However, exclusive breast-feeding rates for children under 4 months of age were relatively low. National average was 38% while Talas had the highest (59%) and Bishkek the lowest rate (25%). More than 60% of the children under 12 months of age had received plain/sweetened water andjuices during the 24 hours preceding the survey. 16.4% of the children under 12 months of aged had received only breast-milk. The only data available on breast-feeding practices was provided by the UNICEFSituation Analysis of November 1994, which revealed that periods of exclusive breast-feeding have declined considerably, and which also quoted the 1993 official figures of 57.2% children receiving breast~ feeding at birth and 38.5% at the age offour months. 3.6. Acute Respiratory Infections The indicator showed that the proportion of mothers of children under 5 years of age who knew the signs of ARI was very low (25%). Among all ARI signs and symptoms, fever and blocked nose were the most frequently mentioned signs. Very low percentage of responded mothers mentioned "fast breathing" as a sign of ARI. There is no other study concerning the knowledge of mothers regarding the danger signs ofARI in the Kyrgyz Republic. However, an analysis of routine reporting on ARI shows that most of the children with ARI receive care from health workers and institutions relatively late, which may be due to the lack of knowledge atthe family level aboutthe danger signs of ARI. MICS Kyrgyz Republic, 1995 24 4. RECOMMENDATIONS A meeting was held in Bishkek on 18 Aprill996 with the supervisors and leaders of the MICS to review the results, draw recommendations and to finalize communication plan of the survey. The supervisors and MOH officials showedtheir concern especially on the low vaccination coverage rates. In the meeting, the following illustrated communication plan which was developed in the initial stages of the survey was presented and discussed: MICS Communication Planning, The. Kyrgyz Republic Segmenting audiences and planning for communication of M/CS methodology and results LEADERS and Feed-back, presentation of report Written Report copies, Translation of National SUPERVISORS OF planning lor and communication presentation, flip chart. blank report (US$5001 gathering THE SURVEY effective plan and transparencies, transparencies, Ma.terials 19 March communication brainstorming blank chart for overhead projector, production 1996 discussion permanent and non· (US$1001 permanent pens, Support for travel board-markers (US$1001 COMMUNITY Individual, group community level Printed hand-out's Printed hand·outs Translation of hand· Community FAMILIES behav.ior change, visits, group with results, blank copies, outs level visits INDIVIDUALS project discussions of chart for discussion blank flip charts IUS$1001 Health participation findings and Materials programme implications production evaluation (US$1001 PERIPHERAL Improved service presentation of Summary report Summary report Translation of Regional LEVEL HEALTH delivery, effective report, discussion of blank chart for copies, report meetings at WORKERS communication implications and discussion blank flip charts (US$2501 oblast/rayon (FA PI with families in action Materials level immunization, production breast· feeding, (US$1001 diarrhoeal diseases and ARI MID·LEVEL EPI Improved service Group discussions of Summary repoit Summary report Materials Mid·level EPI MANAGERS delivery findings and blank chart for copies, production (see managers implications, discussion blank flip charts above) meeting information circular from the MOH COMMUNITY Better support to Group discussions of Printed hand-outs Printed hand·out Materials Primary TEACHERS preventive health findings and showing results, copies, production (see school education on implications for blank chart for blank flip chart above) teachers immunization, schllols discussion meetings as diarrhoeal· diseases part of and ARI CDD/ARI training at regional level OBLAST Better planning Formal presentation Written Report copies, Materials National KHOKIMS. and monitoring of report foUowed by presentation. flip chart, blank production (see gathering HEALTH and discussion transparencies, transparencies, abo vel with MOH EDUCATION blank charts for overhead projector. Support lor travel and MOE OFFICIALS discussion permanent and non· IUS$3001 lone day permanent pens. meeting) board-markers MICS Kyrgyz Republic, 1995 lOCAl RESEARCH COMMUNITY and UNIVERSITIES PEOIATRICIANS OTHER CAAK COUNTRIES INTERNATIONAL AGENCIES OTHER UNICEF OFFICES Greater participation, better research agenda Better res.earch agenda Increased resources, help with advocacy Better communication planning, effective use of survey results. Presentation of methodology and summary results Oral presentation Presentation of report at meetings e·mail, fax Written presentation, MICS presentation, transparencies Summary article, Original article, Transparencies Written report Transparencies discussions In the meeting ,;audience prioritization" was done as follows: I . Oblast khokims, health and education officials Report copies, Materials Copies of MICS production (see methodology, above) EPI.INFO handbooks and diskettes Will be available at Participation in conference facilities Conference (one) US$1.000 Copies of report computer, e·mail Personnel cost (US$?) Minimal 2. Mid-level EPI managers and Peripheral Health Level Workers (FAP) 3. Community teachers 4. Community, families and individuals 5. Local research community and universities 6. International agencies 7. Pediatricians from other CARK countries The following recommendations were drawn during the meeting: Immunization Three major areas of intervention were identified by the participants: 1. To increase coverage rates for all antigens and especially for OPV and measles 2. To supervise field staff in order to prevent false contraindications 3. To improve reporting system. 25 One day meeting (following national gathe1ing for MOHand MOE) Presentation at Ill. Pediatric Conference in Almaty, September 1996 Presentation matched to policy/decisio n cycle As long as it is needed The low coverage of OPV and measles was the major concern. It is recommended that the MOH prepare a special plan of action to increase measles coverage to the l.evel of 80% by the end of 1997. It is also recommended that MOH take the opportunity of all training activities related to EPI to present the EPI results of MICS and stress the importance of increasing the coverage rates and reduce false contraindications. As for the reporting system, it isrecommended that the MOH introduce the "immunization monitor follow-up" charts into the system for monthly monitoring. EPI mid-level training workshops could be used for this opportunity. MICS Kyrgyz Republic, 1995 26 Use ofORT and Mothers' knowledge on danger signs of ARI ORS was found to be widely known and used. However, new definition of ORT use, which includes continued feeding, was very low. As for AR.I, danger signs ofARI were not known by most of the mothers. It is recommended that the ARI analysis inNaryn be evaluated seriously and recommendations be drawn based on the Naryn evaluation and MICS together. It is also recommended that the communication .skills ofhealth personnel be improved through workshops (special workshops should be designed to improve communication and managerial skills of health personnel). Basic Education The proportion of children over seven years of age not attending school was found to be very low. However, it is strongly recommended that the Ministry of Education focus on the. issue as a potential problem and identify the reasons of non-attendance. Water and Sanitation Naryn, Jalal-abad and Osh oblasts were identified as priority areas for intervention. It is recommended that international support be focused on these three oblasts, especially in upgrading the water sources. Survey results showed a very high coverage ofsafe sanitation facilities, however, this figures included "covered dry pit latrines". Fromthe field observations, it is well known that almost all of the pit latrinesare not kept hygienically and cannot be considered as "safe". A special programme is recommended to improve sanitation situation throughout the country, focusing at sub-national level (starting with Naryn and Talas which have the lowest figures). The "School Hygiene and Sanitation Package" which was developed by UNICEF CARl( can serve as an entry point to address the problem. Breast~ feeding Breast-feeding is a common tradition in the Kyrgyz Republic. Exclusive breast-feeding in infants under 4 months of age was found to be 38%. Although the MOH abandoned the famous FSU decree on breast-feeding and issued a new one, it is not fully in line with WHO/UNICEF recommendations. The breast-feeding which was developed by the MOH, needs more attention and support from the international side. · Acute Respiratory Infections Mothers' knowledge on the danger signs of ARI was found to be very little. The findings ofMICS should be combined with the qualitative evaluation of ARI programme which is planned to be carried outin April.I996 in Naryn. Specific recommendations will be drawn based on this ARI evaluation. MICS Kyrgyz Republic, 1995 Annex I. Annex II. Annex Iff. Annex JV. Annex V. Map of The Kyrgyz Republic Location of clusters by oblast List of interviewers andsupervisors List of participants (MJCS eval,uation meeting, 18 April 1996) Questionnaires 27 ANNEXES MICS Kyrgyz Republic, 1995 M1p N&_ 3770 R••· 1 UNITED NATIONS July 1995 Depertrn~nt of Public Information Cartographic section :A. ~ ~ !"-< ~ ~ ~ ~ . D'q ~ :::0 ~ :;:: o- ._ ~· 'v Co 29 Annex ll. Location of clusters by oblast OSH 001 Gulcha A1aiskyi 15,581 002 Toguz-Bu1ak 1,104 003 Aravan Arananskyi 18,681 004 Djcke-Mistc 1,687 005 Kara-Bak Batkenskyi 4,568 006 Aktash Kara-Suiskyi 2,245 007 Bek-Djar 759 008 Besh-Kene " · 2,858 009 Nariman 6,256 010 · Savai 2,098 011 Furkat 3,783 012 Bolshevik Lyaiiyakskyi 2,096 013 Lenin a 2,183 014 Bag! an Naukatskyi 851 015 Botko 1,831 01.6 Borbish 2,255 017 Chapacva 9,983 018 Kara-Kuldja Kara-Kuldja 9;377 019 Ak-Djar Uzgcnskyi 1,590 020 Kysy1-Dyikan 2,048 021 Kainar 399 022 Kyzy1-Charba 681 023 Ak-Kiay Kadamjaiskyi 178 024 Ka1acha 2,200 025 Osh.city I 408,500 026 027 028 029 030 MICS Kyrgyz Republic, 1995 30 . OSH 031 " 032 " 033 Sulukta-city 21,000 034 Uzgen-city 45,000 --.JALAL 035 Ak-Korgon Ala-Buka 4,454 ABAD 036 Baimak " 1,276 037 Sovet-Sai " 622 038 Bazar-Korgon Bazar-Kogon 21,408 039 International Batkenskyi 1,646 040 Charbak " 2,925 041 lstMay " 2,675 042 Djani-Djol Aksyiskyi 1,818 043 Karavan " 11,648 044 Chie " 767 045 Naryn " 4,943 046 Besh-Djigach Nookenskyi 348 047 Rahmandjan " 1,516 048 Birdik " 1,638 049 Cheke-Debe Suzakskyi 1,947 050 Ak-Gook " 1,989 051 Spasovka " 2,414 052 Safarobkaja " 1,740 053 Mundus " 828 054 Gulstan " 2,122 055 Totia " 1,466 056 Lenin a Toguz-Toroiskyi 1,771 057 Ai-Arik Togtogulskyi 642 058 Kyzyl-Uran " 1,948 059 Jalai-Abad city 77,500 060 " 061 . MICS Kyrgyz Republic, 1995 31 JALAL· 062 " ABAD 063 Kara-Kul city 22,900 064 Kok-Yangak city 16,100 065 . 066 " 067 Mailu-Suu city 28,300 068 Tash-Kumir city 39,800 CHUI 069 Kara-Djigach Alamedin 4,484 070 Dachnoe 1,471 071 Ala-Archa 10,078 072 Prigorodnoe 5,546 073 Hydtostroitel Issyk-Atinskyi 1,277 074 Urevka 3,394 075 Kalininskoe Kalininskyi 3,891 076 Iri-Suu 633 077 lnternatsionalnoe Kantskyi 3,192 078 Kirsh elk 1.,942 079 Nooruz 762 080 Piket Keminskyi 855 081 Aleksandrovka Moscovskyi 10,664 082 Belovodskoe 22,871 083 Petrovka 9,109 084 Voznesenovka Panfilovskyi 4,091 085 Djailma 1,060 086 Lesnoe Sokulukskyi 823 087 Djani-Djer 4,536 088 Sokuluk 10,924 089 Nizhnee 2,184 . 090 Djal 2,079 091 Komsomolskoe 2,507 092 Len ina 332 MICS Kyrgyz Republic, 1995 32 <.'Ill I I ()')J Chui Chuiskyi 13,568 094 Tokmok-city 106,000 095 " 096 " 097 Kara-Balta city 40;000 098 . 099 Kant city 20,000 100 Ak-Tuz city 7,000 tot Shopokov city 8,000 102 . Issyk-Kul 103 Djani-Aryk Ak-Suis~yi 1,531 104 Shapak 802 105 Tep1okluchenka 10,282 106 Ai-Osten Djeti-Oguzskyi 1,126 107 Dark an 4,134 108 Chirak 1,456 109 Podgornoe 9% 110 Pokrovka 13,495 Ill Tamga Djeti-Oguzskyi 3,855 112 Ananevo Issyk-Kulskyi 8,954 113 Grigorevka 5,405 114 Semenovka 2,651 115 Temirovka 2,729 116 Chon-Sari-Oi 1,987 117 Ak-Oien Tonskyi 1,898 118 Bokonbaevo 11,890 119 Kara-Tala 1,542 120 Kuturga Tupskyi 1,690 121 Kurmenti 2,382 122 Toktoyan 1,089 123 Tup 12,065 MICS Kyrgyz Republic, 1995 ' 33 lssyk-kul 124 Tup " 12,065 125 Korumdi " 1,238 126 Djalu-Bulak Tupskyi 1,009 127 Karakol - city 66,900 128 " 129 " 130 " 131 " 132 Balikchi city 46,700 133 " 134 " 13.5 Cholpon-Ata city 25,000 136 Djani-Arik Aksuiskyi 1,.531 NARYN 137 Uguk Ak-Talinskyi 754 138 Baetovo 10,386 139 Kara-Burgen 1,731 140 Djani-Talap 1,668 141 Birdik 883 142 At-Bashi At-Bashinskyi 13,979 143 At-Bashi At-Bashinskyi 13,979 144 Acha-Kaindi 3,144 145 Kalibek 2,904 146 Taldy-Suu 1,377 147 Djumgal Djumgal 1,439 148 Kairma 4,455 149 Tugei-Sai 1,383 150 Chaek 9,481 151 Chaek 9,481 152 Kara-Suu Kochkorskyi 1,967 153 Ortok 836 154 Kochkor 10,872 MICS Kyrgyz Republic, 1995 34 Naryn 155 .Kochkor " 10,872 156 Kum-Dube " 2,582 157 Sari-Bulak " 403 158 Cholpon " 3,188 159 8th March Narynskyi 1,834 160 Djerge-Tal " 2,418 IQI Emgekchil " 2,527 162 Ottuk " 1,194 163 Orto-saz " 478 164 Naryn city 47,200 165 " " ; 167 " " 168 " " 169 . " 170 " " TALAS 171 Djyide Kara-Burinskyi 1,038 172 Amanbaev 5,492 173 Bakair 2,126 174 Kirov 11,719 175 Kirov 11,719 176 Kainar 968 177 Chimkent 4,029 178 Kalinin Bakai-Atinskyi ' 2,276 179 Bakiyan · . 2,043 180 Kluchevka 4,476 181 Pervomaiskoe 1,344 182 Madaniyat 1,237 183 Lenin pol 8,505 184 185 186 3,805 MICS Kyrgyz Republic, 1995 Tal as 187 Orlovka " 188 Talas Manasskyi 189 Manas " 190 Pokrovka " 191 Kyzyl-Jyldyz " 192 Aral Ta1asskyi 193 Ataya " 194 Ak-Djar " 195 Ivanovo-A1exeevka " 196 Sasik-Bulak " 197 Kepure~Bazar " 198 Kum-Arik " 199 Ak-Sai " 200 Talas city 201 " 202 " 203 " 204 " BISHKEK- city Clusters from No205 to No238, total population ofBishkek- 593,600 BISHKEK 205 city policlinic No I 206 str.Sverdlov 101-117; Shevchenko 92-100, 99-111 ; Turusbekov 94-1 00,89; Kievskay 166-200, 155.-165; Chui avenue 170-178, 257-261 Pushkin 148-152, 127-149 Riskulov 20"38 Krupskaya 72 Belinskaya 2-10 Kru)Jskaya2-22, 1-17 Shevchenko 5-27,2-12 Sverdlov I ~9 Engels 185,181 ,232-246 Tutusbekov 5-11 Chuikov 143- I 57 35. 4,463 3,209 511 6,833 2,708 3,395 2,627 1,282 6,332 1,551 4 ,429 2,041 2,983 30,100 " " " " Leninskyi 2,178 1,956 MICS Kyrgyz Republic, 1995 36 BISHKEK 207 city policlinic No I polyclinic NO 2 208 209 210 is served by 211 ambulatory policlinic NO 2 212 213 MICS Kyrgyz Republic, 1995 Ala-Archinskaya 8 Akicv 36-54,43-53 Kalinin 290-302,245-275 Moskovskaya 209-223 Molodaya Gvardia 14-22,23-27 Togtogula 226-244 Timeryazev 42 Engels 228-302 Street No 22 p/s 118-208 Arzamasskaya 60-144,75-149 Messarosh 2-64 Abdraev 62-140 pereulok (Jane) "Pochtovyi" all houses Djamgerchinov 97-105 pereulok "Selsovetskyi" aH houses Srednya 102-210, 101.•161 pereulok Chuguevskyi 56-92,53-99 Astrahanskaya 14- 45; Primorskaya 2-32; Pereulok Krasnovodskyi, Stadionnyi, Kamchatskyi, Krasnodarskyi - aU houses Dizelnaya 1-72, Dushanbinskaya 6, 6-a, 6-b, 6- c,8, I 0, 16, 18,20,22,24,26,28,38,44,45 village "Chon·Arik" (belongs to city) Prospect Mira (Peace avenue) 53, 47-a 50Iet Oktyabrya (50 years of October revolution) 142-14S, 187-189 (including 187-a- 189-a) Ordzhonekidze 72-82 Shota Rustaveli 48, 54-a, 52-60, 101-113, 103-a - 109-a Kupyanskaya 30 Akiev 1-a Dronorovapnaya 1-82 Gagarin -1-15 Griboedov - all houses Pereuio.k Vologodskyi 1-36 9 - lineya (9th line) -1-68 Prospect Mira 5~9 Novaya 1-25 Ordzhonikidze 1-85 pereulok Ostrovsryi 1-13 pereulok Ohotskyi - all houses Remeslennaya 96- 126, 131 - to to the end of the street Sevostopolskaya 1-6 Furmanov 1-6 Chapaev 2-58 Rustaveli 1-33 1,527 1,534 1,330 Pervomaiskyi 2,458 4,090 2,553 2,194 37 2I4 Repin II4-255 2,782 Krivonosov 95-I03, I90·208 Tsioikovskyi 69-73, 76-96 69•73, 76-96 Aini 20I, 209, 219 pereulok Dragobichevskyi -all houses " Muromskyi 2-40 "Dagestanskyi 3-33 Kosmicheskaya 120-139 Hoperskaya I-I O~a, 2-58 pereuiok Lutskyi -ail houses " Mozirskyi - ail houses " Tetnopolskyi 3-22 Gagarin I35-I71, 200-270 Sibirskyi tupik 36-38 215 microdistrict "Djal" - ali houses 3,537 50 let Oktyabrya- 20-21, 24- 26,29,31,33,35, 77, 78, 79,74,81-84,86087,90- 92,94,96,98, I 03 policlinic No 4 216 Gogo! 116,179 Sverdlovskyi 1,850 Frunze 282, 300, 423-425, 425-4, 425-1 Ivanitsin 64, 64-1,64-2 217 Baetov I-57 I,773 Frunze 240-280 Osmonkui 65-131 Karpinskyi 166-204 policlinic No 5 218 microdistrict "Bakai-Ata" all houses 2,000 219 microdistrict "Aiamedin" 2,141 220 microdistrict "Tunguch" 25,27,36,37, 39, 34~a, 5 I ,55, 56,58,59,60, 61,62, 63 policlinic No 6 221 Eiebaev 65-71, Oktryabrskyi 1,657 Scryabin 76-80,37-43 Sovetskaya 5,5-a,b,c; 9, 9-a, 13, 13-a,b; Topograficheskyi pereuiok -ali houses; Kommunisticheskaya I 0 I- I 49 222 Maldibaev 36,36-a,38,38/1,40,40-a,42,42-a,44,46 Oktyabrskyi 1,841 Donetskaya 10 microdistrict No 10-13-15 223 microdistrict No8- 3-8, 8/1 1,787 Sovetskaya 3/4, II ,3-g Chardovarskaya 9 I ~b,c 224 microdistrict No 7- 17-27 1,838 MICS Kyrgyz Republic, 1995 38 225 Marx 56-127, 1,678 Djantoshev 1-47 Kropotkin 2-1 04 Beporusskaya 34-111, 18 pereulok Anarchinskyi - all houses Zhugulevskaya 1-47 226 microdistrict No6 - 23-28 1,671 227 microdistrict No 12-16,19,20, 56-59,62,64,65,69 1,995 228 microdistrict No 6- 1-5, 5-a,6-7, 7-a, 8, 9/1, 8-a 1,927 polyclinic No 229 Belinskaya 5, 7 Sverdlovskyi 1,962 7 pereulok Belinskogo· 1-27 Bokonbaev 152-172, 149 Karasuiskaya 1-15, 26,27 Moscovakaya 156-164 lsanov 1-20 230 microdistrict "Ug- 2" (south) -.1-9 J,607 231 Kalinin 75,77, 106-112 2,113 Moscovskaya 49-53, 64,69 Pravda 40,61,63 Usenbaev 44-68 Shopokov 35 policlinic No 232 microdistrict "Vostok-5"-1-11 2,093 8 233 microdistrict "Vostok-5"-12-18, 23-25 2,059 po1ydinic No 234 Frunze 10•42, 49-81 Leninskyi 2,367 9 Kantemirovskaya 2-16 Voronezhskaya 59-105 prospect Chui 39-79 235 microdistrict "Kok-djar" 5,002 polyclinic No 236 pereulok Botkenskyi -all houses 1,815 3 pereulok Batira - " 237 Belinskaya 64-70, 89-113 2, 784 lvanitsin 174-229 Kirov 247-328 Karasuiskaya 78- I 05 50 Jet Kyrgyzii 378-424 RiskuJov 15·61 40 Jet October 108-134 Frunze 403-434, 533-565 Shevchenko 1J4-147 MICS Kyrgyz Republic, 1995 238 pereulok Ak-Tala- all houses Belinskyi- 163-234 Kokchetavskyi - I - 27 Karavanskyi - all houses Kokchetavskaya street -206-232, 235-343 Kisi1kyiskaya- 1-25 Mo1odaya Gvardia -158, 181 - 231 Kuliev - all houses Tu1eberdiev -I- 86 pereu1ok Talasskyi - all houses pereu1ok Tihvinskyi · - " .39 1,538 MICS Kyrgyz Republic, 1995 40 ANNEX Ill. List of supervisors and interviewers Osh oblast Supervisors Interviewers I. Kozhevnikov-head of epidemiological department 0 I. Turdubaev Osh oblast SES 2. Jemuratov-head of the branch of the Center for 02. Tilenchiev Immunoprophylaxis in Osh oblast 3. Saidova•head of statistical unit, Osh oblast Health 03. Berdishev Department 4. Shamshiev-deputy head of the department of high 04. J_anibekov schools, MoEducation 05. Omorova 06.Kanaeva 07. Niyazbaeva 08. Nurakunov Djalal-Abad oblast Supervisors Interviewers I. Denislamova -head of department of clinical and 09. Kadirkulov social prophylaxis, Research Institute on Ecology 2. Tolonova -head of medical statistics bureau, Djalal- 10. Niyazaliev A bad oblast health department 3. Abdrazakova-epidemiologist, Djalai-Abad oblast II. Dosaliev health department 12. Kiyazov 13. Imanaliev 14. Jumadilova 15. Kokumova 16. Karimshakova MICS Kyrgyz Republic, 1995 41 Jssyk-Kul oblast Supervisors Interviewers I. Zadorozhniy ~head of epidemiological department, 17. Kirbashev Republican SES 2. Toropova -researcher, Department of sociology, 18. Kulahunov Institute of Ecology 3. Djumanalieva -epidemiologist, Djalai-Abad oblast 19. Chungulov health department 20. Kadirov 21. Mukaramov 22. Alamuradov 23. Mambetova 24. Babaeva Natyn oblast Supervisors Interviewers I. Adjibaeva •deputy chief physician of Naryn oblas~ 25. Omuraliev Health Department 2. Sharshenbaeva- epidemiologist, Naryn oblast SES 26. Gaparov 3. Eshenalieva -researcher, Institute of Ecology 27. Bolot Jumali 28. Baijanova 29. Baijumanova 30. Karmisheva 31. Kulova 32. Dootalieva MICS Kyrgyz Republic, 1995 42 Talas oblast Supervisors Interviewers I. Oskonaliev -head of epidemiological department, 33. Omursakov Talas oblast SES 2. Denisova - officer in administrative - 34. Chingishbaev methodological section, Talas oblast Health Dep,artment 3. Bashneva -chief of Water/Sanitation Department, 35. Ajimatov Republican SES 36.Jusuev 37. Boshkoeva 38. Tashirbek kisi 39. Japarova 40. Ashiraliev Chui oblast Supervisors Interviewers l . Bobrovskyi -deputy chief-physician Chui oblast 41. Asanbekova Health Department 2. Burlutskyi - head of epidemiological department, 42. Abdrahmanova Chui oblast SES 3. Omurzakova- officer in Research Institute of 43. Umetova Ecology 44. Bikieva 45. Jumasheva 46. Kudimova 47. Moldalieva 48. Kabilova MICS Kyrgyz Republic, 1995 43 Bishkek city Supervisors Interviewers I. Mirzakarimova -head of bureau of statistics, MoH 49, Piskulbekov'a 2. Sokurenko- officer in Research Institute of Ecology 50. Toktobolotova 3. Monolbaev -deputy head of Republican Center for 51. Dnepr kisi lmmunoprophylaxis 52. Konokbaeva 53 . Mamiralieva 54.Muhambetianova 55. Kulevtsova 56. Toktogonova MICS Kyrgyz Republic, 1995 ----- ---------· 44 ANNEX IV List of Participants, M/CS Review Meeting LIST OF PARTICIPANTS MICS RESULTS REVIEW MEETING Thursday, 18 April1996, BISHKEK, The Kyrgz Republic MINISTRY OF HEALTH S. Abdikerimov S. Firsova B. lsrailov N. Vashneva L. Murzakarimova - U. Denis lam ova I. Zadorozhniy I. Burluckiy A. Kushbakeeva I. Jalilov S. Berdiev M. Turdaliev B. Guinazarov A. Ramankulov U. Kulchibaev M. Aliev N. Serkebaev G. Borunchiev G. Askarbekov M. Mambetov UNICEF U. Kartoglu G. Turusbekova MICS Kyrgyz Republic, 1995 Head of SANEPID Department, MOH, Bishkek Head of Centre for Immunoprophylaxis (CIP), Bishkek Deputy Head ofCIP, Bishkek Chief, Department of Water and Sanitation, Republican SES, Bishkek Head, Statistical Department, MOH, Bishkek Head, Department ofClinico-social prophylzXis of diseases, Research Institute of Ecology, Bishkek Head, Department of edidemiological surveillance, Republican SES, Bishkek Head, Department of Epidemiological Surveillance, Chui oblast Chief Pediatrician, National coordiantor of CDD/ ARI and BF brogrammes Chief doctor, SES, Sulukta city Chief doctor of Rayon SES; Kara-Kuldja Chief doctor of Tup Rayon SES, Issyk-kul oblast Chiefdoctor ofUch-Terek Rayon SES, Jalal-abad oblast Chief doctor of Panfilov Rayon SES, Chui oblast Chief doctor of Kern in Rayon SES, Chui oblast Deputy Chief doctor ofNaryn oblast SES Chief doctor of SES kara Balta city, Chui oblast Chief doctor of Ak-Tala Rayon SES, Naryn oblast Chief doctor of Talasskiy Rayon SES, Talas oblast Chief doctor of Cholphan-Ata Rayon SES, Issyk-Kul oblast Health Officer, UNICEF CARK AO National Asistant Project Officer, UNICEF CARK Kyrgyz Republic QUESTIONNAIRE 1. HOUSEHOLD ~ODULE Interviewer nc:i: . . 45 ANNEX V. QUESTIONNAIRES Q1 For all households INTERVIEWER: Begin by introducing yourself, explain to the interviewee that you would like some information that will help government improve the health and well-being of children. Tell that the questions will take only a few minutes. Household Information Panel Cluster number: Hous~hold number: Date of interview (date/month): Name of head of household: Number of persons in the Number of rooms in dwelling: household: INTERVIEWER: I WOULD LIKE TO ASK ALL MOTHERS OR OTHERS WHO CARE FOR CHILDREN SOME QUESTIONS ABOUT THE HEALTH AND WELL-BEING OF THE CHILDREN IN THIS HOUSEHOLD. If there are more than one mother/caretaker living in this household, ask to speak to each mother/caretaker, listing the mother's name in the line 0-1 . Ask mother to list the names and birth dates ofthe children for whom she is responsible who .live in the household, starting with the youngest child, who is listed oh the line number 1-1. Stop listing when you reach a child over age 11. If there is another mother living in the same household, go on to the next woman, listing her name first on the line 0-2, and the children for whom she is responsible who are living in the same household, starting with the youngest child with line number 2-1. Mother and Child Listing Form line no 1. Name 2.Sex 3. Date of Birth 4. 1 =male Respondent l=mother 2=female day month year 2 = caretaker 0- , ••• !················ !:··················· , ••••••••••• ••••• ! ••• ••••••••••••••••••••• ••••••••••••••••••••••• I < ••••••••••••••••••••••••• ••••••••••••• ••••••••• •••••••••• ••• •• 1 (mother) 1-1 1-2 1-3 MICS Kyrgyz Republic, 1995 46 QUESTIONNAIRE 2. WATER AND SANITATION MODULE Q2 For all households · Cluster no: . Household no: . . Ask the questions in this module once for each house visited. Circle the number for only one answer in the space at right If a respondent gives more than one answer, enter the most usual source/facility. 1. What is the main source of drinking water for members of your household? Piped-in dwelling Public tab 1 Unprotected dug well or spring 5 • 2 Pond, river or stream 6 Tube well or borehole Protected dug well or protected spring 3 Tanker-truck, vendor 7 4 Other 9 2. How far is the source from your dwelling? On premises 1 500 m- 1 km Less than 1 00 meters 2 More than 1 km 1 00 m - less than 500 meters 3 Don't know 3. How long does it take to get there, get water and come back? No. of minutes Water on premises Don'tknow 888 999 4 5 9 4. Do you have soap to wash hands? (Ask to see the soap and circle appropriate number) YES 1 NO 2 5. What kind of toilet facility does your household use? Flush 1 Non-flush public Non-flush private 2 No toilet 6. How far is the facility from your dwelling? In dwelling 1 50m or more away Less than 50 m away 2 Don't know 3 9 4 9 GO TO NEXT MODULE . -+ MICS Kyrgyz Republic, 1995 47 --------------------------------------------------~--------------- Q3 For all children between 6-11 years of age QUESTIONNAIRE 3: EDUCA TJON MODULE Cluster n.O: . .-. Household no: . . The questions in this module should be asked for all children in the household between 6-11 years of age. Questions line line line no: . no: •••••••••••.•• no: •••.•.•.•••••••• Name: •••••••••• Name: . Name: . .•. . . . 1. Has [NAME] ever attended school? Yes 1 1 1 1 No 0 -+ GO ON TO NEXT 0 0 0 CHILD 9 9 9 Don't know 9 -+ GO ON TO NEXT CHILD IFTHERE ARE NO OTHER CHILDREN BETWEEN 6-11 YEARS GO TO NEXT MODULE -+ 2. Is he/she currently at school this year? Yes 1 1 1 1 No 0 -+ GO TO QUESTION 4 0 0 0 Don't know 9 -+ GO TO QUESTION 4 9 9 9 3. Which grade is he/she currently attending? 4. Was he/she attending school last year? Yes 1 1 1 1 No 0 -+ GO ON TO NEXT 0 0 0 CHILD 9 9 9 Don't know 9 -+ GO ON TO NEXT CHILD IF NO OTHER CHilD IS BETWEEN 6-11 YEARS OF AGE GOTO NEXT MODULE-+ 5. Which grade did [NAME] attend last year? GO TO NEXT MODULE -+ Line no: ••••.••••••••• · Name: . . . 1 0 9 1 0 9 1 0 9 MICS Kyrgyz Republic, 1995 48 Q4 For all mothers/caretakers who has children under 5 years of age QUESTIONNAIRE 4. CARE OF ACUTE RESPIRATORY ILLNESS This module is directed to the mothers or caretakers of all children under 5 years of age in the household. Fill in the duster and household numbers first and then the name and the line number of the mother. If there are more than one mother in the household, go on to the second column and strat with copying her line number and the name from the Hosehold Questionnaire (Q1 ). Circle the number corresponding to the mother's response where indicated. · Cluster. no: . ~ . Household no: .•. Questions Line Line Line Line no: . no: . no: . .no: . Name: . Name: •••.• Name: •••.•.•• Name: •••••••••.• . ··················· . . . 1. COUGH AND COLD ARE COMMON ILLNESSES. WHEN YOUR CHILD IS ILL WITH A COUGH AND/OR COLD; WHAT SIGNS OR SYMPTOMS WOULD YOU LEAD TO TAKE HIM/HER TO A HEALTH PROVIDER? Do not prompt! Circle the number for each answer mentioned. Morethan one answer can be circled. When he/she: 1 A. has a blocked nose 1 . 1A 1 1 1 1 1 B. has trouble sleeping/eating 2 ······ 1B 2 2 2 2 1 C. has a fever 3 . lC 3 3 3 3 10. is breathing fast 4 . 1D 4 4 4 4 1E. has difficulty breathing 5 . 1E 5 5 5 5 1 F. is ill for a long time 6 . 1F 6 6 6 6 1 G. other: . . , . 7 . 1G 7 7 7 7 1 H. don't know 9 . 1H 9 9 9 9 MICS Kyrgyz Republic, 1995 49 --------------------------------------------~------~------------- Q5 For all children under 5 years of age QUESTIONNAIRE 5. DIARRHOEA This module is directed to the mothers or caretakers of all children under 5 years of age in the household. A spare form should be filled in for each child under 5 years, listed in the HOUSEHOLD MODULE (Q1 ). Fill in the name and line number ofeach child along with the cluster and household numbers in the space at the top of each questionnaire. Circle the number corresponding to the mother's response where indicated. Make sure all identifying information is filled in correctly, until all children under age 5 have been covered. DIARRHOEA MODULE Cluster no: . ~.Household no: . Child no: . . QUESTIONS 1. Has [NAME] had diarrhoea in the last 2 weeks? (Diarrhoea is determined as perceived by the mother, or as three or more loose or watery stools/dayor blood in stool) Yes 1 No 0 -t GO TO NEXT MODULE Don't know 9 -t GO TO NEXT MODULE 2. During this last episode of diarrhoea, did [NAME] drink any of the following? (Prompt and circle code for all items mentioned) 1 =Yes 2 =No 9 =Don't know(DK) 2A. breast milk? . . . . . ~ . . . . 2B. cereal-based gruel or gruel made from roots or soup?. . . 2C. yoghurt, rice,water? . . . . 2D. ORS/regidron package solution? . . 2E. other milk or infant formula? . . . 2F. water with feeding during some part of the day? . . . 2G. water alone?., . . . . . . . . . . 2H. Coca-cola, sweet tea, sweet drinks or juices 3. During [NAME]'s diarrhoea, did he/she drink much less, about the same, or more than usual? Much less or none 1 About the same 2 More 3 Don't know 4 4 . During [NAME]'s diarrhoea, did he/she eat less, about the same, or more food than usual? (If less, probe: MUCI-1 LESS OR A LITTLE LESS THAN USUAL?) None 1 Much less 2 Somewhat less 3 About the same 4 More 5 Don't know 9 Response y N DK 2A 1 0 9 2B 1 0 9 2C 1 0 9 2D 1 0 9 2E 1 0 9 2F 1 0 9 2.G 1 0 9 2H 1 0 9 MICS Kyrgyz Republic, 1995 50 Q6 For all children under 25 months of age QUESTIONNAIRE 6. BREASTFEEDJNG MODULE This module is directed to the mothers or caretakers of all children under 1 year of age in the household. A spare form should be filled in for each child under 1 year listed in the HOUSEHOLD MODULE (Q1) . Fill in the name and line number of each child along with the cluster and household numbers in the space at the top of each questionnaire. Circle the number corresponding to the mother's response where indicated. Make sure aJJ identifying information is filled in correctly, until all children under age 1 have been covered. BREASTFEEDING MODULE Cluster n.o: . ~ •. Househ_ol.d. no: . Ch·ild no: . . QUESTIONS Response 1. Has [NAME] ever been breastfed? Yes 1 No 0 . GO TO QUESTION 4 Don't know 9 . GO TO QUESTION 4 2. Is he/she still being breastfed? Yes 1 No 0 . GO TO QUESTION 5 Don't know 9 . GO TO QUESTION 5 2. Since this time yesterday, did he/she received any of the following? Prompt and circle code for a// items mentioned. 1=Yes 2=No 9=Don't know (DK) y N DK 2A. vitamin, mineral supplements or medicine? . . . . . . . . . 2A 1 0 9 2B. plain water . . , . . . 2C 1 0 9 2C. sweetened, flavoured water or fruit juice or tea or infusion . . 2D 1 0 9 2D . ORS/regidron . . . . . . . . . 2E 1 0 9 2E. tinned, powdered or fresh milk or infant formula . . . . . . . . 2F 1 0 9 2F. any other liquids (specify: . . . . . . . : . . . . . . 2C 1 0 9 2G. solid or semi-solid (mushy) food . . . . 2H 1 0 9 2H. received ·ONLY breastmilk . . . . . . . . . ; . . . . MICS Kyrgyz Republic, 1995 QUESTIONNAIRE 7. IMMUNIZATION MODULE 51 Q7 For all children between 1-2 years of age Aspare form should be filled ' in for each child between 1-2 years of age listed in the HOUSEHOLD MODULE (Q1). This module (except question number 1) should be filled at the polyclinic from the vaccination records. Cluster no: . Household no: . Child no: . . Before you leave the house: Fill in the name and line number of each child ~long with the cluster and household numbers in the space at the top of each questionnaire. Before you leave the house check the BCG scar for each child between 1-2 years of age and circle appropriate number. 1. BCG scar (Check for scar) Yes 1 No 2 Not examined 9 Thank the mother/caretaker for her cooperation. When you go to polyclinic: Find the child's vaccination records. Make sure all identifying information is filled in correctly, until all children between age 1-2 have been covered. Question Record Date of Immunization exists 1 =Yes DAY MONTH YEAR 2 =No BCG DPT1 DPT2 DPT3 OPVO OPV1 OPV2 OPV3 MEASLES Thank the health workers who helped you for polyclinic based records. MICS Kyrgyz Republic, 1995

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