Lebanon - Multiple Indicator Cluster Survey - 2001

Publication date: 2001

./ • • • United Nations Children's Fund (UNICEF) Palestinian Programme Beirut, Lebanon Palestinian Central Bureau of Statistics and Natural Resources MICS2 SURVEY OF HEALTH, EDUCATION & SOCIAL CONDITIONS OF PALESTINIAN WOMEN & CHILDREN IN LEBANON June 2001 • TABLE OF CONTENTS Page INTRODUCTION 2 EXECUTIVE SUMMARY 2 Summary of main Indicators 5 OBJECTIVE OF THE SURVEY 7 METHODOLOGY 7 SURVEY RESULTS 17 Enrollment in pre-school facilities 17 Enrollment in primary schools 19 Literacy 19 Child work 19 Water and Sanitation 20 Infant and Child Mortality 20 Nutritional condition of children 22 • Breastfeeding 25 Vitamin A supplement for mothers and children 25 Immunization coverage 28 Consumption of iodized salt 30 Diarrhea cases among Palestinian children 31 Care seeking for acute respiratory infections of children 33 Mothers' knowledge of preventing HIV/AIDS 35 Childbirth care 37 Contraceptive prevalence 38 Birth registration 40 Recommendations 41 ANNEX: Sample Questionnaire 42 • 1 ./ • • • 2 • • • INTRODUCTION With financing from the United Nations Children's Fund, Beirut Country Office, the Palestinian Central Bureau of Statistics and Natural Resources, headed by its Technical Manager Dr. Yousef al-Madi, conducted a sample survey on the health and social situation of the Palestinian child and mother in the camps and gatherings in Lebanon. The survey covered 4500 families ofthe Palestinian refugees in Lebanon whose total populations estimated by UNRWA records at 373,000 as of June 2000. The survey aims at studying the social, health and educational status of Palestinian children and mothers. The study highlights characteristics of the population with special focus on diseases, social and economic conditions, nutritional and educational situation of children. In addition, the health aspects of pregnant mothers and breast feeding habits were fully investigated. The Central Bureau of Statistics presents its thanks and appreciation to all the parties who contributed to make completion of this survey possible. Special thanks are due to the United Nations Children's Fund (UNICEF) and to UNRWA. EXECUTIVE SUMMARY Education • Survey results revealed that net basic school attendance rate is 96.3%. This rate was close for males and females alike. • Around 86.2% of children entering the first primary class reached the fifth primary class successfully. • Illiteracy rate among the population aged 15 years and above has reached 15% with 20.1% for females and 9.5 for males. Water and Sanitation • Survey results indicate that 70% of the camp population has access to safe drinking water. • Around 73.4% of shelters in camps and gatherings are linked to the public sewerage system. Infant and Child Mortality • Infant and under-five mortality rates are significantly higher in the poorly-served squatter gatherings of Palestinian refugees (42 and 49 respectively) compared to the formal refugee camps under UNRWA mandate (38.0 and 48.5 respectively). • Gender-related disparities in infant and child mortality rates are insignificant. 3 • • • Nutritional status of Palestinian children • Around 3. 7% of Palestinian children under 5 years of age suffer moderate or acute underweight compared to children of their age group. The ratio of children suffering moderate or severe stunting reached 11.1% of children under 5 years of age. The ratio of underweight prevalence reached 4.1% of all children. Breastfeeding • Around 9.6% of children under four months of age are breastfed with no other food supplement, whereas 44.3% of children aged 6 to 9 months are breastfed in addition to soft food supplementation. Only 8% of children aged 20 to 23 months continue to be breastfed. Iodized salt consumption • Approximately 99% of Palestinian families in camps and gatherings in Lebanon use iodized salts. Vitamin A supplement • Only 19.2% of children 6-59 months old received vitamin A supplement during the six months period prior to the MICS2 survey, whereas 16.8% received no vitamin A supplement the last six months but had received the vitamin A supplement before that period. Weight Birth • 5.1% of all births had birth weight below 2.5 kg. Immunization coverage Verification of vaccination certificates of children aged 12-23 months living in Palestinian camps and gathering revealed that: • TB immunization coverage reached 80.1 %. • DPT immunization coverage reached 77.4%. • Polio immunization coverage reached 77.4%. • Measles immunization coverage reached 50.2%. • Only 45.8% of children have received all the immunization required during the first two years of age. • There are no differences in immunization rates between males and females. Prevalence of diarrhea • 10.1% of all children under 5 years of age had diarrhea episode during the two weeks period preceding the survey. 4 • • • Around 34.5% of children with diarrhea were treated at home with ORS . • Two thirds of children with diarrhea were given higher quantities of fluids while 38.8% were given larger or the usual quantities of food intake. Care seeking • 87.8% ofPalestinian mothers believe that, in case ofhigher fever, a child should be taken to a physician or to a health center. • 62.7% ofPalestinian mothers are aware of at least two sickness symptoms which necessitate taking the child to a physician. HIV/AIDS • 77.7% of Palestinian women 15-49 years old have heard of AIDS. • 65.4% of Palestinian women 15-49 years old know at least one way through which HIV/AIDS is transmitted. • Only 16.5% ofPalestinian women 15-49 years old are aware of three ways of HIV I AIDS transmission. • 15% of women in the child bearing age have been tested for HIV/AIDS . Contraceptive prevalence rate • 69% of married Palestinian women use one of the birth control methods. The diaphragm is in the forefront of these methods where 40.5% ofthese women use diaphragm whereas 40% of women use the contraceptive pill. Antenatal care • All women surveyed received medical care during their last pregnancy. • 4 7% of pregnant women received medical care by a physician during their last pregnancy. • 47.5% of pregnant women have received a tetanus shot at least once during the past three years compared to 9.9% who have received at least two tetanus shots during the past three years. Childbirth care • 4 7.1% of women were attended by a physician during their last child birth whereas 45.1 received the help of a certified midwife and 7.1% received the help of a non-certified birth attendant. • Birth registration 5 • • • • 98% of children under five years of age have been registered at birth. No difference in registration exists between males and females . 6 • Summary of main Indicators Indicator Percentages Infant mortality rate\ 1000 live birth 38.0 Under-five mortality rate\ 1000 live birth 48.5 Male 51.9 Female 45.3 Under weight (Male/Female) 3.7 (3.7/3.8) Moderate (Male/Female) 2.8 (3.0/2.6) Severe (Male/Female) 0.9 (0.7/1.2) Stunting (Male/Female) 11.1 (13.1/8.8) Moderate 6.9 Severe 4.2 Wasting (Male/Female) 4.1 (4.5/3.9) Moderate 3.1 Severe 1.0 Access to safe drinking water 70 Use of sanitary means of excreta disposal 73.4 Children reaching grade 5 86.2 Male 84.8 Female 87.7 Net basic school enrollment ratio 96.3 Male 95.9 • Female 96.8 Net basic school attendance rate 98.4 Male 98.2 Female 98.7 Literacy rate 85.0 Male 90.5 Female 79.9 Total child disability rate 1.7 Antenatal care 97.3 Contraceptive _prevalence rate 69 Fertility rate for women 15-19 65 Total fertility rate 3.54 Child birth care 95.4 Iodized salt consumption 93.5 Children receiving vitamin A supplements 16.8 Mothers receiving vitamin A supplements 47.4 Exclusive breast-feeding rate 9.6 Timely complementary feeding rate 44.3 Continued breast-feeding rate: Children 12-15 months 32.3 Children 20-23 months 7.9 DPT immunization coverage 77.4* Measles immunization coverage 50.2* Polio immunization coverage 77.4* TB immunization coverage 80.1 * • Neonatal tetanus protection 57.6 Prevalence of diarrhea 10.1 7 • • • ORTuse 34.5 Home management of diarrhea 76 Prevalence of ARI 17.4 Care seeking for acute respiratory infection 29.5 Birth registration 98.8 Children's living arrangements 4.2 Orphans in households 2.2 Child labor 4.3 Care-seeking knowledge 62.7 Knowledge of preventing HIV\ AIDS 16.5 Knowledge of mother\ to child transmission of HIV 43.9 Attitude to people with HIV\ AIDS 27 Women who know were to be tested for HIV 27 Women who have been tested for HIV 15 * The Coverage Rate reflects the rate of children vaccinated and holding vaccination cards. If holders and non-holders of registration cards are included in the survey, the vaccination coverage exceeds 95% . 8 • OBJECTIVE OF THE SURVEY The survey objectives are the following: • To identify the health, social and education indicators on the Palestinian child at the end of the decade. • To provide a wide up-to-date base of data and indicators on the health, social and educational aspects of the Palestinian children and mothers in Lebanon. • To monitor progress achieved in implementing end decade goals as specified in the World Summit for Children (2000). • To make available the statistical results with a view to help initiate programmes for improving the situation of Palestinian children in Lebanon in all aspects of life. • To contribute to the development of data collection methodology on children and enhance local capabilities in designing and executing surveys on children. • METHODOLOGY • Sample design: The sample was determined in light ofthe survey objectives and the ratio of children under five years of age to the total Palestinian population in Lebanon. In accordance with the living conditions survey conducted in Lebanon in 1999, this ratio was 11.5%. A simple random sample was chosen with a level of confidence of95% and a relative error of 10% of the ratio of children below five years. Accordingly, the sample size was 2600 children expected to be distributed among 4500 households where, in accordance with the results of the living conditions survey, the average number of children under five years of age was 0.7 child per household. The households in each camp or gathering were grouped in clusters with 30 households in each cluster. The total number of clusters was 900 and the number of households was around 2700 in accordance with the full scale survey that was conducted by the Bureau in 1998. These figures represent only the Palestinians in the camps and in some of the gatherings. 150 clusters were tested systematically with a random beginning. % distribution of clusters and households in the camps and gatherings by area Area #of clusters # ofhouseholds Beirut 28 840 9 • • • Tripoli 2 31 930 Bekaa 2 10 300 Saida 4 48 1440 Tyre 7 33 990 Total 32 150 4500 * Household: is one or more persons living together and sharing feeding and drinking arrangements without necessarily being relatives. Questionnaire design: The sample questionnaire on household, women and child provided by UNICEF was used for all the survey questionnaires after redesigning them in order to save efforts and ensure accuracy in data collection and data entry. The questionnaire included information on: household members, access to safe water and sanitation, nutrition of children, consumption of iodized salt, information on immunization ofwomen and children, contraceptive prevalence, awareness on HIV/AIDS, acute respiratory infections, birth registration, child education, learning achievement, vitamin A supplements, breastfeeding, diarrhea prevalence and home management of diarrhea. Training surveyors and supervisors: The supervisors and surveyors participated in a training workshop for six days from 4 to 9 April2001 conducted by experts from the Arab Institute for Training and Research and The Palestinian Central Bureau of Statistics. The training programme aimed at providing the trainees with capabilities in proper filling of the questionnaires, the method of weighing and measuring children under five years of age and the method of testing iodine in the salt consumed by the family. 50 surveyors participated in the workshop, 45 of them were chosen to apply the questionnaire in the field. Three region directors and 15 field supervisors (both males and females) were also trained for two days (10 and 11 April) on technical and administrative aspects of the survey. The pre-test: A pre-test was conducted to verify the applicability of the contents of the questionnaire and the time needed to fill in each questionnaire. The results of the pre-test have led to adjusting the questionnaire to its present form. (sample questionnaire is annexed) Field work: Field work was undertaken for 15 days (12 to 26 April2001) by working groups consisting each of three surveyors and a field supervisor who accompanied the surveyors helping them to reach the survey units, measuring heights and weights of children and overseeing some of the interviews in addition to verifying filled-in questionnaires. 10 • Data processing: • • Five members undertook desk verification and coding of filled-in questionnaires in accordance with set rules and coding manual set for this purpose. These members had undertaken a training cycle of three days (27-29 Aril2001). The desk review and coding process lasted for ten days. Data were entered onto PCs by 16 data entry staff who had been trained on the IMPS during the period 9-29 May 2001. The data entry process was followed by the application of validation programme to ensure data consistency and discover possible mistakes which were then corrected by referring to the relevant questionnaires. This process lasted for one week (30th of May to 5th June). Following that, the statistical; package SPSS version 7.5 was applied to the data to identify any further errors in the data, correct the errors and then produce the majority ofthe statistical tables for later analysis. The remaining tables, particularly those on weight and height measurements, the programme (ANTHR11) and (EP16) was applied and the relevant indicators were obtained using programme (SPSS V10). Level of response: The rate ofhousehold response was 98.4%. The response rate by qualified women (15- 49 years old) was 99.9% the rate ofresponse for children below five years of age was 100%. This high rate of response was due to the following factors: 1. The use of the same frame of the comprehensive population survey conducted in June 1998. 2. The survey was conducted in April2001 during the school year where usually community movement is stable (no movement outside the camp of gathering). 3. Whenever the household was not present, the neighboring households used to lead to the place where they could be found. 4. No households were replaced except in case they had moved permanently out of the camp or gathering, in which case the replacing household will be interviewed. Age and sex structure of the Palestinian Population: The Palestinian population in Lebanon is still a youth population despite the low fertility rate for the Palestinian woman in Lebanon. This fertility rate is the result of the harsh economic and social conditions which affected the life of Palestinian women. The ratio of children under 15 & 18 years of age are 37% & 47.3% respectively and the age pyramid indicates a fast decline in fertility rates during the last decade. It also points out to a high level of emigration among the male youth and the men starting with age 15. The sex ratio is 99 . 11 • % distribution of households according to age group and sex T able (1) Sex ratio Total Female Male Age Group 112 11.8 11.1 12.4 0-4 109 12.1 11.6 12.6 5-9 108 12.5 12.0 13.0 10- 14 • 102 10.9 10.8 11.0 15- 19 101 9.9 9.9 10.0 20-24 96 8.3 8.6 8.0 25-29 98 8.3 8.4 8.2 30-34 97 6.8 6.9 6.7 35-39 93 4.4 4.5 4.2 40-44 93 2.9 3.0 2.8 45-49 75 3.1 3.6 2.7 50-54 81 2.4 2.7 2.2 55-59 88 2.2 2.4 2.1 60-64 94 1.5 1.6 1.5 65-69 100 2.9 2.9 2.9 70+ 21~~~! ,11,054 ' 109l0 lN• 100.0 100.0 100.0 % . Total > .Y ifj • 12 • • • • Figure (1) -15 Age structure for Palestinians in Lebanon -10 -5 Female 0 5 10 Male Marital status of the Palestinian population (15 years or more): 15 It is clear from the table below that the Palestinian population does not suffer social imbalance since the number of married males is the same as that of married females and the divorce rate is low not exceeding 1.5% of all the population aged 15 or more. The survey data reveal that the ratio of females 40 years or above who are not married is 10%, a high rate caused by the difficult economic conditions facing the population. Distribution of households according to marital status & sex Figure (2) 100 90 CWidowed 80 CDivorced 70 •Married 60 50 1111 Not Married 40 30 20 10 0 Male Female 13 • • • • Distribution of households according to marital status Table (2) /;; }i'emal~ . Male ·. · . · Marital:Status Total ;.::: 5740 2774 2967 No. 41.5 38.5 44.7 % Never married 7091 3571 3520 No. 51.2 49.5 53 % Married 201 158 43 No. 1.5 2.2 0.6 % Divorced 815 706 109 No. 5.9 9.8 1.6 % Widowed 13848 7209 6639 No. 100.0 100.0 100.ft % Total Characteristics of sample households: Around one third of the Palestinians are centred in the Saida area whereas one fourth of the population are living in Beirut and the Beqaa, one fifth in the area of Tripoli and the remaining population is in Tyre. % distribution of households according to region and number of family members Table (3) Total :,;.! /• racteristics ; Region 24.8 Beirut & Beqaa 20.2 Tripoli 32.6 Saida 22.4 Tyre 100.0 Total Number of family members 5.6 1 29.4 2-3 18.6 5-4 29.9 7-6 14 • • • Survey results have shown that around one third of the households (29.9%) have between 6 and 7 members each whereas the average Palestinian household size in Lebanon is 5.1 . Household distribution by size Figure (3) 100 --r------ 90 80 70 60 50 40 30 20 10 0-t------- Total % distribution of households by region 15 111110+ •a-9 1:16-7 1:14-5 ·2-3 111 • • • Figure (4) 100 -,------- 90 80 70 60 50 40 30 20 10 0+------ Total Characteristics of Palestinian women 15-49 years old: DTyre DSaida •Tripoli II Beirut & Beqaa Women in the area of Saida are close to one third of total women population, those in Tyre and Beirut areas are one fourth and one fifth are in Tripoli area. The highest rate of women was 22.7%, and that was for women in the age group 30-34 years, and the lowest rate was for the age group 44-49 years . The results show that 10% of married women are divorced, widowed or separated. Ninety percent of married women presently live with their husbands. The distribution of women 15-49 years by educational status, show that less than 8% of women have not completed primary school, whereas 75% of them have completed basic education cycle and the rest, 17% have completed high school or above. This distribution is different from the one for Palestinian women in Syria where women who have completed high school or above reach 38% of the total. This difference is due to the fact that Palestinian women in Syria have access to government educational facilities. %distribution of women 15-49 yrs. According to age group, marital status and level of education 23.9 20.1 31.8 24.2 Region Beirut & Beqaa Tripoli Saida Jyre ________________ _ Age Group 16 • • • ------3.7 14.2 19.5 22.7 18.4 12.9 8.6 ------ 90.0 10.0 ------ 90.0 10.0 ------ 7.7 74.3 18.0 100.0 '3059 Marital Status Married living with her husband 15- 19 20-24 25-29 30-34 35-39 40-44 45-49 Married & permanently not living with husband Child Bearing Gave birth to live children :pid I!,O~~ve b~rth t~ liv~ chil_§ren ____ _ Educational Status Not educated Elementary or Preparatory Secondary or above Total No. Children under 5 years of age: Table No.5 shows that 52% of under 5 children are males and 48% are females. The table also shows that children aged under one year are slightly less in number than those close to two years of age. This is due to either lower fertility rates year after year or to errors in reporting the children ages. It is also seen that 5.5% of mothers of children under five are uneducated. % distribution of children under five according to sex Figure (5) 17 • 100 90 80 •Female 70 II Male 60 50 40 30 20 10 0 Total • % distribution of children according to age by months Figure (6) • 18 • • % distribution of children under five according to the educational status of mother Figure (7) 100 90 80 70 60 50 40 30 20 10 0 Total Cl Secondary and > • Elementary and prep !:iii illiterate % distribution of children according to region, sex and age by months 19 • • • Table (5) Total Characteristics Region 22.6 Beirut & Beqaa 22.1 Tripoli 28.6 Saida --~6.7 ___ ~~~------------ 52.3 47.7 Sex Male Female -------~------------- SURVEY RESULTS 11.4 8.7 21.1 21.2 21.4 16.2 5.5 76.1 18.4 100.0 2580 Enrollment in pre-school facilities: Age by months Less than 6 months 6-11 12-23 24-35 36-47 48-59 Educational level of mother No education Elementary or Preparatory Secondary or above Total 0/o ~0. Enrollment in pre-school facilities in the Palestinian camps and gatherings in Lebanon reached 46% of children 3-4 years old. This is a high percentage compared to the one in Syria, where it reached 8% only. This is due to the fact that most of the pre-school Facilities in the Palestinian camps and gatherings in Lebanon are sponsored by Palestinian philanthropic associations and charge nominal fees. Table No. 6 shows differences in enrollment between the different areas. The highest rate of enrollment is in the Tripoli area (more than 66%) and the lowest rate is in the Saida area 37%. We also see a higher rate of enrollment for male pre-schooler. We observe that enrollment rate increases as the age ofthe child increases as well as with the increase of the mother's level of education . 20 • • • % distribution of children according to preschool enrollment, region, sex, age of child by months and educational level of mother Table (6) Total ~---;. Niii<" < ") "<c--,-_,, " ~-- - ~- --~- ---- - ---- - - Ehroll~l:f Enrolled ' ''<Jc Characteristics No. % ,- Region 230 100.0 59.6 40.4 Beirut & Beqaa 192 100.0 44.8 55.2 Tripoli 265 100.0 63.0 37.0 Saida 283 100.0 47.7 52.3 TJ!e ____________ --- ------- ----- ----- Sex 511 100.0 52.4 47.6 Male 459 100.0 56.0 44.0 Female --- 1-------- ----- ----- --------------Age of child by months 552 100.0 64.3 35.7 36-47 418 100.0 40.7 59.3 48-59 -- ------ -------------------- - ----------------- ----------------- -------------------- ----------------------- Educational level of mother 68 100.0 72.1 27.9 No education 718 100.0 53.9 46.1 Elementary or Preparatory 184 100.0 48.4 51.6 Secondary or above - 100.0 54.1 45.9 ffotal o/o 970 525 _ 445 " N - , - '7 o. >: ,,_,< %distribution of children according to preschool enrollment Figure (8) Not Enrolled Enrolled 21 • • • Enrollment in primary schools: Net emollment ratio in basic education reached 96.3% oftotal children 5-12 years. The ratio was close between males and females. The ratio is higher in Tripoli and Tyre than in Beirut and Saida. It becomes lower with age increase. The rate of children who emolled in the first elementary class and continued successfully to reach the fifth grade was 86.2% ranging from 87.7% for females to 84.8% for males. The rest of the children have either failed or dropped out of school. % distribution of children according to elementary school enrollments Table (7) Total ···· ······ ·· Enrollment Females;En~qllment Mal.es Enrollment -- ---- ----- . ----- . ---- . ------ . No. % . . J'! N.Q. % NQ. . : > % 814 95.1 389 94.0 425 96.2 920 97.1 466 98.1 454 96.2 1246 95.9 572 97.1 674 94.9 1119 997.0 521 97.4 598 96.6 428 99.1 214 99.5 214 98.6 500 98.6 243 99.6 257 97.7 485 98.6 228 99.1 257 98.1 461 97.7 242 99.2 219 96.1 530 96.4 249 97.6 281 95.3 635 98.8 292 98.6 343 98.8 586 96.2 259 95.6 327 96.7 474 86.0 221 85.7 253 86.3 409.9 96.3 1948 · . < 96;8 2151 ·" ········ 95.9 Literacy: Characteristics Region Beirut & Beqaa Tripoli Saida Tyre Age in years 5 6 7 8 9 10 11 12 Literacy rate among the population aged 15 years and above has reached 85% with 79.9% for females and 90.5 for males. Child work: 22 • • • The percentage of child work earning income to the total of 5400 children aged (5-14) was found to be 4.3 (7.1M/1.2F) only. If unpaid work is added to that the percentage rises to 9.2. It is worth noting that 14% of all the children of the sample are school drop- outs. Two thirds of these drop-outs do not work. This is indeed a worrying phenomenon. Where then do these drop-outs spend their time, and doing what? Water and Sanitation: The survey results indicate that 70% of total population have access to a public water system connected directly to their shelters. In Saida the ratio was 94.2% and in Beirut and Beqa it was only 27.8%. Table No.8 shows that 16.5% of the population living in camps and gatherings buy water from mobile water cisterns. One out often households in camps and gatherings use unchlorinated well water for drinking. Infant and Child Mortality : The questionnaire which was used in MICS2 for Palestinian People living in camps and gatherings in Lebanon didn't include any question on deaths during last year because we believe that this question will not lead to correct answer. But when asking about number of live born children for a women in her marriage life and by comparing this number with those living, we could use one of the indirect methods of estimating mortality indicators according to the method explained in Manual No. 10 of U.N. 1983 about indirect techniques for demographic estimation. This method is based on a theory of demographic scientist ( William Brass ), who noticed that deaths rate ( Di ) of female births in each age group is almost equal to death probability between birth and certain ages, also, he found relationship between ( qx , Di ) which is influenced by giving birth type. Female infant mortality rate in age group ( 15 - 19 ) years is the same as that of probable mortality rate since birth until the first year. Also, female mortality rate in age group ( 20- 24) years is the same of that of probable mortality between birth and the second year and so on . The well known demographers ( Solivan & Trussel) improved group of multipliers with which can transfer the value of ( Di ) to ( qx ) according to ( Brass ) theory. We applied this theory using data obtained from number of live births and living ones in camps and gatherings in Lebanon and achieved as result to estimate probability of infant mortality till ages: 1 , 2, 3, 5 , or q1 , q2, q3 , q5 which is one of the basic function in life probability table from which we obtained survival rate until mentioned ages . 23 • • • Infant and under-five mortality rates are significantly higher in the poorly-served squatter gatherings ofPalestinian refugees (42 and 49 respectively) compared to the formal refugee camps under UNRWA mandate (38.0 and 48.5 respectively). Gender-related disparities in infant and child mortality rates are insignificant. Indicators Average ( Thousands ) Gatherin2s Camps Infant Mortality Rate 41.7 38.0 Child Mortality Rate 48.9 48.5 ( Less than 5 years ) 24 • • • % distribution of population according to source of drinking water Region 5082 100.0 3.3 3.6 65.3 27.8 Beirut & Beqaa 4838 100.0 3.6 25.2 71.2 Tripoli 6854 100.0 0.3 4.5 0.1 94.2 Saida 5190 100.0 6.5 11.8 1.1 80.6 Tyre Distribution of population according to source of drinking water Figure (9) 100 90 80 70 60 50 40 30 20 10 0 +----- Total [[]Other [[]Unprotected well • Tank /Vender [[]Water network Distribution of population according to source of drinking water by region Figure (9a) lEI Other D Unprotected well •rank/Vender •water network Tyre Said a Tripoli 25 Beirut & Beqaa 100% 80% 60% 40% 20% 0% • • • Survey results show that 75% of the population have access to public sewerage system. It is 98.7% for camps in Tripoli and 8.4% for camps inTyre. Twenty five percent of the total population in camps and gatherings use toilets connected to cesspits. This is particularly true for the Tyre area where around 89% of the population use cesspits. % distribution of population according to types of sanitation systems Table Region 100.0 0.1 18.2 81.7 Beirut & Beqaa 100.0 1.3 98.7 Tripoli 100.0 0.4 0.4 3.1 96.1 Siada 100.0 0.1 2.9 88.6 8.4 0.2 0.8 25.6 73.4 % distribution of population according to types of sanitation systems Figure (10) 100 90 80 70 60 50 40 30 20 10 0 llil Public network Beirut and Beqaa Tripoli Nutritional condition of children: •cesspit []Open drain Said a Tyre Processed data revealed that out of the 2580 children under 5 covered by the survey, only 2443 were weighed and their height measured. The rest either refused to be weighed and measured or were absent. Underweight prevalence was measured as the proportion of under-fives who fall below minus 2 and below minus 3 standard deviations from median weight for age ofNCHS/WHO reference population. 26 • • • A child who weighs 2 standard deviations less than the median weight recommended for his age is considered to be moderately underweight, whereas the child who weighs 3 standard deviation less than the recommended median weight is severely underweight. Stunting prevalence was measured as the proportion of under-fives who fall below minus 2 and below minus 3 standard deviations from median height for age ofNCHS/WHO reference population. A child whose height is 2 standard deviations below the recommended median for his age is considered moderately stunt, whereas the child whose height is 3 standard deviations lower than the recommended median for his age is considered severely stunt. Wasting prevalence was measured as the proportion of under-fives who fall below minus 2 and below minus 3 standard deviations from median weight for height of age of NCHS/WHO reference population. A child whose weight compared to the height is 2 standard deviations below the recommended median is considered moderately wasted, whereas the child whose weight compared to the height is 3 standard deviations below the recommended median is considered to be severely wasted. The total rate of moderate wasting was 3.1% and of severe wasting was 1%. The survey results indicate that 2.8% of total children under five are moderately underweight for their age and that 0.9% of these total children are severely underweight. The highest underweight rates were found with the children in the Beirut, Beqaa and Saida camps as well as with children 48-59 months old males whose mothers are uneducated. The total rate of children with moderate stunting was 6.9% and that for children with severe stunting was 4.2%. The highest rate of stunting was found in children in the Tyre camps and gatherings, and with those 6-11 months of age males whose mothers are uneducated. Moderate wasting rate reached 3.1% and severe wasting reached 1 %. The highest rate of wasting was found in Saida camps and gatherings with male children 6-11 months of age whose mothers are uneducated. % distribution of children under five according to nutritional status Figure (11) 16 Percentage 14 Wasting ----~- 12 -t-------~~~~-----"~~,------------::c=---=-------1 ·······························Stunting '1 ~===~~~~~~----~~._--~~~---~::~~~~~~~:r:-_:-~un~de~~~eig~ht__j 0 +-----~------~------~------~----~------~ Less than 6 months 11 -6 23 -12 35 -24 47 -36 59 -48 27 Age • % distribution of children under five according to nutritional status Noi oc children Region 548 1.2 0.9 3.0 8.4 2.6 5.8 4.1 0.9 3.2 Beirut & Beqaa 548 1.9 0.4 1.5 7.7 3.1 4.6 3.6 0.6 3.0 Tripoli 679 7.8 2.1 5.7 14.3 5.0 9.3 4.1 1.0 3.1 Saida 668 2.8 0.6 2.2 12.9 5.4 7.5 3.1 1.1 2.0 Tyre ------ ---- --- --- --- ---- ------- -------Age in months 275 5.6 2.0 3.6 2.8 2.8 1.6 1.6 Less than 6 months 209 6.7 1.5 5.2 11.4 6.2 5.2 3.0 1.5 1.5 6-11 520 3.9 0.6 3.3 14.1 4.7 9.4 4.3 1.2 3.1 12-23 517 2.2 0.8 1.4 10.0 4.2 5.8 3.0 1.0 2.0 24-35 523 4.9 1.0 3.9 10.8 4.3 6.5 4.0 1.0 3.0 36-47 399 3.8 1.0 2.8 14.2 4.9 9.3 5.1 0.5 4.6 48-59 ------ ---- --- --- --- --- -------------- 1269 4.5 1.0 3.5 13.1 4.9 8.2 3.7 0.7 3.0 1174 3.9 1.1 2.8 8.8 3.3 5.5 3.8 1.2 2.6 ------ ------- --- --- --------------Educational level of mothers 135 3.8 0.8 3.0 14.3 6.0 8.3 4.5 4.5 Not educated 1851 4.3 0.8 3.5 11.2 4.3 6.9 3.7 1.0 2.7 Elementary or Prep. 457 3.8 1.9 1.9 9.5 3.0 6.5 3.5 0.7 2.8 Secondary or above • 28 • • • Breastfeeding: Survey results show that 9.6% of all children in the age group 0-3 months are exclusively breastfed. The ratio for exclusive breastfeeding is 10.6% for male children and 8.3% for female children. The rate of children 6-9 months whose breastfeeding is supplemented with soft food is 44.3% with a higher rate for male children. Around one third of children 12-15 months continue breastfeeding in addition to the supplement food intake. For children 20-23 months old, this ratio drops to less than 8% of children in this age group. % distribution of children according to breastfeeding Table (11) 20. 9.5 5.8 48.9 39.8 Vitamin A supplement for mothers and children: 0-3 Exclusively breastfeedin 10.6 8.3 Sex Male Female Survey results indicate that 19.2% of total children 6-59 months old have received one dose of vitamin A supplement during the six month period preceding the survey. The rate is the same for males and females, but is higher for Saida where it reaches 22.3%, and is lower for Beirut and Beqaa where it is 15.5%. Table No. 12 show that more than 60% of children have not received vitamin A supplement. Distribution of children 6-59 months by vitamin A supplement intake Figure (12) 100 90 80 70 60 50 40 30 20 10 0 % .----.---.----.--.-----.---- Cl not sure if received Beirut & Beqaa Tripoli Sa ida 29 Tyre • Received Vitamin A II Not received • • • % distribution of children 6-59 months by vitamin A supplement intake Table (12) Region 523 100.0 1.0 67.7 15.9 15.5 Beirut & Beqaa 498 100.0 3.2 66.7 11.6 18.5 Tripoli 649 100.0 4.8 51.2 21.7 22.3 Saida 614 100.0 3.7 59.9 16.6 19.7 T~~----- ----- --------- ----- Sex 100.0 2.9 59.7 17.7 20.1 Male 100.0 3.7 61.7 16.3 18.3 Female --------- --------------- ------------- --------------- --------------- ------------------------Age in months 224 100.0 2.2 55.8 8.0 33.6 6-11 544 100.0 3.5 52.8 11.8 32.0 12-23 546 100.0 2.6 61.7 19.4 16.3 24-35 552 100.0 3.6 66.8 19.6 9.6 36-47 418 100.0 4.1 64.1 20.6 11.2 48 & above ------------- ------------------------Educational level of mother Not educated 30 • • • The percentage ofmothers who have received vitamin A supplement out of all women who have given birth during the year preceding the survey is 47.4%. More than half the mothers did not receive vitamin A supplement. In Saida the rate is 58%, and in Beirut it is 40%. It was found that higher education level of the mothers is accompanied by a lower percentage of mothers taking the vitamin A supplement. This might be due to the fact that illiterate women have a higher fertility rate which, in turn, makes them visit more frequently UNRWA Mother and Child clinics. Mothers who have given birth to a live infant during the year preceding the survey according to vitamin A supplement intake Figure (13) 100 Percentage 90 80 70 60 50 40 30 20 10 0 Beirut Beqaa & Tripoli Said a Tyre CJ Not received • Not sure if received C Received Vitamin A % distribution of mothers who had live births during the year preceding the survey according to vitamin A supplement intake Table (13) Total "'''''' Received ,, ~------------- Not Not sure if · Vitamin A ,·,',, Characteristics No. o;o received received supplements Region 105 100.0 55.2 4.8 40.0 Beirut & Beqaa 130 100.0 51.5 3.1 45.4 Tripoli 145 100.0 41.4 0.7 57.9 Saida 126 100.0 55.6 0.8 43.7 Tyre Educational level 19 100.0 47.4 - 52.6 Not educated 404 100.0 49.3 2.5 48.3 Elementary or Prep. 31 ' • • • ,, 83 100.0 56.6 1.2 42.2 Secondary & above cc ~06 100.0 50.4 2.2 1::: 47.4 '·'" Total Immunization coverage: Table 13a shows that around half of the women who were pregnant during the year preceding the survey have taken a tetanus vaccine once during the pregnancy or during the three years preceding the survey, whereas 10% have taken the vaccine at least twice during the three years preceding the survey. The table shows that the pregnant women who have taken the vaccine once or twice during the three years preceding the survey in the camps and gatherings in Saida area is 73%, whereas inTyre it is around 43%. We also find that this rate is higher for the uneducated than the educated mothers. %distribution of women 15-49 years who were pregnant last year according to No. of tetanus shots received Table (13a) ; Received at Received at ' ,, Total c@ther :least 3 dos.es ·,,· . least 2 do'ses Received 1 dose Characteristics last 3 years ,,,,c last 10 years last 3 years Regions 100.0 42.7 10.7 46.6 Beirut & Beqaa 100.0 45.3 0.8 7.8 46.1 Tripoli 100.0 27.5 11.3 61.3 Saida 100.0 56.6 9.8 33.6 Tyre Educational 100.0 36.8 10.5 52.6 Level of women 100.0 43.0 0.3 9.3 47.5 Not educated 100.0 41.0 12.8 46.2 Elementary or Prep. Secondary & above lOO.O 4~,!4 0.2 ; 9.9 ~7.5 Total Results of the living conditions survey which the Central Bureau of Statistics had conducted in co-operation with FAFO in 1999 indicated that 80.1% of total children 12- 23 months of age whose immunization cards had been viewed had taken a TB test vaccine, whereas 77.4% had taken the DPT first does, 72.6% had received the second dose and 65.9% had received the third dose. For polio, 77.4% of children had received the first dose, 72.8% the second dose and 67% the third dose. 50.2% of children had received the measles vaccine. 45.8% of the children had received all required immunization vaccines. Table 15 shows that there are no differences in immunization coverage between male and female children. However, whatever the immunization vaccines may be, the rate is higher with the higher level of education of the mothers . 32 ,,;;~'il, • • • 45.3 46.3 41.2 46.6 46.2 45.4 46.1 % immunization coverage of children 12-23 months according to type of immunization Regions 49.6 67.6 79.9 84.2 66.2 78.4 84.2 87.1 Beirut 53.7 70.5 74.7 68.9 62.6 74.2 78.4 78.9 Tripoli 41.2 69.1 73.5 76.5 72.1 73.5 76.5 77.9 Beqaa 50.9 66.1 69.0 74.0 65.0 68.6 73.6 76.9 Saida 50.9 67.5 71.6 75.7 67.5 72.2 77.5 81.7 - - - - - - .IY!e ----- -- --- --- 50.1 71.9 64.2 75.5 78.3 50.8 73.6 67.1 79.0 81.3 ----- ----- --- --------Educational level of mother Not educated % of children 12-23 months immunized by type of immunization Figure (14) 100 ,-----------------------------, 90 80 70 60 50 40 30 20 10 0 TB OPT 1 OPT 2 OPT 3 Polio 1 Polio 2 Polio 3 Measles All dose doses doses dose doses doses vaccines 33 • • • Consumption of iodized salt: Salt used by 99.5% ofhousehold was tested and results show that 93.5% of salt samples tested containing enough iodine (+15 PPM) compared to 5.6% that contained iodine (less than 15 PPM). Ten percent ofhouseholds use non-iodized salt. It is worth noting that the rate of iodized salt consumption is much higher in Lebanon than that in Syria where the ratio of ( + 15 PPM) iodized salt consumption is around 57%. % of households using iodized salt Table (15) Regions 1096 100.0 93.4 5.3 1.3 100.0 0.1 99.8 Beirut & Beqaa 893 100.0 83.5 15.7 0.8 100.0 99.8 Tripoli 1442 100.0 95.6 3.1 1.3 100.0 0.1 99.9 Siada 975 100.0 99.4 0.5 0.1 100.0 1.5 98.5 Tyre 34 • • • • Figure (15) D> 15 PPM .< 15 PPM Ill Non iodized salt % of households using iodized salt by region Tyre Saida Tripoli Beirut & Beqaa 100% 80% 60% 40% 20% 0% Diarrhea cases among Palestinian children: It should be pointed out that diarrhea cases occur more frequently in the summer months of June to August, whereas the survey was conducted at the end of the spring (April), a month during which diarrhea is not as common as during the summer. Results of the survey show that 10.1% of total Palestinian children under five suffered diarrhea episodes during the two weeks preceding the survey. The percentage was 2.1% for children six months to one year old, and 5.3% for children 4-5 years of age. Children whose mothers are uneducated, the rate was 15.5%, while for children whose mothers have attained high school or above, the rate was 8.6%. Rates of occurrence of diarrhea were the same for both sexes, 11.9% for Beirut and Beqaa and 9.0% in the Tyre camps and gatherings. One third ofPalestinian children with diarrhea episodes were given oral rehydration salts, 45% of affected children were given soups, and soft foods and 28.4% of affected children were not given any treatment. Results also show that two thirds of children with diarrhea episodes were given increased or same amount of liquids and around 38.8% of children with diarrhea were given increased or same amount of food . 35 • • Children under 5 affected by diarrhea during the two weeks preceding the survey according to age group in months Figure (16) % affected by diarrhea Less than 6 months 6-11 12-23 24-23 Age of child 36 • • % of children less than 5 years who were affected by diarhea during the two weeks preceding the survey according to type of treatment Table (16) No Other Gruel treatment treatment diarrhea Regions 69 36.6 63.4 20.0 37.1 29.6 11.9 Beirut & Beqaa 62 32.3 67.7 27.4 48.4 27.4 10.9 Tripoli 67 25.4 74.6 41.8 41.8 25.4 9.1 Saida 62 18.7 81.3 50.0 53.2 26.6 9.0 ----- .!Y!e ----- ----- 135 26.7 73.3 36.3 45.2 26.7 10.0 125 31.2 68.8 32.5 44.2 27.9 10.2 ----- ----- ------- -------Age in months 30 6.7 93.3 43.3 16.7 76.7 10.2 Less than 6 months 48 8.0 92.0 38.8 42.9 66.0 21.4 6-11 68 24.3 75.7 33.8 57.4 17.1 12.5 12-23 50 46.0 54.0 32.0 44.0 4.0 9.2 24-35 42 52.4 47.6 33.3 38.1 7.6 36-47 22 31.8 68.2 22.7 63.6 9.1 5.3 48 & above ----- ----- --- ---- -------Educational level of 22 30.4 mother No education 197 29.0 Elementary or preparatory 41 24.4 Secondary & above Care seeking for acute respiratory infections of children: Table 17 indicates that more than 87% of caretakers of children believe that when the child develops a fever, it necessitates taking the child to a health provider, while 20.9% of caretakers of children declared that they would take their child to a health provider if they observe that the child becomes sicker. 62.7% of mothers know, at least, two symptoms that necessitate seeking the care of health providers immediately . 37 . • • • % distribution of mothers according to their recognition of sickness symptoms appearing on child less than 5 years that require medical care 38 J • • • Mothers' knowledge of preventing HIVIAIDS: The percentage of mothers 15-49 years of age that have heard of HIV I AIDS was 77.7% (88.5% for Tyre, 60.4% for Saida). 71.1% for age group 15-19 years, 83.3% for the age group 30-35years, 54.2% for women with no educational attainment and 89.5% for those with a high school or above. 16.5% of mothers know of at least three means of transmission ofHIVIAIDS. In Beirut and Beqaa the ratio was 14.4%. In Tripoli it was 18.7%. In the age group 15-19 years the ratio was 13% and in the group 4-44 years it was 22.6%. The rate was 10.6% among illiterate mothers and 17.4 among mothers with basic educational attainment. 6.6% was the percentage of those women unaware of any means of transmission of HIVIAIDS. The percentage was 3.7% and 8.7% in Saida and Tyre respectively. In the age groups 40-44 years and 15-19 years, the percentage was 4.6 and 9.6 respectively. For illiterates, the percentage was 3.8%, whereas for educated it was 8.7%. The results have also shown that more than 47% ofwomen are aware that HIVIAIDS is transmitted from mother to child, 44% of women know that it is transmitted from the pregnant mother to the fetus, 29% of mothers know that it is transmitted during delivery and 27% know that it is transmitted to the child through breastfeeding. Results have also shown that more than one third of mothers believe that a teacher with HIV I AIDS should not be teaching the children and that food should not be bought from an individual with HIVIAIDS. Twenty seven percent of women know where to be tested for HIV and 15% of women have been tested for HIV . 39 • Percentage of women 15-49 years who have heard ofHIV/AIDS according to knowledge of protection methods Table (18) 731 6.8 73.9 14.4 22.2 68.3 41.9 87.7 616 8.3 64.1 18.7 30.8 57.3 33.9 80.4 973 3.7 53.5 15.4 21.4 46.4 42.3 60.4 739 8.7 73.6 18.4 24.2 71.2 49.7 88.5 ---- ---- ---- ---- --------- 114 9.6 50.0 13.2 20.2 46.5 29.8 71.1 434 7.6 64.1 16.8 22.6 59.7 41.2 77.8 595 6.4 67.7 15.5 23.7 61.0 42.5 79.0 695 7.1 70.5 16.1 23.6 64.3 47.1 83.3 564 5.3 67.0 14.9 24.1 60.8 41.8 77.6 394 4.6 64.0 22.6 29.2 59.1 43.4 75.4 263 8.4 54.0 15.6 23.6 50.6 35.7 66.9 40 Age group 15- 19 20-24 25-29 30-34 35-39 40-44 45-49 • • Childbirth care: Results show that 46.8% of women with live births during the year preceding the survey had the birth attended by an obstetrician. 48.6% were attended by an appropriately trained nurse or a midwife, 2% were attended by an assistant midwife, 1.3% by an uncertified birth attendant and 1.6 %by relatives, neighbors or others. Deliveries attended by an obstetrician were at the rate of37.4% in Tripoli, 59.7% in Saida, 43.5% for women with no educational attainment and 52.2% for women with high school or above. The highest rate of deliveries with the assistance of a non-certified birth attendant was in Beirut where it reached around 4%. Women with live births during the previous year according to birth care attendance and place of birth Figure (17) 100 -.----.--.---- 90 80 70 60 50 40 30 20 10 0 Beirut & Beqaa Tripoli Siada Tyre 41 • • % distribution of women with live births during the year preceding the survey according to birth care attendance Regions 100.0 1.6 3.9 1.6 43.4 49.6 Beirut & Beqaa 100.0 2.7 0.7 59.2 37.4 Tripoli 100.0 0.0 1.4 38.9 59.7 Saida 100.0 0.8 0.0 6.4 52.8 40.0 Tyre Educational level 4.3 43.5 43.5 No education 2.1 50.7 45.8 Elementary or Prep. 1.1 40.0 52.2 Secondary or above Contraceptive prevalence: Survey results show that 69% of married Palestinian women use contraceptive methods. 40% use contraceptive pills, 40% use the diaphragm and 7% use modem or traditional contraceptive methods. Table No. 20 shows that 72% of women in the Tyre camps use contraceptive methods whereas only 66% of women in Beirut and Beqaa use these methods. The percentage for women with high school or above using contraceptive methods is 70% while for the uneducated women it is 62%. For women 25-49 years, the rate of use of contraceptive is 71%, and for women less than 20 years old, it is 47% . 42 .- % distribution of women according to use of contraceptive Figure (18) 100 90 80 70 60 50 40 30 20 10 0 +--- Beirut & Beqaa Ill No method • Modern methods Tripoli Said a Tyre % distribution of women 15-49 years old according to use of contraceptive 43 • Birth registration: The percentage of children (0-59 months) that have been registered was 98% out ofthe total number of children under 5 years of age. For Tripoli, the rate was 95.4% and for Tyre it was 99.3%. The rates for the females and males, were 97.9% and 98.1 %, respectively. For children less than 6 months old it was 93.5% and for the age group 48- 59 months old, it was 99.3% For illiterate mothers, the rate was 100%, whereas for mothers with elementary or primary education, it was 97.8%. Registration of children under 5 years Figure (19) 2 Not Registered 98 Registered 44 • Recommendations: It is recommended that: • All U5 Palestinian children be provided with immunization cards. • Remedial education be offered to UNRWA primary school students who are not achieving good results. • Access to safe potable water be extended to all camps and squatter areas. • Provision of vitamin A supplement for children 6-59 months old be increased to reach at least 50% ofU5 children. • Efforts be extended to support the right of all children to be registered at birth. 45

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