Trinidad and Tobago - Multiple Indicator Cluster Survey - 2006

Publication date: 2006

�Trinidad and Tobago Multiple Indicator Cluster Survey 3 ii Trinidad and Tobago Multiple Indicator Cluster Survey 3 Summary Table of Findings Multiple Indicator Cluster Survey (MICS) and Millennium Development Goals (MDG) Indicators, Trinidad and Tobago, 2006 Topic MICS Indicator Number MDG Indicator Number Indicator Value CHILD MORTALITY Child mortality 1 13 Under-five mortality rate 35 Per thousand 2 14 Infant mortality rate 29 Per thousand NUTRITION Breastfeeding 45 Timely initiation of breastfeeding 41.2 Percent 15 Exclusive breastfeeding rate 12.8 Percent 16 Continued breastfeeding rate at 12-15 months 33.8 Percent at 20-23 months 22.4 Percent 17 Timely complementary feeding rate 42.7 Percent 18 Frequency of complementary feeding 27.7 Percent 19 Adequately fed infants 20.5 Percent Salt iodization 41 Iodized salt consumption 27.8 Percent Low Birth Weight 9 Low birth weights infants 18.8 Percent 10 Infants weighed at birth 89.8 Percent CHILD HEALTH Immunization 26 Polio immunization coverage 81.9 Percent 27 DPT immunization coverage 72.5 Percent 28 15 Measles immunization coverage 88.9 Percent 31 Fully immunized children 50.2 Percent 29 Hepatitis B Hepatitis B immunization coverage 70 Percent 30 Yellow fever immunization coverage 35.2 Percent Solid fuel use 24 29 Solid fuels 0.3 Percent ENVIRONMENT Water and Sanitation 11 30 Use of improved drinking water sources 96.4 Percent 13 Water treatment 34.1 Percent 12 31 Use of improved sanitation facilities 98.7 Percent 14 Disposal of child’s faeces 24.9 Percent iiiTrinidad and Tobago Multiple Indicator Cluster Survey 3 Topic MICS Indicator Number MDG Indicator Number Indicator Value REPRODUCTIVE HEALTH Contraception and unmet need 21 19c Contraceptive prevalence 42.5 Percent 98 Unmet need for family planning 26.7 Percent 99 Demand satisfied for family planning 61.4 Percent Maternal and newborn health 20 Antenatal care 95.7 Percent 44 Content of antenatal care Blood test taken 98 Percent Blood pressure measured 98.2 Percent Urine specimen taken 98 Percent Weight measured 97.6 Percent 4 17 Skilled attendant at delivery 97.8 Percent 5 Institutional deliveries 97.4 Percent CHILD DEVELOPMENT Child development 46 Support for learning 94 Percent 47 Father’s support for learning 67.2 Percent 48 Support for learning: children’s books 81.4 Percent 49 Support for learning: non- children’s books 89.9 Percent 50 Support for learning: materials for play 37 Percent 51 Non-adult care 1 Percent EDUCATION Education 52 Pre-school attendance 74.7 Percent 53 School readiness 96.9 Percent 54 Net intake rate in primary education 83.2 Percent 55 6 Net primary school attendance rate 97.7 Percent 56 Net secondary school attendance rate 87.2 Percent 57 7 Children reaching standard five 99.2 Percent 58 Transition rate to secondary school 92.6 Percent 59 7b Primary completion rate 78.1 Percent 61 9 Gender parity index primary school 1.00 Ratio secondary school 1.07 Ratio Literacy 60 8 Adult literacy rate (female) 98.2 Percent iv Trinidad and Tobago Multiple Indicator Cluster Survey 3 Topic MICS Indicator Number MDG Indicator Number Indicator Value CHILD PROTECTION Birth registration 62 Birth registration 95.8 Percent Child discipline 74 Child discipline Any psychological/physical punishment 75.1 Percent Early marriage 67 Marriage before age 15 1.6 Percent Marriage before age 18 10.7 Percent 68 Young women aged 15-19 currently married/in union 6.3 Percent 69 Spousal age difference Women aged 20-24 25.3 Percent Domestic violence 100 Attitudes towards domestic violence 7.6 Percent HIV/AIDS AND SEXUAL BEHAVIOUR HIV/AIDS knowledge and attitudes 82 19b Comprehensive knowledge about HIV prevention among young people 57.5 Percent 89 Knowledge of mother- to-child transmission of HIV 50.3 Percent 86 Attitude towards people with HIV/AIDS 38.6 Percent 87 Women who know where to be tested for HIV 86.1 Percent 88 Women who have been tested for HIV 41.3 Percent 90 Counselling coverage for the prevention of mother-to-child transmission of HIV 75.5 Percent 91 Testing coverage for the prevention of mother-to-child transmission of HIV 79.4 Percent Sexual behaviour 84 Age at first sex among young people 4.7 Percent 92 Age-mixing among sexual partners 15.4 Percent 83 19a Condom use with non-regular partners 51.2 Percent 85 Higher risk sex in the last year 68 Percent vTrinidad and Tobago Multiple Indicator Cluster Survey 3 Table of Contents Summary Table of Findings . ii List of Tables .vii List of Figures . ix List of Abbreviations . x Acknowledgements . xi Executive Summary.xii Introduction . 1 Background . 1 Survey Objectives of the MICS 3 . 4 Sample and Survey Methodology. 5 Sample Design. 5 Questionnaires . 7 Training and Fieldwork . 8 Sample Coverage and the Characteristics of Households and Respondents . 10 Sample Coverage . 10 Characteristics of Households . 11 Child Mortality . 15 Nutrition . 18 Breastfeeding . 18 Salt Iodization . 21 Low Birth Weight . 22 Child Health . 25 Immunization. 25 Tetanus Toxoid . 28 Oral Rehydration Treatment. 29 Care Seeking and Antibiotic Treatment of Pneumonia . 30 Solid Fuel Use. 31 Environment . 33 Water and Sanitation . 33 Reproductive Health . 38 Contraception. 38 Unmet Need . 39 Antenatal Care . 40 Assistance at Delivery. 41 vi Trinidad and Tobago Multiple Indicator Cluster Survey 3 Child Development . 43 Education. 46 Education System . 46 Early Childhood Care and Education . 47 Primary and Secondary School Participation. 48 Adult Literacy . 51 Child Protection . 52 Birth Registration . 52 Child Labour. 52 Child Discipline . 53 Early Marriage. 54 Domestic Violence . 56 HIV/AIDS and Sexual Behaviour . 57 Knowledge of HIV Transmission and Condom Use . 57 Sexual Behaviour Related to HIV Transmission . 60 List of References. 62 Appendix A - Description of the Sample Design . 63 Appendix B - List of Personnel Involved in the Survey. 65 Appendix C - Estimates of Sampling Errors . 67 Appendix D - Data Quality Tables . 81 Appendix E - MICS Indicators: Numerators and Demoninators . 88 Appendix F - Trinidad and Tobago Questionnaires . 91 Appendix G - Listing of Tables . 128 viiTrinidad and Tobago Multiple Indicator Cluster Survey 3 List of Tables Table HH.1: Results of household and individual interviews .128 Table HH.2: Household age distribution by sex .129 Table HH.3: Household composition .130 Table HH.4: Women’s background characteristics .131 Table HH.5: Children’s background characteristics .132 Table CM.1: Child mortality .133 Table NU.1: Initial breastfeeding .133 Table NU.2: Breastfeeding .134 Table NU.3: Adequately fed infants .134 Table NU.4: Iodized salt consumption .135 Table NU.5: Low Birth Weight Infants .136 Table CH.1: Vaccinations in first year of life .137 Table CH.1c: Vaccinations in first year of life (continued) .137 Table CH.2: Vaccinations by background characteristics .138 Table CH.2c: Vaccinations by background characteristics (continued) .139 Table CH.3: Neonatal tetanus protection .140 Table CH.4: Knowledge of the two danger signs of pneumonia .141 Table CH.5: Solid fuel use .142 Table EN.1-A: Use of improved water sources .143 Table EN.1-B: Use of improved water sources .144 Table EN.2: Household water treatment .145 Table EN.3: Time to source of water .146 Table EN.4: Person collecting water .147 Table EN.5: Use of sanitary means of excreta disposal .148 Table EN.6: Disposal of child’s faeces .149 Table EN.7-A: Use of improved water sources and improved sanitation .150 Table EN.7-B: Use of improved water sources and improved sanitation .151 Table RH.1: Use of contraception .152 Table RH.2: Unmet need for contraception .154 Table RH.3: Antenatal care provider .155 Table RH.4: Antenatal care content .156 Table RH.5: Assistance during delivery .157 Table CD.1: Family support for learning .158 Table CD.2: Learning materials .159 viii Trinidad and Tobago Multiple Indicator Cluster Survey 3 Table CD.3: Children left alone or with other children .160 Table ED.1: Early childhood education .161 Table ED.2: Primary school entry .162 Table ED.3: Primary school net attendance ratio .163 Table ED.4: Secondary school net attendance ratio .164 Table ED 4W Secondary school age children attending primary school .165 Table ED.5: Children reaching standard 5 .166 Table ED.6: Primary school completion and transition to secondary education .167 Table ED.7: Education gender parity .168 Table ED.8: Adult literacy .169 Table CP.1: Birth registration .170 Table CP.2: Child discipline .171 Table CP.3: Early marriage .172 Table CP.4: Spousal age difference .173 Table CP.5: Attitudes toward domestic violence .174 Table HA.1: Knowledge of preventing HIV transmission .175 Table HA.2: Identifying misconceptions about HIV/AIDS .176 Table HA.3: Comprehensive knowledge of HIV/AIDS transmission .177 Table HA.4: Knowledge of mother-to-child HIV transmission .178 Table HA.5: Attitudes toward people living with HIV/AIDS .179 Table HA.6: Knowledge of a facility for HIV testing .180 Table HA.7: HIV testing and counselling coverage during antenatal care .181 Table HA.8: Sexual behaviour that increases risk of HIV infection .182 Table HA.9: Condom use at last high-risk sex .183 ixTrinidad and Tobago Multiple Indicator Cluster Survey 3 List of Figures Figure HH.1: Age and sex distribution of household population . 11 Figure CM.1: Trend in under-5 mortality rates .17 Figure NU.1: Percentage of mothers who started breastfeeding within one hour and within one day of birth .20 Figure NU.2: Infant feeding patterns by age: Percent distribution of children aged under 3 years by feeding pattern by age group .21 Figure NU.3: Percentage of households consuming adequately iodized salt .22 Figure NU.4: Percentage of infants weighing less than 2500 grams at birth .24 Figure CH.1: Percentage of children aged 12-23 months who received the recommended vaccination by 12 months .27 Figure CH.2: Percentage of women with a live birth in the last 12 months who are protected against neonatal tentanus .29 Figure EN.1: Percentage distribution of household members by source of drinking water 34 Figure HA.1: Percent of women who have comprehensive knowledge of HIV/AIDS transmission .58 Figure HA.2: Sexual behaviour that increases risk of HIV infection .60 x Trinidad and Tobago Multiple Indicator Cluster Survey 3 List of Abbreviations AIDS Acquired Immune Deficiency Syndrome BCG Bacillis-Cereus-Geuerin (Tuberculosis) CSO Central Statistical Office CSPro Census and Survey Processing System DPT Diphteria Pertussis Tetanus EPI Expanded Programme on Immunization GPI Gender Parity Index HIV Human Immunodeficiency Virus IDD Iodine Deficiency Disorders IUD Intrauterine Device LAM Lactational Amenorrhea Method MDG Millennium Development Goals MICS Multiple Indicator Cluster Survey MoH Ministry of Health NAR Net Attendance Rate ORT Oral rehydration treatment ppm Parts Per Million SPSS Statistical Package for Social Sciences UNAIDS United Nations Programme on HIV/AIDS UNDP United Nations Development Programme UNFPA United Nations Population Fund UNGASS United Nations General Assembly Special Session on HIV/AIDS UNICEF United Nations Children’s Fund WFFC World Fit For Children WHO World Health Organization xiTrinidad and Tobago Multiple Indicator Cluster Survey 3 Acknowledgements The Ministry of Social Development wishes to acknowledge the following persons/ organizations that were involved in the conduct of the MICS 3: • Central Statistical Office; • UNICEF; • Members of the Technical Committee; • Dr. Godfrey St. Bernard (for writing the final report); • Mr. Winston Ramsaran and Mrs. Dawn Ramsingh (Database Specialists); and • Mr. David Thomas (Survey Co-ordinator) and Mr. Simeon Henry (Field Director). The Ministry also extends its gratitude to all the field staff (supervisors, editors and interviewers) who worked tirelessly to ensure the survey was completed on a timely basis. The staff of the MICS Secretariat – Sherene Lisa Ali; Josanne Harry-Roach; Michelle Ramlagan and Nerrisa Derrick – and other members of staff who must also be thanked for their commitment, dedication and willingness to go beyond the call of duty to ensure the project came to fruition. Finally, the Ministry recognizes that without the co-operation of the members of the public, this survey would not have been possible. xii Trinidad and Tobago Multiple Indicator Cluster Survey 3 Executive Summary This Report is based on the Trinidad and Tobago Multiple Indicator Cluster Survey, conducted in 2006 by the Ministry of Social Development in collaboration with the Central Statistical Office (CSO) and UNICEF. The survey provides valuable information on the situation of children and women in Trinidad and Tobago and was based, in large part, on the need to monitor progress towards goals and targets emanating from recent international agreements: the Millennium Declaration, adopted by all 191 United Nations Member States in September 2000, and the Plan of Action of A World Fit For Children, adopted by 189 Member States at the United Nations Special Session on Children in May 2002. Both of these commitments build upon promises made by the international community at the 1990 World Summit for Children. The Multiple Indicator Cluster Survey (MICS) is a household survey programme developed by UNICEF to assist countries in filling data gaps for monitoring the situation of children and women. It is capable of producing statistically sound, internationally comparable estimates of these indicators. Though this is the third rounds of the MICS, it is the second for Trinidad and Tobago. The sample size was approximately 6,000 households and the modular survey instrument consisted of 3 questionnaires: a household questionnaire, a questionnaire for women aged 15- 49, and a questionnaire for children under the age of 5 (addressed to the mother or primary caretaker of the child). The survey covered many of the same topics as the earlier rounds and provided an update on estimates and trends for many indicators. In addition, new indicators were included to provide baseline data or estimates of coverage for other priority issues. The Trinidad and Tobago Multiple Indicator Cluster Survey 3 objectives were to: • provide up-to-date information for assessing the situation of children and women in Trinidad and Tobago; • furnish data needed for monitoring progress toward goals established in the Millennium Declaration, the goals of A World Fit For Children (WFFC), and other internationally agreed upon goals, as a basis for future action; • contribute to the improvement of data and monitoring systems in Trinidad and Tobago and to strengthen technical expertise in the design, implementation, and analysis of such systems. xiiiTrinidad and Tobago Multiple Indicator Cluster Survey 3 Comparative Analysis of the MICS and MDG The Millennium Development Goals were adopted by the international community in 2000 as a framework for the development activities of the 191 member countries of the United Nations. The goals have been articulated into some 20 targets and over 60 indicators. Trinidad and Tobago joined the international community in adopting the MDGs as a framework for making progress towards development. The year 2015 is the target year for the achievement of the Millennium Development Goals. Proper monitoring of the progress of these goals is essential to ensure that the policy planners can take the necessary actions on any exogenous and endogenous shocks that take place, with respect to their local economy and which have the potential to impact significantly on progress towards the goals. The Multiple Indicator Cluster Survey (MICS) 3 provided information on approximately twenty (20) of the MDG indicators. The MDGs are as follows: • Eradicate extreme poverty and hunger • Achieve universal primary education • Promote gender equality and empower women • Reduce child mortality • Improve maternal health • Combat HIV/AIDS, malaria and other diseases • Ensure environmental sustainability • Develop a global partnership for development The MDG baseline year is 1990. The aim has been for the targets to be achieved within a twenty-five (25) year time period, from 1990-2015. These targets are sub divisions of the above listed eight (8) goals. The countries that signed on to the Millennium Declaration (191) all agreed to monitor the framework and structures within their policies to ensure the accomplishment of these goals. An advantage that the MDG brings with it is the ability of countries to make alterations to the goals to suit their respective problems. Some of the MICS indicators are similar to the MDG indicators and this allows for the monitoring of progress of the indicators of the MDGs. The table below shows the identical indicators between databases and the values for the various indicators. xiv Trinidad and Tobago Multiple Indicator Cluster Survey 3 Analysis of the MDG targets using the MICS 3 Data Child Mortality The indicators of this subject area that have been measured under the MICS 3 are as follows: • The infant mortality rate • The under five mortality rate • Solid fuel use • Proportion of one year old children immunized against measles The MDG target for these indicators, which falls under Goal 4 (Reduce Child Mortality), is to reduce by two-thirds the infant mortality and under five mortality rates. However the data from the MICS 3, alongside data that have been sourced from both the Ministry of Health and Central Statistical Office, have shown the rates for both these indicators rising from the year 1996 until 2006. The under five mortality rate rose from under 15 per thousand to 35 per thousand, during the period 1996-2006. For the same period, the infant mortality rate rose from under 15 per thousand (both sexes) to an excess of 29 per thousand (MICS 2006). The data shows that rather than moving toward achievement of this goal the country is lagging behind and there is a need for the Health Sector to pay urgent and specific attention to this issue. MICS (2006), Ministry of Health (1990-2003) and Survey of Living Conditions (2005) and have provided data that suggest that almost 90% of the one year old population continues to be immunized against measles. Another positive statistic that falls under the area of child health is a 0.3% use of solid fuel as quoted by MICS 3, which suggests positive measures to aid in the reduction of child mortality. Maternal and Newborn Health The indicator that appears in both the MDG and MICS is: • Skilled attendant at birth This indicator falls under Goal 5 (Improve Maternal Health) of the Millennium Development Goals. The target for this goal is the reduction in the maternal mortality rate by three quarters during the period 1990-2015. xvTrinidad and Tobago Multiple Indicator Cluster Survey 3 One of the measures identified for ensuring that this goal is achieved is the presence of qualified and skilled health care professionals at the time of birth. During the period 1996- 2006, the percentage of births not attended to by a skilled health care professional has been negligible. In fact, the values have been constantly on the hundred percent marks during this ten (10) year period. The MICS 3 report quotes this figure as being 97.8%. Thus, Trinidad and Tobago has been able to move progressively toward the achievement of this goal. Water and Sanitation The two (2) indicators that have been included in both the MICS and MDG are: • Use of improved drinking water. • Use of improved sanitation facilities. These indicators fall under Goal 7 (Ensure Environmental Stability). The targets for these indicators focus on achieving an optimal level of allocation so that the majority of the population has access to safe drinking water and improved sanitation facilities. MICS 3 has produced highly correlated data on these indicators with over 95% use of both improved drinking water sources and improved sanitation facilities. MICS quotes the use of improved sources of drinking water as 96.4% and the use of improved sanitation as 98.7%. Over the period 1994-2006, the use of unsafe disposal facilities has seen sharp decreases, while the use of more suitable sanitation facilities has increased by over 150% (Central Statistical Office, CSSP). In addition, public water piped into dwellings has almost doubled during the period 1980-2006, moving from just over 40% of dwellings having access to just under 80% in 2006 (Central Statistical Office, CSSP and National Census). The data shows that the country is well on its way to achieve the set MDG targets by the year 2015. HIV/AIDS The indicators common for this area are: • Contraceptive prevalence rate • HIV/AIDS knowledge and attitudes • Condom use with non-regular partners These indicators fall under Goal 6 (Combat HIV/AIDS, Dengue, Diabetes and Hypertension). The target in this case is to begin to reverse the spread of HIV/AIDS by the year 2015. xvi Trinidad and Tobago Multiple Indicator Cluster Survey 3 The MICS 3 provided a contraceptive prevalence rate of 42.5%. A more detailed classification of this shows that the prevalence rate of women between 15-49 using measures that would prevent against HIV/AIDS was approximately 15%, with condom use representing 13%. The MICS 3 also suggests that 51.2% of persons use condoms with non-regular partners. Young persons with comprehensive knowledge of HIV/AIDS stood at 57.5%. These data points suggest that more needs to be done with respect to education on HIV/ AIDS. A more recent KAPB survey conducted by the National AIDS Coordinating Committee (NACC) indicates some progress in HIV-related knowledge and attitudes among young people. Education • Net primary school attendance rate • Children reaching standard five • Primary completion rate • Adult literacy rate (female) • Education- Gender parity index- primary school • Education- Gender parity index- secondary school These indicators are part of the overall Goal 2 (Achieve Universal Primary and Secondary Education), with the latter two (2) indicators being a part of Goal 3 (Promote Gender Equality and Empower Women). The target for Goal 2 is to ensure that by the year 2015, children everywhere would be able to complete a full course of primary schooling. The target for Goal 3 is to eliminate gender disparity in primary and secondary education, preferably by 2005, and in all levels of education no later than 2015. Currently the net enrolment in primary education and the percentage of pupils reaching standard five stand at 97.7% and 99.2% respectively (MICS 2006). However, the MICS 3 Report provides data that states only 78.1% complete the primary level education. The gender parity index for primary and secondary education is 1 and 1.07 respectively (MICS 2006). This provides a situation of equal educational opportunities for both girls and boys, thus the education system is providing opportunities for both sexes to develop their capabilities. Trinidad and Tobago has incorporated the aspects of these goals into its policies for the education sector and the rewards have already been seen. It is safe to pronounce that Trinidad and Tobago will be able to achieve the MDG targets in this area. �Trinidad and Tobago Multiple Indicator Cluster Survey 3 Background This report is based on the Trinidad and Tobago Multiple Indicator Cluster Survey, conducted in 2006 by the Ministry of Social Development in collaboration with the Central Statistical Office (CSO) and UNICEF. The survey provides valuable information on the situation of children and women in Trinidad and Tobago and was based, in large part, on the need to monitor progress towards goals and targets emanating from recent international agreements: the Millennium Declaration, adopted by all 191 United Nations Member States in September 2000, and the Plan of Action of A World Fit For Children, adopted by 189 Member States at the United Nations Special Session on Children in May 2002. Both of these commitments build upon promises made by the international community at the 1990 World Summit for Children. In signing these international agreements, governments committed themselves to improving conditions for their children and to monitoring progress towards that end. UNICEF was assigned a supporting role in this task (see Box below). A Commitment to Action: National and International Reporting Responsibilities The governments that signed the Millennium Declaration and the World Fit for Children Declaration and Plan of Action also committed themselves to monitoring progress towards the goals and objectives they contained: I. Introduction � Trinidad and Tobago Multiple Indicator Cluster Survey 3 “We will monitor regularly at the national level and, where appropriate, at the regional level and assess progress towards the goals and targets of the present Plan of Action at the national, regional and global levels. Accordingly, we will strengthen our national statistical capacity to collect, analyse and disaggregate data, including by sex, age and other relevant factors that may lead to disparities, and support a wide range of child- focused research. We will enhance international cooperation to support statistical capacity-building efforts and build community capacity for monitoring, assessment and planning.” (A World Fit for Children, paragraph 60) “…We will conduct periodic reviews at the national and sub-national levels of progress in order to address obstacles more effectively and accelerate actions.…” (A World Fit for Children, paragraph 61) The Plan of Action (paragraph 61) also calls for the specific involvement of UNICEF in the preparation of periodic progress reports: “… As the world’s lead agency for children, the United Nations Children’s Fund is requested to continue to prepare and disseminate, in close collaboration with Governments, relevant funds, programmes and the specialized agencies of the United Nations system, and all other relevant actors, as appropriate, information on the progress made in the implementation of the Declaration and the Plan of Action.” Similarly, the Millennium Declaration (paragraph 31) calls for periodic reporting on progress: “…We request the General Assembly to review on a regular basis the progress made in implementing the provisions of this Declaration, and ask the Secretary-General to issue periodic reports for consideration by the General Assembly and as a basis for further action.” According to the Social Sector Investment Programme 2008 Report, Trinidad and Tobago continues to maintain its position as a country with high Human Development, with a Human Development Index1 value of 0.089 and a Human Development Rank of 57 when compared to 177 nations (HDR, 2006). According to the Global Competitiveness Report (GCR) (2006-2007), Trinidad and Tobago is considered to be transitioning from stage 2 to stage 3 of development, since the country’s GDP is between US$9,000 and US$17,0002. � “The [Human Development Index] is a summary measure of human development. It measures the average achievements in a country in three basic dimensions of human development: �) a long and healthy life, as measured by life expectancy at birth; 2) knowledge, as measured by the adult literacy rate; 3) a decent standard of living, as measured by GDP per capita in purchasing power parity (PPP) terms in US dollars”. (HDR, 2006: 394). 2 Countries must have a GDP per capita of > US$�7,000 to be categorized at stage 3 which is the highest stage of development. 3Trinidad and Tobago Multiple Indicator Cluster Survey 3 In Trinidad and Tobago in the last five (5) years, at least 20% of the national annual budget was allocated to the social sector and many positive returns have been observed from this investment. In recent times, social ills such as poverty, unemployment and the prevalence of HIV/AIDS have decreased, and high participation rates in education were maintained, with noticeable improvements observed in tertiary education levels. • Poverty The Survey of Living Conditions Report (2005) revealed that 16.7% of the population fell below the national poverty line3, and that 1.2% of the population was indigent. These findings represent a decrease in the level of poverty which was reported as 24% in 1997/984. In an effort to significantly reduce poverty, some of the new activities which will be undertaken in 2007/2008 include: • Refinement and implementation of a framework for decentralization of the social services delivery system; • The conduct of research and needs assessment pertaining to vulnerable and at- risk groups (including, persons addicted to drugs and other substances, older persons, socially displaced persons and at risk children). • Situation of Children A National Plan of Action for Children for the period 2006-2010 for Trinidad and Tobago was developed to provide an action plan with respect to: • Promoting healthy lives; • Providing quality education; • Protecting against abuse, exploitation and violence; and • Combating HIV/AIDS. 3 According to the HDR 2006 report, in �990 approximately 2�% of the population fell below the national poverty line. �2.4% of the population earned $ US � a day or less, while 39% of the population earned $ US 2 a day. 4 Survey of Living Conditions 2005, Trinidad and Tobago � Trinidad and Tobago Multiple Indicator Cluster Survey 3 Survey Objectives of the MICS 3 The 2006 Trinidad and Tobago Multiple Indicator Cluster Survey has as its primary objectives: • To provide up-to-date information for assessing the situation of children and women in Trinidad and Tobago; • To furnish data needed for monitoring progress toward goals established in the Millennium Declaration, the goals of A World Fit For Children (WFFC), and other internationally agreed upon goals, as a basis for future action; • To contribute to the improvement of data and monitoring systems in Trinidad and Tobago and to strengthen technical expertise in the design, implementation, and analysis of such systems. �Trinidad and Tobago Multiple Indicator Cluster Survey 3 Sample Design The sample for the Trinidad and Tobago Multiple Indicator Cluster Survey (MICS) was designed to provide estimates on a large number of indicators on the situation of children and women at the national level. The sample was selected from the following 15 regions: • Port of Spain; • Couva/Tabaquite/Talparo; • San Fernando; • Mayaro/Rio Claro; • Arima; • Sangre Grande; • Chaguanas; • Princes Town; • Point Fortin; • Penal/Debe; • Diego Martin; • Siparia; and • San Juan/Laventille; • Tobago. • Tunapuna/Piarco; II. Sample and Survey Methodology � Trinidad and Tobago Multiple Indicator Cluster Survey 3 Regions were identified as the main sampling domains and the sample was selected in two stages. Within each region, census enumeration areas were selected with probability proportional to size. After carrying out a household listing within the selected enumeration areas, a systematic sample of 15 households was drawn. The sample was stratified by region and self-weighted. For reporting national level results, sample weights are used to address the issue of non-response. The regions were then categorized according to the Ministry of Health’s classification of Regional Health Authorities (RHAs) as follows: • North West RHA: o Diego Martin; o Port-of-Spain; o San Juan/Laventille. • North Central RHA: o Couva/Tabaquite/Talparo; o Chaguanas; o Tunapuna/Piarco; o Arima. • South West RHA: o Siparia; o Penal/Debe; o Princes Town; o San Fernando; o Point Fortin. • Eastern RHA: o Sangre Grande; o Mayaro/Rio Claro. • Tobago. A more detailed description of the sample design can be found in Appendix A. �Trinidad and Tobago Multiple Indicator Cluster Survey 3 Questionnaires Three sets of questionnaires were used in the survey: 1. A household questionnaire which was used to collect information on all de jure household members, the household, and the dwelling; 2. A women’s questionnaire administered in each household to all women aged 15-49 years; and 3. An under-5 questionnaire, administered to mothers or caretakers of all childrenunder 5 years living in households. In cases when the mother was not listed in the household roster, a primary caretaker for the child was identified and interviewed. The questionnaires included the following modules: • Household Questionnaire: o Household listing; o Education; o Water and Sanitation; o Household characteristics; o Child Labour; o Child Discipline; o Salt Iodization. • Questionnaire for Individual Women: o Childbearing and Child Mortality; o Tetanus Toxoid; o Maternal and Newborn Health; o Marriage/Union; o Contraception and Unmet Need; o Attitudes Toward Domestic Violence; o Sexual Behaviour; o HIV/AIDS. • Questionnaire for Children Under Five: o Birth Registration and Early Learning; o Child Development; � Trinidad and Tobago Multiple Indicator Cluster Survey 3 o Breastfeeding; o Care of Illness; o Immunization. The questionnaires are based on the MICS3 model questionnaire5. From the MICS3 model English version, the questionnaires were pre-tested during April, 2006. Based on the results of the pre-test, modifications were made to the wording of the questionnaires. The household listing; education, child labour and immunization modules were notable modified to reflect our local reality. A copy of the Trinidad and Tobago MICS questionnaires is provided in Appendix B. In addition to the administration of questionnaires, fieldwork teams tested the salt used for cooking in the households for iodine content. Details and findings of this measurement are provided in the respective section of the report. Training and Fieldwork Training for the fieldwork was conducted for four (4) days in April, 2006. Training included lectures on interviewing techniques and the contents of the questionnaires, and mock interviews between trainees to gain practice in asking questions. Interviewers were also shown how to accurately use the salt testing kits. Subsequently, during a three (3) day period, interviewers were allowed to complete three (3) questionnaires with selected households. A one (1) day recall session was held to ensure that the initial sets of questionnaires were accurately completed and to address any misconceptions/difficulties that interviewers were experiencing with the questionnaires. The data were collected by 15 teams; each comprised 5 interviewers, one editor and a supervisor. Of the 75 interviewers, there were 9 male and 66 female interviewers. Fieldwork began in late April, 2006 and concluded in early June, 2006. Data Processing Data were entered using the CSPro software. The data were entered on twelve (12) microcomputers and carried out by twenty-four (24) data entry operators and four (4) data entry supervisors. Data entry personnel worked in two (2) daily shifts: 8.00 a.m. to 1 p.m. and 1 p.m. to 6 p.m. In order to ensure quality control, all questionnaires were double entered and internal consistency checks were performed. Procedures and standard programs developed 5 The model MICS3 questionnaire can be found at www.childinfo.org �Trinidad and Tobago Multiple Indicator Cluster Survey 3 under the global MICS3 project and adapted to the Trinidad and Tobago questionnaires were used throughout. Data processing (which included data entry, cleaning, verification and structure checking) began in June, 2006 and finished in November, 2006. Data were analyzed using the Statistical Package for Social Sciences (SPSS) software program, Version 14, and the model syntax and tabulation plans developed by UNICEF for this purpose. �0 Trinidad and Tobago Multiple Indicator Cluster Survey 3 Sample Coverage Five thousand nine hundred and seventy-four (5,974) households were found to be occupied of the 5,979 selected for the sample. Of these, 5,557 were successfully interviewed providing a household response rate of 93%. In the households interviewed, 4,826 women (age 15-49) were identified. Of these, 4,605 were successfully interviewed, yielding a response rate of 95.4%. In addition, 1,149 children under age five years were listed in the household questionnaire. Questionnaires were completed for 1,117 of these children which correspond to a response rate of 97.2%. Overall response rates of 88.8% and 90.4% were calculated for the women and under-5 respectively (Table HH.1). While response rates were consistently lower in Tobago than in the other regions, it should be noted that they were reasonably high in all regions. Lower response rates in Tobago have also been noted in other national surveys and require further investigation to ascertain the underlying reasons for this relatively recent trend. III. Sample Coverage and the Characteristics of Households and Respondents ��Trinidad and Tobago Multiple Indicator Cluster Survey 3 Characteristics of Households The age and sex distribution of the survey population is provided in Table HH.2. The distribution is also used to produce the population pyramid in Figure HH.1. In the 5,557 households successfully interviewed in the survey, 18,669 household members are listed. Of these, 9,461 are males, and 9,207 are females. These figures indicate that the average number of persons per household is 3.4. The sum of persons 0-14 years of age, as shown in Table HH.2, is 3,921. Among the male and female household members, the difference in the respective proportions consisting of persons 0-14 years is negligible being 20.9 percent (1,976 persons) and 21.1 percent (1,946 persons). Meanwhile, those in the age group 15-64, which is the age category usually engaged in labour activities, consist of 13,126 persons. There are 6,769 men accounting for 71.6 percent of all male household members as compared to 6,356 females accounting for 69 percent of all female household members. Additionally, 9.7 percent of all female household members are women 65 years or older while the corresponding proportion among their male counterparts is 7.4 percent. The absolute counts are consistent with a larger female than male population among the elderly (See also Figure HH.1). Figure HH.1: Age and Sex Distribution of Household Population, Trinidad and Tobago, 2006 8 6 4 2 0 2 4 6 8 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70+ Percent Males Females �� Trinidad and Tobago Multiple Indicator Cluster Survey 3 Table HH.3 provides basic background information on the households. Within households, the sex of the household head, region and number of household members are shown in the table. These background characteristics are also used in subsequent tables in this report; the figures in the table are also intended to show the numbers of observations by major categories of analysis in the report. The overall sample size for the weighted and unweighted distribution of households is equal, since sample weights were normalized (See Appendix A). The table also shows the proportions of households where at least one child under 18, at least one child under 5, and at least one eligible woman age 15-49 were found. The majority of households are male-headed, totalling to 68.3 percent with the remainder, 31.7 percent representing female-headed households. In terms of classification by regions, North Central has the largest proportion of households amounting to 36.6 percent, followed by the South West with 26 percent. Close behind by a minimal difference of 0.1 percentage points is the North West Region. The East Region and Tobago trail far behind with 7.4 percent and 4.1 percent respectively. According to the data represented in Table HH.3, it appears that most households comprise 2- 3 members (38.9 percent) and 4-5 members (31 percent). Another 18.1 percent of households are occupied by only 1 member while a small percentage of 2.3 constitute 8-9 member households. Lastly, just under 1 percent of the households are observed to have 10 or more occupants. Characteristics of Respondents Tables HH.4 and HH.5 provide information on the background characteristics of female respondents 15-49 years of age and of children under age 5. In both tables, the total numbers of weighted and unweighted observations are equal, since sample weights have been normalized (standardized). In addition to providing useful information on the background characteristics of women and children, the tables are also intended to show the numbers of observations in each background category. These categories are used in the subsequent tabulations of this report. Table HH.4 provides background characteristics of female respondents 15-49 years of age. The table includes information on the distribution of women according to region, age, marital status, motherhood status, education6 and wealth index quintiles7. 6 Unless otherwise stated, “education” refers to educational level attended by the respondent throughout this report when it is used as a background variable. 7 Principal components analysis was performed by using information on the ownership of household goods and amenities (assets) to assign weights to �3Trinidad and Tobago Multiple Indicator Cluster Survey 3 Once again, the data reveal a pattern that is similar to that observed with regard to household composition. Specifically, the data corroborate observations obtained from Table HH.3 and reveal that the North Central Region accounts for the largest proportion of women 15-49 years (38.4 percent), followed by the South West Region (25.5 percent) and the North West (23.8 percent). Most of the women are between the ages of 20-24 years (17.4 percent), followed by those in the age group 15-19. Older women between the ages 40-44 years account for 13.9 percent of all women interviewed whereas a close 13.6 percent were in the 45-49 age group. Women in their thirties, principally those aged 30-34 years and 35-39 years account for the lowest percentages among women interviewed. Close to 50 percent of women aged 15-49 are currently married or in a common-law union while 41.3 percent have neither been married nor in a common-law union. A much smaller percentage amounting to 10.3 percent have been formerly married or in a common-law union. In terms of their motherhood status, more than half of the women (56.7 percent) had experienced childbirth while 43.3 percent had never given birth. The majority of women attained up to lower level secondary education (57.6 percent), while a much smaller percentage of 17.8 attained either no education, pre-school or a maximum of primary education. Meanwhile, 13.7 percent of the women received upper secondary or technical-vocational education while no more than 10.7 percent achieved university education. The education status of 0.3 percent of the women is not known. Some background characteristics of children under 5 years are presented in Table HH.5. These include distribution of children by several attributes: sex, region, age in months, mother’s or caretaker’s education and wealth status. The percentage distribution of children is such that 50.9 percent are male and 49.1 percent female. The largest percentage of children is from the North Central Region amounting to 39.6 percent. This percentage is followed by that for children from the North West Region (26.1 percent). While children from the South West Region account for 22.1 percent of all children under 5 years, those children from the East Region and Tobago constitute respective each household asset, and obtain wealth scores for each household in the sample (The assets used in these calculations were as follows: [number of rooms used for sleeping; main material of dwelling floor, roof and walls; fuel used for cooking; electricity; radio; television; non-mobile telephone; refrigerator; stove; washing machine; clothes dryer; water heater; microwave oven; air condition unit; internet services; cable/direct TV; DVD player; mobile/cell phone; car/truck; computer; sewing machine; stereo/radio with CD Player; boat for fishing and pleasure; MP3 player; Ipod; drinking water and toilet facility]). Each household was then weighted by the number of household members, and the household population was divided into five groups of equal size, from the poorest quintile to the richest quintile, based on the wealth scores of households they were living in. The wealth index is assumed to capture the underlying long-term wealth through information on the household assets, and is intended to produce a ranking of households by wealth, from poorest to richest. The wealth index does not provide information on absolute poverty, current income or expenditure levels, and the wealth scores calculated are applicable for only the particular data set they are based on. Further information on the construction of the wealth index can be found in Rutstein and Johnson, 2004, and Filmer and Pritchett, 200�. �� Trinidad and Tobago Multiple Indicator Cluster Survey 3 proportions of 7.2 percent and 5.1 percent. Children under 6 months account for 9.2 percent of children under 5 years and those in the 6-11 months age grouping account for 9.8 percent. Most of the children are between the ages 48-59 months and constitute 21.8 percent of the children under review. The next largest set of children consists of those in the 24-35 month age group amounting to 20.7 percent. A little less than 10.0 percent of the children (9.7 percent) live in households where their mothers or caregivers claimed to have had university education status. Larger percentages of children live in households where their mothers and caregivers claimed to have attaining upper secondary/technical-vocational education, this proportion amounting to 11.1 percent and even higher in the case of those children whose mothers or caregivers has attained none/ pre-school/primary school education (17.5 percent). The largest proportion of children, a whopping 61.0 percent, live in households where their mothers or caregivers attained only lower secondary education. It must be noted that less than 1.0 percent of the cases (0.7 percent) consisted of children whose mothers’/caregivers’ education level is not known. The distribution of children according to wealth index quintiles shows that the majority of children are within the poorest quintile (23.2 percent). The next highest proportion is evident among children in the middle quintile. There are 18.5 percent of children in fourth quintile and 16.7 percent in the richest quintile. In sum, the distribution of children among the wealth index quintiles is fairly equal. ��Trinidad and Tobago Multiple Indicator Cluster Survey 3 IV. Child Mortality One of the overarching goals of the Millennium Development Goals (MDGs) and the World Fit for Children (WFFC) is to reduce infant and under-five mortality. Specifically, the MDGs call for the reduction in under-five mortality by two-thirds between 1990 and 2015. Monitoring progress towards this goal is an important but difficult objective. Measuring childhood mortality may seem easy, but attempts using direct questions, such as “Has anyone in this household died in the last year?” give inaccurate results. Using direct measures of child mortality from birth histories is time consuming, more expensive, and requires greater attention to training and supervision. Alternatively, indirect methods developed to measure child mortality produce robust estimates that are comparable with the ones obtained from other sources. Indirect methods minimize the pitfalls of memory lapses, inexact or misinterpreted definitions, and poor interviewing technique. The infant mortality rate is the probability of dying before the first birthday. The under-five mortality rate is the probability of dying before the fifth birthday. In MICS surveys, infant and under five mortality rates are calculated based on an indirect estimation technique known as the Brass method (United Nations, 1983; 1990a; 1990b). The data used in the estimation are: the mean number of children ever born for five year age groups of women from age 15 to 49, and the proportion of these children who are dead, also for five-year age groups of women. �� Trinidad and Tobago Multiple Indicator Cluster Survey 3 The technique converts these data into probabilities of dying by taking into account both the mortality risks to which children are exposed and their length of exposure to the risk of dying, assuming a particular model age pattern of mortality. Based on previous information on mortality in Trinidad and Tobago, the West Model Life Table was selected as the most appropriate. Table CM.1 provides estimates of child mortality by various background characteristics. The infant mortality rate is estimated at 29 infant deaths per thousand live births, while the probability of dying before one’s fifth birthday, the under-5 mortality rate (U5MR) is estimated to be around 35 per one thousand live births. These estimates have been calculated by averaging mortality estimates obtained from women 25-29 years and 30-34 years, and refer to mid 2004. Infant females have a slightly higher mortality rate at 29 per thousand than infant males at 27 per thousand. The same is also true for the under-five mortality rates which stand at 37 per thousand for females and 32 for males. At the same time, it is worth noting that official estimates and data from other sources support more favourable magnitudes of infant mortality and child mortality at the national level. For instance, the World Health Organization (WHO) provides respective figures of 17 infant deaths per 1,000 live births and 19 per one thousand live births for 2005. For 2004, the WHO estimates of under-5 mortality indicate higher levels among males than among females, the respective figures being 24 per one thousand live births and 15 per one thousand live births. Moreover, under-5 mortality was estimated to be about 20 per one thousand live births for Trinidad and Tobago as a whole in 2004. It is worth noting, however, that similar estimates for the different sub-populations whether predicated upon region or education, are not readily available from official sources. Nonetheless, the set of estimates that are derived from the Trinidad and Tobago 2006 MICS though indicative of an upward bias, may still provide insightful means for gauging differentials in the prevalence of infant and under-5 mortality across regions and mothers’ education. Additionally, child mortality, whether from the standpoint of infant or under-5 mortality, is highest among the offspring of mothers or caregivers who have only attained none/pre-school/primary level education. Altogether, the 2006 MICS results pertaining to infant and under-5 mortality should be evaluated further by drawing on data from other sources. ��Trinidad and Tobago Multiple Indicator Cluster Survey 3 Figure CM. 1- Trend in Under 5 Mortality Rates, Trinidad and Tobago, 2006 0 10 20 30 40 50 60 70 80 1950 1960 1970 1980 1990 2000 2010 W FS77q5d DHS87q5d M ICS00q5i M ICS06q5i * Sources of data are: World Fertility Survey 1977; Demographic and Health Survey 1987; MICS 2000; MICS 2006 �� Trinidad and Tobago Multiple Indicator Cluster Survey 3 Breastfeeding Breastfeeding for the first few years of life protects children from infection, provides an ideal source of nutrients, and is economical and safe. However, many mothers stop breastfeeding too soon and there are often pressures to switch to infant formula, which can contribute to growth faltering and micronutrient malnutrition and is unsafe if clean water is not readily available. The World Fit for Children goal states that children should be exclusively breastfed for 6 months and continue to be breastfed with safe, appropriate and adequate complementary feeding for up to 2 years of age and beyond. WHO/UNICEF have the following feeding recommendations: • Exclusive breastfeeding for first six months; • Continued breastfeeding for two years or more; • Safe, appropriate and adequate complementary foods beginning at 6 months; • Frequency of complementary feeding: 2 times per day for 6-8 month olds; 3 times per day for 9-11 month olds. V. Nutrition ��Trinidad and Tobago Multiple Indicator Cluster Survey 3 It is also recommended that breastfeeding be initiated within one hour of birth. The indicators of recommended child feeding practices are as follows: • Exclusive breastfeeding rate (< 6 months & < 4 months); • Timely complementary feeding rate (6-9 months); • Continued breastfeeding rate (12-15 & 20-23 months); • Timely initiation of breastfeeding (within 1 hour of birth); • Frequency of complementary feeding (6-11 months); • Adequately fed infants (0-11 months). Table NU.1 provides the proportion of women who started breastfeeding their infants within one hour of birth, and women who started breastfeeding within one day of birth (which includes those who started within one hour). The overall picture for Table NU.1, shows marked differentials in the percentage of women who started breastfeeding within one hour of birth (41.2 percent) and those women who started breastfeeding within one day of birth (73.6 percent). In looking at specific attributes of the population, the table demonstrates that the lowest proportions for both nursing indicators have been observed among women of the highest socio-economic status. Among the different socio-economic status groups, there were differences between those women who started breastfeeding within one hour of birth and those who started within one day of birth. For example, in the 2 lowest socio- economic groups, the percentage was higher for women who started breastfeeding within an hour of birth (42.6 and 47.0 percent respectively) compared to those women in the richest socio-economic group (36.6 percent). Similarly, for women who started breastfeeding within one day of birth, women from the 2 lowest wealth index quintiles represented 80.6 and 78.2 percent compared to women in the richest households (68.0 percent). Differentials by region are also observed illustrating that the North West RHA had the lowest percentage (33.6 percent) of women who started breastfeeding within one hour of birth. The North Central Region had the highest percentage (75.4 percent) of women who started breastfeeding within one day of birth while the North West Region had the lowest (65.5 percent). �0 Trinidad and Tobago Multiple Indicator Cluster Survey 3 Figure NU.1 Percentage of mothers who started breastfeeding within one hour and within one day of birth, Trinidad and Tobago, 2006 65.5 75.4 69.2 73.6 33.6 46.9 36.4 41.2 0 10 20 30 40 50 60 70 80 North West North Central South West Trinidad and Tobago Pe rc en t Within one day Within one hour East and Tobago regions not shown as the number of cases were too small In Table NU.2, breastfeeding status is based on the reports of mothers/caretakers of children’s consumption of food and fluids in the 24 hours prior to the interview. Exclusively breastfed refers to infants who received only breast milk (and vitamins, mineral supplements, or medicine). The table shows exclusive breastfeeding of infants during the first six months of life (separately for children 0-3 months and children 0-5 months), as well as complementary feeding of children 6-9 months and continued breastfeeding of children at 12-15 and 20-23 months of age. Approximately 12.8 percent of children aged less than six months are exclusively breastfed, a level considerably lower than recommended. At age 6-9 months, 42.7 percent of children are fed breast milk and receive solid or semi-solid foods. By age 12-15 months, 33.8 percent of children are being breastfed and by age 20-23 months, 22.4 percent are still breastfed. ��Trinidad and Tobago Multiple Indicator Cluster Survey 3 0 10 20 30 40 50 60 70 80 90 100 Age (in M onths) P er ce n t Weaned (not breastfed) Breastfed and complementary foods Breastfed and other milk/ formula Breastfed and non-milk liquids Breastfed and plain water only Exclusively breastfed 0- 1 2- 3 4- 5 6- 7 8- 9 10 -1 1 12 -1 3 14 -1 5 16 -1 7 18 -1 9 20 -2 1 22 -2 3 24 -2 5 26 -2 7 28 -2 9 30 -3 1 32 -3 3 34 -3 5 Figure NU.2 Infant feeding patterns by age: Percent distribution of children aged under 3 years by feeding pattern by age group, Trinidad and Tobago, 2006 The adequacy of infant feeding among children under 12 months is provided in Table NU.3. Different criteria of adequate feeding are used depending on the age of the child. For infants aged 0-5 months, exclusive breastfeeding is considered as adequate feeding. Infants aged 6-8 months are considered to be adequately fed if they are receiving breast milk and complementary food at least two times per day, while infants aged 9-11 months are considered to be adequately fed if they are receiving breast milk and eating complementary food at least three times a day. The key findings in this table show that for 8 month old infants, 32.5 percent (the highest among the three age categories) received breast milk and complimentary food at least 2 times in the preceding 24 hours. For 9-11 month old infants, 21.9 percent received breast milk and complementary food at least 3 times in the preceding 24 hours. As a result of these feeding patterns, only 27.7 percent of children aged 6-11 months are being adequately fed. Adequate feeding among all infants (aged 0-11) drops to 20.5 percent. Salt Iodization Iodine Deficiency Disorders (IDD) is the world’s leading cause of preventable mental retardation and impaired psychomotor development in young children. In its most extreme form, iodine deficiency causes cretinism. It also increases the risks of stillbirth and miscarriage in pregnant women. Iodine deficiency is most commonly and visibly associated with goitre. IDD takes its greatest toll in impaired mental growth and development, contributing in turn to poor school performance, reduced intellectual ability, and impaired work performance. The international goal is to achieve sustainable elimination of iodine deficiency by 2005. The indicator is the percentage of households consuming adequately iodized salt (>15 parts per million). �� Trinidad and Tobago Multiple Indicator Cluster Survey 3 Table NU.4 shows that in about 85.7 percent of households, salt used for cooking was tested for iodine content by using salt test kits and testing for the presence of potassium iodide or potassium iodate content or both. Table NU.4 also shows that in a small proportion of households (5.0 percent), there was no salt available. In 27.8 percent of households, salt was found to contain 15 parts per million (ppm) or more of iodine. In accordance with that standard criterion, Table NU.4 and Figure NU.3 show that the use of iodized salt was observed to be lowest in the South Western Region (22.4 percent) and highest in the North Central Region of Trinidad (31.1 percent). There is little notable difference among households according to the socio-economic criteria. 0 5 10 15 20 25 30 35 Figure NU.3 Percentage of households consuming adequately iodized salt, Trinidad and Tobago, 2006 North West South West Tobago Trinidad and Tobago North Central East Pe rc en t Regions 29.7 25.6 31.1 22.4 22.5 27.8 Low Birth Weight Weight at birth is a good indicator not only of a mother’s health and nutritional status but also the newborn’s chances for survival, growth, long-term health and psychosocial development. Low birth weight (less than 2,500 grams) carries a range of grave health risks for children. Babies who were undernourished in the womb face a greatly increased risk of dying during their early months and years. Those who survive have impaired immune function and increased risk of disease; they are likely to remain undernourished, with reduced muscle strength, throughout their lives, and suffer a higher incidence of diabetes and heart disease in later life. Children born underweight also tend to have a lower IQ and cognitive disabilities, affecting their performance in school and their job opportunities as adults. �3Trinidad and Tobago Multiple Indicator Cluster Survey 3 In the developing world, low birth weight stems primarily from the mother’s poor health and nutrition. Three factors have most impact: the mother’s poor nutritional status before conception, short stature (due mostly to under nutrition and infections during her childhood), and poor nutrition during the pregnancy. Inadequate weight gain during pregnancy is particularly important since it accounts for a large proportion of foetal growth retardation. Moreover, diseases such as diarrhoea and malaria, which are common in many developing countries, can significantly impair foetal growth if the mother becomes infected while pregnant. In the industrialized world, cigarette smoking during pregnancy is the leading cause of low birth weight. In developed and developing countries alike, teenagers who give birth when their own bodies have yet to finish growing run the risk of bearing underweight babies. One of the major challenges in measuring the incidence of low birth weight is the fact that more than half of infants in the developing world are not weighed. In the past, most estimates of low birth weight for developing countries were based on data compiled from health facilities. However, these estimates are biased for most developing countries because the majority of newborns are not delivered in facilities, and those who are represent only a selected sample of all births. Because many infants are not weighed at birth and those who are weighed may be a biased sample of all births, the reported birth weights usually cannot be used to estimate the prevalence of low birth weight among all children. Therefore, the percentage of births weighing below 2500 grams is estimated from two items in the questionnaire: the mother’s assessment of the child’s size at birth (i.e., very small, smaller than average, average, larger than average, very large) and the mother’s recall of the child’s weight or the weight as recorded on a health card if the child was weighed at birth8 . Table NU.5 shows that overall, 89.8 percent of live births were weighed at birth and that approximately 18.8 percent of infants are estimated to weigh less than 2500 grams at birth. The table also shows that there was noteworthy variation by socio-economic status. The highest percentages of low birth weight infants were evident among infants who belonged to the poorest and upper middle quintile groups (20.6 percent and 21.5 percent respectively) while the lowest percentages of low birth weight infants were evident among infants who belonged to the richest and lower middle quintile groups (16.4, 18.2 and 17.1 percent respectively). � For a detailed description of the methodology, see Boerma, Weinstein, Rutstein and Sommerfelt, �996. �� Trinidad and Tobago Multiple Indicator Cluster Survey 3 Figure NU.4 Percentage of Infants Weighing Less Than 2500 Grams at Birth, Trinidad and Tobago, 2006 18 20 18 19 0 5 10 15 20 25 North West North Central South West Trinidad and Tobago Regions Pe rc en t * East and Tobago regions not shown as the number of cases were too small ��Trinidad and Tobago Multiple Indicator Cluster Survey 3 Immunization The Millennium Development Goal (MDG 4) is to reduce child mortality by two thirds between 1990 and 2015. Immunization plays a key part in this goal. Immunizations have saved the lives of millions of children in the three decades since the launch of the Expanded Programme on Immunization (EPI) in 1974. Worldwide there are still 27 million children overlooked by routine immunization and as a result, vaccine-preventable diseases cause more than 2 million deaths every year. A World Fit for Children goal is to ensure full immunization of children under one year of age at 90 percent nationally, with at least 80 percent coverage in every district or equivalent administrative unit. VI. Child Health �� Trinidad and Tobago Multiple Indicator Cluster Survey 3 The immunization schedule for Trinidad and Tobago is as follows: DOSE AGE OF CHILD IMMUNIZATION First 3 months DPT/HepB/Hib, Oral Polio Second 4 months DPT/HepB/Hib, Oral Polio Third 6 months DPT/HepB/Hib, Oral Polio 12 months Yellow Fever/MMR Booster 18 months DPT/Oral Polio Vaccine Booster 4-5 years DPT/Oral Polio Vaccine Booster 4-6 years MMR Booster 10-12 years Td(Adult), Yellow Fever Adult 19-45 years MMR According to UNICEF and WHO guidelines, a child should receive a BCG vaccination to protect against tuberculosis, three doses of DPT to protect against diphtheria, pertussis, and tetanus, three doses of polio vaccine, and a measles vaccination by the age of 12 months. Mothers were asked to provide vaccination cards for children under the age of five years. Interviewers were expected to copy the vaccination information from the cards onto the MICS questionnaire. In Trinidad and Tobago, official statistics published by the Ministry of Health reveal that the coverage of polio and DPT among infants in their first year of life was 95 percent in 2005 for both vaccines. With respect to the MMR and yellow fever vaccines, the coverage among children 12-23 months was 93 percent for both vaccines. Similar levels of coverage in the neighbourhood of 90 percent were evident since 2000. Overall, Table CH.2 shows that 78.8 percent of children had health cards. If the child did not have a card, the mother was asked to recall whether or not the child had received each of the vaccinations and, for DPT and Polio, how many times. The percentage of children aged 18 to 29 months who received each of the vaccinations is shown in Table CH.1. The denominator for the table is comprised of children aged 18-29 months so that only children who are old enough to be fully vaccinated are counted. In the top panel, the numerator includes all children who were vaccinated at any time before the survey according to the vaccination card or the mother’s report. In the bottom panel, only those who were vaccinated before their first birthday, as recommended, are included. For children without vaccination cards, the proportion of vaccinations given before the first birthday is assumed to be the same as for children with vaccination cards. By the age of 12 months, 74.1 percent of children aged 18-29 months had received the first dose of DPT vaccinations. The percentage for subsequent doses of DPT is 78.0 percent for the second dose, and declines to 72.5 percent for the third dose (Figure CH.1). Similarly, 95.1 percent of children aged 18-29 months received their first polio vaccine by the age 12 months. ��Trinidad and Tobago Multiple Indicator Cluster Survey 3 However, the respective proportions that received their second and third polio vaccines by the age of 12 months declined to 90.8 percent and 81.9 percent respectively. By the age of 12 months, the coverage for measles vaccination is estimated to be 88.9 percent among children aged 18-29 months. Given such patterns of vaccination, it is estimated that approximately one half (50.2 percent) of the children aged 18-29 months had all of their recommended vaccinations before their first birthday. Moreover, a relatively small proportion amounting to 3.0 percent had none of the recommended vaccinations by their first birthday. Figure CH.1 Percentage of children aged 12-23 months who received the recommended vaccinations by 12 months, Trinidad and Tobago, 2006 74.1 78 72.5 95.1 90.8 81.9 88.9 50.2 0 10 20 30 40 50 60 70 80 90 100 DPT1 DPT2 DPT3 Polio1 Polio2 Polio3 Measles All Pe rc en t In Trinidad and Tobago, additional recommended vaccinations include Hepatitis B, yellow fever and Haemophilus Influenzae type b (Hib), insofar as they are reflected in the above immunization schedule. Accordingly, Table CH.1c reveals that 77.6 percent of all children 18-29 months had received their first Hepatitis B vaccine by their first birthday. Lower proportions amounting to 74.2 percent and 70.0 percent respectively, had received their second and third Hepatitis B vaccinations by their first birthday. In contrast, just over one third (approximately 35.2 percent) of 18-29 month olds had received vaccination against yellow fever by their first birthday. Tables CH.2 and CH.2c show vaccination coverage rates among children 18-29 months by background characteristics including sex, health region of residence, mother’s education and socio-economic status. The figures pertain to children who had received vaccinations at any time up to the date of the survey, and are based on information from both the vaccination cards and mothers’/caretakers’ reports. In the context of different doses of vaccines against polio, measles or diphtheria, pertussis and tetanus, males appear to be a bit more likely than females to have received vaccinations. The estimates also suggest that males are slightly �� Trinidad and Tobago Multiple Indicator Cluster Survey 3 more likely to have received all of these vaccinations when compared to females. Despite relatively small proportions that are less than 5.0 percent, the estimates suggest that females may almost be twice as likely as males to have received none of these vaccines. It is worth noting that some of these findings, whether in the context of children’s sex, health region of residence and socio-economic status, seem counter-intuitive and thus, may rely upon the outcome of further research initiatives that seek to evaluate the statistical significance of such observed patterns. With respect to some of the additional recommended vaccines such as Hepatitis B and yellow fever, Table CH.2c indicates that there is likely to be little or no differentials in vaccination status across the sexes. In the case of the Haemophilus Influenzae type b (Hib) vaccine, there appears to be a slightly higher likelihood of the vaccination being administered to males when compared to females. Tetanus Toxoid One of the MDGs is to reduce by three quarters the maternal mortality ratio, with one strategy to eliminate maternal tetanus. In addition, another goal is to reduce the incidence of neonatal tetanus to less than 1 case of neonatal tetanus per one thousand live births in every district. A World Fit for Children goal is to eliminate maternal and neonatal tetanus by 2005. Prevention of maternal and neonatal tetanus is to assure all pregnant women receive at least two doses of tetanus toxoid vaccine. However, if women have not received two doses of the vaccine during the pregnancy, they (and their newborn) are also considered to be protected if the following conditions are met: • Received at least two doses of tetanus toxoid vaccine, the last within the prior 3 years; • Received at least 3 doses, the last within the prior 5 years; • Received at least 4 doses, the last within 10 years; • Received at least 5 doses during lifetime. Table CH.3 shows the protection status from tetanus among women who have had a live birth within the last 24 months. Figure CH.2 shows the protection of women against neonatal tetanus according to the background characteristic of region. Altogether, 24.4 percent of women with a live birth in the last 24 months were protected against neonatal tetanus. There appeared to be very little variation among women across the regions. ��Trinidad and Tobago Multiple Indicator Cluster Survey 3 Figure CH.2 Percentage of women with a live birth in the last 24 months who are protected against neonatal tetanus, Trinidad and Tobago, 2006 23.9 24 23.1 24.4 0 10 20 30 40 50 Regions North West North Central South West Trinidad and Tobago Percent * East and Tobago regions not shown as the number of cases were too small Oral Rehydration Treatment Diarrhoea is the second leading cause of death among children under five worldwide. Most diarrhoea-related deaths in children are due to dehydration from loss of large quantities of water and electrolytes from the body in liquid stools. Management of diarrhoea – either through oral rehydration salts (ORS) or a recommended home fluid (RHF) - can prevent many of these deaths. Preventing dehydration and malnutrition by increasing fluid intake and continuing to feed the child are also important strategies for managing diarrhoea. The goals are to: 1) reduce by one half death due to diarrhoea among children under five by 2010 compared to 2000 (A World Fit for Children); and 2) reduce by two thirds the mortality rate among children under five by 2015 compared to 1990 (Millennium Development Goals). In addition, the World Fit for Children calls for a reduction in the incidence of diarrhoea by 25 percent. The indicators are: • Prevalence of diarrhoea; • Oral rehydration therapy (ORT); • Home management of diarrhoea; • (ORT or increased fluids) AND continued feeding. 30 Trinidad and Tobago Multiple Indicator Cluster Survey 3 In the MICS questionnaire, mothers (or caretakers) were asked to report whether their child had had diarrhoea in the two weeks prior to the survey. If so, the mother was asked a series of questions about what the child had to drink and eat during the episode and whether this was more or less than the child usually ate and drank. In the case of Trinidad and Tobago, for reporting purposes, there were too few cases of children (3.7 percent) who were found in the data with diarrhoeal related issues. Care Seeking and Antibiotic Treatment of Pneumonia Pneumonia is the leading cause of death in children and the use of antibiotics in children under 5 years with suspected pneumonia is a key intervention. A World Fit for Children goal is to reduce by one-third the deaths due to acute respiratory infections. Children with suspected pneumonia are those who had an illness with a cough accompanied by rapid or difficult breathing and whose symptoms were NOT due to a problem in the chest and a blocked nose. The indicators are: • Prevalence of suspected pneumonia; • Care seeking for suspected pneumonia; • Antibiotic treatment for suspected pneumonia; • Knowledge of the danger signs of pneumonia. In the case of Trinidad and Tobago, for reporting purposes, there were too few cases of children (2.5 percent) who were found in the data with suspected pneumonia. Issues related to knowledge of danger signs of pneumonia are presented in Table CH.4. Obviously, mothers’ knowledge of the danger signs is an important determinant of care- seeking behaviour. Overall, (40.0 percent) of mothers/caregivers know of the two danger signs of pneumonia – fast and difficult breathing. The most commonly identified symptom for taking a child to a health facility is when the child develops a fever (77.7 percent). The least frequently recognized symptom is if the child is drinking poorly (27.6 percent). The percentage of mothers/caregivers who identified fast breathing as a symptom for taking children immediately to a health care provider is 45.7 percent as opposed to 61.1 percent in the case of mothers/caregivers who identified difficult breathing as such a symptom. Interestingly, mothers/caregivers who attained lower levels of education have been observed to be more likely to recognize the two danger signs of pneumonia. With respect to mothers/ caregivers with no more than primary level education, the respective proportion of mothers who recognized the two danger signs of pneumonia is observed to be 41.6 percent while only 3�Trinidad and Tobago Multiple Indicator Cluster Survey 3 37.1 percent recognized such signs among mothers/caregivers with secondary/technical- vocational education. Across the different geographic regions, there does not appear to be much variation in the percentages of mothers/caregivers who recognized the two danger signs of pneumonia although the North Central RHA recorded a slightly lower percentage (35.6 percent) than the other regions. There appears to be a slight positive association between the socio-economic status of mothers/caregivers and recognition of the two danger signs of pneumonia. Specifically, mothers/caregivers belonging to the richest and upper middle class group appear to be a bit more likely than those in the middle, lower middle and poorest groups to have recognized the two danger signs. For the richest and upper middle class groups, the respective percentages are 42.3 and 42.9 percent while corresponding percentages among the poorest, middle and lower middle class groups are 39.2, 38.1 and 38.4 percent respectively. Solid Fuel Use More than 3 billion people around the world rely on solid fuels (biomass and coal) for their basic energy needs, including cooking and heating. Cooking and heating with solid fuels leads to high levels of indoor smoke, a complex mix of health-damaging pollutants. The main problem with the use of solid fuels is products of incomplete combustion, including CO, polyaromatic hydrocarbons, SO2, and other toxic elements. Use of solid fuels increases the risks of acute respiratory illness, pneumonia, chronic obstructive lung disease, cancer, and possibly tuberculosis, low birth weight, cataracts, and asthma. The primary indicator is the proportion of the population using solid fuels as the primary source of domestic energy for cooking. Overall, Table CH.5 shows that point three percent of households used solid fuels for cooking. The use of solid fuels was highest in Tobago (0.9 percent) and Eastern Region (0.7 percent). Use of this fuel varied in other parts of the country from 0.1 to 0.3 percent. The findings also revealed that only the poorest households (1.4 percent) use solid fuels to cook. The most widely used fuels for cooking were liquid propane gas and electricity. The respective fuels were estimated to be used in 92.8 percent and 5.7 percent of all households nationwide. However, electricity was more than four times as likely to be used as a cooking fuel in the richest households than in any other set of households predicated upon socio-economic status. In fact, there is evidence of a positive association between the socio-economic status of households and the likelihood of electricity use as a source of cooking fuel. Specifically, 22.3 percent of the households in which the head had at least a university education and 21.7 percent of the richest households used electricity as a source of cooking fuel. In contrast, more affluent households appear less likely than less affluent ones to use liquid propane gas as a source of cooking fuel, the proportions being 76.7 percent for households with heads who 3� Trinidad and Tobago Multiple Indicator Cluster Survey 3 had at least a university education and 78.1 percent for the richest households. In less affluent households, corresponding percentages in excess of 90 percent are observed in Table CH.5. From the standpoint of the general population, it can be deduced from the findings that the health effects associated with the burning of solid fuels for cooking would be low. However, for the poor households that use solid fuels for cooking, the health effects would be influenced by the type of devices used for cooking and the adequacy of ventilation provided in the households. 33Trinidad and Tobago Multiple Indicator Cluster Survey 3 Water and Sanitation Safe drinking water is a basic necessity for good health. Unsafe drinking water can be a significant carrier of diseases such as trachoma, cholera, typhoid, and schistosomiasis. Drinking water can also be tainted with chemical, physical and radiological contaminants with harmful effects on human health. In addition to its association with disease, access to drinking water may be particularly important for women and children, who bear the primary responsibility for carrying water, often for long distances, especially in rural areas. The MDG goal is to reduce by half, between 1990 and 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation. The World Fit for Children goal calls for a reduction in the proportion of households without access to hygienic sanitation facilities and affordable and safe drinking water by at least one-third. The list of indicators used in MICS are as follows : Water: • Use of improved drinking water sources; • Use of adequate water treatment method; VII. Environment 3� Trinidad and Tobago Multiple Indicator Cluster Survey 3 • Time to source of drinking water; • Person collecting drinking water. Sanitation: • Use of improved sanitation facilities; • Sanitary disposal of child’s faeces. The distribution of the population by source of drinking water is shown in Tables EN.1-A and B and Figure EN.1. The population using improved sources of drinking water are those using any of the following types of supply: piped water (into dwelling, yard or plot), public tap/standpipe, protected spring and rainwater collection. Bottled water is considered as an improved water source only if the household is using an improved water source for other purposes, such as hand-washing and cooking. Rainwater collection being classified as an improved source is consistent with the international standard that is embraced by UNICEF (Table EN.1-A). The report also presents results in accordance with a country-specific standard that more adequately reflects the cultural space of Trinidad and Tobago (Table EN.1-B). Figure EN.1 Percentage distribution of household members by source of drinking water, Trinidad and Tobago, 2006 72.1 7.9 3.3 1.4 1 0.5 5 5.2 0.7 1.6 0.9 Piped into dwelling Piped into yard or plot Public tap/ standpipe Private piped into dwelling Private piped into yard Protected spring Rainwater collection Bottled water Unprotected spring Tanker-truck Other In accordance with the international standard embraced by UNICEF, Table EN.1-A reveals that 96.4 percent of the population had an improved source of drinking water. Moreover, the table also shows that 72.1 percent of the population had their supply piped into dwelling and 7.9 percent piped into yard or plot. In terms of region, the South Western Region and Tobago had the highest percentage of persons living in situations with water piped into yard or plot (12.5 and 10.8 percent respectively). The use of bottled water was observed to be 3�Trinidad and Tobago Multiple Indicator Cluster Survey 3 significantly higher in the population with university education (13.4 percent) and among the richest quintile (12.0 percent) when compared to the average of 5.2 percent for the total population. The data also revealed that relatively larger percentages of poorer household members had water piped into yard or plot (20.3 percent) and used public/standpipe (13.9 percent). The use of rain water was also highest among the poorest household members (14.5 percent) and persons from households in the Eastern Region (19.3 percent) when compared to other relevant groups in the total population. When reference is made to the country-specific conception of improved water sources, Table EN.1-B shows that a lower proportion amounting to 91.4 percent of the population had an improved source of drinking water. Irrespective of the standard embraced, the pattern of variation in improved and unimproved sources of water appear to remain unchanged for the different categories of region, education of household head and wealth index quintiles. Use of in-house water treatment is presented in Table EN.2. Households were asked of ways they may be treating water at home to make it safer to drink – boiling, adding bleach or chlorine, using a water filter, straining through a cloth and letting the water stand and settle were considered as proper treatment of drinking water. The table shows the percentages of household members using appropriate water treatment methods, separately for all households, for households using improved and unimproved drinking water sources. Overall, 34.1 percent of household members use an appropriate water treatment method while 63.3 percent of household members live in environments that do not use any water treatment method. Households that use boiled water accounts for 22.1 percent while filter use as a treatment method was relatively higher among persons from households in which the head was university-trained (27.4 percent) and among richest persons (29.1 percent). When one looks at regional differences in the treatment of water from all drinking sources, the Eastern Region had the lowest proportion of household members exposed to the use of an appropriate water treatment method (18.2 percent). The percentage of household members living in environments that do not use any treatment method (63.3 percent) must be considered in relation to the percentage of household members (96.4 percent) that had been exposed to an improved source of drinking water. Further household treatment of this improved source of drinking water to reduce the likely occurrence of waterborne diseases may not be necessary. Of concern, however, would be household members’ exposure to the unimproved drinking water sources for which only 28.1 percent were exposed to the use of an appropriate water treatment method. A distribution of households according to the amount of time it takes to obtain water is presented in Table EN.3. In the case of households in which drinking water is collected off the premises, Table EN.4 presents a distribution according to the characteristics of persons 3� Trinidad and Tobago Multiple Indicator Cluster Survey 3 collecting such water. Note that these results refer to one roundtrip from home to drinking water source. Information on the number of trips made in one day was not collected. Overall, Table EN.3 shows that the mean time to source drinking water (excluding water on premises) was estimated to be 18.5 minutes. The percentage of households sourcing drinking water however, was low, since 92.9 percent of household had water on their premises. With respect to households in which drinking water is collected off the premises, Table EN.4 shows that adult men (71.1 percent) collected drinking water for a greater proportion of households than any other sub-population. In 20.8 percent of households, adult women collected drinking water. Generally, the percentage of households with children collecting drinking water was found to be extremely low, except in Tobago where female children collected water in 6.3 percent of the households and in the North Central Region where male children collected water in 6.4 percent of all households. Inadequate disposal of human excreta and personal hygiene is associated with a range of diseases including diarrhoeal diseases and polio. Improved sanitation facilities for excreta disposal include: flush or pour flush to a piped sewer system, septic tank, or latrine; ventilated improved pit (VIP) latrine and pit latrine with slab. Table EN.5 reveals that 98.8 percent of the population in households was exposed to using sanitary means of excreta disposal. Improved sanitation facility reflected flush to septic tank as the main source of disposal (65.3 percent) followed by flush to piped sewer system (19.1 percent) and pit latrine with slab (12.7 percent). The highest percentage of exposure to the pit latrine use was among the poorest persons (57.1 percent in the case of pit latrine use with slab, 6.5 percent in the case of VIP and 3.7 percent in the case of pit latrine without slab). With respect to children 0-2 years, in terms of disposal of child’s faeces, Table EN.6 shows the pattern of disposal of faeces. According to the table, solid waste was the principal means of disposal of child faeces which was thrown into the garbage , this being evident in the case of 73.1 percent of the children. This pattern was not very different across the Regional Health Areas (RHAs), mother’s education and wealth index quintiles. Safe disposal of stools was therefore only reflected in the cases of 24.9 percent of the children 0-2 years. Although disposal of children stools into garbage may not be considered to be safe disposal, its contribution to diarrheal disease may be extremely low especially if an efficient collection and disposal system for solid wastes exists in the community. Unsafe drinking water, poor nutrition of the child and poor personal hygiene of the caregivers are more likely to be associated with outbreaks of diarrheal diseases. Table EN.7 presents an overview of the percentage of household members using improved sources of drinking water and sanitary means of excreta disposal. The presence of both indicators was seen in 95.2 percent of the survey population, while the percentage using 3�Trinidad and Tobago Multiple Indicator Cluster Survey 3 improved sources of drinking water was 96.4 percent and sanitary means of excreta disposal at a high of 98.7 percent. Evidently, attributes deemed to be characteristic of socio-economic status, for example, the education of the household head and wealth index quintiles, are positively correlated with persons’ simultaneous exposure to the use of improved sources of drinking water and sanitary means of excreta disposal. 3� Trinidad and Tobago Multiple Indicator Cluster Survey 3 Contraception Appropriate family planning is important to the health of women and children by: 1) preventing pregnancies that are too early or too late; 2) extending the period between births; and 3) limiting the number of children. A World Fit for Children goal is that all couples should have access to information and services to prevent pregnancies that are too early, too closely spaced, too late or too many. According to Table RH.1, current use of contraception was reported by 42.5 percent of women, aged 15-49 years, currently married or in union. Approximately 37.7 percent of women reported using a modern method of contraception as compared to 4.8 percent of women who use any traditional method. The most popular method that such women reported is the condom which is used by the partners of 13.0 percent of women. The pill is the next most popular method that was reported by 10.9 percent of these women. This was followed by female sterilization for which the corresponding proportion is 8.4 percent. Between two and three percent of women reported the use of the IUD and injectables. Between one to two percent reported the use of periodic abstinence, withdrawal and other methods. Male sterilization, vaginal methods, or the lactational amenorrhea method (LAM) were used by less than one percent. VIII. Reproductive Health 3�Trinidad and Tobago Multiple Indicator Cluster Survey 3 Current use of contraception does reflect a pattern that may be indicative of age-related childbearing intentions of women currently married or in union. For married or in union women aged 15-19 years, those who reported current use of a contraceptive method represent 41.3 percent compared to respective proportions of 49.1 percent and 47.4 percent among women aged 30-34 years and 40-44 years. Thus, the relatively higher proportions of current use in these age groups could be indicative of women’s desire to avert or limit pregnancy very early in their reproductive lives or at later stages. In contrast, lower proportions of current use are evident in the 20-24 and 45-49 age groups, the respective figures being 34.1 percent and 30.6 percent which could be indicative of efforts to start on continue childbearing in the case of the younger women 20-24 years and perhaps, the onset of menopause in the case of the older women 45-49 years. Women’s education level is associated with current contraceptive prevalence. The percentage of women using any method of contraception rises from 36.9 percent among those with no/pre- school/primary education to 42.3 percent among those with lower secondary education and to approximately 56.5 percent among those with university education. Thus, the findings are consistent with a positive association between women’s education and current contraceptive prevalence. In addition to differences in prevalence, the method mix varies by education. Among the contraceptive users with no/pre-school/primary, 9.9 percent and 9.7 percent use female sterilization and the condom as the main methods of contraception; this is followed by use of the pill at 7.8 percent. In contrast, contraceptive users with university education use the condom at 17.4 percent and the pill at 14.5 percent as the main methods of contraception. This is followed by an estimated 10.0 percent who are sterilized. Unmet Need Unmet need9 for contraception refers to fecund women who are not using any method of contraception, but who wish to postpone the next birth or who wish to stop childbearing altogether. Unmet need is identified in MICS by using a set of questions eliciting current behaviours and preferences pertaining to contraceptive use, fecundity, and fertility preferences. Women in unmet need for spacing includes women who are currently married (or in union), fecund (are currently pregnant or think that they are physically able to become pregnant), currently not using contraception, and want to space their births. Pregnant women are considered to want to space their births when they did not want the child at the time they got pregnant. Women who are not pregnant are classified in this category if they want to have a(nother) child, but want to have the child at least two years later, or after marriage. 9 Unmet need measurement in MICS is somewhat different than that used in other household surveys, such as the Demographic and Health Surveys (DHS). In DHS, more detailed information is collected on additional variables, such as postpartum amenorrhoea, and sexual activity. Results from the two types of surveys are strictly not comparable. �0 Trinidad and Tobago Multiple Indicator Cluster Survey 3 Women in unmet need for limiting are those women who are currently married (or in union), fecund (are currently pregnant or think that they are physically able to become pregnant), currently not using contraception, and want to limit their births. The latter group includes women who are currently pregnant but had not wanted the pregnancy at all, and women who are not currently pregnant but do not want to have a(nother) child. Total unmet need for contraception is simply the sum of unmet need for spacing and unmet need for limiting. Using information on contraception and unmet need, the percentage of demand for contraception satisfied is also estimated from the MICS data. Percentage of demand for contraception satisfied is defined as the proportion of women currently married or in union who are currently using contraception, of the total demand for contraception. The total demand for contraception includes women who currently have an unmet need (for spacing or limiting), plus those who are currently using contraception. Table RH.2 shows the results of the survey on contraception, unmet need, and the demand for contraception satisfied. In Trinidad and Tobago, the unmet need for contraception is 26.7 percent (spacing is 6.3 percent and limiting is 20.4 percent). The percentage of demand for contraception satisfied is 61.4 percent. Antenatal Care The antenatal period presents important opportunities for reaching pregnant women with a number of interventions that may be vital to their health and well-being and that of their infants. Better understanding of foetal growth and development and its relationship to the mother’s health has resulted in increased attention to the potential of antenatal care as an intervention to improve both maternal and newborn health. For example, if the antenatal period is used to inform women and families about the danger signs and symptoms and about the risks of labour and delivery, it may provide the route for ensuring that pregnant women do, in practice, deliver with the assistance of a skilled health care provider. The antenatal period also provides an opportunity to supply information on birth spacing, which is recognized as an important factor in improving infant survival. Tetanus immunization during pregnancy can be life-saving for both the mother and infant. The prevention and treatment of malaria among pregnant women, management of anaemia during pregnancy and treatment of STIs can significantly improve foetal outcomes and improve maternal health. Adverse outcomes such as low birth weight can be reduced through a combination of interventions to improve women’s nutritional status and prevent infections (e.g., malaria and STIs) during pregnancy. More recently, the potential of the antenatal period as an entry point for HIV prevention and care, in particular for the prevention of HIV transmission from mother to child, has led to renewed interest in access to and use of antenatal ��Trinidad and Tobago Multiple Indicator Cluster Survey 3 services. In Trinidad and Tobago, there is a Prevention of Mother to Child Transmission Unit located in the Ministry of Health which deals specifically with the provision of services identified above. WHO recommends a minimum of four antenatal visits based on a review of the effectiveness of different models of antenatal care. WHO guidelines are specific on the content of antenatal care visits, which include: • Blood pressure measurement; • Urine testing for bateriuria and proteinuria; • Blood testing to detect syphilis and severe anemia; • Weight/height measurement (optional). According to Table RH.3, 95.7 percent of the women aged 15-49 years who gave birth in the last two (2) years preceding the survey received antenatal care by a skilled person such as a doctor, nurse, midwive, and auxiliary nurse midwive who are skilled health personnel with midwifery skills to manage normal deliveries and diagnose or refer obstetric complications. The level of antenatal care does not differ significantly across the regions. The type of personnel providing antenatal care to women aged 15-49 years who gave birth in the two years preceding is presented in Table RH.3. Approximately 88.8 and 6.5 percent of women receive antenatal care from either a medical doctor or nurse/midwife respectively. This was followed by 3.3 percent of women who received assistance from a community health worker and less than 1 percent from an auxiliary midwife or other/missing. Only 0.8 percent of the women reported that they did not receive any antenatal care. An analysis of the services received by the women reveal that 98.0 percent had a blood sample taken; 98.2 percent had blood pressure measured; 98.0 percent had a urine specimen taken and 97.6 percent had weight measured. There is little variance across age, education and socio-economic status. Assistance at Delivery Three quarters of all maternal deaths occur during delivery and the immediate post-partum period. The single most critical intervention for safe motherhood is to ensure a competent health worker with midwifery skills is present at every birth, and transport is available to a referral facility for obstetric care in case of emergency. A World Fit for Children goal is to ensure that women have ready and affordable access to skilled attendance at delivery. The indicators are the proportion of births with a skilled attendant and proportion of institutional deliveries. The skilled attendant at delivery indicator is also used to track progress toward the �� Trinidad and Tobago Multiple Indicator Cluster Survey 3 Millennium Development target of reducing the maternal mortality ratio by three quarters between 1990 and 2015. The MICS included a number of questions to assess the proportion of births attended by a skilled attendant. A skilled attendant includes a doctor, nurse, midwife or auxiliary midwife. According to Table RH.5, about 97.8 percent of births occurring in the two years prior to the MICS survey were delivered by skilled personnel. This percentage does not differ significantly across any of the regions. Further, the educational levels of women did not affect the likelihood of delivery with the assistance of a skilled person. A little less than half of the births (48.8 percent) were delivered with assistance by a doctor. Nurses/midwives assisted with the delivery of 48.1 percent of births. One percent or less of births was delivered with the assistance of auxiliary midwives, traditional birth attendants or a relative/friend. Only 0.3 percent of women reported that there was no attendant to assist with their delivery. Approximately 97.4 percent of the births were delivered in a health facility. �3Trinidad and Tobago Multiple Indicator Cluster Survey 3 It is well recognized that a period of rapid brain development occurs in the first 3-4 years of life, and the quality of home care is the major determinant of the child’s development during this period. In this context, adult activities with children, presence of books in the home, for the child, and the conditions of care are important indicators of the quality of home care. A World Fit for Children goal is that “children should be physically healthy, mentally alert, emotionally secure, socially competent and ready to learn.” Information on a number of activities that support early learning was collected in the survey. These included the involvement of adults with children in the following activities: reading books or looking at picture books, telling stories, singing songs, taking children outside the home, compound or yard, playing with children, and spending time with children naming, counting, or drawing things. According to Table CD.1, 94.0 percent of under-five children had an adult who engaged in four or more activities that promote learning and school readiness during the 3 days preceding the survey. The average number of activities that adults engaged with children was 5.4. Having presented the overall picture, and in looking at specific attributes of the children under review, the table illustrates that father’s level of educational attainment was associated with his involvement in such activities; fathers who had attained university education were more involved than fathers who were not educated or had attained up to a primary school education. The data suggest that there appears to be a relationship between fathers who were IX. Child Development �� Trinidad and Tobago Multiple Indicator Cluster Survey 3 not in the household and the low percentage of involvement in four or more activities. Only 31.4 percent of children were living in a household without their natural fathers. Whether the children were male or female, there appear to be negligible difference in their exposure to activities promoting school readiness. From a gender lens, however, male children were more likely to be exposed to activities initiated by fathers than was the case among female children. Differentials by region and socio-economic status are also observed with the greatest level of exposure to adult activities being evident among children resident in the North Central region (95.5 percent) and the lowest among those resident in the Tobago (86.5 percent). The greatest exposure to adult activities is observed among children living in the richest households (97.3 percent) while the lowest exposure is evident among those living in the poorest households (92.1 percent). Exposure to books in early years not only provides the child with greater understanding of the nature of print, but may also gives the child opportunities to see others reading, such as older siblings doing school work. The presence of books is important for later school performance and IQ scores. Table CD.2 illustrates that 89.9 percent of children are living in households where at least 3 non-children’s books are present. The percentage of children living in households where 3 or more children’s books are present is slightly lower, at 81.4 percent. The richest households had the highest percentage (94.7 percent) of children living in households where there are 3 or more non-children’s books present. The corresponding proportion in the poorest households was 81.2 percent. The differentials observed across the regions are negligible, indicating that children in each of the regions have similar access to both types of books. Children’s exposure to both non- children’s and children’s books is positively associated with the their age; for older children aged 24-59 months, as much as 91.4 percent lived in the homes with 3 or more non-children’s books while in the case of their younger counterparts aged 0-23 months, the corresponding proportion is 87.3 percent. A similar differential exists in terms of children’s books. Mothers/caretakers were asked about their children’s exposure to a specific set of playthings. Accordingly, Table CD.2 shows that 37.0 percent of children aged 0-59 months had 3 or more playthings to play with in their homes, while 5.0 percent had none. The playthings in MICS included household objects, homemade toys, toys that came from a store, and objects and materials found outside the home. It is interesting to note that 91.0 percent of children play with toys that come from a store; however, the percentages for other types of toys are below 50.0 percent. ��Trinidad and Tobago Multiple Indicator Cluster Survey 3 The proportion of children who have 3 or more playthings to play with is 39.9 percent among male children and 34.0 percent among female children. The Eastern Region has the highest percentage (52.4 percent) of children aged 0-59 months who had 3 or more types of playthings. The table also shows that in terms of mother’s education, the highest percentage (44.2 percent of children who belonged to mothers who had an upper secondary / technical-vocational level of education had 3 or more types of playthings. In contrast, the lowest percentage of children (34.7 percent) belonged to mothers whose level of education did not surpass primary school. With respect to differences in the socio-economic status of households, differentials in children’s access to at least three playthings are small. Table CD.2 shows that in the case of the richest households, 43.2 percent of the children aged 0-59 months had 3 or more types of playthings. Age is the only background variable that appears to have a strong association with children’s access to playthings. Leaving children alone or in the presence of other young children is known to increase the risk of accidents. In MICS, two questions were asked to find out whether children aged 0-59 months were left alone during the week preceding the interview, and whether children were left in the care of other children under 10 years of age. According to Table CD.3, less than 1 percent (0.8 percent) of children aged 0-59 months were left in the care of other children, while less than a half percent (0.4 percent) were left alone during the week preceding the interview. Table CD.3 indicates that 1.0 percent of children age 0-59 months was left with inadequate care during the week preceding the survey. Compared to the other Regions of Trinidad and Tobago, the South West Region had the highest percentage of children who were left with inadequate care (2.7 percent). Mother’s education appears to be associated with the likelihood of children being left with inadequate care. Thus, inadequate care was more prevalent among children whose mothers had primary level education or less (4.0 percent), as opposed to among children whose mothers had secondary education (less than 1.0 percent for both categories of secondary education). Estimates reveal that children whose mothers had university education may have had universal exposure to adequate care during the period under review. Notwithstanding earlier observations that just 1.0 percent of the under-five children are left with inadequate care, the survey data also reveal that children under 2 years (i.e. aged 0-23 months) were almost twice as likely to be left with inadequate care when compared to their older counterparts aged 24-59 months, the respective proportions being 1.4 percent and 0.8 percent. With regard to socio-economic status, children in the two poorest groups were more likely to be left with inadequate care when compared to their counterparts from the other socio-economic groups. �� Trinidad and Tobago Multiple Indicator Cluster Survey 3 Education System The government’s education policy has been to create a modernized education system that provides the education and training as well as inculcate the skills and values relevant to the developmental needs of the country. In this regard, the government has accorded high priority to the development of a seamless, quality education system that affords articulation from Early Childhood Care and Education (ECCE) level to the tertiary level. In accordance with Vision 2020, these initiatives are expected to create an education system with contents and methods that reflect the country’s social and cultural realities and provide young people with skills for living, working and citizenship in Trinidad and Tobago. The education system in Trinidad and Tobago includes both public (government and government-assisted) and private schools. It is comprised of five levels, namely, pre-primary, primary, secondary, post-secondary (Advanced Proficiency and Technical /Vocational) and tertiary levels. The Ministry of Education (MOE) is the administrative authority for the pre- primary to post-secondary and the Ministry of Science, Technology and Tertiary Education (MSTTE) has responsibility for tertiary level education. Mission and Vision of the Ministry of X. Education ��Trinidad and Tobago Multiple Indicator Cluster Survey 3 Education is ‘Excellence in Education: developing imagination, intellect and spirit for creating committed enterprising citizens and global leaders’. Early Childhood Care and Education Attendance to early childhood care and education in an organized learning or child education programme is important for the readiness of children to attend primary school. One of the World Fit for Children goals is the promotion of early childhood care and education. In 2005, there were approximately 35,000 children of pre-school age (3 – 4 years old). Of this number 18,000 were males and 17,000 were females (UIS Global Education Database, 2006). According to Table ED.1, 74.7 percent of children aged 36–59 months are attending early childhood care and education programmes. Female children aged 36-59 months appear a bit more likely than their male counterparts to be attending early childhood care and education programmes, the respective proportions being 75.8 percent and 73.5 percent. Among children aged 36-59 months, the survey results did not reveal substantial regional differences with regard to attendance to early childhood centres in Trinidad. However, such attendance was more prevalent in the Eastern Region (79.6%), and lowest in Tobago (63.2%), a difference of 16.4 percentage points. Table ED.1 also shows that mother’s education may be related to children’s attendance at an early childhood care and education programme. Differentials by the socio-economic status of children aged 36-59 months are observed with regard to attendance to early childhood care and education programmes. Overall, 87.3 percent of children living in the richest households were estimated to be attending an early childhood care and education programmes, while the figure falls to 64.8 percent among children in the poorest households. It is interesting to note that 57.5% of children aged 36-47 months and 90.1 percent of children aged 48-59 months are attending early childhood care and education centres. The survey results also show that the children of the official entry age (36-47 months) for ECCE are less represented at early childhood care and education centres throughout the country. This situation is currently being addressed through the Ministry of Education’s thrust to ensure universal quality access to early childhood care and education for all children by 2010. In essence, the goal of the Government of Trinidad and Tobago is to ensure that all children (36–59 months) irrespective of their socio-economic status, place of residence and mother’s educational attainment are attending an ECCE programme of good quality. Table ED.1 also shows the estimated proportion of children who attended pre-school the previous year and currently attending the first level of primary school, an important indicator of school readiness. It is estimated that 96.9 percent of children attending the first level of primary had attended an ECCE programme in the previous year. Overall, 98.6 percent of �� Trinidad and Tobago Multiple Indicator Cluster Survey 3 five year olds and 94.0 percent of 6 year olds in the first level of primary school had attended pre-school in the previous year. There appeared to be little difference between boys and girls. However, almost 100 percent of children in the North Central and South West Regions (98.8% and 98.2% respectively) had attended pre-school the previous year compared to 86.7 percent among children living in Tobago. Primary and Secondary School Participation10 Universal access to basic education and the achievement of primary education by the world’s children is one of the most important goals of the Millennium Development Goals and A World Fit for Children. Education is a vital prerequisite for combating poverty, empowering women, protecting children from hazardous and exploitative labour and sexual exploitation, promoting human rights and democracy, protecting the environment, and influencing population growth. The indicators for primary and secondary school attendance include: • Net intake rate in primary education; • Net primary school attendance rate; • Net secondary school attendance rate; • Net primary school attendance rate of children of secondary school age; • Female to male education ratio (or gender parity index - GPI). The indicators of school progression include: • Survival rate to standard five; • Transition rate to secondary school; • Net primary completion rate. In 2005, the primary school age population was approximately 125,000 children (UIS Global Education Database, 2006). In Trinidad and Tobago, Table ED.2 shows that approximately 83.2 percent of the children who were of primary school entry age (age 6), were attending the first level of primary school. However, significant differentials are evident between such children dependent on their sex and region of residence. In general, female children of primary school entry age appeared more likely to be attending Standard 1 than their male counterparts (86.3% as opposed 79.9%). �0 The survey was conducted towards the end of the academic school year in which many children would have turned one year older than at the start of the school year. During the data analyses children were rejuvenated by one year so children who may no longer be in the age range for either primary or secondary school would be included in the respective net attendance ratios.” ��Trinidad and Tobago Multiple Indicator Cluster Survey 3 In Trinidad and Tobago the official primary school entry age is six years old. However, the general practice has been to enroll children who are five years old at the primary level of education. Table ED.3 provides the percentage of children of official primary school age (6-12 years and children who are 5 years old) attending primary or secondary school. The majority of children of primary school age are attending school (97.7 percent) indicating that 2.3 percent of the children are out of school when they are expected to be attending school. There are no notable differences in the primary school net attendance ratio across the regions. Trinidad and Tobago achieved universal secondary education in 2000. At present, there are approximately 114,000 children of secondary school age (UIS Global Education Database, 2006). According to Table ED.4, the survey results show that the secondary school net attendance ratio is 84.1 percent among males aged 13-17 years and 90.4 percent among their female counterparts. Overall, the secondary school net attendance ratio is 87.2 percent indicating that approximately 12.8 percent of children of secondary school age are not attending schools at the secondary level. At the secondary level, the observations are also indicative of higher net attendance among females aged 13-17 years than among their male counterparts. An analysis of the proportion of children of secondary school age who are not attending secondary schools reveals that some of them are attending primary school or out of school (see below). The primary school net attendance ratio of children of secondary school age is presented in Table ED.4W. The survey results show that 5.7 percent of the children of secondary school age are attending primary school when they should, in fact, be attending secondary school. The remaining 7.1 percent are not attending school at all; they are children out of school. The percentage of children entering Standard 1 and eventually reaching Standard 5 is presented in Table ED.5. Of all children starting Standard 1, the majority of them (99.2 percent) will eventually reach Standard 5. Notice that this number includes children who repeat levels and that eventually move up to reach Standard 5. Irrespective of children’s sex, region of residence, mother’s educational attainment and socio-economic status, there appeared to be no major differences between them with regard to the survival rate between Standard 1 and Standard 5. The net primary school completion rate and transition rate to secondary education are presented in Table ED.6. In 2006, 78.1 percent of the children of primary school completion age (12 years) were attending the last level of primary level education. This value should be distinguished from the gross primary school completion ratio which includes children of any age attending the last level of primary. The difference between the official and actual primary school entry age may account for the small percentage of children aged 12 years old enrolled �0 Trinidad and Tobago Multiple Indicator Cluster Survey 3 at the last standard of the primary. In fact, a high percentage of children aged 12 years may be attending secondary school already. It is estimated that 92.6 percent of the children who successfully completed the last level of primary school were found at the moment of the survey to be attending the first level of secondary school. The net attendance ratio of girls to that of boys attending primary and secondary education permit the derivation of the Gender Parity Index which is shown in Table ED.7. Notice that the ratios included here are obtained from net attendance ratios rather than gross attendance ratios since the latter provides an erroneous description of the GPI mainly because in most of the cases the majority of over-aged children attending primary education tend to be boys. The table shows that gender parity for primary school is 1.00, indicating no difference in the attendance of girls and boys to primary school. However, the indicator increases to 1.07 for secondary education. This result indicates that girls are 7.0 percent more likely to be attending secondary schools than boys, this being particularly pronounced in the North West and Eastern Regions, among children living in the poorest households and among children whose mother had a maximum of a primary education or none whatsoever. The Ministry of Education is cognisant of the low participation of boys at the secondary level and has taken deliberate and specific actions to improve their participation and achievement rates: • Undertaken quantitative and qualitative research at the local level to inform policy decisions. Thus far, two local studies have been initiated and the preliminary analysis of one of these studies has been submitted to the Ministry; • Participated in a regional study; • Devised new strategies for placement through the Secondary Entrance Assessment Examination; • Initiated programmes at the level of the school to encourage fathers and men to participate more fully in school activities and the education of their children; • Revised the curricula at the secondary level [Forms 1 to 4] to capture the diverse interests of all students including male students; • Additionally, teaching and learning strategies at the primary and secondary level continue to be developed; • Provided on-going professional support through the Student Support Services; • Introduced gender specific subject areas such as Physical and Technology Education; and • Articulation, collaboration with teacher education provider for appropriate course (B.Ed). Offerings (Survey of Exceptionalities) and on the design of a B.Ed in Special Education. ��Trinidad and Tobago Multiple Indicator Cluster Survey 3 Adult Literacy One of the World Fit for Children goals is to achieve a 50 percent improvement in levels of adult literacy by 2015, especially for women. Adult literacy is also an MDG indicator, relating to both men and women. In MICS, since only a women’s questionnaire was administered, the results are based only on females aged 15-24 years. Literacy was assessed on the ability of women to read a short simple statement or on school attendance. The percent literate is presented in Table ED.8 which shows a literacy rate of 98.2 percent among young women aged 15-24 years. There is little difference in literacy rates between women aged 15-19 years and 20-24 years. Table ED.8 also shows that there are no major differentials in adult literacy between women according to their region of residence and their socio-economic status. As expected, the survey results are indicative of the impact of education on women’s literacy so that while the attainment of secondary education is associated with near universal literacy, the attainment of primary or lower levels of education may not render all women as literate. For women aged 15-24years, Table ED.8 shows that 72.6 percent of those with primary education were literate as opposed to 100 percent of those with secondary or higher qualifications. �� Trinidad and Tobago Multiple Indicator Cluster Survey 3 Birth Registration The Convention on the Rights of the Child states that every child has the right to a name and a nationality and the right to protection from being deprived of his or her identity. Birth registration is a fundamental means of securing these rights for children. The World Fit for Children states the goal to develop systems to ensure the registration of every child at or shortly after birth, and fulfil his or her right to acquire a name and a nationality, in accordance with national laws and relevant international instruments. The indicator is the percentage of children under 5 years of age whose birth is registered. In the case of Trinidad and Tobago, Table CP.1 shows that the births of 95.8 percent of children under five years have been registered. Moreover, there appears to be very little or no variations in birth registration between children due to differences in sex, age, and mother’s education. Among those whose births are not registered, travel distance and lack of knowledge do not appear to be the main reasons. Child Labour Article 32 of the Convention on the Rights of the Child states: “States Parties recognize the right of the child to be protected from economic exploitation and from performing any work that is likely to be hazardous or to interfere with the child’s education, or to be harmful to XI. Child Protection �3Trinidad and Tobago Multiple Indicator Cluster Survey 3 the child’s health or physical, mental, spiritual, moral or social development.” The World Fit for Children mentions nine strategies to combat child labour and the MDGs call for the protection of children against exploitation. In the MICS questionnaire, a number of questions addressed the issue of child labour, that is, children 5-14 years of age involved in labour activities. A child is considered to be involved in child labour activities at the moment of the survey if during the week preceding the survey: • Ages 5-11: at least one hour of economic work or 28 hours of domestic work per week. • Ages 12-14: at least 14 hours of economic work or 28 hours of domestic work per week. This definition allows differentiation between child labour and child work to identify the type of work that should be eliminated. As such, the estimate provided here is a minimum of the prevalence of child labour since some children may be involved in hazardous labour activities for a number of hours that could be less than the numbers specified in the criteria explained above. In Trinidad and Tobago, the number of children involved in child labour (0.7 percent) was too small to perform any further analyses. Child Discipline As stated in A World Fit for Children, “children must be protected against any acts of violence …” and the Millennium Declaration calls for the protection of children against abuse, exploitation and violence. In the Trinidad and Tobago MICS survey, mothers/caretakers of children aged 2-14 years were asked a series of questions on the ways parents tend to use to discipline their children when they misbehave. Note that for the child discipline module, one child aged 2-14 years per household was selected randomly during fieldwork. Out of these questions, the two indicators used to describe aspects of child discipline are: 1) the number of children 2-14 years that experience psychological aggression as punishment or minor physical punishment or severe physical punishment; and 2) the number of parents/caretakers of children 2-14 years of age that believe that in order to raise their children properly, they need to physically punish them. In households with at least one child 2-14 years, Table CP.2 shows that 75.1 percent had at least one child who was subjected to at least one form of psychological or physical punishment by their mothers/caretakers or other household members. More importantly, 4.4 percent of such cases were subjected to severe physical punishment. From another standpoint, it is worth noting that 25.4 percent of mothers/caretakers who believed that children should be physically punished though such an outcome does not appear to be consistent with the actual prevalence of physical discipline. Altogether, more than half (55.8 percent) of the children under review were subjected to either minor or severe forms of physical discipline. �� Trinidad and Tobago Multiple Indicator Cluster Survey 3 In addition, males appeared to be a bit more likely than females to be subjected to both minor and severe physical discipline at 53.8 and 5.2 percent respectively in the case of males and 49.1 percent and 3.6 percent respectively in the case of females. Early Marriage Marriage before the age of 18 is a reality for many young girls. According to UNICEF’s worldwide estimates, over 60 million women aged 20-24 years were married/in union before the age of 18 years. Factors that influence child marriage rates include: the state of the country’s civil registration system, which provides proof of age for children; the existence of an adequate legislative framework with an accompanying enforcement mechanism to address cases of child marriage; and the existence of customary or religious laws that condone the practice. In many parts of the world parents encourage the marriage of their daughters while they are still children in hopes that the marriage will benefit them both financially and socially, while also relieving financial burdens on the family. In actual fact, child marriage is a violation of human rights, compromising the development of girls and often resulting in early pregnancy and social isolation, with little education and poor vocational training reinforcing the gendered nature of poverty. The right to ‘free and full’ consent to a marriage is recognized in the Universal Declaration of Human Rights - with the recognition that consent cannot be ‘free and full’ when one of the parties involved is not sufficiently mature to make an informed decision about a life partner. The Convention on the Elimination of all Forms of Discrimination against Women mentions the right to protection from child marriage in Article 16, which states: “The betrothal and the marriage of a child shall have no legal effect, and all necessary action, including legislation, shall be taken to specify a minimum age for marriage.” While marriage is not considered directly in the Convention on the Rights of the Child, child marriage is linked to other rights - such as the right to express their views freely, the right to protection from all forms of abuse, and the right to be protected from harmful traditional practices - and is frequently addressed by the Committee on the Rights of the Child. Other international agreements related to child marriage are the Convention on Consent to Marriage, Minimum Age for Marriage and Registration of Marriages and the African Charter on the Rights and Welfare of the Child and the Protocol to the African Charter on Human and People’s Rights on the Rights of Women in Africa. Child marriage was also identified by the Pan-African Forum against the Sexual Exploitation of Children as a type of commercial sexual exploitation of children. Young married girls are a unique, though often invisible, group who are sometimes required to perform heavy amounts of domestic work, under pressure to demonstrate fertility, and responsible for raising children while still children themselves. Married girls and child mothers face constrained decision-making and reduced life choices. Boys are also affected ��Trinidad and Tobago Multiple Indicator Cluster Survey 3 by child marriage but the issue impacts girls in far larger numbers and with more intensity. Cohabitation - when a couple lives together as if married - raises the same human rights concerns as marriage. Where a girl lives with a man and takes on the role of caregiver for him, the assumption is often that she has become an adult woman, even if she has not yet reached the age of 18. Additional concerns due to the informality of the relationship - for example, inheritance, citizenship and social recognition - might make girls in informal unions vulnerable in different ways than those who are in formally recognized marriages. Research suggests that many factors interact to place a child at risk of marriage. Poverty, protection of girls, family honour and the provision of stability during unstable social periods are considered as significant factors in determining a girl’s risk of becoming married while still a child. Women who married at younger ages were more likely to believe that it is sometimes acceptable for a husband to beat his wife and were more likely to experience domestic violence themselves. The age gap between partners is thought to contribute to these abusive power dynamics and to increase the risk of untimely widowhood. Closely related to the issue of child marriage is the age at which girls become sexually active. Women who are married before the age of 18 tend to have more children than those who marry later in life. Pregnancy related deaths are known to be a leading cause of mortality for both married and unmarried girls between the ages of 15 and 19, particularly among the youngest of this cohort. There is evidence to suggest that girls who marry at young ages are more likely to marry older men which puts them at increased risk of HIV infection. Parents seek to marry off their girls to protect their honour, and men often seek younger women as wives as a means to avoid choosing a wife who might already be infected. The demand for this young wife to reproduce and the power imbalance resulting from the age differential lead to very low condom use among such couples. Two of the indicators are to estimate the percentage of women 15-49 years married/in union before their 15th birthday and the percentage of women 20-49 years married/in union before their 18th birthday. The percentage of women married/in union at various ages is provided in Table CP.3. In Trinidad and Tobago, the percentage of women 15-49 years who were married/in union before their 15th birthday is 1.6 percent while 10.7 percent of those 20-49 years were married/in union before their 18th birthday. The lower a women’s educational level and socio-economic status, the greater her chances of being married/in union before the age of 18 years. For example, 22.2 percent of the women with none/pre-school/primary level schooling were married/in union before the age of 18 years old as compared to only 1.9 percent among women with university education. Similarly, 19.9 percent of women from the poorest wealth index quintile are observed to have been married/in union before the age of 18 years as compared to 4.8 percent among their counterparts from the richest quintile. �� Trinidad and Tobago Multiple Indicator Cluster Survey 3 Another component is the spousal age difference with an indicator being the percentage of married/in union women who were 10 or more years younger than their current spouse/ partner. Table CP.4 presents the results of the age difference between partners. The percentage of currently married/in union women aged 20-24 whose husbands/partners were 10 or more years older is 25.3 percent. Among such women, 34.9 percent had none/pre-school/primary level schooling, as compared 13.6 percent with secondary education. Domestic Violence A number of questions were asked of women age 15-49 years to assess their attitudes towards whether husbands are justified to hit or beat their wives/partners bearing in mind a variety of scenarios. These questions were asked to have an indication of cultural beliefs that tend to be associated with the prevalence of violence against women by their husbands/partners. The main assumption here is that women who agree with the statements indicating that husbands/ partners are justified to beat their wives/partners under the situations described constitute potential sub-populations could reinforce abusive behaviour that may be characteristic of husbands/partners with such tendencies. The finding associated with responses to these questions can be found in Table CP.5. In Trinidad and Tobago, the percentage of women aged 15-49 years who believe a husband is justified in beating his wife/partner for a variety of reasons is as follows: when she goes out without telling him (1.0 percent); when she neglects the children (6.5 percent); when she argues with him (1.4 percent); when she refuses to have sex with him (0.5 percent) and when she burns the food (0.7 percent). Table CP.5 shows that 7.6 percent of women aged 15-49 years claimed that at least one of these statements constitute a justifiable means for a husband to beat his wife/partner. However, this proportion varied according the educational level and socio-economic status of the women under review. Hence, while respective proportions of 12.6 percent and 12.2 percent of women with none/pre-school/primary level schooling and from the poorest households made such a claim, respective proportions of 2.2 percent and 3.0 percent had university education and were from the richest households. ��Trinidad and Tobago Multiple Indicator Cluster Survey 3 Knowledge of HIV Transmission and Condom Use One of the most important prerequisites for reducing the rate of HIV infection is accurate knowledge of how HIV is transmitted and strategies for preventing transmission. Correct information is the first step toward raising awareness and giving young people the tools to protect them from infection. Misconceptions about HIV are common and can confuse young people and hinder prevention efforts. In different regions, there are likely to be variations in the prevalence of misconceptions although some categories of misconceptions appear to be universal (for example that sharing food can transmit HIV or mosquito bites can transmit HIV). The UN General Assembly Special Session on HIV/AIDS (UNGASS) called on governments to improve the knowledge and skills of young people to protect themselves from HIV. The indicators to measure this goal as well as the MDG of reducing HIV infections by half include improving the level of knowledge of HIV and its prevention, and changing behaviours to prevent further spread of the disease. The HIV module was administered to women 15-49 years of age. One indicator which is both an MDG and UNGASS indicator is the percent of young women who have comprehensive and correct knowledge of HIV prevention and transmission. Women were asked whether they knew of the three main ways of preventing HIV transmission – having only one faithful uninfected partner, using a condom every time, and abstaining from sex. The results are presented in Table HA.1. In Trinidad and Tobago, 99.7 percent of the women interviewed have heard of AIDS. However, the percentage of women who know of all three ways of preventing HIV transmission is 72.7 percent. Approximately 90.8 percent of women know of having one faithful uninfected partner, 83.8 percent know of using a condom every time, and 89.5 percent know of abstaining from sex as main ways of preventing HIV transmission. While 72.7 percent know all three ways, a high proportion of women (98.5 percent) know at least one way. The knowledge of preventing HIV transmission in women aged 15-49 years who know the main ways of preventing HIV transmission varies according to the level of the women’s education. Those who had none/pre-school/primary education XII. HIV/AIDS and Sexual Behaviour �� Trinidad and Tobago Multiple Indicator Cluster Survey 3 were less likely (61.3%) to have known all three ways of preventing HIV transmission when compared to their counterparts who had university education (82.4%). Table HA.2 presents the percent of women who can correctly identify misconceptions concerning HIV. The indicator is based on the two most common and relevant misconceptions in Trinidad and Tobago. The table shows that 87.3 and 80.5 percent respectively of women knew that HIV/AIDS cannot be transmitted by sharing food and by mosquito bites. In addition, it reveals that 96.2 percent of women knew that a health looking person could be infected with HIV/AIDS. Overall, women from the South West and North Central Regions appear to be less likely than their counterparts in the North Wes and East Regions and Tobago to have identified misconceptions about HIV/AIDS. In addition, there appears to be a positive association between the likelihood of identifying misconceptions about HIV/ AIDS and women’s socio-economic status whether such status is predicated upon women’s educational attainment or the wealth index quintile of their household. Table HA.3 summarizes information from Tables HA.1 and HA.2 and presents the percentage of women who know 2 ways of preventing HIV transmission and reject three common misconceptions (referred to as ‘comprehensive knowledge’). Overall, 57.5 percent of women were found to have comprehensive knowledge of HIV/AIDS. As expected, the percent of women with comprehensive knowledge increases with the woman’s education level (Figure HA.1). For example, for women who had none/pre-school/primary level schooling, 43.1 percent know 2 ways of preventing HIV transmission and reject three common misconceptions as compared to 74.9 percent among women with university level education. With regard to having comprehensive knowledge, observed variation in their ability to identify three misconceptions is much more substantial than that associated with two means of prevention, this being evident when women’s education is taken into account (Figure HA.1). Figure HA.1 Percent of women who have comprehensive knowledge of HIV/AIDS transmission, Trinidad and Tobago, 2006 71 78 82 85 78 56 71 77 88 71 43 57 64 75 58 0 10 20 30 40 50 60 70 80 90 100 None/Pre- School/Primary Lower Secondary Upper Secondary/Tech- Voc University Trinidad and Tobago Pe rc en t Knows 2 ways to prevent HIV Identify 3 misconceptions Comprehensive knowledge ��Trinidad and Tobago Multiple Indicator Cluster Survey 3 Knowledge of mother-to-child transmission of HIV is also an important first step for women to seek HIV testing when they are pregnant to avoid infection in the baby. Women should know that HIV can be transmitted during pregnancy, delivery, and through breastfeeding. The level of knowledge among women aged 15-49 years concerning mother-to-child transmission is presented in Table HA.4. Overall, 95.4 percent of women know that HIV can be transmitted from mother to child. The percentage of women who know all three ways of mother-to-child transmission is 50.3 percent, while 4.4 percent of women did not know of any specific way. The indicators on attitudes toward people living with HIV measure stigma and discrimination in the community. Stigma and discrimination are low if respondents report an accepting attitude on the following four questions: 1) would care for family member sick with AIDS; 2) would buy fresh vegetables from a vendor who was HIV positive; 3) thinks that a female teacher who is HIV positive should be allowed to teach in school; and 4) would not want to keep HIV status of a family member a secret. Table HA.5 presents the attitudes of women toward people living with HIV/AIDS. The responses to the questions were as follows: 1) would care for family member sick with AIDS – 5.2 percent; 2) would buy fresh vegetables from a vendor who was HIV positive – 37.3 percent; 3) thinks that a female teacher who is HIV positive should be allowed to teach in school – 17.4 percent; and 4) would not want to keep HIV status of a family member a secret – 37.5 percent. Of the women interviewed, 61.4 percent agreed with at least one discriminatory statement compared to 38.6 percent who did not agree with any of the discriminatory statements. Table HA.5 is indicative of an inverse relationship between the likelihood embracing discriminatory attitudes and women’s socio-economic status. A similar relationship also emerges between the likelihood of embracing discriminatory attitudes and women’s education. Another important indicator is the knowledge of where to be tested for HIV and the pursuit of such services. Questions related to knowledge among women of a facility for HIV testing and whether they have ever been tested is presented in Table HA.6. Accordingly, 86.1 percent of women know where to be tested, while 41.3 percent have actually been tested. Of these, a large proportion amounting to 89.5 percent have been told the result. Among women who had given birth within the two years preceding the survey, the percent who received counselling and HIV testing during antenatal care is presented in Table HA.7. For Trinidad and Tobago, the proportion of women who received antenatal care from a health professional during their last pregnancy in the two years preceding the survey stands at 95.7 percent. With respect to the magnitudes of the other indicators, 75.5 percent of women were provided with information about HIV prevention during their antenatal care visit. The percentage of women who were tested for HIV at the antenatal care visit was 91.4 percent and of these women, 79.4 percent received the results of the HIV test at the antenatal care visit. �0 Trinidad and Tobago Multiple Indicator Cluster Survey 3 Sexual Behaviour Related to HIV Transmission Promoting safer sexual behaviour is critical for reducing HIV prevalence. The use of condoms during sex, especially with non-regular partners, is especially important for reducing the spread of HIV. In most countries, over half of new HIV infections are among young people 15-24 years thus a change in behaviour among this age group will be especially important to reduce new infections. A module of questions was administered to women 15-24 years of age to assess their risk of HIV infection. Risk factors for HIV include sex at an early age, sex with older men, sex with a non-marital non-cohabitating partner, and failure to use a condom. The frequency of sexual behaviours that increase the risk of HIV infection among women is presented in Table HA.8 and Figure HA.2. According to the results of the survey, 4.7 percent of women aged 15-19 years old had sex before age 15 years and 29.9 percent of women aged 20-24 years old had sex before the age of 18 years. Relatively larger numbers among women aged 15-24 years in Tobago and in the North West Region, claimed to have had sex before their 18th birthday when compared to their counterparts from any of the other regions nationwide (See Figure HA.2). Figure HA.2 Sexual behaviour that increases risk of HIV infection, Trinidad and Tobago, 2006 8 4 4 3 4 5 41 30 27 23 46 30 18 19 15 13 10 15 0 5 10 15 20 25 30 35 40 45 50 North West East North Central South West Tobago Trinidad and Tobago Pe rc en t Women 15-19 who had sex before age 15 Women 20-24 who had sex before age 18 Women 20-24 who had sex in last 12 months with a man 10 years or more older Condom use during sex with men other than husbands or live-in partners (non-marital, non- cohabiting) was assessed in women 15-24 years of age who had sex with such a partner in the previous year (Table HA.9). Approximately 68.0 percent of women 15-24 years who had sex in the last 12 months reported having sex with a non-regular partner during that period. Of those women, only half (51.2 percent) claimed that they used a condom when they had their last sexual encounter with the high risk partner. In addition, there appears to be appositive association between young women’s educational attainment and the likelihood of using ��Trinidad and Tobago Multiple Indicator Cluster Survey 3 condoms during high risk sex so that while 46.5 percent of women with none/pre-school/ primary level education used a condom during higher risk sex in the year before the MICS, the corresponding proportion among women with university education was 61.3 percent. �� Trinidad and Tobago Multiple Indicator Cluster Survey 3 List of References Boerma, J. T., Weinstein, K. I., Rutstein, S.O., and Sommerfelt, A. E. , 1996. Data on Birth Weight in Developing Countries: Can Surveys Help? Bulletin of the World Health Organization, 74(2), 209-16. Blanc, A. and Wardlaw, T. 2005. “Monitoring Low Birth Weight: An Evaluation of International Estimates and an Updated Estimation Procedure”. WHO Bulletin, 83 (3), 178-185. Filmer, D. and Pritchett, L., 2001. Estimating wealth effects without expenditure data – or tears: An application to educational enrolments in states of India. Demography 38(1): 115-132. Rutstein, S.O. and Johnson, K., 2004. The DHS Wealth Index. DHS Comparative Reports No. 6. Calverton, Maryland: ORC Macro. UNICEF, 2006. Monitoring the Situation of Children and Women. Multiple Indicator Cluster Survey Manual, New York. United Nations, 1983. Manual X: Indirect Techniques for Demographic Estimation (United Nations publication, Sales No. E.83.XIII.2). United Nations, 1990a. QFIVE, United Nations Program for Child Mortality Estimation. New York, UN Pop Division United Nations, 1990b. Step-by-step Guide to the Estimation of Child Mortality. New York, UN WHO and UNICEF, 1997. The Sisterhood Method for Estimating Maternal Mortality. Guidance notes for potential users, Geneva. www.Childinfo.org. �3Trinidad and Tobago Multiple Indicator Cluster Survey 3 Appendix A Description of the Sample Design Two basic requirements of the MICS are: (a) That probability sampling be used. In probability sampling, each sampling unit has a known non-zero chance of selection in the sample. The chance of selection must also be calculable. (b) That a nationally representative sample of the population be selected. In order to achieve these two requirements, the decision was made to utilize the current sample design of the CSO’s Continuous Sample Survey of Population (CSSP), with some modifications where necessary. Following the design of the CSSP, the MICS sample utilizes an equal probability of selection method (epsem), whereby each sampling unit (household) has an equal chance of being selected from the population (i.e. The Non-Institutional households in Trinidad and Tobago). Access to the population is made possible through a Frame, a listing of households within Enumeration Districts (EDD). EDD are the smallest geographic units into which the country is sub-divided for the purpose of national surveys and censuses. These units have been demarcated to fit within non-overlapping boundaries based on easily identifiable features as far as possible. The size of an ED ranges between 100 - 200 households and is adequate and manageable for canvassing by interviewers. The CSSP frame is developed and updated from information obtained in decennial censuses. The MICS sample was drawn from a frame based on data from the 2000 Census. Sample size Among the most important modules of the survey requiring the largest sample size is the Immunization Module. The target population for this module is children aged 12 – 23 months. A key indicator for that age domain of the module is the proportion of children aged 12 – 23 months who had received all three doses of DPT. Therefore, the sample size was determined with the view of providing foremost, estimations for that indicator. For the sample size, denoted by n, the following formula was applied: n = t2*deft*r*(1-r)/(me*r)^2, where, n = required number of observations for the target population deft = design effect (deft = 1.5) r = estimated proportion of children aged 12 – 23 months that had received the third dose of DPT (r = .558 which was obtained from the MICS 2000 study) �� Trinidad and Tobago Multiple Indicator Cluster Survey 3 me = an acceptable relative margin of error, with 95 % level of confidence (me = 0.09). t = the value of the ordinate of normal distribution corresponding to .95 of the total area of the distribution (t = 2). Therefore, from the above, n was estimated to be approximately equal to 587 children aged 12 – 23 months. Given that children of that age group (ie. base population) represent approximately 3% of total non- institutional population, and that the average size of the non-institutional households is 3.8 persons, then, allowing for 10% non-responding households to the survey, the number of households, n(Hh), required to be sampled in order to obtain the sample size of 587 children aged 12 – 23 months was: n(Hh) = (587/((.03)*(3.8))*(1.10) = 5662 households, which was rounded upwards to 6,000 households approximately. Sample Selection Based on the CSSP survey plan, the MICS sample was selected in two stages. At the first stage, EDD, representing the Primary Sampling Units (PSUs), were systematically selected with probability proportional to size, the size measure being the number of households assigned to the EDD. For the systematic selection of EDD, the EDD were stratified by sixteen geographic areas within Trinidad and Tobago. The total sample was allocated the strata in proportion to the size of the population in each stratum. In addition to the geographic stratification of EDD, EDD within each stratum were placed in descending order of the proportion of persons in the labour force categorized as “Elementary Workers”. That categorization was used as a proxy for socio-economic status of an ED. At the second stage, for each selected PSU, households were selected with probability inversely proportional to size (pps-1), the size measure used being the same for the EDD. That procedure ensured that the sample was self- weighting, that is, each household in the population was given approximately, the same chance of selection in the sample. In order to improve the precision of the estimates, a decision was made to select 15 households from each selected PSU, so that approximately 407 PSU’s were selected. Listing of EDD A program of listing of certain selected EDD was necessary due to the fact that in the selection process of EDD, some EDD, which were not selected in the current CSSP frame of first stage EDD were selected for the sample due to the process of random selection. Those EDD accounted for approximately 38% of the total sample of PSU’s which were not subjected to listing during the regular listing exercise of the CSSP labour force survey. As was anticipated, some of the selected EDD had burgeoned over time, so that in order to maintain a constant probability of selection for each household, cluster sizes were allowed to vary relative to growth or contraction of EDD over time. ��Trinidad and Tobago Multiple Indicator Cluster Survey 3 Appendix B List of Personnel Involved in the Survey Members of the Technical Steering Committee: • Mrs. Jacinta Bailey-Sobers - Chairperson • Mr. David Thomas - Survey Co-ordinator • Mr. Dennis Williams - Social Policy Analyst • Ms. Sherene Lisa Ali - Research Specialist • Ms. Verna Haynes - Medical Social Worker • Mrs. Dawn Ramsingh - Database Specialist • Mr. Winston Ramsaran - System Analyst • Mrs. Lenor Baptiste-Simmons - Education Specialist • Ms. Kalowatie Gokool - Nutritionist • Mr. Roy Dalrymple - Water & Sanitation Quality Control Officer • Dr. Godfrey St. Bernard - Data Analyst • Mr. Karmesh Sharma - Epidemiologist • Representative - UNICEF Members of the MICS Secretariat: • Sherene Lisa Ali; • Josanne Harry-Roach; • Michelle Ramlagan; and • Nerrisa Derrick. Field Staff: Co-ordinator Mr. Simeon Henry Supervisors Basook Mahadeo; Sundar Narinesingh; Sherron Redhead; Rosemarie Johnson Gay; Patrick Taylor; �� Trinidad and Tobago Multiple Indicator Cluster Survey 3 Onica Fournillier; Roger Jones; Symeon Faria; Hannah Seenath; Sandra Ramrattan; Deodath Harripersad; Louis Gomez; Roland Ballah; Daphne Mahabir; Jesel Rodriguez Editors Jewel Lendor; Monica Greig; Betty Ann Toussaint; Rosaline Jeaniffer; Flament Mendez; Lauren Amos; Judith Gomes; Cheryl-Ann Charles; Marlene Alexander; Roxanne Belgrave; Kerwyn Ballah; Genell Jackson; Anne Maillard; Maureen Mc Donald Medrano; Leslie Mc Gregor Interviewers Ann Meltz-Joseph; Irma Brooks Phillips; Ria Glasgow; Monica Greig; Dale Lewis; Ruth Felix; Denise Mitchell Mc Kain; Marcia Augustus; Rosslyn Salvador; Glenis Foster; Carrie Henry; Sarah Pesnell; Benedict Cooper; Salima Muhammad; Alicia John Thomas; Lincoln Williams; Lenora Britto Joseph; Jennifer Thomas; Ayanna Abdussalaam; Nicole Providence; Eloy Cummings; Siewrani Persad; Patricia Yearwood; Rachel Bobb; Verlyn Cornwall; Helen Jack; Shivanand Persad; Samiyra Abdullah Muhammad; Elizabeth Edwards; Theresa Caton; Kathleen Richards Brooks; Maureen Mohammed; Desmond Lyons; Julianne Jones; Alicia Singh; Savatri Gransam; Gail James; Sharon Quintyne; Jacqueline Jones; Joan Haynes; Marzyia Owen; Mary Clement; Christine Nunez; Felena Pereira; Fazilet Rampersad; Joan Rouse Abinas; Kendra Thomas; Carol Ann Guiseppi Corbin; Karen Wall; Bernadette Byron; Hazel Ann Joseph; Aaron Lewis; Jamerson Heinz-Pooran; Reanna Mohammed; Aviane Ramkissoon; Pamela Pooran; Arlene Ramadhar; Cheryl Bharat; Sophia Campaine; Jenifa Mc Knight; Sharon Pakeerah; Martina Christo; Joy Edwards; Dianne Edwards; Ivis Sanchez; Sparkle Joseph; Beverly Bovell-Philip; Tricia Ann Charles; Veronica Joefield; Pinky Rajaram; Rachael Ramnath; Puran Mungroo; Asha Boodoo; Debbie Breedy; Leon Paul Carmichael Ellis; Lyndi-Ann Fredrick; Patrita Joseph Data Entry Personnel Supervisors Eloy Cummings; Lauren Amos; Jennifer Thomas; Alicia John-Thomas Clerks Gabrielle Pierre; Nerissa Saira Karim; Beena Boodram; Karen Theophilus; Nakita Mc Lean; James Furray; Natalia Mark; Tition Ali; Kritan Maria Elcock; Mackel Belmontes; Nekoda Obrien; Natalie Paul Seemungal; Michelle Boneo; Lenore Julien-Thomas; Angela Morang; Crystal Absolam- Merrique; Christine Hernandez; Alecia Gill; Kamilah Benjamin; Pashion Kellar; Roxanne Desuza; Kenetia Des Isles; Blossom Long; Kheri- Ann Margot; Michelle Ramsawak ��Trinidad and Tobago Multiple Indicator Cluster Survey 3 Appendix C Estimates of Sampling Errors The sample of respondents selected in the Trinidad and Tobago Multiple Indicator Cluster Survey is only one of the samples that could have been selected from the same population, using the same design and size. Each of these samples would yield results that differ somewhat from the results of the actual sample selected. Sampling errors are a measure of the variability between all possible samples. The extent of variability is not known exactly, but can be estimated statistically from the survey results. The following sampling error measures are presented in this appendix for each of the selected indicators: • Standard error (se): Sampling errors are usually measured in terms of standard errors for particular indicators (means, proportions etc). Standard error is the square root of the variance. The Taylor linearization method is used for the estimation of standard errors. • Coefficient of variation (se/r) is the ratio of the standard error to the value of the indicator. • Design effect (deff) is the ratio of the actual variance of an indicator, under the sampling method used in the survey, to the variance calculated under the assumption of simple random sampling. The square root of the design effect (deft) is used to show the efficiency of the sample design. A deft value of 1.0 indicates that the sample design is as efficient as a simple random sample, while a deft value above 1.0 indicates the increase in the standard error due to the use of a more complex sample design. • Confidence limits are calculated to show the interval within which the true value for the population can be reasonably assumed to fall. For any given statistic calculated from the survey, the value of that statistics will fall within a range of plus or minus two times the standard error (p + 2.se or p – 2.se) of the statistic in 95 percent of all possible samples of identical size and design. For the calculation of sampling errors from MICS data, SPSS Version 14 Complex Samples module has been used. The results are shown in the tables that follow. In addition to the sampling error measures described above, the tables also include weighted and unweighted counts of denominators for each indicator. Sampling errors are calculated for indicators of primary interest, for the national total, and for the regions. Two (2) of the selected indicators are based on households, 7 are based on household members, 11 are based on women, and 10 are based on children under 5. All indicators presented here are in the form of proportions. Table SE.1 shows the list of indicators for which sampling errors are calculated, including the base population (denominator) for each indicator. Tables SE.2 to SE.7 show the calculated sampling errors. �� Trinidad and Tobago Multiple Indicator Cluster Survey 3 Table SE.1: Indicators selected for sampling error calculations List of indicators selected for sampling error calculations, and base populations (denominators) for each indicator, Trinidad & Tobago, 2006 MICS Indicator Base Population HOUSEHOLDS 41 Iodized salt consumption All households 74 Child discipline Children aged 2-14 years selected HOUSEHOLD MEMBERS 11 Use of improved drinking water sources All household members 12 Use of improved sanitation facilities All household members 55 Net primary school attendance rate Children of primary school age 56 Net secondary school attendance rate Children of secondary school age 59 Primary completion rate Children of primary school completion age 71 Child labour Children aged 5-14 years 75 Prevalence of orphans Children aged under 18 WOMEN 4 Skilled attendant at delivery Women aged 15-49 years with a live birth in the last 2 years 20 Antenatal care Women aged 15-49 years with a live birth in the last 2 years 21 Contraceptive prevalence Women aged 15-49 currently married/in union 60 Adult literacy Women aged 15-24 years 67 Marriage before age 18 Women aged 20-49 years 82 Comprehensive knowledge about HIV prevention among young people Women aged 15-24 years 83 Condom use with non-regular partners Women aged 15-24 years that had a non-marital, non-cohabiting partner in the last 12 months 84 Age at first sex among young people Women aged 15-24 years 86 Attitude towards people with HIV/AIDS Women aged 15-49 years 88 Women who have been tested for HIV Women aged 15-49 years 89 Knowledge of mother- to-child transmission of HIV Women aged 15-49 years UNDER-5s 26 Polio immunization coverage Children aged 12-23 months 27 Immunization coverage for DPT Children aged 12-23 months 28 Measles immunization coverage Children aged 12-23 months 31 Fully immunized children Children aged 12-23 months - Acute respiratory infection in last two weeks Children under age 5 22 Antibiotic treatment of suspected pneumonia Children under age 5 with suspected pneumonia in the last 2 weeks - Diarrhoea in last two weeks Children under age 5 35 Received ORT or increased fluids and continued feeding Children under age 5 with diarrhoea in the last 2 weeks 46 Support for learning Children under age 5 62 Birth registration Children under age 5 ��Trinidad and Tobago Multiple Indicator Cluster Survey 3 Table SE.2: Sampling errors: Total sample Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Trinidad and Tobago, 2006 Table Value (r) Standard error (se) Coefficient of variation (se/r) Design effect (deff) Square root of design Weighted count Unweighted count Confidence limits r - 2se r + 2se HOUSEHOLDS Iodized salt consumption NU.5 0.278 0.008 0.030 1.776 1.332 5013 5019 0.262 0.295 Child discipline CP.4 0.751 0.011 0.015 1.317 1.148 5013 2063 0.729 0.773 HOUSEHOLD MEMBERS Use of improved drinking water sources EN.1 0.939 0.008 0.009 6.595 2.568 18669 5557 0.923 0.956 Use of improved sanitation facilities EN.5 0.988 0.003 0.003 3.072 1.753 18669 5557 0.983 0.993 Net primary school attendance rate ED.3 0.977 0.005 0.006 2.328 1.526 1844 1842 0.966 0.987 Net secondary school attendance rate ED.4 0.872 0.009 0.011 1.261 1.123 1594 1596 0.853 0.891 Primary completion rate ED.6 0.781 0.017 0.022 0.508 0.712 285 285 0.747 0.816 Child labour CP.2 0.007 0.002 0.331 2.013 1.419 2770 2768 0.002 0.011 Prevalence of orphans HA.10 0.057 0.005 0.089 2.298 1.516 4850 4848 0.047 0.067 WOMEN Skilled attendant at delivery RH.5 0.978 0.006 0.006 0.778 0.882 417 415 0.966 0.991 Antenatal care RH.3 0.957 0.007 0.007 0.446 0.668 417 415 0.943 0.970 Contraceptive prevalence RH.1 0.425 0.012 0.028 1.277 1.130 2229 2236 0.402 0.449 Adult literacy ED.8 0.982 0.003 0.003 0.991 0.995 1579 1583 0.975 0.989 Marriage before age 18 CP.5 0.107 0.005 0.047 1.005 1.002 3827 3827 0.097 0.117 Comprehensive knowledge about HIV prevention among young people HA.3 0.536 0.014 0.025 1.185 1.089 1579 1583 0.509 0.563 Condom use with non-regular partners HA.9 0.512 0.015 0.029 0.415 0.644 464 457 0.482 0.542 Age at first sex among young people HA.8 0.047 0.007 0.148 0.844 0.918 777 778 0.033 0.061 Attitude towards people with HIV/ AIDS HA.5 0.386 0.008 0.022 1.397 1.182 4592 4592 0.369 0.403 �0 Trinidad and Tobago Multiple Indicator Cluster Survey 3 Table Value (r) Standard error (se) Coefficient of variation (se/r) Design effect (deff) Square root of design effect (deft) Weighted count Unweighted count Confidence limits r - 2se r + 2se Knowledge of mother- to-child transmission of HIV HA.4 0.503 0.009 0.017 1.423 1.193 4605 4605 0.486 0.521 UNDER-5s Polio immunization coverage CH.2 0.862 0.020 0.024 0.716 0.846 207 207 0.822 0.903 Immunization coverage for DPT CH.2 0.769 0.012 0.016 0.173 0.416 204 204 0.745 0.794 Measles immunization coverage CH.2 0.907 0.014 0.016 0.490 0.700 207 207 0.878 0.935 Fully immunized children CH.2 0.659 0.018 0.027 0.291 0.540 208 208 0.624 0.695 Acute respiratory infection in last two weeks CH.6 0.025 0.005 0.191 1.028 1.014 1117 1117 0.015 0.034 Antibiotic treatment of suspected pneumonia CH.7 0.337 0.000 0.000 0.000 0.000 28 27 0.337 0.337 Diarrhoea in last two weeks CH.4 0.037 0.006 0.150 0.958 0.979 1117 1117 0.026 0.048 Received ORT or increased fluids and continued feeding CH.5 0.321 0.025 0.077 0.112 0.335 41 41 0.272 0.371 Support for learning CD.1 0.940 0.006 0.007 0.765 0.874 1117 1117 0.928 0.953 Birth registration CP.1 0.958 0.006 0.006 0.999 0.999 1117 1117 0.946 0.970 ��Trinidad and Tobago Multiple Indicator Cluster Survey 3 Table SE.3: Sampling errors: North West Region Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Trinidad, 2006 Table Value (r) Standard error (se) Coefficient of variation (se/r) Design effect (deff) Square root of design effect (deft) Weighted count Unweighted count Confidence limits r - 2se r + 2se HOUSEHOLDS Iodized salt consumption NU.5 0.297 0.017 0.057 1.736 1.317 1316 1271 0.263 0.331 Child discipline CP.4 0.776 0.022 0.028 1.385 1.177 525 507 0.733 0.820 HOUSEHOLD MEMBERS Use of improved drinking water sources EN.1 0.948 0.021 0.022 12.216 3.495 4541 1391 0.906 0.990 Use of improved sanitation facilities EN.5 0.984 0.006 0.006 3.456 1.859 4541 1391 0.971 0.996 Net primary school attendance rate ED.3 0.975 0.008 0.008 1.058 1.029 455 440 0.959 0.990 Net secondary school attendance rate ED.4 0.888 0.016 0.018 0.894 0.946 369 356 0.856 0.920 Primary completion rate ED.6 0.769 0.025 0.032 0.203 0.451 63 61 0.720 0.818 Child labour CP.2 0.006 0.003 0.501 0.999 1.000 684 661 0.000 0.012 Prevalence of orphans HA.10 0.067 0.009 0.127 1.334 1.155 1190 1150 0.050 0.084 WOMEN Skilled attendant at delivery RH.5 0.961 0.013 0.014 0.465 0.682 104 101 0.935 0.988 Antenatal care RH.3 0.961 0.014 0.014 0.493 0.702 104 101 0.934 0.988 Contraceptive prevalence RH.1 0.467 0.025 0.053 1.137 1.066 473 456 0.417 0.517 Adult literacy ED.8 0.992 0.005 0.005 0.983 0.991 370 357 0.982 1.000 Marriage before age 18 CP.5 0.086 0.008 0.095 0.752 0.867 918 885 0.069 0.102 Comprehensive knowledge about HIV prevention among young people HA.3 0.605 0.028 0.045 1.128 1.062 370 357 0.550 0.660 Condom use with non-regular partners HA.9 0.517 0.023 0.045 0.323 0.569 156 151 0.471 0.563 Age at first sex among young people HA.8 0.076 0.021 0.281 1.103 1.050 179 172 0.033 0.118 Attitude towards people with HIV/ AIDS HA.5 0.416 0.018 0.043 1.397 1.182 1096 1056 0.380 0.452 �� Trinidad and Tobago Multiple Indicator Cluster Survey 3 Table Value (r) Standard error (se) Coefficient of variation (se/r) Design effect (deff) Square root of design effect (deft) Weighted count Unweighted count Confidence limits r - 2se r + 2se Knowledge of mother- to-child transmission of HIV HA.4 0.433 0.019 0.043 1.507 1.228 1097 1057 0.395 0.470 UNDER-5s Polio immunization coverage CH.2 0.856 0.006 0.008 0.016 0.128 50 49 0.843 0.869 Immunization coverage for DPT CH.2 0.729 0.024 0.033 0.138 0.371 49 48 0.680 0.777 Measles immunization coverage CH.2 0.897 0.025 0.028 0.315 0.562 49 48 0.847 0.947 Fully immunized children CH.2 0.631 0.041 0.065 0.348 0.590 50 49 0.549 0.713 Acute respiratory infection in last two weeks CH.6 0.024 0.009 0.379 1.016 1.008 292 284 0.006 0.043 Antibiotic treatment of suspected pneumonia CH.7 0.426 0.000 0.000 0.000 0.000 7 7 0.426 0.426 Diarrhoea in last two weeks CH.4 0.031 0.012 0.368 1.238 1.113 292 284 0.008 0.054 Received ORT or increased fluids and continued feeding CH.5 0.221 0.000 0.000 0.000 0.000 9 9 0.221 0.221 Support for learning CD.1 0.937 0.013 0.014 0.818 0.904 292 284 0.911 0.963 Birth registration CP.1 0.968 0.010 0.010 0.915 0.957 292 284 0.948 0.988 �3Trinidad and Tobago Multiple Indicator Cluster Survey 3 Table SE.4: Sampling errors: East Region Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Trinidad, 2006 Table Value (r) Standard error (se) Coefficient of variation (se/r) Design effect (deff) Square root of design effect (deft) Weighted count Unweighted count Confidence limits r - 2se r + 2se HOUSEHOLDS Iodized salt consumption NU.5 0.256 0.032 0.125 1.951 1.397 363 364 0.192 0.319 Child discipline CP.4 0.814 0.028 0.035 0.901 0.949 172 172 0.757 0.870 HOUSEHOLD MEMBERS Use of improved drinking water sources EN.1 0.960 0.016 0.017 2.726 1.651 1451 410 0.928 0.992 Use of improved sanitation facilities EN.5 0.997 0.002 0.002 0.701 0.837 1451 410 0.993 1.000 Net primary school attendance rate ED.3 0.977 0.014 0.014 1.460 1.208 175 175 0.950 1.000 Net secondary school attendance rate ED.4 0.890 0.022 0.024 0.764 0.874 163 163 0.846 0.933 Primary completion rate ED.6 0.759 0.059 0.078 0.538 0.733 29 29 0.640 0.877 Child labour CP.2 0.008 0.008 1.021 2.092 1.446 265 265 0.000 0.023 Prevalence of orphans HA.10 0.054 0.016 0.304 2.339 1.529 442 443 0.021 0.087 WOMEN Skilled attendant at delivery RH.5 1.000 0.000 0.000 . . 27 28 1.000 1.000 Antenatal care RH.3 1.000 0.000 0.000 . . 27 28 1.000 1.000 Contraceptive prevalence RH.1 0.543 0.034 0.063 0.941 0.970 194 199 0.474 0.612 Adult literacy ED.8 0.993 0.007 0.007 1.025 1.012 141 144 0.979 1.000 Marriage before age 18 CP.5 0.151 0.026 0.175 1.682 1.297 305 312 0.098 0.203 Comprehensive knowledge about HIV prevention among young people HA.3 0.597 0.042 0.071 1.056 1.028 141 144 0.513 0.682 Condom use with non-regular partners HA.9 0.364 0.103 0.283 1.472 1.213 32 33 0.158 0.570 Age at first sex among young people HA.8 0.041 0.031 0.751 1.751 1.323 71 73 0.000 0.103 Attitude towards people with HIV/ AIDS HA.5 0.380 0.024 0.064 0.944 0.972 373 382 0.332 0.428 �� Trinidad and Tobago Multiple Indicator Cluster Survey 3 Table Value (r) Standard error (se) Coefficient of variation (se/r) Design effect (deff) Square root of design effect (deft) Weighted count Unweighted count Confidence limits r - 2se r + 2se Knowledge of mother- to-child transmission of HIV HA.4 0.545 0.035 0.065 1.916 1.384 376 385 0.475 0.615 UNDER-5s Polio immunization coverage CH.2 0.835 0.000 0.000 0.000 0.000 18 18 0.835 0.835 Immunization coverage for DPT CH.2 0.945 0.000 0.000 0.000 0.000 18 18 0.945 0.945 Measles immunization coverage CH.2 1.000 0.000 0.000 . . 18 18 1.000 1.000 Fully immunized children CH.2 0.780 0.000 0.000 0.000 0.000 18 18 0.780 0.780 Acute respiratory infection in last two weeks CH.6 0.025 0.017 0.678 0.939 0.969 80 82 0.000 0.058 Antibiotic treatment of suspected pneumonia CH.7 0.500 0.000 0.000 0.000 0.000 2 2 0.500 0.500 Diarrhoea in last two weeks CH.4 0.061 0.011 0.185 0.179 0.423 80 82 0.038 0.083 Received ORT or increased fluids and continued feeding CH.5 0.199 0.199 1.000 0.995 0.998 5 5 0.000 0.598 Support for learning CD.1 0.914 0.027 0.029 0.738 0.859 80 82 0.861 0.968 Birth registration CP.1 0.964 0.015 0.016 0.556 0.746 80 82 0.933 0.995 ��Trinidad and Tobago Multiple Indicator Cluster Survey 3 Table SE.5: Sampling errors: North Central Region Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Trinidad, 2006 Table Value (r) Standard error (se) Coefficient of variation (se/r) Design effect (deff) Square root of design effect (deft) Weighted count Unweighted count Confidence limits r - 2se r + 2se HOUSEHOLDS Iodized salt consumption NU.5 0.311 0.013 0.043 1.571 1.253 1899 1911 0.285 0.338 Child discipline CP.4 0.738 0.019 0.026 1.454 1.206 786 790 0.700 0.775 HOUSEHOLD MEMBERS Use of improved drinking water sources EN.1 0.981 0.005 0.005 2.464 1.570 7186 2045 0.971 0.990 Use of improved sanitation facilities EN.5 0.988 0.004 0.004 3.292 1.814 7186 2045 0.979 0.997 Net primary school attendance rate ED.3 0.984 0.008 0.008 2.762 1.662 696 700 0.968 1.000 Net secondary school attendance rate ED.4 0.848 0.017 0.020 1.318 1.148 592 596 0.815 0.882 Primary completion rate ED.6 0.825 0.030 0.036 0.685 0.828 109 110 0.765 0.885 Child labour CP.2 0.012 0.005 0.433 2.314 1.521 1048 1054 0.002 0.022 Prevalence of orphans HA.10 0.052 0.007 0.136 1.858 1.363 1843 1853 0.038 0.066 WOMEN Skilled attendant at delivery RH.5 0.988 0.009 0.009 1.007 1.003 162 159 0.970 1.000 Antenatal care RH.3 0.981 0.007 0.007 0.406 0.638 162 159 0.968 0.995 Contraceptive prevalence RH.1 0.428 0.020 0.046 1.441 1.200 896 892 0.389 0.468 Adult literacy ED.8 0.976 0.006 0.007 1.008 1.004 581 574 0.963 0.989 Marriage before age 18 CP.5 0.110 0.008 0.074 0.983 0.991 1477 1463 0.094 0.126 Comprehensive knowledge about HIV prevention among young people HA.3 0.479 0.022 0.047 1.138 1.067 581 574 0.434 0.523 Condom use with non-regular partners HA.9 0.515 0.025 0.048 0.370 0.608 156 152 0.466 0.565 Age at first sex among young people HA.8 0.043 0.008 0.184 0.432 0.658 293 289 0.027 0.058 Attitude towards people with HIV/ AIDS HA.5 0.370 0.015 0.040 1.623 1.274 1764 1746 0.340 0.399 Women who have been tested for HIV HA.6 0.389 0.012 0.031 1.083 1.041 1770 1752 0.365 0.413 �� Trinidad and Tobago Multiple Indicator Cluster Survey 3 Table Value (r) Standard error (se) Coefficient of variation (se/r) Design effect (deff) Square root of design effect (deft) Weighted count Unweighted count Confidence limits r - 2se r + 2se UNDER-5s Polio immunization coverage CH.2 0.818 0.047 0.057 1.211 1.100 85 84 0.725 0.912 Immunization coverage for DPT CH.2 0.703 0.021 0.030 0.174 0.417 84 83 0.661 0.745 Measles immunization coverage CH.2 0.870 0.031 0.035 0.692 0.832 86 85 0.809 0.931 Fully immunized children CH.2 0.577 0.033 0.057 0.379 0.616 87 86 0.512 0.643 Acute respiratory infection in last two weeks CH.6 0.030 0.009 0.288 1.118 1.057 442 438 0.013 0.047 Antibiotic treatment of suspected pneumonia CH.7 0.232 0.000 0.000 0.000 0.000 13 13 0.232 0.232 Diarrhoea in last two weeks CH.4 0.037 0.008 0.225 0.838 0.916 442 438 0.020 0.053 Received ORT or increased fluids and continued feeding CH.5 0.381 0.000 0.000 0.000 0.000 16 16 0.381 0.381 Support for learning CD.1 0.955 0.009 0.009 0.795 0.892 442 438 0.937 0.973 Birth registration CP.1 0.960 0.011 0.011 1.305 1.142 442 438 0.938 0.981 ��Trinidad and Tobago Multiple Indicator Cluster Survey 3 Table SE.6: Sampling errors: South West Region Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Trinidad, 2006   Table Value (r) Standard error (se) Coefficient of variation (se/r) Design effect (deff) Square root of design effect (deft) Weighted count Unweighted count Confidence limits r - 2se r + 2se HOUSEHOLDS Iodized salt consumption NU.5 0.224 0.017 0.075 2.213 1.488 1317 1362 0.190 0.257 Child discipline CP.4 0.709 0.023 0.032 1.265 1.125 496 513 0.664 0.755 HOUSEHOLD MEMBERS Use of improved drinking water sources EN.1 0.953 0.013 0.014 5.643 2.375 4767 1495 0.927 0.979 Use of improved sanitation facilities EN.5 0.988 0.005 0.005 2.697 1.642 4767 1495 0.979 0.997 Net primary school attendance rate ED.3 0.987 0.007 0.007 1.743 1.320 432 446 0.972 1.000 Net secondary school attendance rate ED.4 0.881 0.020 0.023 1.653 1.286 406 420 0.840 0.921 Primary completion rate ED.6 0.736 0.038 0.052 0.541 0.735 70 72 0.659 0.813 Child labour CP.2 0.000 0.000 . . . 650 672 0.000 0.000 Prevalence of orphans HA.10 0.061 0.014 0.233 4.167 2.041 1152 1191 0.032 0.089 WOMEN Skilled attendant at delivery RH.5 0.981 0.013 0.014 0.991 0.995 98 104 0.954 1.000 Antenatal care RH.3 0.922 0.010 0.011 0.139 0.372 98 104 0.903 0.942 Contraceptive prevalence RH.1 0.360 0.023 0.063 1.377 1.173 575 609 0.314 0.406 Adult literacy ED.8 0.978 0.007 0.007 0.957 0.978 433 460 0.965 0.991 Marriage before age 18 CP.5 0.113 0.010 0.085 0.952 0.976 969 1028 0.094 0.132 Comprehensive knowledge about HIV prevention among young people HA.3 0.522 0.027 0.053 1.386 1.177 433 460 0.467 0.577 Condom use with non-regular partners HA.9 0.578 0.028 0.049 0.306 0.553 89 95 0.522 0.635 Age at first sex among young people HA.8 0.032 0.010 0.328 0.779 0.882 207 220 0.011 0.053 Attitude towards people with HIV/ AIDS HA.5 0.381 0.016 0.041 1.272 1.128 1174 1245 0.350 0.412 Women who have been tested for HIV HA.6 0.331 0.014 0.043 1.138 1.067 1176 1248 0.302 0.359 Knowledge of mother- to-child transmission of HIV HA.4 0.573 0.016 0.027 1.246 1.116 1176 1248 0.542 0.604 UNDER-5s Polio immunization coverage CH.2 0.957 0.001 0.001 0.002 0.043 44 47 0.955 0.960 Immunization coverage for DPT CH.2 0.870 0.019 0.022 0.142 0.377 43 46 0.832 0.908 �� Trinidad and Tobago Multiple Indicator Cluster Survey 3   Table Value (r) Standard error (se) Coefficient of variation (se/r) Design effect (deff) Square root of design effect (deft) Weighted count Unweighted count Confidence limits r - 2se r + 2se Fully immunized children CH.2 0.804 0.017 0.022 0.087 0.296 43 46 0.769 0.839 Acute respiratory infection in last two weeks CH.6 0.008 0.005 0.688 0.948 0.974 247 261 0.000 0.018 Antibiotic treatment of suspected pneumonia CH.7 0.000 0.000 . . . 2 2 0.000 0.000 Diarrhoea in last two weeks CH.4 0.027 0.010 0.380 1.037 1.018 247 261 0.006 0.047 Received ORT or increased fluids and continued feeding CH.5 0.285 0.041 0.143 0.049 0.221 7 7 0.204 0.367 Support for learning CD.1 0.943 0.011 0.012 0.609 0.781 247 261 0.920 0.965 Birth registration CP.1 0.935 0.014 0.015 0.838 0.915 247 261 0.907 0.963 ��Trinidad and Tobago Multiple Indicator Cluster Survey 3 Table SE.7: Sampling errors: Tobago Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Tobago, 2006 Table Value (r) Standard error (se) Coefficient of variation (se/r) Design effect (deff) Square root of design effect (deft) Weighted count Unweighted count Confidence limits r - 2se r + 2se HOUSEHOLDS Iodized salt consumption NU.5 0.225 0.044 0.196 1.230 1.109 86 111 0.137 0.314 Child discipline CP.4 0.840 0.032 0.038 0.590 0.768 86 81 0.776 0.903 HOUSEHOLD MEMBERS Use of improved drinking water sources EN.1 0.984 0.010 0.010 1.353 1.163 724 216 0.964 1.000 Use of improved sanitation facilities EN.5 0.988 0.008 0.008 1.307 1.143 724 216 0.972 1.000 Net primary school attendance rate ED.3 0.877 0.070 0.080 3.610 1.900 86 81 0.737 1.000 Net secondary school attendance rate ED.4 0.902 0.040 0.044 1.067 1.033 65 61 0.822 0.981 Primary completion rate ED.6 0.769 0.096 0.125 0.627 0.792 14 13 0.577 0.962 Child labour CP.2 0.000 0.000 . . . 123 116 0.000 0.000 Prevalence of orphans HA.10 0.028 0.011 0.400 0.985 0.992 224 211 0.006 0.051 WOMEN Skilled attendant at delivery RH.5 0.957 0.042 0.044 0.924 0.961 26 23 0.873 1.000 Antenatal care RH.3 0.870 0.066 0.076 0.850 0.922 26 23 0.737 1.000 Contraceptive prevalence RH.1 0.337 0.050 0.148 0.886 0.941 91 80 0.237 0.438 Adult literacy ED.8 0.979 0.020 0.021 0.965 0.982 55 48 0.938 1.000 Marriage before age 18 CP.5 0.079 0.024 0.302 1.084 1.041 158 139 0.031 0.127 Comprehensive knowledge about HIV prevention among young people HA.3 0.625 0.077 0.122 1.175 1.084 55 48 0.472 0.778 Condom use with non-regular partners HA.9 0.423 0.064 0.152 0.426 0.652 30 26 0.294 0.552 Age at first sex among young people HA.8 0.042 0.004 0.102 0.010 0.102 27 24 0.033 0.050 Attitude towards people with HIV/ AIDS HA.5 0.399 0.034 0.085 0.771 0.878 185 163 0.331 0.466 Women who have been tested for HIV HA.6 0.607 0.055 0.090 2.029 1.424 185 163 0.498 0.717 �0 Trinidad and Tobago Multiple Indicator Cluster Survey 3 Table Value (r) Standard error (se) Coefficient of variation (se/r) Design effect (deff) Square root of design effect (deft) Weighted count Unweighted count Confidence limits r - 2se r + 2se UNDER-5s Polio immunization coverage CH.2 0.889 0.111 0.125 1.000 1.000 10 9 0.667 1.000 Immunization coverage for DPT CH.2 0.778 0.111 0.143 0.571 0.756 10 9 0.556 1.000 Measles immunization coverage CH.2 0.778 0.000 0.000 0.000 0.000 10 9 0.778 0.778 Fully immunized children CH.2 0.667 0.000 0.000 0.000 0.000 10 9 0.667 0.667 Acute respiratory infection in last two weeks CH.6 0.058 0.026 0.447 0.623 0.790 57 52 0.006 0.109 Antibiotic treatment of suspected pneumonia CH.7 0.667 0.000 0.000 0.000 0.000 3 3 0.667 0.667 Diarrhoea in last two weeks CH.4 0.077 0.045 0.590 1.477 1.216 57 52 0.000 0.168 Received ORT or increased fluids and continued feeding CH.5 0.500 0.000 0.000 0.000 0.000 4 4 0.500 0.500 Support for learning CD.1 0.865 0.039 0.045 0.662 0.813 57 52 0.788 0.943 Birth registration CP.1 0.981 0.018 0.018 0.862 0.928 57 52 0.945 1.000 ��Trinidad and Tobago Multiple Indicator Cluster Survey 3 Appendix D Data Quality Tables Table DQ.1: Age distribution of household population Single-year age distribution of household population by sex (weighted), Trinidad and Tobago, 2006 Males Females Males Females Number Percent Number Percent Number Percent Number Percent 0 111 1.2 116 1.3 41 126 1.3 136 1.5 1 118 1.2 99 1.1 42 155 1.6 130 1.4 2 120 1.3 120 1.3 43 156 1.6 142 1.5 3 110 1.2 112 1.2 44 123 1.3 128 1.4 4 128 1.3 117 1.3 45 140 1.5 154 1.7 5 136 1.4 126 1.4 46 140 1.5 144 1.6 6 126 1.3 131 1.4 47 131 1.4 138 1.5 7 114 1.2 126 1.4 48 123 1.3 118 1.3 8 132 1.4 128 1.4 49 119 1.3 94 1.0 9 123 1.3 127 1.4 50 143 1.5 215 2.3 10 137 1.4 117 1.3 51 118 1.2 144 1.6 11 159 1.7 139 1.5 52 136 1.4 137 1.5 12 137 1.4 148 1.6 53 114 1.2 121 1.3 13 168 1.8 168 1.8 54 109 1.1 109 1.2 14 158 1.7 171 1.9 55 104 1.1 122 1.3 15 137 1.4 147 1.6 56 122 1.3 90 1.0 16 173 1.8 160 1.7 57 106 1.1 83 .9 17 165 1.7 148 1.6 58 81 .9 81 .9 18 213 2.3 173 1.9 59 93 1.0 74 .8 19 191 2.0 177 1.9 60 93 1.0 101 1.1 20 186 2.0 168 1.8 61 75 .8 60 .7 21 202 2.1 190 2.1 62 74 .8 71 .8 22 182 1.9 162 1.8 63 70 .7 66 .7 23 208 2.2 178 1.9 64 59 .6 63 .7 24 169 1.8 158 1.7 65 59 .6 87 1.0 25 188 2.0 169 1.8 66 44 .5 59 .6 26 147 1.5 143 1.5 67 51 .5 59 .6 27 180 1.9 116 1.3 68 37 .4 56 .6 28 118 1.2 127 1.4 69 49 .5 40 .4 29 144 1.5 112 1.2 70 52 .6 57 .6 30 157 1.7 130 1.4 71 30 .3 41 .4 31 104 1.1 108 1.2 72 48 .5 49 .5 32 163 1.7 130 1.4 73 47 .5 38 .4 33 133 1.4 134 1.5 74 21 .2 35 .4 34 118 1.2 117 1.3 75 34 .4 43 .5 35 132 1.4 104 1.1 76 29 .3 32 .3 36 112 1.2 108 1.2 77 34 .4 34 .4 37 108 1.1 106 1.2 78 15 .2 29 .3 38 141 1.5 121 1.3 79 29 .3 21 .2 39 130 1.4 116 1.3 80+ 116 1.2 211 2.3 40 161 1.7 134 1.5 DK/ Missing 19 .2 15 .2 Total 9461 100.0 9207 100.0 �� Trinidad and Tobago Multiple Indicator Cluster Survey 3 Table DQ.2: Age distribution of eligible and interviewed women Household population of women age 10-54, interviewed women age 15-49, and percentage of eligible women who were interviewed (weighted), by five-year age group, Trinidad and Tobago, 2006 Household population of women age 10-54 Interviewed women age 15-49 Percentage of eligible women interviewed Number Number Percent Age 10-14 742 na na na 15-19 804 776 16.9 96.4 20-24 856 802 17.4 93.7 25-29 666 630 13.7 94.6 30-34 619 587 12.8 94.8 35-39 556 538 11.7 96.7 40-44 671 637 13.9 95.0 45-49 647 625 13.6 96.6 50-54 725 Na na Na 15-49 4819 4595 100.0 95.3 na: not applicable Note: Weights for both household population of women and interviewed women are household weights. Age is based on the household schedule. Table DQ.3: Age distribution of eligible and interviewed under-5s Household population of children age 0-4, children whose mothers/caretakers were interviewed, and percentage of under-5 children whose mothers/caretakers were interviewed (weighted), by five-year age group, Trinidad and Tobago, 2006 Household population of children age 0-7 Interviewed children age 0-4 Percentage of eligible children interviewed Number Number Percent Age 0 227 221 19.8 97.3 1 217 212 18.9 97.6 2 240 231 20.7 96.2 3 222 217 19.4 97.7 4 245 238 21.3 97.1 5 262 Na Na na 6 257 Na Na na 7 240 Na Na na 0-4 1151 1119 100.0 97.2 na: not applicable Note: Weights for both household population of children and interviewed children are household weights. Age is based on the household schedule. �3Trinidad and Tobago Multiple Indicator Cluster Survey 3 Table DQ.4: Age distribution of under-5 children Age distribution of under-5 children by 3-month groups (weighted), Trinidad and Tobago, 2006 Males Females Total Number Percent Number Percent Number Percent Age in months 0-2 24 4.2 19 3.5 43 3.9 3-5 23 4.0 36 6.6 59 5.3 6-8 26 4.6 33 6.0 59 5.3 9-11 29 5.0 21 3.9 50 4.5 12-14 26 4.5 23 4.4 50 4.5 15-17 33 5.7 22 3.9 54 4.8 18-20 33 5.8 27 5.0 60 5.4 21-23 24 4.1 24 4.3 47 4.2 24-26 35 6.1 24 4.4 59 5.3 27-29 23 4.1 25 4.5 48 4.3 30-32 37 6.5 35 6.2 71 6.4 33-35 19 3.3 33 6.2 53 4.7 36-38 30 5.3 29 5.3 59 5.3 39-41 38 6.7 27 5.0 65 5.8 42-44 24 4.2 25 4.6 49 4.4 45-47 18 3.2 28 5.1 46 4.2 48-50 29 5.2 30 5.4 59 5.3 51-53 28 4.9 29 5.1 56 5.0 54-56 39 6.9 27 4.9 66 5.9 57-59 31 5.4 30 5.6 62 5.5 Total 568 100.0 549 100.0 1117 100.0 �� Trinidad and Tobago Multiple Indicator Cluster Survey 3 Table DQ.5: Heaping on ages and periods Age and period ratios at boundaries of eligibility by type of information collected (weighted), Trinidad and Tobago, 2006 Age and period ratios* Eligibility boundary (lower-upper) Module or questionnaire Males Females Total Age in household questionnaire 1 1.01 .89 .95 2 1.04 1.09 1.06 Lower Child discipline and child disability 3 .92 .96 .94 4 1.03 .99 1.01 Upper Under-5 questionnaire 5 1.05 1.01 1.03 Lower Child labour and education 6 1.00 1.03 1.01 8 1.07 1.01 1.04 9 .94 1.02 .98 Upper Child disability 10 .98 .92 .95 13 1.09 1.04 1.06 14 1.02 1.06 1.04 Upper Child labour and child discipline 15 .88 .92 .90 Lower Women’s questionnaire 16 1.09 1.06 1.08 17 .90 .92 .91 Upper Orphaned and vulnerable children 18 .87 .89 .88 23 1.12 1.07 1.09 24 .90 .94 .92 Upper Education 25 1.12 1.08 1.10 48 .99 1.01 1.00 49 .93 .66 .79 Upper Women’s questionnaire 50 1.13 1.42 1.29 Age in women’s questionnaire 23 na 1.10 na 24 na .90 na Upper Sexual behaviour 25 na 1.09 na Months since last birth in women’s questionnaire 6-11 na 1.06 na 12-17 na .95 na 18-23 na 1.05 na Upper Tetanus toxoid and maternal and child health 24-29 na .88 na 30-35 na 1.13 na * Age or period ratios are calculated as x / ((xn-1 + xn + xn+1) / 3), where x is age or period. na: not applicable ��Trinidad and Tobago Multiple Indicator Cluster Survey 3 Table DQ.6: Completeness of reporting Percentage of observations missing information for selected questions and indicators (weighted), Trinidad and Tobago, 2006 Questionnaire and Subject Reference group Percent with missing information* Number of cases Household Salt testing All households surveyed .1 5557 Women Date of Birth All women age 15-49 Month only .4 4605 Month and year missing .0 4605 Date of first birth All women age 15-49 with at least one live birth Month only 1.0 2613 Month and year missing .9 2613 Completed years since first birth All women age 15-49 with at least one live birth 2.1 44 Date of last birth All women age 15-49 with at least one live birth Month only .9 2613 Month and year missing .7 2613 Date of first marriage/union All ever married women age 15-49 Month only 8.9 2703 Month and year missing 15.9 2703 Age at first marriage/union All ever married women age 15-49 1.3 2703 Age at first intercourse All women age 15-24 who have ever had sex .5 1579 Time since last intercourse All women age 15-24 who have ever had sex 1.4 741 Under-5 Date of Birth All under five children surveyed Month only .1 1117 Month and year missing .3 1117 * Includes “Don’t know” responses Table DQ.7: Presence of mother in the household and the person interviewed for the under-5 questionnaire Distribution of children under five by whether the mother lives in the same household, and the person interviewed for the under-5 questionnaire (weighted), Trinidad and Tobago, 2006 Mother in the household Mother not in the household Total Number of children aged 0-4 years Mother interviewed Father interviewed Other adult female interviewed Other adult male interviewed Father interviewed Other adult female interviewed Other adult male interviewed Age 0 99.2 .0 .8 .0 100.0 227 1 95.8 .5 3.7 .0 100.0 217 2 95.8 1.7 2.5 .0 100.0 240 3 91.3 2.3 6.4 .0 100.0 222 4 88.4 2.1 9.1 .4 100.0 245 Total 94.0       1.3  4.6  .1 100.0  1151 �� Trinidad and Tobago Multiple Indicator Cluster Survey 3 T a b l e D Q .8 : S c h o o l a t t e n d a n c e b y s in g l e a g e D is tri bu tio n of h ou se ho ld p op ul at io n ag e 5- 24 b y ed uc at io na l l ev el a nd g ra de a tte nd ed in th e cu rr en t y ea r ( w ei gh te d) , Tr in id ad a nd T ob ag o, 2 00 6 Pr im ar y s ch oo l   Se co nd ar y s ch oo l Un ive r- sit y Po st- Gr ad Te ch   /V oc Do n’t   kn ow No t  att en din g  sc ho ol   Pr e- sc ho ol St d  1 St d  2 St d  3 St d  4 St d  5 St d  6 St d  7 St d  8   Fo rm   1 Fo rm   2 Fo rm   3 Fo rm   4 Fo rm   5 Fo rm   6 Fo rm   7 To tal Nu mb er Ag e 5 3.7 34 .1 50 .7 9.1 1.2 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 1.2 10 0.0 25 7 6 .4 5.5 42 .1 42 .4 8.8 .4 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .4 .0 10 0.0 24 0 7 .0 1.9 9.0 27 .7 52 .5 6.1 .7 .0 .0 .4 .0 .4 .0 .0 .0 .0 .0 .0 .0 .8 .4 10 0.0 26 1 8 .4 1.2 1.6 9.7 37 .3 45 .8 3.3 .0 .0 .0 .0 .4 .0 .0 .0 .0 .0 .0 .0 .4 .0 10 0.0 25 0 9 .0 .4 .8 4.8 11 .3 35 .3 39 .9 5.9 .0 .4 .0 .0 .0 .0 .0 .0 .0 .0 .0 .4 .8 10 0.0 25 4 10 .0 .0 .0 1.7 3.4 10 .6 34 .9 45 .2 .3 2.7 .4 .4 .0 .0 .0 .0  .0  .0  .0 .4 .0 10 0.0 29 7 11 .0 .4 .0 .4 1.4 2.9 11 .5 41 .7 .7 33 .3 4.9 1.0 .0 .0 .0 .0 .0 .0 .0 1.1 .7 10 0.0 28 5 12 .0 .3 .0 .0 .9 .0 3.6 11 .7 .0 32 .6 40 .8 6.9 .3 .3 .3 .0 .0 .0 .0 .6 1.7 10 0.0 33 6 13 .0 .0 .3 .0 .3 .3 .9 5.6 .3 11 .7 36 .2 39 .1 2.2 .3 .0 .0  .0  .0 .3 .0 2.4 10 0.0 32 9 14 .0 .0 .0 .0 1.1 .0 1.0 .0 .0 5.3 11 .6 33 .1 40 .1 2.9 .4 .0 .0 .0 .4 .0 4.2 10 0.0 28 3 15 .0 .0 .0 .0 .3 .3 .3 .0 .0 1.5 1.5 11 .2 31 .8 37 .2 1.8 .0 .0 .0 1.2 .0 12 .9 10 0.0 33 3 16 .0 .0 .0 .0 .0 .0 .0 .3 .0 .0 .3 2.9 6.1 38 .4 13 .3 2.2 1.6 .0 5.8 .9 28 .1 10 0.0 31 3 17 .3 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 1.6 15 .3 6.1 8.1 3.4 .3 7.0 .0 57 .9 10 0.0 38 6 18 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 1.1 3.6 3.3 6.1 8.7 1.1 7.3 .3 68 .6 10 0.0 36 8 19 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .6 .3 1.1 9.6 .6 5.0 .3 82 .5 10 0.0 35 4 20 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .2 .0 .0 .7 .8 .5 14 .1 1.0 2.8 .0 79 .8 10 0.0 39 2 21 .0 .0 .0 .0 .0 .0 .0 .0  .0  .0 .0  .0  .0 .3 .0 .6 8.2 .3 3.0 .0 87 .6 10 0.0 34 4 22 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .3 .0 .3 8.1 1.8 4.2 .0 85 .3 10 0.0 38 6 23 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 5.5 .3 2.4 .3 91 .4 10 0.0 32 7 24  .0  .0  .0  .0  .0  .0  .0  .0  .0    .0  .0  .0  .0  .0  .0 .3  6. 8 .6  2. 3  .0  90 .1 10 0.0  35 6 ��Trinidad and Tobago Multiple Indicator Cluster Survey 3 Table DQ.9: Sex ratio at birth among children ever born and living Sex ratio at birth among children ever born, children living, and deceased children, by age of women (weighted), Trinidad and Tobago, 2006 Children Ever Born Children Living Children deceased Number of  women Number of  sons ever  born Number of  daughters  ever born Sex  ratio   Number  of sons  living Number of  daughters  living Sex  ratio   Number of  deceased  sons Number of  deceased   daughters Sex  ratio   Age 15-19 27 24 1.14 27 24 1.14 0 0 na 777 20-24 167 135 1.23 157 133 1.18 10 2 5.05 802 25-29 298 311 .96 288 296 .97 10 16 .64 632 30-34 540 503 1.07 525 495 1.06 15 8 1.93 590 35-39 568 554 1.03 545 539 1.01 23 15 1.56 539 40-44 837 809 1.03 799 781 1.02 38 28 1.35 639 45-49 888 898 .99 843 864 .98 45 33 1.35 626 Total 3326 3235 1.03 3184 3133 1.02 142 102 1.39 4605 Note: Sex ratios are calculated as number of males/ number of females Table DQ.10: Distribution of women by time since last birth Distribution of women aged 15-49 with at least one live birth, by months since last birth (weighted), Trinidad and Tobago, 2006 Months since last birth Number Percent Number Percent 0 9 1.5 18 23 3.8 1 11 1.8 19 23 3.8 2 23 3.8 20 13 2.2 3 19 3.1 21 18 3.0 4 17 2.9 22 9 1.5 5 27 4.4 23 12 2.0 6 17 2.8 24 15 2.5 7 23 3.9 25 20 3.3 8 19 3.2 26 12 2.0 9 18 3.0 27 13 2.2 10 15 2.5 28 8 1.3 11 17 2.8 29 18 3.1 12 14 2.3 30 20 3.3 13 17 2.7 31 24 4.0 14 16 2.6 32 21 3.4 15 14 2.4 33 22 3.7 16 16 2.6 34 15 2.5 17 20 3.3 35 7 1.1       Total 605 100.0 �� Trinidad and Tobago Multiple Indicator Cluster Survey 3 Appendix E MICS Indicators: Numerators and Denominators INDICATOR NUMERATOR DENOMINATOR 1 Under-five mortality rate Probability of dying by exact age 5 years 2 Infant mortality rate Probability of dying by exact age 1 year 4 Skilled attendant at delivery Number of women aged 15-49 years with a birth in the 2 years  preceding the survey that were attended during childbirth by  skilled health personnel Total number of women surveyed aged 15-49 years with a  birth in the 2 years preceding the survey 5 Institutional deliveries Number of women aged 15-49 years with a birth in the 2 years preceding the survey that delivered in a health facility Total number of women surveyed aged 15-49 years with a  birth in 2 years preceding the survey 9 Low-birthweight infants Number of last live births in the 2 years preceding the survey weighing below 2,500 grams Total number of last live births in the 2 years preceding  the survey 10 Infants weighed at birth Number of last live births in the 2 years preceding the survey that were weighed at birth Total number of last live births in the 2 years preceding  the survey 11 Use of improved drinking water sources Number of household members living in households using  improved sources of drinking water Total number of household members in households  surveyed 12 Use of improved sanitation facilities Number of household members using improved sanitation facilities Total number of household members in households  surveyed 13 Water treatment Number of household members using water that has been treated Total number of household members in households  surveyed 14 Disposal of child’s faeces Number of children under age three whose (last) stools were disposed of safely Total number of children under age three surveyed 15 Exclusive breastfeeding rate Number of infants aged 0-5 months that are exclusively breastfed Total number of infants aged 0-5 months surveyed 16 Continued breastfeeding rate Number of infants aged 12-15 months, and 20-23 months, that are currently breastfeeding Total number of children aged 12-15 months and 20-23  months surveyed 17 Timely complementary feeding rate Number of infants aged 6-9 months that are receiving breastmilk and complementary foods Total number of infants aged 6-9 months surveyed 18 Frequency of complementary feeding Number of infants aged 6-11 months that receive breastmilk  and complementary food at least the minimum recommended  number of times per day (two times per day for infants aged  6-8 months, three times per day for infants aged 9-11 months) Total number of infants aged 6-11 months surveyed 19 Adequately fed infants Number of infants aged 0-11 months that are  appropriately  fed: infants aged 0-5 months that are exclusively breastfed and  infants aged 6-11 months that are breastfed and ate solid or  semi-solid foods the  appropriate number of times (see above)  yesterday Total number of infants aged 0-11 months surveyed 20 Antenatal care Number of women aged 15-49 years that were attended at  least once during pregnancy in the 2 years preceding the  survey by skilled health personnel Total number of women surveyed aged 15-49 years with a  birth in the 2 years preceding the survey 21 Contraceptive prevalence Number of women currently married or in union aged  15-49 years that are using (or whose partner is using) a  contraceptive method (either modern or traditional) Total number of women aged 15-49 years that are  currently married or in union 22 Antibiotic treatment of  suspected pneumonia Number of children aged 0-59 months with suspected  pneumonia in the previous 2 weeks receiving antibiotics Total number of children aged 0-59 months with suspected  pneumonia in the previous 2 weeks 23 Care-seeking for suspected pneumonia Number of children aged 0-59 months with suspected  pneumonia in the previous 2 weeks that are taken to an  appropriate health provider Total number of children aged 0-59 months with suspected  pneumonia in the previous 2 weeks 24 Solid fuels Number of residents in households that use solid fuels (wood,  charcoal, crop residues and dung) as the primary source of  domestic energy to cook Total number of residents in households surveyed 26 Polio immunization coverage Number of children aged 12-23 months receiving OPV3 vaccine before their first birthday Total number of children aged 12-23 months surveyed 27 Immunization coverage for  diphtheria, pertussis and tetanus  (DPT)  Number of children aged 12-23 months receiving DPT3  vaccine before their first birthday Total number of children aged 12-23 months surveyed 28 Measles immunization coverage Number of children aged 12-23 months receiving measles vaccine before their first birthday Total number of children aged 12-23 months surveyed ��Trinidad and Tobago Multiple Indicator Cluster Survey 3 INDICATOR NUMERATOR DENOMINATOR 29 Hepatitis B immunization coverage Number of children aged 12-23 months immunized against hepatitis before their first birthday Total number of children aged 12-23 months surveyed 30 Yellow fever immunization coverage Number of children aged 12-23 months immunized against yellow fever before their first birthday Total number of children aged 12-23 months surveyed 31 Fully immunized children Number of children aged 12-23 months receiving DPT1-3, OPV-1-3, BCG and measles vaccines before their first birthday Total number of children aged 12-23 months surveyed 32 Neonatal tetanus protection  Number of mothers with live births in the previous year that  were given at least two doses of tetanus toxoid (TT) vaccine  within the appropriate interval prior to giving birth Total number of women surveyed aged 15-49 years with a  birth in the year preceding the survey 33 Use of oral rehydration therapy (ORT)   Number of children aged 0-59 months with diarrhoea in the  previous 2 weeks that received oral rehydration salts and/or an 

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