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Uzbekistan Multiple Indicator Cluster Survey 2006: Monitoring the Situation of Children and Women

Publication date: 2006

Uzbekistan Multiple Indicator Cluster Survey 2006 U zbekistan 2006 M ultiple Indicator C luster Survey M IC S Uzbekistan Monitoring the Situation of Children and Women Multiple Indicator Cluster Survey 2006 MICS United Nations Children’s Fund State Statistical Committee of the Republic of Uzbekistan United Nations Population Fund The Uzbekistan Multiple Indicator Cluster Survey (MICS) was carried by State Statistical Committee of the Republic of Uzbekistan. Finan- cial and technical support was provided by the United Nations Children’s Fund (UNICEF) and United Nations Population Fund (UNFPA). The survey has been conducted as part of the third round of MICS surveys (MICS3), carried out around the world in more than 50 countries, in 2005–2006, following the ﬁ rst two rounds of MICS surveys that were conducted in 1995 and the year 2000. Survey tools are based on the models and standards developed by the global MICS project, designed to collect information on the situation of children and women in countries around the world. Additional information on the global MICS project may be obtained from www.childinfo.org. Suggested citation: UNICEF and State Statistical Committee of the Republic of Uzbekistan. 2007. Uzbekistan Multiple Indicator Cluster Survey 2006, Final Report. Tashkent, Uzbekistan: UNICEF. Photo on cover: ©UNICEF/Uzbekistan/2007/Brigitte Brefort Printed by Mega Basim FOREWORD Along with 189 countries, the Republic of Uzbekistan has signed up to the Millennium Devel- opment Goals and World Fit for Children Declarations. By signing up to these declarations, the government also committed itself to monitor progress towards achieving goals and objectives they contained. It is within this framework that, in 2006, the Government of Uzbekistan con- ducted a Multiple Indicators Cluster Survey (MICS) with technical support of UNICEF and UNFPA. This multiple indicator cluster survey is the latest in a series of nationwide periodic surveys which depicts the status of women and children in Uzbekistan and provides opportu- nity to track the progress. The present report not only highlights the trend and progress made but more importantly provides data at sub-national level to compare progress between the regions and oblast. This is critical as very often, the national aggregated data masks regional disparities. This nationwide survey was implemented by the State Statistical Committee (SSC) and cov- ered 10,500 households in all regions of the country. The successful implementation of the survey would not have been possible without the joint effort of a number of organizations and individuals, whose participation we would like to acknowledge with gratitude. In preparation for the survey, a coordination working group under the Social Complex on Health, Education and Social Protection of the Cabinet of Ministers was established. This working group com- prised the chairman and the deputy chairman of the State Statistical Committee, the heads of the ministries of Health, Education, Finance, Labour and Social Protection. Representatives of the Women’s Committee of the Republic of Uzbekistan, NGOs and youth organizations were also members of the working group At national level, the State Statistical Committee was in charge of planning and coordination of the survey. Supervision and implementation of the survey at sub-national level was carried out by the heads of the State Statistical Departments at oblast-level, including the State Statisti- cal Department of the Republic of Karakalpakstan and Tashkent city. Local authorities at Ob- last, rayon and mahalla levels supported the implementation of the ﬁ eldwork. We hope that the ﬁ ndings of the survey and this report bring a better understanding of the situation of the women and children in the country and serve in preparation of the social policy and planning by the government and international partners. United Nations Children’s Fund United Nations Population Fund Cabinet of Ministers of the Republic of Uzbekistan State Statistical Committeeof the Republic of Uzbekistan 2 ! Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 Summary Table of Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 List of Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Survey Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 2. Sample and Survey Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Sample Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Questionnaires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Training and Fieldwork . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Data Processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 3. Sample Coverage and the Characteristics of Households and Respondents. . . . . . . . 21 Sample Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Characteristics of Households . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Characteristics of Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 4. Child Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 5. Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Nutritional Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Salt Iodization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Vitamin A Supplements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Low Birth Weight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 6. Child Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Immunization. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Oral Rehydration Treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Care Seeking and Antibiotic Treatment of Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Solid Fuel Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 7. Environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Water and Sanitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 8. Reproductive Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Contraception. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Unmet Need . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Antenatal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Assistance at Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Maternal Mortality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 TABLE OF CONTENTS Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 3 9. Child Development. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 10. Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Pre-School Attendance and School Readiness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Primary and Secondary School Participation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Adult Literacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 11. Child Protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Birth Registration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Child Labour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Early Marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Child Disability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Orphans and Vulnerable Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 12. HIV/AIDS and Sexual Behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Knowledge of HIV Transmission and Condom Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Sexual Behaviour Related to HIV Transmission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 List of References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Appendixes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 A. Sample Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 B. List of Personnel Involved in the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142 C. Sampling errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 D. Data Quality Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 E. MICS Indicators: Numerators and Denominators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170 F. Questionnaires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174 List of Tables 1. Results of household and individual interviews. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 2. Household age distribution by sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 3. Household composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 4. Women’s background characteristics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 5. Children’s background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 6. Child mortality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 7. Child malnourishment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 8. Initial breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 9. Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 10. Adequately fed infants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 11. Iodized salt consumption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 12. Children’s vitamin A supplementation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 13. Low birth weight infants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 14. Vaccinations by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 4 ! Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 15. Vaccinations by background characteristics (continued) . . . . . . . . . . . . . . . . . . . . . . . . . . 86 16. Oral rehydration treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 17. Home management of diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 18. Care seeking for suspected pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 19. Antibiotic treatment of pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 20. Knowledge of the two danger signs of pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 21. Solid fuel use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 22. Solid fuel use by type of stove or ﬁ re . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 23. Use of improved water sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 24. Household water treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 25. Time to source of water . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 26. Person collecting water . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 27. Use of sanitary means of excreta disposal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 28. Disposal of child’s faeces . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 29. Use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 30. Unmet need for contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101 31. Antenatal care provider . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 32. Antenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 33. Assistance during delivery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 34. Completed pregnancies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 35. Maternal mortality ratio. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 36. Family support for learning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 37. Learning materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 38. Early childhood education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 39. Primary school entry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 40. Primary school net attendance ratio. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .111 41. Secondary school net attendance ratio. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 42 Secondary school age children attending primary school . . . . . . . . . . . . . . . . . . . . . . . . 113 43. Children reaching grade 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 44. Primary school completion and transition to secondary education . . . . . . . . . . . . . . . . . 115 45. Education gender parity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 46. Birth registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .117 47. Child labour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 48. Labourer students and student labourers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 49. Early marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 50. Child disability. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 51. Knowledge of preventing HIV transmission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 52. Identifying misconceptions about HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 53. Comprehensive knowledge of HIV/AIDS transmission. . . . . . . . . . . . . . . . . . . . . . . . . . 125 54. Knowledge of mother-to-child HIV transmission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 55. Attitudes toward people living with HIV/AIDS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 56. Knowledge of a facility for HIV testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 57. HIV testing and counselling coverage during antenatal care . . . . . . . . . . . . . . . . . . . . . 129 58. Sexual behaviour that increases risk of HIV infection . . . . . . . . . . . . . . . . . . . . . . . . . . 130 59. Condom use at last high-risk sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .131 60. Children’s living arrangements and orphanhood. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 5 List of Figures 1. Age and sex distribution of household population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 2. Infant mortality rate estimates, 1996–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 3. Under-5 mortality estimates, 2000–2006. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 4. Under-5 mortality rates by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 5. Prevalence of malnutrition, 1996–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 6. Percentage of children under-5 who are undernourished. . . . . . . . . . . . . . . . . . . . . . . . . . 30 7. Percentage of mothers who started breastfeeding within one hour and within one day of birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 8. Percentage of households consuming adequately iodized salt, 2000–2006. . . . . . . . . . . . 35 9. Percentage of infants weighing less than 2500 grams at birth. . . . . . . . . . . . . . . . . . . . . . 37 10. Percentage of children aged 15–26 months who received the recommended vaccination by 12 months. . . . . . . . . . . . . . . . . . . . . . . . 40 11. Percentage of children aged 0–59 months with diarrhoea, who received ORT or increased ﬂ uids, AND continued feeding. . . . . . . . . . . . . . . . . . . . 41 12. Percentage distribution of household members by source of drinking water . . . . . . . . . . 45 13. Contraceptive use, 2000–2006. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 14. Maternal mortality ratio, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 15. Early childhood, primary and secondary school attendance, 2000–2006 . . . . . . . . . . . . . 58 16. Knowledge of HIV Transmission, 2000–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 17. Percent of women who have comprehensive knowledge of HIV/AIDS transmission . . . . 68 18. Sexual behaviour that increases risk of HIV infection . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 6 ! Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 SUMMARY TABLE OF FINDINGS Multiple Indicator Cluster Surveys (MICS) and Millennium Development Goals (MDG) Indicators, Uzbekistan, 2006 Topic MICS Indicator Number MDG Indicator Number Indicator Value CHILD MORTALITY Child mortality 1 13 Under-� ve mortality rate 57 per thousand 2 14 Infant mortality rate 48 per thousand NUTRITION Nutritional status 6 4 Underweight prevalence 5.1 percent 7 Stunting prevalence 14.6 percent 8 Wasting prevalence 3.3 percent Breastfeeding 45 Timely initiation of breastfeeding 67.1 percent 15 Exclusive breastfeeding rate less than 6 months old 26.4 percent less than 4 months old 36.9 percent 16 Continued breastfeeding rate at 12–15 months 78.3 percent at 20–23 months 37.9 percent 17 Timely complementary feeding rate 45.2 percent 18 Frequency of complementary feeding 28.5 percent 19 Adequately fed infants 27.6 percent Salt iodization 41 Iodized salt consumption 53.1 percent Vitamin A 42 Vitamin A supplementation (under-� ves) 72.0 percent Low birth weight 9 Low birth weight infants 4.8 percent 10 Infants weighed at birth 99.2 percent CHILD HEALTH Immunization 25 Tuberculosis immunization coverage 99.2 percent 26 Polio immunization coverage 86.8 percent 27 DPT immunization coverage 90.4 percent 28 15 Measles immunization coverage 96.0 percent 31 Fully immunized children 81.1 percent 29 Hepatitis B immunization coverage 86.5 percent Care of illness 33 Use of oral rehydration therapy (ORT) 78.8 percent 34 Home management of diarrhoea 16.6 percent 35 Received ORT or increased � uids, and continued feeding 28.1 percent 23 Care seeking for suspected pneumonia 67.7 percent 22 Antibiotic treatment of suspected pneumonia 55.7 percent Solid fuel use 24 29 Solid fuels 15.7 percent Source and cost of supplies 96 Source of supplies (from public sources) Antibiotics 12.3 percent 97 Cost of supplies (median costs) Antibiotics (public sources) — UZS (private sources) 1000 UZS Oral rehydration salts (public sources) — UZS (private sources) 200 UZS Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 7 Topic MICS Indicator Number MDG Indicator Number Indicator Value ENVIRONMENT Water and Sanitation 11 30 Use of improved drinking water sources 89.6 percent 13 Water treatment 98.7 percent 12 31 Use of improved sanitation facilities 99.4 percent 14 Disposal of child’s faeces 58.6 percent REPRODUCTIVE HEALTH Contraception and unmet need 21 19c Contraceptive prevalence 64.9 percent 98 Unmet need for family planning 7.8 percent 99 Demand satis� ed for family planning 89.3 percent Maternal and new- born health 20 Antenatal care 99.0 percent 44 Content of antenatal care 99.1 percent Blood test taken 97.7 percent Blood pressure measured 97.7 percent Urine specimen taken 97.6 percent Weight measured 89.8 percent 4 17 Skilled attendant at delivery 99.9 percent 5 Institutional deliveries 97.3 percent Maternal mortality 3 16 Maternal mortality ratio 28 per 100,000 CHILD DEVELOPMENT Child development 46 Support for learning 71.3 percent 47 Father’s support for learning 46.9 percent 48 Support for learning: children’s books 42.5 percent 49 Support for learning: non-children’s books 77.8 percent 50 Support for learning: materials for play 32.3 percent 51 Non-adult care 5.0 percent EDUCATION Education Literacy 52 Pre-school attendance 19.7 percent 53 School readiness 26.9 percent 54 Net intake rate in primary education 88.9 percent 55 6 Net primary school attendance rate 95.8 percent 56 Net secondary school attendance rate 93.1 percent 57 7 Children reaching grade � ve 99.5 percent 58 Transition rate to secondary school 100.0 percent 59 7b Primary completion rate 96.6 percent 61 9 Gender parity index primary school 1.00 ratio secondary school 0.98 ratio 60 8 Adult literacy rate 100.0 percent CHILD PROTECTION Birth registration 62 Birth registration 99.9 percent Child labour 71 Child labour 2.0 percent 72 Labourer students 93.3 percent 73 Student labourers 2.2 percent 8 ! Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 Topic MICS Indicator Number MDG Indicator Number Indicator Value Early marriage 67 Marriage before age 15 0.3 percent Marriage before age 18 12.5 percent 68 Young women aged 15–19 currently married/ in union 4.9 percent Disability 101 Child disability 2.0 percent Orphaned children 75 Prevalence of orphans 4.1 percent 78 Children’s living arrangements 1.9 percent HIV/AIDS AND SEXUAL BEHAVIOUR HIV/AIDS knowl- edge and attitudes 82 19b Comprehensive knowledge about HIV prevention among young people 35.3 percent 89 Knowledge of mother-to-child transmission of HIV 73.4 percent 86 Attitude towards people with HIV/AIDS 2.7 percent 87 Women who know where to be tested for HIV 54.5 percent 88 Women who have been tested for HIV 32.8 percent 90 Counselling coverage for the prevention of mother-to-child transmission of HIV 69.3 percent 91 Testing coverage for the prevention of mother-to-child trans-mission of HIV 65.4 percent Sexual behaviour 84 Age at � rst sex among young people — percent 92 Age-mixing among sexual partners 2.8 percent 83 19a Condom use with non-regular partners 60.5 percent 85 Higher risk sex in the last year 3.6 percent Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 9 LIST OF ABBREVIATIONS AIDS Acquired Immune Deﬁ ciency Syndrome BCG Bacillus-Cereus-Guerin (Tuberculosis) CDC Centre for Disease Control and Prevention CSPr Census and Survey Processing Software DHS Demographic and Health Survey DPT Diphtheria-Pertussis-Tetanus EA Enumeration Area GPI Gender Parity Index HFA-DB Health for All Databases HIV Human Immunodeﬁ ciency Virus IDD Iodine Deﬁ ciency Disorders IUD Intrauterine Device LAM Lactation Amenorrhea Method MOH Ministry of Health MDGs Millennium Development Goals MICS Multiple Indicator Cluster Survey MICS3 Multiple Indicator Cluster Survey—3rd Phase NAR Net Attendance Rate NCHS National Centre for Health Statistics ORS Oral Rehydration Salts ORT Oral Rehydration Treatment PPM Parts Per Million PPS Probability Proportional to Size PSU Primary Sampling Unit RHF Recommended Home Fluid SD Standard Deviation SPSS Statistical Package for Social Sciences SSC State Statistical Committee UDHS Uzbekistan Demographic and Health Survey UHES Uzbekistan Health Examination Survey UNAIDS United Nations Programme on HIV/AIDS UNFPA United Nations Population Fund UNGASS United Nations General Assembly Special Session on HIV/AIDS UNICEF United Nations Children’s Fund UZS Uzbekistan Sum WFFC World Fit For Children WH World Health Organization i-WISP Welfare Improvement Strategy Paper 10 ! Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 EXECUTIVE SUMMARY The Uzbekistan Multiple Indicator Survey is a nationally representative sample survey of households, women, and children. The main objectives of the survey were to provide up-to- date information for assessing the situation of children and women in Uzbekistan; to furnish data needed for monitoring progress toward the Millennium Development Goals, the goals of A World Fit For Children, and other internationally agreed upon goals, as a basis for future action; to contribute to the improvement of data and monitoring systems in Uzbekistan and to strengthen technical expertise in the design, implementation and analysis of such systems. Questionnaires were completed for 10,198 households, 13,919 women (age 15–49), and 4,986 children (age under-5). Child mortality The infant mortality rate is estimated at 48 per thousand, while the under-5 mortality rate is 57 per thousand. Nutritional Status Almost one in twenty children under age ﬁ ve in Uzbekistan are moderately underweight (5 percent) and one percent are classiﬁ ed as severely underweight. Fifteen percent of children are stunted or too short for their age and four percent are severely stunted. Three percent of children under-5 are wasted or too thin for their height. It is estimated that about seven percent of children under-5 are overweight. Breastfeeding More than two-thirds (67 percent) of women with a live birth in the two years preceding the survey started breastfeeding as early as within one hour of birth and only 15 percent of infants were not put to the breast within one day of birth. Approximately 26 percent of children aged less than six months are exclusively breastfed, a level considerably lower than recommended. At age 6–9 months, 45 percent of children are receiving breast milk and solid or semi-solid foods. By age 12–15 months, 78 percent of children are still being breastfed and by age 20–23 months the ﬁ gure decreases to 38 percent. Salt Iodization In 53 percent of households in Uzbekistan, salt was found to contain 15 PPM or more of iodine. Vitamin A Supplements Within the six months prior to the MICS, 72 percent of children aged 6–59 months received a high dose Vitamin A supplement. Low Birth Weight Nearly all infants were weighted at birth and approximately 5 percent were estimated to weigh less than 2500 grams at birth. $ $ $ $ $ $ $ $ $ $ $ Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 11 Immunization Overall, 96 percent of children under-5 had health cards recording vaccinations. Nearly all children aged 15–26 months received a BCG vaccination by the age of 12 months (99.2 %). The ﬁ rst dose of DPT was given to 98 percent. The percentage declines for subsequent doses of DPT (95 percent for the second dose, and 90 percent for the third dose). Similarly, 96 percent received the ﬁ rst dose of Polio by age 12 months and this declines to 87 percent for the last dose. The coverage for measles vaccine by age15 months is also high at 96 percent. As a result, the percentage of children who had received all eight recommended vaccinations is high at 81 percent. Oral Rehydration Treatment Overall, only 3 percent of under-5 children in Uzbekistan had had diarrhea in the two weeks preceding the survey. Approximately 79 percent of children with diarrhea received one or more of the recommend- ed home treatments (i.e., were treated with ORS or RHF), while 21 percent had received no treatment. However, only 17 percent children received increased ﬂ uids and at the same time continued feeding. Overall, 28 percent of children either received ORT or their ﬂ uid intake was in- creased, while feeding was continued, as is recommended. Care Seeking and Antibiotic Treatment of Pneumonia Only 2 percent of children aged 0–59 months were reported to have had symptoms of pneu- monia during the two weeks preceding the survey. Of these children, 68 percent were taken to an appropriate provider. Fifty-six percent of under-5 children with suspected pneumonia had received an antibiotic during the two weeks prior to the survey. Overall, only 15 percent of women knew of the two danger signs of pneumonia—fast and difﬁ cult breathing. Solid Fuel Use Only 16 percent of all households in Uzbekistan are using solid fuels for cooking. Among households using solid fuel, more than one third of them (35 percent) is using an open stove or ﬁ re with no chimney or hood while 54 percent is using an open stove or ﬁ re with a chimney or hood and only 10 percent is using a closed stove with chimney. Water and Sanitation Overall, 90 percent of the population has access to improved drinking water sources (piped water into a dwelling, yard or plot, public tap or standpipe, a borehole or tube-well, a pro- tected well, or a protected spring). Nearly all households (99 percent) in Uzbekistan use an appropriate water treatment method (the overwhelming majority use boiling) and there is no variation according to whether the household is using an improved or unimproved water source. $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 12 ! Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 Nearly all of the population of Uzbekistan is living in households using improved sanitation facilities. Overall, stools are disposed of safely for 59 percent of children aged 0–2 years. Contraception Use of contraception was reported by 65 percent of women currently married or in union. The most popular method is the IUD (Intrauterine Device) which is used by half of all mar- ried women in Uzbekistan. All of the remaining contraceptive methods have percentages not exceeding three percent. Only six percent of currently married women reported the use of traditional methods. Unmet Need Among all currently married women, only 8 percent has an unmet need for contraception (4 percent for spacing and 4 percent for limiting purposes). Overall, 89 percent of the demand for family planning is satisﬁ ed. Antenatal Care Coverage of antenatal care (by a doctor, nurse, or midwife) is nearly a standard in Uzbekistan with 99 percent of women receiving antenatal care at least once during pregnancy. Assistance at Delivery Almost every single birth occurring in the year prior to the survey was delivered by skilled personnel. For 95 percent of the deliveries in the year prior to the survey, medical doctors assisted with the delivery. Child Development For 71 percent of under-ﬁ ve children, an adult engaged in more than four activities that pro- mote learning and school readiness during the 3 days preceding the survey. The average num ber of activities that adults engaged with children was 4.4. Fathers’ involvement with one or more activities was 47 percent but the average number of activities that fathers engaged with children was 0.8. In Uzbekistan, 78 percent of children are living in households where at least 3 non-children’s books are present. However, only 43 percent of children aged 0–59 months have children’s books. The average number of non-children’s books is high (10 books) while the number of children’s books is low (2 books). One-third of children aged 0–59 months had three or more playthings to play with in their homes, while only 4 percent had none of the playthings. Pre-School Attendance and School Readiness Nearly 20 percent of children aged 36–59 months are attending pre-school. Overall, 34 percent of children who are currently age 6 and 26 percent of children aged 7 at- tending the ﬁ rst grade of primary school were attending pre-school the previous year. Primary and Secondary School Participation Among children who are of primary school entry age in Uzbekistan, 79 percent of those aged 7 are attending the ﬁ rst or second grade of primary school and 99 percent of those aged 8 are attending the ﬁ rst, second or third grade of primary school. $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 13 Overall, 96 percent of children of primary school age in Uzbekistan are attending primary school or secondary school. Only 7 percent of the children of secondary school age are not attending secondary school. Of all children starting grade one, nearly all of them will eventually reach grade ﬁ ve. 97 percent of the children of primary completion age (11 years) were attending the last grade of primary education. Gender parity for primary school is exactly 1.00, indicating no difference in the attendance of girls and boys at primary school. The indicator drops only very slightly to 0.98 for second- ary education. Adult Literacy In Uzbekistan, adult literacy is universal. Birth Registration The births of almost all children under ﬁ ve years in Uzbekistan have been registered. Child Labour Only 2 percent of children aged 5–14 are involved in child labour activities and for most of these children this activity is unpaid. Out of the 2 percent of the children classiﬁ ed as child labourers, the majority of them are also attending school (93 percent). Early Marriage Only ﬁ ve percent of women 15–19 years are currently married in Uzbekistan. Among women 15–49 years, less than one percent was married before age 15 and, among women 20–49 years nearly 13 percent was married before age 18. Child Disability Of children aged 2–9, only 2 percent is reported by their mother or caretaker as having at least one disability. For none of the disability types asked about in the questionnaire, did the percentage of children with that particular disability exceed 1 percent. Orphans and Vulnerable Children Overall, 91 percent of children aged 0–17 are living with both parents, 6 percent are living with the mother only, 1 percent with father only and 2 percent with neither biological parent. Knowledge of HIV Transmission and Condom Use Of the interviewed women, 48 percent reject the two most common misconceptions and know that a healthy-looking person can be infected. Overall, 60 percent of women report knowing two prevention methods. Only 31 percent of young women (15–24 years) have comprehensive and accurate knowledge of HIV. Overall, 92 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 73 percent, while 5 percent of women did not know of any speciﬁ c way. More than half of all women know where to be tested for HIV (55 percent), while 33 percent have actually been tested. $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 14 ! Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 1. INTRODUCTION Background This report is based on the Uzbekistan Multiple Indicator Cluster Survey (MICS), conducted in 2006 by the State Statistical Committee of the Republic of Uzbekistan, with the support of its regional-level ofﬁ ces. The survey provides valuable information on the situation of children and women in Uzbekistan, 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 Ses- sion 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 as- signed a supporting role in this task (see table 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: “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 subnational 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 speciﬁ c 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.” Over the past years, the Uzbekistan government has increased its political commitment and capacity in undertaking social reforms in line with the realization of the Millennium Devel- opment Goals (MDGs) and the rights of children and women. As a signatory to the Millen- nium Declaration, Uzbekistan is fulﬁ lling its promises to address the challenges outlined in the MDGs. The Government recognizes the relevance and seriousness of these challenges in the national development context. The Government, in collaboration with the donor community and civil society, has embarked on the process of formulating its own national MDG targets and indicators. The national experts’ team made major steps in analyzing the development context Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 15 for each goal by setting appropriate baselines and indicators. The Government recognizes, in particular, the successful adaptation and integration of MDGs into the interim—Welfare Im- provement Strategy Paper (i-WISP). Additional work is needed to institutionalize monitoring and reporting. Since the purpose of both the national MDGs and the country’s i-WISP is im- proving living standards, the MDG and i-WISP formulations complement each other, especially during the discussion processes. MDGs set a speciﬁ c framework for the i-WISP formulation as well as beneﬁ ting wider national ownership. The completion of the 2006 MICS will comple- ment this strategically related work by providing updated baseline data for future planning and implementation by all stakeholders and duty-bearers. It is expected that the MICS 2006 ﬁ ndings will further enhance the evidence based policy planning and analysis of the Government, thus, contributing to more systematic policy development and its implementation towards the MDGs and A World Fit For Children (WFFC). This ﬁ nal report presents the results of the indicators and topics covered in the survey. Survey Objectives The 2006 Uzbekistan Multiple Indicator Cluster Survey has as its primary objectives: To provide up-to-date information for assessing the situation of children and women in Uz- bekistan; To furnish data needed for monitoring progress toward goals established in the Millennium Development Goals, the goals of A World Fit For Children, and other internationally agreed upon goals, as a basis for future action; To contribute to the improvement of data and monitoring systems in Uzbekistan and to strengthen technical expertise in the design, implementation, and analysis of such systems. $ $ $ 10.198 households were successfully interviewed. 4.986 questionnaires for children under age ﬁ ve and 13.919 questionnaires for women aged 15–49 were ﬁ lled. © U N IC EF /U zb ek is ta n/ 20 06 /R ez a H os sa in i Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 17 2. SAMPLE AND SURVEY METHODOLOGY Sample Design The sample for the Uzbekistan Multiple Indicator Cluster Survey was designed to provide es- timates for a large number of indicators on the situation of children and women at the national level, for urban and rural areas, and for six geo-economical regions of the country, as follows: Regions were identiﬁ ed as the main sampling domains and the sample was selected in three stages. At the ﬁ rst stage, 375 primary sampling units were selected with probability propor- tional to size from a master frame of 14,799 enumeration areas called “mahala” produced by a countrywide population review, conducted by the State Statistical Committee (SSC) in 2002. The list of selected enumeration areas served as the frame for the second stage of selection. Each enumeration area was assigned a measure of size equal to the desired number of “stand- ard segments” it contains by dividing the population size of the enumeration area by 500 and rounding to the nearest whole number. One segment was randomly selected on the basis of a sketch-map prepared for each enumeration area. After a household listing was carried out within the selected segments, a systematic sample of 10,505 households was drawn. All selected enumeration areas were successfully visited. The distribution of clusters between sampling domains is not proportional to the distribution of population and, consequently neither is the ﬁ nal household distribution. The sample is there- fore not a self-weighting household sample. For reporting national level results, sample weights are used. A more detailed description of the sample design can be found in Appendix A. Republic of Karakalpakstan Khorezm Bukhara Navoi Samarkand Kashkadarya Andizhan Namangan Fergana Syrdarya Jizzakh Tashkent Tashkent city Surkhandarya # Western # Central # Southern # Central-Eastern # Eastern # Tashkent city 18 ! Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 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 children under 5 living in the household. A Steering Committee coordinated selection of the most important topics to be covered by the survey and ﬁ nal adjustment of the questionnaires to reﬂ ect issues relevant to Uzbekistan regarding population, women and children’s health, family planning and other health issues. The Household Questionnaire included the following modules: Household Listing Education Water and Sanitation Household Characteristics Child Labour Disability Maternal Mortality Salt Iodization The Questionnaire for Individual Women was administered to all women aged 15–49 years living in the households, and included the following modules: Child Mortality Maternal and Newborn Health Marriage and Union Contraception Sexual Behaviour HIV knowledge The Questionnaire for Children Under Five was administered to mothers or caretakers of children under 5 years of age1 living in the households. Normally, the questionnaire was admin- istered to mothers of under-5 children; in cases when the mother was not listed in the household roster, a primary caretaker for the child was identiﬁ ed and interviewed. The questionnaire in- cluded the following modules: Birth Registration and Early Learning Child Development Vitamin A Breastfeeding Care of Illness Immunization Anthropometry The questionnaires are based on the MICS3 (MICS 3rd Phase) model questionnaire2. The questionnaires were translated into Uzbek and Russian from the MICS3 model English ver- sion and were pre-tested in one urban area of Tashkent city and one rural area of the Zang- iatinsky rayon of Tashkent oblast during January 2006. Twenty eight persons, expected to act as ﬁ eldwork supervisors and editors during the main ﬁ eldwork, were trained for eight days, including a two-day ﬁ eldwork exercise to conduct interviews in both Uzbek and Russian. At this time weight measurements were also taken. Participants conducted interviews working in teams composed of two people, which allowed them to observe and support each other. A 1 The terms “children under 5”, “children age 0–4 years”, and “children aged 0–59 months” are used interchangeably in this report. 2 The model MICS3 questionnaire can be found at www.childinfo.org, or in UNICEF, 2006. $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 19 total of 117 household interviews were conducted, including completion of the 146 individual women’s questionnaire and 55 questionnaires for children under-5. Each team performed ﬁ ve to ten household interviews. After the completion of the ﬁ eld exercise one day was dedicated to reviewing survey questionnaires and discussing issues and concerns which participants met during the interviews. Based on the results of the pre-test, modiﬁ cations were made to the wording and translation of the questionnaires. A copy of the Uzbekistan MICS questionnaires is provided in Appendix F. There were a number of additions made to the Uzbekistan MICS questionnaires compared to the model MICS questionnaires. These were particularly related to education levels of population and pregnancy outcomes. In addition to the administration of questionnaires, ﬁ eldwork teams tested the salt used for cooking in the households for iodine content, and measured the weights and heights of children age under 5 years. Details and ﬁ ndings of these measurements are pro- vided in the respective sections of the report. Training and Fieldwork The ﬁ eld staff was trained for 10 days in early March 2006. A total of 92 participants were trained as ﬁ eld staff supervisors, editors and interviewers. Only female candidates were select- ed for the positions of interviewers and ﬁ eld editors. Males were recruited to act mainly as ﬁ eld supervisors. Training included plenary presentations, demonstrations and discussions. These were supplemented by small group activities such as role playing, mock interviews, discussions and performing, anthropometric measurements and iodine tests. A separate exercise to stand- ardise anthropometric measurements was conducted in three Tashkent kindergartens. Resource people from Ministry of Health, UNFPA and UNICEF made presentations on the country’s programmes in family planning, maternal and child health, HIV/AIDS and salt iodi- zation. In addition to in-class training, participants practiced their interviewing skills during a two days ﬁ eldwork exercise. Once completed, a ﬁ nal session was held to address any lasting concerns or issues that would be faced in the ﬁ eld. Participants selected as ﬁ eld supervisors and editors were given an additional two days of training on the topic of how to supervise ﬁ eldwork and edit questionnaires. The data was collected by 15 teams; each comprising three to four female interviewers, one female editor/measurer, one supervisor and one driver. Senior staff from the State Statistical Committee and two national ﬁ eldwork coordinators coordinated and supervised the ﬁ eld work activities. An external supervision programme was set up to monitor and provide assistance to the survey ﬁ eld work activities. Fieldwork began in the middle of March 2006 and was concluded in the middle of May 2006. Data Processing Data were entered on six microcomputers using the CSPro software and carried out by 9 data entry operators and 2 data entry supervisors. In order to ensure quality control, double entry of questionnaires and internal consistency checks were performed. Procedures and standard pro- grams developed under the global MICS3 project and adapted to the Uzbekistan questionnaire were used throughout. An additional set of data quality control tables was developed by the data collection team and was used throughout the data entry to monitor the quality of incoming data and provide feedback to data collection teams. Data processing began simultaneously with data collection in April 2006 and was completed in early June 2006. Data were analysed using the SPSS (Statistical Package for Social Sciences) software program, Version 14, and the model syntax and tabulation plans developed by UNICEF for this purpose. 53.190 households’ members were listed. Of these, 26.578 were males, and 26.611 were females. The survey estimated average household size is at 5.2. © U N IC EF /U zb ek is ta n/ 20 06 /B ob ur T ur di ev Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 21 3. SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS Sample Coverage Of the 10,505 households selected for the sample, 10,349 were found to be occupied. Of these, 10,198 were successfully interviewed resulting in a household response rate of 98.5 percent. In the interviewed households, 14,205 women (age 15–49) were identiﬁ ed. Of these, 13,919 were suc- cessfully interviewed, yielding a response rate of 98 percent. In addition, 5,039 children under age ﬁ ve were listed in the household questionnaire. Questionnaires were completed for 4,986 of these children, which corresponds to a response rate of 98.9 percent. Overall response rates of 96.6 and 97.5 are calculated for the women’s and under-5’s interviews respectively (Table 1). There are no signiﬁ cant differences in response rates according to regions and urban rural residence. Household, woman and children questionnaires’ response rates are all 95 percent or higher across different regions and urban and rural areas. Characteristics of Households The age and sex distribution of the survey population is provided in Table 2. The distribution is also used to produce the population pyramid in Figure 1. In the 10,198 households successfully interviewed in the survey, 53,190 household members were listed. Of these, 26,578 were males, and 26,611 were females. The survey estimated ﬁ gures also indicate that the survey estimated the average household size at 5.2. Table 3 provides basic background information on the households. Within households, the sex of the household head, region, urban/rural status, number of household members, and moth- er tongue of household head3 are shown in the table. These background characteristics are also used in subsequent tables in this report; the ﬁ gures in the table are also intended to show the numbers of observations by major categories of analysis in the report. The weighted and unweighted numbers of households are equal, since sample weights were normalized (See Appendix A). The table also shows the proportions of households with at least one child under 18 (81%), at least one child under 5 (37%), and at least one eligible woman age 15–49 (89%). The majority of the household heads are males (82%). As a result of the distribu- tion of the population across regions and urban and rural residence, the highest percentage of households in the sample is from the Eastern region (28%) and rural areas (62%). In four out of ﬁ ve households, the mother tongue of the household head is Uzbek. Characteristics of Respondents Tables 4 and 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. 3 This was determined by asking the mother tongue/native language of the head of the household in Household Question- naire. 22 ! Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 Table 4 provides background characteristics of female respondents 15–49 years of age. The table includes information on the distribution of women according to region, urban-rural areas, age, marital status, motherhood status, education4, wealth index quintiles5, and mother tongue of the household head. Reﬂ ecting the results of high fertility rates in the past, there are proportionally more younger than older women and the proportion of respondents in each age group generally declines as age increases. Sixty-four percent of all women were currently married at the time of the survey and ﬁ ve percent were formerly married. As expected, most women reside in rural areas (69 percent) and the highest proportion was living in the Eastern region (29 percent) followed by the Central region (21 percent). Table 4 shows that primary education is almost universal in Uzbekistan and a large majority of women have also completed secondary school; 46 percent of women have completed secondary education and 25 percent completed secondary special, while only eight percent have received higher education. The distribution of women according to wealth quintiles implies nearly equal proportions for each category. As regards mother tongue of the household head, for 85 percent of women it is Uzbek while other languages like Russian, Kara- kalpak, and Tajik are also reported as the mother tongue of the household head. 4 Unless otherwise stated, “education” refers to educational level attended by the respondent throughout this report when it is used as a background variable. 5 Principal components analysis was performed by using information on the ownership of household goods and amenities (as- sets) to assign weights to each household asset, and obtain wealth scores for each household in the sample (The assets used in these calculations were as follows: main material of the dwelling ﬂ oor, main material of the roof, main material of the walls, type of fuel used for cooking, availability of electricity, radio, TV, mobile telephone, non-mobile telephone, refrigera- tor, electric water boiler, table, chair, mirror, washing machine, vacuum cleaner, video player/DVD player, armoire, set of furniture, watch, bicycle, motorcycle or scooter, animal-drawn cart, car or truck, computer, tractor/combine, land that can be used for agriculture, cattle, milk cows or bulls, horses/donkeys/mules, camels, goats, sheep, chickens, rabbits, source of drinking water, and type of sanitary facility). Each household was then weighted by the number of household members, and the household population was divided into ﬁ ve groups of equal size, from the poorest quintile to the richest quintile, based on the wealth scores of households they were living in. It is assumed that the captures 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, 2001. Figure 1. Age and sex distribution of household population, Uzbekistan, 2006 70+ 65–69 60–64 55–59 50–54 45–49 40–44 35–39 30–34 25–29 20–24 15–19 10–14 5–9 0–4 1 Males Females 23456 0 543210 6 Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 23 The weighted and unweighted numbers of observations by regions and residences are in the expected direction and reﬂ ect the deliberate effort of over- and under-sampling of households as a sampling strategy. With regard to other background characteristics, weighted and unweighted numbers of observations do not differ signiﬁ cantly except for wealth and education. Some background characteristics of children under 5 are presented in Table 5. These include distribution of children by several attributes: sex, region and area of residence, age in months, mother’s or caretaker’s education, wealth, and mother tongue of the household head. Most children reside in rural areas (71 percent) and the highest proportion is in the Eastern region (27 percent) followed by the Central (22 percent) and Southern (21 percent) regions. With reference to mother’s education, 49 percent of the children’s mothers have completed secondary school and 28 percent have completed secondary special. The distribution of children accord- ing to wealth quintiles shows a slightly higher proportion for the poorest category and a slightly lower proportion for richest category compared to the others. One of the overarching goals of the MDGs and the WFFC is to reduce infant and under ﬁ ve mortality. The infant mortality rate is estimated at 48 per thousand and the under ﬁ ve mortality rate is 57 per thousand. © U N IC EF /U zb ek is ta n/ 20 07 /B rig itt e Br ef or t Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 25 4. CHILD MORTALITY One of the overarching goals of the MDGs and the WFFC is to reduce infant and under-ﬁ ve mortality. Speciﬁ cally, the MDGs call for the reduction of under-ﬁ ve mortality by two-thirds between 1990 and 2015. Monitoring progress towards this goal is an important but difﬁ cult 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 de- veloped to measure child mortality produce robust estimates that are comparable with those obtained from other sources. Indirect methods minimize the pitfalls of memory lapses, inexact or misinterpreted deﬁ nitions, and poor interviewing technique. The infant mortality rate is the probability of a child dying before the ﬁ rst birthday. The un- der-ﬁ ve mortality rate is the probability of a child dying before the ﬁ fth birthday. In the MICS surveys, infant and under ﬁ ve 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 ﬁ ve year age groups of women from age 15 to 49, and the proportion of these children who are dead, also for ﬁ ve-year age groups of women. 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 in- formation on mortality in Uzbekistan, the East model life table was selected as the most appro- priate pattern and age groups 25–29 and 30–34 were used to produce the mortality estimates6. Recent infant mortality estimates for Uzbekistan are available from three other national- level surveys: the 2002 Uzbekistan Health Examination Survey (UHES), the 2000 Multiple Indicator Cluster Survey (MICS), and the 1996 Uzbekistan Demographic and Health Survey (UDHS). All of these surveys used the World Health Organization’s deﬁ nitions of live birth and child death. Mortality rates were calculated directly by using pregnancy histories of women in the 1996 UDHS and the 2002 UHES while MICS 2000 and MICS 2006 used indirect methods of calculation. Infant mortality estimates from all these sources are shown in Figure 2. 6 In MICS 2000, the age groups used for producing the mortality estimates were 20–24 and 25–29. Considering the declin- ing fertility trends in Uzbekistan and in all other countries, it was decided in the third round of MICS to use 25–29 and 30–34 age groups for producing estimates. Figure 2. Infant mortality rate estimates, Uzbekistan, 1996–2006 UDHS 1996 MICS 2000 UHES 2002 MICS 2006 Male MICS 2006 Female MICS 2006 0 20 40 60 80 per 1000 49.1 52.0 61.7 48.0 56.0 40.0 26 ! Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 The trend in infant mortality based on survey data suggests that there has been a relatively slow change in infant mortality over the past ten years taking into account the broad conﬁ dence inter- vals common for mortality estimates. There are also differences between the registered mortality rates and the survey ﬁ ndings. The existing discrepancy between registered infant mortality rates and survey data may be partially explained by the fact that ofﬁ cial estimates of infant mortality use protocols established during the Soviet time, which do not consider newborns less than 999 grams in weight, those born before 28 weeks of pregnancy and those who do not manifest vital signs other than breath, as live births. At the same time, there is a persistent gap in the registration of births particularly for the ﬁ rst six months of a child’s life (Aleshina and Redmond, 2003). In addition to the differences in deﬁ nitions between the surveys and the registration system, there are differences in the methodology of data collection. In all the surveys mentioned above, information about births and child deaths was obtained from the mother. In contrast, the registra- tion system requires that either a health ofﬁ cial or a family member registers the births or death. Recent under-5 mortality estimates for Uzbekistan are also available from the 2002 UHES and the 2000 MICS (Figure 3). Although the under-5 mortality remained at around 70 per 1,000 in the ﬁ rst years of this decade, this survey implies an important drop in the under-5 mortality rate compared to the previous MICS. Further qualiﬁ cation of these apparent declines and differ- ences as well as its determinants should be taken up in a more detailed and separate analysis. Table 6 provides estimates of child mortality by various background characteristics. The infant mortality rate is estimated at 48 per thousand, while the under-5 mortality rate is 57 per thousand. These estimates have been calculated by averaging mortality estimates obtained from women age 25–29 and 30–34, and refer to mid 2002. There is some difference between the probabilities of dying among males and females. In Uzbekistan, male children experience higher mortality than female children. Nationally, the Karakalpakstan Khorezm Bukhara Navoi Samarkand Kashkadarya Andizhan Namangan Fergana Syrdarya Jizzakh Tashkent Tashkent city Surkhandarya # 63 # 54 # 52 # 45 # 34 # 28 Infant mortality rate, per 1000 Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 27 level of infant mortality is 56 per 1,000 for males and 40 per 1,000 for females. Thus, infant deaths are 42 percent more likely among males than females. Excess male mortality during the ﬁ rst year of life is widespread in the European region and substantial in the countries of Central Asia and the Caucasus region where the ofﬁ cial statistics show a male to female infant mortality ratio of 1.34 (WHO, 2006a). These ﬁ ndings need further analysis taking into consideration the higher than expected differentials. Underreporting of female children deaths might be one of the reasons for such gender differentials (Aleshina and Redmond, 2003). Infant and under-5 mortality rates are lowest in the Central-Eastern region (28 and 31 per 1,000) and Tashkent (34 and 39 per 1,000), while the highest ﬁ gures are registered in the South- ern region (63 and 76 per 1,000). While there are differentials in infant mortality by education level of the mother, differentials by residence are not very high in Uzbekistan; children born in rural areas have a 14 percent higher probability of dying before their ﬁ rst birthday compared to those born in urban areas. There are signiﬁ cant differences in mortality in terms of wealth—the probability of dying among infants and under-5s living in the richest households is almost one- fourth lower then for children living in the poorest households. Differentials in under-5 mortal- ity rates by background characteristics are also shown in Figure 4. Figure 4. Under-5 mortality rates by background characteristics, Uzbekistan, 2006 0 20 40 60 80 per 1000 U zb ek is ta n Ri ch es t 4 0% Po or es t 6 0% H ig he r E du ca tio n Se co nd ar y Sp ec ia l Co m pl et e Se co nd ar y In co m pl et e Se co nd ar y Ru ra l U rb an Ta sh ke nt C ity Ea st er n Ce nt ra l-E as te rn So ut he rn Ce nt ra l W es te rn Wealth Quintiles Mother’s Education Area Regions 63 46 57 32 54 61 58 59 51 39 52 31 76 61 6 5 Figure 3. Under-5 mortality rates, Uzbekistan, 2000–2006 MICS 2000 69.0 UHES 2002 73.3 MICS 2006 57.0 0 20 40 60 80 per 1000 4.986 children aged under ﬁ ve were measured for height and weight during the survey to deﬁ ne their nutritional status. © U N IC EF /U zb ek is ta n/ 20 06 /K on st an tin M yn ai ch en ko Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 29 5. NUTRITION Nutritional Status Children’s nutritional status is a reﬂ ection of their overall health. When children have access to an adequate food supply, are not exposed to repeated illness, and are well cared for, they reach their growth potential and are considered well nourished. Malnutrition is associated with more than half of all children deaths worldwide. Under- nourished children are more likely to die from common childhood ailments, and those who survive are more likely to have recurring sicknesses and faltering growth. Three-quarters of the children who die from causes related to malnutrition were only mildly or moderately malnour- ished—showing no outward sign of their vulnerability. The Millennium Development target is to reduce by half the proportion of people who suffer from hunger between 1990 and 2015. The World Fit for Children goal is to reduce the prevalence of malnutrition among children under ﬁ ve years of age by at least one-third (between 2000 and 2010), with special attention to chil- dren under 2 years of age. A reduction in the prevalence of malnutrition will assist in the goal of reducing child mortality. In a well-nourished population, there is a reference distribution of height and weight for chil- dren under age ﬁ ve. Under-nourishment in a population can be gauged by comparing children to a reference population. The reference population used in this report is the WHO/CDC/NCHS reference, which was recommended for use by UNICEF and the World Health Organization at the time the survey was implemented. Each of the three nutritional status indicators can be expressed in standard deviation units (z-scores) from the median of the reference population. Weight-for-age is a measure of both acute and chronic malnutrition. Children whose weight- for-age is more than two standard deviations below the median of the reference population are considered moderately or severely underweight while those whose weight-for-age is more than three standard deviations below the median are classiﬁ ed as severely underweight. Height-for-age is a measure of linear growth. Children whose height-for-age is more than two standard deviations below the median of the reference population are considered short for their age and are classiﬁ ed as moderately or severely stunted. Those whose height-for-age is more than three standard deviations below the median are classiﬁ ed as severely stunted. Stunting is a reﬂ ection of chronic malnutrition as a result of failure to receive adequate nutrition over a long period and recurrent or chronic illness. Figure 5. Prevalence of malnutrition, Uzbekistan, 1996–2006 O Underweight O Stunting O Wasting UDHS 1996 31.2 UHES 2002 MICS 2006 0 10 20 30 40 Percent 18.8 11.6 21.1 14.6 7.9 5.17.1 3.3 30 ! Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 Figure 6. Percentage of children aged 0–59 months who are undernourished, Uzbekistan, 2006 O Underweight O Stunting O Wasting 24–35 36–47 48–59< 6 6–12 12–23 0 2 4 6 8 Percent 10 12 14 16 18 Finally, children whose weight-for-height is more than two standard deviations below the median of the reference population are classiﬁ ed as moderately or severely wasted, while those who fall more than three standard deviations below the median are severely wasted. Wasting is usually the result of a recent nutritional deﬁ ciency. The indicator may exhibit signiﬁ cant sea- sonal shifts associated with changes in the availability of food or disease prevalence. In MICS, the weight and height of all children under 5 years of age was measured using an- thropometric equipment recommended by UNICEF (UNICEF, 2006). Findings in this section are based on the results of these measurements. For all the three indicators, considerable drops were observed during the last 10 years (see Figure 5). The prevalence of underweight children decreased down from 19 to 5 percent, stunt- ing from 31 to 15 percent, and wasting from 12 percent to 3 percent. Table 7 shows percentages of children classiﬁ ed into each of these categories, based on the anthropometric measurements taken during ﬁ eldwork. Additionally, the table includes the per- centage of children who are overweight, which takes into account those children whose weight for height is above 2 standard deviations from the median of the reference population. In Table 7, children who were not weighed and measured (approximately 2 percent of chil- dren) and those whose measurements are outside a plausible range are excluded. Almost one in twenty children under age ﬁ ve in Uzbekistan are moderately underweight (5 per- cent) and one percent are classiﬁ ed as severely underweight (Table 7). Fifteen percent of children are stunted or too short for their age and four percent are severely stunted, indicating the prevalent fail- ure to receive adequate nutrition over a long period. Three percent of children under-5 are wasted or too thin for their height. It is estimated that about seven percent of children under-5 are overweight. Children from the Southern and Eastern regions are more likely to be underweight (7 and 6 percent accordingly) while stunting is more prevalent in Western (18 percent), Eastern (17 per- cent), Southern (16 percent) and Central-Eastern regions (15 percent). In contrast, the percent- age of children who display wasting is highest in the Central region (6 percent). Those children whose mothers have secondary special or higher education are the least likely to be underweight Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 31 and stunted compared to children of mothers with incomplete or complete secondary educa- tion. Girls appear to be slightly more likely to be underweight and stunted than boys, but the latter are slightly more exposed to wasting. The age pattern shows that a higher percentage of children aged 12–23 months are undernourished according to all three indices in comparison to children who are younger and older (Figure 6). This pattern is expected and is related to the age at which many children cease to be breast- fed and are exposed to contamination in water, food, and the environment. The wealth of the household and mother tongue of household head are also important determinants of the nutri- tional status of the children. Those living in the wealthier households are less exposed to mal- nourishment. Children from the households where the mother language of the household head is Karakalpak are the most exposed to moderate (27 percent) and severe stunting (8 percent). Breastfeeding Breastfeeding for the ﬁ rst 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 faltering growth 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 up to 2 years of age and beyond. WHO/UNICEF have the following feeding recommendations: Exclusive breastfeeding for the ﬁ rst 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 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 8 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 (including those who started within one hour). More than two-thirds (67 percent) of women with a live birth in the two years preceding the survey started breastfeeding as early as within one hour of birth and only 15 percent did not begin breast feeding within one day of birth. Except for regions and mother tongue of household head there were no marked variations among population subgroups with respect to starting breastfeeding within one hour of birth. The Central region had the low- est proportion (50 percent) while the Eastern region had the highest (77 percent). Differences by mother tongue of household head may be due to the low number of observations for some categories but when the household head’s mother tongue is Karakalpak the proportions were quite high (87 percent for starting breastfeeding within one hour and 98 percent for starting within one day) while if it is Russian the proportions were as low as 51 percent and 75 percent, $ $ $ $ $ $ $ $ $ $ Exclusive breastfeeding during ﬁ rst six months and continued for the next two years of life protects children from infections, provides an ideal source of nutrients, and is economical and safe. © U N IC EF /U zb ek is ta n/ 20 07 /B rig itt e Br ef or t Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 33 respectively (Figure 7). Overall, variations among background characteristics are smaller in case of breastfeeding started within one day of birth. In Table 9, breastfeeding status is based on the reports of mothers/caretakers regarding chil- dren’s consumption of food and ﬂ uids in the 24 hours prior to the interview. Exclusively breast- fed refers to infants who received only breast milk (and vitamins, mineral supplements, or medicine). The table shows exclusive breastfeeding of infants during the ﬁ rst six months of life (separately for 0–3 months and 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. Despite the high prevalence of breastfeeding of newborns, the majority of infants are not fed in compliance with WHO/UNICEF recommendations. Exclusive breastfeeding, which should continue until age six months, is not very common in Uzbekistan. Approximately 26 percent of children aged less than six months are exclusively breastfed, a level considerably lower than recommended. At age 6–9 months, 45 percent of children are receiving breast milk and solid or semi-solid foods. By age 12–15 months, 78 percent of children are still being breastfed and by age 20–23 months, 38 percent are still breastfed. There is no difference between boys and girls with regard to exclusively breastfeeding. Continued breastfeeding of infants after one year of age is more common among women living in rural areas and those who classiﬁ ed as poorer according to the wealth index quintiles. Also, among women where the mother tongue of the household head is Uzbek, continued breastfeeding is more common compared to other language groups. The adequacy of infant feeding in children under 12 months is provided in Table 10. Differ- ent 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. Table 10 shows that the proportion of infants age 6–8 months who are adequately fed is 30 percent Figure 7. Percentage of mothers who started breastfeeding within one hour and within one day of birth, Uzbekistan, 2006 O Within one day O Within one hour Uzbek Tajik Urban 0 10 20 30 40 Percent 50 60 70 80 90 100 Russian Karakalpak Other Rural Uzbekistan 85 75 68 98 87 79 90 85 85 85 51 53 82 69 66 67 34 ! Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 and for those age 9–11 months the proportion is only 28 percent. The ﬁ gures imply that the feeding practices with the introduction of complementary foods do not improve after the age of six months. As the age of the infant increases, higher percentages are observed with regard to adequate feeding for females, for those living in urban areas, Tashkent city, the Central-East- ern, and Eastern regions, and for those living in richer households. As a result of these feeding patterns, only 29 percent of children aged 6–11 months are being adequately fed. Adequate feeding among all infants (aged 0–11) drops to 28 percent. When infants age 6–11 months and all infants aged under one year are considered, females and those living in urban and the Cen- tral-Eastern and Eastern regions have higher percentages of appropriate feeding. Salt Iodization Iodine Deﬁ ciency Disorders (IDD) is the world’s leading cause of preventable mental retar- dation and impaired psychomotor development in young children. In its most extreme form, iodine deﬁ ciency causes cretinism. It also increases the risks of stillbirth and miscarriage in pregnant women. Iodine deﬁ ciency 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 interna- tional goal is to achieve sustainable elimination of iodine deﬁ ciency by 2005. The indicator is the percentage of households consuming adequately iodized salt (>15 parts per million). The production of Iodized salt in Uzbekistan commenced in 1998, as a measures to elimi- nate Iodine Deﬁ ciency. Iodine as a fortiﬁ cant comes from potassium iodate, which has been distributed by the Institute of Endocrinology and the Ministry of Health, with the assistance of UNICEF and the Asian Development Bank, who also provided equipment for iodination and established national mechanism for systematic supply with potassium iodate. In a framework of Karakalpakstan Khorezm Bukhara Navoi Samarkand Kashkadarya Andizhan Namangan Fergana Syrdarya Jizzakh Tashkent Tashkent city Surkhandarya Percentage of households consuming adequately iodized salt by oblast # 20.0–39.9 # 40.0–59.9 # 60.0–79.9 # 80.0–90.0 Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 35 Universal Salt Iodination advocacy campaign in Uzbekistan, a number of salt producers were equipped with the laboratories and trained in monitoring of the quality of process. During the campaign, UNICEF and the Ministries of Public Education and Health conducted a series of health lessons at about 10.000 schools with participation of more than 2 million children. By the middle 2005, there are 62 salt producing companies in Uzbekistan, where iodized salt is being produced at 26 enterprises. They produced 91,486 tons of salt in 2004. According to the survey conducted by the Institute of Endocrinology in 2005, the adequate provision of iodized salt are 56% and 63% of population have access to iodized salt. The Uzbekistan Senate approved the IDD law on the 29th of March 2007. UNICEF will work with the MOH & state standard committee to revise existing rules and regulations on sales of none iodized salt, monitoring and quality control, import of the potassium iodate. In about 99 percent of households, salt used for cooking was tested for iodine content by using salt test kits and testing for the presence of potassium iodate. Table 11 shows that in 53 percent of households, salt was found to contain 15 PPM or more of iodine. This indicates the signiﬁ cant progress made over the past ﬁ ve years (19 percent in MICS 2000) (See also Figure 8). Use of iodized salt was lowest in the Eastern region (43 percent) and highest in the Tashkent city (71 percent). More than three-ﬁ fth (62 percent) of urban households were found to be using ad- equately iodized salt as compared to 48 percent in rural areas. There was an increasing trend in the use as the level of education of household head and the wealth of the household increased. Vitamin A Supplements Vitamin A is essential for eye health and proper functioning of the immune system. It is found in foods such as milk, liver, eggs, red and orange fruits, red palm oil and green leafy vegetables, although the amount of vitamin A readily available to the body from these sources varies widely. In developing areas of the world, where vitamin A is largely consumed in the form of fruits and vegetables, daily per capita intake is often insufﬁ cient to meet dietary requirements. Inadequate intakes are further compromised by increased requirements for the vitamin as children grow Figure 8. Percentage of households consuming adequately iodized salt, Uzbekistan, 2000–2006 O MISC 2006 O MISC 2000 Western Cental-Eastern Urban 0 10 20 30 40 Percent 50 60 70 80 Central Southern Eastern Rural Uzbekistan 44 53 69 50 43 62 48 53 71 24 16 19 Tashkent city 36 ! Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 or during periods of illness, as well as increased losses during common childhood infections. As a result, vitamin A deﬁ ciency is quite prevalent in the developing world and particularly in countries with the highest burden of under-ﬁ ve deaths. The 1990 World Summit for Children set the goal of virtual elimination of vitamin A deﬁ ciency and its consequences, including blindness, by the year 2000. This goal was also endorsed at the Policy Conference on Ending Hidden Hunger in 1991, the 1992 International Conference on Nutri- tion, and the United Nations General Assembly’s Special Session on Children in 2002. The critical role of vitamin A for child health and immune function also makes control of deﬁ ciency a primary component of child survival efforts, and therefore critical to the achievement of the fourth Millen- nium Development Goal: a two-thirds reduction in under-ﬁ ve mortality by the year 2015. For countries with vitamin A deﬁ ciency problems, current international recommendations call for high-dose vitamin A supplementation every four to six months, targeted at all children between the ages of 6 to 59 months living in affected areas. Providing young children with two high-dose vitamin A capsules a year is a safe, cost-effective, efﬁ cient strategy for eliminating vitamin A deﬁ - ciency and improving child survival. Giving vitamin A to new mothers who are breastfeeding helps protect their children during the ﬁ rst months of life and helps to replenish the mother’s stores of vitamin A, which are depleted during pregnancy and lactation. For countries with vitamin A sup- plementation programs, the deﬁ nition of the indicator is the percentage of children 6–59 months of age who have received at least one high dose vitamin A supplement in the last six months. Based on UNICEF/WHO guidelines, the Uzbekistan Ministry of Health recommends that chil- dren aged 6–11 months be given one high dose Vitamin A capsule and children aged 12–59 months given a vitamin A capsule every 6 months. In some parts of the country, Vitamin A capsules are linked to immunization services and are given when the child has contact with these services at six months of age. The MoH and UNICEF agreed on a “Prevention of the vitamin A deﬁ ciency” project in Uzbekistan and started the implementation of the program in 2003. This program is targeting children aged 6–59 months and is an integral part of the “Healthy Child Week” program which is conducted twice-yearly using the postnatal health services in all regions of the republic. The last tour of vitamin A supplementation campaign was carried out in February and August 2006. Within the six months prior to the MICS, 72 percent of children aged 6–59 months received a high dose Vitamin A supplement (Table 12). Approximately 6 percent had not received the sup- plement in the last 6 months but had received one prior to that time. Twelve percent of children received a Vitamin A supplement at some time in the past but their mother/ caretaker was un- able to specify when. For 3 percent of children, the mother could not remember if the child had received the supplement or not. Vitamin A supplementation coverage is highest in the Western region (95 percent) and lowest in Tashkent city (37 percent). The age pattern of Vitamin A supplementation shows that supplementation in the last six months drops from around 78 percent among children aged 6–11 and 12–23 months to 63 percent among children aged 48–59 months. The mother’s level of education does not seem to be related to the likelihood of Vitamin A supplementation. The percentage who received a supplement in the last six months was 65 percent among children whose mothers have higher education while for all other education categories the percentage was above 70 percent. Simi- larly, children living in richer households have the lowest percentage (56 percent) compared to all other groups but there was no clear trend. 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. Ba- Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 37 bies 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 per- formance in school and their job opportunities as adults. In the developing world, low birth weight stems primarily from the mother’s poor health and nutrition. Three factors have most impact: the mother’s poor nutritional status before con- ception, 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, dis- eases such as diarrhoea and malaria, which are common in many developing countries, can signiﬁ cantly 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 ﬁ nish growing run the risk of bearing underweight babies. The percentage of infants weighing below 2500 grams at birth 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 recollection of the child’s weight or the weight as recorded on a health card if the child was weighed at birth7 . Overall, nearly all infants were weighed at birth and approximately 5 percent were esti- mated to weigh less than 2500 grams (Table 13). There was only slight variation by region (Figure 9). The percentage of low birth weight was slightly higher among children living in poorer households. 7 For a detailed description of the methodology, see Boerma, Weinstein, Rutstein and Sommerfelt, 1996. Figure 9. Percentage of Infants weighting less than 2500 grams at birth, Uzbekistan, 2006 Western Cental-Eastern 0 1 2 3 4 Percent 5 6 7 8 Central Southern Eastern Uzbekistan 2.7 5.4 4.3 3.5 6.6 4.84.6 Tashkent city “.a World Fit For Children goal is to ensure full immunization of children under one year of age at 90 percent nationally…”. 81 percent of children in Uzbekistan received all eight recommended vaccinations. © U N IC EF /U zb ek is ta n/ 20 06 /R ez a H os sa in i Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 39 Immunization The Millennium Development Goal 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 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. According to UNICEF and WHO guidelines, a child should receive a BCG vaccination to pro- tect against tuberculosis, three doses of DPT to protect against diphtheria, pertussis, and tetanus, three doses of polio vaccine, and a measles vaccination. The vaccination schedule followed by the National Immunization Programme of Uzbekistan provides all vaccinations mentioned above as well as vaccinations against hepatitis B (three doses). In Uzbekistan, a polio vaccination is given right after birth (classiﬁ ed as Polio 0) and then three doses of Polio as well as DPT are given as in many other countries. All vaccinations should be received during the ﬁ rst year of life, with the exception of measles which is given soon after the age of 12 months. Taking into consideration this vaccination schedule, immunization coverage was estimated for the cohort 15–26 months of age, allowing a reasonable interval of three months for children to receive measles vaccine. Mothers were asked to provide vaccination cards for children under the age of ﬁ ve. If there was a card, interviewers copied vaccination information onto the MICS3 questionnaire. Over- all, 96 percent of children had cards (Table 14) but if there was no card, interviewers asked the mother questions about each vaccine separately. In Uzbekistan child health records, including vaccination cards, are routinely kept and updated in the local health facilities. Therefore inter- viewers were required to visit the health clinics near to the interview location and check the vaccination status of every child by completing a separate vaccination module on the question- naire regardless of the availability of a vaccination card at home or the mother’s report. The vaccination status of each child was then reconstructed using all three sources of information, giving priority to the records held at health facilities. The percentage of children aged 15 to 26 months who received each of the vaccinations is shown in Figure 10. Nearly all children aged 15–26 months received a BCG vaccination by the age of 12 months (99.2 %) and the ﬁ rst dose of DPT was given to 98 percent. The percentage declines for subse- quent doses of DPT to 95 percent for the second dose, and 90 percent for the third dose (Figure 10). Similarly, 96 percent received the ﬁ rst dose of Polio by age 12 months and this declines to 87 percent by the last dose. The coverage for measles vaccine by 15 months is also high at 96 percent. As a result, the percentage of children who had all eight recommended vaccinations is high at 81 percent. The corresponding ﬁ gure from MICS 2000 was 60 percent. The coverage of hepatitis B vaccine was analyzed separately since it was only recently in- troduced in Uzbekistan. Nearly all children (99 percent) aged 15–26 months had received the ﬁ rst dose of hepatitis B vaccine by the age of 12 months (Table not shown). As in the case of the polio and DPT coverage, the prevalence of subsequent doses of hepatitis B vaccine drops slightly to 94 percent for the second dose and 86 percent for the third dose. 6. CHILD HEALTH 40 ! Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 Tables 14 and 15 show vaccination coverage rates among children 15–26 months by back- ground characteristics. The ﬁ gures indicate children receiving the 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. There are no signiﬁ cant differences in vaccination coverage by sex. However, although the differences are not very high, it is interesting to note that vaccina- tion coverage is lower in urban areas, among children of women with higher education and those living in richer households. The overall high levels of immunization coverage for differ- ent vaccines are partly responsible for the small differentiations but it is clear that vaccination programs are more successful in rural or less developed areas. Oral Rehydration Treatment Diarrhoea is the second leading cause of death among children under ﬁ ve worldwide. Most diarrhoea-related deaths in children are due to dehydration from loss of large quantities of wa- ter and electrolytes from the body in liquid stools. Management of diarrhoea—either through oral rehydration salts (ORS) or a recommended home ﬂ uid (RHF)—can prevent many of these deaths. Preventing dehydration and malnutrition by increasing ﬂ uid 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 ﬁ ve by 2010 compared to 2000 (A World Fit for Children); and 2) reduce by two thirds the mortality rate among children under ﬁ ve by 2015 compared to 1990 (Millennium Development Goals). In addi- tion, 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 ﬂ uids) AND continued feeding 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 ques- tions 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. $ $ $ $ Percent Figure 10. Percentage of children aged 15–26 months who received the recommended vaccinations by 12 months, Uzbekistan, 2006 BCG DPT1 0 20 40 60 80 Polio1 Measles* 100 DPT2 DPT3 Polio2 Polio3 All 99 95 96 87 81 98 90 92 96 * By 15 months for measles vaccine Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 41 Overall, only 3 percent of children under ﬁ ve had diarrhoea in the two weeks preceding the survey (Table 16). Because of the low number of observations, Tables 16 and 17 are presented only with background characteristics sex and residence. Diarrhoea prevalence was similar in urban and rural residences and among males and females. Table 16 also shows the percentage of children receiving various types of recommended liquids during the episode of diarrhoea. Since mothers were able to name more than one type of liquid, the percentages do not necessarily add up to 100. About 28 percent received ﬂ uids from ORS packets; 36 percent received recommended home- made ﬂ uids, and 60 percent received pre-packaged ORS ﬂ uids. Approximately 79 percent of chil- dren with diarrhoea received one or more of the recommended home treatments (i.e., were treated with ORS or RHF), while 21 percent received no treatment. The low number of cases observed with diarrhoea during the two weeks preceding the survey also does not allow the analysis of the source and cost of supplies for oral rehydration salts. For about 39 percent of the diarrhoea cases who received ORS treatment the source is public without a cost involved while for 41 percent the source is private and the median cost is 200 UZS (Table not shown). About one third (34 percent) of children under ﬁ ve with diarrhoea drank more than usual while 62 percent drank the same or less (Table 17). Forty eight percent ate somewhat less, the same or more (continued feeding), but 49 percent ate much less or ate almost nothing. Given these ﬁ gures, only 17 percent of children received increased ﬂ uids and at the same time con- tinued feeding. Combining the information in Table 17 with those in Table 16 on oral rehydra- tion therapy, it is observed that 28 percent of children either received ORT or ﬂ uid intake was increased, and at the same time, feeding was continued, as is recommended. There are signiﬁ cant differences in the home management of diarrhoea by sex and residence. In rural areas, only 20 percent of children received ORT or increased ﬂ uids AND continued feeding, while the ﬁ gure is 31 percent in rural areas. A higher percentage of females received ORT or increased ﬂ uids AND continued feeding (34 percent versus 24 percent) (Figure 11). Care Seeking and Antibiotic Treatment of Pneumonia Pneumonia is the leading cause of death in children and the use of antibiotics in under-5s 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. Figure 11. Percentage of children aged 0–59 with diarrhoea who received ORT or increased � uids, AND continued feeding, Uzbekistan, 2006 Uzbekistan Male 0 5 10 15 20 Percent 25 30 35 40 Female Urban 28 34 24 31 20 Rural 42 ! Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 Children with suspected pneumonia are those who had an illness with a cough accompanied by rapid or difﬁ cult breathing and whose symptoms were not due to a problem in the chest or 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 This question was limited to children who had had suspected pneumonia within the previous two weeks and whether or not they had received an antibiotic within the previous two weeks. Table 18 presents the prevalence of suspected pneumonia and, if care was sought outside the home, the site of care. Only 2 percent of children aged 0–59 months were reported to have had symptoms of pneumonia during the two weeks preceding the survey. Of these children, 68 percent were taken to an appropriate provider. Because of the low number of cases with acute respiratory infection Table 18 is presented with only two background variables; sex and residence. It is evident that a higher proportion of children are taken to appropriate providers in urban areas. Table 19 presents the use of antibiotics for the treatment of suspected pneumonia in under-5s by sex, and residence. Because of the low number of children with suspected pneumonia, the table only presents differentiation by sex and residence. In Uzbekistan, 56 percent of under-5 children with suspected pneumonia had received an antibiotic during the two weeks prior to the survey. The percentage is higher among females and among children living in urban areas. For most of the cases (86 percent) the source of the antibiotics is the private sector. Those obtaining the antibiotics from public sources received them for free, while the median cost for obtaining the antibiotics from the private sector was 1000 UZS (Table not shown). Issues related to knowledge of the danger signs of pneumonia are presented in Table 20. Obvi- ously, mothers’ knowledge of the danger signs is an important determinant of care-seeking behav- iour. Overall, only 15 percent of women know the two danger signs of pneumonia—fast and dif- ﬁ cult breathing. The most commonly identiﬁ ed reason for taking a child to a health facility is the child developing a fever (94 percent). Thirty ﬁ ve percent of mothers identiﬁ ed fast breathing and 24 percent of mothers identiﬁ ed difﬁ cult breathing as symptoms for taking children immediately to a health care provider. There is signiﬁ cant variation by residence in recognizing the two danger signs of pneumonia. Half of the mothers/care takers in the Western region are able to recognize the two danger signs of pneumonia while this proportion is only 3 percent in the Eastern region and 6 percent in the Southern region. No signiﬁ cant differentiation is observed by residence. This percentage increases with increasing education level and socioeconomic status. Solid Fuel Use More than 3 billion people around the world rely on solid fuels (biomass and coal) for their ba- sic 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 risk of acute res- piratory illness, pneumonia, chronic obstructive lung disease, cancer, and possibly tuberculosis, low birth weight, cataracts, and asthma. The primary indicator is the proportion of the popula- tion using solid fuels as the primary source of domestic energy for cooking. Overall, only 16 percent of all households in Uzbekistan are using solid fuels for cooking (Table 21). Use of solid fuels is very low in urban areas (1 percent) compared to rural areas (25 percent). Differentials with respect to region and household wealth are also signiﬁ cant while $ $ $ $ Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 43 there are very small differences for different educational levels. The table clearly shows that the percentage becomes lower where there is signiﬁ cant use of natural gas and higher where wood is the main fuel used for cooking purposes. Solid fuel use alone is a poor proxy for indoor air pollution, since the concentration of the pol- lutants is different when the same fuel is burnt in different stoves or ﬁ res. The use of closed stoves with chimneys minimizes indoor pollution, while an open stove or ﬁ re with no chimney or hood provides no protection from the harmful effects of solid fuels. The type of stove used with solid fuel is depicted in Table 22. In Uzbekistan, among households using solid fuel, more than one third of them (35 percent) uses an open stove or ﬁ re with no chimney or hood, 54 percent an open stove or ﬁ re with chimney or hood and only 10 percent a closed stove with chimney. As expected, there are regional and residential differences in the use of solid fuels for cooking. In the western region, the majority of households using solid fuel is using closed stove with chimney (81 percent), while the most common use is open stove or ﬁ re with chimney or hood in the Southern region (77 percent) and open stove or ﬁ re without chimney or hood in the Central region (61 percent). No signiﬁ cant relationship is found by residence, education, or socioeconomic status. Karakalpakstan Khorezm Bukhara Navoi Samarkand Kashkadarya Andizhan Namangan Fergana Syrdarya Jizzakh Tashkent Tashkent city Surkhandarya Percentage of households used solid fuels for cooking # 0.1–9.9 # 10.0–19.9 # 20.0–29.9 # 30.0–40.0 Safe drinking water is a basic necessity for good health © U N IC EF /U zb ek is ta n/ 20 07 /B rig itt e Br ef or t Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 45 7. ENVIRONMENT Water and Sanitation Safe drinking water is a basic necessity for good health. Unsafe drinking water can be a sig- niﬁ cant 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 is particularly important for women and children, especially in rural areas, who bear the primary responsibility for carrying water, often for long distances. The MDG goal is to reduce by half, between 1990 and 2015, the proportion of people with- out sustainable access to safe drinking water and basic sanitation. The World Fit for Children goal calls for a reduction of at least one-third in the proportion of households without access to hygienic sanitation facilities and affordable and safe drinking water. The list of indicators used in MICS are as follows: Water Use of improved drinking water sources Use of an adequate water treatment method Time to the source of drinking water Person collecting drinking water Sanitation Use of improved sanitation facilities Sanitary disposal of children’s faeces The distribution of the population by source of drinking water is shown in Table 23 and Figure 12. The population using improved sources of drinking water are those who use any of the following types of supply: piped water (into dwelling, yard or plot) public tap/standpipe, borehole/tube-well, protected well, or protected spring. Overall, 90 percent of the population has access to improved drinking water sources—100 percent in urban areas and 85 percent in rural areas. The situation in the Southern region is considerably worse than in other regions; only 67 percent of the population in this region gets its drinking water from an improved source. $ $ $ $ $ $ Figure 12. Percentage distribution of household members by source of drinking water Uzbekistan, 2006 Tanker truck, 6% Other unimproved, 5% Piped into dwelling, yard or plot, 47% Public tap/standpipe, 23% Protected well or spring, 6% Tubewell/borehole, 13% 46 ! Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 The source of drinking water for the population varies signiﬁ cantly by region (Table 23). Use of water piped into dwellings is quite widespread in Tashkent city (80 percent) and 19 percent use water piped into their yard or plot as their drinking water. The second closest use of piped water, both into dwellings and yards/plots, is in the Central-Eastern region with 55.7 percent. In the Southern region, only 29 percent use piped water (either into the dwelling or the yard/plot) while 19 percent of population in the Southern region use water from tanker trucks as their drinking water (an unsafe source). The source of drinking water also varies signiﬁ cantly by household wealth. There is a strong positive association between the wealth of the household and the use of water piped into the dwelling. Use of in-house water treatment is presented in Table 24. Households were asked about ways they may be treating water at home to make it safer to drink—boiling, adding bleach or chlo- rine, using a water ﬁ lter, and using solar disinfection were considered appropriate treatment methods. The table shows the percentages of household members using each of these methods for households using improved and unimproved drinking water sources. Overall, nearly all households (99 percent) use an appropriate water treatment method (the overwhelming majority use boiling) and there is no variation according to whether the household is using an improved or unimproved water source. There is also no differentiation by background characteristics as almost all categories have very high levels of appropriate water treatment. The amount of time it takes to obtain water is presented in Table 25 and the person who usu- ally collects the water in Table 26. Note that these results refer to one roundtrip from home to the drinking water source. Information on the number of trips made in one day was not collected. Table 25 shows that for 60 percent of households, the drinking water source is on the premis- es. For a third of all households, it takes less than 30 minutes to get to the water source and bring water, while 7 percent of households spend 30 minutes to 1 hour for this purpose. Excluding those households with water on the premises, the average time to the source of drinking water Karakalpakstan Khorezm Bukhara Navoi Samarkand Kashkadarya Andizhan Namangan Fergana Syrdarya Jizzakh Tashkent Tashkent city Surkhandarya Proportion of households with pipe water # 20.0–29.9 # 30.0–39.9 # 40.0–49.9 # 50.0–59.9 # 60.0–69.9 # 70.0–100.0 Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 47 is 15 minutes. The time spent in urban and rural areas in collecting water does not differ signiﬁ - cantly. There are slight differences in the average time to the source of drinking water by region but the differences are negligible for education, and wealth level of the household. Table 26 shows that for the majority of households, an adult female is usually the person collect- ing the water (58 percent), when the source of drinking water is not on the premises. Adult men col- lect water in 36 percent of cases, while it is relatively rare for female or male children under age 15 to collect water (6 percent). For households in the Western region, it is more likely for woman to collect drinking water (69 percent) while in the Eastern region this percentage declines to 54 percent. 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 dis- posal include: ﬂ ush or pour ﬂ ush to a piped sewer system, septic tank, or pit latrine, ventilated improved pit latrine, and pit latrine with slab. Nearly all of the population of Uzbekistan is living in households using improved sanitation facilities and there are no differentiations according to the background characteristics (Table 27). However, there are important differences with respect to the type of facility. The most com- mon facility in Tashkent city is ﬂ ush toilets connected to a sewage system (91 percent). In all other regions, ventilated improved pit latrines or pit latrines with slabs are common. In the East- ern region three out of every four households have a pit latrine with a slab while in the Southern region more than half of the households use ventilated improved pit latrines. The most common facilities in urban areas are ﬂ ush toilets connected to a sewage system or septic tank (39 percent) followed by pit latrines with slabs (30 percent) while in rural areas pit latrines with slabs are the most common (54 percent) followed by ventilated improved pit latrines (40 percent). Safe disposal of children’s faeces is disposal of the stool either by the child using a toilet or by rinsing the stool into a toilet or latrine. The method of disposal of faeces of children 0–2 years of age is presented in Table 28. Overall, stools are disposed of safely for 59 percent of children aged 0–2 years. For more than half of the children, the child’s last stool was put/rinsed into a toilet or latrine (56 percent). The child’s last stool was put/rinsed into a drain or ditch in 20 percent of the cases and in another 15 percent it was buried. The differentiation by regions is signiﬁ cant. Burying the child’s faeces was quite common in the Western region (49 percent) while in the Central region in nearly half of the cases the last stool was put/rinsed into a drain or ditch (47 percent). Putting/rinsing the stool into a toilet or latrine was the most common method in the other regions, the Eastern region having the highest percentage (77 percent). Overall, 90 percent of the households are using improved sources of drinking water and nearly all households use sanitary means of excreta disposal (99 percent) (Table not shown). The use of both improved sources of drinking water and sanitary means of excreta disposal is evident in 89 percent of the households. The lowest percentages are observed for the households in the Southern region and households in rural areas have lower percentages of using improved sources of drinking water and sanitary means of excreta disposal. These indicators increase with increasing socioeconomic status. Almost every single baby in the country is delivered by skilled personnel © U N IC EF /U zb ek is ta n/ un kn ow n Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 49 8. REPRODUCTIVE HEALTH Contraception Appropriate family planning is important to the health of women and children by: 1) prevent- ing 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 access by all couples to information and services to prevent pregnancies that are too early, too closely spaced, too late or too many. Current use of contraception was reported by 65 percent of women currently married or in union (Table 29). Compared to the previous MICS 2000 survey, there was a slight decrease at the overall level of use and modern method use (Figure 13). The most popular method is the IUD (Intrauterine Device) which is used by half of all married women in Uzbekistan. All of the remaining contraceptive methods have percentages not exceeding three percent im- plying clearly that IUD is the most widely preferred method in Uzbekistan. Between two and three percent of women reported the use of the Lactation Amenorrhea Method (LAM), pill, condom, and female sterilization. Only six percent of currently married women reported the use of traditional methods. The use of contraception is highest in the Eastern region at 71 percent and lowest in the Southern region at 56 percent. About two-thirds of currently married women in the other re- gions use a method of contraception. Adolescents are far less likely to use contraception than older women. Only about 22 percent of married or in union women aged 15–19 currently use a method of contraception compared to 68 percent of 25–29 year olds. As a result of high levels of education among women in Uzbekistan, less differentiation is observed among different categories of education. The percentage of women using any method of contraception is lowest among women with incomplete secondary education (60 percent). Differentiation is less clear with regard to wealth status of the household and mother tongue of the household head. The method mix also does not vary signiﬁ cantly according to different characteristics with the exception of regions. Figure 13. Contraceptive use, Uzbekistan, 2000–2006 O MICS 2000 O MICS 2006 Any modern method 4.7 5.60 20 40 60 80 Percent 62.5 59.3 Any traditional method 50 ! Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 Unmet Need Unmet need8 for contraception refers to fecund women who are not using any method of contracep- tion, but who wish to postpone the next birth or to stop childbearing altogether. Unmet need is iden- tiﬁ ed in MICS by using a set of questions eliciting current behaviours and preferences pertaining to contraceptive use, fecundity, and fertility preferences. The total demand for contraception includes women who currently have an unmet need plus those who are currently using contraception. Table 30 shows the results of the survey on contraception, unmet need and the demand for contraception which is satisﬁ ed. Among all currently married women, only 8 percent have an unmet need for contraception (4 percent for spacing and 4 percent for limiting purposes). Overall, 89 percent of the demand for family planning is satisﬁ ed. There is very little variation by background variables in unmet need for contraception and the percentage of demand for contraception which is satisﬁ ed. Unmet need for contraception is slightly higher (10 percent) in the Southern region while the lowest percentage is in the Eastern region (6 percent). It is also slightly higher among women age 15–29 and women living in urban areas. 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 op- portunity 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 signiﬁ cantly 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 services. WHO recommends a minimum of four antenatal visits based on a review of the effectiveness of different models of antenatal care. WHO guidelines are speciﬁ c on the content on antenatal care visits, which include: Blood pressure measurement Urine testing for bacteriuria and proteinuria Blood testing to detect syphilis and severe anaemia Weight/height measurement (optional) Coverage of antenatal care (by a doctor, nurse, or midwife) is nearly a standard in Uzbekistan with 99 percent of women receiving antenatal care at least once during the pregnancy. There are also negligible differences with regard to background characteristics. 8 Unmet need measurement in MICS is somewhat different than that used in other household surveys, such as the De- mographic and Health Surveys (DHS). In DHS, more detailed information is collected on additional variables, such as postpartum amenorrhea, and sexual activity. Results from the two types of surveys are strictly not comparable. $ $ $ $ Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 51 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 31. Nearly all women in Uzbekistan with a birth during the two years preceding the survey had antenatal care from skilled personnel. For 96 percent of the cases, the person providing antenatal care was a medical doctor. Although there is some regional variation, the ﬁ gures do not vary considerably by different background char- acteristics. In the Central-Eastern region, the percentage of medical doctors providing antenatal care declines to 91 while in Tashkent city it is above 99 percent. The types of services pregnant women received are shown in Table 32. Nearly all pregnant women received antenatal care one or more times during their pregnancy (99 percent) with al- most no signiﬁ cant differentiation by background characteristics. In 98 percent of these visits a blood test was carried, blood pressure was measured, and a urine specimen was taken. Weight was measured for 90 percent of these women. Overall, the differentiation by background char- acteristics is small except for education where there is an increasing trend of receiving speciﬁ c care with increasing education of women. The Southern region has slightly lower percentages compared to other regions and the differentiation is more salient for measurement of weight. 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 the proportion of institutional deliveries. The skilled attendant at delivery indicator is also used to track progress toward the 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. Almost every single birth occurring in the year prior to the MICS survey was attended by skilled personnel (Table 33). There was no differentiation with respect to the background char- acteristics. For 95 percent of the deliveries in the year prior to the MICS survey, medical doctors assisted with the delivery. Overall, about ﬁ ve percent of births were delivered by health assist- ants. For women living in the Central-Eastern region, the type of personnel providing delivery assistance was slightly different than in other regions. In the Central-Eastern region, about 13 percent of births were attended by nurses or midwives. Births occurring to older women and women living in poorer households were slightly less likely to be delivered in a health facility. When all pregnancies of women aged 15–49 currently married or in union are considered, 82 percent of them ended with a live birth, 13 percent ended with an induced abortion and 5 percent ended with a miscarriage (Table 34). The percentage of pregnancies that ended with induced abortion is higher in urban areas (18 percent) compared to rural areas (11 percent) and more prevalent in Tashkent city (27 percent). The percentage has an increasing trend with in- creasing education, age, and socioeconomic status. Induced abortion is also more frequent if the mother tongue of the household head is Russian (as high as 40 percent). Miscarriages and stillbirth do not show signiﬁ cant variation by background characteristics. Maternal Mortality The complications of pregnancy and childbirth are a leading cause of death and disability among women of reproductive age in developing countries. It is estimated worldwide that around 52 ! Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 529,000 women die each year from maternal causes. And for every woman who dies, approxi- mately 20 more suffer injuries, infection or disabilities in pregnancy or childbirth. This means that at least 10 million women a year incur this type of damage. The most common fatal complication is post-partum haemorrhage. Sepsis, complications of unsafe abortion, prolonged or obstructed labour and the hypertensive disorders of pregnancy, especially eclampsia, claim further lives. These complications, which can occur at any time during pregnancy and childbirth without forewarning, require prompt access to quality obstet- ric services equipped to provide lifesaving drugs, antibiotics and transfusions and to perform the caesarean sections and other surgical interventions that prevent deaths. One MDG target is to reduce the maternal mortality ratio by three quarters, between 1990 and 2015. Maternal mortality is deﬁ ned as the death of a woman from pregnancy-related causes, when pregnant or within 42 days of termination of the pregnancy. The maternal mortality ratio is the number of maternal deaths per 100,000 live births. In MICS, the maternal mortality ratio is estimated by using the indirect sisterhood method, which produces estimates centred on 10 to 12 years before the survey is carried out. To collect the information needed in this estimation method, adult household members are asked a small number of questions regarding the survival of their sisters and the timing of death relative to pregnancy, childbirth and the postpartum period for deceased sisters. The information collected is then converted to lifetime risks of ma- ternal death and maternal mortality ratios9. Uzbekistan MICS results on maternal mortality are shown in Table 35. The results are also presented only for the national total, since maternal mortality ratios generally have very large sampling errors. When compared with the ﬁ ndings of the Ministry of Health over the last two decades (Figure 14) and considering the fact that the MICS indirect estimate of maternal mortal- ity centres around 10 to 12 years before the survey was carried out, the estimate is lower than those calculated by MoH. 9 For more information on the indirect sisterhood method, see WHO and UNICEF, 1997. Figure 14. Maternal mortality ratio, Uzbekistan MoH 1991 MoH 2004 0 10 20 30 40 Percent 50 60 70 MoH 2001 65 34 30 28 MICS 2006 Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 53 9. CHILD DEVELOPMENT It is well recognized that a period of rapid brain development occurs in the ﬁ rst 3–4 years of life, and the quality of home care is the major determinant of a 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 quality of home care. A World Fit for Children goal is that “children should be physically healthy, mentally alert, emotion- ally secure, socially competent and ready to learn.” Information on a number of activities that support early learning was collected in the sur- vey. These included the involvement of adults with children in the following activities: read- ing 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. For 71 percent of children under ﬁ ve, an adult had been engaged in more than four activi- ties that promote learning and school readiness during the 3 days preceding the survey (Table 36). The average number of activities that adults engaged in with children was 4.4. The table also indicates that the father’s involvement in such activities was somewhat limited. Father’s involvement with one or more activities was 47 percent but the average number of activities that fathers engaged in with children was 0.8. Only 4 percent of children were living in a household without their fathers. There are no gender differentials in terms of adult activities with children; and there is no signiﬁ cant difference in the proportion of fathers engaged in activities with male or female children. A slightly higher proportion of adults engaged in learning and school readiness activities with children in urban areas (75 percent) than in rural areas (70 percent). Larger differentials by region and socio-economic status are also observed: Adult engagement in activities with children was greatest in the Eastern region (85 percent) and lowest in the West- ern region (65 percent), while the proportion was 78 percent for children living in the richest households, as opposed to those living in the poorest households (64 percent). More educated mothers and fathers engaged slightly more in such activities with children than those with less education. Father’s involvement showed a stronger variation by region in terms of en- gagement in such activities. Exposure to books in early years not only provides the child with greater understanding of the nature of print, but may also give the child opportunities to see others reading, such as older siblings doing school work. Presence of books is important for later school performance and IQ scores. In Uzbekistan, 78 percent of children are living in households where at least 3 non-chil- dren’s books are present (Table 37). However, only 43 percent of children aged 0–59 months have children’s books. While the median number of non-children’s books is high (10 books) children’s books are low (2 books). Although no gender differentials are observed, children of educated mothers appear to have more access to both types of books than those less educated. Lower percentages are found in the Western and Southern regions for both non-children and children’s books compared to other regions. The presence of both non-children’s and chil- dren’s books is positively correlated with the socioeconomic status. Table 37 also shows that one-third of children aged 0–59 months had 3 or more playthings in their homes, while only 4 percent had none of the playthings their mothers/caretakers were asked about. The playthings in MICS included household objects, homemade toys, toys 54 ! Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 bought in a store, and objects and materials found outside the home. It is interesting to note that 91 percent of children play with toys from a store while 40 percent play with homemade toys. The proportion of children who have 3 or more playthings does not differ according to sex of child and no or small differentials are observed in terms of urban-rural residence, mother’s education, and wealth of household. The only background variable which appears to have a strong correlation with the number of playthings children have is the age of the child, a not unexpected result. “Children should be physically healthy, mentally alert, emotionally secure, socially competent and ready to learn.” © U N IC EF /U zb ek is ta n/ 20 07 /B rig itt e Br ef or t 56 ! Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 10. EDUCATION Pre-School Attendance and School Readiness Attendance at pre-school in an organized learning or child education program is important for the readiness of children for school. One of the World Fit for Children goals is the promotion of early childhood education. Nearly 20 percent of children aged 36–59 months are attending pre-school (Table 38). Com- pared to the previous MICS, there was no change in preschool attendance (Figure 15). Urban- rural and regional differentials are signiﬁ cant—the ﬁ gure is as high as 35 percent in urban areas, compared to 14 percent in rural areas. Among children aged 36–59 months, attendance at pre-school is more prevalent in Tashkent city (53 percent), and lowest in the Southern region (7 percent). No gender differential exists, but differentials by socioeconomic status are signiﬁ - cant. If the mother has higher education, the ﬁ gure increases to 48 percent while it drops signiﬁ - cantly for children whose mothers’ education is complete secondary and incomplete secondary (11 and 13 percent respectively). Forty-six percent of children living in rich households attend pre-school, while the ﬁ gure drops to 5 percent in poor households. It is interesting to note that the proportions of children attending pre-school at ages 36–47 months and 48–59 months do not differ signiﬁ cantly (18 and 21 percent respectively). The table also shows the proportion of children in the ﬁ rst grade of primary school who at- tended pre-school in the previous year (Table 38), an important indicator of school readiness. In Uzbekistan the survey was conducted in March-May 2006 and school starts in September. Consequently, during the survey dates, there were children aged both 6 and 7 who were attend- ing ﬁ rst grade who had attended a preschool program in the previous year. In order to address this, early childhood education was also assessed for children 7 years of age. Overall, 34 percent of children who are currently age 6 and 26 percent of children aged 7 attending the ﬁ rst grade of primary school had been attending pre-school the previous year. The proportion among males was slightly higher (29 percent) than females (24 percent), while almost one-third of children in urban areas (33 percent) had attended pre-school the previous year compared to 24 percent among children living in rural areas. Regional differentials are also very signiﬁ cant; ﬁ rst graders in Tashkent city were four times more likely (66 percent) to have attended pre-school then their counterparts in the Central-Eastern region (15 percent). Mother’s education appears to have a positive correlation with school readiness—while the in- dicator is only 25 percent among mothers with incomplete secondary education, it increases to 40 percent among mothers with higher education. Socioeconomic status also appears to be re- lated to school readiness—while the percentage of children attending ﬁ rst grade who attended a preschool program in the previous year is only 20 percent among the poorest households, it is 41 percent among those children living in the richest households. Primary and Secondary School Participation Universal access to basic education and the completion 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 inﬂ uencing population growth. Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 57 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 grade ﬁ ve Transition rate to secondary school Net primary completion rate The school system in Uzbekistan has two compulsory levels. The ﬁ rst level, primary education, consist of grades one through four for students age 7–10. The second level consists of grades ﬁ ve through nine for students age 11–15. Students who have completed a minimum of nine grades may enrol in special secondary education. The special secondary school system provides special train- ing of three years. Students who complete special secondary school may enrol in university. The MICS questionnaire does not include questions on whether the children are enrolled in primary or secondary school but include questions on attendance during the current and previ- ous school years. In addition, because the age information in the MICS questionnaire was only collected in the form of completed age, the day and month of birth is not available, so it is very difﬁ cult to assess if children of school starting age are enrolled in the schools or not. However, Table DQ.8 in the Appendix presents valuable information regarding the schooling status of children who are expected to start primary school. Among children aged 7, 67 percent attend ﬁ rst grade (as they had completed age 7 at the beginning of the school year in September 2005) and 12 percent attend grade 2 (they probably started grade 1 in September 2004 while they were still 6 years of age) while 4 percent attend preschool and 17 percent do not attend school (be- cause they had not completed 7 years of age at the beginning of school year in September 2005). It is also observed from Table DQ.8 that 10 percent of children aged 6 were attending grade 1 at the time of the survey, although children are expected to start school at age 7. In Uzbekistan, the survey was conducted in March-May 2006 and the schools start in Sep- tember. Consequently, not all children 7 year of age (born September-March) were eligible for primary school at the beginning of the school year 2005–2006. In order to address the above dif- ﬁ culties in identifying the eligible children who were required to start the primary school in the current school year, the school attendance in Table 39 was assessed not only for children aged 7 but also for children aged 8 and for children who were attending ﬁ rst, second or third grade. Among children who are of primary school entry age in Uzbekistan, 79 percent of those aged 7 are attending the ﬁ rst or second grade of primary school and 99 percent of those aged 8 are attending the ﬁ rst, second or third grade of primary school. Although sex differentials do not exist, there are some differentials by region, urban-rural areas, education, and socioeconomic status. In Tashkent city, for instance, the value of the indicator reaches 94 percent, while it is 87 percent in the Central region. Children’s participation in primary school is timelier in urban ar- eas (92 percent) than in rural areas (88 percent). A positive correlation with mother’s education and socioeconomic status is observed; for children whose mothers have higher education, 94 percent were attending primary school. In rich households, the proportion is around 92 percent, while it is 84 percent among children living in the poorest households. $ $ $ $ $ $ $ $ 58 ! Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 Table 40 provides the percentage of children of primary school age attending primary or sec- ondary school. Overall, 96 percent of children of primary school age in Uzbekistan are attend- ing primary school or secondary school. Compared to the previous MICS, there is a 5 percent net increase in primary school attendance (Figure 15). Only less than 4 percent of the children are not attending school when they are expected to be doing so. At the national level and ac- cording to background characteristics, there is very little difference between male and female primary school attendance as well as overall attendance. The secondary school net attendance ratio is presented in Table 41. Because the survey was conducted in March-May 2006 and the schools start in September, the secondary school attend- ance was assessed for children 12 to 17 years of age although there maybe some children aged 11 who were attending secondary school and some children aged 17 who had already completed secondary school. Again, as in primary school where only 4 percent of the children are not attending school at all, a low percentage of the children of secondary school age are not attending secondary school (7 percent). Of these only a small portion are attending primary school (see below). There is no differentiation by sex; net attendance ratio was 94 percent for males and 92 percent for females. Also no signiﬁ cant differentiation was observed by background characteristics with the excep- tion of mother’s education; net attendance ratio increases with the mother’s education level and this was more prevalent among girls. The primary school net attendance ratio of children of secondary school age is presented in Table 42. Less than one percent of the children of secondary school age are attending primary school when they should be attending secondary school. The remaining 6 percent are not at- tending school at all. The percentage of children entering ﬁ rst grade who eventually reach grade 5 is presented in Table 43. Of all children starting grade one, nearly all of them will eventually reach grade ﬁ ve. Notice that this number includes children that repeat grades and that eventually move up to reach grade ﬁ ve. There is very little or no variation according to the background characteris- tics included in the table reﬂ ecting the full attendance of children during the ﬁ rst ﬁ ve grades of school regardless of their sex, region, residence, mother’s education, or socioeconomic status. The net primary school completion rate and transition rate to secondary education are pre- sented in Table 44. At the time of the survey, 97 percent of the children of primary completion age (11 years) were attending the last grade of primary education. This value should be distin- Figure 15. Early childhood, primary and secondary school attendance, Uzbekistan 2006 O MICS 2000 O MICS 2006 Early childhood education 91 96 0 20 40 60 80 Percent 20 89 Net intake rate in primary school 100 Primary school net attendance ratio Secondary school net attendence ratio 20 93 Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 59 guished from the gross primary completion ratio which includes children of any age attending the last primary grade. No signiﬁ cant variation exists by sex, region, residence, mother’s educa- tion or socioeconomic status. All of the children (100 percent) who successfully completed the last grade of primary school were found to be attending the ﬁ rst grade of secondary school at the time of the survey. Again there is also no signiﬁ cant variation by background variables. The ratio of girls to boys attending primary and secondary education is provided in Table 45. These ratios are better known as the Gender Parity Index (GPI). Notice that the ratios included here are obtained from net attendance ratios rather than gross attendance ratios. The last ratios provide an erroneous description of the GPI mainly because in most of the cases the majority of over-aged children attending primary school tend to be boys. The table shows that gender parity for primary school is exactly 1.00, indicating no difference in the attendance of girls and boys. The indicator drops only very slightly to 0.98 for secondary education. It appears that neither sex is disadvantaged with regard to attendance at primary and secondary school irrespective of the background characteristics. Adult Literacy One of the World Fit for Children goals is to assure adult literacy. Adult literacy is also an MDG indicator, relating to both men and women. In MICS, since only a women’s question- naire was administered, the results are based only on females age 15–24. Literacy was as- sessed on the ability of women to read a short simple statement or on school attendance. In Uzbekistan, adult literacy is universal and there is virtually no variation in adult literacy by background variables. “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…” © U N IC EF /U zb ek is ta n/ 20 06 /R ez a H os sa in i Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 61 11. CHILD PROTECTION 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 registra- tion is a fundamental means of securing these rights for children. The World Fit for Children states the goal of developing systems to ensure the registration of every child at or shortly after birth, and fulﬁ l 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. The births of almost all children under ﬁ ve years in Uzbekistan have been registered (Tab- le 46). There are no variations in birth registration across sex, age, or education categories. 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 the child’s health or physical, mental, spiritual, moral or social development.” The World Fit for Children goals 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 labour activities at the moment of the survey if during the week preceding the survey he/she was engaged in: at least one hour of economic work or 28 hours of domestic work per week (Age 5–11) at least 14 hours of economic work or 28 hours of domestic work per week (Ages 12–14) This deﬁ nition allows differentiation between child labour and child work to identify the type of work that should be eliminated. As such, the estimate provided here represents the minimum prevalence of child labour since some children may be involved in hazardous labour activities for fewer hours than speciﬁ ed in the criteria explained above. Table 47 presents the results of child labour by the type of work. Percentages do not add up to the total extent of child labour as children may be involved in more than one type of work. Only 2 percent of children aged 5–14 are involved in child labour activities and for most of these children this activity is unpaid. There is no differentiation in child labour by sex but there are signiﬁ cant variations by region. Eleven percent of children aged 5–14 in Tashkent city are involved in child labour. For other variables examined, there is no signiﬁ cant variation in child labour. The trend on child labour shows a sharp decline from 23% (MICS2000) to 2% (MICS2006), which could be explained by seasonality of child labour. The MICS2000 was carried out in summer period during school holiday, when many children are believed to be working in the agricultural ﬁ eld. The MICS2006 was conducted between march and may during the school year. Therefore, one cannot compare the ﬁ ndings of the two MICS surveys. Table 48 presents the percentage of children classiﬁ ed as student labourers or as labourer stu- dents. Student labourers are the children attending school that were involved in child labour ac- tivities at the time of the survey. More speciﬁ cally, of the 84 percent of the children 5–14 years $ $ 62 ! Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 of age attending school, 2 percent are also involved in child labour activities. On the other hand, out of the 2 percent of the children classiﬁ ed as child labourers, the majority of them are also attending school (93 percent). The percentage of students who are also involved in child labour is highest in Tashkent city (12 percent) and lowest in the Eastern region (1 percent). For other characteristics there are no signiﬁ cant variation in labourer students and student labourers. 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 were married/in union before the age of 18. Factors that inﬂ uence 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 the hopes that the marriage will beneﬁ t them both ﬁ nancially and socially, while also relieving ﬁ nancial burdens on the family. In 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 gen- dered 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 sufﬁ ciently mature to make an informed decision about a life partner. The Convention on the Elimination of all Forms of Discrimina- tion 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 Karakalpakstan Khorezm Bukhara Navoi Samarkand Kashkadarya Andizhan Namangan Fergana Syrdarya Jizzakh Tashkent Tashkent city Surkhandarya Marriage before the age of 18th among women aged 20–49 # 1.0–9.9 # 10.0–14.9 # 15.0–20.0 Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 63 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 mar- riage is linked to other rights—such as the right to express 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. Young married girls are a unique, though often invisible, group. 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 deci- sion-making and reduced life choices. Boys are also affected 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, it is often assumed 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 recogni- tion—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 signiﬁ cant factors in determining a girl’s risk of becoming married while still a child. Women who married at a younger age are more likely to believe that it is sometimes acceptable for a husband to beat his wife and are more likely to experience domestic violence themselves. The age gap between partners is thought to contribute to these abusive power dy- namics 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 in 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 an 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 re- produce and the power imbalance resulting from the age differential leads to very low condom use among such couples. Two of the indicators are the estimated the percentage of women married before 15 years of age and the percentage married before 18 years of age. The percentage of women married at various ages is provided in Table 49. Only ﬁ ve percent of women 15–19 years are currently mar- ried in Uzbekistan. Among women 15–49 years, less than one percent was married before age 15 and the differences across categories are negligible. On the other hand, among women 20–49 years nearly 13 percent were married before age 18. Marriage before age 18 was more frequent among women with less education and those living in poorer households. Even though there are small differences with respect to region, Tashkent city has the lowest percentage of women marrying before age 18 (10 percent) while the Eastern region has the highest (14 percent). Child Disability One of the World Fit for Children goals is to protect children against abuse, exploitation, and violence, including the elimination of discrimination against children with disabilities. For chil- dren age 2 through 9 years, a series of questions were asked to assess a number of disabilities/ impairments, such as sight impairment, deafness, and difﬁ culties with speech. This approach 64 ! Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 rests in the concept of functional disability developed by WHO and aims to identify the impli- cations of any impairment or disability for the development of the child (e.g. health, nutrition, education, etc.). Table 50 presents the results of these questions. Of children aged 2–9, only 2 percent were reported by their mother or caretaker as having at least one disability. For none of the disability types asked in the questionnaire did the percentage of children with that particular disability exceed one percent. The differentiations are not signiﬁ cant for the background vari- ables included in the table. Among children aged 2 years, only 3 percent were unable to name at least one object and among those aged 3–9, only for 1 percent of mothers/caretakers reported that the child’s speech was abnormal. Orphans and Vulnerable Children Children who are orphaned or in vulnerable households may be at increased risk of neglect or exploitation if the parents are not available to assist them. Monitoring the variations in different outcomes for orphans and vulnerable children and comparing them to their peers gives us a measure of how well communities and governments are responding to their needs. The frequency of children living with neither parent, mother only, and father only is present- ed in Table 60. Overall, 91 percent of children aged 0–17 are living with both parents, 6 percent are living with the mother only, 1 percent are living with the father and 2 percent are not living with either biological parent. For 4 percent of children aged 0–17, one or both parents are dead. The lowest percentages of children living with both parents were found in Tashkent city (82 percent) and in rural areas (86 percent). There was also a declining trend with increasing age as a result of one or both parents being dead (from 95 percent among children aged 0–4 years to 85 percent among children aged 15–17 years). © U N IC EF /U zb ek is ta n/ 20 07 /B rig itt e Br ef or t The United Nations 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 66 ! Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 12. HIV/AIDS AND SEXUAL BEHAVIOUR 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 in- formation is the ﬁ rst step toward raising awareness and giving young people the tools to protect themselves from infection. Misconceptions about HIV are common and can confuse young people and hinder prevention efforts. Different regions are likely to have variations in mis- conceptions although some appear to be universal (for example that food sharing or mosquito bites can transmit HIV). The United Nations General Assembly Special Session on HIV/AIDS (UNGASS) called on governments to improve the knowledge and skills of young people to pro- tect 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 adminis- tered to women 15–49 years of age. One indicator which is both an MDG and UNGASS indicator is the percentage 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 in which HIV can be transmit- ted—having only one faithful uninfected partner, always using a condom and abstaining from sex. The results are presented in Table 51. In Uzbekistan, a large majority of the interviewed women (96 percent) had heard of AIDS, a signiﬁ cant increase compared to MICS 2000 results (Figure 16). However, the percentage of women who knew of all three main ways of prevent- ing HIV transmission is only 49 percent. Seventy-six percent of women knew about having one faithful uninfected sex partner, 65 percent knew about using a condom every time, and 66 percent knew about abstaining from sex as main ways of preventing HIV transmission. While 86 percent of women knew at least one way, 14 percent did not know any of the three ways. As expected, the percent of women who know all three ways and who knew at least one way increases with the woman’s educational level. The highest percentages of women for both indicators were found in the Central-Eastern region while the Western region had the highest percentage of women who do not know any way to prevent HIV transmission. The youngest age group (15–19) has the lowest percentages for both indicators and for women aged 20 and above there was less variation. No signiﬁ cant differentiation was found in knowledge of HIV transmission by urban-rural residence and socioeconomic status. Table 52 presents the percent of women who can correctly identify misconceptions concern- ing HIV. The indicator is based on the two most common and relevant misconceptions in Uz- bekistan, that HIV can be transmitted by supernatural means and mosquito bites. The table also provides information on whether women know that HIV cannot be transmitted by sharing food, and that HIV can be transmitted by sharing needles. Of the interviewed women, 48 percent rejected the two most common misconceptions and knew that a healthy-looking person can be infected. Eighty-three percent of women know that HIV cannot be transmitted by supernatural means, and 68 percent know that HIV cannot be transmitted by mosquito bites, while 71 per- cent know that a healthy-looking person can be infected. Table 52 also presents the percent of women who know that HIV cannot be transmitted by sharing food (67 percent) and that HIV can be transmitted by sharing needles (93 percent). For all the indicators presented, the per- centage of women has an increasing trend with increasing education and socioeconomic status. Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 67 There was no signiﬁ cant variation in identifying misconceptions about HIV/AIDS by urban-ru- ral residence and age. Women living in the Central-Eastern region have the highest percent age rejecting the most two common misconceptions and know that a healthy-looking person can be infected (62 percent) while women in the Southern region had the lowest (33 percent). Table 53 summarizes information from Tables 51 and 52 and presents the percentage of women who know two ways of preventing HIV transmission and reject three common miscon- ceptions. Knowledge of HIV prevention methods is not very high although there are differences by residence. Overall, 60 percent of women knew two prevention methods. In the Central-East- ern region, 77 percent of women identiﬁ ed both methods. Nearly half of the women (48 percent) 15–49 years were able to correctly identify three misconceptions about HIV transmission and the regional differences are considerable (ranging from 33 percent in the Southern to 62 percent in Central-Eastern region. As expected, the percent of women with comprehensive knowledge increases with the woman’s education level (Figure 17). A key indicator used to measure countries’ responses to the HIV epidemic is the proportion of young people 15–24 years who know two methods of preventing HIV reject two misconcep- tions and know that a healthy looking person can have HIV. Only 31 percent of young women (15–24 years) have comprehensive accurate knowledge of HIV. Knowledge of mother-to-child transmission of HIV is also an important ﬁ rst step towards women seeking HIV testing when they are pregnant to avoid infection of the baby. Women should know that HIV can be transmitted during pregnancy, delivery, and through breastfeed- ing. The level of knowledge among women age 15–49 years concerning mother-to-child trans- mission is presented in Table 54. Overall, 92 percent of women know that HIV can be transmit- ted from mother to child. The percentage of women who know all three ways of mother-to-child transmission is 73 percent, while 5 percent of women did not know of any speciﬁ c way. Knowl- edge of mother-to-child HIV transmission increased with increasing education level of women Heard of AIDS 74 18 0 20 40 60 80 96 49 Know 2 ways to prevent transmission 100 Figure 16. Knowledge of HIV transmission, Uzbekistan, 2000–2006 O MICS 2000 O MICS 2006 Percent 48 9 Correctly identify 3 misconseptions on HIV transmission 68 ! Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 and socioeconomic status of the household. Women living in the Central-Eastern region had the highest percentage of knowledge while women in Tashkent city had the lowest. The indicators on attitudes toward people living with HIV measure stigma and discrimina- tion in the community. Stigma and discrimination are low if respondents report an accepting attitude on the following four questions: 1) Would you care for a family member sick with AIDS? 2) Would you buy fresh vegetables from a vendor who was HIV positive? 3) Do you think that a female teacher who is HIV positive should be allowed to teach in school? 4) Would you want to keep the HIV status of a family member secret? Table 55 presents the attitudes of women towards people living with HIV/AIDS. Nearly one-third of the women stated that they would not care for a family member sick with AIDS (32 percent) and nearly half of them said they would want to keep it secret if a family member was HIV positive. Large proportions of women stated that they believe a teacher with HIV should not be allowed to work (80 percent) and that they would not buy food from a person with HIV/AIDS (86 percent). Overall, as many as 97 percent of women agreed with at least one of the discriminatory statements. Although there were large differentiations for particular statements by region, because of the different patterns observed for each statement, the variation in agreeing with at least one discriminatory statement by region was less salient. In rural areas a higher percentage of women agreed with the discriminatory statements. Another important indicator is the knowledge of where to go to be tested for HIV and the use of such services. Questions related to knowledge among women of a HIV testing facility, whether they have ever been tested, and if tested, whether they were told the result is presented in Table 56. More than half of women knew where to be tested (55 percent), while 33 percent had actually been tested. Of these, a large proportion had been informed of the result (92 percent). Knowledge of a place to get tested showed signiﬁ cant variations by region; the highest propor- tion of women who know a place to get tested was in the Central-Eastern region (81 percent) and the lowest was in the Southern region (30 percent). Regional differences in percentages of women who have been tested were less salient. In urban areas more women knew a place to get tested (62 percent) than those in rural areas (51 percent) and more women in urban areas have Figure 17. Percent of women who have comprehensive knowledge of HIV/AIDS transmission, Uzbekistan, 2006 Incomplete Secondary Secondary special 0 10 20 30 40 Percent 50 60 70 80 Complete Secondary UzbekistanHigher education 48 42 28 60 46 34 64 54 41 68 58 45 60 48 35 O Knows 2 ways to prevent HIV O Identify 3 misconceptions O Comprehensive knowledge Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 69 been tested (38 percent) than those in rural areas (30 percent). There was an increasing trend in both the percentage who know a place to be tested and who have been tested with increasing level of education and increasing socioeconomic status of the household. A lower proportion women aged 15–19 knew a place to get tested (35 percent) compared to other age groups. Among women who had given birth within the two years preceding the survey, the percent- age who received counselling and HIV testing during antenatal care is presented in Table 57. Nearly all women aged 15–49 received antenatal care from a health care professional during their last pregnancy (99 percent). During these antenatal care visits, 69 percent of them were given information about HIV prevention, 71 percent were tested for HIV, and 65 percent of them received the results of the HIV test. The proportion of women who were tested for HIV during antenatal care visits was lowest in the Southern region (56 percent) and highest in Tashkent city (87 percent). There was also an increasing trend in being tested for HIV with increasing level of education and increasing socioeconomic status of the household. 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 in reducing 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 condoms. The frequency of sexual behaviours that increase the risk of HIV infection among women is presented in Table 58 and Figure 18. There were no women aged 15–19 who had had sex be- fore age 15 while only 6 percent of women aged 20–24 stated that they had sex before age 18. Among women aged 15–24, only 3 percent stated that they had had sex with a man 10 or more years older than themselves in the 12 months prior to the survey. The percentage of women aged Figure 18. Sexual behaviour that increases risk of HIV infection, Uzbekistan, 2006 Urban Uzbekistan 0 1 2 3 4 Percent 5 6 7 8 Rural O Women 15–19 who had sex before age 15 O Women 20–24 who had sex before age 18 O Women 20–24 who had sex in last 12 months with a man 10 years or more older 0 7.7 4.6 0 5.9 2.1 0 6.4 2.8 70 ! Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 20–24 who had sex before age 18 decreased signiﬁ cantly with increasing level of education. There was no other clear differentiation by background variables. 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 had sex with such a partner in the previous year (Table 59). Among women 15–24 years, 29 percent reported that they had never had sex, 28 percent stated that they had had sex in the last 12 months and the percentage of women who had had sex with non-marital or non-cohabiting partner was very low (4 percent). Sixty-one percent of the women 15–24 years who had had sex with a non-regular partner in the 12 months prior to the survey date reported using a condom when they had sex with their high risk partner. The percentage of women aged 15–24 who had had sex with more than one partner in last 12 months was negligible. Because of the low number of observations it was not possible to comment on any differentiation in high risk sex across different categories. Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 71 LIST OF REFERENCES Aleshina, N. and Redmond, G. 2003. How High is Infant Mortality Rate in Central and Eastern Europe and the CIS?. Innocenti Working Paper No. 95. Florence: UNICEF Innocenti Research Centre. Analytical and Information Center, Ministry of Health of the Republic of Uzbekistan [Uzbekistan], State Department of Statistics, Ministry of Macroeconomics and Statistics [Uzbekistan], and ORC Macro. 2004. Uzbekistan Health Examination Survey 2002. Calverton, Maryland, USA: Analytical and Information Center, State Department of Statistics, and ORC Macro. 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. 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. Institute of Obstetrics and Gynecology [Uzbekistan] and Macro International Inc., 1997. Uz- bekistan Demographic and Health Survey, 1996. Calverton, Maryland: Institute of Obstetrics and Gynecology and Macro International Inc. Rutstein, S.O. and Johnson, K., 2004. The DHS Wealth Index. DHS Comparative Reports No. 6. Calverton, Maryland: ORC Macro. UNICEF, 2000. Multiple Indicator Cluster Survey, Republic of Uzbekistan 2000. 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 Na- tions publication, Sales No. E.83.XIII.2). United Nations, 1990a. QFIVE, United Nations Program for Child Mortality Estimation. New York, United Nations Population Division United Nations, 1990b. Step-by-step Guide to the Estimation of Child Mortality. New York, UN World Health Organization Regional Ofﬁ ce for Europe, 2006. European health for all database (HFA-DB), updated: June 2006, http://data.euro.who.int/hfadb/ WHO and UNICEF, 1997. The Sisterhood Method for Estimating Maternal Mortality. Guid- ance notes for potential users, Geneva. 72 ! Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 Table 1: Results of household and individual interviews Number of households, women, and children under 5 by results of the household, women’s and under-� ve’s interviews, and household, women’s and under-� ve’s response rates, Uzbekistan, 2006 Number of households Sampled 5,213 5,292 1,681 1,622 1,596 1,710 1,680 2,216 10,505 Occupied 5,086 5,263 1,677 1,612 1,582 1,686 1,650 2,142 10,349 Interviewed 4,989 5,209 1,657 1,580 1,562 1,648 1,634 2,117 10,198 Response rate 98.1 99.0 98.8 98.0 98.7 97.7 99.0 98.8 98.5 Number of women Eligible 5,875 8,330 2,711 2,201 2,508 2,353 2,404 2,028 14,205 Interviewed 5,785 8,134 2,671 2,174 2,423 2,308 2,325 2,018 13,919 Response rate 98.5 97.6 98.5 98.8 96.6 98.1 96.7 99.5 98.0 Overall response rate 96.6 96.6 97.3 96.8 95.4 95.9 95.8 98.3 96.6 Number of children under-5 Eligible 1,890 3,149 972 812 1,026 793 804 632 5,039 Mother/Caretaker interviewed 1,874 3,112 970 805 1,015 785 780 631 4,986 Response rate 99.2 98.8 99.8 99.1 98.9 99.0 97.0 99.8 98.9 Overall response rate 97.3 97.8 98.6 97.2 97.7 96.8 96.1 98.7 97.5 Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 73 Table 2: Household age distribution by sex Percent distribution of the household population by � ve-year age groups and dependency age groups, and number of children aged 0-17 years, by sex, Uzbekistan, 2006 Males Females Total Number Percent Number Percent Number Percent Age 0–4 2625 9.9 2540 9.5 5165 9.7 5–9 2675 10.1 2537 9.5 5212 9.8 10–14 3192 12.0 3210 12.1 6402 12.0 15–19 3198 12.0 3088 11.6 6286 11.8 20–24 2731 10.3 2775 10.4 5506 10.4 25–29 2291 8.6 2223 8.4 4514 8.5 30–34 1924 7.2 1830 6.9 3754 7.1 35–39 1537 5.8 1633 6.1 3169 6.0 40–44 1521 5.7 1573 5.9 3093 5.8 45–49 1444 5.4 1487 5.6 2930 5.5 50–54 1016 3.8 1106 4.2 2122 4.0 55–59 715 2.7 811 3.0 1525 2.9 60–64 425 1.6 426 1.6 851 1.6 65–69 486 1.8 496 1.9 982 1.8 70+ 800 3.0 878 3.3 1677 3.2 Dependency age groups <15 8492 32.0 8287 31.1 16779 31.5 15–64 16801 63.2 16951 63.7 33751 63.5 65 + 1285 4.8 1374 5.2 2659 5.0 Children aged 0–17 10370 39.0 10145 38.1 20514 38.6 Adults 18+ 16208 61.0 16467 61.9 32675 61.4 Total 26578 100.0 26611 100.0 53190 100.0 74 ! Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 Table 3: Household composition Percent distribution of households by selected characteristics, Uzbekistan, 2006 Weighted percent Number of households Weighted Unweight. Sex of household head Male 82.2 8387 8116 Female 17.8 1811 2082 Region Western 9.8 996 1657 Central 21.4 2182 1580 Southern 16.3 1658 1562 Central-Eastern 15.0 1527 1648 Eastern 27.9 2841 1634 Tashkent city 9.7 994 2117 Residence Urban 37.7 3843 4989 Rural 62.3 6355 5209 Number of household members 1 4.8 487 598 2–3 15.9 1623 1825 4–5 38.1 3889 3779 6–7 27.9 2848 2666 8–9 8.5 869 829 10+ 4.7 482 501 Mother tongue of household head Uzbek 80.1 8169 7684 Russian 7.0 717 1027 Karakalpak 2.0 202 352 Tajik 6.3 643 511 Kirgiz 0.3 33 26 Other Language 4.3 435 598 Total 100.0 10198 10198 At least one child aged < 18 years 81.3 10198 10198 At least one child aged < 5 years 36.7 10198 10198 At least one woman aged 15–49 years 89.1 10198 10198 Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 75 Table 4: Women’s background characteristics Percent distribution of women aged 15-49 years by background characteristics, Uzbekistan, 2006 Weighted percent Number of women Weighted Unweight. Region Western 11.2 1554 2671 Central 20.9 2915 2174 Southern 18.4 2554 2423 Central-Eastern 14.5 2015 2308 Eastern 28.7 3995 2325 Tashkent city 6.4 885 2018 Residence Urban 31.3 4360 5785 Rural 68.7 9559 8134 Age 15–19 21.0 2929 2901 20–24 18.9 2634 2588 25–29 15.2 2121 2155 30–34 12.6 1754 1758 35–39 11.2 1563 1619 40–44 10.9 1514 1517 45–49 10.1 1405 1381 Marital/Union status Currently married/in union 64.2 8929 8855 Formerly married/in union 5.2 726 789 Never married/in union 30.6 4264 4275 Motherhood status Ever gave birth 63.9 8898 8897 Never gave birth 36.1 5021 5022 Education* Incomplete Secondary 20.3 2827 2777 Complete Secondary 46.3 6448 5901 Secondary special 25.2 3503 3878 Higher education 8.2 1135 1357 Wealth index quintiles Poorest 18.8 2621 2107 Second 20.1 2803 2348 Middle 20.7 2880 2637 Fourth 20.3 2832 2904 Richest 20.0 2782 3923 Mother tongue of household head Uzbek 84.5 11757 11252 Russian 3.3 461 685 Karakalpak 2.1 287 516 Tajik 6.3 880 739 Other Language 3.8 535 727 Total 100.0 13919 13919 * 6 unweighted cases with “Non-standard education” not shown 76 ! Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 Table 5: Children’s background characteristics Percent distribution of children under � ve years of age by background characteristics, Uzbekistan, 2006 Weighted percent Number of under-5 children Weighted Unweight. Sex Male 50.7 2527 2521 Female 49.3 2459 2465 Region Western 11.3 564 970 Central 21.8 1085 805 Southern 21.2 1057 1015 Central-Eastern 13.8 688 785 Eastern 26.6 1325 780 Tashkent city 5.4 267 631 Residence Urban 28.7 1432 1874 Rural 71.3 3554 3112 Age < 6 months 8.7 435 446 6–11 months 11.5 574 565 12–23 months 21.6 1078 1098 24–35 months 19.1 954 938 36–47 months 20.2 1010 994 48–59 months 18.8 936 945 Mother’s education* Incomplete Secondary 15.6 778 756 Complete Secondary 48.9 2438 2281 Secondary special 28.0 1394 1508 Higher education 7.4 369 435 Wealth index quintiles Poorest 22.8 1139 950 Second 19.9 993 857 Middle 19.7 983 930 Fourth 20.1 1003 1021 Richest 17.4 868 1228 Mother tongue of household head Uzbek 86.6 4316 4169 Russian 1.7 84 133 Karakalpak 1.7 87 161 Tajik 6.5 322 273 Other Language 3.5 177 250 Total 100.0 4986 4986 * 6 unweighted cases with “Non-standard education” not shown Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 77 Table 6: Child mortality Infant and under-� ve mortality rates, Uzbekistan, 2006 Infant mortality rate* Under-5 mortality rate** Sex Male 56 66 Female 40 47 Region Western 54 65 Central 52 61 Southern 63 76 Central-Eastern 28 31 Eastern 45 52 Tashkent city 34 39 Residence Urban 44 51 Rural 50 59 Mother’s education*** Incomplete Secondary 49 58 Complete Secondary 51 61 Secondary special 46 54 Higher education 28 32 Wealth index quintiles Poorest 59 72 Second 51 60 Middle 46 54 Fourth 43 50 Richest 36 42 Mother tongue of household head Uzbek 49 57 Russian 19 21 Karakalpak 47 55 Tajik 57 68 Other Language 29 32 Total 48 57 * MICS indicator 2; MDG indicator 14 ** MICS indicator 1; MDG indicator 13 *** 6 unweighted cases with “Non-standard education” not shown 78 ! Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 Table 7: Child malnourishment Percentage of children aged 0-59 months who are severely or moderately malnourished, Uzbekistan, 2006 Weight for age Height for age Weight for height Number of children aged 0–59 months % below – 2 SD* % below – 3 SD % below – 2 SD** % below – 3 SD % below – 2 SD*** % below – 3 SD % above + 2 SD Sex Male 4.8 0.5 13.9 3.7 3.9 0.9 6.6 2,389 Female 5.4 1.1 15.4 4.9 2.7 0.5 7.9 2,303 Region Western 4.1 0.7 18.4 5.6 1.9 0.8 12.0 527 Central 4.1 0.9 10.4 2.1 6.0 1.3 9.6 1,013 Southern 6.9 0.5 15.5 4.3 3.2 0.7 4.1 988 Central-Eastern 4.3 0.5 15.1 4.4 3.3 0.3 9.4 651 Eastern 5.9 1.2 16.6 5.7 2.1 0.4 4.9 1,257 Tashkent city 2.2 0.4 9.1 2.6 2.1 0.6 6.6 255 Residence Urban 4.7 0.5 14.0 4.2 3.3 0.8 8.6 1,337 Rural 5.2 0.9 14.9 4.3 3.3 0.6 6.7 3,354 Age < 6 months 1.3 0.3 5.2 0.5 3.2 0.7 9.8 377 6–11 months 4.3 1.2 7.1 3.2 6.3 1.3 10.1 532 12–23 months 8.2 1.1 16.5 4.9 5.7 1.3 9.8 999 24–35 months 5.8 0.9 16.7 5.2 2.3 0.7 5.1 919 36–47 months 3.7 0.5 16.5 4.6 1.5 0.1 5.4 965 48–59 months 4.4 0.7 16.9 4.5 1.8 0.3 5.9 899 Mother’s education**** Incomplete Secondary 5.3 1.1 17.9 5.4 2.3 0.5 8.1 735 Complete Secondary 5.5 0.8 15.0 4.2 3.3 0.7 6.6 2,307 Secondary special 4.7 0.8 13.3 4.0 4.0 0.8 7.4 1,297 Higher education 2.6 0.2 9.6 3.4 2.9 0.5 9.1 346 Wealth index quintiles Poorest 5.6 0.7 16.1 4.9 4.3 1.0 5.6 1085 Second 7.0 1.0 16.7 4.1 2.8 0.6 7.4 920 Middle 5.0 1.1 14.8 4.2 3.7 0.4 7.1 919 Fourth 4.2 0.7 13.4 3.5 2.2 0.5 8.5 952 Richest 3.4 0.5 11.6 4.8 3.4 0.8 8.0 814 Mother tongue of household head Uzbek 5.1 0.8 14.6 4.1 3.2 0.7 7.0 4,060 Russian 2.6 0.5 9.9 3.2 4.4 — 8.3 83 Karakalpak 5.3 0.9 26.5 7.7 1.9 0.9 18.1 75 Tajik 5.5 0.5 10.9 4.6 4.6 1.1 6.4 304 Other Language 5.3 0.8 18.4 7.5 3.5 0.8 10.7 169 Total 5.1 0.8 14.6 4.3 3.3 0.7 7.3 4,691 * MICS indicator 6; MDG indicator 4 ** MICS indicator 7 *** MICS indicator 8 **** 6 unweighted cases with “Non-standard education” not shown Note: The percent ‘below –2 standard deviations’ includes those who fall -3 standard deviations below the median Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 79 Table 8: Initial breastfeeding Percentage of women aged 15–49 years with a birth in the two years preceding the survey who breastfed their baby within one hour of birth and within one day of birth, Uzbekistan, 2006 Percentage who started breastfeeding within one hour of birth* Percentage who started breastfeeding within one day of birth Number of women with a live birth in the two years preceding the survey Region Western 61.8 85.4 236 Central 49.7 76.5 446 Southern 71.7 92.4 427 Central-Eastern 75.9 84.2 303 Eastern 76.7 86.7 544 Tashkent city 59.9 85.4 115 Residence Urban 68.8 84.5 591 Rural 66.4 85.3 1480 Months since birth <6 months 68.6 85.9 452 6–11 months 68.9 84.7 593 12–23 months 65.4 84.9 1027 Mother’s education** Incomplete Secondary 64.3 78.1 334 Complete Secondary 66.8 85.8 975 Secondary special 69.0 87.2 608 Higher education 67.1 87.1 154 Wealth index quintiles Poorest 67.8 87.7 433 Second 62.6 82.2 416 Middle 73.4 88.1 427 Fourth 67.3 83.0 423 Richest 63.8 84.2 373 Mother tongue of household head Uzbek 67.6 85.3 1765 Russian 51.4 75.4 35 Karakalpak 86.6 98.2 38 Tajik 52.9 78.7 154 Other Language 81.6 90.2 79 Total 67.1 85.1 2072 * MICS indicator 45 ** 2 unweighted cases with “Non-standard education” not shown 80 ! Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 Table 9: Breastfeeding Percentage of living children according to breastfeeding status at each age group, Uzbekistan, 2006 Children 0–3 months Children 0–5 months Children 6–9 months Children 12–15 months Children 20–23 months Percent exclusively breastfed Number of children Percent exclusively breastfed* Number of children Percent receiving breastmilk and solid/ mushy food** Number of children Percent breast- fed*** Number of children Percent breast- fed*** Number of children Sex Male 35.7 147 26.5 229 48.0 195 79.8 183 38.4 178 Female 38.2 134 26.3 206 42.4 194 76.7 165 37.4 181 Region Western 31.3 34 24.1 51 43.3 40 82.9 40 45.1 44 Central (32.4) 51 21.0 84 18.7 87 82.2 76 32.9 90 Southern 44.8 54 30.8 84 43.9 73 80.0 74 35.8 84 Central-Eastern (45.9) 39 30.8 67 53.3 54 63.8 58 35.3 52 Eastern 35.8 88 28.1 123 64.2 113 85.5 82 (47.3) 69 Tashkent city 19.4 (14) 14.5 25 39.2 22 (58.6) 17 (27.5) 21 Residence Urban 31.8 94 22.8 149 48.7 83 73.8 104 27.6 102 Rural 39.5 187 28.3 285 44.2 306 80.3 244 41.9 257 Mother’s education**** Incomplete Secondary (38.2) 47 24.4 73 36.4 51 77.6 53 34.8 56 Complete Secondary 35.5 125 26.2 192 41.4 173 80.4 161 38.0 182 Secondary special 39.7 92 28.6 136 53.7 134 78.8 110 40.4 96 Higher education (*) 18 (24.4) 33 (43.8) (31) (63.7) 24 (33.6) 25 Wealth index quintiles Poorest (33.4) 58 23.9 85 42.5 75 88.5 78 49.3 68 Second (51.4) 53 35.7 89 46.5 84 79.3 73 45.0 78 Middle 31.6 65 25.0 85 41.9 92 85.0 61 31.5 83 Fourth 38.2 58 24.0 95 45.6 73 70.6 78 35.0 76 Richest 30.7 47 23.4 80 50.7 65 66.2 57 27.0 54 Mother tongue of household head Uzbek 37.2 247 26.8 382 44.7 330 82.0 295 39.7 302 Other Language (34.5) 34 24.1 53 47.9 59 57.8 53 28.0 57 Total 36.9 281 26.4 435 45.2 389 78.3 348 37.9 359 * MICS indicator 15 ** MICS indicator 17 *** MICS indicator 16 **** 1 unweighted case with “Non-standard education / Children 0–5 months” not shown ( ) Figures that are based on 25–49 unweighted cases (*) Figures that are based on less than 25 unweighted cases Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 81 Table 10: Adequately fed infants Percentage of infants under 6 months of age exclusively breastfed, percentage of infants 6-11 months who are breastfed and who ate solid/semi-solid food at least the minimum recommended number of times yesterday and percentage of infants adequately fed, Uzbekistan, 2006 Percent of infants Number of infants aged 0–11 months 0–5 months exclusively breastfed 6–8 months who received breastmilk and complementa- ry food at least 2 times in prior 24 hours 9–11 months who received breastmilk and complementa- ry food at least 3 times in prior 24 hours 6–11 months who received breastmilk and complementa- ry food at least the minimum recommended number of times per day* 0–11 months who were appropriately fed** Sex Male 26.5 29.5 24.0 26.6 26.5 510 Female 26.3 29.8 30.9 30.4 28.7 499 Region Western 24.1 28.9 27.0 27.8 26.1 110 Central 21.0 19.8 8.9 14.2 16.9 218 Southern 30.8 17.8 18.2 18.0 23.5 196 Central-Eastern 30.8 36.4 46.4 41.3 36.3 140 Eastern 28.1 43.2 42.5 42.8 36.5 288 Tashkent city 14.5 20.4 25.8 23.2 19.3 56 Residence Urban 22.8 34.9 33.8 34.2 28.4 292 Rural 28.3 28.3 25.0 26.6 27.3 717 Mother’s education*** Incomplete Secondary 24.4 17.9 29.0 24.8 24.6 158 Complete Secondary 26.2 25.6 26.0 25.8 25.9 452 Secondary special 28.6 39.4 28.9 34.1 31.8 321 Higher education 24.4 29.3 27.1 28.1 26.5 76 Wealth index quintiles Poorest 23.9 19.3 24.1 21.8 22.7 197 Second 35.7 30.1 28.3 29.4 32.3 194 Middle 25.0 31.1 23.3 26.6 26.0 227 Fourth 24.0 36.1 28.1 31.9 28.1 201 Richest 23.4 32.1 35.1 33.8 29.4 190 Mother tongue of household head Uzbek 26.8 29.2 27.2 28.1 27.5 866 Other Language 24.1 32.2 29.1 30.5 28.1 143 Total 26.4 29.6 27.5 28.5 27.6 1009 * MICS indicator 18 ** MICS indicator 19 *** 1 unweighted case with “Non-standard education” not shown 82 ! Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 Table 11: Iodized salt consumption Percentage of households consuming adequately iodized salt, Uzbekistan, 2006 Percent of households in which salt was tested Number of households interviewed Percent of households with Total Number of households in which salt was tested or with no salt No salt Salt test result 0 PPM < 15 PPM 15+ PPM* Region Western 99.0 996 0.5 13.4 42.4 43.6 100 991 Central 99.7 2182 0.1 22.8 23.8 53.2 100 2176 Southern 99.0 1658 0.4 18.2 12.8 68.6 100 1648 Central-Eastern 99.9 1527 0.1 15.5 34.8 49.6 100 1527 Eastern 99.2 2841 0.4 21.8 34.9 42.9 100 2830 Tashkent city 98.9 994 0.3 6.4 21.8 71.5 100 986 Residence Urban 99.2 3843 0.2 11.4 26.4 62.0 100 3823 Rural 99.4 6355 0.3 22.3 29.6 47.8 100 6335 Education of household head Primary/Non-standard (100.0) 30 (–) (18.5) (55.7) (25.8) 100.0 30 Incomplete Secondary 99.2 1659 0.3 21.1 30.0 48.7 100 1650 Complete Secondary 99.5 3822 0.2 21.0 30.4 48.4 100 3808 Secondary special 99.2 2801 0.3 15.9 27.8 55.9 100 2789 Higher education 99.4 1885 0.4 13.2 23.4 63.0 100 1880 Wealth index quintiles Poorest 98.8 1864 0.4 24.4 30.0 45.2 100 1849 Second 99.5 1914 0.2 23.7 30.4 45.7 100 1909 Middle 99.6 1888 0.2 21.3 29.8 48.8 100 1885 Fourth 99.5 1903 0.3 16.0 30.6 53.1 100 1899 Richest 99.3 2629 0.3 9.1 23.3 67.3 100 2617 Total 99.3 10198 0.3 18.2 28.4 53.1 100 10158 * MICS indicator 41 ( ) Figures that are based on 25–49 unweighted cases Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 83 Table 12: Children’s vitamin A supplementation Percent distribution of children aged 6-59 months by whether they have received a high dose vitamin A supplement in the last 6 months, Uzbekistan, 2006 Percent of children who received vitamin A: Not sure if received vitamin A Never received vitamin A Total Number of children aged 6–59 months Within last 6 months* Prior to last 6 months Not sure when Sex Male 72.4 5.9 11.8 2.7 7.3 100.0 2298 Female 71.7 5.2 12.0 3.1 8.0 100.0 2253 Region Western 94.7 0.1 1.3 0.1 3.8 100.0 513 Central 65.4 8.6 16.5 2.9 6.6 100.0 1002 Southern 74.6 2.9 8.3 3.3 11.0 100.0 972 Central-Eastern 75.4 5.0 9.5 4.6 5.5 100.0 620 Eastern 71.1 8.3 15.5 2.0 3.1 100.0 1202 Tashkent city 37.3 3.5 18.1 6.6 34.5 100.0 242 Residence Urban 60.8 7.4 15.6 4.4 11.8 100.0 1282 Rural 76.4 4.8 10.5 2.3 6.0 100.0 3269 Age 6–11 months 76.2 1.6 5.8 2.5 13.9 100.0 574 12–23 months 77.7 4.2 8.7 2.7 6.8 100.0 1078 24–35 months 72.5 6.5 12.7 2.0 6.2 100.0 954 36–47 months 71.5 6.5 13.1 2.7 6.2 100.0 1010 48–59 months 63.1 7.6 17.2 4.5 7.7 100.0 936 Mother’s education** Incomplete Secondary 72.3 5.6 11.1 1.3 9.7 100.0 704 Complete Secondary 73.6 5.1 12.0 3.2 6.2 100.0 2246 Secondary special 70.9 6.2 12.3 2.7 7.9 100.0 1259 Higher education 64.6 6.5 11.7 4.9 12.2 100.0 337 Wealth index quintiles Poorest 74.8 5.4 10.9 2.6 6.3 100.0 1054 Second 73.9 4.5 12.0 2.0 7.6 100.0 904 Middle 76.0 6.1 9.6 2.2 6.0 100.0 898 Fourth 76.7 5.0 10.4 2.5 5.3 100.0 908 Richest 56.2 6.9 17.5 5.4 14.0 100.0 788 Mother tongue of household head Uzbek 72.7 5.7 11.6 2.8 7.2 100.0 3933 Russian 38.0 5.4 20.0 8.6 28.0 100.0 76 Karakalpak 88.3 – 4.8 1.7 5.1 100.0 77 Tajik 61.8 7.8 17.7 3.1 9.5 100.0 298 Other Language 81.9 1.4 7.9 2.7 6.0 100.0 166 Total 72.0 5.6 11.9 2.9 7.6 100.0 4551 * MICS indicator 42 ** 5 unweighted cases with “Non-standard education” not shown 84 ! Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 Table 13: Low birth weight infants Percentage of live births in the 2 years preceding the survey that weighed below 2500 grams at birth,Uzbekistan, 2006 Percent of live births: Number of live birthsBelow 2500 grams* Weighed at birth** Region Western 2.7 98.7 236 Central 5.4 99.7 446 Southern 4.3 98.6 427 Central-Eastern 3.5 99.5 303 Eastern 6.6 99.5 544 Tashkent city 4.6 98.8 115 Residence Urban 4.7 99.2 591 Rural 4.9 99.2 1480 Mother’s education*** Incomplete Secondary 4.8 99.0 334 Complete Secondary 4.5 99.1 975 Secondary special 5.4 99.4 608 Higher education 4.7 100.0 154 Wealth index quintiles Poorest 5.4 99.2 433 Second 5.7 99.0 416 Middle 4.8 98.6 427 Fourth 4.2 99.8 423 Richest 4.0 99.6 373 Mother tongue of household head Uzbek 4.9 99.3 1765 Russian 4.8 98.1 35 Karakalpak 2.7 100.0 38 Tajik 5.9 99.2 154 Other Language 3.3 98.9 79 Total 4.8 99.2 2072 * MICS indicator 9 ** MICS indicator 10 *** 2 unweighted cases with “Non-standard education” not shown Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 ! 85 Ta bl e 14 : V ac ci na ti on s by b ac kg ro un d ch ar ac te ri st ic s Pe rc en ta ge o f c hi ld re n ag ed 1 5- 26 m on th s c ur re nt ly v ac ci na te d ag ai ns t c hi ld ho od d ise as es , U zb ek ist an , 2 00 6 Pe rc en ta ge o f c hi ld re n w ho re ce iv ed : Pe rc en t w ith he al th ca rd N um be r of c hi ld re n ag ed 1 5– 26 m on th s BC G D PT 1 D PT 2 D PT 3 Po lio 0 Po lio 1 Po lio 2 Po lio 3 M ea sl es * Al l N on e Se x M al e 10 0. 0 99 .5 96 .3 93 .5 98 .9 98 .1 93 .4 90 .1 97 .0 86 .8 – 95 .6 53 2 Fe m al e 10 0. 0 99 .1 95 .5 92 .8 99 .6 97 .3 93 .5 88 .9 97 .8 87 .0 – 96 .4 51 5 Re gi on W es te rn 10 0. 0 99 .5 95 .4 93 .5 10 0. 0 94 .0 86 .3 82 .2 99 .5 81 .7 – 89 .5 12 9 Ce nt ra l 10 0. 0 99 .3 96 .5 94 .3 98 .3 97 .2 93 .1 87 .0 97 .1 86 .2 – 98 .3 23 5 So ut he rn 10 0. 0 99 .5 96 .4 94 .8 99 .2 99 .0 96 .0 95 .1 96 .3 92 .1 – 97 .4 22 3 Ce nt ra l– Ea st er n 10 0. 0 98 .6 91 .8 83 .6 99 .0 95 .9 85 .5 78 .0 96 .3 73 .3 – 95 .9 15 3 Ea st er n 10 0. 0 10 0. 0 98 .1 97 .1 10 0. 0 99 .7 99 .0 97 .3 98 .7 94 .4 – 96 .4 25 0 Ta sh ke nt c ity 10 0. 0 97 .4 94 .3 90 .1 99 .2 10 0. 0 97 .5 92 .1 95 .4 84 .2 – 94 .8 58 Re sid en ce U rb an 10 0. 0 99 .4 93 .5 89 .1 99 .2 96 .4 89 .7 82 .4 97 .3 78 .1 – 91 .8 30 0 Ru ra l 10 0. 0 99 .3 96 .9 94 .8 99 .2 98 .2 94 .9 92 .4 97 .5 90 .4 – 97 .7 74 7 M ot he r’s e du ca tio n* * In co m pl et e Se co nd ar y 10 0. 0 98 .9 97 .0 92 .9 99 .7 99 .5 93 .4 90 .0 99 .3 87 .2 – 96 .9 16 4 Co m pl et e Se co nd ar y 10 0. 0 99 .4 96 .5 94 .2 99 .1 98 .2 95 .4 92 .3 97 .0 89 .4 – 96 .9 51 8 Se co nd ar y sp ec ia l 10 0. 0 99 .6 95 .1 93 .1 99 .8 95 .8 89 .5 86 .0 96 .8 84 .4 – 95 .8 28 5 H ig he r e du ca tio n 10 0. 0 99 .1 93 .3 87 .3 97 .0 98 .2 94 .6 83 .3 98 .1 78 .6 – 89 .8 79 W ea lth in de x qu in til es Po or es t 10 0. 0 98 .7 95 .2 93 .7 98 .8 98 .2 93 .8 91 .1 96 .6 90 .1 – 96 .8 21 8 Se co nd 10 0. 0 99 .3 97 .6 95 .3 99 .5 98 .6 94 .3 92 .3 96 .9 89 .1 – 97 .5 20 9 M id dl e 10 0. 0 99 .4 96 .3 93 .3 98 .8 98 .3 95 .9 93 .9 98 .5 91 .0 – 96 .9 21 2 Fo ur th 10 0. 0 10 0. 0 94 .5 91 .2 10 0. 0 96 .6 91 .2 85 .2 97 .4 83 .5 – 96 .3 22 2 Ri ch es t 10 0. 0 99 .2 96 .1 92 .5 99 .0 96 .9 91 .8 84 .9 97 .7 80 .0 – 92 .1 18 6 M ot he r t on gu e of h ou se ho ld h ea d U zb ek 10 0. 0 99 .3 96 .1 93 .9 99 .1 98 .6 95 .1 92 .2 97 .5 89 .5 – 97 .4 87 6 Ru ss ia n (1 00 .0 ) (9 7.0 ) (9 7.0 ) (9 5. 1) (1 00 .0 ) (8 7.0 ) (8 6. 1) (7 6. 4) (9 6. 2) (6 7.7 ) (– ) (9 6. 5) 22 Ka ra ka lp ak (1 00 .0 ) (9 7. 2) (8 0. 0) (7 4. 1) (1 00 .0 ) (8 4. 1) (7 0. 9) (5 9. 3) (1 00 .0 ) (5 9. 3) (– ) (8 6. 2) 22 Ta jik 10 0. 0 10 0. 0 98 .1 91 .3 10 0. 0 95 .2 87 .1 79 .4 97 .3 78 .1 – 90 .9 82 O th er L an gu ag e 10 0. 0 10 0. 0 95 .8 90 .2 10 0. 0 96 .4 86 .4 76 .9 95 .7 74 .9 – 83 .7 45 To ta l 10 0. 0 99 .3 95 .9 93 .2 99 .2 97 .7 93 .4 89 .6 97 .4 86 .9 – 96 .0 10 47 * M ea sl es v ac ci na tio n be fo re th e ag e of 1 5 m on th s ** 1 u nw ei gh te d ca se w ith “N on -s ta nd ar d ed uc at io n” n ot sh ow n ( ) F ig ur es th at a re b as ed o n 25 –4 9 un w ei gh te d ca se s 86 ! Findings from the Uzbekistan Multiple Indicator Cluster Survey 2006 Table 15: Vaccinations by background characteristics (continued) Percentage of children aged 15-26 months currently vaccinated against childhood diseases, Uzbekistan, 2006 Percentage of children who received: Percent with health card Number of children aged 15–26 monthsHepB1 HepB2 HepB3 Sex Male 99.7 95.9 90.5 95.6 532 Female 99.7 96.2 90.3 96.4 515 Region Western 99.5 95.8 87.2 89.5 129 Central 99.3 95.3 93.3 98.3 235 Southern 99.5 99.0 95.0 97.4 223 Central-Eastern 100.0 89.2 78.0 95.9 153 Eastern 100.0 98.1 92.8 96.4 250 Tashkent city 100.0 97.9 91.4 94.8 58 Residence Urban 100.0 91.8 85.8 91.8 300 Rural 99.5 97.8

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Uzbekistan Multiple Indicator Cluster Survey 2006: Monitoring the Situation of Children and Women

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