“As the world measures
this progress towards
meeting the MDGs, data
is beginning to show
widening risk between
the rich and the poor
countries, and glaring
disparities within nations,
injustices that should
make everyone of us
furious.”
Anthony Lake
Contents
List of Acronyms.................................................................................................................................4
Introduction........................................................................................................................................6
Background........................................................................................................................................8
Report Methodology.............................................................................................................................................. 8
Millennium Development Goals......................................................................................................................... 11
World Fit for Children........................................................................................................................................... 12
UNGASS.................................................................................................................................................................. 13
Review of Existing Data & Survey Methodologies..........................................................................14
Country Poverty Assessments............................................................................................................................. 14
Census..................................................................................................................................................................... 15
Mortality Estimates from Census Data.............................................................................................................. 16
Labor Force Surveys............................................................................................................................................. 17
Review of Available Data for UNICEF MICS4 Indicators.................................................................20
Mortality.................................................................................................................................................................. 20
Nutrition.................................................................................................................................................................. 21
Child Health........................................................................................................................................................... 23
Environment............................................................................................................................................................ 25
Maternal & Reproductive Health....................................................................................................................... 25
Child Development............................................................................................................................................... 26
Literacy and Education........................................................................................................................................ 27
Child Protection..................................................................................................................................................... 27
HIV/AIDS................................................................................................................................................................. 28
Adolescents and Young People......................................................................................................................... 30
Optional MICS Module: Access to Mass Media and Use of
Information/Communication Technology.......................................................................................................... 30
Optional MICS Module: Tobacco and Alcohol Use....................................................................................... 31
Optional MICS Module: Life Satisfaction......................................................................................................... 31
1
Other Surveys......................................................................................................................................................... 31
DHS.......................................................................................................................................................................... 32
MICS........................................................................................................................................................................ 32
Summary & Challenges....................................................................................................................36
Recommendations...........................................................................................................................37
References........................................................................................................................................39
Appendix 1. MICS4 Indicators: Numerators & Denominators.........................................................42
Appendix 2. MICS Timeline Example..............................................................................................70
2
3
List of Acronyms
AIDS
CARICOM
Caribbean Community
CPA
Country Poverty Assessment
CSO
Central Statistical Office
CDB
Caribbean Development Bank
DfID
UK Department for International Development
DHS
Demographic and Health Surveys
ECLAC
EU
Economic Commission for Latin America
European Union
HBS
Household Budget Surveys
HIV
Human Immunodeficiency Virus
IADG
IDB
Internationally Agreed Upon Development Goals
Inter-American Development Bank
LSMS
Living Standards and Measurement Surveys
MICS
Multiple Indicator Cluster Surveys
NLTA
Non-Lending Technical Assistance
OECS
Organization for Eastern Caribbean States
PPA
Participatory Poverty Assessment
PRSP
Poverty Reduction Strategy Paper
SIDS
Small Island Developing States
SLC
UNAIDS
UNGASS
WHO
4
Acquired Immunodeficiency Syndrome
Survey of Living Conditions
The Joint United Nations Programme on HIV/AIDS
United Nations General Assembly Special Session on HIV/AIDS
World Health Organization
5
Introduction
Despite recent initiatives to support data collection and reporting for the MDGs, and
substantial data on the economic status of the population, Eastern Caribbean countries
have not reported consistently on the MDGs or IADGs. In particular, the region lags
behind in reporting on indicators of social development such as women’s reproductive
health, child health, gender equality in educational attendance and attainment, and
the HIV/AIDS epidemic. One of the major problems facing the region has been lack of
coordination among various national agencies responsible for collecting and reporting
on the MDGs and IADGs. CSOs are lacking in technical capacity, human resources
and financial support, and often do not hold primary responsibility for data collection
or reporting.1 Given that between 55 and 68 percent of the poor in the Caribbean are
children and young people,2 it is particularly relevant to ensure that local indicators best
reflect the status of and the needs of the worst-off so that appropriate interventions can
be targeted. UNICEF is committed to assist Barbados and the OECS countries to gather
the necessary data for monitoring, planning and development needs of women and
children. The purpose of this report is to review existing data for the region, and assess
the need for new data collection to meet monitoring and reporting needs. Indicators
for the UNICEF Multiple Indicator Cluster Surveys (MICS), which span reporting needs
for MDGs and a range of other IADG goals, are reviewed in detail in terms of currently
reported and available data.
In recent decades, several harmonized survey instruments, such as the MICS, Demographic
and Health Surveys (DHS), Living Standards and Measurement Surveys (LSMS) have
been implemented in many countries around the world. Most countries in the Eastern
Caribbean region have not carried out these surveys, either because of lack of resources
or lack of sufficient attention placed on measuring health and socioeconomic status in
the region. The Country Poverty Assessments (CPAs), first carried out in the late 1990s,
were among the first data collection efforts in the region which have attempted to collect
standardized, harmonized information on the wellbeing of the population. Yet despite the
progress, the region is still lacking in consistent, harmonized data which can be used to
measure the current wellbeing of the population, and progress or setbacks as policies
and programs change. Furthermore, almost no studies have analyzed the standard of
living and wellbeing of children and women. Most of the information on these populations
is derived from measures of the household, which may mask inequalities among children
or across genders, who are expected to share equally in the wealth or poverty of the
household.
The purpose of this report is to assess the needs for data on women and children in
Barbados and the OECS countries, and to recommend avenues to fill the data gaps. This
report is organized in three sections:
1. Background: this section describes the methodology for this assessment, and the
Caribbean context
2. Review of existing data: this section includes a review of recent and in-progress data
collection;
3. Comparison of survey methodologies; this section details the sample designs, survey
instruments, data processing, archiving, etc. for data described in the first section;
4. Review of UNICEF key indicators: definitions of indicators, current data sources, and
gaps
5. Recommendations: this section outlines how data gaps on women and children can
feasibly and quickly be filled.
This report covers the Eastern Caribbean region, which includes Antigua and Barbuda,
Barbados, British Virgin Islands, Dominica, Grenada, Montserrat, St. Kitts & Nevis, St.
Lucia, St. Vincent & Grenadines, and Turks and Caicos.
1 See for example ECLAC 2005, “The Statistical Infrastructure of Caribbean Countries,” and
ECLAC 2009, “The Status of Millennium Development Goals: Monitoring and Reporting in
Selected Caribbean Countries.”
2 UNICEF 2009, “State of the World’s Children.”
6
7
Background
Report Methodology
This assessment was commissioned by the UNICEF Eastern Caribbean Office. The main
objectives of the assessment are to (1) review data currently available from existing and
scheduled surveys in the Eastern Caribbean sub-region, and identify major data gaps
to meet monitoring and reporting requirements for MDGs and other IADGs concerning
issues related to women and children; (2) compare survey methodologies (including
sampling designs, survey instruments, data processing methods, archiving of data, and
creation of metadata) of existing surveys in the sub-region and identify potential areas
where existing survey instruments can be harmonized with methods and content of MICS
and DHS surveys, and (3) recommend how data gaps on the situation of children and
women can feasibly and quickly be filled, given the support of programmes such as the
MICS and the assistance of other UN agencies and other development partners.
This assessment is based on meetings and correspondence with UNICEF staff from the
Eastern Caribbean sub-regional office and the Latin American and Caribbean Regional
office, the Caribbean Development Bank, the Organization of Eastern Caribbean States,
the Central Statistical Offices of Barbados and St. Lucia, UNFPA, and ECLAC, as well
as published reports cited here. Survey instruments for published CPA reports were
reviewed, as well as the 2010 Census questionnaire adopted by the CARICOM countries.
CPA published reports provided details on sampling design, as well as tabulations for
indicators collected in the surveys. This report reviews not only the MDG reports and CPA
survey reports, but also UNICEF, PAHO, and UNAIDS publications, as well as Census and
survey instruments to assess the overall availability of data and potential to fill gaps on
the status of women and children in the region.
The Caribbean region has adopted the MDGs as a framework to reduce poverty and
improve human development. Various initiatives have been developed to facilitate the
monitoring and reporting of MDG indicators and other IADGs, yet Barbados and the OECS
countries continue to face challenges in fulfilling the reporting requirements. Recently,
ECLAC funded a project to support the strengthening of national institutional capabilities
for generating reliable data to meet these monitoring and reporting requirements.
The project, Strengthening the capacity of National Statistical Offices (NSOs) in the
Caribbean Small Island Developing States to fulfill the Millennium Development Goals
and other Internationally Agreed Development Goals (IADGs), seeks to build on past
and current initiatives on broadening and improving statistics and indicators through
8
the use of existing knowledge, experience and expertise at national and regional
levels.3 Under this new project, ECLAC published a report which provides an overview of
regional monitoring and reporting efforts in the Caribbean countries, which are currently
very fragmented.4 ECLAC also commissioned a report, “The Status of Demographic and
Health-Related MDGs in Caribbean Countries” published in 2009. The report includes
background information on the organization of data collection in the region, and results
from a two-day expert meeting convened in February 2008 to discuss available health
and demographic data sources and directions for the future reporting needs for the
MDGs.
To fill information gaps on household poverty and inequality, World Bank experts have
drafted a concept note outlining a proposal for a new Non-Lending Technical Assistance
(NLTA) project. The proposed NLTA would support household surveys and poverty
analysis in the OECS countries, potentially within the planned CPA data collection or as
a new set of household surveys similar to the LSMS. A draft concept note outlines the
key problems in the region regarding the collection and analysis of poverty data.5 The
document outlines the rationales for the NTLA, including:
• Severe shortage of poverty indicators, resulting in lack of analysis of poverty and
inequality in the region;
• Lack of human resources, technical capacity and government funding for statistical
institutions;6
• Lack of capacity within CSOs and across other national institutions to analyze poverty
and social development data.
The NLTA project proposes to support capacity building within CSOs to harmonize
household poverty surveys, including development of survey instruments, sampling
design, data processing, documentation, data analysis and reporting. The NLTA has the
3 ECLAC 2009, “The Status of Millennium Development Goals: Monitoring and Reporting in Selected
Caribbean Countries.”
4 Ibid.
5 World Bank, 2010, “OECS Non-Lending Technical Assistance: Household Surveys and Poverty
Analysis.”
6 See also ECLAC 2005, “The Statistical Infrastructure of Caribbean Countries.”
9
potential to fill important gaps on household socioeconomic indicators, but given the
early stages of this proposal, it is unclear whether or when this project will be funded
and implemented.
In 2006, CARICOM established an Early Childhood Development Working Group to
examine the relationships between early childhood development and poverty reduction,
early childhood development and human capacity development and early childhood
development and social vulnerabilities.7 CARICOM has supported the development of a
framework and indicators for monitoring early childhood services as well as vulnerable
and disadvantaged children in Member States. A Regional Action Plan for Children
2002-2015 has been established, and in 2009 a monitoring and evaluation framework
was developed to track progress on key indicators. Following the ratification of the
Convention on the Rights of the Child and other Human Rights Covenants, legal framework
harmonization among OECS countries is also in progress. The OECS Secretariat has
played a major role in the drafting of legislation on child protection. It has also been
instrumental in pushing the sub-regional agenda forward in the area of justice for children.
This process will ensure a protective environment for children, addressing issues such as
the right to an identity, sexual and emotional abuse of children, promoting alternative
and positive disciplinary methods and emerging issues such as trafficking and migration.8
But little progress appears to have been made in establishing the common framework
and collecting data on indicators for monitoring progress towards these goals, as is welldocumented in a 2009 UN ECLAC report, “The Status of Millennium Development Goals:
Monitoring and Reporting in Selected Caribbean Countries.”
Following a 2002 UNDP-commissioned study on data and MDG reporting challenges
facing the region, the Support to Poverty Assessment and Reduction program (SPARC)
was established through funding from the CDB, DfID, and IDB. SPARC was formed with
a broad mandate to provide a framework of support and collaboration in the region.
Specifically, SPARC aims to strengthen national and regional capacities to collect,
analyze and disseminate social data for poverty assessment and social development
programs, both at national and international levels. The SPARC framework aims to lead
to improved data collection and analytical skills which would in turn strengthen poverty
monitoring systems to complement social development strategies and policies linked to
the achievement of the MDGs. So far, the SPARC has achieved the first regional MDG
report. A key staff position has been vacant; it is expected that when the vacancy is filled,
SPARC will move forward towards the goals it has outlined.
7 Speech by UNICEF Regional Director, Nils Kastberg. Special COHSOD on Children, Georgetown,
Guyana. March 17- 19, 2008.
8 Ibid.
10
Under the poverty monitoring support efforts of SPARC, the organization is mandated to
provide technical assistance in three areas: sampling and survey design, data processing
and management, and data analysis and interpretation. This technical assistance has
generally been provided in the form of training workshops in countries carrying out the
CPA. Some of these training workshops have involved multiple countries. The country
CSO is typically involved in the fieldwork, data processing and analysis, with technical
assistance from international consulting firms. Data from the CPAs are used to create
poverty profiles for each country, report on MDGs, and the data is also used in the
National Poverty Reduction Strategy papers. Recent CPA reports are available from the
CDB website.9
Millennium Development Goals
The OECS countries and Barbados submitted a joint report to the United Nations in 2004
for the last round of MDG reporting.10 In 2009, ECLAC administered a survey to 2311
ECLAC countries and territories to collect information on how MDG reporting is carried
out. The report also reviewed the comparability of data and indicators reported, as well
as data sources and gaps. The findings suggest a wide data gap in indicators on women
and children, as well as inconsistent and incomparable data sources for some indicators,
particularly poverty measures. The ECLAC review noted that the majority of countries
in the sub-region do not have a central authority which oversees statistical activities at
the national level. This compounds the issues of fragmentation and incompleteness of
monitoring data availability.
The ECLAC report summarizes data gaps for each of the MDG goals. For the MDG healthrelated goals, there is a range of abilities across countries in the region to report on
specific indicators. The report found that education data is widely available yet several
countries do not have data to report on primary enrollment and completion, or literacy of
young adults. While data on maternal health and mortality is generally available, data
for contraceptive prevalence and family planning needs is generally not available.
9
http://www.caribank.org/titanweb/cdb/webcms.nsf/vwPublicationSearch?SearchView&Query=%22c
pa %22&Count=50&Start=1. Last accessed: August 16, 2010.
10 The 2010 MDG Report is currently in preparation.
11 Antigua and Barbuda, Bahamas, Barbados, Belize, Dominica, Grenada, Guyana, Jamaica, Saint
Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Suriname and Trinidad and Tobago.
Non-Independent countries and territories: Anguilla, Aruba, Bermuda, BVI, Cayman Islands, Montser
rat, Netherlands Antilles, Turks and Caicos Islands and the US Virgin Islands.
11
Finally, data on HIV/AIDS is incomplete. HIV/AIDS data is generally not collected or
available by age or gender, and little to no relevant behavioral information is collected.
ECLAC published a report specific to the health and demographic MDGs, “The Status
of Demographic and Health-Related MDGs in Caribbean Countries” in 2009, which
specifically looked at the sources of data for these MDGs, reporting authority, and
availability of data for the most recent round of MDG reporting. However, the report did
not review whether the health and demographic MDG indicators had been published
outside of the MDG reporting mechanisms. Nonetheless the review provides details
on the responsible reporting agencies for the health and demographic MDGs, and
also provides more specific details on data used for the MDG reporting. This report, in
combination with the MDG monitoring report published in 2009 (ECLAC) provide thorough
overviews of the gaps in MDG reporting for the region.
World Fit for Children
The OECS countries and Barbados have incomplete reporting for most of the indicators
in the 2009 UNICEF World Fit for Children reports. While reasonably complete (though
uneven across time) data exists for several of the MDG indicators, data is extremely sparse
for other indicators of child health, child protection and women’s health. Little information
appears to be regularly collected or reported on measures of nutrition for young children,
such as exclusive breastfeeding duration or feeding practices, micronutrients, or birth
weight. All countries in the region have reported recent immunization rates either in the
UNICEF State of the World’s Children, or the most recent regional MDG report. Household
water and sanitation measures are generally available for countries in the region. But
reproductive health indicators are incomplete and unevenly reported throughout the
region. Surprisingly, literacy and education indicators are also unevenly available across
the Caribbean countries. Almost no information appears to exist for indicators related
to child protection. Furthermore, almost no data exists or is reported on adolescent
development, or life satisfaction.
UNGASS
The 2009 UNAIDS Epidemic Update shows stabilization in the rate of new HIV infections
in some Caribbean countries, and a decline in others.12 Treatment and care coverage
has improved globally in recent years, although treatment is still not universal among
those who need it. Almost half of HIV infections in the region occur among women,
yet little is known about regional behavior dynamics among the Eastern Caribbean
countries. According to the UNAIDS report, young people in the region have yet to
adopt consistently safer sex behaviors; have difficulty accessing sexual, reproductive
and HIV health services; and young women in particular are subject to pressures for
intergenerational and/or transactional sex. Forced sexual debut is an issue affecting
approximately 20 percent of young people, according to UNAIDS. UNICEF is committed
to support the implementation of prevention programs that target young people and
adolescents. The new Caribbean Regional Strategic Framework 2008-2012 emphasizes
an individual country approach towards achieving Universal Access to prevention,
treatment, care and support. Clearly, new comprehensive data will be needed to plan
programs and monitor progress in this area.
12 Joint United Nations Programme on HIV/AIDS (UNAIDS) and World Health Organization (WHO) 2009.
12
13
Review of Existing Data &
Survey Methodologies
Countries in the region have implemented CPAs since the mid-1990s, and the current
round of censuses in the region began in May 2010 (see Appendix 1). Several countries
have been conducting annual labor force surveys, and by 2012 all countries in the
OECS and Barbados will be conducting rolling annual labor force surveys. No regular
population-based demographic or health survey is currently conducted in any of the
countries in the region. This has resulted in major gaps to meet monitoring requirements
for MDGs and other IADGs concerning issues related to women and children.
Country Poverty Assessments
CDB assists countries in the collection of data for the CPAs. The IDB and the EU have
also supported poverty assessments in Barbados and St. Vincent & Grenadines. These
assessments cover both a quantitative assessment of the poor as compared to the nonpoor in per capita consumption, and an assessment of institutional capacity to deliver
poverty alleviating services to the poor. The CPAs also have a specific objective of
developing action plans to identify policies, programs and projects to reduce poverty
and improve the quality of life of the poor. These surveys are typically done every four to
five years (see Appendix 1).
The CPA data is comprised of three data collection efforts: household budget survey
(HBS) or survey of living conditions (SLC), participatory poverty assessment (PPA), and
an institutional assessment (IA). The household survey is typically a sample survey of
households selected within enumeration areas chosen with probability proportional to
population size. The latest round of surveys should have been completed in five OECS
countries by the end of 2009. Three countries are slated to carry out their CPAs in 20102011 (see Appendix 1). The primary contribution of these data is to provide information
on various dimensions of poverty in the Caribbean region.
The household surveys carried out to date followed a two stage stratified systematic
random sample selection design. At the first stage, enumeration districts (or primary
sampling units) were selected based on a sampling frame constructed from Census
enumeration districts. The size of each enumeration district included in the frame is
14
measured in units of clusters of households, approximately eight households per cluster.
In the second stage, one set of households is systematically chosen from the selected
primary sampling unit, with probability proportional to size.
Some countries have conducted the CPAs in five to seven year intervals (Anguilla,
Dominica, St. Kitts & Nevis), and others in ten or eleven year intervals (Barbados,
Grenada, St. Lucia, St. Vincent & Grenadines) (see Appendix 1 for details). Montserrat has
not conducted a CPA but is scheduled to complete one in 2010. CPA reports published
on the CDB website contain very little data on health or demographic indicators. Of
the nine countries in the region with recent reports available, six of the household
surveys contain no health information, and five contain no demographic information
(childbearing indicators for women in the household). Available data on health and
demographics is further discussed in a later section in this report. The next round of
CPA data collection is to be undertaken in 2015. The World Bank had initiated, with
UNDP, the introduction of the Core Welfare Indicator Questionnaire as a tool to gather
more frequent information on unmet basic needs; a pilot was to be undertaken in the
Caribbean though future implementation of these surveys is not yet scheduled.
Census
The current round of national population Censuses in the region began in May 2010.
Six of the ten countries in the region will have carried out the Census in May, a seventh
in December 2010, and the remaining three will carry out the Census in 2011. All
CARICOM countries have agreed to use a standard census form (see Appendix 2). The
household form contains dwelling characteristics, and age, sex, education, occupation
and migration information for all household members. Age and sex of any household
member who died in the last 12 months, and whether any household member was the
victim of a crime will also be collected. An individual questionnaire will be administered
for all persons; this will include relationship to household head, marital status, fertility
(for women age 15 and above) including live births and deaths to children in the last
12 months, migration, disability status, health condition and health insurance, education,
vocational training, economic activity, and income/livelihood.
15
The Census data will provide important data for monitoring development progress.
Because it covers the entire population, indicators can be constructed for geographically
small areas, essential for regional and local planners. The Census will provide the new
sample frame which can be used in specialized surveys to select representative samples.
In the current Census round, all CARICOM countries (with the exception of Suriname) will
capture the data by scanning the Census forms, using the TELEform scanning technology
(Cardiff software). All countries in the region are expected to use CSPro for editing and
tabulations.
Labor Force Surveys
The OECS is supporting the standardized, common Continuous Labor Force Survey (LFS)
for the countries in the region. The new LFS was to be piloted in the end of April 2010
in St. Vincent, Dominica, Grenada, and Antigua. A draft report is expected in June/July
2010. Starting in 2012, OECS expects all countries to carry out the labor force survey
annually. Like the Censuses, the LFS will be scanned using the TELEform technology. The
LFS will provide key information on labor and employment in the region. Employment
and economic activity information will be collected among all household members of
working age, and education information will be collected for all household members.
Mortality Estimates from Census Data
With the inclusion of the fertility section for women age 15 and over, it will be possible to
calculate indirect estimates of infant and under-five mortality. Information on infant births
and deaths in the last 12 months will allow for direct estimates of infant mortality in the
year prior to the Census. Information on the total number of children ever born and total
surviving (the Brass questions), along with assumptions of an underlying distribution of
age specific fertility, provide the necessary information for indirect estimates of under five
mortality. The resulting mortality rates, however, will not provide estimates of age patterns
of mortality or rates for specified time periods (other than the single year infant mortality
rate). Information on deaths among any household members in the last year, their age
and sex, will provide the data needed to construct adult male and female mortality rates
for the population.
Capacity building efforts have been underway for CSOs in the region undertaking the
Census this year. The scanning procedures require special training, and some data
processing training has also been carried out in regional workshops using CSPro. In the
countries where the Census is being undertaken this May, the related activities will likely
fully occupy the CSOs for the coming several months.
The Censuses are crucial sources of information for all Caribbean countries. In many
countries, the census is the only reliable source of data to estimate demographic rates. In
absence of other surveys, the Census may also be the only reliable source of current data
on education attainment or school enrollment. And finally, the new round of censuses will
provide the base population which can be used to update the national sample frame for
selection in representative household surveys.
16
17
“ Education is the way
to move mountains,
to build bridges, to
change the world.
Education is the path
to the future. I believe
that education is
indeed freedom.”
Oprah Winfrey
18
19
Review of Available Data for
UNICEF MICS4 Indicators
The following section describes the UNICEF indicators and current data sources in
the Caribbean region used to report on these indicators. Full definitions of all MICS4
indicators are provided in Appendix 3. These indicators span a wide range of MDG
goals, as well as child health, child protection, education, and the health and wellbeing
of women of childbearing age, many of which correspond to other IADGs.
childbearing age. These data can be used to calculate indirect estimates of mortality.
It will be important to compare previous estimates, Census, and new MICS estimates of
child mortality, since they will likely be somewhat different due to the differing source
data and estimation methodologies.
Mortality
Nutrition
1. Under-five mortality rate (MDG 4.1)
2. Infant mortality rate (MDG 4.2)
The latest UNICEF State of the World’s Children report indicates that all countries have
made substantial reductions in child mortality since 1990, yet countries in the region rank
among both the highest and lowest in infant and under-five mortality in the Caribbean.
All countries in the region have regularly reported infant and under-five mortality rates in
the latest MDG reports from Ministry of Health data. Infant and under five mortality rates
are calculated from vital registration and Census population estimates. The new round of
Censuses will collect data to calculate direct infant mortality rates for the year prior to the
Census. The new Census data will also allow for indirect estimates of under-five mortality.
Since the last round of censuses, direct estimates of mortality have largely been
calculated from vital registration data. It should be noted that child mortality rates can be
underestimated if infant deaths are under-reported. The PAHO 2009 Health in the Americas
estimates that Antigua & Barbuda, Barbados, Dominica, and Turks & Caicosunder-report
seven to 28 percent of child deaths (estimates of under-reporting were not presented for
Grenada, Montserrat, St. Kitts & Nevis, St. Lucia, St. Vincent & Grenadines).13
The current MICS core questionnaire contains a summary birth history for women of
13
Mortality under-registration is determined by subtracting from 1 the total cumulative deaths
registered in a country-period divided by the corresponding total cumulative estimated deaths, obtained
after applying the UN estimated crude death rates to the corresponding population estimates by the UN. For
countries with populations of fewer than 300,000, US Census Bureau rate and population are applied. PAHO
2009.
20
1. Underweight prevalence (MDG 1.8)
2. Stunting prevalence
3. Wasting prevalence
In the 2007 State of the World’s Children, no statistics were reported for underweight
prevalence (MDG 1.8) for any of the Caribbean countries. The 2004 Regional MDG Report
contained underweight estimates for three countries, Belize (1990), Jamaica (2001) and
St. Vincent & Grenadines (1995). More recent estimates for these countries have not been
published, nor are data available for the other eight CARICOM countries and Barbados.
None of the recent CPA household survey modules have collected anthropometric
measurements (height and weight) of children under five, with the exception of the
Grenada 1999 household poverty survey, which collected mother’s report of height
and weight information for children under five. This reflects the perception that undernutrition is not a problem in the region. Yet some studies suggest a growing problem in
middle income countries where households contain both overweight and underweight
household members.14 Evidence from epidemiological and clinical studies reveal that
in sedentary populations, undernourishment in gestation and among young children
predisposes these individuals to subsequent weight gain and fat accumulation.15 Current
data sources for the region do not allow for the exploration of these paradoxes. Many of
the CPA reports discuss the issues of over-nutrition and obesity as major health concerns.
In the Caribbean region, height and weight information for children under five would
be an important contribution to existing data sources not only to establish current rates
14 Doak et al, 2005. “The dual burden household and the nutrition transition paradox.”
15 Caballero, Benjamin. 2005. “Obesity as a consequence of under-nutrition.”
21
of malnutrition, but also current rates of over-nutrition in young children, which may be a
more pressing concern in this region.
1. Tuberculosis immunization coverage
2. Polio immunization coverage
Exclusive breastfeeding under 6 months
3. Immunization coverage for diphtheria, pertussis and tetanus (DPT)
7.
Continued breastfeeding at 1 year
4. Measles immunization coverage (MDG 4.3)
8.
Continued breastfeeding at 2 years
5. Hepatitis B immunization coverage
9.
Predominant breastfeeding under 6 months
6. Yellow fever immunization coverage
10. Duration of breastfeeding
7. Neonatal tetanus protection
11. Bottle feeding
12. Introduction of solid, semi-solid or soft foods
13. Minimum meal frequency
14. Age-appropriate breastfeeding
15. Milk feeding frequency for non-breastfed children
4.
Children ever breastfed
5.
Early initiation of breastfeeding
6.
Data on breastfeeding has been collected in a few recent household budget surveys,
including the 2005 St. Lucia Survey of Living Conditions, Antigua and Barbuda 2005-06
and Grenada 1999. Only Grenada and St. Kitts & Nevis reported any information on
breastfeeding in the 2007 State of the World’s Children; both countries reported on
prevalence of exclusive breastfeeding.
16. Iodized salt consumption
17. Vitamin A supplementation (children under age 5)
18. Low-birth weight infants
19. Infants weighed at birth
PAHO report includes low birth weight information for all countries (2009) with the
exception of Grenada. No published information on micronutrients appears in available
sources.
22
Child Health
The PAHO (2009) report includes 2008 immunization coverage information for all
countries in the region (DPT3, Polio3, BCG, and MMR). Most countries in the region
have achieved 90-100% coverage, yet BVI and Barbados still lag behind. Many studies
have documented concerns with measurement of vaccination coverage, particularly on
quality concerns with administrative data.16 Such problems have not been documented
in the Caribbean region, in spite of the fact that some countries have reported greater
than 100 percent vaccination coverage (PAHO 2009).
Several CPA household surveys (Antigua and Barbuda 2002, Grenada 1999, St. Lucia
2005) have collected immunization coverage for children under five, but these data
have not been presented as standard indicators using MDG definitions. Furthermore,
the questions on immunization only ask for mother’s report, and do not verify (with
observation or mother’s report) with a vaccination card. In addition to that major
limitation, non-response to child health questions was mentioned specifically in one CPA
report (St. Lucia 2005), which could bias the results from these data.
The 2005 St. Lucia Survey of Living Conditions and Household Budgets contained questions
for children under five born to women in the household. Information on place of delivery,
attendance at delivery, breastfeeding, supplemental feeding, and immunization status
was collected for the last five births. The numbers of children ever born and children
surviving were also collected, and might have been used to calculate indirect estimates
of child mortality. Yet the 2007 Country Poverty Assessment Report summarized only the
16 Lim et al, 2008. “Tracking progress towards universal childhood immunisation and the impact of global
initiatives: a systematic analysis of three-dose diphtheria, tetanus, and pertussis immunisation coverage.”
23
immunization coverage results from the survey, and did not provide results on any other
child health indicator. The report noted high non-response rates to the child health section
of the survey. The 2005-06 Antigua and Barbuda household budget survey contained a
set of questions on child health similar to the St. Lucia survey, and reported aggregate
results in the 2007 Poverty Report. The reported estimates for children under five include:
place of delivery, ever and currently breastfed proportions, and immunization coverage.
8.
Oral rehydration therapy with continued feeding
9.
Care-seeking for suspected pneumonia
10. Antibiotic treatment of suspected pneumonia
11. Solid fuels
12. Household availability of insecticide-treated nets (ITNs)
13. Households protected by a vector control method
14. Children under age 5 sleeping under any type of mosquito net
15. Children under age 5 sleeping under insecticide-treated nets (ITNs)
(MDG 6.7)
16. Malaria diagnostics usage
17. Antimalarial treatment (children under age 5) (MDG 6.8)
18. Pregnant women sleeping under insecticide-treated nets (ITNs)
19. Intermittent preventive treatment for malaria
20. Place for hand washing
21. Availability of soap
Other UNICEF indicators on child health and care-seeking behavior are not covered in
existing surveys, and may not be relevant for this Caribbean region. Malaria has largely
been eradicated, and pneumonia is the cause of a very small percentage of deaths
among young children in the region.17
17 Mathers, Lopez, Murray, 2006, “The Burden of Disease and Mortality by Condition: Data, Methods, and
Results for 2001.”
24
Environment
1. Use of improved drinking water sources (MDG 7.8)
2. Water treatment
3. Use of improved sanitation facilities (MDG 7.9)
4. Disposal of child’s faeces
Most countries in the region have recent estimates for MDGs 7.8 and 7.9, with almost
universal coverage of improved drinking water sources and sanitation facilities. These
indicators will be updated with the next round of Census data. Water treatment or
disposal of child faeces are not currently collected or reported in any available sources.
Maternal and Reproductive Health
1. Adolescent birth rate (MDG 5.4)
2. Early childbearing
Teenage pregnancy (MDG 5.4) is mentioned often in CPAs as a health concern, yet
no country reported on this MDG in the most recent regional MDG report (2004), nor
was the information available in recent national MDG reports (ECLAC 2009). St. Lucia
reported age at first birth by consumption quintile, showing that a much higher proportion
of the youngest mothers are among the poorest (2005). St. Kitts & Nevis reported that
41 percent of females had their first birth at ages 15-19 (2007-08), though age specific
fertility rates are not reported.
3. Contraceptive prevalence rate (MDG 5.3)
4. Unmet need (MDG 5.6)
According to the latest PAHO report, only St. Vincent & Grenadines and St. Kitts &
Nevis provided contraceptive prevalence rates, MDG 5.3. The last regional MDG report
included contraceptive prevalence rates for seven countries for the period 1995-2001. Yet
these rates are vastly different from the rates published by PAHO for 2009. St. Vincent
& Grenadines reported 20 percent of women using contraception in 2005-08, while the
MDG report in 2004 reported 58 percent of women were using contraception in the
25
1995-2001 period. No information on unmet need for contraception appears in the latest
MDG regional report, nor was this information collected in any of the household CPA
surveys.
Literacy and Education
1. Literacy rate (for women age 15-24 years) (MDG 2.3)
5. Antenatal care coverage (MDG 5.5)
2. School readiness
6. Content of antenatal care
3. Net intake rate in primary education
7. Skilled attendant at delivery (MDG 5.2)
4. Net primary school attendance ratio (MDG 2.1)
Very little data on maternal and reproductive health exists for the region. Only MDG
5.2 (skilled attendant at delivery) was reported for all countries in the region in national
report, according to ECLAC’s 2009 review of demographic and health-related MDGs. No
country reported on antenatal care coverage in the MDG reports. The 2009 PAHO report
cites data for most countries indicating almost universal coverage of prenatal care by
trained personnel, and at birth, although it is not clear whether these indicators match
the MDG definitions precisely. These data are collected by MOH.
8. Institutional deliveries
9. Caesarean section
These indicators do not appear in any available sources.
Child Development
1. Support for learning
5. Net secondary school attendance ratio
6. Children reaching last grade of primary
7. Primary completion rate (MDG 2.2)
8. Transition rate to secondary school
9. Gender parity index (primary school) (MDG 3.1)
10. Gender parity index (secondary school) (MDG 3.1)
Literacy in the Caribbean is high, ranging from 88 to 97 percent according to the latest
MDG report 2004 (missing data for five countries), yet gender and geographical gaps
remain. In the 2009 PAHO report, no literacy data was reported for any of the 10 countries
in the region. The household budget surveys collect such data for the population over
age 15, but these data are not consistently available across countries, and since the
surveys have been implemented over different time periods and recent data is not yet
available. Among countries which have reported in the last MDG report, gaps also
remain in enrollment measures, and indicators which require disaggregation by sex. It
is expected that the upcoming round of Censuses will fill in many of these data gaps.
2. Father’s support for learning
3. Learning materials: children’s books
4. Learning materials: playthings
5. Inadequate care
1. Birth registration
6. Child Development Index
2. Child labour
7. Attendance to early childhood education
3. Labourer students
No existing publicly available data sources contain information on these indicators.
26
Child Protection
4. Student labourers
27
5. Violent discipline
5. Accepting attitudes towards people living with HIV
6. Marriage before age 15
6. Women who have been tested for HIV
7. Marriage before age 18
8. Young women age 15-19 years currently married or in union
9. Polygyny
10. Spousal age difference
Only four countries (Barbados, Grenada, St. Lucia, St. Vincent & Grenadines) reported on
this indicator (UNAIDS 2008), though Barbados and St. Lucia used methodologies not
harmonized with UNGASS 2008 guidelines.
7. Young women who have been tested for HIV
Only Grenada and St. Vincent reported on this indicator in the 2008 UNAIDS report.
11. Approval for female genital mutilation/cutting (FGM/C)
8. Counselling coverage for the prevention of mother-to-child transmission of HIV
12. Prevalence of female genital mutilation/cutting (FGM/C)
9. Testing coverage for the prevention of mother-to-child transmission of HIV
13. Prevalence of female genital mutilation/cutting among daughters (FGM/C)
10. Young women who never had sex
14. Attitudes towards domestic violence
11. Age at first sex among young women
Most of the data for these indicators is not collected in standard surveys. The upcoming
rounds of Household Labor Surveys are meant to capture information on the working age
population, rather than young labourers. Domestic violence is largely unmeasured in the
Caribbean, though it is considered to be a pressing concern. The FGM indicators are not
relevant for the Caribbean population.
12. Age-mixing among sexual partners
13. Higher risk sex with multiple partners
14. Condom use during higher risk sex with multiple partners
15. Higher risk sex with non-regular partners
16. Condom use with non-regular partners (MDG 6.2)
HIV/AIDS
1. Comprehensive knowledge about HIV prevention
18. Prevalence of orphans
2. Comprehensive knowledge about HIV prevention among young people (MDG
6.3).
19. School attendance of orphans (MDG 6.4)
In the 2008 UNAIDS report, five countries in the region reported on this indicator (Antigua
and Barbuda, Grenada, St. Kitts and Nevis, St. Lucia, and Grenadines). Only three
countries provided estimates disaggregated further by age and sex.
3. Knowledge of mother-to-child transmission of HIV
4. Women who know where to be tested for HIV
28
17. Children’s living arrangements
20. School attendance of non-orphans (MDG 6.4)
Among the ten countries in this region, there is little to no existing data for HIV/AIDS
related indicators. Only Barbados provided HIV prevalence estimates for the 2008
UNAIDS report, and only St. Lucia reported on MDG 6.4. St. Lucia and St. Vincent carried
out AIDS Knowledge, Attitudes, Beliefs and Practices surveys in 1990, but no other such
surveys appear to have been published recently. The USAID-funded Sexual Behavior
Surveys and Behavior Surveillance Surveys have not been conducted in any of the ten
29
countries in the region. The most recent UNAIDS Report on the Global AIDS Epidemic
(2008) contains a few reported indicators for some countries in the region (Barbados,
Grenada, St. Lucia, St. Kitts & Nevis, St. Vincent & Grenadines). The 2009 UNAIDS Update
Report notes the sparseness of behavioral and surveillance data for the region, and
many of the reported indicators were not harmonized with UNGASS guidelines.
Given that women account for an estimated half of all HIV infections in the region,
behavioral and risk factor data collected from the MICS could fill a substantial data gap
for prevention programs. Low levels of comprehensive knowledge in countries which
reported on this indicator suggest a great need to obtain representative information
to better plan HIV awareness campaigns and prevention efforts. Non-institutionalized
children’s living arrangements, as well as orphan prevalence and school attendance
information should be obtained in the current round of Censuses in the region, but the
MICS may also fill this gap.
Adolescents and Young People
1. Percentage of adolescents and young people
Optional MICS Module: Tobacco and Alcohol Use
1. Tobacco use
2. Age at first smoking
3. Alcohol use
4. Age at first alcoholic drink
These indicators are not generally collected or reported in CPA reports, yet they are
important risk factors for a myriad of health conditions and behaviors. The planned STEP
risk factor surveillance survey for St. Lucia would collect these data, though it is uncertain
whether that survey will take place as planned or whether the STEP survey would be
conducted in other Caribbean countries in the region.
Optional MICS Module: Life Satisfaction
1. Life satisfaction
2. Sex ratio among adolescents and young people
2. Overall life satisfaction
Data for these indicators will be collected in the current round of Censuses. The information
needed to construct these indicators is also collected in the household schedule of
the CPA household surveys but not reported. Indicators for maternal and reproductive
health, literacy and education, and HIV/AIDS can be tabulated for adolescents and
young people with data collected in the standard MICS4 questionnaire; see Appendix
3 for the complete list. These indicators are not generally reported in currently available
documents.
Optional MICS Module: Access to Mass Media and Use of
Information/Communication Technology
1. Exposure to mass media
2. Use of computers
3. Use of internet
These indicators will be available following the current round of Censuses.
30
3. Overall happiness
4. Perception of a better life
No available data provides information for these indicators in the region. Though evidence
linking life satisfaction and economic growth is contradictory, increasing attention is
being devoted to alternative measures of health and wellbeing, including measures
of happiness and life satisfaction. For example, French President Nicholas Sarkozy has
established a Commission on Economic Performance and Social Progress to consider
new and alternative measures of societal wellbeing. The Gallup World Poll collected
comparative data on subjective well-being across 132 countries in 2006, though none of
the OECS countries nor Barbados was included in the survey.
Other Surveys
The CSOs are heavily involved in planning and implementing their censuses and
planning for the LFSs. No other large-scale survey program is being planned in the
31
region, though two one-time surveys are being planned in St. Lucia (literacy survey, and
a WHO STEP survey on behavioral risk factor surveillance for chronic disease). The World
Bank NTLS proposal suggests different scenarios for a household consumption survey to
be carried out in all countries in 2012, or a staggered calendar of surveys which would
begin in 2012, though it is unclear whether the proposal will be accepted, funded and
implemented. St. Lucia and Grenada carried out Core Welfare Indicator Questionnaire
(CWIQ) surveys in 2005, but this rapid survey was designed to give an overview of
the effects of natural disasters rather than standard information on overall household
living conditions. The ECLAC report “The Statistical Infrastructure of Caribbean Countries,”
provides a detailed review of CSO capacity in the region, and provides information on
upcoming surveys as of 2005. Appendix 1 contains an updated schedule of planned
surveys and censuses in the region.
purpose of influencing public opinion on the situation of children and women around
the world. MICS surveys are mainly funded by UNICEF and governments, and are often
further supported with funds from other agencies at the country level.
DHS
MICS surveys are typically carried out by government organizations, with the support
and assistance of UNICEF and other partners. Standardized survey tools, manuals,
guidelines and protocols are developed at UNICEF headquarters. UNICEF regional
and country offices coordinate local implementation of the survey with governments.
Technical assistance and training for the surveys is provided by UNICEF through a series
of regional workshops where people from the countries implementing the survey (usually
CSO staff) are trained on various aspects of MICS. UNICEF organizes four workshops at
different stages of the survey implementation:
The USAID-funded Demographic and Health Survey program collects a wide range of
data on women, children and men in developing countries. The household surveys are
nationally and regionally representative two-stage cluster designs, with probability of
selection proportional to population size. Though the DHS has traditionally focused on
family planning, reproductive and child health, the survey instrument has changed in
recent years with adoption of new modules. DHS has recently implemented a survey
module on adult health (Egypt 2008) which collects information on history of cardiovascular
disease and diabetes, and collects blood pressure measurements. Modules on health
care access and expenditures have also been carried out in a number of countries. The
DHS program has implemented surveys recently in Dominican Republic and Haiti, but few
to none in recent years in other Caribbean nations. No DHS surveys are currently planned
for the Eastern Caribbean countries.18
The MICS survey design is a two-stage cluster design, with households included based
on selection probability proportional to population size. Data collected in MICS surveys
can be used to produce local estimates on a wide range of health, education, child
protection, water and sanitation, and HIV/AIDS indicators which are internationally
comparable. The MICS is one of the largest single sources of data for MDG monitoring,
with harmonized definitions for 21 MDG indicators. The MICS can also serve as a
monitoring tool for other international goals, including World Fit for Children, UNGASS
targets on HIV/AIDS, and the Education for All Declaration. To date, the MICS surveys
have been carried out in four countries in the Caribbean: Guyana, Belize, Trinidad and
Tobago, and Jamaica.
g Workshop 1: Survey design Development of customized surveys at country level
g Workshop 2: Data processing Data collection and processing
g Workshop 3: Data analysis and report writing Analysis and report writing
g Workshop 4: Data archiving and dissemination
A full timeline for the implementation of a MICS survey can be found in Appendix 4.
MICS
Among its many roles, UNICEF assists countries in the collection and analysis of data to
fill data gaps in monitoring the status of women and children through its international
household survey initiative, the MICS, now in its fourth round. More than 200 MICS
surveys have been conducted in over 100 countries to date. MICS findings have been
used extensively as a basis for policy decisions and program interventions, and for the
MICS survey data can be disseminated in a range of mediums; it can easily be
incorporated into the local adaptations of DevInfo, for example. Anonymized microdata
are disseminated by the CSOs, as well as UNICEF headquarters for research and
academic purposes.
18 Personal communication, MEASURE DHS director Ann Way, May 2010.
32
33
“...You must work - we
must all work to make
the world worthy of its
children.”
Pablo Casals
34
35
Summary & Challenges
Major gaps in household and individual level data on social development are evident
for all OECS countries and Barbados. Existing data collection activities in the region are
fragmented and focus on few specific indicators. Most existing data (with the exception
of the CPA household budget surveys) do not allow for stratification or detailed analysis
to better understand the situation of women and children in the region, and remaining
social and economic inequalities. Existing household surveys carried out in the region
were not harmonized in data collection on health, or on women and children. Furthermore,
microdata for existing household budget surveys which could be further analyzed is not
publicly available. Lack of human resource capacity and financial support within CSOs
also challenge the potential to expand existing data collection and reporting efforts.
The OECS countries and Barbados could greatly benefit from the implementation of the
MICS, a standardized, harmonized survey program. As documented in this report, the
MICS would fill major gaps in MDG and IADG reporting, and would provide financial
and technical support to ensure capacity building within CSOs in the region. Policy
makers and program planners require timely and standardized data in order to plan
effective programs and monitor progress towards goals. MICS surveys could provide a
wide range of information for subnational, national and international data needs. And
as importantly, national government staff will gain capacity, knowledge and experience
which will spill over to other data collection and analysis towards furthering social
development, reducing inequalities, and improving the lives of women and children in
the Caribbean region.
Recommendations
Given the significant data gaps identified in this report, and the continued challenges in
the coordination, collection and reporting of monitoring indicators, the following specific
recommendations suggest how the data gaps could be quickly and reasonably filled in
the region.
g Implementation of MICS surveys in OECS and Barbados could help serve the
immediate data gap for reporting on the next round of World Fit for Children,
UNGASS, and MDG monitoring indicators. The information could also be
incorporated into the next round of PRSPs.
g The MICS, a well-coordinated survey initiative with standardized questionnaires
tailored to the needs of the region, would be a significant contribution towards
improving the availability of harmonized data for reporting needs.
g The content of the MICS should be tailored for the region. For example, an
adult health module to collect information on chronic disease and risk factors;
and a health insurance and health care expenditures module. These would be
valuable within a MICS survey because the data could be linked directly with
women’s and child health outcomes.
g Implementation of MICS surveys after the Census round would take advantage
of a new sample frame available for survey sample design.
g Implementation of MICS surveys should ensure adequate capacity building
activities are incorporated into the timeline so that CSOs can reap the benefits
of this new survey program and apply the skills gained to existing data collection
efforts.
g A central organizing body such as OECS can serve an important role in
coordinating training and capacity building during implementation of MICS
surveys. SPARC can also serve an important role in providing support to
countries in coordination with UNICEF in the production of monitoring reports,
documentation and metadata, and facilitating the electronic dissemination of
survey results.
36
37
References.
g Stakeholder meetings should be organized at the regional level and within each
country to ensure ownership and involvement for any new data collection efforts.
These meetings should include regional bodies and country agencies which will
use the data for planning and budgeting purposes.
Anguilla Country Poverty Assessment Report. 2002. Volume 1. December. Caribbean
Development Bank.
Antigua and Barbuda Country Poverty Assessment Report. 2007. Vol. 1-3. August.
Caribbean Development Bank.
g CSOs should be centrally involved in all IADG indicator reporting (including
MDGs, World Fit for Children indicators, UNGASS etc) to reduce fragmentation
of monitoring and prevent duplication of effort. The role of CSOs could be better
formalized so that reporting duties are coordinated and met.
British Virgin Islands Country Poverty Assessment Report. 2003. Vol. 1-II. May.
Caribbean Development Bank.
g Existing data collection activities (LFS or household budget surveys) are not able
to carry the extra burden of additional survey instruments to collect information
on women and children. Poverty assessment surveys and labor force surveys
serve very distinct purposes and are already comprised of lengthy modules;
adding more modules could compromise the data quality for all components
and is not advised. Furthermore, given limited capacity of CSOs to carry out
existing surveys as currently planned, it is ill-advised to add elements to existing
surveys.
Doak, C.M., L.S. Adair, M. Bentley, C. Monteiro and B.M. Popkin. 2005. “The dual burden
household and the nutrition transition paradox.” International Journal of Obesity.
No. 29, 129–136.
Caballero, Benjamin. 2005. “Obesity as a consequence of under-nutrition.” The
Journal of Pediatrics. Volume 149, Issue 5, Supplement 1, November, Pages S97-S99.
Dominica Country Poverty Assessment Report. 2003. Vol. 1-2. June. Caribbean
Development Bank.
ECLAC. 2005. “The Statistical Infrastructure of Caribbean Countries.” LC/CAR/L.69.
December. 2009.
ECLAC. 2009. “The Status of Demographic and Health-Related MDGs in Caribbean
Countries.” LC/CAR/L.204. July. Subregional Headquarters for the Caribbean.
ECLAC. 2009b. “The Status of Millennium Development Goals: Monitoring and
Reporting in Selected Caribbean Countries.” LC/CAR/L. 217. Oct. Subregional
Headquarters for the Caribbean.
Grenada Country Poverty Assessment Report. 1999. Vol. 1-3. October. Caribbean
Development Bank.
Lim, S., David B Stein, Alexandra Charrow, and Christopher JL Murray. 2008. “Tracking
progress towards universal childhood immunisation and the impact of global
initiatives: a systematic analysis of three-dose diphtheria, tetanus, and pertussis
immunisation coverage.” Lancet, v372, Issue 9665, 13 December, pp 2031-2046.
Mathers, C., Lopez, A., Murray, C. 2006. “The Burden of Disease and Mortality by
38
39
Condition: Data, Methods, and Results for 2001.” In Global Burden of Disease and
Risk Factors. Lopez, A., Mathers, C., Ezzati, M., Jamison, D., and Murray, C., eds. The
International Bank for Reconstruction and Development / The World Bank: Washington
DC.
MEASURE DHS. http://www.measuredhs.com
PAHO. 2009. “Health Situation in the Americas: Basic Indicators. PAHO: Washington
DC.
State of the World’s Children. 2009. UNICEF. New York: NY.
St. Kitts Nevis Country Poverty Assessment Report. 2001. Vol. 1-3. March. Caribbean
Development Bank.
St. Lucia Country Poverty Assessment Report. 2005/06. Vol. 1-4. June 2007. Caribbean
Development Bank.
St. Vincent and the Grenadines Poverty Assessment Report. 2007/2008. Vol. 1-3. Kairi
Consultants Ltd.
Turks and Caicos Islands Country Poverty Assessment Report. 2000. Caribbean
Development Bank.
UNDP. 2004. “Regional Report on the Achievement of the Millennium Development
Goals in the Caribbean Community.” UNDP: New York, NY.
World Bank. 2010. “OECS Non-Lending Technical Assistance (NLTA): Household
Surveys and Poverty Analysis.” Draft concept note. June 2010. The World Bank:
Washington DC.
40
41
Appendix 1.
MICS4 INDICATOR
MICS4 Indicators: Numerators & Denominators
MICS4 INDICATOR
1. MORTALITY
1.1
Under-five mortality rate
1.2
Infant mortality rate
Module
19
Numerator
Denominator
MDG 20
CM
Probability of dying by exact age 5 years
MDG 4.1
CM
Probability of dying by exact age 1 year
MDG 4.2
2.2a
2.2b
42
19
Numerator
Denominator
MDG 20
Number of children under age 5
who
(a) fall below minus two standard
deviations (moderate and severe)
(b) fall below minus three standard deviations (severe)
from the median weight for age
of the WHO standard
Total number of children under
age 5
MDG 1.8
Number of children under age 5
who
(a) fall below minus two standard
deviations (moderate and severe)
(b) fall below minus three standard deviations (severe)
from the median height for age of
the WHO standard
Total number of children under
age 5
Number of children under age 5
who
(a) fall below minus two standard
deviations (moderate and severe)
(b) fall below minus three standard deviations (severe)
from the median weight for height
of the WHO standard
Total number of children under
age 5
Number of women with a live
birth in the 2 years preceding the
survey who breastfed the child at
any time
Total number of women with a live
birth in the 2 years preceding the
survey
Number of women with a live
birth in the 2 years preceding
the survey who put the new born
infant to the breast within 1 hour
of birth
Total number of women with a live
birth in the 2 years preceding the
survey
2. NUTRITION
2.1a
2.1b
19 Some indicators are constructed by using questions in several modules. In such cases, only the
module(s) which contains most of the necessary information is indicated.
20 MDG indicators as of February 2010
Module
Underweight prevalence
Stunting prevalence
AN
AN
2.3a
2.3b
Wasting prevalence
AN
2.4
Children ever breastfed
MN
2.5
Early initiation of
breastfeeding
MN
43
MICS4 INDICATOR
Module
19
Numerator
Denominator
MDG 20
2. NUTRITION
Exclusive breastfeeding
under 6 months
BF
Number of infants under 6 months
of age who are exclusively breastfed21
Total number of infants under 6
months of age
2.7
Continued breastfeeding
at 1 year
BF
Number of children age 1215 months who are currently
breastfeeding
Total number of children age 1215 months
Continued breastfeeding
at 2 years
BF
Number of children age 20-23
months who are currently breastfeeding
Total number of children age 2023 months
Predominant
breastfeeding under 6
months
BF
Number of infants under 6 months
of age who received breast milk
as the predominant source of
nourishment22 during the previous
day
Total number of infants under 6
months of age
Duration of breastfeeding
BF
2.9
2.10
The age in months when 50 percent of children age 0-35 months did
not receive breast milk during the previous day
2.11
Bottle feeding
BF
Number of children age 0-23
months who were fed with a bottle during the previous day
Total number of children age 0-23
months
2.12
Introduction of solid, semisolid or soft foods
BF
Number of infants age 6-8 months
who received solid, semi-solid or
soft foods during the previous day
Total number of infants age 6-8
months
2.13
Minimum meal frequency
BF
Number of children age 6-23
months receiving solid, semi-solid
and soft foods (plus milk feeds for
non-breastfed children) the minimum times23 or more, according
to breastfeeding status, during the
previous day
Total number of children age 6-23
months
2.14
Age-appropriate
breastfeeding
BF
Number of children age 0-23
months appropriately fed24 during
the previous day
Total number of children age 0-23
months
21
22
23
24
44
Module
19
Numerator
Denominator
MDG 20
2. NUTRITION
2.6
2.8
MICS4 INDICATOR
2.15
Milk feeding frequency for
non-breastfed children
2.16
Iodized salt consumption
2.17
Vitamin A
supplementation (children
under age 5)
IM
2.18
Low-birthweight infants
MN
2.19
Infants weighed at birth
MN
BF
SI
Number of non-breastfed children
age 6-23 months who received at
least 2 milk feedings during the
previous day
Total number of non-breastfed
children age 6-23 months
Number of households with salt
testing 15 parts per million or
more of iodide/iodate
Total number of households in
which salt was tested or with no
salt
Number of children age 6-59
months who received at least one
high-dose vitamin A supplement in
the 6 months preceding the survey
Total number of children age 6-59
months
Number of last live births in the
2 years preceding the survey
weighing below 2,500 grams at
birth
Total number of last live births in
the 2 years preceding the survey
Number of last live births in the 2
years preceding the survey who
were weighed at birth
Total number of last live births in
the 2 years preceding the survey
Infants receiving breast milk, and not receiving any other fluids or foods, with the exception of oral rehydration solution, vitamins,
mineral supplements and medicines
Infants who receive breast milk and certain fluids (water and water-based drinks, fruit juice, ritual fluids, oral rehydration
solution, drops, vitamins, minerals, and medicines), but do not receive anything else (in particular, non-human milk and food-based
fluids)
Breastfeeding children: Solid, semi-solid, or soft foods, two times for infants age 6-8 months, 3 times for children 9-23 months;
Non-breastfeeding children: Solid, semi-solid, or soft foods, or milk feeds, four times for children age 6-23 months
Infants age 0-5 who are exclusively breastfed, and children age 6-23 months who are breastfed and ate solid, semi-solid or soft foods
45
MICS4 INDICATOR
Module
19
Numerator
Denominator
MDG 20
3. CHILD HEALTH
Tuberculosis immunization
coverage25
IM
Number of children age 12-23
months who received BCG vaccine before their first birthday
Total number of children age 1223 months
3.2
Polio immunization
coverage
IM
Number of children age 12-23
months who received OPV3
vaccine before their first birthday
Total number of children age 1223 months
Number of children age 1223 months who received DPT3
vaccine before their first birthday
Total number of children age 1223 months
Number of children age 12-23
months who received measles
vaccine before their first birthday
Total number of children age 1223 months
Immunization coverage for
diphtheria, pertussis and
tetanus (DPT)
3.4
IM
Measles immunization
coverage
IM
3.5
Hepatitis B immunization
coverage
IM
Number of children age 12-23
months who received Hepatitis B
vaccine before their first birthday
Total number of children age 12-23
months
3.6
Yellow fever immunization
coverage
IM
Number of children age 12-23
months who received yellow fever
vaccine before their first birthday
Total number of children age 12-23
months
3.7
Neonatal tetanus
protection
3.8
Oral rehydration therapy
with continued feeding
3.9
Care-seeking for
suspected pneumonia
MN
CA
CA
Number of women age 15-49
years with a live birth in the 12
months preceding the survey who
were given at least two doses
of tetanus toxoid vaccine within
the appropriate interval26 prior to
giving birth
Total number of women age 15-49
years with a live birth in the 12
months preceding the survey
Number of children under age
5 with diarrhoea in the previous
2 weeks who received ORT
(ORS packet or recommended
homemade fluid or increased
fluids) and continued feeding
during the episode of diarrhoea
Total number of children under age
5 with diarrhoea in the previous 2
weeks
Number of children under age 5
with suspected pneumonia in the
previous 2 weeks who were taken
to an appropriate health provider
Total number of children under age
5 with suspected pneumonia in the
previous 2 weeks
3.10
Antibiotic treatment of
suspected pneumonia
CA
3.11
Solid fuels
HC
3.12
Household availability of
insecticide-treated nets
(ITNs)27
TN
3.13
Households protected by
a vector control method
TN - IR
MDG 4.3
Children under age 5
sleeping under any type
of mosquito net
3.14
26
46
Age groups used in indicators 3.1 to 3.6 are applicable when basic immunization schedules are used (with measles administered at 9
months). For the calculation of indicators when different schedules are used, see MICS4 manual for detailed descriptions
See MICS4 manual for a detailed description
TN
3.15
Children under age
5 sleeping under
insecticide-treated nets
(ITNs)
TN
3.16
Malaria diagnostics
usage
ML
27
25
Module
19
Numerator
Denominator
MDG 20
3. CHILD HEALTH
3.1
3.3
MICS4 INDICATOR
28
Number of children under age 5
with suspected pneumonia in the
previous 2 weeks who received
antibiotics
Total number of children under
age 5 with suspected pneumonia
in the previous 2 weeks
Number of household members
in households that use solid fuels
as the primary source of domestic
energy to cook
Total number of household
members
Number of households with at
least one insecticide treated net
(ITN)
Total number of households
Number of households with at
least one insecticide-treated
net (ITN) and/or that received
spraying through an IRS28
campaign in the last 12 months
preceding the survey
Total number of households
Number of children under age 5
who slept under any type of mosquito net the previous night
Total number of children under
age 5
Number of children under age 5
who slept under an insecticidetreated mosquito net (ITN) the
previous night
Total number of children under
age 5
Number of children under age
5 reported to have had fever in
the previous 2 weeks who had
a finger or heel stick for malaria
testing
Total number of children under age
5 reported to have had fever in the
previous 2 weeks
MDG 6.7
An ITN is (1) a factory treated net which does not require any treatment, (2) a pretreated net obtained within the past 12 months, or (3) a
net that has been soaked with insecticide within the past 12 months
Indoor residual spraying
47
MICS4 INDICATOR
Module
19
Numerator
Denominator
MDG 20
3. CHILD HEALTH
3.17
3.18
Module
19
Numerator
Denominator
MDG 20
4. ENVIRONMENT
Antimalarial treatment
(children under age 5)
according to national
policy within 24 hours of
onset of symptoms
ML
Antimalarial treatment
(children under age 5)
ML
3.19
Pregnant women sleeping
under insecticide-treated
nets (ITNs)
TN
3.20
Intermittent preventive
treatment for malaria
MN
3.21
Place for handwashing
HW
3.22
Availability of soap
HW
48
MICS4 INDICATOR
Number of children under age
5 reported to have had fever in
the previous 2 weeks who were
treated with an appropriate
antimalarial according to national
policy (first-line treatment) within
24 hours of onset of symptoms
Total number of children under
age 5 reported to have had fever
in the previous 2 weeks
Number of children under age 5
reported to have had fever in the
previous 2 weeks who received
any antimalarial treatment
Total number of children under
age 5 reported to have had fever
in the previous 2 weeks
Number of pregnant women who
slept under an insecticide-treated
net (ITN) the previous night
Total number of pregnant women
Number of women age 15-49
years who received at least 2
doses of SP/Fansidar to prevent
malaria during antenatal care
visits for their last pregnancy leading to a live birth in the 2 years
preceding the survey
Total number of women age
15-49 years who have had a live
birth in the 2 years preceding the
survey
Number of households with a
designated place for hand washing where water and soap are
present
Total number of households
Number of households with soap
anywhere in the dwelling
Total number of households
MDG 6.8
MDG 7.8
4.1
Use of improved drinking
water sources
WS
Number of household members
using improved sources of drinking water
Total number of household
members
4.2
Water treatment
WS
Number of household members
using drinking water that has
been treated
Total number of household members
4.3
Use of improved sanitation facilities
WS
Number of household members
using improved sanitation facilities
4.4
Disposal of child’s faeces
CA
Number of children age 0-2 years
whose (last) stools were disposed
of safely
MDG 7.9
Total number of household members
Total number of children age 0-2
years
49
MICS4 INDICATOR
Module
19
Numerator
Denominator
MDG 20
5. REPRODUCTIVE HEALTH
MICS4 INDICATOR
Module
MDG 5.4
Adolescent birth rate
CM
Age-specific fertility rate for women age 15-19 years
5.2
Early childbearing
CM
Number of women age 20-24
years who had at least one live
birth before age 18
5.3
Contraceptive prevalence
rate
CP
5.4
Unmet need29
UN
Antenatal care coverage
MN
Number of women age 15-49
years currently married or in union
who are using (or whose partner
is using) a (modern or traditional)
contraceptive method
Number of women who are currently married or in union who are
fecund and want to space their
births or limit the number of children they have and who are not
currently using contraception
Number of women age 15-49
years who were attended during
pregnancy in the 2 years preceding the survey
5.6
Content of antenatal care
MN
(a) at least once by skilled personnel
5.7
Skilled attendant at
delivery
MN
(b) at least four times by any
provider
5.8
Institutional deliveries
MN
25
50
Numerator
Denominator
MDG 20
5. REPRODUCTIVE HEALTH
5.1
5.5a
5.5b
19
Number of women age 15-49
years with a live birth in the
2 years preceding the survey
who had their blood pressure
measured and gave urine and
blood samples during the last
pregnancy
5.9
Caesarean section
MN
Number of last live births in the 2
years preceding the survey who
were delivered by caesarean
section
Total number of last live births in
the 2 years preceding the survey
Total number of women age 2024 years
MDG 5.3
Total number of women age
15-49 years who are currently
married or in union
MDG 5.6
Total number of women age
15-49 years who are currently
married or in union
MDG 5.5
Total number of women age 15-49
years with a live birth in the 2
years preceding the survey
Total number of women age 15-49
years with a live birth in the 2
years preceding the survey
MDG 5.2
Total number of women age 15-49
years with a live birth in the 2
years preceding the survey
Total number of women age 15-49
years with a live birth in the 2
years preceding the survey
See MICS4 manual for a detailed description
51
MICS4 INDICATOR
Module
19
Numerator
Denominator
6. CHILD DEVELOPMENT
Support for learning
CE
6.2
Father’s support for
learning
CE
6.4
6.5
6.6
6.7
52
Learning materials:
children’s books
Learning materials:
playthings
Inadequate care
Child Development Index
Attendance to early
childhood education
MICS4 INDICATOR
Module
19
Numerator
Denominator
MDG 20
7. LITERACY & EDUCATION
6.1
6.3
MDG 20
CE
CE
CE
CE
CE
Number of children under age 5
with whom an adult has engaged in four or more activities
to promote learning and school
readiness in the past 3 days
Total number of children under
age 5
7.1
Literacy rate (for women
age 15-24 years)
WB
Number of children under age
5 whose father has engaged in
one or more activities to promote
learning and school readiness in
the past 3 days
Total number of children under
age 5
7.2
School readiness
ED
Number of children under age 5
who have three or more children’s
books
Total number of children under
age 5
7.3
Net intake rate in primary
education
Total number of children under
age 5
7.4
Number of children under age 5
with two or more playthings
Number of children under age
5 left alone or in the care of another child younger than 10 years
of age for more than one hour at
least once in the past week
Total number of children under
age 5
Number of children age 36-59
months who are developmentally
on target in language-cognitive,
physical, social-emotional, and
approaches to learning domains
Total number of children age 3659 months
Number of children age 36-59
months who are attending an
early childhood education programme
Total number of children age 3659 months
MDG 2.3
Number of women age 15-24
years who are able to read a
short simple statement about
everyday life or who attended
secondary or higher education
Total number of women age 1524 years
Number of children in first grade
of primary school who attended
pre-school during the previous
school year
Total number of children attending the first grade of primary
school
ED
Number of children of school-entry
age who are currently attending
first grade of primary school
Total number of children of
school-entry age
Net primary school
attendance ratio
ED
Number of children of primary
school age currently attending
primary or secondary school
Total number of children of primary school age
7.5
Net secondary school
attendance ratio
ED
Number of children of secondary
school age currently attending
secondary school or higher
7.6
Children reaching last
grade of primary
ED
Proportion of children entering the first grade of primary school who
eventually reach last grade
7.7
Primary completion rate
ED
Number of children (of any age)
attending the last grade of primary school (excluding repeaters)
Total number of children of
primary school completion age
(age appropriate to final grade
of primary school)
7.8
Transition rate to
secondary school
ED
Number of children attending the
first grade of secondary school
who were in the last grade of primary school during the previous
school year
Total number of children who
are attending the first grade of
secondary school
Gender parity index
(primary school)
ED
Net primary school attendance
ratio for girls
Net primary school attendance
ratio for boys
MDG 3.1
7.9
Gender parity index
(secondary school)
ED
Net secondary school attendance
ratio for girls
Net secondary school attendance
ratio for boys
MDG 3.1
7.10
MDG 2.1
Total number of children of
secondary-school age
MDG 2.2
53
MICS4 INDICATOR
Module 19
Numerator
Denominator
8. CHILD PROTECTION
Birth registration
BR
Number of children under age
5 whose births are reported
registered
Total number of children under
age 5
8.2
Child labour
CL
Number of children age 5-14
years who are involved in child
labour
Total number of children age 5-14
years
Number of children age 5-14
years who are involved in child
labour and are currently attending
school
Total number of children age 5-14
years involved in child labour
Number of children age 5-14
years who are involved in child
labour and are currently attending school
Total number of children age 5-14
years attending school
Labourer students
ED - CL
8.4
Student labourers
ED - CL
8.5
Violent discipline
CD
8.6
Marriage before age 15
MA
Number of women age 15-49
years who were first married or in
union by the exact age of 15
Total number of women age 1549 years
8.7
Marriage before age 18
MA
Number of women age 20-49
years who were first married or in
union by the exact age of 18
Total number of women age 2049 years
8.8
Young women age 15-19
years currently married or
in union
MA
Number of women age 15-19
years who are currently married
or in union
Total number of women age 1519 years
8.9
Polygyny
MA
Number of women age 15-49
years who are in a polygynous
union
Total number of women age
15-49 years who are currently
married or in union
8.10a
8.10b
Spousal age difference
MA
Number of women currently married or in union whose spouse is
10 or more years older, (a) for
women age 15-19 years, (b) for
women age 20-24 years
Total number of women currently
married or in union (a) age 15-19
years, (b) age 20-24 years
54
MICS4 INDICATOR
Module
19
Numerator
Denominator
MDG 20
8. CHILD PROTECTION
8.1
8.3
MDG 20
Number of children age
2-14 years who experienced
psychological aggression or
physical punishment during the
past month
Total number of children age 2-14
years
8.11
Approval for female
genital mutilation/cutting
(FGM/C)
FG
8.12
Prevalence of female
genital mutilation/cutting
(FGM/C)
FG
8.13
Prevalence of female
genital mutilation/cutting among daughters
(FGM/C)
FG
8.14
Attitudes towards
domestic violence
DV
Number of women age 15-49
years favouring the continuation
of female genital mutilation/
cutting (FGM/C)
Total number of women age
15-49 years
Number of women age 1549 years who report to have
undergone any form of female
genital mutilation/cutting (FGM/C)
Total number of women age
15-49 years
Number of women age 15-49
years who report that at least one
daughter has undergone female
genital mutilation/cutting (FGM/C)
Total number of women age
15-49 years who have at least
one living daughter
Number of women who state that
a husband/partner is justified
in hitting or beating his wife in
at least one of the following
circumstances: (1) she goes
out without telling him, (2) she
neglects the children, (3) she
argues with him, (4) she refuses
sex with him, (5) she burns the
food
Total number of women age
15-49 years
55
MICS4 INDICATOR
Module
19
Numerator
Denominator
MDG 20
9. HIV/AIDS, SEXUAL BEHAVIOUR & ORPHANS
9.1
9.2
9.3
9.4
9.5
HA
Comprehensive knowledge about HIV prevention among young people
HA
Knowledge of mother-tochild transmission of HIV
HA
Women who know where
to be tested for HIV
HA
Accepting attitudes
towards people living
with HIV
9.6
9.7
30
31
56
Comprehensive knowledge about HIV prevention
HA
Women who have been
tested for HIV
HA
Young women who have
been tested for HIV
HA
MICS4 INDICATOR
Module 19
MDG 20
Numerator
Denominator
Number of women age 15-49
years who gave birth in the
2 years preceding the survey
and received antenatal care
reporting that they were tested
for HIV during antenatal care and
received their results
Total number of women age 1549 years that gave birth in the 2
years preceding the survey
Number of never married women
age 15-24 years who have never
had sex
Total number of women age 1549 years that gave birth in the 2
years preceding the survey
MDG 3.1
Number of women age 15-24
years who have had sexual
intercourse before age 15
Total number of never married
women age 15-24 years
MDG 3.1
Number of women age 15-24
years who had sex in the 12
months preceding the survey with
a partner who was 10 or more
years older than they were
Total number of women age 1524 years
Number of women age 15-49
years who have had sexual
intercourse with more than
one partner in the 12 months
preceding the survey
Total number of women age 1524 years who had sex in the 12
months preceding the survey
Number of women age 15-49
years who report having had
more than one sexual partner
in the 12 months preceding the
survey who also reported that a
condom was used the last time
they had sex
Total number of women age 1549 years
Number of sexually active women
age 15-24 years who have had
sex with a non-marital, noncohabitating partner in the 12
months preceding the survey
Total number of women age
15-49 years who reported having
had more than one sexual partner in the 12 months preceding
the survey
9. HIV/AIDS, SEXUAL BEHAVIOUR & ORPHANS
Number of women age 15-49
years who correctly identify two
ways of preventing HIV infection,
know that a healthy looking person can have HIV, and reject the
two most common misconceptions
about HIV transmission
Total number of women age 1524 years
Number of women age 15-24
years who correctly identify
two ways of preventing HIV
infection, know that a healthy
looking person can have HIV,
and reject the two most common
misconceptions about HIV
transmission
Total number of children
attending the first grade of
primary school
Number of women age 15-49
years who correctly identify all
three means30 of mother-to-child
transmission of HIV
Total number of children of
school-entry age
Number of women age 15-49
years who state knowledge of a
place to be tested
Total number of children of
primary school age
Number of women age 15-49
years expressing accepting
attitudes on all four questions31
toward people living with HIV
9.8
Counselling coverage for
the prevention of motherto-child transmission of
HIV
HA
9.9
Testing coverage for the
prevention of mother-tochild transmission of HIV
SB
9.10
Young women who never
had sex
SB
9.11
Age at first sex among
young women
SB
9.12
Age-mixing among sexual
partners
SB
9.13
Higher risk sex with
multiple partners
SB
9.14
Condom use during
higher risk sex with
multiple partners
SB
9.15
Higher risk sex with nonregular partners
MDG 2.1
Total number of children of
secondary-school age
Number of women age 15-49
years who have been tested for
HIV in the 12 months preceding
the survey and who know their
results
Number of women age 15-24
years who have been tested for
HIV in the 12 months preceding
the survey and who know their
results
MDG 2.3
MDG 2.2
Total number of children of
primary school completion age
(age appropriate to final grade
of primary school)
Transmission during pregnancy, during delivery, and by breastfeeding
Women (1) who think that a female teacher with the AIDS virus should be allowed to teach in school, (2) who would buy fresh vegetables
from a shopkeeper or vendor who has the AIDS virus, (3) who would not want to keep it as a secret if a family member became infected
with the AIDS virus, and (4) who would be willing to care for a family member who became sick with the AIDS virus
Total number of women age
15-24 years who were sexually
active in the 12 months preceding the survey
57
MICS4 INDICATOR
Module
19
Numerator
Denominator
MDG 20
Number of women age 15-24
years reporting the use of a
condom during sexual intercourse
with their last non-marital, noncohabiting sex partner in the 12
months preceding the survey
Total number of women age 1524 years who had a non-marital,
non-cohabiting partner in the 12
months preceding the survey
MDG 6.2
Indicators on Adolescents and Young People in MICS4:
Numerators and Denominators
9. HIV/AIDS, SEXUAL BEHAVIOUR & ORPHANS
9.16
9.17
9.18
Condom use with nonregular partners
Children’s living
arrangements
Prevalence of orphans
SB
HL
HL
9.19
School attendance of
orphans
HL - ED
9.20
School attendance of nonorphans
HL - ED
INDICATOR 32
DEMOGRAPHY
Number of children age 0-17
years not living with a biological
parent
Total number of children age 0-17
years
Number of children age 0-17
years with at least one dead
parent
Total number of children age 0-17
years
Number of children age 10-14
years, who are double orphans
(who have lost both parents) and
attending school
Total number of children age 1014 years, both of whose parents
are alive, who are living with at
least one parent and are attending school
MDG 6.4
Number of children age 10-14
years, whose parents are alive,
who are living with at least one
parent, and who are attending
school
Total number of children age
10-14 years, whose parents are
alive, and who are living with at
least one parent
MDG 6.4
A1.1
Percentage of
adolescents and young
people
A1.2
Numerator
Denominator
MICS 34
HL
Probability of dying by exact age 5 years
Sex ratio among
adolescents and young
people
HL
Probability of dying by exact age 1 year
MDG 4.1
A2.1
Adolescent birth rate
CM
Age-specific fertility rate for females age 15-19 years
5.1
A2.2
Early childbearing
CM
Number of females age 20-24 years Total number of females age 20-24
who had at least one live birth
years
before age 18
5.2
A2.3
Contraceptive prevalence
rate
CP
Number of females age 15-24
years currently married or in union
who are using (or whose partner
is using) a (modern or traditional)
contraceptive method
Total number of females age 15-24
years who are currently married or
in union
5.3
A2.4
Unmet need35
UN
Number of females age 15-24
years who are currently married
or in union who are fecund and
want to space their births or limit
the number of children they have
and who are not currently using
contraception
Total number of females age 15-24
years who are currently married or
in union
MDG 4.2
HEALTH
A2.5a
A2.5b
32
33
34
35
58
Module 33
Antenatal care coverage
MN
Number of females age 15-24
years who were attended during
pregnancy in the 2 years preceding
the survey
Total number of females age 1524 years with a live birth in the 2
years preceding the survey
Wherever applicable, corresponding indicators are calculated for males, in MICS surveys that included the male questionnaire
Some indicators are constructed by using questions in several modules. In such cases, only the module(s) which contains most of the
necessary information is indicated
Numbers refer to codes of indicators in the MICS4 indicator list. In some cases, the age group covered by the indicator has been modified
to cover only adolescents and young people
See MICS4 manual for a detailed description
59
INDICATOR 32
DEMOGRAPHY
Module 33
Numerator
Denominator
MICS 34
INDICATOR 32
A2.6
A2.7
Content of antenatal care
MN
Skilled attendant at
delivery
MN
Number of females age 15-24
Total number of females age 15years with a live birth in the 2 years 24 years with a live birth in the 2
preceding the survey who had their years preceding the survey
blood pressure measured and gave
urine and blood samples during the
last pregnancy
5.6
Total number of females age 15Number of females age 15-24
years with a live birth in the 2 years 24 years with a live birth in the 2
preceding the survey who were
years preceding the survey
attended during childbirth by skilled
health personnel
5.7
Numerator
Denominator
MICS 34
A3.2
Secondary school
net attendance ratio
(adjusted)
ED
Number of males and females of
secondary school age currently
attending secondary school or
higher
Total number of males and females
of secondary-school age
7.5
A3.3
Transition rate to
secondary school
ED
Number of males and females
attending the last grade of primary
school during the previous school
year who are in the first grade of
secondary school during the current
school year
Total number of males and females
who are attending the first grade
of secondary school
7.8
A3.4
Gender parity index
(secondary school)
ED
Secondary school net attendance
ratio (adjusted) for females
Secondary school net attendance
ratio (adjusted) for males
7.10
A3.5
Adolescents and young
people out of school
ED
Number of males and females age
10-24 years currently not attending
school
Total number of males and females
age 15-24 years
na
CL
Number of males and females age
10-14 years who are involved in
child labour
Total number of males and females
age 10-14 years
a) at least once by skilled personnel
(b) at least four times by any
provider
Module 33
CHILD PROTECTION
A2.8
Institutional deliveries
MN
A2.9
Caesarean section
Number of females age 15-24 years Total number of females age 1524 years with a live birth in the 2
with a live birth in the 2 years
preceding the survey who delivered years preceding the survey
in a health facility
5.8
Total number of last live births in
the 2 years preceding the survey to
females age 15-24 years
5.9
60
WB
A4.2
School attendance among
child labourers
ED - CL
Number of males and females
age 10-14 years who are involved
in child labour and are currently
attending school
Total number of males and females
age 10-14 years involved in child
labour
A4.3
Child labour among
students
ED - CL
Number of males and females
age 10-14 years who are involved
in child labour and are currently
attending school
Total number of males and females
age 10-14 years attending school
A4.4
Violent discipline
8.4
LITERACY & EDUCATION
Literacy rate among
young women
Child labour
8.3
MN
Number of last live births to
females age 15-24 years in the 2
years preceding the survey who
were delivered by caesarean
section
A3.1
8.2
A4.1
Number of females age 15-24
years who are able to read a short
simple statement about everyday
life or who attended secondary or
higher education
Total number of females age 15-24
years
7.1
CD
Number of males and females
Total number of males and females
age 10-14 years
age 10-14 years who experienced
psychological aggression or
physical punishment during the past
month
8.5
61
INDICATOR 32
Module 33
Numerator
Denominator
MICS 34
INDICATOR 32
Module 33
Numerator
Denominator
MICS 34
Spousal age difference
A4.5
Marriage before age 15
MA
Number of females age 15-24 years Total number of females age 15-24
who were first married or in union
years
by the exact age of 15
8.6
A4.9a
A4.9b
A4.10
A4.6
Marriage before age 18
MA
Number of females age 20-24 years Total number of females age 20-24
who were first married or in union
years
by the exact age of 18
8.7
A4.11
A4.7
Young women age 15-19
years currently married or
in union
MA
Number of females age 15-24 years Total number of females age 15-24
who were first married or in union
years
by the exact age of 15
8.6
A4.8
Polygyny
MA
Number of females age 20-24 years Total number of females age 20-24
who were first married or in union
years
by the exact age of 18
8.7
A4.12
A4.13
62
Approval for female
genital mutilation/cutting
(FGM/C)
Prevalence of female
genital mutilation/cutting
(FGM/C) among young
women
Prevalence of female
genital mutilation/
cutting (FGM/C) among
adolescent girls
Attitudes towards
domestic violence
MA
Number of females age 15-19 years Total number of females age 15-19
who are currently married or in
years
union
8.8
MA
Number of females age 15-24 years Total number of females age 15-24
who are in a polygynous union
years who are currently married or
in union
8.9
MA
Number of females currently
married or in union whose spouse
is 10 or more years older, (a) for
females age 15-19 years, (b) for
females age 20-24 years
FG
Number of females age 15-24 years Total number of females age 15-24
favouring the continuation of female years who have heard of FGM/C
genital mutilation/cutting (FGM/C)
8.10b
FG
Number of females age 15-24 years Total number of females age 15-24
who state that a husband/partner
years
is justified in hitting or beating his
wife in at least one of the following
circumstances: (1) she goes out
without telling him, (2) she neglects
the children, (3) she argues with
him, (4) she refuses sex with him,
(5) she burns the food
8.11
Total number of females currently
married or in union (a) age 15-19
years, (b) age 20-24 years
8.10a
63
INDICATOR 32
Module 33
HIV/AIDS, SEXUAL BEHAVIOUR & ORPHANS
Numerator
A5.1
Number of females age 15-24 years Total number of females age 15-24
who correctly identify two ways of
years
preventing HIV infection12, know
that a healthy looking person can
have HIV, and reject the two most
common misconceptions about HIV
transmission
9.2
Total number of females age 15-24
years
9.3
Comprehensive
knowledge about HIV
prevention among young
people
A5.2
Knowledge of mother-tochild transmission of HIV
A5.3
Accepting attitudes
towards people living
with HIV
A5.4
Young women who know
where to be tested for HIV
HA
Denominator
INDICATOR 32
A5.7
HA
Number of females age 15-24
years who correctly identify all
three means36 of mother-to-child
transmission of HIV
HA
Total number of females age 15-24
Number of females age 15-24 years years who have heard of HIV
expressing accepting attitudes on
all four questions37 toward people
living with HIV
HA
MICS 34
Total number of females age 15-24
Number of females age 15-24 years years
who state knowledge of a place to
be tested for HIV
A5.8
9.4
Young women who have
been tested for HIV and
know the results
A5.6
Sexually active young
women who have been
tested for HIV and know
the results
HA
9.6
Total number of females age 15-24
years who have had sex in the 12
months preceding the survey
9.7
HA
36
37
Number of females age 15-24
years who have had sex in the 12
months preceding the survey, who
have been tested for HIV in the 12
months preceding the survey and
who know their results
Transmission during pregnancy, during delivery, and by breastfeeding
Females (1) who think that a female teacher with the AIDS virus should be allowed to teach in school, (2) who would buy fresh vegetables
from a shopkeeper or vendor who has the AIDS virus, (3) who would not want to keep it as a secret if a family member became infected
with the AIDS virus, and (4) who would be willing to care for a family member who became sick with the AIDS virus
64
Denominator
HA
Number of females age 15-24
years who gave birth in the 2 years
preceding the survey and received
antenatal care, reporting that they
received counselling on HIV during
antenatal care
Total number of females age 15-24
years who gave birth in the 2 years
preceding the survey
9.8
HIV testing during
antenatal care
HA
Number of females age 15-24
years who gave birth in the 2 years
preceding the survey and received
antenatal care, reporting that they
were offered and accepted an
HIV test during antenatal care and
received their results
Total number of females age 15-24
years who gave birth in the 2 years
preceding the survey
9.9
Total number of never married
females age 15-24 years
9.10
SB
Number of never married females
age 15-24 years who have never
had sex
A5.10
Sex before age 15 among
young women
SB
Total number of females age 15-24
Number of females age 15-24 years years
who have had sexual intercourse
before age 15
Age-mixing among sexual
partners
SB
Sex with multiple partners
SB
A5.12
A5.13
MICS 34
HIV counselling during
antenatal care
Young women who have
never had sex
9.5
Number of females age 15-24 years Total number of females age 15-24
years
who have been tested for HIV in
the 12 months preceding the survey
and who know their results
Numerator
A5.9
A5.11
A5.5
Module 33
Condom use during sex
with multiple partners
Total number of females age 15-24
Number of females age 15-24 years years who have had sex in the 12
who had sex in the 12 months
months preceding the survey
preceding the survey with a partner
who was 10 or more years older
than they were
9.11
9.12
Number of females age 15-24 years Total number of females age 15-24
who have had sexual intercourse
years
with more than one partner in the
12 months preceding the survey
9.13
Number of females age 15-24 years
who report having had more than
one sexual partner in the 12 months
preceding the survey who also
reported that a condom was used
the last time they had sex
9.14
SB
Total number of females age 15-24
years who reported having had
more than one sexual partner in
the 12 months preceding the survey
65
INDICATOR 32
Module 33
Numerator
Denominator
MICS 34
Number of sexually active females
age 15-24 years who have had sex
with a non-marital, non-cohabitating
partner in the 12 months preceding
the survey
Total number of females age 15-24
years who have had sex in the 12
months preceding the survey
9.15
Number of females age 15-24 years
reporting the use of a condom
during sexual intercourse with their
last non-marital, non-cohabiting sex
partner in the 12 months preceding
the survey
Total number of females age 1524 years who had a non-marital,
non-cohabiting partner in the 12
months preceding the survey
9.16
Number of males and females
age 10-17 years not living with a
biological parent
Total number of males and females
age 10-17 years
INDICATOR 32
Module 33
Numerator
Denominator
MICS 34
OPTIONAL MICS MODULE: ACCESS TO MASS MEDIA AND USE OF INFORMATION/COMMUNICATION TECHNOLOGY
A5.14
A5.15
A5.16
Sex with non-regular
partners
Condom use with nonregular partners
Adolescent’s living
arrangements
A5.17
Prevalence of adolescents
with at least one parent
dead
A5.18
School attendance of
orphans
A5.19
School attendance of nonorphans
SB
SB
HL
Total number of males and females
age 10-17 years
9.18
HL - ED
Number of males and females age
10-14 years who have lost both
parents and are attending school
Total number of males and females
age 10-14 years who have lost
both parents
9.19
Total number of males and females
age 10-14 years, whose parents
are alive, and who are living with
at least one parent
MT
A6.2
Use of computers
MT
A6.3
Use of internet
MT
Number of females age 15-24
years who, at least once a week,
read a newspaper or magazine,
listen to the radio, and watch
television
Total number of females age
15-24 years
MT.1
Number of females age 15-24
years who used a computer from
any location during the last 12
months
Total number of females age
15-24 years
MT.2
Number of females age 15-24
who used the internet from any
location during the last 12 months
Total number of females age
15-24 years
MT.3
OPTIONAL MICS MODULE: TOBACCO AND ALCOHOL USE
Number of males and females age
10-17 years with at least one dead
parent
Number of males and females age
10-14 years, whose parents are
alive, who are living with at least
one parent, and who are attending
school
Exposure to mass media
9.17
HL
HL - ED
A6.1
A7.1
Tobacco use
TA
Number of females age 15-24
who smoked cigarettes, or used
smoked or smokeless tobacco
products on one or more days
during the last one month
Total number of females age
15-24 years
TA.1
A7.2
Age at first smoking
TA
Number of females age 15-24
years who smoked a whole
cigarette before age 15
Total number of females age
15-24 years
TA.2
A7.3
Alcohol use
TA
Number of females age 15-24
years who had at least one
alcoholic drink on one or more
days during the last one month
Total number of females age
15-24 years
TA.3
A7.4
Age at first alcoholic drink
TA
Number of females age 15-24
years who had at least one
alcoholic drink before age 15
Total number of females age
15-24 years
TA.4
Number of females age 15-24
years who are very or somewhat
satisfied with their family, friends,
school, current job, self, and
where they live
Total number of females age
15-24 years
9.20
OPTIONAL MICS MODULE: LIFE SATISFACTION
A8.1
66
Life satisfaction
LS
LS.1
67
INDICATOR 32
Module 33
Numerator
Denominator
MICS 34
A8.2
Overall life satisfaction
LS
Number of females 15-24 years who Total number of females age 15-24
are very or somewhat satisfied with years
their family, friends, school, current
job, self, where they live and current
income
LS.2
A8.3
Overall happiness
LS
Number of females age 15-24 who
are very or somewhat happy
Total number of females age 15-24
years
LS.3
A8.4
Perception of a better life
LS
Number of females age 15-24
whose life improved since last one
year, who expect that their life will
be better during the next one year
Total number of females age 15-24
years
LS.4
68
69
Appendix 2.
MICS Timeline Example
70
71
Notes.
72