Reports

Survey Report(s)

MICS III report, Mr. Alieu S.M Ndow - Gambia Bureau of Statistics Mr. Alieu Sarr - Gambia Bureau of Statistics Mr. Sheriffo S. T. Sonko - UNICEF Mr. Edirissa Ceesay - Gambia Bureau of Statistics Mr. Nyakassi Sanyang _ Central Bank of The Gambia Mr. Omar Ngum - Department of Community Development Mrs. Lolley Kah Jallow - Gambia Bureau of Statistics Mr. Baba Suwareh - Gambia Bureau of Statistics Mr. Modou Lamin Cham - Directorate of Planning, DoSH Mr. Amat Bah - National Nutrition Agency Mr. Paul Mendy - Directorate of Planning, DoSE Mr. Alieu Saho - Gambia Bureau of Statistics, 2005, Kurdish [kur], Gambia [gmb]
Contributor(s): Mr. Alieu S.M Ndow - Gambia Bureau of Statistics Mr. Alieu Sarr - Gambia Bureau of Statistics Mr. Sheriffo S. T. Sonko - UNICEF Mr. Edirissa Ceesay - Gambia Bureau of Statistics Mr. Nyakassi Sanyang _ Central Bank of The Gambia Mr. Omar Ngum - Department of Community Development Mrs. Lolley Kah Jallow - Gambia Bureau of Statistics Mr. Baba Suwareh - Gambia Bureau of Statistics Mr. Modou Lamin Cham - Directorate of Planning, DoSH Mr. Amat Bah - National Nutrition Agency Mr. Paul Mendy - Directorate of Planning, DoSE Mr. Alieu Saho - Gambia Bureau of Statistics
Publisher(s): GBOS UNICEF
Reports\MICS3_Gambia_FinalReport_2006_Eng.pdf
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Table of Contents

Table of Contents



Summary Table of Findings	i
Table of Contents	v
List of Tables	vii
List of Figures	ix
List of Abbreviations	x
Acknowledgements	xi
Executive Summary	xiii

I. Introduction	
	Background	1
	Survey Objectives	6

II. Sample and Survey Methodology	
	Sample Design	10
	Questionnaires	10
	Training and Fieldwork	11
	Data Processing	12

III. Sample Coverage and the Characteristics of Households and Respondents	
	Sample Coverage	13
	Characteristics of Households	13
	Characteristics of Respondents	15

IV. Child Mortality	17

V. Nutrition
	Nutritional Status	20
	Breastfeeding	22
	Salt Iodization	24
	Vitamin A Supplements	26
	Low Birth Weight	27

VI. Child Health	
	Immunization	29
	Tetanus Toxoid	30
	Oral Rehydration Treatment	31
	Care Seeking and Antibiotic Treatment of Pneumonia	33
	Solid Fuel Use	33
	Malaria	34
	Source and Cost of Supplies	34

VII. Environment	
	Water and Sanitation	36
	Security of Tenure and Durability of Housing	40

VIII. Reproductive Health	
	Antenatal Care	41
	Assistance at Delivery	42

IX. Child Development	43

X. Education	
	Pre-School Attendance and School Readiness	44
	Primary and Secondary School Participation	45
	Adult Literacy	48

XI. Child Protection	
	Birth Registration	49
	Child Labour	49
	Child Discipline	50
	Early Marriage and Polygyny	50
	Female Genital Mutilation/Cutting	52
	Domestic Violence	53

XII. HIV/AIDS, Sexual Behaviour, and Orphaned and Vulnerable Children	
	Knowledge of HIV Transmission and Condom Use	54
	Sexual Behaviour Related to HIV Transmission 	56 
	Orphans and Vulnerable Children	57
	

Appendix A. Sample Design	A1
Appendix B. List of Personnel Involved in the Survey	A6
Appendix C. Estimates of Sampling Errors	A9
Appendix D. Data Quality Tables	A33
Appendix E. MICS Indicators: Numerators and Denominators	A41
Appendix F. Questionnaires	A48


	

List of Tables



Table HH.1:	Results of household and individual interviews	60
Table HH.2:	Household age distribution by sex	
Table HH.3:	Household composition	
Table HH.4:	Women's background characteristics	
Table HH.5:	Children's background characteristics	
Table CM.1:	Child mortality	
Table CM.2:	Children ever born and proportion dead	
Table NU.1:	Child malnourishment	
Table NU.2:	Initial breastfeeding	
Table NU.3:	Breastfeeding	
Table NU.4:	Adequately fed infants	
Table NU.5:	Iodized salt consumption	
Table NU.6:	Children's vitamin A supplementation	
Table NU.7:	Post-partum mothers' vitamin A supplementation	
Table NU.8:	Low birth weight infants	
Table CH.1:	Vaccinations in first year of life 	
Table CH.1c:	Vaccinations in first year of life (continued)	
Table CH.2:	Vaccinations by background characteristics	
Table CH.2c:	Vaccinations by background characteristics (continued)	
Table CH.3:	Neonatal tetanus protection	
Table CH.4:	Oral rehydration treatment	
Table CH.5:	Home management of diarrhoea 	
Table CH.6:	Care seeking for suspected pneumonia	
Table CH.7:	Antibiotic treatment of pneumonia	
Table CH.7A:	Knowledge of the two danger signs of pneumonia	
Table CH.8:	Solid fuel use	
Table CH.9:	Solid fuel use by type of stove or fire	
Table CH.10:	Availability of insecticide treated nets	
Table CH.11:	Children sleeping under bednets	
Table CH.12:	Treatment of children with anti-malarial drugs	
Table CH.13:	Intermittent preventive treatment for malaria	
Table CH.14:	Source and cost of supplies for insecticide treated nets	
Table CH.15:	Source and cost of supplies for antimalarials	
Table CH.16:	Source and cost of supplies for antibiotics	
Table CH.17:	Source and cost of supplies for oral rehydration salts	
Table EN.1:	Use of improved water sources 	
Table EN.2:	Household water treatment 	
Table EN.3:	Time to source of water 	
Table EN.4:	Person collecting water 	
Table EN.5:	Use of sanitary means of excreta disposal	
Table EN.6:	Disposal of child's faeces	
Table EN.7:	Use of improved water sources and improved sanitation	
Table EN.8:	Security of tenure	
Table EN.9:	Durability of Housing	
Table EN.10:	Slum housing	
Table RH.3:	Antenatal care provider	
Table RH.4:	Antenatal care	
Table RH.5:	Assistance during delivery	
Table CD.1:	Family support for learning	
Table CD.2:	Learning materials	
Table CD.3:	Children left alone or with other children	
Table ED.1:	Early childhood education	
Table ED.2:	Primary school entry	
Table ED.3:	Primary school net attendance ratio	
Table ED.4:	Secondary school net attendance ratio	
Table ED 4W      Secondary school age children attending primary school	 
Table ED.5:	Children reaching grade 5	
Table ED.6:	Primary school completion and transition to secondary education	
Table ED.7:	Education gender parity	
Table ED.8:	Adult literacy	
Table CP.1:	Birth registration	
Table CP.2:	Child labour	
Table CP.3:	Labourer students and student labourers	
Table CP.4:	Child discipline	
Table CP.5:	Early marriage and polygyny	
Table CP.6:	Spousal age difference	
Table CP.7:	Female genital mutilation/cutting (FGM/C)	
Table CP.8:	Female genital mutilation/cutting (FGM/C) among daughters	
Table CP.9:	Attitudes toward domestic violence	
Table HA.1:	Knowledge of preventing HIV transmission	
Table HA.2:	Identifying misconceptions about HIV/AIDS	
Table HA.3:	Comprehensive knowledge of HIV/AIDS transmission	
Table HA.4:	Knowledge of mother-to-child HIV transmission	
Table HA.5:	Attitudes toward people living with HIV/AIDS	
Table HA.6:	Knowledge of a facility for HIV testing	
Table HA.7:	HIV testing and counselling coverage during antenatal care	
Table HA.8:	Sexual behaviour that increases risk of HIV infection	
Table HA.9:	Condom use at last high-risk sex	
Table HA.10:	Children's living arrangements and orphanhood	
Table HA.11:	Prevalence of orphanhood and vulnerability among children	
Table HA.12:	School attendance of orphaned and vulnerable children	
Table HA.13:	Support for children orphaned and vulnerable due to AIDS	
Table HA.14:	Malnutrition among orphans and vulnerable children	
Table HA.15:		Sexual behaviour among young women by orphanhood 
		and vulnerability status due to AIDS	








List of Figures



Figure HH.1:	Age and sex distribution of household population	11
Figure CM.1:	Under-five mortality rates by background characteristics	15
Figure CM.2:	Trend in under-five mortality rates 	16
Figure NU.1: 	Percentage of children under-five who are undernourished	18
Figure NU.2:	Percentage of mothers who started breastfeeding within one hour and within one day of birth	20
Figure NU.3: 	Infant feeding patterns by age: Percentage distribution of children aged under 3 years by feeding pattern and age group	21
Figure NU.4:	Percentage of households consuming adequately iodized salt	22
Figure NU.5:	Percentage of infants weighing less than 2500 grams at birth	25 
Figure CH.1:	Percentage of children aged 12-23 months who received the recommended vaccination by 12 months	26
Figure CH.2:	Percentage of women with a live birth in the last 12 months who are protected against neonatal tetanus	28
Figure CH.3:	Percentage of children aged 0-59 months with diarrhoea who received oral rehydration treatment 	28
Figure CH.4:	Percentage of children aged 0-59 months with diarrhoea who received ORT or increased fluids, AND continued feeding	29
Figure EN.1:	Percentage distribution of household members by source of drinking water	33
Figure HA.1:	Per cent of women who have comprehensive knowledge of HIV/AIDS transmission	55  
Figure HA.2:	Sexual behaviour that increases risk of HIV infection	57

Abstract

The 2005/2006 Gambia Multiple Indicator Cluster Survey (MICS) is a nationally representative survey of households, women, and children.  The main objectives of the survey are to provide up-to-date information for assessing the situation of children and women in The Gambia. Another objective is to furnish data needed for monitoring progress towards the goals established at the World Summit for Children and the Millennium Development Goals as a basis for future action. Findings of this survey would also be utilized by government and development partners in planning and monitoring programme implementation.

Infant and Under Five Mortality

·	The data from the 2005/2006 MICS III show that the infant and under-five mortality rates were 93 and 131 per 1, 000 respectively.  These figures represent an impressive fall in mortality indicators compared to MICS II which showed 98 and 141 per 1,000 respectively for infant and under-five mortality.

Education

·	Sixty-one per cent of children of primary school age in The Gambia are attending primary school. Although over the past five years primary school attendance in the Basse LGA has increased from 29 to 46, it is still among the lowest attendance rate. The lowest primary school attendance (41 per cent) was found in Kuntaur LGA. At the national level, there is a slight difference between male (60 per cent) and female (62 per cent) primary school attendance. 
·	Almost all (97 per cent) of the children who enter first grade of primary school eventually reach grade five.  
·	Literacy level among women aged 15-24 years was 43 per cent.  The highest level was in Banjul and the lowest were found in Basse and Kuntaur each of which registered less than 20 per cent.

Water and Sanitation

·	Eighty-five per cent of the population has access to improved drinking water - 91 per cent in urban areas and 81 per cent in rural areas.  Apart from Kanifing which has the highest percentage (91) the differences among the remaining LGA's are somehow insignificant.
·	Eighty-four per cent of the population of The Gambia is living in households with sanitary means of excreta disposal. The traditional pit latrine is inclusive and this in most places of The Gambia, the traditional pit latrine is not regarded as a sanitary means of excreta disposal.

Child Malnutrition

·	Twenty per cent of children under-five in The Gambia are underweight or too thin for their age.  Twenty-two per cent of children are stunted or too short for their age and six per cent are wasted or too thin for their height.   
·	Children whose mothers have secondary or higher education are the least likely to be underweight and stunted compared to children of mothers with less education.
·	Children of women in the richest quintile are least likely to be underweight and stunted than those of women in the poorest quintile.

Breastfeeding

Approximately 53 per cent of children aged less than four months are exclusively breastfed.  At age 6-9 months, 44 per cent of children are receiving breast milk and solid or semi-solid foods.  By age 20-23 months, about half (53 per cent) of the children are continuing to breastfeed. 

Salt Iodization

·	About 7 per cent of households in The Gambia have adequately iodized salt a level considerably lower than recommended.  The percentage of households with adequately iodized salt ranges from 1 per cent in Banjul to 41 per cent in the Basse LGA.

Vitamin A Supplementation

·	Within the six months prior to the MICS 80 per cent of children aged 6-59 months received a high dose of Vitamin A supplement.  However six months prior to the MICS only 4 per cent received high dose of Vitamin A supplement.
·	About 78 per cent of mothers with a birth in the last 2 years before the MICS received a high dose of Vitamin A supplement within 8 weeks of the birth.

Low Birth weight

·	Approximately 20 per cent of infants were estimated to weigh less than 2,500 grams at birth.  Of the total number of births only 52 per cent were weighed.

Immunization Coverage

·	About 98 per cent of children aged 12-23 months received a BCG vaccination by the age of 12 months and the first dose of DPT was given to 93 per cent.  The second and third doses of DPT were respectively given to 90 and 82 per cent of children aged 12-23 months.
·	Similarly, 93 per cent of children received Polio 1 by age 12 months and this declines to 83 per cent for the third dose.  
·	The coverage for measles was 85 per cent among children vaccinated by 12 months of age
·	Over half, 55 per cent of children had all nine antigens as recommended in the first 12 months of life.
·	There are insignificant differences of vaccination coverage across sex, education and wealth quintiles.

Diarrhoea

·	About 19 per cent of children aged 0-59 months had diarrhoea in the last two weeks prior to the date of interview of the survey. Of these, 37.9 per cent received one or more of the recommended home treatments (i.e., were treated with ORS or RHF) and continued feeding.

Acute Respiratory Infection

·	Six per cent of under-five children had an acute respiratory infection in the two weeks prior to the survey.  About 69 per cent of these children were taken to an appropriate health provider.

Malaria

·	In The Gambia, 63 per cent of under-five children slept under a bed-net the night prior to the survey interview. However, about 54 per cent of the bed-nets used were impregnated with insecticide.
·	Approximately 65 per cent of children with a fever in the two weeks prior to the MICS interview were given Paracetamol/Panadol to treat the fever and 58 per cent were given Chloroquine while 13 per cent were given Fansidar. Sixty-three per cent of these children were given any appropriate anti-malarial drug.

HIV/AIDS

·	Sixty-five per cent of women aged 15-49 know all three of the main ways to prevent HIV transmission - having only one uninfected sex partner, using a condom every time, and abstaining from sex. 
·	Forty-five per cent of women aged 15-49 correctly identified two most common misconceptions about HIV transmission - that HIV can be transmitted through supernatural means, that it can be transmitted through mosquito bites, and that a healthy looking person cannot be infected.
·	Fifty-five per cent of women aged 15-49 know a place to get tested for AIDS and about 14 per cent have been tested.  
·	The percentage of women who have sufficient knowledge of HIV transmission and the percentage who know where to get tested for HIV increase dramatically with the level of education. Similarly the proportion of women with sufficient knowledge on HIV transmission also increases from the poorest to the richest poverty categories.

Antenatal Care

·	Almost all pregnant women (99 per cent) receive antenatal care (ANC) one or more times during pregnancy.

Assistance at Delivery

·	A doctor, nurse, or midwife delivered about 57 per cent of births occurring in the year preceding the MICS. This percentage is highest in Banjul, 95 per cent and lowest in Kuntaur, 28 per cent. Overall, 56.8 per cent of births occurring in the two years preceding the survey were delivered by any skilled personnel and 54.5 per cent of the births were delivered in health facilities. The level of education and wealth quintiles are highly correlated to assistance at delivery by skilled personnel. 


Birth Registration

·	Births of 55 per cent of children aged under-five years have been registered.  Birth registration coverage increases with age of child.  Coverage is influenced by maternal education and wealth index quintile.

Orphan hood and Living Arrangements of Children

·	Overall, 62 per cent of children aged 0-14 are living with both parents.  This proportion is highest for the poorest households and lowest for richest households. Children who are not living with a biological parent comprise 16 per cent. This percentage increases with the age of the child; it is lowest for the poorest households and highest for the richest households. Children who have one or both parents' dead amount to 9 per cent of all children aged 0-14.

Child Labour

·	About 25 per cent of children aged 5-14 years are engaged in child labour.  About 21 per cent of the children aged 5-14 years worked for family business. 
·	About 2 per cent of these children engaged in domestic tasks, such as cooking, fetching water, and caring for other children, for 28 hours in a week.

Study Documentation, english [eng], gambia [gmb]
Reports\Study Documentation.pdf
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