The two water and sanitation indicators are access to improved drinking water sources and sanitary means of excreta disposal. The households having access to
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safe drinking water were defined for this survey as those who use any of the following
types of water supply: piped water; public tap; bore/hole tube well; protected well; protected spring; or rainwater. The actual quality of the water was not tested.
Sanitary means of excreta disposal included: flush toilets connected to sewage
systems or septic tanks; other flush toilets; improved pit latrines; and traditional pit latrines.
Results for the two measured indicators are given in Table 17 below.
Table 17 Water and sanitation indicators, BiH MICS 2000
Entity
Area Indicator Indicator Definition Total BiH
BiH RS Water and sanitation Safe drinking water Percentage of population who use a safe source of
drinking water 97.5% 98.1% 96.5% Water and sanitation Sanitary means of excreta disposal Percentage of population who use a sanitary
means of excreta disposal
93.5% 99.5% 83.7%
(See also Tables E6 and E7 in Appendix E)
Overall 97.5% (C.I. 96.7 – 98.4%) of the population had access to safe drinking water. with a small difference between urban areas (99.7% C.I 99.51 – 100%) and rural areas (96.2% C.I. 94.9 – 97.7%) There were variations across BiH in the source of drinking water between urban and rural areas. In urban areas, 97.2% of households had water piped into their dwellings, but in rural areas this was only 55.4%. Rural households had a range of other water sources including water piped into the yard or plot (13.9%), a protected dug well (8.6%), a protected spring (7.9%) or a tubewell/borehole with a pump (7.6%). (See also Table E6)
Overall, 93.5% (C.I. 92.6 – 94.4%) of the population was living in households with sanitary means of excreta disposal. Urban areas slightly more likely to have sanitary means of excreta disposal (99.0% C.I. 98.3% - 99.8%) than rural areas (90.2% C.I.88.8 - 91.6%). There was also a difference between FBIH (99.5% C.I.92.6 – 94.5% ) and the RS (83.7% C.I. 81.2 – 86.1%) and this is explained by the higher percentage of rural population in the RS survey sample. (See also Table E7)
186 3.23.4 Child malnutrition
The standard or reference population used was the National Center for Health Statistics (NCHS) standard, which was recommended at the time for use by UNICEF and WHO and was being used globally for comparisons in MICS surveys. These 1977 growth charts were developed by the NCHS as a clinical tool for health professionals to determine if the growth of a child is adequate and were adopted and endorsed by WHO for international use.a The nutritional status indicators in the BiH MICS 2000 are expressed in standard deviation units (z-scores) from the mean or average of this reference population.
Children whose weight for age was more than two standard deviations below the median of the reference population were considered moderately underweight while those whose weight for age was more than three standard deviations below the median were classified as severely underweight.
Children whose height for age was more than two standard deviations below the median of the reference population were considered short for their age and were classified as moderately stunted. Children whose height for age was more than three standard deviations below the median were classified as severely stunted.
Children who weight for height was more than two standard deviations below the median of the reference population were classified as moderately wasted while those whose weight was more than three standard deviations below the median were
severely wasted.
Children whose weight for height was more than two standard deviations above the mean were considered overweight and more than three standards above the mean were considered to be obese. Overweight and obese were not included in any of the reporting or monitoring plans in BiH, but they were measured in the BiH MICS 2000 survey and are included here for completeness and are discussed later.
Children who were not weighed and measured (approximately 1%) and children whose measurements were outside a plausible range were excluded. The birth dates
a
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of all the children in the survey were known so all the remaining children were included. The main results for these indicators are given in Table 18 below.
Table 18 Child nutrition indicators including underweight, stunting, wasting, and overweight, BiH MICS 2000
Entity
Area Indicator Indicator Definition Total BiH
BiH RS Child malnutrition Underweight prevalence Percentage of under fives who weigh too little
for their age
4.1% 4.8% 2.1% Child malnutrition Stunting prevalence Percentage of under fives who are too short
for their age
9.7% 10.0% 8.8% Child malnutrition Wasting prevalence Percentage of under fives who are too thin for
their height 6.3% 6.1% 6.6% Child malnutrition Overweight prevalence Percentage of under fives who are overweight
for their height
13.2% 12.2% 16%
(See also Tables E8 and E9 in Appendix E)
In the sample, 4.1% (C.I 3.2 – 5.0%) of children under the age of five years were underweight for their age. Almost one in ten (9.7% C.I. 8.4 – 11.0%) of children were stunted or too short for their age, and 6.3% (C.I. 5.3 – 7.3%) were underweight for their height.
Children whose mothers had secondary or higher education were slightly less likely to be underweight compared to children of mothers with primary or no education. Children in the FBiH were more likely to be underweight and stunted in comparison to those in the RS, and children in rural areas were more likely to be underweight and stunted than those in urban areas. Children were more likely to be obese if the mothers’ education level was secondary or above, if they lived in urban rather than rural areas and if they lived in the RS rather than the FBiH.
3.23.5 Low birth weight
Infants who weighed less than 2500 grams (2.5 kg.) at birth were categorised as low birth weight babies. Since not all infants are weighed at birth and those who are
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weighed may be a biased sample of all births, reported birth weight cannot, normally, be used to estimate the prevalence of low birth weight among all children. Therefore, in the MICS 2 methodology, the percentage of babies weighing below 2500 grams at birth is estimated from the weight recorded on the health card or from the mother’s recall of the baby’s size at birth (that is, very small, smaller than average, average, larger than average, very large).
The approach in the MICS 2 is as follows. First, the two items are cross-tabulated for those children who were weighed at birth to obtain the proportion of babies in each category of size who weighed less than 2500 grams. This proportion is then multiplied by the total number of children falling in the size category to obtain the estimated number of children in each size category who were of low birth weight. The numbers for each size category are summed to obtain the total number of low birth weight children. This number is then divided by the total number of live births to obtain the overall percentage of infants with low birth weight.
However, in BiH MICS 2000, use of mother’s recall of relative size at birth was not needed, as actual birth weights in grams were available for all infants in the survey sample. The numbers are shown in Table 19 below.
Table 19 Birth weight of babies born in previous 12 months, BiH MICS 2000
Entity
Area Indicator Indicator Definition Total BiH
BiH RS
Low Birth Weight
Birth weight below 2.5 kg.
Percentage of live births where the baby’s weight is below 2500 grams
3.8% 2.1% 2.5%
(See also Table E10 in Appendix E)
Almost 100% of babies whose births were reported in the BiH MICS 2000 were weighed at birth and, in almost all cases there was documentary evidence in the form of written records from health care staff at the time of birth. This is an uncommonly high percentage of babies to be weighed at birth in the MICS survey series.
In BiH, only 3.3% of infants were estimated to weigh less than 2500 grams at birth. This figure should be treated with caution as the numbers of infants in denominator for this
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indicator is low (n = 485). In addition, these estimates only refer to children under the age of 5 who were low birth weight babies and who are still alive. The methodology therefore underestimates the numbers of low birth weight babies because some of these babies will have died by the age of five.