Summary Findings of the Southern Sudan …

1 The Republic of South Sudan : The Sudan household Health survey 2010 2 Table of Contents Table of Contents .. 2 List of Tables .. 4 List of 5 List of Abbreviations .. 6 Acknowledgments .. 8 Foreword .. 9 Message from UNICEF s Country Office .. 10 Executive Summary .. 11 Chapter 1: Introduction .. 13 Background .. 13 The Objectives of the survey .. 13 Chapter 2: Sample and survey Methodology .. 14 Sample Design .. 14 Questionnaires .. 14 Fieldwork and Data Processing .. 15 Data Analysis .. 15 Chapter 3: Sample Coverage and the Characteristics of household Respondents .. 17 Chapter 4: 19 Mortality .. 19 Nutrition .. 19 Malnutrition .. 19 Breastfeeding .. 24 Salt Iodization .. 25 Vitamin A Supplements .. 27 Child Health .. 30 Immunization .. 30 Neonatal Tetanus Protection .. 33 Oral Re-hydration Treatment .. 35 Pneumonia .. 37 Solid Fuel Use .. 37 Malaria.

2 39 Environment .. 42 Water and Sanitation .. 42 Use of Sanitary Means of Excreta Disposal .. 45 Reproductive Health .. 47 Adolescent Births .. 47 47 Unmet Need for Contraception .. 49 Antenatal Care .. 50 Assistance at Delivery .. 52 Literacy, Education, and Child Development .. 53 Literacy .. 54 Primary and Secondary School Participation .. 55 Women and Child Protection .. 58 Birth Registration .. 58 Early Marriage, Childbirth and Polygyny .. 60 Domestic Violence .. 62 HIV/AIDS, Orphaned and Vulnerable Children .. 63 3 Knowledge of HIV/AIDS Transmission .. 63 Attitudes toward People with HIV/AIDS .. 65 HIV Testing .. 66 Safe Sex Behavior .. 66 School Attendance by Orphaned and Vulnerable Children .. 67 Food Security .. 67 Chapter 5: Conclusions, Limitations, and Future Directions .. 68 69 Appendices .. 70 Appendix A. Sample Design .. 70 Appendix B: Questionnaires.

3 76 4 List of Tables Table HH 2: household Characteristics Table : Nutritional Status of Children Table : Breastfeeding Table : Iodized Salt Consumption Table : Children's Vitamin A Supplementation Table : Vaccinations by Background Characteristics Table : Neonatal Tetanus Protection Table : Oral Rehydration Solutions and Recommended Homemade Fluids Table : Solid Fuel Use Table : household Availability of Treated Nets Table : Use of Improved Water Sources Table : Time to Source of Drinking Water Table : Drinking Water and Sanitation Ladders Table : Use of Contraception Table : Unmet Need for Contraception Table : Antenatal Care Provider Table : Assistance During Delivery Table : Literacy among Young Women Table : Primary School Attendance Table : Children Reaching Last Grade of Primary School Table : Birth Registration Table : Early Marriage and Polygyny Table : Knowledge about HIV Transmission 5 List of Figures Figure NU1: Underweight prevalence Figure NU2: Percent of children underweight, stunted and wasted Figure NU3: Percent of households consuming adequately iodized salt Figure NU4: Vitamin A supplementation Figure CH1: Percentage of children 12-23 months who received recommended vaccines Figure CH2: Immunization coverage by state Figure CH3: Antenatal care visits by state Figure WS1: Use of improved water source Figure CP1: Birth registration Figure CP2: Early marriage Figure HA1: Comprehensive knowledge of HIV/AIDS by state Figure FS1.

4 Food consumption frequency 6 List of Abbreviations AIDS Acquired Immune Deficiency Syndrome ANC Antenatal Care ARI Acute Respiratory Infection ACSI Accelerated Child Survival Initiative BCG Bacillis-Cereus-Geuerin (Tuberculosis) CBS Central Bureau of Statistics CPA Comprehensive Peace Agreement CPR Contraceptive Prevalence Rate CRC Convention on the Rights of the Child DHS Demographic and Health survey DPT Diphtheria Pertussis Tetanus FGM/C Female Genital Mutilation/Cutting FP Family Planning GPI Gender Parity Index HIV Human Immunodeficiency Virus HTP Harmful Traditional Practice ICP International Conference on Population and Development IDD Iodine Deficiency Disorders IMR Infant Mortality Rate ITN Insecticide Treated Net IUD Intrauterine Device LAM Lactational Amenorrhea Method MD Millennium Declaration MDG Millennium Development Goals MICS Multiple Indicator Cluster survey MMR Maternal Mortality Ratio MMR Measles, Mumps.

5 Rubella MOH Ministry of Health NAR Net Attendance Rate NBG Northern Bahr el Ghazal NBS National Bureau of Statistics NIDs National Immunisation Days NMR Neonatal Mortality Rate PHCC Primary Health Care Centre PHCU Primary health Care Unit ppm Parts Per Million PRSP Poverty Reduction Strategy Paper RH Reproductive Health SHHS Sudan household Health survey SMS Safe Motherhood survey SPSS Statistical Package for Social Sciences SSCCSE Southern Sudan Commission for Census, Statistics and Evaluation TT Tetanus Toxoid UN United Nations U5MR Under-5 Mortality Rate UNAIDS United Nations Programme on HIV/AIDS UNDP United Nations Development Programme 7 UNFPA United Nations Population Fund UNGASS United Nations General Assembly Special Session on HIV/AIDS UNICEF United Nations Children s Fund USAID United States Agency for International Development WBG Western Bahr el Ghazal WFFC World Fit for Children WFP World Food Programme WHO World Health Organisation 8 Acknowledgments The Sudan household Health survey (SHHS II), Southern sector, saw success through a gamut of joint efforts by organisations, individual government institutions and staff, and subject matter experts.

6 The team responsible for the supervision and production of this report acknowledges the extraordinary contributions of these institutions and individuals. The Ministry of Health (MoH) and the National Bureau of Statistics (NBS) played a significant role with respect to the administrative and technical aspects of the survey . In particular, we acknowledge the administrative and institutional contributions of Dr. Lul Riek, Director General for Planning and Coordination of the Ministry of Health and Hon. Isaiah Chol Aruai, Chairperson of the National Bureau of Statistics, Hon. Dr. Esterina Novello, Chairperson of HIV/AIDS Commission and Dr. Richard Laku, Director of Research & Monitoring,whose leadership was instrumental in setting the direction of the study. Many staff of the Ministry of Health and the National Bureau of Statistics were instrumental in this survey , therefore are greatly appreciated.

7 The South Sudan Aid Commission (SSAC) was critical in the planning processes of the survey and is highly acknowledged. We acknowledge the combination of all international agencies, including the United Nations (UN), the bilateral donors, the NGOs and other development partners whose financial and technical assistance to the health sector immensely contributed to effective planning, implementation, and publication of this survey s results. In particular, this survey would have not been possible without the profound contributions of the United Nations Children s Fund (UNICEF), the World Food Programme (WFP), the United Nations Fund for Population Activities (UNFPA), the World Bank, the United States Agency for International Development (USAID), and the World Health Organisation (WHO). We are indebted to the Multiple Indicator Cluster survey (MICS) support desks, both at UNICEF Headquarter offices and MENA Region, for providing technical assistance on methodology, especially with respect to data generation and analysis.

8 Our sincere appreciation equally goes to our colleagues in the then Sudan s Government of National Unity (GoNU) for their collaboration during the survey planning and implementation processes. Our sincere appreciation is also due to the state ministries of health and sub-offices of the National Bureau of Statistics for assisting with data collection in all phases of the survey . Finally, we are grateful to the individual sample units for participating in this important study and allowing us access to their households. This study would have not been a success without their consent and participation. _____ _____ Dr. Makur Matur Kariom Eliaba Yona Damundu Undersecretary Director Ministry of Health Social and Demographic Statistics Dept. National Bureau of Statistics (NBS) 9 Foreword The Sudan household Health survey II (SHHS II), Southern Sector, marks the second household and health study in post-conflict South Sudan .

9 This exercise was timely, given its relevance to changes in Sudanese geopolitics, which have considerable implications for children and women s health in the nascent polity. The emphasis of the study is to assess the state of health for children and women and some other important aspects of their wellbeing following the first survey , and to streamline childhood and maternal health services in South Sudan . The study also assesses the state of other facets related to children and women s livelihood. This study establishes evidence-based insights concerned with childhood and maternal health experience in South Sudan , the results of which could be used to develop key strategies for health policy in the area. Covering the twenty-five states of the Sudan , the SHHS II provides comparative analyses of childhood and maternal health and other aspects of children s welfare across spaces and according to individual and residence specific indicators.

10 The success of this project depended primarily on the extraordinary contributions made by various developmental partners and the then Government of Southern Sudan . The joint efforts enabled efficient and effective planning processes for generating and analysing data. As well, the efforts are crucial in mobilising resources that assist in poverty reduction and equitable distribution of social services in South Sudan . The present data are useful for objectively informing strategies towards attaining the Millennium Development Goals (MDGs) in South Sudan . The principal importance of the data lies in devising solutions geared towards restructuring the health infrastructure, services, and institutional structures in order to ensure effective service delivery practices in the polity. The SHHS II helps illuminate upon current health and other social conditions of children and women in South Sudan , making reference to prior status as provided in the first study.