Child & Family Tracker Tracking the Socio-Economic Impact of COVID-19 on Children and Families in Nepal 3rd Monthly Household Survey
August 2020 Findings © UNICEF Nepal/2017/NShrestha UNICEF © Household characteristics Content (gender, ethnicity, caste, place of residence, employment, income, disability)
• This is the third in a series of monthly household surveys to track the Livelihood losses Migration Immediate needs socio-economic multi-sectoral impact of COVID-19 on children and families in Nepal.
Social protection Nutrition Health services • Where available, the monthly household survey data is supplemented by relevant child-related data from
other sources. WASH Education Protection
COVID-19 risk perception, * Baseline of 7,655 respondents. 6,128 respondents in all three rounds. awareness and 587 respondents dropped out since May. 547 respondents in baseline did not behaviour participate in July but did again in August. 393 respondents were in baseline and July survey but not in August. Hence total August sample = 6,675 Survey Design
• Telephonic survey and interactive voice responses with follow up questions.
• Sample size: 6,675 households with children below the age of 18. Households are selected through random and purposive sampling.
• The sample covers 80+% of municipalities (624). Strong geospatial representation to allow interpolation to non- observed areas.
• Sample remains nationally and provincially representative of households with children. 1 (turquoise blue) = locations covered in the sample. 0 (dark blue) = locations not covered in the sample. • Interviewed caregivers: 49% female and 51% male. Highlights in Findings
• Poverty has deepened and expanded. In August • Critical knowledge gaps identified. Approximately 6 45% of the families sampled had no earnings in 10 respondents know that the disease can be during the past month, with the number of passed through close contact with an infected families below the poverty line marked by 10,000 person. NPR having increased from an estimated 11-14% • Worrying gaps in practice identified: 55% of in May to 59-65% in August. respondents wash their hands all the time. Only 4 • Families are struggling to meet basic needs out 10 are wearing masks all the time. A minority (food, medicine, fuel, hygiene), with almost double of 2 in 10 are observing the two metres physical the number of households reporting shortages of distancing guidance. essential supplies, from an estimated 36% in May to 74% in August. • 26% of respondents with children having a fever experienced challenges in getting treatment. • Approximately 1 in 5 households are struggling Majority from lower-income groups with higher to meet key dietary requirements, mostly due to numbers in Gandaki, Karnali & Province 5. a lack of purchasing power (cash). More families have now reduced food intake for children in • 22% of respondents, drawn largely from lower- August (26%) compared to July (21%). By August, income groups, reported that students are not 10% of respondents (with children under 2 years studying (either home school, online or private old) reported that their children were not eating classes) compared to 17% in July. their usual diet compared to 3-4% in July. Income Losses Continue 46% of respondents had no earnings since July 2020 – an increase of 11%. The distribution of income shifted downwards signaling increased risk of poverty.
• Continued drop in the share of respondents Reported Monthly Earnings (NPR) belonging to the top quintile. Hence, since the May, July, August 2020 beginning of the first lockdown, the income None <10K 10-20K 20-30K 30-50K 50K+ distribution has shifted downward significantly. • An increase in the percentage of low-income households since May 2020 - suggests that Aug 46% 18% 18% 11% 5%2% higher-income households might be moving downward to this group. • 48% of respondents in the bottom quintile reported having no earnings in July, which Jul 35% 14% 19% 17% 11% 4% increased to 46% in August. • Most respondents from low-income families are more likely to borrow funds while middle- and high-income families choose to use their May 15% 29% 28% 20% 9% savings to cope with financial difficulties. Family
and friends continue to provide financial 0% 20% 40% 60% 80% 100% support. Tight Labour Market Conditions:
Earnings/Livelihood Losses Continue Karnali 31% Gandaki 43% • In August, 51% of households reported a loss of livelihood Province 1 47% and earnings a decrease of 14% since July. This could be Bagmati 48%
Province 5 48% Province explained by easing of lockdown during July and August All 51% when some respondents were able to recover their Sudurpaschim 52% livelihood and return to their jobs. Province 2 73% 50K+ 23% 30-50K 33% • Only 2% of respondents who were unemployed were able 20-30K 40% 10-20K 42% to find jobs in August, yet 64% remain unemployed. Income <10K 53% None 62% • 68% of male heads of households lost their employment 9 63% compared to 9% of female heads of households. 8 57% 7 58% 6 54% 5 51% • Moreover, 1.5% of children in the interviewed households Size HH reportedly lost jobs. This suggests that the percentage of 4 46% 3 40% working children during lockdown could be higher if they 2 43% had not lost their employment.
Percentage of respondents who lost earnings and livelihood by province, income and household size Migration: Largely Unchanged Except for Middle East Returnees Percentage of respondents reporting returnees Percentage of returnees experiencing stigma by province and place of origin 10%
9% Karnali 3% 8% 0% Province 1 4% 7% 3% 6% Bagmati 4% 7% 5% 0% Province 2 8% 4% Province 5 0% 9% 3% 1% 0% 3% 0% 5% 2% 0% Sudurpaschim 11% 1% 0% 3% 3% 1% 0% 2% 2% 1% Gandaki 18% 1% 0% Bagmati Gandaki Karnali Province 1 Province 2 Province 5 Sudurpaschim 0% 5% 10% 15% 20%
Internal India Mid East Others • Since April 2020, family members of 4.5% of surveyed households returned home from other provinces in Nepal, India, the Middle East and other countries. • 47% of returnees came from different locations in Nepal, 39% from India and 10% from the Middle East. • Sudurpaschim and Karnali had the highest percentage of returnees. • Of 300 returnees in the survey, 8% reported experiencing stigma on their return. Returnees from Sudurpaschim and Gandaki are more likely to experience stigma. In household surveys, given the sensitivity to report, stigmatization tends to be under reported. Immediate Needs of Respondents’ Households
Percentage of households with immediate needs (May–August 2020) • The percentage of households reporting food as an immediate need increased from 21% in July to 34% in August.
• Medication/medical treatment, soap and toothpaste remain among the top immediate needs of households. The percentage of those needing medication/medical treatment increased in August.
• The greatest immediate needs of families overall were employment, children's education and financial support. These are new categories that were added to the August survey.
• Children's education, food, financial support and employment, also evident from the response rate on the need for cash, are most likely to be the immediate needs of low-income households with children. *question was modified in the August survey with added possible answers. *the percentage of households needing menstrual hygiene products and water for handwashing decreased from 2% in May to below 1% in August. 1% of households continue reporting water among the top immediate needs from May to August. Social Protection 92% of respondents need additional cash to support their children • Over 90% of surveyed families reported need for additional cash to support their children. Over 90% of households in the lowest income groups, including those who had no earnings, emphasized this need. • 60% of highest-income households also reported needing additional cash for their children. Most of them could be among those who lost employment and had no earnings during lockdown. • Bank transfer is more popular than services such as Esewa and other money transfer mechanisms. This is especially important to know for planning cash-based interventions and risk mitigation measures as not all services might be available during emergencies. Social Protection 21% of households with children received financial/material assistance from the government since lockdown
Percentage of households receiving financial/material assistance Percentage of households receiving financial/material assistance – by income - by province
35% 30% Gandaki 7% 30% Bagmati 8% 25% 23% 23% Karnali 10% 20% 18% Province 1 16% 15% All 21% 10% 5% Province 5 23% 5% 3%
0% Sudurpaschim 24% 1 Province 2 47% None <10K 10-20K 20-30K 30-50K 50K+
• 21% of households received financial/material assistance from the government after the first lockdown was imposed. • More low-income families compared to higher-income groups receive government financial/material assistance. • Province 2 has the highest percentage of households receiving government financial/material assistance. Nutrition – Challenges to Provide Food Daily
Variation in % struggling for food by income, province, household size and education status of head of household • The percentage of households struggling to provide food on a daily basis decreased from 28% 12+ 13% 9 to 5 15%
in July to 19% in August. 5 to 9 20% Head 1 to 5 22% None • Households in the lowest income group and EducationStatus: 27% 9 26% in Province 2 are more likely to struggle to provide 8 19% food on a daily basis. 7 21% 6 20% 5 21%
• The top three reasons for caregivers reporting not Size HH 4 16% being able to provide food are the absence of 3 18% 2 15% money, increased food prices and unavailability of 2 15% essential food items at shops. A small percentage Gandaki 12% Bagmati 14% of caregivers are also experiencing fear of going Karnali 15% out to buy food. Province 1 15%
Province 5 16% Province All 19% • 40% of households reporting food as an immediate Sudurpaschim 27% need also reported struggling to provide food daily. Province 2 33% 50K+ 1% This explains why the percentage reporting food as 30-50K 3% an immediate need is likely to be higher than 20-30K 9%
10-20K 13% Income indicated. <10K 23% None 27% 0% 5% 10% 15% 20% 25% 30% 35% Nutrition: Children's Diet Percentage of households with children who experienced dietary changes increased by 5% since July.
• In August, 26% of children below the age of 18 experienced changes in their Aug dietary intake, in comparison 22% 74% to 21% in July.
• There has been a slight increase in the percentage of children eating less often July 17% 79% per day and eating less at mealtimes.
• More children are eating a reduced variety of foods in August compared to July. May 21% 74%
• Low-income families and those without any earnings are those with the highest Decreased Quantity Decreased frequency Decreased variety No Change percentage of children who had to compromise with their diet. Percentage of respondents reporting changes to children’s dietary intake Nutrition: Changes in Diet of Children Under Two Years Old
Gandaki 5.6% • Children under 2 years old in 10% of Province 1 6.4% households were reportedly not eating their Province 2 8.4% usual diet in August. The percentage
All 9.7% of such households increased by 3-4%
Province Sudurpaschim 10.4% since July. Children in households without
Karnali 10.9% any earnings are more likely to experience
Bagmati 11.2% changes in their diets.
Province 5 11.5%
50K+ 3.4% • Province 5, Bagmati & Karnali Provinces have the highest percentage of children 30-50K 9.4% under 2 years old who are not eating their 20-30K 9.8% usual diet. Income 10-20K 8.9%
<10K 7.4%
None 11.6%
0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0%
Percentage of households where children under 2 years old eat less Nutrition: Breastfeeding of Children
• 96% of children under 2 years old are All 6% 78% 15% breastfed. The rate is slightly less than the national rate of children who have Reduced 12% 72% 16% ever been breastfed – 99% in 2019 and 97% in 2014 (Multiple Indicator Cluster Not Reduced 6% 80% 14% Survey). Less Same More Breastfeeding frequency - by mother reducing the number • 16% of mothers reported reducing of meals per day and frequency of breastfeeding
the number of meals per day in August Sudurpaschim 9% 20% 70%
(same as July). Mothers who do not Province 5 8% 13% 79% reduce their meals are more likely to Province 2 3% 14% 82% provide the same frequency of Province 1 7% 14% 79% breastfeeding to their children. Karnali 4% 15% 81% • More mothers in Sudurpaschim Gandaki 3% 12% 84% Province reported an increase in Bagmati 5% 14% 80%
breastfeeding frequency than in Less More Same other provinces. Breastfeeding frequency - by province • 17% of caregivers in August in comparison to 15% in July Nutrition: Children Under Two Years Old stated that their children were Percentage reduction in August becoming too thin. Karnali 25% admissions to OTCs for severe wasting Gandaki 24% Province 5 20% • Respondents in Karnali, among children 6-59 months. Bagmati 18% Province 2 15%
Gandaki and Province 5, Provinces Sudurpashchim 14% including those from low- Province 1 14% income families were more 100 50K+ 10% 95 likely to report that their 91 30-50K 13% 83 20-30K 6% 79 80 children were becoming too 10-20K 8%
thin. Income <10k 16% 57 None 24% 46 • Respondents who reported 0% 5% 10% 15% 20% 25% 30% that their children's diets changed were most likely to be worried about their children becoming too thin. Sudur Karnali All Province 5 Gandaki Province 2 Province 1 Bagmati Children's diet is the same 15% 85% Pachim • COVID-19 has affected the capacity to actively screen for wasting with fewer admissions of severely Percentage reduction in admissions Children's diet is not the same 34% 66% wasted children 6-59 months to OTCs ranges from 100 in to the Outpatient Therapeutic Bagmati to 46 in Sudurpaschim Centre (OTC) in August 2020 Province. Parents are worried Parents are not worried compared to August 2019. Health: Fever and Treatment of Children Under Two Years Old
• In July, 11% of households reported that their children under 2 years old became ill or had a fever. In August, 18% of children were ill or 18% of respondents with Of these, 52% had a fever had a fever - a significant increase in one children under 2 years old lasting more than one week, month. reported their children and 48% reported their having a fever in the past children having a fever for • 26% of respondents with children having a fever month less than one week experienced challenges in getting treatment. The majority of respondents are from lower income groups.
• Despite the challenges, 90% of respondents with children under 2 years old reported their In both cases, nearly 90% were able to visit a health children having a fever visited health facilities 85% of respondents whose facility/doctor and 10% did for treatment, an increase compared to 81% in children had a fever reported not go. Of the 10% who did July. their child was now well not go, 58% of them treated the child independently • Gandaki, Karnali and Province 5 have a significantly higher percentage of children having a fever than the average. Children Treated with Amoxicillin
51% 16000 14753 15060 14438 14038 13835 13459 reduction 14000 12861 13251 13243 11842 12000 10793 10000
8000 6702 6880 6459 6000 4000 2000 0 Nov/Dec Previous Dec/Jan Jan/Feb Feb/Mar Mar/Apr Apr/May May/Jun Yr) 2-59 Months-Treatment-Amoxicillin -2019 2-59 Months-Treatment-Amoxicillin -2020
Source: HMIS, August 2020 • Fever among children can be used as a proxy symptom for an acute respiratory infection (ARI). Recent HMIS data suggested major decreases in ARI cases treated with Amoxicillin since March/April compared to the previous year. Lower utilization of treatment of children for ARI was most likely due to lockdown measures and challenges faced by parents seeking care (see previous slide). Health: Births and Institutional Delivery 72 babies born in the last month (1.1% of households had a newborn)
Bagmati Nearest 18% Health Sudurpaschim Facility 29% 24% Home Gandaki 8% 4% Karnali 2% Pvt. Clinic 2%
Province 1 14% Hospital Others 65% 1%
Province 5 22% Province 2 11%
• 69% of respondents reporting the delivery of a baby in the past month were from Sudurpaschim, Province 5 and Bagmati. • This is slightly different to HMIS data in July 2020 where most institutional deliveries were recorded in Province 5 (21%), Bagmati (18%) and Sudurpaschim Provinces (16%). • 91% were born in: a hospital (65%), nearby health facility (24%), and private clinic (2%). • 48% of respondents reporting the delivery of a baby did not earn any income in the past month. • 73% of babies were born to respondents in the bottom three income groups. Wash: Access to Soap and Masks
11% Karnali • Most respondents had no difficulty buying soap and masks: only 16% had difficulty 8% 7% Gandaki buying soap, 11% could not buy a mask, and 6% of households could not buy both 10% 12% a mask and soap in August. Most of these households live in Sudurpaschim and Bagmati 12% Province 5 and belong to low-income groups. 8% Mask Province 1 13% Soap 6% • Major reasons for difficulties in buying soap and masks include increased prices Province 2 14% and unavailability of the items in shops. 10% Province 5 21% 20% Sudurpaschim • Overall, access to water during the last three months does not seem to be a major 24% issue, especially as over 70% of households had at some time previously experienced a drinking water shortage. Also, 80% of households had sufficient water for cooking, handwashing and bathing during lockdown. 24%
16% 16%
10% Soap Mask 7% 5% 5% 4% 3% 3% 3% 1%
None <10K 10-20K 20-30K 30-50K 50K+ Education Distribution of materials used for studying - by income • Most children study using self-learning materials, regardless of the family’s income. Fewer children use the internet, which is 90% 80% more often used in higher-income households. 70% 60% • The proportions of children studying and receiving help with 50% their education are broadly similar across all income groups 40% and in every province except Karnali. 30% 20% 10% • 80% of nearly 300 U-report participants feel that studying has 0% been a challenge, and 28% are worried about taking exams. Internet TV Radio Home Comm. Mobile Self Learn Prev Text Other Tuit Learn Teach Books
None <10K 20-30K 30-50K 50K+ Protection: Gender-Based Violence & Violence against Children Low number of reports of violence by respondents apart from Province 2 (12%). The findings are to be read together with available from police, psychosocial, and women and child helplines' data that highlights continued concerns over family and gender-based violence.
• Under-reporting of violence in household surveys is in sharp contrast to reports from providers of protection services.
• Data from police records and women and child helplines show continued concerns over family and gender-based violence. Source: Nepal Police
• The number of reported incidents of domestic violence increased from 494 in March-April to 1,000 in June-July. The numbers of reported rapes and attempted rapes have also been increasing since March according to police data.
• GBV cases represent 54% of incidents reported in Karnali and Sudurpaschim through the Incident Report system (20% child marriage). However only 44% of incidents reported had been addressed.
Note: the protection monitoring system is being extended to other provinces. Protection: Children & Adolescent Well-being
• Children in 55% of 1,183 households are reportedly sleeping less during lockdown.
• 46% of children report a loss of interactions with peers.
• According to 36% of respondents, limited education of adolescents is one of the main problems today. 24% of them also stated that adolescents had a lack of interest in education.
• Provincial level data also suggests changes in children's behaviour including regressive behaviour, social withdrawal, upsurge in anxiety and aggressivity. (Protection monitoring data from Karnali and Sudurpaschim provinces)
36%36% 24% 19% 13% 7% 4%
4% 3% 3% 3% 2% 1% 1%
DK
Early…
Others
Lack of… Lack of… Lack
Limited…
Violence
Unhealth…
Increased…
Too much… Too
Limited Edu Limited
No Problem No
Limited social… Limited Limited friends Limited Psychological Impact: Household Experiences of Anxiety, Fear and Stress
% respondents who felt • Since May 2020, 56% of 1,343 respondents 70% reported feeling afraid of going out to buy food stressed during lockdown or medication or run errands due to fear of catching COVID-19. % respondents who were afraid to go out to buy food, 56% • 70% of 1,413 respondents reported feeling medicines and run errands stressed due to lockdown. According to the due to Covid 19 latest U-Report results, 42% of respondents felt stressed, 31% felt indifferent, 19% felt sad, 7% felt happy, and 1% angry. % respondents who resigned from a job out of fear of 18% Covid 19 • 18% of 1,349 respondents resigned from their jobs due to fear of catching COVID-19. Percentage of respondents: • The biggest fear for 74% of respondents (U- - reporting resigning from their jobs out of fear of COVID-19 - afraid to go out because of COVID-19 Report) is getting infected by COVID-19. - feeling stressed since lockdown. Protection: Child Labour & Family Separation • Reports of child labour by Respondents reporting children respondents remain low working 2.39% 2.40% and largely unchanged from July 2020. 1.88% 1.75%
32% 1.36% • The education status of heads of households has an 0.68% important bearing.
• Even upper-income groups None <10K 10-20K 20-30K 30-50K 50K+ report child labour. 2.43% 2.36% 2.04% 1.91% 1.86% • Respondents from Bagmati 1.69% and Province 2 are more likely to report children earning.
8% • Family separation
is emerging as an issue to
Gandaki
Bagmati
Province 5 Province 1 Province Province 2 Province monitor – 3.5% of
2.65% 2.59% Sudurpaschim 2% 2% 2.17% respondents are separated 1.44% 1.24% from their children: 52% with relatives, 19% at another Pre-lockdown May July Aug None 1 to 5 6 to 9 10 to 12 12+ place of work, and 5% in boarding schools. Respondents reporting children working - by income group, province and education of head of household COVID-19 Knowledge Not a threatening disease
Covid 19 is airborne Not a threatening disease 4.8% Social distancing + handwashing + mask reduces Covid 19 transmission
Can be spread by contact with infected person Other 6.9% Caused by corono virus • Critical knowledge 0.0% 20.0% 40.0% 60.0% 80.0% 100.0% gaps identified.
Is Airborne 11.7% 50K+ 30-50K 20-30K 10-20K <10K None • Varies by income Not a threatening disease level and education level of the head of Caused by corona virus 21.6% Covid 19 is airborne household. Social distancing + handwashing + mask reduces Covid 19 transmission
Can be spread by close contact 61.3% Can be spread by contact with infected person with an infected person
Caused by corono virus
Social distancing + handwashing 0% 20% 40% 60% 80% 100% 92.5% reduces Covid 12+ 10 to 12 6 to 9 1 to 5 None
Knowledge about COVID-19 Knowledge about COVID-19 - by income and education of head of household Handwashing with Soap In August, 55% of respondents reported that they wash their hands for 20 seconds all the time. Handwashing behaviour varies by province, income level and education status of the head of household. 50K+ 69% 26% 5% Rarely Never Some of the time 1% 0% 7% • Overall, most 30-50K 66% 31% 2% respondents stated that they wash 20-30K 59% 37% 3% their hands for 20 seconds all the time or 10-20K 56% 38% 5% Most of the time All the time most of the time. <10K 49% 37% 11% 37% 55% • Karnali & Province 2 respondents are least None 54% 37% 7% likely to regularly wash their hands for 20 All the time Most of the time Some of the time Rarely Never Handwashing behaviour seconds . Variation in handwashing behaviour by HH Income
Sudurpaschim 69% 22% 7% • Respondents in 12+ 62% 32% 5% upper-income groups Province 5 56% 38% 5% are more likely to 10 to 12 58% 36% 5% Province 2 41% 47% 9% wash their hands for
Province 1 58% 34% 7% 20 second regularly. 6 to 9 53% 39% 6% • Respondents who live Karnali 45% 41% 10% in households with 1 to 5 46% 42% 9% Gandaki 71% 25% 3% a higher educational level are more likely to None 53% 37% 8% Bagmati 50% 42% 6% wash their hands for
All the time Most of the time Some of the time Rarely Never 20 seconds regularly. All the time Most of the time Some of the time Rarely Never Variation in handwashing behaviour - by province Variation in handwashing behaviour - by education status Use of Masks 71% of respondents in high-income families wear masks all the time compared to 34-40% of respondents who had no earnings in August. However, educational attainment does not have a significant influence on person's decision or ability to wear a mask for protection from COVID-19. 50K+ 71% 21% 5% RarelyNever 30-50K Some of the 3% 3% 56% 33% 8% time 17% • 23% of respondents 20-30K 49% 40% 9% All the time do not wear a mask 40% all or most of the 10-20K 44% 41% 11% time. <10K 40% 33% 21%
None 34% 38% 20% • Karnali & Bagmati
Most of the respondents are All the time Most of the time Some of the time Rarely Never time least likely to wear a 37% Mask wearing behaviour mask all of the time. Variation in mask wearing behaviour by Income
Sudurpaschim 44% 26% 21% • Upper-income 12+ 47% 35% 13% 3% groups are Province 5 32% 43% 21% most likely to report 10 to 12 45% 39% 12% 2%
Province 2 46% 42% 11% wearing masks all of the time. 6 to 9 37% 36% 20% 3% Province 1 42% 31% 21%
• Those from 1 to 5 32% 37% 22% 4% Karnali 37% 41% 15% households where
Gandaki 53% 32% 10% heads have 12+ None 36% 38% 19% 4% education are more Bagmati 38% 38% 14% likely to wear All the time Most of the time Some of the time Rarely Never a mask. Variation in mask wearing behaviour - by province Variation in mask wearing behaviour - by education status Maintaining Two Meters Physical Distance Maintaining two meters physical distance is becoming a challenge in the context of increased mobility. 1 in 5 households rarely or never practice physical distancing Variation in physical distancing behaviour by education status when going out. 50K+ 34% 34% 18% 9% 5% Never • Only 53% of Rarely 6% 30-50K 32% 33% 20% 12% 4% 13% Most of the respondents practice time 32% physical distancing most 20-30K 24% 37% 22% 12% 5% or all the time. 19% of respondents rarely or 10-20K 24% 34% 27% 10% 5% never practice social <10K 18% 27% 29% 17% 8% All of the time 21% distancing. None • Lowest percentage of 19% 31% 31% 13% 6% Some of the 0% 20% 40% 60% 80% 100% time respondents who 28% Physical distancing behaviour practiced physical All the time Most of the time Some of the time Rarely Never distancing were from Variation in physical distancing behaviour by Income Sudurpaschim 25% 33% 25% 8% 9% Bagmati Province. All 21% 32% 28% 13% 6% Province 5 19% 35% 32% 10% 4% • Lower-income groups are less likely to practice Province 2 21% 34% 28% 12% 5% 12+ 24% 32% 26% 13% 6% physical distancing all or Province 1 21% 25% 30% 19% 6% most of the time. This 10 to 12 22% 34% 26% 13% 5%
Karnali 20% 31% 26% 18% 4% could be because they 6 to 9 19% 29% 31% 14% 7% live in high density or Gandaki 30% 36% 21% 11% 2% crowded areas anyway. 1 to 5 18% 31% 27% 15% 8% Bagmati 18% 27% 28% 17% 10% • There is little variation according to education None 21% 32% 30% 12% 6% All the time Most of the time Some of the time Rarely Never status of the head of All the time Most of the time Some of the time Rarely Never Variation in physical distancing behaviour - by province household. Key Reasons Preventing Use of Protective Measures
Major reasons preventing use of protective Variation in reasons by Province Wearing a mask versus risk perception measures
Never 59% 39% Sudurpaschim 27% 20% 21% 42%
Province 5 26% 18% 27% 34% Rarely 61% 38% Province 2 33% 15% 19% 36%
Province 1 23% 17% 16% 54% Some of the time 60% 40%
Karnali 19% 20% 43% 16%
Gandaki 21% 14% 19% 42% Most of the time 51% 49%
Bagmati 28% 17% 30% 32%
0% 20% 40% 60% 80% 100% All the time 48% 52%
Difficulty due to work Lack of infrastructure 0% 20% 40% 60% 80% 100% 120% Other Practising several No difficulty No Yes DKCS • Difficulty practicing protective measures at work. • Difficulty practicing protective measures due to a lack of infrastructure. • Variation by province – with Province 2 respondents likely to cite ‘work’ as a reason. • Behaviour is also linked to the perception of risk – for example, wearing a mask versus the perception of the risk of infection. Response and Sources of Information If respondent felt they had COVID-19 Trusted sources of information (August 2020) Trusted sources of information (July 2020)
Twitter 0% DK 0%
Don’t Know 2% Teachers 1% Others 1%
School Mgmt Comm. 1% School Management Committee 1%
DK 1% Twitter 1% Other 6% Other 1% Local Comm 3% Local comm. 1% Teachers 3% Home remedies 9% Hospital/Clinic 3% Hospitals/Health Centers 5% Newspapers 4% Newspaper 5%
Call helpline 10% Ward/Municip Off. 5% Health Professionals 10% Youtube 7% Ward/Municipality Officers 15% Health Prof. 7% YouTube 18% Isolate at home 28% Online news 12% Online 19% Facebook 19% Mobile Ring Tone 36% Get tested 48% Mobile Ring Tone 20% Faebook 43% Family etc 24% Family, Friends & Neighbors 59% TV 67% Go to clinic or hospital 80% TV 55% Radio Radio 68% 78% • Top three responses in case where respondent THOUGHT that he/she had COVID-19: clinic/hospital, testing and isolation. • Top three trusted source of information: radio, TV and family. • Largely the same order has been observed over the three rounds of the survey – but Facebook, Twitter and YouTube move down the rankings. Mobile ring tones moved up. Credibility and Trust of Information Majority of respondents preferred credible and fact-based information sources. Mother’s groups most likely to be trusted for community action followed by local leaders and women’s groups. 20% also reported not trusting any groups. Note variation by province and income level, and that respondents from Province 2 were most likely to not trust any groups. Lower-income groups also more likely not to trust any groups.
50% 45% Others 3% 40% 35% 30% 25% Religious & Faith based 4% 20% 15% 10% 5%
DKCS 8% 0%
Youth
Others
No one No
Mothers Self Help Self
Youth 14% Womens
Localgovt. Religious/Faith
Self Help 16% 50% Bagmati Gandaki Karnali Province 1 Province 2 Province 5 Sudurpaschim 45% 40% No trust 20% 35% 30% 25% 20% Womens 24% 15% 10% 5% 0% Local govt/Pol. Leaders 26%
Mothers 30%
None <10K 10-20K 20-30K 30-50K 50K+
Reasons for trusting information Groups trusted most for community action Groups most trusted - by province and income source Perceptions on Risk and Dangers of Infection 48% of respondents felt they were at risk of infection – with respondents from Province 2 and Bagmati feeling more at risk. 84% felt that infection would be dangerous for their families. Income also has an effect, with upper-income groups more likely to perceive infection as posing danger to their families. The perceived risk of infection tends to increase with family size. All 52% 48% Not Don’t Know Somewhat Perceived risk of infection & HH dangerous 0% Dangerous Sudurpaschim 59% 41% 7% 9 Size 43% 57% 10% Province 5 58% 41% 8 49% 50%
Province 2 31% 69% 7 52% 47%
Province 1 58% 42% 6 51% 48% Very Karnali 61% 38%
Dangerous HHSize 5 52% 47% 52% Gandaki 59% 39% 4 52% 48% Dangerous 31% Bagmati 47% 52% 3 55% 44%
0% 20% 40% 60% 80% 100% 2 58% 41%
No Yes DK 12% 6% Yes No DKCS 54% 55% 13% 52% 6% 7% 7% 8% 11% 8% 30% 48% 8% 46% 9% 10% 10% 12% 44% 15% 32% 28% 30% 35% 35% 38% 35%
62% 57% 44% 53% 47% 47% 40% 42%
No Yes None <10K 10-20K 20-30K 30-50K 50K+ 30-50K None <10K 10-20K 50K+ 20-30K Very Dangerous Dangerous Slightly dangerous Very Dangerous Dangerous Slightly dangerous No danger DKCS No danger DKCS Percentage feeling at risk of infection Perception of danger posed to family Perceptions of risk of infection and - by province and income group - by income group dangers posed to family Overview of Key Findings
Livelihood/Job Migration Additional Cash Immediate Nutrition Nutrition COVID-19 Losses Transfers Household 19% struggling 96% of children under Infection 4.5% of to feed daily. Context of tight households 92% of Needs 2 years old are response 26% of children breastfed. labour markets. reported returnees, respondents would Top four needs: Top 3 intended experienced 16% of mothers Only 2% of mostly from like to receive an financial actions: changes in reduced the number respondents could Sudurpaschim & additional 450 support, Hospital/Clinic dietary intake. of meals. 78% are find jobs. 51% of Karnali. NPR cash, with children’s (80%), 10% reported breastfeeding with families reported bank or money education, food, Testing (48%), 8% of returnees children under same frequency. earnings or transfers the employment. Isolation (28%). livelihood losses. experienced preferred payment 2 years old 17% felt child is ‘stigma’. method. eating less. becoming too thin.
Health WASH Education Education Protection Protection 18% of 16% had 82% of 6% of respondents Top three COVID-19 Knowledge respondents 22% of students difficulty children witnessed violence problems faced 93% of respondents reported are not studying buying soap. receive help against children and/or by adolescents: know that physical children under (+5% since July). while women limited access distancing can prevent 2 years old 11% could not Self-learning studying. (3% W, 1% C, 2% B). to education, transmission. with a fever. buy masks. packages were Average 2% reported child lack of interest 61% know that it can 25% had most used Income and minutes per labour. in education, spread through contact difficulty in materials for supply day studying 3.5% are separated lack of access with an infected person. accessing constraints. study then the = 130. from their children. to friends. treatment. internet and last year's textbooks. COVID-19 Risk of Infection & Sources Behaviour Health 48% of respondents felt at risk of Physical distancing hardest to 72 babies were born since July (1.1% of infection. follow (21%). Handwashing households): 91% delivered in health facility, Over 80% felt that their infection would practiced by 55% and wearing a clinic or hospital. Six delivered at home. pose a danger to their household. mask by 40%.