Report on Achievement of Mid-Decade Goals in Oman Paul
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' . Towards the Year 2000 Goals of the World Summit for Children: Report on achievement of mid-decade goals in Oman Paul Milligan October 1996 For further information contact: Company Co-ordinator Liverpool Associates in Tropical Health Limited Liverpool School of Tropical Medicine Pembroke Place Liverpool L3 5QA, U.K. Tel: +44 (0)151 708 9359 direct +44 (0)151 708 9393 ext 2259 Fax: +44 (0)151 707 1766 e-mail: [email protected] Towards the Year 2000 Goals of the World Summit for Children: Report on achievement of mid-decade goals in Oman P Milligan Liverpool School of Tropical Medicine June 1996 1. Executive Summary 3 2. Sampling design 5 2.1. The Gulf Family Health Sunrey 5 3. Questionnaire 5 4. Description offield work etc. 6 4.1. Pilot sunrey: 6 4.2. Main sunrey: 6 4.3. Sampling frame: 7 4.4. Coding and checking 7 4.5. Quality control 7 4.6. Data entry procedures: 8 5. Extraction of data for mid-decade indicators: 8 6. Indicators for mid-decade goals 9 7. 1995 Mid-Decade Goals: 12 7.1. Goal1: Elevation of immunization coverage of six antigens of the Expanded Programme on Immunization to 80% or more. 12 7.2. Goa12: Elimination of neonatal tetanus. 13 7.3. Goa13: Reduction of the number of measles deaths by 95%, and of the number of measles cases by 90%, compared with pre-immunization levels. 15 7 .4. Goal 4: Elimination of polio. 15 7.5. GoalS: Virtual elimination ofvitamin A deficiency: at least 80% of all children under 24 months of age in areas with vitamin A deficiency receive adequate vitamin A. 16 7.6. Goa16: Universal iodization ofsalt. __________________ 16 7.6. I. Survey methodology: 16 1 7.6.2. Survey results: __________________________17 7.7. Goal7: 80% usage ofORT (increased fluids) and continued feeding in diarrhoea._18 7.8. GoalS: Ending and preventing free and low-cost supplies of breast milk substitutes in all hospitals and maternity facilities. Have target hospitals and maternity facilities achieve 'baby friendly' status in accordance with BFHI global criteria. 19 7.8.1. Musaiger's results: 21 7.9. Goal 9: Interrupt dracunculiasis transmission. ______________ 21 7.10. Goa110: Ratification of the Convention on the Rights of the Child. 21 7 .11. Goalll: Reduction of1990 levels of severe and moderate malnutrition by 115 or more ___________________________________________________________ 22 7 .11.1. Results for 1-yr-olds from recent surveys: -------:-------------~28 7 .11.2. 198911990 Oman Child Health Survey follow-up study: 29 7.11.3. Health and nutritional status ofOmani Families survey 1991 (Musaiger, 1992). 29 7 .11.4. National Study on the Prevalence of Vitamin A Deficiency, 199415: 30 7.1 1.5. MOH Annual Statistical Report for 1994: 30 7.12. Goal12: Strengthen Basic Education: 31 7.12.1. Education indicator: Girls 33 7.12.2. Education indicators: Boys 35 7.12.3. Education indicators: Boys and Girls: 36 7 .12.4. Estimates of education indicators from 1993 Census: 3 7 7.13. Goa113: Increase water supply and sanitation: ________________________ 38 7.13.1. Water: ____________________________38 7.13 .2.Sanitation: 42 7.14. Goal14: Strengthening health facilities' capability for case management of pneumonia. ------------------------------43 8. Recommendations 43 9. References ---------------------------44 I 0. Acknowledgements 44 Appendix 1: Sample Designfor GulfFamily Health Survey in Oman 45 Appendix 2: 2-stage cluster sampling plan ofthe GulfFamily Health Survey ofOman. 48 Appendix 3: Mid-Decade Goals Table 55 Appendix 4: Acronyms and Abbreviations 59 Maps following page Map of Regions of Oman 2 MOH Primary Health Care through Wilayat Health Services 2 Population distribution (Omani and non-Omani) 2 Number ofOmani children under 5 yrs 2 Number ofnon-Omani children under 5 yrs 2 % households using iodised salt 17 Weight for age malnutrition, under Syr olds 24 Households with safe and convenient water supply (by region) 40 Households with safe and convenient water supply (by Wilayat) 40 2 • Musandam rm~m~ A'Dhahirah D N AI Batinah D S AI Botinah • Muscat ~ A'Dokliyah • S A'Shorqiyah m N A'Sharqiyoh D AI Wusta • Dhofar I Ministry of Health Primary Health Care through Wi/ayat Health Services 1 GULF OF OMAN SAUDI ARABIA ARABIAN SEA • •• • YEMEN • Hospital • Exhc • He I i, d AL DAKHLIYAH ~ ~~it l AL DHAHIRAH I ,,; j AL WUSTA r. DHOFAR l .ci\J~r!i d MUSANDAM 1*11 MUSCAT l t'$1;~' 1 NORTH BATINAH IA>i6~ 1 NORTH SHARQIYA CJ SOUTH BATINAH [Z] SOUTH SHARQIYA Population distribution (Omani and non-Omani),. 1993 (1 dot = 2000 people) ~·)~ .'· / ·\ Number of Omani children under Syrs 1993 No under 5's i I < 1 5ooo [. ...·:::><.·] 1 5000-30000 k::.::~:.::j 30000-45000 ~ 45000-60000 • 60000-90000 Number of non-Omani children under Syrs 1993 No under 5's D <1000 [2] 1000 2000 ~. 2000 3000 ~ 3000 to 4000 • 4000 to 15000 1. Executive Summary In 1990 at the World Summit for Children, heads of state pledged themselves to a Declaration and Plan of Action for Children. Countries around the world proceeded to develop their own National Programmes for Action for Children. The Government of Oman began preparing a National Programme for Action in November 1992. Working groups were established to prepare National Programmes of Action for health and nutrition, education, social services and childhood disability. In 1992 and 1993 UNICEF held a series of regional consultations at which consensus was reached about a set of goals that could be achieved by mid-decade, 1995 (see Appendix 3), as stepping-stones to the goals for the year 2000. The Gulf Family Health Survey (GFHS) was planned and executed in all GCC countries for nationals and was supported in Oman by the Government of Oman, Executive Board of the Council of Health Ministers of GCC States, Arab Gulf Programme for the United Nations Development Organizations (AGFUND), United Nations Population Fund (UNFPA), United Nations Children's Fund (UNICEF) and World Health Organization (WHO). It is a national survey of Omani families with emphasis on women of child bearing age and children under 5yrs in 6250 households selected to be representative of the whole Omani population. The scope of the GFHS was only Omani households; non Omani households were excluded. Nine per cent of children under 5 in Oman are non Omani, but we are unable to report on this section of the community. The GFHS was planned as a four-year follow-up to the Gulf Child Health Survey, 1988/89 and was designed to provide planners and policy makers with a reliable information base to formulate family health and development policies and programmes in Bahrain, Oman, United Arab Emirates (survey activities started in 1995), Kuwait, Saudi Arabia and Qatar (survey work to start in 1996). In Oman, the GFHS consisted of 4 questionnaires: family health, household living conditions, reproductive health and child health. To compile this report on Mid-Decade Goals, data was extracted from the GFHS of Oman which was conducted from September to December 1995, and from a household salt survey conducted in 1995/96, in order to assess achievement of mid-decade goals in the country. The GFHS questionnaire was updated to include the questions from Multiple Indicator Cluster Survey handbook and appropriate coding was provided for it. The data extraction and compilation of report from GFHS was done by the Liverpool School of Hygiene and Tropical Medicine with support from the Ministry of Health and UNICEF. The main results are as follows: Vaccination coverage of 1-yr.-olds for the 6 main antigens (Polio, Diphtheria, Pertussis, Tetanus, Measles, BCG) is 98-99%. 3 . -.; 81% of households have access to convenient water supply generally considered to be safe. Safe water is defined as piped water or water obtained from: an outside tap; a well with a pump; from a tanker or bottled water. Convenient water supply is defined as time up to 30 minutes required to obtain the water. However, there are regional and urban/rural disparities (87% of households have access in urban areas, 70% in rural. Water quality is variable; applying Ministry of Health (MOH) estimates of the proportion of water samples from different sources that were considered fit to drink, based on chemical and bacteriological tests, only 69% of households have access to safe water. In some districts access is much lower than the regional average (see maps). 77% of households have access to safe and convenient sanitation (safe was defined as flush to main sewerage or toilets flushing to a tank; convenient was defined as location of the toilet within the household or outside the house but within the compound), but there are marked regional and urban/rural disparities. In rural areas (settlement population size <2500) the figure is 56% and in urban areas it is as high as 88%. Prevalence of malnutrition is high: 23% of boys and girls under 5yrs are moderately or severely underweight (weight for age), and 23% moderately or severely stunted (height for age). 13% are moderately or severely wasted (weight for height). These estimates are comparable with results from a number of independent surveys. In certain communities the prevalence is much higher than the national average: in Dhakilyah, 32% of under-5's are underweight, 25% stunted, and 23% wasted. The average net enrollment rate (NER: % of primary-school-age children attending school) has risen in recent years, and the gender gap has narrowed. The NER is 93% for both boys and girls. However, many children are not in the correct grade for their age, and there are regional disparities. 35% ofhouseholds use iodized salt. Use of oral rehydration therapy is common, 82% of children with diarrhoea received ORS solution, 89% received increased fluids with continued feeding.