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Mapping of seasonal migrations in the Sanaag region of Somaliland
Authors: David Hadrill and Haroon Yusuf
Shortly after Somaliland declared its independence from Somalia following four years of civil war, ActionAid set up a rehabilitation programme in the Sanaag region. The programme provides basic animal health care to the pastoral communities living in the region whose livelihoods depend upon their livestock. Camel, sheep and goat milk and meat are mostly consumed by the herders and their families, while sheep are frequently sold or exchanged with traders in return for imported wheat, rice and other products.
ActionAid contracted VetAid to design and provide technical support for the programme. The existing rehabilitation programme provides basic veterinary health care training for Primary Veterinary Assistants (PVAs). It also provides drugs, at a subsidised price, to herders who have had their flocks and herds decimated by the war (herders now pay the market price for drugs). PVAs visit the herders and supply them with veterinary drugs and advise them on basic health problems. The PVAs are trained in basic diagnosis, treatment and prevention skills but the majority of medications requested by and prescribed to the herders are used to control internal and external parasites.
The pastoral grazing system
Project staff have been using participatory research methods on an informal basis throughout the course of the development programme. Their main objective was to build up a more detailed picture of the herders' lifestyle, particularly their management of communal resources, animal husbandry practices, and methods of managing disease.
Participatory methods were used during routine meetings with herders rather than as part of a planned, structured appraisal. Much of the information gathered by the project staff was collected using semi-structured, informal interview techniques. Of particular interest, to the team were details of the seasonal migration patterns followed by different groups of pastoralists in the region. These details were mapped and provided a fairly comprehensive picture of seasonal migration patterns in the Sanaag region and the distances covered during the individual migrations.
During the jilal (long, winter dry season), livestock are concentrated around permanent wells. This is the hardest time of year, especially if the preceding dhair rains have failed. Conflicts can break out over access to water during this period. Camels are taken up to seven days' walk from the wells to graze, and watered every two weeks.
The herding boys live only on camels' milk during this time. Women and elderly men look after the sheep and goats up to a day's walk from the wells. As the dry season progresses they are taken further away to graze and camels bring them water. The jilal ends with the gu rain after which herds are moved to grazing lands in places without wells. Livestock can get adequate water from fodder and puddles following showers. As the hagar (summer) progresses the grass becomes dry and fibrous and livestock are moved to grazing near permanent wells. The dhair rains fall at the end of the summer. If they are good the herds are taken back to the wet season grazing grounds.
Migrations in the Sanaag region
The Isaaq and Darod clans inhabit the west and east of the Sanaag region respectively. They maintain a natural buffer zone between them over which neither clan claims to have definitive overall grazing rights. During the civil war, there was a great deal of conflict between the Isaaq and Darod clans in the Sanaag region. But in peace-time, there is greater flexibility of movement and the clans enter into each other's territory, subject to prior agreements.
Interviews with herders indicate that the distances travelled by Sanaag herders and their flocks are relatively short. Typically, the limits of their migration may be around 80km apart. Project staff were surprised to find that the migration patterns are not seasonal movements to and from the same grazing grounds annually, as they had previously believed. Instead, herders are opportunistic and move their animals according to the prevailing rainfall and quality of the pasture. The extent of change in pastoral grazing strategies during the civil war years is not clear. Herders apparently continued with their traditional seasonal migration patterns. In some instances, access rights to grazing lands may have changed hands between clans and sub-clans depending on the outcome of local battles. However, in general, herders continued to migrate with the rains or pasture.
Mapping pastoral movements
One herder, Warasame Hirsi, described herders' general movements and then recalled where his own rer (flock) had been in the recent past. His stock stay near Erigavo, to the east. Their movements are recorded in Figure 1. He was asked questions such as "Where were your animals last season? Where were they the season before that?" and so on. These prompted him to describe his flocks' general movements which are summarised in Table 1.
This table illustrates how the seasonal movements of camels differ from those of the sheep and goats.
Jama Ashkir then recalled the places his rer (flock) had been during the last three years. In peaceful times 10-15 families of the same subclan would move together. However, now about 50 Isaaq families may move together for security. For example, they all moved to Sool Giriyo earlier this year when there was tension between Isaaq and Darod clans. However, when they moved to Kabid recently only three families moved together. The details of where the rer moved are summarised in Table 2, and also illustrated in Figure 2.
Figure 1. Mapping pastoral movements: Warsame Hirsi's Rer (Flock)
The maps indicate that Jama and Warsame move stock to the territories of their Diya paying group. Information about seasonal migration patterns confirmed that herders are likely to be in a certain area during a particular season of the year. This knowledge assisted with the planning of drug distribution, making it compatible with the herders' needs and seasonal location. Informal interviews were always attended by clan chiefs and community leaders and were carried out through an interpreter. More often than not the quality of information collected depended upon the individual characters of the chiefs and leaders. The most successful informal interviews often took place when a member of the project staff was called by the herders to treat an animal and took the opportunity to make a few inquiries about their livelihoods.
The team also endeavoured to draw maps, calendars and use visual aids. If nothing else, they provided a talking point and helped to stimulate a discussion. The strict Muslim culture made it necessary for an exclusively male team of researchers to conduct the informal interviews and mapping exercises. However, this made it virtually impossible for discussions to take place with the women in the communities. The team were aware of the gender bias and consequently appointed a woman to try to redress the balance.
Figure 2. Mapping pastoral movements: migration of Jama Ashkir's Flock over the past three years
Indigenous knowledge
During informal interviews herders gave information on the different celestial observations used to divide their year into seasons. Researchers also learned details of the indigenous system of classifying the characteristics of rainfall, drought periods, plant species, soils, and livestock diseases and their traditional treatments.
The herders' calendar
An appreciation of the herders' calendar is important in the planning phase of any development project. An understanding of the calendar can help explain why herders plan their movements and grazing patterns. The names given to the different seasons are often linked to meteorological factors. The herders divide their year into two seasons, each of 180 days. The first 180 days are called biyo daalalo and are divided into nine periods of 20 days. This season coincides with the dhair (autumn rain) and jilaal (dry winter). The second 180 days are called diriir and are divided into six periods of 28 days. These coincide with the gu (spring rain) season and the following hagar (hot, windy summer). Table 3 lists the names of each of the periods within the Biyo daalalo and Diriir seasons.
View the source document here
Source: RRA Notes (1994), Issue 20, pp.106–112, IIED London
PLA Notes CD-ROM 1988–2001


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There have been talks about four new movies, an animated film, and an animated series produced with Netflix and Nelvana. One of the films was being filmed in El Kadsre, with support from El Kadsre Government's Motion Picture & Television Commission Department.
Due to the cancellation of the four movies and the animated film, the company was closed down on January 30, 2019, and assets were transferred to Qualis Entertainment.
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"Gizmo Richards" at website Tech Support Alert has a list of the 46 best ever free software utilities for windows. The list is very comprehensive and covers basically any piece of software you might be hunting for. The reason I like this list the most is because it is regularly updated and if "Gizmo" finds a piece of software that he thinks is better he will replace it. He has given me a ton of good recommendations for software that I now use regularly.
The 46 best-ever freeware utilities14 08 2007
Comments : Leave a Comment »
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- ONGC CSR Grant, Deadline: 2030-12-31
- Google Grants for NGOs, Deadline: 2022-08-25
- Apply for Grants-ANANDANA- The Coca-Cola India Foundation, Deadline: 2022-05-30
- DBT-European Commission H2020 call (2017-18), Deadline: 2020-12-31
- Global Fund for Women accepting new applications from Women-led NGOs + other opportunities for Women, Deadline: 2020-12-30
List of NGO in Ambad
Here is the list of total 23 NGOs working in Ambad for various social welfare activities.
Showing 0 - 12 of 23 result(s) found.
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Parent University coming to Hillsborough Schools | Events
Hillsborough County, Florida-- Parents with kids enrolled in Hillsborough County public schools have a chance to attend a course of their own this weekend.
According to the public schools superintendent, parents are invited to attend a series of informational sessions designed to support the academic life of children, called Parent University.
It's scheduled for this Saturday, March 2, from 8 a.m. to noon at Chamberlain High School, 9401 N. Boulevard, Tampa.
Here is more information from the superintendent:
This inaugural event will offer sessions focused on academic and support programs in Hillsborough County Public Schools, effective strategies families can use to help every child succeed, and ways to advocate for the resources necessary for our public schools.
School district representatives, along with district community-based partners, will conduct sessions on navigating the education system, student learning, leadership/advocacy, and family health/wellness.
Lunch will be available for all attendees and childcare will be provided by HOST (the Hillsborough Out of School Time program) for those families with children in kindergarten through grade 5.
Parent University is a collaboration of the United Way Suncoast, Hillsborough County Council PTA/PTSA, Alliance for Public Schools, and Hillsborough County Public Schools.
You can register either online at HillsboroughParentU.org or by calling 813-272-4499.


text: I just saw my roster for this year, and while 21 kiddos isn't too bad, I seem to have been given the worst kid in school (not kidding). This little guy (last year in K) liked to scream, hit, kick, bite, spit, curse, etc., at EVERYONE, including our ex-military principal! I'll take any and all suggestions! I'm planning to use the "ready to learn' clip chart for conduct this year, and am really working on providing LOTS of positive reinforcement, but this kid was really a piece of work last year. I know his home life must be absolutely horrible (no one ever came to school for any conferences or anything, not even kindergarten graduation), but how am I gonna (a)turn him around and/or (b)do the rest of the kids justice when I have to deal with him?? (Of course, if he's had a miraculous change over the summer, then this post is moot.)


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Channeled Message
You create within your life through your dreams and intention. Therefore, I invite you to take a moment to breathe deeply into your heart center and align with your creative essence as you flow the love from your divinity into your thoughts:
Without looking through your divinity, have a sense of just going within your consciousness, breathing within yourself and now have a sense of looking down, we'll say 1 year, 5 years, 10 years, and just asked to know what information is in your best interest to become conscious of it this time.
If things are unclear to you then take a moment and as if you are just washing in the energy of your divinity let it wash over you, clearing out where you might get stuck in your head so that you may be fully present in the moment, so that you may be here and now in this vibration.


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By the numbers
2 -- Times Notre Dame freshman Troy Murphy has scored at least 30 points in a Big East game, more than any other freshman in league history.
5 -- Pac-10 games that have ended on game-winning shots this season.
9 -- Seasons between Oregon State's last win over UCLA and its one last week.
11 -- Thirty-point games in the career of Connecticut All-American Richard Hamilton, who missed No. 12 by a point in Tuesday night's 101-70 win over Notre Dame.
20 -- Consecutive games Stanford coach Mike Montgomery has started the same lineup.
41-- The age of Rutgers coach Kevin Bannon, who recently became the youngest Division I coach to win 300 games.
214 -- Interview requests since the regular season began for Rhode Island forward Lamar Odom. According to sports information director Mike Ballweg, Odom has obliged about half.
Teams on the way up
Louisville: The Cardinals have won seven of their past eight games (9-3 overall) and quieted whispers about the possible end of Denny Crum's 28-year reign.
Texas: After a 2-7 start in which the Longhorns lost their first four games under first-year coach Rick Barnes, Texas has gotten strong play from Kris Clack en route to winning five straight and six of seven.
Teams on the way down:
Clemson: Barnes' former team has lost three of its four ACC games, including its last two to Wake Forest and Florida State, to fall to 12-5.
Illinois: There is not much fight in the Illini these days, with the team 0-4 in the Big Ten heading into tomorrow's home game against Michigan State.
Pub Date: 1/15/99


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Twitter earlier this week introduced the ability to schedule tweets from its web application. This feature was previously required by using other tools such as Tweetdeck and Buffer.
Twitter has made this possible only in its web application. The Twitter mobile application on Android and iOS does not yet have this feature. There are no words when Twitter plans to launch it. Twitter has already begun testing scheduling tweets Last November.
For better monitoring of Tweetdeck social media, Social Buffer and Sprout are still recommended. But if you only need to schedule a tweet then doing it from the Twitter web application is enough. And this is how you can do it.
-Open the compose tweet box and type your tweet.
-Once done, tap the calendar with the timer icon.
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Tweets that you schedule from the web application will also appear on Tweetdeck. If not, you can also check scheduled tweets from the "Scheduled Tweets" tab below.
Indonesia also introduces concepts for web applications available on mobile applications. Now whenever you leave the compose box without posting a tweet, you will be asked to save the tweet later. You can also check tweets that have not been sent and send them later whenever needed.


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General Comments: Cotton was higher yesterday and made new highs for the move. The weekly charts still show bullish trends and ideas are that further price gains are coming. A catalyst for the rally has been the trade deal between the US and China. China has also been buying Cotton from the US and Brazil as it needs higher quality Cotton to blend with its domestic production. It will probably resume buying once the new trade deal is signed on January 15. USDA showed the production problems in its annual update and held demand strong. The report was considered bullish for futures. World data also showed reduced ending stocks and the world report was also considered bullish.
Overnight News: The Delta and Southeast should see frequent periods of precipitation through this weekend. Temperatures should be mostly above normal. Texas will have mostly dry conditions except for some rain on Thursday. Temperatures will average above normal. The USDA average price is now 67.07 ct/lb. ICE said that certified stocks are now 6,824 bales, from 8,824 bales yesterday.
Chart Trends: Trends in Cotton are up with objectives of 7150 and 7240 March. Support is at 7080, 7020, and 7000 March, with resistance of 7330, 7440, and 7500 March.
General Comments: FCOJ was lower. Overall chart patterns suggest that more price weakness is coming. Good growing conditions and increased oranges production estimates by USDA this season have been bearish. The weather has been great for the trees as there have been frequent periods of showers and no severe storms this year. Many areas have been dry lately and harvest is expanding. Crop yields and quality should be high for Florida this year. Inventories of FCOJ in the state are high and are more than 36% above last year.
Overnight News: Florida should get mostly dry conditions. Temperatures will average near to above normal. Brazil should get dry conditions through the weekend and near to above normal temperatures. ICE said that 0 notices were posted for delivery against January contracts and that total deliveries for the month are now 0 contracts.
Chart Trends: Trends in FCOJ are down with objectives of 95.00 March. Support is at 95.00, 92.00, and 89.00 March, with resistance at 98.00, 99.00, and 100.00 March.
General Comments: Futures were lower on news that a group of analysts contacted by Bloomberg had estimated Brazil production at almost 65 million bags. It was an enormous amount of Coffee and an amount that would refill coffers and allow for ample exports at the same time. The analysts cited good weather for the prediction. The weekly charts suggest that further price weakness is possible. Rains were reported in Brazil Coffee areas. The Brazilian crop is developing well but some exporters are out of previous crop supplies to sell. It is dry in other parts of Latin America. Central America has had less than normal rains, especially in Honduras. Peru is also too dry right now. The Asian harvest is underway but producers do not seem to be selling on ideas that prices are too low. Vietnam exports remain behind a year ago, but the market anticipates bigger offers with the Tet holiday drawing nearby. Vietnamese crops are expected to be big despite uneven growing conditions earlier in the year.
Overnight News: ICE certified stocks are higher today at 2.068 million bags. The ICO daily average price is now 110.56 ct/lb. Brazil will get showers this week and drier weather this weekend with near to above normal temperatures. Vietnam will see mostly dry conditions.
Chart Trends: Trends in New York are down with objectives of 105.00 and 100.00 March. Support is at 113.00, 110.00, and 106.00 March, and resistance is at 120.00, 123.00 and 125.00 March. Trends in London are down with objectives of 1310, 1280, and 1260 March. Support is at 1310, 1290, and 1270 March, and resistance is at 1370, 1390, and 1410 March.
General Comments: The markets closed higher on ides of less Asian production. Reports indicate that little is on offer from India. Thailand might also have less this year due to reduced planted area and erratic rains during the monsoon season. There is still more than enough Sugar for any demand and that India will have to sell sooner or later. Reports from India indicate that the country is seeing relatively good growing conditions and still holds large inventories from last year. However, these supplies are apparently not moving and this could be due to less government subsidy for mills and exporters. Thailand also has short crops from reduced planted area this year. Reports of improving weather in Brazil imply good crops there, but most of the cane is being used to produce ethanol. More rallies in Sugar prices are needed for the mills to switch back to producing Sugar for export.
Overnight News: Brazil will get scattered showers this week and drier weather this weekend. Temperatures should be near to above normal.
Chart Trends: Trends in New York are up with objectives of 1440 and 1450 March. Support is at 1370, 1340, and 1320 March, and resistance is at 1420, 1440, and 1460 March. Trends in London are up with no objectives. Support is at 376.00, 365.00, and 362.00 March, and resistance is at 386.00, 388.00, and 391.00 March.
DJ Brazil Center-South Sugar, Ethanol Output Drop as Harvest, Production Season Approaches End
By Jeffrey T. Lewis
SAO PAULO–Brazilian sugar mills in the country's center-south region crushed less cane in the second half of December compared with a year earlier, according to industry group Unica.
Center-south mills crushed 734,000 metric tons of cane in the period, a decline of 71.2% from the same period a year earlier. They produced 13,000 tons of sugar, down 82.4%, and made 137 million liters of ethanol, a decrease of 35.7%.
Brazil is the world's biggest sugar producer and exporter, and the center-south grows about 90% of the country's cane. The harvest and production season is coming to an end, with only 31 mills still operating and producing ethanol, compared with 253 mills that had already closed down, according to Unica.
The production mix for the second half of December month was 14.4% sugar to 85.6% ethanol. A year earlier, the mix was 21.4% sugar and 78.6% ethanol.
In the season from April 1 through Jan. 1, mills in the region crushed 578.6 million tons of cane, up 2.9% from the same period a year earlier. Sugar production rose 0.5% to 26.5 million tons, and ethanol output rose 6.5% to 32.1 billion liters.
The production mix for the season through Jan. 1 was 34.5% sugar to 65.5% ethanol. A year earlier, the mix was 35.5% sugar and 64.5% ethanol.
General Comments: Futures closed higher in both markets. Funds and other speculators were the best buyers. Harvest is now active in West Africa and reports are that good volumes and quality are expected. Ivory Coast said that arrivals are now 1.26 million tons, up 1.9% from last year. Ideas are that demand is currently very strong due to the current price action. The reports from West Africa imply that a big harvest is possible in the region. Ivory Coast arrivals are strong and are above year ago levels. The weather in Ivory Coast is good. The precipitation is a little less now so there are no real concerns about disease. Ideas are that the next crop will be very good.
Overnight News: Scattered showers and storms are expected in southern sections of West Africa. Temperatures will be on both sides of normal. Malaysia and Indonesia should see showers. Temperatures should average above normal. Brazil will get mostly dry conditions and near to above normal temperatures. ICE certified stocks are lower today at 2.794 million bags.
Chart Trends: Trends in New York are up with objectives of 2670 and 2780 March. Support is at 2530, 2500, and 2470 March, with resistance at 2610, 2650, and 2670 March. Trends in London are up with objectives of 1900 and 1970 March. Support is at 1860, 1830, and 1810 March, with resistance at 1910, 1930, and 1950 March.


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In 2008, Comcast notified the City of Highland Park that it would be ceasing operation of its local public access studio on December 31, 2009. Recognizing that the Highland Park community has a long tradition of utilizing and supporting public access television, the City of Highland Park worked cooperatively with Comcast and neighboring communities to preserve public access television and assumed responsibility of the previous Comcast studio. The City worked with Comcast to relocate Comcast's studio to the lower level of the Highland Park Police Station Headquarters ("Headquarters"). Additionally, the City entered into intergovernmental agreements with the Village of Deerfield and Village of Winnetka, thereby making this resource accessible to the three communities. On February 1, 2010, the Highland Park Public Access Television Center ("Center") reopened for video production, editing and playback.
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Frustum of a cone
A reservoir contains 28.54 m3 of water when completely full. The diameter of the upper base is 3.5 m while at the lower base is 2.5 m. Determine the height if the reservoir is in the form of a frustum of a right circular cone.
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From the daily archives: Thursday, December 21, 2006
Best of Wishes to Staff!
On December 21, 2006 By Jerid
Our friend over at the Buckeye State Blog announced this evening his retirement from the blogosphere.
Present Plundercrew (Jerid, Joe and Brian), along with Plundermonkey alumni (Eric) want to wish Russell all the best in his new endeavor with Ohio Treasurer Richard Cordray. The blogosphere is losing one of it's best today, but the state of Ohio is gaining a tremendous asset. Stop by BSB and give Mr. Hughlock a warm sendoff in the comments.
All the best Russell!Full Story... →
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Metta Earth Institute is an educational retreat center integrating contemplative practice, deep ecology, regenerative food systems, and social activism to create resilient community.
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Social and environmental determinants of child health in Mongolia across years of rapid economic growth: 2000-2010
International Journal for Equity in Health volume 16, Article number: 189 (2017)
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- The Correction to this article has been published in International Journal for Equity in Health 2018 17:35
To understand the effect of economic growth on health, we investigated the trend in socio-economic and regional determinants of child health in Mongolia. This Central Asian country had the fastest economic growth amongst low and middle-income countries (LMICs) from 2000 to 2010 and a healthcare system in transition.
Data was from Mongolian multiple indicator cluster surveys (MICS) in 2000, 2005 and 2010. Child nutrition/growth was measured by height-for-age z-score (HAZ), weight-for-age z-score (WAZ), prevalence of stunted (HAZ < −2) and underweight (WAZ < −2) children. Access to health care was measured by prevalence of fully immunised children <5 years. Multivariate multi-level logistic mixed modelling was used to estimate the effect of socio-economic and environmental health determinants on each outcome in each year; 2000, 2005 and 2010. T-tests were used to measure significant change in HAZ and WAZ over the decade.
Overall, from 2000 to 2010, there was a significant improvement (p < 0.001) in all three outcomes, but the effect of socio-economic factors increased on both stunting and weight. In 2000, region was a significant determinant: children living in three provinces were significantly more likely to be stunted and less likely to be immunised than Ulaanbaatar, but this was not significant by 2010. By 2010, none of the factors were significant determinants of immunisation in children. In 2000, economic status had no effect on stunting (OR = 0.91; 95%CI:0.49,1.66), however by 2010, children in the poorest economic quintile were 4 times more likely to be stunted than the richest (OR = 0.24; 95% CI:0.13,0.45; p < 0.001). The effect of maternal education on stunting prevalence continued over the 10 years, in both 2000 and 2010 children were twice as likely to be stunted if their mother had no education compared to university education (2000 OR = 0.45; 95% CI:0.28,0.73, p < 0.01,2010 OR =0.55; 95% CI:0.35,0.87, p < 0.05).
Economic growth in Mongolia from 2000 to 2010 resulted in an increase in the effect of social determinants of child health; whilst focused policy improved access to immunisation. Children with less educated mothers and lower household incomes should be targeted in interventions to reduce health inequity.
Absolute poverty has long been highlighted as the enemy to adequate health across the world, however as the numbers living in poverty decrease [1], a new challenge to health is emerging; economic and educational inequality [2]. Unequal income distribution has a detrimental effect on health indicators even after adjusting for total income [3]. Evidence suggests that economic growth can exacerbate health inequities in LMICs [4] and as hugely populated countries, such as India and Nigeria, emerge from their low-income status, the suffering of the poor millions worsen [5,6,7,8]. For example, in India in 2005–06 infant mortality rate (IMR) among the poorest and richest wealth quintiles was 82 and 34 per 1000 births, respectively [8]. Similarly, in Nigeria in 2008, IMR was 87 and 219 per 1000 births in these groups [7]. Tackling inequality is also paramount in the fight to improve health throughout the world [6]. Interventions to improve health in vulnerable populations in LMICs have been proven to be more cost effective than mainstream approaches [9]. Analysis of the determinants of health and inequalities is important to identify vulnerable groups and to design and implement effective, targeted interventions policies to reduce health inequities [9,10,11].
There is scanty data from Central Asia and Eastern Europe on health inequalities where their historic socialist socio-political and economic policies still influence current policies. Mongolia is one such middle-income country that underwent the world's fastest economic growth in the 2000s with foreign investment in the growth of its mining industry and it is predicted to continue growing, with Citigroup naming Mongolia as one of the 11 countries with most promising growth from 2010 to 2050 [12]. Trends for the Gini coefficient over the decade show an increase from 0.33 to 0.37, whereas the poverty rate remained static at 35% [12]. This shows that those who are already wealthier, benefit more from the economic growth, without reducing the overall poverty level. It is of interest to investigate how healthcare distribution changed in Mongolia, as an example of this region, where several countries are undergoing economic growth.
We chose indicators for child health and healthcare access during the period of economic growth. Birth to five-years of age carries a high chance of mortality and morbidity, and therefore indicators for this age group provide a measure of health inequities [13]. Furthermore, inequalities in this age group are significant because poor childhood health and development have detrimental implications on adult health, thus increasing population's future health inequities [14]. Health Indicators, such as growth/nutrition and healthcare access, affect childhood morbidity and mortality; many socioeconomic and environmental factors such as maternal education, income and access to clean water have been shown to influence them [13, 15,16,17,18,19,20].
Therefore, this study used national representative data from Mongolian multiple indicator cluster surveys (MICS) to investigate the role of socioeconomic and environmental factors in child health, specifically growth and immunisation) during the period of economic growth 2000-2010.
Mongolia has much in common with the other Central Asian countries where in spite of low-middle income country status, education level is high with over 94% of males and females attend primary school [21]. Socio-political transition from a socialist system has led to huge changes since the 1990s in these countries.
In Mongolia, parallel to most other such countries, the changes led to a new health insurance funded system where the client requires a health insurance book to access healthcare with co-payments of varying levels depending on the service: 10% at the secondary care and 15% for tertiary care and outpatient drugs [22]. This replaced the socialist (Semashko) system in 1994, which provided universal health coverage free of charge. The new system has produced inequalities in healthcare access for adults and children, because the poor, especially the city migrants from the rural areas, are less likely to be registered with the city authorities to receive healthcare; the percentage of the population with health insurance decreased from 95.3% in 2000 to 82.6% in 2010 [23]. This results in them having to make out-of pocket (OPP) payments for healthcare, estimates for OPP rose sharply during the decade from 14.5% in 2000 to 41.4% in 2010 [12]. Policy included introduction of primary health care centres in urban areas from 2002 as part of a decentralised approach to managing healthcare; patients without health insurance could not access primary or secondary services without paying a fee [12].
Child health indicators collected in surveys, which encompass this unregistered population, demonstrate the reality of the situation [24]. Additionally, in Mongolia and numerous Central Asian countries, the nomadic lifestyle creates unique challenges to providing health care to the mobile population [25]. Mining and extreme weather have changed migration patterns and the health service needs to adapt to meet the needs of the growing urban [23] as well as difficult to access population.
Data sources
This analysis uses the MICS data from 2000, 2005 and 2010. The methods for data collection are designed by UNICEF to produce comparable statistics within and between LMICs [26, 27]. The sample sizes and distribution are displayed in Table 1.
All indicators of child health used in this analysis are defined in Table 2. Growth was measured by both continuous (HAZ and WAZ) and categorical variables (stunted/non stunted and underweight/non-underweight status of children) [28]. Stunting is more important than underweight for measuring inequities [29] as it develops over a longer term and is a better indicator of nonacute factors affecting growth. Immunisation coverage has been used as an indicator of access to healthcare in previous studies exploring health inequity in Africa [30]. Immunisation in Mongolia was implemented through the Extended Programme for Immunisation (EPI) which was introduced in 1994 when the socialist regime ended. This programme was supported by GAVI (Gobal alliance for vaccines and immunsaitons) from 2001 with both financial and technical support [12]. Immunisations are provided by the primary health centres in the urban areas and by the district hospitals in rural areas. Parents are informed about necessary immunisations at child birth, most of which are in institutions in Mongolia. [31]
Independent factors based upon evidence and available data were distributed across three levels; individual, household and community (Table 3). Economic status was measured by the wealth index, which was calculated by principal component analysis using housing type and materials, availability of electricity and household assets [32]. The households were divided into five wealth quintiles when data was collected through the MICS survey. Therefore, there are different numbers of children in each quintile through the years, depending on the percentage of children living in households within each quintile.
Statistical analysis
MICS data have a hierarchical sample selection methodology, [26] [27] with children nested within households and households nested within communities. Observations, e.g. immunisation coverage, from those living in the same area are likely to be correlated because they share characteristics e.g. a local health clinic. Consequently, the standard assumption of the independence of observations in conventional regression models is violated and the model must be adjusted for the clustering of the data. [33] As a result, logistic regression models fitted for the categorical variables were adjusted for clustering using the generalised linear mixed model procedure [34]. The determining factors were all entered separately first (results not shown) and then variables found to be significant were entered into a multivariate model (Table 5) in order to calculate odds ratios for each independent variable. Because HAZ and WAZ were normally distributed, t-tests were used to test for significant change over time. The comparison across the years was carried out for each independent factor i.e. sex, age groups etc.
Regarding missing data, 4.8%, 5.8% and 6.0% of growth indicator data was missing for 2000,2005 and 2010 respectively, but no data on immunisations was missing. The distribution of the independent variables (age, sex, household wealth index etc) for those who had missing growth indicators was not significantly different from the rest of the sample.
Health status measured through nutritional/growth indicators
HAZ and prevalence of stunted children
The mean HAZ score for Mongolian children fluctuated from 2000 to 2010 as the values improved from −1.12(SD1.53) in 2000 to −0.48(SD2.85) in 2005 but then declined slightly to −0.72(SD 1.39) in 2010(Table 4). This change was statistically significant (p < 0.001) from both 2000 to 2005, and 2005 to 2010 (Table 4). In contrast, the prevalence of stunted children decreased throughout the period: 25.5%, 20.5% and 13.3% were stunted in 2000, 2005 and 2010 respectively (Table 4).
The independent significant factors (from the multivariate analysis) affecting the stunting prevalence varied from 2000 to 2010 (Table 5). In 2000, sex, age, number of children <5 in the home, maternal education, sanitation facility and region of residence were all significant predictors of stunting. Female children were less likely to be stunted, OR = 0.87(95% CI0.77, 0.98) (Table 5). Compared to the children aged 0-11 months, children aged 12-23 months were the most likely to be stunted, OR = 2.83(95% CI 2.29, 3.51) (Table 5). The higher the number of children in the home, the more likely they were to be stunted, OR = 1.99 (95% CI 1.50, 2.65) for households with 3 children <5 years (Table 5, Fig. 1c). A higher level of maternal education reduced the prevalence of stunting, OR = 0.45(95% CI 0.28, 0.73) for children whose mother had a university education compared to those with no education (Table 5, Fig. 1a). An improved sanitation facility was protective against stunting, OR = 0.57(95% CI 0.76, 1.22). Lastly, living in the poorer Western, Khangai, or Eastern region increased the likelihood of stunting, OR = 1.59(95% CI 1.19, 2.13), 1.75 (95% CI 1.31, 2.32) and 1.48(95% CI 1.07, 2.04) respectively (Table 5). Household economic status was not a significant factor.
In 2005, the significant factors contributing to stunting were similar; however, sex, sanitation facility and region of residence were no longer significant in the multivariate analysis, showing their effect was overshadowed by the social determinants; maternal education and economic status. (Table 5). Children of weaning age, 11-24 months, were still the most likely to be stunted, OR = 2.94(95% CI 2.20, 3.94) compared to children aged 0-11 months. The trends that increasing number of children in the home and reduced maternal education increased likelihood of stunting were still present in 2005, OR = 1.99(95% CI 1.50, 2.65) and 0.45(95% CI 0.28, 0.73) respectively (Table 5, Fig. 1a and c), and a higher household economic status was protective against stunting, OR = 0.48(95% CI 0.30, 0.77) for children in the richest quintile compared to poorest (Table 5, Fig. 1b).
In 2010, the significant factors contributing to stunting prevalence were the same as in 2005 but ORs indicated increased effect of these factors (Table 5): higher maternal education was more protective than in 2005 (OR = 0.55 (95% CI 0.35,0.87) for children whose mothers had a university education) (Table 5, Fig. 1a), and higher household economic status was more protective against stunting (OR = 0.24 (95% CI 0.13,0.45) for children in richest quintile (Table 5, Fig. 1b).
WAZ and prevalence of underweight children
The mean WAZ for children in Mongolia increased from 2000 to 2010: the values significantly increased from −0.59(SD 1.36) in 2000 to −0.21(SD 1.33) and −0.09(SD 1.23) in 2005 and 2010, respectively (Table 4). The prevalence of underweight children followed this trend and decreased from 2000 to 2005 and to 2010 at 13.3%, 6.2% and 4.1% respectively (Table 4).
During the regression analysis, the independent significant factors varied over the decade similarly to those affecting stunting prevalence. In 2000, age, number of children under 5 in the home and region of residence all significantly affected the prevalence of underweight children. For age, as with stunting, children aged 12-23 months were the most likely to be underweight (OR = 1.90 (95% CI 1.48, 2.45) Table 5). Also in 2000, the likelihood of underweight children increased with the number of children under-5 in the home, OR = 1.26(95% CI 1.15, 1.62) for 2 children and OR = 1.69(95% CI 1.19, 2.39) for 3 children (Table 5, Fig. 1c). The region of residence had an effect as children living in the Western, Central and Eastern regions were all significantly more likely to be underweight than those in Ulaanbaatar (OR = 1.55 (95% CI 1.67,3.91), 1.78 (95% CI 1.20,2.63) and 1.76 (95% CI 1.19,2.61) respectively, Table 5). Household economic status and mothers' education were not significant factors in 2000.
In 2005, age was still a significant factor contributing to underweight status and the other significant factor was maternal education (Table 5, Fig. 1a). Children aged 12-23 were more likely to be underweight, OR = 2.07 (95% CI 1.36, 3.16) (Table 5). A higher level of maternal education was protective against underweight children, OR = 0.44 (95% CI 0.24, 0.83) for mothers with a university education (Table 5).
In 2010, the same factors as 2005 were still significantly contributing to the underweight status of children; child's age and level of maternal education (Table 5). Children aged 12-23 compared to those aged 0-11 months were still more likely to be underweight, OR = 1.66 (95% CI 1.07, 2.58) and children whose mother had a university education were somewhat less likely to be underweight, OR = 0.49 (95% CI 0.27, 0.92) (Table 5, Fig. 1a). There were less independent significant factors overall from 2000 to 2010;.. however, mothers' education became significant from 2000 to 2005 and its related OR increased in 2010.
Overall, these results have shown a reduction in the effect of environmental determinants of health, such as region of residence, across the decade. An important improvement is the lack of significance of rural and urban divide and housing sanitation. However, the effect ofmaternal education and household economic status on child nutritional status, has increased (Table 5).
Access to healthcare measured through immunisation coverage
Over the 10 year period, the proportion of fully immunised children increased, the values were 71.6% in 2000, 74.9% in 2005 and 97.8% in 2010 (Table 4).
The significant factors contributing to the immunisation rate varied through the years. In 2000, age, living in a household with a water source, rural/urban place of residence and region of residence were statistically significant (Table 5). All children over 12 months were more likely to have full immunisation coverage (Table 5), and the presence of a water source in the home was associated with a higher likelihood of full immunisations (OR = 1.44 (95% CI 1.08, 1.90)). In all other regions, children were less likely to be fully immunised than those living in Ulaanbaatar (Tables 4 and 5) although in the rural areas children were more likely to be fully immunised (OR = 3.16 (95% CI 1.71, 5.82)).
In 2005, only age and region of residence were significant contributors to the immunisation rate (Table 5). The trend in age however had reversed from 2000 as children over 12 months were less likely to have full immunisation coverage (Table 5). The older the child the less likely they were to be fully immunised (Table 5). This may be explained by the introduction of the Haemophilus Influenza vaccine between 2000 and 2005 which meant many older children were not vaccinated if they were born before it was introduced. [35] Only two regions of residence had significantly reduced immunisation coverage, the West region, and UB (Table 4).
In 2010, no variables had a significant effect on immunisation rate. Overall, there was a huge progress in immunisation coverage over the decade accompanied by a lack of significant variables in the multiple regression analysis (Table 5).
This paper is the first to identify sources of child health inequity in former Soviet/Socialist States and opportunistically examines changes in health inequality over a period of dramatic economic growth, revealing a case for both celebration and concern. We found that in the Mongolia, despite the improved GDP across the decade, the effect of social determinants on child health increased from 2005 to 2010. Significant improvements in some household conditions (sanitation) and mother's education could not mask the dramatic effects of inequalities as measured by household wealth and maternal education in terms of child health outcomes. Stunting and HAZ rates, which were our best indicator for chronic nutritional deficiency and health improvement, as well as malnutrition and WAZ rates improved for the total population across the decade of 2000-2010, Immunisation, as an indicator of healthcare use, improved dramatically as policy and funding focus increased coverage nationwide in 2010.
This study was limited by the quality of the MICS data on which it was based. For example, an attempt was made to analyse disease burden; which is measured through MICS by asking specifically about respiratory and diarrhoeal illness only, alongside the other measures of health considered. However, scrutiny of raw, analysed data and questionnaires revealed that the data was problematic since if the child was confirmed to have diarrhoea in the 2 weeks preceding the questionnaire, they were not asked about respiratory symptoms and vice a versa thus making disease data unreliable in our MICS surveys as the variables were not collected independently. Immunisation coverage in MICS surveys is limited because it does not account for the fact that young children may not yet have reached the age to have all their recommended immunisations and therefore this is also unaccounted for in our results [36]. Another limitation of the MICS data was the lack of some maternal data, such as age and marital status for children > 1-year of age which prevented adjustments for these important factors. Multiple other studies have shown that maternal characteristics affect child health outcomes [37, 38].
The above limitations on reporting disease, immunisations and maternal factors indicate that researchers using MICS data from all countries should exercise caution when comparing MICS results between years and countries. They should take care to understand how the data was collected and defined during each data collection round, rather than automatically assume all survey data have the same standard and method of collection. Those designing MICS surveys need to attempt to reduce disparities in data collection. Nevertheless, from the information available on the methods of MICS surveys the data chosen and presented in our study is coherent and comparable.
Study strengths were the large representative national database with small amount of missing data, and analysis of the missing data showing no correlation with the variables of interest. Also, the use of MICS data is important as in comparison, official government data collection of health indicators in Mongolia can be considered less accurate, as an example due to the exclusion of a large proportion of the population who are unregistered with the health services [39]. For example, the under-5 mortality rate estimated by MICS is 45 per 1000 live births; 20/1000 higher than that of the state health statistics department that quoted 25 per 1000 live births [40, 41].
Our results are important given that inequity in child health was recognised as a significant barrier to achieving the Millennium Development Goals [29] (and now the Sustainable Development Goals). Although GDPs and health outcomes in most LMIC are improving, this masks an exacerbating divide between poorest, which include the socially vulnerable groups and those most benefitting from economic growth as demonstrated through the inverse care law [42]. Data from our region of Central Asia and Eastern Europe are scarce, but examples are documented for large populations such as Nigeria and India [6, 7]. Below we discuss the importance of the trends in health outcomes and inequalities stemming from our results.
Trends in health outcomes
Overall, results confirm an improvement in nutritional/growth status and immunisation coverage for Mongolian children <5 years from 2000 to 2010, which follows the trend in other Central Asian countries [43,44,45]. However, in spite of its much higher economic growth rate in the decade, Mongolia had only a marginally higher percentage improvement in prevalence of poor nutrition over this time, still not catching-up with the other comparable countries of the region. For example, according to MICS data in 2000, Mongolia's prevalence of stunting (25.5%) and underweight (13.3%) was worse than in other transitioning Central Asian countries; values from 1999 in Kyrgyzstan were 24.8% and 11.0% respectively and in Kazakhstan were 9.8% and 4.6% [46]. This improved to 13.1% stunted and 3.7% underweight in Kazakhstan, 12.9% and 2.8% in Kyrgyzstan compared to 13.3% and 4.1% in Mongolia [5].
Although overall stunting prevalence improved across the country from 2000 to 2005, it significantly deteriorated in Ulaanbaatar in 2005. The same pattern was seen for immunisation. This finding may be due to the huge increase in peri-urban populations in the city, where living conditions are poor, directly affecting children's diets and indirectly affecting their psychosocial environment as well as the unregistered migrants having reduced access to healthcare [24]. The decrease in health outcomes for the capital city was targeted in health policy and the decline reversed by 2010, including government funding for the WHO 's Extended Programme for Immunisation in 2002 [46] There was also introduction of the 'Reaching Every District (RED)' strategy in Mongolia in 2008 [47] which was supported by the WHO and UNICEF and emphasised the need for improvements in child health throughout the country, focussing on the underserved unregistered new migrants in cities. RED, as well as NGO and other internationally funded new projects increased funding in child health [48]. The improved trends in 2010 data clearly demonstration how policy focus and funding can improve health service utilisation and outcomes.
Trends in inequalities
Overall improvements or deterioration of indicators are not a marker of the status of inequalities in health or access to services, since mean rates can mask widening of gaps between/within defined populations such as by sex or socio-economic status. Across the MICS surveys, in Mongolia, gender was not a significant determinant of child health, in contrast to other Asian countrie [48]. This is an important observation possibly due to the reverse gender role in Mongolia, where women are better educated and more likely to have professional careers compared to men [49].
Our results identified that the social determinants of health have the greatest effect on stunting prevalence, an indicator of chronic nutritional deficiency and recommended by the WHO for measuring health equity [50]. Bivariate analysis demonstrated that all socioeconomic and environmental factors significantly affected stunting prevalence in all years analysed (data not shown), and although environmental factors were no longer significant in the multivariate model, economic status and the related indicator, maternal education, were independent mediators in both 2005 and 2010. Thus, Mongolia's high female education rate could not mask the powerful cumulative effects that inequalities in maternal educational attainment has on chronic child health indicators such as stunting. Maternal education and economic status have been shown to be significant, independent determinants of nutrition/growth in other cross-national studies [51,52,53,54,55].
As household economic status from 2000 to 2010 significantly affected prevalence of stunting, it suggests that the economic growth in this time period was not universal and had a negative effect on the equity of children's nutritional/growth status. This finding is reflected in other countries where economic growth has not necessarily resulted in a decline in socio-economic health inequities [14]. Marmot et al. demonstrate that even in a high-income country (HIC), economic growth does not automatically result in equitable improvements in health due to inequitable distribution of wealth and a recent report indicates that in the UK child inequalities have grown in the poorest group [14]. The example of Mongolia demonstrates that this principle applies to LMICs in former Soviet/Socialist countries as well as HICs.
The prevalence of poor nutrition was highest in the 12-23 months age group, consistent with research in other countries [56]. However, the low prevalence of malnourished children aged 0-11 months contradicts the global trends, which demonstrate WAZ to be lowest until 9 months of age [56]. These findings could be attributed to Mongolia having a high rate of prolonged breast-feeding [57] which is likely to reduce the chance of malnutrition in children aged 0-11 months. However, poor weaning strategies and diet [58, 59] are likely to be responsible for the increase in prevalence of malnutrition in older children. MICS in Mongolia (2000, 2005 and 2010) did not provide data on child-feeding practices to test this hypothesis.
Significantly, over the same 10 years, there is an apparent reduction in the effect of location, both regionally and urban vs rural, for all child health indicators measured, which is interesting given the high internal migration rate into Ulaanbaatar. The reduction in inequality between Ulaanbaatar and the rest of the country may be explained by the high numbers of unregistered internal migrants moving into the city who are not eligible to access the healthcare they require [23]. Therefore, the reduction in regional inequality may be explained by worsening outcomes in Ulaanbaatar rather as well as improvement in other regions, as shown by the significant reduction in immunisation rate in Ulaanbaatar from 2000 to 2005 (Table 4).
In spite of this, in 2010, the lack of significant disparity in immunisation coverage by maternal education and household economic status (present between 2000 and 2005) is unusual compared to other countries, in which both factors increase the likelihood of a child receiving all their immunisations [60,61,62]. These studies show that maternal education is often the most important factor. Therefore, Mongolia's high female literacy rate [63], the increased government funding for immunisation since 1999 [64] and a tradition of high immunisation since the Soviet era, may be partly responsible for the reduced inequalities in access to healthcare, at least in terms of immunisation. Furthermore, we question the value of immunisation as a measure of access to healthcare because it could be argued that immunisation is easy to implement in an evidence-based, vertical programme with high coverage and therefore may not reflect all other healthcare access in the case of Mongolia. Future studies on determinants of health should also attempt to investigate other measures of healthcare access.
This is an important study examining the effect of economic growth on healthcare in a LMIC where much funding for aid work has been reduced in the last few years. Increasing GDP is demonstrated not to be correlated with equal benefit for the most vulnerable and this poses an ethical question for the Mongolian Government to impose taxation and development policies which will benefit the poor as well as the newly rich. Such policies should enable the continuing economic growth without widening inequity in health. Lessons are pertinent to LMIC, but particularly other Central Asian and East European countries with similar healthcare systems in transition from previous socialist policy. Important issues are also highlighted about the methodology and use of MICS data.
Change history
Confidence interval
Gross Domestic Product
Height for Age z-score
high income country
Infant mortality rate
lower middle income country
Multiple Indicator Cluster Survey
Non-governmental organisation
odds ratio
Reaching Every District Strategy
United Nations Children's Fund
Weight for Age z-score
World Health Organisation
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Thanks to UNICEF for allowing access to the MICS data and the wealth index construction used in this analysis. Thanks to the medical students at the Health Sciences University of Mongolia who helped with finding sources and translation.
University of Birmingham funded the travel to Mongolia for this study.
Availability of data and materials
The datasets analysed during the current study are available in the UNICEF MICs repository, http://mics.unicef.org/surveys.
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Ethics approval was granted by the University of Birmingham BMedSci Population Sciences and Humanities Internal Ethics Review Committee. Consent for the MICS survey was carried out by UNICEF when collecting the data.
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A correction to this article is available online at https://doi.org/10.1186/s12939-018-0747-7.
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Cite this article
Joshi, N., Bolorhon, B., Narula, I. et al. Social and environmental determinants of child health in Mongolia across years of rapid economic growth: 2000-2010. Int J Equity Health 16, 189 (2017). https://doi.org/10.1186/s12939-017-0684-x
- Health equity
- Child nutrition
- Maternal education
- Socioeconomic status
- Immunisation coverage
- Multiple indicator cluster surveys (MICS)
- Mongolia


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