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Rattanakiri

Introduction

Welcome to the Provincial Food Security Profile pages for Rattanakiri. This first section provides background information on this province including an administrative map and information on its geography, and population.

Administrative Map of Rattanakiri

This map shows the district and commune names and boundaries in Rattanakiri, together with major roads and rivers, for your reference.

Map: Province Administrative map year 2000

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Geography of Rattanakiri

Rattanakiri is located in the Northeast corner of Cambodia. It borders Laos to the North, Vietnam to the East,  Mondulkiri to the South and Stung Treng to the West. The area of the province is 10017 square kilometers (MAFF www.maff.gov.kh). The topography is upland forested areas and river valleys. Rattanakiri is classified as a rural province.

Demography of Rattanakiri

In 2004 the estimated population was 118 thousand persons and was 51% female. The population of children aged under 5 years was 19 thousand which was 16% of the total province population (NIS 2004). The Dependency Ratio (numbers of persons <15 years and 65 or over years per 100 adults aged 15-64 years) was 94. 

The total number of households in 2004 was 22 thousand, giving an average household size of 5.3 persons (MAFF 2004). The people of Rattanakiri live in 9 districts composed of 49 communes and 240 villages (CDB 2004).

The population density of the province is 12 persons/km2 compared to an average population density for Cambodia of 75 persons/km2.

Malnutrition

Mortality among Children

Malnutrition is a common contributing cause of death among children. Table 16.1 below shows  estimates for the year 2000 (latest available) of the rates and numbers of children who died prematurely in Rattanakiri .

These mortality rates are extremely high. The estimate is that over 4,200  children aged under 5 years died prematurely in Rattanakiri in the five years to 2000. Over 670 infants aged under 1 year had died in the preceding one year to the year 2000.

Table 16.1 Child Mortality in Rattanakiri at Year 2000

Mortality
Indicator
Rate
Percent
Rate
Prov.Rank
Number of
Children
Affected
Number
Prov.Rank
Infant Population
(aged < 1 year)
 - 3,981  18 
Infant Mortality
(aged < 1 year)
 17%  1.5  676  15
Child Population
(Aged 0-<5 years)
 -  -  18,647  19
Under 5 year Mortality
(aged 0-5 years)
 22.9% 1.5  4,276   16

Source: Estimates calculated from CDHS 2000 & NIS 2004

Protein-Energy Malnutrition among Children

Table 16.2 below shows  estimates for the years 2000 and 2005  of the rates  and numbers of children aged under five years suffering from protein-energy malnutrition in Rattanakiri.  Three indicators are used: Stunting (height for age) Underweight (weight for age) and Wasting (weight for height). The  international WFP child nutrition standards categories for the rates are also included.

In 2005 Stunting rates were extremely high (the same as year 2000) and over 10,000 children were Stunted (very similar to year 2000). Underweight rates were extremely high (the same as year 2000) and over 10,000 children were Underweight (very similar to year 2000). Wasting rates were medium (a decrease from year 2000) and over 1,500 children were Wasted (a large decrease from year 2000).

Table 16.2 Child Malnutrition in Rattanakiri Years 2000 and 2005

Malnutrition
Indicator
Rate
Percent
2000
WFP Rate
Category
2000
Number of
Children
Affected
2000
Rate
Percent
2005
WFP Rate
Category
2005
Number of
Children
Affected
2005
Population Children
Aged Under 5 years
 100% 18,647  100%  19,907 
Stunted
(moderate &
severe <-2SD)
 55.0%  Extremely
High
 10,256  53.1%  Extremely
High
 10,571
Underweight
(moderate &
severe <-2SD)
 54.0%  Extremely
High
 10,069  51.6%  Extremely
High
 10,272
Wasted
(moderate &
severe <-2SD)
 15.2% Very High  2,834  7.9%  Medium  1,573 

Sources: CDHS 2000 & 2005

As shown in the table above the changes in number of children aged under 5 years affected by malnutrition is almost exclusively due to  changes in malnutrition rates. The population of children in 2005 is almost the same as 2000.

Rank Comparison of Malnutrition in Rattanakiri with all 24 provinces in 2005

Table 16.3 ranks the 2005 child under 5 year malnutrition outcomes  described above in comparison to all other provinces  in Cambodia. Comparing food security outcomes in this province to all other provinces of Cambodia:- The prevalence of Under 5 year mortality was extremely high. The prevalence of malnutrition among the child population was relatively very high to extremely high varying by indicator. The actual numbers of children affected by malnutrition (considering differences in the child population of each province) was  relatively low given Rattanakiri's small child population.

Table 16.3 How Malnutrition in Rattanakiri Ranks Compared to all 24 Provinces of Cambodia in 2005

Malnutrition Indicator
Rank of This Province
Compared to all 24 Provinces:
    1= the worst
24= the best
Population of Children Aged Under 5 years 19 
Number of Children Stunted  16
Number of Children Underweight  16
Number of Children Wasted  19
Rate of Stunting  3.5
Rate of Underweight  1.5
Rate of Wasting  7.5

Maps of the Distribution of Child Malnutrition in Rattanakiri 2000

Below is a series of four maps showing the incidence of Stunting and Underweight by Commune in Rattanakiri in 2000. The maps show both the rates and the numbers of children affected by commune. These estimateswere made by WFP using small area estimation techniques. These maps now categorise communes by the new 2005 international WFP child nutrition standards

It is important to note that there are variations between the direct CHDHS 2000 province level estimates of Stunting and Wasting presented above (which are the best current estimates for the province level in 2000) and the WFP commune estimates for  the individual communes across the province presented in the following maps (percentage and number of children affected). This is a result of the the WFP commune estimates being based on a different methodology (small area estimation techniques-SME) and a different child Under 5 population estimate (1998 Census).

Despite these variations, these WFP commune level estimates or malnutrition are the only estimates of the geographical distribution of malnutrition within provinces for all communes in the country. They remain a useful tool to examine the relative incidence of child malnutrition by commune within provinces and give an initial estimate of proportions and numbers of children affected by commune in year 2000.

Children aged <5 years Stunted: Percent by Commune in Rattanakiri province year 2000

Map RAT 05.00 shows that almost all communes in this upland province were estimated to have at least a Very High percentage of children Stunted. Communes with Extremely High rates of Stunting were also common in the province. Note that the white area to the north on these proince maps (no data) is the area of the Virachey National Park conservation area.

Communes with Extremely High rates of stunting were concentrated particularly in the northern districts of Veun Sai and O Chum and in the southern district of   Lumphat. They were also found in all other districts with the exception of Banlucn district, ther province centre. 

Note that these commune level percentages derived from the SME technique and therefore the WFP Nutrition Standard commune categories are lower on average than the direct CDHS estimates for the province level presented above.

Map RAT 05.00: Children aged <5 years Stunted: Percent by Commune in Rattanakiri province year 2000

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Children aged <5 years Stunted: Number of Children by Commune in Rattanakiri province year 2000

Map RAT 06.00 shows that the number of Stunted children by commune. Given the small child populations of communes in this province most communes have <200 Stunted children. It is useful here to also refer to the scale of the map. These communes with small affected child populations, are large in area, and are often relatively remote from the province centre. Further, they are communes in upland areas often with poor road access infrastructure.

Map RAT 06.00: Children aged <5 years Stunted: Number of Children by Commune in Rattanakiri province year 2000

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Children aged <5 years Underweight: Percent by Commune in Rattanakiri province year 2000

Map RAT 07.00 strikingly shows that almost all communes in the province in all districts had at least an Extremely High percentage of children Underweight, and further, that almost all communes had Extremely High rates of underweight >=50%.

Note that these commune level percentages derived from the SME technique and therefore the WFP Nutrition Standard commune categories are on average similar to  than the direct CDHS estimates for the province level presented above.

Map RAT 07.00: Children aged <5 years Underweight: Percent by Commune in Rattanakiri province year 2000

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Children aged <5 years Underweight: Number of Children by Commune in Rattanakiri province year 2000

Map RAT 08.00 shows that the number of Stunted children by commune. Given the small child populations of communes in this province most communes have <200 Stunted children. It is useful here to also refer to the scale of the map. These communes with small affected child populations, are large in area, and are often relatively remote from the province centre. Further, they are communes in upland areas often with poor road access infrastructure.

Map RAT 08.00: Children aged <5 years Underweight: Number of Children by Commune in Rattanakiri province year 2000

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Food Availability

A lack of food availability can be an important cause of malnutrition and can contribute to premature mortality as well. Food availability is the ability of the people to directly produce the foods they need through their own activities in agriculture and livestock production,and through harvesting wild foods in  agricultural commons areas, forests and fisheries. 

This section examines evidence for a lack of food availability that might be contributing to child malnutrition and mortality levels found among the population of Rattanakiri (see Malnutrition and Food Utilization sections).

Information on food availability is limited in some areas, particularly in relation to wild foods from common property forest, agricultural and fisheries. However, we can still build an overall profile of food availability in Rattanakiri from available information while these limitations do still exist in 2004.

Access to Agricultural Land in Rattanakiri in 2004

Table 16.2.1 shows the percentage of rural households in Rattanakiri by agricultural land holding size.

Rural households in Rattanakiri have limited access to agricultural land for crop production in general. Further, there are also large differences in the quantity of agricultural land available to individual rural households. Small land holdings and other factors limiting crop productivity limit food ability for many rural households.

In 2004, 4% of rural households in Rattanakiri were landless and did not produce their own staple food crops.  A further 12% possessed less than 1.0 hectares of land. These small hold farming households will typically only produce enough food from crop agriculture to meet a part of their staple food needs. 

Table 16.2.1 Agricultural Land Access in Rattanakiri in 2004

Agricultural land per rural household % of Rural HH
This Province
% of Rural HH
National
No agricultural land (landless) 4%  15% 
Less then 1.0 hectare (0.01- <1.0 ha)  12%  49%
1.0- < 3.0 hectares  78%  30%
>= 3.0 hectares 6%   6%

Source: MAFF 2004

Percentage of Rural Households Producing Crops in 2004

Table 16.2.2 shows the percentage of rural households in Rattanakiri engaged in crop production by season. Rural households are very commonly engaged in crop production, most typically rice production to grow their own food and for cash income at least for one season per year.

Most food crop production in Rattanakiri is rain-fed and is confined to the wet season. with 91% of households producing a rice crop in the wet season compared to only 1% of households in the dry season. 

Table 16.2.2 Percentage of Rural Households Producing Crops in Rattanakiri in 2004

Rural Households Producing Crops % of Rural HH
This Province
% of Rural HH
National
Any Season-Any Crop 96%  85% 
Wet Season-Rice Crop  91%  69%
Dy Season-Rice Crop 1%  16% 

Source: MAFF 2004

Crop Production by Type and Season in 2004

Rice Production

Table 16.2.3 shows statistic about rice production in Rattanakiri. Rice is the staple cereal food crop of rural Cambodians. 

Comparing wet season rice production with national averages, the mean rice area cultivated per rural household was higher than the national level and the rice paddy yield per hectare was lower than the national level. No dry season rice production was undertaken in this province.

The area of rice harvested in Rattanakiri in 2004 was reduced substantially through destruction of part of the cultivated area due to flood, drought or insects. Further information on crop damage is found in the Food Vulnerability section.

Table 16.2.3 Rice Crop Production by Season in Rattanakiri in 2004

 Rice Production
Indicator
This
Prov
Wet
Season
National
Wet
Season
This
Prov
Dry
Season
National
Dry
Season
Area Cultivated- '000 ha. 45  2087  330 
Area Harvested- '000 ha.  36  1851  0  318
Paddy Production '000 MT  41  2918  0  973
Yield-MT/ha.  1.2  1.6  0  3.1
Paddy % of total crop area cultivated  93%  81%  0%  84%
Mean Area Cultivated/ Rural HH- ha.  1.9 0.9   0 0.1 

Source: MAFF 2004

Rice Food Balance 

Table 16.2.4 shows the balance between rice food availability from production and defined minimum white rice food needs of the population of Rattanakiri. Rice is the only food crop type for which such a direct measure of food availability compared to food needs can be made.

This overall rice balance at the province level is shown in the table. In addition, to illustrate how rice balances can vary between areas and between households within the province, two further rice balance indicators are included. One is the percentage of communes having >= 100% of minimum rice needs for the commune population. The second rice balance is for small-hold farmers (cropping 0.5 ha. of rice).

At the province level overall the rice balance exceeds the minimum rice food needs of the population. Among the communes of the province 55% of communes produce enough rice to meet minimum food needs while 45% produce less than minimum food needs.  Commune level rice balances are mapped at the bottom of this page.

For households that are small-hold farmers 43% of minimum rice needs are derived from the own production. This is indicative of the rice food balance in households farming 0.1- < 1.0 ha. of land shown in Table 16.2.1 above. Furthermore at the household level, it should be noted that the vast majority of the landless will produce no rice at all as very few rent  or share-crop rice land.

Table 16.2.4 Rice Food Balance in Rattanakiri

Rural Households Prdocing Crops This Province National
Total white rice available for food consumption
'000 MT
23  2166 
Minimum population white rice food needs/ year '000 MT  18  1713
Provincial Level: overall white rice food balance
as % of  minimum rice needs
 130%  126%
Commune Level: Percentage of Communes with rice
food balance >= 100%.
 55%  61%
Smallholders (cropping 0.5 ha.): white rice food balance
as % of  minimum rice needs.
 43% 66% 

Source: MAFF 2004

Other Non-Rice Annual & Perennial Crop Production in 2004

Table 16.2.5 shows some basic overall statistics to give an idea of the relative role of non-rice crops in agricultural cropping systems in Rattanakiri.

A range of other annual field crops are typically grown in the provinces. These include food crops (such as maize, cassava, mung bean, vegetables) and non-food crops (such as jute, tobacco). In addition a range of perennial crops are grown including agricultural fruit trees and coffee. A food balance is not possible for non-rice food crops as there are no nutritional guidelines for these other food types. In addition, statistics do not indicate what proportion of these non-rice food crops are consumed versus being sold for cash income.

In available MAFF statistics, non-rice crops are only partially enumerated estimates (limited range of selected crops, one collective estimate for most vegetables, unclear whether home garden production is included) and are enumerated in less detail than for rice. There is also a limited data on agricultural tree and perennial crops (limited range of crops, trees estimated by area rather than number, no data on production). 

Considering these limitations, non-rice crop production accounts for 7% of the total cultivated area for all crops which is lower than the national average. This does not seem consistent with the prevalence of upland multi-cropping systems in Rattanakiri.

Table 16.2.5 Non-Rice Annual & Perennial Crop Production Overview in Rattanakiri in 2004

Non- Rice
Crop Indicator
Wet
Season
Dry
Season
Both
Seasons
% of total annual crop cultivated area
for non-rice field crops & vegetables
128 
Mean ha./ rural household cultivated
for annual non-rice field crops & vegetables
 0.1  <0.1  0.1
Mean ha./ rural HH agricultural fruit tree
and other perennial crops
0.5 

Source: MAFF 2004

Livestock production in Rattanakiri in 2004

Table 16.2.5 shows some basic statistics on livestock production at the household level in Rattanakiri. Livestock, if consumed, are an important source of protein and other important micro-nutrients such as Iron. A food balance is not possible from these livestock statistics as there are no nutritional guidelines for protein and nutrient supply by livestock type. Livestock statistics are only estimates and may be under-enumerated.

Poultry (second to fish) are typically consumed as a source of protein. Pigs are typically sold for cash and cattle and buffalo are retained for breeding, draught power and as a store of wealth and are therefore not consumed directly for food. However, examining statistics for these large livestock types does give and idea of local supply of pork and beef to markets, where they are bought in small amounts for consumption by rural households.

Table 16.2.5 Household Livestock Production Overview in Rattanakiri in 2004

Livestock Ownership among rural households This Province National
Mean poultry per rural household (head) 2.6  6.5 
Mean pigs per rural household (head)  0.7  0.9
Mean cattle per rural household (head)  0.7  1.2
Mean water buffalo per rural household (head) 0.5   <0.1

Source: MAFF 2004

Percentage of minimum rice needs produced  by Commune in Rattanakiri in 2004

Map RAT.02.01 shows the percentage of per capita minimum rice food  needs produced for the population in each commune in 2004 according to MAFF statistics. This is an average figure for the commune level.

Map RAT.02.01 Percentage of per capita minimum rice food needs produced by Commune in Rattanakiri in 2004

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Food Access

Problems with food access can be  an important cause of food insecurity and malnutrition. This section examines people's ability in the province to earn cash income with which to buy food that they need for an adequate diet but which they cannot produce themselves.

A written description and statistics are found here about food access the province level. There is also a map and description of poverty rates at the commune level in 1997.

Consumption Poverty in Rattanakiri in 2004

Consumption poverty refers to having insufficient cash income (or its equivalent in kind) to meet basic livelihood needs. This includes having insufficient cash income to buy foods that people need for an adequate diet as well as cash income to buy other basic needs such as shelter, clothing, health and education. 

This lack of market purchasing power can be an important cause of food shortages and protein-energy and micro-nutrient malnutrition in the province population.

Table 16.3.1 contains indicators of the prevalence of consumption poverty in Rattanakiri in comparison to national rates. Results show that 44% of households are below the consumption poverty line and 43% of households in the province fall into the poorest two national quintiles of national consumption. These households will struggle to have enough cash available to buy food needs on the market and to meet other expenditure needs such as health services.

Table 16.3.1 Indicators of Consumption Poverty in Rattanakiri 2004

 Consumption Poverty Indicator

This
Province

National
Mean Total per capita HH daily per capita consumption
in riel
2697  3247 
% of households in the lowest Q1 and Q2 (i.e. 40%)
of national consumption quintiles
 43  37
Consumption poverty line in riel  1807  1836
% of households below the  poverty line  44  32
The poverty line value as a percentage of
total consumption
 67 49 

Source: CSES 2004 Knowles Analysis

Household Economic Asset Poverty in Rattanakiri in 2004

Another important dimension of poverty is a lack of physical assets with which to generate household income.  Table 16.3.2 contains indicators of the prevalence of a lack of physical assets among households in Rattanakiri in comparison to national rates. Households lacking economic assets of their own will be more exclusively dependent upon wage labor or common property resources to generate cash income to buy food and other basic needs.

Table 16.3.2 Indicators of Household Asset Poverty in Rattanakiri 2004

Asset Poverty Indicator This
Province
National
% rural households with no crop land-landless 0 ha.  4 15 
Average crop land area cultivated for all annual crops ha./rural hh  2.1  1.2
% households with thatched roof houses  51  34
% HH not owning any cattle or buffalo  60  49
% HH not owning any pigs-CDB 2004  42  54
Mean no. of households per car  80  39
Mean no. of households per motor  4.7  5.4
Mean no. of households per oxcart 16.9  4.0 

Sources: MAFF 2004 & CDB 2004 aggregates from village data

Employment and Labor Force Characteristics in Rattanakiri in 2004

Employment  either in the form of wage labor or operating a business enterprise  can be a very important source of cash income  to Cambodian households.  Unfortunately, we lack information on this important aspect of food security and poverty. This is because most Cambodians generate wage and business cash income outside the "formal sector" of the economy, in what is know as the "├»nformal sector". The limitation of most existing statistics is that they do not distinguish between formal sector (more regulated, more secure, and often higher income activities) and informal sector activities in statistics collection.

Wage labor in the informal sector is unregulated, casual and often low paid. A very typical example is agricultural casual wage labor. Businesses in the informal sector are commonly household based micro-enterprises, unregistered, unregulated and often with poor access to credit, business and legal services. These micro-enterprises are diverse including agro and natural resource processing, small scale industrial/ handicraft and service enterprises.

Table 16.3.3 contains indicators of the characteristics of the labor force and employment in Rattanakiri in comparison to national rates. Total and female adult literacy rates are a good proxy indicator for access to productive employment and higher incomes. The indicator on percentage of the labor force economically active <=10 days/ mth gives some indication of the problem of underemployment, a major limitation to income generation from wage labor in the informal sector.

Table 16.3.3 Employment and Labor Force Indicators in Rattanakiri 2004

Employment and Labor Force Indicator

This
Province

National
Literacy Rate > 15 years % total population 53  67 
Literacy Rate > 15 years % females  47  60
% of the labor force in the primary sector incl. Agriculture  70  60
% of the labor force in the secondary sector/ Industry  6  13
% of the labor force in the tertiary sector/ Services  18  25
% of the labor force economically active <=10 days/ mth 27   29

Source: CSES 2004 Kanol Analysis (NIS)

Market Access in Rattanakiri in 2004

Characteristics of access to markets and major transport systems serving them are an important dimension of food access. Communities more isolated from markets will tend to suffer from lower prices for the products they sell and higher costs in buying food and other needs. 

Table 16.3.4 contains indicators of access to markets and major transport systems serving them in Rattanakiri in comparison to national statistics.

Table 16.3.4 Market Access Indicators in Rattanakiri 2004

market access
indicator

This
Province

National
Average time (minutes) taken from village
to the nearest market
 86 45 
Average farm gate price of paddy in Riel
(December)
 425  521
Distance (Km) to nearest year-round road  5.7  3.8
Average time (minutes) from village
to nearest year-road
26  18 

Source: CDB 2004 aggregates from village data

Percentage of the population below the consumption Poverty Line by Commune in Rattanakiri in 1997

Map RAT.03.01 shows the WFP estimate of the percentage of the population below the consumption Poverty Line in the year 1997. These estimates were made by WFP using small area estimation techniques based on the CSES 1997. This remains the most recent source of poverty data  at the commune level. Note that some communes were not covered in  the CSES 1997 due to insecurity.

Map RAT.03.01 Percentage of the Population Below the Consumption Poverty Line by Commune in Rattanakiri 1997

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Food Utilization

Problems with food use and utilization can be important causes of food insecurity and malnutrition. This section examines patterns of food use and utilization among mothers and children, which contributed to food insecurity in terms of increasing mortality, morbidity and malnutrition in the year 2005. 

Included here are sections on malnutrition rates among women, maternal care, mother- child care practices, child illnesses, child micro-nutrient malnutrition and access to sanitation and safe drinking water.

Malnutrition rates among women in Rattanakiri

"A mother's well-being has a direct impact on her children's well-being. Similarly when one group fares poorly so does the other. For newborns, survival is directly linked to a mother's health during pregnancy" (CDHS 2000). 

Results for 2005 are available for two important maternal micro-nutrient malnutrition indicators, Iron Deficiency Anemia (IDA) and Iodine Deficiency (IDD). Iodine Deficiency is avoided by the use of Iodized salt. The CDHS 2005 provides results for use rates of Iodized salt in households. 

The percentages of women affected by these conditions, together with the outcomes of these forms of malnutrition, are shown in Table 16.04.1. Anemia (IDA) rates in Rattanakiri were lower than the rate at the national level. The percentage of households not using Iodized salt, an indicator for Iodine deficiency (IDD), was higher than the rate at the national level.

Table 16.04.1Malnutrition rates among women in Rattanakiri in 2005

Malnutrition Indicator for
Women aged 15-49 years
% of Women
This
Province
2005
% of Women
National
2005
Women with Iron Deficiency Anemia (IDA)
IDA Outcomes: "contributes to  low birth weight,
lower resistance to infection, poor cognitive development
and decreased work capacity."
43%  47% 
Iodine Deficiency (IDD) Household tested salt not Iodized.
IDD Outcomes: "increased rates of abortion, stillbirths,
congenital abnormalities, cretinism, psychomotor defects
and neonatal mortality."
36%  28% 

Source: CDHS 2005

Maternal health care in Rattanakiri

Access to maternal health care services is of great importance to support maternal and child health and nutrition during pregnancy and at birth. 

Table 16.04.2 presents the percentages of pregnant women not having access to important maternal health care services in 2005. The lack of access to maternal health care services is a causal factor in the observed rates of child and maternal mortality and malnutrition in the province.

Compared to the national level, the percentages of pregnant women not having access to antenatal care services was generally very much higher than the national average. Compared to the national level, a very much higher percentage of pregnant women in this province did not have babies delivered with a health professional and a similar percentage did not deliver babies in a health facility.

Table 16.04.2 Maternal health care in Rattanakiri Year 2005

Maternal Care Indicator for
Women during pregnancy who had a live birth
in the previous five years
% of Women
This
Province
2005
% of Women
National
2005
Pregnant women without antenatal care from a
health professional
71%  31% 
Pregnant women not receiving >=1 Tetanus
toxoid injection
 50%  23%
Pregnant women not given iron tablets  77%  37%
Women not having babies delivered with a
health professional
 86%  56%
Women not having babies delivered in a
health facility
81%  78% 

Source: CDHS 2005

Mother-child care practices in Rattanakiri

After birth, mother-child health and nutrition practices are extremely important for the healthy development and nutrition of a growing child. These practices are influenced by a mother's education and knowledge, and by physical, social and economic access to child health care services. 

Table 16.04.3 presents the percentages of mothers not using appropriate mother-child health and nutrition practices. whether through a lack of knowledge or because of a lack of physical social or economic access to child health care services. The final indicator, women's illiteracy rate, is a more general indicator of mother's education and knowledge which has been shown to have a major affect on mother-child health and nutrition practices overall.

In Rattanakiri a very much higher percentage of children had not received their complete course of vaccinations compared to the national level. Compared to the rates of diarrhea treatment practices at the national level, a higher percentage of children were not taken for medical treatment and a higher percentage of children were not given any sort of Oral Re-hydration treatment. Compared to the rates of ARI/Fever treatment practices at the national level, the same percentage of children with ARI/Fever symptoms in this province were not taken to a health care provider for medical treatment.

Table 16.04.3 Mother-child care practices in Rattanakiri

Mother-Child Care Practices % of Children
This
Province
2005
% of Women
National
2005
Children aged 12-23 months not receiving
all vaccinations (a)
64%  33% 
Children < 5 yrs with Diarrhea
not having medical treatment sought from
health facility or provider
 58%  50%
Children < 5 yrs with Diarrhea
not given Oral Rehydration treatment of any sort
 47%  41%
Children < 5 yrs with Fever/ARI
not having medical treatment sought from
health facility or provider (b)
57%  57% 

Source: CDHS 2005

Child health in Rattanakiri

A combination of mother-child health care practices and external factors, particularly those related to water and sanitation, affect the prevalence rate of child infections. Diarrhea and Acute Respiratory Infections are common causes of morbidity and the most common final causes of death among children aged < 5 years. Diarrhea also directly reduces nutrition intake.

Table 16.04.4 Child Illnesses and Treatment in Rattanakiri in 2005

Children < 5 yrears illnesses % of Children
This
Province
2005
% of Children
National
2005
Children < 5 yrs with Diarrhea within the preceding two weeks 21%  20% 
Children < 5 yrs with symptoms of ARI within the preceding two weeks  20%  8.5%
Children < 5 yrs with fever within the preceding two weeks  34.5%  35%

Source: CDHS 2005

Micro-nutrient malnutrition rates among children in Rattanakiri

The percentages of children affected by these conditions, together with the outcomes of these forms of micro-nutrient malnutrition, are shown in Table 16.04.5. The percentage of children aged 6- 59 months suffering from both any level of IDA, and moderate levels of IDA, are shown. The CDHS 2005 results for use-rates of Iodized salt used in households is repeated here in this table, as an indicator of Iodine Deficiency (IDD) prevalence among children.

Rates for both any level, and moderate level, of Anemia (IDA) were similar to the national average in Rattanakiri, meaning that a similar percentage of children were suffering the outcomes of Anemia described in the table. The proportion of households not using Iodized salt was higher than the national average, with this percentage of children suffering the outcomes of Iodine deficiency (IDD) described in the table.

Table 16.04.5 Micro-nutrient malnutrition rates among children in Rattanakiri in 2005

Micronutrient Malnutrition
Indicator for Children
% of Children
This
Province
2005
% of Children
National
2005
% Children 6-59 months with any Iron Deficiency Anemia (IDA).
Outcomes: "impaired cognitive performance, motor development,
coordination, language development and scholastic achievement.
Increases morbidity from infectious diseases because it adversely
affects immune mechanisms".
63%  62% 
% Children 6-59 months with moderate Iron Deficiency Anemia (IDA).
Outcomes: as above but more severe.
 37%  32%
Iodine Deficiency (IDD) Household tested salt not Iodized
Outcomes: "goiter, hypothyroidism, impaired mental functions,
retarded mental and physical development and diminished
school performance."
 36%  28%

Source: CDHS 2005

Access to sanitation and safe drinking water in Rattanakiri

"The type of water and sanitation facilities are important determinants of the health status of household members and particularly children. Proper hygienic and sanitation practices can reduce exposure to and the seriousness of major childhood diseases such as diarrhea". (CDHS 2000).

Table 16.04.6 shows the percentages of households not having access to sanitary toilets and not having access to safe drinking water in the year 2004. Among these households, members and particularly children are exposed to poor hygiene and sanitation conditions which will increase risks of infections including diarrhea, and which will in turn increase risks of child death, and levels of child malnutrition.

Compared to the national level, a higher percentage of households in this province did not have a sanitary toilet. The percentage of households not having access to safe drinking water in this province was much higher than the national average. Much more needs to be done to promote sanitation and access to safe drinking water in this province, to reduce the risks of child death, and to reduce existing levels of child morbidity and malnutrition.

Table 16.04.6 Access to sanitation and safe drinking water in Rattanakiri 2004

Sanitation and Safe Drinking Water
Access Indicators
% of Households
This Province
% of Households
National
Households not having a sanitary toilet 92%  81% 
Households not having access to a safe source of
drinking water at, or within 150 meters, of their house
60%  34%

Source: CDB 2004

Percentage of the population without access to safe drinking water  by Commune in Rattanakiri in 2004

Map RAT.04.01 shows the percentage of the population without access to a source of safe drinking water by commune according to the Commune Database 2004. This map can be compared with the maps in the malnutrition section. Children without access to safe water are more likely to suffer from Underweight, illnesses and mortality.

Map RAT.04.01 Percentage of the Population Without Access to Safe Drinking Water  by Commune in Rattanakiri in 2004

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Food Vulnerability

A final set of causes of food insecurity are found in the vulnerability of Cambodian rural people to shocks and stresses that can reduce their food supply, or access or utilization of food to levels below minimum needs.

These issues have been shown to be an important dimension of food insecurity and poverty in Cambodia in a large number of studies. However, information about vulnerability covering all individual provinces is limited.

Below are a set of indicators of agro-ecological vulnerability at the province level for Rattanakiri. Some issues related to socio- economic vulnerability to food insecurity are also discussed and a cross reference is provided to the section of this profile that already includes relevant available indicators.

Agro-ecological Vulnerability

Agro-ecological vulnerabilities include risks of damage or destruction to crop production, livestock morbidity and morality and changes to common property fisheries and forest resources' productivity and access.

Indicators of such risks at the province level are limited to those about rice crop production, including flood, drought and pest damage. These results are presented in Table 16.5.1. They give an indication of vulnerability to food production loss for the staple crop rice, and other annual crops produced for food and income under mainly rain-fed cropping systems in Rattanakiri.

In 2004 the wet season crop cultivated area was 100% of the total rice cultivated area for the year.  Of this wet season cultivated area, 19% was destroyed, mostly through drought damage.

Table 16.5.1 Percentage of rice cultivated area destroyed by season and cause in Rattanakiri 2004

Indicator Wet Season Dry Season
% of total rice cultivated area for 2004
by season
100 
% Rice cultivated area destroyed by flood
by season
 0  -
% Rice cultivated area destroyed by drought
by season
 18  -
% Rice cultivated area destroyed by
insect/other by season
 1  -
% cultivated area destroyed-total
by season
19   -

Source: MAFF 2004

Socio-economic Vulnerability

There are a range of socio-economic vulnerabilities that can contribute to food insecurity. One such vulnerability is dependency on low, erratic, and insecure sources of cash income to buy household needs including food. Another characteristic vulnerability is illiteracy, which is associated with higher levels of poverty and low incomes, and higher rates of child malnutrition. A further set of vulnerabilities here relate to remoteness from markets, major transport networks and social services such as health and education.

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