KPC Report V2 HM Reviewed Jan 14

8/3/2019 KPC Report V2 HM Reviewed Jan 14

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ANNEX X. FINAL KPC REPORT

FINAL SURVEYREPORT: KNOWLEDGE

PRACTICE ANDCOVERAGE

Healthy Start Child Survival ProjectKonni Department, Relief International

Niger


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Niger

ACKNOWLEDGEMENTS

The author of this report, Dr. Mahaman Hallarou of Relief International (RI), would like to thank

various contributors who participated in this Knowledge, Practice and Coverage final survey.

In particular, thanks are due to the people who supported this survey either through their

involvement in its planning and implementation. These include the staff of the Konni District

Ministry of Health (MOH), especially Medical District Coordinator Dr. Alio Tayabou; MOH

Supervisor Abuzeidi Chahabou; District Administrator Suleymane Issaka; Health Supervisor

Abuzeidi Chahabou; Konni Statistics Department Supervisor Alio Nahantchi, Mouviento Por La

Paz Medical Officer Dr. Soumana Oumarou; and Initiative for Secure Households Supervisor

Sangar; survey personnel listed in Appendix 1; Meredith Chang of the USAID-Child Survival

and Health Grants Program (CSHGP); and Paulin Ntawangundi of RI.

Thanks are also due to the USAIDCSHGP, which funded the implementation of the survey.


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TABLE OF CONTENTS

ACKNOWLEDGEMENTS.........................................................................................................1

EXECUTIVE SUMMARY.........................................................................................................5

1. BACKGROUND.....................................................................................................................6

1.1. Project location.................................................................................................................6

1.2. Characteristics of the target beneficiary population.........................................................6

1.3 Health, social and economic conditions in the project area...............................................7

1.4. National standards and policies regarding maternal and child health..............................8

1.5. Overview of the Healthy Start Child Survival Project.....................................................8

2. PROCESS AND PARTNERSHIP BUILDING....................................................................10

2.1. Steering Committee collaboration..................................................................................10

3. METHODS............................................................................................................................10

3.1. Questionnaire..................................................................................................................10

3.2. KPC indicators................................................................................................................11

3.3. Sampling design..............................................................................................................12

3.4. Training...........................................................................................................................13

3.5. Data collection................................................................................................................14

3 6 Data analysis 14


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5.1. Key findings and programmatic implications.................................................................23

6. CONCLUSION......................................................................................................................27

7. BIBLIOGRAPHY..................................................................................................................28

Appendix 1. Survey personnel...................................................................................................29

Appendix 2. Maps of Niger and Konni District........................................................................31

Appendix 3. Survey Steering Committee invitation letter.........................................................32

Appendix 4. Questionnaire (English)........................................................................................33

Appendix 5. Questionnaire (French).........................................................................................51

Appendix 6. English-French-Haussa translations of key survey words....................................68

Appendix 7. Population list of communities.............................................................................69

Appendix 8. Budget...................................................................................................................71

Appendix 9. Training of Trainers agenda (English and French)...............................................72

Appendix 10. Enumerator training agenda (English and French).............................................73

Appendix 11. Comparison of Baseline and Final KPC indicators..............................................0

Appendix 11. Comparison of Baseline and Final KPC indicators

Table 1. Summary Table of Beneficiary Population........................................6

Table 2. Summary of Final KPC Rapid CATCH Indicators.........................................................15

Table 3. Age of children under 24 months..........................................................16Table 4. Sex of children under 24 months..........................................................17

Table 5. Clean delivery kit use...................................................................................18

Table 6 Post natal check for mother ithin first eek 18


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Table 16. Children who had malaria and received appropriate treatment

ABBREVIATIONS AND ACRONYMS

CSHGP Child Survival and Health Grants Program

DHSDemographic and Health Survey

DD/AT/DC Direction Departementale de lamnagement du Territoire/Developpement

communautaire

DPTDiphtheria-Pertussis-Tetanus vaccineDS Health district of Konni (French: District Sanitaire)

EOP End of Project

ISCV Initiative for Secure Households

KPC Knowledge, Practice and Coverage

MOH Ministry of Health

MPDL Mouviento Por La Paz

NCHS National Center for Health StatisticsONG Non-governmental organization (Organisation Non Gouvernementale)

ORS Oral Rehydration Solution

ORT Oral Rehydration Therapy

TBA Traditional Birth Attendant

TT Tetanus Toxoid

UNICEF United Nations Childrens Fund

USAID The U.S. Agency for International DevelopmentWHO World Health Organization


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EXECUTIVE SUMMARY

The Healthy Start Child Survival project, designed and implemented by Relief International (RI)in partnership with the Nigerien MOH is located in the Department ofKonni in the Tahoua Region. The estimated direct beneficiary population of the project activitiesis 91,297 women of reproductive age and 83,324 children under five. The project addressesleading causes of childhood morbidity and mortality in the project areas and interventionsinclude (a) malarial control and prevention, (b) control of diarrheal diseases, (c) maternal andchild health, and (d) nutrition.Using behavior change communication (BCC) at the community level, an adaptation of the caregroup model, and training for health care providers at the facility level, the project hasimplemented activities in 60 villages to date in order to increase demand for services, promotehealthy behaviors for child survival, and improve the quality of services offered at health posts

and health centers.

Figure 1. Relief International Care Group


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1. BACKGROUND

1.1. Project location

Niger is a landlocked Sub-Saharan African nation that is ranked third from the last on the 2010

Human Development Index, with 69% of its population living below the poverty line(). Like the

rest of the Sahel, Niger has a long history of endemic hunger characterized by seasonal

fluctuations and geographic variation.

In 2005, a severe drought resulted in a famine that affected nearly three million people and

exacerbated the already fragile health and nutritional status of the country, with disproportional

suffering among women and children. While the current crop harvests have ameliorated some of

the immediate concerns, many areas do not have transitional support to ensure sustained

recovery.

In 2007, in the aftermath of a nutritional crisis, Relief International (RI) launched a four-year

USAID-funded Child Survival project in Konni District in Niger1.

The Department of Birni nKonni occupies a 5,317 square miles area in the southwestern section

of the Tahoua region, 417 kilometers east of Niamey. It is divided into six communes: Konni

City, Allela, Bazaga, Malbaza, Dogueraoua, and Tsernaoua. Villages are widely disbursed. The

climate is dry and hot. A map of Niger and the Department of Birni nKonni is included as

Appendix 2.

1 2 Ch i i f h b fi i l i


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Children, 24-59 months 33,180Total children 0-59

months83,324

1.3 Health, social and economic conditions in the project area

The Republic of Niger covers a land area of almost 1,270,000 km 2 and is inhabited by 14 million

people. Nigers national development is hampered by food and political insecurity. The largely

agrarian and subsistence-based economy is frequently disrupted by extended, deadly droughts

common to the Sahel region of Africa. Niger has experienced two droughts during the projects

implementation period, requiring Niger to import 60% of its food in 2009 and threatening the

health of more than a million people in 2010. Political instability, such as violent conflict in

northern region and last years presidential coup, discourages foreign investment and

complicates the implementation of public services.

Poorly resourced health services are reflected in national health indicators. The 2010 maternal

mortality rate per 100,000 births for Niger is 820. This is compared with 600.7 in 2008 and 890.1in 1990. The neonatal mortality as a percentage of under 5's mortality is 22(). The under-five

mortality rate (U5MR) is 131 in per 1000 live births, according to the Niger National Institute of

Statistics.

Despite this challenging national context, the economy and welfare of the Department of Konni

benefits from its privileged location as a hub of commercial transportation in Nigers fertile

south. Konni exports onions and cattle to countries throughout West Africa. Village householdsin Konni rely on agriculture and trade for income. The major ethnic group in the Konni

department is Hausa, with a minority Tuareg and Peulh population. Hausa are traditionally

sedentary agriculturalists while the Tuareg and Peulh groups are nomadic pastoralists Konnis


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traditional birth attendants in their villages. Malaria, respiratory infections and diarrhea are

leading morbidities. Malnutrition is a common aggravating co-morbidity.

1.4. National standards and policies regarding maternal and child health

Nigers National Health Plan for 2011 to 2015 seeks to contribute to the reduction of maternal

and child mortality by building on existing capacity to improve the efficiency and quality of the

health system(). Government-mandated free health care has been in force since 2006 for

children under-five, as well as for antenatal care, caesarean sections, and family planning. Since2005, active screening, referral and case management of Severe Acute Malnutrition (SAM) have

been scaled up. Nigers Expanded Programme on Immunization (EPI) provides three doses of

combined diphtheria/pertussis/tetanus/Hemophilus influenza/Hepatitis B vaccine

(PENTA)3DPT). Vaccination campaigns against measles are coupled with the distribution of

vitamin A capsules. Public sector facilities and non-governmental organizations implement

large-scale distribution of bednets. The 2008 National Child Survival Strategy includes

increased access to health services through community-based disease management, reinforcedhuman resources and supply chains and monitoring(). Niger is currently finalizing its formation

Management System,Health InHuman Resources Development Plan, Nutrition Plan, and

National Strategy on Community Case management(). In support of the decentralization of

health service management, regional and district Ministry of Health directorates also create five-

year plans.

1.5. Overview of the Healthy Start Child Survival Project

1.5.1. Project goal

The goal of the Healthy Start Child Survival project was to reduce morbidity and mortality rates


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1.5.3. Intervention activities

The intervention activities for achieving the Strategic Objectives were designed to:

1. Increase access to, demand for, and use of quality maternal and child health services,

including emergency care; in order to improved family behaviors related to maternal and

child health.

2. Improve case management of malaria at the community and health post levels; increase

access to treatment for malaria; improve access and use of treated mosquito nets; and toimprove use of chemoprophylaxis for malaria among pregnant women.

3. Improve prevention and treatment of diarrheal disease among rural children under five.

4. Improve nutrition of women and children, through education and household/community

food security and nutrition activities.

5. Improve the capacity of the Ministry of Health and local partner agencies, to plan,

implement, monitor and evaluate child survival interventions at the community and

district levels, with an emphasis on capacity in maternal and child health, nutrition, andhousehold food security.

The project plan initially targeted 90 villages in a two-phased coverage approach. The project

established 266 women care groups and support for 50 health posts. After the mid-term

evaluation (MTE) the project plan was revived to focus on an intervention area of 61 villages.

RI and partners conducted the Baseline KPC Survey, Health Facility Assessment, and Detailed

Implementation Plan workshop from January to February 2008. RI brought togetherstakeholders from the Ministry of Health, NGOs, and rural communities to design the project. To

drive consensus on a project plan, the RI project management team facilitated structured problem

solving from rigorous analysis of the household and facility surveys. RI and the partners agreed


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Measuring the nutritional status of children aged 0-23 months in the project zone;

2. To build the capacity of project local staff and partners data collection and analysis.

2. PROCESS AND PARTNERSHIP BUILDING

2.1. Steering Committee collaboration

In August 2011, RI contacted the following institutions to invite representatives to participate in

a Steering Committee for the Final KPC Survey: USAID Mission in Niamey

Tahoua Regional Ministry of Health

Konni Health District

Konni Department Directorate of Agriculture

Konni Department Directorate of Planning

Konni non-governmental organizations (NGOs) including Mouviento Por La Paz

(MPDL) and the Initiative for Secure Households (ISCV) National Directorate for Health Information (DSSRE)

A sample invitation letter is included as Appendix 3.

The Final KPC Survey Steering Committee met on September 16-17, 2011, to advise on the

preparation of the survey. The Steering Committee reviewed and provided guidance and on the

terms of reference for the training of enumerators; drafts of the data collection tools; survey

logistical needs (including measurement equipment such as height boards, scales, medicines, and

bednets; and the identification of enumerators.

Steering Committee representatives agreed to contribute staff and materials from their respective

i tit ti Th K i H lth Di t i t id d t ff b t k i


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The survey questionnaire was 88 questions in length, excluding anthropometrics. The

anthropometrics module consisted of three measurements: height, weight, and mid-upper arm

circumference when appropriate. RI translated the questionnaire into French from the final

English version. The questionnaire in English is included as Appendix 4, and the French

translation is included as Appendix 5. During the survey, the French questionnaire was used as a

guide for the verbalization of the survey into Konnis local language of Hausa. The Hausa

translations of key words are included in Appendix 6.

3.2. KPC indicators

The 2006 Rapid CATCH indicators covered by the questionnaire were:

Maternal and Newborn Care:

Maternal TT v accination: Percentage of mothers with children age 0-23 months who

received at least two Tetanus toxoid vaccinations before the birth of their youngest child

Skilled delivery a ssistance: Percentage of children age 0-23 months whose births wereattended by skilled personnel

Post-natal visit to check on newborn within the first 3 days after b irth: Percentage of

children age 0-23 who received a post-natal visit from an appropriate trained health

worker within three days after the birth of the youngest child

Breastfeeding and Infant and Young Child Feeding (IYCF)

Exclusive b reastfeeding: Percentage of children age 0-5 months who were exclusively

breastfed during the last 24 hours

Infant and young c hi ld f eeding: % of infants and young children age 6-23 months fed

according to a minimum of appropriate feeding practices

Vitamin A supplementation in the last 6 months: Percentage of children age 6-23 months


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Control of Diarrhea

ORT u se: Percentage of children age 0-23 months with diarrhea in the last two weeks

who received oral rehydration solution (ORS) and/or recommended home fluids

Acute Respiratory Infections

Appropriate care seeking for p neumonia: Percentage of children age 0-23 months with

chest-related cough and fast and/ or difficult breathing in the last two weeks who were

taken to an appropriate health provider.

Water and Sanitation

Point of u se : Percentage of households of children age 0-23 months that treat water

effectively

Appropriate hand washing p ractices : Percentage of mothers of children 0-23 months who

live in a household with soap or a locally appropriate cleanser at the place for hand

washing that and who washed their hands with soap at least 2 of the appropriate timesduring the day or night before the interview

Anthropometry

Underweight : Percentage of children 0-23 months who are underweight (-2 standard

deviation for the median weight for age, according to WHO/NCHS reference population)

3.3. Sampling design

The Core Team designed the Final KPC Survey to survey 30 clusters of 12 households each.

Only one mother of a child aged between 0-23 months was interviewed per household, for a total

sample size of 360.

The sampling design of the Final s r e as modified from the Baseline s r e The Baseline


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3.4. Training

3.4.1. Core Team Training

The RI project team assembled a Core Team to oversee survey trainings and data collection. The

Core Team consisted of six persons: the Healthy Start Projects manager, training coordinator,

and Monitoring and Evaluation Officer; the Konni District Communications Officer, and

representatives of the Konni agricultural office and the local NGO Community Development

Office. The Core Team prepared for the trainings and data collection by reviewing the purposeand methodology of the Final KPC Survey; reviewing and adapting the questionnaire for use in

training exercises; and finalizing logistical arrangements and the activities budget.

RIs project team worked with the Core Team to plan the survey training and implementation to

meet budgetary and time constraints stemming from a project budget realignment process

conducted in end summer 2011. The budget realignment process delayed the transfer of a

project funds wire to Niger until only a few weeks before the end of the project funding period.The team worked within the revised budget by apportioning remaining funds among the Final

KPC Survey, Final Evaluation and project costs. The budget for the survey and data

management is included as Appendix 8.

The team addressed the challenge of a compressed timeline by conducting focused trainings of

two days duration for a Training of Enumerators Trainers and two days for a Training of

Enumerators. To save time and to ensure the quality of the survey results, the Core Team also

decided to recall survey trainers and enumerators who had participated in the Baseline KPC

Survey in 2008.

3 4 2 T i i f E t T i


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identified enumerators with experience in taking anthropometric measurements to establish five

specialized teams for field anthropometric data collection. The supervisors met with the RI

project manager and the Core Team at the end of each day for feedback and to finalize plans for

the survey implementation. The training was a collaborative effort. The agenda for the training

of enumerators is included as Appendix 10.

3.5. Data collection

Six teams of enumerators collected data for five days. ( Sept 18-22) Each team was composed offour enumerators, one measurer and one supervisor. Each day, a team covered one cluster and

filled out 12 questionnaires. At the end of the data collection, the teams had completed a total of

360 questionnaires.

The supervisors were responsible for the selection of the starting household and survey direction.

Information and approval from village authorities were received before data collection

commenced, facilitating easy access to households. The team took daily round trips to Konnibecause of the clusters proximity. The team adapted a two-level quality control which included

a daily check of questionnaires by the team supervisor. Questionnaires were completed and

collected on a daily basis, and then reviewed again in the evening. This quality assurance

process was in place to detect and address recurrent errors. Each team was supervised at least

twice by a member of the Core Team.

3.6. Data analysis

The survey data management team was comprised of one staff person from the MOH health

information systems office, one project monitoring and evaluation officer, and the RI project

manager. The team entered data into Epi Info 7 software and transferred on SPSS for


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Some mothers prenatal consultation cards were not filled out even though their

childrens vaccinations were confirmed by the village workers registers and the mothers

recall.

Anthropometric weight-for-height measurements were done by a single team of six

measurers, which increased the risk of measurement errors.

Anthropometric weight measurements may have been biased. For children who were

aged under one month, or were too small or sick to be weighed, anthropometric weight

measurements were replaced by birth weight in the Child Cards or were by the weights of

same-aged children who were known either by recall or in the Child Health Cards.

Data analysis:

During data analysis, the data management team realized that two questionnaires

were missing for a remote cluster. The team did not have any practical option for

returning to the missed villages to complete the missing questionnaire.

Lack of time for data verification resulted in missing data in some questionnaires.

4. RESULTS

This section presents the findings of the Final knowledge, attitude and coverage survey that was

conducted in the Konni District, Niger. This section also compares the results between the Final

and Baseline KPC Surveys.

4.1. Final KPC Rapid CATCH indicators

Table 2 summarizes the indicators measured in the Final KPC Survey. Values listed in bold-faced font are statistically significantly different from values recorded by the Baseline KPC

Survey.


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INDICATOR

NUMERAT

OR

DENOMINAT

OR VALUE

CONFIDEN

CE LIMITS

breastfed during the last 24 hours

5.% of infants and young childrenage 6-23 months fed according to aminimum of appropriate feedingpractices

147 251 58.6% 50.067.2%

6. Percentage of children age 6-23months who received a dose ofVitamin A in the last 6 months(Mothers recall)

184 251 73.3% 65.681%

7. Percentage of children age 12-23months who received a DPT1vaccination before they reached 12months

94 120 78%

8. Percentage of children age12-23

months who received a DPT3vaccination before they reached 12months

49 120 40.8% 28.453.2%

9. Percentage of children age 12-23months who received a measlesvaccination according to thevaccination card or mothers recallby the time of the survey

94 189 49.7% 39.659.8%

10. Percentage of children age 0-23months with a febrile episode duringthe last two weeks who weretreated with an effective anti-

l i l d ithi 24 h ft

144 212 67.9% 59.076.8%


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INDICATOR

NUMERAT

OR

DENOMINAT

OR VALUE

CONFIDEN

CE LIMITS

15. Percentage of mothers ofchildren 0-23 months who live in ahousehold with soap or a locallyappropriate cleanser at the place forhand washing

85 358 23.7% 17.529.9%

16. Percentage of children 0-23

months who are underweight

145 350 41.4% 33.848.7%

4.2. Demographic characteristics

Table 3. Age of children under 24 months

AGE FREQUENCY PERCENT

0 to 5 months 107 30.0%

6 to 11 months 95 26.5%12 to 23 months 156 43.6%

Total 358 100.0%

Table 4. Sex of children under 24 months

SEX FREQUENCY PERCENT

Female 137 45.7%

Male 163 54.3%

Total 358 100.0%

4.3. Maternal and newborn care


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28

Health Post worker

.0%

5461

1Doctor/Nurse/Midwife

PERCENT

FREQUENCYBIRTH ASSISTANT

BIRTH

ASSISTANT FREQUENCY PERCENTDoctor/Nurse/Midwife

150 42%

Health Post worker 28 8%


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(TBAs, ormatrons) even though they are not considered as skilled personnel. The project has

devoted a considerable level of effort to sensitization activities to teach TBAs about their new

role as companions to delivery. Some of health post workers are nurses, but may not be

known as such by respondents.

Table 6. Home delivery by Traditional Birth Attendant (TBA)

HOME DELIVERY BY TBA FREQUENCY PERCENT

Yes 67 47.2%No 75 52.8%

Total 142 100.0%

More than half of deliveries assisted by TBAs (matrons) occurred in health centers (75/142).

This is a well-known practice, particularly in integrated health centers and district hospitals,

where matrons work night shifts under the supervision of a midwife. Officially, matrons are

expected in those centers to only accompany parturient women to the maternity ward and help

mothers in the post-partum wards. In reality, the matrons continue to assist deliveries when

midwifes rest during night shifts.

Table 7. Delivery at health center or homeDELIVERY LOCATION FREQUENCY PERCENT

Health center 213 59.7%

Home 144 40.3%

Total 357 100.0%

60% of deliveries take place in health centers, doubling the baseline measurement (29%). The

H l h S P j i i i h l h d li d i


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delivery kit to each health center. The kit includes a cloth of two yards in length for wrapping

newborns, a razor blade for cutting the umbilical cord, gloves, and soap. While 60% of

deliveries occurred in health centers, approximately 16% of kits were used either at home or

elsewhere.

Table 6. Post-natal check for mother within first week

TIME OF MOTHERS

POST-NATAL CHECK FREQUENCY PERCENT

Hour 1 159 79.1%

Day 1 19 9.5%

Week 1 3 1.5%

Did not know 20 10.0%

Total 201 100.0%

Back Forward Current Procedure

Q27 FrequencyPercent Cum Percent

Heure1 159 79,1% 79,1%

jour1 19 9,5% 88,6%
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88.6% (178/201) of mothers who delivered in health centers received a post-natal check within

the first week and 80% of them were checked the day after delivery. who with 213 The total

number of the respondents matches delivered in Health Center.=

Only 29 mothers were able to identify the health personnel who performed the post-natal check.

Half of them (51%) were done by a health post worker. Midwives performed four post-natalchecks doctors performed two checks. It appears that doctors and midwives are more

recognizable or may be more communicative with mothers than nurses or health post workers,

since the number of deliveries assisted by midwives and doctors are the same for the post-natal

checks.

Table 7. Post-natal check within three days for newborn

POST-NATAL CHECK

FOR NEWBORN FREQUENCY PERCENTYes 34 54.0%

No 29 46.0%

Total 63 100.0%

36% (63/216) of mothers said that their baby was ever checked by the health personnel of the

facility where they delivered. Half of the newborns (38) were checked within the week after

birth. Only 10.6% of children received a post-natal visit within three days after birth, less thanthe baseline value.

4 4 Breastfeeding


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Breastmilk and water 9 * 8.4%

The findings show 72% of children aged under six months were exclusively breastfed. This is a

significant increase compared to baseline value of 36 percent. Exclusive breastfeeding is a cost

-effective child survival intervention, especially in the developing country context of Niger.

4.5. Complementary feeding.

Table 10. Complementary feedingBREASTFEEDING STATUS FREQUENCY PERCENT

Breastfed 138 55%

Not breastfed 8 3%

Did not know 6

Total 15247 58%9

The Final KPC Survey noted that 59% of children at 6-23 months of age were fed appropriate

minimum frequency of meals. Breastfed children were more likely to be fed a minimum

frequency of meals than non-breastfed children (44% or 138/324 vs. 24% or 8/34). In rural

areas, children who are not breastfed after six months are commonly orphans, have sick mothers,

or may have been weaned early.

Below is a verification table (please delete after your verificatio


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No 62 24.7%

Did not know 4 1.0%

Blank 1 0.1%

Total 251 100.0%

Among children at 6-23 months of age, 74% received a dose of vitamin A in the six months

before data collection, which was not a significant increase from the baseline survey (72%).

4.7. Child immunization

Table 11. Possession of vaccination cardHAVING VACCINATION

CARD FREQUENCY PERCENT

Yes, and seen by enumerator 273 76.3%

Did not know 1 0.3%

Not available 68 19.0%

Never had a card 16 4.5%

Total 358 100.0%

73% of mothers possess health or vaccination cards, a significant increase from the baseline

value of 61 percent. The major issue with Health/vaccination card is that they are not filled

mostly by Health personnel. 72% (258/358) of mothers reported vaccinations that are not

recorded on their cards.

Table 12. Children who received Penta 1 or Penta 3PENTA 1/PENTA 3 RECEIVED FREQUENCY PERCENT


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age who had a card that was not available (n=50), had never possessed a vaccination card (n=

11), or and one mother respondent who was unsure if she possessed a card and was classified as

No. If ownership of a vaccination card is not considered in the calculation, the percentage of

children reported to have received Vitamin A increases to 74%.

Table 14. Children receiving BCG vaccination

BCG RECEIVED FREQUENCY PERCENT

Yes 236 65.9%

No 32 8.9%

Did not know 90 * 24.1%

Total 358 100.0%

Overall, 66% of children were reported to have received BCG vaccinations. At baseline, BCG

was provided to 70% of infants under 12 months of age (137/202) and 63% (99/156) of children

at 12-23 months of age. Konni District appears to have a lower proportion of children receiving

BCG than Tahoua Region (72%), according to the 2010 national Nutrition and Child SurvivalSurvey(). Historically, Konni District has experienced low vaccination coverage and recurrent

outbreaks of measles, meningitis.

Table 15. Children receiving measles vaccinationMEASLES VACCINE

RECEIVED FREQUENCY PERCENT

Yes 94 49.7%

No 48 25.4%Did not know 40 * 21.2%

Total 189 100.0%


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4.8. Malaria

Table 16. Children who had malaria and received appropriate treatmentAPPROPRIATE MALARIA

TREATMENT RECEIVED FREQUENCY PERCENTYes 144 67.9%No 72 34.0%Did not know

Total 2162 100.0%

59% (2162/358) of children had fevers in the two weeks prior the survey. An appropriate

antimalarial (Artemisinin-based combination therapy, Fansidar, chloroquine, or amodiaquine)

was provided to 68% of children within 24 hours of the onset of the fever4.

4.9. Nutritional Status

Figure 2. Nutritional status of children


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infant disease, child immunization, and water and sanitation; and, (2) a deterioration in the

nutritional status of children in the project area.

5.1. Key findings and programmatic implications

Indicator 1. Percentage of mothers with children age 0-23 months who

received at least two Tetanus toxoid vaccinations before the birth of their

youngest child

A significantly increased proportion (81% vs. 28.8% at baseline) of mothers with children at 0-

23 of age had received at least two doses of Tetanus Toxoid (TT) vaccine before the birth of their

youngest child. (A table comparing indicators from the Final and Baseline KPC surveys in

included as Appendix 11.) The Final result exceeded the End of Project (EOP) target of 40%.

The indicator is higher than in Tahoua Region (62.1%)().

The increase may be linked to an increased utilization of antenatal consultation and maternalhealth services. Despite several vaccine stock-outs during the four year project period, the

Government of Nigers 2008 policy of free mother and child care and the Healthy Starts

community sensitization activities may also have contributed to the increased utilization of

services. The survey found that 73% of mothers possessed health/vaccination cards, and that

60% of mothers gave birth in health centers. The project area showed a higher correlation of

completed ANC/TT visits and subsequent births in health facility than the 2010 National Child

Survey, which who showed that despite a significant increase of Antenatal visits (55% in TahouaRegion), deliveries in health facilities were uncommon (31%).

Indicator 2 Percentage of children age 0 23 months whose births were attended by skilled


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natal check-ups, it should be noted that the responses rate in the Final KPC is low. Even though

60% (201/358) of mothers answered positively that they were checked after delivery, only 29

mothers were able to identify who assisted her during the delivery.

Indicator 4.Percentage of children age 0-5 months who were exclusively breastfed during the

last 24 hours

The survey has noted a significant increase (72% vs. 36%) in the proportion of children at 0-5

months of age who were exclusively breastfed during the 24 hours prior to the survey. This is

more than twice the proportion of 26.9% found by the national-level Nutrition and Child

Survival Survey of June 2010. The KPC Final Survey results support the observations made in

the Healthy Start Project MTE Evaluation that breastfeeding behavior has increased in the

project area.

Indicator 5.Percent of infants and young children age 6-23 months fed according to a minimum

of appropriate feeding practices

50 % of children at 6-23 months of age who were fed according to a minimum of appropriate

feeding practices (147/251). This a significant increase over the baseline estimate of 36%.

Indicator 6.Percentage of children age 6-23 months who received a dose of Vitamin A in the

last 6 months (Mothers recall)

According to mothers recall, 74% of children at 6-23 months of age received a dose of VitaminA in the six months prior to the survey, a significant increase over the baseline (10%). When

excluding responses from mothers whose cards did not show a precise date for when Vitamin A


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51% of children received measles vaccination, a significant increase over the baseline value of

38% and exceeding the EOP target of 40%.

Indicator 10.Percentage of children age 0-23 months with a febrile episode during the last two

weeks who were treated with an effective anti-malarial drug within 24 hours after the fever

began

Indicator 11.Percentage of children age 0-23 months who slept under an insecticide-treated

bed net the previous night

The Survey found a significant improvement in the prevention and treatment of malaria. Use of

67.9% of children who had experienced a febrile episode two weeks before the survey had been

treated with an appropriate antimalarial, a significant increase over the baseline (17.6%) and

exceeding the EOP target of 40%. Furthermore, 77.3% of children had slept under a bednet,

compared to 40.0% at baseline, exceeding the EOP target of 60%.

Despite public sector stock outs of nets during the project period the Healthy Start Projects

timing of behavior change activities around peak malaria transmission periods (rainy seasons)

and an increased availability of bednets in the communities may have contributed to these

positive results.

Indicator 12.Percentage of children age 0-23 months with diarrhea in the last two weeks who

received oral rehydration solution (ORS) and/or recommended home fluids

49.7% of children received ORS when they had diarrhea, a significant increase from the baseline

value of 17.5%, but below the EOP target of 70%. ORS coverage might be improved through


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75.4% of households treat water effectively, a significant increase from 15.2%. The projects

behavior change messages included locally- and culturally-appropriate methods for protecting

water quality.

Indicator 15.Percentage of mothers of children 0-23 months who live in a household with soap

or a locally appropriate cleanser at the place for hand washing

23.7% of mothers of children at 0-23 months of age live in houses with soap or cleanser at the

place for hand washing, a significant increase from the baseline value of 11.5%.

The promotion of hand washing was a challenging activity for several reasons. The project

adopted a gradual introduction of BCC packages, so hand washing messages were introduced in

Year 2 and did not benefit from as much time for sensitization as did maternal and newborn care

or breastfeeding. Second, the placement of soap at an appropriate point of use is highly

culturally dependent. Soap is usually used in the bathing area and for prayer ablution. People

instead wash their hands using a kettle, without soap. Soap and detergent cannot be left in theopen air by latrines because birds, hens or domestic animals tend to displace or spoil them, nor

kept in a container because they can easily melt or dilute in the midday heat. Not least, soap and

detergent are costly, so the project launched training for women volunteers in soap production

during the last quarter of implementation period (April-June 2010). Village residents expressed

interest in continuing the activity.

Indicator 16.Percentage of children 0-23 months who are underweight

41.7% (145/350) of children at 0-23 months of age were measured to be underweight (having a

weight for age measurement that is -2 standard deviations from the median weight for age,


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young children by two-thirds by 2015, but there has been no change in under nutrition, and total

mortality rates are still high among young children().

6. CONCLUSION:

The Results of the Final KPC survey in the Konni District showed that Knowlegde, practices

has improved in maternal and child Health in Konni District in general and challenges in thenutritional status( underweight) of children. The District management Team has a useful tool for

refining the projection of Maternal and child Health indicators targets of the new 4 yearsDistrict

Health Developpement Plan ( 2011-2016).


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7. BIBLIOGRAPHY

Institut National de la Statistique. (2010).Nutrition and Child Survival Survey among childrenaged 6 to 59 months. Niger, May - June 2010. Niamey: Institute National de la

Statistique-Niger/UNICE/WFP/HKI.Ministry of Health. (2005).Konni Health District Development Plan 2005-2010. Konni City:Government of Niger.

Ministry of Health. (2008).National Child Survival Strategy (Avant-projet de Stratgie Nationalde Survie de lEnfant). Niamey: Republic of Niger-Ministry of Health.

Ministry of Health. (2011).National Nutritional Plan 2011-2015 (Plan National pour laNutrition PNN 2011-2015). Niamey: Republic of Niger- Ministry of Health.

Ministry of Health. (2011).Plan de Developpement Sanitaire du Niger. Niamey: Republic ofNiger-Ministry of Health.

Relief International. (2008).FY1 Annnual Report. Los Angeles: Relief International.Tilford, K. (March 2010). Child Survival Mid-term Evaluation Report. Los Angeles: Relief

International/USAID.UNDP. (2011).Niger Country Profile: Human Development Indicators. Retrieved September

30, 2011, from International Human Development Indicators:http://hdrstats.undp.org/en/countries/profiles/NER.html

Unicef. (2010, March 2).At a glance: Niger. Retrieved December 22, 2011, from unicef:http://www.unicef.org/infobycountry/niger_statistics.html

United Nations Population Fund. (2011). State of the World's Midwifery. Geneva: UNFPA.Whueler, S., & Biga, A. (2011). Situational analysis of infant and young child nutrition.

Maternal and Child Nutrition 7 (Suppl. 1), 133156.


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Appendix 1. Survey personnel

The following people were instrumental in bringing the Final KPC Survey and report to a

successful completion:

CORE TEAM

NAME ORGANIZATION PHONE CONTACTSalissou Iliassou Drection

DepartementaleP/Amenagem

ent du

Territoire/Developpement

Communautaire Konni

96 87 94 64

Abouzeidi Chouhabou DS Konni 96 87 89 38Dr Soumana Oumarou MPDL Konni 96 08 11 33

Dr Mahaman Hallarou RI 96 29 27 84Moustapha Tcharimi RI 96 88 33 75Rakia Azouma RI 96 87 66 43Remi Sugurono Consultant 90 61 22 27

SURVEY SUPERVISORSNAME ORGANIZATION PHONE CONTACT

Abouzeidi Chouhabou DS Konni 96 87 89 38

Ali Hantchi DDP/AT/DC Konni 96 59 07 60Ary Issaka Ousmane Jeunesse Sport Konni 98 09 19 04Garba Nana Haouaou ISCV Konni 90 79 09 60Kamay Goga Alphabtisation 96 88 76 92


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Dakaou Alio Sociologist 96 46 73 34Fatimatou Issaka Bilali Nurse 96 26 75 84


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NAME PROFESSION PHONE CONTACTGarba Kano Retired teacher 96 97 29 14Hadiza Ibrahim Rural development specialist 97 28 74 80Hassane Almou Amadou Animateur 90 04 12 63Ibrahim Gado Professor 98 74 37 40Ibrahim Maman Sani Professor 96 46 66 01

Ibrahim Oumarou Student 96 52 95 02Ibro Mahamadou Animateur 96 07 69 59Maman Fati Idi Planning agent 98 58 42 66Mato Touraki Journalist 96 75 89 77Mohamed Abolbol Sociologist 96 98 08 66Moussa Abdou Extension agent 90 57 95 34Moussa Jean Traor Sociologist 91 71 50 83Oumarou Djibo Teacher 96 01 43 04Oumarou Ibrahim Student 96 02 76 40

Salamatou Habou Journalist, Radio Anfani 96 06 42 47Salifou Moumouni Kadidja Sociologist 96 58 04 76Salissou Dan Nana Sociologist/ Municipal agent 91 36 34 32Souley Hamidine Sociologist 96 40 20 88


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Appendix 2. Maps of Niger and Konni District

Map 1. Niger regions5


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Map 2. Konni Department6


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Appendix 3. Survey Steering Committee invitation letter

Reprsentation au NigerTl. : (227) 20 35 08 79 / 21 76 74 69 Fax 20 64 00 29

BP : 12 245 NIAMEY

Mr. Noble Williams

USAID Program Manager

USAID Office Niamey, Niger

Reference: USAID CA # GHS-A-00-0-00028-00 ,Niger Child Survival Project

Dear Mr. Williams,

Thank you for the opportunity to inform you that under the referenced project, Relief International (RI) is

planning to carry out a Final Evaluation that will enable the Ministry of Health, the local community, and

RI to verify achievements towards the project objectives. Planned evaluation activities are participatoryand we are expected to invite donors and partner organizations including USAID to participate in the

evaluation activities in Konni district.


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Appendix 4. Questionnaire (English)Ask the mother if she has a child under 24 months who lives with her. If yes, proceed with interview, if no thank themother and end the interview.

IdentificationCluster NumberHousehold NumberRecord NumberCommunity

Name of MotherName of SupervisorData Entered by Date: ___/___/____

day/month/year

1 2 3 Final VisitInterview date ___/___/____

day/month/year___/___/____day/month/year

___/___/____day/month/year

For SupervisorDay

Name of Interviewer MonthYear

Result Code* Result Code*Result Codes:

1. Completed2. Respondent not at home3. Postponed4. Refused5. Other______________________________________

Specify

Consent

INFORMED CONSENT

Hello. My name is ______________________________, and I am working with Relief International and MSP. We are

conducting a survey and would appreciate your participation. I would like to ask you about your health and the health ofyour youngest child under the age of two. This information will help Relief International and MSP to plan health servicesand assess whether it is meeting its goals to improve childrens health. The survey usually takes _______ minutes tocomplete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.


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Questionnaire

ALL QUESTIONS ARE TO BE ADDRESSED TO MOTHERS WITH A CHILD LESS THAN 24 MONTHS OF AGE

IntroductionNo. Questions and Filters Coding Categories Skip

1 How many children do you have?Total number of children

2 What is the name, sex, date of birth of your

youngest child that you gave birth to and that isstill alive?

Youngest Child

Name _______________________________

SexMale....1

Female.......2

Date of Birth

Day

Month

Year

Tetanus Toxoid Immunization

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

3 During pregnancy with (NAME) did you receive aninjection in the arm to prevent the baby from gettingtetanus, that is, convulsions after birth?

Yes.....................................................................1No......................................................................2Dont know.........................................................9

45 5

4 While pregnant with (NAME), how many times did youreceive such an injection? Times.............. ............................ .................. ...... .


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Skilled attendance and clean cord care


7 Who assisted you with the delivery of (NAME)?

Anyone else?

PROBE FOR THE TYPE(S) OF PERSON(S) ANDRECORD ALL MENTIONED.

IF RESPONDENT SAYS NO ONE ASSISTED,PROBE TO DETERMINE WHETHER ANY ADULTSWERE PRESENT AT THE DELIVERY.

HEALTH PERSONNELDOCTOR........................................................ANURSE or MIDWIFE......................................BAUXILIARY MIDWIFE...................................COTHER HEALTH STAFF WITHMIDWIFERY SKILLS....................................D

OTHER PERSONTRADITIONAL BIRTH ATTENDANT.............ECOMMUNITY HEALTH WORKER................FRELATIVE/FRIEND.......................................GOTHER___________________....................H

(SPECIFY)

NO ONE............................................................Y

8 Was a Clean Delivery Kit used during delivery?(SHOW DELIVERY KITS LOCALLY PROMOTED)

Yes....................................................................1No......................................................................2Dont know.........................................................9

10 9 9

9 What instrument was used to cut the cord? New razor blade................................................1New and boiled razor blade..............................2

Used razor blade...............................................3

Used and boiled razor blade.............................4

New scissors.....................................................5

New and boiled scissors....................................6

Used scissors....................................................7

Used and boiled scissors..................................8

Knife..................................................................9

Reed................................................................10

Other ____________________.....................96(Specify)

D t k 97


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Drying and wrapping after birth


13 Was (NAME) dried (wiped) immediately after birthbefore the placenta was delivered?

Yes....................................................................1No......................................................................2Dont know.........................................................9

14 Was (NAME) wrapped in a warm cloth or blanketimmediately after birth before the placenta wasdelivered?

Yes....................................................................1No......................................................................2Dont know.........................................................9

Breastfeeding/ Infant and Young Child Feeding15 Did you ever breastfeed (NAME)? Yes....................................................................1No......................................................................2

16 19

16 How long after birth did you first put (NAME) to thebreast?

IF LESS THAN 1 HOUR, RECORD 00 HOURS,IF LESS THAN 24 HOURS RECORD THE HOURS,OTHERWISE RECORD DAYS

IMMEDIATE....................................................00

HOURS................................................................

DAYS...................................................................

Dont remember.................................................917 During the first three or four days after delivery,

before your regular milk began flowing, did you give(NAME) the liquid (colostrum) that came from yourbreasts?

YES ..................................................................1

NO ..................................................................2

DONT KNOW .................................................918 In the first three days after delivery, was (NAME)

given anything to drink other than breast milk?YES .................................................................1

NO ..................................................................2

DONT KNOW .................................................919 Now I would like to ask you about liquids or foods

(NAME) had yesterday during the day or at night.

Did (NAME) drink/eat:

READ THE LIST OF LIQUIDS (A THROUGH E,STARTING WITH BREAST MILK).

Milk of animalsPowdered milksimple water

sugar waterSalt water sweetenedDcoctions. / infusionsFruit juicehoney


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22

22A

22B

22C

22D

22E

22F

PLEASE FILL OUT THE FOLLOWING TABLE WITHTHE ANSWERS TO THE QUESTIONS BELOW:Now I would like to ask you about (other) liquids orfoods that (NAME) may have had yesterday duringthe day or at night. I am interested in whether yourchild had the item even if it was combined with otherfoods.

Did (NAME) drink/eat:

CHECK THE BOX IF THE CHILD drank the liquid inquestion.

Breast milk?

Water Plate?

Milk powder sold in commerce?

Milk as in any other box, powder, fresh milk oranimal?

Fruit juice?

Other liquids such as sugar water, tea, coffee, softdrinks or broth?

A............................................

B............................................

C............................................

D............................................

E............................................

F............................................


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22G

22H

22I

22J

22K

22L

Now I would like to ask you about the types ofaliments4 that [NAME] ate yesterday during theday or night.

Does [NAME] ate the following foods during theday or last night?

Check the box if the child to eat the food inquestion.

Foods made of seeds [eg, millet, sorghum, maize,rice, wheat, boiled, or other local seeds]?

Pumpkin, red or yellow yams or squash, carrots or

sweet potatoes red?

Any other food from roots or tubers [eg, potatoes,white yams, cassava and other roots / tubers local]? 5

Of green leafy vegetables?

Mango, papaya [or other local fruits rich in Vitamin

A]?

Other fruits and vegetables [eg, bananas, apples /applesauce, avocados, tomatoes]?

G............................................

H............................................

I.............................................

J.............................................

K............................................


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23 How many times did (NAME) eat solid, semi-solid, orsoft foods other than liquids yesterday during the dayor at night?

IF CAREGIVER ANSWERS SEVEN OR MORETIMES, RECORD 7

WE WANT TO FIND OUT HOW MANY TIMES THE

CHILD ATE ENOUGH TO BE FULL. SMALLSNACKS AND SMALL FEEDS SUCH AS ONE ORTWO BITES OF MOTHERS OR SISTERS FOODSHOULD NOT BE COUNTED.

LIQUIDS DO NOT COUNT FOR THIS QUESTION.DO NOT INCLUDE THIN SOUPS OR BROTH,WATERY GRUELS, OR ANY OTHER LIQUID.

USE PROBING QUESTIONS TO HELP THERESPONDENT REMEMBER ALL THE TIMES THECHILD ATE YESTERDAY

Number of Times

Dont Know .9

24 Can I see the salt used for cooking? 6TAKE A teaspoon of SALT and test it for iodine.

IODINE PRSENT 1IODINE NOT PRSENT...................................2

25 Has (NAME) received a dose of Vitamin A like this inthe past six months? 7BULB SHOW / CAPSULE / SYRUP.

YES 1NO 2DONT KNOW...................................................8

Postpartum visit (for mother)26 Where did you give birth to (NAME)? HOME (own or other)........................................1

HEALTH FACILITY (public sector or private) . .2

33

27

27 After (NAME) was born, before you were discharged,did any health care provider check on your health? Yes.....................................................................1No......................................................................2

28 30

28 How long after delivery did the first check take place?HOURS................................................................


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31 How long after delivery did the first check take place?

IF LESS THAN ONE DAY, RECORD HOURS.IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS................................................................

DAYS...................................................................

WEEKS................................................................

DON'T KNOW.................................................99


32 Who checked on your health at that time?

PROBE FOR MOST QUALIFIED PERSON.

HEALTH PERSONNELDOCTOR...........................................................ANURSE or CLINICAL OFFICER.......................BMIDWIFE..........................................................CAUXILIARY.......................................................D

OTHER PERSONTRADITIONAL BIRTHATTENDANT.....................................................EHEALTH WORKER...........................................FTRAINED TBA .................................................GTRAINED HW...................................................H

OTHER..............................................................Z(SPECIFY)

33 After (NAME) was born, did any health care worker ora traditional birth attendant check on your health?

Yes.....................................................................1

No......................................................................2

34

42

34 How long after delivery did the first check take place?

IF LESS THAN ONE DAY, RECORD HOURS.

IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS................................................................

DAYS...................................................................

WEEKS................................................................

DON'T KNOW.................................................99

42


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37 How many hours, days or weeks after the birth of(NAME) did the first check of (NAME) take place?

HOURS................................................................

DAYS...................................................................

WEEKS................................................................

DON'T KNOW.................................................99


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38 Who checked on (NAME)s health at that time?



OTHER PERSONTRADITIONAL BIRTH

ATTENDANT.....................................................EHEALTH WORKER...........................................F

OTHER..............................................................Z(SPECIFY)

39 After you were discharged, did any health careprovider or a traditional birth attendant check on(NAME)s health?

Yes.....................................................................1

No......................................................................2

40

4540 How many hours, days or weeks after the birth of

(NAME) did the first check of (NAME) take place?

IF LESS THAN ONE DAY, RECORD HOURS.IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS................................................................

DAYS...................................................................

WEEKS................................................................

DON'T KNOW.................................................9941 Who checked on (NAME)s health at that time?





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44 Who checked on (NAME)s health at that time?




OTHER..............................................................Z(SPECIFY)

Childhood Immunization


45 Did (NAME) take a vitamin A dose like this during the last 6 months?

SHOW AMPULE/CAPSULE/SYRUP.

YES................................................................1NO.................................................................2DONT KNOW...............................................8

46 Do you have a card where (NAMES) vaccinations are written down?

IF YES: May I see it please? YES, SEEN BY INTERVIEWER...................1NOT AVAILABLE/LOST/MISPLACED..........2NEVER HAD A CARD...................................3DONT KNOW...............................................8

47 49 49 49

47 (1) COPY VACCINATION DATE FOR EACH VACCINE FROM THECARD.

(2) WRITE 44' IN DAY COLUMN IF CARD SHOWS THAT AVACCINATION WAS GIVEN, BUT NO DATE ISRECORDED. DAY MONTH YEAR

DPT 1

D D M M Y Y Y Y


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50

50A

50B

50C

50D

50E

50F

50G

Please tell me if (NAME) received any of the following vaccinations:

A BCG vaccination against tuberculosis, that is, an injection in the armor shoulder that usually causes a scar?

Polio vaccine, that is, drops in the mouth?

When was the first polio vaccine received, just after birth or later?

How many times was the polio vaccine received?

DPT vaccination, that is, an injection given in the thigh or buttocks,sometimes at the same time as polio drops?

How many times?

=======================================

In Rapid CATCH:An injection in the arm to prevent measles?

=======================================

YES 1

NO 2

DONT KNOW 8

YES 1

NO 2

DONT KNOW 8

JUST AFTER BIRTH 1

LATER 2

NUMBER OF TIMES |___|___|

YES 1

NO 2

DONT KNOW 8

NUMBER OF TIMES |___|___|

===========================

YES 1NO 2

DONT KNOW 8

==========================

43C 43E 43E

43F

43G 43G


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54 At any time during the illness did (NAME) takeany drugs for the fever?

Yes..1

No...2

Dont know.9

55

56

56

55 What drugs did (NAME) take?Any other drugs?RECORD ALL MENTIONED.

ASK TO SEE DRUG(S) IF TYPE OF DRUGIS NOT KNOWN. IF TYPE OF DRUG ISSTILL NOT DETERMINED, SHOW TYPICALANTIMALARIAL DRUGS TO RESPONDENT**COUNTRY SPECIFIC BASED ONNATIONAL MALARIAL PROTOCOL.

FOR EACH ANTIMALARIAL MEDICINEASK: How long after the fever started did(NAME) start taking the medicine?

CIRCLE THE APPROPRIATE CODES:SAME DAY = 0NEXT DAY AFTER THE FEVER = 1TWO OR MORE DAYS AFTER THE FEVER= 2DONT KNOW = 9

ANTI-MALARIAL

A. SP/Fansidar...0 1 2 9

B. Chloroquine0 1 2 9

C. Amodiaquine..0 1 2 9

D. Quinine....0 1 2 9

E. ACT..0 1 2 9

OTHER DRUGS

F. ASPRIN.0 1 2 9

G. PARACETAMOL0 1 2 9

X. Other...0 1 2 9

56 What causes malaria?RECORD ALL MENTIONED.

Anything else?

MOSQUITO BITES.....................................AWITCHCRAFT............................................BINTRAVENOUS DRUG USE .....................CBLOOD TRANSFUSIONS..........................D

INJECTIONS ..............................................ESHARING RAZORS/BLADES.....................FKISSING.....................................................G

OTHER W


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Malaria Insecticide-treated Net use


59 Does your household have any mosquito netsthat can be used while sleeping?

Yes.....1

No...2

60

64

60 Who slept under a bed net last night?

If ANYONE OTHER THAN THE CHILD ISMENTIONED, RECORD OTHER.

No One...0

Child (NAME)..1Other ..........2

64

61 57

61 Which brand of bed net did (NAME) sleepunder last night?

SHOW PICTURES OF TYPICAL NET TYPESAND BRANDS.

Permanent Net

Brand A............................................1

Brand B..2

Pretreated NetBrand C.....3

Brand D.....4

Other Net

Other N et .......5

Dont know brand.9

64

64

62

62

62

62

62 Was the bed net that (NAME) slept under lastnight ever soaked or dipped in a liquid treatedto repel mosquitoes or bugs?

Yes1

No..2

63

64


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OTHER_________________ X


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NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP66 When (NAME) had diarrhea, did you breastfeed him/her less than

usual, about the same amount, or more than usual?LESS..........................................................1SAME.........................................................2MORE........................................................3CHILD NOT BREASTFED.........................4DONT KNOW............................................8

67 When (NAME) had diarrhea, was he/she offered less than usual todrink, about the same amount, or more than usual to drink?

LESS..........................................................1SAME.........................................................2

MORE........................................................3NOTHING TO DRINK................................4DONT KNOW............................................8

68 Was (NAME) offered less than usual to eat, about the same amount, ormore than usual to eat?

LESS..........................................................1SAME.........................................................2MORE........................................................3NOTHING TO EAT....................................4DONT KNOW............................................8

69 Did you seek advice or treatment from someone outside of the homefor (NAMES) diarrhea?

YES............................................................1NO..............................................................2

70 74

70 Where did you first go for advice or treatment?

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITETHE NAME OF THE PLACE.

_______________________________________________________(NAME OF PLACE)

HEALTH FACILITYHOSPITAL............................................01HEALTH CENTER................................02HEALTH POST.....................................03PVO CENTER......................................04CLINIC..................................................05FIELD/COMMUNITY HEALTH

WORKER.........................................06OTHER HEALTH

FACILITY____________ 07(SPECIFY)

OTHER SOURCETRADITIONAL PRACTITIONER..........08SHOP....................................................09PHARMACY.........................................10COMMUNITY DISTRIBUTORS 11


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72 Where did you go next for advice or treatment?

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITETHE NAME OF THE PLACE.

______________________________________(NAME OF PLACE)

HEALTH FACILITYHOSPITAL............................................01HEALTH CENTER................................02HEALTH POST.....................................03PVO CENTER......................................04CLINIC..................................................05FIELD/COMMUNITY HEALTH

WORKER.........................................06

OTHER HEALTHFACILITY _______________ 07(SPECIFY)

OTHER SOURCETRADITIONAL PRACTITIONER..........08SHOP....................................................09PHARMACY.........................................10COMMUNITY DISTRIBUTORS............11FRIEND/RELATIVE..............................12

OTHER ___________________ 88

(SPECIFY)

73 During the period when (NAME) was recovering from diarrhea, did yougive him/her less than usual to drink, about the same amount, or morethan usual to drink?

LESS..........................................................1SAME.........................................................2MORE........................................................3NOTHING TO DRINK................................4DONT KNOW............................................8

ORS preparation

74 Have you heard of ORS?

IF YES, ASK MOTHER TO DESCRIBE ORS PREPARATION FORYOU.IF NO, CIRCLE 3 (NEVER HEARD OF ORS).

ONCE MOTHER HAS PROVIDED A DESCRIPTION, RECORDDESCRIBED CORRECTLY.......................1DESCRIBED INCORRECTLY...................2


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77 Did you seek advice or treatment for thecough/fast breathing?

Yes1

No..2

78

79

78Who gave you advice or treatment?Anyone else?

RECORD ALL MENTIONED.

Doctor.....A

Nurse...........................B

Auxiliary Nurse.C

Trained Community HealthWorker...D.Other..X

Water and Sanitation

79 Do you treat your water in any way to make it

safe for drinking?

Yes..1

No...2

79

81

80 If yes, what do you usually do to the water tomake it safer to drink?

ONLY CHECK MORE THAN ONERESPONSE IF SEVERAL METHODS AREUSUALLY USED TOGETHER, FOREXAMPLE, CLOTH FILTRATION AND

CHLORINE.

Let it stand and settle/sedimentation....A

Strain it through cloth..B

Boil.C

Add bleach/ChlorineD

Water filter (Ceramic, sand, composite)..E

Solar Disinfection.F

Other X


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82 OBSERVATION ONLY: IS THERE SOAP ORDETERGENT OR LOCALLY USEDCLEANSING AGENT?

THIS ITEM SHOULD BE EITHER IN PLACEOR BROUGHT BY THE INTERVIEWEEWITHIN ONE MINUTE. IF THE ITEM IS NOTPRESENT WITHIN ONE MINUTE CHECK

NONE, EVEN IF BROUGHT OUT LATER.

Soap.................................................................1

Detergent.........................................................2

Ash...................................................................3

Mud/sand.........................................................4

None.................................................................5

Other .............................................................. 6

83

83

85 85

85 85

83 Did you use soap of any kind for any reasonyesterday during the day or night?

Yes.....1

No.2

83

85

84 When you used soap yesterday in the day ornight, what did you use it for?

RECORD ALL MENTIONED. DO NOT READTHE ANSWERS, ASK TO BE SPECIFIC,ENCOURAGE WHAT ELSE UNTILNOTHING FURTHER IS MENTIONED. IFWASHING MY OR MY CHILDRENS HANDSIS MENTIONED,PROBE WHAT WAS THE OCCASION, BUTDO NOT READ THE ANSWERS.

Before food preparation...................................A

Before feeding children...................................B

After defecation...............................................C

After attending to a child who has defecated .D

Other ............................................................ X

Growth Monitoring

85 Was (NAME) weighed at birth? YES..............................................................1NO................................................................2DONT KNOW..............................................8

86 Does (NAME) have a growth monitoring card?


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Child anthropometry

ASK THE MOTHER FOR PERMISSION TO WEIGH AND MEASURE (NAME). IF SHE AGREES TO LET YOUTAKE (NAMES) MEASUREMENTS, RECORD THE NECESSARY INFORMATION IN THE SPACES BELOW. IFTHE MOTHER REFUSES PERMISSION TO MEASURE (NAME), LEAVE COLUMNS 1-4 BLANK AND RECORD

3' [REFUSED] IN COLUMN 5.ASK TO MEASURE EACH OF (NAMES) SIBLINGS UNDER FIVE YEARS OF AGE. RECORD (NAMES)

MEASUREMENT IN THE FIRST ROW.

1

NAME OF CHILD

MEASURE (NAME)FIRST, THEN MEASURE

HIS/ HER BROTHERSAND SISTERS WHO ARE

UNDER AGEFIVE YEARS.

2

WHAT IS HIS/HER DATE OFBIRTH?

COPY DATE OF BIRTHFROM GM CARD, IF

AVAILABLE. IF GM CARD ISNOT AVAILABLE, RECORDDATE OF BIRTH PROVIDED

BY MOTHER.

3

WEIGHT(KILOGRAMS)

4

HEIGHT(CENTIMETER)

5RESULT

1MEASURED

2 NOTPRESENT

3 REFUSED6 OTHER

_______________

PB__________cm (child from 6 months) and PB_________ (mother)

Bilateral edema (child) NO ______YES________

THANK THE MOTHER FOR THE INTERVIEW.


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Appendix 5. Questionnaire (French)Demander a la mere si elle a un enfant age de moins de 24 mois qui vit avec elle. Si oui proceder a linterview. Si Non,remercier la maman et mettre fin linterview.

Identification

Num de la grappe

Num de la concession

Numero d enregistrement

Village

NOM de la mere

NOM du Superviseur

Saisie des donnees par : Date: ___/___/____Jour/mois/annee

1 2 3 Derniere visite

date dInterview ___/___/____ Jour/mois/annee

___/___/____Jour/mois/annee

___/___/____Jour/mois/annee

Du superviseur

jour

NOM de l interviewer Mois

annee

Resultat * Resutat


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CONSENTEMENT ECLAIRE

Bonjour. Je mappelle ______________________________, et je travaille avec Relief International et MSP. Nous effectuons uneenqute laquelle nous souhaiterions que vous participiez. Je voudrais vous poser des questions sur votre sant et sur la sant devotre plus jeune enfant de moins de deux ans. Ces informations seront utiles Relief International et MSP.) pour planifier des servicesde sant et pour valuer sils sont conformes avec les objectifs damlioration de la sant de lenfant. Lenqute prend habituellement60 minutes. Quelles que soient les informations que vous nous fournirez, elles resteront strictement confidentielles et ne serontdivulgues personne..

La participation cette enqute est volontaire et vous pouvez dcider de ne pas rpondre des questions personnelles ou toutes les

questions. Cependant, Nous esprons que vous allez participer cette enqute car ce que vous pensez est dun grand intrt.

Avez-vous maintenant des questions me poser concernant lenqute ?

Signature de lenquteur: ________________________________ Date: ____________________

LENQUTE ACCEPTE DTRE ENQUTE............1 LENQUTE REFUSE DTRE ENQUTE..............................2 FIN


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QuestionnaireTOUTES LES QUESTIONS DOIVENT TRE POSES AUX MRES AYANT UN ENFANT DE MOINS DE 24 MOIS

PrsentationNo. Questions and Filters Coding Categories SAUT

1 Combien denfants avez vous? Nombre total denfant

2 Quelle est le Nom, date de votre derniervivant?

Dernier enfant vivant

NOM _______________________________

sexeMasculin....1

Feminine...........2

Date de naissance

jour

Moisannee

Vaccination antittanique

NO. QUESTIONS AND FILTERS CODING CATEGORIES SAUT

3 Pendant la grossesse de (NOM), avez-vous reuune injection dans le bras pour protger le bb

Oui.....................................................................1Non 2

4 5


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Skilled attendance and clean cord care


7 Qui vous a assist pour laccouchement de(NOM) ?

Autre personne?

INSISTER POUR AVOIR LE TYPE DAGENT .ENREGISTRER TOUTES LES REPONSES

SI LENQUETEE DIT QUE PERSONNE NE LAASSISTER, INSISTER POUR SAVOIR SIAUCUNE AUTRE PERSONNE NASSISTER ALACCOUCHEMENT

AGENT DE SANTEMEDECIN.AINFIRMIERE/SF..BAUXILIAIRE.CAUTRE AGENT DE SANTEQUALIFIE*..D

AUTRE PERSONNESMATRON...EAGENT DE SANTE

COMMUNAUTAIRE...FMEMBRE DE LA FAMILLLE ...G

AUTRE__________.............................H(SPECIFIER)

PERSONNEY

8 Est-ce quon a utilis une trousse propre ou kitdaccouchement ?

(MONTRER LE KIT DACCOUCHEMENT)

Oui1Non...2Ne sait pas..9

10 9 9

9 Quel instrument a-t-on utilis pour couper lecordon ?

Lame de Rasoir Neuve.1

Lame neuve et lame bouillie2

Lame utilisee..3

Lame utilize et lame bouillie.4

Sciseaux neufs...5

Scisseau neuf ou bouillie..6Sciseaux utilise..7

Sciseaux utilize et bouillie8


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Schage et emballage aprs la naissance


13 Est ce que (NOM) a ete essuy ou secherimmediatement aprs sa sortie et avant la sortiedu placenta

Oui ....................................................................1Non....................................................................2Ne sais pas........................................................9

14 Est ce que (NOM) a ete envoloppe dans unecouverture immediatement aprs sa sortie etavant la sortie du placenta

Oui ....................................................................1Non....................................................................2Ne sais pas........................................................9

Allaitement / alimentation du nourrisson et du jeune enfant

15 Avez vous allait (NOM)? Oui ....................................................................1Non....................................................................2

16 19

16 Combien de temps aprs lanaissance avez-vous mis (NOM)

au sein pour la premire fois ?

SI MOINS D'UNE HEURE,NONTER '00' HEURE.SI MOINS DE 24 HEURES, NOTER ENHEURES.AUTREMENT, NONTER EN JOURS.

IMMEDIATE....................................................00

HEURES..............................................................

JOURS................................................................

NE SE SAIT PAS..............................................9

17 Au cours des 3 ou 4 premiers jours apreslaccouchement avant le premier lait,avez vousdonner a (NOM) le colustrum ; un liquide epaisproduit par le sein

OUI ...................................................................1

NON .................................................................2

NE SAIS PAS ...................................................9

18 Dans les 3 jours qui ont suivi la naissance,(NOM) est ce que (NOM) a bu quelque chose

OUI ...................................................................1


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22

22A

22B

22C22D

22E

22F

22G

22H

22I

Maintenant jaimerais vous poser desquestions sur les types de liquides que (NOM)a bus au cours de la journe et de la nuit. Est-ce que (NOM) a bu les liquides suivants hierau cours de la journe ou de la nuit?COCHEZ DANS LA CASE SI LENFANT A BU LELIQUIDE EN QUESTION.

Lait maternel ?

Eau Plate ?

Lait en poudre vendu en commerce ?Tout autre lait tel quen bote, en poudre, ou dulait frais danimal ?

Jus de fruit ?

Autres liquides tels que de leau sucre, du th,du caf, des boissons gazeuses ou du bouillon ?

Maintenant je voudrais vous poser desquestions sur les types daliments4 que

[NOM] a mangs hier au cours de la journeou de la nuit. Est-ce que [NOM] a mang lesaliments suivants au cours de la journe ou dela nuit dhier ? COCHEZ LA CASE SILENFANT A MANG LALIMENT ENQUESTION.

Des aliments base de graines [par exemple, mil,sorgho, mas, riz, bl, bouillie, ou dautres graineslocales] ?

Citrouille, ignames rouges ou jaunes ou de la

courge, des carottes ou des patates doucesrouges ?

Tout autre aliment base de racines ou detubercules [par exemple, les pommes de terre, les

A............................................

B............................................

C............................................

D............................................

E............................................

F............................................

G............................................


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23Combien de fois (NOM) a t-il mang un alimentsemi-solide (broys ou en pure) au cours de la

journe ou de la nuit dhier ?

SI 7 FOIS OU PLUS, ENREGISTREZ 7.

NOMBRE DE FOIS

NE SAIT PAS ........................................8

24Puis-je voir le sel utilis pour la cuisine ?PRENEZ UNE CUILLERE A CAF DE SEL ET

TESTEZ-LE POUR LIODE.

IODE PRESENT........................................1

IODE PAS PRESENT 2

25Est-ce que (NOM) a reu une dose de Vitamine Acomme celle-ci au cours des six derniers mois ?MONTREZ LAMPOULE/CAPSULE /SIROP.

OUI............................................................1

NON...........................................................2

NE SAIT PAS ..8

Visite post-partum (pour la mre)

26 Ou avez vous accouch (NOM)? MAISON (sienne ou autre)................................1

CENTRE DE SANTE (public ou prive) .............2

33

27

27 Aprs la naissance de (NOM) et avant votredepart de lhopital, est que un agent de santevous a examin ?

Oui.....................................................................1

Non....................................................................2

28

30

28 Combien de temps aprs laccouchement lagentde sante est venu vous examiner?

SI MOINS DUN JOUR NONTER EN HEURES,SI MOINS DUNE SEMAINE, NONTER EN JOUR

Heures.................................................................

JOURS.................................................................

SEMAINES..........................................................NE SAIT PAS..................................................99

29 Q i i t? AGENT DE SANTE


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31 Aprs laccouchement, quand est cette visite estintervenu?

SI MOINS DUN JOUR NONTER EN HEURES,SI MOINS DUNE SEMAINE, NONTER EN JOUR

Heures.................................................................

JOURS.................................................................

SEMAINES..........................................................

NE SAIT PAS..................................................99


32 Qui vous a examine en ce temps la?

NONTER LA PERSONNE LA PLUS QUALIFIEE.

AGENT DE SANTEMEDECIN..........................................................AINFIRMIER/CLINICIEN.......................

KPC Report V2 HM Reviewed Jan 14

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