VL IRS COVERAGE ESTIMATE: FINDINGS FOR IRS 2014 (APRIL-JUNE )

VL ELIMINATION PROGRAMCONCURRENT MONITORING AND LEARNING, TSU-BIHAR

Context1

VL theory of change2

Spray coverage3

Quality of spray4

Spray awareness5

Annexures6

Contents

• IRS activity is being done by the spray squads in all VL affected villages in 33 VL affected

districts of Bihar

• CARE is providing supportive supervision to the spray squads under the BMGF funded VL

Elimination Program.

• The supportive supervision is done through KalaAzar Link Workers (KLW) who monitor the

spraying of each spray squad, help them in maintaining the quality of spraying and provide

support on the same.

• However, there is no data collection procedure in place to reliably report the coverage and

quality of spraying.

• This coverage estimate study aspires to provide project level and district level coverage

estimate of VL IRS activity and to determine change in coverage over time.

• Besides coverage of spraying, this study also attempts to provide estimate of quality of spray

related indicators and will track the change in quality over time.

Context – Need for coverage estimate study1

VL theory of change

Effective IRS Reduction in Vector density

Reduction in case incidence

Focus of Coverage Estimate study

Effective IRS is driven by

a) Maximizing coverage of IRS spray in affected areas

b) Spray squads performing high quality sprays in affected areas

c) Awareness generation amongst general population about the importance of IRS sprays

2

Total coverage as per CE study

2,156

# of HHs Partially sprayed

11,880

1,506

7,020

# of HHs Fully sprayed

# of HHs actually sprayed

# of HH visited by IRS squad

# of HHs not visited by IRS

squad

2,178

5,627

# of HHs covered in

sprayed villages

17,50719,013

9,176

Total # of HHs

covered in the survey

526

# of HHs not sprayed

- refusal and other reasons

# of HHs from villages not

sprayed because of termination of

round

IRS coverage as per CE study (# of HHs)

~48% of HHs were actually sprayed by IRS squads (partially or completely) ~37% of HHs were completely sprayed ~18% of the HHs visited by IRS squads (~11% of total HHs) refused for spraying

Partially sprayed

HHs refused to be sprayed

Excluded from spraying

HHs not refused but not sprayed

Consideration set

3

HHs sprayed

Reasons

11%

8%

35%

3%

26%

16%

others

Any male member/head of family was not present

Post Spray there is a very strong foul smell in the house

Some rooms were locked

Food materials were kept in the rooms

It leaves marks/spots on the wall which looks ugly

Portions of house that were partially sprayed

69%

9%

3%

17%

1%

Only outside of the house was sprayed

The cowshed was left unsprayed

The kitchen was left unsprayed

others

Only a few rooms were sprayed; rest left

Note: Total % of responses have been normalized to 100%

Key reasons for Partial spray

Of the total 2156 cases of Partial spray,

3

No Spray (2704 cases)

Refusal (2178 cases) No refusal (other factors) (526 cases)

16%

51%

10%

23%

No adults was present in the house

Other

House Locked

House was under construction

13%

21%9%

1%

27%

17%

11%

Any male member/head of family was not present

It has a strong and foul smell

It increases the problem of leeches

It doesn’t decrease the problem of mosquitoes (increases)

It leavers marks /spots on the wall which looks ugly

Others

It is poisonous can be dangerous to children

Key reasons for No spray3

Note: Total % of responses have been normalized to 100%

Quality of IRS spray is defined basis multiple dimensions based on actions taken by Spray squad

Determining Quality of spray

Dimension Metric for measurement % houses covered

Complete wall exposure

Spraying corners and cracks 42%

Spraying up to height of 6 ft. 41%

Calendars and posters removed before spraying 22%

Neatness of sprayUniformity of spray done by spray squad 39%

No DDT stains left on the walls 30%

Prevention of contamination

Household items moved away at time of spray 38%

Food items/ utensils / fodder covered before spray 35%

Furniture moved at time of spray 22%

4

A

B

C

Note: Denominator = Number of HHs sprayed = 9176 HHs

Parts of house that were sprayed

Varanda sprayed

Cowshed sprayed

32%

38%

68%Separate kitchen sprayed

22%79%

62%

87% 13%

Sprayed

Separate toilet sprayed

Not sprayedCoverage of house parts

Spray quality in house parts

44%

Sprayed

51%

Spray in Cowshed upto 6 ft.

Spray in Varanda upto 6 ft.

4

Maintaining the spray in the wall

• Among the Households sprayed, only 4.7% were told by the spray squads to maintain the

spraying in the wall

• On an average, the spraying was told to be maintained for 3.75 months

• However, 23.1% among them (those who were told by the spray team to maintain the

spraying in the world) did not maintain the spraying, the walls were painted or mud plastered

at the time of the survey

Stencilling• Stencilling has been done outside of 57.9% of the HH

Maintaining spray and stenciling4

Awareness about IRS

Of the total 19013 respondents, only 379 – mere 2% had advance information about IRS

Yes46%No

54%

Informed about correct reason for spray

Yes20%

No80%

Informed about date/ range of date for spray

Yes14%

No86%

Aware of correct reason for doing IRS

Yes41%

No59%

% population told that IRS was done to kill mosquitoes

Others

Mukhiya/ Sarpanch/ Pradhan

29%

6%

7%

9%

2%

40%

6%

Relatives/ Neighbors/ Friends

Link worker

Spray squad member/ supervisor

ASHA/ AWW

Other PRI member

Source of information about IRS

General awareness level about IRS and the reasons for doing the same is poor

5

Denominator = 379

Denominator = 379

Denominator = 19013

Denominator = 19013

• Overall IRS coverage is 48% of total households

– IRS coverage in kuccha and semi pucca houses is 53%

• Major reasons identified for refusal and partial spray of IRS are

I. IRS leaves mark in the wall which is difficult to remove

II. Foul smell of after IRS spray

III. Unwillingness of HH members to remove food items stored in rooms

IV. Absence of male members/ adult members in the house when spray team visited

• Only 5% HHs were advised by spray squads to maintain the spray in the wall

• Stencilling was done in 58% houses

• Only 2% of HH were informed about IRS in advance – Major sources of information were

a) Spray Squad

b) KLWs

c) PRI members/ FLWs were very less in proportion as source of information about IRS

Key takeaways from VL CE study

• To provide district level estimate, sample size per district has been calculated as 800

assuming the following:

– 95% confidence interval

– 5% absolute precision

– For using the most conservative estimate of the population parameter for coverage, we

used 50% as the expected proportion

– Design Effect of 2 to adjust for the clustering.

• Identifying a 10% change in the district level estimates between two consecutive rounds with:

– 80% power

– 95% confidence interval

• Overall sample size calculated at the project level=20,000

Final Sample Size

Final sample size after the end of data collection till mid of August, 2014 is 19013. Data collection

in a few districts could not be completed because of late start of IRS rounds in those districts

Annexure: Sample size 6

• Out of 38, total 24 districts were chosen excluding

‒ those districts where no Kala Azar cases were found and

‒ those districts where total number of Kala Azar affected villages were less than 40 (to

avoid complete subject selection)

• From each selected district, 40 villages were selected using Probability Proportional to

Size(PPS) method from the list of all Kala Azar affected villages in that district.

• From each selected villages, 20 Households (HH) were selected.

• The remaining 9 Kala Azar affected districts (where no. of affected villages < 40) were clubbed

together as one

• 40 villages from all the villages of these 9 districts were chosen using PPS

• From each selected villages, 20 HH were selected.

• If one village is chosen more than once in the sample list( for example, n times), total 20*n

HH were selected from that village

• The total sample size becomes (800x24)+800=19,200+800=20,000 HH

Annexure: Sample distribution 6

Selection of AWC in the village

• The data collection will start from a certain AWC of the selected village

• If there are more than one AWC in the village then

I. The AWC codes of all the AWC will be written in ascending order

II. If no. of AWCs is an odd number then the middle one will be selected as the selected

AWC

III. Else( if no. of AWCs is an even number), the total no. of AWCs will be divided by 2. The

AWC whose position in the ascended list is same as the quotient will be chosen

For example, if there are 5 AWCs in the village with codes 119, 125,112,134,129 then first those

will be sorted in ascending order and the middle one( i.e. 125) will be selected.

If there are just 4 AWCs with codes as 111, 92, 102, 134 then first it will be sorted as

92,102,111,134. Then 4(total no. of AWCs in the village)/2=2nd one in the list i.e. AWC 102 will be

selected

Annexure: Sampling – HH selection (1/3)6

Selection of Index Household

• From the AWC household registrar, total number of household in an AWC will be determined

by the data collector

• In AWC where cellphone connectivity is there

– The data collector/BMLE coordinator will call the District MLE coordinator(DMLE) and

inform him about the total no. of households in that catchment area. The DMLE will

generate a random number between 0 and ‘total no. of households in the catchment area.

The household in the survey register which has the same serial number( household

number) as the randomly generated number, will be chosen as the ‘Index Household’

• In AWC where cellphone connectivity is not there

– To generate a random number, the BMLE will divide the total number of household in that

AWC catchment area by 2 and after discarding the values after the decimal of the result,

will add 3 with it. The household in the survey register which has the same serial number

(household number) as the randomly generated number, will be chosen as the ‘Index

Household’. For example, if there are total 159 household in the AWC catchment area,

index household number will be (159/2)+3=79.5+3=79+3=82

Annexure: Sampling – HH selection (2/3)6

Selection of Households for Interview

• The data collector will leave 4 houses from the index house using Right Hand Rule and the 5 th

house will be the first house for interview.

• In the same way, the data collector will skip 4 houses after one house of interview and will

choose the 5th house for interview.

• This will go on till the required no. of houses is covered.

• If there are 20 or less number of structures/houses, all of them have to be covered

Annexure: Sampling – HH selection (3/3)6

25.2

35.8

39.0

Type of House

PUCCA SEMI PUCCA KUCHA

85.1

14.8

0.1

Religion

HINDU MUSLIM Others

21.4

3.3

60.3

15.1

Caste

SCHEDULED CASTE SCHEDULED TRIBE OBC OTHER

Among the SC population, 70.3% is Mahadalit

Annexure: Socio Demographic Profile of respondents

6