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ANNEX X KPC REPORT
RELIEF INTERNATIONAL NIGER
Konni District
Final Survey Report:
Knowledge, Practice and Coverage
December 2011
Prepared and written by
Mahaman Hallarou, MD,Child Survival Program Manager/Head of
Country Office
Survey Team Leader
Comment [DE1]: Correct annex number
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Acknowledgements
The authors of this report, Dr. Mahaman Hallarou (Relief International) and David C.
Eastman (consultant) would like to thankvarious 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 theirinvolvement in its planning and
implementation. These include the staff of the Konni District Ministry of Health (MOH),
especially medical district coordinator Dr. Alio Tayabou and MOH supervisor Abuzeidi
Chahabou; district administrator Suleymane Issaka; health supervisor Abuzeidi Chahabou;
Konni Statistics Department supervisor Alio Nahantchi, MPDL Medical Officer Dr.
Soumana Oumarou; and LNGO ISCV supervisor Sangar and survey interviewers (listed in
Appendix 5); Meredith Chang (USAID-Child Survival and Health Grants Program); and
Paulin Ntawangundi (Relief International).
Thanks are also due to USAIDCSHGP, which funded the implementation of the survey.
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The following people were instrumental in bringing the KPC survey and report preparation to
successful completion:
1- CORE TEAM
Num Name Structure Contacts
1 Salissou Iliassou DDP/AT/DC Konni 96879464
2 Abouzeidi Chouhabou DS Konni96878938
3 Dr Mahaman Hallarou RI 96292784
4 Rakia Azouma RI 96876643
5 Moustapha Tcharimi RI 96883375
6 Remi Sugurono Consultant 90612227
7 Dr Soumana Oumarou ONG MPDL Konni 96081133
2- SURVEY SUPERVISORS
N d'ordre Nom et prnom Profil Structure Contacts1 Ali Hantchi Superviseur DDP/AT/DC
Konni96 59 07 60
2 Moussa Maman Tela Superviseur ONG ISCVKonni
96 87 89 38
3 Ary Issaka Ousmane Superviseur DDJS JeunesseSport Konni
98 09 19 04
4 Mme Garba Nana
Haouaou
Superviseur ONG ISCV
Konni
90790960
5 Maman Sani Moussa
Oumarou
Superviseur ONG ISCV
Konni91793857
6 Sangar Rachide Superviseur ONG ISCVKonni
96994552
7 Kamay Goga Superviseur Alphabtisation 96887692
8 Abouzeidi Chouhabou Superviseur DS Konni 96878938
9 Moustapha Tcharimi Superviseur PSE/RI Konni 90466551
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Tchari
10 Dr Soumana Oumarou Superviseur ONG MPDLKonni
96081133
3- INTERVIEWERS
Nd'ordre
Nom et prnom Profil Contacts
1Ibrahim Gado Charg d'enseignement 98 74 37 40/ 94 99 02
63
2Abdoulkarim Ado Marketeur 96 89 75 48/90 39 32
41
3Ibrahim Maman Sani Charg d'enseignement 96 46 66 01/90 17 19
68
4Binta Ibrahim Enseignante 96 58 72 63/90 20 52
64
5Hassane Almou Amadou Animateur 90 04 12 63/94 32 35
91
6 Alzouma Mayaki Oumarou Etudiant 96 21 88 44
7 Oumarou Dji bo Enseignant 96 01 43 04
8 M. Salissou Dan Nana Sociologue/Agent munici pal 91 36 34 32
9 Moussa Abdou Auxiliaire d'levage 90 57 95 34
10Bga Alou Sociologue 96 27 78 38/91 31 00
17
11
Salifou Moumouni Kadidja Sociologue 96 58 04 76/90 88 20
37
12 Mohamed Abolbol Sociologue 96 98 08 66
13Aichatou Abdou Garba Enseignante 96 89 89 97/90 50 11
84
14Alzouma MahamanMoustapha
Etudiant 96 57 44 20
15Arzika Halimatou Biologiste 94 25 45 87/97 71 45
33
16 Dakaou Alio Sociologue 96467334/90416478
17 Abdou Andin Enseignant 91 59 95 35
18 Moussa Jean Traor Sociologue 91 71 50 83
19 Fatimatou Issaka Bilali Infirmire 96 26 75 84/90 83 4376
20Abdoul Razakou Habou
Nagodi
Assistant logistique 96 50 40 96
21 Souley Hamidine Sociologue 96 40 20 88
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22 Mato Touraki Journaliste 96 75 89 77
23 Mme Maman Fati Idi Agent du Plan 98 58 42 66
24 Oumarou Ibrahim Etudiant 96 02 76 40
25Ali Abdoul Karim DDP/AT/DC
96 29 03 63
26 Salamatou Habou Journaliste Radio Anfani 96 06 42 47
27 Garba Kano Enseignant retrait 96 97 29 14
28Ibro Mahamadou Animateur 96 07 69 59/94 08 42
34
29 Ibrahim Oumarou Etudiant 96 52 95 02/90 25 45 37
30Hadiza Ibrahim Tehnicienne de
Developpement Rural
97 28 74 80
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Abbreviations and Acronyms
ACT Artemisinin Combination TherapyBCC Behavior Change CommunicationCCM Community Case ManagementCHA Community Health AgentC-HIS Community Health Information SystemCHN Child Health and NutritionC-IMCI Community-Integrated Management of Childhood Illnesses
CMAM Community Management of Acute MalnutritionCSP Child Survival ProjectCSTS Child Survival Technical Support projectDHS Demographic and Health SurveyDHT District HealthTeamDMCH Department of Maternal and Child HealthDPT or DTC Diphtheria-Pertussis-Tetanus vaccine
EDSN-MICS Enqute Dmographique et de Sant du Niger- Multiple Indicator ClusterSurveys
ENA Essential Nutrition ActionsHC Health Center
HP Health PostIMCI Integrated Management of Childhood IllnessesINS Institut National de la StatistiqueIPT Intermittent Preventive Treatment (Preventive Treatment for Malaria in
Pregnant Women)IT N Insecticide Treated NetsKPC Knowledge, Practice and CoverageLQAS Lot Quality Assurance Sampling
M&E Monitoring and EvaluationMoH Ministry of Health
MUAC Mid-upper Arm Circumference NCHS National Center for Health Statistics (USA Health Statistics Agency)
NMCP National Malaria Control ProgramORS Oral Rehydration Salts
SD Standard DeviationTT Tetanus ToxoidUNICEF United Nations Childrens FundWHO World Health Organization
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1 BackgroundProject Location
Nigeris a landlocked Sahelian country that is ranked third from the last on the 2010 Human
Development Index list of 169 countries1, with 69 percent ofits population living below the
poverty line.2 Like the rest of the Sahel, Nigerhas a long history of endemic hungercharacterized by seasonal fluctuations and geographic variation.
In 2005, a severe drought resulted in a famine that affected nearly 3 million people andexacerbated the already fragile health and nutritional status of the country withdisproportional suffering among women and children. While the current crop harvests haveameliorated some of the immediate concerns, many areas do not have transitional support or
programs to ensure adequate coping mechanisms, particularly in the areas targeted by thisproject.
In 2007, in the aftermath of the Nutritional crisis, Relief International started a four yearUSAID Funded Child Survival Project in Konni District.
The project Intervention Zone is located in the southwestern areat of the Tahoua region and is417 kilometers to the east from the capital Niamey covering 5,317 square miles.
Characteristics of the Target Population
At the Project Start up in 2007, The Konni Department has an estimated 428,623 individualswith the following repartition
3:
Age Group Population
0-11 months 24,200
12-59 months 59,124
Pregnant woman 20,445
Woman of reproductive age 91,297
It is fast growing population with 3.3% annual increase4
and in 2011, Konni total populationis estimated at 478687 , 93057 U5 children and 101960 women of reproductive age. Hausa
and Peulh are the 2 main ethnic groups.
12http://hdrstats.undp.org/en/countries/profiles/NER.html.
33Konni Health District Development Plan 2005-2010
4http//www.ins.ne
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Health, Social and Economic Conditions within the Project Area
Class dans les 4 derniers Pays les plus pauvre du monde dans la classification du Program
des Nations Unies pour le Development ( PNUD)5, le Niger fait rgulirement face auxcontraintes des alas climatiques, et de linstabilit politiques dans un contexte de faible
pouvoir dachats avec plus de la moiti de la population vivant avec moins de 1 dollar/Jour.Il rsulte une situation dinscuritaire alimentaire chronique, dans un contexte daccsinsuffisant aux soins de sant de base et dhygine prcaire.Malgr ce contexte National, Le departement de Konni est nanmoins un carrefour avec sa
situation gographique et la proximit avec le Nigria font de lui une plaque tournante et uncarrefourimportant entre louest (axe Niamey-Konni), le Nord (Agadez-Tahoua), lEst (axeDiffa-Zinder-Maradi) et le Sud (axe Konni-Sokoto au Nigrian).Cette position privilgie lui confere un niveau conomique meilleurque dautresdepartements avec le commerce frontalier.Le Niveau danalphatisme lve denviron 83%6 de la population pose une limitation alinformation et a la communication dans toutes les interventions au niveau communitaire.
National Standards/Policies Regarding Maternal and Child health
The Nigerhealth system has been engaged in the reduction of poverty and the promotion ofdevelopment in relationship to the Millennium Development Goals and National Health Plans
reflect that engagement. Niger is currently validation the 2nd
Cycle of a four Year HealthPlan 2011- 2015 that aims to contribute to the reduction of maternal and child mortality by
building on existing capacity to improve the efficiency and quality of the health system7.
Building on the national planning process, those involved in the ongoing decentralizationprocess have also developed five-year Regional and District Health Plans.
A Free Access Policy to Health care for Under five children and Pregnant women wasadopted by GON since 2007 that resulted in Increase Health Services Demand for these age
groups while Medical supplies and staffing still lacking.
In 2008 the Ministry of Health developed a National Child Survival Strategy whichincludesincreased access to health services through community-based management of malaria,
pneumonia and diarrhea. Furthermore, this new strategy promotes the increased availability ofcompetent personnel, an effective system of supplying essential drugs and equipment,
adequate logistics, strong supervision and a viable monitoring system as critical factors in asuccessful Child Survival Strategy.
8
Niger Nutrition Directorate is currently reviewing for validation a New Nutrition Plan for the
Years 2011-20159
5http://hdrstats.undp.org/fr/pays/profils/NER.html
6http://www.indexmundi.com/g/r.aspx?c=ng&v=39&l=fr
7 RN /Ministere de la SantPublique.Plan de Developpement Sanitaire du Niger adopt Janvier 2011.8
RN/Ministre de la Sant Publique.Avant-projet de Stratgie National de Survie de lEnfant, 2008 ; page 30.9
RN/Ministere de la Sant Publique.Plan National pour la Nutrition PNN 2011-2015
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The Child Survival Project
The goal of the Healthy Start Child Survival project is to reduce morbidity and mortality rates
of mothers and children under five years of age through strengthening community basedhealth care services and information; developing mechanisms to augment food security andfood availability for improved maternal and child nutrition; and, creating awareness ofkey
behaviors forhealth at the community and household level through capacity building of localprimary health care workers, committee members and local organizations.
The technical interventions focus on the leading causes of child mortality in the project zone:Maternal and New born care (30% level of effort); Nutrition (30%); of malaria (30% level ofeffort) and control of diarrhea diseases (20%).
The Intermediate Results (principal objectives) are:
Increase the practice of selected emphasis behaviors for maternal/child survival; Ensure institutionalized sustainable MOH a0nd community support for community
health workers; Strengthen the capacity of communities and local/district health teams.
The activities for achieving the Strategic Objectives are organized into five TechnicalPackages/Sub-Objectives:
y To increase access to, demand for, and use ofquality maternal and child healthservices, including emergency care; in order to improved family behaviors related tomaternal and child health.
y To improve case management of malaria at the community and health post levels;increase access to treatment for malaria; improve access and use of treated mosquitonets; and to improve use of chemoprophylaxis (IPT) for malaria among pregnant
women.y To improve prevention and treatment of diarrheal disease among rural children under
five.y Improve nutrition of women and children, through education and
household/community food security and nutrition activities.y To improve the capacity of the Ministry of Health and local partner agencies, to plan,
implement, monitor and evaluate child survival interventions at the community anddistrict levels, with an emphasis on capacity in maternal and child health, nutrition,
and household food security.
The Project Targeted Initially 90 villages in 2 phased coverage approach. The projectestablished 266 women care groups and support to 50 Health posts. After the MTE, finally
limited its intervention area to 61 villages.
Baseline KPC and Health Facility Assessment and DIP workshop were performed in Januaryand February 2008.
The Project used an adapted version of the care group model and training forhealth careproviders at the facility level that resulted according to the Mid Term Evaluation done inJanuary 2010 in an increased knowledge and practice around key child survival interventions,especially malaria prevention, improved nutrition, control of diarrheal disease, and increased
access to essential obstetric and neonatal care.Final KPC was implemented as part of the overall Final Evaluation Process in September.
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Objectives of the KPC Survey
The general objective of the survey was share to inform Project Team ,Local partners onstake on Project indicators. More specifically, the objectives of the study were:
1) To collect data on the Rapid CATCH indicators by :y Assessing the knowledge and practice of mothers in selected technical
Packages (MNC, Nutrition , Diarrhea, malaria)
y Measuring nutritional status of children 0-23 months in the project Zone2) To build the capacity of local staff of the project and partners to implement KPC surveys.Indicators Selected by Technical Intervention Area (2006 Rapid Catch)
Maternaland Newborn Care:
Percentage of mothers with children age 0-23 months who received at least two Tetanus
toxoid before the birth of the youngest child Percentage of children age 0-23 months whose births were attended by skilled
personnel Percentage of children age 0-23 months who received a post-natal visit from an
appropriately trained health worker within three days after birth
Breastfeedingand Infantand Young Child Feeding Percentage of child age 0-5 months who were exclusively given breatmilkthe day priorto the interview
Percent of children age 6-23 months fed according to minimum of appropriatelyfeeding practices
Vitamin A Supplementation Percent of children age 6-23 months who received a dose of Vitamin A in the last 6
months: card verfied or mothers recall
Immunization Percent of children aged 12-23 months who received measles vaccine according to the
vaccination card or mothers recall by the time of the survey Percent of children aged 12-23 months who received DTP1 according to thevaccination card or mothers recall by the time of the survey Percent of children aged 12-23 months who received DTP3 according to thevaccination card or mothers recall by the time of the survey
Malaria 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 feverbegan
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Percentage of children age 0-23 months who slept under an insecticide-treated bed netthe previous night
Controlof Diarrhea
Percentage of children age 0-23 months with diarrhea in the last two weeks whoreceived oral rehydration solution (ORS) and/or recommended home fluids.
Acute Respiratory Infections Percentage of children age 0-23 months with chest-related cough and fast and/ordifficult breathing in the last two weeks who were taken to an appropriate health provider
Waterand Sanitation
Percentage ofhouseholds of children age 0-23 months that treat water effectively Percentage of mothers of children age 0-23 months who lived in a household with soapat the place forhand washing
Anthropometrics Percentage of children age 0-23 months who are underweight (-2SD for the medianweight for age, according to WHO/NCHS reference population)
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2 Methods
Partnership Building in the Survey preparation :
Dans le mois de Aout 2011 et en prparation a lenqute KPC de Septembre ,lEquipe duprojet a envoy des lettres de participation a la prparation et a la mise en uvre de lEnquteKPC. Ces structures sont :
y La Mission USAID a Niameyy La Direction Rgional8 de la sant publique de Tahouay Le District Sanitairey La Direction dpartemental de lAgriculturey La Direction dpartement du Plany
Les ONGS Mouviento Por La PAZ et Initiatives pour la scurisation des Mnages(ISCV) de Konni
y La Direction National de linformation sanitaire (DSSRE)La Runion du Comit de Pilotage de lEnqute KPC sest tenue le 16-17 septembre en vuede passer en revue le niveau de prparation de lEnqute sur :
- Revue des Termes de Rfrences de la formation des enquteurs,- Revue des drafts doutils de collecte des donnes adapts par lEquipe du projet- Aspects logistiques de lorganisation de lEnqute : Matriels et quipement ( toise et
Balance, Mdicaments, Moustiquaires), identification des enquteurs etc.
Ainsi les contributions des partenaires dans la collecte des ressources ncessaire a la
ralisation de cette enqute sont les suivants :
CONCERN Tahoua :Toise et BalanceDistrict Sanitaire de konni : Echantillon de Medicaments ( Paracetamol, Fer acid folique,
Vitamine A, Zince , Sulfadoxine-Pyrimethamine, balance, Moustiquaires impregnes, etc) etun superviseur
ISCV :- Local et chaises pour la formation des enqueteurs- Datashow- Superviseur et Enqueteurs
Direction Departementale du Plan :- Base des donnes demographiques- Superviseurs
En annexe les lettres dinvitations de ces structures ( USAID, DRSP, DS, MPDL)
Training and Capacity Building
Core Team Training
The core Team is composed of 6 persons: the Project Manager, Project TrainingCoordinator, Project M&E, the District Communition Officer, the Representative of the
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Local Government Agricultural Office, the Representant of the Local GON CommunityDevelopment Office. The Core and the Child Survival Program staff worked on reviewing
the Survey plan. The agenda of the review included refresher session on KPC purpose andMethodology, review and adaptation ofquestionnaires and Training agenda and logistic and
budget arrangement to conduct the Training of Supervisors. The planning intervenes duringan ultimate Budget Revision process that significantly reduces provision of funds for the FinalEvaluation.The Budget Revision process delayed availability of project funds wire in country to startimplementation of the KPC that finally come to Mid Sept 2011.To accommodate the short time implementation of the Survey, the project management Teamdecided to recall Survey Trainers and Enumerators who participated in the Initial KPC survey.This could improve the quality of the Training and save time.Questionnaire:The scope of the survey and the development of the survey questions were focused on thefourintervention area of the project:
y Maternal and newborn healthcarey Control & treatment of malariay Control & treatment of diarrheal diseasey Nutrition/Food Security
The survey questionnaire was 87 questions in length excluding the anthropometrics. The
anthropometrics consisted of three measurements: height, weight, and MUAC (whereappropriate). The questionnaire was translated into French from the final English version.
During the survey the Frenchquestionnaire was used as a guide for the verbalization of thesurvey into Hausa (the local language). Hausa translations ofkey words are included inannexe6
Training of Suveryors Trainer (TOST)From Sept 1617 2011, the Project Senior staff, Konni Health District and Local GovernmentTechnical Services Chief Officer trained five supervisors. 3 supervisors participated in the
initial KPC and all have some professional survey experience according to the Learning Needassessment. Agenda and content ofTOST are in annexe2. It includes review of KPC general
purpose and sampling, review ofquestionnaire and logistics for conducting Surveyorstraining.An Adaptation of Key local language items of Initial KPC was done.Supervisors contributed insight into traditions and cultural issues that could impact surveyresults, and brainstormed solutions to overcome bias.
Training of Surveyors
RIs survey supervisors conducted a two-day training of 30 interviewers to prepare them forthe use of the questionnaire, anthropometric measurement equipment, and presentationsamples.Since 50% of the Surveyors participated in the 2008 initial KPC, the supervisors involvedthem to participated to the rest of the interviewers. The teams ofinterviewers practiced
completing the questionnaire in Konni town on the second training day.A list ofhighly experienced interviewers in anthropometrics was established to set up 5Teams for the Field data collection.The supervisors met with the program manager and the coordination Team at the end of each
day for feedbackand to finalize plans for the survey implementation. The KPC survey wascollaborative effort of RI staff and local partners/stakeholders.
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Some of the constraints in making this Final KPC included the following:
y Delay in start up and Limited funds to recruit more enumeratorsy Limited timeline ( 2 days TOST, 2 days TOT and 5 days data collection)
Study Population
2.4.1 Sample Size Calculation
The Organization Team adopted the 30 Cluster sampling of 10 units for this Final KPC, samemethod as initial survey. However given that the project initial KPC sampling was done onthe basis of the 453 villages of the whole district area, and that the project was finally able todevelop laterits intervention only in 61 as results of MTE recommendation to limitintervention villages. There was a discussion on which sampling to use for the final KPC.Consultation and discussion with the Final Evaluation Consultant and the MCHIP Team andgiven the limited resources and time for the survey implementation, the basis of 61 village is
used to chose the 30 clusters.
2.4.2 Sampling Design
Steps Followed for Choosing 30 Clusters
Step 1: A list of the 61 villages was used as the sampling frame for selection of cluster. Thepopulation of the villages was provided by the Niger Bureau of Statistics. A master list with
cumulative population totals was constructed including all villages.
Step 2:The total estimated population of the Project Zone (61 villages) is 83286 divided by30, giving a sampling interval of 2776. A start number of 3839 was randomly identifiedamong the last 4 Numbers of the serial Number of Niger 10000 CFA currency Lot.
Step 3: After the selection of the first cluster, the remaining 29 clusters were identified usingthe sampling interval.
2.4 Data Collection and AnalysisThe survey team was divided in six teams. Each team was composed of 4 Interviewers, onemeasurer and one supervisor each team covered one cluster per day, filling out 12questionnaires. At the end of the data collection, a total of 360 questionnaires were filled out
by the interviewers.
The supervisors were responsi ble for the selection of the starting household and surveydirection. Eachquestionnaire was reviewed by a supervisorin the field. Eachquestionnairewas further reviewed each evening . This process was efficient to detect and report recurrenterrors to interviewers. Each team was supervised at least twice by a member of the Core team
engaged occasionally in the supervision of supervisor.
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The survey data was entered into Epi Info and checked for analysis. The data management iscomposed of one staff from the MOH HIS , one project M&E Staff and the Project Manager.
Due to the tight timeline to submit an Outline of the Interim by the Consultant andquestionnaire checkremained incomplete and continued through the analysis phase.Several backand forth on the questionnaires lead to a preliminary analysis of the PriorityRapid Cath Indicator.Analysis of one indicator revealed to be difficult to calculate to the Team: perform by theteam : complementary feeding composite indicator.Disease data tables locked and were not accessible temporary for analysis. A specialassistance from Niger WHO Statistician was requested.As results, by September 30, the End of the Child Survival Official contracting period for
Project Staff and therefore the core team of the Survey, IYCF indicators were missing.
2 months laterin Dec 15, the Former child Survival Project was recalled by ReliefInternational-HQ to complete the analysis and the Report.
Challenges and Issues during the Survey Implementation:
Throughout the whole Survey Process, the Team worked under pressure of finalizing thewhole KPC survey and the assist the Consultant to do the qualitative assessment within 9 days
before the official End of the Project Contracting period. Despite the commitment of theSurvey Team, this working atmosphere has resulted in some biases worthy to mention here:
Data Collection phase:
y Some Mothers Prenatal consultation cards were not filled even though childvaccination confirmed by the Village worker register and the Mother saying.
y Weight forheight Measurement was all done by a team of Six measurers, thereforemultiplying the riskof same measurer errors.
y For children under 30 days (One month) to small to be weighed or sick, Weight wasreplaced by Birth weight in the Child Cards or replaced by same age children who wasknown either by recall orin the Child Health Card. The total replacement done was
about. Thus could inflate Num of children less than one month age and toosmall to be measured some surveyorhave reported either 0 Month or 1 month forChildren less that under 1 month or 1 month
Analysis:
y 2 missing questionnaires in a remote cluster that was identified only at the analysisphase without any practical option to go backto the village to complete the missingquestionnaire,
y An insufficient verification of the data that resulted in missing data in somequestionnaires
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3 ResultsDemographic Characteristics
Table 1: Age of Children under 2 (n=358)
Age of children (n=300) Freq %
0 to 5 months 107 30
6 to 11 months 95 27
12 to 23 months 156 43
Total 358 100.0
Table 2: Sex of Children under 2 (n=358)
Sex of children (n=358) Freq %
Female 137 45.7
Male 163 54.3
Total 358 100.0
3.2 Maternal and newborn care
Table 7: Assistance during the Delivery (n=358)
*within this group, 4 answers ( 4) were categorized as auxiliaire and the crosscheckon where this staff workshows that they are in Health Centers. This
Person who assisted Freq %
Doctor/ Nurse/Midwife 161 45
HP worker 28 8
Traditional birth attendant 140 40
Other 25*
Not assisted 2
Total 358 100.0
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refer to Health post workers ( HPw) who temporarily workin Integrated HealthCenters ( CSI) during the Chief Nurse absence.
The Catchindicatorincludes Health post worker among qualified Personnel sincethey were trained by Project in Clean Delivery. Some of this HPW are nurses but maynot be known as such by respondents. The questionnaire does not specify the Name ofthe Health Facility where the delivery tookplace to identify in
There almost 40% of delivery still attended by TBA (Matrons) even though they arenot considered as skilled personnel. The project has devoted considerable time in thesensitization to teach to TBA in their new role of companion to delivery . when wecross where do the Birth assisted by matrons took, we find that only half of them wereat Home, 50% of these Births assisted by TBA( 75/142) occurred in Health Centers.This is well know practices particularly in CSI and District Hospital where matronsare still used for night shift under Midwife supervision. Officially matrons areexpected even in those centers to accompany Parturient to Maternity and help the
women in post partum wards. But the reality is that matrons continue to assistdelivery when the Midwife actually went to rest during.
Next Procedure
Forward
HomedeliveryTBA FrequencyPercent Cum Percent
Yes 67 47,2% 47,2%
No 75 52,8% 100,0%
Total 142 100,0% 100,0%
95% Conf Limits
Yes 38,8% 55,7%
No 44,3% 61,2%
Table 8 : Use of Clean delivery Kits (n=358)
Was a Clean Delivery Kit
used during delivery?
Freq %
Yes 272 76
No 84 23
Do Not Know 2 1
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76% of the deliveries benefited clean de
Total 358 100.0