Niger CS Final KPC Survey Draft Report HM Draft Mahaman Dec 14

8/3/2019 Niger CS Final KPC Survey Draft Report HM Draft Mahaman Dec 14

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NIGER HEALTHY START CHILD SURVIVAL PROJECT FINAL KPC DRAFT REPORT

A. Background information

Niger is a landlocked Sahelian country that is ranked third from the last on the 2010 HumanDevelopment Index list of 169 countries,

1with 69 percent of its population living below the poverty

line.2

Like the rest of the Sahel, Niger has a long history of endemic hunger characterized by seasonalfluctuations and geographic variation.In 2005, a severe drought resulted in a famine that affected nearly 3 million people and exacerbatedthe 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 immediateconcerns, many areas do not have transitional support or programs to ensure adequate copingmechanisms, particularly in the areas targeted by this project.In 2007, in the aftermath of the Nutritionnal crisis, Relief International started a four year USAIDFunded Child Survival Project in Konni District.

The project area is located in the southwestern section of the Tahoua region and is 417 kilometers tothe east from the capital Niamey covering 5,317 square miles.

The Konni Department has an estimated 428,623 individuals with focus populations (2007 estimate)7:

Age Group Population

0-11 months 24,200

12-59 months 59,124

Pregnant woman 20,445Woman of reproductive age 91,297

The health infrastructure in the district is based on a two-tiered system. The first level of care iscomposed of 60 health Post (case de santé) staffed by one staff and perform simple and basic tasks:primary curative and preventive care, health promotion, deliveries and supplemental nutrition.

1UNDP, 2009, http://hdr.undp.org/en/statistics/.

2http://hdrstats.undp.org/en/countries/profiles/NER.html.



The projects over arching goal is to reduce morbidity and mortality rates of mothers and children under five years of age through strengthening community based health care services and information;developing mechanisms to augment food security and food availability for improved maternal and childnutrition; and, creating awareness of key behaviors for health at the community and household levelthrough capacity building of local primary health care workers, committee members and localorganizations.

This 4 years project has five major objectives:y To 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 childhealth.

y To improve case management of malaria at the community and health post levels; increaseaccess to treatment for malaria; improve access and use of treated mosquito nets; and toimprove 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 foodsecurity 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 and districtlevels, with an emphasis on capacity in maternal and child health, nutrition, and householdfood security.

Four targeted interventions were selected:

y Maternal and newborn healthcare (30% level of effort)

y Control and treatment of malaria (20%)

y Control and treatment of diarrheal disease (20%)

y Nutrition/Food security (30%)

Baseline KPC and Health Facility Assessment and DIP workshop were performed in January andFebruary 2008.The Project used an adapted version of the care group model and training for health care providers atthe facility level that resulted according to the Mid Term Evaluation done in January 2010 in anincreased knowledge and practice around key child survival interventions, especially malariaprevention, improved nutrition, control of diarrheal disease, and increased access to essential obstetric

and neonatal care.

B. Process of Final KPC implementation

Planning and Preparation of Survey

A Month prior to the KPC implementation, the Child Survival Program staff worked on review of

Survey plan. The agenda of the review included refresher session on KPC purpose and Methodology,

review and adaptation of questionnaires and Training agenda and logistic and budget arrangement to

conduct the Training of Supervisors. The planning intervenes during an ultimate Budget Revision

process that significantly reduces provision of funds for the Final Evaluation.

The Budget Revision process delayed availabili ty of project funds wire in country to start

implementation of the KPC that finally come to Mid Sept 2011.

To accommodate the short time implementation of the Survey, the project management Team decided

to recall Survey Trainers and Enumerators who participated in the Initial KPC survey. This could

improve the quality of the Training and save time.

T raining of Supervisors ( TO S)

From Sept 16±17 2011, the Project Senior staff, Konni Health District and Local Government

Technical Services Chief Officer trained five supervisors. 3 supervisors participated in the initial and all



have some professional survey experience according to the Learning Need assessment. Agenda and

content of TOST are in annexe2. It includes review of KPC general purpose and sampling, review of

questionnaire and logistics for conducting Surveyors training.

An Adaptation of Key local language items of Initial KPC was done.

Supervisors contributed insight into traditions and cultural issues that could impact survey results, and

brainstormed solutions to overcome bias.

T raining of Interviewers

RI¶s survey supervisors conducted a two-day training of 30 interviewers to prepare them for the use of

the questionnaire, anthropometric measurement equipment, and presentation samples.

Since 50% of the Surveyors participated in the 2008 initial KPC, the supervisors involved them to

participated to the rest of the interviewers. The teams of interviewers practiced completing the

questionnaire in Konni town on the second training day.

A list of highly experienced interviewers in anthropometrics was established to set up 5 Teams for theField data collection.

The supervisors met with the program manager and the coordination Team at the end of each day for

feedback and to finalize plans for the survey implementation. The KPC survey was collaborative

effort of RI staff and local partners/stakeholders.

Some of the constraints in making this Final KPC included the following:

y Delay in start up and Limited funds to recruit more enumerators

y Limited timeline ( 2days TOST, 2 days TOT and 5 days data collection)

D. Methodology

1- Sampling:

The Organization Team adopted the 30 Cluster sampling of 10 units for this Final KPC, same method

as initial survey. However given that the project initial KPC sampling was done on the basis of the 453

villages of the whole district area, and that the project was finally able to develop later its intervention

only in 61 as results of MTE recommendation to limit intervention villages. There was a discussion of

which sampling to use for the final KPC. Consultation and discussion with the Final Evaluation

Consultant and the MCHIP Team and given the limited resources and time for the survey

implementation, the basis of 61 village is used to chose the 30 clusters. ( see annexe3: basis of

sampling )

2 -Q uestionnaire:

The scope of the survey and the development of the survey questions were focused on the four

intervention area of the project:

y Maternal and newborn healthcare

y Control & treatment of malaria

y Control & treatment of diarrheal disease

y Nutrition/Food Security

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



anthropometrics consisted of three measurements: height, weight, and MUAC (where appropriate).

The questionnaire was translated into French from the final English version. During the survey the

French questionnaire was used as a guide for the verbalization of the survey into Hausa (the local

language). Hausa translations of key words are included in annexe6

Study indicators:

The KPC Rapid Catch Priority Child Health Indicators (draft December 16, 2007) is used:

Maternal and Newborn Care:

Percentage of mothers with children age 0-23 months who received at least two Tetanus toxoidbefore 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

Breastfeeding and Infant and Young Child Feeding Percentage of child age 0-5 months who were exclusively given breatmilk the day prior to the

interview Percent of children age 6-23 months fed according to minimum of appropriately feeding

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 mother¶s recall

Immunization Percent of children aged 12-23 months who received measles vaccine according to the

vaccination card or mother¶s recall by the time of the survey Percent of children aged 12-23 months who received DTP1 according to the vaccination card or

mother¶s recall by the time of the survey Percent of children aged 12-23 months who received DTP3 according to the vaccination card or

mother¶s 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 fever began Percentage of children age 0-23 months who slept under an insecticide-treated bed net the

previous night

Control of Diarrhea 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 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 Percentage of households 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 soap at theplace for hand washing

Anthropometrics Percentage of children age 0-23 months who are underweight (-2SD for the median weight for

age, according to WHO/NCHS reference population)



Data Collection:

The average length of interview took between 30-60 minutes. As the five days progressed, the surveyteams became more efficient at conducting the survey and therefore the interview times decreased.Data collection took 5 days covering 30 clusters with 5 survey teams. Each cluster team has sixinterviewers and a supervisor daily round trip to Konni options was adopted because clusters are nottoo distant and prior information and approval of villages authorities facilitated access of households

by surveyors teams.

2 level of quality control: the Team Supervisor who is the Team leader and also proceeds with dailycheck of questionnaire.The Coordination composed of Project staff and the data management Team controls thequestionnaire filled and collected by the project staff on the daily basis.

The survey data was entered into Epi Info and checked for analysis. The data management iscomposed of one staff from the MOH Health Management and Information Central Office, one M&EStaff and the Project Manager.

Due to the tight timeline and short time for data input and analysis, questionnaire check continueduntil the analysis phase.Dispite several back and forth on the questionnaire, the analysis was doneand exported in Microsoft word in several steps.

Analysis of one indicator revealed to be difficult to perform by the team : complementary feeding

composite indicator.Disease data tables locked and was not accessible temporary for analysis.

A special assistance from Niger WHO Statistician was requested. As results, the following results willnot include 2 indicators on appropriate feeding for children , one indicator 1 indicator on antropometryfrom 6-23months and 6 indicators related to CDD, malaria and ARI and antropometrics.

C. Preliminary Results

1- Rapid Catch Indicators:

KPC 2011

INDICATOR

NUMERATO

R

DENOMI

NATOR

PERCENT

1. Maternal & Newborn Care 220 300 73%

Percentage of mothers withchildren age 0±23 monthswho received at least two

Tetanus toxoid before thebirth of the youngest child

2. Maternal & Newborn Care 129 300 43%

Percentage of children age0±23 months whose births

were attended by skilledpersonnel

3. Maternal & Newborn Care 79 300 26,30%



Percentage of children age0±23 months who received apost-natal visit from anappropriately trained healthworker within three daysafter birth

4. Breastfeeding and

Infant/Young Child Feeding

89 105 84.75

Percentage of children age

0±5 months who wereexclusively given breast milk the day prior to the interview

5 . Breastfeeding and Infant/Young Child Feeding

NA NA

Percentage of children 6±23months fed according to aminimum of appropriatefeeding practices

6 . Vitamin ASupplementation

174 219 79%

Percentage of children age6±23 months who received aVitamin A dose in the last 6

months: care verified or mother¶s recall

7.Immunization

78 95 82%

Percentage of children age12±23months whoreceivedDPT1according to

thevaccinationcard or mother¶srecall by thetime of the

survey

8.Immunization

56 95 58,9

Percentage of children age12±23months whoreceived

DPT3according tothevaccinationcard or mother¶srecall by thetime of thesurvey

9. 69 95 72,63



Immunization

Percentage of children age12±23months whoreceivedMeasles

according tothevaccinationcard or mother¶srecall by thetime of thesurvey

10. Malaria 101 209 48,32

Percentage of children age0±23 monthswith a febrile

episodeduring thelast weekswho weretreated withan effectiveanti-malarialdrug within 24hours after the fever began

11. Malaria 289 300 96,33

Percentage of children age0±23 monthswho sleptunder aninsecticide-treated bednet theprevious night

12. Control of Diarrhea

80 161 49.68

Percentage of children age0±23 monthswith diarrhea

in the last twoweeks whoreceived oral

rehydrationsolution(ORS) and/or recommended home fluids

13. AcuteRespiratoryInfection

63 109 57.79



Percentage of children age0±23 monthswith chest-related coughand fastand/or difficult

breathing inthe last twoweeks whowere taken toanappropriateheathprovider

14. Water &Sanitation

24 300 8/300*

Percentage of households of children age0±23 months

that treatedwater effectively

15. Water &Sanitation

88 300 29.33

Percentage of mothers of children age0±23 monthswho live in ahouseholdwith soap atthe place for hand washing

16. Anthropometr y

NA NA NA

Percentage of children age6±23 monthswho areunderweight(-2 SD from

the medianweight-for-age,according totheWHO/NCHSreferencepopulation)



Discussion on Preliminary results:

To be completed with the Final Evaluation Report to be submitted by the Consultant Friday 30th

after

USAID Niger debriefing



Annex2 : TOST agenda

Programme formation Formateurs Vendredi 16 septembre 2011

Horaires Activités Responsables

Jour1 : Généralités-Introduction Méthodologie Enquête KPC

8h00-8h30 Présentation des participants Questions administratives Normes de Travail

Objectifs de la formation- Programme de travail

Dr Mahaman-

Nahiou

8h30-9h00 Aperçu Réalisations Relief international et du ProjetSurvie de l¶enfant de Konni

Dr Mahaman

Rakia Alzouma

9h00-10h15y Objectifs de l¶enquête ±Rôles acteurs dans organisation

y Méthodologie : Echantillonnage KPCDr Hallarou

10h15-10h30 Pause cafe

10h30-11h30Méthodologie : Revue Questionnaire ±Jeu de rôles-Traduction Motsclés

Rakia

11h00- 12h 30Méthodologie : Revue Questionnaire ±Jeu de rôles-Traduction Mots

clés

Rakia

12h30-13h Rappel Evaluation Etat Nutritionnel-Anthropométrie Dr Moudi

13h00-14h30 Pause dejeuner

14h30-16h00 Rappel Evaluation Etat Nutritionnel-Anthropométrie Aspects Logistiques Enquête Terrain (Répartition Equipes,

supervision)

Dr Moudi

Dr Hallarou

16h00-16h30 Pause priere

16h 30-18h Revue Programme formation Enquêteurs J1 Dispositions pratiques pour la formation enquêteurs

Rakia Alzouma



Annexe 3 : Programme formation des enquêteurs du 17-18 septembre 2011

Annexe 4 : List of 61 villages basis for the sampling

Situation des villages d'intervention du PSE

Horaires Activités Responsables

Jour1 : Généralités-Introduction Méthodologie Enquête KPC

15h00-15h30 Inscription des participants Présentation des participants Questions administratives Normes de Travail Programme de travail Objectifs de la formation

Facilitateurs

15h30-16h00 Aperçu sur Relief international et le projet survie de l¶enfantde Konni

Facilitateurs

16h00-16h15 Pause cafe-Prière

16h15-17h

y Enquête KPC :

y Objectifs

y Méthodologie : Echantillonnage ++ Facilitateurs

17h-17h30

Récolte données : Evaluation Etat Nutritionnel (Mesures Anthropométriques)

Facilitateurs

17h30-18h30 Récoltes données 2 :Etude questionnaire

Facilitateurs

18h 30-18h45 Communications et Fin de la journée facilitateurs

J2 : Stage pratique

8h00 -8h30 Resume des notions clées de J1 facilitateurs

8h30-10h00 Jeu de rôle sur le questionnaire+ démonstration anthropométriques facilitateurs

10h ± 10h15 Pause cafe

10h15- 13h00 Test Pratique dans les ménages environnants facilitateurs

13h00-14h30 Pause déjeuner-Prière

14h30- 16h00 Feed back Test pratique- Modalités Départ sur le terrain facilitateurs

16h00 ± 16h30

16h30 ± 17h Modalités depart sur Terrain ( suite) facilitateurs



N°d'ordre

VillagesExistence

ObservationsPromoteur Matrones Case de santé

1 Balgaya

2 Bigal

3 Tsaidaoua Dogarawa

4 Bilando

5 Mounléla Katoria.

6 Mozagué

7 Tsaidaoua Tsernawa

8 Guidan Kadi

9 Tsaouna Gomma

10 Tounga Makéra

11 Malbaza Dadaou

12 Malbaza Bourgoum

13 Tounga Yacouba

14 Katoria

15 Tounga Makoki

16 Kama Kamo I Case pour les 2villages17 Kama Kamo II

18 Ifrikawane

19 Mintchizaré

20 Mounléla Kawara

21 Dessa ICase non

fonctionnelle

22 Dessa II

23 Dessa III

24 Allokoto

25 Guidan Magagi

26 Guidan Roro I

27 Kawara I, II et III

28 Zongon Karaki

29 Kaoura Alassanecentre de santé

integré

30LawèyeTsangalandam

31Lawèye Guidan

Guirdo



32 Kahé DaméCase non

fonctionnelle

33 Guidan Dillé

34 Lawèye Birni

35 Lawèye Gogé

36 Dakilawa Case pour les 2villages37 Kachédawa

38 Zourbatan

39 Dan Hayi Imo

40 Nobi Sédentaire

41 Foura Guirké

42 Tounga Maissabé

43 Takoro

44 Rouga

45 Badabaye Case pour les 2villages46 Tadjaé

47 Dagarka

48 Gazourawa

49 Korop

50 Fari

51 Djarkassa

52 Farssawa

53 Dossèye

54 Nadabar

55 Guidan Zaroumey

56 Boulké

57 Maigozo

58 Tsaouna Kali et Bawa

59 Kanguiwa60 Djima Djimi

61 Chetao

Total

Niger CS Final KPC Survey Draft Report HM Draft Mahaman Dec 14

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