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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



1 Acknowledgements

The authors of this report, Dr. Mahaman Hallarou (Relief International) and David C.Eastman (consultant) 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 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 Sangaré and survey interviewers (listed inAppendix ); Meredith Chang (USAID-Child Survival and Health Grants Program); and Paulin

Ntawangundi (Relief International).

Thanks are also due to USAID±CSHGP, which funded the implementation of the survey.



The following people were instrumental in bringing the KPC survey and report preparation tosuccessful 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 prénom 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 NanaHaouaou

Superviseur ONG ISCVKonni

90790960

5 Maman Sani Moussa

Oumarou

Superviseur ONG ISCV

Konni 91793857

6 Sangaré Rachide Superviseur ONG ISCVKonni

96994552

7 Kamayé Goga Superviseur Alphabétisation 96887692

8 Abouzeidi Chouhabou Superviseur DS Konni 96878938

9 Moustapha Tcharimi Superviseur PSE/RI Konni 90466551



Tchari

10 Dr Soumana Oumarou Superviseur ONG MPDLKonni

96081133

3- INTERVIEWERS

N°d'ordre

Nom et prénom Profil Contacts

1Ibrahim Gado Chargé d'enseignement 98 74 37 40/ 94 99 02

63

2Abdoulkarim Ado Marketeur 96 89 75 48/90 39 32

41

3Ibrahim Maman Sani Chargé d'enseignement 96 46 66 01/90 17 19

68

4Binta Ibrahim Enseignante 96 58 72 63/90 20 52

645

Hassane Almou Amadou Animateur 90 04 12 63/94 32 3591

6 Alzouma Mayaki Oumarou Etudiant 96 21 88 44

7 Oumarou Djibo Enseignant 96 01 43 04

8 M. Salissou Dan Nana Sociologue/Agent municipal 91 36 34 32

9 Moussa Abdou Auxiliaire d'élevage 90 57 95 34

10Béga Alou Sociologue 96 27 78 38/91 31 00

17

11 Salifou Moumouni Kadidja Sociologue 96 58 04 76/90 88 2037

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 3518 Moussa Jean Traoré Sociologue 91 71 50 83

19Fatimatou Issaka Bilali Infirmière 96 26 75 84/90 83 43

76

20Abdoul Razakou Habou

NagodiAssistant logistique 96 50 40 96

21 Souley Hamidine Sociologue 96 40 20 88



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

25

Ali Abdoul Karim DDP/AT/DC

96 29 03 63

26 Salamatou Habou Journaliste Radio Anfani 96 06 42 47

27 Garba Kano Enseignant retraité 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 Rural97 28 74 80





Table of Contents

Sommaire

1 Acknowledgements ........................................................................................................ ii

The authors of this report, Dr. Mahaman Hallarou (Relief International) and David C.Eastman (consultant) would like to thank various contributors who participated in thisKnowledge, Practice and Coverage final survey. In particular, thanks are due to the peoplewho supported this survey either through their involvement in its planning andimplementation. These include the staff of the Konni District Ministry of Health (MOH),especially medical district coordinator Dr. Alio Tayabou and MOH supervisor AbuzeidiChahabou; district administrator Suleymane Issaka; health supervisor Abuzeidi Chahabou;Konni Statistics Department supervisor Alio Nahantchi, MPDL Medical Officer Dr.Soumana Oumarou; and LNGO ISCV supervisor Sangaré and survey interviewers (listedin Appendix ); Meredith Chang (USAID-Child Survival and Health Grants Program); andPaulin Ntawangundi (Relief International). ......................................................................... ii

Thanks are also due to USAID±CSHGP, which funded the implementation of the survey. . ii

Table of Contents ................................................................................................................. vii

2 Abbreviations and Acronyms .......................................................................................... 9

Baseline ....................................................................................................................... 10

(330)............................................................................................................................. 10

End line ....................................................................................................................... 10

Percentage of children age 12-23 months who received DPT1 according to the vaccinationcard or mother¶s recall by the time of the survey .................................................................. 11

Percentage of children age 12-23 months who received DPT3 according to the vaccinationcard or mother¶s recall by the time of the survey .................................................................. 11

Percentage of households of children age 0-23 months that treated water effectively ............ 12

Percentage of mothers of children age 0-23 months who live in a household with soap at the place for hand washing ......................................................................................................... 12

3 Background .................................................................................................................. 14

3.1 Project Location ..................................................................................................... 14

3.2 Characteristics of the Target Population ................................................................. 14

At the Project Start up in 2007, The Konni Department has an estimated 428,623individuals with the following repartition: ........................................................................ 14

Age Group........................................................................................................................ 14

Population ........................................................................................................................ 14

0-11 months ..................................................................................................................... 14

24,200 .............................................................................................................................. 14

12-59 months.................................................................................................................... 14

59,124 .............................................................................................................................. 14

Pregnant woman ..................... ......................................... ......................................... ........ 14

20,445 .............................................................................................................................. 14



Woman of reproductive age .............................................................................................. 14

91,297 .............................................................................................................................. 14

It is fast growing population with 3.3% annual increase and in 2011, Konni total population is estimated at 478687 , 93057 U5 children and 101960 women of reproductiveage. Hausa and Peulh are the 2 main ethnic groups. .............................. .......................... 14

3.3 Health, Social and Economic Conditions within the Project Area ........................... 14

3.4 National Standards/Policies Regarding Maternal and Child health .......................... 15

3.5 The Child Survival Project ..................................................................................... 15

3.6 Objectives of the KPC Survey ................................................................................ 17

1 Methods ....................................................................................................................... 19

1.1 Partnership Building in the Survey preparation: .............................. ........................ 19

1.2 Training and Capacity Building .............................................................................. 19

1.3 Study Population .................................................................................................... 21

1.3.1 Sample Size Calculation .................................................................................. 21

1.3.2 Sampling Design ............................................................................................. 21

1.3.3 Data Collection and Analysis .......................................................................... 21

1.3.4 Challenges and Issues during the Survey Implementation: .............................. . 22

1.4 Introduction............................................................................................................ 23

1.5 Demographic Characteristics .................................................................................. 23

1.6 Maternal and newborn care: ................................................................................... 24

Table 9: Post Natal Check within 3 days for New born ..................... ................................ 27

1.7 Breastfeeding ......................................................................................................... 27

1.8 Complementary feeding. ........................................................................................ 27 1.9 Vitamin A Supplementation ................................................................................... 28

1.10 Vaccination: ....................................................................................................... 28

1.11 Malaria: .............................................................................................................. 30

1.12 . Nutritional Status .............................................................................................. 31

1.13 Discussion .......................................................................................................... 32

1.13.1 Maternal and Newborn .................................................................................... 32

1.13.2 Infant and Yang Child Feeding ........................................................................ 32

1.14 Child Immunization: ........................................................................................... 33

1.15 . Prevention and treatment of childhood illness: .............................. .................... 33

1.16 . Point of use ....................................................................................................... 34

1.17 Nutritional status of children ............................................................................... 34



2 Abbreviations and Acronyms

ACT Artemisinin Combination TherapyBCC Behavior Change CommunicationCCM Community Case ManagementCHA Community Health Agent

C-HIS Community Health Information SystemCHN Child Health and NutritionC-IMCI Community-Integrated Management of Childhood IllnessesCMAM Community Management of Acute MalnutritionCSP Child Survival ProjectCSTS Child Survival Technical Support projectDHS Demographic and Health SurveyDHT District Health TeamDMCH Department of Maternal and Child HealthDPT or DTC Diphtheria-Pertussis-Tetanus vaccineEDSN-MICS Enquête Démographique et de Santé du Niger- Multiple Indicator Cluster

Surveys

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

PregnantWomen)ITN Insecticide Treated NetsKPC Knowledge, Practice and CoverageLQAS Lot Quality Assurance SamplingM&E Monitoring and EvaluationMoH Ministry of HealthMUAC Mid-upper Arm Circumference

NCHS National Center for Health Statistics (USA Health Statistics Agency) NMCP National Malaria Control ProgramORS Oral Rehydration SaltsSD Standard DeviationTT Tetanus ToxoidUNICEF United Nations Children¶s FundWHO World Health Organization



Executive Summary

Relief international in Niger has been implementing a four year USAID funded child Survival project entitled Healthy Start. The Project uses an adaptation of the care group model to

address leading causes of childhood morbidity and mortality in the project areas andinterventions include (a) malarial control and prevention, (b) control of diarrheal diseases, (c)maternal and child health, and (d) nutrition.The estimated direct beneficiary population of the project activities is 91,297 women of Reproductive age and 83,324 children under five.the project has implemented activities in 61 villages to date in order to increase demand for services, promote healthy behaviors for child survival, and improve the quality of servicesoffered at health posts and health centers.As a CSHGP requirement, Relief International conducted a population-based Knowledge,Practice, and Coverage (KPC) household survey at baseline in Konni District to measurevalues for key indicators relating to maternal and newborn care and child health, including aset of child survival indicators known as ³Rapid CATCH.´ At the end of the project, an

endline survey was commissioned with the following objectives: 1)To collect data on theRapid CATCH indicators by Assessing the knowledge and practice of mothers in selectedtechnical Packages (MNC, Nutrition , Diarrhea, malaria); Measuring nutritional status of children 0-23 months in the project Zone; 2)To build the capacity of local staff of the projectand partners to implement KPC surveys.The endline KPC survey implemented in Sept 2011, applied the tool that was used during the

baseline survey in order to establish the changes that the project intervention has brought tothe community.however the sampling was changed to be 61 village where the project has

been able to develop its activities. A 30 cluster sampling was used. 7 core team members and30 enumerators implemented during a 4 survey preparation, 5 day data collection.Data analysis was conducted initially on Epiinfo ( preliminary results) but later in decemredone on SPSS.

Main Results showed an improvement in all indicators except a deterioration of childrennutritional status in the project area.

Detail of the main result is in the following Catch Table:

Baseline

(330)

End line

(358)



Indicator Num/Deno % CI Num/Deno % CI

Maternal and Newborn Care Percentage of mothers withchildren age 0-23 months whoreceived at least two Tetanustoxoid vaccinations before the birth of the youngest child

95/330 28.8% s 6.1% 262/358 73 s 6.5

Percentage of children age 0-23months whose births wereattended by skilled personnel

189/330 26.4% s 6.7% 189/358 52% s 7.3

IYCF :Breastfeeding Percentage of children age 0-5months who were exclusively breastfed during the last 24hours

31/86 36% +-14% 77/107 72 s 12

IYCF: Complementary Feeding

Percentage of infants andyoung children age 6-23months fed according to aminimum of appropriate

feeding practices

94/244 38.1 147 251 59 s 8.6

Vitamin A Supplementation Percentage of children age 6-23months who received a dose of Vitamin A in the last 6 months(Mother¶s recall)

26/244 10% 8.6

184/25174%

s 7.7

Immunization Percentage of children age 12-

23 months who receivedDPT1 according to thevaccination card or mother¶s recall by thetime of the survey

78/120

78

Percentage of children age 12-

23 months who receivedDPT3 according to thevaccination card or mother¶s recall by thetime of the survey

39/137 28.5% s 10.7 %

49/120

41

Percentage of children age 12-23 months who received ameasles vaccination

94/18951

Malaria Percentage of children age 0-23months who slept under aninsecticide-treated bed net the previous night.

132/330 40.0% s 7.5% 266/344 76

Percentage of children age 0-59

months with a febrile episodeduring the last two weeks whowere treated with an effectiveanti-malarial drug within 24hours after the fever began

35/199 17.5% s 7.5% 144/212 68

Diarrhea Percentage of children age 0-59months with diarrhea in the lasttwo weeks who received oralrehydration solution (ORS)

36/180 18.4% s 5.9% 96/193 50 s 10



ARI/Pneumonia Percentage of children age 0-59months with chest-relatedcough and fast and/ or difficult breathing in the last two weekswho were taken to anappropriate health provider.

39/214 18.2% s 5.9% 86/189 44 s 10

Water and Sanitation Percentage of households of children age 0-23 months thattreated water effectively

50/330 15.2%270/358

75 s 6

Percentage of mothers of children age 0-23 months wholive in a household with soap atthe place for hand washing

38/330 11.5%

85/358

24 s 6

Anthropometrics Percentage of children 0-23months who are underweight (-2 SD for the median weight for age, according toWHO/HCHS

reference population)

100/300 30.3% s 7.0%145/350

41.7



Findings from the baseline and endline KPC surveys are indicated below.



3 Background

3.1 Project Location

Niger is a landlocked Sahelian country that is ranked third from the last on the 2010 HumanDevelopment Index list of 169 countries1, with 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 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 this project.In 2007, in the aftermath of the Nutritional crisis, Relief International started a four year USAID 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.

3.2 Characteristics of t he Target Population

At the Project Start up in 2007, The Konni Department has an estimated 428,623 individualswith the following repartition3:

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. Hausaand Peulh are the 2 main ethnic groups.

3.3 H ealt h, Social and Economic C onditions wit hin t he Project AreaClassé dans les 4 derniers Pays les plus pauvre du monde dans la classification du Programdes Nations Unies pour le Development ( PNUD)5, le Niger fait régulièrement face aux

1

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

33Konni Health District Development Plan 2005-2010

4http//www.ins.ne

5 http://hdrstats.undp.org/fr/pays/profils/NER.html



contraintes des aléas climatiques, et de l¶instabilité politiques dans un contexte de faible pouvoir d¶achats avec plus de la moitié de la population vivant avec moins de 1 dollar/Jour.Il résulte une situation d¶insécuritaire alimentaire chronique, dans un contexte d¶accésinsuffisant aux soins de santé de base et d¶hygiène précaire.Malgré ce contexte National, Le departement de Konni est néanmoins un carrefour avec sa

situation géographique et la proximité avec le Nigéria font de lui une plaque tournante et un

carrefour important entre l¶ouest (axe Niamey-Konni), le Nord (Agadez-Tahoua), l¶Est (axeDiffa-Zinder-Maradi) et le Sud (axe Konni-Sokoto au Nigérian).Cette position privilégiée lui confere un niveau économique meilleur que d¶autresdepartements avec le commerce frontalier.Le Niveau d¶analphatisme élévée d¶environ 83%6 de la population pose une limitation al¶information et a la communication dans toutes les interventions au niveau communitaire.

3.4 N ational Standards/Policies Regarding Maternal and Child healt h

The Niger health system has been engaged in the reduction of poverty and the promotion of

development in relationship to the Millennium Development Goals and National Health Plansreflect that engagement. Niger is currently validation the 2nd Cycle of a four Year HealthPlan 2011- 2015 that aims to ³contribute to the reduction of maternal and child mortality by

building on existing capacity to improve the efficiency and quality of the health system´7.Building on the national planning process, those involved in the ongoing decentralization

process 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 which includes

increased access to health services through community-based management of malaria, pneumonia and diarrhea. Furthermore, this new strategy promotes the increased availability of competent 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 theYears 2011-20159

3.5 T he Child Survival Project

The goal of the Healthy Start Child Survival project is to reduce morbidity and mortality ratesof 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 of key

6 http://www.indexmundi.com/g/r.aspx?c=ng&v=39&l=fr

7RN /Ministere de la SantéPublique. Plan de Developpement Sanitaire du Niger adopté Janvier 2011.

8RN/Ministère de la Santé Publique. Avant-projet de Stratégie National de Survie de lEnfant, 2008 ; page 30.

9RN/Ministere de la Santé Publique. Plan National pour la Nutrition PNN 2011-2015



behaviors for health at the community and household level through capacity building of local primary 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 of effort) 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 of quality maternal and child health

services, 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 pregnantwomen.

y To improve prevention and treatment of diarrheal disease among rural children under five.

y Improve nutrition of women and children, through education andhousehold/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 and

district 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 50 Health posts. After the MTE, finallylimited 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 for health care

providers 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 increasedaccess to essential obstetric and neonatal care.Final KPC was implemented as part of the overall Final Evaluation Process in September.



3.6 Ob jectives of t he KP C Survey

The general objective of the survey was to inform Project Team, Local partners on stake andCSHG 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 Zone

2) 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)

Maternal and Newborn C are:

Percentage of mothers with children age 0-23 months who received at least two Tetanustoxoid 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 anappropriately trained health worker within three days after birth

Brea stfeeding and Inf ant and Young Chi l d 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 appropriatelyfeeding practices

V it amin A Suppl ement ation Percent of children age 6-23 months who received a dose of Vitamin A in the last 6months: card verfied or mother¶s recall

I mmuniz ation Percent of children aged 12-23 months who received measles vaccine according to thevaccination card or mother¶s recall by the time of the survey Percent of children aged 12-23 months who received DTP1 according to thevaccination card or mother¶s recall by the time of the survey Percent of children aged 12-23 months who received DTP3 according to thevaccination card or mother¶s recall by the time of the survey

Malari a

Percentage of children age 0-23 months with a febrile episode during the last two weekswho 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 netthe previous night

Control of Di arrhea

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 Respir atory 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

W ater and S anit ation

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 soapat the place for hand washing

Anthropometrics

Percentage of children age 0-23 months who are underweight (-2SD for the medianweight for age, according toWHO/NCHS reference population)



1 Methods

1.1 Partnership Building in the Survey preparation:

Dans le mois de Aout 2011 et en préparation a l¶enquête KPC de Septembre, l¶Equipe du projet a envoyé des lettres de participation a la préparation et a la mise en uvre de l¶EnquêteKPC. Ces structures sont :

y La Mission USAID a Niameyy La Direction Régional8 de la santé publique de Tahouay Le District Sanitairey La Direction départemental de l¶Agriculturey La Direction département du Plany Les ONGS Mouviento Por La PAZ et Initiatives pour la sécurisation des Ménages

(ISCV) de Konniy La Direction National de l¶information sanitaire (DSSRE)

La Réunion du Comité de Pilotage de l¶Enquête KPC s¶est tenue le 16-17 septembre en vuede passer en revue le niveau de préparation de l¶Enquête sur :

- Revue des Termes de Références de la formation des enquêteurs,- Revue des drafts d¶outils de collecte des données adaptés par l¶Equipe du projet- Aspects logistiques de l¶organisation de l¶Enquête : Matériels et équipement ( toise et

Balance, Médicaments, Moustiquaires), identification des enquêteurs etc.

Ainsi les contributions des partenaires dans la collecte des ressources nécessaire a laréalisation de cette enquête sont les suivants :

CONCERN Tahoua : Toise et BalanceDistrict Sanitaire de konni : Echantillon de Médicaments ( Paracetamol, Fer acid folique,Vitamine A, Zinc , Sulfadoxine-Pyrimethamine, balance, Moustiquaires impregnées, etc) etun superviseur ISCV :

- Local et chaises pour la formation des enqueteurs- Datashow- Superviseur et Enqueteurs

Direction Departementale du Plan :

-

Base des données demographiques- Superviseurs

En annexe les lettres d¶invitations de ces structures (USAID, DRSP, DS, MPDL)

1.2 Training and Capacity Building

Core Team Training



The core Team is composed of 6 persons: the Project Manager, Project Training

Coordinator, Project M&E, the District Communition Officer, the Representative of the LocalGovernment Agricultural Office, the Representant of the Local GON CommunityDevelopment Office. The Core and the Child Survival Program staff worked on reviewing theSurvey plan. The agenda of the review included refresher session on KPC purpose andMethodology, review and adaptation of questionnaires 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 thefour intervention 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. Theanthropometrics consisted of three measurements: height, weight, and MUAC (whereappropriate). 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 thesurvey into Hausa (the local language). Hausa translations of key words are included inannexe6

T r aining of Suveryors T r

ainer ( TO S T) 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 theinitial KPC and all have some professional survey experience according to the Learning Needassessment. Agenda and content of TOST are in annexe2. It includes review of KPC general

purpose and sampling, review of questionnaire 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.

T r aining of Surveyors

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 presentationsamples.Since 50% of the Surveyors participated in the 2008 initial KPC, the supervisors involvedthem to participate to the rest of the interviewers. The teams of interviewers practicedcompleting the questionnaire in Konni town on the second training day.A list of highly 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 eachday for feedback and to finalize plans for the survey implementation. The KPC survey wascollaborative 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 enumeratorsy Limited timeline ( 2 days TOST, 2 days TOT and 5 days data collection)

1.3 Study Population

1.3.1 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 later its 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 and

given the limited resources and time for the survey implementation, the basis of 61 villages isused to choose the 30 clusters.

1.3.2 Sampling Design

Steps Followed for Choosing 30 Clusters

S tep 1: A list of the 61 villages was used as the sampling frame for selection of cluster. The population of the villages was provided by the Niger Bureau of Statistics. A master list withcumulative population totals was constructed including all villages.

S tep 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 identified

among the last 4 Numbers of the serial Number of Niger 10000 CFA currency Lot.

S tep 3: After the selection of the first cluster, the remaining 29 clusters were identified usingThe sampling interval.

1.3.3 Data Collection and Analysis

The 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 responsible for the selection of the starting household and surveydirection. Each questionnaire was reviewed by a supervisor in the field. Each questionnairewas 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 teamengaged occasionally in the supervision of supervisor.



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 Report by the Consultant,questionnaire check remained incomplete and continued through the analysis phase.Several back and forth on the questionnaires lead to a preliminary analysis of the Priority

Rapid Cath Indicator.Analysis of one indicator revealed to be difficult to calculate to the Team: complementaryfeeding 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 later in Dec 15, the Former child Survival Project was recalled by Relief International-HQ to complete the analysis and the Report.A complete review of data check was performed and transferred to SPSS for analysis.

Nutrition data were entered and analyzed in ENA.

1.3.4 Challenges and Issues during the Survey Implementation:

Throughout the whole Survey Process, the Team worked under pressure of finalizing thewhole KPC survey and to 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 for height Measurement was all done by a team of six measurers, thereforemultiplying the risk of same measurer errors.

y For children under 30 days (One month) too small for some enumerators to weighthem by Salter scale, Weight was replaced by Birth weight in the Child Cards or replaced by same age children who were known either by recall or in the Child HealthCard. The total replacement done was about 10 but later discarded during in theanalysis phase in ENA.

y Analysis:

y 2 missing questionnaires in a remote cluster that was identified only at the analysis phase without any practical option to go back to the village to complete the missingquestionnaire,

y An insufficient verification of the data that resulted in missing data in somequestionnaires



1.4 I ntroduction

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

was conducted in the Konni District, Niger. Findings are presented under the followingcategories; Demographics characteristics ,Maternal and newborn health, child spacing, breastfeeding, vitamin A supplementation, child immunization, malaria, control of diarrhea, AcuteRespiratory Infections, water and sanitation and Anthropometrics. This section also compares

baseline with endline findings.

1.5 Demographic 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

1.6 Maternal and new born care:

Table 5: Health Center/Home Delivery

Freq %

Health Center 213 59,7

Home 144 40,3

Total 357 100,0

60% of deliveries take place in the Health centers. It is twice the baseline line (29%).Whilethere has been modest increase in the extension of Health facility coverage between 2007 (52Health post) and 2011 (60 Health post) in the Konni District in general. In the surveyed 60villages, the number of HP and Primary Health Care ( CSI) Centers has even remainedunchanged. Improved Health care delivery and Community Mobilization in project area mayhave contributed .

Table 6: Assistance during the Delivery (n=358)

Person who assisted Freq %

Doctor/ Nurse/Midwife 161 45

HP worker 28 8

Traditional birth attendant 140 40

Other 25*



*within this group, 4 responses were categorized as ³ auxiliaire´ and the cross check on where this staff exist shows that they are in Health Centers. This could be related

to Health post workers ( HPw) who temporarily work in Integrated Health Centers (CSI) during the Frequent absence of the Chief CSI nurse in the majority of Healthcenters staffed by only one or 2 nurses.

The Catch indicator includes Health post worker as qualified Personnel since theywere trained by Project in Clean Delivery. Some of this HPW are nurses but may not

be known as such by respondents.

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 ³ companion to delivery´ .

Table 6: Home delivery By TBA

HomedeliveryTBA Frequency Percent

Yes 67 47,2%

No 75

Total 142 100,0%

95% Conf Limits Yes 38,8% 55,7%

No 44,3% 61,2%

Comments:when we cross where do the Birth assisted by matrons took, we find that only half of

them were at Home, 50% of these Births assisted by TBA( 75/142) occurred inHealth Centers. This is well know practices particularly in CSI and District Hospitalwhere matrons are still used for night shift under Midwife supervision. Officiallymatrons are expected even in those centers to only accompany Parturient to Maternityand help the women in post partum wards. But the reality is that matrons continue to

assist delivery when the Midwife actually went to rest during night guards.

Table 7: Use of Clean delivery Kits (n=358)

Not assisted 2

Total 358 100.0

Was a Clean Delivery Kit

used during delivery?

Freq %



76% of the deliveries benefited clean delivery kit. Project has provided a single usedelivery Kit in health centers. The Kit comprises a 2 Yards Cloth to wrap the baby, arazor blade for Cordon Section, a gloves and soap.While 60% of the deliveryoccurred in health centers, approximately 16% of Kit used were either at home or elsewhere. This is a significant increase compared to 21% of Kit delivery use at

baseline KPC

Table 8: Post Natal check for Mother within first week

When did the Check take place ? Frequency PercentHour 1 159 79,1%Day 1 19 9,5%Week1 3 1,5%Do not Know 20 10,0%Total 201 100,0%

95% Conf Limits

Hours 72,8% 84,5%

Day1 5,8% 14,4%

Do not Know 6,2% 14,9%

Week 1 0,3% 4,3%

88% (178/201) of mothers who delivered in Health Centers had a post natal check within thefirst week and 80% of them had the check within the day after delivery. The total number of

the respondents matches with 213 who delivered in Health Center.Only 29 mothers were able to identify the Health personnel who performed the Check. Half of them (51%) were done by Health postWorker. 4 checks done by midwifes and 2 by Doctors.It appears clearly that Doctor and Midwife are most recognizable or may be morecommunicative (?) Than Nurses and Health Post worker, since the number of deliveriesassisted by Midwife and Doctors are the same for the post natal checks.

Yes 272 76

No 84

Do Not Know 2 1

Total 358 100.0



Table 9: Post Natal Check within 3 days for New born

Freq Percent Yes 34 54,0%No 29 46,0%

Total 63 100,0%

36% (63/216) of mothers said that their baby was checked by the health personnel of thefacility where they delivered but only half of the Newborn (38) were checked within the week after birth.

1.7 Breastfeeding

Table10: Time of Breastfeeding after Birth (n=358)

94% of the newborn were breastfed Immediately ( with 1 hour) and same proportionwere given colostrums during the first 3 days after birth and 84% of the newborn werenot given any other feed during the same period. This is twice (42% at baseline)higher than baseline rate.

Table11: Exclusive Breafeeding (EBF)/ breastmilk and simple water (n= 107)

Exclusive Breastfeeding is one of the most cost effective interventions in childsurvival project especially in developing countries. The Guidelines recommend that a

child is not given any other feeds than breast milk until 6 month except medicine. Thefindings showed a 72% of children under 6 month exclusively Breast feed. This is asignificant increase compared to baseline value of 36%.

1.8 C omplementary feeding.

Table12: Complementary Feeding

Time Freq %

Within 1 hour (Initiation ) 339 94%After 1 hour 13 62.0

Did not Know 6 2.7

Total 358 100.0

Type of feeding Freq %EBF 77 72

Breastmilk and water 9* 8.4



The Final Survey noted that 59 % of children 6-23 month were feed with minimum number of meals frequency. Breastfed children represent tend to do twice better, 44% (138/324) than non

breastfed 24% (8/34).lack of Breasfeeding from six month occur exceptionally in rural settingmostly for orphans, sick mother born children or early weaning. All situation are high at risk for the child health and Nutrition.

1.9 Vitamin A Supplementation

Table 12: Children who received Vit A (n=251)

The survey noted that among children aged 6-23 months 74% were reported to have receiveda dose of vitamin A in the last six months while baseline weighed 72% of the children aged6-23 months received a dose of vitamin A in the last six months.

1.10 Vaccination:

Table 13: Health Card/vaccination possessionDo you have a card where your child¶s

vaccinations are written down? Freq %

Yes,seen by the

Surveyor

273 76,3

Do not Know 1 ,3

Not availalbe 68 19,0

Never had a Card 16 4,5

Total 358 100,0

Breastfeeding status Freq %

Breastfed 138 55%

Not Breastfed 8 3

Did not Know 6

Total 147 59

Received Vit A (at least once) Freq %

Yes 184 74

No 62

Did not know 4 1

Blank 1 0

Total 251 100.0



73% of mothers possess Health or vaccination cards. Baseline line value is 61%. The major issue with Health/vaccination card is that they are not filled mostly by Health personnel.

72% (258/358) of mother mentioned to have received vaccination that is not written in the book.

Table 14: Children who received Penta 1 / Penta3 (n=120, children 12-23mth whopossess vaccination card)

Table 15: Children who received Vit A (Most Recent Dose, children 6-23, card

seen by enumerator)

y This result is obtained from a cross table of Q44 (did the child receive a single dose of Vitamin A with the last 6 month) and Q45 ( do the mother possess a vaccination

card?) as indicated in the KPC 2000Tabulation guide .The 65 responses categorizedas ³NA´ includes children 8-23 month who either have the card and not available(n=50) or never possess a vaccination card (n= 11) or 1 mother was not clear whether she possessed a card or not and therefore classified as ³No´. If the we calculate the

percentage of children whose mother said to have received a single dose of Vitamin Awhether or not they have a vaccination card, then the percentage increase to 74%.

y In contrary when we calculate the proportion of children who possessed a vaccinationcard in which is mentioned that the child has received a Vitamin A dose either the dateis or not found; the percentage will drop to 11% only.

Table 16: children with BCG Receive BCG Freq %

Yes 236 66

NON

NS 9

Freq %

Penta 1 94 78

Penta3 49 41

Freq %

Yes 140 56

No 46

NA 65*

Total 251 100.0



Total 358 100,0

66% of children were reported to have received BCG. In infant less than 12 month 70% (137/202) had the BCG. Pending the uncertainty of the 26% of Non specified responses in

either baseline and end line survey, this proportion is lower than the 71% (166/234) weighedat baseline.

63% (99/156) in children 12-23month had the BCG.when compared to 2010 National ChildSurvival Survey who found 72% for Tahoua Region, Konni district declines in BCGcoverage. In fact, Konni District has one the lowest vaccination coverage with recurrentoutbreaks of

Table 17: Children who received Measles vaccine (children 9-23, card seen by

enumerator):

The percentage of children who had measles vaccination is calculated among children 9-23.51% of them had the vaccination. The percentage remains the same when it is calculatedamong children 12-23mth ( 52%= 78/151)

1.11 Malaria:

Table 18: Children who had Malaria and received appropriate Treatment

Received VAR? Freq %

Yes 94 51%

No 48

Do not Know 40* 26%

Total 189 100.0



59% (212/358) of the children had fever in the last 2 weeks prior the survey and 68% of themwere treated with appropriate anti malarial ( ACT, Fansidar, Chloro and amodiaquine) within24h of the onset of the fever. This is a moderate decrease in the prevalence of malaria from2008 KPC (64%) but access to the treatment has been significantly improved from 17.5% in2008. Coexistence of reported high prevalence of malaria cases and ITNS used in DHS andChild Survival National surveys in a pattern known in Niger by Both small scale project andthe National Malaria Program. Possible reason to look at in for further investigation includes:Determining time period when most people start using the ITN at night time and issues

pertaining to drug resistance because even though the National policy has adopted since 2008use of combined Artemisin drugs, Choloroquine, amodiaquine are still be used as first linetherapy mostly by ³ Ambulant Pharmacist´

1.12 . N utritional Status

Anthropometric data analyzed in ENA (Emergency Nutrition Assessment) software showed asignificant left skew of the curve. The Survey found that 41.7% (145/350) are underweight.Analysis was performed on 350 and 10 data are missing.

Freq %

Yes 144 68%

No 72

Do not Know

Total 212 100.0



1.13 Discussion

In general, findings of the endline survey in Konni District have shown 2 major Trends:improvements in most of the indicators in Maternal and newborn care, Prevention andTreatment of infant disease, Immunization andWatsan and deterioration of Nutritional statusof children in the project area that will be discussed more extensively.

1.13.1 Maternal and Newborn

On Mother ±Child Protection against Tetanos indicator, the endline findings has shown thata higher proportion (81% vs 28.8% at baseline) of mothers with children 0-23 who receivedat least 2 doses of Tetanus Toxoid vaccine before the birth of their youngest child. This ishigher than the 62.1% found by the 2010 Child Survival National Survey[1] for the Regionof Tahoua. (Statistique, Juin 2010).Increase in TT is generally related in improved attendance of Antenatal Consultation bywomen. Despite several stock out of vaccines recorded during the four year implementationof the child survival project, the Policy of Free care access to Mother and child care decreed

by the GON in 2008 and community sensitization done by project could be contributingfactor.The increase in TT vaccine has also been correlated with proportionate increase in access tomaternal Health service as shown by 73% of mother possessing a Health/vaccination cardsand 60% of pregnant women that give birth in Health Center. The project area showed a

better correlation of completion of ANC/TT visits and birth in health facility than the NationalChild Survey of 2010 who showed that despite a significant increase of Antenatal visits (55%in Tahoua Region where the project is located), deliveries in Health facility remained low(31%). Among the 60% of pregnant women who gave birth in Health Centers, 52% of thedeliveries were attended by skilled personnel against 26.4% at the project start up.MOH indicator do not account though among skilled personnel Health post Worker who arenot Nurse. This accounts for almost 60% of all the Health workers in the 60 HP of Konni.

76% of the deliveries performed in these facilities used a clean Birth Kit compared to 20%reported in the Initial KPC.

The rate of post-partum check has not changed and have even slightly decreased both for mothers ( 88% vs. 92% at baseline) and children (11% vs. 13% ).

While these results may translate a real stagnation of the post natal check-up, it should benoted that the responses rate in the Final KPC is low. Even though 60% (201/358) of motherssaid ³yes´ that they were checked of their child birth ,Only 29 mothers were able to identifyclearly who assisted her during the delivery.

1.13.2 Infant and Yang Child Feeding

The survey has noted a significant increase (72% vs. 36%) in the proportion of children age 0-5 months who were exclusively breastfed during the last 24 hours from the baseline to endline survey. This is more than twice the proportion found by the National Child SurvivalSurvey of June 2010 (26.9%). However we find similar scale of increase when we comparethe increase between 2008baseline/end line (36/72) and National Survey (13/26.9) during thesame period.



National survey cluster representatively is limited of the Tahoua Region where Konni is oneof the 7 Health Districts.The Survey supported semi -quantitative observations done by the MTE Evaluation thatBreastfeeding has significantly increased in the project area.

Proportion of children 6-23 month who were fed according to a minimum of appropriate

feeding practices was weighed at 59% (147/251).this a noticeable improvement compared to baseline estimate of 36%.

74% of children aged 6-23 month received a dose of Vitamin A in the last 6 month accordingto mother recall and whiles it is only 10% in the baseline KPC. If we exclude responses fromMothers whose card do not mention a precise date Vitamin is received, then the proportiondrops to 8% (20/251). DHS calculate this indicator for children 0-5yrs and 2006 DHS found70% of children fewer than 5 yrs who have received a supplement of mega dose Vitamin.Biannual campaign of National vaccination days are organized in Niger. Since the dose arerenewed every six month to moving cohort of under 5 children, the stagnation of the

proportion over 4 years This indicate almost the limitation of the distribution strategy rather.

1.14 Child I mmunization:

The proportion of mothers with children aged 12-23 months who were vaccinated 3 hasimproved from baseline to endline in Penta3 from 28% to 41 %, in measles ( 38% vs 51%)

but rather decline for BCG ( 72% vs 66%). These all antigens vaccination were still low . asconsequences the project has reported annual outbreaks (International, Oct 31 2008) .District has repeatedly reported stocks out in vaccine (Espace_réservé1)during the annualHealth plan evaluation. It is important to note however the rates were higher that the Endline

projected targets for these antigens ( 40%) (International, Child Survival Mid TermEvaluation Report, March 2010, pp. 18-22)

Use of vitamin A supplementation among children aged 6-23 months has improved from baseline (10%) and endline survey (73%). This improvement is good for the children asvitamin A is essential for their growth. Vit A is integrated in the 2 semiannual Vaccinationcampaign. National surveys has continuously shown high coverage of vitaminsupplementation in Niger to the point to be removed among priority child Survival indicatorstracked by annual Child Survival Survival Surveys.

1.15 . Prevention and treatment of c hild hood illness:

The Survey found a significant improvement in the prevention and treatment of malaria. Useof Mosquito by mother and child and appropriate treatment of malaria have respectively

doubled ( 76% vs 40%) and more for effective treatment of fever ( 17.5% vs 68%). Dispite several stock outs noted during the project course ( (International, ChildSurvival Mid Term Evaluation Report, March 2010), the project BCC effort and increasedavailability of ITN in the communities may have contributed to this results.. Furthermore TheMTE Evaluation showed that the project has been to educate communities in the use of ITN

beyond the rainy season.



Diarrhea has been one of the major causes of morbidity and mortality among children and theuse of ORS is one treatment used to manage the disease. The end line survey noted animprovement in the use of ORS among children aged 0-23 months to control diarrhea ( 50%vs. 17.5%) . this result would have been better if the project has been able to distribute ORSdirectly at household level through the care group volunteers. Access to ORS was only limitedto mothers who consult at the Health post.

The endline survey identified an improvement in health seeking behavior among mothers withchildren aged 0-23 months as evidenced by increased use of appropriate health provider tomanage cough and fast and/or difficult breathing of children aged 0-23 months from baselinefindings (44% vs 18.2%). Even though ARI management is not among the 4 prioritytechnical intervention of the Konni Project.Improvement of case management of childhood illnessess has been promoted throughcapacity building of Health post worker in C-IMCI and better linkages for referral throughcare group mobilization.

1.16 . Point of use

Use of clean water and good sanitation prevents children from having waterborne diseases.The study noted improvements in households with children aged 0-23 months which treatwater effectively ( 75% vs 15.2%) and use soap for hand washing compared to baselinefindings ( 24% vs 11.5%).while the improvement is beyond Dip targets for the POU, handwashing has been one of the most challenging intervention during the projectimplementation for several reasons: the project has adopted a gradual introduction of BCC

packages and hand washing was introduced at Year 2 and did not benefit as muchsensitization time as MNC or Breastfeeding. Second, placement of soap at appropriate pointof use is highly cultural dependant. soap is mostly in the bathing area and prayer ablutionKettle used mostly for handwashing in the project area is not culturally associated with usingsoap. Also, soap and detergent are costly and cannot be exposed outside because of birds,

hens or domestic animal that tend to displace/spoil it or be in a container where it could easilymelt or dilute. The project has trained at the last quarter of implementation period (April-May-june) for few women volunteers to produce locally soap. There is however a need tocreate a mechanism of expanding the production in the project area but this is an outcome thatcould be seen within the current phase of this project.

1.17 N utritional status of c hildren

The study found that 41.7% (145/350) of children 0-23 month are underweight. Accountingminor possible biases in this indicator calculation due to under estimation of weight for children under 1month who were not weighed by enumerators during data collection, theoverall estimate of underweight is higher than the baseline survey of 30%. While the

improvement of exclusive breastfeeding and complementary feeding practices noted in thefinal KPC is not supporting the trend in a Normal food security and disease burden setting, itis however worthy to recall the overall nutrition and food security context of Niger during thefour year implementation of the project.In 2009-2010, Niger recorded food shortage with almost half of the population estimated to

be in food insecurity. At the Konni District level in slept 2009, 169 villages were identified by the Local Government Food security watching committee system to have a crop deficit of 50-80%. At the preparedness phase, Relief International has submitted a CMAM proposal toOFDA to address the looming nutritional crisis that would impact CS projects.



Niger DHS 2006 found 46% of under five children who are underweight, based on this prevalence the projected target for 2011 is 25% to meet the MDG for reducing infantmortality. A Situational Analysis of IYCF policies and programmatic activities in Niger conducted (Whueler Sara,Biga A, 2011) in 2008-2009 showed that ³ Mortality rates are ontrack to reaching the Millennium Development Goal to reduce mortality among

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´.



Bibliograhy :

1. RN/Institut National de la Statistique :Equete Survie de l¶Enfant Juin 20102. RN/ District Sanitaire konni : Plan de Développement Sanitaire 2012-20163. RN/ Institut National de la statistique : Enquête National Nutrition Juin 20114. Population Niger 2011: http//www.ins.ne

5. République du Niger, Institut National de la Statistique± Niger, Ministère del¶Économie et des Finances± Niger, Macro International Inc., United States Agencyfor International Development (USAID),Coordination Inter-Sectorielle de Lutte contreles IST/VIH/SIDA (CISLS) ± Niger, et al. (2007) Enquête Démographique et de Santéet à Indicateurs Multiples 2006.

6. Classement Niger :http://hdrstats.undp.org/fr/pays/profils/NER.html 7. Indicateur s Education Niger:1

http://www.indexmundi.com/g/r.aspx?c=ng&v=39&l=fr 8. RN /Ministere de la SantéPublique. Plan de Developpement S anitaire du Niger adopté

Janvier 2011. 9. RN/Ministère de la Santé Publique. Avant-projet de S tratégie National de S urvie de

l¶Enfant, 2008 ; page 30.10. RN/Ministere de la Santé Publique. Plan National pour la Nutrition PNN 2011-2015 11. USAID/GH/HIDN/Child Survival and Health Grants Program²TRM²MATERNAL

AND NEWBORN CARE²200912. USAID/GH/HIDN/Child Survival and Health Grants Program²TRM²Diarrheal

Disease Prevention and Control-201013. USAID/GH/HIDN/Child Survival and Health Grants Program²TRM² Malaria ²

200914. Sarriot, E., P. Winch, W. Weiss, and J. Wagman. 1999. Methodological and

sampling Issues for KPC surveys. Available at CSTS Web site

(www.childsurvival.com) under KPC2000+.

15. USAID/Core group: KPC 2000 plus Field Guide16. USAID/CSHGP: Final Evaluation Guidelines May 201117. Niger Stats;http://hdrstats.undp.org/en/countries/profiles/NER.html

18. Relief International: Child Survival Annual Report FY07-08 Oct 31 2008

19. Relief International: Child Survival Mid Term Evaluation Mars 201020. Sara E.Wuehler and Abdoulazize Biga Hassoumi:21. Situational analysis of infant and young child nutrition policies and programmatic

activities in Niger@2011 Blackwell Publishing Ltd Maternal and Child Nutrition

(2011), 7 (Suppl. 1), pp. 133±156

Report Compiled Draft1HM Jan 5

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