multiple indicator cluster surveys data dissemination and further analysis workshop
DESCRIPTION
Multiple Indicator Cluster Surveys Data dissemination and further analysis workshop. Child Health. Child health Immunization, Diarrhoea , Pneumonia, Malaria. Countdown to 2015 Decade Report (2000-2010). Child Health in MICS4 Presentation overview. Immunization. Background. - PowerPoint PPT PresentationTRANSCRIPT
Multiple Indicator Cluster SurveysData dissemination and further analysis workshop
Child Health
MICS4 Data dissemination and Further Analysis
Child healthImmunization, Diarrhoea, Pneumonia, Malaria
Countdown to 2015 Decade Report (2000-2010)
Child Health in MICS4 Presentation overview
Immunization
Background
WHO Expanded Programme on Immunization
It is recommended that all children receive the following immunizations:
• At birth BCG (tuberculosis) and Polio 0• At 6 weeks Polio 1 and DPT 1 (diphtheria, pertussis, tetanus)• At 10 weeks Polio 2 and DPT 2• At 14 weeks Polio 3 and DPT 3• At 9 months Measles
• Hepatitis B (HepB) and Haemophilus influenzae type B (Hib) have same schedules as Polio and DPT
• Up-to-date information on recommended vaccines can be obtained from www.who.int/immunization/documents/positionpapers/en/index.html
Indicators
In MICS4, immunization indicators are calculated as - the percentage of children aged 12-23 months who
received each specific vaccine at any time before the survey and by the age of 12 months (before their first birthday)
and- the percentage of children aged 12-23 months who
received BCG, DPT 1-3, Polio 1-3 and measles at any time before the survey and by the age of 12 months
Methodological issues
• The model schedule is adapted in some way by most countries so that it more closely meets their needs.
• Most importantly, the survey questions should reflect the national immunization schedule and take into account recent changes or vaccine introductions (if any)
Methodological issues
• In surveys, coverage estimates are obtained from information copied from observed child health cards and from maternal recall of specific immunizations.
• Immunization or child health cards are not subject to recall bias, but are not always accurate.
• Cards may not be shown to the survey interviewer, or immunizations may not have been recorded on the card.
Methodological issues
• In these cases, maternal recall may provide additional information.
• Maternal recall, however, can either over- or underestimate the true level of coverage
• Some suggest that maternal recall should not be used to determine coverage estimates, since it may introduce recall bias.
• Others maintain that inclusion of recall data yields a more accurate coverage estimate.
Methodological issues
• Indicators are calculated for children aged 12-23 months:– All children should have completed all
vaccinations by this age– Their experience is the most recent
experience which is not truncated
Calculation
Children vaccinated according to card data + Children vaccinated according to mother’s recall= Total number of children vaccinated
For children without cards (or who have cards with missing or incomplete dates), how do we compute the percentage of children vaccinated by 12 months of age (before the first birthday?
–Assume the proportion vaccinated by 12 months of age is same as for children who have cards.
Example: BCG
Percentage vaccinated according to card 85.2Percentage vaccinated according to
mother’s report +3.7Total percentage ever vaccinated 88.9
Percentage vaccinated by 12 months according to card 98.0
Apply percentage 88.9 x .98 Percentage vaccinated by 12 months 87.1
CH3: Neonatal Tetanus Protection• Estimates the percentage of women age 15-49 years
whose last live birth within the 2 years preceding the survey was protected against neonatal tetanus
• Found in women’s questionnaire• Complex calculation: women can be protected from
neonatal tetanus in a variety of circumstances based on the receipt of vaccinations in the previous years
CH3: Neonatal Tetanus Protection
• Percentage of women age 15-49 years whose last live birth within the past 2 years was protected against neonatal tetanus
• Calculation: The information contained in the first five columns of this table are calculated in a hierarchical fashion:– (Column 1) Received at least two tetanus toxoid injections during the most recent pregnancy (MN7>=2)– (Column 2) Received one tetanus toxoid injection during the last pregnancy and at least one dose prior to
the pregnancy (MN7=1 and MN10>=1) OR received at least two tetanus toxoid injections, the last of which was less than 3 years ago (MN10>=2 and MN11<3)
– (Column 3) Received at least 3 tetanus toxoid injections over lifetime, the last of which was in the last 5 years (MN10>=3 and MN11< 5)
– (Column 4) Received at least 4 tetanus toxoid injections over lifetime, the last of which was in the last 10 years (MN10>=4 and MN11< 10)
– (Column 5) Received five or more tetanus toxoid injections (MN10>=5) at any point• The last live birth for all women who fall into one of the first 5 columns is considered
‘protected against tetanus’ and should be included in the sixth column.• In many surveys, the sample sizes may be too small to present breakdowns by
background characteristics.
Table CH.3: Neonatal tetanus protection
Percentage of women age 15-49 years with a live birth in the last 2 years protected against neonatal tetanus, Country, Year
Percentage of women who received at least 2 doses during
last pregnancy
Percentage of women who did not receive two or more doses during last pregnancy but received:
Protected against tetanus1
Number of women with a live birth in the last 2
years 2 doses, the last within prior
3 years3 doses, the last within
prior 5 years4 doses, the last within prior
10 years5 or more doses during
lifetimeRegion
Region 1
Region 2
Region 3
Region 4
Region 5
Area
Urban
Rural
Education
None
Primary
Secondary
Higher
Wealth index quintile
Poorest
Second
Middle
Fourth
Richest
Religion/Language/Ethnicity of household head
Group 1
Group 2
Group 3
Total
1 MICS indicator 3.7
Child Health in MICS4 Presentation overview
Care of illness tables– Diarrhoea (3 tables)– Pneumonia (4 tables)– Malaria (6 tables)
Beyond the tables
Diarrhoea treatment
Table CH.4: Oral rehydration solutions and recommended homemade fluidsPercentage of children age 0-59 months with diarrhoea in the last two weeks, and treatment with oral rehydration solutions and recommended homemade fluids, Country, Year
Had diarrhoea in last two
weeks
Number of
children age 0-59 months
Children with diarrhoea who received:Number of
children age 0-59 months
with diarrhoea in last two
weeks
ORS(Fluid from
ORS packet or pre-packaged
ORS fluid)
Recommended homemade fluids ORS or any
recommended
homemade fluidFluid X Fluid Y Fluid Z
Any recommended
homemade fluid
• Diarrhoea prevalence – varies by season and caretaker reporting
• ORS (Oral Rehydration Salts) – recent push to scale up • Recommended home fluids vary according to country
Diarrhoea treatment
• Preventing dehydration is key to child survival• Feeding should continue during the diarrhoea
episode
Table CH.5: Feeding practices during diarrhoeaPercent distribution of children age 0-59 months with diarrhoea in the last two weeks by amount of liquids and food given during episode of diarrhoea, Country, Year
Had diarrhoea
in last two
weeks
Number of
children age 0-
59 months
Drinking practices during diarrhoea: Eating practices during diarrhoea:
Number of children age 0-59 months
with diarrhoea in last two
weeks
Given much less to drink
Given some-what
less to drink
Given about
the same
to drink
Given more
to drink
Given noth-ing to drink
Missing/DK
Given much less to
eat
Given somewhat
less to eat
Given about
the same to eat
Given more to eat
Stop-ped food
Had never been given food
Miss-ing/DKTotal Total
Diarrhoea treatment
• ORT = Oral rehydration therapy = ORS and/or recommended home fluids and/or increased fluids
• Key diarrhoea indicator in this table – ORT with continued feeding (based on four components)
• Zinc is another key intervention
Table CH.6: Oral rehydration therapy with continued feeding and other treatmentsPercentage of children age 0-59 months with diarrhoea in the last two weeks who received oral rehydration therapy with continued feeding, and percentage of children with diarrhoea who received other treatments, Country, Year
Children with diarrhoea who received: Other treatments:
Not given any
treatment or drug
Number of
children age 0-59 months
with diarrhoea
in last two
weeks
ORS or increased fluids
ORT (ORS or
recommended
homemade fluids or
increased fluids)
ORT with continued feeding1
Pill or syrup Injection
Intra-venou
s
Home remed
y, herbal medici
ne Other
No other
treatment
Anti- biotic
Anti- motili
ty Zinc OtherUn-
known Anti- biotic
Non-antibiot
icUnkno
wn
Key diarrhoea indicators
ORT + continued feeding
ORT
ORS
RHF
Increased fluids
Continued feeding 0 10 20 30 40 50 60 70 80 90 100
61.6
85.4
60.9
57.7
39.4
70.8
Bhutan MICS 2010
Percentage of children with diarrhoea in the two weeks preceding the survey, who received:
Child Health in MICS4 Presentation overview
Care of illness modules– Diarrhoea (3 tables)– Pneumonia (4 tables)– Malaria (6 tables)
Beyond the tables
Pneumonia
• Definition of suspected pneumonia = cough + rapid/difficult breathing + problem in the chest
• Suspected pneumonia prevalence – varies by season and caretaker reporting• Appropriate health providers includes public and private sources (excludes
private pharmacy)• Two key pneumonia indicators = careseeking and antibiotics
Table CH.7: Care seeking for suspected pneumonia and antibiotic use during suspected pneumoniaPercentage of children age 0-59 months with suspected pneumonia in the last two weeks who were taken to a health provider and percentage of children who were given antibiotics, Country, Year
Had suspected pneumonia in the last two weeks
Number of
children age 0-59 months
Children with suspected pneumonia who were taken to:
Any appro-priate
provider1
Percentage of children
with suspected pneumonia
who received
antibiotics in the last
two weeks2
Number of children age 0-59 months with
suspected pneumonia in the last two
weeks
Public sources Private sources Other source
Govt. hospit
al
Govt. health centre
Govt. health post
Village
health work-
er
Mobile/ out-reach clinic
Other publi
c
Private hospit
al/ clinic
Private physici
an
Private pharm
acyMobile clinic
Other private medic
al
Relative or
friend Shop
Trad. Practi- tioner
Antibiotic treatment
Total Urban Rural0
10
20
30
40
50
60
70
80
90
100
4958
47
Bhutan MICS 2010
Percentage of children with suspected pneumonia in the last two weeks who received antibiotics
Antibiotic treatment
Total Urban Rural0
10
20
30
40
50
60
70
80
90
100
Percentage of children with suspected pneumonia in the last two weeks who received antibiotics
Antibiotic treatment
Total Urban Rural0
10
20
30
40
50
60
70
80
90
100
Percentage of children with suspected pneumonia in the last two weeks who received antibiotics
Based on 54 unweighted cases!
Antibiotic treatment
Total Urban Rural0
10
20
30
40
50
60
70
80
90
100
Percentage of children with suspected pneumonia in the last two weeks who received antibiotics
Based on 54 unweighted cases!
Note that *all* treatment indicators based on a subset of children!
Pneumonia
• Note this table is based on mothers/caretakers of all children under-five
• The two danger signs are fast breathing and difficult breathing• Open-ended questions can lead to challenges during data
collection
Table CH.8: Knowledge of the two danger signs of pneumoniaPercentage of mothers and caretakers of children age 0-59 months by symptoms that would cause the to take the child immediately to a health facility, and percentage of mothers who recognize fast and difficult breathing as signs for seeking care immediately, Country, Year
Percentage of mothers/caretakers of children age 0-59 months who think that a child should be taken immediately to a health facility if the child: Mothers/
caretakers who recognize the
two danger signs of pneumonia
Number of mothers/caretakers of children
age 0-59 months
Is not able to drink or breastfeed
Becomes sicker
Develops a fever
Has fast breathing
Has difficult breathing
Has blood in
stool
Is drinking poorly
Has other
symptoms
Pneumonia
MICS4 tables cover three essential steps needed to reduce deaths among children under five with pneumonia:
1. Recognize a child is sick2. Seek appropriate care3. Treat appropriately with antibiotics
Essential steps for reducing pneumonia deaths among children
Caretaker knowledge -both signs
Fast breathing
Difficulty breathing
Any appropriate provider
Antibiotic treatment
0 10 20 30 40 50 60 70 80 90 100
8
21
23
62
71
1
2
3
Mongolia MICS 2005
Pneumonia
• Inhaling smoke from solid fuels is hazardous
• Variation by region
• How valid are data in CH10?
Table CH.9: Solid fuel usePercent distribution of household members according to type of cooking fuel used by the household, and percentage of household members living in households using solid fuels for cooking, Country, Year Percentage of household members in households using:
Number of household members
Elec-tricity
Liquefied Petroleum Gas (LPG)
Natural Gas
Bio-gas Kerosene
Solid fuels
Other fuel
No food cooked in
the househol
d Total
Solid fuels for cooking1
Coal, lignite
Char-coal Wood
Straw, shrubs, grass
Animal dung
Agricultural crop
residueRegion Urban-rural Education of household head Wealth index quintiles Religion/Language/Ethnicity of household head Total 100.0
1 MICS indicator 3.11
Table CH.10: Solid fuel use by place of cookingPercent distribution of household members in households using solid fuels by place of cooking, Country, Year
Place of cooking:Number of household
members in households
using solid fuels for cooking
In a separate
room used as kitchen
Elsewhere in the house
In a separate building Outdoors
At another place Total
Region Urban-rural Education of household head Wealth index quintiles Religion/Language/Ethnicity of household head Total 100.0
Child Health in MICS4 Presentation overview
Care of illness modules– Diarrhoea (3 tables)– Pneumonia (4 tables)– Malaria (6 tables)
Beyond the tables
Standard MICS4 malaria tables
• Household availability of insecticide treated nets and protection by a vector control method
• Children sleeping under mosquito nets
• Pregnant women sleeping under mosquito nets
• Anti-malarial treatment of children with anti-malarial drugs
• Malaria diagnostics usage
• Intermittent preventive treatment for malaria
Take advantage of increasing focus on health for dissemination, advocacy
and analysis!
Further use of data
Health interventions across the continuum of care
Countdown to 2015 Decade Report (2000-2010)
From Diarrhoea: Why children are still dying and what can be done
A second look at diarrhoea-related data?
A second look at pneumonia-related data?
Treatment• Careseeking behavior• Antibiotics
Key prevention measures• Adequate nutrition (including breastfeeding and zinc) • Immunization (measles, Hib and pneumococcal
conjugate)• Reducing indoor air pollution• Water, sanitation and hygiene
Thank You!