niger race endline survey report 31march17 · annex g. details of data cleaning and analysis ......

ENDLINE SURVEY

FINAL REPORT

World Vision, Niger

Prepared by ICF and World Vision for WHO Rapid Access Expansion (RAcE) Program

March 2017

AUTHORS: Grace Nganga,

Yodit Fitigu, Kirsten Zalisk

RAcENigerEndlineSurveyFinalReport ii

ACKNOWLEDGEMENTS

ICF and World Vision would like to thank le Ministère de la Sante Publique and l’Institute National de la Statistique for their contributions to this work. We would also like to thank the Relais Communautaires (Niger’s Community Health Workers), who work hard to provide services to caregivers and children in communities, and the caregivers who give so much to ensure and improve the health of their children. This work was made possible by the World Health Organization through funding by the Canadian Government.

RAcENigerEndlineSurveyFinalReport iii

TABLE OF CONTENTS

ABBREVIATIONS ............................................................................................................................................................. iv

EXECUTIVE SUMMARY .................................................................................................................................................. v

1 BACKGROUND .......................................................................................................................................................... 1 1.1 RAcE Program Goals and Objectives ............................................................................................................ 1 1.2 World Vision Project Background ................................................................................................................. 1 1.3 World Vision Endline Survey Objectives ...................................................................................................... 2

2 SURVEY METHODS ................................................................................................................................................... 3 2.1 Survey Implementation and Partnership ....................................................................................................... 3 2.2 Survey Design ...................................................................................................................................................... 3 2.3 Survey Questionnaire ........................................................................................................................................ 4 2.4 Selection and Training of Survey Staff ............................................................................................................ 5 2.5 Data Collection ................................................................................................................................................... 5 2.6 Data Entry and Management ............................................................................................................................ 6 2.7 Data Analysis........................................................................................................................................................ 6 2.8 Survey Indicators ................................................................................................................................................ 7 2.9 Survey Limitations .............................................................................................................................................. 7

3 FINDINGS ..................................................................................................................................................................... 8 3.1 Characteristics of Sick Children and Caregivers ......................................................................................... 8 3.2 Decision-making ................................................................................................................................................ 10 3.3 Caregiver Knowledge and Perception of iCCM RComs......................................................................... 11 3.4 Care-Seeking ...................................................................................................................................................... 12 3.5 Assessment ......................................................................................................................................................... 13 3.6 Treatment Coverage ........................................................................................................................................ 15 3.7 First Dose of Treatment and Counseling from RCom ............................................................................ 16 3.8 Referral Adherence .......................................................................................................................................... 18 3.9 Sick Child Follow-Up ....................................................................................................................................... 18 3.10 Illness Management and Diagnostics by Sex ............................................................................................... 19

4 DISCUSSION .............................................................................................................................................................. 21

Annex A. List of Persons Involved in the Survey ..................................................................................................... 23

Annex B. Endline Sample ............................................................................................................................................... 24

Annex C. Detailed Sampling Design ............................................................................................................................ 25

Annex D. Survey Questionnaire .................................................................................................................................. 26

Annex E. Survey Training Schedule ............................................................................................................................. 27

Annex F. Fieldwork Schedule ....................................................................................................................................... 30

Annex G. Details of Data Cleaning and Analysis ..................................................................................................... 32

Annex H. Indicator Definitions .................................................................................................................................... 35

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ABBREVIATIONS

ACT artemisinin-based combination therapy

CCM community case management

CSI Case de Santé Intégré (Health Hut)

iCCM integrated community case management

INS Institute National de la Statistique (National Institute of Statistics)

MSP Ministère de la Santé Publique (Ministry of Health)

ODK Open Data Kit

ORS oral rehydration solution

PPS probability proportional to size

RAcE Rapid Access Expansion

RCom Relais Communautaire (community health worker)

WHO World Health Organization

RAcENigerEndlineSurveyFinalReport v

EXECUTIVE SUMMARY

World Vision implemented the Rapid Access Expansion (RAcE) program in four health districts in Niger—Boboye, Dogondoutchi, Dosso, and Keita—since July 2013. In October 2016, World Vision conducted the RAcE endline survey, with technical assistance from ICF, and in collaboration with the Division de la Statistique (Division of Statistics) of the Ministère de la Santé Public (Ministry of Health) and the Institute National de la Statistique (National Institute of Statistics). This report presents endline data and compares baseline and endline data to assess changes in care-seeking, assessment, and treatment of sick children. Baseline and endline data are also used to assess caregivers’ knowledge of childhood illnesses and their perceptions of services provided by Relais Communautaire (RComs, or community health workers). This information is used to present project accomplishments.

Results for key indicators are presented in Table 1. Caregivers’ knowledge and perceptions of RCom increased significantly over the course of the project, as expected, given that RCom were trained and deployed to provide iCCM services after the baseline survey was implemented. The percentage of caregivers who know the RCom who works in their community significantly increased, from 1 percent at baseline to 99.8 percent at endline (p<0.001). At endline, caregiver’s trust in RCom was nearly universal: 99 percent of caregivers viewed RCom as trusted health providers, and 98 percent believe RCom provide quality services. There was no significant change observed in caregiver knowledge of childhood illnesses over the course of the project.

Care-seeking from an appropriate provider was high at baseline (68 percent) and remained high at endline (85 percent). As expected following the extension of health services to the communities via RCom, care-seeking from RComs was high at endline; of cases of illness among children 2-59 months who sought care from an appropriate provider, 88 percent of those sought care from an RCom The percentage of cases of illness among children aged 2-59 months taken to an RCom as the first source of care increased significantly (p<0.001), from 0.1 percent at baseline to 75 percent at endline.

At baseline iCCM services had not yet been rolled out to communities and no RCom administered RDTs to assess cases of fever. At endline, 75 percent of the cases of fever among children 2-59 months that were assessed by an RCom in the two weeks prior the survey were administered an RDT. The overall percentage of illnesses receiving appropriate treatment increased significantly over the course of the project, from 37 percent at baseline to 59 percent at endline (p<0.001). The largest increase observed was for the appropriate treatment for diarrhea, which increased from 23 percent at baseline to 64 percent at endline (p<0.001). Among those who sought care from an RCom, 58 percent received appropriate treatment. Despite the overall increase in appropriate treatment from any provider, the percentage of cases receiving appropriate treatment is low (overall, and from RCom). Little more than half of the cases treated by the RCom received the first dose of the treatment in the presence of the RCom and that 98 percent of caregivers were counseled by the RCom on treatment administration.

At endline, 32 percent of cases managed by an RCom were referred. Overall, reported adherence to referrals made by RCom was high at 91 percent at endline. Overall, more than 68 percent of cases were followed up by an RCom, 93 percent of which were followed-up by the RCom within three days.

The findings from the endline survey suggest the value of iCCM in hard to reach communities in Niger, but greater improvements in access to quality care are needed. There is need to further investigate

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reasons why appropriate treatment for iCCM illnesses remains low despite high care-seeking from and assessment by RCom, and to put solutions in place to address this challenge.

Table 1. Key indicator summary table

Indicator Baseline Endline % Point

change p-value

% (CI %) % (CI %)Caregiver knowledge

1

Percentage of caregivers of children age 2-59 months who have been sick in the two weeks preceding the survey who are aware of the presence of the CCM-trained RCom in their community

1.0 (0.3 - 3.2)

99.8 (98.3 - 100.0)

98.8 0.0000

2

Percentage of caregivers of children age 2-59 months who have been sick in the two weeks preceding the survey who know the role of the CCM-trained RCom in their community

40.0 ** (10.2 - 79.6)

77.4 (70.6 - 83.4)

37.4 0.0425

3

Percentage of caregivers of children age 2-59 months who have been sick in the two weeks preceding the survey who know two or more signs of childhood illness that require immediate assessment by an appropriately trained provider

75.8 (70.3 - 80.5)

81.1 (76.0 - 85.3)

5.3 0.1412

Caregiver perceptions of iCCM services

4

Percentage of caregivers of children age 2-59 months who have been sick in the two weeks preceding the survey who view CCM-trained RComs as trusted health care providers

20.0 ** (1.9 - 76.2)

98.5 (95.6 - 99.5)

78.5 0.0000

5

Percentage of caregivers of children age 2-59 months who have been sick in the two weeks preceding the survey who believe CCM-trained RComs provide quality services

20.0 ** (1.9 - 76.2)

97.6 (95.1 - 98.8)

77.6 0.0000

6

Percentage of caregivers of children age 2-59 months who have been sick in the two weeks preceding the survey who found the CCM-trained RCom at first visit

0* 73.8

(67.4 - 79.4) 73.8 N/A

7

Percentage of caregivers of children age 2-59 months who have been sick in the two weeks preceding the survey who cite the CCM-trained RCom as a convenient source of treatment

60.0 ** (20.4 - 89.8)

87.9 (80.8 - 92.7)

27.9 0.0596

Sick child care-seeking

8

Percentage of children age 2-59 months who have been sick in the two weeks preceding the survey for whom advice or treatment was sought from an appropriate provider

Overall68.8

(62.0 - 75.0) 84.7

(79.2 - 89.0) 15.9 0.0002

Fever72.4

(65.7 - 78.2) 88.9

(82.0 - 93.3) 16.5 0.0001

Diarrhea65.8

(57.2 - 73.5) 84.9

(78.7 - 89.6) 19.1 0.0005

Fast breathing68.3

(59.7 - 75.8) 80.1

(73.1 - 85.7) 11.8 0.0151

9

Percentage of children age 2-59 months who were sick in two weeks preceding the survey taken to a CCM-trained RCom as first source of care

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change p-value

% (CI %) % (CI %)

Overall0.1

(0.0 - 0.8) 75.5

(68.3 - 81.5) 75.4 0.0000

Fever0.3

(0.0 - 2.2) 77.1

(67.8 - 84.3) 76.8 0.0000

Diarrhea 0.0 75.7

(67.8 - 82.1) 75.7 0.0000

Fast breathing 0.0 73.6

(65.9 - 80.1) 73.6 0.0000

Sick child assessment

10 Percentage of children age 2-59 months with fever in the two weeks preceding the survey who had finger or heel stick

20.6 (14.4 - 28.7)

68.2 (57.9 - 77.0)

47.6 0.0000

11

Percentage of children age 2-59 months for whom their caregiver received the results of the malaria diagnostic test of the children who had had finger or heel stick in the two weeks preceding the survey

78.9 (67.3 - 87.1)

84.6 (76.2 - 90.4)

5.7 0.2498

12

Percentage of children age 2-59 months with cough with difficult or fast breathing (suspected pneumonia) in the two weeks preceding the survey who had their respiratory rate counted to assess fast breathing

53.5 (45.5 - 61.4)

52.4 (43.0 - 61.6)

-1.1 0.8541

Sick child assessment by RCom

13

Percentage of children age 2-59 months with fever in the two weeks preceding the survey who had a finger or heel stick by an RCom among those who sought care from an RCom

0** 75.4

(64.3 - 83.9) 75.4 0.0912

14

Percentage of children age 2-59 months for whom their caregiver received the results of the malaria diagnostic test of the children who had a finger or heel stick by an RCom in the two weeks preceding the survey among those who sought care from an RCom

0* 87.7

(79.6 - 92.9) 87.7 n/a

15

Percentage of children age 2-59 months with cough with difficult or fast breathing in the two weeks preceding the survey who had their respiratory rate counted to assess fast breathing by an RCom among those who sought care from an RCom

0* 63.8

(50.9 - 74.9) 63.8 n/a

Sick child treatment

16

Percentage of children age 2-59 months who have been sick in two weeks preceding the survey who received appropriate treatment

Overall37.0

(32.1 - 42.2) 59.4

(51.1 - 67.1) 22.4 0.0000

Confirmed Malaria€ (ACT within 24 hours)79.6

(64.4 - 89.4) 73.4

(61.2 - 82.8) -6.2 0.4135

Diarrhea (ORS and zinc)23.3

(18.8 - 28.6) 64.4

(55.5 - 72.4) 41.1 0.0000

Cough with difficult or fast breathing (amoxicillin)

44.6 (36.5 - 52.9)

46.2 (36.3 - 56.5)

1.6 0.7651

17

Percentage of children age 2-59 months who have been sick in the two weeks preceding the survey who received appropriate treatment from a CCM-trained RCom

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change p-value

% (CI %) % (CI %)

Overall 0 48.3

(40.6 - 56.2) 48.3 0.0000

Confirmed Malaria€ (ACT within 24 hours ) 0 71.0

(58.5 - 81.0) 71.0 0.0000

Diarrhea (ORS and zinc) 0 58.2

(48.3 - 67.5) 58.2 0.0000


0 25.3

(18.6 - 33.6) 25.3 0.0000

18

Percentage of children age 2-59 months who have been sick in the two weeks preceding the survey who received the first dose of treatment in the presence of an RCom among those who received prescription medicines for a CCM condition in the two weeks preceding the survey

Overall 0* 55.0

(42.0 - 67.4) 55.0 n/a

Fever (ACT) 0* 57.3

(40.6 - 72.5) 57.3 n/a

Diarrhea (ORS and zinc) 0* 50.3

(37.9 - 62.7) 50.3 n/a


0* 60.3

(40.2 - 77.4) 60.3 n/a

19

Percentage of sick children age 2-59 months for whom their caregivers received counseling on how to provide the treatment(s) among those who received prescription medicines for a CCM condition in the two weeks preceding the survey

Overall 0* 98.1

(96.3 - 99.1) 98.1 n/a

Fever (ACT) 0* 98.9

(92.0 - 99.9) 98.9 n/a


(92.9 - 98.3) 96.5 n/a


0* 100 100.0 n/a

Sick child referral and follow-up

20

Percentage of sick children age 2-59 who were referred in the two weeks preceding the survey whose caregiver adhered to referral advice

0* 91.4

(79.9 - 96.6) 91.4 n/a

21

Percentage of sick children age 2-59 months receiving treatment from an RCom in the two weeks preceding the survey who received a follow-up visit from an RCom according to country protocol

0* 68.5

(57.8 - 77.6) 68.5 n/a

*No cases **Fewer than 10 cases. € Fever with positive blood test

RAcENigerEndlineSurveyFinalReport 1

1 BACKGROUND

1.1 RAcE Program Goals and Objectives

In 2013, the World Health Organization (WHO) launched the Rapid Access Expansion (RAcE) program in five sub-Saharan African countries—Democratic Republic of Congo, Malawi, Mozambique, Niger, and Nigeria. The goal of the program was to increase coverage of diagnostic, treatment, and referral services for malaria, pneumonia, and diarrhea to decrease overall mortality and the number of severe cases among children aged 2–59 months. The program would accomplish this goal through the following objectives:

Catalyze the scale-up of integrated community case management (iCCM) as an integral part of government-provided health services in sub-Saharan Africa.

Stimulate policy review and regulatory update in each country on disease case management.

Accelerate adaptation of supply management and surveillance systems to include services at the community level.

This effort came at a time when there was great momentum for iCCM at the country level and a high degree of interest among the global health community to understand how to best measure success and how to build country ownership and capacity to sustain iCCM interventions.

1.2 World Vision Project Background

World Vision, in collaboration with the Ministère de la Santé Publique (MSP, or Ministry of Health), implemented the RAcE project in four health districts in Niger— Boboye, Dogondoutchi, Dosso, and Keita—from July 2013 to September 2017, with a target population of children aged 2-59 months. The objective of the project is to use the iCCM approach by extending health care and treatment to households from health facilities to Case de Santé Intégré (CSI, or Health Hut) through trained community health volunteers, referred to as Relais Communautaire (RCom), based within the project area. The project will also strengthen the health system, supply chain management, and health information management.

This project was implemented in accordance with the National iCCM Strategy developed in 2012, part of the larger National Child Survival Strategy that focuses on harmonizing interventions that promote healthy family practices in health, nutrition, hygiene, and sanitation at the community level. One of the objectives of the MSP and RAcE strategy is to ensure that the implementation of primary health care involves community participation as a means of empowering communities in support of their health problems.

The areas of the four districts in which RAcE was implemented have a total population of 1,872,929, including an estimated 414,079 children aged 2-59 months. MSP, together with WHO and World Vision, selected Boboye, Dogondoutchi, Dosso, and Keita as RAcE project areas due to high incidence rates of malaria, diarrhea, and pneumonia. Targeted areas are those that are iCCM eligible, meaning that they are villages located at least five km from a health facility, have limited number of staff at the health facilities, have insufficient access and treatment options due to lack of trained health workers, and have limited


equipment to provide adequate care. A total of 1,227 RComs were actively providing iCCM services in all four health districts at the time of the endline survey.

A baseline survey was conducted from August 26 to September 18, 2013 by World Vision and ADESEN-NAFA, a local nongovernmental organization, and with technical support from ICF. The baseline survey was administered in three steps, including two preparatory phases: training of the coordinating team took place from August 26 to 29, followed by training of the supervisors and enumerators from September 1 to 6. The field data collection was conducted over a 10-day period from September 9 to September 18 in sampled households in the project area.

1.3 World Vision Endline Survey Objectives

The objective of the RAcE endline household survey was to assess care-seeking behavior for sick children, iCCM coverage, and caregiver knowledge, attitudes, and practices related to pneumonia, diarrhea, and malaria in the RAcE Niger intervention areas. We compared baseline and endline data to assess changes in sick child care-seeking, assessment, and treatment coverage as well as caregivers’ knowledge of childhood illnesses and perceptions of RCom services, and used the information to make inferences about project accomplishments.


2 SURVEY METHODS

2.1 Survey Implementation and Partnership

World Vision, in collaboration with the MSP Division de la Statistique (Statistical Division), conducted the RAcE endline survey, with technical assistance from ICF, and l’Institute National de la Statistique (INS, or National Institute of Statistics). World Vision and Division de la Statistique worked with ICF to finalize the questionnaire, led the training of enumerators and supervisors, and provided oversight of the survey implementation. INS, together with World Vision, conducted the training on mobile data collection and prepared data for analysis by ICF.

The survey protocol received ethical approval from ICF’s Institutional Review Board and administrative approval from MSP.

Annex A contains a complete list of the people involved in the survey and their roles.

2.2 Survey Design

This was a cross-sectional cluster-based household survey, targeting primary caregivers of children aged 2-59 months who had recently been sick with diarrhea, fever, or cough with fast breathing. All primary caregivers of children aged 2-59 months reported to have experienced diarrhea, fever, or cough with fast breathing in the two weeks prior to the interview were considered eligible for inclusion in the survey. ICF developed standardized sampling guidance for all RAcE projects, which was adapted for World Vision Niger.

To be able to detect a 20 percent difference at 90 percent power with a two-tailed test and 95 percent confidence using cluster sampling, 263 cases were needed for each disease. ICF rounded up to 300 cases to ensure a consistent number of interviews per cluster and a slight increase in the precision of the coverage estimates.

The Niger household survey used a 30x30 multi-stage cluster sampling methodology. At baseline, the RAcE project area, iCCM-eligible areas—more than five km from a health facility—comprised the target population in Boboye, Dogondoutchi, Dosso, and Keita. At baseline, 30 clusters were selected using probability proportional to size (PPS). The baseline survey was conducted prior to training and equipping RCom to provide iCCM services.

The same clusters sampled at baseline were planned to be sampled at endline. However, nearly the full baseline sample had to be re-selected because they were not active RAcE project areas. RComs had been recruited to provide services in all of the baseline clusters, but in 21 of the baseline clusters RAcE interventions were never implemented1. The sampling frame was updated accordingly and 21 replacement clusters were selected using PPS. Annex B contains the endline sample with the complete list of clusters and communities.

1 World Vision reported that RCom recruited in these areas either did not show up for training or did not pass the test qualifying them to provide iCCM services.


Within each cluster, 10 interviews were conducted for each of the three illness modules—diarrhea, fever, and fast breathing—for a total of 30 interviews per cluster, or 300 interviews per each illness across the project area. Within each cluster, the survey team randomly selected the first household for interview and proceeded to the household with its front door nearest to the front door of the current household until the team conducted 10 interviews for each illness. Because two communities visited did not have 10 cases of each illness, interviewers went to the nearest community of the nearest cluster to complete the questionnaires of 10 cases per illness. See Annex C for the detailed sampling design.

At each household, the interviewer first determined if an eligible child lived there. An eligible child was aged 2-59 months and had been sick with diarrhea, fever, cough with rapid breathing, or any combination of the three illnesses in the two weeks preceding the survey.

If there was an eligible child in the household, the interviewer administered the questionnaire, including all applicable illness modules, to the caregiver of the eligible child. If more than one child was eligible, and they were sick with different illnesses, their caregiver was asked about each instance of illness. If there was more than one eligible child in the household for an illness, the interviewer randomly selected one of the eligible children and interviewed his or her caregiver.

2.3 Survey Questionnaire

ICF developed a standard questionnaire for all RAcE grantees to use for their surveys. World Vision worked with ICF to adapt the questionnaire to fit the Niger iCCM program and country context. This included including appropriate terminology for community health workers in Niger, care-seeking locations, and treatment options.

The survey questionnaire contains seven modules: caregiver and household background information; caregivers’ knowledge of iCCM activities in their community; caregivers’ knowledge of childhood illness danger signs; household decision-making; and a module for each major childhood illness: fever, diarrhea, and fast breathing. In addition to collecting information about caregiver knowledge, care-seeking, and treatment coverage, the questionnaire collects standard Demographic and Health Survey data on household ownership of selected assets, materials used for housing construction, and types of water access and sanitation facilities, which ICF will analyze and use for the final evaluation.

The endline survey questionnaire is approximately 30 pages in length. ICF had the questionnaire professionally translated into French, after which it was reviewed by WHO Niger and World Vision Niger prior to being fielded. However, prior to data collection, World Vision decided to use a mobile data collection program (Open Data Kit [ODK]) instead of the paper questionnaire because mobile data collection was used at baseline. With the help of Division de la Statistique, a programmer from INS programmed the mobile devices. This late decision left a short timeframe for developing the mobile program and did not provide time for ICF to review the program prior to fielding.

Pretesting of the mobile questionnaire took place in Dosso in RAcE villages that were not part of the survey sample. The pretest was conducted on October 22, directly following the enumerator and supervisor training. The questionnaire was fielded in the local languages, using verbal translation by enumerators. A debriefing session was held with all coordinators, supervisors, and interviewers to discuss their pretesting experiences and identify and address problems with preparedness, field procedures, and instruments. Adjustments to the mobile questionnaire to resolve some of the missing


items in a handful of the devices were made by the INS programmer immediately after pretesting, which took a considerable amount of time. Thus, the start of data collection was postponed for a few days to update the program. Questions and the structure of the questionnaire were not changed from the paper version.

The survey questionnaire is provided in Annex D.

2.4 Selection and Training of Survey Staff

Selection and recruitment of enumerators and supervisors was done by the MSP Division de la Statistique; participants with the strongest technical and leadership skills were selected to be supervisors. The enumerators were selected by their skill set and their previous experience in data collection. Many of the enumerators and supervisors who were recruited for the endline survey had also taken part in the baseline survey.

World Vision, together with ICF, the MSP Division de la Statistique, and INS facilitated the training of enumerators and supervisors that took place in Niamey from October 17 to 21. The five-day training covered the following:

Overview of the RAcE project goals and objectives

Objectives of the endline survey

Review of methodology, sampling, and respondent selection

Roles and responsibilities of interviewers, supervisors, and all others in the study; rules; behaviors and ethics

Detailed review of the use of mobile data collection tablets

Question by question review of the household questionnaire

Group practices, mock interviews, and role playing

The survey training schedule is provided in Annex E.

2.5 Data Collection

Endline survey data collection took place from October 27 to November 6 in Boboye, Dosso, and Keita, lasting approximately 10 days. The data collection team members included four coordinators and eight teams consisting of one supervisor and three enumerators. Data collection was done using the mobile program on tablets. The fieldwork schedule is provided in Annex F.

Verbal informed consent was obtained from each caregiver prior to the start of the interview. Respondents were not compensated for their time away from income-earning activities or daily duties for participating in the data collection. The average length of the interview was approximately one hour per respondent.

Quality control procedures during fieldwork included quality control checks by supervisors throughout the data collection process. This was done by observing interviews and going back to the households to re-interview at least 10 of the interviews to ensure quality and validity. The supervisor also oversaw correction of all errors that were detected while in the field and discussed the issues with the


enumerators before the team left the community. The supervisor edited any errors in the questionnaire to the best of his or her knowledge.

Administering the questionnaire using tablets removed the data entry step, which greatly helped in ensuring the availability of data in real time.

2.6 Data Entry and Management

The endline data were collected using tablets with the ODK mobile program and downloaded to a cloud data storage at INS. INS was responsible for housing the data, and together with the MSP Division de la Statistique, was responsible for cleaning and preparing the data for ICF to conduct analysis. During the baseline survey, the data were stored in World Vision Canada’s data cloud and were cleaned in Niger for analysis.

Names of participants were collected only for purposes of listing and were not used during any stage of data analysis. Data entered cannot be traced back to the individuals. Access to data was restricted to authorized personnel only. After data for all clusters were validated, INS stripped the final dataset of any identifying information and shared it with ICF for analysis. However, ICF did not receive a clean dataset. After repeated requests for cleaned data from INS, ICF continued to find inconsistencies and inaccuracies with the final survey dataset sent by INS.

2.7 Data Analysis

After a lengthy process of trying to obtain a clean dataset from INS, ICF did intensive data cleaning. ICF analyzed the survey data using Stata v14 and Microsoft Excel. The ICF analyst imported the Excel and Stata files sent by INS into a single, merged Stata file.

The ICF analyst checked the endline data file for missing values. A list of missing data was sent to INS for corrected files, including the child roster file and missing location information in the caregiver file. There were also duplicate entries in the fever, diarrhea, and caregiver modules. A detailed explanation of the data cleaning and analysis process, including how missing values were handled, is provided in Annex G.

Before analyzing the endline data, the ICF analyst had to redo the analysis of the baseline data; the baseline analysis that World Vision conducted did not account for cluster effects and did not include confidence intervals around the point estimates. Redoing the baseline analysis also allowed ICF to append the baseline and endline data files and calculate changes between the baseline and endline surveys. However, the results generated in World Vision’s initial analysis are different from those that ICF generated. World Vision was unable to share a file that detailed the data cleaning that took place. Thus, ICF excluded records that did not include cluster information and records that contained fewer than 6 of 10 completed modules.

The baseline data files required a substantial amount of cleaning before they could be merged and appended to the endline dataset. Household number fields in the various modules had to be cleaned, dropping duplicates (for example, in several cases, the household number was missing or differed for the same parent record). There was no cluster variable in any of the data files. Therefore, the ICF analyst performed the following steps:


Used text fields (community and other_placename) that interviewers manually filled to generate a cluster variable; ensured that each community name was spelled the same way in all records.

Inferred six missing community names from dates, times, interviewer name, and information in other entries.

Dropped 17 records; 3 records had community names that could not be matched to any of the clusters, and 14 records were missing community information.

Encoded community names to produce a cluster number for each of the 30 communities.

Added the cluster variable to all records as the modules were merged into one baseline data file.

Dropped 13 records from the dataset that did not include at least one completed sick child module.

Dropped 144 records that had fewer than 6 completed modules out of 10.

The ICF analyst did not verify or clean the child roster file; however, the analyst was able to pull age, sex, and two-week illness history for most of the sick child records. Roster information was missing for between 45 and 60 children, depending on the indicator. All variables were then recoded so that their names and values aligned with the names and values of the variables in the endline dataset. The cleaned baseline dataset was then appended to the cleaned endline dataset for analysis.

The ICF analyst calculated survey indicator point estimates and 95 percent confidence intervals accounting for cluster effects, and used Pearson’s chi-squared test to determine statistical significance for binary and categorical variables and regression for continuous variables. We considered indicators with p-values less than 0.05 to show a statistically significant change between baseline and endline.

Endline data are displayed disaggregated by child’s sex and illness. For the comparison of indicators between baseline and endline, we only disaggregated data by sex if we found the differences between males and females to be statistically significant.

2.8 Survey Indicators

The survey collected data on 18 key indicators related to caregiver knowledge of RComs and child illnesses; caregiver perceptions of RComs; and sick child care-seeking, assessment, treatment, referral adherence, and follow-up. The survey also collected information on household and caregiver characteristics and household decision-making. Annex H contains a complete list of indicators and their definitions.

2.9 Survey Limitations

The data collection team reported limitations in the ODK application. Since the mobile phones were verified twice before going to the field, it is feared that, once in the field, some data collectors may have deleted modules by mistake. These modules were, however, re-uploaded in the field. The other major issue was that the modules were not systematically linked, making it easy to skip an entire module without realizing it if a data collector was not paying adequate attention. This may explain some of the missing data, an issue identified during data analysis.

The survey provides estimates for the RAcE project area as a whole. The survey was not powered to provide district-level estimates. Additionally, there are known potential biases and limitations with the


indicators that assess caregiver recall of malaria diagnostic testing and coverage of appropriate treatment for children with fever and cough with difficult or fast breathing. The potential biases and limitations of these indicators are further detailed in the findings section.

3 FINDINGS

3.1 Characteristics of Sick Children and Caregivers

The endline survey collected data on a total of 889 cases of illness among children aged 2-59 months. Table 2 illustrates characteristics of the children experiencing cases of illness in the two weeks prior to the survey. Of the cases of illness, 54.7 percent were among male children, and 45 percent were among female children. The largest age group represented in the survey were children aged 12-23 months (24 percent), followed by children aged 2-11 months and aged 48-59 months (both at about 21 percent). In the baseline survey, 52 percent of sick child cases were among males, and 48 percent were among females. The largest age group during baseline was children aged 12-23 months (23 percent), followed by children aged 24-35 months (21 percent).

Of the cases of illness among children aged 2-59 months who were sick in the two weeks preceding the endline survey, 82 percent had fever, 78 percent had diarrhea, and 44.5 percent had cough with difficult or fast breathing.

The characteristics of caregivers are shown in Table 3. A total of 489 caregivers were surveyed at endline.

Table 2. Characteristics of sick children included in survey

Characteristic* Baseline% (CI %)

Endline% (CI %)

Sex of sick children included in survey

Male, % 51.6

(47.2 -56.0) 54.7

(47.2 - 62.0) Female, %

48.4 (44.0 - 52.9)

45.3 (38.0 - 52.8)

Age (months) of sick children included in survey

2-11, % 19.2

(15.5 - 23.6) 20.7

(17.0 - 25.0) 12-23, %

23.1 (19.1 - 27.8)

23.8 (18.9 - 29.5)

24-35, % 20.5

(16.4 - 25.2) 17.2

(14.2 - 20.8) 36-47, %

19.2 (16.2 - 22.7)

17.8 (14.1 - 22.3)

48-59, % 18.0

(15.3 - 21.0) 20.5

(16.4 - 25.3) Two week history of illness of children included in survey

Had fever, % 75.5

(70.2 - 80.1) 82.4

(79.0 - 85.3) Had diarrhea, %

61.0 (56.4 - 65.4)

78.3 (74.5 - 81.6)

Had cough with difficult or fast breathing, %

56.3 (51.1 - 61.3)

44.5 (37.7 - 51.4)


Average number of illnesses, N

1.9 2.1

Total number of sick children included in survey

605 489

Cases of illness included in survey Fever, N 344 305

Diarrhea, N 339 292 Cough with difficult or fast

breathing, N 312 292

Total number of sick child cases included in survey

995 889

* Missing sex for 45 children at baseline and 1 child at endline; missing age for 43 children at baseline and 1 child at endline; missing fever 2-week history for 46 children at baseline and 1 child at endline; missing diarrhea 2-week history for 54 children at baseline and 1 child at endline; missing cough with difficult or fast breathing 2-week history for 56 children at baseline and 1 child at endline.

Table 3. Caregiver characteristics

Characteristic Baseline % (CI %)

Endline % (CI %)

Age (years)*

15-24 31.6

(26.5 - 37.3) 31.4

(27.6 - 35.5) 25-34

43.8 (38.2 - 49.6)

42.8 (38.3 - 47.4)

35-44 18.1

(14.4 - 22.5) 19.1

(15.2 - 23.8) 45-60

6.5 (4.5 - 9.2)

6.7 (4.6 - 9.6)

Mean age (years) 29.0 28.8 Education*

None 86.8

(82.4 - 90.3) 85.7

(77.2 - 91.3) Primary, ≤ year 4

9.0 (6.0 - 13.3)

10.0 (5.9 - 16.3)

Primary, ≥ year 5 2.4

(1.1 - 5.0) 4.4

(2.3 - 8.1) Secondary or higher

1.8 (0.8 - 4.0)

0.0 (0.0 - 0.0)

Marital status*

Currently married or living with partner

93.4 (89.2 - 96.0)

97.6 (95.3 - 98.8)

Not married but living with a partner

1.6 (0.5 - 5.3)

0.2 (0.0 - 1.7)

Not in union 5.1

(3.3 - 7.9) 2.2

(1.0 - 4.5) Partner living with caregiver (among those in union)**

Yes 79.8

(73.9 - 84.7) 92.2

(87.5 - 95.2) Total number of caregivers 512 489 *Missing age and education for 3 caregivers at baseline and 7 caregivers at endline; missing marital status for 2 caregivers at baseline and 28 caregivers at endline **486 caregivers in a union at baseline, and 450 caregivers in a union at endline

Table 4 shows the results for reported distance and mode of transportation to the nearest health facility. It is important to note that even though baseline data were collected for these indicators, there were a number of missing data. Similarly, there were a lot of missing responses at endline. Therefore,


these data should be interpreted with caution. Please see below the table for notes on specific missing information.

Table 4. Reported distance and mode of transport to nearest health facility

Baseline Endline% (CI%) % (CI%)

Distance to nearest facility

< 5 km N/A 24.2

(14.2 - 38.3) 5 - 9 km N/A

49.8 (37.0 - 62.7)

10 - 19 km

N/A 20.3

(12.4 - 31.4) ≥ 20 km N/A

5.7 (2.5 - 12.6)

Mean distance to nearest facility N/A 7.8 km Number of caregivers N/A 458 Mode of transport

Walk 86.1

(79.2 - 91.0) 68.3

(60.5 - 75.2) Motorbike/taxi/bus

11.0 (7.1 - 16.6)

29.1 (22.0 - 37.4)

Other 2.9

(1.1 - 7.8) 2.6

(0.5 - 13.3) Number of caregivers 510 457 Time to nearest facility (among those who go to the facility)

< 30 minutes

46.2 (34.7 - 58.1)

32.8 (24.6 - 42.3)

30 – 59 minutes

23.0 (16.7 - 30.8)

22.0 (16.2 - 29.2)

1 – < 2 hours

23.2 (16.1 - 32.2)

33.3 (23.9 - 44.1)

2 – < 3 hours

5.5 (2.4 - 12.2)

4.6 (2.6 - 8.1)

3 hours or more

2.2 (0.9 - 5.4)

7.3 (3.9 - 13.1)

Mean time to nearest facility 40 minutes 55 minutes Total number of caregivers 509 454 *Missing distance to nearest facility for 31 caregivers at endline; the baseline data did not make sense so this indicator was not calculated. Missing mode of transport for 1 caregiver at baseline and 31 caregivers at endline; additionally, 1 caregiver in each survey stated that he or she does not go to the health facility. Missing time to nearest facility for 1 caregiver at baseline and 2 caregivers at endline. **The indicator for baseline was not calculated because the data do not make sense.

3.2 Decision-making

As shown in Table 5, at endline, among caregivers who sought care for their child aged 2-59 months who had been sick in the two weeks before the survey, 62 percent made the decision to seek care jointly with their spouse or partner. This joint careseeking increased significantly from baseline (p<0.05).

Table 5. Joint decision-making to seek care for sick child by illness

Illness

Decided to seek care jointly with partner

p-value Baseline

N Endline

N Baseline Endline% (CI %) % (CI %)

Overall 49.8

(42.8 - 56.8) 62.0

(54.0 - 69.4) 0.0161 813 753


Fever 51.5

(44.0 - 58.8) 62.8

(53.5 - 71.2) 0.0305 274 250

Diarrhea 47.7

(39.6 - 55.9) 63.4

(54.4 - 71.5) 0.0055 283 251

Cough with difficult or fast breathing

50.4 (41.8 - 59.0)

59.9 (51.3 - 68.0)

0.1330 256 252

* Missing information for caregivers of children with diarrhea with for 6 caregivers at baseline and 7 caregivers at endline; missing information for caregivers of children with fever with for 2 caregivers at baseline.

3.3 Caregiver Knowledge and Perception of iCCM RComs

There was no significant change observed in caregiver knowledge of childhood illnesses over the course of the project. Caregivers’ knowledge and perceptions of RCom increased significantly over the course of the project, as expected, given that RCom were trained and deployed to provide iCCM services after the baseline survey was implemented. The percentage of caregivers who know the RCom who works in their community significantly increased, from 1 percent at baseline to 99.8 percent at endline (p<0.001). Of caregivers who reported knowing of an RCom in their community, the percentage who knew at least two curative services provided by an RCom was 77 percent at endline. Of the activities that RComs perform in their communities, caregivers most noted that RCom provide treatment for malaria (73 percent), malaria testing (64 percent), and oral rehydration solution (ORS) treatment for diarrhea (60 percent). At endline, caregiver’s trust in RCom was nearly universal. At endline 99 percent of caregivers viewed RCom as trusted health providers, and 98 percent believe RCom provide quality services.

Table 6. Caregiver knowledge of childhood illnesses

Caregiver knowledge Baseline Endline

p-value % (CI %) % (CI %)

Knows 2+ child illness signs 75.8

(70.3 - 80.5) 81.1

(75.9 - 85.3) 0.1412

Knows cause of malaria 89.9

(85.5 - 93.0) 84.8

(78.0 - 89.8) 0.1417

Knows fever is a sign of malaria 85.7

(80.6 - 89.6) 79.4

(72.9 - 84.7) 0.1454

Knows malaria treatment 60.8

(52.8 - 68.3) 58.6

(47.1 - 69.3) 0.7446

Total number of caregivers 503 481

Table 7. Caregiver knowledge of RCom

Caregiver knowledge Baseline Endline


Knows CCM-trained RCom works in community

1.0 (0.3 - 3.2)

99.8 (98.3 - 100.0)

0.0000

Total number of caregivers 511 457

Knows 2+ RCom curative services* 40.0

(10.2 - 79.6) 77.4

(70.0 - 83.4) 0.0425

Total number of caregivers 5 456 *Only asked of caregivers who stated that there was a CCM-trained RCom in their community


Table 8. Caregiver perceptions of iCCM RComs

Caregiver perceptions Baseline Endline


View CCM-trained RComs as trusted health care providers 20.0

(1.9 - 76.2) 98.5

(95.6 - 99.5) 0.0000

Believe CCM-trained RComs provide quality services 20.0

(1.9 - 76.2) 97.6

(95.1 - 98.8) 0.0000

Found the CCM-trained RCom at first visit (for all instances of care-seeking included in survey)*

N/A 73.9

(67.4 - 79.5) N/A

Cite the CCM-trained RCom as a convenient source of treatment 60.0

(20.4 - 89.8) 87.9

(80.8 - 92.7) 0.0594

Total number of caregivers 5 456 N/A=not available * Denominator is 406 caregivers at endline—only those who sought care from an RCom for at least one sick child are included. Response missing for one caregiver who reportedly sought care from an RCom at baseline.

3.4 Care-Seeking

Careseeking from an appropriate provider was high at baseline (68 percent) and remained high at endline (85 percent). As expected following the extension of health services to the communities via RCom, care-seeking from RComs was high at endline; of cases of illness among children 2-59 months who sought care from an appropriate provider, 88 percent of those sought care from an RCom The percentage of cases of illness among children aged 2-59 months taken to an RCom as the first source of care increased significantly (p<0.001), from 0.1 percent at baseline to 75 percent at endline.

Looking at the sources of care sought, findings show a significant shift from public facility to RComs over the course of the project. Caregivers sought care at public facilities more at baseline (93 percent) than at endline (15 percent). However, caregivers have shifted to RComs as the source where most sought care, from 0.1 percent at baseline to 91 percent at endline. At endline, of cases of illness among children 2-59 months who sought care from an appropriate provider in the two weeks prior the survey, only 9 percent sought care from a source other than the RCom. Tables 9-12 illustrate the results of care-seeking behavior throughout the project timeframe.

Table 9. Source of care by illness

Illness

Sought care from appropriate provider*

p-value

RCom was first source of care

p-value Baseline

N Endline

N Baseline Endline Baseline Endline% (CI %) % (CI %) % (CI %) % (CI %)

Overall 68.8

(62.0 - 75.0) 84.7

(79.2 - 89.0) 0.0002

0.1 (0.0 - 0.8)

75.5 (68.3 - 81.5)

0.0000 995 889

Fever 72.4

(65.7 - 78.2) 88.9

(82.0 - 93.3) 0.0001

0.3 (0.0 - 2.2)

77.1 (67.8 - 84.3)

0.0000 344 305

Diarrhea 65.8

(57.2 - 73.5) 84.9

(78.7 - 89.6) 0.0005 0.0

75.7 (67.8 - 82.1)

0.0000 339 292


68.3 (59.7 - 75.8)

80.1 (73.1 - 85.7)

0.0151 0.0 73.6

(65.9 - 80.1) 0.0000 312 292

* Appropriate providers include national, regional, or district hospitals; integrated health center; RCom; health hut and mobile or private clinics.


Table 10. Care-seeking from RCom

Illness

RCom was first source of care amongthose who sought any care

p-value Baseline N Endline N Baseline Endline% (CI %) % (CI %)

Overall 0.1

(0.0 - 1.0) 87.7

(81.2 - 92.1) 0.0000 736 762

Fever 0.4

(0.1 - 2.8) 85.6

(77.7 - 91.0) 0.0000 264 270

Diarrhea 0.0 86.7

(79.5 - 91.7) 0.0000 240 256


0.0 91.1

(84.7 - 95.0) 0.0000 232 236

Table 11. Cases of illness for which no care was sought

Illness Did not seek care

p-value Sought care but not

from RCom p-value Baseline % (CI %)

Endline % (CI %)

Baseline % (CI %)

Endline % (CI %)

Overall 26.0

(20.1 - 33.0) 14.0

(10.2 - 18.9) 0.0021

99.9 (99.0 - 100.0)

9.0 (5.2 - 15.2)

0.0000

Fever 23.3

(17.7 - 29.9) 10.2

(6.2 - 16.3) 0.0011

99.6 (97.2 - 100.0)

9.5 (5.2 - 16.6)

0.0000

Diarrhea 29.2

(22.1 - 37.5) 12.7

(9.0 - 17.5) 0.0006 100

9.8 (5.7 - 16.3)

0.0000


25.6 (18.4 - 34.6)

19.2 (13.8 - 26.1)

0.1896 100 7.6

(4.0 - 13.9) 0.0000

Total number of sick child cases

995 889 736 765

Table 12. Sources of care and first source of care

Location Source of Care First Source

Baseline Endline Baseline Endline% (CI %) % (CI %) % (CI %) % (CI %)

Public facility 92.9

(89.7 - 95.2) 15.0

(9.0 - 24.1) 85.2

(80.6 - 88.9) 8.0

(4.4 - 14.2)

Private clinic 0.0 0.3

(0.1 - 1.1) 0.0

0.3 (0.1 - 1.1)

RCom 0.1

(0.0 - 1.0) 91.0

(84.8 - 94.8) 0.1

(0.0 - 1.0) 87.7

(81.2 - 92.1)

Store, pharmacy, or market 2.6

(1.2 - 5.4) 0.7

(0.2 - 1.9) 2.2

(0.9 - 5.2) 0.5

(0.2 - 1.8)

Traditional practitioner 1.2

(0.5 - 2.7) 0.4

(0.1 - 1.3) 1.2

(0.5 - 2.7) 0.1

(0.0 - 1.0)

Other 9.2

(5.9 - 14.2) 0.9

(0.4 - 2.1) 5.3

(3.4 - 8.2) 1.2

(0.6 - 2.3) Total number of sick child cases 736 765 736 765

3.5 Assessment

Caregiver recall of malaria diagnostic testing is poor, which could affect the malaria diagnosis and appropriate treatment indicators calculated. According to the Indicator Guide: Monitoring and Evaluating Integrated Community Case Management, “Studies have found poor sensitivity and specificity of maternal recall for malaria diagnostic tests (finger/heel stick). Consequently, the current


recommendation is that household surveys track treatment coverage of fever and, where possible, supplement with data from service delivery assessment to better understand the proportion of suspected malaria cases that receive appropriate diagnosis and treatment.”2

Results show a significant increase in the assessment of cases of fever among children aged 2-59 months by any provider from 21 percent at baseline to 68 percent at endline (p<0.001). At baseline iCCM services had not yet been rolled out to communities and no RCom administered RDTs to assess cases of fever. At endline, 75 percent of the cases of fever among children 2-59 months that were assessed by an RCom in the two weeks prior the survey were administered an RDT. The shift in care-seeking is similarly reflected in shifts in provider assessments. At endline, 90 percent of the cases of fever among children 2-59 months that were assessed by any provider were assessed by a RCom; 9 percent by nurses; and 0 percent by doctors or medical assistants. These results are likely due to the accessibility and presence of the RComs in the villages.

Table 13. Malaria assessment among children with fever

Fever assessment Cases managed by RCom

p-value All cases

p-value Baseline Endline Baseline Endline % (CI %) % (CI %) % (CI %) % (CI %)

Child had blood drawn 0.0 75.4

(64.3 - 83.9) 0.0912

20.6 (14.4 - 28.7)

68.2 (57.9 - 77.0)

0.0000

Caregiver received result of blood test

N/A 87.7

(79.6 - 92.9) 78.9

(67.3 - 87.1) 84.6

(76.2 - 90.4) 0.2498

Blood test positive for malaria

N/A 95.7

(90.4 - 98.2) 96.4

(85.1 - 99.2) 96.0

(91.1 - 98.3) 0.8997

Received ACT* after positive blood test, among those who had a positive blood test

N/A 25.3

(18.6 - 33.6) 94.4

(85.0 - 98.1) 85.8

(77.6 - 91.3) 0.0535

Total number of fever cases

1 248 344 305

ACT=artemisinin-based combination therapy N/A=not available * Malaria treatment (ACT Coartem and Artesun Amodiaquine)

Table 14. Fast breathing assessment

Respiratory rate assessment

Cases managed by RCom All casesBaseline%(CI %)

Endline%(CI %)

Baseline%(CI %)

Endline %(CI %)

p-value

Respiratory rate assessed N/A 63.8

(50.9 - 74.9) 53.5

(45.5 - 61.4) 52.4

(43.0 - 61.6) 0.8541

Total number of cough with difficult or fast breathing cases

0 218 312 292

N/A=not available

2 The Maternal and Child Health Integrated Program (MCHIP). Indicator Guide: Monitoring and Evaluating Integrated Community Case Management, July 2013.


3.6 Treatment Coverage

The overall percentage of illnesses receiving appropriate treatment increased significantly over the course of the project, from 37 percent at baseline to 59 percent at endline (p<0.001). The largest increase observed was for the appropriate treatment for diarrhea, which increased from 23 percent at baseline to 64 percent at endline (p<0.001). At endline, the percentage of cases of illness among children aged 2-59 months who received appropriate treatment from an RCom was 48 percent. Among those who sought care from an RCom, 58 percent received appropriate treatment. Despite the overall increase in appropriate treatment from any provider, the percentage of cases receiving appropriate treatment is low (overall, and from RCom). Appropriate treatment provided by RCom, among cases who sought care from RCom, varied by illness. At endline, 73 percent of confirmed malaria cases were provided with artemisinin-based combination therapy (ACT) within the same or next day, 71 percent of cases with diarrhea received appropriate treatment of ORS and zinc, and 34 percent of cases of cough with difficult or fast breathing received treatment with amoxicillin. Treatment of cough with difficult or fast breathing must be interpreted carefully. Pneumonia treatment, for which this indicator is a proxy, is globally recognized to have validity issues3 because diagnosis of presumptive pneumonia is often inaccurate in comparison with clinical diagnosis of pneumonia at health facilities. Therefore, the number of cases of cough with difficult or fast breathing is likely an overestimate of actual clinical pneumonia cases, and the percentage of these treated with amoxicillin can, and should, reasonably not be 100 percent.

It is important to note that at baseline zero illness cases received treatment from an RCom; this is expected because iCCM had not yet been rolled out to communities. For one fever case at baseline, a caregiver sought care from an RCom but received treatment from a CSI.

Table 15. Treatment coverage

Condition (treatment)

Received appropriate treatment from RCom

p-value

Received appropriate treatment

p-value Baseline

N Endline


Overall* 0 48.3

(40.6 - 56.2)0.0000

37.0 (32.1 - 42.2)

59.4 (51.1 - 67.1)

0.0000 705 753

Confirmed malaria (ACT)**

0 78.7

(68.6 - 86.2) 0.0000

94.4 (85.0 - 98.1)

85.8 (77.6 - 91.3)

0.0535 54 169

Confirmed malaria (ACT within same or next day)**

0 71.0

(58.5 - 81.0)0.0000

79.6 (64.4 - 89.4)

73.4 (61.2 - 82.8)

0.4135 54 169

Diarrhea (ORS and zinc)

0 58.2

(48.3 - 67.5)0.0000

23.3 (18.8 - 28.6)

64.4 (55.5 - 72.4)

0.0000 339 292


0 25.3

(18.6 - 33.6)0.0000

44.6 (36.5 - 52.9)

46.2 (36.3 - 56.5)

0.7651 312 292

*Calculated for confirmed malaria (ACT within 24 hours), diarrhea (ORS and zinc), and cough with fast breathing (amoxicillin) **Calculated among fever cases with a positive blood test result; malaria treatment (ACT Coartem and Asucam)

3 Campbell H, el Arifeen S, Hazir T, O'Kelly J, Bryce J, Rudan I, et al. (2013) Measuring Coverage in MNCH: Challenges in Monitoring the Proportion of Young Children with Pneumonia Who Receive Antibiotic Treatment. PLoS Med 10(5): e1001421. doi:10.1371/journal.pmed.1001421


Table 16. Treatment coverage among those who sought care from RCom

Condition (treatment)

Received appropriate treatment from RCom among those who sought care from

RCom p-value Baseline N Endline N

Baseline Endline% (CI %) % (CI %)

Overall* N/A 58.3

(50.8 - 65.4) N/A N/A 611

Confirmed malaria (ACT within same or next day)**

N/A 73.0

(60.3 - 82.8) N/A N/A 163

Diarrhea (ORS and zinc) N/A 70.9

(61.0 - 79.1) N/A N/A 230


N/A 33.9

(25.7 - 43.3) N/A N/A 218

N/A=not available * Calculated for confirmed malaria (ACT within 24 hours), diarrhea (ORS and zinc), and cough with difficult or fast breathing (amoxicillin) ** Calculated among fever cases with a positive blood test result *** Malaria treatment (ACT Coartem and Asucam)

The results for continued fluids and feeding during illness in Table 17 show that overall, provision of continued fluids during an episode of illness did not change over the project timeframe, although continued feeding during an episode of illness increased significantly (p<0.05), from 11 percent at baseline to 20 percent at endline. There were significant increases in continued feeding for cases of fever and cases of cough with difficult or fast breathing among children aged 2-59 months. Continued feeding for cases of fever increased significantly, from 7 percent at baseline to 17 percent at endline, and continued feeding for cough with difficult or fast breathing increased from 11 percent at baseline to 22 percent at endline. Notably, there was no significant change in continued feeding for cases of diarrhea among children 2-59 months; the proportion of these cases that had continued feeding remained low over the course of the project.

Table 17. Continued fluids and feeding during illness

Illness Continued fluids

p-valueContinued feeding

p-value Baseline

N Endline


Overall 36.1

(31.4 - 41.1) 41.6

(34.3 - 49.3) 0.2709

11.4 (8.8 - 14.5)

20.4 (15.0 - 27.0)

0.0079 995 889

Fever 33.7

(27.1 - 41.1) 40.7

(32.8 - 49.1) 0.2472

7.0 (4.4 - 10.8)

17.4 (11.8 - 24.9)

0.0082 344 305

Diarrhea 44.7

(38.8 - 50.7) 50.7

(42.2 - 59.1) 0.2679

16.5 (12.6 - 21.3)

22.3 (16.2 - 29.8)

0.1501 339 292


29.5 (24.0 - 35.7)

33.6 (25.8 - 42.3)

0.4498 10.6

(7.1 - 15.6)21.6

(15.1 - 29.9) 0.0139 312 292

* Missing one response for continued fluids during an episode of diarrhea

3.7 First Dose of Treatment and Counseling from RCom

According iCCM treatment protocols, RComs must provide the first dose of treatment and counsel caregivers on how to administer treatment to their sick child. Findings from the endline survey show that a little more than half of the cases treated by the RCom received the first dose of the treatment in


the presence of the RCom and that 98 percent of caregivers were counseled by the RCom on treatment administration.

Table 18. First dose of treatment from RCom

Condition (Treatment)

First Dose Received in Presence of RCom

p-value Baseline

N Endline

N Baseline Endline

% (CI %) % (CI %)

Overall 0* 55.0

(42.0 - 67.4) 0 427

Confirmed malaria (ACT) 0* 57.3

(40.6 - 72.5) 0 185

Diarrhea (ORS) 0* 56.2

(46.3 - 65.6) 0 194

Diarrhea (zinc) 0* 63.1

(51.3 - 73.5) 0 187


(37.9 - 62.7) 0 169

Cough with fast breathing (Amoxicillin)

0* 60.3

(40.2 - 77.4) 0 73

*No cases at baseline

Missing response for 1 child who received firstline antibiotics for cough with difficult or fast breathing from a RCom, missing responses for 3 children who received ORS from a RCom, missing responses for 2 children who received zinc from a RCom, missing response for 1 child who received both ORS and zinc from a RCom

Table 19. Counseled treatment administration

Condition (Treatment)

Counseled on Treatment Administration

p-value Baseline N Endline N

Baseline Endline

% (CI %) % (CI %)

Overall 0* 98.1

(96.3 - 99.1) 0 428

Confirmed malaria (ACT)

0* 98.9

(92.2 - 99.9) 0 185

Diarrhea (ORS) 0* 99.0

(95.9 - 99.8) 0 194

Diarrhea (zinc) 0* 97.9

(94.6 - 99.2) 0 187

Diarrhea (ORS and zinc)

0* 96.5

(92.8 - 98.3) 0 170

Cough with fast breathing (Amoxicillin)

0* 100 0 73


Missing response for 1 child who received firstline antibiotics for cough with difficult or fast breathing from a RCom at endline, missing responses for 3 children who received ORS from a RCom at endline, missing responses for 2 children who received zinc from a RCom at endline


3.8 Referral Adherence

At endline, 32 percent of cases managed by an RCom were referred. Overall, reported adherence to referrals made by RCom was high at 91 percent at endline. Diarrhea cases had the highest level of referral adherence (95 percent).

Looking at the reason for not complying with the referral, the majority of caregivers (41 percent) stated that they saw improvement in their sick child. Results indicate that the lack of time or transport, as well as not having the husband’s or partner’s permission, were not factors reported to have determined a caregiver’s decision to not comply with the RCom’s referral.

Table 20. Adherence to RCom referral

Condition Baseline Endline

p-value Baseline

N Endline

N % (CI %) % (CI %)

Overall 0* 91.4

(79.9 - 96.6) 0 256

Fever 0* 90.9

(77.9 - 96.6) 0 99

Diarrhea 0* 94.6

(85.5 - 98.1) 0 93


0* 87.5

(68.7 - 95.7) 0 64


Missing responses for whether a child was referred by a RCom for 15 diarrhea cases, 8 fever cases, and 63 Cough with difficult or fast breathing cases at endline and 1 fever case at baseline. Also missing information on whether the caregiver of 1 child with cough and fast or difficult breathing adhered to the referral advice received.

3.9 Sick Child Follow-Up

Overall, the results for the sick child follow-up indicator show that more than 68 percent of cases were followed up by an RCom. Cases of cough with fast breathing had the highest percentage of follow-up (73 percent). Of the 406 cases of illness followed up by an RCom, 93 percent were followed-up by the RCom within three days: a little more than half (52 percent) were followed up within one day, 31 percent within two days, and 10 percent within three days.


Table 21. RCom follow-up with sick child

Condition Baseline Endline

p-value Baseline N Endline N % (CI %) % (CI %)

Overall 0* 68.5

(57.8 - 77.6) 0 604

Fever 0* 67.8

(56.5 - 77.3) 0 236

Diarrhea 0* 66.5

(54.7 - 76.6) 0 215


0* 72.6

(60.9 - 81.8) 0 153


*Missing responses for 1 caregiver at baseline and 12 caregivers at endline who sought care from a RCom for fever, 15 caregivers at endline who sought care from a RCom for diarrhea, and 65 caregivers at endline who sought care from a RCom for cough with fast or difficult breathing

3.10 Illness Management and Diagnostics by Sex

Diagnosis and treatment of cases of illness among children aged 2-59 months did not vary significantly for male and female children. Tables 2–5 provide sex-disaggregated findings for diagnosis and treatment of iCCM illnesses at endline.

Table 22. Confirmed malaria management

Sex

Confirmed malaria treatment* Number of children with

positive blood test

Any anti-malarial

ACT ACT within 24 hours

Overall 91.1

(85.4 - 94.7) 85.8

(77.6 - 91.3) 73.4

(61.2 - 82.8) 169

Male 92.3

(83.9 - 96.5) 85.7

(74.1 - 92.6) 78.0

(64.4 - 87.4) 91

Female 89.7

(80.0 - 95.0) 85.9

(71.6 - 93.6) 68.0

(48.6 - 82.6) 78

ACT=artemisinin-based combination therapy * Malaria treatment (ACT Coartem and Asucam)

Table 23. Fever diagnostics

Sex Had blood taken from

finger or heel

Among those who had blood taken

Number of

children with fever

Were given results

Test result positive

Overall 68.2

(57.9 - 77.0) 84.6

(76.2 - 90.4) 96.0

(91.1 - 98.3) 305

Male 69.4

(56.9 - 79.6) 85.3

(75.5 - 91.7) 97.9

(90.8 - 99.5) 157

Female 66.9

(53.2 - 78.2) 83.8

(73.3 - 90.7) 94.0

(84.0 - 97.9) 148

The results for the indicators on diarrhea management provided in Table 24 show that there are no significant differences between male and female children.


Table 24. Diarrhea management

Sex Sought any advice or treatment

Sought treatment from an

appropriate provider*

Sought treatment from an RCom

Sought treatment from an

RCom as first choice

Given same or more

than usual to drink

Given same or more

than usual to eat**

TreatmentTreated

with ORS AND Zinc

Number of

children with

diarrhea

ORS Homemade

fluid Zinc

Overall 87.3

(82.5 - 91.0) 84.9

(78.7 - 89.6) 78.8

(71.1 - 84.9)75.7

(67.8 - 82.1)50.7

(42.2 - 59.1)22.3

(16.2 - 29.8)78.4

(69.3 - 85.4)48.0

(38.1 - 58.0)72.6

(65.7 - 78.5)64.4

(55.5 - 72.4)292

Male 86.8

(78.2 - 92.3) 85.5

(76.8 - 91.4) 80.7

(72.3 - 87.1)79.5

(70.7 - 86.2)49.4

(39.8 - 59.0)17.5

(12.2 - 24.4)78.9

(69.2 - 86.2)48.8

(37.1 - 60.6)74.7

(65.7 - 82.0)68.1

(58.3 - 76.5)166

Female 88.0

(79.9 - 93.1) 84.0

(75.0 - 90.2) 76.0

(65.5 - 84.1)70.4

(59.9 - 79.1)52.8

(41.0 - 64.3)28.8

(18.2 - 42.4)77.6

(65.7 - 86.3)47.2

(35.0 - 59.7)69.6

(59.4 - 78.2)59.2

(46.6 - 70.7)125

ORS=oral rehydration solution

* Refers to those who sought care from a hospital, private clinic, other health center, or RCom

** Missing sex of one child with diarrhea

Table 25. Cough with difficult or fast breathing management

Sex Sought any advice or treatment

Sought treatment from an appropriate

provider*

Sought treatment from

an RCom

Sought treatment from

an RCom as first choice

Assessed for rapid breathing

Treatment Number of children

with cough and fast or

difficult breathing

Any antibiotic Amoxicillin

Overall 80.8

(73.9 - 86.2) 80.1

(73.1 - 85.7) 74.7

(66.9 - 81.1) 73.6

(65.9 - 80.1) 52.4

(43.0 - 61.6) 48.0

(38.3 - 57.7) 46.2

(36.3 - 56.5) 292

Male 78.4

(69.3 - 85.4) 77.8

(68.6 - 85.0) 73.1

(63.9 - 80.6) 72.5

(63.5 - 79.9) 50.3

(39.5 - 61.1) 47.9

(35.2 - 60.9) 47.3

(34.7 - 60.3) 167

Female 84.0

(77.0 - 89.2) 83.2

(75.8 - 88.7) 76.8

(67.8 - 83.9) 75.2

(66.2 - 82.4) 55.2

(43.6 - 66.3) 48.0

(38.5 - 57.7) 44.8

(34.3 - 55.8) 125

* Refers to those who sought care from a hospital, private clinic, other health center, or RCom


4 DISCUSSION

The presence of iCCM RComs in communities within the RAcE project area has extended health care and treatment to households. Caregivers’ knowledge and perceptions of RCom has increased over the course of the project, as has care seeking from and appropriate treatment by RCom. The baseline survey was conducted during project start-up before RCom were trained and equipped to provide iCCM services in the project area. As such, baseline results for indicators relating to caregiver knowledge of RCom and any case management provided by RCom are essentially zero.

Caregivers’ knowledge and perceptions of RCom increased significantly over the course of the project, as expected, given that RCom were trained and deployed to provide iCCM services after the baseline survey was implemented. Nearly all caregivers (99.8 percent) surveyed at endline know the RCom who works in their community, and most noted that RCom provide iCCM services such as malaria treatment (73 percent of caregivers) and ORS for diarrhea (60 percent of caregivers). Further, caregivers have high trust in the RCom—99 percent viewed RCom as trusted health providers, and 98 percent believe RCom provide quality services—which may be one reason that care-seeking from RCom is so high. As expected, when health services are extended to communities and households via RCom, careseeking increased. Of cases of illness among children 2-59 months who sought care from an appropriate provider, 88 percent of those sought care from an RCom and 75 percent were taken to an RCom as the first source of care.

The overall percentage of illnesses receiving appropriate treatment from any provider increased significantly over the course of the project, from 37 percent at baseline to 59 percent at endline (p<0.001). At endline, among those who sought care from an RCom, 58 percent received appropriate treatment. Despite the overall increase in appropriate treatment from any provider, the percentage of cases receiving appropriate treatment is low (overall, and from RCom). Appropriate treatment provided by RCom, among cases who sought care from RCom, varied by illness: 73 percent of confirmed malaria cases were provided with artemisinin-based combination therapy (ACT) within the same or next day, 71 percent of cases with diarrhea received appropriate treatment of ORS and zinc, and 34 percent of cases of cough with difficult or fast breathing received treatment with amoxicillin. These results should be interpreted with care. Recall bias (caregiver recall of malaria diagnostic testing is poor) may influence the reported coverage of malaria treatment. Given validity issues with the pneumonia indicator4, the percentage of these treated with amoxicillin can, and should, reasonably not be 100 percent, but 34 percent seems unreasonably low. Further, little more than half of the cases treated by the RCom received the first dose of the treatment in the presence of the RCom.

The findings from the endline survey suggest the value of iCCM in hard to reach communities in Niger – well-trained and supported RCom are respected sources of care and their care is sought for a high proportion of cases of illness among young children; utilization of RCom is high. These results show a

4 Campbell H, el Arifeen S, Hazir T, O'Kelly J, Bryce J, Rudan I, et al. (2013) Measuring Coverage in MNCH: Challenges in Monitoring the Proportion of Young Children with Pneumonia Who Receive Antibiotic Treatment. PLoS Med 10(5): e1001421. doi:10.1371/journal.pmed.1001421


greater need for improvements in access to quality case management of childhood illnesses in Niger at both facility and community levels.


ANNEX A. LIST OF PERSONS INVOLVED IN THE SURVEY

Name Organization Role

1. Grace Nganga World Vision RAcE Project Manager

2. Abdou Dade World Vision M&E Coordinator

3. Abdoul Wahab Alassane World Vision RAcE Project Coordinator

4. Ezekiel Mahamane World Vision Mobile Health Research Coordinator

5. Dr. Moise Moussa Gabriel

Division de la Statistique/Ministère de la Santé Publique

Interim Director of the Division of Statistics

6. Mme. Salamatou Institute National de la Statistique

IT and Statistics Specialist

7. Yodit Fitigu ICF Niger Country Technical Support


ANNEX B. ENDLINE SAMPLE

District Name Section / CSI Name Community/Village/Localite

BOBOYE Fabiji Gardi Peulh

DOGONDOUTCHI

DOUMEGA Angoual Magagi

GUECHEME Sabarou

KIECHE Takaré

MAIKALGO Guinge

MAKORWA toullou peulh

RIGIA SAMNA Batamberi 2

DOSSO

GOROUBANKASSAM Dandiborakoira

SABOUDAY Gongomoussa

DOSSO Sodjadey

DOGONDOUTCHI KAUTADEY

DOGONDOUTCHI KOURFAYAWA

DOSSO Zamadey

DOSSO Bodosantche

DOGONDOUTCHI TOUNGA CHAYOU

BOBOYE ALKAWAL PEULH

DOGONDOUTCHI ROUDA ADOUA

DOGONDOUTCHI MAI DAKE

DOGONDOUTCHI ROUNTOU MAOUDE

DOGONDOUTCHI BARAYA SAIDOU

BOBOYE TOUDOU DJERMA

DOGONDOUTCHI SAKOIRA

DOGONDOUTCHI TARAMNA

DOSSO Maigari dey

DOGONDOUTCHI GYAREPCHI PEULH (H)

DOSSO Fondoberi

DOSSO Gode Koira

KEITA IBOHAMAN Keda

INSAFARI Attawari

TAHOUA KEITA TARAMNA


ANNEX C. DETAILED SAMPLING DESIGN

Within each cluster, the survey team selected the first household for interview using the selection by subdivision approach.5 The survey team proceeded from one household to the next by visiting the household with its front door nearest to the front door of the current household until the team conducted 10 interviews for each illness.

At each household, the interviewer first determined if an eligible child lived there. An eligible child was aged 2-59 months and had been sick with diarrhea, fever, cough with difficult or rapid breathing, or any combination of the three illnesses in the two weeks preceding the survey.

The interviewer administered the questionnaire, including all applicable illness modules, to the caregiver of the eligible child. If more than one child was eligible, and they were sick with different illnesses, their caregiver was asked about each instance of illness. If the children had different caregivers, each caregiver was administered a separate questionnaire and answered questions about only his or her eligible child or children. If there was more than one eligible child in the household for an illness, the interviewer randomly selected one of the eligible children and interviewed his or her caregiver.

5 Selection by subdivision instructions: Go to the population center of the sample area and identify four quadrants. Assign each quadrant a number. Write the numbers on separate slips of paper and put them in a container. Randomly select one of the slips of paper. Go to the place that equally divides the selected quadrant’s population in half. Randomly select which of the two ways to proceed, and repeat this step until you have a manageable set of households (for example, 30). Count the households in the area. Use a random number table to select the first household for interview.


ANNEX D. SURVEY QUESTIONNAIRE

Attached in a separate document.


ANNEX E. SURVEY TRAINING SCHEDULE

Horaires Thèmes Responsables

1ère journée 17/10/2016

08h30 -09h00

1. Ouverture de la formation et mots de bienvenue ; 2. Présentation des participants; 3. Formalités administratives 4. Introduction

Dr Moise Moussa Gabriel

9h00 - 09h15 Objectifs de la formation

Yodit Fitigu (ICF)

9h15 - 09h40 Présentation du projet RAcE 2015 Abdou Dade

9h40 - 10h00 Méthodologie


10h00 - 10h30

PAUSE CAFE

10h30-13h00

Revue du questionnaire : 1. Fiche superviseur ; 2. Page de garde ; 3. Consentement ; 4. Module 1 : Identifiant de l’enfant ; 5. Module 2 : Information sur la gardienne d’enfant.

Mme Ibrahim Salamatou

13h00-14h00

PAUSE DEJEUNER / PAUSE PRIERE

14h00-16h00

Revue du questionnaire : 1. Module3 : Contexte du paludisme ; 2. Module 4 : Prise de décision ;

Dade Abdou

16h00-16h20

PAUSE CAFE / PAUSE PREIERE

16H20-17H30

Revue du questionnaire : 1. Module 5 : ASC ou Rcom 2. Module 6 : Connaissance gardienne d’enfant

AbdoulWahab Alassane

17h30-18h00

Rencontre des formateurs Dr Moise Moussa Gabriel

2ème journée 18/10/2016

08h00-08h20

Présentation et amendement du rapport de la première journée Rapporteurs

8h20- 10h00

Revue du questionnaire : 1. Module 7 : Diarrhée ; 2. Module 8 : Fièvre.


10h00-10h30

PAUSE CAFE

10h30-13h00

Revue du questionnaire : 1. Module 8 : Respiration rapide ; 2. Observation de l’enquêteur

Mahamane Ezechiel

13h00-14h00


14h00-16h00

1. Introduction sur l’utilisation du smart phone ; 2. Apprentissage sur l’Application de la collecte de données ; 3. Pratique sur l’utilisation de l’Application de la collecte.


16h00-16h20

PAUSE CAFE / PAUSE PRIERE



16h20-17h00

4. Pratique sur l’utilisation de l’Application de la collecte (suite) Mahamane Ezechiel

17h00-17h30



08h00-08h20

Présentation et amendement du rapport de la deuxième journée Rapporteurs

08h20- 10h00

Travaux de groupe, cas pratique : Simulation & restitution 1. Module 1 : Identifiant de l’enfant ; 2. Module 2 : Information sur la gardienne d’enfant.


10h00-10h30

PAUSE CAFE

10h30-12h00

Travaux de groupe, cas pratique : simulation & restitution 1. Module3 : Contexte du paludisme ; 2. Module 4 : Prise de décision ;

Abdou Dade

12h00-13h00

Travaux de groupe, cas pratique : Simulation & restitution 1. Module 5 : ASC ou Rcom ; 2. Module 6 : Connaissance gardienne d’enfant

AbdoulWahab Alassane

13h00 - 14h00


14h00 - 16h00

Travaux de groupe, cas pratique : Simulation & restitution 1. Module 7 : Diarrhée ; 2. Module 8 : Fièvre ;


16h00-16h20


16h20-17h00

Travaux de groupe, cas pratique : Simulation & restitution 1. Module 8 : Respiration rapide.

Mahamane Ezechiel

17h00-17h20

Informations et directives de la journée pré-test (visite terrain) AbdoulWahab Alassane

17h20-17h45



07H45-08h00

Rassemblement Equipe pour test terrain : Bureau National de World Vision : AbdoulWahab

08h00 - 08h10

Départ de l’équipe sur le terrain AbdoulWahab Alassane 14h00-

14h15 Retour de l’équipe du terrain

14h15-15h00


15h00-15h20

Présentation et amendement du rapport de la troisième journée Rapporteurs

15h20-16h00

Restitution de l’étape pré-test (visite terrain) Abdou Dade

16h00-16h20


16h20-17h00

Restitution de l’étape pré-test (visite terrain), smart phone Mme Ibrahim Salamatou

17h00-17h30





8h 30 - 09h00

Présentation et amendement du rapport de la quatrième journée Rapporteurs

09h00-10h00

Observations et Corrections de l’Application de la collecte Abdou Dade

10h00-10h30

PAUSE CAFE

10h30-12h30

Observations et Corrections de l’Application de la collecte (suite et fin) Mme Ibrahim Salamatou

12h30-14h15


14h15-14h30

Répartition des équipes de la collecte de données AbdoulWahab Alassane

14h30-15h00

Plan de travail de la semaine du 24 Octobre au 02 Novembre 2016 Dr Moise Moussa Gabriel

14h30-15h00

Clôture Dr Moise Moussa Gabriel

15h00-16h00


16h30 Fin


ANNEX F. FIELDWORK SCHEDULE

Plan De Supervision Pour L’évaluation Finale Du Projet RAcE NICE

Districts CSI De Rattachement

Nom Du Village

Coordonnateurs Terrain

Superviseurs De Proximite

Equipes Enqueteurs

Nbre De Repondants

Attendu

Dosso

Goroubankassam Dandiborakoira

Elhadji Ibrahima Adamou

Oumoulkairou Assane Sido

- Ehennou K. Joelle - Kimba Harouna - Amadou Ide

DHR = 40 FIEVRE = 40 TOUX = 40

Sabouday Gongomoussa Sabouday Sodjadey

Mangue Koira Kautadey Aka Kofadey

Mangue Koira Zamadey

Salamatou Ibrahim

-Souleymane Hassane - Idrissa H.Youssouf - Ibrahim Bizo Hassane


Tondigam Bodosantche Tombo Koirey Maigari Dey

Wangal Kaina Fondoberi

Farrey Gode Koira


Rachidatou Sidibé

- Ibrahim Kimba Hassane - Aboubacar Mahamane - Balkissa Illiassou


Boboye

Fabiji Sirakatou

Kouringuel Alkawal Peulh

Kofo Toudou Djerma

Dogondoutchi

Lido Angoual Kade

Abdou Dadé

Salissou Mahaman

- Issoufou Bohari Moustapha -Mahamadou Sani Abdoulaziz - Moussa Mahaman Salissou


Makorwa Sakoira Guecheme Kourfayawa

Makorwa Toullou

Guecheme Mai Dake

Saratou Abdoulaye

- Hassane Abdou Abdel Nasser - Rakiatou Ousmane - Fatouma Ousmane


Guecheme Sabarou

Doumega Tounga Chayou

Kieche Rouda Adoua

Zakari Amadou

- Abdoulaye Bako Mahamane Lawaly - Hanifa Idi Tondi - Michel Gabriel

DHR = 40 FIEVRE =

40 TOUX = 40

Tibiri Gyarepchi Maikalgo Guinge

Kieche Takare

Rigia Samna Batama Beri 2

Abdoulwahab Alassane

Anass Maman Wagé

- Mamane Moussa - Maman Lawan - Zaourou Djmarou Nafissa

DHR = 40 FIEVRE =

40 TOUX = 40

Doutchi Sud Rountou Maoude

Soucoucoutan Baraya Saidou

Makourdi Taramna 1 Keita Ibohaman Keda DHR = 30


Districts CSI De Rattachement

Nom Du Village

Coordonnateurs Terrain

Superviseurs De Proximite

Equipes Enqueteurs

Nbre De Repondants

Attendu Insafari Attawari

Aboubacar Manirou

- Harouna Djataou M. Siradji - Magagi Ali - Hassane Moussa M.Saguirou

FIEVRE = 30

TOUX = 30

Keita Taramna 2


ANNEX G. DETAILS OF DATA CLEANING AND ANALYSIS

RAcE Niger Endline Survey Data Cleaning Log:

Issue Identified by ICF Response from INS

1 It looks like there are only 29 in the dataset, but I was expecting 30.

Regarding the clusters, there are actually 30. The two data collection teams—one at Douctchi and the other at Tahoua—gave the same name to two different villages. I separated them by adding 1 to one and 2 to the other.

2 There are considerably fewer observations in the data file “module2bg_information de baseq201” than in the other caregiver data files. (Only 302 vs. around 500 in the others.) I would like to know the reason for this. I was expecting one entry per caregiver interviewed.

[ICF: received updated data file but no information about what was done or how it was done.] This was corrected by merging module 'information de base' with module 'gardien' through identifiers created by ODK.

3 Within the same data file, there are 11 entries that are missing information in the location fields (village code, name of household head, department, house number), and 17 entries that do not include the caregiver number. How can we identify what these fields should be?

[ICF: received updated data file but no information about what was done or how it was done.] This was corrected using identifiers that were generated by ODK.

4 In both the fever and diarrhea modules, there are duplicate entries for the same household in the same cluster. According to the sampling protocol, this should not have happened, and I think these duplicates may have resulted because of entry errors on the tablets. Is this something that you can correct?

The fever module has no double information. The key for identifying duplicates is the village code, the household number, and the child number. The fever base has no duplicate information so it has not been changed. The diarrhea module has only one double observation and it is a false duplicate. So, at the level of village No. 12, Household No. 11, there are two children each bearing the No. 1 so the 2nd must take the No. 1.

4a

In the corrected diarrhea module from INS, they corrected the child line number in the one instance they mentioned in the email—but they seem to be saying that the observations for households in which multiple children with the same illness were included in the survey are valid, which was not how the sampling protocol was written. There was supposed to be only one child included in the survey with each illness in a household. If more than one child had the same illness, one was supposed to be randomly selected. I’ve included a list of the villages and households that have two or three children included in the diarrhea module. If all these records are valid, we have to decide how to handle them during

[ICF: received updated data file but no information about what was done to correct the data. For instance, was the household number wrong and corrected? Was the record an exact duplicate? If the record was a duplicate but different, how did you decide which to keep?]

This was a numbering error which was corrected.



the analysis. One option is to randomly select one of the children for each household. The same would be true for the fever module.

5 There are different numbers of observations in the caregiver modules (2–6), but there should have been one entry in each of these modules for each caregiver interviewed. Were modules sometimes skipped by interviewers?

The interviewers did not follow the sequential numbering of households in the village, and the agent code entered is not in the mask. I also found that in some households interviewers forgot to administer certain modules. This is the reason why the size of the individuals surveyed sometimes differs from one file to another. However, the difference is not great.

6 Module 3 (contexte du paludisme)—there are several (63) households with more than 1 entry. In one case, there are 6 records for the same household. The module was only supposed to be completed one time per household, so I’m wondering if INS can clarify what happened here. (There is a separate file that contains the household’s bednet roster, which could have multiple records per household.)

This was completed only one time; however, with ODK when there is a page 2 (which in this case is INS) automatically a new page is formed in Excel.

6a

There are now no duplicates, but it looks like there are about 20 fewer records for this module than any of the other modules, so just want to confirm that this is expected.

It is indeed the raw database. The malaria context had 476 records, after clearing (removing duplicates), there are exactly 463 records.

ICF: Can INS confirm that Module 3 was not completed for the households that are missing records?

Yes this is so, these were missing information.

7 Module 5 (asc)—there are 3 households that have duplicate entries for the same caregiver. There are no households with multiple entries in any of the other caregiver modules (2, 4, or 6), so should one record in each of these duplicates be removed?

[ICF: received updated data file but no information about what was done or how it was done.]

There was an error in household number which was corrected by household identifiers created by ODK.

8 The information in Module 1 (identifiantenfantq109) contains a lot of errors.

The data collectors gave code 0 or 99 which means n/a or not concerned instead of leaving this void. I merged q101 and q109 to arrive to the present update.



In the child roster file (identifiantenfantq101), no household is listed as having more than 3 children, so in Module 1, p109_1, p110_1, p111_1 (child line number) should never have a value > 3, but there are numerous instances in which this is not true. These need to be corrected, and any noted as missing filled in using data in the sick child modules and in the child roster.


This was a numbering error which was corrected by classifying households by order of child identifiers.

Also, p109_3, p110_3, p111_3 (caregiver number) should never have a value > 3. Furthermore, there is never an entry for a second caregiver in any of the caregiver modules (2, 4, 5, or 6), so really the caregiver number should ALWAYS be 1. Does this sound correct—that there was only ever one caregiver interviewed in all households? If this can be confirmed to be correct, I can correct this easily on my end as I prepare the data for analysis.


This is confirmed to be so that only one caregiver was interviewed per household per instructions given during the training.

9 In the Niger endline dataset, 244 of 512 caregivers indicated that they were not the only caregiver of children 2-59 months in their household, but only one caregiver was interviewed in each household.

[ICF: Can INS confirm that this makes sense? Did this just happen by chance, or was it how the interviewers were instructed to conduct their interviews? Or is there another explanation?]

This is how the interviewers were instructed to conduct the interviews.

10

In the Niger endline dataset, none of the households had more than two children under 5 listed in their child rosters.

[ICF: Can INS confirm that this makes sense? Did this just happen by chance, or was it how the interviewers were instructed to conduct their interviews? Or is there another explanation? During the ICF/WV/INS phone call on Feb 7, 2017, INS indicated this was because interviewers only recorded children who were eligible for the survey (2-59 months and sick in the past two weeks). Can INS please confirm in writing that this was the protocol?]

Yes this is the conclusion drawn that interviewers limited themselves to the eligible children only, however this is not by protocol.


ANNEX H. INDICATOR DEFINITIONS

CHILD CHARACTERISTICS

1. Sex of sick children included in survey: Proportion of sick children age 2-59 months included in the survey who were male/female

Number of children age 2‐59 months who have been sick in the two weeks preceding the survey who were

male/female

Number of children age 2‐59 months included in the survey

2. Age of sick children included in survey: Proportion of sick children age 2-59 months included in the survey who were 2-11 months/12-23 months/24-35 months/36-47 months/ 48-59 months

Number of children age 2‐59 months who have been sick in the two weeks preceding the survey who were 2‐11 months/12‐23 months/24‐35 months/36‐47

months/48‐59 months

Number of children age 2‐59 months included in the survey

3. Two-week history of illness of children included in survey: Proportion of sick children age 2-59 months included in the survey who had fever/diarrhea/cough with difficult or fast breathing in the two weeks preceding the survey

Number of sick children age 2-59 months included in the survey who had fever/diarrhea/cough with difficult

or fast breathing in the two weeks preceding the survey

Number of children age 2-59 months included in the survey

CAREGIVER CHARACTERISTICS

1. Age of caregivers included in survey: Proportion of caregivers of sick children age 2-59 months included in the survey who were 15-24 years/25-34 years/35-44 years/45+ years *Categories may vary by survey analysis; adjust as needed

Number of caregivers of sick children age 2‐59 months included in the survey who were 15‐24

years/25‐34 years/35‐44 years/45+ years

Number of caregivers included in the survey

2. Highest education of caregivers included in survey: Proportion of caregivers of sick children age 2-59 months included in the survey whose highest level of education was none/primary school, up to level 4/primary school, greater than level 4/secondary or higher *Categories may vary by survey analysis; adjust as needed

Number of caregivers of sick children age 2‐59 months included in the survey whose highest level of education was none/primary school, up to level 4/primary school, greater than level 4/secondary or

higher



3. Marital status of caregivers included in survey: Proportion of caregivers of sick children age 2-59 months included in the survey who were married/ living with a partner as if married/not in a union at the time of the survey

Number of caregivers of sick children age 2-59 months included in the survey who were married/ living with a partner as if married/not in a union at

the time of the survey


4. Partner living with caregiver: Proportion of caregivers of sick children age 2-59 months included in the survey who were living with their partner, among those who were in a union at the time of the survey

Number of caregivers of sick children age 2-59 months included in the survey who were living with their partner, among those who were in a union at

the time of the survey

Number of caregivers included in the survey who were in a union at the time of the survey

NEAREST FACILITY

1. Distance to nearest health facility: Proportion of caregivers of sick children age 2-59 months included in the survey who live <5 km/5-9 km/10-19 km/≥20 km from the nearest health facility *Categories may vary by survey analysis; adjust as needed

Number of caregivers of sick children age 2‐59 months included in the survey who live <5 km/5‐9 km/10‐19 km/≥20 km from the nearest health

facility


2. Mode of transport to nearest health facility: Proportion of caregivers of sick children age 2-59 months included in the survey whose mode of transport to the nearest health facility is walking/motorbike, bus, or taxi/other, among those who report that they go to the nearest health facility

Number of caregivers of sick children age 2‐59 months included in the survey whose mode of

transport to the nearest health facility is walking/motorbike, bus, or taxi/other

Number of caregivers included in the survey who report that they go to their nearest health facility

3. Time to nearest health facility: Proportion of caregivers of sick children age 2-59 months included in the survey who report it takes <30 min/30-59 min/1 - <2 hours/2 - <3 hours/≥ 3 hours to get to the nearest health facility, among those who report that they go to the nearest health facility

Number of caregivers of sick children age 2-59 months included in the survey who report it takes <30 min/30-59 min/1 - <2 hours/2 - <3 hours/≥ 3

hours to get to the nearest health facility

Number of caregivers included in the survey who report that they go to their nearest health facility


HOUSEHOLD DECISION‐MAKING

1. Major household purchases joint decision-making: Proportion of caregivers of children age 2-59 months who have been sick in the two weeks preceding the survey who report that they usually make decisions about making major household purchases jointly with their partner.

Number of caregivers of children age 2‐59 months who have been sick in the two weeks preceding the survey who report that they usually make decisions about making major household purchases jointly

with their partner

Number of caregivers of sick children age 2-59 months in the survey who were married or living

together with a man as if married at the time of the survey

2. Major household purchases decision-making: Proportion of caregivers of children age 2-59 months who have been sick in the two weeks preceding the survey who report that the decision about making major household purchases is usually made by themselves/their partner/jointly with their partner/someone else

Number of caregivers of children age 2-59 months who have been sick in the two weeks preceding the survey who report that the decision about making

major household purchases is usually made by themselves/their partner/jointly with their

partner/someone else



3. Joint care-seeking decision-making for caregiver: Proportion of caregivers of children age 2-59 months who have been sick in the two weeks preceding the survey who report that they usually make decisions about healthcare for themselves jointly with their partner

Number of caregivers of children age 2-59 months who have been sick in the two weeks preceding the survey who report that they usually make decisions about healthcare for themselves jointly with their

partner




4. Care-seeking decision-making for caregiver: Proportion of caregivers of children age 2-59 months who have been sick in the two weeks preceding the survey who report that the decision to seek healthcare for themselves is usually made by themselves/their partner/jointly with their partner/someone else.

Number of caregivers of children age 2-59 months who have been sick in the two weeks preceding the

survey who report that the decision to seek healthcare for themselves is usually made by themselves/their partner/jointly with their

partner/someone else



CAREGIVER KNOWLEDGE

1. Caregiver knowledge of CCM-trained RCOM presence: Proportion of caregivers of children age 2-59 months who have been sick in the two weeks preceding the survey who are aware of the presence of the CCM-trained RCOM in their community

Number of caregivers of children age 2-59 months who have been sick in the two weeks preceding the survey who are aware of the presence of the CCM-

trained RCom in their community

Number of caregivers of sick children age 2-59 months in the survey

2. Caregiver knowledge of location where CCM-trained RCom offers services: Proportion of caregivers of children age 2-59 months who have been sick in the two weeks preceding the survey who know the location where the CCM-trained RCom provides treatment for sick children, among those who are aware of the presence of the CCM-trained RCom in their community


survey who know the location where the CCM-trained RCom provide treatment for sick children




3. Caregiver knowledge of CCM-trained RCom role: Proportion of caregivers of children age 2-59 months who have been sick in the two weeks preceding the survey who know the role of the CCM-trained RCOM in their community


survey who know the role of the CCM-trained RCom* in their community



*Caregiver is able to identify at least 2 curative services provided by the CCM-trained RCom in the community

4. Caregiver knowledge of signs of child illness (2+): Proportion of caregivers of children age 2-59 months who have been sick in the two weeks preceding the survey who know two or more signs of childhood illness that require immediate assessment by an appropriately trained provider

Number of caregivers of children age 2-59 months who have been sick in the two weeks preceding the survey who know two or more signs of childhood

illness that require immediate assessment by an appropriately trained provider


5. Caregiver knowledge of signs of child illness (3+): Proportion of caregivers of children age 2-59 months who have been sick in the two weeks preceding the survey who know three or more signs of childhood illness that require immediate assessment by an appropriately trained provider

Number of caregivers of children age 2-59 months who have been sick in the two weeks preceding the survey who know three or more signs of childhood

illness that require immediate assessment by an appropriately trained provider


6. Caregiver knowledge of malaria cause: Proportion of caregivers of children age 2-59 months who have been sick in the two weeks preceding the survey who know the cause of malaria


survey who know the cause of malaria


7. Caregiver knowledge of fever as a symptom of malaria: Proportion of caregivers of children age 2-59 months who have been sick in the two weeks preceding the survey who know that fever is a symptom of malaria

Number of caregivers of children age 2-59 months who have been sick in the two weeks preceding the survey who know that fever is a symptom of malaria



8. Caregiver knowledge of correct malaria treatment: Proportion of caregivers of children age 2-59 months who have been sick in the two weeks preceding the survey who know the correct treatment for malaria

Number of caregivers of children age 2-59 months who have been sick in the two weeks preceding the survey who know the correct treatment for malaria

(ACT)


9. Caregiver knowledge of CCM-trained RCom activities: Proportion of caregivers of children age 2-59 months who have been sick in the two weeks preceding the survey who know that the CCM-trained RCom performs each of the activities listed in the survey questionnaire, among who are aware of the presence of the CCM-trained CH RCom W in their community


survey who know that the CCM-trained RCom performs “X” activity



10. Caregiver knowledge of signs of child illness: Proportion of caregivers of children age 2-59 months who have been sick in the two weeks preceding the survey who know that each of the signs of illness listed in the survey questionnaire that indicate their child needs treatment


survey who know that each of the signs of illness listed in the survey questionnaire that indicate their

child needs treatment


CAREGIVER PRECEPTIONS OF RCom QUALITY

1. CCM-trained RCOM quality (Trusted providers): Proportion of caregivers of children age 2-59 months who have been sick in the two weeks preceding the survey who view CCM-trained RCom as trusted health care providers

Number of caregivers of children age 2-59 months who have been sick in the two weeks preceding the survey who view CCM-trained RComs as trusted

health care providers



*Caregivers included in the numerator agree with the two statements: (1) People go to the CCM-trained RCom first for treatment of sick children, (2) People trust in the CCM-trained RCom’s ability to cure sick children.


2. CCM-trained RCOM quality (Quality services): Proportion of caregivers of children age 2-59 months who have been sick in the two weeks preceding the survey who believe CCM-trained RComs provide quality services

Number of caregivers of children age 2-59 months who have been sick in the two weeks preceding the survey who believe CCM-trained RCOMs provide

quality services



*Caregivers included in the numerator agree with at least 3 of the 4 statements: (1) Medicines are always available with the CCM-trained RCOM. (2) The CCM-trained RCom gives medicines that are good quality. (3) The CCM-trained RCom shows respect for patients. (4) The CCM-trained RCom conducts home visits and follow-ups.

3. CCM-trained RCOM quality (Available): Proportion of caregivers of children age 2-59 months who have been sick in the two weeks preceding the survey who found the CCM-trained RComs at first visit

Number of caregivers of children age 2-59 months who have been sick in the two weeks preceding the survey who found the CCM-trained RCom at first

visit


survey who sought care from a CCM-trained

*Caregivers included in the numerator had to find the RCom at first visit for each instance of illness included in the survey if the caregiver responded to multiple illness modules

4. CCM-trained RCOM quality (Convenient): Proportion of caregivers of children age 2-59 months who have been sick in the two weeks preceding the survey who cite the CCM-trained RComs as a convenient source of treatment


survey who cite the CCM-trained RCOM as a convenient source of treatment


trained in their community

*Caregivers included in the numerator agree with the two statements: (1) The CCM-trained RCOM is nearby. (2) It is easy to find the CCM-trained RCOM when RCom he or she is needed.


DECIDED TO SEEK CARE JOINTLY WITH PARTNER

1. Decided to seek care jointly with partner (Fever): Proportion of children age 2-59 months who had fever in the two weeks preceding the survey for whom the decision to seek advice or treatment was made jointly by their caregiver and their caregiver’s partner, among caregivers in a union

Number of children age 2-59 months who had fever in the two weeks preceding the survey for whom the decision to seek advice or treatment was made jointly by their caregiver and their caregiver’s

partner, among caregivers in a union

Number of children age 2-59 months who had fever in the survey whose caregiver was in a union

2. Decided to seek care jointly with partner (Diarrhea): Proportion of children age 2-59 months who had diarrhea in the two weeks preceding the survey for whom the decision to seek advice or treatment was made jointly by their caregiver and their caregiver’s partner, among caregivers in a union

Number of children age 2-59 months who had diarrhea in the two weeks preceding the survey for whom the decision to seek advice or treatment

was made jointly by their caregiver and their caregiver’s partner, among caregivers in a union

Number of children age 2-59 months who had diarrhea in the survey whose caregiver was in a union

3. Decided to seek care jointly with partner (Cough with difficult or fast breathing): Proportion of children age 2-59 months who had cough with difficult or fast breathing in the two weeks preceding the survey for whom the decision to seek advice or treatment was made jointly by their caregiver and their caregiver’s partner, among caregivers in a union

Number of children age 2-59 months who had cough with difficult or fast breathing in the two weeks

preceding the survey for whom the decision to seek advice or treatment was made jointly by their caregiver and their caregiver’s partner, among

caregivers in a union

Number of children age 2-59 months who had cough with difficult or fast breathing in the survey whose

caregiver was in a union

4. Decided to seek care jointly with partner (Sick child): Proportion of children age 2-59 months who have been sick in the two weeks preceding the survey for whom the decision to seek advice or treatment was made jointly by their caregiver and their caregiver’s partner, among caregivers in a union

Number of cases of illness among children age 2-59 months who have been sick in the two weeks

preceding the for which the decision to seek advice or treatment was made jointly by their caregiver

and their caregiver’s partner

Number of cases of illness among sick children age 2-59 months in the survey whose caregiver was in a

union


SICK CHILD CARE

1. Appropriate sick child care (Continued fluids): Proportion of children age 2-59 months who have been sick in the two weeks preceding the survey who were offered same or more than usual to drink *In all surveys except Niger and Nigeria (Abia State), this indicator includes only cases of diarrhea. In Niger and Nigeria (Abia State) it includes fever, diarrhea, and cough with difficult or fast breathing. Adapt indicator as applicable.

Number of cases of illness among children age 2-59 months who were sick in the two weeks preceding

the survey that were offered same or more than usual to drink

Number of cases of illness among sick children age 2-59 months in the survey

2. Appropriate sick child care (Continued feeding): Proportion of children age 2-59 months who have been sick in the two weeks preceding the survey who were offered same or more than usual to eat *In all surveys except Niger and Nigeria (Abia State), this indicator includes only cases of diarrhea. In Niger and Nigeria (Abia State) it includes fever, diarrhea, and cough with difficult or fast breathing. Adapt indicator as applicable.


the survey that were offered same or more than usual to eat


CARE SEEKING FROM AN APPROPRIATE PROVIDER

1. Care-seeking from appropriate provider (Fever): Proportion of children age 2-59 months who had fever in the two weeks preceding the survey for whom advice or treatment was sought from an appropriate provider

Number of children age 2-59 months who had fever in the two weeks preceding the survey for whom advice or treatment was sought from an appropriate provider

Number of children age 2-59 months who had fever in the survey

2. Care-seeking from appropriate provider (Diarrhea): Proportion of children age 2-59 months who had diarrhea in the two weeks preceding the survey for whom advice or treatment was sought from an appropriate provider

Number of children age 2-59 months who had diarrhea in the two weeks preceding the survey for

whom advice or treatment was sought from an appropriate provider

Number of children age 2-59 months who had diarrhea in the survey


3. Care-seeking from appropriate provider (Cough with difficult or fast breathing): Proportion of children age 2-59 months who had cough with difficult or fast breathing in the two weeks preceding the survey for whom advice or treatment was sought from an appropriate provider


preceding the survey for whom advice or treatment was sought from an appropriate provider

Number of children age 2-59 months who had cough with difficult or fast breathing

4. Care-seeking from appropriate provider (Sick child): Proportion of children age 2-59 months who have been sick in the two weeks preceding the survey for whom advice or treatment was sought from an appropriate provider


preceding the survey for which advice or treatment was sought from an appropriate provider


RCOM AS FIRST SOURCE OF CARE

5. RCOM as first source of care (Fever): Proportion of children age 2-59 months who had fever in two weeks preceding the survey taken to a CCM-trained RCOM as first source of care

Number of children age 2-59 months who had fever in two weeks preceding the survey taken to a CCM-

trained RCOM as first source of care


6. RCOM as first source of care (Diarrhea): Proportion of children age 2-59 months who had diarrhea in two weeks preceding the survey taken to a CCM-trained RCOM as first source of care

Number of children age 2-59 months who had diarrhea in two weeks preceding the survey taken to a

CCM-trained RCOM as first source of care


7. RCOM as first source of care (Cough with difficult or fast breathing): Proportion of children age 2-59 months who had cough with difficult or fast breathing in two weeks preceding the survey taken to a CCM-trained RCOM as first source of care

Number of children age 2-59 months who had cough with difficult or fast breathing in two weeks preceding

the survey taken to a CCM-trained RCOM as first source of care

Number of children age 2-59 months who had cough with difficult or fast breathing in the survey

8. RCOM as first source of care (Sick child): Proportion of children age 2-59 months who were sick in two weeks preceding the survey taken to a CCM-trained RCOM as first source of care

Number of cases of illness among children age 2-59 months who have been sick in two weeks preceding the survey taken to a CCM-trained RCOM as first

source of care



RCOM AS FIRST SOURCE OF CARE, ANY CARE

9. RCOM as first source of care, any care (Fever): Proportion of children age 2-59 months who had fever in two weeks preceding the survey taken to a CCM-trained RCOM as first source of care, among those for whom any care was sought

Number of children age 2-59 months who had fever in two weeks preceding the survey taken to a

CCM-trained RCOM as first source of care

Number of children age 2-59 months who had fever in the survey for whom any care was sought

10. RCOM as first source of care, any care (Diarrhea): Proportion of children age 2-59 months who had diarrhea in two weeks preceding the survey taken to a CCM-trained RCOM as first source of care, among those for whom any care was sought

Number of children age 2-59 months who had diarrhea in two weeks preceding the survey taken to a CCM-trained RCOM as first source of care

Number of children age 2-59 months who had diarrhea in the survey for whom any care was

sought

11. RCOM as first source of care, any care (Cough with difficult or fast breathing): Proportion of children age 2-59 months who had cough with difficult or fast breathing in two weeks preceding the survey taken to a CCM-trained RCOM as first source of care, among those for whom any care was sought

Number of children age 2-59 months who had cough with difficult or fast breathing in two weeks

preceding the survey taken to a CCM-trained RCOM as first source of care


for whom any care was sought

12. RCOM as first source of care, any care (Sick child): Proportion of children age 2-59 months who were sick in two weeks preceding the survey taken to a CCM-trained RCOM as first source of care, among those for whom any care was sought

Number of cases of illness among children age 2-59 months who have been sick in two weeks

preceding the survey taken to a CCM-trained RCOM as first source of care

Number of cases of illness among sick children age 2-59 months in the survey for which any care was

sought


SOURCES OF CARE

1. Sources of care (Sick child): Proportion of children age 2-59 months who were sick in two weeks preceding the survey taken to a public facility/private facility/RCOM/Store, pharmacy, or market/traditional practitioner/other for advice or treatment, among those for whom any care was sought

Number of cases of illness among children age 2-59 months who were sick in two weeks preceding the

survey taken to a public facility/private facility/RCOM/Store, pharmacy, or

market/traditional practitioner/other for advice or treatment


sought

2. First source of care (Sick child): Proportion of children age 2-59 months who were sick in two weeks preceding the survey taken to a public facility/private facility/RCOM/Store, pharmacy, or market/traditional practitioner/other first for advice or treatment, among those for whom any care was sought

Number of cases of illness among children age 2-59 months who were sick in two weeks preceding the

survey taken to a public facility/private facility/RCOM/Store, pharmacy, or

market/traditional practitioner/other first for advice or treatment


sought

SICK CHILD ASSESSMENT

1. Malaria diagnostic testing (Blood drawn): Proportion of children age 2-59 months who had fever in the two weeks preceding the survey who had finger or heel stick

Number of children age 2-59 months who had fever in the two weeks preceding the survey who had finger or

heel stick


2. Malaria diagnostic testing result shared: Proportion of children age 2-59 months whose caregiver received the result of the malaria diagnostic test, among those who had had a finger or heel stick in the two weeks preceding the survey

Number of children age 2-59 months whose caregiver received the results of the malaria diagnostic test

Number of children age 2-59 months who had fever in the survey who had had finger or heel stick

3. Malaria diagnostic testing result: Proportion of children age 2-59 months who had a positive malaria diagnostic test result, among those whose caregiver received the result of the malaria diagnostic test

Number of children age 2-59 months who had a positive malaria diagnostic test result

Number of children age 2-59 months whose caregiver received the malaria diagnostic test result


4. Confirmed malaria treatment: Proportion of children age 2-59 months who received ACT, among those who received a positive malaria diagnostic test result

Number of children age 2-59 months who received ACT

Number of children age 2-59 months who received a positive malaria diagnostic test result

5. Suspected pneumonia assessment: Proportion of children age 2-59 months who had cough with difficult or fast breathing in the two weeks preceding the survey who had their respiratory rate counted to assess fast breathing


preceding the survey who had their respiratory rate counted to assess fast breathing


SICK CHILD ASSESSMENT BY RCOM

6. RCOM malaria diagnostic testing (Blood drawn): Proportion of children age 2-59 months who had fever in the two weeks preceding the survey who had finger or heel stick by a CCM-trained RCOM

Number of children age 2-59 months who had fever in the two weeks preceding the survey who had finger or

heel stick by a CCM-trained RCOM

Number of children age 2-59 months who had fever in the survey whose caregiver sought care from a

RCOM

7. RCOM malaria diagnostic testing result shared: Proportion of children age 2-59 months whose caregiver received the result of the malaria diagnostic test, among those who had had a finger or heel stick by a CCM-trained RCOM in the two weeks preceding the survey

Number of children age 2-59 months whose caregiver received the result of the malaria diagnostic test

Number of children age 2-59 months who had fever in the survey who had had finger or heel stick by a

CCM-trained RCOM

8. RCOM malaria diagnostic testing result: Proportion of children age 2-59 months for whom the result of the malaria diagnostic test was positive, among those whose caregiver received the result of the malaria diagnostic test performed by a CCM-trained RCOM

Number of children age 2-59 months who had a positive malaria diagnostic test result

Number of children age 2-59 months for whose caregiver received the result of the malaria diagnostic

test performed by a CCM-trained RCOM

9. RCOM confirmed malaria treatment: Proportion of children age 2-59 months who received ACT from a RCOM, among those who received a positive malaria diagnostic test result from a RCOM

Number of children age 2-59 months who received ACT from a RCOM

Number of children age 2-59 months who received a positive result from a malaria diagnostic test

performed by a RCOM


10. RCOM suspected pneumonia assessment: Proportion of children age 2-59 months who had cough with difficult or fast breathing in the two weeks preceding the survey who had their respiratory rate counted by a CCM-trained RCOM to assess fast breathing


preceding the survey who had their respiratory rate counted by a CCM-trained RCOM to assess fast

breathing


caregiver sought care from a RCOM

APPROPRIATE TREATMENT COVERAGE

1. Treatment coverage (Fever: Appropriate ACT treatment with positive diagnostic test): Proportion of children age 2-59 months who received appropriate ACT treatment, according to national policy, among those with fever who had a positive malaria diagnostic test result in the two weeks preceding the survey

Number of children age 2-59 months who received appropriate ACT treatment, according to national

policy

Number of children age 2-59 months who had fever in the survey who had a positive malaria

diagnostic test result

2. Treatment coverage (Fever: Appropriate & prompt ACT treatment with positive diagnostic test): Proportion of children age 2-59 months who received timely and appropriate ACT treatment, according to national policy, among those with fever who had a positive malaria diagnostic test result in the two weeks preceding the survey

Number of children age 2-59 months who received appropriate ACT treatment the same day or the day after the fever started, according to national policy

Number of children age 2-59 months who had fever in the survey who had a positive malaria diagnostic

test result

3. Treatment coverage (Diarrhea: ORS & zinc): Proportion of children age 2-59 months who had diarrhea in the two weeks preceding the survey who received ORS and zinc, according to national policy

Number of children age 2-59 months who had diarrhea in the two weeks preceding the survey who received ORS and zinc according to national policy


4. Treatment coverage (Cough with difficult or fast breathing: First-line antibiotics): Proportion of children age 2-59 months who had cough with difficult or fast breathing in the two weeks preceding the survey who received first-line antibiotic treatment, according to national policy


preceding the survey who received first-line antibiotic treatment according to national policy



5. Overall treatment coverage (Sick child): Proportion of children age 2-59 months who have been sick in the two weeks preceding the survey who received appropriate treatment, according to national policy

*This indicator includes indicators 2, 3, and 4 in this section. Indicator 1 is not included.

Number of cases of illness among children age 2-59 months who have been sick in two weeks preceding

the survey that received appropriate treatment

Number of cases of illness among sick children age 2-59 months in the survey*

*Fever cases only include those with a positive malaria diagnostic test result

APPROPRIATE TREATMENT COVERAGE BY RCOMS

*This set of indicators uses the same denominator as the Appropriate Treatment Coverage indicators above; thus the percentages will always be equal to or less than the percentages for indicators 1-5 in this section.

6. RCOM treatment coverage (Fever: Appropriate ACT treatment with positive diagnostic test): Proportion of children age 2-59 months who received appropriate ACT treatment from a CCM-trained RCOM, according to national policy, among those with fever who had a positive malaria diagnostic test result in the two weeks preceding the survey

Number of children age 2-59 months who received appropriate ACT treatment from a CCM-trained

RCOM, according to national policy

Number of children age 2-59 months who had fever in the survey who had a positive malaria


7. RCOM treatment coverage (Fever: Appropriate & prompt ACT treatment with positive diagnostic test): Proportion of children age 2-59 months who received timely and appropriate ACT treatment from a CCM-trained RCOM, according to national policy, among those with fever who had a positive malaria diagnostic test result in the two weeks preceding the survey

Number of children age 2-59 months who received appropriate ACT treatment from a CCM-trained RCOM the same day or the day after the fever

started, according to national policy


test result

8. RCOM treatment coverage (Diarrhea: ORS & zinc): Proportion of children age 2-59 months who had diarrhea in the two weeks preceding the survey who received ORS and zinc from a CCM-trained RCOM, according to national policy

Number of children age 2-59 months who had diarrhea in the two weeks preceding the survey who received ORS and zinc from a CCM-trained RCOM,

according to national policy


9. RCOM treatment coverage (Cough with difficult or fast breathing: First-line antibiotics): Proportion of children age 2-59 months who had cough with difficult or fast breathing in the two weeks preceding the survey who received antibiotic treatment according to national policy

Number of children age 2-59 months who had cough with difficult or fast breathing in the two weeks preceding the survey who received antibiotic

treatment from a CCM-trained RCOM, according to national policy



10. RCOM treatment coverage (Sick child): Proportion of children age 2-59 months who have been sick in the two weeks preceding the survey who received appropriate treatment from a CCM-trained RCOM

*This indicator includes indicators 7, 8, and 9 in this section. Indicator 6 is not included.


the survey that received appropriate treatment from a CCM-trained RCOM, according to national policy

Number of cases of illness among sick children age 2-59 months in the survey*


APPROPRIATE TREATMENT COVERAGE BY RCOMS, AMONG THOSE WHO SOUGHT CARE FROM RCOM

11. RCOM treatment coverage (Fever: Appropriate & prompt ACT treatment with positive diagnostic test): Proportion of children age 2-59 months who received timely and appropriate ACT treatment from a CCM-trained RCOM, according to national policy, among those with fever who had a positive malaria diagnostic test result in the two weeks preceding the survey

Number of children age 2-59 months who received appropriate ACT treatment from a CCM-trained RCOM the same day or the day after the fever

started, according to national policy


test result whose caregiver sought care from a RCOM

12. RCOM treatment coverage (Diarrhea: ORS & zinc): Proportion of children age 2-59 months who had diarrhea in the two weeks preceding the survey who received ORS and zinc from a CCM-trained RCOM, according to national policy, among those who sought care from a RCOM

Number of children age 2-59 months who had diarrhea in the two weeks preceding the survey who received ORS and zinc from a CCM-trained RCOM,

according to national policy

Number of children age 2-59 months who had diarrhea in the survey whose caregiver sought care

from a RCOM

13. RCOM treatment coverage (Cough with difficult or fast breathing: First-line antibiotics): Proportion of children age 2-59 months who had cough with difficult or fast breathing in the two weeks preceding the survey who received antibiotic treatment according to national policy, among those who sought care from a RCOM

Number of children age 2-59 months who had cough with difficult or fast breathing in the two weeks preceding the survey who received antibiotic

treatment from a CCM-trained RCOM, according to national policy


caregiver sought care from a RCOM

14. RCOM treatment coverage (Sick child): Proportion of children age 2-59 months who have been sick in the two weeks preceding the survey who received appropriate treatment from a CCM-trained RCOM, among those who sought care from a RCOM

*This indicator includes indicators 11, 12, and 13 in this section.


the survey that received appropriate treatment from a CCM-trained RCOM, according to national policy

Number of cases of illness among sick children age 2-59 months in the survey whose caregiver sought

care from a RCOM*



TREATMENTS TAKEN

15. Diarrhea treatment taken: Proportion of children age 2-59 months who had diarrhea in the two weeks preceding the survey who took ORS/zinc/government-approved homemade fluid

Number of children age 2-59 months who had diarrhea in the two weeks preceding the survey

who took ORS/zinc/government-approved homemade fluid


16. Other diarrhea treatment taken: Proportion of children age 2-59 months who had diarrhea in the two weeks preceding the survey who took any of the medicines listed in the survey questionnaire, among children with diarrhea who took any other medicines

Number of children age 2-59 months who had diarrhea in the two weeks preceding the survey

who took “X” medicine

Number of children age 2-59 months who had diarrhea in the survey who took any other medicine

(beside ORS, zinc or government-approved homemade fluid)

17. Fever treatment taken: Proportion of children age 2-59 months who had fever in the two weeks preceding the survey who took any of the medicines listed in the survey questionnaire, among children with fever who took any medicines

Number of children age 2-59 months who had fever in the two weeks preceding the survey who took

“X” medicine

Number of children age 2-59 months who had fever in the survey who took any medicine

18. Cough with difficult or fast breathing treatment taken: Proportion of children age 2-59 months who had cough with difficult or fast breathing in the two weeks preceding the survey who took any of the medicines listed in the survey questionnaire, among children with cough with difficult or fast breathing who took any medicines

Number of children age 2-59 months who had cough with difficult or fast breathing in the two

weeks preceding the survey who took “X” medicine

Number of children age 2-59 months who had cough with difficult or fast breathing in the survey who

took any medicine

SOURCE OF TREATMENT

1. Source of treatment (Malaria: ACT): Proportion of children age 2-59 months who had fever in the two weeks preceding the survey who received ACT from a public facility/private facility/RCOM/Store, pharmacy, or market/traditional practitioner/other, among those who received ACT for malaria

Number of children age 2-59 months who had fever in the two weeks preceding the survey who

received ACT for malaria from a public facility/private facility/RCOM/Store, pharmacy, or

market/traditional practitioner/other

Number of children age 2-59 months in the survey who received ACT for malaria


2. Source of treatment (Diarrhea: ORS): Proportion of children age 2-59 months who had diarrhea in the two weeks preceding the survey who received ORS from a public facility/private facility/RCOM/Store, pharmacy, or market/traditional practitioner/other, among those who received ORS for diarrhea

Number of children age 2-59 months who had diarrhea in the two weeks preceding the survey who received ORS from a public facility/private

facility/RCOM/Store, pharmacy, or market/traditional practitioner/other

Number of children age 2-59 months in the survey who received ORS for diarrhea

3. Source of treatment (Diarrhea: zinc): Proportion of children age 2-59 months who had diarrhea in the two weeks preceding the survey who received zinc from a public facility/private facility/RCOM/Store, pharmacy, or market/traditional practitioner/other, among those who received zinc for diarrhea

Number of children age 2-59 months who had diarrhea in the two weeks preceding the survey who received zinc from a public facility/private


Number of children age 2-59 months in the survey who received zinc for diarrhea

4. Source of treatment (Cough with difficult or fast breathing): Proportion of children age 2-59 months who had cough with difficult or fast breathing in the two weeks preceding the survey who received first-line antibiotics from a public facility/private facility/RCOM/Store, pharmacy, or market/traditional practitioner/other, among those who received first-line antibiotics for cough with difficult or fast breathing

Number of children age 2-59 months who had cough with difficult or fast breathing in the two

weeks preceding the survey who received first-line antibiotics from a public facility/private


Number of children age 2-59 months in the survey who received first-line antibiotics for cough with

difficult or fast breathing

FIRST DOSE OF TREATMENT IN FRONT OF RCOM

1. First dose of treatment (Malaria): Proportion of children age 2-59 months who had fever in the two weeks preceding the survey who received the first dose of ACT in the presence of a RCOM, among those who received ACT from a RCOM

Number of children age 2-59 months who had fever in the two weeks preceding the survey who received the

first dose of ACT in the presence of a RCOM

Number of children age 2-59 months who had fever in the survey who received ACT from a RCOM

2. First dose of treatment (Diarrhea: ORS): Proportion of children age 2-59 months who had diarrhea in the two weeks preceding the survey who received the first dose of ORS in the presence of a RCOM, among those who received ORS from a RCOM

Number of children age 2-59 months who had diarrhea in the two weeks preceding the survey who received the first dose of ORS in the presence of a

RCOM

Number of children age 2-59 months who had diarrhea in the survey who received ORS from a

RCOM


3. First dose of treatment (Diarrhea: zinc): Proportion of children age 2-59 months who had diarrhea in the two weeks preceding the survey who received the first dose of zinc in the presence of a RCOM, among those who received zinc from a RCOM

Number of children age 2-59 months who had diarrhea in the two weeks preceding the survey who

received the first dose of zinc in the presence of a RCOM

Number of children age 2-59 months who had diarrhea in the survey who received zinc from a

RCOM

4. First dose of treatment (Diarrhea: ORS and zinc): Proportion of children age 2-59 months who had diarrhea in the two weeks preceding the survey who received the first dose of both zinc and ORS in the presence of a RCOM, among those who received both ORS and zinc from a RCOM

Number of children age 2-59 months who had diarrhea in the two weeks preceding the survey who received the first dose of both ORS and zinc in the

presence of a RCOM

Number of children age 2-59 months who had diarrhea in the survey who received both ORS and

zinc from a RCOM

5. First dose of treatment (Cough with difficult or fast breathing): Proportion of children age 2-59 months who have had cough with difficult or fast breathing in the two weeks preceding the survey who received the first dose of first-line antibiotics in the presence of a RCOM, among those who received first-line antibiotics from a RCOM


preceding the survey who received the first dose of first-line antibiotics in the presence of a RCOM

Number of children age 2-59 months who had cough with difficult or fast breathing in the survey who

received first-line antibiotics from a RCOM

6. First dose of treatment (Sick child): Proportion of children age 2-59 months who have been sick in the two weeks preceding the survey who received the first dose of treatment in the presence of a RCOM

*This indicator includes indicators 1, 4, and 5 in this section. Indicators 2 and 3 are not included.

Number cases of illness among of children age 2-59 months who have been sick in the two weeks

preceding the survey that received the first dose of treatment in the presence of a RCOM

Number of cases of illness among sick children age 2-59 months in the survey that received treatment from

a RCOM

TREATMENT ADMINISTRATION COUNSELING BY RCOM

1. Counseling quality (Malaria): Proportion of children age 2-59 months who had fever in the two weeks preceding the survey whose caregiver received counseling on how to administer ACT, among those who received ACT from a RCOM for malaria

Number of children age 2-59 months who had fever in the two weeks preceding the survey whose caregiver

received counseling on how to administer ACT to their child

Number of children age 2-59 months with fever in the survey who received ACT from a RCOM


2. Counseling quality (Diarrhea: ORS): Proportion of children age 2-59 months who had diarrhea in the two weeks preceding the survey whose caregiver received counseling on how to administer ORS, among those who received ORS from a RCOM for diarrhea

Number children age 2-59 months who had diarrhea in the two weeks preceding the survey whose

caregiver received counseling on how to administer ORS to their child

Number of children age 2-59 months with diarrhea in the survey who received ORS from a RCOM

3. Counseling quality (Diarrhea: zinc): Proportion of children age 2-59 months who had diarrhea in the two weeks preceding the survey whose caregiver received counseling on how to administer zinc, among those who received zinc from a RCOM for diarrhea

Number children age 2-59 months who had diarrhea in the two weeks preceding the survey whose

caregiver received counseling on how to administer zinc to their child

Number of children age 2-59 months who had diarrhea in the survey who zinc for diarrhea from a

RCOM

4. Counseling quality (Diarrhea: ORS and zinc): Proportion of children age 2-59 months who had diarrhea in the two weeks preceding the survey whose caregiver received counseling on how to administer both ORS and zinc, among those who received both ORS and zinc from a RCOM for diarrhea

Number children age 2-59 months who had diarrhea in the two weeks preceding the survey for whose

caregiver received counseling on how to administer both ORS and zinc to their child

Number of children age 2-59 months in the survey who received both ORS and zinc for diarrhea from a

RCOM

5. Counseling quality (Cough with difficult or fast breathing: first-line antibiotic): Proportion of children age 2-59 months who had cough with difficult or fast breathing in the two weeks preceding the survey whose caregiver received counseling on how to administer first-line antibiotics, among those who received first-line antibiotics from a RCOM for cough with difficult or fast breathing

Number children age 2-59 months who had cough with difficult or fast breathing in the two weeks preceding the survey whose caregiver received

counseling on how to administer first-line antibiotics to their child

Number of children age 2-59 months in the survey who received first-line antibiotics for cough with

difficult or fast breathing from a RCOM

6. Counseling quality (Sick child): Proportion of sick children age 2-59 months whose caregiver received counseling on how to provide the treatment(s) received among those who received treatment(s) for a CCM illness in the two weeks preceding the survey

*This indicator includes indicators 1, 4, and 5 in this section. Indicators 2 and 3 are not included.

Number of cases of illness among sick children age 2-59 months for which caregivers received counseling

on how to provide the treatment(s) received

Number of cases of illness among sick children age 2-59 months in the survey that received treatment(s) for

a CCM illness


RCOM REFERRAL ADHERENCE

1. RCOM referral adherence (Fever): Proportion of children age 2-59 months who had fever in the two weeks preceding the survey whose caregiver adhered to the RCOM’s referral advice, among those who were referred to a health facility by a CCM-trained RCOM

Number of children age 2-59 month who had fever in the two weeks preceding the survey whose caregiver

adhered to the RCOM’s referral advice

Number of children age 2-59 months who had fever in the survey who were referred to a health facility by

a CCM-trained RCOM

2. RCOM referral adherence (Diarrhea): Proportion of sick children age 2-59 months who had diarrhea in the two weeks preceding the survey whose caregiver adhered to the RCOM’s referral advice, among those who were referred to a health facility by a CCM-trained RCOM

Number of children age 2-59 month who had diarrhea in the two weeks preceding the survey whose the caregiver adhered to the RCOM’s referral advice

Number of children age 2-59 months who had diarrhea in the survey who were referred to a health

facility by a CCM-trained RCOM

3. RCOM referral adherence (Cough with difficult or fast breathing): Proportion of sick children age 2-59 months who had cough with difficult or fast breathing in the two weeks preceding the survey whose caregiver adhered to the RCOM’s referral advice, among those who were referred to a health facility by a CCM-trained RCOM

Number of children age 2-59 month who had cough with difficult or fast breathing in the two weeks

preceding the survey whose the caregiver adhered to the RCOM’s referral advice

Number of children age 2-59 months who had cough with difficult or fast breathing in the survey who were

referred to a health facility by a CCM-trained RCOM

4. RCOM referral adherence (Sick child): Proportion of children age 2-59 months who were sick in the two weeks preceding the survey whose caregiver adhered to the RCOM’s referral advice, among those who were referred to a health facility by a CCM-trained RCOM

Number of cases of illness among sick children age 2-59 months for which the caregiver adhered to the

RCOM’s referral advice

Number of cases of illness among sick children age 2-59 months that were referred to a health facility by a CCM-trained RCOM in the two weeks preceding

the survey

5. Reasons caregiver did not adhere to RCOM referral (Sick child): Proportion of children age 2-59 months who were sick in the two weeks preceding the survey whose caregiver did not adhere to the RCOM’s referral advice because of the reasons listed in the survey questionnaire, among those who did not adhere to the referral advice

Number of sick children age 2-59 months included in the survey whose caregiver reported not

adhering to the RCOM’s referral advice because of reason “X”

Number of children age 2-59 months whose caregiver did not adhere to the RCOM’s referral

advice


RCOM SICK CHILD FOLLOW-UP VISIT

1. RCOM sick child follow-up visit (Fever): Proportion of children age 2-59 months who had fever in the two weeks preceding the survey who received a follow-up visit from a RCOM, among those who sought care from a CCM-trained RCOM

Number of children age 2-59 months who had fever in the two weeks preceding the survey who received a

follow-up visit from a CCM-trained RCOM

Number of children age 2-59 months who had fever in the survey whose caregiver sought care from a CCM-

trained RCOM

2. RCOM sick child follow-up visit (Diarrhea): Proportion of children age 2-59 months who had diarrhea in the two weeks preceding the survey who received a follow-up visit from a RCOM, among those who sought care from a CCM-trained RCOM

Number of children age 2-59 months who had diarrhea in the two weeks preceding the survey who received a follow-up visit from a CCM-trained RCOM

Number of children age 2-59 months who had diarrhea in the survey whose caregiver sought care

from a CCM-trained RCOM

3. RCOM sick child follow-up visit (Cough with difficult or fast breathing): Proportion of children age 2-59 months who had cough with difficult or fast breathing in the two weeks preceding the survey who received a follow-up visit from a RCOM, among those who sought care from a CCM-trained RCOM


preceding the survey who received a follow-up visit from a CCM-trained RCOM

Number of children age 2-59 months who had cough with difficult or fast breathing in the survey whose caregiver sought care from a CCM-trained RCOM

4. RCOM sick child follow-up visit (Sick child): Proportion of children age 2-59 months who were sick in the two weeks preceding the survey who received a follow-up visit from a RCOM, among those who sought care from a CCM-trained RCOM

Number of cases of illness among sick children age 2-59 months in the two weeks preceding the survey that received a follow-up visit from a CCM-trained RCOM

Number of cases of illness among sick children age 2-59 months in the survey whose caregiver sought care

from a CCM-trained RCOM

5. When the sick child follow-visit occurred (Sick child): Proportion of children age 2-59 months who were sick in the two weeks preceding the survey who received a follow-up visit from a RCOM one/two/three/four/ five/more than five days after the initial RCOM visit, among those who received a follow-up visit from a RCOM


the survey that received a follow-up visit from a RCOM one/two/three/four/ five/more than five

days after the initial RCOM visit

Number of cases of illness among children age 2-59 months included in the survey that received a

follow-up visit from a RCOM


DID NOT SEEK CARE

1. Did not seek care (Fever): Proportion of children age 2-59 months who had fever in the two weeks preceding the survey for whom advice or treatment was not sought

Number of children age 2-59 months who had fever in the two weeks preceding the survey for whom advice

or treatment was not sought


2. Did not seek care (Diarrhea): Proportion of children age 2-59 months who had diarrhea in the two weeks preceding the survey for whom advice or treatment was not sought

Number of children age 2-59 months who had diarrhea in the two weeks preceding the survey for

whom advice or treatment was not sought


3. Did not seek care (Cough with difficult or fast breathing): Proportion of children age 2-59 months who had cough with difficult or fast breathing in the two weeks preceding the survey for whom advice or treatment was not sought


preceding the survey for whom advice or treatment was not sought

Number of children age 2-59 months who had cough with difficult or fast breathing

4. Did not seek care (Sick child): Proportion of children age 2-59 months who have been sick in the two weeks preceding the survey for whom advice or treatment was not sought


preceding the survey for which advice or treatment was not sought


5. Reasons did not seek care (Sick child): Proportion of children age 2-59 months who were sick in the two weeks preceding the survey whose caregiver did not seek care because of the reasons listed in the survey questionnaire, among those who did not seek care

Number of sick children age 2-59 months included in the survey whose caregiver reported not seeking

care because of reason “X”

Number of cases of illness among sick children age 2-59 months in the survey for which care was not

sought

SOUGHT CARE BUT NOT FROM RCOM

6. Sought care but not from RCOM (Fever): Proportion of children age 2-59 months who had fever in the two weeks preceding the survey for whom advice or treatment was not sought from a CCM-trained RCOM, among those who sought any care

Number of children age 2-59 months who had fever in the two weeks preceding the survey for whom advice or treatment was not sought from a CCM-trained

RCOM

Number of children age 2-59 months who had fever in the survey whose caregiver sought any care


7. Sought care but not from RCOM (Diarrhea): Proportion of children age 2-59 months who had diarrhea in the two weeks preceding the survey for whom advice or treatment was not sought from a CCM-trained RCOM, among those who sought any care

Number of children age 2-59 months who had diarrhea in the two weeks preceding the survey for whom advice or treatment was not sought from a

CCM-trained RCOM

Number of children age 2-59 months who had diarrhea in the survey whose caregiver sought any

care

8. Sought care but not from RCOM (Cough with difficult or fast breathing): Proportion of children age 2-59 months who had cough with difficult or fast breathing in the two weeks preceding the survey for whom advice or treatment was not sought from a CCM-trained RCOM, among those who sought any care


preceding the survey for whom advice or treatment was not sought from a CCM-trained RCOM

Number of children age 2-59 months who had cough with difficult or fast breathing whose caregiver sought

any care

9. Sought care but not from RCOM (Sick child): Proportion of children age 2-59 months who have been sick in the two weeks preceding the survey for whom advice or treatment was not sought from a CCM-trained RCOM, among those who sought any care


preceding the survey for which advice or treatment was not sought from a CCM-trained RCOM

Number of cases of illness among sick children age 2-59 months in the survey whose caregiver sought any

care

10. Reasons did not seek care from RCOM (Sick child): Proportion of children age 2-59 months who were sick in the two weeks preceding the survey whose caregiver did not seek care because of the reasons listed in the survey questionnaire, among those who sought care but did not from a CCM-trained RCOM

Number of sick children age 2-59 months included in the survey whose caregiver reported not seeking

care from a RCOM because of reason “X”

Number of cases of illness among sick children age 2-59 months in the survey for which care was sought but not from a CCM-trained RCOM

ADDITIONAL SEX-DISAGGREGATED TREATMENT COVERAGE INDICATORS

1. Sought any advice or treatment (Sick child): Proportion of children age 2-59 months who had fever/diarrhea/cough with difficult or fast breathing for whom advice or treatment was sought from any source

Number of children age 2-59 months who had fever/diarrhea/cough with difficult or fast breathing for whom advice or treatment was sought from any

source

Number of children age 2-59 who had fever/diarrhea/cough with difficult or fast breathing

included in the survey


2. Sought treatment from a RCOM (Sick child): Proportion of children age 2-59 months who had fever/diarrhea/cough with difficult or fast breathing for whom advice or treatment was sought from a CCM-trained RCOM

Number of children age 2-59 months who had fever/diarrhea/cough with difficult or fast breathing for whom advice or treatment was sought from a

CCM-trained RCOM

Number of children age 2-59 who had fever/diarrhea/cough with difficult or fast breathing

included in the survey

3. Malaria treatment (Any antimalarial): Proportion of children age 2-59 months who had fever in the two weeks preceding the survey who received any antimalarial

Number of children age 2-59 months who had fever in the two weeks preceding the survey who received any

antimalarial


4. Confirmed malaria treatment (Any antimalarial – positive diagnostic test): Proportion of children age 2-59 months with fever in the two weeks preceding the survey who received any antimalarial, among those with a positive malaria diagnostic test result

Number of children age 2-59 months who had fever in the two weeks preceding the survey who had a

positive malaria diagnostic test result and received any antimalarial

Number of children age 2-59 months with fever included in the survey who had a positive malaria


5. Malaria treatment (ACT): Proportion of children age 2-59 months who had fever in the two weeks preceding the survey who received ACT

Number of children age 2-59 months who had fever in the two weeks preceding the survey who received

ACT


6. Confirmed malaria treatment (ACT – positive diagnostic test): Proportion of children age 2-59 months with fever in the two weeks preceding the survey who received ACT, among those with a positive malaria diagnostic test result

Number of children age 2-59 months who had fever in the two weeks preceding the survey who had a

positive malaria diagnostic test result and received ACT



7. Malaria treatment (ACT within 24 hours): Proportion of children age 2-59 months with fever in the two weeks preceding the survey who received ACT the same day or the day after the fever started

Number of children age 2-59 months who had fever in the two weeks preceding the survey who received

ACT the same day or the day after the fever started



8. Confirmed malaria treatment (ACT within 24 hours – positive diagnostic test): Proportion of children age 2-59 months (disaggregated by sex) with fever in the two weeks preceding the survey who received ACT the same day or the day after the fever started, among those with a positive diagnostic test results

Number of children age 2-59 months (disaggregated by sex) who had fever in the two weeks preceding the

survey who received ACT the same day or the day after the fever started



9. Suspected pneumonia treatment (Any antibiotic): Proportion of children age 2-59 months who had cough with difficult or fast breathing in the two weeks preceding the survey who received any antibiotic

Number of children age 2-59 months who had cough with difficult or fast breathing in the two weeks preceding the survey who received any

antibiotic


10. Diarrhea treatment (ORS): Proportion of children age 2-59 months who had diarrhea in the two weeks preceding the survey who received ORS


received ORS


11. Diarrhea treatment (zinc): Proportion of children age 2-59 months who had diarrhea in the two weeks preceding the survey who received zinc


received zinc


12. Diarrhea treatment (government-approved homemade fluid): Proportion of children age 2-59 months who had diarrhea in the two weeks preceding the survey who received a government-approved homemade fluid


received a government-approved homemade fluid


niger race endline survey report 31march17 · annex g. details of data cleaning and analysis ......

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