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ANNEX X KPC REPORT

RELIEF INTERNATIONAL NIGER

Konni District

Final Survey Report:

Knowledge, Practice and Coverage

December 2011

Prepared and written by

Mahaman Hallarou, MD,Child Survival Program Manager/Head ofCountry Office

Survey Team Leader


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Acknowledgements

1.1 The authors of this report, Dr. Mahaman Hallarou (Relief International) and David C.Eastman (consultant) would like to thank various contributors who participated in this

Knowledge, Practice and Coverage final survey. In particular, thanks are due to the

people who supported this survey either through their involvement in its planning and

implementation. These include the staff of the Konni District Ministry of Health

(MOH), especially medical district coordinator Dr. Alio Tayabou and MOH supervisor

Abuzeidi Chahabou; district administrator Suleymane Issaka; health supervisor

Abuzeidi Chahabou; Konni Statistics Department supervisor Alio Nahantchi, MPDL

Medical Officer Dr. Soumana Oumarou; and LNGO ISCV supervisor Sangar and

survey interviewers (listed in Appendix 5); Meredith Chang (USAID-Child Survival

and Health Grants Program); and Paulin Ntawangundi (Relief International).

1.2 Thanks are also due to USAIDCSHGP, which funded the implementation of the

survey.


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1.3

The following people were instrumental in bringing the KPC survey and report preparation tosuccessful completion:

1- CORE TEAM

Num Name Structure Contacts

1 Salissou Iliassou DDP/AT/DC Konni 96879464

2 Abouzeidi Chouhabou DS Konni

968789383 Dr Mahaman Hallarou RI 96292784

4 Rakia Azouma RI 96876643

5 Moustapha Tcharimi RI 96883375

6 Remi Sugurono Consultant 90612227

7 Dr Soumana Oumarou ONG MPDL Konni 96081133

2- SURVEY SUPERVISORS

N d'ordre Nom et prnom Profil Structure Contacts

1 Ali Hantchi Superviseur DDP/AT/DCKonni

96 59 07 60

2 Moussa Maman Tela Superviseur ONG ISCVKonni

96 87 89 38

3 Ary Issaka Ousmane Superviseur DDJS JeunesseSport Konni

98 09 19 04

4 Mme Garba NanaHaouaou

Superviseur ONG ISCVKonni

90790960

5 Maman Sani MoussaOumarou

Superviseur ONG ISCVKonni

91793857

6 Sangar Rachide Superviseur ONG ISCVKonni

96994552

7 Kamay Goga Superviseur Alphabtisation 96887692

8 Abouzeidi Chouhabou Superviseur DS Konni 96878938


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9 Moustapha TcharimiTchari

Superviseur PSE/RI Konni 90466551

10 Dr Soumana Oumarou Superviseur ONG MPDLKonni

96081133

3- INTERVIEWERS

Nd'ordre

Nom et prnom Profil Contacts

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

63

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

41

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

68

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

64

5Hassane Almou Amadou Animateur 90 04 12 63/94 32 35

91

6 Alzouma Mayaki Oumarou Etudiant 96 21 88 44

7 Oumarou Djibo Enseignant 96 01 43 04

8M. Salissou Dan Nana Sociologue/Agent

municipal91 36 34 32

9 Moussa Abdou Auxiliaire d'levage 90 57 95 34

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

17

11Salifou Moumouni Kadidja Sociologue 96 58 04 76/90 88 20

37

12 Mohamed Abolbol Sociologue 96 98 08 66

13Aichatou Abdou Garba Enseignante 96 89 89 97/90 50 11

84

14Alzouma MahamanMoustapha

Etudiant 96 57 44 20

15

Arzika Halimatou Biologiste 94 25 45 87/97 71 45

33

16 Dakaou Alio Sociologue96467334/90416478

17 Abdou Andin Enseignant 91 59 95 35

18 Moussa Jean Traor Sociologue 91 71 50 83

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

76

20Abdoul Razakou Habou

NagodiAssistant logistique 96 50 40 96

21Souley Hamidine Sociologue 96 40 20 88


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22 Mato Touraki Journaliste 96 75 89 77

23 Mme Maman Fati Idi Agent du Plan 98 58 42 66

24 Oumarou Ibrahim Etudiant 96 02 76 40

25 Ali Abdoul Karim DDP/AT/DC 96 29 03 63

26 Salamatou Habou Journaliste Radio Anfani 96 06 42 47

27 Garba Kano Enseignant retrait 96 97 29 14

28Ibro Mahamadou Animateur 96 07 69 59/94 08 42

34

29 Ibrahim Oumarou Etudiant96 52 95 02/90 25 4537

30Hadiza Ibrahim Tehnicienne de

Developpement Rural

97 28 74 80

Table of Contents


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Abbreviations and Acronyms

ACT Artemisinin Combination TherapyBCC Behavior Change CommunicationCCM Community Case Management

CHA Community Health AgentC-HIS Community Health Information SystemCHN Child Health and NutritionC-IMCI Community-Integrated Management of Childhood IllnessesCMAM Community Management of Acute MalnutritionCSP Child Survival ProjectCSTS Child Survival Technical Support projectDHS Demographic and Health SurveyDHT District Health TeamDMCH Department of Maternal and Child HealthDPT or DTC Diphtheria-Pertussis-Tetanus vaccine

EDSN-MICS Enqute Dmographique et de Sant du Niger- Multiple Indicator ClusterSurveysENA Essential Nutrition ActionsHC Health Center HP Health PostIMCI Integrated Management of Childhood IllnessesINS Institut National de la StatistiqueIPT Intermittent Preventive Treatment (Preventive Treatment for Malaria in

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

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


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1 Background

1.1 Project Location

1.2 Niger is a landlocked Sahelian country that is ranked third from the last on the 2010Human Development Index list of 169 countries1, with 69 percent of its population

living below the poverty line.2Like the rest of the Sahel, Niger has a long history of

endemic hunger characterized by seasonal fluctuations and geographic variation.

1.3 In 2005, a severe drought resulted in a famine that affected nearly 3 million people andexacerbated the already fragile health and nutritional status of the country withdisproportional suffering among women and children. While the current crop harvestshave ameliorated some of the immediate concerns, many areas do not have transitionalsupport or programs to ensure adequate coping mechanisms, particularly in the areastargeted by this project.

1.4 In 2007, in the aftermath of the Nutritional crisis, Relief International started a fouryear USAID Funded Child Survival Project in Konni District.

1.5 The project Intervention Zone is located in the southwestern areat of the Tahoua regionand is 417 kilometers to the east from the capital Niamey covering 5,317 square miles.

1.6

1.7 Characteristics of the Target Population

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

1.9

1.10 Age Group 1.11 Population

1.12 0-11 months 1.13 24,200

1.14 12-59 months 1.15 59,124

1.16 Pregnant woman 1.17 20,445

1.18 Woman of reproductiveage

1.19 91,297

12 http://hdrstats.undp.org/en/countries/profiles/NER.html.3 Konni Health District Development Plan 2005-2010


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1.20It is fast growing population with 3.3% annual increase4 and in 2011, Konni totalpopulation is estimated at 478687 , 93057 U5 children and 101960 women ofreproductive age. Hausa and Peulh are the 2 main ethnic groups.

1.21 Health, Social and Economic Conditions within the Project Area

Class dans les 4 derniers Pays les plus pauvre du monde dans la classification du Programdes Nations Unies pour le Development ( PNUD)5, le Niger fait rgulirement face auxcontraintes des alas climatiques, et de linstabilit politiques dans un contexte de faible

pouvoir dachats avec plus de la moiti de la population vivant avec moins de 1 dollar/Jour.Il rsulte une situation dinscuritaire alimentaire chronique, dans un contexte daccsinsuffisant aux soins de sant de base et dhygine prcaire.Malgr ce contexte National, Le departement de Konni est nanmoins un carrefour avec sasituation gographique et la proximit avec le Nigria font de lui une plaque tournante et uncarrefour important entre louest (axe Niamey-Konni), le Nord (Agadez-Tahoua), lEst (axeDiffa-Zinder-Maradi) et le Sud (axe Konni-Sokoto au Nigrian).Cette position privilgie lui confere un niveau conomique meilleur que dautres

departements avec le commerce frontalier.Le Niveau danalphatisme lve denviron 83%6de la population pose une limitation alinformation et a la communication dans toutes les interventions au niveau communitaire.

1.22National Standards/Policies Regarding Maternal and Child health

The Niger health system has been engaged in the reduction of poverty and the promotion ofdevelopment in relationship to the Millennium Development Goals and National Health Plansreflect that engagement. Niger is currently validation the 2nd Cycle of a four Year HealthPlan 2011- 2015 that aims to contribute to the reduction of maternal and child mortality by

building on existing capacity to improve the efficiency and quality of the health system7.

Building on the national planning process, those involved in the ongoing decentralizationprocess have also developed five-year Regional and District Health Plans.

A Free Access Policy to Health care for Under five children and Pregnant women wasadopted by GON since 2007 that resulted in Increase Health Services Demand for these

age groups while Medical supplies and staffing still lacking.

In 2008 the Ministry of Health developed a National Child Survival Strategy which includesincreased access to health services through community-based management of malaria,

pneumonia and diarrhea. Furthermore, this new strategy promotes the increased availability ofcompetent personnel, an effective system of supplying essential drugs and equipment,

adequate logistics, strong supervision and a viable monitoring system as critical factors in asuccessful Child Survival Strategy.8

Niger Nutrition Directorate is currently reviewing for validation a New Nutrition Plan for theYears 2011-20159

4 http//www.ins.ne5http://hdrstats.undp.org/fr/pays/profils/NER.html6http://www.indexmundi.com/g/r.aspx?c=ng&v=39&l=fr

7 RN /Ministere de la SantPublique.Plan de Developpement Sanitaire du Niger adopt Janvier 2011.8 RN/Ministre de la Sant Publique.Avant-projet de Stratgie National de Survie de lEnfant, 2008 ; page 30.9 RN/Ministere de la Sant Publique.Plan National pour la Nutrition PNN 2011-2015
http://hdrstats.undp.org/fr/pays/profils/NER.htmlhttp://hdrstats.undp.org/fr/pays/profils/NER.htmlhttp://www.indexmundi.com/g/r.aspx?c=ng&v=39&l=frhttp://www.indexmundi.com/g/r.aspx?c=ng&v=39&l=frhttp://www.indexmundi.com/g/r.aspx?c=ng&v=39&l=frhttp://www.indexmundi.com/g/r.aspx?c=ng&v=39&l=frhttp://hdrstats.undp.org/fr/pays/profils/NER.html


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1.23The Child Survival Project

The goal of the Healthy Start Child Survival project is to reduce morbidity and mortality ratesof mothers and children under five years of age through strengthening community basedhealth care services and information;developing mechanisms to augment food security andfood availability for improved maternal and child nutrition; and, creating awareness of key

behaviors for health at the community and household level through capacity building of localprimary health care workers, committee members and local organizations.

The technical interventions focus on the leading causes of child mortality in the project zone:Maternal and New born care (30% level of effort); Nutrition (30%); of malaria (30% level ofeffort) and control of diarrhea diseases (20%).

The Intermediate Results (principal objectives) are: Increase the practice of selected emphasis behaviors for maternal/child survival; Ensure institutionalized sustainable MOH a0nd community support for community

health workers; Strengthen the capacity of communities and local/district health teams.

The activities for achieving the Strategic Objectives are organized into five TechnicalPackages/Sub-Objectives:

To increase access to, demand for, and use of quality maternal and child healthservices, including emergency care; in order to improved family behaviors related tomaternal and child health.

To improve case management of malaria at the community and health post levels;increase access to treatment for malaria; improve access and use of treated mosquito

nets; and to improve use of chemoprophylaxis (IPT) for malaria among pregnantwomen. To improve prevention and treatment of diarrheal disease among rural children under

five. Improve nutrition of women and children, through education and

household/community food security and nutrition activities. To improve the capacity of the Ministry of Health and local partner agencies, to plan,

implement, monitor and evaluate child survival interventions at the community anddistrict levels, with an emphasis on capacity in maternal and child health, nutrition,and household food security.

The Project Targeted Initially 90 villages in 2 phased coverage approach. The projectestablished 266 women care groups and support 50 Health posts. After the MTE, finallylimited its intervention area to 61 villages.

Baseline KPC and Health Facility Assessment and DIP workshop were performed in Januaryand February 2008.The Project used an adapted version of the care group model and training for health care

providers at the facility level that resulted according to the Mid Term Evaluation done inJanuary 2010 in an increased knowledge and practice around key child survival interventions,especially malaria prevention, improved nutrition, control of diarrheal disease, and increasedaccess to essential obstetric and neonatal care.Final KPC was implemented as part of the overall Final Evaluation Process in September.


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1.1 Objectives of the KPC Survey

The general objective of the survey was to inform Project Team , Local partners on stake onProject indicators. More specifically, the objectives of the study were:

1) To collect data on the Rapid CATCH indicators by : Assessing the knowledge and practice of mothers in selected technical

Packages (MNC, Nutrition , Diarrhea, malaria) Measuring nutritional status of children 0-23 months in the project Zone

1) To build the capacity of local staff of the project and partners to implement KPC surveys.

Indicators Selected by Technical Intervention Area (2006 Rapid Catch)

Maternal and Newborn Care: Percentage of mothers with children age 0-23 months who received at least two

Tetanus toxoid before the birth of the youngest childPercentage of children age 0-23 months whose births were attended by skilled

personnelPercentage of children age 0-23 months who received a post-natal visit from an

appropriately trained health worker within three days after birth

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

prior to the interview

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

Vitamin A SupplementationPercent of children age 6-23 months who received a dose of Vitamin A in the last 6

months: card verfied or mothers recall

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

vaccination card or mothers recall by the time of the surveyPercent of children aged 12-23 months who received DTP1 according to the

vaccination card or mothers recall by the time of the surveyPercent of children aged 12-23 months who received DTP3 according to the

vaccination card or mothers recall by the time of the survey

MalariaPercentage of children age 0-23 months with a febrile episode during the last two

weeks who were treated with an effective anti-malarial drug within 24 hours after thefever began

Percentage of children age 0-23 months who slept under an insecticide-treated bed net the previous night

Control of Diarrhea


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Percentage of children age 0-23 months with diarrhea in the last two weeks whoreceived oral rehydration solution (ORS) and/or recommended home fluids.

Acute Respiratory InfectionsPercentage of children age 0-23 months with chest-related cough and fast and/or

difficult breathing in the last two weeks who were taken to an appropriate health provider

Water and Sanitation Percentage of households of children age 0-23 months that treat water effectivelyPercentage of mothers of children age 0-23 months who lived in a household with soap

at the place for hand washing

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

weight for age, according to WHO/NCHS reference population)


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1 Methods

1.1 Partnership Building in the Survey preparation :

Dans le mois de Aout 2011 et en prparation a lenqute KPC de Septembre ,lEquipe duprojet a envoy des lettres de participation a la prparation et a la mise en uvre de lEnquteKPC. Ces structures sont :

La Mission USAID a Niamey La Direction Rgional8 de la sant publique de Tahoua Le District Sanitaire La Direction dpartemental de lAgriculture La Direction dpartement du Plan Les ONGS Mouviento Por La PAZ et Initiatives pour la scurisation des Mnages

(ISCV) de Konni

La Direction National de linformation sanitaire (DSSRE)

La Runion du Comit de Pilotage de lEnqute KPC sest tenue le 16-17 septembre en vuede passer en revue le niveau de prparation de lEnqute sur :

Revue des Termes de Rfrences de la formation des enquteurs,

Revue des drafts doutils de collecte des donnes adapts par lEquipe du projet

Aspects logistiques de lorganisation de lEnqute : Matriels et quipement ( toise et

Balance, Mdicaments, Moustiquaires), identification des enquteurs etc.

Ainsi les contributions des partenaires dans la collecte des ressources ncessaire a laralisation de cette enqute sont les suivants :

CONCERN Tahoua : Toise et BalanceDistrict Sanitaire de konni : Echantillon de Medicaments ( Paracetamol, Fer acid folique,Vitamine A, Zince , Sulfadoxine-Pyrimethamine, balance, Moustiquaires impregnes, etc) etun superviseurISCV :

Local et chaises pour la formation des enqueteurs

Datashow

Superviseur et Enqueteurs

Direction Departementale du Plan : Base des donnes demographiques

Superviseurs

En annexe les lettres dinvitations de ces structures ( USAID, DRSP, DS, MPDL)

1.1 Training and Capacity Building

Core Team Training

The core Team is composed of 6 persons: the Project Manager, Project TrainingCoordinator, Project M&E, the District Communition Officer, the Representative of theLocal Government Agricultural Office, the Representant of the Local GON Community

Development Office. The Core and the Child Survival Program staff worked on reviewingthe Survey plan. The agenda of the review included refresher session on KPC purpose and


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Methodology, review and adaptation of questionnaires and Training agenda and logistic andbudget arrangement to conduct the Training of Supervisors. The planning intervenes duringan ultimate Budget Revision process that significantly reduces provision of funds for the FinalEvaluation.The Budget Revision process delayed availability of project funds wire in country to start

implementation of the KPC that finally come to Mid Sept 2011.To accommodate the short time implementation of the Survey, the project management Teamdecided to recall Survey Trainers and Enumerators who participated in the Initial KPC survey.This could improve the quality of the Training and save time.Questionnaire:The scope of the survey and the development of the survey questions were focused on thefour intervention area of the project:

Maternal and newborn healthcare Control & treatment of malaria Control & treatment of diarrheal disease Nutrition/Food Security

The survey questionnaire was 87 questions in length excluding the anthropometrics. Theanthropometrics consisted of three measurements: height, weight, and MUAC (whereappropriate). The questionnaire was translated into French from the final English version.During the survey the French questionnaire was used as a guide for the verbalization of thesurvey into Hausa (the local language). Hausa translations of key words are included inannexe6

Training of Suveryors Trainer (TOST)From Sept 1617 2011, the Project Senior staff, Konni Health District and Local GovernmentTechnical Services Chief Officer trained five supervisors. 3 supervisors participated in theinitial KPC and all have some professional survey experience according to the Learning Needassessment. Agenda and content of TOST are in annexe2. It includes review of KPC general

purpose and sampling, review of questionnaire and logistics for conducting Surveyorstraining.An Adaptation of Key local language items of Initial KPC was done.Supervisors contributed insight into traditions and cultural issues that could impact surveyresults, and brainstormed solutions to overcome bias.

Training of SurveyorsRIs survey supervisors conducted a two-day training of 30 interviewers to prepare them forthe use of the questionnaire, anthropometric measurement equipment, and presentationsamples.

Since 50% of the Surveyors participated in the 2008 initial KPC, the supervisors involvedthem to participate to the rest of the interviewers. The teams of interviewers practicedcompleting the questionnaire in Konni town on the second training day.A list of highly experienced interviewers in anthropometrics was established to set up 5Teams for the Field data collection.The supervisors met with the program manager and the coordination Team at the end of eachday for feedback and to finalize plans for the survey implementation. The KPC survey wascollaborative effort of RI staff and local partners/stakeholders.Some of the constraints in making this Final KPC included the following:

Delay in start up and Limited funds to recruit more enumerators Limited timeline ( 2 days TOST, 2 days TOT and 5 days data collection)


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1.1 Study Population

2.4.1 Sample Size Calculation

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

method as initial survey. However given that the project initial KPC sampling was done onthe basis of the 453 villages of the whole district area, and that the project was finally able todevelop later its intervention only in 61 as results of MTE recommendation to limitintervention villages. There was a discussion on which sampling to use for the final KPC.Consultation and discussion with the Final Evaluation Consultant and the MCHIP Team andgiven the limited resources and time for the survey implementation, the basis of 61 villages isused to choose the 30 clusters.

2.4.2 Sampling Design

Steps Followed for Choosing 30 ClustersStep 1: A list of the 61 villages was used as the sampling frame for selection of cluster. The

population of the villages was provided by the Niger Bureau of Statistics. A master list withcumulative population totals was constructed including all villages.

Step 2: The total estimated population of the Project Zone (61 villages) is 83286 divided by30, giving a sampling interval of 2776. A start number of 3839 was randomly identifiedamong the last 4 Numbers of the serial Number of Niger 10000 CFA currency Lot.

Step 3: After the selection of the first cluster, the remaining 29 clusters were identified usingthe sampling interval.

1.1 Data Collection and Analysis

The survey team was divided in six teams. Each team was composed of 4 Interviewers, onemeasurer and one supervisor each team covered one cluster per day, filling out 12questionnaires. At the end of the data collection, a total of 360 questionnaires were filled out

by the interviewers.

The supervisors were responsible for the selection of the starting household and surveydirection. Each questionnaire was reviewed by a supervisor in the field. Each questionnairewas further reviewed each evening. This process was efficient to detect and report recurrenterrors to interviewers. Each team was supervised at least twice by a member of the Core team

engaged occasionally in the supervision of supervisor.


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The survey data was entered into Epi Info and checked for analysis. The data management iscomposed of one staff from the MOH HIS , one project M&E Staff and the Project Manager.

Due to the tight timeline to submit an Outline of the Interim by the Consultant andquestionnaire check remained incomplete and continued through the analysis phase.

Several back and forth on the questionnaires lead to a preliminary analysis of the PriorityRapid Cath Indicator.Analysis of one indicator revealed to be difficult to calculate to the Team: complementaryfeeding composite indicator.Disease data tables locked and were not accessible temporary for analysis. A specialassistance from Niger WHO Statistician was requested.As results, by September 30, the End of the Child Survival Official contracting period forProject Staff and therefore the core team of the Survey, IYCF indicators were missing.

2 months later in Dec 15, the Former child Survival Project was recalled by ReliefInternational-HQ to complete the analysis and the Report.

Challenges and Issues during the Survey Implementation:

Throughout the whole Survey Process, the Team worked under pressure of finalizing thewhole KPC survey and to assist the Consultant to do the qualitative assessment within 9 days

before the official End of the Project Contracting period. Despite the commitment of theSurvey Team, this working atmosphere has resulted in some biases worthy to mention here:

Data Collection phase:

Some Mothers Prenatal consultation cards were not filled even though childvaccination confirmed by the Village worker register and the Mother saying.

Weight for height Measurement was all done by a team of Six measurers, thereforemultiplying the risk of same measurer errors.

For children under 30 days (One month) too small to be weighed or sick, Weight wasreplaced by Birth weight in the Child Cards or replaced by same age children who wasknown either by recall or in the Child Health Card. The total replacement done wasabout. Thus could inflate Num of children less than one month age and toosmall to be measured some surveyor have reported either 0 Month or 1 month forChildren less that under 1 month or 1 month

Analysis:

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

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


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Result

Sommaire

1.1 Introduction..................................................................................................................1

1.2 Demographic Characteristics.......................................................................................1

1.3 Maternal and newborn care:.........................................................................................2

Table 9: Post Natal Check within 3 days for New born.........................................................4

1.4 Breastfeeding................................................................................................................4

1.5 Vitamin A Supplementation.........................................................................................5

1.6 Vaccinat ion:.................................................................................................................5

1.7 Malaria:........................................................................................................................7

1.8 Discussions and Recommendations............................................................................8

Discussions and Recommendations


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1.1 Introduction

This section presents the findings of the Final knowledge, attitude and coverage survey thatwas conducted in the Konni District, Niger. Findings are presented under the followingcategories; Demographics characteristics ,Maternal and newborn health, child spacing, breastfeeding, vitamin A supplementation, child immunization, malaria, control of diarrhea, Acute

Respiratory Infections, water and sanitation and Anthropometrics. This section also comparesbaseline with endline findings.

1.2 Demographic Characteristics

Table 1: Age of Children under 2 (n=358)

Age of children (n=300) Freq %

0 to 5 months 107 30

6 to 11 months 95 27

12 to 23 months 156 43

Total 358 100.0

Table 2: Sex of Children under 2 (n=358)

Sex of children (n=358) Freq %

Female 137 45.7

Male 163 54.3

Total 358 100.0

1.3 Maternal and newborn care:

Table 5: Health Center/Home Delivery

Freq %

Health Center 213 59,7

Home 144 40,3

Total 357 100,0

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

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


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*within this group, 4 responses were categorized as auxiliaire and the cross checkon where this staff exist shows that they are in Health Centers. This could be relatedto Health post workers ( HPw) who temporarily work in Integrated Health Centers( CSI) during the Frequent absence of the Chief CSI nurse in the majority of Healthcenters staffed by only one or 2 nurses.

The Catch indicator includes Health post worker as qualified Personnel since theywere trained by Project in Clean Delivery. Some of this HPW are nurses but may notbe known as such by respondents.

There almost 40% of delivery still attended by TBA (Matrons) even though they arenot considered as skilled personnel. The project has devoted considerable time in thesensitization to teach to TBA in their new role of companion to delivery .

Table 6: Home delivery By TBA

HomedeliveryTBA Frequency PercentYes 67 47,2%

No 75

Total 142 100,0%

95% Conf Limits

Yes 38,8% 55,7%

No 44,3% 61,2%

Comments:when we cross where do the Birth assisted by matrons took, we find that only half ofthem were at Home, 50% of these Births assisted by TBA( 75/142) occurred inHealth Centers. This is well know practices particularly in CSI and District Hospitalwhere matrons are still used for night shift under Midwife supervision. Officiallymatrons are expected even in those centers to only accompany Parturient to Maternityand help the women in post partum wards. But the reality is that matrons continue toassist delivery when the Midwife actually went to rest during night guards.

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

Person who assisted Freq %

Doctor/ Nurse/Midwife 161 45

HP worker 28 8

Traditional birth attendant 140 40

Other 25*Not assisted 2

Total 358 100.0


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

baseline KPC

Table 8: Post Natal check for Mother within first week

When did the Check take place ? Frequency Percent

Hour 1 159 79,1%

Day 1 19 9,5%

Week1 3 1,5%

Do not Know 20 10,0%

Total 201 100,0%

95% Conf Limits

Hours72,8%

84,5%

Day1 5,8% 14,4%

Do not Know 6,2% 14,9%

Week 1 0,3% 4,3%

88% (178/201) of mothers who delivered in Health Centers had a post natal check within thefirst week and 80% of them had the check within the day after delivery. The total number ofthe respondents matches with 213 who delivered in Health Center.Only 29 mothers were able to identify the Health personnel who performed the Check. Half ofthem (51%) were done by Health post Worker. 4 checks done by midwifes and 2 by Doctors.It appears clearly that Doctor and Midwife are most recognizable or may be morecommunicative (?) Than Nurses and Health Post worker, since the number of deliveriesassisted by Midwife and Doctors are the same for the post natal checks.

Was a Clean Delivery Kitused during delivery?

Freq %

Yes 272 76

No 84 23

Do Not Know 2 1Total 358 100.0


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

Freq PercentYes 34 54,0%No 29 46,0%

Total 63 100,0%

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

1.4 Breastfeeding

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

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

higher than baseline rate.

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

Exclusive Breastfeeding is one of the most cost effective interventions in child survivalproject especially in developing countries. The Guidelines recommend that a child is notgiven any other feeds than breast milk until 6 month except medicine. The findings showed a72% of children under 6 month exclusively Breast feed. This is a significant increasecompared to baseline value of 36%.

1.5 Vitamin A Supplementation

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

Time Freq %

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

Did not Know 6 2.7

Total 358 100.0

Type of feeding Freq %EBF 77 72

Breastmilk and water 9* 8.4


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

1.6 Vaccination:

Table 13: Health Card/vaccination possessionDo you have a card where your childs

vaccinations are written down?Freq %

Yes,seen by theSurveyor

273 76,3

Do not Know 1 ,3

Not availalbe 68 19,0

Never had a Card 16 4,5

Total 358 100,0

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

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

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

Table 15: Children who received Vit A (Most Recent Dose, children 6-23, cardseen by enumerator)

Received Vit A (at least once) Freq %Yes 184 74

No 62 25

Did not know 4 1

Blank 1 0

Total 251 100.0

Freq %Penta 1 94 78

Penta3 49 41


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This result is obtained from a cross table of Q44 (did the child receive a single dose ofVitamin A with the last 6 month) and Q45 ( do the mother possess a vaccinationcard?) as indicated in the KPC 2000Tabulation guide .The 65 responses categorizedas NA includes children 8-23 month who either have the card and not available(n=50) or never possess a vaccination card (n= 11) or 1 mother was not clear whethershe possessed a card or not and therefore classified as No. If the we calculate the

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

In contrary when we calculate the proportion of children who possessed a vaccinationcard in which is mentioned that the child has received a Vitamin A dose either the date

is or not found; the percentage will drop to 11% only.

Table 16: children with BCG

Receive BCG? Freq %

Valide Yes 236 66

NON 32 8,9

NS 90* 24.1

Total 358 100,0

66% of children were reported to have received BCG. In infant less than 12 month 70%( 137/202) had the BCG. Pending the incertainty of the 26% of Non specified responses ineither baseline and endline survey, this proportion is lower than the 71% (166/234) weighedat baseline.

63% (99/156) in children 12-23month had the BCG.when compared to 2010 National ChildSurvival Survey who found 72% for Tahoua Region, Konni district declines in BCG

coverage. In fact, Konni District has one the lowest vaccination coverage with recurrentoutbreaks of

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

Freq %Yes 140 56

No 46 19

NA 65* 25

Total 251 100.0


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The percentage of children who had measles vaccination is calculated among children 9-23.

51% of them had the vaccination. The percentage remains the same when it is calculatedamong children 12-23mth ( 52%= 78/151)

1.1 Malaria:

Table 18: Children who had Malaria and received appropriate Treatment

59% (212/358) of the children had fever in the last 2 weeks prior the survey and 68% of themwere treated with appropriate anti malarial ( ACT, Fansidar, Chloro and amodiaquine) within24h of the onset of the fever. This is a moderate decrease in the prevalence of malaria from2008 KPC (64%) but access to the treatment has been significantly improved from 17.5% in2008. Coexistence of reported high prevalence of malaria cases and ITNS alleged used insurvey in a National pattern known in Niger by Both small scale project and the NationalMalaria Program. Possible reason to look at in further investigation are the time people startusing the ITN at night time and issues pertaining to drug resistance because even though the

National policy has adopted since 2008 use of combined Artemisin drugs, Choloroquine,amodiaquine are still be used as first line therapy mostly by Ambulant Pharmacist.

Received VAR? Freq %

Yes 94 51%No 48 23%Do not Know 40* 26%

Total 189 100.0

Freq %Yes 144 68%No 72 32%Do not Know

Total 212 100.0


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1.2 Discussions and Recommendations

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

1.2.1 Maternal and Newborn

On Mother Child Protection against Tetanos indicator, the endline findings has shown thata higher proportion (81% vs 28.8% at baseline) of mothers with children 0-23 who receivedat least 2 doses of Tetanus Toxoid vaccine before the birth of their youngest child. This ishigher than the 62.1% found by the 2010 Child Survival National Survey[1] for the Region

of Tahoua.(Statistique, Juin 2010).Increase in TT is generally related in improved attendance of Antenatal Consultation bywomen. Despite several stock out of vaccines recorded during the four year implementationof the child survival project, the Policy of Free care access to Mother and child care decreed

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

better correlation of completion of ANC/TT visits and birth in health facility than the NationalChild Survey of 2010 who showed that despite a significant increase of Antenatal visits (55%

in Tahoua Region where the project is located), deliveries in Health facility remained low(31%). Among the 60% of pregnant women who gave birth in Health Centers, 52% of thedeliveries were attended by skilled personnel against 26.4% at the project start up.MOH indicator do not account though among skilled personnel Health post Worker who arenot Nurse. This accounts for almost 60% of all the Health workers in the 60 HP of Konni.76% of the deliveries performed in these facilities used a clean Birth Kit compared to 20%reported in the Initial KPC.

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

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

1.2.2 Infant and Yang Child Feeding

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

the increase between 2008baseline/end line (36/72) and National Survey (13/26.9) during thesame period.


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National survey cluster representatively is limited of the Tahoua Region where Konni is oneof the 7 Health Districts.The Survey supported semi -quantitative observations done by the MTE Evaluation thatBreastfeeding has significantly increased in the project area.Complementary Feeding: ( to be completed after indicator calculation)

On Brezs

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

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

1.3 Child Immunization:

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

but rather decline for BCG ( 72% vs 66%). These all antigens vaccination were still low . asconsequences the project has reported annual outbreaks(International, Oct 31 2008) .District has repeatedly reported stocks out in vaccine ()during the annual Health planevaluation. It is important to note however the rates were higher that the Endline projectedtargets for these antigens ( 40%)(International, March 2010)

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

1.4 . Prevention and treatment of childhood illness:

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

doubled ( 76% vs 40%) and more for effective treatment of fever ( 17.5% vs 68%). Dispite several stock outs noted during the project course ((International, March2010), the project BCC effort and increased availability of ITN in the communities may havecontributed to this results.. Furthermore The MTE Evaluation showed that the project has

been to educate communities in the use of ITN beyond the rainy season.

Diarrhea has been one of the major causes of morbidity and mortality among children and theuse of ORS is one treatment used to manage the disease. The end line survey noted animprovement in the use of ORS among children aged 0-23 months to control diarrhea ( 50%vs. 17.5%) . this result would have been better if the project has been able to distribute ORS

through the care group volunteers. Access to ORS was only limited to consulting mothers atthe Health post.


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The endline survey identified an improvement in health seeking behavior among mothers withchildren aged 0-23 months as evidenced by increased use of appropriate health provider tomanage cough and fast and/or difficult breathing of children aged 0-23 months from baselinefindings (44% vs 18.2%). Even though ARI treatment is not a priority intervention of theKonni.

Improvement of case management has been promoted through capacity building of Healthpost worker in C-IMCI and better linkages for referral through care group mobilization.

1.5 . Point of use

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

packages and hand washing was introduced at Year 2 and did not benefit as muchsensitization time as MNC or Breastfeeding. Second, placement of soap at POU is highlycultural dependant. soap is mostly in the bathing area and prayer ablution Kettle used mostlyfor handwashing in the project is not culturally associated with using soap. also, soap iscostly and cannot be exposed outside because of birds, hens or domestic animal that tend todisplace it or be in a container where it could easily dilute. The project has trained at the lastquarter of implementation period ( april-May-june) for few women volunteers to producelocally soap. there is however a need to create a mechanism of expanding the production inthe project area but this is a an outcome that could be seen within the current phase of this

project.

1.6 .Nutritional status of children

The study found that 44

The national nutrition policy for Malawi indicates that 21% of children under five years oldare underweight. The baseline findings noted that 28% were underweight while the endlinesurvey noted that 16% were underweight. This shows that the nutrition status for children hasimproved in the district.


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Annexe:

Q15:Did you ever breastfeed your child?

Effectifs Pourcentage

Pourcentage valide

Pourcentage cumul

Valide NON 4 1,1 1,1 1,1

OUI 354 98,9 98,9 100,0

Total 358 100,0 100,0

Q16:How long after birth did you first put your child to the breast?


Pourcentag

e valide

Pourcentag

e cumulValide HEURE 80 22,3 22,3 22,3

IMMEDIATEMENT 259 72,3 72,3 94,7

JOURS 13 3,6 3,6 98,3

NSP 6 1,7 1,7 100,0

Total 358 100,0 100,0

Q17:During the first three or four days after delivery, before your regular milk beganflowing, did you give your child the liquid (colostrum) that came from your breast?


Pourcentage valide

Pourcentage cumul

Valide NON 18 5,0 5,0 5,0

OUI 340 95,0 95,0 100,0


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Total 358 100,0 100,0

Q18: In the first three days after delivery, was your child given anything to drink otherthan breast milk?


Pourcentage valide

Pourcentage cumul

Valide NON 302 84,4 84,4 84,4

OUI 56 15,6 15,6 100,0

Total 358 100,0 100,0

Q16:How long after birth did you first put your child to thebreast?

Effectifs

Pourcentage

Pourcentage valide

Pourcentage cumul

Valide

HEURE 80 22,3 22,3 22,3

IMMEDIATEMENT

259 72,3 72,3 94,7

JOURS 13 3,6 3,6 98,3

NSP 6 1,7 1,7 100,0

Total 358 100,0 100,0

Q44:

tr_age Effectifs

Pourcentage

Pourcentagevalide

Pourcentagecumul

1 Valide NON 25 23,4 23,4 23,4

OUI 82 76,6 76,6 100,0

Total 107 100,0 100,0

2 Valide NON 63 25,1 25,1 25,1

NSP 4 1,6 1,6 26,7

OUI 184 73,3 73,3 100,0

Total 251 100,0 100,0

Forward

VITAMINEA Frequency PercentCum Percent

40241 1 3,6% 3,6%

40387 1 3,6% 7,1%

40494 1 3,6% 10,7%

40538 1 3,6% 14,3%

40559 1 3,6% 17,9%

40570 1 3,6% 21,4%

40596 1 3,6% 25,0%

40608 1 3,6% 28,6%

40617 1 3,6% 32,1%40624 1 3,6% 35,7%


29/39

40628 1 3,6% 39,3%

40647 1 3,6% 42,9%

40659 1 3,6% 46,4%

40663 2 7,1% 53,6%

40681 1 3,6% 57,1%

40697 1 3,6% 60,7%

40717 1 3,6% 64,3%

40718 1 3,6% 67,9%

40721 1 3,6% 71,4%

40756 1 3,6% 75,0%

40768 1 3,6% 78,6%

40779 1 3,6% 82,1%

40783 1 3,6% 85,7%

47484 3 10,7% 96,4%

146099 1 3,6% 100,0%Total 28 100,0% 100,0%

95% Conf Limits

40241 0,1% 18,3%

40387 0,1% 18,3%

40494 0,1% 18,3%

40538 0,1% 18,3%

40559 0,1% 18,3%

40570 0,1% 18,3%

40596 0,1% 18,3%

40608 0,1% 18,3%

40617 0,1% 18,3%

40624 0,1% 18,3%

40628 0,1% 18,3%

40647 0,1% 18,3%

40659 0,1% 18,3%

40663 0,9% 23,5%

40681 0,1% 18,3%

40697 0,1% 18,3%

40717 0,1% 18,3%

40718 0,1% 18,3%

40721 0,1% 18,3%

40756 0,1% 18,3%

40768 0,1% 18,3%

40779 0,1% 18,3%

40783 0,1% 18,3%

47484 2,3% 28,2%

146099 0,1% 18,3%

Previous Dataset Results Library
http://c//Users//Relief2//Desktop//Evaluation%20finale%20sept%202011full//Data%20analysis//OUT73.htmhttp://c/Users/Relief2/Desktop/Evaluation%20finale%20sept%202011full/Data%20analysis/IResults.htmhttp://c//Users//Relief2//Desktop//Evaluation%20finale%20sept%202011full//Data%20analysis//OUT73.htmhttp://c/Users/Relief2/Desktop/Evaluation%20finale%20sept%202011full/Data%20analysis/IResults.htm


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1.6.1.1 FREQ Q44

Next Procedure

Forward

Q44 FrequencyPercentCum Percent

NON 62 24,8% 24,8%

NSP 4 1,6% 26,4%

OUI 184 73,6% 100,0%

Total 250 100,0% 100,0%

95% Conf Limits

NON 19,6% 30,6%

NSP 0,4% 4,0%

OUI 67,7% 79,0%

Previous Dataset Results Library

1.6.1.2 TABLES VITAMINEA Q44

Next Procedure

Forward
http://c//Users//Relief2//Desktop//Evaluation%20finale%20sept%202011full//Data%20analysis//OUT73.htmhttp://c/Users/Relief2/Desktop/Evaluation%20finale%20sept%202011full/Data%20analysis/IResults.htmhttp://c//Users//Relief2//Desktop//Evaluation%20finale%20sept%202011full//Data%20analysis//OUT73.htmhttp://c//Users//Relief2//Desktop//Evaluation%20finale%20sept%202011full//Data%20analysis//OUT73.htmhttp://c/Users/Relief2/Desktop/Evaluation%20finale%20sept%202011full/Data%20analysis/IResults.htmhttp://c//Users//Relief2//Desktop//Evaluation%20finale%20sept%202011full//Data%20analysis//OUT73.htm


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1.6.1.3 Single TableAnalysis

Chi-square

df Probability

28,0000 24 0,2600

An expected value is < 5.Chi-square not valid.

Tab: ExclusiveBreastfeeding

Exclusive Breasfeeding bf

Total1 2 3 4 5

tr_age 1 Effectif 92 0 9 6 0 107

% comprisdans tr_age

86,0% ,0% 8,4% 5,6% ,0% 100,0%

% comprisdans bf

29,5% ,0% 34,6% 40,0% ,0% 29,9%

% du total 25,7% ,0% 2,5% 1,7% ,0% 29,9%

2 Effectif 220 3 17 9 2 251

% comprisdans tr_age

87,6% 1,2% 6,8% 3,6% ,8% 100,0%

% comprisdans bf

70,5% 100,0% 65,4% 60,0% 100,0% 70,1%

% du total 61,5% ,8% 4,7% 2,5% ,6% 70,1%

:\Users\Relief2\Desktop\KPC report ne\Ali Results Dec26\ClasseurfullrecombinedHMdec27.xls:Feuil1$

Select: (Q45 = "Oui, vu par l'enqueteur" ) AND (Age >11 )

Record Count:120 Date:31/12/2011 18:02:44

Q44

VITAMINEA NON OUI TOTAL

40241Row %Col %

00,00,0

1100,0

3,8

1100,0

3,6

40387Row %Col %

00,00,0

1100,0

3,8

1100,0

3,6

40494Row %Col %

00,00,0

1100,0

3,8

1100,0

3,6

40538Row %Col %

00,00,0

1100,0

3,8

1100,0

3,6

40559Row %Col %

00,00,0

1100,0

3,8

1100,0

3,6

40570Row %Col %

00,00,0

1100,0

3,8

1100,0

3,6

40596Row %Col %

00,00,0

1100,0

3,8

1100,0

3,6

40608Row %Col %

1100,0

50,0

00,00,0

1100,0

3,6

40617Row %Col %

00,00,0

1100,0

3,8

1100,0

3,6

40624Row %Col %

00,00,0

1100,0

3,8

1100,0

3,6

40628Row %Col %

00,00,0

1100,0

3,8

1100,0

3,6

40647Row %

Col %

00,0

0,0

1100,0

3,8

1100,0

3,640659

Row %Col %

00,00,0

1100,0

3,8

1100,0

3,6

40663Row %Col %

00,00,0

2100,0

7,7

2100,0

7,1

40681Row %Col %

00,00,0

1100,0

3,8

1100,0

3,6

40697Row %Col %

00,00,0

1100,03,8

1100,03,6


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1.6.1.4 FREQ DTC1Penta1 DTC3Penta3

Next ProcedureDTC1Penta1DTC3Penta3

1.6.1.5 DTC1Penta1

Forward

DTC1Penta1 FrequencyPercent Cum Percent

22/05/2001 1 1,1% 1,1%

28/12/2009 1 1,1% 2,1%

24/02/2010 2 2,1% 4,3%

15/03/2010 1 1,1% 5,3%

26/03/2010 1 1,1% 6,4%

09/04/2010 1 1,1% 7,4%

21/04/2010 1 1,1% 8,5%

23/04/2010 1 1,1% 9,6%

24/04/2010 1 1,1% 10,6%

27/04/2010 1 1,1% 11,7%

05/06/2010 1 1,1% 12,8%

21/06/2010 1 1,1% 13,8%

27/06/2010 1 1,1% 14,9%

16/07/2010 1 1,1% 16,0%

29/07/2010 3 3,2% 19,1%

26/08/2010 1 1,1% 20,2%

03/09/2010 1 1,1% 21,3%

05/09/2010 1 1,1% 22,3%

08/09/2010 1 1,1% 23,4%

22/09/2010 1 1,1% 24,5%

23/09/2010 1 1,1% 25,5%

24/09/2010 1 1,1% 26,6%

11/10/2010 1 1,1% 27,7%

23/10/2010 1 1,1% 28,7%

23/11/2010 1 1,1% 29,8%25/11/2010 1 1,1% 30,9%

06/12/2010 1 1,1% 31,9%

08/12/2010 1 1,1% 33,0%

22/12/2010 1 1,1% 34,0%

05/01/2011 1 1,1% 35,1%

07/01/2011 1 1,1% 36,2%

15/01/2011 1 1,1% 37,2%

20/01/2011 1 1,1% 38,3%

22/01/2011 1 1,1% 39,4%

24/01/2011 1 1,1% 40,4%25/01/2011 1 1,1% 41,5%


33/39

15/02/2011 1 1,1% 42,6%

21/02/2011 1 1,1% 43,6%

26/02/2011 1 1,1% 44,7%

14/03/2011 1 1,1% 45,7%

29/03/2011 1 1,1% 46,8%

13/04/2011 1 1,1% 47,9%

21/04/2011 1 1,1% 48,9%

25/04/2011 1 1,1% 50,0%

30/04/2011 5 5,3% 55,3%

02/05/2011 1 1,1% 56,4%

11/05/2011 1 1,1% 57,4%

12/05/2011 1 1,1% 58,5%

18/05/2011 1 1,1% 59,6%

26/05/2011 1 1,1% 60,6%

27/05/2011 1 1,1% 61,7%28/05/2011 1 1,1% 62,8%

30/05/2011 1 1,1% 63,8%

31/05/2011 1 1,1% 64,9%

03/06/2011 4 4,3% 69,1%

05/06/2011 2 2,1% 71,3%

21/06/2011 1 1,1% 72,3%

22/06/2011 1 1,1% 73,4%

23/06/2011 1 1,1% 74,5%

24/06/2011 3 3,2% 77,7%

25/06/2011 2 2,1% 79,8%26/06/2011 1 1,1% 80,9%

28/06/2011 2 2,1% 83,0%

30/06/2011 1 1,1% 84,0%

04/07/2011 1 1,1% 85,1%

17/07/2011 2 2,1% 87,2%

22/07/2011 1 1,1% 88,3%

29/07/2011 1 1,1% 89,4%

10/08/2011 1 1,1% 90,4%

17/08/2011 1 1,1% 91,5%

28/08/2011 1 1,1% 92,6%

12/09/2011 1 1,1% 93,6%

13/09/2011 1 1,1% 94,7%

20/09/2011 1 1,1% 95,7%

28/10/2011 1 1,1% 96,8%

26/11/2011 1 1,1% 97,9%

03/09/2019 1 1,1% 98,9%

01/01/2030 1 1,1% 100,0%

Total 94 100,0% 100,0%

95% Conf Limits


34/39

22/05/2001 0,0% 5,8%

28/12/2009 0,0% 5,8%

24/02/2010 0,3% 7,5%

15/03/2010 0,0% 5,8%

26/03/2010 0,0% 5,8%

09/04/2010 0,0% 5,8%

21/04/2010 0,0% 5,8%

23/04/2010 0,0% 5,8%

24/04/2010 0,0% 5,8%

27/04/2010 0,0% 5,8%

05/06/2010 0,0% 5,8%

21/06/2010 0,0% 5,8%

27/06/2010 0,0% 5,8%

16/07/2010 0,0% 5,8%

29/07/2010 0,7% 9,0%

26/08/2010 0,0% 5,8%03/09/2010 0,0% 5,8%

05/09/2010 0,0% 5,8%

08/09/2010 0,0% 5,8%

22/09/2010 0,0% 5,8%

23/09/2010 0,0% 5,8%

24/09/2010 0,0% 5,8%

11/10/2010 0,0% 5,8%

23/10/2010 0,0% 5,8%

23/11/2010 0,0% 5,8%

25/11/2010 0,0% 5,8%06/12/2010 0,0% 5,8%

08/12/2010 0,0% 5,8%

22/12/2010 0,0% 5,8%

05/01/2011 0,0% 5,8%

07/01/2011 0,0% 5,8%

15/01/2011 0,0% 5,8%

20/01/2011 0,0% 5,8%

22/01/2011 0,0% 5,8%

24/01/2011 0,0% 5,8%

25/01/2011 0,0% 5,8%15/02/2011 0,0% 5,8%

21/02/2011 0,0% 5,8%

26/02/2011 0,0% 5,8%

14/03/2011 0,0% 5,8%

29/03/2011 0,0% 5,8%

13/04/2011 0,0% 5,8%

21/04/2011 0,0% 5,8%

25/04/2011 0,0% 5,8%

30/04/2011 1,7% 12,0%

02/05/2011 0,0% 5,8%11/05/2011 0,0% 5,8%


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12/05/2011 0,0% 5,8%

18/05/2011 0,0% 5,8%

26/05/2011 0,0% 5,8%

27/05/2011 0,0% 5,8%

28/05/2011 0,0% 5,8%

30/05/2011 0,0% 5,8%

31/05/2011 0,0% 5,8%

03/06/2011 1,2% 10,5%

05/06/2011 0,3% 7,5%

21/06/2011 0,0% 5,8%

22/06/2011 0,0% 5,8%

23/06/2011 0,0% 5,8%

24/06/2011 0,7% 9,0%

25/06/2011 0,3% 7,5%

26/06/2011 0,0% 5,8%

28/06/2011 0,3% 7,5%30/06/2011 0,0% 5,8%

04/07/2011 0,0% 5,8%

17/07/2011 0,3% 7,5%

22/07/2011 0,0% 5,8%

29/07/2011 0,0% 5,8%

10/08/2011 0,0% 5,8%

17/08/2011 0,0% 5,8%

28/08/2011 0,0% 5,8%

12/09/2011 0,0% 5,8%

13/09/2011 0,0% 5,8%20/09/2011 0,0% 5,8%

28/10/2011 0,0% 5,8%

26/11/2011 0,0% 5,8%

03/09/2019 0,0% 5,8%

01/01/2030 0,0% 5,8%

1.6.1.6 DTC3Penta3

Back Forward Current Procedure

DTC3Penta3 FrequencyPercent Cum Percent

24/04/2010 1 2,0% 2,0%

10/05/2010 1 2,0% 4,1%

22/06/2010 1 2,0% 6,1%

24/06/2010 1 2,0% 8,2%

21/08/2010 1 2,0% 10,2%

27/08/2010 1 2,0% 12,2%

09/09/2010 1 2,0% 14,3%

19/10/2010 1 2,0% 16,3%10/11/2010 1 2,0% 18,4%


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11/11/2010 1 2,0% 20,4%

07/12/2010 1 2,0% 22,4%

20/12/2010 1 2,0% 24,5%

14/01/2011 2 4,1% 28,6%

15/02/2011 1 2,0% 30,6%

21/02/2011 1 2,0% 32,7%

23/02/2011 1 2,0% 34,7%

09/03/2011 1 2,0% 36,7%

15/03/2011 1 2,0% 38,8%

22/03/2011 1 2,0% 40,8%

25/03/2011 1 2,0% 42,9%

18/04/2011 1 2,0% 44,9%

15/05/2011 1 2,0% 46,9%

18/05/2011 1 2,0% 49,0%

03/06/2011 2 4,1% 53,1%04/06/2011 2 4,1% 57,1%

20/06/2011 1 2,0% 59,2%

29/06/2011 1 2,0% 61,2%

05/07/2011 1 2,0% 63,3%

12/07/2011 1 2,0% 65,3%

15/07/2011 1 2,0% 67,3%

20/07/2011 1 2,0% 69,4%

25/07/2011 1 2,0% 71,4%

26/07/2011 1 2,0% 73,5%

29/07/2011 2 4,1% 77,6%31/07/2011 1 2,0% 79,6%

13/08/2011 1 2,0% 81,6%

27/08/2011 1 2,0% 83,7%

28/08/2011 2 4,1% 87,8%

09/09/2011 1 2,0% 89,8%

18/09/2011 1 2,0% 91,8%

11/10/2011 1 2,0% 93,9%

02/11/2011 1 2,0% 95,9%

14/11/2011 1 2,0% 98,0%

22/11/2011 1 2,0% 100,0%

Total 49 100,0% 100,0%

95% Conf Limits

24/04/2010 0,1% 10,9%

10/05/2010 0,1% 10,9%

22/06/2010 0,1% 10,9%

24/06/2010 0,1% 10,9%

21/08/2010 0,1% 10,9%

27/08/2010 0,1% 10,9%09/09/2010 0,1% 10,9%


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19/10/2010 0,1% 10,9%

10/11/2010 0,1% 10,9%

11/11/2010 0,1% 10,9%

07/12/2010 0,1% 10,9%

20/12/2010 0,1% 10,9%

14/01/2011 0,5% 14,0%

15/02/2011 0,1% 10,9%

21/02/2011 0,1% 10,9%

23/02/2011 0,1% 10,9%

09/03/2011 0,1% 10,9%

15/03/2011 0,1% 10,9%

22/03/2011 0,1% 10,9%

25/03/2011 0,1% 10,9%

18/04/2011 0,1% 10,9%

15/05/2011 0,1% 10,9%

18/05/2011 0,1% 10,9%03/06/2011 0,5% 14,0%

04/06/2011 0,5% 14,0%

20/06/2011 0,1% 10,9%

29/06/2011 0,1% 10,9%

05/07/2011 0,1% 10,9%

12/07/2011 0,1% 10,9%

15/07/2011 0,1% 10,9%

20/07/2011 0,1% 10,9%

25/07/2011 0,1% 10,9%

26/07/2011 0,1% 10,9%29/07/2011 0,5% 14,0%

31/07/2011 0,1% 10,9%

13/08/2011 0,1% 10,9%

27/08/2011 0,1% 10,9%

28/08/2011 0,5% 14,0%

09/09/2011 0,1% 10,9%

18/09/2011 0,1% 10,9%

11/10/2011 0,1% 10,9%

02/11/2011 0,1% 10,9%

14/11/2011 0,1% 10,9%22/11/2011 0,1% 10,9%

Select age>11, freq

Recevoir_VAR FrequencyPercentCum Percent

NON 37 32,2% 32,2%

OUI 78 67,8% 100,0%


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Total 115 100,0% 100,0%

Next Procedure

Forward

Recevoir_VAR FrequencyPercentCum PercentNON 43 31,4% 31,4%

OUI 94 68,6% 100,0%

Total 137 100,0% 100,0%

95% Conf Limits

NON 23,7% 39,9%

OUI 60,1% 76,3%

Next Procedure

Forward

Recevoir_VAR FrequencyPercentCum Percent

NON 37 32,2% 32,2%

OUI 78 67,8% 100,0%

Total 115 100,0% 100,0%

95% Conf Limits

NON 23,8% 41,5%

OUI 58,5% 76,2%

Bibliograhy :

1. RN/Institut National de la Statistique :Equete Survie de lEnfant Juin 2010

2. RN/ District Sanitaire konni : Plan de Developpeemnt Sanitaire 2012-2016

3. RN/ Institut National de la statistique : Enquete Nutrition Juin 2011

4. Population Niger 2011: http//www.ins.ne

5. Classement Niger:http://hdrstats.undp.org/fr/pays/profils/NER.html6. Indicateur s Education Niger:http://www.indexmundi.com/g/r.aspx?c=ng&v=39&l=fr7. RN /Ministere de la SantPublique.Plan de Developpement Sanitaire du Niger adopt Janvier 2011.8. RN/Ministre de la Sant Publique.Avant-projet de Stratgie National de Survie de lEnfant, 2008 ;

page 30.9. RN/Ministere de la Sant Publique.Plan National pour la Nutrition PNN 2011-2015

10. USAID/GH/HIDN/Child Survival and Health Grants ProgramTRM

MATERNAL AND NEWBORN CARE2009

11. USAID/GH/HIDN/Child Survival and Health Grants ProgramTRMDiarrheal

Disease Prevention and Control-2010

12. USAID/GH/HIDN/Child Survival and Health Grants ProgramTRMMalaria

2009
http://hdrstats.undp.org/fr/pays/profils/NER.htmlhttp://hdrstats.undp.org/fr/pays/profils/NER.htmlhttp://www.indexmundi.com/g/r.aspx?c=ng&v=39&l=frhttp://www.indexmundi.com/g/r.aspx?c=ng&v=39&l=frhttp://www.indexmundi.com/g/r.aspx?c=ng&v=39&l=frhttp://hdrstats.undp.org/fr/pays/profils/NER.htmlhttp://www.indexmundi.com/g/r.aspx?c=ng&v=39&l=fr


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

sampling Issues for KPC surveys. Available at CSTS Web site

(www.childsurvival.com) under KPC2000+.

14. USAID/Core group: KPC 2000 plus Field Guide

15. USAID/CSHGP: Final Evaluation Guidelines May 2011

16.NigerStats;http ://hdrstats.undp.org/en/countries/profiles/NER.html17. Relief International: Child Survival Annual Report FY07-08 Oct 31 2008

18. Relief International: Child Survival Mid Term Evaluation Mars 2010

19.
http://www.childsurvival.com/http://www.childsurvival.com/

report compiled draft1hm jan 4

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