kpc report v2 hm reviewed jan 14
TRANSCRIPT
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ANNEX X. FINAL KPC REPORT
FINAL SURVEYREPORT: KNOWLEDGE
PRACTICE ANDCOVERAGE
Healthy Start Child Survival ProjectKonni Department, Relief International
Niger
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Niger
ACKNOWLEDGEMENTS
The author of this report, Dr. Mahaman Hallarou of Relief International (RI), 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; MOH
Supervisor Abuzeidi Chahabou; District Administrator Suleymane Issaka; Health Supervisor
Abuzeidi Chahabou; Konni Statistics Department Supervisor Alio Nahantchi, Mouviento Por La
Paz Medical Officer Dr. Soumana Oumarou; and Initiative for Secure Households Supervisor
Sangar; survey personnel listed in Appendix 1; Meredith Chang of the USAID-Child Survival
and Health Grants Program (CSHGP); and Paulin Ntawangundi of RI.
Thanks are also due to the USAIDCSHGP, which funded the implementation of the survey.
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TABLE OF CONTENTS
ACKNOWLEDGEMENTS.........................................................................................................1
EXECUTIVE SUMMARY.........................................................................................................5
1. BACKGROUND.....................................................................................................................6
1.1. Project location.................................................................................................................6
1.2. Characteristics of the target beneficiary population.........................................................6
1.3 Health, social and economic conditions in the project area...............................................7
1.4. National standards and policies regarding maternal and child health..............................8
1.5. Overview of the Healthy Start Child Survival Project.....................................................8
2. PROCESS AND PARTNERSHIP BUILDING....................................................................10
2.1. Steering Committee collaboration..................................................................................10
3. METHODS............................................................................................................................10
3.1. Questionnaire..................................................................................................................10
3.2. KPC indicators................................................................................................................11
3.3. Sampling design..............................................................................................................12
3.4. Training...........................................................................................................................13
3.5. Data collection................................................................................................................14
3 6 Data analysis 14
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5.1. Key findings and programmatic implications.................................................................23
6. CONCLUSION......................................................................................................................27
7. BIBLIOGRAPHY..................................................................................................................28
Appendix 1. Survey personnel...................................................................................................29
Appendix 2. Maps of Niger and Konni District........................................................................31
Appendix 3. Survey Steering Committee invitation letter.........................................................32
Appendix 4. Questionnaire (English)........................................................................................33
Appendix 5. Questionnaire (French).........................................................................................51
Appendix 6. English-French-Haussa translations of key survey words....................................68
Appendix 7. Population list of communities.............................................................................69
Appendix 8. Budget...................................................................................................................71
Appendix 9. Training of Trainers agenda (English and French)...............................................72
Appendix 10. Enumerator training agenda (English and French).............................................73
Appendix 11. Comparison of Baseline and Final KPC indicators..............................................0
Appendix 11. Comparison of Baseline and Final KPC indicators
Table 1. Summary Table of Beneficiary Population........................................6
Table 2. Summary of Final KPC Rapid CATCH Indicators.........................................................15
Table 3. Age of children under 24 months..........................................................16Table 4. Sex of children under 24 months..........................................................17
Table 5. Clean delivery kit use...................................................................................18
Table 6 Post natal check for mother ithin first eek 18
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Table 16. Children who had malaria and received appropriate treatment
ABBREVIATIONS AND ACRONYMS
CSHGP Child Survival and Health Grants Program
DHSDemographic and Health Survey
DD/AT/DC Direction Departementale de lamnagement du Territoire/Developpement
communautaire
DPTDiphtheria-Pertussis-Tetanus vaccineDS Health district of Konni (French: District Sanitaire)
EOP End of Project
ISCV Initiative for Secure Households
KPC Knowledge, Practice and Coverage
MOH Ministry of Health
MPDL Mouviento Por La Paz
NCHS National Center for Health StatisticsONG Non-governmental organization (Organisation Non Gouvernementale)
ORS Oral Rehydration Solution
ORT Oral Rehydration Therapy
TBA Traditional Birth Attendant
TT Tetanus Toxoid
UNICEF United Nations Childrens Fund
USAID The U.S. Agency for International DevelopmentWHO World Health Organization
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EXECUTIVE SUMMARY
The Healthy Start Child Survival project, designed and implemented by Relief International (RI)in partnership with the Nigerien MOH is located in the Department ofKonni in the Tahoua Region. The estimated direct beneficiary population of the project activitiesis 91,297 women of reproductive age and 83,324 children under five. The project addressesleading causes of childhood morbidity and mortality in the project areas and interventionsinclude (a) malarial control and prevention, (b) control of diarrheal diseases, (c) maternal andchild health, and (d) nutrition.Using behavior change communication (BCC) at the community level, an adaptation of the caregroup model, and training for health care providers at the facility level, the project hasimplemented activities in 60 villages to date in order to increase demand for services, promotehealthy behaviors for child survival, and improve the quality of services offered at health posts
and health centers.
Figure 1. Relief International Care Group
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1. BACKGROUND
1.1. Project location
Niger is a landlocked Sub-Saharan African nation that is ranked third from the last on the 2010
Human Development Index, with 69% of its population living below the poverty line(). Like the
rest of the Sahel, Niger has a long history of endemic hunger characterized by seasonal
fluctuations and geographic variation.
In 2005, a severe drought resulted in a famine that affected nearly three million people and
exacerbated the already fragile health and nutritional status of the country, with disproportional
suffering among women and children. While the current crop harvests have ameliorated some of
the immediate concerns, many areas do not have transitional support to ensure sustained
recovery.
In 2007, in the aftermath of a nutritional crisis, Relief International (RI) launched a four-year
USAID-funded Child Survival project in Konni District in Niger1.
The Department of Birni nKonni occupies a 5,317 square miles area in the southwestern section
of the Tahoua region, 417 kilometers east of Niamey. It is divided into six communes: Konni
City, Allela, Bazaga, Malbaza, Dogueraoua, and Tsernaoua. Villages are widely disbursed. The
climate is dry and hot. A map of Niger and the Department of Birni nKonni is included as
Appendix 2.
1 2 Ch i i f h b fi i l i
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Children, 24-59 months 33,180Total children 0-59
months83,324
1.3 Health, social and economic conditions in the project area
The Republic of Niger covers a land area of almost 1,270,000 km 2 and is inhabited by 14 million
people. Nigers national development is hampered by food and political insecurity. The largely
agrarian and subsistence-based economy is frequently disrupted by extended, deadly droughts
common to the Sahel region of Africa. Niger has experienced two droughts during the projects
implementation period, requiring Niger to import 60% of its food in 2009 and threatening the
health of more than a million people in 2010. Political instability, such as violent conflict in
northern region and last years presidential coup, discourages foreign investment and
complicates the implementation of public services.
Poorly resourced health services are reflected in national health indicators. The 2010 maternal
mortality rate per 100,000 births for Niger is 820. This is compared with 600.7 in 2008 and 890.1in 1990. The neonatal mortality as a percentage of under 5's mortality is 22(). The under-five
mortality rate (U5MR) is 131 in per 1000 live births, according to the Niger National Institute of
Statistics.
Despite this challenging national context, the economy and welfare of the Department of Konni
benefits from its privileged location as a hub of commercial transportation in Nigers fertile
south. Konni exports onions and cattle to countries throughout West Africa. Village householdsin Konni rely on agriculture and trade for income. The major ethnic group in the Konni
department is Hausa, with a minority Tuareg and Peulh population. Hausa are traditionally
sedentary agriculturalists while the Tuareg and Peulh groups are nomadic pastoralists Konnis
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traditional birth attendants in their villages. Malaria, respiratory infections and diarrhea are
leading morbidities. Malnutrition is a common aggravating co-morbidity.
1.4. National standards and policies regarding maternal and child health
Nigers National Health Plan for 2011 to 2015 seeks to contribute to the reduction of maternal
and child mortality by building on existing capacity to improve the efficiency and quality of the
health system(). Government-mandated free health care has been in force since 2006 for
children under-five, as well as for antenatal care, caesarean sections, and family planning. Since2005, active screening, referral and case management of Severe Acute Malnutrition (SAM) have
been scaled up. Nigers Expanded Programme on Immunization (EPI) provides three doses of
combined diphtheria/pertussis/tetanus/Hemophilus influenza/Hepatitis B vaccine
(PENTA)3DPT). Vaccination campaigns against measles are coupled with the distribution of
vitamin A capsules. Public sector facilities and non-governmental organizations implement
large-scale distribution of bednets. The 2008 National Child Survival Strategy includes
increased access to health services through community-based disease management, reinforcedhuman resources and supply chains and monitoring(). Niger is currently finalizing its formation
Management System,Health InHuman Resources Development Plan, Nutrition Plan, and
National Strategy on Community Case management(). In support of the decentralization of
health service management, regional and district Ministry of Health directorates also create five-
year plans.
1.5. Overview of the Healthy Start Child Survival Project
1.5.1. Project goal
The goal of the Healthy Start Child Survival project was to reduce morbidity and mortality rates
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1.5.3. Intervention activities
The intervention activities for achieving the Strategic Objectives were designed to:
1. Increase access to, demand for, and use of quality maternal and child health services,
including emergency care; in order to improved family behaviors related to maternal and
child health.
2. 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 toimprove use of chemoprophylaxis for malaria among pregnant women.
3. Improve prevention and treatment of diarrheal disease among rural children under five.
4. Improve nutrition of women and children, through education and household/community
food security and nutrition activities.
5. Improve the capacity of the Ministry of Health and local partner agencies, to plan,
implement, monitor and evaluate child survival interventions at the community and
district levels, with an emphasis on capacity in maternal and child health, nutrition, andhousehold food security.
The project plan initially targeted 90 villages in a two-phased coverage approach. The project
established 266 women care groups and support for 50 health posts. After the mid-term
evaluation (MTE) the project plan was revived to focus on an intervention area of 61 villages.
RI and partners conducted the Baseline KPC Survey, Health Facility Assessment, and Detailed
Implementation Plan workshop from January to February 2008. RI brought togetherstakeholders from the Ministry of Health, NGOs, and rural communities to design the project. To
drive consensus on a project plan, the RI project management team facilitated structured problem
solving from rigorous analysis of the household and facility surveys. RI and the partners agreed
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Measuring the nutritional status of children aged 0-23 months in the project zone;
2. To build the capacity of project local staff and partners data collection and analysis.
2. PROCESS AND PARTNERSHIP BUILDING
2.1. Steering Committee collaboration
In August 2011, RI contacted the following institutions to invite representatives to participate in
a Steering Committee for the Final KPC Survey: USAID Mission in Niamey
Tahoua Regional Ministry of Health
Konni Health District
Konni Department Directorate of Agriculture
Konni Department Directorate of Planning
Konni non-governmental organizations (NGOs) including Mouviento Por La Paz
(MPDL) and the Initiative for Secure Households (ISCV) National Directorate for Health Information (DSSRE)
A sample invitation letter is included as Appendix 3.
The Final KPC Survey Steering Committee met on September 16-17, 2011, to advise on the
preparation of the survey. The Steering Committee reviewed and provided guidance and on the
terms of reference for the training of enumerators; drafts of the data collection tools; survey
logistical needs (including measurement equipment such as height boards, scales, medicines, and
bednets; and the identification of enumerators.
Steering Committee representatives agreed to contribute staff and materials from their respective
i tit ti Th K i H lth Di t i t id d t ff b t k i
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The survey questionnaire was 88 questions in length, excluding anthropometrics. The
anthropometrics module consisted of three measurements: height, weight, and mid-upper arm
circumference when appropriate. RI translated the questionnaire into French from the final
English version. The questionnaire in English is included as Appendix 4, and the French
translation is included as Appendix 5. During the survey, the French questionnaire was used as a
guide for the verbalization of the survey into Konnis local language of Hausa. The Hausa
translations of key words are included in Appendix 6.
3.2. KPC indicators
The 2006 Rapid CATCH indicators covered by the questionnaire were:
Maternal and Newborn Care:
Maternal TT v accination: Percentage of mothers with children age 0-23 months who
received at least two Tetanus toxoid vaccinations before the birth of their youngest child
Skilled delivery a ssistance: Percentage of children age 0-23 months whose births wereattended by skilled personnel
Post-natal visit to check on newborn within the first 3 days after b irth: Percentage of
children age 0-23 who received a post-natal visit from an appropriate trained health
worker within three days after the birth of the youngest child
Breastfeeding and Infant and Young Child Feeding (IYCF)
Exclusive b reastfeeding: Percentage of children age 0-5 months who were exclusively
breastfed during the last 24 hours
Infant and young c hi ld f eeding: % of infants and young children age 6-23 months fed
according to a minimum of appropriate feeding practices
Vitamin A supplementation in the last 6 months: Percentage of children age 6-23 months
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Control of Diarrhea
ORT u se: Percentage of children age 0-23 months with diarrhea in the last two weeks
who received oral rehydration solution (ORS) and/or recommended home fluids
Acute Respiratory Infections
Appropriate care seeking for p neumonia: Percentage of children age 0-23 months with
chest-related cough and fast and/ or difficult breathing in the last two weeks who were
taken to an appropriate health provider.
Water and Sanitation
Point of u se : Percentage of households of children age 0-23 months that treat water
effectively
Appropriate hand washing p ractices : Percentage of mothers of children 0-23 months who
live in a household with soap or a locally appropriate cleanser at the place for hand
washing that and who washed their hands with soap at least 2 of the appropriate timesduring the day or night before the interview
Anthropometry
Underweight : Percentage of children 0-23 months who are underweight (-2 standard
deviation for the median weight for age, according to WHO/NCHS reference population)
3.3. Sampling design
The Core Team designed the Final KPC Survey to survey 30 clusters of 12 households each.
Only one mother of a child aged between 0-23 months was interviewed per household, for a total
sample size of 360.
The sampling design of the Final s r e as modified from the Baseline s r e The Baseline
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3.4. Training
3.4.1. Core Team Training
The RI project team assembled a Core Team to oversee survey trainings and data collection. The
Core Team consisted of six persons: the Healthy Start Projects manager, training coordinator,
and Monitoring and Evaluation Officer; the Konni District Communications Officer, and
representatives of the Konni agricultural office and the local NGO Community Development
Office. The Core Team prepared for the trainings and data collection by reviewing the purposeand methodology of the Final KPC Survey; reviewing and adapting the questionnaire for use in
training exercises; and finalizing logistical arrangements and the activities budget.
RIs project team worked with the Core Team to plan the survey training and implementation to
meet budgetary and time constraints stemming from a project budget realignment process
conducted in end summer 2011. The budget realignment process delayed the transfer of a
project funds wire to Niger until only a few weeks before the end of the project funding period.The team worked within the revised budget by apportioning remaining funds among the Final
KPC Survey, Final Evaluation and project costs. The budget for the survey and data
management is included as Appendix 8.
The team addressed the challenge of a compressed timeline by conducting focused trainings of
two days duration for a Training of Enumerators Trainers and two days for a Training of
Enumerators. To save time and to ensure the quality of the survey results, the Core Team also
decided to recall survey trainers and enumerators who had participated in the Baseline KPC
Survey in 2008.
3 4 2 T i i f E t T i
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identified enumerators with experience in taking anthropometric measurements to establish five
specialized teams for field anthropometric data collection. The supervisors met with the RI
project manager and the Core Team at the end of each day for feedback and to finalize plans for
the survey implementation. The training was a collaborative effort. The agenda for the training
of enumerators is included as Appendix 10.
3.5. Data collection
Six teams of enumerators collected data for five days. ( Sept 18-22) Each team was composed offour enumerators, one measurer and one supervisor. Each day, a team covered one cluster and
filled out 12 questionnaires. At the end of the data collection, the teams had completed a total of
360 questionnaires.
The supervisors were responsible for the selection of the starting household and survey direction.
Information and approval from village authorities were received before data collection
commenced, facilitating easy access to households. The team took daily round trips to Konnibecause of the clusters proximity. The team adapted a two-level quality control which included
a daily check of questionnaires by the team supervisor. Questionnaires were completed and
collected on a daily basis, and then reviewed again in the evening. This quality assurance
process was in place to detect and address recurrent errors. Each team was supervised at least
twice by a member of the Core Team.
3.6. Data analysis
The survey data management team was comprised of one staff person from the MOH health
information systems office, one project monitoring and evaluation officer, and the RI project
manager. The team entered data into Epi Info 7 software and transferred on SPSS for
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Some mothers prenatal consultation cards were not filled out even though their
childrens vaccinations were confirmed by the village workers registers and the mothers
recall.
Anthropometric weight-for-height measurements were done by a single team of six
measurers, which increased the risk of measurement errors.
Anthropometric weight measurements may have been biased. For children who were
aged under one month, or were too small or sick to be weighed, anthropometric weight
measurements were replaced by birth weight in the Child Cards or were by the weights of
same-aged children who were known either by recall or in the Child Health Cards.
Data analysis:
During data analysis, the data management team realized that two questionnaires
were missing for a remote cluster. The team did not have any practical option for
returning to the missed villages to complete the missing questionnaire.
Lack of time for data verification resulted in missing data in some questionnaires.
4. RESULTS
This section presents the findings of the Final knowledge, attitude and coverage survey that was
conducted in the Konni District, Niger. This section also compares the results between the Final
and Baseline KPC Surveys.
4.1. Final KPC Rapid CATCH indicators
Table 2 summarizes the indicators measured in the Final KPC Survey. Values listed in bold-faced font are statistically significantly different from values recorded by the Baseline KPC
Survey.
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INDICATOR
NUMERAT
OR
DENOMINAT
OR VALUE
CONFIDEN
CE LIMITS
breastfed during the last 24 hours
5.% of infants and young childrenage 6-23 months fed according to aminimum of appropriate feedingpractices
147 251 58.6% 50.067.2%
6. Percentage of children age 6-23months who received a dose ofVitamin A in the last 6 months(Mothers recall)
184 251 73.3% 65.681%
7. Percentage of children age 12-23months who received a DPT1vaccination before they reached 12months
94 120 78%
8. Percentage of children age12-23
months who received a DPT3vaccination before they reached 12months
49 120 40.8% 28.453.2%
9. Percentage of children age 12-23months who received a measlesvaccination according to thevaccination card or mothers recallby the time of the survey
94 189 49.7% 39.659.8%
10. Percentage of children age 0-23months with a febrile episode duringthe last two weeks who weretreated with an effective anti-
l i l d ithi 24 h ft
144 212 67.9% 59.076.8%
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INDICATOR
NUMERAT
OR
DENOMINAT
OR VALUE
CONFIDEN
CE LIMITS
15. Percentage of mothers ofchildren 0-23 months who live in ahousehold with soap or a locallyappropriate cleanser at the place forhand washing
85 358 23.7% 17.529.9%
16. Percentage of children 0-23
months who are underweight
145 350 41.4% 33.848.7%
4.2. Demographic characteristics
Table 3. Age of children under 24 months
AGE FREQUENCY PERCENT
0 to 5 months 107 30.0%
6 to 11 months 95 26.5%12 to 23 months 156 43.6%
Total 358 100.0%
Table 4. Sex of children under 24 months
SEX FREQUENCY PERCENT
Female 137 45.7%
Male 163 54.3%
Total 358 100.0%
4.3. Maternal and newborn care
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28
Health Post worker
.0%
5461
1Doctor/Nurse/Midwife
PERCENT
FREQUENCYBIRTH ASSISTANT
BIRTH
ASSISTANT FREQUENCY PERCENTDoctor/Nurse/Midwife
150 42%
Health Post worker 28 8%
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(TBAs, ormatrons) even though they are not considered as skilled personnel. The project has
devoted a considerable level of effort to sensitization activities to teach TBAs about their new
role as companions to delivery. Some of health post workers are nurses, but may not be
known as such by respondents.
Table 6. Home delivery by Traditional Birth Attendant (TBA)
HOME DELIVERY BY TBA FREQUENCY PERCENT
Yes 67 47.2%No 75 52.8%
Total 142 100.0%
More than half of deliveries assisted by TBAs (matrons) occurred in health centers (75/142).
This is a well-known practice, particularly in integrated health centers and district hospitals,
where matrons work night shifts under the supervision of a midwife. Officially, matrons are
expected in those centers to only accompany parturient women to the maternity ward and help
mothers in the post-partum wards. In reality, the matrons continue to assist deliveries when
midwifes rest during night shifts.
Table 7. Delivery at health center or homeDELIVERY LOCATION FREQUENCY PERCENT
Health center 213 59.7%
Home 144 40.3%
Total 357 100.0%
60% of deliveries take place in health centers, doubling the baseline measurement (29%). The
H l h S P j i i i h l h d li d i
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delivery kit to each health center. The kit includes a cloth of two yards in length for wrapping
newborns, a razor blade for cutting the umbilical cord, gloves, and soap. While 60% of
deliveries occurred in health centers, approximately 16% of kits were used either at home or
elsewhere.
Table 6. Post-natal check for mother within first week
TIME OF MOTHERS
POST-NATAL CHECK FREQUENCY PERCENT
Hour 1 159 79.1%
Day 1 19 9.5%
Week 1 3 1.5%
Did not know 20 10.0%
Total 201 100.0%
Back Forward Current Procedure
Q27 FrequencyPercent Cum Percent
Heure1 159 79,1% 79,1%
jour1 19 9,5% 88,6%
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88.6% (178/201) of mothers who delivered in health centers received a post-natal check within
the first week and 80% of them were checked the day after delivery. who with 213 The total
number of the respondents matches delivered in Health Center.=
Only 29 mothers were able to identify the health personnel who performed the post-natal check.
Half of them (51%) were done by a health post worker. Midwives performed four post-natalchecks doctors performed two checks. It appears that doctors and midwives are more
recognizable or may be more communicative with mothers than nurses or health post workers,
since the number of deliveries assisted by midwives and doctors are the same for the post-natal
checks.
Table 7. Post-natal check within three days for newborn
POST-NATAL CHECK
FOR NEWBORN FREQUENCY PERCENTYes 34 54.0%
No 29 46.0%
Total 63 100.0%
36% (63/216) of mothers said that their baby was ever checked by the health personnel of the
facility where they delivered. Half of the newborns (38) were checked within the week after
birth. Only 10.6% of children received a post-natal visit within three days after birth, less thanthe baseline value.
4 4 Breastfeeding
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Breastmilk and water 9 * 8.4%
The findings show 72% of children aged under six months were exclusively breastfed. This is a
significant increase compared to baseline value of 36 percent. Exclusive breastfeeding is a cost
-effective child survival intervention, especially in the developing country context of Niger.
4.5. Complementary feeding.
Table 10. Complementary feedingBREASTFEEDING STATUS FREQUENCY PERCENT
Breastfed 138 55%
Not breastfed 8 3%
Did not know 6
Total 15247 58%9
The Final KPC Survey noted that 59% of children at 6-23 months of age were fed appropriate
minimum frequency of meals. Breastfed children were more likely to be fed a minimum
frequency of meals than non-breastfed children (44% or 138/324 vs. 24% or 8/34). In rural
areas, children who are not breastfed after six months are commonly orphans, have sick mothers,
or may have been weaned early.
Below is a verification table (please delete after your verificatio
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No 62 24.7%
Did not know 4 1.0%
Blank 1 0.1%
Total 251 100.0%
Among children at 6-23 months of age, 74% received a dose of vitamin A in the six months
before data collection, which was not a significant increase from the baseline survey (72%).
4.7. Child immunization
Table 11. Possession of vaccination cardHAVING VACCINATION
CARD FREQUENCY PERCENT
Yes, and seen by enumerator 273 76.3%
Did not know 1 0.3%
Not available 68 19.0%
Never had a card 16 4.5%
Total 358 100.0%
73% of mothers possess health or vaccination cards, a significant increase from the baseline
value of 61 percent. The major issue with Health/vaccination card is that they are not filled
mostly by Health personnel. 72% (258/358) of mothers reported vaccinations that are not
recorded on their cards.
Table 12. Children who received Penta 1 or Penta 3PENTA 1/PENTA 3 RECEIVED FREQUENCY PERCENT
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age who had a card that was not available (n=50), had never possessed a vaccination card (n=
11), or and one mother respondent who was unsure if she possessed a card and was classified as
No. If ownership of a vaccination card is not considered in the calculation, the percentage of
children reported to have received Vitamin A increases to 74%.
Table 14. Children receiving BCG vaccination
BCG RECEIVED FREQUENCY PERCENT
Yes 236 65.9%
No 32 8.9%
Did not know 90 * 24.1%
Total 358 100.0%
Overall, 66% of children were reported to have received BCG vaccinations. At baseline, BCG
was provided to 70% of infants under 12 months of age (137/202) and 63% (99/156) of children
at 12-23 months of age. Konni District appears to have a lower proportion of children receiving
BCG than Tahoua Region (72%), according to the 2010 national Nutrition and Child SurvivalSurvey(). Historically, Konni District has experienced low vaccination coverage and recurrent
outbreaks of measles, meningitis.
Table 15. Children receiving measles vaccinationMEASLES VACCINE
RECEIVED FREQUENCY PERCENT
Yes 94 49.7%
No 48 25.4%Did not know 40 * 21.2%
Total 189 100.0%
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4.8. Malaria
Table 16. Children who had malaria and received appropriate treatmentAPPROPRIATE MALARIA
TREATMENT RECEIVED FREQUENCY PERCENTYes 144 67.9%No 72 34.0%Did not know
Total 2162 100.0%
59% (2162/358) of children had fevers in the two weeks prior the survey. An appropriate
antimalarial (Artemisinin-based combination therapy, Fansidar, chloroquine, or amodiaquine)
was provided to 68% of children within 24 hours of the onset of the fever4.
4.9. Nutritional Status
Figure 2. Nutritional status of children
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infant disease, child immunization, and water and sanitation; and, (2) a deterioration in the
nutritional status of children in the project area.
5.1. Key findings and programmatic implications
Indicator 1. Percentage of mothers with children age 0-23 months who
received at least two Tetanus toxoid vaccinations before the birth of their
youngest child
A significantly increased proportion (81% vs. 28.8% at baseline) of mothers with children at 0-
23 of age had received at least two doses of Tetanus Toxoid (TT) vaccine before the birth of their
youngest child. (A table comparing indicators from the Final and Baseline KPC surveys in
included as Appendix 11.) The Final result exceeded the End of Project (EOP) target of 40%.
The indicator is higher than in Tahoua Region (62.1%)().
The increase may be linked to an increased utilization of antenatal consultation and maternalhealth services. Despite several vaccine stock-outs during the four year project period, the
Government of Nigers 2008 policy of free mother and child care and the Healthy Starts
community sensitization activities may also have contributed to the increased utilization of
services. The survey found that 73% of mothers possessed health/vaccination cards, and that
60% of mothers gave birth in health centers. The project area showed a higher correlation of
completed ANC/TT visits and subsequent births in health facility than the 2010 National Child
Survey, which who showed that despite a significant increase of Antenatal visits (55% in TahouaRegion), deliveries in health facilities were uncommon (31%).
Indicator 2 Percentage of children age 0 23 months whose births were attended by skilled
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natal check-ups, it should be noted that the responses rate in the Final KPC is low. Even though
60% (201/358) of mothers answered positively that they were checked after delivery, only 29
mothers were able to identify who assisted her during the delivery.
Indicator 4.Percentage of children age 0-5 months who were exclusively breastfed during the
last 24 hours
The survey has noted a significant increase (72% vs. 36%) in the proportion of children at 0-5
months of age who were exclusively breastfed during the 24 hours prior to the survey. This is
more than twice the proportion of 26.9% found by the national-level Nutrition and Child
Survival Survey of June 2010. The KPC Final Survey results support the observations made in
the Healthy Start Project MTE Evaluation that breastfeeding behavior has increased in the
project area.
Indicator 5.Percent of infants and young children age 6-23 months fed according to a minimum
of appropriate feeding practices
50 % of children at 6-23 months of age who were fed according to a minimum of appropriate
feeding practices (147/251). This a significant increase over the baseline estimate of 36%.
Indicator 6.Percentage of children age 6-23 months who received a dose of Vitamin A in the
last 6 months (Mothers recall)
According to mothers recall, 74% of children at 6-23 months of age received a dose of VitaminA in the six months prior to the survey, a significant increase over the baseline (10%). When
excluding responses from mothers whose cards did not show a precise date for when Vitamin A
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51% of children received measles vaccination, a significant increase over the baseline value of
38% and exceeding the EOP target of 40%.
Indicator 10.Percentage of children age 0-23 months with a febrile episode during the last two
weeks who were treated with an effective anti-malarial drug within 24 hours after the fever
began
Indicator 11.Percentage of children age 0-23 months who slept under an insecticide-treated
bed net the previous night
The Survey found a significant improvement in the prevention and treatment of malaria. Use of
67.9% of children who had experienced a febrile episode two weeks before the survey had been
treated with an appropriate antimalarial, a significant increase over the baseline (17.6%) and
exceeding the EOP target of 40%. Furthermore, 77.3% of children had slept under a bednet,
compared to 40.0% at baseline, exceeding the EOP target of 60%.
Despite public sector stock outs of nets during the project period the Healthy Start Projects
timing of behavior change activities around peak malaria transmission periods (rainy seasons)
and an increased availability of bednets in the communities may have contributed to these
positive results.
Indicator 12.Percentage of children age 0-23 months with diarrhea in the last two weeks who
received oral rehydration solution (ORS) and/or recommended home fluids
49.7% of children received ORS when they had diarrhea, a significant increase from the baseline
value of 17.5%, but below the EOP target of 70%. ORS coverage might be improved through
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75.4% of households treat water effectively, a significant increase from 15.2%. The projects
behavior change messages included locally- and culturally-appropriate methods for protecting
water quality.
Indicator 15.Percentage of mothers of children 0-23 months who live in a household with soap
or a locally appropriate cleanser at the place for hand washing
23.7% of mothers of children at 0-23 months of age live in houses with soap or cleanser at the
place for hand washing, a significant increase from the baseline value of 11.5%.
The promotion of hand washing was a challenging activity for several reasons. The project
adopted a gradual introduction of BCC packages, so hand washing messages were introduced in
Year 2 and did not benefit from as much time for sensitization as did maternal and newborn care
or breastfeeding. Second, the placement of soap at an appropriate point of use is highly
culturally dependent. Soap is usually used in the bathing area and for prayer ablution. People
instead wash their hands using a kettle, without soap. Soap and detergent cannot be left in theopen air by latrines because birds, hens or domestic animals tend to displace or spoil them, nor
kept in a container because they can easily melt or dilute in the midday heat. Not least, soap and
detergent are costly, so the project launched training for women volunteers in soap production
during the last quarter of implementation period (April-June 2010). Village residents expressed
interest in continuing the activity.
Indicator 16.Percentage of children 0-23 months who are underweight
41.7% (145/350) of children at 0-23 months of age were measured to be underweight (having a
weight for age measurement that is -2 standard deviations from the median weight for age,
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young children by two-thirds by 2015, but there has been no change in under nutrition, and total
mortality rates are still high among young children().
6. CONCLUSION:
The Results of the Final KPC survey in the Konni District showed that Knowlegde, practices
has improved in maternal and child Health in Konni District in general and challenges in thenutritional status( underweight) of children. The District management Team has a useful tool for
refining the projection of Maternal and child Health indicators targets of the new 4 yearsDistrict
Health Developpement Plan ( 2011-2016).
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7. BIBLIOGRAPHY
Institut National de la Statistique. (2010).Nutrition and Child Survival Survey among childrenaged 6 to 59 months. Niger, May - June 2010. Niamey: Institute National de la
Statistique-Niger/UNICE/WFP/HKI.Ministry of Health. (2005).Konni Health District Development Plan 2005-2010. Konni City:Government of Niger.
Ministry of Health. (2008).National Child Survival Strategy (Avant-projet de Stratgie Nationalde Survie de lEnfant). Niamey: Republic of Niger-Ministry of Health.
Ministry of Health. (2011).National Nutritional Plan 2011-2015 (Plan National pour laNutrition PNN 2011-2015). Niamey: Republic of Niger- Ministry of Health.
Ministry of Health. (2011).Plan de Developpement Sanitaire du Niger. Niamey: Republic ofNiger-Ministry of Health.
Relief International. (2008).FY1 Annnual Report. Los Angeles: Relief International.Tilford, K. (March 2010). Child Survival Mid-term Evaluation Report. Los Angeles: Relief
International/USAID.UNDP. (2011).Niger Country Profile: Human Development Indicators. Retrieved September
30, 2011, from International Human Development Indicators:http://hdrstats.undp.org/en/countries/profiles/NER.html
Unicef. (2010, March 2).At a glance: Niger. Retrieved December 22, 2011, from unicef:http://www.unicef.org/infobycountry/niger_statistics.html
United Nations Population Fund. (2011). State of the World's Midwifery. Geneva: UNFPA.Whueler, S., & Biga, A. (2011). Situational analysis of infant and young child nutrition.
Maternal and Child Nutrition 7 (Suppl. 1), 133156.
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Appendix 1. Survey personnel
The following people were instrumental in bringing the Final KPC Survey and report to a
successful completion:
CORE TEAM
NAME ORGANIZATION PHONE CONTACTSalissou Iliassou Drection
DepartementaleP/Amenagem
ent du
Territoire/Developpement
Communautaire Konni
96 87 94 64
Abouzeidi Chouhabou DS Konni 96 87 89 38Dr Soumana Oumarou MPDL Konni 96 08 11 33
Dr Mahaman Hallarou RI 96 29 27 84Moustapha Tcharimi RI 96 88 33 75Rakia Azouma RI 96 87 66 43Remi Sugurono Consultant 90 61 22 27
SURVEY SUPERVISORSNAME ORGANIZATION PHONE CONTACT
Abouzeidi Chouhabou DS Konni 96 87 89 38
Ali Hantchi DDP/AT/DC Konni 96 59 07 60Ary Issaka Ousmane Jeunesse Sport Konni 98 09 19 04Garba Nana Haouaou ISCV Konni 90 79 09 60Kamay Goga Alphabtisation 96 88 76 92
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Dakaou Alio Sociologist 96 46 73 34Fatimatou Issaka Bilali Nurse 96 26 75 84
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NAME PROFESSION PHONE CONTACTGarba Kano Retired teacher 96 97 29 14Hadiza Ibrahim Rural development specialist 97 28 74 80Hassane Almou Amadou Animateur 90 04 12 63Ibrahim Gado Professor 98 74 37 40Ibrahim Maman Sani Professor 96 46 66 01
Ibrahim Oumarou Student 96 52 95 02Ibro Mahamadou Animateur 96 07 69 59Maman Fati Idi Planning agent 98 58 42 66Mato Touraki Journalist 96 75 89 77Mohamed Abolbol Sociologist 96 98 08 66Moussa Abdou Extension agent 90 57 95 34Moussa Jean Traor Sociologist 91 71 50 83Oumarou Djibo Teacher 96 01 43 04Oumarou Ibrahim Student 96 02 76 40
Salamatou Habou Journalist, Radio Anfani 96 06 42 47Salifou Moumouni Kadidja Sociologist 96 58 04 76Salissou Dan Nana Sociologist/ Municipal agent 91 36 34 32Souley Hamidine Sociologist 96 40 20 88
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Appendix 2. Maps of Niger and Konni District
Map 1. Niger regions5
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Map 2. Konni Department6
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Appendix 3. Survey Steering Committee invitation letter
Reprsentation au NigerTl. : (227) 20 35 08 79 / 21 76 74 69 Fax 20 64 00 29
BP : 12 245 NIAMEY
Mr. Noble Williams
USAID Program Manager
USAID Office Niamey, Niger
Reference: USAID CA # GHS-A-00-0-00028-00 ,Niger Child Survival Project
Dear Mr. Williams,
Thank you for the opportunity to inform you that under the referenced project, Relief International (RI) is
planning to carry out a Final Evaluation that will enable the Ministry of Health, the local community, and
RI to verify achievements towards the project objectives. Planned evaluation activities are participatoryand we are expected to invite donors and partner organizations including USAID to participate in the
evaluation activities in Konni district.
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Appendix 4. Questionnaire (English)Ask the mother if she has a child under 24 months who lives with her. If yes, proceed with interview, if no thank themother and end the interview.
IdentificationCluster NumberHousehold NumberRecord NumberCommunity
Name of MotherName of SupervisorData Entered by Date: ___/___/____
day/month/year
1 2 3 Final VisitInterview date ___/___/____
day/month/year___/___/____day/month/year
___/___/____day/month/year
For SupervisorDay
Name of Interviewer MonthYear
Result Code* Result Code*Result Codes:
1. Completed2. Respondent not at home3. Postponed4. Refused5. Other______________________________________
Specify
Consent
INFORMED CONSENT
Hello. My name is ______________________________, and I am working with Relief International and MSP. We are
conducting a survey and would appreciate your participation. I would like to ask you about your health and the health ofyour youngest child under the age of two. This information will help Relief International and MSP to plan health servicesand assess whether it is meeting its goals to improve childrens health. The survey usually takes _______ minutes tocomplete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.
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Questionnaire
ALL QUESTIONS ARE TO BE ADDRESSED TO MOTHERS WITH A CHILD LESS THAN 24 MONTHS OF AGE
IntroductionNo. Questions and Filters Coding Categories Skip
1 How many children do you have?Total number of children
2 What is the name, sex, date of birth of your
youngest child that you gave birth to and that isstill alive?
Youngest Child
Name _______________________________
SexMale....1
Female.......2
Date of Birth
Day
Month
Year
Tetanus Toxoid Immunization
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
3 During pregnancy with (NAME) did you receive aninjection in the arm to prevent the baby from gettingtetanus, that is, convulsions after birth?
Yes.....................................................................1No......................................................................2Dont know.........................................................9
45 5
4 While pregnant with (NAME), how many times did youreceive such an injection? Times.............. ............................ .................. ...... .
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Skilled attendance and clean cord care
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
7 Who assisted you with the delivery of (NAME)?
Anyone else?
PROBE FOR THE TYPE(S) OF PERSON(S) ANDRECORD ALL MENTIONED.
IF RESPONDENT SAYS NO ONE ASSISTED,PROBE TO DETERMINE WHETHER ANY ADULTSWERE PRESENT AT THE DELIVERY.
HEALTH PERSONNELDOCTOR........................................................ANURSE or MIDWIFE......................................BAUXILIARY MIDWIFE...................................COTHER HEALTH STAFF WITHMIDWIFERY SKILLS....................................D
OTHER PERSONTRADITIONAL BIRTH ATTENDANT.............ECOMMUNITY HEALTH WORKER................FRELATIVE/FRIEND.......................................GOTHER___________________....................H
(SPECIFY)
NO ONE............................................................Y
8 Was a Clean Delivery Kit used during delivery?(SHOW DELIVERY KITS LOCALLY PROMOTED)
Yes....................................................................1No......................................................................2Dont know.........................................................9
10 9 9
9 What instrument was used to cut the cord? New razor blade................................................1New and boiled razor blade..............................2
Used razor blade...............................................3
Used and boiled razor blade.............................4
New scissors.....................................................5
New and boiled scissors....................................6
Used scissors....................................................7
Used and boiled scissors..................................8
Knife..................................................................9
Reed................................................................10
Other ____________________.....................96(Specify)
D t k 97
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Drying and wrapping after birth
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
13 Was (NAME) dried (wiped) immediately after birthbefore the placenta was delivered?
Yes....................................................................1No......................................................................2Dont know.........................................................9
14 Was (NAME) wrapped in a warm cloth or blanketimmediately after birth before the placenta wasdelivered?
Yes....................................................................1No......................................................................2Dont know.........................................................9
Breastfeeding/ Infant and Young Child Feeding15 Did you ever breastfeed (NAME)? Yes....................................................................1No......................................................................2
16 19
16 How long after birth did you first put (NAME) to thebreast?
IF LESS THAN 1 HOUR, RECORD 00 HOURS,IF LESS THAN 24 HOURS RECORD THE HOURS,OTHERWISE RECORD DAYS
IMMEDIATE....................................................00
HOURS................................................................
DAYS...................................................................
Dont remember.................................................917 During the first three or four days after delivery,
before your regular milk began flowing, did you give(NAME) the liquid (colostrum) that came from yourbreasts?
YES ..................................................................1
NO ..................................................................2
DONT KNOW .................................................918 In the first three days after delivery, was (NAME)
given anything to drink other than breast milk?YES .................................................................1
NO ..................................................................2
DONT KNOW .................................................919 Now I would like to ask you about liquids or foods
(NAME) had yesterday during the day or at night.
Did (NAME) drink/eat:
READ THE LIST OF LIQUIDS (A THROUGH E,STARTING WITH BREAST MILK).
Milk of animalsPowdered milksimple water
sugar waterSalt water sweetenedDcoctions. / infusionsFruit juicehoney
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NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
22
22A
22B
22C
22D
22E
22F
PLEASE FILL OUT THE FOLLOWING TABLE WITHTHE ANSWERS TO THE QUESTIONS BELOW:Now I would like to ask you about (other) liquids orfoods that (NAME) may have had yesterday duringthe day or at night. I am interested in whether yourchild had the item even if it was combined with otherfoods.
Did (NAME) drink/eat:
CHECK THE BOX IF THE CHILD drank the liquid inquestion.
Breast milk?
Water Plate?
Milk powder sold in commerce?
Milk as in any other box, powder, fresh milk oranimal?
Fruit juice?
Other liquids such as sugar water, tea, coffee, softdrinks or broth?
A............................................
B............................................
C............................................
D............................................
E............................................
F............................................
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NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
22G
22H
22I
22J
22K
22L
Now I would like to ask you about the types ofaliments4 that [NAME] ate yesterday during theday or night.
Does [NAME] ate the following foods during theday or last night?
Check the box if the child to eat the food inquestion.
Foods made of seeds [eg, millet, sorghum, maize,rice, wheat, boiled, or other local seeds]?
Pumpkin, red or yellow yams or squash, carrots or
sweet potatoes red?
Any other food from roots or tubers [eg, potatoes,white yams, cassava and other roots / tubers local]? 5
Of green leafy vegetables?
Mango, papaya [or other local fruits rich in Vitamin
A]?
Other fruits and vegetables [eg, bananas, apples /applesauce, avocados, tomatoes]?
G............................................
H............................................
I.............................................
J.............................................
K............................................
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NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
23 How many times did (NAME) eat solid, semi-solid, orsoft foods other than liquids yesterday during the dayor at night?
IF CAREGIVER ANSWERS SEVEN OR MORETIMES, RECORD 7
WE WANT TO FIND OUT HOW MANY TIMES THE
CHILD ATE ENOUGH TO BE FULL. SMALLSNACKS AND SMALL FEEDS SUCH AS ONE ORTWO BITES OF MOTHERS OR SISTERS FOODSHOULD NOT BE COUNTED.
LIQUIDS DO NOT COUNT FOR THIS QUESTION.DO NOT INCLUDE THIN SOUPS OR BROTH,WATERY GRUELS, OR ANY OTHER LIQUID.
USE PROBING QUESTIONS TO HELP THERESPONDENT REMEMBER ALL THE TIMES THECHILD ATE YESTERDAY
Number of Times
Dont Know .9
24 Can I see the salt used for cooking? 6TAKE A teaspoon of SALT and test it for iodine.
IODINE PRSENT 1IODINE NOT PRSENT...................................2
25 Has (NAME) received a dose of Vitamin A like this inthe past six months? 7BULB SHOW / CAPSULE / SYRUP.
YES 1NO 2DONT KNOW...................................................8
Postpartum visit (for mother)26 Where did you give birth to (NAME)? HOME (own or other)........................................1
HEALTH FACILITY (public sector or private) . .2
33
27
27 After (NAME) was born, before you were discharged,did any health care provider check on your health? Yes.....................................................................1No......................................................................2
28 30
28 How long after delivery did the first check take place?HOURS................................................................
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31 How long after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS.IF LESS THAN ONE WEEK, RECORD DAYS.
HOURS................................................................
DAYS...................................................................
WEEKS................................................................
DON'T KNOW.................................................99
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
32 Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.
HEALTH PERSONNELDOCTOR...........................................................ANURSE or CLINICAL OFFICER.......................BMIDWIFE..........................................................CAUXILIARY.......................................................D
OTHER PERSONTRADITIONAL BIRTHATTENDANT.....................................................EHEALTH WORKER...........................................FTRAINED TBA .................................................GTRAINED HW...................................................H
OTHER..............................................................Z(SPECIFY)
33 After (NAME) was born, did any health care worker ora traditional birth attendant check on your health?
Yes.....................................................................1
No......................................................................2
34
42
34 How long after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN ONE WEEK, RECORD DAYS.
HOURS................................................................
DAYS...................................................................
WEEKS................................................................
DON'T KNOW.................................................99
42
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37 How many hours, days or weeks after the birth of(NAME) did the first check of (NAME) take place?
HOURS................................................................
DAYS...................................................................
WEEKS................................................................
DON'T KNOW.................................................99
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NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
38 Who checked on (NAME)s health at that time?
PROBE FOR MOST QUALIFIED PERSON.
HEALTH PERSONNELDOCTOR...........................................................ANURSE or CLINICAL OFFICER.......................BMIDWIFE..........................................................CAUXILIARY.......................................................D
OTHER PERSONTRADITIONAL BIRTH
ATTENDANT.....................................................EHEALTH WORKER...........................................F
OTHER..............................................................Z(SPECIFY)
39 After you were discharged, did any health careprovider or a traditional birth attendant check on(NAME)s health?
Yes.....................................................................1
No......................................................................2
40
4540 How many hours, days or weeks after the birth of
(NAME) did the first check of (NAME) take place?
IF LESS THAN ONE DAY, RECORD HOURS.IF LESS THAN ONE WEEK, RECORD DAYS.
HOURS................................................................
DAYS...................................................................
WEEKS................................................................
DON'T KNOW.................................................9941 Who checked on (NAME)s health at that time?
PROBE FOR MOST QUALIFIED PERSON.
HEALTH PERSONNELDOCTOR...........................................................ANURSE or CLINICAL OFFICER.......................BMIDWIFE..........................................................CAUXILIARY.......................................................D
OTHER PERSONTRADITIONAL BIRTHATTENDANT.....................................................EHEALTH WORKER...........................................FTRAINED TBA .................................................GTRAINED HW...................................................H
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44 Who checked on (NAME)s health at that time?
PROBE FOR MOST QUALIFIED PERSON.
HEALTH PERSONNELDOCTOR...........................................................ANURSE or CLINICAL OFFICER.......................BMIDWIFE..........................................................CAUXILIARY.......................................................D
OTHER PERSONTRADITIONAL BIRTHATTENDANT.....................................................EHEALTH WORKER...........................................FTRAINED TBA .................................................GTRAINED HW...................................................H
OTHER..............................................................Z(SPECIFY)
Childhood Immunization
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
45 Did (NAME) take a vitamin A dose like this during the last 6 months?
SHOW AMPULE/CAPSULE/SYRUP.
YES................................................................1NO.................................................................2DONT KNOW...............................................8
46 Do you have a card where (NAMES) vaccinations are written down?
IF YES: May I see it please? YES, SEEN BY INTERVIEWER...................1NOT AVAILABLE/LOST/MISPLACED..........2NEVER HAD A CARD...................................3DONT KNOW...............................................8
47 49 49 49
47 (1) COPY VACCINATION DATE FOR EACH VACCINE FROM THECARD.
(2) WRITE 44' IN DAY COLUMN IF CARD SHOWS THAT AVACCINATION WAS GIVEN, BUT NO DATE ISRECORDED. DAY MONTH YEAR
DPT 1
D D M M Y Y Y Y
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NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
50
50A
50B
50C
50D
50E
50F
50G
Please tell me if (NAME) received any of the following vaccinations:
A BCG vaccination against tuberculosis, that is, an injection in the armor shoulder that usually causes a scar?
Polio vaccine, that is, drops in the mouth?
When was the first polio vaccine received, just after birth or later?
How many times was the polio vaccine received?
DPT vaccination, that is, an injection given in the thigh or buttocks,sometimes at the same time as polio drops?
How many times?
=======================================
In Rapid CATCH:An injection in the arm to prevent measles?
=======================================
YES 1
NO 2
DONT KNOW 8
YES 1
NO 2
DONT KNOW 8
JUST AFTER BIRTH 1
LATER 2
NUMBER OF TIMES |___|___|
YES 1
NO 2
DONT KNOW 8
NUMBER OF TIMES |___|___|
===========================
YES 1NO 2
DONT KNOW 8
==========================
43C 43E 43E
43F
43G 43G
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54 At any time during the illness did (NAME) takeany drugs for the fever?
Yes..1
No...2
Dont know.9
55
56
56
55 What drugs did (NAME) take?Any other drugs?RECORD ALL MENTIONED.
ASK TO SEE DRUG(S) IF TYPE OF DRUGIS NOT KNOWN. IF TYPE OF DRUG ISSTILL NOT DETERMINED, SHOW TYPICALANTIMALARIAL DRUGS TO RESPONDENT**COUNTRY SPECIFIC BASED ONNATIONAL MALARIAL PROTOCOL.
FOR EACH ANTIMALARIAL MEDICINEASK: How long after the fever started did(NAME) start taking the medicine?
CIRCLE THE APPROPRIATE CODES:SAME DAY = 0NEXT DAY AFTER THE FEVER = 1TWO OR MORE DAYS AFTER THE FEVER= 2DONT KNOW = 9
ANTI-MALARIAL
A. SP/Fansidar...0 1 2 9
B. Chloroquine0 1 2 9
C. Amodiaquine..0 1 2 9
D. Quinine....0 1 2 9
E. ACT..0 1 2 9
OTHER DRUGS
F. ASPRIN.0 1 2 9
G. PARACETAMOL0 1 2 9
X. Other...0 1 2 9
56 What causes malaria?RECORD ALL MENTIONED.
Anything else?
MOSQUITO BITES.....................................AWITCHCRAFT............................................BINTRAVENOUS DRUG USE .....................CBLOOD TRANSFUSIONS..........................D
INJECTIONS ..............................................ESHARING RAZORS/BLADES.....................FKISSING.....................................................G
OTHER W
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Malaria Insecticide-treated Net use
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
59 Does your household have any mosquito netsthat can be used while sleeping?
Yes.....1
No...2
60
64
60 Who slept under a bed net last night?
If ANYONE OTHER THAN THE CHILD ISMENTIONED, RECORD OTHER.
No One...0
Child (NAME)..1Other ..........2
64
61 57
61 Which brand of bed net did (NAME) sleepunder last night?
SHOW PICTURES OF TYPICAL NET TYPESAND BRANDS.
Permanent Net
Brand A............................................1
Brand B..2
Pretreated NetBrand C.....3
Brand D.....4
Other Net
Other N et .......5
Dont know brand.9
64
64
62
62
62
62
62 Was the bed net that (NAME) slept under lastnight ever soaked or dipped in a liquid treatedto repel mosquitoes or bugs?
Yes1
No..2
63
64
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OTHER_________________ X
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NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP66 When (NAME) had diarrhea, did you breastfeed him/her less than
usual, about the same amount, or more than usual?LESS..........................................................1SAME.........................................................2MORE........................................................3CHILD NOT BREASTFED.........................4DONT KNOW............................................8
67 When (NAME) had diarrhea, was he/she offered less than usual todrink, about the same amount, or more than usual to drink?
LESS..........................................................1SAME.........................................................2
MORE........................................................3NOTHING TO DRINK................................4DONT KNOW............................................8
68 Was (NAME) offered less than usual to eat, about the same amount, ormore than usual to eat?
LESS..........................................................1SAME.........................................................2MORE........................................................3NOTHING TO EAT....................................4DONT KNOW............................................8
69 Did you seek advice or treatment from someone outside of the homefor (NAMES) diarrhea?
YES............................................................1NO..............................................................2
70 74
70 Where did you first go for advice or treatment?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITETHE NAME OF THE PLACE.
_______________________________________________________(NAME OF PLACE)
HEALTH FACILITYHOSPITAL............................................01HEALTH CENTER................................02HEALTH POST.....................................03PVO CENTER......................................04CLINIC..................................................05FIELD/COMMUNITY HEALTH
WORKER.........................................06OTHER HEALTH
FACILITY____________ 07(SPECIFY)
OTHER SOURCETRADITIONAL PRACTITIONER..........08SHOP....................................................09PHARMACY.........................................10COMMUNITY DISTRIBUTORS 11
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NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
72 Where did you go next for advice or treatment?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITETHE NAME OF THE PLACE.
______________________________________(NAME OF PLACE)
HEALTH FACILITYHOSPITAL............................................01HEALTH CENTER................................02HEALTH POST.....................................03PVO CENTER......................................04CLINIC..................................................05FIELD/COMMUNITY HEALTH
WORKER.........................................06
OTHER HEALTHFACILITY _______________ 07(SPECIFY)
OTHER SOURCETRADITIONAL PRACTITIONER..........08SHOP....................................................09PHARMACY.........................................10COMMUNITY DISTRIBUTORS............11FRIEND/RELATIVE..............................12
OTHER ___________________ 88
(SPECIFY)
73 During the period when (NAME) was recovering from diarrhea, did yougive him/her less than usual to drink, about the same amount, or morethan usual to drink?
LESS..........................................................1SAME.........................................................2MORE........................................................3NOTHING TO DRINK................................4DONT KNOW............................................8
ORS preparation
74 Have you heard of ORS?
IF YES, ASK MOTHER TO DESCRIBE ORS PREPARATION FORYOU.IF NO, CIRCLE 3 (NEVER HEARD OF ORS).
ONCE MOTHER HAS PROVIDED A DESCRIPTION, RECORDDESCRIBED CORRECTLY.......................1DESCRIBED INCORRECTLY...................2
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NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
77 Did you seek advice or treatment for thecough/fast breathing?
Yes1
No..2
78
79
78Who gave you advice or treatment?Anyone else?
RECORD ALL MENTIONED.
Doctor.....A
Nurse...........................B
Auxiliary Nurse.C
Trained Community HealthWorker...D.Other..X
Water and Sanitation
79 Do you treat your water in any way to make it
safe for drinking?
Yes..1
No...2
79
81
80 If yes, what do you usually do to the water tomake it safer to drink?
ONLY CHECK MORE THAN ONERESPONSE IF SEVERAL METHODS AREUSUALLY USED TOGETHER, FOREXAMPLE, CLOTH FILTRATION AND
CHLORINE.
Let it stand and settle/sedimentation....A
Strain it through cloth..B
Boil.C
Add bleach/ChlorineD
Water filter (Ceramic, sand, composite)..E
Solar Disinfection.F
Other X
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NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
82 OBSERVATION ONLY: IS THERE SOAP ORDETERGENT OR LOCALLY USEDCLEANSING AGENT?
THIS ITEM SHOULD BE EITHER IN PLACEOR BROUGHT BY THE INTERVIEWEEWITHIN ONE MINUTE. IF THE ITEM IS NOTPRESENT WITHIN ONE MINUTE CHECK
NONE, EVEN IF BROUGHT OUT LATER.
Soap.................................................................1
Detergent.........................................................2
Ash...................................................................3
Mud/sand.........................................................4
None.................................................................5
Other .............................................................. 6
83
83
85 85
85 85
83 Did you use soap of any kind for any reasonyesterday during the day or night?
Yes.....1
No.2
83
85
84 When you used soap yesterday in the day ornight, what did you use it for?
RECORD ALL MENTIONED. DO NOT READTHE ANSWERS, ASK TO BE SPECIFIC,ENCOURAGE WHAT ELSE UNTILNOTHING FURTHER IS MENTIONED. IFWASHING MY OR MY CHILDRENS HANDSIS MENTIONED,PROBE WHAT WAS THE OCCASION, BUTDO NOT READ THE ANSWERS.
Before food preparation...................................A
Before feeding children...................................B
After defecation...............................................C
After attending to a child who has defecated .D
Other ............................................................ X
Growth Monitoring
85 Was (NAME) weighed at birth? YES..............................................................1NO................................................................2DONT KNOW..............................................8
86 Does (NAME) have a growth monitoring card?
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Child anthropometry
ASK THE MOTHER FOR PERMISSION TO WEIGH AND MEASURE (NAME). IF SHE AGREES TO LET YOUTAKE (NAMES) MEASUREMENTS, RECORD THE NECESSARY INFORMATION IN THE SPACES BELOW. IFTHE MOTHER REFUSES PERMISSION TO MEASURE (NAME), LEAVE COLUMNS 1-4 BLANK AND RECORD
3' [REFUSED] IN COLUMN 5.ASK TO MEASURE EACH OF (NAMES) SIBLINGS UNDER FIVE YEARS OF AGE. RECORD (NAMES)
MEASUREMENT IN THE FIRST ROW.
1
NAME OF CHILD
MEASURE (NAME)FIRST, THEN MEASURE
HIS/ HER BROTHERSAND SISTERS WHO ARE
UNDER AGEFIVE YEARS.
2
WHAT IS HIS/HER DATE OFBIRTH?
COPY DATE OF BIRTHFROM GM CARD, IF
AVAILABLE. IF GM CARD ISNOT AVAILABLE, RECORDDATE OF BIRTH PROVIDED
BY MOTHER.
3
WEIGHT(KILOGRAMS)
4
HEIGHT(CENTIMETER)
5RESULT
1MEASURED
2 NOTPRESENT
3 REFUSED6 OTHER
_______________
PB__________cm (child from 6 months) and PB_________ (mother)
Bilateral edema (child) NO ______YES________
THANK THE MOTHER FOR THE INTERVIEW.
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Appendix 5. Questionnaire (French)Demander a la mere si elle a un enfant age de moins de 24 mois qui vit avec elle. Si oui proceder a linterview. Si Non,remercier la maman et mettre fin linterview.
Identification
Num de la grappe
Num de la concession
Numero d enregistrement
Village
NOM de la mere
NOM du Superviseur
Saisie des donnees par : Date: ___/___/____Jour/mois/annee
1 2 3 Derniere visite
date dInterview ___/___/____ Jour/mois/annee
___/___/____Jour/mois/annee
___/___/____Jour/mois/annee
Du superviseur
jour
NOM de l interviewer Mois
annee
Resultat * Resutat
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CONSENTEMENT ECLAIRE
Bonjour. Je mappelle ______________________________, et je travaille avec Relief International et MSP. Nous effectuons uneenqute laquelle nous souhaiterions que vous participiez. Je voudrais vous poser des questions sur votre sant et sur la sant devotre plus jeune enfant de moins de deux ans. Ces informations seront utiles Relief International et MSP.) pour planifier des servicesde sant et pour valuer sils sont conformes avec les objectifs damlioration de la sant de lenfant. Lenqute prend habituellement60 minutes. Quelles que soient les informations que vous nous fournirez, elles resteront strictement confidentielles et ne serontdivulgues personne..
La participation cette enqute est volontaire et vous pouvez dcider de ne pas rpondre des questions personnelles ou toutes les
questions. Cependant, Nous esprons que vous allez participer cette enqute car ce que vous pensez est dun grand intrt.
Avez-vous maintenant des questions me poser concernant lenqute ?
Signature de lenquteur: ________________________________ Date: ____________________
LENQUTE ACCEPTE DTRE ENQUTE............1 LENQUTE REFUSE DTRE ENQUTE..............................2 FIN
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QuestionnaireTOUTES LES QUESTIONS DOIVENT TRE POSES AUX MRES AYANT UN ENFANT DE MOINS DE 24 MOIS
PrsentationNo. Questions and Filters Coding Categories SAUT
1 Combien denfants avez vous? Nombre total denfant
2 Quelle est le Nom, date de votre derniervivant?
Dernier enfant vivant
NOM _______________________________
sexeMasculin....1
Feminine...........2
Date de naissance
jour
Moisannee
Vaccination antittanique
NO. QUESTIONS AND FILTERS CODING CATEGORIES SAUT
3 Pendant la grossesse de (NOM), avez-vous reuune injection dans le bras pour protger le bb
Oui.....................................................................1Non 2
4 5
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Skilled attendance and clean cord care
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
7 Qui vous a assist pour laccouchement de(NOM) ?
Autre personne?
INSISTER POUR AVOIR LE TYPE DAGENT .ENREGISTRER TOUTES LES REPONSES
SI LENQUETEE DIT QUE PERSONNE NE LAASSISTER, INSISTER POUR SAVOIR SIAUCUNE AUTRE PERSONNE NASSISTER ALACCOUCHEMENT
AGENT DE SANTEMEDECIN.AINFIRMIERE/SF..BAUXILIAIRE.CAUTRE AGENT DE SANTEQUALIFIE*..D
AUTRE PERSONNESMATRON...EAGENT DE SANTE
COMMUNAUTAIRE...FMEMBRE DE LA FAMILLLE ...G
AUTRE__________.............................H(SPECIFIER)
PERSONNEY
8 Est-ce quon a utilis une trousse propre ou kitdaccouchement ?
(MONTRER LE KIT DACCOUCHEMENT)
Oui1Non...2Ne sait pas..9
10 9 9
9 Quel instrument a-t-on utilis pour couper lecordon ?
Lame de Rasoir Neuve.1
Lame neuve et lame bouillie2
Lame utilisee..3
Lame utilize et lame bouillie.4
Sciseaux neufs...5
Scisseau neuf ou bouillie..6Sciseaux utilise..7
Sciseaux utilize et bouillie8
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Schage et emballage aprs la naissance
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
13 Est ce que (NOM) a ete essuy ou secherimmediatement aprs sa sortie et avant la sortiedu placenta
Oui ....................................................................1Non....................................................................2Ne sais pas........................................................9
14 Est ce que (NOM) a ete envoloppe dans unecouverture immediatement aprs sa sortie etavant la sortie du placenta
Oui ....................................................................1Non....................................................................2Ne sais pas........................................................9
Allaitement / alimentation du nourrisson et du jeune enfant
15 Avez vous allait (NOM)? Oui ....................................................................1Non....................................................................2
16 19
16 Combien de temps aprs lanaissance avez-vous mis (NOM)
au sein pour la premire fois ?
SI MOINS D'UNE HEURE,NONTER '00' HEURE.SI MOINS DE 24 HEURES, NOTER ENHEURES.AUTREMENT, NONTER EN JOURS.
IMMEDIATE....................................................00
HEURES..............................................................
JOURS................................................................
NE SE SAIT PAS..............................................9
17 Au cours des 3 ou 4 premiers jours apreslaccouchement avant le premier lait,avez vousdonner a (NOM) le colustrum ; un liquide epaisproduit par le sein
OUI ...................................................................1
NON .................................................................2
NE SAIS PAS ...................................................9
18 Dans les 3 jours qui ont suivi la naissance,(NOM) est ce que (NOM) a bu quelque chose
OUI ...................................................................1
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22
22A
22B
22C22D
22E
22F
22G
22H
22I
Maintenant jaimerais vous poser desquestions sur les types de liquides que (NOM)a bus au cours de la journe et de la nuit. Est-ce que (NOM) a bu les liquides suivants hierau cours de la journe ou de la nuit?COCHEZ DANS LA CASE SI LENFANT A BU LELIQUIDE EN QUESTION.
Lait maternel ?
Eau Plate ?
Lait en poudre vendu en commerce ?Tout autre lait tel quen bote, en poudre, ou dulait frais danimal ?
Jus de fruit ?
Autres liquides tels que de leau sucre, du th,du caf, des boissons gazeuses ou du bouillon ?
Maintenant je voudrais vous poser desquestions sur les types daliments4 que
[NOM] a mangs hier au cours de la journeou de la nuit. Est-ce que [NOM] a mang lesaliments suivants au cours de la journe ou dela nuit dhier ? COCHEZ LA CASE SILENFANT A MANG LALIMENT ENQUESTION.
Des aliments base de graines [par exemple, mil,sorgho, mas, riz, bl, bouillie, ou dautres graineslocales] ?
Citrouille, ignames rouges ou jaunes ou de la
courge, des carottes ou des patates doucesrouges ?
Tout autre aliment base de racines ou detubercules [par exemple, les pommes de terre, les
A............................................
B............................................
C............................................
D............................................
E............................................
F............................................
G............................................
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NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
23Combien de fois (NOM) a t-il mang un alimentsemi-solide (broys ou en pure) au cours de la
journe ou de la nuit dhier ?
SI 7 FOIS OU PLUS, ENREGISTREZ 7.
NOMBRE DE FOIS
NE SAIT PAS ........................................8
24Puis-je voir le sel utilis pour la cuisine ?PRENEZ UNE CUILLERE A CAF DE SEL ET
TESTEZ-LE POUR LIODE.
IODE PRESENT........................................1
IODE PAS PRESENT 2
25Est-ce que (NOM) a reu une dose de Vitamine Acomme celle-ci au cours des six derniers mois ?MONTREZ LAMPOULE/CAPSULE /SIROP.
OUI............................................................1
NON...........................................................2
NE SAIT PAS ..8
Visite post-partum (pour la mre)
26 Ou avez vous accouch (NOM)? MAISON (sienne ou autre)................................1
CENTRE DE SANTE (public ou prive) .............2
33
27
27 Aprs la naissance de (NOM) et avant votredepart de lhopital, est que un agent de santevous a examin ?
Oui.....................................................................1
Non....................................................................2
28
30
28 Combien de temps aprs laccouchement lagentde sante est venu vous examiner?
SI MOINS DUN JOUR NONTER EN HEURES,SI MOINS DUNE SEMAINE, NONTER EN JOUR
Heures.................................................................
JOURS.................................................................
SEMAINES..........................................................NE SAIT PAS..................................................99
29 Q i i t? AGENT DE SANTE
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31 Aprs laccouchement, quand est cette visite estintervenu?
SI MOINS DUN JOUR NONTER EN HEURES,SI MOINS DUNE SEMAINE, NONTER EN JOUR
Heures.................................................................
JOURS.................................................................
SEMAINES..........................................................
NE SAIT PAS..................................................99
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
32 Qui vous a examine en ce temps la?
NONTER LA PERSONNE LA PLUS QUALIFIEE.
AGENT DE SANTEMEDECIN..........................................................AINFIRMIER/CLINICIEN.......................