dec 1993 - world health organization2.2 national ari and cdd prowammes the national cod programme...
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(WP)ICP/CDD/001-E Report series no.: RS/93/0082 (Annex 1)
REPORT ~
DIARRHOEAL DISEASES CONTROL AND ACUTE RESPIRATORY INFECDONS
HOUSEHOLD CASE MANAGEMENT SURVEY
VIENTIANE MUNICIPALITY, LAO PEOPLE'S DEMOCRATIC REPUBLIC
19 April- 10 May 1993
Joint report of the
National CDD and ARI Programmes and WHO
Not for sale
Printed and distributed by the
Regional Office for the Western Pacific of the World Health Organization
Manila, Philippines July 1993
WHOifVPRO LffiRARl lianiUJ. Pki/tip~
2 o DEC 1993
English only
NOTE
The views expressed in this joint report are those of the survey team and do not necessarily reflect the policies of the World Health Organization.
This joint report has been prepared by the Regional Office for the Western Pacific of the World Health Organization for the Government of Lao People's Democratic Republic.
CONTENTS
1. INTRODUCfiON ................................................................................................................ 1
2. BACKGROUND................................................................................................................... 1
2.1 Lao People's Democratic Republic........................................................................... 1 2.2 National ARI and COD programmes....................................................................... 1
3. OBJECfiVES OF TI-lE SURVEY .................................................................................... 2
4. METI-IODS............................................................................................................................. 2
4.1 Geographic area covered............................................................................................. 2 4.2 Sampling design............................................................................................................. 3 4.3 Survey instrument......................................................................................................... 3 4.4 Training of supervisors and surveyors....................................................................... 4 4.5 Analysis of data............................................................................................................. 4
5. RESULTS ............................................................................................................................... 5
5.1 Diarrhoeal diseases...................................................................................................... 5 5.2 Acute respiratory infections ....................................................................................... 10 5.3 Breast-feeding............................................................................................................... 13
6. DISCUSSION........................................................................................................................ 13
6.1 Annual diarrhoea incidence and two-week ARI prevalence................................ 14 6.2 Care-seeking behaviour .............................................................................................. 14 6.3 Home management of diarrhoea .............................................................................. 15 6.4 Drug use........................................................................................................................ 15 6.5 Breast-feeding ............................................................................................................... 16 6.6 Care for diarrhoea and acute respiratory infections
from the health system ................................................................................................ 16
7. CONCLUSION ..................................................................................................................... 16
ANNEXES:
ANNEX I - LIST OF SELECTED CLUSTERS ....................................................... 17
ANNEX 2 • SURVEY QUESTIONNAIRE ............................................................... 21
ANNEX 3 • LIST OF PARTICIPANTS ...................................................................... 55
ANNEX 4 • SCHEDULE OF TRAINING ................................................................ 57
ANNEX 5 • SUPERVISOR'S CHECKLIST .............................................................. 61
ANNEX 6 - SURVEY SUMMARY ............................................................................ 63
ANNEX 7 • LIST OF DRUG CLASSIFICATIONS ................................................ 67
EXECUTIVE SUMMARY
A control of diarrhoeal diseases (CDD)/acute respiratory infections (ARI) household case management survey was conducted in Vientiane Municipality, Lao People's Democratic Republic from 19 April to 10 May 1993. The survey was designed to collect information on population's knowledge about the diseases, care-seeking and home treatment practices.
The objectives of the study were the following:
(a) to assess diarrhoea and acute respiratory infection case management practices in the home;
(b) to collect baseline data on diarrhoea and ARI morbidity in children under five years of age, and on major programme indicators;
(c) to use data collected on care-seeking behaviours of caretakers to guide programme decisions about health education messages for the public and training of health workers;
(d) to assess breast-feeding practices in children under 4 months of age;
(e) to develop national technical capabilities to carry out similar health surveys in the future.
Data were collected through interviews with caretakers of children under 5 years of age using a standard cluster sampling technique. The survey focused on children with diarrhoea, cough or difficulty in breathing in the two weeks preceding the data collection.
A total of 2593 households were surveyed and the same number of caretakers were interviewed. Some 4111 children under five years of age were found. Of these children 7% had diarrhoea on the day of the interview or in the past two weeks. When converted to incidence and adjusted for seasonality, this indicates approximately 1.3 episodes of diarrhoea per child in a year. Some 22% of the children had cough and 3% had pneumonia on the day of the interview or in the past two weeks.
The characteristics of care-seeking behaviour were found to be very similar in both diseases: Regardless of whether their child had diarrhoea or ARI, the mothers were not very well aware of when they should seek care from a health care provider. Few caretakers knew which signs to look for in the sick child. Only about one flfth of the mothers had correct knowledge of when to seek care for a child with diarrhoea or ARI.
Both CDD and ARI programmes need to focus on informing caretakers about when to take their children to health care providers. This could be achieved by giving more emphasis on the communication component during training courses and by developing country-specffic, appropriate communication messages.
Considering the early stage of the COD programme, the promotion of ORS has been successful. The relatively high oral rehydration salts (ORS) and oral rehydration therapy (ORT) use rates- 40% and 55%, respectively- are an encouraging fmding. However, it
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should be noted that the survey did not give information on how ORS was prepared, i.e., the proportion of caretakers who prepared ORS correctly.
In contrast, the extremely high rates of unnecessary drug use in treating diarrhoea and ARI indicate a serious problem in home management. As many as 88% of the children received one or more drugs for diarrhoea, and some 25% of children with ARI were given a harmful drug. This finding also implies a problem in the quality of care provided by both public and private health care sectors. Both CDD and ARI programmes should give high priority to efforts to reduce inappropriate drug use.
In children under four months of age, breast-feeding is a common practice but exclusive breast-feeding is rare. It is worth noting that the proportion of children who were bottlefed is 39%. This is likely to increase owing to the persistent marketing efforts of infant formula manufacturers.
Integrated evaluation of the CDD and ARI programmes followed logically the combined training courses they have conducted. It also demonstrated an effective way to conserve personnel and other resources within the MCH Institute and further encouraged programme integration.
By conducting this study a baseline was established, against which changes in diarrhoea and ARI morbidity and major programme indicators can later be measured. It must be emphasized, though, that the data collected are only representative of Vientiane Municipality, not the entire country. Since significant differences are highly likely to exist between the Municipality and rest of the country, further surveys are needed to collect data from different areas to make nationwide estimates.
1. INTRODUCTION
Acute respiratory infections and diarrhoeal diseases continue to be major causes of mortality and morbidity in children under five years of age in developing countries.
To assist national disease control programmes in effective planning, management and evaluation of their activities, the Acute Respiratory Infections (ARI) and Diarrhoeal Diseases Control (CDD) programmes have recently developed a methodology for combined assessment of diarrhoea and acute respiratory infection case management practices in the home. The survey is designed to collect information on population's knowledge about the diseases, careseeking and home treatment practices.
2. BACKGROUND
2.1 Lao People's Democratic Republic
Lao People's Democratic Republic is a landlocked country with 4.3 million inhabitants. The estimated infant mortality and under-five mortality rates are 101/1000 and 148/1000, respectively (United Nations Population Division estimate for 1990). Acute respiratory infections and diarrhoeal diseases are regarded to be among the largest contributors to these rates, which are among the highest in the region.
2.2 National ARI and CDD prowammes
The national COD programme was established in 1982 and the national ARI programme in 1987. They are under the responsibility ofthe Maternal and Child Health Institute (MCHI). The activities of the COD programme have been mainly concentrated on training of government health workers in correct diarrhoea case management, establishment of oral rehydration therapy (ORT) corners at provincial and district level hospitals, and supply and distribution of oral rehydration salts (ORS). The ARI programme has also trained staff in clinical case-management, and distributed antibiotics, although not on a regular basis.
The CDD programme is distributing ORS to the government health facilities in the provinces. Drugs for ARI, however, are rarely available in these facilities, and the caretakers of children usually need to buy them from private pharmacies.
The ARI and CDD programmes started conducting integrated training courses in 1991. Each of the hospitals and dispensaries in Vientiane Municipality now has at least one member of staff trained in standard CDD and ARI case management. During the training, health staff have been trained in giving advice on home treatment of diarrhoea and ARI but no major communication activities targeted at the public have taken place.
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3. OBJECfiVES OF THE SURVEY
No current data are available on home treatment practices of either diarrhoea or acute respiratory infections. In order to obtain data for effective planning and to strengthen the capacity of national staff to conduct evaluation activities, a combined CDD / ARI household survey was initially planned during the CDD Review and Planning Meeting in Vientiane in January 1993. Preparations for the survey were started shortly after the meeting.
The objectives of the survey were formulated as follows:
(a) to assess diarrhoea and acute respiratory infection case management practices in the home;
(b) to collect baseline data on diarrhoea and ARI morbidity in children under five years of age, and on major programme indicators;
(c) to use data collected on care-seeking behaviours of caretakers to guide programme decisions about health education messages to the public and training of health workers;
(d) to assess breast-feeding practices in children under four months of age;
(e) to develop national technical capabilities to carry out similar health surveys in the future.
4. METHODS
4.1 Geo~auhic area covered
The country is divided administratively into 16 provinces and one municipality. Vientiane Municipality contains the capital and has a population of about 450 000, divided between rural and urban areas. The estimated proportion of children under five years of age is 15 % of the total population.
A community-based survey was conducted in Vientiane Municipality and Champasak Province in 1986 to estimate morbidity and mortality from Expanded Programme on Immunization (EPI) target diseases and diarrhoeal diseases. In the Municipality, the incidence of diarrhoea was calculated to be 2.1 episodes per child per year, and some 27% of children with diarrhoea were treated with ORS.
Vientiane Municipality has the most developed health infrastructure in the country: there are six central hospitals, eight district hospitals and 35 government dispensaries. According to the EPI databank, an estimated 40% of the population lives within three kilometres of a government health facility. There also exists an extensive network of private pharmacies and practitioners which is rapidly expanding.
Seven of the eight districts in Vientiane Municipality were selected as the survey area in view of their accessibility and since they have a population large enough for the
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survey. The Municipality is also an area in which the impact of the CDD and ARI programmes is expected to be greatest.
4.2 Sampling design
The survey was conducted from 19 April to 10 May 1993. This period coincides with the beginning of one of the diarrhoea peak seasons. Data were collected through interviews with caretakers of children under five years of age, using the standard WHO cluster sampling technique. The survey focused on children with diarrhoea, cough or difficult breathing in the two weeks preceding the data collection.
The sample size was 1etermined according to the procedures described in the WHO Household Survey Manual. The total number of children required in the sample was calculated to be 4000 (40 children per cluster).
There are no reliable previous data on diarrhoea and ARI morbidity or careseeking and treatment rates of these conditions. Therefore, the sample size was based on the rough prevalence estimates of 10% for both diarrhoea and pneumonia, and 95% confidence level.
The communities in which clusters were located were selected from a comprehensive list containing all the 438 villages in the seven selected districts of Vientiane Municipality. From this sampling frame 100 villages were selected according to "probability proportionate to population size" principle. A village was chosen as the unit in which the clusters were located for logistic reasons and because it is an easily identified administrative and geographical unit (Annex 1: List of selected clusters).
Within the villages, the groups of households in which interviews were conducted were identified by means of standard random selection procedures. Each team of surveyors covered one cluster a day and found at least 40 children in a cluster.
4.3 Survey instrument
A draft WHO manual for a combined CDD/ARI household survey was used as a basis for developing the questionnaire and survey procedures. The survey instrument was adapted to take into account local conditions, terminology and national CDD and ARI policies.
The survey questionnaire included four sections corresponding to different topics being investigated. Each section was printed on differently colored paper:
( 1) White: This section contains questions asked at all households; questions asked at all households with children under age five about symptoms experienced in the past two weeks; caretaker's knowledge of when to seek care, and how to treat diarrhoea at home; and questions about breast-feeding and fluids given to children under the age of four months.
(2) Green: questions about careseeking for cough and drugs used for cough.
1 Household survey manual: Diarrhoea case management, morbidity and mortality (CDD/SER/86.2 Rev. 1 (1989), Geneva, Diarrhoeal Diseases Control Programme, World Health Organization, 1989.
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(3) Yellow: questions about careseeking for ANAs (ARI needing assessment, i.e., having fast or difficult breathing), drugs used for these conditions.
( 4) Pink: questions about treatment of diarrhoea , use of oral rehydration salts (ORS) and recommended home fluids, use of drugs for diarrhoea, and sources of advice for ORS (Annex 2: Survey questionnaire).
The translation of the forms was reviewed by a group of staff working with the programmes. In March 1993, the questionnaire was first field-tested in two villages. After required revisions, a second pre-test was carried out at out-patient departments of two hospitals.
4.4 Trainine of supervisors and surveyors
The interviewers were health workers from Mother and Child Health Institute, Institute of Health Education and Vientiane Municipality Health Services. The supervisors were staff from the MCH Institute, National Institute for Hygiene and Epidemiology and Vientiane Municipality Health Services (Annex 3: List of participants).
The training of surveyors and supervisors was conducted in two stages at the MCH Institute (Annex 4: Schedule of training): First, a five-day training course in English for ten supervisors was carried out. The training included the following components: thorough question-by-question explanation of the survey instrument, role plays, drills and group discussions on the use of the questionnaire and survey procedures, as well as supervisors' duties. One day was used for field practice and the supervisors also participated in the field practice during surveyor training. During the data collection, close attention was paid to the quality of supervision (Annex 5: Supervisor's checklist).
Following the supervisor training, the two national coordinators and two supervisors trained 30 surveyors with a similar schedule. The surveyor training was conducted in Lao and included two days of field practice.
4.5 Analysis of data
The data were analysed using standard software. A Lotus 1-2-3 spreadsheet, developed by the WHO/CDD and ARI programmes, was modified to meet the requirements of this survey protocol. The formula used for the calculation of the limits of precision (95% confidence intervals) of a rate accounts for the non-random component (design effect) due to the cluster sampling procedure (i.e. homogeneity within clusters).2
Data were entered at the end of each day after the supervisors and coordinators had reviewed and checked the forms for errors and inconsistencies. In this way it was possible to continuously monitor the quality of data. There was practically no need to clean or disregard the data collected, which speaks of their good quality.
The monitoring of field procedures and the recording of information during the survey made the data ready for analysis as soon as the survey was finished. Subsequently, the comprehensive survey report was prepared, and preliminary copies of the report, computer printouts and graphics were available to the national CDD and ARI programmes within one week following completion of data collection.
2Bennet S. et al.: "A simplified general method for cluster-sample surveys of health in developing countries", World Health Statistics Quarterly 44(3): 98-106 (1991).
f
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5. RESULTS
A summary of all the rates obtained with their respective limits of precision is presented in Annex 6.
5.1 Diarrhoeal diseases
5.1.1 Diarrhoea prevalence and incidence
A total of 2593 households were surveyed and 4111 children under five years of age were found. Of these children 269 (7%) had diarrhoea on the day of the interview or in the past two weeks (Figure 1 ). When converted to incidence and adjusted for seasonality, this indicates approximately 1.3 episodes of diarrhoea per child in a year. Fifteen percent of the diarrhoea cases were dysentery.
% 25
20
15
10
5
0 COUGH
Figure 1. Two-week prevalences -Diarrhoea, cough, ANA*
DIARRHOEA ANA
*ANA -Acute respiratory infections needing assessment
1•% OF CHILDREN I
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5.1.2 Key CDD programme indicators
(a) Correct knowledge of home therapy:
The criteria for this indicator consist of knowing to increase fluids and continue feeding during a diarrhoea episode, as well as knowing at least two reasons of when to take a sick child to a health worker or health facility.
Some 20% of caretakers knew at least two reasons for seeking care for diarrhoea, 42% knew they should give more fluids, and 77% knew they should give the same amount as normal, or more food during diarrhoea. However, only 9% of caretakers knew all three rules of correct home care (Figure 2).
Figure 2. Knowledge of home treatment of diarrhoea
% 100r---------------------------------------~
40
20
0 CARESEEKING FLUIDS FEEDING THREE RULES *
• % OF CARETAKERS * CORRECT KNOWLEDGE = ALL THREE RULES
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(b) Correct case management:
In slight contrast to the rates obtained in knowledge interviews, 62% of the cases were actually given more fluids during diarrhoea, and 49% of were given the same amount or more food. During an episode of diarrhoea 31% of the children were treated correctly, i.e., were given both increased fluids and continued feeding (Figure 3).
The apparent discrepancy between knowledge and practice may reflect the way questions were asked in the knowledge interview section of the questionnaire: It sometimes seemed difficult for the mothers to understand the knowledge question and distinguish it from what they usually do. The order in which the questions were asked may also have influenced the results: knowledge questions were asked before practice questions.
Figure 3. Diarrhoea home management practices
%
100.----------------------------------------,
FLUIDS CONTD.FEEDING CORRECT MANAGEMENT *
.% OF CASES * BOTH INCREASED FLUIDS AND CONTINUED FEEDING
(c) Access to ORS
Access to ORS was measured by a community investigation carried out by the supervisors. This indicator determines if the people in the cluster have a regular supply (government or private provider) of ORS in their community. In Vientiane Municipality 85% of the population was found to have access to ORS.
When access to ORS was reported in the cluster, the provider of ORS found was a private pharmacy in 60% and a government provider in 35% of the villages.
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5.1.3 Use of ORS, RHF and ORT
ORS solution was given in 40% of the diarrhoea cases. When ORS was given, the main sources of advice to use it were government health staff (34% of cases) and village health workers (24% of cases). The advice to use ORS was given by drug sellers in 18% and by private practitioners in 15% of cases (Figure 4).
Figure 4. Source of advice to give ORS
GOVERNMENT
PHARMACY VILLAGE HW
OTHER
According to the national COD policy, rice water, coconut water or tea are the recommended home fluids (RHFs). Some 40% of diarrhoea episodes were treated with one or more RHF. The oral rehydration therapy (ORT) use rate was found to be 55%. This rate includes cases given ORS and/or a RHF (Figure 5).
o/o Figure 5. Oral rehydration rates 100.---------------------------------------
ORS USE RHF USE ORT USE*
• o/o OF DIARRHOEA CASES
* ORS AND/OR RHF OAT = ORAL REHYDRATION THERAPY RHF = RECOMMENDED HOME FLUID
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5.1.4 Drug use
As many as 88% of the children received one or more drugs for diarrhoea. Multiple drug use was widespread: 24% of the cases received two, 19% three, and 12% more than four different drugs. Fifty-one percent of diarrhoea cases received antibiotics but only 12% were given an antidiarrhoeal drug (Figures 6 and 7). A considerable proportion, 26%, of the drugs given could not be identified. This has an effect on the accuracy of the findings: the actual rates of drug use are likely to be even higher.
Since the proportion of dysentery was only 15% of diarrhoea cases, the antibiotic use is clearly excessive. Despite the extensive antibiotic use, only 28% of children with dysentery received an antibiotic considered to be appropriate according to the national CDD policy (ampicilline, co-trimoxasole or nalidixic acid).
Figure 6. Drug use - Diarrhoea
% 100r-----------------------------------~
88
80
60
40
20
0 ANY DRUG ANTIBIOTIC ANTIDIARRHOEAL
.% OF CASES 26% OF DRUGS GIVEN COULD NOT BE IDENTIFIED
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Figure 7. Multiple drug use in diarrhoea
% 35,---------~3~2------------------------~
15
10
5
0 NO DRUGS 1 DRUG 2 DRUGS 3 DRUGS 4+ DRUGS
.% OF CASES
5.2 Acute respiratoty infections
5.2.1 Two-week prevalence of ARI:
Some 22% of the children had cough and 3% had pneumonia on the day of the interview or in the past two weeks.
5.2.2 Key ARI programme indicators:
(a) Correct knowledge of when to seek care:
In order to count as having correct knowledge, the caretaker had to mention either fast or difficult breathing, since these are the key signs to recognize in pneumonia. "Abnormal breathing" was added as a local term referring to breathing difficulties. Using this standard, 18% of caretakers knew when to seek care for a child having illness with cough. Specifically, 7% of caretakers knew that fast breathing, 10% that difficult breathing and 2% that abnormal breathing was a reason to seek care (Figure 8). Fever was mentioned as a reason to seek care for a child with cough by 38% of the caretakers.
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Figure 8. Care-seeking knowledge - ARI
% 100~------------------------------------~
80
60
40
20
0
. - . - - - - . . . . - - . . . - . . . - - - - - - - . - . - - - - . . - . - . . - . . . - . . - . . . - - - - . - . . - - - . - - -
. . . . . - - . . - . . . . - - - - . . . - - . . . . . . . . . . - . . . . . . . . -. - - .... - --- .. - - . --- ... - -
..... - - -- .. - ... - - ...... . . . . . . - - . - - ......... - - ...... - . . . . --- - ..... - .
BREATHING 18 . - . - - . -- .... - .. - . - . - .. -- .. - - . - - - .. -- - .... - .. - ............. - . -- . - - . -
10 2
FAST DIFFICULT ABNORMAL CORRECT KNOWLEDGE*
• % OF CARETAKERS
* CARETAKER MENTIONS EITHER FAST, DIFFICULT OR ABNORMAL BREATHING
(b) Careseeking from appropriate providers for ARI needing assessment (ANA)
ANAs are cases of acute respiratory infection needing assessment, i.e., having fast or difficult breathing. An appropriate provider is defined as one who has been trained in standard ARI case management and supplied with appropriate antibiotics, or other providers expected to deliver adequate ARI case management. In this survey government hospitals and health centres were defmed as appropriate providers.
After recognizing that the child had breathing difficulties, the caretakers sought care from appropriate health care providers in 33% of these cases. In practically all of the cases this was also the first provider they went to.
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Care was sought from pharmacies and private practitioners in 49% of ANA cases. When a child had cough 62% of caretakers sought care from either pharmacies or private practitioners, and only 16% went to government facilities (Figure 9). Eighteen percent went to traditional healers in case of ANA.
Figure 9. Careseeking for ARI
GOVERNMENT** PRIVATE
RNMENT
LLAGE HW VILLAGE HW
PHARMACY
OTHER
ANA* COUGH
* ARI NEEDING ASSESSMENT ** APPROPRIATE PROVIDER
5.2.3 Drug use
(a) Antibiotic use for cough:
It was found that 56% of children with cough were given an antibiotic. This provides an estimate of inappropriate use of antibiotics in children with no signs of pneumonia.
(b) Harmful drug use for cough or ANA
Drugs were defined as harmful on the basis of the following criteria:
Recommendations of the ARI programme
Drugs containing the following ingredients: codeine, alcohol, high dose antihistamines, steroids, topical anesthetic sprays, topical nasal decongestants in infants, phenylephrine, phenylpropanolamine, atropine, toxic expectorants.
If a drug contained more than one of the following potentially harmful components it was considered harmful: dextromethorphan, low dose antihistamines, mucolytics, pseudoephedrine.
All injections for cough were considered harmful.
(Annex 7: List of drug classifications)
NOT BR 9%
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According to these criteria, 25% of children with cough or ANA were given a harmful drug. Another 25% of drugs given for cough or ANA could not be identified. Since unidentified drugs were not counted in the numerator of antibiotic use for cough and harmful drug use rates, the rates for inappropriate drug use are probably underestimates.
5.3 Breast-feeding
A high proportion, 91%, of children under four months old were breast-fed in the last 24 hours. However, only 8% were exclusively and 34% predominantly breast-fed (Figure 10).
As an indicator of infant formula use, some 39% of the children were bottlefed.
Figure 10. Breast-feeding practices -children under 4 months
BREASTFED 91%
PREDOMINANTLY 34%
PARTIALLY 58%
ALL CHILDREN BREASTFED CHILDREN
6. DISCUSSION
It must be emphasized that the data collected are only representative of Vientiane Municipality, not the entire country. The situation in the Municipality probably represents a best-case scenario: the CDD and ARI programmes in this area are the most developed in the country. Since significant differences are highly likely to exist between the Municipality and rest of the country, further surveys are needed to collect data from different areas to make nationwide estimates.
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6.1 Annual diarrhoea incidence and two-week ARI prevalence
The annual incidence of 1.3 episodes of diarrhoea per child per year found in this study is lower than the previous estimate of 2.1 episodes per child per year from 1986. Moreover, the prevalence rate of 7% is relatively low considering the timing of the survey, which coincided with the start of diarrhoea season.
To determine whether there has been a true decrease in the incidence rate or not will require further studies. A true decrease might be a reflection of the significant improvements in socio-economic conditions, that have taken place in the survey area over the past seven years.
The two-week prevalence figures for cough (22%) and pneumonia (3%) are in line with what was expected, since it was not the peak season for pneumonia. No previous community-based data are available for comparison of the ARI frequencies.
6.2 Care-seekin~ behaviour
The characteristics of care-seeking behaviour were found to be very similar in both diseases: Regardless of whether their child had diarrhoea or ARI, the mothers were not very well aware of when they should seek care from a health care provider. Few caretakers knew which signs to look for in the sick child. Only about one-fifth of the mothers had correct knowledge of when to seek care for a child with diarrhoea or ARI.
When a child has an episode of diarrhoea each of the three rules of home care play an important role in preventing dehydration and death. In contrast, there is no evide~ce to suggest that home treatment of coughs and colds prevents progression to pneumonia. Therefore, in case of possible pneumonia, the ARI programme emphasizes prompt and appropriate care-seeking.
When a child had a cough, care was sought in the majority of cases from pharmacies and private practitioners. Similarly, when a child had ARI needing assessment, almost half of the cases went to seek care from the private sector. Approximately one-third of the ANA cases went to appropriate providers first after development of breathing difficulties, which can mean significant delay in the rest of the cases.
Both CDD and ARI programmes clearly need to focus on informing caretakers about when to take their children to health care providers. This could be achieved by giving more emphasis on the communication component during training courses and by developing country-specific, appropriate communication messages.
In particular, the ARI home care instructions should be carefully adapted to the community and communicated directly to families in health facilities or in the community.
In view of the major role played by the private drug sellers and practitioners, appropriate providers for AN As cannot continue to be only restricted to the government sector. They must be expanded to include private practitioners as well. Strategies should be developed in order to reach them with correct information and training. A situation analysis and a country assessment are required to investigate the feasibility of different approaches in this difficult task.
3childhood Pneumonia: Strategies to meet the Challenge". Proceedings of the First International Consultation on the Control of Acute Respiratory Infections (ICCARI), Washington D.C., U.S.A., December 1991. London, U.K., AHRTAG, 1992.
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6.3 Home mana&ement of diarrhoea
The high increased fluid rate is a promising finding. However, this cannot be entirely attributed to programme efforts because no major communication activities have taken place, but rather may mainly represent a baseline level of mothers' usual behaviour.
Almost half of the children received less food. This finding reinforces the significance on focusing communication messages on the importance of continued feeding in addition to improving mothers' knowledge of when to seek care.
Considering the early stage of the CDD programme, the promotion of ORS has been successful. The relatively high ORS and ORT use rates are an encouraging finding. However, it should be noted that the survey did not give information on how ORS was prepared, i.e., the proportion of caretakers who prepared ORS correctly.
Moreover, the very high ORS access rate cannot be taken as indicative of the rest of the country, because a similar extensive network of private pharmacies and health facilities does not exist in other provinces.
Since the findings imply that drug sellers tend to advise mothers to use drugs instead of ORS, focusing on improving their prescribing practices will be an important strategy in further promotion of 0 RS.
ORS has received much attention in the past but there have been no major efforts to promote recommended home fluids. The potential of using recommended home fluids in the prevention of dehydration is therefore probably still underutilized. Since RHF's are cost-effective, the home fluids seem to be accepted and there seems to be no tradition to restrict fluids during a diarrhoea episode, it should be feasible to reinforce the promotion ofRHFs.
Education and information on treatment of dysentery should receive more attention since there seems to be no notion among caretakers that dysentery should be treated differently from watery diarrhoea.
6.4 Drut: use
The extremely high rates of unnecessary drug use in treating diarrhoea and ARI indicate a serious problem in home management. They also indicate a problem in the quality of care provided by both public and private health care sectors.
It is well established that most drug use for diarrhoea and antibiotic use for cough is inappropriate. While more than half of both diarrhoea and cough cases received an antibiotic, antidiarrhoeal use was not very common. It appears that antibiotics are being regarded as a standard solution to various health problems. It is also alarming that a quarter of ARI cases received a drug classified as harmful.
Furthermore, the excessive drug use also indicates that families are spending considerable sums of money on drugs that are not only unnecessary but often harmful. Both CDD and ARI programmes should give high priority to efforts to reduce inappropriate and harmful drug use. Development of a training package for drug sellers should be considered. Since many factors influence regulation of pharmaceuticals, collaboration with other programmes, such as the Essential Drugs Programme, is crucial in this issue.
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6.5 Breast-feedin~
In children under four months of age, breast-feeding is a common practice but exclusive breast-feeding is rare. It is worth noting that the proportion of children who were bottlefed is 39%. This is likely to increase owing to the persistent marketing efforts of infant formula manufacturers.
The issues of supporting breast-feeding and legislation concerning infant formula should be addressed promptly by collaborative efforts. Health workers should be trained in breast-feeding counselling skills. The data collected should be communicated to organizations involved in breast-feeding promotion and the responsibilities for coordinating breast-feeding activities should be clarified.
6.6 Care for diarrhoea and acute respiratorv infections from the health system
Even though the study was not designed to assess the quality of health care provided, the fmdings imply that the quality of care from both private and public sector needs to be improved. This is especially the case with drug prescribing practices.
The fmdings also confirm the low utilization of government health services. A possible reason for this may be the lack of appropriate drugs and supplies these facilities often face. A facility-based assessment is required to evaluate the quality of diarrhoea and ARI case management at hospitals and health centres.
7. CONCLUSION
Disease control programmes require different types of information at various stages of the programme. At the early stage of programme development data are needed on the extent of the target diseases for effective planning. By conducting this study a baseline was established, against which changes in diarrhoea and ARI morbidity and major programme indicators can later be measured.
A key issue is that the information collected should be used in further programme development, and the findings of the survey should result in changes in programme planning and implementation.
Integrated evaluation of the CDD and ARI programmes followed logically the combined training courses they have conducted. It also demonstrated an effective way to conserve personnel and other resources within the MCH Institute and further encouraged programme integration.
The objective to strengthen national technical capabilities was successfully accomplished, and the MCH Institute now has a team capable of conducting similar surveys in the future.
- 17 -
ANNEX 1
~1u~u1u ~ §nr.Ban c~a~1e1m~n NAME OF THE CLUSTER VILLAGES FOR THE SU~V;:Y:
~U~1J NAME OF THE
VILLAGES
- ~1U~U ~1U~UU~2 !
-C!.USTER
NO.
mJn1c§au mJmnn No.OF HOUSES TOT~L ?0?.!
u.~um:uB I CKANTFJGUOREE DISTRICT: 12 V . . 1 ~e:m~1n n1J I SISAWATH
2 Oieftcm~a I KATSADEE NEVA
3 2~moJcm~g I KOUALUANG NEVA
4 amau I SEEHOME
5 ~~JDu iJ I"XIENG YEUN
6 m1u,en I HI-SOK
7 e:::r.o•iJ I XA-VANG
8 1 - iJ~~JU1J I THONGSANGNANG
9 '~ue:mo1J I PHONSAVANG
10 nJU1~IDU I DONGPALA?
'' GiJ~u~1~n I THONGKANK~~ TAI
:2 mJ~u I THONG TOUM
1 • _ .. 15 1 -.o
17
18
19
20
U1~1UU1Q1INAXAITHONG
u1n~sn I PAK liATT
1J1111UU1QJ"'tn I NAXAITHONG T.>.I
u'Ju1J i NAYANG
m~2o I HOUA KOUA
~h~ "'tn I ELY TY
u1msu I NA THON
twuuoJ I PHOL MOUANG
1J1~1 I NA GNA
276
202
384
295
284
312
297
330
233
283
282
285
DISTRICT:B v. 200
21i , ' . _oo
205
155
37
158
194
u."t~m1!'1 l X? TF.A NEE DISTRICT:21 21 ngumuu I DONE NOUN 480 . 22 U11J~I1 I BAN XY 169
23 tran<tmil I KOK GNY 79 24 ~1J~ ! XANG KOU 242 . 25 nJtnn I DONGDOK 498 26 a 51~ I XEEVELY 255 2i U~UU1 I BAN NA 408 28 ~1Cl£l01CJ I LAT KOIE 288 29 twu"'t~ I PHOL XY 180 30 m1nan~1 I TKA DOK KHAM 53 31 ~eJaEiu I SAING OUDOH 117 . . . 32 iiiJilJ I THONG KANG 265 33 Gi~~oJ I HOUA XIENG 327
1387
1312
2153
1604
1333
1575
1907
1 ·~cs
1.206
1786
1~i0
1570
12.05
12.90 a·-- 0 ~
1!51
955
666
1059
612
v. 1487
1096 . ! 477
1367
1667
1594
2457
1751
1193
32
586
!- 1713
2042
Annex 1
34
35
36
37
38
39
40
41
42 A." _.,
44
45
' -.. o
A.-- I
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
!
- l8 -
U"':Jgu I liA LOHE 63 O:)~~"'U I DONG KOAI 150
l!lllll:J<;i~.S:J INONG KOU VICNG 173 lJ"'Vl'llJ I NA TliAM 214 c:5un~ciJ'l I VEUNKAEAO 54 ll"'!:l'l I NA XA 96 uc~n I BO LAK 314 lJ"'Cl"'lJ I NAT AN 123
U.III"'Og'lU~Il'l I HATXAI?HONG DISTR: 15 V. latl'lll1rl I SEE TP..AN TAI 294 UI'Ht2n I THA MI:\. 214 ~ucw0 I TliiN ?!iiA z.;z Ill 'Hl ii!J ll '1 I F_>cT r:_;~iSA lii u'tll I BO-O 126 lll'lOOilncd\~ I HATDOKK.::O 11i iluat:J::J I SOM-VANG 428 ilu::J:::nun I
' SOMSANOUK 322
Ul'lU~:J I THA MO.~'fG 219 fi:)'lw2 I DONG ?EOS.::E 267 m 'lC f\g I THA DEUA 283 tn'lw:: I TF...A ?F..A 215 mu1ns.:;n I HAK E!:>.. :!.70 'tnuc:mlJg I DONF. !!EUA 122 ~~'lUCrc1:J I KOIE DAING 244
u.1gC2ClD'l I XAYSETTHA DIST.~ 17 V.
Vl'lCliD~:J1L'1 I T~.T LOUANG TAI 259
Vl'lOID~::lC:111~9 I TEATLOUANG NEUA 292
59:J~n I HONG KA~~
!3!:J~Illl I SEESA..'fGVONE
'twumuc:m09 I ?HOLT~>cN NEUA
IIIU9:JUillJ I NONG BONE
'twuc~~c:mBs I PHOLKAING NEUA
~euu::uc:mue I CHOMMANEE NEUA
~lluu::0n'l:J I CHOMHANY KANG
U'l't~ I NA XY 'tuu::l::lll~'l:J I NOL SAVANG
c:B9:Ju9u I MEUANG NOIE
U'l~~'lu'tn I NA KOIE TAY
'twutnB:J I PHOLTHONG
~::l:J::l:lll~'l:J I SENGSAVANG
39i
257
289
233
154
266
182
369
129
238
127
82
130
·!
! .
::a a 990
1~19
12:57
225
450 1 c, ----0
7S2
1457
SH
1.3~/
95.;.
5::9
622
2<:56 , --. -O:::"l.
12~5
.1..:.:--s 1533
1.273
1C1.6
535 1 ~ - ---:::~
2.;52
2051
2473
1233 , 1 71 -~--
1459
1013
ZZ51 95i
H08
lZ43
507
100ii
72
'73
74
75
76
77
78
79
80
81
82
83
84
85
a.;
87
88
89
90
91
92
93
94
95
96
S7
98
99
100
sg~~W~U I HONG SOU?HAP . 'uu~:m~u I NOLSAVANZ
- 19 -
226
43
u.~'tno I SE!-KOT DISTR:: 13 V. ~n1nffi~ I VAT TAY THON
~UIJ~ I OUP MOUNG ~q~ucmflg I SEET~;N N!UA
111UQ~U~WQ~cmfl9/NONG BOUATHONG
'WU~'l I PHOL KnAM
n~u~~n I DONG NA SOK
IIIUQ~~n~cm~Q I NONG TAING NEUA
U%ID"'l I NALAO
la1£1,CIIli'la I SZEKAY TEOl!G NEUA
cBa~~"'l ~~ I HEUANG VA THONG
!, ~~uc§g~m~ / SEE BOUANH!UANG
dl"'l:J~:J I KAO LEAD
n~oma~ I TAD THONG
'wus:mO'lO I PHOLSAVAD
~
c;ii'ltJQ(l I i<AO GNOD
2: w"'luma~n 'l~ I SA?H..;NT:iONG IIIUQ:).>;\u I NONG CH..;;N . lii~w'lUWQ~ITHON PF..ANTH0!1G w:'tw I PHAPHO
w:1ll I PHAXAY
'wu2:111~U1n1PHOLSAVAN TAY . lii~n1~ I THON KANG
ui'lwi::J"'lU"tlliTHA PHALAN XAY
KANG
'utJ-\cD"'l~~ I PHOL PA?AO TnONG :~'i~c;m5u I Si\NG VEUIE
'19uci:in1fl I CHOHPHET TAY "'twu::l::mo-i::J I PHOL SAVANG
lH
181.
275
311
99
252
252
153
219
258
173
185
106
236
154
396
355
202
174
145 31 --o
330
312
112
282
133
Annex 1
1354
410
1112
1093
15:Z3
6C2
1603
11 iO
1.054
1249
1654
1331
625
... 1 ....... -'.!.0-J
1011.
3094 ?""- 4 -~1"7
1329
!.Z~7
S.25 ?----.:.:.~
2299
2C73
e.::. 1805
SiO
Il"!CU~:
5um 1 1
11 'UIIIJ n!ff ~El ~c§au. uumnei '1t113 u~~~lJ li: • 1,_-l!n- "--~o··
1. EkbaUC:)lJ l.:C:l..""'S~EJU!~CI 5 u,. z:::!Jet~,:-~n::~Chrri!Jt/? . - ...
- 21 -
n .:n "' :n 9 '• n """ • .I 1"\ - () ' lJ_; u. tJlJ :;; u .. r"(IUlJ ~;suo .~.,~~t.:m 2 u.zo:vr:sc~~:J~;.u.
~ ~ f'\ u~:;;:.."sou I I I I I
1 . ilttina"JQ. ilr.::'~ 5 fl ~? I I I I I 2. -=i'11JOU:ME'1l!iJl;;:C1 5 fl I I I I I
J~d~-ceau I 1 I 1 . iltCins"lf! u~ 5 tl ~? I I 2. o:\'11.r.ll.1.:Ma~'m"JC"l 5 tl I I
/
'\'" n COJ. u--.c uc sau I I I 1 . ilteirn;"lf! ill~ 5 fl jp I I 2. o:\'lwutCine~~o:o 5 fl I I I
J~£tSau I I I 1 . ilteirn;"lf! ~ 5 fl 0? I I 2. <i'1J.r.)U;Cins~;;:C1 5 fl I I - ~
1.
2.
3.
ANNEX 2
f.t""
~u~u: ------------
~-.~
~~n:n~,: ------------
LINE
TOTAL
I I I I I I II I I I I II
Y: II
I I I I II
I I I I l I I I I I I Y:
I I I I
I I T I \v: I I I
I l I I I Y:
I I I
Page
Totals
1~ ll 2~ ~
- 22 -
Annex 2
~~"1U: -----5u~ I I ~~S.:J:i.,g:t~C1: -----
~!JnoC'ln"1: . -----. TOTAL
J.,cfk§au I> c ~cnn
r•··•·•·••.}> ~ ~
. </ 4 !ll.,~/lJ'l:) ................. ali3:JtJC1 . •· : ..
De'ln'lutuum.,cm.,fiu? : :) I •
'lu 2 e.,iih.i.,uu., ;JouiibfiO \2 - .. < ' .,: ... '--'- <
········•·•••••:··········~ec;fl'11J\~ ·••''·••-•••···'_·· [> <
' > > I } I\ i I ····.' '··'·:·:· I I :
... : ... _ ~···· ....... ·- : /· ' ··.· n __ .
t]'llJC ~:Jttci;J:::e'1n'1u u;;J::: ~ .· ·. • • .·I
I Vi' 'lm].,tleu;l.,D > \ ~~nie:).: .· ..
• i / ······ '
rt ) : > : ·! ' ' :
<W allJ'lfJ :..:._? ! '> I '' I ' t
C~tJEl I ~.,~De'ln'lu'lC1, ·~ ~ ~~ffl=:lnurm~F:_;_ .i .
' .... ',
I < I. \ '
····-
....... 1··- ' I • b ? Mne:Jn'1u
' .. · . . :.::. I -< _ .. _·_ .,._ I :_. - '. ·'"
~~c"v~. r.i'luttlm'l~ 7
l•·······--········-·····-· 'i•· >I t~~&<z;t~ :
. ../ ... I :1. , ••••..•.•. _ .•.•. _ l!i QU i -::' I 'i/ .•.• ,rr·•-- IIr , .......... '
:>::_-:::.-: ..... : ·::.·;')-~::::;::::::.
' ··.·· ! I· ..
f:;ffi;~~~r(_- :·:-:.:;:.-:: .. < . ; ... -._ ... ::,:: ..•.•....•.••.• , .•....
i->/ ' 1 •. ,.·_·--.····· I £ i i
············.····-··
> ~ ·-·· :::
. >ii 2£ ': --'--'. / .· .'
5 ~.,De'1n'1u !.W. ) • 'lmt]'llJ! 8'1n'1u~~n'l~cuuveuuu I
m'lnun~ ~vsuuum'l ~~~d~n? C1 = nun~ • !J : \~~c~n ·~
B=~U::J !JC1 = iib::m~,tJS=US, •
6 'lmc~enmu'lDc ~v~ ai-..:::Cie~'l~ ~";Jud'in. tj"miiic~en tJ!
~mC'lcmu.,::: ~~~u0: . u = U;), !!] = C~8!), 2 = 2ii0 [1!
~
lt]BnmB~l 1 B"1n'1)J;II> l 1\Bl . I • me~{J"l 9:
7 ~.,6C1e~n.,u'l~c~v~. 'lffi~'l~jj.,fi~.,;sucn~~\tl. tj.,Cis~n'1u, 'liiJr.i.,u\tlm'1c~v\a mu.,lilmib
tt:::l::::2iiuJJ"1C!Jc§au i:ieunov~cnn'l~. W'lviD~fliai.,u\Clfu.J'lllinu.,fi~.,;sucnnO!nEi'ubUl, u;~m.i.,u \tJ~lil s
2
8
9
- 23 -
~mtj"ll.J6"1tj"ll.JCgJ'lfi nuqc;_u.;JcC1ne'1~m~rl 5 tJ ~ll\n:JC~U
1Hl~ml'bu. 'Cl~~:J;;l..,~u ei..,;;l..,w..,C1 QC1U.~cCin~m~:J u u u
~"1ctlcwu
Annex 2
~~'lU: -----~~:S:)~'11J.l~C1: ----
~'C.in~cm'1: u ----------
TOTAL
lx···.··>··· >< • . .
C1"ll.JEl~.,JJgC1,mu2e:Jc"'"1 • c~;J"1&1=t,ndlu?e. ~neJ~uDe'ln"1u~C1&.! ~:)'>~::w..,\tJuu
u.we1 ID\tJ1s:Jmu? ~m;J"1~neuJJ'1Ce:) ~:)::uJ..,v ( Vl~~
e"1n"lu~neuu..,
a U1"1t.J'l"'b I b m"1v7'>~Bnunn::R(m..,v?'>~~C1l I I c I I I I
~:iMJJ"1C1Ru I I ....
I d ••••••••••••• ••••• ••••• '
e C~UID'lt.JgUIS"ln"lLmun i j··.····· ··········. ···. . . I
f D' ~ I ll
•2
m..,v~"'D~o:JCi:J I I········.···· RurfuJ ~\~~ .·.•·· >
e'ln"1u~~gu ~····•:································· I;· .>· •. , ••••••••••.
i·i···;· • .-;tn· S"1n"11JgU::J~n I
!}······<·;·······.······ ·~ ············.}>. us u
. ...... ..
~n~nn'l"'~(~~~eu EJo"llJ5u~~nne:Jt1e'1n"1u • IDm"1V~"1Gu~~en~~nc~ul
- 24 -
Annex 2
J"'cflc~u I I I I I I I I I r I I
)r( • "' • •
10 t1"11JElO"'lJgC1cmu~a:)'"'"1 • coz"'OI;mt']anma~. ;:mEloul:la"'n"1u?c:fuJ ~~"':::W"'ttltJu • •
U.OO ffi\tJ\s:>mlJ? '?m;J"10t113UlJ'1CI3~ ~~l!UJ"'fJ ( /J?=
a'1n"1u~neuu"'
~"''fJCiJuJ"'[l'1t1C oie I. ( i
S"''n;Ji)ufln .· } > .. · .. ···· .··
~oJ., I : ·. . :,
RwfuJ 6\~R ·.··•.··:r.•. .:.· . -·
m.; ~ · .... <,,·: .
l:kaen'?ue"'"iu , .
a"'n"'u68gu;a"''n"'umungu . ·. ···· .. · I .· ... .
I .. •·· I .··.. '
. ··•··
' .
: · .... ·. I
e"''mua~ . 7· <
( ) ·•··: .•. :{ . ·- ~;:::- ······ us :. . . ··,.
• 1 1 ~nonn"''"''::: ! i/l ?::lu'eum".l..
• &!~ ~~n~e~ (2 e'1n'1U ID
no"''nu'?~en~aC),~lJ
D
- 25 -
~~')lJ: ............. . ("'!- .....
i1(J;;):J:;,'lur.:JC1: :-............ . '1. -
~i:ln~Cln'l: ............. . •
7mt]"1lJEi'lt'J"1lJC$.,Ou., ~~u.;;)cnn m~n 5 f) ~rl!n::JID:JEl'lc~u~llcrin m~n 5 f)
u<J7~mii:JU.t'J~~:J ::;"':su Ei"1:::i<JtJ"1(1 ~~u.;;)cnn ~mfh
• ~ )<
12 c~;;)'lakrinqemne:J, '"''~
.,~7mcrinRuJ"1rn~evrio.,
dh~J? ~Rucai"1Crl'l, ~
fuJw<Jvn~"'' fi .,?
... us= us .
• ~ )<
1 3 c~::J"1~cnnqenma:J. c.,., .,~7~0nfiu9'lrn"1Uffi~9V
~bu? IDflu~Crl"1, mQ)'lV
n0"1Crl'l?
·~ us= us . . uet.JIIl;;)() 4 c~eu, V"1tAtlmiJ4.ci:h.Jc ~EJ~ :::i-15ucnn0ll~uc~u, ~'16llei"lC'leu ' . ne~n·UJdc~EJ~, \t.Jc~ufl\tl.
u
"': ..... ~ 11, 12. 13 lir'IW
ro"1lJSt!~~nCie~. u
Annex 2
TOTAL
M+
S+
M:
- 26 -Annex 2
'o' n U'l~u~=----
<'>~
~U'lU: ------
5ual n~ ... • ~~::l:J~'II!\;)CI: ------
~~n:JCin'l: , ------Au?~ mli:Ju. ~:1?b ~'15ud1n~aum~" 4 cRau ( o-3 c?.sw
16
17
l::'.k 11 H. Cl:JU.Cl~ ~ '1:29:JlJJ 'lUU lJ'lSGC'l
H. ~
C1i5JU al/U ........... \CIC'lC'l u
~ ·;'7 .~ ; UlJU.lJU. (1: ICl, U: U
~..,6, ?iC1\uEi'1t)'1JJ 1s
~ "~Q C1o:Ju m;u ........... ·"· .u
. . . . . . . . ' ..... tl~lJt.!.;":~:::]
f. ORS
I. 9'11T1'1U
Lo. .... >< "" "' "" 18 \n7~~Cl~uuuauu.-,;uu7m
•ry lll/lJ ................. u.
1 9 ~'lm'lutnt)'1u~0onu~Cin~svm"ln 4 cRauu.~:;J, m'1uemuv'1u\utj'lu ~~~EJlBu
~.,5u~C'ingu::J?ud~aufi ~., bmm~"ltJ\uc~au§j;?mu'
.···· .
I : .
I
. :
..
lr
li·:·.··-·······/····· .·:, .. .. ;,
- .
.
· ... ·.· .·: ·. .
1
-:c-•. ~' > .· ...
: . .
I • :.· . I
, ...•••..•.•• ,:·········:: •• :
20
I
21
I a.
b.
c.
e.
f.
g.
h.
i.
j.
- 27 -
Annex 2
';' n U"lCU~:. ___ _
I
~;'1U: ------~q5~~~~~= -------
~'C.in~nn '1: . --------~ ~. . . ~
'Cmt]"ll.lei'1t]"ll.lUnl);Jnucnn0ID9"ln'1u\ a 'Cut:;JEJ::: 2 e'101~CJ'1UU'1U
~~::J~nenc~sl'UJ"lU.~::J "1"lnei'1tJ"ll.l~ o. ~"l5uc~v~0;) • TOTAL
J"lcecsau I i - if .
~d'in I . \i . : . . ...
~ I .• ·.:·•· (( C;)::J"11J1'1;)/1J'1::J ...........
· ..
lle"lmlJ\e m"lu\~w"l\r.Jt);)
t.· ·••••••·•••·••••••••••••••••••••••••••••·· < 1 Jueug~.;tn : .: <
•. : o:.:oo:::,:• . : • ~ . """"' . .
0 _ 1 0 u _ :,<" :1nu C.:"lJ,', 1 . !
- .. , - -...; .... •, ' , ' ...... d ~
01"12 22. : .:: .. ·.· ... · ..... . .
m"lu\~w"l\t!u;:v~::r ~ uou·nc.;? •
~ 0'• .. ~ ~ ~ ~ ~ 'CU1UUJ'1V ( l '(:i!"~nEJU~~lJU. 'Cmt~"LC?;:JuWWUcllS::J, uenuu'Cm:;J'1::JC1GUUnca~
-~ "' UUJWl..'Wt;::J I I '
E\tJ") I •
~s~ouj~() 01~:<~'1;;)'1 - . I I
~
I U.IJOU'1U(:;J::JUffi::JU1~G'1U.EJl
u.wncsn:::\(u
:r.::u"l~m:::::u"lifu.JV::J ~
S,U2,EJV,,BU2~EJU,, ~ c!t S,U2,EJCE\8:),C1:~,(l
iJue::J Ulmucdeu~~\~L~~u - . . Ol)::JnU
~gu:J ''Cmuenu. ~::Jl
Annex 2 - 28 -
~~'1U: -----
TOT~L
~
:;h:5'urJn::Jom u
w ~ ~ . i :! 25 'C01:22iu~ !.!.:J::~::Bm.J~. 11~u ;;)
;I .. ;I r: Gl :-1 ;:; ..
a ~-:- Cl ; ;J " s J ~J 
- 29 -
Annex 2
... ~ ~u~u: __________ _
5u!il 1
~~nn~: -----------
, TOTAL
J~d:kwu ~,,.·,·<?;:;::3'-
: .. :-::-., i /
~cnn c., ,? · .. ,·.:.. ··:,:
27 Y:
28a
28b I I I I ~ n ~ ~~ '"' ''( n ~~ ~ :-:> '• E\ ~ ::: '?! ~ ' ::: n
I
I 29 '!"1l.JCnnCJ.,UI;n f) l..iCStlU UL ,;l,:o::E1~r)~U 6 mun.C"'ti , ti'1E.!t.UUl"\C";fJ:.1 u ,
~"'6l3cc=imi~5umu'1c~v:a. c.i'1u~c~s<Ju~rrw'
30 ~:::nn'1u8c:~'1:::c5::J. ~'1cnr1'Ln
sucl'1n"\uc~e ~'15u\e,
ml.J'1EJ c v; th~'1uc~e!il\nsu 31 n B d - ~\~ "':::l.Jn"\U CE\"l:::CU::J; t]'1Wn C'\
8ucl"laue1:::~'1v :5'15uuo\e.
DUJ")EJ 1 .._..;; cl"leUC1:::::J ~vlil\ CiSt.J
32 n'1U8Cfl")::: ~:::Um'1UOUEh~fJS~ V~ 25 u •
- 30 -
Annex 2
';' " U"'CU~ : ___ _ ri}""'
~U'llJ: ------------
~n~n~~= ------------
TOTAL
rr== ~ tl .., ---I I · ......
I U"'C csau ..
I .
I ~cCin h ... I
I m'1u\;ca'1\ubuu~Juau~u~?c~~'1 I I' :
33 I I
u .. ;.,;JtlJ"'::J ............. lln"~CU1'1V':"'b I
II I ~ ' i I m rn"1u~,.,e(i::,.,~~ ' . I' I
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Annex 2
------
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- 34 -
Annex 2
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- 35 -
Annex 2
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- 38 -
Annex 2
CDD/ARI HOUSEHOLD SURVEY QUESTIONNAIRE
Lao People's Democratic Republic. May 1993
CLUSTER NUMBER: NAME OF-COMMUNITY:
DATE: I SURVEYOR: SUPERVISOR :
D ASK AT EVERY HOUSEHOLD. RECORD ANSWERS BELOW.
1.Are there any children less than 5 years old, including newborns, living in this house? YES = Y NO = N If NO, enter 0 by question 2 and go to the next household.
2.How many children less than five years old live in this house~ Record the number of children less than 5 years old.
LINE USE A COLUMN FOR EVERY HOUSEHOLD VISITED TOTAL
Household Serial Number
1 . Household with children < 5 years~
2. Number of children < 5 years in household
-~ ·~
I -
Household Serial Number
1 . Household with children < 5 years:>
2. Number of children < 5 years in household
Household Serial Number
1 . Household with children < 5 years?
2. Number of children < 5 years 1n household
Household Serial Number
1 . Household with children < 5 years~
2. Number of children < 5 years in household
Households with children < 5 years to revisit: 1. 2. 3.
I
-
I I
I
I
I I
I
1 .
2. II
I I lv: I I
'
I
IY:
I I
Y:
Y:
I I
Page Totals
II
II
II
- 39 -
Annex 2
CLUSTER NUMBER: DATE: I I
NAME OF COMMUNITY: SURVEYOR: D
COMPLETE ONE COLUMN FOR EACH CHILO UNDER AGE 5.
TOiAL
Household Serial Number I
I Child's Name !
lr-~-----------.-----------+-+_,~~r-+-4-~~~,~ ----4 Please tell me if dysentery
{name) has had any of ~~~~~-------t--i---r--t--4---r--4--~--~,~----~1 these symptoms or problems in the last 2 fever \ weeks, including t----------t---i--+-+-t---J--t-+--:l.f----11 today. Has (name) t-il_ln_e_s_s_w_it_h_c_o_u~g~h---+-+-t--i--t---1--t--f-~if----il had ... ? I
Prompt for each listed watery diarrhoea \ r-~~----~_,--+--r~--~~-4--+-~~--~1
symptom. sore throat I Tick if yes. J--'-~------+--!--t-+-+---1i--t-+-+---ll
"fast breathing If no shaded symptoms, no coloured pages are needed; skip to 7.
"'difficult breathing
"'abnormal I I breathing
lf----+-------L~-+-+-+--+----+--+--+----+-..::______,1 5 If "' symptom(sJ ticked, ask:
Was/were "' symptom(sJ due to a problem in the chest or a blocked nose' C = Chest N = Nose C, N = Both OK = Does not know 0 =
Other
If any "C" or "OK," leave the tick by the * symptom(s). Otherwise. cross out the tick by the * symptom(s). This child does not have fast or difficult breathing due to a chest problem.
6 Choose what coloured pages this child needs, if any, based on order of priority below.
Record: P = Pink Y = Yellow G = Green = Diarrhoea = • symptoms = Cough or dysentery
G:
Y:
P:
7 If no coloured pages needed, complete t!Jis page for next chl'ld in household. If child needs coloured pages, go to first coloured page and write household number and name of child. When you have completed this page for every child in household, go to question 8.
- 40 -
Annex 2
CLUSTER NUMBER: NAME OF COMMUNITY:
DATE: I I SURVEYOR: SUPERVISOR :
ASK THESE QUESTIONS TO ONE CARETAKER AT EVERY HOUSEHOLD WITH A CHILO UNDER AGE 5. USE ONE COLUMN FOR EVERY CARETAKER INTERVIEWED. ;o
iAL
Household Serial Number '
8. Children commonly have ollnesses with cough. Wh3n should you take a child with cough to a health wori<er or health facility? Do not prompt. Tick all signs mentioned.
a. !list breathing I I
b. difficult breathing I
c. abnormal breathing I d. unable to drink I e. getting sicker/very sick
f. fever I I noisy breathing I
not eating/drinking well ! I I I
not getting better I
I !
any other sign 1.11
I
I
l--- I lj does not know I r I
9. The supervisor will tick for corr~cr I I knowledge. I 1 or more signs in bold box)
10 Another common illness is diarrhoaa. When should you take a child with diarrhoea to a health worker ~r caalth facility? Do nor prompt. Tick all signs mentioned.
many(4-6) water•/ stools
repeated(> 3 times) vomiting
marked thirst
not eating/drinking well
fever
blood in stool I
not getting better/getttng sicker I I I
any other sign (,/)
does not know
: 11. The supervisor will tick for correct I knowledge. (2 or more signs in bold box} I
- 41 -
Annex 2
CLUSTER NUMBER: NAME OF COMMUNITY:
DATE: I SURVEYOR: SUPERVISOR :
ASK THESE QUESTIONS TO ONE CARETAKER AT EVERY HOUSEHOLD WITH A CHILD UNDER AGE 5. USE ONE COLUMN FOR EACH CARETAKER INTERVIEWED.
12.
13.
14.
i 15. I I I I I
Household serial number
When a child has diarrhoea, should the child be given less, about the same, or more fluids 7
L = Less, none S = About the same M =More DK = Doesn't know
When a child has diarrhoea, should the child be given less, about the same, or more food?
L = Less, none S = About the same M =More DK = Doesn't know
I
TO TA -
I M:
I
I " I
I I S +M:
If there is a child under age 4 months (0-3 months) in the household, go to next page. If there are no children under age 4 months, go to any coloured sections needed for
. children in this household. If no coloured sections are needed, go to the next household.
The supervisor will tick for correct knowledge in 11, 12, and 13.
I
- 42 -
Annex 2
CLUSTER NUMBER: NAME OF COMMUNITY:
DATE: SURVEYOR: SUPERVISOR :
COMPLETE ONE COLUMN FOR EACH CHILD UNDER AGE 4 months (0-3 MONTHS I.
Household serial number
I ,LJ Child's name
I ;
i ;
16. Since this time yesterday.
w has !name) been breast-fed' Y; Yes N; No If NO, skip to question 18.
17. Since this time yesterday, did (name) receive ... 7 I
i Prompt for each item. ' Tick if received.
I ' I a. I Vitamins. m;neral
I supplements, medicine
b. Plain water I I I I I I c. Sweetened or flavoured
I I water
' d. Fruit juice I I e. Tea or infusion I I I
! f. ORS solution I I I !
' ' !
I I !\
' g.lnfant formula i
h. ;
i Tinned. powdered, or
I fresh milk '
I. Solid or semi-solid food I I I .1 i! j.
I I Iii Bottled soft drinks : !
k.
' Other fluids (specify) ' ' ' ' J ' :
18. Since this time yesterday. ' 1 did (name) drink anything I I
from a bottle with a
I ! nipple/teat? I
i i Y; Yes N; No ' I I
19. When you have asked the above questions for each child under age 4 monchs, go to any~ coloured sections needed for children in this household. If no coloured sections are , needed, go on to the next household. -~
- 43 -
Annex 2
CLUSTER NUMBER: NAME OF COMMUNITY:
DATE: I I SURVEYOR: SUPERVISOR :
ASK THESE QUESTIONS FOR CHILDREN WITH COUGH IN THE LAST 2 WEEKS WHO WERE SELECTED IN QUESTION 6 FOR GREEN PAGES.
Household Serial Number
Child's Name
20. Did you seek care outside the home for (name) when he/she had this illness with cough?
Y =YES N =NO If NO, go to question 22.
21. Where or from whom did you seek care? Tick each provider mentioned. Prompt only for traditional healers.
a. Traditional healer
I b. Monk
I c. Government hospital
or health .center
d.
e. Village health-worker including TBA's
f. Private practitioner /clinic
g. LWU -member
h. Pharmacy, drug seller, store, market
i. Relative or friend (outside household)
j. Other provider <specify)
TOTAL
I
,LJ I
7 green
- 44 -
Annex 2
CLUSTER NUMBER: NAME OF COMMUNITY:
DATE: I SURVEYOR: SUPERVISOR
COMPLETE ONE COLUMN FOR EACH CHILD WITH COUGH IN THE LAST 2 WEEKS TOTAL
Household Senal Number I
Child's name I 22 Was (name) given any drugs for th1s 1ilness with I
cough? I
(pills, syrups, capsules. injections) Y =Yes N =No If NO, go to question 29.
23 How many types of different drugs was (name) I
given? I Record the number. I
24 Record the names of drugs used in table below I and the range
/e.g., D ,-03). I
FOR SUPERVISOR
25 Record the names and forms of the har antib1 cou trad unk other anti anti as antp drugs. If unknown, record .. unknown . mful otic ghre med now mala thmat yreti and form. (pill, syrup, capsule or dru<J med n rial IC c iniection) y
, I I o, I il o, I i o. I
I
o, I o,
07
o. o, I o,. o, o,, '
D, ! I
o,. '
D,. :
Total !
- 45 -
Annex 2
CLUSTER NUMBER: NAME OF COMMUNITY:
DATE: I SURVEYOR: SUPERVISOR:
COMPLETE ONE COLUMN FOR EACH CHILD WITH COUGH IN THE LAST 2 WEEKS.
TOTAL
Household Serial Number
Child's Name
29. If there is another child in the household for whom you recorded a coloured section in question 6, go to that coloured section. If there are no more children who needed coloured sections, go to the next household.
30. The analyst will determine if the child was given an antibiotic for the cough. Tick if an antibiotic was given.
: 31. The analyst will determine if the child was given a harmful drug. Tick if a
: harmful drug was given.
32. The analyst will count the number of unknown drugs listed in 25.
9 green
Annex 2
· CLUSTER NUMBER:
DATE: I
- 46 -
NAME OF COMMUNITY:
SURVEYOR:
SUPERVISOR:
ASK THESE QUESTIONS FOR CHILDREN WITH * SYMPTOMS IN THE LAST 2 WEEKS WHO WERE SELECTED IN QUESTION 6 FOR YELLOW PAGES.
TOTAL
Household Serial Number I Child's Name
33 Did you seek care outside the home when (name) developed fast or difficult breathing (or ernie term)? Y =YES N =NO If NO, go ro question 38.
34 Where or from whom did you seek care? Tick each provider mentioned. Prompt only for traditional healers.
a. Traditional healer I b. Monk I I *c. Government hospital I *ct. Government health centre or clinic I *e. Community-based practitioner associated
with the health system. including TBA's
*t. I g. Private practitioner/clinic I h. Pharmacy, drug seller, store, market
I. Relative or friend (outside household)
j. Other provider (specify)
35 Which provider did you go to first after (name) developed fast, difficult or abnormal breathing. Circle this tick.
I 36. Supervisor will tick if child went to any * I I provider (i.e., tick in bold box above). : 137. Supervisor will tick if caretaker went to • I provider first. I I
I
I
I
I y~l?w I
CLU::lTER NUMt::lt:H:
DATE: I
- 47 -
Annex 2 NAIVIt Ur
COMMUNITY:
SURVEYOR: SUPERVISOR:
COMPLETE ONE COLUMN FOR EACH CHILD WITH * SYMPTOMS IN LAST 2 WEEKSTAL
Household Senal Number
Child's name
38 Was (name) given any drugs for the illness with fast/difficult breathing (or ernie term)? (pills. sy. ups, capsules, injections) Y= Yes N =No If NO, go to question 45.
.
39 How many types of different drugs was !name) given? Record the number.
40 Record the names of drugs used in table bela w and the range Ex 01-03
FOR SUPERVISOR
41 Record the names and forms of rhe HAA ANTI cou TAAO UNK OTHE ANTI ANTI ANT drugs. If unknown. record "unknown" MFU BlOT! GHR MED NO R AST MALA PYA and form. /pill, syrup, capsule or L c EME WN HMA RIAL ETIC injection) ORU DY TIC
G
1
o, o, I o. I I o, o,
07
o, D,
D,o I D, I D,,
D,
D,.
o,. TOTAL
11 yellow
I I I I I
i I I
i
I I I ' I I
I
' !
I I
i
I
- 48 -
Annex 2
CLUSTER NUMBER: NAME OF COMMUNITY:
DATE: I SURVEYOR:
SUPERVISOR
COMPlETE ONE COlUMN FOR EACH CHilD WITH * SYMPTOMS IN THE LAST 2 WEEKS.
TOTAL
Household Serial Number I Child's Name
II
I ~D ' I I I
45. If there is another child in the household for whom you recorded a coloured section in question 6. go to that coloured section. If there are no more children needing coloured sections, go to the next household.
46. The analyst will determine if the child
I 11 I. was given a harmful drug. Tick if a harmful drug was given. itj 47. The analyst will count the number of unknown drugs listed in 41.
12 yellow
CLUSTER NUMBER:
DATE: I I
- 49 -
Annex 2
NAME OF COMMUNITY:
SURVEYOR: SUPERVISOR :
ASK THESE QUESTIONS FOR CHILDREN WITH DIARRHOEA IN THE LAST 2 WEEKS WHO WERE SELECTED IN QUESTION 6 FOR PINK PAGES.
TOTAL
Household Serial Number l ' Child's Name I
I During (name's) diarrhoea did (name) drink I
M: 48 I much less, somewhat less, about the same,
or more total fluids (including breast milk and ' I ' formula) than usual? I
L = less or none '
S = about same ' M =more i
' 49 Does (name) take solid or semi-solid food?
Y =YES N ==NO I
If NO, skip to question 51 I
' 50 During the diarrhoea did (name) eat much s +
less, somewhat less. about the same, or. M: more food than usual? (Food includes breast milk and formula.)
' : L = less or none I S = about same ! M =more I
I
If question 50 was skipped, the supervisor I 52. I I will now complete it by copying the answer I I I given in 48. \ I I I I I I
The supervisor will then tick if the child I I ' I
II I received increased fluids and continued I I
feeding. I I
I
I '
I I I
- 50 -
Annex 2
CLUSTER NUMBER: NAME OF COMMUNITY:
DATE: I SURVEYOR: SUPERVISOR :
COMPLETE ONE COLUMN FOR EACH CHILD WITH DIARRHOEA IN THE LAST 2
WEEKS. TOTAL
Household Serial Number
Child's name
53. During the diarrhoea did (name) drink ... ?
Ask about each listed fluid (but do not show DRS packet). Tick if received.
a.Water
b.RHF: Rice Water
c: Traditional medicine
d:
e:ORS solution I I
f: RHF: Coconut Water
g: I I
h:RHF: Tea
t: Any other fluids (specify)
54. If DRS was used got to question 57, otherwise go to question 74. I I 55. The supervisor will tick if I I one or more RHF's was I I
used. ~ I
56. The supervisor will tick if I I I DRS and/or RHF was I I used. I
14 pink
- 51 -
Annex 2
CLUSTER NUMBER: NAME OF COMMUNITY:
DATE: I SURVEYOR: SUPERVISOR :
ASK THIS QUESTION FOR EACH CHILD GIVEN ORS. ANSWER IN THE TABLE BELOW.
57. Who advised you to give 0 RS solutini..Uo"-'-tnLL-_u.la!.da:umJJ;;e) Tick in box.
Household Serial Number
Child's Name
57. Source of advice about ORS:
a. Monk
b. Government provider
c. Village-health-worker
d. Private practitioner
e. Pharmacy/drug seller
f. Relative or friend
g. Other
• Don't know
?
TOTAL
.
- 52 -
Annex 2
CLUSTER NUMBER: NAME OF COMMUNITY:
DATE: I I SURVEYOR: SUPERVISOR :
COMPLETE ONE COLUMN FOR EACH CHILD WITH DIARRHOEA IN THE LAST 2 WEE~.AL
Household Serial Number
Child's name
74. Was (name) given any drugs for diarrhoea? (pills. Y: syrups. capsules, injections! Y= Yes N =No If NO, go to question 80.
75. How many different types of drugs was (namel given? Record the number.
76. Record the name of drugs used in table below and record range here
I I 77. The supervisor will record the total of children given 1, 2. 3, or 4 ... drugs. 1 : 2: I I 3: 4+:
FOR SUPEnVISOR
78 Names of Drugs APPR OTHE ANTI AN TIP UNK ANTIH ANTI ANTlE OTH OPRIA R AB DIAR ROTOZ NO ELME PYRE METIC ER TE AB RHO OAL WN NTICS TICS s
EAL
D, I -·-D,
D,
o. D, I I D,
D,
o. D,
o,. D., I Dl,
D,,
D,.
D,,
D,.
TOTAL II I I I I I I I
- 53 -
Annex 2
CLUSTER NUMBER: :-.lAME OF COMMUNITY:
DATE: I I SURVEYOR: SUPERVISOR:
COMPLETE ONE COLUMN FOR EACH CHILD WITH DIARRHOEA IN THE LAST 2 WEEKS.
TOTAL
Household Serial Number
Child's Name
80. Was there blood in (name's) stools? Y: Y = Yes N =No OK = doesn't know
81. If there is another child in the household for whom you recorded a coloured section in question 6, go to that coloured section. If there are no more children needing coloured sections, go to the next household.
82. The analyst will tick if the child was given an ant/diarrhoeal.
:83. The analyst will tick if the child was given an antibiotic. - -
:84. The analyst will determine if the child Y: with dysentery received an
: appropriate antibiotic. Record N/A if : the child did not have dysentery. For
the child with dysentery, record Y for yes if an appropriate antibiotic was given. Record N for no if no antibiotic was given or if an inappropriate
: antibiotic was given.
: 85. The analyst will tick if the child was given an antiprotozoal.
: 86. The analyst will count unknown drugs listed in 78.
19 pink
I.
2.
3.
4.
5.
6.
7.
8.
9.
-55-
LIST OF PARriCIPAITS
SURVEY COORDINATORS
Dr Sisountha Pongpradid, National COD Manager, MCHI Dr Somchan Xaiseeda, National ARI Manager, MCHI
Dr Pekka Nuorti, WHO, Manila Dr Anders Tegnell, WHO, Vientiane
ANNEX 3
LIST OF SUPERVISORS- CDD/ARI HOUSEHOLD SURVEY
Dr Somchid Akkavong ChiefofMCH Vientiane Municipality
Dr Oukeo Khounmanivong CDD Programme Vientiane Municipality
Dr Ladthiphorn ARI Programme Vientiane Municipality
Dr Nee Phol Epidemiology National Institute of Hygiene and Epidemiology
Dr Chansouk Chanthapadid National ARI Committee Mother and Child Health Institute
Dr Kanthong Seehalad National ARI Committee Mother and Child Health Institute
Dr Leesouaku Leeyiavea National ARI Committee Mother and Child Health Institute
Dr Maneesone Oudom National CDD Committee Mother and Child Health Institute
Dr Katthaoudone Phandouangsee National CDD Committee Mother and Child Health Institute
Annex 3
NO.
1
2
3
4
5
6
7
8
9
10
1 1
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
- 56 -
*****************************
NAME OF SURVEYORS FOR CDD/ARI SURVEY
NAME
MA. KHAM MORN
MA. SAYBOUATHONG
Dr. KHAM HOUE
MA. VIENGSAY
MA. VONGKEO
MA. PHOU KHAM
DR. PHETSAMAY
MA. SEEVIENGKHORN
MA. CHANTHAVEE
MRS. KHAM VANH
DR. PHETSAMORN
MRS. BOUATHONG
DR. SEE SANA
MRS. SOU VANH
Dr. BOUA LAVANH
MR. THONG THAP
DR. KHANTALAT
MR. KHAMPASEUT
DR. PHAYPASEUT
MA. KHAM LA
DR. MANEECHANH
DR. KHAM PHAY
MA. SANG VANE
MRS. BOUN SOU
DR. KHAM PHEETHOUNE
DR. SENG SAY
DR. CHID SAVANG
DR. VAN SAY
MS. BOUA PHANH
DR. BOUNCHAY
DR. DAODOUANGCHAN
POSITION
MCH II
" "
" "
MCH
" "
" "
" " II
II
II
HYGIENE STAFF II
PHC
MCH II
STAFF
"
OPD STAFF
MCH STAFF
" TRAINING STAFF
INFORMATION
" EPIDEMIOLO.
" ARI COMMITTEE
INFORMATION
INSTITUTION
HATSAYFONG DIST. II
" SAYSETTHA DIST.
"
" SEE KHOT DIST.
" " II
SEESATTANAK DIST.
" "
SAY THA NEE DIST.
"
" CHANTHBOULEE DIST.!
II
II
" "
NASAY THONG DIST.
" II
HEALTH EDUCATION
" II
NIHE
" MCHI
II
- 57 -
ANNEX 4
SC&mJLE OP TRAIRDIG
TRAINING FOR HOUSEHOLD SURVEY
SCHEDULE OF SUPERVISORS
DAY I C19 April)
0800-0900 Registration and Opening Note I
0900-0930 Introduction to the survey Note 2
0930-1000 Demonstration of interview Example A
1000-1030 Break
1030-1200 Explanation of white pages Note 4
1200-1400 Lunch
1400-1430 Identify children under 4 months Exercise B
1430-1600 Fluids on breast-feeding page Exercise C
1616-1630 Break
1630-1700 Role plays from white pages
DAY 2 (20 April)
0800-0900 Explanation of green pages
0900-1000 Role plays from green pages Exercise F
1000-1030 Break
1030-1100 Explanation of yellow pages
1100-1200 Role plays from yellow pages Exercise G
1200-1400 Lunch
1400-1600 Explanation of pink pages Note 14
1500-1530 Break
1530-1600 Drug identification
1600-1700 Role plays from pink pages Exercise 1
Annex 4
1600-1630
1630-1700
0800-0900
0900-1000
1000-1030
1030-1200
- 58 -
CTD
CTD
DAY 6 (24 April)
Review questionnaires Note 30
Survey schedule Note 31
Break
Conclusion for supervisors Note 32
- 59 -Annex 4
TRAINING FOR HOUSEHOLD.SURVEY
SCHEDULE OF SURVEYORS
DAY 1 (26 April)
0800-0900 Registration and Opening Note I
0900-0930 Introduction to the survey Note 2
0930-1000 Demonstration of interview Example A
1000-1030 Break
1030-1200 Explanation of white pages Note 4
1200-1400 Lunch
1400-1430 Identify children under 4 months Exercise B
1430-1500 Fluids on breast-feeding page Exercise C
1515-1530 ·Break
1530-1700 Role plays from white pages
DAY 2 (27 April)
0800-0900 Explanation of green pages
0900-1000 Role plays from green pages Exercise F
1000-1030 Break
1030-1100 Explanation of yellow pages
1100-1200 Role plays from yellow pages Exercise G
1200-1400 Lunch
1400-1500 Explanation of pink pages Note 14
1500-1530 Break
1530-1600 Drug identification
1600-1700 Role plays from pink pages Exercise J
Annex 4
0800-1000
1000-1030
1030-1200
1200-1400
1400-1500
1500-1530
1530-1700
0800-1200
1200-1400
1400-1500
1500-1530
1530-1700
0800-1200
1200-1400
1400-1500
1500-1530
1530-1700
- 60 -
DAY 3 (28 April)
How to decide on questions to ask Note 19 Exercise K and L
Break
Role plays from different pages Exercise M
Lunch
Role plays from different pages Exercise N
Break
Household selection process Exercise 0 and P Note 22
DAY 4 (29 April)
Field practise Exercise Q
Lunch
Review Questionnaires Note 25
Break
CTD
DAY 5 (30 April)
Field test with supervision Note 27
Lunch
Review questionnaires Note 30
Break
Survey schedule and conclusion for surveyors Note 31
- 61 -ANNEX 5
SUPERVISOR'S CHECKLIST
The supervisor's main task is to make sure that the surveyors follow all instructions and conduct the work in cluster exactly as was taught during the training course. To obtain meaningful data, all surveyors should ask and record the questions in exactly the same way.
1. Before starting the work in the cluster;
Give the surveyors the set of questionnaires intended for the cluster.
Find the village leader and the centre of the village.
Select randomly the first household and direction where surveyors should go.
2. During work in the cluster
Accompany one team of surveyors at a time. Observe interviews and give feedback and answer questions.
Complete ORS access investigation for the cluster.
3. Before leaving the cluster
Check that:
Identification data is at the top of each questionnaire page.
Total number of children found is 40 or more.
Households with children < 5 (question 2) are all listed on pages 2 and 3.
Check that the total number of households (question 1) corresponds with total number of columns used on pages 3, 4 and 5 (caretakers).
Appropriate coloured sections were used for children needing them.
Check all forms for errors and inconsistencies.
If data is missing, have surveyors revisit the household to obtain missing data.
Keep all completed forms from one village (cluster) together and in order. Clip them together. Put all forms from one cluster in a large envelope and write the number of the cluster on it.
4. As soon as possible, after finishing the cluster (not necessarily in the village).
Carefully check all entries and totals of surveyors for errors. Correct them. If there are problems, report them to the coordinator and discuss.
Do the line totals and cumulative totals.
Do the questions designated for the supervisors on the questionnaire. Also, do line totals for these questions.
I I I I I I I I I I I I I .I I I I I I I I I I I I
_I I I I I I I I I I I
SURVEY SUHIIAR Y : COO h t es
DETAILS
Country: Lao PDR
Locality: Vientiane Hun
Urban/rural:
Month/year:
Nur.O.r of clusters:
So~o-nple size:
Both
Hay 1993
100
Children< 5 years: 4111
Calculations based on:
C~ildren with diarrhoea: Z.S~
- 63 -
Ul<S
(~pprox. diarrhoea two week prevalenoel
Correct knowledge of careseeking
Correct knowledge about fluids
Correct knowledge about foods
C~rrect knowledge l rulos
Increased fluid rate
C;n:inyed fe~ding ra:~
Corre~: case ~anagemenc rite
CRS use rate
RHF use r.:u:e
C~T rate (CRS anc/or llHF)
Scurce of advice for ORS:
Moni(
Go¥~r~T.eo: provider
Villase health·~orker ?ri•ate physician Pharmacy/drug seller
lltl at i ••I friend Other
a au
0.07
0.20
0.42
0.77
0.09
o . .sz
0.31
0.40
0.55
o.oz 0.34 0.24 0.15 o. 18 0. II
0.01
ANNEX6
bSE
0.010
0.02!
O.Ol5
0.028
o.o:a
0.0$3
O.Ct!
o.an
D.O!Z
O.C57
0.079
0.025 o. :or o. 115 O.Oal
o.oas 0.006 0.018
I I I I I I I I I' I I I I I I I I I I
i I I I I ·I I I I I I I I
Annex 6
suaver SUMMARY: coo oru~ R~tes
!DETAILS
l (country:
l (Loc~lity:
l (Urban/rural:
l IHonth/yur:
I INU!Cer of lclustors
I I
I I I I I I I 1 I L I I
Lao PDR
Vi ent i ane """
Both
Hay 19Y3
ICO
- 64 -
a.>.ros
Drui use rate
Use oi following ni.IIC~r of drugs:
Use oi ·1 drug
Use oi Z drugs
Use oi 3 c;ugs
Use of 4• drugs
Pr::c:r:i~:-: or c.ases o.h:c:;, ar: dysentery
CRS Ac:ess F~annac has ~cv:rl"llnent prov iC~r
Ctner
aue
0.1!8
0.32
0.24
0.19
0.12
0.15
a. 12
0.51
0.43
o.co
o.z~
0.~5
0.60
0.35
o. 15
2xs:
O.OSi
0.061
0.049
0.052
O.C4~
J.c~a
O .. QS~
a.oez
0.15~ I I
a .. ~co I I
o.:o; I I
o.::o I I
IHST~-CTl·····················································································································
- 65 -
Annex 6
SURVEY ~T: Aal r3tes
·----~----------------------------·----------------------------------------------·----------------------------·--·------------I I I I I I I I I I I I I I I I I I I I I I I r I
DETAILS
CoU>try:lao PDR
Locality: Vientiane llunicipality
Urban and rural
llonth/Ttar: /lay 1993
Hurber of clusters: 100
Saapla si1e (~ousen~lcsl 2593
Ca\;~\aticr.s based on:
C~il.:ren oi:h .\~1 103
Chil~ren With ~N~ and diarr~Otl 11
Chil~ren ~ith co 752
Children with ccugh and diarrhce 46
Two •etk prevalence of hS<:
ANA Cough
0.03 0.22
0.01 0.02
RAiSS
Correc: knowl.C;e signs for cJrtseeking
Rate
0.18
Knowl.C;e ol a SFtcific reason for careseeking:
0.07
Oiificult ore>thing 0.10
Abnormal breathing 0.02
Fl.!ver o.Ja
C.Jr~seeicin; f:::r ~!lA's fr::a a;:prc:pria::e(•) ~rcviders:
An·t sec;uen: e
firs:: aft~r :!'l!l:;:r,Jet",! of fiSt
cr diftic~tt ~r:1thing
C~.-~S~tkir.g fer ~~A's ~0:2:
Tr3di;i~nal he!l:r Mcr.k.
G::~verr.-nenc HOS;l i :Jl
ca~erment heal:h center ar clinic Villa9e healt~·~orkor ir.ol~ing TS~
llri·,ate practiticncr Pharmacy/dru; seller Ktlative or frier4 Other
Carts~eking f~r ==~in fi~~:
0.33
0. 11! 0.01 0.19
0.16
0.17
0.00
0.24
0.25 0.02
0.00
Trlditional he•l•r 0.03
Mor.k 0.00 Cc·•err."nent Hospi al/heal :!l Center 0.16
Vill•ge health·worker including TBA 0.06 Private practitioner 0.18
l~'U·meuober 0.00 Pharmacy/drug seller 0.44 Rel•tive or frier.d 0.01 Ct~er 0.00
Antibiotic use ior c: .. ;n 0.56
:tar:ni..,L ~rug ui~ io;r ,;:..;;;, Qr AHA O.Z5
Uno~cntiiied cr~;s ;iven ior c:u~h :r ~YA 0.25
2xse
0.02
0.01
0.02
0.01
a.oJ
0.12
0.12
0.21 0.02 0.09 0.09 0.11
0.00 0.09 0.09 O.Ol o.co
0.02 0.00 0.04
0.03 0.04 0.0\ 0.06 0.01 o.co
0.04
o.a:.
- 66 -
Annex 6
I I DETAilS RJte ZxSE I I Country: l~a PDR If r~ce 0·3 month• 0.91 0.04
I I I locality: Vientiane Mt..n E•cl aF race 0·3 m 0.08 0.0!. I I I I Urban/rural:9oth I I Preecmin~nc ~; 0 · lon 0.34 0.07 I I Kontn/yur: Kay 1<;'11 I I Scttttde~~:r7 O.lQ ~.~Q I I Nl..o'T.Cer of I I cl~.;sters: 1!!0 I I I I I I Calculations bas~~ c~: I I I I Children Q·j mc~:o 277 I I I
Classi fi cation~
No BlAND N~E/GE~ERIC N~E
Ac1ited 2 Alcopar l Algolropine 4 Aminophylline 5 Ampicillin 6 Alllox i I 7 .ln'.oxyc iII ine 8 Analgin 9 Ant~c·tl
10 Asc in 11 AstmJsolone 12 Aspirin 1l Alropinc 14 Aureomycinc 15 Baby cough syrup 16 Baby's rota cough syrup 17 hctri:n 18 a~ctrine
19 lecancox 20 hnacril 21 !JiS:)l'IOO
zz Busccpan
2l Calyptin 24 CaJillho • pncun inc 25 Carl:>on 26 Clamoxyl 27 Cloramfenicol 28 Chloroquine 29 Cocci Ia 30 Coni~tan · 31 C:rr.cJntrin
32 Oecolgcn 33 Oicophen syrup 34 Disento 35 Disintose 36 Erythrocine l7 Erythr~eine 38 Eucalyptine 39 btencill ine 40 Filnsidar 41 Fecol
42 Fl~!IYl
43 fluver~~al
44 G•nidan 45,Hawkben 46 Hawkperan 47 HlB B~by cough syrup
- 67 -
ANNEX 1
LIST OF DRUG CLASSIFICATIONS DRUG ll Sf
Antibiotic H~rmful druq Cough remedy Antipyretic
Anti i=:ithm.1t ic
Anlibiotic ~pprcpri~te tor dysentery
CON TEN!
p~eudo~phedrine, de~trometarfan
bcpheniua promethazine, plraset~l amincphyll ine ~picillin
An:ox i' ill in
ar.1o,.; yc i ll i r.e
;r.et.!mi ;:ol t
.:.l. nyarox, inJ;resi·..:.•
3cetamino~nf!r~, c~lor~nenirOJmine, phenylt::nrir.e
ephedrine AS.\
3trr.pir:e
tetr3cycl inc:
pllrH e.Crl:t
d!pnc!"'nycr~':'i ~~
cotri•no.r.JlOl~
n.Jtri i dip~.;.~.l~
di ~nenhYcJ•· Jtair.c
&rc.n:ria.dn
n·Cutyl·hydrcsir.e ~rGnlide
eodein, bellad~n~
tJmpher, bromine
t.lrbon amoxyc ill i r.e
cloramienie:l
chloroquine iur~zalidin, neomycin. k3al in <:hl or;;hen1 ;~1ni r:c
pyr:mt~l
.JCft:.01lincpncn, ~n lnyl pr::.plnol.:.mine' en I or~ncni rJmine
acet~minoph~n. phenylprop.lnol~ine, chlorphenir.aine
turatolidin, neomycin, kaol in·pectin
neomycine
erythromycine erythroonyc ine eucalyptus, codcin, c~mpher
penicilline sulpha Acet;xni nophen, chlurphcno rami ooc, phenylephr inc
Hetronid~zol
t lubcndaz:Jle
sul LJguolnic:iin
met:end~zole
metoclwpr~m1oe
onenthol
Antihelmintic Anti protozoal Anti ... tic Antidiarrhoeol Antillllarial
CLASSIFIC-'TION
har:aful drug ant ihel•int ic har11iul drug .nti•sth~tic
""tibiotic (appropriate for dysentery) •ncibiccic (apprpriatt for dysentery) an;i;i~tic (apprpriate fer ~,sentery)
an:i;:yretic
otner
h1rmful drug h>r:ootul drug antipyretic
ontidi>rrhccol, harmful dru;
ant ibiat ic c:us~ r.,.edy
horm;-..l crug on:iaiotic (appropriate !or C/Stnttry) •ntil:>iotic (lppropriatt for dysentery) c:~;;~ remedy har;:nful Cru;-
c:-..:;;, remedy
antiemetic drug
har:oaiul drug coush remedy
other
antibiotic (appropriate for dysentery) antibiotic
anc ioaalari al •nt idiarrhocal har:ni~l drug
~n; i!'1tL11int1c
nJr::oiul drug har10iul drug 1nt idi~trrhoeal
lntibioc:ic
antibiotic Jntibiotic har,.ful drug lntibiotic
anti1111larial harmful drug ant ipratotoal
antihelminlic ~c:ibiotic
ontihel:nintic •nti~ec:ic
ccugh remedy
Annex 7
No B~AND N4~E/CENERIC "AHE
48 Hon11sing
49 Hui le Comenoll!e 50 lmodium 51 Injection for cough 52 lyafin 53 K> Say Pho 54 Lac tool 55 lariam
56 L!'cpard
57 Lcmot i l
58 Hebencbtflll!
59 Metrenidazole
60 Met us san
61 11yecsamt~cng
62 11intHOl
63 N3sol 64 Neg ram
65 Neo·c.cdion 66 Nbaquine
67 Notalgin 68 No·1algin
69 Ole~my:ine
70 ?,~e::ol
71 ParJcet.3mol
72 Peniei ll ine 73 Pher,er;:m
74 Pheni;an
75 Piperazine
76 Polaramine
n Povanyl
78 Pri"'''eran 79 Pyraeone
80 ;{inutan
81 Salbutamol 82 Set::)r.ox.
83 Skorn·oi p · e~ S~Jsf:n
85 St:-!ptcmycin
86 Sul SCD
87 Sulfadiatzin" 88 Terpine gonnon
89 Ttt raeye l i "" 90 Theralene
91 Theophylline
92 Theo24 93 Ti fly 94 Totapen 95 Trisulfa
96 Tussidyl 97 Tylenol 98 Ventol ine
99 Vic:lol syrup 100 Visceral gin 101 Uhite Senjamin
- 68 -
cmHE~T
ASA
natural oils loperJmid any
dextrom~torf~n,pseudoephedrin,chlor~henicole
aeidophi lus mefloquin~
opi~,.;m tincture
dipnonoxyl~te
mel::end.ltcle metr.,nid:l~ole
=e:<: .-01r.e-::or f .1n, c~! .:::-;:hen i r ;mi r.("
carr imox.:n-::t ~
tiab'!!'nd:JZ:Jle
n~~h.Jzol ir.e, chlor;:H·oph•n~yrid,:,mine
n:llidixic acid
CoCein
c~l::roq".Jine
r.:.et~mizole
mec:~i zcle
c~:r:lcyct ine
~Jr)t~C:l~ol
p:~r:~cet:1mol
c~!1ici ll ine
j:rc~~ch.:nir:e
pro:n•rhazineo
pij:ercuine
~exchlor~heniramtne
pyrviniU'ft
me~ocloprJmide
p.:lr3setatnol
p3rOJcet3mol. pht:onylpropanol:mtint
s>lbutamol \c;;cr.:::;mide
pi;:::erJzine
~hl;:r;luc:not
streptomycin
sulf.ldi:~zine
sulf.:ldiazine
codeine tetracycline
at imetazine
theQj:hyll i ne
theephyll i ne
phenylprop3n0l3mine, phcnyl~phrine, c~or~heniramine
ampiciltir.e
sul f:arin•ecopri.n
.lcer.lminophen
ssalbuCJmol
~SA
phlorglueinol pl3nt e111.tract
CL~SSIFIC~TION
antipyretic
ecu~h remedy
anti diarrhoeal
har:nful
harmful drug
antipyrttic:
other
antimalarial
h•r:•f·.Jl drug
anti diarrhoeal
antihe\;n~ntic
anti;:r:tozoal
h.u~;u! arug
an:ibiotie (lpproprate for dysentery) !r.tihe!rnintic:
har:nful drug
ar.tibio:ic (appropriate for eysontery) harr'!'.ft..:l Cr•..:g
ar.':::niltarial
antip-/r'!tic:
a~d ;:::yr~~ic
an: ibb: ir
ar::lp-tr~tic:
ar.:ipyretic
antibio::ic
h!:-;.;f•Jl drug
h3r:':'lf•.Jl drug
an:~:-.et::'lintic:
harr:.ful drug
ant ihtl~int ie
antiemetic drug
antipyretic
hlrrnful drug
antiasthmatic
lr.:idiarrhoeal
antiheot~intic
an~i!~!~i~tancispas~oidic
antibiotic
antibiotic
anti biotic
harmful dr-~g
ar.cibiotic
harmful drug ant ias:r.mat ic
:~r.tiasthmatic
h "'"' u l drug ar.ri~iotic (3pprcpriate for ~s.ntery)
antibiotic (appropriate for dysentery) uni.na·.on
ancipyrecic
anti3sthmatic
Jnt ipyret i c
anciemetictantispasmaidic C'lU9h remedy