mics4 survey design workshop multiple indicator cluster surveys survey design workshop questionnaire...
TRANSCRIPT
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MICS4 Survey Design Workshop
Multiple Indicator Cluster SurveysSurvey Design Workshop
Questionnaire for Children Under Five:
Care of Illness
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MICS4 Survey Design Workshop
Presentation overview
• Pneumonia
• Diarrhoeal diseases
• Safe disposal of children’s stools
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MICS4 Survey Design Workshop
Leading causes of child deathsPneumonia and diarrhoea are the leading causes of under-five deaths
– causing an estimated 40% of child deaths each year globallySource: WHO Global Burden of Disease estimates (2004)
Note: Globally more than one-third of under-five deaths is attributable to under-nutrition
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MICS4 Survey Design Workshop
Pneumonia
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MICS4 Survey Design Workshop
Background (Pneumonia)
• Refers to cases of suspected pneumonia (previously referred to as acute respiratory illness)
• Suspected pneumonia includes children reported to have an illness with a cough accompanied by fast and/or difficult breathing in the previous 2 weeks
• Simple cases of cold are filtered out with a second question: “Were these (symptoms) due to a problem in the chest or a blocked or runny nose?”
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MICS4 Survey Design Workshop
MICS Indicators (Pneumonia)
Pneumonia (no change from MICS3)
• #3.9 Care seeking for suspected pneumonia % under fives with suspected pneumonia in the previous 2
weeks who were taken to an appropriate health provider
• #3.10 Antibiotics treatment of suspected pneumonia % under fives with suspected pneumonia in the previous 2 weeks who
received antibiotics
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MICS4 Survey Design Workshop
– Prevalence of suspected pneumonia
– Care-seeking for suspected pneumonia
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MICS4 Survey Design Workshop
– Antibiotic use for suspected pneumonia
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MICS4 Survey Design Workshop
Method issues (Pneumonia)
• Seasonality of suspected pneumonia may affect comparisons over time and across countries
• Does not measure timing or dosage of treatment, or type of antibiotic used
• Methodological work underway to assess validity of caregivers’ responses regarding treatment by drug type for major childhood illnesses (CHERG)
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Diarrhoeal diseases
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Background (Diarrhoea)
• Treatment recommendations have changed several times over past few decades
• Current treatment recommendations include fluid replacement (including breastfeeding) with continued feeding and zinc treatment
• ORS packets (specifically low-osmolarity ORS) are most effective for preventing & treating life-threatening dehydration due to diarrhoea
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MICS4 Survey Design Workshop
Background (diarrhoea)
• If ORS packets not available, recommended homemade fluids or increased fluids of any type also help prevent dehydration
• Continued feeding supports fluid absorption and improves nutritional status
• Zinc treatment reduces stool volume, including diarrhoea severity and duration
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MICS4 Survey Design Workshop
MICS Indicators (Diarrhoea)• #3.8: ORT with continued feeding - % under fives with
diarrhoea in the previous 2 weeks receiving ORT (ORS packet or recommended homemade fluid or increased fluids) and continued feeding
• Compound indicator reflects multiple components of treatment recommendations (except zinc treatment since data are largely unavailable at present)
• Previously reported ORT indicators not included (e.g. home management of diarrhoea and ORT use)
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MICS4 Survey Design Workshop
MICS Additional Indicators (Diarrhoea)
Components of treatment recommendation (indicators)
• ORS packets % under fives with diarrhoea receiving an ORS packet (includes pre-packaged ORS fluids or fluids from an ORS packet)
• Recommended homemade fluids % under fives with diarrhoea receiving recommended homemade fluids (customized to national guidelines)
• Increased fluids % under fives with diarrhoea receiving more to drink during the illness
• Continued feeding % under fives with diarrhoea receiving either more, same or somewhat less to eat than usual during the illness
• Zinc treatment % under fives with diarrhoea receiving zinc
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MICS4 Survey Design Workshop
– Prevalence of diarrhoea
– Fluids and foods
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MICS4 Survey Design Workshop
– ORS packet or recommended home fluid
– Treatment for diarrhoea
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MICS4 Survey Design Workshop
Method issues (diarrhoea)
Customization of survey questionnaire• Adapt locally to include common names/brands used for ORS
packets (including pre-packaged ORS fluids and fluids from ORS packets)
• If no pre-packaged ORS fluid available in the country, delete this category
• Adapt locally to include country-specific recommendations for homemade fluids based on national or medical guidelines. Ingredients promoted by government to make these fluids should be included in this category.
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MICS4 Survey Design Workshop
Method issues (diarrhoea)
Other methodological issues• Compound indicator – current treatment indicator reflects multiple
components of recommendation (except zinc). Evaluate components to help interpret overall coverage value.
• Changing recommendations, changing indicators – lack of comparable data to measure progress in diarrhoea treatment
– ORT use (1980s to early 1990s) - % U5s with diarrhoea receiving either an ORS packet or recommended homemade fluid
– Home management of diarrhoea (early 1990s to early 2000s) - % U5s with diarrhoea receiving increased fluids and continued feeding
– ORT with continued feeding (early 2000s to present) - % U5s with diarrhoea receiving ORT (ORS packet, RHF or increased fluids) with continued feeding
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MICS4 Survey Design Workshop
Method issues (diarrhoea)
Other methodological issues (continued)
• Diarrhoea prevalence varies by season and timing of outbreaks, and caregivers understanding of what constitutes a diarrhoea episode. Does not measure duration or severity of diarrhoea, nor extent of dehydration accompanying episode.
• Does not measure number or timing of interventions used during episode, or whether ORS or homemade fluids were correctly prepared
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MICS4 Survey Design Workshop
Method issues (diarrhoea)
Other methodological issues (continued)
• Customization of survey questionnaire often not done. For some countries, national guidelines for home fluids may not be defined or readily available to survey managers.
• Wording changes for ORT questions over time may affect responses (although surveys translated into many languages which also may lead to slight differences in question wording)
• Zinc included as response category, not as separate question – more work needed to see how this affects response
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MICS4 Survey Design Workshop
Method issues (diarrhoea)
Other methodological issues (continued)
• Methodological work underway to assess issues outlined above, including whether accuracy of zinc responses improves if separate question included (CHERG)
• Forthcoming UNICEF and WHO report on diarrhoeal diseases to assess prevention and treatment coverage; set for release in Oct/Nov 2009
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Safe disposal of children’s stools
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MICS4 Survey Design Workshop
Background (Child stools)
• Children’s stools tend to carry a higher pathogen load than adult’s stools
• Many children defecate in or around home, as well as play in areas where stools are found
• Safely disposing children’s stools is critical for reducing the number of diarrhoea cases
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MICS4 Survey Design Workshop
MICS Indicators (Child stools)
• # 4.4: Disposal of child’s faeces - % under threes whose (last) stools were disposed of safely
• Adequate disposal includes used a toilet/latrine, rinsed in a toilet/latrine or buried stools. Adequacy of throwing in garbage depends on solid waste collection.
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MICS4 Survey Design Workshop
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MICS4 Survey Design Workshop