report household survey of bilaspur district (chhattisgarh …rltrird.cg.gov.in/pdf/rohfw/field...
TRANSCRIPT
Regional Office of Health and Family Welfare and Regional Leprosy Training and
Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state
1
REPORT HOUSEHOLD SURVEY OF BILASPUR DISTRICT
(Chhattisgarh state) ON
MDA EVALUATION
Date of MDA 2012 – 9th to 11 May 2012 in rural area - 22th to 24th April 2012 in urban area
Regional Office of Health and Family Welfare and
Regional Leprosy Training and Research Institute, Ministry of Health and Family Welfare,
Govt of India, Raipur, Chhattisgarh state
Evaluation Team Dr Sunil Gitte, M.D. (PSM), Deputy Director
Dr Ravi Rao, Medical officer, S.Dhruw, I Maisih, PMW,
14th
- 18th
May
2012
Regional Office of Health and Family Welfare and Regional Leprosy Training and
Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state
2
INDEX PAGE No.
BACKGROUND 03
OBJECTIVES 03
METHOD OF SURVEY 05
OBSERVATIONS 08
SUMMARY 13
CONCLUSION/RECOMMENDATION 15
FORMAT I- BILASPUR DISTRICT 17
PHOTOS 19
Regional Office of Health and Family Welfare and Regional Leprosy Training and
Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state
3
BACKGROUND OF MDA EVALUATION
A Post MDA evaluation survey was conducted with the objective to review the
progress of the single dose of diethyl-carbamazine (DEC) and Albendazole,
administration and to understand the functioning of the programme to
recommend mid-term amendment.
It has been observed in the past that the actual drug consumption was lower
than the reported coverage by peripheral health workers or / volunteers. As per
the norms, the drug is to be consumed by the eligible population in the presence
of drug distributor but on many occasion, the drug was handed over to the family
members for consumption later on. It has been observed that a substantial
proportion of community members do not consume the drug. Therefore, it is
important that the mid term assessment should be conducted by the
independent team members who are not directly connected with the MDA
programme in the selected area. The assessment shall be completed within three
weeks of MDA so that the community will be able to recall the events without
memory lapse. The purpose of the MDA evaluation in the BILASPUR district is the
mid-course corrections and to suggest necessary steps for further course of
action.
Objective:
i) To review the progress of activities of single dose DEC mass
administration in the selected district.
ii) To make an independent assessment of the programme implementation
with respect to process and outcome indicators.
iii) To recommend mid-course corrections and to suggest necessary steps for
further course of action.
Regional Office of Health and Family Welfare and Regional Leprosy Training and
Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state
4
MAP District Bilaspur As of 2011 India census, Bilaspur had a population of 26, 62,077. Males constitute 51%
of the population and females 49%. Bilaspur has an average literacy rate of 72%, lower
than the national average of 74%; with male literacy of 83% and female literacy of 60%.
15% of the population is under 6 years of age.
In the year 2011, new Mungeli district carved from Bilaspur district. But MDA was
carried out by Bilaspur District Health administration. MDA 2012 was carried out into
two phases due to Gram Swaraj Abhiyan
Regional Office of Health and Family Welfare and Regional Leprosy Training and
Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state
5
METHODS: Survey area: Bilaspur District The teams of ROHFW visited the study district and tried to collect data by desk
review, in-depth interviews, on site observations, and from the community.
A) Selection of households: The PHC should be stratified in to 3 groups
depending upon MDA 2012 coverage as given below:
Sr. No
Category MDA Coverage %
1 PHC with coverage below 50 2 PHC with coverage between 50-80 3 PHC with coverage above 80
In case there is no PHC in a particular category, two blocks from the next
category may be selected.
In each category, PHC should be selected randomly
From each of the selected PHC, one village should be selected randomly for
household survey.
In each village, 30 households should be covered. The detailed questionnaire
is enclosed at Annex. 1
Similarly, in urban areas one ward should be selected randomly for the
evaluation of the programme.
In each selected ward, 30 households should be covered.
In this way, in each district, 120 households will be surveyed for the purpose
of MDA evaluation.
Regional Office of Health and Family Welfare and Regional Leprosy Training and
Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state
6
Reported coverage of district Bilaspur by BMO
sr No Name of Block@ Total
Population Eligible
population Population
Covered MDA %
coverage 1 Bilaspur Urban 353198 300218 238359 79.4 2 Marwahi 131709 111953 110222 98.5 3 Gourella 124636 105941 85202 80.4 4 Pendra 91190 77512 75169 97.0 5 Kota 218058 185349 169827 91.6 6 Lormi 230461 195892 196432 100.3
7 Mungeli 247955 210762 187615 89.0 8 Patharia 168188 142960 122923 86.0 9 Takhatpur 269480 229058 180010 78.6
10 Bilha 326303 277358 240733 86.8 11 Masturi 275264 233974 215120 91.9
Total 2436442 2070977 1821612 88.0 @ Source by DMO office
B) Modified Sampling
The BLOCK was stratified into 3 groups depending upon MDA 2012 coverage
of BILASPUR as given below
A) Fixed and Random sites based on above coverage
Sr.no
Category District MDA COVERAGE
Fixed AND Random sites
BILASPUR
1 BLOCK with coverage
below 50 00
2 BLOCK with coverage
between 50-80 02
3 BLOCK with coverage
above >80 09
(* The readymade data of the PHC Coverage/village are not available at district or Block)
Regional Office of Health and Family Welfare and Regional Leprosy Training and
Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state
7
b) The Blocks was stratified into 3 groups depending upon MDA 2012 coverage –
Sr no
Category MDA
Coverage
BILASPUR district
No of PHC/URBAN
Name of village/
ward
1 Block with coverage
below 50% NO PHC NO VILLAGE
2 Block with coverage
between 50-80%
Bilaspur urban Ward no
40,41 Belpan PHC Podikala
3 Block with coverage
above >80%
Ratanpur Urban Karhaiyapara
Nawagaon PHC Lalpur
Amadand PHC Amadand
*From above category, 3 Block was selected randomly.
*From each of selected block, one village was selected randomly for survey.
*In each village, 30 household should covered.
**One urban area was selected randomly and from selected urban area ,one ward
was selected randomly. The 30 households were surveyed in selected ward.
Data analysis: Data was analyzed on the same day and entered in Microsoft Excel
sheet and results were shared with Chief Medical officer (CMO) cum Joint Director
and District Malaria Officer. The VBD consultant was not available during
discussion.
Funds: The IEC funds were not analyzed due to lack of availability of document
during survey.
Regional Office of Health and Family Welfare and Regional Leprosy Training and
Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state
8
RESULTS: Table-1 –Age and sex distribution of surveyed eligible population Particulars Male Female Total
Adult 296 (32.5) 264 (28.9) 560(61.4)
Children (<14 year)
184 (20.1) 168 (18.3) 352(38.6)
Total 480 (52.6) 432 (47.4) 912 (100%)
In surveyed population, 53% were male while 47% were female. 39% were children less than 14years of age. Table-2 -Coverage of MDA in the eligible population
Sr no Profile No
1 Total Houses surveyed 150
2 Total survey population 912
3 Total eligible Surveyed population 807
5 Person consume DEC tablets 509
6 Person not taken DEC on MDA 2012 298
% of actual DEC taken 63%
Regional Office of Health and Family Welfare and Regional Leprosy Training and
Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state
9
Table -3. Area wise coverage of MDA in Urban and Rural area of Bilaspur
Sr no
PARTICULARS
Bilaspur Block
Kota Block Kota Block Pendra Block
Takhatpur Block
Bilaspur (URBAN)
Ratanpur (URBAN)
Nawagaon Lalpur
(RURAL)
Amadand(Rural)
Podikala (Rural)
1 Total Houses
surveyed 30 30 30 30 30
3 Total eligible
population 179 161 117 137
213
5 Person not taken
DEC on MDA 2012
119 115 0 9 55
6 % of actual DEC
taken 33.5% 28.5% 100% 93%
74%
The urban area coverage was significantly low as compare to rural area. The
overall drug consumed coverage was 64% in surveyed houses. This district
reported coverage is very high which needs to review the activity by state.
The population of the district as per census 2011 is 26, 62,077 but total
population of district taken by DMO is 24, 36,442 which need to be updated.
Graph 1 showing the beneficiary who actual swallowed the DEC tablets in presence of Drug distributor
Regional Office of Health and Family Welfare and Regional Leprosy Training and
Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state
10
Out of 807 beneficiaries, none of the interviewed beneficiaries had
consumed the DEC+ Alb tablets in the presence of the drug distributors.
This Distribution drive depends only on anganwadi workers and volunteers at
urban area and ASHA in Rural area. There is minimal involvement of Peripheral
workers at rural area in the present drive. Most of the distributors distributed
the Drugs without giving any information to the beneficiary.
Graph 2- In Urban and Rural area opinion of beneficiaries as who should be the Drug distributor
In Urban area Anganwadi worker was preferred more as the drug distributor.
Regional Office of Health and Family Welfare and Regional Leprosy Training and
Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state
11
In rural area the ASHA workers are preferred more than the other workers, this
might be due to following reasons–
a) Local community workers
b) She can spend more time in village
c) She is close to the villagers than any other worker
In urban area Anganwadi workers are more preferred.
Graph 3 Reasons of non-consumed drugs by beneficiary
Various sources of the health information regarding the MDA None of the interviewed members had any information about MDA. IEC is very
poor in both urban and rural areas and it is restricted to only banners on the wall
of Health institute. However, the level of awareness about the morbidity
management in the community was low. Very few subjects with LF, who were
interviewed, could answer the proper method of care. The training on morbidity
management was not given to the identified cases.
Regional Office of Health and Family Welfare and Regional Leprosy Training and
Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state
12
Drug distributor persuaded swallowing of the drug in his presence
None of the drug distributor had persuaded the beneficiary to swallow the Dec
tablets in his/her presence. This drive was focused only on the distribution
instead of persuaded swallowing of drug in his/her presence.
The interviewed person helps the drug distributor for drug
compliance in his village or mohallah
None of the interviewed persons helps the drug distributor for drug compliance
in his village or mohallah. There is lot of scope for involvement of the community
members in MDA activities. DMO and VBDs should call meetings of the
community leaders at block and urban settings. Most of the community members
are not aware of the MDA activities in their area.
Side effects of DEC +Alb in surveyed population: Out of the surveyed beneficiaries, none had experienced any side effects. None of
them were informed regarding side effects and if occur, where to report
Comments of Action Plan:
The action plan had good micro plans with detailed information on how to
proceed for an activity and could easily serve as a model for the programme,
while no such plan were available in District , where, the work was coordinated
from PHC level, without much input from district malaria office and without
proper planning.
The VBD consultant should involve on the preparation of detailed micro plan,
which was not provided to evaluation team.
Regional Office of Health and Family Welfare and Regional Leprosy Training and
Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state
13
SUMMARY
The MDA activities in the surveyed districts are going through the stage of
planning and implementation and appear to be weak. In none of this
surveyed area of districts, the local authorities sought the active help or
cooperation of the community members for the implementation of MDA
activities. There is need of intensive health education campaign to make
the community aware about LF and, increase their participation in the
programme. None of the drug distributor explained to interview person
and family members regarding DEC intake on elimination of Lymphatic
Filariasis and details of transmission of the disease.
Fear of drug, lack of information of tablets and absence from home due to
travel/Marriage season was the main reason for not taking drug (DEC) on
MDA 2012. The children were not allowed to consume the tablets by their
parents due to fear of drugs.
None of beneficiary swallowed the tablets in presence of Drug distributor;
the consumption of drug is very low in urban area and good in rural area.
In area where there was prophylactic drive of tab chingumsulf, the
consumption is very good. Some of people assumed and consumed these
tab as malaria prevention tablets
Regional Office of Health and Family Welfare and Regional Leprosy Training and
Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state
14
Drug distributor visited all surveyed houses and distributed the drugs in
rural area but in urban area, some of the houses were missing due to lack
of coordination of two workers and also due to unclear demarcation of
wards.
None of the drug distributor had persuaded swallow of the DEC in his or
her presence in 150 houses.
None of the surveyed population has helped the drug distributor for drug
compliance in village/urban area. None of the beneficiaries have prior
information regarding MDA.
The local volunteer/agencies were not actively participated in MDA
activity in urban area.
None of the beneficiary had experienced side effects.
Regional Office of Health and Family Welfare and Regional Leprosy Training and
Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state
15
CONCLUSIONS/RECOMMENDATIONS
1) The major focus of the staff was on the paper work. The implementation
was very poor in the district. The health education activities were not done
satisfactorily. There was limited knowledge and awareness about LF and
MDA amongst the community members. The local modes of awareness
generation were almost missing. The authorities had used TV, Posters and
newspapers for IEC activities, which had limited penetration in the rural
population. IEC activates need to improvement in rural as well as urban
area. These activities should be done timely and more frequently before
MDA.
2) The Community participation In MDA needs improvement by conducting
area wise meetings. The voluntary organization should be involved in the
activity especially in urban area where the coverage is low.
3) The tablets were distributed during the day time, when most of the
population goes to their work place, leading to insufficient coverage.
Therefore, in future, dates should be finalised after due deliberations and
input from the community. The timing for the tablet distribution should
also be made in the evening to make it convenient for the community.
There is definitive need to ensure that drug distributor meets the person.
They may go to the area in evening time or may have to pay one more visit
at the time convenient for the locals.The drug consumption in presence of
drug distributor need to be increased in urban as well as rural areas.
Regional Office of Health and Family Welfare and Regional Leprosy Training and
Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state
16
4) The home-based management of a case of LF is a part of the strategy to
eliminate LF. However, the level of awareness about the morbidity
management in the community is very low. Very few subjects with LF, who
were interviewed, could not answer the proper method of care. The
training on morbidity management was not given to identified cases. IEC
activity regarding Morbidity management in-patients who are suffering
from the elphanttitis should be targeted.
5) The dates of MDA were not properly thought about. The MDA was
rescheduled in rural area.
The ROHFW, Raipur was neither informed by State Programme
Officials nor by NVBDCP division about MDA 2012 drive for elimination
of Lymphatic Filariasis in Chhattisgarh state. The coordination of these
important activity help proper planning, implementation and
evaluation.
Regional Office of Health and Family Welfare and Regional Leprosy Training and
Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state
17
Format I MDA Evaluation report of RD team District: Bilaspur Name of Investigator: Designation : Particulars
1 Name of Village/GULLI selected 2 Population of selected village/ward 3 Name of PHC 4 No of beneficiaries interviewed 5 Total no of Beneficiaries in selected
houses
6 No of beneficiaries consumed tablets 7 No of beneficiaries not consumed
tablets
8 Percentages of consumption 9 District average consumption
10 No of House visited by the drug distributor for MDA in elected houses
11 Percentages of House visited 12 No of beneficiaries swallowed tablets
in presence of drug distributors
13 Percentage of beneficiaries swallowed drug in presence of drug distributor
14 Reasons for not swallowed the drug
A No information about LF/MDA/DEC B Fear of Drug C Beneficiaries on empty stomach at the time
of DD visit
D Side reaction of Drug E
F Complication of previous year MDA G Other
15
A ANM B Health Worker ( Male) C Anganwadi worker D NGO E Volunteer F Students G Other
16 Source of Information about MDA Activity
Regional Office of Health and Family Welfare and Regional Leprosy Training and
Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state
18
A Health Worker ( Male) B Anganwadi worker C NGO D Volunteer E Miking F Davandi G Radio H TV I News paper J Handbills K Other
17 No of beneficiaries experienced side effects of DEC
Details of side effects of DEC A Nausea B Headache C Fever D Rash E Dehydration F Fainting attack g Other
18 Whether you are aware about the nearest treatment facility center for treating side effects of DEC
19 If treated place of treatment A PHC B Rural Hospital C Private Hospital d Others
19 Information of the line listing of Elephantitis and hydrocele.
Regional Office of Health and Family Welfare and Regional Leprosy Training and
Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state
19
Bilaspur Urban- Household
survey
Interaction of Household and
AWW
Regional Office of Health and Family Welfare and Regional Leprosy Training and
Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state
20
Interaction with Community Members
Person with Lymphedema Leg not consumed
Drugs on special activity due to lack of
Knowledge
Regional Office of Health and Family Welfare and Regional Leprosy Training and
Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state
21
Recovered DEC+Alb Tab after
Distribution
Involvement of DM and CMO rally on
MDA day
Regional Office of Health and Family Welfare and Regional Leprosy Training and
Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state
22
MDA Posters