ANNEX 10 KPC REPORT

CONCERN NIGER
Tahoua District

Baseline Survey Report: Knowledge, Practice and Coverage

February 2010
Prepared and written by Jean Bosco AHORANAYEZU, MD, MPH Survey Team Leader

Acknowledgements
The following people were instrumental in bringing the KPC survey and report preparation to successful completion: CORE TEAM Bankali Assoumane Chaibou Saadou Hamid Mohamed Mrs. Aloke Maimouna Project Manager, Concern M&E Officer, Concern Focal Point for Community Participation, Tahoua Health District Nutritionist, Tahoua Regional Health Department SURVEY SUPERVISORS Senior Nurse in charge of Prevention, Concern Pharmacy Manager, Concern Supervisor, Tahoua Health District Supervisor, Tahoua Health District Supervisor, Tahoua Health District INTERVIEWERS

Mrs. Mariama Mahamadou Mrs. Zeinabou Harouna Mrs. Arzika Bary Mrs. Chitou Mamane Sani Mrs. Mariama Bilal

Nurse in charge of Community interventions, Concern Wassila Abdou Nurse, Tahoua Health District Oumarou Amadou Diallo Nurse in charge of Curative interventions (IMCI) Mrs. Rakia Garba Nurse, Tahoua Health District Mrs. Nana Hadiza Adamou Nurse, Tahoua Health District Mrs. Hadiza Ibrahim Nurse, Tahoua Health District Ahamet Ourkel Nutritionist Assistant Mrs. Hadiza Abdou Nurse, Tahoua Health District Abdoulkader Moumbachar Nurse Abdoulaziz Abdou Community Health Agent TECHNICAL ASSISTANCE AND EDITORS Philip Wegner Pierre Lacerte Kathy Tilford Global Health Advisor, Concern USA Niger Health Advisor, Concern Niger External Consultant for Concern Niger

Table of Contents Acknowledgements Table of contents

Abbreviations and Acronyms 1 Background 1.1 Project Location 1.2 Characteristics of the Target Population 1.3 Health, Social, and Economic Conditions within the Project Area 1.4 National Standards/Policies regarding Maternal and Child Health 1.5 Overview of the Child Survival Project 1.6 Objectives of the KPC Survey 1.7 Indicators Selected by technical Intervention Areas Methods 2.1 Human Resources 2.2 Training and Capacity Building 2.3 Questionnaires 2.4 Study Population 2.5 Data Collection and Analysis Results 3.1 Demographic Characteristics 3.2 Maternal and Newborn Care 3.3 Breastfeeding 3.4 Vitamin A Supplementation 3.5 Immunization 3.6 Malaria 3.7 Pneumonia 3.8 Diarrhea 3.9 Anthropometrics 3.10 Summary Table of Rapid CATCH Indicators 3.11 Summary Table of Key Project Indicators Discussion 4.1 Key Findings of KPC Survey and Programmatic Implications Conclusion Bibliography Appendices A. KPC Questionnaire B. Manual Tabulation Tables of Raw Data C. Population/List of all Communities (Villages)

4 5 6 7

Abbreviations and Acronyms

ACT BCC CCM CHA C-HIS CHN C-IMCI CMAM CSP CSTS DHS DHT DMCH DPT or DTC EDSN-MICS ENA HC HP IMCI INS IPT ITN KPC LQAS M&E MoH MUAC NCHS NMCP ORS SD TT UNICEF WHO Artemisinin Combination Therapy Behavior Change Communication Community Case Management Community Health Agent Community Health Information System Child Health and Nutrition Community-Integrated Management of Childhood Illnesses Community Management of Acute Malnutrition Child Survival Project Child Survival Technical Support project Demographic and Health Survey District Health Team Department of Maternal and Child Health Diphtheria-Pertussis-Tetanus vaccine Enqute Dmographique et de Sant du Niger- Multiple Indicator Cluster Surveys Essential Nutrition Actions Health Center Health Post Integrated Management of Childhood Illnesses Institut National de la Statistique Intermittent Preventive Treatment (Preventive Treatment for Malaria in Pregnant Women) Insecticide Treated Nets Knowledge, Practice and Coverage Lot Quality Assurance Sampling Monitoring and Evaluation Ministry of Health Mid-upper Arm Circumference National Center for Health Statistics (USA Health Statistics Agency) National Malaria Control Program Oral Rehydration Salts Standard Deviation Tetanus Toxoid United Nations Childrens Fund World Health Organization

Background

1.1 Project Location

Niger is divided administratively into regions, one of which is Tahoua Region in the central part of the country. Tahoua Region is further divided into eight districts including Tahoua District where the Lahiya Yara Child Survival Project (CSP) will be implemented. Specifically, the project zone will include the six rural communes of Tahoua District: Affala, Barmou, Kalfou, Takanamatt, Tebaram and Bambeye. Under match funding, a limited number of activities will also be implemented in five health centers (HC) in neighboring Illla District. The area is primarily savanna with limited agriculture and grazing for livestock. The Tahoua Region, like many parts of the country, suffers from soil erosion, deforestation, overgrazing and recurring droughts.

1.2 Characteristics of the Target Population

Tahoua District has an estimated total population of 476,583. The target population in the project area (the six rural communes) is estimated at 358,876 including 76,082 children under five years of age and 82,183 women of reproductive age. These are primarily rural and agricultural populations with some mix of regional migratory workers and nomads. The Hausa and Djerma-Songhai are the largest ethnic groups, while the traditionally nomadic Touareg, Fulani and Kanouri make up the other principal groups in the area.

1.3 Health, Social and Economic Conditions within the Project Area
The Republic of Niger is one of the poorest countries in the world with the fourth highest level of child death.1 Sixty-two percent of the population lives below the poverty line.2 Structural poverty reflects more than a decade of periodic political instability, including the recent coup in February 2010 which deposed the former president. The ability of Nigeriens to meet their basic needs is further compromised by low levels of education, gender inequities, persistence of preventable diseases and malnutrition. Inadequate care for the sick child is perpetuated by harmful traditional beliefs and practices, lack of knowledge of disease prevention, inappropriate home treatment, poor feeding practices and gender inequity within the household.3 In Tahoua Region, like much of Niger, care-seeking practices for sick children are limited and the health infrastructures fall short in meeting coverage needs - only 53% of the population lives within 5 kilometers (km) of a health center.4 Although the government has invested heavily in establishing health posts (HP) at the community level, these facilities offer a reduced level of services compared to health centers, the Community Health Agents (CHA) who staff them are less qualified than the health center nurses and coverage is still inadequate.

1.4 National Standards/Policies Regarding Maternal and Child health

The Niger health system has been engaged in the reduction of poverty and the promotion of development in relationship to the Millennium Development Goals and National Health Plans reflect that engagement. The National Health Plan for 2005-2010 aims to contribute to the
1 UNICEF. State of the Worlds Children 2008. 2 RN/ME/F/Institute National de Statistiques, World Bank. Questionnaire Unifi sur les Indicateurs de Bien-re de Base, 2005. 3 Hammpshire K. et.al. for Concern Worldwide Niger. The Social Context of Child Malnutrition: Household Response to Food Crisis, Decision-making and Childcare Practices; 2006; p.47. 4 RN/MSP/DGSP/DEDP. Rapport Annuel d Execution du PDS 2005-2010 Anne 2008, dcembre 2008.

reduction of maternal and child mortality by building on existing capacity to improve the efficiency and quality of the health system.5 Building on the national planning process, those involved in the ongoing decentralization process have also developed five-year Regional and District Health Plans. Under-five and reproductive health services have been free of charge since 2007. In 2008 the Ministry of Health developed a National Child Survival Strategy which includes increased access to health services through community-based management of malaria, pneumonia and diarrhea. Furthermore, this new strategy promotes the increased availability of competent personnel, an effective system of supplying essential drugs and equipment, adequate logistics, strong supervision and a viable monitoring system as critical factors in a successful Child Survival Strategy. 6 Through the Catalytic Initiative in Niger, UNICEF is currently supporting the Ministry of Health (MoH) in providing training in Community Case Management (CCM) of diarrhea, malaria and pneumonia to Community Health Agents (CHA) working at health posts.

1.5 The Child Survival Project

The goal of the Lahiya Yara Child Survival project is sustained reduction in childhood mortality in Tahoua Region with the Strategic Objective of decreased mortality of children under-five in Tahoua District. Project strategies include behavior change communication, community mobilization, community and facility linkages, and health system strengthening. The project will target 50 communities for intense support in addition to working with 24 health centers and 58 health posts. The technical interventions focus on the leading causes of child mortality in the project zone: prevention and treatment of malaria (30% level of effort); nutrition (30%); pneumonia case management (20%) and control of diarrhea diseases (20%). The choice of these technical interventions are consistent with MoH priorities for initial implementation of Community Case Management and respond to felt needs identified by health workers. The Intermediate Results (principal objectives) are: Increased coverage of essential Child Health and Nutrition (CHN) services and interventions. The project will work to ensure provision of quality primary health care and lifesaving interventions to children under-five, especially those living far from a health facility. The project team will 1) engage and empower families and caretakers to use essential CHN services available at health centers and health posts and through mobile outreach and campaigns; 2) improve the quality of service delivery so that children under-five receive safe and effective services and their caregivers are satisfied with services received; and 3) bring health education, disease prevention interventions, malnutrition screening and case management of the sick child as close to the family as possible, particularly in life-threatening situations. Adoption of Key Family Practices at the household level. Guided by a list of Key Family Practices that comprise household and community integrated management of childhood illness (HH/C-IMCI) and essential nutrition actions (ENA), the project team will use Behavior Change Communication (BCC) and community mobilization

5 Republic of Niger. Accelerated Development and Poverty Reduction Strategy 2008-2012, August 2007;page91. 6 RN/Ministre de la Sant Publique. Avant-projet de Stratgie National de Survie de lEnfant, 2008 ; page 30.

strategies to promote good practices, capitalize on enabling factors and structures, and address known barriers. Improved district performance in delivery of essential CHN services. One of the main purposes of the project is to reinforce the District Health Team (DHT) planning and management capacity to effectively deliver quality integrated CHN services. Within this context, the project will work with the district on selected performance needs that can: be met within the scope of the proposed project; build upon Concerns current performance improvement activities; and derive long-lasting returns. Based on current district performance, the project proposes to increase the planning, management and supervision capacity of the DHT; strengthen partnerships between health facilities and communities; address equipment and logistic shortfalls at selected health centers and health posts; and improve coordination at each level of the district health system. Improved policy environment. The project proposes to strengthen the national evidence base of community delivery strategies by studying innovative approaches (CCM and Community Management of Acute Malnutrition or CMAM) to saving lives and, with this evidence, inform or possibly improve national CCM and CMAM strategies and policies. At the same time, the project will be investing in evidence-toadvocacy skills of its staff and MoH partners. Concern will use this opportunity to pilot a community health information system (CHIS), not only a pre-requisite for CCM, but a tool to facilitate coordination within the health system.

At the field level, the Tahoua and Illla District Health Teams are Concerns primary implementing partners, with consultation and support from the Regional Department of Health. Through project innovation, Concern and the MoH propose a CCM model that decreases barriers to lifesaving interventions by investing in community resource persons to manage common childhood illnesses, while strengthening the health system to support this community-based delivery strategy. The innovation will be implemented in Bambeye Commune using a pre-test/post-test non-equivalent control group design for operations research.

1.1 Objectives of the KPC Survey

The general objective of the survey was to collect baseline data on the project indicators. More specifically, the objectives of the study were: 1) To collect data on the Rapid CATCH indicators by : assessing the knowledge and practice of mothers using standard child survival indicators; measuring coverage of specific activities such as immunization, birth spacing and antenatal consultation; and Measuring nutritional status of children and household dietary diversity. 1) To build the capacity of local staff of the project and partners to implement KPC surveys.

1.7 Indicators Selected by Technical Intervention Area

Maternal and newborn care 1) Percentage of mothers of children 0-23 months who had four or more antenatal visits when they were pregnant with the youngest child 2) Percentage of mothers with children age 0-23 months who received at least two tetanus toxoid vaccinations before the birth of the youngest child

3) Percentage of children age 0-23 months whose births were attended by skilled personnel 4) Percentage of mothers of children age 0-23 who received a post-partum visit from an appropriate trained health worker within three days after the birth of the youngest child 5) Percentage of children age 0-23 who received a post-natal visit from an appropriate trained health worker within three days after the birth of the youngest child Breastfeeding 6) Percentage of newborns who were put to the breast within one hour of delivery and did not receive prelacteal feeds 7) Percentage of children age 0-5 months who were exclusively breastfed during the last 24 hours Nutrition 8) Percentage of infants and young children age 6-23 months fed according to a minimum of appropriate feeding practices Vitamin A Supplementation 9) Percentage of children age 6-23 months who received a dose of Vitamin A in the last 6 months (Mothers recall) Immunization 10) Percentage of children age 12-23 months who received a DPT1 vaccination before they reached 12 months 11) Percentage of children age12-23 months who received a DPT3 vaccination before they reached 12 months 12) Percentage of children age 12-23 months who received a measles vaccination Malaria 13) Percentage of children age 0-23 months who slept under an insecticide-treated bed net (ITN) the previous night. 14) Percentage of children age 0-59 months with a febrile episode during the last two weeks who were treated with an effective anti-malarial drug within 24 hours after the fever began 15) Percentage of households of children 0-23 months that own at least one insecticidetreated bed net 16) Percentage of mothers of children 0-23 months who took effective antimalarials during the pregnancy with the youngest child Control of Diarrhea 17) Percentage of children age 0-59 months with diarrhea in the last two weeks who received oral rehydration solution (ORS) and/or recommended home fluids. 18) Percentage of children age 0-59 months with diarrhea in the last two weeks who were treated with zinc supplements. 19) Percentage of children 0-59 months with diarrhea in the last two weeks who were offered more fluids during the illness 20) Percentage of children 0-59 months with diarrhea in the last two weeks who were offered the same amount or more food during the illness 21) Percentage of children 0-59 months with diarrhea in the last two weeks who were not treated with antidiarrheals or antibiotics.

ARI/Pneumonia 22) Percentage of children age 0-59 months with chest-related cough and fast and/ or difficult breathing in the last two weeks who were taken to an appropriate health provider. Water and Sanitation 23) Percentage of households of children age 0-23 months that treat water effectively. 24) Percentage of mothers of children 0-23 months who live in a household with soap or a locally appropriate cleanser at the place for hand washing that and who washed their hands with soap at least 2 of the appropriate times during the day or night before the interview Child Spacing 25) Percentage of children age 0-23 months who were born at least 24 months after the previous surviving child. Anthropometrics 26) Percentage of children 0-23 months who are underweight (-2 SD for the median weight for age, according to WHO/NCHS reference population) .

1 Methods
1.1 Human Resources
The first main activity was to identify a core team to lead the survey design, implementation and analysis. The Core Team was composed of four people: one Child Survival Project (CSP) manager, one Monitoring and Evaluation (M&E) officer, one representative from the Tahoua Health District and one from the Tahoua Regional Health Department. The Core Team received a total of four days training. Five supervisors from the CSP project and 10 interviewers who had been previously involved in other community surveys were recruited for the study. There were five teams composed of three people: one supervisor and two interviewers per team. All five supervisors had computer skills and could enter data every day on an Excel sheet while in the field. Frequently, they also helped with interviewing.

1.2 Training and Capacity Building

The Core Team received four days of training. During this training, the team had the opportunity to review the survey tools and finalize training curriculum for interviewers. The topics covered during the training included: KPC surveys goal and objectives role of key staff information needs and gaps involvement of stakeholders identification of the target population Lot Quality Assurance Sampling (LQAS) selection of sampling community/household/informant selection purpose of anthropometry requirements for conducting anthropometric assessments bias and design effects 2

Under the oversight of the consultant, the Core Team members trained supervisors and interviewers for five days. The following topics were discussed: KPC methodology, review of key indicators, questionnaire, interviewing techniques, measurement of weight and middle upper arm circumference (MUAC), field testing of questionnaire and feedback from the field testing. During the training, the survey questionnaire was tested in two nearby villages, Founkoye (Kalfou Commune) and Bagaye (Tahoua Commune). Each participant administered at least two questionnaires under the supervision of the supervisors with oversight from the Core Team members.

2.3 Questionnaires
Two questionnaires were used for the KPC survey. One instrument collected information on children 0-23 months and another one focused on sick children 0-59 months. The first draft of the questionnaires was written in English by the consultant, using the core KPC questions developed by CSTS. With reference to the set of French KPC modules and the set of indicators selected by the Core Team, a second draft of the questionnaire was developed in French by the Core Team and the consultant. It was agreed that the questionnaire should not be translated in Hausa. The Hausa spoken varies in different areas of Niger and even the interviewers didnt all speak the same Hausa. Finally, the French questionnaires were validated, using back-translation and field testing, during the training for the supervisors and interviewers. The final questionnaire included 49 questions organized into nine sections as follows: Identification: Date, cluster location, interviewer, mother and child description Section 1: Child spacing (Questions 1 5) Section 2: Antenatal Care (Questions 6 11) Section 3: Assistance to the mother during the delivery (Questions 12 13) Section 4: Postpartum visit to the mother and child (Questions 14 19) Section 5: Breastfeeding/ Infant and Young Child Feeding (Questions 20 29) Section 6: Immunization, Vitamin A (Questions 30 32) Section 7: Water and sanitation (Questions 33 43) Section 8: Malaria prevention (Questions 44 49)

1.1 Study Population 2.4.1 Sample Size Calculation

Sample size was calculated using the following formula: n = z2(pq)/d2 where n = sample size z = statistical certainty chosen=1.96 p = estimated prevalence coverage rate level to be investigated q = 1 p=50% d = precision desired =10% The value of p was defined by the coverage rate that requires the largest sample size (p = .5). The value d was dependent on the precision, or margin of error, desired (in this case d = .1). The statistical certainty was chosen to be 95% (z = 1.96). Given the above values, the sample size (n) for a random cluster sample was: n = (1.96 x 1.96)(.5 x .5)/(.1 x .1) 2

n = (3.84)(.25)/.01 n = 96 When using a cluster sample, surveys usually have a design effect of approximately 2, and so the sample size used should be approximately double the value n. Experience has shown that a minimum sample of 210 (7 per cluster) should be used given the values of p, d, and z above (Henderson, R.H & Sundaresan,T., 1982). KPC surveys usually increase the cluster size to 10 households, for a total sample size of 300.

2.4.2 Sampling Design

2.4.2.1 Steps Followed for Choosing 30 Clusters Step 1: A list of villages was used as the sampling frame for selection of clusters. This list was provided by the Niger Bureau of Statistics. A master list with cumulative population totals was constructed including all villages. Step 2: The total estimated population of Tahoua District was divided by 30, giving a sampling interval of 9041. A start number less than or equal to the sampling interval (3415) was randomly selected using Excel. Step 3: After the selection of the first cluster, the remaining 29 clusters were identified using the sampling interval. 2.4.2.2 Parallel sampling In order to get enough power for analysis of key indicators, we sampled two groups in parallel: Mothers of children less than 2 years of age, to whom we asked questions on preventive health measures, such as child spacing, antenatal and postnatal care, immunizations and bed nets. Mothers of children under five years of age who were sick in the last two weeks, to whom we asked questions about treatment for malaria, pneumonia and diarrhea. The following algorithm was used to ensure that questionnaires for a sick child 0-59 months and a child under two were completed in each sampled community.

1.1 Data Collection and Analysis

The survey team was divided in five teams. Each team was composed of two interviewers and one supervisor. Each team covered one cluster per day, filling out 20 questionnaires (10 for children under 2 and 10 for sick children under 5). At the end of the data collection, a total of 600 questionnaires (300 for children under 2 and 300 for sick children under 5) were filled out by the interviewers. The supervisors were responsible for the selection of the starting household and survey direction. Each questionnaire was reviewed by a supervisor in the field. Each questionnaire was further reviewed each evening and entered by the supervisor on an Excel sheet. This process was efficient to detect and report recurrent errors to interviewers. Furthermore, the supervisor used a checklist to improve the performance of the interviewers. Each team was supervised at least twice by the consultant. The supervisors entered data on a daily basis. The team leader regularly reviewed data entered and provided feedback. Excel was used to recode variables and to create composite indicators. On the other hand, EpiInfo 3.2.2 was used to calculate variables and confidence intervals. Anthropometric data were entered in EpiInfo (EpiNut) allowing calculations of Z-scores. The researcher exported the EpiNut file to ACCESS and then to Excel to calculate the anthropometric indicators. Masquer tout

1 Results
1.1 Demographic Characteristics
Table 1: Age of Children under 2 (n=300)

Age of children (n=300) 0 to 5 months 6 to 11 months 12 to 17 months 18 to 23 months Total Age of children (n=300) 0 to 11 months 12 to 23 months 24 to 35 months 36 to 47 months 48 to 59 months Total

Freq 61 70 94 75 300 Freq 90 86 60 43 21 300

% 20.3 23.3 31.3 25.0 100.0 % 30.0 28.7 20.0 14.3 7.0 100.0

Table 2: Age of Sick Children under 5 (n=300) Table 3: Sex of Children under 2 (n=300) Sex of children (n=300) Female Male Total Sex of children (n=300) Female Male Total Table 4: Sex of Children under 5 (n=300) As shown in Table 2, it appears that younger children are more vulnerable to diseases than the older ones. Table 3 shows that there were more boys than girls (ratio of 1.2). This may be due to the higher mortality rate among girls. This difference may also be due to social reasons. According to the interviewers, mothers may have been more eager to talk about their male children. Freq 137 163 300 Freq 151 149 300 % 45.7 54.3 100.0 % 50.3 49.7 100.0

3.2 Maternal and newborn care

Table 5: Antenatal Consultations and Person Conducting the Visit (n=300)

Person conducting the visit Trained health worker Community health Worker No antenatal visit Total

Freq 194 47 59 300

% 64.7 15.7 19.7 100.0

Number of visits recorded 0 visit 1 visit 2 to 3 visits 4 visits or more Total Table 6 : Number of Antenatal Visits (n=300)

Freq 61 40 137 62 300

% 20.3 13.3 45.7 20.7 100.0

Person who assisted Doctor Nurse/Midwife Community health worker Traditional birth attendant Other Not assisted Total

Freq 2 23 4 191 62 18 300

% 0.7 7.7 1.3 63.7 20.7 6.0 100.0

Table 7 : Assistance during the Delivery (n=300) Most of the women were assisted by traditional birth attendants but this category is not considered as skilled personnel. Person who did the visit Qualified health worker Community health worker / Traditional birth attendant Other Not assisted Total Freq 43 19 1 237 300 % 14.3 6.3 0.3 79.0 100.0

Table 8 : Postpartum Visit within 3 days (n=300)

1.1 Breastfeeding
Table 9: Time of Breastfeeding after Birth (n=300)

Time Within 1 hour After 1 hour Did not breastfeed Total

Freq 106 186 8 300

% 35.3 62.0 2.7 100.0

Even if 35.3% children were put to breast within 1 hour after birth, only 21% received breast milk without any other food or liquids.

3.4 Vitamin A Supplementation

Received Vit A (at least once) Yes No Did not know Not applicable Total Freq 182 38 6 13 239 % 76.2 15.9 2.5 5.4 100.0

Table 10 : Children who received Vit A (n=239)

Received Vita A (at least once) Yes No Did not know Not applicable Total Freq 148 62 14 15 239 % 61.9 25.9 5.9 6.3 100.0

Table 11 : Children who received Vita A in the last 6 Months (n=239)

3.5 Immunization
As shown in Table 12 below, an important proportion of mothers lost their cards (26.6%) and probably some of those who reported not having a card may simply have lost them Presence of card Card seen Card lost No card Did not know Total Freq 77 45 46 1 169 % 45.6 26.6 27.2 0.6 100.0

Table 12: Child Health Booklet/ Vaccination Card (n=169)

3.6 Malaria
Episode of Fever Yes No Total Freq 182 118 300 % 60.7 39.3 100.0

Table 13: Children who had Fever in the Last Two Weeks (n=300)

Table 14: Children who had Fever in the Last Two Weeks and Sought Sought treatment for fever Yes No Total Treatment (n=182) Freq 131 51 182 % 72.0 28.0 100.0

Places Public health Facility Street vendors Shops Other Traditional healers Pharmacies Total

Freq 91 30 6 2 1 1 131

% 69.5 22.9 4.6 1.5 0.8 0.8 100.0

Table 15: Places Where Children Got Treatment (n=131)

Households with at least one net Yes No Total

Freq 242 58 300

% 80.7 19.3 100.0

Table 16: Households that Own at least one Net (n=300)

Table 17 : Children who Slept under ITN Last Night (n=300)

Slept under ITN Yes No Total

Freq 116 184 300

% 38.7 61.3 100.0

38.7% of children slept under an ITN but only 29.3% were protected because some ITNs were more than three years old and/or were torn.

1.1 Pneumonia
Table 18: Children who had Suspected Pneumonia in the Last Two Weeks Suspected pneumonia Yes No Total (n=300) Table 19: Children who had Pneumonia the Last Two Weeks and Sought Sought treatment Yes No Total Treatment (n=243) Freq 160 83 243 % 65.8 34.2 100.0 Freq 243 57 300 % 81.0 19.0 100.0

1.2

Diarrhea
Diarrhea Yes No Total Freq 92 208 300 % 30.7 69.3 100.0

Table 20: Children who had Diarrhea in the Last Two Weeks (n=300)

Table 21: Children who had Diarrhea in the Last Two Weeks and Sought Treatment (n=92)

Sought treatment Yes No Total Freq 67 25 92 % 72.8 27.2 100.0

1.1

Anthropometric Measurements

Graph 1: Underweight Malnutrition (Age/Weight) and Age Group (n=300)

3.10 Summary Table of Rapid CATCH Indicators

Table 22: Rapid CATCH Indicators
Indicator Maternal and Newborn Care Percentage of mothers with children age 023 months who received at least two Tetanus toxoid vaccinations before the birth of the youngest child Percentage of children age 0-23 months whose births were attended by skilled personnel Percentage of mothers of children age 0-23 who received a post-partum visit from a trained health worker within 3 days after birth of the youngest child Percentage of mothers of children age 0-23 months who had four or more antenatal visits when they were pregnant with the youngest child Breastfeeding Percentage of children age 0-5 months who were exclusively breastfed during the last 24 hours Nutrition Percentage of infants and young children age 6-23 months fed according to a minimum of appropriate feeding practices Vitamin A Supplementation Percentage of children age 6-23 months who received a dose of Vitamin A in the last 6 months (Mothers recall) Immunization Percentage of children age 12-23 months who received a DPT1 vaccination before they reached 12 months Percentage of children age12-23 months who received a DPT3 vaccination before they reached 12 months Percentage of children age 12-23 months who received a measles vaccination Num. 63 Denom. 300 % 21 CI

6.9

29 62

300 300

9.7 20.7

4.9

6.9

26

300

8.7

4.6

61

4.9

7.8

239

2.9

3.0

148

239

61.9

11.7

46

169

27.2

10.3

24 24

169 169

14.2 14.2

7.7 7.7

Malaria Percentage of children age 0-23 months who slept under an insecticide-treated bed net the previous night. Percentage of children age 0-59 months with a febrile episode during the last two weeks who were treated with an effective anti-malarial drug within 24 hours after the fever began Percentage of children age 0-59 months with diarrhea in the last two weeks who received oral rehydration solution (ORS) ARI/Pneumonia Percentage of children age 0-59 months with chest-related cough and fast and/ or difficult breathing in the last two weeks who were taken to an appropriate health provider. Water and Sanitation Percentage of households of children age 023 months that treat water effectively. Percentage of mothers of children 0-23 months who live in a household with soap or a locally appropriate cleanser at the place for hand washing. Anthropometrics Percentage of children 0-23 months who are underweight (-2 SD for the median weight for age, according to WHO/HCHS reference population)

119 3

300 182

39.7 1.6

9.0

2.6

22

92

23.9

13.3

129

243

53.1 11.1

13 7

300 300

4.3 2.9

3.3 3.0

119

300

39.7

9.0

3.11 Summary Table of Key Project Indicators

Table 23: Summary of Key Project Indicators
Indicator Percentage of children age 0-59 months with a febrile episode during the last two weeks who were treated with an effective antimalarial drug within 24 hours after the fever began Percentage of mothers with infants 0-23 months who received two observed IPTs during last pregnancy Percentage of children age 0-23 months who slept under an insecticide-treated bed net the previous night. Percentage of children 0-59 months with diarrhea in the last two weeks who were offered more fluids during the illness Percentage of children 0-59 months with diarrhea in the last two weeks who were offered the same amount or more food during the illness Percentage of children 0-59 months with diarrhea in the last two weeks who were treated with zinc supplements Percentage of children age 0-59 months with diarrhea in the last two weeks who received oral rehydration solution (ORS) and/or Numerator 3 180 116 78 12 Denominator 182 300 300 92 92 Percentage 1.6% 60% 38.7% 84.8% 13%

5 22

92 92

5.4% 23.9%

recommended home fluids Percentage of mothers of children 0-23 months who live in a household with soap or a locally appropriate cleanser at the place for hand washing and who washed their hands with soap at least two of the appropriate times during the day or night before the interview ( after defecation, after handling childrens feces, before preparing food, and before feeding children/eating) Percentage of children 0-59 months with pneumonia who received appropriate treatment at an appropriate health facility Percentage of children 6-23 months who received vitamin A in the last 6 months

300

2.3%

114 148

243 239

46.9% 61.9%

Discussion

4.1

Key Findings of KPC Survey and Programmatic Implications

The findings of the KPC survey were compared mainly with the Demographic and Health Survey (DHS) 2006 and the Nutrition Survey of 2009. It is important to consider that those surveys were performed at national and regional levels whereas the KPC survey was done at the district level. 1.1.1 Malaria Case Management Indicator 1: Proportion of children under five with fever in the past two weeks who received anti-malarial treatment according to NMCP policy (Coartem) within 24 hours of onset of fever According to our findings, only 1.6% of children received an effective malaria treatment among the sample. Among 182 children who had fever, 131 children (72%) sought treatment, 21 children (11.5 %) sought treatment within 24 hours and only 3 children received appropriate treatment (Coartem). In the 2009 Nutrition Survey7 the percentage of mothers who sought treatment for sick children was at 69.1% in Tahoua District. In the Niger Malaria Strategic Plan 2006-20108, it is stated that at least 80% of subjects infected with simple malaria will have received early diagnosis and effective treatment by artemisinin-based combination therapy (ACT) in the health facilities, including the health posts. Although the target of 80% looks very ambitious, it can however be achieved because most people tend to seek care in formal facilities (91/131= 69.5%) as this is shown by Graph 2 below. However, the question concerning promptness of the treatment was not asked in the nutrition survey. With a good behavior communication strategy, mothers could seek early treatment, especially if appropriate treatment for simple malaria cases (Coartem) is available at the health post which is close to the population. Graph 2 Number of Children and Sources of Treatment for Malaria (n=131)
7 INS-Niger. Rapport denqute nationale Nutrition et Survie de lEnfant. Niger, May-June 2009 8 Ministry of Health-Malaria Control Program. Plan Stratgique de Lutte contre le Paludisme 2006-2010

Indicator 2: Proportion of mothers with infants 0-23 months who received intermittent preventive treatment (IPT) with Fansidar during last pregnancy. Sixty percent of mothers with infants 0-23 months received intermittent preventive treatment (IPT) with Fansidar during the last pregnancy. In the Demographic and Health Survey (EDSN-MICS III), this percentage was very low (0.3%). When this national survey was conducted, the national strategy on Fansidar had not yet been implemented. Interestingly, the KPC survey findings are still below the national target of 80% in the Niger Malaria Strategic Plan. This target will be reached if strategies are put in place to improve adherence to antenatal care where pregnant women can have access to IPT. Indicator 3: Percentage of children 0-23 months sleeping under a treated mosquito net the previous night Nearly 40% of children under five slept under a treated mosquito net the previous night. In reference to the national target, this result is still low. However, this relatively low utilisation could be explained by the fact that the KPC Survey took place during a low malaria transmission season. However, it was interesting to observe that more than 80 % of households visited had treated mosquito nets. 4.1.2 Control of Diarrhea Indicator 4: Percentage of children age 0-59 months with diarrhea in the last two weeks who received oral rehydration solution (ORS) and/or recommended home fluids Our result (23.9%) is lower than the percentage observed in the 2009 Nutrition Survey where 52 % of children received either UNICEF packets or SRO made at home. One factor that can explain this low coverage of children who received ORS is the shortage of ORS in health facilities. Indeed, among 92 children who had diarrhea, 67 children (72.8%) sought treatment but only 18% were given SRO. Indicator 7: Percentage of children 0-59 months with diarrhea in the last two weeks who were offered the same amount or more food during the illness Thirteen percent of children 0-59 months with diarrhea in the last two weeks were offered the same amount or more food during the illness. The main concern during diarrhea episodes is fluid loss leading to dehydration. Moreover, it has been shown that children with fever are more likely to have diarrhea even in the absence of any gastro-intestinal disease. Secondly, both the fever and the diarrhea could have a common underlying cause: malnourished children are more likely to have both diarrhea and febrile illnesses such as pneumonia and malaria. This result is not surprising in an area where there has not been a special program to increase the knowledge of mothers on good practices to feed children. In addition, even with the best knowledge, it is not easy to feed a sick child. Based on our findings, messages on good practices to feed children with diarrhea need to be developed. To be effective, messages covering feeding of the child with diarrhea will need to be given over a long period of time and by a variety of sources. Indicator 8 : Percentage of mothers of children 0-23 months who live in a household with soap or a locally appropriate cleanser at the place for hand washing and who washed their hands with soap at least two of the appropriate times during the day or night before the interview. Only 2.3% of mothers reported washing their hands with soap at least two of the appropriate times during the day or night before the interview. The 2009 nutrition survey indicated that 2

38 % of mothers wash their hands at the appropriate times and 40% wash their hands with soap. Although hand washing is recognized as a major way to prevent diarrheal diseases, hand washing remains low particularly hand washing with soap. A formative and baseline survey on hand washing with soap was conducted in Uganda (The Steadman Group-WSP, January 2007) and shows that nearly 85% of the adults recognized the need to wash hands with soap after using the toilet. 4.1.3 Control of Pneumonia Indicator 9: Percentage of children 0-59 months with pneumonia who received appropriate treatment Children with pneumonia were selected based on suspected pneumonia; therefore it includes children having cough and fast or difficult breathing. However, it was recognized that the establishment of true a diagnosis of pneumonia was often insufficient. Interestingly, out of 243 children who had pneumonia in the last two weeks, 160 children (65.8%) sought for treatment. Among children who sought treatment, treatment was given to 113 (70.6%) of them in the formal health sector. This result is very encouraging because most of the mothers can easily get appropriate treatment in public health facilities. Graph 3 Number of Children and Sources of Treatment for Pneumonia (n=160) Graph 4 below indicates that out of 160 children who sought treatment, 115 received the correct drug and a significant proportion of children were taken to an appropriate health provider. This figure is similar with other data provided by MICS and DHS from many countries. According to previous studies, 54% of children under five in the developing world were taken to an appropriate provider. Sub-Saharan Africa has the lowest levels of care seeking behavior for pneumonia at 41% (UNICEF/WHO, 2006) Graph 4 Where Children with Pneumonia Received Treatment (n=115)

4.1.4 Nutrition Indicator 10: Percentage of children 6-23 months who received Vitamin A in the last 6 months. A relatively high percentage of children (61.9%) in the KPC survey sample received Vitamin A during the last 6 months. Although this proportion is quite good, it is less than the result observed in the 2009 Nutrition Survey at 85 %. Generally, Vitamin A is distributed through semi-annual campaigns in Niger. The project could however consider how to improve routine distribution of Vitamin A and improve nutritional education to mothers, stressing the benefits of consuming of Vitamin A rich foods. Indicator11: Percentage of children aged 0-23 months who are underweight (-2 SD from the median weight-for-age, according to the WHO/NCHS reference population) According to our data, 39.7% of children aged 0-23 months were underweight. This proportion of malnourished children is similar to the finding in the 2006 Demographic and Health Survey in Tahoua Region. Our results indicated that malnutrition increases with age. Fewer children under six months were malnourished. In general, the level of malnutrition 2

among children less than six months of age is very often low compared to older children. It is well known that malnutrition is much more pronounced after six months when children begin taking complementary foods. According to WHO/UNICEF recommendations, if the prevalence of malnutrition in a given population of children under five exceeds 20% of Z-score of -2SD it is concluded that the population is malnourished. The results of this survey show that the prevalence of malnutrition in Tahoua District is far higher. Our results are similar to those observed in the 2009 Nutrition Survey where the prevalence of malnutrition was 39.7%. This Nutrition Survey also provides figures for Height-for-Age and Weight-for-Height. Graph 5 Types of Malnutrition by age group (n=300)

Graph 6 Sex of Child and Malnutrition (n=300) Graph 6 reveals that there is no significant difference between boys and girls as far as malnutrition is concerned. This finding is similar to results observed in the 2006 Demographic and Health Survey. Malnutrition among children under two years of age is a real public health problem and may result from the quasi-permanent food-deficit situation in Niger. It is important to have additional information about household behaviors and illnesses so as to generate hypotheses about which practices are most associated with nutritional status.

Table 24 Comparison of KPC Values with Other Available Data Sources

Indicator KPC value (%) DHS and MICS 2006 Tahoua Region (%) 23.6 14.2 26.9 Not available Nutrition Survey 2009 Tahoua Region (%) 42.7 22.2 Not available Not available

Maternal and Newborn Care Percentage of mothers with children age 0-23 months who received at least two Tetanus toxoid vaccinations before the birth of the youngest child Percentage of children age 0-23 months whose births were attended by skilled personnel Percentage of mothers of children age 0-23 who received a post-partum visit from an appropriate trained health worker within three days after the birth of the youngest child Percentage of children age 0-23 who received a post-natal visit from an appropriate trained health worker within three days after the birth of the youngest child Breastfeeding Percentage of newborns who were put to the breast within one hour of delivery and did not receive prelacteal feeds Percentage of children age 0-5 months who were exclusively breastfed during the last 24 hours Immunization Percentage of children age 12-23 months who received DPT1 vaccination before they reached 12 months

21 9.7 21 25.3

21 4.9 27.2

46 14 58 ( DTC)

32.2 9.9 36.4 (card) 75.7(recall)

Percentage of children age12-23 months who received a DPT3 vaccination before they reached 12 months Percentage of children age 12-23 months who received a measles vaccination

14.2 14.2

39 (DTC) 55 (polio) 47

31.7 card) 64.7 (recall) 65.5

Conclusion

Table 24 shows that for some indicators there are wide differences in values between the KPC survey and the 2009 Nutrition Survey: exclusive breastfeeding (4.9% vs. 9.9%), measles coverage (14% vs. 65%) and proportions of births attended by skilled health personnel (9.7% vs. 22.2%). The percentages reported in previous surveys were often substantially higher than those in the KPC survey. These differences are likely due to variations in how the indicators are defined. The other institutions did not provide information on precise definition of indicators. Regional and seasonal variations may also contribute to the differences observed. Some limitations need to be considered when interpreting the results of this research. First, as the survey was conducted exclusively in Tahoua District, differences of geographic locations should be considered when comparing with other studies performed in the whole region of Tahoua. Second, it is important to consider that the Core Team only trusted information written on the health cards and not the mothers recall concerning immunization. This method could have greatly affected the results of the study but may prove to be more reliable. Finally, as the interviewers included members of the health staff, this could have influenced the responses of the respondents. Respondents may know what the interviewer is looking for and give the correct answer instead of what they actually practice or believe. In the future, it is advisable to conduct periodic performance assessments using Lot Quality Assurance Sampling (LQAS) methodology. This can be done every six months to compare different areas in the district and even to have an overall estimate of the coverage in the district. As LQAS uses supervision areas to choose the samples, the six communes could be considered as supervision areas or another geographical delimitation such as catchment areas of health centers could be used. The project staff together with the district staff can choose the LQAS small sample (generally 19 households for each supervision area) over a two-week period as they travel to the selected communities in the course of their regular work.

Bibliography

Henderson, R.H & Sundaresan,T. (1982). Cluster Sampling to Assess Immunization Coverage : A Review of Experience with a Simplified Method, "Bulletin of the World Health Organization. INS-Niger. (2006). Enqute Dmographique et de Sant et Indicateurs Multiples (EDSNMICS). INS-Niger. (Mai-Juin 2006). Enqute Dmographique et de Sant et indicateurs multiples. Niamey, Niger. INS-Niger. (May-June 2009). Rapport d'Enqute Nationale "Nutrition et Survie de l'Enfant". Ministry of Health-National Malaria Control Program. (Juin 2006). Plan Stratgique de lutte contre le paludisme. Niamey. Niger, H. K. (2006). The Social Context of Child Malnutrition: Household Response to Food Crisis, Decision-Making and Childcare Practices. Republic of Niger. (Aug 2007). Accelerated Development and Poverty Reduction Strategy 2008-2010. RN/ME/F/Institute National des Statistiques, W. B. (2005). Questionnaire Unifi sur les Indicateurs de Bien-tre de Base. RN/Ministre de la Sant Publique. (2008). Avant-projet de Stratgie Nationale de Survie de l'Enfant. RN/MSP/DGSP/DEDP. (Dec 2008). Rapport Annuel d'Excution du PDS 2005-2010. The Steadman Group-WSP. (January 2007). Are Ugandans' Hands Clean Enough. UNICEF. (2008). State of the World's Children. UNICEF/WHO. (2006). Pneumonia, the Forgotten Killer of Children.

Appendices

Appendix A: KPC Questionnaire

INFORMED CONSENT Hello. My name is ______________________________, and I am working with CONCERN. We are conducting a survey and would appreciate your participation. I would like to ask you about your health and the health of your youngest child under the age of two. This information will help CONCERN to plan health services and assess whether it is meeting its goals to improve childrens health. The survey usually takes 20-30 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons. Participation in this survey is voluntary and you can choose not to answer any individual question or all of the questions. However, we hope that you will participate in this survey since your views are important. At this time, do you want to ask me anything about the survey?

IDENTIFICATION
CLUSTER NUMBER HOUSEHOLD NUMBER RESPONDENT AGREES TO BE INTERVIEWED START HOUR OF THE INTERVIEW

|____|____| |____|____| 1 YES 2 NO END |____|____| HOUR |____|____|Minutes

ALL QUESTIONS ARE TO BE ADDRESSED TO MOTHERS WITH A SICK CHILD LESS THAN 59 MONTHS OF AGE
DATE OF INTERVIEW
DAY MONTH YEAR Name of the Interviewer______________________ Name of the Supervisor _______________________ Village ________________________________________ Name of the Mother Name of the youngest child 0-23 months

INTERVIEW POSTPONED TO

_____/_____/_____ (DD/MM/YY)

AGE OF MOTHER..........................................

SEX OF THE CHILD (1=M, 2=F)........................................

Result Codes 1 Completed 2 Respondent not at home 3 Postponed 4 Refused 5 Other Specify_____________________________

DAY BIRTHDATE MONTH YEAR

AGE OF THE YOUNGEST CHILD (in months)............

I.
NO.

ILLNESSES
Questions and Filters Has (Name) been ill with the following symptoms at any time in the last 2 weeks ? CHECK EVERY SYMPTOM MENTIONNED Fever? Malaria ? Convulsions ? MALARIA............................................................1 CODES SKIP

Cough?

1
2 3

PNEUMONIA.......................................................2 DIARRHEA..........................................................3 .............................................................................5

Rapid or Difficult Breathing? Diarrhea without Blood? Diarrhea with Blood?

If Yes, Specify: ________________________________________ 2 Has (NAME) been ill with another Symptom not mentioned above in the last 2 weeks ? ________________________________________ ________________________________________

II.
NO. 3

Drugs received
Questions and Filters Did you seek advice or treatment for (Name) illness What drugs did (Name) take? Any other drugs? Record all mentioned.
Ask to see drug(s) if type of drug is not known. If type of drug is still not determined, show typical antimalarial drugs to respondent ** Country Specific based on National Malarial Protocol For each antimalarial medicine ask: How long after the fever started did (Name) start taking the medicine? Circle the appropriate codes:

CODES YES............................................................1 NO..............................................................2 1. 2. 3. 4. 5. Coartem SRO Zinc Cotrimoxazole /amoxicilline Other

SKIP END

Drug1
5 First Drug mentioned 1. 6 For which illness (name) did he receive the drug? Coartem SRO Zinc Cotrimoxazole /amoxicilline Autres Cough Diarrhea Fever Other

2.
3. 4.

Where did you seek treatment for the illness mentioned above ?

PUBLIC HEALTH FACILITY...................01 PRIVATE HEALTH FACILITY.................02 TRADITIONAL HEALER..........................03 SHOP.......................................................04 PHARMACY.............................................05 STREET VENDORS...............................06 OTHER_________________________ 07 (PRCISEZ)

If the treatment was received from a health facility, record the name of the facility _______________________________________________ (NAME OF THE HEALTH FACILITY)

How much time after the first symptom began did you first seek treatment for (Name)?

1. 2.

Before 24 hours After 24 hours

How much did (Name) take for each medicine per day?

|_____|_____| |_____|_____|
1. Yes 2. No 40

10 11

For How many days did he take the medicines? Did (Name) receive any other medication?

Drug 2
5 Second Drug mentioned 1. 6 For which illness (name) did he receive the drug? Coartem SRO Zinc Cotrimoxazole /amoxicilline Autres Cough Diarrhea Fever Other

2.
3. 4.

Where did you seek treatment for the illness mentioned above ?

PUBLIC HEALTH FACILITY...................01 PRIVATE HEALTH FACILITY.................02 TRADITIONAL HEALER..........................03 SHOP.......................................................04 PHARMACY.............................................05 STREET VENDORS...............................06 OTHER_________________________ 07 (PRCISEZ)

If the treatment was received from a health facility, record the name of the facility _______________________________________________ (NAME OF THE HEALTH FACILITY)

How much time after the first symptom began did you first seek treatment for (Name)?

1. 2.

Before 24 hours After 24 hours

How much did (Name) take for each medicine per day?

|_____|_____| |_____|_____|
1. Yes 2. No 40

10 11

For How many days did he take the medicines? Did (Name) receive any other medication?

Drug 3
5 Third Drug mentioned 1. 6 For which illness (name) did he receive the drug? Coartem SRO Zinc Cotrimoxazole /amoxicilline Autres Cough Diarrhea Fever Other

2.
3. 4.

Where did you seek treatment for the illness mentioned above ?

PUBLIC HEALTH FACILITY...................01 PRIVATE HEALTH FACILITY.................02 TRADITIONAL HEALER..........................03 SHOP.......................................................04 PHARMACY.............................................05 STREET VENDORS...............................06 OTHER_________________________ 07 (PRCISEZ)

If the treatment was received from a health facility, record the name of the facility _______________________________________________ (NAME OF THE HEALTH FACILITY)

How much time after the first symptom began did you first seek treatment for (Name)?

1. 2.

Before 24 hours After 24 hours

How much did (Name) take for each medicine per day?

|_____|_____| |_____|_____|
1. Yes 2. No 40

10 11

For How many days did he take the medicines? Did (Name) receive any other medication?

Drug 4
5 Fourth Drug mentioned 1. 6 For which illness (name) did he receive the drug? Coartem SRO Zinc Cotrimoxazole /amoxicilline Autres Cough Diarrhea Fever Other

2.
3. 4.

Where did you seek treatment for the illness mentioned above ?

PUBLIC HEALTH FACILITY...................01 PRIVATE HEALTH FACILITY.................02 TRADITIONAL HEALER..........................03 SHOP.......................................................04 PHARMACY.............................................05 STREET VENDORS...............................06 OTHER_________________________ 07 (PRCISEZ)

If the treatment was received from a health facility, record the name of the facility _______________________________________________ (NAME OF THE HEALTH FACILITY)

How much time after the first symptom began did you first seek treatment for (Name)?

1. 2.

Before 24 hours After 24 hours

How much did (Name) take for each medicine per day?

|_____|_____| |_____|_____|
1. Yes 2. No 40

10 11

For How many days did he take the medicines? Did (Name) receive any other medication?

Drug 5
5 Fith Drug mentioned 1. 6 For which illness (name) did he receive the drug? Coartem SRO Zinc Cotrimoxazole /amoxicilline Autres Cough Diarrhea Fever Other

2.
3. 4.

Where did you seek treatment for the illness mentioned above ?

PUBLIC HEALTH FACILITY...................01 PRIVATE HEALTH FACILITY.................02 TRADITIONAL HEALER..........................03 SHOP.......................................................04 PHARMACY.............................................05 STREET VENDORS...............................06 OTHER_________________________ 07 (PRCISEZ)

If the treatment was received from a health facility, record the name of the facility _______________________________________________ (NAME OF THE HEALTH FACILITY)

How much time after the first symptom began did you first seek treatment for (Name)?

1. 2.

Before 24 hours After 24 hours

How much did (Name) take for each medicine per day?

|_____|_____| |_____|_____|
1. Yes 2. No 40

10 11

For How many days did he take the medicines? Did (Name) receive any other medication?

II.
NO.

Feeding practices for the Sick Child

Questions and Filters CODES LESS..........................................................1 SKIP

40

When (Name) had diarrhea, did you breastfeed hi m/her less than usual, about the same amount, or more than usual?

SAME.........................................................2 MORE........................................................3 CHILD NOT BREASTFEED......................4 Not applicable ...........................................5 LESS..........................................................1 SAME.........................................................2 MORE........................................................3 NOTHING TO DRINK................................4 Not applicable ...........................................5 LESS..........................................................1 SAME.........................................................2 MORE........................................................3 NOTHING TO EAT....................................4 Not applicable ...........................................5

41

When (Name) had diarrhea, was he/she offered less than usual to drink, about the same amount, or more than usual?

42

When (Name) had diarrhea, was he/she offered less than usual to eat, about the same amount, or more than usual?

END TIME

|___||___| HOUR

|___||___| MInutes

Thank the mother for the interview.

Appendix B: Manual Tabulation Tables of Raw Data

1. ITN Use Percentage of children age 0-23 months who slept under an insecticide-treated bed net the previous night. UtilisationITNEnfant Frequency Percent Cum Percent 0 212 70.7% 70.7% 1 88 29.3% 100.0% Total 300 100.0% 100.0% 2. Water Access Percentage of households of children age 0-23 months that treat water effectively. WaterAccess Frequency Percent Cum Percent 0 287 95.7% 95.7% 1 13 4.3% 100.0% Total 300 100.0% 100.0% 3. Washing Hands Percentage of mothers of children 0-23 months who live in a household with soap or a locally appropriate cleanser at the place for hand washing that and who washed their hands with soap at least 2 of the appropriate times during the day or night before the interview LavageMains Frequency Percent Cum Percent 0 293 97.7% 97.7% 1 7 2.3% 100.0% Total 300 100.0% 100.0% 4. Tetanus Toxoid Vaccinations Percentage of mothers with children age 0-23 months who received at least two Tetanus toxoid vaccinations before the birth of the youngest child VATRecu Frequency Percent Cum Percent 0 237 79.0% 79.0% 1 63 21.0% 100.0% Total 300 100.0% 100.0%

5. Assistance by skilled personnel

Percentage of children age 0-23 months whose births were attended by skilled person AccAssiste Frequency Percent Cum Percent 0 271 90.3% 90.3% 1 29 9.7% 100.0% Total 300 100.0% 100.0% 6. Visit Post Natale of Mother Percentage of mothers of children age 0-23 who received a post-partum visit from an appropriate trained health worker within three days after the birth of the youngest child VisitPostNataleMere Frequency Percent Cum Percent

0 1 Total 7. Exclusive Breasfeeding

236 78.7% 64 21.3% 300 100.0%

78.7% 100.0% 100.0%

Percentage of newborns who were put to the breast within one hour of delivery and did not receive prelacteal feeds AllaitExclusif&Immed 0 1 Total Frequency Percent Cum Percent 237 79.0% 63 21.0% 300 100.0% 79.0% 100.0% 100.0%

8. Vit A Supplementation Percentage of children age 6-23 months who received a dose of Vitamin A in the last 6 months (Mothers recall) Supplement Vit A Frequency Percent Cum Percent 0 91 38.1% 38.1% 1 148 61.9% 100.0% Total 239 100.0% 100.0%

9. Vaccination
Percentage of children age 12-23 months who received a measles vaccination 10Ind10_VAR Frequency Percent Cum Percent 0 145 85.8% 85.8% 1 24 14.2% 100.0% Total 169 100.0% 100.0% 10. Correct treatment for Paludisme Percentage of children age 0-23 months with a febrile episode during the last two weeks who were treated with an effective anti-malarial drug within 24 hours after the fever began TTT_CorrectPalu Frequency Percent Cum Percent 0 179 98.4% 98.4% 1 3 1.6% 100.0% Total 182 100.0% 100.0% 11. More fluids during diarrhea Percentage of children 0-23 months with diarrhea in the last two weeks who were offered more fluids during the illness Plus de liquides Frequency Percent Cum Percent 0 63 68.5% 68.5% 1 29 31.5% 100.0% Total 92 100.0% 100.0% 12. More food during diarrhea P MemeNourriture Frequency Percent Cum Percent r o 1

0 1 Total

80 87.0% 12 13.0% 92 100.0%

87.0% 100.0% 100.0%

13. Correct treatment with ORS Percentage of children age 0-23 months with diarrhea in the last two weeks who received oral rehydration solution (ORS) and/or recommended home fluids CorrectDiarSRO Frequency Percent Cum Percent 0 71 77.2% 77.2% 1 21 22.8% 100.0% Total 92 100.0% 100.0%

14 Correct treatment with Zinc Percentage of children age 0-23 months with diarrhea in the last two weeks who were treated with zinc supplements Correct Zinc Frequency Percent Cum Percent 0 87 94.6% 94.6% 1 5 5.4% 100.0% Total 92 100.0% 100.0% 15 Exclusive breastfeeding Percentage of children age 0-5 months who were exclusively breastfed during the last 24 hours AllaitExclusif_EnfInf5mois Frequency Percent Cum Percent 0 58 95.1% 95.1% 1 3 4.9% 100.0% Total 61 100.0% 100.0%

APPENDIX C: Population/ List of all communities (villages)

COMMUNE AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA LOCALITE TASSAK NAROUA AKORADJ TAGAYE (KALGO) TAGAYE TAWAYAWA TAGAYE (DOUTCHI) TAGAYE BOUZOU CHINNABOUGOULOU GARIN ASNA MAGEMA KANTAWOURI ABALA SANI INDRE CHIGOUFA OUNFFAYE TIGGAR GUIDOMA KARADJI NORD TAMALWADA TALAKIA GADIYAOU IMMI GUILA ABALA MOGARAWA AKARIFO TAKAZATT IKOWKAWAN ABALA BARCHECHE ABALA ISSAKA ALAKO TABAGOTT KAWASSA GARIN MANOMI GARIN MAYE IBBIKAWA MENAGE 62 80 23 42 68 158 40 50 33 24 341 131 30 32 36 85 83 139 43 104 32 23 75 21 84 19 20 36 50 35 5 8 32 Nbre cumulees des mnages 62 142 165 207 275 433 473 523 556 580 921 1 052 1 082 1 114 1 150 1 235 1 318 1 457 1 500 1 604 1 636 1 659 1 734 1 755 1 839 1 858 1 878 1 914 1 964 1 999 2 004 2 012 2 044
TOTAL POPULATION TOTAL POPULATION Cumulative

376 480 136 253 412 953 239 304 198 144 2 057 789 179 193 215 513 501 839 262 628 195 141 449 125 509 115 122 215 300 211 30 50 192

376 856 992 1 245 1 657 2 610 2 849 3 153 3 351 3 495 5 552 6 341 6 520 6 713 6 928 7 441 7 942 8 781 9 043 9 671 9 866 10 007 10 456 10 581 11 090 11 205 11 327 11 542 11 842 12 053 12 083 12 133 12 325

AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA AFALA BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE

AFFALA NASSAM INNA NAKATAN KOUNAWA GAMBAM TIGUIRMASSAN DJIRKAH TAFAGAT INFAL INTAZORI ABOUN TOUDOUN BOULA TOUDOUN BINDIGA TAKACHIWAR ERSAN ROTCHIMGA ADRAWA BARZAZATAN INTADEN TAZA DOGON DADJI EWADAMBO EWADAMBO INGUIDAL TAGIGAL TAGIGAL AFALOLAOU TAGABASTE EGAGUE IJAWANJAWAN IJAWANJAWAN AMALOUL NOMADE ALELA ANEKAR GARIN BAYOU ALAGASS (ALGASS) TIGDIDIT KARKARA INDIA YAYE TASSAK HADDOU GUERMAZEY AGALHER KEL KALAFAN MAROLFA RANGATT I RANGATT II RANGATT II SAKARATOU SOULEYMANE DAN GABA KABOUYA MAIBIGA KALSOURA BAMBAYE ALLELA INGOURSSOUMOUT MAISULMI

583 138 113 24 4 2 4 3 31 15 11 19 19 18 23 20 21 21 34 699 65 26 26 37 118 149 60 18 13 37 261 90 331 131 111 14 115 2 101 40 13 55 14 77 16 56 24 28 15 26 575 18 40 17

2 627 2 765 2 878 2 902 2 906 2 908 2 912 2 915 2 946 2 961 2 972 2 991 3 010 3 028 3 051 3 071 3 092 3 113 3 147 3 846 3 911 3 937 3 963 4 000 4 118 4 267 4 327 4 345 4 358 4 395 4 656 4 746 5 077 5 208 5 319 5 333 5 448 5 450 5 551 5 591 5 604 5 659 5 673 5 750 5 766 5 822 5 846 5 874 5 889 5 915 6 490 6 508 6 548 6 565

3 513 833 682 144 27 11 24 17 187 91 68 112 116 107 141 122 127 125 204 4 209 389 156 156 223 713 899 359 107 79 223 1 575 543 1 993 788 666 87 691 11 606 239 81 332 95 525 111 385 167 189 106 177 3 919 126 273 114

15 838 16 671 17 353 17 497 17 524 17 535 17 559 17 576 17 763 17 854 17 922 18 034 18 150 18 257 18 398 18 520 18 647 18 772 18 976 23 185 23 574 23 730 23 886 24 109 24 822 25 721 26 080 26 187 26 266 26 489 28 064 28 607 30 600 31 388 32 054 32 141 32 832 32 843 33 449 33 688 33 769 34 101 34 196 34 721 34 832 35 217 35 384 35 573 35 679 35 856 39 775 39 901 40 174 40 288

BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE

BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE

LAGGAL MAKARA YASSANI BANKANO MAKERA EDIR ISKITA GUILLAWA TOUNGA AKKA GUILLEY ALLELA GUILLEY KOSSAMA I ET II KOSSAMA ALLELA KALGO DAJIN TSAKA DAN MARKE TALAKYA ZARDAWA SATOUROU (ZARDANA SATOUROU) BAGGA GAO TOUJANI BAGGA MASSAFA KANTCHALAWA GAO MOUSSA ROUBAO ZARDANA GOUMBI DAN YAYE AWANCHALA TRIK ADRAN BOUKAR FALALI DAN TOUDOU DAN TOUDOU TOUNGA GARDAWA SARKAKE ZANGOU MOULLOUT KOLKOLI FASKA INKAFI BAYOU TOUDOU AWANCHALA TOUBA TABOUKAWA MALLAMAWA EDEL TALAZA MAIGUIZAZA AGOY MAFARI ARAWAYE ZONGO ALLELA ARAWAYE TOUNGA TAPKI GALATAN RIDIDI

26 33 6 10 11 419 15 12 6 6 359 318 22 188 125 81 103

6 591 6 624 6 630 6 640 6 651 7 070 7 085 7 097 7 103 7 109 7 468 7 786 7 808 7 996 8 121 8 202 8 305

175 227 43 67 77 2 877 101 81 44 38 2 459 2 180 153 1 287 855 556 706

40 463 40 690 40 733 40 800 40 877 43 754 43 855 43 936 43 980 44 018 46 477 48 657 48 810 50 097 50 952 51 508 52 214

17 9 256 67 230 164 59 37 105 57 154 9 43 28 153 19 189 24 149 40 61 18 120 167 2 16 6 254 68 99 155 2 162 163

8 322 8 331 8 587 8 654 8 884 9 048 9 107 9 144 9 249 9 306 9 460 9 469 9 512 9 540 9 693 9 712 9 901 9 925 10 074 10 114 10 175 10 193 10 313 10 480 10 482 10 498 10 504 10 758 10 826 10 925 11 080 11 082 11 244 11 407

119 59 1 755 461 1 578 1 123 407 256 719 392 1 055 59 298 192 1 048 133 1 297 162 1 019 274 417 125 823 1 147 14 112 38 1 742 463 676 1 059 14 1 111 1 114

52 333 52 392 54 147 54 608 56 186 57 309 57 716 57 972 58 691 59 083 60 138 60 197 60 495 60 687 61 735 61 868 63 165 63 327 64 346 64 620 65 037 65 162 65 985 67 132 67 146 67 258 67 296 69 038 69 501 70 177 71 236 71 250 72 361 73 475

BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE

AGUAYE TOUNGA ILLI HAKIMAWA MOGGAR HOUDOUNA MAGARYATAN CHINSAWATANE (SANSAWATAN) CHIMO TOUNGA AMALAYE GATARAWA INTAZORI ABDOUGA ILLELAWA MAIBAGARINNE TOUDOU TOUDOU WADATA SABON GARI GARGUEN MANI OURAFANE TOUNGA DOLE DANFAN TSADOURA TANERAN DOUTCHI BAYAN TOUDOUN DANfAN TANERAN BUBISSANE TENERAN KALGO TASSOUNFOU SABON KALGO SAFARFARI RAKIN SAKIA KAWADATA LAKOTO INKARKADA TAPKIN ZAKI GARIN WAZIHA BAKAJIBA GUEZZA MAREGA TAKOUSSA JAJA AMALOUL N'GADDOU GUEZAWA MOULLELA MOZA TOUNGA TOUDOU BAREWA TOUDOUN BAREWA JAOURI GARHANGA MARKE MARAKE HADA

117 105 18 250 40 24 184 193 18 124 21 320 100 9 5 15 7 30 7 9 238 14 2 58 10 143 64 92 149 258 202 15 50 422 67 35 9 231 30 208 77 284 25 7 475 189 11 141 103 175 6 152

11 524 11 629 11 647 11 897 11 937 11 961 12 145 12 338 12 356 12 480 12 501 12 821 12 921 12 930 12 935 12 950 12 957 12 987 12 994 13 003 13 241 13 255 13 257 13 315 13 325 13 468 13 532 13 624 13 773 14 031 14 233 14 248 14 298 14 720 14 787 14 822 14 831 15 062 15 092 15 300 15 377 15 661 15 686 15 693 16 168 16 357 16 368 16 509 16 612 16 787 16 793 16 945

804 717 123 1 718 274 165 1 261 1 323 124 847 143 2 188 682 60 34 101 49 203 49 64 1 632 97 16 394 70 983 439 629 1 024 1 767 1 384 100 346 2 889 456 240 64 1 579 208 1 423 529 1 949 174 45 3 253 1 298 78 963 707 1 199 42 1 040

74 279 74 996 75 119 76 837 77 111 77 276 78 537 79 860 79 984 80 831 80 974 83 162 83 844 83 904 83 938 84 039 84 088 84 291 84 340 84 404 86 036 86 133 86 149 86 543 86 613 87 596 88 035 88 664 89 688 91 455 92 839 92 939 93 285 96 174 96 630 96 870 96 934 98 513 98 721 100 144 100 673 102 622 102 796 102 841 106 094 107 392 107 470 108 433 109 140 110 339 110 381 111 421

BAMBEYE BAMBEYE BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU

ZARDANA INGUINA BAYOUNTOUDOU ZARDANA TAMAKAT INGOYE GARIN GABAS DOUTCHI FARA TOUDOUN SOUYA BEZA IBIKI TIGGAR DOLLE BIRGO MOUNLELA TOUKOUKOUT FADAMA WOURKOUTOUS KEHEHE ALBARAKA KOHILELANE INJAJARAN (INJINJIRAN) INJINJIRAN DOUTCHI INJINJIRAN TOUDOU ABOUJA BAHOU INCHIDODANE TOUNGA ADOU BIDAOULA LABE MANANO BARMOU OURHAMIZA II MOULELA SAKAI LOUGOU TOUNFAFIA (SAKEY LOUGOU) SAKEY TOUNFAFI ABAJA TOUNGA HOKO TOUNGA ABARMINI TOUNGA LIMAN SAKEY TOUNGA OURHAMIZA I INAKANKARAM EFFAYE ROUBOUDAOUA ANAKAR (INAKAR) TOUNGA LABBEE AFAGAR IKAKAN GUIDAN ROUHEMOU (IKAKANE OUNOU) ALLI TSALLOLOUA EZAK INTALIWANE

101 49 32 172 25 67 145 33 27 90 216 10 5 219 25 43 223 64 75 107 39 10 20 47 48 51 24 18 8 489 22 40 76 26 94 38 23 48 11 90 144 51 108 64 9 180 78 62 56 196 65

17 046 17 095 17 127 17 299 17 324 17 391 17 536 17 569 17 596 17 686 17 902 17 912 17 917 18 136 18 161 18 204 18 427 18 491 18 566 18 673 18 712 18 722 18 742 18 789 18 837 18 888 18 912 18 930 18 938 19 427 19 449 19 489 19 565 19 591 19 685 19 723 19 746 19 794 19 805 19 895 20 039 20 090 20 198 20 262 20 271 20 451 20 529 20 591 20 647 20 843 20 908

691 337 195 1 038 150 403 872 201 161 545 1 301 59 33 1 322 148 272 1 418 405 476 682 246 62 128 301 305 324 150 114 52 3 112 141 257 481 166 596 242 149 307 70 574 915 321 688 406 60 1 143 496 393 356 1 247 412

112 112 112 449 112 644 113 682 113 832 114 235 115 107 115 308 115 469 116 014 117 315 117 374 117 407 118 729 118 877 119 149 120 567 120 972 121 448 122 130 122 376 122 438 122 566 122 867 123 172 123 496 123 646 123 760 123 812 126 924 127 065 127 322 127 803 127 969 128 565 128 807 128 956 129 263 129 333 129 907 130 822 131 143 131 831 132 237 132 297 133 440 133 936 134 329 134 685 135 932 136 344

BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU BARMOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU

TARIKARNA TAGGA TAKASSABA ILUKI (TORO) ANLI TORO AZA MAHAMAN AZA MATIKAN GARIN AYACHE INOUKOUKOUR AREGUA ABANKOR GUIDAN KATO SABON GUIDAN MOUSSA (SABON GUIDA (SABO)) DAMARGOU (DAMERGOU) GUIDAN TOUDOU (ADOUNA) IHIGARANE TOUNGA ARABI TOUNGA ARAKABI KOUNKOUZOUTT KALFOU DABAGUI TOUDOUN ZORA BAGAYE TOUNDOU GABASS MARARABA DAN ALILA KOURAYA GAMDI GARIN MINAOU MINAOU TOUNGA TABARA TABLA KARAMA KABOBI GORINGO TCHINKAKI SABON GARI LILANGO TOUNGA MAIDAWA TCHINNAHAR MOUNTCHERE MOUJIA BAKIN DABAGUI FASKA FOLAKAWA CHACOTT IBAGALA GALA OLEYAN IDE KAYAN TCHABA MAIGUIZO KALFOU RAFI TOUNGA ACHA

39 18 90 13 44 931 107 167 87 100 14 9 126 57 86 92 254 106 29 17 328 484 61 228 6 33 167 33 9 82 11 142 75 30 73 507 343 304 27 240 198 60 100 146 282 136 36 44 218 342 30

20 947 20 965 21 055 21 068 21 112 22 043 22 150 22 317 22 404 22 504 22 518 22 527 22 653 22 710 22 796 22 888 23 142 23 248 23 277 23 294 23 622 24 106 24 167 24 395 24 401 24 434 24 601 24 634 24 643 24 725 24 736 24 878 24 953 24 983 25 056 25 563 25 906 26 210 26 237 26 477 26 675 26 735 26 835 26 981 27 263 27 399 27 435 27 479 27 697 28 039 28 069

249 112 572 81 282 5 915 683 1 059 556 637 87 57 802 363 549 585 1 616 671 184 105 2 082 3 080 387 1 446 40 209 1 062 208 59 522 69 903 479 189 464 3 222 2 182 1 932 174 1 527 1 259 379 638 928 1 793 862 231 281 1 385 2 175 192

136 593 136 705 137 277 137 358 137 640 143 555 144 238 145 297 145 853 146 490 146 577 146 634 147 436 147 799 148 348 148 933 150 549 151 220 151 404 151 509 153 591 156 671 157 058 158 504 158 544 158 753 159 815 160 023 160 082 160 604 160 673 161 576 162 055 162 244 162 708 165 930 168 112 170 044 170 218 171 745 173 004 173 383 174 021 174 949 176 742 177 604 177 835 178 116 179 501 181 676 181 868

KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU

TOUNGA OUHOUMOUDOU TOUDOUNI BANGUI(TOUGAYE) TCHABA AGALI LATCHINA KETERE TOUNGA KOUSSOU AGOULMAWA ZONGON MAKERA ADERNAGA KAZIGO LILANGAWA LOUGOU KARADJI SUD KAMISSA INDIRE TOUNGA ALIBOU TOUNGA GABASS GUIDAN BARAYA ALIBOU TOUDOU TOULAYA TOULOUA EKLAN EGUEL DABAGOU (DABAGOU) ALIBOU SAMMO-EST SAMMO PEULH IDIC SAMMO-OUEST GUIDAN MOUCHE GUIDAN KAGO GALMAWA TCHIBARO BAGAYE GARBA AKOUKOU TCHEDIA BAGAYE TCHEDIA BIRAM TALDAOU TOUDOUN FAMA TASSIBIK ISSA WEGANE GARIN DABOUGUI GUIGANE MOULELA GUIGANE GUIGANE TOUNGA GABIRAWA TOUNGA IZIRWANE GAWAMOUKE TOUNGA TSEDA TOUNGA HAYI KOUDOUM WAJE GARIN GALO INDAMA

14 638 53 74 284 72 96 110 27 184 87 76 130 324 70 16 195 53 42 75 119 39 56 230 239 23 44 267 104 143 280 87 289 191 98 39 22 88 70 50 44 16 129 15 50 20 38 110 44 138 75 16

28 083 28 721 28 774 28 848 29 132 29 204 29 300 29 410 29 437 29 621 29 708 29 784 29 914 30 238 30 308 30 324 30 519 30 572 30 614 30 689 30 808 30 847 30 903 31 133 31 372 31 395 31 439 31 706 31 810 31 953 32 233 32 320 32 609 32 800 32 898 32 937 32 959 33 047 33 117 33 167 33 211 33 227 33 356 33 371 33 421 33 441 33 479 33 589 33 633 33 771 33 846 33 862

91 4 060 334 473 1 803 459 612 700 171 1 168 552 485 826 2 060 446 100 1 239 336 268 479 757 248 354 1 461 1 517 145 277 1 696 663 907 1 781 552 1 834 1 214 625 249 138 559 447 318 279 102 823 96 317 128 242 699 282 880 479 103

181 959 186 019 186 353 186 826 188 629 189 088 189 700 190 400 190 571 191 739 192 291 192 776 193 602 195 662 196 108 196 208 197 447 197 783 198 051 198 530 199 287 199 535 199 889 201 350 202 867 203 012 203 289 204 985 205 648 206 555 208 336 208 888 210 722 211 936 212 561 212 810 212 948 213 507 213 954 214 272 214 551 214 653 215 476 215 572 215 889 216 017 216 259 216 958 217 240 218 120 218 599 218 702

KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT

GUIGANE KARAMA IMBORAN ALOUMOUDOU (BOUZOU) LANKANE IMBAL GANE KAKAMA ZANGO GUIDAN GARA ALLABAMOU MAKASA ZOMO WAZA WAZA CARRE SARROU SARROU ATIBIS SALKA DAMNA II FATIMA DOROGI FATIMA CHRIM N'GANDOU TOUR SOUBOUT ISSAMAKA TAKOUTAL DANTARE TAKANE N'BILIBASS DAN DABAGUI MAI BADO AMOULOUA CHINILWA INNIBIGUI INKALFAT TCHERANA TAMANGOUR CHIZAGAWAN ABDOU TOUDOUN TARAMNA GUIGANE LANGUIDO MATAMATA IGUIFANE TAMALA ADAMBARO ALBOULAHA CENTRE YEN MARAKE LOKOJORO TOUNGA ADOUA YEN BANGAYE CHIZAWAGANA ISSOUFOU TOUNGA HAMIDOU TEKOU SALKA DAMANA I DAN DOUTCHI TAKANAMAT

25 165 47 10 177 3 29 201 16 1 120 48 68 18 15 15 26 82 40 97 25 32 73 4 7 25 13 4 40 21 29 12 16 21 7 28 5 2 19 29 27 65 31 9 4 4 8 17 13 4 14 28 5 494

33 887 34 052 34 099 34 109 34 286 34 289 34 318 34 519 34 535 34 536 34 656 34 704 34 772 34 790 34 805 34 820 34 846 34 928 34 968 35 065 35 090 35 122 35 195 35 199 35 206 35 231 35 244 35 248 35 288 35 309 35 338 35 350 35 366 35 387 35 394 35 422 35 427 35 429 35 448 35 477 35 504 35 569 35 600 35 609 35 613 35 617 35 625 35 642 35 655 35 659 35 673 35 701 35 706 36 200

157 1 050 300 66 1 128 17 184 1 278 109 4 822 327 467 121 104 104 178 561 273 663 170 222 501 29 47 173 88 29 275 144 202 80 110 141 51 194 37 14 130 197 185 442 212 59 27 27 58 114 89 25 97 191 34 3 385

218 859 219 909 220 209 220 275 221 403 221 420 221 604 222 882 222 991 222 995 223 817 224 144 224 611 224 732 224 836 224 940 225 118 225 679 225 952 226 615 226 785 227 007 227 508 227 537 227 584 227 757 227 845 227 874 228 149 228 293 228 495 228 575 228 685 228 826 228 877 229 071 229 108 229 122 229 252 229 449 229 634 230 076 230 288 230 347 230 374 230 401 230 459 230 573 230 662 230 687 230 784 230 975 231 009 234 394

TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TAKANAMATT TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM

TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM

INNAWARA KASSARAWA ZOUMA ABAKAMAT DOUTCHIN ZOMO AGARDAHAN MOULLELA TOUNGA ALASSA INKARI CHIGUINAWANE INSOUSSOU MAMANE DAN FALALI KORKODE INTAGAMANE MAI TABARE TAMAKAS MAIFARIN KAY HAUSA CHIGUITANE LAHAM SARAE AHANDARAS ACHOUAL TOUDOUNI FARFAROU TEBARAM INTADEYNA MAJE TOUDOUN FOLLOKAWA (INTADEYNA FALLAKAWA) SAYAL MAIFARINKAY ZARMA MAGORANA GARIN GAYYA INTOUWILA DAN WIYA GARIN AHAMADOU ABORAK INTOUILLA GONA AHMADOU TOUNGA JEJI GARIN MALAM BILINGUE MOUMOURAFOU KAFOUGUE TCHOUWAL KOUKAKAME ZAMBO KOMADA MOURRAFOU ELH HOUSSEINI MANARE MAISSOUNGOUMI KOUKATALLA (KOUKATALA)

138 28 21 58 4 8 93 53 25 259 13 16 9 7 6 147 77 55 45 205 59 45 197 413 155 169

36 338 36 366 36 387 36 445 36 449 36 457 36 550 36 603 36 628 36 887 36 900 36 916 36 925 36 932 36 938 37 085 37 162 37 217 37 262 37 467 37 526 37 571 37 768 38 181 38 336 38 505

944 194 143 394 30 58 636 365 170 1 776 87 110 65 49 41 1 006 528 376 307 1 403 407 310 1 349 2 830 1 059 1 157

235 338 235 532 235 675 236 069 236 099 236 157 236 793 237 158 237 328 239 104 239 191 239 301 239 366 239 415 239 456 240 462 240 990 241 366 241 673 243 076 243 483 243 793 245 142 247 972 249 031 250 188

61 148 8 10 27 8 2 5 10 1 4 9 107 44 51 61 253 11 17 9 11 179 138

38 566 38 714 38 722 38 732 38 759 38 767 38 769 38 774 38 784 38 785 38 789 38 798 38 905 38 949 39 000 39 061 39 314 39 325 39 342 39 351 39 362 39 541 39 679

418 1 014 55 66 183 53 14 37 69 10 29 64 730 299 348 418 1 735 73 119 63 76 1 226 947

250 606 251 620 251 675 251 741 251 924 251 977 251 991 252 028 252 097 252 107 252 136 252 200 252 930 253 229 253 577 253 995 255 730 255 803 255 922 255 985 256 061 257 287 258 234

TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM TEBARAM

TARJAMAT SABON YAYI KATSIRA GUIDAN MELLI INTAKANA MADAKA MALGOUNA GODIAL INKACHEWANE DAN GARI DANYA ADARAWA SOUKOUDOU RAWA WARI AJIGA MAI BOURDE IZALI ILMANE SMAGAL ADOUA SMAGAL TOUNGA AKWARA INKOUCHENI CHILIGUIDALANE ZARBOULE INNABAGARGAR INTIGUIDI MATSARGA INNARIDAN INTAKASSEY INNELOU BOUZOU

66 20 34 113 86 39 40 163 20 113 5 48 5 54 7 135 32 71 190 9 22 78 96 128 20 8 12 43 168 71

39 745 39 765 39 799 39 912 39 998 40 037 40 077 40 240 40 260 40 373 40 378 40 426 40 431 40 485 40 492 40 627 40 659 40 730 40 920 40 929 40 951 41 029 41 125 41 253 41 273 41 281 41 293 41 336 41 504 41 575

450 139 230 774 588 267 271 1 118 140 771 37 330 33 372 49 926 219 486 1 300 63 153 537 659 877 135 54 82 298 1 153 488

258 684 258 823 259 053 259 827 260 415 260 682 260 953 262 071 262 211 262 982 263 019 263 349 263 382 263 754 263 803 264 729 264 948 265 434 266 734 266 797 266 950 267 487 268 146 269 023 269 158 269 212 269 294 269 592 270 745 271 233

2.2 List of communities selected (30 clusters)

DEPARTE MENT TAHOUA TAHOUA TAHOUA TAHOUA TAHOUA TAHOUA TAHOUA TAHOUA TAHOUA TAHOUA TAHOUA TAHOUA TAHOUA TAHOUA TAHOUA TAHOUA TAHOUA TAHOUA TAHOUA TAHOUA TAHOUA TAHOUA TAHOUA TAHOUA TAHOUA TAHOUA TAHOUA TAHOUA TAHOUA TAHOUA COMMUN E AFALA AFALA AFALA AFALA AFALA BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BAMBEYE BARMOU BARMOU BARMOU BARMOU KALFOU KALFOU KALFOU KALFOU KALFOU KALFOU TAKANAM ATT TAKANAM ATT TAKANAM ATT TAKANAM ATT TEBARAM TEBARAM TEBARAM TEBARAM LOCALITE 1KANTAWOURI 2ABALA BARCHECHE 3INFAL 4TAGIGAL 5AGALHER 6YASSANI 7TOUJANI 8FASKA 9RIDIDI 10TOUDOU WADATA 11KAWADATA 12TOUDOUN BAREWA 13BIRGO 14LABE 15ANAKAR (INAKAR) 16MATIKAN 17MARARABA 18MOUNTCHERE 19KETERE 20TOULOUA 21TOUDOUN FAMA 22IMBORAN 23FATIMA 24TAMANGOUR 25TOUNGA HAMIDOU 26DAN FALALI 27MAIFARINKAY ZARMA 28ZAMBO 29ADARAWA 30INNARIDAN MASCULIN 70 56 91 349 40 21 29 80 547 50 49 473 29 55 194 266 19 602 220 119 267 502 276 69 12 54 498 36 18 40 FEMININ 74 59 96 364 41 22 30 82 567 51 51 490 30 59 212 290 21 657 239 129 292 548 285 72 13 56 516 37 19 42 TOTAL 144 115 187 713 81 43 59 162 1 114 101 100 963 59 114 406 556 40 1 259 459 248 559 1 050 561 141 25 110 1 014 73 37 82 MENAGE 24 19 31 118 13 6 9 24 163 15 15 141 10 18 64 87 6 198 72 39 88 165 82 21 4 16 148 11 5 12

10