Wa Municipal

LQAS Household Survey Preliminary Findings

23 November, 2012
By: Dachaga Oswald

LOT QUALITY ASSURANCE SAMPLING

PRELIMINARY FINDINGS

Key Findings 1
75.8% of Mothers practiced exclusive breastfeeding in the past 24hrs preceding the survey 63.2% & 69.% of mothers attended at 4 ANC visits in the their last pregnancy by recall and by card Respectively. 61.1% of mothers received at least 2 doses of IPT during last pregnancy. 57.9% of Chn. 0-5mths received PNC & 23.2% of mothers report the children had PNC by skilled provider within 48hrs of childbirth 22.1% of mothers practiced appropriate umbilical cord care (nothing or antiseptic) after birth

Key Findings 2
25.3% of Chn. 0-59mths with suspected ARI received appropriate antibiotic from an appropriate health provider 56.8% of Chn 0-59 mths with diarrhea were taken to an appropriate health provider
27.4% of Chn 0-59 mths with diarrhea received ORS, 1.1% received Zinc and 0.0% received both ORS & Zinc from an appropriate health provider. 15.8% Chn 0-59 mths with fever were taken to an appropriate health provider within 24hrs of onset of symptoms and only 5.3% of them received appropriate antimalarial drugs

Key Findings 3
44.2% of chin 1223 mths received at least one high dose of vitamin A supplement in the last 6 mths (card confirmed) 91.6% households with chn 0-59 mths own at least one LLIN 67.0% & 68.5% of Mothers & chn 0-59mths respectively slept under an LLIN the night preceding the survey 88.4% and 78.9% of Households with chn 0-59s received at least one & Two bed nets respectively from the Hang up Campaign. 42.1% & 49.5% of Mothers of chn 0-59mths were visited by CBAs & CHOs Respectively in the past three months Prevalence of presumed pneumonia among children 0-59 months stands at 9.5%

Prevalence

Pneumonia, diarrhea and malaria prevalence

Knowledge

Care giver knowledge of danger signs in children U5

50.0% 45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Mothers who know at Mothers who know at Motherswho know at least two danger signs of least two danger signs of least two danger signs of diarrhoea fever cough 24.2% 15.8% 44.2%

Accessibility

Pneumonia Case Management

90.0%

80.0%
70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0%

77.9% 66.3% 50.5%

25.3%

suspected ARI taken to an appropriate health provider

suspected ARI in Mothers of Chn 0- Chn 0-59 mths with the last two wks 59 mths with suspected ARI receiving an suspected ARI valid Valid NHIS card appropriate NHIS card antibiotic from an appropriate health provider

Diarrheoa Case Management

70.0%

65.3% 56.8% 54.7%

60.0%

50.0%

40.0%

District Priority 27.4%

30.0%

20.0%

10.0%

1.1%
0.0%

0.0%

Chn 0-59 Receiving Receiving Receiving Mothers of Chn 0-59 mths with ORS from an ZINC from ORS AND Chn 0-59 mths with taken to an appropriate an ZINC from mths with diarrhea with appropriate health appropriate an diarrhea with valid NHIS health provider health appropriate valid NHIS card provider provider health card provider

Malaria Case Management

Children 0-59 Months with Fever in the Last Two weeks Preceding the Survey

67.4%
70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0%

67.4%

15.8% 5.3%

Taken to an Receiving an Mothers of Chn with appropriate health appropriate fever having valid provider within 24hrs antimalarial from an NHIS card of onset of symptoms appropriate health provider within 24hrs of onset of symptoms

Chn with feverhaving valid NHIS card

Intermittent Preventive Treatment(IPT)

70.0% 65.0% 60.0% 55.0% 50.0%

69.5%

69.5%
61.1%

45.0%
40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0%

5.0%

Attended their first ANC visit at < 4 mths pregnant

All doses of IPT as directly observed therapy

At least IPT2 during last pregnancy

Tetanus Toxoid, Iron & Folic Acid

120.0% 100.0%

100.0%

80.0%

60.0%

44.2%
40.0%

20.0%

0.0%

Iron and folic acid during their last pregnancy

At least TT2 during their last pregnancy

Skilled Delivery & Postnatal Care

100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0%

87.4%

87.4%

57.9%

23.2%

22.1%

Birth by skilled Birth in a health PNC by skilled PNC by skilled Practice of birth attendant facility provider within provider within appropriate 2 days of 2 days of umbilical cord childbirth childbirth care (nothing or (Mother's antiseptic) after Report) birth

ANC, Delivery & PNC

100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0%

87.4% 69.5% 57.9%

30.0%
20.0% 10.0% 0.0%

Four ANC visits during their last pregnancy (card)

Birth in a health facility

PNC by skilled provider within 2 days of childbirth

Childhood Immunization
BCG, MEASLES & VITAMIN A
100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0%

91.6% 78.9%

74.7%

44.2%

12.6%

BCG

BCG-Measles Drop out Rate

measles

Fully vaccinated before their first birthday

At least one high dose vitamin A supplement in the last 6 mths (card confirmed)

Childhood Immunization
Pentavalent & Oral Polio Vaccines
93.7% 100.0%

91.6%

90.0%
80.0% 70.0% 60.0% 50.0%

40.0%
30.0% 20.0% 10.0% 0.0% 2.1%

Penta1/Polio1

Penta1 -Penta3 Drop out rate

Penta3/Polio 3

Meningitis Campaign
Did not receive vaccine during the last campaign, 14.7%

Received vaccine during the last campaign, 85.3%

Hang up Campaign Coverage

100.0% 90.0%

92.6%

88.4% 78.9%

80.0%
70.0%

66.3%

60.0%
50.0%

36.8%

40.0%
30.0% 20.0% 10.0% 0.0%
Households Households Registered receiving at before the Hang least one Up Campaign bednet from the Hang Up Campaign Households receiving at least two bednets from the Hang Up Campaign All nets hanged Mothers who by volunteers remember at during Hang up least two of the Campaign main messages transmitted during the Hang Up Campaign

Health Insurance Status

Children Under 5yrs with valid health insurance card, 62.1%

Mothers who have a valid health insurance card, 53.7%

CBA/CHO Services
49.5% 42.1%
50.0%
45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0%

Mothers who were visited Mothers who were visited by a CBA in the past three by a CHO/CHN in the past months three months

Practice

Antenatal Care Visits

69.5%
65.0% 55.0% 45.0% 35.0% 25.0% 15.0%

69.5%
63.2%

5.0%

Attended their first Four ANC visits during Four ANC visits during ANC visit at < 4 mths their last pregnancy their last pregnancy pregnant (card) (recall)

Exclusive Breastfeeding
87.4%
90.0%

70.5%

75.8%

80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0%

Health facility Delivery

Breastfeeding Exclusively breast within one hour of fed in the past 24 birth hours

Malaria Prevention
Access
Knowledge
100.0% 90.0%

Practice
91.6%

80.0%
70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0%

75.8%

74.7%

76.8%
67.0% 68.5%

Mothers who Motherswho Mothers who's Chn 0-59 mths Mothers who know the cause know that household was that own at least slept under a of malaria sleeping under a sprayed with one LLIN LLIN the night (mosquito bite or mosquito net IRS in the last preceding the P Falciparum) prevents malaria 12 mths survey

Children who slept under a LLIN the night preceding the survey

Reasons behind Coverage

Poor Documentation of Services provided by Health staff on record cards of mothers & Children affected coverage on indicators that needed evidence on the record cards Health education at the community level have not had the serious attention that it deserves which is accounting for the poor performance with regards to knowledge and practices for most key indicators. Little supervision & motivation of CBAs/CHOs The turning of CHPS zones into treatment centers & clinics by Community members makes it difficult for CHOs to carry out home Visits

Reasons behind Coverage

Availability of Pharmacies and chemical shops accounts for high rates of self medications Hard to reach and rural Sub districts (Charingu) with poor health seeking behavior.

Business culture in urban areas (Wa Central an Kambali) affected the practice of mothers as far as key interventions are concern.
Not all fevers are due to malaria and that could account for low usage of antimalarial since RDTs are now being used. Shortage of essential program drugs ( SP, ORS & Zinc) in some Facilities during the year.

Priority Indicators that need immediate attention

Proportion of mothers of infants 0-5 months who received at least the 2nd dose of tetanus toxoid Proportion of mothers of infants 0-5 months who practiced appropriate umbilical cord care Proportion of children 1223 months who have received at least one high dose vitamin A supplement in the last 6 months Mothers children 0-59 months who were visited by a CBAs & CHOs. Mothers knowledge of danger signs of diarrhea, fever & cough Health seeking behaviour of mothers whose children have fever, diarrhea or cough Children 0-59 months with diarrhea in the last two weeks receiving ORS or Zinc or both from an appropriate health provider Children 0-59 months with fever or cough in the last two weeks receiving antimalarial or antibiotic respectively from an appropriate health provider

Priority SAs & Indicators

Priority SAs that need Immediate Attention

Charingu Wa central & Kambali

Challenges
Difficult population as most mothers are in commercial business Mothers complained of volume of questionnaires Breakdown of motor bikes Interference by household heads and other members of the house during interviews Some respondents expected gifts after interview Poor documentation on the part of Health care providers was evident in cards that were used during the survey Nature of settlements made sampling of houses difficult No motivation for some volunteers who assisted in the demarcation and sampling of houses Lack of commitment of some respondents Timing of the survey was not favorable because of the harvest season Inaccessibility of some houses due to wild dogs especially in Wa Township

Conclusions
The Survey was a learning experience and skills learnt will be put to use in future surveys to be able to gather quality baseline data for decision making in the municipality

The findings of the survey will also be put to use in order to improve maternal and child health towards to achievement of the MDGs 4 & 5.

Recommendation
The Municipality will have to re-strategize and allocate more resources to priority SAs to help them improve on indicators while sustaining the gains in other SAs as well. Intensify IE&C to raise awareness and encourage practice through the use of support/social groups at community level Embark on massive education on Mothers health seeking behaviors especially for children with diarrhea, fever and pneumonia Intensify the use of ORS & Zinc by Health care providers for the treatment of Diarrhea Engage Mother Support groups to promote appropriate care of newborn care including cord care

Acknowledgement
Ghana Health Service RHA-U.W/R NHRC UNICEF LSTM Community leaders All beneficiaries/Respondents

THANK YOU